hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|WI,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula."
Marshfield Medical Center - River Region at Stevens Point,2026-02-20,3.0.0,Marshfield Medical Center - River Region at Stevens Point,"4100 State Highway 66, Stevens Point, WI 54482-8410", 1023187416| 1124017140| 1154415024| 1205867686| 1346239373| 1376197665| 1588104475| 1700963048| 1841188604| 1902437650| 1902976913| 1942749387| 1952809816| 1952890873|1144987462|1942749387,340,Nelson Spindler,true
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,modifiers,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,72.50,548.00,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,548.00,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,,1231.23,,,,,,,783.51,1551.03,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,,1231.23,,,,,,,440.69,1551.03,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,661.50,1309.50,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,619.65,1309.50,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,inpatient,,,2901.00000,2755.95000,The Alliance,Exception Members,,2233.77,,,,,,,1421.49,2813.97,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Exception Members,,2233.77,,,,,,,1026.39,2813.97,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,,1252.79,,,,,,,894.85,1578.19,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,,1252.79,,,,,,,813.50,3163.00,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,inpatient,,,1383.00000,1313.85000,The Alliance,Exception Members,,1064.91,,,,,,,760.65,1341.51,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Exception Members,,1064.91,,,,,,,691.50,4686.00,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,1444.85,2548.19,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,979.11,2548.19,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,The Alliance,Exception Members,TC,1744.05,,,,,,,1245.75,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Exception Members,TC,1744.05,,,,,,,1132.50,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,1444.30,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,979.11,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,1273.25,2245.55,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,979.11,2245.55,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,545.05,961.27,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,495.50,1820.00,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,TC,109.34,,,,,,,78.10,137.74,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,TC,109.34,,,,,,,71.00,1820.00,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,1029.05,1814.87,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,935.50,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,The Alliance,Exception Members,TC,1946.56,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Exception Members,TC,1946.56,,,,,,,1264.00,2452.16,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,The Alliance,Exception Members,TC,1996.61,,,,,,,1426.15,2515.21,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Exception Members,TC,1996.61,,,,,,,979.11,2515.21,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,TC,950.95,,,,,,,679.25,1197.95,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,TC,950.95,,,,,,,584.87,1820.00,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,The Alliance,Exception Members,TC,1128.05,,,,,,,805.75,1421.05,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Exception Members,TC,1128.05,,,,,,,732.50,1820.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,The Alliance,Exception Members,TC,2002.00,,,,,,,1430.00,2522.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Exception Members,TC,2002.00,,,,,,,1285.85,2522.00,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,The Alliance,Exception Members,TC,1380.61,,,,,,,986.15,1739.21,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Exception Members,TC,1380.61,,,,,,,896.50,1820.00,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,The Alliance,Exception Members,TC,1776.39,,,,,,,1268.85,2237.79,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Exception Members,TC,1776.39,,,,,,,1153.50,2237.79,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,979.11,2209.66,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,TC,1439.13,,,,,,,1027.95,1812.93,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,TC,1439.13,,,,,,,934.50,1964.22,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,The Alliance,Exception Members,TC,1774.08,,,,,,,1267.20,2234.88,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Exception Members,TC,1774.08,,,,,,,979.11,2234.88,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,684.20,1206.68,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,622.00,1820.00,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,TC,2630.32,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,TC,2630.32,,,,,,,979.11,3313.52,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,680.35,1199.89,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,584.87,1820.00,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,TC,1819.51,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,TC,1819.51,,,,,,,979.11,2292.11,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,inpatient,,,7626.00000,7244.70000,The Alliance,Exception Members,,5872.02,,,,,,,3736.74,7397.22,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,outpatient,,,7626.00000,7244.70000,The Alliance,Exception Members,,5872.02,,,,,,,3500.33,7397.22,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,TC,268.73,,,,,,,191.95,338.53,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,TC,268.73,,,,,,,114.83,1213.27,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,49.50,96.03,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,Exception Members,TC,731.50,,,,,,,522.50,921.50,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Exception Members,TC,731.50,,,,,,,384.16,921.50,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2015.00,3909.10,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,584.87,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,23.25,96.03,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,4607.00,52373.21,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,282.15,497.61,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,215.27,548.00,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,inpatient,1,mL,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,outpatient,1,mL,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,inpatient,1,mL,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,inpatient,1,mL,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.56,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.42,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,979.11,2245.55,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,1444.30,2547.22,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,979.11,2547.22,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,1444.85,2548.19,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,979.11,2548.19,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,The Alliance,Exception Members,TC,1745.59,,,,,,,1246.85,2198.99,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Exception Members,TC,1745.59,,,,,,,484.28,2198.99,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,The Alliance,Exception Members,TC,2632.63,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Exception Members,TC,2632.63,,,,,,,1353.88,3316.43,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1128.45,2914.85,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,The Alliance,Exception Members,TC,2671.13,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Exception Members,TC,2671.13,,,,,,,1375.22,3364.93,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,The Alliance,Exception Members,TC,2015.09,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Exception Members,TC,2015.09,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,The Alliance,Exception Members,TC,3066.91,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Exception Members,TC,3066.91,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,The Alliance,Exception Members,TC,2745.82,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Exception Members,TC,2745.82,,,,,,,1321.12,3459.02,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,The Alliance,Exception Members,TC,1955.03,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Exception Members,TC,1955.03,,,,,,,1269.50,2462.83,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,The Alliance,Exception Members,TC,1733.27,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Exception Members,TC,1733.27,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,The Alliance,Exception Members,TC,3353.35,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Exception Members,TC,3353.35,,,,,,,1487.04,4224.35,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,The Alliance,Exception Members,TC,3838.45,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Exception Members,TC,3838.45,,,,,,,1487.04,4835.45,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,68.74,718.77,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,The Alliance,Exception Members,TC,3123.12,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Exception Members,TC,3123.12,,,,,,,1487.04,3934.32,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,The Alliance,Exception Members,TC,2731.96,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Exception Members,TC,2731.96,,,,,,,1353.60,3441.56,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,174.90,308.46,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,154.77,548.00,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,1767.08,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,The Alliance,Exception Members,TC,2748.90,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Exception Members,TC,2748.90,,,,,,,1487.04,3462.90,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1668.70,2942.98,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1329.46,2942.98,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,The Alliance,Exception Members,TC,2661.89,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Exception Members,TC,2661.89,,,,,,,1371.65,3353.29,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,144.65,255.11,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,129.58,1272.59,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,Exception Members,TC,364.21,,,,,,,260.15,458.81,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Exception Members,TC,364.21,,,,,,,179.69,2032.87,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,68.74,718.77,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,151.80,267.72,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,138.00,1371.46,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,125.88,1213.27,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,125.88,1213.27,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,The Alliance,Exception Members,TC,2318.47,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Exception Members,TC,2318.47,,,,,,,1129.95,2920.67,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,160.92,1569.27,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,122.10,215.34,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,111.00,1094.55,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,The Alliance,Exception Members,TC,2658.04,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Exception Members,TC,2658.04,,,,,,,1382.32,3348.44,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,254.10,448.14,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,231.00,548.00,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,The Alliance,Exception Members,TC,2480.94,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Exception Members,TC,2480.94,,,,,,,1318.80,3125.34,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,154.55,272.57,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,140.50,1391.23,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,The Alliance,Exception Members,TC,2762.76,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Exception Members,TC,2762.76,,,,,,,1328.10,3480.36,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,The Alliance,Exception Members,TC,3016.86,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Exception Members,TC,3016.86,,,,,,,1246.80,3800.46,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1295.50,2513.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,inpatient,,,307.50000,292.12000,The Alliance,Exception Members,,236.78,,,,,,,150.68,298.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Exception Members,,236.78,,,,,,,153.75,298.27,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3802.00000,3611.90000,The Alliance,Exception Members,TC,2927.54,,,,,,,2091.10,3687.94,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3802.00000,3611.90000,The Alliance,Exception Members,TC,2927.54,,,,,,,1901.00,3687.94,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,Exception Members,TC,528.22,,,,,,,377.30,665.42,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Exception Members,TC,528.22,,,,,,,343.00,665.42,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,The Alliance,Exception Members,TC,2568.72,,,,,,,1834.80,3235.92,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Exception Members,TC,2568.72,,,,,,,1668.00,3235.92,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,inpatient,,,489.00000,464.55000,The Alliance,Exception Members,TC,376.53,,,,,,,268.95,474.33,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Exception Members,TC,376.53,,,,,,,244.50,474.33,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,inpatient,,,455.00000,432.25000,The Alliance,Exception Members,TC,350.35,,,,,,,250.25,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Exception Members,TC,350.35,,,,,,,227.50,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,inpatient,,,550.00000,522.50000,The Alliance,Exception Members,TC,423.50,,,,,,,302.50,533.50,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,outpatient,,,550.00000,522.50000,The Alliance,Exception Members,TC,423.50,,,,,,,275.00,533.50,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,QW,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,QW,1754.06,,,,,,,4.81,2209.66,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,The Alliance,Exception Members,TC,774.62,,,,,,,553.30,975.82,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Exception Members,TC,774.62,,,,,,,503.00,975.82,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,97.00,212.44,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,584.00000,554.80000,The Alliance,Exception Members,QW,449.68,,,,,,,321.20,566.48,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Exception Members,QW,449.68,,,,,,,292.00,566.48,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,241.18,477.44,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,225.92,477.44,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,28.80000,27.36000,The Alliance,Exception Members,,22.18,,,,,,,14.11,27.94,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,28.80000,27.36000,The Alliance,Exception Members,,22.18,,,,,,,13.22,27.94,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,807.00000,766.65000,The Alliance,Exception Members,QW,621.39,,,,,,,443.85,782.79,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Exception Members,QW,621.39,,,,,,,403.50,782.79,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,The Alliance,Exception Members,TC,2930.62,,,,,,,2093.30,3691.82,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Exception Members,TC,2930.62,,,,,,,1903.00,3691.82,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.00,7.76,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12028.00,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.60,11.64,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.00,11.64,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,6.86,13.58,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,6.43,13.58,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,17.04000,16.19000,The Alliance,Exception Members,,13.12,,,,,,,8.35,16.53,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,17.04000,16.19000,The Alliance,Exception Members,,13.12,,,,,,,7.82,16.53,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,30.36000,28.84000,The Alliance,Exception Members,,23.38,,,,,,,14.88,29.45,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,30.36000,28.84000,The Alliance,Exception Members,,23.38,,,,,,,13.94,29.45,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,inpatient,,,1105.00000,1049.75000,The Alliance,Exception Members,,850.85,,,,,,,607.75,1071.85,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,outpatient,,,1105.00000,1049.75000,The Alliance,Exception Members,,850.85,,,,,,,314.95,1071.85,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,246.10,477.44,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,20.58,40.74,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,19.28,40.74,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,246.10,477.44,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,inpatient,,,1298.00000,1233.10000,The Alliance,Exception Members,,999.46,,,,,,,713.90,1259.06,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,Exception Members,,999.46,,,,,,,314.95,1259.06,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,10.92000,10.37000,The Alliance,Exception Members,,8.41,,,,,,,5.35,10.59,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,10.92000,10.37000,The Alliance,Exception Members,,8.41,,,,,,,5.46,36.65,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,11.15000,10.59000,The Alliance,Exception Members,,8.59,,,,,,,5.46,10.82,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,11.15000,10.59000,The Alliance,Exception Members,,8.59,,,,,,,5.58,102.20,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,The Alliance,Exception Members,,529.76,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Exception Members,,529.76,,,,,,,314.95,667.36,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,191.40000,181.83000,The Alliance,Exception Members,,147.38,,,,,,,93.79,185.66,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,191.40000,181.83000,The Alliance,Exception Members,,147.38,,,,,,,87.85,185.66,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.10000,39.99000,The Alliance,Exception Members,,32.42,,,,,,,20.63,40.84,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.10000,39.99000,The Alliance,Exception Members,,32.42,,,,,,,19.32,40.84,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,44.80000,42.56000,The Alliance,Exception Members,,34.50,,,,,,,21.95,43.46,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,44.80000,42.56000,The Alliance,Exception Members,,34.50,,,,,,,20.56,43.46,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,264.38000,251.16000,The Alliance,Exception Members,,203.57,,,,,,,129.55,256.45,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,264.38000,251.16000,The Alliance,Exception Members,,203.57,,,,,,,126.64,256.45,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,inpatient,,,386.93000,367.58000,The Alliance,Exception Members,,297.94,,,,,,,189.60,375.32,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,outpatient,,,386.93000,367.58000,The Alliance,Exception Members,,297.94,,,,,,,193.47,375.32,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,73.15,129.01,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,64.92,129.01,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,17.00000,16.15000,The Alliance,Exception Members,,13.09,,,,,,,9.35,16.49,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Exception Members,,13.09,,,,,,,8.50,16.49,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,106.56000,101.23000,The Alliance,Exception Members,,82.05,,,,,,,52.21,103.36,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,106.56000,101.23000,The Alliance,Exception Members,,82.05,,,,,,,53.28,103.36,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,1374.00000,1305.30000,The Alliance,Exception Members,,1057.98,,,,,,,673.26,1332.78,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,1374.00000,1305.30000,The Alliance,Exception Members,,1057.98,,,,,,,266.32,1332.78,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,The Alliance,Exception Members,TC,474.32,,,,,,,338.80,597.52,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Exception Members,TC,474.32,,,,,,,308.00,3942.79,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,Exception Members,TC,405.02,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Exception Members,TC,405.02,,,,,,,146.17,1450.63,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,1172.00000,1113.40000,The Alliance,Exception Members,,902.44,,,,,,,574.28,1136.84,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Exception Members,,902.44,,,,,,,326.06,1136.84,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,26.52000,25.19000,The Alliance,Exception Members,,20.42,,,,,,,12.99,25.72,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,26.52000,25.19000,The Alliance,Exception Members,,20.42,,,,,,,12.17,25.72,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,The Alliance,Exception Members,TC,2701.16,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Exception Members,TC,2701.16,,,,,,,1754.00,3402.76,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,The Alliance,Exception Members,TC,3326.40,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Exception Members,TC,3326.40,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,TC,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,TC,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,TC,53.13,,,,,,,37.95,66.93,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,TC,53.13,,,,,,,34.50,5271.00,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,134.08000,127.38000,The Alliance,Exception Members,,103.24,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Exception Members,,103.24,,,,,,,67.04,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,134.08000,127.38000,The Alliance,Exception Members,,103.24,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Exception Members,,103.24,,,,,,,67.04,130.06,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,25.48,50.44,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,26.00,50.44,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,3.66,203.72,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1857.46,5271.00,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,25.78000,24.49000,The Alliance,Exception Members,,19.85,,,,,,,12.63,25.01,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,25.78000,24.49000,The Alliance,Exception Members,,19.85,,,,,,,12.89,65.22,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,inpatient,,,204.99000,194.74000,The Alliance,Exception Members,,157.84,,,,,,,100.45,198.84,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,outpatient,,,204.99000,194.74000,The Alliance,Exception Members,,157.84,,,,,,,102.50,241.40,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,inpatient,,,309.37000,293.90000,The Alliance,Exception Members,,238.21,,,,,,,151.59,300.09,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,outpatient,,,309.37000,293.90000,The Alliance,Exception Members,,238.21,,,,,,,154.69,436.36,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,99.38,192.79,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,259.91000,246.91000,The Alliance,Exception Members,,200.13,,,,,,,127.36,252.11,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,259.91000,246.91000,The Alliance,Exception Members,,200.13,,,,,,,99.97,252.11,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,14.48000,13.76000,The Alliance,Exception Members,,11.15,,,,,,,7.10,14.05,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,14.48000,13.76000,The Alliance,Exception Members,,11.15,,,,,,,7.24,102.20,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,35.60000,33.82000,The Alliance,Exception Members,,27.41,,,,,,,17.44,34.53,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,35.60000,33.82000,The Alliance,Exception Members,,27.41,,,,,,,17.80,65.22,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,inpatient,,,215.44000,204.67000,The Alliance,Exception Members,,165.89,,,,,,,105.57,208.98,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,outpatient,,,215.44000,204.67000,The Alliance,Exception Members,,165.89,,,,,,,107.59,208.98,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,74.05000,70.35000,The Alliance,Exception Members,,57.02,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Exception Members,,57.02,,,,,,,37.02,121.81,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,39.87000,37.88000,The Alliance,Exception Members,,30.70,,,,,,,19.54,38.67,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,39.87000,37.88000,The Alliance,Exception Members,,30.70,,,,,,,19.93,70.48,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,17.24000,16.38000,The Alliance,Exception Members,,13.27,,,,,,,8.45,16.72,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,17.24000,16.38000,The Alliance,Exception Members,,13.27,,,,,,,8.62,70.48,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,121.88000,115.79000,The Alliance,Exception Members,,93.85,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Exception Members,,93.85,,,,,,,60.94,142.65,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,270.94000,257.39000,The Alliance,Exception Members,,208.62,,,,,,,132.76,262.81,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,270.94000,257.39000,The Alliance,Exception Members,,208.62,,,,,,,109.77,262.81,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,27.00,74.34,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,99.38,192.79,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,inpatient,,,233.00000,221.35000,The Alliance,Exception Members,,179.41,,,,,,,114.17,226.01,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Exception Members,,179.41,,,,,,,116.50,274.91,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,74.05000,70.35000,The Alliance,Exception Members,,57.02,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Exception Members,,57.02,,,,,,,37.02,121.81,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,79.00,153.26,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,20.58,40.74,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,21.00,59.94,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,inpatient,,,1751.00000,1663.45000,The Alliance,Exception Members,,1348.27,,,,,,,857.99,1698.47,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,outpatient,,,1751.00000,1663.45000,The Alliance,Exception Members,,1348.27,,,,,,,875.50,1698.47,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,844.00000,801.80000,The Alliance,Exception Members,,649.88,,,,,,,413.56,818.68,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Exception Members,,649.88,,,,,,,360.44,818.68,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,13.46000,12.79000,The Alliance,Exception Members,,10.36,,,,,,,6.60,13.06,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,13.46000,12.79000,The Alliance,Exception Members,,10.36,,,,,,,6.73,102.20,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,9.55,33.95,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,76.13000,72.32000,The Alliance,Exception Members,,58.62,,,,,,,37.30,73.85,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,76.13000,72.32000,The Alliance,Exception Members,,58.62,,,,,,,34.94,73.85,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,inpatient,,,1117.64000,1061.76000,The Alliance,Exception Members,,860.58,,,,,,,547.64,1084.11,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,outpatient,,,1117.64000,1061.76000,The Alliance,Exception Members,,860.58,,,,,,,553.79,1084.11,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,199.84000,189.85000,The Alliance,Exception Members,,153.88,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Exception Members,,153.88,,,,,,,81.64,193.84,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,91.80000,87.21000,The Alliance,Exception Members,,70.69,,,,,,,44.98,89.05,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Exception Members,,70.69,,,,,,,45.90,315.32,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,121.88000,115.79000,The Alliance,Exception Members,,93.85,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Exception Members,,93.85,,,,,,,60.94,118.22,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,260.63000,247.60000,The Alliance,Exception Members,,200.69,,,,,,,127.71,252.81,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,260.63000,247.60000,The Alliance,Exception Members,,200.69,,,,,,,81.64,252.81,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,inpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,47.04,93.12,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,44.06,93.12,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,inpatient,,,441.03000,418.98000,The Alliance,Exception Members,,339.59,,,,,,,216.10,427.80,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Exception Members,,339.59,,,,,,,220.51,432.02,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,91.80000,87.21000,The Alliance,Exception Members,,70.69,,,,,,,44.98,89.05,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Exception Members,,70.69,,,,,,,45.90,315.32,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,inpatient,,,1333.00000,1266.35000,The Alliance,Exception Members,,1026.41,,,,,,,653.17,1293.01,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,Exception Members,,1026.41,,,,,,,666.50,1293.01,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,inpatient,,,160.20000,152.19000,The Alliance,Exception Members,,123.35,,,,,,,78.50,155.39,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Exception Members,,123.35,,,,,,,73.53,155.39,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,199.84000,189.85000,The Alliance,Exception Members,,153.88,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Exception Members,,153.88,,,,,,,99.92,193.84,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,74.34,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,10.45,18.43,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,9.50,79.34,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,60.36,137.74,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,74.00,150.74,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,38.65,150.35,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,89.24,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,38.65,89.24,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,77.50,153.86,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,488.00000,463.60000,The Alliance,Exception Members,,375.76,,,,,,,268.40,473.36,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,488.00000,463.60000,The Alliance,Exception Members,,375.76,,,,,,,242.89,473.36,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,664.00000,630.80000,The Alliance,Exception Members,,511.28,,,,,,,365.20,644.08,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,664.00000,630.80000,The Alliance,Exception Members,,511.28,,,,,,,332.00,644.08,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,760.00000,722.00000,The Alliance,Exception Members,,585.20,,,,,,,418.00,737.20,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Exception Members,,585.20,,,,,,,380.00,737.20,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,336.00000,319.20000,The Alliance,Exception Members,,258.72,,,,,,,184.80,325.92,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Exception Members,,258.72,,,,,,,137.04,325.92,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,134.64,472.39,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,inpatient,,,458.00000,435.10000,The Alliance,Exception Members,,352.66,,,,,,,251.90,444.26,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,outpatient,,,458.00000,435.10000,The Alliance,Exception Members,,352.66,,,,,,,141.69,444.26,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,109.61,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,inpatient,,,291.00000,276.45000,The Alliance,Exception Members,,224.07,,,,,,,160.05,282.27,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Exception Members,,224.07,,,,,,,128.93,282.27,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,inpatient,,,748.00000,710.60000,The Alliance,Exception Members,,575.96,,,,,,,411.40,725.56,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,outpatient,,,748.00000,710.60000,The Alliance,Exception Members,,575.96,,,,,,,374.00,725.56,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,14.86,137.74,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,inpatient,,,828.00000,786.60000,The Alliance,Exception Members,,637.56,,,,,,,455.40,803.16,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,outpatient,,,828.00000,786.60000,The Alliance,Exception Members,,637.56,,,,,,,377.09,803.16,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,169.00000,160.55000,The Alliance,Exception Members,,130.13,,,,,,,92.95,163.93,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Exception Members,,130.13,,,,,,,64.42,163.93,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,,2216.06,,,,,,,1582.90,2791.66,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,,2216.06,,,,,,,558.00,2791.66,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,38.65,279.36,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,inpatient,,,637.00000,605.15000,The Alliance,Exception Members,,490.49,,,,,,,350.35,617.89,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Exception Members,,490.49,,,,,,,318.50,617.89,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,172.82,489.94,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,Exception Members,TC,357.28,,,,,,,255.20,450.08,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Exception Members,TC,357.28,,,,,,,232.00,3299.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,427.00000,405.65000,The Alliance,Exception Members,,328.79,,,,,,,234.85,414.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Exception Members,,328.79,,,,,,,213.50,414.19,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,8.53000,8.10000,The Alliance,Exception Members,,6.57,,,,,,,4.18,8.27,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,8.53000,8.10000,The Alliance,Exception Members,,6.57,,,,,,,3.92,8.27,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,The Alliance,Exception Members,,2158.31,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Exception Members,,2158.31,,,,,,,1401.50,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,The Alliance,Exception Members,,2158.31,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Exception Members,,2158.31,,,,,,,814.56,2718.91,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,188.20000,178.79000,The Alliance,Exception Members,,144.91,,,,,,,92.22,182.55,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,188.20000,178.79000,The Alliance,Exception Members,,144.91,,,,,,,67.53,182.55,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,88.69,175.57,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,90.50,175.57,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,,917.07,,,,,,,583.59,1155.27,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,,917.07,,,,,,,504.90,1155.27,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,303.31,600.43,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,266.32,600.43,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,186.50,361.81,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,241.00000,228.95000,The Alliance,Exception Members,,185.57,,,,,,,118.09,233.77,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Exception Members,,185.57,,,,,,,105.37,233.77,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,429.00000,407.55000,The Alliance,Exception Members,,330.33,,,,,,,210.21,416.13,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,429.00000,407.55000,The Alliance,Exception Members,,330.33,,,,,,,214.50,416.13,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,TC,184.03,,,,,,,131.45,231.83,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,TC,184.03,,,,,,,119.50,2142.86,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,inpatient,,,227.15000,215.79000,The Alliance,Exception Members,,174.91,,,,,,,111.30,220.34,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,outpatient,,,227.15000,215.79000,The Alliance,Exception Members,,174.91,,,,,,,113.58,220.34,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,85.26,168.78,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,67.53,168.78,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,inpatient,,,170.20000,161.69000,The Alliance,Exception Members,,131.05,,,,,,,83.40,165.09,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,outpatient,,,170.20000,161.69000,The Alliance,Exception Members,,131.05,,,,,,,52.68,165.09,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,inpatient,,,200.35000,190.33000,The Alliance,Exception Members,,154.27,,,,,,,98.17,194.34,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,outpatient,,,200.35000,190.33000,The Alliance,Exception Members,,154.27,,,,,,,100.17,196.24,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,inpatient,,,441.03000,418.98000,The Alliance,Exception Members,,339.59,,,,,,,216.10,427.80,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Exception Members,,339.59,,,,,,,220.51,569.51,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,inpatient,,,1817.00000,1726.15000,The Alliance,Exception Members,,1399.09,,,,,,,890.33,1762.49,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,outpatient,,,1817.00000,1726.15000,The Alliance,Exception Members,,1399.09,,,,,,,908.50,1762.49,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,56.10,98.94,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,37.27,98.94,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,inpatient,,,1373.08000,1304.43000,The Alliance,Exception Members,,1057.27,,,,,,,672.81,1331.89,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,outpatient,,,1373.08000,1304.43000,The Alliance,Exception Members,,1057.27,,,,,,,686.54,1616.93,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,inpatient,,,269.63000,256.15000,The Alliance,Exception Members,,207.62,,,,,,,132.12,261.54,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,outpatient,,,269.63000,256.15000,The Alliance,Exception Members,,207.62,,,,,,,105.09,261.54,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,inpatient,,,260.06000,247.06000,The Alliance,Exception Members,,200.25,,,,,,,127.43,252.26,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,outpatient,,,260.06000,247.06000,The Alliance,Exception Members,,200.25,,,,,,,106.15,252.26,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,138.45000,131.53000,The Alliance,Exception Members,,106.61,,,,,,,67.84,134.30,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,138.45000,131.53000,The Alliance,Exception Members,,106.61,,,,,,,69.22,196.91,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,,100.10,,,,,,,63.70,126.10,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,,100.10,,,,,,,65.00,135.57,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,71.26000,67.70000,The Alliance,Exception Members,,54.87,,,,,,,34.92,69.12,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Exception Members,,54.87,,,,,,,35.63,103.42,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,13.26000,12.60000,The Alliance,Exception Members,,10.21,,,,,,,6.50,12.86,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,13.26000,12.60000,The Alliance,Exception Members,,10.21,,,,,,,6.63,65.22,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,545.00000,517.75000,The Alliance,Exception Members,,419.65,,,,,,,267.05,528.65,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Exception Members,,419.65,,,,,,,272.50,528.65,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,inpatient,,,71.26000,67.70000,The Alliance,Exception Members,,54.87,,,,,,,34.92,69.12,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Exception Members,,54.87,,,,,,,35.63,69.12,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,inpatient,,,3043.38000,2891.21000,The Alliance,Exception Members,,2343.40,,,,,,,1491.26,2952.08,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,outpatient,,,3043.38000,2891.21000,The Alliance,Exception Members,,2343.40,,,,,,,1514.36,2952.08,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,inpatient,,,844.00000,801.80000,The Alliance,Exception Members,,649.88,,,,,,,413.56,818.68,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Exception Members,,649.88,,,,,,,422.00,818.68,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,inpatient,,,821.00000,779.95000,The Alliance,Exception Members,,632.17,,,,,,,402.29,796.37,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,outpatient,,,821.00000,779.95000,The Alliance,Exception Members,,632.17,,,,,,,380.93,796.37,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,inpatient,,,36.53000,34.70000,The Alliance,Exception Members,,28.13,,,,,,,17.90,35.43,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,outpatient,,,36.53000,34.70000,The Alliance,Exception Members,,28.13,,,,,,,18.27,130.31,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,294.98,583.94,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,301.00,583.94,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,111.72,221.16,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,114.00,269.05,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,inpatient,,,801.35000,761.28000,The Alliance,Exception Members,,617.04,,,,,,,392.66,777.31,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,outpatient,,,801.35000,761.28000,The Alliance,Exception Members,,617.04,,,,,,,400.68,943.67,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,inpatient,,,773.00000,734.35000,The Alliance,Exception Members,,595.21,,,,,,,378.77,749.81,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,outpatient,,,773.00000,734.35000,The Alliance,Exception Members,,595.21,,,,,,,386.50,749.81,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,102.41,202.73,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,104.50,217.71,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,71.04000,67.49000,The Alliance,Exception Members,,54.70,,,,,,,34.81,68.91,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,71.04000,67.49000,The Alliance,Exception Members,,54.70,,,,,,,32.61,68.91,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,inpatient,,,362.51000,344.38000,The Alliance,Exception Members,,279.13,,,,,,,177.63,351.63,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,outpatient,,,362.51000,344.38000,The Alliance,Exception Members,,279.13,,,,,,,181.25,364.14,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,28.42,56.26,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,29.00,82.83,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,inpatient,,,31.14000,29.58000,The Alliance,Exception Members,,23.98,,,,,,,15.26,30.21,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,outpatient,,,31.14000,29.58000,The Alliance,Exception Members,,23.98,,,,,,,15.57,82.94,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,inpatient,,,817.43000,776.56000,The Alliance,Exception Members,,629.42,,,,,,,400.54,792.91,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,outpatient,,,817.43000,776.56000,The Alliance,Exception Members,,629.42,,,,,,,408.71,792.91,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,inpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,145.00,341.50,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,inpatient,,,2833.00000,2691.35000,The Alliance,Exception Members,,2181.41,,,,,,,1388.17,2748.01,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,outpatient,,,2833.00000,2691.35000,The Alliance,Exception Members,,2181.41,,,,,,,1212.77,2748.01,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,inpatient,,,1335.00000,1268.25000,The Alliance,Exception Members,,1027.95,,,,,,,654.15,1294.95,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,outpatient,,,1335.00000,1268.25000,The Alliance,Exception Members,,1027.95,,,,,,,667.50,1294.95,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,51.20000,48.64000,The Alliance,Exception Members,,39.42,,,,,,,25.09,49.66,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Exception Members,,39.42,,,,,,,23.50,49.66,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,1062.65,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,inpatient,,,760.40000,722.38000,The Alliance,Exception Members,,585.51,,,,,,,372.60,737.59,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,outpatient,,,760.40000,722.38000,The Alliance,Exception Members,,585.51,,,,,,,378.38,737.59,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,inpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,145.00,341.50,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,266.07,526.71,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,271.50,639.03,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,inpatient,,,306.76000,291.42000,The Alliance,Exception Members,,236.21,,,,,,,150.31,297.56,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Exception Members,,236.21,,,,,,,153.38,630.65,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,inpatient,,,174.49000,165.77000,The Alliance,Exception Members,,134.36,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Exception Members,,134.36,,,,,,,87.25,358.73,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,23.25,430.17,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,293.70000,279.02000,The Alliance,Exception Members,,226.15,,,,,,,143.91,284.89,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,293.70000,279.02000,The Alliance,Exception Members,,226.15,,,,,,,146.85,284.89,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,inpatient,,,2541.00000,2413.95000,The Alliance,Exception Members,,1956.57,,,,,,,1245.09,2464.77,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,outpatient,,,2541.00000,2413.95000,The Alliance,Exception Members,,1956.57,,,,,,,1166.32,2464.77,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,inpatient,,,384.09000,364.89000,The Alliance,Exception Members,,295.75,,,,,,,188.20,372.57,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,outpatient,,,384.09000,364.89000,The Alliance,Exception Members,,295.75,,,,,,,192.04,487.84,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,The Alliance,Exception Members,,145.25,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Exception Members,,145.25,,,,,,,55.62,188.63,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,12.54,24.83,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,11.75,24.83,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,31.84,56.16,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,28.95,56.16,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,inpatient,,,174.49000,165.77000,The Alliance,Exception Members,,134.36,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Exception Members,,134.36,,,,,,,87.25,358.73,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,152.90,269.66,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,139.00,269.66,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,The Alliance,Exception Members,,145.25,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Exception Members,,145.25,,,,,,,55.62,188.63,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,294.98,583.94,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,301.00,583.94,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,inpatient,,,148.65000,141.22000,The Alliance,Exception Members,,114.46,,,,,,,72.84,144.19,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,outpatient,,,148.65000,141.22000,The Alliance,Exception Members,,114.46,,,,,,,68.23,144.19,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,inpatient,,,66.80000,63.46000,The Alliance,Exception Members,,51.44,,,,,,,32.73,64.80,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Exception Members,,51.44,,,,,,,33.40,134.06,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,inpatient,,,40.48000,38.46000,The Alliance,Exception Members,,31.17,,,,,,,19.84,39.27,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,outpatient,,,40.48000,38.46000,The Alliance,Exception Members,,31.17,,,,,,,20.24,313.88,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,inpatient,,,80.27000,76.26000,The Alliance,Exception Members,,61.81,,,,,,,39.33,77.86,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,outpatient,,,80.27000,76.26000,The Alliance,Exception Members,,61.81,,,,,,,40.13,77.86,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,inpatient,,,14393.00000,13673.35000,The Alliance,Exception Members,,11082.61,,,,,,,7052.57,13961.21,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,outpatient,,,14393.00000,13673.35000,The Alliance,Exception Members,,11082.61,,,,,,,5640.97,13961.21,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,43.61,86.33,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,44.50,86.33,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,inpatient,,,42.80000,40.66000,The Alliance,Exception Members,,32.96,,,,,,,20.97,41.52,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,outpatient,,,42.80000,40.66000,The Alliance,Exception Members,,32.96,,,,,,,21.40,41.52,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,399.94000,379.94000,The Alliance,Exception Members,,307.95,,,,,,,195.97,387.94,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Exception Members,,307.95,,,,,,,199.97,387.94,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,inpatient,,,89.33000,84.86000,The Alliance,Exception Members,,68.78,,,,,,,43.77,86.65,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,outpatient,,,89.33000,84.86000,The Alliance,Exception Members,,68.78,,,,,,,44.66,91.99,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,inpatient,,,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,outpatient,,,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.30,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,5.87,113.69,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,257.95,454.93,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,56.40,454.93,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,inpatient,,,1327.00000,1260.65000,The Alliance,Exception Members,,1021.79,,,,,,,729.85,1287.19,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,outpatient,,,1327.00000,1260.65000,The Alliance,Exception Members,,1021.79,,,,,,,314.95,1287.19,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,inpatient,,,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,outpatient,,,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,0.31000,5.61,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,inpatient,,,77.20000,73.34000,The Alliance,Exception Members,,59.44,,,,,,,42.46,74.88,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,outpatient,,,77.20000,73.34000,The Alliance,Exception Members,,59.44,,,,,,,38.60,550.14,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,inpatient,,,56.50000,53.67000,The Alliance,Exception Members,,43.51,,,,,,,27.68,54.80,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,outpatient,,,56.50000,53.67000,The Alliance,Exception Members,,43.51,,,,,,,28.25,54.80,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,114.56000,108.83000,The Alliance,Exception Members,,88.21,,,,,,,56.13,111.12,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,114.56000,108.83000,The Alliance,Exception Members,,88.21,,,,,,,57.28,111.12,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,91.53000,86.95000,The Alliance,Exception Members,,70.48,,,,,,,44.85,88.78,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,91.53000,86.95000,The Alliance,Exception Members,,70.48,,,,,,,45.77,95.58,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,302.81000,287.67000,The Alliance,Exception Members,,233.16,,,,,,,148.38,293.73,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,302.81000,287.67000,The Alliance,Exception Members,,233.16,,,,,,,151.41,293.73,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.27,6.47,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,70.48,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,inpatient,,,3562.00000,3383.90000,The Alliance,Exception Members,TC,2742.74,,,,,,,1959.10,3455.14,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Exception Members,TC,2742.74,,,,,,,1781.00,5271.00,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,inpatient,,,51.73000,49.14000,The Alliance,Exception Members,,39.83,,,,,,,25.35,50.18,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,outpatient,,,51.73000,49.14000,The Alliance,Exception Members,,39.83,,,,,,,23.74,50.18,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,inpatient,,,812.00000,771.40000,The Alliance,Exception Members,,625.24,,,,,,,397.88,787.64,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Exception Members,,625.24,,,,,,,372.71,812.00,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,241.18,477.44,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Exception Members,,379.00,,,,,,,246.10,477.44,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,inpatient,,,3214.00000,3053.30000,The Alliance,Exception Members,,2474.78,,,,,,,1574.86,3117.58,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,outpatient,,,3214.00000,3053.30000,The Alliance,Exception Members,,2474.78,,,,,,,1607.00,3117.58,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,inpatient,,,876.00000,832.20000,The Alliance,Exception Members,,674.52,,,,,,,429.24,849.72,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Exception Members,,674.52,,,,,,,438.00,849.72,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,44.77000,42.53000,The Alliance,Exception Members,,34.47,,,,,,,21.94,43.43,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,44.77000,42.53000,The Alliance,Exception Members,,34.47,,,,,,,22.39,121.81,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.48,30.65,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,14.50,30.65,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,436.46000,414.64000,The Alliance,Exception Members,,336.07,,,,,,,213.87,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Exception Members,,336.07,,,,,,,99.97,423.37,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,inpatient,,,2171.00000,2062.45000,The Alliance,Exception Members,,1671.67,,,,,,,1063.79,2105.87,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,outpatient,,,2171.00000,2062.45000,The Alliance,Exception Members,,1671.67,,,,,,,1085.50,2105.87,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1053.99,2086.47,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1075.50,2086.47,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,inpatient,,,55.45000,52.68000,The Alliance,Exception Members,,42.70,,,,,,,27.17,53.79,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,outpatient,,,55.45000,52.68000,The Alliance,Exception Members,,42.70,,,,,,,27.73,102.20,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,inpatient,,,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,0.80300,1.94,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,inpatient,,,307.50000,292.12000,The Alliance,Exception Members,,236.78,,,,,,,150.68,298.27,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Exception Members,,236.78,,,,,,,133.85,298.27,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,57.29000,54.43000,The Alliance,Exception Members,,44.11,,,,,,,28.07,55.57,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,57.29000,54.43000,The Alliance,Exception Members,,44.11,,,,,,,28.64,315.32,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,201.85,355.99,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,56.40,355.99,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,inpatient,,,711.00000,675.45000,The Alliance,Exception Members,,547.47,,,,,,,391.05,689.67,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,outpatient,,,711.00000,675.45000,The Alliance,Exception Members,,547.47,,,,,,,314.95,689.67,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,57.91000,55.01000,The Alliance,Exception Members,,44.59,,,,,,,28.38,56.17,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,57.91000,55.01000,The Alliance,Exception Members,,44.59,,,,,,,28.95,93.98,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,57.80000,54.91000,The Alliance,Exception Members,,44.51,,,,,,,28.32,56.07,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Exception Members,,44.51,,,,,,,28.90,315.32,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,381.46000,362.39000,The Alliance,Exception Members,,293.72,,,,,,,186.92,370.02,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,381.46000,362.39000,The Alliance,Exception Members,,293.72,,,,,,,190.73,449.21,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,152.51,301.91,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,86.36,301.91,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,29.96000,28.46000,The Alliance,Exception Members,,23.07,,,,,,,14.68,29.06,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,29.96000,28.46000,The Alliance,Exception Members,,23.07,,,,,,,14.98,92.45,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,191.95,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,122.40,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,33.55,59.17,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,30.50,134.64,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,56.40,185.27,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,52,123.20,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,52,123.20,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,52,147.07,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,52,147.07,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,52,147.07,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,52,147.07,,,,,,,95.50,185.27,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,191.40,337.56,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,148.57,337.56,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,Exception Members,,355.74,,,,,,,254.10,448.14,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Exception Members,,355.74,,,,,,,231.00,448.14,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,inpatient,,,2008.00000,1907.60000,The Alliance,Exception Members,,1546.16,,,,,,,1104.40,1947.76,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,outpatient,,,2008.00000,1907.60000,The Alliance,Exception Members,,1546.16,,,,,,,87.16,1947.76,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,10.45,18.43,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,9.50,18.43,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,34.92,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,56.40,116.40,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,45.10,79.54,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,41.00,79.54,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,15.50,30.07,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,148.50,261.90,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,56.40,261.90,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,42.50,554.21,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,71.50,308.32,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,41.56000,39.48000,The Alliance,Exception Members,,32.00,,,,,,,20.36,40.31,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,41.56000,39.48000,The Alliance,Exception Members,,32.00,,,,,,,19.08,41.56,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,505.88000,480.59000,The Alliance,Exception Members,,389.53,,,,,,,247.88,490.70,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,505.88000,480.59000,The Alliance,Exception Members,,389.53,,,,,,,232.20,505.88,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,637.50000,605.62000,The Alliance,Exception Members,,490.88,,,,,,,312.38,618.38,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Exception Members,,490.88,,,,,,,292.61,637.50,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,53.50,103.79,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,inpatient,,,1130.00000,1073.50000,The Alliance,Exception Members,TC,870.10,,,,,,,621.50,1096.10,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,Exception Members,TC,870.10,,,,,,,565.00,1096.10,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,inpatient,,,474.00000,450.30000,The Alliance,Exception Members,TC,364.98,,,,,,,260.70,459.78,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,Exception Members,TC,364.98,,,,,,,237.00,459.78,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,The Alliance,Exception Members,TC,1113.42,,,,,,,795.30,1402.62,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Exception Members,TC,1113.42,,,,,,,723.00,1402.62,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,inpatient,,,315.00000,299.25000,The Alliance,Exception Members,TC,242.55,,,,,,,173.25,305.55,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Exception Members,TC,242.55,,,,,,,157.50,305.55,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,inpatient,,,598.00000,568.10000,The Alliance,Exception Members,TC,460.46,,,,,,,328.90,580.06,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Exception Members,TC,460.46,,,,,,,299.00,580.06,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,3.63,254.68,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,TC,56.98,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,TC,56.98,,,,,,,37.00,442.00,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,TC,40.81,,,,,,,29.15,51.41,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,TC,40.81,,,,,,,26.50,51.41,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,Exception Members,TC,20.02,,,,,,,14.30,25.22,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Exception Members,TC,20.02,,,,,,,13.00,25.22,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,TC,100.10,,,,,,,71.50,126.10,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,TC,100.10,,,,,,,65.00,126.10,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,inpatient,,,4627.00000,4395.65000,The Alliance,Exception Members,TC,3562.79,,,,,,,2544.85,4488.19,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,outpatient,,,4627.00000,4395.65000,The Alliance,Exception Members,TC,3562.79,,,,,,,2313.50,4488.19,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,TC,23.10,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,TC,23.10,,,,,,,15.00,29.10,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,TC,1558.48,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,TC,1558.48,,,,,,,864.82,2960.49,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,,2154.46,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,,2154.46,,,,,,,169.04,2714.06,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,The Alliance,Exception Members,TC,2954.49,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Exception Members,TC,2954.49,,,,,,,1626.53,3721.89,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,,1819.51,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,,1819.51,,,,,,,169.04,2292.11,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,272.50,528.65,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,52,56.98,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,52,56.98,,,,,,,37.00,442.00,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,828.00,1606.32,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,18.50,442.00,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,18.50,442.00,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,TC,1282.82,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,TC,1282.82,,,,,,,833.00,1616.02,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,Exception Members,TC,208.67,,,,,,,149.05,262.87,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Exception Members,TC,208.67,,,,,,,135.50,262.87,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,Exception Members,TC,377.30,,,,,,,269.50,475.30,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Exception Members,TC,377.30,,,,,,,245.00,475.30,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,Exception Members,TC,236.39,,,,,,,168.85,297.79,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Exception Members,TC,236.39,,,,,,,153.50,297.79,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,The Alliance,Exception Members,TC,399.63,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Exception Members,TC,399.63,,,,,,,259.50,503.43,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,inpatient,,,316.00000,300.20000,The Alliance,Exception Members,TC,243.32,,,,,,,173.80,306.52,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,Exception Members,TC,243.32,,,,,,,158.00,306.52,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,Exception Members,TC,518.98,,,,,,,370.70,653.78,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Exception Members,TC,518.98,,,,,,,337.00,653.78,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,655.05,1155.27,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,595.50,1155.27,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,The Alliance,Exception Members,TC,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Exception Members,TC,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,The Alliance,Exception Members,TC,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Exception Members,TC,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1360.00000,1292.00000,The Alliance,Exception Members,TC,1047.20,,,,,,,748.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1360.00000,1292.00000,The Alliance,Exception Members,TC,1047.20,,,,,,,680.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,614.00,1191.16,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,TC,191.73,,,,,,,136.95,241.53,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,TC,191.73,,,,,,,124.50,241.53,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,The Alliance,Exception Members,TC,2566.41,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Exception Members,TC,2566.41,,,,,,,1666.50,3233.01,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,TC,982.52,,,,,,,701.80,1237.72,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,TC,982.52,,,,,,,638.00,1237.72,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2015.00,3909.10,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,The Alliance,Exception Members,TC,1965.81,,,,,,,1404.15,2476.41,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Exception Members,TC,1965.81,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,The Alliance,Exception Members,TC,904.75,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Exception Members,TC,904.75,,,,,,,587.50,1139.75,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1247.95,2200.93,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1134.50,2200.93,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,TC,163.24,,,,,,,116.60,205.64,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,TC,163.24,,,,,,,106.00,205.64,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,Exception Members,TC,197.89,,,,,,,141.35,249.29,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Exception Members,TC,197.89,,,,,,,128.50,249.29,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,The Alliance,Exception Members,TC,2069.76,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Exception Members,TC,2069.76,,,,,,,1344.00,2607.36,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,inpatient,,,564.00000,535.80000,The Alliance,Exception Members,TC,434.28,,,,,,,310.20,547.08,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Exception Members,TC,434.28,,,,,,,282.00,5271.00,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,The Alliance,Exception Members,TC,1908.83,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Exception Members,TC,1908.83,,,,,,,909.00,5271.00,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,Exception Members,TC,14.63,,,,,,,10.45,18.43,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Exception Members,TC,14.63,,,,,,,9.50,18.43,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,inpatient,,,2018.00000,1917.10000,The Alliance,Exception Members,TC,1553.86,,,,,,,1109.90,1957.46,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,outpatient,,,2018.00000,1917.10000,The Alliance,Exception Members,TC,1553.86,,,,,,,909.00,5271.00,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,The Alliance,Exception Members,TC,1853.39,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Exception Members,TC,1853.39,,,,,,,1203.50,2334.79,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,inpatient,,,219.00000,208.05000,The Alliance,Exception Members,TC,168.63,,,,,,,120.45,212.43,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,Exception Members,TC,168.63,,,,,,,109.50,212.43,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,The Alliance,Exception Members,,1908.83,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Exception Members,,1908.83,,,,,,,503.83,5271.00,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,TC,260.26,,,,,,,185.90,327.86,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,TC,260.26,,,,,,,169.00,327.86,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,TC,59.29,,,,,,,42.35,74.69,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,TC,59.29,,,,,,,38.50,74.69,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,1004.85,1772.19,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,913.50,1772.19,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,The Alliance,Exception Members,TC,2182.18,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Exception Members,TC,2182.18,,,,,,,1132.05,2748.98,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,inpatient,,,269.00000,255.55000,The Alliance,Exception Members,TC,207.13,,,,,,,147.95,260.93,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,Exception Members,TC,207.13,,,,,,,134.50,1635.52,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,inpatient,,,2546.00000,2418.70000,The Alliance,Exception Members,TC,1960.42,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Exception Members,TC,1960.42,,,,,,,1400.30,5271.00,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,TC,1260.49,,,,,,,900.35,1587.89,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,TC,1260.49,,,,,,,818.50,1587.89,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,TC,141.68,,,,,,,101.20,178.48,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,TC,141.68,,,,,,,92.00,178.48,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,TC,174.02,,,,,,,124.30,219.22,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,TC,174.02,,,,,,,113.00,219.22,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,TC,85.47,,,,,,,61.05,107.67,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,TC,85.47,,,,,,,55.50,107.67,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,81.50,554.21,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,inpatient,,,3396.00000,3226.20000,The Alliance,Exception Members,TC,2614.92,,,,,,,1867.80,3294.12,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,outpatient,,,3396.00000,3226.20000,The Alliance,Exception Members,TC,2614.92,,,,,,,1698.00,3294.12,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,TC,100.10,,,,,,,71.50,126.10,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,TC,100.10,,,,,,,65.00,126.10,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,TC,34.65,,,,,,,24.75,43.65,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,TC,34.65,,,,,,,22.50,43.65,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,Exception Members,TC,723.80,,,,,,,517.00,911.80,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Exception Members,TC,723.80,,,,,,,470.00,911.80,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,inpatient,,,785.00000,745.75000,The Alliance,Exception Members,TC,604.45,,,,,,,431.75,761.45,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Exception Members,TC,604.45,,,,,,,392.50,761.45,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1652.75,2914.85,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1128.45,2914.85,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,Exception Members,TC,739.97,,,,,,,528.55,932.17,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Exception Members,TC,739.97,,,,,,,480.50,932.17,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,Exception Members,TC,366.52,,,,,,,261.80,461.72,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Exception Members,TC,366.52,,,,,,,238.00,461.72,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,47.50,860.53,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,TC,129.36,,,,,,,92.40,162.96,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,TC,129.36,,,,,,,84.00,162.96,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,inpatient,,,12.00000,11.40000,The Alliance,Exception Members,TC,9.24,,,,,,,6.60,11.64,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Exception Members,TC,9.24,,,,,,,6.00,11.64,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,inpatient,,,1134.00000,1077.30000,The Alliance,Exception Members,TC,873.18,,,,,,,623.70,1099.98,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Exception Members,TC,873.18,,,,,,,567.00,1099.98,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,inpatient,,,285.90000,271.60000,The Alliance,Exception Members,TC,220.14,,,,,,,157.25,277.32,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,outpatient,,,285.90000,271.60000,The Alliance,Exception Members,TC,220.14,,,,,,,142.95,277.32,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,inpatient,,,152.50000,144.88000,The Alliance,Exception Members,TC,117.42,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Exception Members,TC,117.42,,,,,,,76.25,147.93,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,TC,438.90,,,,,,,313.50,552.90,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,TC,438.90,,,,,,,118.53,1430.78,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,inpatient,,,2216.00000,2105.20000,The Alliance,Exception Members,TC,1706.32,,,,,,,1218.80,2149.52,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,outpatient,,,2216.00000,2105.20000,The Alliance,Exception Members,TC,1706.32,,,,,,,1108.00,2149.52,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,inpatient,,,80.70000,76.66000,The Alliance,Exception Members,,62.14,,,,,,,44.38,78.28,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,outpatient,,,80.70000,76.66000,The Alliance,Exception Members,,62.14,,,,,,,40.35,91.97,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,288.20,508.28,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,262.00,508.28,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,TC,119.35,,,,,,,85.25,150.35,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,TC,119.35,,,,,,,77.50,150.35,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,Exception Members,TC,107.03,,,,,,,76.45,134.83,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Exception Members,TC,107.03,,,,,,,69.50,134.83,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,,2630.32,,,,,,,1878.80,3313.52,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,,2630.32,,,,,,,169.04,3313.52,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,inpatient,,,375.50000,356.72000,The Alliance,Exception Members,TC,289.13,,,,,,,206.53,364.24,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,outpatient,,,375.50000,356.72000,The Alliance,Exception Members,TC,289.13,,,,,,,187.75,364.24,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,230.00,446.20,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,inpatient,,,6252.00000,5939.40000,The Alliance,Exception Members,TC,4814.04,,,,,,,3438.60,6064.44,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,outpatient,,,6252.00000,5939.40000,The Alliance,Exception Members,TC,4814.04,,,,,,,3126.00,6064.44,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,inpatient,,,152.50000,144.88000,The Alliance,Exception Members,TC,117.42,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Exception Members,TC,117.42,,,,,,,76.25,147.93,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,inpatient,,,13.00000,12.35000,The Alliance,Exception Members,TC,10.01,,,,,,,7.15,12.61,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Exception Members,TC,10.01,,,,,,,6.50,12.61,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,inpatient,,,1150.00000,1092.50000,The Alliance,Exception Members,TC,885.50,,,,,,,632.50,1115.50,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,outpatient,,,1150.00000,1092.50000,The Alliance,Exception Members,TC,885.50,,,,,,,575.00,1115.50,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,5936.70,10470.18,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,5397.00,10470.18,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,inpatient,,,489.00000,464.55000,The Alliance,Exception Members,TC,376.53,,,,,,,268.95,474.33,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Exception Members,TC,376.53,,,,,,,244.50,474.33,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,inpatient,,,5814.00000,5523.30000,The Alliance,Exception Members,TC,4476.78,,,,,,,3197.70,5639.58,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,outpatient,,,5814.00000,5523.30000,The Alliance,Exception Members,TC,4476.78,,,,,,,377.14,7206.00,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,TC,176.33,,,,,,,125.95,222.13,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,TC,176.33,,,,,,,114.50,222.13,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,102.30,180.42,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,93.00,180.42,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,inpatient,,,312.00000,296.40000,The Alliance,Exception Members,TC,240.24,,,,,,,171.60,302.64,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Exception Members,TC,240.24,,,,,,,156.00,302.64,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,Exception Members,TC,154.77,,,,,,,110.55,194.97,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Exception Members,TC,154.77,,,,,,,100.50,194.97,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,299.75,528.65,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,272.50,528.65,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1404.95,2770.32,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,inpatient,,,1073.00000,1019.35000,The Alliance,Exception Members,TC,826.21,,,,,,,590.15,1040.81,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Exception Members,TC,826.21,,,,,,,536.50,1040.81,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1399.96,2770.32,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1047.39,2099.08,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,761.71,1516.11,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,765.41,1516.11,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,inpatient,,,284.00000,269.80000,The Alliance,Exception Members,TC,218.68,,,,,,,156.20,275.48,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,Exception Members,TC,218.68,,,,,,,142.00,275.48,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,763.56,1516.11,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,140.80,248.32,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,128.00,248.32,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,132.00,232.80,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,120.00,232.80,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,Exception Members,TC,271.04,,,,,,,193.60,341.44,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Exception Members,TC,271.04,,,,,,,176.00,341.44,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1056.58,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Exception Members,,1666.28,,,,,,,1049.24,2099.08,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,172.50,4020.73,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,138.00,267.72,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,TC,33.11,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,TC,33.11,,,,,,,21.50,41.71,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,Exception Members,TC,439.67,,,,,,,314.05,553.87,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Exception Members,TC,439.67,,,,,,,285.50,1232.72,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,614.50,1192.13,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,TC,416.57,,,,,,,297.55,524.77,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,TC,416.57,,,,,,,270.50,1232.72,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,1767.08,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,TC,69.30,,,,,,,49.50,87.30,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,TC,69.30,,,,,,,45.00,87.30,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,TC,1382.15,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,TC,1382.15,,,,,,,897.50,1741.15,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,The Alliance,Exception Members,TC,3692.92,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Exception Members,TC,3692.92,,,,,,,2398.00,4652.12,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,TC,32.34,,,,,,,23.10,40.74,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,TC,32.34,,,,,,,21.00,40.74,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,TC,1382.15,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,TC,1382.15,,,,,,,897.50,1741.15,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,157.00,304.58,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,68.74,718.77,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,inpatient,,,15.00000,14.25000,The Alliance,Exception Members,TC,11.55,,,,,,,8.25,14.55,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Exception Members,TC,11.55,,,,,,,7.50,14.55,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,TC,33.11,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,TC,33.11,,,,,,,21.50,41.71,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,TC,1533.84,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,TC,1533.84,,,,,,,996.00,1932.24,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,TC,21.56,,,,,,,15.40,27.16,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,TC,21.56,,,,,,,14.00,27.16,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,TC,2607.22,,,,,,,1862.30,3284.42,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,TC,2607.22,,,,,,,1693.00,3284.42,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,,1533.84,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,,1533.84,,,,,,,100.97,1932.24,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,TC,199.43,,,,,,,142.45,251.23,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,TC,199.43,,,,,,,129.50,1145.46,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,122.10,215.34,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,111.00,215.34,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,The Alliance,Exception Members,TC,1221.22,,,,,,,872.30,1538.42,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Exception Members,TC,1221.22,,,,,,,793.00,1538.42,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,820.60,1447.24,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,746.00,1447.24,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,inpatient,,,930.00000,883.50000,The Alliance,Exception Members,TC,716.10,,,,,,,511.50,902.10,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Exception Members,TC,716.10,,,,,,,465.00,902.10,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,TC,95.48,,,,,,,68.20,120.28,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,TC,95.48,,,,,,,62.00,120.28,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,TC,274.12,,,,,,,195.80,345.32,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,TC,274.12,,,,,,,178.00,2024.21,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,TC,68.53,,,,,,,48.95,86.33,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,TC,68.53,,,,,,,44.50,86.33,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,inpatient,,,617.00000,586.15000,The Alliance,Exception Members,TC,475.09,,,,,,,339.35,598.49,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,outpatient,,,617.00000,586.15000,The Alliance,Exception Members,TC,475.09,,,,,,,297.28,598.49,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,675.95,1192.13,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,606.90,5742.65,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,TC,45.43,,,,,,,32.45,57.23,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,TC,45.43,,,,,,,29.50,57.23,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,Exception Members,TC,329.56,,,,,,,235.40,415.16,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Exception Members,TC,329.56,,,,,,,214.00,467.89,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,300.85,530.59,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,257.00,595.98,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,inpatient,,,465.00000,441.75000,The Alliance,Exception Members,TC,358.05,,,,,,,255.75,451.05,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,outpatient,,,465.00000,441.75000,The Alliance,Exception Members,TC,358.05,,,,,,,232.50,2134.86,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,inpatient,,,1556.00000,1478.20000,The Alliance,Exception Members,,1198.12,,,,,,,762.44,1509.32,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,Exception Members,,1198.12,,,,,,,714.20,1556.00,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,inpatient,,,12133.00000,11526.35000,The Alliance,Exception Members,,9342.41,,,,,,,6673.15,11769.01,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,outpatient,,,12133.00000,11526.35000,The Alliance,Exception Members,,9342.41,,,,,,,6066.50,11769.01,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,9.09,29.10,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,144.65,255.11,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,129.58,1272.59,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,Exception Members,TC,209.44,,,,,,,149.60,263.84,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Exception Members,TC,209.44,,,,,,,125.88,1213.27,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,584.87,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,73.15,129.01,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,66.50,584.87,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,The Alliance,Exception Members,TC,889.35,,,,,,,635.25,1120.35,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Exception Members,TC,889.35,,,,,,,577.50,1120.35,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,inpatient,,,4144.00000,3936.80000,The Alliance,Exception Members,,3190.88,,,,,,,2279.20,4019.68,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,outpatient,,,4144.00000,3936.80000,The Alliance,Exception Members,,3190.88,,,,,,,280.29,4019.68,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,548.00,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,655.05,1155.27,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,384.16,1155.27,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,163.90,289.06,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,149.00,1569.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,TC,160.93,,,,,,,114.95,202.73,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,TC,160.93,,,,,,,104.50,1114.32,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,Exception Members,TC,166.32,,,,,,,118.80,209.52,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Exception Members,TC,166.32,,,,,,,108.00,1193.49,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,Exception Members,TC,204.05,,,,,,,145.75,257.05,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Exception Members,TC,204.05,,,,,,,132.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,151.80,267.72,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,138.00,1371.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,154.77,308.46,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,The Alliance,Exception Members,TC,3704.47,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Exception Members,TC,3704.47,,,,,,,1285.85,4666.67,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,125.88,1213.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,122.10,215.34,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,111.00,1094.55,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,inpatient,1,EA,10866.46000,10323.14000,The Alliance,Exception Members,,8367.17,,,,,,,5976.55,10540.47,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,outpatient,1,EA,10866.46000,10323.14000,The Alliance,Exception Members,,8367.17,,,,,,,4.49,10540.47,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,inpatient,1,mL,1294.48000,1229.75000,The Alliance,Exception Members,,996.75,,,,,,,711.96,1255.65,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,outpatient,1,mL,1294.48000,1229.75000,The Alliance,Exception Members,,996.75,,,,,,,11.03,1255.65,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,inpatient,1,mL,781.97000,742.88000,The Alliance,Exception Members,,602.12,,,,,,,430.08,758.51,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,outpatient,1,mL,781.97000,742.88000,The Alliance,Exception Members,,602.12,,,,,,,24.87,758.51,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,126.50,1331.91,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,42.40000,40.28000,The Alliance,Exception Members,,32.65,,,,,,,20.78,41.13,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,42.40000,40.28000,The Alliance,Exception Members,,32.65,,,,,,,21.20,41.13,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,The Alliance,Exception Members,TC,737.66,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Exception Members,TC,737.66,,,,,,,384.16,1329.46,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,Exception Members,TC,247.94,,,,,,,177.10,312.34,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Exception Members,TC,247.94,,,,,,,161.00,1628.59,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,inpatient,1,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,7.39,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,6.71,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,inpatient,120,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,outpatient,120,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,inpatient,120,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,outpatient,120,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,inpatient,120,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,outpatient,120,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,inpatient,120,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,outpatient,120,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,inpatient,1,mL,17.06000,16.21000,The Alliance,Exception Members,,13.14,,,,,,,9.38,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,outpatient,1,mL,17.06000,16.21000,The Alliance,Exception Members,,13.14,,,,,,,0.14409,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,inpatient,1,mL,20.10000,19.09000,The Alliance,Exception Members,,15.48,,,,,,,11.05,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,outpatient,1,mL,20.10000,19.09000,The Alliance,Exception Members,,15.48,,,,,,,0.14409,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,inpatient,1,mL,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,12.51,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,outpatient,1,mL,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,0.14409,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,inpatient,1,mL,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,14.43,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,0.14409,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,inpatient,1,mL,14.49000,13.77000,The Alliance,Exception Members,,11.16,,,,,,,7.97,14.06,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,outpatient,1,mL,14.49000,13.77000,The Alliance,Exception Members,,11.16,,,,,,,0.14409,14.06,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,inpatient,1,EA,0.83000,0.78000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,outpatient,1,EA,0.83000,0.78000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,137.50,242.50,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,125.00,1331.91,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,151.25,266.75,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,137.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,119.35,210.49,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,108.50,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,145.20,256.08,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,120.38,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,177.65,313.31,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,161.50,1648.36,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,TC,190.19,,,,,,,135.85,239.59,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,TC,190.19,,,,,,,123.50,1233.04,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,Exception Members,TC,644.49,,,,,,,460.35,811.89,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Exception Members,TC,644.49,,,,,,,418.50,811.89,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,73.15,129.01,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,66.50,584.87,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,The Alliance,Exception Members,TC,1076.46,,,,,,,768.90,1356.06,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Exception Members,TC,1076.46,,,,,,,384.16,1356.06,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,The Alliance,Exception Members,TC,451.22,,,,,,,322.30,568.42,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Exception Members,TC,451.22,,,,,,,247.28,568.42,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,567.05,1000.07,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,384.16,1000.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,457.05,806.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,384.16,806.07,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,101.94,1193.49,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,163.90,289.06,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,135.13,1430.78,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,The Alliance,Exception Members,TC,1394.47,,,,,,,996.05,1756.67,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Exception Members,TC,1394.47,,,,,,,905.50,8808.48,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,Exception Members,TC,394.24,,,,,,,281.60,496.64,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Exception Members,TC,394.24,,,,,,,151.73,1628.59,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,172.00,1786.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,Exception Members,TC,234.85,,,,,,,167.75,295.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Exception Members,TC,234.85,,,,,,,152.50,1628.59,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,102.30,180.42,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,93.00,1074.77,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,170.00,1786.85,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,158.40,279.36,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,144.00,1549.49,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,140.80,248.32,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,77.99,1015.45,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,Exception Members,TC,621.39,,,,,,,443.85,782.79,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Exception Members,TC,621.39,,,,,,,403.50,5149.29,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,TC,222.53,,,,,,,158.95,280.33,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,TC,222.53,,,,,,,144.50,1509.95,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,166.47,1628.59,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,TC,134.75,,,,,,,96.25,169.75,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,TC,134.75,,,,,,,87.50,876.96,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,Exception Members,TC,185.57,,,,,,,132.55,233.77,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Exception Members,TC,185.57,,,,,,,120.50,1213.27,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,151.00,1509.95,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,409.20,721.68,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,372.00,4002.11,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,Exception Members,TC,234.08,,,,,,,167.20,294.88,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Exception Members,TC,234.08,,,,,,,152.00,1569.27,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,181.50,320.10,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,165.00,1648.36,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,Exception Members,TC,473.55,,,,,,,338.25,596.55,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Exception Members,TC,473.55,,,,,,,307.50,3329.66,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,115.50,1213.27,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,TC,71.61,,,,,,,51.15,90.21,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,TC,71.61,,,,,,,46.50,3015.65,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,Exception Members,TC,446.60,,,,,,,319.00,562.60,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Exception Members,TC,446.60,,,,,,,290.00,5821.82,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,134.75,237.65,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,122.50,1292.36,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,The Alliance,Exception Members,TC,899.36,,,,,,,642.40,1132.96,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Exception Members,TC,899.36,,,,,,,278.89,2676.90,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,Exception Members,TC,180.95,,,,,,,129.25,227.95,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Exception Members,TC,180.95,,,,,,,117.50,1233.04,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,inpatient,,,1544.00000,1466.80000,The Alliance,Exception Members,,1188.88,,,,,,,849.20,1497.68,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,outpatient,,,1544.00000,1466.80000,The Alliance,Exception Members,,1188.88,,,,,,,772.00,7180.14,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,inpatient,1,mL,8.71000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,0.93155,8.45,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,,2216.06,,,,,,,1582.90,2791.66,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,,2216.06,,,,,,,549.28,22788.40,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,The Alliance,Exception Members,,3988.60,,,,,,,2849.00,5024.60,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Exception Members,,3988.60,,,,,,,549.28,30205.49,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,Exception Members,,558.25,,,,,,,398.75,703.25,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Exception Members,,558.25,,,,,,,237.91,17311.25,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,,3581.27,,,,,,,2558.05,4511.47,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,,3581.27,,,,,,,103.97,7209.59,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,The Alliance,Exception Members,,1677.06,,,,,,,1197.90,2112.66,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Exception Members,,1677.06,,,,,,,381.55,2210.07,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,The Alliance,Exception Members,,1545.39,,,,,,,1103.85,1946.79,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Exception Members,,1545.39,,,,,,,511.11,2960.49,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,The Alliance,Exception Members,,3980.13,,,,,,,2842.95,5013.93,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Exception Members,,3980.13,,,,,,,2584.50,5013.93,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,The Alliance,Exception Members,,944.21,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Exception Members,,944.21,,,,,,,562.85,1226.25,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,427.50000,406.12000,The Alliance,Exception Members,,329.18,,,,,,,209.47,414.68,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Exception Members,,329.18,,,,,,,196.22,427.50,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3087.92,6727.50,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,182.00,456.63,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,The Alliance,Exception Members,,2685.76,,,,,,,1918.40,3383.36,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Exception Members,,2685.76,,,,,,,511.11,3383.36,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,The Alliance,Exception Members,,2674.98,,,,,,,1910.70,3369.78,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Exception Members,,2674.98,,,,,,,1239.61,7180.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,inpatient,,,3562.00000,3383.90000,The Alliance,Exception Members,,2742.74,,,,,,,1959.10,3455.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Exception Members,,2742.74,,,,,,,371.02,10740.24,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,0.60838,61.30,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,The Alliance,Exception Members,,2558.71,,,,,,,1827.65,3223.31,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Exception Members,,2558.71,,,,,,,383.91,10740.24,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,The Alliance,Exception Members,,2426.27,,,,,,,1733.05,3056.47,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,Exception Members,,2426.27,,,,,,,1733.05,5271.00,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,inpatient,,,2262.00000,2148.90000,The Alliance,Exception Members,,1741.74,,,,,,,1244.10,2194.14,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,outpatient,,,2262.00000,2148.90000,The Alliance,Exception Members,,1741.74,,,,,,,1131.00,15808.09,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2137.79,4657.50,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,The Alliance,Exception Members,,2190.49,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Exception Members,,2190.49,,,,,,,1305.76,2844.79,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,The Alliance,Exception Members,,11883.11,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Exception Members,,11883.11,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,The Alliance,Exception Members,,7685.25,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Exception Members,,7685.25,,,,,,,4581.21,9980.85,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4205.10000,3994.85000,The Alliance,Exception Members,,3237.93,,,,,,,2060.50,4078.95,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4205.10000,3994.85000,The Alliance,Exception Members,,3237.93,,,,,,,1930.14,4205.10,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,inpatient,1,mL,78.92000,74.98000,The Alliance,Exception Members,,60.77,,,,,,,43.41,76.55,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,outpatient,1,mL,78.92000,74.98000,The Alliance,Exception Members,,60.77,,,,,,,14.12,76.55,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,549.28,20208.37,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,549.28,20181.52,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,,12778.15,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,,12778.15,,,,,,,1299.22,106944.98,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,2049.30,3614.22,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1863.00,3614.22,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,inpatient,,,497.00000,472.15000,The Alliance,Exception Members,,382.69,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Exception Members,,382.69,,,,,,,248.50,7984.62,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,inpatient,,,497.00000,472.15000,The Alliance,Exception Members,,382.69,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Exception Members,,382.69,,,,,,,248.50,7984.62,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,,948.64,,,,,,,677.60,1195.04,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,,948.64,,,,,,,381.55,2210.07,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,1155.00,2037.00,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,1050.00,2037.00,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,inpatient,,,2184.00000,2074.80000,The Alliance,Exception Members,TC,1681.68,,,,,,,1201.20,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,outpatient,,,2184.00000,2074.80000,The Alliance,Exception Members,TC,1681.68,,,,,,,1092.00,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,1004.85,1772.19,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,913.50,1772.19,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,TC,58.52,,,,,,,41.80,73.72,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,TC,58.52,,,,,,,38.00,73.72,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,inpatient,,,2153.00000,2045.35000,The Alliance,Exception Members,TC,1657.81,,,,,,,1184.15,2088.41,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,outpatient,,,2153.00000,2045.35000,The Alliance,Exception Members,TC,1657.81,,,,,,,1076.50,2088.41,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,,1490.72,,,,,,,1064.80,1877.92,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,,1490.72,,,,,,,511.11,2960.49,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,inpatient,,,4471.00000,4247.45000,The Alliance,Exception Members,,3442.67,,,,,,,2459.05,4336.87,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Exception Members,,3442.67,,,,,,,1923.03,17311.25,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,The Alliance,Exception Members,,1942.71,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Exception Members,,1942.71,,,,,,,1226.87,14613.37,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,inpatient,,,1046.00000,993.70000,The Alliance,Exception Members,,805.42,,,,,,,575.30,1014.62,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Exception Members,,805.42,,,,,,,359.37,4736.20,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,,1282.82,,,,,,,916.30,1616.02,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,,1282.82,,,,,,,833.00,12150.98,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,inpatient,,,1702.00000,1616.90000,The Alliance,Exception Members,,1310.54,,,,,,,936.10,1650.94,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,outpatient,,,1702.00000,1616.90000,The Alliance,Exception Members,,1310.54,,,,,,,381.55,2210.07,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,inpatient,,,1129.00000,1072.55000,The Alliance,Exception Members,TC,869.33,,,,,,,620.95,1095.13,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Exception Members,TC,869.33,,,,,,,564.50,1095.13,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,417.10,17311.25,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,inpatient,,,9110.00000,8654.50000,The Alliance,Exception Members,,7014.70,,,,,,,5010.50,8836.70,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,outpatient,,,9110.00000,8654.50000,The Alliance,Exception Members,,7014.70,,,,,,,381.55,8836.70,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,,906.29,,,,,,,647.35,1141.69,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,,906.29,,,,,,,519.48,7810.26,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,The Alliance,Exception Members,,1740.97,,,,,,,1243.55,2193.17,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,Exception Members,,1740.97,,,,,,,1243.55,5271.00,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,,1952.72,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,,1952.72,,,,,,,990.94,10533.78,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,inpatient,,,45977.00000,43678.15000,The Alliance,Exception Members,,35402.29,,,,,,,25287.35,44597.69,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,outpatient,,,45977.00000,43678.15000,The Alliance,Exception Members,,35402.29,,,,,,,5651.91,58409.77,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,inpatient,,,962.00000,913.90000,The Alliance,Exception Members,,740.74,,,,,,,529.10,933.14,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,outpatient,,,962.00000,913.90000,The Alliance,Exception Members,,740.74,,,,,,,249.71,10786.37,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,103.97,7859.04,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,249.71,14445.56,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,inpatient,,,3724.00000,3537.80000,The Alliance,Exception Members,,2867.48,,,,,,,2048.20,3612.28,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,outpatient,,,3724.00000,3537.80000,The Alliance,Exception Members,,2867.48,,,,,,,103.97,3612.28,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,297.55,524.77,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,126.07,524.77,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,The Alliance,Exception Members,,928.62,,,,,,,663.30,1169.82,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Exception Members,,928.62,,,,,,,381.55,2210.07,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,91.88,181.88,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,86.06,187.50,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,The Alliance,Exception Members,,383.89,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Exception Members,,383.89,,,,,,,228.84,498.56,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,The Alliance,Exception Members,,383.89,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Exception Members,,383.89,,,,,,,228.84,498.56,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,216.31,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,100.97,5080.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,234.00,5323.40,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,283.25,499.55,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,inpatient,,,5332.00000,5065.40000,The Alliance,Exception Members,,4105.64,,,,,,,2932.60,5172.04,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,outpatient,,,5332.00000,5065.40000,The Alliance,Exception Members,,4105.64,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,The Alliance,Exception Members,,4312.00,,,,,,,3080.00,5432.00,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Exception Members,,4312.00,,,,,,,2800.00,24628.72,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Exception Members,,1831.06,,,,,,,138.83,7581.44,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,389.87,849.38,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8040.81,17518.10,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,1667.31,67198.78,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,The Alliance,Exception Members,,1447.60,,,,,,,1034.00,1823.60,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Exception Members,,1447.60,,,,,,,81.69,1823.60,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,Exception Members,,575.19,,,,,,,410.85,724.59,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Exception Members,,575.19,,,,,,,282.87,724.59,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,TC,68.53,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,TC,68.53,,,,,,,44.50,86.33,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,52.50,6772.18,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,inpatient,1,mL,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,outpatient,1,mL,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,111.65,196.91,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,101.50,3679.58,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,433.40,764.36,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,327.36,764.36,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,9.88,184.30,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,182.05,321.07,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,149.44,548.00,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,The Alliance,Exception Members,,1692.46,,,,,,,1208.90,2132.06,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Exception Members,,1692.46,,,,,,,381.55,2210.07,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,,1506.12,,,,,,,1075.80,1897.32,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,,1506.12,,,,,,,295.69,1897.32,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,The Alliance,Exception Members,,2218.37,,,,,,,1584.55,2794.57,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Exception Members,,2218.37,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,361.82,17311.25,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,inpatient,,,4753.00000,4515.35000,The Alliance,Exception Members,,3659.81,,,,,,,2614.15,4610.41,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,outpatient,,,4753.00000,4515.35000,The Alliance,Exception Members,,3659.81,,,,,,,431.85,6628.38,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,Exception Members,,431.20,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Exception Members,,431.20,,,,,,,280.00,4040.81,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,500.59,29731.35,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,439.81,17311.25,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,The Alliance,Exception Members,,3398.01,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Exception Members,,3398.01,,,,,,,498.74,29731.35,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,411.55,17311.25,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,394.96,17311.25,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,The Alliance,Exception Members,,1268.19,,,,,,,905.85,1597.59,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Exception Members,,1268.19,,,,,,,574.33,17311.25,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,The Alliance,Exception Members,,3615.92,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Exception Members,,3615.92,,,,,,,595.74,17311.25,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,378.42,17311.25,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,,3035.34,,,,,,,2168.10,3823.74,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,,3035.34,,,,,,,356.27,17311.25,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,The Alliance,Exception Members,,2437.82,,,,,,,1741.30,3071.02,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Exception Members,,2437.82,,,,,,,418.96,17311.25,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,,1081.08,,,,,,,772.20,1361.88,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,,1081.08,,,,,,,227.70,5633.78,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,The Alliance,Exception Members,,1116.50,,,,,,,797.50,1406.50,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Exception Members,,1116.50,,,,,,,723.58,29731.35,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,inpatient,,,4226.00000,4014.70000,The Alliance,Exception Members,,3254.02,,,,,,,2324.30,4099.22,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,outpatient,,,4226.00000,4014.70000,The Alliance,Exception Members,,3254.02,,,,,,,960.76,17311.25,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,,2779.70,,,,,,,550.38,17311.25,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,,1099.56,,,,,,,785.40,1385.16,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,,1099.56,,,,,,,463.75,17311.25,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,The Alliance,Exception Members,,1278.20,,,,,,,913.00,1610.20,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Exception Members,,1278.20,,,,,,,426.30,17311.25,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,,3223.99,,,,,,,417.10,17311.25,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,72.50,548.00,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,2.24,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,2032.87,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,96.25,169.75,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,87.50,1544.85,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,12.90,679.08,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,72.50,548.00,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.38,458.40,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,9.98,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,90,19.25,,,,,,,13.75,24.25,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,90,19.25,,,,,,,12.50,1426.03,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,0.04803,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,inpatient,1,mL,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,outpatient,1,mL,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,0.04803,5.36,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,inpatient,,,3479.00000,3305.05000,The Alliance,Exception Members,TC,2678.83,,,,,,,1913.45,3374.63,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,outpatient,,,3479.00000,3305.05000,The Alliance,Exception Members,TC,2678.83,,,,,,,1628.38,3374.63,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,inpatient,10,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,outpatient,10,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,0.04803,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,inpatient,10,EA,5.94000,5.64000,The Alliance,Exception Members,,4.57,,,,,,,3.27,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,outpatient,10,EA,5.94000,5.64000,The Alliance,Exception Members,,4.57,,,,,,,0.04803,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,inpatient,10,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,outpatient,10,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.04803,1.32,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,74.34,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.08000,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,inpatient,1,mL,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,outpatient,1,mL,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.08000,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,inpatient,1,mL,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.08000,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,inpatient,1,mL,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.08000,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.08000,0.29100,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,190.85,336.59,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,38.62,2020.22,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,inpatient,1,EA,1.39000,1.33000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,outpatient,1,EA,1.39000,1.33000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,inpatient,1,mL,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,outpatient,1,mL,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,inpatient,1,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,633.75000,602.06000,The Alliance,Exception Members,,487.99,,,,,,,310.54,614.74,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,633.75000,602.06000,The Alliance,Exception Members,,487.99,,,,,,,290.89,633.75,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,inpatient,1,EA,0.43000,0.40000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,outpatient,1,EA,0.43000,0.40000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,14.67,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,inpatient,1,EA,45.56000,43.28000,The Alliance,Exception Members,,35.08,,,,,,,25.06,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,outpatient,1,EA,45.56000,43.28000,The Alliance,Exception Members,,35.08,,,,,,,22.78,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,inpatient,1,mL,7855.65000,7462.87000,The Alliance,Exception Members,,6048.85,,,,,,,4320.61,7619.98,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,outpatient,1,mL,7855.65000,7462.87000,The Alliance,Exception Members,,6048.85,,,,,,,2440.70,7619.98,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,inpatient,1,EA,47.27000,44.91000,The Alliance,Exception Members,,36.40,,,,,,,26.00,45.85,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,outpatient,1,EA,47.27000,44.91000,The Alliance,Exception Members,,36.40,,,,,,,1.13,45.85,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,7.27,373.51,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,968.06,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,3163.00,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,inpatient,1,EA,333.18000,316.52000,The Alliance,Exception Members,,256.55,,,,,,,183.25,323.18,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,outpatient,1,EA,333.18000,316.52000,The Alliance,Exception Members,,256.55,,,,,,,166.59,323.18,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,223.30,393.82,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,32.62,1697.68,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,inpatient,15,EA,38.63000,36.70000,The Alliance,Exception Members,,29.75,,,,,,,21.25,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,outpatient,15,EA,38.63000,36.70000,The Alliance,Exception Members,,29.75,,,,,,,19.32,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,Exception Members,90,122.89,,,,,,,87.78,154.81,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Exception Members,90,122.89,,,,,,,19.00,865.84,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,inpatient,1,EA,3284.86000,3120.62000,The Alliance,Exception Members,,2529.34,,,,,,,1806.67,3186.31,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,outpatient,1,EA,3284.86000,3120.62000,The Alliance,Exception Members,,2529.34,,,,,,,44.49,3186.31,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,inpatient,1,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,8.26,14.56,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,7.50,14.56,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,inpatient,8,EA,8.97000,8.53000,The Alliance,Exception Members,,6.91,,,,,,,4.93,8.70,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,outpatient,8,EA,8.97000,8.53000,The Alliance,Exception Members,,6.91,,,,,,,4.49,8.70,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,inpatient,30,EA,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,outpatient,30,EA,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,inpatient,30,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,inpatient,30,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,outpatient,30,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,14.67,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,inpatient,30,EA,19.80000,18.81000,The Alliance,Exception Members,,15.25,,,,,,,10.89,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,outpatient,30,EA,19.80000,18.81000,The Alliance,Exception Members,,15.25,,,,,,,0.59237,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,inpatient,30,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,outpatient,30,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.59237,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,inpatient,30,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,outpatient,30,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,0.59237,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,inpatient,30,EA,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,10.86,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,outpatient,30,EA,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,0.59237,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,inpatient,30,EA,21.80000,20.71000,The Alliance,Exception Members,,16.79,,,,,,,11.99,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,outpatient,30,EA,21.80000,20.71000,The Alliance,Exception Members,,16.79,,,,,,,0.59237,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,3.09,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,0.59237,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,inpatient,30,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.59237,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,inpatient,30,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,2.14,3.77,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,outpatient,30,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,0.59237,3.77,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,inpatient,5,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,outpatient,5,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,18.40,865.84,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,inpatient,1,EA,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.57,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.34,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,inpatient,,,214.70000,203.96000,The Alliance,Exception Members,90,165.32,,,,,,,118.08,208.26,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Exception Members,90,165.32,,,,,,,12.70,577.23,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,inpatient,1,mL,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,2.85,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,inpatient,1,mL,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,outpatient,1,mL,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,88.11,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,247.50,436.50,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,247.50,5271.00,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,inpatient,3,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,outpatient,3,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,inpatient,3,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,inpatient,3,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,inpatient,3,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,inpatient,3,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,inpatient,3,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,inpatient,3,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,inpatient,3,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,Exception Members,,373.45,,,,,,,266.75,470.45,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Exception Members,,373.45,,,,,,,47.63,2495.58,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,inpatient,30,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,outpatient,30,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,inpatient,1,EA,14.85000,14.11000,The Alliance,Exception Members,,11.43,,,,,,,8.17,14.40,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Exception Members,,11.43,,,,,,,7.42,14.40,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,inpatient,,,167.30000,158.94000,The Alliance,Exception Members,90,128.82,,,,,,,92.02,162.28,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Exception Members,90,128.82,,,,,,,17.43,882.80,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,inpatient,1,EA,5.93000,5.63000,The Alliance,Exception Members,,4.57,,,,,,,3.26,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,outpatient,1,EA,5.93000,5.63000,The Alliance,Exception Members,,4.57,,,,,,,2.96,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,inpatient,1,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.78,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,inpatient,1,EA,4.29000,4.08000,The Alliance,Exception Members,,3.30,,,,,,,2.36,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,outpatient,1,EA,4.29000,4.08000,The Alliance,Exception Members,,3.30,,,,,,,2.15,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,inpatient,1,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.87,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.70,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,inpatient,1,EA,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,outpatient,1,EA,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,inpatient,30,EA,26.39000,25.07000,The Alliance,Exception Members,,20.32,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,outpatient,30,EA,26.39000,25.07000,The Alliance,Exception Members,,20.32,,,,,,,1.13,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,inpatient,30,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,outpatient,30,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,1.13,22.99,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,inpatient,1,mL,10.42000,9.90000,The Alliance,Exception Members,,8.02,,,,,,,5.73,10.11,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,outpatient,1,mL,10.42000,9.90000,The Alliance,Exception Members,,8.02,,,,,,,5.21,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,inpatient,1,mL,11.07000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.09,10.74,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,outpatient,1,mL,11.07000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.54,14.67,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,inpatient,1,mL,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,outpatient,1,mL,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,inpatient,1,mL,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,88.11,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,inpatient,0.5,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,outpatient,0.5,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,inpatient,,,3438.00000,3266.10000,The Alliance,Exception Members,TC,2647.26,,,,,,,1890.90,3334.86,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,outpatient,,,3438.00000,3266.10000,The Alliance,Exception Members,TC,2647.26,,,,,,,1436.74,7180.14,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,inpatient,1,EA,11.41000,10.84000,The Alliance,Exception Members,,8.79,,,,,,,6.28,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Exception Members,,8.79,,,,,,,5.71,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,inpatient,1,EA,8.49000,8.06000,The Alliance,Exception Members,,6.54,,,,,,,4.67,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Exception Members,,6.54,,,,,,,4.25,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,6.07,10.70,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,5.51,10.70,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,inpatient,3,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,inpatient,3,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,outpatient,3,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,inpatient,3,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.11935,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,inpatient,3,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,outpatient,3,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.11935,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,inpatient,3,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,inpatient,3,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,outpatient,3,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.11935,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,inpatient,3,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,outpatient,3,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.11935,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,inpatient,3,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,outpatient,3,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.11935,0.30070,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,9.71,509.30,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,inpatient,,,266.10000,252.80000,The Alliance,Exception Members,90,204.90,,,,,,,146.35,258.12,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,outpatient,,,266.10000,252.80000,The Alliance,Exception Members,90,204.90,,,,,,,31.89,1459.96,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,inpatient,2,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,3.15,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,outpatient,2,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,2.86,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,inpatient,2,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,outpatient,2,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,4.27,10.73,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,inpatient,1,EA,260.67000,247.63000,The Alliance,Exception Members,,200.72,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Exception Members,,200.72,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,inpatient,1,EA,788.15000,748.74000,The Alliance,Exception Members,,606.88,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Exception Members,,606.88,,,,,,,1.13,764.51,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,inpatient,1,EA,104.28000,99.07000,The Alliance,Exception Members,,80.30,,,,,,,57.35,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Exception Members,,80.30,,,,,,,27.59,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,inpatient,1,EA,138.91000,131.97000,The Alliance,Exception Members,,106.96,,,,,,,76.40,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,outpatient,1,EA,138.91000,131.97000,The Alliance,Exception Members,,106.96,,,,,,,27.59,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,inpatient,1,EA,125.45000,119.18000,The Alliance,Exception Members,,96.60,,,,,,,69.00,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,outpatient,1,EA,125.45000,119.18000,The Alliance,Exception Members,,96.60,,,,,,,27.59,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,inpatient,1,EA,99.54000,94.56000,The Alliance,Exception Members,,76.65,,,,,,,54.75,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,outpatient,1,EA,99.54000,94.56000,The Alliance,Exception Members,,76.65,,,,,,,27.59,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,27.59,122.61,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,inpatient,,,210.90000,200.35000,The Alliance,Exception Members,90,162.39,,,,,,,116.00,204.57,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,outpatient,,,210.90000,200.35000,The Alliance,Exception Members,90,162.39,,,,,,,14.72,204.57,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,30.80,54.32,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,4.95,254.68,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,inpatient,,,496.00000,471.20000,The Alliance,Exception Members,,381.92,,,,,,,272.80,481.12,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,outpatient,,,496.00000,471.20000,The Alliance,Exception Members,,381.92,,,,,,,248.00,481.12,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,48.19,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,inpatient,20,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,4.20,7.40,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,outpatient,20,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,0.25616,7.40,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.95,1409.06,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,Exception Members,,329.56,,,,,,,235.40,415.16,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Exception Members,,329.56,,,,,,,40.75,2122.08,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,inpatient,2,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,outpatient,2,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,0.59830,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,inpatient,2,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,outpatient,2,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.59830,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,inpatient,2,EA,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,inpatient,2,EA,25.12000,23.87000,The Alliance,Exception Members,,19.34,,,,,,,13.82,24.37,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,outpatient,2,EA,25.12000,23.87000,The Alliance,Exception Members,,19.34,,,,,,,0.59830,24.37,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,inpatient,,,420.10000,399.10000,The Alliance,Exception Members,,323.48,,,,,,,231.06,407.50,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,outpatient,,,420.10000,399.10000,The Alliance,Exception Members,,323.48,,,,,,,50.73,407.50,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,inpatient,1,mL,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,outpatient,1,mL,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,inpatient,1,mL,1.74000,1.66000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,outpatient,1,mL,1.74000,1.66000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,90,86.24,,,,,,,61.60,108.64,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,90,86.24,,,,,,,9.98,509.30,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,4.57,271.65,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,63.95,788.42,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,inpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,47.85,84.39,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.11935,0.61110,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,14.78,780.94,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,inpatient,10,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,outpatient,10,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.13,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,inpatient,10,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,inpatient,10,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,inpatient,10,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,outpatient,10,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.21,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,inpatient,10,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,outpatient,10,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.13,3.83,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,inpatient,,,17.60000,16.72000,The Alliance,Exception Members,90,13.55,,,,,,,9.68,17.07,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,outpatient,,,17.60000,16.72000,The Alliance,Exception Members,90,13.55,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,45.10,79.54,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,inpatient,,,59.80000,56.81000,The Alliance,Exception Members,90,46.05,,,,,,,32.89,58.01,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Exception Members,90,46.05,,,,,,,17.71,933.70,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,inpatient,,,11.00000,10.45000,The Alliance,Exception Members,90,8.47,,,,,,,6.05,10.67,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Exception Members,90,8.47,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,inpatient,,,174.80000,166.06000,The Alliance,Exception Members,90,134.60,,,,,,,96.14,169.56,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,outpatient,,,174.80000,166.06000,The Alliance,Exception Members,90,134.60,,,,,,,15.58,780.94,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,Exception Members,90,51.59,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Exception Members,90,51.59,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,inpatient,,,179.20000,170.24000,The Alliance,Exception Members,90,137.98,,,,,,,98.56,173.82,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,outpatient,,,179.20000,170.24000,The Alliance,Exception Members,90,137.98,,,,,,,7.97,407.44,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,inpatient,,,59.80000,56.81000,The Alliance,Exception Members,90,46.05,,,,,,,32.89,58.01,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Exception Members,90,46.05,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Exception Members,90,51.44,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,14.57,763.98,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,inpatient,,,194.80000,185.06000,The Alliance,Exception Members,90,150.00,,,,,,,107.14,188.96,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,outpatient,,,194.80000,185.06000,The Alliance,Exception Members,90,150.00,,,,,,,17.57,882.80,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,inpatient,1,EA,378.88000,359.94000,The Alliance,Exception Members,,291.74,,,,,,,208.38,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,outpatient,1,EA,378.88000,359.94000,The Alliance,Exception Members,,291.74,,,,,,,189.44,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,inpatient,1,EA,280.60000,266.57000,The Alliance,Exception Members,,216.06,,,,,,,154.33,272.18,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,outpatient,1,EA,280.60000,266.57000,The Alliance,Exception Members,,216.06,,,,,,,140.30,272.18,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,90,94.71,,,,,,,67.65,119.31,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,90,94.71,,,,,,,14.91,885.37,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,52.25,92.15,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,47.50,1137.41,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,inpatient,1,EA,13388.43000,12719.00000,The Alliance,Exception Members,,10309.09,,,,,,,7363.64,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,outpatient,1,EA,13388.43000,12719.00000,The Alliance,Exception Members,,10309.09,,,,,,,94.15,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,inpatient,1,EA,16720.68000,15884.65000,The Alliance,Exception Members,,12874.92,,,,,,,9196.37,16219.06,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,outpatient,1,EA,16720.68000,15884.65000,The Alliance,Exception Members,,12874.92,,,,,,,94.15,16219.06,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,80.85,142.59,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,16.77,882.80,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,5.30,271.65,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,13.44,696.05,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,inpatient,1,EA,28.62000,27.19000,The Alliance,Exception Members,,22.04,,,,,,,15.74,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,outpatient,1,EA,28.62000,27.19000,The Alliance,Exception Members,,22.04,,,,,,,14.31,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,inpatient,355,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,outpatient,355,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,inpatient,,,399.70000,379.71000,The Alliance,Exception Members,90,307.77,,,,,,,219.84,387.71,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,outpatient,,,399.70000,379.71000,The Alliance,Exception Members,90,307.77,,,,,,,20.26,916.73,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,inpatient,1,EA,7.52000,7.15000,The Alliance,Exception Members,,5.79,,,,,,,4.14,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,outpatient,1,EA,7.52000,7.15000,The Alliance,Exception Members,,5.79,,,,,,,3.76,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,inpatient,1,EA,67.88000,64.48000,The Alliance,Exception Members,,52.27,,,,,,,37.33,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,outpatient,1,EA,67.88000,64.48000,The Alliance,Exception Members,,52.27,,,,,,,33.94,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,inpatient,1,EA,18.85000,17.91000,The Alliance,Exception Members,,14.51,,,,,,,10.37,18.28,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,outpatient,1,EA,18.85000,17.91000,The Alliance,Exception Members,,14.51,,,,,,,9.43,18.28,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Exception Members,90,62.83,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,inpatient,1,EA,456.75000,433.91000,The Alliance,Exception Members,,351.70,,,,,,,251.21,443.05,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,outpatient,1,EA,456.75000,433.91000,The Alliance,Exception Members,,351.70,,,,,,,94.15,443.05,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,inpatient,,,327.70000,311.32000,The Alliance,Exception Members,90,252.33,,,,,,,180.24,317.87,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,outpatient,,,327.70000,311.32000,The Alliance,Exception Members,90,252.33,,,,,,,26.33,1324.17,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,inpatient,9,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,outpatient,9,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.50685,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,inpatient,9,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,outpatient,9,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,0.50685,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,inpatient,9,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,outpatient,9,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.50685,1.43,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,inpatient,80,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,outpatient,80,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,inpatient,80,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,inpatient,1,EA,9108.37000,8652.95000,The Alliance,Exception Members,,7013.44,,,,,,,5009.60,8835.12,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,outpatient,1,EA,9108.37000,8652.95000,The Alliance,Exception Members,,7013.44,,,,,,,94.15,8835.12,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,inpatient,1,EA,0.21000,0.19000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,outpatient,1,EA,0.21000,0.19000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,171.05,301.67,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,4.57,301.67,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,inpatient,1,EA,5.05000,4.80000,The Alliance,Exception Members,,3.89,,,,,,,2.78,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,outpatient,1,EA,5.05000,4.80000,The Alliance,Exception Members,,3.89,,,,,,,2.52,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,76.00,548.00,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Exception Members,90,71.30,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,inpatient,20,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,outpatient,20,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,inpatient,20,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,outpatient,20,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,inpatient,20,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,outpatient,20,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.73,4.82,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.48,18.34,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,inpatient,3,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,outpatient,3,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.84150,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,inpatient,3,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,inpatient,3,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,inpatient,3,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,outpatient,3,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.50685,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,inpatient,3,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,outpatient,3,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.50685,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,inpatient,3,EA,4.04000,3.83000,The Alliance,Exception Members,,3.11,,,,,,,2.22,3.92,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,outpatient,3,EA,4.04000,3.83000,The Alliance,Exception Members,,3.11,,,,,,,0.50685,3.92,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,inpatient,1,EA,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,outpatient,1,EA,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,inpatient,1,EA,1.43000,1.35000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Exception Members,,1.10,,,,,,,0.71500,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,inpatient,50,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,inpatient,50,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,inpatient,50,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,inpatient,50,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,The Alliance,Exception Members,QN,1225.07,,,,,,,875.05,1543.27,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Exception Members,QN,1225.07,,,,,,,795.50,1543.27,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,2.04,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,1.85,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,inpatient,1,EA,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,inpatient,30,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,outpatient,30,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,inpatient,1,EA,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,7.50,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,inpatient,1,EA,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,7.50,14.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.57,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.43,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,243.00000,230.85000,The Alliance,Exception Members,HI,187.11,,,,,,,133.65,235.71,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Exception Members,HI,187.11,,,,,,,121.50,235.71,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,inpatient,,,536.00000,509.20000,The Alliance,Exception Members,,412.72,,,,,,,294.80,519.92,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,Exception Members,,412.72,,,,,,,90.57,4617.66,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,inpatient,1,EA,24.37000,23.15000,The Alliance,Exception Members,,18.76,,,,,,,13.40,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Exception Members,,18.76,,,,,,,2.39,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,inpatient,1,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,7.30,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,outpatient,1,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,2.39,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,9.56,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,2.39,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,inpatient,1,EA,25.12000,23.87000,The Alliance,Exception Members,,19.34,,,,,,,13.82,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,outpatient,1,EA,25.12000,23.87000,The Alliance,Exception Members,,19.34,,,,,,,2.39,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,inpatient,1,EA,8.61000,8.18000,The Alliance,Exception Members,,6.63,,,,,,,4.74,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,outpatient,1,EA,8.61000,8.18000,The Alliance,Exception Members,,6.63,,,,,,,2.39,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,8.43,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,2.39,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,2.39,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,inpatient,1,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,8.92,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,2.39,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,inpatient,1,EA,9.95000,9.46000,The Alliance,Exception Members,,7.66,,,,,,,5.47,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Exception Members,,7.66,,,,,,,2.39,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,inpatient,1,EA,12.72000,12.08000,The Alliance,Exception Members,,9.79,,,,,,,7.00,12.34,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,outpatient,1,EA,12.72000,12.08000,The Alliance,Exception Members,,9.79,,,,,,,2.39,12.34,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,inpatient,1,EA,46.02000,43.72000,The Alliance,Exception Members,,35.44,,,,,,,25.31,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,outpatient,1,EA,46.02000,43.72000,The Alliance,Exception Members,,35.44,,,,,,,2.39,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,inpatient,1,EA,24.08000,22.88000,The Alliance,Exception Members,,18.54,,,,,,,13.24,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,outpatient,1,EA,24.08000,22.88000,The Alliance,Exception Members,,18.54,,,,,,,2.39,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,2.39,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,inpatient,1,EA,50.40000,47.88000,The Alliance,Exception Members,,38.81,,,,,,,27.72,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,outpatient,1,EA,50.40000,47.88000,The Alliance,Exception Members,,38.81,,,,,,,2.39,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,inpatient,1,EA,16.92000,16.08000,The Alliance,Exception Members,,13.03,,,,,,,9.31,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,outpatient,1,EA,16.92000,16.08000,The Alliance,Exception Members,,13.03,,,,,,,2.39,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,inpatient,1,EA,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,10.86,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,outpatient,1,EA,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,2.39,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,inpatient,1,EA,17.85000,16.96000,The Alliance,Exception Members,,13.74,,,,,,,9.82,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,outpatient,1,EA,17.85000,16.96000,The Alliance,Exception Members,,13.74,,,,,,,2.39,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,inpatient,1,EA,12.50000,11.88000,The Alliance,Exception Members,,9.62,,,,,,,6.88,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,outpatient,1,EA,12.50000,11.88000,The Alliance,Exception Members,,9.62,,,,,,,2.39,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,inpatient,1,EA,25.82000,24.53000,The Alliance,Exception Members,,19.88,,,,,,,14.20,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,outpatient,1,EA,25.82000,24.53000,The Alliance,Exception Members,,19.88,,,,,,,2.39,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,inpatient,1,EA,16.75000,15.91000,The Alliance,Exception Members,,12.90,,,,,,,9.21,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,outpatient,1,EA,16.75000,15.91000,The Alliance,Exception Members,,12.90,,,,,,,2.39,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,9.15,16.14,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,2.39,16.14,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,6.48,339.51,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,inpatient,80,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,outpatient,80,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,inpatient,80,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,outpatient,80,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,inpatient,80,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,outpatient,80,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.12,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,inpatient,80,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,outpatient,80,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,inpatient,80,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,inpatient,80,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,outpatient,80,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,inpatient,80,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,inpatient,80,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,outpatient,80,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,inpatient,80,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,outpatient,80,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,inpatient,80,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,outpatient,80,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,inpatient,80,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,outpatient,80,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,The Alliance,Exception Members,QN,1225.07,,,,,,,875.05,1543.27,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Exception Members,QN,1225.07,,,,,,,795.50,1543.27,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.48,339.51,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,215.05,379.27,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,63.95,788.42,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,inpatient,75,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,outpatient,75,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,inpatient,75,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,outpatient,75,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,inpatient,75,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,outpatient,75,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,inpatient,75,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,outpatient,75,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,inpatient,75,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,outpatient,75,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.57,271.65,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,inpatient,1,EA,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,4.05,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,0.78449,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,inpatient,1,EA,8.91000,8.46000,The Alliance,Exception Members,,6.86,,,,,,,4.90,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,outpatient,1,EA,8.91000,8.46000,The Alliance,Exception Members,,6.86,,,,,,,0.78449,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,inpatient,1,EA,11.14000,10.58000,The Alliance,Exception Members,,8.58,,,,,,,6.13,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,outpatient,1,EA,11.14000,10.58000,The Alliance,Exception Members,,8.58,,,,,,,0.78449,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,inpatient,1,EA,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,4.12,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,0.78449,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,inpatient,1,EA,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,4.27,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,0.78449,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,inpatient,1,EA,5.37000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,0.78449,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,0.78449,3.68,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,inpatient,1,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,54.63,147.13,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,17.27,814.87,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1653.75,3273.75,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1549.12,3375.00,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,inpatient,1,EA,20.82000,19.78000,The Alliance,Exception Members,,16.03,,,,,,,11.45,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,outpatient,1,EA,20.82000,19.78000,The Alliance,Exception Members,,16.03,,,,,,,0.78449,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,inpatient,1,EA,22.45000,21.32000,The Alliance,Exception Members,,17.29,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,outpatient,1,EA,22.45000,21.32000,The Alliance,Exception Members,,17.29,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,inpatient,1,EA,347.11000,329.76000,The Alliance,Exception Members,,267.27,,,,,,,190.91,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,outpatient,1,EA,347.11000,329.76000,The Alliance,Exception Members,,267.27,,,,,,,0.78449,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,inpatient,1,EA,42.35000,40.23000,The Alliance,Exception Members,,32.61,,,,,,,23.29,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,outpatient,1,EA,42.35000,40.23000,The Alliance,Exception Members,,32.61,,,,,,,0.78449,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,inpatient,1,EA,87.84000,83.45000,The Alliance,Exception Members,,67.64,,,,,,,48.31,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,outpatient,1,EA,87.84000,83.45000,The Alliance,Exception Members,,67.64,,,,,,,0.78449,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,0.78449,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,0.78449,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,inpatient,1,EA,22.45000,21.33000,The Alliance,Exception Members,,17.29,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,outpatient,1,EA,22.45000,21.33000,The Alliance,Exception Members,,17.29,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,inpatient,1,EA,22.47000,21.34000,The Alliance,Exception Members,,17.30,,,,,,,12.36,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,outpatient,1,EA,22.47000,21.34000,The Alliance,Exception Members,,17.30,,,,,,,0.78449,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,inpatient,1,EA,24.98000,23.73000,The Alliance,Exception Members,,19.23,,,,,,,13.74,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,outpatient,1,EA,24.98000,23.73000,The Alliance,Exception Members,,19.23,,,,,,,0.78449,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,inpatient,1,EA,11.23000,10.67000,The Alliance,Exception Members,,8.65,,,,,,,6.18,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,outpatient,1,EA,11.23000,10.67000,The Alliance,Exception Members,,8.65,,,,,,,0.78449,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,inpatient,1,EA,21.83000,20.74000,The Alliance,Exception Members,,16.81,,,,,,,12.01,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,outpatient,1,EA,21.83000,20.74000,The Alliance,Exception Members,,16.81,,,,,,,0.78449,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,inpatient,1,EA,17.46000,16.59000,The Alliance,Exception Members,,13.44,,,,,,,9.60,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,outpatient,1,EA,17.46000,16.59000,The Alliance,Exception Members,,13.44,,,,,,,0.78449,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,inpatient,1,EA,45.28000,43.02000,The Alliance,Exception Members,,34.87,,,,,,,24.90,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,outpatient,1,EA,45.28000,43.02000,The Alliance,Exception Members,,34.87,,,,,,,0.78449,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,inpatient,1,EA,218.29000,207.38000,The Alliance,Exception Members,,168.08,,,,,,,120.06,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,outpatient,1,EA,218.29000,207.38000,The Alliance,Exception Members,,168.08,,,,,,,0.78449,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,0.78449,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,inpatient,1,EA,15.31000,14.54000,The Alliance,Exception Members,,11.79,,,,,,,8.42,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,outpatient,1,EA,15.31000,14.54000,The Alliance,Exception Members,,11.79,,,,,,,0.78449,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,0.78449,10.73,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,107.80,190.12,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,98.00,190.12,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,4.57,271.65,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,11.16,577.23,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,17.93,933.70,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,90,79.31,,,,,,,56.65,99.91,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,90,79.31,,,,,,,51.50,1137.41,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,inpatient,1,EA,87.62000,83.24000,The Alliance,Exception Members,,67.47,,,,,,,48.19,84.99,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,outpatient,1,EA,87.62000,83.24000,The Alliance,Exception Members,,67.47,,,,,,,43.81,84.99,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,inpatient,50,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,outpatient,50,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,inpatient,50,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,outpatient,50,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,inpatient,50,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,outpatient,50,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,inpatient,50,EA,57.64000,54.76000,The Alliance,Exception Members,,44.38,,,,,,,31.70,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,outpatient,50,EA,57.64000,54.76000,The Alliance,Exception Members,,44.38,,,,,,,28.82,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,inpatient,50,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,outpatient,50,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,62.70,110.58,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,57.00,1137.41,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,14.60,763.98,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,231.00,407.40,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,35.09,1833.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,inpatient,1,mL,302.21000,287.10000,The Alliance,Exception Members,,232.70,,,,,,,166.22,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,outpatient,1,mL,302.21000,287.10000,The Alliance,Exception Members,,232.70,,,,,,,0.74000,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,inpatient,1,mL,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,284.90,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,0.74000,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,inpatient,1,mL,281.47000,267.40000,The Alliance,Exception Members,,216.73,,,,,,,154.81,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,outpatient,1,mL,281.47000,267.40000,The Alliance,Exception Members,,216.73,,,,,,,0.74000,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,inpatient,1,mL,528.36000,501.94000,The Alliance,Exception Members,,406.84,,,,,,,290.60,512.51,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,outpatient,1,mL,528.36000,501.94000,The Alliance,Exception Members,,406.84,,,,,,,0.74000,512.51,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,inpatient,1,EA,5.33000,5.07000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Exception Members,,4.10,,,,,,,2.67,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.57,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.43,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.46,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,inpatient,1,EA,5.12000,4.86000,The Alliance,Exception Members,,3.94,,,,,,,2.82,4.97,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,outpatient,1,EA,5.12000,4.86000,The Alliance,Exception Members,,3.94,,,,,,,2.56,4.97,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,inpatient,,,172.20000,163.59000,The Alliance,Exception Members,90,132.59,,,,,,,94.71,167.03,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,outpatient,,,172.20000,163.59000,The Alliance,Exception Members,90,132.59,,,,,,,86.10,1137.41,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,2122.08,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,inpatient,1,EA,132.86000,126.22000,The Alliance,Exception Members,,102.30,,,,,,,73.07,128.87,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,outpatient,1,EA,132.86000,126.22000,The Alliance,Exception Members,,102.30,,,,,,,66.43,128.87,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,86.35,152.29,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,16.87,882.80,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,inpatient,,,224.30000,213.08000,The Alliance,Exception Members,90,172.71,,,,,,,123.36,217.57,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,outpatient,,,224.30000,213.08000,The Alliance,Exception Members,90,172.71,,,,,,,19.60,984.66,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,inpatient,,,1022.00000,970.90000,The Alliance,Exception Members,,786.94,,,,,,,562.10,991.34,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,outpatient,,,1022.00000,970.90000,The Alliance,Exception Members,,786.94,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1117.00000,1061.15000,The Alliance,Exception Members,,860.09,,,,,,,614.35,1083.49,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1117.00000,1061.15000,The Alliance,Exception Members,,860.09,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,3163.00,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,280.29,3163.00,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.36,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.36,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,15.65,30.37,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,inpatient,,,339.80000,322.81000,The Alliance,Exception Members,90,261.65,,,,,,,186.89,329.61,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,outpatient,,,339.80000,322.81000,The Alliance,Exception Members,90,261.65,,,,,,,30.26,1527.89,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Exception Members,,24.11,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,inpatient,1,EA,19.43000,18.46000,The Alliance,Exception Members,,14.96,,,,,,,10.69,18.85,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,outpatient,1,EA,19.43000,18.46000,The Alliance,Exception Members,,14.96,,,,,,,9.71,18.85,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,inpatient,1,EA,277.92000,264.03000,The Alliance,Exception Members,,214.00,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,outpatient,1,EA,277.92000,264.03000,The Alliance,Exception Members,,214.00,,,,,,,4.35,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,inpatient,1,EA,277.92000,264.02000,The Alliance,Exception Members,,214.00,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,outpatient,1,EA,277.92000,264.02000,The Alliance,Exception Members,,214.00,,,,,,,4.35,269.58,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,968.06,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,3163.00,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,inpatient,1,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.05,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,1.86,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,inpatient,1,EA,31.53000,29.95000,The Alliance,Exception Members,,24.28,,,,,,,17.34,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,outpatient,1,EA,31.53000,29.95000,The Alliance,Exception Members,,24.28,,,,,,,15.77,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,inpatient,1,EA,25.96000,24.66000,The Alliance,Exception Members,,19.99,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Exception Members,,19.99,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,inpatient,1,EA,76.37000,72.55000,The Alliance,Exception Members,,58.80,,,,,,,42.00,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,outpatient,1,EA,76.37000,72.55000,The Alliance,Exception Members,,58.80,,,,,,,38.19,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,inpatient,1,EA,35.86000,34.06000,The Alliance,Exception Members,,27.61,,,,,,,19.72,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,outpatient,1,EA,35.86000,34.06000,The Alliance,Exception Members,,27.61,,,,,,,17.93,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,inpatient,1,EA,29.53000,28.05000,The Alliance,Exception Members,,22.74,,,,,,,16.24,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,outpatient,1,EA,29.53000,28.05000,The Alliance,Exception Members,,22.74,,,,,,,14.77,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,inpatient,1,EA,26.67000,25.34000,The Alliance,Exception Members,,20.54,,,,,,,14.67,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,outpatient,1,EA,26.67000,25.34000,The Alliance,Exception Members,,20.54,,,,,,,13.34,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,inpatient,1,EA,26.45000,25.13000,The Alliance,Exception Members,,20.37,,,,,,,14.55,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,outpatient,1,EA,26.45000,25.13000,The Alliance,Exception Members,,20.37,,,,,,,13.22,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,inpatient,1,EA,70.70000,67.17000,The Alliance,Exception Members,,54.44,,,,,,,38.88,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,outpatient,1,EA,70.70000,67.17000,The Alliance,Exception Members,,54.44,,,,,,,35.35,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,inpatient,1,EA,3.78000,3.60000,The Alliance,Exception Members,,2.91,,,,,,,2.08,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,outpatient,1,EA,3.78000,3.60000,The Alliance,Exception Members,,2.91,,,,,,,1.89,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Exception Members,,72.34,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,inpatient,1,EA,25.96000,24.66000,The Alliance,Exception Members,,19.99,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Exception Members,,19.99,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,inpatient,1,EA,17.97000,17.07000,The Alliance,Exception Members,,13.84,,,,,,,9.88,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,outpatient,1,EA,17.97000,17.07000,The Alliance,Exception Members,,13.84,,,,,,,8.98,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,3163.00,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,inpatient,1,EA,4.46000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,outpatient,1,EA,4.46000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.23,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.03,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,inpatient,1,EA,4.94000,4.70000,The Alliance,Exception Members,,3.80,,,,,,,2.72,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,outpatient,1,EA,4.94000,4.70000,The Alliance,Exception Members,,3.80,,,,,,,2.47,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,inpatient,1,EA,53.59000,50.91000,The Alliance,Exception Members,,41.26,,,,,,,29.47,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,outpatient,1,EA,53.59000,50.91000,The Alliance,Exception Members,,41.26,,,,,,,0.11207,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,inpatient,1,EA,39.69000,37.71000,The Alliance,Exception Members,,30.56,,,,,,,21.83,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,outpatient,1,EA,39.69000,37.71000,The Alliance,Exception Members,,30.56,,,,,,,0.11207,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,inpatient,1,EA,18.36000,17.44000,The Alliance,Exception Members,,14.14,,,,,,,10.10,17.81,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Exception Members,,14.14,,,,,,,0.11207,17.81,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,inpatient,1,EA,15.63000,14.85000,The Alliance,Exception Members,,12.04,,,,,,,8.60,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,outpatient,1,EA,15.63000,14.85000,The Alliance,Exception Members,,12.04,,,,,,,7.82,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,inpatient,1,EA,15.88000,15.09000,The Alliance,Exception Members,,12.23,,,,,,,8.73,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,outpatient,1,EA,15.88000,15.09000,The Alliance,Exception Members,,12.23,,,,,,,7.94,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,inpatient,1,EA,15.76000,14.97000,The Alliance,Exception Members,,12.14,,,,,,,8.67,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,outpatient,1,EA,15.76000,14.97000,The Alliance,Exception Members,,12.14,,,,,,,7.88,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.46,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.46,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,22.34,2082.45,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,3163.00,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,5.18,271.65,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,115.50,203.70,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,115.50,5271.00,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,780.94,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,90,107.80,,,,,,,77.00,135.80,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,90,107.80,,,,,,,12.38,628.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,4.57,271.65,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,,841.61,,,,,,,601.15,1060.21,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,,841.61,,,,,,,384.16,1060.21,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,43.81,161.02,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,inpatient,1,EA,58.40000,55.48000,The Alliance,Exception Members,,44.97,,,,,,,32.12,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,outpatient,1,EA,58.40000,55.48000,The Alliance,Exception Members,,44.97,,,,,,,29.20,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,inpatient,1,EA,47.24000,44.88000,The Alliance,Exception Members,,36.37,,,,,,,25.98,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,outpatient,1,EA,47.24000,44.88000,The Alliance,Exception Members,,36.37,,,,,,,23.62,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,inpatient,1,GM,15.81000,15.02000,The Alliance,Exception Members,,12.17,,,,,,,8.70,15.34,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,outpatient,1,GM,15.81000,15.02000,The Alliance,Exception Members,,12.17,,,,,,,7.91,15.34,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,inpatient,60,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,outpatient,60,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,inpatient,1,EA,35.04000,33.29000,The Alliance,Exception Members,,26.98,,,,,,,19.27,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,outpatient,1,EA,35.04000,33.29000,The Alliance,Exception Members,,26.98,,,,,,,17.52,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,10.27,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,inpatient,1,EA,21.24000,20.17000,The Alliance,Exception Members,,16.35,,,,,,,11.68,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,outpatient,1,EA,21.24000,20.17000,The Alliance,Exception Members,,16.35,,,,,,,10.62,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.37,10.42,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,inpatient,10,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,outpatient,10,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,0.11207,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,inpatient,10,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,outpatient,10,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,0.11207,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,inpatient,10,EA,5.30000,5.04000,The Alliance,Exception Members,,4.08,,,,,,,2.92,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,outpatient,10,EA,5.30000,5.04000,The Alliance,Exception Members,,4.08,,,,,,,0.11207,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,inpatient,10,EA,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,outpatient,10,EA,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,0.11207,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.11207,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,inpatient,10,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,0.11207,2.75,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,inpatient,1,mL,28.25000,26.84000,The Alliance,Exception Members,,21.75,,,,,,,15.54,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,outpatient,1,mL,28.25000,26.84000,The Alliance,Exception Members,,21.75,,,,,,,1.06,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,inpatient,1,mL,10.13000,9.63000,The Alliance,Exception Members,,7.80,,,,,,,5.57,9.83,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,outpatient,1,mL,10.13000,9.63000,The Alliance,Exception Members,,7.80,,,,,,,1.06,9.83,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,Exception Members,TC,431.20,,,,,,,308.00,543.20,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Exception Members,TC,431.20,,,,,,,280.00,543.20,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,37.78,66.64,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,34.35,66.64,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,inpatient,1,EA,1587.93000,1508.53000,The Alliance,Exception Members,,1222.71,,,,,,,873.36,1540.29,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,outpatient,1,EA,1587.93000,1508.53000,The Alliance,Exception Members,,1222.71,,,,,,,56.01,1540.29,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,inpatient,30,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,inpatient,30,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,outpatient,30,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,inpatient,30,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,outpatient,30,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,11.53,594.19,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,3163.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,3.44,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,3.44,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,inpatient,1,EA,9.25000,8.79000,The Alliance,Exception Members,,7.12,,,,,,,5.09,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,outpatient,1,EA,9.25000,8.79000,The Alliance,Exception Members,,7.12,,,,,,,3.44,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,10.77,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,3.44,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,3.44,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,inpatient,1,EA,23.48000,22.30000,The Alliance,Exception Members,,18.08,,,,,,,12.91,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,outpatient,1,EA,23.48000,22.30000,The Alliance,Exception Members,,18.08,,,,,,,3.44,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,inpatient,1,EA,217.44000,206.57000,The Alliance,Exception Members,,167.43,,,,,,,119.59,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,outpatient,1,EA,217.44000,206.57000,The Alliance,Exception Members,,167.43,,,,,,,3.44,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,inpatient,1,EA,14.85000,14.11000,The Alliance,Exception Members,,11.43,,,,,,,8.17,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Exception Members,,11.43,,,,,,,3.44,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,3.44,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,inpatient,1,EA,10.98000,10.43000,The Alliance,Exception Members,,8.45,,,,,,,6.04,10.65,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,outpatient,1,EA,10.98000,10.43000,The Alliance,Exception Members,,8.45,,,,,,,3.44,10.65,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,inpatient,15,EA,5.51000,5.24000,The Alliance,Exception Members,,4.24,,,,,,,3.03,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,outpatient,15,EA,5.51000,5.24000,The Alliance,Exception Members,,4.24,,,,,,,2.75,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,inpatient,15,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,inpatient,15,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,outpatient,15,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,inpatient,15,EA,4.44000,4.21000,The Alliance,Exception Members,,3.42,,,,,,,2.44,4.31,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,outpatient,15,EA,4.44000,4.21000,The Alliance,Exception Members,,3.42,,,,,,,2.22,4.31,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,inpatient,,,180.30000,171.28000,The Alliance,Exception Members,90,138.83,,,,,,,99.17,174.89,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,outpatient,,,180.30000,171.28000,The Alliance,Exception Members,90,138.83,,,,,,,90.15,1137.41,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,inpatient,,,1903.00000,1807.85000,The Alliance,Exception Members,90,1465.31,,,,,,,1046.65,1845.91,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,outpatient,,,1903.00000,1807.85000,The Alliance,Exception Members,90,1465.31,,,,,,,169.42,8573.20,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,63.95,788.42,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,inpatient,1,EA,10.91000,10.36000,The Alliance,Exception Members,,8.40,,,,,,,6.00,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,outpatient,1,EA,10.91000,10.36000,The Alliance,Exception Members,,8.40,,,,,,,5.46,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,inpatient,1,EA,3.90000,3.71000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,inpatient,1,EA,6.72000,6.38000,The Alliance,Exception Members,,5.17,,,,,,,3.70,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,outpatient,1,EA,6.72000,6.38000,The Alliance,Exception Members,,5.17,,,,,,,3.36,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,inpatient,1,EA,4.45000,4.22000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,outpatient,1,EA,4.45000,4.22000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,inpatient,1,EA,2.75000,2.62000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Exception Members,,2.12,,,,,,,1.38,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,inpatient,1,EA,5.37000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,2.69,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,inpatient,1,EA,5.49000,5.21000,The Alliance,Exception Members,,4.23,,,,,,,3.02,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Exception Members,,4.23,,,,,,,2.75,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.46,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.53,2.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.40,2.71,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,113.85,200.79,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,113.85,3163.00,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,inpatient,,,63.50000,60.32000,The Alliance,Exception Members,,48.90,,,,,,,34.92,61.59,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,outpatient,,,63.50000,60.32000,The Alliance,Exception Members,,48.90,,,,,,,28.29,61.59,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,3.53,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,inpatient,1,EA,56.72000,53.89000,The Alliance,Exception Members,,43.67,,,,,,,31.20,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,outpatient,1,EA,56.72000,53.89000,The Alliance,Exception Members,,43.67,,,,,,,28.36,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,inpatient,5,EA,57.46000,54.59000,The Alliance,Exception Members,,44.24,,,,,,,31.60,55.74,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,outpatient,5,EA,57.46000,54.59000,The Alliance,Exception Members,,44.24,,,,,,,28.73,55.74,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,inpatient,1,EA,31.16000,29.60000,The Alliance,Exception Members,,23.99,,,,,,,17.14,30.23,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,outpatient,1,EA,31.16000,29.60000,The Alliance,Exception Members,,23.99,,,,,,,3.44,30.23,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,2234.00000,2122.30000,The Alliance,Exception Members,QN,1720.18,,,,,,,1228.70,2166.98,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,2234.00000,2122.30000,The Alliance,Exception Members,QN,1720.18,,,,,,,1117.00,2166.98,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,inpatient,3.5,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,outpatient,3.5,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,9.83,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,inpatient,3.5,EA,12.55000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.90,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,outpatient,3.5,EA,12.55000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.28,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,inpatient,3.5,EA,20.69000,19.66000,The Alliance,Exception Members,,15.93,,,,,,,11.38,20.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,outpatient,3.5,EA,20.69000,19.66000,The Alliance,Exception Members,,15.93,,,,,,,10.35,20.07,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,The Alliance,Exception Members,,1057.57,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Exception Members,,1057.57,,,,,,,91.02,1332.27,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,inpatient,1,GM,89.11000,84.66000,The Alliance,Exception Members,,68.61,,,,,,,49.01,86.44,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,outpatient,1,GM,89.11000,84.66000,The Alliance,Exception Members,,68.61,,,,,,,44.55,86.44,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,inpatient,1,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.77,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,inpatient,1,EA,5.71000,5.42000,The Alliance,Exception Members,,4.40,,,,,,,3.14,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Exception Members,,4.40,,,,,,,2.85,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,inpatient,1,EA,4.69000,4.46000,The Alliance,Exception Members,,3.61,,,,,,,2.58,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,outpatient,1,EA,4.69000,4.46000,The Alliance,Exception Members,,3.61,,,,,,,2.35,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,15.05,780.94,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,16.18,848.80,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,inpatient,45,EA,3.77000,3.58000,The Alliance,Exception Members,,2.90,,,,,,,2.07,3.66,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,outpatient,45,EA,3.77000,3.58000,The Alliance,Exception Members,,2.90,,,,,,,1.89,3.66,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,inpatient,3.5,EA,7.75000,7.36000,The Alliance,Exception Members,,5.97,,,,,,,4.26,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,outpatient,3.5,EA,7.75000,7.36000,The Alliance,Exception Members,,5.97,,,,,,,3.88,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,inpatient,3.5,EA,8.82000,8.38000,The Alliance,Exception Members,,6.79,,,,,,,4.85,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,outpatient,3.5,EA,8.82000,8.38000,The Alliance,Exception Members,,6.79,,,,,,,4.41,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,inpatient,3.5,EA,6.08000,5.77000,The Alliance,Exception Members,,4.68,,,,,,,3.34,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,outpatient,3.5,EA,6.08000,5.77000,The Alliance,Exception Members,,4.68,,,,,,,3.04,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,inpatient,3.5,EA,7.36000,6.99000,The Alliance,Exception Members,,5.67,,,,,,,4.05,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,outpatient,3.5,EA,7.36000,6.99000,The Alliance,Exception Members,,5.67,,,,,,,3.68,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,inpatient,3.5,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,3.55,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,outpatient,3.5,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,3.23,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,inpatient,3.5,EA,5.87000,5.57000,The Alliance,Exception Members,,4.52,,,,,,,3.23,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,outpatient,3.5,EA,5.87000,5.57000,The Alliance,Exception Members,,4.52,,,,,,,2.94,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,inpatient,3.5,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.36,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,outpatient,3.5,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.24,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,inpatient,3.5,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,outpatient,3.5,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,inpatient,3.5,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,outpatient,3.5,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,inpatient,3.5,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.54,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,outpatient,3.5,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.40,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,inpatient,3.5,EA,4.72000,4.49000,The Alliance,Exception Members,,3.63,,,,,,,2.60,4.58,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,outpatient,3.5,EA,4.72000,4.49000,The Alliance,Exception Members,,3.63,,,,,,,2.36,4.58,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,0.11207,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,inpatient,1,mL,35.49000,33.71000,The Alliance,Exception Members,,27.33,,,,,,,19.52,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,outpatient,1,mL,35.49000,33.71000,The Alliance,Exception Members,,27.33,,,,,,,0.11207,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,inpatient,1,mL,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,0.11207,36.78,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,inpatient,3.5,EA,39.53000,37.55000,The Alliance,Exception Members,,30.44,,,,,,,21.74,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,outpatient,3.5,EA,39.53000,37.55000,The Alliance,Exception Members,,30.44,,,,,,,19.77,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,inpatient,3.5,EA,36.07000,34.26000,The Alliance,Exception Members,,27.77,,,,,,,19.84,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,outpatient,3.5,EA,36.07000,34.26000,The Alliance,Exception Members,,27.77,,,,,,,18.04,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,inpatient,3.5,EA,39.91000,37.91000,The Alliance,Exception Members,,30.73,,,,,,,21.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,outpatient,3.5,EA,39.91000,37.91000,The Alliance,Exception Members,,30.73,,,,,,,19.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,inpatient,3.5,EA,41.14000,39.09000,The Alliance,Exception Members,,31.68,,,,,,,22.63,39.91,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,outpatient,3.5,EA,41.14000,39.09000,The Alliance,Exception Members,,31.68,,,,,,,20.57,39.91,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,inpatient,1,mL,146.15000,138.84000,The Alliance,Exception Members,,112.54,,,,,,,80.38,141.77,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,outpatient,1,mL,146.15000,138.84000,The Alliance,Exception Members,,112.54,,,,,,,73.08,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,inpatient,1,mL,135.88000,129.09000,The Alliance,Exception Members,,104.63,,,,,,,74.73,131.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,outpatient,1,mL,135.88000,129.09000,The Alliance,Exception Members,,104.63,,,,,,,67.94,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,inpatient,1,mL,149.33000,141.87000,The Alliance,Exception Members,,114.98,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Exception Members,,114.98,,,,,,,74.67,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,inpatient,1,mL,160.62000,152.59000,The Alliance,Exception Members,,123.68,,,,,,,88.34,155.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,outpatient,1,mL,160.62000,152.59000,The Alliance,Exception Members,,123.68,,,,,,,80.31,290.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,inpatient,15,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,outpatient,15,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,inpatient,15,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,outpatient,15,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,inpatient,15,EA,13.41000,12.74000,The Alliance,Exception Members,,10.33,,,,,,,7.38,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,outpatient,15,EA,13.41000,12.74000,The Alliance,Exception Members,,10.33,,,,,,,6.71,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,inpatient,1,EA,295.97000,281.17000,The Alliance,Exception Members,,227.90,,,,,,,162.78,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,outpatient,1,EA,295.97000,281.17000,The Alliance,Exception Members,,227.90,,,,,,,0.33621,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,inpatient,1,EA,806.22000,765.90000,The Alliance,Exception Members,,620.79,,,,,,,443.42,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,outpatient,1,EA,806.22000,765.90000,The Alliance,Exception Members,,620.79,,,,,,,0.33621,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,inpatient,1,EA,700.52000,665.49000,The Alliance,Exception Members,,539.40,,,,,,,385.29,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,outpatient,1,EA,700.52000,665.49000,The Alliance,Exception Members,,539.40,,,,,,,0.33621,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,inpatient,1,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,170.94,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,0.33621,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,284.90,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,0.33621,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,inpatient,1,EA,453.25000,430.59000,The Alliance,Exception Members,,349.00,,,,,,,249.29,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,outpatient,1,EA,453.25000,430.59000,The Alliance,Exception Members,,349.00,,,,,,,0.33621,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,inpatient,1,EA,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,outpatient,1,EA,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,0.33621,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,inpatient,1,EA,1515.77000,1439.98000,The Alliance,Exception Members,,1167.14,,,,,,,833.67,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,outpatient,1,EA,1515.77000,1439.98000,The Alliance,Exception Members,,1167.14,,,,,,,0.33621,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,inpatient,1,EA,543.90000,516.70000,The Alliance,Exception Members,,418.80,,,,,,,299.14,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,outpatient,1,EA,543.90000,516.70000,The Alliance,Exception Members,,418.80,,,,,,,0.33621,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,inpatient,1,EA,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,0.33621,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,inpatient,1,EA,123.24000,117.08000,The Alliance,Exception Members,,94.89,,,,,,,67.78,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,outpatient,1,EA,123.24000,117.08000,The Alliance,Exception Members,,94.89,,,,,,,0.33621,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,inpatient,1,EA,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,78.21,137.93,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,outpatient,1,EA,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,0.33621,137.93,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,inpatient,1,mL,36.50000,34.67000,The Alliance,Exception Members,,28.11,,,,,,,20.07,35.41,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,outpatient,1,mL,36.50000,34.67000,The Alliance,Exception Members,,28.11,,,,,,,18.25,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,inpatient,1,mL,33.97000,32.27000,The Alliance,Exception Members,,26.16,,,,,,,18.68,32.95,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,outpatient,1,mL,33.97000,32.27000,The Alliance,Exception Members,,26.16,,,,,,,16.98,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,inpatient,1,mL,37.33000,35.47000,The Alliance,Exception Members,,28.74,,,,,,,20.53,36.21,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,outpatient,1,mL,37.33000,35.47000,The Alliance,Exception Members,,28.74,,,,,,,18.66,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,inpatient,1,mL,40.11000,38.11000,The Alliance,Exception Members,,30.88,,,,,,,22.06,38.91,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,outpatient,1,mL,40.11000,38.11000,The Alliance,Exception Members,,30.88,,,,,,,20.05,290.17,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,inpatient,59.2,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,outpatient,59.2,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,231.00,407.40,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,35.09,1833.46,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,inpatient,1,mL,34.32000,32.61000,The Alliance,Exception Members,,26.43,,,,,,,18.88,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,outpatient,1,mL,34.32000,32.61000,The Alliance,Exception Members,,26.43,,,,,,,17.16,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,inpatient,1,mL,27.68000,26.29000,The Alliance,Exception Members,,21.31,,,,,,,15.22,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,outpatient,1,mL,27.68000,26.29000,The Alliance,Exception Members,,21.31,,,,,,,13.84,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,inpatient,1,mL,28.04000,26.64000,The Alliance,Exception Members,,21.59,,,,,,,15.42,27.20,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,outpatient,1,mL,28.04000,26.64000,The Alliance,Exception Members,,21.59,,,,,,,14.02,27.20,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,7.30,373.51,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,16.87,882.80,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,inpatient,,,340.70000,323.66000,The Alliance,Exception Members,90,262.34,,,,,,,187.38,330.48,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Exception Members,90,262.34,,,,,,,38.99,1969.25,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,5.99,1216.68,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,180.95,319.13,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,180.95,4686.00,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,inpatient,8,EA,302.57000,287.44000,The Alliance,Exception Members,,232.98,,,,,,,166.41,293.49,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,outpatient,8,EA,302.57000,287.44000,The Alliance,Exception Members,,232.98,,,,,,,151.28,293.49,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,inpatient,5,EA,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,outpatient,5,EA,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,2.89,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,inpatient,5,EA,27.09000,25.73000,The Alliance,Exception Members,,20.86,,,,,,,14.90,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,outpatient,5,EA,27.09000,25.73000,The Alliance,Exception Members,,20.86,,,,,,,13.54,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,inpatient,5,EA,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,12.81,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,outpatient,5,EA,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,11.64,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,inpatient,5,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.87,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,outpatient,5,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,9.21,17.87,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,inpatient,56,EA,225.62000,214.34000,The Alliance,Exception Members,,173.73,,,,,,,124.09,218.85,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,outpatient,56,EA,225.62000,214.34000,The Alliance,Exception Members,,173.73,,,,,,,112.81,218.85,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,inpatient,10,EA,98.13000,93.22000,The Alliance,Exception Members,,75.56,,,,,,,53.97,95.19,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,outpatient,10,EA,98.13000,93.22000,The Alliance,Exception Members,,75.56,,,,,,,49.06,95.19,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,3.80,186.75,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,inpatient,1,EA,2511.99000,2386.39000,The Alliance,Exception Members,,1934.23,,,,,,,1381.59,2436.63,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,outpatient,1,EA,2511.99000,2386.39000,The Alliance,Exception Members,,1934.23,,,,,,,3.89,2436.63,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,inpatient,30,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,outpatient,30,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,inpatient,30,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,outpatient,30,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,inpatient,30,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,outpatient,30,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,inpatient,30,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,outpatient,30,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,inpatient,30,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,outpatient,30,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,inpatient,30,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,outpatient,30,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,inpatient,30,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,inpatient,30,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,outpatient,30,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,inpatient,,,2632.00000,2500.40000,The Alliance,Exception Members,,2026.64,,,,,,,1447.60,2553.04,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,outpatient,,,2632.00000,2500.40000,The Alliance,Exception Members,,2026.64,,,,,,,1447.60,4686.00,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,inpatient,,,67.40000,64.03000,The Alliance,Exception Members,90,51.90,,,,,,,37.07,65.38,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Exception Members,90,51.90,,,,,,,8.17,526.26,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,3163.00,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,1324.17,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,4.70,254.68,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,inpatient,1,EA,93.93000,89.23000,The Alliance,Exception Members,,72.33,,,,,,,51.66,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,outpatient,1,EA,93.93000,89.23000,The Alliance,Exception Members,,72.33,,,,,,,3.84,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,inpatient,1,EA,104.28000,99.07000,The Alliance,Exception Members,,80.30,,,,,,,57.35,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Exception Members,,80.30,,,,,,,3.84,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,inpatient,1,EA,114.01000,108.31000,The Alliance,Exception Members,,87.79,,,,,,,62.71,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,outpatient,1,EA,114.01000,108.31000,The Alliance,Exception Members,,87.79,,,,,,,3.84,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,inpatient,1,EA,86.30000,81.98000,The Alliance,Exception Members,,66.45,,,,,,,47.47,83.71,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,outpatient,1,EA,86.30000,81.98000,The Alliance,Exception Members,,66.45,,,,,,,3.84,83.71,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,37.78,66.64,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,34.35,66.64,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,inpatient,1,mL,516.02000,490.22000,The Alliance,Exception Members,,397.34,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Exception Members,,397.34,,,,,,,73.05,500.54,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,273.46,482.28,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,44.27,2240.90,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,inpatient,1,EA,187.86000,178.47000,The Alliance,Exception Members,,144.65,,,,,,,103.32,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,outpatient,1,EA,187.86000,178.47000,The Alliance,Exception Members,,144.65,,,,,,,3.84,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,inpatient,1,EA,231.66000,220.08000,The Alliance,Exception Members,,178.38,,,,,,,127.41,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,outpatient,1,EA,231.66000,220.08000,The Alliance,Exception Members,,178.38,,,,,,,3.84,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,inpatient,1,EA,172.60000,163.97000,The Alliance,Exception Members,,132.90,,,,,,,94.93,167.42,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,outpatient,1,EA,172.60000,163.97000,The Alliance,Exception Members,,132.90,,,,,,,3.84,167.42,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,462.00,814.80,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,420.00,814.80,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,11.00,509.30,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,90,126.28,,,,,,,90.20,159.08,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,90,126.28,,,,,,,17.69,899.77,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,18.70,32.98,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,3.02,152.82,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,37.27,1426.03,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,inpatient,1,EA,295.84000,281.05000,The Alliance,Exception Members,,227.80,,,,,,,162.71,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,outpatient,1,EA,295.84000,281.05000,The Alliance,Exception Members,,227.80,,,,,,,33.41,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,inpatient,1,EA,274.80000,261.06000,The Alliance,Exception Members,,211.60,,,,,,,151.14,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,outpatient,1,EA,274.80000,261.06000,The Alliance,Exception Members,,211.60,,,,,,,33.41,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,inpatient,1,EA,231.41000,219.84000,The Alliance,Exception Members,,178.19,,,,,,,127.28,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,outpatient,1,EA,231.41000,219.84000,The Alliance,Exception Members,,178.19,,,,,,,33.41,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,inpatient,1,EA,210.74000,200.20000,The Alliance,Exception Members,,162.27,,,,,,,115.91,204.42,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,outpatient,1,EA,210.74000,200.20000,The Alliance,Exception Members,,162.27,,,,,,,33.41,204.42,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,741.08,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,3163.00,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,inpatient,2.5,EA,122.58000,116.45000,The Alliance,Exception Members,,94.39,,,,,,,67.42,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,outpatient,2.5,EA,122.58000,116.45000,The Alliance,Exception Members,,94.39,,,,,,,61.29,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,inpatient,2.5,EA,136.13000,129.33000,The Alliance,Exception Members,,104.82,,,,,,,74.87,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,outpatient,2.5,EA,136.13000,129.33000,The Alliance,Exception Members,,104.82,,,,,,,68.06,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,inpatient,2.5,EA,132.04000,125.44000,The Alliance,Exception Members,,101.67,,,,,,,72.62,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,outpatient,2.5,EA,132.04000,125.44000,The Alliance,Exception Members,,101.67,,,,,,,66.02,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,inpatient,2.5,EA,66.74000,63.40000,The Alliance,Exception Members,,51.39,,,,,,,36.71,64.74,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,outpatient,2.5,EA,66.74000,63.40000,The Alliance,Exception Members,,51.39,,,,,,,33.37,64.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,inpatient,5,EA,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,outpatient,5,EA,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,10.61,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,inpatient,5,EA,34.78000,33.04000,The Alliance,Exception Members,,26.78,,,,,,,19.13,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,outpatient,5,EA,34.78000,33.04000,The Alliance,Exception Members,,26.78,,,,,,,10.61,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,inpatient,5,EA,25.44000,24.17000,The Alliance,Exception Members,,19.59,,,,,,,13.99,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,outpatient,5,EA,25.44000,24.17000,The Alliance,Exception Members,,19.59,,,,,,,10.61,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,inpatient,5,EA,18.05000,17.15000,The Alliance,Exception Members,,13.90,,,,,,,9.93,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,outpatient,5,EA,18.05000,17.15000,The Alliance,Exception Members,,13.90,,,,,,,9.03,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,inpatient,5,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,10.61,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,inpatient,5,EA,24.79000,23.55000,The Alliance,Exception Members,,19.09,,,,,,,13.63,24.05,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,outpatient,5,EA,24.79000,23.55000,The Alliance,Exception Members,,19.09,,,,,,,10.61,24.05,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,inpatient,1,EA,84.57000,80.34000,The Alliance,Exception Members,,65.12,,,,,,,46.51,82.03,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,outpatient,1,EA,84.57000,80.34000,The Alliance,Exception Members,,65.12,,,,,,,42.28,82.03,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,inpatient,15,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,outpatient,15,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.77,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,inpatient,15,EA,4.62000,4.38000,The Alliance,Exception Members,,3.56,,,,,,,2.54,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,outpatient,15,EA,4.62000,4.38000,The Alliance,Exception Members,,3.56,,,,,,,2.31,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,inpatient,15,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,outpatient,15,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,inpatient,,,48.40000,45.98000,The Alliance,Exception Members,,37.27,,,,,,,26.62,46.95,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Exception Members,,37.27,,,,,,,24.20,46.95,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,2.99,152.82,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,36.26,1833.46,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,90,102.41,,,,,,,73.15,129.01,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,90,102.41,,,,,,,12.38,628.12,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,inpatient,237,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,outpatient,237,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,inpatient,237,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,outpatient,237,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,TC,1558.48,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,TC,1558.48,,,,,,,864.82,2960.49,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,679.08,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,110.55,194.97,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,26.07,1222.31,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1737.00000,1650.15000,The Alliance,Exception Members,TC,1337.49,,,,,,,955.35,1684.89,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1737.00000,1650.15000,The Alliance,Exception Members,TC,1337.49,,,,,,,868.50,2210.07,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,182.00,456.63,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,20.35,35.89,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,2.99,152.82,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,TC,1867.25,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,TC,1867.25,,,,,,,1212.50,2352.25,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,52.25,92.15,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,13.37,763.98,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,inpatient,,,1888.00000,1793.60000,The Alliance,Exception Members,TC,1453.76,,,,,,,1038.40,1831.36,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,outpatient,,,1888.00000,1793.60000,The Alliance,Exception Members,TC,1453.76,,,,,,,875.87,2210.07,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,inpatient,5,EA,32.06000,30.46000,The Alliance,Exception Members,,24.69,,,,,,,17.63,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,outpatient,5,EA,32.06000,30.46000,The Alliance,Exception Members,,24.69,,,,,,,16.03,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,inpatient,5,EA,32.22000,30.61000,The Alliance,Exception Members,,24.81,,,,,,,17.72,31.25,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,outpatient,5,EA,32.22000,30.61000,The Alliance,Exception Members,,24.81,,,,,,,16.11,31.25,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1444.00000,1371.80000,The Alliance,Exception Members,,1111.88,,,,,,,794.20,1400.68,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1444.00000,1371.80000,The Alliance,Exception Members,,1111.88,,,,,,,143.40,8250.66,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,inpatient,1,mL,516.02000,490.22000,The Alliance,Exception Members,,397.34,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Exception Members,,397.34,,,,,,,73.05,500.54,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,8.46,441.37,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,Exception Members,,180.95,,,,,,,129.25,227.95,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Exception Members,,180.95,,,,,,,20.81,1086.52,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,inpatient,1,GM,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,outpatient,1,GM,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,inpatient,1,GM,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,outpatient,1,GM,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,inpatient,1,GM,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,outpatient,1,GM,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,The Alliance,Exception Members,TC,11198.11,,,,,,,7998.65,14106.71,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Exception Members,TC,11198.11,,,,,,,4549.00,14106.71,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,inpatient,,,733.00000,696.35000,The Alliance,Exception Members,,564.41,,,,,,,403.15,711.01,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,outpatient,,,733.00000,696.35000,The Alliance,Exception Members,,564.41,,,,,,,236.07,2440.34,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,The Alliance,Exception Members,TC,2662.66,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Exception Members,TC,2662.66,,,,,,,1609.99,3354.26,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,The Alliance,Exception Members,,3591.59,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Exception Members,,3591.59,,,,,,,2140.96,4664.40,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.99,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.54,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,inpatient,1,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,3.79,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,inpatient,1,EA,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,4.10,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,outpatient,1,EA,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,3.73,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,inpatient,1,EA,7.92000,7.53000,The Alliance,Exception Members,,6.10,,,,,,,4.36,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,outpatient,1,EA,7.92000,7.53000,The Alliance,Exception Members,,6.10,,,,,,,3.96,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,8.17,1324.17,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,inpatient,2,EA,9.20000,8.74000,The Alliance,Exception Members,,7.08,,,,,,,5.06,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,outpatient,2,EA,9.20000,8.74000,The Alliance,Exception Members,,7.08,,,,,,,1.85,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,inpatient,2,EA,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.70,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,outpatient,2,EA,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,1.85,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,inpatient,2,EA,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,outpatient,2,EA,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,inpatient,2,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,8.92,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,outpatient,2,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,1.85,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,inpatient,2,EA,14.70000,13.97000,The Alliance,Exception Members,,11.32,,,,,,,8.09,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,outpatient,2,EA,14.70000,13.97000,The Alliance,Exception Members,,11.32,,,,,,,1.85,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,inpatient,2,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,1.85,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,inpatient,2,EA,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,5.53,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,outpatient,2,EA,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,1.85,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,inpatient,2,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,outpatient,2,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,1.85,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,inpatient,2,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,8.11,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,outpatient,2,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,1.85,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,inpatient,2,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,inpatient,2,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,outpatient,2,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,7.75,407.44,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,inpatient,10,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,outpatient,10,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,inpatient,10,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,outpatient,10,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,inpatient,10,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,outpatient,10,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,inpatient,10,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,outpatient,10,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.61000,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,inpatient,10,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,inpatient,10,EA,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,outpatient,10,EA,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,inpatient,10,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,outpatient,10,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,inpatient,30,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,outpatient,30,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,inpatient,30,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,outpatient,30,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.01550,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,inpatient,30,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.01550,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,inpatient,30,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.01550,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.01550,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,inpatient,30,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,outpatient,30,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.01550,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,inpatient,30,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.01550,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.01550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,inpatient,30,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,outpatient,30,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.01550,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,inpatient,30,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,outpatient,30,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.01550,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,inpatient,30,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.01550,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,inpatient,30,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,outpatient,30,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.01550,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,inpatient,30,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,outpatient,30,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,inpatient,30,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,outpatient,30,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.01550,0.66930,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,The Alliance,Exception Members,QN,836.22,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Exception Members,QN,836.22,,,,,,,543.00,1053.42,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,37.78,66.64,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,8.17,458.40,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,80.00,155.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,7.27,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,inpatient,1,EA,26.07000,24.76000,The Alliance,Exception Members,,20.07,,,,,,,14.34,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,outpatient,1,EA,26.07000,24.76000,The Alliance,Exception Members,,20.07,,,,,,,7.27,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,inpatient,1,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,205.15,361.81,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,35.09,1662.04,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,inpatient,5,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,outpatient,5,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,inpatient,5,EA,9.16000,8.71000,The Alliance,Exception Members,,7.05,,,,,,,5.04,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,outpatient,5,EA,9.16000,8.71000,The Alliance,Exception Members,,7.05,,,,,,,4.58,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,inpatient,5,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,outpatient,5,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,inpatient,5,EA,3.86000,3.67000,The Alliance,Exception Members,,2.97,,,,,,,2.12,3.74,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,outpatient,5,EA,3.86000,3.67000,The Alliance,Exception Members,,2.97,,,,,,,1.93,3.74,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.01550,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.01550,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.01550,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.01550,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.01550,0.49470,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,inpatient,4,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,outpatient,4,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.61000,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,inpatient,4,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,outpatient,4,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.61000,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,inpatient,4,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.31,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,outpatient,4,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,0.61000,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,inpatient,4,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,outpatient,4,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.61000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,inpatient,4,EA,2.46000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,outpatient,4,EA,2.46000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,0.61000,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,inpatient,4,EA,2.16000,2.06000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,outpatient,4,EA,2.16000,2.06000,The Alliance,Exception Members,,1.66,,,,,,,0.61000,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,inpatient,4,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,outpatient,4,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,0.61000,1.99,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,1237.50000,1175.62000,The Alliance,Exception Members,,952.88,,,,,,,606.38,1200.38,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,1237.50000,1175.62000,The Alliance,Exception Members,,952.88,,,,,,,568.01,1237.50,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,The Alliance,Exception Members,QN,836.22,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Exception Members,QN,836.22,,,,,,,543.00,1053.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.23,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.03,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,inpatient,1,EA,12.10000,11.50000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,outpatient,1,EA,12.10000,11.50000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,The Alliance,Exception Members,,3.17,,,,,,,2.27,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Exception Members,,3.17,,,,,,,2.06,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.29,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.08,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,3.22,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,2.93,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,inpatient,1,EA,8.33000,7.92000,The Alliance,Exception Members,,6.41,,,,,,,4.58,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,outpatient,1,EA,8.33000,7.92000,The Alliance,Exception Members,,6.41,,,,,,,4.17,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,inpatient,1,EA,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,outpatient,1,EA,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.00,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,The Alliance,Exception Members,,4.50,,,,,,,3.22,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Exception Members,,4.50,,,,,,,2.92,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.97,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.43,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,inpatient,30,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,outpatient,30,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,inpatient,30,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,inpatient,30,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,outpatient,30,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,inpatient,30,EA,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,outpatient,30,EA,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,inpatient,10,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,inpatient,10,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,outpatient,10,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.01550,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,inpatient,10,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,outpatient,10,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,inpatient,10,EA,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,outpatient,10,EA,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.01550,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,inpatient,10,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,inpatient,10,EA,1.66000,1.57000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,outpatient,10,EA,1.66000,1.57000,The Alliance,Exception Members,,1.28,,,,,,,0.01550,1.61,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,The Alliance,Exception Members,90,206.82,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Exception Members,90,206.82,,,,,,,24.43,1205.34,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,90,121.66,,,,,,,86.90,153.26,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,90,121.66,,,,,,,14.05,713.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,inpatient,10,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,inpatient,10,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.01550,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,inpatient,10,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,inpatient,10,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.01550,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,inpatient,10,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,inpatient,10,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,outpatient,10,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.01550,1.46,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,inpatient,,,409.00000,388.55000,The Alliance,Exception Members,,314.93,,,,,,,224.95,396.73,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,Exception Members,,314.93,,,,,,,37.27,1833.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.01550,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,inpatient,1,mL,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.01550,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,inpatient,1,mL,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.01550,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,inpatient,1,EA,11.31000,10.74000,The Alliance,Exception Members,,8.71,,,,,,,6.22,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,outpatient,1,EA,11.31000,10.74000,The Alliance,Exception Members,,8.71,,,,,,,5.66,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,inpatient,1,EA,4.73000,4.49000,The Alliance,Exception Members,,3.64,,,,,,,2.60,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,outpatient,1,EA,4.73000,4.49000,The Alliance,Exception Members,,3.64,,,,,,,2.37,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,inpatient,1,EA,7.99000,7.60000,The Alliance,Exception Members,,6.15,,,,,,,4.39,7.75,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,outpatient,1,EA,7.99000,7.60000,The Alliance,Exception Members,,6.15,,,,,,,4.00,7.75,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,inpatient,1,mL,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,inpatient,1,mL,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,outpatient,1,mL,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.08,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,inpatient,1,mL,5.43000,5.16000,The Alliance,Exception Members,,4.18,,,,,,,2.99,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,outpatient,1,mL,5.43000,5.16000,The Alliance,Exception Members,,4.18,,,,,,,2.71,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,inpatient,1,mL,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,outpatient,1,mL,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.97500,1.89,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,inpatient,1,EA,4.35000,4.14000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,outpatient,1,EA,4.35000,4.14000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,741.08,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,4686.00,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.01550,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,inpatient,1,mL,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,outpatient,1,mL,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.01550,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.01550,0.68870,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,inpatient,1,EA,5.95000,5.66000,The Alliance,Exception Members,,4.58,,,,,,,3.27,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,outpatient,1,EA,5.95000,5.66000,The Alliance,Exception Members,,4.58,,,,,,,2.98,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.94,5.19,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.67,5.19,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,11.98,628.12,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,inpatient,50,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.06404,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,inpatient,50,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,outpatient,50,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.06404,6.13,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,inpatient,,,4181.00000,3971.95000,The Alliance,Exception Members,,3219.37,,,,,,,2299.55,4055.57,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,outpatient,,,4181.00000,3971.95000,The Alliance,Exception Members,,3219.37,,,,,,,1538.48,4686.00,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,inpatient,2,EA,50.16000,47.66000,The Alliance,Exception Members,,38.62,,,,,,,27.59,48.66,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,outpatient,2,EA,50.16000,47.66000,The Alliance,Exception Members,,38.62,,,,,,,25.08,48.66,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,90,239.47,,,,,,,171.05,301.67,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,90,239.47,,,,,,,27.68,1392.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,inpatient,1,mL,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,4686.00,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,The Alliance,Exception Members,TC,2954.49,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Exception Members,TC,2954.49,,,,,,,1626.53,3721.89,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,inpatient,1,EA,21473.80000,20400.11000,The Alliance,Exception Members,,16534.83,,,,,,,11810.59,20829.59,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,outpatient,1,EA,21473.80000,20400.11000,The Alliance,Exception Members,,16534.83,,,,,,,258.52,20829.59,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,The Alliance,Exception Members,,4416.72,,,,,,,3154.80,5563.92,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Exception Members,,4416.72,,,,,,,1538.48,5563.92,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.78,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.61,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.64,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.50,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,inpatient,1,EA,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.66,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,The Alliance,Exception Members,,2626.47,,,,,,,1876.05,3308.67,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Exception Members,,2626.47,,,,,,,1538.48,4686.00,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,inpatient,1.5,EA,94.13000,89.42000,The Alliance,Exception Members,,72.48,,,,,,,51.77,91.31,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,outpatient,1.5,EA,94.13000,89.42000,The Alliance,Exception Members,,72.48,,,,,,,47.06,91.31,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,82.67,145.79,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,17.85,814.87,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,3509.55,6189.57,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,1538.48,6189.57,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,5.16,271.65,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,inpatient,10,EA,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,outpatient,10,EA,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,0.06404,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.06404,3.07,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,The Alliance,Exception Members,TC,1271.27,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Exception Members,TC,1271.27,,,,,,,805.84,2210.07,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,147.40,259.96,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,19.63,1018.59,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,inpatient,1,EA,8.55000,8.13000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,outpatient,1,EA,8.55000,8.13000,The Alliance,Exception Members,,6.58,,,,,,,4.28,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,inpatient,1,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,inpatient,1,EA,10.63000,10.10000,The Alliance,Exception Members,,8.19,,,,,,,5.85,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,outpatient,1,EA,10.63000,10.10000,The Alliance,Exception Members,,8.19,,,,,,,5.32,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,inpatient,1,EA,5.44000,5.17000,The Alliance,Exception Members,,4.19,,,,,,,2.99,5.28,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,outpatient,1,EA,5.44000,5.17000,The Alliance,Exception Members,,4.19,,,,,,,2.72,5.28,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,inpatient,10,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,outpatient,10,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,inpatient,10,EA,2.70000,2.56000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,outpatient,10,EA,2.70000,2.56000,The Alliance,Exception Members,,2.08,,,,,,,1.35,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,inpatient,10,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,inpatient,10,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1320.00000,1254.00000,The Alliance,Exception Members,,1016.40,,,,,,,726.00,1280.40,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Exception Members,,1016.40,,,,,,,726.00,5271.00,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,inpatient,1,EA,5.42000,5.15000,The Alliance,Exception Members,,4.17,,,,,,,2.98,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,outpatient,1,EA,5.42000,5.15000,The Alliance,Exception Members,,4.17,,,,,,,2.71,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,The Alliance,Exception Members,,3.59,,,,,,,2.56,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Exception Members,,3.59,,,,,,,2.33,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Exception Members,TC,419.65,,,,,,,272.50,528.65,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,inpatient,,,8368.00000,7949.60000,The Alliance,Exception Members,90,6443.36,,,,,,,4602.40,8116.96,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,outpatient,,,8368.00000,7949.60000,The Alliance,Exception Members,90,6443.36,,,,,,,14.91,8116.96,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.53,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.30,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,inpatient,1,EA,308.21000,292.80000,The Alliance,Exception Members,,237.32,,,,,,,169.52,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,outpatient,1,EA,308.21000,292.80000,The Alliance,Exception Members,,237.32,,,,,,,154.10,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,inpatient,1,EA,766.64000,728.31000,The Alliance,Exception Members,,590.31,,,,,,,421.65,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,outpatient,1,EA,766.64000,728.31000,The Alliance,Exception Members,,590.31,,,,,,,383.32,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,inpatient,1,EA,357.42000,339.55000,The Alliance,Exception Members,,275.21,,,,,,,196.58,346.70,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,outpatient,1,EA,357.42000,339.55000,The Alliance,Exception Members,,275.21,,,,,,,178.71,346.70,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,inpatient,30,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,outpatient,30,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,inpatient,30,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,outpatient,30,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,9.22,475.37,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,254.10,448.14,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,231.00,448.14,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.30,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,The Alliance,Exception Members,,2.99,,,,,,,2.13,3.76,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Exception Members,,2.99,,,,,,,1.94,3.76,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,49.50,87.30,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,7.34,1086.52,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.44,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.22,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.55,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.41,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.15,2.23,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,inpatient,10,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,outpatient,10,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.01550,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,inpatient,10,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,outpatient,10,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.01550,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,inpatient,10,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,outpatient,10,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.01550,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,inpatient,10,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.01550,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,inpatient,10,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.01550,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,inpatient,10,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,outpatient,10,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,0.01550,2.01,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,4686.00,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,inpatient,1,EA,9.52000,9.04000,The Alliance,Exception Members,,7.33,,,,,,,5.24,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,outpatient,1,EA,9.52000,9.04000,The Alliance,Exception Members,,7.33,,,,,,,4.76,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.22,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.02,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,inpatient,3.7,EA,256.63000,243.79000,The Alliance,Exception Members,,197.61,,,,,,,141.15,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,outpatient,3.7,EA,256.63000,243.79000,The Alliance,Exception Members,,197.61,,,,,,,128.31,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,inpatient,3.7,EA,50.82000,48.28000,The Alliance,Exception Members,,39.13,,,,,,,27.95,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,outpatient,3.7,EA,50.82000,48.28000,The Alliance,Exception Members,,39.13,,,,,,,25.41,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,inpatient,3.7,EA,63.94000,60.75000,The Alliance,Exception Members,,49.23,,,,,,,35.17,62.02,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,outpatient,3.7,EA,63.94000,60.75000,The Alliance,Exception Members,,49.23,,,,,,,31.97,62.02,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,inpatient,222,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,outpatient,222,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,inpatient,222,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,outpatient,222,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,inpatient,222,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,outpatient,222,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,inpatient,222,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,outpatient,222,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,inpatient,222,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,outpatient,222,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,inpatient,1,EA,244.62000,232.38000,The Alliance,Exception Members,,188.36,,,,,,,134.54,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,outpatient,1,EA,244.62000,232.38000,The Alliance,Exception Members,,188.36,,,,,,,122.31,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,inpatient,1,EA,917.98000,872.08000,The Alliance,Exception Members,,706.84,,,,,,,504.89,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,outpatient,1,EA,917.98000,872.08000,The Alliance,Exception Members,,706.84,,,,,,,458.99,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,inpatient,1,EA,826.18000,784.87000,The Alliance,Exception Members,,636.16,,,,,,,454.40,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,outpatient,1,EA,826.18000,784.87000,The Alliance,Exception Members,,636.16,,,,,,,413.09,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,63.20,122.61,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,inpatient,1,EA,11.22000,10.66000,The Alliance,Exception Members,,8.64,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Exception Members,,8.64,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,inpatient,1,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,inpatient,1,EA,4.83000,4.59000,The Alliance,Exception Members,,3.72,,,,,,,2.66,4.69,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Exception Members,,3.72,,,,,,,2.42,4.69,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,inpatient,1,mL,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,outpatient,1,mL,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.74,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,inpatient,1,mL,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,outpatient,1,mL,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,inpatient,1,mL,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.89,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,outpatient,1,mL,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.63,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,inpatient,1,mL,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,inpatient,1,mL,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,outpatient,1,mL,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.55,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,2.85,5.52,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,inpatient,12,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,outpatient,12,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,inpatient,12,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,outpatient,12,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,inpatient,12,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,outpatient,12,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,inpatient,12,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,outpatient,12,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,inpatient,12,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,outpatient,12,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,inpatient,12,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,outpatient,12,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,inpatient,12,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,outpatient,12,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,inpatient,,,298.50000,283.58000,The Alliance,Exception Members,90,229.84,,,,,,,164.18,289.55,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,outpatient,,,298.50000,283.58000,The Alliance,Exception Members,90,229.84,,,,,,,26.09,1324.17,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,6.03,322.54,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,13.68,713.01,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,inpatient,15,EA,11.52000,10.94000,The Alliance,Exception Members,,8.87,,,,,,,6.34,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,outpatient,15,EA,11.52000,10.94000,The Alliance,Exception Members,,8.87,,,,,,,5.76,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,inpatient,15,EA,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,5.53,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,outpatient,15,EA,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,5.03,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,inpatient,15,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,outpatient,15,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,inpatient,15,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,outpatient,15,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,inpatient,15,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,inpatient,15,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,outpatient,15,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,inpatient,15,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,outpatient,15,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,inpatient,15,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,outpatient,15,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,inpatient,15,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,outpatient,15,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,inpatient,1,EA,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,8.36,14.74,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,outpatient,1,EA,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,7.60,14.74,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,inpatient,1,mL,10.52000,10.00000,The Alliance,Exception Members,,8.10,,,,,,,5.79,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,outpatient,1,mL,10.52000,10.00000,The Alliance,Exception Members,,8.10,,,,,,,5.26,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,inpatient,1,mL,19.74000,18.75000,The Alliance,Exception Members,,15.20,,,,,,,10.86,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Exception Members,,15.20,,,,,,,9.87,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,inpatient,1,mL,17.91000,17.01000,The Alliance,Exception Members,,13.79,,,,,,,9.85,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,outpatient,1,mL,17.91000,17.01000,The Alliance,Exception Members,,13.79,,,,,,,8.96,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,inpatient,1,mL,5.67000,5.38000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,outpatient,1,mL,5.67000,5.38000,The Alliance,Exception Members,,4.37,,,,,,,2.83,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,inpatient,1,mL,32.79000,31.15000,The Alliance,Exception Members,,25.25,,,,,,,18.03,31.81,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,outpatient,1,mL,32.79000,31.15000,The Alliance,Exception Members,,25.25,,,,,,,16.39,31.81,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,177.51,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,14.57,763.98,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,inpatient,1,EA,874.67000,830.94000,The Alliance,Exception Members,,673.50,,,,,,,481.07,848.43,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,outpatient,1,EA,874.67000,830.94000,The Alliance,Exception Members,,673.50,,,,,,,3.63,848.43,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,inpatient,1,mL,17567.59000,16689.21000,The Alliance,Exception Members,,13527.04,,,,,,,9662.17,17040.56,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,outpatient,1,mL,17567.59000,16689.21000,The Alliance,Exception Members,,13527.04,,,,,,,227.10,17040.56,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,Exception Members,TC,271.04,,,,,,,193.60,341.44,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Exception Members,TC,271.04,,,,,,,176.00,341.44,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,inpatient,,,153.80000,146.11000,The Alliance,Exception Members,90,118.43,,,,,,,84.59,149.19,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Exception Members,90,118.43,,,,,,,13.69,696.05,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,18.96,984.66,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,inpatient,1,EA,11.22000,10.66000,The Alliance,Exception Members,,8.64,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Exception Members,,8.64,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,inpatient,1,mL,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,2.19,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,182.60,322.04,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,166.00,1820.00,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,inpatient,1,EA,3597.38000,3417.51000,The Alliance,Exception Members,,2769.98,,,,,,,1978.56,3489.46,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,outpatient,1,EA,3597.38000,3417.51000,The Alliance,Exception Members,,2769.98,,,,,,,55.09,3489.46,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,1155.00,2037.00,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,980.94,2210.07,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,inpatient,1,EA,24.39000,23.17000,The Alliance,Exception Members,,18.78,,,,,,,13.41,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,outpatient,1,EA,24.39000,23.17000,The Alliance,Exception Members,,18.78,,,,,,,12.20,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,inpatient,1,EA,23.23000,22.07000,The Alliance,Exception Members,,17.89,,,,,,,12.78,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,outpatient,1,EA,23.23000,22.07000,The Alliance,Exception Members,,17.89,,,,,,,11.62,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,2.10,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,1.91,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,inpatient,1,EA,3.47000,3.29000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,outpatient,1,EA,3.47000,3.29000,The Alliance,Exception Members,,2.67,,,,,,,1.74,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,The Alliance,Exception Members,,5.71,,,,,,,4.08,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Exception Members,,5.71,,,,,,,3.71,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.38,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,47.30,83.42,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,8.17,1324.17,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,inpatient,,,67.40000,64.03000,The Alliance,Exception Members,90,51.90,,,,,,,37.07,65.38,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Exception Members,90,51.90,,,,,,,8.17,628.12,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,2.16,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,inpatient,1,mL,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,outpatient,1,mL,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,inpatient,1,mL,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,inpatient,,,1010.55000,960.02000,The Alliance,Exception Members,,778.12,,,,,,,495.17,980.23,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,outpatient,,,1010.55000,960.02000,The Alliance,Exception Members,,778.12,,,,,,,463.84,1010.55,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,inpatient,1,EA,5931.95000,5635.36000,The Alliance,Exception Members,,4567.60,,,,,,,3262.57,5753.99,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,outpatient,1,EA,5931.95000,5635.36000,The Alliance,Exception Members,,4567.60,,,,,,,55.09,5753.99,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1419.00000,1348.05000,The Alliance,Exception Members,,1092.63,,,,,,,780.45,1376.43,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1419.00000,1348.05000,The Alliance,Exception Members,,1092.63,,,,,,,621.36,1376.43,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,,1867.25,,,,,,,1333.75,2352.25,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,,1867.25,,,,,,,1333.75,4686.00,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,inpatient,1,EA,62.57000,59.44000,The Alliance,Exception Members,,48.18,,,,,,,34.41,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,outpatient,1,EA,62.57000,59.44000,The Alliance,Exception Members,,48.18,,,,,,,7.77,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,7.77,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,inpatient,1,EA,63.04000,59.89000,The Alliance,Exception Members,,48.54,,,,,,,34.67,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,outpatient,1,EA,63.04000,59.89000,The Alliance,Exception Members,,48.54,,,,,,,7.77,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,inpatient,1,EA,44.11000,41.91000,The Alliance,Exception Members,,33.96,,,,,,,24.26,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Exception Members,,33.96,,,,,,,7.77,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,inpatient,1,EA,20.26000,19.24000,The Alliance,Exception Members,,15.60,,,,,,,11.14,19.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,outpatient,1,EA,20.26000,19.24000,The Alliance,Exception Members,,15.60,,,,,,,7.77,19.65,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.87,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.61,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,inpatient,1,EA,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,3.19,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,outpatient,1,EA,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,3.16,5.58,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,2.88,5.58,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,inpatient,,,1182.00000,1122.90000,The Alliance,Exception Members,,910.14,,,,,,,650.10,1146.54,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,outpatient,,,1182.00000,1122.90000,The Alliance,Exception Members,,910.14,,,,,,,650.10,5271.00,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,inpatient,1,EA,46.64000,44.31000,The Alliance,Exception Members,,35.91,,,,,,,25.65,45.24,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,outpatient,1,EA,46.64000,44.31000,The Alliance,Exception Members,,35.91,,,,,,,1.28,45.24,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,inpatient,60,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,outpatient,60,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,inpatient,60,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,outpatient,60,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,TC,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,TC,1998.92,,,,,,,1189.19,2518.12,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,7.77,407.44,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,Exception Members,,210.21,,,,,,,150.15,264.81,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Exception Members,,210.21,,,,,,,119.56,264.81,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,inpatient,1,EA,15.16000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,8.34,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,7.58,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,5.60,288.61,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,inpatient,1,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,1.28,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,1.28,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,1.28,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.28,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,1.28,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,inpatient,1,EA,4.52000,4.29000,The Alliance,Exception Members,,3.48,,,,,,,2.49,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,outpatient,1,EA,4.52000,4.29000,The Alliance,Exception Members,,3.48,,,,,,,1.28,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.63,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,1.28,4.63,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,inpatient,,,54.50000,51.77000,The Alliance,Exception Members,90,41.97,,,,,,,29.98,52.87,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,outpatient,,,54.50000,51.77000,The Alliance,Exception Members,90,41.97,,,,,,,13.30,679.08,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,1.28,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,inpatient,1,EA,34.92000,33.17000,The Alliance,Exception Members,,26.89,,,,,,,19.21,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,outpatient,1,EA,34.92000,33.17000,The Alliance,Exception Members,,26.89,,,,,,,1.28,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,1.28,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,1.28,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,inpatient,1,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,1.28,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,inpatient,1,EA,39.63000,37.65000,The Alliance,Exception Members,,30.52,,,,,,,21.80,38.44,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,outpatient,1,EA,39.63000,37.65000,The Alliance,Exception Members,,30.52,,,,,,,1.28,38.44,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,inpatient,1,EA,3686.90000,3502.55000,The Alliance,Exception Members,,2838.91,,,,,,,2027.80,3576.29,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,outpatient,1,EA,3686.90000,3502.55000,The Alliance,Exception Members,,2838.91,,,,,,,2.55,3576.29,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,12.32,645.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,0.76415,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,2.65,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,0.76415,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,inpatient,1,EA,12.32000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,6.78,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,outpatient,1,EA,12.32000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,0.76415,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,inpatient,1,EA,14.73000,13.99000,The Alliance,Exception Members,,11.34,,,,,,,8.10,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,outpatient,1,EA,14.73000,13.99000,The Alliance,Exception Members,,11.34,,,,,,,0.76415,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,inpatient,1,EA,11.06000,10.50000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,outpatient,1,EA,11.06000,10.50000,The Alliance,Exception Members,,8.52,,,,,,,0.76415,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,inpatient,1,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,0.76415,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,0.76415,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,0.76415,21.46,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,inpatient,1,EA,19.34000,18.37000,The Alliance,Exception Members,,14.89,,,,,,,10.64,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,outpatient,1,EA,19.34000,18.37000,The Alliance,Exception Members,,14.89,,,,,,,9.67,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.60,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,inpatient,1,EA,4.46000,4.24000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,outpatient,1,EA,4.46000,4.24000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.46,4.34,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.23,4.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,inpatient,1,EA,9.14000,8.68000,The Alliance,Exception Members,,7.04,,,,,,,5.03,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,outpatient,1,EA,9.14000,8.68000,The Alliance,Exception Members,,7.04,,,,,,,0.76415,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,inpatient,1,EA,24.82000,23.58000,The Alliance,Exception Members,,19.11,,,,,,,13.65,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,outpatient,1,EA,24.82000,23.58000,The Alliance,Exception Members,,19.11,,,,,,,0.76415,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,inpatient,1,EA,28.19000,26.78000,The Alliance,Exception Members,,21.71,,,,,,,15.50,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,outpatient,1,EA,28.19000,26.78000,The Alliance,Exception Members,,21.71,,,,,,,0.76415,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,inpatient,1,EA,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,7.64,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,0.76415,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,inpatient,1,EA,6.97000,6.62000,The Alliance,Exception Members,,5.37,,,,,,,3.83,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,outpatient,1,EA,6.97000,6.62000,The Alliance,Exception Members,,5.37,,,,,,,0.76415,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,inpatient,1,EA,7.41000,7.04000,The Alliance,Exception Members,,5.71,,,,,,,4.08,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,outpatient,1,EA,7.41000,7.04000,The Alliance,Exception Members,,5.71,,,,,,,0.76415,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,0.76415,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,0.76415,33.72,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,Exception Members,,705.32,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Exception Members,,705.32,,,,,,,314.95,888.52,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,inpatient,1,EA,31.44000,29.87000,The Alliance,Exception Members,,24.21,,,,,,,17.29,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,outpatient,1,EA,31.44000,29.87000,The Alliance,Exception Members,,24.21,,,,,,,7.77,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,inpatient,1,EA,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,12.15,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,7.77,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,inpatient,1,EA,10.14000,9.64000,The Alliance,Exception Members,,7.81,,,,,,,5.58,9.84,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,outpatient,1,EA,10.14000,9.64000,The Alliance,Exception Members,,7.81,,,,,,,5.07,9.84,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,0.76415,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,0.76415,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,0.76415,2.59,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,inpatient,1,EA,31.76000,30.17000,The Alliance,Exception Members,,24.46,,,,,,,17.47,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,outpatient,1,EA,31.76000,30.17000,The Alliance,Exception Members,,24.46,,,,,,,1.86,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,1.86,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,inpatient,1,EA,30.97000,29.42000,The Alliance,Exception Members,,23.85,,,,,,,17.03,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Exception Members,,23.85,,,,,,,1.86,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,inpatient,1,EA,16.61000,15.78000,The Alliance,Exception Members,,12.79,,,,,,,9.14,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,outpatient,1,EA,16.61000,15.78000,The Alliance,Exception Members,,12.79,,,,,,,1.86,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,inpatient,1,EA,44.65000,42.42000,The Alliance,Exception Members,,34.38,,,,,,,24.56,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,outpatient,1,EA,44.65000,42.42000,The Alliance,Exception Members,,34.38,,,,,,,1.86,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,inpatient,1,EA,31.28000,29.72000,The Alliance,Exception Members,,24.09,,,,,,,17.20,30.34,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,outpatient,1,EA,31.28000,29.72000,The Alliance,Exception Members,,24.09,,,,,,,1.86,30.34,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,inpatient,1,EA,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,inpatient,1,EA,4.73000,4.50000,The Alliance,Exception Members,,3.64,,,,,,,2.60,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,outpatient,1,EA,4.73000,4.50000,The Alliance,Exception Members,,3.64,,,,,,,2.37,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,inpatient,1,EA,4.91000,4.66000,The Alliance,Exception Members,,3.78,,,,,,,2.70,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,outpatient,1,EA,4.91000,4.66000,The Alliance,Exception Members,,3.78,,,,,,,2.46,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,inpatient,1,EA,4.86000,4.62000,The Alliance,Exception Members,,3.74,,,,,,,2.67,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,outpatient,1,EA,4.86000,4.62000,The Alliance,Exception Members,,3.74,,,,,,,2.43,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,4.72,254.68,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,inpatient,1,EA,9.90000,9.41000,The Alliance,Exception Members,,7.62,,,,,,,5.45,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,outpatient,1,EA,9.90000,9.41000,The Alliance,Exception Members,,7.62,,,,,,,4.95,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,23.46,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,21.33,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,The Alliance,Exception Members,,16.06,,,,,,,11.47,20.23,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Exception Members,,16.06,,,,,,,10.43,20.23,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,inpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,211.46,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,5271.00,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,inpatient,1,EA,2.41000,2.29000,The Alliance,Exception Members,,1.86,,,,,,,1.33,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Exception Members,,1.86,,,,,,,0.76415,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,inpatient,1,EA,5.62000,5.33000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Exception Members,,4.33,,,,,,,0.76415,5.45,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,inpatient,120,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,outpatient,120,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,inpatient,120,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,outpatient,120,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,inpatient,1,mL,49.82000,47.33000,The Alliance,Exception Members,,38.36,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Exception Members,,38.36,,,,,,,24.91,129.48,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,inpatient,1,EA,38.10000,36.19000,The Alliance,Exception Members,,29.34,,,,,,,20.95,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,outpatient,1,EA,38.10000,36.19000,The Alliance,Exception Members,,29.34,,,,,,,19.05,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.46,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,inpatient,1,EA,6.39000,6.07000,The Alliance,Exception Members,,4.92,,,,,,,3.51,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,outpatient,1,EA,6.39000,6.07000,The Alliance,Exception Members,,4.92,,,,,,,3.19,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,2.17,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,110.00,194.00,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,11.53,594.19,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,inpatient,100,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,outpatient,100,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,inpatient,100,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,outpatient,100,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,inpatient,100,EA,25.98000,24.68000,The Alliance,Exception Members,,20.00,,,,,,,14.29,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,outpatient,100,EA,25.98000,24.68000,The Alliance,Exception Members,,20.00,,,,,,,12.99,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,inpatient,,,2419.00000,2298.05000,The Alliance,Exception Members,,1862.63,,,,,,,1330.45,2346.43,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,outpatient,,,2419.00000,2298.05000,The Alliance,Exception Members,,1862.63,,,,,,,1330.45,5271.00,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,inpatient,1,mL,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,outpatient,1,mL,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.97,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,inpatient,1,EA,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.94,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.67,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,inpatient,1,EA,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.80,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.54,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,3.06,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,2.78,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.97,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.43,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,inpatient,1,EA,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,3.20,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,8.17,662.12,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,138.60,244.44,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,26.72,1273.27,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,inpatient,,,35.20000,33.44000,The Alliance,Exception Members,90,27.10,,,,,,,19.36,34.14,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,outpatient,,,35.20000,33.44000,The Alliance,Exception Members,90,27.10,,,,,,,14.59,729.98,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.47,339.51,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,inpatient,2,EA,47.59000,45.21000,The Alliance,Exception Members,,36.64,,,,,,,26.17,46.16,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,outpatient,2,EA,47.59000,45.21000,The Alliance,Exception Members,,36.64,,,,,,,23.80,48.21,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,inpatient,2,EA,52.30000,49.68000,The Alliance,Exception Members,,40.27,,,,,,,28.77,50.73,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,outpatient,2,EA,52.30000,49.68000,The Alliance,Exception Members,,40.27,,,,,,,26.15,50.73,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,inpatient,,,167.30000,158.94000,The Alliance,Exception Members,90,128.82,,,,,,,92.02,162.28,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Exception Members,90,128.82,,,,,,,17.43,882.80,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,The Alliance,Exception Members,,678.37,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Exception Members,,678.37,,,,,,,314.95,854.57,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,inpatient,,,790.00000,750.50000,The Alliance,Exception Members,TC,608.30,,,,,,,434.50,766.30,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Exception Members,TC,608.30,,,,,,,304.21,3547.16,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,67.58,471.42,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,10.74,560.26,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,314.95,700.34,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,inpatient,2,EA,2573.64000,2444.96000,The Alliance,Exception Members,,1981.70,,,,,,,1415.50,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,outpatient,2,EA,2573.64000,2444.96000,The Alliance,Exception Members,,1981.70,,,,,,,835.80,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,inpatient,2,EA,3600.65000,3420.62000,The Alliance,Exception Members,,2772.50,,,,,,,1980.36,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,outpatient,2,EA,3600.65000,3420.62000,The Alliance,Exception Members,,2772.50,,,,,,,835.80,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,inpatient,2,EA,2626.01000,2494.71000,The Alliance,Exception Members,,2022.03,,,,,,,1444.31,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,outpatient,2,EA,2626.01000,2494.71000,The Alliance,Exception Members,,2022.03,,,,,,,835.80,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,inpatient,2,EA,3601.91000,3421.82000,The Alliance,Exception Members,,2773.47,,,,,,,1981.05,3493.85,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,outpatient,2,EA,3601.91000,3421.82000,The Alliance,Exception Members,,2773.47,,,,,,,835.80,3493.85,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,67.58,180.42,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,5.00,254.68,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,37.78,66.64,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,8.17,611.15,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,inpatient,1,EA,18.13000,17.22000,The Alliance,Exception Members,,13.96,,,,,,,9.97,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,outpatient,1,EA,18.13000,17.22000,The Alliance,Exception Members,,13.96,,,,,,,9.06,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,inpatient,1,EA,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,6.57,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,5.97,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,inpatient,1,EA,17.32000,16.45000,The Alliance,Exception Members,,13.34,,,,,,,9.53,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Exception Members,,13.34,,,,,,,8.66,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,inpatient,1,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,4.27,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,inpatient,1,EA,17.40000,16.53000,The Alliance,Exception Members,,13.40,,,,,,,9.57,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,outpatient,1,EA,17.40000,16.53000,The Alliance,Exception Members,,13.40,,,,,,,8.70,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,inpatient,1,EA,12.33000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,6.78,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,6.17,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,inpatient,1,EA,20.14000,19.13000,The Alliance,Exception Members,,15.51,,,,,,,11.08,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,outpatient,1,EA,20.14000,19.13000,The Alliance,Exception Members,,15.51,,,,,,,10.07,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,inpatient,1,EA,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,1.74,3.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,outpatient,1,EA,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,1.58,3.07,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,inpatient,1,EA,6.62000,6.29000,The Alliance,Exception Members,,5.10,,,,,,,3.64,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,outpatient,1,EA,6.62000,6.29000,The Alliance,Exception Members,,5.10,,,,,,,3.31,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,inpatient,1,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.78,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,inpatient,1,EA,16.31000,15.49000,The Alliance,Exception Members,,12.56,,,,,,,8.97,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,outpatient,1,EA,16.31000,15.49000,The Alliance,Exception Members,,12.56,,,,,,,1.86,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,inpatient,1,EA,19.05000,18.10000,The Alliance,Exception Members,,14.67,,,,,,,10.48,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,outpatient,1,EA,19.05000,18.10000,The Alliance,Exception Members,,14.67,,,,,,,1.86,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,1.86,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,inpatient,1,EA,18.01000,17.11000,The Alliance,Exception Members,,13.87,,,,,,,9.91,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Exception Members,,13.87,,,,,,,1.86,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,inpatient,1,EA,22.50000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,12.38,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,1.86,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,1.86,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,inpatient,1,EA,18.33000,17.41000,The Alliance,Exception Members,,14.11,,,,,,,10.08,17.78,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Exception Members,,14.11,,,,,,,1.86,17.78,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.57,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.15,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,inpatient,1,EA,13.54000,12.87000,The Alliance,Exception Members,,10.43,,,,,,,7.45,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,outpatient,1,EA,13.54000,12.87000,The Alliance,Exception Members,,10.43,,,,,,,6.77,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.58,6.31,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.25,6.31,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,inpatient,50,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,outpatient,50,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,inpatient,50,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,inpatient,50,EA,1.85000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,outpatient,50,EA,1.85000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,inpatient,50,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,outpatient,50,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,inpatient,50,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,outpatient,50,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,inpatient,50,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,outpatient,50,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,inpatient,50,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,outpatient,50,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,inpatient,1,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,inpatient,1,EA,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,9.81,458.40,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.75,271.65,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,7.87,407.44,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,4.60,237.65,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,67.58,395.76,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,inpatient,1,mL,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.43,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,outpatient,1,mL,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,0.06045,3.43,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,inpatient,1,mL,104.95000,99.70000,The Alliance,Exception Members,,80.81,,,,,,,57.72,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,outpatient,1,mL,104.95000,99.70000,The Alliance,Exception Members,,80.81,,,,,,,52.48,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,inpatient,1,mL,94.45000,89.73000,The Alliance,Exception Members,,72.73,,,,,,,51.95,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,outpatient,1,mL,94.45000,89.73000,The Alliance,Exception Members,,72.73,,,,,,,47.23,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,inpatient,1,mL,86.63000,82.30000,The Alliance,Exception Members,,66.71,,,,,,,47.65,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,outpatient,1,mL,86.63000,82.30000,The Alliance,Exception Members,,66.71,,,,,,,43.31,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,inpatient,1,mL,73.73000,70.05000,The Alliance,Exception Members,,56.77,,,,,,,40.55,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,outpatient,1,mL,73.73000,70.05000,The Alliance,Exception Members,,56.77,,,,,,,36.87,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,inpatient,1,mL,48.60000,46.17000,The Alliance,Exception Members,,37.42,,,,,,,26.73,47.14,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,outpatient,1,mL,48.60000,46.17000,The Alliance,Exception Members,,37.42,,,,,,,24.30,47.14,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,178.20,314.28,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,35.09,1833.46,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.74,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.32,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.02,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,inpatient,1,EA,6.05000,5.75000,The Alliance,Exception Members,,4.66,,,,,,,3.33,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Exception Members,,4.66,,,,,,,3.02,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,24.09,1137.41,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,76.45,134.83,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,11.98,628.12,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,3.83,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,inpatient,,,1316.00000,1250.20000,The Alliance,Exception Members,,1013.32,,,,,,,723.80,1276.52,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,outpatient,,,1316.00000,1250.20000,The Alliance,Exception Members,,1013.32,,,,,,,144.61,6807.60,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,inpatient,1,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.16,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,169.40,298.76,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,33.47,1578.85,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,,1251.25,,,,,,,893.75,1576.25,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,,1251.25,,,,,,,125.49,6518.98,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,inpatient,1,EA,6.49000,6.17000,The Alliance,Exception Members,,5.00,,,,,,,3.57,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,outpatient,1,EA,6.49000,6.17000,The Alliance,Exception Members,,5.00,,,,,,,3.25,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.53,2.71,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.40,2.71,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,inpatient,,,2292.00000,2177.40000,The Alliance,Exception Members,,1764.84,,,,,,,1260.60,2223.24,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,outpatient,,,2292.00000,2177.40000,The Alliance,Exception Members,,1764.84,,,,,,,248.52,12426.88,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,inpatient,10,EA,9.91000,9.41000,The Alliance,Exception Members,,7.63,,,,,,,5.45,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,outpatient,10,EA,9.91000,9.41000,The Alliance,Exception Members,,7.63,,,,,,,4.96,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,inpatient,10,EA,10.62000,10.09000,The Alliance,Exception Members,,8.18,,,,,,,5.84,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,outpatient,10,EA,10.62000,10.09000,The Alliance,Exception Members,,8.18,,,,,,,5.31,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,inpatient,10,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,outpatient,10,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,inpatient,10,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.29,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,outpatient,10,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.08,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,inpatient,10,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,outpatient,10,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,inpatient,10,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,outpatient,10,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,inpatient,,,890.00000,845.50000,The Alliance,Exception Members,,685.30,,,,,,,489.50,863.30,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,Exception Members,,685.30,,,,,,,68.60,3582.03,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,inpatient,,,84.40000,80.18000,The Alliance,Exception Members,90,64.99,,,,,,,46.42,81.87,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,outpatient,,,84.40000,80.18000,The Alliance,Exception Members,90,64.99,,,,,,,10.23,1052.52,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,11.89,628.12,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,4.35,220.68,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,90,26.18,,,,,,,18.70,32.98,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,90,26.18,,,,,,,17.00,1086.52,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,inpatient,1,mL,22.31000,21.19000,The Alliance,Exception Members,,17.18,,,,,,,12.27,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Exception Members,,17.18,,,,,,,11.15,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.92,3.39,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.39,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,67.58,393.82,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,9.21,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,The Alliance,Exception Members,,13.55,,,,,,,9.68,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Exception Members,,13.55,,,,,,,8.80,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.85,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.60,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,inpatient,1,EA,15.74000,14.95000,The Alliance,Exception Members,,12.12,,,,,,,8.66,15.27,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,outpatient,1,EA,15.74000,14.95000,The Alliance,Exception Members,,12.12,,,,,,,7.87,15.27,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,inpatient,1,EA,15.49000,14.71000,The Alliance,Exception Members,,11.93,,,,,,,8.52,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,outpatient,1,EA,15.49000,14.71000,The Alliance,Exception Members,,11.93,,,,,,,7.75,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,inpatient,1,EA,52.90000,50.26000,The Alliance,Exception Members,,40.73,,,,,,,29.09,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,outpatient,1,EA,52.90000,50.26000,The Alliance,Exception Members,,40.73,,,,,,,26.45,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,inpatient,1,EA,36.26000,34.45000,The Alliance,Exception Members,,27.92,,,,,,,19.94,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,outpatient,1,EA,36.26000,34.45000,The Alliance,Exception Members,,27.92,,,,,,,1.63,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.27,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.16,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,inpatient,1,EA,84.97000,80.72000,The Alliance,Exception Members,,65.43,,,,,,,46.73,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,outpatient,1,EA,84.97000,80.72000,The Alliance,Exception Members,,65.43,,,,,,,1.63,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,inpatient,1,EA,81.63000,77.55000,The Alliance,Exception Members,,62.86,,,,,,,44.90,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,outpatient,1,EA,81.63000,77.55000,The Alliance,Exception Members,,62.86,,,,,,,1.63,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,inpatient,1,EA,17.91000,17.01000,The Alliance,Exception Members,,13.79,,,,,,,9.85,17.37,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,outpatient,1,EA,17.91000,17.01000,The Alliance,Exception Members,,13.79,,,,,,,1.63,17.37,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,inpatient,1,mL,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,245.30,432.62,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,34.43,1799.53,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,177.51,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,6003.00,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,inpatient,,,151.40000,143.83000,The Alliance,Exception Members,90,116.58,,,,,,,83.27,146.86,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,outpatient,,,151.40000,143.83000,The Alliance,Exception Members,90,116.58,,,,,,,28.73,1459.96,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,inpatient,1,mL,49.82000,47.33000,The Alliance,Exception Members,,38.36,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Exception Members,,38.36,,,,,,,24.91,129.48,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,inpatient,1,mL,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,0.06045,3.27,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,10.91,21.17,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.39,288.61,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,inpatient,6,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,inpatient,6,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,outpatient,6,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,inpatient,6,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,inpatient,6,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,outpatient,6,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.15,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,inpatient,6,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,outpatient,6,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,inpatient,6,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,outpatient,6,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,inpatient,1,EA,41.98000,39.89000,The Alliance,Exception Members,,32.32,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,outpatient,1,EA,41.98000,39.89000,The Alliance,Exception Members,,32.32,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,inpatient,1,EA,25.85000,24.56000,The Alliance,Exception Members,,19.90,,,,,,,14.22,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,outpatient,1,EA,25.85000,24.56000,The Alliance,Exception Members,,19.90,,,,,,,12.93,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,inpatient,1,EA,30.74000,29.20000,The Alliance,Exception Members,,23.67,,,,,,,16.91,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,outpatient,1,EA,30.74000,29.20000,The Alliance,Exception Members,,23.67,,,,,,,15.37,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,inpatient,1,EA,65.64000,62.35000,The Alliance,Exception Members,,50.54,,,,,,,36.10,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,outpatient,1,EA,65.64000,62.35000,The Alliance,Exception Members,,50.54,,,,,,,32.82,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,inpatient,1,EA,41.98000,39.88000,The Alliance,Exception Members,,32.32,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,outpatient,1,EA,41.98000,39.88000,The Alliance,Exception Members,,32.32,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,inpatient,1,EA,45.08000,42.83000,The Alliance,Exception Members,,34.71,,,,,,,24.79,43.73,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,outpatient,1,EA,45.08000,42.83000,The Alliance,Exception Members,,34.71,,,,,,,22.54,43.73,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,inpatient,1,EA,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.98,12.31,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,outpatient,1,EA,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.34,12.31,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,inpatient,15,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,outpatient,15,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,inpatient,15,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,outpatient,15,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,inpatient,15,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,outpatient,15,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,inpatient,15,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,outpatient,15,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,inpatient,15,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,outpatient,15,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,220.19,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,113.50,220.19,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,inpatient,10,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,7.30,12.87,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,outpatient,10,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,6.63,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,inpatient,10,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,outpatient,10,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,inpatient,10,EA,9.90000,9.41000,The Alliance,Exception Members,,7.62,,,,,,,5.45,9.60,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,outpatient,10,EA,9.90000,9.41000,The Alliance,Exception Members,,7.62,,,,,,,4.95,29.16,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,inpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,73.70,129.98,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,12.00,628.12,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,inpatient,40,EA,6.86000,6.52000,The Alliance,Exception Members,,5.28,,,,,,,3.77,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,outpatient,40,EA,6.86000,6.52000,The Alliance,Exception Members,,5.28,,,,,,,3.43,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,inpatient,40,EA,8.24000,7.82000,The Alliance,Exception Members,,6.34,,,,,,,4.53,7.99,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,outpatient,40,EA,8.24000,7.82000,The Alliance,Exception Members,,6.34,,,,,,,4.12,7.99,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,inpatient,1,EA,83.73000,79.55000,The Alliance,Exception Members,,64.47,,,,,,,46.05,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,outpatient,1,EA,83.73000,79.55000,The Alliance,Exception Members,,64.47,,,,,,,41.87,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,inpatient,1,EA,52.59000,49.96000,The Alliance,Exception Members,,40.49,,,,,,,28.92,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,outpatient,1,EA,52.59000,49.96000,The Alliance,Exception Members,,40.49,,,,,,,26.30,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,inpatient,1,EA,83.82000,79.63000,The Alliance,Exception Members,,64.54,,,,,,,46.10,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,outpatient,1,EA,83.82000,79.63000,The Alliance,Exception Members,,64.54,,,,,,,41.91,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,inpatient,1,EA,207.99000,197.59000,The Alliance,Exception Members,,160.15,,,,,,,114.39,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,outpatient,1,EA,207.99000,197.59000,The Alliance,Exception Members,,160.15,,,,,,,104.00,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,inpatient,1,EA,60.92000,57.87000,The Alliance,Exception Members,,46.91,,,,,,,33.51,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,outpatient,1,EA,60.92000,57.87000,The Alliance,Exception Members,,46.91,,,,,,,30.46,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,inpatient,1,EA,41.91000,39.81000,The Alliance,Exception Members,,32.27,,,,,,,23.05,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,outpatient,1,EA,41.91000,39.81000,The Alliance,Exception Members,,32.27,,,,,,,20.95,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,inpatient,1,EA,25.98000,24.68000,The Alliance,Exception Members,,20.00,,,,,,,14.29,25.20,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,outpatient,1,EA,25.98000,24.68000,The Alliance,Exception Members,,20.00,,,,,,,12.99,25.20,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,inpatient,6,EA,2.25000,2.13000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,outpatient,6,EA,2.25000,2.13000,The Alliance,Exception Members,,1.73,,,,,,,1.12,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,inpatient,6,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,inpatient,6,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,outpatient,6,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,inpatient,6,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,2.76,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,122.40,5271.00,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,inpatient,1,EA,1.78000,1.70000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,inpatient,30,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,outpatient,30,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,inpatient,30,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,outpatient,30,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,10.91,21.17,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,inpatient,1,EA,20.37000,19.35000,The Alliance,Exception Members,,15.68,,,,,,,11.20,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,outpatient,1,EA,20.37000,19.35000,The Alliance,Exception Members,,15.68,,,,,,,10.19,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,33.55,59.17,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,5.18,271.65,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.18,271.65,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,94.05,165.87,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,14.39,746.94,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,inpatient,,,1930.00000,1833.50000,The Alliance,Exception Members,90,1486.10,,,,,,,1061.50,1872.10,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,outpatient,,,1930.00000,1833.50000,The Alliance,Exception Members,90,1486.10,,,,,,,70.04,7690.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,inpatient,1,EA,1.63000,1.54000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,outpatient,1,EA,1.63000,1.54000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.18,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,inpatient,1,EA,17.74000,16.85000,The Alliance,Exception Members,,13.66,,,,,,,9.76,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,outpatient,1,EA,17.74000,16.85000,The Alliance,Exception Members,,13.66,,,,,,,8.87,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,inpatient,1,EA,15.16000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,8.34,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,7.58,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,8.43,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,7.67,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,inpatient,1,EA,14.19000,13.48000,The Alliance,Exception Members,,10.93,,,,,,,7.80,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,outpatient,1,EA,14.19000,13.48000,The Alliance,Exception Members,,10.93,,,,,,,7.09,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,inpatient,1,EA,16.25000,15.43000,The Alliance,Exception Members,,12.51,,,,,,,8.94,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,outpatient,1,EA,16.25000,15.43000,The Alliance,Exception Members,,12.51,,,,,,,8.12,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,inpatient,1,EA,8.81000,8.37000,The Alliance,Exception Members,,6.78,,,,,,,4.85,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Exception Members,,6.78,,,,,,,4.41,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,2.28,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,2.07,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,inpatient,1,EA,11.76000,11.17000,The Alliance,Exception Members,,9.06,,,,,,,6.47,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,outpatient,1,EA,11.76000,11.17000,The Alliance,Exception Members,,9.06,,,,,,,5.88,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,inpatient,1,EA,29.36000,27.89000,The Alliance,Exception Members,,22.61,,,,,,,16.15,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,outpatient,1,EA,29.36000,27.89000,The Alliance,Exception Members,,22.61,,,,,,,14.68,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,inpatient,1,EA,22.06000,20.96000,The Alliance,Exception Members,,16.99,,,,,,,12.13,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,outpatient,1,EA,22.06000,20.96000,The Alliance,Exception Members,,16.99,,,,,,,11.03,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.08,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.61,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,inpatient,1,EA,5.49000,5.22000,The Alliance,Exception Members,,4.23,,,,,,,3.02,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,outpatient,1,EA,5.49000,5.22000,The Alliance,Exception Members,,4.23,,,,,,,2.75,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,The Alliance,Exception Members,,6.68,,,,,,,4.77,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Exception Members,,6.68,,,,,,,4.34,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.23,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.03,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.99,3.50,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.80,3.50,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,inpatient,1,mL,141.01000,133.96000,The Alliance,Exception Members,,108.58,,,,,,,77.56,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,outpatient,1,mL,141.01000,133.96000,The Alliance,Exception Members,,108.58,,,,,,,70.50,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,inpatient,1,mL,174.20000,165.49000,The Alliance,Exception Members,,134.13,,,,,,,95.81,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,outpatient,1,mL,174.20000,165.49000,The Alliance,Exception Members,,134.13,,,,,,,87.10,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,inpatient,1,mL,193.55000,183.87000,The Alliance,Exception Members,,149.03,,,,,,,106.45,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,outpatient,1,mL,193.55000,183.87000,The Alliance,Exception Members,,149.03,,,,,,,96.78,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,inpatient,1,mL,232.26000,220.65000,The Alliance,Exception Members,,178.84,,,,,,,127.74,225.29,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,outpatient,1,mL,232.26000,220.65000,The Alliance,Exception Members,,178.84,,,,,,,116.13,225.29,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,12.41,645.08,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,inpatient,42.5,EA,47.41000,45.04000,The Alliance,Exception Members,,36.51,,,,,,,26.08,45.99,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,outpatient,42.5,EA,47.41000,45.04000,The Alliance,Exception Members,,36.51,,,,,,,23.70,45.99,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,16.30,848.80,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,inpatient,,,291.00000,276.45000,The Alliance,Exception Members,,224.07,,,,,,,160.05,282.27,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Exception Members,,224.07,,,,,,,145.50,1714.64,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,inpatient,,,6254.85000,5942.11000,The Alliance,Exception Members,,4816.23,,,,,,,3064.88,6067.20,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,outpatient,,,6254.85000,5942.11000,The Alliance,Exception Members,,4816.23,,,,,,,2870.98,6254.85,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,9.02,662.12,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,4.75,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,212.44,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,inpatient,,,1859.00000,1766.05000,The Alliance,Exception Members,TC,1431.43,,,,,,,1022.45,1803.23,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,outpatient,,,1859.00000,1766.05000,The Alliance,Exception Members,TC,1431.43,,,,,,,929.50,1820.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,inpatient,,,3545.00000,3367.75000,The Alliance,Exception Members,TC,2729.65,,,,,,,1949.75,3438.65,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,outpatient,,,3545.00000,3367.75000,The Alliance,Exception Members,TC,2729.65,,,,,,,1285.85,3438.65,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,inpatient,1,EA,103.18000,98.02000,The Alliance,Exception Members,,79.45,,,,,,,56.75,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,outpatient,1,EA,103.18000,98.02000,The Alliance,Exception Members,,79.45,,,,,,,11.16,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,inpatient,1,EA,94.74000,90.00000,The Alliance,Exception Members,,72.95,,,,,,,52.11,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,outpatient,1,EA,94.74000,90.00000,The Alliance,Exception Members,,72.95,,,,,,,11.16,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,11.16,38.31,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,64.90,114.46,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,10.56,441.94,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,37.50,1833.46,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,7417.50000,7046.62000,The Alliance,Exception Members,,5711.48,,,,,,,3634.57,7194.98,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,7417.50000,7046.62000,The Alliance,Exception Members,,5711.48,,,,,,,3404.63,7417.50,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,inpatient,,,974.00000,925.30000,The Alliance,Exception Members,,749.98,,,,,,,535.70,944.78,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Exception Members,,749.98,,,,,,,487.00,944.78,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,5.18,271.65,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,3.83,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,5.12,271.65,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,16.71,865.84,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,8.17,628.12,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,36.50,1544.85,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,inpatient,1,EA,276.04000,262.24000,The Alliance,Exception Members,,212.55,,,,,,,151.82,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,outpatient,1,EA,276.04000,262.24000,The Alliance,Exception Members,,212.55,,,,,,,44.86,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,inpatient,1,EA,253.43000,240.76000,The Alliance,Exception Members,,195.14,,,,,,,139.39,245.83,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,outpatient,1,EA,253.43000,240.76000,The Alliance,Exception Members,,195.14,,,,,,,44.86,245.83,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,TC,950.95,,,,,,,679.25,1197.95,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,TC,950.95,,,,,,,584.87,1820.00,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,8.17,679.08,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,inpatient,118,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,outpatient,118,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,inpatient,118,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,outpatient,118,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,inpatient,118,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,outpatient,118,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,inpatient,118,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,outpatient,118,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,13.82,645.08,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,545.05,961.27,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,495.50,1820.00,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,685.30,1208.62,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,584.87,1820.00,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2823.14,5588.65,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2644.53,5761.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,inpatient,,,2650.00000,2517.50000,The Alliance,Exception Members,TC,2040.50,,,,,,,1457.50,2570.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,outpatient,,,2650.00000,2517.50000,The Alliance,Exception Members,TC,2040.50,,,,,,,1285.85,2570.50,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,The Alliance,Exception Members,TC,1647.80,,,,,,,1177.00,2075.80,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Exception Members,TC,1647.80,,,,,,,1070.00,2075.80,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,inpatient,,,3245.00000,3082.75000,The Alliance,Exception Members,,2498.65,,,,,,,1784.75,3147.65,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Exception Members,,2498.65,,,,,,,800.09,4686.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,inpatient,,,1950.00000,1852.50000,The Alliance,Exception Members,TC,1501.50,,,,,,,1072.50,1891.50,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,outpatient,,,1950.00000,1852.50000,The Alliance,Exception Members,TC,1501.50,,,,,,,975.00,1891.50,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,8.17,679.08,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,inpatient,,,29.20000,27.74000,The Alliance,Exception Members,90,22.48,,,,,,,16.06,28.32,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,outpatient,,,29.20000,27.74000,The Alliance,Exception Members,90,22.48,,,,,,,9.83,611.15,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,62.70,110.58,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,9.46,492.33,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,2.16,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,inpatient,1,mL,9.57000,9.10000,The Alliance,Exception Members,,7.37,,,,,,,5.26,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,outpatient,1,mL,9.57000,9.10000,The Alliance,Exception Members,,7.37,,,,,,,2.50,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,inpatient,1,mL,96.78000,91.94000,The Alliance,Exception Members,,74.52,,,,,,,53.23,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,outpatient,1,mL,96.78000,91.94000,The Alliance,Exception Members,,74.52,,,,,,,2.50,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,inpatient,1,mL,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,outpatient,1,mL,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,2.50,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,inpatient,1,mL,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.84,3.24,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.67,3.24,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,12.95,679.08,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,6.47,339.51,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,2522.85,4449.39,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,1538.48,4686.00,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1020.00000,969.00000,The Alliance,Exception Members,TC,785.40,,,,,,,561.00,989.40,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,Exception Members,TC,785.40,,,,,,,510.00,1820.00,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,7.33,1284.54,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,inpatient,1,mL,9.11000,8.65000,The Alliance,Exception Members,,7.01,,,,,,,5.01,8.84,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,outpatient,1,mL,9.11000,8.65000,The Alliance,Exception Members,,7.01,,,,,,,4.55,8.84,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,The Alliance,Exception Members,TC,1774.08,,,,,,,1267.20,2234.88,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Exception Members,TC,1774.08,,,,,,,979.11,2234.88,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,inpatient,,,2144.00000,2036.80000,The Alliance,Exception Members,TC,1650.88,,,,,,,1179.20,2079.68,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,outpatient,,,2144.00000,2036.80000,The Alliance,Exception Members,TC,1650.88,,,,,,,979.11,2079.68,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,The Alliance,Exception Members,TC,1821.05,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Exception Members,TC,1821.05,,,,,,,979.11,2294.05,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.06,424.40,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.51,339.51,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1081.00000,1026.95000,The Alliance,Exception Members,TC,832.37,,,,,,,594.55,1048.57,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1081.00000,1026.95000,The Alliance,Exception Members,TC,832.37,,,,,,,540.50,1820.00,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,TC,152.46,,,,,,,108.90,192.06,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,TC,152.46,,,,,,,99.00,1820.00,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,8.17,882.80,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,inpatient,,,49.50000,47.02000,The Alliance,Exception Members,TC,38.12,,,,,,,27.23,48.02,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Exception Members,TC,38.12,,,,,,,24.75,484.28,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,The Alliance,Exception Members,TC,1380.61,,,,,,,986.15,1739.21,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Exception Members,TC,1380.61,,,,,,,896.50,1820.00,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,The Alliance,Exception Members,TC,1128.05,,,,,,,805.75,1421.05,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Exception Members,TC,1128.05,,,,,,,732.50,1820.00,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,TC,2154.46,,,,,,,1538.90,2714.06,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,TC,2154.46,,,,,,,979.11,2714.06,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,inpatient,120,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,outpatient,120,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,409.20,721.68,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,306.02,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,The Alliance,Exception Members,TC,2002.00,,,,,,,1430.00,2522.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Exception Members,TC,2002.00,,,,,,,1285.85,2522.00,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,TC,1819.51,,,,,,,1299.65,2292.11,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Exception Members,TC,1819.51,,,,,,,979.11,2292.11,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,122.40,238.62,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,inpatient,,,2299.00000,2184.05000,The Alliance,Exception Members,TC,1770.23,,,,,,,1264.45,2230.03,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,outpatient,,,2299.00000,2184.05000,The Alliance,Exception Members,TC,1770.23,,,,,,,979.11,2230.03,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,Exception Members,,428.89,,,,,,,306.35,540.29,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Exception Members,,428.89,,,,,,,278.50,540.29,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Exception Members,TC,1782.55,,,,,,,979.11,2245.55,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,65.45,115.43,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,10.32,543.22,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,TC,1439.13,,,,,,,1027.95,1812.93,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,TC,1439.13,,,,,,,934.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,584.87,1820.00,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,1029.05,1814.87,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,935.50,1820.00,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,594.19,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,TC,109.34,,,,,,,78.10,137.74,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,TC,109.34,,,,,,,71.00,1820.00,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,1002.10,1767.34,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,911.00,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,The Alliance,Exception Members,TC,1946.56,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Exception Members,TC,1946.56,,,,,,,1264.00,2452.16,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,6.63,339.51,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,177.65,313.31,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,161.50,313.31,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,60.36,222.13,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,685.30,1208.62,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,623.00,1820.00,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,680.35,1199.89,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,584.87,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,inpatient,,,2196.00000,2086.20000,The Alliance,Exception Members,TC,1690.92,,,,,,,1207.80,2130.12,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,outpatient,,,2196.00000,2086.20000,The Alliance,Exception Members,TC,1690.92,,,,,,,1098.00,2130.12,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,The Alliance,Exception Members,,1061.83,,,,,,,758.45,1337.63,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Exception Members,,1061.83,,,,,,,115.36,6026.72,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,inpatient,,,2621.00000,2489.95000,The Alliance,Exception Members,TC,2018.17,,,,,,,1441.55,2542.37,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,outpatient,,,2621.00000,2489.95000,The Alliance,Exception Members,TC,2018.17,,,,,,,1285.85,2542.37,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,979.11,2548.19,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,6.63,339.51,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,14.61,679.08,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,The Alliance,Exception Members,TC,1442.21,,,,,,,1030.15,1816.81,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Exception Members,TC,1442.21,,,,,,,936.50,1820.00,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,19.60,1018.59,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,4686.00,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,979.11,2209.66,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,1016.40,1792.56,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,924.00,1820.00,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,inpatient,,,1776.00000,1687.20000,The Alliance,Exception Members,TC,1367.52,,,,,,,976.80,1722.72,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,outpatient,,,1776.00000,1687.20000,The Alliance,Exception Members,TC,1367.52,,,,,,,837.93,1820.00,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,The Alliance,Exception Members,TC,1841.84,,,,,,,1315.60,2320.24,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Exception Members,TC,1841.84,,,,,,,979.11,2320.24,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,584.87,1820.00,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,684.20,1206.68,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,584.87,1820.00,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,1029.05,1814.87,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Exception Members,TC,1440.67,,,,,,,935.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,inpatient,,,2319.00000,2203.05000,The Alliance,Exception Members,TC,1785.63,,,,,,,1275.45,2249.43,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,outpatient,,,2319.00000,2203.05000,The Alliance,Exception Members,TC,1785.63,,,,,,,979.11,2249.43,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,685.30,1208.62,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Exception Members,TC,959.42,,,,,,,623.00,1820.00,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,,184.80,,,,,,,132.00,232.80,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,,184.80,,,,,,,20.05,1052.52,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,8.07,424.40,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,6.63,339.51,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,Exception Members,,130.90,,,,,,,93.50,164.90,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Exception Members,,130.90,,,,,,,7.36,356.54,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,6.63,339.51,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,TC,2630.32,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Exception Members,TC,2630.32,,,,,,,979.11,3313.52,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,9.47,492.33,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,The Alliance,Exception Members,TC,1204.28,,,,,,,860.20,1517.08,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Exception Members,TC,1204.28,,,,,,,782.00,1820.00,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,52.80,93.12,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,8.62,458.40,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,684.20,1206.68,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,622.00,1820.00,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,6.63,339.51,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,20.32,1069.56,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,The Alliance,Exception Members,TC,987.91,,,,,,,705.65,1244.51,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Exception Members,TC,987.91,,,,,,,584.87,1820.00,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,8.08,424.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,inpatient,1,EA,1451.33000,1378.77000,The Alliance,Exception Members,,1117.52,,,,,,,798.23,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,outpatient,1,EA,1451.33000,1378.77000,The Alliance,Exception Members,,1117.52,,,,,,,0.62000,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,inpatient,1,EA,958.30000,910.38000,The Alliance,Exception Members,,737.89,,,,,,,527.07,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,outpatient,1,EA,958.30000,910.38000,The Alliance,Exception Members,,737.89,,,,,,,0.62000,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,inpatient,1,EA,1897.17000,1802.32000,The Alliance,Exception Members,,1460.82,,,,,,,1043.44,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,outpatient,1,EA,1897.17000,1802.32000,The Alliance,Exception Members,,1460.82,,,,,,,0.62000,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,inpatient,1,EA,1750.45000,1662.93000,The Alliance,Exception Members,,1347.85,,,,,,,962.75,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,outpatient,1,EA,1750.45000,1662.93000,The Alliance,Exception Members,,1347.85,,,,,,,0.62000,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,inpatient,1,EA,655.27000,622.51000,The Alliance,Exception Members,,504.56,,,,,,,360.40,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,outpatient,1,EA,655.27000,622.51000,The Alliance,Exception Members,,504.56,,,,,,,0.62000,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,inpatient,1,EA,932.40000,885.78000,The Alliance,Exception Members,,717.95,,,,,,,512.82,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,outpatient,1,EA,932.40000,885.78000,The Alliance,Exception Members,,717.95,,,,,,,0.62000,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,inpatient,1,EA,1707.46000,1622.08000,The Alliance,Exception Members,,1314.74,,,,,,,939.10,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,outpatient,1,EA,1707.46000,1622.08000,The Alliance,Exception Members,,1314.74,,,,,,,0.62000,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,inpatient,1,EA,1750.53000,1663.00000,The Alliance,Exception Members,,1347.91,,,,,,,962.79,1698.01,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,outpatient,1,EA,1750.53000,1663.00000,The Alliance,Exception Members,,1347.91,,,,,,,0.62000,1698.01,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,8.09,424.40,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,10.32,543.22,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,10.80,560.26,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,inpatient,,,2404.00000,2283.80000,The Alliance,Exception Members,TC,1851.08,,,,,,,1322.20,2331.88,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,outpatient,,,2404.00000,2283.80000,The Alliance,Exception Members,TC,1851.08,,,,,,,979.11,2331.88,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,12.52,662.12,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,inpatient,,,634.00000,602.30000,The Alliance,Exception Members,TC,488.18,,,,,,,348.70,614.98,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,outpatient,,,634.00000,602.30000,The Alliance,Exception Members,TC,488.18,,,,,,,177.63,3899.16,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,216.31,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,18.05,950.66,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,inpatient,1,mL,5.89000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,3.24,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,outpatient,1,mL,5.89000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,2.94,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,3.28,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,2.98,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,3.25,5.72,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,2.95,5.72,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,The Alliance,Exception Members,TC,1744.05,,,,,,,1245.75,2197.05,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Exception Members,TC,1744.05,,,,,,,1132.50,2197.05,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,The Alliance,Exception Members,TC,1996.61,,,,,,,1426.15,2515.21,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Exception Members,TC,1996.61,,,,,,,979.11,2515.21,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,65.45,115.43,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,14.01,797.91,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,1016.40,1792.56,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,924.00,1820.00,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,6.63,339.51,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,inpatient,1,EA,725.69000,689.41000,The Alliance,Exception Members,,558.78,,,,,,,399.13,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,outpatient,1,EA,725.69000,689.41000,The Alliance,Exception Members,,558.78,,,,,,,0.62000,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,inpatient,1,EA,479.15000,455.19000,The Alliance,Exception Members,,368.95,,,,,,,263.53,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,outpatient,1,EA,479.15000,455.19000,The Alliance,Exception Members,,368.95,,,,,,,0.62000,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,inpatient,1,EA,948.59000,901.16000,The Alliance,Exception Members,,730.41,,,,,,,521.72,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,outpatient,1,EA,948.59000,901.16000,The Alliance,Exception Members,,730.41,,,,,,,0.62000,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,inpatient,1,EA,877.73000,833.84000,The Alliance,Exception Members,,675.85,,,,,,,482.75,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,outpatient,1,EA,877.73000,833.84000,The Alliance,Exception Members,,675.85,,,,,,,0.62000,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,inpatient,1,EA,466.20000,442.89000,The Alliance,Exception Members,,358.97,,,,,,,256.41,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,outpatient,1,EA,466.20000,442.89000,The Alliance,Exception Members,,358.97,,,,,,,0.62000,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,inpatient,1,EA,311.63000,296.05000,The Alliance,Exception Members,,239.96,,,,,,,171.40,302.28,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,outpatient,1,EA,311.63000,296.05000,The Alliance,Exception Members,,239.96,,,,,,,0.62000,302.28,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,680.35,1199.89,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Exception Members,TC,952.49,,,,,,,584.87,1820.00,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,6.63,339.51,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,18.52,865.84,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,inpatient,1,mL,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.26,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,inpatient,1,mL,3.30000,3.14000,The Alliance,Exception Members,,2.54,,,,,,,1.81,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,outpatient,1,mL,3.30000,3.14000,The Alliance,Exception Members,,2.54,,,,,,,1.26,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.26,3.07,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,inpatient,2,EA,69.77000,66.28000,The Alliance,Exception Members,,53.72,,,,,,,38.37,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,outpatient,2,EA,69.77000,66.28000,The Alliance,Exception Members,,53.72,,,,,,,34.88,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,inpatient,2,EA,37.30000,35.44000,The Alliance,Exception Members,,28.72,,,,,,,20.52,36.18,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,outpatient,2,EA,37.30000,35.44000,The Alliance,Exception Members,,28.72,,,,,,,18.65,36.18,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,10.32,543.22,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,The Alliance,Exception Members,TC,1750.21,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Exception Members,TC,1750.21,,,,,,,1136.50,2204.81,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,171.05,301.67,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,50.73,3254.22,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,TC,117.81,,,,,,,84.15,148.41,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,TC,117.81,,,,,,,76.50,905.54,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,inpatient,1,EA,15.71000,14.92000,The Alliance,Exception Members,,12.10,,,,,,,8.64,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,outpatient,1,EA,15.71000,14.92000,The Alliance,Exception Members,,12.10,,,,,,,7.86,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,inpatient,1,EA,27.95000,26.56000,The Alliance,Exception Members,,21.52,,,,,,,15.37,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,outpatient,1,EA,27.95000,26.56000,The Alliance,Exception Members,,21.52,,,,,,,13.97,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,inpatient,1,EA,10.35000,9.84000,The Alliance,Exception Members,,7.97,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,outpatient,1,EA,10.35000,9.84000,The Alliance,Exception Members,,7.97,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,inpatient,1,EA,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,inpatient,1,EA,6.83000,6.48000,The Alliance,Exception Members,,5.26,,,,,,,3.76,6.63,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,outpatient,1,EA,6.83000,6.48000,The Alliance,Exception Members,,5.26,,,,,,,3.42,6.63,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,inpatient,1,EA,5.53000,5.26000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,outpatient,1,EA,5.53000,5.26000,The Alliance,Exception Members,,4.26,,,,,,,1.15,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,inpatient,1,EA,8.46000,8.04000,The Alliance,Exception Members,,6.51,,,,,,,4.65,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Exception Members,,6.51,,,,,,,1.15,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.15,2.36,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,49.50,87.30,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,7.71,407.44,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,60.50,106.70,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,9.44,492.33,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,12.68,967.70,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,inpatient,1,EA,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,18.70,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,outpatient,1,EA,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,17.00,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,inpatient,1,EA,14.74000,14.01000,The Alliance,Exception Members,,11.35,,,,,,,8.11,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,outpatient,1,EA,14.74000,14.01000,The Alliance,Exception Members,,11.35,,,,,,,7.37,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,inpatient,1,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,8.11,14.31,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,outpatient,1,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,7.38,14.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,inpatient,2,EA,53.31000,50.64000,The Alliance,Exception Members,,41.05,,,,,,,29.32,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,outpatient,2,EA,53.31000,50.64000,The Alliance,Exception Members,,41.05,,,,,,,26.66,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,inpatient,2,EA,18.68000,17.74000,The Alliance,Exception Members,,14.38,,,,,,,10.27,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,outpatient,2,EA,18.68000,17.74000,The Alliance,Exception Members,,14.38,,,,,,,9.34,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,inpatient,2,EA,229.42000,217.95000,The Alliance,Exception Members,,176.65,,,,,,,126.18,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,outpatient,2,EA,229.42000,217.95000,The Alliance,Exception Members,,176.65,,,,,,,114.71,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,inpatient,2,EA,18.88000,17.94000,The Alliance,Exception Members,,14.54,,,,,,,10.38,18.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,outpatient,2,EA,18.88000,17.94000,The Alliance,Exception Members,,14.54,,,,,,,9.44,18.31,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Exception Members,TC,2022.79,,,,,,,979.11,2548.19,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,inpatient,,,192.00000,182.40000,The Alliance,Exception Members,90,147.84,,,,,,,105.60,186.24,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Exception Members,90,147.84,,,,,,,20.36,1120.45,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.28,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,inpatient,1,EA,4.99000,4.75000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,outpatient,1,EA,4.99000,4.75000,The Alliance,Exception Members,,3.84,,,,,,,2.50,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.86,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.69,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.13,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.60,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,The Alliance,Exception Members,,16.25,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Exception Members,,16.25,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,inpatient,1,EA,10.45000,9.93000,The Alliance,Exception Members,,8.05,,,,,,,5.75,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,outpatient,1,EA,10.45000,9.93000,The Alliance,Exception Members,,8.05,,,,,,,5.22,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,inpatient,1,EA,9.53000,9.05000,The Alliance,Exception Members,,7.34,,,,,,,5.24,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,outpatient,1,EA,9.53000,9.05000,The Alliance,Exception Members,,7.34,,,,,,,4.76,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,inpatient,1,EA,37.86000,35.96000,The Alliance,Exception Members,,29.15,,,,,,,20.82,36.72,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,outpatient,1,EA,37.86000,35.96000,The Alliance,Exception Members,,29.15,,,,,,,18.93,36.72,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,inpatient,1,mL,4.01000,3.81000,The Alliance,Exception Members,,3.09,,,,,,,2.21,3.89,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,outpatient,1,mL,4.01000,3.81000,The Alliance,Exception Members,,3.09,,,,,,,1.26,3.89,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,1444.30,2547.22,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Exception Members,TC,2022.02,,,,,,,979.11,2547.22,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,inpatient,,,2887.00000,2742.65000,The Alliance,Exception Members,90,2222.99,,,,,,,1587.85,2800.39,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,outpatient,,,2887.00000,2742.65000,The Alliance,Exception Members,90,2222.99,,,,,,,608.00,54562.77,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2287.00000,2172.65000,The Alliance,Exception Members,TC,1760.99,,,,,,,1257.85,2218.39,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Exception Members,TC,1760.99,,,,,,,1143.50,2218.39,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,52.25,92.15,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,8.08,424.40,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,inpatient,,,3088.00000,2933.60000,The Alliance,Exception Members,TC,2377.76,,,,,,,1698.40,2995.36,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,outpatient,,,3088.00000,2933.60000,The Alliance,Exception Members,TC,2377.76,,,,,,,1285.85,2995.36,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,TC,58.52,,,,,,,41.80,73.72,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,TC,58.52,,,,,,,30.28,413.21,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,The Alliance,Exception Members,TC,1776.39,,,,,,,1268.85,2237.79,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Exception Members,TC,1776.39,,,,,,,1153.50,2237.79,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,8.42,696.05,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,0.3,EA,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,0.3,EA,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,3.00,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,3.00,7770.57,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,7.06,1018.59,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.57,288.61,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,inpatient,1,EA,6472.37000,6148.75000,The Alliance,Exception Members,,4983.72,,,,,,,3559.80,6278.20,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,outpatient,1,EA,6472.37000,6148.75000,The Alliance,Exception Members,,4983.72,,,,,,,3236.18,6278.20,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,inpatient,1,mL,301.66000,286.57000,The Alliance,Exception Members,,232.28,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Exception Members,,232.28,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,inpatient,1,mL,346.54000,329.21000,The Alliance,Exception Members,,266.84,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Exception Members,,266.84,,,,,,,69.84,336.14,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,inpatient,1,EA,44.48000,42.25000,The Alliance,Exception Members,,34.25,,,,,,,24.46,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,outpatient,1,EA,44.48000,42.25000,The Alliance,Exception Members,,34.25,,,,,,,3.14,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,inpatient,1,EA,38.82000,36.88000,The Alliance,Exception Members,,29.89,,,,,,,21.35,37.66,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Exception Members,,29.89,,,,,,,3.14,37.66,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,8.41,441.37,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,inpatient,1,mL,3994.25000,3794.54000,The Alliance,Exception Members,,3075.57,,,,,,,2196.84,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,outpatient,1,mL,3994.25000,3794.54000,The Alliance,Exception Members,,3075.57,,,,,,,29.24,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,inpatient,1,mL,4108.08000,3902.67000,The Alliance,Exception Members,,3163.22,,,,,,,2259.44,3984.84,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,outpatient,1,mL,4108.08000,3902.67000,The Alliance,Exception Members,,3163.22,,,,,,,29.24,3984.84,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,3.00,7770.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,inpatient,1,mL,501.16000,476.11000,The Alliance,Exception Members,,385.89,,,,,,,275.64,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Exception Members,,385.89,,,,,,,3.00,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,0.4,EA,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,0.4,EA,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,3.00,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,3.00,1944.52,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,The Alliance,Exception Members,,16.25,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Exception Members,,16.25,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,25.45,1453.11,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,3.40,492.33,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,inpatient,1,EA,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,2.55,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,inpatient,1,EA,2460.50000,2337.48000,The Alliance,Exception Members,,1894.59,,,,,,,1353.28,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,outpatient,1,EA,2460.50000,2337.48000,The Alliance,Exception Members,,1894.59,,,,,,,2.55,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,inpatient,1,EA,1554.00000,1476.30000,The Alliance,Exception Members,,1196.58,,,,,,,854.70,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,outpatient,1,EA,1554.00000,1476.30000,The Alliance,Exception Members,,1196.58,,,,,,,2.55,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,356.12,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,2.55,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,inpatient,1,EA,971.25000,922.69000,The Alliance,Exception Members,,747.86,,,,,,,534.19,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,outpatient,1,EA,971.25000,922.69000,The Alliance,Exception Members,,747.86,,,,,,,2.55,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,inpatient,1,EA,3935.30000,3738.53000,The Alliance,Exception Members,,3030.18,,,,,,,2164.41,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,outpatient,1,EA,3935.30000,3738.53000,The Alliance,Exception Members,,3030.18,,,,,,,2.55,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,inpatient,1,EA,1023.05000,971.90000,The Alliance,Exception Members,,787.75,,,,,,,562.68,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,outpatient,1,EA,1023.05000,971.90000,The Alliance,Exception Members,,787.75,,,,,,,2.55,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,284.90,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,2.55,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,inpatient,1,EA,512.82000,487.18000,The Alliance,Exception Members,,394.87,,,,,,,282.05,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,outpatient,1,EA,512.82000,487.18000,The Alliance,Exception Members,,394.87,,,,,,,2.55,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,inpatient,1,EA,2432.29000,2310.68000,The Alliance,Exception Members,,1872.86,,,,,,,1337.76,2359.32,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,outpatient,1,EA,2432.29000,2310.68000,The Alliance,Exception Members,,1872.86,,,,,,,2.55,2359.32,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,inpatient,0.5,EA,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,outpatient,0.5,EA,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,inpatient,0.42,EA,1193.25000,1133.59000,The Alliance,Exception Members,,918.80,,,,,,,656.29,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,outpatient,0.42,EA,1193.25000,1133.59000,The Alliance,Exception Members,,918.80,,,,,,,3.00,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,inpatient,1,mL,1193.24000,1133.58000,The Alliance,Exception Members,,918.79,,,,,,,656.28,1157.44,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,outpatient,1,mL,1193.24000,1133.58000,The Alliance,Exception Members,,918.79,,,,,,,3.00,1157.44,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,inpatient,1,EA,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,1.77,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,6.63,339.51,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,3.00,7770.57,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,inpatient,1,EA,12.93000,12.28000,The Alliance,Exception Members,,9.96,,,,,,,7.11,12.54,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,outpatient,1,EA,12.93000,12.28000,The Alliance,Exception Members,,9.96,,,,,,,1.77,12.54,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2442.77,4835.69,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2288.23,4985.25,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,6.63,339.51,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,inpatient,500,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,outpatient,500,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,inpatient,500,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,outpatient,500,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,12.95,679.08,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,0.14415,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,0.14415,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,inpatient,1,EA,8.31000,7.90000,The Alliance,Exception Members,,6.40,,,,,,,4.57,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,outpatient,1,EA,8.31000,7.90000,The Alliance,Exception Members,,6.40,,,,,,,0.14415,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,0.14415,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,0.14415,2.38,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,inpatient,3.5,EA,206.04000,195.74000,The Alliance,Exception Members,,158.65,,,,,,,113.32,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,outpatient,3.5,EA,206.04000,195.74000,The Alliance,Exception Members,,158.65,,,,,,,103.02,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,inpatient,3.5,EA,244.89000,232.65000,The Alliance,Exception Members,,188.57,,,,,,,134.69,237.54,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,outpatient,3.5,EA,244.89000,232.65000,The Alliance,Exception Members,,188.57,,,,,,,122.44,237.54,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,inpatient,1,mL,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,outpatient,1,mL,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,inpatient,1,mL,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,2.36,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,outpatient,1,mL,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,0.14415,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.14415,0.98940,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,inpatient,1,EA,79.95000,75.95000,The Alliance,Exception Members,,61.56,,,,,,,43.97,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,outpatient,1,EA,79.95000,75.95000,The Alliance,Exception Members,,61.56,,,,,,,0.04803,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,inpatient,1,EA,1061.15000,1008.09000,The Alliance,Exception Members,,817.09,,,,,,,583.63,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,outpatient,1,EA,1061.15000,1008.09000,The Alliance,Exception Members,,817.09,,,,,,,0.04803,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,0.04803,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,inpatient,1,EA,252.14000,239.53000,The Alliance,Exception Members,,194.15,,,,,,,138.68,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,outpatient,1,EA,252.14000,239.53000,The Alliance,Exception Members,,194.15,,,,,,,0.04803,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,inpatient,1,EA,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,0.04803,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,inpatient,1,EA,1153.79000,1096.10000,The Alliance,Exception Members,,888.42,,,,,,,634.58,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,outpatient,1,EA,1153.79000,1096.10000,The Alliance,Exception Members,,888.42,,,,,,,0.04803,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,inpatient,1,EA,323.78000,307.59000,The Alliance,Exception Members,,249.31,,,,,,,178.08,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,outpatient,1,EA,323.78000,307.59000,The Alliance,Exception Members,,249.31,,,,,,,0.04803,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,inpatient,1,EA,1153.82000,1096.13000,The Alliance,Exception Members,,888.44,,,,,,,634.60,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,outpatient,1,EA,1153.82000,1096.13000,The Alliance,Exception Members,,888.44,,,,,,,0.04803,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,0.04803,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,0.04803,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,inpatient,1,EA,58.74000,55.81000,The Alliance,Exception Members,,45.23,,,,,,,32.31,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,outpatient,1,EA,58.74000,55.81000,The Alliance,Exception Members,,45.23,,,,,,,0.04803,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,inpatient,1,EA,1061.41000,1008.34000,The Alliance,Exception Members,,817.29,,,,,,,583.78,1029.57,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,outpatient,1,EA,1061.41000,1008.34000,The Alliance,Exception Members,,817.29,,,,,,,0.04803,1029.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Exception Members,,1543.59,,,,,,,3.00,1944.52,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,inpatient,1,EA,40.14000,38.13000,The Alliance,Exception Members,,30.91,,,,,,,22.08,38.94,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,outpatient,1,EA,40.14000,38.13000,The Alliance,Exception Members,,30.91,,,,,,,20.07,38.94,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,inpatient,,,2468.00000,2344.60000,The Alliance,Exception Members,,1900.36,,,,,,,1357.40,2393.96,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,outpatient,,,2468.00000,2344.60000,The Alliance,Exception Members,,1900.36,,,,,,,1234.00,2393.96,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,inpatient,5,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,outpatient,5,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.14415,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,inpatient,5,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,outpatient,5,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.14415,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,inpatient,5,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,outpatient,5,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.14415,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,inpatient,5,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,outpatient,5,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14415,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,inpatient,5,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.14415,1.19,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,0.3,EA,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,0.3,EA,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,3.00,3453.59,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,inpatient,1,mL,4321.88000,4105.78000,The Alliance,Exception Members,,3327.85,,,,,,,2377.03,4192.22,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,outpatient,1,mL,4321.88000,4105.78000,The Alliance,Exception Members,,3327.85,,,,,,,29.24,4192.22,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,inpatient,,,325.00000,308.75000,The Alliance,Exception Members,,250.25,,,,,,,178.75,315.25,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Exception Members,,250.25,,,,,,,37.27,3305.11,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,22.23,1154.38,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,inpatient,1,EA,1265.09000,1201.83000,The Alliance,Exception Members,,974.12,,,,,,,695.80,1227.14,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,outpatient,1,EA,1265.09000,1201.83000,The Alliance,Exception Members,,974.12,,,,,,,4.36,1227.14,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.08,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,inpatient,1,EA,224.08000,212.87000,The Alliance,Exception Members,,172.54,,,,,,,123.24,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Exception Members,,172.54,,,,,,,112.04,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,inpatient,1,EA,196.46000,186.63000,The Alliance,Exception Members,,151.27,,,,,,,108.05,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,outpatient,1,EA,196.46000,186.63000,The Alliance,Exception Members,,151.27,,,,,,,98.23,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,inpatient,1,EA,255.96000,243.16000,The Alliance,Exception Members,,197.09,,,,,,,140.78,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Exception Members,,197.09,,,,,,,127.98,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,inpatient,1,EA,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,121.66,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,110.60,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,inpatient,1,EA,280.10000,266.10000,The Alliance,Exception Members,,215.68,,,,,,,154.06,271.70,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,outpatient,1,EA,280.10000,266.10000,The Alliance,Exception Members,,215.68,,,,,,,140.05,271.70,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,inpatient,2,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,outpatient,2,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,10.27,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,inpatient,2,EA,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,36.50,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,outpatient,2,EA,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,33.18,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,inpatient,2,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,outpatient,2,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,5.69,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,inpatient,2,EA,56.25000,53.44000,The Alliance,Exception Members,,43.31,,,,,,,30.94,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,outpatient,2,EA,56.25000,53.44000,The Alliance,Exception Members,,43.31,,,,,,,28.12,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,inpatient,2,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,12.86,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,11.69,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,inpatient,2,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,27.81,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,outpatient,2,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,25.28,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,inpatient,2,EA,30.16000,28.65000,The Alliance,Exception Members,,23.22,,,,,,,16.59,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,outpatient,2,EA,30.16000,28.65000,The Alliance,Exception Members,,23.22,,,,,,,15.08,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,inpatient,2,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.57,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,outpatient,2,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.15,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,inpatient,2,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,outpatient,2,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,2.77,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,inpatient,2,EA,26.61000,25.28000,The Alliance,Exception Members,,20.49,,,,,,,14.64,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,outpatient,2,EA,26.61000,25.28000,The Alliance,Exception Members,,20.49,,,,,,,13.30,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,inpatient,2,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,14.22,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,inpatient,2,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,outpatient,2,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.26,8.27,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,inpatient,,,293.20000,278.54000,The Alliance,Exception Members,90,225.76,,,,,,,161.26,284.40,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,outpatient,,,293.20000,278.54000,The Alliance,Exception Members,90,225.76,,,,,,,26.11,1324.17,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,inpatient,3.5,EA,15.03000,14.28000,The Alliance,Exception Members,,11.57,,,,,,,8.27,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,outpatient,3.5,EA,15.03000,14.28000,The Alliance,Exception Members,,11.57,,,,,,,7.51,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,inpatient,3.5,EA,14.35000,13.63000,The Alliance,Exception Members,,11.05,,,,,,,7.89,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,outpatient,3.5,EA,14.35000,13.63000,The Alliance,Exception Members,,11.05,,,,,,,7.17,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,inpatient,3.5,EA,16.25000,15.44000,The Alliance,Exception Members,,12.51,,,,,,,8.94,15.76,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,outpatient,3.5,EA,16.25000,15.44000,The Alliance,Exception Members,,12.51,,,,,,,8.12,15.76,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,inpatient,1,mL,4.52000,4.29000,The Alliance,Exception Members,,3.48,,,,,,,2.49,4.38,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,outpatient,1,mL,4.52000,4.29000,The Alliance,Exception Members,,3.48,,,,,,,0.14415,4.38,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,inpatient,1,EA,4.51000,4.29000,The Alliance,Exception Members,,3.47,,,,,,,2.48,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,outpatient,1,EA,4.51000,4.29000,The Alliance,Exception Members,,3.47,,,,,,,0.14415,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,inpatient,1,EA,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,7.64,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,0.14415,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,0.14415,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,inpatient,1,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,0.14415,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,inpatient,1,EA,16.56000,15.73000,The Alliance,Exception Members,,12.75,,,,,,,9.11,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,outpatient,1,EA,16.56000,15.73000,The Alliance,Exception Members,,12.75,,,,,,,0.14415,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,inpatient,1,EA,18.26000,17.35000,The Alliance,Exception Members,,14.06,,,,,,,10.04,17.71,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,outpatient,1,EA,18.26000,17.35000,The Alliance,Exception Members,,14.06,,,,,,,0.14415,17.71,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,inpatient,1,EA,3.30000,3.14000,The Alliance,Exception Members,,2.54,,,,,,,1.81,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,outpatient,1,EA,3.30000,3.14000,The Alliance,Exception Members,,2.54,,,,,,,1.65,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,Exception Members,,408.10,,,,,,,291.50,514.10,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Exception Members,,408.10,,,,,,,50.73,4789.16,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,inpatient,,,503.00000,477.85000,The Alliance,Exception Members,,387.31,,,,,,,276.65,487.91,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,outpatient,,,503.00000,477.85000,The Alliance,Exception Members,,387.31,,,,,,,251.50,487.91,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.50,4.85,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,inpatient,1,EA,1328.67000,1262.24000,The Alliance,Exception Members,,1023.08,,,,,,,730.77,1288.81,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,outpatient,1,EA,1328.67000,1262.24000,The Alliance,Exception Members,,1023.08,,,,,,,664.34,8365.47,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,inpatient,1,EA,9519.93000,9043.93000,The Alliance,Exception Members,,7330.35,,,,,,,5235.96,9234.33,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,outpatient,1,EA,9519.93000,9043.93000,The Alliance,Exception Members,,7330.35,,,,,,,4759.97,9234.33,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.18,271.65,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,inpatient,2.5,EA,48.01000,45.61000,The Alliance,Exception Members,,36.97,,,,,,,26.41,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,outpatient,2.5,EA,48.01000,45.61000,The Alliance,Exception Members,,36.97,,,,,,,24.00,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,inpatient,2.5,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,7.30,12.87,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,outpatient,2.5,EA,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,6.63,12.87,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,inpatient,1,mL,105.09000,99.83000,The Alliance,Exception Members,,80.92,,,,,,,57.80,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,outpatient,1,mL,105.09000,99.83000,The Alliance,Exception Members,,80.92,,,,,,,52.55,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,inpatient,1,mL,47.94000,45.55000,The Alliance,Exception Members,,36.91,,,,,,,26.37,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,outpatient,1,mL,47.94000,45.55000,The Alliance,Exception Members,,36.91,,,,,,,23.97,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,inpatient,1,mL,63.92000,60.72000,The Alliance,Exception Members,,49.22,,,,,,,35.16,62.00,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,outpatient,1,mL,63.92000,60.72000,The Alliance,Exception Members,,49.22,,,,,,,31.96,62.00,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,The Alliance,Exception Members,TC,399.63,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Exception Members,TC,399.63,,,,,,,259.50,503.43,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Exception Members,,6168.39,,,,,,,3.00,7770.57,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,inpatient,1,mL,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,outpatient,1,mL,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,inpatient,1,mL,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,outpatient,1,mL,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,inpatient,1,mL,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,outpatient,1,mL,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,inpatient,,,293.80000,279.11000,The Alliance,Exception Members,,226.23,,,,,,,161.59,284.99,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,outpatient,,,293.80000,279.11000,The Alliance,Exception Members,,226.23,,,,,,,146.90,284.99,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,inpatient,1,EA,7.66000,7.28000,The Alliance,Exception Members,,5.90,,,,,,,4.21,7.43,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,outpatient,1,EA,7.66000,7.28000,The Alliance,Exception Members,,5.90,,,,,,,3.83,7.43,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,inpatient,1,EA,0.18000,0.18000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,outpatient,1,EA,0.18000,0.18000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,inpatient,2,EA,53.18000,50.53000,The Alliance,Exception Members,,40.95,,,,,,,29.25,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,outpatient,2,EA,53.18000,50.53000,The Alliance,Exception Members,,40.95,,,,,,,8.97,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,inpatient,2,EA,38.88000,36.94000,The Alliance,Exception Members,,29.94,,,,,,,21.38,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,outpatient,2,EA,38.88000,36.94000,The Alliance,Exception Members,,29.94,,,,,,,8.97,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,inpatient,2,EA,38.89000,36.95000,The Alliance,Exception Members,,29.95,,,,,,,21.39,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,outpatient,2,EA,38.89000,36.95000,The Alliance,Exception Members,,29.95,,,,,,,8.97,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,inpatient,2,EA,38.55000,36.62000,The Alliance,Exception Members,,29.68,,,,,,,21.20,37.39,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,outpatient,2,EA,38.55000,36.62000,The Alliance,Exception Members,,29.68,,,,,,,8.97,37.39,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,inpatient,1,mL,124.51000,118.28000,The Alliance,Exception Members,,95.87,,,,,,,68.48,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,outpatient,1,mL,124.51000,118.28000,The Alliance,Exception Members,,95.87,,,,,,,62.26,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,inpatient,1,mL,77.82000,73.93000,The Alliance,Exception Members,,59.92,,,,,,,42.80,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,outpatient,1,mL,77.82000,73.93000,The Alliance,Exception Members,,59.92,,,,,,,38.91,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,inpatient,1,mL,124.50000,118.28000,The Alliance,Exception Members,,95.86,,,,,,,68.47,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,outpatient,1,mL,124.50000,118.28000,The Alliance,Exception Members,,95.86,,,,,,,62.25,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,inpatient,1,mL,113.46000,107.79000,The Alliance,Exception Members,,87.36,,,,,,,62.40,110.06,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,outpatient,1,mL,113.46000,107.79000,The Alliance,Exception Members,,87.36,,,,,,,56.73,110.06,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,inpatient,1,EA,8.02000,7.62000,The Alliance,Exception Members,,6.18,,,,,,,4.41,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,outpatient,1,EA,8.02000,7.62000,The Alliance,Exception Members,,6.18,,,,,,,4.01,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,inpatient,1,EA,8.74000,8.30000,The Alliance,Exception Members,,6.73,,,,,,,4.81,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,outpatient,1,EA,8.74000,8.30000,The Alliance,Exception Members,,6.73,,,,,,,4.37,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,inpatient,1,EA,7.94000,7.55000,The Alliance,Exception Members,,6.11,,,,,,,4.37,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,outpatient,1,EA,7.94000,7.55000,The Alliance,Exception Members,,6.11,,,,,,,3.97,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,The Alliance,Exception Members,,8.05,,,,,,,5.75,10.15,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Exception Members,,8.05,,,,,,,5.23,10.15,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,inpatient,2,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,outpatient,2,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.34,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,inpatient,2,EA,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,5.20,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,outpatient,2,EA,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,4.72,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,inpatient,2,EA,133.60000,126.92000,The Alliance,Exception Members,,102.87,,,,,,,73.48,129.59,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,outpatient,2,EA,133.60000,126.92000,The Alliance,Exception Members,,102.87,,,,,,,6.40,129.59,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,inpatient,1,EA,5.43000,5.16000,The Alliance,Exception Members,,4.18,,,,,,,2.99,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,outpatient,1,EA,5.43000,5.16000,The Alliance,Exception Members,,4.18,,,,,,,2.71,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,inpatient,1,EA,6.56000,6.23000,The Alliance,Exception Members,,5.05,,,,,,,3.61,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,outpatient,1,EA,6.56000,6.23000,The Alliance,Exception Members,,5.05,,,,,,,3.28,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.54,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.31,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,inpatient,1,GM,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,inpatient,1,GM,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,outpatient,1,GM,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,inpatient,1,GM,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,outpatient,1,GM,0.56000,0.54000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,inpatient,1,GM,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,outpatient,1,GM,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,inpatient,1,EA,36.06000,34.26000,The Alliance,Exception Members,,27.77,,,,,,,19.83,34.98,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,outpatient,1,EA,36.06000,34.26000,The Alliance,Exception Members,,27.77,,,,,,,18.03,34.98,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,Exception Members,,291.06,,,,,,,207.90,366.66,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Exception Members,,291.06,,,,,,,23.25,3435.48,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,90.20,159.08,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,13.28,696.05,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,inpatient,,,2211.00000,2100.45000,The Alliance,Exception Members,,1702.47,,,,,,,1216.05,2144.67,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,outpatient,,,2211.00000,2100.45000,The Alliance,Exception Members,,1702.47,,,,,,,1105.50,2144.67,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,The Alliance,Exception Members,,2.88,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Exception Members,,2.88,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,inpatient,1,mL,137.78000,130.89000,The Alliance,Exception Members,,106.09,,,,,,,75.78,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,outpatient,1,mL,137.78000,130.89000,The Alliance,Exception Members,,106.09,,,,,,,68.89,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,inpatient,1,mL,113.36000,107.69000,The Alliance,Exception Members,,87.29,,,,,,,62.35,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,outpatient,1,mL,113.36000,107.69000,The Alliance,Exception Members,,87.29,,,,,,,56.68,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,inpatient,1,mL,110.52000,105.00000,The Alliance,Exception Members,,85.10,,,,,,,60.79,107.20,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,outpatient,1,mL,110.52000,105.00000,The Alliance,Exception Members,,85.10,,,,,,,55.26,107.20,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,2.16,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.30,4.06,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.06,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,inpatient,1,EA,2.47000,2.35000,The Alliance,Exception Members,,1.90,,,,,,,1.36,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,outpatient,1,EA,2.47000,2.35000,The Alliance,Exception Members,,1.90,,,,,,,1.24,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.18,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,2.06,3.63,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,1.87,3.63,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,The Alliance,Exception Members,,7.05,,,,,,,5.04,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Exception Members,,7.05,,,,,,,4.58,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,The Alliance,Exception Members,,6.99,,,,,,,4.99,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Exception Members,,6.99,,,,,,,4.54,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,inpatient,1,EA,12.30000,11.69000,The Alliance,Exception Members,,9.47,,,,,,,6.76,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,outpatient,1,EA,12.30000,11.69000,The Alliance,Exception Members,,9.47,,,,,,,6.15,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,The Alliance,Exception Members,,7.69,,,,,,,5.49,9.69,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Exception Members,,7.69,,,,,,,5.00,9.69,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,6.12,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,inpatient,1,EA,51.86000,49.26000,The Alliance,Exception Members,,39.93,,,,,,,28.52,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,outpatient,1,EA,51.86000,49.26000,The Alliance,Exception Members,,39.93,,,,,,,6.12,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,6.12,30.65,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,inpatient,50,EA,43.92000,41.73000,The Alliance,Exception Members,,33.82,,,,,,,24.16,42.60,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,outpatient,50,EA,43.92000,41.73000,The Alliance,Exception Members,,33.82,,,,,,,21.96,1225.79,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,inpatient,120,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,outpatient,120,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,inpatient,120,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,inpatient,120,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,outpatient,120,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.46480,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,inpatient,25,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,outpatient,25,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,inpatient,25,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,outpatient,25,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,inpatient,25,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,outpatient,25,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,inpatient,25,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,outpatient,25,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,inpatient,25,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,outpatient,25,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,inpatient,25,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,outpatient,25,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,inpatient,25,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,outpatient,25,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,inpatient,25,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,outpatient,25,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,inpatient,25,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,outpatient,25,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,inpatient,,,4574.00000,4345.30000,The Alliance,Exception Members,,3521.98,,,,,,,2515.70,4436.78,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,outpatient,,,4574.00000,4345.30000,The Alliance,Exception Members,,3521.98,,,,,,,970.83,4436.78,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,inpatient,10,EA,23.95000,22.76000,The Alliance,Exception Members,,18.44,,,,,,,13.17,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,outpatient,10,EA,23.95000,22.76000,The Alliance,Exception Members,,18.44,,,,,,,11.97,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,inpatient,10,EA,10.74000,10.20000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,outpatient,10,EA,10.74000,10.20000,The Alliance,Exception Members,,8.27,,,,,,,5.37,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,inpatient,10,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,outpatient,10,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,inpatient,10,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,outpatient,10,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,inpatient,1,EA,1357.11000,1289.25000,The Alliance,Exception Members,,1044.97,,,,,,,746.41,1316.40,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,outpatient,1,EA,1357.11000,1289.25000,The Alliance,Exception Members,,1044.97,,,,,,,678.55,1316.40,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,inpatient,10,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,outpatient,10,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.46480,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,inpatient,10,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,inpatient,10,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,inpatient,10,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,outpatient,10,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,inpatient,5,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,outpatient,5,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,inpatient,5,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,inpatient,5,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,outpatient,5,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,inpatient,5,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,outpatient,5,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,inpatient,5,EA,1.77000,1.69000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,outpatient,5,EA,1.77000,1.69000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,inpatient,5,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,outpatient,5,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,inpatient,5,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,inpatient,1,EA,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,3.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,1.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,inpatient,1,EA,3.70000,3.52000,The Alliance,Exception Members,,2.85,,,,,,,2.04,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,outpatient,1,EA,3.70000,3.52000,The Alliance,Exception Members,,2.85,,,,,,,1.02,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,inpatient,1,EA,9.51000,9.04000,The Alliance,Exception Members,,7.32,,,,,,,5.23,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,outpatient,1,EA,9.51000,9.04000,The Alliance,Exception Members,,7.32,,,,,,,1.02,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.02,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,1.02,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,1.02,7.97,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.97500,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.97500,1.89,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,inpatient,1,EA,48.51000,46.08000,The Alliance,Exception Members,,37.35,,,,,,,26.68,47.05,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,outpatient,1,EA,48.51000,46.08000,The Alliance,Exception Members,,37.35,,,,,,,24.25,47.05,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,1.18,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,inpatient,1,mL,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,outpatient,1,mL,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,1.18,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,inpatient,1,EA,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,11.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,outpatient,1,EA,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,10.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,11.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,10.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,inpatient,1,EA,19.92000,18.93000,The Alliance,Exception Members,,15.34,,,,,,,10.96,19.32,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,outpatient,1,EA,19.92000,18.93000,The Alliance,Exception Members,,15.34,,,,,,,9.96,19.32,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,inpatient,,,173.44000,164.77000,The Alliance,Exception Members,,133.55,,,,,,,95.39,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Exception Members,,133.55,,,,,,,47.59,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,inpatient,1,mL,346.88000,329.54000,The Alliance,Exception Members,,267.10,,,,,,,190.78,336.47,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Exception Members,,267.10,,,,,,,47.59,336.47,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.61,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.29,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,inpatient,1,EA,2.98000,2.84000,The Alliance,Exception Members,,2.29,,,,,,,1.64,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,outpatient,1,EA,2.98000,2.84000,The Alliance,Exception Members,,2.29,,,,,,,1.49,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.35,4.57,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,inpatient,1,mL,301.66000,286.57000,The Alliance,Exception Members,,232.28,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Exception Members,,232.28,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,inpatient,1,mL,346.54000,329.21000,The Alliance,Exception Members,,266.84,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Exception Members,,266.84,,,,,,,69.84,336.14,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,132.00,232.80,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,120.00,584.87,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,655.05,1155.27,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,TC,917.07,,,,,,,595.50,1155.27,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,inpatient,1,EA,9.92000,9.43000,The Alliance,Exception Members,,7.64,,,,,,,5.46,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,outpatient,1,EA,9.92000,9.43000,The Alliance,Exception Members,,7.64,,,,,,,4.96,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,inpatient,1,EA,17.26000,16.40000,The Alliance,Exception Members,,13.29,,,,,,,9.49,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,outpatient,1,EA,17.26000,16.40000,The Alliance,Exception Members,,13.29,,,,,,,8.63,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,inpatient,1,EA,9.88000,9.38000,The Alliance,Exception Members,,7.61,,,,,,,5.43,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Exception Members,,7.61,,,,,,,4.94,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,inpatient,10,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,outpatient,10,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,inpatient,1,EA,13.23000,12.57000,The Alliance,Exception Members,,10.19,,,,,,,7.28,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,outpatient,1,EA,13.23000,12.57000,The Alliance,Exception Members,,10.19,,,,,,,6.62,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,inpatient,,,1828.00000,1736.60000,The Alliance,Exception Members,TC,1407.56,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Exception Members,TC,1407.56,,,,,,,914.00,1773.16,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,9.15,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,8.32,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,8.81,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,8.81,17.09,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,79.75,140.65,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,13.74,713.01,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,inpatient,1,mL,118.72000,112.79000,The Alliance,Exception Members,,91.41,,,,,,,65.30,115.16,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,outpatient,1,mL,118.72000,112.79000,The Alliance,Exception Members,,91.41,,,,,,,59.36,115.16,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,inpatient,3,EA,92.78000,88.14000,The Alliance,Exception Members,,71.44,,,,,,,51.03,90.00,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,outpatient,3,EA,92.78000,88.14000,The Alliance,Exception Members,,71.44,,,,,,,46.39,99.28,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,inpatient,3,EA,178.30000,169.38000,The Alliance,Exception Members,,137.29,,,,,,,98.06,172.95,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,outpatient,3,EA,178.30000,169.38000,The Alliance,Exception Members,,137.29,,,,,,,89.15,172.95,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,478.13000,454.22000,The Alliance,Exception Members,,368.16,,,,,,,262.97,463.79,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,478.13000,454.22000,The Alliance,Exception Members,,368.16,,,,,,,239.06,463.79,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,17.14,797.91,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,3163.00,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,8.17,797.91,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,inpatient,1,EA,18.61000,17.68000,The Alliance,Exception Members,,14.33,,,,,,,10.24,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,outpatient,1,EA,18.61000,17.68000,The Alliance,Exception Members,,14.33,,,,,,,9.30,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,inpatient,1,EA,7.97000,7.57000,The Alliance,Exception Members,,6.14,,,,,,,4.38,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,outpatient,1,EA,7.97000,7.57000,The Alliance,Exception Members,,6.14,,,,,,,3.98,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.58,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.25,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,inpatient,1,EA,10.30000,9.79000,The Alliance,Exception Members,,7.93,,,,,,,5.67,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,outpatient,1,EA,10.30000,9.79000,The Alliance,Exception Members,,7.93,,,,,,,5.15,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,inpatient,1,EA,6.91000,6.57000,The Alliance,Exception Members,,5.32,,,,,,,3.80,6.70,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,outpatient,1,EA,6.91000,6.57000,The Alliance,Exception Members,,5.32,,,,,,,3.46,6.70,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,Exception Members,TC,208.67,,,,,,,149.05,262.87,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Exception Members,TC,208.67,,,,,,,135.50,262.87,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,inpatient,1,EA,34.68000,32.94000,The Alliance,Exception Members,,26.70,,,,,,,19.07,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,outpatient,1,EA,34.68000,32.94000,The Alliance,Exception Members,,26.70,,,,,,,17.34,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,inpatient,1,EA,42.03000,39.93000,The Alliance,Exception Members,,32.36,,,,,,,23.12,40.77,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,outpatient,1,EA,42.03000,39.93000,The Alliance,Exception Members,,32.36,,,,,,,21.02,40.77,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,inpatient,1,EA,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,outpatient,1,EA,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,inpatient,1,EA,9.90000,9.40000,The Alliance,Exception Members,,7.62,,,,,,,5.45,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,outpatient,1,EA,9.90000,9.40000,The Alliance,Exception Members,,7.62,,,,,,,4.95,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,inpatient,1,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Exception Members,,2.73,,,,,,,1.77,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,inpatient,1,EA,6.90000,6.56000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,outpatient,1,EA,6.90000,6.56000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,inpatient,1,EA,7.51000,7.13000,The Alliance,Exception Members,,5.78,,,,,,,4.13,7.28,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,outpatient,1,EA,7.51000,7.13000,The Alliance,Exception Members,,5.78,,,,,,,3.75,7.28,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,inpatient,,,1034.00000,982.30000,The Alliance,Exception Members,TC,796.18,,,,,,,568.70,1002.98,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,outpatient,,,1034.00000,982.30000,The Alliance,Exception Members,TC,796.18,,,,,,,517.00,1002.98,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,inpatient,1,EA,22.50000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,12.38,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,11.25,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.79,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.54,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.53,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.30,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,inpatient,1,EA,4.15000,3.95000,The Alliance,Exception Members,,3.20,,,,,,,2.28,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,outpatient,1,EA,4.15000,3.95000,The Alliance,Exception Members,,3.20,,,,,,,2.08,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.41,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.41,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,inpatient,,,2031.00000,1929.45000,The Alliance,Exception Members,TC,1563.87,,,,,,,1117.05,1970.07,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,outpatient,,,2031.00000,1929.45000,The Alliance,Exception Members,TC,1563.87,,,,,,,1015.50,1970.07,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,inpatient,1,EA,107.57000,102.19000,The Alliance,Exception Members,,82.83,,,,,,,59.16,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,outpatient,1,EA,107.57000,102.19000,The Alliance,Exception Members,,82.83,,,,,,,12.72,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,inpatient,1,EA,29.74000,28.25000,The Alliance,Exception Members,,22.90,,,,,,,16.36,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,outpatient,1,EA,29.74000,28.25000,The Alliance,Exception Members,,22.90,,,,,,,12.72,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,12.72,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,inpatient,1,EA,70.42000,66.90000,The Alliance,Exception Members,,54.22,,,,,,,38.73,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,outpatient,1,EA,70.42000,66.90000,The Alliance,Exception Members,,54.22,,,,,,,12.72,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,inpatient,1,EA,40.92000,38.88000,The Alliance,Exception Members,,31.51,,,,,,,22.51,39.69,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Exception Members,,31.51,,,,,,,12.72,39.69,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,The Alliance,Exception Members,TC,3277.12,,,,,,,2340.80,4128.32,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Exception Members,TC,3277.12,,,,,,,2128.00,4128.32,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,inpatient,1,EA,20.26000,19.25000,The Alliance,Exception Members,,15.60,,,,,,,11.14,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,outpatient,1,EA,20.26000,19.25000,The Alliance,Exception Members,,15.60,,,,,,,10.13,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.66,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.50,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,inpatient,,,1568.00000,1489.60000,The Alliance,Exception Members,TC,1207.36,,,,,,,862.40,1520.96,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,outpatient,,,1568.00000,1489.60000,The Alliance,Exception Members,TC,1207.36,,,,,,,784.00,1520.96,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,TC,268.73,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,TC,268.73,,,,,,,114.83,1213.27,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,5271.00,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,inpatient,1,EA,5.68000,5.40000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,outpatient,1,EA,5.68000,5.40000,The Alliance,Exception Members,,4.37,,,,,,,2.84,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.94,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.67,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.55,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.41,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.84,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.67,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,inpatient,1,EA,2.65000,2.51000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,outpatient,1,EA,2.65000,2.51000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,The Alliance,Exception Members,,10.50,,,,,,,7.50,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Exception Members,,10.50,,,,,,,6.82,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,The Alliance,Exception Members,,3.50,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Exception Members,,3.50,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,18.06,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Exception Members,,25.29,,,,,,,16.42,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,inpatient,1,EA,16.31000,15.50000,The Alliance,Exception Members,,12.56,,,,,,,8.97,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,outpatient,1,EA,16.31000,15.50000,The Alliance,Exception Members,,12.56,,,,,,,8.15,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,inpatient,1,EA,14.62000,13.88000,The Alliance,Exception Members,,11.26,,,,,,,8.04,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,outpatient,1,EA,14.62000,13.88000,The Alliance,Exception Members,,11.26,,,,,,,7.31,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,8.48,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,11.89,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Exception Members,,16.65,,,,,,,10.81,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,7.24,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,6.58,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,8.48,16.46,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,TC,982.52,,,,,,,701.80,1237.72,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,TC,982.52,,,,,,,638.00,1237.72,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1828.00000,1736.60000,The Alliance,Exception Members,TC,1407.56,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Exception Members,TC,1407.56,,,,,,,914.00,1773.16,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,227.15,400.61,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,33.63,400.61,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,inpatient,1,EA,10.60000,10.07000,The Alliance,Exception Members,,8.16,,,,,,,5.83,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,outpatient,1,EA,10.60000,10.07000,The Alliance,Exception Members,,8.16,,,,,,,5.30,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.51,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.01,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,2.65,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,2.40,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,inpatient,1,EA,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,2.24,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,outpatient,1,EA,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,2.04,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.42,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.10,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.56,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.33,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.40,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.09,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,inpatient,,,484.00000,459.80000,The Alliance,Exception Members,,372.68,,,,,,,266.20,469.48,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Exception Members,,372.68,,,,,,,242.00,572.69,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,216.31,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,18.14,950.66,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,1004.85,1772.19,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Exception Members,TC,1406.79,,,,,,,913.50,1772.19,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,inpatient,,,455.00000,432.25000,The Alliance,Exception Members,TC,350.35,,,,,,,250.25,441.35,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Exception Members,TC,350.35,,,,,,,201.46,2123.08,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,The Alliance,Exception Members,TC,451.22,,,,,,,322.30,568.42,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Exception Members,TC,451.22,,,,,,,247.28,568.42,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,94.05,165.87,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,85.50,1375.13,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,1007.60,1777.04,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,916.00,1777.04,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,inpatient,1,mL,209.51000,199.03000,The Alliance,Exception Members,,161.32,,,,,,,115.23,203.22,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,outpatient,1,mL,209.51000,199.03000,The Alliance,Exception Members,,161.32,,,,,,,104.75,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,inpatient,1,mL,188.56000,179.13000,The Alliance,Exception Members,,145.19,,,,,,,103.71,182.90,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,outpatient,1,mL,188.56000,179.13000,The Alliance,Exception Members,,145.19,,,,,,,94.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,inpatient,1,mL,244.90000,232.66000,The Alliance,Exception Members,,188.57,,,,,,,134.69,237.55,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Exception Members,,188.57,,,,,,,109.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,78.21,137.93,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,71.10,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,inpatient,1,mL,306.20000,290.89000,The Alliance,Exception Members,,235.77,,,,,,,168.41,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,outpatient,1,mL,306.20000,290.89000,The Alliance,Exception Members,,235.77,,,,,,,109.28,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,inpatient,1,mL,323.48000,307.31000,The Alliance,Exception Members,,249.08,,,,,,,177.91,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,outpatient,1,mL,323.48000,307.31000,The Alliance,Exception Members,,249.08,,,,,,,109.28,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,inpatient,1,mL,214.34000,203.63000,The Alliance,Exception Members,,165.04,,,,,,,117.89,207.91,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,outpatient,1,mL,214.34000,203.63000,The Alliance,Exception Members,,165.04,,,,,,,107.17,249.68,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,13.12,679.08,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,inpatient,,,742.00000,704.90000,The Alliance,Exception Members,,571.34,,,,,,,408.10,719.74,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,outpatient,,,742.00000,704.90000,The Alliance,Exception Members,,571.34,,,,,,,262.92,1172.00,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,inpatient,,,1496.00000,1421.20000,The Alliance,Exception Members,TC,1151.92,,,,,,,822.80,1451.12,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,outpatient,,,1496.00000,1421.20000,The Alliance,Exception Members,TC,1151.92,,,,,,,748.00,1451.12,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,The Alliance,Exception Members,TC,2566.41,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Exception Members,TC,2566.41,,,,,,,1666.50,3233.01,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,99.00,174.60,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,15.29,797.91,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,163.90,289.06,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,135.13,1430.78,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,inpatient,,,2546.00000,2418.70000,The Alliance,Exception Members,TC,1960.42,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Exception Members,TC,1960.42,,,,,,,1273.00,2469.62,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,inpatient,,,2109.00000,2003.55000,The Alliance,Exception Members,,1623.93,,,,,,,1159.95,2045.73,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,outpatient,,,2109.00000,2003.55000,The Alliance,Exception Members,,1623.93,,,,,,,582.16,3515.00,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,8.17,696.05,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,inpatient,,,2224.00000,2112.80000,The Alliance,Exception Members,TC,1712.48,,,,,,,1223.20,2157.28,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,outpatient,,,2224.00000,2112.80000,The Alliance,Exception Members,TC,1712.48,,,,,,,1112.00,14719.32,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,Exception Members,TC,394.24,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Exception Members,TC,394.24,,,,,,,151.73,1628.59,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,675.40,1191.16,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,614.00,1191.16,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,inpatient,1,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.41,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.19,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,inpatient,1,EA,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,6.03,10.64,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,5.49,10.64,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,inpatient,1,EA,5030.77000,4779.23000,The Alliance,Exception Members,,3873.69,,,,,,,2766.92,4879.85,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,outpatient,1,EA,5030.77000,4779.23000,The Alliance,Exception Members,,3873.69,,,,,,,7.88,4879.85,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,8.17,696.05,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,inpatient,,,544.00000,516.80000,The Alliance,Exception Members,,418.88,,,,,,,299.20,527.68,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Exception Members,,418.88,,,,,,,272.00,572.69,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1160.00000,1102.00000,The Alliance,Exception Members,,893.20,,,,,,,638.00,1125.20,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Exception Members,,893.20,,,,,,,404.33,3515.00,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,inpatient,,,2660.00000,2527.00000,The Alliance,Exception Members,,2048.20,,,,,,,1463.00,2580.20,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,outpatient,,,2660.00000,2527.00000,The Alliance,Exception Members,,2048.20,,,,,,,264.01,15261.97,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.84,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.68,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,inpatient,1,EA,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,3.39,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,outpatient,1,EA,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,3.08,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,inpatient,1,EA,150.45000,142.92000,The Alliance,Exception Members,,115.85,,,,,,,82.75,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,outpatient,1,EA,150.45000,142.92000,The Alliance,Exception Members,,115.85,,,,,,,75.22,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,inpatient,1,EA,25.25000,23.99000,The Alliance,Exception Members,,19.44,,,,,,,13.89,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,outpatient,1,EA,25.25000,23.99000,The Alliance,Exception Members,,19.44,,,,,,,12.62,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,inpatient,1,EA,4.30000,4.08000,The Alliance,Exception Members,,3.31,,,,,,,2.37,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Exception Members,,3.31,,,,,,,2.15,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,The Alliance,Exception Members,,3.50,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Exception Members,,3.50,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.12,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,inpatient,1,EA,3.30000,3.13000,The Alliance,Exception Members,,2.54,,,,,,,1.81,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,outpatient,1,EA,3.30000,3.13000,The Alliance,Exception Members,,2.54,,,,,,,1.65,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,The Alliance,Exception Members,,2.98,,,,,,,2.13,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Exception Members,,2.98,,,,,,,1.94,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,8.20,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,7.45,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,inpatient,1,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,inpatient,1,mL,1.25000,1.18000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,outpatient,1,mL,1.25000,1.18000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,Exception Members,,121.89,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Exception Members,,121.89,,,,,,,79.15,153.55,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,inpatient,1,EA,79.03000,75.08000,The Alliance,Exception Members,,60.85,,,,,,,43.47,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,outpatient,1,EA,79.03000,75.08000,The Alliance,Exception Members,,60.85,,,,,,,39.52,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,inpatient,1,EA,89.66000,85.18000,The Alliance,Exception Members,,69.04,,,,,,,49.31,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,outpatient,1,EA,89.66000,85.18000,The Alliance,Exception Members,,69.04,,,,,,,44.83,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,23.70,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,inpatient,1,EA,115.04000,109.28000,The Alliance,Exception Members,,88.58,,,,,,,63.27,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,outpatient,1,EA,115.04000,109.28000,The Alliance,Exception Members,,88.58,,,,,,,57.52,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,inpatient,1,EA,62.15000,59.05000,The Alliance,Exception Members,,47.86,,,,,,,34.18,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,outpatient,1,EA,62.15000,59.05000,The Alliance,Exception Members,,47.86,,,,,,,31.07,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,inpatient,1,EA,138.98000,132.03000,The Alliance,Exception Members,,107.01,,,,,,,76.44,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Exception Members,,107.01,,,,,,,69.49,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,inpatient,1,EA,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,60.83,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,55.30,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,inpatient,1,EA,91.77000,87.18000,The Alliance,Exception Members,,70.66,,,,,,,50.47,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,outpatient,1,EA,91.77000,87.18000,The Alliance,Exception Members,,70.66,,,,,,,45.88,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,inpatient,1,EA,48.66000,46.23000,The Alliance,Exception Members,,37.47,,,,,,,26.76,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Exception Members,,37.47,,,,,,,24.33,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,inpatient,1,EA,32.58000,30.95000,The Alliance,Exception Members,,25.09,,,,,,,17.92,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,outpatient,1,EA,32.58000,30.95000,The Alliance,Exception Members,,25.09,,,,,,,16.29,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,inpatient,1,EA,24.62000,23.39000,The Alliance,Exception Members,,18.96,,,,,,,13.54,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,outpatient,1,EA,24.62000,23.39000,The Alliance,Exception Members,,18.96,,,,,,,12.31,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,inpatient,1,EA,32.90000,31.26000,The Alliance,Exception Members,,25.33,,,,,,,18.09,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,outpatient,1,EA,32.90000,31.26000,The Alliance,Exception Members,,25.33,,,,,,,16.45,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,inpatient,1,EA,35.20000,33.44000,The Alliance,Exception Members,,27.10,,,,,,,19.36,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,outpatient,1,EA,35.20000,33.44000,The Alliance,Exception Members,,27.10,,,,,,,17.60,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,inpatient,1,EA,59.44000,56.47000,The Alliance,Exception Members,,45.77,,,,,,,32.69,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,outpatient,1,EA,59.44000,56.47000,The Alliance,Exception Members,,45.77,,,,,,,29.72,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,inpatient,1,EA,87.82000,83.43000,The Alliance,Exception Members,,67.62,,,,,,,48.30,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Exception Members,,67.62,,,,,,,43.91,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,Exception Members,TC,236.39,,,,,,,168.85,297.79,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Exception Members,TC,236.39,,,,,,,153.50,297.79,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,inpatient,1,EA,6707.63000,6372.25000,The Alliance,Exception Members,,5164.88,,,,,,,3689.20,6506.40,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,outpatient,1,EA,6707.63000,6372.25000,The Alliance,Exception Members,,5164.88,,,,,,,7.88,6506.40,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,inpatient,,,188.00000,178.60000,The Alliance,Exception Members,,144.76,,,,,,,103.40,182.36,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,Exception Members,,144.76,,,,,,,35.09,1833.46,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,8.17,696.05,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,inpatient,2,EA,11.29000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,6.21,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,outpatient,2,EA,11.29000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,5.64,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,inpatient,2,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.53,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.30,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,inpatient,2,EA,14.98000,14.23000,The Alliance,Exception Members,,11.53,,,,,,,8.24,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,outpatient,2,EA,14.98000,14.23000,The Alliance,Exception Members,,11.53,,,,,,,7.49,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,inpatient,2,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,4.90,9.51,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1134.50,2200.93,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,62.14,3038.81,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,inpatient,20,mL,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,outpatient,20,mL,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,inpatient,20,mL,2.86000,2.71000,The Alliance,Exception Members,,2.20,,,,,,,1.57,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,outpatient,20,mL,2.86000,2.71000,The Alliance,Exception Members,,2.20,,,,,,,1.43,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,inpatient,5,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,outpatient,5,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,inpatient,5,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,212.85,375.39,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,150.37,585.00,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,407.50,790.55,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,inpatient,1,EA,26.39000,25.07000,The Alliance,Exception Members,,20.32,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,outpatient,1,EA,26.39000,25.07000,The Alliance,Exception Members,,20.32,,,,,,,13.20,25.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,inpatient,1,mL,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,83.61,585.00,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,inpatient,1,EA,511.80000,486.21000,The Alliance,Exception Members,,394.09,,,,,,,281.49,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,outpatient,1,EA,511.80000,486.21000,The Alliance,Exception Members,,394.09,,,,,,,1.13,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,inpatient,1,EA,260.67000,247.63000,The Alliance,Exception Members,,200.72,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Exception Members,,200.72,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,inpatient,1,EA,788.15000,748.74000,The Alliance,Exception Members,,606.88,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Exception Members,,606.88,,,,,,,1.13,764.51,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Exception Members,TC,3103.10,,,,,,,2015.00,3909.10,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,inpatient,1,EA,59.06000,56.11000,The Alliance,Exception Members,,45.48,,,,,,,32.48,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,outpatient,1,EA,59.06000,56.11000,The Alliance,Exception Members,,45.48,,,,,,,24.92,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,inpatient,1,EA,51.19000,48.63000,The Alliance,Exception Members,,39.42,,,,,,,28.15,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,outpatient,1,EA,51.19000,48.63000,The Alliance,Exception Members,,39.42,,,,,,,24.92,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,inpatient,1,EA,74.01000,70.31000,The Alliance,Exception Members,,56.99,,,,,,,40.71,71.79,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,outpatient,1,EA,74.01000,70.31000,The Alliance,Exception Members,,56.99,,,,,,,24.92,71.79,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,2.50,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,inpatient,1,mL,12.05000,11.44000,The Alliance,Exception Members,,9.28,,,,,,,6.63,11.69,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,outpatient,1,mL,12.05000,11.44000,The Alliance,Exception Members,,9.28,,,,,,,2.50,11.69,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,inpatient,1,EA,8.14000,7.74000,The Alliance,Exception Members,,6.27,,,,,,,4.48,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,outpatient,1,EA,8.14000,7.74000,The Alliance,Exception Members,,6.27,,,,,,,4.07,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,inpatient,1,EA,3.84000,3.64000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,outpatient,1,EA,3.84000,3.64000,The Alliance,Exception Members,,2.96,,,,,,,1.92,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,inpatient,1,EA,4.08000,3.87000,The Alliance,Exception Members,,3.14,,,,,,,2.24,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Exception Members,,3.14,,,,,,,2.04,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,7.01,373.51,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,inpatient,1,EA,142.64000,135.51000,The Alliance,Exception Members,,109.83,,,,,,,78.45,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,outpatient,1,EA,142.64000,135.51000,The Alliance,Exception Members,,109.83,,,,,,,24.92,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,inpatient,1,EA,146.56000,139.23000,The Alliance,Exception Members,,112.85,,,,,,,80.61,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,outpatient,1,EA,146.56000,139.23000,The Alliance,Exception Members,,112.85,,,,,,,24.92,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,inpatient,1,EA,148.01000,140.61000,The Alliance,Exception Members,,113.97,,,,,,,81.41,143.57,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,outpatient,1,EA,148.01000,140.61000,The Alliance,Exception Members,,113.97,,,,,,,24.92,143.57,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,inpatient,1,mL,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.87,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.61,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,The Alliance,Exception Members,,22.55,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Exception Members,,22.55,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,The Alliance,Exception Members,,22.55,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Exception Members,,22.55,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,inpatient,1,EA,19.85000,18.86000,The Alliance,Exception Members,,15.28,,,,,,,10.92,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,outpatient,1,EA,19.85000,18.86000,The Alliance,Exception Members,,15.28,,,,,,,9.93,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,inpatient,1,EA,26.70000,25.37000,The Alliance,Exception Members,,20.56,,,,,,,14.69,25.90,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,outpatient,1,EA,26.70000,25.37000,The Alliance,Exception Members,,20.56,,,,,,,13.35,25.90,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,inpatient,1,mL,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,outpatient,1,mL,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,inpatient,1,mL,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.47,4.36,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,outpatient,1,mL,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.25,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,inpatient,1,mL,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,outpatient,1,mL,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,5.23,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,inpatient,10,EA,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,outpatient,10,EA,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,inpatient,1,EA,121.79000,115.70000,The Alliance,Exception Members,,93.78,,,,,,,66.98,118.14,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,outpatient,1,EA,121.79000,115.70000,The Alliance,Exception Members,,93.78,,,,,,,2.50,118.14,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,inpatient,1,EA,36.03000,34.23000,The Alliance,Exception Members,,27.74,,,,,,,19.82,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,outpatient,1,EA,36.03000,34.23000,The Alliance,Exception Members,,27.74,,,,,,,18.02,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,inpatient,1,EA,27.49000,26.11000,The Alliance,Exception Members,,21.17,,,,,,,15.12,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,outpatient,1,EA,27.49000,26.11000,The Alliance,Exception Members,,21.17,,,,,,,13.74,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,inpatient,1,EA,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,6.03,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,5.49,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,4.90,9.51,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,49.50,96.03,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,526.26,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,inpatient,10,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,0.43710,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,inpatient,10,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,outpatient,10,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,0.43710,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.43710,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,inpatient,10,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,outpatient,10,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.43710,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,inpatient,10,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,outpatient,10,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,0.43710,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,inpatient,10,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,outpatient,10,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,inpatient,10,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,outpatient,10,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.43710,2.14,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,inpatient,1,mL,1825.95000,1734.65000,The Alliance,Exception Members,,1405.98,,,,,,,1004.27,1771.17,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,outpatient,1,mL,1825.95000,1734.65000,The Alliance,Exception Members,,1405.98,,,,,,,104.58,1771.17,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,The Alliance,Exception Members,,19.20,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Exception Members,,19.20,,,,,,,12.46,24.18,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,18.79,984.66,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,27.94,1459.96,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,inpatient,20,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,outpatient,20,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,inpatient,20,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.00,15.24,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,inpatient,1,EA,333.23000,316.57000,The Alliance,Exception Members,,256.59,,,,,,,183.28,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,outpatient,1,EA,333.23000,316.57000,The Alliance,Exception Members,,256.59,,,,,,,14.23,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,inpatient,1,EA,349.86000,332.36000,The Alliance,Exception Members,,269.39,,,,,,,192.42,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,outpatient,1,EA,349.86000,332.36000,The Alliance,Exception Members,,269.39,,,,,,,14.23,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,14.23,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,inpatient,1,EA,274.88000,261.14000,The Alliance,Exception Members,,211.66,,,,,,,151.18,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,outpatient,1,EA,274.88000,261.14000,The Alliance,Exception Members,,211.66,,,,,,,14.23,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,inpatient,1,EA,303.21000,288.05000,The Alliance,Exception Members,,233.47,,,,,,,166.77,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,outpatient,1,EA,303.21000,288.05000,The Alliance,Exception Members,,233.47,,,,,,,14.23,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,inpatient,1,EA,359.49000,341.52000,The Alliance,Exception Members,,276.81,,,,,,,197.72,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,outpatient,1,EA,359.49000,341.52000,The Alliance,Exception Members,,276.81,,,,,,,14.23,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,14.23,183.91,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,inpatient,1,EA,22.90000,21.75000,The Alliance,Exception Members,,17.63,,,,,,,12.60,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,outpatient,1,EA,22.90000,21.75000,The Alliance,Exception Members,,17.63,,,,,,,11.45,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,inpatient,1,EA,25.83000,24.54000,The Alliance,Exception Members,,19.89,,,,,,,14.21,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,outpatient,1,EA,25.83000,24.54000,The Alliance,Exception Members,,19.89,,,,,,,12.91,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,inpatient,1,EA,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,17.26,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,outpatient,1,EA,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,15.69,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,inpatient,1,EA,47.49000,45.11000,The Alliance,Exception Members,,36.57,,,,,,,26.12,46.07,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,outpatient,1,EA,47.49000,45.11000,The Alliance,Exception Members,,36.57,,,,,,,23.75,46.07,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,inpatient,1,EA,33.11000,31.46000,The Alliance,Exception Members,,25.49,,,,,,,18.21,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,outpatient,1,EA,33.11000,31.46000,The Alliance,Exception Members,,25.49,,,,,,,16.55,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,inpatient,1,EA,24.04000,22.84000,The Alliance,Exception Members,,18.51,,,,,,,13.22,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Exception Members,,18.51,,,,,,,12.02,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,inpatient,57,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,outpatient,57,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,inpatient,57,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,outpatient,57,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,Exception Members,,121.89,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Exception Members,,121.89,,,,,,,79.15,153.55,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,inpatient,50,EA,7.45000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,4.10,7.23,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,outpatient,50,EA,7.45000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,3.73,7.23,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,inpatient,1,GM,13.52000,12.84000,The Alliance,Exception Members,,10.41,,,,,,,7.44,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,outpatient,1,GM,13.52000,12.84000,The Alliance,Exception Members,,10.41,,,,,,,6.76,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,inpatient,1,GM,13.47000,12.80000,The Alliance,Exception Members,,10.37,,,,,,,7.41,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,outpatient,1,GM,13.47000,12.80000,The Alliance,Exception Members,,10.37,,,,,,,6.74,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,inpatient,1,GM,13.72000,13.04000,The Alliance,Exception Members,,10.56,,,,,,,7.55,13.31,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,outpatient,1,GM,13.72000,13.04000,The Alliance,Exception Members,,10.56,,,,,,,6.86,13.31,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,inpatient,,,189.00000,179.55000,The Alliance,Exception Members,,145.53,,,,,,,103.95,183.33,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Exception Members,,145.53,,,,,,,17.93,933.70,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,inpatient,1,mL,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,3.25,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,outpatient,1,mL,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,0.43710,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,inpatient,1,mL,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.43710,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.43710,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,inpatient,1,mL,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,0.43710,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,inpatient,1,mL,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.43710,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,inpatient,1,mL,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Exception Members,,3.14,,,,,,,0.43710,3.96,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,19.35,1018.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,inpatient,20,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,outpatient,20,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,24.18,1256.24,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,inpatient,20,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,outpatient,20,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,inpatient,20,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,outpatient,20,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,inpatient,20,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,inpatient,20,EA,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.47,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,outpatient,20,EA,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.25,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,inpatient,20,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,outpatient,20,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,inpatient,20,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,outpatient,20,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,inpatient,20,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,outpatient,20,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,12.87,679.08,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,inpatient,,,189.60000,180.12000,The Alliance,Exception Members,90,145.99,,,,,,,104.28,183.91,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,outpatient,,,189.60000,180.12000,The Alliance,Exception Members,90,145.99,,,,,,,16.88,848.80,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,inpatient,1,EA,240.56000,228.53000,The Alliance,Exception Members,,185.23,,,,,,,132.31,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,outpatient,1,EA,240.56000,228.53000,The Alliance,Exception Members,,185.23,,,,,,,102.24,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,inpatient,1,EA,287.19000,272.83000,The Alliance,Exception Members,,221.14,,,,,,,157.95,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,outpatient,1,EA,287.19000,272.83000,The Alliance,Exception Members,,221.14,,,,,,,102.24,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,284.90,502.46,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,102.24,502.46,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,inpatient,1,mL,10.74000,10.20000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,outpatient,1,mL,10.74000,10.20000,The Alliance,Exception Members,,8.27,,,,,,,5.37,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,inpatient,1,mL,11.65000,11.07000,The Alliance,Exception Members,,8.97,,,,,,,6.41,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,outpatient,1,mL,11.65000,11.07000,The Alliance,Exception Members,,8.97,,,,,,,5.83,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,50.05,88.27,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,50.05,3163.00,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,inpatient,10,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,outpatient,10,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,inpatient,10,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,outpatient,10,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,inpatient,10,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,inpatient,10,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,outpatient,10,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,inpatient,10,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.92,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,outpatient,10,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,inpatient,10,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,outpatient,10,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,The Alliance,Exception Members,,19.20,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Exception Members,,19.20,,,,,,,12.46,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.13,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,inpatient,1,mL,12.40000,11.78000,The Alliance,Exception Members,,9.55,,,,,,,6.82,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,outpatient,1,mL,12.40000,11.78000,The Alliance,Exception Members,,9.55,,,,,,,6.20,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,The Alliance,Exception Members,,6.45,,,,,,,4.61,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Exception Members,,6.45,,,,,,,4.19,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,inpatient,1,mL,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,outpatient,1,mL,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,inpatient,1,mL,1384.36000,1315.14000,The Alliance,Exception Members,,1065.96,,,,,,,761.40,1342.83,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,outpatient,1,mL,1384.36000,1315.14000,The Alliance,Exception Members,,1065.96,,,,,,,7.68,1342.83,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,inpatient,100,EA,89.81000,85.32000,The Alliance,Exception Members,,69.15,,,,,,,49.40,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,outpatient,100,EA,89.81000,85.32000,The Alliance,Exception Members,,69.15,,,,,,,44.91,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,inpatient,100,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,outpatient,100,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,inpatient,100,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,outpatient,100,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,inpatient,100,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.21,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,outpatient,100,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.10,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,inpatient,100,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,outpatient,100,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.15,2.23,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,147.40,259.96,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,17.90,933.70,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,180.95,319.13,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,164.50,3321.00,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,inpatient,,,475.00000,451.25000,The Alliance,Exception Members,,365.75,,,,,,,261.25,460.75,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Exception Members,,365.75,,,,,,,53.70,3089.77,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.84,3.25,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.68,3.25,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,inpatient,,,598.00000,568.10000,The Alliance,Exception Members,,460.46,,,,,,,328.90,580.06,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Exception Members,,460.46,,,,,,,66.70,3446.25,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,inpatient,1,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,inpatient,1,mL,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,outpatient,1,mL,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,inpatient,250,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,outpatient,250,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,211.46,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,17.90,933.70,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,inpatient,,,233.00000,221.35000,The Alliance,Exception Members,,179.41,,,,,,,128.15,226.01,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Exception Members,,179.41,,,,,,,17.65,916.73,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,inpatient,2,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,outpatient,2,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,inpatient,2,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,inpatient,2,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,inpatient,2,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,outpatient,2,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,inpatient,2,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,outpatient,2,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,inpatient,2,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,outpatient,2,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,inpatient,2,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,outpatient,2,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,inpatient,2,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,outpatient,2,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,inpatient,2,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,outpatient,2,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,22.94,1205.34,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,Exception Members,90,161.47,,,,,,,115.33,203.41,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Exception Members,90,161.47,,,,,,,20.41,950.66,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,56.65,99.91,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,9.84,933.70,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,133.10,234.74,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,22.94,1205.34,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,inpatient,1,EA,48.88000,46.43000,The Alliance,Exception Members,,37.64,,,,,,,26.88,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,outpatient,1,EA,48.88000,46.43000,The Alliance,Exception Members,,37.64,,,,,,,24.44,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,inpatient,1,EA,51.32000,48.76000,The Alliance,Exception Members,,39.52,,,,,,,28.23,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,outpatient,1,EA,51.32000,48.76000,The Alliance,Exception Members,,39.52,,,,,,,25.66,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,inpatient,1,EA,30.07000,28.57000,The Alliance,Exception Members,,23.15,,,,,,,16.54,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,outpatient,1,EA,30.07000,28.57000,The Alliance,Exception Members,,23.15,,,,,,,15.04,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,inpatient,1,EA,34.89000,33.14000,The Alliance,Exception Members,,26.87,,,,,,,19.19,33.84,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,outpatient,1,EA,34.89000,33.14000,The Alliance,Exception Members,,26.87,,,,,,,17.45,33.84,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,inpatient,1,EA,8.50000,8.08000,The Alliance,Exception Members,,6.54,,,,,,,4.67,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,outpatient,1,EA,8.50000,8.08000,The Alliance,Exception Members,,6.54,,,,,,,4.25,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,inpatient,1,EA,9.24000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,5.08,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,4.62,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,Exception Members,,167.09,,,,,,,119.35,210.49,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Exception Members,,167.09,,,,,,,17.90,933.70,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,inpatient,8,EA,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,3.51,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,outpatient,8,EA,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,3.19,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,inpatient,8,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.40,5.99,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,outpatient,8,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.09,5.99,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,inpatient,,,315.40000,299.63000,The Alliance,Exception Members,90,242.86,,,,,,,173.47,305.94,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,outpatient,,,315.40000,299.63000,The Alliance,Exception Members,90,242.86,,,,,,,23.70,1205.34,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,inpatient,50,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,outpatient,50,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,inpatient,,,154.40000,146.68000,The Alliance,Exception Members,90,118.89,,,,,,,84.92,149.77,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,outpatient,,,154.40000,146.68000,The Alliance,Exception Members,90,118.89,,,,,,,18.72,882.80,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,inpatient,1,EA,141.09000,134.04000,The Alliance,Exception Members,,108.64,,,,,,,77.60,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,outpatient,1,EA,141.09000,134.04000,The Alliance,Exception Members,,108.64,,,,,,,70.55,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,inpatient,1,EA,132.34000,125.72000,The Alliance,Exception Members,,101.90,,,,,,,72.79,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,outpatient,1,EA,132.34000,125.72000,The Alliance,Exception Members,,101.90,,,,,,,66.17,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,inpatient,1,EA,110.28000,104.77000,The Alliance,Exception Members,,84.92,,,,,,,60.65,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,outpatient,1,EA,110.28000,104.77000,The Alliance,Exception Members,,84.92,,,,,,,55.14,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,inpatient,1,EA,109.02000,103.57000,The Alliance,Exception Members,,83.95,,,,,,,59.96,105.75,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,outpatient,1,EA,109.02000,103.57000,The Alliance,Exception Members,,83.95,,,,,,,54.51,105.75,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,inpatient,1,EA,101.66000,96.57000,The Alliance,Exception Members,,78.28,,,,,,,55.91,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,outpatient,1,EA,101.66000,96.57000,The Alliance,Exception Members,,78.28,,,,,,,50.83,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,inpatient,1,EA,63.26000,60.10000,The Alliance,Exception Members,,48.71,,,,,,,34.79,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,outpatient,1,EA,63.26000,60.10000,The Alliance,Exception Members,,48.71,,,,,,,31.63,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,inpatient,1,EA,39.09000,37.13000,The Alliance,Exception Members,,30.10,,,,,,,21.50,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,outpatient,1,EA,39.09000,37.13000,The Alliance,Exception Members,,30.10,,,,,,,19.55,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,inpatient,1,EA,39.10000,37.14000,The Alliance,Exception Members,,30.11,,,,,,,21.50,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,outpatient,1,EA,39.10000,37.14000,The Alliance,Exception Members,,30.11,,,,,,,19.55,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,inpatient,1,EA,19.48000,18.51000,The Alliance,Exception Members,,15.00,,,,,,,10.71,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,outpatient,1,EA,19.48000,18.51000,The Alliance,Exception Members,,15.00,,,,,,,9.74,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,inpatient,1,EA,40.92000,38.88000,The Alliance,Exception Members,,31.51,,,,,,,22.51,39.69,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Exception Members,,31.51,,,,,,,20.46,39.69,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,inpatient,1,EA,321.99000,305.89000,The Alliance,Exception Members,,247.93,,,,,,,177.09,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,outpatient,1,EA,321.99000,305.89000,The Alliance,Exception Members,,247.93,,,,,,,161.00,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,The Alliance,Exception Members,,2.88,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Exception Members,,2.88,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,inpatient,50,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,outpatient,50,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,inpatient,50,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,outpatient,50,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,inpatient,50,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,inpatient,50,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,inpatient,50,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.58,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,221.10,389.94,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,35.09,1833.46,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,inpatient,1,EA,4.16000,3.95000,The Alliance,Exception Members,,3.20,,,,,,,2.29,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,outpatient,1,EA,4.16000,3.95000,The Alliance,Exception Members,,3.20,,,,,,,2.08,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,6.82,984.66,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,inpatient,1,EA,22.53000,21.40000,The Alliance,Exception Members,,17.35,,,,,,,12.39,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,outpatient,1,EA,22.53000,21.40000,The Alliance,Exception Members,,17.35,,,,,,,11.27,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,7.57,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,6.88,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,inpatient,1,EA,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.94,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,outpatient,1,EA,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.21,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,5.53,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,5.03,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,inpatient,1,EA,14.84000,14.10000,The Alliance,Exception Members,,11.43,,,,,,,8.16,14.39,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,outpatient,1,EA,14.84000,14.10000,The Alliance,Exception Members,,11.43,,,,,,,7.42,14.39,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,inpatient,1,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,outpatient,1,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,inpatient,5,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,inpatient,5,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,outpatient,5,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,inpatient,5,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,outpatient,5,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,inpatient,5,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,outpatient,5,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,inpatient,5,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,outpatient,5,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,inpatient,5,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,outpatient,5,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,inpatient,5,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,outpatient,5,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,inpatient,5,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,outpatient,5,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,inpatient,5,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,outpatient,5,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,inpatient,5,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,outpatient,5,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,inpatient,5,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,inpatient,1,EA,87.08000,82.73000,The Alliance,Exception Members,,67.05,,,,,,,47.89,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,outpatient,1,EA,87.08000,82.73000,The Alliance,Exception Members,,67.05,,,,,,,43.54,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,inpatient,1,EA,87.09000,82.74000,The Alliance,Exception Members,,67.06,,,,,,,47.90,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,outpatient,1,EA,87.09000,82.74000,The Alliance,Exception Members,,67.06,,,,,,,43.55,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,inpatient,1,EA,134.90000,128.16000,The Alliance,Exception Members,,103.87,,,,,,,74.19,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,outpatient,1,EA,134.90000,128.16000,The Alliance,Exception Members,,103.87,,,,,,,67.45,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,inpatient,1,EA,43.32000,41.16000,The Alliance,Exception Members,,33.36,,,,,,,23.83,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,outpatient,1,EA,43.32000,41.16000,The Alliance,Exception Members,,33.36,,,,,,,21.66,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,inpatient,1,EA,61.30000,58.24000,The Alliance,Exception Members,,47.20,,,,,,,33.72,59.46,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,outpatient,1,EA,61.30000,58.24000,The Alliance,Exception Members,,47.20,,,,,,,30.65,59.46,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,5271.00,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,13.63,713.01,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,5.88,271.65,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,inpatient,1,mL,99.43000,94.46000,The Alliance,Exception Members,,76.56,,,,,,,54.69,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,outpatient,1,mL,99.43000,94.46000,The Alliance,Exception Members,,76.56,,,,,,,0.60838,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,inpatient,1,mL,97.76000,92.87000,The Alliance,Exception Members,,75.28,,,,,,,53.77,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,outpatient,1,mL,97.76000,92.87000,The Alliance,Exception Members,,75.28,,,,,,,0.60838,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,0.60838,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,inpatient,1,mL,113.48000,107.80000,The Alliance,Exception Members,,87.38,,,,,,,62.41,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,outpatient,1,mL,113.48000,107.80000,The Alliance,Exception Members,,87.38,,,,,,,0.60838,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,inpatient,1,mL,189.13000,179.67000,The Alliance,Exception Members,,145.63,,,,,,,104.02,183.46,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,outpatient,1,mL,189.13000,179.67000,The Alliance,Exception Members,,145.63,,,,,,,0.60838,183.46,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,6.89,356.54,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,360.00,4457.06,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,inpatient,,,256.60000,243.77000,The Alliance,Exception Members,90,197.58,,,,,,,141.13,248.90,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,outpatient,,,256.60000,243.77000,The Alliance,Exception Members,90,197.58,,,,,,,17.85,814.87,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,171.05,301.67,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,22.17,1035.56,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,inpatient,1,mL,14.59000,13.86000,The Alliance,Exception Members,,11.23,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Exception Members,,11.23,,,,,,,7.29,73.49,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,inpatient,30,EA,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,outpatient,30,EA,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,inpatient,30,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,outpatient,30,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,inpatient,1,mL,221.87000,210.78000,The Alliance,Exception Members,,170.84,,,,,,,122.03,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,outpatient,1,mL,221.87000,210.78000,The Alliance,Exception Members,,170.84,,,,,,,0.31000,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,inpatient,1,mL,221.86000,210.77000,The Alliance,Exception Members,,170.83,,,,,,,122.02,215.20,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,outpatient,1,mL,221.86000,210.77000,The Alliance,Exception Members,,170.83,,,,,,,0.31000,215.20,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,60.50,106.70,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,10.18,526.26,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,inpatient,,,568.00000,539.60000,The Alliance,Exception Members,,437.36,,,,,,,312.40,550.96,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Exception Members,,437.36,,,,,,,64.41,3361.35,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,inpatient,1,EA,40.02000,38.02000,The Alliance,Exception Members,,30.82,,,,,,,22.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,outpatient,1,EA,40.02000,38.02000,The Alliance,Exception Members,,30.82,,,,,,,20.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,inpatient,1,EA,30.97000,29.42000,The Alliance,Exception Members,,23.85,,,,,,,17.03,30.04,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Exception Members,,23.85,,,,,,,15.48,30.04,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,187.00,329.80,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,38.65,329.80,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,inpatient,2,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.55,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,outpatient,2,EA,2.82000,2.68000,The Alliance,Exception Members,,2.17,,,,,,,1.30,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,inpatient,2,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,outpatient,2,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,inpatient,2,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,outpatient,2,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,inpatient,2,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,outpatient,2,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.30,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,inpatient,2,EA,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.99,3.51,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,outpatient,2,EA,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.30,3.51,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,inpatient,,,964.00000,915.80000,The Alliance,Exception Members,,742.28,,,,,,,530.20,935.08,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,outpatient,,,964.00000,915.80000,The Alliance,Exception Members,,742.28,,,,,,,295.54,4230.40,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,3.67,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,inpatient,1,EA,66.55000,63.22000,The Alliance,Exception Members,,51.24,,,,,,,36.60,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Exception Members,,51.24,,,,,,,33.27,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,inpatient,1,EA,73.10000,69.44000,The Alliance,Exception Members,,56.29,,,,,,,40.20,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,outpatient,1,EA,73.10000,69.44000,The Alliance,Exception Members,,56.29,,,,,,,36.55,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,inpatient,1,EA,38.24000,36.32000,The Alliance,Exception Members,,29.44,,,,,,,21.03,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,outpatient,1,EA,38.24000,36.32000,The Alliance,Exception Members,,29.44,,,,,,,19.12,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,inpatient,1,EA,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,45.76,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,41.60,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,inpatient,1,EA,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,36.50,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,outpatient,1,EA,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,33.18,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,inpatient,1,EA,52.68000,50.05000,The Alliance,Exception Members,,40.56,,,,,,,28.97,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,outpatient,1,EA,52.68000,50.05000,The Alliance,Exception Members,,40.56,,,,,,,26.34,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,inpatient,1,EA,76.35000,72.53000,The Alliance,Exception Members,,58.79,,,,,,,41.99,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,outpatient,1,EA,76.35000,72.53000,The Alliance,Exception Members,,58.79,,,,,,,38.17,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,inpatient,1,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,27.81,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,25.28,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,inpatient,1,EA,46.36000,44.04000,The Alliance,Exception Members,,35.70,,,,,,,25.50,44.97,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,outpatient,1,EA,46.36000,44.04000,The Alliance,Exception Members,,35.70,,,,,,,23.18,44.97,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,inpatient,1,EA,2.06000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.13,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,outpatient,1,EA,2.06000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,inpatient,1,EA,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,4.05,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,3.69,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,inpatient,1,EA,10.43000,9.90000,The Alliance,Exception Members,,8.03,,,,,,,5.74,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,outpatient,1,EA,10.43000,9.90000,The Alliance,Exception Members,,8.03,,,,,,,5.21,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,inpatient,30,EA,7.68000,7.29000,The Alliance,Exception Members,,5.91,,,,,,,4.22,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,outpatient,30,EA,7.68000,7.29000,The Alliance,Exception Members,,5.91,,,,,,,3.84,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,inpatient,30,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,outpatient,30,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,inpatient,1,mL,281.66000,267.58000,The Alliance,Exception Members,,216.88,,,,,,,154.91,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,outpatient,1,mL,281.66000,267.58000,The Alliance,Exception Members,,216.88,,,,,,,71.65,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,inpatient,1,mL,171.83000,163.23000,The Alliance,Exception Members,,132.31,,,,,,,94.51,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,outpatient,1,mL,171.83000,163.23000,The Alliance,Exception Members,,132.31,,,,,,,71.65,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,inpatient,1,mL,352.08000,334.48000,The Alliance,Exception Members,,271.10,,,,,,,193.64,341.52,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,outpatient,1,mL,352.08000,334.48000,The Alliance,Exception Members,,271.10,,,,,,,71.65,341.52,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,14.70,763.98,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,108.90,192.06,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,13.65,984.66,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,inpatient,1,mL,12.47000,11.85000,The Alliance,Exception Members,,9.60,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Exception Members,,9.60,,,,,,,6.24,73.49,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,inpatient,1,mL,12.47000,11.85000,The Alliance,Exception Members,,9.60,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Exception Members,,9.60,,,,,,,6.24,73.49,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,inpatient,100,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,outpatient,100,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,inpatient,100,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,outpatient,100,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,inpatient,100,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,outpatient,100,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,inpatient,100,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,outpatient,100,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,inpatient,100,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,outpatient,100,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,inpatient,100,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,inpatient,100,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,outpatient,100,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,5.94,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.71500,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,3.64,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,3.31,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,inpatient,1,EA,34.79000,33.05000,The Alliance,Exception Members,,26.79,,,,,,,19.13,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,outpatient,1,EA,34.79000,33.05000,The Alliance,Exception Members,,26.79,,,,,,,17.39,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,inpatient,1,EA,28.96000,27.52000,The Alliance,Exception Members,,22.30,,,,,,,15.93,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,outpatient,1,EA,28.96000,27.52000,The Alliance,Exception Members,,22.30,,,,,,,14.48,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,inpatient,1,EA,15.79000,15.00000,The Alliance,Exception Members,,12.16,,,,,,,8.68,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,outpatient,1,EA,15.79000,15.00000,The Alliance,Exception Members,,12.16,,,,,,,7.89,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,The Alliance,Exception Members,,25.13,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Exception Members,,25.13,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,The Alliance,Exception Members,,25.13,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Exception Members,,25.13,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,18.17,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,inpatient,1,EA,12.84000,12.19000,The Alliance,Exception Members,,9.89,,,,,,,7.06,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Exception Members,,9.89,,,,,,,6.42,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,inpatient,1,mL,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,outpatient,1,mL,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,3.67,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,inpatient,,,195.10000,185.34000,The Alliance,Exception Members,90,150.23,,,,,,,107.31,189.25,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,outpatient,,,195.10000,185.34000,The Alliance,Exception Members,90,150.23,,,,,,,17.36,882.80,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,inpatient,1,mL,30.39000,28.87000,The Alliance,Exception Members,,23.40,,,,,,,16.71,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Exception Members,,23.40,,,,,,,1.15,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,inpatient,1,mL,291.73000,277.14000,The Alliance,Exception Members,,224.63,,,,,,,160.45,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,outpatient,1,mL,291.73000,277.14000,The Alliance,Exception Members,,224.63,,,,,,,1.15,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,inpatient,1,mL,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,81.69,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,outpatient,1,mL,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,1.15,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,inpatient,1,mL,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,1.15,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,inpatient,1,mL,157.10000,149.25000,The Alliance,Exception Members,,120.97,,,,,,,86.41,152.39,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,outpatient,1,mL,157.10000,149.25000,The Alliance,Exception Members,,120.97,,,,,,,1.15,152.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,inpatient,1,EA,5.56000,5.29000,The Alliance,Exception Members,,4.28,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,outpatient,1,EA,5.56000,5.29000,The Alliance,Exception Members,,4.28,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.46,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.23,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.93,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,inpatient,1,EA,5.37000,5.11000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,outpatient,1,EA,5.37000,5.11000,The Alliance,Exception Members,,4.13,,,,,,,2.69,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,inpatient,1,EA,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,3.25,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,2.96,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,inpatient,1,EA,55.82000,53.03000,The Alliance,Exception Members,,42.98,,,,,,,30.70,54.15,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,outpatient,1,EA,55.82000,53.03000,The Alliance,Exception Members,,42.98,,,,,,,27.91,54.15,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.79,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.63,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.78,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.61,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,inpatient,1,EA,3.99000,3.79000,The Alliance,Exception Members,,3.07,,,,,,,2.19,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,outpatient,1,EA,3.99000,3.79000,The Alliance,Exception Members,,3.07,,,,,,,2.00,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,inpatient,1,EA,4.08000,3.87000,The Alliance,Exception Members,,3.14,,,,,,,2.24,3.96,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Exception Members,,3.14,,,,,,,2.04,3.96,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,inpatient,1,EA,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,1.63,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,outpatient,1,EA,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,1.49,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,inpatient,1,EA,2.96000,2.82000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,outpatient,1,EA,2.96000,2.82000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,52.25,92.15,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,47.50,1075.26,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,inpatient,4,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,outpatient,4,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,inpatient,4,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,outpatient,4,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,0.64740,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,inpatient,4,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,outpatient,4,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.64740,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,inpatient,4,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,outpatient,4,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,0.64740,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,inpatient,4,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,outpatient,4,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,inpatient,4,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,outpatient,4,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.64740,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,inpatient,4,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,outpatient,4,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,inpatient,4,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,outpatient,4,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,inpatient,4,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,outpatient,4,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,inpatient,1,mL,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.22,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,outpatient,1,mL,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.02,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,inpatient,1,mL,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,3.67,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,inpatient,1,mL,2655.14000,2522.38000,The Alliance,Exception Members,,2044.46,,,,,,,1460.33,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,outpatient,1,mL,2655.14000,2522.38000,The Alliance,Exception Members,,2044.46,,,,,,,6.03,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,inpatient,1,mL,1849.97000,1757.47000,The Alliance,Exception Members,,1424.48,,,,,,,1017.48,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,outpatient,1,mL,1849.97000,1757.47000,The Alliance,Exception Members,,1424.48,,,,,,,6.03,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,inpatient,1,mL,1856.17000,1763.36000,The Alliance,Exception Members,,1429.25,,,,,,,1020.89,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,outpatient,1,mL,1856.17000,1763.36000,The Alliance,Exception Members,,1429.25,,,,,,,6.03,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,inpatient,1,mL,1702.49000,1617.37000,The Alliance,Exception Members,,1310.92,,,,,,,936.37,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,outpatient,1,mL,1702.49000,1617.37000,The Alliance,Exception Members,,1310.92,,,,,,,6.03,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,inpatient,1,mL,2300.00000,2185.00000,The Alliance,Exception Members,,1771.00,,,,,,,1265.00,2231.00,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,outpatient,1,mL,2300.00000,2185.00000,The Alliance,Exception Members,,1771.00,,,,,,,6.03,2231.00,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,inpatient,5,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,inpatient,5,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.58,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.35,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,inpatient,5,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,outpatient,5,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,inpatient,16,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,outpatient,16,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,inpatient,16,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,outpatient,16,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,inpatient,16,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,outpatient,16,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,inpatient,16,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,outpatient,16,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.78,3.45,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,inpatient,100,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,outpatient,100,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,5.94,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,10.00,30.07,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,313.50,552.90,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,285.00,3186.14,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,inpatient,1,EA,866.69000,823.36000,The Alliance,Exception Members,,667.35,,,,,,,476.68,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,outpatient,1,EA,866.69000,823.36000,The Alliance,Exception Members,,667.35,,,,,,,0.17611,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,inpatient,1,EA,829.37000,787.90000,The Alliance,Exception Members,,638.61,,,,,,,456.15,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,outpatient,1,EA,829.37000,787.90000,The Alliance,Exception Members,,638.61,,,,,,,0.17611,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,inpatient,1,EA,205.40000,195.13000,The Alliance,Exception Members,,158.16,,,,,,,112.97,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,outpatient,1,EA,205.40000,195.13000,The Alliance,Exception Members,,158.16,,,,,,,0.17611,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,inpatient,1,EA,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,0.17611,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,0.17611,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,inpatient,1,EA,748.82000,711.38000,The Alliance,Exception Members,,576.59,,,,,,,411.85,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,outpatient,1,EA,748.82000,711.38000,The Alliance,Exception Members,,576.59,,,,,,,0.17611,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,inpatient,1,EA,259.69000,246.70000,The Alliance,Exception Members,,199.96,,,,,,,142.83,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,outpatient,1,EA,259.69000,246.70000,The Alliance,Exception Members,,199.96,,,,,,,0.17611,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,inpatient,1,EA,780.03000,741.03000,The Alliance,Exception Members,,600.62,,,,,,,429.02,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,outpatient,1,EA,780.03000,741.03000,The Alliance,Exception Members,,600.62,,,,,,,0.17611,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,inpatient,1,EA,256.53000,243.70000,The Alliance,Exception Members,,197.53,,,,,,,141.09,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,outpatient,1,EA,256.53000,243.70000,The Alliance,Exception Members,,197.53,,,,,,,0.17611,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,inpatient,1,EA,530.95000,504.40000,The Alliance,Exception Members,,408.83,,,,,,,292.02,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Exception Members,,408.83,,,,,,,0.17611,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,inpatient,1,EA,454.54000,431.82000,The Alliance,Exception Members,,350.00,,,,,,,250.00,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,outpatient,1,EA,454.54000,431.82000,The Alliance,Exception Members,,350.00,,,,,,,0.17611,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,inpatient,1,EA,271.95000,258.35000,The Alliance,Exception Members,,209.40,,,,,,,149.57,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Exception Members,,209.40,,,,,,,0.17611,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,inpatient,1,EA,714.37000,678.66000,The Alliance,Exception Members,,550.06,,,,,,,392.90,692.94,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,outpatient,1,EA,714.37000,678.66000,The Alliance,Exception Members,,550.06,,,,,,,0.17611,692.94,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,Exception Members,TC,133.21,,,,,,,95.15,167.81,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Exception Members,TC,133.21,,,,,,,86.50,167.81,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,89.24,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,9.72,458.40,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,7.20,373.51,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,Exception Members,TC,405.02,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Exception Members,TC,405.02,,,,,,,146.17,1450.63,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,129.80,228.92,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,118.00,1635.52,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,44.50,210.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,107.80,190.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,18.54,967.70,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,inpatient,2.5,EA,45.50000,43.23000,The Alliance,Exception Members,,35.03,,,,,,,25.02,44.13,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,outpatient,2.5,EA,45.50000,43.23000,The Alliance,Exception Members,,35.03,,,,,,,22.75,44.13,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,inpatient,1,mL,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,3.64,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,outpatient,1,mL,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,0.64740,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,inpatient,1,mL,5.40000,5.13000,The Alliance,Exception Members,,4.16,,,,,,,2.97,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,outpatient,1,mL,5.40000,5.13000,The Alliance,Exception Members,,4.16,,,,,,,0.64740,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,0.64740,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,0.64740,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,0.64740,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.64740,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.64740,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,inpatient,1,mL,4.29000,4.08000,The Alliance,Exception Members,,3.30,,,,,,,2.36,4.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,outpatient,1,mL,4.29000,4.08000,The Alliance,Exception Members,,3.30,,,,,,,0.64740,4.16,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,inpatient,12,EA,72.11000,68.50000,The Alliance,Exception Members,,55.52,,,,,,,39.66,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,outpatient,12,EA,72.11000,68.50000,The Alliance,Exception Members,,55.52,,,,,,,36.05,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,inpatient,12,EA,46.87000,44.53000,The Alliance,Exception Members,,36.09,,,,,,,25.78,45.46,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,outpatient,12,EA,46.87000,44.53000,The Alliance,Exception Members,,36.09,,,,,,,23.43,45.46,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,inpatient,2,EA,43.15000,40.99000,The Alliance,Exception Members,,33.23,,,,,,,23.73,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,outpatient,2,EA,43.15000,40.99000,The Alliance,Exception Members,,33.23,,,,,,,21.57,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,inpatient,2,EA,63.88000,60.69000,The Alliance,Exception Members,,49.19,,,,,,,35.13,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,outpatient,2,EA,63.88000,60.69000,The Alliance,Exception Members,,49.19,,,,,,,31.94,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,inpatient,2,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.27,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,outpatient,2,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.16,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,inpatient,2,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,inpatient,2,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,outpatient,2,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,inpatient,2,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,12.86,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,11.69,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,inpatient,2,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,outpatient,2,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,inpatient,2,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,outpatient,2,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,inpatient,2,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,outpatient,2,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,11.85,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,inpatient,2,EA,7.78000,7.39000,The Alliance,Exception Members,,5.99,,,,,,,4.28,7.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,outpatient,2,EA,7.78000,7.39000,The Alliance,Exception Members,,5.99,,,,,,,3.89,7.55,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,17.27,823.21,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,17.12,33.22,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,inpatient,1,mL,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,outpatient,1,mL,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,inpatient,1,mL,5.38000,5.11000,The Alliance,Exception Members,,4.14,,,,,,,2.96,5.22,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,outpatient,1,mL,5.38000,5.11000,The Alliance,Exception Members,,4.14,,,,,,,2.69,5.22,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,82.67,145.79,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,17.85,814.87,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,191.95,338.53,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,77.53,1052.52,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,9.70,509.30,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,inpatient,,,137.20000,130.34000,The Alliance,Exception Members,90,105.64,,,,,,,75.46,133.08,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,outpatient,,,137.20000,130.34000,The Alliance,Exception Members,90,105.64,,,,,,,16.62,780.94,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,433.40,764.36,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,394.00,4298.79,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,inpatient,10.6,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,outpatient,10.6,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,inpatient,10.6,EA,60.98000,57.93000,The Alliance,Exception Members,,46.95,,,,,,,33.54,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,outpatient,10.6,EA,60.98000,57.93000,The Alliance,Exception Members,,46.95,,,,,,,30.49,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,inpatient,10.6,EA,39.63000,37.65000,The Alliance,Exception Members,,30.52,,,,,,,21.80,38.44,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,outpatient,10.6,EA,39.63000,37.65000,The Alliance,Exception Members,,30.52,,,,,,,19.82,38.44,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,inpatient,1,mL,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,inpatient,1,mL,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,inpatient,1,mL,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,1.65,7.62,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,inpatient,1,GM,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,outpatient,1,GM,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,5.39,288.61,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,inpatient,100,EA,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,outpatient,100,EA,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,26.79,78.87,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,69.30,122.22,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,16.37,899.77,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,inpatient,2,EA,8.55000,8.12000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,outpatient,2,EA,8.55000,8.12000,The Alliance,Exception Members,,6.58,,,,,,,3.82,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,inpatient,2,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,inpatient,2,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,outpatient,2,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,inpatient,2,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,outpatient,2,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,inpatient,1,EA,1919.06000,1823.11000,The Alliance,Exception Members,,1477.68,,,,,,,1055.48,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,outpatient,1,EA,1919.06000,1823.11000,The Alliance,Exception Members,,1477.68,,,,,,,4.61,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,inpatient,1,EA,145.14000,137.88000,The Alliance,Exception Members,,111.76,,,,,,,79.83,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,outpatient,1,EA,145.14000,137.88000,The Alliance,Exception Members,,111.76,,,,,,,4.61,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,inpatient,1,EA,157.65000,149.77000,The Alliance,Exception Members,,121.39,,,,,,,86.71,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,outpatient,1,EA,157.65000,149.77000,The Alliance,Exception Members,,121.39,,,,,,,4.61,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,inpatient,1,EA,156.74000,148.90000,The Alliance,Exception Members,,120.69,,,,,,,86.21,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,outpatient,1,EA,156.74000,148.90000,The Alliance,Exception Members,,120.69,,,,,,,4.61,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,inpatient,1,EA,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,199.43,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,4.61,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,inpatient,1,EA,154.84000,147.10000,The Alliance,Exception Members,,119.23,,,,,,,85.16,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,outpatient,1,EA,154.84000,147.10000,The Alliance,Exception Members,,119.23,,,,,,,4.61,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,inpatient,1,EA,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,81.69,144.06,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,4.61,144.06,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,inpatient,1,mL,3.92000,3.72000,The Alliance,Exception Members,,3.02,,,,,,,2.16,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,outpatient,1,mL,3.92000,3.72000,The Alliance,Exception Members,,3.02,,,,,,,1.96,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,inpatient,1,mL,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,inpatient,1,mL,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,3.67,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.54,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.31,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,inpatient,1,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,outpatient,1,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.44,4.32,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,The Alliance,Exception Members,TC,474.32,,,,,,,338.80,597.52,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Exception Members,TC,474.32,,,,,,,308.00,3942.79,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,69.30,122.22,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,12.05,574.73,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,inpatient,50,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,outpatient,50,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,inpatient,50,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,outpatient,50,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,inpatient,50,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,outpatient,50,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,inpatient,50,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,outpatient,50,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,inpatient,50,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,outpatient,50,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,inpatient,50,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,outpatient,50,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,inpatient,,,614.00000,583.30000,The Alliance,Exception Members,,472.78,,,,,,,337.70,595.58,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,outpatient,,,614.00000,583.30000,The Alliance,Exception Members,,472.78,,,,,,,125.97,1861.90,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,19.04,1001.63,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,inpatient,,,189.00000,179.55000,The Alliance,Exception Members,,145.53,,,,,,,103.95,183.33,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Exception Members,,145.53,,,,,,,17.63,916.73,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.93,203.72,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,inpatient,,,153.80000,146.11000,The Alliance,Exception Members,90,118.43,,,,,,,84.59,149.19,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Exception Members,90,118.43,,,,,,,14.48,1018.59,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.32,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.02,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,inpatient,1,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,26.79,78.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Exception Members,,2.76,,,,,,,1.79,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,577.23,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,TC,2656.50,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,TC,2656.50,,,,,,,1591.55,3346.50,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,35.50,68.87,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Exception Members,,15.14,,,,,,,9.83,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,17.12,33.22,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,7.15,645.08,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,inpatient,30,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,81.87,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,inpatient,5,EA,9.70000,9.22000,The Alliance,Exception Members,,7.47,,,,,,,5.33,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,outpatient,5,EA,9.70000,9.22000,The Alliance,Exception Members,,7.47,,,,,,,4.85,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,inpatient,5,EA,22.57000,21.44000,The Alliance,Exception Members,,17.38,,,,,,,12.41,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,outpatient,5,EA,22.57000,21.44000,The Alliance,Exception Members,,17.38,,,,,,,11.29,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,inpatient,5,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,outpatient,5,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,The Alliance,Exception Members,TC,2182.18,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Exception Members,TC,2182.18,,,,,,,1132.05,2748.98,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,inpatient,1,mL,5.36000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,outpatient,1,mL,5.36000,5.10000,The Alliance,Exception Members,,4.13,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,inpatient,1,mL,5.61000,5.32000,The Alliance,Exception Members,,4.32,,,,,,,3.09,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,outpatient,1,mL,5.61000,5.32000,The Alliance,Exception Members,,4.32,,,,,,,2.81,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,4.95,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,inpatient,,,90.60000,86.07000,The Alliance,Exception Members,90,69.76,,,,,,,49.83,87.88,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Exception Members,90,69.76,,,,,,,13.88,746.94,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,12.05,1539.22,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,inpatient,10,EA,16.13000,15.33000,The Alliance,Exception Members,,12.42,,,,,,,8.87,15.65,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,outpatient,10,EA,16.13000,15.33000,The Alliance,Exception Members,,12.42,,,,,,,8.06,15.65,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,inpatient,1,EA,383.81000,364.62000,The Alliance,Exception Members,,295.53,,,,,,,211.10,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,outpatient,1,EA,383.81000,364.62000,The Alliance,Exception Members,,295.53,,,,,,,4.61,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,inpatient,1,EA,31.35000,29.78000,The Alliance,Exception Members,,24.14,,,,,,,17.24,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,outpatient,1,EA,31.35000,29.78000,The Alliance,Exception Members,,24.14,,,,,,,4.61,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,4.61,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,4.61,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,inpatient,1,EA,29.01000,27.56000,The Alliance,Exception Members,,22.34,,,,,,,15.96,28.14,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Exception Members,,22.34,,,,,,,4.61,28.14,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,inpatient,1,EA,3.14000,2.99000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,outpatient,1,EA,3.14000,2.99000,The Alliance,Exception Members,,2.42,,,,,,,1.57,3.05,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,inpatient,15,EA,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,outpatient,15,EA,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.16,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,inpatient,15,EA,6.87000,6.52000,The Alliance,Exception Members,,5.29,,,,,,,3.78,6.66,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,outpatient,15,EA,6.87000,6.52000,The Alliance,Exception Members,,5.29,,,,,,,3.44,6.66,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,122.10,215.34,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,16.38,848.80,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,inpatient,10,EA,25.01000,23.76000,The Alliance,Exception Members,,19.26,,,,,,,13.76,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,outpatient,10,EA,25.01000,23.76000,The Alliance,Exception Members,,19.26,,,,,,,12.51,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,inpatient,10,EA,38.33000,36.41000,The Alliance,Exception Members,,29.51,,,,,,,21.08,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,outpatient,10,EA,38.33000,36.41000,The Alliance,Exception Members,,29.51,,,,,,,19.16,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,inpatient,10,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,inpatient,10,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,inpatient,10,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,outpatient,10,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,inpatient,10,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,8.26,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,7.50,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,inpatient,10,EA,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.47,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,outpatient,10,EA,4.49000,4.27000,The Alliance,Exception Members,,3.46,,,,,,,2.25,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,inpatient,10,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,outpatient,10,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,7.58,14.71,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,inpatient,1,EA,1566.95000,1488.60000,The Alliance,Exception Members,,1206.55,,,,,,,861.82,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,outpatient,1,EA,1566.95000,1488.60000,The Alliance,Exception Members,,1206.55,,,,,,,734.15,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,inpatient,1,EA,2451.28000,2328.72000,The Alliance,Exception Members,,1887.49,,,,,,,1348.20,2377.74,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,outpatient,1,EA,2451.28000,2328.72000,The Alliance,Exception Members,,1887.49,,,,,,,734.15,2377.74,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,inpatient,200,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,outpatient,200,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,26.79,78.87,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,4.75,254.68,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.92,203.72,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,11.53,574.73,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,115.50,203.70,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,18.58,967.70,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,inpatient,1,EA,727.27000,690.91000,The Alliance,Exception Members,,560.00,,,,,,,400.00,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,outpatient,1,EA,727.27000,690.91000,The Alliance,Exception Members,,560.00,,,,,,,195.79,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,inpatient,1,EA,730.51000,693.98000,The Alliance,Exception Members,,562.49,,,,,,,401.78,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,outpatient,1,EA,730.51000,693.98000,The Alliance,Exception Members,,562.49,,,,,,,195.79,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,inpatient,1,EA,725.20000,688.94000,The Alliance,Exception Members,,558.40,,,,,,,398.86,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,outpatient,1,EA,725.20000,688.94000,The Alliance,Exception Members,,558.40,,,,,,,195.79,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,inpatient,1,EA,410.23000,389.72000,The Alliance,Exception Members,,315.88,,,,,,,225.63,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,outpatient,1,EA,410.23000,389.72000,The Alliance,Exception Members,,315.88,,,,,,,195.79,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,inpatient,1,EA,444.44000,422.22000,The Alliance,Exception Members,,342.22,,,,,,,244.44,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,outpatient,1,EA,444.44000,422.22000,The Alliance,Exception Members,,342.22,,,,,,,195.79,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,inpatient,1,EA,724.68000,688.45000,The Alliance,Exception Members,,558.00,,,,,,,398.57,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,outpatient,1,EA,724.68000,688.45000,The Alliance,Exception Members,,558.00,,,,,,,195.79,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,inpatient,1,EA,441.85000,419.76000,The Alliance,Exception Members,,340.22,,,,,,,243.02,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,outpatient,1,EA,441.85000,419.76000,The Alliance,Exception Members,,340.22,,,,,,,195.79,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,inpatient,1,EA,273.01000,259.36000,The Alliance,Exception Members,,210.22,,,,,,,150.16,264.82,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,outpatient,1,EA,273.01000,259.36000,The Alliance,Exception Members,,210.22,,,,,,,136.50,323.05,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,inpatient,1,EA,441.60000,419.52000,The Alliance,Exception Members,,340.03,,,,,,,242.88,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,outpatient,1,EA,441.60000,419.52000,The Alliance,Exception Members,,340.03,,,,,,,195.79,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,inpatient,1,EA,419.58000,398.60000,The Alliance,Exception Members,,323.08,,,,,,,230.77,406.99,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,outpatient,1,EA,419.58000,398.60000,The Alliance,Exception Members,,323.08,,,,,,,195.79,406.99,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,inpatient,1,mL,57.32000,54.46000,The Alliance,Exception Members,,44.14,,,,,,,31.53,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,outpatient,1,mL,57.32000,54.46000,The Alliance,Exception Members,,44.14,,,,,,,0.36823,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,0.36823,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,0.36823,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,inpatient,1,mL,29.61000,28.13000,The Alliance,Exception Members,,22.80,,,,,,,16.29,28.72,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,outpatient,1,mL,29.61000,28.13000,The Alliance,Exception Members,,22.80,,,,,,,0.36823,28.72,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,1.20,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,inpatient,1,EA,65.21000,61.95000,The Alliance,Exception Members,,50.21,,,,,,,35.87,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,outpatient,1,EA,65.21000,61.95000,The Alliance,Exception Members,,50.21,,,,,,,1.20,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,1.20,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.20,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,inpatient,1,EA,18.93000,17.98000,The Alliance,Exception Members,,14.58,,,,,,,10.41,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Exception Members,,14.58,,,,,,,1.20,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.20,2.70,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,1.82,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,inpatient,,,147.70000,140.31000,The Alliance,Exception Members,,113.73,,,,,,,81.23,143.27,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,outpatient,,,147.70000,140.31000,The Alliance,Exception Members,,113.73,,,,,,,36.30,143.27,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,inpatient,2,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,inpatient,2,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,inpatient,2,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,inpatient,2,EA,6.43000,6.11000,The Alliance,Exception Members,,4.95,,,,,,,3.54,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,outpatient,2,EA,6.43000,6.11000,The Alliance,Exception Members,,4.95,,,,,,,3.21,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,inpatient,2,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,outpatient,2,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,4.32,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,7.52,390.47,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,inpatient,10,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,outpatient,10,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.64740,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,inpatient,10,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,outpatient,10,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,inpatient,10,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,inpatient,10,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,outpatient,10,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,inpatient,10,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,outpatient,10,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,inpatient,10,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,4.06,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,outpatient,10,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,0.64740,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,inpatient,10,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.64740,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,inpatient,10,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,outpatient,10,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.64740,1.29,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,inpatient,12,EA,40.91000,38.87000,The Alliance,Exception Members,,31.50,,,,,,,22.50,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,outpatient,12,EA,40.91000,38.87000,The Alliance,Exception Members,,31.50,,,,,,,20.45,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,inpatient,12,EA,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,outpatient,12,EA,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,inpatient,12,EA,72.80000,69.16000,The Alliance,Exception Members,,56.06,,,,,,,40.04,70.62,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,outpatient,12,EA,72.80000,69.16000,The Alliance,Exception Members,,56.06,,,,,,,36.40,70.62,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,56.10,98.94,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,4.90,373.51,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,2.37,118.82,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,12.87,679.08,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,inpatient,1,mL,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,0.43000,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,0.43000,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,inpatient,1,mL,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,outpatient,1,mL,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,inpatient,1,mL,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,0.43000,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,inpatient,1,mL,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,0.43000,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,inpatient,1,mL,22.27000,21.15000,The Alliance,Exception Members,,17.15,,,,,,,12.25,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,outpatient,1,mL,22.27000,21.15000,The Alliance,Exception Members,,17.15,,,,,,,0.43000,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,0.43000,7.66,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,177.65,313.31,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,35.09,1833.46,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,73.15,129.01,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,11.84,611.15,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,inpatient,1,EA,6103.28000,5798.12000,The Alliance,Exception Members,,4699.53,,,,,,,3356.80,5920.18,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,outpatient,1,EA,6103.28000,5798.12000,The Alliance,Exception Members,,4699.53,,,,,,,734.15,5920.18,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1278.00000,1214.10000,The Alliance,Exception Members,,984.06,,,,,,,702.90,1239.66,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1278.00000,1214.10000,The Alliance,Exception Members,,984.06,,,,,,,128.29,6705.74,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,inpatient,1,mL,5.44000,5.17000,The Alliance,Exception Members,,4.19,,,,,,,2.99,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,outpatient,1,mL,5.44000,5.17000,The Alliance,Exception Members,,4.19,,,,,,,2.72,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,inpatient,1,mL,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,inpatient,1,mL,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,outpatient,1,mL,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.35,4.95,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,The Alliance,Exception Members,,45.58,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Exception Members,,45.58,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,The Alliance,Exception Members,,91.15,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Exception Members,,91.15,,,,,,,49.09,114.83,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,inpatient,10,EA,15.54000,14.76000,The Alliance,Exception Members,,11.97,,,,,,,8.55,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,outpatient,10,EA,15.54000,14.76000,The Alliance,Exception Members,,11.97,,,,,,,7.77,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,inpatient,10,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.64,8.19,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,outpatient,10,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.22,8.19,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,inpatient,4,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,outpatient,4,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,inpatient,4,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,outpatient,4,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,391.60,690.64,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,67.36,3514.18,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,inpatient,,,4882.00000,4637.90000,The Alliance,Exception Members,TC,3759.14,,,,,,,2685.10,4735.54,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,outpatient,,,4882.00000,4637.90000,The Alliance,Exception Members,TC,3759.14,,,,,,,2091.58,4735.54,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,2.37,118.82,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,733.05000,696.40000,The Alliance,Exception Members,,564.45,,,,,,,359.19,711.06,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,733.05000,696.40000,The Alliance,Exception Members,,564.45,,,,,,,336.47,733.05,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,inpatient,,,22.90000,21.75000,The Alliance,Exception Members,,17.63,,,,,,,12.60,22.21,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,outpatient,,,22.90000,21.75000,The Alliance,Exception Members,,17.63,,,,,,,11.45,22.21,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,inpatient,1,EA,1.77000,1.69000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,outpatient,1,EA,1.77000,1.69000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,inpatient,1,mL,414.52000,393.79000,The Alliance,Exception Members,,319.18,,,,,,,227.99,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,outpatient,1,mL,414.52000,393.79000,The Alliance,Exception Members,,319.18,,,,,,,207.26,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,inpatient,1,mL,378.56000,359.63000,The Alliance,Exception Members,,291.49,,,,,,,208.21,367.20,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,outpatient,1,mL,378.56000,359.63000,The Alliance,Exception Members,,291.49,,,,,,,189.28,367.20,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,inpatient,1,EA,24.19000,22.98000,The Alliance,Exception Members,,18.63,,,,,,,13.30,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,outpatient,1,EA,24.19000,22.98000,The Alliance,Exception Members,,18.63,,,,,,,0.43000,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,0.43000,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,0.43000,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.43000,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,0.43000,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,0.43000,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,inpatient,1,EA,23.47000,22.30000,The Alliance,Exception Members,,18.07,,,,,,,12.91,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,outpatient,1,EA,23.47000,22.30000,The Alliance,Exception Members,,18.07,,,,,,,0.43000,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,inpatient,1,EA,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,outpatient,1,EA,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,0.43000,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,inpatient,1,EA,22.91000,21.76000,The Alliance,Exception Members,,17.64,,,,,,,12.60,22.22,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Exception Members,,17.64,,,,,,,0.43000,22.22,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,inpatient,1,mL,458.17000,435.26000,The Alliance,Exception Members,,352.79,,,,,,,251.99,444.42,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,outpatient,1,mL,458.17000,435.26000,The Alliance,Exception Members,,352.79,,,,,,,229.09,444.42,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,12.39,645.08,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,10.74,560.26,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,3.28,152.82,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,inpatient,10,EA,4.89000,4.64000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.74,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,outpatient,10,EA,4.89000,4.64000,The Alliance,Exception Members,,3.77,,,,,,,2.44,4.74,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,inpatient,1,mL,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,69.38,134.59,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,13.09,679.08,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,inpatient,,,383.00000,363.85000,The Alliance,Exception Members,,294.91,,,,,,,210.65,371.51,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Exception Members,,294.91,,,,,,,35.09,1833.46,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,inpatient,1,mL,75.21000,71.45000,The Alliance,Exception Members,,57.91,,,,,,,41.37,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,outpatient,1,mL,75.21000,71.45000,The Alliance,Exception Members,,57.91,,,,,,,7.15,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,inpatient,1,mL,88.73000,84.30000,The Alliance,Exception Members,,68.32,,,,,,,48.80,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,outpatient,1,mL,88.73000,84.30000,The Alliance,Exception Members,,68.32,,,,,,,7.15,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,7.15,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,inpatient,1,mL,67.43000,64.06000,The Alliance,Exception Members,,51.92,,,,,,,37.09,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,outpatient,1,mL,67.43000,64.06000,The Alliance,Exception Members,,51.92,,,,,,,7.15,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,inpatient,1,mL,67.31000,63.94000,The Alliance,Exception Members,,51.83,,,,,,,37.02,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,outpatient,1,mL,67.31000,63.94000,The Alliance,Exception Members,,51.83,,,,,,,7.15,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,7.15,61.30,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,inpatient,,,231.53000,219.95000,The Alliance,Exception Members,,178.28,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,outpatient,,,231.53000,219.95000,The Alliance,Exception Members,,178.28,,,,,,,115.77,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,inpatient,1,mL,231.53000,219.95000,The Alliance,Exception Members,,178.28,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,outpatient,1,mL,231.53000,219.95000,The Alliance,Exception Members,,178.28,,,,,,,115.77,224.58,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,11.98,628.12,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,8.17,424.40,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,inpatient,,,146.22000,138.91000,The Alliance,Exception Members,,112.59,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,outpatient,,,146.22000,138.91000,The Alliance,Exception Members,,112.59,,,,,,,73.11,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,inpatient,1,mL,146.22000,138.91000,The Alliance,Exception Members,,112.59,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,outpatient,1,mL,146.22000,138.91000,The Alliance,Exception Members,,112.59,,,,,,,73.11,141.83,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,11.98,628.12,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,8.17,797.91,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,3.93,203.72,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,inpatient,1,mL,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,outpatient,1,mL,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,0.33945,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,0.33945,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,inpatient,1,mL,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,3.02,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,outpatient,1,mL,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,0.33945,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,inpatient,1,mL,4.00000,3.80000,The Alliance,Exception Members,,3.08,,,,,,,2.20,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,outpatient,1,mL,4.00000,3.80000,The Alliance,Exception Members,,3.08,,,,,,,0.33945,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,inpatient,1,mL,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,0.33945,2.96,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,10.33,543.22,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,90,100.10,,,,,,,71.50,126.10,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,90,100.10,,,,,,,11.91,594.19,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,26.00000,24.70000,The Alliance,Exception Members,QN,20.02,,,,,,,14.30,25.22,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Exception Members,QN,20.02,,,,,,,13.00,25.22,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,275.62,545.62,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,258.19,562.50,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,Exception Members,,317.24,,,,,,,226.60,399.64,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Exception Members,,317.24,,,,,,,38.30,1901.39,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,9.71,509.30,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,69.30,122.22,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Exception Members,,97.02,,,,,,,12.05,628.12,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,inpatient,,,254.90000,242.16000,The Alliance,Exception Members,90,196.27,,,,,,,140.19,247.25,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,outpatient,,,254.90000,242.16000,The Alliance,Exception Members,90,196.27,,,,,,,22.69,1154.38,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,13.52,713.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,inpatient,1,EA,1.21000,1.14000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,outpatient,1,EA,1.21000,1.14000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,14.27,746.94,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,11.77,611.15,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,inpatient,,,139.34000,132.37000,The Alliance,Exception Members,,107.29,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,outpatient,,,139.34000,132.37000,The Alliance,Exception Members,,107.29,,,,,,,69.67,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,inpatient,1,EA,139.34000,132.37000,The Alliance,Exception Members,,107.29,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,outpatient,1,EA,139.34000,132.37000,The Alliance,Exception Members,,107.29,,,,,,,69.67,135.16,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,inpatient,1,mL,10.40000,9.88000,The Alliance,Exception Members,,8.01,,,,,,,5.72,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,outpatient,1,mL,10.40000,9.88000,The Alliance,Exception Members,,8.01,,,,,,,0.33945,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,0.33945,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,inpatient,1,mL,24.11000,22.91000,The Alliance,Exception Members,,18.56,,,,,,,13.26,23.39,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,outpatient,1,mL,24.11000,22.91000,The Alliance,Exception Members,,18.56,,,,,,,0.33945,23.39,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,12.58,662.12,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,inpatient,,,276.60000,262.77000,The Alliance,Exception Members,90,212.98,,,,,,,152.13,268.30,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,outpatient,,,276.60000,262.77000,The Alliance,Exception Members,90,212.98,,,,,,,8.17,679.08,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,8.61,407.44,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,73.15,129.01,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,,102.41,,,,,,,13.79,645.08,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,8.00,373.51,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,6.82,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,inpatient,1,EA,134.16000,127.46000,The Alliance,Exception Members,,103.30,,,,,,,73.79,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,outpatient,1,EA,134.16000,127.46000,The Alliance,Exception Members,,103.30,,,,,,,6.82,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,6.82,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,24.89,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,6.82,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,inpatient,1,EA,7.65000,7.26000,The Alliance,Exception Members,,5.89,,,,,,,4.21,7.42,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Exception Members,,5.89,,,,,,,3.83,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,6.82,36.78,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,171.05,301.67,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,58.00,3038.81,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,inpatient,,,392.00000,372.40000,The Alliance,Exception Members,,301.84,,,,,,,215.60,380.24,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,outpatient,,,392.00000,372.40000,The Alliance,Exception Members,,301.84,,,,,,,196.00,380.24,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,90,40.81,,,,,,,29.15,51.41,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,90,40.81,,,,,,,6.41,1590.11,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,The Alliance,Exception Members,TC,2631.86,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Exception Members,TC,2631.86,,,,,,,1578.65,3315.46,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,14.38,746.94,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,inpatient,,,301.21000,286.15000,The Alliance,Exception Members,,231.93,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,outpatient,,,301.21000,286.15000,The Alliance,Exception Members,,231.93,,,,,,,150.60,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,inpatient,1,mL,301.21000,286.15000,The Alliance,Exception Members,,231.93,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,outpatient,1,mL,301.21000,286.15000,The Alliance,Exception Members,,231.93,,,,,,,150.60,292.17,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,inpatient,1,EA,36.47000,34.64000,The Alliance,Exception Members,,28.08,,,,,,,20.06,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,outpatient,1,EA,36.47000,34.64000,The Alliance,Exception Members,,28.08,,,,,,,18.23,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,18.17,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,inpatient,1,EA,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,outpatient,1,EA,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,inpatient,1,EA,34.63000,32.90000,The Alliance,Exception Members,,26.67,,,,,,,19.05,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,outpatient,1,EA,34.63000,32.90000,The Alliance,Exception Members,,26.67,,,,,,,17.32,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,inpatient,1,EA,9.39000,8.92000,The Alliance,Exception Members,,7.23,,,,,,,5.16,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Exception Members,,7.23,,,,,,,4.70,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,inpatient,1,EA,151.75000,144.17000,The Alliance,Exception Members,,116.85,,,,,,,83.46,147.20,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,outpatient,1,EA,151.75000,144.17000,The Alliance,Exception Members,,116.85,,,,,,,75.88,147.20,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,Exception Members,,304.92,,,,,,,217.80,384.12,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Exception Members,,304.92,,,,,,,24.06,1137.41,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,Exception Members,TC,358.82,,,,,,,256.30,452.02,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,Exception Members,TC,358.82,,,,,,,233.00,4012.21,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,19.35,1018.59,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,9.09,441.37,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,inpatient,28.35,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,outpatient,28.35,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,inpatient,28.35,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,outpatient,28.35,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,inpatient,28.35,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,outpatient,28.35,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,inpatient,28.35,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,outpatient,28.35,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,Exception Members,,377.30,,,,,,,269.50,475.30,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Exception Members,,377.30,,,,,,,42.84,2240.90,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,The Alliance,Exception Members,,45.58,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Exception Members,,45.58,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,The Alliance,Exception Members,,91.15,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Exception Members,,91.15,,,,,,,49.09,114.83,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,inpatient,30,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,inpatient,30,EA,7.80000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,4.29,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,outpatient,30,EA,7.80000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,3.90,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,inpatient,30,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,outpatient,30,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,inpatient,30,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,outpatient,30,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,inpatient,30,EA,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,4.01,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,outpatient,30,EA,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,3.65,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,inpatient,30,EA,1.59000,1.52000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,outpatient,30,EA,1.59000,1.52000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,inpatient,30,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,outpatient,30,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.32,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,inpatient,30,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,outpatient,30,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,inpatient,30,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,outpatient,30,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,inpatient,30,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,outpatient,30,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,71.00,137.74,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,497.20,876.88,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,85.10,4447.87,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,inpatient,,,217.70000,206.81000,The Alliance,Exception Members,90,167.63,,,,,,,119.73,211.17,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,outpatient,,,217.70000,206.81000,The Alliance,Exception Members,90,167.63,,,,,,,26.67,1341.13,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,11.98,628.12,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,inpatient,1,EA,10.30000,9.78000,The Alliance,Exception Members,,7.93,,,,,,,5.67,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,outpatient,1,EA,10.30000,9.78000,The Alliance,Exception Members,,7.93,,,,,,,5.15,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,inpatient,1,EA,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,outpatient,1,EA,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,inpatient,1,mL,5.92000,5.62000,The Alliance,Exception Members,,4.56,,,,,,,3.26,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,outpatient,1,mL,5.92000,5.62000,The Alliance,Exception Members,,4.56,,,,,,,0.14409,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,inpatient,1,mL,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.45,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,outpatient,1,mL,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,0.14409,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,inpatient,1,mL,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,6.03,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,outpatient,1,mL,10.97000,10.42000,The Alliance,Exception Members,,8.45,,,,,,,0.14409,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,inpatient,1,mL,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,3.21,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,outpatient,1,mL,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,0.14409,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,0.14409,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,inpatient,1,mL,13.11000,12.46000,The Alliance,Exception Members,,10.09,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,outpatient,1,mL,13.11000,12.46000,The Alliance,Exception Members,,10.09,,,,,,,0.14409,12.72,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,inpatient,1,mL,133.27000,126.60000,The Alliance,Exception Members,,102.62,,,,,,,73.30,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,outpatient,1,mL,133.27000,126.60000,The Alliance,Exception Members,,102.62,,,,,,,0.56420,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,inpatient,1,mL,176.33000,167.51000,The Alliance,Exception Members,,135.77,,,,,,,96.98,171.04,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,outpatient,1,mL,176.33000,167.51000,The Alliance,Exception Members,,135.77,,,,,,,0.56420,171.04,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,13.19,696.05,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,inpatient,1,mL,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,outpatient,1,mL,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,inpatient,1,mL,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.42,6.02,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,outpatient,1,mL,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.10,6.02,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,8.89,458.40,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,inpatient,,,459.00000,436.05000,The Alliance,Exception Members,,353.43,,,,,,,252.45,445.23,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,Exception Members,,353.43,,,,,,,42.84,2240.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,203.50,358.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,35.09,1833.46,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,The Alliance,Exception Members,,2.99,,,,,,,2.13,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Exception Members,,2.99,,,,,,,1.94,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,2.85,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,inpatient,1,EA,3.86000,3.66000,The Alliance,Exception Members,,2.97,,,,,,,2.12,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Exception Members,,2.97,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,inpatient,60,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,outpatient,60,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,inpatient,60,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,outpatient,60,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,inpatient,60,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,outpatient,60,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,inpatient,60,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,outpatient,60,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,inpatient,60,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,outpatient,60,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,inpatient,,,1293.00000,1228.35000,The Alliance,Exception Members,90,995.61,,,,,,,711.15,1254.21,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,outpatient,,,1293.00000,1228.35000,The Alliance,Exception Members,90,995.61,,,,,,,121.54,5992.72,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,inpatient,50,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,4.20,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,outpatient,50,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,0.14409,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,inpatient,50,EA,6.54000,6.21000,The Alliance,Exception Members,,5.04,,,,,,,3.60,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,outpatient,50,EA,6.54000,6.21000,The Alliance,Exception Members,,5.04,,,,,,,0.14409,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,inpatient,50,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,3.55,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,outpatient,50,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,0.14409,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,inpatient,50,EA,8.96000,8.51000,The Alliance,Exception Members,,6.90,,,,,,,4.93,8.69,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,outpatient,50,EA,8.96000,8.51000,The Alliance,Exception Members,,6.90,,,,,,,0.14409,8.69,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,inpatient,500,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,outpatient,500,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,inpatient,500,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,outpatient,500,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,11.85,611.15,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,inpatient,1,EA,4.31000,4.10000,The Alliance,Exception Members,,3.32,,,,,,,2.37,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,outpatient,1,EA,4.31000,4.10000,The Alliance,Exception Members,,3.32,,,,,,,2.15,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,90,100.87,,,,,,,72.05,127.07,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,90,100.87,,,,,,,11.96,611.15,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,3.19,5.63,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,2.90,40.87,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,16.46,865.84,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,inpatient,1,EA,64.46000,61.24000,The Alliance,Exception Members,,49.63,,,,,,,35.45,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,outpatient,1,EA,64.46000,61.24000,The Alliance,Exception Members,,49.63,,,,,,,31.90,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,inpatient,1,EA,64.49000,61.26000,The Alliance,Exception Members,,49.66,,,,,,,35.47,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,outpatient,1,EA,64.49000,61.26000,The Alliance,Exception Members,,49.66,,,,,,,31.90,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,inpatient,1,EA,47.72000,45.33000,The Alliance,Exception Members,,36.74,,,,,,,26.25,46.29,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,outpatient,1,EA,47.72000,45.33000,The Alliance,Exception Members,,36.74,,,,,,,23.86,46.29,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,inpatient,1,EA,5.29000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,2.91,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,outpatient,1,EA,5.29000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,2.65,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,2.83,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,inpatient,1,EA,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.90,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.64,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.35,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.44,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,inpatient,,,32.40000,30.78000,The Alliance,Exception Members,90,24.95,,,,,,,17.82,31.43,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,outpatient,,,32.40000,30.78000,The Alliance,Exception Members,90,24.95,,,,,,,16.20,814.87,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,inpatient,1,mL,263.33000,250.17000,The Alliance,Exception Members,,202.76,,,,,,,144.83,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,outpatient,1,mL,263.33000,250.17000,The Alliance,Exception Members,,202.76,,,,,,,34.44,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,inpatient,1,mL,363.46000,345.29000,The Alliance,Exception Members,,279.86,,,,,,,199.90,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,outpatient,1,mL,363.46000,345.29000,The Alliance,Exception Members,,279.86,,,,,,,34.44,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,inpatient,1,mL,258.07000,245.16000,The Alliance,Exception Members,,198.71,,,,,,,141.94,250.33,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,outpatient,1,mL,258.07000,245.16000,The Alliance,Exception Members,,198.71,,,,,,,34.44,250.33,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.35,1018.59,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,inpatient,1,EA,238.67000,226.74000,The Alliance,Exception Members,,183.78,,,,,,,131.27,231.51,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,outpatient,1,EA,238.67000,226.74000,The Alliance,Exception Members,,183.78,,,,,,,31.90,231.51,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,inpatient,1,EA,93.35000,88.68000,The Alliance,Exception Members,,71.88,,,,,,,51.34,90.55,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,outpatient,1,EA,93.35000,88.68000,The Alliance,Exception Members,,71.88,,,,,,,27.10,90.55,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,inpatient,,,842.00000,799.90000,The Alliance,Exception Members,,648.34,,,,,,,463.10,816.74,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,Exception Members,,648.34,,,,,,,50.62,3666.93,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,inpatient,1,mL,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,17.80,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,inpatient,1,mL,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,4.37,7.70,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,outpatient,1,mL,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,3.97,17.80,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,24.08,1256.24,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,inpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,233.75,412.25,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,34.81,1680.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,inpatient,1,EA,26.51000,25.19000,The Alliance,Exception Members,,20.41,,,,,,,14.58,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,outpatient,1,EA,26.51000,25.19000,The Alliance,Exception Members,,20.41,,,,,,,13.26,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,inpatient,1,EA,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,12.51,22.07,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,outpatient,1,EA,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,11.38,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,inpatient,1,EA,8.66000,8.23000,The Alliance,Exception Members,,6.67,,,,,,,4.76,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,outpatient,1,EA,8.66000,8.23000,The Alliance,Exception Members,,6.67,,,,,,,0.14409,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,inpatient,1,EA,10.64000,10.10000,The Alliance,Exception Members,,8.19,,,,,,,5.85,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,outpatient,1,EA,10.64000,10.10000,The Alliance,Exception Members,,8.19,,,,,,,0.14409,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,0.14409,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,0.14409,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,inpatient,1,EA,6.05000,5.75000,The Alliance,Exception Members,,4.66,,,,,,,3.33,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Exception Members,,4.66,,,,,,,0.14409,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,inpatient,1,EA,4.55000,4.32000,The Alliance,Exception Members,,3.50,,,,,,,2.50,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,outpatient,1,EA,4.55000,4.32000,The Alliance,Exception Members,,3.50,,,,,,,0.14409,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.14409,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.14409,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,0.14409,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,inpatient,1,EA,13.65000,12.97000,The Alliance,Exception Members,,10.51,,,,,,,7.51,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,outpatient,1,EA,13.65000,12.97000,The Alliance,Exception Members,,10.51,,,,,,,0.14409,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,inpatient,1,EA,13.11000,12.46000,The Alliance,Exception Members,,10.09,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,outpatient,1,EA,13.11000,12.46000,The Alliance,Exception Members,,10.09,,,,,,,0.14409,12.72,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,19.62,1052.52,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,49.50,87.30,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,,69.30,,,,,,,7.73,407.44,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,inpatient,5,EA,119.08000,113.13000,The Alliance,Exception Members,,91.69,,,,,,,65.49,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,outpatient,5,EA,119.08000,113.13000,The Alliance,Exception Members,,91.69,,,,,,,59.54,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,inpatient,5,EA,4.55000,4.32000,The Alliance,Exception Members,,3.50,,,,,,,2.50,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,outpatient,5,EA,4.55000,4.32000,The Alliance,Exception Members,,3.50,,,,,,,2.27,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,inpatient,5,EA,4.84000,4.60000,The Alliance,Exception Members,,3.73,,,,,,,2.66,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,outpatient,5,EA,4.84000,4.60000,The Alliance,Exception Members,,3.73,,,,,,,2.42,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,inpatient,5,EA,252.80000,240.16000,The Alliance,Exception Members,,194.66,,,,,,,139.04,245.22,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,outpatient,5,EA,252.80000,240.16000,The Alliance,Exception Members,,194.66,,,,,,,126.40,245.22,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,99.55,175.57,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,16.67,865.84,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,The Alliance,Exception Members,,2355.43,,,,,,,1682.45,2967.23,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Exception Members,,2355.43,,,,,,,1538.48,4686.00,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,inpatient,1,EA,116.10000,110.29000,The Alliance,Exception Members,,89.40,,,,,,,63.85,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,outpatient,1,EA,116.10000,110.29000,The Alliance,Exception Members,,89.40,,,,,,,37.62,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,inpatient,1,EA,183.44000,174.27000,The Alliance,Exception Members,,141.25,,,,,,,100.89,177.94,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,outpatient,1,EA,183.44000,174.27000,The Alliance,Exception Members,,141.25,,,,,,,37.62,177.94,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,inpatient,10,EA,166.90000,158.56000,The Alliance,Exception Members,,128.51,,,,,,,91.80,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,outpatient,10,EA,166.90000,158.56000,The Alliance,Exception Members,,128.51,,,,,,,3.89,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,inpatient,10,EA,94.35000,89.64000,The Alliance,Exception Members,,72.65,,,,,,,51.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,outpatient,10,EA,94.35000,89.64000,The Alliance,Exception Members,,72.65,,,,,,,3.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,inpatient,10,EA,256.40000,243.58000,The Alliance,Exception Members,,197.43,,,,,,,141.02,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,outpatient,10,EA,256.40000,243.58000,The Alliance,Exception Members,,197.43,,,,,,,3.89,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,inpatient,10,EA,185.79000,176.50000,The Alliance,Exception Members,,143.06,,,,,,,102.18,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,outpatient,10,EA,185.79000,176.50000,The Alliance,Exception Members,,143.06,,,,,,,3.89,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,inpatient,10,EA,100.32000,95.31000,The Alliance,Exception Members,,77.25,,,,,,,55.18,97.31,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,outpatient,10,EA,100.32000,95.31000,The Alliance,Exception Members,,77.25,,,,,,,3.89,97.31,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,90,84.70,,,,,,,60.50,106.70,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,90,84.70,,,,,,,9.61,492.33,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,inpatient,1,GM,11.69000,11.11000,The Alliance,Exception Members,,9.00,,,,,,,6.43,11.34,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,outpatient,1,GM,11.69000,11.11000,The Alliance,Exception Members,,9.00,,,,,,,5.84,11.34,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,inpatient,,,475.00000,451.25000,The Alliance,Exception Members,TC,365.75,,,,,,,261.25,460.75,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Exception Members,TC,365.75,,,,,,,237.50,3299.19,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,17.85,814.87,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,Exception Members,,204.05,,,,,,,145.75,257.05,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Exception Members,,204.05,,,,,,,22.34,2082.45,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,inpatient,1,EA,3703.00000,3517.85000,The Alliance,Exception Members,,2851.31,,,,,,,2036.65,3591.91,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,outpatient,1,EA,3703.00000,3517.85000,The Alliance,Exception Members,,2851.31,,,,,,,43.29,3591.91,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,inpatient,1,EA,10.33000,9.82000,The Alliance,Exception Members,,7.95,,,,,,,5.68,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Exception Members,,7.95,,,,,,,5.17,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,inpatient,1,EA,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,4.11,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,outpatient,1,EA,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,3.73,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,inpatient,1,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.48,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,inpatient,1,EA,9.19000,8.73000,The Alliance,Exception Members,,7.08,,,,,,,5.05,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,outpatient,1,EA,9.19000,8.73000,The Alliance,Exception Members,,7.08,,,,,,,4.59,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,inpatient,1,EA,4.67000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.57,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,outpatient,1,EA,4.67000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.33,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.58,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.25,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,The Alliance,Exception Members,,7.42,,,,,,,5.30,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Exception Members,,7.42,,,,,,,4.82,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,inpatient,,,1160.00000,1102.00000,The Alliance,Exception Members,TC,893.20,,,,,,,638.00,1125.20,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Exception Members,TC,893.20,,,,,,,580.00,10163.53,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,inpatient,,,603.00000,572.85000,The Alliance,Exception Members,,464.31,,,,,,,331.65,584.91,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Exception Members,,464.31,,,,,,,51.19,2410.69,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,inpatient,1,EA,28.05000,26.64000,The Alliance,Exception Members,,21.60,,,,,,,15.43,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,outpatient,1,EA,28.05000,26.64000,The Alliance,Exception Members,,21.60,,,,,,,2.48,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,inpatient,1,EA,13.47000,12.80000,The Alliance,Exception Members,,10.37,,,,,,,7.41,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,outpatient,1,EA,13.47000,12.80000,The Alliance,Exception Members,,10.37,,,,,,,2.48,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,2.48,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,9.04,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,2.48,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,2.48,13.79,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,inpatient,0.5,mL,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,7.64,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,outpatient,0.5,mL,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,0.33945,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,inpatient,0.5,mL,18.14000,17.23000,The Alliance,Exception Members,,13.97,,,,,,,9.98,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,outpatient,0.5,mL,18.14000,17.23000,The Alliance,Exception Members,,13.97,,,,,,,0.33945,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,inpatient,0.5,mL,9.67000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,outpatient,0.5,mL,9.67000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,0.33945,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,inpatient,0.5,mL,35.83000,34.04000,The Alliance,Exception Members,,27.59,,,,,,,19.71,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,outpatient,0.5,mL,35.83000,34.04000,The Alliance,Exception Members,,27.59,,,,,,,0.33945,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,inpatient,0.5,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,outpatient,0.5,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,0.33945,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,inpatient,0.5,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,outpatient,0.5,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,0.33945,24.52,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,The Alliance,Exception Members,90,177.49,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Exception Members,90,177.49,,,,,,,45.08,679.08,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,11.26,594.19,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,inpatient,10,EA,173.44000,164.76000,The Alliance,Exception Members,,133.55,,,,,,,95.39,168.24,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,outpatient,10,EA,173.44000,164.76000,The Alliance,Exception Members,,133.55,,,,,,,86.72,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,inpatient,10,EA,142.92000,135.77000,The Alliance,Exception Members,,110.05,,,,,,,78.61,138.63,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,outpatient,10,EA,142.92000,135.77000,The Alliance,Exception Members,,110.05,,,,,,,71.46,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,inpatient,10,EA,94.26000,89.55000,The Alliance,Exception Members,,72.58,,,,,,,51.84,91.43,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,outpatient,10,EA,94.26000,89.55000,The Alliance,Exception Members,,72.58,,,,,,,47.13,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,inpatient,10,EA,71.43000,67.85000,The Alliance,Exception Members,,55.00,,,,,,,39.29,69.29,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,outpatient,10,EA,71.43000,67.85000,The Alliance,Exception Members,,55.00,,,,,,,35.72,340.40,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,inpatient,1,mL,211.33000,200.76000,The Alliance,Exception Members,,162.72,,,,,,,116.23,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,outpatient,1,mL,211.33000,200.76000,The Alliance,Exception Members,,162.72,,,,,,,3.89,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,3.89,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,inpatient,1,mL,165.90000,157.60000,The Alliance,Exception Members,,127.74,,,,,,,91.25,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,outpatient,1,mL,165.90000,157.60000,The Alliance,Exception Members,,127.74,,,,,,,3.89,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,inpatient,1,mL,259.60000,246.62000,The Alliance,Exception Members,,199.89,,,,,,,142.78,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,outpatient,1,mL,259.60000,246.62000,The Alliance,Exception Members,,199.89,,,,,,,3.89,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,inpatient,1,mL,187.77000,178.38000,The Alliance,Exception Members,,144.58,,,,,,,103.27,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,outpatient,1,mL,187.77000,178.38000,The Alliance,Exception Members,,144.58,,,,,,,3.89,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,inpatient,1,mL,188.08000,178.68000,The Alliance,Exception Members,,144.82,,,,,,,103.44,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,outpatient,1,mL,188.08000,178.68000,The Alliance,Exception Members,,144.82,,,,,,,3.89,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,inpatient,1,mL,101.57000,96.49000,The Alliance,Exception Members,,78.21,,,,,,,55.86,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,outpatient,1,mL,101.57000,96.49000,The Alliance,Exception Members,,78.21,,,,,,,3.89,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,inpatient,1,mL,124.82000,118.58000,The Alliance,Exception Members,,96.11,,,,,,,68.65,121.08,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,outpatient,1,mL,124.82000,118.58000,The Alliance,Exception Members,,96.11,,,,,,,3.89,121.08,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,264.00,465.60,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,28.92,2088.15,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,inpatient,1,EA,801.42000,761.35000,The Alliance,Exception Members,,617.09,,,,,,,440.78,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,outpatient,1,EA,801.42000,761.35000,The Alliance,Exception Members,,617.09,,,,,,,400.71,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,inpatient,1,EA,483.89000,459.70000,The Alliance,Exception Members,,372.60,,,,,,,266.14,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,outpatient,1,EA,483.89000,459.70000,The Alliance,Exception Members,,372.60,,,,,,,241.94,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,inpatient,1,EA,937.33000,890.47000,The Alliance,Exception Members,,721.74,,,,,,,515.53,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,outpatient,1,EA,937.33000,890.47000,The Alliance,Exception Members,,721.74,,,,,,,468.67,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,inpatient,1,EA,890.47000,845.94000,The Alliance,Exception Members,,685.66,,,,,,,489.76,863.76,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,outpatient,1,EA,890.47000,845.94000,The Alliance,Exception Members,,685.66,,,,,,,445.24,863.76,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,The Alliance,Exception Members,,886.27,,,,,,,633.05,1116.47,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Exception Members,,886.27,,,,,,,633.05,3163.00,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,inpatient,,,3081.00000,2926.95000,The Alliance,Exception Members,,2372.37,,,,,,,1694.55,2988.57,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,outpatient,,,3081.00000,2926.95000,The Alliance,Exception Members,,2372.37,,,,,,,257.45,13462.44,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,inpatient,1,EA,8055.92000,7653.13000,The Alliance,Exception Members,,6203.06,,,,,,,4430.76,7814.24,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,outpatient,1,EA,8055.92000,7653.13000,The Alliance,Exception Members,,6203.06,,,,,,,41.85,7814.24,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,inpatient,,,333.00000,316.35000,The Alliance,Exception Members,,256.41,,,,,,,183.15,323.01,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Exception Members,,256.41,,,,,,,29.35,2438.99,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,79.75,140.65,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,79.75,5271.00,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.44,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,inpatient,10,EA,9.15000,8.69000,The Alliance,Exception Members,,7.05,,,,,,,5.03,8.88,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,outpatient,10,EA,9.15000,8.69000,The Alliance,Exception Members,,7.05,,,,,,,4.58,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,inpatient,10,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,outpatient,10,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,17.80,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,inpatient,1,EA,11830.90000,11239.36000,The Alliance,Exception Members,,9109.79,,,,,,,6506.99,11475.97,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,outpatient,1,EA,11830.90000,11239.36000,The Alliance,Exception Members,,9109.79,,,,,,,41.85,11475.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,inpatient,1,mL,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,2.10,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,outpatient,1,mL,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,0.33945,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,inpatient,1,mL,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,4.96,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,outpatient,1,mL,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,0.33945,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,inpatient,1,mL,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,3.51,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,outpatient,1,mL,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,0.33945,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,inpatient,1,mL,8.10000,7.70000,The Alliance,Exception Members,,6.24,,,,,,,4.46,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,outpatient,1,mL,8.10000,7.70000,The Alliance,Exception Members,,6.24,,,,,,,0.33945,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,inpatient,1,mL,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,0.33945,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,inpatient,1,mL,13.15000,12.49000,The Alliance,Exception Members,,10.13,,,,,,,7.23,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,outpatient,1,mL,13.15000,12.49000,The Alliance,Exception Members,,10.13,,,,,,,0.33945,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,0.33945,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,inpatient,1,mL,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,outpatient,1,mL,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,0.33945,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,inpatient,1,mL,10.65000,10.12000,The Alliance,Exception Members,,8.20,,,,,,,5.86,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,outpatient,1,mL,10.65000,10.12000,The Alliance,Exception Members,,8.20,,,,,,,0.33945,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,inpatient,1,mL,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,5.20,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,outpatient,1,mL,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,0.33945,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,0.33945,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,inpatient,1,mL,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,outpatient,1,mL,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,0.33945,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,inpatient,1,mL,12.17000,11.56000,The Alliance,Exception Members,,9.37,,,,,,,6.69,11.80,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,outpatient,1,mL,12.17000,11.56000,The Alliance,Exception Members,,9.37,,,,,,,0.33945,11.80,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,52.80,93.12,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,15.59,814.87,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,inpatient,0.4,EA,241.18000,229.12000,The Alliance,Exception Members,,185.71,,,,,,,132.65,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,outpatient,0.4,EA,241.18000,229.12000,The Alliance,Exception Members,,185.71,,,,,,,0.79980,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,inpatient,0.4,EA,113.78000,108.09000,The Alliance,Exception Members,,87.61,,,,,,,62.58,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,outpatient,0.4,EA,113.78000,108.09000,The Alliance,Exception Members,,87.61,,,,,,,0.79980,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,inpatient,0.4,EA,261.30000,248.24000,The Alliance,Exception Members,,201.20,,,,,,,143.72,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,outpatient,0.4,EA,261.30000,248.24000,The Alliance,Exception Members,,201.20,,,,,,,0.79980,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,inpatient,0.4,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,outpatient,0.4,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,inpatient,0.4,EA,26.46000,25.14000,The Alliance,Exception Members,,20.37,,,,,,,14.55,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,outpatient,0.4,EA,26.46000,25.14000,The Alliance,Exception Members,,20.37,,,,,,,0.79980,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,inpatient,0.4,EA,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,31.84,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,outpatient,0.4,EA,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,0.79980,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,inpatient,0.4,EA,70.55000,67.03000,The Alliance,Exception Members,,54.32,,,,,,,38.80,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,outpatient,0.4,EA,70.55000,67.03000,The Alliance,Exception Members,,54.32,,,,,,,0.79980,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,inpatient,0.4,EA,86.73000,82.39000,The Alliance,Exception Members,,66.78,,,,,,,47.70,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,outpatient,0.4,EA,86.73000,82.39000,The Alliance,Exception Members,,66.78,,,,,,,0.79980,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,inpatient,0.4,EA,61.62000,58.54000,The Alliance,Exception Members,,47.45,,,,,,,33.89,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,outpatient,0.4,EA,61.62000,58.54000,The Alliance,Exception Members,,47.45,,,,,,,0.79980,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,inpatient,0.4,EA,44.40000,42.18000,The Alliance,Exception Members,,34.19,,,,,,,24.42,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,outpatient,0.4,EA,44.40000,42.18000,The Alliance,Exception Members,,34.19,,,,,,,0.79980,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,inpatient,0.4,EA,62.73000,59.59000,The Alliance,Exception Members,,48.30,,,,,,,34.50,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,outpatient,0.4,EA,62.73000,59.59000,The Alliance,Exception Members,,48.30,,,,,,,0.79980,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,inpatient,0.4,EA,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,17.42,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,outpatient,0.4,EA,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,0.79980,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,inpatient,0.4,EA,29.07000,27.62000,The Alliance,Exception Members,,22.38,,,,,,,15.99,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,outpatient,0.4,EA,29.07000,27.62000,The Alliance,Exception Members,,22.38,,,,,,,0.79980,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,inpatient,0.4,EA,25.09000,23.84000,The Alliance,Exception Members,,19.32,,,,,,,13.80,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,outpatient,0.4,EA,25.09000,23.84000,The Alliance,Exception Members,,19.32,,,,,,,0.79980,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,inpatient,0.4,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,outpatient,0.4,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,0.79980,35.25,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,inpatient,1,EA,78.48000,74.56000,The Alliance,Exception Members,,60.43,,,,,,,43.16,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,outpatient,1,EA,78.48000,74.56000,The Alliance,Exception Members,,60.43,,,,,,,0.79980,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,inpatient,1,EA,67.53000,64.15000,The Alliance,Exception Members,,52.00,,,,,,,37.14,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,outpatient,1,EA,67.53000,64.15000,The Alliance,Exception Members,,52.00,,,,,,,0.79980,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.79980,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,inpatient,1,EA,31.73000,30.14000,The Alliance,Exception Members,,24.43,,,,,,,17.45,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,outpatient,1,EA,31.73000,30.14000,The Alliance,Exception Members,,24.43,,,,,,,0.79980,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,inpatient,1,EA,62.82000,59.68000,The Alliance,Exception Members,,48.37,,,,,,,34.55,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,outpatient,1,EA,62.82000,59.68000,The Alliance,Exception Members,,48.37,,,,,,,0.79980,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,inpatient,1,EA,70.63000,67.10000,The Alliance,Exception Members,,54.39,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,outpatient,1,EA,70.63000,67.10000,The Alliance,Exception Members,,54.39,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,inpatient,1,EA,21.05000,20.00000,The Alliance,Exception Members,,16.21,,,,,,,11.58,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Exception Members,,16.21,,,,,,,0.79980,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,inpatient,1,EA,60.99000,57.94000,The Alliance,Exception Members,,46.96,,,,,,,33.54,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,outpatient,1,EA,60.99000,57.94000,The Alliance,Exception Members,,46.96,,,,,,,0.79980,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,inpatient,1,EA,27.71000,26.33000,The Alliance,Exception Members,,21.34,,,,,,,15.24,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,outpatient,1,EA,27.71000,26.33000,The Alliance,Exception Members,,21.34,,,,,,,0.79980,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,16.20,28.57,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,0.79980,28.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,inpatient,28.35,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,outpatient,28.35,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,inpatient,28.35,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,outpatient,28.35,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,inpatient,28.35,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,outpatient,28.35,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,inpatient,28.35,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,outpatient,28.35,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,108.35,191.09,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,98.50,212.44,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,inpatient,1,EA,30.18000,28.68000,The Alliance,Exception Members,,23.24,,,,,,,16.60,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,outpatient,1,EA,30.18000,28.68000,The Alliance,Exception Members,,23.24,,,,,,,2.48,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,inpatient,1,EA,50.50000,47.97000,The Alliance,Exception Members,,38.88,,,,,,,27.77,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,outpatient,1,EA,50.50000,47.97000,The Alliance,Exception Members,,38.88,,,,,,,2.48,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,2.48,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,2.48,30.65,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,inpatient,,,160.90000,152.85000,The Alliance,Exception Members,90,123.89,,,,,,,88.50,156.07,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Exception Members,90,123.89,,,,,,,5.90,424.40,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,inpatient,5,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.73,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,outpatient,5,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,0.14409,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,inpatient,5,EA,5.95000,5.66000,The Alliance,Exception Members,,4.58,,,,,,,3.27,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,outpatient,5,EA,5.95000,5.66000,The Alliance,Exception Members,,4.58,,,,,,,0.14409,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,inpatient,5,EA,4.35000,4.14000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,outpatient,5,EA,4.35000,4.14000,The Alliance,Exception Members,,3.35,,,,,,,0.14409,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,inpatient,5,EA,8.78000,8.35000,The Alliance,Exception Members,,6.76,,,,,,,4.83,8.52,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,outpatient,5,EA,8.78000,8.35000,The Alliance,Exception Members,,6.76,,,,,,,0.14409,8.52,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,104.50,212.44,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,inpatient,1,mL,1728.59000,1642.16000,The Alliance,Exception Members,,1331.01,,,,,,,950.72,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,outpatient,1,mL,1728.59000,1642.16000,The Alliance,Exception Members,,1331.01,,,,,,,0.99000,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,inpatient,1,mL,1728.57000,1642.14000,The Alliance,Exception Members,,1331.00,,,,,,,950.71,1676.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,outpatient,1,mL,1728.57000,1642.14000,The Alliance,Exception Members,,1331.00,,,,,,,0.99000,1676.71,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,Exception Members,TC,361.90,,,,,,,258.50,455.90,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Exception Members,TC,361.90,,,,,,,215.60,3038.81,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,inpatient,1,mL,5.66000,5.38000,The Alliance,Exception Members,,4.36,,,,,,,3.11,5.49,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,outpatient,1,mL,5.66000,5.38000,The Alliance,Exception Members,,4.36,,,,,,,2.83,40.87,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,Exception Members,TC,366.52,,,,,,,261.80,461.72,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Exception Members,TC,366.52,,,,,,,238.00,3910.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,inpatient,1,mL,52.80000,50.16000,The Alliance,Exception Members,,40.66,,,,,,,29.04,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,outpatient,1,mL,52.80000,50.16000,The Alliance,Exception Members,,40.66,,,,,,,1.42,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,inpatient,1,mL,49.77000,47.28000,The Alliance,Exception Members,,38.32,,,,,,,27.37,48.28,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,outpatient,1,mL,49.77000,47.28000,The Alliance,Exception Members,,38.32,,,,,,,1.42,48.28,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,inpatient,20,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,outpatient,20,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,inpatient,20,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,outpatient,20,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,inpatient,20,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,outpatient,20,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,inpatient,20,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,13.53,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,inpatient,,,351.00000,333.45000,The Alliance,Exception Members,,270.27,,,,,,,193.05,340.47,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Exception Members,,270.27,,,,,,,175.50,340.47,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,inpatient,,,839.00000,797.05000,The Alliance,Exception Members,TC,646.03,,,,,,,461.45,813.83,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,outpatient,,,839.00000,797.05000,The Alliance,Exception Members,TC,646.03,,,,,,,419.50,6479.64,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,inpatient,1,EA,16.22000,15.41000,The Alliance,Exception Members,,12.49,,,,,,,8.92,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Exception Members,,12.49,,,,,,,0.33945,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,inpatient,1,EA,6.66000,6.33000,The Alliance,Exception Members,,5.13,,,,,,,3.66,6.46,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,outpatient,1,EA,6.66000,6.33000,The Alliance,Exception Members,,5.13,,,,,,,0.33945,6.46,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,Exception Members,,769.23,,,,,,,549.45,969.03,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Exception Members,,769.23,,,,,,,549.45,5271.00,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,inpatient,1,mL,292.42000,277.80000,The Alliance,Exception Members,,225.16,,,,,,,160.83,283.65,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,outpatient,1,mL,292.42000,277.80000,The Alliance,Exception Members,,225.16,,,,,,,1.14,283.65,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,50.62,3666.93,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,90,217.91,,,,,,,155.65,274.51,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,90,217.91,,,,,,,25.18,1273.27,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,Exception Members,,419.65,,,,,,,299.75,528.65,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Exception Members,,419.65,,,,,,,299.75,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,inpatient,0.8,EA,261.61000,248.53000,The Alliance,Exception Members,,201.44,,,,,,,143.89,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,outpatient,0.8,EA,261.61000,248.53000,The Alliance,Exception Members,,201.44,,,,,,,0.79980,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,inpatient,0.8,EA,67.52000,64.14000,The Alliance,Exception Members,,51.99,,,,,,,37.14,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,outpatient,0.8,EA,67.52000,64.14000,The Alliance,Exception Members,,51.99,,,,,,,0.79980,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,inpatient,0.8,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,outpatient,0.8,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,0.79980,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,inpatient,0.8,EA,31.72000,30.13000,The Alliance,Exception Members,,24.42,,,,,,,17.45,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,outpatient,0.8,EA,31.72000,30.13000,The Alliance,Exception Members,,24.42,,,,,,,0.79980,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,inpatient,0.8,EA,62.80000,59.66000,The Alliance,Exception Members,,48.36,,,,,,,34.54,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,outpatient,0.8,EA,62.80000,59.66000,The Alliance,Exception Members,,48.36,,,,,,,0.79980,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,inpatient,0.8,EA,70.63000,67.09000,The Alliance,Exception Members,,54.39,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,outpatient,0.8,EA,70.63000,67.09000,The Alliance,Exception Members,,54.39,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,inpatient,0.8,EA,235.19000,223.43000,The Alliance,Exception Members,,181.10,,,,,,,129.35,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,outpatient,0.8,EA,235.19000,223.43000,The Alliance,Exception Members,,181.10,,,,,,,0.79980,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,inpatient,0.8,EA,62.41000,59.29000,The Alliance,Exception Members,,48.06,,,,,,,34.33,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,outpatient,0.8,EA,62.41000,59.29000,The Alliance,Exception Members,,48.06,,,,,,,0.79980,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,inpatient,0.8,EA,44.40000,42.18000,The Alliance,Exception Members,,34.19,,,,,,,24.42,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,outpatient,0.8,EA,44.40000,42.18000,The Alliance,Exception Members,,34.19,,,,,,,0.79980,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,inpatient,0.8,EA,20.30000,19.28000,The Alliance,Exception Members,,15.63,,,,,,,11.16,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,outpatient,0.8,EA,20.30000,19.28000,The Alliance,Exception Members,,15.63,,,,,,,0.79980,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,inpatient,0.8,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,16.08,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,outpatient,0.8,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,0.79980,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,inpatient,0.8,EA,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,31.28,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,outpatient,0.8,EA,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,0.79980,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,inpatient,0.8,EA,32.39000,30.77000,The Alliance,Exception Members,,24.94,,,,,,,17.81,31.42,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,outpatient,0.8,EA,32.39000,30.77000,The Alliance,Exception Members,,24.94,,,,,,,0.79980,31.42,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,9.32,16.43,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,2.48,16.43,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,inpatient,1,mL,1720.49000,1634.47000,The Alliance,Exception Members,,1324.78,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,outpatient,1,mL,1720.49000,1634.47000,The Alliance,Exception Members,,1324.78,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,inpatient,1,mL,1720.50000,1634.48000,The Alliance,Exception Members,,1324.79,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,outpatient,1,mL,1720.50000,1634.48000,The Alliance,Exception Members,,1324.79,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,inpatient,100,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,inpatient,100,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,inpatient,100,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,inpatient,100,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,outpatient,100,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.82500,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,282.15,497.61,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,256.50,4266.89,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,inpatient,1,EA,953.25000,905.59000,The Alliance,Exception Members,,734.00,,,,,,,524.29,924.65,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,outpatient,1,EA,953.25000,905.59000,The Alliance,Exception Members,,734.00,,,,,,,390.74,924.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,inpatient,0.6,EA,261.61000,248.53000,The Alliance,Exception Members,,201.44,,,,,,,143.89,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,outpatient,0.6,EA,261.61000,248.53000,The Alliance,Exception Members,,201.44,,,,,,,0.79980,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,inpatient,0.6,EA,67.53000,64.16000,The Alliance,Exception Members,,52.00,,,,,,,37.14,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,outpatient,0.6,EA,67.53000,64.16000,The Alliance,Exception Members,,52.00,,,,,,,0.79980,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,inpatient,0.6,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,outpatient,0.6,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,inpatient,0.6,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,outpatient,0.6,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,0.79980,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,inpatient,0.6,EA,62.83000,59.69000,The Alliance,Exception Members,,48.38,,,,,,,34.56,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,outpatient,0.6,EA,62.83000,59.69000,The Alliance,Exception Members,,48.38,,,,,,,0.79980,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,inpatient,0.6,EA,70.64000,67.10000,The Alliance,Exception Members,,54.39,,,,,,,38.85,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,outpatient,0.6,EA,70.64000,67.10000,The Alliance,Exception Members,,54.39,,,,,,,0.79980,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,inpatient,0.6,EA,62.15000,59.04000,The Alliance,Exception Members,,47.86,,,,,,,34.18,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,outpatient,0.6,EA,62.15000,59.04000,The Alliance,Exception Members,,47.86,,,,,,,0.79980,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,inpatient,0.6,EA,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,15.55,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,outpatient,0.6,EA,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,0.79980,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,inpatient,0.6,EA,30.65000,29.12000,The Alliance,Exception Members,,23.60,,,,,,,16.86,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,outpatient,0.6,EA,30.65000,29.12000,The Alliance,Exception Members,,23.60,,,,,,,0.79980,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,inpatient,0.6,EA,31.71000,30.12000,The Alliance,Exception Members,,24.42,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,outpatient,0.6,EA,31.71000,30.12000,The Alliance,Exception Members,,24.42,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,inpatient,0.6,EA,62.82000,59.68000,The Alliance,Exception Members,,48.37,,,,,,,34.55,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,outpatient,0.6,EA,62.82000,59.68000,The Alliance,Exception Members,,48.37,,,,,,,0.79980,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,inpatient,0.6,EA,30.55000,29.02000,The Alliance,Exception Members,,23.52,,,,,,,16.80,29.63,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,outpatient,0.6,EA,30.55000,29.02000,The Alliance,Exception Members,,23.52,,,,,,,0.79980,29.63,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,545.05,961.27,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Exception Members,TC,763.07,,,,,,,495.50,6355.04,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,inpatient,0.3,EA,261.31000,248.25000,The Alliance,Exception Members,,201.21,,,,,,,143.72,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,outpatient,0.3,EA,261.31000,248.25000,The Alliance,Exception Members,,201.21,,,,,,,0.79980,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,inpatient,0.3,EA,67.57000,64.19000,The Alliance,Exception Members,,52.03,,,,,,,37.16,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,outpatient,0.3,EA,67.57000,64.19000,The Alliance,Exception Members,,52.03,,,,,,,0.79980,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,inpatient,0.3,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,outpatient,0.3,EA,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,inpatient,0.3,EA,21.55000,20.47000,The Alliance,Exception Members,,16.59,,,,,,,11.85,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,outpatient,0.3,EA,21.55000,20.47000,The Alliance,Exception Members,,16.59,,,,,,,0.79980,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,inpatient,0.3,EA,62.88000,59.74000,The Alliance,Exception Members,,48.42,,,,,,,34.58,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,outpatient,0.3,EA,62.88000,59.74000,The Alliance,Exception Members,,48.42,,,,,,,0.79980,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,inpatient,0.3,EA,21.57000,20.49000,The Alliance,Exception Members,,16.61,,,,,,,11.86,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,outpatient,0.3,EA,21.57000,20.49000,The Alliance,Exception Members,,16.61,,,,,,,0.79980,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,inpatient,0.3,EA,102.07000,96.96000,The Alliance,Exception Members,,78.59,,,,,,,56.14,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,outpatient,0.3,EA,102.07000,96.96000,The Alliance,Exception Members,,78.59,,,,,,,0.79980,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,inpatient,0.3,EA,31.71000,30.12000,The Alliance,Exception Members,,24.42,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,outpatient,0.3,EA,31.71000,30.12000,The Alliance,Exception Members,,24.42,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,inpatient,0.3,EA,29.18000,27.72000,The Alliance,Exception Members,,22.47,,,,,,,16.05,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,outpatient,0.3,EA,29.18000,27.72000,The Alliance,Exception Members,,22.47,,,,,,,0.79980,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,inpatient,0.3,EA,29.17000,27.71000,The Alliance,Exception Members,,22.46,,,,,,,16.04,28.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,outpatient,0.3,EA,29.17000,27.71000,The Alliance,Exception Members,,22.46,,,,,,,0.79980,28.29,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,inpatient,10,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,outpatient,10,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.33945,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.33945,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,inpatient,10,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,outpatient,10,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.33945,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,inpatient,10,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,outpatient,10,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,inpatient,10,EA,2.30000,2.18000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,outpatient,10,EA,2.30000,2.18000,The Alliance,Exception Members,,1.77,,,,,,,0.33945,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,inpatient,10,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,outpatient,10,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.33945,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,inpatient,10,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,outpatient,10,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.33945,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,inpatient,10,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,outpatient,10,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.33945,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,inpatient,10,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,outpatient,10,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.33945,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,inpatient,10,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.33945,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,inpatient,10,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,outpatient,10,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.33945,1.51,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,67.58,157.14,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,The Alliance,Exception Members,,624.88,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Exception Members,,624.88,,,,,,,0.99000,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,The Alliance,Exception Members,,624.88,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Exception Members,,624.88,,,,,,,0.99000,787.18,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,inpatient,2,EA,56.10000,53.30000,The Alliance,Exception Members,,43.20,,,,,,,30.86,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,outpatient,2,EA,56.10000,53.30000,The Alliance,Exception Members,,43.20,,,,,,,18.03,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,inpatient,2,EA,41.90000,39.81000,The Alliance,Exception Members,,32.26,,,,,,,23.05,40.64,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,outpatient,2,EA,41.90000,39.81000,The Alliance,Exception Members,,32.26,,,,,,,18.03,40.64,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,inpatient,1,EA,387.20000,367.84000,The Alliance,Exception Members,,298.14,,,,,,,212.96,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,outpatient,1,EA,387.20000,367.84000,The Alliance,Exception Members,,298.14,,,,,,,132.91,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,inpatient,1,EA,340.20000,323.19000,The Alliance,Exception Members,,261.95,,,,,,,187.11,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,outpatient,1,EA,340.20000,323.19000,The Alliance,Exception Members,,261.95,,,,,,,132.91,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,inpatient,1,EA,323.19000,307.03000,The Alliance,Exception Members,,248.86,,,,,,,177.75,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,outpatient,1,EA,323.19000,307.03000,The Alliance,Exception Members,,248.86,,,,,,,132.91,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,inpatient,1,EA,323.18000,307.02000,The Alliance,Exception Members,,248.85,,,,,,,177.75,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,outpatient,1,EA,323.18000,307.02000,The Alliance,Exception Members,,248.85,,,,,,,132.91,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,inpatient,1,EA,266.10000,252.80000,The Alliance,Exception Members,,204.90,,,,,,,146.35,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,outpatient,1,EA,266.10000,252.80000,The Alliance,Exception Members,,204.90,,,,,,,132.91,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,8.35,14.73,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,7.59,160.17,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,inpatient,1,EA,209.51000,199.03000,The Alliance,Exception Members,,161.32,,,,,,,115.23,203.22,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,outpatient,1,EA,209.51000,199.03000,The Alliance,Exception Members,,161.32,,,,,,,104.75,203.22,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,inpatient,1,mL,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.27,2.24,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,outpatient,1,mL,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,0.19995,2.24,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.82500,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,6.98,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,inpatient,1,mL,502.21000,477.10000,The Alliance,Exception Members,,386.70,,,,,,,276.22,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,outpatient,1,mL,502.21000,477.10000,The Alliance,Exception Members,,386.70,,,,,,,6.98,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,inpatient,1,mL,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,60.83,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,6.98,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,inpatient,1,mL,433.92000,412.22000,The Alliance,Exception Members,,334.12,,,,,,,238.66,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,outpatient,1,mL,433.92000,412.22000,The Alliance,Exception Members,,334.12,,,,,,,6.98,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,inpatient,1,mL,205.40000,195.13000,The Alliance,Exception Members,,158.16,,,,,,,112.97,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,outpatient,1,mL,205.40000,195.13000,The Alliance,Exception Members,,158.16,,,,,,,6.98,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,6.98,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,inpatient,1,mL,420.23000,399.22000,The Alliance,Exception Members,,323.58,,,,,,,231.13,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,outpatient,1,mL,420.23000,399.22000,The Alliance,Exception Members,,323.58,,,,,,,6.98,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,inpatient,1,mL,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,6.98,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,inpatient,1,mL,451.99000,429.39000,The Alliance,Exception Members,,348.03,,,,,,,248.59,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,outpatient,1,mL,451.99000,429.39000,The Alliance,Exception Members,,348.03,,,,,,,6.98,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,inpatient,1,mL,268.60000,255.17000,The Alliance,Exception Members,,206.82,,,,,,,147.73,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,outpatient,1,mL,268.60000,255.17000,The Alliance,Exception Members,,206.82,,,,,,,6.98,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,inpatient,1,mL,58.46000,55.54000,The Alliance,Exception Members,,45.01,,,,,,,32.15,56.71,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,outpatient,1,mL,58.46000,55.54000,The Alliance,Exception Members,,45.01,,,,,,,6.98,56.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,inpatient,1,EA,815.41000,774.64000,The Alliance,Exception Members,,627.87,,,,,,,448.48,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,outpatient,1,EA,815.41000,774.64000,The Alliance,Exception Members,,627.87,,,,,,,0.99000,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,inpatient,1,EA,815.42000,774.65000,The Alliance,Exception Members,,627.87,,,,,,,448.48,790.96,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,outpatient,1,EA,815.42000,774.65000,The Alliance,Exception Members,,627.87,,,,,,,0.99000,790.96,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,13.55,713.01,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,inpatient,1,mL,2952.26000,2804.64000,The Alliance,Exception Members,,2273.24,,,,,,,1623.74,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,outpatient,1,mL,2952.26000,2804.64000,The Alliance,Exception Members,,2273.24,,,,,,,58.56,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,inpatient,1,mL,3195.57000,3035.80000,The Alliance,Exception Members,,2460.59,,,,,,,1757.56,3099.70,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,outpatient,1,mL,3195.57000,3035.80000,The Alliance,Exception Members,,2460.59,,,,,,,58.56,3099.70,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,33.00,783.52,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,inpatient,,,830.00000,788.50000,The Alliance,Exception Members,TC,639.10,,,,,,,456.50,805.10,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,outpatient,,,830.00000,788.50000,The Alliance,Exception Members,TC,639.10,,,,,,,370.62,4895.01,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,inpatient,1,EA,250.17000,237.66000,The Alliance,Exception Members,,192.63,,,,,,,137.59,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,outpatient,1,EA,250.17000,237.66000,The Alliance,Exception Members,,192.63,,,,,,,7.86,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,inpatient,1,EA,295.08000,280.33000,The Alliance,Exception Members,,227.21,,,,,,,162.29,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,outpatient,1,EA,295.08000,280.33000,The Alliance,Exception Members,,227.21,,,,,,,7.86,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,inpatient,1,EA,351.81000,334.22000,The Alliance,Exception Members,,270.89,,,,,,,193.50,341.26,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,outpatient,1,EA,351.81000,334.22000,The Alliance,Exception Members,,270.89,,,,,,,7.86,341.26,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,inpatient,1,EA,321.74000,305.65000,The Alliance,Exception Members,,247.74,,,,,,,176.96,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,outpatient,1,EA,321.74000,305.65000,The Alliance,Exception Members,,247.74,,,,,,,0.79980,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,inpatient,1,EA,101.28000,96.21000,The Alliance,Exception Members,,77.99,,,,,,,55.70,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,outpatient,1,EA,101.28000,96.21000,The Alliance,Exception Members,,77.99,,,,,,,0.79980,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,inpatient,1,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,inpatient,1,EA,94.20000,89.49000,The Alliance,Exception Members,,72.53,,,,,,,51.81,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,outpatient,1,EA,94.20000,89.49000,The Alliance,Exception Members,,72.53,,,,,,,0.79980,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,inpatient,1,EA,92.59000,87.96000,The Alliance,Exception Members,,71.29,,,,,,,50.92,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,outpatient,1,EA,92.59000,87.96000,The Alliance,Exception Members,,71.29,,,,,,,0.79980,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,inpatient,1,EA,47.59000,45.21000,The Alliance,Exception Members,,36.64,,,,,,,26.17,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,outpatient,1,EA,47.59000,45.21000,The Alliance,Exception Members,,36.64,,,,,,,0.79980,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,inpatient,1,EA,44.11000,41.91000,The Alliance,Exception Members,,33.96,,,,,,,24.26,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Exception Members,,33.96,,,,,,,0.79980,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,inpatient,1,EA,105.99000,100.69000,The Alliance,Exception Members,,81.61,,,,,,,58.29,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,outpatient,1,EA,105.99000,100.69000,The Alliance,Exception Members,,81.61,,,,,,,0.79980,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,inpatient,1,EA,55.30000,52.53000,The Alliance,Exception Members,,42.58,,,,,,,30.41,53.64,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Exception Members,,42.58,,,,,,,0.79980,53.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,inpatient,10,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,outpatient,10,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.19995,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,inpatient,10,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,outpatient,10,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.19995,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,inpatient,10,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,outpatient,10,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.26400,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,inpatient,10,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.19995,1.75,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,inpatient,1,mL,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,367.95,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,outpatient,1,mL,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,65.26,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,inpatient,1,mL,507.12000,481.77000,The Alliance,Exception Members,,390.48,,,,,,,278.92,491.91,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,outpatient,1,mL,507.12000,481.77000,The Alliance,Exception Members,,390.48,,,,,,,65.26,491.91,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,5271.00,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,inpatient,2,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,outpatient,2,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.76570,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,inpatient,2,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,outpatient,2,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,0.76570,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,inpatient,2,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,outpatient,2,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.76570,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,inpatient,2,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,outpatient,2,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.76570,1.84,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,inpatient,2,EA,26.78000,25.44000,The Alliance,Exception Members,,20.62,,,,,,,14.73,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,outpatient,2,EA,26.78000,25.44000,The Alliance,Exception Members,,20.62,,,,,,,13.39,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,inpatient,2,EA,49.77000,47.28000,The Alliance,Exception Members,,38.32,,,,,,,27.37,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,outpatient,2,EA,49.77000,47.28000,The Alliance,Exception Members,,38.32,,,,,,,14.28,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,inpatient,2,EA,49.53000,47.06000,The Alliance,Exception Members,,38.14,,,,,,,27.24,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,outpatient,2,EA,49.53000,47.06000,The Alliance,Exception Members,,38.14,,,,,,,14.28,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,inpatient,2,EA,24.89000,23.64000,The Alliance,Exception Members,,19.17,,,,,,,13.69,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,outpatient,2,EA,24.89000,23.64000,The Alliance,Exception Members,,19.17,,,,,,,12.45,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,inpatient,2,EA,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,28.68,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,outpatient,2,EA,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,14.28,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,inpatient,2,EA,20.48000,19.45000,The Alliance,Exception Members,,15.77,,,,,,,11.26,19.87,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,outpatient,2,EA,20.48000,19.45000,The Alliance,Exception Members,,15.77,,,,,,,10.24,19.87,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,inpatient,5,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,outpatient,5,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.19995,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,inpatient,5,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,outpatient,5,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.19995,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,inpatient,5,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,outpatient,5,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.19995,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,inpatient,5,EA,1.79000,1.71000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,outpatient,5,EA,1.79000,1.71000,The Alliance,Exception Members,,1.38,,,,,,,0.19995,1.74,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,101.20,178.48,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,64.92,178.48,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,inpatient,1,mL,137.46000,130.59000,The Alliance,Exception Members,,105.84,,,,,,,75.60,133.34,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,outpatient,1,mL,137.46000,130.59000,The Alliance,Exception Members,,105.84,,,,,,,9.73,133.34,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,inpatient,1,EA,2685.99000,2551.69000,The Alliance,Exception Members,,2068.21,,,,,,,1477.29,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,outpatient,1,EA,2685.99000,2551.69000,The Alliance,Exception Members,,2068.21,,,,,,,31.18,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,inpatient,1,EA,1230.25000,1168.74000,The Alliance,Exception Members,,947.29,,,,,,,676.64,1193.34,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,outpatient,1,EA,1230.25000,1168.74000,The Alliance,Exception Members,,947.29,,,,,,,31.18,1193.34,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,inpatient,100,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,outpatient,100,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,inpatient,100,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,inpatient,100,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,outpatient,100,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,inpatient,10,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,outpatient,10,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.27217,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,inpatient,10,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,outpatient,10,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27217,0.53350,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,inpatient,1,mL,22.86000,21.72000,The Alliance,Exception Members,,17.60,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,outpatient,1,mL,22.86000,21.72000,The Alliance,Exception Members,,17.60,,,,,,,1.49,22.17,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,inpatient,1,mL,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,outpatient,1,mL,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,inpatient,,,403.00000,382.85000,The Alliance,Exception Members,,310.31,,,,,,,221.65,390.91,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,outpatient,,,403.00000,382.85000,The Alliance,Exception Members,,310.31,,,,,,,221.65,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,inpatient,0.8,EA,117.76000,111.87000,The Alliance,Exception Members,,90.68,,,,,,,64.77,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,outpatient,0.8,EA,117.76000,111.87000,The Alliance,Exception Members,,90.68,,,,,,,0.79980,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,inpatient,0.8,EA,101.27000,96.21000,The Alliance,Exception Members,,77.98,,,,,,,55.70,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,outpatient,0.8,EA,101.27000,96.21000,The Alliance,Exception Members,,77.98,,,,,,,0.79980,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,inpatient,0.8,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,outpatient,0.8,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,inpatient,0.8,EA,94.21000,89.50000,The Alliance,Exception Members,,72.54,,,,,,,51.82,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,outpatient,0.8,EA,94.21000,89.50000,The Alliance,Exception Members,,72.54,,,,,,,0.79980,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,inpatient,0.8,EA,289.24000,274.78000,The Alliance,Exception Members,,222.71,,,,,,,159.08,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,outpatient,0.8,EA,289.24000,274.78000,The Alliance,Exception Members,,222.71,,,,,,,0.79980,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,inpatient,0.8,EA,93.61000,88.93000,The Alliance,Exception Members,,72.08,,,,,,,51.49,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,outpatient,0.8,EA,93.61000,88.93000,The Alliance,Exception Members,,72.08,,,,,,,0.79980,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,inpatient,0.8,EA,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,26.18,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,outpatient,0.8,EA,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,0.79980,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,inpatient,0.8,EA,43.81000,41.62000,The Alliance,Exception Members,,33.73,,,,,,,24.10,42.50,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,outpatient,0.8,EA,43.81000,41.62000,The Alliance,Exception Members,,33.73,,,,,,,0.79980,42.50,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,inpatient,20,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,outpatient,20,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.27217,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,inpatient,20,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,outpatient,20,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.19995,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.19995,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.19995,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,inpatient,1,mL,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,outpatient,1,mL,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.19995,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,inpatient,1,mL,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,outpatient,1,mL,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.19995,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,0.19995,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,inpatient,10,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,outpatient,10,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,inpatient,10,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,outpatient,10,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,0.19995,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,inpatient,10,EA,3.65000,3.46000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,outpatient,10,EA,3.65000,3.46000,The Alliance,Exception Members,,2.81,,,,,,,0.19995,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,inpatient,10,EA,1.69000,1.61000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,outpatient,10,EA,1.69000,1.61000,The Alliance,Exception Members,,1.30,,,,,,,0.19995,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,inpatient,10,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,outpatient,10,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.19995,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,inpatient,10,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,outpatient,10,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,0.19995,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,inpatient,10,EA,8.76000,8.32000,The Alliance,Exception Members,,6.75,,,,,,,4.82,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,outpatient,10,EA,8.76000,8.32000,The Alliance,Exception Members,,6.75,,,,,,,0.19995,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,inpatient,10,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,outpatient,10,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.19995,0.52380,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,inpatient,1,EA,11.45000,10.87000,The Alliance,Exception Members,,8.82,,,,,,,6.30,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,outpatient,1,EA,11.45000,10.87000,The Alliance,Exception Members,,8.82,,,,,,,4.77,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,inpatient,1,EA,11.34000,10.78000,The Alliance,Exception Members,,8.73,,,,,,,6.24,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Exception Members,,8.73,,,,,,,4.77,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,inpatient,1,EA,19.55000,18.57000,The Alliance,Exception Members,,15.05,,,,,,,10.75,18.96,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,outpatient,1,EA,19.55000,18.57000,The Alliance,Exception Members,,15.05,,,,,,,4.77,18.96,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,inpatient,1,EA,50.02000,47.52000,The Alliance,Exception Members,,38.52,,,,,,,27.51,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,outpatient,1,EA,50.02000,47.52000,The Alliance,Exception Members,,38.52,,,,,,,14.28,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,inpatient,1,EA,49.26000,46.80000,The Alliance,Exception Members,,37.93,,,,,,,27.09,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,outpatient,1,EA,49.26000,46.80000,The Alliance,Exception Members,,37.93,,,,,,,14.28,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,inpatient,1,EA,48.79000,46.35000,The Alliance,Exception Members,,37.57,,,,,,,26.83,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,outpatient,1,EA,48.79000,46.35000,The Alliance,Exception Members,,37.57,,,,,,,14.28,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,14.28,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,inpatient,1,EA,41.38000,39.31000,The Alliance,Exception Members,,31.86,,,,,,,22.76,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,outpatient,1,EA,41.38000,39.31000,The Alliance,Exception Members,,31.86,,,,,,,14.28,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,inpatient,1,EA,47.98000,45.58000,The Alliance,Exception Members,,36.94,,,,,,,26.39,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,outpatient,1,EA,47.98000,45.58000,The Alliance,Exception Members,,36.94,,,,,,,14.28,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,inpatient,1,EA,34.71000,32.97000,The Alliance,Exception Members,,26.73,,,,,,,19.09,33.67,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,outpatient,1,EA,34.71000,32.97000,The Alliance,Exception Members,,26.73,,,,,,,14.28,33.67,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,inpatient,2,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,outpatient,2,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,inpatient,2,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,outpatient,2,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.19995,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,inpatient,2,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,outpatient,2,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.19995,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,inpatient,2,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,outpatient,2,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.19995,1.92,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,inpatient,2,EA,61.91000,58.82000,The Alliance,Exception Members,,47.67,,,,,,,34.05,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,outpatient,2,EA,61.91000,58.82000,The Alliance,Exception Members,,47.67,,,,,,,25.99,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,inpatient,2,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,outpatient,2,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,25.99,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,inpatient,2,EA,74.26000,70.55000,The Alliance,Exception Members,,57.18,,,,,,,40.84,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,outpatient,2,EA,74.26000,70.55000,The Alliance,Exception Members,,57.18,,,,,,,25.99,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,inpatient,2,EA,86.90000,82.56000,The Alliance,Exception Members,,66.91,,,,,,,47.80,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,outpatient,2,EA,86.90000,82.56000,The Alliance,Exception Members,,66.91,,,,,,,25.99,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,inpatient,2,EA,184.58000,175.35000,The Alliance,Exception Members,,142.13,,,,,,,101.52,179.04,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,outpatient,2,EA,184.58000,175.35000,The Alliance,Exception Members,,142.13,,,,,,,25.99,179.04,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,inpatient,1,EA,1642.06000,1559.96000,The Alliance,Exception Members,,1264.39,,,,,,,903.13,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,outpatient,1,EA,1642.06000,1559.96000,The Alliance,Exception Members,,1264.39,,,,,,,6.50,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,inpatient,1,EA,1556.59000,1478.76000,The Alliance,Exception Members,,1198.57,,,,,,,856.12,1509.89,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,outpatient,1,EA,1556.59000,1478.76000,The Alliance,Exception Members,,1198.57,,,,,,,6.50,1509.89,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,13.53,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,13.53,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,182.05,321.07,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,95.80,4498.77,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,inpatient,30,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,outpatient,30,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,inpatient,30,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,inpatient,30,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.33945,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,inpatient,30,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,outpatient,30,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.33945,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,inpatient,30,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,outpatient,30,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.33945,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,inpatient,30,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,inpatient,1,mL,14.09000,13.39000,The Alliance,Exception Members,,10.85,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,outpatient,1,mL,14.09000,13.39000,The Alliance,Exception Members,,10.85,,,,,,,1.49,13.67,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,inpatient,1,EA,2916.40000,2770.58000,The Alliance,Exception Members,,2245.63,,,,,,,1604.02,2828.91,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,outpatient,1,EA,2916.40000,2770.58000,The Alliance,Exception Members,,2245.63,,,,,,,6.50,2828.91,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,inpatient,,,938.00000,891.10000,The Alliance,Exception Members,,722.26,,,,,,,515.90,909.86,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Exception Members,,722.26,,,,,,,515.90,4686.00,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,138.05,243.47,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,125.50,419.70,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,inpatient,,,1949.00000,1851.55000,The Alliance,Exception Members,,1500.73,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Exception Members,,1500.73,,,,,,,1071.95,16988.00,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.14409,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,inpatient,1,mL,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.14409,0.36860,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,inpatient,3,EA,46.99000,44.64000,The Alliance,Exception Members,,36.18,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,outpatient,3,EA,46.99000,44.64000,The Alliance,Exception Members,,36.18,,,,,,,1.49,45.58,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,The Alliance,Exception Members,TC,2679.60,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Exception Members,TC,2679.60,,,,,,,1609.99,3375.60,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,inpatient,1,mL,1612.59000,1531.96000,The Alliance,Exception Members,,1241.69,,,,,,,886.92,1564.21,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Exception Members,,1241.69,,,,,,,13.34,1564.21,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,32.00,134.64,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,inpatient,1,mL,1294.64000,1229.91000,The Alliance,Exception Members,,996.87,,,,,,,712.05,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,outpatient,1,mL,1294.64000,1229.91000,The Alliance,Exception Members,,996.87,,,,,,,0.30000,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,inpatient,1,mL,1215.93000,1155.13000,The Alliance,Exception Members,,936.27,,,,,,,668.76,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,outpatient,1,mL,1215.93000,1155.13000,The Alliance,Exception Members,,936.27,,,,,,,0.30000,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,inpatient,1,mL,1294.63000,1229.90000,The Alliance,Exception Members,,996.87,,,,,,,712.05,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,outpatient,1,mL,1294.63000,1229.90000,The Alliance,Exception Members,,996.87,,,,,,,0.30000,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,inpatient,1,mL,1544.61000,1467.38000,The Alliance,Exception Members,,1189.35,,,,,,,849.54,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,outpatient,1,mL,1544.61000,1467.38000,The Alliance,Exception Members,,1189.35,,,,,,,0.30000,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,inpatient,1,mL,1544.29000,1467.07000,The Alliance,Exception Members,,1189.10,,,,,,,849.36,1497.96,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,outpatient,1,mL,1544.29000,1467.07000,The Alliance,Exception Members,,1189.10,,,,,,,0.30000,1497.96,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,inpatient,5,EA,6.69000,6.35000,The Alliance,Exception Members,,5.15,,,,,,,3.68,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,outpatient,5,EA,6.69000,6.35000,The Alliance,Exception Members,,5.15,,,,,,,2.17,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,inpatient,5,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.29,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,outpatient,5,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.08,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,inpatient,5,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,outpatient,5,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,inpatient,10,EA,26.99000,25.64000,The Alliance,Exception Members,,20.78,,,,,,,14.84,26.18,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,outpatient,10,EA,26.99000,25.64000,The Alliance,Exception Members,,20.78,,,,,,,1.49,26.18,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,inpatient,1,EA,8.99000,8.54000,The Alliance,Exception Members,,6.92,,,,,,,4.94,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,outpatient,1,EA,8.99000,8.54000,The Alliance,Exception Members,,6.92,,,,,,,4.50,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,inpatient,1,mL,1294.27000,1229.56000,The Alliance,Exception Members,,996.59,,,,,,,711.85,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,outpatient,1,mL,1294.27000,1229.56000,The Alliance,Exception Members,,996.59,,,,,,,0.30000,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,inpatient,1,mL,1275.16000,1211.40000,The Alliance,Exception Members,,981.87,,,,,,,701.34,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,outpatient,1,mL,1275.16000,1211.40000,The Alliance,Exception Members,,981.87,,,,,,,0.30000,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,inpatient,1,mL,1294.29000,1229.58000,The Alliance,Exception Members,,996.60,,,,,,,711.86,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,outpatient,1,mL,1294.29000,1229.58000,The Alliance,Exception Members,,996.60,,,,,,,0.30000,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,inpatient,1,mL,1551.93000,1474.33000,The Alliance,Exception Members,,1194.99,,,,,,,853.56,1505.37,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,outpatient,1,mL,1551.93000,1474.33000,The Alliance,Exception Members,,1194.99,,,,,,,0.30000,1505.37,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,inpatient,50,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,outpatient,50,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,inpatient,50,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,outpatient,50,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,inpatient,50,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,outpatient,50,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,inpatient,50,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,inpatient,50,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,outpatient,50,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,inpatient,50,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,inpatient,50,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,outpatient,50,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,inpatient,50,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,outpatient,50,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,inpatient,1,mL,5.23000,4.97000,The Alliance,Exception Members,,4.03,,,,,,,2.88,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,outpatient,1,mL,5.23000,4.97000,The Alliance,Exception Members,,4.03,,,,,,,0.76570,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,inpatient,1,mL,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,outpatient,1,mL,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.82500,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,Exception Members,90,156.31,,,,,,,111.65,196.91,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Exception Members,90,156.31,,,,,,,17.85,814.87,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,558.11000,530.20000,The Alliance,Exception Members,,429.74,,,,,,,273.47,541.37,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,558.11000,530.20000,The Alliance,Exception Members,,429.74,,,,,,,256.17,558.11,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,3163.00,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,inpatient,,,635.00000,603.25000,The Alliance,Exception Members,,488.95,,,,,,,349.25,615.95,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,outpatient,,,635.00000,603.25000,The Alliance,Exception Members,,488.95,,,,,,,288.84,615.95,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,inpatient,1,mL,1885.86000,1791.57000,The Alliance,Exception Members,,1452.11,,,,,,,1037.22,1829.28,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,outpatient,1,mL,1885.86000,1791.57000,The Alliance,Exception Members,,1452.11,,,,,,,183.41,1829.28,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,inpatient,3,EA,14.09000,13.39000,The Alliance,Exception Members,,10.85,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,outpatient,3,EA,14.09000,13.39000,The Alliance,Exception Members,,10.85,,,,,,,1.49,13.67,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,inpatient,,,164.10000,155.89000,The Alliance,Exception Members,90,126.36,,,,,,,90.25,159.18,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Exception Members,90,126.36,,,,,,,19.00,865.84,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,,188.65,,,,,,,134.75,237.65,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,,188.65,,,,,,,21.26,1103.49,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,inpatient,10,EA,22.86000,21.72000,The Alliance,Exception Members,,17.60,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,outpatient,10,EA,22.86000,21.72000,The Alliance,Exception Members,,17.60,,,,,,,1.49,22.17,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,inpatient,1,mL,14.10000,13.39000,The Alliance,Exception Members,,10.86,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Exception Members,,10.86,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,1.49,14.77,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,inpatient,,,248.60000,236.17000,The Alliance,Exception Members,90,191.42,,,,,,,136.73,241.14,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,outpatient,,,248.60000,236.17000,The Alliance,Exception Members,90,191.42,,,,,,,22.12,1120.45,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.11,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.00,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.66,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.50,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.38,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.12,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.60,3.10,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,inpatient,1,mL,23.59000,22.41000,The Alliance,Exception Members,,18.16,,,,,,,12.97,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,outpatient,1,mL,23.59000,22.41000,The Alliance,Exception Members,,18.16,,,,,,,2.24,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,2.24,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,inpatient,1,mL,19.38000,18.41000,The Alliance,Exception Members,,14.92,,,,,,,10.66,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,outpatient,1,mL,19.38000,18.41000,The Alliance,Exception Members,,14.92,,,,,,,2.24,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,inpatient,1,mL,22.31000,21.19000,The Alliance,Exception Members,,17.18,,,,,,,12.27,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Exception Members,,17.18,,,,,,,2.24,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,inpatient,1,mL,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,9.04,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,outpatient,1,mL,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,2.24,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,inpatient,1,mL,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,10.45,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,outpatient,1,mL,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,2.24,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,inpatient,1,mL,12.56000,11.93000,The Alliance,Exception Members,,9.67,,,,,,,6.91,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,outpatient,1,mL,12.56000,11.93000,The Alliance,Exception Members,,9.67,,,,,,,2.24,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,inpatient,1,mL,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,11.82,20.85,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,outpatient,1,mL,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,2.24,20.85,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,inpatient,2,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,outpatient,2,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,inpatient,2,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,outpatient,2,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,inpatient,2,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,outpatient,2,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,inpatient,2,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,outpatient,2,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,inpatient,2,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,outpatient,2,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,inpatient,2,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,outpatient,2,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.64350,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,6.47,339.51,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,inpatient,1,mL,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,199.43,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,outpatient,1,mL,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,7.86,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,inpatient,1,mL,325.82000,309.53000,The Alliance,Exception Members,,250.88,,,,,,,179.20,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,outpatient,1,mL,325.82000,309.53000,The Alliance,Exception Members,,250.88,,,,,,,7.86,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,inpatient,1,mL,577.02000,548.17000,The Alliance,Exception Members,,444.31,,,,,,,317.36,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,outpatient,1,mL,577.02000,548.17000,The Alliance,Exception Members,,444.31,,,,,,,7.86,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,inpatient,1,mL,458.13000,435.23000,The Alliance,Exception Members,,352.76,,,,,,,251.97,444.39,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,outpatient,1,mL,458.13000,435.23000,The Alliance,Exception Members,,352.76,,,,,,,7.86,444.39,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,33.00,783.52,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,inpatient,1,EA,6883.45000,6539.28000,The Alliance,Exception Members,,5300.26,,,,,,,3785.90,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,outpatient,1,EA,6883.45000,6539.28000,The Alliance,Exception Members,,5300.26,,,,,,,31.33,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,inpatient,1,EA,7635.88000,7254.08000,The Alliance,Exception Members,,5879.63,,,,,,,4199.73,7406.80,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,outpatient,1,EA,7635.88000,7254.08000,The Alliance,Exception Members,,5879.63,,,,,,,31.33,7406.80,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,56.40,158.11,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,inpatient,,,552.00000,524.40000,The Alliance,Exception Members,,425.04,,,,,,,303.60,535.44,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,outpatient,,,552.00000,524.40000,The Alliance,Exception Members,,425.04,,,,,,,303.60,5271.00,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,inpatient,10,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,outpatient,10,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,0.33945,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,inpatient,10,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,9.04,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,outpatient,10,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,0.33945,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,inpatient,10,EA,20.84000,19.80000,The Alliance,Exception Members,,16.05,,,,,,,11.46,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,outpatient,10,EA,20.84000,19.80000,The Alliance,Exception Members,,16.05,,,,,,,0.33945,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,inpatient,10,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,10.25,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,outpatient,10,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,0.33945,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,inpatient,10,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,8.26,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,0.33945,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,inpatient,10,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,7.39,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,outpatient,10,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,0.33945,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,inpatient,10,EA,19.09000,18.14000,The Alliance,Exception Members,,14.70,,,,,,,10.50,18.52,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,outpatient,10,EA,19.09000,18.14000,The Alliance,Exception Members,,14.70,,,,,,,0.33945,18.52,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,inpatient,5,EA,927.28000,880.91000,The Alliance,Exception Members,,714.01,,,,,,,510.00,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,outpatient,5,EA,927.28000,880.91000,The Alliance,Exception Members,,714.01,,,,,,,463.64,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,inpatient,5,EA,30.66000,29.13000,The Alliance,Exception Members,,23.61,,,,,,,16.86,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,outpatient,5,EA,30.66000,29.13000,The Alliance,Exception Members,,23.61,,,,,,,15.33,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,inpatient,5,EA,118.23000,112.32000,The Alliance,Exception Members,,91.04,,,,,,,65.03,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,outpatient,5,EA,118.23000,112.32000,The Alliance,Exception Members,,91.04,,,,,,,59.12,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,inpatient,5,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,170.94,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,outpatient,5,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,155.40,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,inpatient,5,EA,88.48000,84.06000,The Alliance,Exception Members,,68.13,,,,,,,48.66,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,outpatient,5,EA,88.48000,84.06000,The Alliance,Exception Members,,68.13,,,,,,,44.24,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,inpatient,5,EA,673.40000,639.73000,The Alliance,Exception Members,,518.52,,,,,,,370.37,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,outpatient,5,EA,673.40000,639.73000,The Alliance,Exception Members,,518.52,,,,,,,336.70,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,inpatient,5,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,outpatient,5,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,75.84,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,inpatient,5,EA,569.80000,541.31000,The Alliance,Exception Members,,438.75,,,,,,,313.39,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,outpatient,5,EA,569.80000,541.31000,The Alliance,Exception Members,,438.75,,,,,,,284.90,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,inpatient,5,EA,44.24000,42.03000,The Alliance,Exception Members,,34.06,,,,,,,24.33,42.91,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,outpatient,5,EA,44.24000,42.03000,The Alliance,Exception Members,,34.06,,,,,,,22.12,42.91,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,131.92,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.82500,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.31,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.20,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.21,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.10,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,inpatient,,,163.90000,155.70000,The Alliance,Exception Members,90,126.20,,,,,,,90.14,158.98,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,outpatient,,,163.90000,155.70000,The Alliance,Exception Members,90,126.20,,,,,,,14.59,729.98,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,inpatient,1,mL,23.97000,22.77000,The Alliance,Exception Members,,18.46,,,,,,,13.18,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,outpatient,1,mL,23.97000,22.77000,The Alliance,Exception Members,,18.46,,,,,,,2.24,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,inpatient,1,mL,23.98000,22.79000,The Alliance,Exception Members,,18.46,,,,,,,13.19,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,outpatient,1,mL,23.98000,22.79000,The Alliance,Exception Members,,18.46,,,,,,,2.24,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,inpatient,1,mL,23.26000,22.09000,The Alliance,Exception Members,,17.91,,,,,,,12.79,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,outpatient,1,mL,23.26000,22.09000,The Alliance,Exception Members,,17.91,,,,,,,2.24,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,inpatient,1,mL,27.13000,25.77000,The Alliance,Exception Members,,20.89,,,,,,,14.92,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,outpatient,1,mL,27.13000,25.77000,The Alliance,Exception Members,,20.89,,,,,,,2.24,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,inpatient,1,mL,34.13000,32.42000,The Alliance,Exception Members,,26.28,,,,,,,18.77,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,outpatient,1,mL,34.13000,32.42000,The Alliance,Exception Members,,26.28,,,,,,,2.24,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,inpatient,1,mL,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,12.63,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,outpatient,1,mL,22.97000,21.82000,The Alliance,Exception Members,,17.69,,,,,,,2.24,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,inpatient,1,mL,19.50000,18.52000,The Alliance,Exception Members,,15.02,,,,,,,10.72,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,outpatient,1,mL,19.50000,18.52000,The Alliance,Exception Members,,15.02,,,,,,,2.24,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,2.24,24.52,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.13,6.07,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,inpatient,1,mL,2209.91000,2099.41000,The Alliance,Exception Members,,1701.63,,,,,,,1215.45,2143.61,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,outpatient,1,mL,2209.91000,2099.41000,The Alliance,Exception Members,,1701.63,,,,,,,183.41,2143.61,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,inpatient,1,EA,3.06000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,outpatient,1,EA,3.06000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,inpatient,1,EA,3.05000,2.89000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,outpatient,1,EA,3.05000,2.89000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,inpatient,1,EA,3.04000,2.88000,The Alliance,Exception Members,,2.34,,,,,,,1.67,2.95,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,outpatient,1,EA,3.04000,2.88000,The Alliance,Exception Members,,2.34,,,,,,,1.52,2.95,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,inpatient,10,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,outpatient,10,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,inpatient,10,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,outpatient,10,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,inpatient,10,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,outpatient,10,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,inpatient,10,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,outpatient,10,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,inpatient,10,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,outpatient,10,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,inpatient,10,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,outpatient,10,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,inpatient,10,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,inpatient,10,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.79,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.63,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,inpatient,0.6,EA,20323.63000,19307.45000,The Alliance,Exception Members,,15649.20,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,outpatient,0.6,EA,20323.63000,19307.45000,The Alliance,Exception Members,,15649.20,,,,,,,30.97,19713.92,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,inpatient,1,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,2.18,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,0.33000,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,inpatient,1,EA,6.04000,5.73000,The Alliance,Exception Members,,4.65,,,,,,,3.32,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,outpatient,1,EA,6.04000,5.73000,The Alliance,Exception Members,,4.65,,,,,,,0.33000,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,inpatient,1,EA,9.51000,9.03000,The Alliance,Exception Members,,7.32,,,,,,,5.23,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,outpatient,1,EA,9.51000,9.03000,The Alliance,Exception Members,,7.32,,,,,,,0.33000,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,inpatient,1,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.58,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,0.33000,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.84,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,0.33000,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.33000,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,inpatient,1,EA,10.68000,10.15000,The Alliance,Exception Members,,8.22,,,,,,,5.87,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Exception Members,,8.22,,,,,,,0.33000,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,0.33000,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,0.33000,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,6.52,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,0.33000,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,0.33000,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,0.33000,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,0.33000,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,inpatient,1,EA,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,3.25,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Exception Members,,4.55,,,,,,,0.33000,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,0.33000,3.01,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,inpatient,5,EA,38.69000,36.76000,The Alliance,Exception Members,,29.79,,,,,,,21.28,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,outpatient,5,EA,38.69000,36.76000,The Alliance,Exception Members,,29.79,,,,,,,0.35222,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,inpatient,5,EA,23.26000,22.09000,The Alliance,Exception Members,,17.91,,,,,,,12.79,22.56,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,outpatient,5,EA,23.26000,22.09000,The Alliance,Exception Members,,17.91,,,,,,,0.35222,22.56,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,43.81,120.28,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,43.81,142.59,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,inpatient,1,EA,115.64000,109.85000,The Alliance,Exception Members,,89.04,,,,,,,63.60,112.17,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,outpatient,1,EA,115.64000,109.85000,The Alliance,Exception Members,,89.04,,,,,,,57.82,112.17,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,inpatient,3,EA,20.98000,19.93000,The Alliance,Exception Members,,16.15,,,,,,,11.54,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,outpatient,3,EA,20.98000,19.93000,The Alliance,Exception Members,,16.15,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,inpatient,3,EA,41.32000,39.26000,The Alliance,Exception Members,,31.82,,,,,,,22.73,40.08,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,outpatient,3,EA,41.32000,39.26000,The Alliance,Exception Members,,31.82,,,,,,,1.49,40.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,inpatient,20,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,outpatient,20,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,inpatient,20,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,outpatient,20,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,inpatient,20,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,outpatient,20,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,0.62439,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,inpatient,20,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,outpatient,20,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,inpatient,20,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,outpatient,20,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,inpatient,20,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,outpatient,20,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.62439,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,inpatient,20,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,inpatient,20,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,outpatient,20,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.62439,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,inpatient,20,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,outpatient,20,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,211.46,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,109.00,211.46,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,inpatient,10,EA,20.31000,19.29000,The Alliance,Exception Members,,15.64,,,,,,,11.17,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,outpatient,10,EA,20.31000,19.29000,The Alliance,Exception Members,,15.64,,,,,,,1.49,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,inpatient,10,EA,89.60000,85.12000,The Alliance,Exception Members,,68.99,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,outpatient,10,EA,89.60000,85.12000,The Alliance,Exception Members,,68.99,,,,,,,1.49,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,inpatient,10,EA,35.84000,34.05000,The Alliance,Exception Members,,27.60,,,,,,,19.71,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,outpatient,10,EA,35.84000,34.05000,The Alliance,Exception Members,,27.60,,,,,,,1.49,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,inpatient,10,EA,31.17000,29.61000,The Alliance,Exception Members,,24.00,,,,,,,17.14,30.23,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,outpatient,10,EA,31.17000,29.61000,The Alliance,Exception Members,,24.00,,,,,,,1.49,30.23,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,inpatient,1,EA,2.49000,2.37000,The Alliance,Exception Members,,1.92,,,,,,,1.37,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,outpatient,1,EA,2.49000,2.37000,The Alliance,Exception Members,,1.92,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.54,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.40,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.71500,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,42.50,82.45,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.00,36.40,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,inpatient,1,EA,16466.50000,15643.18000,The Alliance,Exception Members,,12679.20,,,,,,,9056.58,15972.50,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,outpatient,1,EA,16466.50000,15643.18000,The Alliance,Exception Members,,12679.20,,,,,,,22.06,15972.50,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,inpatient,,,467.00000,443.65000,The Alliance,Exception Members,,359.59,,,,,,,256.85,452.99,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,Exception Members,,359.59,,,,,,,230.94,3163.00,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,67.58,194.97,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,12.11,628.12,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,65.45,115.43,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,11.43,594.19,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,43.81,97.00,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,inpatient,1,mL,20323.63000,19307.45000,The Alliance,Exception Members,,15649.20,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,outpatient,1,mL,20323.63000,19307.45000,The Alliance,Exception Members,,15649.20,,,,,,,30.97,19713.92,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,inpatient,,,658.00000,625.10000,The Alliance,Exception Members,,506.66,,,,,,,361.90,638.26,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Exception Members,,506.66,,,,,,,162.71,16444.87,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,TC,1024.87,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,TC,1024.87,,,,,,,644.24,2960.49,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,47.30,83.42,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,8.74,458.40,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,inpatient,,,317.00000,301.15000,The Alliance,Exception Members,,244.09,,,,,,,174.35,307.49,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,outpatient,,,317.00000,301.15000,The Alliance,Exception Members,,244.09,,,,,,,158.50,307.49,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,inpatient,,,754.00000,716.30000,The Alliance,Exception Members,,580.58,,,,,,,414.70,731.38,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,Exception Members,,580.58,,,,,,,414.70,5271.00,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,inpatient,2.5,EA,179.56000,170.58000,The Alliance,Exception Members,,138.26,,,,,,,98.76,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,outpatient,2.5,EA,179.56000,170.58000,The Alliance,Exception Members,,138.26,,,,,,,89.78,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,inpatient,2.5,EA,273.80000,260.11000,The Alliance,Exception Members,,210.83,,,,,,,150.59,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,outpatient,2.5,EA,273.80000,260.11000,The Alliance,Exception Members,,210.83,,,,,,,136.90,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,inpatient,2.5,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,outpatient,2.5,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,7.58,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,inpatient,2.5,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,outpatient,2.5,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,9.83,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,inpatient,2.5,EA,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,12.51,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,outpatient,2.5,EA,22.75000,21.61000,The Alliance,Exception Members,,17.52,,,,,,,11.38,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,inpatient,2.5,EA,13.13000,12.48000,The Alliance,Exception Members,,10.11,,,,,,,7.22,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,outpatient,2.5,EA,13.13000,12.48000,The Alliance,Exception Members,,10.11,,,,,,,6.57,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,inpatient,2.5,EA,13.52000,12.85000,The Alliance,Exception Members,,10.41,,,,,,,7.44,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,outpatient,2.5,EA,13.52000,12.85000,The Alliance,Exception Members,,10.41,,,,,,,6.76,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,inpatient,2.5,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,9.32,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,outpatient,2.5,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,8.47,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,inpatient,2.5,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,outpatient,2.5,EA,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.13,6.07,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,4.27,220.68,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,8.17,424.40,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,187.00,362.78,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,inpatient,2,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,outpatient,2,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,0.33000,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,inpatient,2,EA,8.90000,8.45000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,outpatient,2,EA,8.90000,8.45000,The Alliance,Exception Members,,6.85,,,,,,,0.33000,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,inpatient,2,EA,11.36000,10.79000,The Alliance,Exception Members,,8.75,,,,,,,6.25,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,outpatient,2,EA,11.36000,10.79000,The Alliance,Exception Members,,8.75,,,,,,,0.33000,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,inpatient,2,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,outpatient,2,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.33000,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,inpatient,2,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.33000,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,inpatient,2,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,outpatient,2,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,0.33000,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.33000,1.90,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,inpatient,,,1064.00000,1010.80000,The Alliance,Exception Members,90,819.28,,,,,,,585.20,1032.08,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,outpatient,,,1064.00000,1010.80000,The Alliance,Exception Members,90,819.28,,,,,,,94.71,4787.38,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,The Alliance,Exception Members,,95.15,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Exception Members,,95.15,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,inpatient,1,EA,6.12000,5.82000,The Alliance,Exception Members,,4.71,,,,,,,3.37,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,outpatient,1,EA,6.12000,5.82000,The Alliance,Exception Members,,4.71,,,,,,,3.06,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,9.15,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Exception Members,,12.81,,,,,,,8.32,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,inpatient,1,EA,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.45,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.04,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,inpatient,,,1733.00000,1646.35000,The Alliance,Exception Members,TC,1334.41,,,,,,,953.15,1681.01,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,outpatient,,,1733.00000,1646.35000,The Alliance,Exception Members,TC,1334.41,,,,,,,811.39,2210.07,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,Exception Members,,348.04,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Exception Members,,348.04,,,,,,,200.06,438.44,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,inpatient,1,EA,73.95000,70.25000,The Alliance,Exception Members,,56.94,,,,,,,40.67,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,outpatient,1,EA,73.95000,70.25000,The Alliance,Exception Members,,56.94,,,,,,,36.98,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,inpatient,1,EA,1114.87000,1059.12000,The Alliance,Exception Members,,858.45,,,,,,,613.18,1081.42,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,outpatient,1,EA,1114.87000,1059.12000,The Alliance,Exception Members,,858.45,,,,,,,557.43,1081.42,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,The Alliance,Exception Members,TC,1659.35,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Exception Members,TC,1659.35,,,,,,,1006.74,2960.49,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,inpatient,4,EA,7.18000,6.82000,The Alliance,Exception Members,,5.53,,,,,,,3.95,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,outpatient,4,EA,7.18000,6.82000,The Alliance,Exception Members,,5.53,,,,,,,0.62439,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,inpatient,4,EA,3.33000,3.17000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,outpatient,4,EA,3.33000,3.17000,The Alliance,Exception Members,,2.56,,,,,,,0.62439,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,inpatient,4,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,outpatient,4,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,0.62439,2.09,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,53.00,102.82,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,inpatient,1,EA,9777.53000,9288.66000,The Alliance,Exception Members,,7528.70,,,,,,,5377.64,9484.20,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,outpatient,1,EA,9777.53000,9288.66000,The Alliance,Exception Members,,7528.70,,,,,,,1737.10,9484.20,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,6.07,10.70,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,5.51,10.70,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,inpatient,,,181.10000,172.04000,The Alliance,Exception Members,90,139.45,,,,,,,99.61,175.67,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,outpatient,,,181.10000,172.04000,The Alliance,Exception Members,90,139.45,,,,,,,15.81,797.91,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,inpatient,,,1949.00000,1851.55000,The Alliance,Exception Members,,1500.73,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Exception Members,,1500.73,,,,,,,1071.95,16988.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,inpatient,1,mL,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,outpatient,1,mL,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,inpatient,1,mL,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.85,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,outpatient,1,mL,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.59,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,inpatient,1,mL,6.24000,5.93000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,outpatient,1,mL,6.24000,5.93000,The Alliance,Exception Members,,4.80,,,,,,,3.12,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,inpatient,,,205.00000,194.75000,The Alliance,Exception Members,90,157.85,,,,,,,112.75,198.85,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Exception Members,90,157.85,,,,,,,16.82,1018.59,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,inpatient,1,EA,43.58000,41.40000,The Alliance,Exception Members,,33.56,,,,,,,23.97,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,outpatient,1,EA,43.58000,41.40000,The Alliance,Exception Members,,33.56,,,,,,,21.79,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,inpatient,1,EA,47.47000,45.10000,The Alliance,Exception Members,,36.55,,,,,,,26.11,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,outpatient,1,EA,47.47000,45.10000,The Alliance,Exception Members,,36.55,,,,,,,23.73,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,inpatient,1,EA,19.63000,18.64000,The Alliance,Exception Members,,15.12,,,,,,,10.80,19.04,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,outpatient,1,EA,19.63000,18.64000,The Alliance,Exception Members,,15.12,,,,,,,9.81,19.04,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,90.75,160.05,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,13.25,696.05,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,inpatient,1,EA,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,45.19,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,outpatient,1,EA,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,5.45,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,inpatient,1,EA,59.88000,56.89000,The Alliance,Exception Members,,46.11,,,,,,,32.93,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,outpatient,1,EA,59.88000,56.89000,The Alliance,Exception Members,,46.11,,,,,,,5.45,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,inpatient,1,EA,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,121.66,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,5.45,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,inpatient,1,EA,55.62000,52.84000,The Alliance,Exception Members,,42.83,,,,,,,30.59,53.95,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,outpatient,1,EA,55.62000,52.84000,The Alliance,Exception Members,,42.83,,,,,,,5.45,53.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,inpatient,1,EA,1.83000,1.73000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,outpatient,1,EA,1.83000,1.73000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,inpatient,1,EA,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,outpatient,1,EA,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,243.10,428.74,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,172.82,489.94,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,inpatient,1,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,0.33000,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,inpatient,1,EA,11.50000,10.93000,The Alliance,Exception Members,,8.86,,,,,,,6.33,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Exception Members,,8.86,,,,,,,0.33000,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,inpatient,1,EA,20.63000,19.60000,The Alliance,Exception Members,,15.89,,,,,,,11.35,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,outpatient,1,EA,20.63000,19.60000,The Alliance,Exception Members,,15.89,,,,,,,0.33000,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.33000,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,inpatient,1,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.96,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,0.33000,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,0.33000,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,0.33000,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.33000,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,0.33000,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,0.33000,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,0.33000,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,inpatient,1,EA,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Exception Members,,2.73,,,,,,,0.33000,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,0.33000,10.42,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,5.45,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,inpatient,1,EA,75.84000,72.05000,The Alliance,Exception Members,,58.40,,,,,,,41.71,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,outpatient,1,EA,75.84000,72.05000,The Alliance,Exception Members,,58.40,,,,,,,5.45,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,5.45,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,inpatient,1,EA,48.66000,46.23000,The Alliance,Exception Members,,37.47,,,,,,,26.76,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Exception Members,,37.47,,,,,,,5.45,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,inpatient,1,EA,72.87000,69.23000,The Alliance,Exception Members,,56.11,,,,,,,40.08,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,outpatient,1,EA,72.87000,69.23000,The Alliance,Exception Members,,56.11,,,,,,,5.45,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,inpatient,1,EA,66.55000,63.22000,The Alliance,Exception Members,,51.24,,,,,,,36.60,64.55,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Exception Members,,51.24,,,,,,,5.45,64.55,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,inpatient,1,mL,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,outpatient,1,mL,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,19.75,38.31,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,inpatient,1,EA,11651.31000,11068.75000,The Alliance,Exception Members,,8971.51,,,,,,,6408.22,11301.77,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,outpatient,1,EA,11651.31000,11068.75000,The Alliance,Exception Members,,8971.51,,,,,,,155.42,11301.77,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,11.57,560.26,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,inpatient,100,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,inpatient,100,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,inpatient,100,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,outpatient,100,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,inpatient,100,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,inpatient,100,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,inpatient,100,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,inpatient,100,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,outpatient,100,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,inpatient,100,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,outpatient,100,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,3.23,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,inpatient,1,EA,298.62000,283.69000,The Alliance,Exception Members,,229.94,,,,,,,164.24,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,outpatient,1,EA,298.62000,283.69000,The Alliance,Exception Members,,229.94,,,,,,,11.25,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,inpatient,1,EA,273.45000,259.78000,The Alliance,Exception Members,,210.56,,,,,,,150.40,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,outpatient,1,EA,273.45000,259.78000,The Alliance,Exception Members,,210.56,,,,,,,11.25,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,inpatient,1,EA,290.12000,275.61000,The Alliance,Exception Members,,223.39,,,,,,,159.57,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,outpatient,1,EA,290.12000,275.61000,The Alliance,Exception Members,,223.39,,,,,,,11.25,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,inpatient,1,EA,322.97000,306.82000,The Alliance,Exception Members,,248.69,,,,,,,177.63,313.28,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,outpatient,1,EA,322.97000,306.82000,The Alliance,Exception Members,,248.69,,,,,,,11.25,313.28,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,inpatient,1,EA,23303.03000,22137.87000,The Alliance,Exception Members,,17943.33,,,,,,,12816.67,22603.94,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,outpatient,1,EA,23303.03000,22137.87000,The Alliance,Exception Members,,17943.33,,,,,,,155.42,22603.94,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,inpatient,30,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,outpatient,30,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,inpatient,30,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,inpatient,30,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,outpatient,30,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,inpatient,30,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.63,4.65,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,outpatient,30,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.40,4.65,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,90,152.46,,,,,,,108.90,192.06,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,90,152.46,,,,,,,16.84,848.80,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,inpatient,1,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,27.81,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Exception Members,,38.93,,,,,,,5.45,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,5.45,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,inpatient,1,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,15.30,26.98,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,5.45,26.98,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,185.50,359.87,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,inpatient,1,EA,46.10000,43.80000,The Alliance,Exception Members,,35.50,,,,,,,25.36,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,outpatient,1,EA,46.10000,43.80000,The Alliance,Exception Members,,35.50,,,,,,,23.05,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,6.04,322.54,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,inpatient,40,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,outpatient,40,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,inpatient,40,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,outpatient,40,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,inpatient,40,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,outpatient,40,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,inpatient,40,EA,3.75000,3.56000,The Alliance,Exception Members,,2.89,,,,,,,2.06,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,outpatient,40,EA,3.75000,3.56000,The Alliance,Exception Members,,2.89,,,,,,,0.62439,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,inpatient,40,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,outpatient,40,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,inpatient,40,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,outpatient,40,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.62439,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,inpatient,40,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,outpatient,40,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.69720,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,inpatient,1,EA,248.72000,236.29000,The Alliance,Exception Members,,191.51,,,,,,,136.80,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,outpatient,1,EA,248.72000,236.29000,The Alliance,Exception Members,,191.51,,,,,,,5.45,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,inpatient,1,EA,272.36000,258.74000,The Alliance,Exception Members,,209.72,,,,,,,149.80,264.19,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,outpatient,1,EA,272.36000,258.74000,The Alliance,Exception Members,,209.72,,,,,,,5.45,264.19,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,2.54,135.79,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,inpatient,1,EA,62.02000,58.92000,The Alliance,Exception Members,,47.76,,,,,,,34.11,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,outpatient,1,EA,62.02000,58.92000,The Alliance,Exception Members,,47.76,,,,,,,31.01,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,inpatient,1,EA,94.91000,90.17000,The Alliance,Exception Members,,73.08,,,,,,,52.20,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,outpatient,1,EA,94.91000,90.17000,The Alliance,Exception Members,,73.08,,,,,,,47.45,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,inpatient,1,mL,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,outpatient,1,mL,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,3.23,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,inpatient,3,EA,5.65000,5.36000,The Alliance,Exception Members,,4.35,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,outpatient,3,EA,5.65000,5.36000,The Alliance,Exception Members,,4.35,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,inpatient,3,EA,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,outpatient,3,EA,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,inpatient,3,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,outpatient,3,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,0.13485,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,inpatient,3,EA,8.27000,7.86000,The Alliance,Exception Members,,6.37,,,,,,,4.55,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,outpatient,3,EA,8.27000,7.86000,The Alliance,Exception Members,,6.37,,,,,,,0.13485,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,inpatient,3,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,outpatient,3,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,inpatient,3,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.22,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,outpatient,3,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,0.13485,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,inpatient,3,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,outpatient,3,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.13485,1.64,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,16.07,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,inpatient,1,EA,6.81000,6.47000,The Alliance,Exception Members,,5.24,,,,,,,3.75,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,outpatient,1,EA,6.81000,6.47000,The Alliance,Exception Members,,5.24,,,,,,,3.40,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,inpatient,1,EA,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,2.84,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.94,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Exception Members,,4.12,,,,,,,2.67,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,inpatient,1,EA,1.87000,1.78000,The Alliance,Exception Members,,1.44,,,,,,,1.03,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Exception Members,,1.44,,,,,,,0.93500,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,inpatient,1,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.36,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.24,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,inpatient,1,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,inpatient,5,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,outpatient,5,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,0.08005,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,inpatient,5,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,0.08005,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,inpatient,5,EA,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,outpatient,5,EA,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,0.08005,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,inpatient,5,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,outpatient,5,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,0.08005,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,inpatient,5,EA,2.46000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,outpatient,5,EA,2.46000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,0.08005,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,inpatient,5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,0.08005,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,inpatient,5,EA,3.92000,3.72000,The Alliance,Exception Members,,3.02,,,,,,,2.16,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,outpatient,5,EA,3.92000,3.72000,The Alliance,Exception Members,,3.02,,,,,,,0.08005,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,inpatient,5,EA,21.12000,20.06000,The Alliance,Exception Members,,16.26,,,,,,,11.62,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,outpatient,5,EA,21.12000,20.06000,The Alliance,Exception Members,,16.26,,,,,,,0.08005,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,inpatient,5,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,outpatient,5,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.08005,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,inpatient,5,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,0.08005,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,inpatient,5,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,outpatient,5,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,0.08005,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,inpatient,5,EA,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,outpatient,5,EA,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,0.08005,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,inpatient,5,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,outpatient,5,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,0.08005,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,inpatient,5,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.08005,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,inpatient,5,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.08005,1.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,inpatient,1,mL,33272.80000,31609.16000,The Alliance,Exception Members,,25620.06,,,,,,,18300.04,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,outpatient,1,mL,33272.80000,31609.16000,The Alliance,Exception Members,,25620.06,,,,,,,36.66,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,inpatient,1,mL,36335.60000,34518.82000,The Alliance,Exception Members,,27978.41,,,,,,,19984.58,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,outpatient,1,mL,36335.60000,34518.82000,The Alliance,Exception Members,,27978.41,,,,,,,36.66,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,inpatient,1,mL,33792.11000,32102.50000,The Alliance,Exception Members,,26019.92,,,,,,,18585.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,outpatient,1,mL,33792.11000,32102.50000,The Alliance,Exception Members,,26019.92,,,,,,,36.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,inpatient,1,mL,11961.94000,11363.85000,The Alliance,Exception Members,,9210.69,,,,,,,6579.07,11603.08,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,outpatient,1,mL,11961.94000,11363.85000,The Alliance,Exception Members,,9210.69,,,,,,,36.66,11603.08,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,inpatient,1,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,inpatient,1,EA,9.41000,8.94000,The Alliance,Exception Members,,7.25,,,,,,,5.18,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,outpatient,1,EA,9.41000,8.94000,The Alliance,Exception Members,,7.25,,,,,,,4.71,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,inpatient,1,EA,31.20000,29.64000,The Alliance,Exception Members,,24.02,,,,,,,17.16,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,outpatient,1,EA,31.20000,29.64000,The Alliance,Exception Members,,24.02,,,,,,,15.60,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.60,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,inpatient,1,EA,15535.12000,14758.37000,The Alliance,Exception Members,,11962.04,,,,,,,8544.32,15069.07,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,outpatient,1,EA,15535.12000,14758.37000,The Alliance,Exception Members,,11962.04,,,,,,,155.42,15069.07,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,inpatient,1,mL,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,outpatient,1,mL,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.08005,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.08005,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,inpatient,1,mL,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.08005,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.08005,0.39770,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,inpatient,5,EA,11.32000,10.75000,The Alliance,Exception Members,,8.72,,,,,,,6.23,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,outpatient,5,EA,11.32000,10.75000,The Alliance,Exception Members,,8.72,,,,,,,5.66,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,inpatient,1,mL,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,inpatient,30,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.41,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,outpatient,30,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.19,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,inpatient,30,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,outpatient,30,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,inpatient,30,EA,4.27000,4.06000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,outpatient,30,EA,4.27000,4.06000,The Alliance,Exception Members,,3.29,,,,,,,2.13,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,inpatient,30,EA,4.01000,3.81000,The Alliance,Exception Members,,3.09,,,,,,,2.21,3.89,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,outpatient,30,EA,4.01000,3.81000,The Alliance,Exception Members,,3.09,,,,,,,2.00,3.89,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,inpatient,1,EA,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,inpatient,1,EA,23.83000,22.64000,The Alliance,Exception Members,,18.35,,,,,,,13.11,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,outpatient,1,EA,23.83000,22.64000,The Alliance,Exception Members,,18.35,,,,,,,11.91,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,inpatient,1,EA,85.13000,80.87000,The Alliance,Exception Members,,65.55,,,,,,,46.82,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,outpatient,1,EA,85.13000,80.87000,The Alliance,Exception Members,,65.55,,,,,,,42.56,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,11.06,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,inpatient,1,EA,102.70000,97.56000,The Alliance,Exception Members,,79.08,,,,,,,56.48,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Exception Members,,79.08,,,,,,,51.35,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,31.60,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,23.46,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,21.33,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,inpatient,1,EA,92.43000,87.81000,The Alliance,Exception Members,,71.17,,,,,,,50.84,89.66,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,outpatient,1,EA,92.43000,87.81000,The Alliance,Exception Members,,71.17,,,,,,,46.22,89.66,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,inpatient,5,EA,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,outpatient,5,EA,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,inpatient,5,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,outpatient,5,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,inpatient,5,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.58,4.55,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.35,4.55,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,The Alliance,Exception Members,,33.66,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Exception Members,,33.66,,,,,,,21.86,42.41,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,The Alliance,Exception Members,,56.84,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Exception Members,,56.84,,,,,,,36.91,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,The Alliance,Exception Members,,56.84,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Exception Members,,56.84,,,,,,,36.91,71.61,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,inpatient,1,EA,4.98000,4.74000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,inpatient,,,193.00000,183.35000,The Alliance,Exception Members,,148.61,,,,,,,106.15,187.21,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Exception Members,,148.61,,,,,,,14.69,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,inpatient,5,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,outpatient,5,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,inpatient,5,EA,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.39,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,outpatient,5,EA,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.26,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,inpatient,5,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,outpatient,5,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,inpatient,5,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,3.09,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,outpatient,5,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,2.81,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,inpatient,1,mL,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,inpatient,1,mL,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,outpatient,1,mL,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.31,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,inpatient,1,mL,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,inpatient,1,GM,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,outpatient,1,GM,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,inpatient,1,GM,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,outpatient,1,GM,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,inpatient,1,GM,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,outpatient,1,GM,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,inpatient,1,GM,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,outpatient,1,GM,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,inpatient,1,EA,4701.43000,4466.36000,The Alliance,Exception Members,,3620.10,,,,,,,2585.79,4560.39,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,outpatient,1,EA,4701.43000,4466.36000,The Alliance,Exception Members,,3620.10,,,,,,,155.42,4560.39,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,inpatient,50,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,outpatient,50,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,inpatient,50,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,outpatient,50,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,inpatient,50,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,outpatient,50,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,inpatient,50,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,inpatient,50,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,inpatient,50,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,inpatient,50,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,outpatient,50,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,inpatient,50,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,outpatient,50,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,inpatient,50,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,inpatient,50,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,3.23,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,61.05,107.67,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,55.50,107.67,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,inpatient,1,mL,21.71000,20.62000,The Alliance,Exception Members,,16.72,,,,,,,11.94,21.06,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,outpatient,1,mL,21.71000,20.62000,The Alliance,Exception Members,,16.72,,,,,,,10.86,21.06,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,inpatient,1,EA,21.40000,20.33000,The Alliance,Exception Members,,16.48,,,,,,,11.77,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,outpatient,1,EA,21.40000,20.33000,The Alliance,Exception Members,,16.48,,,,,,,10.70,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,inpatient,1,EA,5.76000,5.47000,The Alliance,Exception Members,,4.44,,,,,,,3.17,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,outpatient,1,EA,5.76000,5.47000,The Alliance,Exception Members,,4.44,,,,,,,2.88,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,inpatient,1,EA,9.33000,8.86000,The Alliance,Exception Members,,7.18,,,,,,,5.13,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,outpatient,1,EA,9.33000,8.86000,The Alliance,Exception Members,,7.18,,,,,,,4.67,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,inpatient,1,EA,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,4.27,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,3.88,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,inpatient,50,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,outpatient,50,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,inpatient,50,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,outpatient,50,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,inpatient,50,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,outpatient,50,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,inpatient,50,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,inpatient,50,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.87,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,outpatient,50,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.70,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,inpatient,50,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,outpatient,50,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,inpatient,50,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,outpatient,50,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,inpatient,50,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,outpatient,50,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,inpatient,50,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,outpatient,50,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,inpatient,30,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,outpatient,30,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,inpatient,30,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,outpatient,30,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,inpatient,30,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,inpatient,30,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,outpatient,30,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,inpatient,30,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,outpatient,30,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,inpatient,20,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,outpatient,20,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,inpatient,20,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,inpatient,20,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,outpatient,20,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,inpatient,20,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,outpatient,20,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,inpatient,20,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,outpatient,20,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,inpatient,20,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,outpatient,20,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,inpatient,20,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,inpatient,20,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,outpatient,20,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,inpatient,5,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,outpatient,5,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,inpatient,5,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,inpatient,5,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,outpatient,5,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,inpatient,5,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,outpatient,5,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,inpatient,5,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,outpatient,5,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,inpatient,5,EA,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,outpatient,5,EA,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,inpatient,5,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,outpatient,5,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,inpatient,5,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,outpatient,5,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,inpatient,5,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,outpatient,5,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,inpatient,5,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,outpatient,5,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,inpatient,5,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,outpatient,5,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,inpatient,1,EA,7754.97000,7367.22000,The Alliance,Exception Members,,5971.33,,,,,,,4265.23,7522.32,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,outpatient,1,EA,7754.97000,7367.22000,The Alliance,Exception Members,,5971.33,,,,,,,1737.10,7522.32,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,inpatient,50,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,inpatient,50,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,outpatient,50,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,inpatient,50,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,outpatient,50,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,inpatient,2,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,outpatient,2,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,inpatient,2,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,outpatient,2,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,inpatient,2,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,outpatient,2,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,inpatient,2,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,outpatient,2,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,inpatient,2,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,outpatient,2,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,inpatient,2,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,outpatient,2,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,inpatient,1,mL,2.03000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,outpatient,1,mL,2.03000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.97,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,inpatient,1,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,1.59,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,3.23,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,inpatient,1,EA,9.47000,8.99000,The Alliance,Exception Members,,7.29,,,,,,,5.21,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,outpatient,1,EA,9.47000,8.99000,The Alliance,Exception Members,,7.29,,,,,,,4.74,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,inpatient,1,EA,22.15000,21.04000,The Alliance,Exception Members,,17.06,,,,,,,12.18,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,outpatient,1,EA,22.15000,21.04000,The Alliance,Exception Members,,17.06,,,,,,,11.07,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,inpatient,1,EA,20.38000,19.36000,The Alliance,Exception Members,,15.69,,,,,,,11.21,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,outpatient,1,EA,20.38000,19.36000,The Alliance,Exception Members,,15.69,,,,,,,10.19,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,inpatient,1,EA,57.42000,54.55000,The Alliance,Exception Members,,44.21,,,,,,,31.58,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,outpatient,1,EA,57.42000,54.55000,The Alliance,Exception Members,,44.21,,,,,,,28.71,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,4.37,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,3.97,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,4.96,8.74,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,4.50,8.74,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,inpatient,10,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,inpatient,1,mL,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,inpatient,1,EA,4.48000,4.25000,The Alliance,Exception Members,,3.45,,,,,,,2.46,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,outpatient,1,EA,4.48000,4.25000,The Alliance,Exception Members,,3.45,,,,,,,2.24,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.87,5.06,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Exception Members,,4.02,,,,,,,2.61,5.06,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,55.55,97.97,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,10.50,492.33,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,inpatient,1,EA,3945.28000,3748.02000,The Alliance,Exception Members,,3037.87,,,,,,,2169.90,3826.92,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,outpatient,1,EA,3945.28000,3748.02000,The Alliance,Exception Members,,3037.87,,,,,,,1737.10,3826.92,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,inpatient,,,1981.00000,1881.95000,The Alliance,Exception Members,TC,1525.37,,,,,,,1089.55,1921.57,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,outpatient,,,1981.00000,1881.95000,The Alliance,Exception Members,TC,1525.37,,,,,,,931.15,2210.07,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,8.19,424.40,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,inpatient,1,mL,997.15000,947.29000,The Alliance,Exception Members,,767.81,,,,,,,548.43,967.24,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,outpatient,1,mL,997.15000,947.29000,The Alliance,Exception Members,,767.81,,,,,,,498.57,967.24,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,inpatient,1,EA,2.24000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.15,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,TC,169.40,,,,,,,121.00,213.40,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,TC,169.40,,,,,,,110.00,213.40,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,6.89,356.54,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,14.32,679.08,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,inpatient,300,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,outpatient,300,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.50,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,inpatient,300,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,outpatient,300,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,inpatient,300,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,outpatient,300,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,inpatient,300,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,outpatient,300,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,inpatient,300,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,outpatient,300,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,inpatient,300,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,outpatient,300,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,inpatient,300,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,outpatient,300,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,5.76,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,90,281.82,,,,,,,201.30,355.02,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,90,281.82,,,,,,,35.33,1646.71,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,13.39,833.98,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,inpatient,1,EA,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,inpatient,1,EA,4.98000,4.74000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,inpatient,1,EA,1.86000,1.76000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.00465,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.00465,0.07760,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,inpatient,1,mL,12.70000,12.07000,The Alliance,Exception Members,,9.78,,,,,,,6.99,12.32,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,outpatient,1,mL,12.70000,12.07000,The Alliance,Exception Members,,9.78,,,,,,,0.22165,12.32,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,inpatient,1,EA,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,Exception Members,TC,210.21,,,,,,,150.15,264.81,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Exception Members,TC,210.21,,,,,,,136.50,1499.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,inpatient,1,EA,440.47000,418.45000,The Alliance,Exception Members,,339.16,,,,,,,242.26,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,outpatient,1,EA,440.47000,418.45000,The Alliance,Exception Members,,339.16,,,,,,,220.24,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,inpatient,1,EA,19.56000,18.58000,The Alliance,Exception Members,,15.06,,,,,,,10.76,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,outpatient,1,EA,19.56000,18.58000,The Alliance,Exception Members,,15.06,,,,,,,9.78,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,inpatient,1,EA,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,10.22,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,9.29,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,inpatient,1,EA,30.43000,28.91000,The Alliance,Exception Members,,23.43,,,,,,,16.74,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,outpatient,1,EA,30.43000,28.91000,The Alliance,Exception Members,,23.43,,,,,,,15.21,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.34,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,inpatient,50,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,107.25,189.15,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,17.03,882.80,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,TC,1251.25,,,,,,,893.75,1576.25,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,TC,1251.25,,,,,,,812.50,9133.75,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,inpatient,1,EA,11.72000,11.14000,The Alliance,Exception Members,,9.02,,,,,,,6.45,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,outpatient,1,EA,11.72000,11.14000,The Alliance,Exception Members,,9.02,,,,,,,5.86,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,inpatient,,,205.00000,194.75000,The Alliance,Exception Members,,157.85,,,,,,,112.75,198.85,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Exception Members,,157.85,,,,,,,18.52,967.70,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,4.27,220.68,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,inpatient,1,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.64,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,2.11,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,inpatient,1,EA,5.39000,5.12000,The Alliance,Exception Members,,4.15,,,,,,,2.96,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Exception Members,,4.15,,,,,,,2.11,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,inpatient,1,EA,6.01000,5.71000,The Alliance,Exception Members,,4.63,,,,,,,3.31,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,outpatient,1,EA,6.01000,5.71000,The Alliance,Exception Members,,4.63,,,,,,,2.11,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,2.11,9.96,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,TC,152.46,,,,,,,108.90,192.06,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,TC,152.46,,,,,,,88.31,1126.22,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,Exception Members,TC,63.14,,,,,,,45.10,79.54,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Exception Members,TC,63.14,,,,,,,41.00,515.07,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,2.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,1397.87,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,inpatient,,,306.10000,290.80000,The Alliance,Exception Members,90,235.70,,,,,,,168.35,296.92,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,outpatient,,,306.10000,290.80000,The Alliance,Exception Members,90,235.70,,,,,,,27.54,1290.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,18.50,442.00,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1425.05,2513.27,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1295.50,12902.54,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,4.31,220.68,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,inpatient,300,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,outpatient,300,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,inpatient,300,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,outpatient,300,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,inpatient,100,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,inpatient,100,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,outpatient,100,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,inpatient,100,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,outpatient,100,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,inpatient,100,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,outpatient,100,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,inpatient,100,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,outpatient,100,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,The Alliance,Exception Members,TC,2667.28,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Exception Members,TC,2667.28,,,,,,,1611.84,3360.08,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,inpatient,1,EA,2.24000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,inpatient,1,mL,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,inpatient,1,mL,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,outpatient,1,mL,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,inpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,44.55,78.57,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,40.50,134.64,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,177.65,313.31,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,161.50,2815.39,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,4.06,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,The Alliance,Exception Members,,18.03,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Exception Members,,18.03,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,6.61,339.51,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,6.70,356.54,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,inpatient,,,2973.00000,2824.35000,The Alliance,Exception Members,,2289.21,,,,,,,1635.15,2883.81,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,outpatient,,,2973.00000,2824.35000,The Alliance,Exception Members,,2289.21,,,,,,,636.00,37399.48,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,inpatient,30,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,outpatient,30,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,2.61,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,inpatient,1,mL,166.31000,158.00000,The Alliance,Exception Members,,128.06,,,,,,,91.47,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,outpatient,1,mL,166.31000,158.00000,The Alliance,Exception Members,,128.06,,,,,,,0.94620,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,inpatient,1,mL,173.64000,164.96000,The Alliance,Exception Members,,133.70,,,,,,,95.50,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,outpatient,1,mL,173.64000,164.96000,The Alliance,Exception Members,,133.70,,,,,,,0.94620,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,78.21,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,0.94620,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,inpatient,1,mL,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,95.59,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,0.94620,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,inpatient,1,mL,257.67000,244.78000,The Alliance,Exception Members,,198.41,,,,,,,141.72,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,outpatient,1,mL,257.67000,244.78000,The Alliance,Exception Members,,198.41,,,,,,,0.94620,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,inpatient,1,mL,257.40000,244.53000,The Alliance,Exception Members,,198.20,,,,,,,141.57,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,outpatient,1,mL,257.40000,244.53000,The Alliance,Exception Members,,198.20,,,,,,,0.94620,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,inpatient,1,mL,193.96000,184.26000,The Alliance,Exception Members,,149.35,,,,,,,106.68,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,outpatient,1,mL,193.96000,184.26000,The Alliance,Exception Members,,149.35,,,,,,,0.94620,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,inpatient,1,mL,115.78000,109.99000,The Alliance,Exception Members,,89.15,,,,,,,63.68,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,outpatient,1,mL,115.78000,109.99000,The Alliance,Exception Members,,89.15,,,,,,,0.94620,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,inpatient,1,mL,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,121.66,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,outpatient,1,mL,221.20000,210.14000,The Alliance,Exception Members,,170.32,,,,,,,0.94620,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,inpatient,1,mL,193.05000,183.40000,The Alliance,Exception Members,,148.65,,,,,,,106.18,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,outpatient,1,mL,193.05000,183.40000,The Alliance,Exception Members,,148.65,,,,,,,0.94620,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,inpatient,1,mL,108.69000,103.25000,The Alliance,Exception Members,,83.69,,,,,,,59.78,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,outpatient,1,mL,108.69000,103.25000,The Alliance,Exception Members,,83.69,,,,,,,0.94620,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,inpatient,1,mL,108.67000,103.24000,The Alliance,Exception Members,,83.68,,,,,,,59.77,105.41,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,outpatient,1,mL,108.67000,103.24000,The Alliance,Exception Members,,83.68,,,,,,,0.94620,105.41,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,inpatient,500,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,outpatient,500,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,3.75,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,inpatient,500,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,outpatient,500,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,3.75,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,inpatient,1,EA,23.42000,22.24000,The Alliance,Exception Members,,18.03,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,outpatient,1,EA,23.42000,22.24000,The Alliance,Exception Members,,18.03,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,The Alliance,Exception Members,,18.03,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Exception Members,,18.03,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,inpatient,1,EA,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,outpatient,1,EA,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,inpatient,50,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,outpatient,50,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,3.75,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,inpatient,50,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,outpatient,50,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,3.75,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Exception Members,,287.21,,,,,,,186.50,361.81,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,TC,28.49,,,,,,,18.50,442.00,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,inpatient,1,mL,19.43000,18.46000,The Alliance,Exception Members,,14.96,,,,,,,10.69,18.85,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,outpatient,1,mL,19.43000,18.46000,The Alliance,Exception Members,,14.96,,,,,,,9.71,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,inpatient,1,mL,11.57000,10.99000,The Alliance,Exception Members,,8.91,,,,,,,6.36,11.22,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,outpatient,1,mL,11.57000,10.99000,The Alliance,Exception Members,,8.91,,,,,,,5.79,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,inpatient,1,mL,8.35000,7.93000,The Alliance,Exception Members,,6.43,,,,,,,4.59,8.10,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,outpatient,1,mL,8.35000,7.93000,The Alliance,Exception Members,,6.43,,,,,,,4.17,25.89,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,95.70,168.78,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,15.49,814.87,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,inpatient,1,EA,45.82000,43.53000,The Alliance,Exception Members,,35.28,,,,,,,25.20,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,outpatient,1,EA,45.82000,43.53000,The Alliance,Exception Members,,35.28,,,,,,,0.66805,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.66805,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,0.66805,18.39,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,2.11,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,2.11,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,inpatient,1,mL,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,inpatient,1,mL,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,11.52,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,outpatient,1,mL,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,2.11,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,inpatient,1,mL,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,outpatient,1,mL,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,2.11,6.29,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,inpatient,1,mL,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.57,2.76,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,outpatient,1,mL,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.43,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,4.28,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,inpatient,1,mL,18.20000,17.29000,The Alliance,Exception Members,,14.01,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Exception Members,,14.01,,,,,,,9.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,inpatient,1,mL,12.20000,11.59000,The Alliance,Exception Members,,9.39,,,,,,,6.71,11.83,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,outpatient,1,mL,12.20000,11.59000,The Alliance,Exception Members,,9.39,,,,,,,6.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,inpatient,1,mL,8.33000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.58,8.08,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,outpatient,1,mL,8.33000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.17,25.89,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,inpatient,,,286.43000,272.11000,The Alliance,Exception Members,,220.55,,,,,,,157.54,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,outpatient,,,286.43000,272.11000,The Alliance,Exception Members,,220.55,,,,,,,143.22,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,inpatient,1,mL,572.85000,544.21000,The Alliance,Exception Members,,441.09,,,,,,,315.07,555.66,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,outpatient,1,mL,572.85000,544.21000,The Alliance,Exception Members,,441.09,,,,,,,187.18,555.66,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,inpatient,1,EA,24.86000,23.62000,The Alliance,Exception Members,,19.14,,,,,,,13.67,24.11,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,outpatient,1,EA,24.86000,23.62000,The Alliance,Exception Members,,19.14,,,,,,,12.43,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,inpatient,1,EA,370.86000,352.32000,The Alliance,Exception Members,,285.56,,,,,,,203.97,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,outpatient,1,EA,370.86000,352.32000,The Alliance,Exception Members,,285.56,,,,,,,32.99,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,inpatient,1,EA,95.97000,91.17000,The Alliance,Exception Members,,73.90,,,,,,,52.78,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,outpatient,1,EA,95.97000,91.17000,The Alliance,Exception Members,,73.90,,,,,,,32.99,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,inpatient,1,EA,21.68000,20.60000,The Alliance,Exception Members,,16.69,,,,,,,11.92,21.03,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,outpatient,1,EA,21.68000,20.60000,The Alliance,Exception Members,,16.69,,,,,,,10.84,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,inpatient,1,EA,62.44000,59.32000,The Alliance,Exception Members,,48.08,,,,,,,34.34,60.57,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,outpatient,1,EA,62.44000,59.32000,The Alliance,Exception Members,,48.08,,,,,,,31.22,60.57,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,inpatient,30,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,inpatient,30,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,inpatient,30,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.51,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.01,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,inpatient,1,EA,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.57,4.54,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.34,4.54,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,inpatient,1,EA,92.08000,87.48000,The Alliance,Exception Members,,70.90,,,,,,,50.64,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,outpatient,1,EA,92.08000,87.48000,The Alliance,Exception Members,,70.90,,,,,,,0.66805,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,0.66805,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,inpatient,1,EA,212.08000,201.47000,The Alliance,Exception Members,,163.30,,,,,,,116.64,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,outpatient,1,EA,212.08000,201.47000,The Alliance,Exception Members,,163.30,,,,,,,0.66805,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,inpatient,1,EA,86.25000,81.93000,The Alliance,Exception Members,,66.41,,,,,,,47.44,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,outpatient,1,EA,86.25000,81.93000,The Alliance,Exception Members,,66.41,,,,,,,0.66805,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,inpatient,1,EA,32.77000,31.13000,The Alliance,Exception Members,,25.23,,,,,,,18.02,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,outpatient,1,EA,32.77000,31.13000,The Alliance,Exception Members,,25.23,,,,,,,0.66805,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,inpatient,1,EA,177.91000,169.01000,The Alliance,Exception Members,,136.99,,,,,,,97.85,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,outpatient,1,EA,177.91000,169.01000,The Alliance,Exception Members,,136.99,,,,,,,0.66805,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,inpatient,1,EA,87.82000,83.43000,The Alliance,Exception Members,,67.62,,,,,,,48.30,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Exception Members,,67.62,,,,,,,0.66805,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,inpatient,1,EA,91.64000,87.06000,The Alliance,Exception Members,,70.56,,,,,,,50.40,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,outpatient,1,EA,91.64000,87.06000,The Alliance,Exception Members,,70.56,,,,,,,0.66805,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,0.66805,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,10.25,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,0.66805,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,0.66805,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,0.66805,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,inpatient,1,EA,18.17000,17.26000,The Alliance,Exception Members,,13.99,,,,,,,9.99,17.62,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,outpatient,1,EA,18.17000,17.26000,The Alliance,Exception Members,,13.99,,,,,,,0.66805,17.62,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,inpatient,,,188.80000,179.36000,The Alliance,Exception Members,90,145.38,,,,,,,103.84,183.14,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,outpatient,,,188.80000,179.36000,The Alliance,Exception Members,90,145.38,,,,,,,16.80,848.80,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,inpatient,1,EA,5.74000,5.45000,The Alliance,Exception Members,,4.42,,,,,,,3.16,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,outpatient,1,EA,5.74000,5.45000,The Alliance,Exception Members,,4.42,,,,,,,2.87,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.32,6.44,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,inpatient,1,EA,9.63000,9.15000,The Alliance,Exception Members,,7.42,,,,,,,5.30,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,outpatient,1,EA,9.63000,9.15000,The Alliance,Exception Members,,7.42,,,,,,,0.31155,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,inpatient,1,EA,8.80000,8.36000,The Alliance,Exception Members,,6.78,,,,,,,4.84,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Exception Members,,6.78,,,,,,,0.31155,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,5.18,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,0.31155,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.31155,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,0.31155,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,inpatient,1,EA,8.75000,8.32000,The Alliance,Exception Members,,6.74,,,,,,,4.81,8.49,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,outpatient,1,EA,8.75000,8.32000,The Alliance,Exception Members,,6.74,,,,,,,0.31155,8.49,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,inpatient,1,EA,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,outpatient,1,EA,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,inpatient,1,EA,133.19000,126.53000,The Alliance,Exception Members,,102.56,,,,,,,73.25,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,outpatient,1,EA,133.19000,126.53000,The Alliance,Exception Members,,102.56,,,,,,,2.53,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,inpatient,1,EA,262.28000,249.17000,The Alliance,Exception Members,,201.96,,,,,,,144.25,254.41,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,outpatient,1,EA,262.28000,249.17000,The Alliance,Exception Members,,201.96,,,,,,,2.53,254.41,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,inpatient,1,EA,5.38000,5.11000,The Alliance,Exception Members,,4.14,,,,,,,2.96,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,outpatient,1,EA,5.38000,5.11000,The Alliance,Exception Members,,4.14,,,,,,,2.69,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,inpatient,1,EA,9.83000,9.34000,The Alliance,Exception Members,,7.57,,,,,,,5.41,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,outpatient,1,EA,9.83000,9.34000,The Alliance,Exception Members,,7.57,,,,,,,4.92,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,TC,184.03,,,,,,,131.45,231.83,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,TC,184.03,,,,,,,119.50,2142.86,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,inpatient,1,EA,19.37000,18.40000,The Alliance,Exception Members,,14.91,,,,,,,10.65,18.79,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,outpatient,1,EA,19.37000,18.40000,The Alliance,Exception Members,,14.91,,,,,,,9.69,18.79,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,inpatient,1,EA,224.08000,212.87000,The Alliance,Exception Members,,172.54,,,,,,,123.24,217.36,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Exception Members,,172.54,,,,,,,112.04,217.36,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,4.12,390.47,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,inpatient,1,EA,149.72000,142.23000,The Alliance,Exception Members,,115.28,,,,,,,82.35,145.23,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,outpatient,1,EA,149.72000,142.23000,The Alliance,Exception Members,,115.28,,,,,,,0.26000,145.23,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,inpatient,1,EA,62.79000,59.65000,The Alliance,Exception Members,,48.35,,,,,,,34.53,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,outpatient,1,EA,62.79000,59.65000,The Alliance,Exception Members,,48.35,,,,,,,31.39,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,inpatient,1,EA,196.71000,186.87000,The Alliance,Exception Members,,151.47,,,,,,,108.19,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,outpatient,1,EA,196.71000,186.87000,The Alliance,Exception Members,,151.47,,,,,,,98.36,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,36.93,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,33.58,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,inpatient,1,EA,169.96000,161.46000,The Alliance,Exception Members,,130.87,,,,,,,93.48,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,outpatient,1,EA,169.96000,161.46000,The Alliance,Exception Members,,130.87,,,,,,,84.98,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,inpatient,1,EA,169.86000,161.37000,The Alliance,Exception Members,,130.79,,,,,,,93.42,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,outpatient,1,EA,169.86000,161.37000,The Alliance,Exception Members,,130.79,,,,,,,84.93,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,inpatient,1,EA,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,95.59,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,86.90,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,inpatient,1,EA,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,28.68,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,outpatient,1,EA,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,26.07,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,inpatient,1,EA,44.32000,42.10000,The Alliance,Exception Members,,34.13,,,,,,,24.38,42.99,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,outpatient,1,EA,44.32000,42.10000,The Alliance,Exception Members,,34.13,,,,,,,22.16,42.99,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,inpatient,1,GM,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,outpatient,1,GM,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,inpatient,1,GM,1.36000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,outpatient,1,GM,1.36000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,inpatient,45,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,outpatient,45,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,inpatient,45,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,outpatient,45,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,inpatient,45,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,outpatient,45,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,inpatient,45,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,outpatient,45,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,inpatient,1,EA,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,2.84,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.54,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.31,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,inpatient,1,EA,3.85000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.12,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,outpatient,1,EA,3.85000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.93,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.57,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,The Alliance,Exception Members,,2.99,,,,,,,2.13,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Exception Members,,2.99,,,,,,,1.94,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.77,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.52,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,inpatient,1,mL,82.30000,78.18000,The Alliance,Exception Members,,63.37,,,,,,,45.27,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,outpatient,1,mL,82.30000,78.18000,The Alliance,Exception Members,,63.37,,,,,,,7.86,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,inpatient,1,mL,74.07000,70.36000,The Alliance,Exception Members,,57.03,,,,,,,40.74,71.85,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,outpatient,1,mL,74.07000,70.36000,The Alliance,Exception Members,,57.03,,,,,,,7.86,71.85,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,inpatient,1,mL,10.61000,10.08000,The Alliance,Exception Members,,8.17,,,,,,,5.84,10.29,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,outpatient,1,mL,10.61000,10.08000,The Alliance,Exception Members,,8.17,,,,,,,3.62,10.29,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,inpatient,1,EA,32.92000,31.27000,The Alliance,Exception Members,,25.35,,,,,,,18.11,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,outpatient,1,EA,32.92000,31.27000,The Alliance,Exception Members,,25.35,,,,,,,0.26000,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,inpatient,1,EA,20.41000,19.39000,The Alliance,Exception Members,,15.72,,,,,,,11.23,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,outpatient,1,EA,20.41000,19.39000,The Alliance,Exception Members,,15.72,,,,,,,0.26000,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,13.21,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,0.26000,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,inpatient,1,EA,36.81000,34.97000,The Alliance,Exception Members,,28.34,,,,,,,20.25,35.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,outpatient,1,EA,36.81000,34.97000,The Alliance,Exception Members,,28.34,,,,,,,0.26000,35.71,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,4.75,254.68,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,inpatient,1,EA,262.63000,249.50000,The Alliance,Exception Members,,202.23,,,,,,,144.45,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,outpatient,1,EA,262.63000,249.50000,The Alliance,Exception Members,,202.23,,,,,,,0.26000,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,inpatient,1,EA,138.98000,132.03000,The Alliance,Exception Members,,107.01,,,,,,,76.44,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Exception Members,,107.01,,,,,,,0.26000,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,inpatient,1,EA,132.37000,125.75000,The Alliance,Exception Members,,101.92,,,,,,,72.80,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,outpatient,1,EA,132.37000,125.75000,The Alliance,Exception Members,,101.92,,,,,,,0.26000,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,inpatient,1,EA,102.70000,97.56000,The Alliance,Exception Members,,79.08,,,,,,,56.48,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Exception Members,,79.08,,,,,,,0.26000,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,inpatient,1,EA,108.14000,102.73000,The Alliance,Exception Members,,83.27,,,,,,,59.48,104.90,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,outpatient,1,EA,108.14000,102.73000,The Alliance,Exception Members,,83.27,,,,,,,0.26000,104.90,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,inpatient,5,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,inpatient,1,EA,20.44000,19.42000,The Alliance,Exception Members,,15.74,,,,,,,11.24,19.83,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,outpatient,1,EA,20.44000,19.42000,The Alliance,Exception Members,,15.74,,,,,,,0.26000,19.83,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,5.78,305.58,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,95.70,168.78,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,14.55,763.98,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,inpatient,1,EA,1.37000,1.31000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,outpatient,1,EA,1.37000,1.31000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,inpatient,1,EA,31.54000,29.96000,The Alliance,Exception Members,,24.29,,,,,,,17.35,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,outpatient,1,EA,31.54000,29.96000,The Alliance,Exception Members,,24.29,,,,,,,15.77,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,3.49,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,inpatient,1,EA,62.32000,59.20000,The Alliance,Exception Members,,47.99,,,,,,,34.28,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,outpatient,1,EA,62.32000,59.20000,The Alliance,Exception Members,,47.99,,,,,,,0.12000,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,inpatient,1,EA,62.33000,59.21000,The Alliance,Exception Members,,47.99,,,,,,,34.28,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,outpatient,1,EA,62.33000,59.21000,The Alliance,Exception Members,,47.99,,,,,,,0.12000,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,inpatient,1,EA,45.19000,42.93000,The Alliance,Exception Members,,34.80,,,,,,,24.85,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,outpatient,1,EA,45.19000,42.93000,The Alliance,Exception Members,,34.80,,,,,,,0.12000,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,inpatient,1,EA,51.57000,48.99000,The Alliance,Exception Members,,39.71,,,,,,,28.36,50.02,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,outpatient,1,EA,51.57000,48.99000,The Alliance,Exception Members,,39.71,,,,,,,0.12000,50.02,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,16.94,882.80,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,inpatient,2,EA,5.30000,5.03000,The Alliance,Exception Members,,4.08,,,,,,,2.92,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,outpatient,2,EA,5.30000,5.03000,The Alliance,Exception Members,,4.08,,,,,,,1.60,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,inpatient,2,EA,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,2.37,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,outpatient,2,EA,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,1.60,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,inpatient,2,EA,5.29000,5.03000,The Alliance,Exception Members,,4.07,,,,,,,2.91,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,outpatient,2,EA,5.29000,5.03000,The Alliance,Exception Members,,4.07,,,,,,,1.60,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,inpatient,2,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,outpatient,2,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,1.88,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,inpatient,2,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.60,3.38,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,inpatient,1,mL,56.56000,53.73000,The Alliance,Exception Members,,43.55,,,,,,,31.11,54.86,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,outpatient,1,mL,56.56000,53.73000,The Alliance,Exception Members,,43.55,,,,,,,7.86,54.86,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,8.65,458.40,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.82,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.66,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.14,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.04,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,inpatient,1,EA,1.43000,1.35000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Exception Members,,1.10,,,,,,,0.71500,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.12,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,inpatient,5,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,outpatient,5,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,inpatient,5,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,outpatient,5,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,inpatient,5,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,outpatient,5,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,1.82,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,inpatient,5,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,outpatient,5,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,inpatient,5,EA,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,outpatient,5,EA,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,inpatient,5,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,outpatient,5,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,inpatient,5,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,outpatient,5,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,inpatient,5,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,outpatient,5,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,inpatient,5,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,outpatient,5,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,inpatient,5,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,inpatient,5,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,outpatient,5,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,inpatient,1,EA,9.67000,9.18000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Exception Members,,7.45,,,,,,,0.36823,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.36823,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,0.36823,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,inpatient,1,EA,5.88000,5.58000,The Alliance,Exception Members,,4.53,,,,,,,3.23,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,outpatient,1,EA,5.88000,5.58000,The Alliance,Exception Members,,4.53,,,,,,,0.36823,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.36823,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.36823,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,0.36823,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,inpatient,1,EA,5.28000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,2.90,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,outpatient,1,EA,5.28000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,0.36823,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.36823,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,inpatient,5,EA,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,outpatient,5,EA,3.48000,3.31000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,inpatient,5,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,outpatient,5,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,inpatient,5,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,The Alliance,Exception Members,,13.41,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Exception Members,,13.41,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,The Alliance,Exception Members,,13.41,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Exception Members,,13.41,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,inpatient,1,EA,7.18000,6.82000,The Alliance,Exception Members,,5.53,,,,,,,3.95,6.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,outpatient,1,EA,7.18000,6.82000,The Alliance,Exception Members,,5.53,,,,,,,3.59,6.96,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,inpatient,,,25.30000,24.04000,The Alliance,Exception Members,,19.48,,,,,,,13.91,24.54,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,outpatient,,,25.30000,24.04000,The Alliance,Exception Members,,19.48,,,,,,,12.65,24.54,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,53.00,788.42,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,inpatient,1,EA,9.04000,8.59000,The Alliance,Exception Members,,6.96,,,,,,,4.97,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,outpatient,1,EA,9.04000,8.59000,The Alliance,Exception Members,,6.96,,,,,,,0.12000,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,inpatient,1,EA,35.92000,34.13000,The Alliance,Exception Members,,27.66,,,,,,,19.76,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,outpatient,1,EA,35.92000,34.13000,The Alliance,Exception Members,,27.66,,,,,,,0.12000,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,inpatient,1,EA,35.90000,34.10000,The Alliance,Exception Members,,27.64,,,,,,,19.75,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,outpatient,1,EA,35.90000,34.10000,The Alliance,Exception Members,,27.64,,,,,,,0.12000,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,inpatient,1,EA,27.49000,26.12000,The Alliance,Exception Members,,21.17,,,,,,,15.12,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,outpatient,1,EA,27.49000,26.12000,The Alliance,Exception Members,,21.17,,,,,,,0.12000,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,inpatient,1,EA,27.99000,26.59000,The Alliance,Exception Members,,21.55,,,,,,,15.39,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,outpatient,1,EA,27.99000,26.59000,The Alliance,Exception Members,,21.55,,,,,,,0.12000,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,inpatient,1,EA,30.46000,28.94000,The Alliance,Exception Members,,23.45,,,,,,,16.75,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,outpatient,1,EA,30.46000,28.94000,The Alliance,Exception Members,,23.45,,,,,,,0.12000,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,inpatient,1,EA,30.45000,28.92000,The Alliance,Exception Members,,23.45,,,,,,,16.75,29.54,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,outpatient,1,EA,30.45000,28.92000,The Alliance,Exception Members,,23.45,,,,,,,0.12000,29.54,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.39,288.61,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,inpatient,1,EA,569.80000,541.31000,The Alliance,Exception Members,,438.75,,,,,,,313.39,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,outpatient,1,EA,569.80000,541.31000,The Alliance,Exception Members,,438.75,,,,,,,28.27,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,inpatient,1,EA,2907.20000,2761.84000,The Alliance,Exception Members,,2238.54,,,,,,,1598.96,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,outpatient,1,EA,2907.20000,2761.84000,The Alliance,Exception Members,,2238.54,,,,,,,28.27,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,inpatient,1,EA,2907.11000,2761.75000,The Alliance,Exception Members,,2238.47,,,,,,,1598.91,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,outpatient,1,EA,2907.11000,2761.75000,The Alliance,Exception Members,,2238.47,,,,,,,28.27,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,356.12,628.08,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,28.27,628.08,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,45.10,79.54,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,4.05,339.51,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,7.48,356.54,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,The Alliance,Exception Members,,2.98,,,,,,,2.13,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Exception Members,,2.98,,,,,,,1.94,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,inpatient,1,EA,5.16000,4.90000,The Alliance,Exception Members,,3.97,,,,,,,2.84,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,inpatient,1,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.05,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,1.86,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,inpatient,,,161.35000,153.28000,The Alliance,Exception Members,,124.24,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,outpatient,,,161.35000,153.28000,The Alliance,Exception Members,,124.24,,,,,,,80.67,185.08,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,inpatient,1,EA,161.35000,153.28000,The Alliance,Exception Members,,124.24,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,outpatient,1,EA,161.35000,153.28000,The Alliance,Exception Members,,124.24,,,,,,,80.67,185.08,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,inpatient,1,EA,6.15000,5.84000,The Alliance,Exception Members,,4.74,,,,,,,3.38,5.97,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,outpatient,1,EA,6.15000,5.84000,The Alliance,Exception Members,,4.74,,,,,,,3.08,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,inpatient,1,EA,7.89000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.65,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,outpatient,1,EA,7.89000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.94,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.54,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,inpatient,1,EA,10.88000,10.34000,The Alliance,Exception Members,,8.38,,,,,,,5.98,10.55,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,outpatient,1,EA,10.88000,10.34000,The Alliance,Exception Members,,8.38,,,,,,,5.44,10.55,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,inpatient,1,EA,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,4.01,7.08,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,outpatient,1,EA,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,3.65,7.69,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,inpatient,1,EA,17.65000,16.77000,The Alliance,Exception Members,,13.59,,,,,,,9.71,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,outpatient,1,EA,17.65000,16.77000,The Alliance,Exception Members,,13.59,,,,,,,7.18,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,inpatient,1,EA,8.05000,7.65000,The Alliance,Exception Members,,6.20,,,,,,,4.43,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,outpatient,1,EA,8.05000,7.65000,The Alliance,Exception Members,,6.20,,,,,,,4.03,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,inpatient,1,EA,8.41000,7.99000,The Alliance,Exception Members,,6.48,,,,,,,4.63,8.16,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,outpatient,1,EA,8.41000,7.99000,The Alliance,Exception Members,,6.48,,,,,,,4.21,8.16,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,108.35,191.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,98.50,212.44,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,inpatient,1,EA,12.55000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.90,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,outpatient,1,EA,12.55000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.28,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,The Alliance,Exception Members,,5.03,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Exception Members,,5.03,,,,,,,3.27,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,The Alliance,Exception Members,,5.03,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Exception Members,,5.03,,,,,,,3.27,6.33,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,inpatient,1,EA,217.79000,206.90000,The Alliance,Exception Members,,167.70,,,,,,,119.78,211.26,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,outpatient,1,EA,217.79000,206.90000,The Alliance,Exception Members,,167.70,,,,,,,0.26000,211.26,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,inpatient,100,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,inpatient,100,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,outpatient,100,EA,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,inpatient,100,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,inpatient,100,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,inpatient,100,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,inpatient,100,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,outpatient,100,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,inpatient,100,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,inpatient,100,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,outpatient,100,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,39.60,69.84,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,5.99,1216.68,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,inpatient,1,EA,15.06000,14.31000,The Alliance,Exception Members,,11.60,,,,,,,8.28,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,outpatient,1,EA,15.06000,14.31000,The Alliance,Exception Members,,11.60,,,,,,,7.53,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,inpatient,1,EA,4.07000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.24,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,outpatient,1,EA,4.07000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.04,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,6.64,339.51,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,inpatient,30,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,outpatient,30,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,inpatient,30,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,outpatient,30,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,inpatient,30,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,outpatient,30,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,inpatient,,,656.00000,623.20000,The Alliance,Exception Members,,505.12,,,,,,,360.80,636.32,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,outpatient,,,656.00000,623.20000,The Alliance,Exception Members,,505.12,,,,,,,360.80,5271.00,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,inpatient,1,EA,630.07000,598.57000,The Alliance,Exception Members,,485.15,,,,,,,346.54,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,outpatient,1,EA,630.07000,598.57000,The Alliance,Exception Members,,485.15,,,,,,,28.27,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,28.27,376.85,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,34.92,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,33.55,59.17,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,4.75,254.68,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,inpatient,1,EA,7.85000,7.46000,The Alliance,Exception Members,,6.04,,,,,,,4.32,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Exception Members,,6.04,,,,,,,3.92,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,4.90,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,inpatient,1,EA,9.82000,9.33000,The Alliance,Exception Members,,7.56,,,,,,,5.40,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,outpatient,1,EA,9.82000,9.33000,The Alliance,Exception Members,,7.56,,,,,,,4.91,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,inpatient,1,mL,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,outpatient,1,mL,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,7.69,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,inpatient,1,EA,5.70000,5.42000,The Alliance,Exception Members,,4.39,,,,,,,3.13,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,outpatient,1,EA,5.70000,5.42000,The Alliance,Exception Members,,4.39,,,,,,,2.85,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,inpatient,1,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,2.35,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,inpatient,1,EA,9.88000,9.39000,The Alliance,Exception Members,,7.61,,,,,,,5.43,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,outpatient,1,EA,9.88000,9.39000,The Alliance,Exception Members,,7.61,,,,,,,4.94,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,inpatient,1,EA,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,3.28,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,2.98,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,inpatient,1,EA,8.65000,8.22000,The Alliance,Exception Members,,6.66,,,,,,,4.76,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Exception Members,,6.66,,,,,,,4.33,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,inpatient,1,EA,3.50000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.93,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,inpatient,,,760.00000,722.00000,The Alliance,Exception Members,TC,585.20,,,,,,,418.00,737.20,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Exception Members,TC,585.20,,,,,,,380.00,7351.18,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,inpatient,1,EA,11.63000,11.05000,The Alliance,Exception Members,,8.96,,,,,,,6.40,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,outpatient,1,EA,11.63000,11.05000,The Alliance,Exception Members,,8.96,,,,,,,5.82,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,inpatient,1,EA,14.54000,13.81000,The Alliance,Exception Members,,11.20,,,,,,,8.00,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,outpatient,1,EA,14.54000,13.81000,The Alliance,Exception Members,,11.20,,,,,,,7.27,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.41,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.41,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,inpatient,1,mL,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,inpatient,1,mL,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,outpatient,1,mL,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,inpatient,1,mL,2.57000,2.45000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,outpatient,1,mL,2.57000,2.45000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,inpatient,1,mL,3.86000,3.67000,The Alliance,Exception Members,,2.97,,,,,,,2.12,3.74,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,outpatient,1,mL,3.86000,3.67000,The Alliance,Exception Members,,2.97,,,,,,,1.93,3.74,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,The Alliance,Exception Members,TC,1955.03,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Exception Members,TC,1955.03,,,,,,,1269.50,2462.83,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,inpatient,1,EA,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.39,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,outpatient,1,EA,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.26,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,The Alliance,Exception Members,TC,2661.89,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Exception Members,TC,2661.89,,,,,,,1371.65,3353.29,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,inpatient,,,3007.00000,2856.65000,The Alliance,Exception Members,TC,2315.39,,,,,,,1653.85,2916.79,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,outpatient,,,3007.00000,2856.65000,The Alliance,Exception Members,TC,2315.39,,,,,,,1329.46,2916.79,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,inpatient,1,mL,5.47000,5.19000,The Alliance,Exception Members,,4.21,,,,,,,3.01,5.31,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Exception Members,,4.21,,,,,,,2.73,7.69,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,The Alliance,Exception Members,TC,3838.45,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Exception Members,TC,3838.45,,,,,,,1487.04,4835.45,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,inpatient,1,EA,3.62000,3.43000,The Alliance,Exception Members,,2.79,,,,,,,1.99,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,outpatient,1,EA,3.62000,3.43000,The Alliance,Exception Members,,2.79,,,,,,,1.81,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,inpatient,1,EA,2.55000,2.43000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,outpatient,1,EA,2.55000,2.43000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,inpatient,1,EA,1636.88000,1555.04000,The Alliance,Exception Members,,1260.40,,,,,,,900.28,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,outpatient,1,EA,1636.88000,1555.04000,The Alliance,Exception Members,,1260.40,,,,,,,28.27,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,inpatient,1,EA,1636.83000,1554.99000,The Alliance,Exception Members,,1260.36,,,,,,,900.26,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,outpatient,1,EA,1636.83000,1554.99000,The Alliance,Exception Members,,1260.36,,,,,,,28.27,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,inpatient,1,EA,471.38000,447.81000,The Alliance,Exception Members,,362.96,,,,,,,259.26,457.24,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,outpatient,1,EA,471.38000,447.81000,The Alliance,Exception Members,,362.96,,,,,,,28.27,457.24,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Exception Members,TC,3863.86,,,,,,,1487.04,4867.46,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,inpatient,3,EA,183.41000,174.24000,The Alliance,Exception Members,,141.23,,,,,,,100.88,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,outpatient,3,EA,183.41000,174.24000,The Alliance,Exception Members,,141.23,,,,,,,91.70,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,inpatient,3,EA,35.81000,34.02000,The Alliance,Exception Members,,27.57,,,,,,,19.70,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,outpatient,3,EA,35.81000,34.02000,The Alliance,Exception Members,,27.57,,,,,,,17.91,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,inpatient,3,EA,36.87000,35.02000,The Alliance,Exception Members,,28.39,,,,,,,20.28,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,outpatient,3,EA,36.87000,35.02000,The Alliance,Exception Members,,28.39,,,,,,,18.43,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,inpatient,3,EA,26.64000,25.31000,The Alliance,Exception Members,,20.51,,,,,,,14.65,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,outpatient,3,EA,26.64000,25.31000,The Alliance,Exception Members,,20.51,,,,,,,13.32,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,inpatient,3,EA,53.75000,51.06000,The Alliance,Exception Members,,41.39,,,,,,,29.56,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,outpatient,3,EA,53.75000,51.06000,The Alliance,Exception Members,,41.39,,,,,,,26.88,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,inpatient,3,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,outpatient,3,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,20.54,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,inpatient,3,EA,70.51000,66.98000,The Alliance,Exception Members,,54.29,,,,,,,38.78,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,outpatient,3,EA,70.51000,66.98000,The Alliance,Exception Members,,54.29,,,,,,,35.26,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,inpatient,3,EA,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,11.59,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,outpatient,3,EA,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,10.54,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,inpatient,3,EA,35.26000,33.49000,The Alliance,Exception Members,,27.15,,,,,,,19.39,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,outpatient,3,EA,35.26000,33.49000,The Alliance,Exception Members,,27.15,,,,,,,17.63,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,inpatient,3,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,outpatient,3,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,inpatient,3,EA,12.22000,11.61000,The Alliance,Exception Members,,9.41,,,,,,,6.72,11.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,outpatient,3,EA,12.22000,11.61000,The Alliance,Exception Members,,9.41,,,,,,,6.11,11.85,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.31,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.20,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,The Alliance,Exception Members,TC,3123.12,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Exception Members,TC,3123.12,,,,,,,1487.04,3934.32,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,inpatient,1,mL,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,2.24,12.26,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,inpatient,,,4381.00000,4161.95000,The Alliance,Exception Members,TC,3373.37,,,,,,,2409.55,4249.57,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,outpatient,,,4381.00000,4161.95000,The Alliance,Exception Members,TC,3373.37,,,,,,,1487.04,4249.57,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,The Alliance,Exception Members,TC,1330.56,,,,,,,950.40,1676.16,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Exception Members,TC,1330.56,,,,,,,864.00,2032.87,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,1016.40,1792.56,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,924.00,2032.87,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,The Alliance,Exception Members,TC,2318.47,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Exception Members,TC,2318.47,,,,,,,1129.95,2920.67,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.18,271.65,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,The Alliance,Exception Members,TC,2632.63,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Exception Members,TC,2632.63,,,,,,,1353.88,3316.43,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,inpatient,,,4352.00000,4134.40000,The Alliance,Exception Members,TC,3351.04,,,,,,,2393.60,4221.44,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Exception Members,TC,3351.04,,,,,,,1487.04,4221.44,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,The Alliance,Exception Members,TC,2718.87,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Exception Members,TC,2718.87,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,inpatient,,,1560.00000,1482.00000,The Alliance,Exception Members,TC,1201.20,,,,,,,858.00,1513.20,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,outpatient,,,1560.00000,1482.00000,The Alliance,Exception Members,TC,1201.20,,,,,,,608.47,2032.87,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,16.91,1211.55,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Exception Members,TC,2794.33,,,,,,,1214.33,3520.13,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,inpatient,,,3032.00000,2880.40000,The Alliance,Exception Members,TC,2334.64,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Exception Members,TC,2334.64,,,,,,,1329.46,2941.04,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,The Alliance,Exception Members,,3.10,,,,,,,2.21,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Exception Members,,3.10,,,,,,,2.01,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.77,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.52,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,inpatient,1,EA,3.95000,3.76000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,outpatient,1,EA,3.95000,3.76000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,inpatient,,,2867.00000,2723.65000,The Alliance,Exception Members,TC,2207.59,,,,,,,1576.85,2780.99,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,outpatient,,,2867.00000,2723.65000,The Alliance,Exception Members,TC,2207.59,,,,,,,902.40,2780.99,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,inpatient,1,EA,6.73000,6.39000,The Alliance,Exception Members,,5.18,,,,,,,3.70,6.53,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Exception Members,,5.18,,,,,,,3.37,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,inpatient,1,EA,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.69,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.17,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.54,8.80,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,The Alliance,Exception Members,TC,2671.13,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Exception Members,TC,2671.13,,,,,,,1375.22,3364.93,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,inpatient,,,2725.00000,2588.75000,The Alliance,Exception Members,TC,2098.25,,,,,,,1498.75,2643.25,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,outpatient,,,2725.00000,2588.75000,The Alliance,Exception Members,TC,2098.25,,,,,,,1329.46,2643.25,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,1272.04,4844.18,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,The Alliance,Exception Members,TC,3066.91,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Exception Members,TC,3066.91,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,inpatient,,,4145.00000,3937.75000,The Alliance,Exception Members,TC,3191.65,,,,,,,2279.75,4020.65,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,outpatient,,,4145.00000,3937.75000,The Alliance,Exception Members,TC,3191.65,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,The Alliance,Exception Members,TC,2480.94,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Exception Members,TC,2480.94,,,,,,,1318.80,3125.34,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,The Alliance,Exception Members,TC,2762.76,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Exception Members,TC,2762.76,,,,,,,1328.10,3480.36,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,116.05,204.67,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,28.00,1341.13,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,The Alliance,Exception Members,TC,1733.27,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Exception Members,TC,1733.27,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,inpatient,,,3500.00000,3325.00000,The Alliance,Exception Members,TC,2695.00,,,,,,,1925.00,3395.00,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,outpatient,,,3500.00000,3325.00000,The Alliance,Exception Members,TC,2695.00,,,,,,,1487.04,3395.00,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,828.00,2032.87,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,inpatient,,,5051.00000,4798.45000,The Alliance,Exception Members,TC,3889.27,,,,,,,2778.05,4899.47,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,outpatient,,,5051.00000,4798.45000,The Alliance,Exception Members,TC,3889.27,,,,,,,1487.04,4899.47,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1127.62,2942.98,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,The Alliance,Exception Members,TC,2845.15,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Exception Members,TC,2845.15,,,,,,,1487.04,3584.15,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,inpatient,,,2339.00000,2222.05000,The Alliance,Exception Members,TC,1801.03,,,,,,,1286.45,2268.83,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,outpatient,,,2339.00000,2222.05000,The Alliance,Exception Members,TC,1801.03,,,,,,,989.10,2268.83,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,inpatient,1,EA,2.03000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,outpatient,1,EA,2.03000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.97,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,inpatient,,,4202.00000,3991.90000,The Alliance,Exception Members,TC,3235.54,,,,,,,2311.10,4075.94,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,outpatient,,,4202.00000,3991.90000,The Alliance,Exception Members,TC,3235.54,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,The Alliance,Exception Members,TC,2731.96,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Exception Members,TC,2731.96,,,,,,,1353.60,3441.56,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,The Alliance,Exception Members,TC,2015.09,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Exception Members,TC,2015.09,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,TC,2537.92,,,,,,,1812.80,3197.12,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,TC,2537.92,,,,,,,1487.04,4345.33,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,inpatient,1,EA,44.30000,42.09000,The Alliance,Exception Members,,34.11,,,,,,,24.36,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,outpatient,1,EA,44.30000,42.09000,The Alliance,Exception Members,,34.11,,,,,,,22.15,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,inpatient,1,EA,48.68000,46.25000,The Alliance,Exception Members,,37.48,,,,,,,26.77,47.22,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,outpatient,1,EA,48.68000,46.25000,The Alliance,Exception Members,,37.48,,,,,,,24.34,47.22,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,inpatient,2,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.53,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.30,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,inpatient,2,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,outpatient,2,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,inpatient,2,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,outpatient,2,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,The Alliance,Exception Members,TC,2748.90,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Exception Members,TC,2748.90,,,,,,,1487.04,3462.90,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4235.00000,4023.25000,The Alliance,Exception Members,TC,3260.95,,,,,,,2329.25,4107.95,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4235.00000,4023.25000,The Alliance,Exception Members,TC,3260.95,,,,,,,1929.64,4107.95,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,inpatient,,,978.00000,929.10000,The Alliance,Exception Members,,753.06,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Exception Members,,753.06,,,,,,,537.90,3163.00,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,inpatient,30,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,outpatient,30,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,TC,1275.12,,,,,,,828.00,2032.87,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,Exception Members,TC,364.21,,,,,,,260.15,458.81,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Exception Members,TC,364.21,,,,,,,179.69,2032.87,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,inpatient,,,2936.00000,2789.20000,The Alliance,Exception Members,TC,2260.72,,,,,,,1614.80,2847.92,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,outpatient,,,2936.00000,2789.20000,The Alliance,Exception Members,TC,2260.72,,,,,,,1468.00,2847.92,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,inpatient,20,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,outpatient,20,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,7.69,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,inpatient,,,2082.00000,1977.90000,The Alliance,Exception Members,TC,1603.14,,,,,,,1145.10,2019.54,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,outpatient,,,2082.00000,1977.90000,The Alliance,Exception Members,TC,1603.14,,,,,,,862.95,2032.87,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,The Alliance,Exception Members,90,168.78,,,,,,,120.56,212.62,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Exception Members,90,168.78,,,,,,,11.91,594.19,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,The Alliance,Exception Members,TC,3353.35,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Exception Members,TC,3353.35,,,,,,,1487.04,4224.35,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Exception Members,TC,2313.85,,,,,,,1128.45,2914.85,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,inpatient,1,EA,85.92000,81.62000,The Alliance,Exception Members,,66.16,,,,,,,47.26,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,outpatient,1,EA,85.92000,81.62000,The Alliance,Exception Members,,66.16,,,,,,,42.96,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,inpatient,1,EA,94.42000,89.70000,The Alliance,Exception Members,,72.70,,,,,,,51.93,91.59,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,outpatient,1,EA,94.42000,89.70000,The Alliance,Exception Members,,72.70,,,,,,,47.21,91.59,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,inpatient,,,4289.00000,4074.55000,The Alliance,Exception Members,TC,3302.53,,,,,,,2358.95,4160.33,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,outpatient,,,4289.00000,4074.55000,The Alliance,Exception Members,TC,3302.53,,,,,,,1487.04,4160.33,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5104.10000,4848.90000,The Alliance,Exception Members,,3930.16,,,,,,,2501.01,4950.98,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5104.10000,4848.90000,The Alliance,Exception Members,,3930.16,,,,,,,2342.78,5104.10,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,inpatient,,,343.00000,325.85000,The Alliance,Exception Members,,264.11,,,,,,,188.65,332.71,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,Exception Members,,264.11,,,,,,,35.09,1833.46,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,The Alliance,Exception Members,TC,1745.59,,,,,,,1246.85,2198.99,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Exception Members,TC,1745.59,,,,,,,484.28,2198.99,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,inpatient,,,12277.00000,11663.15000,The Alliance,Exception Members,TC,9453.29,,,,,,,6752.35,11908.69,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,outpatient,,,12277.00000,11663.15000,The Alliance,Exception Members,TC,9453.29,,,,,,,4549.00,11908.69,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,231.00,407.40,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,41.68,1952.29,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,The Alliance,Exception Members,TC,2658.04,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Exception Members,TC,2658.04,,,,,,,1382.32,3348.44,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,inpatient,,,1408.00000,1337.60000,The Alliance,Exception Members,,1084.16,,,,,,,774.40,1365.76,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,outpatient,,,1408.00000,1337.60000,The Alliance,Exception Members,,1084.16,,,,,,,750.19,3163.00,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Exception Members,TC,2336.18,,,,,,,1329.46,2942.98,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,The Alliance,Exception Members,TC,3016.86,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Exception Members,TC,3016.86,,,,,,,1246.80,3800.46,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,The Alliance,Exception Members,,4.79,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Exception Members,,4.79,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,inpatient,,,3032.00000,2880.40000,The Alliance,Exception Members,TC,2334.64,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Exception Members,TC,2334.64,,,,,,,1153.12,2941.04,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,inpatient,,,2960.00000,2812.00000,The Alliance,Exception Members,TC,2279.20,,,,,,,1628.00,2871.20,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,outpatient,,,2960.00000,2812.00000,The Alliance,Exception Members,TC,2279.20,,,,,,,1360.59,7180.14,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,inpatient,5,EA,20.10000,19.09000,The Alliance,Exception Members,,15.48,,,,,,,11.05,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,outpatient,5,EA,20.10000,19.09000,The Alliance,Exception Members,,15.48,,,,,,,3.00,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,inpatient,5,EA,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.85,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,outpatient,5,EA,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.59,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,inpatient,5,EA,24.12000,22.91000,The Alliance,Exception Members,,18.57,,,,,,,13.27,23.40,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,outpatient,5,EA,24.12000,22.91000,The Alliance,Exception Members,,18.57,,,,,,,3.00,23.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,inpatient,,,920.00000,874.00000,The Alliance,Exception Members,TC,708.40,,,,,,,506.00,892.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Exception Members,TC,708.40,,,,,,,288.68,2535.29,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,inpatient,1,EA,28.43000,27.01000,The Alliance,Exception Members,,21.89,,,,,,,15.64,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Exception Members,,21.89,,,,,,,0.23870,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.23870,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,0.23870,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.23870,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.23870,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.23870,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.23870,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.23870,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.23870,1.84,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,inpatient,1,EA,71.61000,68.03000,The Alliance,Exception Members,,55.14,,,,,,,39.39,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,outpatient,1,EA,71.61000,68.03000,The Alliance,Exception Members,,55.14,,,,,,,35.80,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,inpatient,1,EA,71.60000,68.02000,The Alliance,Exception Members,,55.13,,,,,,,39.38,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,outpatient,1,EA,71.60000,68.02000,The Alliance,Exception Members,,55.13,,,,,,,35.80,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,inpatient,1,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,39.10,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Exception Members,,54.75,,,,,,,35.55,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,inpatient,1,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,38.24,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,34.76,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,19.75,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,inpatient,1,EA,71.73000,68.15000,The Alliance,Exception Members,,55.23,,,,,,,39.45,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,outpatient,1,EA,71.73000,68.15000,The Alliance,Exception Members,,55.23,,,,,,,35.87,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,inpatient,1,EA,91.29000,86.73000,The Alliance,Exception Members,,70.29,,,,,,,50.21,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,outpatient,1,EA,91.29000,86.73000,The Alliance,Exception Members,,70.29,,,,,,,45.65,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,inpatient,1,EA,68.57000,65.14000,The Alliance,Exception Members,,52.80,,,,,,,37.71,66.51,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,outpatient,1,EA,68.57000,65.14000,The Alliance,Exception Members,,52.80,,,,,,,34.28,66.51,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,inpatient,,,4361.00000,4142.95000,The Alliance,Exception Members,TC,3357.97,,,,,,,2398.55,4230.17,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Exception Members,TC,3357.97,,,,,,,1487.04,4230.17,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,inpatient,1,mL,270.61000,257.08000,The Alliance,Exception Members,,208.37,,,,,,,148.84,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,outpatient,1,mL,270.61000,257.08000,The Alliance,Exception Members,,208.37,,,,,,,135.31,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,inpatient,1,mL,270.60000,257.07000,The Alliance,Exception Members,,208.36,,,,,,,148.83,262.48,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,outpatient,1,mL,270.60000,257.07000,The Alliance,Exception Members,,208.36,,,,,,,135.30,262.48,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,2.36,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,2.15,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,inpatient,,,4739.00000,4502.05000,The Alliance,Exception Members,TC,3649.03,,,,,,,2606.45,4596.83,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,outpatient,,,4739.00000,4502.05000,The Alliance,Exception Members,TC,3649.03,,,,,,,2369.50,8022.25,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,156.75,276.45,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,142.50,417.31,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,inpatient,,,3038.00000,2886.10000,The Alliance,Exception Members,TC,2339.26,,,,,,,1670.90,2946.86,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,outpatient,,,3038.00000,2886.10000,The Alliance,Exception Members,TC,2339.26,,,,,,,1329.46,2946.86,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,90,202.12,,,,,,,144.38,254.62,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,90,202.12,,,,,,,19.37,984.66,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,inpatient,,,2932.00000,2785.40000,The Alliance,Exception Members,TC,2257.64,,,,,,,1612.60,2844.04,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,outpatient,,,2932.00000,2785.40000,The Alliance,Exception Members,TC,2257.64,,,,,,,1466.00,2844.04,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1488.32,7180.14,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2150.56,7180.14,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,1288.05,4844.18,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,inpatient,1,EA,3.24000,3.08000,The Alliance,Exception Members,,2.49,,,,,,,1.78,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,outpatient,1,EA,3.24000,3.08000,The Alliance,Exception Members,,2.49,,,,,,,1.62,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,inpatient,1,EA,2.08000,1.98000,The Alliance,Exception Members,,1.60,,,,,,,1.14,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,outpatient,1,EA,2.08000,1.98000,The Alliance,Exception Members,,1.60,,,,,,,1.04,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,inpatient,10,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,outpatient,10,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,inpatient,10,EA,15.98000,15.18000,The Alliance,Exception Members,,12.30,,,,,,,8.79,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,outpatient,10,EA,15.98000,15.18000,The Alliance,Exception Members,,12.30,,,,,,,7.99,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,inpatient,10,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.99,3.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,outpatient,10,EA,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.80,3.50,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,inpatient,,,196.50000,186.67000,The Alliance,Exception Members,90,151.31,,,,,,,108.08,190.60,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Exception Members,90,151.31,,,,,,,17.47,882.80,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Exception Members,TC,1995.07,,,,,,,1295.50,2513.27,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,inpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,218.35,385.09,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,198.50,385.09,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,The Alliance,Exception Members,TC,2745.82,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Exception Members,TC,2745.82,,,,,,,1321.12,3459.02,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,0.23870,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.23870,1.23,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,inpatient,1,EA,5.07000,4.81000,The Alliance,Exception Members,,3.90,,,,,,,2.79,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,outpatient,1,EA,5.07000,4.81000,The Alliance,Exception Members,,3.90,,,,,,,2.54,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,inpatient,4,EA,11.39000,10.82000,The Alliance,Exception Members,,8.77,,,,,,,6.26,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,outpatient,4,EA,11.39000,10.82000,The Alliance,Exception Members,,8.77,,,,,,,5.70,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,inpatient,4,EA,17.76000,16.87000,The Alliance,Exception Members,,13.68,,,,,,,9.77,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,outpatient,4,EA,17.76000,16.87000,The Alliance,Exception Members,,13.68,,,,,,,8.88,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,inpatient,4,EA,14.24000,13.52000,The Alliance,Exception Members,,10.96,,,,,,,7.83,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,outpatient,4,EA,14.24000,13.52000,The Alliance,Exception Members,,10.96,,,,,,,7.12,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,inpatient,4,EA,6.90000,6.56000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,outpatient,4,EA,6.90000,6.56000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,inpatient,4,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.61,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,outpatient,4,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.29,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,inpatient,4,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,outpatient,4,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,inpatient,4,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.57,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,outpatient,4,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.15,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,inpatient,4,EA,13.79000,13.10000,The Alliance,Exception Members,,10.62,,,,,,,7.58,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,outpatient,4,EA,13.79000,13.10000,The Alliance,Exception Members,,10.62,,,,,,,6.89,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,inpatient,4,EA,10.10000,9.59000,The Alliance,Exception Members,,7.78,,,,,,,5.55,9.80,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,outpatient,4,EA,10.10000,9.59000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.80,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,Exception Members,,344.19,,,,,,,245.85,433.59,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Exception Members,,344.19,,,,,,,223.50,433.59,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,76.45,134.83,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,12.92,679.08,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,185.90,327.86,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,39.26,1850.43,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,36.85,64.99,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,5.79,271.65,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,220.19,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,3163.00,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,inpatient,,,192.80000,183.16000,The Alliance,Exception Members,90,148.46,,,,,,,106.04,187.02,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,outpatient,,,192.80000,183.16000,The Alliance,Exception Members,90,148.46,,,,,,,19.00,865.84,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,inpatient,,,416.00000,395.20000,The Alliance,Exception Members,,320.32,,,,,,,228.80,403.52,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,Exception Members,,320.32,,,,,,,37.73,1969.25,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,4.01,7.08,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,2.79,7.08,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.16,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.11,2.16,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,The Alliance,Exception Members,,5125.12,,,,,,,3660.80,6456.32,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Exception Members,,5125.12,,,,,,,2074.81,6456.32,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,inpatient,1,GM,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.48,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,outpatient,1,GM,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.79,3.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,inpatient,1,mL,291.38000,276.81000,The Alliance,Exception Members,,224.36,,,,,,,160.26,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,outpatient,1,mL,291.38000,276.81000,The Alliance,Exception Members,,224.36,,,,,,,145.69,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,39.50,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,inpatient,1,mL,23.61000,22.42000,The Alliance,Exception Members,,18.18,,,,,,,12.99,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,outpatient,1,mL,23.61000,22.42000,The Alliance,Exception Members,,18.18,,,,,,,11.80,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,inpatient,1,mL,37.76000,35.87000,The Alliance,Exception Members,,29.08,,,,,,,20.77,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,outpatient,1,mL,37.76000,35.87000,The Alliance,Exception Members,,29.08,,,,,,,18.88,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,inpatient,1,mL,22.14000,21.03000,The Alliance,Exception Members,,17.05,,,,,,,12.18,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,outpatient,1,mL,22.14000,21.03000,The Alliance,Exception Members,,17.05,,,,,,,11.07,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,inpatient,1,mL,25.68000,24.39000,The Alliance,Exception Members,,19.77,,,,,,,14.12,24.91,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,outpatient,1,mL,25.68000,24.39000,The Alliance,Exception Members,,19.77,,,,,,,12.84,24.91,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,11.53,594.19,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,inpatient,1,GM,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,outpatient,1,GM,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,11.53,594.19,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,inpatient,1,EA,10.42000,9.90000,The Alliance,Exception Members,,8.02,,,,,,,5.73,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,outpatient,1,EA,10.42000,9.90000,The Alliance,Exception Members,,8.02,,,,,,,5.21,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,inpatient,1,EA,8.10000,7.70000,The Alliance,Exception Members,,6.24,,,,,,,4.46,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,outpatient,1,EA,8.10000,7.70000,The Alliance,Exception Members,,6.24,,,,,,,4.05,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,inpatient,1,EA,7.29000,6.93000,The Alliance,Exception Members,,5.61,,,,,,,4.01,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,outpatient,1,EA,7.29000,6.93000,The Alliance,Exception Members,,5.61,,,,,,,3.65,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.73,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.48,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,inpatient,1,EA,11.28000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,6.20,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,outpatient,1,EA,11.28000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,5.64,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,inpatient,1,EA,12.18000,11.58000,The Alliance,Exception Members,,9.38,,,,,,,6.70,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,outpatient,1,EA,12.18000,11.58000,The Alliance,Exception Members,,9.38,,,,,,,6.09,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.14,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.04,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,inpatient,1,EA,4.45000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,inpatient,,,978.00000,929.10000,The Alliance,Exception Members,,753.06,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Exception Members,,753.06,,,,,,,537.90,3163.00,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,inpatient,1,EA,6.96000,6.62000,The Alliance,Exception Members,,5.36,,,,,,,3.83,6.75,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,outpatient,1,EA,6.96000,6.62000,The Alliance,Exception Members,,5.36,,,,,,,3.48,6.75,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,inpatient,1,EA,35.25000,33.49000,The Alliance,Exception Members,,27.14,,,,,,,19.39,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,outpatient,1,EA,35.25000,33.49000,The Alliance,Exception Members,,27.14,,,,,,,17.62,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,inpatient,1,EA,39.17000,37.21000,The Alliance,Exception Members,,30.16,,,,,,,21.54,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,outpatient,1,EA,39.17000,37.21000,The Alliance,Exception Members,,30.16,,,,,,,19.59,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,inpatient,1,EA,25.65000,24.36000,The Alliance,Exception Members,,19.75,,,,,,,14.11,24.88,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,outpatient,1,EA,25.65000,24.36000,The Alliance,Exception Members,,19.75,,,,,,,12.82,24.88,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,The Alliance,Exception Members,,3.18,,,,,,,2.27,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Exception Members,,3.18,,,,,,,2.06,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,inpatient,1,mL,6.36000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,3.50,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,outpatient,1,mL,6.36000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,0.13795,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,inpatient,1,mL,8.06000,7.66000,The Alliance,Exception Members,,6.21,,,,,,,4.43,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Exception Members,,6.21,,,,,,,0.13795,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,inpatient,1,mL,7.68000,7.29000,The Alliance,Exception Members,,5.91,,,,,,,4.22,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,outpatient,1,mL,7.68000,7.29000,The Alliance,Exception Members,,5.91,,,,,,,0.13795,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,0.13795,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,inpatient,1,mL,6.71000,6.38000,The Alliance,Exception Members,,5.17,,,,,,,3.69,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,outpatient,1,mL,6.71000,6.38000,The Alliance,Exception Members,,5.17,,,,,,,0.13795,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,inpatient,1,mL,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.32,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,outpatient,1,mL,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,0.13795,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,inpatient,1,mL,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,0.13795,6.44,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,inpatient,15,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,outpatient,15,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,inpatient,1,mL,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,outpatient,1,mL,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,inpatient,1,mL,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,2.85,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,3.19,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,inpatient,1,mL,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,3.20,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,inpatient,1,mL,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,outpatient,1,mL,1.27000,1.20000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,90,120.89,,,,,,,86.35,152.29,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,90,120.89,,,,,,,13.68,696.05,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,28.50,70.98,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,inpatient,,,988.00000,938.60000,The Alliance,Exception Members,90,760.76,,,,,,,543.40,958.36,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,outpatient,,,988.00000,938.60000,The Alliance,Exception Members,90,760.76,,,,,,,14.72,958.36,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,inpatient,,,293.00000,278.35000,The Alliance,Exception Members,,225.61,,,,,,,161.15,284.21,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Exception Members,,225.61,,,,,,,146.50,284.21,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,75.00,155.84,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,inpatient,,,1190.00000,1130.50000,The Alliance,Exception Members,,916.30,,,,,,,654.50,1154.30,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,outpatient,,,1190.00000,1130.50000,The Alliance,Exception Members,,916.30,,,,,,,595.00,1154.30,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,inpatient,1,EA,287.54000,273.16000,The Alliance,Exception Members,,221.41,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,outpatient,1,EA,287.54000,273.16000,The Alliance,Exception Members,,221.41,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,inpatient,1,EA,287.54000,273.17000,The Alliance,Exception Members,,221.41,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,outpatient,1,EA,287.54000,273.17000,The Alliance,Exception Members,,221.41,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,inpatient,1,EA,284.90000,270.65000,The Alliance,Exception Members,,219.37,,,,,,,156.69,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Exception Members,,219.37,,,,,,,142.45,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,inpatient,1,EA,288.79000,274.35000,The Alliance,Exception Members,,222.37,,,,,,,158.83,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,outpatient,1,EA,288.79000,274.35000,The Alliance,Exception Members,,222.37,,,,,,,144.40,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,inpatient,1,EA,366.61000,348.28000,The Alliance,Exception Members,,282.29,,,,,,,201.64,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,outpatient,1,EA,366.61000,348.28000,The Alliance,Exception Members,,282.29,,,,,,,183.31,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,inpatient,1,EA,121.38000,115.31000,The Alliance,Exception Members,,93.46,,,,,,,66.76,117.74,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,outpatient,1,EA,121.38000,115.31000,The Alliance,Exception Members,,93.46,,,,,,,60.69,117.74,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,The Alliance,Exception Members,,2.10,,,,,,,1.50,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Exception Members,,2.10,,,,,,,1.36,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.35,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,inpatient,1,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,outpatient,1,EA,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,inpatient,1,EA,7.17000,6.81000,The Alliance,Exception Members,,5.52,,,,,,,3.94,6.95,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,outpatient,1,EA,7.17000,6.81000,The Alliance,Exception Members,,5.52,,,,,,,3.58,6.95,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,inpatient,1,EA,1787.36000,1697.99000,The Alliance,Exception Members,,1376.27,,,,,,,983.05,1733.74,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,outpatient,1,EA,1787.36000,1697.99000,The Alliance,Exception Members,,1376.27,,,,,,,409.52,1733.74,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,672.00,1303.68,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,inpatient,10,EA,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,3.25,5.72,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,outpatient,10,EA,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,2.08,5.72,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,2.34,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,2.34,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,inpatient,1,EA,6.60000,6.27000,The Alliance,Exception Members,,5.08,,,,,,,3.63,6.40,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,outpatient,1,EA,6.60000,6.27000,The Alliance,Exception Members,,5.08,,,,,,,3.30,6.40,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,inpatient,15,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,outpatient,15,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.18,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,inpatient,15,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,outpatient,15,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,inpatient,15,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,outpatient,15,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,inpatient,15,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,outpatient,15,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,inpatient,1,EA,11.41000,10.84000,The Alliance,Exception Members,,8.79,,,,,,,6.28,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Exception Members,,8.79,,,,,,,5.71,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,inpatient,1,EA,19.03000,18.08000,The Alliance,Exception Members,,14.65,,,,,,,10.47,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,outpatient,1,EA,19.03000,18.08000,The Alliance,Exception Members,,14.65,,,,,,,9.52,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,inpatient,1,EA,11.30000,10.74000,The Alliance,Exception Members,,8.70,,,,,,,6.21,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,outpatient,1,EA,11.30000,10.74000,The Alliance,Exception Members,,8.70,,,,,,,5.65,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,inpatient,1,EA,10.04000,9.54000,The Alliance,Exception Members,,7.73,,,,,,,5.52,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,outpatient,1,EA,10.04000,9.54000,The Alliance,Exception Members,,7.73,,,,,,,5.02,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,182.50,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,90,281.05,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,90,281.05,,,,,,,182.50,354.05,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,inpatient,5,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,outpatient,5,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,inpatient,5,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,outpatient,5,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,inpatient,5,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,outpatient,5,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,inpatient,5,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,outpatient,5,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,inpatient,5,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,outpatient,5,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,The Alliance,Exception Members,,4926.46,,,,,,,3518.90,6206.06,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Exception Members,,4926.46,,,,,,,1914.61,6206.06,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,inpatient,1,EA,86.53000,82.20000,The Alliance,Exception Members,,66.63,,,,,,,47.59,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,outpatient,1,EA,86.53000,82.20000,The Alliance,Exception Members,,66.63,,,,,,,0.91450,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,inpatient,1,EA,84.85000,80.60000,The Alliance,Exception Members,,65.33,,,,,,,46.67,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,outpatient,1,EA,84.85000,80.60000,The Alliance,Exception Members,,65.33,,,,,,,0.91450,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,0.91450,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,inpatient,1,EA,39.10000,37.15000,The Alliance,Exception Members,,30.11,,,,,,,21.50,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,outpatient,1,EA,39.10000,37.15000,The Alliance,Exception Members,,30.11,,,,,,,0.91450,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,inpatient,1,EA,31.41000,29.84000,The Alliance,Exception Members,,24.19,,,,,,,17.28,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,outpatient,1,EA,31.41000,29.84000,The Alliance,Exception Members,,24.19,,,,,,,0.91450,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,0.91450,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,inpatient,1,EA,21.19000,20.13000,The Alliance,Exception Members,,16.32,,,,,,,11.65,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,outpatient,1,EA,21.19000,20.13000,The Alliance,Exception Members,,16.32,,,,,,,0.91450,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,0.91450,9.96,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,5271.00,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,inpatient,2,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,outpatient,2,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.13330,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,inpatient,2,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,outpatient,2,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.13330,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,inpatient,2,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,outpatient,2,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.13330,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,inpatient,2,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,outpatient,2,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,0.13330,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,inpatient,2,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,outpatient,2,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.13330,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,inpatient,2,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.13330,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,inpatient,2,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,outpatient,2,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,0.13330,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,inpatient,2,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,outpatient,2,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.13330,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,inpatient,2,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,outpatient,2,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.13330,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,inpatient,2,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,outpatient,2,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.13330,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,inpatient,2,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.13330,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,inpatient,2,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,outpatient,2,EA,2.77000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,0.13330,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,inpatient,2,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.13330,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,inpatient,2,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,outpatient,2,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.13330,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,inpatient,2,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,outpatient,2,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,0.13330,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,inpatient,2,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,outpatient,2,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,0.13330,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,inpatient,2,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,outpatient,2,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,0.13330,3.01,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,inpatient,60,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,outpatient,60,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,inpatient,60,EA,27.49000,26.12000,The Alliance,Exception Members,,21.17,,,,,,,15.12,26.67,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,outpatient,60,EA,27.49000,26.12000,The Alliance,Exception Members,,21.17,,,,,,,13.74,26.67,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,inpatient,1,EA,5474.37000,5200.65000,The Alliance,Exception Members,,4215.26,,,,,,,3010.90,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,outpatient,1,EA,5474.37000,5200.65000,The Alliance,Exception Members,,4215.26,,,,,,,212.20,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,inpatient,1,EA,7150.48000,6792.96000,The Alliance,Exception Members,,5505.87,,,,,,,3932.76,6935.97,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,outpatient,1,EA,7150.48000,6792.96000,The Alliance,Exception Members,,5505.87,,,,,,,212.20,6935.97,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,133.10,234.74,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,11.98,628.12,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,inpatient,1,EA,0.62000,0.58000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,outpatient,1,EA,0.62000,0.58000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,inpatient,1,mL,461.19000,438.14000,The Alliance,Exception Members,,355.12,,,,,,,253.65,447.35,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,outpatient,1,mL,461.19000,438.14000,The Alliance,Exception Members,,355.12,,,,,,,78.46,447.35,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,inpatient,60,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,outpatient,60,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,inpatient,60,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,outpatient,60,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,inpatient,60,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,outpatient,60,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,inpatient,60,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,outpatient,60,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,inpatient,60,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,outpatient,60,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,inpatient,60,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,outpatient,60,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,inpatient,1,EA,5.11000,4.85000,The Alliance,Exception Members,,3.93,,,,,,,2.81,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,outpatient,1,EA,5.11000,4.85000,The Alliance,Exception Members,,3.93,,,,,,,2.56,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.43,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.30,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,inpatient,1,EA,6455.15000,6132.39000,The Alliance,Exception Members,,4970.47,,,,,,,3550.33,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,outpatient,1,EA,6455.15000,6132.39000,The Alliance,Exception Members,,4970.47,,,,,,,212.20,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,inpatient,1,EA,9368.36000,8899.95000,The Alliance,Exception Members,,7213.64,,,,,,,5152.60,9087.31,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,outpatient,1,EA,9368.36000,8899.95000,The Alliance,Exception Members,,7213.64,,,,,,,212.20,9087.31,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,inpatient,1,EA,5.45000,5.17000,The Alliance,Exception Members,,4.20,,,,,,,3.00,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,outpatient,1,EA,5.45000,5.17000,The Alliance,Exception Members,,4.20,,,,,,,2.73,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,inpatient,1,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.19,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,2.83,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,inpatient,1,EA,7.28000,6.91000,The Alliance,Exception Members,,5.61,,,,,,,4.00,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,outpatient,1,EA,7.28000,6.91000,The Alliance,Exception Members,,5.61,,,,,,,3.64,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,3.09,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,2.81,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,inpatient,1,EA,33.81000,32.12000,The Alliance,Exception Members,,26.03,,,,,,,18.60,32.80,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,outpatient,1,EA,33.81000,32.12000,The Alliance,Exception Members,,26.03,,,,,,,16.91,32.80,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,inpatient,15,EA,14.15000,13.44000,The Alliance,Exception Members,,10.90,,,,,,,7.78,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,outpatient,15,EA,14.15000,13.44000,The Alliance,Exception Members,,10.90,,,,,,,7.08,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.13330,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.13330,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.13330,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.13330,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,inpatient,1,mL,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.13330,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,0.13330,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,inpatient,1,mL,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,outpatient,1,mL,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,0.13330,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.13330,1.53,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,27.39,1290.24,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,18.70,32.98,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,3.66,203.72,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,inpatient,,,22948.00000,21800.60000,The Alliance,Exception Members,,17669.96,,,,,,,12621.40,22259.56,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,outpatient,,,22948.00000,21800.60000,The Alliance,Exception Members,,17669.96,,,,,,,4607.00,22259.56,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,4.23,203.72,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,15.92,831.84,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,inpatient,5,EA,81.26000,77.19000,The Alliance,Exception Members,,62.57,,,,,,,44.69,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,outpatient,5,EA,81.26000,77.19000,The Alliance,Exception Members,,62.57,,,,,,,40.63,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,inpatient,5,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,outpatient,5,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,20.54,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,inpatient,5,EA,40.75000,38.71000,The Alliance,Exception Members,,31.38,,,,,,,22.41,39.53,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,outpatient,5,EA,40.75000,38.71000,The Alliance,Exception Members,,31.38,,,,,,,20.38,39.53,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,,945.56,,,,,,,675.40,1191.16,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,,945.56,,,,,,,523.04,11041.20,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,Exception Members,TC,681.45,,,,,,,486.75,858.45,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Exception Members,TC,681.45,,,,,,,442.50,858.45,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,4.26,254.68,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,199.65,352.11,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,41.63,352.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Exception Members,,4.17,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,inpatient,1,EA,5.62000,5.33000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,inpatient,1,EA,9666.09000,9182.79000,The Alliance,Exception Members,,7442.89,,,,,,,5316.35,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,outpatient,1,EA,9666.09000,9182.79000,The Alliance,Exception Members,,7442.89,,,,,,,212.20,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,inpatient,1,EA,12876.34000,12232.52000,The Alliance,Exception Members,,9914.78,,,,,,,7081.99,12490.05,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,outpatient,1,EA,12876.34000,12232.52000,The Alliance,Exception Members,,9914.78,,,,,,,212.20,12490.05,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,inpatient,1,EA,45.60000,43.32000,The Alliance,Exception Members,,35.11,,,,,,,25.08,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,outpatient,1,EA,45.60000,43.32000,The Alliance,Exception Members,,35.11,,,,,,,22.80,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,4.26,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,3.87,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.35,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,inpatient,1,EA,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,3.02,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Exception Members,,4.24,,,,,,,2.75,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,inpatient,1,EA,5.46000,5.19000,The Alliance,Exception Members,,4.20,,,,,,,3.00,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,outpatient,1,EA,5.46000,5.19000,The Alliance,Exception Members,,4.20,,,,,,,2.73,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.35,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,inpatient,1,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.87,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.70,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,inpatient,1,EA,2.27000,2.15000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,outpatient,1,EA,2.27000,2.15000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.53,2.71,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.40,2.71,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,67.50,1137.41,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,inpatient,,,36445.00000,34622.75000,The Alliance,Exception Members,,28062.65,,,,,,,20044.75,35351.65,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,outpatient,,,36445.00000,34622.75000,The Alliance,Exception Members,,28062.65,,,,,,,4607.00,35351.65,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,inpatient,5,EA,183.67000,174.48000,The Alliance,Exception Members,,141.43,,,,,,,101.02,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,outpatient,5,EA,183.67000,174.48000,The Alliance,Exception Members,,141.43,,,,,,,91.83,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,inpatient,5,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,5.29,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,outpatient,5,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,4.80,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,inpatient,5,EA,24.99000,23.74000,The Alliance,Exception Members,,19.24,,,,,,,13.74,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,outpatient,5,EA,24.99000,23.74000,The Alliance,Exception Members,,19.24,,,,,,,12.49,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,inpatient,5,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,outpatient,5,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,inpatient,5,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,outpatient,5,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.40,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,inpatient,5,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,outpatient,5,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,13.43,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,inpatient,5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,inpatient,5,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,outpatient,5,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,inpatient,5,EA,4.46000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,outpatient,5,EA,4.46000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,inpatient,5,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.41,4.26,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,outpatient,5,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.19,4.26,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,inpatient,1,EA,15.87000,15.08000,The Alliance,Exception Members,,12.22,,,,,,,8.73,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,outpatient,1,EA,15.87000,15.08000,The Alliance,Exception Members,,12.22,,,,,,,7.93,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,8.43,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Exception Members,,11.80,,,,,,,7.67,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,inpatient,1,EA,24.33000,23.12000,The Alliance,Exception Members,,18.73,,,,,,,13.38,23.60,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,outpatient,1,EA,24.33000,23.12000,The Alliance,Exception Members,,18.73,,,,,,,12.16,23.60,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,inpatient,1,EA,38.67000,36.74000,The Alliance,Exception Members,,29.78,,,,,,,21.27,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,outpatient,1,EA,38.67000,36.74000,The Alliance,Exception Members,,29.78,,,,,,,19.34,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,The Alliance,Exception Members,,8.09,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Exception Members,,8.09,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,inpatient,15,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,outpatient,15,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,The Alliance,Exception Members,,8.09,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Exception Members,,8.09,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,inpatient,15,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,outpatient,15,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.28,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,inpatient,1,EA,659.69000,626.71000,The Alliance,Exception Members,,507.96,,,,,,,362.83,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,outpatient,1,EA,659.69000,626.71000,The Alliance,Exception Members,,507.96,,,,,,,4.35,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,inpatient,1,EA,659.70000,626.71000,The Alliance,Exception Members,,507.97,,,,,,,362.83,639.91,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,outpatient,1,EA,659.70000,626.71000,The Alliance,Exception Members,,507.97,,,,,,,4.35,639.91,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,3273.75,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,5271.00,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.21,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.10,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,inpatient,15,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,outpatient,15,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,inpatient,15,EA,4.59000,4.36000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,outpatient,15,EA,4.59000,4.36000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,inpatient,15,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,outpatient,15,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,inpatient,15,EA,3.15000,2.99000,The Alliance,Exception Members,,2.43,,,,,,,1.73,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,outpatient,15,EA,3.15000,2.99000,The Alliance,Exception Members,,2.43,,,,,,,1.57,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,inpatient,1,EA,285.49000,271.21000,The Alliance,Exception Members,,219.83,,,,,,,157.02,276.93,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,outpatient,1,EA,285.49000,271.21000,The Alliance,Exception Members,,219.83,,,,,,,142.75,276.93,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,inpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,44.55,78.57,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,44.55,5271.00,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,inpatient,1,EA,2.41000,2.29000,The Alliance,Exception Members,,1.86,,,,,,,1.33,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Exception Members,,1.86,,,,,,,1.21,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,inpatient,,,13836.00000,13144.20000,The Alliance,Exception Members,,10653.72,,,,,,,7609.80,13420.92,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,outpatient,,,13836.00000,13144.20000,The Alliance,Exception Members,,10653.72,,,,,,,4607.00,13420.92,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,inpatient,5,EA,10.59000,10.06000,The Alliance,Exception Members,,8.15,,,,,,,5.82,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,outpatient,5,EA,10.59000,10.06000,The Alliance,Exception Members,,8.15,,,,,,,5.29,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,inpatient,5,EA,12.92000,12.27000,The Alliance,Exception Members,,9.95,,,,,,,7.11,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,outpatient,5,EA,12.92000,12.27000,The Alliance,Exception Members,,9.95,,,,,,,6.46,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,inpatient,5,EA,12.27000,11.66000,The Alliance,Exception Members,,9.45,,,,,,,6.75,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,outpatient,5,EA,12.27000,11.66000,The Alliance,Exception Members,,9.45,,,,,,,6.13,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,inpatient,5,EA,14.21000,13.50000,The Alliance,Exception Members,,10.94,,,,,,,7.82,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,outpatient,5,EA,14.21000,13.50000,The Alliance,Exception Members,,10.94,,,,,,,7.11,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,3.22,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,2.93,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,4607.00,52373.21,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,The Alliance,Exception Members,,136.61,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Exception Members,,136.61,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,inpatient,1,EA,120.63000,114.60000,The Alliance,Exception Members,,92.89,,,,,,,66.35,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,outpatient,1,EA,120.63000,114.60000,The Alliance,Exception Members,,92.89,,,,,,,60.31,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,The Alliance,Exception Members,,136.61,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Exception Members,,136.61,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,inpatient,1,EA,122.44000,116.32000,The Alliance,Exception Members,,94.28,,,,,,,67.34,118.77,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,outpatient,1,EA,122.44000,116.32000,The Alliance,Exception Members,,94.28,,,,,,,61.22,118.77,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,inpatient,,,21293.00000,20228.35000,The Alliance,Exception Members,,16395.61,,,,,,,11711.15,20654.21,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,outpatient,,,21293.00000,20228.35000,The Alliance,Exception Members,,16395.61,,,,,,,4607.00,20654.21,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,inpatient,1,EA,422.19000,401.08000,The Alliance,Exception Members,,325.09,,,,,,,232.20,409.52,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,outpatient,1,EA,422.19000,401.08000,The Alliance,Exception Members,,325.09,,,,,,,4.35,409.52,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,6.61,339.51,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,inpatient,,,10089.00000,9584.55000,The Alliance,Exception Members,,7768.53,,,,,,,5548.95,9786.33,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,outpatient,,,10089.00000,9584.55000,The Alliance,Exception Members,,7768.53,,,,,,,4607.00,9786.33,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,inpatient,1,EA,47.99000,45.59000,The Alliance,Exception Members,,36.95,,,,,,,26.39,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,outpatient,1,EA,47.99000,45.59000,The Alliance,Exception Members,,36.95,,,,,,,24.00,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,inpatient,1,EA,30.22000,28.71000,The Alliance,Exception Members,,23.27,,,,,,,16.62,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,outpatient,1,EA,30.22000,28.71000,The Alliance,Exception Members,,23.27,,,,,,,15.11,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,inpatient,1,EA,25.22000,23.96000,The Alliance,Exception Members,,19.42,,,,,,,13.87,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,outpatient,1,EA,25.22000,23.96000,The Alliance,Exception Members,,19.42,,,,,,,12.61,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,inpatient,1,EA,32.24000,30.62000,The Alliance,Exception Members,,24.82,,,,,,,17.73,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,outpatient,1,EA,32.24000,30.62000,The Alliance,Exception Members,,24.82,,,,,,,16.12,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,inpatient,1,EA,25.28000,24.01000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,outpatient,1,EA,25.28000,24.01000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,inpatient,1,EA,35.97000,34.17000,The Alliance,Exception Members,,27.70,,,,,,,19.78,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,outpatient,1,EA,35.97000,34.17000,The Alliance,Exception Members,,27.70,,,,,,,17.98,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,inpatient,1,EA,5.85000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,3.22,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,outpatient,1,EA,5.85000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,2.92,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,inpatient,1,EA,27.40000,26.03000,The Alliance,Exception Members,,21.10,,,,,,,15.07,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,outpatient,1,EA,27.40000,26.03000,The Alliance,Exception Members,,21.10,,,,,,,13.70,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,inpatient,1,EA,5.43000,5.15000,The Alliance,Exception Members,,4.18,,,,,,,2.99,5.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,outpatient,1,EA,5.43000,5.15000,The Alliance,Exception Members,,4.18,,,,,,,2.71,5.27,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,6.82,356.54,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,Exception Members,GO,108.57,,,,,,,77.55,136.77,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Exception Members,GO,108.57,,,,,,,70.50,264.00,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,inpatient,1,EA,2595.50000,2465.73000,The Alliance,Exception Members,,1998.54,,,,,,,1427.53,2517.64,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,outpatient,1,EA,2595.50000,2465.73000,The Alliance,Exception Members,,1998.54,,,,,,,40.56,2517.64,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,Exception Members,GO,75.46,,,,,,,53.90,95.06,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Exception Members,GO,75.46,,,,,,,49.00,264.00,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,inpatient,60,mL,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,3.49,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,outpatient,60,mL,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,3.17,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,inpatient,60,mL,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,outpatient,60,mL,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.00,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,inpatient,60,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,outpatient,60,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,inpatient,60,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,outpatient,60,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,inpatient,60,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,outpatient,60,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,inpatient,60,mL,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,outpatient,60,mL,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,inpatient,60,mL,5.28000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,outpatient,60,mL,5.28000,5.02000,The Alliance,Exception Members,,4.07,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,inpatient,60,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,outpatient,60,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,inpatient,60,mL,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,outpatient,60,mL,0.93000,0.89000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,GO,66.22,,,,,,,47.30,83.42,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,GO,66.22,,,,,,,43.00,264.00,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,The Alliance,Exception Members,,2855.74,,,,,,,1817.29,3597.49,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Exception Members,,2855.74,,,,,,,1702.32,3708.75,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,126.65,264.00,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,inpatient,,,213.20000,202.54000,The Alliance,Exception Members,GO,164.16,,,,,,,117.26,206.80,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,outpatient,,,213.20000,202.54000,The Alliance,Exception Members,GO,164.16,,,,,,,106.60,264.00,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,GO,88.55,,,,,,,63.25,111.55,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,GO,88.55,,,,,,,57.50,264.00,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,126.65,264.00,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,GO,95.48,,,,,,,68.20,120.28,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,GO,95.48,,,,,,,62.00,264.00,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,GO,117.04,,,,,,,83.60,147.44,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,GO,117.04,,,,,,,76.00,264.00,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Exception Members,,701.47,,,,,,,501.05,5271.00,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Exception Members,GO,196.35,,,,,,,126.65,264.00,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,GO,85.47,,,,,,,61.05,107.67,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,GO,85.47,,,,,,,55.50,264.00,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,GO,88.55,,,,,,,63.25,111.55,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,GO,88.55,,,,,,,57.50,264.00,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,GO,43.89,,,,,,,31.35,55.29,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,GO,43.89,,,,,,,28.50,264.00,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,90,147.07,,,,,,,105.05,185.27,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,90,147.07,,,,,,,17.00,865.84,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,inpatient,1,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,outpatient,1,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,5.69,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,inpatient,1,EA,10.90000,10.36000,The Alliance,Exception Members,,8.39,,,,,,,6.00,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,outpatient,1,EA,10.90000,10.36000,The Alliance,Exception Members,,8.39,,,,,,,5.45,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,8.90,458.40,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,GO,81.62,,,,,,,58.30,102.82,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,GO,81.62,,,,,,,53.00,264.00,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,inpatient,1,EA,686.35000,652.03000,The Alliance,Exception Members,,528.49,,,,,,,377.49,665.76,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,outpatient,1,EA,686.35000,652.03000,The Alliance,Exception Members,,528.49,,,,,,,0.07595,665.76,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,14.86,713.01,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,GO,66.22,,,,,,,47.30,83.42,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,GO,66.22,,,,,,,43.00,264.00,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,inpatient,1,EA,24.43000,23.21000,The Alliance,Exception Members,,18.81,,,,,,,13.44,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,outpatient,1,EA,24.43000,23.21000,The Alliance,Exception Members,,18.81,,,,,,,12.21,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,inpatient,1,EA,40.62000,38.59000,The Alliance,Exception Members,,31.28,,,,,,,22.34,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,outpatient,1,EA,40.62000,38.59000,The Alliance,Exception Members,,31.28,,,,,,,20.31,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,inpatient,1,EA,55.18000,52.42000,The Alliance,Exception Members,,42.49,,,,,,,30.35,53.52,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,outpatient,1,EA,55.18000,52.42000,The Alliance,Exception Members,,42.49,,,,,,,27.59,53.52,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,inpatient,,,184.10000,174.89000,The Alliance,Exception Members,90,141.76,,,,,,,101.25,178.58,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Exception Members,90,141.76,,,,,,,92.05,1137.41,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,inpatient,1,mL,853.63000,810.95000,The Alliance,Exception Members,,657.30,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Exception Members,,657.30,,,,,,,172.55,828.02,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,GO,77.77,,,,,,,55.55,97.97,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,GO,77.77,,,,,,,50.50,264.00,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,inpatient,1,mL,303.44000,288.27000,The Alliance,Exception Members,,233.65,,,,,,,166.89,294.34,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,outpatient,1,mL,303.44000,288.27000,The Alliance,Exception Members,,233.65,,,,,,,62.23,294.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,inpatient,1,EA,7.65000,7.26000,The Alliance,Exception Members,,5.89,,,,,,,4.21,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Exception Members,,5.89,,,,,,,3.83,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,inpatient,1,EA,5.66000,5.37000,The Alliance,Exception Members,,4.36,,,,,,,3.11,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Exception Members,,4.36,,,,,,,2.83,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,inpatient,1,EA,16.85000,16.01000,The Alliance,Exception Members,,12.97,,,,,,,9.27,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,outpatient,1,EA,16.85000,16.01000,The Alliance,Exception Members,,12.97,,,,,,,8.43,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,The Alliance,Exception Members,,13.32,,,,,,,9.52,16.78,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Exception Members,,13.32,,,,,,,8.65,16.78,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,inpatient,1,EA,66.39000,63.07000,The Alliance,Exception Members,,51.12,,,,,,,36.51,64.40,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,outpatient,1,EA,66.39000,63.07000,The Alliance,Exception Members,,51.12,,,,,,,33.20,64.40,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,inpatient,,,3486.00000,3311.70000,The Alliance,Exception Members,TC,2684.22,,,,,,,1917.30,3381.42,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,outpatient,,,3486.00000,3311.70000,The Alliance,Exception Members,TC,2684.22,,,,,,,1598.89,3381.42,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,inpatient,1,EA,31.42000,29.85000,The Alliance,Exception Members,,24.19,,,,,,,17.28,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,outpatient,1,EA,31.42000,29.85000,The Alliance,Exception Members,,24.19,,,,,,,15.71,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,inpatient,1,EA,32.23000,30.62000,The Alliance,Exception Members,,24.82,,,,,,,17.73,31.26,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,outpatient,1,EA,32.23000,30.62000,The Alliance,Exception Members,,24.82,,,,,,,16.11,31.26,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,inpatient,1,EA,1372.70000,1304.06000,The Alliance,Exception Members,,1056.98,,,,,,,754.99,1331.52,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,outpatient,1,EA,1372.70000,1304.06000,The Alliance,Exception Members,,1056.98,,,,,,,0.07595,1331.52,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,inpatient,,,143.70000,136.51000,The Alliance,Exception Members,90,110.65,,,,,,,79.03,139.39,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,outpatient,,,143.70000,136.51000,The Alliance,Exception Members,90,110.65,,,,,,,14.93,679.08,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,inpatient,1,mL,343.87000,326.68000,The Alliance,Exception Members,,264.78,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Exception Members,,264.78,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,inpatient,1,mL,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,5.95,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,outpatient,1,mL,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,0.07595,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,inpatient,1,mL,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,9.56,16.86,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,outpatient,1,mL,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,0.07595,16.86,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,GO,84.70,,,,,,,60.50,106.70,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,GO,84.70,,,,,,,55.00,264.00,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,13.36,696.05,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,86.35,152.29,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,21.21,1001.63,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.72045,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,0.72045,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.72045,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,inpatient,1,mL,178.67000,169.73000,The Alliance,Exception Members,,137.58,,,,,,,98.27,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,outpatient,1,mL,178.67000,169.73000,The Alliance,Exception Members,,137.58,,,,,,,0.72045,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,inpatient,1,mL,154.58000,146.85000,The Alliance,Exception Members,,119.03,,,,,,,85.02,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,outpatient,1,mL,154.58000,146.85000,The Alliance,Exception Members,,119.03,,,,,,,0.72045,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,0.72045,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,0.72045,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,inpatient,1,mL,286.30000,271.98000,The Alliance,Exception Members,,220.45,,,,,,,157.47,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,outpatient,1,mL,286.30000,271.98000,The Alliance,Exception Members,,220.45,,,,,,,0.72045,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,45.19,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,0.72045,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,0.72045,5.52,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,inpatient,1,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,inpatient,1,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,inpatient,1,EA,1.36000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,outpatient,1,EA,1.36000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,195.94,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,inpatient,500,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,outpatient,500,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.12,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,inpatient,1,EA,5.73000,5.44000,The Alliance,Exception Members,,4.41,,,,,,,3.15,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,outpatient,1,EA,5.73000,5.44000,The Alliance,Exception Members,,4.41,,,,,,,2.87,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,The Alliance,Exception Members,90,367.29,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Exception Members,90,367.29,,,,,,,22.97,1087.31,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,The Alliance,Exception Members,,367.29,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Exception Members,,367.29,,,,,,,22.97,1087.31,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,inpatient,1,mL,5.46000,5.19000,The Alliance,Exception Members,,4.20,,,,,,,3.00,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,outpatient,1,mL,5.46000,5.19000,The Alliance,Exception Members,,4.20,,,,,,,0.17611,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,0.17611,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,inpatient,1,mL,4.51000,4.28000,The Alliance,Exception Members,,3.47,,,,,,,2.48,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Exception Members,,3.47,,,,,,,0.17611,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,inpatient,1,mL,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,inpatient,1,mL,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,4.10,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,0.17611,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,inpatient,1,mL,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,0.17611,2.33,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,inpatient,1,EA,45.34000,43.07000,The Alliance,Exception Members,,34.91,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Exception Members,,34.91,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,inpatient,,,1058.00000,1005.10000,The Alliance,Exception Members,,814.66,,,,,,,581.90,1026.26,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,outpatient,,,1058.00000,1005.10000,The Alliance,Exception Members,,814.66,,,,,,,529.00,42186.85,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,inpatient,1,mL,295.86000,281.06000,The Alliance,Exception Members,,227.81,,,,,,,162.72,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,outpatient,1,mL,295.86000,281.06000,The Alliance,Exception Members,,227.81,,,,,,,62.23,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,inpatient,1,mL,261.75000,248.66000,The Alliance,Exception Members,,201.55,,,,,,,143.96,253.90,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,outpatient,1,mL,261.75000,248.66000,The Alliance,Exception Members,,201.55,,,,,,,62.23,253.90,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,inpatient,,,4243.50000,4031.32000,The Alliance,Exception Members,,3267.49,,,,,,,2079.32,4116.19,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Exception Members,,3267.49,,,,,,,1947.77,4116.19,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,inpatient,,,169.00000,160.55000,The Alliance,Exception Members,GO,130.13,,,,,,,92.95,163.93,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Exception Members,GO,130.13,,,,,,,84.50,264.00,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,inpatient,1,mL,5334.01000,5067.31000,The Alliance,Exception Members,,4107.19,,,,,,,2933.71,5173.99,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,outpatient,1,mL,5334.01000,5067.31000,The Alliance,Exception Members,,4107.19,,,,,,,15.08,5173.99,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,inpatient,1,mL,65.43000,62.16000,The Alliance,Exception Members,,50.38,,,,,,,35.99,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,outpatient,1,mL,65.43000,62.16000,The Alliance,Exception Members,,50.38,,,,,,,32.72,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,inpatient,1,mL,59.25000,56.29000,The Alliance,Exception Members,,45.62,,,,,,,32.59,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,outpatient,1,mL,59.25000,56.29000,The Alliance,Exception Members,,45.62,,,,,,,29.62,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,inpatient,1,mL,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,28.24,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,25.68,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,inpatient,1,mL,61.40000,58.33000,The Alliance,Exception Members,,47.28,,,,,,,33.77,59.56,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,outpatient,1,mL,61.40000,58.33000,The Alliance,Exception Members,,47.28,,,,,,,30.70,59.56,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,15.05,780.94,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,inpatient,,,215.00000,204.25000,The Alliance,Exception Members,,165.55,,,,,,,118.25,208.55,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Exception Members,,165.55,,,,,,,17.98,933.70,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,inpatient,1,EA,13.12000,12.47000,The Alliance,Exception Members,,10.10,,,,,,,7.22,12.73,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Exception Members,,10.10,,,,,,,6.56,12.73,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,inpatient,,,264.90000,251.65000,The Alliance,Exception Members,90,203.97,,,,,,,145.69,256.95,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,outpatient,,,264.90000,251.65000,The Alliance,Exception Members,90,203.97,,,,,,,19.00,865.84,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,inpatient,120,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,outpatient,120,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,inpatient,120,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,inpatient,120,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,outpatient,120,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,inpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,130.90,230.86,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,20.26,230.86,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,inpatient,1,EA,1.84000,1.74000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,outpatient,1,EA,1.84000,1.74000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.72,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.47,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.36,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.36,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,The Alliance,Exception Members,,33.90,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Exception Members,,33.90,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,inpatient,1,EA,28.43000,27.01000,The Alliance,Exception Members,,21.89,,,,,,,15.64,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Exception Members,,21.89,,,,,,,14.21,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,inpatient,1,EA,29.57000,28.10000,The Alliance,Exception Members,,22.77,,,,,,,16.26,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,outpatient,1,EA,29.57000,28.10000,The Alliance,Exception Members,,22.77,,,,,,,14.79,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,inpatient,1,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,12.86,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,outpatient,1,EA,23.38000,22.21000,The Alliance,Exception Members,,18.00,,,,,,,11.69,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,inpatient,1,EA,32.62000,30.99000,The Alliance,Exception Members,,25.12,,,,,,,17.94,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,outpatient,1,EA,32.62000,30.99000,The Alliance,Exception Members,,25.12,,,,,,,16.31,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,inpatient,1,EA,25.14000,23.88000,The Alliance,Exception Members,,19.36,,,,,,,13.83,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,outpatient,1,EA,25.14000,23.88000,The Alliance,Exception Members,,19.36,,,,,,,12.57,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,inpatient,1,mL,10069.36000,9565.89000,The Alliance,Exception Members,,7753.41,,,,,,,5538.15,9767.28,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,outpatient,1,mL,10069.36000,9565.89000,The Alliance,Exception Members,,7753.41,,,,,,,5034.68,46899.70,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,inpatient,15,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,outpatient,15,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,inpatient,15,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,outpatient,15,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,inpatient,15,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,outpatient,15,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,inpatient,15,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,outpatient,15,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,inpatient,15,EA,1.21000,1.14000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,outpatient,15,EA,1.21000,1.14000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,TC,3028.41,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,TC,3028.41,,,,,,,1966.50,3815.01,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,inpatient,30,EA,18.43000,17.51000,The Alliance,Exception Members,,14.19,,,,,,,10.14,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,outpatient,30,EA,18.43000,17.51000,The Alliance,Exception Members,,14.19,,,,,,,9.21,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,inpatient,30,EA,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.92,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,outpatient,30,EA,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.56,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,inpatient,30,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,6.37,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,outpatient,30,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,5.79,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,inpatient,30,EA,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,outpatient,30,EA,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,8.90,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,inpatient,30,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,outpatient,30,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,inpatient,30,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,8.11,14.31,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,outpatient,30,EA,14.75000,14.01000,The Alliance,Exception Members,,11.36,,,,,,,7.38,14.31,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,inpatient,1,mL,3.33000,3.17000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,outpatient,1,mL,3.33000,3.17000,The Alliance,Exception Members,,2.56,,,,,,,1.67,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,inpatient,1,mL,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.56,2.75,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.42,2.75,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,The Alliance,Exception Members,,93.17,,,,,,,66.55,117.37,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Exception Members,,93.17,,,,,,,11.54,543.22,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,203.50,358.90,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,41.28,2156.01,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,inpatient,1,mL,343.87000,326.68000,The Alliance,Exception Members,,264.78,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Exception Members,,264.78,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.07595,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,0.07595,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,inpatient,1,mL,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,outpatient,1,mL,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,0.07595,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,inpatient,1,mL,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,0.07595,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,inpatient,1,mL,15.58000,14.80000,The Alliance,Exception Members,,12.00,,,,,,,8.57,15.11,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,outpatient,1,mL,15.58000,14.80000,The Alliance,Exception Members,,12.00,,,,,,,0.07595,15.11,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,inpatient,,,3021.00000,2869.95000,The Alliance,Exception Members,TC,2326.17,,,,,,,1661.55,2930.37,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,outpatient,,,3021.00000,2869.95000,The Alliance,Exception Members,TC,2326.17,,,,,,,1390.09,2930.37,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,inpatient,1,EA,6.08000,5.77000,The Alliance,Exception Members,,4.68,,,,,,,3.34,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,outpatient,1,EA,6.08000,5.77000,The Alliance,Exception Members,,4.68,,,,,,,1.07,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,1.07,30.65,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,inpatient,1,EA,3.68000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,outpatient,1,EA,3.68000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,inpatient,1,EA,14.71000,13.97000,The Alliance,Exception Members,,11.33,,,,,,,8.09,14.27,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,outpatient,1,EA,14.71000,13.97000,The Alliance,Exception Members,,11.33,,,,,,,7.36,14.27,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,21.45,37.83,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,3.58,186.75,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,inpatient,1,EA,2094.27000,1989.56000,The Alliance,Exception Members,,1612.59,,,,,,,1151.85,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,outpatient,1,EA,2094.27000,1989.56000,The Alliance,Exception Members,,1612.59,,,,,,,3.73,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,3.73,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,inpatient,1,EA,261.69000,248.61000,The Alliance,Exception Members,,201.50,,,,,,,143.93,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,outpatient,1,EA,261.69000,248.61000,The Alliance,Exception Members,,201.50,,,,,,,3.73,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,inpatient,1,EA,411.81000,391.22000,The Alliance,Exception Members,,317.09,,,,,,,226.50,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,outpatient,1,EA,411.81000,391.22000,The Alliance,Exception Members,,317.09,,,,,,,3.73,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,inpatient,1,EA,38.55000,36.62000,The Alliance,Exception Members,,29.68,,,,,,,21.20,37.39,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,outpatient,1,EA,38.55000,36.62000,The Alliance,Exception Members,,29.68,,,,,,,3.73,37.39,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,inpatient,1,mL,29.56000,28.09000,The Alliance,Exception Members,,22.76,,,,,,,16.26,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,outpatient,1,mL,29.56000,28.09000,The Alliance,Exception Members,,22.76,,,,,,,14.78,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,inpatient,1,mL,11.33000,10.76000,The Alliance,Exception Members,,8.72,,,,,,,6.23,10.99,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,outpatient,1,mL,11.33000,10.76000,The Alliance,Exception Members,,8.72,,,,,,,5.67,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.26,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,17.87,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,inpatient,1,EA,59.38000,56.41000,The Alliance,Exception Members,,45.72,,,,,,,32.66,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,outpatient,1,EA,59.38000,56.41000,The Alliance,Exception Members,,45.72,,,,,,,17.87,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,inpatient,1,EA,4.43000,4.21000,The Alliance,Exception Members,,3.41,,,,,,,2.44,4.30,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Exception Members,,3.41,,,,,,,2.21,23.04,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,inpatient,30,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,outpatient,30,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,inpatient,30,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.11,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.00,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,2.04,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,1.85,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,inpatient,1,EA,40.20000,38.19000,The Alliance,Exception Members,,30.95,,,,,,,22.11,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,outpatient,1,EA,40.20000,38.19000,The Alliance,Exception Members,,30.95,,,,,,,1.20,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,inpatient,1,EA,13.78000,13.09000,The Alliance,Exception Members,,10.61,,,,,,,7.58,13.37,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,outpatient,1,EA,13.78000,13.09000,The Alliance,Exception Members,,10.61,,,,,,,1.20,13.37,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,inpatient,1,EA,374.26000,355.54000,The Alliance,Exception Members,,288.18,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Exception Members,,288.18,,,,,,,123.22,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,156.42,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,123.22,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,inpatient,1,EA,432.25000,410.63000,The Alliance,Exception Members,,332.83,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Exception Members,,332.83,,,,,,,123.22,419.28,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,The Alliance,Exception Members,,5.05,,,,,,,3.61,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Exception Members,,5.05,,,,,,,3.28,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.61,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.29,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,inpatient,1,EA,6.25000,5.94000,The Alliance,Exception Members,,4.81,,,,,,,3.44,6.06,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,outpatient,1,EA,6.25000,5.94000,The Alliance,Exception Members,,4.81,,,,,,,3.12,6.06,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,inpatient,,,1466.00000,1392.70000,The Alliance,Exception Members,,1128.82,,,,,,,806.30,1422.02,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Exception Members,,1128.82,,,,,,,162.71,7221.66,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,inpatient,1,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.96,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,0.00310,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,inpatient,1,EA,16.68000,15.85000,The Alliance,Exception Members,,12.84,,,,,,,9.17,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,outpatient,1,EA,16.68000,15.85000,The Alliance,Exception Members,,12.84,,,,,,,0.00310,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,0.00310,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.00310,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.00310,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,inpatient,1,EA,7.84000,7.44000,The Alliance,Exception Members,,6.04,,,,,,,4.31,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,outpatient,1,EA,7.84000,7.44000,The Alliance,Exception Members,,6.04,,,,,,,0.00310,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.00310,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Exception Members,,6.33,,,,,,,0.00310,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,inpatient,1,EA,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.45,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,0.00310,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,inpatient,1,EA,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,outpatient,1,EA,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,0.00310,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,inpatient,1,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,0.00310,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,inpatient,1,EA,12.33000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,6.78,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,Exception Members,,9.49,,,,,,,0.00310,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,0.00310,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,inpatient,1,EA,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,0.00310,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,0.00310,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,0.00310,4.91,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,inpatient,2,EA,359.05000,341.10000,The Alliance,Exception Members,,276.47,,,,,,,197.48,348.28,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,outpatient,2,EA,359.05000,341.10000,The Alliance,Exception Members,,276.47,,,,,,,29.30,348.28,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,7940.90,14004.86,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,4549.00,14004.86,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,inpatient,1,EA,8369.01000,7950.56000,The Alliance,Exception Members,,6444.14,,,,,,,4602.96,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,outpatient,1,EA,8369.01000,7950.56000,The Alliance,Exception Members,,6444.14,,,,,,,3.73,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,inpatient,1,EA,1289.41000,1224.94000,The Alliance,Exception Members,,992.85,,,,,,,709.18,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,outpatient,1,EA,1289.41000,1224.94000,The Alliance,Exception Members,,992.85,,,,,,,3.73,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,inpatient,1,EA,1179.64000,1120.66000,The Alliance,Exception Members,,908.32,,,,,,,648.80,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,outpatient,1,EA,1179.64000,1120.66000,The Alliance,Exception Members,,908.32,,,,,,,3.73,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,inpatient,1,EA,2053.87000,1951.18000,The Alliance,Exception Members,,1581.48,,,,,,,1129.63,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,outpatient,1,EA,2053.87000,1951.18000,The Alliance,Exception Members,,1581.48,,,,,,,3.73,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,712.25,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,3.73,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,inpatient,1,EA,166.28000,157.97000,The Alliance,Exception Members,,128.04,,,,,,,91.45,161.29,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,outpatient,1,EA,166.28000,157.97000,The Alliance,Exception Members,,128.04,,,,,,,3.73,161.29,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,inpatient,100,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,15.03,780.94,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,inpatient,2,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,outpatient,2,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,21.00,264.00,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Exception Members,,3.80,,,,,,,2.46,4.78,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,inpatient,1,EA,16.04000,15.24000,The Alliance,Exception Members,,12.35,,,,,,,8.82,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,outpatient,1,EA,16.04000,15.24000,The Alliance,Exception Members,,12.35,,,,,,,8.02,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,inpatient,1,EA,5.16000,4.90000,The Alliance,Exception Members,,3.97,,,,,,,2.84,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,10.27,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,inpatient,1,EA,15.48000,14.71000,The Alliance,Exception Members,,11.92,,,,,,,8.51,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,outpatient,1,EA,15.48000,14.71000,The Alliance,Exception Members,,11.92,,,,,,,7.74,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,8.35,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,7.59,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,inpatient,1,EA,14.16000,13.45000,The Alliance,Exception Members,,10.90,,,,,,,7.79,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,outpatient,1,EA,14.16000,13.45000,The Alliance,Exception Members,,10.90,,,,,,,7.08,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,inpatient,1,EA,9.39000,8.92000,The Alliance,Exception Members,,7.23,,,,,,,5.16,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Exception Members,,7.23,,,,,,,4.70,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,inpatient,1,EA,14.06000,13.36000,The Alliance,Exception Members,,10.83,,,,,,,7.73,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Exception Members,,10.83,,,,,,,7.03,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.90,13.94,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.18,13.94,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,inpatient,1,EA,1.92000,1.82000,The Alliance,Exception Members,,1.48,,,,,,,1.06,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,outpatient,1,EA,1.92000,1.82000,The Alliance,Exception Members,,1.48,,,,,,,0.96000,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,inpatient,10,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,outpatient,10,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,0.00310,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,inpatient,10,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.05,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,outpatient,10,EA,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,0.00310,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.00310,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,inpatient,10,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,outpatient,10,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.00310,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,inpatient,10,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,outpatient,10,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.00310,1.64,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,inpatient,,,14531.00000,13804.45000,The Alliance,Exception Members,TC,11188.87,,,,,,,7992.05,14095.07,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,outpatient,,,14531.00000,13804.45000,The Alliance,Exception Members,TC,11188.87,,,,,,,4549.00,14095.07,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,5.78,271.65,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,TC,11128.04,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,TC,11128.04,,,,,,,4549.00,14018.44,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,15.30,713.01,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,inpatient,1,EA,4.30000,4.08000,The Alliance,Exception Members,,3.31,,,,,,,2.37,4.17,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Exception Members,,3.31,,,,,,,2.15,50.75,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,inpatient,1,EA,83.28000,79.11000,The Alliance,Exception Members,,64.13,,,,,,,45.80,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,outpatient,1,EA,83.28000,79.11000,The Alliance,Exception Members,,64.13,,,,,,,41.64,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,inpatient,1,EA,55.30000,52.53000,The Alliance,Exception Members,,42.58,,,,,,,30.41,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Exception Members,,42.58,,,,,,,27.65,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,inpatient,1,EA,68.95000,65.50000,The Alliance,Exception Members,,53.09,,,,,,,37.92,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,outpatient,1,EA,68.95000,65.50000,The Alliance,Exception Members,,53.09,,,,,,,34.48,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,inpatient,1,EA,67.94000,64.54000,The Alliance,Exception Members,,52.31,,,,,,,37.37,65.90,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,outpatient,1,EA,67.94000,64.54000,The Alliance,Exception Members,,52.31,,,,,,,33.97,65.90,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,inpatient,2,EA,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,outpatient,2,EA,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,9.21,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,inpatient,2,EA,16.48000,15.66000,The Alliance,Exception Members,,12.69,,,,,,,9.06,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,outpatient,2,EA,16.48000,15.66000,The Alliance,Exception Members,,12.69,,,,,,,8.24,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,inpatient,2,EA,16.99000,16.14000,The Alliance,Exception Members,,13.08,,,,,,,9.34,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,outpatient,2,EA,16.99000,16.14000,The Alliance,Exception Members,,13.08,,,,,,,8.49,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,inpatient,2,EA,13.59000,12.91000,The Alliance,Exception Members,,10.46,,,,,,,7.47,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,outpatient,2,EA,13.59000,12.91000,The Alliance,Exception Members,,10.46,,,,,,,6.79,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,inpatient,2,EA,15.99000,15.19000,The Alliance,Exception Members,,12.31,,,,,,,8.79,15.51,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,outpatient,2,EA,15.99000,15.19000,The Alliance,Exception Members,,12.31,,,,,,,8.00,15.51,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,inpatient,30,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,outpatient,30,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,inpatient,30,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,outpatient,30,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,inpatient,30,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,outpatient,30,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,inpatient,1,mL,853.63000,810.95000,The Alliance,Exception Members,,657.30,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Exception Members,,657.30,,,,,,,172.55,828.02,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.85,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.60,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,The Alliance,Exception Members,,3.18,,,,,,,2.27,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Exception Members,,3.18,,,,,,,2.06,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,inpatient,2,EA,6.93000,6.58000,The Alliance,Exception Members,,5.34,,,,,,,3.81,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,outpatient,2,EA,6.93000,6.58000,The Alliance,Exception Members,,5.34,,,,,,,3.46,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,inpatient,2,EA,123.69000,117.51000,The Alliance,Exception Members,,95.24,,,,,,,68.03,119.98,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,outpatient,2,EA,123.69000,117.51000,The Alliance,Exception Members,,95.24,,,,,,,61.84,119.98,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,Exception Members,,130.90,,,,,,,93.50,164.90,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Exception Members,,130.90,,,,,,,13.25,696.05,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,122.40,495.67,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,Exception Members,,185.57,,,,,,,132.55,233.77,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Exception Members,,185.57,,,,,,,24.91,2082.45,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,inpatient,1,mL,19.60000,18.62000,The Alliance,Exception Members,,15.09,,,,,,,10.78,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,outpatient,1,mL,19.60000,18.62000,The Alliance,Exception Members,,15.09,,,,,,,9.80,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,inpatient,1,mL,16.11000,15.31000,The Alliance,Exception Members,,12.40,,,,,,,8.86,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,outpatient,1,mL,16.11000,15.31000,The Alliance,Exception Members,,12.40,,,,,,,8.05,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,inpatient,1,mL,16.61000,15.78000,The Alliance,Exception Members,,12.79,,,,,,,9.14,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,outpatient,1,mL,16.61000,15.78000,The Alliance,Exception Members,,12.79,,,,,,,8.30,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,inpatient,1,mL,13.28000,12.62000,The Alliance,Exception Members,,10.23,,,,,,,7.30,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,outpatient,1,mL,13.28000,12.62000,The Alliance,Exception Members,,10.23,,,,,,,6.64,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,inpatient,1,mL,15.63000,14.85000,The Alliance,Exception Members,,12.04,,,,,,,8.60,15.16,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,outpatient,1,mL,15.63000,14.85000,The Alliance,Exception Members,,12.04,,,,,,,7.82,15.16,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,inpatient,1,mL,151.84000,144.25000,The Alliance,Exception Members,,116.92,,,,,,,83.51,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,outpatient,1,mL,151.84000,144.25000,The Alliance,Exception Members,,116.92,,,,,,,43.80,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,inpatient,1,mL,167.67000,159.29000,The Alliance,Exception Members,,129.11,,,,,,,92.22,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,outpatient,1,mL,167.67000,159.29000,The Alliance,Exception Members,,129.11,,,,,,,43.80,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,inpatient,1,mL,106.18000,100.87000,The Alliance,Exception Members,,81.76,,,,,,,58.40,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,outpatient,1,mL,106.18000,100.87000,The Alliance,Exception Members,,81.76,,,,,,,43.80,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,inpatient,1,mL,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,95.59,168.59,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,43.80,168.59,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,inpatient,5,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,outpatient,5,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,inpatient,5,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,outpatient,5,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,1.09,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,inpatient,,,510.82000,485.28000,The Alliance,Exception Members,,393.33,,,,,,,280.95,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,outpatient,,,510.82000,485.28000,The Alliance,Exception Members,,393.33,,,,,,,255.41,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,inpatient,1,mL,1021.64000,970.56000,The Alliance,Exception Members,,786.66,,,,,,,561.90,990.99,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,outpatient,1,mL,1021.64000,970.56000,The Alliance,Exception Members,,786.66,,,,,,,399.88,990.99,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,inpatient,1,EA,5.13000,4.87000,The Alliance,Exception Members,,3.95,,,,,,,2.82,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Exception Members,,3.95,,,,,,,2.56,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.50,288.61,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6366.00000,6047.70000,The Alliance,Exception Members,TC,4901.82,,,,,,,3501.30,6175.02,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6366.00000,6047.70000,The Alliance,Exception Members,TC,4901.82,,,,,,,1929.64,6175.02,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,inpatient,1,EA,41.77000,39.68000,The Alliance,Exception Members,,32.16,,,,,,,22.97,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,outpatient,1,EA,41.77000,39.68000,The Alliance,Exception Members,,32.16,,,,,,,20.89,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,inpatient,1,EA,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.77,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,outpatient,1,EA,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.60,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,inpatient,,,41.50000,39.42000,The Alliance,Exception Members,90,31.95,,,,,,,22.82,40.26,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,outpatient,,,41.50000,39.42000,The Alliance,Exception Members,90,31.95,,,,,,,3.70,186.75,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,inpatient,1,mL,1207.45000,1147.08000,The Alliance,Exception Members,,929.74,,,,,,,664.10,1171.23,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,outpatient,1,mL,1207.45000,1147.08000,The Alliance,Exception Members,,929.74,,,,,,,16.89,1171.23,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,inpatient,2,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,outpatient,2,EA,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,3.79,7.35,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,inpatient,,,762.00000,723.90000,The Alliance,Exception Members,,586.74,,,,,,,419.10,739.14,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,outpatient,,,762.00000,723.90000,The Alliance,Exception Members,,586.74,,,,,,,419.10,5271.00,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,661.50,1309.50,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,619.65,1350.00,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,inpatient,2,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,outpatient,2,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,0.80910,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,inpatient,2,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,outpatient,2,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,0.80910,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,inpatient,2,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,outpatient,2,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,inpatient,1,EA,160.78000,152.74000,The Alliance,Exception Members,,123.80,,,,,,,88.43,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,outpatient,1,EA,160.78000,152.74000,The Alliance,Exception Members,,123.80,,,,,,,1.20,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,inpatient,1,EA,159.99000,151.99000,The Alliance,Exception Members,,123.19,,,,,,,87.99,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Exception Members,,123.19,,,,,,,1.20,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,inpatient,1,EA,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,95.59,168.59,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Exception Members,,133.83,,,,,,,1.20,168.59,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.71500,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,inpatient,1,EA,26.02000,24.71000,The Alliance,Exception Members,,20.04,,,,,,,14.31,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,outpatient,1,EA,26.02000,24.71000,The Alliance,Exception Members,,20.04,,,,,,,13.01,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,inpatient,1,EA,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,14.08,24.83,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,outpatient,1,EA,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,12.80,24.83,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,inpatient,1,EA,12.84000,12.19000,The Alliance,Exception Members,,9.89,,,,,,,7.06,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Exception Members,,9.89,,,,,,,1.73,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,inpatient,1,EA,32.55000,30.92000,The Alliance,Exception Members,,25.06,,,,,,,17.90,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,outpatient,1,EA,32.55000,30.92000,The Alliance,Exception Members,,25.06,,,,,,,1.73,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,inpatient,1,EA,37.72000,35.83000,The Alliance,Exception Members,,29.04,,,,,,,20.75,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,outpatient,1,EA,37.72000,35.83000,The Alliance,Exception Members,,29.04,,,,,,,1.73,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,inpatient,1,EA,33.04000,31.39000,The Alliance,Exception Members,,25.44,,,,,,,18.17,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,outpatient,1,EA,33.04000,31.39000,The Alliance,Exception Members,,25.44,,,,,,,1.73,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,inpatient,1,EA,43.77000,41.58000,The Alliance,Exception Members,,33.70,,,,,,,24.07,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,outpatient,1,EA,43.77000,41.58000,The Alliance,Exception Members,,33.70,,,,,,,1.73,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.95,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,1.73,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,1.73,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,inpatient,1,EA,36.59000,34.76000,The Alliance,Exception Members,,28.17,,,,,,,20.12,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,outpatient,1,EA,36.59000,34.76000,The Alliance,Exception Members,,28.17,,,,,,,1.73,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,inpatient,1,EA,23.18000,22.02000,The Alliance,Exception Members,,17.85,,,,,,,12.75,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,outpatient,1,EA,23.18000,22.02000,The Alliance,Exception Members,,17.85,,,,,,,1.73,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,inpatient,1,EA,18.01000,17.11000,The Alliance,Exception Members,,13.87,,,,,,,9.91,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Exception Members,,13.87,,,,,,,1.73,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,inpatient,1,EA,43.83000,41.64000,The Alliance,Exception Members,,33.75,,,,,,,24.11,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,outpatient,1,EA,43.83000,41.64000,The Alliance,Exception Members,,33.75,,,,,,,1.73,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,inpatient,1,EA,36.43000,34.61000,The Alliance,Exception Members,,28.05,,,,,,,20.04,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,outpatient,1,EA,36.43000,34.61000,The Alliance,Exception Members,,28.05,,,,,,,1.73,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,1.73,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,inpatient,1,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,8.92,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Exception Members,,12.48,,,,,,,1.73,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,inpatient,1,EA,23.07000,21.91000,The Alliance,Exception Members,,17.76,,,,,,,12.69,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,outpatient,1,EA,23.07000,21.91000,The Alliance,Exception Members,,17.76,,,,,,,1.73,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,inpatient,1,EA,16.12000,15.31000,The Alliance,Exception Members,,12.41,,,,,,,8.87,15.64,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Exception Members,,12.41,,,,,,,1.73,15.64,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,inpatient,237,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,outpatient,237,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,inpatient,237,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,outpatient,237,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,inpatient,237,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,outpatient,237,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,inpatient,237,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,outpatient,237,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,inpatient,,,14477.00000,13753.15000,The Alliance,Exception Members,TC,11147.29,,,,,,,7962.35,14042.69,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,outpatient,,,14477.00000,13753.15000,The Alliance,Exception Members,TC,11147.29,,,,,,,4549.00,14042.69,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,57.20,100.88,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,52.00,967.70,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,4.76,237.65,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,inpatient,1,EA,10.26000,9.75000,The Alliance,Exception Members,,7.90,,,,,,,5.64,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,outpatient,1,EA,10.26000,9.75000,The Alliance,Exception Members,,7.90,,,,,,,5.13,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,The Alliance,Exception Members,,1.48,,,,,,,1.06,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Exception Members,,1.48,,,,,,,0.96000,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,inpatient,1,EA,62.55000,59.42000,The Alliance,Exception Members,,48.16,,,,,,,34.40,60.67,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,outpatient,1,EA,62.55000,59.42000,The Alliance,Exception Members,,48.16,,,,,,,31.27,60.67,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,30.80,54.32,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,4.27,220.68,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,inpatient,20,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,outpatient,20,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,inpatient,20,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,outpatient,20,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,inpatient,20,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,outpatient,20,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,inpatient,,,522.00000,495.90000,The Alliance,Exception Members,,401.94,,,,,,,287.10,506.34,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Exception Members,,401.94,,,,,,,287.10,5271.00,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,inpatient,17,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,outpatient,17,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,inpatient,17,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,outpatient,17,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,inpatient,17,EA,4.92000,4.67000,The Alliance,Exception Members,,3.79,,,,,,,2.71,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,outpatient,17,EA,4.92000,4.67000,The Alliance,Exception Members,,3.79,,,,,,,2.46,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,inpatient,17,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,outpatient,17,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,inpatient,17,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,outpatient,17,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,inpatient,17,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,outpatient,17,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,inpatient,17,EA,6.49000,6.16000,The Alliance,Exception Members,,5.00,,,,,,,3.57,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,outpatient,17,EA,6.49000,6.16000,The Alliance,Exception Members,,5.00,,,,,,,3.25,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,inpatient,17,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,outpatient,17,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,inpatient,17,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,outpatient,17,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,inpatient,17,EA,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,outpatient,17,EA,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.66,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,inpatient,17,EA,4.22000,4.01000,The Alliance,Exception Members,,3.25,,,,,,,2.32,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,outpatient,17,EA,4.22000,4.01000,The Alliance,Exception Members,,3.25,,,,,,,2.11,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,inpatient,17,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,outpatient,17,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,inpatient,17,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,outpatient,17,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,inpatient,17,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.96,3.46,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,outpatient,17,EA,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.78,3.46,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,inpatient,,,130.70000,124.16000,The Alliance,Exception Members,90,100.64,,,,,,,71.89,126.78,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,outpatient,,,130.70000,124.16000,The Alliance,Exception Members,90,100.64,,,,,,,8.72,441.37,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,inpatient,30,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,0.00620,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,inpatient,30,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,outpatient,30,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.00620,1.90,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,inpatient,,,206.80000,196.46000,The Alliance,Exception Members,90,159.24,,,,,,,113.74,200.60,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,outpatient,,,206.80000,196.46000,The Alliance,Exception Members,90,159.24,,,,,,,25.05,1256.24,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,4.74,254.68,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,inpatient,1,EA,154.75000,147.01000,The Alliance,Exception Members,,119.16,,,,,,,85.11,150.11,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,outpatient,1,EA,154.75000,147.01000,The Alliance,Exception Members,,119.16,,,,,,,77.38,150.11,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,230.00,446.20,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,100.10,176.54,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,91.00,1595.82,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,inpatient,1,EA,35.55000,33.77000,The Alliance,Exception Members,,27.37,,,,,,,19.55,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Exception Members,,27.37,,,,,,,17.77,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,9.56,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,8.69,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,inpatient,1,EA,31.57000,29.99000,The Alliance,Exception Members,,24.31,,,,,,,17.36,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,outpatient,1,EA,31.57000,29.99000,The Alliance,Exception Members,,24.31,,,,,,,15.79,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,14.22,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,inpatient,1,EA,30.21000,28.70000,The Alliance,Exception Members,,23.26,,,,,,,16.62,29.30,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,outpatient,1,EA,30.21000,28.70000,The Alliance,Exception Members,,23.26,,,,,,,15.11,29.30,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,inpatient,15,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,outpatient,15,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,4.73,220.68,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,inpatient,30,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,outpatient,30,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,0.43227,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,inpatient,30,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,outpatient,30,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,0.43227,2.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,1132.00000,1075.40000,The Alliance,Exception Members,,871.64,,,,,,,622.60,1098.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,Exception Members,,871.64,,,,,,,566.00,1098.04,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,2386.00000,2266.70000,The Alliance,Exception Members,,1837.22,,,,,,,1312.30,2314.42,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,2386.00000,2266.70000,The Alliance,Exception Members,,1837.22,,,,,,,462.52,2314.42,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.00620,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.00620,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.00620,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.00620,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.00620,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.00620,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.00620,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.00620,0.26190,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,inpatient,1,EA,273.97000,260.27000,The Alliance,Exception Members,,210.96,,,,,,,150.68,265.75,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,outpatient,1,EA,273.97000,260.27000,The Alliance,Exception Members,,210.96,,,,,,,136.99,265.75,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,inpatient,1,EA,48.35000,45.93000,The Alliance,Exception Members,,37.23,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Exception Members,,37.23,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.30,2.53,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.06640,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.06640,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.06640,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.06640,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.06640,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.06640,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.06640,0.40740,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,7.85,763.98,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,inpatient,1,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,inpatient,15,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,inpatient,15,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,outpatient,15,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,inpatient,15,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,outpatient,15,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,inpatient,15,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,outpatient,15,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,inpatient,15,EA,2.93000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.61,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,outpatient,15,EA,2.93000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,inpatient,15,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,outpatient,15,EA,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.78,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,inpatient,15,EA,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,outpatient,15,EA,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,inpatient,15,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,outpatient,15,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,96.80,170.72,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,19.38,1018.59,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,inpatient,,,6058.00000,5755.10000,The Alliance,Exception Members,TC,4664.66,,,,,,,3331.90,5876.26,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,outpatient,,,6058.00000,5755.10000,The Alliance,Exception Members,TC,4664.66,,,,,,,1929.64,5876.26,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,inpatient,30,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,outpatient,30,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,inpatient,4000,EA,40.07000,38.07000,The Alliance,Exception Members,,30.85,,,,,,,22.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,outpatient,4000,EA,40.07000,38.07000,The Alliance,Exception Members,,30.85,,,,,,,20.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,inpatient,4000,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,outpatient,4000,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,55.94,98.65,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,6.75,339.51,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,inpatient,1,mL,29.09000,27.64000,The Alliance,Exception Members,,22.40,,,,,,,16.00,28.22,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,outpatient,1,mL,29.09000,27.64000,The Alliance,Exception Members,,22.40,,,,,,,14.54,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,47.40,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,13.43,472.00,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,4.48,237.65,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,inpatient,,,1267.00000,1203.65000,The Alliance,Exception Members,,975.59,,,,,,,696.85,1228.99,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,outpatient,,,1267.00000,1203.65000,The Alliance,Exception Members,,975.59,,,,,,,668.09,3163.00,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.00620,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.00620,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,0.00620,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.00620,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,inpatient,1,EA,0.61000,0.57000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,outpatient,1,EA,0.61000,0.57000,The Alliance,Exception Members,,0.46970,,,,,,,0.00620,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.00620,0.24250,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,110.00,194.00,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,20.86,1086.52,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,75.35,132.89,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,12.01,628.12,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,inpatient,1,EA,1.14000,1.09000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,outpatient,1,EA,1.14000,1.09000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,inpatient,1,EA,2.06000,1.95000,The Alliance,Exception Members,,1.59,,,,,,,1.13,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,inpatient,,,264.28000,251.07000,The Alliance,Exception Members,,203.50,,,,,,,145.35,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,outpatient,,,264.28000,251.07000,The Alliance,Exception Members,,203.50,,,,,,,132.14,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,inpatient,0.5,EA,528.55000,502.12000,The Alliance,Exception Members,,406.98,,,,,,,290.70,512.69,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,outpatient,0.5,EA,528.55000,502.12000,The Alliance,Exception Members,,406.98,,,,,,,206.88,512.69,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,inpatient,30,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,outpatient,30,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,inpatient,30,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,outpatient,30,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,0.43227,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,inpatient,30,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,inpatient,30,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,inpatient,30,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,inpatient,30,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,inpatient,30,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,inpatient,30,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,outpatient,30,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,0.43227,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,inpatient,30,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.79680,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,inpatient,1,EA,48.35000,45.93000,The Alliance,Exception Members,,37.23,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Exception Members,,37.23,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,inpatient,1,EA,58.39000,55.47000,The Alliance,Exception Members,,44.96,,,,,,,32.11,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,outpatient,1,EA,58.39000,55.47000,The Alliance,Exception Members,,44.96,,,,,,,29.20,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.30,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,inpatient,1,EA,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,3.21,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,2.92,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,inpatient,1,EA,2.25000,2.13000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,outpatient,1,EA,2.25000,2.13000,The Alliance,Exception Members,,1.73,,,,,,,1.12,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,inpatient,1,EA,5.52000,5.24000,The Alliance,Exception Members,,4.25,,,,,,,3.04,5.35,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,outpatient,1,EA,5.52000,5.24000,The Alliance,Exception Members,,4.25,,,,,,,2.76,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,inpatient,1,EA,6.74000,6.40000,The Alliance,Exception Members,,5.19,,,,,,,3.71,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,outpatient,1,EA,6.74000,6.40000,The Alliance,Exception Members,,5.19,,,,,,,3.37,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,inpatient,1,EA,10.16000,9.65000,The Alliance,Exception Members,,7.82,,,,,,,5.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,outpatient,1,EA,10.16000,9.65000,The Alliance,Exception Members,,7.82,,,,,,,4.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,inpatient,,,173.90000,165.20000,The Alliance,Exception Members,90,133.90,,,,,,,95.64,168.68,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Exception Members,90,133.90,,,,,,,15.20,763.98,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,inpatient,15,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,outpatient,15,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,inpatient,15,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,inpatient,15,EA,7.88000,7.48000,The Alliance,Exception Members,,6.07,,,,,,,4.33,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,outpatient,15,EA,7.88000,7.48000,The Alliance,Exception Members,,6.07,,,,,,,3.94,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,inpatient,15,EA,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,3.51,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,outpatient,15,EA,6.38000,6.06000,The Alliance,Exception Members,,4.91,,,,,,,3.19,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,inpatient,15,EA,10.10000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.55,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,outpatient,15,EA,10.10000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,inpatient,15,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,outpatient,15,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,inpatient,1,EA,1154.70000,1096.96000,The Alliance,Exception Members,,889.12,,,,,,,635.09,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,outpatient,1,EA,1154.70000,1096.96000,The Alliance,Exception Members,,889.12,,,,,,,436.51,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,inpatient,1,EA,1087.28000,1032.92000,The Alliance,Exception Members,,837.21,,,,,,,598.00,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,outpatient,1,EA,1087.28000,1032.92000,The Alliance,Exception Members,,837.21,,,,,,,436.51,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,213.68,376.85,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Exception Members,,299.14,,,,,,,194.25,745.84,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,inpatient,10,EA,16.66000,15.82000,The Alliance,Exception Members,,12.83,,,,,,,9.16,16.16,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,outpatient,10,EA,16.66000,15.82000,The Alliance,Exception Members,,12.83,,,,,,,8.33,16.16,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,inpatient,,,147.30000,139.94000,The Alliance,Exception Members,90,113.42,,,,,,,81.02,142.88,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Exception Members,90,113.42,,,,,,,2.79,142.88,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,inpatient,10,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,outpatient,10,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,inpatient,10,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.87,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,outpatient,10,EA,3.40000,3.23000,The Alliance,Exception Members,,2.62,,,,,,,1.70,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,inpatient,10,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,outpatient,10,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,inpatient,10,EA,3.27000,3.11000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,outpatient,10,EA,3.27000,3.11000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,inpatient,1,EA,27.53000,26.15000,The Alliance,Exception Members,,21.20,,,,,,,15.14,26.70,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,outpatient,1,EA,27.53000,26.15000,The Alliance,Exception Members,,21.20,,,,,,,13.77,26.70,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,inpatient,,,785.00000,745.75000,The Alliance,Exception Members,,604.45,,,,,,,431.75,761.45,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Exception Members,,604.45,,,,,,,392.50,1692.33,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,56.10,98.94,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,10.74,1471.29,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,inpatient,118,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,outpatient,118,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,inpatient,1,mL,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.14409,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,inpatient,1,mL,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.14409,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.14409,0.55290,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,24.20,42.68,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,3.94,203.72,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,inpatient,1,EA,31.98000,30.38000,The Alliance,Exception Members,,24.62,,,,,,,17.59,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,outpatient,1,EA,31.98000,30.38000,The Alliance,Exception Members,,24.62,,,,,,,15.99,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.29,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.08,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,inpatient,5,EA,59.96000,56.97000,The Alliance,Exception Members,,46.17,,,,,,,32.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,outpatient,5,EA,59.96000,56.97000,The Alliance,Exception Members,,46.17,,,,,,,29.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,inpatient,5,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,15.30,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,outpatient,5,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,13.90,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,inpatient,5,EA,27.97000,26.57000,The Alliance,Exception Members,,21.54,,,,,,,15.38,27.13,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,outpatient,5,EA,27.97000,26.57000,The Alliance,Exception Members,,21.54,,,,,,,13.98,27.13,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,Exception Members,GP,137.83,,,,,,,98.45,173.63,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Exception Members,GP,137.83,,,,,,,89.50,264.00,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,3.50,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,3.19,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,inpatient,1,EA,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,outpatient,1,EA,1.88000,1.78000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,The Alliance,Exception Members,,23.72,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Exception Members,,23.72,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,inpatient,1,EA,4.52000,4.30000,The Alliance,Exception Members,,3.48,,,,,,,2.49,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,outpatient,1,EA,4.52000,4.30000,The Alliance,Exception Members,,3.48,,,,,,,2.26,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.32,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Exception Members,,4.65,,,,,,,3.02,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,inpatient,1,EA,1.69000,1.61000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,outpatient,1,EA,1.69000,1.61000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,140.80,248.32,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,27.22,1392.10,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,2.28,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,2.07,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,inpatient,1,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Exception Members,,3.63,,,,,,,2.35,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,inpatient,1,EA,11.34000,10.78000,The Alliance,Exception Members,,8.73,,,,,,,6.24,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Exception Members,,8.73,,,,,,,5.67,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,inpatient,1,EA,10.83000,10.29000,The Alliance,Exception Members,,8.34,,,,,,,5.96,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,outpatient,1,EA,10.83000,10.29000,The Alliance,Exception Members,,8.34,,,,,,,5.42,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,The Alliance,Exception Members,,1.48,,,,,,,1.06,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Exception Members,,1.48,,,,,,,0.96000,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.00620,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.00620,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,inpatient,1,EA,1.42000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,outpatient,1,EA,1.42000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.00620,1.38,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,inpatient,30,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,outpatient,30,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,inpatient,30,EA,45.29000,43.03000,The Alliance,Exception Members,,34.87,,,,,,,24.91,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,outpatient,30,EA,45.29000,43.03000,The Alliance,Exception Members,,34.87,,,,,,,22.64,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,inpatient,30,EA,35.01000,33.26000,The Alliance,Exception Members,,26.96,,,,,,,19.26,33.96,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,outpatient,30,EA,35.01000,33.26000,The Alliance,Exception Members,,26.96,,,,,,,17.50,33.96,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,15.32,797.91,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,inpatient,2,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,outpatient,2,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,4.85,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,inpatient,2,EA,11.46000,10.89000,The Alliance,Exception Members,,8.82,,,,,,,6.30,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,outpatient,2,EA,11.46000,10.89000,The Alliance,Exception Members,,8.82,,,,,,,4.03,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,inpatient,2,EA,7.31000,6.94000,The Alliance,Exception Members,,5.63,,,,,,,4.02,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,outpatient,2,EA,7.31000,6.94000,The Alliance,Exception Members,,5.63,,,,,,,3.65,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,inpatient,2,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,outpatient,2,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,4.03,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,inpatient,2,EA,8.37000,7.96000,The Alliance,Exception Members,,6.44,,,,,,,4.60,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,outpatient,2,EA,8.37000,7.96000,The Alliance,Exception Members,,6.44,,,,,,,4.03,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,inpatient,2,EA,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,4.00,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,3.63,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,inpatient,2,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,16.08,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,outpatient,2,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,4.03,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,inpatient,2,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,4.03,27.59,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,inpatient,1,mL,9.78000,9.29000,The Alliance,Exception Members,,7.53,,,,,,,5.38,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,outpatient,1,mL,9.78000,9.29000,The Alliance,Exception Members,,7.53,,,,,,,2.17,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,inpatient,1,mL,7.05000,6.69000,The Alliance,Exception Members,,5.43,,,,,,,3.88,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,outpatient,1,mL,7.05000,6.69000,The Alliance,Exception Members,,5.43,,,,,,,2.17,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,inpatient,1,mL,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,3.40,6.00,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,2.17,6.00,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,inpatient,1,EA,5.66000,5.37000,The Alliance,Exception Members,,4.36,,,,,,,3.11,5.49,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Exception Members,,4.36,,,,,,,2.14,5.49,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,inpatient,1,EA,17.88000,16.98000,The Alliance,Exception Members,,13.77,,,,,,,9.83,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,outpatient,1,EA,17.88000,16.98000,The Alliance,Exception Members,,13.77,,,,,,,8.94,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,inpatient,1,EA,2.63000,2.49000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,outpatient,1,EA,2.63000,2.49000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,inpatient,15,EA,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,4.73,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,outpatient,15,EA,8.60000,8.17000,The Alliance,Exception Members,,6.62,,,,,,,4.30,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,inpatient,15,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,4.06,7.16,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,outpatient,15,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,3.69,7.16,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,18.39,967.70,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,The Alliance,Exception Members,,20.88,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Exception Members,,20.88,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,inpatient,1,EA,24.66000,23.42000,The Alliance,Exception Members,,18.99,,,,,,,13.56,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,outpatient,1,EA,24.66000,23.42000,The Alliance,Exception Members,,18.99,,,,,,,12.33,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,GP,46.97,,,,,,,33.55,59.17,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,GP,46.97,,,,,,,30.50,264.00,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,Exception Members,,148.30,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Exception Members,,148.30,,,,,,,16.59,865.84,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,Exception Members,90,148.30,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Exception Members,90,148.30,,,,,,,16.59,865.84,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,inpatient,20,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,outpatient,20,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,inpatient,20,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,outpatient,20,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,inpatient,20,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,inpatient,20,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,outpatient,20,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,inpatient,20,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,outpatient,20,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.14409,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,inpatient,20,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,outpatient,20,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,inpatient,20,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,outpatient,20,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,inpatient,20,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,outpatient,20,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.14409,0.85360,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,GP,81.62,,,,,,,58.30,102.82,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,GP,81.62,,,,,,,53.00,264.00,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.42,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.10,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.40,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.09,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.22,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.02,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,The Alliance,Exception Members,,5.57,,,,,,,3.98,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Exception Members,,5.57,,,,,,,3.62,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.63,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.40,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,inpatient,1,EA,7.25000,6.89000,The Alliance,Exception Members,,5.58,,,,,,,3.99,7.03,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Exception Members,,5.58,,,,,,,3.62,7.03,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,13.84,729.98,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,72.60,128.04,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,11.61,611.15,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,GP,40.81,,,,,,,29.15,51.41,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,GP,40.81,,,,,,,26.50,264.00,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.00620,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.00620,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.00620,0.22310,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,inpatient,1,EA,9.73000,9.25000,The Alliance,Exception Members,,7.49,,,,,,,5.35,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,outpatient,1,EA,9.73000,9.25000,The Alliance,Exception Members,,7.49,,,,,,,4.87,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.65,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,Exception Members,GP,72.38,,,,,,,51.70,91.18,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Exception Members,GP,72.38,,,,,,,47.00,264.00,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,397.10,700.34,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,397.10,3163.00,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,4.00,186.75,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,4.29,203.72,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,GP,48.51,,,,,,,34.65,61.11,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,GP,48.51,,,,,,,31.50,264.00,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,18.39,967.70,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,Exception Members,GP,208.67,,,,,,,149.05,262.87,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Exception Members,GP,208.67,,,,,,,126.65,264.00,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,GP,105.49,,,,,,,75.35,132.89,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,GP,105.49,,,,,,,68.50,264.00,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,GP,84.70,,,,,,,60.50,106.70,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,GP,84.70,,,,,,,55.00,264.00,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,GP,202.51,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,GP,202.51,,,,,,,126.65,264.00,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,GP,32.34,,,,,,,23.10,40.74,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,GP,32.34,,,,,,,21.00,264.00,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,Exception Members,,782.32,,,,,,,558.80,985.52,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Exception Members,,782.32,,,,,,,558.80,5271.00,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,inpatient,1,EA,17.19000,16.33000,The Alliance,Exception Members,,13.24,,,,,,,9.45,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,outpatient,1,EA,17.19000,16.33000,The Alliance,Exception Members,,13.24,,,,,,,1.73,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,inpatient,1,EA,48.57000,46.14000,The Alliance,Exception Members,,37.40,,,,,,,26.71,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,outpatient,1,EA,48.57000,46.14000,The Alliance,Exception Members,,37.40,,,,,,,1.73,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,inpatient,1,EA,44.05000,41.85000,The Alliance,Exception Members,,33.92,,,,,,,24.23,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Exception Members,,33.92,,,,,,,1.73,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,inpatient,1,EA,21.69000,20.61000,The Alliance,Exception Members,,16.70,,,,,,,11.93,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,outpatient,1,EA,21.69000,20.61000,The Alliance,Exception Members,,16.70,,,,,,,1.73,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,inpatient,1,EA,49.30000,46.83000,The Alliance,Exception Members,,37.96,,,,,,,27.11,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,outpatient,1,EA,49.30000,46.83000,The Alliance,Exception Members,,37.96,,,,,,,1.73,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,inpatient,1,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,outpatient,1,EA,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,1.73,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,inpatient,1,EA,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,11.82,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,1.73,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,inpatient,1,EA,48.24000,45.83000,The Alliance,Exception Members,,37.14,,,,,,,26.53,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,outpatient,1,EA,48.24000,45.83000,The Alliance,Exception Members,,37.14,,,,,,,1.73,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,1.73,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,13.21,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,1.73,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,inpatient,1,EA,55.49000,52.72000,The Alliance,Exception Members,,42.73,,,,,,,30.52,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,outpatient,1,EA,55.49000,52.72000,The Alliance,Exception Members,,42.73,,,,,,,1.73,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,inpatient,1,EA,43.39000,41.22000,The Alliance,Exception Members,,33.41,,,,,,,23.86,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,outpatient,1,EA,43.39000,41.22000,The Alliance,Exception Members,,33.41,,,,,,,1.73,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,inpatient,1,EA,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,25.38,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,outpatient,1,EA,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,1.73,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,inpatient,1,EA,33.43000,31.76000,The Alliance,Exception Members,,25.74,,,,,,,18.39,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,outpatient,1,EA,33.43000,31.76000,The Alliance,Exception Members,,25.74,,,,,,,1.73,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,inpatient,1,EA,21.33000,20.26000,The Alliance,Exception Members,,16.42,,,,,,,11.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,outpatient,1,EA,21.33000,20.26000,The Alliance,Exception Members,,16.42,,,,,,,1.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,inpatient,1,EA,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,15.90,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,outpatient,1,EA,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,1.73,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,1.73,18.39,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,GP,83.16,,,,,,,59.40,104.76,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,GP,83.16,,,,,,,54.00,264.00,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,GP,66.22,,,,,,,47.30,83.42,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,GP,66.22,,,,,,,43.00,264.00,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,inpatient,1,EA,2.11000,2.01000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,outpatient,1,EA,2.11000,2.01000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,inpatient,,,2160.00000,2052.00000,The Alliance,Exception Members,,1663.20,,,,,,,1188.00,2095.20,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,outpatient,,,2160.00000,2052.00000,The Alliance,Exception Members,,1663.20,,,,,,,255.05,12002.48,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,inpatient,,,3096.00000,2941.20000,The Alliance,Exception Members,TC,2383.92,,,,,,,1702.80,3003.12,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,Exception Members,TC,2383.92,,,,,,,1428.78,3003.12,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,2.08,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Exception Members,,2.91,,,,,,,0.73040,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.73040,1.60,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,Exception Members,GP,75.46,,,,,,,53.90,95.06,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Exception Members,GP,75.46,,,,,,,49.00,264.00,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,inpatient,,,1881.00000,1786.95000,The Alliance,Exception Members,TC,1448.37,,,,,,,1034.55,1824.57,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,outpatient,,,1881.00000,1786.95000,The Alliance,Exception Members,TC,1448.37,,,,,,,885.12,2210.07,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,72.60,128.04,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,11.53,594.19,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,inpatient,1,EA,48.03000,45.63000,The Alliance,Exception Members,,36.98,,,,,,,26.42,46.59,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,outpatient,1,EA,48.03000,45.63000,The Alliance,Exception Members,,36.98,,,,,,,19.48,46.59,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.00620,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.00620,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.00620,0.22310,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,inpatient,,,166.60000,158.27000,The Alliance,Exception Members,90,128.28,,,,,,,91.63,161.60,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Exception Members,90,128.28,,,,,,,14.83,746.94,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.67,186.75,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,inpatient,,,743.00000,705.85000,The Alliance,Exception Members,,572.11,,,,,,,408.65,720.71,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,Exception Members,,572.11,,,,,,,408.65,3163.00,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,216.70,382.18,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,197.00,382.18,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,GP,64.68,,,,,,,46.20,81.48,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,GP,64.68,,,,,,,42.00,264.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,5.51,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,10.77,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,5.51,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,inpatient,1,EA,31.82000,30.23000,The Alliance,Exception Members,,24.50,,,,,,,17.50,30.87,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,outpatient,1,EA,31.82000,30.23000,The Alliance,Exception Members,,24.50,,,,,,,5.51,30.87,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,Exception Members,GP,108.57,,,,,,,77.55,136.77,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Exception Members,GP,108.57,,,,,,,70.50,264.00,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,inpatient,0.5,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,outpatient,0.5,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,inpatient,0.5,EA,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,3.39,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,outpatient,0.5,EA,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,3.08,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,inpatient,0.5,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,outpatient,0.5,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,The Alliance,Exception Members,,23.72,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Exception Members,,23.72,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,273.50,1232.72,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,GP,66.22,,,,,,,47.30,83.42,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,GP,66.22,,,,,,,43.00,264.00,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,The Alliance,Exception Members,TC,2513.28,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Exception Members,TC,2513.28,,,,,,,1527.07,3166.08,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,152.90,269.66,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,139.00,269.66,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,inpatient,1,EA,45.52000,43.24000,The Alliance,Exception Members,,35.05,,,,,,,25.04,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,outpatient,1,EA,45.52000,43.24000,The Alliance,Exception Members,,35.05,,,,,,,22.76,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,inpatient,1,EA,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.34,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.12,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,inpatient,1,EA,3.90000,3.71000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,inpatient,1,EA,4.37000,4.16000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,outpatient,1,EA,4.37000,4.16000,The Alliance,Exception Members,,3.36,,,,,,,2.19,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.61,3.12,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,GP,95.48,,,,,,,68.20,120.28,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,GP,95.48,,,,,,,62.00,264.00,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,inpatient,1,EA,0.23000,0.21000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,outpatient,1,EA,0.23000,0.21000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,31.84,56.16,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Exception Members,,44.58,,,,,,,28.95,56.16,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,3163.00,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,62.50,121.25,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,inpatient,,,2360.00000,2242.00000,The Alliance,Exception Members,TC,1817.20,,,,,,,1298.00,2289.20,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,outpatient,,,2360.00000,2242.00000,The Alliance,Exception Members,TC,1817.20,,,,,,,1087.81,2289.20,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,GP,202.51,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,GP,202.51,,,,,,,126.65,264.00,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,107.25,189.15,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,97.50,1714.64,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,inpatient,1,EA,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,inpatient,1,EA,55.27000,52.50000,The Alliance,Exception Members,,42.56,,,,,,,30.40,53.61,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,outpatient,1,EA,55.27000,52.50000,The Alliance,Exception Members,,42.56,,,,,,,27.64,53.61,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,GP,85.47,,,,,,,61.05,107.67,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,GP,85.47,,,,,,,55.50,264.00,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,GP,88.55,,,,,,,63.25,111.55,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,GP,88.55,,,,,,,57.50,264.00,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,inpatient,,,893.00000,848.35000,The Alliance,Exception Members,TC,687.61,,,,,,,491.15,866.21,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,Exception Members,TC,687.61,,,,,,,437.23,1232.72,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,Exception Members,,75.46,,,,,,,53.90,95.06,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Exception Members,,75.46,,,,,,,8.68,458.40,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,GP,77.77,,,,,,,55.55,97.97,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,GP,77.77,,,,,,,50.50,264.00,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,inpatient,1,EA,12.28000,11.66000,The Alliance,Exception Members,,9.46,,,,,,,6.75,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,outpatient,1,EA,12.28000,11.66000,The Alliance,Exception Members,,9.46,,,,,,,6.14,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,The Alliance,Exception Members,,16.06,,,,,,,11.47,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Exception Members,,16.06,,,,,,,10.43,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,inpatient,1,EA,12.22000,11.61000,The Alliance,Exception Members,,9.41,,,,,,,6.72,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,outpatient,1,EA,12.22000,11.61000,The Alliance,Exception Members,,9.41,,,,,,,6.11,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,inpatient,1,EA,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,outpatient,1,EA,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.45,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,inpatient,1,EA,19.31000,18.34000,The Alliance,Exception Members,,14.87,,,,,,,10.62,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,outpatient,1,EA,19.31000,18.34000,The Alliance,Exception Members,,14.87,,,,,,,9.65,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,1.82,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,inpatient,,,1923.00000,1826.85000,The Alliance,Exception Members,TC,1480.71,,,,,,,1057.65,1865.31,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,outpatient,,,1923.00000,1826.85000,The Alliance,Exception Members,TC,1480.71,,,,,,,905.36,2210.07,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,TC,416.57,,,,,,,297.55,524.77,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,TC,416.57,,,,,,,270.50,1232.72,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.86,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.69,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,inpatient,1,EA,22.91000,21.76000,The Alliance,Exception Members,,17.64,,,,,,,12.60,22.22,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Exception Members,,17.64,,,,,,,11.46,22.22,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,The Alliance,Exception Members,,98.79,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Exception Members,,98.79,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,The Alliance,Exception Members,90,98.79,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Exception Members,90,98.79,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,inpatient,1,EA,38.14000,36.23000,The Alliance,Exception Members,,29.37,,,,,,,20.98,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,outpatient,1,EA,38.14000,36.23000,The Alliance,Exception Members,,29.37,,,,,,,19.07,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,inpatient,2,EA,40.56000,38.53000,The Alliance,Exception Members,,31.23,,,,,,,22.31,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,outpatient,2,EA,40.56000,38.53000,The Alliance,Exception Members,,31.23,,,,,,,20.28,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,inpatient,2,EA,53.34000,50.67000,The Alliance,Exception Members,,41.07,,,,,,,29.34,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,outpatient,2,EA,53.34000,50.67000,The Alliance,Exception Members,,41.07,,,,,,,26.67,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,inpatient,2,EA,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,17.26,30.44,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,outpatient,2,EA,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,15.69,30.44,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,56.40,1426.03,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,34.10,60.14,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,5.57,288.61,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,inpatient,1,EA,20.17000,19.17000,The Alliance,Exception Members,,15.53,,,,,,,11.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,outpatient,1,EA,20.17000,19.17000,The Alliance,Exception Members,,15.53,,,,,,,10.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,inpatient,,,221.00000,209.95000,The Alliance,Exception Members,,170.17,,,,,,,121.55,214.37,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,outpatient,,,221.00000,209.95000,The Alliance,Exception Members,,170.17,,,,,,,121.55,5271.00,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,28.50,55.29,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,inpatient,1,mL,296.89000,282.04000,The Alliance,Exception Members,,228.61,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Exception Members,,228.61,,,,,,,75.93,287.98,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,290.95,513.13,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,173.99,513.13,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,inpatient,1,EA,317.28000,301.41000,The Alliance,Exception Members,,244.31,,,,,,,174.50,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,outpatient,1,EA,317.28000,301.41000,The Alliance,Exception Members,,244.31,,,,,,,158.64,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,inpatient,1,EA,259.49000,246.51000,The Alliance,Exception Members,,199.81,,,,,,,142.72,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,outpatient,1,EA,259.49000,246.51000,The Alliance,Exception Members,,199.81,,,,,,,129.75,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,inpatient,1,EA,317.48000,301.61000,The Alliance,Exception Members,,244.46,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Exception Members,,244.46,,,,,,,158.74,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,inpatient,1,EA,317.48000,301.61000,The Alliance,Exception Members,,244.46,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Exception Members,,244.46,,,,,,,158.74,307.96,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,GP,93.94,,,,,,,67.10,118.34,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,GP,93.94,,,,,,,61.00,264.00,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,inpatient,1,EA,105.16000,99.91000,The Alliance,Exception Members,,80.97,,,,,,,57.84,102.01,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,outpatient,1,EA,105.16000,99.91000,The Alliance,Exception Members,,80.97,,,,,,,52.58,102.01,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,1137.41,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,inpatient,5,EA,162.90000,154.76000,The Alliance,Exception Members,,125.43,,,,,,,89.59,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,outpatient,5,EA,162.90000,154.76000,The Alliance,Exception Members,,125.43,,,,,,,4.63,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,inpatient,5,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,outpatient,5,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,4.63,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,inpatient,5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,4.63,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,inpatient,5,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,outpatient,5,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,4.63,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,inpatient,5,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,outpatient,5,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,4.63,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,inpatient,5,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,outpatient,5,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,4.63,18.39,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,565.00000,536.75000,The Alliance,Exception Members,,435.05,,,,,,,310.75,548.05,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,565.00000,536.75000,The Alliance,Exception Members,,435.05,,,,,,,242.89,548.05,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,264.00,465.60,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,240.00,465.60,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,6.47,339.51,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,5.67,288.61,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Exception Members,,14.18,,,,,,,9.21,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.92,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,The Alliance,Exception Members,,13.32,,,,,,,9.52,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Exception Members,,13.32,,,,,,,8.65,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,The Alliance,Exception Members,,8.94,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Exception Members,,8.94,,,,,,,5.80,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,The Alliance,Exception Members,,8.94,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Exception Members,,8.94,,,,,,,5.80,11.26,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,inpatient,1,mL,369.91000,351.42000,The Alliance,Exception Members,,284.83,,,,,,,203.45,358.81,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,outpatient,1,mL,369.91000,351.42000,The Alliance,Exception Members,,284.83,,,,,,,74.45,358.81,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,inpatient,1,EA,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,11.59,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,outpatient,1,EA,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,10.54,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Exception Members,,2.37,,,,,,,1.54,2.99,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,,100.10,,,,,,,71.50,126.10,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,,100.10,,,,,,,71.50,5271.00,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,89.24,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,3163.00,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,inpatient,1,EA,193.55000,183.87000,The Alliance,Exception Members,,149.03,,,,,,,106.45,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,outpatient,1,EA,193.55000,183.87000,The Alliance,Exception Members,,149.03,,,,,,,96.78,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,inpatient,1,EA,203.22000,193.06000,The Alliance,Exception Members,,156.48,,,,,,,111.77,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,outpatient,1,EA,203.22000,193.06000,The Alliance,Exception Members,,156.48,,,,,,,101.61,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,inpatient,1,EA,193.68000,184.00000,The Alliance,Exception Members,,149.13,,,,,,,106.52,187.87,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,outpatient,1,EA,193.68000,184.00000,The Alliance,Exception Members,,149.13,,,,,,,96.84,187.87,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,Exception Members,,512.05,,,,,,,365.75,645.05,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Exception Members,,512.05,,,,,,,365.75,4686.00,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,inpatient,1,mL,296.89000,282.04000,The Alliance,Exception Members,,228.61,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Exception Members,,228.61,,,,,,,75.93,287.98,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,inpatient,,,114.40000,108.68000,The Alliance,Exception Members,90,88.09,,,,,,,62.92,110.97,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,outpatient,,,114.40000,108.68000,The Alliance,Exception Members,90,88.09,,,,,,,10.18,509.30,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,4.06,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,GP,88.55,,,,,,,63.25,111.55,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,GP,88.55,,,,,,,57.50,264.00,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,inpatient,,,234.90000,223.16000,The Alliance,Exception Members,90,180.87,,,,,,,129.19,227.85,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,outpatient,,,234.90000,223.16000,The Alliance,Exception Members,90,180.87,,,,,,,20.91,1052.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,inpatient,1,mL,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,outpatient,1,mL,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,inpatient,1,mL,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,inpatient,1,mL,2.27000,2.15000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,outpatient,1,mL,2.27000,2.15000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,inpatient,1,mL,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,outpatient,1,mL,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,inpatient,1,mL,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,inpatient,1,mL,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,outpatient,1,mL,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,inpatient,1,mL,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.61,3.12,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,GP,43.89,,,,,,,31.35,55.29,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,GP,43.89,,,,,,,28.50,264.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,inpatient,2,EA,919.61000,873.63000,The Alliance,Exception Members,,708.10,,,,,,,505.79,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,outpatient,2,EA,919.61000,873.63000,The Alliance,Exception Members,,708.10,,,,,,,266.44,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,inpatient,2,EA,965.58000,917.30000,The Alliance,Exception Members,,743.50,,,,,,,531.07,936.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,outpatient,2,EA,965.58000,917.30000,The Alliance,Exception Members,,743.50,,,,,,,266.44,936.61,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,inpatient,1,mL,335.14000,318.38000,The Alliance,Exception Members,,258.06,,,,,,,184.33,325.09,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,outpatient,1,mL,335.14000,318.38000,The Alliance,Exception Members,,258.06,,,,,,,74.45,325.09,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,inpatient,1,EA,8.42000,8.00000,The Alliance,Exception Members,,6.48,,,,,,,4.63,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,outpatient,1,EA,8.42000,8.00000,The Alliance,Exception Members,,6.48,,,,,,,4.21,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,30.00,58.20,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,30.00,58.20,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,inpatient,1,EA,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,8.41,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,outpatient,1,EA,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,7.65,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,inpatient,1,mL,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.08525,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.08525,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,inpatient,1,mL,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,inpatient,1,mL,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,1.63,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,0.08525,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,inpatient,1,mL,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,outpatient,1,mL,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.08525,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,inpatient,1,mL,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.08525,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,inpatient,30,EA,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,outpatient,30,EA,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,0.08525,2.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,30.00,58.20,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,9.58,492.33,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.17,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,inpatient,5,EA,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,outpatient,5,EA,3.25000,3.08000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,inpatient,5,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,inpatient,5,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,outpatient,5,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,inpatient,5,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,inpatient,5,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,outpatient,5,EA,4.76000,4.52000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,inpatient,5,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,outpatient,5,EA,3.07000,2.91000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,inpatient,5,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,inpatient,5,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,outpatient,5,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,inpatient,5,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,outpatient,5,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,inpatient,5,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,outpatient,5,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,inpatient,5,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,inpatient,5,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.67,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,inpatient,5,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,outpatient,5,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,inpatient,5,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,outpatient,5,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,inpatient,5,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,outpatient,5,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,inpatient,5,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,inpatient,5,EA,3.71000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.04,3.60,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,outpatient,5,EA,3.71000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,1.85,3.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,inpatient,1,EA,462.47000,439.35000,The Alliance,Exception Members,,356.10,,,,,,,254.36,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,outpatient,1,EA,462.47000,439.35000,The Alliance,Exception Members,,356.10,,,,,,,231.24,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,inpatient,1,EA,396.27000,376.46000,The Alliance,Exception Members,,305.13,,,,,,,217.95,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,outpatient,1,EA,396.27000,376.46000,The Alliance,Exception Members,,305.13,,,,,,,198.13,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,inpatient,1,EA,399.12000,379.16000,The Alliance,Exception Members,,307.32,,,,,,,219.52,387.15,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,outpatient,1,EA,399.12000,379.16000,The Alliance,Exception Members,,307.32,,,,,,,199.56,387.15,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,11.98,628.12,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,inpatient,20,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,outpatient,20,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.08525,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,inpatient,20,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,outpatient,20,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.08525,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,inpatient,20,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.08525,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,inpatient,20,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,outpatient,20,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.08525,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,inpatient,20,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,outpatient,20,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,inpatient,20,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,outpatient,20,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.08525,1.32,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,62.70,110.58,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Exception Members,,87.78,,,,,,,14.48,679.08,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,Exception Members,,694.54,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Exception Members,,694.54,,,,,,,200.06,874.94,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,The Alliance,Exception Members,TC,737.66,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Exception Members,TC,737.66,,,,,,,384.16,1329.46,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,The Alliance,Exception Members,,21.16,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Exception Members,,21.16,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,inpatient,400,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,outpatient,400,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,inpatient,400,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,outpatient,400,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,TC,56.98,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,TC,56.98,,,,,,,37.00,442.00,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,inpatient,1,EA,172.07000,163.47000,The Alliance,Exception Members,,132.49,,,,,,,94.64,166.91,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,outpatient,1,EA,172.07000,163.47000,The Alliance,Exception Members,,132.49,,,,,,,86.03,166.91,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,inpatient,250,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,outpatient,250,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,inpatient,250,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,outpatient,250,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,inpatient,250,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,outpatient,250,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,inpatient,250,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,outpatient,250,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,inpatient,250,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,outpatient,250,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,inpatient,28,EA,25.82000,24.53000,The Alliance,Exception Members,,19.88,,,,,,,14.20,25.05,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,outpatient,28,EA,25.82000,24.53000,The Alliance,Exception Members,,19.88,,,,,,,12.91,25.05,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.29,4.04,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Exception Members,,3.21,,,,,,,2.08,4.04,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,13.91,662.12,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,inpatient,1,EA,29.01000,27.56000,The Alliance,Exception Members,,22.34,,,,,,,15.96,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Exception Members,,22.34,,,,,,,14.51,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.65,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,5339.00000,5072.05000,The Alliance,Exception Members,,4111.03,,,,,,,2936.45,5178.83,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,5339.00000,5072.05000,The Alliance,Exception Members,,4111.03,,,,,,,416.78,5178.83,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,69.33,3666.93,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,inpatient,1,EA,33.84000,32.15000,The Alliance,Exception Members,,26.06,,,,,,,18.61,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,outpatient,1,EA,33.84000,32.15000,The Alliance,Exception Members,,26.06,,,,,,,16.92,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,inpatient,1,EA,31.84000,30.25000,The Alliance,Exception Members,,24.52,,,,,,,17.51,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,outpatient,1,EA,31.84000,30.25000,The Alliance,Exception Members,,24.52,,,,,,,15.92,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,inpatient,1,GM,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,outpatient,1,GM,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,inpatient,1,GM,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,outpatient,1,GM,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,inpatient,1,GM,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,outpatient,1,GM,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,inpatient,1,GM,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,outpatient,1,GM,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,inpatient,1,EA,14.60000,13.87000,The Alliance,Exception Members,,11.24,,,,,,,8.03,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,outpatient,1,EA,14.60000,13.87000,The Alliance,Exception Members,,11.24,,,,,,,7.30,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,inpatient,,,913.00000,867.35000,The Alliance,Exception Members,TC,703.01,,,,,,,502.15,885.61,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,outpatient,,,913.00000,867.35000,The Alliance,Exception Members,TC,703.01,,,,,,,455.68,2210.07,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,The Alliance,Exception Members,,46.48,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Exception Members,,46.48,,,,,,,30.18,58.55,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,inpatient,10,EA,37.19000,35.33000,The Alliance,Exception Members,,28.64,,,,,,,20.45,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,outpatient,10,EA,37.19000,35.33000,The Alliance,Exception Members,,28.64,,,,,,,0.08525,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,inpatient,10,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,outpatient,10,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.08525,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,inpatient,10,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,outpatient,10,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,0.08525,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,inpatient,10,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,outpatient,10,EA,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.08525,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,inpatient,10,EA,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,outpatient,10,EA,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,0.08525,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,inpatient,10,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,outpatient,10,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.08525,1.13,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,2.70,135.79,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,inpatient,200,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,outpatient,200,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.08525,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,inpatient,200,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,outpatient,200,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,inpatient,200,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,outpatient,200,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,inpatient,200,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,outpatient,200,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,inpatient,200,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,outpatient,200,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.08525,1.11,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,inpatient,1,EA,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,4.12,7.27,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,3.75,7.27,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,inpatient,,,296.20000,281.39000,The Alliance,Exception Members,90,228.07,,,,,,,162.91,287.31,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Exception Members,90,228.07,,,,,,,26.38,1341.13,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,inpatient,1,EA,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,outpatient,1,EA,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,90.75,160.05,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,12.88,679.08,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,inpatient,50,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,inpatient,50,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,outpatient,50,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,inpatient,1,EA,56.35000,53.53000,The Alliance,Exception Members,,43.39,,,,,,,30.99,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,outpatient,1,EA,56.35000,53.53000,The Alliance,Exception Members,,43.39,,,,,,,28.18,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,inpatient,1,EA,34.93000,33.19000,The Alliance,Exception Members,,26.90,,,,,,,19.21,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,outpatient,1,EA,34.93000,33.19000,The Alliance,Exception Members,,26.90,,,,,,,17.46,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,inpatient,1,EA,58.08000,55.18000,The Alliance,Exception Members,,44.72,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,outpatient,1,EA,58.08000,55.18000,The Alliance,Exception Members,,44.72,,,,,,,29.04,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,inpatient,1,EA,51.07000,48.51000,The Alliance,Exception Members,,39.32,,,,,,,28.09,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,outpatient,1,EA,51.07000,48.51000,The Alliance,Exception Members,,39.32,,,,,,,25.54,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,inpatient,1,EA,42.19000,40.08000,The Alliance,Exception Members,,32.49,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Exception Members,,32.49,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,inpatient,1,EA,42.19000,40.08000,The Alliance,Exception Members,,32.49,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Exception Members,,32.49,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,inpatient,1,EA,67.30000,63.93000,The Alliance,Exception Members,,51.82,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Exception Members,,51.82,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,inpatient,1,EA,67.30000,63.93000,The Alliance,Exception Members,,51.82,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Exception Members,,51.82,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,inpatient,1,EA,60.57000,57.54000,The Alliance,Exception Members,,46.64,,,,,,,33.31,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,outpatient,1,EA,60.57000,57.54000,The Alliance,Exception Members,,46.64,,,,,,,30.29,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,inpatient,1,EA,50.72000,48.18000,The Alliance,Exception Members,,39.05,,,,,,,27.90,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,outpatient,1,EA,50.72000,48.18000,The Alliance,Exception Members,,39.05,,,,,,,25.36,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,inpatient,1,EA,30.02000,28.52000,The Alliance,Exception Members,,23.12,,,,,,,16.51,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Exception Members,,23.12,,,,,,,15.01,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,inpatient,1,EA,58.08000,55.17000,The Alliance,Exception Members,,44.72,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,outpatient,1,EA,58.08000,55.17000,The Alliance,Exception Members,,44.72,,,,,,,29.04,56.34,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,inpatient,1,EA,333.36000,316.69000,The Alliance,Exception Members,,256.69,,,,,,,183.35,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,outpatient,1,EA,333.36000,316.69000,The Alliance,Exception Members,,256.69,,,,,,,166.68,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,The Alliance,Exception Members,,21.16,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Exception Members,,21.16,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Exception Members,,22.43,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,The Alliance,Exception Members,,3.37,,,,,,,2.41,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Exception Members,,3.37,,,,,,,2.19,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,inpatient,1,EA,283.39000,269.22000,The Alliance,Exception Members,,218.21,,,,,,,155.86,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,outpatient,1,EA,283.39000,269.22000,The Alliance,Exception Members,,218.21,,,,,,,141.69,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,inpatient,1,EA,353.87000,336.18000,The Alliance,Exception Members,,272.48,,,,,,,194.63,343.25,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,outpatient,1,EA,353.87000,336.18000,The Alliance,Exception Members,,272.48,,,,,,,176.94,343.25,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,inpatient,,,205.00000,194.75000,The Alliance,Exception Members,,157.85,,,,,,,112.75,198.85,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Exception Members,,157.85,,,,,,,7.57,198.85,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.51,288.61,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,Exception Members,,197.89,,,,,,,141.35,249.29,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Exception Members,,197.89,,,,,,,21.73,1137.41,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,11.53,574.73,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,inpatient,50,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,outpatient,50,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,inpatient,50,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,outpatient,50,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,inpatient,50,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,outpatient,50,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,inpatient,50,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,outpatient,50,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,inpatient,50,EA,1.37000,1.31000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,outpatient,50,EA,1.37000,1.31000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,inpatient,50,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,outpatient,50,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,inpatient,1,EA,6621.21000,6290.15000,The Alliance,Exception Members,,5098.33,,,,,,,3641.67,6422.57,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,outpatient,1,EA,6621.21000,6290.15000,The Alliance,Exception Members,,5098.33,,,,,,,31.08,6422.57,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,12.05,628.12,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,8.61,458.40,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,inpatient,100,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,outpatient,100,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.08525,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,inpatient,100,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,inpatient,100,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,outpatient,100,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,inpatient,100,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,outpatient,100,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.08525,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,inpatient,100,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,outpatient,100,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,inpatient,100,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.08525,1.18,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,inpatient,,,18565.90000,17637.60000,The Alliance,Exception Members,,14295.74,,,,,,,9097.29,18008.92,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,outpatient,,,18565.90000,17637.60000,The Alliance,Exception Members,,14295.74,,,,,,,8521.75,18565.90,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,inpatient,133,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,outpatient,133,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,inpatient,133,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,outpatient,133,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,inpatient,133,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,outpatient,133,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,inpatient,1,EA,49.86000,47.37000,The Alliance,Exception Members,,38.39,,,,,,,27.42,48.36,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,outpatient,1,EA,49.86000,47.37000,The Alliance,Exception Members,,38.39,,,,,,,24.93,48.36,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,4.81,254.68,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,4.27,220.68,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,inpatient,120,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,outpatient,120,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,inpatient,120,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,outpatient,120,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,inpatient,50,EA,6.13000,5.82000,The Alliance,Exception Members,,4.72,,,,,,,3.37,5.95,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,outpatient,50,EA,6.13000,5.82000,The Alliance,Exception Members,,4.72,,,,,,,3.06,5.95,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,inpatient,10,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,outpatient,10,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,inpatient,10,EA,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,outpatient,10,EA,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,2.89,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,inpatient,10,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,outpatient,10,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,inpatient,10,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,outpatient,10,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,inpatient,1,EA,15.92000,15.13000,The Alliance,Exception Members,,12.26,,,,,,,8.76,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,outpatient,1,EA,15.92000,15.13000,The Alliance,Exception Members,,12.26,,,,,,,7.96,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,inpatient,1,EA,22.30000,21.18000,The Alliance,Exception Members,,17.17,,,,,,,12.27,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,outpatient,1,EA,22.30000,21.18000,The Alliance,Exception Members,,17.17,,,,,,,11.15,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,inpatient,1,EA,23.50000,22.33000,The Alliance,Exception Members,,18.09,,,,,,,12.93,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,outpatient,1,EA,23.50000,22.33000,The Alliance,Exception Members,,18.09,,,,,,,11.75,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,inpatient,1,EA,13.15000,12.49000,The Alliance,Exception Members,,10.13,,,,,,,7.23,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,outpatient,1,EA,13.15000,12.49000,The Alliance,Exception Members,,10.13,,,,,,,6.58,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,inpatient,1,EA,20.33000,19.32000,The Alliance,Exception Members,,15.65,,,,,,,11.18,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,outpatient,1,EA,20.33000,19.32000,The Alliance,Exception Members,,15.65,,,,,,,10.16,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,inpatient,1,EA,16.17000,15.36000,The Alliance,Exception Members,,12.45,,,,,,,8.89,15.68,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,outpatient,1,EA,16.17000,15.36000,The Alliance,Exception Members,,12.45,,,,,,,8.09,15.68,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,inpatient,30,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,inpatient,30,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,outpatient,30,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,inpatient,30,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,outpatient,30,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,inpatient,1,mL,5.10000,4.84000,The Alliance,Exception Members,,3.93,,,,,,,2.81,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,outpatient,1,mL,5.10000,4.84000,The Alliance,Exception Members,,3.93,,,,,,,2.55,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,inpatient,1,mL,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.44,4.31,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,outpatient,1,mL,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.22,4.31,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,12.31,628.12,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,inpatient,1,GM,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,outpatient,1,GM,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,inpatient,30,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,outpatient,30,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,inpatient,15,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,outpatient,15,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,inpatient,15,EA,9.38000,8.91000,The Alliance,Exception Members,,7.22,,,,,,,5.16,9.10,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,outpatient,15,EA,9.38000,8.91000,The Alliance,Exception Members,,7.22,,,,,,,4.69,9.10,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,5.06,254.68,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,inpatient,500,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,outpatient,500,EA,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.15000,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,inpatient,500,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,outpatient,500,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.15000,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,inpatient,50,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,outpatient,50,EA,1.44000,1.36000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,inpatient,50,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,outpatient,50,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,inpatient,1,mL,987.52000,938.14000,The Alliance,Exception Members,,760.39,,,,,,,543.14,957.89,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,outpatient,1,mL,987.52000,938.14000,The Alliance,Exception Members,,760.39,,,,,,,493.76,957.89,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,inpatient,,,359.60000,341.62000,The Alliance,Exception Members,90,276.89,,,,,,,197.78,348.81,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,outpatient,,,359.60000,341.62000,The Alliance,Exception Members,90,276.89,,,,,,,32.01,1612.78,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,inpatient,1,mL,426.59000,405.26000,The Alliance,Exception Members,,328.47,,,,,,,234.62,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,outpatient,1,mL,426.59000,405.26000,The Alliance,Exception Members,,328.47,,,,,,,213.29,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,inpatient,1,mL,360.24000,342.23000,The Alliance,Exception Members,,277.38,,,,,,,198.13,349.43,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,outpatient,1,mL,360.24000,342.23000,The Alliance,Exception Members,,277.38,,,,,,,180.12,349.43,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,14.39,746.94,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,inpatient,45,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,outpatient,45,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,inpatient,45,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,outpatient,45,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,inpatient,45,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,outpatient,45,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,inpatient,45,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,outpatient,45,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17034.50000,16182.77000,The Alliance,Exception Members,,13116.57,,,,,,,8346.91,16523.47,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17034.50000,16182.77000,The Alliance,Exception Members,,13116.57,,,,,,,7818.84,17034.50,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,inpatient,60,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,outpatient,60,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,inpatient,60,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,inpatient,60,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,108.35,191.09,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Exception Members,,151.69,,,,,,,98.50,212.44,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,39.60,69.84,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,5.99,1216.68,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,inpatient,10,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,outpatient,10,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,inpatient,10,EA,6.12000,5.82000,The Alliance,Exception Members,,4.71,,,,,,,3.37,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,outpatient,10,EA,6.12000,5.82000,The Alliance,Exception Members,,4.71,,,,,,,3.06,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,inpatient,10,EA,6.06000,5.76000,The Alliance,Exception Members,,4.67,,,,,,,3.33,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,outpatient,10,EA,6.06000,5.76000,The Alliance,Exception Members,,4.67,,,,,,,3.03,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,inpatient,10,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,inpatient,10,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,inpatient,10,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,outpatient,10,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,inpatient,10,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,inpatient,10,EA,6.30000,5.99000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,outpatient,10,EA,6.30000,5.99000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,inpatient,10,EA,10.45000,9.93000,The Alliance,Exception Members,,8.05,,,,,,,5.75,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,outpatient,10,EA,10.45000,9.93000,The Alliance,Exception Members,,8.05,,,,,,,5.22,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,inpatient,1,EA,5.04000,4.79000,The Alliance,Exception Members,,3.88,,,,,,,2.77,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,outpatient,1,EA,5.04000,4.79000,The Alliance,Exception Members,,3.88,,,,,,,2.52,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.13,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,inpatient,1,EA,53.17000,50.51000,The Alliance,Exception Members,,40.94,,,,,,,29.24,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,outpatient,1,EA,53.17000,50.51000,The Alliance,Exception Members,,40.94,,,,,,,26.59,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,The Alliance,Exception Members,,3.10,,,,,,,2.21,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Exception Members,,3.10,,,,,,,2.01,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,TC,406.56,,,,,,,290.40,512.16,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,TC,406.56,,,,,,,177.63,3723.67,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,inpatient,,,427.00000,405.65000,The Alliance,Exception Members,TC,328.79,,,,,,,234.85,414.19,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Exception Members,TC,328.79,,,,,,,121.00,3027.62,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2771.00000,2632.45000,The Alliance,Exception Members,QN,2133.67,,,,,,,1524.05,2687.87,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2771.00000,2632.45000,The Alliance,Exception Members,QN,2133.67,,,,,,,1385.50,2687.87,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,inpatient,1,EA,8.95000,8.51000,The Alliance,Exception Members,,6.89,,,,,,,4.92,8.68,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,outpatient,1,EA,8.95000,8.51000,The Alliance,Exception Members,,6.89,,,,,,,2.17,8.68,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,16.07,763.98,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,GN,254.87,,,,,,,182.05,321.07,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,GN,254.87,,,,,,,126.65,321.07,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,inpatient,1,mL,123.44000,117.27000,The Alliance,Exception Members,,95.05,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Exception Members,,95.05,,,,,,,61.72,119.74,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,inpatient,1,EA,12.01000,11.41000,The Alliance,Exception Members,,9.25,,,,,,,6.61,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Exception Members,,9.25,,,,,,,6.00,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,inpatient,1,EA,16.88000,16.04000,The Alliance,Exception Members,,13.00,,,,,,,9.28,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,outpatient,1,EA,16.88000,16.04000,The Alliance,Exception Members,,13.00,,,,,,,8.44,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,inpatient,,,582.00000,552.90000,The Alliance,Exception Members,GN,448.14,,,,,,,320.10,564.54,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Exception Members,GN,448.14,,,,,,,126.65,564.54,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,inpatient,1,mL,22.59000,21.46000,The Alliance,Exception Members,,17.39,,,,,,,12.42,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Exception Members,,17.39,,,,,,,11.29,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,inpatient,1,mL,14.17000,13.46000,The Alliance,Exception Members,,10.91,,,,,,,7.79,13.74,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,outpatient,1,mL,14.17000,13.46000,The Alliance,Exception Members,,10.91,,,,,,,7.08,13.74,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,inpatient,,,662.00000,628.90000,The Alliance,Exception Members,GN,509.74,,,,,,,364.10,642.14,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,outpatient,,,662.00000,628.90000,The Alliance,Exception Members,GN,509.74,,,,,,,126.65,642.14,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,Exception Members,90,148.30,,,,,,,105.93,186.82,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Exception Members,90,148.30,,,,,,,11.91,594.19,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,Exception Members,GN,183.26,,,,,,,130.90,230.86,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Exception Members,GN,183.26,,,,,,,119.00,264.00,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,GN,203.28,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,GN,203.28,,,,,,,126.65,264.00,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,GN,203.28,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,GN,203.28,,,,,,,126.65,264.00,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,Exception Members,,344.19,,,,,,,245.85,433.59,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Exception Members,,344.19,,,,,,,49.49,3666.93,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,Exception Members,GN,259.49,,,,,,,185.35,326.89,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Exception Members,GN,259.49,,,,,,,126.65,326.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,QW,28.49,,,,,,,20.35,35.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,QW,28.49,,,,,,,16.53,780.94,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,inpatient,1,mL,447.36000,425.00000,The Alliance,Exception Members,,344.47,,,,,,,246.05,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,outpatient,1,mL,447.36000,425.00000,The Alliance,Exception Members,,344.47,,,,,,,223.68,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,inpatient,1,mL,485.51000,461.23000,The Alliance,Exception Members,,373.84,,,,,,,267.03,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,outpatient,1,mL,485.51000,461.23000,The Alliance,Exception Members,,373.84,,,,,,,242.75,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,inpatient,1,mL,669.82000,636.33000,The Alliance,Exception Members,,515.76,,,,,,,368.40,649.73,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,outpatient,1,mL,669.82000,636.33000,The Alliance,Exception Members,,515.76,,,,,,,334.91,649.73,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,71.50,1256.24,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,71.00,137.74,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,inpatient,1,mL,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,Exception Members,GN,344.19,,,,,,,245.85,433.59,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Exception Members,GN,344.19,,,,,,,126.65,433.59,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,GN,140.91,,,,,,,100.65,177.51,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,GN,140.91,,,,,,,91.50,264.00,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1443.75000,1371.56000,The Alliance,Exception Members,,1111.69,,,,,,,707.44,1400.44,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Exception Members,,1111.69,,,,,,,662.68,1443.75,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,GN,82.39,,,,,,,58.85,103.79,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,GN,82.39,,,,,,,53.50,264.00,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,inpatient,,,202.80000,192.66000,The Alliance,Exception Members,90,156.16,,,,,,,111.54,196.72,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,outpatient,,,202.80000,192.66000,The Alliance,Exception Members,90,156.16,,,,,,,17.85,814.87,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,GN,199.43,,,,,,,142.45,251.23,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,GN,199.43,,,,,,,126.65,264.00,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,inpatient,,,683.00000,648.85000,The Alliance,Exception Members,GN,525.91,,,,,,,375.65,662.51,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,Exception Members,GN,525.91,,,,,,,126.65,662.51,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,Exception Members,GN,782.32,,,,,,,558.80,985.52,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Exception Members,GN,782.32,,,,,,,126.65,985.52,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,inpatient,,,579.00000,550.05000,The Alliance,Exception Members,GN,445.83,,,,,,,318.45,561.63,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Exception Members,GN,445.83,,,,,,,126.65,561.63,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,Exception Members,GN,348.04,,,,,,,248.60,438.44,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Exception Members,GN,348.04,,,,,,,126.65,438.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,4.86,254.68,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,5.25,356.54,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,Exception Members,GN,361.90,,,,,,,258.50,455.90,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Exception Members,GN,361.90,,,,,,,126.65,455.90,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,inpatient,5,EA,3.96000,3.77000,The Alliance,Exception Members,,3.05,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,outpatient,5,EA,3.96000,3.77000,The Alliance,Exception Members,,3.05,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,inpatient,5,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,outpatient,5,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,inpatient,5,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,outpatient,5,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.92,3.72,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,inpatient,,,1727.00000,1640.65000,The Alliance,Exception Members,TC,1329.79,,,,,,,949.85,1675.19,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,outpatient,,,1727.00000,1640.65000,The Alliance,Exception Members,TC,1329.79,,,,,,,863.50,1675.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,inpatient,10,EA,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.77,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,outpatient,10,EA,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.60,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,inpatient,10,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.57,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,outpatient,10,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.43,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,inpatient,10,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,outpatient,10,EA,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,inpatient,10,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,outpatient,10,EA,2.59000,2.46000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,inpatient,10,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,outpatient,10,EA,3.28000,3.11000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,inpatient,10,EA,2.98000,2.83000,The Alliance,Exception Members,,2.29,,,,,,,1.64,2.89,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,outpatient,10,EA,2.98000,2.83000,The Alliance,Exception Members,,2.29,,,,,,,1.49,2.89,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,3.12,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,inpatient,1,EA,18.47000,17.55000,The Alliance,Exception Members,,14.22,,,,,,,10.16,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,outpatient,1,EA,18.47000,17.55000,The Alliance,Exception Members,,14.22,,,,,,,3.12,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,inpatient,1,EA,19.28000,18.31000,The Alliance,Exception Members,,14.85,,,,,,,10.60,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Exception Members,,14.85,,,,,,,3.12,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,inpatient,1,EA,35.42000,33.65000,The Alliance,Exception Members,,27.27,,,,,,,19.48,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,outpatient,1,EA,35.42000,33.65000,The Alliance,Exception Members,,27.27,,,,,,,3.12,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,inpatient,1,EA,17.15000,16.29000,The Alliance,Exception Members,,13.21,,,,,,,9.43,16.64,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,outpatient,1,EA,17.15000,16.29000,The Alliance,Exception Members,,13.21,,,,,,,3.12,16.64,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,170.50,300.70,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,155.00,1239.81,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,inpatient,1,EA,24.50000,23.28000,The Alliance,Exception Members,,18.86,,,,,,,13.47,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,outpatient,1,EA,24.50000,23.28000,The Alliance,Exception Members,,18.86,,,,,,,12.25,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,inpatient,1,EA,1.25000,1.18000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,outpatient,1,EA,1.25000,1.18000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,inpatient,1,EA,1.82000,1.72000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,outpatient,1,EA,1.82000,1.72000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,inpatient,1,EA,1.87000,1.77000,The Alliance,Exception Members,,1.44,,,,,,,1.03,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,outpatient,1,EA,1.87000,1.77000,The Alliance,Exception Members,,1.44,,,,,,,0.93500,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,inpatient,5,EA,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,165.11,291.19,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,outpatient,5,EA,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,150.10,291.19,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,The Alliance,Exception Members,,58.96,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Exception Members,,58.96,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,inpatient,0.5,EA,153.14000,145.48000,The Alliance,Exception Members,,117.92,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,outpatient,0.5,EA,153.14000,145.48000,The Alliance,Exception Members,,117.92,,,,,,,60.56,148.55,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,inpatient,1,EA,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,14.43,25.44,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,outpatient,1,EA,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,13.12,25.44,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,The Alliance,Exception Members,,399.63,,,,,,,285.45,503.43,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Exception Members,,399.63,,,,,,,48.58,503.43,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,inpatient,30,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,outpatient,30,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,Exception Members,GN,291.06,,,,,,,207.90,366.66,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Exception Members,GN,291.06,,,,,,,126.65,366.66,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.24015,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.24015,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,inpatient,1,EA,4.10000,3.89000,The Alliance,Exception Members,,3.16,,,,,,,2.25,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Exception Members,,3.16,,,,,,,0.24015,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.44,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,0.24015,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.24015,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,0.24015,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.24015,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,inpatient,1,EA,6.26000,5.95000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,outpatient,1,EA,6.26000,5.95000,The Alliance,Exception Members,,4.82,,,,,,,0.24015,6.07,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,157.00,304.58,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,Exception Members,GN,373.45,,,,,,,266.75,470.45,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Exception Members,GN,373.45,,,,,,,126.65,470.45,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,14.18,746.94,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,151.25,266.75,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,25.47,1324.17,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,inpatient,,,294.00000,279.30000,The Alliance,Exception Members,,226.38,,,,,,,161.70,285.18,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,outpatient,,,294.00000,279.30000,The Alliance,Exception Members,,226.38,,,,,,,161.70,5271.00,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,inpatient,,,5159.00000,4901.05000,The Alliance,Exception Members,,3972.43,,,,,,,2837.45,5004.23,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,outpatient,,,5159.00000,4901.05000,The Alliance,Exception Members,,3972.43,,,,,,,1475.05,17574.00,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,inpatient,,,454.00000,431.30000,The Alliance,Exception Members,GN,349.58,,,,,,,249.70,440.38,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Exception Members,GN,349.58,,,,,,,126.65,440.38,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,inpatient,1,mL,4070.06000,3866.55000,The Alliance,Exception Members,,3133.95,,,,,,,2238.53,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,outpatient,1,mL,4070.06000,3866.55000,The Alliance,Exception Members,,3133.95,,,,,,,32.29,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,inpatient,1,mL,3296.38000,3131.56000,The Alliance,Exception Members,,2538.21,,,,,,,1813.01,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,outpatient,1,mL,3296.38000,3131.56000,The Alliance,Exception Members,,2538.21,,,,,,,32.29,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,inpatient,1,mL,2714.00000,2578.30000,The Alliance,Exception Members,,2089.78,,,,,,,1492.70,2632.58,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,outpatient,1,mL,2714.00000,2578.30000,The Alliance,Exception Members,,2089.78,,,,,,,32.29,2632.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,0.24015,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,inpatient,1,EA,18.87000,17.93000,The Alliance,Exception Members,,14.53,,,,,,,10.38,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,outpatient,1,EA,18.87000,17.93000,The Alliance,Exception Members,,14.53,,,,,,,0.24015,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,inpatient,1,EA,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,10.22,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,0.24015,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,0.24015,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,0.24015,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,2.65,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Exception Members,,3.70,,,,,,,0.24015,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,inpatient,1,EA,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.24015,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,0.24015,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.24015,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,0.24015,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,inpatient,1,EA,4.72000,4.49000,The Alliance,Exception Members,,3.63,,,,,,,2.60,4.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,outpatient,1,EA,4.72000,4.49000,The Alliance,Exception Members,,3.63,,,,,,,0.24015,4.58,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,inpatient,1,mL,150.10000,142.60000,The Alliance,Exception Members,,115.58,,,,,,,82.56,145.60,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Exception Members,,115.58,,,,,,,75.05,145.60,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,21.23,1103.49,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,inpatient,0.5,EA,47.34000,44.97000,The Alliance,Exception Members,,36.45,,,,,,,26.04,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,outpatient,0.5,EA,47.34000,44.97000,The Alliance,Exception Members,,36.45,,,,,,,23.67,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,inpatient,0.5,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,outpatient,0.5,EA,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,75.84,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,inpatient,0.5,EA,352.92000,335.28000,The Alliance,Exception Members,,271.75,,,,,,,194.11,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,outpatient,0.5,EA,352.92000,335.28000,The Alliance,Exception Members,,271.75,,,,,,,176.46,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,inpatient,0.5,EA,352.91000,335.27000,The Alliance,Exception Members,,271.74,,,,,,,194.10,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,outpatient,0.5,EA,352.91000,335.27000,The Alliance,Exception Members,,271.74,,,,,,,176.46,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,inpatient,0.5,EA,164.32000,156.10000,The Alliance,Exception Members,,126.53,,,,,,,90.38,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,outpatient,0.5,EA,164.32000,156.10000,The Alliance,Exception Members,,126.53,,,,,,,82.16,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,inpatient,0.5,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,38.24,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,outpatient,0.5,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,34.76,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,inpatient,0.5,EA,309.68000,294.20000,The Alliance,Exception Members,,238.45,,,,,,,170.32,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,outpatient,0.5,EA,309.68000,294.20000,The Alliance,Exception Members,,238.45,,,,,,,154.84,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,inpatient,0.5,EA,20.22000,19.21000,The Alliance,Exception Members,,15.57,,,,,,,11.12,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,outpatient,0.5,EA,20.22000,19.21000,The Alliance,Exception Members,,15.57,,,,,,,10.11,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,inpatient,0.5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,outpatient,0.5,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,21.34,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,inpatient,1,EA,6.02000,5.72000,The Alliance,Exception Members,,4.64,,,,,,,3.31,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,outpatient,1,EA,6.02000,5.72000,The Alliance,Exception Members,,4.64,,,,,,,3.01,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,inpatient,1,EA,5.48000,5.21000,The Alliance,Exception Members,,4.22,,,,,,,3.01,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,outpatient,1,EA,5.48000,5.21000,The Alliance,Exception Members,,4.22,,,,,,,2.74,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,inpatient,1,EA,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,5.25,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,outpatient,1,EA,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,4.77,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,3.15,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,2.86,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,200.75,354.05,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,182.50,743.46,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,inpatient,,,422.00000,400.90000,The Alliance,Exception Members,,324.94,,,,,,,232.10,409.34,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,Exception Members,,324.94,,,,,,,200.06,409.34,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,The Alliance,Exception Members,,736.89,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Exception Members,,736.89,,,,,,,478.50,1267.58,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,5.77,305.58,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,4.40,237.65,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,4.40,237.65,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,inpatient,1,EA,4.49000,4.26000,The Alliance,Exception Members,,3.46,,,,,,,2.47,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,outpatient,1,EA,4.49000,4.26000,The Alliance,Exception Members,,3.46,,,,,,,2.25,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,inpatient,2,EA,15.72000,14.93000,The Alliance,Exception Members,,12.10,,,,,,,8.65,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,outpatient,2,EA,15.72000,14.93000,The Alliance,Exception Members,,12.10,,,,,,,2.72,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,inpatient,2,EA,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,outpatient,2,EA,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,2.72,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,inpatient,2,EA,10.39000,9.87000,The Alliance,Exception Members,,8.00,,,,,,,5.71,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,outpatient,2,EA,10.39000,9.87000,The Alliance,Exception Members,,8.00,,,,,,,2.72,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,inpatient,2,EA,10.93000,10.39000,The Alliance,Exception Members,,8.42,,,,,,,6.01,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,outpatient,2,EA,10.93000,10.39000,The Alliance,Exception Members,,8.42,,,,,,,2.72,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,inpatient,2,EA,9.65000,9.17000,The Alliance,Exception Members,,7.43,,,,,,,5.31,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,outpatient,2,EA,9.65000,9.17000,The Alliance,Exception Members,,7.43,,,,,,,2.72,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,inpatient,2,EA,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,outpatient,2,EA,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,2.72,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,inpatient,2,EA,13.49000,12.81000,The Alliance,Exception Members,,10.39,,,,,,,7.42,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,outpatient,2,EA,13.49000,12.81000,The Alliance,Exception Members,,10.39,,,,,,,2.72,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,inpatient,2,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,2.72,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,inpatient,2,EA,14.83000,14.09000,The Alliance,Exception Members,,11.42,,,,,,,8.16,14.39,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,outpatient,2,EA,14.83000,14.09000,The Alliance,Exception Members,,11.42,,,,,,,2.72,14.39,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,The Alliance,Exception Members,,12.94,,,,,,,9.24,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Exception Members,,12.94,,,,,,,8.40,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,The Alliance,Exception Members,,7.42,,,,,,,5.30,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Exception Members,,7.42,,,,,,,4.82,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,inpatient,1,EA,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.67,5.17,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,24.11,1137.41,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,inpatient,,,173.90000,165.20000,The Alliance,Exception Members,90,133.90,,,,,,,95.64,168.68,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Exception Members,90,133.90,,,,,,,15.49,780.94,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,inpatient,1,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,2.19,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,inpatient,1,EA,62.25000,59.14000,The Alliance,Exception Members,,47.93,,,,,,,34.24,60.38,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,outpatient,1,EA,62.25000,59.14000,The Alliance,Exception Members,,47.93,,,,,,,2.19,60.38,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,16.06,831.84,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,inpatient,,,819.00000,778.05000,The Alliance,Exception Members,,630.63,,,,,,,450.45,794.43,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,Exception Members,,630.63,,,,,,,450.45,3163.00,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,47.30,83.42,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,11.13,696.05,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,inpatient,1,mL,10.44000,9.92000,The Alliance,Exception Members,,8.04,,,,,,,5.74,10.13,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,outpatient,1,mL,10.44000,9.92000,The Alliance,Exception Members,,8.04,,,,,,,5.22,10.13,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,6.01,305.58,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,inpatient,1,EA,226.79000,215.45000,The Alliance,Exception Members,,174.63,,,,,,,124.73,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,outpatient,1,EA,226.79000,215.45000,The Alliance,Exception Members,,174.63,,,,,,,113.39,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,inpatient,1,EA,227.93000,216.53000,The Alliance,Exception Members,,175.51,,,,,,,125.36,221.09,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,outpatient,1,EA,227.93000,216.53000,The Alliance,Exception Members,,175.51,,,,,,,113.97,221.09,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,inpatient,,,2006.00000,1905.70000,The Alliance,Exception Members,TC,1544.62,,,,,,,1103.30,1945.82,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,outpatient,,,2006.00000,1905.70000,The Alliance,Exception Members,TC,1544.62,,,,,,,957.00,2210.07,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,16.62,882.80,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,inpatient,,,495.00000,470.25000,The Alliance,Exception Members,,381.15,,,,,,,272.25,480.15,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Exception Members,,381.15,,,,,,,46.98,2461.58,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,inpatient,,,1987.00000,1887.65000,The Alliance,Exception Members,TC,1529.99,,,,,,,1092.85,1927.39,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,outpatient,,,1987.00000,1887.65000,The Alliance,Exception Members,TC,1529.99,,,,,,,960.65,2210.07,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,inpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,47.85,84.39,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,5.50,288.61,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,inpatient,1,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,15.30,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,13.90,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,inpatient,1,EA,64.09000,60.89000,The Alliance,Exception Members,,49.35,,,,,,,35.25,62.17,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,outpatient,1,EA,64.09000,60.89000,The Alliance,Exception Members,,49.35,,,,,,,32.05,62.17,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,187.21,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,Exception Members,TC,617.54,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Exception Members,TC,617.54,,,,,,,389.35,2210.07,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,inpatient,2,EA,14.52000,13.79000,The Alliance,Exception Members,,11.18,,,,,,,7.99,14.08,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,outpatient,2,EA,14.52000,13.79000,The Alliance,Exception Members,,11.18,,,,,,,7.26,14.08,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.57,2.76,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.43,2.76,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,19.16,1646.71,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,14.14,746.94,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,inpatient,1,EA,3.04000,2.89000,The Alliance,Exception Members,,2.34,,,,,,,1.67,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,outpatient,1,EA,3.04000,2.89000,The Alliance,Exception Members,,2.34,,,,,,,1.52,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,inpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,227.15,400.61,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,35.09,1833.46,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,9.02,475.37,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,The Alliance,Exception Members,TC,2427.81,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Exception Members,TC,2427.81,,,,,,,1479.13,3058.41,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,5.88,305.58,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,100.10,176.54,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,16.80,882.80,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,inpatient,2,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,outpatient,2,EA,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.92,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,inpatient,2,EA,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,9.52,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,2.47,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,inpatient,2,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,outpatient,2,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,inpatient,2,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,2.10,3.70,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,outpatient,2,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,1.91,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,inpatient,2,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,outpatient,2,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,inpatient,2,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.20,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,outpatient,2,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.47,5.20,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,inpatient,,,2168.00000,2059.60000,The Alliance,Exception Members,TC,1669.36,,,,,,,1192.40,2102.96,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,outpatient,,,2168.00000,2059.60000,The Alliance,Exception Members,TC,1669.36,,,,,,,1050.98,2210.07,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,The Alliance,Exception Members,TC,1938.86,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Exception Members,TC,1938.86,,,,,,,1163.40,2442.46,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.97,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Exception Members,,8.36,,,,,,,5.43,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,inpatient,1,EA,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,4.90,8.64,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,outpatient,1,EA,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,4.46,8.64,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,inpatient,1,EA,1681.35000,1597.28000,The Alliance,Exception Members,,1294.64,,,,,,,924.74,1630.91,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,outpatient,1,EA,1681.35000,1597.28000,The Alliance,Exception Members,,1294.64,,,,,,,577.05,1630.91,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,Exception Members,,439.67,,,,,,,314.05,553.87,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Exception Members,,439.67,,,,,,,70.04,6756.70,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,90,120.89,,,,,,,86.35,152.29,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,90,120.89,,,,,,,17.85,814.87,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,inpatient,1,EA,23.76000,22.57000,The Alliance,Exception Members,,18.30,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,outpatient,1,EA,23.76000,22.57000,The Alliance,Exception Members,,18.30,,,,,,,11.88,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,11.88,23.05,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,inpatient,5,EA,64.51000,61.28000,The Alliance,Exception Members,,49.67,,,,,,,35.48,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,outpatient,5,EA,64.51000,61.28000,The Alliance,Exception Members,,49.67,,,,,,,32.26,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,inpatient,5,EA,7.34000,6.98000,The Alliance,Exception Members,,5.65,,,,,,,4.04,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,outpatient,5,EA,7.34000,6.98000,The Alliance,Exception Members,,5.65,,,,,,,3.67,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,inpatient,5,EA,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,4.09,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,outpatient,5,EA,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,3.71,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,inpatient,5,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,outpatient,5,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,4.90,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,inpatient,5,EA,9.79000,9.30000,The Alliance,Exception Members,,7.54,,,,,,,5.38,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,outpatient,5,EA,9.79000,9.30000,The Alliance,Exception Members,,7.54,,,,,,,4.89,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,inpatient,1,EA,2662.25000,2529.14000,The Alliance,Exception Members,,2049.93,,,,,,,1464.24,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,outpatient,1,EA,2662.25000,2529.14000,The Alliance,Exception Members,,2049.93,,,,,,,1.97,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,inpatient,1,EA,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,199.43,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Exception Members,,279.20,,,,,,,1.97,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,inpatient,1,EA,608.65000,578.22000,The Alliance,Exception Members,,468.66,,,,,,,334.76,590.39,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,outpatient,1,EA,608.65000,578.22000,The Alliance,Exception Members,,468.66,,,,,,,1.97,590.39,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.87,356.54,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,11.53,543.65,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,101.75,179.45,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,15.91,831.84,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,inpatient,2,EA,3.67000,3.48000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,outpatient,2,EA,3.67000,3.48000,The Alliance,Exception Members,,2.83,,,,,,,1.83,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,inpatient,2,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,outpatient,2,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,inpatient,2,EA,55.42000,52.65000,The Alliance,Exception Members,,42.67,,,,,,,30.48,53.76,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,outpatient,2,EA,55.42000,52.65000,The Alliance,Exception Members,,42.67,,,,,,,27.71,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,inpatient,2,EA,33.79000,32.10000,The Alliance,Exception Members,,26.02,,,,,,,18.58,32.78,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,outpatient,2,EA,33.79000,32.10000,The Alliance,Exception Members,,26.02,,,,,,,16.89,88.11,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,136.95,241.53,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,25.81,1341.13,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,inpatient,1,EA,10.52000,10.00000,The Alliance,Exception Members,,8.10,,,,,,,5.79,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,outpatient,1,EA,10.52000,10.00000,The Alliance,Exception Members,,8.10,,,,,,,5.26,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.00,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,inpatient,1,EA,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.89,5.10,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,outpatient,1,EA,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.63,5.10,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,5.79,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,5.79,333.61,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,inpatient,0.5,EA,261.85000,248.76000,The Alliance,Exception Members,,201.62,,,,,,,144.02,253.99,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,outpatient,0.5,EA,261.85000,248.76000,The Alliance,Exception Members,,201.62,,,,,,,130.93,253.99,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,inpatient,5,EA,114.66000,108.93000,The Alliance,Exception Members,,88.29,,,,,,,63.06,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,outpatient,5,EA,114.66000,108.93000,The Alliance,Exception Members,,88.29,,,,,,,57.33,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,inpatient,5,EA,109.85000,104.36000,The Alliance,Exception Members,,84.58,,,,,,,60.42,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,outpatient,5,EA,109.85000,104.36000,The Alliance,Exception Members,,84.58,,,,,,,54.92,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,inpatient,5,EA,134.53000,127.81000,The Alliance,Exception Members,,103.59,,,,,,,73.99,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,outpatient,5,EA,134.53000,127.81000,The Alliance,Exception Members,,103.59,,,,,,,67.27,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,inpatient,5,EA,119.69000,113.71000,The Alliance,Exception Members,,92.16,,,,,,,65.83,116.10,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,outpatient,5,EA,119.69000,113.71000,The Alliance,Exception Members,,92.16,,,,,,,59.84,116.10,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,19.75,38.31,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,267.30,471.42,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,70.04,7707.36,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,inpatient,1,EA,20.31000,19.30000,The Alliance,Exception Members,,15.64,,,,,,,11.17,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,outpatient,1,EA,20.31000,19.30000,The Alliance,Exception Members,,15.64,,,,,,,10.15,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,inpatient,1,EA,35.69000,33.91000,The Alliance,Exception Members,,27.48,,,,,,,19.63,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,outpatient,1,EA,35.69000,33.91000,The Alliance,Exception Members,,27.48,,,,,,,17.84,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,The Alliance,Exception Members,,24.60,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Exception Members,,24.60,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,inpatient,1,EA,7.99000,7.59000,The Alliance,Exception Members,,6.15,,,,,,,4.39,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,outpatient,1,EA,7.99000,7.59000,The Alliance,Exception Members,,6.15,,,,,,,4.00,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,inpatient,1,EA,38.08000,36.17000,The Alliance,Exception Members,,29.32,,,,,,,20.94,36.94,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,outpatient,1,EA,38.08000,36.17000,The Alliance,Exception Members,,29.32,,,,,,,19.04,36.94,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,Exception Members,90,444.29,,,,,,,317.35,559.69,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,Exception Members,90,444.29,,,,,,,70.04,7690.40,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,inpatient,,,5977.00000,5678.15000,The Alliance,Exception Members,TC,4602.29,,,,,,,3287.35,5797.69,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,outpatient,,,5977.00000,5678.15000,The Alliance,Exception Members,TC,4602.29,,,,,,,2988.50,7180.14,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,inpatient,2,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,outpatient,2,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,inpatient,2,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,3.55,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,outpatient,2,EA,6.45000,6.12000,The Alliance,Exception Members,,4.97,,,,,,,3.23,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Exception Members,,1.38,,,,,,,0.89500,1.74,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,inpatient,1,mL,13.87000,13.17000,The Alliance,Exception Members,,10.68,,,,,,,7.63,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,outpatient,1,mL,13.87000,13.17000,The Alliance,Exception Members,,10.68,,,,,,,6.93,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,inpatient,1,mL,6.31000,6.00000,The Alliance,Exception Members,,4.86,,,,,,,3.47,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,outpatient,1,mL,6.31000,6.00000,The Alliance,Exception Members,,4.86,,,,,,,3.15,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,inpatient,1,mL,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,inpatient,1,mL,9.70000,9.22000,The Alliance,Exception Members,,7.47,,,,,,,5.33,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,outpatient,1,mL,9.70000,9.22000,The Alliance,Exception Members,,7.47,,,,,,,4.85,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,inpatient,1,mL,21.93000,20.84000,The Alliance,Exception Members,,16.89,,,,,,,12.06,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,outpatient,1,mL,21.93000,20.84000,The Alliance,Exception Members,,16.89,,,,,,,10.96,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,inpatient,1,mL,9.23000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,5.08,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,outpatient,1,mL,9.23000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,4.62,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.15,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,inpatient,1,mL,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,inpatient,1,mL,107.83000,102.44000,The Alliance,Exception Members,,83.03,,,,,,,59.31,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,outpatient,1,mL,107.83000,102.44000,The Alliance,Exception Members,,83.03,,,,,,,1.97,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,inpatient,1,mL,118.50000,112.57000,The Alliance,Exception Members,,91.25,,,,,,,65.17,114.94,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,outpatient,1,mL,118.50000,112.57000,The Alliance,Exception Members,,91.25,,,,,,,1.97,114.94,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,inpatient,1,EA,19.58000,18.60000,The Alliance,Exception Members,,15.08,,,,,,,10.77,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,outpatient,1,EA,19.58000,18.60000,The Alliance,Exception Members,,15.08,,,,,,,9.79,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,inpatient,1,EA,56.44000,53.62000,The Alliance,Exception Members,,43.46,,,,,,,31.04,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,outpatient,1,EA,56.44000,53.62000,The Alliance,Exception Members,,43.46,,,,,,,28.22,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,inpatient,1,EA,0.78000,0.75000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,outpatient,1,EA,0.78000,0.75000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,inpatient,1,EA,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,outpatient,1,EA,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,TC,142.45,,,,,,,101.75,179.45,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,TC,142.45,,,,,,,92.50,2210.07,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,inpatient,3.5,EA,223.32000,212.15000,The Alliance,Exception Members,,171.96,,,,,,,122.83,216.62,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,outpatient,3.5,EA,223.32000,212.15000,The Alliance,Exception Members,,171.96,,,,,,,111.66,216.62,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,90,36.19,,,,,,,25.85,45.59,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,90,36.19,,,,,,,4.08,203.72,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,inpatient,1,mL,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,inpatient,1,mL,4.51000,4.28000,The Alliance,Exception Members,,3.47,,,,,,,2.48,4.37,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Exception Members,,3.47,,,,,,,2.25,4.37,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,inpatient,1,EA,7235.17000,6873.41000,The Alliance,Exception Members,,5571.08,,,,,,,3979.34,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,outpatient,1,EA,7235.17000,6873.41000,The Alliance,Exception Members,,5571.08,,,,,,,171.94,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,inpatient,1,EA,11815.83000,11225.04000,The Alliance,Exception Members,,9098.19,,,,,,,6498.71,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,outpatient,1,EA,11815.83000,11225.04000,The Alliance,Exception Members,,9098.19,,,,,,,171.94,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,inpatient,1,EA,15764.79000,14976.55000,The Alliance,Exception Members,,12138.89,,,,,,,8670.63,15291.85,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Exception Members,,12138.89,,,,,,,171.94,15291.85,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,inpatient,,,142.40000,135.28000,The Alliance,Exception Members,90,109.65,,,,,,,78.32,138.13,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Exception Members,90,109.65,,,,,,,12.32,628.12,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,inpatient,5,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,outpatient,5,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,inpatient,5,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,outpatient,5,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,inpatient,5,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,outpatient,5,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Exception Members,,29.61,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,inpatient,1,EA,38.84000,36.90000,The Alliance,Exception Members,,29.91,,,,,,,21.36,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,outpatient,1,EA,38.84000,36.90000,The Alliance,Exception Members,,29.91,,,,,,,19.42,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,inpatient,1,EA,37.34000,35.47000,The Alliance,Exception Members,,28.75,,,,,,,20.54,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,outpatient,1,EA,37.34000,35.47000,The Alliance,Exception Members,,28.75,,,,,,,18.67,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,inpatient,1,EA,14.20000,13.49000,The Alliance,Exception Members,,10.93,,,,,,,7.81,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,outpatient,1,EA,14.20000,13.49000,The Alliance,Exception Members,,10.93,,,,,,,7.10,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,The Alliance,Exception Members,,3.75,,,,,,,2.68,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Exception Members,,3.75,,,,,,,2.44,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,The Alliance,Exception Members,,24.60,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Exception Members,,24.60,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,inpatient,1,EA,10.65000,10.12000,The Alliance,Exception Members,,8.20,,,,,,,5.86,10.33,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,outpatient,1,EA,10.65000,10.12000,The Alliance,Exception Members,,8.20,,,,,,,5.33,10.33,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,inpatient,1,EA,252.80000,240.16000,The Alliance,Exception Members,,194.66,,,,,,,139.04,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,outpatient,1,EA,252.80000,240.16000,The Alliance,Exception Members,,194.66,,,,,,,2.47,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,inpatient,1,EA,218.47000,207.54000,The Alliance,Exception Members,,168.22,,,,,,,120.16,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,outpatient,1,EA,218.47000,207.54000,The Alliance,Exception Members,,168.22,,,,,,,2.47,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,inpatient,1,EA,263.86000,250.67000,The Alliance,Exception Members,,203.17,,,,,,,145.12,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,outpatient,1,EA,263.86000,250.67000,The Alliance,Exception Members,,203.17,,,,,,,2.47,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,inpatient,1,EA,245.53000,233.26000,The Alliance,Exception Members,,189.06,,,,,,,135.04,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,outpatient,1,EA,245.53000,233.26000,The Alliance,Exception Members,,189.06,,,,,,,2.47,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,inpatient,1,EA,243.32000,231.15000,The Alliance,Exception Members,,187.36,,,,,,,133.83,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,outpatient,1,EA,243.32000,231.15000,The Alliance,Exception Members,,187.36,,,,,,,2.47,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,inpatient,1,EA,244.43000,232.20000,The Alliance,Exception Members,,188.21,,,,,,,134.44,237.10,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,outpatient,1,EA,244.43000,232.20000,The Alliance,Exception Members,,188.21,,,,,,,2.47,237.10,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,396.00,698.40,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,360.00,4496.60,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,60.50,106.70,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,10.63,543.22,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.67,186.75,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,inpatient,2.5,EA,200.57000,190.54000,The Alliance,Exception Members,,154.44,,,,,,,110.31,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,outpatient,2.5,EA,200.57000,190.54000,The Alliance,Exception Members,,154.44,,,,,,,100.28,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,inpatient,2.5,EA,209.17000,198.71000,The Alliance,Exception Members,,161.06,,,,,,,115.04,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,outpatient,2.5,EA,209.17000,198.71000,The Alliance,Exception Members,,161.06,,,,,,,104.58,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,inpatient,2.5,EA,158.96000,151.01000,The Alliance,Exception Members,,122.40,,,,,,,87.43,154.19,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,outpatient,2.5,EA,158.96000,151.01000,The Alliance,Exception Members,,122.40,,,,,,,79.48,154.19,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,79.75,140.65,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,12.76,662.12,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,inpatient,1,EA,6411.37000,6090.80000,The Alliance,Exception Members,,4936.75,,,,,,,3526.25,6219.03,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,outpatient,1,EA,6411.37000,6090.80000,The Alliance,Exception Members,,4936.75,,,,,,,383.07,6219.03,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,inpatient,15,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,outpatient,15,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,inpatient,15,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,outpatient,15,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,The Alliance,Exception Members,TC,2524.06,,,,,,,1802.90,3179.66,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Exception Members,TC,2524.06,,,,,,,1489.61,7180.14,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,5.56,254.68,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,12.47,594.19,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,inpatient,1,EA,6835.14000,6493.38000,The Alliance,Exception Members,,5263.06,,,,,,,3759.33,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,outpatient,1,EA,6835.14000,6493.38000,The Alliance,Exception Members,,5263.06,,,,,,,1.85,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,inpatient,1,EA,906.50000,861.18000,The Alliance,Exception Members,,698.00,,,,,,,498.57,879.30,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,outpatient,1,EA,906.50000,861.18000,The Alliance,Exception Members,,698.00,,,,,,,1.85,879.30,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,inpatient,5,EA,7.64000,7.26000,The Alliance,Exception Members,,5.88,,,,,,,4.20,7.41,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,outpatient,5,EA,7.64000,7.26000,The Alliance,Exception Members,,5.88,,,,,,,1.35,7.41,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,110.00,194.00,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,11.53,594.19,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,14.39,746.94,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,inpatient,1,EA,1924.24000,1828.03000,The Alliance,Exception Members,,1481.66,,,,,,,1058.33,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,outpatient,1,EA,1924.24000,1828.03000,The Alliance,Exception Members,,1481.66,,,,,,,1.85,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,inpatient,1,EA,276.50000,262.68000,The Alliance,Exception Members,,212.91,,,,,,,152.07,268.20,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,outpatient,1,EA,276.50000,262.68000,The Alliance,Exception Members,,212.91,,,,,,,1.85,268.20,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.14,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.04,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,3.95,203.72,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,4686.00,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,inpatient,,,215.00000,204.25000,The Alliance,Exception Members,,165.55,,,,,,,118.25,208.55,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Exception Members,,165.55,,,,,,,118.25,3163.00,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,3.48,169.79,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,inpatient,15,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,outpatient,15,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,inpatient,15,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,outpatient,15,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,inpatient,15,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,outpatient,15,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,64.90,114.46,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,59.00,6094.58,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,inpatient,,,794.00000,754.30000,The Alliance,Exception Members,TC,611.38,,,,,,,436.70,770.18,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,outpatient,,,794.00000,754.30000,The Alliance,Exception Members,TC,611.38,,,,,,,313.12,770.18,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,170.50,300.70,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,155.00,1239.81,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,inpatient,,,335.80000,319.01000,The Alliance,Exception Members,,258.57,,,,,,,184.69,325.73,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,outpatient,,,335.80000,319.01000,The Alliance,Exception Members,,258.57,,,,,,,23.25,325.73,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,4.52,237.65,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,134.20,236.68,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,20.81,1086.52,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,200.75,354.05,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,35.09,1833.46,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,inpatient,1,EA,29.58000,28.10000,The Alliance,Exception Members,,22.78,,,,,,,16.27,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,outpatient,1,EA,29.58000,28.10000,The Alliance,Exception Members,,22.78,,,,,,,1.35,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,inpatient,1,EA,25.56000,24.29000,The Alliance,Exception Members,,19.68,,,,,,,14.06,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,outpatient,1,EA,25.56000,24.29000,The Alliance,Exception Members,,19.68,,,,,,,1.35,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,1.35,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,inpatient,1,EA,28.09000,26.69000,The Alliance,Exception Members,,21.63,,,,,,,15.45,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,outpatient,1,EA,28.09000,26.69000,The Alliance,Exception Members,,21.63,,,,,,,1.35,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,inpatient,1,EA,16.59000,15.76000,The Alliance,Exception Members,,12.77,,,,,,,9.12,16.09,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,outpatient,1,EA,16.59000,15.76000,The Alliance,Exception Members,,12.77,,,,,,,1.35,16.09,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,inpatient,1,EA,1.74000,1.66000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,outpatient,1,EA,1.74000,1.66000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.74,305.58,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,The Alliance,Exception Members,,5.34,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Exception Members,,5.34,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,The Alliance,Exception Members,,5.34,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Exception Members,,5.34,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,6.37,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,5.79,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,inpatient,1,EA,9.27000,8.81000,The Alliance,Exception Members,,7.14,,,,,,,5.10,8.99,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,outpatient,1,EA,9.27000,8.81000,The Alliance,Exception Members,,7.14,,,,,,,4.63,8.99,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,Exception Members,TC,555.94,,,,,,,397.10,700.34,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Exception Members,TC,555.94,,,,,,,361.00,700.34,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,14.41,746.94,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,107.25,189.15,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,56.40,189.15,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,90,115.50,,,,,,,82.50,145.50,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,90,115.50,,,,,,,17.85,814.87,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,TC,260.26,,,,,,,185.90,327.86,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,TC,260.26,,,,,,,169.00,584.87,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,inpatient,1,mL,1601.79000,1521.70000,The Alliance,Exception Members,,1233.38,,,,,,,880.98,1553.74,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,outpatient,1,mL,1601.79000,1521.70000,The Alliance,Exception Members,,1233.38,,,,,,,13.12,1553.74,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,inpatient,1,EA,30.15000,28.64000,The Alliance,Exception Members,,23.22,,,,,,,16.58,29.25,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,outpatient,1,EA,30.15000,28.64000,The Alliance,Exception Members,,23.22,,,,,,,15.07,29.25,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,5.08,254.68,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,Exception Members,,166.32,,,,,,,118.80,209.52,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Exception Members,,166.32,,,,,,,20.81,1086.52,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,inpatient,1,mL,389.56000,370.08000,The Alliance,Exception Members,,299.96,,,,,,,214.26,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,outpatient,1,mL,389.56000,370.08000,The Alliance,Exception Members,,299.96,,,,,,,24.51,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,inpatient,1,mL,2444.96000,2322.71000,The Alliance,Exception Members,,1882.62,,,,,,,1344.73,2371.61,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,outpatient,1,mL,2444.96000,2322.71000,The Alliance,Exception Members,,1882.62,,,,,,,24.51,2371.61,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,inpatient,15,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,outpatient,15,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,inpatient,80,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,outpatient,80,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,inpatient,80,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,inpatient,80,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,outpatient,80,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,The Alliance,Exception Members,TC,2581.04,,,,,,,1843.60,3251.44,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Exception Members,TC,2581.04,,,,,,,1676.00,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Exception Members,,264.83,,,,,,,5.79,333.61,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,Exception Members,90,207.90,,,,,,,148.50,261.90,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Exception Members,90,207.90,,,,,,,32.70,2665.30,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,inpatient,,,83.60000,79.42000,The Alliance,Exception Members,90,64.37,,,,,,,45.98,81.09,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Exception Members,90,64.37,,,,,,,8.17,662.12,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,3.17,169.79,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,inpatient,,,5196.00000,4936.20000,The Alliance,Exception Members,90,4000.92,,,,,,,2857.80,5040.12,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,outpatient,,,5196.00000,4936.20000,The Alliance,Exception Members,90,4000.92,,,,,,,533.12,27787.37,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,457.05,806.07,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,384.16,806.07,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,inpatient,,,729.00000,692.55000,The Alliance,Exception Members,TC,561.33,,,,,,,400.95,707.13,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,outpatient,,,729.00000,692.55000,The Alliance,Exception Members,TC,561.33,,,,,,,364.50,707.13,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,Exception Members,TC,321.09,,,,,,,229.35,404.49,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Exception Members,TC,321.09,,,,,,,208.50,584.87,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,inpatient,60,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,outpatient,60,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,inpatient,60,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,outpatient,60,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,inpatient,60,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,outpatient,60,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,282.15,497.61,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,215.27,548.00,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,inpatient,1,mL,246.06000,233.75000,The Alliance,Exception Members,,189.47,,,,,,,135.33,238.68,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,outpatient,1,mL,246.06000,233.75000,The Alliance,Exception Members,,189.47,,,,,,,13.29,238.68,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,The Alliance,Exception Members,TC,861.63,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Exception Members,TC,861.63,,,,,,,384.16,1085.43,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,382.80,675.12,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,348.00,675.12,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,inpatient,,,38.00000,36.10000,The Alliance,Exception Members,,29.26,,,,,,,20.90,36.86,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Exception Members,,29.26,,,,,,,3.05,152.82,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,15.50,814.87,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,Exception Members,TC,447.37,,,,,,,319.55,563.57,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Exception Members,TC,447.37,,,,,,,290.50,584.87,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,584.87,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,inpatient,1,EA,25.18000,23.92000,The Alliance,Exception Members,,19.39,,,,,,,13.85,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,outpatient,1,EA,25.18000,23.92000,The Alliance,Exception Members,,19.39,,,,,,,12.59,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,inpatient,1,EA,12.70000,12.07000,The Alliance,Exception Members,,9.78,,,,,,,6.99,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,outpatient,1,EA,12.70000,12.07000,The Alliance,Exception Members,,9.78,,,,,,,6.35,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,2.10,3.70,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Exception Members,,2.93,,,,,,,1.91,3.70,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,30.25,53.35,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,5.67,254.68,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,154.77,548.00,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,13.54,713.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,inpatient,15,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,outpatient,15,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,inpatient,15,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,outpatient,15,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,inpatient,15,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,outpatient,15,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,inpatient,15,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,outpatient,15,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,inpatient,,,850.00000,807.50000,The Alliance,Exception Members,TC,654.50,,,,,,,467.50,824.50,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Exception Members,TC,654.50,,,,,,,384.16,824.50,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,inpatient,,,641.00000,608.95000,The Alliance,Exception Members,TC,493.57,,,,,,,352.55,621.77,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Exception Members,TC,493.57,,,,,,,320.50,621.77,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,Exception Members,TC,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Exception Members,TC,797.72,,,,,,,384.16,1004.92,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,inpatient,,,963.00000,914.85000,The Alliance,Exception Members,TC,741.51,,,,,,,529.65,934.11,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,outpatient,,,963.00000,914.85000,The Alliance,Exception Members,TC,741.51,,,,,,,384.16,934.11,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,Exception Members,TC,731.50,,,,,,,522.50,921.50,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Exception Members,TC,731.50,,,,,,,384.16,921.50,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,inpatient,15,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,outpatient,15,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,inpatient,15,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,outpatient,15,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,inpatient,15,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,outpatient,15,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,inpatient,15,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,outpatient,15,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,inpatient,15,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,outpatient,15,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,inpatient,15,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,outpatient,15,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,567.05,1000.07,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,384.16,1000.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,inpatient,5,EA,20.05000,19.04000,The Alliance,Exception Members,,15.44,,,,,,,11.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,outpatient,5,EA,20.05000,19.04000,The Alliance,Exception Members,,15.44,,,,,,,10.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,inpatient,5,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,outpatient,5,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,inpatient,5,EA,10.93000,10.38000,The Alliance,Exception Members,,8.42,,,,,,,6.01,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,outpatient,5,EA,10.93000,10.38000,The Alliance,Exception Members,,8.42,,,,,,,5.46,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,inpatient,5,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,outpatient,5,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,inpatient,5,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,outpatient,5,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.12,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,inpatient,5,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,outpatient,5,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,inpatient,,,706.00000,670.70000,The Alliance,Exception Members,TC,543.62,,,,,,,388.30,684.82,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Exception Members,TC,543.62,,,,,,,353.00,684.82,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,13.54,713.01,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,inpatient,1,mL,25.54000,24.26000,The Alliance,Exception Members,,19.67,,,,,,,14.05,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,outpatient,1,mL,25.54000,24.26000,The Alliance,Exception Members,,19.67,,,,,,,12.77,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,inpatient,1,mL,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,6.52,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,outpatient,1,mL,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,5.92,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.32,12.26,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,inpatient,1,EA,16.60000,15.77000,The Alliance,Exception Members,,12.78,,,,,,,9.13,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,outpatient,1,EA,16.60000,15.77000,The Alliance,Exception Members,,12.78,,,,,,,8.30,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,The Alliance,Exception Members,,20.39,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Exception Members,,20.39,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,inpatient,1,EA,9.77000,9.28000,The Alliance,Exception Members,,7.52,,,,,,,5.37,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,outpatient,1,EA,9.77000,9.28000,The Alliance,Exception Members,,7.52,,,,,,,4.88,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,The Alliance,Exception Members,,15.84,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Exception Members,,15.84,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,inpatient,1,EA,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,8.38,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,outpatient,1,EA,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,7.62,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,inpatient,1,EA,12.83000,12.19000,The Alliance,Exception Members,,9.88,,,,,,,7.06,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,outpatient,1,EA,12.83000,12.19000,The Alliance,Exception Members,,9.88,,,,,,,6.42,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,inpatient,1,EA,19.91000,18.91000,The Alliance,Exception Members,,15.33,,,,,,,10.95,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,outpatient,1,EA,19.91000,18.91000,The Alliance,Exception Members,,15.33,,,,,,,9.96,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.95,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.13,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,inpatient,1,EA,16.62000,15.79000,The Alliance,Exception Members,,12.80,,,,,,,9.14,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,outpatient,1,EA,16.62000,15.79000,The Alliance,Exception Members,,12.80,,,,,,,8.31,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,13.43,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,6.07,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,5.51,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,inpatient,1,EA,12.51000,11.89000,The Alliance,Exception Members,,9.63,,,,,,,6.88,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,outpatient,1,EA,12.51000,11.89000,The Alliance,Exception Members,,9.63,,,,,,,6.25,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,9.04,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,8.21,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,inpatient,1,EA,6.54000,6.21000,The Alliance,Exception Members,,5.04,,,,,,,3.60,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,outpatient,1,EA,6.54000,6.21000,The Alliance,Exception Members,,5.04,,,,,,,3.27,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,19.75,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,inpatient,1,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,8.26,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,7.50,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,inpatient,1,EA,58.52000,55.59000,The Alliance,Exception Members,,45.06,,,,,,,32.19,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,outpatient,1,EA,58.52000,55.59000,The Alliance,Exception Members,,45.06,,,,,,,29.26,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,inpatient,1,EA,91.70000,87.12000,The Alliance,Exception Members,,70.61,,,,,,,50.44,88.95,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,outpatient,1,EA,91.70000,87.12000,The Alliance,Exception Members,,70.61,,,,,,,45.85,88.95,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,The Alliance,Exception Members,TC,1076.46,,,,,,,768.90,1356.06,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Exception Members,TC,1076.46,,,,,,,384.16,1356.06,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,384.16,867.18,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,7.20,339.51,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,The Alliance,Exception Members,,35391.17,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Exception Members,,35391.17,,,,,,,157.68,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,inpatient,1,mL,52901.43000,50256.36000,The Alliance,Exception Members,,40734.10,,,,,,,29095.79,51314.39,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,outpatient,1,mL,52901.43000,50256.36000,The Alliance,Exception Members,,40734.10,,,,,,,157.68,51314.39,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,36.26,1833.46,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,145.20,256.08,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,110.28,548.00,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,inpatient,1,mL,16.99000,16.14000,The Alliance,Exception Members,,13.08,,,,,,,9.34,16.48,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,outpatient,1,mL,16.99000,16.14000,The Alliance,Exception Members,,13.08,,,,,,,7.96,16.48,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,inpatient,1,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,10.81,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,outpatient,1,EA,19.66000,18.67000,The Alliance,Exception Members,,15.14,,,,,,,3.02,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,3.02,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,inpatient,1,EA,51.45000,48.88000,The Alliance,Exception Members,,39.62,,,,,,,28.30,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,outpatient,1,EA,51.45000,48.88000,The Alliance,Exception Members,,39.62,,,,,,,3.02,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,inpatient,1,EA,11.80000,11.21000,The Alliance,Exception Members,,9.09,,,,,,,6.49,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,outpatient,1,EA,11.80000,11.21000,The Alliance,Exception Members,,9.09,,,,,,,3.02,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,3.02,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,inpatient,1,EA,50.69000,48.15000,The Alliance,Exception Members,,39.03,,,,,,,27.88,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,outpatient,1,EA,50.69000,48.15000,The Alliance,Exception Members,,39.03,,,,,,,3.02,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,9.04,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Exception Members,,12.65,,,,,,,3.02,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,3.02,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,inpatient,1,EA,50.24000,47.73000,The Alliance,Exception Members,,38.68,,,,,,,27.63,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,outpatient,1,EA,50.24000,47.73000,The Alliance,Exception Members,,38.68,,,,,,,3.02,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,inpatient,1,EA,13.59000,12.91000,The Alliance,Exception Members,,10.46,,,,,,,7.47,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,outpatient,1,EA,13.59000,12.91000,The Alliance,Exception Members,,10.46,,,,,,,3.02,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,inpatient,1,EA,8.80000,8.36000,The Alliance,Exception Members,,6.78,,,,,,,4.84,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Exception Members,,6.78,,,,,,,3.02,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,inpatient,1,EA,16.42000,15.60000,The Alliance,Exception Members,,12.64,,,,,,,9.03,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,outpatient,1,EA,16.42000,15.60000,The Alliance,Exception Members,,12.64,,,,,,,3.02,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,3.02,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,inpatient,1,EA,18.93000,17.98000,The Alliance,Exception Members,,14.58,,,,,,,10.41,18.36,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Exception Members,,14.58,,,,,,,3.02,18.36,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,2522.85,4449.39,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,1538.48,4686.00,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,inpatient,,,1068.00000,1014.60000,The Alliance,Exception Members,TC,822.36,,,,,,,587.40,1035.96,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,outpatient,,,1068.00000,1014.60000,The Alliance,Exception Members,TC,822.36,,,,,,,384.16,1035.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,inpatient,1,EA,23.41000,22.24000,The Alliance,Exception Members,,18.03,,,,,,,12.88,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,outpatient,1,EA,23.41000,22.24000,The Alliance,Exception Members,,18.03,,,,,,,11.71,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,6.52,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,5.92,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,inpatient,1,EA,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,outpatient,1,EA,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,2.04,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Exception Members,,2.85,,,,,,,1.85,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.86,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.69,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.90,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.18,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,6.38,11.25,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,5.80,11.25,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,inpatient,,,613.00000,582.35000,The Alliance,Exception Members,TC,472.01,,,,,,,337.15,594.61,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,Exception Members,TC,472.01,,,,,,,306.50,594.61,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,31.28,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,3.14,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,3.14,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,inpatient,1,mL,27.71000,26.32000,The Alliance,Exception Members,,21.34,,,,,,,15.24,26.88,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,outpatient,1,mL,27.71000,26.32000,The Alliance,Exception Members,,21.34,,,,,,,3.14,26.88,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,inpatient,1,EA,25.79000,24.50000,The Alliance,Exception Members,,19.86,,,,,,,14.18,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,outpatient,1,EA,25.79000,24.50000,The Alliance,Exception Members,,19.86,,,,,,,3.02,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,3.02,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,3.02,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,inpatient,1,EA,7.81000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,4.30,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,outpatient,1,EA,7.81000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,3.02,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,3.02,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,inpatient,1,EA,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.90,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Exception Members,,4.07,,,,,,,2.64,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,inpatient,1,EA,25.41000,24.14000,The Alliance,Exception Members,,19.57,,,,,,,13.98,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,outpatient,1,EA,25.41000,24.14000,The Alliance,Exception Members,,19.57,,,,,,,3.02,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,inpatient,1,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,7.39,13.03,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Exception Members,,10.34,,,,,,,3.02,13.03,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,The Alliance,Exception Members,,9.64,,,,,,,6.89,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Exception Members,,9.64,,,,,,,6.26,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,inpatient,1,EA,44.47000,42.25000,The Alliance,Exception Members,,34.24,,,,,,,24.46,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,outpatient,1,EA,44.47000,42.25000,The Alliance,Exception Members,,34.24,,,,,,,22.23,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,8.17,679.08,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,TC,1975.82,,,,,,,1411.30,2489.02,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,TC,1975.82,,,,,,,1283.00,2489.02,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,3.14,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,3.14,91.96,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,73.15,129.01,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Exception Members,TC,102.41,,,,,,,66.50,584.87,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,3.02,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,inpatient,1,EA,285.22000,270.96000,The Alliance,Exception Members,,219.62,,,,,,,156.87,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,outpatient,1,EA,285.22000,270.96000,The Alliance,Exception Members,,219.62,,,,,,,3.02,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,inpatient,1,EA,63.17000,60.01000,The Alliance,Exception Members,,48.64,,,,,,,34.74,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,outpatient,1,EA,63.17000,60.01000,The Alliance,Exception Members,,48.64,,,,,,,3.02,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,inpatient,1,EA,217.76000,206.87000,The Alliance,Exception Members,,167.68,,,,,,,119.77,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,outpatient,1,EA,217.76000,206.87000,The Alliance,Exception Members,,167.68,,,,,,,3.02,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,inpatient,1,EA,95.12000,90.36000,The Alliance,Exception Members,,73.24,,,,,,,52.32,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,outpatient,1,EA,95.12000,90.36000,The Alliance,Exception Members,,73.24,,,,,,,3.02,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,inpatient,1,EA,157.97000,150.07000,The Alliance,Exception Members,,121.64,,,,,,,86.88,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,outpatient,1,EA,157.97000,150.07000,The Alliance,Exception Members,,121.64,,,,,,,3.02,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,inpatient,1,EA,251.22000,238.66000,The Alliance,Exception Members,,193.44,,,,,,,138.17,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,outpatient,1,EA,251.22000,238.66000,The Alliance,Exception Members,,193.44,,,,,,,3.02,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,inpatient,1,EA,281.02000,266.97000,The Alliance,Exception Members,,216.39,,,,,,,154.56,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,outpatient,1,EA,281.02000,266.97000,The Alliance,Exception Members,,216.39,,,,,,,3.02,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,3.02,91.96,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,inpatient,,,372.00000,353.40000,The Alliance,Exception Members,,286.44,,,,,,,204.60,360.84,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,outpatient,,,372.00000,353.40000,The Alliance,Exception Members,,286.44,,,,,,,35.09,1833.46,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,Exception Members,,592.13,,,,,,,422.95,745.93,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Exception Members,,592.13,,,,,,,384.50,745.93,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,inpatient,1,EA,37.70000,35.81000,The Alliance,Exception Members,,29.03,,,,,,,20.73,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,outpatient,1,EA,37.70000,35.81000,The Alliance,Exception Members,,29.03,,,,,,,18.85,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Exception Members,,1.97,,,,,,,1.28,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,The Alliance,Exception Members,,6.35,,,,,,,4.54,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Exception Members,,6.35,,,,,,,4.12,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,inpatient,1,EA,12.21000,11.60000,The Alliance,Exception Members,,9.40,,,,,,,6.72,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,outpatient,1,EA,12.21000,11.60000,The Alliance,Exception Members,,9.40,,,,,,,6.11,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1475.05,4686.00,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,inpatient,,,888.00000,843.60000,The Alliance,Exception Members,TC,683.76,,,,,,,488.40,861.36,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,outpatient,,,888.00000,843.60000,The Alliance,Exception Members,TC,683.76,,,,,,,384.16,861.36,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,548.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,inpatient,1,EA,30.62000,29.09000,The Alliance,Exception Members,,23.58,,,,,,,16.84,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,outpatient,1,EA,30.62000,29.09000,The Alliance,Exception Members,,23.58,,,,,,,3.02,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,3.02,27.59,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,inpatient,1,EA,36.27000,34.45000,The Alliance,Exception Members,,27.93,,,,,,,19.95,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,outpatient,1,EA,36.27000,34.45000,The Alliance,Exception Members,,27.93,,,,,,,18.14,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,90,122.58,,,,,,,87.56,154.42,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,90,122.58,,,,,,,14.18,713.01,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,28.10,1476.99,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,inpatient,1,EA,5.20000,4.94000,The Alliance,Exception Members,,4.00,,,,,,,2.86,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,outpatient,1,EA,5.20000,4.94000,The Alliance,Exception Members,,4.00,,,,,,,2.60,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,inpatient,1,EA,9.74000,9.26000,The Alliance,Exception Members,,7.50,,,,,,,5.36,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,outpatient,1,EA,9.74000,9.26000,The Alliance,Exception Members,,7.50,,,,,,,4.87,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,5.82,271.65,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,inpatient,,,892.00000,847.40000,The Alliance,Exception Members,,686.84,,,,,,,490.60,865.24,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,Exception Members,,686.84,,,,,,,446.00,865.24,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,inpatient,2,EA,46.41000,44.09000,The Alliance,Exception Members,,35.74,,,,,,,25.53,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,outpatient,2,EA,46.41000,44.09000,The Alliance,Exception Members,,35.74,,,,,,,23.20,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,inpatient,2,EA,28.92000,27.47000,The Alliance,Exception Members,,22.27,,,,,,,15.91,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,outpatient,2,EA,28.92000,27.47000,The Alliance,Exception Members,,22.27,,,,,,,14.46,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,inpatient,2,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,outpatient,2,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,inpatient,2,EA,50.80000,48.26000,The Alliance,Exception Members,,39.12,,,,,,,27.94,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,outpatient,2,EA,50.80000,48.26000,The Alliance,Exception Members,,39.12,,,,,,,25.40,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,inpatient,2,EA,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,4.00,7.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,3.63,7.05,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,15.08,780.94,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,10.77,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Exception Members,,15.08,,,,,,,9.79,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,inpatient,1,EA,4.56000,4.33000,The Alliance,Exception Members,,3.51,,,,,,,2.51,4.42,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,outpatient,1,EA,4.56000,4.33000,The Alliance,Exception Members,,3.51,,,,,,,2.28,4.42,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,Exception Members,TC,602.14,,,,,,,430.10,758.54,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,Exception Members,TC,602.14,,,,,,,384.16,758.54,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,548.00,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,inpatient,,,296.20000,281.39000,The Alliance,Exception Members,90,228.07,,,,,,,162.91,287.31,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Exception Members,90,228.07,,,,,,,26.94,1358.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,inpatient,0.5,EA,29.99000,28.49000,The Alliance,Exception Members,,23.09,,,,,,,16.49,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,outpatient,0.5,EA,29.99000,28.49000,The Alliance,Exception Members,,23.09,,,,,,,3.79,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,inpatient,0.5,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,outpatient,0.5,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,3.79,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,inpatient,0.5,EA,154.73000,147.00000,The Alliance,Exception Members,,119.14,,,,,,,85.10,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,outpatient,0.5,EA,154.73000,147.00000,The Alliance,Exception Members,,119.14,,,,,,,3.79,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,inpatient,0.5,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,outpatient,0.5,EA,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,3.79,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,inpatient,0.5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,outpatient,0.5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,3.79,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,inpatient,0.5,EA,156.29000,148.48000,The Alliance,Exception Members,,120.34,,,,,,,85.96,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,outpatient,0.5,EA,156.29000,148.48000,The Alliance,Exception Members,,120.34,,,,,,,3.79,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,inpatient,0.5,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,outpatient,0.5,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,3.79,38.31,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,inpatient,1,EA,3.75000,3.57000,The Alliance,Exception Members,,2.89,,,,,,,2.06,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,outpatient,1,EA,3.75000,3.57000,The Alliance,Exception Members,,2.89,,,,,,,1.88,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,inpatient,1,EA,7.04000,6.69000,The Alliance,Exception Members,,5.42,,,,,,,3.87,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Exception Members,,5.42,,,,,,,3.52,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.74,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,inpatient,1,EA,6.52000,6.19000,The Alliance,Exception Members,,5.02,,,,,,,3.59,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,outpatient,1,EA,6.52000,6.19000,The Alliance,Exception Members,,5.02,,,,,,,3.26,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,Exception Members,TC,696.08,,,,,,,497.20,876.88,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Exception Members,TC,696.08,,,,,,,384.16,876.88,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,inpatient,,,164.80000,156.56000,The Alliance,Exception Members,90,126.90,,,,,,,90.64,159.86,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Exception Members,90,126.90,,,,,,,19.61,1052.52,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,The Alliance,Exception Members,,5.05,,,,,,,3.61,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Exception Members,,5.05,,,,,,,3.28,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.62,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Exception Members,,3.67,,,,,,,2.38,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,13.75,24.25,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,12.50,24.25,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,inpatient,60,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,outpatient,60,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,inpatient,60,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,outpatient,60,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,inpatient,30,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,outpatient,30,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,90,113.96,,,,,,,81.40,143.56,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,90,113.96,,,,,,,17.93,1850.43,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,inpatient,1,EA,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.99,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,outpatient,1,EA,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.81,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,3.50,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Exception Members,,4.90,,,,,,,3.19,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,inpatient,1,EA,6.80000,6.46000,The Alliance,Exception Members,,5.24,,,,,,,3.74,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,outpatient,1,EA,6.80000,6.46000,The Alliance,Exception Members,,5.24,,,,,,,3.40,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,inpatient,,,162.60000,154.47000,The Alliance,Exception Members,90,125.20,,,,,,,89.43,157.72,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Exception Members,90,125.20,,,,,,,16.32,797.91,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,151.25,266.75,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,137.50,1430.78,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,166.10,292.94,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,101.94,1193.49,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,inpatient,1,EA,154.74000,147.00000,The Alliance,Exception Members,,119.15,,,,,,,85.11,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,outpatient,1,EA,154.74000,147.00000,The Alliance,Exception Members,,119.15,,,,,,,3.79,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,inpatient,1,EA,151.66000,144.08000,The Alliance,Exception Members,,116.78,,,,,,,83.41,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,outpatient,1,EA,151.66000,144.08000,The Alliance,Exception Members,,116.78,,,,,,,3.79,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,inpatient,1,EA,152.44000,144.82000,The Alliance,Exception Members,,117.38,,,,,,,83.84,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,outpatient,1,EA,152.44000,144.82000,The Alliance,Exception Members,,117.38,,,,,,,3.79,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,inpatient,1,EA,150.13000,142.63000,The Alliance,Exception Members,,115.60,,,,,,,82.57,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,outpatient,1,EA,150.13000,142.63000,The Alliance,Exception Members,,115.60,,,,,,,3.79,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,inpatient,1,EA,135.14000,128.39000,The Alliance,Exception Members,,104.06,,,,,,,74.33,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,outpatient,1,EA,135.14000,128.39000,The Alliance,Exception Members,,104.06,,,,,,,3.79,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,inpatient,1,EA,135.15000,128.40000,The Alliance,Exception Members,,104.07,,,,,,,74.33,131.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,outpatient,1,EA,135.15000,128.40000,The Alliance,Exception Members,,104.07,,,,,,,3.79,131.10,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,TC,89.32,,,,,,,63.80,112.52,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,TC,89.32,,,,,,,58.00,896.81,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,inpatient,1,EA,3.76000,3.58000,The Alliance,Exception Members,,2.90,,,,,,,2.07,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,outpatient,1,EA,3.76000,3.58000,The Alliance,Exception Members,,2.90,,,,,,,1.88,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,The Alliance,Exception Members,,5.44,,,,,,,3.88,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Exception Members,,5.44,,,,,,,3.53,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,2.02,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,inpatient,1,EA,255.96000,243.16000,The Alliance,Exception Members,,197.09,,,,,,,140.78,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Exception Members,,197.09,,,,,,,2.02,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,inpatient,1,EA,409.34000,388.88000,The Alliance,Exception Members,,315.19,,,,,,,225.14,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,outpatient,1,EA,409.34000,388.88000,The Alliance,Exception Members,,315.19,,,,,,,2.02,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,inpatient,1,EA,72.68000,69.05000,The Alliance,Exception Members,,55.96,,,,,,,39.97,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,outpatient,1,EA,72.68000,69.05000,The Alliance,Exception Members,,55.96,,,,,,,2.02,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,2.02,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,inpatient,1,EA,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,outpatient,1,EA,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,2.02,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,inpatient,1,EA,272.22000,258.61000,The Alliance,Exception Members,,209.61,,,,,,,149.72,264.05,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,outpatient,1,EA,272.22000,258.61000,The Alliance,Exception Members,,209.61,,,,,,,2.02,264.05,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,9.09,29.10,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,inpatient,1,EA,21.87000,20.77000,The Alliance,Exception Members,,16.84,,,,,,,12.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,outpatient,1,EA,21.87000,20.77000,The Alliance,Exception Members,,16.84,,,,,,,1.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,inpatient,1,EA,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,12.15,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,1.03,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,inpatient,1,EA,15.09000,14.33000,The Alliance,Exception Members,,11.62,,,,,,,8.30,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Exception Members,,11.62,,,,,,,1.03,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,inpatient,1,EA,8.63000,8.20000,The Alliance,Exception Members,,6.65,,,,,,,4.75,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Exception Members,,6.65,,,,,,,1.03,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,1.03,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,inpatient,1,EA,21.84000,20.74000,The Alliance,Exception Members,,16.82,,,,,,,12.01,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,outpatient,1,EA,21.84000,20.74000,The Alliance,Exception Members,,16.82,,,,,,,1.03,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,1.03,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,inpatient,1,EA,11.25000,10.69000,The Alliance,Exception Members,,8.66,,,,,,,6.19,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,outpatient,1,EA,11.25000,10.69000,The Alliance,Exception Members,,8.66,,,,,,,1.03,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,inpatient,1,EA,8.65000,8.22000,The Alliance,Exception Members,,6.66,,,,,,,4.76,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Exception Members,,6.66,,,,,,,1.03,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,1.03,5.45,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,inpatient,,,865.00000,821.75000,The Alliance,Exception Members,TC,666.05,,,,,,,475.75,839.05,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,outpatient,,,865.00000,821.75000,The Alliance,Exception Members,TC,666.05,,,,,,,384.16,839.05,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,The Alliance,Exception Members,TC,245.63,,,,,,,175.45,309.43,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Exception Members,TC,245.63,,,,,,,159.50,3015.65,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,2.25,118.82,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,157.00,1786.85,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,inpatient,1,EA,26.49000,25.17000,The Alliance,Exception Members,,20.40,,,,,,,14.57,25.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,outpatient,1,EA,26.49000,25.17000,The Alliance,Exception Members,,20.40,,,,,,,3.02,25.70,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,inpatient,1,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,outpatient,1,EA,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.15,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,The Alliance,Exception Members,,4.70,,,,,,,3.35,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Exception Members,,4.70,,,,,,,3.05,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.93,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1082.00000,1027.90000,The Alliance,Exception Members,TC,833.14,,,,,,,595.10,1049.54,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1082.00000,1027.90000,The Alliance,Exception Members,TC,833.14,,,,,,,384.16,1049.54,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,inpatient,,,723.00000,686.85000,The Alliance,Exception Members,TC,556.71,,,,,,,397.65,701.31,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,outpatient,,,723.00000,686.85000,The Alliance,Exception Members,TC,556.71,,,,,,,361.50,3665.88,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,129.80,228.92,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,118.00,1964.22,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,189.20,333.68,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,172.00,1786.85,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,25.31,2286.16,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1631.25000,1549.69000,The Alliance,Exception Members,,1256.06,,,,,,,799.31,1582.31,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Exception Members,,1256.06,,,,,,,748.74,1631.25,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,TC,229.46,,,,,,,149.00,1569.27,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,11.67,611.15,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,inpatient,,,170.10000,161.60000,The Alliance,Exception Members,90,130.98,,,,,,,93.56,165.00,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Exception Members,90,130.98,,,,,,,14.87,746.94,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,21.45,37.83,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,3.64,169.79,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,The Alliance,Exception Members,TC,1394.47,,,,,,,996.05,1756.67,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Exception Members,TC,1394.47,,,,,,,905.50,8808.48,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,inpatient,,,157.10000,149.24000,The Alliance,Exception Members,90,120.97,,,,,,,86.41,152.39,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,outpatient,,,157.10000,149.24000,The Alliance,Exception Members,90,120.97,,,,,,,13.99,713.01,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,inpatient,,,134.80000,128.06000,The Alliance,Exception Members,90,103.80,,,,,,,74.14,130.76,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,outpatient,,,134.80000,128.06000,The Alliance,Exception Members,90,103.80,,,,,,,12.00,611.15,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Exception Members,TC,241.78,,,,,,,136.98,1331.91,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,154.55,272.57,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,140.50,1569.27,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,37.78,66.64,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,8.17,882.80,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,inpatient,,,369.00000,350.55000,The Alliance,Exception Members,TC,284.13,,,,,,,202.95,357.93,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,Exception Members,TC,284.13,,,,,,,184.50,1865.95,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,inpatient,,,208.30000,197.88000,The Alliance,Exception Members,90,160.39,,,,,,,114.56,202.05,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,outpatient,,,208.30000,197.88000,The Alliance,Exception Members,90,160.39,,,,,,,16.32,797.91,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.46,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.46,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,inpatient,1,EA,5.39000,5.12000,The Alliance,Exception Members,,4.15,,,,,,,2.96,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Exception Members,,4.15,,,,,,,2.69,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,111.13,1094.55,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,TC,212.52,,,,,,,138.00,1371.46,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,111.13,1094.55,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,90,26.95,,,,,,,19.25,33.95,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,90,26.95,,,,,,,17.50,2020.22,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,Exception Members,TC,166.32,,,,,,,118.80,209.52,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Exception Members,TC,166.32,,,,,,,108.00,1193.49,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,187.00,329.80,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,170.00,1786.85,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,126.50,1331.91,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,inpatient,,,1120.00000,1064.00000,The Alliance,Exception Members,TC,862.40,,,,,,,616.00,1086.40,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,outpatient,,,1120.00000,1064.00000,The Alliance,Exception Members,TC,862.40,,,,,,,560.00,5663.55,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,inpatient,,,498.00000,473.10000,The Alliance,Exception Members,TC,383.46,,,,,,,273.90,483.06,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,Exception Members,TC,383.46,,,,,,,247.55,2380.22,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,TC,154.00,,,,,,,110.00,194.00,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,TC,154.00,,,,,,,100.00,1094.55,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,189.20,333.68,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Exception Members,TC,264.88,,,,,,,160.92,1569.27,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,2.06,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,1.87,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,The Alliance,Exception Members,,5.40,,,,,,,3.86,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Exception Members,,5.40,,,,,,,3.50,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,inpatient,,,532.00000,505.40000,The Alliance,Exception Members,TC,409.64,,,,,,,292.60,516.04,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Exception Members,TC,409.64,,,,,,,128.10,1813.71,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,409.20,721.68,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Exception Members,TC,572.88,,,,,,,372.00,4002.11,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,inpatient,,,755.00000,717.25000,The Alliance,Exception Members,TC,581.35,,,,,,,415.25,732.35,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,outpatient,,,755.00000,717.25000,The Alliance,Exception Members,TC,581.35,,,,,,,377.50,3764.75,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,TC,127.82,,,,,,,91.30,161.02,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,TC,127.82,,,,,,,83.00,857.19,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,181.50,320.10,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,165.00,1648.36,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,Exception Members,TC,247.94,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Exception Members,TC,247.94,,,,,,,161.00,1628.59,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,158.40,279.36,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,144.00,1549.49,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,inpatient,1,mL,47.56000,45.18000,The Alliance,Exception Members,,36.62,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Exception Members,,36.62,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,inpatient,1,mL,24.33000,23.12000,The Alliance,Exception Members,,18.73,,,,,,,13.38,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,outpatient,1,mL,24.33000,23.12000,The Alliance,Exception Members,,18.73,,,,,,,12.16,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,12.58,26.05,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,TC,170.94,,,,,,,111.00,1094.55,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,inpatient,,,379.00000,360.05000,The Alliance,Exception Members,TC,291.83,,,,,,,208.45,367.63,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,Exception Members,TC,291.83,,,,,,,189.50,1925.27,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,Exception Members,TC,185.57,,,,,,,132.55,233.77,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Exception Members,TC,185.57,,,,,,,120.50,1213.27,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,134.75,237.65,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,122.23,1213.27,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,Exception Members,TC,204.05,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Exception Members,TC,204.05,,,,,,,132.50,1430.78,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,187.00,329.80,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,170.00,1786.85,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,Exception Members,TC,209.44,,,,,,,149.60,263.84,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Exception Members,TC,209.44,,,,,,,125.88,1213.27,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,187.00,329.80,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,TC,261.80,,,,,,,166.47,1628.59,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,115.50,1252.81,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,Exception Members,TC,164.78,,,,,,,117.70,207.58,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Exception Members,TC,164.78,,,,,,,107.00,1233.04,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,Exception Members,TC,642.95,,,,,,,459.25,809.95,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Exception Members,TC,642.95,,,,,,,417.50,3942.79,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,inpatient,,,1073.00000,1019.35000,The Alliance,Exception Members,TC,826.21,,,,,,,590.15,1040.81,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Exception Members,TC,826.21,,,,,,,536.50,5960.23,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,inpatient,,,282.00000,267.90000,The Alliance,Exception Members,,217.14,,,,,,,155.10,273.54,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,outpatient,,,282.00000,267.90000,The Alliance,Exception Members,,217.14,,,,,,,29.60,1544.85,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,TC,211.75,,,,,,,137.50,1509.95,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,254.10,448.14,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Exception Members,TC,355.74,,,,,,,203.31,1945.04,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,282.15,497.61,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,234.65,2261.57,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,Exception Members,TC,234.08,,,,,,,167.20,294.88,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Exception Members,TC,234.08,,,,,,,152.00,1569.27,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,TC,190.19,,,,,,,135.85,239.59,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,TC,190.19,,,,,,,123.50,1233.04,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,inpatient,,,287.00000,272.65000,The Alliance,Exception Members,TC,220.99,,,,,,,157.85,278.39,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,Exception Members,TC,220.99,,,,,,,143.50,1470.40,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,inpatient,,,862.00000,818.90000,The Alliance,Exception Members,TC,663.74,,,,,,,474.10,836.14,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,Exception Members,TC,663.74,,,,,,,431.00,4417.51,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,137.50,242.50,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,125.00,1331.91,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,154.55,272.57,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,140.50,1549.49,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,TC,222.53,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,TC,222.53,,,,,,,144.50,1509.95,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,inpatient,240,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,outpatient,240,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,inpatient,240,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,outpatient,240,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,119.35,210.49,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,108.50,1173.72,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,137.50,242.50,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Exception Members,TC,192.50,,,,,,,125.00,1252.81,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,TC,160.93,,,,,,,114.95,202.73,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,TC,160.93,,,,,,,104.50,1114.32,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,154.55,272.57,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,140.50,1391.23,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,134.75,237.65,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,122.50,1292.36,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,Exception Members,TC,214.83,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Exception Members,TC,214.83,,,,,,,101.94,1074.77,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,1470.40,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,The Alliance,Exception Members,TC,790.79,,,,,,,564.85,996.19,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Exception Members,TC,790.79,,,,,,,513.50,5169.06,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,166.10,292.94,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,144.32,1391.23,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,675.95,1192.13,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,606.90,5742.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,189.75,334.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,TC,265.65,,,,,,,172.50,1687.91,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,Exception Members,TC,234.85,,,,,,,167.75,295.85,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Exception Members,TC,234.85,,,,,,,152.50,1628.59,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,161.50,1648.36,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,Exception Members,TC,220.22,,,,,,,157.30,277.42,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Exception Members,TC,220.22,,,,,,,142.47,1391.23,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,TC,213.29,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,TC,213.29,,,,,,,120.38,1173.72,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,144.65,255.11,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,129.58,1272.59,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,Exception Members,TC,446.60,,,,,,,319.00,562.60,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Exception Members,TC,446.60,,,,,,,290.00,5821.82,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,TC,140.91,,,,,,,100.65,177.51,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,TC,140.91,,,,,,,74.29,738.55,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,102.30,180.42,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,TC,143.22,,,,,,,93.00,1074.77,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,The Alliance,Exception Members,TC,899.36,,,,,,,642.40,1132.96,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Exception Members,TC,899.36,,,,,,,278.89,2676.90,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,Exception Members,TC,273.35,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Exception Members,TC,273.35,,,,,,,159.07,1549.49,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,The Alliance,Exception Members,TC,689.92,,,,,,,492.80,869.12,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Exception Members,TC,689.92,,,,,,,448.00,4437.28,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,57.20,100.88,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,11.39,594.19,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,120.38,1173.72,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,inpatient,30,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,outpatient,30,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,Exception Members,TC,621.39,,,,,,,443.85,782.79,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Exception Members,TC,621.39,,,,,,,403.50,5149.29,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,inpatient,1,mL,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,18.84,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,outpatient,1,mL,34.25000,32.54000,The Alliance,Exception Members,,26.37,,,,,,,8.33,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,inpatient,1,mL,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,inpatient,1,mL,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,4.09,7.21,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,outpatient,1,mL,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,3.71,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,15.80,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,145.20,256.08,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,TC,203.28,,,,,,,132.00,1331.91,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,inpatient,,,411.00000,390.45000,The Alliance,Exception Members,TC,316.47,,,,,,,226.05,398.67,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,outpatient,,,411.00000,390.45000,The Alliance,Exception Members,TC,316.47,,,,,,,205.50,2043.99,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,Exception Members,TC,473.55,,,,,,,338.25,596.55,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Exception Members,TC,473.55,,,,,,,307.50,3329.66,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,Exception Members,TC,620.62,,,,,,,443.30,781.82,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Exception Members,TC,620.62,,,,,,,403.00,5188.83,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Exception Members,TC,254.10,,,,,,,153.52,1470.40,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,118.50,1233.04,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,144.65,255.11,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,131.50,1668.14,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,TC,194.81,,,,,,,125.88,1213.27,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,inpatient,1,EA,15.25000,14.48000,The Alliance,Exception Members,,11.74,,,,,,,8.39,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Exception Members,,11.74,,,,,,,7.62,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,inpatient,1,EA,9.68000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,outpatient,1,EA,9.68000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,4.84,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,inpatient,1,EA,8.79000,8.35000,The Alliance,Exception Members,,6.77,,,,,,,4.83,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,outpatient,1,EA,8.79000,8.35000,The Alliance,Exception Members,,6.77,,,,,,,4.39,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,The Alliance,Exception Members,,6.74,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Exception Members,,6.74,,,,,,,4.38,8.49,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,Exception Members,TC,180.95,,,,,,,129.25,227.95,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Exception Members,TC,180.95,,,,,,,117.50,1233.04,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,inpatient,20,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,outpatient,20,EA,4.32000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.16,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,inpatient,20,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,3.04,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,outpatient,20,EA,5.53000,5.25000,The Alliance,Exception Members,,4.26,,,,,,,2.35,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,inpatient,20,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,outpatient,20,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,inpatient,,,1106.00000,1050.70000,The Alliance,Exception Members,TC,851.62,,,,,,,608.30,1072.82,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,outpatient,,,1106.00000,1050.70000,The Alliance,Exception Members,TC,851.62,,,,,,,553.00,5703.10,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,inpatient,,,312.00000,296.40000,The Alliance,Exception Members,TC,240.24,,,,,,,171.60,302.64,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Exception Members,TC,240.24,,,,,,,156.00,1549.49,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,2.15,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,inpatient,1,EA,7.31000,6.94000,The Alliance,Exception Members,,5.63,,,,,,,4.02,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,outpatient,1,EA,7.31000,6.94000,The Alliance,Exception Members,,5.63,,,,,,,3.65,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,inpatient,,,564.00000,535.80000,The Alliance,Exception Members,TC,434.28,,,,,,,310.20,547.08,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Exception Members,TC,434.28,,,,,,,282.00,2835.16,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,Exception Members,TC,219.45,,,,,,,156.75,276.45,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Exception Members,TC,219.45,,,,,,,142.50,1450.63,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,inpatient,1,EA,5.99000,5.69000,The Alliance,Exception Members,,4.61,,,,,,,3.29,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,outpatient,1,EA,5.99000,5.69000,The Alliance,Exception Members,,4.61,,,,,,,3.00,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,2.14,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.63,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.40,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,inpatient,1,EA,5.69000,5.41000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,outpatient,1,EA,5.69000,5.41000,The Alliance,Exception Members,,4.38,,,,,,,2.85,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,The Alliance,Exception Members,,2.90,,,,,,,2.07,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Exception Members,,2.90,,,,,,,1.88,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,inpatient,1,EA,7.62000,7.24000,The Alliance,Exception Members,,5.87,,,,,,,4.19,7.39,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,outpatient,1,EA,7.62000,7.24000,The Alliance,Exception Members,,5.87,,,,,,,3.81,7.39,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,TC,274.12,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,TC,274.12,,,,,,,178.00,2024.21,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,253.00,446.20,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Exception Members,TC,354.20,,,,,,,230.00,2340.67,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,inpatient,,,740.00000,703.00000,The Alliance,Exception Members,TC,569.80,,,,,,,407.00,717.80,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Exception Members,TC,569.80,,,,,,,370.00,3725.20,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,inpatient,,,582.00000,552.90000,The Alliance,Exception Members,TC,448.14,,,,,,,320.10,564.54,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Exception Members,TC,448.14,,,,,,,238.63,3015.65,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,140.80,248.32,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,TC,197.12,,,,,,,77.99,1015.45,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,inpatient,1,mL,477.84000,453.95000,The Alliance,Exception Members,,367.94,,,,,,,262.81,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,outpatient,1,mL,477.84000,453.95000,The Alliance,Exception Members,,367.94,,,,,,,8.33,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,inpatient,1,mL,63.69000,60.51000,The Alliance,Exception Members,,49.04,,,,,,,35.03,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,outpatient,1,mL,63.69000,60.51000,The Alliance,Exception Members,,49.04,,,,,,,8.33,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,inpatient,1,mL,21.94000,20.85000,The Alliance,Exception Members,,16.89,,,,,,,12.07,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,outpatient,1,mL,21.94000,20.85000,The Alliance,Exception Members,,16.89,,,,,,,8.33,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,inpatient,1,mL,113.76000,108.07000,The Alliance,Exception Members,,87.60,,,,,,,62.57,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Exception Members,,87.60,,,,,,,8.33,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,8.33,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,8.33,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,inpatient,1,mL,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,20.86,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Exception Members,,29.20,,,,,,,8.33,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,inpatient,1,mL,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,15.30,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,8.33,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,inpatient,1,mL,42.75000,40.61000,The Alliance,Exception Members,,32.92,,,,,,,23.51,41.47,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,outpatient,1,mL,42.75000,40.61000,The Alliance,Exception Members,,32.92,,,,,,,8.33,41.47,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,TC,134.75,,,,,,,96.25,169.75,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,TC,134.75,,,,,,,87.50,876.96,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,Exception Members,TC,361.13,,,,,,,257.95,454.93,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Exception Members,TC,361.13,,,,,,,234.50,2439.54,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,119.35,210.49,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Exception Members,TC,167.09,,,,,,,108.50,1193.49,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,73.70,129.98,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,67.00,129.98,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,inpatient,,,336.00000,319.20000,The Alliance,Exception Members,TC,258.72,,,,,,,184.80,325.92,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Exception Members,TC,258.72,,,,,,,157.22,1529.72,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,166.10,292.94,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,TC,232.54,,,,,,,151.00,1509.95,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,TC,177.87,,,,,,,115.50,1213.27,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,inpatient,,,2119.00000,2013.05000,The Alliance,Exception Members,TC,1631.63,,,,,,,1165.45,2055.43,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,outpatient,,,2119.00000,2013.05000,The Alliance,Exception Members,TC,1631.63,,,,,,,942.37,19073.89,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,129.80,228.92,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Exception Members,TC,181.72,,,,,,,118.00,1292.36,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,TC,71.61,,,,,,,51.15,90.21,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,TC,71.61,,,,,,,46.50,3015.65,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,27.50,134.64,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,24.50,47.53,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,inpatient,,,465.80000,442.51000,The Alliance,Exception Members,TC,358.67,,,,,,,256.19,451.83,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,outpatient,,,465.80000,442.51000,The Alliance,Exception Members,TC,358.67,,,,,,,232.90,1820.00,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,4.20,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,inpatient,1,mL,20.10000,19.10000,The Alliance,Exception Members,,15.48,,,,,,,11.05,19.50,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,outpatient,1,mL,20.10000,19.10000,The Alliance,Exception Members,,15.48,,,,,,,10.05,35.77,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,inpatient,1,mL,17.85000,16.96000,The Alliance,Exception Members,,13.74,,,,,,,9.82,17.31,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,outpatient,1,mL,17.85000,16.96000,The Alliance,Exception Members,,13.74,,,,,,,8.93,35.77,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,inpatient,,,2163.00000,2054.85000,The Alliance,Exception Members,,1665.51,,,,,,,1189.65,2098.11,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Exception Members,,1665.51,,,,,,,1189.65,7803.00,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,inpatient,1,mL,165.78000,157.49000,The Alliance,Exception Members,,127.65,,,,,,,91.18,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,outpatient,1,mL,165.78000,157.49000,The Alliance,Exception Members,,127.65,,,,,,,82.89,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,inpatient,1,mL,20.24000,19.22000,The Alliance,Exception Members,,15.58,,,,,,,11.13,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,outpatient,1,mL,20.24000,19.22000,The Alliance,Exception Members,,15.58,,,,,,,10.12,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,inpatient,1,mL,20.26000,19.24000,The Alliance,Exception Members,,15.60,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,outpatient,1,mL,20.26000,19.24000,The Alliance,Exception Members,,15.60,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,inpatient,1,mL,20.26000,19.25000,The Alliance,Exception Members,,15.60,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,outpatient,1,mL,20.26000,19.25000,The Alliance,Exception Members,,15.60,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,8.85,17.17,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,inpatient,1,EA,4748.76000,4511.33000,The Alliance,Exception Members,,3656.55,,,,,,,2611.82,4606.30,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,outpatient,1,EA,4748.76000,4511.33000,The Alliance,Exception Members,,3656.55,,,,,,,11.00,4606.30,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,inpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,204.05,359.87,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,185.50,359.87,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,62.14,3038.81,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,62.14,3038.81,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Exception Members,,621.97,,,,,,,33.00,783.52,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,inpatient,1,mL,7.05000,6.70000,The Alliance,Exception Members,,5.43,,,,,,,3.88,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,outpatient,1,mL,7.05000,6.70000,The Alliance,Exception Members,,5.43,,,,,,,0.01550,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,inpatient,1,mL,4.50000,4.28000,The Alliance,Exception Members,,3.46,,,,,,,2.48,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,outpatient,1,mL,4.50000,4.28000,The Alliance,Exception Members,,3.46,,,,,,,0.01550,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,inpatient,1,mL,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,4.26,7.51,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,outpatient,1,mL,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,0.01550,7.51,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,inpatient,1,EA,1951.28000,1853.72000,The Alliance,Exception Members,,1502.49,,,,,,,1073.20,1892.74,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,outpatient,1,EA,1951.28000,1853.72000,The Alliance,Exception Members,,1502.49,,,,,,,25.05,1892.74,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,inpatient,10,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,outpatient,10,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,inpatient,10,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,inpatient,10,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,outpatient,10,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,5.39,288.61,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,inpatient,,,383.00000,363.85000,The Alliance,Exception Members,,294.91,,,,,,,210.65,371.51,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Exception Members,,294.91,,,,,,,191.50,2122.08,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.93,203.72,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,inpatient,1,EA,3584.37000,3405.15000,The Alliance,Exception Members,,2759.96,,,,,,,1971.40,3476.84,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,outpatient,1,EA,3584.37000,3405.15000,The Alliance,Exception Members,,2759.96,,,,,,,76.18,3476.84,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,inpatient,1,mL,5.55000,5.27000,The Alliance,Exception Members,,4.27,,,,,,,3.05,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,outpatient,1,mL,5.55000,5.27000,The Alliance,Exception Members,,4.27,,,,,,,0.11207,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,inpatient,1,mL,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,0.11207,10.73,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.39,288.61,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,2.99,152.82,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,24.20,42.68,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,4.00,186.75,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,3.93,203.72,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,26.07,1222.31,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,4.72,254.68,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,inpatient,1,mL,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,5.23,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,inpatient,,,169.00000,160.55000,The Alliance,Exception Members,,130.13,,,,,,,92.95,163.93,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Exception Members,,130.13,,,,,,,26.07,1222.31,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,4.27,220.68,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,GY,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,GY,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,inpatient,1,mL,1.06000,1.01000,The Alliance,Exception Members,GY,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,outpatient,1,mL,1.06000,1.01000,The Alliance,Exception Members,GY,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,inpatient,1,mL,0.91000,0.86000,The Alliance,Exception Members,GY,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Exception Members,GY,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,4.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,inpatient,1,EA,7470.42000,7096.90000,The Alliance,Exception Members,,5752.22,,,,,,,4108.73,7246.31,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,outpatient,1,EA,7470.42000,7096.90000,The Alliance,Exception Members,,5752.22,,,,,,,11.00,7246.31,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,inpatient,1,EA,254.92000,242.17000,The Alliance,Exception Members,,196.29,,,,,,,140.21,247.27,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,outpatient,1,EA,254.92000,242.17000,The Alliance,Exception Members,,196.29,,,,,,,127.46,247.27,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,5.18,271.65,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,34.10,60.14,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,5.39,288.61,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,5.60,288.61,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,inpatient,,,568.00000,539.60000,The Alliance,Exception Members,TC,437.36,,,,,,,312.40,550.96,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Exception Members,TC,437.36,,,,,,,158.62,1499.73,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,inpatient,,,2478.00000,2354.10000,The Alliance,Exception Members,,1908.06,,,,,,,1362.90,2403.66,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,outpatient,,,2478.00000,2354.10000,The Alliance,Exception Members,,1908.06,,,,,,,162.71,16444.87,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,6.04,322.54,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,The Alliance,Exception Members,TC,1086.47,,,,,,,776.05,1368.67,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Exception Members,TC,1086.47,,,,,,,705.50,1368.67,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,107.25,189.15,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,19.63,1018.59,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,GO,28.49,,,,,,,20.35,35.89,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,GO,28.49,,,,,,,18.50,264.00,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,2910.60,5133.24,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,1388.02,5133.24,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,3038.81,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,146.85,258.99,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,TC,205.59,,,,,,,133.50,1470.40,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,inpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,44.55,78.57,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Exception Members,,62.37,,,,,,,40.50,134.64,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,97.00,212.44,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,The Alliance,Exception Members,TC,889.35,,,,,,,635.25,1120.35,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Exception Members,TC,889.35,,,,,,,577.50,1120.35,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,inpatient,1,mL,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,outpatient,1,mL,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,inpatient,1,mL,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,outpatient,1,mL,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,TC,346.50,,,,,,,247.50,436.50,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,TC,346.50,,,,,,,225.00,492.80,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,177.51,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,16.80,882.80,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,inpatient,1,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,outpatient,1,EA,0.45000,0.42000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.08005,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.08005,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.08005,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,inpatient,1,mL,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.08005,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,inpatient,1,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.08005,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.08005,0.64990,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,30.80,54.32,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,5.18,271.65,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,15.05,780.94,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,5.37,305.58,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,inpatient,1,mL,1043.05000,990.90000,The Alliance,Exception Members,,803.15,,,,,,,573.68,1011.76,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,outpatient,1,mL,1043.05000,990.90000,The Alliance,Exception Members,,803.15,,,,,,,85.25,1011.76,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,inpatient,1,mL,977.93000,929.03000,The Alliance,Exception Members,,753.01,,,,,,,537.86,948.59,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,outpatient,1,mL,977.93000,929.03000,The Alliance,Exception Members,,753.01,,,,,,,85.25,948.59,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,151.25,266.75,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,62.14,3038.81,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,30.80,54.32,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,5.18,271.65,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,4.24,254.68,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,15.32,797.91,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,4.29,203.72,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,224.40,395.76,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,37.27,1833.46,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,6.47,339.51,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,5.60,288.61,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,inpatient,1,EA,1320.90000,1254.86000,The Alliance,Exception Members,,1017.09,,,,,,,726.50,1281.27,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,outpatient,1,EA,1320.90000,1254.86000,The Alliance,Exception Members,,1017.09,,,,,,,5.71,1281.27,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,77.53,1052.52,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,212.44,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,inpatient,1,mL,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,outpatient,1,mL,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,8.85,17.17,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,5.38,458.40,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,5.56,254.68,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.18,271.65,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,2.25,118.82,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,56.65,99.91,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,8.62,458.40,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,inpatient,1,EA,635.07000,603.31000,The Alliance,Exception Members,,489.00,,,,,,,349.29,616.02,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Exception Members,,489.00,,,,,,,4.24,616.02,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,392.70,5858.00,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,5271.00,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,5271.00,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,inpatient,1,mL,12.99000,12.34000,The Alliance,Exception Members,,10.00,,,,,,,7.14,12.60,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,outpatient,1,mL,12.99000,12.34000,The Alliance,Exception Members,,10.00,,,,,,,6.50,12.60,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,26.11,147.44,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,inpatient,,,77.07000,73.22000,The Alliance,Exception Members,,59.34,,,,,,,42.39,74.76,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Exception Members,,59.34,,,,,,,25.05,74.76,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,62.50,121.25,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,182.05,321.07,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,29.35,2438.99,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2195.00000,2085.25000,The Alliance,Exception Members,TC,1690.15,,,,,,,1207.25,2129.15,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2195.00000,2085.25000,The Alliance,Exception Members,TC,1690.15,,,,,,,1097.50,2210.07,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,The Alliance,Exception Members,TC,1545.39,,,,,,,1103.85,1946.79,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Exception Members,TC,1545.39,,,,,,,940.41,2960.49,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,5115.55,9021.97,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,4467.66,9021.97,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,The Alliance,Exception Members,TC,2674.98,,,,,,,1910.70,3369.78,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Exception Members,TC,2674.98,,,,,,,1364.86,7180.14,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,The Alliance,Exception Members,TC,1677.06,,,,,,,1197.90,2112.66,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Exception Members,TC,1677.06,,,,,,,1036.23,2210.07,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,TC,948.64,,,,,,,677.60,1195.04,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,TC,948.64,,,,,,,466.73,2210.07,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,inpatient,,,1038.00000,986.10000,The Alliance,Exception Members,TC,799.26,,,,,,,570.90,1006.86,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,outpatient,,,1038.00000,986.10000,The Alliance,Exception Members,TC,799.26,,,,,,,84.70,1006.86,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,The Alliance,Exception Members,TC,1692.46,,,,,,,1208.90,2132.06,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Exception Members,TC,1692.46,,,,,,,1047.28,2210.07,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,11015.00,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,3612.55,10015.25,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,TC,1490.72,,,,,,,1064.80,1877.92,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,TC,1490.72,,,,,,,918.26,2960.49,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,Exception Members,TC,575.19,,,,,,,410.85,724.59,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Exception Members,TC,575.19,,,,,,,282.87,724.59,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,The Alliance,Exception Members,TC,928.62,,,,,,,663.30,1169.82,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Exception Members,TC,928.62,,,,,,,455.68,2210.07,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5343.33,11015.00,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Exception Members,,3685.22,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,inpatient,,,4662.00000,4428.90000,The Alliance,Exception Members,,3589.74,,,,,,,2564.10,4522.14,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,outpatient,,,4662.00000,4428.90000,The Alliance,Exception Members,,3589.74,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5343.33,11015.00,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,72.50,1820.00,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,The Alliance,Exception Members,TC,2813.58,,,,,,,2009.70,3544.38,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Exception Members,TC,2813.58,,,,,,,1487.04,3544.38,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,inpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,166.65,293.91,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,78.72,293.91,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,14.69,25.90,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,5.25,254.68,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,inpatient,1,mL,503.59000,478.41000,The Alliance,Exception Members,,387.76,,,,,,,276.97,488.48,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,outpatient,1,mL,503.59000,478.41000,The Alliance,Exception Members,,387.76,,,,,,,5.86,488.48,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,3.09,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Exception Members,,4.32,,,,,,,2.81,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,inpatient,1,EA,2.35000,2.24000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,outpatient,1,EA,2.35000,2.24000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,152.35,268.69,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,62.14,3038.81,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,14.55,763.98,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,inpatient,1,mL,10785.83000,10246.53000,The Alliance,Exception Members,,8305.09,,,,,,,5932.21,10462.26,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,outpatient,1,mL,10785.83000,10246.53000,The Alliance,Exception Members,,8305.09,,,,,,,168.13,10462.26,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,inpatient,1,mL,4534.31000,4307.59000,The Alliance,Exception Members,,3491.42,,,,,,,2493.87,4398.28,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,outpatient,1,mL,4534.31000,4307.59000,The Alliance,Exception Members,,3491.42,,,,,,,59.70,4398.28,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,inpatient,1,mL,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,inpatient,1,mL,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,outpatient,1,mL,2.17000,2.07000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,inpatient,,,740.00000,703.00000,The Alliance,Exception Members,90,569.80,,,,,,,407.00,717.80,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Exception Members,90,569.80,,,,,,,67.54,3412.32,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,inpatient,,,815.00000,774.25000,The Alliance,Exception Members,90,627.55,,,,,,,448.25,790.55,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Exception Members,90,627.55,,,,,,,12.45,1539.22,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,inpatient,,,106.20000,100.89000,The Alliance,Exception Members,90,81.77,,,,,,,58.41,103.01,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,outpatient,,,106.20000,100.89000,The Alliance,Exception Members,90,81.77,,,,,,,53.10,103.01,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,inpatient,,,1376.00000,1307.20000,The Alliance,Exception Members,90,1059.52,,,,,,,756.80,1334.72,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,outpatient,,,1376.00000,1307.20000,The Alliance,Exception Members,90,1059.52,,,,,,,132.74,7792.26,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,inpatient,,,5754.00000,5466.30000,The Alliance,Exception Members,TC,4430.58,,,,,,,3164.70,5581.38,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,outpatient,,,5754.00000,5466.30000,The Alliance,Exception Members,TC,4430.58,,,,,,,1631.86,5581.38,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,inpatient,,,4909.00000,4663.55000,The Alliance,Exception Members,,3779.93,,,,,,,2699.95,4761.73,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,outpatient,,,4909.00000,4663.55000,The Alliance,Exception Members,,3779.93,,,,,,,2699.95,7803.00,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,TC,2216.06,,,,,,,1582.90,2791.66,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Exception Members,TC,2216.06,,,,,,,1114.22,2791.66,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,The Alliance,Exception Members,TC,3988.60,,,,,,,2849.00,5024.60,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Exception Members,TC,3988.60,,,,,,,1273.18,5024.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,The Alliance,Exception Members,,1447.60,,,,,,,1034.00,1823.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Exception Members,,1447.60,,,,,,,81.69,1823.60,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,inpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,158.76,314.28,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,148.72,324.00,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,inpatient,,,70906.00000,67360.70000,The Alliance,Exception Members,,54597.62,,,,,,,38998.30,68778.82,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,outpatient,,,70906.00000,67360.70000,The Alliance,Exception Members,,54597.62,,,,,,,6083.48,68778.82,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,inpatient,,,1634.00000,1552.30000,The Alliance,Exception Members,TC,1258.18,,,,,,,898.70,1584.98,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,outpatient,,,1634.00000,1552.30000,The Alliance,Exception Members,TC,1258.18,,,,,,,671.89,1584.98,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,69.00,212.44,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,inpatient,,,5032.00000,4780.40000,The Alliance,Exception Members,,3874.64,,,,,,,2767.60,4881.04,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,outpatient,,,5032.00000,4780.40000,The Alliance,Exception Members,,3874.64,,,,,,,2516.00,5156.10,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,inpatient,,,2892.00000,2747.40000,The Alliance,Exception Members,,2226.84,,,,,,,1590.60,2805.24,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,outpatient,,,2892.00000,2747.40000,The Alliance,Exception Members,,2226.84,,,,,,,1446.00,18061.43,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,inpatient,,,589.00000,559.55000,The Alliance,Exception Members,,453.53,,,,,,,323.95,571.33,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,outpatient,,,589.00000,559.55000,The Alliance,Exception Members,,453.53,,,,,,,288.84,1203.43,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,The Alliance,Exception Members,,791.56,,,,,,,503.72,997.16,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Exception Members,,791.56,,,,,,,325.11,1028.00,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,TC,3581.27,,,,,,,2558.05,4511.47,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,TC,3581.27,,,,,,,380.83,4511.47,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,inpatient,,,2232.00000,2120.40000,The Alliance,Exception Members,TC,1718.64,,,,,,,1227.60,2165.04,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,outpatient,,,2232.00000,2120.40000,The Alliance,Exception Members,TC,1718.64,,,,,,,837.18,2210.07,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,Exception Members,,681.45,,,,,,,486.75,858.45,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Exception Members,,681.45,,,,,,,122.40,858.45,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,122.40,5271.00,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,inpatient,1,mL,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,outpatient,1,mL,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,inpatient,1,mL,55.71000,52.93000,The Alliance,Exception Members,,42.90,,,,,,,30.64,54.04,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,outpatient,1,mL,55.71000,52.93000,The Alliance,Exception Members,,42.90,,,,,,,27.86,54.04,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,218.35,385.09,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,218.35,5271.00,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,37.00,71.78,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.19,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Exception Members,,1.66,,,,,,,1.08,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,inpatient,1,GM,316.85000,301.01000,The Alliance,Exception Members,,243.97,,,,,,,174.27,307.34,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,outpatient,1,GM,316.85000,301.01000,The Alliance,Exception Members,,243.97,,,,,,,158.43,307.34,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,inpatient,,,504.00000,478.80000,The Alliance,Exception Members,,388.08,,,,,,,277.20,488.88,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,outpatient,,,504.00000,478.80000,The Alliance,Exception Members,,388.08,,,,,,,252.00,488.88,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,inpatient,,,1145.00000,1087.75000,The Alliance,Exception Members,,881.65,,,,,,,629.75,1110.65,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,outpatient,,,1145.00000,1087.75000,The Alliance,Exception Members,,881.65,,,,,,,629.75,5271.00,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1183.05,2086.47,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1183.05,5271.00,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,20.35,35.89,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,18.50,35.89,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,inpatient,,,1103.00000,1047.85000,The Alliance,Exception Members,,849.31,,,,,,,606.65,1069.91,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,outpatient,,,1103.00000,1047.85000,The Alliance,Exception Members,,849.31,,,,,,,606.65,5271.00,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,190.85,336.59,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,173.50,336.59,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,inpatient,,,1542.00000,1464.90000,The Alliance,Exception Members,,1187.34,,,,,,,848.10,1495.74,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,outpatient,,,1542.00000,1464.90000,The Alliance,Exception Members,,1187.34,,,,,,,848.10,5271.00,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,inpatient,,,1023.00000,971.85000,The Alliance,Exception Members,,787.71,,,,,,,562.65,992.31,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,outpatient,,,1023.00000,971.85000,The Alliance,Exception Members,,787.71,,,,,,,562.65,5271.00,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,23.25,197.88,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,The Alliance,Exception Members,,58.96,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Exception Members,,58.96,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,inpatient,1,mL,153.14000,145.48000,The Alliance,Exception Members,,117.92,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,outpatient,1,mL,153.14000,145.48000,The Alliance,Exception Members,,117.92,,,,,,,60.56,148.55,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,Exception Members,,251.79,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Exception Members,,251.79,,,,,,,179.85,3163.00,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,inpatient,,,1375.00000,1306.25000,The Alliance,Exception Members,TC,1058.75,,,,,,,756.25,1333.75,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,Exception Members,TC,1058.75,,,,,,,384.29,6707.24,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,inpatient,,,2192.00000,2082.40000,The Alliance,Exception Members,,1687.84,,,,,,,1205.60,2126.24,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,outpatient,,,2192.00000,2082.40000,The Alliance,Exception Members,,1687.84,,,,,,,1205.60,5271.00,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,inpatient,1,mL,7.93000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,4.36,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,0.19995,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,inpatient,1,mL,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,0.19995,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,inpatient,1,mL,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,outpatient,1,mL,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,0.19995,3.15,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,inpatient,1,mL,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,3.20,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,0.33945,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,inpatient,1,mL,6.47000,6.14000,The Alliance,Exception Members,,4.98,,,,,,,3.56,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,outpatient,1,mL,6.47000,6.14000,The Alliance,Exception Members,,4.98,,,,,,,0.33945,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,inpatient,1,mL,12.23000,11.62000,The Alliance,Exception Members,,9.42,,,,,,,6.73,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,outpatient,1,mL,12.23000,11.62000,The Alliance,Exception Members,,9.42,,,,,,,0.33945,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,inpatient,1,mL,6.03000,5.73000,The Alliance,Exception Members,,4.64,,,,,,,3.32,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,outpatient,1,mL,6.03000,5.73000,The Alliance,Exception Members,,4.64,,,,,,,0.33945,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,inpatient,1,mL,7.93000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,4.36,7.69,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,0.33945,7.69,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,3.24,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,295.90,521.86,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,269.00,521.86,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,inpatient,,,3127.00000,2970.65000,The Alliance,Exception Members,,2407.79,,,,,,,1719.85,3033.19,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,outpatient,,,3127.00000,2970.65000,The Alliance,Exception Members,,2407.79,,,,,,,1563.50,3388.98,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,inpatient,,,2098.00000,1993.10000,The Alliance,Exception Members,,1615.46,,,,,,,1153.90,2035.06,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,outpatient,,,2098.00000,1993.10000,The Alliance,Exception Members,,1615.46,,,,,,,1049.00,2035.06,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,inpatient,1,GM,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,outpatient,1,GM,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,218.35,385.09,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Exception Members,,305.69,,,,,,,218.35,5271.00,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,inpatient,1,mL,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.39,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,inpatient,1,EA,126.59000,120.26000,The Alliance,Exception Members,,97.47,,,,,,,69.62,122.79,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,outpatient,1,EA,126.59000,120.26000,The Alliance,Exception Members,,97.47,,,,,,,63.30,122.79,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,inpatient,1,EA,0.97000,0.93000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,outpatient,1,EA,0.97000,0.93000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.43,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.30,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,inpatient,1,EA,7.14000,6.78000,The Alliance,Exception Members,,5.50,,,,,,,3.93,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Exception Members,,5.50,,,,,,,3.57,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.74,3.37,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,inpatient,1,EA,3.34000,3.18000,The Alliance,Exception Members,,2.57,,,,,,,1.84,3.24,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,outpatient,1,EA,3.34000,3.18000,The Alliance,Exception Members,,2.57,,,,,,,1.67,3.24,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,3.25,5.72,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Exception Members,,4.54,,,,,,,2.95,5.72,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,inpatient,1,mL,13.23000,12.57000,The Alliance,Exception Members,,10.19,,,,,,,7.28,12.83,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,outpatient,1,mL,13.23000,12.57000,The Alliance,Exception Members,,10.19,,,,,,,6.62,12.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,inpatient,1,mL,31.25000,29.69000,The Alliance,Exception Members,,24.06,,,,,,,17.19,30.31,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,outpatient,1,mL,31.25000,29.69000,The Alliance,Exception Members,,24.06,,,,,,,15.62,39.57,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,inpatient,1,GM,154.10000,146.40000,The Alliance,Exception Members,,118.66,,,,,,,84.75,149.48,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,outpatient,1,GM,154.10000,146.40000,The Alliance,Exception Members,,118.66,,,,,,,77.05,149.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,inpatient,1,EA,149.05000,141.60000,The Alliance,Exception Members,,114.77,,,,,,,81.98,144.58,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,outpatient,1,EA,149.05000,141.60000,The Alliance,Exception Members,,114.77,,,,,,,74.53,144.58,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,inpatient,1,GM,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,inpatient,1,GM,13.38000,12.71000,The Alliance,Exception Members,,10.30,,,,,,,7.36,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,outpatient,1,GM,13.38000,12.71000,The Alliance,Exception Members,,10.30,,,,,,,0.11935,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,inpatient,1,GM,10.01000,9.51000,The Alliance,Exception Members,,7.71,,,,,,,5.51,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,outpatient,1,GM,10.01000,9.51000,The Alliance,Exception Members,,7.71,,,,,,,0.11935,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,inpatient,1,GM,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,inpatient,1,GM,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,outpatient,1,GM,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.11935,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,inpatient,1,GM,12.25000,11.64000,The Alliance,Exception Members,,9.43,,,,,,,6.74,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,outpatient,1,GM,12.25000,11.64000,The Alliance,Exception Members,,9.43,,,,,,,0.11935,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,inpatient,1,GM,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,outpatient,1,GM,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,0.11935,4.10,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,inpatient,1,EA,8081.09000,7677.04000,The Alliance,Exception Members,,6222.44,,,,,,,4444.60,7838.66,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,outpatient,1,EA,8081.09000,7677.04000,The Alliance,Exception Members,,6222.44,,,,,,,4040.55,8747.08,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,31.64,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,1.82,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,83.12,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,inpatient,1,mL,2.06000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.13,2.00,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,outpatient,1,mL,2.06000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,88.11,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,63.20,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,inpatient,1,EA,264.15000,250.94000,The Alliance,Exception Members,,203.40,,,,,,,145.28,256.23,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,outpatient,1,EA,264.15000,250.94000,The Alliance,Exception Members,,203.40,,,,,,,132.07,256.23,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,inpatient,1,EA,4.43000,4.21000,The Alliance,Exception Members,,3.41,,,,,,,2.44,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Exception Members,,3.41,,,,,,,2.21,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,inpatient,1,EA,6.31000,5.99000,The Alliance,Exception Members,,4.86,,,,,,,3.47,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,outpatient,1,EA,6.31000,5.99000,The Alliance,Exception Members,,4.86,,,,,,,3.15,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,inpatient,1,mL,23.23000,22.07000,The Alliance,Exception Members,,17.89,,,,,,,12.78,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,outpatient,1,mL,23.23000,22.07000,The Alliance,Exception Members,,17.89,,,,,,,11.62,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,inpatient,1,mL,33.95000,32.25000,The Alliance,Exception Members,,26.14,,,,,,,18.67,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,outpatient,1,mL,33.95000,32.25000,The Alliance,Exception Members,,26.14,,,,,,,16.98,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,inpatient,1,mL,9.47000,8.99000,The Alliance,Exception Members,,7.29,,,,,,,5.21,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,outpatient,1,mL,9.47000,8.99000,The Alliance,Exception Members,,7.29,,,,,,,4.74,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,inpatient,1,mL,26.76000,25.43000,The Alliance,Exception Members,,20.61,,,,,,,14.72,25.96,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,outpatient,1,mL,26.76000,25.43000,The Alliance,Exception Members,,20.61,,,,,,,13.38,25.96,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,inpatient,,,3442.00000,3269.90000,The Alliance,Exception Members,,2650.34,,,,,,,1893.10,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,outpatient,,,3442.00000,3269.90000,The Alliance,Exception Members,,2650.34,,,,,,,1343.28,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,712.25,1256.15,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,647.50,1885.25,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,inpatient,1,mL,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,inpatient,1,mL,2.18000,2.08000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,outpatient,1,mL,2.18000,2.08000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,inpatient,1,mL,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.11935,0.61110,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,4.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,inpatient,1,mL,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,outpatient,1,mL,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,inpatient,1,EA,11533.00000,10956.35000,The Alliance,Exception Members,,8880.41,,,,,,,6343.15,11187.01,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,outpatient,1,EA,11533.00000,10956.35000,The Alliance,Exception Members,,8880.41,,,,,,,230.26,11187.01,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,inpatient,1,mL,40.61000,38.58000,The Alliance,Exception Members,,31.27,,,,,,,22.34,39.39,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,outpatient,1,mL,40.61000,38.58000,The Alliance,Exception Members,,31.27,,,,,,,20.30,39.39,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,inpatient,1,EA,1.86000,1.76000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,8.57,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,inpatient,1,mL,540.41000,513.39000,The Alliance,Exception Members,,416.12,,,,,,,297.23,524.20,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,outpatient,1,mL,540.41000,513.39000,The Alliance,Exception Members,,416.12,,,,,,,270.20,524.20,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,1.02,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,inpatient,1,mL,42.81000,40.67000,The Alliance,Exception Members,,32.96,,,,,,,23.55,41.53,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,outpatient,1,mL,42.81000,40.67000,The Alliance,Exception Members,,32.96,,,,,,,21.41,41.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,inpatient,1,EA,15.50000,14.73000,The Alliance,Exception Members,,11.94,,,,,,,8.53,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,outpatient,1,EA,15.50000,14.73000,The Alliance,Exception Members,,11.94,,,,,,,7.75,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,inpatient,1,EA,12.28000,11.67000,The Alliance,Exception Members,,9.46,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Exception Members,,9.46,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,inpatient,1,EA,8.46000,8.04000,The Alliance,Exception Members,,6.51,,,,,,,4.65,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Exception Members,,6.51,,,,,,,0.78449,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,inpatient,1,EA,10.58000,10.05000,The Alliance,Exception Members,,8.15,,,,,,,5.82,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,outpatient,1,EA,10.58000,10.05000,The Alliance,Exception Members,,8.15,,,,,,,0.78449,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,0.78449,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,0.78449,6.90,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,inpatient,1,EA,12.26000,11.65000,The Alliance,Exception Members,,9.44,,,,,,,6.74,11.89,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Exception Members,,9.44,,,,,,,4.09,11.89,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,inpatient,1,mL,16.95000,16.10000,The Alliance,Exception Members,,13.05,,,,,,,9.32,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,outpatient,1,mL,16.95000,16.10000,The Alliance,Exception Members,,13.05,,,,,,,0.59830,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,inpatient,1,mL,13.45000,12.77000,The Alliance,Exception Members,,10.36,,,,,,,7.40,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,outpatient,1,mL,13.45000,12.77000,The Alliance,Exception Members,,10.36,,,,,,,0.59830,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,inpatient,1,mL,16.54000,15.72000,The Alliance,Exception Members,,12.74,,,,,,,9.10,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,outpatient,1,mL,16.54000,15.72000,The Alliance,Exception Members,,12.74,,,,,,,0.59830,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,0.59830,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,inpatient,1,mL,20.44000,19.42000,The Alliance,Exception Members,,15.74,,,,,,,11.24,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,outpatient,1,mL,20.44000,19.42000,The Alliance,Exception Members,,15.74,,,,,,,0.59830,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,inpatient,1,mL,20.65000,19.61000,The Alliance,Exception Members,,15.90,,,,,,,11.36,20.03,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Exception Members,,15.90,,,,,,,0.59830,20.03,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,inpatient,1,EA,19.82000,18.82000,The Alliance,Exception Members,,15.26,,,,,,,10.90,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,outpatient,1,EA,19.82000,18.82000,The Alliance,Exception Members,,15.26,,,,,,,9.91,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,inpatient,1,EA,12.31000,11.69000,The Alliance,Exception Members,,9.48,,,,,,,6.77,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,outpatient,1,EA,12.31000,11.69000,The Alliance,Exception Members,,9.48,,,,,,,6.16,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,inpatient,1,EA,11.08000,10.53000,The Alliance,Exception Members,,8.53,,,,,,,6.09,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,outpatient,1,EA,11.08000,10.53000,The Alliance,Exception Members,,8.53,,,,,,,5.54,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.07,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,2.74,4.84,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Exception Members,,3.84,,,,,,,1.54,4.84,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,11.26,21.83,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,inpatient,1,EA,8343.84000,7926.65000,The Alliance,Exception Members,,6424.76,,,,,,,4589.11,8093.52,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,outpatient,1,EA,8343.84000,7926.65000,The Alliance,Exception Members,,6424.76,,,,,,,709.27,8093.52,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,inpatient,1,mL,17.85000,16.95000,The Alliance,Exception Members,,13.74,,,,,,,9.82,17.31,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,outpatient,1,mL,17.85000,16.95000,The Alliance,Exception Members,,13.74,,,,,,,8.93,17.31,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,inpatient,1,EA,494.41000,469.68000,The Alliance,Exception Members,,380.70,,,,,,,271.93,479.58,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,outpatient,1,EA,494.41000,469.68000,The Alliance,Exception Members,,380.70,,,,,,,0.73160,479.58,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,inpatient,1,EA,15.58000,14.80000,The Alliance,Exception Members,,12.00,,,,,,,8.57,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,outpatient,1,EA,15.58000,14.80000,The Alliance,Exception Members,,12.00,,,,,,,7.79,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.04803,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,83.12,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,2.28,4.02,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Exception Members,,3.19,,,,,,,1.49,4.02,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Exception Members,,2.80,,,,,,,1.82,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,inpatient,1,EA,93.95000,89.25000,The Alliance,Exception Members,,72.34,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,outpatient,1,EA,93.95000,89.25000,The Alliance,Exception Members,,72.34,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,inpatient,1,EA,29.95000,28.45000,The Alliance,Exception Members,,23.06,,,,,,,16.47,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,outpatient,1,EA,29.95000,28.45000,The Alliance,Exception Members,,23.06,,,,,,,14.97,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,inpatient,1,mL,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,inpatient,1,mL,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,inpatient,1,mL,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,outpatient,1,mL,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,inpatient,1,mL,67.32000,63.95000,The Alliance,Exception Members,,51.84,,,,,,,37.03,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,outpatient,1,mL,67.32000,63.95000,The Alliance,Exception Members,,51.84,,,,,,,33.66,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,inpatient,1,mL,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,inpatient,1,mL,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,outpatient,1,mL,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.35,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.04,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,inpatient,1,mL,10.92000,10.38000,The Alliance,Exception Members,,8.41,,,,,,,6.01,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,outpatient,1,mL,10.92000,10.38000,The Alliance,Exception Members,,8.41,,,,,,,5.46,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,inpatient,1,mL,6.02000,5.72000,The Alliance,Exception Members,,4.64,,,,,,,3.31,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,outpatient,1,mL,6.02000,5.72000,The Alliance,Exception Members,,4.64,,,,,,,3.01,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,inpatient,1,mL,16.59000,15.76000,The Alliance,Exception Members,,12.77,,,,,,,9.12,16.09,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,outpatient,1,mL,16.59000,15.76000,The Alliance,Exception Members,,12.77,,,,,,,8.29,16.09,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,inpatient,1,EA,1.64000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,outpatient,1,EA,1.64000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.75900,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Exception Members,,1.06,,,,,,,0.69000,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,inpatient,1,EA,18.36000,17.44000,The Alliance,Exception Members,,14.14,,,,,,,10.10,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Exception Members,,14.14,,,,,,,9.18,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,inpatient,1,EA,25.47000,24.20000,The Alliance,Exception Members,,19.61,,,,,,,14.01,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,outpatient,1,EA,25.47000,24.20000,The Alliance,Exception Members,,19.61,,,,,,,12.73,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,inpatient,1,EA,20.34000,19.32000,The Alliance,Exception Members,,15.66,,,,,,,11.19,19.73,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,outpatient,1,EA,20.34000,19.32000,The Alliance,Exception Members,,15.66,,,,,,,10.17,19.73,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,inpatient,1,EA,800.41000,760.39000,The Alliance,Exception Members,,616.32,,,,,,,440.23,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,outpatient,1,EA,800.41000,760.39000,The Alliance,Exception Members,,616.32,,,,,,,22.62,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,inpatient,1,EA,659.80000,626.81000,The Alliance,Exception Members,,508.05,,,,,,,362.89,640.01,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,outpatient,1,EA,659.80000,626.81000,The Alliance,Exception Members,,508.05,,,,,,,22.62,640.01,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,inpatient,1,EA,8073.00000,7669.35000,The Alliance,Exception Members,,6216.21,,,,,,,4440.15,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,outpatient,1,EA,8073.00000,7669.35000,The Alliance,Exception Members,,6216.21,,,,,,,4.54,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,inpatient,1,EA,1258.61000,1195.68000,The Alliance,Exception Members,,969.13,,,,,,,692.24,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,outpatient,1,EA,1258.61000,1195.68000,The Alliance,Exception Members,,969.13,,,,,,,4.54,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,inpatient,1,EA,8253.21000,7840.55000,The Alliance,Exception Members,,6354.97,,,,,,,4539.27,8005.61,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,outpatient,1,EA,8253.21000,7840.55000,The Alliance,Exception Members,,6354.97,,,,,,,4.54,8005.61,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,156.42,275.87,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,0.73160,275.87,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,inpatient,1,mL,11.66000,11.08000,The Alliance,Exception Members,,8.98,,,,,,,6.41,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,outpatient,1,mL,11.66000,11.08000,The Alliance,Exception Members,,8.98,,,,,,,0.93155,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,inpatient,1,mL,19.36000,18.39000,The Alliance,Exception Members,,14.91,,,,,,,10.65,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,outpatient,1,mL,19.36000,18.39000,The Alliance,Exception Members,,14.91,,,,,,,0.93155,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,inpatient,1,mL,8.71000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,0.93155,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,inpatient,1,mL,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.86,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,0.93155,17.86,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,inpatient,1,EA,1024.57000,973.34000,The Alliance,Exception Members,,788.92,,,,,,,563.51,993.83,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,outpatient,1,EA,1024.57000,973.34000,The Alliance,Exception Members,,788.92,,,,,,,104.95,993.83,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,inpatient,1,EA,2067.60000,1964.22000,The Alliance,Exception Members,,1592.05,,,,,,,1137.18,2005.57,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,outpatient,1,EA,2067.60000,1964.22000,The Alliance,Exception Members,,1592.05,,,,,,,996.39,2005.57,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,2.61,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,inpatient,1,mL,149.33000,141.87000,The Alliance,Exception Members,,114.98,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Exception Members,,114.98,,,,,,,74.67,290.17,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,inpatient,1,mL,9.36000,8.90000,The Alliance,Exception Members,,7.21,,,,,,,5.15,9.08,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,outpatient,1,mL,9.36000,8.90000,The Alliance,Exception Members,,7.21,,,,,,,4.68,9.08,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,inpatient,1,mL,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.64,2.90,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.50,2.90,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,inpatient,1,GM,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,outpatient,1,GM,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,inpatient,1,mL,177.67000,168.78000,The Alliance,Exception Members,,136.81,,,,,,,97.72,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,outpatient,1,mL,177.67000,168.78000,The Alliance,Exception Members,,136.81,,,,,,,5.86,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,inpatient,1,mL,187.70000,178.32000,The Alliance,Exception Members,,144.53,,,,,,,103.23,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,outpatient,1,mL,187.70000,178.32000,The Alliance,Exception Members,,144.53,,,,,,,5.86,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,inpatient,1,mL,119.78000,113.79000,The Alliance,Exception Members,,92.23,,,,,,,65.88,116.19,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,outpatient,1,mL,119.78000,113.79000,The Alliance,Exception Members,,92.23,,,,,,,5.86,116.19,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.57,2.76,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.43,2.76,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,inpatient,1,EA,2.71000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,outpatient,1,EA,2.71000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.35,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,inpatient,1,EA,83.83000,79.64000,The Alliance,Exception Members,,64.55,,,,,,,46.11,81.32,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,outpatient,1,EA,83.83000,79.64000,The Alliance,Exception Members,,64.55,,,,,,,41.91,81.32,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,3.15,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,2.86,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,9.69,17.09,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Exception Members,,13.57,,,,,,,8.81,17.09,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,inpatient,1,mL,73.39000,69.72000,The Alliance,Exception Members,,56.51,,,,,,,40.36,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,outpatient,1,mL,73.39000,69.72000,The Alliance,Exception Members,,56.51,,,,,,,36.70,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,inpatient,1,mL,26.33000,25.02000,The Alliance,Exception Members,,20.27,,,,,,,14.48,25.54,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,outpatient,1,mL,26.33000,25.02000,The Alliance,Exception Members,,20.27,,,,,,,13.16,25.54,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,inpatient,1,EA,12.28000,11.67000,The Alliance,Exception Members,,9.46,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Exception Members,,9.46,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Exception Members,,17.33,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,inpatient,1,mL,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,inpatient,1,GM,193.93000,184.24000,The Alliance,Exception Members,,149.33,,,,,,,106.66,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,outpatient,1,GM,193.93000,184.24000,The Alliance,Exception Members,,149.33,,,,,,,96.97,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,inpatient,1,GM,247.45000,235.08000,The Alliance,Exception Members,,190.54,,,,,,,136.10,240.03,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,outpatient,1,GM,247.45000,235.08000,The Alliance,Exception Members,,190.54,,,,,,,123.72,240.03,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,4.31,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,inpatient,1,EA,41.65000,39.57000,The Alliance,Exception Members,,32.07,,,,,,,22.91,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,outpatient,1,EA,41.65000,39.57000,The Alliance,Exception Members,,32.07,,,,,,,20.82,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.17,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,inpatient,1,mL,230.68000,219.15000,The Alliance,Exception Members,,177.62,,,,,,,126.87,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,outpatient,1,mL,230.68000,219.15000,The Alliance,Exception Members,,177.62,,,,,,,83.42,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,inpatient,1,mL,277.83000,263.94000,The Alliance,Exception Members,,213.93,,,,,,,152.81,269.50,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,outpatient,1,mL,277.83000,263.94000,The Alliance,Exception Members,,213.93,,,,,,,83.42,269.50,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Exception Members,,34.84,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.35,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Exception Members,,3.29,,,,,,,2.13,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,inpatient,1,EA,5.49000,5.21000,The Alliance,Exception Members,,4.23,,,,,,,3.02,5.33,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Exception Members,,4.23,,,,,,,2.75,5.33,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,inpatient,1,GM,63.71000,60.52000,The Alliance,Exception Members,,49.06,,,,,,,35.04,61.80,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,outpatient,1,GM,63.71000,60.52000,The Alliance,Exception Members,,49.06,,,,,,,31.86,61.80,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,inpatient,1,mL,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,10.61,22.93,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,inpatient,1,EA,530.95000,504.40000,The Alliance,Exception Members,,408.83,,,,,,,292.02,515.02,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Exception Members,,408.83,,,,,,,224.97,515.02,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,inpatient,1,mL,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,inpatient,1,mL,12.49000,11.87000,The Alliance,Exception Members,,9.62,,,,,,,6.87,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,outpatient,1,mL,12.49000,11.87000,The Alliance,Exception Members,,9.62,,,,,,,1.85,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,inpatient,1,mL,7.51000,7.13000,The Alliance,Exception Members,,5.78,,,,,,,4.13,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,outpatient,1,mL,7.51000,7.13000,The Alliance,Exception Members,,5.78,,,,,,,1.85,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,inpatient,1,mL,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,inpatient,1,mL,9.59000,9.11000,The Alliance,Exception Members,,7.38,,,,,,,5.27,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,outpatient,1,mL,9.59000,9.11000,The Alliance,Exception Members,,7.38,,,,,,,1.85,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,inpatient,1,mL,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,inpatient,1,mL,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,outpatient,1,mL,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,inpatient,1,GM,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,inpatient,1,GM,17.98000,17.08000,The Alliance,Exception Members,,13.84,,,,,,,9.89,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,outpatient,1,GM,17.98000,17.08000,The Alliance,Exception Members,,13.84,,,,,,,8.99,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,inpatient,1,GM,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,outpatient,1,GM,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,inpatient,1,EA,511.78000,486.19000,The Alliance,Exception Members,,394.07,,,,,,,281.48,496.43,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,outpatient,1,EA,511.78000,486.19000,The Alliance,Exception Members,,394.07,,,,,,,255.89,496.43,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,inpatient,1,EA,157.08000,149.23000,The Alliance,Exception Members,,120.95,,,,,,,86.39,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,outpatient,1,EA,157.08000,149.23000,The Alliance,Exception Members,,120.95,,,,,,,33.41,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,inpatient,1,EA,180.75000,171.71000,The Alliance,Exception Members,,139.18,,,,,,,99.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,outpatient,1,EA,180.75000,171.71000,The Alliance,Exception Members,,139.18,,,,,,,33.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,inpatient,1,EA,121.63000,115.55000,The Alliance,Exception Members,,93.66,,,,,,,66.90,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,outpatient,1,EA,121.63000,115.55000,The Alliance,Exception Members,,93.66,,,,,,,33.41,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,inpatient,1,EA,159.45000,151.48000,The Alliance,Exception Members,,122.78,,,,,,,87.70,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,outpatient,1,EA,159.45000,151.48000,The Alliance,Exception Members,,122.78,,,,,,,33.41,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,inpatient,1,EA,104.66000,99.43000,The Alliance,Exception Members,,80.59,,,,,,,57.56,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,outpatient,1,EA,104.66000,99.43000,The Alliance,Exception Members,,80.59,,,,,,,33.41,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,inpatient,1,EA,96.95000,92.10000,The Alliance,Exception Members,,74.65,,,,,,,53.32,94.04,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,outpatient,1,EA,96.95000,92.10000,The Alliance,Exception Members,,74.65,,,,,,,33.41,94.04,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,inpatient,1,mL,17.10000,16.25000,The Alliance,Exception Members,,13.17,,,,,,,9.40,16.59,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,outpatient,1,mL,17.10000,16.25000,The Alliance,Exception Members,,13.17,,,,,,,8.55,16.59,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,inpatient,1,EA,12.01000,11.41000,The Alliance,Exception Members,,9.25,,,,,,,6.61,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Exception Members,,9.25,,,,,,,6.00,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,inpatient,1,GM,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,outpatient,1,GM,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,inpatient,1,GM,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,outpatient,1,GM,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,inpatient,1,GM,124.12000,117.92000,The Alliance,Exception Members,,95.57,,,,,,,68.27,120.40,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,outpatient,1,GM,124.12000,117.92000,The Alliance,Exception Members,,95.57,,,,,,,62.06,120.40,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,inpatient,1,GM,9.43000,8.96000,The Alliance,Exception Members,,7.26,,,,,,,5.19,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,outpatient,1,GM,9.43000,8.96000,The Alliance,Exception Members,,7.26,,,,,,,4.71,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.11,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.53,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.40,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,inpatient,1,mL,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,11.59,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,outpatient,1,mL,21.07000,20.01000,The Alliance,Exception Members,,16.22,,,,,,,10.54,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Exception Members,,19.47,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,inpatient,1,mL,40.82000,38.78000,The Alliance,Exception Members,,31.43,,,,,,,22.45,39.60,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,outpatient,1,mL,40.82000,38.78000,The Alliance,Exception Members,,31.43,,,,,,,20.41,39.60,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,inpatient,1,EA,2.87000,2.72000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,outpatient,1,EA,2.87000,2.72000,The Alliance,Exception Members,,2.21,,,,,,,1.44,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.04,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.12,6.04,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,inpatient,1,EA,4700.21000,4465.20000,The Alliance,Exception Members,,3619.16,,,,,,,2585.12,4559.20,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,outpatient,1,EA,4700.21000,4465.20000,The Alliance,Exception Members,,3619.16,,,,,,,56.01,4559.20,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,inpatient,1,EA,3.71000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.04,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,outpatient,1,EA,3.71000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,1.85,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.56,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.33,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,inpatient,1,EA,5.58000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,outpatient,1,EA,5.58000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.12,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Exception Members,,3.62,,,,,,,2.35,4.56,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,inpatient,1,EA,142.79000,135.65000,The Alliance,Exception Members,,109.95,,,,,,,78.53,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,outpatient,1,EA,142.79000,135.65000,The Alliance,Exception Members,,109.95,,,,,,,0.05000,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,inpatient,1,EA,17.12000,16.26000,The Alliance,Exception Members,,13.18,,,,,,,9.42,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,outpatient,1,EA,17.12000,16.26000,The Alliance,Exception Members,,13.18,,,,,,,0.05000,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,0.05000,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,0.05000,3.12,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,inpatient,1,EA,27.33000,25.96000,The Alliance,Exception Members,,21.04,,,,,,,15.03,26.51,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,outpatient,1,EA,27.33000,25.96000,The Alliance,Exception Members,,21.04,,,,,,,13.66,26.51,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,inpatient,1,EA,251.66000,239.08000,The Alliance,Exception Members,,193.78,,,,,,,138.41,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,outpatient,1,EA,251.66000,239.08000,The Alliance,Exception Members,,193.78,,,,,,,0.23715,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,inpatient,1,EA,1245.79000,1183.50000,The Alliance,Exception Members,,959.26,,,,,,,685.18,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,outpatient,1,EA,1245.79000,1183.50000,The Alliance,Exception Members,,959.26,,,,,,,0.23715,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,inpatient,1,EA,1424.50000,1353.27000,The Alliance,Exception Members,,1096.87,,,,,,,783.48,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,outpatient,1,EA,1424.50000,1353.27000,The Alliance,Exception Members,,1096.87,,,,,,,0.23715,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,0.23715,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,inpatient,1,EA,226.21000,214.90000,The Alliance,Exception Members,,174.18,,,,,,,124.42,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,outpatient,1,EA,226.21000,214.90000,The Alliance,Exception Members,,174.18,,,,,,,0.23715,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,inpatient,1,EA,295.71000,280.93000,The Alliance,Exception Members,,227.70,,,,,,,162.64,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,outpatient,1,EA,295.71000,280.93000,The Alliance,Exception Members,,227.70,,,,,,,0.23715,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,inpatient,1,EA,1315.72000,1249.93000,The Alliance,Exception Members,,1013.10,,,,,,,723.65,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,outpatient,1,EA,1315.72000,1249.93000,The Alliance,Exception Members,,1013.10,,,,,,,0.23715,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,inpatient,1,EA,280.13000,266.13000,The Alliance,Exception Members,,215.70,,,,,,,154.07,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,outpatient,1,EA,280.13000,266.13000,The Alliance,Exception Members,,215.70,,,,,,,0.23715,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,8.35,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Exception Members,,11.70,,,,,,,0.23715,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,156.42,275.87,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Exception Members,,218.99,,,,,,,0.23715,275.87,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,inpatient,1,mL,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,1.84,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,inpatient,1,mL,265.48000,252.20000,The Alliance,Exception Members,,204.42,,,,,,,146.01,257.52,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,outpatient,1,mL,265.48000,252.20000,The Alliance,Exception Members,,204.42,,,,,,,1.84,257.52,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,inpatient,1,mL,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Exception Members,,3.33,,,,,,,2.16,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,inpatient,1,EA,6.45000,6.13000,The Alliance,Exception Members,,4.97,,,,,,,3.55,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,outpatient,1,EA,6.45000,6.13000,The Alliance,Exception Members,,4.97,,,,,,,3.23,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,inpatient,1,GM,6.43000,6.11000,The Alliance,Exception Members,,4.95,,,,,,,3.54,6.24,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,outpatient,1,GM,6.43000,6.11000,The Alliance,Exception Members,,4.95,,,,,,,3.21,6.24,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,inpatient,1,GM,93.82000,89.13000,The Alliance,Exception Members,,72.24,,,,,,,51.60,91.01,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,outpatient,1,GM,93.82000,89.13000,The Alliance,Exception Members,,72.24,,,,,,,46.91,91.01,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,inpatient,1,EA,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.53,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,outpatient,1,EA,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.21,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.69,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,The Alliance,Exception Members,,2.99,,,,,,,2.13,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Exception Members,,2.99,,,,,,,1.94,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,inpatient,1,EA,2.70000,2.56000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,outpatient,1,EA,2.70000,2.56000,The Alliance,Exception Members,,2.08,,,,,,,1.35,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,inpatient,1,mL,30.17000,28.66000,The Alliance,Exception Members,,23.23,,,,,,,16.59,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,outpatient,1,mL,30.17000,28.66000,The Alliance,Exception Members,,23.23,,,,,,,15.09,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Exception Members,,2.46,,,,,,,1.60,3.10,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,inpatient,1,mL,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.75,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.45,4.86,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,inpatient,1,mL,146.16000,138.85000,The Alliance,Exception Members,,112.54,,,,,,,80.39,141.78,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,outpatient,1,mL,146.16000,138.85000,The Alliance,Exception Members,,112.54,,,,,,,73.08,141.78,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,inpatient,1,EA,406.81000,386.47000,The Alliance,Exception Members,,313.24,,,,,,,223.75,394.61,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,outpatient,1,EA,406.81000,386.47000,The Alliance,Exception Members,,313.24,,,,,,,203.41,394.61,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,inpatient,1,EA,10.92000,10.38000,The Alliance,Exception Members,,8.41,,,,,,,6.01,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,outpatient,1,EA,10.92000,10.38000,The Alliance,Exception Members,,8.41,,,,,,,5.46,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,6.38,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,5.80,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,inpatient,1,mL,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,0.06404,3.12,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,inpatient,1,mL,43.04000,40.89000,The Alliance,Exception Members,,33.14,,,,,,,23.67,41.75,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,outpatient,1,mL,43.04000,40.89000,The Alliance,Exception Members,,33.14,,,,,,,6.48,41.75,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,inpatient,1,EA,6.33000,6.01000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,outpatient,1,EA,6.33000,6.01000,The Alliance,Exception Members,,4.87,,,,,,,1.28,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,inpatient,1,EA,24.61000,23.38000,The Alliance,Exception Members,,18.95,,,,,,,13.54,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,outpatient,1,EA,24.61000,23.38000,The Alliance,Exception Members,,18.95,,,,,,,1.28,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,1.28,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,1.28,4.91,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,inpatient,1,mL,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,3.22,5.68,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,outpatient,1,mL,5.86000,5.57000,The Alliance,Exception Members,,4.51,,,,,,,2.93,5.68,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,inpatient,1,mL,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,inpatient,1,mL,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.24,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,outpatient,1,mL,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.19,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,inpatient,1,mL,8.34000,7.93000,The Alliance,Exception Members,,6.42,,,,,,,4.59,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Exception Members,,6.42,,,,,,,3.38,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,inpatient,1,mL,8.47000,8.05000,The Alliance,Exception Members,,6.52,,,,,,,4.66,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,outpatient,1,mL,8.47000,8.05000,The Alliance,Exception Members,,6.52,,,,,,,3.38,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,inpatient,1,mL,4.56000,4.34000,The Alliance,Exception Members,,3.51,,,,,,,2.51,4.42,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,outpatient,1,mL,4.56000,4.34000,The Alliance,Exception Members,,3.51,,,,,,,2.28,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,inpatient,1,mL,3.31000,3.14000,The Alliance,Exception Members,,2.55,,,,,,,1.82,3.21,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,outpatient,1,mL,3.31000,3.14000,The Alliance,Exception Members,,2.55,,,,,,,1.66,4.86,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,inpatient,1,mL,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,inpatient,1,GM,10.36000,9.84000,The Alliance,Exception Members,,7.98,,,,,,,5.70,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,outpatient,1,GM,10.36000,9.84000,The Alliance,Exception Members,,7.98,,,,,,,5.18,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,inpatient,1,GM,8.28000,7.86000,The Alliance,Exception Members,,6.38,,,,,,,4.55,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,outpatient,1,GM,8.28000,7.86000,The Alliance,Exception Members,,6.38,,,,,,,4.14,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,inpatient,1,GM,4.48000,4.25000,The Alliance,Exception Members,,3.45,,,,,,,2.46,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,outpatient,1,GM,4.48000,4.25000,The Alliance,Exception Members,,3.45,,,,,,,2.24,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,inpatient,1,GM,10.34000,9.83000,The Alliance,Exception Members,,7.96,,,,,,,5.69,10.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,outpatient,1,GM,10.34000,9.83000,The Alliance,Exception Members,,7.96,,,,,,,5.17,10.03,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,5.39,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Exception Members,,7.55,,,,,,,4.90,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Exception Members,,3.98,,,,,,,2.58,5.01,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,inpatient,1,EA,27.93000,26.54000,The Alliance,Exception Members,,21.51,,,,,,,15.36,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,outpatient,1,EA,27.93000,26.54000,The Alliance,Exception Members,,21.51,,,,,,,13.96,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,inpatient,1,EA,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,45.76,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,41.60,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,inpatient,1,EA,27.65000,26.27000,The Alliance,Exception Members,,21.29,,,,,,,15.21,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,outpatient,1,EA,27.65000,26.27000,The Alliance,Exception Members,,21.29,,,,,,,13.82,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,inpatient,1,EA,17.89000,16.99000,The Alliance,Exception Members,,13.78,,,,,,,9.84,17.35,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,outpatient,1,EA,17.89000,16.99000,The Alliance,Exception Members,,13.78,,,,,,,8.95,17.35,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,inpatient,1,EA,2.48000,2.35000,The Alliance,Exception Members,,1.91,,,,,,,1.36,2.41,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,outpatient,1,EA,2.48000,2.35000,The Alliance,Exception Members,,1.91,,,,,,,1.24,2.41,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,inpatient,1,GM,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,outpatient,1,GM,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,inpatient,1,EA,24.16000,22.96000,The Alliance,Exception Members,,18.60,,,,,,,13.29,23.44,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,outpatient,1,EA,24.16000,22.96000,The Alliance,Exception Members,,18.60,,,,,,,12.08,23.44,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,inpatient,1,EA,7.03000,6.68000,The Alliance,Exception Members,,5.41,,,,,,,3.87,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,outpatient,1,EA,7.03000,6.68000,The Alliance,Exception Members,,5.41,,,,,,,3.52,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,inpatient,1,EA,15.83000,15.04000,The Alliance,Exception Members,,12.19,,,,,,,8.71,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,outpatient,1,EA,15.83000,15.04000,The Alliance,Exception Members,,12.19,,,,,,,7.92,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,inpatient,1,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.64,8.19,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.22,8.19,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,inpatient,1,EA,18.30000,17.38000,The Alliance,Exception Members,,14.09,,,,,,,10.06,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,outpatient,1,EA,18.30000,17.38000,The Alliance,Exception Members,,14.09,,,,,,,1.86,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,inpatient,1,EA,59.37000,56.40000,The Alliance,Exception Members,,45.71,,,,,,,32.65,57.59,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,outpatient,1,EA,59.37000,56.40000,The Alliance,Exception Members,,45.71,,,,,,,1.86,57.59,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,2.36,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Exception Members,,3.30,,,,,,,2.15,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,inpatient,1,EA,2.89000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,outpatient,1,EA,2.89000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,inpatient,1,mL,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,1.33,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,inpatient,1,mL,31.44000,29.87000,The Alliance,Exception Members,,24.21,,,,,,,17.29,30.50,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,outpatient,1,mL,31.44000,29.87000,The Alliance,Exception Members,,24.21,,,,,,,1.33,30.50,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,inpatient,1,EA,414.40000,393.68000,The Alliance,Exception Members,,319.09,,,,,,,227.92,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,outpatient,1,EA,414.40000,393.68000,The Alliance,Exception Members,,319.09,,,,,,,50.35,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,50.35,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,inpatient,1,EA,100.11000,95.10000,The Alliance,Exception Members,,77.08,,,,,,,55.06,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,outpatient,1,EA,100.11000,95.10000,The Alliance,Exception Members,,77.08,,,,,,,50.05,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,inpatient,1,EA,153.86000,146.17000,The Alliance,Exception Members,,118.47,,,,,,,84.62,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,outpatient,1,EA,153.86000,146.17000,The Alliance,Exception Members,,118.47,,,,,,,50.35,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,inpatient,1,EA,515.41000,489.64000,The Alliance,Exception Members,,396.87,,,,,,,283.48,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,outpatient,1,EA,515.41000,489.64000,The Alliance,Exception Members,,396.87,,,,,,,50.35,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,inpatient,1,EA,751.10000,713.54000,The Alliance,Exception Members,,578.35,,,,,,,413.11,728.57,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,outpatient,1,EA,751.10000,713.54000,The Alliance,Exception Members,,578.35,,,,,,,50.35,728.57,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,inpatient,1,mL,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,outpatient,1,mL,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,The Alliance,Exception Members,,13.11,,,,,,,9.37,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Exception Members,,13.11,,,,,,,8.52,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,The Alliance,Exception Members,,10.50,,,,,,,7.50,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Exception Members,,10.50,,,,,,,6.82,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,3.64,6.41,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Exception Members,,5.09,,,,,,,3.31,6.41,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,inpatient,1,EA,30.94000,29.39000,The Alliance,Exception Members,,23.82,,,,,,,17.02,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,outpatient,1,EA,30.94000,29.39000,The Alliance,Exception Members,,23.82,,,,,,,1.86,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,inpatient,1,EA,67.73000,64.35000,The Alliance,Exception Members,,52.15,,,,,,,37.25,65.70,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,outpatient,1,EA,67.73000,64.35000,The Alliance,Exception Members,,52.15,,,,,,,1.86,65.70,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.12,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,inpatient,1,EA,9.24000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,5.08,8.96,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,3.12,8.96,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,2.71,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,inpatient,20,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,outpatient,20,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,3.83,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,inpatient,20,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,outpatient,20,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,3.83,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,inpatient,1,EA,12.12000,11.51000,The Alliance,Exception Members,,9.33,,,,,,,6.67,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,outpatient,1,EA,12.12000,11.51000,The Alliance,Exception Members,,9.33,,,,,,,6.06,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.68,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.44,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.44,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.31,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,inpatient,1,EA,10.66000,10.13000,The Alliance,Exception Members,,8.21,,,,,,,5.86,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,outpatient,1,EA,10.66000,10.13000,The Alliance,Exception Members,,8.21,,,,,,,5.33,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,inpatient,1,EA,443.95000,421.75000,The Alliance,Exception Members,,341.84,,,,,,,244.17,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,outpatient,1,EA,443.95000,421.75000,The Alliance,Exception Members,,341.84,,,,,,,173.64,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,inpatient,1,EA,8136.71000,7729.88000,The Alliance,Exception Members,,6265.27,,,,,,,4475.19,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,outpatient,1,EA,8136.71000,7729.88000,The Alliance,Exception Members,,6265.27,,,,,,,173.64,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,inpatient,1,EA,6780.60000,6441.57000,The Alliance,Exception Members,,5221.06,,,,,,,3729.33,6577.18,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,outpatient,1,EA,6780.60000,6441.57000,The Alliance,Exception Members,,5221.06,,,,,,,173.64,6577.18,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,inpatient,1,mL,91.29000,86.72000,The Alliance,Exception Members,,70.29,,,,,,,50.21,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,outpatient,1,mL,91.29000,86.72000,The Alliance,Exception Members,,70.29,,,,,,,43.34,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,inpatient,1,mL,78.87000,74.93000,The Alliance,Exception Members,,60.73,,,,,,,43.38,76.50,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,outpatient,1,mL,78.87000,74.93000,The Alliance,Exception Members,,60.73,,,,,,,39.44,76.50,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,inpatient,1,mL,9.87000,9.38000,The Alliance,Exception Members,,7.60,,,,,,,5.43,9.57,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,outpatient,1,mL,9.87000,9.38000,The Alliance,Exception Members,,7.60,,,,,,,4.93,9.57,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,inpatient,1,EA,8.44000,8.01000,The Alliance,Exception Members,,6.50,,,,,,,4.64,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,outpatient,1,EA,8.44000,8.01000,The Alliance,Exception Members,,6.50,,,,,,,4.22,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,inpatient,1,EA,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,28.24,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,outpatient,1,EA,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,25.68,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,inpatient,1,EA,9.88000,9.38000,The Alliance,Exception Members,,7.61,,,,,,,5.43,9.58,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Exception Members,,7.61,,,,,,,4.94,9.58,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,1.28,6.13,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,inpatient,1,mL,4.12000,3.91000,The Alliance,Exception Members,,3.17,,,,,,,2.27,4.00,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,outpatient,1,mL,4.12000,3.91000,The Alliance,Exception Members,,3.17,,,,,,,2.06,4.00,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,inpatient,1,EA,9.49000,9.02000,The Alliance,Exception Members,,7.31,,,,,,,5.22,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,outpatient,1,EA,9.49000,9.02000,The Alliance,Exception Members,,7.31,,,,,,,4.75,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,The Alliance,Exception Members,,8.05,,,,,,,5.75,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Exception Members,,8.05,,,,,,,5.23,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,inpatient,1,EA,9.23000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,5.08,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,outpatient,1,EA,9.23000,8.77000,The Alliance,Exception Members,,7.11,,,,,,,4.62,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,inpatient,1,EA,21.79000,20.70000,The Alliance,Exception Members,,16.78,,,,,,,11.98,21.14,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,outpatient,1,EA,21.79000,20.70000,The Alliance,Exception Members,,16.78,,,,,,,10.89,21.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,inpatient,1,EA,76.88000,73.03000,The Alliance,Exception Members,,59.20,,,,,,,42.28,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,outpatient,1,EA,76.88000,73.03000,The Alliance,Exception Members,,59.20,,,,,,,38.44,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,inpatient,1,EA,64.06000,60.86000,The Alliance,Exception Members,,49.33,,,,,,,35.23,62.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,outpatient,1,EA,64.06000,60.86000,The Alliance,Exception Members,,49.33,,,,,,,32.03,62.14,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.73,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.39,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,inpatient,1,EA,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,4.49,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,outpatient,1,EA,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,4.08,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,inpatient,1,EA,22.28000,21.16000,The Alliance,Exception Members,,17.16,,,,,,,12.25,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,outpatient,1,EA,22.28000,21.16000,The Alliance,Exception Members,,17.16,,,,,,,11.14,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,inpatient,1,EA,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.74,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,outpatient,1,EA,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.44,4.74,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,inpatient,1,mL,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,outpatient,1,mL,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,0.06045,1.84,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,inpatient,1,EA,122.99000,116.84000,The Alliance,Exception Members,,94.70,,,,,,,67.64,119.30,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,outpatient,1,EA,122.99000,116.84000,The Alliance,Exception Members,,94.70,,,,,,,61.49,119.30,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,inpatient,50,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,inpatient,50,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,inpatient,50,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,inpatient,50,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,outpatient,50,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,inpatient,50,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,inpatient,50,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,outpatient,50,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,2.76,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Exception Members,,2.13,,,,,,,1.39,2.69,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.35,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.06404,0.92150,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,inpatient,1,GM,6.83000,6.49000,The Alliance,Exception Members,,5.26,,,,,,,3.76,6.63,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,outpatient,1,GM,6.83000,6.49000,The Alliance,Exception Members,,5.26,,,,,,,3.42,6.63,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,inpatient,1,GM,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,outpatient,1,GM,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,inpatient,1,EA,7.08000,6.72000,The Alliance,Exception Members,,5.45,,,,,,,3.89,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,outpatient,1,EA,7.08000,6.72000,The Alliance,Exception Members,,5.45,,,,,,,3.54,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,inpatient,1,EA,10.38000,9.86000,The Alliance,Exception Members,,7.99,,,,,,,5.71,10.07,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,outpatient,1,EA,10.38000,9.86000,The Alliance,Exception Members,,7.99,,,,,,,5.19,10.07,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,inpatient,1,EA,17.09000,16.24000,The Alliance,Exception Members,,13.16,,,,,,,9.40,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,outpatient,1,EA,17.09000,16.24000,The Alliance,Exception Members,,13.16,,,,,,,8.54,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,inpatient,1,EA,10.50000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.78,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,outpatient,1,EA,10.50000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.25,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,inpatient,1,EA,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,3.49,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,3.17,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,inpatient,1,EA,18.34000,17.42000,The Alliance,Exception Members,,14.12,,,,,,,10.09,17.79,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,outpatient,1,EA,18.34000,17.42000,The Alliance,Exception Members,,14.12,,,,,,,9.17,17.79,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,inpatient,1,mL,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,2.37,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,outpatient,1,mL,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,2.15,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,inpatient,1,mL,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,outpatient,1,mL,1.50000,1.42000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,inpatient,1,mL,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,inpatient,1,mL,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,inpatient,1,mL,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,2.03,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,4.75,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,inpatient,1,GM,7.87000,7.47000,The Alliance,Exception Members,,6.06,,,,,,,4.33,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,outpatient,1,GM,7.87000,7.47000,The Alliance,Exception Members,,6.06,,,,,,,3.94,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,inpatient,1,GM,6.56000,6.23000,The Alliance,Exception Members,,5.05,,,,,,,3.61,6.36,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,outpatient,1,GM,6.56000,6.23000,The Alliance,Exception Members,,5.05,,,,,,,3.28,6.36,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,inpatient,1,mL,46.93000,44.58000,The Alliance,Exception Members,,36.14,,,,,,,25.81,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,outpatient,1,mL,46.93000,44.58000,The Alliance,Exception Members,,36.14,,,,,,,23.46,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,inpatient,1,mL,43.17000,41.01000,The Alliance,Exception Members,,33.24,,,,,,,23.74,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,outpatient,1,mL,43.17000,41.01000,The Alliance,Exception Members,,33.24,,,,,,,21.59,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,inpatient,1,mL,42.74000,40.60000,The Alliance,Exception Members,,32.91,,,,,,,23.51,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,outpatient,1,mL,42.74000,40.60000,The Alliance,Exception Members,,32.91,,,,,,,21.37,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,inpatient,1,mL,32.38000,30.76000,The Alliance,Exception Members,,24.93,,,,,,,17.81,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,outpatient,1,mL,32.38000,30.76000,The Alliance,Exception Members,,24.93,,,,,,,16.19,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,inpatient,1,mL,15.72000,14.93000,The Alliance,Exception Members,,12.10,,,,,,,8.65,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,outpatient,1,mL,15.72000,14.93000,The Alliance,Exception Members,,12.10,,,,,,,7.86,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,inpatient,1,GM,19.34000,18.37000,The Alliance,Exception Members,,14.89,,,,,,,10.64,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,outpatient,1,GM,19.34000,18.37000,The Alliance,Exception Members,,14.89,,,,,,,9.67,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,7.77,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,inpatient,1,EA,158.63000,150.70000,The Alliance,Exception Members,,122.15,,,,,,,87.25,153.87,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,outpatient,1,EA,158.63000,150.70000,The Alliance,Exception Members,,122.15,,,,,,,7.77,153.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,inpatient,1,GM,18.19000,17.28000,The Alliance,Exception Members,,14.01,,,,,,,10.00,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,outpatient,1,GM,18.19000,17.28000,The Alliance,Exception Members,,14.01,,,,,,,9.10,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,inpatient,1,GM,26.20000,24.89000,The Alliance,Exception Members,,20.17,,,,,,,14.41,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,outpatient,1,GM,26.20000,24.89000,The Alliance,Exception Members,,20.17,,,,,,,13.10,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,inpatient,1,GM,13.79000,13.10000,The Alliance,Exception Members,,10.62,,,,,,,7.58,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,outpatient,1,GM,13.79000,13.10000,The Alliance,Exception Members,,10.62,,,,,,,6.89,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,inpatient,1,GM,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,outpatient,1,GM,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,inpatient,1,GM,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,outpatient,1,GM,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,inpatient,1,GM,6.55000,6.22000,The Alliance,Exception Members,,5.04,,,,,,,3.60,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,outpatient,1,GM,6.55000,6.22000,The Alliance,Exception Members,,5.04,,,,,,,3.27,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,inpatient,1,GM,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,outpatient,1,GM,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,inpatient,1,GM,8.15000,7.74000,The Alliance,Exception Members,,6.28,,,,,,,4.48,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,outpatient,1,GM,8.15000,7.74000,The Alliance,Exception Members,,6.28,,,,,,,4.08,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,inpatient,1,GM,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,outpatient,1,GM,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,inpatient,1,GM,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,4.32,7.62,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,outpatient,1,GM,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,3.93,7.62,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,EA,8.63000,8.20000,The Alliance,Exception Members,,6.65,,,,,,,4.75,8.37,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Exception Members,,6.65,,,,,,,1.28,8.37,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,inpatient,1,mL,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,outpatient,1,mL,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.76415,1.61,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,inpatient,1,mL,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,outpatient,1,mL,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.34,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,inpatient,1,mL,7.34000,6.97000,The Alliance,Exception Members,,5.65,,,,,,,4.04,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,outpatient,1,mL,7.34000,6.97000,The Alliance,Exception Members,,5.65,,,,,,,3.67,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,inpatient,1,mL,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,4.00,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,outpatient,1,mL,7.27000,6.90000,The Alliance,Exception Members,,5.60,,,,,,,3.63,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,inpatient,1,mL,7.99000,7.60000,The Alliance,Exception Members,,6.15,,,,,,,4.39,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,outpatient,1,mL,7.99000,7.60000,The Alliance,Exception Members,,6.15,,,,,,,4.00,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,inpatient,1,mL,2.88000,2.74000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,outpatient,1,mL,2.88000,2.74000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,inpatient,1,mL,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.32,6.44,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.81,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,inpatient,1,mL,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.79,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,outpatient,1,mL,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.54,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,inpatient,1,mL,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,outpatient,1,mL,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,inpatient,1,GM,193.54000,183.86000,The Alliance,Exception Members,,149.03,,,,,,,106.45,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,outpatient,1,GM,193.54000,183.86000,The Alliance,Exception Members,,149.03,,,,,,,96.77,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,inpatient,1,GM,223.33000,212.16000,The Alliance,Exception Members,,171.96,,,,,,,122.83,216.63,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,outpatient,1,GM,223.33000,212.16000,The Alliance,Exception Members,,171.96,,,,,,,111.67,216.63,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,inpatient,1,mL,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,inpatient,1,mL,30.48000,28.95000,The Alliance,Exception Members,,23.47,,,,,,,16.76,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,outpatient,1,mL,30.48000,28.95000,The Alliance,Exception Members,,23.47,,,,,,,15.24,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,inpatient,1,mL,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,outpatient,1,mL,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,inpatient,1,mL,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.96,3.45,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,outpatient,1,mL,3.56000,3.38000,The Alliance,Exception Members,,2.74,,,,,,,1.78,3.45,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,inpatient,1,EA,195.57000,185.79000,The Alliance,Exception Members,,150.59,,,,,,,107.56,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,outpatient,1,EA,195.57000,185.79000,The Alliance,Exception Members,,150.59,,,,,,,97.78,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,inpatient,1,EA,398.19000,378.28000,The Alliance,Exception Members,,306.61,,,,,,,219.00,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,outpatient,1,EA,398.19000,378.28000,The Alliance,Exception Members,,306.61,,,,,,,199.09,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,inpatient,1,EA,195.79000,186.00000,The Alliance,Exception Members,,150.76,,,,,,,107.68,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,outpatient,1,EA,195.79000,186.00000,The Alliance,Exception Members,,150.76,,,,,,,97.89,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,inpatient,1,EA,97.90000,93.00000,The Alliance,Exception Members,,75.38,,,,,,,53.84,94.96,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,outpatient,1,EA,97.90000,93.00000,The Alliance,Exception Members,,75.38,,,,,,,48.95,94.96,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,inpatient,1,GM,21.61000,20.53000,The Alliance,Exception Members,,16.64,,,,,,,11.89,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,outpatient,1,GM,21.61000,20.53000,The Alliance,Exception Members,,16.64,,,,,,,10.80,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,inpatient,1,GM,15.06000,14.31000,The Alliance,Exception Members,,11.60,,,,,,,8.28,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,outpatient,1,GM,15.06000,14.31000,The Alliance,Exception Members,,11.60,,,,,,,7.53,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,inpatient,1,GM,13.12000,12.46000,The Alliance,Exception Members,,10.10,,,,,,,7.22,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,outpatient,1,GM,13.12000,12.46000,The Alliance,Exception Members,,10.10,,,,,,,6.56,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,inpatient,1,GM,11.48000,10.91000,The Alliance,Exception Members,,8.84,,,,,,,6.31,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,outpatient,1,GM,11.48000,10.91000,The Alliance,Exception Members,,8.84,,,,,,,5.74,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,inpatient,1,GM,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,outpatient,1,GM,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,inpatient,1,GM,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.44,2.54,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,outpatient,1,GM,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.31,2.54,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,5.69,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,inpatient,1,mL,8.15000,7.75000,The Alliance,Exception Members,,6.28,,,,,,,4.48,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,outpatient,1,mL,8.15000,7.75000,The Alliance,Exception Members,,6.28,,,,,,,4.08,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,inpatient,1,mL,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,7.30,12.87,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,outpatient,1,mL,13.27000,12.61000,The Alliance,Exception Members,,10.22,,,,,,,6.63,12.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,inpatient,1,GM,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,8.36,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,outpatient,1,GM,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,7.60,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,inpatient,1,GM,21.89000,20.79000,The Alliance,Exception Members,,16.86,,,,,,,12.04,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,outpatient,1,GM,21.89000,20.79000,The Alliance,Exception Members,,16.86,,,,,,,10.95,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,inpatient,1,GM,11.17000,10.61000,The Alliance,Exception Members,,8.60,,,,,,,6.14,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,outpatient,1,GM,11.17000,10.61000,The Alliance,Exception Members,,8.60,,,,,,,5.58,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,inpatient,1,GM,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,outpatient,1,GM,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,inpatient,1,GM,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,outpatient,1,GM,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,inpatient,1,GM,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,outpatient,1,GM,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,inpatient,1,mL,99.81000,94.82000,The Alliance,Exception Members,,76.85,,,,,,,54.90,96.82,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,outpatient,1,mL,99.81000,94.82000,The Alliance,Exception Members,,76.85,,,,,,,49.91,96.82,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,inpatient,1,mL,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,outpatient,1,mL,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,inpatient,1,EA,10.87000,10.33000,The Alliance,Exception Members,,8.37,,,,,,,5.98,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,outpatient,1,EA,10.87000,10.33000,The Alliance,Exception Members,,8.37,,,,,,,5.43,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,inpatient,1,EA,8.36000,7.94000,The Alliance,Exception Members,,6.44,,,,,,,4.60,8.11,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,outpatient,1,EA,8.36000,7.94000,The Alliance,Exception Members,,6.44,,,,,,,4.18,8.11,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,inpatient,1,mL,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,outpatient,1,mL,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,The Alliance,Exception Members,,16.41,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Exception Members,,16.41,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,inpatient,1,EA,21.57000,20.49000,The Alliance,Exception Members,,16.61,,,,,,,11.86,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,outpatient,1,EA,21.57000,20.49000,The Alliance,Exception Members,,16.61,,,,,,,10.79,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,The Alliance,Exception Members,,16.41,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Exception Members,,16.41,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,inpatient,1,EA,21.32000,20.25000,The Alliance,Exception Members,,16.42,,,,,,,11.73,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,outpatient,1,EA,21.32000,20.25000,The Alliance,Exception Members,,16.42,,,,,,,10.66,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,inpatient,1,mL,801.86000,761.77000,The Alliance,Exception Members,,617.43,,,,,,,441.02,777.80,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,outpatient,1,mL,801.86000,761.77000,The Alliance,Exception Members,,617.43,,,,,,,3.00,777.80,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,inpatient,1,mL,23.90000,22.71000,The Alliance,Exception Members,,18.40,,,,,,,13.14,23.18,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,outpatient,1,mL,23.90000,22.71000,The Alliance,Exception Members,,18.40,,,,,,,11.95,23.18,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.79,4.92,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Exception Members,,3.90,,,,,,,2.54,4.92,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,inpatient,1,mL,10.43000,9.91000,The Alliance,Exception Members,,8.03,,,,,,,5.74,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,outpatient,1,mL,10.43000,9.91000,The Alliance,Exception Members,,8.03,,,,,,,5.21,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,inpatient,1,EA,140.98000,133.93000,The Alliance,Exception Members,,108.55,,,,,,,77.54,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,outpatient,1,EA,140.98000,133.93000,The Alliance,Exception Members,,108.55,,,,,,,70.49,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,inpatient,1,EA,141.13000,134.08000,The Alliance,Exception Members,,108.67,,,,,,,77.62,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,outpatient,1,EA,141.13000,134.08000,The Alliance,Exception Members,,108.67,,,,,,,70.56,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,inpatient,1,EA,43.75000,41.56000,The Alliance,Exception Members,,33.69,,,,,,,24.06,42.44,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,outpatient,1,EA,43.75000,41.56000,The Alliance,Exception Members,,33.69,,,,,,,21.88,42.44,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,inpatient,1,EA,5.54000,5.26000,The Alliance,Exception Members,,4.27,,,,,,,3.05,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,outpatient,1,EA,5.54000,5.26000,The Alliance,Exception Members,,4.27,,,,,,,2.77,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.86,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.69,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,inpatient,1,EA,63.57000,60.39000,The Alliance,Exception Members,,48.95,,,,,,,34.96,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,outpatient,1,EA,63.57000,60.39000,The Alliance,Exception Members,,48.95,,,,,,,31.79,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Exception Members,,16.80,,,,,,,10.91,21.17,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,inpatient,1,mL,375.55000,356.77000,The Alliance,Exception Members,,289.17,,,,,,,206.55,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,outpatient,1,mL,375.55000,356.77000,The Alliance,Exception Members,,289.17,,,,,,,13.96,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,inpatient,1,mL,335.74000,318.95000,The Alliance,Exception Members,,258.52,,,,,,,184.66,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,outpatient,1,mL,335.74000,318.95000,The Alliance,Exception Members,,258.52,,,,,,,13.96,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,165.11,291.19,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,13.96,291.19,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.90,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.55,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,inpatient,1,EA,3.26000,3.10000,The Alliance,Exception Members,,2.51,,,,,,,1.79,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,outpatient,1,EA,3.26000,3.10000,The Alliance,Exception Members,,2.51,,,,,,,1.63,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.25,2.20,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Exception Members,,1.75,,,,,,,1.14,2.20,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,inpatient,1,EA,25.93000,24.63000,The Alliance,Exception Members,,19.97,,,,,,,14.26,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,outpatient,1,EA,25.93000,24.63000,The Alliance,Exception Members,,19.97,,,,,,,3.14,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,inpatient,1,EA,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,13.56,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,outpatient,1,EA,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,3.14,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,inpatient,1,EA,13.89000,13.20000,The Alliance,Exception Members,,10.70,,,,,,,7.64,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,outpatient,1,EA,13.89000,13.20000,The Alliance,Exception Members,,10.70,,,,,,,3.14,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,inpatient,1,EA,9.72000,9.24000,The Alliance,Exception Members,,7.48,,,,,,,5.35,9.43,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,outpatient,1,EA,9.72000,9.24000,The Alliance,Exception Members,,7.48,,,,,,,3.14,9.43,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,inpatient,1,mL,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,10.35,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,outpatient,1,mL,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,9.41,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,inpatient,1,mL,22.36000,21.24000,The Alliance,Exception Members,,17.22,,,,,,,12.30,21.69,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,outpatient,1,mL,22.36000,21.24000,The Alliance,Exception Members,,17.22,,,,,,,11.18,21.69,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,inpatient,1,GM,31.85000,30.26000,The Alliance,Exception Members,,24.52,,,,,,,17.52,30.89,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,outpatient,1,GM,31.85000,30.26000,The Alliance,Exception Members,,24.52,,,,,,,15.93,30.89,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,inpatient,1,GM,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,outpatient,1,GM,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,inpatient,1,EA,11.53000,10.96000,The Alliance,Exception Members,,8.88,,,,,,,6.34,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,outpatient,1,EA,11.53000,10.96000,The Alliance,Exception Members,,8.88,,,,,,,5.76,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.56,2.75,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Exception Members,,2.18,,,,,,,1.42,2.75,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.91300,1.61,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Exception Members,,1.28,,,,,,,0.83000,1.61,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,inpatient,1,mL,105.97000,100.67000,The Alliance,Exception Members,,81.60,,,,,,,58.28,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,outpatient,1,mL,105.97000,100.67000,The Alliance,Exception Members,,81.60,,,,,,,19.76,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,inpatient,1,mL,103.60000,98.42000,The Alliance,Exception Members,,79.77,,,,,,,56.98,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,outpatient,1,mL,103.60000,98.42000,The Alliance,Exception Members,,79.77,,,,,,,19.76,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,inpatient,1,mL,54.12000,51.41000,The Alliance,Exception Members,,41.67,,,,,,,29.77,52.50,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,outpatient,1,mL,54.12000,51.41000,The Alliance,Exception Members,,41.67,,,,,,,19.76,52.50,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,inpatient,1,mL,38.34000,36.43000,The Alliance,Exception Members,,29.52,,,,,,,21.09,37.19,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,outpatient,1,mL,38.34000,36.43000,The Alliance,Exception Members,,29.52,,,,,,,19.17,37.19,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,inpatient,1,mL,383.32000,364.15000,The Alliance,Exception Members,,295.16,,,,,,,210.83,371.82,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,outpatient,1,mL,383.32000,364.15000,The Alliance,Exception Members,,295.16,,,,,,,191.66,873.48,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,inpatient,1,EA,43.43000,41.26000,The Alliance,Exception Members,,33.44,,,,,,,23.89,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,outpatient,1,EA,43.43000,41.26000,The Alliance,Exception Members,,33.44,,,,,,,1.77,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,1.77,12.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,4.75,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,4.75,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,14.77,26.05,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Exception Members,,20.68,,,,,,,1.26,26.05,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,inpatient,1,EA,11.14000,10.59000,The Alliance,Exception Members,,8.58,,,,,,,6.13,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Exception Members,,8.58,,,,,,,1.15,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,inpatient,1,EA,9.73000,9.24000,The Alliance,Exception Members,,7.49,,,,,,,5.35,9.44,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,outpatient,1,EA,9.73000,9.24000,The Alliance,Exception Members,,7.49,,,,,,,1.15,9.44,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,inpatient,1,mL,36.86000,35.01000,The Alliance,Exception Members,,28.38,,,,,,,20.27,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,outpatient,1,mL,36.86000,35.01000,The Alliance,Exception Members,,28.38,,,,,,,3.14,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,inpatient,1,mL,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,8.20,14.45,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,outpatient,1,mL,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,3.14,14.45,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,inpatient,1,mL,36.06000,34.25000,The Alliance,Exception Members,,27.77,,,,,,,19.83,34.98,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,outpatient,1,mL,36.06000,34.25000,The Alliance,Exception Members,,27.77,,,,,,,18.03,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,inpatient,1,mL,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,9.33,16.46,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,outpatient,1,mL,16.97000,16.12000,The Alliance,Exception Members,,13.07,,,,,,,8.48,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,inpatient,1,mL,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,7.64,13.48,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,outpatient,1,mL,13.90000,13.21000,The Alliance,Exception Members,,10.70,,,,,,,6.95,119.94,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,inpatient,1,mL,16.03000,15.23000,The Alliance,Exception Members,,12.34,,,,,,,8.82,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,outpatient,1,mL,16.03000,15.23000,The Alliance,Exception Members,,12.34,,,,,,,8.02,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,inpatient,1,mL,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,5.53,9.76,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,outpatient,1,mL,10.06000,9.56000,The Alliance,Exception Members,,7.75,,,,,,,5.03,9.76,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,inpatient,1,EA,88.48000,84.06000,The Alliance,Exception Members,,68.13,,,,,,,48.66,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,outpatient,1,EA,88.48000,84.06000,The Alliance,Exception Members,,68.13,,,,,,,18.24,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,inpatient,1,EA,32.01000,30.41000,The Alliance,Exception Members,,24.65,,,,,,,17.61,31.05,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Exception Members,,24.65,,,,,,,16.00,31.05,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,inpatient,1,EA,405.06000,384.81000,The Alliance,Exception Members,,311.90,,,,,,,222.78,392.91,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,outpatient,1,EA,405.06000,384.81000,The Alliance,Exception Members,,311.90,,,,,,,202.53,392.91,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,inpatient,1,mL,29.93000,28.43000,The Alliance,Exception Members,,23.05,,,,,,,16.46,29.03,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,outpatient,1,mL,29.93000,28.43000,The Alliance,Exception Members,,23.05,,,,,,,14.96,29.03,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,inpatient,1,mL,43.19000,41.03000,The Alliance,Exception Members,,33.26,,,,,,,23.75,41.89,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,outpatient,1,mL,43.19000,41.03000,The Alliance,Exception Members,,33.26,,,,,,,3.14,41.89,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,inpatient,1,EA,7.04000,6.69000,The Alliance,Exception Members,,5.42,,,,,,,3.87,6.83,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Exception Members,,5.42,,,,,,,1.77,6.83,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,inpatient,1,mL,89.25000,84.79000,The Alliance,Exception Members,,68.72,,,,,,,49.09,86.57,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,outpatient,1,mL,89.25000,84.79000,The Alliance,Exception Members,,68.72,,,,,,,44.62,3007.94,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,inpatient,1,EA,11.50000,10.93000,The Alliance,Exception Members,,8.86,,,,,,,6.33,11.15,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Exception Members,,8.86,,,,,,,5.75,11.15,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,inpatient,1,mL,417.74000,396.85000,The Alliance,Exception Members,,321.66,,,,,,,229.76,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,outpatient,1,mL,417.74000,396.85000,The Alliance,Exception Members,,321.66,,,,,,,24.87,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,inpatient,1,mL,459.10000,436.15000,The Alliance,Exception Members,,353.51,,,,,,,252.50,445.33,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,outpatient,1,mL,459.10000,436.15000,The Alliance,Exception Members,,353.51,,,,,,,24.87,445.33,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,2.76,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,inpatient,1,EA,23.67000,22.48000,The Alliance,Exception Members,,18.23,,,,,,,13.02,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,outpatient,1,EA,23.67000,22.48000,The Alliance,Exception Members,,18.23,,,,,,,1.77,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,13.21,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Exception Members,,18.50,,,,,,,1.77,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,inpatient,1,EA,5.32000,5.05000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.16,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,outpatient,1,EA,5.32000,5.05000,The Alliance,Exception Members,,4.10,,,,,,,1.77,5.16,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,inpatient,1,EA,3353.56000,3185.88000,The Alliance,Exception Members,,2582.24,,,,,,,1844.46,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,outpatient,1,EA,3353.56000,3185.88000,The Alliance,Exception Members,,2582.24,,,,,,,302.92,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,inpatient,1,EA,3885.76000,3691.47000,The Alliance,Exception Members,,2992.04,,,,,,,2137.17,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,outpatient,1,EA,3885.76000,3691.47000,The Alliance,Exception Members,,2992.04,,,,,,,302.92,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,inpatient,1,EA,1610.02000,1529.52000,The Alliance,Exception Members,,1239.72,,,,,,,885.51,1561.72,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,outpatient,1,EA,1610.02000,1529.52000,The Alliance,Exception Members,,1239.72,,,,,,,302.92,1561.72,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.14,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Exception Members,,1.60,,,,,,,1.04,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,inpatient,1,mL,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,outpatient,1,mL,1.71000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.34,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,inpatient,1,EA,1973.81000,1875.12000,The Alliance,Exception Members,,1519.83,,,,,,,1085.60,1914.60,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,outpatient,1,EA,1973.81000,1875.12000,The Alliance,Exception Members,,1519.83,,,,,,,4.36,1914.60,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,inpatient,1,mL,1535.35000,1458.58000,The Alliance,Exception Members,,1182.22,,,,,,,844.44,1489.29,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,outpatient,1,mL,1535.35000,1458.58000,The Alliance,Exception Members,,1182.22,,,,,,,767.67,1489.29,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,inpatient,1,EA,12.03000,11.43000,The Alliance,Exception Members,,9.26,,,,,,,6.62,11.67,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,outpatient,1,EA,12.03000,11.43000,The Alliance,Exception Members,,9.26,,,,,,,6.01,11.67,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,inpatient,1,EA,11.51000,10.94000,The Alliance,Exception Members,,8.86,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Exception Members,,8.86,,,,,,,5.75,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,inpatient,1,EA,11.51000,10.94000,The Alliance,Exception Members,,8.86,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Exception Members,,8.86,,,,,,,5.75,11.16,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,inpatient,1,mL,28.47000,27.05000,The Alliance,Exception Members,,21.92,,,,,,,15.66,27.62,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,outpatient,1,mL,28.47000,27.05000,The Alliance,Exception Members,,21.92,,,,,,,3.89,27.62,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,The Alliance,Exception Members,,5.55,,,,,,,3.97,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Exception Members,,5.55,,,,,,,3.60,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,The Alliance,Exception Members,,13.11,,,,,,,9.37,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Exception Members,,13.11,,,,,,,8.52,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,inpatient,1,EA,19.28000,18.31000,The Alliance,Exception Members,,14.85,,,,,,,10.60,18.70,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Exception Members,,14.85,,,,,,,9.64,18.70,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,inpatient,1,EA,2.88000,2.74000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,outpatient,1,EA,2.88000,2.74000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.00,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.82,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.66,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,The Alliance,Exception Members,,13.34,,,,,,,9.53,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Exception Members,,13.34,,,,,,,8.66,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,inpatient,1,EA,7.44000,7.07000,The Alliance,Exception Members,,5.73,,,,,,,4.09,7.22,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,outpatient,1,EA,7.44000,7.07000,The Alliance,Exception Members,,5.73,,,,,,,3.72,7.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.57,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.43,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,1.88,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.20,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Exception Members,,3.33,,,,,,,1.88,4.20,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.34,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Exception Members,,9.77,,,,,,,6.34,12.31,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,inpatient,1,EA,43.56000,41.39000,The Alliance,Exception Members,,33.54,,,,,,,23.96,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,outpatient,1,EA,43.56000,41.39000,The Alliance,Exception Members,,33.54,,,,,,,21.78,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,inpatient,1,EA,23.96000,22.76000,The Alliance,Exception Members,,18.45,,,,,,,13.18,23.24,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,outpatient,1,EA,23.96000,22.76000,The Alliance,Exception Members,,18.45,,,,,,,11.98,23.24,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.54,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Exception Members,,3.55,,,,,,,2.31,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,inpatient,1,EA,9.22000,8.75000,The Alliance,Exception Members,,7.10,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Exception Members,,7.10,,,,,,,4.61,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,inpatient,1,EA,9.22000,8.75000,The Alliance,Exception Members,,7.10,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Exception Members,,7.10,,,,,,,4.61,8.94,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,inpatient,1,EA,40.08000,38.08000,The Alliance,Exception Members,,30.86,,,,,,,22.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,outpatient,1,EA,40.08000,38.08000,The Alliance,Exception Members,,30.86,,,,,,,20.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,inpatient,1,EA,20.55000,19.52000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.93,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,outpatient,1,EA,20.55000,19.52000,The Alliance,Exception Members,,15.82,,,,,,,10.28,19.93,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,inpatient,1,EA,1420.64000,1349.61000,The Alliance,Exception Members,,1093.89,,,,,,,781.35,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,outpatient,1,EA,1420.64000,1349.61000,The Alliance,Exception Members,,1093.89,,,,,,,32.09,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,inpatient,1,EA,1187.54000,1128.16000,The Alliance,Exception Members,,914.41,,,,,,,653.15,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,outpatient,1,EA,1187.54000,1128.16000,The Alliance,Exception Members,,914.41,,,,,,,32.09,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,inpatient,1,EA,1033.41000,981.74000,The Alliance,Exception Members,,795.73,,,,,,,568.38,1002.41,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,outpatient,1,EA,1033.41000,981.74000,The Alliance,Exception Members,,795.73,,,,,,,32.09,1002.41,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,inpatient,1,mL,501.16000,476.11000,The Alliance,Exception Members,,385.89,,,,,,,275.64,486.13,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Exception Members,,385.89,,,,,,,3.00,486.13,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,inpatient,1,EA,73.47000,69.80000,The Alliance,Exception Members,,56.57,,,,,,,40.41,71.27,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,outpatient,1,EA,73.47000,69.80000,The Alliance,Exception Members,,56.57,,,,,,,1.26,71.27,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,inpatient,1,EA,608.34000,577.92000,The Alliance,Exception Members,,468.42,,,,,,,334.59,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,outpatient,1,EA,608.34000,577.92000,The Alliance,Exception Members,,468.42,,,,,,,32.09,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,inpatient,1,EA,710.33000,674.82000,The Alliance,Exception Members,,546.95,,,,,,,390.68,689.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,outpatient,1,EA,710.33000,674.82000,The Alliance,Exception Members,,546.95,,,,,,,32.09,689.02,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.74250,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Exception Members,,1.04,,,,,,,0.67500,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,inpatient,1,GM,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,outpatient,1,GM,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,inpatient,1,GM,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,outpatient,1,GM,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,inpatient,1,GM,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,outpatient,1,GM,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,inpatient,1,mL,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,inpatient,1,mL,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,0.14415,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.14415,1.22,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,inpatient,1,mL,11.35000,10.79000,The Alliance,Exception Members,,8.74,,,,,,,6.24,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,outpatient,1,mL,11.35000,10.79000,The Alliance,Exception Members,,8.74,,,,,,,5.67,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,inpatient,1,mL,11.53000,10.95000,The Alliance,Exception Members,,8.88,,,,,,,6.34,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,outpatient,1,mL,11.53000,10.95000,The Alliance,Exception Members,,8.88,,,,,,,5.76,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,inpatient,1,mL,15.13000,14.38000,The Alliance,Exception Members,,11.65,,,,,,,8.32,14.68,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,outpatient,1,mL,15.13000,14.38000,The Alliance,Exception Members,,11.65,,,,,,,7.57,14.68,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,inpatient,1,mL,34.06000,32.36000,The Alliance,Exception Members,,26.23,,,,,,,18.73,33.04,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,outpatient,1,mL,34.06000,32.36000,The Alliance,Exception Members,,26.23,,,,,,,17.03,33.04,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,inpatient,1,EA,583.45000,554.28000,The Alliance,Exception Members,,449.26,,,,,,,320.90,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,outpatient,1,EA,583.45000,554.28000,The Alliance,Exception Members,,449.26,,,,,,,291.73,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,inpatient,1,EA,375.39000,356.62000,The Alliance,Exception Members,,289.05,,,,,,,206.46,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,outpatient,1,EA,375.39000,356.62000,The Alliance,Exception Members,,289.05,,,,,,,187.69,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,inpatient,1,EA,331.20000,314.64000,The Alliance,Exception Members,,255.02,,,,,,,182.16,321.26,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,outpatient,1,EA,331.20000,314.64000,The Alliance,Exception Members,,255.02,,,,,,,165.60,321.26,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,inpatient,1,EA,17147.50000,16290.12000,The Alliance,Exception Members,,13203.58,,,,,,,9431.12,16633.08,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,outpatient,1,EA,17147.50000,16290.12000,The Alliance,Exception Members,,13203.58,,,,,,,255.09,16633.08,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,inpatient,1,mL,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,4.05,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,outpatient,1,mL,7.37000,7.00000,The Alliance,Exception Members,,5.67,,,,,,,3.69,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,inpatient,1,mL,6.27000,5.95000,The Alliance,Exception Members,,4.83,,,,,,,3.45,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,outpatient,1,mL,6.27000,5.95000,The Alliance,Exception Members,,4.83,,,,,,,3.13,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,inpatient,1,mL,7.48000,7.10000,The Alliance,Exception Members,,5.76,,,,,,,4.11,7.26,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,outpatient,1,mL,7.48000,7.10000,The Alliance,Exception Members,,5.76,,,,,,,3.74,7.26,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,inpatient,1,EA,692.13000,657.52000,The Alliance,Exception Members,,532.94,,,,,,,380.67,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,outpatient,1,EA,692.13000,657.52000,The Alliance,Exception Members,,532.94,,,,,,,346.06,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,inpatient,1,EA,445.31000,423.05000,The Alliance,Exception Members,,342.89,,,,,,,244.92,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,outpatient,1,EA,445.31000,423.05000,The Alliance,Exception Members,,342.89,,,,,,,222.66,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,inpatient,1,EA,785.75000,746.47000,The Alliance,Exception Members,,605.03,,,,,,,432.16,762.18,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,outpatient,1,EA,785.75000,746.47000,The Alliance,Exception Members,,605.03,,,,,,,392.88,762.18,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,2.24,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.84,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.68,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,inpatient,1,mL,2.91000,2.77000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,inpatient,1,GM,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.85,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,outpatient,1,GM,5.19000,4.93000,The Alliance,Exception Members,,4.00,,,,,,,2.60,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,inpatient,1,GM,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,outpatient,1,GM,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,inpatient,1,GM,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,outpatient,1,GM,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,inpatient,1,GM,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,outpatient,1,GM,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,inpatient,1,GM,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,outpatient,1,GM,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,inpatient,1,GM,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,outpatient,1,GM,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,inpatient,1,GM,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,outpatient,1,GM,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,inpatient,1,GM,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,outpatient,1,GM,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,inpatient,1,GM,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,outpatient,1,GM,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,inpatient,1,mL,4537.21000,4310.35000,The Alliance,Exception Members,,3493.65,,,,,,,2495.47,4401.09,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,outpatient,1,mL,4537.21000,4310.35000,The Alliance,Exception Members,,3493.65,,,,,,,155.39,4401.09,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,inpatient,1,EA,8.94000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,4.92,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,outpatient,1,EA,8.94000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,4.47,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,inpatient,1,EA,23.81000,22.62000,The Alliance,Exception Members,,18.33,,,,,,,13.10,23.10,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,outpatient,1,EA,23.81000,22.62000,The Alliance,Exception Members,,18.33,,,,,,,11.90,23.10,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,inpatient,1,mL,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,outpatient,1,mL,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,8.10,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,2.24,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,inpatient,1,mL,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,284.90,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Exception Members,,398.86,,,,,,,0.60838,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,inpatient,1,mL,312.84000,297.20000,The Alliance,Exception Members,,240.89,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Exception Members,,240.89,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,0.60838,76.63,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,inpatient,1,EA,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,6.57,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,5.97,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,6.52,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,5.92,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,inpatient,1,EA,17.17000,16.31000,The Alliance,Exception Members,,13.22,,,,,,,9.44,16.65,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Exception Members,,13.22,,,,,,,8.59,16.65,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,inpatient,1,EA,12.67000,12.04000,The Alliance,Exception Members,,9.76,,,,,,,6.97,12.29,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,outpatient,1,EA,12.67000,12.04000,The Alliance,Exception Members,,9.76,,,,,,,6.33,12.29,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.46,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Exception Members,,4.85,,,,,,,3.15,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,inpatient,1,EA,11.14000,10.59000,The Alliance,Exception Members,,8.58,,,,,,,6.13,10.81,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Exception Members,,8.58,,,,,,,5.57,10.81,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,inpatient,1,EA,34.50000,32.78000,The Alliance,Exception Members,,26.57,,,,,,,18.98,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,outpatient,1,EA,34.50000,32.78000,The Alliance,Exception Members,,26.57,,,,,,,2.29,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,inpatient,1,EA,5.33000,5.07000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Exception Members,,4.10,,,,,,,2.29,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,inpatient,1,EA,14.93000,14.18000,The Alliance,Exception Members,,11.50,,,,,,,8.21,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,outpatient,1,EA,14.93000,14.18000,The Alliance,Exception Members,,11.50,,,,,,,2.29,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,inpatient,1,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Exception Members,,3.36,,,,,,,2.19,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,inpatient,1,EA,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,8.95,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,2.29,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,inpatient,1,EA,6.24000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,outpatient,1,EA,6.24000,5.92000,The Alliance,Exception Members,,4.80,,,,,,,2.29,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,inpatient,1,EA,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.29,5.17,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,inpatient,1,mL,22.88000,21.74000,The Alliance,Exception Members,,17.62,,,,,,,12.58,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,outpatient,1,mL,22.88000,21.74000,The Alliance,Exception Members,,17.62,,,,,,,11.44,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,inpatient,1,mL,23.28000,22.11000,The Alliance,Exception Members,,17.93,,,,,,,12.80,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,outpatient,1,mL,23.28000,22.11000,The Alliance,Exception Members,,17.93,,,,,,,11.64,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,inpatient,1,mL,23.77000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,13.07,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,outpatient,1,mL,23.77000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,11.88,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,inpatient,1,mL,6.66000,6.33000,The Alliance,Exception Members,,5.13,,,,,,,3.66,6.46,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,outpatient,1,mL,6.66000,6.33000,The Alliance,Exception Members,,5.13,,,,,,,3.33,6.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,inpatient,1,mL,1490.77000,1416.23000,The Alliance,Exception Members,,1147.89,,,,,,,819.92,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,outpatient,1,mL,1490.77000,1416.23000,The Alliance,Exception Members,,1147.89,,,,,,,0.60838,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,inpatient,1,mL,312.84000,297.20000,The Alliance,Exception Members,,240.89,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Exception Members,,240.89,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,inpatient,1,mL,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,36.93,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,outpatient,1,mL,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,0.60838,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,inpatient,1,mL,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,0.60838,153.26,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.90,6.89,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.55,6.89,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,inpatient,1,EA,4.93000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.71,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,outpatient,1,EA,4.93000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.46,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Exception Members,,1.97,,,,,,,1.28,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.28,2.48,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,inpatient,1,mL,29.02000,27.57000,The Alliance,Exception Members,,22.35,,,,,,,15.96,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,outpatient,1,mL,29.02000,27.57000,The Alliance,Exception Members,,22.35,,,,,,,14.51,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,inpatient,1,mL,34.10000,32.39000,The Alliance,Exception Members,,26.26,,,,,,,18.75,33.08,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,outpatient,1,mL,34.10000,32.39000,The Alliance,Exception Members,,26.26,,,,,,,17.05,33.08,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,1.18,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,1.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,inpatient,1,EA,103.29000,98.13000,The Alliance,Exception Members,,79.53,,,,,,,56.81,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,outpatient,1,EA,103.29000,98.13000,The Alliance,Exception Members,,79.53,,,,,,,51.65,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,The Alliance,Exception Members,,6.49,,,,,,,4.64,8.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Exception Members,,6.49,,,,,,,4.21,8.18,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,inpatient,1,EA,256.92000,244.08000,The Alliance,Exception Members,,197.83,,,,,,,141.31,249.21,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,outpatient,1,EA,256.92000,244.08000,The Alliance,Exception Members,,197.83,,,,,,,128.46,249.21,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,inpatient,1,mL,563.15000,534.99000,The Alliance,Exception Members,,433.63,,,,,,,309.73,546.26,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,outpatient,1,mL,563.15000,534.99000,The Alliance,Exception Members,,433.63,,,,,,,281.57,546.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,inpatient,1,EA,16.22000,15.41000,The Alliance,Exception Members,,12.49,,,,,,,8.92,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Exception Members,,12.49,,,,,,,8.11,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,inpatient,1,EA,2.33000,2.22000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,outpatient,1,EA,2.33000,2.22000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,inpatient,1,mL,692.18000,657.57000,The Alliance,Exception Members,,532.98,,,,,,,380.70,671.41,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,outpatient,1,mL,692.18000,657.57000,The Alliance,Exception Members,,532.98,,,,,,,7.68,671.41,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,inpatient,1,EA,36.05000,34.24000,The Alliance,Exception Members,,27.76,,,,,,,19.83,34.97,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,outpatient,1,EA,36.05000,34.24000,The Alliance,Exception Members,,27.76,,,,,,,18.02,34.97,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,inpatient,1,EA,175.38000,166.61000,The Alliance,Exception Members,,135.04,,,,,,,96.46,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,outpatient,1,EA,175.38000,166.61000,The Alliance,Exception Members,,135.04,,,,,,,4.35,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,inpatient,1,EA,681.25000,647.19000,The Alliance,Exception Members,,524.56,,,,,,,374.69,660.81,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,outpatient,1,EA,681.25000,647.19000,The Alliance,Exception Members,,524.56,,,,,,,4.35,660.81,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,inpatient,1,mL,10.99000,10.44000,The Alliance,Exception Members,,8.46,,,,,,,6.04,10.66,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Exception Members,,8.46,,,,,,,0.58280,10.66,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Exception Members,,2.37,,,,,,,1.54,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,inpatient,1,EA,4.10000,3.89000,The Alliance,Exception Members,,3.16,,,,,,,2.25,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Exception Members,,3.16,,,,,,,2.05,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,inpatient,1,GM,45.93000,43.64000,The Alliance,Exception Members,,35.37,,,,,,,25.26,44.55,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,outpatient,1,GM,45.93000,43.64000,The Alliance,Exception Members,,35.37,,,,,,,22.96,44.55,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,inpatient,1,mL,108.82000,103.38000,The Alliance,Exception Members,,83.79,,,,,,,59.85,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,outpatient,1,mL,108.82000,103.38000,The Alliance,Exception Members,,83.79,,,,,,,54.41,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,inpatient,1,mL,164.17000,155.96000,The Alliance,Exception Members,,126.41,,,,,,,90.29,159.24,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,outpatient,1,mL,164.17000,155.96000,The Alliance,Exception Members,,126.41,,,,,,,82.08,159.24,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,inpatient,1,mL,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,outpatient,1,mL,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,inpatient,1,mL,1.14000,1.09000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,outpatient,1,mL,1.14000,1.09000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,inpatient,1,mL,2.42000,2.30000,The Alliance,Exception Members,,1.86,,,,,,,1.33,2.35,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,outpatient,1,mL,2.42000,2.30000,The Alliance,Exception Members,,1.86,,,,,,,1.21,2.35,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,inpatient,,,173.44000,164.77000,The Alliance,Exception Members,,133.55,,,,,,,95.39,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Exception Members,,133.55,,,,,,,86.72,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,inpatient,1,mL,346.88000,329.54000,The Alliance,Exception Members,,267.10,,,,,,,190.78,336.47,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Exception Members,,267.10,,,,,,,137.83,336.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,inpatient,1,EA,60.28000,57.26000,The Alliance,Exception Members,,46.42,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Exception Members,,46.42,,,,,,,30.14,58.47,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,inpatient,1,EA,2.68000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,outpatient,1,EA,2.68000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,inpatient,1,EA,15.76000,14.98000,The Alliance,Exception Members,,12.14,,,,,,,8.67,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,outpatient,1,EA,15.76000,14.98000,The Alliance,Exception Members,,12.14,,,,,,,7.88,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,The Alliance,Exception Members,,17.90,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Exception Members,,17.90,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,The Alliance,Exception Members,,17.90,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Exception Members,,17.90,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,inpatient,1,EA,12.77000,12.13000,The Alliance,Exception Members,,9.83,,,,,,,7.02,12.39,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Exception Members,,9.83,,,,,,,6.38,12.39,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,The Alliance,Exception Members,,5.02,,,,,,,3.59,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Exception Members,,5.02,,,,,,,3.26,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,inpatient,1,mL,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,inpatient,1,GM,25.64000,24.36000,The Alliance,Exception Members,,19.74,,,,,,,14.10,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,outpatient,1,GM,25.64000,24.36000,The Alliance,Exception Members,,19.74,,,,,,,12.82,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,inpatient,1,GM,26.37000,25.05000,The Alliance,Exception Members,,20.30,,,,,,,14.50,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,outpatient,1,GM,26.37000,25.05000,The Alliance,Exception Members,,20.30,,,,,,,13.19,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,inpatient,1,GM,21.11000,20.05000,The Alliance,Exception Members,,16.25,,,,,,,11.61,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,outpatient,1,GM,21.11000,20.05000,The Alliance,Exception Members,,16.25,,,,,,,10.55,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,inpatient,1,GM,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,10.35,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,outpatient,1,GM,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,9.41,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,inpatient,1,GM,21.14000,20.08000,The Alliance,Exception Members,,16.28,,,,,,,11.63,20.51,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,outpatient,1,GM,21.14000,20.08000,The Alliance,Exception Members,,16.28,,,,,,,10.57,20.51,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,inpatient,1,EA,1675.10000,1591.35000,The Alliance,Exception Members,,1289.83,,,,,,,921.30,1624.85,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,outpatient,1,EA,1675.10000,1591.35000,The Alliance,Exception Members,,1289.83,,,,,,,837.55,1624.85,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,inpatient,1,EA,729.64000,693.16000,The Alliance,Exception Members,,561.82,,,,,,,401.30,707.75,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,outpatient,1,EA,729.64000,693.16000,The Alliance,Exception Members,,561.82,,,,,,,364.82,707.75,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,inpatient,1,mL,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,inpatient,1,EA,24.37000,23.15000,The Alliance,Exception Members,,18.76,,,,,,,13.40,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Exception Members,,18.76,,,,,,,12.19,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,The Alliance,Exception Members,,7.69,,,,,,,5.49,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Exception Members,,7.69,,,,,,,5.00,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,inpatient,1,EA,6.40000,6.08000,The Alliance,Exception Members,,4.93,,,,,,,3.52,6.21,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,outpatient,1,EA,6.40000,6.08000,The Alliance,Exception Members,,4.93,,,,,,,3.20,6.21,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,inpatient,1,mL,9.05000,8.60000,The Alliance,Exception Members,,6.97,,,,,,,4.98,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,outpatient,1,mL,9.05000,8.60000,The Alliance,Exception Members,,6.97,,,,,,,4.53,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,inpatient,1,mL,3.18000,3.03000,The Alliance,Exception Members,,2.45,,,,,,,1.75,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,outpatient,1,mL,3.18000,3.03000,The Alliance,Exception Members,,2.45,,,,,,,1.59,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,inpatient,1,mL,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,inpatient,1,mL,16.78000,15.94000,The Alliance,Exception Members,,12.92,,,,,,,9.23,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,outpatient,1,mL,16.78000,15.94000,The Alliance,Exception Members,,12.92,,,,,,,8.39,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,inpatient,1,mL,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.65,5.15,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,inpatient,1,EA,58.67000,55.73000,The Alliance,Exception Members,,45.18,,,,,,,32.27,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,outpatient,1,EA,58.67000,55.73000,The Alliance,Exception Members,,45.18,,,,,,,29.34,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,The Alliance,Exception Members,,40.33,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Exception Members,,40.33,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,inpatient,1,EA,60.28000,57.26000,The Alliance,Exception Members,,46.42,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Exception Members,,46.42,,,,,,,30.14,58.47,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,inpatient,1,mL,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,inpatient,1,mL,10.99000,10.44000,The Alliance,Exception Members,,8.46,,,,,,,6.04,10.66,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Exception Members,,8.46,,,,,,,0.43710,10.66,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,inpatient,1,EA,9527.85000,9051.46000,The Alliance,Exception Members,,7336.44,,,,,,,5240.32,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,outpatient,1,EA,9527.85000,9051.46000,The Alliance,Exception Members,,7336.44,,,,,,,4763.93,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,inpatient,1,EA,7866.00000,7472.70000,The Alliance,Exception Members,,6056.82,,,,,,,4326.30,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,outpatient,1,EA,7866.00000,7472.70000,The Alliance,Exception Members,,6056.82,,,,,,,3933.00,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,inpatient,1,EA,7863.93000,7470.73000,The Alliance,Exception Members,,6055.23,,,,,,,4325.16,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,outpatient,1,EA,7863.93000,7470.73000,The Alliance,Exception Members,,6055.23,,,,,,,3931.97,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,inpatient,1,EA,2067.86000,1964.46000,The Alliance,Exception Members,,1592.25,,,,,,,1137.32,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,outpatient,1,EA,2067.86000,1964.46000,The Alliance,Exception Members,,1592.25,,,,,,,1033.93,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,inpatient,1,EA,4370.00000,4151.50000,The Alliance,Exception Members,,3364.90,,,,,,,2403.50,4238.90,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,outpatient,1,EA,4370.00000,4151.50000,The Alliance,Exception Members,,3364.90,,,,,,,2185.00,4238.90,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,inpatient,1,EA,53.76000,51.07000,The Alliance,Exception Members,,41.40,,,,,,,29.57,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,outpatient,1,EA,53.76000,51.07000,The Alliance,Exception Members,,41.40,,,,,,,26.88,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,The Alliance,Exception Members,,40.33,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Exception Members,,40.33,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,inpatient,1,EA,99.17000,94.21000,The Alliance,Exception Members,,76.36,,,,,,,54.54,96.19,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,outpatient,1,EA,99.17000,94.21000,The Alliance,Exception Members,,76.36,,,,,,,49.59,96.19,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,3.79,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,inpatient,1,mL,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.26,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,inpatient,1,mL,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,8.26,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,outpatient,1,mL,15.01000,14.26000,The Alliance,Exception Members,,11.56,,,,,,,7.50,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,inpatient,1,mL,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,4.90,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,4.46,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,inpatient,1,mL,1.87000,1.77000,The Alliance,Exception Members,,1.44,,,,,,,1.03,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,outpatient,1,mL,1.87000,1.77000,The Alliance,Exception Members,,1.44,,,,,,,0.93500,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,inpatient,1,mL,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,inpatient,1,EA,238.04000,226.14000,The Alliance,Exception Members,,183.29,,,,,,,130.92,230.90,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,outpatient,1,EA,238.04000,226.14000,The Alliance,Exception Members,,183.29,,,,,,,118.51,230.90,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,inpatient,1,mL,15.31000,14.54000,The Alliance,Exception Members,,11.79,,,,,,,8.42,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,outpatient,1,mL,15.31000,14.54000,The Alliance,Exception Members,,11.79,,,,,,,7.66,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,inpatient,1,mL,14.71000,13.97000,The Alliance,Exception Members,,11.33,,,,,,,8.09,14.27,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,outpatient,1,mL,14.71000,13.97000,The Alliance,Exception Members,,11.33,,,,,,,7.36,14.27,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.80300,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Exception Members,,1.12,,,,,,,0.73000,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Exception Members,,9.16,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Exception Members,,9.16,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,inpatient,1,mL,7.83000,7.44000,The Alliance,Exception Members,,6.03,,,,,,,4.31,7.60,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,outpatient,1,mL,7.83000,7.44000,The Alliance,Exception Members,,6.03,,,,,,,3.92,7.60,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,inpatient,1,mL,553.63000,525.95000,The Alliance,Exception Members,,426.30,,,,,,,304.50,537.02,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,outpatient,1,mL,553.63000,525.95000,The Alliance,Exception Members,,426.30,,,,,,,276.81,857.21,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,inpatient,1,GM,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.45,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,outpatient,1,GM,8.09000,7.69000,The Alliance,Exception Members,,6.23,,,,,,,4.04,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,inpatient,1,GM,11.75000,11.16000,The Alliance,Exception Members,,9.05,,,,,,,6.46,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,outpatient,1,GM,11.75000,11.16000,The Alliance,Exception Members,,9.05,,,,,,,5.88,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,inpatient,1,GM,25.64000,24.35000,The Alliance,Exception Members,,19.74,,,,,,,14.10,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,outpatient,1,GM,25.64000,24.35000,The Alliance,Exception Members,,19.74,,,,,,,12.82,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,inpatient,1,GM,5.45000,5.18000,The Alliance,Exception Members,,4.20,,,,,,,3.00,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,outpatient,1,GM,5.45000,5.18000,The Alliance,Exception Members,,4.20,,,,,,,2.73,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,inpatient,1,GM,7.44000,7.06000,The Alliance,Exception Members,,5.73,,,,,,,4.09,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,outpatient,1,GM,7.44000,7.06000,The Alliance,Exception Members,,5.73,,,,,,,3.72,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,inpatient,1,GM,12.44000,11.81000,The Alliance,Exception Members,,9.58,,,,,,,6.84,12.07,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,outpatient,1,GM,12.44000,11.81000,The Alliance,Exception Members,,9.58,,,,,,,6.22,12.07,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,inpatient,1,EA,5520.00000,5244.00000,The Alliance,Exception Members,,4250.40,,,,,,,3036.00,5354.40,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,outpatient,1,EA,5520.00000,5244.00000,The Alliance,Exception Members,,4250.40,,,,,,,2.65,5354.40,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,inpatient,1,mL,104.79000,99.55000,The Alliance,Exception Members,,80.69,,,,,,,57.63,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,outpatient,1,mL,104.79000,99.55000,The Alliance,Exception Members,,80.69,,,,,,,7.68,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,inpatient,1,mL,168.93000,160.49000,The Alliance,Exception Members,,130.08,,,,,,,92.91,163.86,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,outpatient,1,mL,168.93000,160.49000,The Alliance,Exception Members,,130.08,,,,,,,7.68,163.86,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,inpatient,1,EA,116.01000,110.21000,The Alliance,Exception Members,,89.33,,,,,,,63.81,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,outpatient,1,EA,116.01000,110.21000,The Alliance,Exception Members,,89.33,,,,,,,58.01,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,inpatient,1,EA,34.32000,32.60000,The Alliance,Exception Members,,26.43,,,,,,,18.88,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,outpatient,1,EA,34.32000,32.60000,The Alliance,Exception Members,,26.43,,,,,,,17.16,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,inpatient,1,EA,12.10000,11.49000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,outpatient,1,EA,12.10000,11.49000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,inpatient,1,mL,801.35000,761.28000,The Alliance,Exception Members,,617.04,,,,,,,440.74,777.31,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,outpatient,1,mL,801.35000,761.28000,The Alliance,Exception Members,,617.04,,,,,,,400.68,777.31,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,inpatient,1,EA,34.56000,32.84000,The Alliance,Exception Members,,26.61,,,,,,,19.01,33.52,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,outpatient,1,EA,34.56000,32.84000,The Alliance,Exception Members,,26.61,,,,,,,17.28,33.52,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,1.58,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,inpatient,1,mL,7.69000,7.31000,The Alliance,Exception Members,,5.92,,,,,,,4.23,7.46,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,outpatient,1,mL,7.69000,7.31000,The Alliance,Exception Members,,5.92,,,,,,,1.30,7.46,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,inpatient,1,EA,77.24000,73.38000,The Alliance,Exception Members,,59.47,,,,,,,42.48,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,outpatient,1,EA,77.24000,73.38000,The Alliance,Exception Members,,59.47,,,,,,,38.62,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,inpatient,1,EA,63.07000,59.91000,The Alliance,Exception Members,,48.56,,,,,,,34.69,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,outpatient,1,EA,63.07000,59.91000,The Alliance,Exception Members,,48.56,,,,,,,31.54,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,11.85,22.99,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Exception Members,,2.64,,,,,,,1.72,3.33,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,inpatient,1,EA,37.51000,35.63000,The Alliance,Exception Members,,28.88,,,,,,,20.63,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,outpatient,1,EA,37.51000,35.63000,The Alliance,Exception Members,,28.88,,,,,,,18.75,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,inpatient,1,EA,11.92000,11.33000,The Alliance,Exception Members,,9.18,,,,,,,6.56,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,outpatient,1,EA,11.92000,11.33000,The Alliance,Exception Members,,9.18,,,,,,,5.96,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,inpatient,1,EA,2.98000,2.83000,The Alliance,Exception Members,,2.29,,,,,,,1.64,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,outpatient,1,EA,2.98000,2.83000,The Alliance,Exception Members,,2.29,,,,,,,1.49,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,The Alliance,Exception Members,,10.16,,,,,,,7.26,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Exception Members,,10.16,,,,,,,6.60,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,The Alliance,Exception Members,,3.59,,,,,,,2.56,4.52,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Exception Members,,3.59,,,,,,,2.33,4.52,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,inpatient,1,mL,118.23000,112.32000,The Alliance,Exception Members,,91.04,,,,,,,65.03,114.68,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,outpatient,1,mL,118.23000,112.32000,The Alliance,Exception Members,,91.04,,,,,,,11.32,114.68,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,inpatient,1,mL,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,1.58,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,inpatient,1,mL,78.39000,74.47000,The Alliance,Exception Members,,60.36,,,,,,,43.11,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,outpatient,1,mL,78.39000,74.47000,The Alliance,Exception Members,,60.36,,,,,,,0.79980,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,inpatient,1,mL,67.57000,64.19000,The Alliance,Exception Members,,52.03,,,,,,,37.16,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,outpatient,1,mL,67.57000,64.19000,The Alliance,Exception Members,,52.03,,,,,,,0.79980,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,inpatient,1,mL,28.06000,26.66000,The Alliance,Exception Members,,21.61,,,,,,,15.43,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,outpatient,1,mL,28.06000,26.66000,The Alliance,Exception Members,,21.61,,,,,,,0.79980,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,inpatient,1,mL,34.60000,32.87000,The Alliance,Exception Members,,26.64,,,,,,,19.03,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,outpatient,1,mL,34.60000,32.87000,The Alliance,Exception Members,,26.64,,,,,,,0.79980,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,inpatient,1,mL,74.18000,70.47000,The Alliance,Exception Members,,57.12,,,,,,,40.80,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,outpatient,1,mL,74.18000,70.47000,The Alliance,Exception Members,,57.12,,,,,,,0.79980,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,inpatient,1,mL,37.46000,35.58000,The Alliance,Exception Members,,28.84,,,,,,,20.60,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,outpatient,1,mL,37.46000,35.58000,The Alliance,Exception Members,,28.84,,,,,,,0.79980,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Exception Members,,36.50,,,,,,,0.79980,45.98,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.93,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Exception Members,,2.69,,,,,,,1.75,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,inpatient,1,mL,19.45000,18.48000,The Alliance,Exception Members,,14.98,,,,,,,10.70,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,outpatient,1,mL,19.45000,18.48000,The Alliance,Exception Members,,14.98,,,,,,,9.72,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,inpatient,1,mL,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.73,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,outpatient,1,mL,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.39,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,inpatient,1,EA,42.99000,40.84000,The Alliance,Exception Members,,33.10,,,,,,,23.64,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,outpatient,1,EA,42.99000,40.84000,The Alliance,Exception Members,,33.10,,,,,,,21.50,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,inpatient,1,EA,13.66000,12.98000,The Alliance,Exception Members,,10.52,,,,,,,7.51,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,outpatient,1,EA,13.66000,12.98000,The Alliance,Exception Members,,10.52,,,,,,,6.83,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.32,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.32,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,inpatient,1,EA,286.94000,272.59000,The Alliance,Exception Members,,220.94,,,,,,,157.82,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,outpatient,1,EA,286.94000,272.59000,The Alliance,Exception Members,,220.94,,,,,,,143.47,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,4.37,7.70,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Exception Members,,6.11,,,,,,,3.97,7.70,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,inpatient,1,EA,38.47000,36.54000,The Alliance,Exception Members,,29.62,,,,,,,21.16,37.32,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,outpatient,1,EA,38.47000,36.54000,The Alliance,Exception Members,,29.62,,,,,,,19.23,37.32,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,inpatient,1,EA,198.21000,188.30000,The Alliance,Exception Members,,152.62,,,,,,,109.02,192.26,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,outpatient,1,EA,198.21000,188.30000,The Alliance,Exception Members,,152.62,,,,,,,99.11,192.26,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,inpatient,1,EA,8.69000,8.25000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,outpatient,1,EA,8.69000,8.25000,The Alliance,Exception Members,,6.69,,,,,,,4.34,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,The Alliance,Exception Members,,3.37,,,,,,,2.41,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Exception Members,,3.37,,,,,,,2.19,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,inpatient,1,EA,6.28000,5.96000,The Alliance,Exception Members,,4.84,,,,,,,3.45,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Exception Members,,4.84,,,,,,,3.14,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Exception Members,,5.11,,,,,,,3.32,6.44,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.24,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Exception Members,,1.73,,,,,,,1.12,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Exception Members,,1.77,,,,,,,1.15,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,inpatient,1,EA,4.00000,3.80000,The Alliance,Exception Members,,3.08,,,,,,,2.20,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,outpatient,1,EA,4.00000,3.80000,The Alliance,Exception Members,,3.08,,,,,,,2.00,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,inpatient,1,EA,3.75000,3.56000,The Alliance,Exception Members,,2.89,,,,,,,2.06,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,outpatient,1,EA,3.75000,3.56000,The Alliance,Exception Members,,2.89,,,,,,,1.88,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,inpatient,1,EA,4.89000,4.64000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,outpatient,1,EA,4.89000,4.64000,The Alliance,Exception Members,,3.77,,,,,,,2.44,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,inpatient,1,mL,6.75000,6.41000,The Alliance,Exception Members,,5.20,,,,,,,3.71,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,outpatient,1,mL,6.75000,6.41000,The Alliance,Exception Members,,5.20,,,,,,,3.38,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,inpatient,1,EA,165.58000,157.30000,The Alliance,Exception Members,,127.50,,,,,,,91.07,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,outpatient,1,EA,165.58000,157.30000,The Alliance,Exception Members,,127.50,,,,,,,82.79,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,inpatient,1,EA,179.07000,170.11000,The Alliance,Exception Members,,137.88,,,,,,,98.49,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,outpatient,1,EA,179.07000,170.11000,The Alliance,Exception Members,,137.88,,,,,,,89.53,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,31.60,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,inpatient,1,EA,329.03000,312.58000,The Alliance,Exception Members,,253.35,,,,,,,180.97,319.16,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,outpatient,1,EA,329.03000,312.58000,The Alliance,Exception Members,,253.35,,,,,,,164.51,319.16,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,inpatient,1,mL,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,outpatient,1,mL,2.14000,2.04000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,inpatient,1,mL,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.29,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,outpatient,1,mL,2.35000,2.23000,The Alliance,Exception Members,,1.81,,,,,,,1.18,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,inpatient,1,mL,1.84000,1.74000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,outpatient,1,mL,1.84000,1.74000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,inpatient,1,EA,10.41000,9.89000,The Alliance,Exception Members,,8.02,,,,,,,5.73,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,outpatient,1,EA,10.41000,9.89000,The Alliance,Exception Members,,8.02,,,,,,,5.21,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,4.96,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Exception Members,,6.94,,,,,,,4.50,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,inpatient,1,mL,49.30000,46.83000,The Alliance,Exception Members,,37.96,,,,,,,27.11,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,outpatient,1,mL,49.30000,46.83000,The Alliance,Exception Members,,37.96,,,,,,,12.06,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,inpatient,1,mL,75.84000,72.05000,The Alliance,Exception Members,,58.40,,,,,,,41.71,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,outpatient,1,mL,75.84000,72.05000,The Alliance,Exception Members,,58.40,,,,,,,12.06,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,inpatient,1,mL,97.94000,93.04000,The Alliance,Exception Members,,75.41,,,,,,,53.87,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,outpatient,1,mL,97.94000,93.04000,The Alliance,Exception Members,,75.41,,,,,,,12.06,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,inpatient,1,mL,76.47000,72.65000,The Alliance,Exception Members,,58.88,,,,,,,42.06,74.18,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,outpatient,1,mL,76.47000,72.65000,The Alliance,Exception Members,,58.88,,,,,,,12.06,74.18,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,5.94,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,inpatient,1,mL,154.05000,146.35000,The Alliance,Exception Members,,118.62,,,,,,,84.73,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,outpatient,1,mL,154.05000,146.35000,The Alliance,Exception Members,,118.62,,,,,,,1.15,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,inpatient,1,mL,308.10000,292.70000,The Alliance,Exception Members,,237.24,,,,,,,169.46,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,outpatient,1,mL,308.10000,292.70000,The Alliance,Exception Members,,237.24,,,,,,,1.15,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,inpatient,1,mL,468.96000,445.51000,The Alliance,Exception Members,,361.10,,,,,,,257.93,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,outpatient,1,mL,468.96000,445.51000,The Alliance,Exception Members,,361.10,,,,,,,1.15,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,inpatient,1,mL,160.32000,152.30000,The Alliance,Exception Members,,123.45,,,,,,,88.18,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,outpatient,1,mL,160.32000,152.30000,The Alliance,Exception Members,,123.45,,,,,,,1.15,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,inpatient,1,mL,305.46000,290.19000,The Alliance,Exception Members,,235.20,,,,,,,168.00,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,outpatient,1,mL,305.46000,290.19000,The Alliance,Exception Members,,235.20,,,,,,,1.15,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,inpatient,1,mL,308.09000,292.68000,The Alliance,Exception Members,,237.23,,,,,,,169.45,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,outpatient,1,mL,308.09000,292.68000,The Alliance,Exception Members,,237.23,,,,,,,1.15,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,inpatient,1,mL,564.92000,536.68000,The Alliance,Exception Members,,434.99,,,,,,,310.71,547.97,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,outpatient,1,mL,564.92000,536.68000,The Alliance,Exception Members,,434.99,,,,,,,1.15,547.97,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,inpatient,1,EA,284.90000,270.65000,The Alliance,Exception Members,,219.37,,,,,,,156.69,276.35,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Exception Members,,219.37,,,,,,,71.65,276.35,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,inpatient,1,mL,60.69000,57.66000,The Alliance,Exception Members,,46.73,,,,,,,33.38,58.87,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,outpatient,1,mL,60.69000,57.66000,The Alliance,Exception Members,,46.73,,,,,,,7.43,58.87,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,inpatient,1,EA,9.92000,9.42000,The Alliance,Exception Members,,7.64,,,,,,,5.46,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,outpatient,1,EA,9.92000,9.42000,The Alliance,Exception Members,,7.64,,,,,,,4.96,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,inpatient,1,EA,14.06000,13.36000,The Alliance,Exception Members,,10.83,,,,,,,7.73,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Exception Members,,10.83,,,,,,,7.03,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,inpatient,1,EA,6.76000,6.42000,The Alliance,Exception Members,,5.21,,,,,,,3.72,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,outpatient,1,EA,6.76000,6.42000,The Alliance,Exception Members,,5.21,,,,,,,3.38,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.51,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.10,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,inpatient,1,EA,6.44000,6.12000,The Alliance,Exception Members,,4.96,,,,,,,3.54,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,outpatient,1,EA,6.44000,6.12000,The Alliance,Exception Members,,4.96,,,,,,,3.22,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,inpatient,1,EA,8.51000,8.09000,The Alliance,Exception Members,,6.55,,,,,,,4.68,8.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,outpatient,1,EA,8.51000,8.09000,The Alliance,Exception Members,,6.55,,,,,,,4.25,8.25,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.54,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.04,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.63,4.65,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.40,4.65,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,inpatient,1,mL,5.92000,5.63000,The Alliance,Exception Members,,4.56,,,,,,,3.26,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,outpatient,1,mL,5.92000,5.63000,The Alliance,Exception Members,,4.56,,,,,,,1.65,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,1.65,7.62,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,inpatient,1,GM,83.93000,79.73000,The Alliance,Exception Members,,64.63,,,,,,,46.16,81.41,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,outpatient,1,GM,83.93000,79.73000,The Alliance,Exception Members,,64.63,,,,,,,41.97,81.41,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,inpatient,1,EA,645.01000,612.76000,The Alliance,Exception Members,,496.66,,,,,,,354.76,625.66,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,outpatient,1,EA,645.01000,612.76000,The Alliance,Exception Members,,496.66,,,,,,,322.50,625.66,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,inpatient,1,mL,30.84000,29.30000,The Alliance,Exception Members,,23.75,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,outpatient,1,mL,30.84000,29.30000,The Alliance,Exception Members,,23.75,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,inpatient,1,mL,30.84000,29.29000,The Alliance,Exception Members,,23.75,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,outpatient,1,mL,30.84000,29.29000,The Alliance,Exception Members,,23.75,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,inpatient,1,mL,25.38000,24.11000,The Alliance,Exception Members,,19.54,,,,,,,13.96,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,outpatient,1,mL,25.38000,24.11000,The Alliance,Exception Members,,19.54,,,,,,,2.63,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,inpatient,1,mL,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,outpatient,1,mL,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,2.63,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,inpatient,1,mL,25.37000,24.11000,The Alliance,Exception Members,,19.53,,,,,,,13.95,24.61,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,outpatient,1,mL,25.37000,24.11000,The Alliance,Exception Members,,19.53,,,,,,,2.63,24.61,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,inpatient,1,mL,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,outpatient,1,mL,0.95000,0.91000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,63.16,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,inpatient,1,mL,5.98000,5.68000,The Alliance,Exception Members,,4.60,,,,,,,3.29,5.80,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,outpatient,1,mL,5.98000,5.68000,The Alliance,Exception Members,,4.60,,,,,,,2.99,63.16,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.48,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,inpatient,1,mL,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,15.30,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Exception Members,,21.41,,,,,,,13.90,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,inpatient,1,mL,6.52000,6.19000,The Alliance,Exception Members,,5.02,,,,,,,3.59,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,outpatient,1,mL,6.52000,6.19000,The Alliance,Exception Members,,5.02,,,,,,,3.26,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,3.19,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,inpatient,1,mL,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.92,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,outpatient,1,mL,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.56,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,inpatient,1,mL,6.93000,6.58000,The Alliance,Exception Members,,5.34,,,,,,,3.81,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,outpatient,1,mL,6.93000,6.58000,The Alliance,Exception Members,,5.34,,,,,,,3.46,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,inpatient,1,mL,19.74000,18.75000,The Alliance,Exception Members,,15.20,,,,,,,10.86,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Exception Members,,15.20,,,,,,,9.87,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,inpatient,1,mL,4.85000,4.61000,The Alliance,Exception Members,,3.73,,,,,,,2.67,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,outpatient,1,mL,4.85000,4.61000,The Alliance,Exception Members,,3.73,,,,,,,2.42,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.56,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Exception Members,,7.78,,,,,,,5.05,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,inpatient,1,EA,1.87000,1.78000,The Alliance,Exception Members,,1.44,,,,,,,1.03,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Exception Members,,1.44,,,,,,,0.93500,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,inpatient,1,EA,7.24000,6.88000,The Alliance,Exception Members,,5.57,,,,,,,3.98,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,outpatient,1,EA,7.24000,6.88000,The Alliance,Exception Members,,5.57,,,,,,,3.62,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,inpatient,1,GM,101.02000,95.97000,The Alliance,Exception Members,,77.79,,,,,,,55.56,97.99,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,outpatient,1,GM,101.02000,95.97000,The Alliance,Exception Members,,77.79,,,,,,,50.51,97.99,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,inpatient,1,mL,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,outpatient,1,mL,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,inpatient,1,mL,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,inpatient,1,mL,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,outpatient,1,mL,2.67000,2.53000,The Alliance,Exception Members,,2.06,,,,,,,1.33,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,inpatient,1,mL,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,outpatient,1,mL,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,inpatient,1,mL,48.94000,46.49000,The Alliance,Exception Members,,37.68,,,,,,,26.92,47.47,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,outpatient,1,mL,48.94000,46.49000,The Alliance,Exception Members,,37.68,,,,,,,24.47,47.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,inpatient,1,EA,288.41000,273.99000,The Alliance,Exception Members,,222.08,,,,,,,158.63,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,outpatient,1,EA,288.41000,273.99000,The Alliance,Exception Members,,222.08,,,,,,,144.21,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,inpatient,1,EA,191.20000,181.64000,The Alliance,Exception Members,,147.22,,,,,,,105.16,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,outpatient,1,EA,191.20000,181.64000,The Alliance,Exception Members,,147.22,,,,,,,95.60,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,inpatient,1,EA,220.57000,209.54000,The Alliance,Exception Members,,169.84,,,,,,,121.31,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,outpatient,1,EA,220.57000,209.54000,The Alliance,Exception Members,,169.84,,,,,,,110.28,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,94.80,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,inpatient,1,EA,253.81000,241.12000,The Alliance,Exception Members,,195.43,,,,,,,139.60,246.20,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,outpatient,1,EA,253.81000,241.12000,The Alliance,Exception Members,,195.43,,,,,,,126.91,246.20,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,inpatient,1,mL,114.91000,109.16000,The Alliance,Exception Members,,88.48,,,,,,,63.20,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,outpatient,1,mL,114.91000,109.16000,The Alliance,Exception Members,,88.48,,,,,,,1.15,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,inpatient,1,mL,214.56000,203.84000,The Alliance,Exception Members,,165.21,,,,,,,118.01,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,outpatient,1,mL,214.56000,203.84000,The Alliance,Exception Members,,165.21,,,,,,,1.15,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,inpatient,1,mL,229.50000,218.02000,The Alliance,Exception Members,,176.72,,,,,,,126.22,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,outpatient,1,mL,229.50000,218.02000,The Alliance,Exception Members,,176.72,,,,,,,1.15,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,inpatient,1,mL,231.07000,219.51000,The Alliance,Exception Members,,177.92,,,,,,,127.09,224.14,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,outpatient,1,mL,231.07000,219.51000,The Alliance,Exception Members,,177.92,,,,,,,1.15,224.14,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,inpatient,1,mL,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.54,9.78,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,outpatient,1,mL,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.04,9.78,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,inpatient,1,GM,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,outpatient,1,GM,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.16,8.07,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,34.98,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,inpatient,,,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,12.50,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,outpatient,,,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,11.36,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,inpatient,1,mL,45.44000,43.17000,The Alliance,Exception Members,,34.99,,,,,,,24.99,44.08,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,outpatient,1,mL,45.44000,43.17000,The Alliance,Exception Members,,34.99,,,,,,,22.72,44.08,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,inpatient,1,EA,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,9.73,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,2.42,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,inpatient,1,EA,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,5.95,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,outpatient,1,EA,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,2.42,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,inpatient,1,mL,22.59000,21.46000,The Alliance,Exception Members,,17.39,,,,,,,12.42,21.91,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Exception Members,,17.39,,,,,,,11.29,21.91,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,65.37,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.54,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.40,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,4.27,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,3.88,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,inpatient,1,mL,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.99,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,outpatient,1,mL,3.61000,3.43000,The Alliance,Exception Members,,2.78,,,,,,,1.80,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,inpatient,1,mL,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,outpatient,1,mL,5.31000,5.05000,The Alliance,Exception Members,,4.09,,,,,,,2.65,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Exception Members,,1.96,,,,,,,1.27,2.46,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.00,34.98,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,inpatient,,,52.92000,50.27000,The Alliance,Exception Members,,40.75,,,,,,,29.11,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,outpatient,,,52.92000,50.27000,The Alliance,Exception Members,,40.75,,,,,,,26.46,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,inpatient,1,mL,105.83000,100.54000,The Alliance,Exception Members,,81.49,,,,,,,58.21,102.66,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,outpatient,1,mL,105.83000,100.54000,The Alliance,Exception Members,,81.49,,,,,,,45.95,102.66,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.57,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Exception Members,,2.20,,,,,,,1.43,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,The Alliance,Exception Members,,3.75,,,,,,,2.68,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Exception Members,,3.75,,,,,,,2.44,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,inpatient,1,EA,5.48000,5.20000,The Alliance,Exception Members,,4.22,,,,,,,3.01,5.32,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,outpatient,1,EA,5.48000,5.20000,The Alliance,Exception Members,,4.22,,,,,,,2.74,5.32,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,inpatient,,,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.54,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,outpatient,,,11.90000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,5.95,46.30,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,inpatient,1,EA,23.79000,22.60000,The Alliance,Exception Members,,18.32,,,,,,,13.08,23.08,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Exception Members,,18.32,,,,,,,11.89,46.30,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,inpatient,1,mL,351.72000,334.14000,The Alliance,Exception Members,,270.82,,,,,,,193.45,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,outpatient,1,mL,351.72000,334.14000,The Alliance,Exception Members,,270.82,,,,,,,1.15,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,inpatient,1,mL,666.20000,632.89000,The Alliance,Exception Members,,512.97,,,,,,,366.41,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,outpatient,1,mL,666.20000,632.89000,The Alliance,Exception Members,,512.97,,,,,,,1.15,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,inpatient,1,mL,354.77000,337.03000,The Alliance,Exception Members,,273.17,,,,,,,195.12,344.13,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,outpatient,1,mL,354.77000,337.03000,The Alliance,Exception Members,,273.17,,,,,,,1.15,344.13,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,inpatient,1,GM,68.84000,65.40000,The Alliance,Exception Members,,53.01,,,,,,,37.86,66.77,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,outpatient,1,GM,68.84000,65.40000,The Alliance,Exception Members,,53.01,,,,,,,34.42,66.77,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,inpatient,1,GM,17.05000,16.19000,The Alliance,Exception Members,,13.13,,,,,,,9.38,16.54,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,outpatient,1,GM,17.05000,16.19000,The Alliance,Exception Members,,13.13,,,,,,,8.53,16.54,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,inpatient,1,mL,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,inpatient,1,EA,2212.30000,2101.69000,The Alliance,Exception Members,,1703.47,,,,,,,1216.77,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,outpatient,1,EA,2212.30000,2101.69000,The Alliance,Exception Members,,1703.47,,,,,,,5.18,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,inpatient,1,EA,1874.56000,1780.84000,The Alliance,Exception Members,,1443.41,,,,,,,1031.01,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,outpatient,1,EA,1874.56000,1780.84000,The Alliance,Exception Members,,1443.41,,,,,,,5.18,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,inpatient,1,EA,2390.57000,2271.04000,The Alliance,Exception Members,,1840.74,,,,,,,1314.81,2318.85,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,outpatient,1,EA,2390.57000,2271.04000,The Alliance,Exception Members,,1840.74,,,,,,,5.18,2318.85,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,inpatient,1,mL,882.96000,838.81000,The Alliance,Exception Members,,679.88,,,,,,,485.63,856.47,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,outpatient,1,mL,882.96000,838.81000,The Alliance,Exception Members,,679.88,,,,,,,441.48,856.47,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,inpatient,1,mL,84.66000,80.42000,The Alliance,Exception Members,,65.19,,,,,,,46.56,82.12,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,outpatient,1,mL,84.66000,80.42000,The Alliance,Exception Members,,65.19,,,,,,,27.10,82.12,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,inpatient,1,mL,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,inpatient,1,mL,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.84,3.24,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.67,3.24,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,2.64,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,inpatient,1,mL,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,2.14,3.77,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,outpatient,1,mL,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.77,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,inpatient,1,GM,15.35000,14.58000,The Alliance,Exception Members,,11.82,,,,,,,8.44,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,outpatient,1,GM,15.35000,14.58000,The Alliance,Exception Members,,11.82,,,,,,,7.67,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,inpatient,1,GM,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,5.25,9.25,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,outpatient,1,GM,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,4.77,9.25,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,The Alliance,Exception Members,,6.45,,,,,,,4.61,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Exception Members,,6.45,,,,,,,4.19,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,inpatient,1,mL,24.27000,23.06000,The Alliance,Exception Members,,18.69,,,,,,,13.35,23.54,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,outpatient,1,mL,24.27000,23.06000,The Alliance,Exception Members,,18.69,,,,,,,12.13,23.54,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,inpatient,1,mL,290.44000,275.91000,The Alliance,Exception Members,,223.64,,,,,,,159.74,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,outpatient,1,mL,290.44000,275.91000,The Alliance,Exception Members,,223.64,,,,,,,145.22,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,inpatient,1,mL,590.83000,561.29000,The Alliance,Exception Members,,454.94,,,,,,,324.96,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,outpatient,1,mL,590.83000,561.29000,The Alliance,Exception Members,,454.94,,,,,,,295.42,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,inpatient,1,mL,657.21000,624.35000,The Alliance,Exception Members,,506.05,,,,,,,361.47,637.49,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,outpatient,1,mL,657.21000,624.35000,The Alliance,Exception Members,,506.05,,,,,,,328.61,637.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,inpatient,1,mL,52.05000,49.44000,The Alliance,Exception Members,,40.08,,,,,,,28.63,50.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,outpatient,1,mL,52.05000,49.44000,The Alliance,Exception Members,,40.08,,,,,,,26.02,72.23,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,inpatient,1,EA,216.14000,205.34000,The Alliance,Exception Members,,166.43,,,,,,,118.88,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,outpatient,1,EA,216.14000,205.34000,The Alliance,Exception Members,,166.43,,,,,,,49.73,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,65.37,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,inpatient,1,EA,154.73000,146.99000,The Alliance,Exception Members,,119.14,,,,,,,85.10,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,outpatient,1,EA,154.73000,146.99000,The Alliance,Exception Members,,119.14,,,,,,,49.73,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,inpatient,1,EA,139.04000,132.09000,The Alliance,Exception Members,,107.06,,,,,,,76.47,134.87,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,outpatient,1,EA,139.04000,132.09000,The Alliance,Exception Members,,107.06,,,,,,,49.73,134.87,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,inpatient,1,mL,3.67000,3.48000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,outpatient,1,mL,3.67000,3.48000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,inpatient,1,EA,295.90000,281.10000,The Alliance,Exception Members,,227.84,,,,,,,162.75,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,outpatient,1,EA,295.90000,281.10000,The Alliance,Exception Members,,227.84,,,,,,,147.95,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,inpatient,1,EA,17.25000,16.39000,The Alliance,Exception Members,,13.28,,,,,,,9.49,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,outpatient,1,EA,17.25000,16.39000,The Alliance,Exception Members,,13.28,,,,,,,8.62,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,inpatient,1,EA,10.77000,10.23000,The Alliance,Exception Members,,8.29,,,,,,,5.92,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,outpatient,1,EA,10.77000,10.23000,The Alliance,Exception Members,,8.29,,,,,,,5.38,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,inpatient,1,EA,138.44000,131.51000,The Alliance,Exception Members,,106.60,,,,,,,76.14,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,outpatient,1,EA,138.44000,131.51000,The Alliance,Exception Members,,106.60,,,,,,,69.22,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,inpatient,1,EA,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.85,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,outpatient,1,EA,5.18000,4.92000,The Alliance,Exception Members,,3.99,,,,,,,2.59,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,inpatient,1,EA,3.86000,3.66000,The Alliance,Exception Members,,2.97,,,,,,,2.12,3.74,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Exception Members,,2.97,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,inpatient,1,GM,18.18000,17.27000,The Alliance,Exception Members,,14.00,,,,,,,10.00,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,outpatient,1,GM,18.18000,17.27000,The Alliance,Exception Members,,14.00,,,,,,,9.09,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,inpatient,1,GM,12.78000,12.14000,The Alliance,Exception Members,,9.84,,,,,,,7.03,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,outpatient,1,GM,12.78000,12.14000,The Alliance,Exception Members,,9.84,,,,,,,6.39,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,inpatient,1,GM,24.03000,22.83000,The Alliance,Exception Members,,18.50,,,,,,,13.22,23.31,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,outpatient,1,GM,24.03000,22.83000,The Alliance,Exception Members,,18.50,,,,,,,12.02,23.31,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,inpatient,1,EA,873.90000,830.21000,The Alliance,Exception Members,,672.90,,,,,,,480.64,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,outpatient,1,EA,873.90000,830.21000,The Alliance,Exception Members,,672.90,,,,,,,436.95,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,inpatient,1,EA,13.82000,13.12000,The Alliance,Exception Members,,10.64,,,,,,,7.60,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,outpatient,1,EA,13.82000,13.12000,The Alliance,Exception Members,,10.64,,,,,,,6.91,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,inpatient,1,EA,38.82000,36.88000,The Alliance,Exception Members,,29.89,,,,,,,21.35,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Exception Members,,29.89,,,,,,,19.41,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,inpatient,1,EA,248.13000,235.72000,The Alliance,Exception Members,,191.06,,,,,,,136.47,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,outpatient,1,EA,248.13000,235.72000,The Alliance,Exception Members,,191.06,,,,,,,124.06,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,inpatient,1,EA,411.72000,391.14000,The Alliance,Exception Members,,317.02,,,,,,,226.45,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,outpatient,1,EA,411.72000,391.14000,The Alliance,Exception Members,,317.02,,,,,,,205.86,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,inpatient,1,EA,60.61000,57.58000,The Alliance,Exception Members,,46.67,,,,,,,33.34,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,outpatient,1,EA,60.61000,57.58000,The Alliance,Exception Members,,46.67,,,,,,,30.30,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,inpatient,1,EA,12.77000,12.13000,The Alliance,Exception Members,,9.83,,,,,,,7.02,12.39,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Exception Members,,9.83,,,,,,,6.38,12.39,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,inpatient,1,mL,669.10000,635.64000,The Alliance,Exception Members,,515.21,,,,,,,368.00,649.03,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,outpatient,1,mL,669.10000,635.64000,The Alliance,Exception Members,,515.21,,,,,,,30.77,649.03,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.36,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,inpatient,1,GM,18.68000,17.75000,The Alliance,Exception Members,,14.38,,,,,,,10.27,18.12,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,outpatient,1,GM,18.68000,17.75000,The Alliance,Exception Members,,14.38,,,,,,,9.34,18.12,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,inpatient,100,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,outpatient,100,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,inpatient,100,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,outpatient,100,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,inpatient,100,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,4.32,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,inpatient,,,52.65000,50.02000,The Alliance,Exception Members,,40.54,,,,,,,28.96,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,outpatient,,,52.65000,50.02000,The Alliance,Exception Members,,40.54,,,,,,,26.32,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,inpatient,1,mL,105.30000,100.03000,The Alliance,Exception Members,,81.08,,,,,,,57.91,102.14,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,outpatient,1,mL,105.30000,100.03000,The Alliance,Exception Members,,81.08,,,,,,,52.65,102.14,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,inpatient,1,EA,1369.95000,1301.46000,The Alliance,Exception Members,,1054.86,,,,,,,753.47,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,outpatient,1,EA,1369.95000,1301.46000,The Alliance,Exception Members,,1054.86,,,,,,,684.98,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,inpatient,1,EA,1025.64000,974.36000,The Alliance,Exception Members,,789.74,,,,,,,564.10,994.87,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,outpatient,1,EA,1025.64000,974.36000,The Alliance,Exception Members,,789.74,,,,,,,512.82,994.87,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,inpatient,1,EA,119.29000,113.33000,The Alliance,Exception Members,,91.85,,,,,,,65.61,115.71,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,outpatient,1,EA,119.29000,113.33000,The Alliance,Exception Members,,91.85,,,,,,,31.90,115.71,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,inpatient,1,EA,7.59000,7.21000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,outpatient,1,EA,7.59000,7.21000,The Alliance,Exception Members,,5.84,,,,,,,3.79,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Exception Members,,0.79310,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,inpatient,1,GM,19.63000,18.65000,The Alliance,Exception Members,,15.12,,,,,,,10.80,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,outpatient,1,GM,19.63000,18.65000,The Alliance,Exception Members,,15.12,,,,,,,9.81,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,inpatient,1,GM,13.80000,13.11000,The Alliance,Exception Members,,10.63,,,,,,,7.59,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,outpatient,1,GM,13.80000,13.11000,The Alliance,Exception Members,,10.63,,,,,,,6.90,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,inpatient,1,GM,7.48000,7.10000,The Alliance,Exception Members,,5.76,,,,,,,4.11,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,outpatient,1,GM,7.48000,7.10000,The Alliance,Exception Members,,5.76,,,,,,,3.74,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,inpatient,1,GM,9.66000,9.18000,The Alliance,Exception Members,,7.44,,,,,,,5.31,9.37,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,outpatient,1,GM,9.66000,9.18000,The Alliance,Exception Members,,7.44,,,,,,,4.83,9.37,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,inpatient,1,mL,34.08000,32.38000,The Alliance,Exception Members,,26.24,,,,,,,18.74,33.06,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,outpatient,1,mL,34.08000,32.38000,The Alliance,Exception Members,,26.24,,,,,,,1.49,33.06,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,inpatient,1,mL,11.95000,11.35000,The Alliance,Exception Members,,9.20,,,,,,,6.57,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,outpatient,1,mL,11.95000,11.35000,The Alliance,Exception Members,,9.20,,,,,,,5.97,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,inpatient,1,mL,10.34000,9.82000,The Alliance,Exception Members,,7.96,,,,,,,5.69,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,outpatient,1,mL,10.34000,9.82000,The Alliance,Exception Members,,7.96,,,,,,,5.17,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,inpatient,1,mL,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.69,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,outpatient,1,mL,10.35000,9.83000,The Alliance,Exception Members,,7.97,,,,,,,5.17,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,inpatient,1,mL,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,inpatient,1,mL,805.95000,765.65000,The Alliance,Exception Members,,620.58,,,,,,,443.27,781.77,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,outpatient,1,mL,805.95000,765.65000,The Alliance,Exception Members,,620.58,,,,,,,30.77,781.77,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.82,3.21,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Exception Members,,2.55,,,,,,,1.66,3.21,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,inpatient,1,mL,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,6.07,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,0.14409,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,inpatient,1,mL,7.57000,7.19000,The Alliance,Exception Members,,5.83,,,,,,,4.16,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,outpatient,1,mL,7.57000,7.19000,The Alliance,Exception Members,,5.83,,,,,,,0.14409,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,inpatient,1,mL,12.39000,11.77000,The Alliance,Exception Members,,9.54,,,,,,,6.81,12.02,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,outpatient,1,mL,12.39000,11.77000,The Alliance,Exception Members,,9.54,,,,,,,0.14409,12.02,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,inpatient,1,mL,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,inpatient,1,EA,10088.89000,9584.45000,The Alliance,Exception Members,,7768.45,,,,,,,5548.89,9786.22,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,outpatient,1,EA,10088.89000,9584.45000,The Alliance,Exception Members,,7768.45,,,,,,,5044.44,75174.64,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.97500,1.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,inpatient,1,mL,6.23000,5.91000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.04,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,outpatient,1,mL,6.23000,5.91000,The Alliance,Exception Members,,4.80,,,,,,,3.12,6.04,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.22,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Exception Members,,3.11,,,,,,,2.02,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.92,3.72,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,inpatient,1,mL,11.89000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,6.54,11.53,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,outpatient,1,mL,11.89000,11.30000,The Alliance,Exception Members,,9.16,,,,,,,5.95,11.53,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,inpatient,1,mL,170.43000,161.91000,The Alliance,Exception Members,,131.23,,,,,,,93.74,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,outpatient,1,mL,170.43000,161.91000,The Alliance,Exception Members,,131.23,,,,,,,85.22,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,inpatient,1,mL,38.40000,36.48000,The Alliance,Exception Members,,29.57,,,,,,,21.12,37.25,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,outpatient,1,mL,38.40000,36.48000,The Alliance,Exception Members,,29.57,,,,,,,19.20,37.25,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,inpatient,1,EA,31.01000,29.46000,The Alliance,Exception Members,,23.88,,,,,,,17.06,30.08,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,outpatient,1,EA,31.01000,29.46000,The Alliance,Exception Members,,23.88,,,,,,,15.51,30.08,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,inpatient,1,mL,117.24000,111.37000,The Alliance,Exception Members,,90.27,,,,,,,64.48,113.72,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,outpatient,1,mL,117.24000,111.37000,The Alliance,Exception Members,,90.27,,,,,,,58.62,113.72,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,1.02,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Exception Members,,1.43,,,,,,,0.93000,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.44330,1.24,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,inpatient,1,mL,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,inpatient,1,mL,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,inpatient,1,GM,10.14000,9.63000,The Alliance,Exception Members,,7.81,,,,,,,5.58,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,outpatient,1,GM,10.14000,9.63000,The Alliance,Exception Members,,7.81,,,,,,,5.07,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,inpatient,1,GM,3.46000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.36,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,outpatient,1,GM,3.46000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.36,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,inpatient,1,mL,131.99000,125.39000,The Alliance,Exception Members,,101.63,,,,,,,72.59,128.03,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,outpatient,1,mL,131.99000,125.39000,The Alliance,Exception Members,,101.63,,,,,,,66.00,128.03,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,5.29,9.32,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,4.80,9.32,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,inpatient,1,mL,7009.02000,6658.57000,The Alliance,Exception Members,,5396.95,,,,,,,3854.96,6798.75,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,outpatient,1,mL,7009.02000,6658.57000,The Alliance,Exception Members,,5396.95,,,,,,,3504.51,6798.75,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.69,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,inpatient,1,EA,39.75000,37.76000,The Alliance,Exception Members,,30.61,,,,,,,21.86,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,outpatient,1,EA,39.75000,37.76000,The Alliance,Exception Members,,30.61,,,,,,,19.88,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,inpatient,1,EA,14.82000,14.07000,The Alliance,Exception Members,,11.41,,,,,,,8.15,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Exception Members,,11.41,,,,,,,7.41,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,8.20,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,7.45,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,inpatient,1,mL,22.54000,21.42000,The Alliance,Exception Members,,17.36,,,,,,,12.40,21.86,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,outpatient,1,mL,22.54000,21.42000,The Alliance,Exception Members,,17.36,,,,,,,11.27,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.48,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,inpatient,1,mL,10.50000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.78,10.19,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,outpatient,1,mL,10.50000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.25,40.47,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,4.17,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Exception Members,,5.84,,,,,,,3.79,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,inpatient,1,mL,7.62000,7.24000,The Alliance,Exception Members,,5.87,,,,,,,4.19,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,outpatient,1,mL,7.62000,7.24000,The Alliance,Exception Members,,5.87,,,,,,,3.81,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,inpatient,1,mL,7.69000,7.30000,The Alliance,Exception Members,,5.92,,,,,,,4.23,7.46,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,outpatient,1,mL,7.69000,7.30000,The Alliance,Exception Members,,5.92,,,,,,,3.85,7.46,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,inpatient,1,EA,45.52000,43.25000,The Alliance,Exception Members,,35.05,,,,,,,25.04,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,outpatient,1,EA,45.52000,43.25000,The Alliance,Exception Members,,35.05,,,,,,,22.76,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,inpatient,1,EA,64.01000,60.81000,The Alliance,Exception Members,,49.29,,,,,,,35.21,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,outpatient,1,EA,64.01000,60.81000,The Alliance,Exception Members,,49.29,,,,,,,32.01,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,inpatient,1,EA,2.73000,2.59000,The Alliance,Exception Members,,2.10,,,,,,,1.50,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,outpatient,1,EA,2.73000,2.59000,The Alliance,Exception Members,,2.10,,,,,,,1.36,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,The Alliance,Exception Members,,95.15,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Exception Members,,95.15,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.00465,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.00465,0.03880,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,inpatient,1,EA,19.26000,18.30000,The Alliance,Exception Members,,14.83,,,,,,,10.59,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,outpatient,1,EA,19.26000,18.30000,The Alliance,Exception Members,,14.83,,,,,,,9.63,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,inpatient,1,EA,1.78000,1.70000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.44330,0.95060,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,inpatient,1,GM,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,outpatient,1,GM,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,inpatient,1,GM,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,outpatient,1,GM,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,inpatient,1,GM,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,outpatient,1,GM,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,39.50,76.63,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.35,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.04,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,inpatient,1,mL,7.22000,6.86000,The Alliance,Exception Members,,5.56,,,,,,,3.97,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,outpatient,1,mL,7.22000,6.86000,The Alliance,Exception Members,,5.56,,,,,,,3.61,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,inpatient,1,mL,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,3.40,6.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,3.10,6.00,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.13485,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,inpatient,1,mL,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,inpatient,1,mL,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.13485,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,0.13485,2.55,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,inpatient,1,mL,274.18000,260.47000,The Alliance,Exception Members,,211.12,,,,,,,150.80,265.95,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,outpatient,1,mL,274.18000,260.47000,The Alliance,Exception Members,,211.12,,,,,,,137.09,265.95,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,inpatient,1,EA,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.34,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.22,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.64900,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Exception Members,,0.90860,,,,,,,0.59000,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,inpatient,1,EA,4.78000,4.54000,The Alliance,Exception Members,,3.68,,,,,,,2.63,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Exception Members,,3.68,,,,,,,2.39,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,inpatient,1,EA,6.06000,5.76000,The Alliance,Exception Members,,4.67,,,,,,,3.33,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,outpatient,1,EA,6.06000,5.76000,The Alliance,Exception Members,,4.67,,,,,,,3.03,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.27,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.16,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,inpatient,1,EA,2.12000,2.02000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,outpatient,1,EA,2.12000,2.02000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,inpatient,1,EA,13.08000,12.43000,The Alliance,Exception Members,,10.07,,,,,,,7.19,12.69,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,outpatient,1,EA,13.08000,12.43000,The Alliance,Exception Members,,10.07,,,,,,,6.54,12.69,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,inpatient,1,EA,21.51000,20.44000,The Alliance,Exception Members,,16.56,,,,,,,11.83,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,outpatient,1,EA,21.51000,20.44000,The Alliance,Exception Members,,16.56,,,,,,,10.76,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,inpatient,1,EA,37.94000,36.04000,The Alliance,Exception Members,,29.21,,,,,,,20.87,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,outpatient,1,EA,37.94000,36.04000,The Alliance,Exception Members,,29.21,,,,,,,18.97,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,inpatient,1,EA,34.11000,32.40000,The Alliance,Exception Members,,26.26,,,,,,,18.76,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,outpatient,1,EA,34.11000,32.40000,The Alliance,Exception Members,,26.26,,,,,,,17.05,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,inpatient,1,EA,17.55000,16.68000,The Alliance,Exception Members,,13.51,,,,,,,9.65,17.02,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,outpatient,1,EA,17.55000,16.68000,The Alliance,Exception Members,,13.51,,,,,,,8.78,17.02,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,The Alliance,Exception Members,,2.72,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Exception Members,,2.72,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,The Alliance,Exception Members,,2.72,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Exception Members,,2.72,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,inpatient,1,EA,8.28000,7.87000,The Alliance,Exception Members,,6.38,,,,,,,4.55,8.03,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,outpatient,1,EA,8.28000,7.87000,The Alliance,Exception Members,,6.38,,,,,,,4.14,8.03,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,inpatient,1,mL,8.12000,7.71000,The Alliance,Exception Members,,6.25,,,,,,,4.47,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,outpatient,1,mL,8.12000,7.71000,The Alliance,Exception Members,,6.25,,,,,,,4.06,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,inpatient,1,mL,4.90000,4.66000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.75,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,outpatient,1,mL,4.90000,4.66000,The Alliance,Exception Members,,3.77,,,,,,,2.45,4.75,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,inpatient,1,EA,26.97000,25.62000,The Alliance,Exception Members,,20.77,,,,,,,14.83,26.16,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,outpatient,1,EA,26.97000,25.62000,The Alliance,Exception Members,,20.77,,,,,,,13.48,26.16,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,inpatient,1,mL,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,inpatient,1,mL,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,outpatient,1,mL,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,inpatient,1,mL,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,inpatient,1,mL,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,3.11,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Exception Members,,4.35,,,,,,,2.83,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,inpatient,1,mL,6.10000,5.79000,The Alliance,Exception Members,,4.70,,,,,,,3.35,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,outpatient,1,mL,6.10000,5.79000,The Alliance,Exception Members,,4.70,,,,,,,3.05,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,inpatient,1,mL,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,outpatient,1,mL,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,inpatient,1,EA,21.90000,20.80000,The Alliance,Exception Members,,16.86,,,,,,,12.04,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,outpatient,1,EA,21.90000,20.80000,The Alliance,Exception Members,,16.86,,,,,,,10.95,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,6.52,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Exception Members,,9.12,,,,,,,5.92,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,2.17,3.83,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Exception Members,,3.04,,,,,,,1.98,3.83,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,inpatient,1,mL,15.07000,14.32000,The Alliance,Exception Members,,11.60,,,,,,,8.29,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,outpatient,1,mL,15.07000,14.32000,The Alliance,Exception Members,,11.60,,,,,,,7.54,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,inpatient,1,mL,20.19000,19.18000,The Alliance,Exception Members,,15.55,,,,,,,11.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,outpatient,1,mL,20.19000,19.18000,The Alliance,Exception Members,,15.55,,,,,,,10.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,inpatient,1,mL,15.74000,14.95000,The Alliance,Exception Members,,12.12,,,,,,,8.66,15.27,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,outpatient,1,mL,15.74000,14.95000,The Alliance,Exception Members,,12.12,,,,,,,7.87,15.27,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,The Alliance,Exception Members,,27.49,,,,,,,19.64,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Exception Members,,27.49,,,,,,,17.85,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,inpatient,1,EA,28.25000,26.84000,The Alliance,Exception Members,,21.75,,,,,,,15.54,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,outpatient,1,EA,28.25000,26.84000,The Alliance,Exception Members,,21.75,,,,,,,14.12,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,inpatient,1,EA,33.83000,32.14000,The Alliance,Exception Members,,26.05,,,,,,,18.61,32.82,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,outpatient,1,EA,33.83000,32.14000,The Alliance,Exception Members,,26.05,,,,,,,16.91,32.82,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,inpatient,1,mL,201.05000,191.00000,The Alliance,Exception Members,,154.81,,,,,,,110.58,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,outpatient,1,mL,201.05000,191.00000,The Alliance,Exception Members,,154.81,,,,,,,100.53,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,inpatient,1,mL,135.06000,128.31000,The Alliance,Exception Members,,104.00,,,,,,,74.28,131.01,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,outpatient,1,mL,135.06000,128.31000,The Alliance,Exception Members,,104.00,,,,,,,67.53,131.01,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,The Alliance,Exception Members,,1386.99,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Exception Members,,1386.99,,,,,,,900.64,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,The Alliance,Exception Members,,1386.99,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Exception Members,,1386.99,,,,,,,900.64,1747.25,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,3.23,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,inpatient,1,mL,54.06000,51.36000,The Alliance,Exception Members,,41.63,,,,,,,29.73,52.44,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,outpatient,1,mL,54.06000,51.36000,The Alliance,Exception Members,,41.63,,,,,,,27.03,52.44,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,inpatient,1,EA,51.38000,48.81000,The Alliance,Exception Members,,39.56,,,,,,,28.26,49.84,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,outpatient,1,EA,51.38000,48.81000,The Alliance,Exception Members,,39.56,,,,,,,25.69,49.84,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,inpatient,1,GM,12.42000,11.80000,The Alliance,Exception Members,,9.56,,,,,,,6.83,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,outpatient,1,GM,12.42000,11.80000,The Alliance,Exception Members,,9.56,,,,,,,6.21,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,7.54,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,7.54,14.64,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,inpatient,1,EA,37.22000,35.36000,The Alliance,Exception Members,,28.66,,,,,,,20.47,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,outpatient,1,EA,37.22000,35.36000,The Alliance,Exception Members,,28.66,,,,,,,18.61,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,inpatient,1,EA,40.94000,38.90000,The Alliance,Exception Members,,31.52,,,,,,,22.52,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,outpatient,1,EA,40.94000,38.90000,The Alliance,Exception Members,,31.52,,,,,,,20.47,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,2.14,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Exception Members,,3.00,,,,,,,1.95,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.42,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Exception Members,,4.78,,,,,,,3.10,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,The Alliance,Exception Members,,33.66,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Exception Members,,33.66,,,,,,,21.86,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,inpatient,1,EA,28.51000,27.09000,The Alliance,Exception Members,,21.95,,,,,,,15.68,27.65,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,outpatient,1,EA,28.51000,27.09000,The Alliance,Exception Members,,21.95,,,,,,,14.26,27.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,inpatient,1,mL,16.68000,15.85000,The Alliance,Exception Members,,12.84,,,,,,,9.17,16.18,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,outpatient,1,mL,16.68000,15.85000,The Alliance,Exception Members,,12.84,,,,,,,8.34,25.89,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.61,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.29,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,inpatient,1,mL,6.70000,6.36000,The Alliance,Exception Members,,5.16,,,,,,,3.69,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,outpatient,1,mL,6.70000,6.36000,The Alliance,Exception Members,,5.16,,,,,,,3.35,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,2.89,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,inpatient,1,mL,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.91,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,outpatient,1,mL,3.47000,3.30000,The Alliance,Exception Members,,2.67,,,,,,,1.74,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,inpatient,1,mL,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,3.06,5.39,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,outpatient,1,mL,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,2.78,5.39,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,inpatient,1,mL,1032.80000,981.16000,The Alliance,Exception Members,,795.26,,,,,,,568.04,1001.82,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,outpatient,1,mL,1032.80000,981.16000,The Alliance,Exception Members,,795.26,,,,,,,516.40,8271.63,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,inpatient,1,mL,1186.38000,1127.06000,The Alliance,Exception Members,,913.51,,,,,,,652.51,1150.79,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,outpatient,1,mL,1186.38000,1127.06000,The Alliance,Exception Members,,913.51,,,,,,,593.19,8271.63,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,20.43,39.62,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Exception Members,,13.04,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,inpatient,1,EA,21.59000,20.51000,The Alliance,Exception Members,,16.62,,,,,,,11.87,20.94,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,outpatient,1,EA,21.59000,20.51000,The Alliance,Exception Members,,16.62,,,,,,,0.43865,20.94,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,inpatient,1,EA,9.59000,9.11000,The Alliance,Exception Members,,7.38,,,,,,,5.27,9.30,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,outpatient,1,EA,9.59000,9.11000,The Alliance,Exception Members,,7.38,,,,,,,4.79,9.30,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,inpatient,1,mL,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,inpatient,,,386.68000,367.35000,The Alliance,Exception Members,,297.74,,,,,,,212.67,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,outpatient,,,386.68000,367.35000,The Alliance,Exception Members,,297.74,,,,,,,148.70,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,inpatient,1,mL,773.36000,734.69000,The Alliance,Exception Members,,595.49,,,,,,,425.35,750.16,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,outpatient,1,mL,773.36000,734.69000,The Alliance,Exception Members,,595.49,,,,,,,148.70,750.16,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Exception Members,,3.83,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,inpatient,1,EA,2.74000,2.61000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,inpatient,1,EA,2.49000,2.36000,The Alliance,Exception Members,,1.92,,,,,,,1.37,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,outpatient,1,EA,2.49000,2.36000,The Alliance,Exception Members,,1.92,,,,,,,1.25,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,inpatient,1,EA,2.74000,2.61000,The Alliance,Exception Members,,2.11,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Exception Members,,2.11,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,inpatient,1,EA,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,inpatient,1,EA,140.32000,133.31000,The Alliance,Exception Members,,108.05,,,,,,,77.18,136.11,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,outpatient,1,EA,140.32000,133.31000,The Alliance,Exception Members,,108.05,,,,,,,70.16,136.11,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,inpatient,1,EA,2.66000,2.52000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,inpatient,1,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.41,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.19,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,inpatient,1,EA,6.28000,5.96000,The Alliance,Exception Members,,4.84,,,,,,,3.45,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Exception Members,,4.84,,,,,,,3.14,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,inpatient,1,EA,7.96000,7.56000,The Alliance,Exception Members,,6.13,,,,,,,4.38,7.72,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,outpatient,1,EA,7.96000,7.56000,The Alliance,Exception Members,,6.13,,,,,,,3.98,7.72,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,inpatient,5,EA,10.04000,9.54000,The Alliance,Exception Members,,7.73,,,,,,,5.52,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,outpatient,5,EA,10.04000,9.54000,The Alliance,Exception Members,,7.73,,,,,,,5.02,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,inpatient,5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,5.69,11.04,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,inpatient,1,EA,45.77000,43.48000,The Alliance,Exception Members,,35.24,,,,,,,25.17,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,outpatient,1,EA,45.77000,43.48000,The Alliance,Exception Members,,35.24,,,,,,,22.89,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.78,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.61,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,inpatient,1,EA,2.42000,2.30000,The Alliance,Exception Members,,1.86,,,,,,,1.33,2.35,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,outpatient,1,EA,2.42000,2.30000,The Alliance,Exception Members,,1.86,,,,,,,1.21,2.35,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,inpatient,1,mL,18.20000,17.29000,The Alliance,Exception Members,,14.01,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Exception Members,,14.01,,,,,,,9.10,25.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,inpatient,1,EA,12.26000,11.65000,The Alliance,Exception Members,,9.44,,,,,,,6.74,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Exception Members,,9.44,,,,,,,6.13,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,inpatient,1,EA,10.59000,10.06000,The Alliance,Exception Members,,8.15,,,,,,,5.82,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,outpatient,1,EA,10.59000,10.06000,The Alliance,Exception Members,,8.15,,,,,,,5.29,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,inpatient,1,EA,7.36000,6.99000,The Alliance,Exception Members,,5.67,,,,,,,4.05,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,outpatient,1,EA,7.36000,6.99000,The Alliance,Exception Members,,5.67,,,,,,,3.68,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,inpatient,1,EA,16.12000,15.31000,The Alliance,Exception Members,,12.41,,,,,,,8.87,15.64,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Exception Members,,12.41,,,,,,,8.06,15.64,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,inpatient,1,mL,28.12000,26.72000,The Alliance,Exception Members,,21.65,,,,,,,15.47,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,outpatient,1,mL,28.12000,26.72000,The Alliance,Exception Members,,21.65,,,,,,,14.06,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,inpatient,1,mL,14.15000,13.44000,The Alliance,Exception Members,,10.90,,,,,,,7.78,13.73,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,outpatient,1,mL,14.15000,13.44000,The Alliance,Exception Members,,10.90,,,,,,,7.08,13.73,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,inpatient,1,mL,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,inpatient,1,EA,28.94000,27.50000,The Alliance,Exception Members,,22.28,,,,,,,15.92,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,outpatient,1,EA,28.94000,27.50000,The Alliance,Exception Members,,22.28,,,,,,,14.47,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,inpatient,1,EA,35.77000,33.98000,The Alliance,Exception Members,,27.54,,,,,,,19.67,34.70,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,outpatient,1,EA,35.77000,33.98000,The Alliance,Exception Members,,27.54,,,,,,,17.89,34.70,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.32,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.18,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,inpatient,1,EA,41.78000,39.69000,The Alliance,Exception Members,,32.17,,,,,,,22.98,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,outpatient,1,EA,41.78000,39.69000,The Alliance,Exception Members,,32.17,,,,,,,20.89,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,The Alliance,Exception Members,,12.94,,,,,,,9.24,16.30,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Exception Members,,12.94,,,,,,,8.40,16.30,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Exception Members,,22.68,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,20.43,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,The Alliance,Exception Members,,6.35,,,,,,,4.54,8.00,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Exception Members,,6.35,,,,,,,4.12,8.00,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,inpatient,1,EA,37.02000,35.17000,The Alliance,Exception Members,,28.51,,,,,,,20.36,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,outpatient,1,EA,37.02000,35.17000,The Alliance,Exception Members,,28.51,,,,,,,18.51,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,inpatient,1,EA,13.95000,13.25000,The Alliance,Exception Members,,10.74,,,,,,,7.67,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,outpatient,1,EA,13.95000,13.25000,The Alliance,Exception Members,,10.74,,,,,,,6.97,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,inpatient,1,EA,122.37000,116.26000,The Alliance,Exception Members,,94.22,,,,,,,67.30,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,outpatient,1,EA,122.37000,116.26000,The Alliance,Exception Members,,94.22,,,,,,,61.19,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,inpatient,1,EA,48.95000,46.50000,The Alliance,Exception Members,,37.69,,,,,,,26.92,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,outpatient,1,EA,48.95000,46.50000,The Alliance,Exception Members,,37.69,,,,,,,24.48,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,inpatient,1,EA,18.49000,17.56000,The Alliance,Exception Members,,14.24,,,,,,,10.17,17.94,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Exception Members,,14.24,,,,,,,9.24,17.94,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,9.56,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,8.69,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,inpatient,1,EA,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,9.73,17.17,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Exception Members,,13.63,,,,,,,8.85,17.17,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,2.56,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,inpatient,1,EA,20.11000,19.11000,The Alliance,Exception Members,,15.48,,,,,,,11.06,19.51,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,outpatient,1,EA,20.11000,19.11000,The Alliance,Exception Members,,15.48,,,,,,,10.05,19.51,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,inpatient,1,mL,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,outpatient,1,mL,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,inpatient,1,EA,19.54000,18.57000,The Alliance,Exception Members,,15.05,,,,,,,10.75,18.95,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,outpatient,1,EA,19.54000,18.57000,The Alliance,Exception Members,,15.05,,,,,,,9.77,18.95,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,inpatient,1,EA,692.00000,657.40000,The Alliance,Exception Members,,532.84,,,,,,,380.60,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,outpatient,1,EA,692.00000,657.40000,The Alliance,Exception Members,,532.84,,,,,,,346.00,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,inpatient,1,EA,188.18000,178.77000,The Alliance,Exception Members,,144.90,,,,,,,103.50,182.53,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,outpatient,1,EA,188.18000,178.77000,The Alliance,Exception Members,,144.90,,,,,,,94.09,182.53,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,inpatient,1,mL,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.29,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,outpatient,1,mL,2.36000,2.24000,The Alliance,Exception Members,,1.82,,,,,,,1.18,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,inpatient,1,mL,3.36000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,outpatient,1,mL,3.36000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,inpatient,1,mL,19.18000,18.22000,The Alliance,Exception Members,,14.77,,,,,,,10.55,18.60,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,outpatient,1,mL,19.18000,18.22000,The Alliance,Exception Members,,14.77,,,,,,,9.59,18.60,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,inpatient,1,EA,5.51000,5.23000,The Alliance,Exception Members,,4.24,,,,,,,3.03,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,outpatient,1,EA,5.51000,5.23000,The Alliance,Exception Members,,4.24,,,,,,,2.75,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.95,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.50,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,inpatient,1,EA,7.78000,7.39000,The Alliance,Exception Members,,5.99,,,,,,,4.28,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,outpatient,1,EA,7.78000,7.39000,The Alliance,Exception Members,,5.99,,,,,,,3.89,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,inpatient,1,GM,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,outpatient,1,GM,0.22000,0.20000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,inpatient,1,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,38.24,67.43,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Exception Members,,53.53,,,,,,,3.23,67.43,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,inpatient,1,EA,10.54000,10.01000,The Alliance,Exception Members,,8.12,,,,,,,5.80,10.22,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,outpatient,1,EA,10.54000,10.01000,The Alliance,Exception Members,,8.12,,,,,,,5.27,10.22,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Exception Members,,0.88550,,,,,,,0.57500,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,inpatient,1,mL,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,outpatient,1,mL,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.35,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,inpatient,1,mL,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Exception Members,,2.23,,,,,,,1.45,4.28,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,inpatient,1,mL,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,2.61,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,31.28,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,28.44,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,inpatient,1,mL,61.46000,58.39000,The Alliance,Exception Members,,47.32,,,,,,,33.80,59.62,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,outpatient,1,mL,61.46000,58.39000,The Alliance,Exception Members,,47.32,,,,,,,30.73,59.62,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,inpatient,1,EA,31.45000,29.88000,The Alliance,Exception Members,,24.22,,,,,,,17.30,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,outpatient,1,EA,31.45000,29.88000,The Alliance,Exception Members,,24.22,,,,,,,15.72,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,inpatient,1,EA,14.34000,13.63000,The Alliance,Exception Members,,11.04,,,,,,,7.89,13.91,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,outpatient,1,EA,14.34000,13.63000,The Alliance,Exception Members,,11.04,,,,,,,7.17,13.91,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,inpatient,,,241.67000,229.59000,The Alliance,Exception Members,,186.09,,,,,,,132.92,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Exception Members,,186.09,,,,,,,120.83,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,inpatient,1,EA,483.34000,459.17000,The Alliance,Exception Members,,372.17,,,,,,,265.84,468.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Exception Members,,372.17,,,,,,,187.18,468.84,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,inpatient,1,EA,669.20000,635.74000,The Alliance,Exception Members,,515.28,,,,,,,368.06,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,outpatient,1,EA,669.20000,635.74000,The Alliance,Exception Members,,515.28,,,,,,,108.03,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,inpatient,1,EA,3779.13000,3590.17000,The Alliance,Exception Members,,2909.93,,,,,,,2078.52,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,outpatient,1,EA,3779.13000,3590.17000,The Alliance,Exception Members,,2909.93,,,,,,,108.03,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,inpatient,1,EA,4600.00000,4370.00000,The Alliance,Exception Members,,3542.00,,,,,,,2530.00,4462.00,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,outpatient,1,EA,4600.00000,4370.00000,The Alliance,Exception Members,,3542.00,,,,,,,108.03,4462.00,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,5.18,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,4.71,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,inpatient,1,EA,14.55000,13.82000,The Alliance,Exception Members,,11.20,,,,,,,8.00,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,outpatient,1,EA,14.55000,13.82000,The Alliance,Exception Members,,11.20,,,,,,,7.28,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,inpatient,1,EA,40.76000,38.72000,The Alliance,Exception Members,,31.39,,,,,,,22.42,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,outpatient,1,EA,40.76000,38.72000,The Alliance,Exception Members,,31.39,,,,,,,20.38,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,inpatient,1,EA,16.38000,15.57000,The Alliance,Exception Members,,12.61,,,,,,,9.01,15.89,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,outpatient,1,EA,16.38000,15.57000,The Alliance,Exception Members,,12.61,,,,,,,8.19,15.89,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,inpatient,1,EA,20.97000,19.92000,The Alliance,Exception Members,,16.15,,,,,,,11.53,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,outpatient,1,EA,20.97000,19.92000,The Alliance,Exception Members,,16.15,,,,,,,0.36823,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,inpatient,1,EA,7.85000,7.46000,The Alliance,Exception Members,,6.04,,,,,,,4.32,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Exception Members,,6.04,,,,,,,0.36823,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,inpatient,1,EA,8.95000,8.50000,The Alliance,Exception Members,,6.89,,,,,,,4.92,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,outpatient,1,EA,8.95000,8.50000,The Alliance,Exception Members,,6.89,,,,,,,0.36823,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,inpatient,1,EA,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,4.09,7.21,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,outpatient,1,EA,7.43000,7.05000,The Alliance,Exception Members,,5.72,,,,,,,0.36823,7.21,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,inpatient,1,EA,54.15000,51.44000,The Alliance,Exception Members,,41.70,,,,,,,29.78,52.53,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,outpatient,1,EA,54.15000,51.44000,The Alliance,Exception Members,,41.70,,,,,,,27.07,52.53,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.25,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Exception Members,,3.15,,,,,,,2.04,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,inpatient,1,mL,12.48000,11.86000,The Alliance,Exception Members,,9.61,,,,,,,6.86,12.11,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,outpatient,1,mL,12.48000,11.86000,The Alliance,Exception Members,,9.61,,,,,,,2.24,12.11,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,inpatient,1,mL,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,outpatient,1,mL,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,0.26000,4.10,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,inpatient,1,GM,19.83000,18.84000,The Alliance,Exception Members,,15.27,,,,,,,10.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,outpatient,1,GM,19.83000,18.84000,The Alliance,Exception Members,,15.27,,,,,,,9.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,inpatient,1,GM,11.68000,11.10000,The Alliance,Exception Members,,8.99,,,,,,,6.42,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,outpatient,1,GM,11.68000,11.10000,The Alliance,Exception Members,,8.99,,,,,,,5.84,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.09,7.93,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,inpatient,1,GM,5.01000,4.76000,The Alliance,Exception Members,,3.86,,,,,,,2.76,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,outpatient,1,GM,5.01000,4.76000,The Alliance,Exception Members,,3.86,,,,,,,2.50,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,inpatient,1,GM,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,outpatient,1,GM,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,inpatient,1,EA,9.03000,8.58000,The Alliance,Exception Members,,6.95,,,,,,,4.97,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,outpatient,1,EA,9.03000,8.58000,The Alliance,Exception Members,,6.95,,,,,,,4.51,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.75,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.59,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Exception Members,,2.83,,,,,,,1.84,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,inpatient,1,GM,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,outpatient,1,GM,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,inpatient,1,EA,8.68000,8.24000,The Alliance,Exception Members,,6.68,,,,,,,4.77,8.42,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,outpatient,1,EA,8.68000,8.24000,The Alliance,Exception Members,,6.68,,,,,,,4.34,8.42,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,inpatient,1,mL,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.58300,1.03,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Exception Members,,0.81620,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.31,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Exception Members,,1.83,,,,,,,1.19,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.19995,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,inpatient,1,mL,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,4.90,8.64,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Exception Members,,6.86,,,,,,,0.19995,8.64,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,inpatient,1,mL,6.74000,6.40000,The Alliance,Exception Members,,5.19,,,,,,,3.71,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,outpatient,1,mL,6.74000,6.40000,The Alliance,Exception Members,,5.19,,,,,,,3.37,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,inpatient,1,mL,6.67000,6.33000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,outpatient,1,mL,6.67000,6.33000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,inpatient,1,mL,68.41000,64.98000,The Alliance,Exception Members,,52.68,,,,,,,37.63,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,outpatient,1,mL,68.41000,64.98000,The Alliance,Exception Members,,52.68,,,,,,,29.60,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,inpatient,1,mL,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,inpatient,1,mL,142.39000,135.27000,The Alliance,Exception Members,,109.64,,,,,,,78.31,138.12,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,outpatient,1,mL,142.39000,135.27000,The Alliance,Exception Members,,109.64,,,,,,,29.60,138.12,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,inpatient,1,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,7.58,14.71,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,inpatient,1,EA,5.82000,5.53000,The Alliance,Exception Members,,4.48,,,,,,,3.20,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,outpatient,1,EA,5.82000,5.53000,The Alliance,Exception Members,,4.48,,,,,,,2.91,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,inpatient,1,EA,2.76000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,outpatient,1,EA,2.76000,2.63000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.20,2.11,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Exception Members,,1.68,,,,,,,1.09,2.11,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,inpatient,1,mL,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.35,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,outpatient,1,mL,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.35,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,inpatient,1,GM,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,outpatient,1,GM,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,inpatient,1,EA,32.55000,30.93000,The Alliance,Exception Members,,25.06,,,,,,,17.90,31.57,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,outpatient,1,EA,32.55000,30.93000,The Alliance,Exception Members,,25.06,,,,,,,16.27,31.57,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,inpatient,1,mL,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,8.25,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,outpatient,1,mL,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,7.50,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,inpatient,1,mL,13.24000,12.58000,The Alliance,Exception Members,,10.19,,,,,,,7.28,12.84,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,outpatient,1,mL,13.24000,12.58000,The Alliance,Exception Members,,10.19,,,,,,,6.62,12.84,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,2.17,3.82,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.82,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,inpatient,1,mL,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.45,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,inpatient,1,mL,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,inpatient,1,mL,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,inpatient,1,mL,128.82000,122.38000,The Alliance,Exception Members,,99.19,,,,,,,70.85,124.96,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,outpatient,1,mL,128.82000,122.38000,The Alliance,Exception Members,,99.19,,,,,,,29.60,124.96,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,inpatient,1,GM,5.52000,5.24000,The Alliance,Exception Members,,4.25,,,,,,,3.04,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,outpatient,1,GM,5.52000,5.24000,The Alliance,Exception Members,,4.25,,,,,,,2.76,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,inpatient,1,GM,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,outpatient,1,GM,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,inpatient,1,GM,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,3.16,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,outpatient,1,GM,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,2.88,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,inpatient,1,GM,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.23,3.94,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,outpatient,1,GM,4.06000,3.86000,The Alliance,Exception Members,,3.13,,,,,,,2.03,3.94,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,inpatient,1,mL,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,outpatient,1,mL,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.73,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Exception Members,,3.83,,,,,,,2.48,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.31,2.32,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.20,2.32,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,inpatient,1,mL,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,6.07,10.70,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Exception Members,,8.49,,,,,,,5.51,10.70,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,inpatient,1,mL,19.99000,18.99000,The Alliance,Exception Members,,15.39,,,,,,,10.99,19.39,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,outpatient,1,mL,19.99000,18.99000,The Alliance,Exception Members,,15.39,,,,,,,9.99,19.39,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,inpatient,1,EA,6.34000,6.02000,The Alliance,Exception Members,,4.88,,,,,,,3.49,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,outpatient,1,EA,6.34000,6.02000,The Alliance,Exception Members,,4.88,,,,,,,3.17,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,3.16,5.58,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,2.88,5.58,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,inpatient,1,EA,13.86000,13.17000,The Alliance,Exception Members,,10.67,,,,,,,7.62,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,outpatient,1,EA,13.86000,13.17000,The Alliance,Exception Members,,10.67,,,,,,,0.58745,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,inpatient,1,EA,24.04000,22.84000,The Alliance,Exception Members,,18.51,,,,,,,13.22,23.32,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Exception Members,,18.51,,,,,,,0.58745,23.32,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,inpatient,1,mL,27.27000,25.91000,The Alliance,Exception Members,,21.00,,,,,,,15.00,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,outpatient,1,mL,27.27000,25.91000,The Alliance,Exception Members,,21.00,,,,,,,0.23870,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,inpatient,1,mL,8.93000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,4.91,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,outpatient,1,mL,8.93000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,0.23870,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,inpatient,1,mL,8.94000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,4.92,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,outpatient,1,mL,8.94000,8.49000,The Alliance,Exception Members,,6.88,,,,,,,0.23870,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,inpatient,1,mL,22.91000,21.77000,The Alliance,Exception Members,,17.64,,,,,,,12.60,22.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,outpatient,1,mL,22.91000,21.77000,The Alliance,Exception Members,,17.64,,,,,,,0.23870,22.22,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,3.18,5.62,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Exception Members,,4.46,,,,,,,2.90,5.62,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,inpatient,1,EA,17.10000,16.25000,The Alliance,Exception Members,,13.17,,,,,,,9.40,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,outpatient,1,EA,17.10000,16.25000,The Alliance,Exception Members,,13.17,,,,,,,0.58745,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,inpatient,1,EA,11.55000,10.97000,The Alliance,Exception Members,,8.89,,,,,,,6.35,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,outpatient,1,EA,11.55000,10.97000,The Alliance,Exception Members,,8.89,,,,,,,0.58745,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,inpatient,1,EA,13.12000,12.47000,The Alliance,Exception Members,,10.10,,,,,,,7.22,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Exception Members,,10.10,,,,,,,0.58745,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,inpatient,1,EA,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,0.58745,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.63080,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,inpatient,1,EA,11.77000,11.18000,The Alliance,Exception Members,,9.06,,,,,,,6.47,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,outpatient,1,EA,11.77000,11.18000,The Alliance,Exception Members,,9.06,,,,,,,0.58745,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,0.58745,4.44,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,inpatient,1,EA,16.30000,15.49000,The Alliance,Exception Members,,12.55,,,,,,,8.96,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,outpatient,1,EA,16.30000,15.49000,The Alliance,Exception Members,,12.55,,,,,,,8.15,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.44,2.54,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.31,2.54,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,The Alliance,Exception Members,,3.20,,,,,,,2.28,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Exception Members,,3.20,,,,,,,2.08,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,inpatient,1,EA,12.79000,12.15000,The Alliance,Exception Members,,9.85,,,,,,,7.03,12.41,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,outpatient,1,EA,12.79000,12.15000,The Alliance,Exception Members,,9.85,,,,,,,6.39,12.41,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,14.37,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,inpatient,1,mL,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,14.37,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,inpatient,1,EA,1.65000,1.56000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,outpatient,1,EA,1.65000,1.56000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,inpatient,1,EA,39.82000,37.83000,The Alliance,Exception Members,,30.66,,,,,,,21.90,38.63,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,outpatient,1,EA,39.82000,37.83000,The Alliance,Exception Members,,30.66,,,,,,,19.91,38.63,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,inpatient,1,mL,11.10000,10.55000,The Alliance,Exception Members,,8.55,,,,,,,6.11,10.77,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,outpatient,1,mL,11.10000,10.55000,The Alliance,Exception Members,,8.55,,,,,,,4.77,10.77,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,inpatient,1,EA,16.69000,15.86000,The Alliance,Exception Members,,12.85,,,,,,,9.18,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,outpatient,1,EA,16.69000,15.86000,The Alliance,Exception Members,,12.85,,,,,,,8.35,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,inpatient,1,EA,43.24000,41.07000,The Alliance,Exception Members,,33.29,,,,,,,23.78,41.94,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,outpatient,1,EA,43.24000,41.07000,The Alliance,Exception Members,,33.29,,,,,,,21.62,41.94,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,inpatient,1,EA,96.21000,91.40000,The Alliance,Exception Members,,74.08,,,,,,,52.92,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,outpatient,1,EA,96.21000,91.40000,The Alliance,Exception Members,,74.08,,,,,,,48.10,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,inpatient,1,EA,23.30000,22.13000,The Alliance,Exception Members,,17.94,,,,,,,12.81,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,outpatient,1,EA,23.30000,22.13000,The Alliance,Exception Members,,17.94,,,,,,,11.65,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,inpatient,1,EA,31.97000,30.37000,The Alliance,Exception Members,,24.62,,,,,,,17.58,31.01,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,outpatient,1,EA,31.97000,30.37000,The Alliance,Exception Members,,24.62,,,,,,,15.98,31.01,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,3.55,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,The Alliance,Exception Members,,4.79,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Exception Members,,4.79,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,inpatient,1,mL,69.35000,65.88000,The Alliance,Exception Members,,53.40,,,,,,,38.14,67.27,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,outpatient,1,mL,69.35000,65.88000,The Alliance,Exception Members,,53.40,,,,,,,34.67,67.27,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,inpatient,1,EA,15.09000,14.33000,The Alliance,Exception Members,,11.62,,,,,,,8.30,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Exception Members,,11.62,,,,,,,7.54,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,3.09,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Exception Members,,4.33,,,,,,,2.81,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,The Alliance,Exception Members,,2.10,,,,,,,1.50,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Exception Members,,2.10,,,,,,,1.36,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,inpatient,1,EA,6.82000,6.48000,The Alliance,Exception Members,,5.25,,,,,,,3.75,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,outpatient,1,EA,6.82000,6.48000,The Alliance,Exception Members,,5.25,,,,,,,3.41,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,inpatient,1,EA,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.44,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,outpatient,1,EA,6.64000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.32,6.44,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,inpatient,1,mL,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.34,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,outpatient,1,mL,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.22,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,inpatient,1,EA,11.37000,10.80000,The Alliance,Exception Members,,8.75,,,,,,,6.25,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,outpatient,1,EA,11.37000,10.80000,The Alliance,Exception Members,,8.75,,,,,,,5.68,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,inpatient,1,EA,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,3.28,5.79,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,2.98,5.79,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,inpatient,1,EA,45.02000,42.77000,The Alliance,Exception Members,,34.67,,,,,,,24.76,43.67,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,outpatient,1,EA,45.02000,42.77000,The Alliance,Exception Members,,34.67,,,,,,,22.51,43.67,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,inpatient,1,EA,29.46000,27.99000,The Alliance,Exception Members,,22.68,,,,,,,16.20,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,outpatient,1,EA,29.46000,27.99000,The Alliance,Exception Members,,22.68,,,,,,,14.73,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,inpatient,1,EA,77.26000,73.40000,The Alliance,Exception Members,,59.49,,,,,,,42.49,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,outpatient,1,EA,77.26000,73.40000,The Alliance,Exception Members,,59.49,,,,,,,38.63,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,inpatient,1,mL,37.52000,35.65000,The Alliance,Exception Members,,28.89,,,,,,,20.64,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,outpatient,1,mL,37.52000,35.65000,The Alliance,Exception Members,,28.89,,,,,,,14.28,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,inpatient,1,mL,29.64000,28.16000,The Alliance,Exception Members,,22.82,,,,,,,16.30,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,outpatient,1,mL,29.64000,28.16000,The Alliance,Exception Members,,22.82,,,,,,,14.28,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,inpatient,1,mL,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,12.17,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,outpatient,1,mL,22.12000,21.01000,The Alliance,Exception Members,,17.03,,,,,,,11.06,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,inpatient,1,mL,11.63000,11.05000,The Alliance,Exception Members,,8.96,,,,,,,6.40,11.28,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,outpatient,1,mL,11.63000,11.05000,The Alliance,Exception Members,,8.96,,,,,,,5.82,15.29,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,inpatient,1,mL,29.39000,27.92000,The Alliance,Exception Members,,22.63,,,,,,,16.16,28.51,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,outpatient,1,mL,29.39000,27.92000,The Alliance,Exception Members,,22.63,,,,,,,14.28,28.51,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,inpatient,1,EA,36.90000,35.06000,The Alliance,Exception Members,,28.41,,,,,,,20.30,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,outpatient,1,EA,36.90000,35.06000,The Alliance,Exception Members,,28.41,,,,,,,18.45,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,inpatient,1,EA,35.55000,33.77000,The Alliance,Exception Members,,27.37,,,,,,,19.55,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Exception Members,,27.37,,,,,,,17.77,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,inpatient,1,EA,36.97000,35.12000,The Alliance,Exception Members,,28.47,,,,,,,20.33,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,outpatient,1,EA,36.97000,35.12000,The Alliance,Exception Members,,28.47,,,,,,,18.48,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,18.17,35.25,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,inpatient,1,GM,41.32000,39.25000,The Alliance,Exception Members,,31.82,,,,,,,22.73,40.08,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,outpatient,1,GM,41.32000,39.25000,The Alliance,Exception Members,,31.82,,,,,,,20.66,40.08,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,inpatient,1,GM,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,2.03,3.58,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,outpatient,1,GM,3.69000,3.50000,The Alliance,Exception Members,,2.84,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,inpatient,1,mL,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.16,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,outpatient,1,mL,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.11,2.16,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,inpatient,1,EA,11.81000,11.22000,The Alliance,Exception Members,,9.09,,,,,,,6.50,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,outpatient,1,EA,11.81000,11.22000,The Alliance,Exception Members,,9.09,,,,,,,5.91,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,inpatient,1,EA,6.29000,5.97000,The Alliance,Exception Members,,4.84,,,,,,,3.46,6.10,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,outpatient,1,EA,6.29000,5.97000,The Alliance,Exception Members,,4.84,,,,,,,3.15,6.10,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,inpatient,1,mL,5.47000,5.19000,The Alliance,Exception Members,,4.21,,,,,,,3.01,5.31,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Exception Members,,4.21,,,,,,,2.73,5.31,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,inpatient,1,EA,158.82000,150.88000,The Alliance,Exception Members,,122.29,,,,,,,87.35,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,outpatient,1,EA,158.82000,150.88000,The Alliance,Exception Members,,122.29,,,,,,,1.44,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,inpatient,1,EA,124.79000,118.55000,The Alliance,Exception Members,,96.09,,,,,,,68.63,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,outpatient,1,EA,124.79000,118.55000,The Alliance,Exception Members,,96.09,,,,,,,1.44,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,inpatient,1,EA,80.71000,76.67000,The Alliance,Exception Members,,62.15,,,,,,,44.39,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,outpatient,1,EA,80.71000,76.67000,The Alliance,Exception Members,,62.15,,,,,,,1.44,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,inpatient,1,EA,104.91000,99.67000,The Alliance,Exception Members,,80.78,,,,,,,57.70,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,outpatient,1,EA,104.91000,99.67000,The Alliance,Exception Members,,80.78,,,,,,,1.44,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,1.44,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,inpatient,1,EA,111.99000,106.39000,The Alliance,Exception Members,,86.23,,,,,,,61.59,108.63,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,outpatient,1,EA,111.99000,106.39000,The Alliance,Exception Members,,86.23,,,,,,,1.44,108.63,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,inpatient,1,EA,6.36000,6.04000,The Alliance,Exception Members,,4.90,,,,,,,3.50,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,outpatient,1,EA,6.36000,6.04000,The Alliance,Exception Members,,4.90,,,,,,,3.18,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,The Alliance,Exception Members,,4.50,,,,,,,3.22,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Exception Members,,4.50,,,,,,,2.92,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,inpatient,1,EA,7.81000,7.42000,The Alliance,Exception Members,,6.01,,,,,,,4.30,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,outpatient,1,EA,7.81000,7.42000,The Alliance,Exception Members,,6.01,,,,,,,3.90,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,inpatient,1,mL,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.77,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,0.13795,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,0.13795,2.91,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,inpatient,1,EA,7.11000,6.76000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,outpatient,1,EA,7.11000,6.76000,The Alliance,Exception Members,,5.47,,,,,,,3.56,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,inpatient,1,EA,7.60000,7.22000,The Alliance,Exception Members,,5.85,,,,,,,4.18,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,outpatient,1,EA,7.60000,7.22000,The Alliance,Exception Members,,5.85,,,,,,,3.80,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,inpatient,1,EA,6.75000,6.41000,The Alliance,Exception Members,,5.20,,,,,,,3.71,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,outpatient,1,EA,6.75000,6.41000,The Alliance,Exception Members,,5.20,,,,,,,3.38,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,The Alliance,Exception Members,,4.70,,,,,,,3.35,5.92,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Exception Members,,4.70,,,,,,,3.05,5.92,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,inpatient,1,EA,20.67000,19.64000,The Alliance,Exception Members,,15.92,,,,,,,11.37,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,outpatient,1,EA,20.67000,19.64000,The Alliance,Exception Members,,15.92,,,,,,,10.34,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,inpatient,1,EA,13.02000,12.37000,The Alliance,Exception Members,,10.03,,,,,,,7.16,12.63,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,outpatient,1,EA,13.02000,12.37000,The Alliance,Exception Members,,10.03,,,,,,,6.51,12.63,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,inpatient,1,EA,6.07000,5.77000,The Alliance,Exception Members,,4.67,,,,,,,3.34,5.89,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,outpatient,1,EA,6.07000,5.77000,The Alliance,Exception Members,,4.67,,,,,,,3.04,5.89,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,inpatient,1,EA,8.07000,7.67000,The Alliance,Exception Members,,6.21,,,,,,,4.44,7.83,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,outpatient,1,EA,8.07000,7.67000,The Alliance,Exception Members,,6.21,,,,,,,4.04,7.83,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,inpatient,1,mL,46.48000,44.15000,The Alliance,Exception Members,,35.79,,,,,,,25.56,45.09,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,outpatient,1,mL,46.48000,44.15000,The Alliance,Exception Members,,35.79,,,,,,,23.24,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,inpatient,1,mL,51.07000,48.51000,The Alliance,Exception Members,,39.32,,,,,,,28.09,49.54,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,outpatient,1,mL,51.07000,48.51000,The Alliance,Exception Members,,39.32,,,,,,,25.54,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,inpatient,1,mL,41.78000,39.69000,The Alliance,Exception Members,,32.17,,,,,,,22.98,40.53,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,outpatient,1,mL,41.78000,39.69000,The Alliance,Exception Members,,32.17,,,,,,,20.89,123.35,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,inpatient,1,EA,10.68000,10.15000,The Alliance,Exception Members,,8.22,,,,,,,5.87,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Exception Members,,8.22,,,,,,,5.34,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,5.29,9.32,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Exception Members,,7.40,,,,,,,4.80,9.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,inpatient,1,mL,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,83.42,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Exception Members,,116.79,,,,,,,0.91450,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,inpatient,1,mL,121.98000,115.88000,The Alliance,Exception Members,,93.92,,,,,,,67.09,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,outpatient,1,mL,121.98000,115.88000,The Alliance,Exception Members,,93.92,,,,,,,0.91450,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,inpatient,1,mL,314.03000,298.33000,The Alliance,Exception Members,,241.80,,,,,,,172.72,304.61,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,outpatient,1,mL,314.03000,298.33000,The Alliance,Exception Members,,241.80,,,,,,,0.91450,304.61,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,inpatient,1,EA,279.66000,265.68000,The Alliance,Exception Members,,215.34,,,,,,,153.81,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,outpatient,1,EA,279.66000,265.68000,The Alliance,Exception Members,,215.34,,,,,,,0.47275,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,inpatient,1,EA,233.84000,222.15000,The Alliance,Exception Members,,180.06,,,,,,,128.61,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,outpatient,1,EA,233.84000,222.15000,The Alliance,Exception Members,,180.06,,,,,,,0.47275,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,inpatient,1,EA,229.10000,217.64000,The Alliance,Exception Members,,176.41,,,,,,,126.00,222.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,outpatient,1,EA,229.10000,217.64000,The Alliance,Exception Members,,176.41,,,,,,,0.47275,222.23,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,The Alliance,Exception Members,,6.99,,,,,,,4.99,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Exception Members,,6.99,,,,,,,4.54,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.57,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Exception Members,,6.39,,,,,,,4.15,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,inpatient,1,EA,287.00000,272.65000,The Alliance,Exception Members,,220.99,,,,,,,157.85,278.39,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,outpatient,1,EA,287.00000,272.65000,The Alliance,Exception Members,,220.99,,,,,,,143.50,278.39,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,inpatient,1,EA,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,outpatient,1,EA,4.63000,4.40000,The Alliance,Exception Members,,3.57,,,,,,,2.31,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,inpatient,1,EA,9.26000,8.80000,The Alliance,Exception Members,,7.13,,,,,,,5.09,8.98,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,outpatient,1,EA,9.26000,8.80000,The Alliance,Exception Members,,7.13,,,,,,,4.63,8.98,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,inpatient,1,EA,41.11000,39.06000,The Alliance,Exception Members,,31.65,,,,,,,22.61,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,outpatient,1,EA,41.11000,39.06000,The Alliance,Exception Members,,31.65,,,,,,,20.55,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,inpatient,1,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.58,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Exception Members,,3.61,,,,,,,2.35,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.78,3.13,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Exception Members,,2.49,,,,,,,1.61,3.13,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,inpatient,1,mL,13.34000,12.67000,The Alliance,Exception Members,,10.27,,,,,,,7.34,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,outpatient,1,mL,13.34000,12.67000,The Alliance,Exception Members,,10.27,,,,,,,0.91450,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,inpatient,1,mL,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,4.10,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Exception Members,,5.74,,,,,,,0.91450,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,inpatient,1,mL,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,17.26,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,outpatient,1,mL,31.38000,29.81000,The Alliance,Exception Members,,24.16,,,,,,,0.91450,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,inpatient,1,mL,12.34000,11.73000,The Alliance,Exception Members,,9.50,,,,,,,6.79,11.97,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,outpatient,1,mL,12.34000,11.73000,The Alliance,Exception Members,,9.50,,,,,,,0.91450,11.97,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,inpatient,1,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,4.06,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,outpatient,1,EA,7.38000,7.01000,The Alliance,Exception Members,,5.68,,,,,,,3.69,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,inpatient,1,EA,8.84000,8.40000,The Alliance,Exception Members,,6.81,,,,,,,4.86,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,outpatient,1,EA,8.84000,8.40000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,The Alliance,Exception Members,,5.57,,,,,,,3.98,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Exception Members,,5.57,,,,,,,3.62,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.81950,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Exception Members,,1.15,,,,,,,0.74500,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,The Alliance,Exception Members,,7.05,,,,,,,5.04,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Exception Members,,7.05,,,,,,,4.58,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,inpatient,1,EA,8.12000,7.72000,The Alliance,Exception Members,,6.25,,,,,,,4.47,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,outpatient,1,EA,8.12000,7.72000,The Alliance,Exception Members,,6.25,,,,,,,4.06,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.21,2.13,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.10,2.13,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.78,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Exception Members,,6.69,,,,,,,4.34,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,inpatient,1,EA,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,140.80,248.32,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,outpatient,1,EA,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,128.00,248.32,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,The Alliance,Exception Members,,137.67,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Exception Members,,137.67,,,,,,,89.39,173.43,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,inpatient,1,mL,19.62000,18.64000,The Alliance,Exception Members,,15.11,,,,,,,10.79,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,outpatient,1,mL,19.62000,18.64000,The Alliance,Exception Members,,15.11,,,,,,,9.81,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,inpatient,1,mL,8.01000,7.61000,The Alliance,Exception Members,,6.17,,,,,,,4.41,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,outpatient,1,mL,8.01000,7.61000,The Alliance,Exception Members,,6.17,,,,,,,4.00,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,inpatient,1,mL,6.69000,6.36000,The Alliance,Exception Members,,5.15,,,,,,,3.68,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,outpatient,1,mL,6.69000,6.36000,The Alliance,Exception Members,,5.15,,,,,,,3.35,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,inpatient,1,mL,31.50000,29.92000,The Alliance,Exception Members,,24.25,,,,,,,17.32,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,outpatient,1,mL,31.50000,29.92000,The Alliance,Exception Members,,24.25,,,,,,,15.75,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,inpatient,1,mL,19.63000,18.65000,The Alliance,Exception Members,,15.12,,,,,,,10.80,19.04,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,outpatient,1,mL,19.63000,18.65000,The Alliance,Exception Members,,15.12,,,,,,,9.81,19.04,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,The Alliance,Exception Members,,137.67,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Exception Members,,137.67,,,,,,,89.39,173.43,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,inpatient,1,EA,4.90000,4.66000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.75,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,outpatient,1,EA,4.90000,4.66000,The Alliance,Exception Members,,3.77,,,,,,,2.45,4.75,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,inpatient,1,mL,5.08000,4.83000,The Alliance,Exception Members,,3.91,,,,,,,2.79,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,outpatient,1,mL,5.08000,4.83000,The Alliance,Exception Members,,3.91,,,,,,,2.54,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,inpatient,1,mL,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,outpatient,1,mL,2.09000,1.99000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,inpatient,1,mL,10.62000,10.09000,The Alliance,Exception Members,,8.18,,,,,,,5.84,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,outpatient,1,mL,10.62000,10.09000,The Alliance,Exception Members,,8.18,,,,,,,0.17611,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,inpatient,1,mL,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,outpatient,1,mL,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,0.17611,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,inpatient,1,mL,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,0.17611,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,0.17611,4.91,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,The Alliance,Exception Members,,259.44,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Exception Members,,259.44,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,The Alliance,Exception Members,,259.44,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Exception Members,,259.44,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,inpatient,1,EA,348.70000,331.27000,The Alliance,Exception Members,,268.50,,,,,,,191.78,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,outpatient,1,EA,348.70000,331.27000,The Alliance,Exception Members,,268.50,,,,,,,174.35,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,inpatient,1,EA,316.63000,300.80000,The Alliance,Exception Members,,243.81,,,,,,,174.15,307.13,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,outpatient,1,EA,316.63000,300.80000,The Alliance,Exception Members,,243.81,,,,,,,158.31,307.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,inpatient,1,EA,5.91000,5.61000,The Alliance,Exception Members,,4.55,,,,,,,3.25,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,outpatient,1,EA,5.91000,5.61000,The Alliance,Exception Members,,4.55,,,,,,,2.96,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,inpatient,1,EA,3.52000,3.35000,The Alliance,Exception Members,,2.71,,,,,,,1.94,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,outpatient,1,EA,3.52000,3.35000,The Alliance,Exception Members,,2.71,,,,,,,1.76,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,inpatient,1,mL,7116.49000,6760.67000,The Alliance,Exception Members,,5479.70,,,,,,,3914.07,6903.00,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,outpatient,1,mL,7116.49000,6760.67000,The Alliance,Exception Members,,5479.70,,,,,,,719.87,6903.00,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,inpatient,1,mL,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,2.05,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,outpatient,1,mL,3.73000,3.54000,The Alliance,Exception Members,,2.87,,,,,,,1.86,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,inpatient,1,mL,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,4.23,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,inpatient,1,EA,9.67000,9.18000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Exception Members,,7.45,,,,,,,4.83,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,inpatient,1,EA,8.54000,8.12000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,outpatient,1,EA,8.54000,8.12000,The Alliance,Exception Members,,6.58,,,,,,,4.27,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Exception Members,,0.98560,,,,,,,0.13795,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,inpatient,1,mL,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.13795,1.56,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,inpatient,1,mL,8.73000,8.29000,The Alliance,Exception Members,,6.72,,,,,,,4.80,8.47,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,outpatient,1,mL,8.73000,8.29000,The Alliance,Exception Members,,6.72,,,,,,,4.37,8.47,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,inpatient,1,mL,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,13.56,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,12.32,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,inpatient,1,mL,25.06000,23.81000,The Alliance,Exception Members,,19.30,,,,,,,13.78,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,outpatient,1,mL,25.06000,23.81000,The Alliance,Exception Members,,19.30,,,,,,,12.53,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,20.47,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,inpatient,1,mL,25.91000,24.62000,The Alliance,Exception Members,,19.95,,,,,,,14.25,25.13,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,outpatient,1,mL,25.91000,24.62000,The Alliance,Exception Members,,19.95,,,,,,,12.96,25.13,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,inpatient,1,EA,374.26000,355.54000,The Alliance,Exception Members,,288.18,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Exception Members,,288.18,,,,,,,187.13,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,inpatient,1,EA,308.73000,293.30000,The Alliance,Exception Members,,237.72,,,,,,,169.80,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,outpatient,1,EA,308.73000,293.30000,The Alliance,Exception Members,,237.72,,,,,,,154.37,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,inpatient,1,EA,432.25000,410.63000,The Alliance,Exception Members,,332.83,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Exception Members,,332.83,,,,,,,216.12,419.28,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,inpatient,1,EA,20.64000,19.61000,The Alliance,Exception Members,,15.89,,,,,,,11.35,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,outpatient,1,EA,20.64000,19.61000,The Alliance,Exception Members,,15.89,,,,,,,10.32,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,inpatient,1,EA,20.17000,19.16000,The Alliance,Exception Members,,15.53,,,,,,,11.09,19.56,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,outpatient,1,EA,20.17000,19.16000,The Alliance,Exception Members,,15.53,,,,,,,10.09,19.56,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,inpatient,1,EA,45.34000,43.07000,The Alliance,Exception Members,,34.91,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Exception Members,,34.91,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,inpatient,1,EA,0.41000,0.38000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,outpatient,1,EA,0.41000,0.38000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,inpatient,1,EA,20.77000,19.73000,The Alliance,Exception Members,,15.99,,,,,,,11.42,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,outpatient,1,EA,20.77000,19.73000,The Alliance,Exception Members,,15.99,,,,,,,10.38,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,inpatient,1,EA,13.45000,12.78000,The Alliance,Exception Members,,10.36,,,,,,,7.40,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,outpatient,1,EA,13.45000,12.78000,The Alliance,Exception Members,,10.36,,,,,,,6.72,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,inpatient,1,EA,25.32000,24.06000,The Alliance,Exception Members,,19.50,,,,,,,13.93,24.56,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,outpatient,1,EA,25.32000,24.06000,The Alliance,Exception Members,,19.50,,,,,,,12.66,24.56,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,inpatient,1,GM,67.76000,64.37000,The Alliance,Exception Members,,52.18,,,,,,,37.27,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,outpatient,1,GM,67.76000,64.37000,The Alliance,Exception Members,,52.18,,,,,,,33.88,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,inpatient,1,GM,51.80000,49.21000,The Alliance,Exception Members,,39.89,,,,,,,28.49,50.25,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,outpatient,1,GM,51.80000,49.21000,The Alliance,Exception Members,,39.89,,,,,,,25.90,50.25,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,36.93,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Exception Members,,51.71,,,,,,,33.58,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,inpatient,1,EA,5.06000,4.81000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,outpatient,1,EA,5.06000,4.81000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,inpatient,1,EA,22.94000,21.79000,The Alliance,Exception Members,,17.66,,,,,,,12.62,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,outpatient,1,EA,22.94000,21.79000,The Alliance,Exception Members,,17.66,,,,,,,11.47,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,inpatient,1,mL,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.96,3.46,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,outpatient,1,mL,3.57000,3.39000,The Alliance,Exception Members,,2.75,,,,,,,1.78,3.46,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,inpatient,1,GM,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,outpatient,1,GM,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,inpatient,1,EA,279.39000,265.42000,The Alliance,Exception Members,,215.13,,,,,,,153.66,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,outpatient,1,EA,279.39000,265.42000,The Alliance,Exception Members,,215.13,,,,,,,139.69,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,inpatient,1,EA,621.55000,590.47000,The Alliance,Exception Members,,478.59,,,,,,,341.85,602.90,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,outpatient,1,EA,621.55000,590.47000,The Alliance,Exception Members,,478.59,,,,,,,310.77,602.90,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,inpatient,1,mL,107.32000,101.96000,The Alliance,Exception Members,,82.64,,,,,,,59.03,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,outpatient,1,mL,107.32000,101.96000,The Alliance,Exception Members,,82.64,,,,,,,37.52,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,37.52,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,inpatient,1,EA,7.64000,7.26000,The Alliance,Exception Members,,5.88,,,,,,,4.20,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,outpatient,1,EA,7.64000,7.26000,The Alliance,Exception Members,,5.88,,,,,,,3.82,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,inpatient,1,mL,4.64000,4.41000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.50,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Exception Members,,3.57,,,,,,,2.32,4.50,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,inpatient,1,EA,14.24000,13.53000,The Alliance,Exception Members,,10.96,,,,,,,7.83,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,outpatient,1,EA,14.24000,13.53000,The Alliance,Exception Members,,10.96,,,,,,,7.12,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,inpatient,1,EA,4.58000,4.36000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,outpatient,1,EA,4.58000,4.36000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.59,4.57,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Exception Members,,3.63,,,,,,,2.35,4.57,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,inpatient,1,mL,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.46,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,outpatient,1,mL,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,0.01601,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,inpatient,1,mL,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,outpatient,1,mL,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.01601,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,inpatient,1,mL,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.01601,1.44,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,inpatient,1,mL,4.83000,4.58000,The Alliance,Exception Members,,3.72,,,,,,,2.66,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,outpatient,1,mL,4.83000,4.58000,The Alliance,Exception Members,,3.72,,,,,,,0.17611,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,inpatient,1,mL,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Exception Members,,6.29,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,inpatient,1,mL,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,4.11,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,0.17611,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,inpatient,1,mL,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,1.77,3.11,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Exception Members,,2.47,,,,,,,0.17611,3.11,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,inpatient,,,482.51000,458.38000,The Alliance,Exception Members,,371.53,,,,,,,265.38,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,outpatient,,,482.51000,458.38000,The Alliance,Exception Members,,371.53,,,,,,,51.13,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,inpatient,1,mL,965.01000,916.76000,The Alliance,Exception Members,,743.06,,,,,,,530.76,936.06,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,outpatient,1,mL,965.01000,916.76000,The Alliance,Exception Members,,743.06,,,,,,,51.13,936.06,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.78650,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Exception Members,,1.10,,,,,,,0.53900,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Exception Members,,3.40,,,,,,,0.53900,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,0.53900,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,inpatient,1,EA,21.70000,20.61000,The Alliance,Exception Members,,16.71,,,,,,,11.94,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,outpatient,1,EA,21.70000,20.61000,The Alliance,Exception Members,,16.71,,,,,,,1.73,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,inpatient,1,EA,21.71000,20.62000,The Alliance,Exception Members,,16.72,,,,,,,11.94,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,outpatient,1,EA,21.71000,20.62000,The Alliance,Exception Members,,16.72,,,,,,,1.73,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,inpatient,1,EA,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,12.81,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,outpatient,1,EA,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,1.73,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,inpatient,1,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,16.08,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,outpatient,1,EA,29.23000,27.77000,The Alliance,Exception Members,,22.51,,,,,,,1.73,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,1.73,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,inpatient,1,EA,29.22000,27.76000,The Alliance,Exception Members,,22.50,,,,,,,16.07,28.34,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,outpatient,1,EA,29.22000,27.76000,The Alliance,Exception Members,,22.50,,,,,,,1.73,28.34,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,inpatient,1,mL,50.03000,47.53000,The Alliance,Exception Members,,38.52,,,,,,,27.52,48.53,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,outpatient,1,mL,50.03000,47.53000,The Alliance,Exception Members,,38.52,,,,,,,1.68,48.53,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,The Alliance,Exception Members,,5.02,,,,,,,3.59,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Exception Members,,5.02,,,,,,,3.26,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,inpatient,1,mL,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,inpatient,1,GM,31.50000,29.92000,The Alliance,Exception Members,,24.25,,,,,,,17.32,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,outpatient,1,GM,31.50000,29.92000,The Alliance,Exception Members,,24.25,,,,,,,15.75,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,inpatient,1,GM,25.68000,24.39000,The Alliance,Exception Members,,19.77,,,,,,,14.12,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,outpatient,1,GM,25.68000,24.39000,The Alliance,Exception Members,,19.77,,,,,,,12.84,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,inpatient,1,GM,26.72000,25.38000,The Alliance,Exception Members,,20.57,,,,,,,14.70,25.92,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,outpatient,1,GM,26.72000,25.38000,The Alliance,Exception Members,,20.57,,,,,,,13.36,25.92,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,inpatient,1,mL,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,0.27217,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.27217,1.77,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.34860,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,inpatient,1,mL,14.25000,13.53000,The Alliance,Exception Members,,10.97,,,,,,,7.84,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,outpatient,1,mL,14.25000,13.53000,The Alliance,Exception Members,,10.97,,,,,,,7.12,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,inpatient,1,mL,17.81000,16.92000,The Alliance,Exception Members,,13.71,,,,,,,9.80,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,outpatient,1,mL,17.81000,16.92000,The Alliance,Exception Members,,13.71,,,,,,,8.90,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,inpatient,1,mL,16.76000,15.92000,The Alliance,Exception Members,,12.91,,,,,,,9.22,16.26,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,outpatient,1,mL,16.76000,15.92000,The Alliance,Exception Members,,12.91,,,,,,,8.38,16.26,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,inpatient,1,EA,678.29000,644.37000,The Alliance,Exception Members,,522.28,,,,,,,373.06,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,outpatient,1,EA,678.29000,644.37000,The Alliance,Exception Members,,522.28,,,,,,,339.14,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,inpatient,1,EA,34.13000,32.42000,The Alliance,Exception Members,,26.28,,,,,,,18.77,33.11,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,outpatient,1,EA,34.13000,32.42000,The Alliance,Exception Members,,26.28,,,,,,,17.07,33.11,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,inpatient,1,mL,972.04000,923.43000,The Alliance,Exception Members,,748.47,,,,,,,534.62,942.88,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,outpatient,1,mL,972.04000,923.43000,The Alliance,Exception Members,,748.47,,,,,,,486.02,942.88,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,inpatient,1,EA,4.82000,4.58000,The Alliance,Exception Members,,3.71,,,,,,,2.65,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,outpatient,1,EA,4.82000,4.58000,The Alliance,Exception Members,,3.71,,,,,,,2.41,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.75,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.59,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,inpatient,1,EA,30.51000,28.98000,The Alliance,Exception Members,,23.49,,,,,,,16.78,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,outpatient,1,EA,30.51000,28.98000,The Alliance,Exception Members,,23.49,,,,,,,0.27217,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,inpatient,1,EA,22.79000,21.65000,The Alliance,Exception Members,,17.55,,,,,,,12.53,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,outpatient,1,EA,22.79000,21.65000,The Alliance,Exception Members,,17.55,,,,,,,0.27217,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,inpatient,1,EA,8.94000,8.50000,The Alliance,Exception Members,,6.88,,,,,,,4.92,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,outpatient,1,EA,8.94000,8.50000,The Alliance,Exception Members,,6.88,,,,,,,0.27217,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,inpatient,1,EA,23.98000,22.79000,The Alliance,Exception Members,,18.46,,,,,,,13.19,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,outpatient,1,EA,23.98000,22.79000,The Alliance,Exception Members,,18.46,,,,,,,0.27217,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,9.56,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Exception Members,,13.38,,,,,,,0.27217,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,5.53,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,0.27217,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,inpatient,1,EA,17.06000,16.21000,The Alliance,Exception Members,,13.14,,,,,,,9.38,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,outpatient,1,EA,17.06000,16.21000,The Alliance,Exception Members,,13.14,,,,,,,0.27217,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,inpatient,1,EA,8.88000,8.44000,The Alliance,Exception Members,,6.84,,,,,,,4.88,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,outpatient,1,EA,8.88000,8.44000,The Alliance,Exception Members,,6.84,,,,,,,0.27217,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,inpatient,1,EA,10.33000,9.82000,The Alliance,Exception Members,,7.95,,,,,,,5.68,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Exception Members,,7.95,,,,,,,0.27217,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,inpatient,1,EA,7.14000,6.78000,The Alliance,Exception Members,,5.50,,,,,,,3.93,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Exception Members,,5.50,,,,,,,0.27217,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,inpatient,1,EA,4.78000,4.54000,The Alliance,Exception Members,,3.68,,,,,,,2.63,4.64,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Exception Members,,3.68,,,,,,,0.27217,4.64,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,inpatient,1,EA,5.71000,5.42000,The Alliance,Exception Members,,4.40,,,,,,,3.14,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Exception Members,,4.40,,,,,,,2.85,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,The Alliance,Exception Members,,5.71,,,,,,,4.08,7.20,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Exception Members,,5.71,,,,,,,3.71,7.20,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,inpatient,1,EA,36.01000,34.21000,The Alliance,Exception Members,,27.73,,,,,,,19.81,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,outpatient,1,EA,36.01000,34.21000,The Alliance,Exception Members,,27.73,,,,,,,18.00,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,inpatient,1,mL,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,outpatient,1,mL,1.24000,1.17000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,inpatient,1,mL,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,28.68,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,outpatient,1,mL,52.14000,49.53000,The Alliance,Exception Members,,40.15,,,,,,,26.07,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,inpatient,1,mL,35.71000,33.92000,The Alliance,Exception Members,,27.50,,,,,,,19.64,34.64,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,outpatient,1,mL,35.71000,33.92000,The Alliance,Exception Members,,27.50,,,,,,,17.86,34.64,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,inpatient,1,mL,43.32000,41.16000,The Alliance,Exception Members,,33.36,,,,,,,23.83,42.02,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,outpatient,1,mL,43.32000,41.16000,The Alliance,Exception Members,,33.36,,,,,,,21.66,42.02,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Exception Members,,2.03,,,,,,,1.32,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,inpatient,1,mL,114.96000,109.22000,The Alliance,Exception Members,,88.52,,,,,,,63.23,111.51,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,outpatient,1,mL,114.96000,109.22000,The Alliance,Exception Members,,88.52,,,,,,,57.48,472.00,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,inpatient,1,mL,777.00000,738.15000,The Alliance,Exception Members,,598.29,,,,,,,427.35,753.69,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,outpatient,1,mL,777.00000,738.15000,The Alliance,Exception Members,,598.29,,,,,,,194.32,753.69,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,inpatient,1,EA,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,outpatient,1,EA,5.32000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.66,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.33,4.10,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Exception Members,,3.26,,,,,,,2.12,4.10,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,The Alliance,Exception Members,,27.49,,,,,,,19.64,34.63,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Exception Members,,27.49,,,,,,,17.85,34.63,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,inpatient,1,EA,22.83000,21.69000,The Alliance,Exception Members,,17.58,,,,,,,12.56,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,outpatient,1,EA,22.83000,21.69000,The Alliance,Exception Members,,17.58,,,,,,,0.43227,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,inpatient,1,EA,48.81000,46.37000,The Alliance,Exception Members,,37.58,,,,,,,26.85,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,outpatient,1,EA,48.81000,46.37000,The Alliance,Exception Members,,37.58,,,,,,,0.43227,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,inpatient,1,EA,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,outpatient,1,EA,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,0.43227,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,inpatient,1,EA,44.24000,42.03000,The Alliance,Exception Members,,34.06,,,,,,,24.33,42.91,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,outpatient,1,EA,44.24000,42.03000,The Alliance,Exception Members,,34.06,,,,,,,0.43227,42.91,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,inpatient,1,mL,7537.53000,7160.66000,The Alliance,Exception Members,,5803.90,,,,,,,4145.64,7311.40,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,outpatient,1,mL,7537.53000,7160.66000,The Alliance,Exception Members,,5803.90,,,,,,,719.87,7311.40,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,The Alliance,Exception Members,,5.54,,,,,,,3.95,6.97,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Exception Members,,5.54,,,,,,,3.60,6.97,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.46,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Exception Members,,3.44,,,,,,,2.23,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.44,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Exception Members,,3.42,,,,,,,2.22,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,inpatient,1,EA,7.62000,7.23000,The Alliance,Exception Members,,5.87,,,,,,,4.19,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,outpatient,1,EA,7.62000,7.23000,The Alliance,Exception Members,,5.87,,,,,,,3.81,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.54,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Exception Members,,7.76,,,,,,,5.04,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,inpatient,1,mL,7.82000,7.43000,The Alliance,Exception Members,,6.02,,,,,,,4.30,7.59,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,outpatient,1,mL,7.82000,7.43000,The Alliance,Exception Members,,6.02,,,,,,,3.91,7.59,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,inpatient,1,EA,6.65000,6.31000,The Alliance,Exception Members,,5.12,,,,,,,3.66,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,outpatient,1,EA,6.65000,6.31000,The Alliance,Exception Members,,5.12,,,,,,,3.33,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.77550,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Exception Members,,1.09,,,,,,,0.70500,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.33550,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Exception Members,,0.46970,,,,,,,0.30500,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,inpatient,1,mL,12088.99000,11484.54000,The Alliance,Exception Members,,9308.52,,,,,,,6648.94,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,outpatient,1,mL,12088.99000,11484.54000,The Alliance,Exception Members,,9308.52,,,,,,,38.71,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,inpatient,1,mL,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1518.00,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,outpatient,1,mL,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,38.71,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,inpatient,1,mL,1079.15000,1025.19000,The Alliance,Exception Members,,830.95,,,,,,,593.53,1046.78,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,outpatient,1,mL,1079.15000,1025.19000,The Alliance,Exception Members,,830.95,,,,,,,38.71,1046.78,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,inpatient,1,mL,15.36000,14.59000,The Alliance,Exception Members,,11.83,,,,,,,8.45,14.90,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,outpatient,1,mL,15.36000,14.59000,The Alliance,Exception Members,,11.83,,,,,,,7.68,14.90,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,inpatient,1,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.00620,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.00620,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.00620,0.37830,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.32,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,inpatient,1,mL,14.54000,13.81000,The Alliance,Exception Members,,11.20,,,,,,,8.00,14.10,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,outpatient,1,mL,14.54000,13.81000,The Alliance,Exception Members,,11.20,,,,,,,7.27,14.10,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.16,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.84,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Exception Members,,2.57,,,,,,,1.67,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.39,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,inpatient,1,mL,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,3.12,5.51,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,outpatient,1,mL,5.68000,5.39000,The Alliance,Exception Members,,4.37,,,,,,,2.84,5.51,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,inpatient,1,EA,216.55000,205.73000,The Alliance,Exception Members,,166.74,,,,,,,119.10,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,outpatient,1,EA,216.55000,205.73000,The Alliance,Exception Members,,166.74,,,,,,,108.28,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,inpatient,1,EA,95.56000,90.78000,The Alliance,Exception Members,,73.58,,,,,,,52.56,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,outpatient,1,EA,95.56000,90.78000,The Alliance,Exception Members,,73.58,,,,,,,47.78,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,inpatient,1,EA,149.05000,141.59000,The Alliance,Exception Members,,114.77,,,,,,,81.98,144.58,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,outpatient,1,EA,149.05000,141.59000,The Alliance,Exception Members,,114.77,,,,,,,74.53,144.58,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,inpatient,1,EA,309.43000,293.96000,The Alliance,Exception Members,,238.26,,,,,,,170.19,300.15,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,outpatient,1,EA,309.43000,293.96000,The Alliance,Exception Members,,238.26,,,,,,,154.72,300.15,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,inpatient,1,EA,3.50000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,1.93,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Exception Members,,2.69,,,,,,,0.73040,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.73040,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,inpatient,1,EA,86.34000,82.02000,The Alliance,Exception Members,,66.48,,,,,,,47.49,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,outpatient,1,EA,86.34000,82.02000,The Alliance,Exception Members,,66.48,,,,,,,43.17,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,inpatient,1,EA,50.96000,48.41000,The Alliance,Exception Members,,39.24,,,,,,,28.03,49.43,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,outpatient,1,EA,50.96000,48.41000,The Alliance,Exception Members,,39.24,,,,,,,25.48,49.43,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,inpatient,1,EA,10.61000,10.08000,The Alliance,Exception Members,,8.17,,,,,,,5.84,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,outpatient,1,EA,10.61000,10.08000,The Alliance,Exception Members,,8.17,,,,,,,5.30,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,inpatient,1,EA,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,outpatient,1,EA,3.45000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,The Alliance,Exception Members,,20.88,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Exception Members,,20.88,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,inpatient,1,GM,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,outpatient,1,GM,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,inpatient,1,EA,23.14000,21.98000,The Alliance,Exception Members,,17.82,,,,,,,12.73,22.45,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,outpatient,1,EA,23.14000,21.98000,The Alliance,Exception Members,,17.82,,,,,,,11.57,22.45,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.79200,1.40,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Exception Members,,1.11,,,,,,,0.72000,1.40,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,inpatient,1,EA,20.66000,19.63000,The Alliance,Exception Members,,15.91,,,,,,,11.36,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,outpatient,1,EA,20.66000,19.63000,The Alliance,Exception Members,,15.91,,,,,,,10.33,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,inpatient,1,EA,14.28000,13.57000,The Alliance,Exception Members,,11.00,,,,,,,7.85,13.85,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,outpatient,1,EA,14.28000,13.57000,The Alliance,Exception Members,,11.00,,,,,,,7.14,13.85,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,inpatient,1,EA,27.09000,25.73000,The Alliance,Exception Members,,20.86,,,,,,,14.90,26.28,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,outpatient,1,EA,27.09000,25.73000,The Alliance,Exception Members,,20.86,,,,,,,13.54,26.28,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Exception Members,,1.72,,,,,,,1.11,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.22,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Exception Members,,1.71,,,,,,,1.11,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,4.26,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Exception Members,,5.96,,,,,,,3.87,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,inpatient,1,EA,10.76000,10.23000,The Alliance,Exception Members,,8.29,,,,,,,5.92,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,outpatient,1,EA,10.76000,10.23000,The Alliance,Exception Members,,8.29,,,,,,,5.38,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,inpatient,1,EA,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,3.21,5.66,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Exception Members,,4.50,,,,,,,2.92,5.66,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,inpatient,1,EA,47426.37000,45055.05000,The Alliance,Exception Members,,36518.30,,,,,,,26084.50,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,outpatient,1,EA,47426.37000,45055.05000,The Alliance,Exception Members,,36518.30,,,,,,,23713.19,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,inpatient,1,EA,38000.00000,36100.00000,The Alliance,Exception Members,,29260.00,,,,,,,20900.00,36860.00,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,outpatient,1,EA,38000.00000,36100.00000,The Alliance,Exception Members,,29260.00,,,,,,,19000.00,36860.00,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.10,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.76,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Exception Members,,3.87,,,,,,,2.51,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.77,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Exception Members,,3.87,,,,,,,2.52,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Exception Members,,6.31,,,,,,,4.10,7.95,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,inpatient,1,EA,18.52000,17.59000,The Alliance,Exception Members,,14.26,,,,,,,10.19,17.96,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,outpatient,1,EA,18.52000,17.59000,The Alliance,Exception Members,,14.26,,,,,,,9.26,17.96,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,inpatient,1,EA,9.35000,8.89000,The Alliance,Exception Members,,7.20,,,,,,,5.14,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,outpatient,1,EA,9.35000,8.89000,The Alliance,Exception Members,,7.20,,,,,,,4.67,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,inpatient,1,EA,18.11000,17.21000,The Alliance,Exception Members,,13.94,,,,,,,9.96,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,outpatient,1,EA,18.11000,17.21000,The Alliance,Exception Members,,13.94,,,,,,,9.05,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,inpatient,1,EA,2062.94000,1959.79000,The Alliance,Exception Members,,1588.46,,,,,,,1134.62,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,outpatient,1,EA,2062.94000,1959.79000,The Alliance,Exception Members,,1588.46,,,,,,,10.94,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,inpatient,1,EA,2387.67000,2268.29000,The Alliance,Exception Members,,1838.51,,,,,,,1313.22,2316.04,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,outpatient,1,EA,2387.67000,2268.29000,The Alliance,Exception Members,,1838.51,,,,,,,10.94,2316.04,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,inpatient,1,EA,43.45000,41.27000,The Alliance,Exception Members,,33.46,,,,,,,23.90,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,outpatient,1,EA,43.45000,41.27000,The Alliance,Exception Members,,33.46,,,,,,,21.73,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,inpatient,1,EA,75.34000,71.58000,The Alliance,Exception Members,,58.01,,,,,,,41.44,73.08,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,outpatient,1,EA,75.34000,71.58000,The Alliance,Exception Members,,58.01,,,,,,,37.67,73.08,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,inpatient,1,EA,256.79000,243.95000,The Alliance,Exception Members,,197.73,,,,,,,141.23,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,outpatient,1,EA,256.79000,243.95000,The Alliance,Exception Members,,197.73,,,,,,,128.40,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,inpatient,1,EA,35.71000,33.92000,The Alliance,Exception Members,,27.50,,,,,,,19.64,34.64,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,outpatient,1,EA,35.71000,33.92000,The Alliance,Exception Members,,27.50,,,,,,,17.86,34.64,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,inpatient,1,EA,10.73000,10.19000,The Alliance,Exception Members,,8.26,,,,,,,5.90,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,outpatient,1,EA,10.73000,10.19000,The Alliance,Exception Members,,8.26,,,,,,,5.37,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,18.12,35.15,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.90,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.18,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,inpatient,1,EA,4.22000,4.00000,The Alliance,Exception Members,,3.25,,,,,,,2.32,4.09,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,outpatient,1,EA,4.22000,4.00000,The Alliance,Exception Members,,3.25,,,,,,,2.11,4.09,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,inpatient,1,EA,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,outpatient,1,EA,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,inpatient,1,EA,12.91000,12.26000,The Alliance,Exception Members,,9.94,,,,,,,7.10,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,outpatient,1,EA,12.91000,12.26000,The Alliance,Exception Members,,9.94,,,,,,,6.46,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,inpatient,1,EA,6.89000,6.54000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.68,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,outpatient,1,EA,6.89000,6.54000,The Alliance,Exception Members,,5.31,,,,,,,3.44,6.68,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,inpatient,1,mL,789.60000,750.12000,The Alliance,Exception Members,,607.99,,,,,,,434.28,765.91,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,outpatient,1,mL,789.60000,750.12000,The Alliance,Exception Members,,607.99,,,,,,,394.80,765.91,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,inpatient,1,EA,63.19000,60.03000,The Alliance,Exception Members,,48.66,,,,,,,34.75,61.29,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,outpatient,1,EA,63.19000,60.03000,The Alliance,Exception Members,,48.66,,,,,,,31.59,61.29,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,inpatient,1,EA,46.75000,44.41000,The Alliance,Exception Members,,36.00,,,,,,,25.71,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,outpatient,1,EA,46.75000,44.41000,The Alliance,Exception Members,,36.00,,,,,,,23.38,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,inpatient,1,EA,1375.24000,1306.48000,The Alliance,Exception Members,,1058.93,,,,,,,756.38,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,outpatient,1,EA,1375.24000,1306.48000,The Alliance,Exception Members,,1058.93,,,,,,,10.94,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,inpatient,1,EA,1591.71000,1512.12000,The Alliance,Exception Members,,1225.62,,,,,,,875.44,1543.96,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,outpatient,1,EA,1591.71000,1512.12000,The Alliance,Exception Members,,1225.62,,,,,,,10.94,1543.96,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,inpatient,1,EA,2471.39000,2347.82000,The Alliance,Exception Members,,1902.97,,,,,,,1359.26,2397.25,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,outpatient,1,EA,2471.39000,2347.82000,The Alliance,Exception Members,,1902.97,,,,,,,376.48,2397.25,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,inpatient,1,EA,1664.33000,1581.12000,The Alliance,Exception Members,,1281.53,,,,,,,915.38,1614.40,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,outpatient,1,EA,1664.33000,1581.12000,The Alliance,Exception Members,,1281.53,,,,,,,43.79,1614.40,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,inpatient,1,EA,100.29000,95.28000,The Alliance,Exception Members,,77.22,,,,,,,55.16,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,outpatient,1,EA,100.29000,95.28000,The Alliance,Exception Members,,77.22,,,,,,,50.15,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,inpatient,1,EA,44.23000,42.01000,The Alliance,Exception Members,,34.06,,,,,,,24.33,42.90,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,outpatient,1,EA,44.23000,42.01000,The Alliance,Exception Members,,34.06,,,,,,,22.11,42.90,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,inpatient,1,mL,10.78000,10.24000,The Alliance,Exception Members,,8.30,,,,,,,5.93,10.46,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,outpatient,1,mL,10.78000,10.24000,The Alliance,Exception Members,,8.30,,,,,,,5.39,10.46,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,inpatient,1,EA,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,outpatient,1,EA,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,1.54,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,21.73,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Exception Members,,30.41,,,,,,,1.54,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,inpatient,1,EA,42.55000,40.42000,The Alliance,Exception Members,,32.76,,,,,,,23.40,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,outpatient,1,EA,42.55000,40.42000,The Alliance,Exception Members,,32.76,,,,,,,1.54,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,inpatient,1,EA,43.10000,40.94000,The Alliance,Exception Members,,33.19,,,,,,,23.70,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,outpatient,1,EA,43.10000,40.94000,The Alliance,Exception Members,,33.19,,,,,,,1.54,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,inpatient,1,EA,43.87000,41.67000,The Alliance,Exception Members,,33.78,,,,,,,24.13,42.55,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,outpatient,1,EA,43.87000,41.67000,The Alliance,Exception Members,,33.78,,,,,,,1.54,42.55,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,inpatient,1,EA,33.47000,31.79000,The Alliance,Exception Members,,25.77,,,,,,,18.41,32.47,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,outpatient,1,EA,33.47000,31.79000,The Alliance,Exception Members,,25.77,,,,,,,16.73,32.47,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,inpatient,1,EA,223.47000,212.29000,The Alliance,Exception Members,,172.07,,,,,,,122.91,216.77,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,outpatient,1,EA,223.47000,212.29000,The Alliance,Exception Members,,172.07,,,,,,,111.73,216.77,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,inpatient,1,EA,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.66,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.51,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,4.70,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Exception Members,,6.58,,,,,,,4.27,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,inpatient,1,EA,10.51000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.78,10.19,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,outpatient,1,EA,10.51000,9.98000,The Alliance,Exception Members,,8.09,,,,,,,5.25,10.19,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Exception Members,,27.90,,,,,,,18.12,35.15,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,3.28,5.79,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Exception Members,,4.60,,,,,,,2.98,5.79,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,inpatient,1,mL,37.82000,35.92000,The Alliance,Exception Members,,29.12,,,,,,,20.80,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,outpatient,1,mL,37.82000,35.92000,The Alliance,Exception Members,,29.12,,,,,,,18.91,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,inpatient,1,mL,3.18000,3.02000,The Alliance,Exception Members,,2.45,,,,,,,1.75,3.08,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,outpatient,1,mL,3.18000,3.02000,The Alliance,Exception Members,,2.45,,,,,,,1.59,3.08,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,inpatient,1,EA,12.36000,11.74000,The Alliance,Exception Members,,9.52,,,,,,,6.80,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,outpatient,1,EA,12.36000,11.74000,The Alliance,Exception Members,,9.52,,,,,,,6.18,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Exception Members,,2.76,,,,,,,1.79,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,inpatient,1,EA,40.98000,38.93000,The Alliance,Exception Members,,31.55,,,,,,,22.54,39.75,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,outpatient,1,EA,40.98000,38.93000,The Alliance,Exception Members,,31.55,,,,,,,20.49,39.75,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,inpatient,1,EA,641.04000,608.99000,The Alliance,Exception Members,,493.60,,,,,,,352.57,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,outpatient,1,EA,641.04000,608.99000,The Alliance,Exception Members,,493.60,,,,,,,56.09,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,inpatient,1,EA,565.96000,537.66000,The Alliance,Exception Members,,435.79,,,,,,,311.28,548.98,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,outpatient,1,EA,565.96000,537.66000,The Alliance,Exception Members,,435.79,,,,,,,56.09,548.98,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.89100,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Exception Members,,1.25,,,,,,,0.81000,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,inpatient,1,EA,53.51000,50.83000,The Alliance,Exception Members,,41.20,,,,,,,29.43,51.90,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,outpatient,1,EA,53.51000,50.83000,The Alliance,Exception Members,,41.20,,,,,,,26.75,51.90,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,The Alliance,Exception Members,,5.54,,,,,,,3.95,6.97,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Exception Members,,5.54,,,,,,,3.60,6.97,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,inpatient,1,EA,5.29000,5.03000,The Alliance,Exception Members,,4.07,,,,,,,2.91,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,outpatient,1,EA,5.29000,5.03000,The Alliance,Exception Members,,4.07,,,,,,,2.65,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,inpatient,1,EA,7.70000,7.32000,The Alliance,Exception Members,,5.93,,,,,,,4.24,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,outpatient,1,EA,7.70000,7.32000,The Alliance,Exception Members,,5.93,,,,,,,3.85,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,inpatient,1,EA,5.01000,4.75000,The Alliance,Exception Members,,3.86,,,,,,,2.76,4.86,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,outpatient,1,EA,5.01000,4.75000,The Alliance,Exception Members,,3.86,,,,,,,2.50,4.86,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,inpatient,1,mL,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,outpatient,1,mL,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,inpatient,1,EA,11.15000,10.59000,The Alliance,Exception Members,,8.59,,,,,,,6.13,10.82,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,outpatient,1,EA,11.15000,10.59000,The Alliance,Exception Members,,8.59,,,,,,,5.58,10.82,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,inpatient,1,mL,839.47000,797.49000,The Alliance,Exception Members,,646.39,,,,,,,461.71,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,outpatient,1,mL,839.47000,797.49000,The Alliance,Exception Members,,646.39,,,,,,,266.44,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,inpatient,1,mL,881.44000,837.37000,The Alliance,Exception Members,,678.71,,,,,,,484.79,855.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,outpatient,1,mL,881.44000,837.37000,The Alliance,Exception Members,,678.71,,,,,,,266.44,855.00,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,inpatient,1,EA,40.61000,38.58000,The Alliance,Exception Members,,31.27,,,,,,,22.34,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,outpatient,1,EA,40.61000,38.58000,The Alliance,Exception Members,,31.27,,,,,,,20.30,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,inpatient,1,mL,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,outpatient,1,mL,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,1.54,89.63,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,inpatient,1,mL,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,outpatient,1,mL,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,3.10,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Exception Members,,4.34,,,,,,,2.82,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,inpatient,1,mL,101.37000,96.30000,The Alliance,Exception Members,,78.05,,,,,,,55.75,98.33,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,outpatient,1,mL,101.37000,96.30000,The Alliance,Exception Members,,78.05,,,,,,,50.69,98.33,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,inpatient,1,GM,24.73000,23.49000,The Alliance,Exception Members,,19.04,,,,,,,13.60,23.99,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,outpatient,1,GM,24.73000,23.49000,The Alliance,Exception Members,,19.04,,,,,,,12.37,23.99,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,inpatient,1,mL,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,5.25,9.25,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,outpatient,1,mL,9.54000,9.06000,The Alliance,Exception Members,,7.35,,,,,,,4.77,9.25,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,inpatient,1,EA,57.87000,54.97000,The Alliance,Exception Members,,44.56,,,,,,,31.83,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,outpatient,1,EA,57.87000,54.97000,The Alliance,Exception Members,,44.56,,,,,,,28.93,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,inpatient,1,EA,46.74000,44.40000,The Alliance,Exception Members,,35.99,,,,,,,25.71,45.34,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,outpatient,1,EA,46.74000,44.40000,The Alliance,Exception Members,,35.99,,,,,,,23.37,45.34,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,inpatient,1,EA,402.97000,382.82000,The Alliance,Exception Members,,310.29,,,,,,,221.63,390.88,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,outpatient,1,EA,402.97000,382.82000,The Alliance,Exception Members,,310.29,,,,,,,201.49,390.88,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.49500,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Exception Members,,0.69300,,,,,,,0.45000,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,inpatient,1,EA,89.24000,84.77000,The Alliance,Exception Members,,68.71,,,,,,,49.08,86.56,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,outpatient,1,EA,89.24000,84.77000,The Alliance,Exception Members,,68.71,,,,,,,44.62,86.56,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,inpatient,1,mL,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,outpatient,1,mL,1.32000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,inpatient,1,mL,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.11,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,outpatient,1,mL,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.00,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,inpatient,1,mL,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,outpatient,1,mL,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,inpatient,1,mL,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,outpatient,1,mL,1.07000,1.01000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,inpatient,1,EA,250.10000,237.60000,The Alliance,Exception Members,,192.58,,,,,,,137.56,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,outpatient,1,EA,250.10000,237.60000,The Alliance,Exception Members,,192.58,,,,,,,125.05,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,inpatient,1,EA,190.56000,181.03000,The Alliance,Exception Members,,146.73,,,,,,,104.81,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,outpatient,1,EA,190.56000,181.03000,The Alliance,Exception Members,,146.73,,,,,,,95.28,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,The Alliance,Exception Members,,119.72,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Exception Members,,119.72,,,,,,,77.74,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,The Alliance,Exception Members,,119.72,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Exception Members,,119.72,,,,,,,77.74,150.82,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,inpatient,1,GM,9.26000,8.80000,The Alliance,Exception Members,,7.13,,,,,,,5.09,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,outpatient,1,GM,9.26000,8.80000,The Alliance,Exception Members,,7.13,,,,,,,4.63,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.94,14.00,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.21,14.00,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,inpatient,1,mL,1627.34000,1545.97000,The Alliance,Exception Members,,1253.05,,,,,,,895.04,1578.52,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,outpatient,1,mL,1627.34000,1545.97000,The Alliance,Exception Members,,1253.05,,,,,,,813.67,1578.52,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,inpatient,1,mL,121.66000,115.58000,The Alliance,Exception Members,,93.68,,,,,,,66.91,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,outpatient,1,mL,121.66000,115.58000,The Alliance,Exception Members,,93.68,,,,,,,60.83,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,inpatient,1,mL,123.44000,117.27000,The Alliance,Exception Members,,95.05,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Exception Members,,95.05,,,,,,,61.72,119.74,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.79750,1.41,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Exception Members,,1.12,,,,,,,0.72500,1.41,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,inpatient,1,mL,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,outpatient,1,mL,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,inpatient,1,mL,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,outpatient,1,mL,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,inpatient,1,mL,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,inpatient,1,mL,3.85000,3.66000,The Alliance,Exception Members,,2.96,,,,,,,2.12,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,outpatient,1,mL,3.85000,3.66000,The Alliance,Exception Members,,2.96,,,,,,,1.93,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,inpatient,1,mL,0.41000,0.38000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,outpatient,1,mL,0.41000,0.38000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,2.51,4.43,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,2.29,4.43,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,inpatient,1,EA,70.34000,66.82000,The Alliance,Exception Members,,54.16,,,,,,,38.69,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,outpatient,1,EA,70.34000,66.82000,The Alliance,Exception Members,,54.16,,,,,,,35.17,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,inpatient,1,EA,26.05000,24.74000,The Alliance,Exception Members,,20.06,,,,,,,14.33,25.27,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,outpatient,1,EA,26.05000,24.74000,The Alliance,Exception Members,,20.06,,,,,,,13.03,25.27,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,inpatient,1,EA,2.43000,2.30000,The Alliance,Exception Members,,1.87,,,,,,,1.34,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,outpatient,1,EA,2.43000,2.30000,The Alliance,Exception Members,,1.87,,,,,,,1.22,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.27,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Exception Members,,1.78,,,,,,,1.16,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,inpatient,1,mL,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,0.43650,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,inpatient,1,mL,10.20000,9.69000,The Alliance,Exception Members,,7.85,,,,,,,5.61,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,outpatient,1,mL,10.20000,9.69000,The Alliance,Exception Members,,7.85,,,,,,,5.10,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,inpatient,1,mL,10.76000,10.22000,The Alliance,Exception Members,,8.29,,,,,,,5.92,10.44,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,outpatient,1,mL,10.76000,10.22000,The Alliance,Exception Members,,8.29,,,,,,,5.38,10.44,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,inpatient,1,GM,41.98000,39.88000,The Alliance,Exception Members,,32.32,,,,,,,23.09,40.72,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,outpatient,1,GM,41.98000,39.88000,The Alliance,Exception Members,,32.32,,,,,,,20.99,40.72,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,inpatient,1,EA,122.59000,116.46000,The Alliance,Exception Members,,94.39,,,,,,,67.42,118.91,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,outpatient,1,EA,122.59000,116.46000,The Alliance,Exception Members,,94.39,,,,,,,0.57636,118.91,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,inpatient,1,mL,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,inpatient,1,mL,3.53000,3.36000,The Alliance,Exception Members,,2.72,,,,,,,1.94,3.42,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,outpatient,1,mL,3.53000,3.36000,The Alliance,Exception Members,,2.72,,,,,,,1.76,3.42,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,inpatient,1,EA,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.22,3.91,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.02,3.91,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,inpatient,1,EA,177.91000,169.02000,The Alliance,Exception Members,,136.99,,,,,,,97.85,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,outpatient,1,EA,177.91000,169.02000,The Alliance,Exception Members,,136.99,,,,,,,88.95,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,inpatient,1,mL,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.79,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,outpatient,1,mL,6.90000,6.55000,The Alliance,Exception Members,,5.31,,,,,,,3.45,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,inpatient,1,mL,13.21000,12.55000,The Alliance,Exception Members,,10.17,,,,,,,7.27,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,outpatient,1,mL,13.21000,12.55000,The Alliance,Exception Members,,10.17,,,,,,,6.61,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,inpatient,1,mL,6.29000,5.97000,The Alliance,Exception Members,,4.84,,,,,,,3.46,6.10,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,outpatient,1,mL,6.29000,5.97000,The Alliance,Exception Members,,4.84,,,,,,,3.15,6.10,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,inpatient,1,GM,21.95000,20.85000,The Alliance,Exception Members,,16.90,,,,,,,12.07,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,outpatient,1,GM,21.95000,20.85000,The Alliance,Exception Members,,16.90,,,,,,,10.97,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,The Alliance,Exception Members,,20.71,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Exception Members,,20.71,,,,,,,13.45,26.08,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,inpatient,1,EA,24.28000,23.06000,The Alliance,Exception Members,,18.70,,,,,,,13.35,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,outpatient,1,EA,24.28000,23.06000,The Alliance,Exception Members,,18.70,,,,,,,12.14,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,inpatient,1,EA,5.66000,5.38000,The Alliance,Exception Members,,4.36,,,,,,,3.11,5.49,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,outpatient,1,EA,5.66000,5.38000,The Alliance,Exception Members,,4.36,,,,,,,2.83,5.49,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Exception Members,,4.31,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.77000,1.36,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Exception Members,,1.08,,,,,,,0.70000,1.36,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,inpatient,1,EA,716.81000,680.97000,The Alliance,Exception Members,,551.94,,,,,,,394.25,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,outpatient,1,EA,716.81000,680.97000,The Alliance,Exception Members,,551.94,,,,,,,1.91,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,inpatient,1,EA,828.93000,787.48000,The Alliance,Exception Members,,638.28,,,,,,,455.91,804.06,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,outpatient,1,EA,828.93000,787.48000,The Alliance,Exception Members,,638.28,,,,,,,1.91,804.06,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,3.16,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,2.88,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,inpatient,1,mL,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,outpatient,1,mL,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.92,3.72,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,inpatient,1,EA,19.45000,18.47000,The Alliance,Exception Members,,14.98,,,,,,,10.70,18.87,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,outpatient,1,EA,19.45000,18.47000,The Alliance,Exception Members,,14.98,,,,,,,9.72,18.87,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,The Alliance,Exception Members,,6.68,,,,,,,4.77,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Exception Members,,6.68,,,,,,,4.34,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,inpatient,1,EA,18.49000,17.57000,The Alliance,Exception Members,,14.24,,,,,,,10.17,17.94,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,outpatient,1,EA,18.49000,17.57000,The Alliance,Exception Members,,14.24,,,,,,,9.24,17.94,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,The Alliance,Exception Members,,20.71,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Exception Members,,20.71,,,,,,,13.45,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,inpatient,1,GM,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.79,10.21,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,outpatient,1,GM,10.53000,10.01000,The Alliance,Exception Members,,8.11,,,,,,,5.26,10.21,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,inpatient,1,EA,30.81000,29.27000,The Alliance,Exception Members,,23.72,,,,,,,16.95,29.89,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,outpatient,1,EA,30.81000,29.27000,The Alliance,Exception Members,,23.72,,,,,,,0.57636,29.89,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,inpatient,1,mL,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,36.50,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,0.04650,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,0.04650,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,31.28,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Exception Members,,43.80,,,,,,,0.04650,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,inpatient,1,mL,58.43000,55.51000,The Alliance,Exception Members,,44.99,,,,,,,32.14,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,outpatient,1,mL,58.43000,55.51000,The Alliance,Exception Members,,44.99,,,,,,,0.04650,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,inpatient,1,mL,58.59000,55.66000,The Alliance,Exception Members,,45.11,,,,,,,32.22,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,outpatient,1,mL,58.59000,55.66000,The Alliance,Exception Members,,45.11,,,,,,,0.04650,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,inpatient,1,mL,51.29000,48.72000,The Alliance,Exception Members,,39.49,,,,,,,28.21,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,outpatient,1,mL,51.29000,48.72000,The Alliance,Exception Members,,39.49,,,,,,,0.04650,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,inpatient,1,mL,57.67000,54.79000,The Alliance,Exception Members,,44.41,,,,,,,31.72,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,outpatient,1,mL,57.67000,54.79000,The Alliance,Exception Members,,44.41,,,,,,,0.04650,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,inpatient,1,mL,60.83000,57.79000,The Alliance,Exception Members,,46.84,,,,,,,33.46,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,outpatient,1,mL,60.83000,57.79000,The Alliance,Exception Members,,46.84,,,,,,,0.04650,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,inpatient,1,mL,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,23.46,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,outpatient,1,mL,42.66000,40.53000,The Alliance,Exception Members,,32.85,,,,,,,0.04650,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,0.04650,39.85,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,inpatient,1,mL,1493.82000,1419.13000,The Alliance,Exception Members,,1150.24,,,,,,,821.60,1449.01,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,outpatient,1,mL,1493.82000,1419.13000,The Alliance,Exception Members,,1150.24,,,,,,,48.92,1449.01,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,inpatient,1,EA,20.76000,19.72000,The Alliance,Exception Members,,15.99,,,,,,,11.42,20.14,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,outpatient,1,EA,20.76000,19.72000,The Alliance,Exception Members,,15.99,,,,,,,10.38,20.14,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,inpatient,1,GM,183.72000,174.54000,The Alliance,Exception Members,,141.46,,,,,,,101.05,178.21,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,outpatient,1,GM,183.72000,174.54000,The Alliance,Exception Members,,141.46,,,,,,,91.86,178.21,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,inpatient,1,mL,533.15000,506.50000,The Alliance,Exception Members,,410.53,,,,,,,293.23,517.16,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,outpatient,1,mL,533.15000,506.50000,The Alliance,Exception Members,,410.53,,,,,,,262.23,517.16,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,8.20,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Exception Members,,11.47,,,,,,,7.45,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,inpatient,1,EA,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.92,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,outpatient,1,EA,7.12000,6.76000,The Alliance,Exception Members,,5.48,,,,,,,3.56,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,inpatient,1,EA,132.04000,125.43000,The Alliance,Exception Members,,101.67,,,,,,,72.62,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,outpatient,1,EA,132.04000,125.43000,The Alliance,Exception Members,,101.67,,,,,,,66.02,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,8.07,14.24,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,7.34,14.24,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,7.57,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,6.88,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,inpatient,1,EA,307.01000,291.66000,The Alliance,Exception Members,,236.40,,,,,,,168.86,297.80,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,outpatient,1,EA,307.01000,291.66000,The Alliance,Exception Members,,236.40,,,,,,,153.50,297.80,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,inpatient,1,EA,904.51000,859.28000,The Alliance,Exception Members,,696.47,,,,,,,497.48,877.37,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,outpatient,1,EA,904.51000,859.28000,The Alliance,Exception Members,,696.47,,,,,,,452.25,877.37,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,inpatient,1,mL,47.20000,44.84000,The Alliance,Exception Members,,36.34,,,,,,,25.96,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,outpatient,1,mL,47.20000,44.84000,The Alliance,Exception Members,,36.34,,,,,,,0.08060,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,inpatient,1,mL,42.95000,40.80000,The Alliance,Exception Members,,33.07,,,,,,,23.62,41.66,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,outpatient,1,mL,42.95000,40.80000,The Alliance,Exception Members,,33.07,,,,,,,0.08060,41.66,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,inpatient,1,EA,21.04000,19.99000,The Alliance,Exception Members,,16.20,,,,,,,11.57,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,outpatient,1,EA,21.04000,19.99000,The Alliance,Exception Members,,16.20,,,,,,,10.52,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Exception Members,,18.30,,,,,,,11.88,23.05,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,inpatient,1,mL,26.54000,25.22000,The Alliance,Exception Members,,20.44,,,,,,,14.60,25.74,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,outpatient,1,mL,26.54000,25.22000,The Alliance,Exception Members,,20.44,,,,,,,13.27,25.74,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,39.66,229.89,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,inpatient,1,EA,904.31000,859.09000,The Alliance,Exception Members,,696.32,,,,,,,497.37,877.18,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,outpatient,1,EA,904.31000,859.09000,The Alliance,Exception Members,,696.32,,,,,,,452.15,877.18,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,The Alliance,Exception Members,,43.67,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Exception Members,,43.67,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,inpatient,1,mL,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,52.64,110.03,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,inpatient,1,mL,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.13,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,inpatient,1,mL,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,outpatient,1,mL,2.32000,2.20000,The Alliance,Exception Members,,1.79,,,,,,,1.16,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.15,4.06,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Exception Members,,2.12,,,,,,,1.38,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,inpatient,1,EA,61.04000,57.99000,The Alliance,Exception Members,,47.00,,,,,,,33.57,59.21,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,outpatient,1,EA,61.04000,57.99000,The Alliance,Exception Members,,47.00,,,,,,,30.52,59.21,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,The Alliance,Exception Members,,4.04,,,,,,,2.89,5.09,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Exception Members,,4.04,,,,,,,2.62,5.09,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,inpatient,1,GM,26.25000,24.94000,The Alliance,Exception Members,,20.21,,,,,,,14.44,25.46,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,outpatient,1,GM,26.25000,24.94000,The Alliance,Exception Members,,20.21,,,,,,,13.12,25.46,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,inpatient,1,mL,100.25000,95.24000,The Alliance,Exception Members,,77.19,,,,,,,55.14,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,outpatient,1,mL,100.25000,95.24000,The Alliance,Exception Members,,77.19,,,,,,,50.12,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,inpatient,1,mL,64.08000,60.88000,The Alliance,Exception Members,,49.34,,,,,,,35.24,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,outpatient,1,mL,64.08000,60.88000,The Alliance,Exception Members,,49.34,,,,,,,32.04,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,inpatient,1,mL,73.53000,69.86000,The Alliance,Exception Members,,56.62,,,,,,,40.44,71.32,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,outpatient,1,mL,73.53000,69.86000,The Alliance,Exception Members,,56.62,,,,,,,36.77,71.32,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,inpatient,1,EA,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,2.37,4.18,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,outpatient,1,EA,4.31000,4.09000,The Alliance,Exception Members,,3.32,,,,,,,2.15,4.18,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,inpatient,1,EA,20.06000,19.06000,The Alliance,Exception Members,,15.45,,,,,,,11.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,outpatient,1,EA,20.06000,19.06000,The Alliance,Exception Members,,15.45,,,,,,,10.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,inpatient,1,EA,27.01000,25.66000,The Alliance,Exception Members,,20.80,,,,,,,14.86,26.20,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,outpatient,1,EA,27.01000,25.66000,The Alliance,Exception Members,,20.80,,,,,,,13.51,26.20,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,inpatient,1,mL,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,outpatient,1,mL,12.11000,11.51000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,inpatient,1,mL,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.47,2.85,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.86,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Exception Members,,2.60,,,,,,,1.69,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,inpatient,1,EA,23.22000,22.06000,The Alliance,Exception Members,,17.88,,,,,,,12.77,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,outpatient,1,EA,23.22000,22.06000,The Alliance,Exception Members,,17.88,,,,,,,11.61,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,inpatient,1,EA,8.59000,8.16000,The Alliance,Exception Members,,6.61,,,,,,,4.72,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,outpatient,1,EA,8.59000,8.16000,The Alliance,Exception Members,,6.61,,,,,,,4.29,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.72600,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Exception Members,,1.02,,,,,,,0.66000,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,inpatient,1,EA,4.83000,4.59000,The Alliance,Exception Members,,3.72,,,,,,,2.66,4.69,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Exception Members,,3.72,,,,,,,2.42,4.69,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.30,4.06,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.06,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,inpatient,1,mL,3283.73000,3119.54000,The Alliance,Exception Members,,2528.47,,,,,,,1806.05,3185.22,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,outpatient,1,mL,3283.73000,3119.54000,The Alliance,Exception Members,,2528.47,,,,,,,1641.87,3185.22,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,inpatient,1,EA,950.25000,902.73000,The Alliance,Exception Members,,731.69,,,,,,,522.64,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,outpatient,1,EA,950.25000,902.73000,The Alliance,Exception Members,,731.69,,,,,,,365.89,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,inpatient,1,EA,1541.05000,1464.00000,The Alliance,Exception Members,,1186.61,,,,,,,847.58,1494.82,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,outpatient,1,EA,1541.05000,1464.00000,The Alliance,Exception Members,,1186.61,,,,,,,365.89,1494.82,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,inpatient,1,EA,112.97000,107.32000,The Alliance,Exception Members,,86.99,,,,,,,62.13,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,outpatient,1,EA,112.97000,107.32000,The Alliance,Exception Members,,86.99,,,,,,,56.48,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,inpatient,1,EA,122.45000,116.33000,The Alliance,Exception Members,,94.29,,,,,,,67.35,118.78,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,outpatient,1,EA,122.45000,116.33000,The Alliance,Exception Members,,94.29,,,,,,,61.23,118.78,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.73,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Exception Members,,5.22,,,,,,,3.39,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,inpatient,1,EA,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,60.83,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,55.30,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,inpatient,1,mL,30.03000,28.53000,The Alliance,Exception Members,,23.12,,,,,,,16.52,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,outpatient,1,mL,30.03000,28.53000,The Alliance,Exception Members,,23.12,,,,,,,1.35,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,inpatient,1,mL,27.40000,26.03000,The Alliance,Exception Members,,21.10,,,,,,,15.07,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,outpatient,1,mL,27.40000,26.03000,The Alliance,Exception Members,,21.10,,,,,,,1.35,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,inpatient,1,mL,22.16000,21.06000,The Alliance,Exception Members,,17.06,,,,,,,12.19,21.50,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,outpatient,1,mL,22.16000,21.06000,The Alliance,Exception Members,,17.06,,,,,,,1.35,21.50,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,inpatient,1,EA,72.11000,68.51000,The Alliance,Exception Members,,55.52,,,,,,,39.66,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,outpatient,1,EA,72.11000,68.51000,The Alliance,Exception Members,,55.52,,,,,,,36.05,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,inpatient,1,EA,101.10000,96.04000,The Alliance,Exception Members,,77.85,,,,,,,55.60,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,outpatient,1,EA,101.10000,96.04000,The Alliance,Exception Members,,77.85,,,,,,,50.55,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,inpatient,1,EA,84.98000,80.73000,The Alliance,Exception Members,,65.43,,,,,,,46.74,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,outpatient,1,EA,84.98000,80.73000,The Alliance,Exception Members,,65.43,,,,,,,42.49,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,inpatient,1,EA,86.99000,82.64000,The Alliance,Exception Members,,66.98,,,,,,,47.84,84.38,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,outpatient,1,EA,86.99000,82.64000,The Alliance,Exception Members,,66.98,,,,,,,43.49,84.38,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,inpatient,1,GM,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.39,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,outpatient,1,GM,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.26,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,inpatient,1,GM,2.30000,2.18000,The Alliance,Exception Members,,1.77,,,,,,,1.26,2.23,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,outpatient,1,GM,2.30000,2.18000,The Alliance,Exception Members,,1.77,,,,,,,1.15,2.23,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.57,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Exception Members,,2.19,,,,,,,1.43,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,inpatient,1,EA,690.86000,656.31000,The Alliance,Exception Members,,531.96,,,,,,,379.97,670.13,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,outpatient,1,EA,690.86000,656.31000,The Alliance,Exception Members,,531.96,,,,,,,0.57636,670.13,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,inpatient,1,EA,12.76000,12.12000,The Alliance,Exception Members,,9.83,,,,,,,7.02,12.38,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,outpatient,1,EA,12.76000,12.12000,The Alliance,Exception Members,,9.83,,,,,,,6.38,12.38,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,The Alliance,Exception Members,,5.44,,,,,,,3.88,6.85,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Exception Members,,5.44,,,,,,,3.53,6.85,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,inpatient,1,EA,486.88000,462.54000,The Alliance,Exception Members,,374.90,,,,,,,267.78,472.27,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,outpatient,1,EA,486.88000,462.54000,The Alliance,Exception Members,,374.90,,,,,,,243.44,472.27,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,inpatient,1,GM,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,outpatient,1,GM,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,inpatient,1,GM,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.89,5.10,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,outpatient,1,GM,5.26000,5.00000,The Alliance,Exception Members,,4.05,,,,,,,2.63,5.10,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,inpatient,1,mL,11.32000,10.76000,The Alliance,Exception Members,,8.72,,,,,,,6.23,10.98,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,outpatient,1,mL,11.32000,10.76000,The Alliance,Exception Members,,8.72,,,,,,,5.66,10.98,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,inpatient,1,EA,5.89000,5.59000,The Alliance,Exception Members,,4.54,,,,,,,3.24,5.71,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,outpatient,1,EA,5.89000,5.59000,The Alliance,Exception Members,,4.54,,,,,,,2.94,5.71,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,1.07,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Exception Members,,1.49,,,,,,,0.97000,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.59400,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Exception Members,,0.83160,,,,,,,0.54000,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,inpatient,1,GM,26.57000,25.24000,The Alliance,Exception Members,,20.46,,,,,,,14.61,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,outpatient,1,GM,26.57000,25.24000,The Alliance,Exception Members,,20.46,,,,,,,13.29,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,inpatient,1,GM,10.25000,9.74000,The Alliance,Exception Members,,7.89,,,,,,,5.64,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,outpatient,1,GM,10.25000,9.74000,The Alliance,Exception Members,,7.89,,,,,,,5.12,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,inpatient,1,GM,9.74000,9.25000,The Alliance,Exception Members,,7.50,,,,,,,5.36,9.45,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,outpatient,1,GM,9.74000,9.25000,The Alliance,Exception Members,,7.50,,,,,,,4.87,9.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,inpatient,1,mL,82.81000,78.67000,The Alliance,Exception Members,,63.76,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Exception Members,,63.76,,,,,,,22.94,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,inpatient,1,mL,82.81000,78.67000,The Alliance,Exception Members,,63.76,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Exception Members,,63.76,,,,,,,22.94,80.33,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,inpatient,1,EA,3.53000,3.36000,The Alliance,Exception Members,,2.72,,,,,,,1.94,3.42,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,outpatient,1,EA,3.53000,3.36000,The Alliance,Exception Members,,2.72,,,,,,,1.76,3.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Exception Members,,12.53,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,inpatient,1,EA,12.80000,12.16000,The Alliance,Exception Members,,9.86,,,,,,,7.04,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,outpatient,1,EA,12.80000,12.16000,The Alliance,Exception Members,,9.86,,,,,,,6.40,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,inpatient,1,EA,23.45000,22.27000,The Alliance,Exception Members,,18.06,,,,,,,12.90,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,outpatient,1,EA,23.45000,22.27000,The Alliance,Exception Members,,18.06,,,,,,,11.72,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,inpatient,1,mL,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.66,2.93,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,outpatient,1,mL,3.02000,2.87000,The Alliance,Exception Members,,2.33,,,,,,,1.51,5.89,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,inpatient,1,EA,1283.15000,1219.00000,The Alliance,Exception Members,,988.03,,,,,,,705.73,1244.66,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,outpatient,1,EA,1283.15000,1219.00000,The Alliance,Exception Members,,988.03,,,,,,,641.58,1244.66,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,inpatient,1,GM,3.99000,3.79000,The Alliance,Exception Members,,3.07,,,,,,,2.19,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,outpatient,1,GM,3.99000,3.79000,The Alliance,Exception Members,,3.07,,,,,,,2.00,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,inpatient,1,GM,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,outpatient,1,GM,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,inpatient,1,EA,405.34000,385.07000,The Alliance,Exception Members,,312.11,,,,,,,222.94,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,outpatient,1,EA,405.34000,385.07000,The Alliance,Exception Members,,312.11,,,,,,,0.46810,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,inpatient,1,EA,404.04000,383.84000,The Alliance,Exception Members,,311.11,,,,,,,222.22,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,outpatient,1,EA,404.04000,383.84000,The Alliance,Exception Members,,311.11,,,,,,,0.46810,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,inpatient,1,EA,271.95000,258.35000,The Alliance,Exception Members,,209.40,,,,,,,149.57,263.79,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Exception Members,,209.40,,,,,,,0.46810,263.79,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,inpatient,1,mL,75.14000,71.39000,The Alliance,Exception Members,,57.86,,,,,,,41.33,72.89,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,outpatient,1,mL,75.14000,71.39000,The Alliance,Exception Members,,57.86,,,,,,,37.57,72.89,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,inpatient,1,mL,38.43000,36.51000,The Alliance,Exception Members,,29.59,,,,,,,21.14,37.28,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,outpatient,1,mL,38.43000,36.51000,The Alliance,Exception Members,,29.59,,,,,,,19.21,37.28,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,inpatient,1,EA,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,outpatient,1,EA,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.79,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,inpatient,1,EA,4.22000,4.01000,The Alliance,Exception Members,,3.25,,,,,,,2.32,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,outpatient,1,EA,4.22000,4.01000,The Alliance,Exception Members,,3.25,,,,,,,2.11,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,inpatient,1,EA,6.71000,6.37000,The Alliance,Exception Members,,5.17,,,,,,,3.69,6.51,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,outpatient,1,EA,6.71000,6.37000,The Alliance,Exception Members,,5.17,,,,,,,3.35,6.51,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,inpatient,1,EA,89.14000,84.68000,The Alliance,Exception Members,,68.64,,,,,,,49.03,86.47,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,outpatient,1,EA,89.14000,84.68000,The Alliance,Exception Members,,68.64,,,,,,,44.57,86.47,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,inpatient,1,GM,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,outpatient,1,GM,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,inpatient,1,mL,40.04000,38.04000,The Alliance,Exception Members,,30.83,,,,,,,22.02,38.84,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,outpatient,1,mL,40.04000,38.04000,The Alliance,Exception Members,,30.83,,,,,,,20.02,38.84,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,The Alliance,Exception Members,,20.39,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Exception Members,,20.39,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,The Alliance,Exception Members,,15.84,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Exception Members,,15.84,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,inpatient,1,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.20,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.68,5.20,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,inpatient,1,mL,16.20000,15.39000,The Alliance,Exception Members,,12.47,,,,,,,8.91,15.71,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,outpatient,1,mL,16.20000,15.39000,The Alliance,Exception Members,,12.47,,,,,,,8.10,15.71,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,inpatient,1,EA,43.61000,41.43000,The Alliance,Exception Members,,33.58,,,,,,,23.99,42.30,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,outpatient,1,EA,43.61000,41.43000,The Alliance,Exception Members,,33.58,,,,,,,7.96,42.30,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.10,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Exception Members,,1.54,,,,,,,1.00,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.32,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.32,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,inpatient,1,EA,190.55000,181.02000,The Alliance,Exception Members,,146.72,,,,,,,104.80,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,outpatient,1,EA,190.55000,181.02000,The Alliance,Exception Members,,146.72,,,,,,,1.25,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,inpatient,1,EA,388.34000,368.93000,The Alliance,Exception Members,,299.02,,,,,,,213.59,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,outpatient,1,EA,388.34000,368.93000,The Alliance,Exception Members,,299.02,,,,,,,1.25,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,inpatient,1,EA,386.40000,367.08000,The Alliance,Exception Members,,297.53,,,,,,,212.52,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,outpatient,1,EA,386.40000,367.08000,The Alliance,Exception Members,,297.53,,,,,,,1.25,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,1.25,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,1.25,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,inpatient,1,EA,316.16000,300.35000,The Alliance,Exception Members,,243.44,,,,,,,173.89,306.68,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,outpatient,1,EA,316.16000,300.35000,The Alliance,Exception Members,,243.44,,,,,,,1.25,306.68,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,inpatient,1,EA,203.60000,193.42000,The Alliance,Exception Members,,156.77,,,,,,,111.98,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,outpatient,1,EA,203.60000,193.42000,The Alliance,Exception Members,,156.77,,,,,,,5.03,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,inpatient,1,EA,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,81.69,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Exception Members,,114.36,,,,,,,5.03,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,inpatient,1,EA,103.62000,98.44000,The Alliance,Exception Members,,79.79,,,,,,,56.99,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,outpatient,1,EA,103.62000,98.44000,The Alliance,Exception Members,,79.79,,,,,,,5.03,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,inpatient,1,EA,62.92000,59.77000,The Alliance,Exception Members,,48.45,,,,,,,34.61,61.03,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,outpatient,1,EA,62.92000,59.77000,The Alliance,Exception Members,,48.45,,,,,,,5.03,61.03,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,inpatient,1,EA,79.88000,75.88000,The Alliance,Exception Members,,61.51,,,,,,,43.93,77.48,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,outpatient,1,EA,79.88000,75.88000,The Alliance,Exception Members,,61.51,,,,,,,39.94,77.48,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,inpatient,1,EA,279.35000,265.38000,The Alliance,Exception Members,,215.10,,,,,,,153.64,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,outpatient,1,EA,279.35000,265.38000,The Alliance,Exception Members,,215.10,,,,,,,139.68,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,inpatient,1,EA,65.31000,62.04000,The Alliance,Exception Members,,50.29,,,,,,,35.92,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,outpatient,1,EA,65.31000,62.04000,The Alliance,Exception Members,,50.29,,,,,,,32.66,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,6.37,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Exception Members,,8.92,,,,,,,5.79,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,inpatient,1,EA,50.36000,47.85000,The Alliance,Exception Members,,38.78,,,,,,,27.70,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,outpatient,1,EA,50.36000,47.85000,The Alliance,Exception Members,,38.78,,,,,,,25.18,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,inpatient,1,EA,12.54000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.90,12.16,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,outpatient,1,EA,12.54000,11.92000,The Alliance,Exception Members,,9.66,,,,,,,6.27,12.16,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,inpatient,1,EA,2.44000,2.31000,The Alliance,Exception Members,,1.88,,,,,,,1.34,2.37,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,outpatient,1,EA,2.44000,2.31000,The Alliance,Exception Members,,1.88,,,,,,,1.22,2.37,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,inpatient,1,mL,1495.72000,1420.94000,The Alliance,Exception Members,,1151.70,,,,,,,822.65,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,outpatient,1,mL,1495.72000,1420.94000,The Alliance,Exception Members,,1151.70,,,,,,,747.86,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,inpatient,1,mL,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,94.80,183.91,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,inpatient,,,150.51000,142.98000,The Alliance,Exception Members,,115.89,,,,,,,82.78,145.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,outpatient,,,150.51000,142.98000,The Alliance,Exception Members,,115.89,,,,,,,75.25,147.29,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,inpatient,1,EA,301.02000,285.97000,The Alliance,Exception Members,,231.79,,,,,,,165.56,291.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,outpatient,1,EA,301.02000,285.97000,The Alliance,Exception Members,,231.79,,,,,,,147.29,291.99,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,inpatient,1,mL,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,inpatient,1,mL,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.50,7.93,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,outpatient,1,mL,8.18000,7.77000,The Alliance,Exception Members,,6.30,,,,,,,4.09,7.93,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,7.07,13.71,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,inpatient,1,mL,482.37000,458.26000,The Alliance,Exception Members,,371.42,,,,,,,265.30,467.90,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,outpatient,1,mL,482.37000,458.26000,The Alliance,Exception Members,,371.42,,,,,,,10.13,467.90,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,inpatient,1,EA,23.06000,21.91000,The Alliance,Exception Members,,17.76,,,,,,,12.68,22.37,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,outpatient,1,EA,23.06000,21.91000,The Alliance,Exception Members,,17.76,,,,,,,11.53,22.37,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,inpatient,1,GM,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,outpatient,1,GM,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,inpatient,1,GM,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,1.81,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,outpatient,1,GM,3.29000,3.13000,The Alliance,Exception Members,,2.53,,,,,,,1.65,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,inpatient,1,GM,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,outpatient,1,GM,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,inpatient,1,EA,277.41000,263.54000,The Alliance,Exception Members,,213.61,,,,,,,152.58,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,outpatient,1,EA,277.41000,263.54000,The Alliance,Exception Members,,213.61,,,,,,,138.71,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,The Alliance,Exception Members,,13.34,,,,,,,9.53,16.81,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Exception Members,,13.34,,,,,,,8.66,16.81,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,inpatient,1,EA,64.78000,61.54000,The Alliance,Exception Members,,49.88,,,,,,,35.63,62.84,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,outpatient,1,EA,64.78000,61.54000,The Alliance,Exception Members,,49.88,,,,,,,32.39,62.84,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,inpatient,1,GM,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,inpatient,1,EA,11.16000,10.61000,The Alliance,Exception Members,,8.59,,,,,,,6.14,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,outpatient,1,EA,11.16000,10.61000,The Alliance,Exception Members,,8.59,,,,,,,5.58,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,31.60,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,inpatient,1,EA,30.02000,28.52000,The Alliance,Exception Members,,23.12,,,,,,,16.51,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Exception Members,,23.12,,,,,,,15.01,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,5.18,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Exception Members,,7.25,,,,,,,4.71,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,inpatient,1,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.36,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.24,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,inpatient,1,EA,3.72000,3.54000,The Alliance,Exception Members,,2.86,,,,,,,2.05,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,outpatient,1,EA,3.72000,3.54000,The Alliance,Exception Members,,2.86,,,,,,,1.86,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,inpatient,1,EA,140.09000,133.09000,The Alliance,Exception Members,,107.87,,,,,,,77.05,135.89,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,outpatient,1,EA,140.09000,133.09000,The Alliance,Exception Members,,107.87,,,,,,,70.05,135.89,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,inpatient,1,EA,53.19000,50.53000,The Alliance,Exception Members,,40.96,,,,,,,29.25,51.59,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,outpatient,1,EA,53.19000,50.53000,The Alliance,Exception Members,,40.96,,,,,,,26.59,51.59,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,inpatient,1,mL,8.06000,7.66000,The Alliance,Exception Members,,6.21,,,,,,,4.43,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Exception Members,,6.21,,,,,,,4.03,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,4.29,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,inpatient,1,EA,30.27000,28.76000,The Alliance,Exception Members,,23.31,,,,,,,16.65,29.36,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,outpatient,1,EA,30.27000,28.76000,The Alliance,Exception Members,,23.31,,,,,,,15.13,29.36,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,inpatient,1,EA,37.52000,35.65000,The Alliance,Exception Members,,28.89,,,,,,,20.64,36.39,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,outpatient,1,EA,37.52000,35.65000,The Alliance,Exception Members,,28.89,,,,,,,18.76,36.39,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,inpatient,1,EA,126.72000,120.39000,The Alliance,Exception Members,,97.57,,,,,,,69.70,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,outpatient,1,EA,126.72000,120.39000,The Alliance,Exception Members,,97.57,,,,,,,63.36,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,inpatient,1,EA,13.26000,12.60000,The Alliance,Exception Members,,10.21,,,,,,,7.29,12.86,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,outpatient,1,EA,13.26000,12.60000,The Alliance,Exception Members,,10.21,,,,,,,6.63,12.86,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,inpatient,1,EA,4.96000,4.71000,The Alliance,Exception Members,,3.82,,,,,,,2.73,4.81,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,outpatient,1,EA,4.96000,4.71000,The Alliance,Exception Members,,3.82,,,,,,,2.48,4.81,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.82500,1.46,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Exception Members,,1.16,,,,,,,0.75000,1.46,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,inpatient,1,EA,162.76000,154.62000,The Alliance,Exception Members,,125.33,,,,,,,89.52,157.88,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,outpatient,1,EA,162.76000,154.62000,The Alliance,Exception Members,,125.33,,,,,,,81.38,157.88,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,inpatient,1,EA,23.65000,22.47000,The Alliance,Exception Members,,18.21,,,,,,,13.01,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,outpatient,1,EA,23.65000,22.47000,The Alliance,Exception Members,,18.21,,,,,,,11.82,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,inpatient,1,EA,13.88000,13.19000,The Alliance,Exception Members,,10.69,,,,,,,7.63,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,outpatient,1,EA,13.88000,13.19000,The Alliance,Exception Members,,10.69,,,,,,,6.94,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,inpatient,1,EA,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.34,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Exception Members,,1.88,,,,,,,1.22,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,inpatient,1,EA,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,10.35,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,outpatient,1,EA,18.82000,17.88000,The Alliance,Exception Members,,14.49,,,,,,,9.41,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,inpatient,1,mL,44.32000,42.10000,The Alliance,Exception Members,,34.13,,,,,,,24.38,42.99,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,outpatient,1,mL,44.32000,42.10000,The Alliance,Exception Members,,34.13,,,,,,,22.16,42.99,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.63,4.65,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Exception Members,,3.69,,,,,,,2.40,4.65,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,inpatient,1,EA,24.78000,23.54000,The Alliance,Exception Members,,19.08,,,,,,,13.63,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,outpatient,1,EA,24.78000,23.54000,The Alliance,Exception Members,,19.08,,,,,,,12.39,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,inpatient,1,EA,69.38000,65.91000,The Alliance,Exception Members,,53.42,,,,,,,38.16,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,outpatient,1,EA,69.38000,65.91000,The Alliance,Exception Members,,53.42,,,,,,,34.69,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,11.85,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,inpatient,1,EA,18.99000,18.04000,The Alliance,Exception Members,,14.62,,,,,,,10.44,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,outpatient,1,EA,18.99000,18.04000,The Alliance,Exception Members,,14.62,,,,,,,9.49,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,inpatient,1,EA,104.09000,98.88000,The Alliance,Exception Members,,80.15,,,,,,,57.25,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,outpatient,1,EA,104.09000,98.88000,The Alliance,Exception Members,,80.15,,,,,,,52.05,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,inpatient,1,EA,100.16000,95.15000,The Alliance,Exception Members,,77.12,,,,,,,55.09,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,outpatient,1,EA,100.16000,95.15000,The Alliance,Exception Members,,77.12,,,,,,,50.08,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,The Alliance,Exception Members,,5.40,,,,,,,3.86,6.80,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Exception Members,,5.40,,,,,,,3.50,6.80,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,inpatient,1,mL,47.56000,45.18000,The Alliance,Exception Members,,36.62,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Exception Members,,36.62,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,inpatient,1,mL,17.89000,16.99000,The Alliance,Exception Members,,13.78,,,,,,,9.84,17.35,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,outpatient,1,mL,17.89000,16.99000,The Alliance,Exception Members,,13.78,,,,,,,8.95,17.35,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,5.53,9.75,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Exception Members,,7.74,,,,,,,5.03,9.75,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,inpatient,1,EA,18.22000,17.31000,The Alliance,Exception Members,,14.03,,,,,,,10.02,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,outpatient,1,EA,18.22000,17.31000,The Alliance,Exception Members,,14.03,,,,,,,9.11,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,inpatient,1,EA,14.92000,14.17000,The Alliance,Exception Members,,11.49,,,,,,,8.21,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,outpatient,1,EA,14.92000,14.17000,The Alliance,Exception Members,,11.49,,,,,,,7.46,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,inpatient,1,EA,26.25000,24.94000,The Alliance,Exception Members,,20.21,,,,,,,14.44,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,outpatient,1,EA,26.25000,24.94000,The Alliance,Exception Members,,20.21,,,,,,,13.12,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,The Alliance,Exception Members,,3.20,,,,,,,2.28,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Exception Members,,3.20,,,,,,,2.08,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.56,6.29,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Exception Members,,4.99,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,inpatient,1,EA,40.35000,38.34000,The Alliance,Exception Members,,31.07,,,,,,,22.19,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,outpatient,1,EA,40.35000,38.34000,The Alliance,Exception Members,,31.07,,,,,,,20.18,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,inpatient,1,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.48,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Exception Members,,2.07,,,,,,,1.34,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,inpatient,1,EA,8.78000,8.35000,The Alliance,Exception Members,,6.76,,,,,,,4.83,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,outpatient,1,EA,8.78000,8.35000,The Alliance,Exception Members,,6.76,,,,,,,4.39,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,The Alliance,Exception Members,,6.74,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Exception Members,,6.74,,,,,,,4.38,8.49,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,inpatient,1,mL,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,13.00,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Exception Members,,18.20,,,,,,,11.82,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,inpatient,1,mL,35.57000,33.79000,The Alliance,Exception Members,,27.39,,,,,,,19.56,34.50,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,outpatient,1,mL,35.57000,33.79000,The Alliance,Exception Members,,27.39,,,,,,,17.79,34.50,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,inpatient,1,GM,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,25.38,44.76,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,outpatient,1,GM,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,23.07,44.76,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,inpatient,1,EA,15.86000,15.07000,The Alliance,Exception Members,,12.21,,,,,,,8.72,15.38,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,outpatient,1,EA,15.86000,15.07000,The Alliance,Exception Members,,12.21,,,,,,,7.93,15.38,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Exception Members,,1.42,,,,,,,0.92000,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.68,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Exception Members,,2.36,,,,,,,1.53,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,inpatient,1,EA,8.49000,8.06000,The Alliance,Exception Members,,6.54,,,,,,,4.67,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Exception Members,,6.54,,,,,,,4.25,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,50.05,88.27,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,8.08,424.40,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,111.65,196.91,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,11.61,611.15,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,inpatient,,,1089.00000,1034.55000,The Alliance,Exception Members,,838.53,,,,,,,598.95,1056.33,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,outpatient,,,1089.00000,1034.55000,The Alliance,Exception Members,,838.53,,,,,,,544.50,1056.33,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,405.35,714.89,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,368.50,714.89,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.63085,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.63085,1.29,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1825.74,3614.22,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1710.23,3726.00,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1084.39,2362.50,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1420.03,3093.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,43.12,85.36,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,40.39,88.00,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6488.42,14136.00,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1290.94,2812.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1290.94,2812.50,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,105.00,228.75,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,9533.43,20770.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,38.19,83.20,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,9533.43,20770.00,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6488.42,14136.00,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2358.25,4668.37,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2209.05,4812.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,9988.76,21762.00,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,The Alliance,Exception Members,,1007.74,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Exception Members,,1007.74,,,,,,,600.72,1308.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.68000,180.20000,The Alliance,Exception Members,,146.05,,,,,,,92.94,183.99,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.68000,180.20000,The Alliance,Exception Members,,146.05,,,,,,,87.06,189.68,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,The Alliance,Exception Members,,1007.74,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Exception Members,,1007.74,,,,,,,600.72,1308.75,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,387.28,843.75,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,247.50000,235.12000,The Alliance,Exception Members,,190.57,,,,,,,121.28,240.07,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,247.50000,235.12000,The Alliance,Exception Members,,190.57,,,,,,,113.60,247.50,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,122.20,241.90,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,114.47,249.38,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Exception Members,,16756.74,,,,,,,9988.76,21762.00,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,321.56,636.56,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,301.22,656.25,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Exception Members,,10884.72,,,,,,,6488.42,14136.00,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,967.59,2108.03,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,93.10,184.30,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,87.21,190.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,The Alliance,Exception Members,,1362.90,,,,,,,867.30,1716.90,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Exception Members,,1362.90,,,,,,,812.43,1770.00,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13020.00000,12369.00000,The Alliance,Exception Members,,10025.40,,,,,,,6379.80,12629.40,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13020.00000,12369.00000,The Alliance,Exception Members,,10025.40,,,,,,,5976.18,13020.00,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13485.00000,12810.75000,The Alliance,Exception Members,,10383.45,,,,,,,6607.65,13080.45,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13485.00000,12810.75000,The Alliance,Exception Members,,10383.45,,,,,,,6189.61,13485.00,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3296.47,6525.68,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3087.92,6727.50,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1266.64000,1203.31000,The Alliance,Exception Members,,975.31,,,,,,,620.65,1228.64,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1266.64000,1203.31000,The Alliance,Exception Members,,975.31,,,,,,,581.39,1266.64,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,284.01,618.75,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3476.25000,3302.44000,The Alliance,Exception Members,,2676.71,,,,,,,1703.36,3371.96,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3476.25000,3302.44000,The Alliance,Exception Members,,2676.71,,,,,,,1595.60,3476.25,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5126.70000,4870.36000,The Alliance,Exception Members,,3947.56,,,,,,,2512.08,4972.90,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5126.70000,4870.36000,The Alliance,Exception Members,,3947.56,,,,,,,2353.16,5126.70,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,45.32000,43.05000,The Alliance,Exception Members,,34.90,,,,,,,22.21,43.96,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,45.32000,43.05000,The Alliance,Exception Members,,34.90,,,,,,,20.80,45.32,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,The Alliance,Exception Members,,3930.56,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Exception Members,,3930.56,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Exception Members,,524.95,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,The Alliance,Exception Members,,3930.56,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Exception Members,,3930.56,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Exception Members,,668.54,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,The Alliance,Exception Members,,573.03,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Exception Members,,573.03,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,The Alliance,Exception Members,,1437.97,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Exception Members,,1437.97,,,,,,,857.18,1867.50,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,702.86000,667.72000,The Alliance,Exception Members,,541.20,,,,,,,344.40,681.77,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,702.86000,667.72000,The Alliance,Exception Members,,541.20,,,,,,,322.61,702.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,The Alliance,Exception Members,,573.03,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Exception Members,,573.03,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4936.95000,4690.10000,The Alliance,Exception Members,,3801.45,,,,,,,2419.11,4788.84,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4936.95000,4690.10000,The Alliance,Exception Members,,3801.45,,,,,,,2266.06,4936.95,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,The Alliance,Exception Members,,1437.97,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Exception Members,,1437.97,,,,,,,857.18,1867.50,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,The Alliance,Exception Members,,981.75,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Exception Members,,981.75,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,The Alliance,Exception Members,,981.75,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Exception Members,,981.75,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,18.95,37.52,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,90.88000,86.34000,The Alliance,Exception Members,,69.98,,,,,,,44.53,88.15,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,90.88000,86.34000,The Alliance,Exception Members,,69.98,,,,,,,41.71,90.88,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,The Alliance,Exception Members,,7296.87,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Exception Members,,7296.87,,,,,,,4349.70,9476.46,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,49.00,97.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,45.90,100.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,91.88,181.88,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,86.06,187.50,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,687.15000,652.79000,The Alliance,Exception Members,,529.11,,,,,,,336.70,666.54,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,687.15000,652.79000,The Alliance,Exception Members,,529.11,,,,,,,315.40,687.15,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2620.28,5187.07,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Exception Members,,270.59,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6520.50000,6194.47000,The Alliance,Exception Members,,5020.78,,,,,,,3195.05,6324.89,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6520.50000,6194.47000,The Alliance,Exception Members,,5020.78,,,,,,,2992.91,6520.50,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,485.25000,460.99000,The Alliance,Exception Members,,373.64,,,,,,,237.77,470.69,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,485.25000,460.99000,The Alliance,Exception Members,,373.64,,,,,,,222.73,485.25,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,757.50000,719.62000,The Alliance,Exception Members,,583.27,,,,,,,371.18,734.77,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,757.50000,719.62000,The Alliance,Exception Members,,583.27,,,,,,,347.69,757.50,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,8558.74,18646.50,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,431.25000,409.69000,The Alliance,Exception Members,,332.06,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Exception Members,,332.06,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,The Alliance,Exception Members,,3833.33,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Exception Members,,3833.33,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,The Alliance,Exception Members,,3833.33,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Exception Members,,3833.33,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,The Alliance,Exception Members,,4914.52,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Exception Members,,4914.52,,,,,,,2929.57,6382.50,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2497.50000,2372.62000,The Alliance,Exception Members,,1923.08,,,,,,,1223.78,2422.57,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2497.50000,2372.62000,The Alliance,Exception Members,,1923.08,,,,,,,1146.35,2497.50,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,The Alliance,Exception Members,,348.66,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Exception Members,,348.66,,,,,,,207.84,452.81,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,The Alliance,Exception Members,,4914.52,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Exception Members,,4914.52,,,,,,,2929.57,6382.50,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,The Alliance,Exception Members,,348.66,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Exception Members,,348.66,,,,,,,207.84,452.81,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,38.56,84.00,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,495.72,1080.00,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,318.35,630.20,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,287.45,626.25,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Exception Members,,500.26,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4648.88,9202.88,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4354.76,9487.50,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,666.00000,632.70000,The Alliance,Exception Members,,512.82,,,,,,,326.34,646.02,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,666.00000,632.70000,The Alliance,Exception Members,,512.82,,,,,,,305.69,666.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,643.12,1273.12,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,78.40000,74.48000,The Alliance,Exception Members,,60.37,,,,,,,38.42,76.05,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Exception Members,,60.37,,,,,,,35.99,78.40,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,205.80,407.40,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,,323.40,,,,,,,192.78,420.00,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,746.29000,708.98000,The Alliance,Exception Members,,574.64,,,,,,,365.68,723.90,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,746.29000,708.98000,The Alliance,Exception Members,,574.64,,,,,,,342.55,746.29,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,661.50,1309.50,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,619.65,1350.00,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,643.12,1273.12,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,The Alliance,Exception Members,,1492.84,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Exception Members,,1492.84,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,47.68000,45.30000,The Alliance,Exception Members,,36.71,,,,,,,23.36,46.25,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,47.68000,45.30000,The Alliance,Exception Members,,36.71,,,,,,,21.89,47.68,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3479.63000,3305.65000,The Alliance,Exception Members,,2679.32,,,,,,,1705.02,3375.24,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3479.63000,3305.65000,The Alliance,Exception Members,,2679.32,,,,,,,1597.15,3479.63,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1162.50000,1104.38000,The Alliance,Exception Members,,895.12,,,,,,,569.62,1127.62,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1162.50000,1104.38000,The Alliance,Exception Members,,895.12,,,,,,,533.59,1162.50,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9970.50000,9471.98000,The Alliance,Exception Members,,7677.28,,,,,,,4885.55,9671.39,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9970.50000,9471.98000,The Alliance,Exception Members,,7677.28,,,,,,,4576.46,9970.50,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,The Alliance,Exception Members,,1208.42,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Exception Members,,1208.42,,,,,,,720.35,1569.38,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,96.44000,91.62000,The Alliance,Exception Members,,74.26,,,,,,,47.26,93.55,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,96.44000,91.62000,The Alliance,Exception Members,,74.26,,,,,,,44.27,96.44,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,3851.19,8390.40,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9270.15000,8806.64000,The Alliance,Exception Members,,7138.02,,,,,,,4542.37,8992.05,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9270.15000,8806.64000,The Alliance,Exception Members,,7138.02,,,,,,,4255.00,9270.15,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,38.56,84.00,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,498.26000,473.35000,The Alliance,Exception Members,,383.66,,,,,,,244.15,483.31,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,498.26000,473.35000,The Alliance,Exception Members,,383.66,,,,,,,228.70,498.26,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,431.25000,409.69000,The Alliance,Exception Members,,332.06,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Exception Members,,332.06,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,The Alliance,Exception Members,,1492.84,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Exception Members,,1492.84,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,The Alliance,Exception Members,,7145.98,,,,,,,4547.44,9002.08,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Exception Members,,7145.98,,,,,,,4259.75,9280.50,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,3851.19,8390.40,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,119.76000,113.77000,The Alliance,Exception Members,,92.22,,,,,,,58.68,116.17,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,119.76000,113.77000,The Alliance,Exception Members,,92.22,,,,,,,54.97,119.76,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3660.00000,3477.00000,The Alliance,Exception Members,,2818.20,,,,,,,1793.40,3550.20,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3660.00000,3477.00000,The Alliance,Exception Members,,2818.20,,,,,,,1679.94,3660.00,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,The Alliance,Exception Members,,137.09,,,,,,,87.24,172.70,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Exception Members,,137.09,,,,,,,81.72,178.04,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,176.38,384.26,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,247.43000,235.06000,The Alliance,Exception Members,,190.52,,,,,,,121.24,240.01,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,247.43000,235.06000,The Alliance,Exception Members,,190.52,,,,,,,113.57,247.43,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Exception Members,,290.54,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,510.00000,484.50000,The Alliance,Exception Members,,392.70,,,,,,,249.90,494.70,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,510.00000,484.50000,The Alliance,Exception Members,,392.70,,,,,,,234.09,510.00,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,37.61,74.46,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,35.23,76.76,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2124.00000,2017.80000,The Alliance,Exception Members,,1635.48,,,,,,,1040.76,2060.28,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2124.00000,2017.80000,The Alliance,Exception Members,,1635.48,,,,,,,974.92,2124.00,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,93.40000,88.73000,The Alliance,Exception Members,,71.92,,,,,,,45.77,90.60,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,93.40000,88.73000,The Alliance,Exception Members,,71.92,,,,,,,42.87,93.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,The Alliance,Exception Members,,1572.56,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Exception Members,,1572.56,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,320.59000,304.56000,The Alliance,Exception Members,,246.85,,,,,,,157.09,310.97,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,320.59000,304.56000,The Alliance,Exception Members,,246.85,,,,,,,147.15,320.59,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,305.33000,290.06000,The Alliance,Exception Members,,235.10,,,,,,,149.61,296.17,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,305.33000,290.06000,The Alliance,Exception Members,,235.10,,,,,,,140.15,305.33,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,836.25000,794.44000,The Alliance,Exception Members,,643.91,,,,,,,409.76,811.16,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,836.25000,794.44000,The Alliance,Exception Members,,643.91,,,,,,,383.84,836.25,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,The Alliance,Exception Members,,13844.60,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Exception Members,,13844.60,,,,,,,8252.82,17980.00,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,The Alliance,Exception Members,,13844.60,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Exception Members,,13844.60,,,,,,,8252.82,17980.00,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,The Alliance,Exception Members,,621.54,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Exception Members,,621.54,,,,,,,370.50,807.19,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,903.75000,858.56000,The Alliance,Exception Members,,695.89,,,,,,,442.84,876.64,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,903.75000,858.56000,The Alliance,Exception Members,,695.89,,,,,,,414.82,903.75,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,The Alliance,Exception Members,,399.86,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Exception Members,,399.86,,,,,,,238.36,519.30,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3120.00000,2964.00000,The Alliance,Exception Members,,2402.40,,,,,,,1528.80,3026.40,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Exception Members,,2402.40,,,,,,,1432.08,3120.00,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,416.25000,395.44000,The Alliance,Exception Members,,320.51,,,,,,,203.96,403.76,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,416.25000,395.44000,The Alliance,Exception Members,,320.51,,,,,,,191.06,416.25,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,921.79000,875.70000,The Alliance,Exception Members,,709.78,,,,,,,451.68,894.14,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,921.79000,875.70000,The Alliance,Exception Members,,709.78,,,,,,,423.10,921.79,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1561.17,3401.25,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2891.25000,2746.69000,The Alliance,Exception Members,,2226.26,,,,,,,1416.71,2804.51,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2891.25000,2746.69000,The Alliance,Exception Members,,2226.26,,,,,,,1327.08,2891.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,The Alliance,Exception Members,,127.94,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Exception Members,,127.94,,,,,,,76.27,166.16,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13104.65,28550.44,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,inpatient,,,47250.00000,44887.50000,The Alliance,Exception Members,,36382.50,,,,,,,23152.50,45832.50,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,outpatient,,,47250.00000,44887.50000,The Alliance,Exception Members,,36382.50,,,,,,,21687.75,47250.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,The Alliance,Exception Members,,1681.97,,,,,,,1070.35,2118.85,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Exception Members,,1681.97,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13104.65,28550.44,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Exception Members,,21983.84,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Exception Members,,2618.96,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,The Alliance,Exception Members,,1572.56,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Exception Members,,1572.56,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,5137.91000,4881.01000,The Alliance,Exception Members,,3956.19,,,,,,,2517.58,4983.77,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,5137.91000,4881.01000,The Alliance,Exception Members,,3956.19,,,,,,,2358.30,5137.91,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,191.25000,181.69000,The Alliance,Exception Members,,147.26,,,,,,,93.71,185.51,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,191.25000,181.69000,The Alliance,Exception Members,,147.26,,,,,,,87.78,191.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2137.79,4657.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,The Alliance,Exception Members,,8056.12,,,,,,,5126.62,10148.62,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Exception Members,,8056.12,,,,,,,4802.29,10148.62,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11082.50000,10528.38000,The Alliance,Exception Members,,8533.52,,,,,,,5430.43,10750.02,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11082.50000,10528.38000,The Alliance,Exception Members,,8533.52,,,,,,,5086.87,10750.02,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,The Alliance,Exception Members,,15694.76,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Exception Members,,15694.76,,,,,,,9355.71,20382.81,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,98.97,215.63,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,24570.00000,23341.50000,The Alliance,Exception Members,,18918.90,,,,,,,12039.30,23832.90,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,24570.00000,23341.50000,The Alliance,Exception Members,,18918.90,,,,,,,11277.63,24570.00,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,92.95,202.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9842.50000,9350.38000,The Alliance,Exception Members,,7578.73,,,,,,,4822.82,9547.23,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9842.50000,9350.38000,The Alliance,Exception Members,,7578.73,,,,,,,4517.71,9547.23,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,637.50000,605.62000,The Alliance,Exception Members,,490.88,,,,,,,312.38,618.38,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Exception Members,,490.88,,,,,,,292.61,637.50,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11173.92,24344.05,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,46200.00000,43890.00000,The Alliance,Exception Members,,35574.00,,,,,,,22638.00,44814.00,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,46200.00000,43890.00000,The Alliance,Exception Members,,35574.00,,,,,,,21205.80,46200.00,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,22575.00000,21446.25000,The Alliance,Exception Members,,17382.75,,,,,,,11061.75,21897.75,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,22575.00000,21446.25000,The Alliance,Exception Members,,17382.75,,,,,,,10361.92,22575.00,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11532.00000,10955.40000,The Alliance,Exception Members,,8879.64,,,,,,,5650.68,11186.04,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11532.00000,10955.40000,The Alliance,Exception Members,,8879.64,,,,,,,5293.19,11186.04,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,33.89,73.84,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,431.63000,410.05000,The Alliance,Exception Members,,332.36,,,,,,,211.50,418.68,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,431.63000,410.05000,The Alliance,Exception Members,,332.36,,,,,,,198.12,431.63,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,The Alliance,Exception Members,,7877.10,,,,,,,5012.70,9923.10,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Exception Members,,7877.10,,,,,,,4695.57,10230.00,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11780.00000,11191.00000,The Alliance,Exception Members,,9070.60,,,,,,,5772.20,11426.60,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11780.00000,11191.00000,The Alliance,Exception Members,,9070.60,,,,,,,5407.02,11426.60,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,The Alliance,Exception Members,,568.84,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Exception Members,,568.84,,,,,,,339.09,738.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,29.28000,27.82000,The Alliance,Exception Members,,22.55,,,,,,,14.35,28.40,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,29.28000,27.82000,The Alliance,Exception Members,,22.55,,,,,,,13.44,29.28,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,217.50000,206.62000,The Alliance,Exception Members,,167.47,,,,,,,106.58,210.97,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,217.50000,206.62000,The Alliance,Exception Members,,167.47,,,,,,,99.83,217.50,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,9513.90000,9038.20000,The Alliance,Exception Members,,7325.70,,,,,,,4661.81,9228.48,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,9513.90000,9038.20000,The Alliance,Exception Members,,7325.70,,,,,,,4366.88,9513.90,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,541.50000,514.42000,The Alliance,Exception Members,,416.95,,,,,,,265.33,525.25,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,541.50000,514.42000,The Alliance,Exception Members,,416.95,,,,,,,248.55,541.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,33.89,73.84,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,881.25000,837.19000,The Alliance,Exception Members,,678.56,,,,,,,431.81,854.81,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,881.25000,837.19000,The Alliance,Exception Members,,678.56,,,,,,,404.49,881.25,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,128.20000,121.79000,The Alliance,Exception Members,,98.71,,,,,,,62.82,124.35,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,128.20000,121.79000,The Alliance,Exception Members,,98.71,,,,,,,58.84,128.20,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,77.64000,73.76000,The Alliance,Exception Members,,59.78,,,,,,,38.04,75.31,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.64000,73.76000,The Alliance,Exception Members,,59.78,,,,,,,35.64,77.64,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,The Alliance,Exception Members,,304.64,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Exception Members,,304.64,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Exception Members,,64.06,,,,,,,38.19,83.20,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.85000,253.51000,The Alliance,Exception Members,,205.47,,,,,,,130.76,258.84,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.85000,253.51000,The Alliance,Exception Members,,205.47,,,,,,,122.48,266.85,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,69.72000,66.23000,The Alliance,Exception Members,,53.68,,,,,,,34.16,67.63,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Exception Members,,53.68,,,,,,,32.00,69.72,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,The Alliance,Exception Members,,4261.03,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Exception Members,,4261.03,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,94.96000,90.21000,The Alliance,Exception Members,,73.12,,,,,,,46.53,92.11,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,94.96000,90.21000,The Alliance,Exception Members,,73.12,,,,,,,43.59,94.96,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,46.72000,44.38000,The Alliance,Exception Members,,35.97,,,,,,,22.89,45.32,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,46.72000,44.38000,The Alliance,Exception Members,,35.97,,,,,,,21.44,46.72,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,The Alliance,Exception Members,,4261.03,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Exception Members,,4261.03,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,58.84000,55.90000,The Alliance,Exception Members,,45.31,,,,,,,28.83,57.07,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,58.84000,55.90000,The Alliance,Exception Members,,45.31,,,,,,,27.01,58.84,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,The Alliance,Exception Members,,3410.95,,,,,,,2170.60,4296.91,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Exception Members,,3410.95,,,,,,,2033.28,4429.80,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3397.09000,3227.24000,The Alliance,Exception Members,,2615.76,,,,,,,1664.57,3295.18,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3397.09000,3227.24000,The Alliance,Exception Members,,2615.76,,,,,,,1559.26,3397.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2006.21000,1905.90000,The Alliance,Exception Members,,1544.78,,,,,,,983.04,1946.02,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Exception Members,,1544.78,,,,,,,920.85,2006.21,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8752.62000,8314.99000,The Alliance,Exception Members,,6739.52,,,,,,,4288.78,8490.04,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8752.62000,8314.99000,The Alliance,Exception Members,,6739.52,,,,,,,4017.45,8752.62,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.83000,274.39000,The Alliance,Exception Members,,222.40,,,,,,,141.53,280.17,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.83000,274.39000,The Alliance,Exception Members,,222.40,,,,,,,132.57,288.83,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,The Alliance,Exception Members,,3410.95,,,,,,,2170.60,4296.91,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Exception Members,,3410.95,,,,,,,2033.28,4429.80,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,59.44000,56.47000,The Alliance,Exception Members,,45.77,,,,,,,29.13,57.66,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,59.44000,56.47000,The Alliance,Exception Members,,45.77,,,,,,,27.28,59.44,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,The Alliance,Exception Members,,43659.00,,,,,,,27783.00,54999.00,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Exception Members,,43659.00,,,,,,,26025.30,56700.00,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,183.32,399.38,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,46.60,101.52,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,67.75,147.60,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,162.40000,154.28000,The Alliance,Exception Members,,125.05,,,,,,,79.58,157.53,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,162.40000,154.28000,The Alliance,Exception Members,,125.05,,,,,,,74.54,162.40,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9953.60000,9455.92000,The Alliance,Exception Members,,7664.27,,,,,,,4877.26,9654.99,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9953.60000,9455.92000,The Alliance,Exception Members,,7664.27,,,,,,,4568.70,9953.60,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,606.38000,576.06000,The Alliance,Exception Members,,466.91,,,,,,,297.13,588.19,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,606.38000,576.06000,The Alliance,Exception Members,,466.91,,,,,,,278.33,606.38,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,The Alliance,Exception Members,,170.36,,,,,,,108.41,214.61,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Exception Members,,170.36,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,177.68000,168.80000,The Alliance,Exception Members,,136.81,,,,,,,87.06,172.35,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,177.68000,168.80000,The Alliance,Exception Members,,136.81,,,,,,,81.56,177.68,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,131.64000,125.06000,The Alliance,Exception Members,,101.36,,,,,,,64.50,127.69,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,131.64000,125.06000,The Alliance,Exception Members,,101.36,,,,,,,60.42,131.64,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,59.56000,56.58000,The Alliance,Exception Members,,45.86,,,,,,,29.18,57.77,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,59.56000,56.58000,The Alliance,Exception Members,,45.86,,,,,,,27.34,59.56,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,189.20000,179.74000,The Alliance,Exception Members,,145.68,,,,,,,92.71,183.52,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Exception Members,,145.68,,,,,,,86.84,189.20,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,137.96000,131.06000,The Alliance,Exception Members,,106.23,,,,,,,67.60,133.82,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,137.96000,131.06000,The Alliance,Exception Members,,106.23,,,,,,,63.32,137.96,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,440.63000,418.60000,The Alliance,Exception Members,,339.29,,,,,,,215.91,427.41,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,440.63000,418.60000,The Alliance,Exception Members,,339.29,,,,,,,202.25,440.63,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1049.63000,997.15000,The Alliance,Exception Members,,808.22,,,,,,,514.32,1018.14,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1049.63000,997.15000,The Alliance,Exception Members,,808.22,,,,,,,481.78,1049.63,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,164.80000,156.56000,The Alliance,Exception Members,,126.90,,,,,,,80.75,159.86,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Exception Members,,126.90,,,,,,,75.64,164.80,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.46000,1745.59000,The Alliance,Exception Members,,1414.84,,,,,,,900.36,1782.34,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.46000,1745.59000,The Alliance,Exception Members,,1414.84,,,,,,,843.39,1837.46,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,78.95,172.00,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,2850.39,6210.00,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4142.31000,3935.19000,The Alliance,Exception Members,,3189.58,,,,,,,2029.73,4018.04,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4142.31000,3935.19000,The Alliance,Exception Members,,3189.58,,,,,,,1901.32,4142.31,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,764.24,1615.05,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3225.00000,3063.75000,The Alliance,Exception Members,,2483.25,,,,,,,1580.25,3128.25,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3225.00000,3063.75000,The Alliance,Exception Members,,2483.25,,,,,,,1480.28,3225.00,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,The Alliance,Exception Members,,1036.61,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Exception Members,,1036.61,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,The Alliance,Exception Members,,1036.61,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Exception Members,,1036.61,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2625.00000,2493.75000,The Alliance,Exception Members,,2021.25,,,,,,,1286.25,2546.25,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Exception Members,,2021.25,,,,,,,1204.88,2625.00,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4227.56000,4016.18000,The Alliance,Exception Members,,3255.22,,,,,,,2071.50,4100.73,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4227.56000,4016.18000,The Alliance,Exception Members,,3255.22,,,,,,,1940.45,4227.56,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7900.50000,7505.47000,The Alliance,Exception Members,,6083.39,,,,,,,3871.24,7663.48,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7900.50000,7505.47000,The Alliance,Exception Members,,6083.39,,,,,,,3626.33,7900.50,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2733.75000,2597.06000,The Alliance,Exception Members,,2104.99,,,,,,,1339.54,2651.74,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2733.75000,2597.06000,The Alliance,Exception Members,,2104.99,,,,,,,1254.79,2733.75,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2572.50000,2443.88000,The Alliance,Exception Members,,1980.83,,,,,,,1260.53,2495.32,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2572.50000,2443.88000,The Alliance,Exception Members,,1980.83,,,,,,,1180.78,2572.50,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.00000,572.85000,The Alliance,Exception Members,,464.31,,,,,,,295.47,584.91,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Exception Members,,464.31,,,,,,,276.78,603.00,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,The Alliance,Exception Members,,2712.69,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Exception Members,,2712.69,,,,,,,1617.04,3522.97,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,The Alliance,Exception Members,,3533.68,,,,,,,2248.70,4451.51,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Exception Members,,3533.68,,,,,,,2106.44,4589.19,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,The Alliance,Exception Members,,3533.68,,,,,,,2248.70,4451.51,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Exception Members,,3533.68,,,,,,,2106.44,4589.19,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Exception Members,,3218.08,,,,,,,1918.31,4179.33,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4305.84000,4090.55000,The Alliance,Exception Members,,3315.50,,,,,,,2109.86,4176.66,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4305.84000,4090.55000,The Alliance,Exception Members,,3315.50,,,,,,,1976.38,4305.84,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,The Alliance,Exception Members,,187.06,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Exception Members,,187.06,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,315.00000,299.25000,The Alliance,Exception Members,,242.55,,,,,,,154.35,305.55,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Exception Members,,242.55,,,,,,,144.59,315.00,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,The Alliance,Exception Members,,187.06,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Exception Members,,187.06,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,The Alliance,Exception Members,,201.05,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Exception Members,,201.05,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4692.00000,4457.40000,The Alliance,Exception Members,,3612.84,,,,,,,2299.08,4551.24,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Exception Members,,3612.84,,,,,,,2153.63,4692.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,The Alliance,Exception Members,,2844.19,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Exception Members,,2844.19,,,,,,,1695.43,3693.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.52000,42.29000,The Alliance,Exception Members,,34.28,,,,,,,21.81,43.18,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.52000,42.29000,The Alliance,Exception Members,,34.28,,,,,,,20.43,44.52,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2644.53,5761.50,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,900.38,1782.38,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,2051.96000,1949.36000,The Alliance,Exception Members,,1580.01,,,,,,,1005.46,1990.40,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,2051.96000,1949.36000,The Alliance,Exception Members,,1580.01,,,,,,,941.85,2051.96,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,The Alliance,Exception Members,,2844.19,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Exception Members,,2844.19,,,,,,,1695.43,3693.75,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,499.16,1087.50,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,The Alliance,Exception Members,,3089.51,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Exception Members,,3089.51,,,,,,,1841.67,4012.35,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,455.70,902.10,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,426.87,930.00,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Exception Members,,7916.37,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8521.50000,8095.42000,The Alliance,Exception Members,,6561.56,,,,,,,4175.53,8265.85,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Exception Members,,6561.56,,,,,,,3911.37,8521.50,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2644.53,5761.50,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,187.20000,177.84000,The Alliance,Exception Members,,144.14,,,,,,,91.73,181.58,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,187.20000,177.84000,The Alliance,Exception Members,,144.14,,,,,,,85.92,187.20,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Exception Members,,4436.35,,,,,,,2644.53,5761.50,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Exception Members,,716.10,,,,,,,426.87,930.00,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,The Alliance,Exception Members,,909.56,,,,,,,578.81,1145.81,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Exception Members,,909.56,,,,,,,542.19,1181.25,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,The Alliance,Exception Members,,3089.51,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Exception Members,,3089.51,,,,,,,1841.67,4012.35,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3904.68000,3709.45000,The Alliance,Exception Members,,3006.60,,,,,,,1913.29,3787.54,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3904.68000,3709.45000,The Alliance,Exception Members,,3006.60,,,,,,,1792.25,3904.68,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,693.75000,659.06000,The Alliance,Exception Members,,534.19,,,,,,,339.94,672.94,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Exception Members,,534.19,,,,,,,318.43,693.75,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,639.45,1265.85,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,599.00,1305.00,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Exception Members,,482.21,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1717.50000,1631.62000,The Alliance,Exception Members,,1322.47,,,,,,,841.58,1665.97,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1717.50000,1631.62000,The Alliance,Exception Members,,1322.47,,,,,,,788.33,1717.50,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13934.50000,13237.77000,The Alliance,Exception Members,,10729.57,,,,,,,6827.90,13516.47,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13934.50000,13237.77000,The Alliance,Exception Members,,10729.57,,,,,,,6395.94,13934.50,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,13.77,30.00,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1097.25000,1042.39000,The Alliance,Exception Members,,844.88,,,,,,,537.65,1064.33,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1097.25000,1042.39000,The Alliance,Exception Members,,844.88,,,,,,,503.64,1097.25,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,The Alliance,Exception Members,,424.46,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Exception Members,,424.46,,,,,,,253.02,551.25,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1383.88,3015.00,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,222.04,483.75,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,The Alliance,Exception Members,,424.46,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Exception Members,,424.46,,,,,,,253.02,551.25,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,667.50000,634.12000,The Alliance,Exception Members,,513.98,,,,,,,327.07,647.48,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,667.50000,634.12000,The Alliance,Exception Members,,513.98,,,,,,,306.38,667.50,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5796.00000,5506.20000,The Alliance,Exception Members,,4462.92,,,,,,,2840.04,5622.12,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5796.00000,5506.20000,The Alliance,Exception Members,,4462.92,,,,,,,2660.36,5796.00,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,35.23,76.76,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,14.54,31.68,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2255.03000,2142.28000,The Alliance,Exception Members,,1736.37,,,,,,,1104.96,2187.38,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2255.03000,2142.28000,The Alliance,Exception Members,,1736.37,,,,,,,1035.06,2255.03,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,4731.14,10307.50,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,4731.14,10307.50,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Exception Members,,1284.94,,,,,,,765.96,1668.75,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Exception Members,,21876.14,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2454.50,5347.50,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,The Alliance,Exception Members,,9025.25,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Exception Members,,9025.25,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,The Alliance,Exception Members,,10046.88,,,,,,,6393.47,12656.46,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Exception Members,,10046.88,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4661.42,10155.60,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8745.75000,8308.46000,The Alliance,Exception Members,,6734.23,,,,,,,4285.42,8483.38,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Exception Members,,6734.23,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,4856.36,10580.30,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6244.50000,5932.27000,The Alliance,Exception Members,,4808.27,,,,,,,3059.80,6057.16,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6244.50000,5932.27000,The Alliance,Exception Members,,4808.27,,,,,,,2866.23,6244.50,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,The Alliance,Exception Members,,10046.88,,,,,,,6393.47,12656.46,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Exception Members,,10046.88,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,The Alliance,Exception Members,,9025.25,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Exception Members,,9025.25,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2527.30,5003.02,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2367.41,5157.75,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6192.75000,5883.11000,The Alliance,Exception Members,,4768.42,,,,,,,3034.45,6006.97,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6192.75000,5883.11000,The Alliance,Exception Members,,4768.42,,,,,,,2842.47,6192.75,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6882.75000,6538.61000,The Alliance,Exception Members,,5299.72,,,,,,,3372.55,6676.27,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6882.75000,6538.61000,The Alliance,Exception Members,,5299.72,,,,,,,3159.18,6882.75,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.50000,363.38000,The Alliance,Exception Members,,294.52,,,,,,,187.43,371.02,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Exception Members,,294.52,,,,,,,175.57,382.50,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,843.41,1837.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,188.68000,179.25000,The Alliance,Exception Members,,145.28,,,,,,,92.45,183.02,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,188.68000,179.25000,The Alliance,Exception Members,,145.28,,,,,,,86.60,188.68,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,716.62,1418.62,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,671.29,1462.50,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,1586.25000,1506.94000,The Alliance,Exception Members,,1221.41,,,,,,,777.26,1538.66,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1586.25000,1506.94000,The Alliance,Exception Members,,1221.41,,,,,,,728.09,1586.25,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1053.40,2295.00,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1053.40,2295.00,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,213.00,421.66,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Exception Members,,334.72,,,,,,,199.53,434.70,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2676.38000,2542.56000,The Alliance,Exception Members,,2060.81,,,,,,,1311.43,2596.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2676.38000,2542.56000,The Alliance,Exception Members,,2060.81,,,,,,,1228.46,2676.38,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,78.95,172.00,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,16861.49000,16018.42000,The Alliance,Exception Members,,12983.35,,,,,,,8262.13,16355.65,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16861.49000,16018.42000,The Alliance,Exception Members,,12983.35,,,,,,,7739.42,16861.49,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,629.05,1245.27,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,589.26,1283.78,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.69000,839.51000,The Alliance,Exception Members,,680.44,,,,,,,433.01,857.18,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.69000,839.51000,The Alliance,Exception Members,,680.44,,,,,,,405.61,883.69,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,59.56,129.76,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,198.37,349.86,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,349.86,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,926.25000,879.94000,The Alliance,Exception Members,,713.21,,,,,,,453.86,898.46,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,926.25000,879.94000,The Alliance,Exception Members,,713.21,,,,,,,425.15,926.25,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,31.21,68.00,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,303.75000,288.56000,The Alliance,Exception Members,,233.89,,,,,,,148.84,294.64,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,303.75000,288.56000,The Alliance,Exception Members,,233.89,,,,,,,139.42,303.75,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,The Alliance,Exception Members,,2855.74,,,,,,,1817.29,3597.49,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Exception Members,,2855.74,,,,,,,1702.32,3708.75,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,3966.79,8642.25,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,3966.79,8642.25,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8040.81,17518.10,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,37537.50,66202.50,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,34125.00,66202.50,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,297.00000,282.15000,The Alliance,Exception Members,,228.69,,,,,,,145.53,288.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,297.00000,282.15000,The Alliance,Exception Members,,228.69,,,,,,,136.32,297.00,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1176.15000,1117.34000,The Alliance,Exception Members,,905.64,,,,,,,576.31,1140.87,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1176.15000,1117.34000,The Alliance,Exception Members,,905.64,,,,,,,539.85,1176.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,13.86,27.43,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,12.98,28.28,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,31326.75,68250.00,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8040.81,17518.10,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Exception Members,,1767.15,,,,,,,1053.40,2295.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,41.48000,39.41000,The Alliance,Exception Members,,31.94,,,,,,,20.33,40.24,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,41.48000,39.41000,The Alliance,Exception Members,,31.94,,,,,,,19.04,41.48,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,9.33,441.37,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,inpatient,,,1234.00000,1172.30000,The Alliance,Exception Members,,950.18,,,,,,,678.70,1196.98,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,Exception Members,,950.18,,,,,,,617.00,1196.98,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,822.25,1450.15,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,747.50,1450.15,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,,1260.49,,,,,,,900.35,1587.89,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,,1260.49,,,,,,,520.63,1587.89,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,The Alliance,Exception Members,TC,904.75,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Exception Members,TC,904.75,,,,,,,587.50,1139.75,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,The Alliance,Exception Members,TC,1965.81,,,,,,,1404.15,2476.41,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Exception Members,TC,1965.81,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,The Alliance,Exception Members,,2069.76,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Exception Members,,2069.76,,,,,,,1344.00,2607.36,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,The Alliance,Exception Members,TC,1853.39,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Exception Members,TC,1853.39,,,,,,,1203.50,2334.79,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,inpatient,1,mL,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,12.81,22.59,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,outpatient,1,mL,23.29000,22.12000,The Alliance,Exception Members,,17.93,,,,,,,11.64,22.59,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,inpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,73.70,129.98,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,67.00,264.00,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,inpatient,1,mL,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,outpatient,1,mL,1.47000,1.39000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,122.40,5271.00,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,Exception Members,TC,709.94,,,,,,,507.10,894.34,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Exception Members,TC,709.94,,,,,,,391.31,29731.35,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,TC,3035.34,,,,,,,2168.10,3823.74,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,TC,3035.34,,,,,,,356.27,17311.25,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,The Alliance,Exception Members,TC,2638.79,,,,,,,1884.85,3324.19,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Exception Members,TC,2638.79,,,,,,,1713.50,3324.19,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,378.42,17311.25,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,491.70,867.18,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,361.82,8543.92,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,inpatient,,,17686.00000,16801.70000,The Alliance,Exception Members,TC,13618.22,,,,,,,9727.30,17155.42,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,outpatient,,,17686.00000,16801.70000,The Alliance,Exception Members,TC,13618.22,,,,,,,8843.00,52322.00,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,The Alliance,Exception Members,TC,727.65,,,,,,,519.75,916.65,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Exception Members,TC,727.65,,,,,,,383.91,8543.92,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,13.75,24.25,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,12.50,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,13.75,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,12.50,24.25,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,inpatient,1,mL,42.94000,40.80000,The Alliance,Exception Members,,33.06,,,,,,,23.62,41.65,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,outpatient,1,mL,42.94000,40.80000,The Alliance,Exception Members,,33.06,,,,,,,21.47,78.87,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,132.00,232.80,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,120.00,584.87,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,14.39,746.94,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,inpatient,,,572.00000,543.40000,The Alliance,Exception Members,,440.44,,,,,,,314.60,554.84,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,outpatient,,,572.00000,543.40000,The Alliance,Exception Members,,440.44,,,,,,,70.04,6756.70,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,inpatient,1,mL,1767.80000,1679.41000,The Alliance,Exception Members,,1361.21,,,,,,,972.29,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,outpatient,1,mL,1767.80000,1679.41000,The Alliance,Exception Members,,1361.21,,,,,,,883.90,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,inpatient,1,mL,738.15000,701.24000,The Alliance,Exception Members,,568.38,,,,,,,405.98,716.01,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,outpatient,1,mL,738.15000,701.24000,The Alliance,Exception Members,,568.38,,,,,,,369.07,716.01,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,inpatient,,,361.00000,342.95000,The Alliance,Exception Members,,277.97,,,,,,,198.55,350.17,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,outpatient,,,361.00000,342.95000,The Alliance,Exception Members,,277.97,,,,,,,77.53,1052.52,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,inpatient,,,1962.00000,1863.90000,The Alliance,Exception Members,,1510.74,,,,,,,1079.10,1903.14,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,outpatient,,,1962.00000,1863.90000,The Alliance,Exception Members,,1510.74,,,,,,,1079.10,4686.00,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,inpatient,1,mL,204.86000,194.62000,The Alliance,Exception Members,,157.74,,,,,,,112.67,198.71,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,outpatient,1,mL,204.86000,194.62000,The Alliance,Exception Members,,157.74,,,,,,,102.43,198.71,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,inpatient,,,4230.00000,4018.50000,The Alliance,Exception Members,,3257.10,,,,,,,2326.50,4103.10,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,outpatient,,,4230.00000,4018.50000,The Alliance,Exception Members,,3257.10,,,,,,,2115.00,4103.10,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,inpatient,1,mL,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,3.15,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,outpatient,1,mL,5.72000,5.43000,The Alliance,Exception Members,,4.40,,,,,,,2.86,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,290.40,512.16,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,264.00,689.02,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,inpatient,,,6076.00000,5772.20000,The Alliance,Exception Members,,4678.52,,,,,,,3341.80,5893.72,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,outpatient,,,6076.00000,5772.20000,The Alliance,Exception Members,,4678.52,,,,,,,1801.27,5982.26,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,TC,918.61,,,,,,,656.15,1157.21,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,TC,918.61,,,,,,,404.21,17311.25,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,inpatient,,,1482.00000,1407.90000,The Alliance,Exception Members,,1141.14,,,,,,,815.10,1437.54,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Exception Members,,1141.14,,,,,,,815.10,4686.00,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,inpatient,1,EA,6.73000,6.39000,The Alliance,Exception Members,,5.18,,,,,,,3.70,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Exception Members,,5.18,,,,,,,3.37,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,inpatient,1,EA,6.67000,6.33000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,outpatient,1,EA,6.67000,6.33000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.95,8.73,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.50,8.73,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,484.00000,459.80000,The Alliance,Exception Members,,372.68,,,,,,,266.20,469.48,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Exception Members,,372.68,,,,,,,63.95,788.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,inpatient,1,GM,5.94000,5.64000,The Alliance,Exception Members,,4.57,,,,,,,3.27,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,outpatient,1,GM,5.94000,5.64000,The Alliance,Exception Members,,4.57,,,,,,,2.97,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,inpatient,1,GM,5.09000,4.84000,The Alliance,Exception Members,,3.92,,,,,,,2.80,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,outpatient,1,GM,5.09000,4.84000,The Alliance,Exception Members,,3.92,,,,,,,2.54,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,inpatient,1,GM,4.94000,4.70000,The Alliance,Exception Members,,3.80,,,,,,,2.72,4.79,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,outpatient,1,GM,4.94000,4.70000,The Alliance,Exception Members,,3.80,,,,,,,2.47,4.79,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,The Alliance,Exception Members,,93.17,,,,,,,66.55,117.37,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Exception Members,,93.17,,,,,,,11.54,543.22,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,inpatient,1,mL,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.66,2.92,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,outpatient,1,mL,3.01000,2.86000,The Alliance,Exception Members,,2.32,,,,,,,1.50,2.92,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,inpatient,,,303.50000,288.32000,The Alliance,Exception Members,90,233.69,,,,,,,166.93,294.39,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,outpatient,,,303.50000,288.32000,The Alliance,Exception Members,90,233.69,,,,,,,12.40,628.12,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,inpatient,,,1482.00000,1407.90000,The Alliance,Exception Members,,1141.14,,,,,,,815.10,1437.54,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Exception Members,,1141.14,,,,,,,483.55,3163.00,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,inpatient,1,mL,348.87000,331.43000,The Alliance,Exception Members,,268.63,,,,,,,191.88,338.40,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,outpatient,1,mL,348.87000,331.43000,The Alliance,Exception Members,,268.63,,,,,,,174.44,338.40,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.48,339.51,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,inpatient,,,164.10000,155.89000,The Alliance,Exception Members,90,126.36,,,,,,,90.25,159.18,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Exception Members,90,126.36,,,,,,,19.88,1103.49,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,10.25,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,9.32,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,inpatient,1,EA,13.00000,12.35000,The Alliance,Exception Members,,10.01,,,,,,,7.15,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,outpatient,1,EA,13.00000,12.35000,The Alliance,Exception Members,,10.01,,,,,,,6.50,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,3.07,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Exception Members,,4.30,,,,,,,2.79,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,inpatient,1,EA,34.76000,33.03000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,outpatient,1,EA,34.76000,33.03000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,inpatient,,,3378.00000,3209.10000,The Alliance,Exception Members,,2601.06,,,,,,,1857.90,3276.66,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,outpatient,,,3378.00000,3209.10000,The Alliance,Exception Members,,2601.06,,,,,,,1689.00,3276.66,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,inpatient,,,1370.00000,1301.50000,The Alliance,Exception Members,TC,1054.90,,,,,,,753.50,1328.90,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,outpatient,,,1370.00000,1301.50000,The Alliance,Exception Members,TC,1054.90,,,,,,,413.96,17311.25,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,inpatient,,,243.00000,230.85000,The Alliance,Exception Members,,187.11,,,,,,,133.65,235.71,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Exception Members,,187.11,,,,,,,121.50,278.37,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,Exception Members,TC,754.60,,,,,,,539.00,950.60,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Exception Members,TC,754.60,,,,,,,384.16,950.60,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,inpatient,1,mL,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.24,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,25159.00000,23901.05000,The Alliance,Exception Members,,19372.43,,,,,,,13837.45,24404.23,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,25159.00000,23901.05000,The Alliance,Exception Members,,19372.43,,,,,,,772.64,24404.23,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,8.17,696.05,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,2708.00,5253.52,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,inpatient,1,EA,41.89000,39.79000,The Alliance,Exception Members,,32.26,,,,,,,23.04,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,outpatient,1,EA,41.89000,39.79000,The Alliance,Exception Members,,32.26,,,,,,,20.95,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,14.22,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,inpatient,1,EA,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,29.55,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,outpatient,1,EA,53.72000,51.03000,The Alliance,Exception Members,,41.36,,,,,,,26.86,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,17.38,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,inpatient,,,335.00000,318.25000,The Alliance,Exception Members,,257.95,,,,,,,184.25,324.95,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,Exception Members,,257.95,,,,,,,167.50,324.95,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,inpatient,,,1040.00000,988.00000,The Alliance,Exception Members,,800.80,,,,,,,572.00,1008.80,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,outpatient,,,1040.00000,988.00000,The Alliance,Exception Members,,800.80,,,,,,,520.00,1008.80,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,inpatient,,,6048.00000,5745.60000,The Alliance,Exception Members,,4656.96,,,,,,,3326.40,5866.56,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,outpatient,,,6048.00000,5745.60000,The Alliance,Exception Members,,4656.96,,,,,,,1556.56,5866.56,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,inpatient,,,6019.00000,5718.05000,The Alliance,Exception Members,,4634.63,,,,,,,3310.45,5838.43,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,outpatient,,,6019.00000,5718.05000,The Alliance,Exception Members,,4634.63,,,,,,,1556.56,5838.43,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,inpatient,,,4922.00000,4675.90000,The Alliance,Exception Members,,3789.94,,,,,,,2707.10,4774.34,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,outpatient,,,4922.00000,4675.90000,The Alliance,Exception Members,,3789.94,,,,,,,2461.00,4774.34,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,inpatient,,,7244.00000,6881.80000,The Alliance,Exception Members,,5577.88,,,,,,,3984.20,7026.68,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,outpatient,,,7244.00000,6881.80000,The Alliance,Exception Members,,5577.88,,,,,,,1556.56,7026.68,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,Exception Members,90,136.29,,,,,,,97.35,171.69,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Exception Members,90,136.29,,,,,,,17.43,882.80,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,70.28000,66.77000,The Alliance,Exception Members,,54.12,,,,,,,34.44,68.17,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,70.28000,66.77000,The Alliance,Exception Members,,54.12,,,,,,,32.26,70.28,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,23.25,63.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,inpatient,1,mL,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.15,2.22,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,5.18,271.65,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,224.40,395.76,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,204.00,5271.00,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,inpatient,,,168.70000,160.26000,The Alliance,Exception Members,90,129.90,,,,,,,92.78,163.64,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,outpatient,,,168.70000,160.26000,The Alliance,Exception Members,90,129.90,,,,,,,10.22,509.30,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,31.50,264.00,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,inpatient,1,mL,8.61000,8.18000,The Alliance,Exception Members,,6.63,,,,,,,4.74,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,outpatient,1,mL,8.61000,8.18000,The Alliance,Exception Members,,6.63,,,,,,,4.30,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,76.45,134.83,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Exception Members,,107.03,,,,,,,12.92,679.08,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1741.85,3071.99,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1488.32,7180.14,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,inpatient,,,57.50000,54.62000,The Alliance,Exception Members,90,44.27,,,,,,,31.62,55.77,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,outpatient,,,57.50000,54.62000,The Alliance,Exception Members,90,44.27,,,,,,,28.75,1137.41,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.12,271.65,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,6.48,339.51,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,38.16000,36.25000,The Alliance,Exception Members,,29.38,,,,,,,18.70,37.02,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,38.16000,36.25000,The Alliance,Exception Members,,29.38,,,,,,,17.52,38.16,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,77.53,1052.52,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,60.50,106.70,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,55.00,106.70,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,4.81,254.68,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,2.54,135.79,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,5.06,254.68,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,inpatient,,,1172.00000,1113.40000,The Alliance,Exception Members,TC,902.44,,,,,,,644.60,1136.84,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Exception Members,TC,902.44,,,,,,,405.63,4412.20,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,86.79,153.07,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,14.05,713.01,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,inpatient,1,EA,4.50000,4.28000,The Alliance,Exception Members,,3.46,,,,,,,2.48,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,outpatient,1,EA,4.50000,4.28000,The Alliance,Exception Members,,3.46,,,,,,,2.25,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,inpatient,1,GM,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,5.95,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,outpatient,1,GM,10.81000,10.27000,The Alliance,Exception Members,,8.32,,,,,,,5.41,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.26,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Exception Members,,1.76,,,,,,,1.15,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.67100,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Exception Members,,0.93940,,,,,,,0.61000,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,1.39,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,4.88,254.68,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,inpatient,1,EA,2578.99000,2450.04000,The Alliance,Exception Members,,1985.82,,,,,,,1418.44,2501.62,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,outpatient,1,EA,2578.99000,2450.04000,The Alliance,Exception Members,,1985.82,,,,,,,81.70,2501.62,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.64,2.90,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.50,2.90,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,inpatient,1,mL,7.28000,6.92000,The Alliance,Exception Members,,5.61,,,,,,,4.00,7.06,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,outpatient,1,mL,7.28000,6.92000,The Alliance,Exception Members,,5.61,,,,,,,3.64,7.06,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,inpatient,1,EA,2310.25000,2194.74000,The Alliance,Exception Members,,1778.89,,,,,,,1270.64,2240.94,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,outpatient,1,EA,2310.25000,2194.74000,The Alliance,Exception Members,,1778.89,,,,,,,19.81,2240.94,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,The Alliance,Exception Members,90,206.82,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Exception Members,90,206.82,,,,,,,24.43,1205.34,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,4.91,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,inpatient,1,mL,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Exception Members,,5.01,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Exception Members,,6.05,,,,,,,1.65,7.62,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.23,2.17,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Exception Members,,1.72,,,,,,,1.12,2.17,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,8.30,14.64,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Exception Members,,11.62,,,,,,,7.54,14.64,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,inpatient,1,mL,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Exception Members,,1.35,,,,,,,0.87500,1.70,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,4.32,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,inpatient,1,mL,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,0.46480,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.46480,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.46480,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,inpatient,1,mL,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Exception Members,,1.03,,,,,,,0.46480,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,inpatient,1,EA,237.78000,225.89000,The Alliance,Exception Members,,183.09,,,,,,,130.78,230.65,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,outpatient,1,EA,237.78000,225.89000,The Alliance,Exception Members,,183.09,,,,,,,118.89,230.65,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,,1533.84,,,,,,,1095.60,1932.24,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Exception Members,,1533.84,,,,,,,100.97,1932.24,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2502.50,4413.50,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2150.56,7180.14,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,inpatient,1,EA,483.76000,459.57000,The Alliance,Exception Members,,372.50,,,,,,,266.07,469.25,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,outpatient,1,EA,483.76000,459.57000,The Alliance,Exception Members,,372.50,,,,,,,241.88,469.25,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,7.34,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Exception Members,,11.30,,,,,,,7.34,14.24,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,inpatient,1,EA,40.03000,38.03000,The Alliance,Exception Members,,30.82,,,,,,,22.02,38.83,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,outpatient,1,EA,40.03000,38.03000,The Alliance,Exception Members,,30.82,,,,,,,20.02,38.83,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,The Alliance,Exception Members,TC,3628.24,,,,,,,2591.60,4570.64,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Exception Members,TC,3628.24,,,,,,,2210.90,23155.09,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,134.64,472.39,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,inpatient,1,mL,54.93000,52.19000,The Alliance,Exception Members,,42.30,,,,,,,30.21,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,outpatient,1,mL,54.93000,52.19000,The Alliance,Exception Members,,42.30,,,,,,,27.46,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,14.22,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,inpatient,1,mL,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.82,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,outpatient,1,mL,14.22000,13.51000,The Alliance,Exception Members,,10.95,,,,,,,7.11,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,inpatient,1,mL,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,60.83,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,0.91450,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,inpatient,1,mL,157.02000,149.17000,The Alliance,Exception Members,,120.91,,,,,,,86.36,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,outpatient,1,mL,157.02000,149.17000,The Alliance,Exception Members,,120.91,,,,,,,0.91450,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,inpatient,1,mL,105.95000,100.65000,The Alliance,Exception Members,,81.58,,,,,,,58.27,102.77,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,outpatient,1,mL,105.95000,100.65000,The Alliance,Exception Members,,81.58,,,,,,,0.91450,102.77,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,99.55,175.57,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,16.26,848.80,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,The Alliance,Exception Members,,2.90,,,,,,,2.07,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Exception Members,,2.90,,,,,,,1.88,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,inpatient,1,GM,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,outpatient,1,GM,1.72000,1.63000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,inpatient,1,GM,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,outpatient,1,GM,1.72000,1.64000,The Alliance,Exception Members,,1.32,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,inpatient,1,mL,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,inpatient,1,mL,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.53,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,outpatient,1,mL,2.78000,2.64000,The Alliance,Exception Members,,2.14,,,,,,,1.30,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,inpatient,1,mL,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,3.39,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,outpatient,1,mL,6.16000,5.85000,The Alliance,Exception Members,,4.74,,,,,,,1.30,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,inpatient,1,mL,6.98000,6.63000,The Alliance,Exception Members,,5.37,,,,,,,3.84,6.77,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,outpatient,1,mL,6.98000,6.63000,The Alliance,Exception Members,,5.37,,,,,,,1.30,6.77,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,2.76,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,inpatient,1,mL,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,inpatient,1,mL,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,outpatient,1,mL,1.11000,1.06000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,inpatient,1,mL,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,inpatient,,,869.00000,825.55000,The Alliance,Exception Members,,669.13,,,,,,,477.95,842.93,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Exception Members,,669.13,,,,,,,434.50,1820.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,inpatient,1,mL,16.53000,15.70000,The Alliance,Exception Members,,12.73,,,,,,,9.09,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,outpatient,1,mL,16.53000,15.70000,The Alliance,Exception Members,,12.73,,,,,,,8.27,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,inpatient,1,mL,12.05000,11.45000,The Alliance,Exception Members,,9.28,,,,,,,6.63,11.69,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,outpatient,1,mL,12.05000,11.45000,The Alliance,Exception Members,,9.28,,,,,,,6.03,11.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,67.50,1595.82,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,inpatient,1,EA,34.43000,32.71000,The Alliance,Exception Members,,26.51,,,,,,,18.94,33.40,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,outpatient,1,EA,34.43000,32.71000,The Alliance,Exception Members,,26.51,,,,,,,17.21,33.40,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,inpatient,,,790.00000,750.50000,The Alliance,Exception Members,TC,608.30,,,,,,,434.50,766.30,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Exception Members,TC,608.30,,,,,,,268.62,3270.26,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,The Alliance,Exception Members,,3324.86,,,,,,,2374.90,4188.46,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Exception Members,,3324.86,,,,,,,1031.39,4188.46,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,Exception Members,TC,259.49,,,,,,,185.35,326.89,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Exception Members,TC,259.49,,,,,,,168.50,326.89,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,inpatient,1,GM,1.65000,1.56000,The Alliance,Exception Members,,1.27,,,,,,,0.90750,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,outpatient,1,GM,1.65000,1.56000,The Alliance,Exception Members,,1.27,,,,,,,0.82500,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,inpatient,1,GM,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,outpatient,1,GM,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,inpatient,1,GM,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,outpatient,1,GM,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,inpatient,1,mL,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.69,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Exception Members,,3.77,,,,,,,2.44,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,inpatient,1,mL,11.91000,11.32000,The Alliance,Exception Members,,9.17,,,,,,,6.55,11.55,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,outpatient,1,mL,11.91000,11.32000,The Alliance,Exception Members,,9.17,,,,,,,5.96,11.55,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,The Alliance,Exception Members,TC,3615.92,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Exception Members,TC,3615.92,,,,,,,595.74,17311.25,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,2.34,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,inpatient,,,1047.00000,994.65000,The Alliance,Exception Members,TC,806.19,,,,,,,575.85,1015.59,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,outpatient,,,1047.00000,994.65000,The Alliance,Exception Members,TC,806.19,,,,,,,447.16,29731.35,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,The Alliance,Exception Members,,10.16,,,,,,,7.26,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Exception Members,,10.16,,,,,,,6.60,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,inpatient,1,EA,135.69000,128.91000,The Alliance,Exception Members,,104.48,,,,,,,74.63,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,outpatient,1,EA,135.69000,128.91000,The Alliance,Exception Members,,104.48,,,,,,,67.84,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,The Alliance,Exception Members,,6.49,,,,,,,4.64,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Exception Members,,6.49,,,,,,,4.21,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,inpatient,1,EA,13.73000,13.04000,The Alliance,Exception Members,,10.57,,,,,,,7.55,13.32,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,outpatient,1,EA,13.73000,13.04000,The Alliance,Exception Members,,10.57,,,,,,,6.87,13.32,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,79.75,140.65,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,,111.65,,,,,,,12.05,574.73,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,inpatient,1,EA,387.28000,367.92000,The Alliance,Exception Members,,298.21,,,,,,,213.00,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,outpatient,1,EA,387.28000,367.92000,The Alliance,Exception Members,,298.21,,,,,,,6.30,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,inpatient,1,EA,546.90000,519.56000,The Alliance,Exception Members,,421.11,,,,,,,300.80,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,outpatient,1,EA,546.90000,519.56000,The Alliance,Exception Members,,421.11,,,,,,,6.30,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,inpatient,1,EA,140.13000,133.12000,The Alliance,Exception Members,,107.90,,,,,,,77.07,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,outpatient,1,EA,140.13000,133.12000,The Alliance,Exception Members,,107.90,,,,,,,6.30,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,inpatient,1,EA,493.01000,468.36000,The Alliance,Exception Members,,379.62,,,,,,,271.16,478.22,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,outpatient,1,EA,493.01000,468.36000,The Alliance,Exception Members,,379.62,,,,,,,6.30,478.22,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,The Alliance,Exception Members,,5.55,,,,,,,3.97,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Exception Members,,5.55,,,,,,,3.60,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.65,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Exception Members,,5.11,,,,,,,3.31,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,inpatient,1,EA,5.83000,5.54000,The Alliance,Exception Members,,4.49,,,,,,,3.21,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,outpatient,1,EA,5.83000,5.54000,The Alliance,Exception Members,,4.49,,,,,,,2.92,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,inpatient,1,EA,21.16000,20.10000,The Alliance,Exception Members,,16.29,,,,,,,11.64,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,outpatient,1,EA,21.16000,20.10000,The Alliance,Exception Members,,16.29,,,,,,,10.58,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,3.06,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Exception Members,,4.28,,,,,,,2.78,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,inpatient,1,GM,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,6.57,11.58,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,outpatient,1,GM,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,5.97,11.58,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,439.81,17311.25,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,inpatient,1,EA,23.40000,22.23000,The Alliance,Exception Members,,18.02,,,,,,,12.87,22.70,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,outpatient,1,EA,23.40000,22.23000,The Alliance,Exception Members,,18.02,,,,,,,11.70,22.70,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,inpatient,1,EA,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,3.40,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,outpatient,1,EA,6.19000,5.88000,The Alliance,Exception Members,,4.77,,,,,,,3.10,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,inpatient,1,EA,60150.20000,57142.69000,The Alliance,Exception Members,,46315.65,,,,,,,33082.61,58345.69,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,outpatient,1,EA,60150.20000,57142.69000,The Alliance,Exception Members,,46315.65,,,,,,,30075.10,58345.69,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,inpatient,1,EA,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,outpatient,1,EA,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,312.03,631.01,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,inpatient,1,mL,113.76000,108.07000,The Alliance,Exception Members,,87.60,,,,,,,62.57,110.35,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Exception Members,,87.60,,,,,,,7.57,110.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,inpatient,1,mL,67.86000,64.47000,The Alliance,Exception Members,,52.25,,,,,,,37.32,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,outpatient,1,mL,67.86000,64.47000,The Alliance,Exception Members,,52.25,,,,,,,1.42,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,inpatient,1,mL,71.93000,68.34000,The Alliance,Exception Members,,55.39,,,,,,,39.56,69.77,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,outpatient,1,mL,71.93000,68.34000,The Alliance,Exception Members,,55.39,,,,,,,1.42,69.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,inpatient,1,mL,46.99000,44.64000,The Alliance,Exception Members,,36.18,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,outpatient,1,mL,46.99000,44.64000,The Alliance,Exception Members,,36.18,,,,,,,23.50,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,7.62,14.77,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,177.51,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,91.50,1544.85,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,inpatient,1,mL,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.78,4.91,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Exception Members,,3.90,,,,,,,2.53,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,inpatient,1,mL,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.02,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Exception Members,,2.39,,,,,,,1.55,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Exception Members,,3.40,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,inpatient,1,mL,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.71,3.01,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,outpatient,1,mL,3.10000,2.94000,The Alliance,Exception Members,,2.39,,,,,,,1.55,5.23,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,inpatient,1,mL,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,126.07,4371.88,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,inpatient,,,953.00000,905.35000,The Alliance,Exception Members,TC,733.81,,,,,,,524.15,924.41,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Exception Members,TC,733.81,,,,,,,354.42,3685.66,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,281.05,495.67,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,122.40,495.67,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,inpatient,,,563.00000,534.85000,The Alliance,Exception Members,90,433.51,,,,,,,309.65,546.11,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Exception Members,90,433.51,,,,,,,70.04,6094.58,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,154.55,272.57,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,62.14,3038.81,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,,4142.60,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,,4142.60,,,,,,,759.53,35735.73,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,inpatient,,,320.70000,304.66000,The Alliance,Exception Members,90,246.94,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Exception Members,90,246.94,,,,,,,154.60,9082.50,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,inpatient,,,320.70000,304.66000,The Alliance,Exception Members,90,246.94,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Exception Members,90,246.94,,,,,,,160.35,13920.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,inpatient,,,972.00000,923.40000,The Alliance,Exception Members,90,748.44,,,,,,,534.60,942.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,outpatient,,,972.00000,923.40000,The Alliance,Exception Members,90,748.44,,,,,,,486.00,8610.62,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,Exception Members,TC,308.00,,,,,,,220.00,388.00,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,Exception Members,TC,308.00,,,,,,,200.00,3536.91,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,158.40,279.36,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,144.00,2342.52,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,TC,137.06,,,,,,,97.90,172.66,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,TC,137.06,,,,,,,67.83,848.80,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,inpatient,,,325.00000,308.75000,The Alliance,Exception Members,TC,250.25,,,,,,,178.75,315.25,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Exception Members,TC,250.25,,,,,,,162.50,2993.62,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,inpatient,,,1919.00000,1823.05000,The Alliance,Exception Members,,1477.63,,,,,,,1055.45,1861.43,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,outpatient,,,1919.00000,1823.05000,The Alliance,Exception Members,,1477.63,,,,,,,959.50,1861.43,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,Exception Members,TC,377.30,,,,,,,269.50,475.30,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Exception Members,TC,377.30,,,,,,,245.00,475.30,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,inpatient,,,1014.00000,963.30000,The Alliance,Exception Members,TC,780.78,,,,,,,557.70,983.58,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,outpatient,,,1014.00000,963.30000,The Alliance,Exception Members,TC,780.78,,,,,,,384.16,983.58,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,TC,1282.82,,,,,,,916.30,1616.02,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,TC,1282.82,,,,,,,833.00,10812.84,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,128.70,226.98,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,20.05,1052.52,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,128.70,226.98,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,20.05,1052.52,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,8.17,679.08,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,1037.00000,985.15000,The Alliance,Exception Members,,798.49,,,,,,,570.35,1005.89,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,1037.00000,985.15000,The Alliance,Exception Members,,798.49,,,,,,,213.76,1005.89,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,inpatient,,,3274.00000,3110.30000,The Alliance,Exception Members,TC,2520.98,,,,,,,1800.70,3175.78,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,outpatient,,,3274.00000,3110.30000,The Alliance,Exception Members,TC,2520.98,,,,,,,1487.04,3175.78,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,inpatient,,,29288.00000,27823.60000,The Alliance,Exception Members,,22551.76,,,,,,,14351.12,28409.36,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,outpatient,,,29288.00000,27823.60000,The Alliance,Exception Members,,22551.76,,,,,,,13443.19,29288.00,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.28,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.49,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Exception Members,,2.09,,,,,,,1.35,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,The Alliance,Exception Members,,2.38,,,,,,,1.70,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Exception Members,,2.38,,,,,,,1.54,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,183.32,399.38,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.56100,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Exception Members,,0.78540,,,,,,,0.51000,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,inpatient,1,mL,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,outpatient,1,mL,1.56000,1.49000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.81,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,inpatient,1,mL,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.47,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,outpatient,1,mL,2.68000,2.55000,The Alliance,Exception Members,,2.06,,,,,,,1.34,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,inpatient,1,mL,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.95150,1.68,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,outpatient,1,mL,1.73000,1.64000,The Alliance,Exception Members,,1.33,,,,,,,0.86500,1.68,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,GO,199.43,,,,,,,142.45,251.23,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,GO,199.43,,,,,,,126.65,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,GO,79.31,,,,,,,56.65,99.91,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,GO,79.31,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,GP,79.31,,,,,,,56.65,99.91,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,GP,79.31,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,GP,199.43,,,,,,,142.45,251.23,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,GP,199.43,,,,,,,126.65,264.00,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,163.52,356.25,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,inpatient,,,5390.00000,5120.50000,The Alliance,Exception Members,,4150.30,,,,,,,2964.50,5228.30,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,outpatient,,,5390.00000,5120.50000,The Alliance,Exception Members,,4150.30,,,,,,,2964.50,5271.00,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,inpatient,1,mL,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.91,10.42,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,outpatient,1,mL,10.74000,10.21000,The Alliance,Exception Members,,8.27,,,,,,,5.37,10.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,The Alliance,Exception Members,TC,1991.22,,,,,,,1422.30,2508.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Exception Members,TC,1991.22,,,,,,,1293.00,13397.25,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,inpatient,1,mL,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,19.12,33.72,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,outpatient,1,mL,34.76000,33.02000,The Alliance,Exception Members,,26.77,,,,,,,3.49,33.72,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,Exception Members,TC,558.25,,,,,,,398.75,703.25,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Exception Members,TC,558.25,,,,,,,237.91,17311.25,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,inpatient,,,919.00000,873.05000,The Alliance,Exception Members,TC,707.63,,,,,,,505.45,891.43,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,outpatient,,,919.00000,873.05000,The Alliance,Exception Members,TC,707.63,,,,,,,389.46,8543.92,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,1.58,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,inpatient,1,mL,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,inpatient,1,mL,24.07000,22.86000,The Alliance,Exception Members,,18.53,,,,,,,13.24,23.35,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,outpatient,1,mL,24.07000,22.86000,The Alliance,Exception Members,,18.53,,,,,,,12.04,23.35,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,inpatient,1,mL,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,0.88270,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,inpatient,1,mL,14.10000,13.39000,The Alliance,Exception Members,,10.86,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Exception Members,,10.86,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Exception Members,,11.73,,,,,,,1.49,14.77,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2084.29000,1980.08000,The Alliance,Exception Members,,1604.90,,,,,,,1021.30,2021.76,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2084.29000,1980.08000,The Alliance,Exception Members,,1604.90,,,,,,,956.69,2084.29,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,163.52,356.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,307.13000,291.77000,The Alliance,Exception Members,,236.49,,,,,,,150.49,297.92,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,307.13000,291.77000,The Alliance,Exception Members,,236.49,,,,,,,140.97,307.13,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,The Alliance,Exception Members,,11883.11,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Exception Members,,11883.11,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2500.84000,2375.80000,The Alliance,Exception Members,,1925.65,,,,,,,1225.41,2425.81,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2500.84000,2375.80000,The Alliance,Exception Members,,1925.65,,,,,,,1147.89,2500.84,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,The Alliance,Exception Members,,7685.25,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Exception Members,,7685.25,,,,,,,4581.21,9980.85,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,9.88,184.30,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,38.16,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,2115.00000,2009.25000,The Alliance,Exception Members,,1628.55,,,,,,,1163.25,2051.55,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,2115.00000,2009.25000,The Alliance,Exception Members,,1628.55,,,,,,,802.34,2051.55,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Exception Members,,7950.25,,,,,,,3612.55,10015.25,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,The Alliance,Exception Members,TC,1116.50,,,,,,,797.50,1406.50,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Exception Members,TC,1116.50,,,,,,,723.58,29731.35,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,500.59,29731.35,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,The Alliance,Exception Members,TC,8256.71,,,,,,,5897.65,10401.31,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Exception Members,TC,8256.71,,,,,,,5057.86,51844.17,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,inpatient,,,1400.00000,1330.00000,The Alliance,Exception Members,TC,1078.00,,,,,,,770.00,1358.00,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,outpatient,,,1400.00000,1330.00000,The Alliance,Exception Members,TC,1078.00,,,,,,,450.12,4834.29,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,inpatient,,,1399.00000,1329.05000,The Alliance,Exception Members,TC,1077.23,,,,,,,769.45,1357.03,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,outpatient,,,1399.00000,1329.05000,The Alliance,Exception Members,TC,1077.23,,,,,,,282.87,4511.07,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,1007.60,1777.04,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,916.00,1777.04,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,Exception Members,TC,767.69,,,,,,,548.35,967.09,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Exception Members,TC,767.69,,,,,,,384.16,1329.46,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,382.25,674.15,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,298.87,674.15,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,The Alliance,Exception Members,,3704.47,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Exception Members,,3704.47,,,,,,,1285.85,4666.67,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,,83.93,,,,,,,59.95,105.73,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,,83.93,,,,,,,11.57,560.26,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,inpatient,,,484.20000,459.99000,The Alliance,Exception Members,90,372.83,,,,,,,266.31,469.67,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Exception Members,90,372.83,,,,,,,44.27,2240.90,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,152.35,268.69,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,60.36,268.69,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,2.25,118.82,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,2.25,118.82,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,3.93,203.72,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,inpatient,,,1122.00000,1065.90000,The Alliance,Exception Members,,863.94,,,,,,,617.10,1088.34,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,outpatient,,,1122.00000,1065.90000,The Alliance,Exception Members,,863.94,,,,,,,415.12,1088.34,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,158.95,280.33,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,25.81,1341.13,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,27.50,48.50,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,5.08,254.68,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,inpatient,,,9216.00000,8755.20000,The Alliance,Exception Members,,7096.32,,,,,,,5068.80,8939.52,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Exception Members,,7096.32,,,,,,,3500.91,8939.52,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,3509.55,6189.57,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,1637.45,6189.57,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,16.07,763.98,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,99.55,175.57,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,13.73,713.01,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,inpatient,,,271.10000,257.54000,The Alliance,Exception Members,90,208.75,,,,,,,149.10,262.97,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,outpatient,,,271.10000,257.54000,The Alliance,Exception Members,90,208.75,,,,,,,8.91,458.40,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,Exception Members,,528.22,,,,,,,377.30,665.42,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Exception Members,,528.22,,,,,,,314.95,665.42,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,97.35,171.69,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,38.57,1832.89,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,inpatient,,,94.30000,89.58000,The Alliance,Exception Members,90,72.61,,,,,,,51.87,91.47,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,outpatient,,,94.30000,89.58000,The Alliance,Exception Members,90,72.61,,,,,,,47.15,4702.48,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,GP,58.52,,,,,,,41.80,73.72,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,GP,58.52,,,,,,,38.00,264.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,3163.00,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,587.06,3163.00,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,inpatient,,,371.50000,352.92000,The Alliance,Exception Members,,286.06,,,,,,,204.32,360.36,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Exception Members,,286.06,,,,,,,185.75,360.36,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,12.09,628.12,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,2.25,118.82,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,inpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,134.64,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,433.40,764.36,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,327.36,764.36,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,inpatient,1,EA,8.81000,8.37000,The Alliance,Exception Members,,6.78,,,,,,,4.85,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Exception Members,,6.78,,,,,,,4.41,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,inpatient,1,EA,11.12000,10.57000,The Alliance,Exception Members,,8.56,,,,,,,6.12,10.79,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,outpatient,1,EA,11.12000,10.57000,The Alliance,Exception Members,,8.56,,,,,,,5.56,10.79,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,inpatient,1,mL,43.92000,41.73000,The Alliance,Exception Members,,33.82,,,,,,,24.16,42.60,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,outpatient,1,mL,43.92000,41.73000,The Alliance,Exception Members,,33.82,,,,,,,21.96,83.21,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,143.55,253.17,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,13.25,696.05,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,The Alliance,Exception Members,,2873.06,,,,,,,1828.31,3619.31,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Exception Members,,2873.06,,,,,,,1712.64,3731.25,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,inpatient,,,1441.00000,1368.95000,The Alliance,Exception Members,,1109.57,,,,,,,792.55,1397.77,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,outpatient,,,1441.00000,1368.95000,The Alliance,Exception Members,,1109.57,,,,,,,792.55,4686.00,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,inpatient,,,1616.00000,1535.20000,The Alliance,Exception Members,,1244.32,,,,,,,888.80,1567.52,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,outpatient,,,1616.00000,1535.20000,The Alliance,Exception Members,,1244.32,,,,,,,888.80,5271.00,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,Exception Members,90,164.78,,,,,,,117.70,207.58,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Exception Members,90,164.78,,,,,,,21.00,1069.56,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4467.75000,4244.36000,The Alliance,Exception Members,,3440.17,,,,,,,2189.20,4333.72,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Exception Members,,3440.17,,,,,,,2050.70,4467.75,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,224.40,395.76,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,204.00,26177.94,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,inpatient,,,484.20000,459.99000,The Alliance,Exception Members,90,372.83,,,,,,,266.31,469.67,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Exception Members,90,372.83,,,,,,,44.27,2240.90,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,inpatient,1,mL,29.77000,28.29000,The Alliance,Exception Members,,22.92,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Exception Members,,22.92,,,,,,,14.88,73.49,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,inpatient,1,mL,29.78000,28.29000,The Alliance,Exception Members,,22.93,,,,,,,16.38,28.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,outpatient,1,mL,29.78000,28.29000,The Alliance,Exception Members,,22.93,,,,,,,14.89,73.49,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,90.03,158.79,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,20.36,1120.45,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,52.50,264.00,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,inpatient,,,351.00000,333.45000,The Alliance,Exception Members,,270.27,,,,,,,193.05,340.47,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Exception Members,,270.27,,,,,,,115.36,6026.72,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.06,254.68,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,49.50,264.00,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,417.10,17311.25,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.17,2.06,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Exception Members,,1.63,,,,,,,1.06,2.06,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,30.80,54.32,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,22.80,54.32,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,143.55,253.17,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,25.47,1324.17,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,26.40,46.56,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,6.41,1590.11,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,The Alliance,Exception Members,TC,3980.13,,,,,,,2842.95,5013.93,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Exception Members,TC,3980.13,,,,,,,2584.50,5271.00,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1084.39,2362.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,inpatient,1,mL,29.77000,28.29000,The Alliance,Exception Members,,22.92,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Exception Members,,22.92,,,,,,,14.88,73.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,inpatient,,,130.40000,123.88000,The Alliance,Exception Members,90,100.41,,,,,,,71.72,126.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,outpatient,,,130.40000,123.88000,The Alliance,Exception Members,90,100.41,,,,,,,12.41,628.12,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,inpatient,,,454.10000,431.40000,The Alliance,Exception Members,90,349.66,,,,,,,249.75,440.48,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,outpatient,,,454.10000,431.40000,The Alliance,Exception Members,90,349.66,,,,,,,52.89,2410.69,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,inpatient,,,192.50000,182.88000,The Alliance,Exception Members,90,148.22,,,,,,,105.88,186.72,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,outpatient,,,192.50000,182.88000,The Alliance,Exception Members,90,148.22,,,,,,,17.60,882.80,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,36.26,1833.46,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,The Alliance,Exception Members,,1362.90,,,,,,,867.30,1716.90,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Exception Members,,1362.90,,,,,,,812.43,1770.00,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Exception Members,,13488.94,,,,,,,8040.81,17518.10,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,14201.10000,13491.04000,The Alliance,Exception Members,,10934.85,,,,,,,6958.54,13775.07,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,14201.10000,13491.04000,The Alliance,Exception Members,,10934.85,,,,,,,6518.30,14201.10,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,34.10,60.14,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,31.00,264.00,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,717.75,1265.85,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,126.07,6798.73,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,90,117.81,,,,,,,84.15,148.41,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,90,117.81,,,,,,,15.53,780.94,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,Exception Members,90,193.27,,,,,,,138.05,243.47,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Exception Members,90,193.27,,,,,,,12.40,628.12,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,218.24,384.90,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,36.26,1833.46,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,113.30,199.82,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,18.37,967.70,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,22.91,1035.56,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3505.20000,3329.94000,The Alliance,Exception Members,,2699.00,,,,,,,1717.55,3400.04,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3505.20000,3329.94000,The Alliance,Exception Members,,2699.00,,,,,,,1608.89,3505.20,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,inpatient,1,EA,169.94000,161.45000,The Alliance,Exception Members,,130.85,,,,,,,93.47,164.84,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,outpatient,1,EA,169.94000,161.45000,The Alliance,Exception Members,,130.85,,,,,,,84.97,164.84,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,inpatient,1,EA,13.76000,13.08000,The Alliance,Exception Members,,10.60,,,,,,,7.57,13.35,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,outpatient,1,EA,13.76000,13.08000,The Alliance,Exception Members,,10.60,,,,,,,0.73160,13.35,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,351.45000,333.88000,The Alliance,Exception Members,,270.62,,,,,,,172.21,340.91,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,351.45000,333.88000,The Alliance,Exception Members,,270.62,,,,,,,161.32,351.45,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Exception Members,,0.67760,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,inpatient,,,1354.00000,1286.30000,The Alliance,Exception Members,TC,1042.58,,,,,,,744.70,1313.38,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,outpatient,,,1354.00000,1286.30000,The Alliance,Exception Members,TC,1042.58,,,,,,,384.16,1313.38,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5168.10000,4909.70000,The Alliance,Exception Members,,3979.44,,,,,,,2532.37,5013.06,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5168.10000,4909.70000,The Alliance,Exception Members,,3979.44,,,,,,,2372.16,5168.10,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,inpatient,,,1356.00000,1288.20000,The Alliance,Exception Members,,1044.12,,,,,,,745.80,1315.32,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,outpatient,,,1356.00000,1288.20000,The Alliance,Exception Members,,1044.12,,,,,,,227.78,5858.00,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,90,157.08,,,,,,,112.20,197.88,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,90,157.08,,,,,,,18.65,950.66,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,13.25,696.05,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,13.25,696.05,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,Exception Members,90,121.89,,,,,,,87.06,153.55,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Exception Members,90,121.89,,,,,,,19.26,882.80,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,36.26,1833.46,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,90,175.56,,,,,,,125.40,221.16,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,90,175.56,,,,,,,12.38,628.12,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,90.75,160.05,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Exception Members,,127.05,,,,,,,13.25,696.05,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,24.89,1137.41,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,85.80,151.32,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,16.46,865.84,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,218.24,384.90,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,36.26,1833.46,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,218.24,384.90,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Exception Members,90,305.54,,,,,,,50.62,3666.93,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,6.47,339.51,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,Exception Members,90,127.05,,,,,,,90.75,160.05,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Exception Members,90,127.05,,,,,,,15.09,763.98,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,inpatient,,,5028.00000,4776.60000,The Alliance,Exception Members,90,3871.56,,,,,,,2765.40,4877.16,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,outpatient,,,5028.00000,4776.60000,The Alliance,Exception Members,90,3871.56,,,,,,,430.66,21780.96,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,The Alliance,Exception Members,90,303.00,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Exception Members,90,303.00,,,,,,,43.79,1986.29,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,The Alliance,Exception Members,90,303.00,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Exception Members,90,303.00,,,,,,,43.79,1986.29,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,129.67,6518.98,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,inpatient,,,149.70000,142.21000,The Alliance,Exception Members,90,115.27,,,,,,,82.33,145.21,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,outpatient,,,149.70000,142.21000,The Alliance,Exception Members,90,115.27,,,,,,,13.33,679.08,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,78.10,137.74,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Exception Members,,109.34,,,,,,,14.86,137.74,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,273.46,482.28,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,44.27,2240.90,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,inpatient,,,160.20000,152.19000,The Alliance,Exception Members,90,123.35,,,,,,,88.11,155.39,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Exception Members,90,123.35,,,,,,,14.65,746.94,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,inpatient,,,460.60000,437.57000,The Alliance,Exception Members,90,354.66,,,,,,,253.33,446.78,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,outpatient,,,460.60000,437.57000,The Alliance,Exception Members,90,354.66,,,,,,,42.11,2122.08,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,inpatient,1,GM,379.18000,360.22000,The Alliance,Exception Members,,291.97,,,,,,,208.55,367.80,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,outpatient,1,GM,379.18000,360.22000,The Alliance,Exception Members,,291.97,,,,,,,189.59,367.80,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.19800,0.34920,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Exception Members,,0.27720,,,,,,,0.18000,0.34920,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,inpatient,1,EA,15.47000,14.69000,The Alliance,Exception Members,,11.91,,,,,,,8.51,15.01,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,outpatient,1,EA,15.47000,14.69000,The Alliance,Exception Members,,11.91,,,,,,,7.74,15.01,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.44,2.53,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.30,2.53,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,2.00,3.52,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Exception Members,,2.80,,,,,,,1.02,3.52,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,inpatient,1,EA,10.18000,9.67000,The Alliance,Exception Members,,7.84,,,,,,,5.60,9.87,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,outpatient,1,EA,10.18000,9.67000,The Alliance,Exception Members,,7.84,,,,,,,5.09,9.87,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,inpatient,1,EA,3.16000,3.01000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,outpatient,1,EA,3.16000,3.01000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,inpatient,1,mL,1421.20000,1350.14000,The Alliance,Exception Members,,1094.32,,,,,,,781.66,1378.56,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,outpatient,1,mL,1421.20000,1350.14000,The Alliance,Exception Members,,1094.32,,,,,,,0.37000,1378.56,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,inpatient,1,EA,3.93000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,2.16,3.81,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,outpatient,1,EA,3.93000,3.74000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.81,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.29150,0.51410,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Exception Members,,0.40810,,,,,,,0.26500,0.51410,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.57,3.05,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.96800,1.71,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88000,1.71,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,inpatient,1,EA,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.17,2.07,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Exception Members,,1.64,,,,,,,1.06,2.07,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,inpatient,1,EA,40.37000,38.36000,The Alliance,Exception Members,,31.08,,,,,,,22.20,39.16,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,outpatient,1,EA,40.37000,38.36000,The Alliance,Exception Members,,31.08,,,,,,,20.18,39.16,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,inpatient,1,mL,301.09000,286.03000,The Alliance,Exception Members,,231.84,,,,,,,165.60,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,outpatient,1,mL,301.09000,286.03000,The Alliance,Exception Members,,231.84,,,,,,,92.50,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,inpatient,1,mL,305.62000,290.34000,The Alliance,Exception Members,,235.33,,,,,,,168.09,296.45,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,outpatient,1,mL,305.62000,290.34000,The Alliance,Exception Members,,235.33,,,,,,,92.50,296.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,inpatient,1,mL,14.59000,13.86000,The Alliance,Exception Members,,11.23,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Exception Members,,11.23,,,,,,,7.29,73.49,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,inpatient,1,EA,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.80,4.94,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.54,4.94,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,1.08,1.91,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Exception Members,,1.52,,,,,,,0.98500,1.91,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.39,4.22,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Exception Members,,3.35,,,,,,,2.17,4.22,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,inpatient,1,EA,8.72000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,4.80,8.46,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,outpatient,1,EA,8.72000,8.28000,The Alliance,Exception Members,,6.71,,,,,,,4.36,8.46,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,inpatient,1,mL,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.92,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Exception Members,,4.09,,,,,,,2.65,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,inpatient,1,mL,16.35000,15.54000,The Alliance,Exception Members,,12.59,,,,,,,8.99,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,outpatient,1,mL,16.35000,15.54000,The Alliance,Exception Members,,12.59,,,,,,,3.62,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,inpatient,1,mL,6.68000,6.35000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.48,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,outpatient,1,mL,6.68000,6.35000,The Alliance,Exception Members,,5.14,,,,,,,3.34,6.48,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,inpatient,1,EA,890.96000,846.41000,The Alliance,Exception Members,,686.04,,,,,,,490.03,864.23,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,outpatient,1,EA,890.96000,846.41000,The Alliance,Exception Members,,686.04,,,,,,,445.48,864.23,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,inpatient,1,mL,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,outpatient,1,mL,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,inpatient,1,GM,11.29000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,6.21,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,outpatient,1,GM,11.29000,10.72000,The Alliance,Exception Members,,8.69,,,,,,,5.64,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,inpatient,1,GM,13.50000,12.82000,The Alliance,Exception Members,,10.39,,,,,,,7.42,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,outpatient,1,GM,13.50000,12.82000,The Alliance,Exception Members,,10.39,,,,,,,6.75,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,inpatient,1,GM,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,outpatient,1,GM,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,inpatient,1,mL,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.21,2.13,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Exception Members,,1.69,,,,,,,1.10,2.13,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.00620,0.23280,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,inpatient,,,2143.00000,2035.85000,The Alliance,Exception Members,,1650.11,,,,,,,1178.65,2078.71,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,outpatient,,,2143.00000,2035.85000,The Alliance,Exception Members,,1650.11,,,,,,,1178.65,4686.00,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,124.80000,118.56000,The Alliance,Exception Members,,96.10,,,,,,,61.15,121.06,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,124.80000,118.56000,The Alliance,Exception Members,,96.10,,,,,,,57.28,124.80,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,90,163.24,,,,,,,116.60,205.64,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,90,163.24,,,,,,,18.53,933.70,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,62.14,3038.81,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,7.33,1284.54,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,inpatient,,,876.00000,832.20000,The Alliance,Exception Members,,674.52,,,,,,,481.80,849.72,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Exception Members,,674.52,,,,,,,18.40,865.84,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,411.55,17311.25,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,inpatient,,,959.00000,911.05000,The Alliance,Exception Members,90,738.43,,,,,,,527.45,930.23,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,outpatient,,,959.00000,911.05000,The Alliance,Exception Members,90,738.43,,,,,,,59.93,3038.81,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,The Alliance,Exception Members,TC,2437.82,,,,,,,1741.30,3071.02,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Exception Members,TC,2437.82,,,,,,,418.96,17311.25,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,4.95,254.68,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,13.38,679.08,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,inpatient,,,129.20000,122.74000,The Alliance,Exception Members,90,99.48,,,,,,,71.06,125.32,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,outpatient,,,129.20000,122.74000,The Alliance,Exception Members,90,99.48,,,,,,,11.81,594.19,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,inpatient,,,170.50000,161.98000,The Alliance,Exception Members,90,131.28,,,,,,,93.78,165.38,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,outpatient,,,170.50000,161.98000,The Alliance,Exception Members,90,131.28,,,,,,,15.18,763.98,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,90,78.54,,,,,,,56.10,98.94,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,90,78.54,,,,,,,17.85,814.87,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,Exception Members,90,739.97,,,,,,,528.55,932.17,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Exception Members,90,739.97,,,,,,,87.93,4447.87,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,inpatient,,,413.30000,392.64000,The Alliance,Exception Members,90,318.24,,,,,,,227.31,400.90,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,outpatient,,,413.30000,392.64000,The Alliance,Exception Members,90,318.24,,,,,,,37.79,1918.36,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,inpatient,,,192.00000,182.40000,The Alliance,Exception Members,90,147.84,,,,,,,105.60,186.24,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Exception Members,90,147.84,,,,,,,17.50,882.80,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,257.95,454.93,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,122.40,454.93,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,inpatient,,,1007.00000,956.65000,The Alliance,Exception Members,,775.39,,,,,,,553.85,976.79,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,outpatient,,,1007.00000,956.65000,The Alliance,Exception Members,,775.39,,,,,,,503.50,8610.62,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,90,1142.68,,,,,,,816.20,1439.48,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,90,1142.68,,,,,,,143.40,8250.66,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,15.29,780.94,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,The Alliance,Exception Members,,1761.38,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Exception Members,,1761.38,,,,,,,1049.96,2287.50,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,inpatient,,,2733.00000,2596.35000,The Alliance,Exception Members,90,2104.41,,,,,,,1503.15,2651.01,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,outpatient,,,2733.00000,2596.35000,The Alliance,Exception Members,90,2104.41,,,,,,,264.01,15261.97,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,74.91,132.11,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,12.45,1539.22,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,17.85,814.87,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,inpatient,,,416.90000,396.05000,The Alliance,Exception Members,90,321.01,,,,,,,229.29,404.39,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,outpatient,,,416.90000,396.05000,The Alliance,Exception Members,90,321.01,,,,,,,137.00,6451.13,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,inpatient,,,386.00000,366.70000,The Alliance,Exception Members,,297.22,,,,,,,212.30,374.42,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,Exception Members,,297.22,,,,,,,193.00,446.00,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1475.00000,1401.25000,The Alliance,Exception Members,,1135.75,,,,,,,811.25,1430.75,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,Exception Members,,1135.75,,,,,,,162.71,8693.45,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1422.00000,1350.90000,The Alliance,Exception Members,90,1094.94,,,,,,,782.10,1379.34,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1422.00000,1350.90000,The Alliance,Exception Members,90,1094.94,,,,,,,533.12,8693.45,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,inpatient,,,65.80000,62.51000,The Alliance,Exception Members,90,50.67,,,,,,,36.19,63.83,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,outpatient,,,65.80000,62.51000,The Alliance,Exception Members,90,50.67,,,,,,,32.90,1850.43,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,inpatient,,,227.60000,216.22000,The Alliance,Exception Members,90,175.25,,,,,,,125.18,220.77,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,outpatient,,,227.60000,216.22000,The Alliance,Exception Members,90,175.25,,,,,,,54.46,2682.34,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,inpatient,,,461.00000,437.95000,The Alliance,Exception Members,90,354.97,,,,,,,253.55,447.17,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,outpatient,,,461.00000,437.95000,The Alliance,Exception Members,90,354.97,,,,,,,42.11,2122.08,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,90,191.73,,,,,,,136.95,241.53,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,90,191.73,,,,,,,22.72,1154.38,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,inpatient,,,630.00000,598.50000,The Alliance,Exception Members,,485.10,,,,,,,346.50,611.10,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,Exception Members,,485.10,,,,,,,18.37,967.70,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,35.09,1833.46,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,Exception Members,90,455.07,,,,,,,325.05,573.27,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Exception Members,90,455.07,,,,,,,295.50,4462.27,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,inpatient,,,148.10000,140.70000,The Alliance,Exception Members,90,114.04,,,,,,,81.45,143.66,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,outpatient,,,148.10000,140.70000,The Alliance,Exception Members,90,114.04,,,,,,,15.06,763.98,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,24.20,42.68,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,22.00,42.68,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,inpatient,,,1743.00000,1655.85000,The Alliance,Exception Members,,1342.11,,,,,,,958.65,1690.71,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,outpatient,,,1743.00000,1655.85000,The Alliance,Exception Members,,1342.11,,,,,,,50.73,11449.71,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,The Alliance,Exception Members,90,177.49,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Exception Members,90,177.49,,,,,,,45.08,679.08,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,inpatient,,,299.70000,284.71000,The Alliance,Exception Members,90,230.77,,,,,,,164.84,290.71,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,outpatient,,,299.70000,284.71000,The Alliance,Exception Members,90,230.77,,,,,,,18.98,967.70,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2282.18,4517.77,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2137.79,4657.50,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.80000,534.66000,The Alliance,Exception Members,,433.36,,,,,,,275.77,545.92,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.80000,534.66000,The Alliance,Exception Members,,433.36,,,,,,,258.33,562.80,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,104.14,226.88,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,13.77,30.00,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,inpatient,,,196.50000,186.67000,The Alliance,Exception Members,90,151.31,,,,,,,108.08,190.60,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Exception Members,90,151.31,,,,,,,98.25,9523.86,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,inpatient,,,440.20000,418.19000,The Alliance,Exception Members,90,338.95,,,,,,,242.11,426.99,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,outpatient,,,440.20000,418.19000,The Alliance,Exception Members,90,338.95,,,,,,,19.60,984.66,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,90,117.04,,,,,,,83.60,147.44,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,90,117.04,,,,,,,76.00,241.38,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,90.03,158.79,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,20.36,1120.45,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,14.61,679.08,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,inpatient,,,569.00000,540.55000,The Alliance,Exception Members,,438.13,,,,,,,312.95,551.93,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Exception Members,,438.13,,,,,,,35.09,1833.46,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,inpatient,,,216.20000,205.39000,The Alliance,Exception Members,90,166.47,,,,,,,118.91,209.71,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Exception Members,90,166.47,,,,,,,8.17,645.08,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,inpatient,,,383.80000,364.61000,The Alliance,Exception Members,,295.53,,,,,,,211.09,372.29,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,outpatient,,,383.80000,364.61000,The Alliance,Exception Members,,295.53,,,,,,,33.94,1765.53,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,inpatient,,,220.40000,209.38000,The Alliance,Exception Members,90,169.71,,,,,,,121.22,213.79,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,outpatient,,,220.40000,209.38000,The Alliance,Exception Members,90,169.71,,,,,,,20.36,1120.45,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,248.05,437.47,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,37.73,1969.25,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,90,157.08,,,,,,,112.20,197.88,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,90,157.08,,,,,,,18.66,950.66,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,90,1260.49,,,,,,,900.35,1587.89,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,90,1260.49,,,,,,,149.66,7571.58,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,inpatient,,,1818.00000,1727.10000,The Alliance,Exception Members,90,1399.86,,,,,,,999.90,1763.46,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1818.00000,1727.10000,The Alliance,Exception Members,90,1399.86,,,,,,,175.54,10101.09,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,273.46,482.28,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Exception Members,90,382.84,,,,,,,44.27,2240.90,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,inpatient,,,102.40000,97.28000,The Alliance,Exception Members,90,78.85,,,,,,,56.32,99.33,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,outpatient,,,102.40000,97.28000,The Alliance,Exception Members,90,78.85,,,,,,,3.40,492.33,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,inpatient,,,156.70000,148.86000,The Alliance,Exception Members,90,120.66,,,,,,,86.19,152.00,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,outpatient,,,156.70000,148.86000,The Alliance,Exception Members,90,120.66,,,,,,,5.90,424.40,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,Exception Members,90,127.05,,,,,,,90.75,160.05,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Exception Members,90,127.05,,,,,,,15.09,763.98,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,33.47,1578.85,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,TC,1952.72,,,,,,,1394.80,2459.92,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,TC,1952.72,,,,,,,990.94,2459.92,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,inpatient,1,mL,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.43,2.52,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,outpatient,1,mL,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.30,2.52,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,392.70,5858.00,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,inpatient,,,2201.00000,2090.95000,The Alliance,Exception Members,,1694.77,,,,,,,1210.55,2134.97,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,outpatient,,,2201.00000,2090.95000,The Alliance,Exception Members,,1694.77,,,,,,,1210.55,7803.00,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,inpatient,,,248.10000,235.70000,The Alliance,Exception Members,90,191.04,,,,,,,136.46,240.66,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,outpatient,,,248.10000,235.70000,The Alliance,Exception Members,90,191.04,,,,,,,22.69,1154.38,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.58,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,inpatient,1,mL,3285.02000,3120.77000,The Alliance,Exception Members,,2529.47,,,,,,,1806.76,3186.47,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,outpatient,1,mL,3285.02000,3120.77000,The Alliance,Exception Members,,2529.47,,,,,,,28.70,3186.47,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,inpatient,,,49.30000,46.83000,The Alliance,Exception Members,90,37.96,,,,,,,27.11,47.82,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Exception Members,90,37.96,,,,,,,24.65,1527.89,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,8.17,645.08,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,83.98,148.12,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,18.40,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,,112.73,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,,112.73,,,,,,,17.27,814.87,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,Exception Members,,122.89,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Exception Members,,122.89,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.30000,129.49000,The Alliance,Exception Members,90,104.95,,,,,,,74.97,132.21,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.30000,129.49000,The Alliance,Exception Members,90,104.95,,,,,,,12.45,1539.22,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,90,100.87,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,90,100.87,,,,,,,14.99,780.94,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,14.99,780.94,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,133.10,234.74,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Exception Members,,186.34,,,,,,,21.41,1120.45,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,83.98,148.12,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,18.40,865.84,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,Exception Members,,122.89,,,,,,,87.78,154.81,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Exception Members,,122.89,,,,,,,19.88,1103.49,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,16.07,763.98,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,5.35,271.65,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,inpatient,,,52.40000,49.78000,The Alliance,Exception Members,90,40.35,,,,,,,28.82,50.83,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,outpatient,,,52.40000,49.78000,The Alliance,Exception Members,90,40.35,,,,,,,4.79,237.65,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,24.89,1137.41,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,775.50,1367.70,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,129.67,6518.98,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,inpatient,,,777.00000,738.15000,The Alliance,Exception Members,90,598.29,,,,,,,427.35,753.69,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,Exception Members,90,598.29,,,,,,,70.88,3582.03,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.14409,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,inpatient,1,mL,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,outpatient,1,mL,1.03000,0.97000,The Alliance,Exception Members,,0.79310,,,,,,,0.14409,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,inpatient,1,mL,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Exception Members,,1.35,,,,,,,0.14409,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,inpatient,1,mL,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,outpatient,1,mL,1.33000,1.27000,The Alliance,Exception Members,,1.02,,,,,,,0.14409,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,inpatient,1,mL,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Exception Members,,0.86240,,,,,,,0.14409,1.09,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,,44.97,,,,,,,32.12,56.65,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,,44.97,,,,,,,7.27,373.51,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,inpatient,,,135.40000,128.63000,The Alliance,Exception Members,,104.26,,,,,,,74.47,131.34,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,outpatient,,,135.40000,128.63000,The Alliance,Exception Members,,104.26,,,,,,,11.98,628.12,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,Exception Members,TC,705.32,,,,,,,503.80,888.52,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Exception Members,TC,705.32,,,,,,,384.16,888.52,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,366.85,646.99,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,333.50,646.99,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,548.35,967.09,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,384.16,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,366.85,646.99,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,333.50,2161.00,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,548.35,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,498.50,2161.00,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,inpatient,,,2025.00000,1923.75000,The Alliance,Exception Members,,1559.25,,,,,,,1113.75,1964.25,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,outpatient,,,2025.00000,1923.75000,The Alliance,Exception Members,,1559.25,,,,,,,1012.50,1964.25,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,inpatient,,,4212.00000,4001.40000,The Alliance,Exception Members,,3243.24,,,,,,,2316.60,4085.64,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,outpatient,,,4212.00000,4001.40000,The Alliance,Exception Members,,3243.24,,,,,,,542.77,4085.64,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,366.85,646.99,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,333.50,646.99,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,548.35,967.09,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Exception Members,,767.69,,,,,,,498.50,967.09,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1290.94,2812.50,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,13.82,645.08,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,128.32,279.56,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,31.90,56.26,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,8.17,696.05,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,130.90,285.19,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,inpatient,1,EA,1.54000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.84700,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,outpatient,1,EA,1.54000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77000,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,31.90,56.26,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,8.17,696.05,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,20.36,1120.45,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,0.24250,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,inpatient,,,640.00000,608.00000,The Alliance,Exception Members,TC,492.80,,,,,,,352.00,620.80,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,outpatient,,,640.00000,608.00000,The Alliance,Exception Members,TC,492.80,,,,,,,320.00,620.80,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.46200,0.81480,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Exception Members,,0.64680,,,,,,,0.42000,0.81480,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,44.12000,41.91000,The Alliance,Exception Members,,33.97,,,,,,,21.62,42.80,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,44.12000,41.91000,The Alliance,Exception Members,,33.97,,,,,,,20.25,44.12,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.97350,1.72,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Exception Members,,1.36,,,,,,,0.88500,1.72,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,90,110.88,,,,,,,79.20,139.68,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,90,110.88,,,,,,,8.17,882.80,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,inpatient,1,mL,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.72050,1.27,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Exception Members,,1.01,,,,,,,0.65500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,inpatient,1,mL,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.61600,1.09,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Exception Members,,0.86240,,,,,,,0.56000,7.69,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,361.82,17311.25,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,182.60,322.04,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,166.00,1692.33,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,31.90,56.26,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,90,44.66,,,,,,,8.17,696.05,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,11.98,628.12,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2810.00000,2669.50000,The Alliance,Exception Members,90,2163.70,,,,,,,1545.50,2725.70,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2810.00000,2669.50000,The Alliance,Exception Members,90,2163.70,,,,,,,608.00,54562.77,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2066.00000,1962.70000,The Alliance,Exception Members,90,1590.82,,,,,,,1136.30,2004.02,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2066.00000,1962.70000,The Alliance,Exception Members,90,1590.82,,,,,,,608.00,54562.77,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,inpatient,,,214.70000,203.96000,The Alliance,Exception Members,90,165.32,,,,,,,118.08,208.26,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Exception Members,90,165.32,,,,,,,26.72,1273.27,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Exception Members,90,1085.70,,,,,,,129.67,6518.98,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,inpatient,,,157.60000,149.72000,The Alliance,Exception Members,90,121.35,,,,,,,86.68,152.87,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,outpatient,,,157.60000,149.72000,The Alliance,Exception Members,90,121.35,,,,,,,9.19,458.40,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,inpatient,,,152.80000,145.16000,The Alliance,Exception Members,90,117.66,,,,,,,84.04,148.22,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,outpatient,,,152.80000,145.16000,The Alliance,Exception Members,90,117.66,,,,,,,13.97,713.01,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,inpatient,,,208.80000,198.36000,The Alliance,Exception Members,90,160.78,,,,,,,114.84,202.54,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,outpatient,,,208.80000,198.36000,The Alliance,Exception Members,90,160.78,,,,,,,15.49,780.94,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,Exception Members,90,133.98,,,,,,,95.70,168.78,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Exception Members,90,133.98,,,,,,,15.49,780.94,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,,313.70,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,,313.70,,,,,,,203.70,3727.42,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,203.70,3727.42,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,Exception Members,90,117.58,,,,,,,83.98,148.12,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Exception Members,90,117.58,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,17.85,814.87,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,inpatient,,,153.10000,145.44000,The Alliance,Exception Members,90,117.89,,,,,,,84.20,148.51,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,outpatient,,,153.10000,145.44000,The Alliance,Exception Members,90,117.89,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,17.85,814.87,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,26.50,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,126.65,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,126.65,264.00,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,inpatient,,,257.80000,244.91000,The Alliance,Exception Members,90,198.51,,,,,,,141.79,250.07,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,outpatient,,,257.80000,244.91000,The Alliance,Exception Members,90,198.51,,,,,,,23.57,1188.38,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,inpatient,,,149.40000,141.93000,The Alliance,Exception Members,,115.04,,,,,,,82.17,144.92,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,outpatient,,,149.40000,141.93000,The Alliance,Exception Members,,115.04,,,,,,,29.28,1527.89,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,inpatient,,,101.90000,96.81000,The Alliance,Exception Members,90,78.46,,,,,,,56.05,98.84,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Exception Members,90,78.46,,,,,,,9.32,475.37,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,inpatient,,,131.80000,125.21000,The Alliance,Exception Members,90,101.49,,,,,,,72.49,127.85,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,outpatient,,,131.80000,125.21000,The Alliance,Exception Members,90,101.49,,,,,,,14.80,679.08,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,90,160.93,,,,,,,114.95,202.73,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,90,160.93,,,,,,,20.18,967.70,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1775.03,3513.82,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,The Alliance,Exception Members,,1061.83,,,,,,,758.45,1337.63,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Exception Members,,1061.83,,,,,,,115.36,6026.72,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,The Alliance,Exception Members,,1761.38,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Exception Members,,1761.38,,,,,,,1049.96,2287.50,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,inpatient,,,339.20000,322.24000,The Alliance,Exception Members,90,261.18,,,,,,,186.56,329.02,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,outpatient,,,339.20000,322.24000,The Alliance,Exception Members,90,261.18,,,,,,,18.72,882.80,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,inpatient,,,3791.00000,3601.45000,The Alliance,Exception Members,,2919.07,,,,,,,1857.59,3677.27,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,outpatient,,,3791.00000,3601.45000,The Alliance,Exception Members,,2919.07,,,,,,,1040.32,3791.00,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1533.19000,1456.53000,The Alliance,Exception Members,,1180.56,,,,,,,751.26,1487.19,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1533.19000,1456.53000,The Alliance,Exception Members,,1180.56,,,,,,,703.73,1533.19,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,246.14,536.25,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,246.14,536.25,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,297.55,524.77,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,212.82,1232.72,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,14.54,31.68,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,54.00,264.00,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,,1747.13,,,,,,,1247.95,2200.93,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,,1747.13,,,,,,,384.16,3015.65,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,90,120.12,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,90,120.12,,,,,,,13.89,696.05,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4481.55000,4257.47000,The Alliance,Exception Members,,3450.79,,,,,,,2195.96,4347.10,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4481.55000,4257.47000,The Alliance,Exception Members,,3450.79,,,,,,,2057.03,4481.55,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,inpatient,1,EA,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.22,3.91,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Exception Members,,3.10,,,,,,,2.02,3.91,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,42.23,92.00,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,inpatient,1,mL,8.95000,8.50000,The Alliance,Exception Members,,6.89,,,,,,,4.92,8.68,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,outpatient,1,mL,8.95000,8.50000,The Alliance,Exception Members,,6.89,,,,,,,4.47,8.68,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,The Alliance,Exception Members,,10741.50,,,,,,,6835.50,13531.50,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Exception Members,,10741.50,,,,,,,6403.05,13950.00,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,967.50000,919.12000,The Alliance,Exception Members,,744.98,,,,,,,474.07,938.48,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,967.50000,919.12000,The Alliance,Exception Members,,744.98,,,,,,,444.08,967.50,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,1042.50000,990.38000,The Alliance,Exception Members,,802.73,,,,,,,510.82,1011.23,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1042.50000,990.38000,The Alliance,Exception Members,,802.73,,,,,,,478.51,1042.50,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,The Alliance,Exception Members,,2568.72,,,,,,,1834.80,3235.92,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Exception Members,,2568.72,,,,,,,295.69,3235.92,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,The Alliance,Exception Members,,2930.62,,,,,,,2093.30,3691.82,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Exception Members,,2930.62,,,,,,,295.69,3691.82,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,The Alliance,Exception Members,,2701.16,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Exception Members,,2701.16,,,,,,,295.69,3402.76,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,The Alliance,Exception Members,TC,3326.40,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Exception Members,TC,3326.40,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3612.00000,3431.40000,The Alliance,Exception Members,TC,2781.24,,,,,,,1986.60,3503.64,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3612.00000,3431.40000,The Alliance,Exception Members,TC,2781.24,,,,,,,1806.00,3503.64,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,Exception Members,TC,251.79,,,,,,,179.85,317.19,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Exception Members,TC,251.79,,,,,,,163.50,317.19,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,,1382.15,,,,,,,987.25,1741.15,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,,1382.15,,,,,,,295.69,1741.15,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,The Alliance,Exception Members,TC,1221.22,,,,,,,872.30,1538.42,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Exception Members,TC,1221.22,,,,,,,793.00,1538.42,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,Exception Members,TC,321.09,,,,,,,229.35,404.49,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Exception Members,TC,321.09,,,,,,,208.50,404.49,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,,2607.22,,,,,,,1862.30,3284.42,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,,2607.22,,,,,,,503.83,3284.42,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,820.60,1447.24,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,746.00,1447.24,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,,1275.12,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Exception Members,,1275.12,,,,,,,828.00,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,,1282.82,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Exception Members,,1282.82,,,,,,,503.83,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,The Alliance,Exception Members,,3384.92,,,,,,,2417.80,4264.12,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Exception Members,,3384.92,,,,,,,966.05,4264.12,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,inpatient,1,EA,5074.51000,4820.79000,The Alliance,Exception Members,,3907.37,,,,,,,2790.98,4922.27,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,outpatient,1,EA,5074.51000,4820.79000,The Alliance,Exception Members,,3907.37,,,,,,,2537.26,4922.27,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.10000,227.14000,The Alliance,Exception Members,,184.11,,,,,,,117.16,231.93,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.10000,227.14000,The Alliance,Exception Members,,184.11,,,,,,,109.75,239.10,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,inpatient,1,EA,3.52000,3.34000,The Alliance,Exception Members,,2.71,,,,,,,1.94,3.41,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,outpatient,1,EA,3.52000,3.34000,The Alliance,Exception Members,,2.71,,,,,,,1.76,3.41,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.68,4.72,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.44,4.72,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,inpatient,1,EA,52.04000,49.44000,The Alliance,Exception Members,,40.07,,,,,,,28.62,50.48,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,outpatient,1,EA,52.04000,49.44000,The Alliance,Exception Members,,40.07,,,,,,,26.02,50.48,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.11,1.95,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Exception Members,,1.55,,,,,,,1.00,1.95,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,inpatient,1,EA,2.75000,2.62000,The Alliance,Exception Members,,2.12,,,,,,,1.51,2.67,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Exception Members,,2.12,,,,,,,1.38,2.67,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,inpatient,1,EA,8.15000,7.74000,The Alliance,Exception Members,,6.28,,,,,,,4.48,7.91,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,outpatient,1,EA,8.15000,7.74000,The Alliance,Exception Members,,6.28,,,,,,,4.08,7.91,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,389.87,849.38,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1853.00000,1760.35000,The Alliance,Exception Members,90,1426.81,,,,,,,1019.15,1797.41,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1853.00000,1760.35000,The Alliance,Exception Members,90,1426.81,,,,,,,169.42,8573.20,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,The Alliance,Exception Members,90,89.40,,,,,,,63.85,112.62,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Exception Members,90,89.40,,,,,,,12.82,645.08,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,inpatient,,,521.00000,494.95000,The Alliance,Exception Members,TC,401.17,,,,,,,286.55,505.37,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Exception Members,TC,401.17,,,,,,,121.00,3027.62,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,382.25,674.15,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,298.87,3487.84,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,The Alliance,Exception Members,TC,1942.71,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Exception Members,TC,1942.71,,,,,,,1226.87,11271.02,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,394.96,17311.25,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,inpatient,,,736.00000,699.20000,The Alliance,Exception Members,TC,566.72,,,,,,,404.80,713.92,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,outpatient,,,736.00000,699.20000,The Alliance,Exception Members,TC,566.72,,,,,,,368.00,11266.81,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,52.25,92.15,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,,73.15,,,,,,,9.30,492.33,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.57230,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1332.19,2637.19,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1247.91,2718.75,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,104.14,226.88,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,16.32,80.51,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,32.85,679.08,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,90,274.12,,,,,,,195.80,345.32,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,90,274.12,,,,,,,178.00,345.32,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,,1439.13,,,,,,,1027.95,1812.93,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Exception Members,,1439.13,,,,,,,172.18,1812.93,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,inpatient,1,EA,16.52000,15.69000,The Alliance,Exception Members,,12.72,,,,,,,9.09,16.02,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,outpatient,1,EA,16.52000,15.69000,The Alliance,Exception Members,,12.72,,,,,,,8.26,16.02,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,The Alliance,Exception Members,,46.48,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Exception Members,,46.48,,,,,,,30.18,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,inpatient,1,EA,11.31000,10.75000,The Alliance,Exception Members,,8.71,,,,,,,6.22,10.97,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,outpatient,1,EA,11.31000,10.75000,The Alliance,Exception Members,,8.71,,,,,,,5.66,10.97,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,inpatient,,,971.00000,922.45000,The Alliance,Exception Members,90,747.67,,,,,,,534.05,941.87,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Exception Members,90,747.67,,,,,,,485.50,8610.62,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,inpatient,,,203.50000,193.32000,The Alliance,Exception Members,90,156.69,,,,,,,111.92,197.40,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,outpatient,,,203.50000,193.32000,The Alliance,Exception Members,90,156.69,,,,,,,25.31,2286.16,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Exception Members,,307.52,,,,,,,183.32,399.38,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Exception Members,,1819.12,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,inpatient,1,EA,1113.31000,1057.65000,The Alliance,Exception Members,,857.25,,,,,,,612.32,1079.91,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,outpatient,1,EA,1113.31000,1057.65000,The Alliance,Exception Members,,857.25,,,,,,,55.09,1079.91,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,inpatient,1,mL,7201.88000,6841.78000,The Alliance,Exception Members,,5545.45,,,,,,,3961.03,6985.82,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,outpatient,1,mL,7201.88000,6841.78000,The Alliance,Exception Members,,5545.45,,,,,,,103.71,6985.82,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,inpatient,1,EA,3.36000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,outpatient,1,EA,3.36000,3.20000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,GO,95.48,,,,,,,68.20,120.28,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,GO,95.48,,,,,,,62.00,264.00,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,inpatient,,,168.30000,159.88000,The Alliance,Exception Members,90,129.59,,,,,,,92.56,163.25,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,outpatient,,,168.30000,159.88000,The Alliance,Exception Members,90,129.59,,,,,,,16.02,814.87,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,Exception Members,90,585.97,,,,,,,418.55,738.17,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Exception Members,90,585.97,,,,,,,50.62,3666.93,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,inpatient,1,EA,153.61000,145.93000,The Alliance,Exception Members,,118.28,,,,,,,84.49,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,outpatient,1,EA,153.61000,145.93000,The Alliance,Exception Members,,118.28,,,,,,,2.39,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,inpatient,1,EA,207.93000,197.53000,The Alliance,Exception Members,,160.11,,,,,,,114.36,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,outpatient,1,EA,207.93000,197.53000,The Alliance,Exception Members,,160.11,,,,,,,2.39,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,inpatient,1,EA,227.52000,216.14000,The Alliance,Exception Members,,175.19,,,,,,,125.14,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,outpatient,1,EA,227.52000,216.14000,The Alliance,Exception Members,,175.19,,,,,,,2.39,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,inpatient,1,EA,75.90000,72.11000,The Alliance,Exception Members,,58.44,,,,,,,41.74,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,outpatient,1,EA,75.90000,72.11000,The Alliance,Exception Members,,58.44,,,,,,,2.39,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,inpatient,1,EA,90.66000,86.13000,The Alliance,Exception Members,,69.81,,,,,,,49.86,87.94,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,outpatient,1,EA,90.66000,86.13000,The Alliance,Exception Members,,69.81,,,,,,,2.39,87.94,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,160.60,283.24,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,160.60,3163.00,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,inpatient,,,624.00000,592.80000,The Alliance,Exception Members,,480.48,,,,,,,343.20,605.28,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,outpatient,,,624.00000,592.80000,The Alliance,Exception Members,,480.48,,,,,,,343.20,5271.00,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,,395.01,,,,,,,282.15,497.61,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,,395.01,,,,,,,256.50,497.61,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,inpatient,,,4933.00000,4686.35000,The Alliance,Exception Members,,3798.41,,,,,,,2713.15,4785.01,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,outpatient,,,4933.00000,4686.35000,The Alliance,Exception Members,,3798.41,,,,,,,2466.50,4785.01,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,inpatient,,,673.00000,639.35000,The Alliance,Exception Members,TC,518.21,,,,,,,370.15,652.81,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Exception Members,TC,518.21,,,,,,,336.50,3685.66,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,Exception Members,TC,549.78,,,,,,,392.70,692.58,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Exception Members,TC,549.78,,,,,,,297.11,692.58,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,inpatient,,,1255.00000,1192.25000,The Alliance,Exception Members,TC,966.35,,,,,,,690.25,1217.35,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,outpatient,,,1255.00000,1192.25000,The Alliance,Exception Members,TC,966.35,,,,,,,627.50,7087.64,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,Exception Members,TC,309.54,,,,,,,221.10,389.94,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Exception Members,TC,309.54,,,,,,,221.10,6003.00,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,The Alliance,Exception Members,,424.27,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Exception Members,,424.27,,,,,,,100.97,584.87,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,The Alliance,Exception Members,,225.61,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Exception Members,,225.61,,,,,,,100.97,584.87,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,TC,67.76,,,,,,,48.40,85.36,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,TC,67.76,,,,,,,44.00,548.00,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,The Alliance,Exception Members,TC,2798.18,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Exception Members,TC,2798.18,,,,,,,1396.56,3524.98,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,,1867.25,,,,,,,1333.75,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,,1867.25,,,,,,,1212.50,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1320.00000,1254.00000,The Alliance,Exception Members,,1016.40,,,,,,,726.00,1280.40,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Exception Members,,1016.40,,,,,,,660.00,2161.00,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,inpatient,,,869.00000,825.55000,The Alliance,Exception Members,,669.13,,,,,,,477.95,842.93,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Exception Members,,669.13,,,,,,,477.95,3163.00,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,inpatient,,,1383.00000,1313.85000,The Alliance,Exception Members,,1064.91,,,,,,,760.65,1341.51,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Exception Members,,1064.91,,,,,,,384.16,1341.51,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,22.50,163.43,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,Exception Members,,724.57,,,,,,,517.55,912.77,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Exception Members,,724.57,,,,,,,517.55,3163.00,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,3163.00,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,Exception Members,,724.57,,,,,,,517.55,912.77,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Exception Members,,724.57,,,,,,,517.55,3163.00,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,3163.00,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,TC,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,TC,921.69,,,,,,,658.35,7621.00,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,TC,123.20,,,,,,,88.00,155.20,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,TC,123.20,,,,,,,88.00,3163.00,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,177.65,313.31,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,TC,248.71,,,,,,,177.65,4686.00,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,The Alliance,Exception Members,,2626.47,,,,,,,1876.05,3308.67,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Exception Members,,2626.47,,,,,,,1538.48,4686.00,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Exception Members,,921.69,,,,,,,658.35,4686.00,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,The Alliance,Exception Members,,886.27,,,,,,,633.05,1116.47,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Exception Members,,886.27,,,,,,,633.05,3163.00,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,The Alliance,Exception Members,,4416.72,,,,,,,3154.80,5563.92,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Exception Members,,4416.72,,,,,,,1538.48,5563.92,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,4686.00,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,TC,1506.12,,,,,,,1075.80,1897.32,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,TC,1506.12,,,,,,,384.16,1897.32,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,inpatient,,,3829.00000,3637.55000,The Alliance,Exception Members,TC,2948.33,,,,,,,2105.95,3714.13,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,outpatient,,,3829.00000,3637.55000,The Alliance,Exception Members,TC,2948.33,,,,,,,1329.46,3714.13,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,1007.60,1777.04,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Exception Members,TC,1410.64,,,,,,,916.00,1777.04,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,Exception Members,TC,513.59,,,,,,,366.85,646.99,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Exception Members,TC,513.59,,,,,,,333.50,4081.21,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,53.41,94.19,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,48.55,3038.81,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,90,4142.60,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,90,4142.60,,,,,,,759.53,35735.73,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,inpatient,,,154.60000,146.87000,The Alliance,Exception Members,90,119.04,,,,,,,85.03,149.96,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Exception Members,90,119.04,,,,,,,21.69,186.79,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,inpatient,,,158.40000,150.48000,The Alliance,Exception Members,90,121.97,,,,,,,87.12,153.65,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,outpatient,,,158.40000,150.48000,The Alliance,Exception Members,90,121.97,,,,,,,14.91,885.37,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,inpatient,,,174.60000,165.87000,The Alliance,Exception Members,90,134.44,,,,,,,96.03,169.36,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,outpatient,,,174.60000,165.87000,The Alliance,Exception Members,90,134.44,,,,,,,15.55,780.94,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,inpatient,,,72.30000,68.68000,The Alliance,Exception Members,90,55.67,,,,,,,39.77,70.13,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,outpatient,,,72.30000,68.68000,The Alliance,Exception Members,90,55.67,,,,,,,36.15,70.13,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,inpatient,,,97.60000,92.72000,The Alliance,Exception Members,90,75.15,,,,,,,53.68,94.67,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,outpatient,,,97.60000,92.72000,The Alliance,Exception Members,90,75.15,,,,,,,5.68,288.61,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,52.80,93.12,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,11.13,696.05,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,inpatient,,,397.00000,377.15000,The Alliance,Exception Members,90,305.69,,,,,,,218.35,385.09,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Exception Members,90,305.69,,,,,,,43.07,1952.29,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,10.38,950.66,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,inpatient,,,162.80000,154.66000,The Alliance,Exception Members,90,125.36,,,,,,,89.54,157.92,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Exception Members,90,125.36,,,,,,,17.43,882.80,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,24.89,1137.41,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,inpatient,,,276.50000,262.68000,The Alliance,Exception Members,90,212.91,,,,,,,152.07,268.20,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,outpatient,,,276.50000,262.68000,The Alliance,Exception Members,90,212.91,,,,,,,138.25,19453.17,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,3.93,203.72,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1018.98,2220.00,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,The Alliance,Exception Members,,6627.97,,,,,,,4217.80,8349.52,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Exception Members,,6627.97,,,,,,,3950.96,8607.75,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,The Alliance,Exception Members,,2355.43,,,,,,,1682.45,2967.23,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Exception Members,,2355.43,,,,,,,1306.65,2967.23,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,The Alliance,Exception Members,TC,1740.97,,,,,,,1243.55,2193.17,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,Exception Members,TC,1740.97,,,,,,,866.42,2193.17,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,The Alliance,Exception Members,TC,2558.71,,,,,,,1827.65,3223.31,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Exception Members,TC,2558.71,,,,,,,383.91,10740.24,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,The Alliance,Exception Members,TC,64.06,,,,,,,45.76,80.70,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Exception Members,TC,64.06,,,,,,,41.60,484.28,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,417.10,17311.25,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,382.25,674.15,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,298.87,1820.00,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,875.89000,832.10000,The Alliance,Exception Members,,674.44,,,,,,,429.19,849.61,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,875.89000,832.10000,The Alliance,Exception Members,,674.44,,,,,,,402.03,875.89,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,589.26,1283.78,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,471.23000,447.67000,The Alliance,Exception Members,,362.85,,,,,,,230.90,457.09,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,471.23000,447.67000,The Alliance,Exception Members,,362.85,,,,,,,216.29,471.23,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,41.80,73.72,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,38.00,264.00,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,inpatient,,,636.00000,604.20000,The Alliance,Exception Members,,489.72,,,,,,,349.80,616.92,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,outpatient,,,636.00000,604.20000,The Alliance,Exception Members,,489.72,,,,,,,126.65,616.92,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,29.50,264.00,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,inpatient,,,507.00000,481.65000,The Alliance,Exception Members,,390.39,,,,,,,278.85,491.79,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Exception Members,,390.39,,,,,,,126.65,491.79,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,54.00,264.00,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,264.00,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,264.00,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,21.00,264.00,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,inpatient,,,69.60000,66.12000,The Alliance,Exception Members,,53.59,,,,,,,38.28,67.51,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,outpatient,,,69.60000,66.12000,The Alliance,Exception Members,,53.59,,,,,,,34.80,264.00,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,GP,76.23,,,,,,,54.45,96.03,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,GP,76.23,,,,,,,49.50,264.00,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,GO,26.95,,,,,,,19.25,33.95,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,GO,26.95,,,,,,,17.50,264.00,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,199.65,352.11,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,119.56,352.11,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,56.40,248.32,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.79,3.16,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Exception Members,,2.51,,,,,,,1.63,3.16,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,inpatient,,,438.50000,416.58000,The Alliance,Exception Members,90,337.64,,,,,,,241.18,425.35,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,outpatient,,,438.50000,416.58000,The Alliance,Exception Members,90,337.64,,,,,,,24.89,1137.41,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,inpatient,,,307.50000,292.12000,The Alliance,Exception Members,90,236.78,,,,,,,169.12,298.27,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Exception Members,90,236.78,,,,,,,24.89,1137.41,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,inpatient,,,454.90000,432.15000,The Alliance,Exception Members,90,350.27,,,,,,,250.19,441.25,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,outpatient,,,454.90000,432.15000,The Alliance,Exception Members,90,350.27,,,,,,,18.98,967.70,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,1.09,1.93,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Exception Members,,1.53,,,,,,,0.99500,1.93,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,90,4142.60,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Exception Members,90,4142.60,,,,,,,759.53,35735.73,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,The Alliance,Exception Members,90,129.51,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Exception Members,90,129.51,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,The Alliance,Exception Members,90,208.59,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Exception Members,90,208.59,,,,,,,135.45,19453.17,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,inpatient,,,110.60000,105.07000,The Alliance,Exception Members,90,85.16,,,,,,,60.83,107.28,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,outpatient,,,110.60000,105.07000,The Alliance,Exception Members,90,85.16,,,,,,,45.08,679.08,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,inpatient,,,286.80000,272.46000,The Alliance,Exception Members,90,220.84,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Exception Members,90,220.84,,,,,,,12.45,1539.22,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,inpatient,,,286.80000,272.46000,The Alliance,Exception Members,90,220.84,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Exception Members,90,220.84,,,,,,,17.85,814.87,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,23.10,40.74,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,21.00,264.00,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,GO,32.34,,,,,,,21.00,264.00,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,inpatient,,,154.60000,146.87000,The Alliance,Exception Members,90,119.04,,,,,,,85.03,149.96,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Exception Members,90,119.04,,,,,,,27.11,1289.24,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,90,104.72,,,,,,,74.80,131.92,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,90,104.72,,,,,,,12.40,628.12,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,inpatient,,,668.00000,634.60000,The Alliance,Exception Members,90,514.36,,,,,,,367.40,647.96,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,outpatient,,,668.00000,634.60000,The Alliance,Exception Members,90,514.36,,,,,,,20.36,1120.45,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,inpatient,,,305.90000,290.60000,The Alliance,Exception Members,90,235.54,,,,,,,168.25,296.72,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,outpatient,,,305.90000,290.60000,The Alliance,Exception Members,90,235.54,,,,,,,13.80,696.05,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,inpatient,,,320.40000,304.38000,The Alliance,Exception Members,90,246.71,,,,,,,176.22,310.79,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,outpatient,,,320.40000,304.38000,The Alliance,Exception Members,90,246.71,,,,,,,12.45,1539.22,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,inpatient,,,146.60000,139.27000,The Alliance,Exception Members,90,112.88,,,,,,,80.63,142.20,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,outpatient,,,146.60000,139.27000,The Alliance,Exception Members,90,112.88,,,,,,,14.96,679.08,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,90,138.60,,,,,,,99.00,174.60,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,90,138.60,,,,,,,13.69,628.12,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,90,1260.49,,,,,,,900.35,1587.89,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Exception Members,90,1260.49,,,,,,,149.66,7571.58,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,90,115.50,,,,,,,82.50,145.50,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,90,115.50,,,,,,,13.68,696.05,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.14409,0.76630,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,inpatient,,,935.00000,888.25000,The Alliance,Exception Members,,719.95,,,,,,,514.25,906.95,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,outpatient,,,935.00000,888.25000,The Alliance,Exception Members,,719.95,,,,,,,514.25,5271.00,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,inpatient,1,EA,64.97000,61.72000,The Alliance,Exception Members,,50.03,,,,,,,35.73,63.02,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,outpatient,1,EA,64.97000,61.72000,The Alliance,Exception Members,,50.03,,,,,,,7.77,63.02,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,8.17,628.12,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,inpatient,1,EA,1.89000,1.79000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.83,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,outpatient,1,EA,1.89000,1.79000,The Alliance,Exception Members,,1.46,,,,,,,0.94500,1.83,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,154.55,272.57,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,50.62,3666.93,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,35.09,1833.46,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,The Alliance,Exception Members,,13.64,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Exception Members,,13.64,,,,,,,8.86,17.18,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,35.09,1833.46,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,inpatient,,,284.40000,270.18000,The Alliance,Exception Members,90,218.99,,,,,,,156.42,275.87,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,outpatient,,,284.40000,270.18000,The Alliance,Exception Members,90,218.99,,,,,,,12.05,1786.28,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,The Alliance,Exception Members,90,129.51,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Exception Members,90,129.51,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,The Alliance,Exception Members,90,208.59,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Exception Members,90,208.59,,,,,,,135.45,19453.17,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,The Alliance,Exception Members,90,247.02,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Exception Members,90,247.02,,,,,,,30.85,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,The Alliance,Exception Members,,247.02,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Exception Members,,247.02,,,,,,,30.85,311.18,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,TC,906.29,,,,,,,647.35,1141.69,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,TC,906.29,,,,,,,519.48,5638.86,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,221.10,389.94,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,201.00,389.94,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,inpatient,1,EA,2.66000,2.52000,The Alliance,Exception Members,,2.05,,,,,,,1.46,2.58,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Exception Members,,2.05,,,,,,,1.33,2.58,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,The Alliance,Exception Members,,13.64,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Exception Members,,13.64,,,,,,,8.86,17.18,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.64350,1.13,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Exception Members,,0.90090,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.29700,0.52380,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Exception Members,,0.41580,,,,,,,0.27000,0.52380,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,59.56,129.76,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,4856.36,10580.30,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,inpatient,1,GM,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,outpatient,1,GM,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,14.22,27.59,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,inpatient,1,EA,21.96000,20.86000,The Alliance,Exception Members,,16.91,,,,,,,12.08,21.30,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,outpatient,1,EA,21.96000,20.86000,The Alliance,Exception Members,,16.91,,,,,,,10.98,21.30,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,inpatient,1,GM,205.53000,195.25000,The Alliance,Exception Members,,158.26,,,,,,,113.04,199.36,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,outpatient,1,GM,205.53000,195.25000,The Alliance,Exception Members,,158.26,,,,,,,102.77,199.36,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,inpatient,1,GM,313.19000,297.53000,The Alliance,Exception Members,,241.16,,,,,,,172.25,303.79,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,outpatient,1,GM,313.19000,297.53000,The Alliance,Exception Members,,241.16,,,,,,,156.59,303.79,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,inpatient,1,EA,25.01000,23.76000,The Alliance,Exception Members,,19.26,,,,,,,13.76,24.26,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,outpatient,1,EA,25.01000,23.76000,The Alliance,Exception Members,,19.26,,,,,,,12.51,24.26,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,inpatient,1,EA,14.17000,13.46000,The Alliance,Exception Members,,10.91,,,,,,,7.79,13.74,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,outpatient,1,EA,14.17000,13.46000,The Alliance,Exception Members,,10.91,,,,,,,7.08,13.74,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,inpatient,,,1965.00000,1866.75000,The Alliance,Exception Members,,1513.05,,,,,,,1080.75,1906.05,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Exception Members,,1513.05,,,,,,,1080.75,7304.63,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,inpatient,,,1280.00000,1216.00000,The Alliance,Exception Members,,985.60,,,,,,,704.00,1241.60,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Exception Members,,985.60,,,,,,,704.00,4686.00,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,inpatient,,,592.00000,562.40000,The Alliance,Exception Members,,455.84,,,,,,,325.60,574.24,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,outpatient,,,592.00000,562.40000,The Alliance,Exception Members,,455.84,,,,,,,296.00,574.24,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,1.02,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Exception Members,,1.42,,,,,,,0.92500,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.75350,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Exception Members,,1.05,,,,,,,0.68500,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,1.08,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Exception Members,,1.51,,,,,,,0.98000,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,inpatient,1,EA,1.57000,1.50000,The Alliance,Exception Members,,1.21,,,,,,,0.86350,1.52,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,outpatient,1,EA,1.57000,1.50000,The Alliance,Exception Members,,1.21,,,,,,,0.78500,1.52,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,inpatient,1,mL,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,outpatient,1,mL,1.93000,1.83000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,1.87,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,28.50,70.98,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,237.49000,225.62000,The Alliance,Exception Members,,182.87,,,,,,,116.37,230.37,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,237.49000,225.62000,The Alliance,Exception Members,,182.87,,,,,,,109.01,237.49,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2315.94,5045.63,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2315.94,5045.63,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,,946.33,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,,946.33,,,,,,,148.57,1447.00,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,Exception Members,90,585.97,,,,,,,418.55,738.17,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Exception Members,90,585.97,,,,,,,380.50,6088.74,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.80500,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,inpatient,1,EA,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,outpatient,1,EA,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,21.34,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,inpatient,1,EA,34.14000,32.44000,The Alliance,Exception Members,,26.29,,,,,,,18.78,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,outpatient,1,EA,34.14000,32.44000,The Alliance,Exception Members,,26.29,,,,,,,17.07,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,inpatient,1,EA,32.01000,30.41000,The Alliance,Exception Members,,24.65,,,,,,,17.61,31.05,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Exception Members,,24.65,,,,,,,16.00,31.05,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,86.35,152.29,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,13.05,679.08,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,90,141.68,,,,,,,101.20,178.48,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,90,141.68,,,,,,,16.80,848.80,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,Exception Members,90,164.78,,,,,,,117.70,207.58,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Exception Members,90,164.78,,,,,,,19.60,984.66,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,Exception Members,90,201.74,,,,,,,144.10,254.14,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Exception Members,90,201.74,,,,,,,24.43,1205.34,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,Exception Members,90,108.57,,,,,,,77.55,136.77,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Exception Members,90,108.57,,,,,,,12.51,628.12,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.90,17.46,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,0.63085,17.46,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,4686.00,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,inpatient,1,mL,2753.58000,2615.90000,The Alliance,Exception Members,,2120.26,,,,,,,1514.47,2670.97,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,outpatient,1,mL,2753.58000,2615.90000,The Alliance,Exception Members,,2120.26,,,,,,,40.56,2670.97,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.44550,0.78570,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Exception Members,,0.62370,,,,,,,0.40500,0.78570,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,inpatient,,,453.80000,431.11000,The Alliance,Exception Members,90,349.43,,,,,,,249.59,440.19,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,outpatient,,,453.80000,431.11000,The Alliance,Exception Members,90,349.43,,,,,,,17.43,882.80,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,Exception Members,90,117.58,,,,,,,83.98,148.12,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Exception Members,90,117.58,,,,,,,19.00,865.84,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,80.52,142.01,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Exception Members,90,112.73,,,,,,,17.85,814.87,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,74.91,132.11,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,12.45,1539.22,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,577.50,1018.50,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,525.00,1180.23,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,The Alliance,Exception Members,,23456.20,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Exception Members,,23456.20,,,,,,,13982.33,30462.60,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1368.75000,1300.31000,The Alliance,Exception Members,,1053.94,,,,,,,670.69,1327.69,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1368.75000,1300.31000,The Alliance,Exception Members,,1053.94,,,,,,,628.26,1368.75,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,33159.00000,31501.05000,The Alliance,Exception Members,,25532.43,,,,,,,16247.91,32164.23,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,33159.00000,31501.05000,The Alliance,Exception Members,,25532.43,,,,,,,15219.98,33159.00,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Exception Members,,8146.83,,,,,,,4856.36,10580.30,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,276.10,486.94,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,62.14,3038.81,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,22.91,1035.56,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,inpatient,,,234.30000,222.58000,The Alliance,Exception Members,90,180.41,,,,,,,128.87,227.27,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,outpatient,,,234.30000,222.58000,The Alliance,Exception Members,90,180.41,,,,,,,117.15,1137.41,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,The Alliance,Exception Members,90,89.40,,,,,,,63.85,112.62,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Exception Members,90,89.40,,,,,,,12.82,645.08,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,inpatient,,,228.40000,216.98000,The Alliance,Exception Members,90,175.87,,,,,,,125.62,221.55,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Exception Members,90,175.87,,,,,,,8.17,526.26,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,438.35,773.09,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,100.97,773.09,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,inpatient,1,EA,271.76000,258.17000,The Alliance,Exception Members,,209.26,,,,,,,149.47,263.61,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,outpatient,1,EA,271.76000,258.17000,The Alliance,Exception Members,,209.26,,,,,,,135.88,263.61,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,inpatient,1,mL,222.19000,211.08000,The Alliance,Exception Members,,171.09,,,,,,,122.20,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,outpatient,1,mL,222.19000,211.08000,The Alliance,Exception Members,,171.09,,,,,,,64.92,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,inpatient,1,mL,150.10000,142.60000,The Alliance,Exception Members,,115.58,,,,,,,82.56,145.60,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Exception Members,,115.58,,,,,,,64.92,145.60,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,2.19,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,inpatient,1,EA,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,3.20,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Exception Members,,4.47,,,,,,,2.90,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,inpatient,1,EA,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,5.20,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,outpatient,1,EA,9.45000,8.98000,The Alliance,Exception Members,,7.28,,,,,,,4.72,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,inpatient,1,mL,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,2049.30,3614.22,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,outpatient,1,mL,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1863.00,3614.22,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,497.20,876.88,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,268.42,876.88,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,inpatient,,,658.00000,625.10000,The Alliance,Exception Members,90,506.66,,,,,,,361.90,638.26,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Exception Members,90,506.66,,,,,,,18.72,882.80,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,3163.00,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,257.95,454.93,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,257.95,3163.00,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,inpatient,,,3369.00000,3200.55000,The Alliance,Exception Members,,2594.13,,,,,,,1852.95,3267.93,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,outpatient,,,3369.00000,3200.55000,The Alliance,Exception Members,,2594.13,,,,,,,1852.95,5271.00,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,The Alliance,Exception Members,,3.17,,,,,,,2.27,4.00,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Exception Members,,3.17,,,,,,,2.06,4.00,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,inpatient,1,GM,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,outpatient,1,GM,0.94000,0.89000,The Alliance,Exception Members,,0.72380,,,,,,,0.47000,0.91180,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,The Alliance,Exception Members,TC,1278.20,,,,,,,913.00,1610.20,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Exception Members,TC,1278.20,,,,,,,426.30,17311.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1475.05,3963.00,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1475.05,4686.00,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,inpatient,,,2762.00000,2623.90000,The Alliance,Exception Members,,2126.74,,,,,,,1519.10,2679.14,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,outpatient,,,2762.00000,2623.90000,The Alliance,Exception Members,,2126.74,,,,,,,1519.10,6003.00,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,Exception Members,,782.32,,,,,,,558.80,985.52,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Exception Members,,782.32,,,,,,,558.80,5271.00,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.78,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,Exception Members,90,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Exception Members,90,797.72,,,,,,,94.71,4787.38,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,inpatient,,,1965.00000,1866.75000,The Alliance,Exception Members,TC,1513.05,,,,,,,1080.75,1906.05,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Exception Members,TC,1513.05,,,,,,,1080.75,4686.00,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,78.40,155.20,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,73.44,160.00,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,163.52,356.25,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,876.23000,832.42000,The Alliance,Exception Members,,674.70,,,,,,,429.35,849.94,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Exception Members,,674.70,,,,,,,402.19,876.23,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1140.19000,1083.18000,The Alliance,Exception Members,,877.95,,,,,,,558.69,1105.98,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1140.19000,1083.18000,The Alliance,Exception Members,,877.95,,,,,,,523.35,1140.19,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12400.00,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,inpatient,,,457.00000,434.15000,The Alliance,Exception Members,,351.89,,,,,,,251.35,443.29,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,outpatient,,,457.00000,434.15000,The Alliance,Exception Members,,351.89,,,,,,,228.50,443.29,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,36.30,145.50,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.91850,1.62,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Exception Members,,1.29,,,,,,,0.83500,1.62,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1931.25000,1834.69000,The Alliance,Exception Members,,1487.06,,,,,,,946.31,1873.31,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1931.25000,1834.69000,The Alliance,Exception Members,,1487.06,,,,,,,886.44,1931.25,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,49.20000,46.74000,The Alliance,Exception Members,,37.88,,,,,,,24.11,47.72,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,49.20000,46.74000,The Alliance,Exception Members,,37.88,,,,,,,22.58,49.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,1.07,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,99.66,175.76,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,21.69,186.79,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,3163.00,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,The Alliance,Exception Members,,3601.74,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Exception Members,,3601.74,,,,,,,2147.01,4677.58,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,inpatient,1,GM,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,outpatient,1,GM,0.14000,0.14000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,inpatient,1,EA,11.69000,11.11000,The Alliance,Exception Members,,9.00,,,,,,,6.43,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,outpatient,1,EA,11.69000,11.11000,The Alliance,Exception Members,,9.00,,,,,,,5.84,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,inpatient,1,EA,28.38000,26.96000,The Alliance,Exception Members,,21.85,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Exception Members,,21.85,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,10.01,19.41,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,TC,323.40,,,,,,,231.00,407.40,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,TC,323.40,,,,,,,210.00,2162.63,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,158.40,279.36,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,144.00,1509.95,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,130.35,229.89,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,112.98,1134.10,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,The Alliance,Exception Members,TC,2835.91,,,,,,,2025.65,3572.51,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Exception Members,TC,2835.91,,,,,,,1841.50,3572.51,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,264.00,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,264.00,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,126.65,267.72,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,510.40,900.16,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,464.00,900.16,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,5271.00,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,inpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,391.60,690.64,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,391.60,5271.00,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,73.07,159.20,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1150.20000,1092.69000,The Alliance,Exception Members,,885.65,,,,,,,563.60,1115.69,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1150.20000,1092.69000,The Alliance,Exception Members,,885.65,,,,,,,527.94,1150.20,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1751.25000,1663.69000,The Alliance,Exception Members,,1348.46,,,,,,,858.11,1698.71,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1751.25000,1663.69000,The Alliance,Exception Members,,1348.46,,,,,,,803.82,1751.25,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,967.59,2108.03,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,103.50,200.79,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,946.09000,898.79000,The Alliance,Exception Members,,728.49,,,,,,,463.58,917.71,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,946.09000,898.79000,The Alliance,Exception Members,,728.49,,,,,,,434.26,946.09,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,73.07,159.20,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,8.17,882.80,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,inpatient,,,162.60000,154.47000,The Alliance,Exception Members,90,125.20,,,,,,,89.43,157.72,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Exception Members,90,125.20,,,,,,,14.87,746.94,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,inpatient,,,176.30000,167.49000,The Alliance,Exception Members,90,135.75,,,,,,,96.97,171.01,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,outpatient,,,176.30000,167.49000,The Alliance,Exception Members,90,135.75,,,,,,,16.11,814.87,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,inpatient,,,210.20000,199.69000,The Alliance,Exception Members,90,161.85,,,,,,,115.61,203.89,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Exception Members,90,161.85,,,,,,,19.62,1052.52,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,968.06,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Exception Members,,768.46,,,,,,,548.90,3163.00,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,inpatient,,,1134.00000,1077.30000,The Alliance,Exception Members,,873.18,,,,,,,623.70,1099.98,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Exception Members,,873.18,,,,,,,567.00,1099.98,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,672.00,1820.00,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,2.76,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,2.76,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,14.67,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,The Alliance,Exception Members,,262.95,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Exception Members,,262.95,,,,,,,170.75,331.25,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,inpatient,1,mL,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,1.74,3.07,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,outpatient,1,mL,3.17000,3.01000,The Alliance,Exception Members,,2.44,,,,,,,1.58,3.07,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,inpatient,1,GM,7.76000,7.37000,The Alliance,Exception Members,,5.98,,,,,,,4.27,7.53,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,outpatient,1,GM,7.76000,7.37000,The Alliance,Exception Members,,5.98,,,,,,,3.88,7.53,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.40700,0.71780,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Exception Members,,0.56980,,,,,,,0.37000,0.71780,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.15950,0.28130,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Exception Members,,0.22330,,,,,,,0.14500,0.28130,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,inpatient,1,mL,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,28.24,49.81,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Exception Members,,39.54,,,,,,,25.68,49.81,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,inpatient,1,mL,492.10000,467.50000,The Alliance,Exception Members,,378.92,,,,,,,270.65,477.34,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,outpatient,1,mL,492.10000,467.50000,The Alliance,Exception Members,,378.92,,,,,,,246.05,477.34,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,inpatient,1,mL,705.23000,669.97000,The Alliance,Exception Members,,543.03,,,,,,,387.88,684.07,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,outpatient,1,mL,705.23000,669.97000,The Alliance,Exception Members,,543.03,,,,,,,352.62,684.07,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,inpatient,1,mL,117.73000,111.84000,The Alliance,Exception Members,,90.65,,,,,,,64.75,114.20,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,outpatient,1,mL,117.73000,111.84000,The Alliance,Exception Members,,90.65,,,,,,,58.87,114.20,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,inpatient,1,mL,42.98000,40.83000,The Alliance,Exception Members,,33.09,,,,,,,23.64,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,outpatient,1,mL,42.98000,40.83000,The Alliance,Exception Members,,33.09,,,,,,,0.91450,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,inpatient,1,mL,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,13.56,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Exception Members,,18.98,,,,,,,0.91450,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,inpatient,1,mL,62.81000,59.67000,The Alliance,Exception Members,,48.36,,,,,,,34.55,60.93,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,outpatient,1,mL,62.81000,59.67000,The Alliance,Exception Members,,48.36,,,,,,,0.91450,60.93,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,inpatient,1,mL,33.52000,31.85000,The Alliance,Exception Members,,25.81,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Exception Members,,25.81,,,,,,,1.49,32.51,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,inpatient,1,mL,198.20000,188.29000,The Alliance,Exception Members,,152.61,,,,,,,109.01,192.25,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,outpatient,1,mL,198.20000,188.29000,The Alliance,Exception Members,,152.61,,,,,,,17.37,192.25,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,inpatient,1,GM,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,outpatient,1,GM,0.04000,0.03000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,90,140.91,,,,,,,100.65,177.51,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,90,140.91,,,,,,,18.52,882.80,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,7.69,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,7.69,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,13.53,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,13.53,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.60500,1.07,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Exception Members,,0.84700,,,,,,,0.55000,4.31,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,,964.81,,,,,,,689.15,1215.41,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,,964.81,,,,,,,626.50,1215.41,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,inpatient,,,244.20000,231.99000,The Alliance,Exception Members,90,188.03,,,,,,,134.31,236.87,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,outpatient,,,244.20000,231.99000,The Alliance,Exception Members,90,188.03,,,,,,,12.40,628.12,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,303.60000,288.42000,The Alliance,Exception Members,,233.77,,,,,,,148.76,294.49,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,303.60000,288.42000,The Alliance,Exception Members,,233.77,,,,,,,139.35,303.60,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,302.10000,287.00000,The Alliance,Exception Members,,232.62,,,,,,,148.03,293.04,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,302.10000,287.00000,The Alliance,Exception Members,,232.62,,,,,,,138.66,302.10,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,inpatient,1,mL,96.92000,92.07000,The Alliance,Exception Members,,74.63,,,,,,,53.31,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,outpatient,1,mL,96.92000,92.07000,The Alliance,Exception Members,,74.63,,,,,,,48.46,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,inpatient,1,mL,96.91000,92.07000,The Alliance,Exception Members,,74.62,,,,,,,53.30,94.00,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,outpatient,1,mL,96.91000,92.07000,The Alliance,Exception Members,,74.62,,,,,,,48.45,94.00,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,54.00,264.00,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,3851.19,8390.40,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,4761.02,10372.60,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,inpatient,,,3818.00000,3627.10000,The Alliance,Exception Members,,2939.86,,,,,,,2099.90,3703.46,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,outpatient,,,3818.00000,3627.10000,The Alliance,Exception Members,,2939.86,,,,,,,569.17,3703.46,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,inpatient,1,EA,25.76000,24.47000,The Alliance,Exception Members,,19.84,,,,,,,14.17,24.99,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,outpatient,1,EA,25.76000,24.47000,The Alliance,Exception Members,,19.84,,,,,,,12.88,24.99,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,29.10,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,138.00,325.26,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,185.90,327.86,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,148.57,327.86,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,23.25,197.88,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,83.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,58.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,106.70,188.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,97.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,147.40,259.96,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,134.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,Exception Members,,303.38,,,,,,,216.70,382.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Exception Members,,303.38,,,,,,,197.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,inpatient,,,516.00000,490.20000,The Alliance,Exception Members,,397.32,,,,,,,283.80,500.52,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,outpatient,,,516.00000,490.20000,The Alliance,Exception Members,,397.32,,,,,,,258.00,500.52,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,inpatient,,,454.00000,431.30000,The Alliance,Exception Members,TC,349.58,,,,,,,249.70,440.38,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Exception Members,TC,349.58,,,,,,,227.00,2320.90,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,inpatient,,,601.00000,570.95000,The Alliance,Exception Members,TC,462.77,,,,,,,330.55,582.97,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,outpatient,,,601.00000,570.95000,The Alliance,Exception Members,TC,462.77,,,,,,,284.63,3099.68,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,inpatient,,,1218.00000,1157.10000,The Alliance,Exception Members,,937.86,,,,,,,669.90,1181.46,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,outpatient,,,1218.00000,1157.10000,The Alliance,Exception Members,,937.86,,,,,,,669.90,5271.00,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,3163.00,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,293.70,517.98,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,267.00,3586.71,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Exception Members,TC,73.15,,,,,,,47.50,860.53,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,238.70,420.98,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,217.00,488.81,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,inpatient,,,1280.00000,1216.00000,The Alliance,Exception Members,90,985.60,,,,,,,704.00,1241.60,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Exception Members,90,985.60,,,,,,,377.60,6141.84,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,inpatient,,,1161.00000,1102.95000,The Alliance,Exception Members,90,893.97,,,,,,,638.55,1126.17,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,outpatient,,,1161.00000,1102.95000,The Alliance,Exception Members,90,893.97,,,,,,,389.13,6047.82,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,inpatient,1,EA,2.06000,1.95000,The Alliance,Exception Members,,1.59,,,,,,,1.13,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,432.00000,410.40000,The Alliance,Exception Members,,332.64,,,,,,,237.60,419.04,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Exception Members,,332.64,,,,,,,98.39,1078.91,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,164.45,290.03,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,62.14,3038.81,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,90,2537.92,,,,,,,1812.80,3197.12,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,90,2537.92,,,,,,,533.12,19453.17,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,inpatient,,,2336.00000,2219.20000,The Alliance,Exception Members,90,1798.72,,,,,,,1284.80,2265.92,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,outpatient,,,2336.00000,2219.20000,The Alliance,Exception Members,90,1798.72,,,,,,,234.70,11238.50,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,inpatient,,,2681.00000,2546.95000,The Alliance,Exception Members,90,2064.37,,,,,,,1474.55,2600.57,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,outpatient,,,2681.00000,2546.95000,The Alliance,Exception Members,90,2064.37,,,,,,,304.81,14345.24,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,inpatient,1,GM,14.97000,14.22000,The Alliance,Exception Members,,11.53,,,,,,,8.23,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,outpatient,1,GM,14.97000,14.22000,The Alliance,Exception Members,,11.53,,,,,,,7.49,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,inpatient,1,mL,5334.14000,5067.43000,The Alliance,Exception Members,,4107.29,,,,,,,2933.78,5174.12,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,outpatient,1,mL,5334.14000,5067.43000,The Alliance,Exception Members,,4107.29,,,,,,,15.08,5174.12,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,inpatient,1,mL,29.43000,27.96000,The Alliance,Exception Members,,22.66,,,,,,,16.19,28.55,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,outpatient,1,mL,29.43000,27.96000,The Alliance,Exception Members,,22.66,,,,,,,1.49,28.55,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,inpatient,1,EA,795.93000,756.14000,The Alliance,Exception Members,,612.87,,,,,,,437.76,772.05,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,outpatient,1,EA,795.93000,756.14000,The Alliance,Exception Members,,612.87,,,,,,,10.94,772.05,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,inpatient,,,22663.00000,21529.85000,The Alliance,Exception Members,,17450.51,,,,,,,12464.65,21983.11,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,outpatient,,,22663.00000,21529.85000,The Alliance,Exception Members,,17450.51,,,,,,,1519.65,21983.11,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,74.34,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,29.50,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,34.50,66.93,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,67.58,393.82,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,Exception Members,,705.32,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Exception Members,,705.32,,,,,,,314.95,888.52,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,The Alliance,Exception Members,,678.37,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Exception Members,,678.37,,,,,,,314.95,854.57,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Exception Members,,555.94,,,,,,,314.95,700.34,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,67.58,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,,314.16,,,,,,,67.58,395.76,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,67.58,471.42,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,122.40,238.62,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,122.40,267.72,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,126.07,4371.88,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,The Alliance,Exception Members,,23456.20,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Exception Members,,23456.20,,,,,,,13982.33,30462.60,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,Exception Members,,251.79,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Exception Members,,251.79,,,,,,,179.85,3163.00,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,281.60,496.64,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,100.97,2190.64,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,100.97,584.87,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,100.97,584.87,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,inpatient,,,1004.00000,953.80000,The Alliance,Exception Members,,773.08,,,,,,,552.20,973.88,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Exception Members,,773.08,,,,,,,100.97,973.88,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,83.61,484.28,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,35.41,103.79,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,245.30,432.62,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,56.40,432.62,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,Exception Members,,405.02,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Exception Members,,405.02,,,,,,,146.17,2313.59,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,10.00,30.07,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,Exception Members,,554.40,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Exception Members,,554.40,,,,,,,360.00,6037.79,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,inpatient,,,974.00000,925.30000,The Alliance,Exception Members,,749.98,,,,,,,535.70,944.78,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Exception Members,,749.98,,,,,,,122.37,944.78,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,104.50,212.44,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,43.81,120.28,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,Exception Members,,348.04,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Exception Members,,348.04,,,,,,,200.06,438.44,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,43.81,97.00,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,131.92,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,67.58,194.97,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,43.81,142.59,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Exception Members,,285.67,,,,,,,185.50,359.87,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,56.40,158.11,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,187.00,362.78,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,275.62,545.62,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,153.47,545.62,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,inpatient,,,207.20000,196.84000,The Alliance,Exception Members,,159.54,,,,,,,113.96,200.98,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,outpatient,,,207.20000,196.84000,The Alliance,Exception Members,,159.54,,,,,,,103.60,212.44,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,The Alliance,Exception Members,,2845.15,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Exception Members,,2845.15,,,,,,,339.11,3584.15,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,190.85,336.59,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,173.50,336.59,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,The Alliance,Exception Members,,854.70,,,,,,,610.50,1076.70,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Exception Members,,854.70,,,,,,,100.97,1076.70,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,166.65,293.91,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,35.41,293.91,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,122.40,495.67,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,inpatient,,,877.00000,833.15000,The Alliance,Exception Members,,675.29,,,,,,,482.35,850.69,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,outpatient,,,877.00000,833.15000,The Alliance,Exception Members,,675.29,,,,,,,188.67,850.69,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,Exception Members,,694.54,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Exception Members,,694.54,,,,,,,200.06,874.94,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,3163.00,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,37.00,442.00,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,26.40,46.56,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,24.00,46.56,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,37.27,101.85,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,The Alliance,Exception Members,,861.63,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Exception Members,,861.63,,,,,,,100.97,1085.43,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,107.25,189.15,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Exception Members,,150.15,,,,,,,56.40,5271.00,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,83.61,1553.42,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,83.61,2009.44,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,83.61,1811.63,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,83.61,2113.62,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,100.97,2811.23,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,Exception Members,,247.94,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Exception Members,,247.94,,,,,,,83.61,2168.71,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,Exception Members,,204.05,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Exception Members,,204.05,,,,,,,83.61,1930.27,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,83.61,1550.26,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Exception Members,,248.71,,,,,,,83.61,2147.86,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,Exception Members,,254.10,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Exception Members,,254.10,,,,,,,100.97,2113.62,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,83.61,1533.65,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,83.61,1965.59,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,inpatient,,,353.00000,335.35000,The Alliance,Exception Members,,271.81,,,,,,,194.15,342.41,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Exception Members,,271.81,,,,,,,100.97,1772.08,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Exception Members,,212.52,,,,,,,83.61,1850.10,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,83.61,1732.53,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,100.97,1755.46,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,100.97,1574.27,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,100.97,2277.19,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,Exception Members,,273.35,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Exception Members,,273.35,,,,,,,100.97,2192.71,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,83.61,1811.63,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,81.50,158.11,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,138.60,244.44,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,126.00,244.44,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,inpatient,,,687.00000,652.65000,The Alliance,Exception Members,,528.99,,,,,,,377.85,666.39,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,outpatient,,,687.00000,652.65000,The Alliance,Exception Members,,528.99,,,,,,,343.50,666.39,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,95.15,167.81,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,86.50,308.32,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,inpatient,,,1230.00000,1168.50000,The Alliance,Exception Members,,947.10,,,,,,,676.50,1193.10,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,outpatient,,,1230.00000,1168.50000,The Alliance,Exception Members,,947.10,,,,,,,615.00,1193.10,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,Exception Members,,180.95,,,,,,,129.25,227.95,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Exception Members,,180.95,,,,,,,117.50,277.40,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,Exception Members,,479.71,,,,,,,342.65,604.31,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,Exception Members,,479.71,,,,,,,311.50,2139.65,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,101.75,179.45,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,92.50,179.45,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,inpatient,,,248.00000,235.60000,The Alliance,Exception Members,,190.96,,,,,,,136.40,240.56,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,outpatient,,,248.00000,235.60000,The Alliance,Exception Members,,190.96,,,,,,,124.00,277.40,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,89.00,172.66,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,inpatient,,,901.00000,855.95000,The Alliance,Exception Members,,693.77,,,,,,,495.55,873.97,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,outpatient,,,901.00000,855.95000,The Alliance,Exception Members,,693.77,,,,,,,227.78,873.97,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,inpatient,,,309.00000,293.55000,The Alliance,Exception Members,,237.93,,,,,,,169.95,299.73,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,outpatient,,,309.00000,293.55000,The Alliance,Exception Members,,237.93,,,,,,,154.50,317.72,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,33.55,59.17,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,30.50,62.04,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,211.46,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,109.00,417.31,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,inpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.00,9.70,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,Exception Members,,329.56,,,,,,,235.40,415.16,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Exception Members,,329.56,,,,,,,214.00,531.90,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,340.45,600.43,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,309.50,2989.39,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,Exception Members,,723.80,,,,,,,517.00,911.80,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Exception Members,,723.80,,,,,,,470.00,3999.66,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,288.20,508.28,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,262.00,1692.33,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,TC,65.45,,,,,,,46.75,82.45,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,TC,65.45,,,,,,,42.50,82.45,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,169.40,298.76,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,154.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,inpatient,,,596.00000,566.20000,The Alliance,Exception Members,,458.92,,,,,,,327.80,578.12,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,outpatient,,,596.00000,566.20000,The Alliance,Exception Members,,458.92,,,,,,,298.00,1692.33,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,113.85,200.79,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,103.50,200.79,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,inpatient,,,728.00000,691.60000,The Alliance,Exception Members,,560.56,,,,,,,400.40,706.16,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,outpatient,,,728.00000,691.60000,The Alliance,Exception Members,,560.56,,,,,,,364.00,2989.39,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,inpatient,,,506.00000,480.70000,The Alliance,Exception Members,,389.62,,,,,,,278.30,490.82,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,Exception Members,,389.62,,,,,,,253.00,734.90,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,95.70,168.78,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Exception Members,,133.98,,,,,,,87.00,168.78,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,inpatient,,,376.00000,357.20000,The Alliance,Exception Members,,289.52,,,,,,,206.80,364.72,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,outpatient,,,376.00000,357.20000,The Alliance,Exception Members,,289.52,,,,,,,188.00,1692.33,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,inpatient,,,22.37000,21.25000,The Alliance,Exception Members,,17.22,,,,,,,12.30,21.70,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,outpatient,,,22.37000,21.25000,The Alliance,Exception Members,,17.22,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,inpatient,,,838.00000,796.10000,The Alliance,Exception Members,,645.26,,,,,,,460.90,812.86,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,outpatient,,,838.00000,796.10000,The Alliance,Exception Members,,645.26,,,,,,,419.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,229.35,404.49,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,208.50,1692.33,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,inpatient,,,1210.00000,1149.50000,The Alliance,Exception Members,,931.70,,,,,,,665.50,1173.70,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,outpatient,,,1210.00000,1149.50000,The Alliance,Exception Members,,931.70,,,,,,,605.00,1692.33,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,101.75,179.45,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,92.50,242.55,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,77.00,210.12,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,74.00,207.54,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,152.35,268.69,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,138.50,417.31,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,52.80,93.12,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Exception Members,,73.92,,,,,,,48.00,93.12,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,Exception Members,,209.44,,,,,,,149.60,263.84,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Exception Members,,209.44,,,,,,,136.00,317.72,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,inpatient,,,427.00000,405.65000,The Alliance,Exception Members,,328.79,,,,,,,234.85,414.19,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Exception Members,,328.79,,,,,,,213.50,639.36,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,182.05,321.07,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,,254.87,,,,,,,165.50,321.07,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,inpatient,,,1189.00000,1129.55000,The Alliance,Exception Members,,915.53,,,,,,,653.95,1153.33,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,outpatient,,,1189.00000,1129.55000,The Alliance,Exception Members,,915.53,,,,,,,594.50,1692.33,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,283.25,499.55,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Exception Members,,396.55,,,,,,,257.50,2989.39,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,inpatient,,,326.00000,309.70000,The Alliance,Exception Members,,251.02,,,,,,,179.30,316.22,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,outpatient,,,326.00000,309.70000,The Alliance,Exception Members,,251.02,,,,,,,163.00,1692.33,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,inpatient,,,313.00000,297.35000,The Alliance,Exception Members,,241.01,,,,,,,172.15,303.61,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,outpatient,,,313.00000,297.35000,The Alliance,Exception Members,,241.01,,,,,,,156.50,734.90,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,inpatient,,,1879.00000,1785.05000,The Alliance,Exception Members,,1446.83,,,,,,,1033.45,1822.63,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,outpatient,,,1879.00000,1785.05000,The Alliance,Exception Members,,1446.83,,,,,,,939.50,2989.39,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,319.00,562.60,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,290.00,1692.33,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,114.50,1692.33,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,145.20,256.08,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Exception Members,,203.28,,,,,,,132.00,1910.62,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,inpatient,,,384.00000,364.80000,The Alliance,Exception Members,,295.68,,,,,,,211.20,372.48,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,outpatient,,,384.00000,364.80000,The Alliance,Exception Members,,295.68,,,,,,,192.00,372.48,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,160.60,283.24,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,146.00,734.90,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,inpatient,,,258.00000,245.10000,The Alliance,Exception Members,,198.66,,,,,,,141.90,250.26,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,outpatient,,,258.00000,245.10000,The Alliance,Exception Members,,198.66,,,,,,,129.00,909.48,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,inpatient,,,429.00000,407.55000,The Alliance,Exception Members,,330.33,,,,,,,235.95,416.13,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,outpatient,,,429.00000,407.55000,The Alliance,Exception Members,,330.33,,,,,,,214.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,inpatient,,,404.00000,383.80000,The Alliance,Exception Members,,311.08,,,,,,,222.20,391.88,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,outpatient,,,404.00000,383.80000,The Alliance,Exception Members,,311.08,,,,,,,202.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,138.60,244.44,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,126.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,205.70,362.78,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,Exception Members,,287.98,,,,,,,187.00,734.90,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,inpatient,,,471.50000,447.92000,The Alliance,Exception Members,,363.06,,,,,,,259.32,457.36,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,outpatient,,,471.50000,447.92000,The Alliance,Exception Members,,363.06,,,,,,,235.75,1910.62,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,290.40,512.16,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,264.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,404.25,712.95,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,367.50,1692.33,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,inpatient,,,362.00000,343.90000,The Alliance,Exception Members,,278.74,,,,,,,199.10,351.14,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,outpatient,,,362.00000,343.90000,The Alliance,Exception Members,,278.74,,,,,,,181.00,1692.33,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,238.70,420.98,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,217.00,1692.33,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,Exception Members,,358.82,,,,,,,256.30,452.02,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,Exception Members,,358.82,,,,,,,233.00,1547.18,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,inpatient,,,1517.00000,1441.15000,The Alliance,Exception Members,,1168.09,,,,,,,834.35,1471.49,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,outpatient,,,1517.00000,1441.15000,The Alliance,Exception Members,,1168.09,,,,,,,758.50,2989.39,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,38.50,67.90,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Exception Members,,53.90,,,,,,,35.00,134.61,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,inpatient,,,638.00000,606.10000,The Alliance,Exception Members,,491.26,,,,,,,350.90,618.86,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,outpatient,,,638.00000,606.10000,The Alliance,Exception Members,,491.26,,,,,,,319.00,618.86,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,inpatient,,,759.00000,721.05000,The Alliance,Exception Members,,584.43,,,,,,,417.45,736.23,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,outpatient,,,759.00000,721.05000,The Alliance,Exception Members,,584.43,,,,,,,379.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,inpatient,,,1270.00000,1206.50000,The Alliance,Exception Members,,977.90,,,,,,,698.50,1231.90,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,outpatient,,,1270.00000,1206.50000,The Alliance,Exception Members,,977.90,,,,,,,635.00,2989.39,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,195.80,345.32,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,178.00,734.90,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,213.40,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,Exception Members,,431.20,,,,,,,308.00,543.20,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Exception Members,,431.20,,,,,,,280.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,Exception Members,,739.97,,,,,,,528.55,932.17,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Exception Members,,739.97,,,,,,,480.50,2989.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,inpatient,,,587.00000,557.65000,The Alliance,Exception Members,,451.99,,,,,,,322.85,569.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,outpatient,,,587.00000,557.65000,The Alliance,Exception Members,,451.99,,,,,,,293.50,734.90,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,inpatient,,,631.00000,599.45000,The Alliance,Exception Members,,485.87,,,,,,,347.05,612.07,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,outpatient,,,631.00000,599.45000,The Alliance,Exception Members,,485.87,,,,,,,315.50,1692.33,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,Exception Members,,208.67,,,,,,,149.05,262.87,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Exception Members,,208.67,,,,,,,135.50,417.31,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,62.00,207.54,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,inpatient,,,478.00000,454.10000,The Alliance,Exception Members,,368.06,,,,,,,262.90,463.66,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,outpatient,,,478.00000,454.10000,The Alliance,Exception Members,,368.06,,,,,,,239.00,734.90,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,Exception Members,,259.49,,,,,,,185.35,326.89,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Exception Members,,259.49,,,,,,,168.50,1231.54,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,Exception Members,,355.74,,,,,,,254.10,448.14,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Exception Members,,355.74,,,,,,,231.00,448.14,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,33.00,134.61,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,55.55,97.97,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,50.50,134.61,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,inpatient,,,1192.00000,1132.40000,The Alliance,Exception Members,,917.84,,,,,,,655.60,1156.24,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,outpatient,,,1192.00000,1132.40000,The Alliance,Exception Members,,917.84,,,,,,,596.00,1692.33,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,inpatient,,,1513.00000,1437.35000,The Alliance,Exception Members,,1165.01,,,,,,,832.15,1467.61,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,outpatient,,,1513.00000,1437.35000,The Alliance,Exception Members,,1165.01,,,,,,,756.50,2989.39,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,inpatient,,,584.00000,554.80000,The Alliance,Exception Members,,449.68,,,,,,,321.20,566.48,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Exception Members,,449.68,,,,,,,292.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,inpatient,,,444.00000,421.80000,The Alliance,Exception Members,,341.88,,,,,,,244.20,430.68,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,outpatient,,,444.00000,421.80000,The Alliance,Exception Members,,341.88,,,,,,,222.00,734.90,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,inpatient,,,819.00000,778.05000,The Alliance,Exception Members,,630.63,,,,,,,450.45,794.43,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,Exception Members,,630.63,,,,,,,409.50,1692.33,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,inpatient,,,1535.00000,1458.25000,The Alliance,Exception Members,,1181.95,,,,,,,844.25,1488.95,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,Exception Members,,1181.95,,,,,,,767.50,2989.39,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,191.95,338.53,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Exception Members,,268.73,,,,,,,174.50,734.90,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,inpatient,,,1061.00000,1007.95000,The Alliance,Exception Members,,816.97,,,,,,,583.55,1029.17,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,outpatient,,,1061.00000,1007.95000,The Alliance,Exception Members,,816.97,,,,,,,530.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,inpatient,,,1183.00000,1123.85000,The Alliance,Exception Members,,910.91,,,,,,,650.65,1147.51,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,outpatient,,,1183.00000,1123.85000,The Alliance,Exception Members,,910.91,,,,,,,591.50,1692.33,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,inpatient,,,1394.00000,1324.30000,The Alliance,Exception Members,,1073.38,,,,,,,766.70,1352.18,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,outpatient,,,1394.00000,1324.30000,The Alliance,Exception Members,,1073.38,,,,,,,697.00,1692.33,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,,982.52,,,,,,,701.80,1237.72,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Exception Members,,982.52,,,,,,,638.00,2039.65,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,inpatient,,,652.00000,619.40000,The Alliance,Exception Members,,502.04,,,,,,,358.60,632.44,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,outpatient,,,652.00000,619.40000,The Alliance,Exception Members,,502.04,,,,,,,227.78,632.44,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,134.61,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,213.40,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,79.00,308.32,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,23.50,96.61,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,,188.65,,,,,,,134.75,237.65,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,,188.65,,,,,,,122.50,237.65,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,276.10,486.94,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,251.00,734.90,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,inpatient,,,335.00000,318.25000,The Alliance,Exception Members,,257.95,,,,,,,184.25,324.95,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,Exception Members,,257.95,,,,,,,167.50,734.90,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,inpatient,,,457.00000,434.15000,The Alliance,Exception Members,,351.89,,,,,,,251.35,443.29,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,outpatient,,,457.00000,434.15000,The Alliance,Exception Members,,351.89,,,,,,,228.50,2989.39,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,Exception Members,,234.85,,,,,,,167.75,295.85,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Exception Members,,234.85,,,,,,,152.50,1692.33,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,156.75,276.45,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,142.50,417.31,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,TH,120.12,,,,,,,85.80,151.32,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,TH,120.12,,,,,,,78.00,151.32,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,187.00,329.80,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,170.00,417.31,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,inpatient,,,1490.00000,1415.50000,The Alliance,Exception Members,,1147.30,,,,,,,819.50,1445.30,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,outpatient,,,1490.00000,1415.50000,The Alliance,Exception Members,,1147.30,,,,,,,745.00,2989.39,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,203.50,358.90,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,185.00,952.28,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,inpatient,,,1922.00000,1825.90000,The Alliance,Exception Members,,1479.94,,,,,,,1057.10,1864.34,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,outpatient,,,1922.00000,1825.90000,The Alliance,Exception Members,,1479.94,,,,,,,961.00,1981.40,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,inpatient,,,386.00000,366.70000,The Alliance,Exception Members,,297.22,,,,,,,212.30,374.42,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,Exception Members,,297.22,,,,,,,193.00,417.31,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,76.50,148.41,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,154.00,271.60,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,140.00,271.60,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,76.00,207.54,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,inpatient,,,219.00000,208.05000,The Alliance,Exception Members,,168.63,,,,,,,120.45,212.43,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,Exception Members,,168.63,,,,,,,109.50,308.32,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,207.54,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,42.90,75.66,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Exception Members,,60.06,,,,,,,39.00,75.66,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,Exception Members,,273.35,,,,,,,195.25,344.35,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Exception Members,,273.35,,,,,,,148.57,344.35,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,92.40,162.96,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,84.00,308.32,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,143.55,253.17,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,122.40,253.17,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,Exception Members,,754.60,,,,,,,539.00,950.60,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Exception Members,,754.60,,,,,,,490.00,1231.54,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,The Alliance,Exception Members,TC,2662.66,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Exception Members,TC,2662.66,,,,,,,1609.99,3354.26,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,20.00,38.80,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,,83.93,,,,,,,59.95,105.73,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,,83.93,,,,,,,54.50,207.54,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,inpatient,,,1375.00000,1306.25000,The Alliance,Exception Members,,1058.75,,,,,,,756.25,1333.75,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,Exception Members,,1058.75,,,,,,,687.50,1692.33,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,inpatient,,,341.00000,323.95000,The Alliance,Exception Members,,262.57,,,,,,,187.55,330.77,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,outpatient,,,341.00000,323.95000,The Alliance,Exception Members,,262.57,,,,,,,122.40,330.77,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,134.20,236.68,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,122.00,417.31,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,100.65,177.51,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Exception Members,,140.91,,,,,,,91.50,177.51,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,64.90,114.46,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,59.00,114.46,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,44.50,207.54,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,36.85,64.99,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Exception Members,,51.59,,,,,,,33.50,64.99,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,Exception Members,,232.54,,,,,,,166.10,292.94,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Exception Members,,232.54,,,,,,,151.00,292.94,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,Exception Members,,575.19,,,,,,,410.85,724.59,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Exception Members,,575.19,,,,,,,373.50,734.90,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,90.20,159.08,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,82.00,207.54,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,34.92,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,295.90,521.86,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,269.00,521.86,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,inpatient,,,248.00000,235.60000,The Alliance,Exception Members,,190.96,,,,,,,136.40,240.56,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,outpatient,,,248.00000,235.60000,The Alliance,Exception Members,,190.96,,,,,,,124.00,240.56,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,TC,1867.25,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Exception Members,TC,1867.25,,,,,,,1212.50,2352.25,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,inpatient,,,416.00000,395.20000,The Alliance,Exception Members,,320.32,,,,,,,228.80,403.52,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,Exception Members,,320.32,,,,,,,208.00,416.79,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,inpatient,,,549.00000,521.55000,The Alliance,Exception Members,,422.73,,,,,,,301.95,532.53,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,outpatient,,,549.00000,521.55000,The Alliance,Exception Members,,422.73,,,,,,,274.50,532.53,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,317.72,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,inpatient,,,718.00000,682.10000,The Alliance,Exception Members,,552.86,,,,,,,394.90,696.46,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,outpatient,,,718.00000,682.10000,The Alliance,Exception Members,,552.86,,,,,,,359.00,696.46,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,inpatient,,,213.00000,202.35000,The Alliance,Exception Members,,164.01,,,,,,,117.15,206.61,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,outpatient,,,213.00000,202.35000,The Alliance,Exception Members,,164.01,,,,,,,106.50,207.54,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,inpatient,,,565.00000,536.75000,The Alliance,Exception Members,,435.05,,,,,,,310.75,548.05,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,outpatient,,,565.00000,536.75000,The Alliance,Exception Members,,435.05,,,,,,,282.50,548.05,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,195.50,645.77,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,93.00,207.54,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,438.35,773.09,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,398.50,773.09,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,TC,81.62,,,,,,,58.30,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,TC,81.62,,,,,,,53.00,102.82,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,111.65,196.91,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Exception Members,,156.31,,,,,,,101.50,207.54,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,inpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,243.10,428.74,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,outpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,221.00,428.74,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,119.31,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,391.60,690.64,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Exception Members,,548.24,,,,,,,356.00,690.64,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,33.00,64.02,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,55.55,97.97,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,50.50,97.97,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,Exception Members,,241.78,,,,,,,172.70,304.58,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Exception Members,,241.78,,,,,,,157.00,417.31,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,104.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,65.50,127.07,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,139.70,246.38,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,127.00,246.38,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,Exception Members,,20.02,,,,,,,14.30,25.22,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Exception Members,,20.02,,,,,,,13.00,62.04,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,inpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,159.50,281.30,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Exception Members,,223.30,,,,,,,145.00,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,inpatient,,,159.00000,151.05000,The Alliance,Exception Members,,122.43,,,,,,,87.45,154.23,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,outpatient,,,159.00000,151.05000,The Alliance,Exception Members,,122.43,,,,,,,79.50,154.23,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,220.19,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,113.50,220.19,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,207.54,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,inpatient,,,188.00000,178.60000,The Alliance,Exception Members,,144.76,,,,,,,103.40,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,Exception Members,,144.76,,,,,,,94.00,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,109.61,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,164.81,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,216.31,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,111.50,216.31,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,23.00,44.62,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,245.41,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,inpatient,,,946.00000,898.70000,The Alliance,Exception Members,,728.42,,,,,,,520.30,917.62,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,outpatient,,,946.00000,898.70000,The Alliance,Exception Members,,728.42,,,,,,,473.00,917.62,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,178.20,314.28,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,162.00,314.28,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,144.65,255.11,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,131.50,255.11,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,164.45,290.03,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,149.50,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,58.30,102.82,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,,81.62,,,,,,,53.00,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,38.50,74.69,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,95.50,317.72,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,inpatient,,,362.00000,343.90000,The Alliance,Exception Members,,278.74,,,,,,,199.10,351.14,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,outpatient,,,362.00000,343.90000,The Alliance,Exception Members,,278.74,,,,,,,181.00,351.14,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,319.00,562.60,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,290.00,562.60,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,231.83,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,inpatient,,,296.00000,281.20000,The Alliance,Exception Members,,227.92,,,,,,,162.80,287.12,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,outpatient,,,296.00000,281.20000,The Alliance,Exception Members,,227.92,,,,,,,148.00,416.79,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,48.95,86.33,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Exception Members,,68.53,,,,,,,44.50,86.33,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,inpatient,,,644.00000,611.80000,The Alliance,Exception Members,,495.88,,,,,,,354.20,624.68,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,outpatient,,,644.00000,611.80000,The Alliance,Exception Members,,495.88,,,,,,,322.00,624.68,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,197.88,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,49.50,96.03,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,inpatient,,,1540.00000,1463.00000,The Alliance,Exception Members,,1185.80,,,,,,,847.00,1493.80,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,outpatient,,,1540.00000,1463.00000,The Alliance,Exception Members,,1185.80,,,,,,,770.00,1493.80,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,76.50,148.41,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,inpatient,,,1074.00000,1020.30000,The Alliance,Exception Members,,826.98,,,,,,,590.70,1041.78,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,outpatient,,,1074.00000,1020.30000,The Alliance,Exception Members,,826.98,,,,,,,537.00,3686.08,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,264.55,466.57,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,240.50,466.57,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,46.50,90.21,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,80.85,142.59,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Exception Members,,113.19,,,,,,,73.50,142.59,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,86.35,152.29,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Exception Members,,120.89,,,,,,,78.50,152.29,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,99.55,175.57,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,90.50,417.31,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,41.50,80.51,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,83.50,207.54,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,81.00,157.14,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,116.05,204.67,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,105.50,207.54,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,89.24,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,46.00,89.24,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,85.80,151.32,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,78.00,151.32,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,83.00,416.79,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,197.88,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,147.40,259.96,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,134.00,259.96,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,inpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,243.10,428.74,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,outpatient,,,442.00000,419.90000,The Alliance,Exception Members,,340.34,,,,,,,221.00,428.74,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2078.89000,1974.95000,The Alliance,Exception Members,,1600.75,,,,,,,1018.66,2016.52,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2078.89000,1974.95000,The Alliance,Exception Members,,1600.75,,,,,,,954.21,2078.89,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,inpatient,,,11128.16000,10571.75000,The Alliance,Exception Members,,8568.68,,,,,,,5452.80,10794.32,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,outpatient,,,11128.16000,10571.75000,The Alliance,Exception Members,,8568.68,,,,,,,5107.83,11128.16,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,inpatient,1,mL,97.37000,92.50000,The Alliance,Exception Members,,74.97,,,,,,,53.55,94.45,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,outpatient,1,mL,97.37000,92.50000,The Alliance,Exception Members,,74.97,,,,,,,1.49,94.45,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,inpatient,1,mL,486.83000,462.49000,The Alliance,Exception Members,,374.86,,,,,,,267.76,472.23,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,outpatient,1,mL,486.83000,462.49000,The Alliance,Exception Members,,374.86,,,,,,,100.30,472.23,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,inpatient,1,EA,5750.00000,5462.50000,The Alliance,Exception Members,,4427.50,,,,,,,3162.50,5577.50,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,outpatient,1,EA,5750.00000,5462.50000,The Alliance,Exception Members,,4427.50,,,,,,,131.56,5577.50,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,inpatient,1,mL,1421.18000,1350.13000,The Alliance,Exception Members,,1094.31,,,,,,,781.65,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,outpatient,1,mL,1421.18000,1350.13000,The Alliance,Exception Members,,1094.31,,,,,,,0.37000,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,inpatient,1,mL,2524.14000,2397.93000,The Alliance,Exception Members,,1943.59,,,,,,,1388.28,2448.42,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,outpatient,1,mL,2524.14000,2397.93000,The Alliance,Exception Members,,1943.59,,,,,,,0.37000,2448.42,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,41.36000,39.29000,The Alliance,Exception Members,,31.85,,,,,,,20.27,40.12,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,41.36000,39.29000,The Alliance,Exception Members,,31.85,,,,,,,18.98,41.36,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,214.03,423.70,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,200.49,436.80,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,35.09,1833.46,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,2.31,12.33,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.25,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,1.09,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Exception Members,,1.52,,,,,,,0.99000,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Exception Members,,0.39270,,,,,,,0.25500,0.49470,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,TC,176.33,,,,,,,125.95,222.13,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,TC,176.33,,,,,,,114.50,1153.87,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,inpatient,,,218.90000,207.95000,The Alliance,Exception Members,90,168.55,,,,,,,120.39,212.33,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,outpatient,,,218.90000,207.95000,The Alliance,Exception Members,90,168.55,,,,,,,19.99,1018.59,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,The Alliance,Exception Members,90,168.78,,,,,,,120.56,212.62,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Exception Members,90,168.78,,,,,,,11.91,594.19,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,inpatient,,,161.60000,153.52000,The Alliance,Exception Members,90,124.43,,,,,,,88.88,156.75,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Exception Members,90,124.43,,,,,,,14.96,679.08,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,inpatient,,,240.30000,228.28000,The Alliance,Exception Members,90,185.03,,,,,,,132.16,233.09,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,outpatient,,,240.30000,228.28000,The Alliance,Exception Members,90,185.03,,,,,,,21.97,1103.49,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,Exception Members,90,161.47,,,,,,,115.33,203.41,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Exception Members,90,161.47,,,,,,,24.89,1137.41,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,90,120.12,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,90,120.12,,,,,,,13.89,696.05,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,90,66.22,,,,,,,47.30,83.42,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,90,66.22,,,,,,,5.11,254.68,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,90,69.30,,,,,,,49.50,87.30,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,90,69.30,,,,,,,7.27,373.51,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,inpatient,,,295.70000,280.91000,The Alliance,Exception Members,90,227.69,,,,,,,162.63,286.83,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,outpatient,,,295.70000,280.91000,The Alliance,Exception Members,90,227.69,,,,,,,9.61,492.33,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,inpatient,,,161.60000,153.52000,The Alliance,Exception Members,90,124.43,,,,,,,88.88,156.75,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Exception Members,90,124.43,,,,,,,17.60,882.80,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,inpatient,,,99.50000,94.52000,The Alliance,Exception Members,90,76.61,,,,,,,54.73,96.52,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,outpatient,,,99.50000,94.52000,The Alliance,Exception Members,90,76.61,,,,,,,49.75,1137.41,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,inpatient,,,2343.00000,2225.85000,The Alliance,Exception Members,90,1804.11,,,,,,,1288.65,2272.71,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,outpatient,,,2343.00000,2225.85000,The Alliance,Exception Members,90,1804.11,,,,,,,214.21,10831.07,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,188.60000,179.17000,The Alliance,Exception Members,,145.22,,,,,,,92.41,182.94,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,188.60000,179.17000,The Alliance,Exception Members,,145.22,,,,,,,86.57,188.60,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1496.25000,1421.44000,The Alliance,Exception Members,,1152.11,,,,,,,733.16,1451.36,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1496.25000,1421.44000,The Alliance,Exception Members,,1152.11,,,,,,,686.78,1496.25,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,Exception Members,TC,201.74,,,,,,,144.10,254.14,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Exception Members,TC,201.74,,,,,,,131.00,1331.91,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,inpatient,,,13067.00000,12413.65000,The Alliance,Exception Members,,10061.59,,,,,,,7186.85,12674.99,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,outpatient,,,13067.00000,12413.65000,The Alliance,Exception Members,,10061.59,,,,,,,4314.91,12674.99,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,27.24000,25.88000,The Alliance,Exception Members,,20.97,,,,,,,14.98,26.42,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,27.24000,25.88000,The Alliance,Exception Members,,20.97,,,,,,,13.62,26.42,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,inpatient,,,191.30000,181.74000,The Alliance,Exception Members,90,147.30,,,,,,,105.22,185.56,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,outpatient,,,191.30000,181.74000,The Alliance,Exception Members,90,147.30,,,,,,,17.47,882.80,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,inpatient,1,mL,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,outpatient,1,mL,0.15000,0.15000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.27217,1.22,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.18,2.09,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Exception Members,,1.66,,,,,,,1.07,2.09,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,24.89,1137.41,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,11.85,22.99,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,inpatient,1,EA,2450.87000,2328.32000,The Alliance,Exception Members,,1887.17,,,,,,,1347.98,2377.34,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,outpatient,1,EA,2450.87000,2328.32000,The Alliance,Exception Members,,1887.17,,,,,,,19.06,2377.34,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,inpatient,1,EA,5991.52000,5691.95000,The Alliance,Exception Members,,4613.47,,,,,,,3295.34,5811.77,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,outpatient,1,EA,5991.52000,5691.95000,The Alliance,Exception Members,,4613.47,,,,,,,75.86,5811.77,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.20,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Exception Members,,1.69,,,,,,,1.09,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,inpatient,1,EA,149.44000,141.96000,The Alliance,Exception Members,,115.07,,,,,,,82.19,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,outpatient,1,EA,149.44000,141.96000,The Alliance,Exception Members,,115.07,,,,,,,74.72,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.67650,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Exception Members,,0.94710,,,,,,,0.61500,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,inpatient,1,EA,22.44000,21.31000,The Alliance,Exception Members,,17.28,,,,,,,12.34,21.77,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,outpatient,1,EA,22.44000,21.31000,The Alliance,Exception Members,,17.28,,,,,,,11.22,21.77,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,inpatient,1,mL,5333.95000,5067.25000,The Alliance,Exception Members,,4107.14,,,,,,,2933.67,5173.93,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,outpatient,1,mL,5333.95000,5067.25000,The Alliance,Exception Members,,4107.14,,,,,,,15.08,5173.93,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,Exception Members,TC,764.61,,,,,,,546.15,963.21,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Exception Members,TC,764.61,,,,,,,420.81,17311.25,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6744.75000,6407.51000,The Alliance,Exception Members,,5193.46,,,,,,,3304.93,6542.41,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6744.75000,6407.51000,The Alliance,Exception Members,,5193.46,,,,,,,3095.84,6744.75,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,21.07,41.71,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,21.50,81.82,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,11.36,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,inpatient,1,mL,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,10.25,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,outpatient,1,mL,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,9.32,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,inpatient,1,mL,20.05000,19.05000,The Alliance,Exception Members,,15.44,,,,,,,11.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,outpatient,1,mL,20.05000,19.05000,The Alliance,Exception Members,,15.44,,,,,,,10.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,inpatient,1,mL,9.60000,9.12000,The Alliance,Exception Members,,7.39,,,,,,,5.28,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,outpatient,1,mL,9.60000,9.12000,The Alliance,Exception Members,,7.39,,,,,,,4.80,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Exception Members,,17.49,,,,,,,11.36,22.04,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,The Alliance,Exception Members,,37.33,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Exception Members,,37.33,,,,,,,24.24,47.03,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,inpatient,1,mL,104.41000,99.19000,The Alliance,Exception Members,,80.40,,,,,,,57.43,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,outpatient,1,mL,104.41000,99.19000,The Alliance,Exception Members,,80.40,,,,,,,52.20,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,inpatient,1,mL,95.21000,90.45000,The Alliance,Exception Members,,73.31,,,,,,,52.37,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,outpatient,1,mL,95.21000,90.45000,The Alliance,Exception Members,,73.31,,,,,,,47.60,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,inpatient,1,mL,122.77000,116.63000,The Alliance,Exception Members,,94.53,,,,,,,67.52,119.09,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,outpatient,1,mL,122.77000,116.63000,The Alliance,Exception Members,,94.53,,,,,,,61.38,119.09,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,inpatient,,,521.00000,494.95000,The Alliance,Exception Members,,401.17,,,,,,,286.55,505.37,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Exception Members,,401.17,,,,,,,286.55,5271.00,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,inpatient,1,mL,107.11000,101.75000,The Alliance,Exception Members,,82.47,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Exception Members,,82.47,,,,,,,53.55,103.90,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,742.50,1309.50,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,,1039.50,,,,,,,742.50,5271.00,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Exception Members,TC,2779.70,,,,,,,550.38,17311.25,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,inpatient,,,2929.00000,2782.55000,The Alliance,Exception Members,,2255.33,,,,,,,1610.95,2841.13,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,outpatient,,,2929.00000,2782.55000,The Alliance,Exception Members,,2255.33,,,,,,,1610.95,5271.00,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,122.40,3163.00,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,The Alliance,Exception Members,TC,1565.41,,,,,,,1118.15,1972.01,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Exception Members,TC,1565.41,,,,,,,909.00,5271.00,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,inpatient,,,738.00000,701.10000,The Alliance,Exception Members,TC,568.26,,,,,,,405.90,715.86,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,Exception Members,TC,568.26,,,,,,,369.00,715.86,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,790.55,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,5271.00,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1653.75,3273.75,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1549.12,3375.00,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,inpatient,1,mL,107.11000,101.75000,The Alliance,Exception Members,,82.47,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Exception Members,,82.47,,,,,,,1.49,103.90,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,inpatient,1,GM,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.59,2.81,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,outpatient,1,GM,2.90000,2.75000,The Alliance,Exception Members,,2.23,,,,,,,1.45,2.81,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,The Alliance,Exception Members,,529.76,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Exception Members,,529.76,,,,,,,314.95,667.36,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,inpatient,1,EA,24.48000,23.25000,The Alliance,Exception Members,,18.85,,,,,,,13.46,23.75,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,outpatient,1,EA,24.48000,23.25000,The Alliance,Exception Members,,18.85,,,,,,,12.24,23.75,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.90200,1.59,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Exception Members,,1.26,,,,,,,0.82000,1.59,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,inpatient,1,mL,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,14.46,80.87,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,inpatient,1,GM,184.32000,175.11000,The Alliance,Exception Members,,141.93,,,,,,,101.38,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,outpatient,1,GM,184.32000,175.11000,The Alliance,Exception Members,,141.93,,,,,,,92.16,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,inpatient,1,GM,131.67000,125.08000,The Alliance,Exception Members,,101.39,,,,,,,72.42,127.72,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,outpatient,1,GM,131.67000,125.08000,The Alliance,Exception Members,,101.39,,,,,,,65.83,127.72,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,inpatient,1,mL,285.68000,271.39000,The Alliance,Exception Members,,219.97,,,,,,,157.12,277.11,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,outpatient,1,mL,285.68000,271.39000,The Alliance,Exception Members,,219.97,,,,,,,0.76000,277.11,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.01550,0.17460,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,inpatient,1,mL,1762.49000,1674.37000,The Alliance,Exception Members,,1357.12,,,,,,,969.37,1709.62,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,outpatient,1,mL,1762.49000,1674.37000,The Alliance,Exception Members,,1357.12,,,,,,,266.44,1709.62,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,The Alliance,Exception Members,,220.41,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Exception Members,,220.41,,,,,,,143.12,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,The Alliance,Exception Members,,220.41,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Exception Members,,220.41,,,,,,,143.12,277.66,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,inpatient,1,mL,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.42350,0.74690,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Exception Members,,0.59290,,,,,,,0.38500,0.74690,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,inpatient,1,GM,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,outpatient,1,GM,0.64000,0.61000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,The Alliance,Exception Members,,16732.72,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Exception Members,,16732.72,,,,,,,9974.44,21730.80,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,110.00,194.00,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,83.61,1614.89,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1881.86000,1787.77000,The Alliance,Exception Members,,1449.03,,,,,,,922.11,1825.40,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1881.86000,1787.77000,The Alliance,Exception Members,,1449.03,,,,,,,863.77,1881.86,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,6.86,13.58,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.00,13.58,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,inpatient,,,30.90000,29.35000,The Alliance,Exception Members,,23.79,,,,,,,17.00,29.97,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,outpatient,,,30.90000,29.35000,The Alliance,Exception Members,,23.79,,,,,,,15.45,29.97,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,154.55,272.57,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,TC,216.37,,,,,,,140.50,1569.27,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,7443.72000,7071.53000,The Alliance,Exception Members,,5731.66,,,,,,,3647.42,7220.41,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,7443.72000,7071.53000,The Alliance,Exception Members,,5731.66,,,,,,,3416.67,7443.72,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.91000,363.76000,The Alliance,Exception Members,,294.84,,,,,,,187.63,371.42,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.91000,363.76000,The Alliance,Exception Members,,294.84,,,,,,,175.76,382.91,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,inpatient,1,mL,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,2.57,4.54,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,outpatient,1,mL,4.68000,4.44000,The Alliance,Exception Members,,3.60,,,,,,,0.08005,4.54,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,inpatient,1,EA,26.01000,24.71000,The Alliance,Exception Members,,20.03,,,,,,,14.31,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,outpatient,1,EA,26.01000,24.71000,The Alliance,Exception Members,,20.03,,,,,,,13.01,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,inpatient,1,EA,17.32000,16.45000,The Alliance,Exception Members,,13.34,,,,,,,9.53,16.80,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Exception Members,,13.34,,,,,,,8.66,16.80,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,The Alliance,Exception Members,,7669.32,,,,,,,4880.47,9661.35,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Exception Members,,7669.32,,,,,,,4571.71,9960.15,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,Exception Members,TC,210.98,,,,,,,150.70,265.78,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,Exception Members,TC,210.98,,,,,,,137.00,1509.95,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,21.50,62.04,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,514.50,1018.50,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,481.95,1050.00,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,135.30,238.62,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,25.25,1324.17,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,130.90,230.86,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,119.00,230.86,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,inpatient,1,mL,8182.76000,7773.62000,The Alliance,Exception Members,,6300.73,,,,,,,4500.52,7937.28,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,outpatient,1,mL,8182.76000,7773.62000,The Alliance,Exception Members,,6300.73,,,,,,,12.96,7937.28,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,inpatient,1,EA,254.49000,241.77000,The Alliance,Exception Members,,195.96,,,,,,,139.97,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,outpatient,1,EA,254.49000,241.77000,The Alliance,Exception Members,,195.96,,,,,,,127.25,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,inpatient,1,EA,197.29000,187.43000,The Alliance,Exception Members,,151.91,,,,,,,108.51,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,outpatient,1,EA,197.29000,187.43000,The Alliance,Exception Members,,151.91,,,,,,,98.64,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,inpatient,1,EA,330.51000,313.98000,The Alliance,Exception Members,,254.49,,,,,,,181.78,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,outpatient,1,EA,330.51000,313.98000,The Alliance,Exception Members,,254.49,,,,,,,165.25,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,inpatient,1,EA,251.01000,238.46000,The Alliance,Exception Members,,193.28,,,,,,,138.06,243.48,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,outpatient,1,EA,251.01000,238.46000,The Alliance,Exception Members,,193.28,,,,,,,125.50,243.48,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,inpatient,1,EA,167.34000,158.97000,The Alliance,Exception Members,,128.85,,,,,,,92.04,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,outpatient,1,EA,167.34000,158.97000,The Alliance,Exception Members,,128.85,,,,,,,83.67,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,inpatient,1,EA,169.66000,161.18000,The Alliance,Exception Members,,130.64,,,,,,,93.31,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,outpatient,1,EA,169.66000,161.18000,The Alliance,Exception Members,,130.64,,,,,,,84.83,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,inpatient,1,EA,131.53000,124.95000,The Alliance,Exception Members,,101.28,,,,,,,72.34,127.58,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,outpatient,1,EA,131.53000,124.95000,The Alliance,Exception Members,,101.28,,,,,,,65.77,127.58,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,inpatient,1,EA,237.52000,225.65000,The Alliance,Exception Members,,182.89,,,,,,,130.64,230.39,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,outpatient,1,EA,237.52000,225.65000,The Alliance,Exception Members,,182.89,,,,,,,118.76,230.39,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,inpatient,1,mL,8229.81000,7818.32000,The Alliance,Exception Members,,6336.95,,,,,,,4526.40,7982.92,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,outpatient,1,mL,8229.81000,7818.32000,The Alliance,Exception Members,,6336.95,,,,,,,12.96,7982.92,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,inpatient,1,GM,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,outpatient,1,GM,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,Exception Members,,208.67,,,,,,,149.05,262.87,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Exception Members,,208.67,,,,,,,135.50,417.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,70.56,139.68,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,66.10,144.00,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,inpatient,1,GM,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,4.11,7.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,outpatient,1,GM,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,3.73,7.25,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,inpatient,1,GM,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,outpatient,1,GM,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,inpatient,1,EA,21.38000,20.31000,The Alliance,Exception Members,,16.46,,,,,,,11.76,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,outpatient,1,EA,21.38000,20.31000,The Alliance,Exception Members,,16.46,,,,,,,10.69,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,inpatient,1,EA,11.79000,11.20000,The Alliance,Exception Members,,9.08,,,,,,,6.48,11.44,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,outpatient,1,EA,11.79000,11.20000,The Alliance,Exception Members,,9.08,,,,,,,5.89,11.44,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,inpatient,1,mL,35308.12000,33542.71000,The Alliance,Exception Members,,27187.25,,,,,,,19419.47,34248.88,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,outpatient,1,mL,35308.12000,33542.71000,The Alliance,Exception Members,,27187.25,,,,,,,3638.86,34248.88,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Exception Members,,0.66990,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.43,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Exception Members,,2.00,,,,,,,1.30,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,inpatient,,,451.40000,428.83000,The Alliance,Exception Members,90,347.58,,,,,,,248.27,437.86,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,outpatient,,,451.40000,428.83000,The Alliance,Exception Members,90,347.58,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,inpatient,,,124.60000,118.37000,The Alliance,Exception Members,90,95.94,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Exception Members,90,95.94,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,inpatient,,,124.60000,118.37000,The Alliance,Exception Members,90,95.94,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Exception Members,90,95.94,,,,,,,12.45,1539.22,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,inpatient,,,176.70000,167.86000,The Alliance,Exception Members,90,136.06,,,,,,,97.19,171.40,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,outpatient,,,176.70000,167.86000,The Alliance,Exception Members,90,136.06,,,,,,,21.79,984.66,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,90,105.49,,,,,,,75.35,132.89,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,90,105.49,,,,,,,13.69,696.05,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,inpatient,,,332.20000,315.59000,The Alliance,Exception Members,90,255.79,,,,,,,182.71,322.23,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,outpatient,,,332.20000,315.59000,The Alliance,Exception Members,90,255.79,,,,,,,35.97,1680.71,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,50.05,88.27,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Exception Members,,70.07,,,,,,,45.50,88.27,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,inpatient,1,mL,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,outpatient,1,mL,650.53000,618.00000,The Alliance,Exception Members,,500.91,,,,,,,312.03,631.01,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,55.55,97.97,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,,77.77,,,,,,,55.55,5271.00,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,20.37,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,48.19,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,inpatient,1,mL,3.13000,2.98000,The Alliance,Exception Members,,2.41,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,outpatient,1,mL,3.13000,2.98000,The Alliance,Exception Members,,2.41,,,,,,,1.56,3.04,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,The Alliance,Exception Members,,3601.74,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Exception Members,,3601.74,,,,,,,2147.01,4677.58,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,73.07,159.20,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2790.71000,2651.17000,The Alliance,Exception Members,,2148.85,,,,,,,1367.45,2706.99,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2790.71000,2651.17000,The Alliance,Exception Members,,2148.85,,,,,,,1280.94,2790.71,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,790.55,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Exception Members,,627.55,,,,,,,448.25,5271.00,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,inpatient,,,3561.00000,3382.95000,The Alliance,Exception Members,,2741.97,,,,,,,1958.55,3454.17,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,outpatient,,,3561.00000,3382.95000,The Alliance,Exception Members,,2741.97,,,,,,,1958.55,5271.00,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,inpatient,,,319.00000,303.05000,The Alliance,Exception Members,,245.63,,,,,,,175.45,309.43,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Exception Members,,245.63,,,,,,,175.45,5271.00,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,inpatient,,,966.00000,917.70000,The Alliance,Exception Members,,743.82,,,,,,,531.30,937.02,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Exception Members,,743.82,,,,,,,531.30,5271.00,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.61,6.37,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Exception Members,,5.06,,,,,,,3.29,6.37,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,9.32000,8.85000,The Alliance,Exception Members,,7.18,,,,,,,5.13,9.04,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,9.32000,8.85000,The Alliance,Exception Members,,7.18,,,,,,,4.66,9.04,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.87,8.58,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.58,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,inpatient,1,EA,38.05000,36.14000,The Alliance,Exception Members,,29.30,,,,,,,20.93,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,outpatient,1,EA,38.05000,36.14000,The Alliance,Exception Members,,29.30,,,,,,,19.02,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,inpatient,1,EA,44.05000,41.85000,The Alliance,Exception Members,,33.92,,,,,,,24.23,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Exception Members,,33.92,,,,,,,22.02,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1858.06,3678.20,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1740.51,3791.96,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1740.51,3791.96,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1018.98,2220.00,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,691.90,1220.26,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,629.00,7964.98,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.61050,1.08,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Exception Members,,0.85470,,,,,,,0.55500,1.49,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,90,2537.92,,,,,,,1812.80,3197.12,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Exception Members,90,2537.92,,,,,,,533.12,19453.17,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,26.40,46.56,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,4.28,220.68,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.29100,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4706.00000,4470.70000,The Alliance,Exception Members,90,3623.62,,,,,,,2588.30,4564.82,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4706.00000,4470.70000,The Alliance,Exception Members,90,3623.62,,,,,,,597.91,28130.22,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,Exception Members,90,769.23,,,,,,,549.45,969.03,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Exception Members,90,769.23,,,,,,,499.50,8610.62,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.00620,0.46560,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,inpatient,1,GM,66.56000,63.23000,The Alliance,Exception Members,,51.25,,,,,,,36.61,64.56,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,outpatient,1,GM,66.56000,63.23000,The Alliance,Exception Members,,51.25,,,,,,,33.28,64.56,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,inpatient,,,510.69000,485.16000,The Alliance,Exception Members,,393.23,,,,,,,280.88,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,outpatient,,,510.69000,485.16000,The Alliance,Exception Members,,393.23,,,,,,,255.34,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,inpatient,1,mL,1021.38000,970.31000,The Alliance,Exception Members,,786.46,,,,,,,561.76,990.74,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,outpatient,1,mL,1021.38000,970.31000,The Alliance,Exception Members,,786.46,,,,,,,273.14,990.74,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,inpatient,1,GM,29.41000,27.94000,The Alliance,Exception Members,,22.65,,,,,,,16.18,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,outpatient,1,GM,29.41000,27.94000,The Alliance,Exception Members,,22.65,,,,,,,14.71,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,inpatient,1,GM,46.98000,44.64000,The Alliance,Exception Members,,36.17,,,,,,,25.84,45.57,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,outpatient,1,GM,46.98000,44.64000,The Alliance,Exception Members,,36.17,,,,,,,23.49,45.57,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,inpatient,1,mL,108.46000,103.04000,The Alliance,Exception Members,,83.51,,,,,,,59.65,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,outpatient,1,mL,108.46000,103.04000,The Alliance,Exception Members,,83.51,,,,,,,54.23,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,inpatient,1,mL,93.71000,89.02000,The Alliance,Exception Members,,72.16,,,,,,,51.54,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,outpatient,1,mL,93.71000,89.02000,The Alliance,Exception Members,,72.16,,,,,,,46.85,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,inpatient,1,mL,92.53000,87.90000,The Alliance,Exception Members,,71.25,,,,,,,50.89,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,outpatient,1,mL,92.53000,87.90000,The Alliance,Exception Members,,71.25,,,,,,,46.27,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,inpatient,1,mL,97.51000,92.63000,The Alliance,Exception Members,,75.08,,,,,,,53.63,94.58,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,outpatient,1,mL,97.51000,92.63000,The Alliance,Exception Members,,75.08,,,,,,,48.76,94.58,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,The Alliance,Exception Members,TC,1204.28,,,,,,,860.20,1517.08,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Exception Members,TC,1204.28,,,,,,,782.00,1820.00,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,inpatient,,,352.80000,335.16000,The Alliance,Exception Members,,271.66,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,outpatient,,,352.80000,335.16000,The Alliance,Exception Members,,271.66,,,,,,,176.40,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,inpatient,1,EA,352.80000,335.16000,The Alliance,Exception Members,,271.66,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,outpatient,1,EA,352.80000,335.16000,The Alliance,Exception Members,,271.66,,,,,,,176.40,342.22,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,inpatient,1,GM,83.98000,79.78000,The Alliance,Exception Members,,64.66,,,,,,,46.19,81.46,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,outpatient,1,GM,83.98000,79.78000,The Alliance,Exception Members,,64.66,,,,,,,41.99,81.46,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,14647.50000,13915.12000,The Alliance,Exception Members,,11278.58,,,,,,,7177.27,14208.08,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,14647.50000,13915.12000,The Alliance,Exception Members,,11278.58,,,,,,,6723.20,14208.08,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1046.52,2280.00,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,The Alliance,Exception Members,TC,1268.19,,,,,,,905.85,1597.59,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Exception Members,TC,1268.19,,,,,,,574.33,17311.25,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,The Alliance,Exception Members,TC,2218.37,,,,,,,1584.55,2794.57,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Exception Members,TC,2218.37,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,The Alliance,Exception Members,TC,3398.01,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Exception Members,TC,3398.01,,,,,,,498.74,29731.35,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,1002.10,1767.34,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,911.00,1964.22,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,The Alliance,Exception Members,,16732.72,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Exception Members,,16732.72,,,,,,,9974.44,21730.80,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,inpatient,,,2209.00000,2098.55000,The Alliance,Exception Members,TC,1700.93,,,,,,,1214.95,2142.73,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,outpatient,,,2209.00000,2098.55000,The Alliance,Exception Members,TC,1700.93,,,,,,,1104.50,14176.04,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,inpatient,,,6409.00000,6088.55000,The Alliance,Exception Members,,4934.93,,,,,,,3524.95,6216.73,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,outpatient,,,6409.00000,6088.55000,The Alliance,Exception Members,,4934.93,,,,,,,2786.18,11015.00,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,5271.00,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,inpatient,1,mL,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,outpatient,1,mL,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,0.59830,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,inpatient,1,mL,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,outpatient,1,mL,17.30000,16.44000,The Alliance,Exception Members,,13.32,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,0.59830,7.66,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00550,0.00970,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Exception Members,,0.00770,,,,,,,0.00500,0.00970,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,inpatient,1,mL,38.69000,36.75000,The Alliance,Exception Members,,29.79,,,,,,,21.28,37.53,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,outpatient,1,mL,38.69000,36.75000,The Alliance,Exception Members,,29.79,,,,,,,0.35222,37.53,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,inpatient,1,mL,20.65000,19.61000,The Alliance,Exception Members,,15.90,,,,,,,11.36,20.03,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Exception Members,,15.90,,,,,,,10.32,20.03,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,inpatient,1,EA,3.39000,3.22000,The Alliance,Exception Members,,2.61,,,,,,,1.86,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,outpatient,1,EA,3.39000,3.22000,The Alliance,Exception Members,,2.61,,,,,,,1.70,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,inpatient,1,EA,4.45000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.32,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.32,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,inpatient,1,mL,17.68000,16.80000,The Alliance,Exception Members,,13.61,,,,,,,9.72,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,outpatient,1,mL,17.68000,16.80000,The Alliance,Exception Members,,13.61,,,,,,,8.84,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,inpatient,1,mL,11.12000,10.57000,The Alliance,Exception Members,,8.56,,,,,,,6.12,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,outpatient,1,mL,11.12000,10.57000,The Alliance,Exception Members,,8.56,,,,,,,5.56,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,inpatient,1,mL,34.01000,32.31000,The Alliance,Exception Members,,26.19,,,,,,,18.71,32.99,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,outpatient,1,mL,34.01000,32.31000,The Alliance,Exception Members,,26.19,,,,,,,17.00,32.99,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,inpatient,1,EA,170.64000,162.11000,The Alliance,Exception Members,,131.39,,,,,,,93.85,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,outpatient,1,EA,170.64000,162.11000,The Alliance,Exception Members,,131.39,,,,,,,85.32,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,inpatient,1,EA,197.50000,187.62000,The Alliance,Exception Members,,152.07,,,,,,,108.62,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,outpatient,1,EA,197.50000,187.62000,The Alliance,Exception Members,,152.07,,,,,,,98.75,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,inpatient,1,EA,71.08000,67.53000,The Alliance,Exception Members,,54.73,,,,,,,39.09,68.95,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,outpatient,1,EA,71.08000,67.53000,The Alliance,Exception Members,,54.73,,,,,,,35.54,68.95,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.40,5.99,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Exception Members,,4.76,,,,,,,3.09,5.99,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,The Alliance,Exception Members,,873.50,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Exception Members,,873.50,,,,,,,0.29000,1100.39,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,inpatient,1,EA,68.99000,65.54000,The Alliance,Exception Members,,53.12,,,,,,,37.94,66.92,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,outpatient,1,EA,68.99000,65.54000,The Alliance,Exception Members,,53.12,,,,,,,34.49,66.92,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,inpatient,1,mL,27.94000,26.55000,The Alliance,Exception Members,,21.51,,,,,,,15.37,27.10,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,outpatient,1,mL,27.94000,26.55000,The Alliance,Exception Members,,21.51,,,,,,,13.97,27.10,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,0.08525,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,inpatient,1,mL,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.64,2.90,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,0.08525,2.90,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,inpatient,1,EA,86.43000,82.10000,The Alliance,Exception Members,,66.55,,,,,,,47.54,83.84,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,outpatient,1,EA,86.43000,82.10000,The Alliance,Exception Members,,66.55,,,,,,,43.22,83.84,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,165.11,291.19,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,114.64,291.19,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,188.29,372.73,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Exception Members,,295.88,,,,,,,176.38,384.26,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,The Alliance,Exception Members,,568.84,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Exception Members,,568.84,,,,,,,339.09,738.75,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,764.24,1615.05,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,73.07,159.20,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,inpatient,1,mL,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Exception Members,,22.26,,,,,,,14.46,80.87,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,inpatient,1,GM,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,outpatient,1,GM,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.45,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,inpatient,1,GM,7.65000,7.27000,The Alliance,Exception Members,,5.89,,,,,,,4.21,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,outpatient,1,GM,7.65000,7.27000,The Alliance,Exception Members,,5.89,,,,,,,3.83,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,inpatient,1,GM,7.42000,7.04000,The Alliance,Exception Members,,5.71,,,,,,,4.08,7.20,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,outpatient,1,GM,7.42000,7.04000,The Alliance,Exception Members,,5.71,,,,,,,3.71,7.20,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,inpatient,1,EA,3324.53000,3158.31000,The Alliance,Exception Members,,2559.89,,,,,,,1828.49,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,outpatient,1,EA,3324.53000,3158.31000,The Alliance,Exception Members,,2559.89,,,,,,,138.67,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,inpatient,1,EA,11037.06000,10485.21000,The Alliance,Exception Members,,8498.54,,,,,,,6070.38,10705.95,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,outpatient,1,EA,11037.06000,10485.21000,The Alliance,Exception Members,,8498.54,,,,,,,138.67,10705.95,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,inpatient,1,mL,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,7.98,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,inpatient,1,mL,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,7.98,1004.92,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,inpatient,1,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,2.18,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Exception Members,,3.05,,,,,,,1.98,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,3.95,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,inpatient,1,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,4.06,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,outpatient,1,EA,7.39000,7.02000,The Alliance,Exception Members,,5.69,,,,,,,3.69,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,inpatient,1,EA,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,2.15,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Exception Members,,3.01,,,,,,,1.96,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Exception Members,,2.65,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.79,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Exception Members,,2.50,,,,,,,1.62,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.68,4.72,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Exception Members,,3.75,,,,,,,2.44,4.72,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,The Alliance,Exception Members,,91.28,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Exception Members,,91.28,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,The Alliance,Exception Members,,91.28,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Exception Members,,91.28,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,inpatient,1,EA,212.90000,202.26000,The Alliance,Exception Members,,163.93,,,,,,,117.09,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,outpatient,1,EA,212.90000,202.26000,The Alliance,Exception Members,,163.93,,,,,,,106.45,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,inpatient,1,EA,169.34000,160.87000,The Alliance,Exception Members,,130.39,,,,,,,93.14,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,outpatient,1,EA,169.34000,160.87000,The Alliance,Exception Members,,130.39,,,,,,,84.67,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,inpatient,1,EA,71.12000,67.57000,The Alliance,Exception Members,,54.76,,,,,,,39.12,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,outpatient,1,EA,71.12000,67.57000,The Alliance,Exception Members,,54.76,,,,,,,35.56,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,63.20,122.61,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,20.00,38.80,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.69850,1.23,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Exception Members,,0.97790,,,,,,,0.63500,1.23,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,inpatient,1,mL,4.64000,4.41000,The Alliance,Exception Members,,3.57,,,,,,,2.55,4.50,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Exception Members,,3.57,,,,,,,2.32,4.50,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.14409,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,0.14409,5.61,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,26.40,46.56,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,4.40,237.65,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.46000,839.29000,The Alliance,Exception Members,,680.26,,,,,,,432.90,856.96,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.46000,839.29000,The Alliance,Exception Members,,680.26,,,,,,,405.51,883.46,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6693.00000,6358.35000,The Alliance,Exception Members,,5153.61,,,,,,,3279.57,6492.21,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6693.00000,6358.35000,The Alliance,Exception Members,,5153.61,,,,,,,3072.09,6693.00,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,565.01000,536.76000,The Alliance,Exception Members,,435.06,,,,,,,276.85,548.06,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,565.01000,536.76000,The Alliance,Exception Members,,435.06,,,,,,,259.34,565.01,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,312.86000,297.22000,The Alliance,Exception Members,,240.90,,,,,,,153.30,303.47,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,312.86000,297.22000,The Alliance,Exception Members,,240.90,,,,,,,143.60,312.86,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,The Alliance,Exception Members,TC,987.91,,,,,,,705.65,1244.51,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Exception Members,TC,987.91,,,,,,,584.87,1820.00,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Exception Members,,3885.14,,,,,,,2315.94,5045.63,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,688.69000,654.26000,The Alliance,Exception Members,,530.29,,,,,,,337.46,668.03,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,688.69000,654.26000,The Alliance,Exception Members,,530.29,,,,,,,316.11,688.69,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,inpatient,1,mL,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.26950,0.47530,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,outpatient,1,mL,0.49000,0.46000,The Alliance,Exception Members,,0.37730,,,,,,,0.24500,10.52,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.75500,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.49,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Exception Members,,2.08,,,,,,,1.35,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Exception Members,,2.22,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Exception Members,,0.63910,,,,,,,0.41500,0.80510,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,Exception Members,TC,131.67,,,,,,,94.05,165.87,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Exception Members,TC,131.67,,,,,,,85.50,165.87,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,inpatient,1,mL,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,10.86,19.16,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,outpatient,1,mL,19.75000,18.76000,The Alliance,Exception Members,,15.21,,,,,,,9.88,19.16,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,inpatient,1,mL,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.93500,1.65,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,outpatient,1,mL,1.70000,1.62000,The Alliance,Exception Members,,1.31,,,,,,,0.85000,7.69,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,The Alliance,Exception Members,TC,225.61,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Exception Members,TC,225.61,,,,,,,146.50,584.87,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,382.25,674.15,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,298.87,1820.00,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,The Alliance,Exception Members,TC,424.27,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Exception Members,TC,424.27,,,,,,,275.50,584.87,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,inpatient,1,GM,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,60.83,107.28,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,outpatient,1,GM,110.60000,105.07000,The Alliance,Exception Members,,85.16,,,,,,,55.30,107.28,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,inpatient,1,mL,435.00000,413.25000,The Alliance,Exception Members,,334.95,,,,,,,239.25,421.95,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,outpatient,1,mL,435.00000,413.25000,The Alliance,Exception Members,,334.95,,,,,,,217.50,421.95,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,inpatient,,,27.90000,26.50000,The Alliance,Exception Members,,21.48,,,,,,,15.35,27.06,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,outpatient,,,27.90000,26.50000,The Alliance,Exception Members,,21.48,,,,,,,13.95,27.06,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Exception Members,,0.14630,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.85800,1.51,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Exception Members,,1.20,,,,,,,0.78000,1.51,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,128.32,279.56,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,17.75,38.68,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,inpatient,,,12.60000,11.97000,The Alliance,Exception Members,90,9.70,,,,,,,6.93,12.22,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,outpatient,,,12.60000,11.97000,The Alliance,Exception Members,90,9.70,,,,,,,5.35,271.65,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.58,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,inpatient,1,mL,3.27000,3.11000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,outpatient,1,mL,3.27000,3.11000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.56,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Exception Members,,2.19,,,,,,,1.42,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,inpatient,1,mL,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.24,2.19,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Exception Members,,1.74,,,,,,,1.13,2.19,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Exception Members,,0.23100,,,,,,,0.15000,0.81340,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,inpatient,1,mL,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Exception Members,,106.84,,,,,,,69.38,134.59,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,873.75000,830.06000,The Alliance,Exception Members,,672.79,,,,,,,428.14,847.54,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,873.75000,830.06000,The Alliance,Exception Members,,672.79,,,,,,,401.05,873.75,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,800.63000,760.60000,The Alliance,Exception Members,,616.49,,,,,,,392.31,776.61,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,800.63000,760.60000,The Alliance,Exception Members,,616.49,,,,,,,367.49,800.63,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,54.36000,51.64000,The Alliance,Exception Members,,41.86,,,,,,,26.64,52.73,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,54.36000,51.64000,The Alliance,Exception Members,,41.86,,,,,,,24.95,54.36,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,72.32,143.17,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,56.84,112.52,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,53.24,116.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,inpatient,,,1944.00000,1846.80000,The Alliance,Exception Members,TC,1496.88,,,,,,,1069.20,1885.68,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Exception Members,TC,1496.88,,,,,,,797.92,1885.68,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,The Alliance,Exception Members,,621.54,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Exception Members,,621.54,,,,,,,370.50,807.19,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,387.28,843.75,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,The Alliance,Exception Members,,1208.42,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Exception Members,,1208.42,,,,,,,720.35,1569.38,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,19.58,63.05,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,56.40,248.32,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.40920,2.21,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,372.50,1820.00,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,inpatient,,,2602.00000,2471.90000,The Alliance,Exception Members,TC,2003.54,,,,,,,1431.10,2523.94,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Exception Members,TC,2003.54,,,,,,,384.16,2523.94,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,The Alliance,Exception Members,,2287.67,,,,,,,1634.05,2881.87,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Exception Members,,2287.67,,,,,,,581.10,2881.87,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,inpatient,,,812.00000,771.40000,The Alliance,Exception Members,TC,625.24,,,,,,,446.60,787.64,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Exception Members,TC,625.24,,,,,,,406.00,4081.21,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,5115.55,9021.97,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,4467.66,9021.97,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,691.90,1220.26,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,384.16,1220.26,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,372.50,792.37,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,inpatient,,,7033.00000,6681.35000,The Alliance,Exception Members,TC,5415.41,,,,,,,3868.15,6822.01,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,outpatient,,,7033.00000,6681.35000,The Alliance,Exception Members,TC,5415.41,,,,,,,3383.38,7180.14,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,TC,120.12,,,,,,,85.80,151.32,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,TC,120.12,,,,,,,78.00,8022.25,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,The Alliance,Exception Members,TC,3635.94,,,,,,,2597.10,4580.34,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Exception Members,TC,3635.94,,,,,,,2288.22,7180.14,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,The Alliance,Exception Members,,2287.67,,,,,,,1634.05,2881.87,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Exception Members,,2287.67,,,,,,,657.58,2881.87,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,288.20,508.28,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,257.95,2630.66,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,inpatient,1,mL,1762.48000,1674.36000,The Alliance,Exception Members,,1357.11,,,,,,,969.36,1709.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,outpatient,1,mL,1762.48000,1674.36000,The Alliance,Exception Members,,1357.11,,,,,,,266.44,1709.61,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,inpatient,1,mL,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,2.71,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,inpatient,1,mL,185.02000,175.77000,The Alliance,Exception Members,,142.47,,,,,,,101.76,179.47,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,outpatient,1,mL,185.02000,175.77000,The Alliance,Exception Members,,142.47,,,,,,,32.41,179.47,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,72.00,260.45,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,inpatient,1,mL,7691.77000,7307.18000,The Alliance,Exception Members,,5922.66,,,,,,,4230.47,7461.02,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,outpatient,1,mL,7691.77000,7307.18000,The Alliance,Exception Members,,5922.66,,,,,,,3845.89,7461.02,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,inpatient,,,94.40000,89.68000,The Alliance,Exception Members,90,72.69,,,,,,,51.92,91.57,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,outpatient,,,94.40000,89.68000,The Alliance,Exception Members,90,72.69,,,,,,,47.20,3038.81,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,inpatient,,,2215.00000,2104.25000,The Alliance,Exception Members,,1705.55,,,,,,,1218.25,2148.55,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,outpatient,,,2215.00000,2104.25000,The Alliance,Exception Members,,1705.55,,,,,,,1107.50,2148.55,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,43.81,161.02,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,inpatient,,,882.84000,838.70000,The Alliance,Exception Members,,679.79,,,,,,,485.56,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,outpatient,,,882.84000,838.70000,The Alliance,Exception Members,,679.79,,,,,,,393.87,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,inpatient,1,EA,998.46000,948.54000,The Alliance,Exception Members,,768.81,,,,,,,549.15,968.51,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,outpatient,1,EA,998.46000,948.54000,The Alliance,Exception Members,,768.81,,,,,,,393.87,968.51,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,inpatient,,,430.57000,409.04000,The Alliance,Exception Members,,331.54,,,,,,,236.81,417.65,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,outpatient,,,430.57000,409.04000,The Alliance,Exception Members,,331.54,,,,,,,215.28,417.65,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,inpatient,,,2328.75000,2212.31000,The Alliance,Exception Members,,1793.14,,,,,,,1280.81,2258.89,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,2328.75000,2212.31000,The Alliance,Exception Members,,1793.14,,,,,,,376.51,2258.89,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,41.00,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,TC,2656.50,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,TC,2656.50,,,,,,,1591.55,3346.50,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,108.90,192.06,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,99.00,192.06,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,20.35,35.89,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,18.50,264.00,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,inpatient,,,1236.00000,1174.20000,The Alliance,Exception Members,,951.72,,,,,,,679.80,1198.92,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,outpatient,,,1236.00000,1174.20000,The Alliance,Exception Members,,951.72,,,,,,,314.95,1198.92,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,inpatient,,,561.00000,532.95000,The Alliance,Exception Members,TC,431.97,,,,,,,308.55,544.17,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,outpatient,,,561.00000,532.95000,The Alliance,Exception Members,TC,431.97,,,,,,,168.00,544.17,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,inpatient,,,40.55000,38.52000,The Alliance,Exception Members,,31.22,,,,,,,22.30,39.33,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,outpatient,,,40.55000,38.52000,The Alliance,Exception Members,,31.22,,,,,,,20.27,39.33,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,Exception Members,,108.57,,,,,,,77.55,136.77,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Exception Members,,108.57,,,,,,,70.50,264.00,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,183.56,323.74,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,163.27,323.74,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,inpatient,,,744.63000,707.40000,The Alliance,Exception Members,,573.37,,,,,,,409.55,722.29,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,outpatient,,,744.63000,707.40000,The Alliance,Exception Members,,573.37,,,,,,,372.31,722.29,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,TC,2154.46,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Exception Members,TC,2154.46,,,,,,,979.11,2714.06,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,inpatient,,,3.39000,3.22000,The Alliance,Exception Members,,2.61,,,,,,,1.86,3.29,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,outpatient,,,3.39000,3.22000,The Alliance,Exception Members,,2.61,,,,,,,1.70,3.29,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,inpatient,,,24.82000,23.58000,The Alliance,Exception Members,,19.11,,,,,,,13.65,24.08,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,outpatient,,,24.82000,23.58000,The Alliance,Exception Members,,19.11,,,,,,,7.57,24.08,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,inpatient,,,95.07000,90.32000,The Alliance,Exception Members,,73.20,,,,,,,52.29,92.22,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,outpatient,,,95.07000,90.32000,The Alliance,Exception Members,,73.20,,,,,,,35.64,92.22,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,The Alliance,Exception Members,TC,169.25,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Exception Members,TC,169.25,,,,,,,109.90,213.21,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,47.06,111.55,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,inpatient,,,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,outpatient,,,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.62500,1.21,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,36.30,145.50,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,inpatient,,,710.00000,674.50000,The Alliance,Exception Members,,546.70,,,,,,,390.50,688.70,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Exception Members,,546.70,,,,,,,122.40,688.70,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,186.45,328.83,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,56.40,328.83,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,The Alliance,Exception Members,,3324.86,,,,,,,2374.90,4188.46,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Exception Members,,3324.86,,,,,,,1031.39,4188.46,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,inpatient,,,5.24000,4.98000,The Alliance,Exception Members,,4.03,,,,,,,2.88,5.08,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,outpatient,,,5.24000,4.98000,The Alliance,Exception Members,,4.03,,,,,,,2.62,5.08,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,75.00,155.84,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,The Alliance,Exception Members,,4926.46,,,,,,,3518.90,6206.06,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Exception Members,,4926.46,,,,,,,1914.61,6206.06,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,inpatient,,,115.43000,109.66000,The Alliance,Exception Members,,88.88,,,,,,,63.49,111.97,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,outpatient,,,115.43000,109.66000,The Alliance,Exception Members,,88.88,,,,,,,57.47,111.97,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,5.83,41.71,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,The Alliance,Exception Members,TC,2631.86,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Exception Members,TC,2631.86,,,,,,,1578.65,3315.46,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,107.80,190.12,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,39.18,190.12,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,inpatient,,,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,26.18,46.17,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,17.81,46.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,inpatient,,,254.81000,242.07000,The Alliance,Exception Members,,196.20,,,,,,,140.15,247.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,outpatient,,,254.81000,242.07000,The Alliance,Exception Members,,196.20,,,,,,,102.07,247.17,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,49.87,87.95,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,45.34,87.95,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,inpatient,,,59.60000,56.62000,The Alliance,Exception Members,,45.89,,,,,,,32.78,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Exception Members,,45.89,,,,,,,22.93,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,inpatient,,,28.13000,26.72000,The Alliance,Exception Members,,21.66,,,,,,,15.47,27.29,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,outpatient,,,28.13000,26.72000,The Alliance,Exception Members,,21.66,,,,,,,13.42,27.29,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,inpatient,,,41.60000,39.52000,The Alliance,Exception Members,,32.03,,,,,,,22.88,40.35,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Exception Members,,32.03,,,,,,,9.78,40.35,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,2910.60,5133.24,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,1388.02,5133.24,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,The Alliance,Exception Members,,5125.12,,,,,,,3660.80,6456.32,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Exception Members,,5125.12,,,,,,,2074.81,6456.32,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,21.41,37.76,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,12.21,37.76,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,inpatient,,,259.13000,246.17000,The Alliance,Exception Members,,199.53,,,,,,,142.52,251.36,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,outpatient,,,259.13000,246.17000,The Alliance,Exception Members,,199.53,,,,,,,79.20,251.36,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,inpatient,,,55.73000,52.94000,The Alliance,Exception Members,,42.91,,,,,,,30.65,54.06,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,outpatient,,,55.73000,52.94000,The Alliance,Exception Members,,42.91,,,,,,,26.83,54.06,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,inpatient,,,83.07000,78.92000,The Alliance,Exception Members,,63.96,,,,,,,45.69,80.58,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,outpatient,,,83.07000,78.92000,The Alliance,Exception Members,,63.96,,,,,,,19.47,80.58,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,inpatient,,,42.67000,40.54000,The Alliance,Exception Members,,32.86,,,,,,,23.47,41.39,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,outpatient,,,42.67000,40.54000,The Alliance,Exception Members,,32.86,,,,,,,19.37,41.39,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,inpatient,,,77.07000,73.22000,The Alliance,Exception Members,,59.34,,,,,,,42.39,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Exception Members,,59.34,,,,,,,38.53,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,inpatient,,,216.94000,206.09000,The Alliance,Exception Members,,167.04,,,,,,,119.32,210.43,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,outpatient,,,216.94000,206.09000,The Alliance,Exception Members,,167.04,,,,,,,89.94,210.43,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,inpatient,,,40.28000,38.27000,The Alliance,Exception Members,,31.02,,,,,,,22.15,39.07,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,outpatient,,,40.28000,38.27000,The Alliance,Exception Members,,31.02,,,,,,,7.86,39.07,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,45.80,172.66,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,inpatient,,,61.47000,58.40000,The Alliance,Exception Members,,47.33,,,,,,,33.81,59.63,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,outpatient,,,61.47000,58.40000,The Alliance,Exception Members,,47.33,,,,,,,17.39,59.63,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,inpatient,,,30.67000,29.14000,The Alliance,Exception Members,,23.62,,,,,,,16.87,29.75,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,outpatient,,,30.67000,29.14000,The Alliance,Exception Members,,23.62,,,,,,,8.69,29.75,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,549.28,20208.37,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,inpatient,,,85.33000,81.06000,The Alliance,Exception Members,,65.70,,,,,,,46.93,82.77,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,outpatient,,,85.33000,81.06000,The Alliance,Exception Members,,65.70,,,,,,,38.77,82.77,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,inpatient,,,30.40000,28.88000,The Alliance,Exception Members,,23.41,,,,,,,14.90,29.49,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Exception Members,,23.41,,,,,,,13.95,30.40,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,inpatient,,,2245.00000,2132.75000,The Alliance,Exception Members,,1728.65,,,,,,,1234.75,2177.65,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,outpatient,,,2245.00000,2132.75000,The Alliance,Exception Members,,1728.65,,,,,,,1122.50,2177.65,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,inpatient,,,4544.00000,4316.80000,The Alliance,Exception Members,,3498.88,,,,,,,2226.56,4407.68,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,outpatient,,,4544.00000,4316.80000,The Alliance,Exception Members,,3498.88,,,,,,,2085.70,4544.00,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,inpatient,,,97.73000,92.84000,The Alliance,Exception Members,,75.25,,,,,,,53.75,94.80,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,outpatient,,,97.73000,92.84000,The Alliance,Exception Members,,75.25,,,,,,,22.03,94.80,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,85.80,151.32,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,27.63,151.32,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,11.62,45.59,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.90,17.46,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,7.75,17.46,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,inpatient,,,41.60000,39.52000,The Alliance,Exception Members,,32.03,,,,,,,22.88,40.35,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Exception Members,,32.03,,,,,,,8.17,40.35,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,inpatient,,,38.53000,36.60000,The Alliance,Exception Members,,29.67,,,,,,,21.19,37.37,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,outpatient,,,38.53000,36.60000,The Alliance,Exception Members,,29.67,,,,,,,12.54,37.37,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,inpatient,,,50.53000,48.00000,The Alliance,Exception Members,,38.91,,,,,,,27.79,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,outpatient,,,50.53000,48.00000,The Alliance,Exception Members,,38.91,,,,,,,13.09,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,inpatient,,,23.60000,22.42000,The Alliance,Exception Members,,18.17,,,,,,,12.98,22.89,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,outpatient,,,23.60000,22.42000,The Alliance,Exception Members,,18.17,,,,,,,5.79,22.89,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,53.50,264.00,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,21.34,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,inpatient,,,19.47000,18.50000,The Alliance,Exception Members,,14.99,,,,,,,10.71,18.89,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Exception Members,,14.99,,,,,,,4.54,18.89,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,3853.00000,3660.35000,The Alliance,Exception Members,,2966.81,,,,,,,2119.15,3737.41,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,3853.00000,3660.35000,The Alliance,Exception Members,,2966.81,,,,,,,1040.32,3737.41,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,inpatient,,,75805.34000,72015.07000,The Alliance,Exception Members,,58370.11,,,,,,,41692.94,73531.18,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,outpatient,,,75805.34000,72015.07000,The Alliance,Exception Members,,58370.11,,,,,,,37902.67,94648.39,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,The Alliance,Exception Members,TC,1659.35,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Exception Members,TC,1659.35,,,,,,,1006.74,2960.49,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,inpatient,,,19.47000,18.50000,The Alliance,Exception Members,,14.99,,,,,,,10.71,18.89,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Exception Members,,14.99,,,,,,,6.12,18.89,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,7.66,156.25,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,37.27,149.38,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,21.41,37.76,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,9.04,37.76,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,inpatient,,,42.76000,40.62000,The Alliance,Exception Members,,32.93,,,,,,,23.52,41.48,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,outpatient,,,42.76000,40.62000,The Alliance,Exception Members,,32.93,,,,,,,21.38,41.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,inpatient,,,357.20000,339.34000,The Alliance,Exception Members,,275.04,,,,,,,196.46,346.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,outpatient,,,357.20000,339.34000,The Alliance,Exception Members,,275.04,,,,,,,178.60,346.48,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,9.88,184.30,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,Exception Members,TC,284.90,,,,,,,203.50,358.90,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Exception Members,TC,284.90,,,,,,,181.22,1865.95,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,inpatient,,,2901.00000,2755.95000,The Alliance,Exception Members,TC,2233.77,,,,,,,1595.55,2813.97,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Exception Members,TC,2233.77,,,,,,,1390.65,14479.11,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,inpatient,,,4368.00000,4149.60000,The Alliance,Exception Members,TC,3363.36,,,,,,,2402.40,4236.96,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,outpatient,,,4368.00000,4149.60000,The Alliance,Exception Members,TC,3363.36,,,,,,,2181.80,4236.96,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,148.57,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,The Alliance,Exception Members,,12397.00,,,,,,,8855.00,15617.00,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Exception Members,,12397.00,,,,,,,966.05,15617.00,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,The Alliance,Exception Members,,9.64,,,,,,,6.89,12.14,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Exception Members,,9.64,,,,,,,6.26,12.14,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,382.80,675.12,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,348.00,675.12,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,548.00,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,The Alliance,Exception Members,,947.87,,,,,,,677.05,1194.07,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Exception Members,,947.87,,,,,,,615.50,1194.07,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,290.40,512.16,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,,406.56,,,,,,,264.00,689.02,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,TC,143.99,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,TC,143.99,,,,,,,93.50,181.39,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,TC,12778.15,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,TC,12778.15,,,,,,,7955.77,82746.35,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,TC,1024.87,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,TC,1024.87,,,,,,,644.24,2960.49,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,inpatient,,,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,23.32,46.17,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Exception Members,,36.65,,,,,,,2.83,46.17,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,The Alliance,Exception Members,,947.87,,,,,,,677.05,1194.07,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Exception Members,,947.87,,,,,,,615.50,1194.07,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,21.41,37.76,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,19.46,37.76,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,TC,45.43,,,,,,,32.45,57.23,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,TC,45.43,,,,,,,29.50,57.23,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,496.88000,472.04000,The Alliance,Exception Members,,382.60,,,,,,,273.28,481.97,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,496.88000,472.04000,The Alliance,Exception Members,,382.60,,,,,,,143.61,874.50,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,The Alliance,Exception Members,TC,2667.28,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Exception Members,TC,2667.28,,,,,,,1611.84,3360.08,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,433.40,764.36,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,394.00,4298.79,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,8.36,14.74,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,15.20000,14.44000,The Alliance,Exception Members,,11.70,,,,,,,7.60,14.74,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,740.63000,703.60000,The Alliance,Exception Members,,570.29,,,,,,,407.35,718.41,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,740.63000,703.60000,The Alliance,Exception Members,,570.29,,,,,,,143.61,874.50,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,395.31000,375.54000,The Alliance,Exception Members,,304.39,,,,,,,217.42,383.45,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,395.31000,375.54000,The Alliance,Exception Members,,304.39,,,,,,,143.61,874.50,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,TC,129.36,,,,,,,92.40,162.96,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,TC,129.36,,,,,,,84.00,162.96,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,238.63000,226.70000,The Alliance,Exception Members,,183.75,,,,,,,131.25,231.47,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,238.63000,226.70000,The Alliance,Exception Members,,183.75,,,,,,,119.31,874.50,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,Exception Members,TC,360.36,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Exception Members,TC,360.36,,,,,,,234.00,2419.76,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,307.27000,291.91000,The Alliance,Exception Members,,236.60,,,,,,,169.00,298.05,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,307.27000,291.91000,The Alliance,Exception Members,,236.60,,,,,,,143.61,874.50,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Exception Members,TC,1747.13,,,,,,,1134.50,2200.93,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,33.56000,31.88000,The Alliance,Exception Members,,25.84,,,,,,,16.44,32.55,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Exception Members,,25.84,,,,,,,11.56,32.55,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,42.52000,40.39000,The Alliance,Exception Members,,32.74,,,,,,,20.83,41.24,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,42.52000,40.39000,The Alliance,Exception Members,,32.74,,,,,,,11.56,41.24,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,421.88000,400.79000,The Alliance,Exception Members,,324.85,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Exception Members,,324.85,,,,,,,157.76,409.22,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,703.13000,667.97000,The Alliance,Exception Members,,541.41,,,,,,,386.72,682.04,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,703.13000,667.97000,The Alliance,Exception Members,,541.41,,,,,,,157.76,682.04,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,TC,80.85,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,TC,80.85,,,,,,,52.50,4496.60,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,464.06,818.44,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,157.76,818.44,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,52,346.50,,,,,,,247.50,436.50,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,52,346.50,,,,,,,225.00,492.80,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,inpatient,,,18.48000,17.56000,The Alliance,Exception Members,,14.23,,,,,,,9.06,17.93,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,outpatient,,,18.48000,17.56000,The Alliance,Exception Members,,14.23,,,,,,,8.48,17.93,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,148.24,261.44,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,134.76,874.50,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,358.80000,340.86000,The Alliance,Exception Members,,276.28,,,,,,,197.34,348.04,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,358.80000,340.86000,The Alliance,Exception Members,,276.28,,,,,,,157.76,348.04,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,TC,124.74,,,,,,,89.10,157.14,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,TC,124.74,,,,,,,81.00,2210.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,inpatient,,,60.90000,57.85000,The Alliance,Exception Members,TC,46.89,,,,,,,33.49,59.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,outpatient,,,60.90000,57.85000,The Alliance,Exception Members,TC,46.89,,,,,,,30.45,59.07,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,TC,468.93,,,,,,,334.95,590.73,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,TC,468.93,,,,,,,304.50,590.73,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.66,3.22,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,inpatient,1,EA,3695.71000,3510.92000,The Alliance,Exception Members,,2845.70,,,,,,,2032.64,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,outpatient,1,EA,3695.71000,3510.92000,The Alliance,Exception Members,,2845.70,,,,,,,12.12,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,inpatient,1,EA,3270.72000,3107.18000,The Alliance,Exception Members,,2518.45,,,,,,,1798.90,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,outpatient,1,EA,3270.72000,3107.18000,The Alliance,Exception Members,,2518.45,,,,,,,12.12,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,inpatient,1,EA,3314.32000,3148.61000,The Alliance,Exception Members,,2552.03,,,,,,,1822.88,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,outpatient,1,EA,3314.32000,3148.61000,The Alliance,Exception Members,,2552.03,,,,,,,12.12,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,inpatient,1,EA,3634.14000,3452.43000,The Alliance,Exception Members,,2798.29,,,,,,,1998.78,3525.12,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,outpatient,1,EA,3634.14000,3452.43000,The Alliance,Exception Members,,2798.29,,,,,,,12.12,3525.12,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,269.85000,256.36000,The Alliance,Exception Members,,207.78,,,,,,,132.23,261.75,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,269.85000,256.36000,The Alliance,Exception Members,,207.78,,,,,,,123.86,269.85,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,The Alliance,Exception Members,,304.64,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Exception Members,,304.64,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,30261.00000,28747.95000,The Alliance,Exception Members,,23300.97,,,,,,,14827.89,29353.17,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30261.00000,28747.95000,The Alliance,Exception Members,,23300.97,,,,,,,13889.80,30261.00,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,160.60,283.24,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,55.26,283.24,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,35.50,68.87,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,58.39000,55.47000,The Alliance,Exception Members,,44.96,,,,,,,32.11,56.64,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,58.39000,55.47000,The Alliance,Exception Members,,44.96,,,,,,,29.20,56.64,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,52.36000,49.74000,The Alliance,Exception Members,,40.32,,,,,,,28.80,50.79,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Exception Members,,40.32,,,,,,,26.18,50.79,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,23.00,44.62,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,18.70,32.98,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,17.00,32.98,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,inpatient,,,209.81000,199.32000,The Alliance,Exception Members,,161.55,,,,,,,102.81,203.52,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,outpatient,,,209.81000,199.32000,The Alliance,Exception Members,,161.55,,,,,,,104.91,203.52,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,13.07000,12.42000,The Alliance,Exception Members,,10.06,,,,,,,7.19,12.68,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,13.07000,12.42000,The Alliance,Exception Members,,10.06,,,,,,,2.63,12.68,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,inpatient,,,172.04000,163.44000,The Alliance,Exception Members,,132.47,,,,,,,84.30,166.88,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,outpatient,,,172.04000,163.44000,The Alliance,Exception Members,,132.47,,,,,,,86.02,180.06,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,14.00,27.16,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,Exception Members,NU,12.32,,,,,,,8.80,15.52,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Exception Members,NU,12.32,,,,,,,8.00,16.05,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,The Alliance,Exception Members,,57.08,,,,,,,36.32,71.91,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Exception Members,,57.08,,,,,,,37.06,71.91,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,17.00000,16.15000,The Alliance,Exception Members,NU,13.09,,,,,,,9.35,16.49,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Exception Members,NU,13.09,,,,,,,8.50,16.49,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,472.50000,448.88000,The Alliance,Exception Members,,363.82,,,,,,,231.53,458.32,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Exception Members,,363.82,,,,,,,216.88,458.32,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,inpatient,,,65.73000,62.44000,The Alliance,Exception Members,,50.61,,,,,,,36.15,63.76,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,outpatient,,,65.73000,62.44000,The Alliance,Exception Members,,50.61,,,,,,,32.87,63.76,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,The Alliance,Exception Members,,24.74,,,,,,,17.67,31.17,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Exception Members,,24.74,,,,,,,16.07,31.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,15.64000,14.86000,The Alliance,Exception Members,,12.04,,,,,,,8.60,15.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,15.64000,14.86000,The Alliance,Exception Members,,12.04,,,,,,,7.82,15.17,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,144.31000,137.09000,The Alliance,Exception Members,,111.12,,,,,,,79.37,139.98,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,144.31000,137.09000,The Alliance,Exception Members,,111.12,,,,,,,72.16,139.98,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,82.93000,78.78000,The Alliance,Exception Members,,63.86,,,,,,,45.61,80.44,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,82.93000,78.78000,The Alliance,Exception Members,,63.86,,,,,,,41.47,80.44,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,inpatient,,,1245.79000,1183.50000,The Alliance,Exception Members,,959.26,,,,,,,610.44,1208.42,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,outpatient,,,1245.79000,1183.50000,The Alliance,Exception Members,,959.26,,,,,,,622.89,1208.42,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,167.80000,159.41000,The Alliance,Exception Members,,129.21,,,,,,,92.29,162.77,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,167.80000,159.41000,The Alliance,Exception Members,,129.21,,,,,,,83.90,162.77,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,95.46000,90.69000,The Alliance,Exception Members,,73.50,,,,,,,46.78,92.60,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,95.46000,90.69000,The Alliance,Exception Members,,73.50,,,,,,,47.73,232.52,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,inpatient,,,31.33000,29.76000,The Alliance,Exception Members,,24.12,,,,,,,15.35,30.39,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,outpatient,,,31.33000,29.76000,The Alliance,Exception Members,,24.12,,,,,,,15.66,90.87,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,inpatient,,,306.76000,291.42000,The Alliance,Exception Members,,236.21,,,,,,,150.31,297.56,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Exception Members,,236.21,,,,,,,153.38,630.65,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,The Alliance,Exception Members,,24.74,,,,,,,17.67,31.17,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Exception Members,,24.74,,,,,,,16.07,31.17,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,257.76000,244.87000,The Alliance,Exception Members,,198.48,,,,,,,126.30,250.03,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,257.76000,244.87000,The Alliance,Exception Members,,198.48,,,,,,,81.64,250.03,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,50.06000,47.56000,The Alliance,Exception Members,NU,38.55,,,,,,,27.53,48.56,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,50.06000,47.56000,The Alliance,Exception Members,NU,38.55,,,,,,,25.03,75.83,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,25.77000,24.48000,The Alliance,Exception Members,,19.84,,,,,,,14.17,25.00,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,25.77000,24.48000,The Alliance,Exception Members,,19.84,,,,,,,12.88,25.00,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,45.34,87.95,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,64.53000,61.30000,The Alliance,Exception Members,,49.69,,,,,,,35.49,62.59,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,64.53000,61.30000,The Alliance,Exception Members,,49.69,,,,,,,32.27,62.59,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.80,15.52,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.00,17.60,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,38.27000,36.36000,The Alliance,Exception Members,,29.47,,,,,,,18.75,37.12,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,38.27000,36.36000,The Alliance,Exception Members,,29.47,,,,,,,19.14,102.20,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,127.79000,121.40000,The Alliance,Exception Members,,98.40,,,,,,,70.28,123.96,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,127.79000,121.40000,The Alliance,Exception Members,,98.40,,,,,,,63.90,123.96,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,31.56000,29.98000,The Alliance,Exception Members,,24.30,,,,,,,15.46,30.61,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,31.56000,29.98000,The Alliance,Exception Members,,24.30,,,,,,,14.49,30.61,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,inpatient,,,94.13000,89.42000,The Alliance,Exception Members,,72.48,,,,,,,51.77,91.31,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,outpatient,,,94.13000,89.42000,The Alliance,Exception Members,,72.48,,,,,,,47.06,91.31,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,196.16000,186.35000,The Alliance,Exception Members,NU,151.04,,,,,,,107.89,190.28,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,196.16000,186.35000,The Alliance,Exception Members,NU,151.04,,,,,,,56.49,190.28,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,20.00,43.75,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,inpatient,,,78.37000,74.45000,The Alliance,Exception Members,,60.34,,,,,,,43.10,76.02,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,outpatient,,,78.37000,74.45000,The Alliance,Exception Members,,60.34,,,,,,,39.19,76.02,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,64.42000,61.20000,The Alliance,Exception Members,,49.60,,,,,,,31.57,62.49,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,64.42000,61.20000,The Alliance,Exception Members,,49.60,,,,,,,32.21,62.49,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,inpatient,,,13.82000,13.13000,The Alliance,Exception Members,,10.64,,,,,,,7.60,13.41,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,outpatient,,,13.82000,13.13000,The Alliance,Exception Members,,10.64,,,,,,,2.09,13.41,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,90.20,159.08,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,82.00,159.08,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,NU,77.00,,,,,,,55.00,97.00,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,NU,77.00,,,,,,,14.99,97.00,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,33.00,64.02,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,15.68,31.04,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,38.21,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,53.73000,51.04000,The Alliance,Exception Members,,41.37,,,,,,,29.55,52.12,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,53.73000,51.04000,The Alliance,Exception Members,,41.37,,,,,,,26.86,52.12,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,29.70,52.38,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Exception Members,,41.58,,,,,,,27.00,52.38,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,2.63,6.47,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,33.92000,32.22000,The Alliance,Exception Members,,26.12,,,,,,,18.66,32.90,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,33.92000,32.22000,The Alliance,Exception Members,,26.12,,,,,,,16.96,32.90,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,inpatient,,,96.88000,92.04000,The Alliance,Exception Members,,74.60,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Exception Members,,74.60,,,,,,,48.44,93.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.94000,188.99000,The Alliance,Exception Members,,153.18,,,,,,,97.48,192.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.94000,188.99000,The Alliance,Exception Members,,153.18,,,,,,,91.31,192.97,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,11.21000,10.65000,The Alliance,Exception Members,,8.63,,,,,,,6.17,10.87,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,11.21000,10.65000,The Alliance,Exception Members,,8.63,,,,,,,5.61,10.87,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,76.89000,73.05000,The Alliance,Exception Members,,59.21,,,,,,,37.68,74.58,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,76.89000,73.05000,The Alliance,Exception Members,,59.21,,,,,,,38.45,74.58,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,1.73,6.47,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,45.56000,43.28000,The Alliance,Exception Members,,35.08,,,,,,,22.32,44.19,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,45.56000,43.28000,The Alliance,Exception Members,,35.08,,,,,,,22.78,121.81,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,197.06000,187.21000,The Alliance,Exception Members,,151.74,,,,,,,96.56,191.15,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,197.06000,187.21000,The Alliance,Exception Members,,151.74,,,,,,,77.37,191.15,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,247.54000,235.16000,The Alliance,Exception Members,,190.61,,,,,,,136.15,240.11,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,247.54000,235.16000,The Alliance,Exception Members,,190.61,,,,,,,123.77,240.11,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,12.00,26.40,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,inpatient,,,96.88000,92.04000,The Alliance,Exception Members,,74.60,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Exception Members,,74.60,,,,,,,48.44,93.97,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,inpatient,,,1579.84000,1500.85000,The Alliance,Exception Members,,1216.48,,,,,,,774.12,1532.44,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,outpatient,,,1579.84000,1500.85000,The Alliance,Exception Members,,1216.48,,,,,,,789.92,1532.44,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,46.20,81.48,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,42.00,81.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,inpatient,,,608.74000,578.30000,The Alliance,Exception Members,,468.73,,,,,,,298.28,590.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Exception Members,,468.73,,,,,,,206.75,590.48,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,inpatient,,,179.66000,170.68000,The Alliance,Exception Members,,138.34,,,,,,,98.81,174.27,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,outpatient,,,179.66000,170.68000,The Alliance,Exception Members,,138.34,,,,,,,1.71,174.27,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,44.00,77.60,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,40.00,77.60,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,11.00000,10.45000,The Alliance,Exception Members,,8.47,,,,,,,6.05,10.67,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Exception Members,,8.47,,,,,,,5.50,10.67,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,27.44,54.32,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Exception Members,,43.12,,,,,,,28.00,92.45,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,29.10,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,92.48000,87.86000,The Alliance,Exception Members,,71.21,,,,,,,50.86,89.71,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,92.48000,87.86000,The Alliance,Exception Members,,71.21,,,,,,,46.24,89.71,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,55.84,98.47,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,50.76,98.47,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,inpatient,,,223.09000,211.94000,The Alliance,Exception Members,,171.78,,,,,,,109.31,216.40,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,outpatient,,,223.09000,211.94000,The Alliance,Exception Members,,171.78,,,,,,,111.55,216.40,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,218.81000,207.87000,The Alliance,Exception Members,,168.48,,,,,,,107.22,212.25,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,218.81000,207.87000,The Alliance,Exception Members,,168.48,,,,,,,100.43,212.25,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,inpatient,,,8.67000,8.24000,The Alliance,Exception Members,,6.68,,,,,,,4.77,8.41,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,outpatient,,,8.67000,8.24000,The Alliance,Exception Members,,6.68,,,,,,,2.72,8.41,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,118.34,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,18.15,32.01,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,16.50,36.30,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,inpatient,,,24.93000,23.68000,The Alliance,Exception Members,,19.20,,,,,,,13.71,24.18,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,outpatient,,,24.93000,23.68000,The Alliance,Exception Members,,19.20,,,,,,,12.46,25.71,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,44.06000,41.86000,The Alliance,Exception Members,,33.93,,,,,,,24.23,42.74,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,44.06000,41.86000,The Alliance,Exception Members,,33.93,,,,,,,22.03,42.74,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,185.09000,175.84000,The Alliance,Exception Members,,142.52,,,,,,,90.69,179.54,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,185.09000,175.84000,The Alliance,Exception Members,,142.52,,,,,,,92.55,179.54,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,183.56,323.74,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,166.88,323.74,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.90,17.46,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.00,17.46,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,inpatient,,,241.12000,229.06000,The Alliance,Exception Members,,185.66,,,,,,,118.15,233.89,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,outpatient,,,241.12000,229.06000,The Alliance,Exception Members,,185.66,,,,,,,120.56,233.89,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,22.55,39.77,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Exception Members,,31.57,,,,,,,20.50,39.77,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,inpatient,,,19.20000,18.24000,The Alliance,Exception Members,,14.78,,,,,,,10.56,18.62,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,outpatient,,,19.20000,18.24000,The Alliance,Exception Members,,14.78,,,,,,,9.60,19.71,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,300.00000,285.00000,The Alliance,Exception Members,,231.00,,,,,,,147.00,291.00,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,300.00000,285.00000,The Alliance,Exception Members,,231.00,,,,,,,150.00,449.21,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,inpatient,,,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,10.22,18.02,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,outpatient,,,18.58000,17.65000,The Alliance,Exception Members,,14.31,,,,,,,9.29,18.02,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,11.00,19.40,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,10.00,19.40,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,inpatient,,,208.28000,197.87000,The Alliance,Exception Members,,160.38,,,,,,,102.06,202.03,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,outpatient,,,208.28000,197.87000,The Alliance,Exception Members,,160.38,,,,,,,101.76,202.03,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,67.80000,64.41000,The Alliance,Exception Members,,52.21,,,,,,,37.29,65.77,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,67.80000,64.41000,The Alliance,Exception Members,,52.21,,,,,,,33.90,65.77,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,206.25000,195.94000,The Alliance,Exception Members,,158.81,,,,,,,113.44,200.06,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,206.25000,195.94000,The Alliance,Exception Members,,158.81,,,,,,,103.12,200.06,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,inpatient,,,53.07000,50.42000,The Alliance,Exception Members,,40.86,,,,,,,26.00,51.48,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,outpatient,,,53.07000,50.42000,The Alliance,Exception Members,,40.86,,,,,,,26.54,54.64,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,79.96000,75.96000,The Alliance,Exception Members,,61.57,,,,,,,43.98,77.56,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,79.96000,75.96000,The Alliance,Exception Members,,61.57,,,,,,,39.98,77.56,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,106.89000,101.55000,The Alliance,Exception Members,,82.31,,,,,,,52.38,103.68,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,106.89000,101.55000,The Alliance,Exception Members,,82.31,,,,,,,39.47,103.68,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,53.14000,50.48000,The Alliance,Exception Members,,40.92,,,,,,,29.23,51.55,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,53.14000,50.48000,The Alliance,Exception Members,,40.92,,,,,,,26.57,51.55,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,196.04000,186.24000,The Alliance,Exception Members,,150.95,,,,,,,107.82,190.16,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,196.04000,186.24000,The Alliance,Exception Members,,150.95,,,,,,,98.02,190.16,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,2.63,6.47,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,The Alliance,Exception Members,TC,64.06,,,,,,,45.76,80.70,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Exception Members,TC,64.06,,,,,,,41.60,484.28,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,62.92000,59.77000,The Alliance,Exception Members,,48.45,,,,,,,30.83,61.03,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,62.92000,59.77000,The Alliance,Exception Members,,48.45,,,,,,,28.88,61.03,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,14.40000,13.68000,The Alliance,Exception Members,,11.09,,,,,,,7.92,13.97,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,14.40000,13.68000,The Alliance,Exception Members,,11.09,,,,,,,7.20,13.97,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,14.65000,13.92000,The Alliance,Exception Members,,11.28,,,,,,,7.18,14.21,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,14.65000,13.92000,The Alliance,Exception Members,,11.28,,,,,,,6.72,14.21,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,72.00,139.68,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,128.32,279.56,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3590.14000,3410.63000,The Alliance,Exception Members,,2764.41,,,,,,,1759.17,3482.44,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3590.14000,3410.63000,The Alliance,Exception Members,,2764.41,,,,,,,1647.87,3590.14,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20057.00000,19054.15000,The Alliance,Exception Members,,15443.89,,,,,,,9827.93,19455.29,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20057.00000,19054.15000,The Alliance,Exception Members,,15443.89,,,,,,,9206.16,20057.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13068.64000,12415.21000,The Alliance,Exception Members,,10062.85,,,,,,,6403.63,12676.58,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13068.64000,12415.21000,The Alliance,Exception Members,,10062.85,,,,,,,5998.51,12676.58,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,51.09,119.31,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.42900,0.75660,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Exception Members,,0.60060,,,,,,,0.39000,0.75660,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,2871.77,6256.58,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Exception Members,,56.86,,,,,,,33.89,73.84,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Exception Members,,113.65,,,,,,,67.75,147.60,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3499.34,6927.26,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3277.95,6927.26,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9004.50000,8554.27000,The Alliance,Exception Members,,6933.47,,,,,,,4412.20,8734.36,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9004.50000,8554.27000,The Alliance,Exception Members,,6933.47,,,,,,,4133.07,8734.36,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,inpatient,1,mL,971.25000,922.69000,The Alliance,Exception Members,,747.86,,,,,,,534.19,942.11,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,outpatient,1,mL,971.25000,922.69000,The Alliance,Exception Members,,747.86,,,,,,,485.62,1101.64,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,486.94,963.94,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,456.13,993.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,42.41,92.40,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,39.50,264.00,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,42.20000,40.09000,The Alliance,Exception Members,,32.49,,,,,,,20.68,40.93,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,42.20000,40.09000,The Alliance,Exception Members,,32.49,,,,,,,19.37,42.20,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,231.49,504.34,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,Exception Members,,439.67,,,,,,,314.05,553.87,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Exception Members,,439.67,,,,,,,212.82,1232.72,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,41.25,72.75,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Exception Members,,57.75,,,,,,,37.50,264.00,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,77.50,150.35,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,inpatient,,,533.00000,506.35000,The Alliance,Exception Members,,410.41,,,,,,,293.15,517.01,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,outpatient,,,533.00000,506.35000,The Alliance,Exception Members,,410.41,,,,,,,266.50,1547.18,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,Exception Members,,90.09,,,,,,,64.35,113.49,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Exception Members,,90.09,,,,,,,58.50,134.64,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,Exception Members,,210.98,,,,,,,150.70,265.78,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,Exception Members,,210.98,,,,,,,137.00,277.40,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,113.85,200.79,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,103.50,200.79,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,144.65,255.11,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,131.50,1910.62,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,141.50,1547.18,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,inpatient,,,491.00000,466.45000,The Alliance,Exception Members,,378.07,,,,,,,270.05,476.27,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,outpatient,,,491.00000,466.45000,The Alliance,Exception Members,,378.07,,,,,,,245.50,476.27,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,231.83,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,154.55,272.57,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,140.50,1910.62,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,inpatient,,,358.00000,340.10000,The Alliance,Exception Members,,275.66,,,,,,,196.90,347.26,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,outpatient,,,358.00000,340.10000,The Alliance,Exception Members,,275.66,,,,,,,179.00,531.90,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,inpatient,,,724.00000,687.80000,The Alliance,Exception Members,,557.48,,,,,,,398.20,702.28,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,outpatient,,,724.00000,687.80000,The Alliance,Exception Members,,557.48,,,,,,,362.00,1692.33,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,95.15,167.81,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,86.50,210.12,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,141.50,274.51,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,164.45,290.03,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,149.50,697.17,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,25.50,49.47,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,130.90,230.86,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,119.00,242.55,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,Exception Members,,361.90,,,,,,,258.50,455.90,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Exception Members,,361.90,,,,,,,235.00,1692.33,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,inpatient,,,632.00000,600.40000,The Alliance,Exception Members,,486.64,,,,,,,347.60,613.04,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,outpatient,,,632.00000,600.40000,The Alliance,Exception Members,,486.64,,,,,,,316.00,3999.66,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,408.37,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,210.50,2139.65,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,37.95,66.93,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Exception Members,,53.13,,,,,,,34.50,134.64,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,inpatient,,,773.00000,734.35000,The Alliance,Exception Members,,595.21,,,,,,,425.15,749.81,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,outpatient,,,773.00000,734.35000,The Alliance,Exception Members,,595.21,,,,,,,386.50,1692.33,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,405.35,714.89,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,368.50,1692.33,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,Exception Members,,137.83,,,,,,,98.45,173.63,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Exception Members,,137.83,,,,,,,89.50,909.48,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,Exception Members,,756.91,,,,,,,540.65,953.51,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Exception Members,,756.91,,,,,,,491.50,1692.33,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,41.80,73.72,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,38.00,73.72,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,163.90,289.06,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,149.00,1547.18,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,inpatient,,,316.00000,300.20000,The Alliance,Exception Members,,243.32,,,,,,,173.80,306.52,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,Exception Members,,243.32,,,,,,,158.00,531.90,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,83.00,909.48,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,Exception Members,,271.04,,,,,,,193.60,341.44,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Exception Members,,271.04,,,,,,,176.00,697.17,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,inpatient,,,389.00000,369.55000,The Alliance,Exception Members,,299.53,,,,,,,213.95,377.33,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,outpatient,,,389.00000,369.55000,The Alliance,Exception Members,,299.53,,,,,,,194.50,377.33,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,136.95,241.53,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,124.50,254.03,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,201.85,355.99,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,183.50,355.99,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,inpatient,,,418.00000,397.10000,The Alliance,Exception Members,,321.86,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,outpatient,,,418.00000,397.10000,The Alliance,Exception Members,,321.86,,,,,,,209.00,723.34,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,151.25,266.75,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,137.50,266.75,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,inpatient,,,443.00000,420.85000,The Alliance,Exception Members,,341.11,,,,,,,243.65,429.71,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,Exception Members,,341.11,,,,,,,221.50,723.34,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,inpatient,,,341.00000,323.95000,The Alliance,Exception Members,,262.57,,,,,,,187.55,330.77,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,outpatient,,,341.00000,323.95000,The Alliance,Exception Members,,262.57,,,,,,,170.50,330.77,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,inpatient,,,418.00000,397.10000,The Alliance,Exception Members,,321.86,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,outpatient,,,418.00000,397.10000,The Alliance,Exception Members,,321.86,,,,,,,209.00,405.46,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,inpatient,,,951.00000,903.45000,The Alliance,Exception Members,,732.27,,,,,,,523.05,922.47,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,outpatient,,,951.00000,903.45000,The Alliance,Exception Members,,732.27,,,,,,,227.78,922.47,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,594.00,1047.60,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,227.78,1047.60,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,inpatient,,,622.00000,590.90000,The Alliance,Exception Members,,478.94,,,,,,,342.10,603.34,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,outpatient,,,622.00000,590.90000,The Alliance,Exception Members,,478.94,,,,,,,227.78,603.34,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,inpatient,,,932.00000,885.40000,The Alliance,Exception Members,,717.64,,,,,,,512.60,904.04,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,Exception Members,,717.64,,,,,,,227.78,904.04,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,288.20,508.28,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,227.78,508.28,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,inpatient,,,1550.00000,1472.50000,The Alliance,Exception Members,,1193.50,,,,,,,852.50,1503.50,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,outpatient,,,1550.00000,1472.50000,The Alliance,Exception Members,,1193.50,,,,,,,775.00,1671.62,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,inpatient,,,1494.00000,1419.30000,The Alliance,Exception Members,,1150.38,,,,,,,821.70,1449.18,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,Exception Members,,1150.38,,,,,,,227.78,1449.18,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,inpatient,,,866.00000,822.70000,The Alliance,Exception Members,,666.82,,,,,,,476.30,840.02,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,outpatient,,,866.00000,822.70000,The Alliance,Exception Members,,666.82,,,,,,,227.78,840.02,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,inpatient,,,419.00000,398.05000,The Alliance,Exception Members,,322.63,,,,,,,230.45,406.43,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,outpatient,,,419.00000,398.05000,The Alliance,Exception Members,,322.63,,,,,,,209.50,406.43,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,inpatient,,,1476.00000,1402.20000,The Alliance,Exception Members,,1136.52,,,,,,,811.80,1431.72,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,outpatient,,,1476.00000,1402.20000,The Alliance,Exception Members,,1136.52,,,,,,,227.78,1431.72,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,Exception Members,,602.14,,,,,,,430.10,758.54,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,Exception Members,,602.14,,,,,,,227.78,758.54,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,inpatient,,,1017.00000,966.15000,The Alliance,Exception Members,,783.09,,,,,,,559.35,986.49,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,outpatient,,,1017.00000,966.15000,The Alliance,Exception Members,,783.09,,,,,,,227.78,986.49,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,227.78,882.70,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,inpatient,,,912.00000,866.40000,The Alliance,Exception Members,,702.24,,,,,,,501.60,884.64,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,outpatient,,,912.00000,866.40000,The Alliance,Exception Members,,702.24,,,,,,,227.78,884.64,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,inpatient,,,872.00000,828.40000,The Alliance,Exception Members,,671.44,,,,,,,479.60,845.84,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,outpatient,,,872.00000,828.40000,The Alliance,Exception Members,,671.44,,,,,,,227.78,845.84,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,inpatient,,,563.00000,534.85000,The Alliance,Exception Members,,433.51,,,,,,,309.65,546.11,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Exception Members,,433.51,,,,,,,227.78,546.11,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,inpatient,,,927.00000,880.65000,The Alliance,Exception Members,,713.79,,,,,,,509.85,899.19,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,outpatient,,,927.00000,880.65000,The Alliance,Exception Members,,713.79,,,,,,,227.78,899.19,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,inpatient,,,743.00000,705.85000,The Alliance,Exception Members,,572.11,,,,,,,408.65,720.71,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,Exception Members,,572.11,,,,,,,227.78,720.71,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,inpatient,,,789.00000,749.55000,The Alliance,Exception Members,,607.53,,,,,,,433.95,765.33,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,outpatient,,,789.00000,749.55000,The Alliance,Exception Members,,607.53,,,,,,,227.78,765.33,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,227.78,722.65,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,inpatient,,,985.00000,935.75000,The Alliance,Exception Members,,758.45,,,,,,,541.75,955.45,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,outpatient,,,985.00000,935.75000,The Alliance,Exception Members,,758.45,,,,,,,227.78,955.45,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,227.78,882.70,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,inpatient,,,424.00000,402.80000,The Alliance,Exception Members,,326.48,,,,,,,233.20,411.28,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,outpatient,,,424.00000,402.80000,The Alliance,Exception Members,,326.48,,,,,,,212.00,411.28,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,90.20,159.08,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,82.00,159.08,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,inpatient,,,800.00000,760.00000,The Alliance,Exception Members,,616.00,,,,,,,440.00,776.00,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,outpatient,,,800.00000,760.00000,The Alliance,Exception Members,,616.00,,,,,,,227.78,776.00,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,Exception Members,,444.29,,,,,,,317.35,559.69,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,Exception Members,,444.29,,,,,,,283.85,559.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,inpatient,,,777.00000,738.15000,The Alliance,Exception Members,,598.29,,,,,,,427.35,753.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,Exception Members,,598.29,,,,,,,227.78,753.69,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,144.00,317.72,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,inpatient,,,644.00000,611.80000,The Alliance,Exception Members,,495.88,,,,,,,354.20,624.68,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,outpatient,,,644.00000,611.80000,The Alliance,Exception Members,,495.88,,,,,,,322.00,3321.00,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,213.40,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,124.30,219.22,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,113.00,219.22,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,72.00,139.68,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,113.30,199.82,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,103.00,909.48,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,Exception Members,,572.88,,,,,,,409.20,721.68,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Exception Members,,572.88,,,,,,,372.00,2139.65,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,Exception Members,,512.05,,,,,,,365.75,645.05,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Exception Members,,512.05,,,,,,,332.50,2139.65,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,inpatient,,,630.00000,598.50000,The Alliance,Exception Members,,485.10,,,,,,,346.50,611.10,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,Exception Members,,485.10,,,,,,,227.78,611.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,inpatient,,,1130.00000,1073.50000,The Alliance,Exception Members,,870.10,,,,,,,621.50,1096.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,Exception Members,,870.10,,,,,,,565.00,2139.65,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,inpatient,,,317.00000,301.15000,The Alliance,Exception Members,,244.09,,,,,,,174.35,307.49,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,outpatient,,,317.00000,301.15000,The Alliance,Exception Members,,244.09,,,,,,,158.50,909.48,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,inpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,32.45,57.23,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Exception Members,,45.43,,,,,,,29.50,96.61,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,113.30,199.82,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,Exception Members,,158.62,,,,,,,103.00,207.54,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,Exception Members,,210.98,,,,,,,150.70,265.78,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,Exception Members,,210.98,,,,,,,137.00,265.78,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,inpatient,,,409.00000,388.55000,The Alliance,Exception Members,,314.93,,,,,,,224.95,396.73,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,Exception Members,,314.93,,,,,,,204.50,531.90,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,inpatient,,,531.00000,504.45000,The Alliance,Exception Members,,408.87,,,,,,,292.05,515.07,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,outpatient,,,531.00000,504.45000,The Alliance,Exception Members,,408.87,,,,,,,265.50,3321.00,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,248.05,437.47,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,225.50,2436.76,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,inpatient,,,381.00000,361.95000,The Alliance,Exception Members,,293.37,,,,,,,209.55,369.57,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,outpatient,,,381.00000,361.95000,The Alliance,Exception Members,,293.37,,,,,,,188.67,369.57,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,inpatient,,,613.00000,582.35000,The Alliance,Exception Members,,472.01,,,,,,,337.15,594.61,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,Exception Members,,472.01,,,,,,,306.50,1011.64,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,inpatient,,,422.00000,400.90000,The Alliance,Exception Members,,324.94,,,,,,,232.10,409.34,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,Exception Members,,324.94,,,,,,,211.00,1910.62,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,521.95,920.53,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,474.50,920.53,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,Exception Members,,201.74,,,,,,,144.10,254.14,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Exception Members,,201.74,,,,,,,131.00,254.14,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,inpatient,,,456.00000,433.20000,The Alliance,Exception Members,,351.12,,,,,,,250.80,442.32,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,outpatient,,,456.00000,433.20000,The Alliance,Exception Members,,351.12,,,,,,,228.00,442.32,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,Exception Members,,430.43,,,,,,,307.45,542.23,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,Exception Members,,430.43,,,,,,,279.50,1547.18,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,inpatient,,,405.00000,384.75000,The Alliance,Exception Members,,311.85,,,,,,,222.75,392.85,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,Exception Members,,311.85,,,,,,,122.40,392.85,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,297.55,524.77,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,270.50,734.90,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,215.05,379.27,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,195.50,379.27,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,inpatient,,,552.00000,524.40000,The Alliance,Exception Members,,425.04,,,,,,,303.60,535.44,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,outpatient,,,552.00000,524.40000,The Alliance,Exception Members,,425.04,,,,,,,276.00,1547.18,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,inpatient,,,359.00000,341.05000,The Alliance,Exception Members,,276.43,,,,,,,197.45,348.23,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,outpatient,,,359.00000,341.05000,The Alliance,Exception Members,,276.43,,,,,,,179.50,734.90,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,Exception Members,,764.61,,,,,,,546.15,963.21,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Exception Members,,764.61,,,,,,,546.15,4686.00,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,,1558.48,,,,,,,1113.20,1963.28,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Exception Members,,1558.48,,,,,,,1012.00,5156.10,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,Exception Members,,642.95,,,,,,,459.25,809.95,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Exception Members,,642.95,,,,,,,227.78,809.95,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,inpatient,,,914.00000,868.30000,The Alliance,Exception Members,,703.78,,,,,,,502.70,886.58,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,outpatient,,,914.00000,868.30000,The Alliance,Exception Members,,703.78,,,,,,,457.00,3999.66,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,212.85,375.39,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,193.50,3321.00,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,inpatient,,,1333.00000,1266.35000,The Alliance,Exception Members,,1026.41,,,,,,,733.15,1293.01,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,Exception Members,,1026.41,,,,,,,666.50,2989.39,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,154.55,272.57,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Exception Members,,216.37,,,,,,,140.50,272.57,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,210.12,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,inpatient,,,1611.00000,1530.45000,The Alliance,Exception Members,,1240.47,,,,,,,886.05,1562.67,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,outpatient,,,1611.00000,1530.45000,The Alliance,Exception Members,,1240.47,,,,,,,805.50,3387.36,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,inpatient,,,607.00000,576.65000,The Alliance,Exception Members,,467.39,,,,,,,333.85,588.79,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,outpatient,,,607.00000,576.65000,The Alliance,Exception Members,,467.39,,,,,,,303.50,1547.18,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,271.15,478.21,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,246.50,952.28,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,22.37000,21.25000,The Alliance,Exception Members,,17.22,,,,,,,12.30,21.70,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,22.37000,21.25000,The Alliance,Exception Members,,17.22,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,inpatient,,,426.00000,404.70000,The Alliance,Exception Members,,328.02,,,,,,,234.30,413.22,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,outpatient,,,426.00000,404.70000,The Alliance,Exception Members,,328.02,,,,,,,213.00,734.90,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,inpatient,,,727.00000,690.65000,The Alliance,Exception Members,,559.79,,,,,,,399.85,705.19,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,outpatient,,,727.00000,690.65000,The Alliance,Exception Members,,559.79,,,,,,,363.50,1692.33,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,inpatient,,,1005.00000,954.75000,The Alliance,Exception Members,,773.85,,,,,,,552.75,974.85,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,Exception Members,,773.85,,,,,,,502.50,2139.65,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,124.30,219.22,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,113.00,3387.36,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,183.00,355.02,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,The Alliance,Exception Members,TC,7638.40,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Exception Members,TC,7638.40,,,,,,,484.28,9622.40,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,inpatient,,,389.00000,369.55000,The Alliance,Exception Members,,299.53,,,,,,,213.95,377.33,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,outpatient,,,389.00000,369.55000,The Alliance,Exception Members,,299.53,,,,,,,194.50,1547.18,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,inpatient,,,1199.00000,1139.05000,The Alliance,Exception Members,,923.23,,,,,,,659.45,1163.03,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,outpatient,,,1199.00000,1139.05000,The Alliance,Exception Members,,923.23,,,,,,,227.78,1163.03,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,inpatient,,,1657.00000,1574.15000,The Alliance,Exception Members,,1275.89,,,,,,,911.35,1607.29,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,outpatient,,,1657.00000,1574.15000,The Alliance,Exception Members,,1275.89,,,,,,,828.50,1692.33,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,inpatient,,,864.00000,820.80000,The Alliance,Exception Members,,665.28,,,,,,,475.20,838.08,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,outpatient,,,864.00000,820.80000,The Alliance,Exception Members,,665.28,,,,,,,227.78,838.08,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,99.00,174.60,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,90.00,308.32,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,148.50,261.90,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,135.00,723.34,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,72.60,128.04,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,66.00,723.34,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,70.95,125.13,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Exception Members,,99.33,,,,,,,64.50,207.54,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,195.80,345.32,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,178.00,345.32,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,inpatient,,,873.00000,829.35000,The Alliance,Exception Members,,672.21,,,,,,,480.15,846.81,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,outpatient,,,873.00000,829.35000,The Alliance,Exception Members,,672.21,,,,,,,436.50,6854.91,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,72.00,308.32,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,inpatient,,,230.00000,218.50000,The Alliance,Exception Members,,177.10,,,,,,,126.50,223.10,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,outpatient,,,230.00000,218.50000,The Alliance,Exception Members,,177.10,,,,,,,115.00,417.31,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,135.30,238.62,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Exception Members,,189.42,,,,,,,123.00,238.62,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,271.15,478.21,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,246.50,2989.39,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,Exception Members,,181.72,,,,,,,129.80,228.92,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Exception Members,,181.72,,,,,,,118.00,417.31,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,inpatient,,,1256.00000,1193.20000,The Alliance,Exception Members,,967.12,,,,,,,690.80,1218.32,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,outpatient,,,1256.00000,1193.20000,The Alliance,Exception Members,,967.12,,,,,,,628.00,2989.39,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,158.95,280.33,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,144.50,723.34,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,101.75,179.45,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,92.50,179.45,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,114.00,1910.62,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,468.60,826.44,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Exception Members,,656.04,,,,,,,426.00,826.44,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,115.50,203.70,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,105.00,203.70,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,110.00,194.00,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,,154.00,,,,,,,100.00,194.00,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,154.00,271.60,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,140.00,271.60,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,inpatient,,,741.00000,703.95000,The Alliance,Exception Members,,570.57,,,,,,,407.55,718.77,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,outpatient,,,741.00000,703.95000,The Alliance,Exception Members,,570.57,,,,,,,370.50,3287.55,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,95.15,167.81,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,86.50,308.32,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,510.40,900.16,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,464.00,2864.41,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,207.54,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,inpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,504.90,890.46,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,outpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,227.78,890.46,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,163.90,289.06,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,149.00,317.72,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,500.50,882.70,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,455.00,1671.62,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,97.00,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,inpatient,,,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,8.25,14.55,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,7.50,25.57,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,155.65,274.51,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,141.50,639.36,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,inpatient,,,1518.00000,1442.10000,The Alliance,Exception Members,,1168.86,,,,,,,834.90,1472.46,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,Exception Members,,1168.86,,,,,,,520.92,1472.46,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,inpatient,,,423.00000,401.85000,The Alliance,Exception Members,,325.71,,,,,,,232.65,410.31,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,outpatient,,,423.00000,401.85000,The Alliance,Exception Members,,325.71,,,,,,,211.50,1547.18,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,118.50,317.72,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,91.00,308.32,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,220.19,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,113.50,734.90,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,inpatient,,,377.00000,358.15000,The Alliance,Exception Members,,290.29,,,,,,,207.35,365.69,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,outpatient,,,377.00000,358.15000,The Alliance,Exception Members,,290.29,,,,,,,188.50,3321.00,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,inpatient,,,967.00000,918.65000,The Alliance,Exception Members,,744.59,,,,,,,531.85,937.99,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,outpatient,,,967.00000,918.65000,The Alliance,Exception Members,,744.59,,,,,,,483.50,3321.00,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,1622.56,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,inpatient,,,851.00000,808.45000,The Alliance,Exception Members,,655.27,,,,,,,468.05,825.47,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,outpatient,,,851.00000,808.45000,The Alliance,Exception Members,,655.27,,,,,,,425.50,2139.65,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,20.37,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,The Alliance,Exception Members,TC,2813.58,,,,,,,2009.70,3544.38,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Exception Members,TC,2813.58,,,,,,,1487.04,3544.38,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,57.20,100.88,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,52.00,207.54,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,133.50,734.90,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,inpatient,,,738.00000,701.10000,The Alliance,Exception Members,,568.26,,,,,,,405.90,715.86,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,Exception Members,,568.26,,,,,,,369.00,715.86,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,inpatient,,,1153.00000,1095.35000,The Alliance,Exception Members,,887.81,,,,,,,634.15,1118.41,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,outpatient,,,1153.00000,1095.35000,The Alliance,Exception Members,,887.81,,,,,,,576.50,2989.39,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,inpatient,,,1367.00000,1298.65000,The Alliance,Exception Members,,1052.59,,,,,,,751.85,1325.99,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,outpatient,,,1367.00000,1298.65000,The Alliance,Exception Members,,1052.59,,,,,,,520.92,1325.99,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,inpatient,,,1426.00000,1354.70000,The Alliance,Exception Members,,1098.02,,,,,,,784.30,1383.22,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,outpatient,,,1426.00000,1354.70000,The Alliance,Exception Members,,1098.02,,,,,,,713.00,3388.98,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,102.30,180.42,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Exception Members,,143.22,,,,,,,93.00,207.54,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,81.00,157.14,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,inpatient,,,1130.25000,1073.74000,The Alliance,Exception Members,,870.29,,,,,,,621.64,1096.34,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,outpatient,,,1130.25000,1073.74000,The Alliance,Exception Members,,870.29,,,,,,,565.12,1671.62,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,10.45,18.43,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Exception Members,,14.63,,,,,,,9.50,18.43,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,inpatient,,,693.00000,658.35000,The Alliance,Exception Members,,533.61,,,,,,,381.15,672.21,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,outpatient,,,693.00000,658.35000,The Alliance,Exception Members,,533.61,,,,,,,283.85,672.21,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,114.50,1011.64,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,325.05,573.27,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,295.50,1692.33,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,inpatient,,,739.00000,702.05000,The Alliance,Exception Members,,569.03,,,,,,,406.45,716.83,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,outpatient,,,739.00000,702.05000,The Alliance,Exception Members,,569.03,,,,,,,369.50,2989.39,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,108.90,192.06,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,99.00,416.79,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,inpatient,,,765.00000,726.75000,The Alliance,Exception Members,,589.05,,,,,,,420.75,742.05,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,outpatient,,,765.00000,726.75000,The Alliance,Exception Members,,589.05,,,,,,,227.78,742.05,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,187.00,329.80,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Exception Members,,261.80,,,,,,,170.00,417.31,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,inpatient,,,982.00000,932.90000,The Alliance,Exception Members,,756.14,,,,,,,540.10,952.54,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,outpatient,,,982.00000,932.90000,The Alliance,Exception Members,,756.14,,,,,,,491.00,952.54,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,201.85,355.99,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,183.50,645.77,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,147.50,346.44,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,97.90,172.66,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Exception Members,,137.06,,,,,,,89.00,172.66,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,128.70,226.98,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Exception Members,,180.18,,,,,,,117.00,417.31,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,inpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.90,17.46,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Exception Members,,13.86,,,,,,,9.00,62.04,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,196.35,346.29,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,178.50,346.29,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,inpatient,,,931.00000,884.45000,The Alliance,Exception Members,,716.87,,,,,,,512.05,903.07,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,outpatient,,,931.00000,884.45000,The Alliance,Exception Members,,716.87,,,,,,,465.50,2864.41,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,21.00,40.74,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,inpatient,,,2601.00000,2470.95000,The Alliance,Exception Members,,2002.77,,,,,,,1430.55,2522.97,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,outpatient,,,2601.00000,2470.95000,The Alliance,Exception Members,,2002.77,,,,,,,1300.50,2522.97,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,inpatient,,,741.00000,703.95000,The Alliance,Exception Members,,570.57,,,,,,,407.55,718.77,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,outpatient,,,741.00000,703.95000,The Alliance,Exception Members,,570.57,,,,,,,370.50,2139.65,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,inpatient,,,377.00000,358.15000,The Alliance,Exception Members,,290.29,,,,,,,207.35,365.69,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,outpatient,,,377.00000,358.15000,The Alliance,Exception Members,,290.29,,,,,,,188.50,531.90,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,57.50,111.55,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,31.04,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,33.00,64.02,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,21.45,37.83,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,19.50,207.54,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,The Alliance,Exception Members,TC,2835.91,,,,,,,2025.65,3572.51,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Exception Members,TC,2835.91,,,,,,,1841.50,3572.51,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,96.80,170.72,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,88.00,416.79,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,200.20,353.08,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,182.00,1547.18,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,433.40,764.36,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,394.00,1011.64,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,inpatient,1,EA,9729.00000,9242.55000,The Alliance,Exception Members,,7491.33,,,,,,,5350.95,9437.13,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,outpatient,1,EA,9729.00000,9242.55000,The Alliance,Exception Members,,7491.33,,,,,,,365.89,9437.13,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Exception Members,,0.34650,,,,,,,0.22500,1.39,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3562.99,7762.50,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,2850.39,6210.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4354.76,9487.50,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2137.79,4517.77,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,inpatient,,,182.80000,173.66000,The Alliance,Exception Members,90,140.76,,,,,,,100.54,177.32,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,outpatient,,,182.80000,173.66000,The Alliance,Exception Members,90,140.76,,,,,,,16.72,848.80,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,2.25,118.82,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,90,964.81,,,,,,,689.15,1215.41,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,90,964.81,,,,,,,119.20,6026.72,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,56.40,1714.64,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,inpatient,1,EA,26.02000,24.72000,The Alliance,Exception Members,,20.04,,,,,,,14.31,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,outpatient,1,EA,26.02000,24.72000,The Alliance,Exception Members,,20.04,,,,,,,13.01,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,inpatient,1,EA,6233.30000,5921.63000,The Alliance,Exception Members,,4799.64,,,,,,,3428.32,6046.30,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,outpatient,1,EA,6233.30000,5921.63000,The Alliance,Exception Members,,4799.64,,,,,,,155.42,6046.30,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3562.99,7762.50,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7.48000,7.11000,The Alliance,Exception Members,,5.76,,,,,,,3.67,7.26,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7.48000,7.11000,The Alliance,Exception Members,,5.76,,,,,,,3.43,7.48,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,124.85,220.19,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,,174.79,,,,,,,113.50,254.03,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,The Alliance,Exception Members,GP,47.12,,,,,,,33.66,59.36,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Exception Members,GP,47.12,,,,,,,30.60,264.00,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,The Alliance,Exception Members,GP,31.11,,,,,,,22.22,39.19,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Exception Members,GP,31.11,,,,,,,20.20,264.00,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,inpatient,1,mL,18.80000,17.86000,The Alliance,Exception Members,,14.48,,,,,,,10.34,18.24,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,outpatient,1,mL,18.80000,17.86000,The Alliance,Exception Members,,14.48,,,,,,,9.40,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,inpatient,1,mL,23.51000,22.33000,The Alliance,Exception Members,,18.10,,,,,,,12.93,22.80,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,outpatient,1,mL,23.51000,22.33000,The Alliance,Exception Members,,18.10,,,,,,,11.76,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,inpatient,1,mL,7.29000,6.93000,The Alliance,Exception Members,,5.61,,,,,,,4.01,7.07,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,outpatient,1,mL,7.29000,6.93000,The Alliance,Exception Members,,5.61,,,,,,,3.65,25.89,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,inpatient,1,mL,451.78000,429.19000,The Alliance,Exception Members,,347.87,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Exception Members,,347.87,,,,,,,28.85,438.23,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,1256.40,5253.52,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,inpatient,,,8064.00000,7660.80000,The Alliance,Exception Members,,6209.28,,,,,,,4435.20,7822.08,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,outpatient,,,8064.00000,7660.80000,The Alliance,Exception Members,,6209.28,,,,,,,1256.40,7822.08,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,Exception Members,,430.43,,,,,,,307.45,542.23,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,Exception Members,,430.43,,,,,,,279.50,697.17,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,The Alliance,Exception Members,TC,1841.84,,,,,,,1315.60,2320.24,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Exception Members,TC,1841.84,,,,,,,979.11,2320.24,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.68000,47.20000,The Alliance,Exception Members,,38.25,,,,,,,24.34,48.19,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.68000,47.20000,The Alliance,Exception Members,,38.25,,,,,,,22.80,49.68,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,The Alliance,Exception Members,,12397.00,,,,,,,8855.00,15617.00,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Exception Members,,12397.00,,,,,,,966.05,15617.00,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,717.75,1265.85,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,126.07,6798.73,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Exception Members,,3452.68,,,,,,,148.57,4349.48,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Exception Members,,6622.77,,,,,,,503.83,8342.97,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,inpatient,1,mL,267.19000,253.83000,The Alliance,Exception Members,,205.74,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Exception Members,,205.74,,,,,,,31.18,259.17,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,308.32,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Exception Members,,1414.88,,,,,,,843.41,1837.50,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1046.52,2280.00,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,139.65,276.45,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Exception Members,,219.45,,,,,,,130.81,285.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,The Alliance,Exception Members,TC,699.93,,,,,,,499.95,881.73,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Exception Members,TC,699.93,,,,,,,359.37,881.73,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,260.25,567.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,inpatient,1,EA,11.13000,10.57000,The Alliance,Exception Members,,8.57,,,,,,,6.12,10.80,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,outpatient,1,EA,11.13000,10.57000,The Alliance,Exception Members,,8.57,,,,,,,5.57,10.80,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,39.20,77.60,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,36.72,80.00,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,inpatient,,,4020.00000,3819.00000,The Alliance,Exception Members,TC,3095.40,,,,,,,2211.00,3899.40,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,outpatient,,,4020.00000,3819.00000,The Alliance,Exception Members,TC,3095.40,,,,,,,2010.00,3899.40,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,The Alliance,Exception Members,TC,2396.24,,,,,,,1711.60,3018.64,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Exception Members,TC,2396.24,,,,,,,1334.13,14413.40,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,5271.00,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.23000,103.77000,The Alliance,Exception Members,,84.11,,,,,,,60.08,105.95,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.23000,103.77000,The Alliance,Exception Members,,84.11,,,,,,,51.64,105.95,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.92000,100.62000,The Alliance,Exception Members,,81.56,,,,,,,58.26,102.74,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.92000,100.62000,The Alliance,Exception Members,,81.56,,,,,,,51.64,102.74,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,The Alliance,Exception Members,,58.70,,,,,,,41.93,73.95,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Exception Members,,58.70,,,,,,,38.12,73.95,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,The Alliance,Exception Members,,57.00,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Exception Members,,57.00,,,,,,,37.01,71.80,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.22000,103.76000,The Alliance,Exception Members,,84.10,,,,,,,60.07,105.94,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.22000,103.76000,The Alliance,Exception Members,,84.10,,,,,,,51.64,105.94,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,The Alliance,Exception Members,,57.00,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Exception Members,,57.00,,,,,,,37.01,71.80,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,48.19,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Exception Members,TC,3503.50,,,,,,,2150.56,7180.14,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,73.93000,70.23000,The Alliance,Exception Members,,56.93,,,,,,,40.66,71.71,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,73.93000,70.23000,The Alliance,Exception Members,,56.93,,,,,,,36.97,71.71,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,46.75,82.45,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Exception Members,,65.45,,,,,,,42.50,82.45,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,568.00000,539.60000,The Alliance,Exception Members,,437.36,,,,,,,312.40,550.96,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Exception Members,,437.36,,,,,,,9.09,550.96,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,28.50,55.29,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,124.30,219.22,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,113.00,219.22,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,inpatient,,,19.50000,18.52000,The Alliance,Exception Members,,15.02,,,,,,,10.72,18.91,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,outpatient,,,19.50000,18.52000,The Alliance,Exception Members,,15.02,,,,,,,2.83,18.91,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,inpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,11.00,19.40,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,10.00,19.40,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,The Alliance,Exception Members,TC,2140.60,,,,,,,1529.00,2696.60,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Exception Members,TC,2140.60,,,,,,,1390.00,2696.60,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,inpatient,,,40.42000,38.40000,The Alliance,Exception Members,,31.12,,,,,,,22.23,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,outpatient,,,40.42000,38.40000,The Alliance,Exception Members,,31.12,,,,,,,20.21,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,inpatient,,,57.77000,54.88000,The Alliance,Exception Members,,44.48,,,,,,,31.77,56.04,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,outpatient,,,57.77000,54.88000,The Alliance,Exception Members,,44.48,,,,,,,28.89,56.04,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,inpatient,,,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,1.38,2.43,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,outpatient,,,2.51000,2.38000,The Alliance,Exception Members,,1.93,,,,,,,0.37000,2.43,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,548.00,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,inpatient,,,189.20000,179.74000,The Alliance,Exception Members,TC,145.68,,,,,,,104.06,183.52,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Exception Members,TC,145.68,,,,,,,94.60,183.52,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,Exception Members,TC,428.89,,,,,,,306.35,540.29,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Exception Members,TC,428.89,,,,,,,278.50,5271.00,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,inpatient,,,1070.00000,1016.50000,The Alliance,Exception Members,,823.90,,,,,,,588.50,1037.90,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,outpatient,,,1070.00000,1016.50000,The Alliance,Exception Members,,823.90,,,,,,,535.00,3823.86,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,4.25000,4.04000,The Alliance,Exception Members,,3.27,,,,,,,2.34,4.12,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,4.25000,4.04000,The Alliance,Exception Members,,3.27,,,,,,,2.12,4.12,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,inpatient,,,1846.00000,1753.70000,The Alliance,Exception Members,,1421.42,,,,,,,1015.30,1790.62,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,outpatient,,,1846.00000,1753.70000,The Alliance,Exception Members,,1421.42,,,,,,,923.00,1790.62,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,250.00000,237.50000,The Alliance,Exception Members,,192.50,,,,,,,137.50,242.50,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Exception Members,,192.50,,,,,,,125.00,242.50,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,264.00,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,57.75,101.85,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,,80.85,,,,,,,52.50,264.00,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1067.00000,1013.65000,The Alliance,Exception Members,,821.59,,,,,,,586.85,1034.99,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1067.00000,1013.65000,The Alliance,Exception Members,,821.59,,,,,,,211.37,1034.99,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,inpatient,,,1300.00000,1235.00000,The Alliance,Exception Members,,1001.00,,,,,,,715.00,1261.00,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,outpatient,,,1300.00000,1235.00000,The Alliance,Exception Members,,1001.00,,,,,,,50.73,7472.50,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,inpatient,,,751.00000,713.45000,The Alliance,Exception Members,TC,578.27,,,,,,,413.05,728.47,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,outpatient,,,751.00000,713.45000,The Alliance,Exception Members,TC,578.27,,,,,,,375.50,728.47,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,84.15,148.41,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,,117.81,,,,,,,76.50,148.41,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,inpatient,,,38.20000,36.29000,The Alliance,Exception Members,,29.41,,,,,,,21.01,37.05,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,outpatient,,,38.20000,36.29000,The Alliance,Exception Members,,29.41,,,,,,,19.10,37.05,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,inpatient,,,157.20000,149.34000,The Alliance,Exception Members,TC,121.04,,,,,,,86.46,152.48,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,outpatient,,,157.20000,149.34000,The Alliance,Exception Members,TC,121.04,,,,,,,78.60,152.48,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,TC,46.97,,,,,,,33.55,59.17,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,TC,46.97,,,,,,,30.50,548.00,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1129.00000,1072.55000,The Alliance,Exception Members,,869.33,,,,,,,553.21,1095.13,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Exception Members,,869.33,,,,,,,440.69,1095.13,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,,3845.38,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,,3845.38,,,,,,,1272.04,4844.18,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,inpatient,,,957.00000,909.15000,The Alliance,Exception Members,TC,736.89,,,,,,,526.35,928.29,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Exception Members,TC,736.89,,,,,,,384.16,928.29,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,129.50,251.23,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,81.00,325.26,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,61.50,119.31,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,inpatient,,,84.70000,80.47000,The Alliance,Exception Members,,65.22,,,,,,,46.59,82.16,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,outpatient,,,84.70000,80.47000,The Alliance,Exception Members,,65.22,,,,,,,42.35,82.16,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,197.00,382.18,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,inpatient,,,98.00000,93.10000,The Alliance,Exception Members,,75.46,,,,,,,53.90,95.06,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Exception Members,,75.46,,,,,,,49.00,95.06,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,549.28,20181.52,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,Exception Members,52,694.54,,,,,,,496.10,874.94,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Exception Members,52,694.54,,,,,,,257.00,874.94,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,The Alliance,Exception Members,TC,3635.94,,,,,,,2597.10,4580.34,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Exception Members,TC,3635.94,,,,,,,2288.22,7180.14,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,The Alliance,Exception Members,,399.63,,,,,,,285.45,503.43,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Exception Members,,399.63,,,,,,,48.58,503.43,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Exception Members,TC,303.38,,,,,,,197.00,382.18,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,5.87,113.69,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,290.95,513.13,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,173.99,513.13,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,227.15,400.61,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,33.63,400.61,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,200.75,354.05,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,182.50,743.46,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,187.21,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,170.50,300.70,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,155.00,1239.81,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,,244.86,,,,,,,154.77,548.00,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,73.70,129.98,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,67.00,129.98,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,Exception Members,TC,156.31,,,,,,,111.65,196.91,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Exception Members,TC,156.31,,,,,,,101.50,1035.23,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,111.10,195.94,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,TC,155.54,,,,,,,101.00,548.00,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,TC,1506.12,,,,,,,1075.80,1897.32,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Exception Members,TC,1506.12,,,,,,,384.16,1897.32,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,The Alliance,Exception Members,TC,790.79,,,,,,,564.85,996.19,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Exception Members,TC,790.79,,,,,,,513.50,5169.06,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,5115.55,9021.97,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Exception Members,TC,7161.77,,,,,,,4467.66,9021.97,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,The Alliance,Exception Members,TC,854.70,,,,,,,610.50,1076.70,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Exception Members,TC,854.70,,,,,,,384.16,1076.70,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,90.60000,86.07000,The Alliance,Exception Members,,69.76,,,,,,,44.39,87.88,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Exception Members,,69.76,,,,,,,41.59,90.60,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,248.06,491.06,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,232.37,506.25,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,24.50,48.50,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,22.95,50.00,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,The Alliance,Exception Members,TC,2679.60,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Exception Members,TC,2679.60,,,,,,,1609.99,3375.60,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,321.56,636.56,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,301.22,656.25,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,23870.00000,22676.50000,The Alliance,Exception Members,,18379.90,,,,,,,11696.30,23153.90,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,23870.00000,22676.50000,The Alliance,Exception Members,,18379.90,,,,,,,10956.33,23870.00,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Exception Members,,4170.32,,,,,,,2708.00,5253.52,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,inpatient,,,326.80000,310.46000,The Alliance,Exception Members,90,251.64,,,,,,,179.74,317.00,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,outpatient,,,326.80000,310.46000,The Alliance,Exception Members,90,251.64,,,,,,,36.26,1833.46,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,Exception Members,90,254.87,,,,,,,182.05,321.07,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Exception Members,90,254.87,,,,,,,27.54,1290.24,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,Exception Members,TC,476.63,,,,,,,340.45,600.43,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Exception Members,TC,476.63,,,,,,,309.50,600.43,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,inpatient,,,244.40000,232.18000,The Alliance,Exception Members,90,188.19,,,,,,,134.42,237.07,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,outpatient,,,244.40000,232.18000,The Alliance,Exception Members,90,188.19,,,,,,,14.59,729.98,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,inpatient,,,529.00000,502.55000,The Alliance,Exception Members,90,407.33,,,,,,,290.95,513.13,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Exception Members,90,407.33,,,,,,,12.45,1539.22,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,41.63,73.43,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,6.92,356.54,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,93.50,207.54,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,51.15,90.21,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Exception Members,,71.61,,,,,,,46.50,134.64,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,143.55,253.17,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,130.50,308.32,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,inpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,292.60,516.04,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,266.00,645.77,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,75.00,145.50,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,inpatient,,,126.70000,120.36000,The Alliance,Exception Members,TC,97.56,,,,,,,69.69,122.90,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,outpatient,,,126.70000,120.36000,The Alliance,Exception Members,TC,97.56,,,,,,,63.35,122.90,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,95.50,185.27,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,,184.80,,,,,,,132.00,232.80,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,,184.80,,,,,,,120.00,232.80,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,Exception Members,,366.52,,,,,,,261.80,461.72,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Exception Members,,366.52,,,,,,,238.00,723.34,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,95.50,185.27,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,inpatient,1,mL,451.78000,429.19000,The Alliance,Exception Members,,347.87,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Exception Members,,347.87,,,,,,,28.85,438.23,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,inpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.70,13.58,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.00,31.12,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,inpatient,,,27.00000,25.65000,The Alliance,Exception Members,,20.79,,,,,,,14.85,26.19,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,Exception Members,,20.79,,,,,,,13.50,31.12,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,93.50,264.00,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,inpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,298.65,526.71,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,271.50,979.27,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,inpatient,,,415.00000,394.25000,The Alliance,Exception Members,,319.55,,,,,,,228.25,402.55,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,outpatient,,,415.00000,394.25000,The Alliance,Exception Members,,319.55,,,,,,,149.83,402.55,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,22.50,134.64,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,125.40,221.16,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Exception Members,,175.56,,,,,,,114.00,723.34,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,18.15,32.01,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,16.50,32.01,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,317.72,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,99.50,734.90,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,113.85,200.79,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,103.50,308.32,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,inpatient,,,890.00000,845.50000,The Alliance,Exception Members,,685.30,,,,,,,489.50,863.30,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,Exception Members,,685.30,,,,,,,227.78,863.30,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,25.50,49.47,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,23.50,45.59,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,,950.95,,,,,,,679.25,1197.95,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Exception Members,,950.95,,,,,,,227.78,1197.95,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,116.60,205.64,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,,163.24,,,,,,,106.00,734.90,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,28.05,49.47,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Exception Members,,39.27,,,,,,,25.50,49.47,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,inpatient,,,893.00000,848.35000,The Alliance,Exception Members,,687.61,,,,,,,491.15,866.21,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,Exception Members,,687.61,,,,,,,227.78,866.21,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,inpatient,,,467.00000,443.65000,The Alliance,Exception Members,,359.59,,,,,,,256.85,452.99,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,Exception Members,,359.59,,,,,,,233.50,1011.64,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1534.00000,1457.30000,The Alliance,Exception Members,,1181.18,,,,,,,843.70,1487.98,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1534.00000,1457.30000,The Alliance,Exception Members,,1181.18,,,,,,,767.00,2161.00,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,14.00,96.61,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,Exception Members,,254.10,,,,,,,181.50,320.10,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Exception Members,,254.10,,,,,,,165.00,416.79,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,138.60,244.44,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Exception Members,,194.04,,,,,,,126.00,734.90,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,inpatient,,,1077.00000,1023.15000,The Alliance,Exception Members,,829.29,,,,,,,592.35,1044.69,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,outpatient,,,1077.00000,1023.15000,The Alliance,Exception Members,,829.29,,,,,,,538.50,1044.69,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,569.80,1004.92,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Exception Members,,797.72,,,,,,,569.80,5271.00,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,inpatient,,,956.00000,908.20000,The Alliance,Exception Members,,736.12,,,,,,,525.80,927.32,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,outpatient,,,956.00000,908.20000,The Alliance,Exception Members,,736.12,,,,,,,227.78,927.32,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,203.50,358.90,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Exception Members,,284.90,,,,,,,185.00,358.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,Exception Members,,234.08,,,,,,,167.20,294.88,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Exception Members,,234.08,,,,,,,152.00,294.88,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,319.00,562.60,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Exception Members,,446.60,,,,,,,283.85,562.60,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,inpatient,,,694.00000,659.30000,The Alliance,Exception Members,,534.38,,,,,,,381.70,673.18,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,outpatient,,,694.00000,659.30000,The Alliance,Exception Members,,534.38,,,,,,,283.85,673.18,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,96.80,170.72,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,88.00,207.54,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,238.70,420.98,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,217.00,420.98,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,114.50,308.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,195.80,345.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Exception Members,,274.12,,,,,,,178.00,345.32,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,392.70,692.58,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Exception Members,,549.78,,,,,,,227.78,692.58,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,inpatient,,,912.00000,866.40000,The Alliance,Exception Members,,702.24,,,,,,,501.60,884.64,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,outpatient,,,912.00000,866.40000,The Alliance,Exception Members,,702.24,,,,,,,227.78,884.64,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,212.85,375.39,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Exception Members,,297.99,,,,,,,193.50,417.31,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,Exception Members,,181.72,,,,,,,129.80,228.92,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Exception Members,,181.72,,,,,,,118.00,531.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,147.40,259.96,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Exception Members,,206.36,,,,,,,134.00,259.96,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,inpatient,,,1431.00000,1359.45000,The Alliance,Exception Members,,1101.87,,,,,,,787.05,1388.07,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,Exception Members,,1101.87,,,,,,,227.78,1388.07,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,158.95,280.33,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Exception Members,,222.53,,,,,,,144.50,416.79,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,inpatient,,,965.00000,916.75000,The Alliance,Exception Members,,743.05,,,,,,,530.75,936.05,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,outpatient,,,965.00000,916.75000,The Alliance,Exception Members,,743.05,,,,,,,227.78,936.05,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,114.50,254.03,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,inpatient,,,382.00000,362.90000,The Alliance,Exception Members,,294.14,,,,,,,210.10,370.54,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,outpatient,,,382.00000,362.90000,The Alliance,Exception Members,,294.14,,,,,,,191.00,417.31,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,129.50,308.32,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,HP,177.87,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,HP,177.87,,,,,,,115.50,224.07,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,12.10,21.34,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Exception Members,,16.94,,,,,,,11.00,31.12,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,inpatient,,,326.00000,309.70000,The Alliance,Exception Members,,251.02,,,,,,,179.30,316.22,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,outpatient,,,326.00000,309.70000,The Alliance,Exception Members,,251.02,,,,,,,163.00,316.22,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,48.50,94.09,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,inpatient,,,458.00000,435.10000,The Alliance,Exception Members,,352.66,,,,,,,251.90,444.26,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,outpatient,,,458.00000,435.10000,The Alliance,Exception Members,,352.66,,,,,,,229.00,444.26,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,190.85,336.59,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Exception Members,,267.19,,,,,,,173.50,336.59,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,inpatient,,,1005.00000,954.75000,The Alliance,Exception Members,,773.85,,,,,,,552.75,974.85,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,Exception Members,,773.85,,,,,,,502.50,974.85,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,Exception Members,,291.06,,,,,,,207.90,366.66,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Exception Members,,291.06,,,,,,,189.00,1231.54,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,inpatient,,,787.00000,747.65000,The Alliance,Exception Members,,605.99,,,,,,,432.85,763.39,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,outpatient,,,787.00000,747.65000,The Alliance,Exception Members,,605.99,,,,,,,393.50,763.39,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,15.50,30.07,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,inpatient,,,37.65000,35.77000,The Alliance,Exception Members,,28.99,,,,,,,20.71,36.52,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,outpatient,,,37.65000,35.77000,The Alliance,Exception Members,,28.99,,,,,,,18.82,242.55,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,inpatient,,,1455.00000,1382.25000,The Alliance,Exception Members,,1120.35,,,,,,,800.25,1411.35,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,outpatient,,,1455.00000,1382.25000,The Alliance,Exception Members,,1120.35,,,,,,,668.09,1411.35,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,734.90,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,inpatient,,,377.50000,358.62000,The Alliance,Exception Members,,290.68,,,,,,,207.62,366.18,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,outpatient,,,377.50000,358.62000,The Alliance,Exception Members,,290.68,,,,,,,188.75,952.28,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,408.37,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,210.50,408.37,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,113.85,200.79,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,,159.39,,,,,,,103.50,254.03,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,57.50,419.70,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,295.90,521.86,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,269.00,521.86,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,87.75000,83.36000,The Alliance,Exception Members,,67.57,,,,,,,48.26,85.12,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,87.75000,83.36000,The Alliance,Exception Members,,67.57,,,,,,,43.88,85.12,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,Exception Members,,234.08,,,,,,,167.20,294.88,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Exception Members,,234.08,,,,,,,152.00,645.77,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,308.32,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,190.30,335.62,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,173.00,417.31,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,330.00,582.00,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,300.00,723.34,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,inpatient,,,719.00000,683.05000,The Alliance,Exception Members,,553.63,,,,,,,395.45,697.43,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,outpatient,,,719.00000,683.05000,The Alliance,Exception Members,,553.63,,,,,,,359.50,825.21,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,Exception Members,,559.02,,,,,,,399.30,704.22,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Exception Members,,559.02,,,,,,,363.00,825.21,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,inpatient,,,482.00000,457.90000,The Alliance,Exception Members,,371.14,,,,,,,265.10,467.54,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,outpatient,,,482.00000,457.90000,The Alliance,Exception Members,,371.14,,,,,,,241.00,467.54,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,inpatient,,,786.00000,746.70000,The Alliance,Exception Members,,605.22,,,,,,,432.30,762.42,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,outpatient,,,786.00000,746.70000,The Alliance,Exception Members,,605.22,,,,,,,393.00,762.42,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,Exception Members,,167.09,,,,,,,119.35,210.49,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Exception Members,,167.09,,,,,,,108.50,531.90,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,206.25,363.75,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,187.50,363.75,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,Exception Members,,358.82,,,,,,,256.30,452.02,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,Exception Members,,358.82,,,,,,,233.00,452.02,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,inpatient,,,423.00000,401.85000,The Alliance,Exception Members,,325.71,,,,,,,232.65,410.31,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,outpatient,,,423.00000,401.85000,The Alliance,Exception Members,,325.71,,,,,,,188.67,410.31,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,84.70,149.38,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Exception Members,,118.58,,,,,,,77.00,202.77,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,72.05,127.07,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Exception Members,,100.87,,,,,,,65.50,207.54,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,23.10,40.74,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Exception Members,,32.34,,,,,,,21.00,417.31,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,HP,140.14,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,HP,140.14,,,,,,,91.00,176.54,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,Exception Members,HP,107.03,,,,,,,76.45,134.83,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Exception Members,HP,107.03,,,,,,,69.50,134.83,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,HP,110.11,,,,,,,78.65,138.71,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,HP,110.11,,,,,,,71.50,138.71,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,HP,140.14,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,HP,140.14,,,,,,,91.00,176.54,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,Exception Members,,554.40,,,,,,,396.00,698.40,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Exception Members,,554.40,,,,,,,360.00,734.90,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,186.45,328.83,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,169.50,328.83,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,Exception Members,,220.22,,,,,,,157.30,277.42,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Exception Members,,220.22,,,,,,,143.00,417.31,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,211.75,373.45,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,184.34,373.45,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,inpatient,,,968.00000,919.60000,The Alliance,Exception Members,,745.36,,,,,,,532.40,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,outpatient,,,968.00000,919.60000,The Alliance,Exception Members,,745.36,,,,,,,384.16,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,inpatient,,,849.00000,806.55000,The Alliance,Exception Members,,653.73,,,,,,,466.95,823.53,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,Exception Members,,653.73,,,,,,,384.16,823.53,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,Exception Members,,498.96,,,,,,,356.40,628.56,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Exception Members,,498.96,,,,,,,324.00,645.77,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,248.05,437.47,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Exception Members,,347.27,,,,,,,225.50,1692.33,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,inpatient,,,315.00000,299.25000,The Alliance,Exception Members,,242.55,,,,,,,173.25,305.55,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Exception Members,,242.55,,,,,,,157.50,305.55,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,HP,49.28,,,,,,,35.20,62.08,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,HP,49.28,,,,,,,32.00,62.08,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,HP,40.04,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,HP,40.04,,,,,,,26.00,50.44,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,134.20,236.68,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,Exception Members,,187.88,,,,,,,122.00,417.31,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,inpatient,,,652.00000,619.40000,The Alliance,Exception Members,,502.04,,,,,,,358.60,632.44,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,outpatient,,,652.00000,619.40000,The Alliance,Exception Members,,502.04,,,,,,,326.00,639.36,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,105.05,185.27,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,,147.07,,,,,,,95.50,277.40,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,inpatient,,,889.00000,844.55000,The Alliance,Exception Members,,684.53,,,,,,,488.95,862.33,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,outpatient,,,889.00000,844.55000,The Alliance,Exception Members,,684.53,,,,,,,444.50,862.33,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,497.20,876.88,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,452.00,876.88,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,389.40,686.76,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,354.00,1692.33,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,HP,104.72,,,,,,,74.80,131.92,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,HP,104.72,,,,,,,68.00,131.92,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,inpatient,,,987.00000,937.65000,The Alliance,Exception Members,,759.99,,,,,,,542.85,957.39,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,outpatient,,,987.00000,937.65000,The Alliance,Exception Members,,759.99,,,,,,,493.50,1692.33,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,inpatient,,,639.00000,607.05000,The Alliance,Exception Members,,492.03,,,,,,,351.45,619.83,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,outpatient,,,639.00000,607.05000,The Alliance,Exception Members,,492.03,,,,,,,319.50,1011.64,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,The Alliance,Exception Members,,1411.41,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,The Alliance,Exception Members,,1411.41,,,,,,,916.50,1778.01,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,inpatient,,,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,outpatient,,,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,7.58,25.57,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,65.45,115.43,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,,91.63,,,,,,,59.50,416.79,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,inpatient,,,492.00000,467.40000,The Alliance,Exception Members,,378.84,,,,,,,270.60,477.24,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,outpatient,,,492.00000,467.40000,The Alliance,Exception Members,,378.84,,,,,,,246.00,1011.64,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,HP,46.20,,,,,,,33.00,58.20,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,HP,46.20,,,,,,,30.00,58.20,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,155.65,274.51,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,141.50,417.31,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,242.55,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,HP,40.04,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,HP,40.04,,,,,,,26.00,50.44,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,104.00,417.31,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,183.70,323.98,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,167.00,531.90,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,inpatient,,,198.50000,188.57000,The Alliance,Exception Members,,152.84,,,,,,,109.17,192.54,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,outpatient,,,198.50000,188.57000,The Alliance,Exception Members,,152.84,,,,,,,99.25,645.77,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,inpatient,,,1511.00000,1435.45000,The Alliance,Exception Members,,1163.47,,,,,,,831.05,1465.67,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,outpatient,,,1511.00000,1435.45000,The Alliance,Exception Members,,1163.47,,,,,,,755.50,1910.62,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,inpatient,,,368.00000,349.60000,The Alliance,Exception Members,,283.36,,,,,,,202.40,356.96,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,outpatient,,,368.00000,349.60000,The Alliance,Exception Members,,283.36,,,,,,,184.00,356.96,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,178.20,314.28,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,162.00,734.90,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,inpatient,,,622.00000,590.90000,The Alliance,Exception Members,,478.94,,,,,,,342.10,603.34,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,outpatient,,,622.00000,590.90000,The Alliance,Exception Members,,478.94,,,,,,,227.78,603.34,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.65450,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Exception Members,,0.91630,,,,,,,0.59500,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,inpatient,1,EA,6.69000,6.36000,The Alliance,Exception Members,,5.15,,,,,,,3.68,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,outpatient,1,EA,6.69000,6.36000,The Alliance,Exception Members,,5.15,,,,,,,3.35,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.15,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Exception Members,,1.61,,,,,,,1.04,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,inpatient,1,mL,70300.00000,66785.00000,The Alliance,Exception Members,,54131.00,,,,,,,38665.00,68191.00,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Exception Members,,54131.00,,,,,,,346.19,68191.00,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,251.25000,238.69000,The Alliance,Exception Members,,193.46,,,,,,,123.11,243.71,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,251.25000,238.69000,The Alliance,Exception Members,,193.46,,,,,,,115.32,251.25,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Exception Members,,29.78,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.50,9.70,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Exception Members,,7.70,,,,,,,5.00,9.70,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,5271.00,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,The Alliance,Exception Members,,246.28,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Exception Members,,246.28,,,,,,,146.81,319.84,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,214.03,423.70,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,200.49,436.80,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,inpatient,1,mL,34526.48000,32800.15000,The Alliance,Exception Members,,26585.39,,,,,,,18989.56,33490.69,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,outpatient,1,mL,34526.48000,32800.15000,The Alliance,Exception Members,,26585.39,,,,,,,141.00,33490.69,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,5.11,9.01,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Exception Members,,7.15,,,,,,,4.64,9.01,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,inpatient,1,mL,267.19000,253.83000,The Alliance,Exception Members,,205.74,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Exception Members,,205.74,,,,,,,31.18,259.17,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,The Alliance,Exception Members,,687.23,,,,,,,437.32,865.73,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Exception Members,,687.23,,,,,,,409.66,892.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,116.86,231.34,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,109.47,238.50,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,TC,3028.41,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,TC,3028.41,,,,,,,1966.50,3815.01,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9780.75000,9291.71000,The Alliance,Exception Members,,7531.18,,,,,,,4792.57,9487.33,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9780.75000,9291.71000,The Alliance,Exception Members,,7531.18,,,,,,,4489.36,9780.75,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,231.49,504.34,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,inpatient,1,EA,7882.93000,7488.79000,The Alliance,Exception Members,,6069.86,,,,,,,4335.61,7646.44,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,outpatient,1,EA,7882.93000,7488.79000,The Alliance,Exception Members,,6069.86,,,,,,,43.25,7646.44,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,1327.58000,1261.20000,The Alliance,Exception Members,,1022.24,,,,,,,730.17,1287.75,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Exception Members,,1022.24,,,,,,,663.79,1287.75,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,152.81,332.93,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,152.81,332.93,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,152.81,332.93,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,TC,40.81,,,,,,,29.15,51.41,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,TC,40.81,,,,,,,26.50,51.41,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,96.25,169.75,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,51.31,2438.63,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,inpatient,1,EA,29396.04000,27926.24000,The Alliance,Exception Members,,22634.95,,,,,,,16167.82,28514.16,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,outpatient,1,EA,29396.04000,27926.24000,The Alliance,Exception Members,,22634.95,,,,,,,359.09,28514.16,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,inpatient,1,mL,1417.48000,1346.61000,The Alliance,Exception Members,,1091.46,,,,,,,779.61,1374.96,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,outpatient,1,mL,1417.48000,1346.61000,The Alliance,Exception Members,,1091.46,,,,,,,24.13,1374.96,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1383.88,3015.00,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,1002.10,1767.34,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Exception Members,TC,1402.94,,,,,,,484.28,2161.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,550.80,1200.00,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,TC,86.24,,,,,,,61.60,108.64,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,TC,86.24,,,,,,,42.95,484.28,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,84.28,166.84,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,78.95,172.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Exception Members,,7305.38,,,,,,,4354.76,9487.50,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,83.60,147.44,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,76.00,264.00,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,The Alliance,Exception Members,TC,7638.40,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Exception Members,TC,7638.40,,,,,,,484.28,9622.40,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,inpatient,,,456.00000,433.20000,The Alliance,Exception Members,,351.12,,,,,,,250.80,442.32,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,outpatient,,,456.00000,433.20000,The Alliance,Exception Members,,351.12,,,,,,,250.80,5271.00,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,inpatient,1,EA,40006.82000,38006.48000,The Alliance,Exception Members,,30805.25,,,,,,,22003.75,38806.62,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,outpatient,1,EA,40006.82000,38006.48000,The Alliance,Exception Members,,30805.25,,,,,,,2698.05,38806.62,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,inpatient,1,mL,9841.58000,9349.50000,The Alliance,Exception Members,,7578.02,,,,,,,5412.87,9546.33,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,outpatient,1,mL,9841.58000,9349.50000,The Alliance,Exception Members,,7578.02,,,,,,,73.55,9546.33,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,inpatient,1,GM,2.34000,2.23000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,outpatient,1,GM,2.34000,2.23000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,inpatient,1,mL,271.28000,257.72000,The Alliance,Exception Members,,208.89,,,,,,,149.20,263.14,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,outpatient,1,mL,271.28000,257.72000,The Alliance,Exception Members,,208.89,,,,,,,135.64,263.14,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,TC,1952.72,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,Exception Members,TC,1952.72,,,,,,,990.94,2459.92,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.38000,179.91000,The Alliance,Exception Members,,145.82,,,,,,,92.80,183.70,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.38000,179.91000,The Alliance,Exception Members,,145.82,,,,,,,86.93,189.38,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.31,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.31,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,TC,11128.04,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,TC,11128.04,,,,,,,4549.00,14018.44,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.63085,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.63085,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.40920,2.21,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,2.79,7.08,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.40920,0.97000,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,26.95,47.53,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Exception Members,,37.73,,,,,,,22.80,47.53,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.40920,0.97000,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Exception Members,,5.62,,,,,,,2.79,7.08,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,0.40920,2.21,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2137.79,4657.50,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Exception Members,,3.97,,,,,,,2.58,5.00,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,907.50000,862.12000,The Alliance,Exception Members,,698.77,,,,,,,444.68,880.27,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,907.50000,862.12000,The Alliance,Exception Members,,698.77,,,,,,,416.54,907.50,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,inpatient,,,1334.00000,1267.30000,The Alliance,Exception Members,,1027.18,,,,,,,733.70,1293.98,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,outpatient,,,1334.00000,1267.30000,The Alliance,Exception Members,,1027.18,,,,,,,667.00,1692.33,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,inpatient,,,474.00000,450.30000,The Alliance,Exception Members,,364.98,,,,,,,260.70,459.78,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,Exception Members,,364.98,,,,,,,237.00,1801.19,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.37950,0.66930,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Exception Members,,0.53130,,,,,,,0.34500,0.66930,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,Exception Members,,305.54,,,,,,,218.24,384.90,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Exception Members,,305.54,,,,,,,23.25,384.90,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2797.00000,2657.15000,The Alliance,Exception Members,90,2153.69,,,,,,,1538.35,2713.09,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2797.00000,2657.15000,The Alliance,Exception Members,90,2153.69,,,,,,,266.02,13462.44,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,inpatient,,,177.50000,168.62000,The Alliance,Exception Members,90,136.68,,,,,,,97.62,172.18,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,outpatient,,,177.50000,168.62000,The Alliance,Exception Members,90,136.68,,,,,,,11.91,594.19,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,78.05,137.64,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,70.95,1137.41,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,inpatient,,,147.90000,140.50000,The Alliance,Exception Members,90,113.88,,,,,,,81.34,143.46,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,outpatient,,,147.90000,140.50000,The Alliance,Exception Members,90,113.88,,,,,,,73.95,1137.41,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,inpatient,,,166.60000,158.27000,The Alliance,Exception Members,90,128.28,,,,,,,91.63,161.60,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Exception Members,90,128.28,,,,,,,11.91,594.19,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,90,170.94,,,,,,,122.10,215.34,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,90,170.94,,,,,,,63.40,3038.81,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,The Alliance,Exception Members,TC,1647.80,,,,,,,1177.00,2075.80,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Exception Members,TC,1647.80,,,,,,,1070.00,2075.80,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,90,87.01,,,,,,,62.15,109.61,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,90,87.01,,,,,,,56.50,788.42,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,inpatient,,,65.50000,62.22000,The Alliance,Exception Members,90,50.44,,,,,,,36.02,63.53,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Exception Members,90,50.44,,,,,,,4.57,373.51,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,Exception Members,90,100.10,,,,,,,71.50,126.10,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Exception Members,90,100.10,,,,,,,8.13,407.44,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,Exception Members,TC,642.95,,,,,,,459.25,809.95,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Exception Members,TC,642.95,,,,,,,417.50,3942.79,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,7.65,25.57,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,inpatient,1,mL,33.71000,32.03000,The Alliance,Exception Members,,25.96,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,outpatient,1,mL,33.71000,32.03000,The Alliance,Exception Members,,25.96,,,,,,,16.86,83.21,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,281.28000,267.22000,The Alliance,Exception Members,,216.59,,,,,,,154.70,272.84,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,281.28000,267.22000,The Alliance,Exception Members,,216.59,,,,,,,140.64,272.84,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,137.46000,130.59000,The Alliance,Exception Members,,105.84,,,,,,,75.60,133.34,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,137.46000,130.59000,The Alliance,Exception Members,,105.84,,,,,,,68.73,192.52,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,79.20,139.68,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Exception Members,,110.88,,,,,,,72.00,260.45,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,148.24,261.44,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,101.38,261.44,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,inpatient,,,45.60000,43.32000,The Alliance,Exception Members,90,35.11,,,,,,,25.08,44.23,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Exception Members,90,35.11,,,,,,,5.17,254.68,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,inpatient,,,62.40000,59.28000,The Alliance,Exception Members,90,48.05,,,,,,,34.32,60.53,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,outpatient,,,62.40000,59.28000,The Alliance,Exception Members,90,48.05,,,,,,,6.92,356.54,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,inpatient,,,45.20000,42.94000,The Alliance,Exception Members,90,34.80,,,,,,,24.86,43.84,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Exception Members,90,34.80,,,,,,,5.02,254.68,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,inpatient,,,44.20000,41.99000,The Alliance,Exception Members,90,34.03,,,,,,,24.31,42.87,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,outpatient,,,44.20000,41.99000,The Alliance,Exception Members,90,34.03,,,,,,,4.90,254.68,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,inpatient,,,2.00000,1.90000,The Alliance,Exception Members,90,1.54,,,,,,,1.10,1.94,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Exception Members,90,1.54,,,,,,,1.00,1.94,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,The Alliance,Exception Members,90,273.81,,,,,,,195.58,344.93,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Exception Members,90,273.81,,,,,,,12.45,1539.22,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,The Alliance,Exception Members,90,273.81,,,,,,,195.58,344.93,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Exception Members,90,273.81,,,,,,,12.45,1539.22,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,inpatient,,,112.20000,106.59000,The Alliance,Exception Members,90,86.39,,,,,,,61.71,108.83,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,outpatient,,,112.20000,106.59000,The Alliance,Exception Members,90,86.39,,,,,,,4.90,373.51,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,inpatient,,,383.70000,364.52000,The Alliance,Exception Members,90,295.45,,,,,,,211.03,372.19,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,outpatient,,,383.70000,364.52000,The Alliance,Exception Members,90,295.45,,,,,,,127.80,6468.09,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,inpatient,,,6329.00000,6012.55000,The Alliance,Exception Members,90,4873.33,,,,,,,3480.95,6139.13,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,outpatient,,,6329.00000,6012.55000,The Alliance,Exception Members,90,4873.33,,,,,,,2520.00,6139.13,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,inpatient,,,297.00000,282.15000,The Alliance,Exception Members,,228.69,,,,,,,163.35,288.09,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,outpatient,,,297.00000,282.15000,The Alliance,Exception Members,,228.69,,,,,,,148.50,2139.65,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,The Alliance,Exception Members,TC,1442.21,,,,,,,1030.15,1816.81,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Exception Members,TC,1442.21,,,,,,,936.50,1820.00,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,281.05,495.67,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Exception Members,,393.47,,,,,,,122.40,495.67,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,inpatient,,,287.00000,272.65000,The Alliance,Exception Members,,220.99,,,,,,,157.85,278.39,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,Exception Members,,220.99,,,,,,,143.50,417.31,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,inpatient,,,91836.00000,87244.20000,The Alliance,Exception Members,,70713.72,,,,,,,50509.80,89080.92,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,outpatient,,,91836.00000,87244.20000,The Alliance,Exception Members,,70713.72,,,,,,,45918.00,93760.51,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,inpatient,,,969.00000,920.55000,The Alliance,Exception Members,TC,746.13,,,,,,,532.95,939.93,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,outpatient,,,969.00000,920.55000,The Alliance,Exception Members,TC,746.13,,,,,,,484.50,5445.97,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,The Alliance,Exception Members,,7200.92,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Exception Members,,7200.92,,,,,,,4292.50,9351.85,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,449.25,978.75,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,43.52000,41.34000,The Alliance,Exception Members,,33.51,,,,,,,21.32,42.21,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,43.52000,41.34000,The Alliance,Exception Members,,33.51,,,,,,,19.98,43.52,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,inpatient,1,GM,9.60000,9.12000,The Alliance,Exception Members,,7.39,,,,,,,5.28,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,outpatient,1,GM,9.60000,9.12000,The Alliance,Exception Members,,7.39,,,,,,,4.80,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,inpatient,1,GM,6.88000,6.54000,The Alliance,Exception Members,,5.30,,,,,,,3.78,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,outpatient,1,GM,6.88000,6.54000,The Alliance,Exception Members,,5.30,,,,,,,3.44,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,inpatient,1,GM,9.67000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,outpatient,1,GM,9.67000,9.19000,The Alliance,Exception Members,,7.45,,,,,,,4.83,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,inpatient,1,GM,9.68000,9.20000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.39,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,outpatient,1,GM,9.68000,9.20000,The Alliance,Exception Members,,7.45,,,,,,,4.84,9.39,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,34.76,61.30,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Exception Members,,48.66,,,,,,,1.28,61.30,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4936.75,9772.75,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4624.43,10075.00,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,inpatient,,,135.60000,128.82000,The Alliance,Exception Members,90,104.41,,,,,,,74.58,131.53,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Exception Members,90,104.41,,,,,,,12.40,628.12,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,inpatient,,,629.80000,598.31000,The Alliance,Exception Members,90,484.95,,,,,,,346.39,610.91,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,outpatient,,,629.80000,598.31000,The Alliance,Exception Members,90,484.95,,,,,,,20.36,1120.45,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,inpatient,,,223.90000,212.70000,The Alliance,Exception Members,90,172.40,,,,,,,123.14,217.18,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,outpatient,,,223.90000,212.70000,The Alliance,Exception Members,90,172.40,,,,,,,8.37,373.51,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,3.24,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,24.89,1137.41,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,563.00000,534.85000,The Alliance,Exception Members,,433.51,,,,,,,309.65,546.11,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Exception Members,,433.51,,,,,,,158.39,546.11,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,TC,3035.34,,,,,,,2168.10,3823.74,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Exception Members,TC,3035.34,,,,,,,356.27,17311.25,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,inpatient,,,9708.00000,9222.60000,The Alliance,Exception Members,TC,7475.16,,,,,,,5339.40,9416.76,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,outpatient,,,9708.00000,9222.60000,The Alliance,Exception Members,TC,7475.16,,,,,,,4854.00,17574.00,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,inpatient,,,10317.00000,9801.15000,The Alliance,Exception Members,TC,7944.09,,,,,,,5674.35,10007.49,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,outpatient,,,10317.00000,9801.15000,The Alliance,Exception Members,TC,7944.09,,,,,,,5158.50,17574.00,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,987.13000,937.77000,The Alliance,Exception Members,,760.09,,,,,,,542.92,957.52,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,987.13000,937.77000,The Alliance,Exception Members,,760.09,,,,,,,240.68,957.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,224.25000,213.04000,The Alliance,Exception Members,,172.67,,,,,,,123.34,217.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,224.25000,213.04000,The Alliance,Exception Members,,172.67,,,,,,,77.18,217.52,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1186.00000,1126.70000,The Alliance,Exception Members,,913.22,,,,,,,652.30,1150.42,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1186.00000,1126.70000,The Alliance,Exception Members,,913.22,,,,,,,158.39,1150.42,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,Exception Members,TC,559.02,,,,,,,399.30,704.22,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Exception Members,TC,559.02,,,,,,,363.00,704.22,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,inpatient,,,8822.00000,8380.90000,The Alliance,Exception Members,TC,6792.94,,,,,,,4852.10,8557.34,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,outpatient,,,8822.00000,8380.90000,The Alliance,Exception Members,TC,6792.94,,,,,,,4411.00,17574.00,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,32.00,62.08,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,128.00000,121.60000,The Alliance,Exception Members,,98.56,,,,,,,70.40,124.16,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Exception Members,,98.56,,,,,,,64.00,124.16,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,The Alliance,Exception Members,,736.89,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Exception Members,,736.89,,,,,,,478.50,1267.58,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,The Alliance,Exception Members,TC,2581.04,,,,,,,1843.60,3251.44,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Exception Members,TC,2581.04,,,,,,,1676.00,7180.14,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,62.50,121.25,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,2302.85,4061.39,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Exception Members,TC,3223.99,,,,,,,361.82,17311.25,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,The Alliance,Exception Members,TC,727.65,,,,,,,519.75,916.65,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Exception Members,TC,727.65,,,,,,,383.91,8543.92,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,TC,918.61,,,,,,,656.15,1157.21,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,TC,918.61,,,,,,,404.21,17311.25,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,98.24000,93.33000,The Alliance,Exception Members,,75.64,,,,,,,54.03,95.29,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,98.24000,93.33000,The Alliance,Exception Members,,75.64,,,,,,,49.12,95.29,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,288.75,509.25,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.68,509.25,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,112.49000,106.87000,The Alliance,Exception Members,,86.62,,,,,,,61.87,109.12,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,112.49000,106.87000,The Alliance,Exception Members,,86.62,,,,,,,51.64,109.12,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,412.50,727.50,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,240.68,727.50,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,504.90,890.46,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,240.68,890.46,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,241.88000,229.79000,The Alliance,Exception Members,,186.25,,,,,,,133.03,234.62,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,241.88000,229.79000,The Alliance,Exception Members,,186.25,,,,,,,51.64,234.62,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,137.16,241.90,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,51.64,241.90,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,The Alliance,Exception Members,,58.70,,,,,,,41.93,73.95,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Exception Members,,58.70,,,,,,,38.12,73.95,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,684.00000,649.80000,The Alliance,Exception Members,,526.68,,,,,,,376.20,663.48,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,684.00000,649.80000,The Alliance,Exception Members,,526.68,,,,,,,240.68,663.48,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,125.49000,119.22000,The Alliance,Exception Members,,96.63,,,,,,,69.02,121.73,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,125.49000,119.22000,The Alliance,Exception Members,,96.63,,,,,,,51.64,121.73,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,325.05,573.27,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,240.68,573.27,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.93000,100.63000,The Alliance,Exception Members,,81.57,,,,,,,58.26,102.75,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.93000,100.63000,The Alliance,Exception Members,,81.57,,,,,,,51.64,102.75,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,115.05000,109.30000,The Alliance,Exception Members,,88.59,,,,,,,63.28,111.60,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,115.05000,109.30000,The Alliance,Exception Members,,88.59,,,,,,,51.64,111.60,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,123.23000,117.07000,The Alliance,Exception Members,,94.89,,,,,,,67.78,119.53,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,123.23000,117.07000,The Alliance,Exception Members,,94.89,,,,,,,51.64,119.53,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Exception Members,,81.60,,,,,,,51.64,102.80,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,inpatient,,,757.00000,719.15000,The Alliance,Exception Members,,582.89,,,,,,,416.35,734.29,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,outpatient,,,757.00000,719.15000,The Alliance,Exception Members,,582.89,,,,,,,416.35,5271.00,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,288.20,508.28,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,TC,403.48,,,,,,,257.95,2630.66,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,inpatient,,,641.00000,608.95000,The Alliance,Exception Members,,493.57,,,,,,,352.55,621.77,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Exception Members,,493.57,,,,,,,352.55,5271.00,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1207.50000,1147.12000,The Alliance,Exception Members,,929.77,,,,,,,664.12,1171.28,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1207.50000,1147.12000,The Alliance,Exception Members,,929.77,,,,,,,158.39,1171.28,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,412.50,727.50,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,158.39,727.50,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,288.75,509.25,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,158.39,509.25,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,309.38,545.62,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,158.39,545.62,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,893.55000,848.87000,The Alliance,Exception Members,,688.03,,,,,,,491.45,866.74,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,893.55000,848.87000,The Alliance,Exception Members,,688.03,,,,,,,158.39,866.74,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,219.94000,208.94000,The Alliance,Exception Members,,169.35,,,,,,,120.97,213.34,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,219.94000,208.94000,The Alliance,Exception Members,,169.35,,,,,,,109.97,213.34,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,158.70000,150.76000,The Alliance,Exception Members,,122.20,,,,,,,87.28,153.94,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,158.70000,150.76000,The Alliance,Exception Members,,122.20,,,,,,,79.35,192.52,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,inpatient,,,706.00000,670.70000,The Alliance,Exception Members,TC,543.62,,,,,,,388.30,684.82,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Exception Members,TC,543.62,,,,,,,353.00,5271.00,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,Exception Members,TC,408.10,,,,,,,291.50,514.10,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Exception Members,TC,408.10,,,,,,,265.00,514.10,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,Exception Members,TC,266.42,,,,,,,190.30,335.62,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Exception Members,TC,266.42,,,,,,,173.00,5271.00,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,TC,36.96,,,,,,,26.40,46.56,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,TC,36.96,,,,,,,24.00,46.56,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,Exception Members,TC,317.24,,,,,,,226.60,399.64,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Exception Members,TC,317.24,,,,,,,127.30,1245.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,The Alliance,Exception Members,TC,1821.05,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Exception Members,TC,1821.05,,,,,,,979.11,2294.05,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,101.20,178.48,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,92.00,178.48,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,691.90,1220.26,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Exception Members,TC,968.66,,,,,,,629.00,1220.26,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Exception Members,TC,945.56,,,,,,,614.00,1191.16,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,TC,906.29,,,,,,,647.35,1141.69,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Exception Members,TC,906.29,,,,,,,588.50,1141.69,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,inpatient,,,1416.00000,1345.20000,The Alliance,Exception Members,TC,1090.32,,,,,,,778.80,1373.52,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Exception Members,TC,1090.32,,,,,,,708.00,1373.52,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,inpatient,,,2287.00000,2172.65000,The Alliance,Exception Members,TC,1760.99,,,,,,,1257.85,2218.39,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Exception Members,TC,1760.99,,,,,,,1143.50,2218.39,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,The Alliance,Exception Members,TC,1531.53,,,,,,,1093.95,1929.33,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Exception Members,TC,1531.53,,,,,,,994.50,1929.33,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,Exception Members,TC,130.90,,,,,,,93.50,164.90,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Exception Members,TC,130.90,,,,,,,85.00,164.90,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,Exception Members,TC,255.64,,,,,,,182.60,322.04,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Exception Members,TC,255.64,,,,,,,166.00,322.04,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,TC,163.24,,,,,,,116.60,205.64,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,TC,163.24,,,,,,,106.00,205.64,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,58.13,1226.08,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,58.13,412.25,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,687.00000,652.65000,The Alliance,Exception Members,,528.99,,,,,,,377.85,666.39,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,687.00000,652.65000,The Alliance,Exception Members,,528.99,,,,,,,211.37,666.39,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,211.37,436.50,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,211.37,1226.08,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,58.13,436.50,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,455.21000,432.45000,The Alliance,Exception Members,,350.51,,,,,,,250.37,441.55,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,455.21000,432.45000,The Alliance,Exception Members,,350.51,,,,,,,211.37,441.55,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,424.00000,402.80000,The Alliance,Exception Members,,326.48,,,,,,,233.20,411.28,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,424.00000,402.80000,The Alliance,Exception Members,,326.48,,,,,,,211.37,411.28,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Exception Members,,327.25,,,,,,,211.37,412.25,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,684.20,1206.68,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Exception Members,TC,957.88,,,,,,,584.87,1820.00,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,TC,169.40,,,,,,,121.00,213.40,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,TC,169.40,,,,,,,110.00,213.40,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,537.00000,510.15000,The Alliance,Exception Members,,413.49,,,,,,,295.35,520.89,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,537.00000,510.15000,The Alliance,Exception Members,,413.49,,,,,,,240.68,520.89,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,366.85,646.99,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Exception Members,,513.59,,,,,,,240.68,646.99,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,The Alliance,Exception Members,TC,2798.18,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Exception Members,TC,2798.18,,,,,,,1396.56,3524.98,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,The Alliance,Exception Members,TC,2718.87,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Exception Members,TC,2718.87,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,The Alliance,Exception Members,52,1330.56,,,,,,,950.40,1676.16,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Exception Members,52,1330.56,,,,,,,864.00,2032.87,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,1759.50000,1671.52000,The Alliance,Exception Members,,1354.82,,,,,,,967.73,1706.71,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,1759.50000,1671.52000,The Alliance,Exception Members,,1354.82,,,,,,,101.38,1706.71,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,149.25000,141.79000,The Alliance,Exception Members,,114.92,,,,,,,82.09,144.77,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,149.25000,141.79000,The Alliance,Exception Members,,114.92,,,,,,,74.62,144.77,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,615.25000,584.49000,The Alliance,Exception Members,,473.74,,,,,,,338.39,596.79,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,615.25000,584.49000,The Alliance,Exception Members,,473.74,,,,,,,101.38,596.79,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,239.49000,227.52000,The Alliance,Exception Members,,184.41,,,,,,,131.72,232.31,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,239.49000,227.52000,The Alliance,Exception Members,,184.41,,,,,,,101.38,232.31,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,518.75000,492.81000,The Alliance,Exception Members,,399.44,,,,,,,285.31,503.19,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,518.75000,492.81000,The Alliance,Exception Members,,399.44,,,,,,,101.38,503.19,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,inpatient,,,1928.00000,1831.60000,The Alliance,Exception Members,TC,1484.56,,,,,,,1060.40,1870.16,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,outpatient,,,1928.00000,1831.60000,The Alliance,Exception Members,TC,1484.56,,,,,,,909.00,5271.00,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Exception Members,TC,159.39,,,,,,,103.50,200.79,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,TC,67.76,,,,,,,48.40,85.36,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,TC,67.76,,,,,,,44.00,85.36,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,The Alliance,Exception Members,TC,689.92,,,,,,,492.80,869.12,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Exception Members,TC,689.92,,,,,,,448.00,4437.28,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,200.75,354.05,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Exception Members,,281.05,,,,,,,182.50,743.46,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,672.00,1303.68,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,inpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,178.20,314.28,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Exception Members,,249.48,,,,,,,122.37,314.28,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,433.40,764.36,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,TC,606.76,,,,,,,327.36,764.36,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,396.00,698.40,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Exception Members,TC,554.40,,,,,,,360.00,4496.60,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Exception Members,TC,244.86,,,,,,,154.77,548.00,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Exception Members,TC,688.38,,,,,,,384.16,867.18,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,inpatient,,,731.00000,694.45000,The Alliance,Exception Members,TC,562.87,,,,,,,402.05,709.07,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,outpatient,,,731.00000,694.45000,The Alliance,Exception Members,TC,562.87,,,,,,,365.50,709.07,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,282.15,497.61,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Exception Members,TC,395.01,,,,,,,234.65,2261.57,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,Exception Members,TC,620.62,,,,,,,443.30,781.82,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Exception Members,TC,620.62,,,,,,,403.00,5188.83,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,516.38,1125.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,449.25,978.75,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,212.73,421.12,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,199.27,434.14,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1024.14,2231.25,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,inpatient,,,52.60000,49.97000,The Alliance,Exception Members,90,40.50,,,,,,,28.93,51.02,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Exception Members,90,40.50,,,,,,,26.30,3186.14,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,inpatient,,,52.60000,49.97000,The Alliance,Exception Members,90,40.50,,,,,,,28.93,51.02,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Exception Members,90,40.50,,,,,,,26.30,1052.52,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,inpatient,,,147.20000,139.84000,The Alliance,Exception Members,90,113.34,,,,,,,80.96,142.78,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,outpatient,,,147.20000,139.84000,The Alliance,Exception Members,90,113.34,,,,,,,17.27,865.84,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,inpatient,,,367.40000,349.03000,The Alliance,Exception Members,90,282.90,,,,,,,202.07,356.38,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,outpatient,,,367.40000,349.03000,The Alliance,Exception Members,90,282.90,,,,,,,16.67,848.80,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,78.05,137.64,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,16.67,848.80,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,Exception Members,90,197.89,,,,,,,141.35,249.29,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Exception Members,90,197.89,,,,,,,25.31,2286.16,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,inpatient,,,45.70000,43.42000,The Alliance,Exception Members,90,35.19,,,,,,,25.14,44.33,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.70000,43.42000,The Alliance,Exception Members,90,35.19,,,,,,,5.35,271.65,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.32,4.08,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Exception Members,,3.24,,,,,,,2.10,4.08,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,790.00000,750.50000,The Alliance,Exception Members,,608.30,,,,,,,434.50,766.30,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Exception Members,,608.30,,,,,,,58.13,766.30,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,22.50,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,43.13000,40.97000,The Alliance,Exception Members,,33.21,,,,,,,23.72,41.84,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,43.13000,40.97000,The Alliance,Exception Members,,33.21,,,,,,,21.57,41.84,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,35.41,120.28,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,130.90,230.86,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Exception Members,,183.26,,,,,,,119.00,230.86,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,67.50,130.95,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,78.65,138.71,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,,110.11,,,,,,,71.50,308.32,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,inpatient,,,1527.00000,1450.65000,The Alliance,Exception Members,,1175.79,,,,,,,839.85,1481.19,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,outpatient,,,1527.00000,1450.65000,The Alliance,Exception Members,,1175.79,,,,,,,763.50,3938.79,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,inpatient,,,5740.00000,5453.00000,The Alliance,Exception Members,,4419.80,,,,,,,3157.00,5567.80,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,outpatient,,,5740.00000,5453.00000,The Alliance,Exception Members,,4419.80,,,,,,,2870.00,5646.22,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,220.00,388.00,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,200.00,388.00,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,inpatient,,,592.00000,562.40000,The Alliance,Exception Members,,455.84,,,,,,,325.60,574.24,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,outpatient,,,592.00000,562.40000,The Alliance,Exception Members,,455.84,,,,,,,296.00,1547.18,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,80.00,220.07,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,109.61,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,183.70,323.98,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,167.00,323.98,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,Exception Members,,236.39,,,,,,,168.85,297.79,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Exception Members,,236.39,,,,,,,23.25,297.79,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,Exception Members,,681.45,,,,,,,486.75,858.45,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Exception Members,,681.45,,,,,,,442.50,1820.00,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,22.51,39.70,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,40.93000,38.88000,The Alliance,Exception Members,,31.52,,,,,,,20.46,39.70,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,184.30,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,45.20000,42.94000,The Alliance,Exception Members,,34.80,,,,,,,24.86,43.84,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Exception Members,,34.80,,,,,,,22.60,43.84,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,20.00,264.00,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,inpatient,,,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,8.25,14.55,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Exception Members,,11.55,,,,,,,7.50,264.00,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,inpatient,,,7.00000,6.65000,The Alliance,Exception Members,,5.39,,,,,,,3.85,6.79,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,outpatient,,,7.00000,6.65000,The Alliance,Exception Members,,5.39,,,,,,,3.50,264.00,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,28.29,264.00,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,inpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,227.15,400.61,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,206.50,400.61,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,inpatient,,,369.00000,350.55000,The Alliance,Exception Members,,284.13,,,,,,,202.95,357.93,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,Exception Members,,284.13,,,,,,,184.50,357.93,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,183.00,1692.33,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,180.95,319.13,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,164.50,929.91,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,68.75,121.25,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Exception Members,,96.25,,,,,,,62.50,121.25,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,109.61,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,255.20,450.08,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,232.00,450.08,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,382.25,674.15,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,347.50,2139.65,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,7.33,12.93,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,6.67,12.93,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,104.50,184.30,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Exception Members,,146.30,,,,,,,95.00,207.54,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,The Alliance,Exception Members,,13.55,,,,,,,9.68,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Exception Members,,13.55,,,,,,,8.80,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,inpatient,1,EA,19.94000,18.94000,The Alliance,Exception Members,,15.35,,,,,,,10.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,outpatient,1,EA,19.94000,18.94000,The Alliance,Exception Members,,15.35,,,,,,,9.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,inpatient,1,EA,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,11.82,20.85,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Exception Members,,16.55,,,,,,,10.74,20.85,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,31.21,68.00,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,The Alliance,Exception Members,,7296.87,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Exception Members,,7296.87,,,,,,,4349.70,9476.46,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,46.20,81.48,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,42.00,81.48,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,inpatient,,,2010.00000,1909.50000,The Alliance,Exception Members,,1547.70,,,,,,,1105.50,1949.70,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,outpatient,,,2010.00000,1909.50000,The Alliance,Exception Members,,1547.70,,,,,,,1005.00,3823.86,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,48.19,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,83.50,909.48,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,inpatient,,,554.00000,526.30000,The Alliance,Exception Members,,426.58,,,,,,,304.70,537.38,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,outpatient,,,554.00000,526.30000,The Alliance,Exception Members,,426.58,,,,,,,277.00,3823.86,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,41.00,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,124.30,219.22,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,113.00,277.40,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,72.60,128.04,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,66.00,128.04,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,inpatient,,,1836.00000,1744.20000,The Alliance,Exception Members,,1413.72,,,,,,,1009.80,1780.92,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,outpatient,,,1836.00000,1744.20000,The Alliance,Exception Members,,1413.72,,,,,,,918.00,3388.98,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,inpatient,,,388.00000,368.60000,The Alliance,Exception Members,,298.76,,,,,,,213.40,376.36,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,outpatient,,,388.00000,368.60000,The Alliance,Exception Members,,298.76,,,,,,,194.00,376.36,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,693.00,1222.20,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,384.16,1692.33,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,inpatient,,,671.00000,637.45000,The Alliance,Exception Members,,516.67,,,,,,,369.05,650.87,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,outpatient,,,671.00000,637.45000,The Alliance,Exception Members,,516.67,,,,,,,335.50,1692.33,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,Exception Members,,90.09,,,,,,,64.35,113.49,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Exception Members,,90.09,,,,,,,58.50,113.49,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,221.10,389.94,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Exception Members,,309.54,,,,,,,201.00,389.94,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,inpatient,,,1672.00000,1588.40000,The Alliance,Exception Members,,1287.44,,,,,,,919.60,1621.84,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,outpatient,,,1672.00000,1588.40000,The Alliance,Exception Members,,1287.44,,,,,,,836.00,2382.20,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,inpatient,,,1238.00000,1176.10000,The Alliance,Exception Members,,953.26,,,,,,,680.90,1200.86,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,outpatient,,,1238.00000,1176.10000,The Alliance,Exception Members,,953.26,,,,,,,680.90,7803.00,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,inpatient,,,1131.00000,1074.45000,The Alliance,Exception Members,,870.87,,,,,,,622.05,1097.07,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,outpatient,,,1131.00000,1074.45000,The Alliance,Exception Members,,870.87,,,,,,,565.50,2989.39,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,inpatient,,,482.00000,457.90000,The Alliance,Exception Members,,371.14,,,,,,,265.10,467.54,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,outpatient,,,482.00000,457.90000,The Alliance,Exception Members,,371.14,,,,,,,241.00,1692.33,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,201.85,355.99,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Exception Members,,282.59,,,,,,,183.50,3387.36,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,166.65,293.91,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,151.50,1692.33,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,inpatient,,,1582.00000,1502.90000,The Alliance,Exception Members,,1218.14,,,,,,,870.10,1534.54,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,outpatient,,,1582.00000,1502.90000,The Alliance,Exception Members,,1218.14,,,,,,,791.00,2989.39,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,inpatient,,,639.00000,607.05000,The Alliance,Exception Members,,492.03,,,,,,,351.45,619.83,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,outpatient,,,639.00000,607.05000,The Alliance,Exception Members,,492.03,,,,,,,319.50,1801.19,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,inpatient,,,388.00000,368.60000,The Alliance,Exception Members,,298.76,,,,,,,213.40,376.36,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,outpatient,,,388.00000,368.60000,The Alliance,Exception Members,,298.76,,,,,,,194.00,683.50,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,inpatient,,,1510.00000,1434.50000,The Alliance,Exception Members,,1162.70,,,,,,,830.50,1464.70,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,outpatient,,,1510.00000,1434.50000,The Alliance,Exception Members,,1162.70,,,,,,,755.00,1692.33,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,166.65,293.91,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Exception Members,,233.31,,,,,,,151.50,1692.33,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,Exception Members,,259.49,,,,,,,185.35,326.89,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Exception Members,,259.49,,,,,,,168.50,326.89,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,inpatient,,,862.00000,818.90000,The Alliance,Exception Members,,663.74,,,,,,,474.10,836.14,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,Exception Members,,663.74,,,,,,,379.37,836.14,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,,1490.72,,,,,,,1064.80,1877.92,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Exception Members,,1490.72,,,,,,,968.00,2161.00,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,264.55,466.57,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,240.50,723.34,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,,1142.68,,,,,,,816.20,1439.48,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,,1142.68,,,,,,,742.00,2989.39,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,inpatient,,,935.00000,888.25000,The Alliance,Exception Members,,719.95,,,,,,,514.25,906.95,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,outpatient,,,935.00000,888.25000,The Alliance,Exception Members,,719.95,,,,,,,283.85,906.95,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,Exception Members,,373.45,,,,,,,266.75,470.45,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Exception Members,,373.45,,,,,,,242.50,1692.33,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,257.40,453.96,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,227.78,453.96,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,Exception Members,,428.89,,,,,,,306.35,540.29,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Exception Members,,428.89,,,,,,,278.50,1801.19,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,inpatient,,,1528.00000,1451.60000,The Alliance,Exception Members,,1176.56,,,,,,,840.40,1482.16,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,outpatient,,,1528.00000,1451.60000,The Alliance,Exception Members,,1176.56,,,,,,,764.00,1671.62,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,inpatient,,,858.00000,815.10000,The Alliance,Exception Members,,660.66,,,,,,,471.90,832.26,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,outpatient,,,858.00000,815.10000,The Alliance,Exception Members,,660.66,,,,,,,227.78,832.26,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,inpatient,,,826.00000,784.70000,The Alliance,Exception Members,,636.02,,,,,,,454.30,801.22,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,outpatient,,,826.00000,784.70000,The Alliance,Exception Members,,636.02,,,,,,,227.78,801.22,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,inpatient,,,685.00000,650.75000,The Alliance,Exception Members,,527.45,,,,,,,376.75,664.45,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,outpatient,,,685.00000,650.75000,The Alliance,Exception Members,,527.45,,,,,,,342.50,3602.42,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,inpatient,,,1094.00000,1039.30000,The Alliance,Exception Members,,842.38,,,,,,,601.70,1061.18,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,outpatient,,,1094.00000,1039.30000,The Alliance,Exception Members,,842.38,,,,,,,227.78,1061.18,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,522.50,921.50,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,227.78,921.50,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,inpatient,,,1329.00000,1262.55000,The Alliance,Exception Members,,1023.33,,,,,,,730.95,1289.13,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,outpatient,,,1329.00000,1262.55000,The Alliance,Exception Members,,1023.33,,,,,,,664.50,1671.62,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,inpatient,,,683.00000,648.85000,The Alliance,Exception Members,,525.91,,,,,,,375.65,662.51,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,Exception Members,,525.91,,,,,,,341.50,3602.42,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,inpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,504.90,890.46,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,outpatient,,,918.00000,872.10000,The Alliance,Exception Members,,706.86,,,,,,,459.00,890.46,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,inpatient,,,1879.00000,1785.05000,The Alliance,Exception Members,,1446.83,,,,,,,1033.45,1822.63,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,outpatient,,,1879.00000,1785.05000,The Alliance,Exception Members,,1446.83,,,,,,,939.50,3602.42,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,inpatient,,,754.00000,716.30000,The Alliance,Exception Members,,580.58,,,,,,,414.70,731.38,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,Exception Members,,580.58,,,,,,,377.00,1692.33,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,inpatient,,,1288.00000,1223.60000,The Alliance,Exception Members,,991.76,,,,,,,708.40,1249.36,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,outpatient,,,1288.00000,1223.60000,The Alliance,Exception Members,,991.76,,,,,,,644.00,1671.62,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,inpatient,,,588.00000,558.60000,The Alliance,Exception Members,,452.76,,,,,,,323.40,570.36,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,outpatient,,,588.00000,558.60000,The Alliance,Exception Members,,452.76,,,,,,,294.00,1692.33,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,153.45,270.63,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,139.50,1692.33,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,313.50,552.90,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,285.00,3321.00,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,Exception Members,,764.61,,,,,,,546.15,963.21,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Exception Members,,764.61,,,,,,,496.50,3387.36,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,inpatient,,,789.00000,749.55000,The Alliance,Exception Members,,607.53,,,,,,,433.95,765.33,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,outpatient,,,789.00000,749.55000,The Alliance,Exception Members,,607.53,,,,,,,394.50,3602.42,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,inpatient,,,1302.00000,1236.90000,The Alliance,Exception Members,,1002.54,,,,,,,716.10,1262.94,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Exception Members,,1002.54,,,,,,,651.00,1692.33,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,75.35,132.89,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,68.50,132.89,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,46.20,81.48,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,,64.68,,,,,,,42.00,81.48,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,inpatient,,,842.00000,799.90000,The Alliance,Exception Members,,648.34,,,,,,,463.10,816.74,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,Exception Members,,648.34,,,,,,,421.00,3602.42,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,inpatient,,,1475.00000,1401.25000,The Alliance,Exception Members,,1135.75,,,,,,,811.25,1430.75,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,Exception Members,,1135.75,,,,,,,737.50,1671.62,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,inpatient,,,1269.00000,1205.55000,The Alliance,Exception Members,,977.13,,,,,,,697.95,1230.93,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,outpatient,,,1269.00000,1205.55000,The Alliance,Exception Members,,977.13,,,,,,,634.50,1692.33,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,inpatient,,,382.00000,362.90000,The Alliance,Exception Members,,294.14,,,,,,,210.10,370.54,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,outpatient,,,382.00000,362.90000,The Alliance,Exception Members,,294.14,,,,,,,191.00,1692.33,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,inpatient,,,1539.00000,1462.05000,The Alliance,Exception Members,,1185.03,,,,,,,846.45,1492.83,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,outpatient,,,1539.00000,1462.05000,The Alliance,Exception Members,,1185.03,,,,,,,520.92,1492.83,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,190.30,335.62,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,173.00,1910.62,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,inpatient,,,1118.00000,1062.10000,The Alliance,Exception Members,,860.86,,,,,,,614.90,1084.46,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,outpatient,,,1118.00000,1062.10000,The Alliance,Exception Members,,860.86,,,,,,,559.00,2436.76,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,Exception Members,,408.10,,,,,,,291.50,514.10,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Exception Members,,408.10,,,,,,,265.00,514.10,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,23.50,96.61,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,91.85,161.99,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Exception Members,,128.59,,,,,,,83.50,346.44,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,125.95,222.13,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Exception Members,,176.33,,,,,,,114.50,3321.00,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,Exception Members,,617.54,,,,,,,441.10,777.94,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Exception Members,,617.54,,,,,,,401.00,3602.42,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,inpatient,,,811.00000,770.45000,The Alliance,Exception Members,,624.47,,,,,,,446.05,786.67,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,outpatient,,,811.00000,770.45000,The Alliance,Exception Members,,624.47,,,,,,,405.50,786.67,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,inpatient,,,171.25000,162.69000,The Alliance,Exception Members,,131.86,,,,,,,94.19,166.11,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,outpatient,,,171.25000,162.69000,The Alliance,Exception Members,,131.86,,,,,,,85.62,979.27,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,37.27,197.88,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,inpatient,,,985.00000,935.75000,The Alliance,Exception Members,,758.45,,,,,,,541.75,955.45,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,outpatient,,,985.00000,935.75000,The Alliance,Exception Members,,758.45,,,,,,,492.50,3602.42,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,inpatient,,,405.25000,384.99000,The Alliance,Exception Members,,312.04,,,,,,,222.89,393.09,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,outpatient,,,405.25000,384.99000,The Alliance,Exception Members,,312.04,,,,,,,202.62,979.27,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,,918.61,,,,,,,656.15,1157.21,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Exception Members,,918.61,,,,,,,596.50,1910.62,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,inpatient,,,1308.00000,1242.60000,The Alliance,Exception Members,,1007.16,,,,,,,719.40,1268.76,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,outpatient,,,1308.00000,1242.60000,The Alliance,Exception Members,,1007.16,,,,,,,654.00,2139.65,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,inpatient,,,1330.00000,1263.50000,The Alliance,Exception Members,,1024.10,,,,,,,731.50,1290.10,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,outpatient,,,1330.00000,1263.50000,The Alliance,Exception Members,,1024.10,,,,,,,665.00,3602.42,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,89.65,158.11,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,,125.51,,,,,,,81.50,313.26,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,143.55,253.17,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Exception Members,,200.97,,,,,,,130.50,1547.18,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,139.70,246.38,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,127.00,417.31,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,inpatient,,,620.00000,589.00000,The Alliance,Exception Members,,477.40,,,,,,,341.00,601.40,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,outpatient,,,620.00000,589.00000,The Alliance,Exception Members,,477.40,,,,,,,310.00,1692.33,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,inpatient,,,857.00000,814.15000,The Alliance,Exception Members,,659.89,,,,,,,471.35,831.29,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,outpatient,,,857.00000,814.15000,The Alliance,Exception Members,,659.89,,,,,,,428.50,1910.62,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,56.65,99.91,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,51.50,313.26,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,433.40,764.36,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Exception Members,,606.76,,,,,,,394.00,3287.55,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,inpatient,,,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,367.95,648.93,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,outpatient,,,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,334.50,648.93,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,229.35,404.49,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,208.50,1692.33,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,inpatient,,,948.00000,900.60000,The Alliance,Exception Members,,729.96,,,,,,,521.40,919.56,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,outpatient,,,948.00000,900.60000,The Alliance,Exception Members,,729.96,,,,,,,474.00,3287.55,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,U6,177.87,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,U6,177.87,,,,,,,115.50,224.07,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,37.00,313.26,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,404.25,712.95,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,367.50,2139.65,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,inpatient,,,849.00000,806.55000,The Alliance,Exception Members,,653.73,,,,,,,466.95,823.53,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,Exception Members,,653.73,,,,,,,424.50,2989.39,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,inpatient,,,284.00000,269.80000,The Alliance,Exception Members,,218.68,,,,,,,156.20,275.48,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,Exception Members,,218.68,,,,,,,142.00,308.32,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,inpatient,,,1631.00000,1549.45000,The Alliance,Exception Members,,1255.87,,,,,,,897.05,1582.07,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,outpatient,,,1631.00000,1549.45000,The Alliance,Exception Members,,1255.87,,,,,,,815.50,1671.62,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,122.10,215.34,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Exception Members,,170.94,,,,,,,111.00,215.34,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,inpatient,,,1107.00000,1051.65000,The Alliance,Exception Members,,852.39,,,,,,,608.85,1073.79,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,outpatient,,,1107.00000,1051.65000,The Alliance,Exception Members,,852.39,,,,,,,553.50,1692.33,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,119.90,211.46,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Exception Members,,167.86,,,,,,,109.00,3321.00,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,57.20,100.88,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,52.00,313.26,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,inpatient,,,379.00000,360.05000,The Alliance,Exception Members,,291.83,,,,,,,208.45,367.63,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,Exception Members,,291.83,,,,,,,189.50,3387.36,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,inpatient,,,459.00000,436.05000,The Alliance,Exception Members,,353.43,,,,,,,252.45,445.23,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,Exception Members,,353.43,,,,,,,229.50,445.23,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,inpatient,,,1281.00000,1216.95000,The Alliance,Exception Members,,986.37,,,,,,,704.55,1242.57,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,Exception Members,,986.37,,,,,,,640.50,1692.33,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,717.75,1265.85,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,652.50,1692.33,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,inpatient,,,1432.00000,1360.40000,The Alliance,Exception Members,,1102.64,,,,,,,787.60,1389.04,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,outpatient,,,1432.00000,1360.40000,The Alliance,Exception Members,,1102.64,,,,,,,716.00,1692.33,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,220.00,388.00,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,200.00,3387.36,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,inpatient,,,1509.00000,1433.55000,The Alliance,Exception Members,,1161.93,,,,,,,829.95,1463.73,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,outpatient,,,1509.00000,1433.55000,The Alliance,Exception Members,,1161.93,,,,,,,227.78,1463.73,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,,1382.15,,,,,,,987.25,1741.15,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Exception Members,,1382.15,,,,,,,897.50,3602.42,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,inpatient,,,1181.00000,1121.95000,The Alliance,Exception Members,,909.37,,,,,,,649.55,1145.57,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,outpatient,,,1181.00000,1121.95000,The Alliance,Exception Members,,909.37,,,,,,,590.50,2989.39,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,inpatient,,,1020.00000,969.00000,The Alliance,Exception Members,,785.40,,,,,,,561.00,989.40,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,Exception Members,,785.40,,,,,,,510.00,3602.42,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,90.00,264.00,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,inpatient,,,1245.00000,1182.75000,The Alliance,Exception Members,,958.65,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,outpatient,,,1245.00000,1182.75000,The Alliance,Exception Members,,958.65,,,,,,,622.50,1692.33,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,inpatient,,,1245.00000,1182.75000,The Alliance,Exception Members,,958.65,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,outpatient,,,1245.00000,1182.75000,The Alliance,Exception Members,,958.65,,,,,,,622.50,2989.39,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,inpatient,,,407.00000,386.65000,The Alliance,Exception Members,,313.39,,,,,,,223.85,394.79,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,outpatient,,,407.00000,386.65000,The Alliance,Exception Members,,313.39,,,,,,,203.50,3387.36,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,438.35,773.09,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,398.50,3602.42,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,288.20,508.28,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,,403.48,,,,,,,262.00,1547.18,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,inpatient,,,752.00000,714.40000,The Alliance,Exception Members,,579.04,,,,,,,413.60,729.44,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,outpatient,,,752.00000,714.40000,The Alliance,Exception Members,,579.04,,,,,,,188.67,729.44,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,inpatient,,,966.00000,917.70000,The Alliance,Exception Members,,743.82,,,,,,,531.30,937.02,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Exception Members,,743.82,,,,,,,531.30,4686.00,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,,1024.87,,,,,,,732.05,1291.07,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Exception Members,,1024.87,,,,,,,665.50,1692.33,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,Exception Members,,304.92,,,,,,,217.80,384.12,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Exception Members,,304.92,,,,,,,198.00,3387.36,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,90.00,264.00,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,inpatient,,,1181.00000,1121.95000,The Alliance,Exception Members,,909.37,,,,,,,649.55,1145.57,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,outpatient,,,1181.00000,1121.95000,The Alliance,Exception Members,,909.37,,,,,,,590.50,1671.62,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,inpatient,,,681.00000,646.95000,The Alliance,Exception Members,,524.37,,,,,,,374.55,660.57,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,outpatient,,,681.00000,646.95000,The Alliance,Exception Members,,524.37,,,,,,,340.50,2436.76,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,340.45,600.43,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Exception Members,,476.63,,,,,,,309.50,3321.00,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,148.50,261.90,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Exception Members,,207.90,,,,,,,135.00,929.91,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,61.05,107.67,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,55.50,107.67,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,inpatient,,,739.00000,702.05000,The Alliance,Exception Members,,569.03,,,,,,,406.45,716.83,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,outpatient,,,739.00000,702.05000,The Alliance,Exception Members,,569.03,,,,,,,369.50,3387.36,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,151.25,266.75,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Exception Members,,211.75,,,,,,,137.50,266.75,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,25.85,45.59,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Exception Members,,36.19,,,,,,,23.50,264.00,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,93.50,264.00,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,90.00,264.00,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,inpatient,,,1359.00000,1291.05000,The Alliance,Exception Members,,1046.43,,,,,,,747.45,1318.23,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,outpatient,,,1359.00000,1291.05000,The Alliance,Exception Members,,1046.43,,,,,,,679.50,1692.33,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,inpatient,,,1905.00000,1809.75000,The Alliance,Exception Members,,1466.85,,,,,,,1047.75,1847.85,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,outpatient,,,1905.00000,1809.75000,The Alliance,Exception Members,,1466.85,,,,,,,952.50,1910.62,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,26.50,264.00,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,31.04,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,U6,143.99,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,U6,143.99,,,,,,,93.50,264.00,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,500.50,882.70,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,455.00,3387.36,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,243.50,2436.76,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,inpatient,,,1589.00000,1509.55000,The Alliance,Exception Members,,1223.53,,,,,,,873.95,1541.33,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,outpatient,,,1589.00000,1509.55000,The Alliance,Exception Members,,1223.53,,,,,,,794.50,3823.86,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,inpatient,,,1623.00000,1541.85000,The Alliance,Exception Members,,1249.71,,,,,,,892.65,1574.31,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,outpatient,,,1623.00000,1541.85000,The Alliance,Exception Members,,1249.71,,,,,,,811.50,1671.62,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,inpatient,,,437.00000,415.15000,The Alliance,Exception Members,,336.49,,,,,,,240.35,423.89,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,outpatient,,,437.00000,415.15000,The Alliance,Exception Members,,336.49,,,,,,,218.50,3387.36,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,inpatient,,,887.00000,842.65000,The Alliance,Exception Members,,682.99,,,,,,,487.85,860.39,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,outpatient,,,887.00000,842.65000,The Alliance,Exception Members,,682.99,,,,,,,443.50,1671.62,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,74.25,130.95,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Exception Members,,103.95,,,,,,,67.50,130.95,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,Exception Members,,444.29,,,,,,,317.35,559.69,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,Exception Members,,444.29,,,,,,,288.50,2864.41,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,inpatient,,,627.00000,595.65000,The Alliance,Exception Members,,482.79,,,,,,,344.85,608.19,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,outpatient,,,627.00000,595.65000,The Alliance,Exception Members,,482.79,,,,,,,313.50,2989.39,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,inpatient,,,851.00000,808.45000,The Alliance,Exception Members,,655.27,,,,,,,468.05,825.47,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,outpatient,,,851.00000,808.45000,The Alliance,Exception Members,,655.27,,,,,,,425.50,3387.36,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,inpatient,,,2092.00000,1987.40000,The Alliance,Exception Members,,1610.84,,,,,,,1150.60,2029.24,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,outpatient,,,2092.00000,1987.40000,The Alliance,Exception Members,,1610.84,,,,,,,1046.00,2989.39,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,264.00,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,92.40,162.96,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,84.00,554.21,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,inpatient,,,659.00000,626.05000,The Alliance,Exception Members,,507.43,,,,,,,362.45,639.23,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,outpatient,,,659.00000,626.05000,The Alliance,Exception Members,,507.43,,,,,,,227.78,639.23,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,inpatient,,,1744.00000,1656.80000,The Alliance,Exception Members,,1342.88,,,,,,,959.20,1691.68,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,outpatient,,,1744.00000,1656.80000,The Alliance,Exception Members,,1342.88,,,,,,,872.00,1910.62,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,26.50,264.00,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,inpatient,,,1895.00000,1800.25000,The Alliance,Exception Members,,1459.15,,,,,,,1042.25,1838.15,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,Exception Members,,1459.15,,,,,,,947.50,1910.62,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,The Alliance,Exception Members,,342.65,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,Exception Members,,342.65,,,,,,,222.50,697.17,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,264.00,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,93.50,264.00,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,276.10,486.94,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,Exception Members,,386.54,,,,,,,251.00,486.94,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,Exception Members,,196.35,,,,,,,140.25,247.35,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Exception Members,,196.35,,,,,,,127.50,247.35,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,254.03,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,Exception Members,,155.54,,,,,,,111.10,195.94,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Exception Members,,155.54,,,,,,,101.00,308.32,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,inpatient,,,1078.00000,1024.10000,The Alliance,Exception Members,,830.06,,,,,,,592.90,1045.66,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,outpatient,,,1078.00000,1024.10000,The Alliance,Exception Members,,830.06,,,,,,,539.00,6178.88,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,inpatient,,,672.00000,638.40000,The Alliance,Exception Members,,517.44,,,,,,,369.60,651.84,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,Exception Members,,517.44,,,,,,,336.00,651.84,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,63.50,264.00,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,inpatient,,,556.00000,528.20000,The Alliance,Exception Members,,428.12,,,,,,,305.80,539.32,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,Exception Members,,428.12,,,,,,,278.00,1547.18,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,189.75,334.65,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,172.50,334.65,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,7940.90,14004.86,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,4549.00,14004.86,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,160.60,283.24,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,,224.84,,,,,,,146.00,283.24,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,23.00,979.27,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,92.40,162.96,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,84.00,308.32,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,264.55,466.57,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,Exception Members,,370.37,,,,,,,240.50,1801.19,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,129.50,1547.18,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,139.70,246.38,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Exception Members,,195.58,,,,,,,127.00,246.38,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,Exception Members,,317.24,,,,,,,226.60,399.64,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Exception Members,,317.24,,,,,,,206.00,1801.19,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,189.75,334.65,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Exception Members,,265.65,,,,,,,172.50,1011.64,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,inpatient,,,498.00000,473.10000,The Alliance,Exception Members,,383.46,,,,,,,273.90,483.06,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,Exception Members,,383.46,,,,,,,249.00,2139.65,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,inpatient,,,1153.00000,1095.35000,The Alliance,Exception Members,,887.81,,,,,,,634.15,1118.41,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,outpatient,,,1153.00000,1095.35000,The Alliance,Exception Members,,887.81,,,,,,,576.50,2989.39,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,inpatient,,,1321.00000,1254.95000,The Alliance,Exception Members,,1017.17,,,,,,,726.55,1281.37,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,outpatient,,,1321.00000,1254.95000,The Alliance,Exception Members,,1017.17,,,,,,,660.50,1910.62,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,inpatient,,,1152.00000,1094.40000,The Alliance,Exception Members,,887.04,,,,,,,633.60,1117.44,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,outpatient,,,1152.00000,1094.40000,The Alliance,Exception Members,,887.04,,,,,,,576.00,1117.44,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Exception Members,,143.99,,,,,,,93.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,382.25,674.15,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,347.50,674.15,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,28.13,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,144.53,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,,948.64,,,,,,,677.60,1195.04,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Exception Members,,948.64,,,,,,,581.24,1195.04,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,inpatient,,,102.75000,97.61000,The Alliance,Exception Members,,79.12,,,,,,,56.51,99.67,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,outpatient,,,102.75000,97.61000,The Alliance,Exception Members,,79.12,,,,,,,51.38,99.67,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,121.00,213.40,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Exception Members,,169.40,,,,,,,110.00,723.34,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,96.25,169.75,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,87.50,254.03,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,inpatient,,,1135.00000,1078.25000,The Alliance,Exception Members,,873.95,,,,,,,624.25,1100.95,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,outpatient,,,1135.00000,1078.25000,The Alliance,Exception Members,,873.95,,,,,,,567.50,2436.76,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,inpatient,,,11.00000,10.45000,The Alliance,Exception Members,,8.47,,,,,,,6.05,10.67,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Exception Members,,8.47,,,,,,,5.50,62.04,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,522.50,921.50,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,475.00,1671.62,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,22.50,264.00,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,183.00,1692.33,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,672.00,1692.33,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,200.20,353.08,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Exception Members,,280.28,,,,,,,182.00,3851.00,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,Exception Members,,479.71,,,,,,,342.65,604.31,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,Exception Members,,479.71,,,,,,,311.50,3851.00,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,271.15,478.21,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,Exception Members,,379.61,,,,,,,246.50,531.90,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,21.50,41.71,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,inpatient,,,1187.00000,1127.65000,The Alliance,Exception Members,,913.99,,,,,,,652.85,1151.39,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,outpatient,,,1187.00000,1127.65000,The Alliance,Exception Members,,913.99,,,,,,,593.50,3388.98,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,,34.65,,,,,,,22.50,264.00,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,inpatient,,,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,712.25,1256.15,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,outpatient,,,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,647.50,3387.36,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,inpatient,,,134.25000,127.54000,The Alliance,Exception Members,,103.37,,,,,,,73.84,130.22,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,outpatient,,,134.25000,127.54000,The Alliance,Exception Members,,103.37,,,,,,,67.12,130.22,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,73.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,264.00,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,inpatient,,,343.00000,325.85000,The Alliance,Exception Members,,264.11,,,,,,,188.65,332.71,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,Exception Members,,264.11,,,,,,,171.50,2382.20,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,56.65,99.91,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Exception Members,,79.31,,,,,,,51.50,1787.56,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,inpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.95,8.73,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.50,1062.65,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,118.34,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,inpatient,,,724.00000,687.80000,The Alliance,Exception Members,,557.48,,,,,,,398.20,702.28,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,outpatient,,,724.00000,687.80000,The Alliance,Exception Members,,557.48,,,,,,,362.00,702.28,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,183.00,1692.33,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,Exception Members,,364.21,,,,,,,260.15,458.81,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Exception Members,,364.21,,,,,,,236.50,1801.19,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,The Alliance,Exception Members,,1298.22,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,The Alliance,Exception Members,,1298.22,,,,,,,843.00,1692.33,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,inpatient,,,390.00000,370.50000,The Alliance,Exception Members,,300.30,,,,,,,214.50,378.30,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,outpatient,,,390.00000,370.50000,The Alliance,Exception Members,,300.30,,,,,,,195.00,1547.18,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,201.30,355.02,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Exception Members,,281.82,,,,,,,183.00,1692.33,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,U6,86.24,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,U6,86.24,,,,,,,56.00,264.00,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,inpatient,,,610.00000,579.50000,The Alliance,Exception Members,,469.70,,,,,,,335.50,591.70,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,outpatient,,,610.00000,579.50000,The Alliance,Exception Members,,469.70,,,,,,,305.00,2864.41,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,inpatient,,,1234.00000,1172.30000,The Alliance,Exception Members,,950.18,,,,,,,678.70,1196.98,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,Exception Members,,950.18,,,,,,,617.00,1196.98,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,510.40,900.16,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,464.00,3999.66,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,inpatient,,,2738.00000,2601.10000,The Alliance,Exception Members,,2108.26,,,,,,,1505.90,2655.86,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,outpatient,,,2738.00000,2601.10000,The Alliance,Exception Members,,2108.26,,,,,,,1369.00,2989.39,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,186.45,328.83,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,Exception Members,,261.03,,,,,,,169.50,645.77,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,The Alliance,Exception Members,,1298.22,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,The Alliance,Exception Members,,1298.22,,,,,,,843.00,1692.33,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,61.05,107.67,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Exception Members,,85.47,,,,,,,55.50,264.00,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,inpatient,,,1729.00000,1642.55000,The Alliance,Exception Members,,1331.33,,,,,,,950.95,1677.13,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,outpatient,,,1729.00000,1642.55000,The Alliance,Exception Members,,1331.33,,,,,,,864.50,2436.76,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,196.35,346.29,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,178.50,2139.65,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,95.15,167.81,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Exception Members,,133.21,,,,,,,86.50,723.34,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,inpatient,,,218.50000,207.57000,The Alliance,Exception Members,,168.25,,,,,,,120.17,211.94,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,outpatient,,,218.50000,207.57000,The Alliance,Exception Members,,168.25,,,,,,,109.25,250.56,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,The Alliance,Exception Members,U6,238.70,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Exception Members,U6,238.70,,,,,,,155.00,300.70,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,inpatient,,,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,367.95,648.93,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,outpatient,,,669.00000,635.55000,The Alliance,Exception Members,,515.13,,,,,,,334.50,648.93,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,inpatient,,,986.00000,936.70000,The Alliance,Exception Members,,759.22,,,,,,,542.30,956.42,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,outpatient,,,986.00000,936.70000,The Alliance,Exception Members,,759.22,,,,,,,493.00,1671.62,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,inpatient,,,1876.00000,1782.20000,The Alliance,Exception Members,,1444.52,,,,,,,1031.80,1819.72,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,outpatient,,,1876.00000,1782.20000,The Alliance,Exception Members,,1444.52,,,,,,,938.00,1819.72,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,inpatient,,,1296.00000,1231.20000,The Alliance,Exception Members,,997.92,,,,,,,712.80,1257.12,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,outpatient,,,1296.00000,1231.20000,The Alliance,Exception Members,,997.92,,,,,,,648.00,2989.39,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,inpatient,,,1056.00000,1003.20000,The Alliance,Exception Members,,813.12,,,,,,,580.80,1024.32,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,outpatient,,,1056.00000,1003.20000,The Alliance,Exception Members,,813.12,,,,,,,528.00,1547.18,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,inpatient,,,1132.00000,1075.40000,The Alliance,Exception Members,,871.64,,,,,,,622.60,1098.04,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,Exception Members,,871.64,,,,,,,566.00,1671.62,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,500.50,882.70,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,Exception Members,,700.70,,,,,,,455.00,3287.55,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,,1251.25,,,,,,,893.75,1576.25,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Exception Members,,1251.25,,,,,,,812.50,1910.62,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,inpatient,,,1856.00000,1763.20000,The Alliance,Exception Members,,1429.12,,,,,,,1020.80,1800.32,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,outpatient,,,1856.00000,1763.20000,The Alliance,Exception Members,,1429.12,,,,,,,928.00,7461.59,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,inpatient,,,1318.00000,1252.10000,The Alliance,Exception Members,,1014.86,,,,,,,724.90,1278.46,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,outpatient,,,1318.00000,1252.10000,The Alliance,Exception Members,,1014.86,,,,,,,659.00,2436.76,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,inpatient,,,1896.00000,1801.20000,The Alliance,Exception Members,,1459.92,,,,,,,1042.80,1839.12,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,outpatient,,,1896.00000,1801.20000,The Alliance,Exception Members,,1459.92,,,,,,,948.00,1910.62,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,inpatient,,,1556.00000,1478.20000,The Alliance,Exception Members,,1198.12,,,,,,,855.80,1509.32,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,Exception Members,,1198.12,,,,,,,778.00,3287.55,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,24.02,97.00,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,inpatient,,,1493.00000,1418.35000,The Alliance,Exception Members,,1149.61,,,,,,,821.15,1448.21,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,outpatient,,,1493.00000,1418.35000,The Alliance,Exception Members,,1149.61,,,,,,,520.92,1448.21,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,281.60,496.64,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Exception Members,,394.24,,,,,,,256.00,1692.33,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1183.05,2086.47,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Exception Members,,1656.27,,,,,,,1075.50,2436.76,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,255.20,450.08,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,232.00,3851.00,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,inpatient,,,3133.00000,2976.35000,The Alliance,Exception Members,,2412.41,,,,,,,1723.15,3039.01,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,outpatient,,,3133.00000,2976.35000,The Alliance,Exception Members,,2412.41,,,,,,,1566.50,3039.01,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,inpatient,,,2190.00000,2080.50000,The Alliance,Exception Members,,1686.30,,,,,,,1204.50,2124.30,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,outpatient,,,2190.00000,2080.50000,The Alliance,Exception Members,,1686.30,,,,,,,1095.00,3602.42,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,inpatient,,,307.00000,291.65000,The Alliance,Exception Members,,236.39,,,,,,,168.85,297.79,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Exception Members,,236.39,,,,,,,153.50,952.28,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,372.35,656.69,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,Exception Members,,521.29,,,,,,,338.50,2139.65,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,inpatient,,,1549.00000,1471.55000,The Alliance,Exception Members,,1192.73,,,,,,,851.95,1502.53,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,outpatient,,,1549.00000,1471.55000,The Alliance,Exception Members,,1192.73,,,,,,,774.50,1692.33,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,115.50,203.70,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Exception Members,,161.70,,,,,,,37.27,4190.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,35.75,63.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,,50.05,,,,,,,32.50,63.05,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,57.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,U6,114.73,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,U6,114.73,,,,,,,74.50,264.00,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,Exception Members,,196.35,,,,,,,140.25,247.35,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Exception Members,,196.35,,,,,,,127.50,1231.54,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,24.02,61.11,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,inpatient,,,4100.00000,3895.00000,The Alliance,Exception Members,,3157.00,,,,,,,2255.00,3977.00,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,outpatient,,,4100.00000,3895.00000,The Alliance,Exception Members,,3157.00,,,,,,,919.67,3977.00,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,inpatient,,,2189.00000,2079.55000,The Alliance,Exception Members,,1685.53,,,,,,,1203.95,2123.33,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,outpatient,,,2189.00000,2079.55000,The Alliance,Exception Members,,1685.53,,,,,,,1094.50,2382.20,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,138.05,243.47,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,125.50,346.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,inpatient,,,752.00000,714.40000,The Alliance,Exception Members,,579.04,,,,,,,413.60,729.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,outpatient,,,752.00000,714.40000,The Alliance,Exception Members,,579.04,,,,,,,376.00,729.44,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,255.20,450.08,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Exception Members,,357.28,,,,,,,232.00,450.08,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,229.35,404.49,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Exception Members,,321.09,,,,,,,208.50,404.49,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,inpatient,,,1423.00000,1351.85000,The Alliance,Exception Members,,1095.71,,,,,,,782.65,1380.31,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,outpatient,,,1423.00000,1351.85000,The Alliance,Exception Members,,1095.71,,,,,,,711.50,1910.62,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,inpatient,,,1107.00000,1051.65000,The Alliance,Exception Members,,852.39,,,,,,,608.85,1073.79,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,outpatient,,,1107.00000,1051.65000,The Alliance,Exception Members,,852.39,,,,,,,553.50,1671.62,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,171.05,301.67,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Exception Members,,239.47,,,,,,,155.50,417.31,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,inpatient,,,1763.00000,1674.85000,The Alliance,Exception Members,,1357.51,,,,,,,969.65,1710.11,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,outpatient,,,1763.00000,1674.85000,The Alliance,Exception Members,,1357.51,,,,,,,881.50,1910.62,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,Exception Members,,447.37,,,,,,,319.55,563.57,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Exception Members,,447.37,,,,,,,290.50,1692.33,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,45.10,79.54,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Exception Members,,63.14,,,,,,,24.02,79.54,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,138.05,243.47,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Exception Members,,193.27,,,,,,,125.50,308.32,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,438.35,773.09,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Exception Members,,613.69,,,,,,,398.50,3387.36,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,inpatient,,,21.92000,20.82000,The Alliance,Exception Members,,16.88,,,,,,,12.06,21.26,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,outpatient,,,21.92000,20.82000,The Alliance,Exception Members,,16.88,,,,,,,10.96,242.55,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,U6,172.48,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,U6,172.48,,,,,,,112.00,264.00,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,Exception Members,,723.80,,,,,,,517.00,911.80,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Exception Members,,723.80,,,,,,,470.00,3387.36,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,inpatient,,,715.00000,679.25000,The Alliance,Exception Members,,550.55,,,,,,,393.25,693.55,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,outpatient,,,715.00000,679.25000,The Alliance,Exception Members,,550.55,,,,,,,357.50,1547.18,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,inpatient,,,269.00000,255.55000,The Alliance,Exception Members,,207.13,,,,,,,147.95,260.93,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,Exception Members,,207.13,,,,,,,134.50,2139.65,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,183.70,323.98,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,Exception Members,,257.18,,,,,,,167.00,323.98,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,inpatient,,,1317.00000,1251.15000,The Alliance,Exception Members,,1014.09,,,,,,,724.35,1277.49,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,outpatient,,,1317.00000,1251.15000,The Alliance,Exception Members,,1014.09,,,,,,,658.50,2436.76,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,99.50,2139.65,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,645.77,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,521.95,920.53,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,474.50,920.53,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,inpatient,,,647.00000,614.65000,The Alliance,Exception Members,,498.19,,,,,,,355.85,627.59,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,outpatient,,,647.00000,614.65000,The Alliance,Exception Members,,498.19,,,,,,,323.50,1910.62,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,inpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,371.25,654.75,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,337.50,1671.62,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,inpatient,,,1585.00000,1505.75000,The Alliance,Exception Members,,1220.45,,,,,,,871.75,1537.45,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,outpatient,,,1585.00000,1505.75000,The Alliance,Exception Members,,1220.45,,,,,,,792.50,1671.62,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,inpatient,,,2916.00000,2770.20000,The Alliance,Exception Members,,2245.32,,,,,,,1603.80,2828.52,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,outpatient,,,2916.00000,2770.20000,The Alliance,Exception Members,,2245.32,,,,,,,1458.00,2989.39,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,199.65,352.11,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Exception Members,,279.51,,,,,,,181.50,639.36,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,inpatient,,,1196.00000,1136.20000,The Alliance,Exception Members,,920.92,,,,,,,657.80,1160.12,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,outpatient,,,1196.00000,1136.20000,The Alliance,Exception Members,,920.92,,,,,,,598.00,6178.88,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,inpatient,,,813.00000,772.35000,The Alliance,Exception Members,,626.01,,,,,,,447.15,788.61,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,outpatient,,,813.00000,772.35000,The Alliance,Exception Members,,626.01,,,,,,,406.50,3388.98,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,inpatient,,,1452.00000,1379.40000,The Alliance,Exception Members,,1118.04,,,,,,,798.60,1408.44,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,outpatient,,,1452.00000,1379.40000,The Alliance,Exception Members,,1118.04,,,,,,,726.00,1910.62,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,inpatient,,,1837.00000,1745.15000,The Alliance,Exception Members,,1414.49,,,,,,,1010.35,1781.89,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,Exception Members,,1414.49,,,,,,,918.50,2436.76,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,101.75,179.45,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Exception Members,,142.45,,,,,,,92.50,179.45,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,inpatient,,,1274.00000,1210.30000,The Alliance,Exception Members,,980.98,,,,,,,700.70,1235.78,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,outpatient,,,1274.00000,1210.30000,The Alliance,Exception Members,,980.98,,,,,,,637.00,3287.55,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,inpatient,,,1271.00000,1207.45000,The Alliance,Exception Members,,978.67,,,,,,,699.05,1232.87,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,outpatient,,,1271.00000,1207.45000,The Alliance,Exception Members,,978.67,,,,,,,635.50,1671.62,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,inpatient,,,536.00000,509.20000,The Alliance,Exception Members,,412.72,,,,,,,294.80,519.92,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,Exception Members,,412.72,,,,,,,268.00,2382.20,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,124.30,219.22,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Exception Members,,174.02,,,,,,,113.00,219.22,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,116.05,204.67,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Exception Members,,162.47,,,,,,,23.25,204.67,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,inpatient,,,1298.00000,1233.10000,The Alliance,Exception Members,,999.46,,,,,,,713.90,1259.06,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,Exception Members,,999.46,,,,,,,649.00,1910.62,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,164.45,290.03,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Exception Members,,230.23,,,,,,,149.50,1547.18,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,Exception Members,,602.14,,,,,,,430.10,758.54,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,Exception Members,,602.14,,,,,,,391.00,758.54,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,inpatient,,,443.00000,420.85000,The Alliance,Exception Members,,341.11,,,,,,,243.65,429.71,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,Exception Members,,341.11,,,,,,,221.50,429.71,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,44.00,308.32,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Exception Members,,238.70,,,,,,,152.56,300.70,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,Exception Members,,558.25,,,,,,,398.75,703.25,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Exception Members,,558.25,,,,,,,362.50,2139.65,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,155.65,274.51,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Exception Members,,217.91,,,,,,,141.50,277.40,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,inpatient,,,1355.00000,1287.25000,The Alliance,Exception Members,,1043.35,,,,,,,745.25,1314.35,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,Exception Members,,1043.35,,,,,,,677.50,3388.98,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Exception Members,TC,2438.59,,,,,,,1488.32,7180.14,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,295.90,521.86,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Exception Members,,414.26,,,,,,,269.00,639.36,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,245.30,432.62,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,223.00,432.62,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,521.95,920.53,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,Exception Members,,730.73,,,,,,,474.50,3387.36,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,inpatient,,,436.00000,414.20000,The Alliance,Exception Members,,335.72,,,,,,,239.80,422.92,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,outpatient,,,436.00000,414.20000,The Alliance,Exception Members,,335.72,,,,,,,218.00,3387.36,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,inpatient,,,1437.00000,1365.15000,The Alliance,Exception Members,,1106.49,,,,,,,790.35,1393.89,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,outpatient,,,1437.00000,1365.15000,The Alliance,Exception Members,,1106.49,,,,,,,718.50,1910.62,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,153.45,270.63,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Exception Members,,214.83,,,,,,,139.50,312.24,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,inpatient,,,521.00000,494.95000,The Alliance,Exception Members,,401.17,,,,,,,286.55,505.37,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Exception Members,,401.17,,,,,,,260.50,639.36,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,inpatient,1,mL,87.06000,82.71000,The Alliance,Exception Members,,67.04,,,,,,,47.88,84.45,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,outpatient,1,mL,87.06000,82.71000,The Alliance,Exception Members,,67.04,,,,,,,43.53,84.45,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Exception Members,,0.16170,,,,,,,0.10500,0.20370,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,inpatient,,,1579.00000,1500.05000,The Alliance,Exception Members,90,1215.83,,,,,,,868.45,1531.63,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1579.00000,1500.05000,The Alliance,Exception Members,90,1215.83,,,,,,,109.60,6451.13,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,inpatient,,,361.10000,343.04000,The Alliance,Exception Members,90,278.05,,,,,,,198.60,350.27,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,outpatient,,,361.10000,343.04000,The Alliance,Exception Members,90,278.05,,,,,,,180.55,350.27,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,inpatient,,,2880.00000,2736.00000,The Alliance,Exception Members,90,2217.60,,,,,,,1584.00,2793.60,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,outpatient,,,2880.00000,2736.00000,The Alliance,Exception Members,90,2217.60,,,,,,,304.33,15397.76,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,inpatient,1,EA,1348.98000,1281.53000,The Alliance,Exception Members,,1038.71,,,,,,,741.94,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,outpatient,1,EA,1348.98000,1281.53000,The Alliance,Exception Members,,1038.71,,,,,,,6.35,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,inpatient,1,EA,1552.65000,1475.02000,The Alliance,Exception Members,,1195.54,,,,,,,853.96,1506.07,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,outpatient,1,EA,1552.65000,1475.02000,The Alliance,Exception Members,,1195.54,,,,,,,6.35,1506.07,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,90,129.36,,,,,,,92.40,162.96,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,90,129.36,,,,,,,14.94,763.98,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,82.67,145.79,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Exception Members,90,115.73,,,,,,,17.85,823.21,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,The Alliance,Exception Members,90,1818.74,,,,,,,1299.10,2291.14,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Exception Members,90,1818.74,,,,,,,215.88,10915.96,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,90,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,90,1754.06,,,,,,,208.21,10525.49,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,TC,1975.82,,,,,,,1411.30,2489.02,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,TC,1975.82,,,,,,,1283.00,2489.02,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,1.74,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Exception Members,,2.43,,,,,,,0.27125,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.27125,6.13,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,inpatient,1,mL,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,2.54,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,outpatient,1,mL,4.62000,4.39000,The Alliance,Exception Members,,3.56,,,,,,,1.06,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.53350,0.94090,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Exception Members,,0.74690,,,,,,,0.48500,1.18,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,The Alliance,Exception Members,TC,245.63,,,,,,,175.45,309.43,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Exception Members,TC,245.63,,,,,,,159.50,3015.65,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,inpatient,,,36.27000,34.46000,The Alliance,Exception Members,,27.93,,,,,,,19.95,35.18,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,outpatient,,,36.27000,34.46000,The Alliance,Exception Members,,27.93,,,,,,,15.58,35.18,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,516.38,1125.00,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,824.89000,783.65000,The Alliance,Exception Members,,635.17,,,,,,,404.20,800.14,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,824.89000,783.65000,The Alliance,Exception Members,,635.17,,,,,,,378.62,824.89,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Exception Members,,24.39,,,,,,,14.54,31.68,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,264.00,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,inpatient,,,167.90000,159.50000,The Alliance,Exception Members,90,129.28,,,,,,,92.34,162.86,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,outpatient,,,167.90000,159.50000,The Alliance,Exception Members,90,129.28,,,,,,,17.73,899.77,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,86.79,153.07,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,17.71,933.70,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,90,63.91,,,,,,,45.65,80.51,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,90,63.91,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,inpatient,,,80.10000,76.09000,The Alliance,Exception Members,90,61.68,,,,,,,44.05,77.70,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,outpatient,,,80.10000,76.09000,The Alliance,Exception Members,90,61.68,,,,,,,4.57,271.65,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,inpatient,,,452.70000,430.06000,The Alliance,Exception Members,90,348.58,,,,,,,248.99,439.12,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,outpatient,,,452.70000,430.06000,The Alliance,Exception Members,90,348.58,,,,,,,30.85,439.12,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,inpatient,,,308.60000,293.17000,The Alliance,Exception Members,90,237.62,,,,,,,169.73,299.34,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,outpatient,,,308.60000,293.17000,The Alliance,Exception Members,90,237.62,,,,,,,17.85,814.87,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,inpatient,,,400.10000,380.10000,The Alliance,Exception Members,90,308.08,,,,,,,220.06,388.10,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,outpatient,,,400.10000,380.10000,The Alliance,Exception Members,90,308.08,,,,,,,19.26,882.80,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.27500,0.53350,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.16,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.51,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Exception Members,,7.72,,,,,,,5.01,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,136.95,241.53,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,124.50,241.53,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,inpatient,,,1035.00000,983.25000,The Alliance,Exception Members,,796.95,,,,,,,569.25,1003.95,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,Exception Members,,796.95,,,,,,,227.78,1003.95,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,inpatient,,,514.00000,488.30000,The Alliance,Exception Members,,395.78,,,,,,,282.70,498.58,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,outpatient,,,514.00000,488.30000,The Alliance,Exception Members,,395.78,,,,,,,227.78,498.58,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,inpatient,,,625.00000,593.75000,The Alliance,Exception Members,,481.25,,,,,,,343.75,606.25,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,outpatient,,,625.00000,593.75000,The Alliance,Exception Members,,481.25,,,,,,,312.50,3387.36,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,513.38000,487.71000,The Alliance,Exception Members,,395.30,,,,,,,251.56,497.98,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,513.38000,487.71000,The Alliance,Exception Members,,395.30,,,,,,,235.64,513.38,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,Exception Members,,592.13,,,,,,,422.95,745.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Exception Members,,592.13,,,,,,,384.50,2039.65,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,12.05,1539.22,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,inpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,292.60,516.04,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,63.95,788.42,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,90,221.76,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,90,221.76,,,,,,,26.32,1324.17,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,inpatient,,,284.90000,270.65000,The Alliance,Exception Members,90,219.37,,,,,,,156.69,276.35,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,outpatient,,,284.90000,270.65000,The Alliance,Exception Members,90,219.37,,,,,,,26.67,1341.13,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,90,221.76,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,90,221.76,,,,,,,52.99,2682.34,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,112.31,198.07,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,90,157.23,,,,,,,18.72,882.80,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,11764.50000,11176.27000,The Alliance,Exception Members,,9058.67,,,,,,,5764.60,11411.57,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11764.50000,11176.27000,The Alliance,Exception Members,,9058.67,,,,,,,5399.91,11764.50,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,The Alliance,Exception Members,TC,11198.11,,,,,,,7998.65,14106.71,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Exception Members,TC,11198.11,,,,,,,4549.00,14106.71,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,The Alliance,Exception Members,,7577.42,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Exception Members,,7577.42,,,,,,,4516.93,9840.80,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.84000,47.35000,The Alliance,Exception Members,,38.38,,,,,,,24.42,48.34,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.84000,47.35000,The Alliance,Exception Members,,38.38,,,,,,,22.88,49.84,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Exception Members,,388.34,,,,,,,231.49,504.34,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,Exception Members,TC,219.45,,,,,,,156.75,276.45,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Exception Members,TC,219.45,,,,,,,142.50,1450.63,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,The Alliance,Exception Members,,11.78,,,,,,,7.65,25.57,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,inpatient,1,mL,541.98000,514.88000,The Alliance,Exception Members,,417.32,,,,,,,298.09,525.72,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,outpatient,1,mL,541.98000,514.88000,The Alliance,Exception Members,,417.32,,,,,,,270.99,94648.39,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,inpatient,,,892.00000,847.40000,The Alliance,Exception Members,,686.84,,,,,,,490.60,865.24,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,Exception Members,,686.84,,,,,,,227.78,865.24,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,inpatient,,,1366.00000,1297.70000,The Alliance,Exception Members,,1051.82,,,,,,,751.30,1325.02,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,outpatient,,,1366.00000,1297.70000,The Alliance,Exception Members,,1051.82,,,,,,,683.00,6178.88,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,0.14409,9.20,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,254.36000,241.64000,The Alliance,Exception Members,,195.86,,,,,,,124.64,246.73,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,254.36000,241.64000,The Alliance,Exception Members,,195.86,,,,,,,116.75,254.36,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,inpatient,,,4631.00000,4399.45000,The Alliance,Exception Members,,3565.87,,,,,,,2547.05,4492.07,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,outpatient,,,4631.00000,4399.45000,The Alliance,Exception Members,,3565.87,,,,,,,2315.50,4492.07,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,4455.00,7857.00,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,4050.00,7857.00,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,inpatient,1,EA,12.60000,11.97000,The Alliance,Exception Members,,9.70,,,,,,,6.93,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,outpatient,1,EA,12.60000,11.97000,The Alliance,Exception Members,,9.70,,,,,,,6.30,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,inpatient,1,EA,28.38000,26.96000,The Alliance,Exception Members,,21.85,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Exception Members,,21.85,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Exception Members,,15.41,,,,,,,10.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,inpatient,1,EA,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,outpatient,1,EA,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.45,8.63,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Exception Members,,988.51,,,,,,,589.26,1283.78,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,inpatient,1,mL,1142.71000,1085.57000,The Alliance,Exception Members,,879.89,,,,,,,628.49,1108.43,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,outpatient,1,mL,1142.71000,1085.57000,The Alliance,Exception Members,,879.89,,,,,,,0.76000,1108.43,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Exception Members,,7936.77,,,,,,,4731.14,10307.50,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,76.00,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1093.31,2164.31,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1024.14,2231.25,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,inpatient,1,mL,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,6.57,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,outpatient,1,mL,11.94000,11.35000,The Alliance,Exception Members,,9.19,,,,,,,5.97,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,inpatient,1,mL,11.08000,10.53000,The Alliance,Exception Members,,8.53,,,,,,,6.09,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,outpatient,1,mL,11.08000,10.53000,The Alliance,Exception Members,,8.53,,,,,,,5.54,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,inpatient,1,mL,43.42000,41.25000,The Alliance,Exception Members,,33.43,,,,,,,23.88,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,outpatient,1,mL,43.42000,41.25000,The Alliance,Exception Members,,33.43,,,,,,,21.71,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,inpatient,1,mL,13.51000,12.84000,The Alliance,Exception Members,,10.40,,,,,,,7.43,13.10,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,outpatient,1,mL,13.51000,12.84000,The Alliance,Exception Members,,10.40,,,,,,,6.75,13.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,0.37830,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,inpatient,1,mL,162.98000,154.83000,The Alliance,Exception Members,,125.49,,,,,,,89.64,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,outpatient,1,mL,162.98000,154.83000,The Alliance,Exception Members,,125.49,,,,,,,81.49,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,inpatient,1,mL,184.83000,175.59000,The Alliance,Exception Members,,142.32,,,,,,,101.66,179.29,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,outpatient,1,mL,184.83000,175.59000,The Alliance,Exception Members,,142.32,,,,,,,92.42,179.29,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,inpatient,1,mL,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.41,4.26,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,outpatient,1,mL,4.39000,4.17000,The Alliance,Exception Members,,3.38,,,,,,,2.19,4.26,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,inpatient,,,1048.00000,995.60000,The Alliance,Exception Members,,806.96,,,,,,,576.40,1016.56,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,outpatient,,,1048.00000,995.60000,The Alliance,Exception Members,,806.96,,,,,,,524.00,6178.88,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,337.50000,320.62000,The Alliance,Exception Members,,259.88,,,,,,,165.38,327.38,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Exception Members,,259.88,,,,,,,154.91,337.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,36.30,145.50,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,275.62,545.62,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,258.19,562.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.80850,1.43,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Exception Members,,1.13,,,,,,,0.73500,1.43,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.51150,0.90210,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Exception Members,,0.71610,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,inpatient,1,mL,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,outpatient,1,mL,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,0.14409,2.99,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,The Alliance,Exception Members,TC,1565.41,,,,,,,1118.15,1972.01,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Exception Members,TC,1565.41,,,,,,,909.00,5271.00,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,TC,841.61,,,,,,,601.15,1060.21,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,TC,841.61,,,,,,,546.50,1060.21,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,inpatient,,,539.00000,512.05000,The Alliance,Exception Members,TC,415.03,,,,,,,296.45,522.83,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,outpatient,,,539.00000,512.05000,The Alliance,Exception Members,TC,415.03,,,,,,,269.50,522.83,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,inpatient,,,210.40000,199.88000,The Alliance,Exception Members,90,162.01,,,,,,,115.72,204.09,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,outpatient,,,210.40000,199.88000,The Alliance,Exception Members,90,162.01,,,,,,,12.00,611.15,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,inpatient,,,291.00000,276.45000,The Alliance,Exception Members,90,224.07,,,,,,,160.05,282.27,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Exception Members,90,224.07,,,,,,,12.41,628.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,35.23,76.76,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,inpatient,,,134.90000,128.16000,The Alliance,Exception Members,90,103.87,,,,,,,74.19,130.85,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,outpatient,,,134.90000,128.16000,The Alliance,Exception Members,90,103.87,,,,,,,15.83,797.91,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,inpatient,1,EA,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,42.22,74.46,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,outpatient,1,EA,76.76000,72.92000,The Alliance,Exception Members,,59.11,,,,,,,7.82,74.46,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,inpatient,,,188.40000,178.98000,The Alliance,Exception Members,90,145.07,,,,,,,103.62,182.75,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,outpatient,,,188.40000,178.98000,The Alliance,Exception Members,90,145.07,,,,,,,22.12,1120.45,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,Exception Members,90,279.51,,,,,,,199.65,352.11,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Exception Members,90,279.51,,,,,,,36.26,1833.46,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,inpatient,1,mL,1400.41000,1330.39000,The Alliance,Exception Members,,1078.32,,,,,,,770.23,1358.40,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,outpatient,1,mL,1400.41000,1330.39000,The Alliance,Exception Members,,1078.32,,,,,,,700.21,1358.40,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1383.88,3015.00,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.80000,197.41000,The Alliance,Exception Members,90,160.01,,,,,,,114.29,201.57,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.80000,197.41000,The Alliance,Exception Members,90,160.01,,,,,,,19.88,1103.49,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,inpatient,,,162.90000,154.76000,The Alliance,Exception Members,90,125.43,,,,,,,89.59,158.01,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,outpatient,,,162.90000,154.76000,The Alliance,Exception Members,90,125.43,,,,,,,19.14,967.70,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,The Alliance,Exception Members,TC,4312.00,,,,,,,3080.00,5432.00,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Exception Members,TC,4312.00,,,,,,,2751.30,21823.18,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,inpatient,1,mL,1673.67000,1589.99000,The Alliance,Exception Members,,1288.73,,,,,,,920.52,1623.46,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,outpatient,1,mL,1673.67000,1589.99000,The Alliance,Exception Members,,1288.73,,,,,,,54.67,1623.46,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,inpatient,,,472.50000,448.88000,The Alliance,Exception Members,90,363.82,,,,,,,259.88,458.32,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Exception Members,90,363.82,,,,,,,35.07,1765.53,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,Exception Members,,72.38,,,,,,,51.70,91.18,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Exception Members,,72.38,,,,,,,9.77,458.40,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,The Alliance,Exception Members,,944.21,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Exception Members,,944.21,,,,,,,562.85,1226.25,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,The Alliance,Exception Members,TC,1750.21,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Exception Members,TC,1750.21,,,,,,,1136.50,2204.81,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,370.70,653.78,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,63.40,3038.81,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,36.13,63.73,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Exception Members,90,50.59,,,,,,,8.17,679.08,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,317.40000,301.53000,The Alliance,Exception Members,,244.40,,,,,,,174.57,307.88,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,317.40000,301.53000,The Alliance,Exception Members,,244.40,,,,,,,155.27,307.88,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.35200,0.62080,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Exception Members,,0.49280,,,,,,,0.32000,0.62080,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,144.38,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,131.25,254.62,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Exception Members,,4217.46,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.34860,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,3.24,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,10.86,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,491.00000,466.45000,The Alliance,Exception Members,,378.07,,,,,,,270.05,476.27,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,491.00000,466.45000,The Alliance,Exception Members,,378.07,,,,,,,63.95,788.42,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,56.40,1426.03,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,The Alliance,Exception Members,,7669.32,,,,,,,4880.47,9661.35,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Exception Members,,7669.32,,,,,,,4571.71,9960.15,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26931.87000,25585.28000,The Alliance,Exception Members,,20737.54,,,,,,,13196.62,26123.91,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26931.87000,25585.28000,The Alliance,Exception Members,,20737.54,,,,,,,12361.73,26931.87,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6722.33000,6386.21000,The Alliance,Exception Members,,5176.19,,,,,,,3293.94,6520.66,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6722.33000,6386.21000,The Alliance,Exception Members,,5176.19,,,,,,,3085.55,6722.33,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,The Alliance,Exception Members,,7438.20,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Exception Members,,7438.20,,,,,,,4433.94,9660.00,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,inpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,292.60,516.04,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Exception Members,,409.64,,,,,,,266.00,516.04,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1515.94,3000.94,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1420.03,3093.75,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3087.92,6727.50,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1024.14,2231.25,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,The Alliance,Exception Members,TC,2685.76,,,,,,,1918.40,3383.36,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Exception Members,TC,2685.76,,,,,,,1648.68,3383.36,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,Exception Members,,559.02,,,,,,,399.30,704.22,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Exception Members,,559.02,,,,,,,100.97,704.22,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,The Alliance,Exception Members,,262.95,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Exception Members,,262.95,,,,,,,170.75,331.25,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4232.12000,4020.51000,The Alliance,Exception Members,,3258.73,,,,,,,2073.74,4105.16,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4232.12000,4020.51000,The Alliance,Exception Members,,3258.73,,,,,,,1942.54,4232.12,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,10.86,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,inpatient,,,42.42000,40.30000,The Alliance,Exception Members,,32.66,,,,,,,23.33,41.15,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,outpatient,,,42.42000,40.30000,The Alliance,Exception Members,,32.66,,,,,,,21.21,47.59,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,inpatient,0.5,EA,84.84000,80.60000,The Alliance,Exception Members,,65.33,,,,,,,46.66,82.29,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,outpatient,0.5,EA,84.84000,80.60000,The Alliance,Exception Members,,65.33,,,,,,,42.42,82.29,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,94.05,165.87,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Exception Members,,131.67,,,,,,,12.05,628.12,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,Exception Members,TC,431.20,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Exception Members,TC,431.20,,,,,,,280.00,3015.65,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2916.11,5772.71,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2731.62,5951.25,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,310.01000,294.51000,The Alliance,Exception Members,,238.71,,,,,,,151.90,300.71,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,310.01000,294.51000,The Alliance,Exception Members,,238.71,,,,,,,142.29,310.01,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,319.30000,303.34000,The Alliance,Exception Members,,245.86,,,,,,,175.62,309.72,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Exception Members,,245.86,,,,,,,155.27,309.72,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,224.07,395.18,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Exception Members,90,313.70,,,,,,,36.26,1833.46,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Exception Members,,0.29260,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,inpatient,1,GM,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,outpatient,1,GM,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,inpatient,1,EA,3070.66000,2917.13000,The Alliance,Exception Members,,2364.41,,,,,,,1688.86,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,outpatient,1,EA,3070.66000,2917.13000,The Alliance,Exception Members,,2364.41,,,,,,,155.42,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,inpatient,1,EA,3116.66000,2960.83000,The Alliance,Exception Members,,2399.83,,,,,,,1714.16,3023.16,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,outpatient,1,EA,3116.66000,2960.83000,The Alliance,Exception Members,,2399.83,,,,,,,155.42,3023.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,inpatient,1,EA,33331.78000,31665.19000,The Alliance,Exception Members,,25665.47,,,,,,,18332.48,32331.83,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,outpatient,1,EA,33331.78000,31665.19000,The Alliance,Exception Members,,25665.47,,,,,,,136.23,32331.83,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,inpatient,1,EA,13.13000,12.47000,The Alliance,Exception Members,,10.11,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Exception Members,,10.11,,,,,,,6.57,12.74,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,128.57000,122.14000,The Alliance,Exception Members,,99.00,,,,,,,70.71,124.71,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,128.57000,122.14000,The Alliance,Exception Members,,99.00,,,,,,,64.28,124.71,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,The Alliance,Exception Members,TC,699.93,,,,,,,499.95,881.73,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Exception Members,TC,699.93,,,,,,,359.37,881.73,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Exception Members,,215.26,,,,,,,128.32,279.56,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,The Alliance,Exception Members,,18797.62,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Exception Members,,18797.62,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,The Alliance,Exception Members,,18797.62,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Exception Members,,18797.62,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,The Alliance,Exception Members,,20301.44,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Exception Members,,20301.44,,,,,,,12101.76,26365.50,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,15500.00000,14725.00000,The Alliance,Exception Members,,11935.00,,,,,,,7595.00,15035.00,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,15500.00000,14725.00000,The Alliance,Exception Members,,11935.00,,,,,,,7114.50,15500.00,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,2871.77,6256.58,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Exception Members,,4817.57,,,,,,,2871.77,6256.58,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,The Alliance,Exception Members,,20301.44,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Exception Members,,20301.44,,,,,,,12101.76,26365.50,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,27825.00000,26433.75000,The Alliance,Exception Members,,21425.25,,,,,,,13634.25,26990.25,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,27825.00000,26433.75000,The Alliance,Exception Members,,21425.25,,,,,,,12771.67,27825.00,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Exception Members,TC,3845.38,,,,,,,1288.05,4844.18,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.28,2.49,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,inpatient,1,EA,2442.69000,2320.56000,The Alliance,Exception Members,,1880.87,,,,,,,1343.48,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,outpatient,1,EA,2442.69000,2320.56000,The Alliance,Exception Members,,1880.87,,,,,,,10.94,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,inpatient,1,EA,2827.18000,2685.82000,The Alliance,Exception Members,,2176.93,,,,,,,1554.95,2742.36,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,outpatient,1,EA,2827.18000,2685.82000,The Alliance,Exception Members,,2176.93,,,,,,,10.94,2742.36,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,inpatient,1,EA,21354.33000,20286.61000,The Alliance,Exception Members,,16442.83,,,,,,,11744.88,20713.70,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,outpatient,1,EA,21354.33000,20286.61000,The Alliance,Exception Members,,16442.83,,,,,,,1737.10,20713.70,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,321.56,636.56,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Exception Members,,505.31,,,,,,,301.22,656.25,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,99.22,196.43,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Exception Members,,155.93,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,The Alliance,Exception Members,,2873.06,,,,,,,1828.31,3619.31,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Exception Members,,2873.06,,,,,,,1712.64,3731.25,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,inpatient,1,GM,297.08000,282.23000,The Alliance,Exception Members,,228.75,,,,,,,163.39,288.17,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,outpatient,1,GM,297.08000,282.23000,The Alliance,Exception Members,,228.75,,,,,,,148.54,288.17,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,39270.00000,37306.50000,The Alliance,Exception Members,,30237.90,,,,,,,19242.30,38091.90,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,39270.00000,37306.50000,The Alliance,Exception Members,,30237.90,,,,,,,18024.93,39270.00,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,inpatient,1,EA,3774.55000,3585.83000,The Alliance,Exception Members,,2906.40,,,,,,,2076.00,3661.31,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,outpatient,1,EA,3774.55000,3585.83000,The Alliance,Exception Members,,2906.40,,,,,,,4.24,3661.31,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2442.77,4835.69,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2288.23,4985.25,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,inpatient,1,EA,9775.80000,9287.01000,The Alliance,Exception Members,,7527.37,,,,,,,5376.69,9482.53,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,outpatient,1,EA,9775.80000,9287.01000,The Alliance,Exception Members,,7527.37,,,,,,,163.21,9482.53,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,inpatient,1,EA,13.13000,12.47000,The Alliance,Exception Members,,10.11,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Exception Members,,10.11,,,,,,,6.57,12.74,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,inpatient,1,mL,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.52,4.44,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,outpatient,1,mL,4.58000,4.35000,The Alliance,Exception Members,,3.53,,,,,,,2.29,4.44,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,inpatient,,,10207.00000,9696.65000,The Alliance,Exception Members,90,7859.39,,,,,,,5613.85,9900.79,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,outpatient,,,10207.00000,9696.65000,The Alliance,Exception Members,90,7859.39,,,,,,,608.00,54562.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28637.91000,27206.01000,The Alliance,Exception Members,,22051.19,,,,,,,14032.58,27778.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28637.91000,27206.01000,The Alliance,Exception Members,,22051.19,,,,,,,13144.80,28637.91,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,inpatient,,,1024.00000,972.80000,The Alliance,Exception Members,TC,788.48,,,,,,,563.20,993.28,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,outpatient,,,1024.00000,972.80000,The Alliance,Exception Members,TC,788.48,,,,,,,433.70,17311.25,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,The Alliance,Exception Members,TC,2426.27,,,,,,,1733.05,3056.47,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,Exception Members,TC,2426.27,,,,,,,1575.50,3056.47,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Exception Members,,3121.39,,,,,,,1860.67,4053.75,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,90,866.25,,,,,,,618.75,1091.25,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,90,866.25,,,,,,,83.09,5856.94,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,90,87.01,,,,,,,62.15,109.61,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,90,87.01,,,,,,,56.50,8610.62,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,421.88000,400.79000,The Alliance,Exception Members,,324.85,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Exception Members,,324.85,,,,,,,155.27,409.22,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Exception Members,,256.36,,,,,,,152.81,332.93,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,inpatient,,,6126.00000,5819.70000,The Alliance,Exception Members,TC,4717.02,,,,,,,3369.30,5942.22,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,outpatient,,,6126.00000,5819.70000,The Alliance,Exception Members,TC,4717.02,,,,,,,3063.00,5942.22,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,110.25,218.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,103.28,225.00,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,4.27,7.54,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Exception Members,,5.98,,,,,,,3.88,7.54,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,238.70,420.98,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,,334.18,,,,,,,217.00,488.81,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,inpatient,1,mL,2194.08000,2084.37000,The Alliance,Exception Members,,1689.44,,,,,,,1206.74,2128.26,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,outpatient,1,mL,2194.08000,2084.37000,The Alliance,Exception Members,,1689.44,,,,,,,63.39,2128.26,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,TC,120.12,,,,,,,85.80,151.32,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,TC,120.12,,,,,,,78.00,8022.25,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,inpatient,,,53550.00000,50872.50000,The Alliance,Exception Members,,41233.50,,,,,,,26239.50,51943.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,53550.00000,50872.50000,The Alliance,Exception Members,,41233.50,,,,,,,24579.45,53550.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,Exception Members,90,549.78,,,,,,,392.70,692.58,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Exception Members,90,549.78,,,,,,,36.26,1833.46,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,inpatient,,,1525.00000,1448.75000,The Alliance,Exception Members,90,1174.25,,,,,,,838.75,1479.25,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,outpatient,,,1525.00000,1448.75000,The Alliance,Exception Members,90,1174.25,,,,,,,19.00,1479.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,The Alliance,Exception Members,,43.67,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Exception Members,,43.67,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,inpatient,1,mL,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,52.64,110.03,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,inpatient,1,EA,11.46000,10.88000,The Alliance,Exception Members,,8.82,,,,,,,6.30,11.12,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,outpatient,1,EA,11.46000,10.88000,The Alliance,Exception Members,,8.82,,,,,,,5.73,11.12,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,inpatient,1,EA,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,85.25,150.35,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,outpatient,1,EA,155.00000,147.25000,The Alliance,Exception Members,,119.35,,,,,,,77.50,150.35,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.39050,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Exception Members,,0.54670,,,,,,,0.35500,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.23100,0.40740,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Exception Members,,0.32340,,,,,,,0.21000,0.40740,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4487.78,9777.30,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,424.06000,402.86000,The Alliance,Exception Members,,326.53,,,,,,,233.23,411.34,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,424.06000,402.86000,The Alliance,Exception Members,,326.53,,,,,,,158.39,411.34,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,80.12000,76.11000,The Alliance,Exception Members,,61.69,,,,,,,39.26,77.72,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,80.12000,76.11000,The Alliance,Exception Members,,61.69,,,,,,,36.78,80.12,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,31326.75,68250.00,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,inpatient,1,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,4.20,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,outpatient,1,EA,7.63000,7.25000,The Alliance,Exception Members,,5.88,,,,,,,3.81,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,inpatient,1,EA,31.40000,29.83000,The Alliance,Exception Members,,24.18,,,,,,,17.27,30.46,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,outpatient,1,EA,31.40000,29.83000,The Alliance,Exception Members,,24.18,,,,,,,15.70,30.46,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,152.51,301.91,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,142.86,311.25,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,inpatient,,,984.00000,934.80000,The Alliance,Exception Members,,757.68,,,,,,,541.20,954.48,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,outpatient,,,984.00000,934.80000,The Alliance,Exception Members,,757.68,,,,,,,200.06,954.48,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,26.40,46.56,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Exception Members,,36.96,,,,,,,4.28,220.68,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,657.80000,624.91000,The Alliance,Exception Members,,506.51,,,,,,,361.79,638.07,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,657.80000,624.91000,The Alliance,Exception Members,,506.51,,,,,,,240.68,638.07,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,inpatient,1,GM,10.04000,9.53000,The Alliance,Exception Members,,7.73,,,,,,,5.52,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,outpatient,1,GM,10.04000,9.53000,The Alliance,Exception Members,,7.73,,,,,,,5.02,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24404.10000,23183.89000,The Alliance,Exception Members,,18791.16,,,,,,,11958.01,23671.98,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Exception Members,,18791.16,,,,,,,11201.48,24404.10,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,The Alliance,Exception Members,,6109.95,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Exception Members,,6109.95,,,,,,,3642.16,7935.00,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,495.00000,470.25000,The Alliance,Exception Members,,381.15,,,,,,,242.55,480.15,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Exception Members,,381.15,,,,,,,227.21,495.00,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,267.75000,254.36000,The Alliance,Exception Members,,206.17,,,,,,,131.20,259.72,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,267.75000,254.36000,The Alliance,Exception Members,,206.17,,,,,,,122.90,267.75,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,The Alliance,Exception Members,,20184.47,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Exception Members,,20184.47,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4487.78,9777.30,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,220.50,436.50,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,206.55,450.00,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,182.60,322.04,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Exception Members,,255.64,,,,,,,166.00,325.26,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,Exception Members,,644.49,,,,,,,460.35,811.89,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Exception Members,,644.49,,,,,,,122.40,811.89,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,inpatient,,,1310.00000,1244.50000,The Alliance,Exception Members,TC,1008.70,,,,,,,720.50,1270.70,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,outpatient,,,1310.00000,1244.50000,The Alliance,Exception Members,TC,1008.70,,,,,,,655.00,1270.70,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,inpatient,,,1538.00000,1461.10000,The Alliance,Exception Members,TC,1184.26,,,,,,,845.90,1491.86,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,outpatient,,,1538.00000,1461.10000,The Alliance,Exception Members,TC,1184.26,,,,,,,769.00,1491.86,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,Exception Members,,528.22,,,,,,,377.30,665.42,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Exception Members,,528.22,,,,,,,122.40,665.42,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,Exception Members,TC,154.00,,,,,,,110.00,194.00,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Exception Members,TC,154.00,,,,,,,100.00,194.00,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,inpatient,,,1812.00000,1721.40000,The Alliance,Exception Members,TC,1395.24,,,,,,,996.60,1757.64,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,outpatient,,,1812.00000,1721.40000,The Alliance,Exception Members,TC,1395.24,,,,,,,906.00,1757.64,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,822.25,1450.15,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,747.50,1450.15,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,,841.61,,,,,,,601.15,1060.21,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Exception Members,,841.61,,,,,,,295.69,1060.21,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,The Alliance,Exception Members,,774.62,,,,,,,553.30,975.82,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Exception Members,,774.62,,,,,,,503.00,975.82,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,inpatient,1,mL,25.54000,24.27000,The Alliance,Exception Members,,19.67,,,,,,,14.05,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,outpatient,1,mL,25.54000,24.27000,The Alliance,Exception Members,,19.67,,,,,,,12.77,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,inpatient,1,mL,12.79000,12.15000,The Alliance,Exception Members,,9.85,,,,,,,7.03,12.41,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,outpatient,1,mL,12.79000,12.15000,The Alliance,Exception Members,,9.85,,,,,,,6.39,12.41,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,inpatient,1,mL,2462.57000,2339.44000,The Alliance,Exception Members,,1896.18,,,,,,,1354.41,2388.69,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,outpatient,1,mL,2462.57000,2339.44000,The Alliance,Exception Members,,1896.18,,,,,,,1231.29,2388.69,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,inpatient,1,EA,1284.64000,1220.41000,The Alliance,Exception Members,,989.17,,,,,,,706.55,1246.10,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,outpatient,1,EA,1284.64000,1220.41000,The Alliance,Exception Members,,989.17,,,,,,,5.31,1246.10,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,inpatient,1,mL,2259.81000,2146.82000,The Alliance,Exception Members,,1740.05,,,,,,,1242.90,2192.02,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,outpatient,1,mL,2259.81000,2146.82000,The Alliance,Exception Members,,1740.05,,,,,,,63.39,2192.02,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,inpatient,1,EA,1367.29000,1298.92000,The Alliance,Exception Members,,1052.81,,,,,,,752.01,1326.27,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,outpatient,1,EA,1367.29000,1298.92000,The Alliance,Exception Members,,1052.81,,,,,,,11.25,1326.27,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,inpatient,1,mL,7668.27000,7284.86000,The Alliance,Exception Members,,5904.57,,,,,,,4217.55,7438.22,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,outpatient,1,mL,7668.27000,7284.86000,The Alliance,Exception Members,,5904.57,,,,,,,3834.14,7438.22,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,45.19,79.70,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,6.35,79.70,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,inpatient,,,59.20000,56.24000,The Alliance,Exception Members,,45.58,,,,,,,32.56,57.42,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,outpatient,,,59.20000,56.24000,The Alliance,Exception Members,,45.58,,,,,,,29.60,57.42,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1433.85000,1362.16000,The Alliance,Exception Members,,1104.06,,,,,,,702.59,1390.83,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1433.85000,1362.16000,The Alliance,Exception Members,,1104.06,,,,,,,658.14,1433.85,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,The Alliance,Exception Members,,127.94,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Exception Members,,127.94,,,,,,,76.27,166.16,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,408.37,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,5271.00,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,10.86,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,,237.70,,,,,,,151.26,299.44,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,,237.70,,,,,,,141.69,308.70,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,inpatient,,,8474.00000,8050.30000,The Alliance,Exception Members,,6524.98,,,,,,,4660.70,8219.78,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,outpatient,,,8474.00000,8050.30000,The Alliance,Exception Members,,6524.98,,,,,,,295.69,8219.78,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,497.20,876.88,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Exception Members,,696.08,,,,,,,268.42,876.88,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,inpatient,,,48.67000,46.24000,The Alliance,Exception Members,,37.48,,,,,,,26.77,47.21,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,outpatient,,,48.67000,46.24000,The Alliance,Exception Members,,37.48,,,,,,,11.05,47.21,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,inpatient,,,106.68000,101.35000,The Alliance,Exception Members,,82.14,,,,,,,58.67,103.48,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,outpatient,,,106.68000,101.35000,The Alliance,Exception Members,,82.14,,,,,,,53.34,103.48,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,1.39,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,inpatient,1,EA,34.59000,32.86000,The Alliance,Exception Members,,26.63,,,,,,,19.02,33.55,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Exception Members,,26.63,,,,,,,17.30,33.55,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.17050,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Exception Members,,0.23870,,,,,,,0.15500,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07700,0.13580,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Exception Members,,0.10780,,,,,,,0.07000,0.13580,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.83,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Exception Members,,3.96,,,,,,,2.57,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,inpatient,1,EA,15.15000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,8.33,14.70,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,outpatient,1,EA,15.15000,14.40000,The Alliance,Exception Members,,11.67,,,,,,,7.58,14.70,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,inpatient,1,mL,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.57,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,inpatient,1,mL,4.46000,4.24000,The Alliance,Exception Members,,3.43,,,,,,,2.45,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,outpatient,1,mL,4.46000,4.24000,The Alliance,Exception Members,,3.43,,,,,,,2.23,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,inpatient,1,mL,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.44000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,outpatient,1,mL,0.80000,0.76000,The Alliance,Exception Members,,0.61600,,,,,,,0.40000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,Exception Members,TC,567.49,,,,,,,405.35,714.89,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Exception Members,TC,567.49,,,,,,,368.50,714.89,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,inpatient,1,mL,61.62000,58.54000,The Alliance,Exception Members,,47.45,,,,,,,33.89,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,outpatient,1,mL,61.62000,58.54000,The Alliance,Exception Members,,47.45,,,,,,,18.70,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,inpatient,1,mL,38.30000,36.38000,The Alliance,Exception Members,,29.49,,,,,,,21.07,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,outpatient,1,mL,38.30000,36.38000,The Alliance,Exception Members,,29.49,,,,,,,18.70,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,inpatient,1,mL,132.81000,126.17000,The Alliance,Exception Members,,102.26,,,,,,,73.05,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,outpatient,1,mL,132.81000,126.17000,The Alliance,Exception Members,,102.26,,,,,,,18.70,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,inpatient,1,mL,38.87000,36.92000,The Alliance,Exception Members,,29.93,,,,,,,21.38,37.70,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,outpatient,1,mL,38.87000,36.92000,The Alliance,Exception Members,,29.93,,,,,,,18.70,37.70,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.95700,1.69,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Exception Members,,1.34,,,,,,,0.87000,1.69,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,The Alliance,Exception Members,,37.33,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Exception Members,,37.33,,,,,,,24.24,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,inpatient,1,EA,41.87000,39.78000,The Alliance,Exception Members,,32.24,,,,,,,23.03,40.61,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,outpatient,1,EA,41.87000,39.78000,The Alliance,Exception Members,,32.24,,,,,,,20.93,40.61,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,50.96,100.88,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,47.74,104.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,inpatient,,,1740.00000,1653.00000,The Alliance,Exception Members,,1339.80,,,,,,,957.00,1687.80,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,outpatient,,,1740.00000,1653.00000,The Alliance,Exception Members,,1339.80,,,,,,,384.16,1692.33,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,78.95,172.00,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,542.90000,515.76000,The Alliance,Exception Members,,418.03,,,,,,,298.60,526.61,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,542.90000,515.76000,The Alliance,Exception Members,,418.03,,,,,,,158.39,526.61,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,48.40,85.36,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,44.00,85.36,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,408.37,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Exception Members,,324.17,,,,,,,231.55,5271.00,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,The Alliance,Exception Members,,1577.96,,,,,,,1127.12,1987.82,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Exception Members,,1577.96,,,,,,,595.10,1987.82,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,967.59,2108.03,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Exception Members,,334.29,,,,,,,199.27,434.14,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,236.44,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.65,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Exception Members,,2.31,,,,,,,1.50,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Exception Members,,3.28,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,1.05,1.85,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Exception Members,,1.47,,,,,,,0.95500,1.85,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,0.70810,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,inpatient,1,EA,33.88000,32.19000,The Alliance,Exception Members,,26.09,,,,,,,18.63,32.86,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,outpatient,1,EA,33.88000,32.19000,The Alliance,Exception Members,,26.09,,,,,,,16.94,32.86,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,inpatient,1,mL,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,2.06,3.63,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,outpatient,1,mL,3.74000,3.55000,The Alliance,Exception Members,,2.88,,,,,,,1.87,3.63,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,inpatient,1,EA,8541.32000,8114.25000,The Alliance,Exception Members,,6576.82,,,,,,,4697.73,8285.08,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,outpatient,1,EA,8541.32000,8114.25000,The Alliance,Exception Members,,6576.82,,,,,,,155.42,8285.08,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,inpatient,1,EA,33.71000,32.03000,The Alliance,Exception Members,,25.96,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,outpatient,1,EA,33.71000,32.03000,The Alliance,Exception Members,,25.96,,,,,,,16.86,83.21,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,3273.75,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,5271.00,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,502.50000,477.38000,The Alliance,Exception Members,,386.93,,,,,,,246.22,487.43,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,502.50000,477.38000,The Alliance,Exception Members,,386.93,,,,,,,230.65,502.50,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Exception Members,,132.44,,,,,,,78.95,172.00,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35.16000,33.40000,The Alliance,Exception Members,,27.07,,,,,,,17.23,34.11,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Exception Members,,27.07,,,,,,,16.14,35.16,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,10.86,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,10.86,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.71500,1.26,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Exception Members,,1.00,,,,,,,0.65000,1.26,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.06404,1.21,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,inpatient,1,mL,2421.77000,2300.69000,The Alliance,Exception Members,,1864.76,,,,,,,1331.97,2349.12,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,outpatient,1,mL,2421.77000,2300.69000,The Alliance,Exception Members,,1864.76,,,,,,,62.97,2349.12,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,TC,3581.27,,,,,,,2558.05,4511.47,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Exception Members,TC,3581.27,,,,,,,380.83,4511.47,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,90,101.64,,,,,,,72.60,128.04,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,90,101.64,,,,,,,14.00,713.01,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,Exception Members,90,90.09,,,,,,,64.35,113.49,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Exception Members,90,90.09,,,,,,,12.38,628.12,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,90,43.89,,,,,,,31.35,55.29,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,90,43.89,,,,,,,8.17,662.12,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,90,101.64,,,,,,,72.60,128.04,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,90,101.64,,,,,,,19.00,865.84,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,90,97.79,,,,,,,69.85,123.19,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,90,97.79,,,,,,,17.85,814.87,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,Exception Members,90,122.89,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Exception Members,90,122.89,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,90,90.86,,,,,,,64.90,114.46,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,90,90.86,,,,,,,12.45,1539.22,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.85,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Exception Members,,2.59,,,,,,,1.68,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.32,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Exception Members,,1.85,,,,,,,1.20,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.31,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Exception Members,,1.84,,,,,,,1.20,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,inpatient,1,EA,6.77000,6.43000,The Alliance,Exception Members,,5.21,,,,,,,3.72,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,outpatient,1,EA,6.77000,6.43000,The Alliance,Exception Members,,5.21,,,,,,,3.38,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.77,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Exception Members,,2.48,,,,,,,1.61,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Exception Members,,1.18,,,,,,,0.76500,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1012.50000,961.88000,The Alliance,Exception Members,,779.62,,,,,,,496.12,982.12,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1012.50000,961.88000,The Alliance,Exception Members,,779.62,,,,,,,464.74,1012.50,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,91.23,198.75,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.25000,252.94000,The Alliance,Exception Members,,205.01,,,,,,,130.46,258.26,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.25000,252.94000,The Alliance,Exception Members,,205.01,,,,,,,122.21,266.25,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,220.50,436.50,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,206.55,450.00,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,25.48,50.44,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,23.87,52.00,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,17.64,34.92,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,42.23,92.00,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,459.38,909.38,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,430.31,937.50,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Exception Members,,0.96250,,,,,,,0.11780,1.21,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,The Alliance,Exception Members,,1057.57,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Exception Members,,1057.57,,,,,,,91.02,1332.27,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,inpatient,1,mL,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Exception Members,,2.82,,,,,,,1.83,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Exception Members,,2.24,,,,,,,1.46,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,inpatient,1,mL,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.44,2.53,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,outpatient,1,mL,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.30,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,inpatient,1,mL,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Exception Members,,2.26,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Exception Members,,2.26,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,inpatient,1,mL,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.36,2.41,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,outpatient,1,mL,2.48000,2.36000,The Alliance,Exception Members,,1.91,,,,,,,1.24,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,35.24,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,inpatient,,,49.36000,46.89000,The Alliance,Exception Members,,38.01,,,,,,,27.15,47.88,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,outpatient,,,49.36000,46.89000,The Alliance,Exception Members,,38.01,,,,,,,24.68,47.88,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,352.50000,334.88000,The Alliance,Exception Members,,271.43,,,,,,,193.88,341.93,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Exception Members,,271.43,,,,,,,47.62,341.93,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,inpatient,,,261.94000,248.84000,The Alliance,Exception Members,,201.69,,,,,,,128.35,254.08,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,outpatient,,,261.94000,248.84000,The Alliance,Exception Members,,201.69,,,,,,,130.34,254.08,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,inpatient,,,245.10000,232.84000,The Alliance,Exception Members,RR,188.73,,,,,,,134.81,237.75,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,outpatient,,,245.10000,232.84000,The Alliance,Exception Members,RR,188.73,,,,,,,122.55,346.38,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,inpatient,,,228.95000,217.50000,The Alliance,Exception Members,RR,176.29,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Exception Members,RR,176.29,,,,,,,114.47,242.15,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,inpatient,,,52.36000,49.74000,The Alliance,Exception Members,,40.32,,,,,,,28.80,50.79,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Exception Members,,40.32,,,,,,,26.18,50.79,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,The Alliance,Exception Members,UE,2351.19,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Exception Members,UE,2351.19,,,,,,,1526.74,2961.89,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,inpatient,,,6.24000,5.93000,The Alliance,Exception Members,,4.80,,,,,,,3.43,6.05,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,outpatient,,,6.24000,5.93000,The Alliance,Exception Members,,4.80,,,,,,,0.41800,6.05,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,,957.86,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,,957.86,,,,,,,621.99,1206.66,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,inpatient,,,515.78000,489.99000,The Alliance,Exception Members,RR,397.15,,,,,,,283.68,500.31,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,outpatient,,,515.78000,489.99000,The Alliance,Exception Members,RR,397.15,,,,,,,257.89,545.53,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,NU,957.86,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,NU,957.86,,,,,,,621.99,1206.66,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,50.82,89.63,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,46.20,89.63,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,228.95000,217.50000,The Alliance,Exception Members,,176.29,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Exception Members,,176.29,,,,,,,114.47,222.08,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,60.76000,57.72000,The Alliance,Exception Members,,46.79,,,,,,,33.42,58.94,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,60.76000,57.72000,The Alliance,Exception Members,,46.79,,,,,,,30.38,58.94,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,,957.86,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,,957.86,,,,,,,621.99,1206.66,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,29.00,56.26,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,inpatient,,,69.72000,66.23000,The Alliance,Exception Members,NU,53.68,,,,,,,38.35,67.63,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Exception Members,NU,53.68,,,,,,,34.86,74.36,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,inpatient,,,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.40,4.23,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,outpatient,,,4.36000,4.14000,The Alliance,Exception Members,,3.36,,,,,,,2.18,5.11,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,inpatient,,,51.33000,48.76000,The Alliance,Exception Members,,39.52,,,,,,,28.23,49.79,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,outpatient,,,51.33000,48.76000,The Alliance,Exception Members,,39.52,,,,,,,25.66,49.79,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,inpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,163.90,289.06,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Exception Members,,229.46,,,,,,,149.00,289.06,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,The Alliance,Exception Members,UE,5297.75,,,,,,,3784.10,6673.78,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Exception Members,UE,5297.75,,,,,,,3440.09,6673.78,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,NU,74.69,,,,,,,53.35,94.09,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,NU,74.69,,,,,,,43.58,94.09,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,inpatient,,,6.80000,6.46000,The Alliance,Exception Members,,5.24,,,,,,,3.74,6.60,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,outpatient,,,6.80000,6.46000,The Alliance,Exception Members,,5.24,,,,,,,3.40,6.60,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,The Alliance,Exception Members,NU,2351.19,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Exception Members,NU,2351.19,,,,,,,1526.74,2961.89,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,37.24,73.72,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,34.88,73.72,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,inpatient,,,920.00000,874.00000,The Alliance,Exception Members,,708.40,,,,,,,506.00,892.40,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Exception Members,,708.40,,,,,,,460.00,892.40,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,Exception Members,,285.35,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Exception Members,,285.35,,,,,,,185.29,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,Exception Members,NU,285.35,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Exception Members,NU,285.35,,,,,,,177.13,359.46,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,121.07000,115.02000,The Alliance,Exception Members,,93.22,,,,,,,66.59,117.44,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,121.07000,115.02000,The Alliance,Exception Members,,93.22,,,,,,,60.53,117.44,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,30.00,58.20,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,7.33,12.93,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,6.67,12.93,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,inpatient,,,336.75000,319.91000,The Alliance,Exception Members,NU,259.30,,,,,,,185.21,326.65,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,outpatient,,,336.75000,319.91000,The Alliance,Exception Members,NU,259.30,,,,,,,114.55,326.65,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,inpatient,,,30.40000,28.88000,The Alliance,Exception Members,,23.41,,,,,,,16.72,29.49,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Exception Members,,23.41,,,,,,,15.20,31.25,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,Exception Members,,285.35,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Exception Members,,285.35,,,,,,,185.29,359.46,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,inpatient,,,30380.00000,28861.00000,The Alliance,Exception Members,NU,23392.60,,,,,,,14886.20,29468.60,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,outpatient,,,30380.00000,28861.00000,The Alliance,Exception Members,NU,23392.60,,,,,,,12765.57,30380.00,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,93.29000,88.63000,The Alliance,Exception Members,,71.83,,,,,,,51.31,90.49,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Exception Members,,71.83,,,,,,,46.65,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,inpatient,,,93.29000,88.63000,The Alliance,Exception Members,RR,71.83,,,,,,,51.31,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Exception Members,RR,71.83,,,,,,,46.65,98.67,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,The Alliance,Exception Members,,5297.75,,,,,,,3784.10,6673.78,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Exception Members,,5297.75,,,,,,,3440.09,6673.78,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,inpatient,,,12.13000,11.52000,The Alliance,Exception Members,,9.34,,,,,,,6.67,11.77,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,outpatient,,,12.13000,11.52000,The Alliance,Exception Members,,9.34,,,,,,,6.07,12.52,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,UE,957.86,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Exception Members,UE,957.86,,,,,,,621.99,1206.66,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,inpatient,,,33.36000,31.69000,The Alliance,Exception Members,,25.69,,,,,,,18.35,32.36,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,outpatient,,,33.36000,31.69000,The Alliance,Exception Members,,25.69,,,,,,,16.68,51.01,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,inpatient,,,217.88000,206.99000,The Alliance,Exception Members,NU,167.77,,,,,,,119.83,211.34,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,outpatient,,,217.88000,206.99000,The Alliance,Exception Members,NU,167.77,,,,,,,108.94,211.34,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.60,11.64,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.00,12.41,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,40.13000,38.12000,The Alliance,Exception Members,NU,30.90,,,,,,,22.07,38.93,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,40.13000,38.12000,The Alliance,Exception Members,NU,30.90,,,,,,,20.07,38.93,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,inpatient,,,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,9.69,19.18,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,outpatient,,,19.77000,18.78000,The Alliance,Exception Members,,15.22,,,,,,,9.88,22.52,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,inpatient,,,80.09000,76.09000,The Alliance,Exception Members,NU,61.67,,,,,,,44.05,77.69,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,outpatient,,,80.09000,76.09000,The Alliance,Exception Members,NU,61.67,,,,,,,28.30,77.69,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,256.72000,243.88000,The Alliance,Exception Members,,197.67,,,,,,,141.20,249.02,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,256.72000,243.88000,The Alliance,Exception Members,,197.67,,,,,,,128.36,249.02,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,inpatient,,,575.26000,546.50000,The Alliance,Exception Members,,442.95,,,,,,,316.39,558.00,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,outpatient,,,575.26000,546.50000,The Alliance,Exception Members,,442.95,,,,,,,286.24,558.00,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,27.78000,26.39000,The Alliance,Exception Members,,21.39,,,,,,,15.28,26.95,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Exception Members,,21.39,,,,,,,13.89,26.95,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,45.73000,43.44000,The Alliance,Exception Members,,35.21,,,,,,,25.15,44.36,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,45.73000,43.44000,The Alliance,Exception Members,,35.21,,,,,,,22.86,44.36,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,85.52000,81.24000,The Alliance,Exception Members,NU,65.85,,,,,,,47.04,82.95,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,85.52000,81.24000,The Alliance,Exception Members,NU,65.85,,,,,,,42.76,86.57,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,inpatient,,,938.00000,891.10000,The Alliance,Exception Members,NU,722.26,,,,,,,515.90,909.86,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Exception Members,NU,722.26,,,,,,,469.00,909.86,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,7.33,12.93,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,3.01,12.93,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,107.80,190.12,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,98.00,190.12,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,inpatient,,,197.20000,187.34000,The Alliance,Exception Members,,151.84,,,,,,,96.63,191.28,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,outpatient,,,197.20000,187.34000,The Alliance,Exception Members,,151.84,,,,,,,81.91,191.28,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,inpatient,,,27.78000,26.39000,The Alliance,Exception Members,RR,21.39,,,,,,,15.28,26.95,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Exception Members,RR,21.39,,,,,,,13.89,29.38,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,7.33,12.93,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Exception Members,,10.26,,,,,,,6.67,12.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,inpatient,,,352.50000,334.88000,The Alliance,Exception Members,,271.43,,,,,,,193.88,341.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Exception Members,,271.43,,,,,,,176.25,341.93,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,inpatient,,,40.53000,38.50000,The Alliance,Exception Members,,31.21,,,,,,,22.29,39.31,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,outpatient,,,40.53000,38.50000,The Alliance,Exception Members,,31.21,,,,,,,20.27,41.68,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,inpatient,,,3400.00000,3230.00000,The Alliance,Exception Members,,2618.00,,,,,,,1870.00,3298.00,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,outpatient,,,3400.00000,3230.00000,The Alliance,Exception Members,,2618.00,,,,,,,1700.00,3298.00,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,inpatient,,,382.22000,363.11000,The Alliance,Exception Members,,294.31,,,,,,,187.29,370.75,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,outpatient,,,382.22000,363.11000,The Alliance,Exception Members,,294.31,,,,,,,190.18,370.75,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,inpatient,,,51.87000,49.28000,The Alliance,Exception Members,,39.94,,,,,,,28.53,50.31,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,outpatient,,,51.87000,49.28000,The Alliance,Exception Members,,39.94,,,,,,,25.93,50.31,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,31.04,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,472.50000,448.88000,The Alliance,Exception Members,,363.82,,,,,,,259.88,458.32,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Exception Members,,363.82,,,,,,,236.25,751.69,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,inpatient,,,107.52000,102.14000,The Alliance,Exception Members,,82.79,,,,,,,52.68,104.29,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,outpatient,,,107.52000,102.14000,The Alliance,Exception Members,,82.79,,,,,,,53.76,183.28,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.93,5.17,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,5.33000,5.06000,The Alliance,Exception Members,,4.10,,,,,,,2.67,5.17,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,inpatient,,,305.06000,289.81000,The Alliance,Exception Members,,234.90,,,,,,,149.48,295.91,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,outpatient,,,305.06000,289.81000,The Alliance,Exception Members,,234.90,,,,,,,151.81,295.91,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,95.96000,91.16000,The Alliance,Exception Members,,73.89,,,,,,,52.78,93.08,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,95.96000,91.16000,The Alliance,Exception Members,,73.89,,,,,,,47.98,93.08,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,195.94,345.56,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,178.12,345.56,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,inpatient,,,45.21000,42.95000,The Alliance,Exception Members,,34.81,,,,,,,24.87,43.85,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,outpatient,,,45.21000,42.95000,The Alliance,Exception Members,,34.81,,,,,,,22.61,43.85,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,436.07000,414.27000,The Alliance,Exception Members,NU,335.77,,,,,,,239.84,422.99,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,436.07000,414.27000,The Alliance,Exception Members,NU,335.77,,,,,,,67.27,422.99,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,inpatient,,,12.40000,11.78000,The Alliance,Exception Members,,9.55,,,,,,,6.82,12.03,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,outpatient,,,12.40000,11.78000,The Alliance,Exception Members,,9.55,,,,,,,6.20,12.71,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,29.10,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,inpatient,,,245.44000,233.17000,The Alliance,Exception Members,,188.99,,,,,,,120.27,238.08,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,outpatient,,,245.44000,233.17000,The Alliance,Exception Members,,188.99,,,,,,,122.72,238.08,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,inpatient,,,2021.78000,1920.69000,The Alliance,Exception Members,NU,1556.77,,,,,,,1111.98,1961.13,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,outpatient,,,2021.78000,1920.69000,The Alliance,Exception Members,NU,1556.77,,,,,,,1010.89,1961.13,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,66.67000,63.34000,The Alliance,Exception Members,NU,51.34,,,,,,,36.67,64.67,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,66.67000,63.34000,The Alliance,Exception Members,NU,51.34,,,,,,,21.38,64.67,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,inpatient,,,3430.67000,3259.14000,The Alliance,Exception Members,,2641.62,,,,,,,1681.03,3327.75,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,outpatient,,,3430.67000,3259.14000,The Alliance,Exception Members,,2641.62,,,,,,,1707.07,3327.75,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,inpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,39.60,69.84,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Exception Members,,55.44,,,,,,,36.00,69.84,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,inpatient,,,1941.00000,1843.95000,The Alliance,Exception Members,,1494.57,,,,,,,951.09,1882.77,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,outpatient,,,1941.00000,1843.95000,The Alliance,Exception Members,,1494.57,,,,,,,699.50,1882.77,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,292.69000,278.06000,The Alliance,Exception Members,NU,225.37,,,,,,,160.98,283.91,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,292.69000,278.06000,The Alliance,Exception Members,NU,225.37,,,,,,,67.27,283.91,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,0.94600,6.47,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,inpatient,,,7.28000,6.92000,The Alliance,Exception Members,,5.61,,,,,,,4.00,7.06,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,outpatient,,,7.28000,6.92000,The Alliance,Exception Members,,5.61,,,,,,,1.18,7.06,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,inpatient,,,69.07000,65.62000,The Alliance,Exception Members,,53.18,,,,,,,33.84,67.00,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,outpatient,,,69.07000,65.62000,The Alliance,Exception Members,,53.18,,,,,,,34.53,80.76,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,inpatient,,,976.08000,927.28000,The Alliance,Exception Members,,751.58,,,,,,,478.28,946.80,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,outpatient,,,976.08000,927.28000,The Alliance,Exception Members,,751.58,,,,,,,485.68,946.80,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,inpatient,,,14.34000,13.62000,The Alliance,Exception Members,,11.04,,,,,,,7.89,13.91,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,outpatient,,,14.34000,13.62000,The Alliance,Exception Members,,11.04,,,,,,,4.88,13.91,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,6.47,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,inpatient,,,11.87000,11.28000,The Alliance,Exception Members,,9.14,,,,,,,6.53,11.51,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,outpatient,,,11.87000,11.28000,The Alliance,Exception Members,,9.14,,,,,,,5.93,12.01,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,33.00,72.60,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.55550,0.97970,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.01000,0.96000,The Alliance,Exception Members,,0.77770,,,,,,,0.50500,0.97970,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,inpatient,,,1219.00000,1158.05000,The Alliance,Exception Members,,938.63,,,,,,,597.31,1182.43,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,outpatient,,,1219.00000,1158.05000,The Alliance,Exception Members,,938.63,,,,,,,559.52,1182.43,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,inpatient,,,20.24000,19.23000,The Alliance,Exception Members,,15.58,,,,,,,11.13,19.63,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,outpatient,,,20.24000,19.23000,The Alliance,Exception Members,,15.58,,,,,,,8.86,19.63,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,44.00,77.60,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Exception Members,,61.60,,,,,,,4.97,77.60,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,NU,78.54,,,,,,,56.10,98.94,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,NU,78.54,,,,,,,51.00,98.94,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,inpatient,,,916.18000,870.37000,The Alliance,Exception Members,,705.46,,,,,,,448.93,888.69,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,outpatient,,,916.18000,870.37000,The Alliance,Exception Members,,705.46,,,,,,,455.88,888.69,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,inpatient,,,1431.00000,1359.45000,The Alliance,Exception Members,,1101.87,,,,,,,701.19,1388.07,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,Exception Members,,1101.87,,,,,,,508.43,1388.07,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,341.25000,324.19000,The Alliance,Exception Members,,262.76,,,,,,,187.69,331.01,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,341.25000,324.19000,The Alliance,Exception Members,,262.76,,,,,,,170.62,751.69,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,inpatient,,,139.36000,132.39000,The Alliance,Exception Members,NU,107.31,,,,,,,76.65,135.18,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,outpatient,,,139.36000,132.39000,The Alliance,Exception Members,NU,107.31,,,,,,,63.78,135.18,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,inpatient,,,176.52000,167.69000,The Alliance,Exception Members,NU,135.92,,,,,,,97.09,171.22,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,outpatient,,,176.52000,167.69000,The Alliance,Exception Members,NU,135.92,,,,,,,55.44,171.22,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,inpatient,,,49.62000,47.14000,The Alliance,Exception Members,NU,38.21,,,,,,,27.29,48.13,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,outpatient,,,49.62000,47.14000,The Alliance,Exception Members,NU,38.21,,,,,,,24.81,48.13,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,inpatient,,,364.24000,346.03000,The Alliance,Exception Members,NU,280.46,,,,,,,200.33,353.31,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,outpatient,,,364.24000,346.03000,The Alliance,Exception Members,NU,280.46,,,,,,,182.12,353.31,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,45.00000,42.75000,The Alliance,Exception Members,NU,34.65,,,,,,,24.75,43.65,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Exception Members,NU,34.65,,,,,,,17.89,43.65,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,inpatient,,,13.00000,12.35000,The Alliance,Exception Members,,10.01,,,,,,,7.15,12.61,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Exception Members,,10.01,,,,,,,6.50,12.61,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,306.75000,291.41000,The Alliance,Exception Members,NU,236.20,,,,,,,168.71,297.55,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,306.75000,291.41000,The Alliance,Exception Members,NU,236.20,,,,,,,63.78,297.55,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,inpatient,,,7.73000,7.34000,The Alliance,Exception Members,,5.95,,,,,,,4.25,7.50,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,outpatient,,,7.73000,7.34000,The Alliance,Exception Members,,5.95,,,,,,,3.87,7.90,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,inpatient,,,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,4.99,8.80,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,outpatient,,,9.07000,8.62000,The Alliance,Exception Members,,6.98,,,,,,,3.33,8.80,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,Exception Members,UE,285.35,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Exception Members,UE,285.35,,,,,,,132.85,359.46,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,31.04,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.97900,1.73,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.78000,1.69000,The Alliance,Exception Members,,1.37,,,,,,,0.89000,1.73,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,inpatient,,,6478.28000,6154.37000,The Alliance,Exception Members,,4988.28,,,,,,,3174.36,6283.93,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,outpatient,,,6478.28000,6154.37000,The Alliance,Exception Members,,4988.28,,,,,,,3223.54,6283.93,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,inpatient,,,461.88000,438.79000,The Alliance,Exception Members,NU,355.65,,,,,,,254.03,448.02,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,outpatient,,,461.88000,438.79000,The Alliance,Exception Members,NU,355.65,,,,,,,116.46,448.02,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,inpatient,1,mL,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.51700,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Exception Members,,0.72380,,,,,,,0.19995,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.19995,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Exception Members,,0.66220,,,,,,,0.19995,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.19995,0.76630,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,inpatient,1,mL,70.06000,66.56000,The Alliance,Exception Members,,53.95,,,,,,,38.53,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,outpatient,1,mL,70.06000,66.56000,The Alliance,Exception Members,,53.95,,,,,,,6.30,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,inpatient,1,mL,47.36000,44.99000,The Alliance,Exception Members,,36.47,,,,,,,26.05,45.94,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,outpatient,1,mL,47.36000,44.99000,The Alliance,Exception Members,,36.47,,,,,,,6.30,45.94,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,3725.18000,3538.92000,The Alliance,Exception Members,,2868.39,,,,,,,1825.34,3613.42,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,3725.18000,3538.92000,The Alliance,Exception Members,,2868.39,,,,,,,1709.86,3725.18,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,inpatient,,,1687.00000,1602.65000,The Alliance,Exception Members,90,1298.99,,,,,,,927.85,1636.39,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,outpatient,,,1687.00000,1602.65000,The Alliance,Exception Members,90,1298.99,,,,,,,162.98,8131.76,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,inpatient,,,2238.00000,2126.10000,The Alliance,Exception Members,90,1723.26,,,,,,,1230.90,2170.86,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,outpatient,,,2238.00000,2126.10000,The Alliance,Exception Members,90,1723.26,,,,,,,204.58,10355.70,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,10.86,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.62700,1.11,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Exception Members,,0.87780,,,,,,,0.57000,1.11,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,inpatient,1,mL,78.08000,74.18000,The Alliance,Exception Members,,60.12,,,,,,,42.94,75.74,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,outpatient,1,mL,78.08000,74.18000,The Alliance,Exception Members,,60.12,,,,,,,39.04,75.74,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,405.56000,385.28000,The Alliance,Exception Members,,312.28,,,,,,,198.72,393.39,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,405.56000,385.28000,The Alliance,Exception Members,,312.28,,,,,,,186.15,405.56,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,118.34,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,inpatient,,,779.00000,740.05000,The Alliance,Exception Members,,599.83,,,,,,,428.45,755.63,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,outpatient,,,779.00000,740.05000,The Alliance,Exception Members,,599.83,,,,,,,389.50,6858.56,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.13200,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Exception Members,,0.18480,,,,,,,0.12000,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,The Alliance,Exception Members,,791.56,,,,,,,503.72,997.16,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Exception Members,,791.56,,,,,,,325.11,1028.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,TC,1099.56,,,,,,,785.40,1385.16,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,TC,1099.56,,,,,,,463.75,17311.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1755.00000,1667.25000,The Alliance,Exception Members,,1351.35,,,,,,,859.95,1702.35,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1755.00000,1667.25000,The Alliance,Exception Members,,1351.35,,,,,,,805.54,1755.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2454.50,5347.50,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.72,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Exception Members,,3.80,,,,,,,2.47,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,inpatient,1,EA,8.22000,7.80000,The Alliance,Exception Members,,6.33,,,,,,,4.52,7.97,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,outpatient,1,EA,8.22000,7.80000,The Alliance,Exception Members,,6.33,,,,,,,4.11,7.97,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,0.33945,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,inpatient,1,mL,6.86000,6.51000,The Alliance,Exception Members,,5.28,,,,,,,3.77,6.65,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,outpatient,1,mL,6.86000,6.51000,The Alliance,Exception Members,,5.28,,,,,,,0.33945,6.65,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,905.96000,860.66000,The Alliance,Exception Members,,697.59,,,,,,,443.92,878.78,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,905.96000,860.66000,The Alliance,Exception Members,,697.59,,,,,,,415.84,905.96,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,The Alliance,Exception Members,,701.66,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Exception Members,,701.66,,,,,,,418.26,911.25,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,inpatient,,,4079.00000,3875.05000,The Alliance,Exception Members,TC,3140.83,,,,,,,2243.45,3956.63,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,outpatient,,,4079.00000,3875.05000,The Alliance,Exception Members,TC,3140.83,,,,,,,2039.50,52322.00,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,inpatient,,,1952.00000,1854.40000,The Alliance,Exception Members,TC,1503.04,,,,,,,1073.60,1893.44,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Exception Members,TC,1503.04,,,,,,,976.00,52322.00,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.90,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Exception Members,,4.06,,,,,,,2.63,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,inpatient,1,EA,35.83000,34.04000,The Alliance,Exception Members,,27.59,,,,,,,19.71,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,outpatient,1,EA,35.83000,34.04000,The Alliance,Exception Members,,27.59,,,,,,,17.91,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,inpatient,1,EA,13.44000,12.77000,The Alliance,Exception Members,,10.35,,,,,,,7.39,13.04,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,outpatient,1,EA,13.44000,12.77000,The Alliance,Exception Members,,10.35,,,,,,,6.72,13.04,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,28350.00000,26932.50000,The Alliance,Exception Members,,21829.50,,,,,,,13891.50,27499.50,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,28350.00000,26932.50000,The Alliance,Exception Members,,21829.50,,,,,,,13012.65,27499.50,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,inpatient,,,2371.00000,2252.45000,The Alliance,Exception Members,,1825.67,,,,,,,1304.05,2299.87,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Exception Members,,1825.67,,,,,,,1304.05,5271.00,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,577.50,1018.50,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Exception Members,,808.50,,,,,,,280.29,5858.00,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,3810.53000,3620.00000,The Alliance,Exception Members,,2934.11,,,,,,,1867.16,3696.21,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,3810.53000,3620.00000,The Alliance,Exception Members,,2934.11,,,,,,,1749.03,3810.53,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11005.00000,10454.75000,The Alliance,Exception Members,,8473.85,,,,,,,5392.45,10674.85,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11005.00000,10454.75000,The Alliance,Exception Members,,8473.85,,,,,,,5051.30,11005.00,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,275.62,545.62,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,258.19,562.50,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,The Alliance,Exception Members,,399.86,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Exception Members,,399.86,,,,,,,238.36,519.30,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,inpatient,1,EA,265.32000,252.05000,The Alliance,Exception Members,,204.30,,,,,,,145.93,257.36,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,outpatient,1,EA,265.32000,252.05000,The Alliance,Exception Members,,204.30,,,,,,,132.66,257.36,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,inpatient,1,EA,15105.00000,14349.75000,The Alliance,Exception Members,,11630.85,,,,,,,8307.75,14651.85,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,outpatient,1,EA,15105.00000,14349.75000,The Alliance,Exception Members,,11630.85,,,,,,,206.13,14651.85,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,inpatient,,,1046.00000,993.70000,The Alliance,Exception Members,,805.42,,,,,,,512.54,1014.62,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Exception Members,,805.42,,,,,,,523.00,1014.62,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,19.30,80.87,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,19.30,80.87,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,The Alliance,Exception Members,,28.18,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Exception Members,,28.18,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,inpatient,1,EA,26.11000,24.81000,The Alliance,Exception Members,,20.10,,,,,,,14.36,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,outpatient,1,EA,26.11000,24.81000,The Alliance,Exception Members,,20.10,,,,,,,13.05,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,inpatient,1,EA,9.68000,9.20000,The Alliance,Exception Members,,7.45,,,,,,,5.32,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,outpatient,1,EA,9.68000,9.20000,The Alliance,Exception Members,,7.45,,,,,,,4.84,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,inpatient,1,EA,21.05000,20.00000,The Alliance,Exception Members,,16.21,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Exception Members,,16.21,,,,,,,10.53,20.42,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Exception Members,,10.04,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Exception Members,,31.45,,,,,,,20.43,39.62,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,74.91,132.11,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,16.01,814.87,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,inpatient,,,710.00000,674.50000,The Alliance,Exception Members,,546.70,,,,,,,390.50,688.70,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Exception Members,,546.70,,,,,,,390.50,5271.00,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,29696.15,52373.21,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Exception Members,,41574.61,,,,,,,4607.00,52373.21,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,189.20000,179.74000,The Alliance,Exception Members,,145.68,,,,,,,92.71,183.52,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Exception Members,,145.68,,,,,,,86.84,189.20,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30690.00000,29155.50000,The Alliance,Exception Members,,23631.30,,,,,,,15038.10,29769.30,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30690.00000,29155.50000,The Alliance,Exception Members,,23631.30,,,,,,,14086.71,30690.00,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,97.02,192.06,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,90.88,198.00,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,424.88000,403.64000,The Alliance,Exception Members,,327.16,,,,,,,208.19,412.13,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,424.88000,403.64000,The Alliance,Exception Members,,327.16,,,,,,,195.02,424.88,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1328.81,2895.00,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1747.46000,1660.09000,The Alliance,Exception Members,,1345.54,,,,,,,856.26,1695.04,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1747.46000,1660.09000,The Alliance,Exception Members,,1345.54,,,,,,,802.08,1747.46,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,9642.75000,9160.61000,The Alliance,Exception Members,,7424.92,,,,,,,4724.95,9353.47,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,9642.75000,9160.61000,The Alliance,Exception Members,,7424.92,,,,,,,4426.02,9642.75,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,The Alliance,Exception Members,,701.66,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Exception Members,,701.66,,,,,,,418.26,911.25,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,235.20,465.60,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,220.32,480.00,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Exception Members,,0.08470,,,,,,,0.05500,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,23.25,197.88,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12220.20000,11609.19000,The Alliance,Exception Members,,9409.55,,,,,,,5987.90,11853.59,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12220.20000,11609.19000,The Alliance,Exception Members,,9409.55,,,,,,,5609.07,12220.20,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Exception Members,,52552.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,9136.78,18087.10,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Exception Members,,14357.81,,,,,,,8558.74,18646.50,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.40000,227.43000,The Alliance,Exception Members,,184.34,,,,,,,117.31,232.22,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.40000,227.43000,The Alliance,Exception Members,,184.34,,,,,,,109.88,239.40,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,75.90,133.86,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Exception Members,,106.26,,,,,,,69.00,133.86,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,inpatient,1,mL,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.30250,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Exception Members,,0.42350,,,,,,,0.08525,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,inpatient,1,mL,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,outpatient,1,mL,1.53000,1.45000,The Alliance,Exception Members,,1.18,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,inpatient,1,mL,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.08525,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,inpatient,1,mL,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.83050,1.46,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,outpatient,1,mL,1.51000,1.44000,The Alliance,Exception Members,,1.16,,,,,,,0.08525,1.46,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,inpatient,1,mL,119.99000,113.99000,The Alliance,Exception Members,,92.39,,,,,,,65.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,outpatient,1,mL,119.99000,113.99000,The Alliance,Exception Members,,92.39,,,,,,,59.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,inpatient,1,mL,134.30000,127.59000,The Alliance,Exception Members,,103.41,,,,,,,73.86,130.27,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,outpatient,1,mL,134.30000,127.59000,The Alliance,Exception Members,,103.41,,,,,,,67.15,130.27,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,inpatient,1,mL,2.45000,2.32000,The Alliance,Exception Members,,1.89,,,,,,,1.35,2.38,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,outpatient,1,mL,2.45000,2.32000,The Alliance,Exception Members,,1.89,,,,,,,1.23,2.38,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,59.61,105.14,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Exception Members,,83.46,,,,,,,54.20,105.14,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,1.49,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,inpatient,1,mL,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,8.90,17.27,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,10625.41,21033.97,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3490.74000,3316.20000,The Alliance,Exception Members,,2687.87,,,,,,,1710.46,3386.02,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3490.74000,3316.20000,The Alliance,Exception Members,,2687.87,,,,,,,1602.25,3490.74,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,72.60000,68.97000,The Alliance,Exception Members,,55.90,,,,,,,35.57,70.42,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,72.60000,68.97000,The Alliance,Exception Members,,55.90,,,,,,,33.32,72.60,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,39.47,86.00,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,355.69000,337.91000,The Alliance,Exception Members,,273.88,,,,,,,174.29,345.02,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,355.69000,337.91000,The Alliance,Exception Members,,273.88,,,,,,,163.26,355.69,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,25668.00000,24384.60000,The Alliance,Exception Members,,19764.36,,,,,,,12577.32,24897.96,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,25668.00000,24384.60000,The Alliance,Exception Members,,19764.36,,,,,,,11781.61,25668.00,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,39.47,86.00,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,277.12,603.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1653.75,3273.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1549.12,3375.00,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,53.16000,50.50000,The Alliance,Exception Members,,40.93,,,,,,,26.05,51.57,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,53.16000,50.50000,The Alliance,Exception Members,,40.93,,,,,,,24.40,53.16,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,53.41,94.19,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,21.69,1289.24,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,90.20,159.08,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,,126.28,,,,,,,14.91,885.37,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,158.40,279.36,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,,221.76,,,,,,,144.00,1137.41,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,13.82,823.21,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,97.35,171.69,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,14.91,885.37,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,96.80,170.72,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,,135.52,,,,,,,14.91,885.37,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,inpatient,1,EA,2.95000,2.81000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,outpatient,1,EA,2.95000,2.81000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.63,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Exception Members,,2.28,,,,,,,1.48,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,577.50000,548.62000,The Alliance,Exception Members,,444.68,,,,,,,282.98,560.17,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,577.50000,548.62000,The Alliance,Exception Members,,444.68,,,,,,,41.23,560.17,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,126.04000,119.74000,The Alliance,Exception Members,,97.05,,,,,,,69.32,122.26,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,126.04000,119.74000,The Alliance,Exception Members,,97.05,,,,,,,63.02,122.26,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.11,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Exception Members,,1.56,,,,,,,1.01,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,inpatient,1,EA,2.04000,1.94000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,outpatient,1,EA,2.04000,1.94000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.44,2.53,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Exception Members,,2.01,,,,,,,1.30,2.53,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,The Alliance,Exception Members,TC,1086.47,,,,,,,776.05,1368.67,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Exception Members,TC,1086.47,,,,,,,705.50,1368.67,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,The Alliance,Exception Members,,28.18,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Exception Members,,28.18,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,inpatient,1,EA,26.10000,24.80000,The Alliance,Exception Members,,20.10,,,,,,,14.36,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,outpatient,1,EA,26.10000,24.80000,The Alliance,Exception Members,,20.10,,,,,,,13.05,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,inpatient,1,EA,3.55000,3.38000,The Alliance,Exception Members,,2.73,,,,,,,1.95,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,outpatient,1,EA,3.55000,3.38000,The Alliance,Exception Members,,2.73,,,,,,,1.77,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,inpatient,1,EA,21.05000,19.99000,The Alliance,Exception Members,,16.21,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,outpatient,1,EA,21.05000,19.99000,The Alliance,Exception Members,,16.21,,,,,,,10.53,20.42,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,199.44000,189.47000,The Alliance,Exception Members,,153.57,,,,,,,109.69,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,199.44000,189.47000,The Alliance,Exception Members,,153.57,,,,,,,99.72,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,250.65000,238.12000,The Alliance,Exception Members,,193.00,,,,,,,137.86,243.13,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,250.65000,238.12000,The Alliance,Exception Members,,193.00,,,,,,,125.33,243.13,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,inpatient,,,2750.00000,2612.50000,The Alliance,Exception Members,,2117.50,,,,,,,1347.50,2667.50,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,outpatient,,,2750.00000,2612.50000,The Alliance,Exception Members,,2117.50,,,,,,,1262.25,2667.50,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,37.27,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,122.40,327.86,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,37.27,161.02,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,693.75000,659.06000,The Alliance,Exception Members,,534.19,,,,,,,339.94,672.94,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Exception Members,,534.19,,,,,,,318.43,693.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Exception Members,,260.26,,,,,,,122.40,327.86,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,TC,27.72,,,,,,,19.80,34.92,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,TC,27.72,,,,,,,18.00,34.92,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,inpatient,1,EA,106.41000,101.09000,The Alliance,Exception Members,,81.94,,,,,,,58.53,103.22,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,outpatient,1,EA,106.41000,101.09000,The Alliance,Exception Members,,81.94,,,,,,,53.20,103.22,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,inpatient,,,713.00000,677.35000,The Alliance,Exception Members,TC,549.01,,,,,,,392.15,691.61,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,outpatient,,,713.00000,677.35000,The Alliance,Exception Members,TC,549.01,,,,,,,356.50,691.61,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,The Alliance,Exception Members,TC,1271.27,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Exception Members,TC,1271.27,,,,,,,805.84,2210.07,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,293.70,517.98,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,267.00,517.98,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,60.50,106.70,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Exception Members,,84.70,,,,,,,55.00,106.70,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,TC,1754.06,,,,,,,979.11,2209.66,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,1016.40,1792.56,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Exception Members,TC,1422.96,,,,,,,924.00,1820.00,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,284.01,618.75,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,inpatient,,,781.00000,741.95000,The Alliance,Exception Members,90,601.37,,,,,,,429.55,757.57,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,outpatient,,,781.00000,741.95000,The Alliance,Exception Members,90,601.37,,,,,,,12.05,1786.28,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,inpatient,,,126.20000,119.89000,The Alliance,Exception Members,90,97.17,,,,,,,69.41,122.41,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,outpatient,,,126.20000,119.89000,The Alliance,Exception Members,90,97.17,,,,,,,11.52,577.23,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,inpatient,,,971.00000,922.45000,The Alliance,Exception Members,90,747.67,,,,,,,534.05,941.87,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Exception Members,90,747.67,,,,,,,143.40,8250.66,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,90,1142.68,,,,,,,816.20,1439.48,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Exception Members,90,1142.68,,,,,,,664.97,8610.62,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,inpatient,1,EA,4864.22000,4621.01000,The Alliance,Exception Members,,3745.45,,,,,,,2675.32,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,outpatient,1,EA,4864.22000,4621.01000,The Alliance,Exception Members,,3745.45,,,,,,,7.24,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,inpatient,1,EA,4120.10000,3914.10000,The Alliance,Exception Members,,3172.48,,,,,,,2266.05,3996.50,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,outpatient,1,EA,4120.10000,3914.10000,The Alliance,Exception Members,,3172.48,,,,,,,7.24,3996.50,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,inpatient,1,mL,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.88,3.32,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,outpatient,1,mL,3.42000,3.25000,The Alliance,Exception Members,,2.63,,,,,,,1.71,3.32,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,inpatient,1,mL,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,1.63,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Exception Members,,2.29,,,,,,,1.49,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,4721.18,10285.80,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,237.04,469.24,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,222.04,483.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Exception Members,,29909.28,,,,,,,17829.04,38843.22,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,982.50000,933.38000,The Alliance,Exception Members,,756.52,,,,,,,481.43,953.02,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Exception Members,,756.52,,,,,,,450.97,982.50,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,The Alliance,Exception Members,,1577.96,,,,,,,1127.12,1987.82,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Exception Members,,1577.96,,,,,,,595.10,1987.82,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,inpatient,,,36.64000,34.81000,The Alliance,Exception Members,,28.21,,,,,,,20.15,35.54,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,outpatient,,,36.64000,34.81000,The Alliance,Exception Members,,28.21,,,,,,,18.32,35.54,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,inpatient,1,EA,7781.61000,7392.53000,The Alliance,Exception Members,,5991.84,,,,,,,4279.89,7548.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,outpatient,1,EA,7781.61000,7392.53000,The Alliance,Exception Members,,5991.84,,,,,,,136.23,7548.16,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,21.45,37.83,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Exception Members,,30.03,,,,,,,19.50,37.83,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,inpatient,,,184.60000,175.37000,The Alliance,Exception Members,90,142.14,,,,,,,101.53,179.06,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,outpatient,,,184.60000,175.37000,The Alliance,Exception Members,90,142.14,,,,,,,16.88,848.80,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,23.00,979.27,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,inpatient,1,EA,5033.44000,4781.76000,The Alliance,Exception Members,,3875.75,,,,,,,2768.39,4882.44,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,outpatient,1,EA,5033.44000,4781.76000,The Alliance,Exception Members,,3875.75,,,,,,,36.26,4882.44,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,The Alliance,Exception Members,TC,2524.06,,,,,,,1802.90,3179.66,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Exception Members,TC,2524.06,,,,,,,1489.61,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Exception Members,,0.82390,,,,,,,0.53500,1.04,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,inpatient,1,EA,42.44000,40.32000,The Alliance,Exception Members,,32.68,,,,,,,23.34,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,outpatient,1,EA,42.44000,40.32000,The Alliance,Exception Members,,32.68,,,,,,,21.22,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,inpatient,1,EA,6.86000,6.51000,The Alliance,Exception Members,,5.28,,,,,,,3.77,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,outpatient,1,EA,6.86000,6.51000,The Alliance,Exception Members,,5.28,,,,,,,3.43,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,inpatient,1,EA,38.63000,36.70000,The Alliance,Exception Members,,29.75,,,,,,,21.25,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,outpatient,1,EA,38.63000,36.70000,The Alliance,Exception Members,,29.75,,,,,,,19.32,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.77,6.64,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Exception Members,,5.27,,,,,,,3.42,6.64,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.66500,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,inpatient,1,EA,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,15.55,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,outpatient,1,EA,28.28000,26.87000,The Alliance,Exception Members,,21.78,,,,,,,14.14,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.29,2.27,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Exception Members,,1.80,,,,,,,1.17,2.27,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25659.63000,24376.65000,The Alliance,Exception Members,,19757.92,,,,,,,12573.22,24889.84,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25659.63000,24376.65000,The Alliance,Exception Members,,19757.92,,,,,,,11777.77,25659.63,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,30.87,61.11,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,28.92,63.00,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,76.44,151.32,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,71.60,156.00,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,510.40,900.16,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Exception Members,,714.56,,,,,,,510.40,3163.00,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,Exception Members,TC,233.31,,,,,,,166.65,293.91,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Exception Members,TC,233.31,,,,,,,151.50,293.91,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,,1148.84,,,,,,,820.60,1447.24,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,,1148.84,,,,,,,746.00,2139.65,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,90,49.28,,,,,,,35.20,62.08,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,90,49.28,,,,,,,8.72,441.37,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,Exception Members,,220.22,,,,,,,157.30,277.42,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Exception Members,,220.22,,,,,,,143.00,4855.31,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4661.42,10155.60,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2030.96000,1929.41000,The Alliance,Exception Members,,1563.84,,,,,,,995.17,1970.03,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2030.96000,1929.41000,The Alliance,Exception Members,,1563.84,,,,,,,932.21,2030.96,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2715.00000,2579.25000,The Alliance,Exception Members,,2090.55,,,,,,,1330.35,2633.55,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Exception Members,,2090.55,,,,,,,1246.18,2715.00,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,273.79,541.99,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,256.47,558.75,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,64.40000,61.18000,The Alliance,Exception Members,,49.59,,,,,,,31.56,62.47,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,64.40000,61.18000,The Alliance,Exception Members,,49.59,,,,,,,29.56,64.40,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5558.02,11002.61,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5206.39,11342.90,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2906.25000,2760.94000,The Alliance,Exception Members,,2237.81,,,,,,,1424.06,2819.06,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2906.25000,2760.94000,The Alliance,Exception Members,,2237.81,,,,,,,1333.97,2906.25,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,163.68000,155.50000,The Alliance,Exception Members,,126.03,,,,,,,90.02,158.77,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,163.68000,155.50000,The Alliance,Exception Members,,126.03,,,,,,,81.84,192.52,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.80,3.18,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Exception Members,,2.53,,,,,,,1.64,3.18,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,inpatient,1,mL,992.83000,943.19000,The Alliance,Exception Members,,764.48,,,,,,,546.06,963.05,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,outpatient,1,mL,992.83000,943.19000,The Alliance,Exception Members,,764.48,,,,,,,114.64,963.05,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,727.50000,691.12000,The Alliance,Exception Members,,560.17,,,,,,,356.48,705.67,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,727.50000,691.12000,The Alliance,Exception Members,,560.17,,,,,,,333.92,727.50,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Exception Members,,831.60,,,,,,,495.72,1080.00,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,626.53,1365.00,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,inpatient,1,mL,2.33000,2.22000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.26,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,outpatient,1,mL,2.33000,2.22000,The Alliance,Exception Members,,1.79,,,,,,,1.17,2.26,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,The Alliance,Exception Members,TC,2638.79,,,,,,,1884.85,3324.19,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Exception Members,TC,2638.79,,,,,,,1713.50,3324.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,inpatient,,,7997.10000,7597.24000,The Alliance,Exception Members,,6157.77,,,,,,,3918.58,7757.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Exception Members,,6157.77,,,,,,,2236.93,7997.10,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1488.71000,1414.27000,The Alliance,Exception Members,,1146.31,,,,,,,729.47,1444.05,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1488.71000,1414.27000,The Alliance,Exception Members,,1146.31,,,,,,,683.32,1488.71,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,inpatient,,,805.00000,764.75000,The Alliance,Exception Members,TC,619.85,,,,,,,442.75,780.85,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,outpatient,,,805.00000,764.75000,The Alliance,Exception Members,TC,619.85,,,,,,,318.45,780.85,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,97.35,171.69,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Exception Members,,136.29,,,,,,,97.35,3163.00,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Exception Members,,40.84,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,459.38,909.38,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,430.31,937.50,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2786.25000,2646.94000,The Alliance,Exception Members,,2145.41,,,,,,,1365.26,2702.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2786.25000,2646.94000,The Alliance,Exception Members,,2145.41,,,,,,,1278.89,2786.25,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,The Alliance,Exception Members,,15694.76,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Exception Members,,15694.76,,,,,,,9355.71,20382.81,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,182.97,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,0.95060,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,2.10,3.71,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Exception Members,,2.94,,,,,,,1.91,3.71,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Exception Members,,389.81,,,,,,,232.37,506.25,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,17.99,35.62,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,16.85,36.72,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70.56000,67.03000,The Alliance,Exception Members,,54.33,,,,,,,34.57,68.44,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Exception Members,,54.33,,,,,,,32.39,70.56,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1420.03,3093.75,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,30.29,66.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,588.00,1164.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,550.80,1200.00,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,233.36,461.96,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,218.60,476.25,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,372.60000,353.97000,The Alliance,Exception Members,,286.90,,,,,,,204.93,361.42,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,372.60000,353.97000,The Alliance,Exception Members,,286.90,,,,,,,157.76,361.42,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,227.15,400.61,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Exception Members,,318.01,,,,,,,157.76,400.61,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,Exception Members,TC,724.57,,,,,,,517.55,912.77,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Exception Members,TC,724.57,,,,,,,470.50,912.77,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,The Alliance,Exception Members,,1681.97,,,,,,,1070.35,2118.85,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Exception Members,,1681.97,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,inpatient,,,2117.00000,2011.15000,The Alliance,Exception Members,TC,1630.09,,,,,,,1164.35,2053.49,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,outpatient,,,2117.00000,2011.15000,The Alliance,Exception Members,TC,1630.09,,,,,,,1058.50,11495.30,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,inpatient,,,2717.00000,2581.15000,The Alliance,Exception Members,TC,2092.09,,,,,,,1494.35,2635.49,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,outpatient,,,2717.00000,2581.15000,The Alliance,Exception Members,TC,2092.09,,,,,,,1358.50,17311.25,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,inpatient,1,EA,6485.63000,6161.35000,The Alliance,Exception Members,,4993.94,,,,,,,3567.10,6291.06,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,outpatient,1,EA,6485.63000,6161.35000,The Alliance,Exception Members,,4993.94,,,,,,,7.24,6291.06,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,inpatient,1,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.66550,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Exception Members,,0.93170,,,,,,,0.60500,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,1.16,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,inpatient,1,mL,2392.75000,2273.11000,The Alliance,Exception Members,,1842.42,,,,,,,1316.01,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,outpatient,1,mL,2392.75000,2273.11000,The Alliance,Exception Members,,1842.42,,,,,,,12.00,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,inpatient,1,mL,2460.93000,2337.88000,The Alliance,Exception Members,,1894.92,,,,,,,1353.51,2387.10,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,outpatient,1,mL,2460.93000,2337.88000,The Alliance,Exception Members,,1894.92,,,,,,,12.00,2387.10,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9528.90000,9052.46000,The Alliance,Exception Members,,7337.25,,,,,,,4669.16,9243.03,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9528.90000,9052.46000,The Alliance,Exception Members,,7337.25,,,,,,,4373.77,9528.90,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,330.75,654.75,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,309.82,675.00,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,The Alliance,Exception Members,,1531.53,,,,,,,1093.95,1929.33,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Exception Members,,1531.53,,,,,,,122.40,1929.33,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,The Alliance,Exception Members,,7577.42,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Exception Members,,7577.42,,,,,,,4516.93,9840.80,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,445.31000,423.04000,The Alliance,Exception Members,,342.89,,,,,,,244.92,431.95,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,445.31000,423.04000,The Alliance,Exception Members,,342.89,,,,,,,143.61,874.50,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.56,4.51,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Exception Members,,3.58,,,,,,,2.33,4.51,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,inpatient,1,GM,77.47000,73.60000,The Alliance,Exception Members,,59.65,,,,,,,42.61,75.15,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,outpatient,1,GM,77.47000,73.60000,The Alliance,Exception Members,,59.65,,,,,,,38.73,75.15,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,The Alliance,Exception Members,TC,2140.60,,,,,,,1529.00,2696.60,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Exception Members,TC,2140.60,,,,,,,1390.00,2696.60,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,385.56,840.00,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Exception Members,,78.17,,,,,,,46.60,101.52,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,264.00,465.60,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,264.00,5271.00,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Exception Members,,174.70,,,,,,,104.14,226.88,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,154.00,271.60,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,Exception Members,,215.60,,,,,,,126.65,271.60,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,Exception Members,90,87.78,,,,,,,62.70,110.58,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Exception Members,90,87.78,,,,,,,13.35,679.08,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,inpatient,,,10.00000,9.50000,The Alliance,Exception Members,90,7.70,,,,,,,5.50,9.70,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Exception Members,90,7.70,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,Exception Members,90,147.07,,,,,,,105.05,185.27,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Exception Members,90,147.07,,,,,,,17.01,865.84,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,Exception Members,90,47.74,,,,,,,34.10,60.14,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Exception Members,90,47.74,,,,,,,5.35,271.65,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,inpatient,,,176.90000,168.06000,The Alliance,Exception Members,90,136.21,,,,,,,97.30,171.59,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,outpatient,,,176.90000,168.06000,The Alliance,Exception Members,90,136.21,,,,,,,15.27,780.94,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,inpatient,,,98.20000,93.29000,The Alliance,Exception Members,90,75.61,,,,,,,54.01,95.25,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,outpatient,,,98.20000,93.29000,The Alliance,Exception Members,90,75.61,,,,,,,8.17,679.08,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,inpatient,,,178.30000,169.38000,The Alliance,Exception Members,90,137.29,,,,,,,98.06,172.95,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,outpatient,,,178.30000,169.38000,The Alliance,Exception Members,90,137.29,,,,,,,16.37,831.84,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,inpatient,,,582.00000,552.90000,The Alliance,Exception Members,90,448.14,,,,,,,320.10,564.54,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Exception Members,90,448.14,,,,,,,291.00,839.96,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,inpatient,,,343.70000,326.52000,The Alliance,Exception Members,90,264.65,,,,,,,189.03,333.39,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,outpatient,,,343.70000,326.52000,The Alliance,Exception Members,90,264.65,,,,,,,19.00,865.84,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,222.04,483.75,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,18.36,40.00,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,643.12,1273.12,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,602.44,1312.50,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,279.53,609.00,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,2995.31000,2845.54000,The Alliance,Exception Members,,2306.39,,,,,,,1467.70,2905.45,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,2995.31000,2845.54000,The Alliance,Exception Members,,2306.39,,,,,,,1374.85,2995.31,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,548.10000,520.70000,The Alliance,Exception Members,,422.04,,,,,,,301.45,531.66,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,548.10000,520.70000,The Alliance,Exception Members,,422.04,,,,,,,211.37,531.66,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,Exception Members,TC,709.94,,,,,,,507.10,894.34,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Exception Members,TC,709.94,,,,,,,391.31,29731.35,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,inpatient,1,mL,9.14000,8.69000,The Alliance,Exception Members,,7.04,,,,,,,5.03,8.87,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,outpatient,1,mL,9.14000,8.69000,The Alliance,Exception Members,,7.04,,,,,,,1.49,8.87,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,The Alliance,Exception Members,,954.03,,,,,,,681.45,1201.83,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Exception Members,,954.03,,,,,,,498.67,1201.83,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,2.51,4.43,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,1.49,4.43,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,331.88000,315.29000,The Alliance,Exception Members,,255.55,,,,,,,162.62,321.92,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,331.88000,315.29000,The Alliance,Exception Members,,255.55,,,,,,,152.33,331.88,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,The Alliance,Exception Members,,1600.83,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Exception Members,,1600.83,,,,,,,954.26,2079.00,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.75000,359.81000,The Alliance,Exception Members,,291.64,,,,,,,185.59,367.39,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.75000,359.81000,The Alliance,Exception Members,,291.64,,,,,,,173.85,378.75,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,900.00000,855.00000,The Alliance,Exception Members,,693.00,,,,,,,441.00,873.00,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,900.00000,855.00000,The Alliance,Exception Members,,693.00,,,,,,,413.10,900.00,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,The Alliance,Exception Members,,6627.97,,,,,,,4217.80,8349.52,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Exception Members,,6627.97,,,,,,,3950.96,8607.75,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,550.80,1200.00,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1887.98000,1793.58000,The Alliance,Exception Members,,1453.74,,,,,,,925.11,1831.34,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1887.98000,1793.58000,The Alliance,Exception Members,,1453.74,,,,,,,866.58,1887.98,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Exception Members,,646.80,,,,,,,385.56,840.00,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Exception Members,,654.02,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4661.42,10155.60,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,5271.00,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,inpatient,,,94.00000,89.30000,The Alliance,Exception Members,,72.38,,,,,,,51.70,91.18,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Exception Members,,72.38,,,,,,,51.70,5271.00,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Exception Members,,163.15,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,218.60,476.25,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,inpatient,,,117.80000,111.91000,The Alliance,Exception Members,90,90.71,,,,,,,64.79,114.27,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,outpatient,,,117.80000,111.91000,The Alliance,Exception Members,90,90.71,,,,,,,14.65,984.66,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,The Alliance,Exception Members,,954.03,,,,,,,681.45,1201.83,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Exception Members,,954.03,,,,,,,498.67,1201.83,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,inpatient,,,73500.00000,69825.00000,The Alliance,Exception Members,,56595.00,,,,,,,36015.00,71295.00,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,outpatient,,,73500.00000,69825.00000,The Alliance,Exception Members,,56595.00,,,,,,,33736.50,73500.00,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,inpatient,,,5128.00000,4871.60000,The Alliance,Exception Members,,3948.56,,,,,,,2820.40,4974.16,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,outpatient,,,5128.00000,4871.60000,The Alliance,Exception Members,,3948.56,,,,,,,384.16,4974.16,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,The Alliance,Exception Members,,5313.00,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Exception Members,,5313.00,,,,,,,3167.10,6900.00,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,626.53,1365.00,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,The Alliance,Exception Members,,3384.92,,,,,,,2417.80,4264.12,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Exception Members,,3384.92,,,,,,,966.05,4264.12,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,The Alliance,Exception Members,,342.65,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,Exception Members,,342.65,,,,,,,244.75,3163.00,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,488.05000,463.65000,The Alliance,Exception Members,,375.80,,,,,,,268.43,473.41,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,488.05000,463.65000,The Alliance,Exception Members,,375.80,,,,,,,158.39,473.41,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,inpatient,,,120.40000,114.38000,The Alliance,Exception Members,90,92.71,,,,,,,66.22,116.79,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,outpatient,,,120.40000,114.38000,The Alliance,Exception Members,90,92.71,,,,,,,60.20,1137.41,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10064.34000,9561.12000,The Alliance,Exception Members,,7749.54,,,,,,,4931.53,9762.41,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10064.34000,9561.12000,The Alliance,Exception Members,,7749.54,,,,,,,4619.53,10064.34,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,50.96,100.88,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,47.74,104.00,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11169.30000,10610.83000,The Alliance,Exception Members,,8600.36,,,,,,,5472.96,10834.22,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11169.30000,10610.83000,The Alliance,Exception Members,,8600.36,,,,,,,5126.71,11169.30,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4623.00000,4391.85000,The Alliance,Exception Members,,3559.71,,,,,,,2265.27,4484.31,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4623.00000,4391.85000,The Alliance,Exception Members,,3559.71,,,,,,,2121.96,4623.00,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,988.88000,939.44000,The Alliance,Exception Members,,761.44,,,,,,,484.55,959.21,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,988.88000,939.44000,The Alliance,Exception Members,,761.44,,,,,,,453.90,988.88,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,TC,1034.88,,,,,,,672.00,1820.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,inpatient,,,707.00000,671.65000,The Alliance,Exception Members,,544.39,,,,,,,388.85,685.79,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,outpatient,,,707.00000,671.65000,The Alliance,Exception Members,,544.39,,,,,,,353.50,697.17,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,765.00000,726.75000,The Alliance,Exception Members,,589.05,,,,,,,374.85,742.05,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,765.00000,726.75000,The Alliance,Exception Members,,589.05,,,,,,,351.13,765.00,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.64000,99.41000,The Alliance,Exception Members,,80.57,,,,,,,51.27,101.50,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.64000,99.41000,The Alliance,Exception Members,,80.57,,,,,,,48.03,104.64,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,381.56000,362.48000,The Alliance,Exception Members,,293.80,,,,,,,186.96,370.11,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,381.56000,362.48000,The Alliance,Exception Members,,293.80,,,,,,,175.14,381.56,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1669.61,3637.50,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,Exception Members,TC,644.49,,,,,,,460.35,811.89,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Exception Members,TC,644.49,,,,,,,418.50,811.89,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1024.14,2231.25,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3912.30000,3716.68000,The Alliance,Exception Members,,3012.47,,,,,,,1917.03,3794.93,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3912.30000,3716.68000,The Alliance,Exception Members,,3012.47,,,,,,,1795.75,3912.30,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,The Alliance,Exception Members,,17625.30,,,,,,,11216.10,22203.30,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Exception Members,,17625.30,,,,,,,10506.51,22890.00,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,509.06000,483.61000,The Alliance,Exception Members,,391.98,,,,,,,279.98,493.79,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,509.06000,483.61000,The Alliance,Exception Members,,391.98,,,,,,,44.30,493.79,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,241.50000,229.42000,The Alliance,Exception Members,,185.96,,,,,,,118.33,234.25,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,241.50000,229.42000,The Alliance,Exception Members,,185.96,,,,,,,120.75,485.24,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,The Alliance,Exception Members,,292.21,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Exception Members,,292.21,,,,,,,157.76,368.12,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,Exception Members,,709.94,,,,,,,507.10,894.34,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Exception Members,,709.94,,,,,,,379.37,894.34,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10192.80000,9683.16000,The Alliance,Exception Members,,7848.46,,,,,,,4994.47,9887.02,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Exception Members,,7848.46,,,,,,,4678.50,10192.80,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12077.43,26312.49,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,12555.00000,11927.25000,The Alliance,Exception Members,,9667.35,,,,,,,6151.95,12178.35,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12555.00000,11927.25000,The Alliance,Exception Members,,9667.35,,,,,,,5762.74,12178.35,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,The Alliance,Exception Members,,345.35,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Exception Members,,345.35,,,,,,,205.86,448.50,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,inpatient,1,GM,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.64,4.66,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,outpatient,1,GM,4.80000,4.56000,The Alliance,Exception Members,,3.70,,,,,,,2.40,4.66,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,inpatient,1,GM,59.25000,56.29000,The Alliance,Exception Members,,45.62,,,,,,,32.59,57.47,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,outpatient,1,GM,59.25000,56.29000,The Alliance,Exception Members,,45.62,,,,,,,29.62,57.47,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,inpatient,1,EA,12.89000,12.25000,The Alliance,Exception Members,,9.93,,,,,,,7.09,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,outpatient,1,EA,12.89000,12.25000,The Alliance,Exception Members,,9.93,,,,,,,0.26000,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,inpatient,1,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,8.34,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Exception Members,,11.68,,,,,,,0.26000,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,inpatient,1,EA,19.21000,18.25000,The Alliance,Exception Members,,14.79,,,,,,,10.57,18.63,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,outpatient,1,EA,19.21000,18.25000,The Alliance,Exception Members,,14.79,,,,,,,0.26000,18.63,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,inpatient,,,471.00000,447.45000,The Alliance,Exception Members,,362.67,,,,,,,259.05,456.87,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,outpatient,,,471.00000,447.45000,The Alliance,Exception Members,,362.67,,,,,,,37.73,1969.25,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,0.48500,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,249.71,14445.56,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Exception Members,,7355.04,,,,,,,549.28,20208.37,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,The Alliance,Exception Members,TC,1170.40,,,,,,,836.00,1474.40,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Exception Members,TC,1170.40,,,,,,,726.61,7529.89,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,The Alliance,Exception Members,,1138.83,,,,,,,813.45,1434.63,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Exception Members,,1138.83,,,,,,,347.60,8423.93,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,245.30,432.62,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Exception Members,,343.42,,,,,,,34.43,1799.53,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,inpatient,,,1208.00000,1147.60000,The Alliance,Exception Members,,930.16,,,,,,,664.40,1171.76,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,outpatient,,,1208.00000,1147.60000,The Alliance,Exception Members,,930.16,,,,,,,604.00,1171.76,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,inpatient,,,1957.00000,1859.15000,The Alliance,Exception Members,TC,1506.89,,,,,,,1076.35,1898.29,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,outpatient,,,1957.00000,1859.15000,The Alliance,Exception Members,TC,1506.89,,,,,,,978.50,2032.87,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,inpatient,,,1952.00000,1854.40000,The Alliance,Exception Members,TC,1503.04,,,,,,,1073.60,1893.44,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Exception Members,TC,1503.04,,,,,,,976.00,2032.87,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,99.55,175.57,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,,139.37,,,,,,,90.50,317.72,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,64.90,114.46,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,59.00,619.83,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,The Alliance,Exception Members,,5313.00,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Exception Members,,5313.00,,,,,,,3167.10,6900.00,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,740.51,1465.91,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,693.66,1511.25,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24370.50000,23151.97000,The Alliance,Exception Members,,18765.28,,,,,,,11941.55,23639.38,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24370.50000,23151.97000,The Alliance,Exception Members,,18765.28,,,,,,,11186.06,24370.50,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,The Alliance,Exception Members,,20184.47,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Exception Members,,20184.47,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,5905.03,12865.00,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1927.17,3815.01,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1805.25,3933.00,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,The Alliance,Exception Members,,292.21,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Exception Members,,292.21,,,,,,,157.76,368.12,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,Exception Members,TC,348.04,,,,,,,248.60,438.44,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Exception Members,TC,348.04,,,,,,,226.00,438.44,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,inpatient,,,23.07000,21.92000,The Alliance,Exception Members,,17.76,,,,,,,12.69,22.38,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,outpatient,,,23.07000,21.92000,The Alliance,Exception Members,,17.76,,,,,,,11.54,23.80,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,2.02,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Exception Members,,2.83,,,,,,,1.83,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,inpatient,1,EA,17.16000,16.30000,The Alliance,Exception Members,,13.21,,,,,,,9.44,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,outpatient,1,EA,17.16000,16.30000,The Alliance,Exception Members,,13.21,,,,,,,8.58,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,3.38,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,10.40000,9.88000,The Alliance,Exception Members,,8.01,,,,,,,5.72,10.09,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,10.40000,9.88000,The Alliance,Exception Members,,8.01,,,,,,,5.20,10.66,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,70.44000,66.92000,The Alliance,Exception Members,,54.24,,,,,,,38.74,68.33,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,70.44000,66.92000,The Alliance,Exception Members,,54.24,,,,,,,35.22,68.33,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,99.47000,94.50000,The Alliance,Exception Members,,76.59,,,,,,,48.74,96.49,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,99.47000,94.50000,The Alliance,Exception Members,,76.59,,,,,,,49.73,639.03,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,87.25000,82.89000,The Alliance,Exception Members,,67.18,,,,,,,47.99,84.63,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,87.25000,82.89000,The Alliance,Exception Members,,67.18,,,,,,,43.62,84.63,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,78.40000,74.48000,The Alliance,Exception Members,,60.37,,,,,,,43.12,76.05,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Exception Members,,60.37,,,,,,,39.20,76.05,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,11.78000,11.19000,The Alliance,Exception Members,,9.07,,,,,,,6.48,11.43,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,11.78000,11.19000,The Alliance,Exception Members,,9.07,,,,,,,5.89,11.43,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,69.33000,65.86000,The Alliance,Exception Members,,53.38,,,,,,,38.13,67.25,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,69.33000,65.86000,The Alliance,Exception Members,,53.38,,,,,,,34.66,67.25,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,36.13000,34.32000,The Alliance,Exception Members,,27.82,,,,,,,19.87,35.05,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,36.13000,34.32000,The Alliance,Exception Members,,27.82,,,,,,,18.07,35.05,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,153.40000,145.73000,The Alliance,Exception Members,,118.12,,,,,,,84.37,148.80,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,153.40000,145.73000,The Alliance,Exception Members,,118.12,,,,,,,76.70,148.80,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.53000,29.00000,The Alliance,Exception Members,,23.51,,,,,,,16.79,29.61,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Exception Members,,23.51,,,,,,,15.27,29.61,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,81.40,143.56,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Exception Members,,113.96,,,,,,,74.00,143.56,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,209.31000,198.84000,The Alliance,Exception Members,,161.17,,,,,,,115.12,203.03,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,209.31000,198.84000,The Alliance,Exception Members,,161.17,,,,,,,104.66,203.03,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,160.90000,152.85000,The Alliance,Exception Members,,123.89,,,,,,,88.50,156.07,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Exception Members,,123.89,,,,,,,80.45,156.07,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,40.67000,38.64000,The Alliance,Exception Members,,31.32,,,,,,,22.37,39.45,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,40.67000,38.64000,The Alliance,Exception Members,,31.32,,,,,,,20.34,39.45,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,49.47000,47.00000,The Alliance,Exception Members,,38.09,,,,,,,27.21,47.99,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,49.47000,47.00000,The Alliance,Exception Members,,38.09,,,,,,,24.73,47.99,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,370.50000,351.97000,The Alliance,Exception Members,,285.29,,,,,,,203.78,359.38,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,370.50000,351.97000,The Alliance,Exception Members,,285.29,,,,,,,185.25,359.38,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.20000,41.04000,The Alliance,Exception Members,,33.26,,,,,,,23.76,41.90,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.20000,41.04000,The Alliance,Exception Members,,33.26,,,,,,,21.60,41.90,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,59.60000,56.62000,The Alliance,Exception Members,,45.89,,,,,,,32.78,57.81,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Exception Members,,45.89,,,,,,,29.80,57.81,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.80,15.52,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.00,15.52,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,182.76000,173.62000,The Alliance,Exception Members,,140.73,,,,,,,100.52,177.28,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,182.76000,173.62000,The Alliance,Exception Members,,140.73,,,,,,,91.38,177.28,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,15.60000,14.82000,The Alliance,Exception Members,NU,12.01,,,,,,,8.58,15.13,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,15.60000,14.82000,The Alliance,Exception Members,NU,12.01,,,,,,,7.80,16.05,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,80.44000,76.42000,The Alliance,Exception Members,,61.94,,,,,,,39.42,78.03,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,80.44000,76.42000,The Alliance,Exception Members,,61.94,,,,,,,40.22,349.06,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,29.60000,28.12000,The Alliance,Exception Members,,22.79,,,,,,,14.50,28.71,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,29.60000,28.12000,The Alliance,Exception Members,,22.79,,,,,,,14.80,28.71,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,inpatient,,,20.27000,19.26000,The Alliance,Exception Members,,15.61,,,,,,,11.15,19.66,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,outpatient,,,20.27000,19.26000,The Alliance,Exception Members,,15.61,,,,,,,10.13,19.66,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.68000,92.80000,The Alliance,Exception Members,,75.21,,,,,,,53.72,94.75,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.68000,92.80000,The Alliance,Exception Members,,75.21,,,,,,,48.84,94.75,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,78.80000,74.86000,The Alliance,Exception Members,,60.68,,,,,,,38.61,76.44,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Exception Members,,60.68,,,,,,,39.40,76.44,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,The Alliance,Exception Members,,49.65,,,,,,,35.46,62.55,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Exception Members,,49.65,,,,,,,32.24,62.55,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,89.56000,85.08000,The Alliance,Exception Members,,68.96,,,,,,,49.26,86.87,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,89.56000,85.08000,The Alliance,Exception Members,,68.96,,,,,,,44.78,86.87,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,671.26000,637.70000,The Alliance,Exception Members,,516.87,,,,,,,369.19,651.12,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,671.26000,637.70000,The Alliance,Exception Members,,516.87,,,,,,,335.63,651.12,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,104.10000,98.89000,The Alliance,Exception Members,,80.16,,,,,,,57.26,100.98,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,104.10000,98.89000,The Alliance,Exception Members,,80.16,,,,,,,52.05,100.98,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,inpatient,,,66.50000,63.17000,The Alliance,Exception Members,NU,51.20,,,,,,,36.58,64.50,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,outpatient,,,66.50000,63.17000,The Alliance,Exception Members,NU,51.20,,,,,,,33.25,64.50,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,100.08000,95.08000,The Alliance,Exception Members,,77.06,,,,,,,49.04,97.08,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,100.08000,95.08000,The Alliance,Exception Members,,77.06,,,,,,,50.04,232.52,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,inpatient,,,30.53000,29.00000,The Alliance,Exception Members,,23.51,,,,,,,16.79,29.61,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Exception Members,,23.51,,,,,,,15.27,29.61,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,19.97000,18.97000,The Alliance,Exception Members,,15.38,,,,,,,9.79,19.37,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,19.97000,18.97000,The Alliance,Exception Members,,15.38,,,,,,,9.17,19.37,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,20.30000,19.28000,The Alliance,Exception Members,,15.63,,,,,,,11.16,19.69,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,20.30000,19.28000,The Alliance,Exception Members,,15.63,,,,,,,10.15,19.69,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,23.33000,22.16000,The Alliance,Exception Members,,17.96,,,,,,,12.83,22.63,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,23.33000,22.16000,The Alliance,Exception Members,,17.96,,,,,,,2.63,22.63,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,268.98000,255.53000,The Alliance,Exception Members,,207.11,,,,,,,147.94,260.91,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,268.98000,255.53000,The Alliance,Exception Members,,207.11,,,,,,,134.49,260.91,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,21.70000,20.61000,The Alliance,Exception Members,,16.71,,,,,,,11.94,21.05,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,21.70000,20.61000,The Alliance,Exception Members,,16.71,,,,,,,10.85,21.05,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,321.94000,305.84000,The Alliance,Exception Members,NU,247.89,,,,,,,177.07,312.28,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,321.94000,305.84000,The Alliance,Exception Members,NU,247.89,,,,,,,70.83,312.28,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,79.20000,75.24000,The Alliance,Exception Members,,60.98,,,,,,,43.56,76.82,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,79.20000,75.24000,The Alliance,Exception Members,,60.98,,,,,,,39.60,76.82,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,276.53000,262.70000,The Alliance,Exception Members,,212.93,,,,,,,152.09,268.23,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,276.53000,262.70000,The Alliance,Exception Members,,212.93,,,,,,,138.26,268.23,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,401.25000,381.19000,The Alliance,Exception Members,,308.96,,,,,,,220.69,389.21,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,401.25000,381.19000,The Alliance,Exception Members,,308.96,,,,,,,200.62,389.21,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,58.00,112.52,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,359.81000,341.82000,The Alliance,Exception Members,,277.05,,,,,,,197.90,349.02,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,359.81000,341.82000,The Alliance,Exception Members,,277.05,,,,,,,179.91,349.02,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,702.00000,666.90000,The Alliance,Exception Members,,540.54,,,,,,,386.10,680.94,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,702.00000,666.90000,The Alliance,Exception Members,,540.54,,,,,,,351.00,680.94,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,inpatient,,,251.80000,239.21000,The Alliance,Exception Members,,193.89,,,,,,,123.38,244.25,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,outpatient,,,251.80000,239.21000,The Alliance,Exception Members,,193.89,,,,,,,115.58,244.25,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,96.04,190.12,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,89.96,190.12,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,233.36,461.96,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,218.60,461.96,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,73.50,145.50,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,68.85,145.50,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,517.50000,491.62000,The Alliance,Exception Members,,398.48,,,,,,,253.57,501.98,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,517.50000,491.62000,The Alliance,Exception Members,,398.48,,,,,,,237.53,501.98,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,13.80000,13.11000,The Alliance,Exception Members,,10.63,,,,,,,7.59,13.39,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,13.80000,13.11000,The Alliance,Exception Members,,10.63,,,,,,,6.90,13.39,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,351.10000,333.54000,The Alliance,Exception Members,,270.35,,,,,,,193.10,340.57,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,351.10000,333.54000,The Alliance,Exception Members,,270.35,,,,,,,175.55,340.57,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,22.00,38.80,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Exception Members,,30.80,,,,,,,20.00,38.80,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,inpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,142.45,251.23,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Exception Members,,199.43,,,,,,,129.50,251.23,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,137.16,241.90,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Exception Members,,192.02,,,,,,,124.69,241.90,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,181.40000,172.33000,The Alliance,Exception Members,,139.68,,,,,,,88.89,175.96,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,181.40000,172.33000,The Alliance,Exception Members,,139.68,,,,,,,83.26,175.96,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,inpatient,,,18.56000,17.63000,The Alliance,Exception Members,,14.29,,,,,,,9.09,18.00,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,outpatient,,,18.56000,17.63000,The Alliance,Exception Members,,14.29,,,,,,,8.52,18.00,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,195.08000,185.33000,The Alliance,Exception Members,,150.21,,,,,,,95.59,189.23,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,195.08000,185.33000,The Alliance,Exception Members,,150.21,,,,,,,89.54,189.23,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,275.62,545.62,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Exception Members,,433.12,,,,,,,105.37,545.62,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,59.90000,56.90000,The Alliance,Exception Members,,46.12,,,,,,,29.35,58.10,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,59.90000,56.90000,The Alliance,Exception Members,,46.12,,,,,,,29.95,65.22,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,584.33000,555.11000,The Alliance,Exception Members,,449.93,,,,,,,321.38,566.80,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,584.33000,555.11000,The Alliance,Exception Members,,449.93,,,,,,,292.17,566.80,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,inpatient,,,356.30000,338.48000,The Alliance,Exception Members,,274.35,,,,,,,195.97,345.61,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,outpatient,,,356.30000,338.48000,The Alliance,Exception Members,,274.35,,,,,,,178.15,345.61,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,152.51,301.91,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Exception Members,,239.66,,,,,,,142.86,301.91,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,97.39,192.79,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Exception Members,,153.04,,,,,,,91.23,192.79,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,55.07000,52.32000,The Alliance,Exception Members,,42.40,,,,,,,30.29,53.42,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,55.07000,52.32000,The Alliance,Exception Members,,42.40,,,,,,,27.54,53.42,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,926.00000,879.70000,The Alliance,Exception Members,,713.02,,,,,,,509.30,898.22,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,926.00000,879.70000,The Alliance,Exception Members,,713.02,,,,,,,463.00,898.22,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,596.00000,566.20000,The Alliance,Exception Members,,458.92,,,,,,,292.04,578.12,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,596.00000,566.20000,The Alliance,Exception Members,,458.92,,,,,,,273.56,578.12,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,228.79000,217.35000,The Alliance,Exception Members,,176.17,,,,,,,125.83,221.93,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,228.79000,217.35000,The Alliance,Exception Members,,176.17,,,,,,,114.39,221.93,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,263.81000,250.62000,The Alliance,Exception Members,NU,203.13,,,,,,,145.10,255.90,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,263.81000,250.62000,The Alliance,Exception Members,NU,203.13,,,,,,,62.66,255.90,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,87.08000,82.73000,The Alliance,Exception Members,,67.05,,,,,,,42.67,84.47,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,87.08000,82.73000,The Alliance,Exception Members,,67.05,,,,,,,43.54,135.57,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,76.44,151.32,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,71.60,151.32,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,25.10000,23.84000,The Alliance,Exception Members,,19.33,,,,,,,13.80,24.35,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,25.10000,23.84000,The Alliance,Exception Members,,19.33,,,,,,,12.55,24.35,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,100.44000,95.42000,The Alliance,Exception Members,,77.34,,,,,,,49.22,97.43,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,100.44000,95.42000,The Alliance,Exception Members,,77.34,,,,,,,39.47,97.43,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,98.67000,93.74000,The Alliance,Exception Members,,75.98,,,,,,,54.27,95.71,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,98.67000,93.74000,The Alliance,Exception Members,,75.98,,,,,,,49.34,95.71,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,507.00000,481.65000,The Alliance,Exception Members,,390.39,,,,,,,278.85,491.79,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Exception Members,,390.39,,,,,,,253.50,491.79,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,The Alliance,Exception Members,,131.82,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Exception Members,,131.82,,,,,,,85.60,166.06,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,159.90000,151.90000,The Alliance,Exception Members,,123.12,,,,,,,87.94,155.10,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,159.90000,151.90000,The Alliance,Exception Members,,123.12,,,,,,,44.30,155.10,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,231.38000,219.81000,The Alliance,Exception Members,,178.16,,,,,,,113.38,224.44,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,231.38000,219.81000,The Alliance,Exception Members,,178.16,,,,,,,106.20,224.44,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,104.00,201.76,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,107.80,190.12,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Exception Members,,150.92,,,,,,,98.00,190.12,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,39.80000,37.81000,The Alliance,Exception Members,,30.65,,,,,,,21.89,38.61,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,39.80000,37.81000,The Alliance,Exception Members,,30.65,,,,,,,19.90,38.61,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,193.71000,184.02000,The Alliance,Exception Members,,149.16,,,,,,,94.92,187.90,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,193.71000,184.02000,The Alliance,Exception Members,,149.16,,,,,,,88.91,187.90,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,101.20,178.48,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,,141.68,,,,,,,92.00,178.48,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,The Alliance,Exception Members,,57.08,,,,,,,40.77,71.91,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Exception Members,,57.08,,,,,,,37.06,71.91,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,inpatient,,,333.00000,316.35000,The Alliance,Exception Members,,256.41,,,,,,,183.15,323.01,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Exception Members,,256.41,,,,,,,166.50,323.01,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.00,7.76,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,2.63,6.47,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,21.41,37.76,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Exception Members,,29.98,,,,,,,2.63,37.76,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,41.33000,39.26000,The Alliance,Exception Members,,31.82,,,,,,,22.73,40.09,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,41.33000,39.26000,The Alliance,Exception Members,,31.82,,,,,,,20.66,40.09,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,21.47000,20.40000,The Alliance,Exception Members,,16.53,,,,,,,10.52,20.83,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,21.47000,20.40000,The Alliance,Exception Members,,16.53,,,,,,,9.85,20.83,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,197.33000,187.46000,The Alliance,Exception Members,,151.94,,,,,,,108.53,191.41,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,197.33000,187.46000,The Alliance,Exception Members,,151.94,,,,,,,98.67,191.41,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,267.68000,254.30000,The Alliance,Exception Members,,206.11,,,,,,,131.16,259.65,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,267.68000,254.30000,The Alliance,Exception Members,,206.11,,,,,,,122.87,259.65,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.44000,28.92000,The Alliance,Exception Members,,23.44,,,,,,,16.74,29.53,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.44000,28.92000,The Alliance,Exception Members,,23.44,,,,,,,15.22,29.53,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.27,6.47,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.33,65.22,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,163.54,323.74,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Exception Members,,256.99,,,,,,,153.19,323.74,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,51.63000,49.05000,The Alliance,Exception Members,,39.76,,,,,,,25.30,50.08,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,51.63000,49.05000,The Alliance,Exception Members,,39.76,,,,,,,23.70,50.08,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,14.08,24.83,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Exception Members,,19.71,,,,,,,12.80,24.83,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,,139.52,,,,,,,88.79,175.76,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,,139.52,,,,,,,39.47,175.76,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,254.66000,241.93000,The Alliance,Exception Members,,196.09,,,,,,,140.06,247.02,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,254.66000,241.93000,The Alliance,Exception Members,,196.09,,,,,,,127.33,247.02,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.33000,92.46000,The Alliance,Exception Members,,74.94,,,,,,,53.53,94.41,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.33000,92.46000,The Alliance,Exception Members,,74.94,,,,,,,48.66,94.41,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,16.40000,15.58000,The Alliance,Exception Members,,12.63,,,,,,,8.04,15.91,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.40000,15.58000,The Alliance,Exception Members,,12.63,,,,,,,8.20,36.65,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,645.11000,612.85000,The Alliance,Exception Members,,496.73,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Exception Members,,496.73,,,,,,,217.19,625.76,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,694.00000,659.30000,The Alliance,Exception Members,,534.38,,,,,,,381.70,673.18,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,694.00000,659.30000,The Alliance,Exception Members,,534.38,,,,,,,347.00,673.18,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,67.73000,64.34000,The Alliance,Exception Members,,52.15,,,,,,,37.25,65.70,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,67.73000,64.34000,The Alliance,Exception Members,,52.15,,,,,,,33.87,65.70,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,56.84,112.52,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,58.00,112.52,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,15.70000,14.91000,The Alliance,Exception Members,,12.09,,,,,,,8.63,15.23,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,15.70000,14.91000,The Alliance,Exception Members,,12.09,,,,,,,7.85,15.23,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,363.75,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,184.19000,174.98000,The Alliance,Exception Members,,141.83,,,,,,,90.25,178.66,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,184.19000,174.98000,The Alliance,Exception Members,,141.83,,,,,,,77.73,178.66,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,399.94000,379.94000,The Alliance,Exception Members,,307.95,,,,,,,195.97,387.94,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Exception Members,,307.95,,,,,,,199.97,387.94,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,131.96000,125.36000,The Alliance,Exception Members,,101.61,,,,,,,72.58,128.00,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,131.96000,125.36000,The Alliance,Exception Members,,101.61,,,,,,,65.98,128.00,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,347.50,674.15,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,381.20000,362.14000,The Alliance,Exception Members,,293.52,,,,,,,209.66,369.76,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,381.20000,362.14000,The Alliance,Exception Members,,293.52,,,,,,,190.60,369.76,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,inpatient,,,2903.00000,2757.85000,The Alliance,Exception Members,,2235.31,,,,,,,1422.47,2815.91,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,outpatient,,,2903.00000,2757.85000,The Alliance,Exception Members,,2235.31,,,,,,,1332.48,2815.91,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,The Alliance,Exception Members,,49.65,,,,,,,35.46,62.55,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Exception Members,,49.65,,,,,,,32.24,62.55,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,62.72000,59.58000,The Alliance,Exception Members,,48.29,,,,,,,34.50,60.84,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,62.72000,59.58000,The Alliance,Exception Members,,48.29,,,,,,,31.36,60.84,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,108.80000,103.36000,The Alliance,Exception Members,,83.78,,,,,,,59.84,105.54,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,108.80000,103.36000,The Alliance,Exception Members,,83.78,,,,,,,54.40,105.54,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,179.28000,170.32000,The Alliance,Exception Members,,138.05,,,,,,,98.60,173.90,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,179.28000,170.32000,The Alliance,Exception Members,,138.05,,,,,,,89.64,173.90,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,88.50000,84.08000,The Alliance,Exception Members,,68.14,,,,,,,48.67,85.84,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,88.50000,84.08000,The Alliance,Exception Members,,68.14,,,,,,,44.25,85.84,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,40.70,71.78,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Exception Members,,56.98,,,,,,,37.00,71.78,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.36000,41.19000,The Alliance,Exception Members,,33.39,,,,,,,23.85,42.06,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.36000,41.19000,The Alliance,Exception Members,,33.39,,,,,,,21.68,42.06,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,49.88000,47.39000,The Alliance,Exception Members,,38.41,,,,,,,27.43,48.38,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,49.88000,47.39000,The Alliance,Exception Members,,38.41,,,,,,,24.94,48.38,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,386.21000,366.90000,The Alliance,Exception Members,,297.38,,,,,,,212.42,374.62,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,386.21000,366.90000,The Alliance,Exception Members,,297.38,,,,,,,193.10,374.62,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,77.00,135.80,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,70.00,135.80,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.99,3.51,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,3.62000,3.44000,The Alliance,Exception Members,,2.79,,,,,,,1.81,3.51,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,326.25000,309.94000,The Alliance,Exception Members,,251.21,,,,,,,179.44,316.46,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,326.25000,309.94000,The Alliance,Exception Members,,251.21,,,,,,,163.12,316.46,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,356.81000,338.97000,The Alliance,Exception Members,NU,274.74,,,,,,,196.25,346.11,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,356.81000,338.97000,The Alliance,Exception Members,NU,274.74,,,,,,,62.66,346.11,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,104.83000,99.59000,The Alliance,Exception Members,,80.72,,,,,,,57.66,101.69,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,104.83000,99.59000,The Alliance,Exception Members,,80.72,,,,,,,52.41,101.69,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,560.66,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,110.25,218.25,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,67.53,218.25,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,314.21000,298.50000,The Alliance,Exception Members,,241.94,,,,,,,153.96,304.78,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,314.21000,298.50000,The Alliance,Exception Members,,241.94,,,,,,,113.78,304.78,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,29.47000,28.00000,The Alliance,Exception Members,,22.69,,,,,,,14.44,28.59,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,29.47000,28.00000,The Alliance,Exception Members,,22.69,,,,,,,11.56,28.59,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,1683.30000,1599.13000,The Alliance,Exception Members,,1296.14,,,,,,,925.82,1632.80,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,1683.30000,1599.13000,The Alliance,Exception Members,,1296.14,,,,,,,841.65,1632.80,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,92.30000,87.68000,The Alliance,Exception Members,,71.07,,,,,,,50.77,89.53,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,92.30000,87.68000,The Alliance,Exception Members,,71.07,,,,,,,46.15,89.53,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,58.68000,55.75000,The Alliance,Exception Members,,45.18,,,,,,,32.27,56.92,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,58.68000,55.75000,The Alliance,Exception Members,,45.18,,,,,,,29.34,56.92,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,33.00,58.20,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,,46.20,,,,,,,30.00,58.20,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,6.92,13.71,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,14.13000,13.42000,The Alliance,Exception Members,,10.88,,,,,,,6.49,13.71,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.80,15.52,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Exception Members,,12.32,,,,,,,8.00,15.52,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,608.74000,578.30000,The Alliance,Exception Members,,468.73,,,,,,,334.81,590.48,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Exception Members,,468.73,,,,,,,304.37,590.48,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,51.20000,48.64000,The Alliance,Exception Members,,39.42,,,,,,,28.16,49.66,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Exception Members,,39.42,,,,,,,25.60,49.66,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Exception Members,,69.82,,,,,,,45.34,98.18,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,39.52000,37.54000,The Alliance,Exception Members,,30.43,,,,,,,19.36,38.33,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Exception Members,,30.43,,,,,,,19.76,65.22,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,192.18000,182.57000,The Alliance,Exception Members,NU,147.98,,,,,,,105.70,186.41,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,192.18000,182.57000,The Alliance,Exception Members,NU,147.98,,,,,,,62.66,186.41,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,The Alliance,Exception Members,,131.82,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Exception Members,,131.82,,,,,,,85.60,166.06,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,57.96000,55.06000,The Alliance,Exception Members,,44.63,,,,,,,31.88,56.22,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,57.96000,55.06000,The Alliance,Exception Members,,44.63,,,,,,,28.98,56.22,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,95.32000,90.55000,The Alliance,Exception Members,,73.40,,,,,,,46.71,92.46,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,95.32000,90.55000,The Alliance,Exception Members,,73.40,,,,,,,47.66,103.42,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.95,8.73,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.50,8.73,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,335.63000,318.85000,The Alliance,Exception Members,,258.44,,,,,,,184.60,325.56,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,335.63000,318.85000,The Alliance,Exception Members,,258.44,,,,,,,167.81,325.56,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,18.15,32.01,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,16.50,32.01,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,645.11000,612.85000,The Alliance,Exception Members,,496.73,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Exception Members,,496.73,,,,,,,217.19,625.76,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,436.46000,414.64000,The Alliance,Exception Members,,336.07,,,,,,,240.05,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Exception Members,,336.07,,,,,,,218.23,423.37,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,inpatient,,,51.48000,48.91000,The Alliance,Exception Members,,39.64,,,,,,,28.31,49.94,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,outpatient,,,51.48000,48.91000,The Alliance,Exception Members,,39.64,,,,,,,25.74,49.94,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,,535.15,,,,,,,347.50,674.15,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,inpatient,,,29.04000,27.59000,The Alliance,Exception Members,,22.36,,,,,,,14.23,28.17,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,outpatient,,,29.04000,27.59000,The Alliance,Exception Members,,22.36,,,,,,,13.33,28.17,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,145.36000,138.09000,The Alliance,Exception Members,,111.93,,,,,,,71.23,141.00,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,145.36000,138.09000,The Alliance,Exception Members,,111.93,,,,,,,72.68,141.00,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,11.20000,10.64000,The Alliance,Exception Members,,8.62,,,,,,,6.16,10.86,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,11.20000,10.64000,The Alliance,Exception Members,,8.62,,,,,,,2.63,10.86,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,inpatient,1,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Exception Members,,41.25,,,,,,,26.79,78.87,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,Exception Members,90,274.89,,,,,,,196.35,346.29,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Exception Members,90,274.89,,,,,,,28.07,346.29,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,446.70000,424.36000,The Alliance,Exception Members,,343.96,,,,,,,245.69,433.30,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,446.70000,424.36000,The Alliance,Exception Members,,343.96,,,,,,,63.95,788.42,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,inpatient,1,mL,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.50050,0.88270,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,outpatient,1,mL,0.91000,0.87000,The Alliance,Exception Members,,0.70070,,,,,,,0.45500,1.49,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,inpatient,,,2376.00000,2257.20000,The Alliance,Exception Members,,1829.52,,,,,,,1306.80,2304.72,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,outpatient,,,2376.00000,2257.20000,The Alliance,Exception Members,,1829.52,,,,,,,1306.80,7803.00,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,455.36000,432.59000,The Alliance,Exception Members,,350.63,,,,,,,250.45,441.70,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,455.36000,432.59000,The Alliance,Exception Members,,350.63,,,,,,,36.03,441.70,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,148.24,261.44,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Exception Members,,207.54,,,,,,,36.03,261.44,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,inpatient,,,176.02000,167.22000,The Alliance,Exception Members,,135.54,,,,,,,96.81,170.74,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,outpatient,,,176.02000,167.22000,The Alliance,Exception Members,,135.54,,,,,,,88.01,170.74,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,inpatient,,,3030.00000,2878.50000,The Alliance,Exception Members,TC,2333.10,,,,,,,1666.50,2939.10,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,outpatient,,,3030.00000,2878.50000,The Alliance,Exception Members,TC,2333.10,,,,,,,1515.00,2939.10,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,78.40,155.20,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,73.44,160.00,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,38272.50000,36358.88000,The Alliance,Exception Members,,29469.83,,,,,,,18753.53,37124.32,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,38272.50000,36358.88000,The Alliance,Exception Members,,29469.83,,,,,,,17567.08,38272.50,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,inpatient,,,981.00000,931.95000,The Alliance,Exception Members,,755.37,,,,,,,539.55,951.57,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,outpatient,,,981.00000,931.95000,The Alliance,Exception Members,,755.37,,,,,,,539.55,5271.00,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Exception Members,,16.17,,,,,,,10.50,74.34,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,419.33000,398.36000,The Alliance,Exception Members,NU,322.88,,,,,,,230.63,406.75,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,419.33000,398.36000,The Alliance,Exception Members,NU,322.88,,,,,,,62.66,406.75,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,inpatient,1,EA,34562.60000,32834.47000,The Alliance,Exception Members,,26613.20,,,,,,,19009.43,33525.72,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,outpatient,1,EA,34562.60000,32834.47000,The Alliance,Exception Members,,26613.20,,,,,,,3772.85,33525.72,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,The Alliance,Exception Members,,8056.12,,,,,,,5126.62,10148.62,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Exception Members,,8056.12,,,,,,,4802.29,10462.50,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,The Alliance,Exception Members,,169.25,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Exception Members,,169.25,,,,,,,109.90,213.21,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30132.00000,28625.40000,The Alliance,Exception Members,,23201.64,,,,,,,14764.68,29228.04,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Exception Members,,23201.64,,,,,,,13830.59,30132.00,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,TC,83.93,,,,,,,59.95,105.73,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,TC,83.93,,,,,,,54.50,105.73,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,inpatient,1,EA,5576.35000,5297.53000,The Alliance,Exception Members,,4293.79,,,,,,,3066.99,5409.06,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,outpatient,1,EA,5576.35000,5297.53000,The Alliance,Exception Members,,4293.79,,,,,,,30.00,5409.06,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,308.32,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,inpatient,1,EA,3147.55000,2990.17000,The Alliance,Exception Members,,2423.61,,,,,,,1731.15,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,outpatient,1,EA,3147.55000,2990.17000,The Alliance,Exception Members,,2423.61,,,,,,,14.08,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,inpatient,1,EA,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1518.00,2677.20,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,outpatient,1,EA,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,14.08,2677.20,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,550.80,1200.00,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,inpatient,,,11573.00000,10994.35000,The Alliance,Exception Members,,8911.21,,,,,,,6365.15,11225.81,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,outpatient,,,11573.00000,10994.35000,The Alliance,Exception Members,,8911.21,,,,,,,4607.00,11225.81,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2612.86,5692.50,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27304.80000,25939.56000,The Alliance,Exception Members,,21024.70,,,,,,,13379.35,26485.66,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27304.80000,25939.56000,The Alliance,Exception Members,,21024.70,,,,,,,12532.90,27304.80,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,The Alliance,Exception Members,,676.83,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Exception Members,,676.83,,,,,,,96.44,2659.05,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,inpatient,1,GM,1230.25000,1168.74000,The Alliance,Exception Members,,947.29,,,,,,,676.64,1193.34,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,outpatient,1,GM,1230.25000,1168.74000,The Alliance,Exception Members,,947.29,,,,,,,615.12,1193.34,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,inpatient,1,mL,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,3.62,153.26,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,inpatient,1,EA,111.42000,105.85000,The Alliance,Exception Members,,85.79,,,,,,,61.28,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,outpatient,1,EA,111.42000,105.85000,The Alliance,Exception Members,,85.79,,,,,,,12.72,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,inpatient,1,EA,130.19000,123.68000,The Alliance,Exception Members,,100.25,,,,,,,71.60,126.28,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,outpatient,1,EA,130.19000,123.68000,The Alliance,Exception Members,,100.25,,,,,,,12.72,126.28,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,1.04,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Exception Members,,1.46,,,,,,,0.95000,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Exception Members,,1.59,,,,,,,1.03,2.01,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.66000,1.16,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Exception Members,,0.92400,,,,,,,0.60000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,3.13,5.52,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Exception Members,,4.38,,,,,,,2.85,15.80,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,inpatient,1,EA,736.75000,699.91000,The Alliance,Exception Members,,567.30,,,,,,,405.21,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,outpatient,1,EA,736.75000,699.91000,The Alliance,Exception Members,,567.30,,,,,,,368.38,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,inpatient,1,EA,769.75000,731.26000,The Alliance,Exception Members,,592.71,,,,,,,423.36,746.66,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,outpatient,1,EA,769.75000,731.26000,The Alliance,Exception Members,,592.71,,,,,,,384.88,746.66,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,The Alliance,Exception Members,,1313.81,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Exception Members,,1313.81,,,,,,,783.17,1706.25,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,5939.18,12939.40,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,156.19,309.19,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Exception Members,,245.44,,,,,,,146.31,318.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,18699.66,40740.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,116.86,231.34,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,109.47,238.50,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,The Alliance,Exception Members,,170.36,,,,,,,108.41,214.61,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Exception Members,,170.36,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,230.10000,218.59000,The Alliance,Exception Members,,177.18,,,,,,,112.75,223.20,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,230.10000,218.59000,The Alliance,Exception Members,,177.18,,,,,,,105.62,230.10,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Exception Members,,412.91,,,,,,,246.14,536.25,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,79.75,140.65,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Exception Members,TC,111.65,,,,,,,72.50,1820.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,inpatient,,,68.34000,64.92000,The Alliance,Exception Members,,52.62,,,,,,,37.59,66.29,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,outpatient,,,68.34000,64.92000,The Alliance,Exception Members,,52.62,,,,,,,34.17,137.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,inpatient,1,EA,136.68000,129.85000,The Alliance,Exception Members,,105.24,,,,,,,75.17,132.58,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,outpatient,1,EA,136.68000,129.85000,The Alliance,Exception Members,,105.24,,,,,,,68.34,137.03,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,inpatient,1,EA,269.42000,255.95000,The Alliance,Exception Members,,207.45,,,,,,,148.18,261.34,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,outpatient,1,EA,269.42000,255.95000,The Alliance,Exception Members,,207.45,,,,,,,134.71,261.34,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,inpatient,1,EA,1846.15000,1753.84000,The Alliance,Exception Members,,1421.54,,,,,,,1015.38,1790.77,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,outpatient,1,EA,1846.15000,1753.84000,The Alliance,Exception Members,,1421.54,,,,,,,14.79,1790.77,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,inpatient,1,GM,66.04000,62.74000,The Alliance,Exception Members,,50.85,,,,,,,36.32,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,outpatient,1,GM,66.04000,62.74000,The Alliance,Exception Members,,50.85,,,,,,,33.02,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,inpatient,1,GM,115.79000,110.00000,The Alliance,Exception Members,,89.16,,,,,,,63.68,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,outpatient,1,GM,115.79000,110.00000,The Alliance,Exception Members,,89.16,,,,,,,57.90,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,inpatient,1,GM,18.26000,17.35000,The Alliance,Exception Members,,14.06,,,,,,,10.04,17.71,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,outpatient,1,GM,18.26000,17.35000,The Alliance,Exception Members,,14.06,,,,,,,9.13,17.71,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,inpatient,1,mL,129.01000,122.56000,The Alliance,Exception Members,,99.34,,,,,,,70.96,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,outpatient,1,mL,129.01000,122.56000,The Alliance,Exception Members,,99.34,,,,,,,64.50,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,inpatient,1,mL,112.05000,106.45000,The Alliance,Exception Members,,86.28,,,,,,,61.63,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,outpatient,1,mL,112.05000,106.45000,The Alliance,Exception Members,,86.28,,,,,,,56.02,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,inpatient,1,mL,80.89000,76.85000,The Alliance,Exception Members,,62.29,,,,,,,44.49,78.46,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,outpatient,1,mL,80.89000,76.85000,The Alliance,Exception Members,,62.29,,,,,,,40.45,78.46,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,inpatient,1,mL,12896.29000,12251.47000,The Alliance,Exception Members,,9930.14,,,,,,,7092.96,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,outpatient,1,mL,12896.29000,12251.47000,The Alliance,Exception Members,,9930.14,,,,,,,388.83,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,inpatient,1,mL,11683.35000,11099.18000,The Alliance,Exception Members,,8996.18,,,,,,,6425.84,11332.85,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,outpatient,1,mL,11683.35000,11099.18000,The Alliance,Exception Members,,8996.18,,,,,,,388.83,11332.85,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,inpatient,1,mL,728.31000,691.89000,The Alliance,Exception Members,,560.80,,,,,,,400.57,706.46,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,outpatient,1,mL,728.31000,691.89000,The Alliance,Exception Members,,560.80,,,,,,,364.15,2397.95,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,inpatient,1,mL,1149.90000,1092.40000,The Alliance,Exception Members,,885.42,,,,,,,632.45,1115.40,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,outpatient,1,mL,1149.90000,1092.40000,The Alliance,Exception Members,,885.42,,,,,,,574.95,2397.95,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,inpatient,1,mL,81.79000,77.70000,The Alliance,Exception Members,,62.98,,,,,,,44.98,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,outpatient,1,mL,81.79000,77.70000,The Alliance,Exception Members,,62.98,,,,,,,40.90,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,inpatient,1,mL,75.33000,71.57000,The Alliance,Exception Members,,58.00,,,,,,,41.43,73.07,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,outpatient,1,mL,75.33000,71.57000,The Alliance,Exception Members,,58.00,,,,,,,37.66,73.07,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,inpatient,1,mL,2474.98000,2351.23000,The Alliance,Exception Members,,1905.73,,,,,,,1361.24,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,outpatient,1,mL,2474.98000,2351.23000,The Alliance,Exception Members,,1905.73,,,,,,,3.33,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,inpatient,1,mL,2500.42000,2375.40000,The Alliance,Exception Members,,1925.32,,,,,,,1375.23,2425.41,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,outpatient,1,mL,2500.42000,2375.40000,The Alliance,Exception Members,,1925.32,,,,,,,3.33,2425.41,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,inpatient,1,mL,49140.33000,46683.32000,The Alliance,Exception Members,,37838.05,,,,,,,27027.18,47666.12,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,outpatient,1,mL,49140.33000,46683.32000,The Alliance,Exception Members,,37838.05,,,,,,,36.66,47666.12,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,inpatient,1,mL,414.62000,393.89000,The Alliance,Exception Members,,319.26,,,,,,,228.04,402.18,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,outpatient,1,mL,414.62000,393.89000,The Alliance,Exception Members,,319.26,,,,,,,29.30,402.18,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,inpatient,1,mL,32751.19000,31113.63000,The Alliance,Exception Members,,25218.42,,,,,,,18013.15,31768.65,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,outpatient,1,mL,32751.19000,31113.63000,The Alliance,Exception Members,,25218.42,,,,,,,126.24,31768.65,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1944.08,3848.47,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Exception Members,,3054.97,,,,,,,1821.08,3967.50,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.44,6.07,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Exception Members,,4.82,,,,,,,3.13,6.07,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.06045,1.89,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,inpatient,1,mL,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,2.05,3.61,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,outpatient,1,mL,3.72000,3.53000,The Alliance,Exception Members,,2.86,,,,,,,1.86,3.61,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,132.00,232.80,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Exception Members,TC,184.80,,,,,,,120.00,1272.59,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,inpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,216.31,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Exception Members,,171.71,,,,,,,122.65,5271.00,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3296.47,6525.68,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3087.92,6727.50,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,inpatient,1,EA,6334.20000,6017.49000,The Alliance,Exception Members,,4877.33,,,,,,,3483.81,6144.17,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,outpatient,1,EA,6334.20000,6017.49000,The Alliance,Exception Members,,4877.33,,,,,,,36.66,6144.17,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,inpatient,1,EA,8023.11000,7621.96000,The Alliance,Exception Members,,6177.79,,,,,,,4412.71,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,outpatient,1,EA,8023.11000,7621.96000,The Alliance,Exception Members,,6177.79,,,,,,,41.96,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,inpatient,1,EA,22092.57000,20987.94000,The Alliance,Exception Members,,17011.28,,,,,,,12150.91,21429.79,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,outpatient,1,EA,22092.57000,20987.94000,The Alliance,Exception Members,,17011.28,,,,,,,41.96,21429.79,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,inpatient,1,EA,3037.03000,2885.18000,The Alliance,Exception Members,,2338.51,,,,,,,1670.37,2945.92,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,outpatient,1,EA,3037.03000,2885.18000,The Alliance,Exception Members,,2338.51,,,,,,,43.25,2945.92,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,inpatient,1,mL,2458.76000,2335.82000,The Alliance,Exception Members,,1893.25,,,,,,,1352.32,2385.00,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,outpatient,1,mL,2458.76000,2335.82000,The Alliance,Exception Members,,1893.25,,,,,,,7.68,2385.00,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,inpatient,1,mL,3612.56000,3431.94000,The Alliance,Exception Members,,2781.67,,,,,,,1986.91,3504.18,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,outpatient,1,mL,3612.56000,3431.94000,The Alliance,Exception Members,,2781.67,,,,,,,19.85,3504.18,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.48,6.74,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,inpatient,,,548.00000,520.60000,The Alliance,Exception Members,,421.96,,,,,,,301.40,531.56,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,outpatient,,,548.00000,520.60000,The Alliance,Exception Members,,421.96,,,,,,,274.00,531.56,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,1.41,2.49,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Exception Members,,1.98,,,,,,,0.08525,2.49,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,inpatient,1,mL,2.93000,2.78000,The Alliance,Exception Members,,2.26,,,,,,,1.61,2.84,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,outpatient,1,mL,2.93000,2.78000,The Alliance,Exception Members,,2.26,,,,,,,0.08525,2.84,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,inpatient,1,mL,399.99000,379.99000,The Alliance,Exception Members,,307.99,,,,,,,219.99,387.99,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,outpatient,1,mL,399.99000,379.99000,The Alliance,Exception Members,,307.99,,,,,,,82.86,387.99,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,inpatient,1,mL,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,220.00,388.00,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,outpatient,1,mL,400.00000,380.00000,The Alliance,Exception Members,,308.00,,,,,,,82.86,388.00,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,inpatient,1,mL,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Exception Members,,4.94,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.91,3.38,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Exception Members,,2.68,,,,,,,1.74,5.23,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,26.50,219.71,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,55.44,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,inpatient,1,mL,13220.83000,12559.79000,The Alliance,Exception Members,,10180.04,,,,,,,7271.46,12824.21,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Exception Members,,10180.04,,,,,,,136.04,12824.21,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.14409,0.92150,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,inpatient,1,EA,56.21000,53.40000,The Alliance,Exception Members,,43.28,,,,,,,30.92,54.52,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,outpatient,1,EA,56.21000,53.40000,The Alliance,Exception Members,,43.28,,,,,,,28.11,54.52,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,473.00000,449.35000,The Alliance,Exception Members,,364.21,,,,,,,260.15,458.81,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Exception Members,,364.21,,,,,,,63.95,788.42,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,78.21,137.93,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,37.52,137.93,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.36850,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Exception Members,,0.51590,,,,,,,0.33500,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,TC,23.10,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,TC,23.10,,,,,,,15.00,29.10,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,382.80,675.12,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Exception Members,TC,535.92,,,,,,,348.00,675.12,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,inpatient,,,71.65000,68.07000,The Alliance,Exception Members,,55.17,,,,,,,39.41,69.50,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,outpatient,,,71.65000,68.07000,The Alliance,Exception Members,,55.17,,,,,,,35.83,69.50,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,741.08,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Exception Members,,588.28,,,,,,,420.20,4686.00,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,Exception Members,TC,769.23,,,,,,,549.45,969.03,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Exception Members,TC,769.23,,,,,,,422.60,17311.25,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,inpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,41.71,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Exception Members,,33.11,,,,,,,23.65,5271.00,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,5271.00,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,inpatient,,,94.77000,90.03000,The Alliance,Exception Members,,72.97,,,,,,,52.12,91.93,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,outpatient,,,94.77000,90.03000,The Alliance,Exception Members,,72.97,,,,,,,52.12,5858.00,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,inpatient,1,mL,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,13.04,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Exception Members,,18.25,,,,,,,11.85,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,inpatient,1,mL,7.81000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,4.30,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,outpatient,1,mL,7.81000,7.41000,The Alliance,Exception Members,,6.01,,,,,,,3.90,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,inpatient,1,mL,14.71000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,8.09,14.27,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,outpatient,1,mL,14.71000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.36,14.27,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,The Alliance,Exception Members,TC,2396.24,,,,,,,1711.60,3018.64,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Exception Members,TC,2396.24,,,,,,,1334.13,14413.40,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,,12778.15,,,,,,,9127.25,16097.15,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Exception Members,,12778.15,,,,,,,1299.22,106944.98,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1804.69,3182.81,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1640.62,3182.81,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,The Alliance,Exception Members,,6109.95,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Exception Members,,6109.95,,,,,,,3642.16,7935.00,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Exception Members,,2259.38,,,,,,,1346.83,2934.26,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1845.00000,1752.75000,The Alliance,Exception Members,,1420.65,,,,,,,904.05,1789.65,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1845.00000,1752.75000,The Alliance,Exception Members,,1420.65,,,,,,,846.86,1845.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,360.00000,342.00000,The Alliance,Exception Members,,277.20,,,,,,,176.40,349.20,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,360.00000,342.00000,The Alliance,Exception Members,,277.20,,,,,,,165.24,360.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,98.97,215.63,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,116.86,231.34,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,109.47,238.50,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1713.75000,1628.06000,The Alliance,Exception Members,,1319.59,,,,,,,839.74,1662.34,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1713.75000,1628.06000,The Alliance,Exception Members,,1319.59,,,,,,,786.61,1713.75,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.45100,0.79540,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Exception Members,,0.63140,,,,,,,0.41000,0.79540,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,41.80,73.72,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,6.47,339.51,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.30,2.30,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Exception Members,,1.82,,,,,,,1.19,2.30,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,inpatient,1,EA,76.72000,72.89000,The Alliance,Exception Members,,59.07,,,,,,,42.20,74.42,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,outpatient,1,EA,76.72000,72.89000,The Alliance,Exception Members,,59.07,,,,,,,0.26000,74.42,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,inpatient,1,EA,4092.00000,3887.40000,The Alliance,Exception Members,,3150.84,,,,,,,2250.60,3969.24,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,outpatient,1,EA,4092.00000,3887.40000,The Alliance,Exception Members,,3150.84,,,,,,,15.55,3969.24,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,Exception Members,TC,585.97,,,,,,,418.55,738.17,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Exception Members,TC,585.97,,,,,,,380.50,4635.02,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,inpatient,1,EA,34.64000,32.91000,The Alliance,Exception Members,,26.67,,,,,,,19.05,33.60,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,outpatient,1,EA,34.64000,32.91000,The Alliance,Exception Members,,26.67,,,,,,,17.32,33.60,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,130.35,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Exception Members,,182.49,,,,,,,2.55,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,inpatient,1,EA,1548.82000,1471.38000,The Alliance,Exception Members,,1192.59,,,,,,,851.85,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,outpatient,1,EA,1548.82000,1471.38000,The Alliance,Exception Members,,1192.59,,,,,,,2.55,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,356.12,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Exception Members,,498.57,,,,,,,2.55,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,inpatient,1,EA,738.15000,701.24000,The Alliance,Exception Members,,568.38,,,,,,,405.98,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,outpatient,1,EA,738.15000,701.24000,The Alliance,Exception Members,,568.38,,,,,,,2.55,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,inpatient,1,EA,582.75000,553.61000,The Alliance,Exception Members,,448.72,,,,,,,320.51,565.27,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,outpatient,1,EA,582.75000,553.61000,The Alliance,Exception Members,,448.72,,,,,,,2.55,565.27,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,929.91,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,Exception Members,90,324.17,,,,,,,231.55,408.37,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Exception Members,90,324.17,,,,,,,28.00,1341.13,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,Exception Members,90,80.85,,,,,,,57.75,101.85,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Exception Members,90,80.85,,,,,,,5.35,271.65,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,inpatient,,,116.30000,110.48000,The Alliance,Exception Members,90,89.55,,,,,,,63.97,112.81,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Exception Members,90,89.55,,,,,,,4.57,271.65,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,inpatient,,,84.60000,80.37000,The Alliance,Exception Members,90,65.14,,,,,,,46.53,82.06,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,outpatient,,,84.60000,80.37000,The Alliance,Exception Members,90,65.14,,,,,,,20.20,305.58,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,267.85,472.39,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Exception Members,,374.99,,,,,,,63.95,788.42,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,inpatient,1,EA,6.13000,5.83000,The Alliance,Exception Members,,4.72,,,,,,,3.37,5.95,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,outpatient,1,EA,6.13000,5.83000,The Alliance,Exception Members,,4.72,,,,,,,3.06,5.95,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,inpatient,,,11828.00000,11236.60000,The Alliance,Exception Members,TC,9107.56,,,,,,,6505.40,11473.16,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Exception Members,TC,9107.56,,,,,,,1929.64,11473.16,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,Exception Members,TC,585.97,,,,,,,418.55,738.17,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Exception Members,TC,585.97,,,,,,,380.50,4635.02,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,inpatient,,,2963.00000,2814.85000,The Alliance,Exception Members,,2281.51,,,,,,,1629.65,2874.11,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,outpatient,,,2963.00000,2814.85000,The Alliance,Exception Members,,2281.51,,,,,,,1538.48,4686.00,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,676.99000,643.14000,The Alliance,Exception Members,,521.28,,,,,,,331.73,656.68,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,676.99000,643.14000,The Alliance,Exception Members,,521.28,,,,,,,310.74,676.99,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Exception Members,,0.68530,,,,,,,0.44500,0.86330,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,174.56,345.56,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,163.52,356.25,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,820.60,1447.24,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Exception Members,TC,1148.84,,,,,,,820.60,6003.00,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,The Alliance,Exception Members,,1600.83,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Exception Members,,1600.83,,,,,,,954.26,2079.00,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,103.97,7859.04,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Exception Members,,99.92,,,,,,,59.56,129.76,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,Exception Members,TC,498.96,,,,,,,356.40,628.56,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Exception Members,TC,498.96,,,,,,,324.00,2941.42,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,2850.39,6210.00,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Exception Members,,1718.06,,,,,,,1024.14,2231.25,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2388.60000,2269.17000,The Alliance,Exception Members,,1839.22,,,,,,,1170.41,2316.94,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2388.60000,2269.17000,The Alliance,Exception Members,,1839.22,,,,,,,1096.37,2388.60,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,The Alliance,Exception Members,,246.28,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Exception Members,,246.28,,,,,,,146.81,319.84,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3296.47,6525.68,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Exception Members,,5180.18,,,,,,,3087.92,6727.50,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,Exception Members,,769.23,,,,,,,549.45,969.03,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Exception Members,,769.23,,,,,,,422.60,17311.25,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,The Alliance,Exception Members,,4644.64,,,,,,,3317.60,5851.04,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Exception Members,,4644.64,,,,,,,2194.62,5851.04,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,The Alliance,Exception Members,,6675.13,,,,,,,4767.95,8408.93,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Exception Members,,6675.13,,,,,,,4334.50,8408.93,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,inpatient,,,137.23000,130.37000,The Alliance,Exception Members,,105.67,,,,,,,75.48,133.11,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,outpatient,,,137.23000,130.37000,The Alliance,Exception Members,,105.67,,,,,,,68.61,133.11,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Exception Members,,0.56210,,,,,,,0.36500,4.31,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,inpatient,1,GM,31.19000,29.63000,The Alliance,Exception Members,,24.02,,,,,,,17.15,30.25,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,outpatient,1,GM,31.19000,29.63000,The Alliance,Exception Members,,24.02,,,,,,,15.60,30.25,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,The Alliance,Exception Members,TC,8256.71,,,,,,,5897.65,10401.31,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Exception Members,TC,8256.71,,,,,,,5057.86,51844.17,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,inpatient,1,EA,288.61000,274.18000,The Alliance,Exception Members,,222.23,,,,,,,158.74,279.95,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,outpatient,1,EA,288.61000,274.18000,The Alliance,Exception Members,,222.23,,,,,,,144.31,279.95,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Exception Members,,1442.98,,,,,,,937.00,1817.78,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,The Alliance,Exception Members,TC,2513.28,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Exception Members,TC,2513.28,,,,,,,1527.07,3166.08,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3487.31000,3312.94000,The Alliance,Exception Members,,2685.23,,,,,,,1708.78,3382.69,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3487.31000,3312.94000,The Alliance,Exception Members,,2685.23,,,,,,,1600.68,3487.31,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1342.24,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,898.32,1778.30,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2276.25000,2162.44000,The Alliance,Exception Members,,1752.71,,,,,,,1115.36,2207.96,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2276.25000,2162.44000,The Alliance,Exception Members,,1752.71,,,,,,,1044.80,2276.25,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12077.43,26312.49,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,The Alliance,Exception Members,,345.35,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Exception Members,,345.35,,,,,,,205.86,448.50,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,The Alliance,Exception Members,,4644.64,,,,,,,3317.60,5851.04,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Exception Members,,4644.64,,,,,,,2194.62,5851.04,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1383.88,3015.00,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,inpatient,,,3408.00000,3237.60000,The Alliance,Exception Members,TC,2624.16,,,,,,,1874.40,3305.76,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,outpatient,,,3408.00000,3237.60000,The Alliance,Exception Members,TC,2624.16,,,,,,,1704.00,3305.76,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,inpatient,1,EA,19551.00000,18573.45000,The Alliance,Exception Members,,15054.27,,,,,,,10753.05,18964.47,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,outpatient,1,EA,19551.00000,18573.45000,The Alliance,Exception Members,,15054.27,,,,,,,2.65,18964.47,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10121.50000,9615.42000,The Alliance,Exception Members,,7793.56,,,,,,,4959.53,9817.85,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10121.50000,9615.42000,The Alliance,Exception Members,,7793.56,,,,,,,4645.77,10121.50,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,37.40,65.96,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Exception Members,,52.36,,,,,,,5.99,1216.68,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,5.83,44.62,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,inpatient,1,EA,250.52000,238.00000,The Alliance,Exception Members,,192.90,,,,,,,137.79,243.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,outpatient,1,EA,250.52000,238.00000,The Alliance,Exception Members,,192.90,,,,,,,125.26,243.00,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,inpatient,1,EA,90046.64000,85544.31000,The Alliance,Exception Members,,69335.91,,,,,,,49525.65,87345.24,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,outpatient,1,EA,90046.64000,85544.31000,The Alliance,Exception Members,,69335.91,,,,,,,45023.32,87345.24,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,inpatient,1,EA,1289.61000,1225.13000,The Alliance,Exception Members,,993.00,,,,,,,709.29,1250.92,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,outpatient,1,EA,1289.61000,1225.13000,The Alliance,Exception Members,,993.00,,,,,,,5.19,1250.92,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,inpatient,1,mL,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,2.58,4.56,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,outpatient,1,mL,4.70000,4.46000,The Alliance,Exception Members,,3.62,,,,,,,1.49,4.56,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.14300,0.25220,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Exception Members,,0.20020,,,,,,,0.13000,0.25220,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,inpatient,,,6.70000,6.36000,The Alliance,Exception Members,,5.16,,,,,,,3.69,6.50,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,outpatient,,,6.70000,6.36000,The Alliance,Exception Members,,5.16,,,,,,,3.35,6.50,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,inpatient,,,1803.00000,1712.85000,The Alliance,Exception Members,,1388.31,,,,,,,991.65,1748.91,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,outpatient,,,1803.00000,1712.85000,The Alliance,Exception Members,,1388.31,,,,,,,283.85,1748.91,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,413.44,818.44,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Exception Members,,649.69,,,,,,,421.88,818.44,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,inpatient,1,EA,51.13000,48.57000,The Alliance,Exception Members,,39.37,,,,,,,28.12,49.60,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,outpatient,1,EA,51.13000,48.57000,The Alliance,Exception Members,,39.37,,,,,,,25.57,49.60,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,inpatient,1,mL,2753.56000,2615.88000,The Alliance,Exception Members,,2120.24,,,,,,,1514.46,2670.95,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,outpatient,1,mL,2753.56000,2615.88000,The Alliance,Exception Members,,2120.24,,,,,,,40.56,2670.95,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Exception Members,,1.62,,,,,,,0.00620,2.05,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,inpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,83.98,148.12,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Exception Members,,117.58,,,,,,,33.32,148.12,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,inpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,4.95,8.73,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Exception Members,,6.93,,,,,,,3.96,8.73,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,inpatient,1,mL,51.13000,48.57000,The Alliance,Exception Members,,39.37,,,,,,,28.12,49.60,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,outpatient,1,mL,51.13000,48.57000,The Alliance,Exception Members,,39.37,,,,,,,25.57,49.60,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,inpatient,1,mL,4909.73000,4664.25000,The Alliance,Exception Members,,3780.49,,,,,,,2700.35,4762.44,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Exception Members,,3780.49,,,,,,,225.19,4762.44,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,25.30,44.62,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,23.00,44.62,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,0.43000,18.39,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,50.60,89.24,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Exception Members,,70.84,,,,,,,46.00,1714.64,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,inpatient,1,EA,8520.12000,8094.11000,The Alliance,Exception Members,,6560.49,,,,,,,4686.07,8264.52,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,outpatient,1,EA,8520.12000,8094.11000,The Alliance,Exception Members,,6560.49,,,,,,,2.65,8264.52,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,inpatient,1,mL,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,4.12,7.27,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,outpatient,1,mL,7.49000,7.11000,The Alliance,Exception Members,,5.77,,,,,,,3.75,7.27,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,inpatient,1,mL,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.50,2.64,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Exception Members,,2.09,,,,,,,1.02,2.64,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,inpatient,,,322.90000,306.75000,The Alliance,Exception Members,,248.63,,,,,,,177.59,313.21,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,outpatient,,,322.90000,306.75000,The Alliance,Exception Members,,248.63,,,,,,,23.25,313.21,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,153.86,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,inpatient,1,mL,147.89000,140.49000,The Alliance,Exception Members,,113.88,,,,,,,81.34,143.45,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,outpatient,1,mL,147.89000,140.49000,The Alliance,Exception Members,,113.88,,,,,,,64.92,143.45,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,453.75000,431.06000,The Alliance,Exception Members,,349.39,,,,,,,222.34,440.14,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,453.75000,431.06000,The Alliance,Exception Members,,349.39,,,,,,,208.27,440.14,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,400.12,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,80.00,155.20,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,39.52000,37.54000,The Alliance,Exception Members,,30.43,,,,,,,19.36,38.33,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Exception Members,,30.43,,,,,,,18.14,39.52,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,The Alliance,Exception Members,,2954.03,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Exception Members,,2954.03,,,,,,,1760.91,3836.40,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Exception Members,,1203.51,,,,,,,103.97,7859.04,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,9953.19,21684.50,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,The Alliance,Exception Members,,2954.03,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Exception Members,,2954.03,,,,,,,1760.91,3836.40,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,17391.00000,16521.45000,The Alliance,Exception Members,,13391.07,,,,,,,8521.59,16869.27,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,17391.00000,16521.45000,The Alliance,Exception Members,,13391.07,,,,,,,7982.47,17391.00,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,The Alliance,Exception Members,,7145.98,,,,,,,4547.44,9002.08,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Exception Members,,7145.98,,,,,,,4259.75,9280.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,inpatient,1,mL,1032.24000,980.63000,The Alliance,Exception Members,,794.82,,,,,,,567.73,1001.27,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,outpatient,1,mL,1032.24000,980.63000,The Alliance,Exception Members,,794.82,,,,,,,347.32,1001.27,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,inpatient,1,mL,453.41000,430.74000,The Alliance,Exception Members,,349.13,,,,,,,249.38,439.81,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,outpatient,1,mL,453.41000,430.74000,The Alliance,Exception Members,,349.13,,,,,,,114.48,439.81,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,inpatient,1,mL,20.79000,19.75000,The Alliance,Exception Members,,16.01,,,,,,,11.43,20.17,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,outpatient,1,mL,20.79000,19.75000,The Alliance,Exception Members,,16.01,,,,,,,6.35,20.17,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,7334.70000,6967.96000,The Alliance,Exception Members,,5647.72,,,,,,,3594.00,7114.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,7334.70000,6967.96000,The Alliance,Exception Members,,5647.72,,,,,,,3366.63,7334.70,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,3086.00000,2931.70000,The Alliance,Exception Members,,2376.22,,,,,,,1697.30,2993.42,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,3086.00000,2931.70000,The Alliance,Exception Members,,2376.22,,,,,,,557.65,2993.42,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,inpatient,1,mL,299.83000,284.84000,The Alliance,Exception Members,,230.87,,,,,,,164.91,290.84,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,outpatient,1,mL,299.83000,284.84000,The Alliance,Exception Members,,230.87,,,,,,,114.64,290.84,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,152.35,268.69,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,,213.29,,,,,,,62.14,3038.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,290.95,513.13,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Exception Members,,407.33,,,,,,,63.95,788.42,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,673.00000,639.35000,The Alliance,Exception Members,,518.21,,,,,,,370.15,652.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Exception Members,,518.21,,,,,,,98.39,1078.91,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,inpatient,,,1508.00000,1432.60000,The Alliance,Exception Members,,1161.16,,,,,,,829.40,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,outpatient,,,1508.00000,1432.60000,The Alliance,Exception Members,,1161.16,,,,,,,132.80,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1840.00000,1748.00000,The Alliance,Exception Members,,1416.80,,,,,,,1012.00,1784.80,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1840.00000,1748.00000,The Alliance,Exception Members,,1416.80,,,,,,,172.18,1784.80,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,inpatient,,,350.40000,332.88000,The Alliance,Exception Members,90,269.81,,,,,,,192.72,339.89,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,outpatient,,,350.40000,332.88000,The Alliance,Exception Members,90,269.81,,,,,,,63.40,3038.81,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1383.41000,1314.24000,The Alliance,Exception Members,,1065.23,,,,,,,677.87,1341.91,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1383.41000,1314.24000,The Alliance,Exception Members,,1065.23,,,,,,,634.99,1383.41,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,81.96000,77.86000,The Alliance,Exception Members,,63.11,,,,,,,40.16,79.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,81.96000,77.86000,The Alliance,Exception Members,,63.11,,,,,,,37.62,81.96,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,288.60000,274.17000,The Alliance,Exception Members,,222.22,,,,,,,141.41,279.94,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,288.60000,274.17000,The Alliance,Exception Members,,222.22,,,,,,,132.47,288.60,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,34469.40000,32745.93000,The Alliance,Exception Members,,26541.44,,,,,,,16890.01,33435.32,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Exception Members,,26541.44,,,,,,,15821.45,33435.32,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,The Alliance,Exception Members,,9089.70,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Exception Members,,9089.70,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,1927.18,4198.65,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Exception Members,TC,421.19,,,,,,,273.50,1232.72,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,1927.18,4198.65,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,The Alliance,Exception Members,,10741.50,,,,,,,6835.50,13531.50,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Exception Members,,10741.50,,,,,,,6403.05,13950.00,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5558.02,11002.61,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5206.39,11342.90,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1653.75,3273.75,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1549.12,3375.00,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10741.50000,10204.42000,The Alliance,Exception Members,,8270.95,,,,,,,5263.34,10419.25,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10741.50000,10204.42000,The Alliance,Exception Members,,8270.95,,,,,,,4930.35,10741.50,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Exception Members,,20260.62,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2343.75000,2226.56000,The Alliance,Exception Members,,1804.69,,,,,,,1148.44,2273.44,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Exception Members,,1804.69,,,,,,,1075.78,2343.75,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1515.94,3000.94,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Exception Members,,2382.19,,,,,,,1420.03,3093.75,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,The Alliance,Exception Members,,7877.10,,,,,,,5012.70,9923.10,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Exception Members,,7877.10,,,,,,,4695.57,9923.10,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2568.75000,2440.31000,The Alliance,Exception Members,,1977.94,,,,,,,1258.69,2491.69,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2568.75000,2440.31000,The Alliance,Exception Members,,1977.94,,,,,,,1179.06,2568.75,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,286.88000,272.54000,The Alliance,Exception Members,,220.90,,,,,,,140.57,278.27,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,286.88000,272.54000,The Alliance,Exception Members,,220.90,,,,,,,131.68,286.88,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,29826.53000,28335.20000,The Alliance,Exception Members,,22966.43,,,,,,,14615.00,28931.73,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,29826.53000,28335.20000,The Alliance,Exception Members,,22966.43,,,,,,,13690.38,29826.53,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13814.10000,13123.40000,The Alliance,Exception Members,,10636.86,,,,,,,6768.91,13399.68,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13814.10000,13123.40000,The Alliance,Exception Members,,10636.86,,,,,,,6340.67,13814.10,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,The Alliance,Exception Members,,3591.59,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Exception Members,,3591.59,,,,,,,2140.96,4664.40,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,118.60,209.16,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Exception Members,,166.04,,,,,,,107.81,209.16,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.14415,0.57230,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,inpatient,1,EA,2879.90000,2735.90000,The Alliance,Exception Members,,2217.52,,,,,,,1583.94,2793.50,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,outpatient,1,EA,2879.90000,2735.90000,The Alliance,Exception Members,,2217.52,,,,,,,11.00,2793.50,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,inpatient,1,mL,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,12.15,21.43,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,outpatient,1,mL,22.09000,20.98000,The Alliance,Exception Members,,17.01,,,,,,,11.04,37.80,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,inpatient,1,EA,14.82000,14.07000,The Alliance,Exception Members,,11.41,,,,,,,8.15,14.38,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Exception Members,,11.41,,,,,,,7.41,14.38,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,inpatient,1,EA,4547.65000,4320.27000,The Alliance,Exception Members,,3501.69,,,,,,,2501.21,4411.22,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,outpatient,1,EA,4547.65000,4320.27000,The Alliance,Exception Members,,3501.69,,,,,,,2113.24,4411.22,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,4229.70000,4018.21000,The Alliance,Exception Members,,3256.87,,,,,,,2072.55,4102.81,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Exception Members,,3256.87,,,,,,,1941.43,4229.70,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,20528.18,43381.99,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,The Alliance,Exception Members,,9089.70,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Exception Members,,9089.70,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,66.64,131.92,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,62.42,136.00,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1328.81,2895.00,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,The Alliance,Exception Members,,101.55,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Exception Members,,101.55,,,,,,,60.53,131.88,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,The Alliance,Exception Members,,101.55,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Exception Members,,101.55,,,,,,,60.53,131.88,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.34860,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Exception Members,,16697.06,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.46,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Exception Members,,2.04,,,,,,,1.32,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Exception Members,,2.96,,,,,,,1.92,3.72,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,inpatient,1,mL,436.17000,414.36000,The Alliance,Exception Members,,335.85,,,,,,,239.89,423.08,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,outpatient,1,mL,436.17000,414.36000,The Alliance,Exception Members,,335.85,,,,,,,218.09,423.08,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,inpatient,1,mL,1265.76000,1202.47000,The Alliance,Exception Members,,974.64,,,,,,,696.17,1227.79,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,outpatient,1,mL,1265.76000,1202.47000,The Alliance,Exception Members,,974.64,,,,,,,632.88,1227.79,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,3.02,15.33,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,395.06,782.06,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Exception Members,,620.81,,,,,,,370.07,806.25,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,The Alliance,Exception Members,,24022.15,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Exception Members,,24022.15,,,,,,,14319.70,31197.60,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10551.84000,10024.25000,The Alliance,Exception Members,,8124.92,,,,,,,5170.40,10235.28,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10551.84000,10024.25000,The Alliance,Exception Members,,8124.92,,,,,,,4843.29,10551.84,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,4027.90,7973.60,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Exception Members,,6329.56,,,,,,,3773.08,8220.21,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,inpatient,1,mL,33.52000,31.85000,The Alliance,Exception Members,,25.81,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Exception Members,,25.81,,,,,,,1.49,32.51,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,inpatient,1,EA,82.92000,78.77000,The Alliance,Exception Members,,63.85,,,,,,,45.61,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,outpatient,1,EA,82.92000,78.77000,The Alliance,Exception Members,,63.85,,,,,,,0.76415,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.62150,1.10,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Exception Members,,0.87010,,,,,,,0.56500,1.10,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.31900,0.56260,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Exception Members,,0.44660,,,,,,,0.29000,0.56260,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,4721.18,10285.80,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,inpatient,1,EA,62.19000,59.08000,The Alliance,Exception Members,,47.89,,,,,,,34.20,60.32,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,outpatient,1,EA,62.19000,59.08000,The Alliance,Exception Members,,47.89,,,,,,,7.82,60.32,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Exception Members,,7920.07,,,,,,,4721.18,10285.80,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,14312.70000,13597.07000,The Alliance,Exception Members,,11020.78,,,,,,,7013.22,13883.32,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,14312.70000,13597.07000,The Alliance,Exception Members,,11020.78,,,,,,,6569.53,14312.70,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,inpatient,1,mL,1746.98000,1659.63000,The Alliance,Exception Members,,1345.17,,,,,,,960.84,1694.57,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,outpatient,1,mL,1746.98000,1659.63000,The Alliance,Exception Members,,1345.17,,,,,,,873.49,1694.57,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,inpatient,1,mL,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.58,2.78,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,outpatient,1,mL,2.87000,2.73000,The Alliance,Exception Members,,2.21,,,,,,,1.44,2.78,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,inpatient,1,mL,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.75,3.09,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,outpatient,1,mL,3.19000,3.03000,The Alliance,Exception Members,,2.46,,,,,,,1.59,3.09,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,inpatient,1,mL,3836.56000,3644.73000,The Alliance,Exception Members,,2954.15,,,,,,,2110.11,3721.46,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,outpatient,1,mL,3836.56000,3644.73000,The Alliance,Exception Members,,2954.15,,,,,,,1918.28,3721.46,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,4.06,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3360.00000,3192.00000,The Alliance,Exception Members,,2587.20,,,,,,,1646.40,3259.20,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3360.00000,3192.00000,The Alliance,Exception Members,,2587.20,,,,,,,1542.24,3360.00,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,712.50000,676.88000,The Alliance,Exception Members,,548.62,,,,,,,349.12,691.12,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,712.50000,676.88000,The Alliance,Exception Members,,548.62,,,,,,,327.04,712.50,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,inpatient,1,mL,69.71000,66.22000,The Alliance,Exception Members,,53.68,,,,,,,38.34,67.62,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,outpatient,1,mL,69.71000,66.22000,The Alliance,Exception Members,,53.68,,,,,,,7.57,67.62,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,inpatient,1,mL,379.44000,360.46000,The Alliance,Exception Members,,292.17,,,,,,,208.69,368.06,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Exception Members,,292.17,,,,,,,1.16,368.06,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,inpatient,,,155.60000,147.82000,The Alliance,Exception Members,90,119.81,,,,,,,85.58,150.93,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,outpatient,,,155.60000,147.82000,The Alliance,Exception Members,90,119.81,,,,,,,19.00,865.84,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,15.55,780.94,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,inpatient,,,257.50000,244.62000,The Alliance,Exception Members,90,198.28,,,,,,,141.62,249.78,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,outpatient,,,257.50000,244.62000,The Alliance,Exception Members,90,198.28,,,,,,,30.26,1527.89,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,88.99,156.95,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,19.00,865.84,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,137.72,242.89,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,30.59,1544.85,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,inpatient,,,211.80000,201.21000,The Alliance,Exception Members,90,163.09,,,,,,,116.49,205.45,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,outpatient,,,211.80000,201.21000,The Alliance,Exception Members,90,163.09,,,,,,,24.89,1137.41,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,inpatient,,,101.60000,96.52000,The Alliance,Exception Members,90,78.23,,,,,,,55.88,98.55,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,outpatient,,,101.60000,96.52000,The Alliance,Exception Members,90,78.23,,,,,,,9.64,98.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,Exception Members,90,393.47,,,,,,,281.05,495.67,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Exception Members,90,393.47,,,,,,,50.66,2563.44,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,inpatient,,,130.20000,123.69000,The Alliance,Exception Members,90,100.25,,,,,,,71.61,126.29,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,outpatient,,,130.20000,123.69000,The Alliance,Exception Members,90,100.25,,,,,,,12.45,1539.22,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,536.80,946.72,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,119.20,6026.72,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,inpatient,,,73.30000,69.63000,The Alliance,Exception Members,90,56.44,,,,,,,40.31,71.10,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,outpatient,,,73.30000,69.63000,The Alliance,Exception Members,90,56.44,,,,,,,8.35,424.40,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,inpatient,,,23.40000,22.23000,The Alliance,Exception Members,90,18.02,,,,,,,12.87,22.70,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,outpatient,,,23.40000,22.23000,The Alliance,Exception Members,90,18.02,,,,,,,4.57,271.65,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,inpatient,,,458.30000,435.38000,The Alliance,Exception Members,90,352.89,,,,,,,252.06,444.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,outpatient,,,458.30000,435.38000,The Alliance,Exception Members,90,352.89,,,,,,,50.66,2563.44,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,inpatient,,,5277.00000,5013.15000,The Alliance,Exception Members,90,4063.29,,,,,,,2902.35,5118.69,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,outpatient,,,5277.00000,5013.15000,The Alliance,Exception Members,90,4063.29,,,,,,,480.00,28232.08,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,15.80,780.94,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,inpatient,,,65.30000,62.03000,The Alliance,Exception Members,90,50.28,,,,,,,35.91,63.34,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,outpatient,,,65.30000,62.03000,The Alliance,Exception Members,90,50.28,,,,,,,17.33,882.80,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,inpatient,,,118.10000,112.19000,The Alliance,Exception Members,90,90.94,,,,,,,64.95,114.56,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,outpatient,,,118.10000,112.19000,The Alliance,Exception Members,90,90.94,,,,,,,13.89,696.05,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,inpatient,,,579.00000,550.05000,The Alliance,Exception Members,TC,445.83,,,,,,,318.45,561.63,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Exception Members,TC,445.83,,,,,,,121.00,3027.62,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,53.52,94.38,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,4.57,271.65,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,The Alliance,Exception Members,,2604.91,,,,,,,1860.65,3281.51,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Exception Members,,2604.91,,,,,,,370.62,4872.27,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,163.24,287.90,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,12.40,628.12,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,Exception Members,90,473.55,,,,,,,338.25,596.55,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Exception Members,90,473.55,,,,,,,307.50,3186.14,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,The Alliance,Exception Members,90,155.93,,,,,,,111.38,196.43,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Exception Members,90,155.93,,,,,,,77.53,1052.52,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,389.40,686.76,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,259.66,15261.97,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,inpatient,,,132.40000,125.78000,The Alliance,Exception Members,90,101.95,,,,,,,72.82,128.43,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,outpatient,,,132.40000,125.78000,The Alliance,Exception Members,90,101.95,,,,,,,8.17,780.94,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,inpatient,,,194.30000,184.58000,The Alliance,Exception Members,90,149.61,,,,,,,106.86,188.47,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,outpatient,,,194.30000,184.58000,The Alliance,Exception Members,90,149.61,,,,,,,8.94,458.40,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,12.00,23.28,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,inpatient,,,645.00000,612.75000,The Alliance,Exception Members,90,496.65,,,,,,,354.75,625.65,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,outpatient,,,645.00000,612.75000,The Alliance,Exception Members,90,496.65,,,,,,,12.45,1539.22,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,inpatient,,,174.70000,165.96000,The Alliance,Exception Members,90,134.52,,,,,,,96.08,169.46,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,outpatient,,,174.70000,165.96000,The Alliance,Exception Members,90,134.52,,,,,,,12.40,628.12,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,90,77.00,,,,,,,55.00,97.00,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,90,77.00,,,,,,,50.00,1137.41,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,inpatient,,,116.90000,111.06000,The Alliance,Exception Members,90,90.01,,,,,,,64.30,113.39,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,outpatient,,,116.90000,111.06000,The Alliance,Exception Members,90,90.01,,,,,,,12.40,628.12,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,69.96,123.38,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,12.40,628.12,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1075.00000,1021.25000,The Alliance,Exception Members,90,827.75,,,,,,,591.25,1042.75,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1075.00000,1021.25000,The Alliance,Exception Members,90,827.75,,,,,,,126.29,6383.20,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,207.24,365.50,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,44.27,2240.90,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,169.78,299.44,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,12.40,628.12,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,inpatient,,,160.40000,152.38000,The Alliance,Exception Members,90,123.51,,,,,,,88.22,155.59,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,outpatient,,,160.40000,152.38000,The Alliance,Exception Members,90,123.51,,,,,,,12.29,628.12,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,Exception Members,90,77.77,,,,,,,55.55,97.97,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Exception Members,90,77.77,,,,,,,8.17,594.19,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,90,121.66,,,,,,,86.90,153.26,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,90,121.66,,,,,,,79.00,1137.41,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,inpatient,,,38.00000,36.10000,The Alliance,Exception Members,90,29.26,,,,,,,20.90,36.86,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Exception Members,90,29.26,,,,,,,19.00,3038.81,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,The Alliance,Exception Members,90,121.20,,,,,,,86.57,152.68,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Exception Members,90,121.20,,,,,,,20.36,1120.45,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,The Alliance,Exception Members,90,121.20,,,,,,,86.57,152.68,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Exception Members,90,121.20,,,,,,,20.36,1120.45,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3810.00000,3619.50000,The Alliance,Exception Members,TC,2933.70,,,,,,,2095.50,3695.70,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3810.00000,3619.50000,The Alliance,Exception Members,TC,2933.70,,,,,,,533.12,16173.22,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,Exception Members,TC,304.92,,,,,,,217.80,384.12,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Exception Members,TC,304.92,,,,,,,127.30,1245.05,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,inpatient,,,432.00000,410.40000,The Alliance,Exception Members,,332.64,,,,,,,237.60,419.04,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Exception Members,,332.64,,,,,,,142.63,6772.31,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,inpatient,,,952.00000,904.40000,The Alliance,Exception Members,,733.04,,,,,,,523.60,923.44,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,outpatient,,,952.00000,904.40000,The Alliance,Exception Members,,733.04,,,,,,,329.46,4329.05,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,inpatient,,,171.80000,163.21000,The Alliance,Exception Members,90,132.29,,,,,,,94.49,166.65,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,outpatient,,,171.80000,163.21000,The Alliance,Exception Members,90,132.29,,,,,,,21.00,1069.56,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.40000,303.43000,The Alliance,Exception Members,90,245.94,,,,,,,175.67,309.82,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.40000,303.43000,The Alliance,Exception Members,90,245.94,,,,,,,8.94,458.40,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,inpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,50.82,89.63,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Exception Members,,71.15,,,,,,,6.48,339.51,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,536.80,946.72,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,119.20,6026.72,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,91.80,161.89,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,8.94,458.40,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,inpatient,,,655.00000,622.25000,The Alliance,Exception Members,,504.35,,,,,,,360.25,635.35,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,outpatient,,,655.00000,622.25000,The Alliance,Exception Members,,504.35,,,,,,,161.92,9523.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,inpatient,,,2638.00000,2506.10000,The Alliance,Exception Members,90,2031.26,,,,,,,1450.90,2558.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,outpatient,,,2638.00000,2506.10000,The Alliance,Exception Members,90,2031.26,,,,,,,195.07,14107.52,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,404.25,712.95,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,Exception Members,,565.95,,,,,,,367.50,28232.08,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,inpatient,,,43.30000,41.13000,The Alliance,Exception Members,90,33.34,,,,,,,23.82,42.00,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,outpatient,,,43.30000,41.13000,The Alliance,Exception Members,90,33.34,,,,,,,4.91,254.68,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,inpatient,,,113.40000,107.73000,The Alliance,Exception Members,90,87.32,,,,,,,62.37,110.00,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Exception Members,90,87.32,,,,,,,8.17,679.08,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,inpatient,,,255.30000,242.54000,The Alliance,Exception Members,90,196.58,,,,,,,140.41,247.64,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,outpatient,,,255.30000,242.54000,The Alliance,Exception Members,90,196.58,,,,,,,20.36,1120.45,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,86.79,153.07,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Exception Members,90,121.51,,,,,,,17.71,933.70,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,inpatient,,,227.90000,216.50000,The Alliance,Exception Members,90,175.48,,,,,,,125.34,221.06,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,outpatient,,,227.90000,216.50000,The Alliance,Exception Members,90,175.48,,,,,,,113.95,1137.41,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,inpatient,,,105.70000,100.41000,The Alliance,Exception Members,90,81.39,,,,,,,58.13,102.53,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,outpatient,,,105.70000,100.41000,The Alliance,Exception Members,90,81.39,,,,,,,8.94,458.40,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,69.96,123.38,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,12.40,628.12,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,inpatient,,,119.40000,113.43000,The Alliance,Exception Members,90,91.94,,,,,,,65.67,115.82,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,outpatient,,,119.40000,113.43000,The Alliance,Exception Members,90,91.94,,,,,,,14.59,729.98,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,inpatient,,,855.00000,812.25000,The Alliance,Exception Members,,658.35,,,,,,,470.25,829.35,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,outpatient,,,855.00000,812.25000,The Alliance,Exception Members,,658.35,,,,,,,142.63,6772.31,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,The Alliance,Exception Members,90,94.17,,,,,,,67.27,118.63,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Exception Members,90,94.17,,,,,,,12.40,628.12,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,90.03,158.79,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Exception Members,90,126.05,,,,,,,20.36,1120.45,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,inpatient,,,199.20000,189.24000,The Alliance,Exception Members,90,153.38,,,,,,,109.56,193.22,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,outpatient,,,199.20000,189.24000,The Alliance,Exception Members,90,153.38,,,,,,,20.36,1120.45,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1635.00000,1553.25000,The Alliance,Exception Members,90,1258.95,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Exception Members,90,1258.95,,,,,,,157.98,9082.50,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,inpatient,,,95.20000,90.44000,The Alliance,Exception Members,90,73.30,,,,,,,52.36,92.34,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,outpatient,,,95.20000,90.44000,The Alliance,Exception Members,90,73.30,,,,,,,11.17,560.26,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,inpatient,,,74.80000,71.06000,The Alliance,Exception Members,90,57.60,,,,,,,41.14,72.56,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Exception Members,90,57.60,,,,,,,8.35,424.40,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,inpatient,,,111.80000,106.21000,The Alliance,Exception Members,90,86.09,,,,,,,61.49,108.45,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,outpatient,,,111.80000,106.21000,The Alliance,Exception Members,90,86.09,,,,,,,12.40,628.12,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,inpatient,,,20708.00000,19672.60000,The Alliance,Exception Members,90,15945.16,,,,,,,11389.40,20086.76,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,outpatient,,,20708.00000,19672.60000,The Alliance,Exception Members,90,15945.16,,,,,,,8569.96,115186.20,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,The Alliance,Exception Members,,2604.91,,,,,,,1860.65,3281.51,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Exception Members,,2604.91,,,,,,,370.62,4872.27,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2812.00000,2671.40000,The Alliance,Exception Members,TC,2165.24,,,,,,,1546.60,2727.64,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Exception Members,TC,2165.24,,,,,,,533.12,16173.22,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,inpatient,,,170.40000,161.88000,The Alliance,Exception Members,90,131.21,,,,,,,93.72,165.29,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,outpatient,,,170.40000,161.88000,The Alliance,Exception Members,90,131.21,,,,,,,12.40,628.12,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,inpatient,,,213.50000,202.82000,The Alliance,Exception Members,90,164.40,,,,,,,117.42,207.09,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,outpatient,,,213.50000,202.82000,The Alliance,Exception Members,90,164.40,,,,,,,26.09,1324.17,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,inpatient,,,241.80000,229.71000,The Alliance,Exception Members,90,186.19,,,,,,,132.99,234.55,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,outpatient,,,241.80000,229.71000,The Alliance,Exception Members,90,186.19,,,,,,,45.08,679.08,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,Exception Members,90,756.91,,,,,,,540.65,953.51,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Exception Members,90,756.91,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,inpatient,,,459.10000,436.14000,The Alliance,Exception Members,90,353.51,,,,,,,252.50,445.33,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,outpatient,,,459.10000,436.14000,The Alliance,Exception Members,90,353.51,,,,,,,25.31,2286.16,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,69.96,123.38,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Exception Members,90,97.94,,,,,,,14.94,763.98,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,inpatient,,,334.30000,317.58000,The Alliance,Exception Members,90,257.41,,,,,,,183.87,324.27,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,outpatient,,,334.30000,317.58000,The Alliance,Exception Members,90,257.41,,,,,,,24.89,1137.41,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,inpatient,,,226.40000,215.08000,The Alliance,Exception Members,90,174.33,,,,,,,124.52,219.61,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,outpatient,,,226.40000,215.08000,The Alliance,Exception Members,90,174.33,,,,,,,27.67,1392.10,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,inpatient,,,158.90000,150.96000,The Alliance,Exception Members,90,122.35,,,,,,,87.39,154.13,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,outpatient,,,158.90000,150.96000,The Alliance,Exception Members,90,122.35,,,,,,,10.38,950.66,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,55.83,98.45,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Exception Members,90,78.16,,,,,,,12.40,628.12,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,90,1130.36,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,90,1130.36,,,,,,,179.44,8692.03,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,36.26,1833.46,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,Exception Members,90,479.71,,,,,,,342.65,604.31,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,Exception Members,90,479.71,,,,,,,38.99,1969.25,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,inpatient,,,700.00000,665.00000,The Alliance,Exception Members,90,539.00,,,,,,,385.00,679.00,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,outpatient,,,700.00000,665.00000,The Alliance,Exception Members,90,539.00,,,,,,,66.55,3361.35,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,The Alliance,Exception Members,TC,656.81,,,,,,,469.15,827.41,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Exception Members,TC,656.81,,,,,,,426.50,7351.18,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1483.00000,1408.85000,The Alliance,Exception Members,90,1141.91,,,,,,,815.65,1438.51,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Exception Members,90,1141.91,,,,,,,143.40,8250.66,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,inpatient,,,1635.00000,1553.25000,The Alliance,Exception Members,90,1258.95,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Exception Members,90,1258.95,,,,,,,116.74,9082.50,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,inpatient,,,4042.00000,3839.90000,The Alliance,Exception Members,TC,3112.34,,,,,,,2223.10,3920.74,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Exception Members,TC,3112.34,,,,,,,1836.07,19225.77,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,The Alliance,Exception Members,90,119.97,,,,,,,85.69,151.13,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Exception Members,90,119.97,,,,,,,12.45,1539.22,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,36.26,1833.46,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,The Alliance,Exception Members,90,114.19,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Exception Members,90,114.19,,,,,,,12.40,628.12,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,207.24,365.50,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,44.27,2240.90,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,inpatient,,,85.70000,81.41000,The Alliance,Exception Members,90,65.99,,,,,,,47.13,83.13,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,outpatient,,,85.70000,81.41000,The Alliance,Exception Members,90,65.99,,,,,,,12.40,628.12,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,inpatient,,,10203.00000,9692.85000,The Alliance,Exception Members,90,7856.31,,,,,,,5611.65,9896.91,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,outpatient,,,10203.00000,9692.85000,The Alliance,Exception Members,90,7856.31,,,,,,,928.00,9896.91,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,12.45,1539.22,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,19.88,1103.49,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,inpatient,,,108.70000,103.26000,The Alliance,Exception Members,90,83.70,,,,,,,59.78,105.44,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,outpatient,,,108.70000,103.26000,The Alliance,Exception Members,90,83.70,,,,,,,8.17,526.26,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,Exception Members,,473.55,,,,,,,338.25,596.55,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Exception Members,,473.55,,,,,,,17.90,933.70,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,inpatient,,,205.30000,195.04000,The Alliance,Exception Members,90,158.08,,,,,,,112.92,199.14,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,outpatient,,,205.30000,195.04000,The Alliance,Exception Members,90,158.08,,,,,,,19.26,882.80,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,inpatient,,,203.40000,193.23000,The Alliance,Exception Members,90,156.62,,,,,,,111.87,197.30,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,outpatient,,,203.40000,193.23000,The Alliance,Exception Members,90,156.62,,,,,,,15.10,679.08,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,4.75,254.68,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,inpatient,,,660.00000,627.00000,The Alliance,Exception Members,,508.20,,,,,,,363.00,640.20,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,outpatient,,,660.00000,627.00000,The Alliance,Exception Members,,508.20,,,,,,,35.91,891.44,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,Exception Members,TC,139.37,,,,,,,99.55,175.57,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Exception Members,TC,139.37,,,,,,,90.50,2993.62,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,The Alliance,Exception Members,90,114.19,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Exception Members,90,114.19,,,,,,,12.40,628.12,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4707.00000,4471.65000,The Alliance,Exception Members,90,3624.39,,,,,,,2588.85,4565.79,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4707.00000,4471.65000,The Alliance,Exception Members,90,3624.39,,,,,,,210.00,26177.94,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,inpatient,,,236.40000,224.58000,The Alliance,Exception Members,90,182.03,,,,,,,130.02,229.31,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,outpatient,,,236.40000,224.58000,The Alliance,Exception Members,90,182.03,,,,,,,28.87,1459.96,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,inpatient,,,212.80000,202.16000,The Alliance,Exception Members,90,163.86,,,,,,,117.04,206.42,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,outpatient,,,212.80000,202.16000,The Alliance,Exception Members,90,163.86,,,,,,,24.99,1256.24,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,inpatient,,,172.80000,164.16000,The Alliance,Exception Members,90,133.06,,,,,,,95.04,167.62,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,outpatient,,,172.80000,164.16000,The Alliance,Exception Members,90,133.06,,,,,,,45.08,679.08,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4895.00000,4650.25000,The Alliance,Exception Members,90,3769.15,,,,,,,2692.25,4748.15,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4895.00000,4650.25000,The Alliance,Exception Members,90,3769.15,,,,,,,210.00,26177.94,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,inpatient,,,319.60000,303.62000,The Alliance,Exception Members,90,246.09,,,,,,,175.78,310.01,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,outpatient,,,319.60000,303.62000,The Alliance,Exception Members,90,246.09,,,,,,,9.83,611.15,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,114.02,201.08,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,19.88,1103.49,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,inpatient,,,78.80000,74.86000,The Alliance,Exception Members,90,60.68,,,,,,,43.34,76.44,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Exception Members,90,60.68,,,,,,,8.17,696.05,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,inpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,18.15,32.01,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Exception Members,,25.41,,,,,,,3.48,169.79,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,inpatient,,,154.30000,146.58000,The Alliance,Exception Members,90,118.81,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Exception Members,90,118.81,,,,,,,17.85,814.87,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,140.80,248.32,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Exception Members,,197.12,,,,,,,128.00,1833.46,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,inpatient,,,672.00000,638.40000,The Alliance,Exception Members,TC,517.44,,,,,,,369.60,651.84,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,Exception Members,TC,517.44,,,,,,,336.00,4266.89,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,90,334.18,,,,,,,238.70,420.98,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,90,334.18,,,,,,,12.45,1539.22,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,99.66,175.76,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,20.36,1120.45,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1355.00000,1287.25000,The Alliance,Exception Members,TC,1043.35,,,,,,,745.25,1314.35,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,Exception Members,TC,1043.35,,,,,,,664.97,7351.18,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.10000,46.64000,The Alliance,Exception Members,90,37.81,,,,,,,27.00,47.63,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.10000,46.64000,The Alliance,Exception Members,90,37.81,,,,,,,4.49,220.68,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,169.78,299.44,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,12.45,1539.22,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,90,917.07,,,,,,,655.05,1155.27,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Exception Members,90,917.07,,,,,,,70.04,7350.89,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,inpatient,,,290.50000,275.97000,The Alliance,Exception Members,90,223.69,,,,,,,159.78,281.79,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,outpatient,,,290.50000,275.97000,The Alliance,Exception Members,90,223.69,,,,,,,28.73,1459.96,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,297.55,524.77,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Exception Members,,416.57,,,,,,,70.04,7350.89,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,inpatient,,,80.90000,76.86000,The Alliance,Exception Members,90,62.29,,,,,,,44.49,78.47,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,outpatient,,,80.90000,76.86000,The Alliance,Exception Members,90,62.29,,,,,,,8.17,424.40,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,19.88,1103.49,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,inpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,39.05,68.87,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Exception Members,,54.67,,,,,,,9.74,68.87,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,inpatient,,,184.30000,175.08000,The Alliance,Exception Members,,141.91,,,,,,,101.36,178.77,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,outpatient,,,184.30000,175.08000,The Alliance,Exception Members,,141.91,,,,,,,9.83,611.15,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,inpatient,,,199.30000,189.34000,The Alliance,Exception Members,90,153.46,,,,,,,109.61,193.32,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,outpatient,,,199.30000,189.34000,The Alliance,Exception Members,90,153.46,,,,,,,19.88,1103.49,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,Exception Members,90,50.05,,,,,,,35.75,63.05,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Exception Members,90,50.05,,,,,,,5.93,305.58,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,99.66,175.76,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,20.36,1120.45,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,Exception Members,90,46.20,,,,,,,33.00,58.20,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Exception Members,90,46.20,,,,,,,5.48,271.65,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,inpatient,,,81.30000,77.24000,The Alliance,Exception Members,90,62.60,,,,,,,44.72,78.86,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,outpatient,,,81.30000,77.24000,The Alliance,Exception Members,90,62.60,,,,,,,7.44,373.51,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,TC,2230.69,,,,,,,1593.35,2810.09,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,TC,2230.69,,,,,,,533.12,16173.22,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,inpatient,,,44.40000,42.18000,The Alliance,Exception Members,90,34.19,,,,,,,24.42,43.07,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,outpatient,,,44.40000,42.18000,The Alliance,Exception Members,90,34.19,,,,,,,4.06,203.72,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,inpatient,,,106.50000,101.17000,The Alliance,Exception Members,90,82.00,,,,,,,58.58,103.31,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,outpatient,,,106.50000,101.17000,The Alliance,Exception Members,90,82.00,,,,,,,12.51,628.12,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,inpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,267.30,471.42,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Exception Members,,374.22,,,,,,,35.91,891.44,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,Exception Members,90,408.10,,,,,,,291.50,514.10,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Exception Members,90,408.10,,,,,,,100.54,7096.21,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,5.35,271.65,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,90,403.48,,,,,,,288.20,508.28,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,90,403.48,,,,,,,12.45,1539.22,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,inpatient,,,2799.00000,2659.05000,The Alliance,Exception Members,90,2155.23,,,,,,,1539.45,2715.03,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,outpatient,,,2799.00000,2659.05000,The Alliance,Exception Members,90,2155.23,,,,,,,266.02,13462.44,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,40.15,70.81,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Exception Members,,56.21,,,,,,,6.47,339.51,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,inpatient,,,379.70000,360.71000,The Alliance,Exception Members,90,292.37,,,,,,,208.84,368.31,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,outpatient,,,379.70000,360.71000,The Alliance,Exception Members,90,292.37,,,,,,,46.38,2105.11,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,inpatient,,,556.00000,528.20000,The Alliance,Exception Members,,428.12,,,,,,,305.80,539.32,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,Exception Members,,428.12,,,,,,,278.00,539.32,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,inpatient,,,33.00000,31.35000,The Alliance,Exception Members,90,25.41,,,,,,,18.15,32.01,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Exception Members,90,25.41,,,,,,,4.57,271.65,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,58.35,102.92,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,inpatient,,,56.80000,53.96000,The Alliance,Exception Members,90,43.74,,,,,,,31.24,55.10,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,outpatient,,,56.80000,53.96000,The Alliance,Exception Members,90,43.74,,,,,,,4.24,254.68,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,The Alliance,Exception Members,90,333.26,,,,,,,238.04,419.82,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Exception Members,90,333.26,,,,,,,52.89,2410.69,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,inpatient,,,201.60000,191.52000,The Alliance,Exception Members,,155.23,,,,,,,110.88,195.55,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,outpatient,,,201.60000,191.52000,The Alliance,Exception Members,,155.23,,,,,,,18.54,967.70,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,inpatient,,,154.30000,146.58000,The Alliance,Exception Members,90,118.81,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Exception Members,90,118.81,,,,,,,14.59,729.98,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,58.35,102.92,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,12.45,628.12,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,inpatient,,,211.70000,201.11000,The Alliance,Exception Members,90,163.01,,,,,,,116.44,205.35,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,outpatient,,,211.70000,201.11000,The Alliance,Exception Members,90,163.01,,,,,,,24.88,1256.24,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,inpatient,,,49.60000,47.12000,The Alliance,Exception Members,90,38.19,,,,,,,27.28,48.11,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,outpatient,,,49.60000,47.12000,The Alliance,Exception Members,90,38.19,,,,,,,24.80,1052.52,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,inpatient,,,142.10000,134.99000,The Alliance,Exception Members,90,109.42,,,,,,,78.16,137.84,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,outpatient,,,142.10000,134.99000,The Alliance,Exception Members,90,109.42,,,,,,,13.00,662.12,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,inpatient,,,164.70000,156.46000,The Alliance,Exception Members,,126.82,,,,,,,90.58,159.76,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,outpatient,,,164.70000,156.46000,The Alliance,Exception Members,,126.82,,,,,,,15.78,763.98,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,inpatient,,,175.10000,166.34000,The Alliance,Exception Members,90,134.83,,,,,,,96.31,169.85,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,outpatient,,,175.10000,166.34000,The Alliance,Exception Members,90,134.83,,,,,,,21.79,984.66,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,The Alliance,Exception Members,TC,1991.22,,,,,,,1422.30,2508.42,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Exception Members,TC,1991.22,,,,,,,1293.00,13397.25,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,inpatient,,,101.90000,96.81000,The Alliance,Exception Members,90,78.46,,,,,,,56.05,98.84,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Exception Members,90,78.46,,,,,,,12.45,628.12,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,inpatient,,,259.70000,246.71000,The Alliance,Exception Members,90,199.97,,,,,,,142.84,251.91,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,outpatient,,,259.70000,246.71000,The Alliance,Exception Members,90,199.97,,,,,,,30.51,1544.85,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,90,91.63,,,,,,,65.45,115.43,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,90,91.63,,,,,,,6.85,339.51,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,inpatient,,,153.70000,146.01000,The Alliance,Exception Members,90,118.35,,,,,,,84.53,149.09,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,outpatient,,,153.70000,146.01000,The Alliance,Exception Members,90,118.35,,,,,,,14.05,713.01,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,Exception Members,90,61.45,,,,,,,43.89,77.41,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Exception Members,90,61.45,,,,,,,4.57,271.65,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,inpatient,,,77.70000,73.82000,The Alliance,Exception Members,,59.83,,,,,,,42.73,75.37,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,outpatient,,,77.70000,73.82000,The Alliance,Exception Members,,59.83,,,,,,,6.87,356.54,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,90,1130.36,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,90,1130.36,,,,,,,179.44,8692.03,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,inpatient,,,145.40000,138.13000,The Alliance,Exception Members,90,111.96,,,,,,,79.97,141.04,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,outpatient,,,145.40000,138.13000,The Alliance,Exception Members,90,111.96,,,,,,,72.70,1137.41,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,inpatient,,,2846.00000,2703.70000,The Alliance,Exception Members,90,2191.42,,,,,,,1565.30,2760.62,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,outpatient,,,2846.00000,2703.70000,The Alliance,Exception Members,90,2191.42,,,,,,,139.23,15227.97,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,inpatient,,,455.80000,433.01000,The Alliance,Exception Members,,350.97,,,,,,,250.69,442.13,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,outpatient,,,455.80000,433.01000,The Alliance,Exception Members,,350.97,,,,,,,109.60,6451.13,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,inpatient,,,792.00000,752.40000,The Alliance,Exception Members,90,609.84,,,,,,,435.60,768.24,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,outpatient,,,792.00000,752.40000,The Alliance,Exception Members,90,609.84,,,,,,,12.45,1539.22,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,Exception Members,90,548.24,,,,,,,391.60,690.64,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Exception Members,90,548.24,,,,,,,36.26,1833.46,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,37.56,66.25,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,8.35,424.40,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,inpatient,,,193.40000,183.73000,The Alliance,Exception Members,90,148.92,,,,,,,106.37,187.60,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,outpatient,,,193.40000,183.73000,The Alliance,Exception Members,90,148.92,,,,,,,45.08,679.08,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,207.24,365.50,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Exception Members,90,290.14,,,,,,,44.27,2240.90,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,90,2230.69,,,,,,,1593.35,2810.09,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,90,2230.69,,,,,,,329.51,15625.93,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,inpatient,,,121.30000,115.23000,The Alliance,Exception Members,90,93.40,,,,,,,66.72,117.66,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,outpatient,,,121.30000,115.23000,The Alliance,Exception Members,90,93.40,,,,,,,14.25,645.08,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,24.89,1137.41,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,inpatient,,,85.30000,81.03000,The Alliance,Exception Members,90,65.68,,,,,,,46.91,82.74,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,outpatient,,,85.30000,81.03000,The Alliance,Exception Members,90,65.68,,,,,,,10.02,509.30,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,88.99,156.95,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,14.05,713.01,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,58.30,102.82,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,10.66,543.22,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,37.56,66.25,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,8.35,424.40,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,inpatient,,,238.60000,226.67000,The Alliance,Exception Members,,183.72,,,,,,,131.23,231.44,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,outpatient,,,238.60000,226.67000,The Alliance,Exception Members,,183.72,,,,,,,24.11,1137.41,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,Exception Members,90,110.11,,,,,,,78.65,138.71,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Exception Members,90,110.11,,,,,,,16.80,848.80,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,inpatient,,,122.60000,116.47000,The Alliance,Exception Members,,94.40,,,,,,,67.43,118.92,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Exception Members,,94.40,,,,,,,5.51,288.61,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,inpatient,,,5712.00000,5426.40000,The Alliance,Exception Members,90,4398.24,,,,,,,3141.60,5540.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,outpatient,,,5712.00000,5426.40000,The Alliance,Exception Members,90,4398.24,,,,,,,270.25,31763.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,90,160.16,,,,,,,114.40,201.76,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,90,160.16,,,,,,,24.43,1205.34,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,389.40,686.76,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Exception Members,,545.16,,,,,,,354.00,686.76,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2794.00000,2654.30000,The Alliance,Exception Members,TC,2151.38,,,,,,,1536.70,2710.18,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2794.00000,2654.30000,The Alliance,Exception Members,TC,2151.38,,,,,,,533.12,16173.22,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,inpatient,,,103.50000,98.32000,The Alliance,Exception Members,90,79.69,,,,,,,56.92,100.39,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,outpatient,,,103.50000,98.32000,The Alliance,Exception Members,90,79.69,,,,,,,12.16,611.15,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,inpatient,,,275.40000,261.63000,The Alliance,Exception Members,90,212.06,,,,,,,151.47,267.14,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,outpatient,,,275.40000,261.63000,The Alliance,Exception Members,90,212.06,,,,,,,23.08,2082.45,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,91.80,161.89,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,19.60,984.66,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,QW,83.93,,,,,,,59.95,105.73,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,QW,83.93,,,,,,,9.71,509.30,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2906.00000,2760.70000,The Alliance,Exception Members,TC,2237.62,,,,,,,1598.30,2818.82,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2906.00000,2760.70000,The Alliance,Exception Members,TC,2237.62,,,,,,,533.12,16173.22,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,163.24,287.90,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,36.26,1833.46,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,inpatient,,,5428.00000,5156.60000,The Alliance,Exception Members,90,4179.56,,,,,,,2985.40,5265.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,outpatient,,,5428.00000,5156.60000,The Alliance,Exception Members,90,4179.56,,,,,,,230.26,30184.37,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,5.68,372.96,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,inpatient,,,398.80000,378.86000,The Alliance,Exception Members,90,307.08,,,,,,,219.34,386.84,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,outpatient,,,398.80000,378.86000,The Alliance,Exception Members,90,307.08,,,,,,,50.66,2563.44,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,inpatient,,,162.80000,154.66000,The Alliance,Exception Members,,125.36,,,,,,,89.54,157.92,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Exception Members,,125.36,,,,,,,9.30,492.33,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,169.78,299.44,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,36.26,1833.46,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,inpatient,,,282.30000,268.18000,The Alliance,Exception Members,90,217.37,,,,,,,155.26,273.83,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,outpatient,,,282.30000,268.18000,The Alliance,Exception Members,90,217.37,,,,,,,25.78,1307.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2560.00000,2432.00000,The Alliance,Exception Members,90,1971.20,,,,,,,1408.00,2483.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2560.00000,2432.00000,The Alliance,Exception Members,90,1971.20,,,,,,,266.02,13462.44,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,Exception Members,90,141.68,,,,,,,101.20,178.48,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Exception Members,90,141.68,,,,,,,20.36,1120.45,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,The Alliance,Exception Members,90,5861.24,,,,,,,4186.60,7383.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Exception Members,90,5861.24,,,,,,,516.91,42339.61,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,inpatient,,,1098.00000,1043.10000,The Alliance,Exception Members,90,845.46,,,,,,,603.90,1065.06,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,outpatient,,,1098.00000,1043.10000,The Alliance,Exception Members,90,845.46,,,,,,,73.92,5873.90,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,inpatient,,,1721.00000,1634.95000,The Alliance,Exception Members,90,1325.17,,,,,,,946.55,1669.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,outpatient,,,1721.00000,1634.95000,The Alliance,Exception Members,90,1325.17,,,,,,,177.33,9574.83,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,inpatient,,,92.90000,88.25000,The Alliance,Exception Members,90,71.53,,,,,,,51.09,90.11,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,outpatient,,,92.90000,88.25000,The Alliance,Exception Members,90,71.53,,,,,,,46.45,90.11,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,inpatient,,,283.10000,268.94000,The Alliance,Exception Members,90,217.99,,,,,,,155.71,274.61,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,outpatient,,,283.10000,268.94000,The Alliance,Exception Members,90,217.99,,,,,,,34.58,1578.85,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,Exception Members,,161.47,,,,,,,115.33,203.41,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Exception Members,,161.47,,,,,,,24.11,1137.41,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,96.36,169.94,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Exception Members,90,134.90,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,inpatient,,,5721.00000,5434.95000,The Alliance,Exception Members,90,4405.17,,,,,,,3146.55,5549.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,outpatient,,,5721.00000,5434.95000,The Alliance,Exception Members,90,4405.17,,,,,,,625.03,31831.15,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,Exception Members,TC,91.63,,,,,,,65.45,115.43,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Exception Members,TC,91.63,,,,,,,59.50,7351.18,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,inpatient,,,134.60000,127.87000,The Alliance,Exception Members,90,103.64,,,,,,,74.03,130.56,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,outpatient,,,134.60000,127.87000,The Alliance,Exception Members,90,103.64,,,,,,,15.10,679.08,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,The Alliance,Exception Members,90,94.17,,,,,,,67.27,118.63,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Exception Members,90,94.17,,,,,,,12.40,628.12,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,Exception Members,90,756.91,,,,,,,540.65,953.51,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Exception Members,90,756.91,,,,,,,36.26,1833.46,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,inpatient,,,654.00000,621.30000,The Alliance,Exception Members,90,503.58,,,,,,,359.70,634.38,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,outpatient,,,654.00000,621.30000,The Alliance,Exception Members,90,503.58,,,,,,,76.81,3802.79,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,56.10,98.94,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Exception Members,,78.54,,,,,,,11.89,645.08,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,Exception Members,,157.23,,,,,,,112.31,198.07,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Exception Members,,157.23,,,,,,,24.11,1137.41,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,90,1252.79,,,,,,,894.85,1578.19,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,90,1252.79,,,,,,,164.96,9048.50,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,The Alliance,Exception Members,90,96.40,,,,,,,68.86,121.44,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Exception Members,90,96.40,,,,,,,62.60,8610.62,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,163.24,287.90,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Exception Members,90,228.54,,,,,,,36.26,1833.46,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,inpatient,,,216.20000,205.39000,The Alliance,Exception Members,90,166.47,,,,,,,118.91,209.71,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Exception Members,90,166.47,,,,,,,108.10,1137.41,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,28.00,1341.13,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,The Alliance,Exception Members,90,72.07,,,,,,,51.48,90.79,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Exception Members,90,72.07,,,,,,,4.57,271.65,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,24.91,1137.41,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,169.78,299.44,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,36.26,1833.46,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Exception Members,90,296.06,,,,,,,5.35,372.96,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,Exception Members,90,64.68,,,,,,,46.20,81.48,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Exception Members,90,64.68,,,,,,,10.66,543.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,inpatient,,,618.00000,587.10000,The Alliance,Exception Members,90,475.86,,,,,,,339.90,599.46,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,outpatient,,,618.00000,587.10000,The Alliance,Exception Members,90,475.86,,,,,,,36.26,1833.46,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,inpatient,,,345.50000,328.22000,The Alliance,Exception Members,90,266.04,,,,,,,190.03,335.13,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,outpatient,,,345.50000,328.22000,The Alliance,Exception Members,90,266.04,,,,,,,20.36,1120.45,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,90,334.18,,,,,,,238.70,420.98,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,90,334.18,,,,,,,12.45,1539.22,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,inpatient,,,431.20000,409.64000,The Alliance,Exception Members,90,332.02,,,,,,,237.16,418.26,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,outpatient,,,431.20000,409.64000,The Alliance,Exception Members,90,332.02,,,,,,,50.66,2563.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,The Alliance,Exception Members,90,96.40,,,,,,,68.86,121.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Exception Members,90,96.40,,,,,,,62.60,8610.62,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,90,1252.79,,,,,,,894.85,1578.19,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Exception Members,90,1252.79,,,,,,,164.96,9048.50,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,inpatient,,,109.40000,103.93000,The Alliance,Exception Members,90,84.24,,,,,,,60.17,106.12,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,outpatient,,,109.40000,103.93000,The Alliance,Exception Members,90,84.24,,,,,,,11.16,560.26,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,Exception Members,TC,396.55,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Exception Members,TC,396.55,,,,,,,138.83,1411.00,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,inpatient,,,285.50000,271.22000,The Alliance,Exception Members,90,219.84,,,,,,,157.03,276.94,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,outpatient,,,285.50000,271.22000,The Alliance,Exception Members,90,219.84,,,,,,,36.26,1833.46,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,Exception Members,90,77.92,,,,,,,55.66,98.16,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Exception Members,90,77.92,,,,,,,50.60,1137.41,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,12.45,1539.22,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,inpatient,,,3228.00000,3066.60000,The Alliance,Exception Members,90,2485.56,,,,,,,1775.40,3131.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,outpatient,,,3228.00000,3066.60000,The Alliance,Exception Members,90,2485.56,,,,,,,103.62,17961.21,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,12.45,1539.22,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,The Alliance,Exception Members,,107.65,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Exception Members,,107.65,,,,,,,12.05,1786.28,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,The Alliance,Exception Members,90,107.65,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Exception Members,90,107.65,,,,,,,12.05,1786.28,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,inpatient,,,58.30000,55.38000,The Alliance,Exception Members,90,44.89,,,,,,,32.06,56.55,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,outpatient,,,58.30000,55.38000,The Alliance,Exception Members,90,44.89,,,,,,,6.85,339.51,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,37.56,66.25,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Exception Members,90,52.59,,,,,,,8.35,424.40,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,inpatient,,,100.50000,95.47000,The Alliance,Exception Members,,77.39,,,,,,,55.27,97.48,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,outpatient,,,100.50000,95.47000,The Alliance,Exception Members,,77.39,,,,,,,50.25,97.48,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,inpatient,,,4214.00000,4003.30000,The Alliance,Exception Members,90,3244.78,,,,,,,2317.70,4087.58,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4214.00000,4003.30000,The Alliance,Exception Members,90,3244.78,,,,,,,282.88,13309.69,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,The Alliance,Exception Members,TC,657.58,,,,,,,469.70,828.38,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Exception Members,TC,657.58,,,,,,,427.00,7351.18,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,90,2230.69,,,,,,,1593.35,2810.09,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Exception Members,90,2230.69,,,,,,,329.51,15625.93,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,inpatient,,,2602.00000,2471.90000,The Alliance,Exception Members,90,2003.54,,,,,,,1431.10,2523.94,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Exception Members,90,2003.54,,,,,,,236.63,13920.84,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,inpatient,,,5275.00000,5011.25000,The Alliance,Exception Members,90,4061.75,,,,,,,2901.25,5116.75,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,outpatient,,,5275.00000,5011.25000,The Alliance,Exception Members,90,4061.75,,,,,,,2637.50,5605.44,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,inpatient,,,1456.00000,1383.20000,The Alliance,Exception Members,90,1121.12,,,,,,,800.80,1412.32,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,outpatient,,,1456.00000,1383.20000,The Alliance,Exception Members,90,1121.12,,,,,,,132.74,7792.26,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,inpatient,,,1483.00000,1408.85000,The Alliance,Exception Members,90,1141.91,,,,,,,815.65,1438.51,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Exception Members,90,1141.91,,,,,,,140.32,8250.66,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,20.35,35.89,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,,28.49,,,,,,,18.50,35.89,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,inpatient,,,321.00000,304.95000,The Alliance,Exception Members,90,247.17,,,,,,,176.55,311.37,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,outpatient,,,321.00000,304.95000,The Alliance,Exception Members,90,247.17,,,,,,,14.19,713.01,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,The Alliance,Exception Members,TC,657.58,,,,,,,469.70,828.38,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Exception Members,TC,657.58,,,,,,,427.00,7351.18,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,The Alliance,Exception Members,90,589.82,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Exception Members,90,589.82,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,536.80,946.72,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Exception Members,90,751.52,,,,,,,119.20,6026.72,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,inpatient,,,152.40000,144.78000,The Alliance,Exception Members,,117.35,,,,,,,83.82,147.83,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,outpatient,,,152.40000,144.78000,The Alliance,Exception Members,,117.35,,,,,,,15.00,713.01,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,inpatient,,,134.50000,127.77000,The Alliance,Exception Members,90,103.56,,,,,,,73.97,130.47,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,outpatient,,,134.50000,127.77000,The Alliance,Exception Members,90,103.56,,,,,,,14.93,679.08,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,inpatient,,,153.50000,145.82000,The Alliance,Exception Members,90,118.19,,,,,,,84.42,148.90,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,outpatient,,,153.50000,145.82000,The Alliance,Exception Members,90,118.19,,,,,,,76.75,1137.41,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,inpatient,,,154.10000,146.39000,The Alliance,Exception Members,,118.66,,,,,,,84.75,149.48,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,outpatient,,,154.10000,146.39000,The Alliance,Exception Members,,118.66,,,,,,,13.05,679.08,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,inpatient,,,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.45,8.63,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.20000,53.39000,The Alliance,Exception Members,,43.27,,,,,,,30.91,54.51,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.20000,53.39000,The Alliance,Exception Members,,43.27,,,,,,,5.18,271.65,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,inpatient,,,1567.00000,1488.65000,The Alliance,Exception Members,90,1206.59,,,,,,,861.85,1519.99,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,outpatient,,,1567.00000,1488.65000,The Alliance,Exception Members,90,1206.59,,,,,,,185.20,8708.99,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,196.35,346.29,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Exception Members,,274.89,,,,,,,35.09,1833.46,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,87.23,153.84,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Exception Members,90,122.12,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,The Alliance,Exception Members,90,589.82,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Exception Members,90,589.82,,,,,,,12.45,1539.22,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,inpatient,,,217.80000,206.91000,The Alliance,Exception Members,,167.71,,,,,,,119.79,211.27,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,outpatient,,,217.80000,206.91000,The Alliance,Exception Members,,167.71,,,,,,,14.28,780.94,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,Exception Members,90,137.83,,,,,,,98.45,173.63,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Exception Members,90,137.83,,,,,,,89.50,1137.41,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,37.78,66.64,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,,52.90,,,,,,,8.17,679.08,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,inpatient,,,11319.00000,10753.05000,The Alliance,Exception Members,90,8715.63,,,,,,,6225.45,10979.43,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,outpatient,,,11319.00000,10753.05000,The Alliance,Exception Members,90,8715.63,,,,,,,1287.00,60538.53,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,Exception Members,,104.87,,,,,,,74.91,132.11,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Exception Members,,104.87,,,,,,,12.05,1539.22,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,169.78,299.44,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Exception Members,90,237.70,,,,,,,28.07,299.44,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,inpatient,,,8234.00000,7822.30000,The Alliance,Exception Members,90,6340.18,,,,,,,4528.70,7986.98,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,outpatient,,,8234.00000,7822.30000,The Alliance,Exception Members,90,6340.18,,,,,,,936.00,44037.28,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,inpatient,,,340.70000,323.66000,The Alliance,Exception Members,90,262.34,,,,,,,187.38,330.48,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Exception Members,90,262.34,,,,,,,20.36,1120.45,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,inpatient,,,193.00000,183.35000,The Alliance,Exception Members,,148.61,,,,,,,106.15,187.21,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Exception Members,,148.61,,,,,,,20.26,1052.52,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,The Alliance,Exception Members,TC,676.83,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Exception Members,TC,676.83,,,,,,,96.44,1292.36,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,inpatient,,,170.10000,161.60000,The Alliance,Exception Members,,130.98,,,,,,,93.56,165.00,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Exception Members,,130.98,,,,,,,14.39,746.94,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,53.52,94.38,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,inpatient,,,63.80000,60.61000,The Alliance,Exception Members,,49.13,,,,,,,35.09,61.89,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,outpatient,,,63.80000,60.61000,The Alliance,Exception Members,,49.13,,,,,,,5.50,288.61,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,inpatient,,,382.00000,362.90000,The Alliance,Exception Members,90,294.14,,,,,,,210.10,370.54,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,outpatient,,,382.00000,362.90000,The Alliance,Exception Members,90,294.14,,,,,,,152.01,370.54,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,inpatient,,,3120.00000,2964.00000,The Alliance,Exception Members,TC,2402.40,,,,,,,1716.00,3026.40,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Exception Members,TC,2402.40,,,,,,,1560.00,14719.32,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,3.48,169.79,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,inpatient,,,61.50000,58.42000,The Alliance,Exception Members,,47.35,,,,,,,33.83,59.66,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,outpatient,,,61.50000,58.42000,The Alliance,Exception Members,,47.35,,,,,,,30.75,59.66,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,inpatient,,,1700.00000,1615.00000,The Alliance,Exception Members,90,1309.00,,,,,,,935.00,1649.00,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,outpatient,,,1700.00000,1615.00000,The Alliance,Exception Members,90,1309.00,,,,,,,154.60,9082.50,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,inpatient,,,846.00000,803.70000,The Alliance,Exception Members,90,651.42,,,,,,,465.30,820.62,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,outpatient,,,846.00000,803.70000,The Alliance,Exception Members,90,651.42,,,,,,,423.00,820.62,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,5.35,271.65,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,inpatient,,,280.70000,266.66000,The Alliance,Exception Members,90,216.14,,,,,,,154.38,272.28,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,outpatient,,,280.70000,266.66000,The Alliance,Exception Members,90,216.14,,,,,,,8.35,424.40,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,Exception Members,,43.20,,,,,,,30.86,54.42,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Exception Members,,43.20,,,,,,,28.05,54.42,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,inpatient,,,155.70000,147.92000,The Alliance,Exception Members,90,119.89,,,,,,,85.64,151.03,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,outpatient,,,155.70000,147.92000,The Alliance,Exception Members,90,119.89,,,,,,,19.00,865.84,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,inpatient,,,105.50000,100.22000,The Alliance,Exception Members,90,81.23,,,,,,,58.02,102.33,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,outpatient,,,105.50000,100.22000,The Alliance,Exception Members,90,81.23,,,,,,,8.37,373.51,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,58.35,102.92,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Exception Members,90,81.70,,,,,,,12.45,1539.22,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,inpatient,,,2324.00000,2207.80000,The Alliance,Exception Members,90,1789.48,,,,,,,1278.20,2254.28,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,outpatient,,,2324.00000,2207.80000,The Alliance,Exception Members,90,1789.48,,,,,,,274.83,12936.18,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,inpatient,,,2548.00000,2420.60000,The Alliance,Exception Members,90,1961.96,,,,,,,1401.40,2471.56,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,outpatient,,,2548.00000,2420.60000,The Alliance,Exception Members,90,1961.96,,,,,,,301.35,14175.45,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,inpatient,,,730.00000,693.50000,The Alliance,Exception Members,90,562.10,,,,,,,401.50,708.10,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,outpatient,,,730.00000,693.50000,The Alliance,Exception Members,90,562.10,,,,,,,85.76,3904.65,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,The Alliance,Exception Members,90,333.26,,,,,,,238.04,419.82,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Exception Members,90,333.26,,,,,,,52.89,2410.69,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,Exception Members,90,512.05,,,,,,,365.75,645.05,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Exception Members,90,512.05,,,,,,,52.77,2410.69,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,Exception Members,TC,87.78,,,,,,,62.70,110.58,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Exception Members,TC,87.78,,,,,,,57.00,7351.18,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1382.00000,1312.90000,The Alliance,Exception Members,,1064.14,,,,,,,760.10,1340.54,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1382.00000,1312.90000,The Alliance,Exception Members,,1064.14,,,,,,,122.22,6383.20,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,Exception Members,90,314.16,,,,,,,224.40,395.76,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Exception Members,90,314.16,,,,,,,5.68,395.76,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,inpatient,,,233.40000,221.73000,The Alliance,Exception Members,90,179.72,,,,,,,128.37,226.40,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,outpatient,,,233.40000,221.73000,The Alliance,Exception Members,90,179.72,,,,,,,21.69,226.40,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,The Alliance,Exception Members,90,257.03,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Exception Members,90,257.03,,,,,,,166.90,19453.17,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,90,59.29,,,,,,,42.35,74.69,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,90,59.29,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,inpatient,,,120.70000,114.66000,The Alliance,Exception Members,,92.94,,,,,,,66.39,117.08,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,outpatient,,,120.70000,114.66000,The Alliance,Exception Members,,92.94,,,,,,,10.63,543.22,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,Exception Members,90,620.62,,,,,,,443.30,781.82,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Exception Members,90,620.62,,,,,,,94.71,4787.38,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,inpatient,,,569.00000,540.55000,The Alliance,Exception Members,,438.13,,,,,,,312.95,551.93,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Exception Members,,438.13,,,,,,,284.50,551.93,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2393.00000,2273.35000,The Alliance,Exception Members,90,1842.61,,,,,,,1316.15,2321.21,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2393.00000,2273.35000,The Alliance,Exception Members,90,1842.61,,,,,,,282.88,13309.69,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,inpatient,,,252.90000,240.26000,The Alliance,Exception Members,90,194.73,,,,,,,139.09,245.31,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,outpatient,,,252.90000,240.26000,The Alliance,Exception Members,90,194.73,,,,,,,24.89,1137.41,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,12.45,1539.22,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,The Alliance,Exception Members,90,257.03,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Exception Members,90,257.03,,,,,,,166.90,19453.17,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,inpatient,,,590.40000,560.88000,The Alliance,Exception Members,90,454.61,,,,,,,324.72,572.69,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,outpatient,,,590.40000,560.88000,The Alliance,Exception Members,90,454.61,,,,,,,295.20,572.69,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4864.00000,4620.80000,The Alliance,Exception Members,90,3745.28,,,,,,,2675.20,4718.08,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4864.00000,4620.80000,The Alliance,Exception Members,90,3745.28,,,,,,,597.91,28130.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Exception Members,90,406.56,,,,,,,12.45,1539.22,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Exception Members,90,190.19,,,,,,,25.31,2286.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,inpatient,,,934.00000,887.30000,The Alliance,Exception Members,,719.18,,,,,,,513.70,905.98,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,outpatient,,,934.00000,887.30000,The Alliance,Exception Members,,719.18,,,,,,,467.00,8610.62,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,,1099.56,,,,,,,785.40,1385.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Exception Members,,1099.56,,,,,,,143.40,8250.66,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,99.66,175.76,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,20.36,1120.45,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,inpatient,,,250.50000,237.98000,The Alliance,Exception Members,90,192.88,,,,,,,137.78,242.99,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,outpatient,,,250.50000,237.98000,The Alliance,Exception Members,90,192.88,,,,,,,24.89,1137.41,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,inpatient,,,220.90000,209.85000,The Alliance,Exception Members,90,170.09,,,,,,,121.50,214.27,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,outpatient,,,220.90000,209.85000,The Alliance,Exception Members,90,170.09,,,,,,,8.35,424.40,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,The Alliance,Exception Members,90,5861.24,,,,,,,4186.60,7383.64,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Exception Members,90,5861.24,,,,,,,516.91,42339.61,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,inpatient,,,2501.00000,2375.95000,The Alliance,Exception Members,90,1925.77,,,,,,,1375.55,2425.97,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,outpatient,,,2501.00000,2375.95000,The Alliance,Exception Members,90,1925.77,,,,,,,175.10,13920.84,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,inpatient,,,27.00000,25.65000,The Alliance,Exception Members,,20.79,,,,,,,14.85,26.19,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,Exception Members,,20.79,,,,,,,2.25,118.82,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Exception Members,90,250.63,,,,,,,12.45,1539.22,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,QW,26.95,,,,,,,19.25,33.95,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,QW,26.95,,,,,,,16.53,780.94,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,inpatient,,,96.60000,91.77000,The Alliance,Exception Members,90,74.38,,,,,,,53.13,93.70,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,outpatient,,,96.60000,91.77000,The Alliance,Exception Members,90,74.38,,,,,,,48.30,1137.41,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,inpatient,,,263.80000,250.61000,The Alliance,Exception Members,90,203.13,,,,,,,145.09,255.89,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,outpatient,,,263.80000,250.61000,The Alliance,Exception Members,90,203.13,,,,,,,131.90,3072.74,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,inpatient,,,37.10000,35.24000,The Alliance,Exception Members,90,28.57,,,,,,,20.41,35.99,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,outpatient,,,37.10000,35.24000,The Alliance,Exception Members,90,28.57,,,,,,,4.55,237.65,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,inpatient,,,233.70000,222.01000,The Alliance,Exception Members,,179.95,,,,,,,128.53,226.69,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,outpatient,,,233.70000,222.01000,The Alliance,Exception Members,,179.95,,,,,,,20.67,1086.52,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1574.00000,1495.30000,The Alliance,Exception Members,,1211.98,,,,,,,865.70,1526.78,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1574.00000,1495.30000,The Alliance,Exception Members,,1211.98,,,,,,,157.98,9082.50,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,21.21,1001.63,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,inpatient,,,291.20000,276.64000,The Alliance,Exception Members,,224.22,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Exception Members,,224.22,,,,,,,145.60,13920.84,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,The Alliance,Exception Members,TC,656.81,,,,,,,469.15,827.41,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Exception Members,TC,656.81,,,,,,,426.50,7351.18,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,inpatient,,,291.20000,276.64000,The Alliance,Exception Members,,224.22,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Exception Members,,224.22,,,,,,,145.60,8708.99,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,Exception Members,,20.02,,,,,,,14.30,25.22,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Exception Members,,20.02,,,,,,,2.37,118.82,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,5.35,271.65,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,3526.00000,3349.70000,The Alliance,Exception Members,90,2715.02,,,,,,,1939.30,3420.22,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,3526.00000,3349.70000,The Alliance,Exception Members,90,2715.02,,,,,,,1458.73,3420.22,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,6.23,322.54,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,3.28,152.82,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,114.02,201.08,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Exception Members,90,159.62,,,,,,,11.91,594.19,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,inpatient,,,98.10000,93.19000,The Alliance,Exception Members,90,75.54,,,,,,,53.95,95.16,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,outpatient,,,98.10000,93.19000,The Alliance,Exception Members,90,75.54,,,,,,,9.32,475.37,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,inpatient,,,283.60000,269.42000,The Alliance,Exception Members,,218.37,,,,,,,155.98,275.09,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,outpatient,,,283.60000,269.42000,The Alliance,Exception Members,,218.37,,,,,,,20.36,1120.45,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,inpatient,,,438.90000,416.96000,The Alliance,Exception Members,,337.95,,,,,,,241.40,425.73,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,outpatient,,,438.90000,416.96000,The Alliance,Exception Members,,337.95,,,,,,,219.45,425.73,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,inpatient,,,123.40000,117.23000,The Alliance,Exception Members,90,95.02,,,,,,,67.87,119.70,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,outpatient,,,123.40000,117.23000,The Alliance,Exception Members,90,95.02,,,,,,,28.73,1459.96,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,inpatient,,,12.10000,11.49000,The Alliance,Exception Members,,9.32,,,,,,,6.66,11.74,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,outpatient,,,12.10000,11.49000,The Alliance,Exception Members,,9.32,,,,,,,6.05,11.74,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,Exception Members,90,43.20,,,,,,,30.86,54.42,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Exception Members,90,43.20,,,,,,,4.91,254.68,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,inpatient,,,49.30000,46.83000,The Alliance,Exception Members,90,37.96,,,,,,,27.11,47.82,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Exception Members,90,37.96,,,,,,,5.67,254.68,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,inpatient,,,320.60000,304.57000,The Alliance,Exception Members,90,246.86,,,,,,,176.33,310.98,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,outpatient,,,320.60000,304.57000,The Alliance,Exception Members,90,246.86,,,,,,,16.59,831.84,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.80000,58.71000,The Alliance,Exception Members,90,47.59,,,,,,,33.99,59.95,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.80000,58.71000,The Alliance,Exception Members,90,47.59,,,,,,,5.35,271.65,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,inpatient,,,116.30000,110.48000,The Alliance,Exception Members,90,89.55,,,,,,,63.97,112.81,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Exception Members,90,89.55,,,,,,,58.15,1137.41,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,inpatient,,,425.70000,404.41000,The Alliance,Exception Members,90,327.79,,,,,,,234.13,412.93,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,outpatient,,,425.70000,404.41000,The Alliance,Exception Members,90,327.79,,,,,,,24.89,1137.41,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,90,83.93,,,,,,,59.95,105.73,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,90,83.93,,,,,,,8.17,679.08,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,inpatient,,,75.10000,71.34000,The Alliance,Exception Members,90,57.83,,,,,,,41.30,72.85,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,outpatient,,,75.10000,71.34000,The Alliance,Exception Members,90,57.83,,,,,,,8.94,458.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,The Alliance,Exception Members,TC,1138.83,,,,,,,813.45,1434.63,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Exception Members,TC,1138.83,,,,,,,401.07,4167.07,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,inpatient,,,153.00000,145.35000,The Alliance,Exception Members,90,117.81,,,,,,,84.15,148.41,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Exception Members,90,117.81,,,,,,,63.32,148.41,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,inpatient,,,49.70000,47.22000,The Alliance,Exception Members,90,38.27,,,,,,,27.34,48.21,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,outpatient,,,49.70000,47.22000,The Alliance,Exception Members,90,38.27,,,,,,,6.08,305.58,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,inpatient,,,59.50000,56.52000,The Alliance,Exception Members,90,45.81,,,,,,,32.73,57.72,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,outpatient,,,59.50000,56.52000,The Alliance,Exception Members,90,45.81,,,,,,,14.93,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,inpatient,,,271.50000,257.92000,The Alliance,Exception Members,90,209.06,,,,,,,149.32,263.36,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,outpatient,,,271.50000,257.92000,The Alliance,Exception Members,90,209.06,,,,,,,20.36,1120.45,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,inpatient,,,292.10000,277.50000,The Alliance,Exception Members,90,224.92,,,,,,,160.66,283.34,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,outpatient,,,292.10000,277.50000,The Alliance,Exception Members,90,224.92,,,,,,,24.89,1137.41,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,inpatient,,,903.00000,857.85000,The Alliance,Exception Members,90,695.31,,,,,,,496.65,875.91,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,outpatient,,,903.00000,857.85000,The Alliance,Exception Members,90,695.31,,,,,,,19.88,1103.49,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,inpatient,,,78.80000,74.86000,The Alliance,Exception Members,90,60.68,,,,,,,43.34,76.44,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Exception Members,90,60.68,,,,,,,8.17,882.80,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,5.23,254.68,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,137.72,242.89,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,inpatient,,,59.40000,56.43000,The Alliance,Exception Members,90,45.74,,,,,,,32.67,57.62,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,outpatient,,,59.40000,56.43000,The Alliance,Exception Members,90,45.74,,,,,,,5.35,271.65,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,inpatient,,,179.50000,170.52000,The Alliance,Exception Members,90,138.22,,,,,,,98.72,174.12,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,outpatient,,,179.50000,170.52000,The Alliance,Exception Members,90,138.22,,,,,,,21.94,1103.49,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2812.00000,2671.40000,The Alliance,Exception Members,,2165.24,,,,,,,1546.60,2727.64,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Exception Members,,2165.24,,,,,,,282.88,13309.69,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.30000,303.34000,The Alliance,Exception Members,90,245.86,,,,,,,175.62,309.72,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Exception Members,90,245.86,,,,,,,8.94,458.40,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,The Alliance,Exception Members,90,72.07,,,,,,,51.48,90.79,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Exception Members,90,72.07,,,,,,,4.57,271.65,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,5.97,271.65,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,The Alliance,Exception Members,90,114.58,,,,,,,81.84,144.34,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Exception Members,90,114.58,,,,,,,19.26,882.80,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,inpatient,,,5074.00000,4820.30000,The Alliance,Exception Members,90,3906.98,,,,,,,2790.70,4921.78,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,outpatient,,,5074.00000,4820.30000,The Alliance,Exception Members,90,3906.98,,,,,,,480.56,28232.08,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,inpatient,,,78.90000,74.96000,The Alliance,Exception Members,90,60.75,,,,,,,43.40,76.53,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,outpatient,,,78.90000,74.96000,The Alliance,Exception Members,90,60.75,,,,,,,39.45,3038.81,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,inpatient,,,57.70000,54.81000,The Alliance,Exception Members,90,44.43,,,,,,,31.73,55.97,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,outpatient,,,57.70000,54.81000,The Alliance,Exception Members,90,44.43,,,,,,,15.06,763.98,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,inpatient,,,210.20000,199.69000,The Alliance,Exception Members,90,161.85,,,,,,,115.61,203.89,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Exception Members,90,161.85,,,,,,,8.17,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,99.66,175.76,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Exception Members,90,139.52,,,,,,,20.36,1120.45,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,29.15,51.41,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Exception Members,,40.81,,,,,,,5.87,113.69,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,Exception Members,90,174.79,,,,,,,124.85,220.19,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Exception Members,90,174.79,,,,,,,26.67,1341.13,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,53.52,94.38,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Exception Members,90,74.92,,,,,,,4.57,271.65,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,The Alliance,Exception Members,90,155.93,,,,,,,111.38,196.43,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Exception Members,90,155.93,,,,,,,77.53,1052.52,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,inpatient,,,141.20000,134.14000,The Alliance,Exception Members,90,108.72,,,,,,,77.66,136.96,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,outpatient,,,141.20000,134.14000,The Alliance,Exception Members,90,108.72,,,,,,,8.17,679.08,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,inpatient,,,637.00000,605.15000,The Alliance,Exception Members,,490.49,,,,,,,350.35,617.89,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Exception Members,,490.49,,,,,,,90.57,4617.66,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,inpatient,,,31.30000,29.74000,The Alliance,Exception Members,90,24.10,,,,,,,17.21,30.36,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,outpatient,,,31.30000,29.74000,The Alliance,Exception Members,90,24.10,,,,,,,3.09,152.82,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,inpatient,,,576.00000,547.20000,The Alliance,Exception Members,90,443.52,,,,,,,316.80,558.72,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,outpatient,,,576.00000,547.20000,The Alliance,Exception Members,90,443.52,,,,,,,288.00,558.72,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,5.00,254.68,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,inpatient,,,248.90000,236.45000,The Alliance,Exception Members,90,191.65,,,,,,,136.90,241.43,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,outpatient,,,248.90000,236.45000,The Alliance,Exception Members,90,191.65,,,,,,,17.85,814.87,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,inpatient,,,329.50000,313.02000,The Alliance,Exception Members,90,253.72,,,,,,,181.22,319.62,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,outpatient,,,329.50000,313.02000,The Alliance,Exception Members,90,253.72,,,,,,,16.44,831.84,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,57.20,100.88,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,12.05,1539.22,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,Exception Members,90,473.55,,,,,,,338.25,596.55,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Exception Members,90,473.55,,,,,,,307.50,3186.14,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,inpatient,,,86.90000,82.56000,The Alliance,Exception Members,90,66.91,,,,,,,47.80,84.29,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,outpatient,,,86.90000,82.56000,The Alliance,Exception Members,90,66.91,,,,,,,10.82,831.84,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,The Alliance,Exception Members,,1818.74,,,,,,,1299.10,2291.14,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Exception Members,,1818.74,,,,,,,208.92,10915.96,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,inpatient,,,238.40000,226.48000,The Alliance,Exception Members,90,183.57,,,,,,,131.12,231.25,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,outpatient,,,238.40000,226.48000,The Alliance,Exception Members,90,183.57,,,,,,,19.70,1273.27,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,inpatient,,,253.30000,240.64000,The Alliance,Exception Members,90,195.04,,,,,,,139.31,245.70,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,outpatient,,,253.30000,240.64000,The Alliance,Exception Members,90,195.04,,,,,,,20.36,1120.45,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,inpatient,,,1837.00000,1745.15000,The Alliance,Exception Members,90,1414.49,,,,,,,1010.35,1781.89,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,Exception Members,90,1414.49,,,,,,,648.20,8708.99,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,inpatient,,,18.00000,17.10000,The Alliance,Exception Members,90,13.86,,,,,,,9.90,17.46,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Exception Members,90,13.86,,,,,,,3.70,186.75,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,6.92,356.54,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,41.80,73.72,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Exception Members,,58.52,,,,,,,8.61,407.44,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,The Alliance,Exception Members,90,119.97,,,,,,,85.69,151.13,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Exception Members,90,119.97,,,,,,,12.45,1539.22,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,inpatient,,,111.90000,106.31000,The Alliance,Exception Members,90,86.16,,,,,,,61.55,108.54,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,outpatient,,,111.90000,106.31000,The Alliance,Exception Members,90,86.16,,,,,,,11.13,696.05,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,10.42,177.63,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,inpatient,,,109.70000,104.22000,The Alliance,Exception Members,90,84.47,,,,,,,60.34,106.41,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,outpatient,,,109.70000,104.22000,The Alliance,Exception Members,90,84.47,,,,,,,12.89,594.19,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,74.91,132.11,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Exception Members,90,104.87,,,,,,,7.27,2581.26,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,inpatient,,,145.60000,138.32000,The Alliance,Exception Members,90,112.11,,,,,,,80.08,141.23,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Exception Members,90,112.11,,,,,,,17.01,865.84,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,inpatient,,,165.50000,157.22000,The Alliance,Exception Members,90,127.44,,,,,,,91.03,160.53,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,outpatient,,,165.50000,157.22000,The Alliance,Exception Members,90,127.44,,,,,,,7.06,1018.59,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,inpatient,,,273.70000,260.02000,The Alliance,Exception Members,90,210.75,,,,,,,150.53,265.49,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,outpatient,,,273.70000,260.02000,The Alliance,Exception Members,90,210.75,,,,,,,21.01,1086.52,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Exception Members,90,20.56,,,,,,,5.25,254.68,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,41.63,73.43,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,37.85,73.43,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Exception Members,90,17.94,,,,,,,4.89,220.68,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,inpatient,,,318.30000,302.38000,The Alliance,Exception Members,90,245.09,,,,,,,175.06,308.75,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,outpatient,,,318.30000,302.38000,The Alliance,Exception Members,90,245.09,,,,,,,16.59,831.84,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,inpatient,,,128.00000,121.60000,The Alliance,Exception Members,90,98.56,,,,,,,70.40,124.16,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Exception Members,90,98.56,,,,,,,15.03,763.98,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,The Alliance,Exception Members,,114.58,,,,,,,81.84,144.34,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Exception Members,,114.58,,,,,,,18.64,882.80,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,,1754.06,,,,,,,1252.90,2209.66,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Exception Members,,1754.06,,,,,,,201.50,10525.49,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,inpatient,,,4578.00000,4349.10000,The Alliance,Exception Members,TC,3525.06,,,,,,,2517.90,4440.66,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,outpatient,,,4578.00000,4349.10000,The Alliance,Exception Members,TC,3525.06,,,,,,,533.12,24865.24,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,inpatient,,,144.40000,137.18000,The Alliance,Exception Members,90,111.19,,,,,,,79.42,140.07,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,outpatient,,,144.40000,137.18000,The Alliance,Exception Members,90,111.19,,,,,,,16.32,797.91,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,91.80,161.89,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Exception Members,90,128.51,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,inpatient,,,276.10000,262.30000,The Alliance,Exception Members,90,212.60,,,,,,,151.85,267.82,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,outpatient,,,276.10000,262.30000,The Alliance,Exception Members,90,212.60,,,,,,,24.89,1137.41,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,inpatient,,,57.20000,54.34000,The Alliance,Exception Members,,44.04,,,,,,,31.46,55.48,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,outpatient,,,57.20000,54.34000,The Alliance,Exception Members,,44.04,,,,,,,28.60,55.48,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,Exception Members,,61.45,,,,,,,43.89,77.41,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Exception Members,,61.45,,,,,,,39.90,77.41,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,inpatient,,,398.70000,378.76000,The Alliance,Exception Members,,307.00,,,,,,,219.28,386.74,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,outpatient,,,398.70000,378.76000,The Alliance,Exception Members,,307.00,,,,,,,144.13,2223.94,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,inpatient,,,65.50000,62.22000,The Alliance,Exception Members,90,50.44,,,,,,,36.02,63.53,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Exception Members,90,50.44,,,,,,,19.26,882.80,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.94,14.00,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Exception Members,,11.11,,,,,,,7.21,14.00,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,inpatient,1,GM,8.13000,7.73000,The Alliance,Exception Members,,6.26,,,,,,,4.47,7.89,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,outpatient,1,GM,8.13000,7.73000,The Alliance,Exception Members,,6.26,,,,,,,4.07,7.89,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Exception Members,,1.39,,,,,,,0.90500,1.76,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,inpatient,1,mL,45.79000,43.50000,The Alliance,Exception Members,,35.26,,,,,,,25.18,44.42,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,outpatient,1,mL,45.79000,43.50000,The Alliance,Exception Members,,35.26,,,,,,,22.89,78.87,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,inpatient,1,mL,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.13,1.99,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,outpatient,1,mL,2.05000,1.95000,The Alliance,Exception Members,,1.58,,,,,,,1.02,1.99,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.39600,0.69840,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Exception Members,,0.55440,,,,,,,0.36000,0.69840,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,inpatient,1,mL,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,25.38,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,outpatient,1,mL,46.14000,43.83000,The Alliance,Exception Members,,35.53,,,,,,,23.07,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,inpatient,1,mL,24.67000,23.44000,The Alliance,Exception Members,,19.00,,,,,,,13.57,23.93,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,outpatient,1,mL,24.67000,23.44000,The Alliance,Exception Members,,19.00,,,,,,,12.34,23.93,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,inpatient,1,mL,122.89000,116.74000,The Alliance,Exception Members,,94.63,,,,,,,67.59,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,outpatient,1,mL,122.89000,116.74000,The Alliance,Exception Members,,94.63,,,,,,,61.45,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,inpatient,1,mL,112.07000,106.47000,The Alliance,Exception Members,,86.29,,,,,,,61.64,108.71,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,outpatient,1,mL,112.07000,106.47000,The Alliance,Exception Members,,86.29,,,,,,,56.03,108.71,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,2.16,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Exception Members,,3.03,,,,,,,1.97,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,inpatient,1,mL,4.47000,4.24000,The Alliance,Exception Members,,3.44,,,,,,,2.46,4.34,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,outpatient,1,mL,4.47000,4.24000,The Alliance,Exception Members,,3.44,,,,,,,2.23,4.34,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Exception Members,,14.60,,,,,,,9.48,18.39,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.84,3.25,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Exception Members,,2.58,,,,,,,1.68,3.25,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,inpatient,1,mL,28.33000,26.92000,The Alliance,Exception Members,,21.81,,,,,,,15.58,27.48,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,outpatient,1,mL,28.33000,26.92000,The Alliance,Exception Members,,21.81,,,,,,,0.40920,27.48,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,inpatient,1,EA,16163.08000,15354.93000,The Alliance,Exception Members,,12445.57,,,,,,,8889.69,15678.19,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,outpatient,1,EA,16163.08000,15354.93000,The Alliance,Exception Members,,12445.57,,,,,,,8081.54,15678.19,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,inpatient,1,mL,30.39000,28.87000,The Alliance,Exception Members,,23.40,,,,,,,16.71,29.48,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Exception Members,,23.40,,,,,,,0.12000,29.48,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,inpatient,1,mL,286.22000,271.90000,The Alliance,Exception Members,,220.39,,,,,,,157.42,277.63,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,outpatient,1,mL,286.22000,271.90000,The Alliance,Exception Members,,220.39,,,,,,,17.37,277.63,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1821.00000,1729.95000,The Alliance,Exception Members,TC,1402.17,,,,,,,1001.55,1766.37,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1821.00000,1729.95000,The Alliance,Exception Members,TC,1402.17,,,,,,,484.28,2161.00,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,inpatient,,,77.40000,73.53000,The Alliance,Exception Members,90,59.60,,,,,,,42.57,75.08,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,outpatient,,,77.40000,73.53000,The Alliance,Exception Members,90,59.60,,,,,,,38.70,1137.41,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,165.11,291.19,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Exception Members,,231.15,,,,,,,39.83,291.19,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.41,2.48,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Exception Members,,1.97,,,,,,,1.21,2.48,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,464.18000,440.97000,The Alliance,Exception Members,,357.42,,,,,,,255.30,450.25,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,464.18000,440.97000,The Alliance,Exception Members,,357.42,,,,,,,158.39,450.25,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,,964.81,,,,,,,689.15,1215.41,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Exception Members,,964.81,,,,,,,626.50,1215.41,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,The Alliance,Exception Members,,10065.98,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Exception Members,,10065.98,,,,,,,6000.37,13072.70,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,The Alliance,Exception Members,,7956.22,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Exception Members,,7956.22,,,,,,,4742.73,10332.75,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,The Alliance,Exception Members,,7956.22,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Exception Members,,7956.22,,,,,,,4742.73,10332.75,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,18511.22,40329.45,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,The Alliance,Exception Members,,7438.20,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Exception Members,,7438.20,,,,,,,4433.94,9660.00,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,2848.81,6206.55,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.11207,0.32980,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,inpatient,,,698.00000,663.10000,The Alliance,Exception Members,,537.46,,,,,,,383.90,677.06,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,outpatient,,,698.00000,663.10000,The Alliance,Exception Members,,537.46,,,,,,,50.73,677.06,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,inpatient,1,EA,4155.55000,3947.77000,The Alliance,Exception Members,,3199.77,,,,,,,2285.55,4030.88,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,outpatient,1,EA,4155.55000,3947.77000,The Alliance,Exception Members,,3199.77,,,,,,,155.42,4030.88,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,inpatient,,,192.00000,182.40000,The Alliance,Exception Members,,147.84,,,,,,,105.60,186.24,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Exception Members,,147.84,,,,,,,19.31,186.24,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,inpatient,,,1804.00000,1713.80000,The Alliance,Exception Members,,1389.08,,,,,,,992.20,1749.88,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,outpatient,,,1804.00000,1713.80000,The Alliance,Exception Members,,1389.08,,,,,,,902.00,1749.88,percent of total billed charges,
ROOM/BED   ICU-CRITICAL CARE,82445,CDM,200,RC,,,,,facility,inpatient,,,4204.00000,3993.80000,The Alliance,Exception Members,,3237.08,,,,,,,2312.20,4077.88,percent of total billed charges,
ROOM/BED   MED-SURG,82446,CDM,111,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,The Alliance,Exception Members,,1553.09,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   HOME RECOVERY,82448,CDM,161,RC,,,,,facility,inpatient,,,1805.00000,1714.75000,The Alliance,Exception Members,,1389.85,,,,,,,992.75,1750.85,percent of total billed charges,
ROOM/BED   NICU LEVEL 4,82449,CDM,174,RC,,,,,facility,inpatient,,,8326.00000,7909.70000,The Alliance,Exception Members,,6411.02,,,,,,,4579.30,8076.22,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 2,82450,CDM,172,RC,,,,,facility,inpatient,,,2073.00000,1969.35000,The Alliance,Exception Members,,1596.21,,,,,,,1140.15,2010.81,percent of total billed charges,
ROOM/BED   NEWBORN,82451,CDM,170,RC,,,,,facility,inpatient,,,1779.00000,1690.05000,The Alliance,Exception Members,,1369.83,,,,,,,978.45,1725.63,percent of total billed charges,
ROOM/BED   NICU LEVEL 2,82452,CDM,172,RC,,,,,facility,inpatient,,,5606.00000,5325.70000,The Alliance,Exception Members,,4316.62,,,,,,,3083.30,5437.82,percent of total billed charges,
ROOM/BED   NICU LEVEL 3,82453,CDM,173,RC,,,,,facility,inpatient,,,7149.00000,6791.55000,The Alliance,Exception Members,,5504.73,,,,,,,3931.95,6934.53,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 4,82454,CDM,174,RC,,,,,facility,inpatient,,,3875.00000,3681.25000,The Alliance,Exception Members,,2983.75,,,,,,,2131.25,3758.75,percent of total billed charges,
ROOM/BED   PICU,82455,CDM,203,RC,,,,,facility,inpatient,,,5446.00000,5173.70000,The Alliance,Exception Members,,4193.42,,,,,,,2995.30,5282.62,percent of total billed charges,
ROOM/BED   REHAB,82456,CDM,118,RC,,,,,facility,inpatient,,,1724.00000,1637.80000,The Alliance,Exception Members,,1327.48,,,,,,,948.20,2638.00,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 3,82457,CDM,173,RC,,,,,facility,inpatient,,,2969.00000,2820.55000,The Alliance,Exception Members,,2286.13,,,,,,,1632.95,2879.93,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,47.30,83.42,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,43.00,6456.00,percent of total billed charges,
ROOM/BED   WOMEN'S HEALTH,82459,CDM,112,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,The Alliance,Exception Members,,1553.09,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   TELEMETRY,82460,CDM,110,RC,,,,,facility,inpatient,,,2054.00000,1951.30000,The Alliance,Exception Members,,1581.58,,,,,,,1129.70,1992.38,percent of total billed charges,
ROOM/BED   SWING BED,82461,CDM,120,RC,,,,,facility,inpatient,,,1052.00000,999.40000,The Alliance,Exception Members,,810.04,,,,,,,578.60,1020.44,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,The Alliance,Exception Members,TC,3277.12,,,,,,,2340.80,4128.32,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Exception Members,TC,3277.12,,,,,,,2128.00,4128.32,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,inpatient,1,mL,730.38000,693.86000,The Alliance,Exception Members,,562.39,,,,,,,401.71,708.47,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Exception Members,,562.39,,,,,,,5.98,708.47,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,inpatient,,,2454.00000,2331.30000,The Alliance,Exception Members,TC,1889.58,,,,,,,1349.70,2380.38,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,outpatient,,,2454.00000,2331.30000,The Alliance,Exception Members,TC,1889.58,,,,,,,1227.00,5271.00,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,inpatient,,,7396.00000,7026.20000,The Alliance,Exception Members,TC,5694.92,,,,,,,4067.80,7174.12,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,outpatient,,,7396.00000,7026.20000,The Alliance,Exception Members,TC,5694.92,,,,,,,3698.00,17574.00,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,inpatient,,,555.00000,527.25000,The Alliance,Exception Members,,427.35,,,,,,,305.25,538.35,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,outpatient,,,555.00000,527.25000,The Alliance,Exception Members,,427.35,,,,,,,277.50,538.35,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,inpatient,1,mL,20.30000,19.29000,The Alliance,Exception Members,,15.63,,,,,,,11.16,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,outpatient,1,mL,20.30000,19.29000,The Alliance,Exception Members,,15.63,,,,,,,0.92000,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,inpatient,1,mL,89.60000,85.12000,The Alliance,Exception Members,,68.99,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,outpatient,1,mL,89.60000,85.12000,The Alliance,Exception Members,,68.99,,,,,,,0.92000,86.91,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,inpatient,1,EA,2370.47000,2251.95000,The Alliance,Exception Members,,1825.26,,,,,,,1303.76,2299.36,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,outpatient,1,EA,2370.47000,2251.95000,The Alliance,Exception Members,,1825.26,,,,,,,1185.23,2299.36,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,46.35,319.35,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,inpatient,,,394.00000,374.30000,The Alliance,Exception Members,,303.38,,,,,,,216.70,382.18,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Exception Members,,303.38,,,,,,,35.09,382.18,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,inpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,110.55,194.97,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Exception Members,,154.77,,,,,,,18.05,194.97,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,96.25,169.75,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,,134.75,,,,,,,24.08,169.75,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,inpatient,,,522.00000,495.90000,The Alliance,Exception Members,,401.94,,,,,,,287.10,506.34,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Exception Members,,401.94,,,,,,,50.73,506.34,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,Exception Members,TC,617.54,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Exception Members,TC,617.54,,,,,,,389.35,2210.07,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,The Alliance,Exception Members,,282.48,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Exception Members,,282.48,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,The Alliance,Exception Members,,10065.98,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Exception Members,,10065.98,,,,,,,6000.37,13072.70,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1342.24,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,25.79,50.03,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,The Alliance,Exception Members,TC,3628.24,,,,,,,2591.60,4570.64,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Exception Members,TC,3628.24,,,,,,,2210.90,23155.09,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,1667.31,67198.78,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,The Alliance,Exception Members,,24022.15,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Exception Members,,24022.15,,,,,,,14319.70,31197.60,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30271.50000,28757.92000,The Alliance,Exception Members,,23309.06,,,,,,,14833.03,29363.35,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Exception Members,,23309.06,,,,,,,13894.62,30271.50,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,inpatient,1,mL,19494.00000,18519.30000,The Alliance,Exception Members,,15010.38,,,,,,,10721.70,18909.18,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,outpatient,1,mL,19494.00000,18519.30000,The Alliance,Exception Members,,15010.38,,,,,,,55.30,18909.18,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,mL,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,mL,3.32000,3.16000,The Alliance,Exception Members,,2.56,,,,,,,1.28,3.22,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,18511.22,40329.45,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,20528.18,44723.70,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,144.65,255.11,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,TC,202.51,,,,,,,131.50,1668.14,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,108.90,192.06,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Exception Members,,152.46,,,,,,,99.00,723.34,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,TC,117.04,,,,,,,83.60,147.44,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,TC,117.04,,,,,,,76.00,548.00,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,146.85,258.99,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Exception Members,,205.59,,,,,,,133.50,929.91,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Exception Members,,140.14,,,,,,,91.00,308.32,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,19.28000,18.32000,The Alliance,Exception Members,,14.85,,,,,,,10.60,18.70,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,19.28000,18.32000,The Alliance,Exception Members,,14.85,,,,,,,9.64,18.70,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,inpatient,,,571.56000,542.98000,The Alliance,Exception Members,,440.10,,,,,,,314.36,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,outpatient,,,571.56000,542.98000,The Alliance,Exception Members,,440.10,,,,,,,285.78,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,inpatient,1,mL,1143.11000,1085.95000,The Alliance,Exception Members,,880.19,,,,,,,628.71,1108.82,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,outpatient,1,mL,1143.11000,1085.95000,The Alliance,Exception Members,,880.19,,,,,,,485.00,1108.82,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,inpatient,1,EA,205.24000,194.98000,The Alliance,Exception Members,,158.03,,,,,,,112.88,199.08,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,outpatient,1,EA,205.24000,194.98000,The Alliance,Exception Members,,158.03,,,,,,,102.62,199.08,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,inpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,190.30,335.62,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Exception Members,,266.42,,,,,,,28.27,335.62,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1611.00000,1530.45000,The Alliance,Exception Members,,1240.47,,,,,,,886.05,1562.67,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1611.00000,1530.45000,The Alliance,Exception Members,,1240.47,,,,,,,805.50,1692.33,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,The Alliance,Exception Members,,21709.76,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Exception Members,,21709.76,,,,,,,12941.28,28194.50,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,The Alliance,Exception Members,,21709.76,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Exception Members,,21709.76,,,,,,,12941.28,28194.50,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,The Alliance,Exception Members,,201.05,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Exception Members,,201.05,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,8814.75000,8374.01000,The Alliance,Exception Members,,6787.36,,,,,,,4319.23,8550.31,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,8814.75000,8374.01000,The Alliance,Exception Members,,6787.36,,,,,,,4045.97,8814.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Exception Members,,2199.12,,,,,,,249.71,14445.56,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,131.45,231.83,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Exception Members,,184.03,,,,,,,119.50,734.90,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,56.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,169.40,298.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Exception Members,,237.16,,,,,,,56.40,298.76,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Exception Members,,116.27,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Exception Members,,194.81,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Exception Members,,92.40,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Exception Members,,157.08,,,,,,,102.00,197.88,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,inpatient,1,EA,3362.49000,3194.36000,The Alliance,Exception Members,,2589.12,,,,,,,1849.37,3261.62,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,outpatient,1,EA,3362.49000,3194.36000,The Alliance,Exception Members,,2589.12,,,,,,,161.96,3261.62,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,inpatient,1,mL,22.42000,21.30000,The Alliance,Exception Members,,17.26,,,,,,,12.33,21.75,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,outpatient,1,mL,22.42000,21.30000,The Alliance,Exception Members,,17.26,,,,,,,1.35,21.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.64,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Exception Members,,2.30,,,,,,,1.50,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7193.25000,6833.59000,The Alliance,Exception Members,,5538.80,,,,,,,3524.69,6977.45,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7193.25000,6833.59000,The Alliance,Exception Members,,5538.80,,,,,,,3301.70,7193.25,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1406.25000,1335.94000,The Alliance,Exception Members,,1082.81,,,,,,,689.06,1364.06,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1406.25000,1335.94000,The Alliance,Exception Members,,1082.81,,,,,,,645.47,1406.25,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Exception Members,,2047.82,,,,,,,1220.71,2659.50,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Exception Members,,6.41,,,,,,,4.16,8.07,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Exception Members,TC,946.33,,,,,,,316.68,1447.00,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,The Alliance,Exception Members,TC,3692.92,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Exception Members,TC,3692.92,,,,,,,1929.64,4652.12,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6365.00000,6046.75000,The Alliance,Exception Members,TC,4901.05,,,,,,,3500.75,6174.05,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6365.00000,6046.75000,The Alliance,Exception Members,TC,4901.05,,,,,,,1929.64,6174.05,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,152.90,269.66,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Exception Members,,214.06,,,,,,,139.00,269.66,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,The Alliance,Exception Members,TC,1113.42,,,,,,,795.30,1402.62,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Exception Members,TC,1113.42,,,,,,,316.68,1447.00,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,inpatient,1,mL,4864.58000,4621.36000,The Alliance,Exception Members,,3745.73,,,,,,,2675.52,4718.64,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,outpatient,1,mL,4864.58000,4621.36000,The Alliance,Exception Members,,3745.73,,,,,,,18.30,4718.64,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,Exception Members,TC,754.60,,,,,,,539.00,950.60,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Exception Members,TC,754.60,,,,,,,384.16,950.60,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,inpatient,1,mL,110.58000,105.05000,The Alliance,Exception Members,,85.15,,,,,,,60.82,107.26,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,outpatient,1,mL,110.58000,105.05000,The Alliance,Exception Members,,85.15,,,,,,,55.29,107.26,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,The Alliance,Exception Members,,43659.00,,,,,,,27783.00,54999.00,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Exception Members,,43659.00,,,,,,,26025.30,56700.00,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,inpatient,,,241.67000,229.59000,The Alliance,Exception Members,,186.09,,,,,,,132.92,234.42,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Exception Members,,186.09,,,,,,,120.83,240.53,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,inpatient,1,EA,483.34000,459.17000,The Alliance,Exception Members,,372.17,,,,,,,265.84,468.84,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Exception Members,,372.17,,,,,,,240.53,468.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,inpatient,,,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,62.39,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,outpatient,,,113.43000,107.76000,The Alliance,Exception Members,,87.34,,,,,,,56.72,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,inpatient,1,mL,226.86000,215.52000,The Alliance,Exception Members,,174.68,,,,,,,124.77,220.05,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,outpatient,1,mL,226.86000,215.52000,The Alliance,Exception Members,,174.68,,,,,,,113.43,220.05,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Exception Members,,1.22,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,inpatient,1,GM,8.39000,7.97000,The Alliance,Exception Members,,6.46,,,,,,,4.61,8.14,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,outpatient,1,GM,8.39000,7.97000,The Alliance,Exception Members,,6.46,,,,,,,4.20,8.14,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,Exception Members,QW,28.49,,,,,,,20.35,35.89,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Exception Members,QW,28.49,,,,,,,16.53,780.94,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,inpatient,,,1895.00000,1800.25000,The Alliance,Exception Members,,1459.15,,,,,,,1042.25,1838.15,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,Exception Members,,1459.15,,,,,,,12.05,10344.80,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,inpatient,,,506.00000,480.70000,The Alliance,Exception Members,RT,389.62,,,,,,,278.30,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,Exception Members,RT,389.62,,,,,,,253.00,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,RT,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,RT,1898.82,,,,,,,1233.00,2392.02,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,847.16000,804.80000,The Alliance,Exception Members,,652.31,,,,,,,415.11,821.75,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,847.16000,804.80000,The Alliance,Exception Members,,652.31,,,,,,,388.85,847.16,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,The Alliance,Exception Members,,6675.13,,,,,,,4767.95,8408.93,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Exception Members,,6675.13,,,,,,,4334.50,8408.93,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,4416.00000,4195.20000,The Alliance,Exception Members,,3400.32,,,,,,,2163.84,4283.52,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4416.00000,4195.20000,The Alliance,Exception Members,,3400.32,,,,,,,2026.94,4416.00,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,1.39,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,6555.00000,6227.25000,The Alliance,Exception Members,,5047.35,,,,,,,3211.95,6358.35,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Exception Members,,5047.35,,,,,,,3008.74,6555.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1466.00000,1392.70000,The Alliance,Exception Members,,1128.82,,,,,,,806.30,1422.02,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Exception Members,,1128.82,,,,,,,128.29,6705.74,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1290.94,2812.50,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.08250,0.14550,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Exception Members,,0.11550,,,,,,,0.07500,0.14550,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,inpatient,1,EA,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.70,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,outpatient,1,EA,14.00000,13.30000,The Alliance,Exception Members,,10.78,,,,,,,7.00,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,inpatient,1,EA,13.21000,12.55000,The Alliance,Exception Members,,10.17,,,,,,,7.27,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,outpatient,1,EA,13.21000,12.55000,The Alliance,Exception Members,,10.17,,,,,,,6.61,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.90,13.94,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Exception Members,,11.06,,,,,,,7.18,13.94,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.15400,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Exception Members,,0.21560,,,,,,,0.14000,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,inpatient,,,152.78000,145.14000,The Alliance,Exception Members,,117.64,,,,,,,84.03,148.20,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,outpatient,,,152.78000,145.14000,The Alliance,Exception Members,,117.64,,,,,,,76.39,195.41,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,inpatient,1,mL,76.39000,72.57000,The Alliance,Exception Members,,58.82,,,,,,,42.01,74.10,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,outpatient,1,mL,76.39000,72.57000,The Alliance,Exception Members,,58.82,,,,,,,38.20,195.41,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Exception Members,,2165.62,,,,,,,1290.94,2812.50,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,inpatient,1,EA,2588.14000,2458.73000,The Alliance,Exception Members,,1992.87,,,,,,,1423.48,2510.50,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Exception Members,,1992.87,,,,,,,1294.07,2510.50,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,inpatient,1,mL,66.57000,63.24000,The Alliance,Exception Members,,51.26,,,,,,,36.61,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,outpatient,1,mL,66.57000,63.24000,The Alliance,Exception Members,,51.26,,,,,,,0.77000,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,inpatient,1,mL,60.38000,57.36000,The Alliance,Exception Members,,46.49,,,,,,,33.21,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,outpatient,1,mL,60.38000,57.36000,The Alliance,Exception Members,,46.49,,,,,,,0.77000,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,inpatient,1,mL,69.89000,66.40000,The Alliance,Exception Members,,53.82,,,,,,,38.44,67.79,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,outpatient,1,mL,69.89000,66.40000,The Alliance,Exception Members,,53.82,,,,,,,0.77000,67.79,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14399.50000,13679.52000,The Alliance,Exception Members,,11087.61,,,,,,,7055.76,13967.51,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14399.50000,13679.52000,The Alliance,Exception Members,,11087.61,,,,,,,6609.37,14399.50,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,inpatient,,,606.00000,575.70000,The Alliance,Exception Members,,466.62,,,,,,,333.30,587.82,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,outpatient,,,606.00000,575.70000,The Alliance,Exception Members,,466.62,,,,,,,303.00,587.82,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.40000,203.68000,The Alliance,Exception Members,90,165.09,,,,,,,117.92,207.97,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.40000,203.68000,The Alliance,Exception Members,90,165.09,,,,,,,19.60,984.66,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,inpatient,,,136.80000,129.96000,The Alliance,Exception Members,90,105.34,,,,,,,75.24,132.70,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,outpatient,,,136.80000,129.96000,The Alliance,Exception Members,90,105.34,,,,,,,12.51,628.12,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1100.00000,1045.00000,The Alliance,Exception Members,,847.00,,,,,,,605.00,1067.00,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1100.00000,1045.00000,The Alliance,Exception Members,,847.00,,,,,,,158.39,1067.00,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,inpatient,,,117.28000,111.42000,The Alliance,Exception Members,,90.31,,,,,,,57.47,113.76,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,outpatient,,,117.28000,111.42000,The Alliance,Exception Members,,90.31,,,,,,,58.64,113.76,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,inpatient,,,71282.00000,67717.90000,The Alliance,Exception Members,,54887.14,,,,,,,39205.10,69143.54,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Exception Members,,54887.14,,,,,,,35641.00,74614.73,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,822.25,1450.15,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Exception Members,TC,1151.15,,,,,,,747.50,1450.15,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,The Alliance,Exception Members,,1411.41,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,The Alliance,Exception Members,,1411.41,,,,,,,916.50,1778.01,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,inpatient,,,82.50000,78.38000,The Alliance,Exception Members,,63.52,,,,,,,45.38,80.03,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,outpatient,,,82.50000,78.38000,The Alliance,Exception Members,,63.52,,,,,,,20.89,80.03,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,,1081.08,,,,,,,772.20,1361.88,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,,1081.08,,,,,,,702.00,1361.88,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13175.00000,12516.25000,The Alliance,Exception Members,,10144.75,,,,,,,6455.75,12779.75,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13175.00000,12516.25000,The Alliance,Exception Members,,10144.75,,,,,,,6047.32,12779.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,inpatient,,,1069.00000,1015.55000,The Alliance,Exception Members,,823.13,,,,,,,587.95,1036.93,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,outpatient,,,1069.00000,1015.55000,The Alliance,Exception Members,,823.13,,,,,,,247.20,1036.93,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,The Alliance,Exception Members,,137.09,,,,,,,87.24,172.70,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Exception Members,,137.09,,,,,,,81.72,178.04,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2389.84000,2270.35000,The Alliance,Exception Members,,1840.18,,,,,,,1171.02,2318.14,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2389.84000,2270.35000,The Alliance,Exception Members,,1840.18,,,,,,,1096.94,2389.84,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,631.13000,599.57000,The Alliance,Exception Members,,485.97,,,,,,,309.25,612.20,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,631.13000,599.57000,The Alliance,Exception Members,,485.97,,,,,,,289.69,631.13,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9305.77,20274.00,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9305.77,20274.00,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,21296.39000,20231.57000,The Alliance,Exception Members,,16398.22,,,,,,,10435.23,20657.50,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Exception Members,,16398.22,,,,,,,10648.19,27182.63,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,inpatient,,,784.00000,744.80000,The Alliance,Exception Members,TC,603.68,,,,,,,431.20,760.48,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,outpatient,,,784.00000,744.80000,The Alliance,Exception Members,TC,603.68,,,,,,,384.16,760.48,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,Exception Members,QW,134.75,,,,,,,96.25,169.75,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Exception Members,QW,134.75,,,,,,,22.48,1052.52,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,The Alliance,Exception Members,TC,1170.40,,,,,,,836.00,1474.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Exception Members,TC,1170.40,,,,,,,726.61,7529.89,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9305.77,20274.00,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,The Alliance,Exception Members,,17625.30,,,,,,,11216.10,22203.30,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Exception Members,,17625.30,,,,,,,10506.51,22890.00,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2789.32,5521.73,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2612.86,5692.50,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,34353.61000,32635.93000,The Alliance,Exception Members,,26452.28,,,,,,,16833.27,33323.00,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,34353.61000,32635.93000,The Alliance,Exception Members,,26452.28,,,,,,,17176.81,34353.61,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,inpatient,1,mL,619.01000,588.06000,The Alliance,Exception Members,,476.64,,,,,,,340.46,600.44,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,outpatient,1,mL,619.01000,588.06000,The Alliance,Exception Members,,476.64,,,,,,,97.70,600.44,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.43450,0.76630,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Exception Members,,0.60830,,,,,,,0.39500,0.76630,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.37400,0.65960,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Exception Members,,0.52360,,,,,,,0.34000,0.65960,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,645.77,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Exception Members,,301.07,,,,,,,195.50,645.77,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Exception Members,,445.06,,,,,,,289.00,1622.56,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,136.95,241.53,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Exception Members,,191.73,,,,,,,124.50,254.03,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,279.23000,265.27000,The Alliance,Exception Members,,215.01,,,,,,,136.82,270.85,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,279.23000,265.27000,The Alliance,Exception Members,,215.01,,,,,,,128.17,279.23,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,The Alliance,Exception Members,TC,1938.86,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Exception Members,TC,1938.86,,,,,,,1163.40,2442.46,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.01000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,0.01940,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,2.02,15.33,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,inpatient,1,mL,515.41000,489.64000,The Alliance,Exception Members,,396.87,,,,,,,283.48,499.95,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,outpatient,1,mL,515.41000,489.64000,The Alliance,Exception Members,,396.87,,,,,,,257.70,499.95,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Exception Members,,0.03850,,,,,,,0.02500,0.04850,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,inpatient,1,mL,96.55000,91.72000,The Alliance,Exception Members,,74.34,,,,,,,53.10,93.65,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,outpatient,1,mL,96.55000,91.72000,The Alliance,Exception Members,,74.34,,,,,,,48.27,93.65,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,inpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,331.10,583.94,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,280.29,3163.00,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,40880.70000,38836.66000,The Alliance,Exception Members,,31478.14,,,,,,,20031.54,39654.28,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,40880.70000,38836.66000,The Alliance,Exception Members,,31478.14,,,,,,,18764.24,40880.70,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,116.86,231.34,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,109.47,238.50,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,134.06,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,121.88,236.44,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,64.90,114.46,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,,90.86,,,,,,,59.00,619.83,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1675.00000,1591.25000,The Alliance,Exception Members,,1289.75,,,,,,,921.25,1624.75,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1675.00000,1591.25000,The Alliance,Exception Members,,1289.75,,,,,,,837.50,1692.33,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18331.42000,17414.85000,The Alliance,Exception Members,,14115.19,,,,,,,8982.40,17781.48,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18331.42000,17414.85000,The Alliance,Exception Members,,14115.19,,,,,,,8414.12,18331.42,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,inpatient,,,2290.00000,2175.50000,The Alliance,Exception Members,,1763.30,,,,,,,1259.50,2221.30,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,outpatient,,,2290.00000,2175.50000,The Alliance,Exception Members,,1763.30,,,,,,,232.94,12375.92,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,712.25,1256.15,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Exception Members,,997.15,,,,,,,20.89,1256.15,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,3163.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9357.04000,8889.19000,The Alliance,Exception Members,,7204.92,,,,,,,4584.95,9076.33,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9357.04000,8889.19000,The Alliance,Exception Members,,7204.92,,,,,,,4294.88,9357.04,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,7036.72000,6684.88000,The Alliance,Exception Members,,5418.27,,,,,,,3447.99,6825.62,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,7036.72000,6684.88000,The Alliance,Exception Members,,5418.27,,,,,,,3229.85,7036.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,582.19000,553.08000,The Alliance,Exception Members,,448.29,,,,,,,320.20,564.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,582.19000,553.08000,The Alliance,Exception Members,,448.29,,,,,,,240.68,564.72,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,inpatient,1,mL,25103.16000,23848.00000,The Alliance,Exception Members,,19329.43,,,,,,,13806.74,24350.07,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,outpatient,1,mL,25103.16000,23848.00000,The Alliance,Exception Members,,19329.43,,,,,,,74.86,24350.07,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,inpatient,1,EA,18.49000,17.56000,The Alliance,Exception Members,,14.24,,,,,,,10.17,17.94,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Exception Members,,14.24,,,,,,,1.28,17.94,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,11.30,19.92,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Exception Members,,15.82,,,,,,,10.27,19.92,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,inpatient,,,588.75000,559.31000,The Alliance,Exception Members,,453.34,,,,,,,323.81,571.09,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,outpatient,,,588.75000,559.31000,The Alliance,Exception Members,,453.34,,,,,,,132.04,571.09,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Exception Members,,0.09240,,,,,,,0.06000,0.11640,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,inpatient,1,EA,39.92000,37.92000,The Alliance,Exception Members,,30.74,,,,,,,21.96,38.72,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,outpatient,1,EA,39.92000,37.92000,The Alliance,Exception Members,,30.74,,,,,,,19.96,38.72,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Exception Members,,20170.15,,,,,,,12023.50,26195.00,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,inpatient,1,EA,51.56000,48.98000,The Alliance,Exception Members,,39.70,,,,,,,28.36,50.01,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,outpatient,1,EA,51.56000,48.98000,The Alliance,Exception Members,,39.70,,,,,,,7.77,50.01,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,inpatient,1,EA,29.86000,28.37000,The Alliance,Exception Members,,22.99,,,,,,,16.42,28.96,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,outpatient,1,EA,29.86000,28.37000,The Alliance,Exception Members,,22.99,,,,,,,6.12,28.96,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,86.90,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Exception Members,,121.66,,,,,,,0.04803,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,inpatient,1,EA,717.43000,681.56000,The Alliance,Exception Members,,552.42,,,,,,,394.59,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,outpatient,1,EA,717.43000,681.56000,The Alliance,Exception Members,,552.42,,,,,,,0.04803,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,inpatient,1,EA,169.28000,160.82000,The Alliance,Exception Members,,130.35,,,,,,,93.10,164.20,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,outpatient,1,EA,169.28000,160.82000,The Alliance,Exception Members,,130.35,,,,,,,0.04803,164.20,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,inpatient,1,mL,1202.80000,1142.66000,The Alliance,Exception Members,,926.16,,,,,,,661.54,1166.72,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,outpatient,1,mL,1202.80000,1142.66000,The Alliance,Exception Members,,926.16,,,,,,,3.00,1166.72,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,inpatient,1,EA,36.67000,34.84000,The Alliance,Exception Members,,28.24,,,,,,,20.17,35.57,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,outpatient,1,EA,36.67000,34.84000,The Alliance,Exception Members,,28.24,,,,,,,18.34,35.57,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,The Alliance,Exception Members,,33.90,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Exception Members,,33.90,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Exception Members,,4.69,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Exception Members,,9.73,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.41800,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Exception Members,,0.58520,,,,,,,0.38000,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,2.18,3.85,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Exception Members,,3.06,,,,,,,1.99,3.85,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,inpatient,,,1380.75000,1311.71000,The Alliance,Exception Members,,1063.18,,,,,,,759.41,1339.33,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,outpatient,,,1380.75000,1311.71000,The Alliance,Exception Members,,1063.18,,,,,,,690.38,1339.33,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,The Alliance,Exception Members,,909.56,,,,,,,578.81,1145.81,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Exception Members,,909.56,,,,,,,542.19,1181.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,123.75,218.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Exception Members,,173.25,,,,,,,112.50,218.25,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,144.65,255.11,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Exception Members,,202.51,,,,,,,100.97,2441.08,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,372.50,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Exception Members,,573.65,,,,,,,372.50,929.91,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,inpatient,,,2449.00000,2326.55000,The Alliance,Exception Members,LT,1885.73,,,,,,,1346.95,2375.53,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,outpatient,,,2449.00000,2326.55000,The Alliance,Exception Members,LT,1885.73,,,,,,,1224.50,2375.53,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,inpatient,,,1281.00000,1216.95000,The Alliance,Exception Members,LT,986.37,,,,,,,704.55,1242.57,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,Exception Members,LT,986.37,,,,,,,640.50,1242.57,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,75.00,308.32,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,257.95,454.93,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Exception Members,,361.13,,,,,,,234.50,454.93,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,The Alliance,Exception Members,TC,2427.81,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Exception Members,TC,2427.81,,,,,,,1479.13,3058.41,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,inpatient,1,EA,343.71000,326.53000,The Alliance,Exception Members,,264.66,,,,,,,189.04,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,outpatient,1,EA,343.71000,326.53000,The Alliance,Exception Members,,264.66,,,,,,,171.85,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,inpatient,1,EA,309.79000,294.30000,The Alliance,Exception Members,,238.54,,,,,,,170.38,300.50,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,outpatient,1,EA,309.79000,294.30000,The Alliance,Exception Members,,238.54,,,,,,,154.90,300.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,The Alliance,Exception Members,,873.50,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Exception Members,,873.50,,,,,,,0.29000,1100.39,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,inpatient,1,mL,12429.17000,11807.71000,The Alliance,Exception Members,,9570.46,,,,,,,6836.04,12056.29,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,outpatient,1,mL,12429.17000,11807.71000,The Alliance,Exception Members,,9570.46,,,,,,,132.04,12056.29,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,inpatient,,,169.40000,160.93000,The Alliance,Exception Members,90,130.44,,,,,,,93.17,164.32,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,outpatient,,,169.40000,160.93000,The Alliance,Exception Members,90,130.44,,,,,,,15.49,780.94,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2612.86,5692.50,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Exception Members,,4383.23,,,,,,,2612.86,5692.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,76.32000,72.50000,The Alliance,Exception Members,,58.77,,,,,,,37.40,74.03,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Exception Members,,58.77,,,,,,,35.03,76.32,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1352.40,2677.20,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1266.84,2760.00,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1352.40,2677.20,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Exception Members,,2125.20,,,,,,,1266.84,2760.00,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2620.28,5187.07,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Exception Members,,4117.57,,,,,,,2454.50,5347.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,inpatient,,,136.51000,129.68000,The Alliance,Exception Members,,105.11,,,,,,,75.08,132.41,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,outpatient,,,136.51000,129.68000,The Alliance,Exception Members,,105.11,,,,,,,68.25,144.20,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,inpatient,1,EA,273.02000,259.37000,The Alliance,Exception Members,,210.23,,,,,,,150.16,264.83,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,outpatient,1,EA,273.02000,259.37000,The Alliance,Exception Members,,210.23,,,,,,,136.51,264.83,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,75.35,132.89,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,68.50,264.00,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,33.55,59.17,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Exception Members,,46.97,,,,,,,30.50,264.00,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,The Alliance,Exception Members,GO,31.11,,,,,,,22.22,39.19,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Exception Members,GO,31.11,,,,,,,20.20,264.00,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,The Alliance,Exception Members,GO,47.12,,,,,,,33.66,59.36,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Exception Members,GO,47.12,,,,,,,30.60,264.00,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,382.25,674.15,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Exception Members,TC,535.15,,,,,,,298.87,3487.84,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,inpatient,,,2470.00000,2346.50000,The Alliance,Exception Members,TC,1901.90,,,,,,,1358.50,2395.90,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,outpatient,,,2470.00000,2346.50000,The Alliance,Exception Members,TC,1901.90,,,,,,,1235.00,2395.90,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,inpatient,,,3096.00000,2941.20000,The Alliance,Exception Members,,2383.92,,,,,,,1702.80,3003.12,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,Exception Members,,2383.92,,,,,,,1548.00,6178.88,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Exception Members,,4.45,,,,,,,0.14409,5.61,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,inpatient,,,214.12000,203.41000,The Alliance,Exception Members,,164.87,,,,,,,117.77,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,outpatient,,,214.12000,203.41000,The Alliance,Exception Members,,164.87,,,,,,,107.06,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,inpatient,1,mL,428.24000,406.83000,The Alliance,Exception Members,,329.74,,,,,,,235.53,415.39,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,outpatient,1,mL,428.24000,406.83000,The Alliance,Exception Members,,329.74,,,,,,,214.12,415.39,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,2.29,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,inpatient,,,113.40000,107.73000,The Alliance,Exception Members,90,87.32,,,,,,,62.37,110.00,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Exception Members,90,87.32,,,,,,,13.33,679.08,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,137.72,242.89,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Exception Members,90,192.81,,,,,,,22.91,1035.56,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,inpatient,1,mL,11.48000,10.91000,The Alliance,Exception Members,,8.84,,,,,,,6.31,11.14,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,outpatient,1,mL,11.48000,10.91000,The Alliance,Exception Members,,8.84,,,,,,,3.62,11.14,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,inpatient,1,EA,156.07000,148.27000,The Alliance,Exception Members,,120.17,,,,,,,85.84,151.39,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,outpatient,1,EA,156.07000,148.27000,The Alliance,Exception Members,,120.17,,,,,,,78.03,151.39,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,inpatient,,,123.97000,117.77000,The Alliance,Exception Members,,95.46,,,,,,,68.18,120.25,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,outpatient,,,123.97000,117.77000,The Alliance,Exception Members,,95.46,,,,,,,23.25,120.25,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,inpatient,1,mL,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.80,3.17,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,outpatient,1,mL,3.27000,3.10000,The Alliance,Exception Members,,2.52,,,,,,,1.64,3.17,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,The Alliance,Exception Members,,687.23,,,,,,,437.32,865.73,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Exception Members,,687.23,,,,,,,409.66,892.50,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,0.01000,2.55,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.18150,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Exception Members,,0.25410,,,,,,,0.16500,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Exception Members,,0.46200,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,inpatient,1,mL,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,inpatient,1,EA,57.15000,54.29000,The Alliance,Exception Members,,44.01,,,,,,,31.43,55.44,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Exception Members,,44.01,,,,,,,3.02,55.44,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3198.75000,3038.81000,The Alliance,Exception Members,,2463.04,,,,,,,1567.39,3102.79,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3198.75000,3038.81000,The Alliance,Exception Members,,2463.04,,,,,,,1468.23,3198.75,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3168.75000,3010.31000,The Alliance,Exception Members,,2439.94,,,,,,,1552.69,3073.69,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3168.75000,3010.31000,The Alliance,Exception Members,,2439.94,,,,,,,1454.46,3168.75,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,506.93000,481.58000,The Alliance,Exception Members,,390.34,,,,,,,248.40,491.72,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,506.93000,481.58000,The Alliance,Exception Members,,390.34,,,,,,,232.68,491.72,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,179.60000,170.62000,The Alliance,Exception Members,,138.29,,,,,,,88.00,174.21,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,179.60000,170.62000,The Alliance,Exception Members,,138.29,,,,,,,82.44,174.21,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,382.50000,363.38000,The Alliance,Exception Members,,294.52,,,,,,,187.43,371.02,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Exception Members,,294.52,,,,,,,175.57,382.50,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3499.34,6927.26,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3277.95,7141.50,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2916.11,5772.71,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2731.62,5951.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2043.75000,1941.56000,The Alliance,Exception Members,,1573.69,,,,,,,1001.44,1982.44,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Exception Members,,1573.69,,,,,,,938.08,2043.75,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,inpatient,1,EA,10207.88000,9697.49000,The Alliance,Exception Members,,7860.07,,,,,,,5614.33,9901.64,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,outpatient,1,EA,10207.88000,9697.49000,The Alliance,Exception Members,,7860.07,,,,,,,376.48,9901.64,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.53,2.71,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Exception Members,,2.15,,,,,,,1.40,2.71,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,inpatient,1,EA,53.80000,51.11000,The Alliance,Exception Members,,41.43,,,,,,,29.59,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,outpatient,1,EA,53.80000,51.11000,The Alliance,Exception Members,,41.43,,,,,,,0.76415,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.32450,0.57230,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Exception Members,,0.45430,,,,,,,0.29500,0.81340,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,25.79,50.03,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,inpatient,1,EA,64.37000,61.15000,The Alliance,Exception Members,,49.56,,,,,,,35.40,62.44,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Exception Members,,49.56,,,,,,,32.19,62.44,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,inpatient,1,EA,61.33000,58.26000,The Alliance,Exception Members,,47.22,,,,,,,33.73,59.49,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,outpatient,1,EA,61.33000,58.26000,The Alliance,Exception Members,,47.22,,,,,,,30.66,59.49,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.92950,1.64,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Exception Members,,1.30,,,,,,,0.84500,1.64,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,inpatient,1,mL,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.70950,1.25,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,outpatient,1,mL,1.29000,1.22000,The Alliance,Exception Members,,0.99330,,,,,,,0.64500,1.25,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.07150,0.12610,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Exception Members,,0.10010,,,,,,,0.06500,0.12610,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,inpatient,1,mL,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.88000,1.55,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,outpatient,1,mL,1.60000,1.52000,The Alliance,Exception Members,,1.23,,,,,,,0.80000,18.34,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,inpatient,1,mL,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Exception Members,,0.50050,,,,,,,0.32500,0.63050,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,inpatient,1,mL,95.59000,90.81000,The Alliance,Exception Members,,73.60,,,,,,,52.57,92.72,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,outpatient,1,mL,95.59000,90.81000,The Alliance,Exception Members,,73.60,,,,,,,47.80,92.72,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,inpatient,1,EA,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,3.49,6.16,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Exception Members,,4.89,,,,,,,2.14,6.16,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,inpatient,1,mL,4.34000,4.12000,The Alliance,Exception Members,,3.34,,,,,,,2.39,4.21,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,outpatient,1,mL,4.34000,4.12000,The Alliance,Exception Members,,3.34,,,,,,,0.33945,4.21,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,264.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,29.92000,28.42000,The Alliance,Exception Members,,23.04,,,,,,,14.66,29.02,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,29.92000,28.42000,The Alliance,Exception Members,,23.04,,,,,,,13.73,29.92,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,821.25000,780.19000,The Alliance,Exception Members,,632.36,,,,,,,402.41,796.61,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,821.25000,780.19000,The Alliance,Exception Members,,632.36,,,,,,,376.95,821.25,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,52.32000,49.70000,The Alliance,Exception Members,,40.29,,,,,,,25.64,50.75,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,52.32000,49.70000,The Alliance,Exception Members,,40.29,,,,,,,24.01,52.32,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,44.64000,42.41000,The Alliance,Exception Members,,34.37,,,,,,,21.87,43.30,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,44.64000,42.41000,The Alliance,Exception Members,,34.37,,,,,,,20.49,44.64,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,46.08000,43.78000,The Alliance,Exception Members,,35.48,,,,,,,22.58,44.70,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,46.08000,43.78000,The Alliance,Exception Members,,35.48,,,,,,,21.15,46.08,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,inpatient,,,308.50000,293.08000,The Alliance,Exception Members,90,237.54,,,,,,,169.68,299.25,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,outpatient,,,308.50000,293.08000,The Alliance,Exception Members,90,237.54,,,,,,,28.07,299.25,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,inpatient,1,GM,13.05000,12.40000,The Alliance,Exception Members,,10.05,,,,,,,7.18,12.66,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,outpatient,1,GM,13.05000,12.40000,The Alliance,Exception Members,,10.05,,,,,,,6.53,12.66,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,inpatient,1,mL,42.10000,40.00000,The Alliance,Exception Members,,32.42,,,,,,,23.16,40.84,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,outpatient,1,mL,42.10000,40.00000,The Alliance,Exception Members,,32.42,,,,,,,21.05,40.84,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Exception Members,,3.16,,,,,,,2.06,3.99,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,inpatient,1,mL,15.52000,14.74000,The Alliance,Exception Members,,11.95,,,,,,,8.54,15.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,outpatient,1,mL,15.52000,14.74000,The Alliance,Exception Members,,11.95,,,,,,,7.76,15.05,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,inpatient,1,mL,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.63250,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,outpatient,1,mL,1.15000,1.09000,The Alliance,Exception Members,,0.88550,,,,,,,0.08525,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,inpatient,1,mL,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,outpatient,1,mL,3.59000,3.41000,The Alliance,Exception Members,,2.76,,,,,,,0.08525,3.48,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,24.68000,23.45000,The Alliance,Exception Members,,19.00,,,,,,,13.57,23.94,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,24.68000,23.45000,The Alliance,Exception Members,,19.00,,,,,,,12.34,23.94,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,The Alliance,Exception Members,,2190.49,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Exception Members,,2190.49,,,,,,,1305.76,2844.79,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,The Alliance,Exception Members,,2712.69,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Exception Members,,2712.69,,,,,,,1617.04,3522.97,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Exception Members,,7528.52,,,,,,,4487.78,9777.30,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.82500,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,The Alliance,Exception Members,,35391.17,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Exception Members,,35391.17,,,,,,,157.68,44583.68,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6486.00000,6161.70000,The Alliance,Exception Members,,4994.22,,,,,,,3178.14,6291.42,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6486.00000,6161.70000,The Alliance,Exception Members,,4994.22,,,,,,,2977.07,6486.00,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,The Alliance,Exception Members,,43.87,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Exception Members,,43.87,,,,,,,28.49,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,The Alliance,Exception Members,,43.87,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Exception Members,,43.87,,,,,,,28.49,55.27,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Exception Members,,5113.76,,,,,,,3048.33,6641.25,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,18511.22,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,20528.18,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Exception Members,,34437.25,,,,,,,20528.18,43381.99,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,Exception Members,TC,498.96,,,,,,,356.40,628.56,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Exception Members,TC,498.96,,,,,,,324.00,2941.42,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,33730.20000,32043.69000,The Alliance,Exception Members,,25972.25,,,,,,,16527.80,32718.29,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,33730.20000,32043.69000,The Alliance,Exception Members,,25972.25,,,,,,,15482.16,33730.20,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,4761.02,10372.60,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,13658.95,27039.14,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,12794.81,27875.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,The Alliance,Exception Members,,1313.81,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Exception Members,,1313.81,,,,,,,783.17,1706.25,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,229.32,453.96,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,214.81,468.00,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12130.22,26427.50,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Exception Members,,1709.40,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1701.49,3368.26,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1593.85,3472.43,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1875.00000,1781.25000,The Alliance,Exception Members,,1443.75,,,,,,,918.75,1818.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1875.00000,1781.25000,The Alliance,Exception Members,,1443.75,,,,,,,860.62,1875.00,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.75000,274.31000,The Alliance,Exception Members,,222.34,,,,,,,141.49,280.09,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.75000,274.31000,The Alliance,Exception Members,,222.34,,,,,,,132.54,288.75,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Exception Members,,99.08,,,,,,,59.06,128.68,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.86000,359.92000,The Alliance,Exception Members,,291.72,,,,,,,185.64,367.49,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.86000,359.92000,The Alliance,Exception Members,,291.72,,,,,,,173.90,378.86,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,The Alliance,Exception Members,,7200.92,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Exception Members,,7200.92,,,,,,,4292.50,9351.85,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1672.50000,1588.88000,The Alliance,Exception Members,,1287.83,,,,,,,819.52,1622.33,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1672.50000,1588.88000,The Alliance,Exception Members,,1287.83,,,,,,,767.68,1672.50,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Exception Members,,19404.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,28138.24000,26731.33000,The Alliance,Exception Members,,21666.44,,,,,,,13787.74,27294.09,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,28138.24000,26731.33000,The Alliance,Exception Members,,21666.44,,,,,,,12915.45,28138.24,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,18698.80000,17763.86000,The Alliance,Exception Members,,14398.08,,,,,,,9162.41,18137.84,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,18698.80000,17763.86000,The Alliance,Exception Members,,14398.08,,,,,,,8582.75,18698.80,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2981.25000,2832.19000,The Alliance,Exception Members,,2295.56,,,,,,,1460.81,2891.81,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2981.25000,2832.19000,The Alliance,Exception Members,,2295.56,,,,,,,1368.39,2981.25,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,5789.10000,5499.65000,The Alliance,Exception Members,,4457.61,,,,,,,2836.66,5615.43,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,5789.10000,5499.65000,The Alliance,Exception Members,,4457.61,,,,,,,2657.20,5789.10,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,The Alliance,Exception Members,,282.48,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Exception Members,,282.48,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,27830.25000,26438.74000,The Alliance,Exception Members,,21429.29,,,,,,,13636.82,26995.34,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,27830.25000,26438.74000,The Alliance,Exception Members,,21429.29,,,,,,,12774.08,26995.34,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,1927.18,4198.65,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,1927.18,4198.65,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2873.85,5689.05,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2692.03,5865.00,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Exception Members,,33.88,,,,,,,20.20,44.00,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,898.32,1778.30,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3915.41000,3719.64000,The Alliance,Exception Members,,3014.87,,,,,,,1918.55,3797.95,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3915.41000,3719.64000,The Alliance,Exception Members,,3014.87,,,,,,,1797.17,3915.41,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,10260.30000,9747.28000,The Alliance,Exception Members,,7900.43,,,,,,,5027.55,9952.49,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,10260.30000,9747.28000,The Alliance,Exception Members,,7900.43,,,,,,,4709.48,10260.30,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,30.04000,28.54000,The Alliance,Exception Members,,23.13,,,,,,,14.72,29.14,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,30.04000,28.54000,The Alliance,Exception Members,,23.13,,,,,,,13.79,30.04,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,TC,2607.22,,,,,,,1862.30,3284.42,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Exception Members,TC,2607.22,,,,,,,1693.00,3284.42,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,34.10,60.14,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Exception Members,,47.74,,,,,,,31.00,264.00,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,84.28000,80.07000,The Alliance,Exception Members,,64.90,,,,,,,41.30,81.75,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,84.28000,80.07000,The Alliance,Exception Members,,64.90,,,,,,,38.68,84.28,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Exception Members,,7658.69,,,,,,,4565.37,9946.35,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,8125.15,14329.81,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Exception Members,,11375.21,,,,,,,1667.31,67198.78,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Exception Members,,5844.30,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,337.50000,320.62000,The Alliance,Exception Members,,259.88,,,,,,,165.38,327.38,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Exception Members,,259.88,,,,,,,154.91,337.50,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,3777.75000,3588.86000,The Alliance,Exception Members,,2908.87,,,,,,,1851.10,3664.42,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Exception Members,,2908.87,,,,,,,1733.99,3777.75,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,TC,1081.08,,,,,,,772.20,1361.88,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Exception Members,TC,1081.08,,,,,,,227.70,3600.87,percent of total billed charges,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,inpatient,,,71282.00000,67717.90000,The Alliance,Exception Members,,54887.14,,,,,,,39205.10,69143.54,percent of total billed charges,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Exception Members,,54887.14,,,,,,,35641.00,74614.73,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,inpatient,,,2612.00000,2481.40000,The Alliance,Exception Members,,2011.24,,,,,,,1436.60,2533.64,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,outpatient,,,2612.00000,2481.40000,The Alliance,Exception Members,,2011.24,,,,,,,1436.60,7803.00,percent of total billed charges,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,inpatient,,,3855.00000,3662.25000,The Alliance,Exception Members,,2968.35,,,,,,,2120.25,3739.35,percent of total billed charges,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,outpatient,,,3855.00000,3662.25000,The Alliance,Exception Members,,2968.35,,,,,,,471.52,3739.35,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.11207,0.29100,percent of total billed charges,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,inpatient,,,1944.00000,1846.80000,The Alliance,Exception Members,TC,1496.88,,,,,,,1069.20,1885.68,percent of total billed charges,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Exception Members,TC,1496.88,,,,,,,384.16,1885.68,percent of total billed charges,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,155.20,percent of total billed charges,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,88.00,3163.00,percent of total billed charges,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,982.50000,933.38000,The Alliance,Exception Members,,756.52,,,,,,,481.43,953.02,percent of total billed charges,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Exception Members,,756.52,,,,,,,450.97,982.50,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,inpatient,,,194.68000,184.95000,The Alliance,Exception Members,,149.90,,,,,,,107.07,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,outpatient,,,194.68000,184.95000,The Alliance,Exception Members,,149.90,,,,,,,97.34,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,inpatient,1,mL,389.35000,369.88000,The Alliance,Exception Members,,299.80,,,,,,,214.14,377.67,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,outpatient,1,mL,389.35000,369.88000,The Alliance,Exception Members,,299.80,,,,,,,194.68,377.67,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,165.55,349.86,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,473.44000,449.77000,The Alliance,Exception Members,,364.55,,,,,,,231.99,459.24,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,473.44000,449.77000,The Alliance,Exception Members,,364.55,,,,,,,217.31,473.44,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,273.79,541.99,percent of total billed charges,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,153.47,541.99,percent of total billed charges,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,inpatient,1,EA,1677.88000,1593.99000,The Alliance,Exception Members,,1291.97,,,,,,,922.83,1627.54,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,outpatient,1,EA,1677.88000,1593.99000,The Alliance,Exception Members,,1291.97,,,,,,,18.21,1627.54,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,inpatient,1,EA,1476.30000,1402.48000,The Alliance,Exception Members,,1136.75,,,,,,,811.97,1432.01,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,outpatient,1,EA,1476.30000,1402.48000,The Alliance,Exception Members,,1136.75,,,,,,,18.21,1432.01,percent of total billed charges,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,214.03,423.70,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Exception Members,,336.34,,,,,,,200.49,436.80,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,11492.32000,10917.70000,The Alliance,Exception Members,,8849.09,,,,,,,5631.24,11147.55,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11492.32000,10917.70000,The Alliance,Exception Members,,8849.09,,,,,,,5274.97,11492.32,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,inpatient,1,mL,591.22000,561.66000,The Alliance,Exception Members,,455.24,,,,,,,325.17,573.48,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Exception Members,,455.24,,,,,,,9.09,573.48,percent of total billed charges,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Exception Members,,6362.32,,,,,,,3792.60,8262.75,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Exception Members,,26.18,,,,,,,15.61,34.00,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,inpatient,1,EA,2061.77000,1958.68000,The Alliance,Exception Members,,1587.56,,,,,,,1133.97,1999.92,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,outpatient,1,EA,2061.77000,1958.68000,The Alliance,Exception Members,,1587.56,,,,,,,1030.88,1999.92,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,inpatient,,,184.10000,174.89000,The Alliance,Exception Members,,141.76,,,,,,,101.25,178.58,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Exception Members,,141.76,,,,,,,92.05,205.31,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,inpatient,1,mL,368.20000,349.79000,The Alliance,Exception Members,,283.51,,,,,,,202.51,357.15,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,outpatient,1,mL,368.20000,349.79000,The Alliance,Exception Members,,283.51,,,,,,,184.10,357.15,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,inpatient,1,mL,591.22000,561.66000,The Alliance,Exception Members,,455.24,,,,,,,325.17,573.48,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Exception Members,,455.24,,,,,,,9.09,573.48,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,inpatient,1,EA,8551.17000,8123.61000,The Alliance,Exception Members,,6584.40,,,,,,,4703.14,8294.63,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,outpatient,1,EA,8551.17000,8123.61000,The Alliance,Exception Members,,6584.40,,,,,,,36.66,8294.63,percent of total billed charges,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,inpatient,,,953.00000,905.35000,The Alliance,Exception Members,TC,733.81,,,,,,,524.15,924.41,percent of total billed charges,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Exception Members,TC,733.81,,,,,,,354.42,3685.66,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,inpatient,1,EA,2588.14000,2458.73000,The Alliance,Exception Members,,1992.87,,,,,,,1423.48,2510.50,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Exception Members,,1992.87,,,,,,,1294.07,2510.50,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,inpatient,1,mL,138.09000,131.19000,The Alliance,Exception Members,,106.33,,,,,,,75.95,133.95,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,outpatient,1,mL,138.09000,131.19000,The Alliance,Exception Members,,106.33,,,,,,,7.15,133.95,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,inpatient,1,mL,155.95000,148.15000,The Alliance,Exception Members,,120.08,,,,,,,85.77,151.27,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,outpatient,1,mL,155.95000,148.15000,The Alliance,Exception Members,,120.08,,,,,,,7.15,151.27,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,inpatient,1,mL,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,69.52,122.61,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,outpatient,1,mL,126.40000,120.08000,The Alliance,Exception Members,,97.33,,,,,,,7.15,122.61,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,inpatient,1,mL,162.68000,154.54000,The Alliance,Exception Members,,125.26,,,,,,,89.47,157.80,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,outpatient,1,mL,162.68000,154.54000,The Alliance,Exception Members,,125.26,,,,,,,7.15,157.80,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,inpatient,1,mL,139.04000,132.09000,The Alliance,Exception Members,,107.06,,,,,,,76.47,134.87,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,outpatient,1,mL,139.04000,132.09000,The Alliance,Exception Members,,107.06,,,,,,,7.15,134.87,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,inpatient,1,mL,132.72000,126.08000,The Alliance,Exception Members,,102.19,,,,,,,73.00,128.74,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,outpatient,1,mL,132.72000,126.08000,The Alliance,Exception Members,,102.19,,,,,,,7.15,128.74,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,inpatient,1,mL,85.32000,81.05000,The Alliance,Exception Members,,65.70,,,,,,,46.93,82.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,outpatient,1,mL,85.32000,81.05000,The Alliance,Exception Members,,65.70,,,,,,,7.15,82.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,52.14,91.96,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Exception Members,,73.00,,,,,,,7.15,91.96,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,inpatient,1,mL,123.46000,117.29000,The Alliance,Exception Members,,95.06,,,,,,,67.90,119.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,outpatient,1,mL,123.46000,117.29000,The Alliance,Exception Members,,95.06,,,,,,,7.15,119.76,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,inpatient,,,317.36000,301.49000,The Alliance,Exception Members,,244.37,,,,,,,174.55,307.84,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,outpatient,,,317.36000,301.49000,The Alliance,Exception Members,,244.37,,,,,,,158.68,307.84,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,inpatient,1,mL,634.72000,602.98000,The Alliance,Exception Members,,488.73,,,,,,,349.10,615.68,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,outpatient,1,mL,634.72000,602.98000,The Alliance,Exception Members,,488.73,,,,,,,275.21,615.68,percent of total billed charges,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,inpatient,1,mL,117.25000,111.39000,The Alliance,Exception Members,,90.28,,,,,,,64.49,113.73,percent of total billed charges,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,outpatient,1,mL,117.25000,111.39000,The Alliance,Exception Members,,90.28,,,,,,,58.62,113.73,percent of total billed charges,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,inpatient,1,EA,12040.81000,11438.77000,The Alliance,Exception Members,,9271.42,,,,,,,6622.45,11679.59,percent of total billed charges,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,outpatient,1,EA,12040.81000,11438.77000,The Alliance,Exception Members,,9271.42,,,,,,,73.16,11679.59,percent of total billed charges,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Exception Members,,2741.51,,,,,,,3.00,3453.59,percent of total billed charges,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,inpatient,,,3536.25000,3359.44000,The Alliance,Exception Members,,2722.91,,,,,,,1732.76,3430.16,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Exception Members,,2722.91,,,,,,,1768.12,3430.16,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,inpatient,1,mL,38.54000,36.61000,The Alliance,Exception Members,,29.68,,,,,,,21.20,37.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,outpatient,1,mL,38.54000,36.61000,The Alliance,Exception Members,,29.68,,,,,,,0.04650,37.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,inpatient,1,mL,24.96000,23.72000,The Alliance,Exception Members,,19.22,,,,,,,13.73,24.21,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,outpatient,1,mL,24.96000,23.72000,The Alliance,Exception Members,,19.22,,,,,,,0.04650,24.21,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,inpatient,1,mL,25.63000,24.35000,The Alliance,Exception Members,,19.74,,,,,,,14.10,24.86,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,outpatient,1,mL,25.63000,24.35000,The Alliance,Exception Members,,19.74,,,,,,,0.04650,24.86,percent of total billed charges,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,inpatient,1,mL,485.62000,461.34000,The Alliance,Exception Members,,373.93,,,,,,,267.09,471.05,percent of total billed charges,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,outpatient,1,mL,485.62000,461.34000,The Alliance,Exception Members,,373.93,,,,,,,0.91760,471.05,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,inpatient,1,mL,2502.32000,2377.20000,The Alliance,Exception Members,,1926.79,,,,,,,1376.28,2427.25,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,outpatient,1,mL,2502.32000,2377.20000,The Alliance,Exception Members,,1926.79,,,,,,,3.33,2427.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2043.75000,1941.56000,The Alliance,Exception Members,,1573.69,,,,,,,1001.44,1982.44,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Exception Members,,1573.69,,,,,,,938.08,2043.75,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,inpatient,,,19.40000,18.43000,The Alliance,Exception Members,,14.94,,,,,,,9.51,18.82,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,outpatient,,,19.40000,18.43000,The Alliance,Exception Members,,14.94,,,,,,,9.70,51.01,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,inpatient,1,mL,62.37000,59.25000,The Alliance,Exception Members,,48.02,,,,,,,34.30,60.50,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,outpatient,1,mL,62.37000,59.25000,The Alliance,Exception Members,,48.02,,,,,,,0.12000,60.50,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,inpatient,1,mL,212.86000,202.21000,The Alliance,Exception Members,,163.90,,,,,,,117.07,206.47,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,outpatient,1,mL,212.86000,202.21000,The Alliance,Exception Members,,163.90,,,,,,,106.43,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,inpatient,1,mL,244.90000,232.66000,The Alliance,Exception Members,,188.57,,,,,,,134.69,237.55,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Exception Members,,188.57,,,,,,,109.28,249.68,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,inpatient,1,mL,30.54000,29.02000,The Alliance,Exception Members,,23.52,,,,,,,16.80,29.62,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,outpatient,1,mL,30.54000,29.02000,The Alliance,Exception Members,,23.52,,,,,,,15.27,83.21,percent of total billed charges,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,inpatient,1,mL,256.88000,244.04000,The Alliance,Exception Members,,197.80,,,,,,,141.28,249.17,percent of total billed charges,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,outpatient,1,mL,256.88000,244.04000,The Alliance,Exception Members,,197.80,,,,,,,128.44,249.17,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,inpatient,,,700.93000,665.88000,The Alliance,Exception Members,,539.72,,,,,,,385.51,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,outpatient,,,700.93000,665.88000,The Alliance,Exception Members,,539.72,,,,,,,331.10,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,inpatient,1,mL,1401.86000,1331.77000,The Alliance,Exception Members,,1079.43,,,,,,,771.02,1359.80,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,outpatient,1,mL,1401.86000,1331.77000,The Alliance,Exception Members,,1079.43,,,,,,,331.10,1359.80,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Exception Members,,10037.33,,,,,,,5983.29,13035.50,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,13658.95,27039.14,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,12794.81,27875.40,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,inpatient,1,mL,4909.73000,4664.25000,The Alliance,Exception Members,,3780.49,,,,,,,2700.35,4762.44,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Exception Members,,3780.49,,,,,,,225.19,4762.44,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,inpatient,1,EA,2155.06000,2047.31000,The Alliance,Exception Members,,1659.40,,,,,,,1185.28,2090.41,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,outpatient,1,EA,2155.06000,2047.31000,The Alliance,Exception Members,,1659.40,,,,,,,1077.53,2090.41,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,inpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,47.85,84.39,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Exception Members,,66.99,,,,,,,43.50,84.39,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.62,2.86,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Exception Members,,2.27,,,,,,,1.48,2.86,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,inpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,63.80,112.52,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Exception Members,,89.32,,,,,,,58.00,112.52,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.34000,356.57000,The Alliance,Exception Members,,289.01,,,,,,,183.92,364.08,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.34000,356.57000,The Alliance,Exception Members,,289.01,,,,,,,172.28,375.34,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,229.32,453.96,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Exception Members,,360.36,,,,,,,214.81,468.00,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Exception Members,,7989.53,,,,,,,4762.59,10376.01,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,674.25,2392.02,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,323.55000,307.37000,The Alliance,Exception Members,,249.13,,,,,,,158.54,313.84,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Exception Members,,249.13,,,,,,,148.51,323.55,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1858.06,3678.20,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Exception Members,,2919.81,,,,,,,1740.51,3791.96,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1745.03000,1657.78000,The Alliance,Exception Members,,1343.67,,,,,,,855.06,1692.68,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1745.03000,1657.78000,The Alliance,Exception Members,,1343.67,,,,,,,800.97,1745.03,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,91.88,181.88,percent of total billed charges,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,86.06,187.50,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Exception Members,,7986.90,,,,,,,4761.02,10372.60,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3041.25000,2889.19000,The Alliance,Exception Members,,2341.76,,,,,,,1490.21,2950.01,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3041.25000,2889.19000,The Alliance,Exception Members,,2341.76,,,,,,,1395.93,3041.25,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,136.34,269.90,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Exception Members,,214.25,,,,,,,127.72,278.25,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9300.00000,8835.00000,The Alliance,Exception Members,,7161.00,,,,,,,4557.00,9021.00,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9300.00000,8835.00000,The Alliance,Exception Members,,7161.00,,,,,,,4268.70,9300.00,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,47.62,2280.00,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Exception Members,,11698.69,,,,,,,6973.63,15193.10,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,Exception Members,TC,267.96,,,,,,,191.40,337.56,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Exception Members,TC,267.96,,,,,,,144.10,548.00,percent of total billed charges,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,inpatient,,,76.60000,72.77000,The Alliance,Exception Members,90,58.98,,,,,,,42.13,74.30,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,outpatient,,,76.60000,72.77000,The Alliance,Exception Members,90,58.98,,,,,,,4.57,271.65,percent of total billed charges,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,inpatient,1,mL,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.54,2.72,percent of total billed charges,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,outpatient,1,mL,2.80000,2.66000,The Alliance,Exception Members,,2.16,,,,,,,1.40,2.72,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Exception Members,,1299.38,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,inpatient,1,mL,8.34000,7.93000,The Alliance,Exception Members,,6.42,,,,,,,4.59,8.09,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Exception Members,,6.42,,,,,,,0.17611,8.09,percent of total billed charges,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,4467.75000,4244.36000,The Alliance,Exception Members,,3440.17,,,,,,,2189.20,4333.72,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Exception Members,,3440.17,,,,,,,2050.70,4467.75,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
VISIT EST PAT LEVEL 1 .,83777,CDM,510,RC,99211,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,58.85,103.79,percent of total billed charges,
VISIT EST PAT LEVEL 1 .,83777,CDM,510,RC,99211,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Exception Members,,82.39,,,,,,,53.50,103.79,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,inpatient,1,GM,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,outpatient,1,GM,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,inpatient,1,GM,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,2.01,3.54,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,outpatient,1,GM,3.65000,3.47000,The Alliance,Exception Members,,2.81,,,,,,,1.82,3.54,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,inpatient,1,EA,5037.00000,4785.15000,The Alliance,Exception Members,,3878.49,,,,,,,2770.35,4885.89,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,outpatient,1,EA,5037.00000,4785.15000,The Alliance,Exception Members,,3878.49,,,,,,,34.48,4885.89,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,inpatient,1,EA,84884.40000,80640.18000,The Alliance,Exception Members,,65360.99,,,,,,,46686.42,82337.87,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,outpatient,1,EA,84884.40000,80640.18000,The Alliance,Exception Members,,65360.99,,,,,,,34.48,82337.87,percent of total billed charges,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,1155.00,2037.00,percent of total billed charges,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Exception Members,TC,1617.00,,,,,,,980.94,2210.07,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,inpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,106.70,188.18,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Exception Members,,149.38,,,,,,,19.57,188.18,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,inpatient,,,122.40000,116.28000,The Alliance,Exception Members,90,94.25,,,,,,,67.32,118.73,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,outpatient,,,122.40000,116.28000,The Alliance,Exception Members,90,94.25,,,,,,,6.69,339.51,percent of total billed charges,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,inpatient,,,186.10000,176.79000,The Alliance,Exception Members,90,143.30,,,,,,,102.36,180.52,percent of total billed charges,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,outpatient,,,186.10000,176.79000,The Alliance,Exception Members,90,143.30,,,,,,,93.05,1137.41,percent of total billed charges,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,41.63,73.43,percent of total billed charges,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,37.85,1137.41,percent of total billed charges,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,inpatient,1,mL,26.42000,25.10000,The Alliance,Exception Members,,20.34,,,,,,,14.53,25.63,percent of total billed charges,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,outpatient,1,mL,26.42000,25.10000,The Alliance,Exception Members,,20.34,,,,,,,13.21,25.63,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.53,4.46,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Exception Members,,3.54,,,,,,,2.30,4.46,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.17600,0.31040,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Exception Members,,0.24640,,,,,,,0.16000,0.31040,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,inpatient,1,EA,64.37000,61.15000,The Alliance,Exception Members,,49.56,,,,,,,35.40,62.44,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Exception Members,,49.56,,,,,,,32.19,62.44,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,inpatient,,,457.32000,434.45000,The Alliance,Exception Members,,352.14,,,,,,,251.53,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,outpatient,,,457.32000,434.45000,The Alliance,Exception Members,,352.14,,,,,,,228.66,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,2.51,4.43,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Exception Members,,3.52,,,,,,,2.29,4.43,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,7940.90,14004.86,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Exception Members,TC,11117.26,,,,,,,4549.00,14004.86,percent of total billed charges,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,PS,11128.04,,,,,,,7948.60,14018.44,percent of total billed charges,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Exception Members,PS,11128.04,,,,,,,4549.00,14018.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7279.50000,6915.52000,The Alliance,Exception Members,,5605.22,,,,,,,3566.95,7061.11,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Exception Members,,5605.22,,,,,,,3341.29,7279.50,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7279.50000,6915.52000,The Alliance,Exception Members,,5605.22,,,,,,,3566.95,7061.11,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Exception Members,,5605.22,,,,,,,3341.29,7279.50,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,716.62,1418.62,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,671.29,1462.50,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,530.63000,504.10000,The Alliance,Exception Members,,408.59,,,,,,,260.01,514.71,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,530.63000,504.10000,The Alliance,Exception Members,,408.59,,,,,,,243.56,530.63,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,inpatient,1,EA,278.53000,264.60000,The Alliance,Exception Members,,214.47,,,,,,,153.19,270.17,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,outpatient,1,EA,278.53000,264.60000,The Alliance,Exception Members,,214.47,,,,,,,37.62,270.17,percent of total billed charges,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,50.04000,47.54000,The Alliance,Exception Members,,38.53,,,,,,,27.52,48.54,percent of total billed charges,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,50.04000,47.54000,The Alliance,Exception Members,,38.53,,,,,,,0.22165,48.54,percent of total billed charges,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,inpatient,,,828.75000,787.31000,The Alliance,Exception Members,,638.14,,,,,,,406.09,803.89,percent of total billed charges,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,outpatient,,,828.75000,787.31000,The Alliance,Exception Members,,638.14,,,,,,,245.60,803.89,percent of total billed charges,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,inpatient,1,EA,18525.59000,17599.31000,The Alliance,Exception Members,,14264.70,,,,,,,10189.07,17969.82,percent of total billed charges,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,outpatient,1,EA,18525.59000,17599.31000,The Alliance,Exception Members,,14264.70,,,,,,,236.62,17969.82,percent of total billed charges,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Exception Members,,15610.98,,,,,,,9305.77,20274.00,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,inpatient,1,mL,2334.42000,2217.70000,The Alliance,Exception Members,,1797.50,,,,,,,1283.93,2264.39,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,outpatient,1,mL,2334.42000,2217.70000,The Alliance,Exception Members,,1797.50,,,,,,,248.50,2264.39,percent of total billed charges,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,32130.00000,30523.50000,The Alliance,Exception Members,,24740.10,,,,,,,15743.70,31166.10,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,32130.00000,30523.50000,The Alliance,Exception Members,,24740.10,,,,,,,14747.67,32130.00,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Exception Members,,31053.68,,,,,,,18511.22,40329.45,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,716.62,1418.62,percent of total billed charges,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Exception Members,,1126.12,,,,,,,671.29,1462.50,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,inpatient,1,EA,48.98000,46.53000,The Alliance,Exception Members,,37.71,,,,,,,26.94,47.51,percent of total billed charges,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,outpatient,1,EA,48.98000,46.53000,The Alliance,Exception Members,,37.71,,,,,,,24.49,47.51,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,inpatient,1,EA,74.26000,70.55000,The Alliance,Exception Members,,57.18,,,,,,,40.84,72.03,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,outpatient,1,EA,74.26000,70.55000,The Alliance,Exception Members,,57.18,,,,,,,37.13,72.03,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,19.99,35.25,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Exception Members,,27.98,,,,,,,18.17,35.25,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,inpatient,,,518.56000,492.63000,The Alliance,Exception Members,,399.29,,,,,,,285.21,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,outpatient,,,518.56000,492.63000,The Alliance,Exception Members,,399.29,,,,,,,0.01000,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,inpatient,1,mL,1037.12000,985.26000,The Alliance,Exception Members,,798.58,,,,,,,570.42,1006.01,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,outpatient,1,mL,1037.12000,985.26000,The Alliance,Exception Members,,798.58,,,,,,,0.01000,1006.01,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,inpatient,1,mL,4.57000,4.35000,The Alliance,Exception Members,,3.52,,,,,,,2.51,4.43,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,outpatient,1,mL,4.57000,4.35000,The Alliance,Exception Members,,3.52,,,,,,,2.11,4.43,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,inpatient,1,mL,2.91000,2.77000,The Alliance,Exception Members,,2.24,,,,,,,1.60,2.82,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Exception Members,,2.24,,,,,,,1.46,2.82,percent of total billed charges,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,inpatient,1,EA,12538.10000,11911.19000,The Alliance,Exception Members,,9654.34,,,,,,,6895.95,12161.96,percent of total billed charges,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,outpatient,1,EA,12538.10000,11911.19000,The Alliance,Exception Members,,9654.34,,,,,,,188.65,12161.96,percent of total billed charges,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,30271.50000,28757.92000,The Alliance,Exception Members,,23309.06,,,,,,,14833.03,29363.35,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Exception Members,,23309.06,,,,,,,13894.62,30271.50,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,19659.70,42831.60,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,inpatient,1,mL,5172.56000,4913.93000,The Alliance,Exception Members,,3982.87,,,,,,,2844.91,5017.38,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,outpatient,1,mL,5172.56000,4913.93000,The Alliance,Exception Members,,3982.87,,,,,,,12.35,5017.38,percent of total billed charges,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9632.40000,9150.78000,The Alliance,Exception Members,,7416.95,,,,,,,4719.88,9343.43,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9632.40000,9150.78000,The Alliance,Exception Members,,7416.95,,,,,,,4421.27,9632.40,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,235.20,465.60,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,220.32,480.00,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,105.00,228.75,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Exception Members,,18744.92,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,363.23000,345.07000,The Alliance,Exception Members,,279.69,,,,,,,177.98,352.33,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,363.23000,345.07000,The Alliance,Exception Members,,279.69,,,,,,,166.72,363.23,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,370.05000,351.55000,The Alliance,Exception Members,,284.94,,,,,,,181.32,358.95,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,370.05000,351.55000,The Alliance,Exception Members,,284.94,,,,,,,169.85,370.05,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,13330.00000,12663.50000,The Alliance,Exception Members,,10264.10,,,,,,,6531.70,12930.10,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,13330.00000,12663.50000,The Alliance,Exception Members,,10264.10,,,,,,,6118.47,13330.00,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Exception Members,,3232.96,,,,,,,1927.18,4198.65,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,inpatient,1,mL,8213.96000,7803.27000,The Alliance,Exception Members,,6324.75,,,,,,,4517.68,7967.54,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,outpatient,1,mL,8213.96000,7803.27000,The Alliance,Exception Members,,6324.75,,,,,,,12.96,7967.54,percent of total billed charges,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,34469.40000,32745.93000,The Alliance,Exception Members,,26541.44,,,,,,,16890.01,33435.32,percent of total billed charges,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Exception Members,,26541.44,,,,,,,15821.45,34469.40,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,74.80000,71.06000,The Alliance,Exception Members,,57.60,,,,,,,36.65,72.56,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Exception Members,,57.60,,,,,,,34.33,74.80,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,750.75,1324.05,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Exception Members,,1051.05,,,,,,,682.50,1324.05,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,inpatient,1,EA,15764.79000,14976.55000,The Alliance,Exception Members,,12138.89,,,,,,,8670.63,15291.85,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Exception Members,,12138.89,,,,,,,171.94,15291.85,percent of total billed charges,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,inpatient,1,mL,9512.59000,9036.96000,The Alliance,Exception Members,,7324.69,,,,,,,5231.92,9227.21,percent of total billed charges,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,outpatient,1,mL,9512.59000,9036.96000,The Alliance,Exception Members,,7324.69,,,,,,,118.62,9227.21,percent of total billed charges,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,inpatient,1,mL,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,14.43,25.44,percent of total billed charges,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Exception Members,,20.20,,,,,,,0.40920,25.44,percent of total billed charges,
INJ NON-CMP SCHLEROSANT;SNG VN-TECH,83999,CDM,510,RC,36465,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,180.95,319.13,percent of total billed charges,
INJ NON-CMP SCHLEROSANT;SNG VN-TECH,83999,CDM,510,RC,36465,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Exception Members,,253.33,,,,,,,164.50,1910.62,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,inpatient,1,EA,34.59000,32.86000,The Alliance,Exception Members,,26.63,,,,,,,19.02,33.55,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Exception Members,,26.63,,,,,,,17.30,33.55,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,8414.55000,7993.82000,The Alliance,Exception Members,,6479.20,,,,,,,4123.13,8162.11,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,8414.55000,7993.82000,The Alliance,Exception Members,,6479.20,,,,,,,3862.28,8414.55,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,19659.70,42831.60,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,220.50,436.50,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Exception Members,,346.50,,,,,,,206.55,450.00,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.47300,0.83420,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Exception Members,,0.66220,,,,,,,0.43000,0.83420,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12130.22,26427.50,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,3489.78000,3315.29000,The Alliance,Exception Members,,2687.13,,,,,,,1709.99,3385.09,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,3489.78000,3315.29000,The Alliance,Exception Members,,2687.13,,,,,,,1601.81,3489.78,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Exception Members,,32980.33,,,,,,,19659.70,42831.60,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,273.79,541.99,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Exception Members,,430.24,,,,,,,153.47,541.99,percent of total billed charges,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,21296.39000,20231.57000,The Alliance,Exception Members,,16398.22,,,,,,,10435.23,20657.50,percent of total billed charges,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Exception Members,,16398.22,,,,,,,10648.19,27182.63,percent of total billed charges,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,inpatient,,,556.38000,528.56000,The Alliance,Exception Members,,428.41,,,,,,,306.01,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Exception Members,,428.41,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,inpatient,1,mL,2225.52000,2114.24000,The Alliance,Exception Members,,1713.65,,,,,,,1224.04,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,outpatient,1,mL,2225.52000,2114.24000,The Alliance,Exception Members,,1713.65,,,,,,,1112.76,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,inpatient,,,556.38000,528.56000,The Alliance,Exception Members,,428.41,,,,,,,306.01,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Exception Members,,428.41,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,inpatient,1,mL,1112.76000,1057.12000,The Alliance,Exception Members,,856.83,,,,,,,612.02,1079.38,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,outpatient,1,mL,1112.76000,1057.12000,The Alliance,Exception Members,,856.83,,,,,,,556.38,1079.38,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,inpatient,,,6705.11000,6369.85000,The Alliance,Exception Members,NU,5162.93,,,,,,,3687.81,6503.96,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,outpatient,,,6705.11000,6369.85000,The Alliance,Exception Members,NU,5162.93,,,,,,,3352.55,6503.96,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1327.58000,1261.20000,The Alliance,Exception Members,,1022.24,,,,,,,650.51,1287.75,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Exception Members,,1022.24,,,,,,,609.36,1327.58,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
"BX,SFT TISS-UPR ARM/ELBOW;SUPR-TECH",84032,CDM,510,RC,24065,CPT,,,facility,inpatient,,,704.50000,669.28000,The Alliance,Exception Members,,542.47,,,,,,,387.48,683.37,percent of total billed charges,
"BX,SFT TISS-UPR ARM/ELBOW;SUPR-TECH",84032,CDM,510,RC,24065,CPT,,,facility,outpatient,,,704.50000,669.28000,The Alliance,Exception Members,,542.47,,,,,,,352.25,1692.33,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,inpatient,,,4200.00000,3990.00000,The Alliance,Exception Members,,3234.00,,,,,,,2310.00,4074.00,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,outpatient,,,4200.00000,3990.00000,The Alliance,Exception Members,,3234.00,,,,,,,2100.00,4158.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Exception Members,,176.14,,,,,,,105.00,228.75,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,16998.91000,16148.96000,The Alliance,Exception Members,,13089.16,,,,,,,8329.47,16488.94,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Exception Members,,13089.16,,,,,,,7802.50,16998.91,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.69,8.27,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Exception Members,,6.57,,,,,,,4.26,8.27,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,inpatient,1,EA,15.67000,14.88000,The Alliance,Exception Members,,12.07,,,,,,,8.62,15.20,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,outpatient,1,EA,15.67000,14.88000,The Alliance,Exception Members,,12.07,,,,,,,7.83,15.20,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,24.80000,23.56000,The Alliance,Exception Members,,19.10,,,,,,,12.15,24.06,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,24.80000,23.56000,The Alliance,Exception Members,,19.10,,,,,,,11.38,24.80,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,412.24000,391.63000,The Alliance,Exception Members,,317.42,,,,,,,202.00,399.87,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,412.24000,391.63000,The Alliance,Exception Members,,317.42,,,,,,,206.12,399.87,percent of total billed charges,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,4229.70000,4018.21000,The Alliance,Exception Members,,3256.87,,,,,,,2072.55,4102.81,percent of total billed charges,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Exception Members,,3256.87,,,,,,,1941.43,4229.70,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,366.26000,347.95000,The Alliance,Exception Members,,282.02,,,,,,,179.47,355.27,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,366.26000,347.95000,The Alliance,Exception Members,,282.02,,,,,,,113.78,355.27,percent of total billed charges,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,2.63,6.47,percent of total billed charges,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,3.67,6.47,percent of total billed charges,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Exception Members,,5.14,,,,,,,2.63,6.47,percent of total billed charges,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,43.12,85.36,percent of total billed charges,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Exception Members,,67.76,,,,,,,40.39,85.36,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,52.27000,49.66000,The Alliance,Exception Members,,40.25,,,,,,,28.75,50.70,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,52.27000,49.66000,The Alliance,Exception Members,,40.25,,,,,,,2.63,50.70,percent of total billed charges,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,62.67000,59.54000,The Alliance,Exception Members,,48.26,,,,,,,34.47,60.79,percent of total billed charges,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,62.67000,59.54000,The Alliance,Exception Members,,48.26,,,,,,,2.63,60.79,percent of total billed charges,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,inpatient,,,337.88000,320.99000,The Alliance,Exception Members,NU,260.17,,,,,,,185.83,327.74,percent of total billed charges,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,outpatient,,,337.88000,320.99000,The Alliance,Exception Members,NU,260.17,,,,,,,62.66,327.74,percent of total billed charges,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,135.60000,128.82000,The Alliance,Exception Members,,104.41,,,,,,,66.44,131.53,percent of total billed charges,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Exception Members,,104.41,,,,,,,67.80,315.32,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,Exception Members,TC,575.19,,,,,,,410.85,724.59,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Exception Members,TC,575.19,,,,,,,282.87,724.59,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,1.73,23.28,percent of total billed charges,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2771.25000,2632.69000,The Alliance,Exception Members,,2133.86,,,,,,,1357.91,2688.11,percent of total billed charges,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2771.25000,2632.69000,The Alliance,Exception Members,,2133.86,,,,,,,1272.00,2771.25,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1701.49,3368.26,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1593.85,3472.43,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,inpatient,,,151.70000,144.11000,The Alliance,Exception Members,90,116.81,,,,,,,83.44,147.15,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,outpatient,,,151.70000,144.11000,The Alliance,Exception Members,90,116.81,,,,,,,17.85,814.87,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,79.60000,75.62000,The Alliance,Exception Members,,61.29,,,,,,,39.00,77.21,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Exception Members,,61.29,,,,,,,36.54,79.60,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Exception Members,,1755.60,,,,,,,1046.52,2280.00,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,13.20,23.28,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Exception Members,,18.48,,,,,,,12.00,264.00,percent of total billed charges,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,130.35,229.89,percent of total billed charges,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,112.98,1134.10,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,inpatient,1,mL,2500.41000,2375.39000,The Alliance,Exception Members,,1925.32,,,,,,,1375.23,2425.40,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,outpatient,1,mL,2500.41000,2375.39000,The Alliance,Exception Members,,1925.32,,,,,,,3.33,2425.40,percent of total billed charges,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30132.00000,28625.40000,The Alliance,Exception Members,,23201.64,,,,,,,14764.68,29228.04,percent of total billed charges,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Exception Members,,23201.64,,,,,,,13830.59,30132.00,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1600.31000,1520.29000,The Alliance,Exception Members,,1232.24,,,,,,,784.15,1552.30,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1600.31000,1520.29000,The Alliance,Exception Members,,1232.24,,,,,,,440.69,1600.31,percent of total billed charges,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,798.75000,758.81000,The Alliance,Exception Members,,615.04,,,,,,,391.39,774.79,percent of total billed charges,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,798.75000,758.81000,The Alliance,Exception Members,,615.04,,,,,,,366.63,798.75,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,862.50000,819.38000,The Alliance,Exception Members,,664.12,,,,,,,422.62,836.62,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,862.50000,819.38000,The Alliance,Exception Members,,664.12,,,,,,,395.89,862.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,inpatient,1,mL,2890.18000,2745.67000,The Alliance,Exception Members,,2225.44,,,,,,,1589.60,2803.47,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,outpatient,1,mL,2890.18000,2745.67000,The Alliance,Exception Members,,2225.44,,,,,,,73.05,2803.47,percent of total billed charges,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,inpatient,1,mL,70300.00000,66785.00000,The Alliance,Exception Members,,54131.00,,,,,,,38665.00,68191.00,percent of total billed charges,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Exception Members,,54131.00,,,,,,,790.04,68191.00,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,inpatient,1,EA,673.40000,639.73000,The Alliance,Exception Members,,518.52,,,,,,,370.37,653.20,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,outpatient,1,EA,673.40000,639.73000,The Alliance,Exception Members,,518.52,,,,,,,5.31,653.20,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,0.19995,3.68,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,inpatient,1,mL,9.04000,8.59000,The Alliance,Exception Members,,6.96,,,,,,,4.97,8.77,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,outpatient,1,mL,9.04000,8.59000,The Alliance,Exception Members,,6.96,,,,,,,0.19995,8.77,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1631.25000,1549.69000,The Alliance,Exception Members,,1256.06,,,,,,,799.31,1582.31,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Exception Members,,1256.06,,,,,,,748.74,1631.25,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24404.10000,23183.89000,The Alliance,Exception Members,,18791.16,,,,,,,11958.01,23671.98,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Exception Members,,18791.16,,,,,,,11201.48,24404.10,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3532.50000,3355.88000,The Alliance,Exception Members,,2720.03,,,,,,,1730.92,3426.53,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3532.50000,3355.88000,The Alliance,Exception Members,,2720.03,,,,,,,1621.42,3532.50,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,inpatient,1,mL,1881.95000,1787.86000,The Alliance,Exception Members,,1449.10,,,,,,,1035.07,1825.49,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,outpatient,1,mL,1881.95000,1787.86000,The Alliance,Exception Members,,1449.10,,,,,,,197.65,1825.49,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.53900,0.95060,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Exception Members,,0.75460,,,,,,,0.49000,1.58,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CORNEAL HYSTER AIR STIM UNI/BI-TECH,84172,CDM,510,RC,92145,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,TC,21.56,,,,,,,15.40,27.16,percent of total billed charges,
CORNEAL HYSTER AIR STIM UNI/BI-TECH,84172,CDM,510,RC,92145,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,TC,21.56,,,,,,,14.00,27.16,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Exception Members,,29054.26,,,,,,,17319.36,37732.80,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Exception Members,,264.12,,,,,,,157.44,343.01,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,245.70000,233.42000,The Alliance,Exception Members,,189.19,,,,,,,120.39,238.33,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,245.70000,233.42000,The Alliance,Exception Members,,189.19,,,,,,,112.78,245.70,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,Exception Members,,310.48,,,,,,,221.77,391.12,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Exception Members,,310.48,,,,,,,201.61,398.00,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,787.50000,748.12000,The Alliance,Exception Members,,606.38,,,,,,,385.88,763.88,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,787.50000,748.12000,The Alliance,Exception Members,,606.38,,,,,,,361.46,787.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,Exception Members,,310.48,,,,,,,221.77,391.12,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Exception Members,,310.48,,,,,,,201.61,398.00,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,876.23000,832.42000,The Alliance,Exception Members,,674.70,,,,,,,429.35,849.94,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Exception Members,,674.70,,,,,,,402.19,876.23,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,323.55000,307.37000,The Alliance,Exception Members,,249.13,,,,,,,158.54,313.84,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Exception Members,,249.13,,,,,,,148.51,323.55,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,645.04,1276.91,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12400.00,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,inpatient,,,647.36000,614.99000,The Alliance,Exception Members,,498.47,,,,,,,317.21,627.94,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,outpatient,,,647.36000,614.99000,The Alliance,Exception Members,,498.47,,,,,,,2.81,647.36,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9566.51000,9088.18000,The Alliance,Exception Members,,7366.21,,,,,,,4687.59,9279.51,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9566.51000,9088.18000,The Alliance,Exception Members,,7366.21,,,,,,,4391.03,9566.51,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,762.49000,724.37000,The Alliance,Exception Members,,587.12,,,,,,,373.62,739.62,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,762.49000,724.37000,The Alliance,Exception Members,,587.12,,,,,,,349.98,762.49,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,1031.25000,979.69000,The Alliance,Exception Members,,794.06,,,,,,,567.19,1000.31,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Exception Members,,794.06,,,,,,,44.30,1000.31,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,367.50,727.50,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Exception Members,,577.50,,,,,,,344.25,750.00,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,inpatient,1,EA,5157.98000,4900.08000,The Alliance,Exception Members,,3971.64,,,,,,,2836.89,5003.24,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,outpatient,1,EA,5157.98000,4900.08000,The Alliance,Exception Members,,3971.64,,,,,,,81.70,5003.24,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,inpatient,1,mL,8.74000,8.30000,The Alliance,Exception Members,,6.73,,,,,,,4.81,8.48,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,outpatient,1,mL,8.74000,8.30000,The Alliance,Exception Members,,6.73,,,,,,,0.77000,8.48,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,inpatient,,,1402.00000,1331.90000,The Alliance,Exception Members,TC,1079.54,,,,,,,771.10,1359.94,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,outpatient,,,1402.00000,1331.90000,The Alliance,Exception Members,TC,1079.54,,,,,,,316.68,1447.00,percent of total billed charges,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,153.47,454.69,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,17.99,35.62,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,16.85,36.72,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,179.80000,170.81000,The Alliance,Exception Members,,138.45,,,,,,,98.89,174.41,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,179.80000,170.81000,The Alliance,Exception Members,,138.45,,,,,,,89.90,174.41,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,inpatient,1,mL,12430.84000,11809.30000,The Alliance,Exception Members,,9571.75,,,,,,,6836.96,12057.91,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,outpatient,1,mL,12430.84000,11809.30000,The Alliance,Exception Members,,9571.75,,,,,,,27.99,12057.91,percent of total billed charges,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,358.31,709.31,percent of total billed charges,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Exception Members,,563.06,,,,,,,335.64,731.25,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Exception Members,,18778.22,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,16817.50000,15976.62000,The Alliance,Exception Members,,12949.48,,,,,,,8240.58,16312.98,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16817.50000,15976.62000,The Alliance,Exception Members,,12949.48,,,,,,,7719.23,16817.50,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,77.64,150.62,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4936.75,9772.75,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4624.43,10075.00,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,898.32,1778.30,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Exception Members,,1411.64,,,,,,,841.48,1833.30,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,inpatient,,,1089.74000,1035.25000,The Alliance,Exception Members,,839.10,,,,,,,599.36,1057.05,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,outpatient,,,1089.74000,1035.25000,The Alliance,Exception Members,,839.10,,,,,,,332.44,1057.05,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2006.21000,1905.90000,The Alliance,Exception Members,,1544.78,,,,,,,983.04,1946.02,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Exception Members,,1544.78,,,,,,,920.85,2006.21,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,Exception Members,TC,90.86,,,,,,,64.90,114.46,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Exception Members,TC,90.86,,,,,,,59.00,548.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,inpatient,,,3492.00000,3317.40000,The Alliance,Exception Members,,2688.84,,,,,,,1920.60,3387.24,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,outpatient,,,3492.00000,3317.40000,The Alliance,Exception Members,,2688.84,,,,,,,1920.60,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,inpatient,,,6918.00000,6572.10000,The Alliance,Exception Members,,5326.86,,,,,,,3804.90,6710.46,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,outpatient,,,6918.00000,6572.10000,The Alliance,Exception Members,,5326.86,,,,,,,3804.90,6710.46,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,inpatient,1,EA,9557.99000,9080.09000,The Alliance,Exception Members,,7359.65,,,,,,,5256.89,9271.25,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,outpatient,1,EA,9557.99000,9080.09000,The Alliance,Exception Members,,7359.65,,,,,,,41.40,9271.25,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,inpatient,1,EA,387.46000,368.09000,The Alliance,Exception Members,,298.34,,,,,,,213.10,375.84,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,outpatient,1,EA,387.46000,368.09000,The Alliance,Exception Members,,298.34,,,,,,,0.39525,375.84,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,inpatient,1,EA,484.33000,460.11000,The Alliance,Exception Members,,372.93,,,,,,,266.38,469.80,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,outpatient,1,EA,484.33000,460.11000,The Alliance,Exception Members,,372.93,,,,,,,0.39525,469.80,percent of total billed charges,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,inpatient,1,EA,295.46000,280.69000,The Alliance,Exception Members,,227.50,,,,,,,162.50,286.60,percent of total billed charges,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,outpatient,1,EA,295.46000,280.69000,The Alliance,Exception Members,,227.50,,,,,,,0.39525,286.60,percent of total billed charges,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.16500,0.29100,percent of total billed charges,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Exception Members,,0.23100,,,,,,,0.11207,0.29100,percent of total billed charges,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1202.00000,1141.90000,The Alliance,Exception Members,,925.54,,,,,,,661.10,1165.94,percent of total billed charges,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1202.00000,1141.90000,The Alliance,Exception Members,,925.54,,,,,,,211.37,1165.94,percent of total billed charges,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,211.75,373.45,percent of total billed charges,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Exception Members,,296.45,,,,,,,192.50,373.45,percent of total billed charges,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,inpatient,,,104.55000,99.32000,The Alliance,Exception Members,,80.50,,,,,,,57.50,101.41,percent of total billed charges,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,104.55000,99.32000,The Alliance,Exception Members,,80.50,,,,,,,33.32,101.41,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,218.60,476.25,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10192.80000,9683.16000,The Alliance,Exception Members,,7848.46,,,,,,,4994.47,9887.02,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Exception Members,,7848.46,,,,,,,4678.50,10192.80,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,inpatient,,,350.60000,333.07000,The Alliance,Exception Members,90,269.96,,,,,,,192.83,340.08,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Exception Members,90,269.96,,,,,,,17.85,814.87,percent of total billed charges,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,inpatient,,,350.60000,333.07000,The Alliance,Exception Members,90,269.96,,,,,,,192.83,340.08,percent of total billed charges,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Exception Members,90,269.96,,,,,,,12.45,1539.22,percent of total billed charges,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,Exception Members,90,447.37,,,,,,,319.55,563.57,percent of total billed charges,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Exception Members,90,447.37,,,,,,,12.45,1539.22,percent of total billed charges,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,RT,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,RT,1898.82,,,,,,,451.27,2392.02,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,inpatient,1,mL,71288.00000,67723.60000,The Alliance,Exception Members,,54891.76,,,,,,,39208.40,69149.36,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,outpatient,1,mL,71288.00000,67723.60000,The Alliance,Exception Members,,54891.76,,,,,,,217.09,69149.36,percent of total billed charges,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,126.79,250.99,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Exception Members,,199.24,,,,,,,118.77,258.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,222.94000,211.79000,The Alliance,Exception Members,,171.66,,,,,,,109.24,216.25,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,222.94000,211.79000,The Alliance,Exception Members,,171.66,,,,,,,102.33,222.94,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,22.54,44.62,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Exception Members,,35.42,,,,,,,21.11,46.00,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4936.75,9772.75,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Exception Members,,7757.75,,,,,,,4624.43,10075.00,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,899.63000,854.65000,The Alliance,Exception Members,,692.72,,,,,,,440.82,872.64,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Exception Members,,692.72,,,,,,,412.93,899.63,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1118.81,2437.50,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,393.75000,374.06000,The Alliance,Exception Members,,303.19,,,,,,,192.94,381.94,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,393.75000,374.06000,The Alliance,Exception Members,,303.19,,,,,,,180.73,393.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,inpatient,1,EA,23519.66000,22343.68000,The Alliance,Exception Members,,18110.14,,,,,,,12935.81,22814.07,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,outpatient,1,EA,23519.66000,22343.68000,The Alliance,Exception Members,,18110.14,,,,,,,1737.10,22814.07,percent of total billed charges,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,inpatient,,,1769.00000,1680.55000,The Alliance,Exception Members,LT,1362.13,,,,,,,972.95,1715.93,percent of total billed charges,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,outpatient,,,1769.00000,1680.55000,The Alliance,Exception Members,LT,1362.13,,,,,,,493.80,1715.93,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,inpatient,1,mL,770.52000,732.00000,The Alliance,Exception Members,,593.30,,,,,,,423.79,747.40,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,outpatient,1,mL,770.52000,732.00000,The Alliance,Exception Members,,593.30,,,,,,,32.40,747.40,percent of total billed charges,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1194.38,2364.38,percent of total billed charges,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1218.75,2437.50,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,370.70,653.78,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,63.40,3038.81,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,370.70,653.78,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Exception Members,90,518.98,,,,,,,63.40,3038.81,percent of total billed charges,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,130.35,229.89,percent of total billed charges,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Exception Members,TC,182.49,,,,,,,112.98,1134.10,percent of total billed charges,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,338.78000,321.84000,The Alliance,Exception Members,,260.86,,,,,,,166.00,328.62,percent of total billed charges,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,338.78000,321.84000,The Alliance,Exception Members,,260.86,,,,,,,155.50,338.78,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,349.86,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5165.13,11253.00,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,10524.50000,9998.27000,The Alliance,Exception Members,,8103.86,,,,,,,5157.01,10208.76,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Exception Members,,8103.86,,,,,,,4830.75,10524.50,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,15.40,27.16,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Exception Members,,21.56,,,,,,,2.25,118.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1927.17,3815.01,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1805.25,3933.00,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,724.02,1276.91,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Exception Members,,1013.63,,,,,,,47.62,1276.91,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Exception Members,,1623.18,,,,,,,967.59,2108.03,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18910.00000,17964.50000,The Alliance,Exception Members,,14560.70,,,,,,,9265.90,18342.70,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Exception Members,,14560.70,,,,,,,8679.69,18910.00,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Exception Members,,4779.04,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,104.80000,99.56000,The Alliance,Exception Members,,80.70,,,,,,,51.35,101.66,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.80000,99.56000,The Alliance,Exception Members,,80.70,,,,,,,48.10,104.80,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Exception Members,,202.12,,,,,,,120.49,262.50,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,inpatient,1,EA,2224.81000,2113.57000,The Alliance,Exception Members,,1713.10,,,,,,,1223.65,2158.07,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,outpatient,1,EA,2224.81000,2113.57000,The Alliance,Exception Members,,1713.10,,,,,,,9.17,2158.07,percent of total billed charges,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,inpatient,1,mL,8182.59000,7773.46000,The Alliance,Exception Members,,6300.59,,,,,,,4500.42,7937.11,percent of total billed charges,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,outpatient,1,mL,8182.59000,7773.46000,The Alliance,Exception Members,,6300.59,,,,,,,12.96,7937.11,percent of total billed charges,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,inpatient,1,GM,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.34,4.12,percent of total billed charges,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,outpatient,1,GM,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.12,4.12,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,inpatient,1,EA,1061.90000,1008.81000,The Alliance,Exception Members,,817.66,,,,,,,584.04,1030.04,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,outpatient,1,EA,1061.90000,1008.81000,The Alliance,Exception Members,,817.66,,,,,,,530.95,1030.04,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,inpatient,1,EA,44.74000,42.50000,The Alliance,Exception Members,,34.45,,,,,,,24.61,43.40,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,outpatient,1,EA,44.74000,42.50000,The Alliance,Exception Members,,34.45,,,,,,,22.37,43.40,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Exception Members,,29.73,,,,,,,19.30,80.87,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,1.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,inpatient,1,EA,15.25000,14.48000,The Alliance,Exception Members,,11.74,,,,,,,8.39,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Exception Members,,11.74,,,,,,,7.62,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,inpatient,1,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.95,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Exception Members,,4.13,,,,,,,2.68,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,6.38,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Exception Members,,8.93,,,,,,,5.80,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,inpatient,1,EA,5.13000,4.87000,The Alliance,Exception Members,,3.95,,,,,,,2.82,4.98,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Exception Members,,3.95,,,,,,,2.56,4.98,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.73700,1.30,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Exception Members,,1.03,,,,,,,0.67000,1.30,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,218.90,386.06,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,35.09,1662.04,percent of total billed charges,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,218.90,386.06,percent of total billed charges,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,35.09,1662.04,percent of total billed charges,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,218.90,386.06,percent of total billed charges,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Exception Members,,306.46,,,,,,,35.09,1662.04,percent of total billed charges,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1071.00000,1017.45000,The Alliance,Exception Members,,824.67,,,,,,,589.05,1038.87,percent of total billed charges,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1071.00000,1017.45000,The Alliance,Exception Members,,824.67,,,,,,,535.50,1038.87,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,74.69,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Exception Members,,59.29,,,,,,,42.35,5271.00,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,5271.00,percent of total billed charges,
NASAL VALVE RPR W/RADIOFRQ SUBCUTAN/SUBMUC REMODL 30469-TECH,84355,CDM,510,RC,30469,CPT,,,facility,inpatient,,,4602.00000,4371.90000,The Alliance,Exception Members,,3543.54,,,,,,,2531.10,4463.94,percent of total billed charges,
NASAL VALVE RPR W/RADIOFRQ SUBCUTAN/SUBMUC REMODL 30469-TECH,84355,CDM,510,RC,30469,CPT,,,facility,outpatient,,,4602.00000,4371.90000,The Alliance,Exception Members,,3543.54,,,,,,,2301.00,6178.88,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,inpatient,1,mL,821.60000,780.52000,The Alliance,Exception Members,,632.63,,,,,,,451.88,796.95,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,outpatient,1,mL,821.60000,780.52000,The Alliance,Exception Members,,632.63,,,,,,,69.52,796.95,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,inpatient,1,mL,5980.00000,5681.00000,The Alliance,Exception Members,,4604.60,,,,,,,3289.00,5800.60,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Exception Members,,4604.60,,,,,,,141.17,5800.60,percent of total billed charges,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,inpatient,,,19270.00000,18306.50000,The Alliance,Exception Members,,14837.90,,,,,,,10598.50,18691.90,percent of total billed charges,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,outpatient,,,19270.00000,18306.50000,The Alliance,Exception Members,,14837.90,,,,,,,9635.00,18691.90,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,inpatient,1,mL,5980.00000,5681.00000,The Alliance,Exception Members,,4604.60,,,,,,,3289.00,5800.60,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Exception Members,,4604.60,,,,,,,141.17,5800.60,percent of total billed charges,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,57.80000,54.91000,The Alliance,Exception Members,,44.51,,,,,,,31.79,56.07,percent of total billed charges,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Exception Members,,44.51,,,,,,,28.90,88.70,percent of total billed charges,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,inpatient,1,mL,928.08000,881.68000,The Alliance,Exception Members,,714.62,,,,,,,510.44,900.24,percent of total billed charges,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,outpatient,1,mL,928.08000,881.68000,The Alliance,Exception Members,,714.62,,,,,,,6.68,900.24,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,inpatient,1,mL,367.88000,349.49000,The Alliance,Exception Members,,283.27,,,,,,,202.33,356.84,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,outpatient,1,mL,367.88000,349.49000,The Alliance,Exception Members,,283.27,,,,,,,29.30,356.84,percent of total billed charges,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,inpatient,1,EA,1767.52000,1679.14000,The Alliance,Exception Members,,1360.99,,,,,,,972.14,1714.49,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,outpatient,1,EA,1767.52000,1679.14000,The Alliance,Exception Members,,1360.99,,,,,,,1.18,1714.49,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,inpatient,1,EA,3123.40000,2967.23000,The Alliance,Exception Members,,2405.02,,,,,,,1717.87,3029.70,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,outpatient,1,EA,3123.40000,2967.23000,The Alliance,Exception Members,,2405.02,,,,,,,1.18,3029.70,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,inpatient,1,EA,6578.00000,6249.10000,The Alliance,Exception Members,,5065.06,,,,,,,3617.90,6380.66,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,outpatient,1,EA,6578.00000,6249.10000,The Alliance,Exception Members,,5065.06,,,,,,,1.18,6380.66,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,29.92,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,29.92,219.71,percent of total billed charges,
"INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS 46500-TECH",84415,CDM,510,RC,46500,CPT,,,facility,inpatient,,,358.00000,340.10000,The Alliance,Exception Members,,275.66,,,,,,,196.90,347.26,percent of total billed charges,
"INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS 46500-TECH",84415,CDM,510,RC,46500,CPT,,,facility,outpatient,,,358.00000,340.10000,The Alliance,Exception Members,,275.66,,,,,,,179.00,952.28,percent of total billed charges,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,inpatient,,,1697.40000,1612.53000,The Alliance,Exception Members,,1307.00,,,,,,,933.57,1646.48,percent of total billed charges,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,outpatient,,,1697.40000,1612.53000,The Alliance,Exception Members,,1307.00,,,,,,,511.55,1711.73,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,inpatient,1,mL,162.95000,154.81000,The Alliance,Exception Members,,125.47,,,,,,,89.62,158.06,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,outpatient,1,mL,162.95000,154.81000,The Alliance,Exception Members,,125.47,,,,,,,81.47,158.06,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,inpatient,1,mL,110.25000,104.74000,The Alliance,Exception Members,,84.89,,,,,,,60.64,106.94,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,outpatient,1,mL,110.25000,104.74000,The Alliance,Exception Members,,84.89,,,,,,,0.60838,106.94,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Exception Members,,174.41,,,,,,,26.50,219.71,percent of total billed charges,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2527.30,5003.02,percent of total billed charges,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2367.41,5157.75,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2527.30,5003.02,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Exception Members,,3971.47,,,,,,,2367.41,5157.75,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,Exception Members,JW,310.48,,,,,,,221.77,391.12,percent of total billed charges,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Exception Members,JW,310.48,,,,,,,201.61,398.00,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,inpatient,,,1467.00000,1393.65000,The Alliance,Exception Members,GN,1129.59,,,,,,,806.85,1422.99,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,outpatient,,,1467.00000,1393.65000,The Alliance,Exception Members,GN,1129.59,,,,,,,126.65,1422.99,percent of total billed charges,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,inpatient,,,68.20000,64.79000,The Alliance,Exception Members,90,52.51,,,,,,,37.51,66.15,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Exception Members,90,52.51,,,,,,,6.23,322.54,percent of total billed charges,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,30.25,53.35,percent of total billed charges,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,5.23,254.68,percent of total billed charges,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,5.97,271.65,percent of total billed charges,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,41.63,73.43,percent of total billed charges,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Exception Members,90,58.29,,,,,,,6.92,356.54,percent of total billed charges,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,32.12,56.65,percent of total billed charges,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Exception Members,90,44.97,,,,,,,5.35,271.65,percent of total billed charges,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,inpatient,,,48.70000,46.26000,The Alliance,Exception Members,90,37.50,,,,,,,26.79,47.24,percent of total billed charges,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,outpatient,,,48.70000,46.26000,The Alliance,Exception Members,90,37.50,,,,,,,4.89,220.68,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,inpatient,1,mL,730.38000,693.86000,The Alliance,Exception Members,,562.39,,,,,,,401.71,708.47,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Exception Members,,562.39,,,,,,,5.98,708.47,percent of total billed charges,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,inpatient,,,152.20000,144.59000,The Alliance,Exception Members,90,117.19,,,,,,,83.71,147.63,percent of total billed charges,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,outpatient,,,152.20000,144.59000,The Alliance,Exception Members,90,117.19,,,,,,,76.10,1137.41,percent of total billed charges,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,inpatient,1,mL,2539.73000,2412.75000,The Alliance,Exception Members,,1955.59,,,,,,,1396.85,2463.54,percent of total billed charges,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,outpatient,1,mL,2539.73000,2412.75000,The Alliance,Exception Members,,1955.59,,,,,,,14.84,2463.54,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,inpatient,1,mL,1612.59000,1531.96000,The Alliance,Exception Members,,1241.69,,,,,,,886.92,1564.21,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Exception Members,,1241.69,,,,,,,13.34,1564.21,percent of total billed charges,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.45,2.55,percent of total billed charges,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Exception Members,,2.03,,,,,,,1.31,2.55,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17866.91000,16973.56000,The Alliance,Exception Members,,13757.52,,,,,,,8754.79,17330.90,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17866.91000,16973.56000,The Alliance,Exception Members,,13757.52,,,,,,,8200.91,17866.91,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,691.00000,656.45000,The Alliance,Exception Members,,532.07,,,,,,,380.05,670.27,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,691.00000,656.45000,The Alliance,Exception Members,,532.07,,,,,,,211.37,670.27,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,444.19000,421.98000,The Alliance,Exception Members,,342.03,,,,,,,217.65,430.86,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,444.19000,421.98000,The Alliance,Exception Members,,342.03,,,,,,,203.88,444.19,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,9098.81,18011.93,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,8523.17,18569.00,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.26350,1.35,percent of total billed charges,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05500,0.09700,percent of total billed charges,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Exception Members,,0.07700,,,,,,,0.05000,0.09700,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Exception Members,,0.03080,,,,,,,0.02000,0.03880,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Exception Members,,5445.82,,,,,,,3246.28,7072.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Exception Members,,288.75,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2715.00000,2579.25000,The Alliance,Exception Members,,2090.55,,,,,,,1330.35,2633.55,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Exception Members,,2090.55,,,,,,,1246.18,2715.00,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,237.04,469.24,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,483.75,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.76450,1.35,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Exception Members,,1.07,,,,,,,0.69500,1.35,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,79.60000,75.62000,The Alliance,Exception Members,,61.29,,,,,,,39.00,77.21,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Exception Members,,61.29,,,,,,,36.54,79.60,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1135.28000,1078.52000,The Alliance,Exception Members,,874.17,,,,,,,556.29,1101.22,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1135.28000,1078.52000,The Alliance,Exception Members,,874.17,,,,,,,521.09,1135.28,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,88.99,156.95,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Exception Members,90,124.59,,,,,,,19.00,865.84,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.60000,357.77000,The Alliance,Exception Members,90,289.98,,,,,,,207.13,365.30,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.60000,357.77000,The Alliance,Exception Members,90,289.98,,,,,,,44.27,2240.90,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,inpatient,,,1518.00000,1442.10000,The Alliance,Exception Members,90,1168.86,,,,,,,834.90,1472.46,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,Exception Members,90,1168.86,,,,,,,162.98,8131.76,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,inpatient,,,1741.00000,1653.95000,The Alliance,Exception Members,90,1340.57,,,,,,,957.55,1688.77,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,outpatient,,,1741.00000,1653.95000,The Alliance,Exception Members,90,1340.57,,,,,,,204.58,10355.70,percent of total billed charges,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,inpatient,1,mL,1455.84000,1383.05000,The Alliance,Exception Members,,1121.00,,,,,,,800.71,1412.16,percent of total billed charges,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,outpatient,1,mL,1455.84000,1383.05000,The Alliance,Exception Members,,1121.00,,,,,,,36.96,1412.16,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,inpatient,1,mL,329.98000,313.48000,The Alliance,Exception Members,,254.08,,,,,,,181.49,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Exception Members,,254.08,,,,,,,1.33,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,inpatient,1,mL,329.98000,313.48000,The Alliance,Exception Members,,254.08,,,,,,,181.49,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Exception Members,,254.08,,,,,,,1.33,320.08,percent of total billed charges,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,inpatient,,,574.00000,545.30000,The Alliance,Exception Members,90,441.98,,,,,,,315.70,556.78,percent of total billed charges,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,outpatient,,,574.00000,545.30000,The Alliance,Exception Members,90,441.98,,,,,,,67.54,3412.32,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,Exception Members,90,163.24,,,,,,,116.60,205.64,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Exception Members,90,163.24,,,,,,,24.91,1137.41,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,inpatient,,,250.60000,238.07000,The Alliance,Exception Members,90,192.96,,,,,,,137.83,243.08,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,outpatient,,,250.60000,238.07000,The Alliance,Exception Members,90,192.96,,,,,,,28.00,1341.13,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,inpatient,,,45.60000,43.32000,The Alliance,Exception Members,90,35.11,,,,,,,25.08,44.23,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Exception Members,90,35.11,,,,,,,5.35,271.65,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,inpatient,,,48.40000,45.98000,The Alliance,Exception Members,90,37.27,,,,,,,26.62,46.95,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Exception Members,90,37.27,,,,,,,5.68,288.61,percent of total billed charges,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Exception Members,,3785.51,,,,,,,2256.56,4916.25,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,inpatient,1,mL,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.88550,1.56,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Exception Members,,1.24,,,,,,,0.22165,1.56,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,inpatient,40,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,outpatient,40,EA,0.27000,0.26000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,3.83,percent of total billed charges,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,37.78,66.64,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Exception Members,90,52.90,,,,,,,4.57,373.51,percent of total billed charges,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,86.68000,82.35000,The Alliance,Exception Members,,66.74,,,,,,,42.47,84.08,percent of total billed charges,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,86.68000,82.35000,The Alliance,Exception Members,,66.74,,,,,,,39.79,86.68,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,17.99,35.62,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Exception Members,,28.27,,,,,,,16.85,36.72,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1310.63000,1245.10000,The Alliance,Exception Members,,1009.19,,,,,,,642.21,1271.31,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1310.63000,1245.10000,The Alliance,Exception Members,,1009.19,,,,,,,601.58,1310.63,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,18699.66,40740.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1607.81,3182.81,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Exception Members,,2526.56,,,,,,,1506.09,3281.25,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,24.50,48.50,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Exception Members,,38.50,,,,,,,22.95,50.00,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2873.85,5689.05,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2692.03,5865.00,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18910.00000,17964.50000,The Alliance,Exception Members,,14560.70,,,,,,,9265.90,18342.70,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Exception Members,,14560.70,,,,,,,8679.69,18910.00,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,,1975.82,,,,,,,1411.30,2489.02,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Exception Members,,1975.82,,,,,,,381.55,2489.02,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,inpatient,1,mL,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.64,8.19,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,outpatient,1,mL,8.44000,8.02000,The Alliance,Exception Members,,6.50,,,,,,,4.22,8.19,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,inpatient,1,mL,776.38000,737.56000,The Alliance,Exception Members,,597.81,,,,,,,427.01,753.09,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,outpatient,1,mL,776.38000,737.56000,The Alliance,Exception Members,,597.81,,,,,,,33.00,753.09,percent of total billed charges,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,inpatient,1,mL,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.19,2.10,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Exception Members,,1.67,,,,,,,1.08,2.10,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,58.30,102.82,percent of total billed charges,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Exception Members,90,81.62,,,,,,,8.17,679.08,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,inpatient,1,EA,18.33000,17.41000,The Alliance,Exception Members,,14.11,,,,,,,10.08,17.78,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Exception Members,,14.11,,,,,,,1.54,17.78,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,7.57,13.35,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Exception Members,,10.60,,,,,,,1.54,13.35,percent of total billed charges,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,15510.66000,14735.13000,The Alliance,Exception Members,,11943.21,,,,,,,7600.22,15045.34,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Exception Members,,11943.21,,,,,,,7119.39,15510.66,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1927.17,3815.01,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1805.25,3933.00,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,53.56000,50.88000,The Alliance,Exception Members,,41.24,,,,,,,26.24,51.95,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,53.56000,50.88000,The Alliance,Exception Members,,41.24,,,,,,,24.58,53.56,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1567.50000,1489.12000,The Alliance,Exception Members,,1206.97,,,,,,,862.12,1520.47,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1567.50000,1489.12000,The Alliance,Exception Members,,1206.97,,,,,,,783.75,1520.47,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,6258.30000,5945.38000,The Alliance,Exception Members,,4818.89,,,,,,,3066.57,6070.55,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,6258.30000,5945.38000,The Alliance,Exception Members,,4818.89,,,,,,,2872.56,6258.30,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1690.50,3346.50,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1583.55,3450.00,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,inpatient,,,1938.64000,1841.71000,The Alliance,Exception Members,,1492.75,,,,,,,1066.25,1880.48,percent of total billed charges,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1938.64000,1841.71000,The Alliance,Exception Members,,1492.75,,,,,,,142.07,1880.48,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,inpatient,1,EA,25.15000,23.90000,The Alliance,Exception Members,,19.37,,,,,,,13.83,24.40,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,outpatient,1,EA,25.15000,23.90000,The Alliance,Exception Members,,19.37,,,,,,,12.57,24.40,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
APPL SK GRF > 100 SQ CM 1ST 100 15277-TECH,84641,CDM,510,RC,15277,CPT,,,facility,inpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,331.10,583.94,percent of total billed charges,
APPL SK GRF > 100 SQ CM 1ST 100 15277-TECH,84641,CDM,510,RC,15277,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Exception Members,,463.54,,,,,,,301.00,1910.62,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4573.00000,4344.35000,The Alliance,Exception Members,90,3521.21,,,,,,,2515.15,4435.81,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Exception Members,90,3521.21,,,,,,,210.00,26177.94,percent of total billed charges,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,90,866.25,,,,,,,618.75,1091.25,percent of total billed charges,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,90,866.25,,,,,,,109.60,6451.13,percent of total billed charges,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,inpatient,,,5957.00000,5659.15000,The Alliance,Exception Members,90,4586.89,,,,,,,3276.35,5778.29,percent of total billed charges,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,outpatient,,,5957.00000,5659.15000,The Alliance,Exception Members,90,4586.89,,,,,,,2537.50,5778.29,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,36.30,64.02,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Exception Members,,50.82,,,,,,,5.86,305.58,percent of total billed charges,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,inpatient,1,mL,41610.00000,39529.50000,The Alliance,Exception Members,,32039.70,,,,,,,22885.50,40361.70,percent of total billed charges,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,outpatient,1,mL,41610.00000,39529.50000,The Alliance,Exception Members,,32039.70,,,,,,,141.91,40361.70,percent of total billed charges,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,inpatient,1,EA,2516.97000,2391.12000,The Alliance,Exception Members,,1938.07,,,,,,,1384.33,2441.46,percent of total billed charges,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,outpatient,1,EA,2516.97000,2391.12000,The Alliance,Exception Members,,1938.07,,,,,,,28.52,2441.46,percent of total billed charges,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,77.64,150.62,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,inpatient,1,mL,260.44000,247.42000,The Alliance,Exception Members,,200.54,,,,,,,143.24,252.63,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,outpatient,1,mL,260.44000,247.42000,The Alliance,Exception Members,,200.54,,,,,,,130.22,252.63,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,1.93,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Exception Members,,2.70,,,,,,,1.75,3.40,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,inpatient,1,mL,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.91,6.90,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Exception Members,,5.47,,,,,,,3.56,6.90,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,38.40000,36.48000,The Alliance,Exception Members,,29.57,,,,,,,18.82,37.25,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,38.40000,36.48000,The Alliance,Exception Members,,29.57,,,,,,,17.63,38.40,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,inpatient,1,mL,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,1.28,2.25,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,outpatient,1,mL,2.32000,2.21000,The Alliance,Exception Members,,1.79,,,,,,,0.22165,2.25,percent of total billed charges,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,inpatient,1,mL,18.09000,17.19000,The Alliance,Exception Members,,13.93,,,,,,,9.95,17.55,percent of total billed charges,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,outpatient,1,mL,18.09000,17.19000,The Alliance,Exception Members,,13.93,,,,,,,0.22165,17.55,percent of total billed charges,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,inpatient,1,EA,200.98000,190.93000,The Alliance,Exception Members,,154.75,,,,,,,110.54,194.95,percent of total billed charges,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,outpatient,1,EA,200.98000,190.93000,The Alliance,Exception Members,,154.75,,,,,,,3.62,194.95,percent of total billed charges,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,10177.30,20146.90,percent of total billed charges,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,9533.43,20770.00,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2358.25,4668.37,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2209.05,4812.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4573.00000,4344.35000,The Alliance,Exception Members,90,3521.21,,,,,,,2515.15,4435.81,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Exception Members,90,3521.21,,,,,,,210.00,26177.94,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,inpatient,,,3575.00000,3396.25000,The Alliance,Exception Members,90,2752.75,,,,,,,1966.25,3467.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,outpatient,,,3575.00000,3396.25000,The Alliance,Exception Members,90,2752.75,,,,,,,103.64,20473.75,percent of total billed charges,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,25160.53000,23902.50000,The Alliance,Exception Members,,19373.61,,,,,,,12328.66,24405.71,percent of total billed charges,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Exception Members,,19373.61,,,,,,,11548.68,25160.53,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,inpatient,,,288.33000,273.91000,The Alliance,Exception Members,,222.01,,,,,,,158.58,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,outpatient,,,288.33000,273.91000,The Alliance,Exception Members,,222.01,,,,,,,144.16,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,inpatient,1,mL,576.66000,547.83000,The Alliance,Exception Members,,444.03,,,,,,,317.16,559.36,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,outpatient,1,mL,576.66000,547.83000,The Alliance,Exception Members,,444.03,,,,,,,145.98,559.36,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,71400.00000,67830.00000,The Alliance,Exception Members,,54978.00,,,,,,,34986.00,69258.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Exception Members,,54978.00,,,,,,,32772.60,71400.00,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,inpatient,1,EA,432.53000,410.90000,The Alliance,Exception Members,,333.05,,,,,,,237.89,419.55,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,outpatient,1,EA,432.53000,410.90000,The Alliance,Exception Members,,333.05,,,,,,,216.26,419.55,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,1.00,1.77,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Exception Members,,1.40,,,,,,,0.91000,1.77,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,277.83,549.99,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,260.25,567.00,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,inpatient,,,2163.00000,2054.85000,The Alliance,Exception Members,,1665.51,,,,,,,1189.65,2098.11,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Exception Members,,1665.51,,,,,,,1189.65,7803.00,percent of total billed charges,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,inpatient,,,9216.00000,8755.20000,The Alliance,Exception Members,,7096.32,,,,,,,5068.80,8939.52,percent of total billed charges,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Exception Members,,7096.32,,,,,,,2988.68,8939.52,percent of total billed charges,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,inpatient,,,1035.00000,983.25000,The Alliance,Exception Members,,796.95,,,,,,,569.25,1003.95,percent of total billed charges,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,Exception Members,,796.95,,,,,,,376.51,1003.95,percent of total billed charges,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,inpatient,,,421.60000,400.52000,The Alliance,Exception Members,,324.63,,,,,,,231.88,408.95,percent of total billed charges,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,outpatient,,,421.60000,400.52000,The Alliance,Exception Members,,324.63,,,,,,,113.74,408.95,percent of total billed charges,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,inpatient,1,mL,1604.51000,1524.28000,The Alliance,Exception Members,,1235.47,,,,,,,882.48,1556.37,percent of total billed charges,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,outpatient,1,mL,1604.51000,1524.28000,The Alliance,Exception Members,,1235.47,,,,,,,33.27,1556.37,percent of total billed charges,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,inpatient,1,mL,10593.45000,10063.78000,The Alliance,Exception Members,,8156.96,,,,,,,5826.40,10275.65,percent of total billed charges,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,outpatient,1,mL,10593.45000,10063.78000,The Alliance,Exception Members,,8156.96,,,,,,,33.27,10275.65,percent of total billed charges,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1745.62,3455.62,percent of total billed charges,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1635.19,3562.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Exception Members,,8951.25,,,,,,,5335.88,11625.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1927.17,3815.01,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Exception Members,,3028.41,,,,,,,1805.25,3933.00,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,Exception Members,JW,334.18,,,,,,,238.70,420.98,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Exception Members,JW,334.18,,,,,,,217.00,488.81,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,inpatient,,,316.60000,300.77000,The Alliance,Exception Members,90,243.78,,,,,,,174.13,307.10,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Exception Members,90,243.78,,,,,,,36.26,1833.46,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,inpatient,,,316.60000,300.77000,The Alliance,Exception Members,90,243.78,,,,,,,174.13,307.10,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Exception Members,90,243.78,,,,,,,36.26,1833.46,percent of total billed charges,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8173.05000,7764.40000,The Alliance,Exception Members,,6293.25,,,,,,,4004.79,7927.86,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Exception Members,,6293.25,,,,,,,3751.43,8173.05,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,inpatient,1,mL,150.22000,142.71000,The Alliance,Exception Members,,115.67,,,,,,,82.62,145.71,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,outpatient,1,mL,150.22000,142.71000,The Alliance,Exception Members,,115.67,,,,,,,48.42,145.71,percent of total billed charges,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,Exception Members,90,61.45,,,,,,,43.89,77.41,percent of total billed charges,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Exception Members,90,61.45,,,,,,,10.03,509.30,percent of total billed charges,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8521.50000,8095.42000,The Alliance,Exception Members,,6561.56,,,,,,,4175.53,8265.85,percent of total billed charges,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Exception Members,,6561.56,,,,,,,3911.37,8521.50,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,15391.50000,14621.92000,The Alliance,Exception Members,,11851.45,,,,,,,7541.84,14929.75,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,15391.50000,14621.92000,The Alliance,Exception Members,,11851.45,,,,,,,7064.70,15391.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,inpatient,1,mL,1762.49000,1674.36000,The Alliance,Exception Members,,1357.12,,,,,,,969.37,1709.62,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,outpatient,1,mL,1762.49000,1674.36000,The Alliance,Exception Members,,1357.12,,,,,,,266.44,1709.62,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,22.59,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Exception Members,,31.63,,,,,,,20.54,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,inpatient,1,mL,46.94000,44.59000,The Alliance,Exception Members,,36.14,,,,,,,25.82,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,outpatient,1,mL,46.94000,44.59000,The Alliance,Exception Members,,36.14,,,,,,,23.47,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,inpatient,1,mL,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.61,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,outpatient,1,mL,2.92000,2.78000,The Alliance,Exception Members,,2.25,,,,,,,1.46,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,inpatient,1,mL,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,36.50,64.37,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Exception Members,,51.10,,,,,,,33.18,64.37,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,inpatient,1,mL,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Exception Members,,13.71,,,,,,,8.90,17.27,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,inpatient,,,371.50000,352.92000,The Alliance,Exception Members,,286.06,,,,,,,204.32,360.36,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Exception Members,,286.06,,,,,,,185.75,360.36,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,3851.19,8390.40,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5558.02,11002.61,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Exception Members,,8734.03,,,,,,,5206.39,11342.90,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,13.73,713.01,percent of total billed charges,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,67.65,119.31,percent of total billed charges,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Exception Members,,94.71,,,,,,,13.73,713.01,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.48,6.13,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,0.25616,6.13,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,inpatient,1,mL,44.13000,41.93000,The Alliance,Exception Members,,33.98,,,,,,,24.27,42.81,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,outpatient,1,mL,44.13000,41.93000,The Alliance,Exception Members,,33.98,,,,,,,22.07,80.87,percent of total billed charges,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,inpatient,1,mL,2518.47000,2392.54000,The Alliance,Exception Members,,1939.22,,,,,,,1385.16,2442.92,percent of total billed charges,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,outpatient,1,mL,2518.47000,2392.54000,The Alliance,Exception Members,,1939.22,,,,,,,243.82,2442.92,percent of total billed charges,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.28600,0.50440,percent of total billed charges,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Exception Members,,0.40040,,,,,,,0.26000,0.50440,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,5520.00000,5244.00000,The Alliance,Exception Members,,4250.40,,,,,,,2704.80,5354.40,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,5520.00000,5244.00000,The Alliance,Exception Members,,4250.40,,,,,,,2533.68,5520.00,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30450.00000,28927.50000,The Alliance,Exception Members,,23446.50,,,,,,,14920.50,29536.50,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30450.00000,28927.50000,The Alliance,Exception Members,,23446.50,,,,,,,13976.55,30450.00,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1477.35,2924.55,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Exception Members,,2321.55,,,,,,,1383.88,3015.00,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,2.08,3.68,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Exception Members,,2.92,,,,,,,1.90,3.68,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,inpatient,1,mL,9246.90000,8784.55000,The Alliance,Exception Members,,7120.11,,,,,,,5085.80,8969.49,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,outpatient,1,mL,9246.90000,8784.55000,The Alliance,Exception Members,,7120.11,,,,,,,494.43,8969.49,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,inpatient,1,mL,9459.55000,8986.57000,The Alliance,Exception Members,,7283.85,,,,,,,5202.75,9175.76,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,outpatient,1,mL,9459.55000,8986.57000,The Alliance,Exception Members,,7283.85,,,,,,,494.43,9175.76,percent of total billed charges,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.22000,0.38800,percent of total billed charges,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Exception Members,,0.30800,,,,,,,0.20000,0.38800,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,42.14,83.42,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Exception Members,,66.22,,,,,,,39.47,86.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,inpatient,,,95.22000,90.46000,The Alliance,Exception Members,,73.32,,,,,,,52.37,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,outpatient,,,95.22000,90.46000,The Alliance,Exception Members,,73.32,,,,,,,47.61,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,inpatient,1,mL,190.45000,180.93000,The Alliance,Exception Members,,146.65,,,,,,,104.75,184.74,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,outpatient,1,mL,190.45000,180.93000,The Alliance,Exception Members,,146.65,,,,,,,95.22,184.74,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.68200,1.20,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Exception Members,,0.95480,,,,,,,0.62000,1.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,inpatient,1,EA,63.52000,60.34000,The Alliance,Exception Members,,48.91,,,,,,,34.94,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,outpatient,1,EA,63.52000,60.34000,The Alliance,Exception Members,,48.91,,,,,,,9.78,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,inpatient,1,EA,57.15000,54.29000,The Alliance,Exception Members,,44.01,,,,,,,31.43,55.44,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Exception Members,,44.01,,,,,,,9.78,55.44,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,inpatient,1,EA,27.73000,26.34000,The Alliance,Exception Members,,21.35,,,,,,,15.25,26.90,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,outpatient,1,EA,27.73000,26.34000,The Alliance,Exception Members,,21.35,,,,,,,0.91000,26.90,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,10.25,18.08,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Exception Members,,14.35,,,,,,,0.91000,18.08,percent of total billed charges,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Exception Members,,7819.81,,,,,,,4661.42,10155.60,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,50.96,100.88,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Exception Members,,80.08,,,,,,,47.74,104.00,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1775.03,3513.82,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1662.73,3622.50,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1775.03,3513.82,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,277.83,549.99,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Exception Members,,436.59,,,,,,,260.25,567.00,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Exception Members,,216.56,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,inpatient,1,mL,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.52800,0.93120,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,outpatient,1,mL,0.96000,0.91000,The Alliance,Exception Members,,0.73920,,,,,,,0.48000,0.93120,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,inpatient,1,mL,39932.98000,37936.33000,The Alliance,Exception Members,,30748.39,,,,,,,21963.14,38734.99,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,outpatient,1,mL,39932.98000,37936.33000,The Alliance,Exception Members,,30748.39,,,,,,,19966.49,38734.99,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,inpatient,1,mL,20.22000,19.21000,The Alliance,Exception Members,,15.57,,,,,,,11.12,19.61,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,outpatient,1,mL,20.22000,19.21000,The Alliance,Exception Members,,15.57,,,,,,,10.11,19.61,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.25850,0.45590,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Exception Members,,0.36190,,,,,,,0.23500,0.45590,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,inpatient,1,EA,26.29000,24.98000,The Alliance,Exception Members,,20.24,,,,,,,14.46,25.50,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,outpatient,1,EA,26.29000,24.98000,The Alliance,Exception Members,,20.24,,,,,,,13.14,25.50,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.34100,0.60140,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Exception Members,,0.47740,,,,,,,0.31000,0.60140,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,1646.25000,1563.94000,The Alliance,Exception Members,,1267.61,,,,,,,806.66,1596.86,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1646.25000,1563.94000,The Alliance,Exception Members,,1267.61,,,,,,,755.63,1646.25,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.80,93.98,percent of total billed charges,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04950,0.08730,percent of total billed charges,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Exception Members,,0.06930,,,,,,,0.04500,0.08730,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3796.02,7514.57,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3555.86,7746.98,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,264.00,465.60,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Exception Members,,369.60,,,,,,,240.00,465.60,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8173.05000,7764.40000,The Alliance,Exception Members,,6293.25,,,,,,,4004.79,7927.86,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Exception Members,,6293.25,,,,,,,3751.43,8173.05,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,inpatient,,,4073.00000,3869.35000,The Alliance,Exception Members,90,3136.21,,,,,,,2240.15,3950.81,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4073.00000,3869.35000,The Alliance,Exception Members,90,3136.21,,,,,,,282.88,13309.69,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,inpatient,1,EA,406.91000,386.57000,The Alliance,Exception Members,,313.32,,,,,,,223.80,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Exception Members,,313.32,,,,,,,203.46,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,inpatient,1,EA,406.91000,386.57000,The Alliance,Exception Members,,313.32,,,,,,,223.80,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Exception Members,,313.32,,,,,,,203.46,394.70,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,,1.02,,,,,,,0.63085,1.29,percent of total billed charges,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Exception Members,,9963.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,inpatient,,,35.16000,33.40000,The Alliance,Exception Members,,27.07,,,,,,,17.23,34.11,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Exception Members,,27.07,,,,,,,17.58,72.27,percent of total billed charges,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Exception Members,,8454.75,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,inpatient,1,mL,309.57000,294.09000,The Alliance,Exception Members,,238.37,,,,,,,170.26,300.28,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,outpatient,1,mL,309.57000,294.09000,The Alliance,Exception Members,,238.37,,,,,,,154.78,300.28,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,inpatient,1,GM,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,outpatient,1,GM,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,inpatient,1,GM,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.30800,0.54320,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Exception Members,,0.43120,,,,,,,0.28000,0.54320,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,inpatient,,,11828.00000,11236.60000,The Alliance,Exception Members,52,9107.56,,,,,,,6505.40,11473.16,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Exception Members,52,9107.56,,,,,,,1929.64,11473.16,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,5936.70,10470.18,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,1929.64,10470.18,percent of total billed charges,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,23436.00000,22264.20000,The Alliance,Exception Members,,18045.72,,,,,,,11483.64,22732.92,percent of total billed charges,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Exception Members,,18045.72,,,,,,,10757.12,23436.00,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.83600,1.47,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Exception Members,,1.17,,,,,,,0.76000,1.47,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,21.64000,20.56000,The Alliance,Exception Members,,16.66,,,,,,,11.90,20.99,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,21.64000,20.56000,The Alliance,Exception Members,,16.66,,,,,,,10.82,20.99,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.80,93.98,percent of total billed charges,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,Exception Members,90,723.80,,,,,,,517.00,911.80,percent of total billed charges,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Exception Members,90,723.80,,,,,,,470.00,911.80,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,inpatient,1,mL,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,104.28,183.91,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Exception Members,,145.99,,,,,,,64.03,183.91,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,inpatient,,,584.00000,554.80000,The Alliance,Exception Members,90,449.68,,,,,,,321.20,566.48,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Exception Members,90,449.68,,,,,,,292.00,3186.14,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,inpatient,,,187.80000,178.41000,The Alliance,Exception Members,90,144.61,,,,,,,103.29,182.17,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,outpatient,,,187.80000,178.41000,The Alliance,Exception Members,90,144.61,,,,,,,77.53,1052.52,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,inpatient,,,278.30000,264.38000,The Alliance,Exception Members,90,214.29,,,,,,,153.06,269.95,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,outpatient,,,278.30000,264.38000,The Alliance,Exception Members,90,214.29,,,,,,,125.97,1861.90,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,53.41,94.19,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Exception Members,90,74.77,,,,,,,8.17,611.15,percent of total billed charges,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,78.05,137.64,percent of total billed charges,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Exception Members,90,109.26,,,,,,,17.85,823.21,percent of total billed charges,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,inpatient,,,510.50000,484.97000,The Alliance,Exception Members,90,393.08,,,,,,,280.77,495.19,percent of total billed charges,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,outpatient,,,510.50000,484.97000,The Alliance,Exception Members,90,393.08,,,,,,,63.40,3038.81,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,inpatient,,,104.20000,98.99000,The Alliance,Exception Members,90,80.23,,,,,,,57.31,101.07,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,outpatient,,,104.20000,98.99000,The Alliance,Exception Members,90,80.23,,,,,,,8.17,662.12,percent of total billed charges,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,Exception Members,90,403.48,,,,,,,288.20,508.28,percent of total billed charges,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Exception Members,90,403.48,,,,,,,22.91,1035.56,percent of total billed charges,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,inpatient,,,123.90000,117.70000,The Alliance,Exception Members,90,95.40,,,,,,,68.14,120.18,percent of total billed charges,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Exception Members,90,95.40,,,,,,,15.58,780.94,percent of total billed charges,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,inpatient,,,245.20000,232.94000,The Alliance,Exception Members,90,188.80,,,,,,,134.86,237.84,percent of total billed charges,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,outpatient,,,245.20000,232.94000,The Alliance,Exception Members,90,188.80,,,,,,,30.84,1561.82,percent of total billed charges,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,inpatient,,,153.20000,145.54000,The Alliance,Exception Members,90,117.96,,,,,,,84.26,148.60,percent of total billed charges,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,outpatient,,,153.20000,145.54000,The Alliance,Exception Members,90,117.96,,,,,,,19.26,882.80,percent of total billed charges,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,inpatient,,,19344.00000,18376.80000,The Alliance,Exception Members,90,14894.88,,,,,,,10639.20,18763.68,percent of total billed charges,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,outpatient,,,19344.00000,18376.80000,The Alliance,Exception Members,90,14894.88,,,,,,,8569.96,115186.20,percent of total billed charges,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,inpatient,,,3556.00000,3378.20000,The Alliance,Exception Members,,2738.12,,,,,,,1955.80,3449.32,percent of total billed charges,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,outpatient,,,3556.00000,3378.20000,The Alliance,Exception Members,,2738.12,,,,,,,416.78,21780.96,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1004.00000,953.80000,The Alliance,Exception Members,90,773.08,,,,,,,552.20,973.88,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Exception Members,90,773.08,,,,,,,126.29,6383.20,percent of total billed charges,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,inpatient,,,235.20000,223.44000,The Alliance,Exception Members,90,181.10,,,,,,,129.36,228.14,percent of total billed charges,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Exception Members,90,181.10,,,,,,,19.26,882.80,percent of total billed charges,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,inpatient,,,108.40000,102.98000,The Alliance,Exception Members,90,83.47,,,,,,,59.62,105.15,percent of total billed charges,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,outpatient,,,108.40000,102.98000,The Alliance,Exception Members,90,83.47,,,,,,,42.13,2003.75,percent of total billed charges,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,inpatient,,,126.80000,120.46000,The Alliance,Exception Members,90,97.64,,,,,,,69.74,123.00,percent of total billed charges,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,outpatient,,,126.80000,120.46000,The Alliance,Exception Members,90,97.64,,,,,,,14.59,729.98,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,inpatient,,,76.40000,72.58000,The Alliance,Exception Members,90,58.83,,,,,,,42.02,74.11,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Exception Members,90,58.83,,,,,,,9.61,492.33,percent of total billed charges,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,inpatient,,,235.20000,223.44000,The Alliance,Exception Members,90,181.10,,,,,,,129.36,228.14,percent of total billed charges,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Exception Members,90,181.10,,,,,,,17.85,814.87,percent of total billed charges,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,inpatient,,,380.20000,361.19000,The Alliance,Exception Members,90,292.75,,,,,,,209.11,368.79,percent of total billed charges,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,outpatient,,,380.20000,361.19000,The Alliance,Exception Members,90,292.75,,,,,,,30.85,368.79,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,inpatient,,,76.40000,72.58000,The Alliance,Exception Members,90,58.83,,,,,,,42.02,74.11,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Exception Members,90,58.83,,,,,,,9.61,492.33,percent of total billed charges,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,inpatient,,,99.30000,94.33000,The Alliance,Exception Members,90,76.46,,,,,,,54.62,96.32,percent of total billed charges,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,outpatient,,,99.30000,94.33000,The Alliance,Exception Members,90,76.46,,,,,,,12.05,574.73,percent of total billed charges,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,inpatient,,,97.90000,93.00000,The Alliance,Exception Members,90,75.38,,,,,,,53.84,94.96,percent of total billed charges,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,outpatient,,,97.90000,93.00000,The Alliance,Exception Members,90,75.38,,,,,,,8.17,645.08,percent of total billed charges,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,inpatient,,,147.30000,139.94000,The Alliance,Exception Members,90,113.42,,,,,,,81.02,142.88,percent of total billed charges,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Exception Members,90,113.42,,,,,,,17.71,933.70,percent of total billed charges,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,inpatient,,,94.70000,89.97000,The Alliance,Exception Members,90,72.92,,,,,,,52.09,91.86,percent of total billed charges,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,outpatient,,,94.70000,89.97000,The Alliance,Exception Members,90,72.92,,,,,,,11.53,543.65,percent of total billed charges,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,inpatient,,,3830.00000,3638.50000,The Alliance,Exception Members,90,2949.10,,,,,,,2106.50,3715.10,percent of total billed charges,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,outpatient,,,3830.00000,3638.50000,The Alliance,Exception Members,90,2949.10,,,,,,,1631.60,3715.10,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,inpatient,,,461.90000,438.80000,The Alliance,Exception Members,90,355.66,,,,,,,254.04,448.04,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,outpatient,,,461.90000,438.80000,The Alliance,Exception Members,90,355.66,,,,,,,19.26,882.80,percent of total billed charges,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,90,76.23,,,,,,,54.45,96.03,percent of total billed charges,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,90,76.23,,,,,,,11.53,574.73,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,inpatient,1,GM,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.41250,0.72750,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,outpatient,1,GM,0.75000,0.71000,The Alliance,Exception Members,,0.57750,,,,,,,0.37500,0.72750,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,inpatient,1,GM,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,6.26,11.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,outpatient,1,GM,11.38000,10.81000,The Alliance,Exception Members,,8.76,,,,,,,5.69,11.04,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Exception Members,,2281.12,,,,,,,1359.79,2962.50,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,4111.30,8138.69,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Exception Members,,6460.61,,,,,,,3851.19,8390.40,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.09350,0.16490,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Exception Members,,0.13090,,,,,,,0.08500,0.16490,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2756.25000,2618.44000,The Alliance,Exception Members,,2122.31,,,,,,,1350.56,2673.56,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Exception Members,,2122.31,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4361.00000,4142.95000,The Alliance,Exception Members,,3357.97,,,,,,,2398.55,4230.17,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Exception Members,,3357.97,,,,,,,339.11,4230.17,percent of total billed charges,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4352.00000,4134.40000,The Alliance,Exception Members,,3351.04,,,,,,,2393.60,4221.44,percent of total billed charges,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Exception Members,,3351.04,,,,,,,339.11,4221.44,percent of total billed charges,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,Exception Members,TC,592.13,,,,,,,422.95,745.93,percent of total billed charges,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Exception Members,TC,592.13,,,,,,,384.50,745.93,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,2522.85,4449.39,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Exception Members,,3531.99,,,,,,,1308.97,4449.39,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10385.00000,9865.75000,The Alliance,Exception Members,,7996.45,,,,,,,5088.65,10073.45,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10385.00000,9865.75000,The Alliance,Exception Members,,7996.45,,,,,,,4766.72,10385.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30287.00000,28772.65000,The Alliance,Exception Members,,23320.99,,,,,,,14840.63,29378.39,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Exception Members,,23320.99,,,,,,,13901.73,30287.00,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,inpatient,1,EA,7.25000,6.89000,The Alliance,Exception Members,,5.58,,,,,,,3.99,7.03,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Exception Members,,5.58,,,,,,,3.62,7.03,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,19.80,34.92,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Exception Members,,27.72,,,,,,,18.00,38.16,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,45.19,79.70,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Exception Members,,63.26,,,,,,,41.08,79.70,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04400,0.07760,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Exception Members,,0.06160,,,,,,,0.04000,0.07760,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,inpatient,1,mL,9633.00000,9151.35000,The Alliance,Exception Members,,7417.41,,,,,,,5298.15,9344.01,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,outpatient,1,mL,9633.00000,9151.35000,The Alliance,Exception Members,,7417.41,,,,,,,189.75,9344.01,percent of total billed charges,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,inpatient,1,mL,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.80,4.94,percent of total billed charges,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,outpatient,1,mL,5.09000,4.83000,The Alliance,Exception Members,,3.92,,,,,,,2.39,4.94,percent of total billed charges,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,15510.66000,14735.13000,The Alliance,Exception Members,,11943.21,,,,,,,7600.22,15045.34,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Exception Members,,11943.21,,,,,,,7119.39,15510.66,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,422.74000,401.60000,The Alliance,Exception Members,,325.51,,,,,,,207.14,410.06,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,422.74000,401.60000,The Alliance,Exception Members,,325.51,,,,,,,194.04,422.74,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,24800.00000,23560.00000,The Alliance,Exception Members,,19096.00,,,,,,,12152.00,24056.00,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,24800.00000,23560.00000,The Alliance,Exception Members,,19096.00,,,,,,,11383.20,24800.00,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2606.25000,2475.94000,The Alliance,Exception Members,,2006.81,,,,,,,1277.06,2528.06,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2606.25000,2475.94000,The Alliance,Exception Members,,2006.81,,,,,,,1196.27,2606.25,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,418.54000,397.61000,The Alliance,Exception Members,,322.28,,,,,,,205.08,405.98,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,418.54000,397.61000,The Alliance,Exception Members,,322.28,,,,,,,192.11,418.54,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,145.60000,138.32000,The Alliance,Exception Members,,112.11,,,,,,,71.34,141.23,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Exception Members,,112.11,,,,,,,66.83,145.60,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.36,143.36,percent of total billed charges,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5779.41000,5490.44000,The Alliance,Exception Members,,4450.15,,,,,,,2831.91,5606.03,percent of total billed charges,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5779.41000,5490.44000,The Alliance,Exception Members,,4450.15,,,,,,,2652.75,5779.41,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.36,143.36,percent of total billed charges,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,34.24000,32.53000,The Alliance,Exception Members,,26.36,,,,,,,16.78,33.21,percent of total billed charges,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,34.24000,32.53000,The Alliance,Exception Members,,26.36,,,,,,,17.12,36.65,percent of total billed charges,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,25.72000,24.43000,The Alliance,Exception Members,,19.80,,,,,,,12.60,24.95,percent of total billed charges,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Exception Members,,19.80,,,,,,,11.81,24.95,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Exception Members,,56.67,,,,,,,36.80,93.98,percent of total billed charges,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Exception Members,,39.72,,,,,,,25.79,50.03,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.13750,0.24250,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Exception Members,,0.19250,,,,,,,0.12500,2.34,percent of total billed charges,
ALLERG IMMUNOTH-3-TECH,84996,CDM,510,RC,95147,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,31.35,55.29,percent of total billed charges,
ALLERG IMMUNOTH-3-TECH,84996,CDM,510,RC,95147,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Exception Members,,43.89,,,,,,,28.50,74.34,percent of total billed charges,
ALLERG IMMUNOTH-5-TECH,84997,CDM,510,RC,95149,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,62.15,109.61,percent of total billed charges,
ALLERG IMMUNOTH-5-TECH,84997,CDM,510,RC,95149,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Exception Members,,87.01,,,,,,,56.50,109.61,percent of total billed charges,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,inpatient,1,mL,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,outpatient,1,mL,1.48000,1.40000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.87,5.05,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Exception Members,,4.01,,,,,,,2.60,5.05,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,inpatient,1,EA,10.45000,9.92000,The Alliance,Exception Members,,8.05,,,,,,,5.75,10.14,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,outpatient,1,EA,10.45000,9.92000,The Alliance,Exception Members,,8.05,,,,,,,5.22,10.14,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,inpatient,1,GM,67.78000,64.39000,The Alliance,Exception Members,,52.19,,,,,,,37.28,65.75,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,outpatient,1,GM,67.78000,64.39000,The Alliance,Exception Members,,52.19,,,,,,,33.89,65.75,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,1.07,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Exception Members,,1.50,,,,,,,0.97500,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,inpatient,1,mL,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.55,2.73,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,outpatient,1,mL,2.81000,2.67000,The Alliance,Exception Members,,2.16,,,,,,,1.41,2.73,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,inpatient,1,EA,7019.54000,6668.56000,The Alliance,Exception Members,,5405.05,,,,,,,3860.75,6808.95,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,outpatient,1,EA,7019.54000,6668.56000,The Alliance,Exception Members,,5405.05,,,,,,,28.62,6808.95,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,inpatient,1,mL,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.26400,0.46560,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Exception Members,,0.36960,,,,,,,0.24000,1.86,percent of total billed charges,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,inpatient,1,mL,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,10.13,17.86,percent of total billed charges,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Exception Members,,14.18,,,,,,,4.77,17.86,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,18699.66,40740.00,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,13671.00,27063.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Exception Members,,21483.00,,,,,,,12806.10,27063.00,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2325.00000,2208.75000,The Alliance,Exception Members,,1790.25,,,,,,,1278.75,2255.25,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2325.00000,2208.75000,The Alliance,Exception Members,,1790.25,,,,,,,1162.50,2255.25,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.07,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1669.61,3637.50,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Exception Members,,2093.44,,,,,,,1247.91,2718.75,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,inpatient,1,GM,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,inpatient,1,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,170.94,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Exception Members,,239.32,,,,,,,155.40,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,inpatient,1,EA,1244.56000,1182.33000,The Alliance,Exception Members,,958.31,,,,,,,684.51,1207.22,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,outpatient,1,EA,1244.56000,1182.33000,The Alliance,Exception Members,,958.31,,,,,,,622.28,1207.22,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.39,2.45,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Exception Members,,1.95,,,,,,,1.26,10.56,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,inpatient,1,mL,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,1.03,1.82,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,outpatient,1,mL,1.88000,1.79000,The Alliance,Exception Members,,1.45,,,,,,,0.94000,10.56,percent of total billed charges,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,5.21,9.20,percent of total billed charges,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Exception Members,,7.30,,,,,,,4.74,9.20,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03300,0.05820,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Exception Members,,0.04620,,,,,,,0.03000,0.05820,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.38500,0.67900,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Exception Members,,0.53900,,,,,,,0.35000,0.67900,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.31350,0.55290,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Exception Members,,0.43890,,,,,,,0.28500,0.55290,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,inpatient,1,mL,59.16000,56.20000,The Alliance,Exception Members,,45.55,,,,,,,32.54,57.39,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,outpatient,1,mL,59.16000,56.20000,The Alliance,Exception Members,,45.55,,,,,,,1.35,57.39,percent of total billed charges,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,inpatient,1,mL,379.44000,360.46000,The Alliance,Exception Members,,292.17,,,,,,,208.69,368.06,percent of total billed charges,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Exception Members,,292.17,,,,,,,1.16,368.06,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,inpatient,1,EA,9.95000,9.46000,The Alliance,Exception Members,,7.66,,,,,,,5.47,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Exception Members,,7.66,,,,,,,4.97,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,inpatient,1,EA,4.33000,4.12000,The Alliance,Exception Members,,3.33,,,,,,,2.38,4.20,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,outpatient,1,EA,4.33000,4.12000,The Alliance,Exception Members,,3.33,,,,,,,2.17,4.20,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,inpatient,1,EA,2377.67000,2258.79000,The Alliance,Exception Members,,1830.81,,,,,,,1307.72,2306.34,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,outpatient,1,EA,2377.67000,2258.79000,The Alliance,Exception Members,,1830.81,,,,,,,230.26,2306.34,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,inpatient,1,EA,1087.80000,1033.41000,The Alliance,Exception Members,,837.61,,,,,,,598.29,1055.17,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,outpatient,1,EA,1087.80000,1033.41000,The Alliance,Exception Members,,837.61,,,,,,,5.19,1055.17,percent of total billed charges,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,inpatient,1,mL,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,1.44,2.54,percent of total billed charges,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,outpatient,1,mL,2.62000,2.49000,The Alliance,Exception Members,,2.02,,,,,,,0.50685,2.54,percent of total billed charges,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,6.08,10.73,percent of total billed charges,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Exception Members,,8.52,,,,,,,5.53,10.73,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,inpatient,1,mL,11.46000,10.88000,The Alliance,Exception Members,,8.82,,,,,,,6.30,11.12,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,outpatient,1,mL,11.46000,10.88000,The Alliance,Exception Members,,8.82,,,,,,,5.73,11.12,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.52250,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Exception Members,,0.73150,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.55000,0.97000,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Exception Members,,0.77000,,,,,,,0.50000,0.97000,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,inpatient,1,mL,39.15000,37.19000,The Alliance,Exception Members,,30.15,,,,,,,21.53,37.98,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,outpatient,1,mL,39.15000,37.19000,The Alliance,Exception Members,,30.15,,,,,,,19.57,37.98,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,inpatient,1,mL,100.36000,95.34000,The Alliance,Exception Members,,77.28,,,,,,,55.20,97.35,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,outpatient,1,mL,100.36000,95.34000,The Alliance,Exception Members,,77.28,,,,,,,50.18,97.35,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Exception Members,,0.02310,,,,,,,0.01500,0.02910,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,inpatient,1,EA,14.92000,14.18000,The Alliance,Exception Members,,11.49,,,,,,,8.21,14.47,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,outpatient,1,EA,14.92000,14.18000,The Alliance,Exception Members,,11.49,,,,,,,7.46,14.47,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Exception Members,,0.13860,,,,,,,0.09000,0.17460,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.57750,1.02,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Exception Members,,0.80850,,,,,,,0.52500,1.02,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.22,2.14,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Exception Members,,1.70,,,,,,,1.10,2.14,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1701.49,3368.26,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1593.85,3472.43,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.42,2.50,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Exception Members,,1.99,,,,,,,1.29,2.50,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,inpatient,1,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.70400,1.24,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Exception Members,,0.98560,,,,,,,0.64000,1.24,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,inpatient,1,EA,56.51000,53.69000,The Alliance,Exception Members,,43.51,,,,,,,31.08,54.81,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,outpatient,1,EA,56.51000,53.69000,The Alliance,Exception Members,,43.51,,,,,,,28.25,54.81,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,inpatient,1,EA,12.02000,11.42000,The Alliance,Exception Members,,9.26,,,,,,,6.61,11.66,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,outpatient,1,EA,12.02000,11.42000,The Alliance,Exception Members,,9.26,,,,,,,6.01,11.66,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1669.61,3637.50,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Exception Members,,3.85,,,,,,,0.03202,4.85,percent of total billed charges,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.36,143.36,percent of total billed charges,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,76.32000,72.50000,The Alliance,Exception Members,,58.77,,,,,,,41.98,74.03,percent of total billed charges,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Exception Members,,58.77,,,,,,,38.16,74.03,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,inpatient,,,582.12000,553.01000,The Alliance,Exception Members,,448.23,,,,,,,320.17,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,outpatient,,,582.12000,553.01000,The Alliance,Exception Members,,448.23,,,,,,,291.06,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,inpatient,1,EA,582.12000,553.01000,The Alliance,Exception Members,,448.23,,,,,,,320.17,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,outpatient,1,EA,582.12000,553.01000,The Alliance,Exception Members,,448.23,,,,,,,291.06,564.66,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.19250,0.33950,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Exception Members,,0.26950,,,,,,,0.17500,0.33950,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,1.45,percent of total billed charges,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,inpatient,1,GM,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,87.60000,83.22000,The Alliance,Exception Members,,67.45,,,,,,,42.92,84.97,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,87.60000,83.22000,The Alliance,Exception Members,,67.45,,,,,,,40.21,87.60,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,inpatient,1,EA,36.75000,34.91000,The Alliance,Exception Members,,28.30,,,,,,,20.21,35.65,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,outpatient,1,EA,36.75000,34.91000,The Alliance,Exception Members,,28.30,,,,,,,0.98580,35.65,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,inpatient,1,mL,616.69000,585.86000,The Alliance,Exception Members,,474.85,,,,,,,339.18,598.19,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,outpatient,1,mL,616.69000,585.86000,The Alliance,Exception Members,,474.85,,,,,,,308.35,598.19,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,inpatient,1,GM,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,7.24,12.77,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,outpatient,1,GM,13.17000,12.51000,The Alliance,Exception Members,,10.14,,,,,,,6.58,12.77,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1342.24,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,85.80,151.32,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Exception Members,,120.12,,,,,,,78.00,151.32,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,inpatient,,,850.00000,807.50000,The Alliance,Exception Members,TC,654.50,,,,,,,467.50,824.50,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Exception Members,TC,654.50,,,,,,,384.16,824.50,percent of total billed charges,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.85250,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Exception Members,,1.19,,,,,,,0.77500,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.23650,0.41710,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Exception Members,,0.33110,,,,,,,0.21500,0.41710,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.54450,0.96030,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Exception Members,,0.76230,,,,,,,0.49500,0.96030,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,inpatient,1,mL,2944.76000,2797.52000,The Alliance,Exception Members,,2267.47,,,,,,,1619.62,2856.42,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,outpatient,1,mL,2944.76000,2797.52000,The Alliance,Exception Members,,2267.47,,,,,,,1472.38,3261.31,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,inpatient,1,EA,23.79000,22.60000,The Alliance,Exception Members,,18.32,,,,,,,13.08,23.08,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Exception Members,,18.32,,,,,,,11.89,46.30,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,43.45,76.63,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Exception Members,,60.83,,,,,,,39.50,76.63,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,inpatient,1,mL,571.35000,542.79000,The Alliance,Exception Members,,439.94,,,,,,,314.24,554.21,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,outpatient,1,mL,571.35000,542.79000,The Alliance,Exception Members,,439.94,,,,,,,7.57,554.21,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.50600,0.89240,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Exception Members,,0.70840,,,,,,,0.46000,0.89240,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,92400.00000,87780.00000,The Alliance,Exception Members,,71148.00,,,,,,,45276.00,89628.00,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92400.00000,87780.00000,The Alliance,Exception Members,,71148.00,,,,,,,42411.60,92400.00,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,434.11,859.36,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Exception Members,,682.17,,,,,,,406.65,885.94,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4151.56000,3943.98000,The Alliance,Exception Members,,3196.70,,,,,,,2034.26,4027.01,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4151.56000,3943.98000,The Alliance,Exception Members,,3196.70,,,,,,,1905.57,4151.56,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3649.24000,3466.78000,The Alliance,Exception Members,,2809.91,,,,,,,1788.13,3539.76,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3649.24000,3466.78000,The Alliance,Exception Members,,2809.91,,,,,,,1675.00,3649.24,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.21450,0.37830,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Exception Members,,0.30030,,,,,,,0.19500,1.86,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,inpatient,1,mL,20.98000,19.93000,The Alliance,Exception Members,,16.15,,,,,,,11.54,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,outpatient,1,mL,20.98000,19.93000,The Alliance,Exception Members,,16.15,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,4.34,7.66,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Exception Members,,6.08,,,,,,,1.49,7.66,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,inpatient,,,147.06000,139.71000,The Alliance,Exception Members,,113.24,,,,,,,80.88,142.65,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,outpatient,,,147.06000,139.71000,The Alliance,Exception Members,,113.24,,,,,,,73.53,244.12,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,inpatient,1,mL,1164.72000,1106.48000,The Alliance,Exception Members,,896.83,,,,,,,640.60,1129.78,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,outpatient,1,mL,1164.72000,1106.48000,The Alliance,Exception Members,,896.83,,,,,,,227.94,1129.78,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,inpatient,,,320.07000,304.07000,The Alliance,Exception Members,,246.45,,,,,,,176.04,310.47,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,outpatient,,,320.07000,304.07000,The Alliance,Exception Members,,246.45,,,,,,,160.03,310.47,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,inpatient,1,mL,640.14000,608.13000,The Alliance,Exception Members,,492.91,,,,,,,352.08,620.94,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,outpatient,1,mL,640.14000,608.13000,The Alliance,Exception Members,,492.91,,,,,,,250.56,620.94,percent of total billed charges,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,inpatient,1,mL,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,outpatient,1,mL,0.66000,0.62000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,inpatient,1,mL,39900.00000,37905.00000,The Alliance,Exception Members,,30723.00,,,,,,,21945.00,38703.00,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,outpatient,1,mL,39900.00000,37905.00000,The Alliance,Exception Members,,30723.00,,,,,,,105.90,38703.00,percent of total billed charges,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Exception Members,,2754.68,,,,,,,1642.07,3577.50,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,inpatient,1,mL,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.94050,1.66,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Exception Members,,1.32,,,,,,,0.85500,2.61,percent of total billed charges,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,inpatient,,,1077.53000,1023.65000,The Alliance,Exception Members,,829.70,,,,,,,592.64,1045.20,percent of total billed charges,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1077.53000,1023.65000,The Alliance,Exception Members,,829.70,,,,,,,142.07,1045.20,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,30.25,53.35,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,,42.35,,,,,,,4.90,373.51,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,39.42,111.55,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Exception Members,,2546.78,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,29862.00000,28368.90000,The Alliance,Exception Members,,22993.74,,,,,,,14632.38,28966.14,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,29862.00000,28368.90000,The Alliance,Exception Members,,22993.74,,,,,,,13706.66,28966.14,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,inpatient,1,mL,1346.15000,1278.84000,The Alliance,Exception Members,,1036.54,,,,,,,740.38,1305.77,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,outpatient,1,mL,1346.15000,1278.84000,The Alliance,Exception Members,,1036.54,,,,,,,673.08,1305.77,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,330.75,654.75,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Exception Members,,519.75,,,,,,,309.82,675.00,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,inpatient,1,mL,2390.85000,2271.31000,The Alliance,Exception Members,,1840.95,,,,,,,1314.97,2319.12,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,outpatient,1,mL,2390.85000,2271.31000,The Alliance,Exception Members,,1840.95,,,,,,,1195.42,2319.12,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,100.20000,95.19000,The Alliance,Exception Members,,77.15,,,,,,,49.10,97.19,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,100.20000,95.19000,The Alliance,Exception Members,,77.15,,,,,,,50.10,97.19,percent of total billed charges,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,151.92000,144.32000,The Alliance,Exception Members,,116.98,,,,,,,74.44,147.36,percent of total billed charges,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,151.92000,144.32000,The Alliance,Exception Members,,116.98,,,,,,,75.96,639.03,percent of total billed charges,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,13.52000,12.84000,The Alliance,Exception Members,,10.41,,,,,,,6.62,13.11,percent of total billed charges,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,13.52000,12.84000,The Alliance,Exception Members,,10.41,,,,,,,6.76,121.81,percent of total billed charges,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,inpatient,1,mL,49.61000,47.13000,The Alliance,Exception Members,,38.20,,,,,,,27.29,48.12,percent of total billed charges,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,outpatient,1,mL,49.61000,47.13000,The Alliance,Exception Members,,38.20,,,,,,,24.80,48.12,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,inpatient,1,mL,73.08000,69.42000,The Alliance,Exception Members,,56.27,,,,,,,40.19,70.89,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,outpatient,1,mL,73.08000,69.42000,The Alliance,Exception Members,,56.27,,,,,,,36.54,70.89,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Exception Members,,25255.28,,,,,,,15054.77,32799.06,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6551.55000,6223.97000,The Alliance,Exception Members,,5044.69,,,,,,,3210.26,6355.00,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6551.55000,6223.97000,The Alliance,Exception Members,,5044.69,,,,,,,3007.16,6551.55,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,91.88,181.88,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,86.06,187.50,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,831.19,1465.91,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,755.62,1465.91,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,555.04000,527.29000,The Alliance,Exception Members,,427.38,,,,,,,305.27,538.39,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,555.04000,527.29000,The Alliance,Exception Members,,427.38,,,,,,,277.52,538.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,1.86,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.86,percent of total billed charges,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Exception Members,,123.20,,,,,,,73.44,160.00,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,inpatient,,,584.10000,554.90000,The Alliance,Exception Members,,449.76,,,,,,,321.25,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,outpatient,,,584.10000,554.90000,The Alliance,Exception Members,,449.76,,,,,,,292.05,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,inpatient,1,EA,584.10000,554.90000,The Alliance,Exception Members,,449.76,,,,,,,321.25,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,outpatient,1,EA,584.10000,554.90000,The Alliance,Exception Members,,449.76,,,,,,,292.05,566.58,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Exception Members,JW,1.02,,,,,,,0.22165,1.29,percent of total billed charges,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,25.72000,24.43000,The Alliance,Exception Members,,19.80,,,,,,,12.60,24.95,percent of total billed charges,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Exception Members,,19.80,,,,,,,11.81,24.95,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,inpatient,,,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,8.95,15.79,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,8.14,15.79,percent of total billed charges,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,inpatient,,,123.90000,117.70000,The Alliance,Exception Members,90,95.40,,,,,,,68.14,120.18,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Exception Members,90,95.40,,,,,,,15.58,780.94,percent of total billed charges,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,inpatient,,,329.20000,312.74000,The Alliance,Exception Members,90,253.48,,,,,,,181.06,319.32,percent of total billed charges,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,outpatient,,,329.20000,312.74000,The Alliance,Exception Members,90,253.48,,,,,,,36.26,1833.46,percent of total billed charges,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,inpatient,,,49.50000,47.02000,The Alliance,Exception Members,90,38.12,,,,,,,27.23,48.02,percent of total billed charges,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Exception Members,90,38.12,,,,,,,6.23,322.54,percent of total billed charges,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,inpatient,,,47.50000,45.12000,The Alliance,Exception Members,90,36.58,,,,,,,26.12,46.08,percent of total billed charges,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,outpatient,,,47.50000,45.12000,The Alliance,Exception Members,90,36.58,,,,,,,5.97,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,inpatient,,,47.20000,44.84000,The Alliance,Exception Members,90,36.34,,,,,,,25.96,45.78,percent of total billed charges,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,outpatient,,,47.20000,44.84000,The Alliance,Exception Members,90,36.34,,,,,,,5.94,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,inpatient,,,41.70000,39.62000,The Alliance,Exception Members,90,32.11,,,,,,,22.93,40.45,percent of total billed charges,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,outpatient,,,41.70000,39.62000,The Alliance,Exception Members,90,32.11,,,,,,,5.25,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,inpatient,,,119.70000,113.72000,The Alliance,Exception Members,90,92.17,,,,,,,65.83,116.11,percent of total billed charges,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,outpatient,,,119.70000,113.72000,The Alliance,Exception Members,90,92.17,,,,,,,15.06,763.98,percent of total billed charges,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,inpatient,,,228.40000,216.98000,The Alliance,Exception Members,90,175.87,,,,,,,125.62,221.55,percent of total billed charges,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Exception Members,90,175.87,,,,,,,28.73,1459.96,percent of total billed charges,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,inpatient,,,44.70000,42.47000,The Alliance,Exception Members,90,34.42,,,,,,,24.59,43.36,percent of total billed charges,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,outpatient,,,44.70000,42.47000,The Alliance,Exception Members,90,34.42,,,,,,,22.35,1137.41,percent of total billed charges,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,inpatient,,,45.80000,43.51000,The Alliance,Exception Members,90,35.27,,,,,,,25.19,44.43,percent of total billed charges,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,outpatient,,,45.80000,43.51000,The Alliance,Exception Members,90,35.27,,,,,,,5.75,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,Exception Members,90,43.20,,,,,,,30.86,54.42,percent of total billed charges,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Exception Members,90,43.20,,,,,,,7.05,356.54,percent of total billed charges,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,inpatient,,,45.10000,42.84000,The Alliance,Exception Members,90,34.73,,,,,,,24.80,43.75,percent of total billed charges,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,outpatient,,,45.10000,42.84000,The Alliance,Exception Members,90,34.73,,,,,,,5.67,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,inpatient,,,41.60000,39.52000,The Alliance,Exception Members,90,32.03,,,,,,,22.88,40.35,percent of total billed charges,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Exception Members,90,32.03,,,,,,,5.23,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,inpatient,,,118.80000,112.86000,The Alliance,Exception Members,90,91.48,,,,,,,65.34,115.24,percent of total billed charges,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,outpatient,,,118.80000,112.86000,The Alliance,Exception Members,90,91.48,,,,,,,14.93,679.08,percent of total billed charges,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,inpatient,,,38.90000,36.95000,The Alliance,Exception Members,90,29.95,,,,,,,21.39,37.73,percent of total billed charges,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,outpatient,,,38.90000,36.95000,The Alliance,Exception Members,90,29.95,,,,,,,4.89,220.68,percent of total billed charges,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,inpatient,,,42.50000,40.38000,The Alliance,Exception Members,90,32.73,,,,,,,23.38,41.23,percent of total billed charges,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,outpatient,,,42.50000,40.38000,The Alliance,Exception Members,90,32.73,,,,,,,5.35,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,inpatient,,,29.40000,27.93000,The Alliance,Exception Members,90,22.64,,,,,,,16.17,28.52,percent of total billed charges,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,outpatient,,,29.40000,27.93000,The Alliance,Exception Members,90,22.64,,,,,,,3.70,186.75,percent of total billed charges,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,30.25,53.35,percent of total billed charges,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Exception Members,90,42.35,,,,,,,6.92,356.54,percent of total billed charges,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,inpatient,,,327.60000,311.22000,The Alliance,Exception Members,90,252.25,,,,,,,180.18,317.77,percent of total billed charges,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,outpatient,,,327.60000,311.22000,The Alliance,Exception Members,90,252.25,,,,,,,17.85,814.87,percent of total billed charges,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,23961.00000,22762.95000,The Alliance,Exception Members,,18449.97,,,,,,,11740.89,23242.17,percent of total billed charges,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,23961.00000,22762.95000,The Alliance,Exception Members,,18449.97,,,,,,,10998.10,23242.17,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,24862.00000,23618.90000,The Alliance,Exception Members,,19143.74,,,,,,,13674.10,24116.14,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,24862.00000,23618.90000,The Alliance,Exception Members,,19143.74,,,,,,,12431.00,24116.14,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,Exception Members,TC,126.28,,,,,,,90.20,159.08,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Exception Members,TC,126.28,,,,,,,90.20,3163.00,percent of total billed charges,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,Exception Members,JW,0.68530,,,,,,,0.48950,0.86330,percent of total billed charges,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Exception Members,JW,0.68530,,,,,,,0.22165,0.86330,percent of total billed charges,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,344.77,2392.02,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,inpatient,,,1133.00000,1076.35000,The Alliance,Exception Members,TC,872.41,,,,,,,623.15,1099.01,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,outpatient,,,1133.00000,1076.35000,The Alliance,Exception Members,TC,872.41,,,,,,,566.50,8017.30,percent of total billed charges,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,inpatient,,,6363.00000,6044.85000,The Alliance,Exception Members,,4899.51,,,,,,,3499.65,6172.11,percent of total billed charges,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,outpatient,,,6363.00000,6044.85000,The Alliance,Exception Members,,4899.51,,,,,,,83.61,6172.11,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,inpatient,1,mL,8.97000,8.52000,The Alliance,Exception Members,,6.91,,,,,,,4.93,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,outpatient,1,mL,8.97000,8.52000,The Alliance,Exception Members,,6.91,,,,,,,4.49,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,inpatient,1,mL,8.64000,8.21000,The Alliance,Exception Members,,6.65,,,,,,,4.75,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,outpatient,1,mL,8.64000,8.21000,The Alliance,Exception Members,,6.65,,,,,,,4.32,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,inpatient,1,mL,8.07000,7.67000,The Alliance,Exception Members,,6.21,,,,,,,4.44,7.83,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,outpatient,1,mL,8.07000,7.67000,The Alliance,Exception Members,,6.21,,,,,,,4.04,7.83,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,inpatient,1,mL,19684.00000,18699.80000,The Alliance,Exception Members,,15156.68,,,,,,,10826.20,19093.48,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,outpatient,1,mL,19684.00000,18699.80000,The Alliance,Exception Members,,15156.68,,,,,,,72.40,19093.48,percent of total billed charges,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,inpatient,1,mL,5752.33000,5464.72000,The Alliance,Exception Members,,4429.29,,,,,,,3163.78,5579.76,percent of total billed charges,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,outpatient,1,mL,5752.33000,5464.72000,The Alliance,Exception Members,,4429.29,,,,,,,18.10,5579.76,percent of total billed charges,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12130.22,26427.50,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,70.56000,67.03000,The Alliance,Exception Members,,54.33,,,,,,,34.57,68.44,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Exception Members,,54.33,,,,,,,32.39,70.56,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12400.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12400.00,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2625.00000,2493.75000,The Alliance,Exception Members,,2021.25,,,,,,,1286.25,2546.25,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Exception Members,,2021.25,,,,,,,1204.88,2625.00,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,308.32,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,191.40,337.56,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,144.10,548.00,percent of total billed charges,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,inpatient,,,233.19000,221.53000,The Alliance,Exception Members,,179.56,,,,,,,128.25,226.19,percent of total billed charges,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,outpatient,,,233.19000,221.53000,The Alliance,Exception Members,,179.56,,,,,,,6.95,226.19,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,865.71,5858.00,percent of total billed charges,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,89.10,157.14,percent of total billed charges,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Exception Members,,124.74,,,,,,,81.00,344.85,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1285.85,2518.12,percent of total billed charges,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,4242.12000,4030.01000,The Alliance,Exception Members,,3266.43,,,,,,,2333.17,4114.86,percent of total billed charges,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,4242.12000,4030.01000,The Alliance,Exception Members,,3266.43,,,,,,,683.80,4114.86,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,3777.75000,3588.86000,The Alliance,Exception Members,,2908.87,,,,,,,1851.10,3664.42,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Exception Members,,2908.87,,,,,,,1733.99,3777.75,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,inpatient,,,1416.00000,1345.20000,The Alliance,Exception Members,,1090.32,,,,,,,778.80,1373.52,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Exception Members,,1090.32,,,,,,,122.40,1373.52,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Exception Members,,821.41,,,,,,,489.64,1066.76,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3499.34,6927.26,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Exception Members,,5498.95,,,,,,,3277.95,7141.50,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,514.09000,488.39000,The Alliance,Exception Members,,395.85,,,,,,,251.90,498.67,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,514.09000,488.39000,The Alliance,Exception Members,,395.85,,,,,,,235.97,514.09,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,1909.84,3368.26,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Exception Members,,2673.77,,,,,,,11.35,3368.26,percent of total billed charges,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1476.56000,1402.73000,The Alliance,Exception Members,,1136.95,,,,,,,723.51,1432.26,percent of total billed charges,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1476.56000,1402.73000,The Alliance,Exception Members,,1136.95,,,,,,,677.74,1476.56,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,5936.70,10470.18,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Exception Members,TC,8311.38,,,,,,,1929.64,10470.18,percent of total billed charges,
INJ NON-CMP SCHLEROSANT MLT VN-TECH,85278,CDM,510,RC,36466,CPT,,,facility,inpatient,,,419.00000,398.05000,The Alliance,Exception Members,,322.63,,,,,,,230.45,406.43,percent of total billed charges,
INJ NON-CMP SCHLEROSANT MLT VN-TECH,85278,CDM,510,RC,36466,CPT,,,facility,outpatient,,,419.00000,398.05000,The Alliance,Exception Members,,322.63,,,,,,,209.50,1910.62,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,inpatient,,,101.80000,96.71000,The Alliance,Exception Members,90,78.39,,,,,,,55.99,98.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,outpatient,,,101.80000,96.71000,The Alliance,Exception Members,90,78.39,,,,,,,8.17,645.08,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,inpatient,,,83.60000,79.42000,The Alliance,Exception Members,90,64.37,,,,,,,45.98,81.09,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Exception Members,90,64.37,,,,,,,8.17,526.26,percent of total billed charges,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,inpatient,,,121.50000,115.42000,The Alliance,Exception Members,90,93.56,,,,,,,66.83,117.86,percent of total billed charges,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,outpatient,,,121.50000,115.42000,The Alliance,Exception Members,90,93.56,,,,,,,15.27,780.94,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,inpatient,,,139.90000,132.90000,The Alliance,Exception Members,90,107.72,,,,,,,76.94,135.70,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,outpatient,,,139.90000,132.90000,The Alliance,Exception Members,90,107.72,,,,,,,17.60,882.80,percent of total billed charges,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Exception Members,,1689.19,,,,,,,1006.93,2193.75,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,38850.00000,36907.50000,The Alliance,Exception Members,,29914.50,,,,,,,19036.50,37684.50,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,38850.00000,36907.50000,The Alliance,Exception Members,,29914.50,,,,,,,17832.15,38850.00,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,inpatient,1,mL,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,outpatient,1,mL,0.85000,0.80000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,inpatient,1,mL,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.46750,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,outpatient,1,mL,0.85000,0.81000,The Alliance,Exception Members,,0.65450,,,,,,,0.42500,0.82450,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.25,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Exception Members,,1.76,,,,,,,1.14,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.04000,1.94000,The Alliance,Exception Members,,1.57,,,,,,,1.12,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.04000,1.94000,The Alliance,Exception Members,,1.57,,,,,,,1.02,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.60,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.00,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.92400,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.68000,1.60000,The Alliance,Exception Members,,1.29,,,,,,,0.84000,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.31,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,4.20000,3.99000,The Alliance,Exception Members,,3.23,,,,,,,2.10,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,13.75,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,12.50,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.98,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.60000,3.42000,The Alliance,Exception Members,,2.77,,,,,,,1.80,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.52,2.68,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.76000,2.62000,The Alliance,Exception Members,,2.13,,,,,,,1.38,2.68,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,inpatient,,,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.89,8.63,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Exception Members,,6.85,,,,,,,4.45,20.67,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.39,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.52000,2.39000,The Alliance,Exception Members,,1.94,,,,,,,1.26,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.92000,1.82000,The Alliance,Exception Members,,1.48,,,,,,,1.06,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.92000,1.82000,The Alliance,Exception Members,,1.48,,,,,,,0.96000,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.99000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.80000,1.71000,The Alliance,Exception Members,,1.39,,,,,,,0.90000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.40,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Exception Members,,6.16,,,,,,,4.00,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.30,5.82,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,6.00000,5.70000,The Alliance,Exception Members,,4.62,,,,,,,3.00,5.82,percent of total billed charges,
DRY NEEDLING;1-2 MUSCLES-TECH,85313,CDM,510,RC,20560,CPT,,,facility,inpatient,,,10.10000,9.59000,The Alliance,Exception Members,,7.78,,,,,,,5.55,9.80,percent of total billed charges,
DRY NEEDLING;1-2 MUSCLES-TECH,85313,CDM,510,RC,20560,CPT,,,facility,outpatient,,,10.10000,9.59000,The Alliance,Exception Members,,7.78,,,,,,,5.05,25.57,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,441.38,778.42,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,47.62,778.42,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,inpatient,1,EA,48514.58000,46088.85000,The Alliance,Exception Members,,37356.23,,,,,,,26683.02,47059.14,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,outpatient,1,EA,48514.58000,46088.85000,The Alliance,Exception Members,,37356.23,,,,,,,216.74,47059.14,percent of total billed charges,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,inpatient,1,mL,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.81400,1.44,percent of total billed charges,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Exception Members,,1.14,,,,,,,0.74000,1.44,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,inpatient,,,105.90000,100.61000,The Alliance,Exception Members,90,81.54,,,,,,,58.24,102.72,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Exception Members,90,81.54,,,,,,,8.17,679.08,percent of total billed charges,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,inpatient,,,1002.00000,951.90000,The Alliance,Exception Members,90,771.54,,,,,,,551.10,971.94,percent of total billed charges,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,outpatient,,,1002.00000,951.90000,The Alliance,Exception Members,90,771.54,,,,,,,426.69,971.94,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,Exception Members,90,125.51,,,,,,,89.65,158.11,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Exception Members,90,125.51,,,,,,,8.17,763.98,percent of total billed charges,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,90,97.79,,,,,,,69.85,123.19,percent of total billed charges,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,90,97.79,,,,,,,16.61,763.98,percent of total billed charges,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,inpatient,,,277.20000,263.34000,The Alliance,Exception Members,90,213.44,,,,,,,152.46,268.88,percent of total billed charges,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Exception Members,90,213.44,,,,,,,36.26,1833.46,percent of total billed charges,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,inpatient,,,105.90000,100.61000,The Alliance,Exception Members,90,81.54,,,,,,,58.24,102.72,percent of total billed charges,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Exception Members,90,81.54,,,,,,,13.31,679.08,percent of total billed charges,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,20150.00000,19142.50000,The Alliance,Exception Members,,15515.50,,,,,,,9873.50,19545.50,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,20150.00000,19142.50000,The Alliance,Exception Members,,15515.50,,,,,,,9248.85,20150.00,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.69,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Exception Members,,2.37,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.69300,1.22,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Exception Members,,0.97020,,,,,,,0.63000,1.22,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,3.10,6.13,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,6.32000,6.00000,The Alliance,Exception Members,,4.87,,,,,,,2.90,6.32,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,91.30,161.02,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Exception Members,,127.82,,,,,,,83.00,161.02,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6070.28000,5766.77000,The Alliance,Exception Members,,4674.12,,,,,,,2974.44,5888.17,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6070.28000,5766.77000,The Alliance,Exception Members,,4674.12,,,,,,,2786.26,6070.28,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1775.03,3513.82,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Exception Members,,2789.32,,,,,,,1662.73,3622.50,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1774.50000,1685.77000,The Alliance,Exception Members,,1366.37,,,,,,,975.98,1721.27,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1774.50000,1685.77000,The Alliance,Exception Members,,1366.37,,,,,,,887.25,1721.27,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1959.38,3455.62,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Exception Members,,2743.12,,,,,,,1781.25,3455.62,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,825.00000,783.75000,The Alliance,Exception Members,,635.25,,,,,,,453.75,800.25,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,825.00000,783.75000,The Alliance,Exception Members,,635.25,,,,,,,412.50,800.25,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1650.00,2910.00,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1500.00,2910.00,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,35.20,62.08,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Exception Members,,49.28,,,,,,,32.00,62.08,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,131.18,231.34,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Exception Members,,183.65,,,,,,,119.25,231.34,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,845.37,3163.00,percent of total billed charges,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1475.05,4686.00,percent of total billed charges,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,360.68,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1548.45,percent of total billed charges,
OPHTHALMSCPY XTND OPTIC NERV/MACUL 92202-TECH,85368,CDM,510,RC,92202,CPT,,,facility,inpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.60,11.64,percent of total billed charges,
OPHTHALMSCPY XTND OPTIC NERV/MACUL 92202-TECH,85368,CDM,510,RC,92202,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Exception Members,,9.24,,,,,,,6.00,62.04,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,740.51,1465.91,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Exception Members,,1163.66,,,,,,,693.66,1511.25,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Exception Members,,123.97,,,,,,,80.50,264.00,percent of total billed charges,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52500.00000,49875.00000,The Alliance,Exception Members,,40425.00,,,,,,,25725.00,50925.00,percent of total billed charges,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52500.00000,49875.00000,The Alliance,Exception Members,,40425.00,,,,,,,24097.50,52500.00,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34639.50000,32907.53000,The Alliance,Exception Members,,26672.42,,,,,,,16973.35,33600.32,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34639.50000,32907.53000,The Alliance,Exception Members,,26672.42,,,,,,,15899.53,34639.50,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2358.25,4668.37,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2209.05,4812.75,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2358.25,4668.37,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Exception Members,,3705.82,,,,,,,2209.05,4812.75,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,inpatient,,,57750.00000,54862.50000,The Alliance,Exception Members,,44467.50,,,,,,,28297.50,56017.50,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,57750.00000,54862.50000,The Alliance,Exception Members,,44467.50,,,,,,,26507.25,57750.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,158.40,279.36,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Exception Members,TC,221.76,,,,,,,144.00,1509.95,percent of total billed charges,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1374.98000,1306.23000,The Alliance,Exception Members,,1058.73,,,,,,,673.74,1333.73,percent of total billed charges,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Exception Members,,1058.73,,,,,,,440.69,1374.98,percent of total billed charges,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,inpatient,,,8798.00000,8358.10000,The Alliance,Exception Members,TC,6774.46,,,,,,,4838.90,8534.06,percent of total billed charges,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,outpatient,,,8798.00000,8358.10000,The Alliance,Exception Members,TC,6774.46,,,,,,,4399.00,8534.06,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,Exception Members,TC,297.99,,,,,,,212.85,375.39,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Exception Members,TC,297.99,,,,,,,193.50,375.39,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,99.50,264.00,percent of total billed charges,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,457.05,806.07,percent of total billed charges,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Exception Members,TC,639.87,,,,,,,415.50,806.07,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,99.50,264.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,GP,77.00,,,,,,,55.00,97.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,GP,77.00,,,,,,,50.00,264.00,percent of total billed charges,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,41.50,264.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,109.45,193.03,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Exception Members,,153.23,,,,,,,99.50,264.00,percent of total billed charges,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,45.65,80.51,percent of total billed charges,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Exception Members,,63.91,,,,,,,41.50,264.00,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,GO,77.00,,,,,,,55.00,97.00,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,GO,77.00,,,,,,,50.00,264.00,percent of total billed charges,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,55.00,97.00,percent of total billed charges,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Exception Members,,77.00,,,,,,,50.00,264.00,percent of total billed charges,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,inpatient,1,mL,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,1.06,1.87,percent of total billed charges,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Exception Members,,1.49,,,,,,,0.96500,7.69,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,inpatient,1,mL,9.16000,8.71000,The Alliance,Exception Members,,7.05,,,,,,,5.04,8.89,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,outpatient,1,mL,9.16000,8.71000,The Alliance,Exception Members,,7.05,,,,,,,4.58,8.89,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,inpatient,1,mL,7.17000,6.81000,The Alliance,Exception Members,,5.52,,,,,,,3.94,6.95,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,outpatient,1,mL,7.17000,6.81000,The Alliance,Exception Members,,5.52,,,,,,,2.50,6.95,percent of total billed charges,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,7400.25000,7030.24000,The Alliance,Exception Members,,5698.19,,,,,,,3626.12,7178.24,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Exception Members,,5698.19,,,,,,,3396.71,7400.25,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,10177.30,20146.90,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Exception Members,,15992.90,,,,,,,9533.43,20146.90,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3796.02,7514.57,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3555.86,7746.98,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,284.10000,269.90000,The Alliance,Exception Members,,218.76,,,,,,,156.25,275.58,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,284.10000,269.90000,The Alliance,Exception Members,,218.76,,,,,,,77.18,275.58,percent of total billed charges,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1340.62,2364.38,percent of total billed charges,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Exception Members,,1876.88,,,,,,,1218.75,2364.38,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,12.25,24.25,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Exception Members,,19.25,,,,,,,11.47,25.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,71400.00000,67830.00000,The Alliance,Exception Members,,54978.00,,,,,,,34986.00,69258.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Exception Members,,54978.00,,,,,,,32772.60,71400.00,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,726.83,2392.02,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,inpatient,1,mL,1315.72000,1249.93000,The Alliance,Exception Members,,1013.10,,,,,,,723.65,1276.25,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,outpatient,1,mL,1315.72000,1249.93000,The Alliance,Exception Members,,1013.10,,,,,,,72.40,1276.25,percent of total billed charges,
APP CAST CYLINDER-TECH,85500,CDM,510,RC,29365,CPT,,,facility,inpatient,,,350.00000,332.50000,The Alliance,Exception Members,,269.50,,,,,,,192.50,339.50,percent of total billed charges,
APP CAST CYLINDER-TECH,85500,CDM,510,RC,29365,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,Exception Members,,269.50,,,,,,,175.00,339.50,percent of total billed charges,
APP HIP SPICA CST 1 1/2 OR BTH-TECH,85501,CDM,510,RC,29325,CPT,,,facility,inpatient,,,776.00000,737.20000,The Alliance,Exception Members,,597.52,,,,,,,426.80,752.72,percent of total billed charges,
APP HIP SPICA CST 1 1/2 OR BTH-TECH,85501,CDM,510,RC,29325,CPT,,,facility,outpatient,,,776.00000,737.20000,The Alliance,Exception Members,,597.52,,,,,,,252.18,752.72,percent of total billed charges,
APPLY HAND/WRIST CAST-TECH,85502,CDM,510,RC,29085,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,Exception Members,,210.21,,,,,,,150.15,264.81,percent of total billed charges,
APPLY HAND/WRIST CAST-TECH,85502,CDM,510,RC,29085,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Exception Members,,210.21,,,,,,,136.50,264.81,percent of total billed charges,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,257.25,509.25,percent of total billed charges,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,,404.25,,,,,,,240.97,525.00,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,inpatient,,,142.40000,135.28000,The Alliance,Exception Members,,109.65,,,,,,,78.32,138.13,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Exception Members,,109.65,,,,,,,12.05,628.12,percent of total billed charges,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,349.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,inpatient,,,725.63000,689.35000,The Alliance,Exception Members,,558.74,,,,,,,399.10,703.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,outpatient,,,725.63000,689.35000,The Alliance,Exception Members,,558.74,,,,,,,362.81,703.86,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,50.34,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,45.76,88.77,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,546.56,963.94,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Exception Members,,765.19,,,,,,,44.30,963.94,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,inpatient,1,mL,173.36000,164.69000,The Alliance,Exception Members,,133.49,,,,,,,95.35,168.16,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,outpatient,1,mL,173.36000,164.69000,The Alliance,Exception Members,,133.49,,,,,,,73.55,168.16,percent of total billed charges,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,inpatient,1,mL,3408.61000,3238.18000,The Alliance,Exception Members,,2624.63,,,,,,,1874.74,3306.35,percent of total billed charges,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,outpatient,1,mL,3408.61000,3238.18000,The Alliance,Exception Members,,2624.63,,,,,,,39.50,3306.35,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,inpatient,1,mL,21.52000,20.44000,The Alliance,Exception Members,,16.57,,,,,,,11.84,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,outpatient,1,mL,21.52000,20.44000,The Alliance,Exception Members,,16.57,,,,,,,10.76,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,inpatient,1,mL,21.27000,20.20000,The Alliance,Exception Members,,16.38,,,,,,,11.70,20.63,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,outpatient,1,mL,21.27000,20.20000,The Alliance,Exception Members,,16.38,,,,,,,10.63,20.63,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,inpatient,,,420.60000,399.57000,The Alliance,Exception Members,90,323.86,,,,,,,231.33,407.98,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Exception Members,90,323.86,,,,,,,52.89,2410.69,percent of total billed charges,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,inpatient,,,260.10000,247.10000,The Alliance,Exception Members,90,200.28,,,,,,,143.06,252.30,percent of total billed charges,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Exception Members,90,200.28,,,,,,,117.50,1643.57,percent of total billed charges,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,90,135.52,,,,,,,96.80,170.72,percent of total billed charges,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,90,135.52,,,,,,,20.36,1120.45,percent of total billed charges,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,inpatient,,,420.60000,399.57000,The Alliance,Exception Members,90,323.86,,,,,,,231.33,407.98,percent of total billed charges,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Exception Members,90,323.86,,,,,,,52.89,2410.69,percent of total billed charges,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,inpatient,,,260.10000,247.10000,The Alliance,Exception Members,90,200.28,,,,,,,143.06,252.30,percent of total billed charges,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Exception Members,90,200.28,,,,,,,117.50,1643.57,percent of total billed charges,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,Exception Members,90,135.52,,,,,,,96.80,170.72,percent of total billed charges,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Exception Members,90,135.52,,,,,,,20.36,1120.45,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,825.00,1455.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,750.00,1455.00,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,inpatient,1,EA,1169.88000,1111.38000,The Alliance,Exception Members,,900.81,,,,,,,643.43,1134.78,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,outpatient,1,EA,1169.88000,1111.38000,The Alliance,Exception Members,,900.81,,,,,,,155.42,1134.78,percent of total billed charges,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,inpatient,,,532.14000,505.53000,The Alliance,Exception Members,90,409.75,,,,,,,292.68,516.18,percent of total billed charges,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,outpatient,,,532.14000,505.53000,The Alliance,Exception Members,90,409.75,,,,,,,69.60,3514.18,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,inpatient,,,1050.30000,997.78000,The Alliance,Exception Members,,808.73,,,,,,,577.66,1018.79,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,outpatient,,,1050.30000,997.78000,The Alliance,Exception Members,,808.73,,,,,,,525.15,3999.66,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,inpatient,,,915.50000,869.72000,The Alliance,Exception Members,,704.93,,,,,,,503.52,888.03,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,outpatient,,,915.50000,869.72000,The Alliance,Exception Members,,704.93,,,,,,,457.75,3999.66,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,TC,4913.37,,,,,,,3509.55,6189.57,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,TC,4913.37,,,,,,,2786.18,6189.57,percent of total billed charges,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Exception Members,,5379.22,,,,,,,3842.30,6776.42,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,256.50000,243.67000,The Alliance,Exception Members,,197.50,,,,,,,125.69,248.81,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,256.50000,243.67000,The Alliance,Exception Members,,197.50,,,,,,,117.73,256.50,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,3273.75,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Exception Members,,2598.75,,,,,,,1856.25,5271.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,5271.00,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.18,2.08,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Exception Members,,1.65,,,,,,,1.07,3.53,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,204.75000,194.51000,The Alliance,Exception Members,,157.66,,,,,,,100.33,198.61,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,204.75000,194.51000,The Alliance,Exception Members,,157.66,,,,,,,93.98,204.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,3675.00000,3491.25000,The Alliance,Exception Members,,2829.75,,,,,,,2021.25,3564.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,3675.00000,3491.25000,The Alliance,Exception Members,,2829.75,,,,,,,1837.50,3564.75,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,50.34,88.77,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Exception Members,,70.47,,,,,,,45.76,88.77,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,1513.80000,1438.11000,The Alliance,Exception Members,,1165.63,,,,,,,832.59,1468.39,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1513.80000,1438.11000,The Alliance,Exception Members,,1165.63,,,,,,,47.62,1468.39,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,inpatient,,,1494.00000,1419.30000,The Alliance,Exception Members,TC,1150.38,,,,,,,821.70,1449.18,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,Exception Members,TC,1150.38,,,,,,,747.00,2210.07,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,inpatient,1,mL,12.96000,12.31000,The Alliance,Exception Members,,9.98,,,,,,,7.13,12.57,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,outpatient,1,mL,12.96000,12.31000,The Alliance,Exception Members,,9.98,,,,,,,6.48,25.89,percent of total billed charges,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17084.19000,16229.98000,The Alliance,Exception Members,,13154.83,,,,,,,8371.25,16571.66,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Exception Members,,13154.83,,,,,,,7841.64,17084.19,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,77.60000,73.72000,The Alliance,Exception Members,,59.75,,,,,,,38.02,75.27,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.60000,73.72000,The Alliance,Exception Members,,59.75,,,,,,,35.62,77.60,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,inpatient,1,mL,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,3320.62,5856.38,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,outpatient,1,mL,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,3018.75,5856.38,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,inpatient,,,4690.00000,4455.50000,The Alliance,Exception Members,,3611.30,,,,,,,2298.10,4549.30,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,outpatient,,,4690.00000,4455.50000,The Alliance,Exception Members,,3611.30,,,,,,,2152.71,4690.00,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,inpatient,,,42710.00000,40574.50000,The Alliance,Exception Members,,32886.70,,,,,,,23490.50,41428.70,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,outpatient,,,42710.00000,40574.50000,The Alliance,Exception Members,,32886.70,,,,,,,4095.00,41428.70,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,inpatient,1,EA,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.34,4.12,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Exception Members,,3.27,,,,,,,2.12,4.12,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,899.63000,854.65000,The Alliance,Exception Members,,692.72,,,,,,,440.82,872.64,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Exception Members,,692.72,,,,,,,412.93,899.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Exception Members,,219.60,,,,,,,130.90,285.19,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,inpatient,,,325.01000,308.76000,The Alliance,Exception Members,,250.26,,,,,,,159.25,315.26,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,outpatient,,,325.01000,308.76000,The Alliance,Exception Members,,250.26,,,,,,,149.18,325.01,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,567.05,1000.07,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Exception Members,TC,793.87,,,,,,,384.16,1000.07,percent of total billed charges,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,3698.33000,3513.41000,The Alliance,Exception Members,,2847.71,,,,,,,1812.18,3587.38,percent of total billed charges,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,3698.33000,3513.41000,The Alliance,Exception Members,,2847.71,,,,,,,1697.53,3698.33,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,417.15000,396.29000,The Alliance,Exception Members,,321.21,,,,,,,204.40,404.64,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,417.15000,396.29000,The Alliance,Exception Members,,321.21,,,,,,,191.47,417.15,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Exception Members,,225.22,,,,,,,134.26,292.50,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3553.98000,3376.28000,The Alliance,Exception Members,,2736.56,,,,,,,1741.45,3447.36,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3553.98000,3376.28000,The Alliance,Exception Members,,2736.56,,,,,,,1631.28,3553.98,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6934.50000,6587.77000,The Alliance,Exception Members,,5339.56,,,,,,,3397.91,6726.47,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6934.50000,6587.77000,The Alliance,Exception Members,,5339.56,,,,,,,3182.94,6934.50,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Exception Members,,479.32,,,,,,,285.73,622.50,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,Exception Members,TC,83.93,,,,,,,59.95,105.73,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Exception Members,TC,83.93,,,,,,,41.10,484.28,percent of total billed charges,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,inpatient,,,4471.00000,4247.45000,The Alliance,Exception Members,TC,3442.67,,,,,,,2459.05,4336.87,percent of total billed charges,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Exception Members,TC,3442.67,,,,,,,1523.24,17311.25,percent of total billed charges,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,,1898.82,,,,,,,280.29,3163.00,percent of total billed charges,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5165.13,11253.00,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,68.60,135.80,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Exception Members,,107.80,,,,,,,64.26,140.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Exception Members,,22127.49,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Exception Members,,9168.47,,,,,,,5465.36,11907.10,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20398.96000,19379.01000,The Alliance,Exception Members,,15707.20,,,,,,,9995.49,19786.99,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Exception Members,,15707.20,,,,,,,9363.12,20398.96,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,6076.00,12028.00,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Exception Members,,9548.00,,,,,,,5691.60,12028.00,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,inpatient,,,138.70000,131.76000,The Alliance,Exception Members,90,106.80,,,,,,,76.28,134.54,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,outpatient,,,138.70000,131.76000,The Alliance,Exception Members,90,106.80,,,,,,,14.22,713.01,percent of total billed charges,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,inpatient,,,94.60000,89.87000,The Alliance,Exception Members,90,72.84,,,,,,,52.03,91.76,percent of total billed charges,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,outpatient,,,94.60000,89.87000,The Alliance,Exception Members,90,72.84,,,,,,,12.38,628.12,percent of total billed charges,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,inpatient,,,51.10000,48.55000,The Alliance,Exception Members,90,39.35,,,,,,,28.11,49.57,percent of total billed charges,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Exception Members,90,39.35,,,,,,,6.69,339.51,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,inpatient,,,51.10000,48.55000,The Alliance,Exception Members,90,39.35,,,,,,,28.11,49.57,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Exception Members,90,39.35,,,,,,,6.69,339.51,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,inpatient,,,111.70000,106.11000,The Alliance,Exception Members,90,86.01,,,,,,,61.44,108.35,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,outpatient,,,111.70000,106.11000,The Alliance,Exception Members,90,86.01,,,,,,,9.02,662.12,percent of total billed charges,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,inpatient,,,405.00000,384.75000,The Alliance,Exception Members,,311.85,,,,,,,222.75,392.85,percent of total billed charges,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,Exception Members,,311.85,,,,,,,35.09,1833.46,percent of total billed charges,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,405.35,714.89,percent of total billed charges,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Exception Members,,567.49,,,,,,,61.98,3242.53,percent of total billed charges,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,inpatient,,,176.50000,167.67000,The Alliance,Exception Members,90,135.91,,,,,,,97.08,171.21,percent of total billed charges,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,outpatient,,,176.50000,167.67000,The Alliance,Exception Members,90,135.91,,,,,,,23.08,2082.45,percent of total billed charges,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1545.94,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,67200.00000,63840.00000,The Alliance,Exception Members,,51744.00,,,,,,,32928.00,65184.00,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,67200.00000,63840.00000,The Alliance,Exception Members,,51744.00,,,,,,,30844.80,67200.00,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,5658.00000,5375.10000,The Alliance,Exception Members,,4356.66,,,,,,,2772.42,5488.26,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5658.00000,5375.10000,The Alliance,Exception Members,,4356.66,,,,,,,2597.02,5658.00,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1545.94,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1500.00,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,inpatient,1,mL,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.25300,0.44620,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,outpatient,1,mL,0.46000,0.44000,The Alliance,Exception Members,,0.35420,,,,,,,0.23000,0.44620,percent of total billed charges,
COMPR AUDIOMETRY EVAL UNI-TECH,85636,CDM,510,RC,92557,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
COMPR AUDIOMETRY EVAL UNI-TECH,85636,CDM,510,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,26.00,163.43,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,28.60,50.44,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Exception Members,,40.04,,,,,,,26.00,163.43,percent of total billed charges,
ASSESSMENT OF TINNITUS-TECH,85638,CDM,510,RC,92625,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,53.35,94.09,percent of total billed charges,
ASSESSMENT OF TINNITUS-TECH,85638,CDM,510,RC,92625,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Exception Members,,74.69,,,,,,,48.50,163.43,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS PR-TECH,85641,CDM,510,RC,92603,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,114.95,202.73,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS PR-TECH,85641,CDM,510,RC,92603,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Exception Members,,160.93,,,,,,,104.50,202.73,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS RP-TECH,85642,CDM,510,RC,92604,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS RP-TECH,85642,CDM,510,RC,92604,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,62.00,163.43,percent of total billed charges,
EVAL AUD REHAB STAT 1ST HR-TECH,85643,CDM,510,RC,92626,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,68.20,120.28,percent of total billed charges,
EVAL AUD REHAB STAT 1ST HR-TECH,85643,CDM,510,RC,92626,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Exception Members,,95.48,,,,,,,62.00,163.43,percent of total billed charges,
EVAL AUD REHAB-TECH,85644,CDM,510,RC,92627,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,17.05,30.07,percent of total billed charges,
EVAL AUD REHAB-TECH,85644,CDM,510,RC,92627,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Exception Members,,23.87,,,,,,,15.50,30.07,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST UNI-TECH,85645,CDM,510,RC,92567,CPT,,,facility,inpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,11.00,19.40,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST UNI-TECH,85645,CDM,510,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,10.00,41.00,percent of total billed charges,
TYMPANOMETRY/REFLEX MEASUREMT-TECH,85646,CDM,510,RC,92550,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,15.95,28.13,percent of total billed charges,
TYMPANOMETRY/REFLEX MEASUREMT-TECH,85646,CDM,510,RC,92550,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Exception Members,,22.33,,,,,,,14.50,163.43,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,inpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,11.00,19.40,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Exception Members,,15.40,,,,,,,10.00,41.00,percent of total billed charges,
VISUAL REINFORCEMENT AUDIOMETR-TECH,85648,CDM,510,RC,92579,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,31.90,56.26,percent of total billed charges,
VISUAL REINFORCEMENT AUDIOMETR-TECH,85648,CDM,510,RC,92579,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Exception Members,,44.66,,,,,,,29.00,163.43,percent of total billed charges,
ELECTROCOCHLEOGRAPHY-TECH,85649,CDM,510,RC,92584,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,54.45,96.03,percent of total billed charges,
ELECTROCOCHLEOGRAPHY-TECH,85649,CDM,510,RC,92584,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,,76.23,,,,,,,49.50,163.43,percent of total billed charges,
AEP HEARING STATUS W/INTRP/RPT-TECH,85650,CDM,510,RC,92651,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,74.80,131.92,percent of total billed charges,
AEP HEARING STATUS W/INTRP/RPT-TECH,85650,CDM,510,RC,92651,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Exception Members,,104.72,,,,,,,68.00,325.26,percent of total billed charges,
AEP THRESHOLD ESTIMATION-TECH,85651,CDM,510,RC,92652,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,82.50,145.50,percent of total billed charges,
AEP THRESHOLD ESTIMATION-TECH,85651,CDM,510,RC,92652,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Exception Members,,115.50,,,,,,,75.00,325.26,percent of total billed charges,
AEP NEURODIAGNOSTIC INTRP/RPT-TECH,85652,CDM,510,RC,92653,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,72.60,128.04,percent of total billed charges,
AEP NEURODIAGNOSTIC INTRP/RPT-TECH,85652,CDM,510,RC,92653,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Exception Members,,101.64,,,,,,,66.00,325.26,percent of total billed charges,
CERVICAL VEMP TESING W/I&R-TECH,85653,CDM,510,RC,92517,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,59.40,104.76,percent of total billed charges,
CERVICAL VEMP TESING W/I&R-TECH,85653,CDM,510,RC,92517,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Exception Members,,83.16,,,,,,,54.00,163.43,percent of total billed charges,
CERVICAL & OCULAR VEMP TESTING W/I&R-TECH,85654,CDM,510,RC,92519,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,92.40,162.96,percent of total billed charges,
CERVICAL & OCULAR VEMP TESTING W/I&R-TECH,85654,CDM,510,RC,92519,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Exception Members,,129.36,,,,,,,84.00,325.26,percent of total billed charges,
ALLERG IMMUNOTH-2- TECH,85655,CDM,510,RC,95146,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,34.65,61.11,percent of total billed charges,
ALLERG IMMUNOTH-2- TECH,85655,CDM,510,RC,95146,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Exception Members,,48.51,,,,,,,31.50,61.11,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,inpatient,,,544.00000,516.80000,The Alliance,Exception Members,,418.88,,,,,,,299.20,527.68,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Exception Members,,418.88,,,,,,,299.20,4686.00,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,15174.50000,14415.77000,The Alliance,Exception Members,,11684.36,,,,,,,7435.51,14719.26,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,15174.50000,14415.77000,The Alliance,Exception Members,,11684.36,,,,,,,6965.10,15174.50,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1374.98000,1306.23000,The Alliance,Exception Members,,1058.73,,,,,,,673.74,1333.73,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Exception Members,,1058.73,,,,,,,440.69,1374.98,percent of total billed charges,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,inpatient,1,EA,291.05000,276.50000,The Alliance,Exception Members,,224.11,,,,,,,160.08,282.32,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,outpatient,1,EA,291.05000,276.50000,The Alliance,Exception Members,,224.11,,,,,,,145.53,282.32,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,,1130.36,,,,,,,807.40,1423.96,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Exception Members,,1130.36,,,,,,,734.00,1801.19,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,inpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,298.65,526.71,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Exception Members,,418.11,,,,,,,271.50,526.71,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1479.03,3681.15,percent of total billed charges,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2846.25,5019.75,percent of total billed charges,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2587.50,5019.75,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,202.01000,191.91000,The Alliance,Exception Members,,155.55,,,,,,,98.98,195.95,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,202.01000,191.91000,The Alliance,Exception Members,,155.55,,,,,,,92.72,202.01,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.78100,1.38,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Exception Members,,1.09,,,,,,,0.71000,1.38,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Exception Members,,0.50820,,,,,,,0.33000,0.64020,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,TC,1898.82,,,,,,,1356.30,2392.02,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Exception Members,TC,1898.82,,,,,,,1233.00,2392.02,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,1.83,3.22,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Exception Members,,2.56,,,,,,,0.78449,3.22,percent of total billed charges,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Exception Members,,2858.62,,,,,,,1704.04,3712.50,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20017.48000,19016.61000,The Alliance,Exception Members,,15413.46,,,,,,,9808.57,19416.96,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20017.48000,19016.61000,The Alliance,Exception Members,,15413.46,,,,,,,9188.02,20017.48,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,inpatient,1,EA,1437.45000,1365.58000,The Alliance,Exception Members,,1106.84,,,,,,,790.60,1394.33,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,outpatient,1,EA,1437.45000,1365.58000,The Alliance,Exception Members,,1106.84,,,,,,,96.37,1394.33,percent of total billed charges,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,inpatient,1,EA,1131.92000,1075.32000,The Alliance,Exception Members,,871.58,,,,,,,622.56,1097.96,percent of total billed charges,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,outpatient,1,EA,1131.92000,1075.32000,The Alliance,Exception Members,,871.58,,,,,,,4.01,1097.96,percent of total billed charges,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,inpatient,,,3050.00000,2897.50000,The Alliance,Exception Members,,2348.50,,,,,,,1677.50,2958.50,percent of total billed charges,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,outpatient,,,3050.00000,2897.50000,The Alliance,Exception Members,,2348.50,,,,,,,148.57,2958.50,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.27500,0.48500,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Exception Members,,0.38500,,,,,,,0.25000,13.53,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,195.94,345.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,178.12,345.56,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,inpatient,1,EA,2435.92000,2314.12000,The Alliance,Exception Members,,1875.66,,,,,,,1339.76,2362.84,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,outpatient,1,EA,2435.92000,2314.12000,The Alliance,Exception Members,,1875.66,,,,,,,44.59,2362.84,percent of total billed charges,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,223.30,393.82,percent of total billed charges,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Exception Members,,312.62,,,,,,,35.09,1833.46,percent of total billed charges,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,inpatient,,,414.00000,393.30000,The Alliance,Exception Members,90,318.78,,,,,,,227.70,401.58,percent of total billed charges,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,outpatient,,,414.00000,393.30000,The Alliance,Exception Members,90,318.78,,,,,,,36.26,1833.46,percent of total billed charges,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,75.35,132.89,percent of total billed charges,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Exception Members,,105.49,,,,,,,12.00,628.12,percent of total billed charges,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,91.88,181.88,percent of total billed charges,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Exception Members,,144.38,,,,,,,86.06,187.50,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,inpatient,1,GM,2.73000,2.59000,The Alliance,Exception Members,,2.10,,,,,,,1.50,2.65,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,outpatient,1,GM,2.73000,2.59000,The Alliance,Exception Members,,2.10,,,,,,,1.36,2.65,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.20350,0.35890,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Exception Members,,0.28490,,,,,,,0.18500,0.35890,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,inpatient,,,4398.75000,4178.81000,The Alliance,Exception Members,,3387.04,,,,,,,2419.31,4266.79,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,4398.75000,4178.81000,The Alliance,Exception Members,,3387.04,,,,,,,47.06,4266.79,percent of total billed charges,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,40.16000,38.15000,The Alliance,Exception Members,,30.92,,,,,,,19.68,38.96,percent of total billed charges,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,40.16000,38.15000,The Alliance,Exception Members,,30.92,,,,,,,20.08,143.36,percent of total billed charges,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1455.00,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,848.59000,806.16000,The Alliance,Exception Members,,653.41,,,,,,,415.81,823.13,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,848.59000,806.16000,The Alliance,Exception Members,,653.41,,,,,,,389.50,848.59,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,inpatient,1,EA,6927.88000,6581.48000,The Alliance,Exception Members,,5334.47,,,,,,,3810.33,6720.04,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,outpatient,1,EA,6927.88000,6581.48000,The Alliance,Exception Members,,5334.47,,,,,,,3463.94,6720.04,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,2990.51,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Exception Members,,2373.91,,,,,,,1695.65,5271.00,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,inpatient,,,315.50000,299.72000,The Alliance,Exception Members,90,242.94,,,,,,,173.53,306.04,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Exception Members,90,242.94,,,,,,,12.45,1539.22,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,inpatient,,,315.50000,299.72000,The Alliance,Exception Members,90,242.94,,,,,,,173.53,306.04,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Exception Members,90,242.94,,,,,,,25.31,2286.16,percent of total billed charges,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,inpatient,,,146.80000,139.46000,The Alliance,Exception Members,90,113.04,,,,,,,80.74,142.40,percent of total billed charges,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,outpatient,,,146.80000,139.46000,The Alliance,Exception Members,90,113.04,,,,,,,12.80,645.08,percent of total billed charges,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,158.56,279.65,percent of total billed charges,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Exception Members,90,221.99,,,,,,,36.26,1833.46,percent of total billed charges,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4952.48000,4704.86000,The Alliance,Exception Members,,3813.41,,,,,,,2723.86,4803.91,percent of total billed charges,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Exception Members,,3813.41,,,,,,,2476.24,4803.91,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,inpatient,5,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.68,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,outpatient,5,EA,3.05000,2.90000,The Alliance,Exception Members,,2.35,,,,,,,1.52,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,inpatient,5,EA,3.46000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.90,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,outpatient,5,EA,3.46000,3.28000,The Alliance,Exception Members,,2.66,,,,,,,1.73,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,inpatient,5,EA,6.10000,5.79000,The Alliance,Exception Members,,4.70,,,,,,,3.35,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,outpatient,5,EA,6.10000,5.79000,The Alliance,Exception Members,,4.70,,,,,,,3.05,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,inpatient,5,EA,6.13000,5.82000,The Alliance,Exception Members,,4.72,,,,,,,3.37,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,outpatient,5,EA,6.13000,5.82000,The Alliance,Exception Members,,4.72,,,,,,,3.06,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,inpatient,5,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.82,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,outpatient,5,EA,6.95000,6.60000,The Alliance,Exception Members,,5.35,,,,,,,3.48,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,inpatient,5,EA,6.11000,5.81000,The Alliance,Exception Members,,4.70,,,,,,,3.36,5.93,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,outpatient,5,EA,6.11000,5.81000,The Alliance,Exception Members,,4.70,,,,,,,3.06,5.93,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,inpatient,1,mL,13220.83000,12559.79000,The Alliance,Exception Members,,10180.04,,,,,,,7271.46,12824.21,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Exception Members,,10180.04,,,,,,,136.04,12824.21,percent of total billed charges,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,Exception Members,TC,430.43,,,,,,,307.45,542.23,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,Exception Members,TC,430.43,,,,,,,279.50,4345.33,percent of total billed charges,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,3509.55,6189.57,percent of total billed charges,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Exception Members,,4913.37,,,,,,,1556.56,6189.57,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,inpatient,1,mL,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.65,9.96,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,outpatient,1,mL,10.27000,9.76000,The Alliance,Exception Members,,7.91,,,,,,,5.13,9.96,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,28140.00000,26733.00000,The Alliance,Exception Members,,21667.80,,,,,,,13788.60,27295.80,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,28140.00000,26733.00000,The Alliance,Exception Members,,21667.80,,,,,,,12916.26,27295.80,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Exception Members,,1282.05,,,,,,,764.24,1615.05,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,inpatient,,,54600.00000,51870.00000,The Alliance,Exception Members,,42042.00,,,,,,,26754.00,52962.00,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,outpatient,,,54600.00000,51870.00000,The Alliance,Exception Members,,42042.00,,,,,,,25061.40,54600.00,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,3320.62,5856.38,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,3018.75,5856.38,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,24645.00000,23412.75000,The Alliance,Exception Members,,18976.65,,,,,,,12076.05,23905.65,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Exception Members,,18976.65,,,,,,,11312.06,24645.00,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,479.40000,455.43000,The Alliance,Exception Members,,369.14,,,,,,,234.91,465.02,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Exception Members,,369.14,,,,,,,220.04,479.40,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Exception Members,,725.29,,,,,,,432.35,941.93,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1455.00,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,522.50,921.50,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Exception Members,,731.50,,,,,,,114.10,6772.31,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,inpatient,1,mL,82.19000,78.08000,The Alliance,Exception Members,,63.29,,,,,,,45.20,79.72,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,outpatient,1,mL,82.19000,78.08000,The Alliance,Exception Members,,63.29,,,,,,,41.09,81.54,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,inpatient,1,EA,44799.32000,42559.35000,The Alliance,Exception Members,,34495.48,,,,,,,24639.63,43455.34,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,outpatient,1,EA,44799.32000,42559.35000,The Alliance,Exception Members,,34495.48,,,,,,,1737.10,43455.34,percent of total billed charges,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,777.68000,738.80000,The Alliance,Exception Members,,598.81,,,,,,,381.06,754.35,percent of total billed charges,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Exception Members,,598.81,,,,,,,356.96,777.68,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,inpatient,,,3115.00000,2959.25000,The Alliance,Exception Members,,2398.55,,,,,,,1713.25,3021.55,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,outpatient,,,3115.00000,2959.25000,The Alliance,Exception Members,,2398.55,,,,,,,314.95,3021.55,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,inpatient,,,501.00000,475.95000,The Alliance,Exception Members,,385.77,,,,,,,275.55,485.97,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,outpatient,,,501.00000,475.95000,The Alliance,Exception Members,,385.77,,,,,,,275.55,4686.00,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,inpatient,1,EA,874.01000,830.31000,The Alliance,Exception Members,,672.99,,,,,,,480.71,847.79,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,outpatient,1,EA,874.01000,830.31000,The Alliance,Exception Members,,672.99,,,,,,,437.00,847.79,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,inpatient,1,EA,1575.00000,1496.25000,The Alliance,Exception Members,,1212.75,,,,,,,866.25,1527.75,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,outpatient,1,EA,1575.00000,1496.25000,The Alliance,Exception Members,,1212.75,,,,,,,787.50,1527.75,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,inpatient,1,EA,513.56000,487.88000,The Alliance,Exception Members,,395.44,,,,,,,282.46,498.15,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,outpatient,1,EA,513.56000,487.88000,The Alliance,Exception Members,,395.44,,,,,,,256.78,498.15,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,inpatient,1,EA,663.39000,630.22000,The Alliance,Exception Members,,510.81,,,,,,,364.86,643.49,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,outpatient,1,EA,663.39000,630.22000,The Alliance,Exception Members,,510.81,,,,,,,331.69,643.49,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,inpatient,1,EA,1575.27000,1496.50000,The Alliance,Exception Members,,1212.96,,,,,,,866.40,1528.01,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,outpatient,1,EA,1575.27000,1496.50000,The Alliance,Exception Members,,1212.96,,,,,,,787.63,1528.01,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,inpatient,,,1135.60000,1078.82000,The Alliance,Exception Members,90,874.41,,,,,,,624.58,1101.53,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Exception Members,90,874.41,,,,,,,70.04,6756.70,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,inpatient,,,1135.60000,1078.82000,The Alliance,Exception Members,90,874.41,,,,,,,624.58,1101.53,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Exception Members,90,874.41,,,,,,,70.04,6756.70,percent of total billed charges,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,201.76,percent of total billed charges,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Exception Members,,160.16,,,,,,,114.40,3163.00,percent of total billed charges,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,inpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,74.48,147.44,percent of total billed charges,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Exception Members,,117.04,,,,,,,33.34,152.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Exception Members,,2229.15,,,,,,,1328.81,2895.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Exception Members,,1192.31,,,,,,,710.74,1502.00,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,inpatient,1,mL,647.15000,614.79000,The Alliance,Exception Members,,498.31,,,,,,,355.93,627.74,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,outpatient,1,mL,647.15000,614.79000,The Alliance,Exception Members,,498.31,,,,,,,0.30000,627.74,percent of total billed charges,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87.48000,83.11000,The Alliance,Exception Members,,67.36,,,,,,,42.87,84.86,percent of total billed charges,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87.48000,83.11000,The Alliance,Exception Members,,67.36,,,,,,,40.15,87.48,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,299.89000,284.90000,The Alliance,Exception Members,,230.92,,,,,,,146.95,290.89,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,299.89000,284.90000,The Alliance,Exception Members,,230.92,,,,,,,137.65,299.89,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1828.43000,1737.01000,The Alliance,Exception Members,,1407.89,,,,,,,895.93,1773.58,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1828.43000,1737.01000,The Alliance,Exception Members,,1407.89,,,,,,,839.25,1828.43,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4110.81000,3905.27000,The Alliance,Exception Members,,3165.32,,,,,,,2014.30,3987.49,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4110.81000,3905.27000,The Alliance,Exception Members,,3165.32,,,,,,,1886.86,4110.81,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,inpatient,,,350.00000,332.50000,The Alliance,Exception Members,90,269.50,,,,,,,192.50,339.50,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,Exception Members,90,269.50,,,,,,,175.00,339.50,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Exception Members,,134.47,,,,,,,80.16,174.64,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,386.10000,366.80000,The Alliance,Exception Members,,297.30,,,,,,,189.19,374.52,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,386.10000,366.80000,The Alliance,Exception Members,,297.30,,,,,,,177.22,386.10,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1518.75000,1442.81000,The Alliance,Exception Members,,1169.44,,,,,,,744.19,1473.19,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1518.75000,1442.81000,The Alliance,Exception Members,,1169.44,,,,,,,697.11,1518.75,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.14850,0.26190,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Exception Members,,0.20790,,,,,,,0.13500,0.26190,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,inpatient,,,3183.75000,3024.56000,The Alliance,Exception Members,,2451.49,,,,,,,1560.04,3088.24,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,3183.75000,3024.56000,The Alliance,Exception Members,,2451.49,,,,,,,1461.34,3183.75,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,47.62,469.24,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8280.00000,7866.00000,The Alliance,Exception Members,,6375.60,,,,,,,4057.20,8031.60,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Exception Members,,6375.60,,,,,,,3800.52,8280.00,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2340.75000,2223.71000,The Alliance,Exception Members,,1802.38,,,,,,,1146.97,2270.53,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2340.75000,2223.71000,The Alliance,Exception Members,,1802.38,,,,,,,1074.40,2340.75,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.86900,1.53,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Exception Members,,1.22,,,,,,,0.73040,1.53,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,inpatient,1,mL,83.36000,79.19000,The Alliance,Exception Members,,64.19,,,,,,,45.85,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,outpatient,1,mL,83.36000,79.19000,The Alliance,Exception Members,,64.19,,,,,,,1.49,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,inpatient,1,mL,19.90000,18.90000,The Alliance,Exception Members,,15.32,,,,,,,10.95,19.30,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,outpatient,1,mL,19.90000,18.90000,The Alliance,Exception Members,,15.32,,,,,,,1.49,19.30,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2418.75000,2297.81000,The Alliance,Exception Members,,1862.44,,,,,,,1185.19,2346.19,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2418.75000,2297.81000,The Alliance,Exception Members,,1862.44,,,,,,,1110.21,2418.75,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,15.96,81.35,percent of total billed charges,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,inpatient,1,GM,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.74800,1.32,percent of total billed charges,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,outpatient,1,GM,1.36000,1.29000,The Alliance,Exception Members,,1.05,,,,,,,0.68000,1.32,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Exception Members,,27489.00,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,45150.00000,42892.50000,The Alliance,Exception Members,,34765.50,,,,,,,22123.50,43795.50,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,45150.00000,42892.50000,The Alliance,Exception Members,,34765.50,,,,,,,20723.85,45150.00,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,294.00,582.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,,462.00,,,,,,,275.40,600.00,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,16709.00000,15873.55000,The Alliance,Exception Members,,12865.93,,,,,,,8187.41,16207.73,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,16709.00000,15873.55000,The Alliance,Exception Members,,12865.93,,,,,,,7669.43,16709.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7109.10000,6753.65000,The Alliance,Exception Members,,5474.01,,,,,,,3483.46,6895.83,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Exception Members,,5474.01,,,,,,,3263.08,7109.10,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2632.50000,2500.88000,The Alliance,Exception Members,,2027.03,,,,,,,1289.92,2553.53,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2632.50000,2500.88000,The Alliance,Exception Members,,2027.03,,,,,,,1208.32,2632.50,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,739.20,1303.68,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Exception Members,,1034.88,,,,,,,739.20,4686.00,percent of total billed charges,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4310.77,8533.58,percent of total billed charges,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Exception Members,,6774.07,,,,,,,4038.05,8797.50,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,479.59,949.39,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Exception Members,,753.64,,,,,,,449.25,978.75,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,711.11,1407.71,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Exception Members,,1117.46,,,,,,,666.12,1451.25,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,19.25,33.95,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,,26.95,,,,,,,17.50,33.95,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,inpatient,1,EA,635.07000,603.31000,The Alliance,Exception Members,,489.00,,,,,,,349.29,616.02,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Exception Members,,489.00,,,,,,,4.24,616.02,percent of total billed charges,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.17000,0.32980,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,inpatient,1,mL,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.61,4.60,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Exception Members,,3.65,,,,,,,2.37,5.99,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,inpatient,1,mL,31.63000,30.05000,The Alliance,Exception Members,,24.36,,,,,,,17.40,30.68,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,outpatient,1,mL,31.63000,30.05000,The Alliance,Exception Members,,24.36,,,,,,,15.81,81.35,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,15.96,81.35,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Exception Members,,24.58,,,,,,,15.96,81.35,percent of total billed charges,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,inpatient,,,29629.15000,28147.69000,The Alliance,Exception Members,,22814.45,,,,,,,14518.28,28740.28,percent of total billed charges,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,outpatient,,,29629.15000,28147.69000,The Alliance,Exception Members,,22814.45,,,,,,,10900.23,28740.28,percent of total billed charges,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,inpatient,1,mL,71250.00000,67687.50000,The Alliance,Exception Members,,54862.50,,,,,,,39187.50,69112.50,percent of total billed charges,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,outpatient,1,mL,71250.00000,67687.50000,The Alliance,Exception Members,,54862.50,,,,,,,319.74,69112.50,percent of total billed charges,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,inpatient,1,mL,1095.57000,1040.79000,The Alliance,Exception Members,,843.59,,,,,,,602.56,1062.70,percent of total billed charges,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,outpatient,1,mL,1095.57000,1040.79000,The Alliance,Exception Members,,843.59,,,,,,,17.84,1062.70,percent of total billed charges,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,588.00,1164.00,percent of total billed charges,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Exception Members,,924.00,,,,,,,550.80,1200.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4952.48000,4704.86000,The Alliance,Exception Members,,3813.41,,,,,,,2426.72,4803.91,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Exception Members,,3813.41,,,,,,,2273.19,4952.48,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Exception Members,,306.07,,,,,,,182.45,397.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,1443.75000,1371.56000,The Alliance,Exception Members,,1111.69,,,,,,,707.44,1400.44,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Exception Members,,1111.69,,,,,,,662.68,1443.75,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,inpatient,,,1031.25000,979.69000,The Alliance,Exception Members,,794.06,,,,,,,505.31,1000.31,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Exception Members,,794.06,,,,,,,515.62,1031.25,percent of total billed charges,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,897.53000,852.65000,The Alliance,Exception Members,,691.10,,,,,,,439.79,870.60,percent of total billed charges,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,897.53000,852.65000,The Alliance,Exception Members,,691.10,,,,,,,411.97,897.53,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4798.95000,4559.00000,The Alliance,Exception Members,,3695.19,,,,,,,2351.49,4654.98,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4798.95000,4559.00000,The Alliance,Exception Members,,3695.19,,,,,,,2202.72,4798.95,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1455.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1470.00,2910.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Exception Members,,2310.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03850,0.06790,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Exception Members,,0.05390,,,,,,,0.03500,0.06790,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,inpatient,,,2371.00000,2252.45000,The Alliance,Exception Members,,1825.67,,,,,,,1304.05,2299.87,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Exception Members,,1825.67,,,,,,,1304.05,5271.00,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3796.02,7514.57,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Exception Members,,5965.17,,,,,,,3555.86,7746.98,percent of total billed charges,
RMVL/BIVLV HIP SPICA/MINERVA/RISSER 29710-TECH,85858,CDM,510,RC,29710,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,191.40,337.56,percent of total billed charges,
RMVL/BIVLV HIP SPICA/MINERVA/RISSER 29710-TECH,85858,CDM,510,RC,29710,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Exception Members,,267.96,,,,,,,174.00,337.56,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2873.85,5689.05,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Exception Members,,4516.05,,,,,,,2692.03,5865.00,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,16.32000,15.50000,The Alliance,Exception Members,,12.57,,,,,,,8.00,15.83,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.32000,15.50000,The Alliance,Exception Members,,12.57,,,,,,,8.16,36.65,percent of total billed charges,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1318.46000,1252.54000,The Alliance,Exception Members,,1015.21,,,,,,,646.05,1278.91,percent of total billed charges,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1318.46000,1252.54000,The Alliance,Exception Members,,1015.21,,,,,,,605.17,1318.46,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Exception Members,,366.71,,,,,,,218.60,476.25,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,643.12,1273.12,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Exception Members,,1010.62,,,,,,,602.44,1312.50,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.57200,1.01,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Exception Members,,0.80080,,,,,,,0.52000,1.01,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,inpatient,1,mL,208.56000,198.13000,The Alliance,Exception Members,,160.59,,,,,,,114.71,202.30,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,outpatient,1,mL,208.56000,198.13000,The Alliance,Exception Members,,160.59,,,,,,,104.28,202.30,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8624.83000,8193.59000,The Alliance,Exception Members,,6641.12,,,,,,,4226.17,8366.09,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Exception Members,,6641.12,,,,,,,3958.80,8624.83,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8624.83000,8193.59000,The Alliance,Exception Members,,6641.12,,,,,,,4226.17,8366.09,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Exception Members,,6641.12,,,,,,,3958.80,8624.83,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8745.75000,8308.46000,The Alliance,Exception Members,,6734.23,,,,,,,4285.42,8483.38,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Exception Members,,6734.23,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2916.11,5772.71,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Exception Members,,4582.46,,,,,,,2731.62,5951.25,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,8.10,14.28,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Exception Members,,11.33,,,,,,,7.36,14.28,percent of total billed charges,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,33390.00000,31720.50000,The Alliance,Exception Members,,25710.30,,,,,,,16361.10,32388.30,percent of total billed charges,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,33390.00000,31720.50000,The Alliance,Exception Members,,25710.30,,,,,,,15326.01,32388.30,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1825.74,3614.22,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Exception Members,,2869.02,,,,,,,1710.23,3726.00,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,31395.00000,29825.25000,The Alliance,Exception Members,,24174.15,,,,,,,15383.55,30453.15,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,31395.00000,29825.25000,The Alliance,Exception Members,,24174.15,,,,,,,14410.31,31395.00,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32970.00000,31321.50000,The Alliance,Exception Members,,25386.90,,,,,,,16155.30,31980.90,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Exception Members,,25386.90,,,,,,,15133.23,32970.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,inpatient,,,39.04000,37.09000,The Alliance,Exception Members,,30.06,,,,,,,21.47,37.87,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,39.04000,37.09000,The Alliance,Exception Members,,30.06,,,,,,,19.52,37.87,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,229.69,454.69,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Exception Members,,360.94,,,,,,,215.16,468.75,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,inpatient,1,mL,438.62000,416.69000,The Alliance,Exception Members,,337.74,,,,,,,241.24,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Exception Members,,337.74,,,,,,,43.62,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,inpatient,1,mL,438.62000,416.69000,The Alliance,Exception Members,,337.74,,,,,,,241.24,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Exception Members,,337.74,,,,,,,43.62,425.46,percent of total billed charges,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,inpatient,1,mL,823.62000,782.44000,The Alliance,Exception Members,,634.19,,,,,,,452.99,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Exception Members,,634.19,,,,,,,0.41000,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,inpatient,1,mL,823.62000,782.44000,The Alliance,Exception Members,,634.19,,,,,,,452.99,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Exception Members,,634.19,,,,,,,0.41000,798.91,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,inpatient,1,EA,6037.62000,5735.73000,The Alliance,Exception Members,,4648.97,,,,,,,3320.69,5856.49,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,outpatient,1,EA,6037.62000,5735.73000,The Alliance,Exception Members,,4648.97,,,,,,,44.59,5856.49,percent of total billed charges,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,inpatient,1,mL,5333.84000,5067.15000,The Alliance,Exception Members,,4107.06,,,,,,,2933.61,5173.82,percent of total billed charges,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,outpatient,1,mL,5333.84000,5067.15000,The Alliance,Exception Members,,4107.06,,,,,,,15.08,5173.82,percent of total billed charges,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1893.75000,1799.06000,The Alliance,Exception Members,,1458.19,,,,,,,927.94,1836.94,percent of total billed charges,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1893.75000,1799.06000,The Alliance,Exception Members,,1458.19,,,,,,,869.23,1893.75,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,459.38,909.38,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Exception Members,,721.88,,,,,,,430.31,937.50,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,551.25,1091.25,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Exception Members,,866.25,,,,,,,516.38,1125.00,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,7997.10000,7597.24000,The Alliance,Exception Members,,6157.77,,,,,,,3918.58,7757.19,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Exception Members,,6157.77,,,,,,,3670.67,7997.10,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2442.77,4835.69,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Exception Members,,3838.64,,,,,,,2288.23,4985.25,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,51282.00000,48717.90000,The Alliance,Exception Members,,39487.14,,,,,,,25128.18,49743.54,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,51282.00000,48717.90000,The Alliance,Exception Members,,39487.14,,,,,,,23538.44,51282.00,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,775.39000,736.62000,The Alliance,Exception Members,,597.05,,,,,,,379.94,752.13,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,775.39000,736.62000,The Alliance,Exception Members,,597.05,,,,,,,355.90,775.39,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,1581.25000,1502.19000,The Alliance,Exception Members,,1217.56,,,,,,,869.69,1533.81,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1581.25000,1502.19000,The Alliance,Exception Members,,1217.56,,,,,,,790.62,1533.81,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,984.38000,935.16000,The Alliance,Exception Members,,757.97,,,,,,,541.41,954.85,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,984.38000,935.16000,The Alliance,Exception Members,,757.97,,,,,,,492.19,954.85,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,1433.75000,1362.06000,The Alliance,Exception Members,,1103.99,,,,,,,788.56,1390.74,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1433.75000,1362.06000,The Alliance,Exception Members,,1103.99,,,,,,,716.88,1390.74,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,inpatient,1,mL,139.42000,132.45000,The Alliance,Exception Members,,107.35,,,,,,,76.68,135.24,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,outpatient,1,mL,139.42000,132.45000,The Alliance,Exception Members,,107.35,,,,,,,7.57,135.24,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,inpatient,1,mL,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.63800,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Exception Members,,0.89320,,,,,,,0.58000,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.59950,1.06,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Exception Members,,0.83930,,,,,,,0.54500,1.06,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,Exception Members,TC,201.74,,,,,,,144.10,254.14,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Exception Members,TC,201.74,,,,,,,131.00,1331.91,percent of total billed charges,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,inpatient,1,EA,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,11.52,20.32,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,10.47,20.32,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,17633.23000,16751.57000,The Alliance,Exception Members,,13577.59,,,,,,,8640.28,17104.23,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17633.23000,16751.57000,The Alliance,Exception Members,,13577.59,,,,,,,8093.65,17633.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,3025.99,5990.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Exception Members,,4755.14,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,393.23,778.42,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,368.35,802.50,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,393.23,778.42,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Exception Members,,617.92,,,,,,,368.35,802.50,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.34650,0.61110,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Exception Members,,0.48510,,,,,,,0.31500,0.61110,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,inpatient,,,21312.50000,20246.88000,The Alliance,Exception Members,,16410.62,,,,,,,10443.12,20673.12,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Exception Members,,16410.62,,,,,,,9782.44,21312.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,inpatient,1,mL,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.89650,1.58,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,outpatient,1,mL,1.63000,1.55000,The Alliance,Exception Members,,1.26,,,,,,,0.81500,1.58,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,24180.00000,22971.00000,The Alliance,Exception Members,,18618.60,,,,,,,11848.20,23454.60,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24180.00000,22971.00000,The Alliance,Exception Members,,18618.60,,,,,,,11098.62,24180.00,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,inpatient,,,1123.13000,1066.97000,The Alliance,Exception Members,,864.81,,,,,,,550.33,1089.44,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,1123.13000,1066.97000,The Alliance,Exception Members,,864.81,,,,,,,515.52,1123.13,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,277.12,603.75,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.12650,0.22310,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Exception Members,,0.17710,,,,,,,0.11500,0.22310,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,inpatient,1,mL,10018.32000,9517.40000,The Alliance,Exception Members,,7714.11,,,,,,,5510.08,9717.77,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,outpatient,1,mL,10018.32000,9517.40000,The Alliance,Exception Members,,7714.11,,,,,,,189.75,9717.77,percent of total billed charges,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,16.50,29.10,percent of total billed charges,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Exception Members,,23.10,,,,,,,15.00,29.10,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,inpatient,,,94.90000,90.16000,The Alliance,Exception Members,,73.07,,,,,,,52.20,92.05,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,outpatient,,,94.90000,90.16000,The Alliance,Exception Members,,73.07,,,,,,,47.45,92.05,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.11000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Exception Members,,0.15400,,,,,,,0.10000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.12100,0.21340,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Exception Members,,0.16940,,,,,,,0.11000,0.21340,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.73,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Exception Members,,2.42,,,,,,,1.57,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.72,3.03,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Exception Members,,2.40,,,,,,,1.56,3.03,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,inpatient,1,mL,12.80000,12.16000,The Alliance,Exception Members,,9.86,,,,,,,7.04,12.42,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,outpatient,1,mL,12.80000,12.16000,The Alliance,Exception Members,,9.86,,,,,,,6.40,48.87,percent of total billed charges,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,293.70,517.98,percent of total billed charges,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Exception Members,TC,411.18,,,,,,,267.00,3586.71,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,7400.25000,7030.24000,The Alliance,Exception Members,,5698.19,,,,,,,3626.12,7178.24,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Exception Members,,5698.19,,,,,,,3396.71,7400.25,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,8452.50000,8029.88000,The Alliance,Exception Members,,6508.43,,,,,,,4141.73,8198.92,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,8452.50000,8029.88000,The Alliance,Exception Members,,6508.43,,,,,,,3879.70,8452.50,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,inpatient,1,mL,27.97000,26.57000,The Alliance,Exception Members,,21.54,,,,,,,15.38,27.13,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,outpatient,1,mL,27.97000,26.57000,The Alliance,Exception Members,,21.54,,,,,,,13.98,27.13,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Exception Members,,3426.89,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Exception Members,,274.31,,,,,,,163.52,356.25,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1500.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1500.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,735.00,1455.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Exception Members,,1155.00,,,,,,,688.50,1500.00,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,13658.95,27039.14,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Exception Members,,21464.06,,,,,,,12794.81,27875.40,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Exception Members,,48510.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,523.69,1036.69,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Exception Members,,822.94,,,,,,,490.56,1068.75,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,748.13000,710.72000,The Alliance,Exception Members,,576.06,,,,,,,366.58,725.69,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,748.13000,710.72000,The Alliance,Exception Members,,576.06,,,,,,,343.39,748.13,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3510.00000,3334.50000,The Alliance,Exception Members,,2702.70,,,,,,,1719.90,3404.70,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3510.00000,3334.50000,The Alliance,Exception Members,,2702.70,,,,,,,1611.09,3510.00,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,inpatient,,,737.50000,700.62000,The Alliance,Exception Members,TC,567.88,,,,,,,405.62,715.38,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,outpatient,,,737.50000,700.62000,The Alliance,Exception Members,TC,567.88,,,,,,,368.75,7351.18,percent of total billed charges,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1535.00000,1458.25000,The Alliance,Exception Members,,1181.95,,,,,,,844.25,1488.95,percent of total billed charges,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,Exception Members,,1181.95,,,,,,,128.29,6705.74,percent of total billed charges,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,inpatient,1,EA,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,11.52,20.32,percent of total billed charges,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Exception Members,,16.13,,,,,,,10.47,20.32,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,inpatient,,,108.90000,103.46000,The Alliance,Exception Members,90,83.85,,,,,,,59.90,105.63,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,outpatient,,,108.90000,103.46000,The Alliance,Exception Members,90,83.85,,,,,,,14.25,645.08,percent of total billed charges,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1383.75,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Exception Members,,464.89,,,,,,,277.12,603.75,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,inpatient,,,22.49000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,12.37,21.82,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,outpatient,,,22.49000,21.37000,The Alliance,Exception Members,,17.32,,,,,,,11.24,37.10,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,inpatient,1,mL,44.98000,42.73000,The Alliance,Exception Members,,34.63,,,,,,,24.74,43.63,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,outpatient,1,mL,44.98000,42.73000,The Alliance,Exception Members,,34.63,,,,,,,22.49,43.63,percent of total billed charges,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,12477.50000,11853.62000,The Alliance,Exception Members,,9607.67,,,,,,,6113.98,12103.17,percent of total billed charges,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,12477.50000,11853.62000,The Alliance,Exception Members,,9607.67,,,,,,,5727.17,12477.50,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1383.75,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,41160.00000,39102.00000,The Alliance,Exception Members,,31693.20,,,,,,,20168.40,39925.20,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,41160.00000,39102.00000,The Alliance,Exception Members,,31693.20,,,,,,,18892.44,39925.20,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,inpatient,,,114.90000,109.16000,The Alliance,Exception Members,90,88.47,,,,,,,63.20,111.45,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,outpatient,,,114.90000,109.16000,The Alliance,Exception Members,90,88.47,,,,,,,15.03,763.98,percent of total billed charges,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,inpatient,,,855.60000,812.82000,The Alliance,Exception Members,90,658.81,,,,,,,470.58,829.93,percent of total billed charges,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,outpatient,,,855.60000,812.82000,The Alliance,Exception Members,90,658.81,,,,,,,35.09,1662.04,percent of total billed charges,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,inpatient,1,mL,50.24000,47.73000,The Alliance,Exception Members,,38.68,,,,,,,27.63,48.73,percent of total billed charges,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,outpatient,1,mL,50.24000,47.73000,The Alliance,Exception Members,,38.68,,,,,,,0.41000,48.73,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,3.16,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Exception Members,,4.43,,,,,,,2.88,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,inpatient,1,EA,8.58000,8.15000,The Alliance,Exception Members,,6.61,,,,,,,4.72,8.32,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,outpatient,1,EA,8.58000,8.15000,The Alliance,Exception Members,,6.61,,,,,,,4.29,8.32,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,inpatient,1,EA,17.17000,16.31000,The Alliance,Exception Members,,13.22,,,,,,,9.44,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Exception Members,,13.22,,,,,,,8.59,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,inpatient,1,EA,25.75000,24.47000,The Alliance,Exception Members,,19.83,,,,,,,14.16,24.98,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,outpatient,1,EA,25.75000,24.47000,The Alliance,Exception Members,,19.83,,,,,,,12.88,24.98,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5654.55000,5371.82000,The Alliance,Exception Members,,4354.00,,,,,,,2770.73,5484.91,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5654.55000,5371.82000,The Alliance,Exception Members,,4354.00,,,,,,,2595.44,5654.55,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4183.13000,3973.97000,The Alliance,Exception Members,,3221.01,,,,,,,2049.73,4057.64,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4183.13000,3973.97000,The Alliance,Exception Members,,3221.01,,,,,,,1920.06,4183.13,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2475.00000,2351.25000,The Alliance,Exception Members,,1905.75,,,,,,,1212.75,2400.75,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2475.00000,2351.25000,The Alliance,Exception Members,,1905.75,,,,,,,1136.03,2475.00,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Exception Members,,7140.67,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,19957.80000,18959.91000,The Alliance,Exception Members,,15367.51,,,,,,,9779.32,19359.07,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,19957.80000,18959.91000,The Alliance,Exception Members,,15367.51,,,,,,,9160.63,19957.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1383.75,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,inpatient,,,83.49000,79.32000,The Alliance,Exception Members,,64.29,,,,,,,45.92,80.99,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Exception Members,,64.29,,,,,,,41.74,138.59,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,inpatient,1,mL,166.98000,158.63000,The Alliance,Exception Members,,128.57,,,,,,,91.84,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Exception Members,,128.57,,,,,,,83.49,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,inpatient,,,83.49000,79.32000,The Alliance,Exception Members,,64.29,,,,,,,45.92,80.99,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Exception Members,,64.29,,,,,,,41.74,138.59,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,inpatient,1,mL,166.98000,158.63000,The Alliance,Exception Members,,128.57,,,,,,,91.84,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Exception Members,,128.57,,,,,,,83.49,161.97,percent of total billed charges,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,inpatient,1,mL,4383.75000,4164.57000,The Alliance,Exception Members,,3375.49,,,,,,,2411.06,4252.24,percent of total billed charges,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,outpatient,1,mL,4383.75000,4164.57000,The Alliance,Exception Members,,3375.49,,,,,,,1080.88,4252.24,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Exception Members,,9906.05,,,,,,,5905.03,12865.00,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,Exception Members,90,75.46,,,,,,,53.90,95.06,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Exception Members,90,75.46,,,,,,,12.82,645.08,percent of total billed charges,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,Exception Members,90,69.30,,,,,,,49.50,87.30,percent of total billed charges,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Exception Members,90,69.30,,,,,,,11.77,594.19,percent of total billed charges,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,Exception Members,TC,323.40,,,,,,,231.00,407.40,percent of total billed charges,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Exception Members,TC,323.40,,,,,,,210.00,2162.63,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,inpatient,,,36.49000,34.67000,The Alliance,Exception Members,,28.10,,,,,,,20.07,35.40,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,outpatient,,,36.49000,34.67000,The Alliance,Exception Members,,28.10,,,,,,,18.25,61.17,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,inpatient,1,mL,72.98000,69.33000,The Alliance,Exception Members,,56.19,,,,,,,40.14,70.79,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,outpatient,1,mL,72.98000,69.33000,The Alliance,Exception Members,,56.19,,,,,,,36.49,70.79,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3803.62,7529.62,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3562.99,7762.50,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3803.62,7529.62,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Exception Members,,5977.12,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,24645.00000,23412.75000,The Alliance,Exception Members,,18976.65,,,,,,,12076.05,23905.65,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Exception Members,,18976.65,,,,,,,11312.06,24645.00,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,36372.00000,34553.40000,The Alliance,Exception Members,,28006.44,,,,,,,17822.28,35280.84,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,36372.00000,34553.40000,The Alliance,Exception Members,,28006.44,,,,,,,16694.75,36372.00,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1256.25000,1193.44000,The Alliance,Exception Members,,967.31,,,,,,,615.56,1218.56,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1256.25000,1193.44000,The Alliance,Exception Members,,967.31,,,,,,,576.62,1256.25,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Exception Members,,707.44,,,,,,,421.71,918.75,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,532.88,1054.88,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,44688.00000,42453.60000,The Alliance,Exception Members,,34409.76,,,,,,,21897.12,43347.36,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,44688.00000,42453.60000,The Alliance,Exception Members,,34409.76,,,,,,,20511.79,44688.00,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4243.50000,4031.32000,The Alliance,Exception Members,,3267.49,,,,,,,2079.32,4116.19,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Exception Members,,3267.49,,,,,,,1947.77,4243.50,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,3536.25000,3359.44000,The Alliance,Exception Members,,2722.91,,,,,,,1732.76,3430.16,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Exception Members,,2722.91,,,,,,,1623.14,3536.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Exception Members,,8235.15,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1383.75,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Exception Members,,119.57,,,,,,,77.64,150.62,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,915.56000,869.78000,The Alliance,Exception Members,,704.98,,,,,,,448.62,888.09,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,915.56000,869.78000,The Alliance,Exception Members,,704.98,,,,,,,420.24,915.56,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,inpatient,,,932.00000,885.40000,The Alliance,Exception Members,TC,717.64,,,,,,,512.60,904.04,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,Exception Members,TC,717.64,,,,,,,466.00,904.04,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,inpatient,1,mL,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,4.11,7.25,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Exception Members,,5.75,,,,,,,3.73,7.25,percent of total billed charges,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,331.50000,314.92000,The Alliance,Exception Members,,255.25,,,,,,,162.44,321.56,percent of total billed charges,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,331.50000,314.92000,The Alliance,Exception Members,,255.25,,,,,,,152.16,331.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,inpatient,,,66150.00000,62842.50000,The Alliance,Exception Members,,50935.50,,,,,,,32413.50,64165.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,outpatient,,,66150.00000,62842.50000,The Alliance,Exception Members,,50935.50,,,,,,,30362.85,64165.50,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1856.25000,1763.44000,The Alliance,Exception Members,,1429.31,,,,,,,909.56,1800.56,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1856.25000,1763.44000,The Alliance,Exception Members,,1429.31,,,,,,,852.02,1856.25,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,415.12,5858.00,percent of total billed charges,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,90,1039.50,,,,,,,742.50,1309.50,percent of total billed charges,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,90,1039.50,,,,,,,675.00,1309.50,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,50.10,88.37,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,11.91,594.19,percent of total billed charges,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,5271.00,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,220.50,3163.00,percent of total billed charges,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,2518.12,percent of total billed charges,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Exception Members,,1998.92,,,,,,,1427.80,5271.00,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,4692.00000,4457.40000,The Alliance,Exception Members,,3612.84,,,,,,,2299.08,4551.24,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Exception Members,,3612.84,,,,,,,2153.63,4692.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Exception Members,,2922.15,,,,,,,1741.90,3795.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Exception Members,,659.80,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Exception Members,,317.62,,,,,,,189.34,412.50,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2484.38000,2360.16000,The Alliance,Exception Members,,1912.97,,,,,,,1217.35,2409.85,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2484.38000,2360.16000,The Alliance,Exception Members,,1912.97,,,,,,,1140.33,2484.38,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2925.00000,2778.75000,The Alliance,Exception Members,,2252.25,,,,,,,1433.25,2837.25,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2925.00000,2778.75000,The Alliance,Exception Members,,2252.25,,,,,,,1342.58,2925.00,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,inpatient,,,1477.00000,1403.15000,The Alliance,Exception Members,TC,1137.29,,,,,,,812.35,1432.69,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,outpatient,,,1477.00000,1403.15000,The Alliance,Exception Members,TC,1137.29,,,,,,,738.50,1432.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,Exception Members,TC,213.29,,,,,,,152.35,268.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Exception Members,TC,213.29,,,,,,,138.50,268.69,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,134.75,237.65,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Exception Members,TC,188.65,,,,,,,122.50,237.65,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,inpatient,,,201.10000,191.04000,The Alliance,Exception Members,90,154.85,,,,,,,110.61,195.07,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,outpatient,,,201.10000,191.04000,The Alliance,Exception Members,90,154.85,,,,,,,16.91,1211.55,percent of total billed charges,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,inpatient,,,167.70000,159.31000,The Alliance,Exception Members,90,129.13,,,,,,,92.23,162.67,percent of total billed charges,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,outpatient,,,167.70000,159.31000,The Alliance,Exception Members,90,129.13,,,,,,,21.94,1103.49,percent of total billed charges,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,inpatient,,,277.20000,263.34000,The Alliance,Exception Members,,213.44,,,,,,,152.46,268.88,percent of total billed charges,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Exception Members,,213.44,,,,,,,35.09,1833.46,percent of total billed charges,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,90,1039.50,,,,,,,742.50,1309.50,percent of total billed charges,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Exception Members,90,1039.50,,,,,,,675.00,4687.50,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,10524.50000,9998.27000,The Alliance,Exception Members,,8103.86,,,,,,,5157.01,10208.76,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Exception Members,,8103.86,,,,,,,4830.75,10524.50,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,inpatient,,,533.61000,506.93000,The Alliance,Exception Members,,410.88,,,,,,,293.49,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,outpatient,,,533.61000,506.93000,The Alliance,Exception Members,,410.88,,,,,,,266.81,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,inpatient,1,EA,533.61000,506.93000,The Alliance,Exception Members,,410.88,,,,,,,293.49,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,outpatient,1,EA,533.61000,506.93000,The Alliance,Exception Members,,410.88,,,,,,,266.81,517.60,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,349.86,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3550.05,7027.65,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Exception Members,,5578.65,,,,,,,3325.45,7245.00,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,6399.89000,6079.90000,The Alliance,Exception Members,,4927.92,,,,,,,3135.95,6207.89,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,6399.89000,6079.90000,The Alliance,Exception Members,,4927.92,,,,,,,2937.55,6399.89,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,468.56,927.56,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Exception Members,,736.31,,,,,,,438.92,956.25,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,3.24,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,inpatient,1,EA,42.84000,40.70000,The Alliance,Exception Members,,32.99,,,,,,,23.56,41.55,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,outpatient,1,EA,42.84000,40.70000,The Alliance,Exception Members,,32.99,,,,,,,0.05000,41.55,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,inpatient,1,EA,19.09000,18.13000,The Alliance,Exception Members,,14.70,,,,,,,10.50,18.52,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,outpatient,1,EA,19.09000,18.13000,The Alliance,Exception Members,,14.70,,,,,,,0.05000,18.52,percent of total billed charges,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,inpatient,,,3245.00000,3082.75000,The Alliance,Exception Members,,2498.65,,,,,,,1784.75,3147.65,percent of total billed charges,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Exception Members,,2498.65,,,,,,,1784.75,5271.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Exception Members,,11218.90,,,,,,,6687.63,14570.00,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,inpatient,1,mL,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.16,2.04,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,outpatient,1,mL,2.10000,1.99000,The Alliance,Exception Members,,1.62,,,,,,,1.05,2.04,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,8.69,15.33,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Exception Members,,12.17,,,,,,,7.90,15.33,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2535.75,5019.75,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Exception Members,,3984.75,,,,,,,2375.32,5175.00,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,65.66,129.98,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Exception Members,,103.18,,,,,,,61.51,134.00,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,Exception Members,GP,621.39,,,,,,,443.85,782.79,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Exception Members,GP,621.39,,,,,,,126.65,782.79,percent of total billed charges,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,inpatient,,,710.00000,674.50000,The Alliance,Exception Members,GO,546.70,,,,,,,390.50,688.70,percent of total billed charges,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Exception Members,GO,546.70,,,,,,,126.65,688.70,percent of total billed charges,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,inpatient,,,710.00000,674.50000,The Alliance,Exception Members,GP,546.70,,,,,,,390.50,688.70,percent of total billed charges,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Exception Members,GP,546.70,,,,,,,126.65,688.70,percent of total billed charges,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,Exception Members,G0,621.39,,,,,,,443.85,782.79,percent of total billed charges,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Exception Members,G0,621.39,,,,,,,126.65,782.79,percent of total billed charges,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,866.25000,822.94000,The Alliance,Exception Members,,667.01,,,,,,,424.46,840.26,percent of total billed charges,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,866.25000,822.94000,The Alliance,Exception Members,,667.01,,,,,,,397.61,866.25,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3195.98000,3036.18000,The Alliance,Exception Members,,2460.90,,,,,,,1566.03,3100.10,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3195.98000,3036.18000,The Alliance,Exception Members,,2460.90,,,,,,,1466.95,3195.98,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,479.40000,455.43000,The Alliance,Exception Members,,369.14,,,,,,,234.91,465.02,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Exception Members,,369.14,,,,,,,220.04,479.40,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08800,0.15520,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Exception Members,,0.12320,,,,,,,0.08000,0.15520,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,inpatient,,,1576.91000,1498.06000,The Alliance,Exception Members,,1214.22,,,,,,,867.30,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Exception Members,,1214.22,,,,,,,671.22,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,inpatient,,,1576.91000,1498.06000,The Alliance,Exception Members,JW,1214.22,,,,,,,867.30,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Exception Members,JW,1214.22,,,,,,,788.46,1529.60,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,inpatient,1,EA,364.23000,346.02000,The Alliance,Exception Members,,280.46,,,,,,,200.33,353.30,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,outpatient,1,EA,364.23000,346.02000,The Alliance,Exception Members,,280.46,,,,,,,182.12,353.30,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,inpatient,1,mL,1585.11000,1505.85000,The Alliance,Exception Members,,1220.53,,,,,,,871.81,1537.56,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,outpatient,1,mL,1585.11000,1505.85000,The Alliance,Exception Members,,1220.53,,,,,,,652.75,1537.56,percent of total billed charges,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,inpatient,1,mL,13617.45000,12936.58000,The Alliance,Exception Members,,10485.44,,,,,,,7489.60,13208.93,percent of total billed charges,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,outpatient,1,mL,13617.45000,12936.58000,The Alliance,Exception Members,,10485.44,,,,,,,229.11,13208.93,percent of total billed charges,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,2850.39,6023.70,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1144.20000,1086.99000,The Alliance,Exception Members,90,881.03,,,,,,,629.31,1109.87,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Exception Members,90,881.03,,,,,,,149.66,7571.58,percent of total billed charges,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,50.10,88.37,percent of total billed charges,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,11.91,594.19,percent of total billed charges,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,inpatient,,,1695.50000,1610.72000,The Alliance,Exception Members,90,1305.54,,,,,,,932.52,1644.63,percent of total billed charges,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1695.50000,1610.72000,The Alliance,Exception Members,90,1305.54,,,,,,,175.54,10101.09,percent of total billed charges,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1144.20000,1086.99000,The Alliance,Exception Members,90,881.03,,,,,,,629.31,1109.87,percent of total billed charges,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Exception Members,90,881.03,,,,,,,149.66,7571.58,percent of total billed charges,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1295.30000,1230.53000,The Alliance,Exception Members,90,997.38,,,,,,,712.41,1256.44,percent of total billed charges,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Exception Members,90,997.38,,,,,,,169.42,8573.20,percent of total billed charges,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1295.30000,1230.53000,The Alliance,Exception Members,90,997.38,,,,,,,712.41,1256.44,percent of total billed charges,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Exception Members,90,997.38,,,,,,,169.42,8573.20,percent of total billed charges,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,inpatient,1,EA,7168.24000,6809.83000,The Alliance,Exception Members,,5519.54,,,,,,,3942.53,6953.19,percent of total billed charges,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,outpatient,1,EA,7168.24000,6809.83000,The Alliance,Exception Members,,5519.54,,,,,,,31.33,6953.19,percent of total billed charges,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,inpatient,1,mL,1585.12000,1505.86000,The Alliance,Exception Members,,1220.54,,,,,,,871.82,1537.57,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,outpatient,1,mL,1585.12000,1505.86000,The Alliance,Exception Members,,1220.54,,,,,,,652.75,1537.57,percent of total billed charges,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Exception Members,,0.01540,,,,,,,0.01000,4.06,percent of total billed charges,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2343.75000,2226.56000,The Alliance,Exception Members,,1804.69,,,,,,,1289.06,2273.44,percent of total billed charges,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Exception Members,,1804.69,,,,,,,1171.88,2273.44,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,8280.00000,7866.00000,The Alliance,Exception Members,,6375.60,,,,,,,4554.00,8031.60,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Exception Members,,6375.60,,,,,,,4140.00,8031.60,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,7759.05000,7371.10000,The Alliance,Exception Members,,5974.47,,,,,,,3801.93,7526.28,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Exception Members,,5974.47,,,,,,,3561.40,7759.05,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,inpatient,,,21312.50000,20246.88000,The Alliance,Exception Members,,16410.62,,,,,,,10443.12,20673.12,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Exception Members,,16410.62,,,,,,,9782.44,21312.50,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,4753.24,8382.98,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Exception Members,,6654.53,,,,,,,4321.12,8382.98,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5765.30000,5477.04000,The Alliance,Exception Members,,4439.28,,,,,,,2825.00,5592.34,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5765.30000,5477.04000,The Alliance,Exception Members,,4439.28,,,,,,,2646.27,5765.30,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,231.75000,220.16000,The Alliance,Exception Members,,178.45,,,,,,,113.56,224.80,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,231.75000,220.16000,The Alliance,Exception Members,,178.45,,,,,,,106.37,231.75,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,inpatient,1,mL,31.13000,29.57000,The Alliance,Exception Members,,23.97,,,,,,,17.12,30.20,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,outpatient,1,mL,31.13000,29.57000,The Alliance,Exception Members,,23.97,,,,,,,15.56,30.20,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,inpatient,1,mL,5333.61000,5066.93000,The Alliance,Exception Members,,4106.88,,,,,,,2933.49,5173.60,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,outpatient,1,mL,5333.61000,5066.93000,The Alliance,Exception Members,,4106.88,,,,,,,15.08,5173.60,percent of total billed charges,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32970.00000,31321.50000,The Alliance,Exception Members,,25386.90,,,,,,,16155.30,31980.90,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Exception Members,,25386.90,,,,,,,15133.23,32970.00,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,777.68000,738.80000,The Alliance,Exception Members,,598.81,,,,,,,381.06,754.35,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Exception Members,,598.81,,,,,,,356.96,777.68,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,639.45,1265.85,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,599.00,1305.00,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25160.53000,23902.50000,The Alliance,Exception Members,,19373.61,,,,,,,12328.66,24405.71,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Exception Members,,19373.61,,,,,,,11548.68,25160.53,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1781.25000,1692.19000,The Alliance,Exception Members,,1371.56,,,,,,,872.81,1727.81,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1781.25000,1692.19000,The Alliance,Exception Members,,1371.56,,,,,,,817.59,1781.25,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,153.47,600.19,percent of total billed charges,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,inpatient,1,mL,1796.53000,1706.70000,The Alliance,Exception Members,,1383.33,,,,,,,988.09,1742.63,percent of total billed charges,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,outpatient,1,mL,1796.53000,1706.70000,The Alliance,Exception Members,,1383.33,,,,,,,74.86,1742.63,percent of total billed charges,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20398.96000,19379.01000,The Alliance,Exception Members,,15707.20,,,,,,,9995.49,19786.99,percent of total billed charges,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Exception Members,,15707.20,,,,,,,9363.12,20398.96,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,inpatient,1,mL,72.68000,69.05000,The Alliance,Exception Members,,55.96,,,,,,,39.97,70.50,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,outpatient,1,mL,72.68000,69.05000,The Alliance,Exception Members,,55.96,,,,,,,36.34,70.50,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,inpatient,1,mL,20263.50000,19250.32000,The Alliance,Exception Members,,15602.90,,,,,,,11144.92,19655.60,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,outpatient,1,mL,20263.50000,19250.32000,The Alliance,Exception Members,,15602.90,,,,,,,481.57,19655.60,percent of total billed charges,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30287.00000,28772.65000,The Alliance,Exception Members,,23320.99,,,,,,,14840.63,29378.39,percent of total billed charges,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Exception Members,,23320.99,,,,,,,13901.73,30287.00,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1782.38,3528.38,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Exception Members,,2800.88,,,,,,,1669.61,3637.50,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,inpatient,1,EA,11110.82000,10555.28000,The Alliance,Exception Members,,8555.33,,,,,,,6110.95,10777.50,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,outpatient,1,EA,11110.82000,10555.28000,The Alliance,Exception Members,,8555.33,,,,,,,161.96,10777.50,percent of total billed charges,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,1114.70,1965.93,percent of total billed charges,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,1013.37,1965.93,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,1.01,1.78,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Exception Members,,1.41,,,,,,,0.91500,1.78,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Exception Members,,918.23,,,,,,,547.36,1192.50,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Exception Members,,4781.70,,,,,,,2850.39,6210.00,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5165.13,11253.00,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17084.19000,16229.98000,The Alliance,Exception Members,,13154.83,,,,,,,8371.25,16571.66,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Exception Members,,13154.83,,,,,,,7841.64,17084.19,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1302.00000,1236.90000,The Alliance,Exception Members,,1002.54,,,,,,,637.98,1262.94,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Exception Members,,1002.54,,,,,,,597.62,1302.00,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,930.27,2026.73,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,inpatient,1,EA,161.86000,153.76000,The Alliance,Exception Members,,124.63,,,,,,,89.02,157.00,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,outpatient,1,EA,161.86000,153.76000,The Alliance,Exception Members,,124.63,,,,,,,80.93,157.00,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.24200,0.42680,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Exception Members,,0.33880,,,,,,,0.22000,0.42680,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6555.00000,6227.25000,The Alliance,Exception Members,,5047.35,,,,,,,3211.95,6358.35,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Exception Members,,5047.35,,,,,,,3008.74,6555.00,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10036.05000,9534.25000,The Alliance,Exception Members,,7727.76,,,,,,,4917.66,9734.97,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10036.05000,9534.25000,The Alliance,Exception Members,,7727.76,,,,,,,4606.55,10036.05,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,7759.05000,7371.10000,The Alliance,Exception Members,,5974.47,,,,,,,3801.93,7526.28,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Exception Members,,5974.47,,,,,,,3561.40,7759.05,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,288.75,509.25,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,17.85,814.87,percent of total billed charges,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,inpatient,,,225.00000,213.75000,The Alliance,Exception Members,90,173.25,,,,,,,123.75,218.25,percent of total billed charges,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Exception Members,90,173.25,,,,,,,11.91,594.19,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,288.75,509.25,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,262.50,509.25,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,50.10,88.37,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Exception Members,90,70.15,,,,,,,11.91,594.19,percent of total billed charges,
INS VAG RAD AFTERLOADING APPAR 57156 TECH,86263,CDM,510,RC,57156,CPT,,,facility,inpatient,,,404.75000,384.51000,The Alliance,Exception Members,,311.66,,,,,,,222.61,392.61,percent of total billed charges,
INS VAG RAD AFTERLOADING APPAR 57156 TECH,86263,CDM,510,RC,57156,CPT,,,facility,outpatient,,,404.75000,384.51000,The Alliance,Exception Members,,311.66,,,,,,,202.38,392.61,percent of total billed charges,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,inpatient,,,600.00000,570.00000,The Alliance,Exception Members,90,462.00,,,,,,,330.00,582.00,percent of total billed charges,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Exception Members,90,462.00,,,,,,,43.15,2190.01,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,inpatient,,,534.80000,508.06000,The Alliance,Exception Members,90,411.80,,,,,,,294.14,518.76,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,outpatient,,,534.80000,508.06000,The Alliance,Exception Members,90,411.80,,,,,,,24.89,1137.41,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,inpatient,,,133.70000,127.01000,The Alliance,Exception Members,90,102.95,,,,,,,73.53,129.69,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,outpatient,,,133.70000,127.01000,The Alliance,Exception Members,90,102.95,,,,,,,5.35,271.65,percent of total billed charges,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,inpatient,,,225.00000,213.75000,The Alliance,Exception Members,90,173.25,,,,,,,123.75,218.25,percent of total billed charges,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Exception Members,90,173.25,,,,,,,24.89,1137.41,percent of total billed charges,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,48.52000,46.09000,The Alliance,Exception Members,,37.36,,,,,,,23.77,47.06,percent of total billed charges,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,48.52000,46.09000,The Alliance,Exception Members,,37.36,,,,,,,22.27,48.52,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,617.40,1222.20,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Exception Members,,970.20,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,inpatient,,,2246.25000,2133.94000,The Alliance,Exception Members,,1729.61,,,,,,,1100.66,2178.86,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,2246.25000,2133.94000,The Alliance,Exception Members,,1729.61,,,,,,,1031.03,2246.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,inpatient,,,68.20000,64.79000,The Alliance,Exception Members,,52.51,,,,,,,37.51,66.15,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Exception Members,,52.51,,,,,,,37.51,5271.00,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,inpatient,1,EA,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,8.95,15.79,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Exception Members,,12.54,,,,,,,8.14,15.79,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,Exception Members,GO,110.96,,,,,,,79.25,139.78,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Exception Members,GO,110.96,,,,,,,72.05,264.00,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,GO,224.84,,,,,,,160.60,283.24,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,GO,224.84,,,,,,,126.65,283.24,percent of total billed charges,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,Exception Members,GO,94.40,,,,,,,67.43,118.92,percent of total billed charges,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Exception Members,GO,94.40,,,,,,,61.30,264.00,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,Exception Members,GP,110.96,,,,,,,79.25,139.78,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Exception Members,GP,110.96,,,,,,,72.05,264.00,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,GP,224.84,,,,,,,160.60,283.24,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,GP,224.84,,,,,,,126.65,283.24,percent of total billed charges,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,Exception Members,GP,94.40,,,,,,,67.43,118.92,percent of total billed charges,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Exception Members,GP,94.40,,,,,,,61.30,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,Exception Members,GN,110.96,,,,,,,79.25,139.78,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Exception Members,GN,110.96,,,,,,,72.05,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,Exception Members,GN,224.84,,,,,,,160.60,283.24,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Exception Members,GN,224.84,,,,,,,126.65,283.24,percent of total billed charges,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,Exception Members,GN,94.40,,,,,,,67.43,118.92,percent of total billed charges,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Exception Members,GN,94.40,,,,,,,61.30,264.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,500.74000,475.70000,The Alliance,Exception Members,,385.57,,,,,,,245.36,485.72,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Exception Members,,385.57,,,,,,,229.84,500.74,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,2910.60,5133.24,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Exception Members,,4074.84,,,,,,,1388.02,5133.24,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1041.00000,988.95000,The Alliance,Exception Members,,801.57,,,,,,,510.09,1009.77,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1041.00000,988.95000,The Alliance,Exception Members,,801.57,,,,,,,477.82,1041.00,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Exception Members,,31369.80,,,,,,,18699.66,39517.80,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9455.00000,8982.25000,The Alliance,Exception Members,,7280.35,,,,,,,4632.95,9171.35,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9455.00000,8982.25000,The Alliance,Exception Members,,7280.35,,,,,,,4339.85,9455.00,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,10617.50000,10086.62000,The Alliance,Exception Members,,8175.48,,,,,,,5202.57,10298.98,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Exception Members,,8175.48,,,,,,,4873.43,10617.50,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,113.92,225.53,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Exception Members,,179.03,,,,,,,106.72,232.50,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2756.25000,2618.44000,The Alliance,Exception Members,,2122.31,,,,,,,1350.56,2673.56,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Exception Members,,2122.31,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,1873.91000,1780.21000,The Alliance,Exception Members,,1442.91,,,,,,,918.22,1817.69,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1873.91000,1780.21000,The Alliance,Exception Members,,1442.91,,,,,,,860.12,1873.91,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,90,1231.23,,,,,,,879.45,1551.03,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,90,1231.23,,,,,,,161.92,9523.86,percent of total billed charges,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,90,1231.23,,,,,,,879.45,1551.03,percent of total billed charges,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Exception Members,90,1231.23,,,,,,,161.92,9523.86,percent of total billed charges,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,inpatient,,,74.60000,70.87000,The Alliance,Exception Members,90,57.44,,,,,,,41.03,72.36,percent of total billed charges,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,outpatient,,,74.60000,70.87000,The Alliance,Exception Members,90,57.44,,,,,,,3.40,492.33,percent of total billed charges,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,Exception Members,90,26.95,,,,,,,19.25,33.95,percent of total billed charges,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Exception Members,90,26.95,,,,,,,17.50,2020.22,percent of total billed charges,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,55.94,98.65,percent of total billed charges,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,45.08,679.08,percent of total billed charges,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,55.94,98.65,percent of total billed charges,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Exception Members,90,78.31,,,,,,,45.08,679.08,percent of total billed charges,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,inpatient,,,427.50000,406.12000,The Alliance,Exception Members,90,329.18,,,,,,,235.12,414.68,percent of total billed charges,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Exception Members,90,329.18,,,,,,,35.09,1969.25,percent of total billed charges,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,inpatient,,,312.60000,296.97000,The Alliance,Exception Members,90,240.70,,,,,,,171.93,303.22,percent of total billed charges,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,outpatient,,,312.60000,296.97000,The Alliance,Exception Members,90,240.70,,,,,,,45.08,679.08,percent of total billed charges,
EXN TMR THIGH/KNE SUBQ>=3CM-TECH,86367,CDM,510,RC,27337,CPT,,,facility,inpatient,,,1188.00000,1128.60000,The Alliance,Exception Members,,914.76,,,,,,,653.40,1152.36,percent of total billed charges,
EXN TMR THIGH/KNE SUBQ>=3CM-TECH,86367,CDM,510,RC,27337,CPT,,,facility,outpatient,,,1188.00000,1128.60000,The Alliance,Exception Members,,914.76,,,,,,,594.00,2989.39,percent of total billed charges,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,inpatient,1,EA,135.25000,128.49000,The Alliance,Exception Members,,104.14,,,,,,,74.39,131.19,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,outpatient,1,EA,135.25000,128.49000,The Alliance,Exception Members,,104.14,,,,,,,9.78,131.19,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,inpatient,1,EA,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1897.50,3346.50,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,outpatient,1,EA,3450.00000,3277.50000,The Alliance,Exception Members,,2656.50,,,,,,,1567.49,3346.50,percent of total billed charges,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,inpatient,1,EA,28500.00000,27075.00000,The Alliance,Exception Members,,21945.00,,,,,,,15675.00,27645.00,percent of total billed charges,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,outpatient,1,EA,28500.00000,27075.00000,The Alliance,Exception Members,,21945.00,,,,,,,1567.49,27645.00,percent of total billed charges,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,17.38,30.65,percent of total billed charges,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Exception Members,,24.33,,,,,,,15.80,30.65,percent of total billed charges,
ROOM/BED   INTERMEDIATE CARE,86380,CDM,206,RC,,,,,facility,inpatient,,,2465.00000,2341.75000,The Alliance,Exception Members,,1898.05,,,,,,,1355.75,2391.05,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,930.27,2026.73,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8350.38000,7932.86000,The Alliance,Exception Members,,6429.79,,,,,,,4091.69,8099.87,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8350.38000,7932.86000,The Alliance,Exception Members,,6429.79,,,,,,,3832.82,8350.38,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,26.88000,25.54000,The Alliance,Exception Members,,20.70,,,,,,,13.17,26.07,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,26.88000,25.54000,The Alliance,Exception Members,,20.70,,,,,,,12.34,26.88,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3631.24000,3449.68000,The Alliance,Exception Members,,2796.05,,,,,,,1779.31,3522.30,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3631.24000,3449.68000,The Alliance,Exception Members,,2796.05,,,,,,,1666.74,3631.24,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,inpatient,1,EA,159.99000,151.99000,The Alliance,Exception Members,,123.19,,,,,,,87.99,155.19,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Exception Members,,123.19,,,,,,,80.00,155.19,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,inpatient,,,4042.00000,3839.90000,The Alliance,Exception Members,,3112.34,,,,,,,2223.10,3920.74,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Exception Members,,3112.34,,,,,,,1836.07,25313.80,percent of total billed charges,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1228.13000,1166.72000,The Alliance,Exception Members,,945.66,,,,,,,601.78,1191.29,percent of total billed charges,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1228.13000,1166.72000,The Alliance,Exception Members,,945.66,,,,,,,563.71,1228.13,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2311.39000,2195.82000,The Alliance,Exception Members,,1779.77,,,,,,,1132.58,2242.05,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2311.39000,2195.82000,The Alliance,Exception Members,,1779.77,,,,,,,1060.93,2311.39,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Exception Members,,7703.85,,,,,,,4592.30,10005.00,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,532.88,1054.88,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Exception Members,,837.38,,,,,,,499.16,1087.50,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Exception Members,,1560.58,,,,,,,930.27,2026.73,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,78.21,137.93,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Exception Members,,109.49,,,,,,,2.53,137.93,percent of total billed charges,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,280.78000,266.74000,The Alliance,Exception Members,,216.20,,,,,,,154.43,272.36,percent of total billed charges,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,280.78000,266.74000,The Alliance,Exception Members,,216.20,,,,,,,51.64,272.36,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,73.00,264.00,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,73.00,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,126.65,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,126.65,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,80.30,141.62,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Exception Members,,112.42,,,,,,,73.00,264.00,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,162.25,286.15,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Exception Members,,227.15,,,,,,,126.65,286.15,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,inpatient,1,mL,15.29000,14.53000,The Alliance,Exception Members,,11.77,,,,,,,8.41,14.83,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,outpatient,1,mL,15.29000,14.53000,The Alliance,Exception Members,,11.77,,,,,,,7.64,14.83,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,inpatient,1,mL,13763.10000,13074.94000,The Alliance,Exception Members,,10597.59,,,,,,,7569.70,13350.21,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,outpatient,1,mL,13763.10000,13074.94000,The Alliance,Exception Members,,10597.59,,,,,,,185.31,13350.21,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,inpatient,1,mL,13762.90000,13074.75000,The Alliance,Exception Members,,10597.43,,,,,,,7569.60,13350.01,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,outpatient,1,mL,13762.90000,13074.75000,The Alliance,Exception Members,,10597.43,,,,,,,185.31,13350.01,percent of total billed charges,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,inpatient,1,mL,840.20000,798.19000,The Alliance,Exception Members,,646.95,,,,,,,462.11,814.99,percent of total billed charges,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,outpatient,1,mL,840.20000,798.19000,The Alliance,Exception Members,,646.95,,,,,,,7.86,814.99,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,inpatient,,,26565.00000,25236.75000,The Alliance,Exception Members,,20455.05,,,,,,,13016.85,25768.05,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,outpatient,,,26565.00000,25236.75000,The Alliance,Exception Members,,20455.05,,,,,,,12193.33,25768.05,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4653.95,9212.91,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Exception Members,,7313.34,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2958.38,5856.38,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Exception Members,,4648.88,,,,,,,2771.21,6037.50,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5633.85000,5352.16000,The Alliance,Exception Members,,4338.06,,,,,,,2760.59,5464.83,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5633.85000,5352.16000,The Alliance,Exception Members,,4338.06,,,,,,,2585.94,5633.85,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,inpatient,1,mL,8.84000,8.40000,The Alliance,Exception Members,,6.81,,,,,,,4.86,8.57,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,outpatient,1,mL,8.84000,8.40000,The Alliance,Exception Members,,6.81,,,,,,,4.42,8.57,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,500.74000,475.70000,The Alliance,Exception Members,,385.57,,,,,,,245.36,485.72,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Exception Members,,385.57,,,,,,,229.84,500.74,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,668.09,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1485.00,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Exception Members,,2079.00,,,,,,,1350.00,2619.00,percent of total billed charges,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,128.96000,122.51000,The Alliance,Exception Members,,99.30,,,,,,,70.93,125.09,percent of total billed charges,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,128.96000,122.51000,The Alliance,Exception Members,,99.30,,,,,,,64.48,125.09,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,695.20,1226.08,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Exception Members,,973.28,,,,,,,632.00,1226.08,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Exception Members,,6498.33,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Exception Members,,564.07,,,,,,,336.25,732.56,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,127.05,224.07,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Exception Members,,177.87,,,,,,,115.50,224.07,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Exception Members,,1176.60,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,10617.50000,10086.62000,The Alliance,Exception Members,,8175.48,,,,,,,5202.57,10298.98,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Exception Members,,8175.48,,,,,,,4873.43,10617.50,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,15.64,27.59,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Exception Members,,21.90,,,,,,,3.49,27.59,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,105.60000,100.32000,The Alliance,Exception Members,,81.31,,,,,,,51.74,102.43,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,105.60000,100.32000,The Alliance,Exception Members,,81.31,,,,,,,48.47,105.60,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,,9.79,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,JW,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,JW,9.79,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,Exception Members,JW,9.79,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Exception Members,JW,9.79,,,,,,,2.31,12.33,percent of total billed charges,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2366.70,4685.10,percent of total billed charges,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Exception Members,,3719.10,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,2028.60,4015.80,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Exception Members,,3187.80,,,,,,,1900.26,4140.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Exception Members,,438.90,,,,,,,261.63,570.00,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Exception Members,,6591.58,,,,,,,3929.26,8560.49,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Exception Members,,8664.81,,,,,,,5165.13,11253.00,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2171.96000,2063.36000,The Alliance,Exception Members,,1672.41,,,,,,,1064.26,2106.80,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2171.96000,2063.36000,The Alliance,Exception Members,,1672.41,,,,,,,996.93,2171.96,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,23436.00000,22264.20000,The Alliance,Exception Members,,18045.72,,,,,,,11483.64,22732.92,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Exception Members,,18045.72,,,,,,,10757.12,23436.00,percent of total billed charges,
CPR- TECH,86472,CDM,510,RC,92950,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,325.05,573.27,percent of total billed charges,
CPR- TECH,86472,CDM,510,RC,92950,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Exception Members,,455.07,,,,,,,295.50,573.27,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,inpatient,1,EA,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,2561.62,4517.77,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,outpatient,1,EA,4657.50000,4424.62000,The Alliance,Exception Members,,3586.28,,,,,,,212.36,4517.77,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,678.04,1342.24,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Exception Members,,1065.49,,,,,,,635.14,1383.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7109.10000,6753.65000,The Alliance,Exception Members,,5474.01,,,,,,,3483.46,6895.83,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Exception Members,,5474.01,,,,,,,3263.08,7109.10,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Exception Members,,138.60,,,,,,,82.62,180.00,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,33.56000,31.88000,The Alliance,Exception Members,,25.84,,,,,,,16.44,32.55,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Exception Members,,25.84,,,,,,,16.78,92.45,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,inpatient,1,mL,2420.87000,2299.83000,The Alliance,Exception Members,,1864.07,,,,,,,1331.48,2348.24,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,outpatient,1,mL,2420.87000,2299.83000,The Alliance,Exception Members,,1864.07,,,,,,,1210.43,4602.85,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,inpatient,1,mL,2420.88000,2299.83000,The Alliance,Exception Members,,1864.08,,,,,,,1331.48,2348.25,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,outpatient,1,mL,2420.88000,2299.83000,The Alliance,Exception Members,,1864.08,,,,,,,1210.44,4602.85,percent of total billed charges,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Exception Members,,7669.43,,,,,,,4571.78,9960.30,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1016.03000,965.23000,The Alliance,Exception Members,,782.34,,,,,,,497.85,985.55,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1016.03000,965.23000,The Alliance,Exception Members,,782.34,,,,,,,466.36,1016.03,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Exception Members,,1227.19,,,,,,,731.53,1593.75,percent of total billed charges,
90837 PSYCHOTHERAPY 60 MIN-APNP TECH,86485,CDM,510,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,123.20,217.28,percent of total billed charges,
90837 PSYCHOTHERAPY 60 MIN-APNP TECH,86485,CDM,510,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Exception Members,,172.48,,,,,,,112.00,217.28,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,inpatient,,,4764.17000,4525.96000,The Alliance,Exception Members,,3668.41,,,,,,,2620.29,4621.24,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,4764.17000,4525.96000,The Alliance,Exception Members,,3668.41,,,,,,,2382.09,4621.24,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,266.44,527.44,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Exception Members,,418.69,,,,,,,249.58,543.75,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,inpatient,,,99.00000,94.05000,The Alliance,Exception Members,TC,76.23,,,,,,,54.45,96.03,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Exception Members,TC,76.23,,,,,,,49.50,96.03,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,inpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,334.95,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Exception Members,,468.93,,,,,,,282.87,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,69.85,123.19,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Exception Members,,97.79,,,,,,,23.25,134.70,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,inpatient,,,84.10000,79.89000,The Alliance,Exception Members,90,64.76,,,,,,,46.26,81.58,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,outpatient,,,84.10000,79.89000,The Alliance,Exception Members,90,64.76,,,,,,,4.57,271.65,percent of total billed charges,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,inpatient,,,194.10000,184.39000,The Alliance,Exception Members,,149.46,,,,,,,106.75,188.28,percent of total billed charges,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,outpatient,,,194.10000,184.39000,The Alliance,Exception Members,,149.46,,,,,,,22.97,1087.31,percent of total billed charges,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,Exception Members,,77.92,,,,,,,55.66,98.16,percent of total billed charges,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Exception Members,,77.92,,,,,,,11.98,628.12,percent of total billed charges,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,Exception Members,,77.92,,,,,,,55.66,98.16,percent of total billed charges,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Exception Members,,77.92,,,,,,,11.98,628.12,percent of total billed charges,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,10540.00000,10013.00000,The Alliance,Exception Members,,8115.80,,,,,,,5164.60,10223.80,percent of total billed charges,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,10540.00000,10013.00000,The Alliance,Exception Members,,8115.80,,,,,,,4837.86,10540.00,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,inpatient,,,26090.40000,24785.88000,The Alliance,Exception Members,,20089.61,,,,,,,12784.30,25307.69,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,outpatient,,,26090.40000,24785.88000,The Alliance,Exception Members,,20089.61,,,,,,,11975.49,26090.40,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11466.90000,10893.55000,The Alliance,Exception Members,,8829.51,,,,,,,5618.78,11122.89,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11466.90000,10893.55000,The Alliance,Exception Members,,8829.51,,,,,,,5263.31,11466.90,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,61.12000,58.06000,The Alliance,Exception Members,,47.06,,,,,,,29.95,59.29,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,61.12000,58.06000,The Alliance,Exception Members,,47.06,,,,,,,30.56,93.98,percent of total billed charges,
BIOPSY EXTRAOCULAR MUSCLE 67346-TECH,86510,CDM,510,RC,67346,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,Exception Members,,421.19,,,,,,,300.85,530.59,percent of total billed charges,
BIOPSY EXTRAOCULAR MUSCLE 67346-TECH,86510,CDM,510,RC,67346,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Exception Members,,421.19,,,,,,,273.50,3938.79,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,16998.91000,16148.96000,The Alliance,Exception Members,,13089.16,,,,,,,8329.47,16488.94,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Exception Members,,13089.16,,,,,,,7802.50,16998.91,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Exception Members,,0.26180,,,,,,,0.11207,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.34000,0.32000,The Alliance,Exception Members,JW,0.26180,,,,,,,0.18700,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Exception Members,JW,0.26180,,,,,,,0.11207,0.32980,percent of total billed charges,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,inpatient,1,mL,7608.04000,7227.63000,The Alliance,Exception Members,,5858.19,,,,,,,4184.42,7379.80,percent of total billed charges,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,outpatient,1,mL,7608.04000,7227.63000,The Alliance,Exception Members,,5858.19,,,,,,,23.16,7379.80,percent of total billed charges,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.22550,0.39770,percent of total billed charges,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Exception Members,,0.31570,,,,,,,0.20500,0.39770,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,264.00,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,inpatient,,,296.50000,281.68000,The Alliance,Exception Members,90,228.31,,,,,,,163.07,287.61,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,outpatient,,,296.50000,281.68000,The Alliance,Exception Members,90,228.31,,,,,,,36.26,1833.46,percent of total billed charges,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Exception Members,,19692.75,,,,,,,11738.92,25575.00,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,639.45,1265.85,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Exception Members,,1004.85,,,,,,,599.00,1305.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Exception Members,,6641.25,,,,,,,3958.88,8625.00,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,67.10,118.34,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Exception Members,,93.94,,,,,,,61.00,118.34,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,134.06,236.44,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Exception Members,,187.69,,,,,,,121.88,236.44,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,4455.00,7857.00,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Exception Members,,6237.00,,,,,,,1285.85,7857.00,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,288.75,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,262.50,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,288.75,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Exception Members,90,404.25,,,,,,,262.50,509.25,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,inpatient,,,545.93000,518.63000,The Alliance,Exception Members,,420.37,,,,,,,300.26,529.55,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,outpatient,,,545.93000,518.63000,The Alliance,Exception Members,,420.37,,,,,,,272.96,529.55,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Exception Members,,277.72,,,,,,,47.62,349.86,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,9098.81,18011.93,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,8523.17,18569.00,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,inpatient,,,5985.75000,5686.46000,The Alliance,Exception Members,,4609.03,,,,,,,2933.02,5806.18,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,outpatient,,,5985.75000,5686.46000,The Alliance,Exception Members,,4609.03,,,,,,,2747.46,5985.75,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,87.56,154.42,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Exception Members,,122.58,,,,,,,79.60,154.42,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1561.88,3091.88,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Exception Members,,2454.38,,,,,,,1463.06,3187.50,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,5783.37000,5494.20000,The Alliance,Exception Members,,4453.19,,,,,,,3180.85,5609.87,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,5783.37000,5494.20000,The Alliance,Exception Members,,4453.19,,,,,,,2891.68,5609.87,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-MD-TECH,86538,CDM,510,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,81.95,144.53,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-MD-TECH,86538,CDM,510,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Exception Members,,114.73,,,,,,,74.50,167.82,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,inpatient,1,mL,1408.47000,1338.04000,The Alliance,Exception Members,,1084.52,,,,,,,774.66,1366.22,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,outpatient,1,mL,1408.47000,1338.04000,The Alliance,Exception Members,,1084.52,,,,,,,22.21,1366.22,percent of total billed charges,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4602.30000,4372.19000,The Alliance,Exception Members,,3543.77,,,,,,,2255.13,4464.23,percent of total billed charges,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4602.30000,4372.19000,The Alliance,Exception Members,,3543.77,,,,,,,2112.46,4602.30,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Exception Members,,20349.17,,,,,,,12130.22,26427.50,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,303.19,600.19,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Exception Members,,476.44,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1102.50,2182.50,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Exception Members,,1732.50,,,,,,,1032.75,2250.00,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,266.06,469.24,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Exception Members,,372.49,,,,,,,241.88,469.24,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,61.60,108.64,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Exception Members,,86.24,,,,,,,56.00,264.00,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,63.25,111.55,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Exception Members,,88.55,,,,,,,57.50,264.00,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Exception Members,,1660.31,,,,,,,989.72,2156.25,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,9098.81,18011.93,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Exception Members,,14298.13,,,,,,,8523.17,18569.00,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,23932.00000,22735.40000,The Alliance,Exception Members,,18427.64,,,,,,,13162.60,23214.04,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,23932.00000,22735.40000,The Alliance,Exception Members,,18427.64,,,,,,,11966.00,23214.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,17.60,31.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Exception Members,,24.64,,,,,,,16.00,31.04,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,Exception Members,GO,72.38,,,,,,,51.70,91.18,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Exception Members,GO,72.38,,,,,,,47.00,264.00,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,inpatient,,,353.00000,335.35000,The Alliance,Exception Members,90,271.81,,,,,,,194.15,342.41,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Exception Members,90,271.81,,,,,,,35.09,1969.25,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,inpatient,,,43.80000,41.61000,The Alliance,Exception Members,90,33.73,,,,,,,24.09,42.49,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,outpatient,,,43.80000,41.61000,The Alliance,Exception Members,90,33.73,,,,,,,5.35,271.65,percent of total billed charges,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,inpatient,,,1055.10000,1002.34000,The Alliance,Exception Members,90,812.43,,,,,,,580.30,1023.45,percent of total billed charges,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,outpatient,,,1055.10000,1002.34000,The Alliance,Exception Members,90,812.43,,,,,,,73.92,5873.90,percent of total billed charges,
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,72.50,548.00,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,548.00,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,,1328.77,,,,,,,783.51,1551.03,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,,1328.77,,,,,,,440.69,1551.03,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,661.50,1309.50,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,619.65,1309.50,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,inpatient,,,2901.00000,2755.95000,The Alliance,PPO Network,,2410.73,,,,,,,1421.49,2813.97,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,PPO Network,,2410.73,,,,,,,1026.39,2813.97,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,,1352.04,,,,,,,894.85,1578.19,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,,1352.04,,,,,,,813.50,3163.00,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,inpatient,,,1383.00000,1313.85000,The Alliance,PPO Network,,1149.27,,,,,,,760.65,1341.51,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,PPO Network,,1149.27,,,,,,,691.50,4686.00,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,1444.85,2548.19,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,979.11,2548.19,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,The Alliance,PPO Network,TC,1882.21,,,,,,,1245.75,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,PPO Network,TC,1882.21,,,,,,,1132.50,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,1444.30,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,979.11,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,1273.25,2245.55,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,979.11,2245.55,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,545.05,961.27,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,495.50,1820.00,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,TC,118.00,,,,,,,78.10,137.74,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,TC,118.00,,,,,,,71.00,1820.00,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,1029.05,1814.87,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,935.50,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,The Alliance,PPO Network,TC,2100.77,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,PPO Network,TC,2100.77,,,,,,,1264.00,2452.16,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,The Alliance,PPO Network,TC,2154.78,,,,,,,1426.15,2515.21,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,PPO Network,TC,2154.78,,,,,,,979.11,2515.21,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,TC,1026.29,,,,,,,679.25,1197.95,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,TC,1026.29,,,,,,,584.87,1820.00,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,The Alliance,PPO Network,TC,1217.41,,,,,,,805.75,1421.05,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,PPO Network,TC,1217.41,,,,,,,732.50,1820.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,The Alliance,PPO Network,TC,2160.60,,,,,,,1430.00,2522.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,PPO Network,TC,2160.60,,,,,,,1285.85,2522.00,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,The Alliance,PPO Network,TC,1489.98,,,,,,,986.15,1739.21,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,PPO Network,TC,1489.98,,,,,,,896.50,1820.00,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,The Alliance,PPO Network,TC,1917.12,,,,,,,1268.85,2237.79,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,PPO Network,TC,1917.12,,,,,,,1153.50,2237.79,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,979.11,2209.66,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,TC,1553.14,,,,,,,1027.95,1812.93,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,TC,1553.14,,,,,,,934.50,1964.22,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,The Alliance,PPO Network,TC,1914.62,,,,,,,1267.20,2234.88,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,PPO Network,TC,1914.62,,,,,,,979.11,2234.88,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,684.20,1206.68,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,622.00,1820.00,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,TC,2838.70,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,TC,2838.70,,,,,,,979.11,3313.52,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,680.35,1199.89,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,584.87,1820.00,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,TC,1963.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,TC,1963.65,,,,,,,979.11,2292.11,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,inpatient,,,7626.00000,7244.70000,The Alliance,PPO Network,,6337.21,,,,,,,3736.74,7397.22,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,outpatient,,,7626.00000,7244.70000,The Alliance,PPO Network,,6337.21,,,,,,,3500.33,7397.22,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,TC,290.02,,,,,,,191.95,338.53,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,TC,290.02,,,,,,,114.83,1213.27,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,49.50,96.03,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,PPO Network,TC,789.45,,,,,,,522.50,921.50,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,PPO Network,TC,789.45,,,,,,,384.16,921.50,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2015.00,3909.10,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,584.87,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,23.25,96.03,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,4607.00,52373.21,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,282.15,497.61,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,215.27,548.00,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,inpatient,1,mL,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,outpatient,1,mL,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,inpatient,1,mL,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,inpatient,1,mL,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.56,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.42,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,979.11,2245.55,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,1444.30,2547.22,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,979.11,2547.22,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,1444.85,2548.19,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,979.11,2548.19,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,The Alliance,PPO Network,TC,1883.88,,,,,,,1246.85,2198.99,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,PPO Network,TC,1883.88,,,,,,,484.28,2198.99,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,The Alliance,PPO Network,TC,2841.19,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,PPO Network,TC,2841.19,,,,,,,1353.88,3316.43,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1128.45,2914.85,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,The Alliance,PPO Network,TC,2882.74,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,PPO Network,TC,2882.74,,,,,,,1375.22,3364.93,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,The Alliance,PPO Network,TC,2174.73,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,PPO Network,TC,2174.73,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,The Alliance,PPO Network,TC,3309.87,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,PPO Network,TC,3309.87,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,The Alliance,PPO Network,TC,2963.35,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,PPO Network,TC,2963.35,,,,,,,1321.12,3459.02,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,The Alliance,PPO Network,TC,2109.91,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,PPO Network,TC,2109.91,,,,,,,1269.50,2462.83,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,The Alliance,PPO Network,TC,1870.58,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,PPO Network,TC,1870.58,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,The Alliance,PPO Network,TC,3619.01,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,PPO Network,TC,3619.01,,,,,,,1487.04,4224.35,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,The Alliance,PPO Network,TC,4142.53,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,PPO Network,TC,4142.53,,,,,,,1487.04,4835.45,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,68.74,718.77,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,The Alliance,PPO Network,TC,3370.54,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,PPO Network,TC,3370.54,,,,,,,1487.04,3934.32,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,The Alliance,PPO Network,TC,2948.39,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,PPO Network,TC,2948.39,,,,,,,1353.60,3441.56,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,174.90,308.46,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,154.77,548.00,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,1767.08,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,The Alliance,PPO Network,TC,2966.67,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,PPO Network,TC,2966.67,,,,,,,1487.04,3462.90,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1668.70,2942.98,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1329.46,2942.98,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,The Alliance,PPO Network,TC,2872.77,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,PPO Network,TC,2872.77,,,,,,,1371.65,3353.29,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,144.65,255.11,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,129.58,1272.59,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,PPO Network,TC,393.06,,,,,,,260.15,458.81,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,PPO Network,TC,393.06,,,,,,,179.69,2032.87,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,68.74,718.77,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,151.80,267.72,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,138.00,1371.46,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,125.88,1213.27,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,125.88,1213.27,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,The Alliance,PPO Network,TC,2502.14,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,PPO Network,TC,2502.14,,,,,,,1129.95,2920.67,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,160.92,1569.27,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,122.10,215.34,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,111.00,1094.55,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,The Alliance,PPO Network,TC,2868.61,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,PPO Network,TC,2868.61,,,,,,,1382.32,3348.44,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,254.10,448.14,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,231.00,548.00,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,The Alliance,PPO Network,TC,2677.48,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,PPO Network,TC,2677.48,,,,,,,1318.80,3125.34,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,154.55,272.57,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,140.50,1391.23,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,The Alliance,PPO Network,TC,2981.63,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,PPO Network,TC,2981.63,,,,,,,1328.10,3480.36,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,The Alliance,PPO Network,TC,3255.86,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,PPO Network,TC,3255.86,,,,,,,1246.80,3800.46,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1295.50,2513.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,inpatient,,,307.50000,292.12000,The Alliance,PPO Network,,255.53,,,,,,,150.68,298.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,PPO Network,,255.53,,,,,,,153.75,298.27,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3802.00000,3611.90000,The Alliance,PPO Network,TC,3159.46,,,,,,,2091.10,3687.94,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3802.00000,3611.90000,The Alliance,PPO Network,TC,3159.46,,,,,,,1901.00,3687.94,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,PPO Network,TC,570.07,,,,,,,377.30,665.42,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,PPO Network,TC,570.07,,,,,,,343.00,665.42,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,The Alliance,PPO Network,TC,2772.22,,,,,,,1834.80,3235.92,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,PPO Network,TC,2772.22,,,,,,,1668.00,3235.92,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,inpatient,,,489.00000,464.55000,The Alliance,PPO Network,TC,406.36,,,,,,,268.95,474.33,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,PPO Network,TC,406.36,,,,,,,244.50,474.33,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,inpatient,,,455.00000,432.25000,The Alliance,PPO Network,TC,378.11,,,,,,,250.25,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,PPO Network,TC,378.11,,,,,,,227.50,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,inpatient,,,550.00000,522.50000,The Alliance,PPO Network,TC,457.05,,,,,,,302.50,533.50,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,outpatient,,,550.00000,522.50000,The Alliance,PPO Network,TC,457.05,,,,,,,275.00,533.50,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,QW,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,QW,1893.02,,,,,,,4.81,2209.66,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,The Alliance,PPO Network,TC,835.99,,,,,,,553.30,975.82,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,PPO Network,TC,835.99,,,,,,,503.00,975.82,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,97.00,212.44,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,584.00000,554.80000,The Alliance,PPO Network,QW,485.30,,,,,,,321.20,566.48,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,584.00000,554.80000,The Alliance,PPO Network,QW,485.30,,,,,,,292.00,566.48,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,241.18,477.44,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,225.92,477.44,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,28.80000,27.36000,The Alliance,PPO Network,,23.93,,,,,,,14.11,27.94,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,28.80000,27.36000,The Alliance,PPO Network,,23.93,,,,,,,13.22,27.94,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,807.00000,766.65000,The Alliance,PPO Network,QW,670.62,,,,,,,443.85,782.79,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,807.00000,766.65000,The Alliance,PPO Network,QW,670.62,,,,,,,403.50,782.79,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,The Alliance,PPO Network,TC,3162.79,,,,,,,2093.30,3691.82,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,PPO Network,TC,3162.79,,,,,,,1903.00,3691.82,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.00,7.76,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12028.00,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.60,11.64,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.00,11.64,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,6.86,13.58,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,6.43,13.58,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,17.04000,16.19000,The Alliance,PPO Network,,14.16,,,,,,,8.35,16.53,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,17.04000,16.19000,The Alliance,PPO Network,,14.16,,,,,,,7.82,16.53,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,30.36000,28.84000,The Alliance,PPO Network,,25.23,,,,,,,14.88,29.45,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,30.36000,28.84000,The Alliance,PPO Network,,25.23,,,,,,,13.94,29.45,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,inpatient,,,1105.00000,1049.75000,The Alliance,PPO Network,,918.25,,,,,,,607.75,1071.85,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,outpatient,,,1105.00000,1049.75000,The Alliance,PPO Network,,918.25,,,,,,,314.95,1071.85,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,246.10,477.44,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,20.58,40.74,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,19.28,40.74,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,246.10,477.44,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,inpatient,,,1298.00000,1233.10000,The Alliance,PPO Network,,1078.64,,,,,,,713.90,1259.06,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,PPO Network,,1078.64,,,,,,,314.95,1259.06,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,10.92000,10.37000,The Alliance,PPO Network,,9.07,,,,,,,5.35,10.59,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,10.92000,10.37000,The Alliance,PPO Network,,9.07,,,,,,,5.46,36.65,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,11.15000,10.59000,The Alliance,PPO Network,,9.27,,,,,,,5.46,10.82,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,11.15000,10.59000,The Alliance,PPO Network,,9.27,,,,,,,5.58,102.20,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,The Alliance,PPO Network,,571.73,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,PPO Network,,571.73,,,,,,,314.95,667.36,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,191.40000,181.83000,The Alliance,PPO Network,,159.05,,,,,,,93.79,185.66,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,191.40000,181.83000,The Alliance,PPO Network,,159.05,,,,,,,87.85,185.66,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.10000,39.99000,The Alliance,PPO Network,,34.99,,,,,,,20.63,40.84,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.10000,39.99000,The Alliance,PPO Network,,34.99,,,,,,,19.32,40.84,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,44.80000,42.56000,The Alliance,PPO Network,,37.23,,,,,,,21.95,43.46,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,44.80000,42.56000,The Alliance,PPO Network,,37.23,,,,,,,20.56,43.46,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,264.38000,251.16000,The Alliance,PPO Network,,219.70,,,,,,,129.55,256.45,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,264.38000,251.16000,The Alliance,PPO Network,,219.70,,,,,,,126.64,256.45,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,inpatient,,,386.93000,367.58000,The Alliance,PPO Network,,321.54,,,,,,,189.60,375.32,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,outpatient,,,386.93000,367.58000,The Alliance,PPO Network,,321.54,,,,,,,193.47,375.32,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,73.15,129.01,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,64.92,129.01,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,17.00000,16.15000,The Alliance,PPO Network,,14.13,,,,,,,9.35,16.49,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,PPO Network,,14.13,,,,,,,8.50,16.49,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,106.56000,101.23000,The Alliance,PPO Network,,88.55,,,,,,,52.21,103.36,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,106.56000,101.23000,The Alliance,PPO Network,,88.55,,,,,,,53.28,103.36,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,1374.00000,1305.30000,The Alliance,PPO Network,,1141.79,,,,,,,673.26,1332.78,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,1374.00000,1305.30000,The Alliance,PPO Network,,1141.79,,,,,,,266.32,1332.78,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,The Alliance,PPO Network,TC,511.90,,,,,,,338.80,597.52,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,PPO Network,TC,511.90,,,,,,,308.00,3942.79,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,PPO Network,TC,437.11,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,PPO Network,TC,437.11,,,,,,,146.17,1450.63,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,1172.00000,1113.40000,The Alliance,PPO Network,,973.93,,,,,,,574.28,1136.84,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,PPO Network,,973.93,,,,,,,326.06,1136.84,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,26.52000,25.19000,The Alliance,PPO Network,,22.04,,,,,,,12.99,25.72,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,26.52000,25.19000,The Alliance,PPO Network,,22.04,,,,,,,12.17,25.72,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,The Alliance,PPO Network,TC,2915.15,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,PPO Network,TC,2915.15,,,,,,,1754.00,3402.76,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,The Alliance,PPO Network,TC,3589.92,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,PPO Network,TC,3589.92,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,TC,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,TC,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,TC,57.34,,,,,,,37.95,66.93,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,TC,57.34,,,,,,,34.50,5271.00,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,134.08000,127.38000,The Alliance,PPO Network,,111.42,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,PPO Network,,111.42,,,,,,,67.04,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,134.08000,127.38000,The Alliance,PPO Network,,111.42,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,PPO Network,,111.42,,,,,,,67.04,130.06,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,25.48,50.44,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,26.00,50.44,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,3.66,203.72,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1857.46,5271.00,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,25.78000,24.49000,The Alliance,PPO Network,,21.42,,,,,,,12.63,25.01,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,25.78000,24.49000,The Alliance,PPO Network,,21.42,,,,,,,12.89,65.22,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,inpatient,,,204.99000,194.74000,The Alliance,PPO Network,,170.35,,,,,,,100.45,198.84,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,outpatient,,,204.99000,194.74000,The Alliance,PPO Network,,170.35,,,,,,,102.50,241.40,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,inpatient,,,309.37000,293.90000,The Alliance,PPO Network,,257.09,,,,,,,151.59,300.09,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,outpatient,,,309.37000,293.90000,The Alliance,PPO Network,,257.09,,,,,,,154.69,436.36,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,99.38,192.79,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,259.91000,246.91000,The Alliance,PPO Network,,215.99,,,,,,,127.36,252.11,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,259.91000,246.91000,The Alliance,PPO Network,,215.99,,,,,,,99.97,252.11,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,14.48000,13.76000,The Alliance,PPO Network,,12.03,,,,,,,7.10,14.05,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,14.48000,13.76000,The Alliance,PPO Network,,12.03,,,,,,,7.24,102.20,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,35.60000,33.82000,The Alliance,PPO Network,,29.58,,,,,,,17.44,34.53,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,35.60000,33.82000,The Alliance,PPO Network,,29.58,,,,,,,17.80,65.22,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,inpatient,,,215.44000,204.67000,The Alliance,PPO Network,,179.03,,,,,,,105.57,208.98,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,outpatient,,,215.44000,204.67000,The Alliance,PPO Network,,179.03,,,,,,,107.59,208.98,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,74.05000,70.35000,The Alliance,PPO Network,,61.54,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,PPO Network,,61.54,,,,,,,37.02,121.81,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,39.87000,37.88000,The Alliance,PPO Network,,33.13,,,,,,,19.54,38.67,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,39.87000,37.88000,The Alliance,PPO Network,,33.13,,,,,,,19.93,70.48,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,17.24000,16.38000,The Alliance,PPO Network,,14.33,,,,,,,8.45,16.72,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,17.24000,16.38000,The Alliance,PPO Network,,14.33,,,,,,,8.62,70.48,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,121.88000,115.79000,The Alliance,PPO Network,,101.28,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,PPO Network,,101.28,,,,,,,60.94,142.65,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,270.94000,257.39000,The Alliance,PPO Network,,225.15,,,,,,,132.76,262.81,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,270.94000,257.39000,The Alliance,PPO Network,,225.15,,,,,,,109.77,262.81,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,27.00,74.34,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,99.38,192.79,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,inpatient,,,233.00000,221.35000,The Alliance,PPO Network,,193.62,,,,,,,114.17,226.01,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,outpatient,,,233.00000,221.35000,The Alliance,PPO Network,,193.62,,,,,,,116.50,274.91,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,74.05000,70.35000,The Alliance,PPO Network,,61.54,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,PPO Network,,61.54,,,,,,,37.02,121.81,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,79.00,153.26,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,20.58,40.74,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,21.00,59.94,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,inpatient,,,1751.00000,1663.45000,The Alliance,PPO Network,,1455.08,,,,,,,857.99,1698.47,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,outpatient,,,1751.00000,1663.45000,The Alliance,PPO Network,,1455.08,,,,,,,875.50,1698.47,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,844.00000,801.80000,The Alliance,PPO Network,,701.36,,,,,,,413.56,818.68,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,PPO Network,,701.36,,,,,,,360.44,818.68,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,13.46000,12.79000,The Alliance,PPO Network,,11.19,,,,,,,6.60,13.06,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,13.46000,12.79000,The Alliance,PPO Network,,11.19,,,,,,,6.73,102.20,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,9.55,33.95,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,76.13000,72.32000,The Alliance,PPO Network,,63.26,,,,,,,37.30,73.85,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,76.13000,72.32000,The Alliance,PPO Network,,63.26,,,,,,,34.94,73.85,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,inpatient,,,1117.64000,1061.76000,The Alliance,PPO Network,,928.76,,,,,,,547.64,1084.11,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,outpatient,,,1117.64000,1061.76000,The Alliance,PPO Network,,928.76,,,,,,,553.79,1084.11,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,199.84000,189.85000,The Alliance,PPO Network,,166.07,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,PPO Network,,166.07,,,,,,,81.64,193.84,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,91.80000,87.21000,The Alliance,PPO Network,,76.29,,,,,,,44.98,89.05,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,PPO Network,,76.29,,,,,,,45.90,315.32,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,121.88000,115.79000,The Alliance,PPO Network,,101.28,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,PPO Network,,101.28,,,,,,,60.94,118.22,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,260.63000,247.60000,The Alliance,PPO Network,,216.58,,,,,,,127.71,252.81,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,260.63000,247.60000,The Alliance,PPO Network,,216.58,,,,,,,81.64,252.81,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,inpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,47.04,93.12,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,outpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,44.06,93.12,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,inpatient,,,441.03000,418.98000,The Alliance,PPO Network,,366.50,,,,,,,216.10,427.80,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,PPO Network,,366.50,,,,,,,220.51,432.02,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,91.80000,87.21000,The Alliance,PPO Network,,76.29,,,,,,,44.98,89.05,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,PPO Network,,76.29,,,,,,,45.90,315.32,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,inpatient,,,1333.00000,1266.35000,The Alliance,PPO Network,,1107.72,,,,,,,653.17,1293.01,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,PPO Network,,1107.72,,,,,,,666.50,1293.01,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,inpatient,,,160.20000,152.19000,The Alliance,PPO Network,,133.13,,,,,,,78.50,155.39,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,outpatient,,,160.20000,152.19000,The Alliance,PPO Network,,133.13,,,,,,,73.53,155.39,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,199.84000,189.85000,The Alliance,PPO Network,,166.07,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,PPO Network,,166.07,,,,,,,99.92,193.84,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,74.34,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,10.45,18.43,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,9.50,79.34,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,60.36,137.74,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,74.00,150.74,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,38.65,150.35,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,89.24,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,38.65,89.24,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,77.50,153.86,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,488.00000,463.60000,The Alliance,PPO Network,,405.53,,,,,,,268.40,473.36,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,488.00000,463.60000,The Alliance,PPO Network,,405.53,,,,,,,242.89,473.36,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,664.00000,630.80000,The Alliance,PPO Network,,551.78,,,,,,,365.20,644.08,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,664.00000,630.80000,The Alliance,PPO Network,,551.78,,,,,,,332.00,644.08,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,760.00000,722.00000,The Alliance,PPO Network,,631.56,,,,,,,418.00,737.20,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,760.00000,722.00000,The Alliance,PPO Network,,631.56,,,,,,,380.00,737.20,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,336.00000,319.20000,The Alliance,PPO Network,,279.22,,,,,,,184.80,325.92,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,336.00000,319.20000,The Alliance,PPO Network,,279.22,,,,,,,137.04,325.92,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,134.64,472.39,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,inpatient,,,458.00000,435.10000,The Alliance,PPO Network,,380.60,,,,,,,251.90,444.26,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,outpatient,,,458.00000,435.10000,The Alliance,PPO Network,,380.60,,,,,,,141.69,444.26,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,109.61,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,inpatient,,,291.00000,276.45000,The Alliance,PPO Network,,241.82,,,,,,,160.05,282.27,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,outpatient,,,291.00000,276.45000,The Alliance,PPO Network,,241.82,,,,,,,128.93,282.27,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,inpatient,,,748.00000,710.60000,The Alliance,PPO Network,,621.59,,,,,,,411.40,725.56,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,outpatient,,,748.00000,710.60000,The Alliance,PPO Network,,621.59,,,,,,,374.00,725.56,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,14.86,137.74,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,inpatient,,,828.00000,786.60000,The Alliance,PPO Network,,688.07,,,,,,,455.40,803.16,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,outpatient,,,828.00000,786.60000,The Alliance,PPO Network,,688.07,,,,,,,377.09,803.16,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,169.00000,160.55000,The Alliance,PPO Network,,140.44,,,,,,,92.95,163.93,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,169.00000,160.55000,The Alliance,PPO Network,,140.44,,,,,,,64.42,163.93,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,,2391.62,,,,,,,1582.90,2791.66,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,,2391.62,,,,,,,558.00,2791.66,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,38.65,279.36,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,inpatient,,,637.00000,605.15000,The Alliance,PPO Network,,529.35,,,,,,,350.35,617.89,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,outpatient,,,637.00000,605.15000,The Alliance,PPO Network,,529.35,,,,,,,318.50,617.89,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,172.82,489.94,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,PPO Network,TC,385.58,,,,,,,255.20,450.08,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,PPO Network,TC,385.58,,,,,,,232.00,3299.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,427.00000,405.65000,The Alliance,PPO Network,,354.84,,,,,,,234.85,414.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,427.00000,405.65000,The Alliance,PPO Network,,354.84,,,,,,,213.50,414.19,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,8.53000,8.10000,The Alliance,PPO Network,,7.09,,,,,,,4.18,8.27,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,8.53000,8.10000,The Alliance,PPO Network,,7.09,,,,,,,3.92,8.27,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,The Alliance,PPO Network,,2329.29,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,PPO Network,,2329.29,,,,,,,1401.50,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,The Alliance,PPO Network,,2329.29,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,PPO Network,,2329.29,,,,,,,814.56,2718.91,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,188.20000,178.79000,The Alliance,PPO Network,,156.39,,,,,,,92.22,182.55,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,188.20000,178.79000,The Alliance,PPO Network,,156.39,,,,,,,67.53,182.55,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,88.69,175.57,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,90.50,175.57,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,,989.72,,,,,,,583.59,1155.27,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,,989.72,,,,,,,504.90,1155.27,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,303.31,600.43,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,266.32,600.43,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,186.50,361.81,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,241.00000,228.95000,The Alliance,PPO Network,,200.27,,,,,,,118.09,233.77,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,241.00000,228.95000,The Alliance,PPO Network,,200.27,,,,,,,105.37,233.77,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,429.00000,407.55000,The Alliance,PPO Network,,356.50,,,,,,,210.21,416.13,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,429.00000,407.55000,The Alliance,PPO Network,,356.50,,,,,,,214.50,416.13,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,TC,198.61,,,,,,,131.45,231.83,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,TC,198.61,,,,,,,119.50,2142.86,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,inpatient,,,227.15000,215.79000,The Alliance,PPO Network,,188.76,,,,,,,111.30,220.34,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,outpatient,,,227.15000,215.79000,The Alliance,PPO Network,,188.76,,,,,,,113.58,220.34,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,85.26,168.78,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,67.53,168.78,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,inpatient,,,170.20000,161.69000,The Alliance,PPO Network,,141.44,,,,,,,83.40,165.09,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,outpatient,,,170.20000,161.69000,The Alliance,PPO Network,,141.44,,,,,,,52.68,165.09,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,inpatient,,,200.35000,190.33000,The Alliance,PPO Network,,166.49,,,,,,,98.17,194.34,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,outpatient,,,200.35000,190.33000,The Alliance,PPO Network,,166.49,,,,,,,100.17,196.24,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,inpatient,,,441.03000,418.98000,The Alliance,PPO Network,,366.50,,,,,,,216.10,427.80,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,PPO Network,,366.50,,,,,,,220.51,569.51,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,inpatient,,,1817.00000,1726.15000,The Alliance,PPO Network,,1509.93,,,,,,,890.33,1762.49,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,outpatient,,,1817.00000,1726.15000,The Alliance,PPO Network,,1509.93,,,,,,,908.50,1762.49,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,56.10,98.94,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,37.27,98.94,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,inpatient,,,1373.08000,1304.43000,The Alliance,PPO Network,,1141.03,,,,,,,672.81,1331.89,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,outpatient,,,1373.08000,1304.43000,The Alliance,PPO Network,,1141.03,,,,,,,686.54,1616.93,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,inpatient,,,269.63000,256.15000,The Alliance,PPO Network,,224.06,,,,,,,132.12,261.54,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,outpatient,,,269.63000,256.15000,The Alliance,PPO Network,,224.06,,,,,,,105.09,261.54,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,inpatient,,,260.06000,247.06000,The Alliance,PPO Network,,216.11,,,,,,,127.43,252.26,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,outpatient,,,260.06000,247.06000,The Alliance,PPO Network,,216.11,,,,,,,106.15,252.26,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,138.45000,131.53000,The Alliance,PPO Network,,115.05,,,,,,,67.84,134.30,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,138.45000,131.53000,The Alliance,PPO Network,,115.05,,,,,,,69.22,196.91,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,,108.03,,,,,,,63.70,126.10,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,,108.03,,,,,,,65.00,135.57,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,71.26000,67.70000,The Alliance,PPO Network,,59.22,,,,,,,34.92,69.12,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,PPO Network,,59.22,,,,,,,35.63,103.42,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,13.26000,12.60000,The Alliance,PPO Network,,11.02,,,,,,,6.50,12.86,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,13.26000,12.60000,The Alliance,PPO Network,,11.02,,,,,,,6.63,65.22,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,545.00000,517.75000,The Alliance,PPO Network,,452.89,,,,,,,267.05,528.65,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,545.00000,517.75000,The Alliance,PPO Network,,452.89,,,,,,,272.50,528.65,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,inpatient,,,71.26000,67.70000,The Alliance,PPO Network,,59.22,,,,,,,34.92,69.12,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,PPO Network,,59.22,,,,,,,35.63,69.12,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,inpatient,,,3043.38000,2891.21000,The Alliance,PPO Network,,2529.05,,,,,,,1491.26,2952.08,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,outpatient,,,3043.38000,2891.21000,The Alliance,PPO Network,,2529.05,,,,,,,1514.36,2952.08,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,inpatient,,,844.00000,801.80000,The Alliance,PPO Network,,701.36,,,,,,,413.56,818.68,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,PPO Network,,701.36,,,,,,,422.00,818.68,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,inpatient,,,821.00000,779.95000,The Alliance,PPO Network,,682.25,,,,,,,402.29,796.37,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,outpatient,,,821.00000,779.95000,The Alliance,PPO Network,,682.25,,,,,,,380.93,796.37,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,inpatient,,,36.53000,34.70000,The Alliance,PPO Network,,30.36,,,,,,,17.90,35.43,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,outpatient,,,36.53000,34.70000,The Alliance,PPO Network,,30.36,,,,,,,18.27,130.31,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,294.98,583.94,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,301.00,583.94,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,111.72,221.16,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,114.00,269.05,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,inpatient,,,801.35000,761.28000,The Alliance,PPO Network,,665.92,,,,,,,392.66,777.31,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,outpatient,,,801.35000,761.28000,The Alliance,PPO Network,,665.92,,,,,,,400.68,943.67,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,inpatient,,,773.00000,734.35000,The Alliance,PPO Network,,642.36,,,,,,,378.77,749.81,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,outpatient,,,773.00000,734.35000,The Alliance,PPO Network,,642.36,,,,,,,386.50,749.81,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,102.41,202.73,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,104.50,217.71,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,71.04000,67.49000,The Alliance,PPO Network,,59.03,,,,,,,34.81,68.91,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,71.04000,67.49000,The Alliance,PPO Network,,59.03,,,,,,,32.61,68.91,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,inpatient,,,362.51000,344.38000,The Alliance,PPO Network,,301.25,,,,,,,177.63,351.63,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,outpatient,,,362.51000,344.38000,The Alliance,PPO Network,,301.25,,,,,,,181.25,364.14,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,28.42,56.26,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,29.00,82.83,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,inpatient,,,31.14000,29.58000,The Alliance,PPO Network,,25.88,,,,,,,15.26,30.21,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,outpatient,,,31.14000,29.58000,The Alliance,PPO Network,,25.88,,,,,,,15.57,82.94,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,inpatient,,,817.43000,776.56000,The Alliance,PPO Network,,679.28,,,,,,,400.54,792.91,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,outpatient,,,817.43000,776.56000,The Alliance,PPO Network,,679.28,,,,,,,408.71,792.91,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,inpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,145.00,341.50,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,inpatient,,,2833.00000,2691.35000,The Alliance,PPO Network,,2354.22,,,,,,,1388.17,2748.01,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,outpatient,,,2833.00000,2691.35000,The Alliance,PPO Network,,2354.22,,,,,,,1212.77,2748.01,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,inpatient,,,1335.00000,1268.25000,The Alliance,PPO Network,,1109.38,,,,,,,654.15,1294.95,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,outpatient,,,1335.00000,1268.25000,The Alliance,PPO Network,,1109.38,,,,,,,667.50,1294.95,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,51.20000,48.64000,The Alliance,PPO Network,,42.55,,,,,,,25.09,49.66,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,PPO Network,,42.55,,,,,,,23.50,49.66,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,1062.65,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,inpatient,,,760.40000,722.38000,The Alliance,PPO Network,,631.89,,,,,,,372.60,737.59,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,outpatient,,,760.40000,722.38000,The Alliance,PPO Network,,631.89,,,,,,,378.38,737.59,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,inpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,145.00,341.50,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,266.07,526.71,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,271.50,639.03,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,inpatient,,,306.76000,291.42000,The Alliance,PPO Network,,254.92,,,,,,,150.31,297.56,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,PPO Network,,254.92,,,,,,,153.38,630.65,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,inpatient,,,174.49000,165.77000,The Alliance,PPO Network,,145.00,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,PPO Network,,145.00,,,,,,,87.25,358.73,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,23.25,430.17,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,293.70000,279.02000,The Alliance,PPO Network,,244.06,,,,,,,143.91,284.89,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,293.70000,279.02000,The Alliance,PPO Network,,244.06,,,,,,,146.85,284.89,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,inpatient,,,2541.00000,2413.95000,The Alliance,PPO Network,,2111.57,,,,,,,1245.09,2464.77,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,outpatient,,,2541.00000,2413.95000,The Alliance,PPO Network,,2111.57,,,,,,,1166.32,2464.77,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,inpatient,,,384.09000,364.89000,The Alliance,PPO Network,,319.18,,,,,,,188.20,372.57,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,outpatient,,,384.09000,364.89000,The Alliance,PPO Network,,319.18,,,,,,,192.04,487.84,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,The Alliance,PPO Network,,156.75,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,PPO Network,,156.75,,,,,,,55.62,188.63,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,12.54,24.83,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,11.75,24.83,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,31.84,56.16,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,28.95,56.16,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,inpatient,,,174.49000,165.77000,The Alliance,PPO Network,,145.00,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,PPO Network,,145.00,,,,,,,87.25,358.73,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,152.90,269.66,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,139.00,269.66,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,The Alliance,PPO Network,,156.75,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,PPO Network,,156.75,,,,,,,55.62,188.63,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,294.98,583.94,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,301.00,583.94,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,inpatient,,,148.65000,141.22000,The Alliance,PPO Network,,123.53,,,,,,,72.84,144.19,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,outpatient,,,148.65000,141.22000,The Alliance,PPO Network,,123.53,,,,,,,68.23,144.19,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,inpatient,,,66.80000,63.46000,The Alliance,PPO Network,,55.51,,,,,,,32.73,64.80,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,outpatient,,,66.80000,63.46000,The Alliance,PPO Network,,55.51,,,,,,,33.40,134.06,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,inpatient,,,40.48000,38.46000,The Alliance,PPO Network,,33.64,,,,,,,19.84,39.27,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,outpatient,,,40.48000,38.46000,The Alliance,PPO Network,,33.64,,,,,,,20.24,313.88,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,inpatient,,,80.27000,76.26000,The Alliance,PPO Network,,66.70,,,,,,,39.33,77.86,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,outpatient,,,80.27000,76.26000,The Alliance,PPO Network,,66.70,,,,,,,40.13,77.86,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,inpatient,,,14393.00000,13673.35000,The Alliance,PPO Network,,11960.58,,,,,,,7052.57,13961.21,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,outpatient,,,14393.00000,13673.35000,The Alliance,PPO Network,,11960.58,,,,,,,5640.97,13961.21,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,43.61,86.33,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,44.50,86.33,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,inpatient,,,42.80000,40.66000,The Alliance,PPO Network,,35.57,,,,,,,20.97,41.52,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,outpatient,,,42.80000,40.66000,The Alliance,PPO Network,,35.57,,,,,,,21.40,41.52,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,399.94000,379.94000,The Alliance,PPO Network,,332.35,,,,,,,195.97,387.94,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,PPO Network,,332.35,,,,,,,199.97,387.94,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,inpatient,,,89.33000,84.86000,The Alliance,PPO Network,,74.23,,,,,,,43.77,86.65,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,outpatient,,,89.33000,84.86000,The Alliance,PPO Network,,74.23,,,,,,,44.66,91.99,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,inpatient,,,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,outpatient,,,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.30,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,5.87,113.69,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,257.95,454.93,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,56.40,454.93,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,inpatient,,,1327.00000,1260.65000,The Alliance,PPO Network,,1102.74,,,,,,,729.85,1287.19,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,outpatient,,,1327.00000,1260.65000,The Alliance,PPO Network,,1102.74,,,,,,,314.95,1287.19,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,inpatient,,,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,outpatient,,,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,0.31000,5.61,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,inpatient,,,77.20000,73.34000,The Alliance,PPO Network,,64.15,,,,,,,42.46,74.88,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,outpatient,,,77.20000,73.34000,The Alliance,PPO Network,,64.15,,,,,,,38.60,550.14,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,inpatient,,,56.50000,53.67000,The Alliance,PPO Network,,46.95,,,,,,,27.68,54.80,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,outpatient,,,56.50000,53.67000,The Alliance,PPO Network,,46.95,,,,,,,28.25,54.80,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,114.56000,108.83000,The Alliance,PPO Network,,95.20,,,,,,,56.13,111.12,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,114.56000,108.83000,The Alliance,PPO Network,,95.20,,,,,,,57.28,111.12,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,91.53000,86.95000,The Alliance,PPO Network,,76.06,,,,,,,44.85,88.78,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,91.53000,86.95000,The Alliance,PPO Network,,76.06,,,,,,,45.77,95.58,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,302.81000,287.67000,The Alliance,PPO Network,,251.64,,,,,,,148.38,293.73,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,302.81000,287.67000,The Alliance,PPO Network,,251.64,,,,,,,151.41,293.73,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.27,6.47,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,70.48,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,inpatient,,,3562.00000,3383.90000,The Alliance,PPO Network,TC,2960.02,,,,,,,1959.10,3455.14,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,PPO Network,TC,2960.02,,,,,,,1781.00,5271.00,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,inpatient,,,51.73000,49.14000,The Alliance,PPO Network,,42.99,,,,,,,25.35,50.18,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,outpatient,,,51.73000,49.14000,The Alliance,PPO Network,,42.99,,,,,,,23.74,50.18,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,inpatient,,,812.00000,771.40000,The Alliance,PPO Network,,674.77,,,,,,,397.88,787.64,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,outpatient,,,812.00000,771.40000,The Alliance,PPO Network,,674.77,,,,,,,372.71,812.00,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,241.18,477.44,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,PPO Network,,409.03,,,,,,,246.10,477.44,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,inpatient,,,3214.00000,3053.30000,The Alliance,PPO Network,,2670.83,,,,,,,1574.86,3117.58,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,outpatient,,,3214.00000,3053.30000,The Alliance,PPO Network,,2670.83,,,,,,,1607.00,3117.58,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,inpatient,,,876.00000,832.20000,The Alliance,PPO Network,,727.96,,,,,,,429.24,849.72,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,outpatient,,,876.00000,832.20000,The Alliance,PPO Network,,727.96,,,,,,,438.00,849.72,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,44.77000,42.53000,The Alliance,PPO Network,,37.20,,,,,,,21.94,43.43,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,44.77000,42.53000,The Alliance,PPO Network,,37.20,,,,,,,22.39,121.81,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.48,30.65,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,14.50,30.65,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,436.46000,414.64000,The Alliance,PPO Network,,362.70,,,,,,,213.87,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,PPO Network,,362.70,,,,,,,99.97,423.37,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,inpatient,,,2171.00000,2062.45000,The Alliance,PPO Network,,1804.10,,,,,,,1063.79,2105.87,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,outpatient,,,2171.00000,2062.45000,The Alliance,PPO Network,,1804.10,,,,,,,1085.50,2105.87,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1053.99,2086.47,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1075.50,2086.47,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,inpatient,,,55.45000,52.68000,The Alliance,PPO Network,,46.08,,,,,,,27.17,53.79,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,outpatient,,,55.45000,52.68000,The Alliance,PPO Network,,46.08,,,,,,,27.73,102.20,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,inpatient,,,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,outpatient,,,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,0.80300,1.94,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,inpatient,,,307.50000,292.12000,The Alliance,PPO Network,,255.53,,,,,,,150.68,298.27,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,PPO Network,,255.53,,,,,,,133.85,298.27,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,57.29000,54.43000,The Alliance,PPO Network,,47.61,,,,,,,28.07,55.57,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,57.29000,54.43000,The Alliance,PPO Network,,47.61,,,,,,,28.64,315.32,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,201.85,355.99,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,56.40,355.99,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,inpatient,,,711.00000,675.45000,The Alliance,PPO Network,,590.84,,,,,,,391.05,689.67,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,outpatient,,,711.00000,675.45000,The Alliance,PPO Network,,590.84,,,,,,,314.95,689.67,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,57.91000,55.01000,The Alliance,PPO Network,,48.12,,,,,,,28.38,56.17,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,57.91000,55.01000,The Alliance,PPO Network,,48.12,,,,,,,28.95,93.98,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,57.80000,54.91000,The Alliance,PPO Network,,48.03,,,,,,,28.32,56.07,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,PPO Network,,48.03,,,,,,,28.90,315.32,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,381.46000,362.39000,The Alliance,PPO Network,,316.99,,,,,,,186.92,370.02,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,381.46000,362.39000,The Alliance,PPO Network,,316.99,,,,,,,190.73,449.21,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,152.51,301.91,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,86.36,301.91,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,29.96000,28.46000,The Alliance,PPO Network,,24.90,,,,,,,14.68,29.06,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,29.96000,28.46000,The Alliance,PPO Network,,24.90,,,,,,,14.98,92.45,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,191.95,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,122.40,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,33.55,59.17,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,30.50,134.64,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,56.40,185.27,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,52,132.96,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,52,132.96,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,52,158.72,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,52,158.72,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,52,158.72,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,52,158.72,,,,,,,95.50,185.27,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,191.40,337.56,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,148.57,337.56,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,PPO Network,,383.92,,,,,,,254.10,448.14,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,PPO Network,,383.92,,,,,,,231.00,448.14,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,inpatient,,,2008.00000,1907.60000,The Alliance,PPO Network,,1668.65,,,,,,,1104.40,1947.76,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,outpatient,,,2008.00000,1907.60000,The Alliance,PPO Network,,1668.65,,,,,,,87.16,1947.76,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,10.45,18.43,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,9.50,18.43,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,34.92,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,56.40,116.40,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,45.10,79.54,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,41.00,79.54,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,15.50,30.07,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,148.50,261.90,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,56.40,261.90,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,42.50,554.21,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,71.50,308.32,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,41.56000,39.48000,The Alliance,PPO Network,,34.54,,,,,,,20.36,40.31,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,41.56000,39.48000,The Alliance,PPO Network,,34.54,,,,,,,19.08,41.56,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,505.88000,480.59000,The Alliance,PPO Network,,420.39,,,,,,,247.88,490.70,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,505.88000,480.59000,The Alliance,PPO Network,,420.39,,,,,,,232.20,505.88,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,637.50000,605.62000,The Alliance,PPO Network,,529.76,,,,,,,312.38,618.38,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,PPO Network,,529.76,,,,,,,292.61,637.50,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,53.50,103.79,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,inpatient,,,1130.00000,1073.50000,The Alliance,PPO Network,TC,939.03,,,,,,,621.50,1096.10,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,PPO Network,TC,939.03,,,,,,,565.00,1096.10,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,inpatient,,,474.00000,450.30000,The Alliance,PPO Network,TC,393.89,,,,,,,260.70,459.78,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,PPO Network,TC,393.89,,,,,,,237.00,459.78,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,The Alliance,PPO Network,TC,1201.63,,,,,,,795.30,1402.62,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,PPO Network,TC,1201.63,,,,,,,723.00,1402.62,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,inpatient,,,315.00000,299.25000,The Alliance,PPO Network,TC,261.76,,,,,,,173.25,305.55,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,PPO Network,TC,261.76,,,,,,,157.50,305.55,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,inpatient,,,598.00000,568.10000,The Alliance,PPO Network,TC,496.94,,,,,,,328.90,580.06,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,PPO Network,TC,496.94,,,,,,,299.00,580.06,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,3.63,254.68,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,TC,61.49,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,TC,61.49,,,,,,,37.00,442.00,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,TC,44.04,,,,,,,29.15,51.41,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,TC,44.04,,,,,,,26.50,51.41,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,PPO Network,TC,21.61,,,,,,,14.30,25.22,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,PPO Network,TC,21.61,,,,,,,13.00,25.22,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,TC,108.03,,,,,,,71.50,126.10,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,TC,108.03,,,,,,,65.00,126.10,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,inpatient,,,4627.00000,4395.65000,The Alliance,PPO Network,TC,3845.04,,,,,,,2544.85,4488.19,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,outpatient,,,4627.00000,4395.65000,The Alliance,PPO Network,TC,3845.04,,,,,,,2313.50,4488.19,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,TC,24.93,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,TC,24.93,,,,,,,15.00,29.10,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,TC,1681.94,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,TC,1681.94,,,,,,,864.82,2960.49,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,,2325.14,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,,2325.14,,,,,,,169.04,2714.06,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,The Alliance,PPO Network,TC,3188.55,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,PPO Network,TC,3188.55,,,,,,,1626.53,3721.89,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,,1963.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,,1963.65,,,,,,,169.04,2292.11,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,272.50,528.65,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,52,61.49,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,52,61.49,,,,,,,37.00,442.00,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,828.00,1606.32,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,18.50,442.00,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,18.50,442.00,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,TC,1384.45,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,TC,1384.45,,,,,,,833.00,1616.02,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,PPO Network,TC,225.20,,,,,,,149.05,262.87,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,PPO Network,TC,225.20,,,,,,,135.50,262.87,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,PPO Network,TC,407.19,,,,,,,269.50,475.30,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,PPO Network,TC,407.19,,,,,,,245.00,475.30,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,PPO Network,TC,255.12,,,,,,,168.85,297.79,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,PPO Network,TC,255.12,,,,,,,153.50,297.79,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,The Alliance,PPO Network,TC,431.29,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,PPO Network,TC,431.29,,,,,,,259.50,503.43,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,inpatient,,,316.00000,300.20000,The Alliance,PPO Network,TC,262.60,,,,,,,173.80,306.52,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,PPO Network,TC,262.60,,,,,,,158.00,306.52,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,PPO Network,TC,560.09,,,,,,,370.70,653.78,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,PPO Network,TC,560.09,,,,,,,337.00,653.78,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,655.05,1155.27,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,595.50,1155.27,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,The Alliance,PPO Network,TC,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,PPO Network,TC,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,The Alliance,PPO Network,TC,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,PPO Network,TC,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1360.00000,1292.00000,The Alliance,PPO Network,TC,1130.16,,,,,,,748.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1360.00000,1292.00000,The Alliance,PPO Network,TC,1130.16,,,,,,,680.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,614.00,1191.16,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,TC,206.92,,,,,,,136.95,241.53,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,TC,206.92,,,,,,,124.50,241.53,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,The Alliance,PPO Network,TC,2769.72,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,PPO Network,TC,2769.72,,,,,,,1666.50,3233.01,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,TC,1060.36,,,,,,,701.80,1237.72,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,TC,1060.36,,,,,,,638.00,1237.72,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2015.00,3909.10,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,The Alliance,PPO Network,TC,2121.54,,,,,,,1404.15,2476.41,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,PPO Network,TC,2121.54,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,The Alliance,PPO Network,TC,976.42,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,PPO Network,TC,976.42,,,,,,,587.50,1139.75,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1247.95,2200.93,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1134.50,2200.93,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,TC,176.17,,,,,,,116.60,205.64,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,TC,176.17,,,,,,,106.00,205.64,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,PPO Network,TC,213.57,,,,,,,141.35,249.29,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,PPO Network,TC,213.57,,,,,,,128.50,249.29,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,The Alliance,PPO Network,TC,2233.73,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,PPO Network,TC,2233.73,,,,,,,1344.00,2607.36,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,inpatient,,,564.00000,535.80000,The Alliance,PPO Network,TC,468.68,,,,,,,310.20,547.08,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,PPO Network,TC,468.68,,,,,,,282.00,5271.00,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,The Alliance,PPO Network,TC,2060.05,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,PPO Network,TC,2060.05,,,,,,,909.00,5271.00,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,PPO Network,TC,15.79,,,,,,,10.45,18.43,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,PPO Network,TC,15.79,,,,,,,9.50,18.43,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,inpatient,,,2018.00000,1917.10000,The Alliance,PPO Network,TC,1676.96,,,,,,,1109.90,1957.46,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,outpatient,,,2018.00000,1917.10000,The Alliance,PPO Network,TC,1676.96,,,,,,,909.00,5271.00,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,The Alliance,PPO Network,TC,2000.22,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,PPO Network,TC,2000.22,,,,,,,1203.50,2334.79,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,inpatient,,,219.00000,208.05000,The Alliance,PPO Network,TC,181.99,,,,,,,120.45,212.43,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,PPO Network,TC,181.99,,,,,,,109.50,212.43,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,The Alliance,PPO Network,,2060.05,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,PPO Network,,2060.05,,,,,,,503.83,5271.00,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,TC,280.88,,,,,,,185.90,327.86,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,TC,280.88,,,,,,,169.00,327.86,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,TC,63.99,,,,,,,42.35,74.69,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,TC,63.99,,,,,,,38.50,74.69,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,1004.85,1772.19,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,913.50,1772.19,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,The Alliance,PPO Network,TC,2355.05,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,PPO Network,TC,2355.05,,,,,,,1132.05,2748.98,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,inpatient,,,269.00000,255.55000,The Alliance,PPO Network,TC,223.54,,,,,,,147.95,260.93,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,PPO Network,TC,223.54,,,,,,,134.50,1635.52,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,inpatient,,,2546.00000,2418.70000,The Alliance,PPO Network,TC,2115.73,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,PPO Network,TC,2115.73,,,,,,,1400.30,5271.00,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,TC,1360.35,,,,,,,900.35,1587.89,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,TC,1360.35,,,,,,,818.50,1587.89,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,TC,152.90,,,,,,,101.20,178.48,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,TC,152.90,,,,,,,92.00,178.48,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,TC,187.81,,,,,,,124.30,219.22,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,TC,187.81,,,,,,,113.00,219.22,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,TC,92.24,,,,,,,61.05,107.67,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,TC,92.24,,,,,,,55.50,107.67,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,81.50,554.21,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,inpatient,,,3396.00000,3226.20000,The Alliance,PPO Network,TC,2822.08,,,,,,,1867.80,3294.12,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,outpatient,,,3396.00000,3226.20000,The Alliance,PPO Network,TC,2822.08,,,,,,,1698.00,3294.12,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,TC,108.03,,,,,,,71.50,126.10,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,TC,108.03,,,,,,,65.00,126.10,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,TC,37.40,,,,,,,24.75,43.65,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,TC,37.40,,,,,,,22.50,43.65,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,PPO Network,TC,781.14,,,,,,,517.00,911.80,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,PPO Network,TC,781.14,,,,,,,470.00,911.80,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,inpatient,,,785.00000,745.75000,The Alliance,PPO Network,TC,652.34,,,,,,,431.75,761.45,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,PPO Network,TC,652.34,,,,,,,392.50,761.45,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1652.75,2914.85,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1128.45,2914.85,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,PPO Network,TC,798.59,,,,,,,528.55,932.17,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,PPO Network,TC,798.59,,,,,,,480.50,932.17,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,PPO Network,TC,395.56,,,,,,,261.80,461.72,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,PPO Network,TC,395.56,,,,,,,238.00,461.72,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,47.50,860.53,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,TC,139.61,,,,,,,92.40,162.96,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,TC,139.61,,,,,,,84.00,162.96,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,inpatient,,,12.00000,11.40000,The Alliance,PPO Network,TC,9.97,,,,,,,6.60,11.64,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,PPO Network,TC,9.97,,,,,,,6.00,11.64,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,inpatient,,,1134.00000,1077.30000,The Alliance,PPO Network,TC,942.35,,,,,,,623.70,1099.98,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,PPO Network,TC,942.35,,,,,,,567.00,1099.98,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,inpatient,,,285.90000,271.60000,The Alliance,PPO Network,TC,237.58,,,,,,,157.25,277.32,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,outpatient,,,285.90000,271.60000,The Alliance,PPO Network,TC,237.58,,,,,,,142.95,277.32,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,inpatient,,,152.50000,144.88000,The Alliance,PPO Network,TC,126.73,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,PPO Network,TC,126.73,,,,,,,76.25,147.93,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,TC,473.67,,,,,,,313.50,552.90,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,TC,473.67,,,,,,,118.53,1430.78,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,inpatient,,,2216.00000,2105.20000,The Alliance,PPO Network,TC,1841.50,,,,,,,1218.80,2149.52,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,outpatient,,,2216.00000,2105.20000,The Alliance,PPO Network,TC,1841.50,,,,,,,1108.00,2149.52,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,inpatient,,,80.70000,76.66000,The Alliance,PPO Network,,67.06,,,,,,,44.38,78.28,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,outpatient,,,80.70000,76.66000,The Alliance,PPO Network,,67.06,,,,,,,40.35,91.97,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,288.20,508.28,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,262.00,508.28,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,TC,128.81,,,,,,,85.25,150.35,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,TC,128.81,,,,,,,77.50,150.35,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,PPO Network,TC,115.51,,,,,,,76.45,134.83,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,PPO Network,TC,115.51,,,,,,,69.50,134.83,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,,2838.70,,,,,,,1878.80,3313.52,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,,2838.70,,,,,,,169.04,3313.52,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,inpatient,,,375.50000,356.72000,The Alliance,PPO Network,TC,312.04,,,,,,,206.53,364.24,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,outpatient,,,375.50000,356.72000,The Alliance,PPO Network,TC,312.04,,,,,,,187.75,364.24,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,230.00,446.20,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,inpatient,,,6252.00000,5939.40000,The Alliance,PPO Network,TC,5195.41,,,,,,,3438.60,6064.44,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,outpatient,,,6252.00000,5939.40000,The Alliance,PPO Network,TC,5195.41,,,,,,,3126.00,6064.44,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,inpatient,,,152.50000,144.88000,The Alliance,PPO Network,TC,126.73,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,PPO Network,TC,126.73,,,,,,,76.25,147.93,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,inpatient,,,13.00000,12.35000,The Alliance,PPO Network,TC,10.80,,,,,,,7.15,12.61,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,outpatient,,,13.00000,12.35000,The Alliance,PPO Network,TC,10.80,,,,,,,6.50,12.61,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,inpatient,,,1150.00000,1092.50000,The Alliance,PPO Network,TC,955.65,,,,,,,632.50,1115.50,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,outpatient,,,1150.00000,1092.50000,The Alliance,PPO Network,TC,955.65,,,,,,,575.00,1115.50,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,5936.70,10470.18,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,5397.00,10470.18,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,inpatient,,,489.00000,464.55000,The Alliance,PPO Network,TC,406.36,,,,,,,268.95,474.33,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,PPO Network,TC,406.36,,,,,,,244.50,474.33,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,inpatient,,,5814.00000,5523.30000,The Alliance,PPO Network,TC,4831.43,,,,,,,3197.70,5639.58,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,outpatient,,,5814.00000,5523.30000,The Alliance,PPO Network,TC,4831.43,,,,,,,377.14,7206.00,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,TC,190.30,,,,,,,125.95,222.13,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,TC,190.30,,,,,,,114.50,222.13,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,102.30,180.42,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,93.00,180.42,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,inpatient,,,312.00000,296.40000,The Alliance,PPO Network,TC,259.27,,,,,,,171.60,302.64,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,PPO Network,TC,259.27,,,,,,,156.00,302.64,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,PPO Network,TC,167.03,,,,,,,110.55,194.97,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,PPO Network,TC,167.03,,,,,,,100.50,194.97,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,299.75,528.65,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,272.50,528.65,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1404.95,2770.32,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,inpatient,,,1073.00000,1019.35000,The Alliance,PPO Network,TC,891.66,,,,,,,590.15,1040.81,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,PPO Network,TC,891.66,,,,,,,536.50,1040.81,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1399.96,2770.32,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1047.39,2099.08,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,761.71,1516.11,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,765.41,1516.11,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,inpatient,,,284.00000,269.80000,The Alliance,PPO Network,TC,236.00,,,,,,,156.20,275.48,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,PPO Network,TC,236.00,,,,,,,142.00,275.48,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,763.56,1516.11,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,140.80,248.32,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,128.00,248.32,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,132.00,232.80,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,120.00,232.80,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,PPO Network,TC,292.51,,,,,,,193.60,341.44,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,PPO Network,TC,292.51,,,,,,,176.00,341.44,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1056.58,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,PPO Network,,1798.28,,,,,,,1049.24,2099.08,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,172.50,4020.73,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,138.00,267.72,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,TC,35.73,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,TC,35.73,,,,,,,21.50,41.71,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,PPO Network,TC,474.50,,,,,,,314.05,553.87,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,PPO Network,TC,474.50,,,,,,,285.50,1232.72,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,614.50,1192.13,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,TC,449.57,,,,,,,297.55,524.77,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,TC,449.57,,,,,,,270.50,1232.72,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,1767.08,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,TC,74.79,,,,,,,49.50,87.30,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,TC,74.79,,,,,,,45.00,87.30,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,TC,1491.64,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,TC,1491.64,,,,,,,897.50,1741.15,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,The Alliance,PPO Network,TC,3985.48,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,PPO Network,TC,3985.48,,,,,,,2398.00,4652.12,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,TC,34.90,,,,,,,23.10,40.74,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,TC,34.90,,,,,,,21.00,40.74,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,TC,1491.64,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,TC,1491.64,,,,,,,897.50,1741.15,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,157.00,304.58,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,68.74,718.77,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,inpatient,,,15.00000,14.25000,The Alliance,PPO Network,TC,12.46,,,,,,,8.25,14.55,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,PPO Network,TC,12.46,,,,,,,7.50,14.55,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,TC,35.73,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,TC,35.73,,,,,,,21.50,41.71,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,TC,1655.35,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,TC,1655.35,,,,,,,996.00,1932.24,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,TC,23.27,,,,,,,15.40,27.16,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,TC,23.27,,,,,,,14.00,27.16,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,TC,2813.77,,,,,,,1862.30,3284.42,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,TC,2813.77,,,,,,,1693.00,3284.42,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,,1655.35,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,,1655.35,,,,,,,100.97,1932.24,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,TC,215.23,,,,,,,142.45,251.23,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,TC,215.23,,,,,,,129.50,1145.46,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,122.10,215.34,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,111.00,215.34,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,The Alliance,PPO Network,TC,1317.97,,,,,,,872.30,1538.42,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,PPO Network,TC,1317.97,,,,,,,793.00,1538.42,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,820.60,1447.24,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,746.00,1447.24,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,inpatient,,,930.00000,883.50000,The Alliance,PPO Network,TC,772.83,,,,,,,511.50,902.10,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,outpatient,,,930.00000,883.50000,The Alliance,PPO Network,TC,772.83,,,,,,,465.00,902.10,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,TC,103.04,,,,,,,68.20,120.28,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,TC,103.04,,,,,,,62.00,120.28,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,TC,295.84,,,,,,,195.80,345.32,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,TC,295.84,,,,,,,178.00,2024.21,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,TC,73.96,,,,,,,48.95,86.33,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,TC,73.96,,,,,,,44.50,86.33,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,inpatient,,,617.00000,586.15000,The Alliance,PPO Network,TC,512.73,,,,,,,339.35,598.49,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,outpatient,,,617.00000,586.15000,The Alliance,PPO Network,TC,512.73,,,,,,,297.28,598.49,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,675.95,1192.13,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,606.90,5742.65,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,TC,49.03,,,,,,,32.45,57.23,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,TC,49.03,,,,,,,29.50,57.23,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,PPO Network,TC,355.67,,,,,,,235.40,415.16,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,PPO Network,TC,355.67,,,,,,,214.00,467.89,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,300.85,530.59,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,257.00,595.98,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,inpatient,,,465.00000,441.75000,The Alliance,PPO Network,TC,386.42,,,,,,,255.75,451.05,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,outpatient,,,465.00000,441.75000,The Alliance,PPO Network,TC,386.42,,,,,,,232.50,2134.86,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,inpatient,,,1556.00000,1478.20000,The Alliance,PPO Network,,1293.04,,,,,,,762.44,1509.32,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,PPO Network,,1293.04,,,,,,,714.20,1556.00,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,inpatient,,,12133.00000,11526.35000,The Alliance,PPO Network,,10082.52,,,,,,,6673.15,11769.01,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,outpatient,,,12133.00000,11526.35000,The Alliance,PPO Network,,10082.52,,,,,,,6066.50,11769.01,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,9.09,29.10,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,144.65,255.11,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,129.58,1272.59,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,PPO Network,TC,226.03,,,,,,,149.60,263.84,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,PPO Network,TC,226.03,,,,,,,125.88,1213.27,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,584.87,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,73.15,129.01,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,66.50,584.87,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,The Alliance,PPO Network,TC,959.80,,,,,,,635.25,1120.35,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,PPO Network,TC,959.80,,,,,,,577.50,1120.35,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,inpatient,,,4144.00000,3936.80000,The Alliance,PPO Network,,3443.66,,,,,,,2279.20,4019.68,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,outpatient,,,4144.00000,3936.80000,The Alliance,PPO Network,,3443.66,,,,,,,280.29,4019.68,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,548.00,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,655.05,1155.27,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,384.16,1155.27,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,163.90,289.06,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,149.00,1569.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,TC,173.68,,,,,,,114.95,202.73,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,TC,173.68,,,,,,,104.50,1114.32,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,PPO Network,TC,179.50,,,,,,,118.80,209.52,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,PPO Network,TC,179.50,,,,,,,108.00,1193.49,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,PPO Network,TC,220.22,,,,,,,145.75,257.05,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,PPO Network,TC,220.22,,,,,,,132.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,151.80,267.72,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,138.00,1371.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,154.77,308.46,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,The Alliance,PPO Network,TC,3997.94,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,PPO Network,TC,3997.94,,,,,,,1285.85,4666.67,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,125.88,1213.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,122.10,215.34,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,111.00,1094.55,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,inpatient,1,EA,10866.46000,10323.14000,The Alliance,PPO Network,,9030.03,,,,,,,5976.55,10540.47,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,outpatient,1,EA,10866.46000,10323.14000,The Alliance,PPO Network,,9030.03,,,,,,,4.49,10540.47,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,inpatient,1,mL,1294.48000,1229.75000,The Alliance,PPO Network,,1075.71,,,,,,,711.96,1255.65,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,outpatient,1,mL,1294.48000,1229.75000,The Alliance,PPO Network,,1075.71,,,,,,,11.03,1255.65,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,inpatient,1,mL,781.97000,742.88000,The Alliance,PPO Network,,649.82,,,,,,,430.08,758.51,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,outpatient,1,mL,781.97000,742.88000,The Alliance,PPO Network,,649.82,,,,,,,24.87,758.51,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,126.50,1331.91,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,42.40000,40.28000,The Alliance,PPO Network,,35.23,,,,,,,20.78,41.13,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,42.40000,40.28000,The Alliance,PPO Network,,35.23,,,,,,,21.20,41.13,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,The Alliance,PPO Network,TC,796.10,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,PPO Network,TC,796.10,,,,,,,384.16,1329.46,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,PPO Network,TC,267.58,,,,,,,177.10,312.34,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,PPO Network,TC,267.58,,,,,,,161.00,1628.59,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,inpatient,1,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,7.39,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,6.71,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,3.07,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,2.79,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,inpatient,120,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,outpatient,120,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,inpatient,120,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,outpatient,120,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,inpatient,120,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,outpatient,120,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,inpatient,120,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,outpatient,120,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,inpatient,1,mL,17.06000,16.21000,The Alliance,PPO Network,,14.18,,,,,,,9.38,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,outpatient,1,mL,17.06000,16.21000,The Alliance,PPO Network,,14.18,,,,,,,0.14409,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,inpatient,1,mL,20.10000,19.09000,The Alliance,PPO Network,,16.70,,,,,,,11.05,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,outpatient,1,mL,20.10000,19.09000,The Alliance,PPO Network,,16.70,,,,,,,0.14409,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,inpatient,1,mL,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,12.51,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,outpatient,1,mL,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,0.14409,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,inpatient,1,mL,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,14.43,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,0.14409,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,inpatient,1,mL,14.49000,13.77000,The Alliance,PPO Network,,12.04,,,,,,,7.97,14.06,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,outpatient,1,mL,14.49000,13.77000,The Alliance,PPO Network,,12.04,,,,,,,0.14409,14.06,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,inpatient,1,EA,0.83000,0.78000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,outpatient,1,EA,0.83000,0.78000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,137.50,242.50,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,125.00,1331.91,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,151.25,266.75,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,137.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,119.35,210.49,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,108.50,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,145.20,256.08,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,120.38,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,177.65,313.31,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,161.50,1648.36,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,TC,205.26,,,,,,,135.85,239.59,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,TC,205.26,,,,,,,123.50,1233.04,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,PPO Network,TC,695.55,,,,,,,460.35,811.89,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,PPO Network,TC,695.55,,,,,,,418.50,811.89,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,73.15,129.01,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,66.50,584.87,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,The Alliance,PPO Network,TC,1161.74,,,,,,,768.90,1356.06,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,PPO Network,TC,1161.74,,,,,,,384.16,1356.06,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,The Alliance,PPO Network,TC,486.97,,,,,,,322.30,568.42,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,PPO Network,TC,486.97,,,,,,,247.28,568.42,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,567.05,1000.07,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,384.16,1000.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,457.05,806.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,384.16,806.07,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,101.94,1193.49,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,163.90,289.06,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,135.13,1430.78,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,The Alliance,PPO Network,TC,1504.94,,,,,,,996.05,1756.67,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,PPO Network,TC,1504.94,,,,,,,905.50,8808.48,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,PPO Network,TC,425.47,,,,,,,281.60,496.64,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,PPO Network,TC,425.47,,,,,,,151.73,1628.59,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,172.00,1786.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,PPO Network,TC,253.46,,,,,,,167.75,295.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,PPO Network,TC,253.46,,,,,,,152.50,1628.59,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,102.30,180.42,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,93.00,1074.77,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,170.00,1786.85,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,158.40,279.36,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,144.00,1549.49,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,140.80,248.32,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,77.99,1015.45,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,PPO Network,TC,670.62,,,,,,,443.85,782.79,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,PPO Network,TC,670.62,,,,,,,403.50,5149.29,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,TC,240.16,,,,,,,158.95,280.33,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,TC,240.16,,,,,,,144.50,1509.95,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,166.47,1628.59,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,TC,145.43,,,,,,,96.25,169.75,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,TC,145.43,,,,,,,87.50,876.96,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,PPO Network,TC,200.27,,,,,,,132.55,233.77,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,PPO Network,TC,200.27,,,,,,,120.50,1213.27,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,151.00,1509.95,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,409.20,721.68,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,372.00,4002.11,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,PPO Network,TC,252.62,,,,,,,167.20,294.88,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,PPO Network,TC,252.62,,,,,,,152.00,1569.27,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,181.50,320.10,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,165.00,1648.36,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,PPO Network,TC,511.06,,,,,,,338.25,596.55,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,PPO Network,TC,511.06,,,,,,,307.50,3329.66,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,115.50,1213.27,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,TC,77.28,,,,,,,51.15,90.21,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,TC,77.28,,,,,,,46.50,3015.65,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,PPO Network,TC,481.98,,,,,,,319.00,562.60,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,PPO Network,TC,481.98,,,,,,,290.00,5821.82,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,134.75,237.65,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,122.50,1292.36,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,The Alliance,PPO Network,TC,970.61,,,,,,,642.40,1132.96,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,PPO Network,TC,970.61,,,,,,,278.89,2676.90,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,PPO Network,TC,195.28,,,,,,,129.25,227.95,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,PPO Network,TC,195.28,,,,,,,117.50,1233.04,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,inpatient,,,1544.00000,1466.80000,The Alliance,PPO Network,,1283.06,,,,,,,849.20,1497.68,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,outpatient,,,1544.00000,1466.80000,The Alliance,PPO Network,,1283.06,,,,,,,772.00,7180.14,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,inpatient,1,mL,8.71000,8.28000,The Alliance,PPO Network,,7.24,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,PPO Network,,7.24,,,,,,,0.93155,8.45,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,,2391.62,,,,,,,1582.90,2791.66,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,,2391.62,,,,,,,549.28,22788.40,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,The Alliance,PPO Network,,4304.58,,,,,,,2849.00,5024.60,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,PPO Network,,4304.58,,,,,,,549.28,30205.49,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,PPO Network,,602.48,,,,,,,398.75,703.25,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,PPO Network,,602.48,,,,,,,237.91,17311.25,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,,3864.98,,,,,,,2558.05,4511.47,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,,3864.98,,,,,,,103.97,7209.59,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,The Alliance,PPO Network,,1809.92,,,,,,,1197.90,2112.66,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,PPO Network,,1809.92,,,,,,,381.55,2210.07,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,The Alliance,PPO Network,,1667.82,,,,,,,1103.85,1946.79,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,PPO Network,,1667.82,,,,,,,511.11,2960.49,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,The Alliance,PPO Network,,4295.44,,,,,,,2842.95,5013.93,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,PPO Network,,4295.44,,,,,,,2584.50,5013.93,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,The Alliance,PPO Network,,1019.01,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,PPO Network,,1019.01,,,,,,,562.85,1226.25,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,427.50000,406.12000,The Alliance,PPO Network,,355.25,,,,,,,209.47,414.68,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,427.50000,406.12000,The Alliance,PPO Network,,355.25,,,,,,,196.22,427.50,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3087.92,6727.50,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,182.00,456.63,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,The Alliance,PPO Network,,2898.53,,,,,,,1918.40,3383.36,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,PPO Network,,2898.53,,,,,,,511.11,3383.36,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,The Alliance,PPO Network,,2886.89,,,,,,,1910.70,3369.78,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,PPO Network,,2886.89,,,,,,,1239.61,7180.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,inpatient,,,3562.00000,3383.90000,The Alliance,PPO Network,,2960.02,,,,,,,1959.10,3455.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,PPO Network,,2960.02,,,,,,,371.02,10740.24,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,0.60838,61.30,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,The Alliance,PPO Network,,2761.41,,,,,,,1827.65,3223.31,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,PPO Network,,2761.41,,,,,,,383.91,10740.24,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,The Alliance,PPO Network,,2618.48,,,,,,,1733.05,3056.47,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,PPO Network,,2618.48,,,,,,,1733.05,5271.00,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,inpatient,,,2262.00000,2148.90000,The Alliance,PPO Network,,1879.72,,,,,,,1244.10,2194.14,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,outpatient,,,2262.00000,2148.90000,The Alliance,PPO Network,,1879.72,,,,,,,1131.00,15808.09,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2137.79,4657.50,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,The Alliance,PPO Network,,2364.02,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,PPO Network,,2364.02,,,,,,,1305.76,2844.79,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,The Alliance,PPO Network,,12824.50,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,PPO Network,,12824.50,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,The Alliance,PPO Network,,8294.09,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,PPO Network,,8294.09,,,,,,,4581.21,9980.85,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4205.10000,3994.85000,The Alliance,PPO Network,,3494.44,,,,,,,2060.50,4078.95,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4205.10000,3994.85000,The Alliance,PPO Network,,3494.44,,,,,,,1930.14,4205.10,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,inpatient,1,mL,78.92000,74.98000,The Alliance,PPO Network,,65.58,,,,,,,43.41,76.55,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,outpatient,1,mL,78.92000,74.98000,The Alliance,PPO Network,,65.58,,,,,,,14.12,76.55,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,549.28,20208.37,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,549.28,20181.52,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,,13790.44,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,,13790.44,,,,,,,1299.22,106944.98,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,2049.30,3614.22,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1863.00,3614.22,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,inpatient,,,497.00000,472.15000,The Alliance,PPO Network,,413.01,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,PPO Network,,413.01,,,,,,,248.50,7984.62,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,inpatient,,,497.00000,472.15000,The Alliance,PPO Network,,413.01,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,PPO Network,,413.01,,,,,,,248.50,7984.62,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,,1023.79,,,,,,,677.60,1195.04,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,,1023.79,,,,,,,381.55,2210.07,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,1155.00,2037.00,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,1050.00,2037.00,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,inpatient,,,2184.00000,2074.80000,The Alliance,PPO Network,TC,1814.90,,,,,,,1201.20,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,outpatient,,,2184.00000,2074.80000,The Alliance,PPO Network,TC,1814.90,,,,,,,1092.00,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,1004.85,1772.19,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,913.50,1772.19,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,TC,63.16,,,,,,,41.80,73.72,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,TC,63.16,,,,,,,38.00,73.72,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,inpatient,,,2153.00000,2045.35000,The Alliance,PPO Network,TC,1789.14,,,,,,,1184.15,2088.41,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,outpatient,,,2153.00000,2045.35000,The Alliance,PPO Network,TC,1789.14,,,,,,,1076.50,2088.41,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,,1608.82,,,,,,,1064.80,1877.92,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,,1608.82,,,,,,,511.11,2960.49,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,inpatient,,,4471.00000,4247.45000,The Alliance,PPO Network,,3715.40,,,,,,,2459.05,4336.87,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,PPO Network,,3715.40,,,,,,,1923.03,17311.25,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,The Alliance,PPO Network,,2096.61,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,PPO Network,,2096.61,,,,,,,1226.87,14613.37,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,inpatient,,,1046.00000,993.70000,The Alliance,PPO Network,,869.23,,,,,,,575.30,1014.62,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,PPO Network,,869.23,,,,,,,359.37,4736.20,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,,1384.45,,,,,,,916.30,1616.02,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,,1384.45,,,,,,,833.00,12150.98,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,inpatient,,,1702.00000,1616.90000,The Alliance,PPO Network,,1414.36,,,,,,,936.10,1650.94,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,outpatient,,,1702.00000,1616.90000,The Alliance,PPO Network,,1414.36,,,,,,,381.55,2210.07,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,inpatient,,,1129.00000,1072.55000,The Alliance,PPO Network,TC,938.20,,,,,,,620.95,1095.13,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,PPO Network,TC,938.20,,,,,,,564.50,1095.13,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,417.10,17311.25,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,inpatient,,,9110.00000,8654.50000,The Alliance,PPO Network,,7570.41,,,,,,,5010.50,8836.70,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,outpatient,,,9110.00000,8654.50000,The Alliance,PPO Network,,7570.41,,,,,,,381.55,8836.70,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,,978.09,,,,,,,647.35,1141.69,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,,978.09,,,,,,,519.48,7810.26,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,The Alliance,PPO Network,,1878.89,,,,,,,1243.55,2193.17,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,PPO Network,,1878.89,,,,,,,1243.55,5271.00,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,,2107.42,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,,2107.42,,,,,,,990.94,10533.78,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,inpatient,,,45977.00000,43678.15000,The Alliance,PPO Network,,38206.89,,,,,,,25287.35,44597.69,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,outpatient,,,45977.00000,43678.15000,The Alliance,PPO Network,,38206.89,,,,,,,5651.91,58409.77,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,inpatient,,,962.00000,913.90000,The Alliance,PPO Network,,799.42,,,,,,,529.10,933.14,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,outpatient,,,962.00000,913.90000,The Alliance,PPO Network,,799.42,,,,,,,249.71,10786.37,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,103.97,7859.04,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,249.71,14445.56,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,inpatient,,,3724.00000,3537.80000,The Alliance,PPO Network,,3094.64,,,,,,,2048.20,3612.28,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,outpatient,,,3724.00000,3537.80000,The Alliance,PPO Network,,3094.64,,,,,,,103.97,3612.28,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,297.55,524.77,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,126.07,524.77,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,The Alliance,PPO Network,,1002.19,,,,,,,663.30,1169.82,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,PPO Network,,1002.19,,,,,,,381.55,2210.07,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,91.88,181.88,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,86.06,187.50,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,The Alliance,PPO Network,,414.30,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,PPO Network,,414.30,,,,,,,228.84,498.56,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,The Alliance,PPO Network,,414.30,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,PPO Network,,414.30,,,,,,,228.84,498.56,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,216.31,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,100.97,5080.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,234.00,5323.40,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,283.25,499.55,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,inpatient,,,5332.00000,5065.40000,The Alliance,PPO Network,,4430.89,,,,,,,2932.60,5172.04,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,outpatient,,,5332.00000,5065.40000,The Alliance,PPO Network,,4430.89,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,The Alliance,PPO Network,,4653.60,,,,,,,3080.00,5432.00,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,PPO Network,,4653.60,,,,,,,2800.00,24628.72,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,PPO Network,,1976.12,,,,,,,138.83,7581.44,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,389.87,849.38,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8040.81,17518.10,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,1667.31,67198.78,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,The Alliance,PPO Network,,1562.28,,,,,,,1034.00,1823.60,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,PPO Network,,1562.28,,,,,,,81.69,1823.60,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,PPO Network,,620.76,,,,,,,410.85,724.59,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,PPO Network,,620.76,,,,,,,282.87,724.59,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,TC,73.96,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,TC,73.96,,,,,,,44.50,86.33,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,52.50,6772.18,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,inpatient,1,mL,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,outpatient,1,mL,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,111.65,196.91,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,101.50,3679.58,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,433.40,764.36,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,327.36,764.36,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,9.88,184.30,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,182.05,321.07,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,149.44,548.00,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,The Alliance,PPO Network,,1826.54,,,,,,,1208.90,2132.06,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,PPO Network,,1826.54,,,,,,,381.55,2210.07,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,,1625.44,,,,,,,1075.80,1897.32,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,,1625.44,,,,,,,295.69,1897.32,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,The Alliance,PPO Network,,2394.11,,,,,,,1584.55,2794.57,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,PPO Network,,2394.11,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,361.82,17311.25,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,inpatient,,,4753.00000,4515.35000,The Alliance,PPO Network,,3949.74,,,,,,,2614.15,4610.41,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,outpatient,,,4753.00000,4515.35000,The Alliance,PPO Network,,3949.74,,,,,,,431.85,6628.38,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,PPO Network,,465.36,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,PPO Network,,465.36,,,,,,,280.00,4040.81,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,500.59,29731.35,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,439.81,17311.25,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,The Alliance,PPO Network,,3667.20,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,PPO Network,,3667.20,,,,,,,498.74,29731.35,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,411.55,17311.25,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,394.96,17311.25,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,The Alliance,PPO Network,,1368.66,,,,,,,905.85,1597.59,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,PPO Network,,1368.66,,,,,,,574.33,17311.25,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,The Alliance,PPO Network,,3902.38,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,PPO Network,,3902.38,,,,,,,595.74,17311.25,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,378.42,17311.25,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,,3275.80,,,,,,,2168.10,3823.74,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,,3275.80,,,,,,,356.27,17311.25,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,The Alliance,PPO Network,,2630.95,,,,,,,1741.30,3071.02,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,PPO Network,,2630.95,,,,,,,418.96,17311.25,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,,1166.72,,,,,,,772.20,1361.88,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,,1166.72,,,,,,,227.70,5633.78,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,The Alliance,PPO Network,,1204.95,,,,,,,797.50,1406.50,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,PPO Network,,1204.95,,,,,,,723.58,29731.35,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,inpatient,,,4226.00000,4014.70000,The Alliance,PPO Network,,3511.81,,,,,,,2324.30,4099.22,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,outpatient,,,4226.00000,4014.70000,The Alliance,PPO Network,,3511.81,,,,,,,960.76,17311.25,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,,2999.91,,,,,,,550.38,17311.25,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,,1186.67,,,,,,,785.40,1385.16,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,,1186.67,,,,,,,463.75,17311.25,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,The Alliance,PPO Network,,1379.46,,,,,,,913.00,1610.20,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,PPO Network,,1379.46,,,,,,,426.30,17311.25,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,,3479.40,,,,,,,417.10,17311.25,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,72.50,548.00,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,2.24,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,2032.87,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,96.25,169.75,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,87.50,1544.85,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,12.90,679.08,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,72.50,548.00,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.38,458.40,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,9.98,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,90,20.77,,,,,,,13.75,24.25,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,90,20.77,,,,,,,12.50,1426.03,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,0.04803,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,inpatient,1,mL,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,outpatient,1,mL,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,0.04803,5.36,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,inpatient,,,3479.00000,3305.05000,The Alliance,PPO Network,TC,2891.05,,,,,,,1913.45,3374.63,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,outpatient,,,3479.00000,3305.05000,The Alliance,PPO Network,TC,2891.05,,,,,,,1628.38,3374.63,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,inpatient,10,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,outpatient,10,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,0.04803,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,inpatient,10,EA,5.94000,5.64000,The Alliance,PPO Network,,4.94,,,,,,,3.27,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,outpatient,10,EA,5.94000,5.64000,The Alliance,PPO Network,,4.94,,,,,,,0.04803,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,inpatient,10,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,outpatient,10,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.04803,1.32,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,74.34,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.08000,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,inpatient,1,mL,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,outpatient,1,mL,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.08000,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,inpatient,1,mL,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.08000,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,inpatient,1,mL,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.08000,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.08000,0.29100,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,190.85,336.59,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,38.62,2020.22,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,inpatient,1,EA,1.39000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,outpatient,1,EA,1.39000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,inpatient,1,mL,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,outpatient,1,mL,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,inpatient,1,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,633.75000,602.06000,The Alliance,PPO Network,,526.65,,,,,,,310.54,614.74,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,633.75000,602.06000,The Alliance,PPO Network,,526.65,,,,,,,290.89,633.75,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,inpatient,1,EA,0.43000,0.40000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,outpatient,1,EA,0.43000,0.40000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,14.67,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,inpatient,1,EA,45.56000,43.28000,The Alliance,PPO Network,,37.86,,,,,,,25.06,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,outpatient,1,EA,45.56000,43.28000,The Alliance,PPO Network,,37.86,,,,,,,22.78,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,inpatient,1,mL,7855.65000,7462.87000,The Alliance,PPO Network,,6528.05,,,,,,,4320.61,7619.98,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,outpatient,1,mL,7855.65000,7462.87000,The Alliance,PPO Network,,6528.05,,,,,,,2440.70,7619.98,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,inpatient,1,EA,47.27000,44.91000,The Alliance,PPO Network,,39.28,,,,,,,26.00,45.85,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,outpatient,1,EA,47.27000,44.91000,The Alliance,PPO Network,,39.28,,,,,,,1.13,45.85,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,7.27,373.51,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,968.06,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,3163.00,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,inpatient,1,EA,333.18000,316.52000,The Alliance,PPO Network,,276.87,,,,,,,183.25,323.18,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,outpatient,1,EA,333.18000,316.52000,The Alliance,PPO Network,,276.87,,,,,,,166.59,323.18,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,223.30,393.82,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,32.62,1697.68,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,inpatient,15,EA,38.63000,36.70000,The Alliance,PPO Network,,32.10,,,,,,,21.25,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,outpatient,15,EA,38.63000,36.70000,The Alliance,PPO Network,,32.10,,,,,,,19.32,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,PPO Network,90,132.63,,,,,,,87.78,154.81,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,PPO Network,90,132.63,,,,,,,19.00,865.84,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,inpatient,1,EA,3284.86000,3120.62000,The Alliance,PPO Network,,2729.72,,,,,,,1806.67,3186.31,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,outpatient,1,EA,3284.86000,3120.62000,The Alliance,PPO Network,,2729.72,,,,,,,44.49,3186.31,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,inpatient,1,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,8.26,14.56,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,7.50,14.56,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,inpatient,8,EA,8.97000,8.53000,The Alliance,PPO Network,,7.45,,,,,,,4.93,8.70,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,outpatient,8,EA,8.97000,8.53000,The Alliance,PPO Network,,7.45,,,,,,,4.49,8.70,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,inpatient,30,EA,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,outpatient,30,EA,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,inpatient,30,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,inpatient,30,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,outpatient,30,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,14.67,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,inpatient,30,EA,19.80000,18.81000,The Alliance,PPO Network,,16.45,,,,,,,10.89,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,outpatient,30,EA,19.80000,18.81000,The Alliance,PPO Network,,16.45,,,,,,,0.59237,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,inpatient,30,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,outpatient,30,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.59237,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,inpatient,30,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.40,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,outpatient,30,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,0.59237,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,inpatient,30,EA,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,10.86,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,outpatient,30,EA,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,0.59237,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,inpatient,30,EA,21.80000,20.71000,The Alliance,PPO Network,,18.12,,,,,,,11.99,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,outpatient,30,EA,21.80000,20.71000,The Alliance,PPO Network,,18.12,,,,,,,0.59237,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,3.09,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,0.59237,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,inpatient,30,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.59237,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,inpatient,30,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,2.14,3.77,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,outpatient,30,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,0.59237,3.77,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,inpatient,5,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,outpatient,5,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,18.40,865.84,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,inpatient,1,EA,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,2.57,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,2.34,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,inpatient,,,214.70000,203.96000,The Alliance,PPO Network,90,178.42,,,,,,,118.08,208.26,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,PPO Network,90,178.42,,,,,,,12.70,577.23,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,inpatient,1,mL,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,2.85,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,inpatient,1,mL,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,outpatient,1,mL,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,88.11,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,247.50,436.50,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,247.50,5271.00,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,inpatient,3,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,outpatient,3,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,inpatient,3,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,inpatient,3,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,inpatient,3,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,inpatient,3,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,inpatient,3,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,inpatient,3,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,inpatient,3,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,PPO Network,,403.04,,,,,,,266.75,470.45,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,PPO Network,,403.04,,,,,,,47.63,2495.58,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,inpatient,30,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,outpatient,30,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,inpatient,1,EA,14.85000,14.11000,The Alliance,PPO Network,,12.34,,,,,,,8.17,14.40,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,PPO Network,,12.34,,,,,,,7.42,14.40,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,inpatient,,,167.30000,158.94000,The Alliance,PPO Network,90,139.03,,,,,,,92.02,162.28,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,PPO Network,90,139.03,,,,,,,17.43,882.80,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,inpatient,1,EA,5.93000,5.63000,The Alliance,PPO Network,,4.93,,,,,,,3.26,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,outpatient,1,EA,5.93000,5.63000,The Alliance,PPO Network,,4.93,,,,,,,2.96,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,inpatient,1,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.78,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,inpatient,1,EA,4.29000,4.08000,The Alliance,PPO Network,,3.56,,,,,,,2.36,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,outpatient,1,EA,4.29000,4.08000,The Alliance,PPO Network,,3.56,,,,,,,2.15,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,inpatient,1,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.87,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.70,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,inpatient,1,EA,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,outpatient,1,EA,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,inpatient,30,EA,26.39000,25.07000,The Alliance,PPO Network,,21.93,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,outpatient,30,EA,26.39000,25.07000,The Alliance,PPO Network,,21.93,,,,,,,1.13,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,inpatient,30,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,outpatient,30,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,1.13,22.99,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,inpatient,1,mL,10.42000,9.90000,The Alliance,PPO Network,,8.66,,,,,,,5.73,10.11,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,outpatient,1,mL,10.42000,9.90000,The Alliance,PPO Network,,8.66,,,,,,,5.21,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,inpatient,1,mL,11.07000,10.51000,The Alliance,PPO Network,,9.20,,,,,,,6.09,10.74,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,outpatient,1,mL,11.07000,10.51000,The Alliance,PPO Network,,9.20,,,,,,,5.54,14.67,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,inpatient,1,mL,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,outpatient,1,mL,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,inpatient,1,mL,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,88.11,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,inpatient,0.5,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,outpatient,0.5,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,inpatient,,,3438.00000,3266.10000,The Alliance,PPO Network,TC,2856.98,,,,,,,1890.90,3334.86,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,outpatient,,,3438.00000,3266.10000,The Alliance,PPO Network,TC,2856.98,,,,,,,1436.74,7180.14,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,inpatient,1,EA,11.41000,10.84000,The Alliance,PPO Network,,9.48,,,,,,,6.28,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,PPO Network,,9.48,,,,,,,5.71,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,inpatient,1,EA,8.49000,8.06000,The Alliance,PPO Network,,7.06,,,,,,,4.67,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,PPO Network,,7.06,,,,,,,4.25,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,6.07,10.70,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,5.51,10.70,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,inpatient,3,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,inpatient,3,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,outpatient,3,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,inpatient,3,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.11935,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,inpatient,3,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,outpatient,3,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.11935,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,inpatient,3,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,inpatient,3,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,outpatient,3,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.11935,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,inpatient,3,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,outpatient,3,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.11935,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,inpatient,3,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,outpatient,3,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.11935,0.30070,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,9.71,509.30,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,inpatient,,,266.10000,252.80000,The Alliance,PPO Network,90,221.13,,,,,,,146.35,258.12,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,outpatient,,,266.10000,252.80000,The Alliance,PPO Network,90,221.13,,,,,,,31.89,1459.96,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,inpatient,2,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,3.15,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,outpatient,2,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,2.86,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,inpatient,2,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,outpatient,2,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,4.27,10.73,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,inpatient,1,EA,260.67000,247.63000,The Alliance,PPO Network,,216.62,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,PPO Network,,216.62,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,inpatient,1,EA,788.15000,748.74000,The Alliance,PPO Network,,654.95,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,PPO Network,,654.95,,,,,,,1.13,764.51,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,inpatient,1,EA,104.28000,99.07000,The Alliance,PPO Network,,86.66,,,,,,,57.35,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,PPO Network,,86.66,,,,,,,27.59,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,inpatient,1,EA,138.91000,131.97000,The Alliance,PPO Network,,115.43,,,,,,,76.40,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,outpatient,1,EA,138.91000,131.97000,The Alliance,PPO Network,,115.43,,,,,,,27.59,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,inpatient,1,EA,125.45000,119.18000,The Alliance,PPO Network,,104.25,,,,,,,69.00,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,outpatient,1,EA,125.45000,119.18000,The Alliance,PPO Network,,104.25,,,,,,,27.59,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,inpatient,1,EA,99.54000,94.56000,The Alliance,PPO Network,,82.72,,,,,,,54.75,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,outpatient,1,EA,99.54000,94.56000,The Alliance,PPO Network,,82.72,,,,,,,27.59,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,27.59,122.61,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,inpatient,,,210.90000,200.35000,The Alliance,PPO Network,90,175.26,,,,,,,116.00,204.57,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,outpatient,,,210.90000,200.35000,The Alliance,PPO Network,90,175.26,,,,,,,14.72,204.57,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,30.80,54.32,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,4.95,254.68,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,inpatient,,,496.00000,471.20000,The Alliance,PPO Network,,412.18,,,,,,,272.80,481.12,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,outpatient,,,496.00000,471.20000,The Alliance,PPO Network,,412.18,,,,,,,248.00,481.12,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,48.19,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,inpatient,20,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,4.20,7.40,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,outpatient,20,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,0.25616,7.40,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.95,1409.06,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,PPO Network,,355.67,,,,,,,235.40,415.16,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,PPO Network,,355.67,,,,,,,40.75,2122.08,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,inpatient,2,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,outpatient,2,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,0.59830,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,inpatient,2,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,outpatient,2,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.59830,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,inpatient,2,EA,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,inpatient,2,EA,25.12000,23.87000,The Alliance,PPO Network,,20.87,,,,,,,13.82,24.37,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,outpatient,2,EA,25.12000,23.87000,The Alliance,PPO Network,,20.87,,,,,,,0.59830,24.37,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,inpatient,,,420.10000,399.10000,The Alliance,PPO Network,,349.10,,,,,,,231.06,407.50,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,outpatient,,,420.10000,399.10000,The Alliance,PPO Network,,349.10,,,,,,,50.73,407.50,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,inpatient,1,mL,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,outpatient,1,mL,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,inpatient,1,mL,1.74000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,outpatient,1,mL,1.74000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,90,93.07,,,,,,,61.60,108.64,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,90,93.07,,,,,,,9.98,509.30,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,4.57,271.65,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,63.95,788.42,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,inpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,47.85,84.39,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.11935,0.61110,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,14.78,780.94,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,inpatient,10,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,outpatient,10,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.13,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,inpatient,10,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,inpatient,10,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,inpatient,10,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,outpatient,10,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.21,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,inpatient,10,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,outpatient,10,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.13,3.83,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,inpatient,,,17.60000,16.72000,The Alliance,PPO Network,90,14.63,,,,,,,9.68,17.07,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,outpatient,,,17.60000,16.72000,The Alliance,PPO Network,90,14.63,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,45.10,79.54,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,inpatient,,,59.80000,56.81000,The Alliance,PPO Network,90,49.69,,,,,,,32.89,58.01,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,PPO Network,90,49.69,,,,,,,17.71,933.70,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,inpatient,,,11.00000,10.45000,The Alliance,PPO Network,90,9.14,,,,,,,6.05,10.67,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,PPO Network,90,9.14,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,inpatient,,,174.80000,166.06000,The Alliance,PPO Network,90,145.26,,,,,,,96.14,169.56,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,outpatient,,,174.80000,166.06000,The Alliance,PPO Network,90,145.26,,,,,,,15.58,780.94,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,PPO Network,90,55.68,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,PPO Network,90,55.68,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,inpatient,,,179.20000,170.24000,The Alliance,PPO Network,90,148.92,,,,,,,98.56,173.82,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,outpatient,,,179.20000,170.24000,The Alliance,PPO Network,90,148.92,,,,,,,7.97,407.44,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,inpatient,,,59.80000,56.81000,The Alliance,PPO Network,90,49.69,,,,,,,32.89,58.01,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,PPO Network,90,49.69,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,PPO Network,90,55.51,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,14.57,763.98,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,inpatient,,,194.80000,185.06000,The Alliance,PPO Network,90,161.88,,,,,,,107.14,188.96,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,outpatient,,,194.80000,185.06000,The Alliance,PPO Network,90,161.88,,,,,,,17.57,882.80,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,inpatient,1,EA,378.88000,359.94000,The Alliance,PPO Network,,314.85,,,,,,,208.38,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,outpatient,1,EA,378.88000,359.94000,The Alliance,PPO Network,,314.85,,,,,,,189.44,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,inpatient,1,EA,280.60000,266.57000,The Alliance,PPO Network,,233.18,,,,,,,154.33,272.18,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,outpatient,1,EA,280.60000,266.57000,The Alliance,PPO Network,,233.18,,,,,,,140.30,272.18,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,90,102.21,,,,,,,67.65,119.31,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,90,102.21,,,,,,,14.91,885.37,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,52.25,92.15,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,47.50,1137.41,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,inpatient,1,EA,13388.43000,12719.00000,The Alliance,PPO Network,,11125.79,,,,,,,7363.64,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,outpatient,1,EA,13388.43000,12719.00000,The Alliance,PPO Network,,11125.79,,,,,,,94.15,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,inpatient,1,EA,16720.68000,15884.65000,The Alliance,PPO Network,,13894.89,,,,,,,9196.37,16219.06,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,outpatient,1,EA,16720.68000,15884.65000,The Alliance,PPO Network,,13894.89,,,,,,,94.15,16219.06,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,80.85,142.59,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,16.77,882.80,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,5.30,271.65,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,13.44,696.05,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,inpatient,1,EA,28.62000,27.19000,The Alliance,PPO Network,,23.78,,,,,,,15.74,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,outpatient,1,EA,28.62000,27.19000,The Alliance,PPO Network,,23.78,,,,,,,14.31,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,inpatient,355,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,outpatient,355,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,inpatient,,,399.70000,379.71000,The Alliance,PPO Network,90,332.15,,,,,,,219.84,387.71,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,outpatient,,,399.70000,379.71000,The Alliance,PPO Network,90,332.15,,,,,,,20.26,916.73,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,inpatient,1,EA,7.52000,7.15000,The Alliance,PPO Network,,6.25,,,,,,,4.14,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,outpatient,1,EA,7.52000,7.15000,The Alliance,PPO Network,,6.25,,,,,,,3.76,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,inpatient,1,EA,67.88000,64.48000,The Alliance,PPO Network,,56.41,,,,,,,37.33,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,outpatient,1,EA,67.88000,64.48000,The Alliance,PPO Network,,56.41,,,,,,,33.94,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,inpatient,1,EA,18.85000,17.91000,The Alliance,PPO Network,,15.66,,,,,,,10.37,18.28,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,outpatient,1,EA,18.85000,17.91000,The Alliance,PPO Network,,15.66,,,,,,,9.43,18.28,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,PPO Network,90,67.81,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,inpatient,1,EA,456.75000,433.91000,The Alliance,PPO Network,,379.56,,,,,,,251.21,443.05,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,outpatient,1,EA,456.75000,433.91000,The Alliance,PPO Network,,379.56,,,,,,,94.15,443.05,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,inpatient,,,327.70000,311.32000,The Alliance,PPO Network,90,272.32,,,,,,,180.24,317.87,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,outpatient,,,327.70000,311.32000,The Alliance,PPO Network,90,272.32,,,,,,,26.33,1324.17,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,inpatient,9,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,outpatient,9,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.50685,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,inpatient,9,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,outpatient,9,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,0.50685,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,inpatient,9,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,outpatient,9,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.50685,1.43,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,inpatient,80,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,outpatient,80,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,inpatient,80,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,inpatient,1,EA,9108.37000,8652.95000,The Alliance,PPO Network,,7569.06,,,,,,,5009.60,8835.12,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,outpatient,1,EA,9108.37000,8652.95000,The Alliance,PPO Network,,7569.06,,,,,,,94.15,8835.12,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,inpatient,1,EA,0.21000,0.19000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,outpatient,1,EA,0.21000,0.19000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,171.05,301.67,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,4.57,301.67,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,inpatient,1,EA,5.05000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,outpatient,1,EA,5.05000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.52,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,76.00,548.00,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,PPO Network,90,76.95,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,inpatient,20,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,outpatient,20,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,inpatient,20,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,outpatient,20,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,inpatient,20,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,outpatient,20,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.73,4.82,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.48,18.34,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,inpatient,3,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,outpatient,3,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.84150,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,inpatient,3,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,inpatient,3,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,inpatient,3,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,outpatient,3,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.50685,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,inpatient,3,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,outpatient,3,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.50685,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,inpatient,3,EA,4.04000,3.83000,The Alliance,PPO Network,,3.36,,,,,,,2.22,3.92,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,outpatient,3,EA,4.04000,3.83000,The Alliance,PPO Network,,3.36,,,,,,,0.50685,3.92,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,inpatient,1,EA,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,outpatient,1,EA,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,inpatient,1,EA,1.43000,1.35000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,PPO Network,,1.19,,,,,,,0.71500,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,inpatient,50,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,inpatient,50,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,inpatient,50,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,inpatient,50,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,inpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,The Alliance,PPO Network,QN,1322.12,,,,,,,875.05,1543.27,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,PPO Network,QN,1322.12,,,,,,,795.50,1543.27,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,2.04,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,1.85,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,inpatient,1,EA,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,inpatient,30,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,outpatient,30,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,inpatient,1,EA,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,7.50,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,inpatient,1,EA,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,7.50,14.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.57,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.43,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,243.00000,230.85000,The Alliance,PPO Network,HI,201.93,,,,,,,133.65,235.71,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,PPO Network,HI,201.93,,,,,,,121.50,235.71,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,inpatient,,,536.00000,509.20000,The Alliance,PPO Network,,445.42,,,,,,,294.80,519.92,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,PPO Network,,445.42,,,,,,,90.57,4617.66,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,inpatient,1,EA,24.37000,23.15000,The Alliance,PPO Network,,20.25,,,,,,,13.40,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,PPO Network,,20.25,,,,,,,2.39,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,inpatient,1,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,7.30,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,outpatient,1,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,2.39,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,9.56,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,2.39,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,inpatient,1,EA,25.12000,23.87000,The Alliance,PPO Network,,20.87,,,,,,,13.82,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,outpatient,1,EA,25.12000,23.87000,The Alliance,PPO Network,,20.87,,,,,,,2.39,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,inpatient,1,EA,8.61000,8.18000,The Alliance,PPO Network,,7.15,,,,,,,4.74,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,outpatient,1,EA,8.61000,8.18000,The Alliance,PPO Network,,7.15,,,,,,,2.39,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,8.43,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,2.39,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,2.39,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,inpatient,1,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,8.92,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,2.39,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,inpatient,1,EA,9.95000,9.46000,The Alliance,PPO Network,,8.27,,,,,,,5.47,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,PPO Network,,8.27,,,,,,,2.39,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,inpatient,1,EA,12.72000,12.08000,The Alliance,PPO Network,,10.57,,,,,,,7.00,12.34,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,outpatient,1,EA,12.72000,12.08000,The Alliance,PPO Network,,10.57,,,,,,,2.39,12.34,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,inpatient,1,EA,46.02000,43.72000,The Alliance,PPO Network,,38.24,,,,,,,25.31,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,outpatient,1,EA,46.02000,43.72000,The Alliance,PPO Network,,38.24,,,,,,,2.39,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,inpatient,1,EA,24.08000,22.88000,The Alliance,PPO Network,,20.01,,,,,,,13.24,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,outpatient,1,EA,24.08000,22.88000,The Alliance,PPO Network,,20.01,,,,,,,2.39,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,2.39,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,inpatient,1,EA,50.40000,47.88000,The Alliance,PPO Network,,41.88,,,,,,,27.72,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,outpatient,1,EA,50.40000,47.88000,The Alliance,PPO Network,,41.88,,,,,,,2.39,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,inpatient,1,EA,16.92000,16.08000,The Alliance,PPO Network,,14.06,,,,,,,9.31,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,outpatient,1,EA,16.92000,16.08000,The Alliance,PPO Network,,14.06,,,,,,,2.39,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,inpatient,1,EA,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,10.86,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,outpatient,1,EA,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,2.39,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,inpatient,1,EA,17.85000,16.96000,The Alliance,PPO Network,,14.83,,,,,,,9.82,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,outpatient,1,EA,17.85000,16.96000,The Alliance,PPO Network,,14.83,,,,,,,2.39,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,inpatient,1,EA,12.50000,11.88000,The Alliance,PPO Network,,10.39,,,,,,,6.88,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,outpatient,1,EA,12.50000,11.88000,The Alliance,PPO Network,,10.39,,,,,,,2.39,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,inpatient,1,EA,25.82000,24.53000,The Alliance,PPO Network,,21.46,,,,,,,14.20,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,outpatient,1,EA,25.82000,24.53000,The Alliance,PPO Network,,21.46,,,,,,,2.39,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,inpatient,1,EA,16.75000,15.91000,The Alliance,PPO Network,,13.92,,,,,,,9.21,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,outpatient,1,EA,16.75000,15.91000,The Alliance,PPO Network,,13.92,,,,,,,2.39,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,9.15,16.14,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,2.39,16.14,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,6.48,339.51,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,inpatient,80,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,outpatient,80,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,inpatient,80,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,outpatient,80,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,inpatient,80,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,outpatient,80,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.12,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,inpatient,80,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,outpatient,80,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,inpatient,80,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,inpatient,80,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,outpatient,80,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,inpatient,80,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,inpatient,80,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,outpatient,80,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,inpatient,80,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,outpatient,80,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,inpatient,80,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,outpatient,80,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,inpatient,80,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,outpatient,80,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,The Alliance,PPO Network,QN,1322.12,,,,,,,875.05,1543.27,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,PPO Network,QN,1322.12,,,,,,,795.50,1543.27,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.48,339.51,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,215.05,379.27,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,63.95,788.42,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,inpatient,75,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,outpatient,75,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,inpatient,75,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,outpatient,75,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,inpatient,75,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,outpatient,75,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,inpatient,75,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,outpatient,75,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,inpatient,75,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,outpatient,75,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.57,271.65,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,inpatient,1,EA,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,4.05,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,0.78449,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,inpatient,1,EA,8.91000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.90,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,outpatient,1,EA,8.91000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,0.78449,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,inpatient,1,EA,11.14000,10.58000,The Alliance,PPO Network,,9.26,,,,,,,6.13,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,outpatient,1,EA,11.14000,10.58000,The Alliance,PPO Network,,9.26,,,,,,,0.78449,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,inpatient,1,EA,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,4.12,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,0.78449,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,inpatient,1,EA,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,4.27,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,0.78449,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,inpatient,1,EA,5.37000,5.10000,The Alliance,PPO Network,,4.46,,,,,,,2.95,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,PPO Network,,4.46,,,,,,,0.78449,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,0.78449,3.68,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,inpatient,1,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,54.63,147.13,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,17.27,814.87,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1653.75,3273.75,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1549.12,3375.00,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,inpatient,1,EA,20.82000,19.78000,The Alliance,PPO Network,,17.30,,,,,,,11.45,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,outpatient,1,EA,20.82000,19.78000,The Alliance,PPO Network,,17.30,,,,,,,0.78449,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,inpatient,1,EA,22.45000,21.32000,The Alliance,PPO Network,,18.66,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,outpatient,1,EA,22.45000,21.32000,The Alliance,PPO Network,,18.66,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,inpatient,1,EA,347.11000,329.76000,The Alliance,PPO Network,,288.45,,,,,,,190.91,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,outpatient,1,EA,347.11000,329.76000,The Alliance,PPO Network,,288.45,,,,,,,0.78449,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,inpatient,1,EA,42.35000,40.23000,The Alliance,PPO Network,,35.19,,,,,,,23.29,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,outpatient,1,EA,42.35000,40.23000,The Alliance,PPO Network,,35.19,,,,,,,0.78449,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,inpatient,1,EA,87.84000,83.45000,The Alliance,PPO Network,,73.00,,,,,,,48.31,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,outpatient,1,EA,87.84000,83.45000,The Alliance,PPO Network,,73.00,,,,,,,0.78449,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,0.78449,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,0.78449,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,inpatient,1,EA,22.45000,21.33000,The Alliance,PPO Network,,18.66,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,outpatient,1,EA,22.45000,21.33000,The Alliance,PPO Network,,18.66,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,inpatient,1,EA,22.47000,21.34000,The Alliance,PPO Network,,18.67,,,,,,,12.36,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,outpatient,1,EA,22.47000,21.34000,The Alliance,PPO Network,,18.67,,,,,,,0.78449,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,inpatient,1,EA,24.98000,23.73000,The Alliance,PPO Network,,20.76,,,,,,,13.74,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,outpatient,1,EA,24.98000,23.73000,The Alliance,PPO Network,,20.76,,,,,,,0.78449,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,inpatient,1,EA,11.23000,10.67000,The Alliance,PPO Network,,9.33,,,,,,,6.18,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,outpatient,1,EA,11.23000,10.67000,The Alliance,PPO Network,,9.33,,,,,,,0.78449,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,inpatient,1,EA,21.83000,20.74000,The Alliance,PPO Network,,18.14,,,,,,,12.01,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,outpatient,1,EA,21.83000,20.74000,The Alliance,PPO Network,,18.14,,,,,,,0.78449,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,inpatient,1,EA,17.46000,16.59000,The Alliance,PPO Network,,14.51,,,,,,,9.60,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,outpatient,1,EA,17.46000,16.59000,The Alliance,PPO Network,,14.51,,,,,,,0.78449,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,inpatient,1,EA,45.28000,43.02000,The Alliance,PPO Network,,37.63,,,,,,,24.90,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,outpatient,1,EA,45.28000,43.02000,The Alliance,PPO Network,,37.63,,,,,,,0.78449,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,inpatient,1,EA,218.29000,207.38000,The Alliance,PPO Network,,181.40,,,,,,,120.06,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,outpatient,1,EA,218.29000,207.38000,The Alliance,PPO Network,,181.40,,,,,,,0.78449,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,0.78449,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,inpatient,1,EA,15.31000,14.54000,The Alliance,PPO Network,,12.72,,,,,,,8.42,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,outpatient,1,EA,15.31000,14.54000,The Alliance,PPO Network,,12.72,,,,,,,0.78449,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,0.78449,10.73,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,107.80,190.12,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,98.00,190.12,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,4.57,271.65,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,11.16,577.23,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,17.93,933.70,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,90,85.59,,,,,,,56.65,99.91,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,90,85.59,,,,,,,51.50,1137.41,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,inpatient,1,EA,87.62000,83.24000,The Alliance,PPO Network,,72.81,,,,,,,48.19,84.99,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,outpatient,1,EA,87.62000,83.24000,The Alliance,PPO Network,,72.81,,,,,,,43.81,84.99,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,inpatient,50,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,outpatient,50,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,inpatient,50,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,outpatient,50,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,inpatient,50,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,outpatient,50,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,inpatient,50,EA,57.64000,54.76000,The Alliance,PPO Network,,47.90,,,,,,,31.70,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,outpatient,50,EA,57.64000,54.76000,The Alliance,PPO Network,,47.90,,,,,,,28.82,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,inpatient,50,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,outpatient,50,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,62.70,110.58,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,57.00,1137.41,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,14.60,763.98,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,231.00,407.40,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,35.09,1833.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,inpatient,1,mL,302.21000,287.10000,The Alliance,PPO Network,,251.14,,,,,,,166.22,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,outpatient,1,mL,302.21000,287.10000,The Alliance,PPO Network,,251.14,,,,,,,0.74000,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,inpatient,1,mL,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,284.90,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,0.74000,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,inpatient,1,mL,281.47000,267.40000,The Alliance,PPO Network,,233.90,,,,,,,154.81,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,outpatient,1,mL,281.47000,267.40000,The Alliance,PPO Network,,233.90,,,,,,,0.74000,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,inpatient,1,mL,528.36000,501.94000,The Alliance,PPO Network,,439.07,,,,,,,290.60,512.51,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,outpatient,1,mL,528.36000,501.94000,The Alliance,PPO Network,,439.07,,,,,,,0.74000,512.51,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,inpatient,1,EA,5.33000,5.07000,The Alliance,PPO Network,,4.43,,,,,,,2.93,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,PPO Network,,4.43,,,,,,,2.67,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.57,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.43,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.46,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,inpatient,1,EA,5.12000,4.86000,The Alliance,PPO Network,,4.25,,,,,,,2.82,4.97,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,outpatient,1,EA,5.12000,4.86000,The Alliance,PPO Network,,4.25,,,,,,,2.56,4.97,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,inpatient,,,172.20000,163.59000,The Alliance,PPO Network,90,143.10,,,,,,,94.71,167.03,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,outpatient,,,172.20000,163.59000,The Alliance,PPO Network,90,143.10,,,,,,,86.10,1137.41,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,2122.08,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,inpatient,1,EA,132.86000,126.22000,The Alliance,PPO Network,,110.41,,,,,,,73.07,128.87,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,outpatient,1,EA,132.86000,126.22000,The Alliance,PPO Network,,110.41,,,,,,,66.43,128.87,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,86.35,152.29,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,16.87,882.80,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,inpatient,,,224.30000,213.08000,The Alliance,PPO Network,90,186.39,,,,,,,123.36,217.57,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,outpatient,,,224.30000,213.08000,The Alliance,PPO Network,90,186.39,,,,,,,19.60,984.66,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,inpatient,,,1022.00000,970.90000,The Alliance,PPO Network,,849.28,,,,,,,562.10,991.34,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,outpatient,,,1022.00000,970.90000,The Alliance,PPO Network,,849.28,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1117.00000,1061.15000,The Alliance,PPO Network,,928.23,,,,,,,614.35,1083.49,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1117.00000,1061.15000,The Alliance,PPO Network,,928.23,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,3163.00,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,280.29,3163.00,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.90,3.36,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.73,3.36,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,15.65,30.37,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,inpatient,,,339.80000,322.81000,The Alliance,PPO Network,90,282.37,,,,,,,186.89,329.61,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,outpatient,,,339.80000,322.81000,The Alliance,PPO Network,90,282.37,,,,,,,30.26,1527.89,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,PPO Network,,26.02,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,inpatient,1,EA,19.43000,18.46000,The Alliance,PPO Network,,16.15,,,,,,,10.69,18.85,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,outpatient,1,EA,19.43000,18.46000,The Alliance,PPO Network,,16.15,,,,,,,9.71,18.85,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,inpatient,1,EA,277.92000,264.03000,The Alliance,PPO Network,,230.95,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,outpatient,1,EA,277.92000,264.03000,The Alliance,PPO Network,,230.95,,,,,,,4.35,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,inpatient,1,EA,277.92000,264.02000,The Alliance,PPO Network,,230.95,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,outpatient,1,EA,277.92000,264.02000,The Alliance,PPO Network,,230.95,,,,,,,4.35,269.58,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,968.06,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,3163.00,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,inpatient,1,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,2.05,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,1.86,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,inpatient,1,EA,31.53000,29.95000,The Alliance,PPO Network,,26.20,,,,,,,17.34,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,outpatient,1,EA,31.53000,29.95000,The Alliance,PPO Network,,26.20,,,,,,,15.77,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,inpatient,1,EA,25.96000,24.66000,The Alliance,PPO Network,,21.57,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,PPO Network,,21.57,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,inpatient,1,EA,76.37000,72.55000,The Alliance,PPO Network,,63.46,,,,,,,42.00,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,outpatient,1,EA,76.37000,72.55000,The Alliance,PPO Network,,63.46,,,,,,,38.19,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,inpatient,1,EA,35.86000,34.06000,The Alliance,PPO Network,,29.80,,,,,,,19.72,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,outpatient,1,EA,35.86000,34.06000,The Alliance,PPO Network,,29.80,,,,,,,17.93,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,inpatient,1,EA,29.53000,28.05000,The Alliance,PPO Network,,24.54,,,,,,,16.24,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,outpatient,1,EA,29.53000,28.05000,The Alliance,PPO Network,,24.54,,,,,,,14.77,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,inpatient,1,EA,26.67000,25.34000,The Alliance,PPO Network,,22.16,,,,,,,14.67,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,outpatient,1,EA,26.67000,25.34000,The Alliance,PPO Network,,22.16,,,,,,,13.34,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,inpatient,1,EA,26.45000,25.13000,The Alliance,PPO Network,,21.98,,,,,,,14.55,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,outpatient,1,EA,26.45000,25.13000,The Alliance,PPO Network,,21.98,,,,,,,13.22,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,inpatient,1,EA,70.70000,67.17000,The Alliance,PPO Network,,58.75,,,,,,,38.88,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,outpatient,1,EA,70.70000,67.17000,The Alliance,PPO Network,,58.75,,,,,,,35.35,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,inpatient,1,EA,3.78000,3.60000,The Alliance,PPO Network,,3.14,,,,,,,2.08,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,outpatient,1,EA,3.78000,3.60000,The Alliance,PPO Network,,3.14,,,,,,,1.89,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,inpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,PPO Network,,78.07,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,inpatient,1,EA,25.96000,24.66000,The Alliance,PPO Network,,21.57,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,PPO Network,,21.57,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,inpatient,1,EA,17.97000,17.07000,The Alliance,PPO Network,,14.93,,,,,,,9.88,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,outpatient,1,EA,17.97000,17.07000,The Alliance,PPO Network,,14.93,,,,,,,8.98,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,3163.00,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,inpatient,1,EA,4.46000,4.23000,The Alliance,PPO Network,,3.71,,,,,,,2.45,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,outpatient,1,EA,4.46000,4.23000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.23,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.03,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,inpatient,1,EA,4.94000,4.70000,The Alliance,PPO Network,,4.11,,,,,,,2.72,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,outpatient,1,EA,4.94000,4.70000,The Alliance,PPO Network,,4.11,,,,,,,2.47,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,inpatient,1,EA,53.59000,50.91000,The Alliance,PPO Network,,44.53,,,,,,,29.47,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,outpatient,1,EA,53.59000,50.91000,The Alliance,PPO Network,,44.53,,,,,,,0.11207,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,inpatient,1,EA,39.69000,37.71000,The Alliance,PPO Network,,32.98,,,,,,,21.83,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,outpatient,1,EA,39.69000,37.71000,The Alliance,PPO Network,,32.98,,,,,,,0.11207,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,inpatient,1,EA,18.36000,17.44000,The Alliance,PPO Network,,15.26,,,,,,,10.10,17.81,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,PPO Network,,15.26,,,,,,,0.11207,17.81,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,inpatient,1,EA,15.63000,14.85000,The Alliance,PPO Network,,12.99,,,,,,,8.60,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,outpatient,1,EA,15.63000,14.85000,The Alliance,PPO Network,,12.99,,,,,,,7.82,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,inpatient,1,EA,15.88000,15.09000,The Alliance,PPO Network,,13.20,,,,,,,8.73,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,outpatient,1,EA,15.88000,15.09000,The Alliance,PPO Network,,13.20,,,,,,,7.94,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,inpatient,1,EA,15.76000,14.97000,The Alliance,PPO Network,,13.10,,,,,,,8.67,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,outpatient,1,EA,15.76000,14.97000,The Alliance,PPO Network,,13.10,,,,,,,7.88,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.40,2.46,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.27,2.46,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,22.34,2082.45,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,3163.00,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,5.18,271.65,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,115.50,203.70,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,115.50,5271.00,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,780.94,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,90,116.34,,,,,,,77.00,135.80,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,90,116.34,,,,,,,12.38,628.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,4.57,271.65,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,,908.28,,,,,,,601.15,1060.21,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,,908.28,,,,,,,384.16,1060.21,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,43.81,161.02,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,inpatient,1,EA,58.40000,55.48000,The Alliance,PPO Network,,48.53,,,,,,,32.12,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,outpatient,1,EA,58.40000,55.48000,The Alliance,PPO Network,,48.53,,,,,,,29.20,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,inpatient,1,EA,47.24000,44.88000,The Alliance,PPO Network,,39.26,,,,,,,25.98,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,outpatient,1,EA,47.24000,44.88000,The Alliance,PPO Network,,39.26,,,,,,,23.62,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,inpatient,1,GM,15.81000,15.02000,The Alliance,PPO Network,,13.14,,,,,,,8.70,15.34,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,outpatient,1,GM,15.81000,15.02000,The Alliance,PPO Network,,13.14,,,,,,,7.91,15.34,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,inpatient,60,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,outpatient,60,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,inpatient,1,EA,35.04000,33.29000,The Alliance,PPO Network,,29.12,,,,,,,19.27,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,outpatient,1,EA,35.04000,33.29000,The Alliance,PPO Network,,29.12,,,,,,,17.52,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,10.27,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,inpatient,1,EA,21.24000,20.17000,The Alliance,PPO Network,,17.65,,,,,,,11.68,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,outpatient,1,EA,21.24000,20.17000,The Alliance,PPO Network,,17.65,,,,,,,10.62,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.37,10.42,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,inpatient,10,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,outpatient,10,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,0.11207,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,inpatient,10,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,outpatient,10,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,0.11207,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,inpatient,10,EA,5.30000,5.04000,The Alliance,PPO Network,,4.40,,,,,,,2.92,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,outpatient,10,EA,5.30000,5.04000,The Alliance,PPO Network,,4.40,,,,,,,0.11207,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,inpatient,10,EA,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,outpatient,10,EA,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,0.11207,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.11207,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,inpatient,10,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,0.11207,2.75,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,inpatient,1,mL,28.25000,26.84000,The Alliance,PPO Network,,23.48,,,,,,,15.54,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,outpatient,1,mL,28.25000,26.84000,The Alliance,PPO Network,,23.48,,,,,,,1.06,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,inpatient,1,mL,10.13000,9.63000,The Alliance,PPO Network,,8.42,,,,,,,5.57,9.83,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,outpatient,1,mL,10.13000,9.63000,The Alliance,PPO Network,,8.42,,,,,,,1.06,9.83,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,PPO Network,TC,465.36,,,,,,,308.00,543.20,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,PPO Network,TC,465.36,,,,,,,280.00,543.20,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,37.78,66.64,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,34.35,66.64,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,inpatient,1,EA,1587.93000,1508.53000,The Alliance,PPO Network,,1319.57,,,,,,,873.36,1540.29,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,outpatient,1,EA,1587.93000,1508.53000,The Alliance,PPO Network,,1319.57,,,,,,,56.01,1540.29,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,inpatient,30,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,inpatient,30,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,outpatient,30,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,inpatient,30,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,outpatient,30,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,11.53,594.19,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,3163.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,3.44,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,3.44,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,inpatient,1,EA,9.25000,8.79000,The Alliance,PPO Network,,7.69,,,,,,,5.09,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,outpatient,1,EA,9.25000,8.79000,The Alliance,PPO Network,,7.69,,,,,,,3.44,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,10.77,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,3.44,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,3.44,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,inpatient,1,EA,23.48000,22.30000,The Alliance,PPO Network,,19.51,,,,,,,12.91,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,outpatient,1,EA,23.48000,22.30000,The Alliance,PPO Network,,19.51,,,,,,,3.44,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,inpatient,1,EA,217.44000,206.57000,The Alliance,PPO Network,,180.69,,,,,,,119.59,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,outpatient,1,EA,217.44000,206.57000,The Alliance,PPO Network,,180.69,,,,,,,3.44,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,inpatient,1,EA,14.85000,14.11000,The Alliance,PPO Network,,12.34,,,,,,,8.17,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,PPO Network,,12.34,,,,,,,3.44,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,3.44,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,inpatient,1,EA,10.98000,10.43000,The Alliance,PPO Network,,9.12,,,,,,,6.04,10.65,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,outpatient,1,EA,10.98000,10.43000,The Alliance,PPO Network,,9.12,,,,,,,3.44,10.65,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,inpatient,15,EA,5.51000,5.24000,The Alliance,PPO Network,,4.58,,,,,,,3.03,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,outpatient,15,EA,5.51000,5.24000,The Alliance,PPO Network,,4.58,,,,,,,2.75,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,inpatient,15,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,inpatient,15,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,outpatient,15,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,inpatient,15,EA,4.44000,4.21000,The Alliance,PPO Network,,3.69,,,,,,,2.44,4.31,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,outpatient,15,EA,4.44000,4.21000,The Alliance,PPO Network,,3.69,,,,,,,2.22,4.31,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,inpatient,,,180.30000,171.28000,The Alliance,PPO Network,90,149.83,,,,,,,99.17,174.89,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,outpatient,,,180.30000,171.28000,The Alliance,PPO Network,90,149.83,,,,,,,90.15,1137.41,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,inpatient,,,1903.00000,1807.85000,The Alliance,PPO Network,90,1581.39,,,,,,,1046.65,1845.91,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,outpatient,,,1903.00000,1807.85000,The Alliance,PPO Network,90,1581.39,,,,,,,169.42,8573.20,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,63.95,788.42,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,inpatient,1,EA,10.91000,10.36000,The Alliance,PPO Network,,9.07,,,,,,,6.00,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,outpatient,1,EA,10.91000,10.36000,The Alliance,PPO Network,,9.07,,,,,,,5.46,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,inpatient,1,EA,3.90000,3.71000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,inpatient,1,EA,6.72000,6.38000,The Alliance,PPO Network,,5.58,,,,,,,3.70,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,outpatient,1,EA,6.72000,6.38000,The Alliance,PPO Network,,5.58,,,,,,,3.36,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,inpatient,1,EA,4.45000,4.22000,The Alliance,PPO Network,,3.70,,,,,,,2.45,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,outpatient,1,EA,4.45000,4.22000,The Alliance,PPO Network,,3.70,,,,,,,2.23,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,inpatient,1,EA,2.75000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,inpatient,1,EA,5.37000,5.10000,The Alliance,PPO Network,,4.46,,,,,,,2.95,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,PPO Network,,4.46,,,,,,,2.69,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,inpatient,1,EA,5.49000,5.21000,The Alliance,PPO Network,,4.56,,,,,,,3.02,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,PPO Network,,4.56,,,,,,,2.75,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.46,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.53,2.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.40,2.71,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,113.85,200.79,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,113.85,3163.00,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,inpatient,,,63.50000,60.32000,The Alliance,PPO Network,,52.77,,,,,,,34.92,61.59,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,outpatient,,,63.50000,60.32000,The Alliance,PPO Network,,52.77,,,,,,,28.29,61.59,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,3.53,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,inpatient,1,EA,56.72000,53.89000,The Alliance,PPO Network,,47.13,,,,,,,31.20,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,outpatient,1,EA,56.72000,53.89000,The Alliance,PPO Network,,47.13,,,,,,,28.36,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,inpatient,5,EA,57.46000,54.59000,The Alliance,PPO Network,,47.75,,,,,,,31.60,55.74,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,outpatient,5,EA,57.46000,54.59000,The Alliance,PPO Network,,47.75,,,,,,,28.73,55.74,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,inpatient,1,EA,31.16000,29.60000,The Alliance,PPO Network,,25.89,,,,,,,17.14,30.23,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,outpatient,1,EA,31.16000,29.60000,The Alliance,PPO Network,,25.89,,,,,,,3.44,30.23,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,2234.00000,2122.30000,The Alliance,PPO Network,QN,1856.45,,,,,,,1228.70,2166.98,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,2234.00000,2122.30000,The Alliance,PPO Network,QN,1856.45,,,,,,,1117.00,2166.98,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,inpatient,3.5,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,outpatient,3.5,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,9.83,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,inpatient,3.5,EA,12.55000,11.92000,The Alliance,PPO Network,,10.43,,,,,,,6.90,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,outpatient,3.5,EA,12.55000,11.92000,The Alliance,PPO Network,,10.43,,,,,,,6.28,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,inpatient,3.5,EA,20.69000,19.66000,The Alliance,PPO Network,,17.19,,,,,,,11.38,20.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,outpatient,3.5,EA,20.69000,19.66000,The Alliance,PPO Network,,17.19,,,,,,,10.35,20.07,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,The Alliance,PPO Network,,1141.35,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,PPO Network,,1141.35,,,,,,,91.02,1332.27,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,inpatient,1,GM,89.11000,84.66000,The Alliance,PPO Network,,74.05,,,,,,,49.01,86.44,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,outpatient,1,GM,89.11000,84.66000,The Alliance,PPO Network,,74.05,,,,,,,44.55,86.44,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,inpatient,1,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.95,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.77,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,inpatient,1,EA,5.71000,5.42000,The Alliance,PPO Network,,4.75,,,,,,,3.14,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,PPO Network,,4.75,,,,,,,2.85,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,inpatient,1,EA,4.69000,4.46000,The Alliance,PPO Network,,3.90,,,,,,,2.58,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,outpatient,1,EA,4.69000,4.46000,The Alliance,PPO Network,,3.90,,,,,,,2.35,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,15.05,780.94,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,16.18,848.80,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,inpatient,45,EA,3.77000,3.58000,The Alliance,PPO Network,,3.13,,,,,,,2.07,3.66,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,outpatient,45,EA,3.77000,3.58000,The Alliance,PPO Network,,3.13,,,,,,,1.89,3.66,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,inpatient,3.5,EA,7.75000,7.36000,The Alliance,PPO Network,,6.44,,,,,,,4.26,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,outpatient,3.5,EA,7.75000,7.36000,The Alliance,PPO Network,,6.44,,,,,,,3.88,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,inpatient,3.5,EA,8.82000,8.38000,The Alliance,PPO Network,,7.33,,,,,,,4.85,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,outpatient,3.5,EA,8.82000,8.38000,The Alliance,PPO Network,,7.33,,,,,,,4.41,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,inpatient,3.5,EA,6.08000,5.77000,The Alliance,PPO Network,,5.05,,,,,,,3.34,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,outpatient,3.5,EA,6.08000,5.77000,The Alliance,PPO Network,,5.05,,,,,,,3.04,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,inpatient,3.5,EA,7.36000,6.99000,The Alliance,PPO Network,,6.12,,,,,,,4.05,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,outpatient,3.5,EA,7.36000,6.99000,The Alliance,PPO Network,,6.12,,,,,,,3.68,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,inpatient,3.5,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,3.55,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,outpatient,3.5,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,3.23,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,inpatient,3.5,EA,5.87000,5.57000,The Alliance,PPO Network,,4.88,,,,,,,3.23,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,outpatient,3.5,EA,5.87000,5.57000,The Alliance,PPO Network,,4.88,,,,,,,2.94,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,inpatient,3.5,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.36,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,outpatient,3.5,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.24,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,inpatient,3.5,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,outpatient,3.5,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,inpatient,3.5,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,outpatient,3.5,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,inpatient,3.5,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.54,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,outpatient,3.5,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.40,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,inpatient,3.5,EA,4.72000,4.49000,The Alliance,PPO Network,,3.92,,,,,,,2.60,4.58,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,outpatient,3.5,EA,4.72000,4.49000,The Alliance,PPO Network,,3.92,,,,,,,2.36,4.58,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,0.11207,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,inpatient,1,mL,35.49000,33.71000,The Alliance,PPO Network,,29.49,,,,,,,19.52,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,outpatient,1,mL,35.49000,33.71000,The Alliance,PPO Network,,29.49,,,,,,,0.11207,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,inpatient,1,mL,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,0.11207,36.78,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,inpatient,3.5,EA,39.53000,37.55000,The Alliance,PPO Network,,32.85,,,,,,,21.74,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,outpatient,3.5,EA,39.53000,37.55000,The Alliance,PPO Network,,32.85,,,,,,,19.77,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,inpatient,3.5,EA,36.07000,34.26000,The Alliance,PPO Network,,29.97,,,,,,,19.84,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,outpatient,3.5,EA,36.07000,34.26000,The Alliance,PPO Network,,29.97,,,,,,,18.04,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,inpatient,3.5,EA,39.91000,37.91000,The Alliance,PPO Network,,33.17,,,,,,,21.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,outpatient,3.5,EA,39.91000,37.91000,The Alliance,PPO Network,,33.17,,,,,,,19.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,inpatient,3.5,EA,41.14000,39.09000,The Alliance,PPO Network,,34.19,,,,,,,22.63,39.91,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,outpatient,3.5,EA,41.14000,39.09000,The Alliance,PPO Network,,34.19,,,,,,,20.57,39.91,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,inpatient,1,mL,146.15000,138.84000,The Alliance,PPO Network,,121.45,,,,,,,80.38,141.77,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,outpatient,1,mL,146.15000,138.84000,The Alliance,PPO Network,,121.45,,,,,,,73.08,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,inpatient,1,mL,135.88000,129.09000,The Alliance,PPO Network,,112.92,,,,,,,74.73,131.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,outpatient,1,mL,135.88000,129.09000,The Alliance,PPO Network,,112.92,,,,,,,67.94,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,inpatient,1,mL,149.33000,141.87000,The Alliance,PPO Network,,124.09,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,PPO Network,,124.09,,,,,,,74.67,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,inpatient,1,mL,160.62000,152.59000,The Alliance,PPO Network,,133.48,,,,,,,88.34,155.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,outpatient,1,mL,160.62000,152.59000,The Alliance,PPO Network,,133.48,,,,,,,80.31,290.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,inpatient,15,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,outpatient,15,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,inpatient,15,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,outpatient,15,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,inpatient,15,EA,13.41000,12.74000,The Alliance,PPO Network,,11.14,,,,,,,7.38,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,outpatient,15,EA,13.41000,12.74000,The Alliance,PPO Network,,11.14,,,,,,,6.71,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,inpatient,1,EA,295.97000,281.17000,The Alliance,PPO Network,,245.95,,,,,,,162.78,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,outpatient,1,EA,295.97000,281.17000,The Alliance,PPO Network,,245.95,,,,,,,0.33621,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,inpatient,1,EA,806.22000,765.90000,The Alliance,PPO Network,,669.97,,,,,,,443.42,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,outpatient,1,EA,806.22000,765.90000,The Alliance,PPO Network,,669.97,,,,,,,0.33621,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,inpatient,1,EA,700.52000,665.49000,The Alliance,PPO Network,,582.13,,,,,,,385.29,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,outpatient,1,EA,700.52000,665.49000,The Alliance,PPO Network,,582.13,,,,,,,0.33621,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,inpatient,1,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,170.94,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,0.33621,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,284.90,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,0.33621,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,inpatient,1,EA,453.25000,430.59000,The Alliance,PPO Network,,376.65,,,,,,,249.29,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,outpatient,1,EA,453.25000,430.59000,The Alliance,PPO Network,,376.65,,,,,,,0.33621,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,inpatient,1,EA,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,outpatient,1,EA,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,0.33621,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,inpatient,1,EA,1515.77000,1439.98000,The Alliance,PPO Network,,1259.60,,,,,,,833.67,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,outpatient,1,EA,1515.77000,1439.98000,The Alliance,PPO Network,,1259.60,,,,,,,0.33621,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,inpatient,1,EA,543.90000,516.70000,The Alliance,PPO Network,,451.98,,,,,,,299.14,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,outpatient,1,EA,543.90000,516.70000,The Alliance,PPO Network,,451.98,,,,,,,0.33621,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,inpatient,1,EA,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,0.33621,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,inpatient,1,EA,123.24000,117.08000,The Alliance,PPO Network,,102.41,,,,,,,67.78,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,outpatient,1,EA,123.24000,117.08000,The Alliance,PPO Network,,102.41,,,,,,,0.33621,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,inpatient,1,EA,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,78.21,137.93,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,outpatient,1,EA,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,0.33621,137.93,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,inpatient,1,mL,36.50000,34.67000,The Alliance,PPO Network,,30.33,,,,,,,20.07,35.41,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,outpatient,1,mL,36.50000,34.67000,The Alliance,PPO Network,,30.33,,,,,,,18.25,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,inpatient,1,mL,33.97000,32.27000,The Alliance,PPO Network,,28.23,,,,,,,18.68,32.95,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,outpatient,1,mL,33.97000,32.27000,The Alliance,PPO Network,,28.23,,,,,,,16.98,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,inpatient,1,mL,37.33000,35.47000,The Alliance,PPO Network,,31.02,,,,,,,20.53,36.21,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,outpatient,1,mL,37.33000,35.47000,The Alliance,PPO Network,,31.02,,,,,,,18.66,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,inpatient,1,mL,40.11000,38.11000,The Alliance,PPO Network,,33.33,,,,,,,22.06,38.91,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,outpatient,1,mL,40.11000,38.11000,The Alliance,PPO Network,,33.33,,,,,,,20.05,290.17,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,inpatient,59.2,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,outpatient,59.2,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,231.00,407.40,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,35.09,1833.46,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,inpatient,1,mL,34.32000,32.61000,The Alliance,PPO Network,,28.52,,,,,,,18.88,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,outpatient,1,mL,34.32000,32.61000,The Alliance,PPO Network,,28.52,,,,,,,17.16,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,inpatient,1,mL,27.68000,26.29000,The Alliance,PPO Network,,23.00,,,,,,,15.22,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,outpatient,1,mL,27.68000,26.29000,The Alliance,PPO Network,,23.00,,,,,,,13.84,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,inpatient,1,mL,28.04000,26.64000,The Alliance,PPO Network,,23.30,,,,,,,15.42,27.20,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,outpatient,1,mL,28.04000,26.64000,The Alliance,PPO Network,,23.30,,,,,,,14.02,27.20,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,7.30,373.51,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,16.87,882.80,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,inpatient,,,340.70000,323.66000,The Alliance,PPO Network,90,283.12,,,,,,,187.38,330.48,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,PPO Network,90,283.12,,,,,,,38.99,1969.25,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,5.99,1216.68,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,180.95,319.13,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,180.95,4686.00,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,inpatient,8,EA,302.57000,287.44000,The Alliance,PPO Network,,251.44,,,,,,,166.41,293.49,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,outpatient,8,EA,302.57000,287.44000,The Alliance,PPO Network,,251.44,,,,,,,151.28,293.49,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,inpatient,5,EA,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,outpatient,5,EA,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,2.89,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,inpatient,5,EA,27.09000,25.73000,The Alliance,PPO Network,,22.51,,,,,,,14.90,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,outpatient,5,EA,27.09000,25.73000,The Alliance,PPO Network,,22.51,,,,,,,13.54,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,inpatient,5,EA,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,12.81,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,outpatient,5,EA,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,11.64,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,inpatient,5,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,10.13,17.87,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,outpatient,5,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,9.21,17.87,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,inpatient,56,EA,225.62000,214.34000,The Alliance,PPO Network,,187.49,,,,,,,124.09,218.85,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,outpatient,56,EA,225.62000,214.34000,The Alliance,PPO Network,,187.49,,,,,,,112.81,218.85,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,inpatient,10,EA,98.13000,93.22000,The Alliance,PPO Network,,81.55,,,,,,,53.97,95.19,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,outpatient,10,EA,98.13000,93.22000,The Alliance,PPO Network,,81.55,,,,,,,49.06,95.19,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,3.80,186.75,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,inpatient,1,EA,2511.99000,2386.39000,The Alliance,PPO Network,,2087.46,,,,,,,1381.59,2436.63,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,outpatient,1,EA,2511.99000,2386.39000,The Alliance,PPO Network,,2087.46,,,,,,,3.89,2436.63,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,inpatient,30,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,outpatient,30,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,inpatient,30,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,outpatient,30,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,inpatient,30,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,outpatient,30,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,inpatient,30,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,outpatient,30,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,inpatient,30,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,outpatient,30,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,inpatient,30,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,outpatient,30,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,inpatient,30,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,inpatient,30,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,outpatient,30,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,inpatient,,,2632.00000,2500.40000,The Alliance,PPO Network,,2187.19,,,,,,,1447.60,2553.04,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,outpatient,,,2632.00000,2500.40000,The Alliance,PPO Network,,2187.19,,,,,,,1447.60,4686.00,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,inpatient,,,67.40000,64.03000,The Alliance,PPO Network,90,56.01,,,,,,,37.07,65.38,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,PPO Network,90,56.01,,,,,,,8.17,526.26,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,3163.00,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,1324.17,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,4.70,254.68,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,inpatient,1,EA,93.93000,89.23000,The Alliance,PPO Network,,78.06,,,,,,,51.66,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,outpatient,1,EA,93.93000,89.23000,The Alliance,PPO Network,,78.06,,,,,,,3.84,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,inpatient,1,EA,104.28000,99.07000,The Alliance,PPO Network,,86.66,,,,,,,57.35,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,PPO Network,,86.66,,,,,,,3.84,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,inpatient,1,EA,114.01000,108.31000,The Alliance,PPO Network,,94.74,,,,,,,62.71,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,outpatient,1,EA,114.01000,108.31000,The Alliance,PPO Network,,94.74,,,,,,,3.84,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,inpatient,1,EA,86.30000,81.98000,The Alliance,PPO Network,,71.72,,,,,,,47.47,83.71,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,outpatient,1,EA,86.30000,81.98000,The Alliance,PPO Network,,71.72,,,,,,,3.84,83.71,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,37.78,66.64,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,34.35,66.64,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,inpatient,1,mL,516.02000,490.22000,The Alliance,PPO Network,,428.81,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,PPO Network,,428.81,,,,,,,73.05,500.54,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,273.46,482.28,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,44.27,2240.90,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,inpatient,1,EA,187.86000,178.47000,The Alliance,PPO Network,,156.11,,,,,,,103.32,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,outpatient,1,EA,187.86000,178.47000,The Alliance,PPO Network,,156.11,,,,,,,3.84,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,inpatient,1,EA,231.66000,220.08000,The Alliance,PPO Network,,192.51,,,,,,,127.41,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,outpatient,1,EA,231.66000,220.08000,The Alliance,PPO Network,,192.51,,,,,,,3.84,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,inpatient,1,EA,172.60000,163.97000,The Alliance,PPO Network,,143.43,,,,,,,94.93,167.42,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,outpatient,1,EA,172.60000,163.97000,The Alliance,PPO Network,,143.43,,,,,,,3.84,167.42,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,462.00,814.80,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,420.00,814.80,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,11.00,509.30,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,90,136.28,,,,,,,90.20,159.08,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,90,136.28,,,,,,,17.69,899.77,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,18.70,32.98,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,3.02,152.82,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,37.27,1426.03,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,inpatient,1,EA,295.84000,281.05000,The Alliance,PPO Network,,245.84,,,,,,,162.71,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,outpatient,1,EA,295.84000,281.05000,The Alliance,PPO Network,,245.84,,,,,,,33.41,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,inpatient,1,EA,274.80000,261.06000,The Alliance,PPO Network,,228.36,,,,,,,151.14,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,outpatient,1,EA,274.80000,261.06000,The Alliance,PPO Network,,228.36,,,,,,,33.41,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,inpatient,1,EA,231.41000,219.84000,The Alliance,PPO Network,,192.30,,,,,,,127.28,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,outpatient,1,EA,231.41000,219.84000,The Alliance,PPO Network,,192.30,,,,,,,33.41,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,inpatient,1,EA,210.74000,200.20000,The Alliance,PPO Network,,175.12,,,,,,,115.91,204.42,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,outpatient,1,EA,210.74000,200.20000,The Alliance,PPO Network,,175.12,,,,,,,33.41,204.42,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,741.08,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,3163.00,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,inpatient,2.5,EA,122.58000,116.45000,The Alliance,PPO Network,,101.86,,,,,,,67.42,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,outpatient,2.5,EA,122.58000,116.45000,The Alliance,PPO Network,,101.86,,,,,,,61.29,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,inpatient,2.5,EA,136.13000,129.33000,The Alliance,PPO Network,,113.12,,,,,,,74.87,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,outpatient,2.5,EA,136.13000,129.33000,The Alliance,PPO Network,,113.12,,,,,,,68.06,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,inpatient,2.5,EA,132.04000,125.44000,The Alliance,PPO Network,,109.73,,,,,,,72.62,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,outpatient,2.5,EA,132.04000,125.44000,The Alliance,PPO Network,,109.73,,,,,,,66.02,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,inpatient,2.5,EA,66.74000,63.40000,The Alliance,PPO Network,,55.46,,,,,,,36.71,64.74,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,outpatient,2.5,EA,66.74000,63.40000,The Alliance,PPO Network,,55.46,,,,,,,33.37,64.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,inpatient,5,EA,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,outpatient,5,EA,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,10.61,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,inpatient,5,EA,34.78000,33.04000,The Alliance,PPO Network,,28.90,,,,,,,19.13,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,outpatient,5,EA,34.78000,33.04000,The Alliance,PPO Network,,28.90,,,,,,,10.61,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,inpatient,5,EA,25.44000,24.17000,The Alliance,PPO Network,,21.14,,,,,,,13.99,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,outpatient,5,EA,25.44000,24.17000,The Alliance,PPO Network,,21.14,,,,,,,10.61,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,inpatient,5,EA,18.05000,17.15000,The Alliance,PPO Network,,15.00,,,,,,,9.93,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,outpatient,5,EA,18.05000,17.15000,The Alliance,PPO Network,,15.00,,,,,,,9.03,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,inpatient,5,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,10.61,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,inpatient,5,EA,24.79000,23.55000,The Alliance,PPO Network,,20.60,,,,,,,13.63,24.05,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,outpatient,5,EA,24.79000,23.55000,The Alliance,PPO Network,,20.60,,,,,,,10.61,24.05,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,inpatient,1,EA,84.57000,80.34000,The Alliance,PPO Network,,70.28,,,,,,,46.51,82.03,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,outpatient,1,EA,84.57000,80.34000,The Alliance,PPO Network,,70.28,,,,,,,42.28,82.03,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,inpatient,15,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.95,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,outpatient,15,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.77,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,inpatient,15,EA,4.62000,4.38000,The Alliance,PPO Network,,3.84,,,,,,,2.54,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,outpatient,15,EA,4.62000,4.38000,The Alliance,PPO Network,,3.84,,,,,,,2.31,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,inpatient,15,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,outpatient,15,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,inpatient,,,48.40000,45.98000,The Alliance,PPO Network,,40.22,,,,,,,26.62,46.95,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,PPO Network,,40.22,,,,,,,24.20,46.95,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,2.99,152.82,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,36.26,1833.46,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,90,110.52,,,,,,,73.15,129.01,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,90,110.52,,,,,,,12.38,628.12,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,inpatient,237,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,outpatient,237,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,inpatient,237,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,outpatient,237,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,TC,1681.94,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,TC,1681.94,,,,,,,864.82,2960.49,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,679.08,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,110.55,194.97,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,26.07,1222.31,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1737.00000,1650.15000,The Alliance,PPO Network,TC,1443.45,,,,,,,955.35,1684.89,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1737.00000,1650.15000,The Alliance,PPO Network,TC,1443.45,,,,,,,868.50,2210.07,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,182.00,456.63,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,20.35,35.89,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,2.99,152.82,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,TC,2015.17,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,TC,2015.17,,,,,,,1212.50,2352.25,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,52.25,92.15,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,13.37,763.98,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,inpatient,,,1888.00000,1793.60000,The Alliance,PPO Network,TC,1568.93,,,,,,,1038.40,1831.36,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,outpatient,,,1888.00000,1793.60000,The Alliance,PPO Network,TC,1568.93,,,,,,,875.87,2210.07,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,inpatient,5,EA,32.06000,30.46000,The Alliance,PPO Network,,26.64,,,,,,,17.63,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,outpatient,5,EA,32.06000,30.46000,The Alliance,PPO Network,,26.64,,,,,,,16.03,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,inpatient,5,EA,32.22000,30.61000,The Alliance,PPO Network,,26.77,,,,,,,17.72,31.25,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,outpatient,5,EA,32.22000,30.61000,The Alliance,PPO Network,,26.77,,,,,,,16.11,31.25,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1444.00000,1371.80000,The Alliance,PPO Network,,1199.96,,,,,,,794.20,1400.68,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1444.00000,1371.80000,The Alliance,PPO Network,,1199.96,,,,,,,143.40,8250.66,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,inpatient,1,mL,516.02000,490.22000,The Alliance,PPO Network,,428.81,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,PPO Network,,428.81,,,,,,,73.05,500.54,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,8.46,441.37,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,PPO Network,,195.28,,,,,,,129.25,227.95,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,PPO Network,,195.28,,,,,,,20.81,1086.52,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,inpatient,1,GM,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,outpatient,1,GM,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,inpatient,1,GM,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,outpatient,1,GM,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,inpatient,1,GM,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,outpatient,1,GM,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,The Alliance,PPO Network,TC,12085.23,,,,,,,7998.65,14106.71,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,PPO Network,TC,12085.23,,,,,,,4549.00,14106.71,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,inpatient,,,733.00000,696.35000,The Alliance,PPO Network,,609.12,,,,,,,403.15,711.01,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,outpatient,,,733.00000,696.35000,The Alliance,PPO Network,,609.12,,,,,,,236.07,2440.34,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,The Alliance,PPO Network,TC,2873.60,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,PPO Network,TC,2873.60,,,,,,,1609.99,3354.26,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,The Alliance,PPO Network,,3876.12,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,PPO Network,,3876.12,,,,,,,2140.96,4664.40,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.99,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.54,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,inpatient,1,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,3.79,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,inpatient,1,EA,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,4.10,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,outpatient,1,EA,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,3.73,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,inpatient,1,EA,7.92000,7.53000,The Alliance,PPO Network,,6.58,,,,,,,4.36,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,outpatient,1,EA,7.92000,7.53000,The Alliance,PPO Network,,6.58,,,,,,,3.96,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,8.17,1324.17,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,inpatient,2,EA,9.20000,8.74000,The Alliance,PPO Network,,7.65,,,,,,,5.06,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,outpatient,2,EA,9.20000,8.74000,The Alliance,PPO Network,,7.65,,,,,,,1.85,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,inpatient,2,EA,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.70,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,outpatient,2,EA,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,1.85,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,inpatient,2,EA,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,outpatient,2,EA,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,inpatient,2,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,8.92,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,outpatient,2,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,1.85,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,inpatient,2,EA,14.70000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,8.09,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,outpatient,2,EA,14.70000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,1.85,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,inpatient,2,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,1.85,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,inpatient,2,EA,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,5.53,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,outpatient,2,EA,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,1.85,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,inpatient,2,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,outpatient,2,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,1.85,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,inpatient,2,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,8.11,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,outpatient,2,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,1.85,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,inpatient,2,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,inpatient,2,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,outpatient,2,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,7.75,407.44,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,inpatient,10,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,outpatient,10,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,inpatient,10,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,outpatient,10,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,inpatient,10,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,outpatient,10,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,inpatient,10,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,outpatient,10,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.61000,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,inpatient,10,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,inpatient,10,EA,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,outpatient,10,EA,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,inpatient,10,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,outpatient,10,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,inpatient,30,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,outpatient,30,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,inpatient,30,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,outpatient,30,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.01550,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,inpatient,30,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.01550,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,inpatient,30,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.01550,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.01550,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,inpatient,30,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,outpatient,30,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.01550,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,inpatient,30,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.01550,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.01550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,inpatient,30,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,outpatient,30,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.01550,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,inpatient,30,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,outpatient,30,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.01550,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,inpatient,30,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.01550,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,inpatient,30,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,outpatient,30,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.01550,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,inpatient,30,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,outpatient,30,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,inpatient,30,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,outpatient,30,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.01550,0.66930,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,The Alliance,PPO Network,QN,902.47,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,PPO Network,QN,902.47,,,,,,,543.00,1053.42,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,37.78,66.64,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,8.17,458.40,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,80.00,155.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,7.27,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,inpatient,1,EA,26.07000,24.76000,The Alliance,PPO Network,,21.66,,,,,,,14.34,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,outpatient,1,EA,26.07000,24.76000,The Alliance,PPO Network,,21.66,,,,,,,7.27,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,inpatient,1,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,205.15,361.81,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,35.09,1662.04,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,inpatient,5,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,outpatient,5,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,inpatient,5,EA,9.16000,8.71000,The Alliance,PPO Network,,7.61,,,,,,,5.04,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,outpatient,5,EA,9.16000,8.71000,The Alliance,PPO Network,,7.61,,,,,,,4.58,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,inpatient,5,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,outpatient,5,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,inpatient,5,EA,3.86000,3.67000,The Alliance,PPO Network,,3.21,,,,,,,2.12,3.74,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,outpatient,5,EA,3.86000,3.67000,The Alliance,PPO Network,,3.21,,,,,,,1.93,3.74,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.01550,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.01550,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.01550,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.01550,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.01550,0.49470,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,inpatient,4,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,outpatient,4,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.61000,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,inpatient,4,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,outpatient,4,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.61000,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,inpatient,4,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.31,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,outpatient,4,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,0.61000,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,inpatient,4,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,outpatient,4,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.61000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,inpatient,4,EA,2.46000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,outpatient,4,EA,2.46000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,0.61000,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,inpatient,4,EA,2.16000,2.06000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,outpatient,4,EA,2.16000,2.06000,The Alliance,PPO Network,,1.79,,,,,,,0.61000,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,inpatient,4,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,outpatient,4,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,0.61000,1.99,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,1237.50000,1175.62000,The Alliance,PPO Network,,1028.36,,,,,,,606.38,1200.38,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,1237.50000,1175.62000,The Alliance,PPO Network,,1028.36,,,,,,,568.01,1237.50,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,The Alliance,PPO Network,QN,902.47,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,PPO Network,QN,902.47,,,,,,,543.00,1053.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.23,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.03,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,inpatient,1,EA,12.10000,11.50000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,outpatient,1,EA,12.10000,11.50000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,The Alliance,PPO Network,,3.42,,,,,,,2.27,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,PPO Network,,3.42,,,,,,,2.06,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.29,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.08,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,3.22,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,2.93,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,inpatient,1,EA,8.33000,7.92000,The Alliance,PPO Network,,6.92,,,,,,,4.58,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,outpatient,1,EA,8.33000,7.92000,The Alliance,PPO Network,,6.92,,,,,,,4.17,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,inpatient,1,EA,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,outpatient,1,EA,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.00,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,The Alliance,PPO Network,,4.86,,,,,,,3.22,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,PPO Network,,4.86,,,,,,,2.92,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.97,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.43,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,inpatient,30,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,outpatient,30,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,inpatient,30,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,inpatient,30,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,outpatient,30,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,inpatient,30,EA,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,outpatient,30,EA,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,inpatient,10,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,inpatient,10,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,outpatient,10,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.01550,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,inpatient,10,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,outpatient,10,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,inpatient,10,EA,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,outpatient,10,EA,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.01550,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,inpatient,10,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,inpatient,10,EA,1.66000,1.57000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,outpatient,10,EA,1.66000,1.57000,The Alliance,PPO Network,,1.38,,,,,,,0.01550,1.61,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,The Alliance,PPO Network,90,223.21,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,PPO Network,90,223.21,,,,,,,24.43,1205.34,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,90,131.30,,,,,,,86.90,153.26,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,90,131.30,,,,,,,14.05,713.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,inpatient,10,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,inpatient,10,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.01550,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,inpatient,10,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,inpatient,10,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.01550,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,inpatient,10,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,inpatient,10,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,outpatient,10,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.01550,1.46,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,inpatient,,,409.00000,388.55000,The Alliance,PPO Network,,339.88,,,,,,,224.95,396.73,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,PPO Network,,339.88,,,,,,,37.27,1833.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.01550,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,inpatient,1,mL,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.01550,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,inpatient,1,mL,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.01550,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,inpatient,1,EA,11.31000,10.74000,The Alliance,PPO Network,,9.40,,,,,,,6.22,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,outpatient,1,EA,11.31000,10.74000,The Alliance,PPO Network,,9.40,,,,,,,5.66,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,inpatient,1,EA,4.73000,4.49000,The Alliance,PPO Network,,3.93,,,,,,,2.60,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,outpatient,1,EA,4.73000,4.49000,The Alliance,PPO Network,,3.93,,,,,,,2.37,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,inpatient,1,EA,7.99000,7.60000,The Alliance,PPO Network,,6.64,,,,,,,4.39,7.75,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,outpatient,1,EA,7.99000,7.60000,The Alliance,PPO Network,,6.64,,,,,,,4.00,7.75,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,inpatient,1,mL,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,inpatient,1,mL,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,outpatient,1,mL,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.08,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,inpatient,1,mL,5.43000,5.16000,The Alliance,PPO Network,,4.51,,,,,,,2.99,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,outpatient,1,mL,5.43000,5.16000,The Alliance,PPO Network,,4.51,,,,,,,2.71,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,inpatient,1,mL,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,outpatient,1,mL,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.97500,1.89,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,inpatient,1,EA,4.35000,4.14000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,outpatient,1,EA,4.35000,4.14000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,741.08,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,4686.00,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.01550,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,inpatient,1,mL,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,outpatient,1,mL,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.01550,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.01550,0.68870,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,inpatient,1,EA,5.95000,5.66000,The Alliance,PPO Network,,4.94,,,,,,,3.27,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,outpatient,1,EA,5.95000,5.66000,The Alliance,PPO Network,,4.94,,,,,,,2.98,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.94,5.19,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.67,5.19,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,11.98,628.12,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,inpatient,50,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.06404,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,inpatient,50,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,outpatient,50,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.06404,6.13,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,inpatient,,,4181.00000,3971.95000,The Alliance,PPO Network,,3474.41,,,,,,,2299.55,4055.57,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,outpatient,,,4181.00000,3971.95000,The Alliance,PPO Network,,3474.41,,,,,,,1538.48,4686.00,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,inpatient,2,EA,50.16000,47.66000,The Alliance,PPO Network,,41.68,,,,,,,27.59,48.66,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,outpatient,2,EA,50.16000,47.66000,The Alliance,PPO Network,,41.68,,,,,,,25.08,48.66,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,90,258.44,,,,,,,171.05,301.67,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,90,258.44,,,,,,,27.68,1392.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,inpatient,1,mL,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,4686.00,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,The Alliance,PPO Network,TC,3188.55,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,PPO Network,TC,3188.55,,,,,,,1626.53,3721.89,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,inpatient,1,EA,21473.80000,20400.11000,The Alliance,PPO Network,,17844.73,,,,,,,11810.59,20829.59,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,outpatient,1,EA,21473.80000,20400.11000,The Alliance,PPO Network,,17844.73,,,,,,,258.52,20829.59,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,The Alliance,PPO Network,,4766.62,,,,,,,3154.80,5563.92,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,PPO Network,,4766.62,,,,,,,1538.48,5563.92,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.78,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.50,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,inpatient,1,EA,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.66,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.51,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.53,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,The Alliance,PPO Network,,2834.54,,,,,,,1876.05,3308.67,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,PPO Network,,2834.54,,,,,,,1538.48,4686.00,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,inpatient,1.5,EA,94.13000,89.42000,The Alliance,PPO Network,,78.22,,,,,,,51.77,91.31,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,outpatient,1.5,EA,94.13000,89.42000,The Alliance,PPO Network,,78.22,,,,,,,47.06,91.31,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,82.67,145.79,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,17.85,814.87,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,3509.55,6189.57,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,1538.48,6189.57,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,5.16,271.65,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,inpatient,10,EA,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,outpatient,10,EA,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,0.06404,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.06404,3.07,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,The Alliance,PPO Network,TC,1371.98,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,PPO Network,TC,1371.98,,,,,,,805.84,2210.07,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,147.40,259.96,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,19.63,1018.59,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,inpatient,1,EA,8.55000,8.13000,The Alliance,PPO Network,,7.11,,,,,,,4.70,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,outpatient,1,EA,8.55000,8.13000,The Alliance,PPO Network,,7.11,,,,,,,4.28,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,inpatient,1,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,inpatient,1,EA,10.63000,10.10000,The Alliance,PPO Network,,8.83,,,,,,,5.85,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,outpatient,1,EA,10.63000,10.10000,The Alliance,PPO Network,,8.83,,,,,,,5.32,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,inpatient,1,EA,5.44000,5.17000,The Alliance,PPO Network,,4.52,,,,,,,2.99,5.28,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,outpatient,1,EA,5.44000,5.17000,The Alliance,PPO Network,,4.52,,,,,,,2.72,5.28,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,inpatient,10,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,outpatient,10,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,inpatient,10,EA,2.70000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,outpatient,10,EA,2.70000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.35,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,inpatient,10,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,inpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,inpatient,10,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1320.00000,1254.00000,The Alliance,PPO Network,,1096.92,,,,,,,726.00,1280.40,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,PPO Network,,1096.92,,,,,,,726.00,5271.00,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,inpatient,1,EA,5.42000,5.15000,The Alliance,PPO Network,,4.50,,,,,,,2.98,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,outpatient,1,EA,5.42000,5.15000,The Alliance,PPO Network,,4.50,,,,,,,2.71,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,The Alliance,PPO Network,,3.87,,,,,,,2.56,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,PPO Network,,3.87,,,,,,,2.33,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,PPO Network,TC,452.89,,,,,,,272.50,528.65,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,inpatient,,,8368.00000,7949.60000,The Alliance,PPO Network,90,6953.81,,,,,,,4602.40,8116.96,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,outpatient,,,8368.00000,7949.60000,The Alliance,PPO Network,90,6953.81,,,,,,,14.91,8116.96,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.29,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.53,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.30,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,inpatient,1,EA,308.21000,292.80000,The Alliance,PPO Network,,256.12,,,,,,,169.52,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,outpatient,1,EA,308.21000,292.80000,The Alliance,PPO Network,,256.12,,,,,,,154.10,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,inpatient,1,EA,766.64000,728.31000,The Alliance,PPO Network,,637.08,,,,,,,421.65,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,outpatient,1,EA,766.64000,728.31000,The Alliance,PPO Network,,637.08,,,,,,,383.32,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,inpatient,1,EA,357.42000,339.55000,The Alliance,PPO Network,,297.02,,,,,,,196.58,346.70,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,outpatient,1,EA,357.42000,339.55000,The Alliance,PPO Network,,297.02,,,,,,,178.71,346.70,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,inpatient,30,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,outpatient,30,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,inpatient,30,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,outpatient,30,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,9.22,475.37,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,254.10,448.14,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,231.00,448.14,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.30,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.10,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.76,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.76,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,49.50,87.30,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,7.34,1086.52,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.44,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.22,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.15,2.23,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,inpatient,10,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,outpatient,10,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.01550,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,inpatient,10,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,outpatient,10,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.01550,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,inpatient,10,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,outpatient,10,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.01550,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,inpatient,10,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.01550,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,inpatient,10,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.01550,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,inpatient,10,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,outpatient,10,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,0.01550,2.01,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,4686.00,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,inpatient,1,EA,9.52000,9.04000,The Alliance,PPO Network,,7.91,,,,,,,5.24,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,outpatient,1,EA,9.52000,9.04000,The Alliance,PPO Network,,7.91,,,,,,,4.76,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.22,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.02,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,inpatient,3.7,EA,256.63000,243.79000,The Alliance,PPO Network,,213.26,,,,,,,141.15,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,outpatient,3.7,EA,256.63000,243.79000,The Alliance,PPO Network,,213.26,,,,,,,128.31,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,inpatient,3.7,EA,50.82000,48.28000,The Alliance,PPO Network,,42.23,,,,,,,27.95,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,outpatient,3.7,EA,50.82000,48.28000,The Alliance,PPO Network,,42.23,,,,,,,25.41,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,inpatient,3.7,EA,63.94000,60.75000,The Alliance,PPO Network,,53.13,,,,,,,35.17,62.02,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,outpatient,3.7,EA,63.94000,60.75000,The Alliance,PPO Network,,53.13,,,,,,,31.97,62.02,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,inpatient,222,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,outpatient,222,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,inpatient,222,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,outpatient,222,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,inpatient,222,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,outpatient,222,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,inpatient,222,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,outpatient,222,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,inpatient,222,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,outpatient,222,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,inpatient,1,EA,244.62000,232.38000,The Alliance,PPO Network,,203.28,,,,,,,134.54,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,outpatient,1,EA,244.62000,232.38000,The Alliance,PPO Network,,203.28,,,,,,,122.31,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,inpatient,1,EA,917.98000,872.08000,The Alliance,PPO Network,,762.84,,,,,,,504.89,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,outpatient,1,EA,917.98000,872.08000,The Alliance,PPO Network,,762.84,,,,,,,458.99,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,inpatient,1,EA,826.18000,784.87000,The Alliance,PPO Network,,686.56,,,,,,,454.40,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,outpatient,1,EA,826.18000,784.87000,The Alliance,PPO Network,,686.56,,,,,,,413.09,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,63.20,122.61,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,inpatient,1,EA,11.22000,10.66000,The Alliance,PPO Network,,9.32,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,PPO Network,,9.32,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,inpatient,1,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,inpatient,1,EA,4.83000,4.59000,The Alliance,PPO Network,,4.01,,,,,,,2.66,4.69,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,PPO Network,,4.01,,,,,,,2.42,4.69,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,inpatient,1,mL,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,outpatient,1,mL,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.74,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,inpatient,1,mL,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,outpatient,1,mL,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.25,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,inpatient,1,mL,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.89,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,outpatient,1,mL,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.63,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,inpatient,1,mL,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,inpatient,1,mL,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,outpatient,1,mL,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.55,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,2.85,5.52,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,inpatient,12,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,outpatient,12,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,inpatient,12,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,outpatient,12,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,inpatient,12,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,outpatient,12,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,inpatient,12,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,outpatient,12,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,inpatient,12,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,outpatient,12,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,inpatient,12,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,outpatient,12,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,inpatient,12,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,outpatient,12,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,inpatient,,,298.50000,283.58000,The Alliance,PPO Network,90,248.05,,,,,,,164.18,289.55,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,outpatient,,,298.50000,283.58000,The Alliance,PPO Network,90,248.05,,,,,,,26.09,1324.17,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,6.03,322.54,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,13.68,713.01,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,inpatient,15,EA,11.52000,10.94000,The Alliance,PPO Network,,9.57,,,,,,,6.34,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,outpatient,15,EA,11.52000,10.94000,The Alliance,PPO Network,,9.57,,,,,,,5.76,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,inpatient,15,EA,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,5.53,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,outpatient,15,EA,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,5.03,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,inpatient,15,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,outpatient,15,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,inpatient,15,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,outpatient,15,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,inpatient,15,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,inpatient,15,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,outpatient,15,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,inpatient,15,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,outpatient,15,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,inpatient,15,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,outpatient,15,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,inpatient,15,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,outpatient,15,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,inpatient,1,EA,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,8.36,14.74,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,outpatient,1,EA,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,7.60,14.74,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,inpatient,1,mL,10.52000,10.00000,The Alliance,PPO Network,,8.74,,,,,,,5.79,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,outpatient,1,mL,10.52000,10.00000,The Alliance,PPO Network,,8.74,,,,,,,5.26,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,inpatient,1,mL,19.74000,18.75000,The Alliance,PPO Network,,16.40,,,,,,,10.86,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,PPO Network,,16.40,,,,,,,9.87,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,inpatient,1,mL,17.91000,17.01000,The Alliance,PPO Network,,14.88,,,,,,,9.85,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,outpatient,1,mL,17.91000,17.01000,The Alliance,PPO Network,,14.88,,,,,,,8.96,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,inpatient,1,mL,5.67000,5.38000,The Alliance,PPO Network,,4.71,,,,,,,3.12,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,outpatient,1,mL,5.67000,5.38000,The Alliance,PPO Network,,4.71,,,,,,,2.83,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,inpatient,1,mL,32.79000,31.15000,The Alliance,PPO Network,,27.25,,,,,,,18.03,31.81,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,outpatient,1,mL,32.79000,31.15000,The Alliance,PPO Network,,27.25,,,,,,,16.39,31.81,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,177.51,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,14.57,763.98,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,inpatient,1,EA,874.67000,830.94000,The Alliance,PPO Network,,726.85,,,,,,,481.07,848.43,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,outpatient,1,EA,874.67000,830.94000,The Alliance,PPO Network,,726.85,,,,,,,3.63,848.43,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,inpatient,1,mL,17567.59000,16689.21000,The Alliance,PPO Network,,14598.67,,,,,,,9662.17,17040.56,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,outpatient,1,mL,17567.59000,16689.21000,The Alliance,PPO Network,,14598.67,,,,,,,227.10,17040.56,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,PPO Network,TC,292.51,,,,,,,193.60,341.44,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,PPO Network,TC,292.51,,,,,,,176.00,341.44,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,inpatient,,,153.80000,146.11000,The Alliance,PPO Network,90,127.81,,,,,,,84.59,149.19,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,PPO Network,90,127.81,,,,,,,13.69,696.05,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,18.96,984.66,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,inpatient,1,EA,11.22000,10.66000,The Alliance,PPO Network,,9.32,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,PPO Network,,9.32,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,inpatient,1,mL,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,2.19,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,182.60,322.04,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,166.00,1820.00,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,inpatient,1,EA,3597.38000,3417.51000,The Alliance,PPO Network,,2989.42,,,,,,,1978.56,3489.46,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,outpatient,1,EA,3597.38000,3417.51000,The Alliance,PPO Network,,2989.42,,,,,,,55.09,3489.46,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,1155.00,2037.00,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,980.94,2210.07,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,inpatient,1,EA,24.39000,23.17000,The Alliance,PPO Network,,20.27,,,,,,,13.41,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,outpatient,1,EA,24.39000,23.17000,The Alliance,PPO Network,,20.27,,,,,,,12.20,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,inpatient,1,EA,23.23000,22.07000,The Alliance,PPO Network,,19.30,,,,,,,12.78,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,outpatient,1,EA,23.23000,22.07000,The Alliance,PPO Network,,19.30,,,,,,,11.62,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,inpatient,1,EA,3.47000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,outpatient,1,EA,3.47000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.74,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,4.08,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,3.71,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,47.30,83.42,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,8.17,1324.17,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,inpatient,,,67.40000,64.03000,The Alliance,PPO Network,90,56.01,,,,,,,37.07,65.38,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,PPO Network,90,56.01,,,,,,,8.17,628.12,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,2.16,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,inpatient,1,mL,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,outpatient,1,mL,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,inpatient,1,mL,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,inpatient,,,1010.55000,960.02000,The Alliance,PPO Network,,839.77,,,,,,,495.17,980.23,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,outpatient,,,1010.55000,960.02000,The Alliance,PPO Network,,839.77,,,,,,,463.84,1010.55,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,inpatient,1,EA,5931.95000,5635.36000,The Alliance,PPO Network,,4929.45,,,,,,,3262.57,5753.99,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,outpatient,1,EA,5931.95000,5635.36000,The Alliance,PPO Network,,4929.45,,,,,,,55.09,5753.99,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1419.00000,1348.05000,The Alliance,PPO Network,,1179.19,,,,,,,780.45,1376.43,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1419.00000,1348.05000,The Alliance,PPO Network,,1179.19,,,,,,,621.36,1376.43,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,,2015.17,,,,,,,1333.75,2352.25,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,,2015.17,,,,,,,1333.75,4686.00,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,inpatient,1,EA,62.57000,59.44000,The Alliance,PPO Network,,52.00,,,,,,,34.41,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,outpatient,1,EA,62.57000,59.44000,The Alliance,PPO Network,,52.00,,,,,,,7.77,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,7.77,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,inpatient,1,EA,63.04000,59.89000,The Alliance,PPO Network,,52.39,,,,,,,34.67,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,outpatient,1,EA,63.04000,59.89000,The Alliance,PPO Network,,52.39,,,,,,,7.77,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,inpatient,1,EA,44.11000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,24.26,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,7.77,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,inpatient,1,EA,20.26000,19.24000,The Alliance,PPO Network,,16.84,,,,,,,11.14,19.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,outpatient,1,EA,20.26000,19.24000,The Alliance,PPO Network,,16.84,,,,,,,7.77,19.65,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.87,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.61,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,inpatient,1,EA,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,3.19,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,outpatient,1,EA,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,2.90,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,3.16,5.58,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,2.88,5.58,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,inpatient,,,1182.00000,1122.90000,The Alliance,PPO Network,,982.24,,,,,,,650.10,1146.54,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,outpatient,,,1182.00000,1122.90000,The Alliance,PPO Network,,982.24,,,,,,,650.10,5271.00,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,inpatient,1,EA,46.64000,44.31000,The Alliance,PPO Network,,38.76,,,,,,,25.65,45.24,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,outpatient,1,EA,46.64000,44.31000,The Alliance,PPO Network,,38.76,,,,,,,1.28,45.24,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,inpatient,60,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,outpatient,60,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,inpatient,60,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,outpatient,60,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,TC,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,TC,2157.28,,,,,,,1189.19,2518.12,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,7.77,407.44,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,PPO Network,,226.86,,,,,,,150.15,264.81,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,PPO Network,,226.86,,,,,,,119.56,264.81,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,inpatient,1,EA,15.16000,14.40000,The Alliance,PPO Network,,12.60,,,,,,,8.34,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,PPO Network,,12.60,,,,,,,7.58,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,5.60,288.61,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,inpatient,1,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,1.28,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,1.28,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,1.28,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.28,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,1.28,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,inpatient,1,EA,4.52000,4.29000,The Alliance,PPO Network,,3.76,,,,,,,2.49,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,outpatient,1,EA,4.52000,4.29000,The Alliance,PPO Network,,3.76,,,,,,,1.28,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.63,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,1.28,4.63,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,inpatient,,,54.50000,51.77000,The Alliance,PPO Network,90,45.29,,,,,,,29.98,52.87,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,outpatient,,,54.50000,51.77000,The Alliance,PPO Network,90,45.29,,,,,,,13.30,679.08,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,1.28,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,inpatient,1,EA,34.92000,33.17000,The Alliance,PPO Network,,29.02,,,,,,,19.21,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,outpatient,1,EA,34.92000,33.17000,The Alliance,PPO Network,,29.02,,,,,,,1.28,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,1.28,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,1.28,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,inpatient,1,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,1.28,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,inpatient,1,EA,39.63000,37.65000,The Alliance,PPO Network,,32.93,,,,,,,21.80,38.44,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,outpatient,1,EA,39.63000,37.65000,The Alliance,PPO Network,,32.93,,,,,,,1.28,38.44,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,inpatient,1,EA,3686.90000,3502.55000,The Alliance,PPO Network,,3063.81,,,,,,,2027.80,3576.29,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,outpatient,1,EA,3686.90000,3502.55000,The Alliance,PPO Network,,3063.81,,,,,,,2.55,3576.29,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,12.32,645.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,0.76415,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,2.65,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,0.76415,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,inpatient,1,EA,12.32000,11.71000,The Alliance,PPO Network,,10.24,,,,,,,6.78,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,outpatient,1,EA,12.32000,11.71000,The Alliance,PPO Network,,10.24,,,,,,,0.76415,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,inpatient,1,EA,14.73000,13.99000,The Alliance,PPO Network,,12.24,,,,,,,8.10,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,outpatient,1,EA,14.73000,13.99000,The Alliance,PPO Network,,12.24,,,,,,,0.76415,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,inpatient,1,EA,11.06000,10.50000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,outpatient,1,EA,11.06000,10.50000,The Alliance,PPO Network,,9.19,,,,,,,0.76415,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,inpatient,1,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,0.76415,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,0.76415,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,0.76415,21.46,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,inpatient,1,EA,19.34000,18.37000,The Alliance,PPO Network,,16.07,,,,,,,10.64,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,outpatient,1,EA,19.34000,18.37000,The Alliance,PPO Network,,16.07,,,,,,,9.67,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.60,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,inpatient,1,EA,4.46000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.45,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,outpatient,1,EA,4.46000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.46,4.34,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,inpatient,1,EA,9.14000,8.68000,The Alliance,PPO Network,,7.60,,,,,,,5.03,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,outpatient,1,EA,9.14000,8.68000,The Alliance,PPO Network,,7.60,,,,,,,0.76415,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,inpatient,1,EA,24.82000,23.58000,The Alliance,PPO Network,,20.63,,,,,,,13.65,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,outpatient,1,EA,24.82000,23.58000,The Alliance,PPO Network,,20.63,,,,,,,0.76415,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,inpatient,1,EA,28.19000,26.78000,The Alliance,PPO Network,,23.43,,,,,,,15.50,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,outpatient,1,EA,28.19000,26.78000,The Alliance,PPO Network,,23.43,,,,,,,0.76415,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,inpatient,1,EA,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,7.64,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,0.76415,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,inpatient,1,EA,6.97000,6.62000,The Alliance,PPO Network,,5.79,,,,,,,3.83,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,outpatient,1,EA,6.97000,6.62000,The Alliance,PPO Network,,5.79,,,,,,,0.76415,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,inpatient,1,EA,7.41000,7.04000,The Alliance,PPO Network,,6.16,,,,,,,4.08,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,outpatient,1,EA,7.41000,7.04000,The Alliance,PPO Network,,6.16,,,,,,,0.76415,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,0.76415,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,0.76415,33.72,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,PPO Network,,761.20,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,PPO Network,,761.20,,,,,,,314.95,888.52,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,inpatient,1,EA,31.44000,29.87000,The Alliance,PPO Network,,26.13,,,,,,,17.29,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,outpatient,1,EA,31.44000,29.87000,The Alliance,PPO Network,,26.13,,,,,,,7.77,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,inpatient,1,EA,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,12.15,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,7.77,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,inpatient,1,EA,10.14000,9.64000,The Alliance,PPO Network,,8.43,,,,,,,5.58,9.84,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,outpatient,1,EA,10.14000,9.64000,The Alliance,PPO Network,,8.43,,,,,,,5.07,9.84,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,0.76415,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,0.76415,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,0.76415,2.59,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,inpatient,1,EA,31.76000,30.17000,The Alliance,PPO Network,,26.39,,,,,,,17.47,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,outpatient,1,EA,31.76000,30.17000,The Alliance,PPO Network,,26.39,,,,,,,1.86,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,1.86,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,inpatient,1,EA,30.97000,29.42000,The Alliance,PPO Network,,25.74,,,,,,,17.03,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,PPO Network,,25.74,,,,,,,1.86,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,inpatient,1,EA,16.61000,15.78000,The Alliance,PPO Network,,13.80,,,,,,,9.14,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,outpatient,1,EA,16.61000,15.78000,The Alliance,PPO Network,,13.80,,,,,,,1.86,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,inpatient,1,EA,44.65000,42.42000,The Alliance,PPO Network,,37.10,,,,,,,24.56,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,outpatient,1,EA,44.65000,42.42000,The Alliance,PPO Network,,37.10,,,,,,,1.86,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,inpatient,1,EA,31.28000,29.72000,The Alliance,PPO Network,,25.99,,,,,,,17.20,30.34,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,outpatient,1,EA,31.28000,29.72000,The Alliance,PPO Network,,25.99,,,,,,,1.86,30.34,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,inpatient,1,EA,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,inpatient,1,EA,4.73000,4.50000,The Alliance,PPO Network,,3.93,,,,,,,2.60,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,outpatient,1,EA,4.73000,4.50000,The Alliance,PPO Network,,3.93,,,,,,,2.37,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,inpatient,1,EA,4.91000,4.66000,The Alliance,PPO Network,,4.08,,,,,,,2.70,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,outpatient,1,EA,4.91000,4.66000,The Alliance,PPO Network,,4.08,,,,,,,2.46,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,inpatient,1,EA,4.86000,4.62000,The Alliance,PPO Network,,4.04,,,,,,,2.67,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,outpatient,1,EA,4.86000,4.62000,The Alliance,PPO Network,,4.04,,,,,,,2.43,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,4.72,254.68,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,inpatient,1,EA,9.90000,9.41000,The Alliance,PPO Network,,8.23,,,,,,,5.45,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,outpatient,1,EA,9.90000,9.41000,The Alliance,PPO Network,,8.23,,,,,,,4.95,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,23.46,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,21.33,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,The Alliance,PPO Network,,17.33,,,,,,,11.47,20.23,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,PPO Network,,17.33,,,,,,,10.43,20.23,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,inpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,211.46,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,outpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,5271.00,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,inpatient,1,EA,2.41000,2.29000,The Alliance,PPO Network,,2.00,,,,,,,1.33,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,PPO Network,,2.00,,,,,,,0.76415,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,inpatient,1,EA,5.62000,5.33000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,PPO Network,,4.67,,,,,,,0.76415,5.45,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,inpatient,120,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,outpatient,120,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,inpatient,120,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,outpatient,120,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,inpatient,1,mL,49.82000,47.33000,The Alliance,PPO Network,,41.40,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,PPO Network,,41.40,,,,,,,24.91,129.48,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,inpatient,1,EA,38.10000,36.19000,The Alliance,PPO Network,,31.66,,,,,,,20.95,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,outpatient,1,EA,38.10000,36.19000,The Alliance,PPO Network,,31.66,,,,,,,19.05,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.46,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,inpatient,1,EA,6.39000,6.07000,The Alliance,PPO Network,,5.31,,,,,,,3.51,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,outpatient,1,EA,6.39000,6.07000,The Alliance,PPO Network,,5.31,,,,,,,3.19,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,2.17,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,110.00,194.00,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,11.53,594.19,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,inpatient,100,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,outpatient,100,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,inpatient,100,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,outpatient,100,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,inpatient,100,EA,25.98000,24.68000,The Alliance,PPO Network,,21.59,,,,,,,14.29,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,outpatient,100,EA,25.98000,24.68000,The Alliance,PPO Network,,21.59,,,,,,,12.99,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,inpatient,,,2419.00000,2298.05000,The Alliance,PPO Network,,2010.19,,,,,,,1330.45,2346.43,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,outpatient,,,2419.00000,2298.05000,The Alliance,PPO Network,,2010.19,,,,,,,1330.45,5271.00,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,inpatient,1,mL,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,outpatient,1,mL,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.01,1.97,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,inpatient,1,EA,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.94,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.67,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,inpatient,1,EA,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.80,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.54,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,3.06,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,2.78,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.97,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.43,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,inpatient,1,EA,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,3.20,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,2.90,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,8.17,662.12,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,138.60,244.44,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,26.72,1273.27,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,inpatient,,,35.20000,33.44000,The Alliance,PPO Network,90,29.25,,,,,,,19.36,34.14,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,outpatient,,,35.20000,33.44000,The Alliance,PPO Network,90,29.25,,,,,,,14.59,729.98,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.47,339.51,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,inpatient,2,EA,47.59000,45.21000,The Alliance,PPO Network,,39.55,,,,,,,26.17,46.16,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,outpatient,2,EA,47.59000,45.21000,The Alliance,PPO Network,,39.55,,,,,,,23.80,48.21,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,inpatient,2,EA,52.30000,49.68000,The Alliance,PPO Network,,43.46,,,,,,,28.77,50.73,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,outpatient,2,EA,52.30000,49.68000,The Alliance,PPO Network,,43.46,,,,,,,26.15,50.73,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,inpatient,,,167.30000,158.94000,The Alliance,PPO Network,90,139.03,,,,,,,92.02,162.28,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,PPO Network,90,139.03,,,,,,,17.43,882.80,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,The Alliance,PPO Network,,732.11,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,PPO Network,,732.11,,,,,,,314.95,854.57,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,inpatient,,,790.00000,750.50000,The Alliance,PPO Network,TC,656.49,,,,,,,434.50,766.30,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,PPO Network,TC,656.49,,,,,,,304.21,3547.16,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,67.58,471.42,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,10.74,560.26,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,314.95,700.34,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,inpatient,2,EA,2573.64000,2444.96000,The Alliance,PPO Network,,2138.69,,,,,,,1415.50,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,outpatient,2,EA,2573.64000,2444.96000,The Alliance,PPO Network,,2138.69,,,,,,,835.80,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,inpatient,2,EA,3600.65000,3420.62000,The Alliance,PPO Network,,2992.14,,,,,,,1980.36,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,outpatient,2,EA,3600.65000,3420.62000,The Alliance,PPO Network,,2992.14,,,,,,,835.80,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,inpatient,2,EA,2626.01000,2494.71000,The Alliance,PPO Network,,2182.21,,,,,,,1444.31,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,outpatient,2,EA,2626.01000,2494.71000,The Alliance,PPO Network,,2182.21,,,,,,,835.80,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,inpatient,2,EA,3601.91000,3421.82000,The Alliance,PPO Network,,2993.19,,,,,,,1981.05,3493.85,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,outpatient,2,EA,3601.91000,3421.82000,The Alliance,PPO Network,,2993.19,,,,,,,835.80,3493.85,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,67.58,180.42,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,5.00,254.68,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,37.78,66.64,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,8.17,611.15,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,inpatient,1,EA,18.13000,17.22000,The Alliance,PPO Network,,15.07,,,,,,,9.97,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,outpatient,1,EA,18.13000,17.22000,The Alliance,PPO Network,,15.07,,,,,,,9.06,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,inpatient,1,EA,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,6.57,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,5.97,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,inpatient,1,EA,17.32000,16.45000,The Alliance,PPO Network,,14.39,,,,,,,9.53,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,PPO Network,,14.39,,,,,,,8.66,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,inpatient,1,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,4.70,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,4.27,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,inpatient,1,EA,17.40000,16.53000,The Alliance,PPO Network,,14.46,,,,,,,9.57,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,outpatient,1,EA,17.40000,16.53000,The Alliance,PPO Network,,14.46,,,,,,,8.70,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,inpatient,1,EA,12.33000,11.71000,The Alliance,PPO Network,,10.25,,,,,,,6.78,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,PPO Network,,10.25,,,,,,,6.17,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,inpatient,1,EA,20.14000,19.13000,The Alliance,PPO Network,,16.74,,,,,,,11.08,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,outpatient,1,EA,20.14000,19.13000,The Alliance,PPO Network,,16.74,,,,,,,10.07,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,inpatient,1,EA,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,outpatient,1,EA,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,inpatient,1,EA,6.62000,6.29000,The Alliance,PPO Network,,5.50,,,,,,,3.64,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,outpatient,1,EA,6.62000,6.29000,The Alliance,PPO Network,,5.50,,,,,,,3.31,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,inpatient,1,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.78,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,inpatient,1,EA,16.31000,15.49000,The Alliance,PPO Network,,13.55,,,,,,,8.97,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,outpatient,1,EA,16.31000,15.49000,The Alliance,PPO Network,,13.55,,,,,,,1.86,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,inpatient,1,EA,19.05000,18.10000,The Alliance,PPO Network,,15.83,,,,,,,10.48,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,outpatient,1,EA,19.05000,18.10000,The Alliance,PPO Network,,15.83,,,,,,,1.86,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,1.86,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,inpatient,1,EA,18.01000,17.11000,The Alliance,PPO Network,,14.97,,,,,,,9.91,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,PPO Network,,14.97,,,,,,,1.86,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,inpatient,1,EA,22.50000,21.37000,The Alliance,PPO Network,,18.70,,,,,,,12.38,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,PPO Network,,18.70,,,,,,,1.86,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,1.86,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,inpatient,1,EA,18.33000,17.41000,The Alliance,PPO Network,,15.23,,,,,,,10.08,17.78,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,PPO Network,,15.23,,,,,,,1.86,17.78,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.57,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.15,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,inpatient,1,EA,13.54000,12.87000,The Alliance,PPO Network,,11.25,,,,,,,7.45,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,outpatient,1,EA,13.54000,12.87000,The Alliance,PPO Network,,11.25,,,,,,,6.77,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.58,6.31,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.25,6.31,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,inpatient,50,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,outpatient,50,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,inpatient,50,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,inpatient,50,EA,1.85000,1.75000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,outpatient,50,EA,1.85000,1.75000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,inpatient,50,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,outpatient,50,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,inpatient,50,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,outpatient,50,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,inpatient,50,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,outpatient,50,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,inpatient,50,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,outpatient,50,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,inpatient,1,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,inpatient,1,EA,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,9.81,458.40,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.75,271.65,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,7.87,407.44,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,4.60,237.65,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,67.58,395.76,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,inpatient,1,mL,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,1.95,3.43,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,outpatient,1,mL,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,0.06045,3.43,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,inpatient,1,mL,104.95000,99.70000,The Alliance,PPO Network,,87.21,,,,,,,57.72,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,outpatient,1,mL,104.95000,99.70000,The Alliance,PPO Network,,87.21,,,,,,,52.48,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,inpatient,1,mL,94.45000,89.73000,The Alliance,PPO Network,,78.49,,,,,,,51.95,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,outpatient,1,mL,94.45000,89.73000,The Alliance,PPO Network,,78.49,,,,,,,47.23,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,inpatient,1,mL,86.63000,82.30000,The Alliance,PPO Network,,71.99,,,,,,,47.65,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,outpatient,1,mL,86.63000,82.30000,The Alliance,PPO Network,,71.99,,,,,,,43.31,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,inpatient,1,mL,73.73000,70.05000,The Alliance,PPO Network,,61.27,,,,,,,40.55,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,outpatient,1,mL,73.73000,70.05000,The Alliance,PPO Network,,61.27,,,,,,,36.87,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,inpatient,1,mL,48.60000,46.17000,The Alliance,PPO Network,,40.39,,,,,,,26.73,47.14,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,outpatient,1,mL,48.60000,46.17000,The Alliance,PPO Network,,40.39,,,,,,,24.30,47.14,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,178.20,314.28,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,35.09,1833.46,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.74,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.32,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.02,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,inpatient,1,EA,6.05000,5.75000,The Alliance,PPO Network,,5.03,,,,,,,3.33,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,PPO Network,,5.03,,,,,,,3.02,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,24.09,1137.41,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,76.45,134.83,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,11.98,628.12,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,3.83,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,inpatient,,,1316.00000,1250.20000,The Alliance,PPO Network,,1093.60,,,,,,,723.80,1276.52,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,outpatient,,,1316.00000,1250.20000,The Alliance,PPO Network,,1093.60,,,,,,,144.61,6807.60,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,inpatient,1,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,2.16,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,169.40,298.76,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,33.47,1578.85,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,,1350.38,,,,,,,893.75,1576.25,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,,1350.38,,,,,,,125.49,6518.98,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,inpatient,1,EA,6.49000,6.17000,The Alliance,PPO Network,,5.39,,,,,,,3.57,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,outpatient,1,EA,6.49000,6.17000,The Alliance,PPO Network,,5.39,,,,,,,3.25,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.53,2.71,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.40,2.71,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,inpatient,,,2292.00000,2177.40000,The Alliance,PPO Network,,1904.65,,,,,,,1260.60,2223.24,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,outpatient,,,2292.00000,2177.40000,The Alliance,PPO Network,,1904.65,,,,,,,248.52,12426.88,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,inpatient,10,EA,9.91000,9.41000,The Alliance,PPO Network,,8.24,,,,,,,5.45,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,outpatient,10,EA,9.91000,9.41000,The Alliance,PPO Network,,8.24,,,,,,,4.96,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,inpatient,10,EA,10.62000,10.09000,The Alliance,PPO Network,,8.83,,,,,,,5.84,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,outpatient,10,EA,10.62000,10.09000,The Alliance,PPO Network,,8.83,,,,,,,5.31,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,inpatient,10,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,outpatient,10,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,inpatient,10,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.29,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,outpatient,10,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.08,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,inpatient,10,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,outpatient,10,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,inpatient,10,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,outpatient,10,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,inpatient,,,890.00000,845.50000,The Alliance,PPO Network,,739.59,,,,,,,489.50,863.30,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,PPO Network,,739.59,,,,,,,68.60,3582.03,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,inpatient,,,84.40000,80.18000,The Alliance,PPO Network,90,70.14,,,,,,,46.42,81.87,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,outpatient,,,84.40000,80.18000,The Alliance,PPO Network,90,70.14,,,,,,,10.23,1052.52,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,11.89,628.12,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,4.35,220.68,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,90,28.25,,,,,,,18.70,32.98,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,90,28.25,,,,,,,17.00,1086.52,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,inpatient,1,mL,22.31000,21.19000,The Alliance,PPO Network,,18.54,,,,,,,12.27,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,PPO Network,,18.54,,,,,,,11.15,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.92,3.39,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.75,3.39,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,67.58,393.82,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,10.13,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,9.21,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,The Alliance,PPO Network,,14.63,,,,,,,9.68,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,PPO Network,,14.63,,,,,,,8.80,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.85,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.60,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,inpatient,1,EA,15.74000,14.95000,The Alliance,PPO Network,,13.08,,,,,,,8.66,15.27,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,outpatient,1,EA,15.74000,14.95000,The Alliance,PPO Network,,13.08,,,,,,,7.87,15.27,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,inpatient,1,EA,15.49000,14.71000,The Alliance,PPO Network,,12.87,,,,,,,8.52,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,outpatient,1,EA,15.49000,14.71000,The Alliance,PPO Network,,12.87,,,,,,,7.75,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,inpatient,1,EA,52.90000,50.26000,The Alliance,PPO Network,,43.96,,,,,,,29.09,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,outpatient,1,EA,52.90000,50.26000,The Alliance,PPO Network,,43.96,,,,,,,26.45,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,inpatient,1,EA,36.26000,34.45000,The Alliance,PPO Network,,30.13,,,,,,,19.94,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,outpatient,1,EA,36.26000,34.45000,The Alliance,PPO Network,,30.13,,,,,,,1.63,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.27,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.16,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,inpatient,1,EA,84.97000,80.72000,The Alliance,PPO Network,,70.61,,,,,,,46.73,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,outpatient,1,EA,84.97000,80.72000,The Alliance,PPO Network,,70.61,,,,,,,1.63,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,inpatient,1,EA,81.63000,77.55000,The Alliance,PPO Network,,67.83,,,,,,,44.90,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,outpatient,1,EA,81.63000,77.55000,The Alliance,PPO Network,,67.83,,,,,,,1.63,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,inpatient,1,EA,17.91000,17.01000,The Alliance,PPO Network,,14.88,,,,,,,9.85,17.37,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,outpatient,1,EA,17.91000,17.01000,The Alliance,PPO Network,,14.88,,,,,,,1.63,17.37,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,inpatient,1,mL,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,245.30,432.62,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,34.43,1799.53,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,177.51,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,6003.00,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,inpatient,,,151.40000,143.83000,The Alliance,PPO Network,90,125.81,,,,,,,83.27,146.86,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,outpatient,,,151.40000,143.83000,The Alliance,PPO Network,90,125.81,,,,,,,28.73,1459.96,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,inpatient,1,mL,49.82000,47.33000,The Alliance,PPO Network,,41.40,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,PPO Network,,41.40,,,,,,,24.91,129.48,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,inpatient,1,mL,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,0.06045,3.27,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,10.91,21.17,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.39,288.61,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,inpatient,6,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,inpatient,6,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,outpatient,6,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,inpatient,6,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,inpatient,6,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,outpatient,6,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.15,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,inpatient,6,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,outpatient,6,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,inpatient,6,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,outpatient,6,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,inpatient,1,EA,41.98000,39.89000,The Alliance,PPO Network,,34.89,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,outpatient,1,EA,41.98000,39.89000,The Alliance,PPO Network,,34.89,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,inpatient,1,EA,25.85000,24.56000,The Alliance,PPO Network,,21.48,,,,,,,14.22,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,outpatient,1,EA,25.85000,24.56000,The Alliance,PPO Network,,21.48,,,,,,,12.93,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,inpatient,1,EA,30.74000,29.20000,The Alliance,PPO Network,,25.54,,,,,,,16.91,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,outpatient,1,EA,30.74000,29.20000,The Alliance,PPO Network,,25.54,,,,,,,15.37,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,inpatient,1,EA,65.64000,62.35000,The Alliance,PPO Network,,54.55,,,,,,,36.10,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,outpatient,1,EA,65.64000,62.35000,The Alliance,PPO Network,,54.55,,,,,,,32.82,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,inpatient,1,EA,41.98000,39.88000,The Alliance,PPO Network,,34.89,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,outpatient,1,EA,41.98000,39.88000,The Alliance,PPO Network,,34.89,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,inpatient,1,EA,45.08000,42.83000,The Alliance,PPO Network,,37.46,,,,,,,24.79,43.73,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,outpatient,1,EA,45.08000,42.83000,The Alliance,PPO Network,,37.46,,,,,,,22.54,43.73,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,inpatient,1,EA,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.98,12.31,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,outpatient,1,EA,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.34,12.31,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,inpatient,15,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,outpatient,15,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,inpatient,15,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,outpatient,15,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,inpatient,15,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,outpatient,15,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,inpatient,15,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,outpatient,15,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,inpatient,15,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,outpatient,15,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,220.19,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,113.50,220.19,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,inpatient,10,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,7.30,12.87,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,outpatient,10,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,6.63,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,inpatient,10,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,outpatient,10,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,inpatient,10,EA,9.90000,9.41000,The Alliance,PPO Network,,8.23,,,,,,,5.45,9.60,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,outpatient,10,EA,9.90000,9.41000,The Alliance,PPO Network,,8.23,,,,,,,4.95,29.16,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,inpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,73.70,129.98,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,12.00,628.12,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,inpatient,40,EA,6.86000,6.52000,The Alliance,PPO Network,,5.70,,,,,,,3.77,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,outpatient,40,EA,6.86000,6.52000,The Alliance,PPO Network,,5.70,,,,,,,3.43,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,inpatient,40,EA,8.24000,7.82000,The Alliance,PPO Network,,6.85,,,,,,,4.53,7.99,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,outpatient,40,EA,8.24000,7.82000,The Alliance,PPO Network,,6.85,,,,,,,4.12,7.99,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,inpatient,1,EA,83.73000,79.55000,The Alliance,PPO Network,,69.58,,,,,,,46.05,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,outpatient,1,EA,83.73000,79.55000,The Alliance,PPO Network,,69.58,,,,,,,41.87,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,inpatient,1,EA,52.59000,49.96000,The Alliance,PPO Network,,43.70,,,,,,,28.92,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,outpatient,1,EA,52.59000,49.96000,The Alliance,PPO Network,,43.70,,,,,,,26.30,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,inpatient,1,EA,83.82000,79.63000,The Alliance,PPO Network,,69.65,,,,,,,46.10,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,outpatient,1,EA,83.82000,79.63000,The Alliance,PPO Network,,69.65,,,,,,,41.91,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,inpatient,1,EA,207.99000,197.59000,The Alliance,PPO Network,,172.84,,,,,,,114.39,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,outpatient,1,EA,207.99000,197.59000,The Alliance,PPO Network,,172.84,,,,,,,104.00,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,inpatient,1,EA,60.92000,57.87000,The Alliance,PPO Network,,50.62,,,,,,,33.51,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,outpatient,1,EA,60.92000,57.87000,The Alliance,PPO Network,,50.62,,,,,,,30.46,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,inpatient,1,EA,41.91000,39.81000,The Alliance,PPO Network,,34.83,,,,,,,23.05,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,outpatient,1,EA,41.91000,39.81000,The Alliance,PPO Network,,34.83,,,,,,,20.95,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,inpatient,1,EA,25.98000,24.68000,The Alliance,PPO Network,,21.59,,,,,,,14.29,25.20,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,outpatient,1,EA,25.98000,24.68000,The Alliance,PPO Network,,21.59,,,,,,,12.99,25.20,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,inpatient,6,EA,2.25000,2.13000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,outpatient,6,EA,2.25000,2.13000,The Alliance,PPO Network,,1.87,,,,,,,1.12,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,inpatient,6,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,inpatient,6,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,outpatient,6,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,inpatient,6,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,2.76,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,122.40,5271.00,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,inpatient,1,EA,1.78000,1.70000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,inpatient,30,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,outpatient,30,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,inpatient,30,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,outpatient,30,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,10.91,21.17,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,inpatient,1,EA,20.37000,19.35000,The Alliance,PPO Network,,16.93,,,,,,,11.20,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,outpatient,1,EA,20.37000,19.35000,The Alliance,PPO Network,,16.93,,,,,,,10.19,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,33.55,59.17,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,5.18,271.65,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.18,271.65,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,94.05,165.87,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,14.39,746.94,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,inpatient,,,1930.00000,1833.50000,The Alliance,PPO Network,90,1603.83,,,,,,,1061.50,1872.10,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,outpatient,,,1930.00000,1833.50000,The Alliance,PPO Network,90,1603.83,,,,,,,70.04,7690.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,inpatient,1,EA,1.63000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,outpatient,1,EA,1.63000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.30,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.18,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,inpatient,1,EA,17.74000,16.85000,The Alliance,PPO Network,,14.74,,,,,,,9.76,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,outpatient,1,EA,17.74000,16.85000,The Alliance,PPO Network,,14.74,,,,,,,8.87,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,inpatient,1,EA,15.16000,14.40000,The Alliance,PPO Network,,12.60,,,,,,,8.34,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,PPO Network,,12.60,,,,,,,7.58,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,8.43,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,7.67,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,inpatient,1,EA,14.19000,13.48000,The Alliance,PPO Network,,11.79,,,,,,,7.80,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,outpatient,1,EA,14.19000,13.48000,The Alliance,PPO Network,,11.79,,,,,,,7.09,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,inpatient,1,EA,16.25000,15.43000,The Alliance,PPO Network,,13.50,,,,,,,8.94,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,outpatient,1,EA,16.25000,15.43000,The Alliance,PPO Network,,13.50,,,,,,,8.12,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,inpatient,1,EA,8.81000,8.37000,The Alliance,PPO Network,,7.32,,,,,,,4.85,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,PPO Network,,7.32,,,,,,,4.41,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,2.28,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,2.07,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,inpatient,1,EA,11.76000,11.17000,The Alliance,PPO Network,,9.77,,,,,,,6.47,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,outpatient,1,EA,11.76000,11.17000,The Alliance,PPO Network,,9.77,,,,,,,5.88,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,inpatient,1,EA,29.36000,27.89000,The Alliance,PPO Network,,24.40,,,,,,,16.15,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,outpatient,1,EA,29.36000,27.89000,The Alliance,PPO Network,,24.40,,,,,,,14.68,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,inpatient,1,EA,22.06000,20.96000,The Alliance,PPO Network,,18.33,,,,,,,12.13,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,outpatient,1,EA,22.06000,20.96000,The Alliance,PPO Network,,18.33,,,,,,,11.03,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.08,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,inpatient,1,EA,5.49000,5.22000,The Alliance,PPO Network,,4.56,,,,,,,3.02,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,outpatient,1,EA,5.49000,5.22000,The Alliance,PPO Network,,4.56,,,,,,,2.75,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,The Alliance,PPO Network,,7.21,,,,,,,4.77,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,PPO Network,,7.21,,,,,,,4.34,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.23,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.03,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.99,3.50,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.80,3.50,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,inpatient,1,mL,141.01000,133.96000,The Alliance,PPO Network,,117.18,,,,,,,77.56,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,outpatient,1,mL,141.01000,133.96000,The Alliance,PPO Network,,117.18,,,,,,,70.50,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,inpatient,1,mL,174.20000,165.49000,The Alliance,PPO Network,,144.76,,,,,,,95.81,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,outpatient,1,mL,174.20000,165.49000,The Alliance,PPO Network,,144.76,,,,,,,87.10,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,inpatient,1,mL,193.55000,183.87000,The Alliance,PPO Network,,160.84,,,,,,,106.45,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,outpatient,1,mL,193.55000,183.87000,The Alliance,PPO Network,,160.84,,,,,,,96.78,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,inpatient,1,mL,232.26000,220.65000,The Alliance,PPO Network,,193.01,,,,,,,127.74,225.29,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,outpatient,1,mL,232.26000,220.65000,The Alliance,PPO Network,,193.01,,,,,,,116.13,225.29,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,12.41,645.08,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,inpatient,42.5,EA,47.41000,45.04000,The Alliance,PPO Network,,39.40,,,,,,,26.08,45.99,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,outpatient,42.5,EA,47.41000,45.04000,The Alliance,PPO Network,,39.40,,,,,,,23.70,45.99,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,16.30,848.80,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,inpatient,,,291.00000,276.45000,The Alliance,PPO Network,,241.82,,,,,,,160.05,282.27,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,PPO Network,,241.82,,,,,,,145.50,1714.64,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,inpatient,,,6254.85000,5942.11000,The Alliance,PPO Network,,5197.78,,,,,,,3064.88,6067.20,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,outpatient,,,6254.85000,5942.11000,The Alliance,PPO Network,,5197.78,,,,,,,2870.98,6254.85,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,9.02,662.12,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,4.75,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,212.44,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,inpatient,,,1859.00000,1766.05000,The Alliance,PPO Network,TC,1544.83,,,,,,,1022.45,1803.23,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,outpatient,,,1859.00000,1766.05000,The Alliance,PPO Network,TC,1544.83,,,,,,,929.50,1820.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,inpatient,,,3545.00000,3367.75000,The Alliance,PPO Network,TC,2945.89,,,,,,,1949.75,3438.65,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,outpatient,,,3545.00000,3367.75000,The Alliance,PPO Network,TC,2945.89,,,,,,,1285.85,3438.65,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,inpatient,1,EA,103.18000,98.02000,The Alliance,PPO Network,,85.74,,,,,,,56.75,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,outpatient,1,EA,103.18000,98.02000,The Alliance,PPO Network,,85.74,,,,,,,11.16,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,inpatient,1,EA,94.74000,90.00000,The Alliance,PPO Network,,78.73,,,,,,,52.11,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,outpatient,1,EA,94.74000,90.00000,The Alliance,PPO Network,,78.73,,,,,,,11.16,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,11.16,38.31,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,64.90,114.46,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,10.56,441.94,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,37.50,1833.46,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,7417.50000,7046.62000,The Alliance,PPO Network,,6163.94,,,,,,,3634.57,7194.98,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,7417.50000,7046.62000,The Alliance,PPO Network,,6163.94,,,,,,,3404.63,7417.50,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,inpatient,,,974.00000,925.30000,The Alliance,PPO Network,,809.39,,,,,,,535.70,944.78,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,PPO Network,,809.39,,,,,,,487.00,944.78,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,5.18,271.65,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,3.83,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,5.12,271.65,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,16.71,865.84,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,8.17,628.12,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,36.50,1544.85,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,inpatient,1,EA,276.04000,262.24000,The Alliance,PPO Network,,229.39,,,,,,,151.82,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,outpatient,1,EA,276.04000,262.24000,The Alliance,PPO Network,,229.39,,,,,,,44.86,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,inpatient,1,EA,253.43000,240.76000,The Alliance,PPO Network,,210.60,,,,,,,139.39,245.83,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,outpatient,1,EA,253.43000,240.76000,The Alliance,PPO Network,,210.60,,,,,,,44.86,245.83,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,TC,1026.29,,,,,,,679.25,1197.95,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,TC,1026.29,,,,,,,584.87,1820.00,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,8.17,679.08,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,inpatient,118,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,outpatient,118,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,inpatient,118,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,outpatient,118,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,inpatient,118,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,outpatient,118,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,inpatient,118,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,outpatient,118,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,13.82,645.08,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,545.05,961.27,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,495.50,1820.00,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,685.30,1208.62,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,584.87,1820.00,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2823.14,5588.65,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2644.53,5761.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,inpatient,,,2650.00000,2517.50000,The Alliance,PPO Network,TC,2202.15,,,,,,,1457.50,2570.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,outpatient,,,2650.00000,2517.50000,The Alliance,PPO Network,TC,2202.15,,,,,,,1285.85,2570.50,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,The Alliance,PPO Network,TC,1778.34,,,,,,,1177.00,2075.80,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,PPO Network,TC,1778.34,,,,,,,1070.00,2075.80,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,inpatient,,,3245.00000,3082.75000,The Alliance,PPO Network,,2696.59,,,,,,,1784.75,3147.65,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,PPO Network,,2696.59,,,,,,,800.09,4686.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,inpatient,,,1950.00000,1852.50000,The Alliance,PPO Network,TC,1620.45,,,,,,,1072.50,1891.50,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,outpatient,,,1950.00000,1852.50000,The Alliance,PPO Network,TC,1620.45,,,,,,,975.00,1891.50,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,8.17,679.08,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,inpatient,,,29.20000,27.74000,The Alliance,PPO Network,90,24.27,,,,,,,16.06,28.32,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,outpatient,,,29.20000,27.74000,The Alliance,PPO Network,90,24.27,,,,,,,9.83,611.15,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,62.70,110.58,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,9.46,492.33,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,2.16,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,inpatient,1,mL,9.57000,9.10000,The Alliance,PPO Network,,7.95,,,,,,,5.26,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,outpatient,1,mL,9.57000,9.10000,The Alliance,PPO Network,,7.95,,,,,,,2.50,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,inpatient,1,mL,96.78000,91.94000,The Alliance,PPO Network,,80.42,,,,,,,53.23,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,outpatient,1,mL,96.78000,91.94000,The Alliance,PPO Network,,80.42,,,,,,,2.50,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,inpatient,1,mL,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,outpatient,1,mL,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,2.50,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,inpatient,1,mL,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.24,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.67,3.24,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,12.95,679.08,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,6.47,339.51,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,2522.85,4449.39,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,1538.48,4686.00,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1020.00000,969.00000,The Alliance,PPO Network,TC,847.62,,,,,,,561.00,989.40,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,PPO Network,TC,847.62,,,,,,,510.00,1820.00,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,7.33,1284.54,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,inpatient,1,mL,9.11000,8.65000,The Alliance,PPO Network,,7.57,,,,,,,5.01,8.84,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,outpatient,1,mL,9.11000,8.65000,The Alliance,PPO Network,,7.57,,,,,,,4.55,8.84,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,The Alliance,PPO Network,TC,1914.62,,,,,,,1267.20,2234.88,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,PPO Network,TC,1914.62,,,,,,,979.11,2234.88,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,inpatient,,,2144.00000,2036.80000,The Alliance,PPO Network,TC,1781.66,,,,,,,1179.20,2079.68,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,outpatient,,,2144.00000,2036.80000,The Alliance,PPO Network,TC,1781.66,,,,,,,979.11,2079.68,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,The Alliance,PPO Network,TC,1965.32,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,PPO Network,TC,1965.32,,,,,,,979.11,2294.05,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.06,424.40,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.51,339.51,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1081.00000,1026.95000,The Alliance,PPO Network,TC,898.31,,,,,,,594.55,1048.57,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1081.00000,1026.95000,The Alliance,PPO Network,TC,898.31,,,,,,,540.50,1820.00,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,TC,164.54,,,,,,,108.90,192.06,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,TC,164.54,,,,,,,99.00,1820.00,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,8.17,882.80,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,inpatient,,,49.50000,47.02000,The Alliance,PPO Network,TC,41.13,,,,,,,27.23,48.02,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,PPO Network,TC,41.13,,,,,,,24.75,484.28,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,The Alliance,PPO Network,TC,1489.98,,,,,,,986.15,1739.21,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,PPO Network,TC,1489.98,,,,,,,896.50,1820.00,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,The Alliance,PPO Network,TC,1217.41,,,,,,,805.75,1421.05,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,PPO Network,TC,1217.41,,,,,,,732.50,1820.00,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,TC,2325.14,,,,,,,1538.90,2714.06,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,TC,2325.14,,,,,,,979.11,2714.06,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,inpatient,120,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,outpatient,120,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,409.20,721.68,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,306.02,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,The Alliance,PPO Network,TC,2160.60,,,,,,,1430.00,2522.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,PPO Network,TC,2160.60,,,,,,,1285.85,2522.00,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,TC,1963.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,PPO Network,TC,1963.65,,,,,,,979.11,2292.11,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,122.40,238.62,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,inpatient,,,2299.00000,2184.05000,The Alliance,PPO Network,TC,1910.47,,,,,,,1264.45,2230.03,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,outpatient,,,2299.00000,2184.05000,The Alliance,PPO Network,TC,1910.47,,,,,,,979.11,2230.03,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,PPO Network,,462.87,,,,,,,306.35,540.29,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,PPO Network,,462.87,,,,,,,278.50,540.29,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,PPO Network,TC,1923.77,,,,,,,979.11,2245.55,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,65.45,115.43,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,10.32,543.22,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,TC,1553.14,,,,,,,1027.95,1812.93,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,TC,1553.14,,,,,,,934.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,584.87,1820.00,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,1029.05,1814.87,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,935.50,1820.00,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,594.19,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,TC,118.00,,,,,,,78.10,137.74,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,TC,118.00,,,,,,,71.00,1820.00,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,1002.10,1767.34,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,911.00,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,The Alliance,PPO Network,TC,2100.77,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,PPO Network,TC,2100.77,,,,,,,1264.00,2452.16,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,6.63,339.51,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,177.65,313.31,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,161.50,313.31,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,60.36,222.13,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,685.30,1208.62,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,623.00,1820.00,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,680.35,1199.89,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,584.87,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,inpatient,,,2196.00000,2086.20000,The Alliance,PPO Network,TC,1824.88,,,,,,,1207.80,2130.12,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,outpatient,,,2196.00000,2086.20000,The Alliance,PPO Network,TC,1824.88,,,,,,,1098.00,2130.12,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,The Alliance,PPO Network,,1145.95,,,,,,,758.45,1337.63,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,PPO Network,,1145.95,,,,,,,115.36,6026.72,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,inpatient,,,2621.00000,2489.95000,The Alliance,PPO Network,TC,2178.05,,,,,,,1441.55,2542.37,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,outpatient,,,2621.00000,2489.95000,The Alliance,PPO Network,TC,2178.05,,,,,,,1285.85,2542.37,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,979.11,2548.19,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,6.63,339.51,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,14.61,679.08,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,The Alliance,PPO Network,TC,1556.46,,,,,,,1030.15,1816.81,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,PPO Network,TC,1556.46,,,,,,,936.50,1820.00,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,19.60,1018.59,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,4686.00,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,979.11,2209.66,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,1016.40,1792.56,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,924.00,1820.00,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,inpatient,,,1776.00000,1687.20000,The Alliance,PPO Network,TC,1475.86,,,,,,,976.80,1722.72,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,outpatient,,,1776.00000,1687.20000,The Alliance,PPO Network,TC,1475.86,,,,,,,837.93,1820.00,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,The Alliance,PPO Network,TC,1987.75,,,,,,,1315.60,2320.24,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,PPO Network,TC,1987.75,,,,,,,979.11,2320.24,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,584.87,1820.00,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,684.20,1206.68,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,584.87,1820.00,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,1029.05,1814.87,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,PPO Network,TC,1554.80,,,,,,,935.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,inpatient,,,2319.00000,2203.05000,The Alliance,PPO Network,TC,1927.09,,,,,,,1275.45,2249.43,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,outpatient,,,2319.00000,2203.05000,The Alliance,PPO Network,TC,1927.09,,,,,,,979.11,2249.43,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,685.30,1208.62,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,PPO Network,TC,1035.43,,,,,,,623.00,1820.00,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,,199.44,,,,,,,132.00,232.80,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,,199.44,,,,,,,20.05,1052.52,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,8.07,424.40,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,6.63,339.51,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,PPO Network,,141.27,,,,,,,93.50,164.90,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,PPO Network,,141.27,,,,,,,7.36,356.54,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,6.63,339.51,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,TC,2838.70,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,PPO Network,TC,2838.70,,,,,,,979.11,3313.52,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,9.47,492.33,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,The Alliance,PPO Network,TC,1299.68,,,,,,,860.20,1517.08,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,PPO Network,TC,1299.68,,,,,,,782.00,1820.00,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,52.80,93.12,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,8.62,458.40,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,684.20,1206.68,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,622.00,1820.00,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,6.63,339.51,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,20.32,1069.56,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,The Alliance,PPO Network,TC,1066.17,,,,,,,705.65,1244.51,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,PPO Network,TC,1066.17,,,,,,,584.87,1820.00,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,8.08,424.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,inpatient,1,EA,1451.33000,1378.77000,The Alliance,PPO Network,,1206.06,,,,,,,798.23,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,outpatient,1,EA,1451.33000,1378.77000,The Alliance,PPO Network,,1206.06,,,,,,,0.62000,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,inpatient,1,EA,958.30000,910.38000,The Alliance,PPO Network,,796.35,,,,,,,527.07,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,outpatient,1,EA,958.30000,910.38000,The Alliance,PPO Network,,796.35,,,,,,,0.62000,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,inpatient,1,EA,1897.17000,1802.32000,The Alliance,PPO Network,,1576.55,,,,,,,1043.44,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,outpatient,1,EA,1897.17000,1802.32000,The Alliance,PPO Network,,1576.55,,,,,,,0.62000,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,inpatient,1,EA,1750.45000,1662.93000,The Alliance,PPO Network,,1454.62,,,,,,,962.75,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,outpatient,1,EA,1750.45000,1662.93000,The Alliance,PPO Network,,1454.62,,,,,,,0.62000,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,inpatient,1,EA,655.27000,622.51000,The Alliance,PPO Network,,544.53,,,,,,,360.40,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,outpatient,1,EA,655.27000,622.51000,The Alliance,PPO Network,,544.53,,,,,,,0.62000,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,inpatient,1,EA,932.40000,885.78000,The Alliance,PPO Network,,774.82,,,,,,,512.82,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,outpatient,1,EA,932.40000,885.78000,The Alliance,PPO Network,,774.82,,,,,,,0.62000,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,inpatient,1,EA,1707.46000,1622.08000,The Alliance,PPO Network,,1418.90,,,,,,,939.10,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,outpatient,1,EA,1707.46000,1622.08000,The Alliance,PPO Network,,1418.90,,,,,,,0.62000,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,inpatient,1,EA,1750.53000,1663.00000,The Alliance,PPO Network,,1454.69,,,,,,,962.79,1698.01,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,outpatient,1,EA,1750.53000,1663.00000,The Alliance,PPO Network,,1454.69,,,,,,,0.62000,1698.01,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,8.09,424.40,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,10.32,543.22,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,10.80,560.26,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,inpatient,,,2404.00000,2283.80000,The Alliance,PPO Network,TC,1997.72,,,,,,,1322.20,2331.88,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,outpatient,,,2404.00000,2283.80000,The Alliance,PPO Network,TC,1997.72,,,,,,,979.11,2331.88,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,12.52,662.12,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,inpatient,,,634.00000,602.30000,The Alliance,PPO Network,TC,526.85,,,,,,,348.70,614.98,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,outpatient,,,634.00000,602.30000,The Alliance,PPO Network,TC,526.85,,,,,,,177.63,3899.16,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,216.31,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,18.05,950.66,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,inpatient,1,mL,5.89000,5.60000,The Alliance,PPO Network,,4.89,,,,,,,3.24,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,outpatient,1,mL,5.89000,5.60000,The Alliance,PPO Network,,4.89,,,,,,,2.94,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,3.28,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,2.98,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,3.25,5.72,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,2.95,5.72,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,The Alliance,PPO Network,TC,1882.21,,,,,,,1245.75,2197.05,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,PPO Network,TC,1882.21,,,,,,,1132.50,2197.05,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,The Alliance,PPO Network,TC,2154.78,,,,,,,1426.15,2515.21,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,PPO Network,TC,2154.78,,,,,,,979.11,2515.21,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,65.45,115.43,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,14.01,797.91,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,1016.40,1792.56,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,924.00,1820.00,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,6.63,339.51,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,inpatient,1,EA,725.69000,689.41000,The Alliance,PPO Network,,603.05,,,,,,,399.13,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,outpatient,1,EA,725.69000,689.41000,The Alliance,PPO Network,,603.05,,,,,,,0.62000,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,inpatient,1,EA,479.15000,455.19000,The Alliance,PPO Network,,398.17,,,,,,,263.53,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,outpatient,1,EA,479.15000,455.19000,The Alliance,PPO Network,,398.17,,,,,,,0.62000,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,inpatient,1,EA,948.59000,901.16000,The Alliance,PPO Network,,788.28,,,,,,,521.72,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,outpatient,1,EA,948.59000,901.16000,The Alliance,PPO Network,,788.28,,,,,,,0.62000,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,inpatient,1,EA,877.73000,833.84000,The Alliance,PPO Network,,729.39,,,,,,,482.75,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,outpatient,1,EA,877.73000,833.84000,The Alliance,PPO Network,,729.39,,,,,,,0.62000,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,inpatient,1,EA,466.20000,442.89000,The Alliance,PPO Network,,387.41,,,,,,,256.41,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,outpatient,1,EA,466.20000,442.89000,The Alliance,PPO Network,,387.41,,,,,,,0.62000,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,inpatient,1,EA,311.63000,296.05000,The Alliance,PPO Network,,258.96,,,,,,,171.40,302.28,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,outpatient,1,EA,311.63000,296.05000,The Alliance,PPO Network,,258.96,,,,,,,0.62000,302.28,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,680.35,1199.89,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,PPO Network,TC,1027.95,,,,,,,584.87,1820.00,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,6.63,339.51,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,18.52,865.84,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,inpatient,1,mL,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.26,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,inpatient,1,mL,3.30000,3.14000,The Alliance,PPO Network,,2.74,,,,,,,1.81,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,outpatient,1,mL,3.30000,3.14000,The Alliance,PPO Network,,2.74,,,,,,,1.26,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.26,3.07,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,inpatient,2,EA,69.77000,66.28000,The Alliance,PPO Network,,57.98,,,,,,,38.37,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,outpatient,2,EA,69.77000,66.28000,The Alliance,PPO Network,,57.98,,,,,,,34.88,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,inpatient,2,EA,37.30000,35.44000,The Alliance,PPO Network,,31.00,,,,,,,20.52,36.18,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,outpatient,2,EA,37.30000,35.44000,The Alliance,PPO Network,,31.00,,,,,,,18.65,36.18,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,10.32,543.22,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,The Alliance,PPO Network,TC,1888.86,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,PPO Network,TC,1888.86,,,,,,,1136.50,2204.81,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,171.05,301.67,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,50.73,3254.22,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,TC,127.14,,,,,,,84.15,148.41,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,TC,127.14,,,,,,,76.50,905.54,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,inpatient,1,EA,15.71000,14.92000,The Alliance,PPO Network,,13.06,,,,,,,8.64,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,outpatient,1,EA,15.71000,14.92000,The Alliance,PPO Network,,13.06,,,,,,,7.86,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,inpatient,1,EA,27.95000,26.56000,The Alliance,PPO Network,,23.23,,,,,,,15.37,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,outpatient,1,EA,27.95000,26.56000,The Alliance,PPO Network,,23.23,,,,,,,13.97,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,inpatient,1,EA,10.35000,9.84000,The Alliance,PPO Network,,8.60,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,outpatient,1,EA,10.35000,9.84000,The Alliance,PPO Network,,8.60,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,inpatient,1,EA,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,inpatient,1,EA,6.83000,6.48000,The Alliance,PPO Network,,5.68,,,,,,,3.76,6.63,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,outpatient,1,EA,6.83000,6.48000,The Alliance,PPO Network,,5.68,,,,,,,3.42,6.63,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,inpatient,1,EA,5.53000,5.26000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,outpatient,1,EA,5.53000,5.26000,The Alliance,PPO Network,,4.60,,,,,,,1.15,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,inpatient,1,EA,8.46000,8.04000,The Alliance,PPO Network,,7.03,,,,,,,4.65,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,PPO Network,,7.03,,,,,,,1.15,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.15,2.36,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,49.50,87.30,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,7.71,407.44,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,60.50,106.70,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,9.44,492.33,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,12.68,967.70,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,inpatient,1,EA,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,18.70,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,outpatient,1,EA,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,17.00,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,inpatient,1,EA,14.74000,14.01000,The Alliance,PPO Network,,12.25,,,,,,,8.11,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,outpatient,1,EA,14.74000,14.01000,The Alliance,PPO Network,,12.25,,,,,,,7.37,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,inpatient,1,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,8.11,14.31,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,outpatient,1,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,7.38,14.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,inpatient,2,EA,53.31000,50.64000,The Alliance,PPO Network,,44.30,,,,,,,29.32,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,outpatient,2,EA,53.31000,50.64000,The Alliance,PPO Network,,44.30,,,,,,,26.66,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,inpatient,2,EA,18.68000,17.74000,The Alliance,PPO Network,,15.52,,,,,,,10.27,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,outpatient,2,EA,18.68000,17.74000,The Alliance,PPO Network,,15.52,,,,,,,9.34,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,inpatient,2,EA,229.42000,217.95000,The Alliance,PPO Network,,190.65,,,,,,,126.18,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,outpatient,2,EA,229.42000,217.95000,The Alliance,PPO Network,,190.65,,,,,,,114.71,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,inpatient,2,EA,18.88000,17.94000,The Alliance,PPO Network,,15.69,,,,,,,10.38,18.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,outpatient,2,EA,18.88000,17.94000,The Alliance,PPO Network,,15.69,,,,,,,9.44,18.31,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,PPO Network,TC,2183.04,,,,,,,979.11,2548.19,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,inpatient,,,192.00000,182.40000,The Alliance,PPO Network,90,159.55,,,,,,,105.60,186.24,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,PPO Network,90,159.55,,,,,,,20.36,1120.45,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.28,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,inpatient,1,EA,4.99000,4.75000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,outpatient,1,EA,4.99000,4.75000,The Alliance,PPO Network,,4.15,,,,,,,2.50,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.86,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.69,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.13,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.60,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,The Alliance,PPO Network,,17.53,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,PPO Network,,17.53,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,inpatient,1,EA,10.45000,9.93000,The Alliance,PPO Network,,8.68,,,,,,,5.75,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,outpatient,1,EA,10.45000,9.93000,The Alliance,PPO Network,,8.68,,,,,,,5.22,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,inpatient,1,EA,9.53000,9.05000,The Alliance,PPO Network,,7.92,,,,,,,5.24,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,outpatient,1,EA,9.53000,9.05000,The Alliance,PPO Network,,7.92,,,,,,,4.76,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,inpatient,1,EA,37.86000,35.96000,The Alliance,PPO Network,,31.46,,,,,,,20.82,36.72,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,outpatient,1,EA,37.86000,35.96000,The Alliance,PPO Network,,31.46,,,,,,,18.93,36.72,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,inpatient,1,mL,4.01000,3.81000,The Alliance,PPO Network,,3.33,,,,,,,2.21,3.89,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,outpatient,1,mL,4.01000,3.81000,The Alliance,PPO Network,,3.33,,,,,,,1.26,3.89,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,1444.30,2547.22,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,PPO Network,TC,2182.21,,,,,,,979.11,2547.22,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,inpatient,,,2887.00000,2742.65000,The Alliance,PPO Network,90,2399.10,,,,,,,1587.85,2800.39,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,outpatient,,,2887.00000,2742.65000,The Alliance,PPO Network,90,2399.10,,,,,,,608.00,54562.77,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2287.00000,2172.65000,The Alliance,PPO Network,TC,1900.50,,,,,,,1257.85,2218.39,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,PPO Network,TC,1900.50,,,,,,,1143.50,2218.39,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,52.25,92.15,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,8.08,424.40,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,inpatient,,,3088.00000,2933.60000,The Alliance,PPO Network,TC,2566.13,,,,,,,1698.40,2995.36,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,outpatient,,,3088.00000,2933.60000,The Alliance,PPO Network,TC,2566.13,,,,,,,1285.85,2995.36,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,TC,63.16,,,,,,,41.80,73.72,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,TC,63.16,,,,,,,30.28,413.21,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,The Alliance,PPO Network,TC,1917.12,,,,,,,1268.85,2237.79,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,PPO Network,TC,1917.12,,,,,,,1153.50,2237.79,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,8.42,696.05,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,0.3,EA,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,0.3,EA,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,3.00,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,3.00,7770.57,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,7.06,1018.59,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.57,288.61,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,inpatient,1,EA,6472.37000,6148.75000,The Alliance,PPO Network,,5378.54,,,,,,,3559.80,6278.20,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,outpatient,1,EA,6472.37000,6148.75000,The Alliance,PPO Network,,5378.54,,,,,,,3236.18,6278.20,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,inpatient,1,mL,301.66000,286.57000,The Alliance,PPO Network,,250.68,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,PPO Network,,250.68,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,inpatient,1,mL,346.54000,329.21000,The Alliance,PPO Network,,287.97,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,PPO Network,,287.97,,,,,,,69.84,336.14,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,inpatient,1,EA,44.48000,42.25000,The Alliance,PPO Network,,36.96,,,,,,,24.46,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,outpatient,1,EA,44.48000,42.25000,The Alliance,PPO Network,,36.96,,,,,,,3.14,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,inpatient,1,EA,38.82000,36.88000,The Alliance,PPO Network,,32.26,,,,,,,21.35,37.66,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,PPO Network,,32.26,,,,,,,3.14,37.66,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,8.41,441.37,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,inpatient,1,mL,3994.25000,3794.54000,The Alliance,PPO Network,,3319.22,,,,,,,2196.84,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,outpatient,1,mL,3994.25000,3794.54000,The Alliance,PPO Network,,3319.22,,,,,,,29.24,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,inpatient,1,mL,4108.08000,3902.67000,The Alliance,PPO Network,,3413.81,,,,,,,2259.44,3984.84,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,outpatient,1,mL,4108.08000,3902.67000,The Alliance,PPO Network,,3413.81,,,,,,,29.24,3984.84,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,3.00,7770.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,inpatient,1,mL,501.16000,476.11000,The Alliance,PPO Network,,416.46,,,,,,,275.64,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,PPO Network,,416.46,,,,,,,3.00,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,0.4,EA,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,0.4,EA,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,3.00,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,3.00,1944.52,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,The Alliance,PPO Network,,17.53,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,PPO Network,,17.53,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,25.45,1453.11,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,3.40,492.33,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,inpatient,1,EA,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,2.55,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,inpatient,1,EA,2460.50000,2337.48000,The Alliance,PPO Network,,2044.68,,,,,,,1353.28,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,outpatient,1,EA,2460.50000,2337.48000,The Alliance,PPO Network,,2044.68,,,,,,,2.55,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,inpatient,1,EA,1554.00000,1476.30000,The Alliance,PPO Network,,1291.37,,,,,,,854.70,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,outpatient,1,EA,1554.00000,1476.30000,The Alliance,PPO Network,,1291.37,,,,,,,2.55,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,356.12,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,2.55,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,inpatient,1,EA,971.25000,922.69000,The Alliance,PPO Network,,807.11,,,,,,,534.19,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,outpatient,1,EA,971.25000,922.69000,The Alliance,PPO Network,,807.11,,,,,,,2.55,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,inpatient,1,EA,3935.30000,3738.53000,The Alliance,PPO Network,,3270.23,,,,,,,2164.41,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,outpatient,1,EA,3935.30000,3738.53000,The Alliance,PPO Network,,3270.23,,,,,,,2.55,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,inpatient,1,EA,1023.05000,971.90000,The Alliance,PPO Network,,850.15,,,,,,,562.68,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,outpatient,1,EA,1023.05000,971.90000,The Alliance,PPO Network,,850.15,,,,,,,2.55,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,284.90,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,2.55,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,inpatient,1,EA,512.82000,487.18000,The Alliance,PPO Network,,426.15,,,,,,,282.05,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,outpatient,1,EA,512.82000,487.18000,The Alliance,PPO Network,,426.15,,,,,,,2.55,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,inpatient,1,EA,2432.29000,2310.68000,The Alliance,PPO Network,,2021.23,,,,,,,1337.76,2359.32,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,outpatient,1,EA,2432.29000,2310.68000,The Alliance,PPO Network,,2021.23,,,,,,,2.55,2359.32,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,inpatient,0.5,EA,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,outpatient,0.5,EA,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,inpatient,0.42,EA,1193.25000,1133.59000,The Alliance,PPO Network,,991.59,,,,,,,656.29,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,outpatient,0.42,EA,1193.25000,1133.59000,The Alliance,PPO Network,,991.59,,,,,,,3.00,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,inpatient,1,mL,1193.24000,1133.58000,The Alliance,PPO Network,,991.58,,,,,,,656.28,1157.44,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,outpatient,1,mL,1193.24000,1133.58000,The Alliance,PPO Network,,991.58,,,,,,,3.00,1157.44,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,inpatient,1,EA,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,1.95,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,1.77,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,6.63,339.51,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,3.00,7770.57,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,inpatient,1,EA,12.93000,12.28000,The Alliance,PPO Network,,10.74,,,,,,,7.11,12.54,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,outpatient,1,EA,12.93000,12.28000,The Alliance,PPO Network,,10.74,,,,,,,1.77,12.54,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2442.77,4835.69,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2288.23,4985.25,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,6.63,339.51,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,inpatient,500,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,outpatient,500,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,inpatient,500,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,outpatient,500,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,12.95,679.08,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,0.14415,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,0.14415,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,inpatient,1,EA,8.31000,7.90000,The Alliance,PPO Network,,6.91,,,,,,,4.57,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,outpatient,1,EA,8.31000,7.90000,The Alliance,PPO Network,,6.91,,,,,,,0.14415,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,0.14415,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,0.14415,2.38,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,inpatient,3.5,EA,206.04000,195.74000,The Alliance,PPO Network,,171.22,,,,,,,113.32,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,outpatient,3.5,EA,206.04000,195.74000,The Alliance,PPO Network,,171.22,,,,,,,103.02,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,inpatient,3.5,EA,244.89000,232.65000,The Alliance,PPO Network,,203.50,,,,,,,134.69,237.54,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,outpatient,3.5,EA,244.89000,232.65000,The Alliance,PPO Network,,203.50,,,,,,,122.44,237.54,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,inpatient,1,mL,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,outpatient,1,mL,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,inpatient,1,mL,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,2.36,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,outpatient,1,mL,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,0.14415,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.14415,0.98940,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,inpatient,1,EA,79.95000,75.95000,The Alliance,PPO Network,,66.44,,,,,,,43.97,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,outpatient,1,EA,79.95000,75.95000,The Alliance,PPO Network,,66.44,,,,,,,0.04803,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,inpatient,1,EA,1061.15000,1008.09000,The Alliance,PPO Network,,881.82,,,,,,,583.63,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,outpatient,1,EA,1061.15000,1008.09000,The Alliance,PPO Network,,881.82,,,,,,,0.04803,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,0.04803,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,inpatient,1,EA,252.14000,239.53000,The Alliance,PPO Network,,209.53,,,,,,,138.68,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,outpatient,1,EA,252.14000,239.53000,The Alliance,PPO Network,,209.53,,,,,,,0.04803,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,inpatient,1,EA,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,0.04803,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,inpatient,1,EA,1153.79000,1096.10000,The Alliance,PPO Network,,958.80,,,,,,,634.58,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,outpatient,1,EA,1153.79000,1096.10000,The Alliance,PPO Network,,958.80,,,,,,,0.04803,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,inpatient,1,EA,323.78000,307.59000,The Alliance,PPO Network,,269.06,,,,,,,178.08,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,outpatient,1,EA,323.78000,307.59000,The Alliance,PPO Network,,269.06,,,,,,,0.04803,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,inpatient,1,EA,1153.82000,1096.13000,The Alliance,PPO Network,,958.82,,,,,,,634.60,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,outpatient,1,EA,1153.82000,1096.13000,The Alliance,PPO Network,,958.82,,,,,,,0.04803,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,0.04803,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,0.04803,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,inpatient,1,EA,58.74000,55.81000,The Alliance,PPO Network,,48.81,,,,,,,32.31,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,outpatient,1,EA,58.74000,55.81000,The Alliance,PPO Network,,48.81,,,,,,,0.04803,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,inpatient,1,EA,1061.41000,1008.34000,The Alliance,PPO Network,,882.03,,,,,,,583.78,1029.57,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,outpatient,1,EA,1061.41000,1008.34000,The Alliance,PPO Network,,882.03,,,,,,,0.04803,1029.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,PPO Network,,1665.87,,,,,,,3.00,1944.52,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,inpatient,1,EA,40.14000,38.13000,The Alliance,PPO Network,,33.36,,,,,,,22.08,38.94,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,outpatient,1,EA,40.14000,38.13000,The Alliance,PPO Network,,33.36,,,,,,,20.07,38.94,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,inpatient,,,2468.00000,2344.60000,The Alliance,PPO Network,,2050.91,,,,,,,1357.40,2393.96,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,outpatient,,,2468.00000,2344.60000,The Alliance,PPO Network,,2050.91,,,,,,,1234.00,2393.96,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,inpatient,5,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,outpatient,5,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.14415,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,inpatient,5,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,outpatient,5,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.14415,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,inpatient,5,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,outpatient,5,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.14415,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,inpatient,5,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,outpatient,5,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14415,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,inpatient,5,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.14415,1.19,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,0.3,EA,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,0.3,EA,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,3.00,3453.59,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,inpatient,1,mL,4321.88000,4105.78000,The Alliance,PPO Network,,3591.48,,,,,,,2377.03,4192.22,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,outpatient,1,mL,4321.88000,4105.78000,The Alliance,PPO Network,,3591.48,,,,,,,29.24,4192.22,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,inpatient,,,325.00000,308.75000,The Alliance,PPO Network,,270.07,,,,,,,178.75,315.25,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,PPO Network,,270.07,,,,,,,37.27,3305.11,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,22.23,1154.38,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,inpatient,1,EA,1265.09000,1201.83000,The Alliance,PPO Network,,1051.29,,,,,,,695.80,1227.14,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,outpatient,1,EA,1265.09000,1201.83000,The Alliance,PPO Network,,1051.29,,,,,,,4.36,1227.14,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.08,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,inpatient,1,EA,224.08000,212.87000,The Alliance,PPO Network,,186.21,,,,,,,123.24,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,PPO Network,,186.21,,,,,,,112.04,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,inpatient,1,EA,196.46000,186.63000,The Alliance,PPO Network,,163.26,,,,,,,108.05,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,outpatient,1,EA,196.46000,186.63000,The Alliance,PPO Network,,163.26,,,,,,,98.23,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,inpatient,1,EA,255.96000,243.16000,The Alliance,PPO Network,,212.70,,,,,,,140.78,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,PPO Network,,212.70,,,,,,,127.98,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,inpatient,1,EA,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,121.66,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,110.60,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,inpatient,1,EA,280.10000,266.10000,The Alliance,PPO Network,,232.76,,,,,,,154.06,271.70,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,outpatient,1,EA,280.10000,266.10000,The Alliance,PPO Network,,232.76,,,,,,,140.05,271.70,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,inpatient,2,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,outpatient,2,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,10.27,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,inpatient,2,EA,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,36.50,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,outpatient,2,EA,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,33.18,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,inpatient,2,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,outpatient,2,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,5.69,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,inpatient,2,EA,56.25000,53.44000,The Alliance,PPO Network,,46.74,,,,,,,30.94,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,outpatient,2,EA,56.25000,53.44000,The Alliance,PPO Network,,46.74,,,,,,,28.12,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,inpatient,2,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,12.86,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,11.69,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,inpatient,2,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,27.81,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,outpatient,2,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,25.28,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,inpatient,2,EA,30.16000,28.65000,The Alliance,PPO Network,,25.06,,,,,,,16.59,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,outpatient,2,EA,30.16000,28.65000,The Alliance,PPO Network,,25.06,,,,,,,15.08,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,inpatient,2,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.57,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,outpatient,2,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.15,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,inpatient,2,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,outpatient,2,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,2.77,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,inpatient,2,EA,26.61000,25.28000,The Alliance,PPO Network,,22.11,,,,,,,14.64,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,outpatient,2,EA,26.61000,25.28000,The Alliance,PPO Network,,22.11,,,,,,,13.30,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,inpatient,2,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,14.22,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,inpatient,2,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,outpatient,2,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.26,8.27,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,inpatient,,,293.20000,278.54000,The Alliance,PPO Network,90,243.65,,,,,,,161.26,284.40,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,outpatient,,,293.20000,278.54000,The Alliance,PPO Network,90,243.65,,,,,,,26.11,1324.17,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,inpatient,3.5,EA,15.03000,14.28000,The Alliance,PPO Network,,12.49,,,,,,,8.27,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,outpatient,3.5,EA,15.03000,14.28000,The Alliance,PPO Network,,12.49,,,,,,,7.51,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,inpatient,3.5,EA,14.35000,13.63000,The Alliance,PPO Network,,11.92,,,,,,,7.89,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,outpatient,3.5,EA,14.35000,13.63000,The Alliance,PPO Network,,11.92,,,,,,,7.17,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,inpatient,3.5,EA,16.25000,15.44000,The Alliance,PPO Network,,13.50,,,,,,,8.94,15.76,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,outpatient,3.5,EA,16.25000,15.44000,The Alliance,PPO Network,,13.50,,,,,,,8.12,15.76,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,inpatient,1,mL,4.52000,4.29000,The Alliance,PPO Network,,3.76,,,,,,,2.49,4.38,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,outpatient,1,mL,4.52000,4.29000,The Alliance,PPO Network,,3.76,,,,,,,0.14415,4.38,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,inpatient,1,EA,4.51000,4.29000,The Alliance,PPO Network,,3.75,,,,,,,2.48,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,outpatient,1,EA,4.51000,4.29000,The Alliance,PPO Network,,3.75,,,,,,,0.14415,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,inpatient,1,EA,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,7.64,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,0.14415,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,0.14415,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,inpatient,1,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,0.14415,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,inpatient,1,EA,16.56000,15.73000,The Alliance,PPO Network,,13.76,,,,,,,9.11,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,outpatient,1,EA,16.56000,15.73000,The Alliance,PPO Network,,13.76,,,,,,,0.14415,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,inpatient,1,EA,18.26000,17.35000,The Alliance,PPO Network,,15.17,,,,,,,10.04,17.71,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,outpatient,1,EA,18.26000,17.35000,The Alliance,PPO Network,,15.17,,,,,,,0.14415,17.71,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,inpatient,1,EA,3.30000,3.14000,The Alliance,PPO Network,,2.74,,,,,,,1.81,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,outpatient,1,EA,3.30000,3.14000,The Alliance,PPO Network,,2.74,,,,,,,1.65,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,PPO Network,,440.43,,,,,,,291.50,514.10,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,PPO Network,,440.43,,,,,,,50.73,4789.16,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,inpatient,,,503.00000,477.85000,The Alliance,PPO Network,,417.99,,,,,,,276.65,487.91,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,outpatient,,,503.00000,477.85000,The Alliance,PPO Network,,417.99,,,,,,,251.50,487.91,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.50,4.85,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,inpatient,1,EA,1328.67000,1262.24000,The Alliance,PPO Network,,1104.12,,,,,,,730.77,1288.81,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,outpatient,1,EA,1328.67000,1262.24000,The Alliance,PPO Network,,1104.12,,,,,,,664.34,8365.47,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,inpatient,1,EA,9519.93000,9043.93000,The Alliance,PPO Network,,7911.06,,,,,,,5235.96,9234.33,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,outpatient,1,EA,9519.93000,9043.93000,The Alliance,PPO Network,,7911.06,,,,,,,4759.97,9234.33,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.18,271.65,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,inpatient,2.5,EA,48.01000,45.61000,The Alliance,PPO Network,,39.90,,,,,,,26.41,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,outpatient,2.5,EA,48.01000,45.61000,The Alliance,PPO Network,,39.90,,,,,,,24.00,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,inpatient,2.5,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,7.30,12.87,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,outpatient,2.5,EA,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,6.63,12.87,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,inpatient,1,mL,105.09000,99.83000,The Alliance,PPO Network,,87.33,,,,,,,57.80,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,outpatient,1,mL,105.09000,99.83000,The Alliance,PPO Network,,87.33,,,,,,,52.55,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,inpatient,1,mL,47.94000,45.55000,The Alliance,PPO Network,,39.84,,,,,,,26.37,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,outpatient,1,mL,47.94000,45.55000,The Alliance,PPO Network,,39.84,,,,,,,23.97,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,inpatient,1,mL,63.92000,60.72000,The Alliance,PPO Network,,53.12,,,,,,,35.16,62.00,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,outpatient,1,mL,63.92000,60.72000,The Alliance,PPO Network,,53.12,,,,,,,31.96,62.00,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,The Alliance,PPO Network,TC,431.29,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,PPO Network,TC,431.29,,,,,,,259.50,503.43,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,PPO Network,,6657.06,,,,,,,3.00,7770.57,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,inpatient,1,mL,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,outpatient,1,mL,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,inpatient,1,mL,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,outpatient,1,mL,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,inpatient,1,mL,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,outpatient,1,mL,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.29,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,inpatient,,,293.80000,279.11000,The Alliance,PPO Network,,244.15,,,,,,,161.59,284.99,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,outpatient,,,293.80000,279.11000,The Alliance,PPO Network,,244.15,,,,,,,146.90,284.99,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,inpatient,1,EA,7.66000,7.28000,The Alliance,PPO Network,,6.37,,,,,,,4.21,7.43,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,outpatient,1,EA,7.66000,7.28000,The Alliance,PPO Network,,6.37,,,,,,,3.83,7.43,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,inpatient,1,EA,0.18000,0.18000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,outpatient,1,EA,0.18000,0.18000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,inpatient,2,EA,53.18000,50.53000,The Alliance,PPO Network,,44.19,,,,,,,29.25,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,outpatient,2,EA,53.18000,50.53000,The Alliance,PPO Network,,44.19,,,,,,,8.97,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,inpatient,2,EA,38.88000,36.94000,The Alliance,PPO Network,,32.31,,,,,,,21.38,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,outpatient,2,EA,38.88000,36.94000,The Alliance,PPO Network,,32.31,,,,,,,8.97,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,inpatient,2,EA,38.89000,36.95000,The Alliance,PPO Network,,32.32,,,,,,,21.39,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,outpatient,2,EA,38.89000,36.95000,The Alliance,PPO Network,,32.32,,,,,,,8.97,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,inpatient,2,EA,38.55000,36.62000,The Alliance,PPO Network,,32.04,,,,,,,21.20,37.39,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,outpatient,2,EA,38.55000,36.62000,The Alliance,PPO Network,,32.04,,,,,,,8.97,37.39,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,inpatient,1,mL,124.51000,118.28000,The Alliance,PPO Network,,103.47,,,,,,,68.48,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,outpatient,1,mL,124.51000,118.28000,The Alliance,PPO Network,,103.47,,,,,,,62.26,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,inpatient,1,mL,77.82000,73.93000,The Alliance,PPO Network,,64.67,,,,,,,42.80,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,outpatient,1,mL,77.82000,73.93000,The Alliance,PPO Network,,64.67,,,,,,,38.91,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,inpatient,1,mL,124.50000,118.28000,The Alliance,PPO Network,,103.46,,,,,,,68.47,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,outpatient,1,mL,124.50000,118.28000,The Alliance,PPO Network,,103.46,,,,,,,62.25,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,inpatient,1,mL,113.46000,107.79000,The Alliance,PPO Network,,94.29,,,,,,,62.40,110.06,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,outpatient,1,mL,113.46000,107.79000,The Alliance,PPO Network,,94.29,,,,,,,56.73,110.06,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,inpatient,1,EA,8.02000,7.62000,The Alliance,PPO Network,,6.66,,,,,,,4.41,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,outpatient,1,EA,8.02000,7.62000,The Alliance,PPO Network,,6.66,,,,,,,4.01,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,inpatient,1,EA,8.74000,8.30000,The Alliance,PPO Network,,7.26,,,,,,,4.81,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,outpatient,1,EA,8.74000,8.30000,The Alliance,PPO Network,,7.26,,,,,,,4.37,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,inpatient,1,EA,7.94000,7.55000,The Alliance,PPO Network,,6.60,,,,,,,4.37,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,outpatient,1,EA,7.94000,7.55000,The Alliance,PPO Network,,6.60,,,,,,,3.97,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,The Alliance,PPO Network,,8.69,,,,,,,5.75,10.15,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,PPO Network,,8.69,,,,,,,5.23,10.15,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,inpatient,2,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,outpatient,2,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.34,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,inpatient,2,EA,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,5.20,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,outpatient,2,EA,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,4.72,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,inpatient,2,EA,133.60000,126.92000,The Alliance,PPO Network,,111.02,,,,,,,73.48,129.59,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,outpatient,2,EA,133.60000,126.92000,The Alliance,PPO Network,,111.02,,,,,,,6.40,129.59,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,inpatient,1,EA,5.43000,5.16000,The Alliance,PPO Network,,4.51,,,,,,,2.99,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,outpatient,1,EA,5.43000,5.16000,The Alliance,PPO Network,,4.51,,,,,,,2.71,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,The Alliance,PPO Network,,4.65,,,,,,,3.07,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,PPO Network,,4.65,,,,,,,2.79,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,inpatient,1,EA,6.56000,6.23000,The Alliance,PPO Network,,5.45,,,,,,,3.61,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,outpatient,1,EA,6.56000,6.23000,The Alliance,PPO Network,,5.45,,,,,,,3.28,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.54,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.31,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,inpatient,1,GM,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,inpatient,1,GM,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,outpatient,1,GM,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,inpatient,1,GM,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,outpatient,1,GM,0.56000,0.54000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,inpatient,1,GM,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,outpatient,1,GM,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,inpatient,1,EA,36.06000,34.26000,The Alliance,PPO Network,,29.97,,,,,,,19.83,34.98,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,outpatient,1,EA,36.06000,34.26000,The Alliance,PPO Network,,29.97,,,,,,,18.03,34.98,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,PPO Network,,314.12,,,,,,,207.90,366.66,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,PPO Network,,314.12,,,,,,,23.25,3435.48,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,90.20,159.08,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,13.28,696.05,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,inpatient,,,2211.00000,2100.45000,The Alliance,PPO Network,,1837.34,,,,,,,1216.05,2144.67,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,outpatient,,,2211.00000,2100.45000,The Alliance,PPO Network,,1837.34,,,,,,,1105.50,2144.67,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,The Alliance,PPO Network,,3.11,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,PPO Network,,3.11,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,inpatient,1,mL,137.78000,130.89000,The Alliance,PPO Network,,114.50,,,,,,,75.78,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,outpatient,1,mL,137.78000,130.89000,The Alliance,PPO Network,,114.50,,,,,,,68.89,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,inpatient,1,mL,113.36000,107.69000,The Alliance,PPO Network,,94.20,,,,,,,62.35,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,outpatient,1,mL,113.36000,107.69000,The Alliance,PPO Network,,94.20,,,,,,,56.68,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,inpatient,1,mL,110.52000,105.00000,The Alliance,PPO Network,,91.84,,,,,,,60.79,107.20,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,outpatient,1,mL,110.52000,105.00000,The Alliance,PPO Network,,91.84,,,,,,,55.26,107.20,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,2.16,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.30,4.06,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.10,4.06,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,inpatient,1,EA,2.47000,2.35000,The Alliance,PPO Network,,2.05,,,,,,,1.36,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,outpatient,1,EA,2.47000,2.35000,The Alliance,PPO Network,,2.05,,,,,,,1.24,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.30,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.18,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,2.06,3.63,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,1.87,3.63,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,The Alliance,PPO Network,,7.61,,,,,,,5.04,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,PPO Network,,7.61,,,,,,,4.58,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,The Alliance,PPO Network,,7.55,,,,,,,4.99,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,PPO Network,,7.55,,,,,,,4.54,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,inpatient,1,EA,12.30000,11.69000,The Alliance,PPO Network,,10.22,,,,,,,6.76,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,outpatient,1,EA,12.30000,11.69000,The Alliance,PPO Network,,10.22,,,,,,,6.15,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,The Alliance,PPO Network,,8.30,,,,,,,5.49,9.69,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,PPO Network,,8.30,,,,,,,5.00,9.69,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,6.12,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,inpatient,1,EA,51.86000,49.26000,The Alliance,PPO Network,,43.10,,,,,,,28.52,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,outpatient,1,EA,51.86000,49.26000,The Alliance,PPO Network,,43.10,,,,,,,6.12,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,6.12,30.65,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,inpatient,50,EA,43.92000,41.73000,The Alliance,PPO Network,,36.50,,,,,,,24.16,42.60,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,outpatient,50,EA,43.92000,41.73000,The Alliance,PPO Network,,36.50,,,,,,,21.96,1225.79,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,inpatient,120,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,outpatient,120,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,inpatient,120,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,inpatient,120,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,outpatient,120,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.46480,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,inpatient,25,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,outpatient,25,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,inpatient,25,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,outpatient,25,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,inpatient,25,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,outpatient,25,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,inpatient,25,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,outpatient,25,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,inpatient,25,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,outpatient,25,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,inpatient,25,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,outpatient,25,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,inpatient,25,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,outpatient,25,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,inpatient,25,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,outpatient,25,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,inpatient,25,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,outpatient,25,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,inpatient,,,4574.00000,4345.30000,The Alliance,PPO Network,,3800.99,,,,,,,2515.70,4436.78,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,outpatient,,,4574.00000,4345.30000,The Alliance,PPO Network,,3800.99,,,,,,,970.83,4436.78,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,inpatient,10,EA,23.95000,22.76000,The Alliance,PPO Network,,19.90,,,,,,,13.17,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,outpatient,10,EA,23.95000,22.76000,The Alliance,PPO Network,,19.90,,,,,,,11.97,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,inpatient,10,EA,10.74000,10.20000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,outpatient,10,EA,10.74000,10.20000,The Alliance,PPO Network,,8.92,,,,,,,5.37,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,inpatient,10,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,outpatient,10,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,inpatient,10,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,outpatient,10,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,inpatient,1,EA,1357.11000,1289.25000,The Alliance,PPO Network,,1127.76,,,,,,,746.41,1316.40,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,outpatient,1,EA,1357.11000,1289.25000,The Alliance,PPO Network,,1127.76,,,,,,,678.55,1316.40,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,inpatient,10,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,outpatient,10,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.46480,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,inpatient,10,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,inpatient,10,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,inpatient,10,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,outpatient,10,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,inpatient,5,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,outpatient,5,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,inpatient,5,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,inpatient,5,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,outpatient,5,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,inpatient,5,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,outpatient,5,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,inpatient,5,EA,1.77000,1.69000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,outpatient,5,EA,1.77000,1.69000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,inpatient,5,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,outpatient,5,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,inpatient,5,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,inpatient,1,EA,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,3.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,1.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,inpatient,1,EA,3.70000,3.52000,The Alliance,PPO Network,,3.07,,,,,,,2.04,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,outpatient,1,EA,3.70000,3.52000,The Alliance,PPO Network,,3.07,,,,,,,1.02,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,inpatient,1,EA,9.51000,9.04000,The Alliance,PPO Network,,7.90,,,,,,,5.23,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,outpatient,1,EA,9.51000,9.04000,The Alliance,PPO Network,,7.90,,,,,,,1.02,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.02,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,1.02,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,1.02,7.97,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.97500,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.97500,1.89,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,inpatient,1,EA,48.51000,46.08000,The Alliance,PPO Network,,40.31,,,,,,,26.68,47.05,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,outpatient,1,EA,48.51000,46.08000,The Alliance,PPO Network,,40.31,,,,,,,24.25,47.05,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,1.18,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,inpatient,1,mL,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,outpatient,1,mL,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,1.18,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,inpatient,1,EA,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,11.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,outpatient,1,EA,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,10.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,11.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,10.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,inpatient,1,EA,19.92000,18.93000,The Alliance,PPO Network,,16.55,,,,,,,10.96,19.32,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,outpatient,1,EA,19.92000,18.93000,The Alliance,PPO Network,,16.55,,,,,,,9.96,19.32,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,inpatient,,,173.44000,164.77000,The Alliance,PPO Network,,144.13,,,,,,,95.39,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,PPO Network,,144.13,,,,,,,47.59,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,inpatient,1,mL,346.88000,329.54000,The Alliance,PPO Network,,288.26,,,,,,,190.78,336.47,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,PPO Network,,288.26,,,,,,,47.59,336.47,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.61,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.29,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,inpatient,1,EA,2.98000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,outpatient,1,EA,2.98000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.49,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.57,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,inpatient,1,mL,301.66000,286.57000,The Alliance,PPO Network,,250.68,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,PPO Network,,250.68,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,inpatient,1,mL,346.54000,329.21000,The Alliance,PPO Network,,287.97,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,PPO Network,,287.97,,,,,,,69.84,336.14,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,132.00,232.80,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,120.00,584.87,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,655.05,1155.27,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,TC,989.72,,,,,,,595.50,1155.27,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,inpatient,1,EA,9.92000,9.43000,The Alliance,PPO Network,,8.24,,,,,,,5.46,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,outpatient,1,EA,9.92000,9.43000,The Alliance,PPO Network,,8.24,,,,,,,4.96,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,inpatient,1,EA,17.26000,16.40000,The Alliance,PPO Network,,14.34,,,,,,,9.49,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,outpatient,1,EA,17.26000,16.40000,The Alliance,PPO Network,,14.34,,,,,,,8.63,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,inpatient,1,EA,9.88000,9.38000,The Alliance,PPO Network,,8.21,,,,,,,5.43,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,PPO Network,,8.21,,,,,,,4.94,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,inpatient,10,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,outpatient,10,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,inpatient,1,EA,13.23000,12.57000,The Alliance,PPO Network,,10.99,,,,,,,7.28,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,outpatient,1,EA,13.23000,12.57000,The Alliance,PPO Network,,10.99,,,,,,,6.62,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,inpatient,,,1828.00000,1736.60000,The Alliance,PPO Network,TC,1519.07,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,PPO Network,TC,1519.07,,,,,,,914.00,1773.16,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,9.15,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,8.32,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,8.81,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,8.81,17.09,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,79.75,140.65,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,13.74,713.01,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,inpatient,1,mL,118.72000,112.79000,The Alliance,PPO Network,,98.66,,,,,,,65.30,115.16,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,outpatient,1,mL,118.72000,112.79000,The Alliance,PPO Network,,98.66,,,,,,,59.36,115.16,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,inpatient,3,EA,92.78000,88.14000,The Alliance,PPO Network,,77.10,,,,,,,51.03,90.00,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,outpatient,3,EA,92.78000,88.14000,The Alliance,PPO Network,,77.10,,,,,,,46.39,99.28,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,inpatient,3,EA,178.30000,169.38000,The Alliance,PPO Network,,148.17,,,,,,,98.06,172.95,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,outpatient,3,EA,178.30000,169.38000,The Alliance,PPO Network,,148.17,,,,,,,89.15,172.95,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,478.13000,454.22000,The Alliance,PPO Network,,397.33,,,,,,,262.97,463.79,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,478.13000,454.22000,The Alliance,PPO Network,,397.33,,,,,,,239.06,463.79,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,17.14,797.91,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,3163.00,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,8.17,797.91,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,inpatient,1,EA,18.61000,17.68000,The Alliance,PPO Network,,15.46,,,,,,,10.24,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,outpatient,1,EA,18.61000,17.68000,The Alliance,PPO Network,,15.46,,,,,,,9.30,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,inpatient,1,EA,7.97000,7.57000,The Alliance,PPO Network,,6.62,,,,,,,4.38,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,outpatient,1,EA,7.97000,7.57000,The Alliance,PPO Network,,6.62,,,,,,,3.98,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.58,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.25,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,inpatient,1,EA,10.30000,9.79000,The Alliance,PPO Network,,8.56,,,,,,,5.67,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,outpatient,1,EA,10.30000,9.79000,The Alliance,PPO Network,,8.56,,,,,,,5.15,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,inpatient,1,EA,6.91000,6.57000,The Alliance,PPO Network,,5.74,,,,,,,3.80,6.70,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,outpatient,1,EA,6.91000,6.57000,The Alliance,PPO Network,,5.74,,,,,,,3.46,6.70,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,PPO Network,TC,225.20,,,,,,,149.05,262.87,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,PPO Network,TC,225.20,,,,,,,135.50,262.87,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,inpatient,1,EA,34.68000,32.94000,The Alliance,PPO Network,,28.82,,,,,,,19.07,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,outpatient,1,EA,34.68000,32.94000,The Alliance,PPO Network,,28.82,,,,,,,17.34,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,inpatient,1,EA,42.03000,39.93000,The Alliance,PPO Network,,34.93,,,,,,,23.12,40.77,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,outpatient,1,EA,42.03000,39.93000,The Alliance,PPO Network,,34.93,,,,,,,21.02,40.77,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,inpatient,1,EA,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,outpatient,1,EA,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,inpatient,1,EA,9.90000,9.40000,The Alliance,PPO Network,,8.23,,,,,,,5.45,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,outpatient,1,EA,9.90000,9.40000,The Alliance,PPO Network,,8.23,,,,,,,4.95,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,inpatient,1,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.95,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,PPO Network,,2.95,,,,,,,1.77,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,inpatient,1,EA,6.90000,6.56000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,outpatient,1,EA,6.90000,6.56000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,inpatient,1,EA,7.51000,7.13000,The Alliance,PPO Network,,6.24,,,,,,,4.13,7.28,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,outpatient,1,EA,7.51000,7.13000,The Alliance,PPO Network,,6.24,,,,,,,3.75,7.28,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,inpatient,,,1034.00000,982.30000,The Alliance,PPO Network,TC,859.25,,,,,,,568.70,1002.98,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,outpatient,,,1034.00000,982.30000,The Alliance,PPO Network,TC,859.25,,,,,,,517.00,1002.98,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,inpatient,1,EA,22.50000,21.37000,The Alliance,PPO Network,,18.70,,,,,,,12.38,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,PPO Network,,18.70,,,,,,,11.25,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.79,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.54,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.53,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.30,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,inpatient,1,EA,4.15000,3.95000,The Alliance,PPO Network,,3.45,,,,,,,2.28,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,outpatient,1,EA,4.15000,3.95000,The Alliance,PPO Network,,3.45,,,,,,,2.08,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,3.07,5.41,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,2.79,5.41,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,inpatient,,,2031.00000,1929.45000,The Alliance,PPO Network,TC,1687.76,,,,,,,1117.05,1970.07,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,outpatient,,,2031.00000,1929.45000,The Alliance,PPO Network,TC,1687.76,,,,,,,1015.50,1970.07,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,inpatient,1,EA,107.57000,102.19000,The Alliance,PPO Network,,89.39,,,,,,,59.16,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,outpatient,1,EA,107.57000,102.19000,The Alliance,PPO Network,,89.39,,,,,,,12.72,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,inpatient,1,EA,29.74000,28.25000,The Alliance,PPO Network,,24.71,,,,,,,16.36,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,outpatient,1,EA,29.74000,28.25000,The Alliance,PPO Network,,24.71,,,,,,,12.72,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,12.72,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,inpatient,1,EA,70.42000,66.90000,The Alliance,PPO Network,,58.52,,,,,,,38.73,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,outpatient,1,EA,70.42000,66.90000,The Alliance,PPO Network,,58.52,,,,,,,12.72,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,inpatient,1,EA,40.92000,38.88000,The Alliance,PPO Network,,34.00,,,,,,,22.51,39.69,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,PPO Network,,34.00,,,,,,,12.72,39.69,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,The Alliance,PPO Network,TC,3536.74,,,,,,,2340.80,4128.32,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,PPO Network,TC,3536.74,,,,,,,2128.00,4128.32,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,inpatient,1,EA,20.26000,19.25000,The Alliance,PPO Network,,16.84,,,,,,,11.14,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,outpatient,1,EA,20.26000,19.25000,The Alliance,PPO Network,,16.84,,,,,,,10.13,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.66,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.50,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,inpatient,,,1568.00000,1489.60000,The Alliance,PPO Network,TC,1303.01,,,,,,,862.40,1520.96,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,outpatient,,,1568.00000,1489.60000,The Alliance,PPO Network,TC,1303.01,,,,,,,784.00,1520.96,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,TC,290.02,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,TC,290.02,,,,,,,114.83,1213.27,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,5271.00,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,inpatient,1,EA,5.68000,5.40000,The Alliance,PPO Network,,4.72,,,,,,,3.12,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,outpatient,1,EA,5.68000,5.40000,The Alliance,PPO Network,,4.72,,,,,,,2.84,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.94,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.67,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.67,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,inpatient,1,EA,2.65000,2.51000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,outpatient,1,EA,2.65000,2.51000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,The Alliance,PPO Network,,11.33,,,,,,,7.50,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,PPO Network,,11.33,,,,,,,6.82,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,The Alliance,PPO Network,,3.77,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,PPO Network,,3.77,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,inpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.29,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,18.06,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,PPO Network,,27.29,,,,,,,16.42,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,inpatient,1,EA,16.31000,15.50000,The Alliance,PPO Network,,13.55,,,,,,,8.97,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,outpatient,1,EA,16.31000,15.50000,The Alliance,PPO Network,,13.55,,,,,,,8.15,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,inpatient,1,EA,14.62000,13.88000,The Alliance,PPO Network,,12.15,,,,,,,8.04,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,outpatient,1,EA,14.62000,13.88000,The Alliance,PPO Network,,12.15,,,,,,,7.31,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,8.48,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,11.89,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,PPO Network,,17.97,,,,,,,10.81,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,7.24,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,6.58,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,8.48,16.46,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,TC,1060.36,,,,,,,701.80,1237.72,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,TC,1060.36,,,,,,,638.00,1237.72,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1828.00000,1736.60000,The Alliance,PPO Network,TC,1519.07,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,PPO Network,TC,1519.07,,,,,,,914.00,1773.16,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,227.15,400.61,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,33.63,400.61,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,inpatient,1,EA,10.60000,10.07000,The Alliance,PPO Network,,8.81,,,,,,,5.83,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,outpatient,1,EA,10.60000,10.07000,The Alliance,PPO Network,,8.81,,,,,,,5.30,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.51,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.01,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,2.65,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,2.40,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,inpatient,1,EA,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,2.24,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,outpatient,1,EA,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,2.04,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.42,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.10,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.56,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.33,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.40,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.09,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,inpatient,,,484.00000,459.80000,The Alliance,PPO Network,,402.20,,,,,,,266.20,469.48,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,outpatient,,,484.00000,459.80000,The Alliance,PPO Network,,402.20,,,,,,,242.00,572.69,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,216.31,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,18.14,950.66,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,1004.85,1772.19,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,PPO Network,TC,1518.24,,,,,,,913.50,1772.19,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,inpatient,,,455.00000,432.25000,The Alliance,PPO Network,TC,378.11,,,,,,,250.25,441.35,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,PPO Network,TC,378.11,,,,,,,201.46,2123.08,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,The Alliance,PPO Network,TC,486.97,,,,,,,322.30,568.42,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,PPO Network,TC,486.97,,,,,,,247.28,568.42,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,94.05,165.87,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,85.50,1375.13,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,1007.60,1777.04,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,916.00,1777.04,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,inpatient,1,mL,209.51000,199.03000,The Alliance,PPO Network,,174.10,,,,,,,115.23,203.22,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,outpatient,1,mL,209.51000,199.03000,The Alliance,PPO Network,,174.10,,,,,,,104.75,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,inpatient,1,mL,188.56000,179.13000,The Alliance,PPO Network,,156.69,,,,,,,103.71,182.90,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,outpatient,1,mL,188.56000,179.13000,The Alliance,PPO Network,,156.69,,,,,,,94.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,inpatient,1,mL,244.90000,232.66000,The Alliance,PPO Network,,203.51,,,,,,,134.69,237.55,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,PPO Network,,203.51,,,,,,,109.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,78.21,137.93,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,71.10,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,inpatient,1,mL,306.20000,290.89000,The Alliance,PPO Network,,254.45,,,,,,,168.41,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,outpatient,1,mL,306.20000,290.89000,The Alliance,PPO Network,,254.45,,,,,,,109.28,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,inpatient,1,mL,323.48000,307.31000,The Alliance,PPO Network,,268.81,,,,,,,177.91,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,outpatient,1,mL,323.48000,307.31000,The Alliance,PPO Network,,268.81,,,,,,,109.28,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,inpatient,1,mL,214.34000,203.63000,The Alliance,PPO Network,,178.12,,,,,,,117.89,207.91,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,outpatient,1,mL,214.34000,203.63000,The Alliance,PPO Network,,178.12,,,,,,,107.17,249.68,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,13.12,679.08,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,inpatient,,,742.00000,704.90000,The Alliance,PPO Network,,616.60,,,,,,,408.10,719.74,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,outpatient,,,742.00000,704.90000,The Alliance,PPO Network,,616.60,,,,,,,262.92,1172.00,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,inpatient,,,1496.00000,1421.20000,The Alliance,PPO Network,TC,1243.18,,,,,,,822.80,1451.12,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,outpatient,,,1496.00000,1421.20000,The Alliance,PPO Network,TC,1243.18,,,,,,,748.00,1451.12,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,The Alliance,PPO Network,TC,2769.72,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,PPO Network,TC,2769.72,,,,,,,1666.50,3233.01,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,99.00,174.60,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,15.29,797.91,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,163.90,289.06,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,135.13,1430.78,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,inpatient,,,2546.00000,2418.70000,The Alliance,PPO Network,TC,2115.73,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,PPO Network,TC,2115.73,,,,,,,1273.00,2469.62,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,inpatient,,,2109.00000,2003.55000,The Alliance,PPO Network,,1752.58,,,,,,,1159.95,2045.73,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,outpatient,,,2109.00000,2003.55000,The Alliance,PPO Network,,1752.58,,,,,,,582.16,3515.00,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,8.17,696.05,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,inpatient,,,2224.00000,2112.80000,The Alliance,PPO Network,TC,1848.14,,,,,,,1223.20,2157.28,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,outpatient,,,2224.00000,2112.80000,The Alliance,PPO Network,TC,1848.14,,,,,,,1112.00,14719.32,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,PPO Network,TC,425.47,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,PPO Network,TC,425.47,,,,,,,151.73,1628.59,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,675.40,1191.16,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,614.00,1191.16,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,inpatient,1,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.41,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.19,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,inpatient,1,EA,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,6.03,10.64,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,5.49,10.64,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,inpatient,1,EA,5030.77000,4779.23000,The Alliance,PPO Network,,4180.57,,,,,,,2766.92,4879.85,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,outpatient,1,EA,5030.77000,4779.23000,The Alliance,PPO Network,,4180.57,,,,,,,7.88,4879.85,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,8.17,696.05,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,inpatient,,,544.00000,516.80000,The Alliance,PPO Network,,452.06,,,,,,,299.20,527.68,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,PPO Network,,452.06,,,,,,,272.00,572.69,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1160.00000,1102.00000,The Alliance,PPO Network,,963.96,,,,,,,638.00,1125.20,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,PPO Network,,963.96,,,,,,,404.33,3515.00,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,inpatient,,,2660.00000,2527.00000,The Alliance,PPO Network,,2210.46,,,,,,,1463.00,2580.20,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,outpatient,,,2660.00000,2527.00000,The Alliance,PPO Network,,2210.46,,,,,,,264.01,15261.97,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.68,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,inpatient,1,EA,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,3.39,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,outpatient,1,EA,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,3.08,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,inpatient,1,EA,150.45000,142.92000,The Alliance,PPO Network,,125.02,,,,,,,82.75,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,outpatient,1,EA,150.45000,142.92000,The Alliance,PPO Network,,125.02,,,,,,,75.22,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,inpatient,1,EA,25.25000,23.99000,The Alliance,PPO Network,,20.98,,,,,,,13.89,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,outpatient,1,EA,25.25000,23.99000,The Alliance,PPO Network,,20.98,,,,,,,12.62,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,inpatient,1,EA,4.30000,4.08000,The Alliance,PPO Network,,3.57,,,,,,,2.37,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,PPO Network,,3.57,,,,,,,2.15,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,The Alliance,PPO Network,,3.77,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,PPO Network,,3.77,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.12,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,inpatient,1,EA,3.30000,3.13000,The Alliance,PPO Network,,2.74,,,,,,,1.81,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,outpatient,1,EA,3.30000,3.13000,The Alliance,PPO Network,,2.74,,,,,,,1.65,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,8.20,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,7.45,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,inpatient,1,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,inpatient,1,mL,1.25000,1.18000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,outpatient,1,mL,1.25000,1.18000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,PPO Network,,131.55,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,PPO Network,,131.55,,,,,,,79.15,153.55,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,inpatient,1,EA,79.03000,75.08000,The Alliance,PPO Network,,65.67,,,,,,,43.47,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,outpatient,1,EA,79.03000,75.08000,The Alliance,PPO Network,,65.67,,,,,,,39.52,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,inpatient,1,EA,89.66000,85.18000,The Alliance,PPO Network,,74.51,,,,,,,49.31,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,outpatient,1,EA,89.66000,85.18000,The Alliance,PPO Network,,74.51,,,,,,,44.83,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,23.70,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,inpatient,1,EA,115.04000,109.28000,The Alliance,PPO Network,,95.60,,,,,,,63.27,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,outpatient,1,EA,115.04000,109.28000,The Alliance,PPO Network,,95.60,,,,,,,57.52,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,inpatient,1,EA,62.15000,59.05000,The Alliance,PPO Network,,51.65,,,,,,,34.18,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,outpatient,1,EA,62.15000,59.05000,The Alliance,PPO Network,,51.65,,,,,,,31.07,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,inpatient,1,EA,138.98000,132.03000,The Alliance,PPO Network,,115.49,,,,,,,76.44,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,PPO Network,,115.49,,,,,,,69.49,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,inpatient,1,EA,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,60.83,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,55.30,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,inpatient,1,EA,91.77000,87.18000,The Alliance,PPO Network,,76.26,,,,,,,50.47,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,outpatient,1,EA,91.77000,87.18000,The Alliance,PPO Network,,76.26,,,,,,,45.88,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,inpatient,1,EA,48.66000,46.23000,The Alliance,PPO Network,,40.44,,,,,,,26.76,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,PPO Network,,40.44,,,,,,,24.33,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,inpatient,1,EA,32.58000,30.95000,The Alliance,PPO Network,,27.07,,,,,,,17.92,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,outpatient,1,EA,32.58000,30.95000,The Alliance,PPO Network,,27.07,,,,,,,16.29,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,inpatient,1,EA,24.62000,23.39000,The Alliance,PPO Network,,20.46,,,,,,,13.54,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,outpatient,1,EA,24.62000,23.39000,The Alliance,PPO Network,,20.46,,,,,,,12.31,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,inpatient,1,EA,32.90000,31.26000,The Alliance,PPO Network,,27.34,,,,,,,18.09,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,outpatient,1,EA,32.90000,31.26000,The Alliance,PPO Network,,27.34,,,,,,,16.45,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,inpatient,1,EA,35.20000,33.44000,The Alliance,PPO Network,,29.25,,,,,,,19.36,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,outpatient,1,EA,35.20000,33.44000,The Alliance,PPO Network,,29.25,,,,,,,17.60,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,inpatient,1,EA,59.44000,56.47000,The Alliance,PPO Network,,49.39,,,,,,,32.69,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,outpatient,1,EA,59.44000,56.47000,The Alliance,PPO Network,,49.39,,,,,,,29.72,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,inpatient,1,EA,87.82000,83.43000,The Alliance,PPO Network,,72.98,,,,,,,48.30,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,PPO Network,,72.98,,,,,,,43.91,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,PPO Network,TC,255.12,,,,,,,168.85,297.79,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,PPO Network,TC,255.12,,,,,,,153.50,297.79,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,inpatient,1,EA,6707.63000,6372.25000,The Alliance,PPO Network,,5574.04,,,,,,,3689.20,6506.40,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,outpatient,1,EA,6707.63000,6372.25000,The Alliance,PPO Network,,5574.04,,,,,,,7.88,6506.40,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,inpatient,,,188.00000,178.60000,The Alliance,PPO Network,,156.23,,,,,,,103.40,182.36,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,PPO Network,,156.23,,,,,,,35.09,1833.46,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,8.17,696.05,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,inpatient,2,EA,11.29000,10.72000,The Alliance,PPO Network,,9.38,,,,,,,6.21,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,outpatient,2,EA,11.29000,10.72000,The Alliance,PPO Network,,9.38,,,,,,,5.64,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,inpatient,2,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.53,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.30,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,inpatient,2,EA,14.98000,14.23000,The Alliance,PPO Network,,12.45,,,,,,,8.24,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,outpatient,2,EA,14.98000,14.23000,The Alliance,PPO Network,,12.45,,,,,,,7.49,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,inpatient,2,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,4.90,9.51,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1134.50,2200.93,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,62.14,3038.81,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,inpatient,20,mL,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,outpatient,20,mL,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,inpatient,20,mL,2.86000,2.71000,The Alliance,PPO Network,,2.38,,,,,,,1.57,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,outpatient,20,mL,2.86000,2.71000,The Alliance,PPO Network,,2.38,,,,,,,1.43,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,inpatient,5,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,outpatient,5,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,inpatient,5,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,212.85,375.39,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,150.37,585.00,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,407.50,790.55,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,inpatient,1,EA,26.39000,25.07000,The Alliance,PPO Network,,21.93,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,outpatient,1,EA,26.39000,25.07000,The Alliance,PPO Network,,21.93,,,,,,,13.20,25.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,inpatient,1,mL,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,83.61,585.00,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,inpatient,1,EA,511.80000,486.21000,The Alliance,PPO Network,,425.31,,,,,,,281.49,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,outpatient,1,EA,511.80000,486.21000,The Alliance,PPO Network,,425.31,,,,,,,1.13,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,inpatient,1,EA,260.67000,247.63000,The Alliance,PPO Network,,216.62,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,PPO Network,,216.62,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,inpatient,1,EA,788.15000,748.74000,The Alliance,PPO Network,,654.95,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,PPO Network,,654.95,,,,,,,1.13,764.51,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,PPO Network,TC,3348.93,,,,,,,2015.00,3909.10,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,inpatient,1,EA,59.06000,56.11000,The Alliance,PPO Network,,49.08,,,,,,,32.48,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,outpatient,1,EA,59.06000,56.11000,The Alliance,PPO Network,,49.08,,,,,,,24.92,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,inpatient,1,EA,51.19000,48.63000,The Alliance,PPO Network,,42.54,,,,,,,28.15,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,outpatient,1,EA,51.19000,48.63000,The Alliance,PPO Network,,42.54,,,,,,,24.92,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,inpatient,1,EA,74.01000,70.31000,The Alliance,PPO Network,,61.50,,,,,,,40.71,71.79,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,outpatient,1,EA,74.01000,70.31000,The Alliance,PPO Network,,61.50,,,,,,,24.92,71.79,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,2.50,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,inpatient,1,mL,12.05000,11.44000,The Alliance,PPO Network,,10.01,,,,,,,6.63,11.69,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,outpatient,1,mL,12.05000,11.44000,The Alliance,PPO Network,,10.01,,,,,,,2.50,11.69,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,inpatient,1,EA,8.14000,7.74000,The Alliance,PPO Network,,6.76,,,,,,,4.48,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,outpatient,1,EA,8.14000,7.74000,The Alliance,PPO Network,,6.76,,,,,,,4.07,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,inpatient,1,EA,3.84000,3.64000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,outpatient,1,EA,3.84000,3.64000,The Alliance,PPO Network,,3.19,,,,,,,1.92,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,inpatient,1,EA,4.08000,3.87000,The Alliance,PPO Network,,3.39,,,,,,,2.24,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,PPO Network,,3.39,,,,,,,2.04,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,7.01,373.51,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,inpatient,1,EA,142.64000,135.51000,The Alliance,PPO Network,,118.53,,,,,,,78.45,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,outpatient,1,EA,142.64000,135.51000,The Alliance,PPO Network,,118.53,,,,,,,24.92,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,inpatient,1,EA,146.56000,139.23000,The Alliance,PPO Network,,121.79,,,,,,,80.61,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,outpatient,1,EA,146.56000,139.23000,The Alliance,PPO Network,,121.79,,,,,,,24.92,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,inpatient,1,EA,148.01000,140.61000,The Alliance,PPO Network,,123.00,,,,,,,81.41,143.57,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,outpatient,1,EA,148.01000,140.61000,The Alliance,PPO Network,,123.00,,,,,,,24.92,143.57,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,inpatient,1,mL,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.87,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.61,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,The Alliance,PPO Network,,24.33,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,PPO Network,,24.33,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,The Alliance,PPO Network,,24.33,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,PPO Network,,24.33,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,inpatient,1,EA,19.85000,18.86000,The Alliance,PPO Network,,16.50,,,,,,,10.92,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,outpatient,1,EA,19.85000,18.86000,The Alliance,PPO Network,,16.50,,,,,,,9.93,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,inpatient,1,EA,26.70000,25.37000,The Alliance,PPO Network,,22.19,,,,,,,14.69,25.90,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,outpatient,1,EA,26.70000,25.37000,The Alliance,PPO Network,,22.19,,,,,,,13.35,25.90,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,inpatient,1,mL,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,outpatient,1,mL,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.03,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,inpatient,1,mL,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.47,4.36,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,outpatient,1,mL,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.25,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,inpatient,1,mL,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,outpatient,1,mL,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,5.23,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,inpatient,10,EA,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,outpatient,10,EA,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,inpatient,1,EA,121.79000,115.70000,The Alliance,PPO Network,,101.21,,,,,,,66.98,118.14,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,outpatient,1,EA,121.79000,115.70000,The Alliance,PPO Network,,101.21,,,,,,,2.50,118.14,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,inpatient,1,EA,36.03000,34.23000,The Alliance,PPO Network,,29.94,,,,,,,19.82,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,outpatient,1,EA,36.03000,34.23000,The Alliance,PPO Network,,29.94,,,,,,,18.02,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,inpatient,1,EA,27.49000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,15.12,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,outpatient,1,EA,27.49000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,13.74,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,inpatient,1,EA,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,6.03,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,5.49,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,4.90,9.51,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,49.50,96.03,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,526.26,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,inpatient,10,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,0.43710,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,inpatient,10,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,outpatient,10,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,0.43710,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.43710,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,inpatient,10,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,outpatient,10,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.43710,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,inpatient,10,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,outpatient,10,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,0.43710,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,inpatient,10,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,outpatient,10,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,inpatient,10,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,outpatient,10,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.43710,2.14,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,inpatient,1,mL,1825.95000,1734.65000,The Alliance,PPO Network,,1517.36,,,,,,,1004.27,1771.17,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,outpatient,1,mL,1825.95000,1734.65000,The Alliance,PPO Network,,1517.36,,,,,,,104.58,1771.17,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,The Alliance,PPO Network,,20.72,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,PPO Network,,20.72,,,,,,,12.46,24.18,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,18.79,984.66,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,27.94,1459.96,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,inpatient,20,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,outpatient,20,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,inpatient,20,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.00,15.24,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,inpatient,1,EA,333.23000,316.57000,The Alliance,PPO Network,,276.91,,,,,,,183.28,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,outpatient,1,EA,333.23000,316.57000,The Alliance,PPO Network,,276.91,,,,,,,14.23,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,inpatient,1,EA,349.86000,332.36000,The Alliance,PPO Network,,290.73,,,,,,,192.42,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,outpatient,1,EA,349.86000,332.36000,The Alliance,PPO Network,,290.73,,,,,,,14.23,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,14.23,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,inpatient,1,EA,274.88000,261.14000,The Alliance,PPO Network,,228.43,,,,,,,151.18,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,outpatient,1,EA,274.88000,261.14000,The Alliance,PPO Network,,228.43,,,,,,,14.23,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,inpatient,1,EA,303.21000,288.05000,The Alliance,PPO Network,,251.97,,,,,,,166.77,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,outpatient,1,EA,303.21000,288.05000,The Alliance,PPO Network,,251.97,,,,,,,14.23,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,inpatient,1,EA,359.49000,341.52000,The Alliance,PPO Network,,298.74,,,,,,,197.72,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,outpatient,1,EA,359.49000,341.52000,The Alliance,PPO Network,,298.74,,,,,,,14.23,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,14.23,183.91,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,inpatient,1,EA,22.90000,21.75000,The Alliance,PPO Network,,19.03,,,,,,,12.60,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,outpatient,1,EA,22.90000,21.75000,The Alliance,PPO Network,,19.03,,,,,,,11.45,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,inpatient,1,EA,25.83000,24.54000,The Alliance,PPO Network,,21.46,,,,,,,14.21,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,outpatient,1,EA,25.83000,24.54000,The Alliance,PPO Network,,21.46,,,,,,,12.91,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,inpatient,1,EA,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,17.26,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,outpatient,1,EA,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,15.69,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,inpatient,1,EA,47.49000,45.11000,The Alliance,PPO Network,,39.46,,,,,,,26.12,46.07,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,outpatient,1,EA,47.49000,45.11000,The Alliance,PPO Network,,39.46,,,,,,,23.75,46.07,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,inpatient,1,EA,33.11000,31.46000,The Alliance,PPO Network,,27.51,,,,,,,18.21,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,outpatient,1,EA,33.11000,31.46000,The Alliance,PPO Network,,27.51,,,,,,,16.55,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,inpatient,1,EA,24.04000,22.84000,The Alliance,PPO Network,,19.98,,,,,,,13.22,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,PPO Network,,19.98,,,,,,,12.02,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,inpatient,57,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,outpatient,57,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,inpatient,57,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,outpatient,57,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,PPO Network,,131.55,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,PPO Network,,131.55,,,,,,,79.15,153.55,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,inpatient,50,EA,7.45000,7.08000,The Alliance,PPO Network,,6.19,,,,,,,4.10,7.23,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,outpatient,50,EA,7.45000,7.08000,The Alliance,PPO Network,,6.19,,,,,,,3.73,7.23,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,inpatient,1,GM,13.52000,12.84000,The Alliance,PPO Network,,11.24,,,,,,,7.44,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,outpatient,1,GM,13.52000,12.84000,The Alliance,PPO Network,,11.24,,,,,,,6.76,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,inpatient,1,GM,13.47000,12.80000,The Alliance,PPO Network,,11.19,,,,,,,7.41,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,outpatient,1,GM,13.47000,12.80000,The Alliance,PPO Network,,11.19,,,,,,,6.74,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,inpatient,1,GM,13.72000,13.04000,The Alliance,PPO Network,,11.40,,,,,,,7.55,13.31,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,outpatient,1,GM,13.72000,13.04000,The Alliance,PPO Network,,11.40,,,,,,,6.86,13.31,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,inpatient,,,189.00000,179.55000,The Alliance,PPO Network,,157.06,,,,,,,103.95,183.33,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,PPO Network,,157.06,,,,,,,17.93,933.70,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,inpatient,1,mL,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,3.25,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,outpatient,1,mL,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,0.43710,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,inpatient,1,mL,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.43710,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.43710,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,inpatient,1,mL,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,0.43710,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,inpatient,1,mL,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.43710,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,inpatient,1,mL,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,PPO Network,,3.39,,,,,,,0.43710,3.96,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,19.35,1018.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,inpatient,20,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,outpatient,20,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,24.18,1256.24,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,inpatient,20,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,outpatient,20,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,inpatient,20,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,outpatient,20,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,inpatient,20,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,inpatient,20,EA,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.47,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,outpatient,20,EA,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.25,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,inpatient,20,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,outpatient,20,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,inpatient,20,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,outpatient,20,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,inpatient,20,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,outpatient,20,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,12.87,679.08,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,inpatient,,,189.60000,180.12000,The Alliance,PPO Network,90,157.56,,,,,,,104.28,183.91,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,outpatient,,,189.60000,180.12000,The Alliance,PPO Network,90,157.56,,,,,,,16.88,848.80,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,inpatient,1,EA,240.56000,228.53000,The Alliance,PPO Network,,199.91,,,,,,,132.31,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,outpatient,1,EA,240.56000,228.53000,The Alliance,PPO Network,,199.91,,,,,,,102.24,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,inpatient,1,EA,287.19000,272.83000,The Alliance,PPO Network,,238.65,,,,,,,157.95,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,outpatient,1,EA,287.19000,272.83000,The Alliance,PPO Network,,238.65,,,,,,,102.24,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,inpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,284.90,502.46,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,102.24,502.46,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,inpatient,1,mL,10.74000,10.20000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,outpatient,1,mL,10.74000,10.20000,The Alliance,PPO Network,,8.92,,,,,,,5.37,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,inpatient,1,mL,11.65000,11.07000,The Alliance,PPO Network,,9.68,,,,,,,6.41,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,outpatient,1,mL,11.65000,11.07000,The Alliance,PPO Network,,9.68,,,,,,,5.83,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,50.05,88.27,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,50.05,3163.00,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,inpatient,10,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,outpatient,10,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,inpatient,10,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,outpatient,10,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,inpatient,10,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,inpatient,10,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,outpatient,10,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,inpatient,10,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.92,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,outpatient,10,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.75,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,inpatient,10,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,outpatient,10,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,The Alliance,PPO Network,,20.72,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,PPO Network,,20.72,,,,,,,12.46,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.13,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,inpatient,1,mL,12.40000,11.78000,The Alliance,PPO Network,,10.30,,,,,,,6.82,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,outpatient,1,mL,12.40000,11.78000,The Alliance,PPO Network,,10.30,,,,,,,6.20,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.61,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.19,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,inpatient,1,mL,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,outpatient,1,mL,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,inpatient,1,mL,1384.36000,1315.14000,The Alliance,PPO Network,,1150.40,,,,,,,761.40,1342.83,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,outpatient,1,mL,1384.36000,1315.14000,The Alliance,PPO Network,,1150.40,,,,,,,7.68,1342.83,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,inpatient,100,EA,89.81000,85.32000,The Alliance,PPO Network,,74.63,,,,,,,49.40,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,outpatient,100,EA,89.81000,85.32000,The Alliance,PPO Network,,74.63,,,,,,,44.91,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,inpatient,100,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,outpatient,100,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,inpatient,100,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,outpatient,100,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,inpatient,100,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.21,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,outpatient,100,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.10,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,inpatient,100,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,outpatient,100,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.15,2.23,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,147.40,259.96,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,17.90,933.70,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,180.95,319.13,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,164.50,3321.00,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,inpatient,,,475.00000,451.25000,The Alliance,PPO Network,,394.73,,,,,,,261.25,460.75,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,PPO Network,,394.73,,,,,,,53.70,3089.77,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.25,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.68,3.25,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,inpatient,,,598.00000,568.10000,The Alliance,PPO Network,,496.94,,,,,,,328.90,580.06,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,PPO Network,,496.94,,,,,,,66.70,3446.25,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,inpatient,1,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,inpatient,1,mL,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,outpatient,1,mL,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,inpatient,250,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,outpatient,250,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,211.46,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,17.90,933.70,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,inpatient,,,233.00000,221.35000,The Alliance,PPO Network,,193.62,,,,,,,128.15,226.01,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,outpatient,,,233.00000,221.35000,The Alliance,PPO Network,,193.62,,,,,,,17.65,916.73,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,inpatient,2,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,outpatient,2,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,inpatient,2,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,inpatient,2,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,inpatient,2,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,outpatient,2,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,inpatient,2,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,outpatient,2,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,inpatient,2,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,outpatient,2,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,inpatient,2,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,outpatient,2,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,inpatient,2,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,outpatient,2,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,inpatient,2,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,outpatient,2,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,22.94,1205.34,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,PPO Network,90,174.26,,,,,,,115.33,203.41,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,PPO Network,90,174.26,,,,,,,20.41,950.66,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,56.65,99.91,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,9.84,933.70,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,133.10,234.74,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,22.94,1205.34,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,inpatient,1,EA,48.88000,46.43000,The Alliance,PPO Network,,40.62,,,,,,,26.88,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,outpatient,1,EA,48.88000,46.43000,The Alliance,PPO Network,,40.62,,,,,,,24.44,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,inpatient,1,EA,51.32000,48.76000,The Alliance,PPO Network,,42.65,,,,,,,28.23,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,outpatient,1,EA,51.32000,48.76000,The Alliance,PPO Network,,42.65,,,,,,,25.66,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,inpatient,1,EA,30.07000,28.57000,The Alliance,PPO Network,,24.99,,,,,,,16.54,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,outpatient,1,EA,30.07000,28.57000,The Alliance,PPO Network,,24.99,,,,,,,15.04,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,inpatient,1,EA,34.89000,33.14000,The Alliance,PPO Network,,28.99,,,,,,,19.19,33.84,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,outpatient,1,EA,34.89000,33.14000,The Alliance,PPO Network,,28.99,,,,,,,17.45,33.84,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,inpatient,1,EA,8.50000,8.08000,The Alliance,PPO Network,,7.06,,,,,,,4.67,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,outpatient,1,EA,8.50000,8.08000,The Alliance,PPO Network,,7.06,,,,,,,4.25,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,PPO Network,,8.40,,,,,,,5.05,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,inpatient,1,EA,9.24000,8.77000,The Alliance,PPO Network,,7.68,,,,,,,5.08,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,PPO Network,,7.68,,,,,,,4.62,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,PPO Network,,180.33,,,,,,,119.35,210.49,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,PPO Network,,180.33,,,,,,,17.90,933.70,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,inpatient,8,EA,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,3.51,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,outpatient,8,EA,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,3.19,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,inpatient,8,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.40,5.99,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,outpatient,8,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.09,5.99,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,inpatient,,,315.40000,299.63000,The Alliance,PPO Network,90,262.10,,,,,,,173.47,305.94,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,outpatient,,,315.40000,299.63000,The Alliance,PPO Network,90,262.10,,,,,,,23.70,1205.34,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,inpatient,50,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,outpatient,50,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,inpatient,,,154.40000,146.68000,The Alliance,PPO Network,90,128.31,,,,,,,84.92,149.77,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,outpatient,,,154.40000,146.68000,The Alliance,PPO Network,90,128.31,,,,,,,18.72,882.80,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,inpatient,1,EA,141.09000,134.04000,The Alliance,PPO Network,,117.25,,,,,,,77.60,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,outpatient,1,EA,141.09000,134.04000,The Alliance,PPO Network,,117.25,,,,,,,70.55,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,inpatient,1,EA,132.34000,125.72000,The Alliance,PPO Network,,109.97,,,,,,,72.79,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,outpatient,1,EA,132.34000,125.72000,The Alliance,PPO Network,,109.97,,,,,,,66.17,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,inpatient,1,EA,110.28000,104.77000,The Alliance,PPO Network,,91.64,,,,,,,60.65,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,outpatient,1,EA,110.28000,104.77000,The Alliance,PPO Network,,91.64,,,,,,,55.14,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,inpatient,1,EA,109.02000,103.57000,The Alliance,PPO Network,,90.60,,,,,,,59.96,105.75,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,outpatient,1,EA,109.02000,103.57000,The Alliance,PPO Network,,90.60,,,,,,,54.51,105.75,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,inpatient,1,EA,101.66000,96.57000,The Alliance,PPO Network,,84.48,,,,,,,55.91,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,outpatient,1,EA,101.66000,96.57000,The Alliance,PPO Network,,84.48,,,,,,,50.83,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,inpatient,1,EA,63.26000,60.10000,The Alliance,PPO Network,,52.57,,,,,,,34.79,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,outpatient,1,EA,63.26000,60.10000,The Alliance,PPO Network,,52.57,,,,,,,31.63,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,inpatient,1,EA,39.09000,37.13000,The Alliance,PPO Network,,32.48,,,,,,,21.50,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,outpatient,1,EA,39.09000,37.13000,The Alliance,PPO Network,,32.48,,,,,,,19.55,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,inpatient,1,EA,39.10000,37.14000,The Alliance,PPO Network,,32.49,,,,,,,21.50,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,outpatient,1,EA,39.10000,37.14000,The Alliance,PPO Network,,32.49,,,,,,,19.55,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,inpatient,1,EA,19.48000,18.51000,The Alliance,PPO Network,,16.19,,,,,,,10.71,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,outpatient,1,EA,19.48000,18.51000,The Alliance,PPO Network,,16.19,,,,,,,9.74,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,inpatient,1,EA,40.92000,38.88000,The Alliance,PPO Network,,34.00,,,,,,,22.51,39.69,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,PPO Network,,34.00,,,,,,,20.46,39.69,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,inpatient,1,EA,321.99000,305.89000,The Alliance,PPO Network,,267.57,,,,,,,177.09,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,outpatient,1,EA,321.99000,305.89000,The Alliance,PPO Network,,267.57,,,,,,,161.00,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,The Alliance,PPO Network,,3.11,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,PPO Network,,3.11,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,inpatient,50,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,outpatient,50,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,inpatient,50,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,outpatient,50,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,inpatient,50,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,inpatient,50,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,inpatient,50,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.58,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,221.10,389.94,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,35.09,1833.46,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,inpatient,1,EA,4.16000,3.95000,The Alliance,PPO Network,,3.46,,,,,,,2.29,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,outpatient,1,EA,4.16000,3.95000,The Alliance,PPO Network,,3.46,,,,,,,2.08,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,6.82,984.66,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,inpatient,1,EA,22.53000,21.40000,The Alliance,PPO Network,,18.72,,,,,,,12.39,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,outpatient,1,EA,22.53000,21.40000,The Alliance,PPO Network,,18.72,,,,,,,11.27,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,7.57,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,6.88,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,inpatient,1,EA,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.94,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,outpatient,1,EA,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.21,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,5.53,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,5.03,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,inpatient,1,EA,14.84000,14.10000,The Alliance,PPO Network,,12.33,,,,,,,8.16,14.39,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,outpatient,1,EA,14.84000,14.10000,The Alliance,PPO Network,,12.33,,,,,,,7.42,14.39,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,inpatient,1,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,outpatient,1,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,inpatient,5,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,inpatient,5,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,outpatient,5,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,inpatient,5,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,outpatient,5,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,inpatient,5,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,outpatient,5,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,inpatient,5,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,outpatient,5,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,inpatient,5,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,outpatient,5,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,inpatient,5,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,outpatient,5,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,inpatient,5,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,outpatient,5,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,inpatient,5,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,outpatient,5,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,inpatient,5,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,outpatient,5,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,inpatient,5,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,inpatient,1,EA,87.08000,82.73000,The Alliance,PPO Network,,72.36,,,,,,,47.89,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,outpatient,1,EA,87.08000,82.73000,The Alliance,PPO Network,,72.36,,,,,,,43.54,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,inpatient,1,EA,87.09000,82.74000,The Alliance,PPO Network,,72.37,,,,,,,47.90,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,outpatient,1,EA,87.09000,82.74000,The Alliance,PPO Network,,72.37,,,,,,,43.55,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,inpatient,1,EA,134.90000,128.16000,The Alliance,PPO Network,,112.10,,,,,,,74.19,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,outpatient,1,EA,134.90000,128.16000,The Alliance,PPO Network,,112.10,,,,,,,67.45,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,inpatient,1,EA,43.32000,41.16000,The Alliance,PPO Network,,36.00,,,,,,,23.83,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,outpatient,1,EA,43.32000,41.16000,The Alliance,PPO Network,,36.00,,,,,,,21.66,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,inpatient,1,EA,61.30000,58.24000,The Alliance,PPO Network,,50.94,,,,,,,33.72,59.46,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,outpatient,1,EA,61.30000,58.24000,The Alliance,PPO Network,,50.94,,,,,,,30.65,59.46,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,5271.00,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,13.63,713.01,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,5.88,271.65,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,inpatient,1,mL,99.43000,94.46000,The Alliance,PPO Network,,82.63,,,,,,,54.69,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,outpatient,1,mL,99.43000,94.46000,The Alliance,PPO Network,,82.63,,,,,,,0.60838,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,inpatient,1,mL,97.76000,92.87000,The Alliance,PPO Network,,81.24,,,,,,,53.77,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,outpatient,1,mL,97.76000,92.87000,The Alliance,PPO Network,,81.24,,,,,,,0.60838,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,0.60838,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,inpatient,1,mL,113.48000,107.80000,The Alliance,PPO Network,,94.30,,,,,,,62.41,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,outpatient,1,mL,113.48000,107.80000,The Alliance,PPO Network,,94.30,,,,,,,0.60838,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,inpatient,1,mL,189.13000,179.67000,The Alliance,PPO Network,,157.17,,,,,,,104.02,183.46,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,outpatient,1,mL,189.13000,179.67000,The Alliance,PPO Network,,157.17,,,,,,,0.60838,183.46,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,6.89,356.54,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,360.00,4457.06,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,inpatient,,,256.60000,243.77000,The Alliance,PPO Network,90,213.23,,,,,,,141.13,248.90,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,outpatient,,,256.60000,243.77000,The Alliance,PPO Network,90,213.23,,,,,,,17.85,814.87,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,171.05,301.67,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,22.17,1035.56,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,inpatient,1,mL,14.59000,13.86000,The Alliance,PPO Network,,12.12,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,PPO Network,,12.12,,,,,,,7.29,73.49,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,inpatient,30,EA,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,outpatient,30,EA,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,inpatient,30,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,outpatient,30,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,inpatient,1,mL,221.87000,210.78000,The Alliance,PPO Network,,184.37,,,,,,,122.03,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,outpatient,1,mL,221.87000,210.78000,The Alliance,PPO Network,,184.37,,,,,,,0.31000,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,inpatient,1,mL,221.86000,210.77000,The Alliance,PPO Network,,184.37,,,,,,,122.02,215.20,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,outpatient,1,mL,221.86000,210.77000,The Alliance,PPO Network,,184.37,,,,,,,0.31000,215.20,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,60.50,106.70,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,10.18,526.26,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,inpatient,,,568.00000,539.60000,The Alliance,PPO Network,,472.01,,,,,,,312.40,550.96,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,PPO Network,,472.01,,,,,,,64.41,3361.35,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,inpatient,1,EA,40.02000,38.02000,The Alliance,PPO Network,,33.26,,,,,,,22.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,outpatient,1,EA,40.02000,38.02000,The Alliance,PPO Network,,33.26,,,,,,,20.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,inpatient,1,EA,30.97000,29.42000,The Alliance,PPO Network,,25.74,,,,,,,17.03,30.04,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,PPO Network,,25.74,,,,,,,15.48,30.04,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,187.00,329.80,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,38.65,329.80,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,inpatient,2,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,outpatient,2,EA,2.82000,2.68000,The Alliance,PPO Network,,2.34,,,,,,,1.30,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,inpatient,2,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,outpatient,2,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,inpatient,2,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,outpatient,2,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,inpatient,2,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,outpatient,2,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.30,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,inpatient,2,EA,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.99,3.51,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,outpatient,2,EA,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.30,3.51,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,inpatient,,,964.00000,915.80000,The Alliance,PPO Network,,801.08,,,,,,,530.20,935.08,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,outpatient,,,964.00000,915.80000,The Alliance,PPO Network,,801.08,,,,,,,295.54,4230.40,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,3.67,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,inpatient,1,EA,66.55000,63.22000,The Alliance,PPO Network,,55.30,,,,,,,36.60,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,PPO Network,,55.30,,,,,,,33.27,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,inpatient,1,EA,73.10000,69.44000,The Alliance,PPO Network,,60.75,,,,,,,40.20,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,outpatient,1,EA,73.10000,69.44000,The Alliance,PPO Network,,60.75,,,,,,,36.55,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,inpatient,1,EA,38.24000,36.32000,The Alliance,PPO Network,,31.78,,,,,,,21.03,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,outpatient,1,EA,38.24000,36.32000,The Alliance,PPO Network,,31.78,,,,,,,19.12,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,inpatient,1,EA,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,45.76,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,41.60,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,inpatient,1,EA,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,36.50,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,outpatient,1,EA,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,33.18,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,inpatient,1,EA,52.68000,50.05000,The Alliance,PPO Network,,43.78,,,,,,,28.97,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,outpatient,1,EA,52.68000,50.05000,The Alliance,PPO Network,,43.78,,,,,,,26.34,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,inpatient,1,EA,76.35000,72.53000,The Alliance,PPO Network,,63.45,,,,,,,41.99,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,outpatient,1,EA,76.35000,72.53000,The Alliance,PPO Network,,63.45,,,,,,,38.17,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,inpatient,1,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,27.81,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,25.28,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,inpatient,1,EA,46.36000,44.04000,The Alliance,PPO Network,,38.53,,,,,,,25.50,44.97,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,outpatient,1,EA,46.36000,44.04000,The Alliance,PPO Network,,38.53,,,,,,,23.18,44.97,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,inpatient,1,EA,2.06000,1.96000,The Alliance,PPO Network,,1.71,,,,,,,1.13,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,outpatient,1,EA,2.06000,1.96000,The Alliance,PPO Network,,1.71,,,,,,,1.03,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,inpatient,1,EA,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,4.05,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,3.69,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,inpatient,1,EA,10.43000,9.90000,The Alliance,PPO Network,,8.67,,,,,,,5.74,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,outpatient,1,EA,10.43000,9.90000,The Alliance,PPO Network,,8.67,,,,,,,5.21,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,inpatient,30,EA,7.68000,7.29000,The Alliance,PPO Network,,6.38,,,,,,,4.22,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,outpatient,30,EA,7.68000,7.29000,The Alliance,PPO Network,,6.38,,,,,,,3.84,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,inpatient,30,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,outpatient,30,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,inpatient,1,mL,281.66000,267.58000,The Alliance,PPO Network,,234.06,,,,,,,154.91,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,outpatient,1,mL,281.66000,267.58000,The Alliance,PPO Network,,234.06,,,,,,,71.65,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,inpatient,1,mL,171.83000,163.23000,The Alliance,PPO Network,,142.79,,,,,,,94.51,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,outpatient,1,mL,171.83000,163.23000,The Alliance,PPO Network,,142.79,,,,,,,71.65,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,inpatient,1,mL,352.08000,334.48000,The Alliance,PPO Network,,292.58,,,,,,,193.64,341.52,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,outpatient,1,mL,352.08000,334.48000,The Alliance,PPO Network,,292.58,,,,,,,71.65,341.52,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,14.70,763.98,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,108.90,192.06,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,13.65,984.66,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,inpatient,1,mL,12.47000,11.85000,The Alliance,PPO Network,,10.36,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,PPO Network,,10.36,,,,,,,6.24,73.49,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,inpatient,1,mL,12.47000,11.85000,The Alliance,PPO Network,,10.36,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,PPO Network,,10.36,,,,,,,6.24,73.49,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,inpatient,100,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,outpatient,100,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,inpatient,100,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,outpatient,100,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,inpatient,100,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,outpatient,100,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,inpatient,100,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,outpatient,100,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,inpatient,100,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,outpatient,100,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,inpatient,100,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,inpatient,100,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,outpatient,100,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,5.94,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.71500,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,3.64,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,3.31,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,inpatient,1,EA,34.79000,33.05000,The Alliance,PPO Network,,28.91,,,,,,,19.13,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,outpatient,1,EA,34.79000,33.05000,The Alliance,PPO Network,,28.91,,,,,,,17.39,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,inpatient,1,EA,28.96000,27.52000,The Alliance,PPO Network,,24.07,,,,,,,15.93,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,outpatient,1,EA,28.96000,27.52000,The Alliance,PPO Network,,24.07,,,,,,,14.48,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,inpatient,1,EA,15.79000,15.00000,The Alliance,PPO Network,,13.12,,,,,,,8.68,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,outpatient,1,EA,15.79000,15.00000,The Alliance,PPO Network,,13.12,,,,,,,7.89,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,The Alliance,PPO Network,,27.12,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,PPO Network,,27.12,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,The Alliance,PPO Network,,27.12,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,PPO Network,,27.12,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,18.17,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,inpatient,1,EA,12.84000,12.19000,The Alliance,PPO Network,,10.67,,,,,,,7.06,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,PPO Network,,10.67,,,,,,,6.42,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,inpatient,1,mL,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,outpatient,1,mL,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,inpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,3.67,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,inpatient,,,195.10000,185.34000,The Alliance,PPO Network,90,162.13,,,,,,,107.31,189.25,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,outpatient,,,195.10000,185.34000,The Alliance,PPO Network,90,162.13,,,,,,,17.36,882.80,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,inpatient,1,mL,30.39000,28.87000,The Alliance,PPO Network,,25.25,,,,,,,16.71,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,PPO Network,,25.25,,,,,,,1.15,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,inpatient,1,mL,291.73000,277.14000,The Alliance,PPO Network,,242.43,,,,,,,160.45,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,outpatient,1,mL,291.73000,277.14000,The Alliance,PPO Network,,242.43,,,,,,,1.15,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,inpatient,1,mL,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,81.69,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,outpatient,1,mL,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,1.15,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,inpatient,1,mL,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,1.15,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,inpatient,1,mL,157.10000,149.25000,The Alliance,PPO Network,,130.55,,,,,,,86.41,152.39,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,outpatient,1,mL,157.10000,149.25000,The Alliance,PPO Network,,130.55,,,,,,,1.15,152.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,inpatient,1,EA,5.56000,5.29000,The Alliance,PPO Network,,4.62,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,outpatient,1,EA,5.56000,5.29000,The Alliance,PPO Network,,4.62,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.46,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.93,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.75,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,inpatient,1,EA,5.37000,5.11000,The Alliance,PPO Network,,4.46,,,,,,,2.95,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,outpatient,1,EA,5.37000,5.11000,The Alliance,PPO Network,,4.46,,,,,,,2.69,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,inpatient,1,EA,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,3.25,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,2.96,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,inpatient,1,EA,55.82000,53.03000,The Alliance,PPO Network,,46.39,,,,,,,30.70,54.15,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,outpatient,1,EA,55.82000,53.03000,The Alliance,PPO Network,,46.39,,,,,,,27.91,54.15,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.79,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.63,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.78,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,inpatient,1,EA,3.99000,3.79000,The Alliance,PPO Network,,3.32,,,,,,,2.19,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,outpatient,1,EA,3.99000,3.79000,The Alliance,PPO Network,,3.32,,,,,,,2.00,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,inpatient,1,EA,4.08000,3.87000,The Alliance,PPO Network,,3.39,,,,,,,2.24,3.96,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,PPO Network,,3.39,,,,,,,2.04,3.96,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,inpatient,1,EA,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,1.63,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,outpatient,1,EA,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,1.49,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,inpatient,1,EA,2.96000,2.82000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,outpatient,1,EA,2.96000,2.82000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,52.25,92.15,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,47.50,1075.26,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,inpatient,4,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,outpatient,4,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,inpatient,4,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,outpatient,4,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,0.64740,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,inpatient,4,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,outpatient,4,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.64740,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,inpatient,4,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,outpatient,4,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,0.64740,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,inpatient,4,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,outpatient,4,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,inpatient,4,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,outpatient,4,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.64740,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,inpatient,4,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,outpatient,4,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,inpatient,4,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,outpatient,4,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,inpatient,4,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,outpatient,4,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,inpatient,1,mL,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.22,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,outpatient,1,mL,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.02,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,inpatient,1,mL,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,3.67,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,inpatient,1,mL,2655.14000,2522.38000,The Alliance,PPO Network,,2206.42,,,,,,,1460.33,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,outpatient,1,mL,2655.14000,2522.38000,The Alliance,PPO Network,,2206.42,,,,,,,6.03,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,inpatient,1,mL,1849.97000,1757.47000,The Alliance,PPO Network,,1537.33,,,,,,,1017.48,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,outpatient,1,mL,1849.97000,1757.47000,The Alliance,PPO Network,,1537.33,,,,,,,6.03,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,inpatient,1,mL,1856.17000,1763.36000,The Alliance,PPO Network,,1542.48,,,,,,,1020.89,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,outpatient,1,mL,1856.17000,1763.36000,The Alliance,PPO Network,,1542.48,,,,,,,6.03,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,inpatient,1,mL,1702.49000,1617.37000,The Alliance,PPO Network,,1414.77,,,,,,,936.37,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,outpatient,1,mL,1702.49000,1617.37000,The Alliance,PPO Network,,1414.77,,,,,,,6.03,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,inpatient,1,mL,2300.00000,2185.00000,The Alliance,PPO Network,,1911.30,,,,,,,1265.00,2231.00,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,outpatient,1,mL,2300.00000,2185.00000,The Alliance,PPO Network,,1911.30,,,,,,,6.03,2231.00,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,inpatient,5,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,inpatient,5,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.58,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.35,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,inpatient,5,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,outpatient,5,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,inpatient,16,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,outpatient,16,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,inpatient,16,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,outpatient,16,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,inpatient,16,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,outpatient,16,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,inpatient,16,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,outpatient,16,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.78,3.45,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,inpatient,100,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,outpatient,100,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,5.94,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,10.00,30.07,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,313.50,552.90,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,285.00,3186.14,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,inpatient,1,EA,866.69000,823.36000,The Alliance,PPO Network,,720.22,,,,,,,476.68,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,outpatient,1,EA,866.69000,823.36000,The Alliance,PPO Network,,720.22,,,,,,,0.17611,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,inpatient,1,EA,829.37000,787.90000,The Alliance,PPO Network,,689.21,,,,,,,456.15,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,outpatient,1,EA,829.37000,787.90000,The Alliance,PPO Network,,689.21,,,,,,,0.17611,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,inpatient,1,EA,205.40000,195.13000,The Alliance,PPO Network,,170.69,,,,,,,112.97,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,outpatient,1,EA,205.40000,195.13000,The Alliance,PPO Network,,170.69,,,,,,,0.17611,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,inpatient,1,EA,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,0.17611,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,0.17611,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,inpatient,1,EA,748.82000,711.38000,The Alliance,PPO Network,,622.27,,,,,,,411.85,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,outpatient,1,EA,748.82000,711.38000,The Alliance,PPO Network,,622.27,,,,,,,0.17611,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,inpatient,1,EA,259.69000,246.70000,The Alliance,PPO Network,,215.80,,,,,,,142.83,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,outpatient,1,EA,259.69000,246.70000,The Alliance,PPO Network,,215.80,,,,,,,0.17611,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,inpatient,1,EA,780.03000,741.03000,The Alliance,PPO Network,,648.20,,,,,,,429.02,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,outpatient,1,EA,780.03000,741.03000,The Alliance,PPO Network,,648.20,,,,,,,0.17611,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,inpatient,1,EA,256.53000,243.70000,The Alliance,PPO Network,,213.18,,,,,,,141.09,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,outpatient,1,EA,256.53000,243.70000,The Alliance,PPO Network,,213.18,,,,,,,0.17611,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,inpatient,1,EA,530.95000,504.40000,The Alliance,PPO Network,,441.22,,,,,,,292.02,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,PPO Network,,441.22,,,,,,,0.17611,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,inpatient,1,EA,454.54000,431.82000,The Alliance,PPO Network,,377.72,,,,,,,250.00,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,outpatient,1,EA,454.54000,431.82000,The Alliance,PPO Network,,377.72,,,,,,,0.17611,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,inpatient,1,EA,271.95000,258.35000,The Alliance,PPO Network,,225.99,,,,,,,149.57,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,PPO Network,,225.99,,,,,,,0.17611,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,inpatient,1,EA,714.37000,678.66000,The Alliance,PPO Network,,593.64,,,,,,,392.90,692.94,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,outpatient,1,EA,714.37000,678.66000,The Alliance,PPO Network,,593.64,,,,,,,0.17611,692.94,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,PPO Network,TC,143.76,,,,,,,95.15,167.81,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,PPO Network,TC,143.76,,,,,,,86.50,167.81,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,89.24,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,9.72,458.40,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,7.20,373.51,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,PPO Network,TC,437.11,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,PPO Network,TC,437.11,,,,,,,146.17,1450.63,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,129.80,228.92,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,118.00,1635.52,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,44.50,210.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,107.80,190.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,18.54,967.70,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,inpatient,2.5,EA,45.50000,43.23000,The Alliance,PPO Network,,37.81,,,,,,,25.02,44.13,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,outpatient,2.5,EA,45.50000,43.23000,The Alliance,PPO Network,,37.81,,,,,,,22.75,44.13,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,inpatient,1,mL,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,3.64,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,outpatient,1,mL,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,0.64740,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,inpatient,1,mL,5.40000,5.13000,The Alliance,PPO Network,,4.49,,,,,,,2.97,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,outpatient,1,mL,5.40000,5.13000,The Alliance,PPO Network,,4.49,,,,,,,0.64740,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,0.64740,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,0.64740,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,0.64740,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.64740,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.64740,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,inpatient,1,mL,4.29000,4.08000,The Alliance,PPO Network,,3.56,,,,,,,2.36,4.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,outpatient,1,mL,4.29000,4.08000,The Alliance,PPO Network,,3.56,,,,,,,0.64740,4.16,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,inpatient,12,EA,72.11000,68.50000,The Alliance,PPO Network,,59.92,,,,,,,39.66,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,outpatient,12,EA,72.11000,68.50000,The Alliance,PPO Network,,59.92,,,,,,,36.05,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,inpatient,12,EA,46.87000,44.53000,The Alliance,PPO Network,,38.95,,,,,,,25.78,45.46,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,outpatient,12,EA,46.87000,44.53000,The Alliance,PPO Network,,38.95,,,,,,,23.43,45.46,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,inpatient,2,EA,43.15000,40.99000,The Alliance,PPO Network,,35.86,,,,,,,23.73,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,outpatient,2,EA,43.15000,40.99000,The Alliance,PPO Network,,35.86,,,,,,,21.57,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,inpatient,2,EA,63.88000,60.69000,The Alliance,PPO Network,,53.08,,,,,,,35.13,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,outpatient,2,EA,63.88000,60.69000,The Alliance,PPO Network,,53.08,,,,,,,31.94,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,inpatient,2,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.27,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,outpatient,2,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.16,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,inpatient,2,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,inpatient,2,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,outpatient,2,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,inpatient,2,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,12.86,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,11.69,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,inpatient,2,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,outpatient,2,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,inpatient,2,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,outpatient,2,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.47,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,inpatient,2,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,outpatient,2,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,11.85,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,inpatient,2,EA,7.78000,7.39000,The Alliance,PPO Network,,6.47,,,,,,,4.28,7.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,outpatient,2,EA,7.78000,7.39000,The Alliance,PPO Network,,6.47,,,,,,,3.89,7.55,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,17.27,823.21,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,17.12,33.22,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,inpatient,1,mL,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,outpatient,1,mL,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,inpatient,1,mL,5.38000,5.11000,The Alliance,PPO Network,,4.47,,,,,,,2.96,5.22,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,outpatient,1,mL,5.38000,5.11000,The Alliance,PPO Network,,4.47,,,,,,,2.69,5.22,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,82.67,145.79,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,17.85,814.87,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,191.95,338.53,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,77.53,1052.52,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,9.70,509.30,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,inpatient,,,137.20000,130.34000,The Alliance,PPO Network,90,114.01,,,,,,,75.46,133.08,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,outpatient,,,137.20000,130.34000,The Alliance,PPO Network,90,114.01,,,,,,,16.62,780.94,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,433.40,764.36,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,394.00,4298.79,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,inpatient,10.6,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,outpatient,10.6,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.29,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,inpatient,10.6,EA,60.98000,57.93000,The Alliance,PPO Network,,50.67,,,,,,,33.54,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,outpatient,10.6,EA,60.98000,57.93000,The Alliance,PPO Network,,50.67,,,,,,,30.49,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,inpatient,10.6,EA,39.63000,37.65000,The Alliance,PPO Network,,32.93,,,,,,,21.80,38.44,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,outpatient,10.6,EA,39.63000,37.65000,The Alliance,PPO Network,,32.93,,,,,,,19.82,38.44,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,inpatient,1,mL,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,inpatient,1,mL,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,inpatient,1,mL,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,1.65,7.62,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,inpatient,1,GM,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,outpatient,1,GM,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,5.39,288.61,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,inpatient,100,EA,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,outpatient,100,EA,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,26.79,78.87,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,69.30,122.22,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,16.37,899.77,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,inpatient,2,EA,8.55000,8.12000,The Alliance,PPO Network,,7.11,,,,,,,4.70,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,outpatient,2,EA,8.55000,8.12000,The Alliance,PPO Network,,7.11,,,,,,,3.82,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,inpatient,2,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,inpatient,2,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,outpatient,2,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,inpatient,2,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,outpatient,2,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,inpatient,1,EA,1919.06000,1823.11000,The Alliance,PPO Network,,1594.74,,,,,,,1055.48,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,outpatient,1,EA,1919.06000,1823.11000,The Alliance,PPO Network,,1594.74,,,,,,,4.61,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,inpatient,1,EA,145.14000,137.88000,The Alliance,PPO Network,,120.61,,,,,,,79.83,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,outpatient,1,EA,145.14000,137.88000,The Alliance,PPO Network,,120.61,,,,,,,4.61,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,inpatient,1,EA,157.65000,149.77000,The Alliance,PPO Network,,131.01,,,,,,,86.71,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,outpatient,1,EA,157.65000,149.77000,The Alliance,PPO Network,,131.01,,,,,,,4.61,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,inpatient,1,EA,156.74000,148.90000,The Alliance,PPO Network,,130.25,,,,,,,86.21,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,outpatient,1,EA,156.74000,148.90000,The Alliance,PPO Network,,130.25,,,,,,,4.61,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,inpatient,1,EA,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,199.43,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,4.61,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,inpatient,1,EA,154.84000,147.10000,The Alliance,PPO Network,,128.67,,,,,,,85.16,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,outpatient,1,EA,154.84000,147.10000,The Alliance,PPO Network,,128.67,,,,,,,4.61,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,inpatient,1,EA,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,81.69,144.06,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,4.61,144.06,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,inpatient,1,mL,3.92000,3.72000,The Alliance,PPO Network,,3.26,,,,,,,2.16,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,outpatient,1,mL,3.92000,3.72000,The Alliance,PPO Network,,3.26,,,,,,,1.96,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,inpatient,1,mL,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,inpatient,1,mL,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,3.67,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.54,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.31,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,inpatient,1,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,outpatient,1,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.44,4.32,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,The Alliance,PPO Network,TC,511.90,,,,,,,338.80,597.52,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,PPO Network,TC,511.90,,,,,,,308.00,3942.79,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,69.30,122.22,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,12.05,574.73,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,inpatient,50,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,outpatient,50,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,inpatient,50,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,outpatient,50,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,inpatient,50,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,outpatient,50,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,inpatient,50,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,outpatient,50,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,inpatient,50,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,outpatient,50,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,inpatient,50,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,outpatient,50,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,inpatient,,,614.00000,583.30000,The Alliance,PPO Network,,510.23,,,,,,,337.70,595.58,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,outpatient,,,614.00000,583.30000,The Alliance,PPO Network,,510.23,,,,,,,125.97,1861.90,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,19.04,1001.63,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,inpatient,,,189.00000,179.55000,The Alliance,PPO Network,,157.06,,,,,,,103.95,183.33,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,PPO Network,,157.06,,,,,,,17.63,916.73,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.93,203.72,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,inpatient,,,153.80000,146.11000,The Alliance,PPO Network,90,127.81,,,,,,,84.59,149.19,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,PPO Network,90,127.81,,,,,,,14.48,1018.59,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.32,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.02,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,1.03,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,inpatient,1,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,26.79,78.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,The Alliance,PPO Network,,2.97,,,,,,,1.97,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,PPO Network,,2.97,,,,,,,1.79,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,577.23,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,TC,2866.95,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,TC,2866.95,,,,,,,1591.55,3346.50,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,35.50,68.87,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,inpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,PPO Network,,16.34,,,,,,,9.83,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,17.12,33.22,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,7.15,645.08,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,inpatient,30,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,81.87,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,inpatient,5,EA,9.70000,9.22000,The Alliance,PPO Network,,8.06,,,,,,,5.33,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,outpatient,5,EA,9.70000,9.22000,The Alliance,PPO Network,,8.06,,,,,,,4.85,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,inpatient,5,EA,22.57000,21.44000,The Alliance,PPO Network,,18.76,,,,,,,12.41,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,outpatient,5,EA,22.57000,21.44000,The Alliance,PPO Network,,18.76,,,,,,,11.29,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,inpatient,5,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,outpatient,5,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,The Alliance,PPO Network,TC,2355.05,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,PPO Network,TC,2355.05,,,,,,,1132.05,2748.98,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,inpatient,1,mL,5.36000,5.10000,The Alliance,PPO Network,,4.45,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,outpatient,1,mL,5.36000,5.10000,The Alliance,PPO Network,,4.45,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,inpatient,1,mL,5.61000,5.32000,The Alliance,PPO Network,,4.66,,,,,,,3.09,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,outpatient,1,mL,5.61000,5.32000,The Alliance,PPO Network,,4.66,,,,,,,2.81,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,4.95,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,inpatient,,,90.60000,86.07000,The Alliance,PPO Network,90,75.29,,,,,,,49.83,87.88,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,outpatient,,,90.60000,86.07000,The Alliance,PPO Network,90,75.29,,,,,,,13.88,746.94,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,12.05,1539.22,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,inpatient,10,EA,16.13000,15.33000,The Alliance,PPO Network,,13.40,,,,,,,8.87,15.65,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,outpatient,10,EA,16.13000,15.33000,The Alliance,PPO Network,,13.40,,,,,,,8.06,15.65,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,inpatient,1,EA,383.81000,364.62000,The Alliance,PPO Network,,318.95,,,,,,,211.10,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,outpatient,1,EA,383.81000,364.62000,The Alliance,PPO Network,,318.95,,,,,,,4.61,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,inpatient,1,EA,31.35000,29.78000,The Alliance,PPO Network,,26.05,,,,,,,17.24,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,outpatient,1,EA,31.35000,29.78000,The Alliance,PPO Network,,26.05,,,,,,,4.61,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,4.61,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,4.61,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,inpatient,1,EA,29.01000,27.56000,The Alliance,PPO Network,,24.11,,,,,,,15.96,28.14,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,PPO Network,,24.11,,,,,,,4.61,28.14,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,inpatient,1,EA,3.14000,2.99000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,outpatient,1,EA,3.14000,2.99000,The Alliance,PPO Network,,2.61,,,,,,,1.57,3.05,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,inpatient,15,EA,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,outpatient,15,EA,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.16,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,inpatient,15,EA,6.87000,6.52000,The Alliance,PPO Network,,5.71,,,,,,,3.78,6.66,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,outpatient,15,EA,6.87000,6.52000,The Alliance,PPO Network,,5.71,,,,,,,3.44,6.66,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,122.10,215.34,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,16.38,848.80,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,inpatient,10,EA,25.01000,23.76000,The Alliance,PPO Network,,20.78,,,,,,,13.76,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,outpatient,10,EA,25.01000,23.76000,The Alliance,PPO Network,,20.78,,,,,,,12.51,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,inpatient,10,EA,38.33000,36.41000,The Alliance,PPO Network,,31.85,,,,,,,21.08,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,outpatient,10,EA,38.33000,36.41000,The Alliance,PPO Network,,31.85,,,,,,,19.16,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,inpatient,10,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,inpatient,10,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,inpatient,10,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,outpatient,10,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,inpatient,10,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,8.26,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,7.50,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,inpatient,10,EA,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.47,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,outpatient,10,EA,4.49000,4.27000,The Alliance,PPO Network,,3.73,,,,,,,2.25,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,inpatient,10,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,outpatient,10,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,7.58,14.71,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,inpatient,1,EA,1566.95000,1488.60000,The Alliance,PPO Network,,1302.14,,,,,,,861.82,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,outpatient,1,EA,1566.95000,1488.60000,The Alliance,PPO Network,,1302.14,,,,,,,734.15,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,inpatient,1,EA,2451.28000,2328.72000,The Alliance,PPO Network,,2037.01,,,,,,,1348.20,2377.74,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,outpatient,1,EA,2451.28000,2328.72000,The Alliance,PPO Network,,2037.01,,,,,,,734.15,2377.74,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,inpatient,200,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,outpatient,200,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,26.79,78.87,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,4.75,254.68,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.92,203.72,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,11.53,574.73,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,115.50,203.70,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,18.58,967.70,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,inpatient,1,EA,727.27000,690.91000,The Alliance,PPO Network,,604.36,,,,,,,400.00,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,outpatient,1,EA,727.27000,690.91000,The Alliance,PPO Network,,604.36,,,,,,,195.79,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,inpatient,1,EA,730.51000,693.98000,The Alliance,PPO Network,,607.05,,,,,,,401.78,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,outpatient,1,EA,730.51000,693.98000,The Alliance,PPO Network,,607.05,,,,,,,195.79,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,inpatient,1,EA,725.20000,688.94000,The Alliance,PPO Network,,602.64,,,,,,,398.86,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,outpatient,1,EA,725.20000,688.94000,The Alliance,PPO Network,,602.64,,,,,,,195.79,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,inpatient,1,EA,410.23000,389.72000,The Alliance,PPO Network,,340.90,,,,,,,225.63,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,outpatient,1,EA,410.23000,389.72000,The Alliance,PPO Network,,340.90,,,,,,,195.79,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,inpatient,1,EA,444.44000,422.22000,The Alliance,PPO Network,,369.33,,,,,,,244.44,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,outpatient,1,EA,444.44000,422.22000,The Alliance,PPO Network,,369.33,,,,,,,195.79,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,inpatient,1,EA,724.68000,688.45000,The Alliance,PPO Network,,602.21,,,,,,,398.57,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,outpatient,1,EA,724.68000,688.45000,The Alliance,PPO Network,,602.21,,,,,,,195.79,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,inpatient,1,EA,441.85000,419.76000,The Alliance,PPO Network,,367.18,,,,,,,243.02,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,outpatient,1,EA,441.85000,419.76000,The Alliance,PPO Network,,367.18,,,,,,,195.79,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,inpatient,1,EA,273.01000,259.36000,The Alliance,PPO Network,,226.87,,,,,,,150.16,264.82,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,outpatient,1,EA,273.01000,259.36000,The Alliance,PPO Network,,226.87,,,,,,,136.50,323.05,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,inpatient,1,EA,441.60000,419.52000,The Alliance,PPO Network,,366.97,,,,,,,242.88,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,outpatient,1,EA,441.60000,419.52000,The Alliance,PPO Network,,366.97,,,,,,,195.79,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,inpatient,1,EA,419.58000,398.60000,The Alliance,PPO Network,,348.67,,,,,,,230.77,406.99,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,outpatient,1,EA,419.58000,398.60000,The Alliance,PPO Network,,348.67,,,,,,,195.79,406.99,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,inpatient,1,mL,57.32000,54.46000,The Alliance,PPO Network,,47.63,,,,,,,31.53,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,outpatient,1,mL,57.32000,54.46000,The Alliance,PPO Network,,47.63,,,,,,,0.36823,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,0.36823,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,0.36823,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,inpatient,1,mL,29.61000,28.13000,The Alliance,PPO Network,,24.61,,,,,,,16.29,28.72,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,outpatient,1,mL,29.61000,28.13000,The Alliance,PPO Network,,24.61,,,,,,,0.36823,28.72,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,1.20,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,inpatient,1,EA,65.21000,61.95000,The Alliance,PPO Network,,54.19,,,,,,,35.87,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,outpatient,1,EA,65.21000,61.95000,The Alliance,PPO Network,,54.19,,,,,,,1.20,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,1.20,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.20,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,inpatient,1,EA,18.93000,17.98000,The Alliance,PPO Network,,15.73,,,,,,,10.41,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,PPO Network,,15.73,,,,,,,1.20,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.20,2.70,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,1.82,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,inpatient,,,147.70000,140.31000,The Alliance,PPO Network,,122.74,,,,,,,81.23,143.27,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,outpatient,,,147.70000,140.31000,The Alliance,PPO Network,,122.74,,,,,,,36.30,143.27,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,inpatient,2,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,inpatient,2,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,inpatient,2,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,inpatient,2,EA,6.43000,6.11000,The Alliance,PPO Network,,5.34,,,,,,,3.54,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,outpatient,2,EA,6.43000,6.11000,The Alliance,PPO Network,,5.34,,,,,,,3.21,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,inpatient,2,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,outpatient,2,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,4.32,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,7.52,390.47,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,inpatient,10,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,outpatient,10,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.64740,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,inpatient,10,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,outpatient,10,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,inpatient,10,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,inpatient,10,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,outpatient,10,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,inpatient,10,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,outpatient,10,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,inpatient,10,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,4.06,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,outpatient,10,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,0.64740,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,inpatient,10,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.64740,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,inpatient,10,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,outpatient,10,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.64740,1.29,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,inpatient,12,EA,40.91000,38.87000,The Alliance,PPO Network,,34.00,,,,,,,22.50,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,outpatient,12,EA,40.91000,38.87000,The Alliance,PPO Network,,34.00,,,,,,,20.45,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,inpatient,12,EA,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,outpatient,12,EA,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,inpatient,12,EA,72.80000,69.16000,The Alliance,PPO Network,,60.50,,,,,,,40.04,70.62,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,outpatient,12,EA,72.80000,69.16000,The Alliance,PPO Network,,60.50,,,,,,,36.40,70.62,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,56.10,98.94,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,4.90,373.51,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,2.37,118.82,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,12.87,679.08,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,inpatient,1,mL,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,0.43000,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,0.43000,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,inpatient,1,mL,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,outpatient,1,mL,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,inpatient,1,mL,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,0.43000,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,inpatient,1,mL,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,0.43000,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,inpatient,1,mL,22.27000,21.15000,The Alliance,PPO Network,,18.51,,,,,,,12.25,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,outpatient,1,mL,22.27000,21.15000,The Alliance,PPO Network,,18.51,,,,,,,0.43000,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,0.43000,7.66,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,177.65,313.31,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,35.09,1833.46,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,73.15,129.01,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,11.84,611.15,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,inpatient,1,EA,6103.28000,5798.12000,The Alliance,PPO Network,,5071.83,,,,,,,3356.80,5920.18,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,outpatient,1,EA,6103.28000,5798.12000,The Alliance,PPO Network,,5071.83,,,,,,,734.15,5920.18,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1278.00000,1214.10000,The Alliance,PPO Network,,1062.02,,,,,,,702.90,1239.66,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1278.00000,1214.10000,The Alliance,PPO Network,,1062.02,,,,,,,128.29,6705.74,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,inpatient,1,mL,5.44000,5.17000,The Alliance,PPO Network,,4.52,,,,,,,2.99,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,outpatient,1,mL,5.44000,5.17000,The Alliance,PPO Network,,4.52,,,,,,,2.72,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,inpatient,1,mL,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,inpatient,1,mL,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,outpatient,1,mL,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.35,4.95,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,The Alliance,PPO Network,,49.19,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,PPO Network,,49.19,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,The Alliance,PPO Network,,98.37,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,PPO Network,,98.37,,,,,,,49.09,114.83,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,inpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,inpatient,10,EA,15.54000,14.76000,The Alliance,PPO Network,,12.91,,,,,,,8.55,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,outpatient,10,EA,15.54000,14.76000,The Alliance,PPO Network,,12.91,,,,,,,7.77,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,inpatient,10,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.19,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,outpatient,10,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.22,8.19,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,inpatient,4,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,outpatient,4,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,inpatient,4,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,outpatient,4,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,391.60,690.64,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,67.36,3514.18,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,inpatient,,,4882.00000,4637.90000,The Alliance,PPO Network,TC,4056.94,,,,,,,2685.10,4735.54,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,outpatient,,,4882.00000,4637.90000,The Alliance,PPO Network,TC,4056.94,,,,,,,2091.58,4735.54,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,2.37,118.82,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,733.05000,696.40000,The Alliance,PPO Network,,609.16,,,,,,,359.19,711.06,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,733.05000,696.40000,The Alliance,PPO Network,,609.16,,,,,,,336.47,733.05,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,inpatient,,,22.90000,21.75000,The Alliance,PPO Network,,19.03,,,,,,,12.60,22.21,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,outpatient,,,22.90000,21.75000,The Alliance,PPO Network,,19.03,,,,,,,11.45,22.21,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,inpatient,1,EA,1.77000,1.69000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,outpatient,1,EA,1.77000,1.69000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,inpatient,1,mL,414.52000,393.79000,The Alliance,PPO Network,,344.47,,,,,,,227.99,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,outpatient,1,mL,414.52000,393.79000,The Alliance,PPO Network,,344.47,,,,,,,207.26,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,inpatient,1,mL,378.56000,359.63000,The Alliance,PPO Network,,314.58,,,,,,,208.21,367.20,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,outpatient,1,mL,378.56000,359.63000,The Alliance,PPO Network,,314.58,,,,,,,189.28,367.20,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,inpatient,1,EA,24.19000,22.98000,The Alliance,PPO Network,,20.10,,,,,,,13.30,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,outpatient,1,EA,24.19000,22.98000,The Alliance,PPO Network,,20.10,,,,,,,0.43000,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,0.43000,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,0.43000,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.43000,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,0.43000,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,0.43000,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,inpatient,1,EA,23.47000,22.30000,The Alliance,PPO Network,,19.50,,,,,,,12.91,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,outpatient,1,EA,23.47000,22.30000,The Alliance,PPO Network,,19.50,,,,,,,0.43000,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,inpatient,1,EA,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,outpatient,1,EA,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,4.70,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,0.43000,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,inpatient,1,EA,22.91000,21.76000,The Alliance,PPO Network,,19.04,,,,,,,12.60,22.22,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,PPO Network,,19.04,,,,,,,0.43000,22.22,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,inpatient,1,mL,458.17000,435.26000,The Alliance,PPO Network,,380.74,,,,,,,251.99,444.42,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,outpatient,1,mL,458.17000,435.26000,The Alliance,PPO Network,,380.74,,,,,,,229.09,444.42,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,12.39,645.08,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,10.74,560.26,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,3.28,152.82,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,inpatient,10,EA,4.89000,4.64000,The Alliance,PPO Network,,4.06,,,,,,,2.69,4.74,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,outpatient,10,EA,4.89000,4.64000,The Alliance,PPO Network,,4.06,,,,,,,2.44,4.74,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,inpatient,1,mL,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,69.38,134.59,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,13.09,679.08,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,inpatient,,,383.00000,363.85000,The Alliance,PPO Network,,318.27,,,,,,,210.65,371.51,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,PPO Network,,318.27,,,,,,,35.09,1833.46,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,inpatient,1,mL,75.21000,71.45000,The Alliance,PPO Network,,62.50,,,,,,,41.37,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,outpatient,1,mL,75.21000,71.45000,The Alliance,PPO Network,,62.50,,,,,,,7.15,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,inpatient,1,mL,88.73000,84.30000,The Alliance,PPO Network,,73.73,,,,,,,48.80,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,outpatient,1,mL,88.73000,84.30000,The Alliance,PPO Network,,73.73,,,,,,,7.15,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,7.15,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,inpatient,1,mL,67.43000,64.06000,The Alliance,PPO Network,,56.03,,,,,,,37.09,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,outpatient,1,mL,67.43000,64.06000,The Alliance,PPO Network,,56.03,,,,,,,7.15,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,inpatient,1,mL,67.31000,63.94000,The Alliance,PPO Network,,55.93,,,,,,,37.02,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,outpatient,1,mL,67.31000,63.94000,The Alliance,PPO Network,,55.93,,,,,,,7.15,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,7.15,61.30,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,inpatient,,,231.53000,219.95000,The Alliance,PPO Network,,192.40,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,outpatient,,,231.53000,219.95000,The Alliance,PPO Network,,192.40,,,,,,,115.77,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,inpatient,1,mL,231.53000,219.95000,The Alliance,PPO Network,,192.40,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,outpatient,1,mL,231.53000,219.95000,The Alliance,PPO Network,,192.40,,,,,,,115.77,224.58,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,11.98,628.12,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,8.17,424.40,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,inpatient,,,146.22000,138.91000,The Alliance,PPO Network,,121.51,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,outpatient,,,146.22000,138.91000,The Alliance,PPO Network,,121.51,,,,,,,73.11,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,inpatient,1,mL,146.22000,138.91000,The Alliance,PPO Network,,121.51,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,outpatient,1,mL,146.22000,138.91000,The Alliance,PPO Network,,121.51,,,,,,,73.11,141.83,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,11.98,628.12,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,8.17,797.91,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,3.93,203.72,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,inpatient,1,mL,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,outpatient,1,mL,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,0.33945,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,0.33945,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,inpatient,1,mL,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,3.02,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,outpatient,1,mL,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,0.33945,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,inpatient,1,mL,4.00000,3.80000,The Alliance,PPO Network,,3.32,,,,,,,2.20,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,outpatient,1,mL,4.00000,3.80000,The Alliance,PPO Network,,3.32,,,,,,,0.33945,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,inpatient,1,mL,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,0.33945,2.96,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,10.33,543.22,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,90,108.03,,,,,,,71.50,126.10,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,90,108.03,,,,,,,11.91,594.19,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,26.00000,24.70000,The Alliance,PPO Network,QN,21.61,,,,,,,14.30,25.22,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,26.00000,24.70000,The Alliance,PPO Network,QN,21.61,,,,,,,13.00,25.22,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,275.62,545.62,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,258.19,562.50,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,PPO Network,,342.37,,,,,,,226.60,399.64,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,PPO Network,,342.37,,,,,,,38.30,1901.39,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,9.71,509.30,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,inpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,69.30,122.22,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,PPO Network,,104.71,,,,,,,12.05,628.12,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,inpatient,,,254.90000,242.16000,The Alliance,PPO Network,90,211.82,,,,,,,140.19,247.25,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,outpatient,,,254.90000,242.16000,The Alliance,PPO Network,90,211.82,,,,,,,22.69,1154.38,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,13.52,713.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,inpatient,1,EA,1.21000,1.14000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,outpatient,1,EA,1.21000,1.14000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,14.27,746.94,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,11.77,611.15,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,inpatient,,,139.34000,132.37000,The Alliance,PPO Network,,115.79,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,outpatient,,,139.34000,132.37000,The Alliance,PPO Network,,115.79,,,,,,,69.67,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,inpatient,1,EA,139.34000,132.37000,The Alliance,PPO Network,,115.79,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,outpatient,1,EA,139.34000,132.37000,The Alliance,PPO Network,,115.79,,,,,,,69.67,135.16,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,inpatient,1,mL,10.40000,9.88000,The Alliance,PPO Network,,8.64,,,,,,,5.72,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,outpatient,1,mL,10.40000,9.88000,The Alliance,PPO Network,,8.64,,,,,,,0.33945,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,0.33945,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,inpatient,1,mL,24.11000,22.91000,The Alliance,PPO Network,,20.04,,,,,,,13.26,23.39,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,outpatient,1,mL,24.11000,22.91000,The Alliance,PPO Network,,20.04,,,,,,,0.33945,23.39,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,12.58,662.12,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,inpatient,,,276.60000,262.77000,The Alliance,PPO Network,90,229.85,,,,,,,152.13,268.30,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,outpatient,,,276.60000,262.77000,The Alliance,PPO Network,90,229.85,,,,,,,8.17,679.08,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,8.61,407.44,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,73.15,129.01,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,,110.52,,,,,,,13.79,645.08,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,8.00,373.51,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,6.82,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,inpatient,1,EA,134.16000,127.46000,The Alliance,PPO Network,,111.49,,,,,,,73.79,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,outpatient,1,EA,134.16000,127.46000,The Alliance,PPO Network,,111.49,,,,,,,6.82,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,6.82,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,24.89,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,6.82,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,inpatient,1,EA,7.65000,7.26000,The Alliance,PPO Network,,6.36,,,,,,,4.21,7.42,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,PPO Network,,6.36,,,,,,,3.83,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,6.82,36.78,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,171.05,301.67,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,58.00,3038.81,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,inpatient,,,392.00000,372.40000,The Alliance,PPO Network,,325.75,,,,,,,215.60,380.24,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,outpatient,,,392.00000,372.40000,The Alliance,PPO Network,,325.75,,,,,,,196.00,380.24,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,90,44.04,,,,,,,29.15,51.41,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,90,44.04,,,,,,,6.41,1590.11,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,The Alliance,PPO Network,TC,2840.36,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,PPO Network,TC,2840.36,,,,,,,1578.65,3315.46,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,14.38,746.94,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,inpatient,,,301.21000,286.15000,The Alliance,PPO Network,,250.31,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,outpatient,,,301.21000,286.15000,The Alliance,PPO Network,,250.31,,,,,,,150.60,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,inpatient,1,mL,301.21000,286.15000,The Alliance,PPO Network,,250.31,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,outpatient,1,mL,301.21000,286.15000,The Alliance,PPO Network,,250.31,,,,,,,150.60,292.17,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,inpatient,1,EA,36.47000,34.64000,The Alliance,PPO Network,,30.31,,,,,,,20.06,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,outpatient,1,EA,36.47000,34.64000,The Alliance,PPO Network,,30.31,,,,,,,18.23,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,18.17,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,inpatient,1,EA,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,outpatient,1,EA,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,inpatient,1,EA,34.63000,32.90000,The Alliance,PPO Network,,28.78,,,,,,,19.05,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,outpatient,1,EA,34.63000,32.90000,The Alliance,PPO Network,,28.78,,,,,,,17.32,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,inpatient,1,EA,9.39000,8.92000,The Alliance,PPO Network,,7.80,,,,,,,5.16,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,PPO Network,,7.80,,,,,,,4.70,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,inpatient,1,EA,151.75000,144.17000,The Alliance,PPO Network,,126.10,,,,,,,83.46,147.20,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,outpatient,1,EA,151.75000,144.17000,The Alliance,PPO Network,,126.10,,,,,,,75.88,147.20,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,PPO Network,,329.08,,,,,,,217.80,384.12,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,PPO Network,,329.08,,,,,,,24.06,1137.41,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,PPO Network,TC,387.25,,,,,,,256.30,452.02,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,PPO Network,TC,387.25,,,,,,,233.00,4012.21,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,19.35,1018.59,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,9.09,441.37,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,inpatient,28.35,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,outpatient,28.35,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,inpatient,28.35,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,outpatient,28.35,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,inpatient,28.35,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,outpatient,28.35,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,inpatient,28.35,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,outpatient,28.35,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,PPO Network,,407.19,,,,,,,269.50,475.30,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,PPO Network,,407.19,,,,,,,42.84,2240.90,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,The Alliance,PPO Network,,49.19,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,PPO Network,,49.19,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,The Alliance,PPO Network,,98.37,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,PPO Network,,98.37,,,,,,,49.09,114.83,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,inpatient,30,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,inpatient,30,EA,7.80000,7.41000,The Alliance,PPO Network,,6.48,,,,,,,4.29,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,outpatient,30,EA,7.80000,7.41000,The Alliance,PPO Network,,6.48,,,,,,,3.90,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,inpatient,30,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,outpatient,30,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,inpatient,30,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,outpatient,30,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,inpatient,30,EA,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,4.01,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,outpatient,30,EA,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,3.65,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,inpatient,30,EA,1.59000,1.52000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,outpatient,30,EA,1.59000,1.52000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,inpatient,30,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,outpatient,30,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.32,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,inpatient,30,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,outpatient,30,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,inpatient,30,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,outpatient,30,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,inpatient,30,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,outpatient,30,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,71.00,137.74,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,497.20,876.88,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,85.10,4447.87,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,inpatient,,,217.70000,206.81000,The Alliance,PPO Network,90,180.91,,,,,,,119.73,211.17,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,outpatient,,,217.70000,206.81000,The Alliance,PPO Network,90,180.91,,,,,,,26.67,1341.13,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,11.98,628.12,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,inpatient,1,EA,10.30000,9.78000,The Alliance,PPO Network,,8.56,,,,,,,5.67,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,outpatient,1,EA,10.30000,9.78000,The Alliance,PPO Network,,8.56,,,,,,,5.15,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,inpatient,1,EA,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,outpatient,1,EA,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,inpatient,1,mL,5.92000,5.62000,The Alliance,PPO Network,,4.92,,,,,,,3.26,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,outpatient,1,mL,5.92000,5.62000,The Alliance,PPO Network,,4.92,,,,,,,0.14409,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,inpatient,1,mL,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.45,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,outpatient,1,mL,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,0.14409,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,inpatient,1,mL,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,6.03,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,outpatient,1,mL,10.97000,10.42000,The Alliance,PPO Network,,9.12,,,,,,,0.14409,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,inpatient,1,mL,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,3.21,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,outpatient,1,mL,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,0.14409,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,0.14409,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,inpatient,1,mL,13.11000,12.46000,The Alliance,PPO Network,,10.89,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,outpatient,1,mL,13.11000,12.46000,The Alliance,PPO Network,,10.89,,,,,,,0.14409,12.72,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,inpatient,1,mL,133.27000,126.60000,The Alliance,PPO Network,,110.75,,,,,,,73.30,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,outpatient,1,mL,133.27000,126.60000,The Alliance,PPO Network,,110.75,,,,,,,0.56420,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,inpatient,1,mL,176.33000,167.51000,The Alliance,PPO Network,,146.53,,,,,,,96.98,171.04,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,outpatient,1,mL,176.33000,167.51000,The Alliance,PPO Network,,146.53,,,,,,,0.56420,171.04,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,13.19,696.05,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,inpatient,1,mL,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,outpatient,1,mL,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,inpatient,1,mL,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.42,6.02,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,outpatient,1,mL,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.10,6.02,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,8.89,458.40,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,inpatient,,,459.00000,436.05000,The Alliance,PPO Network,,381.43,,,,,,,252.45,445.23,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,PPO Network,,381.43,,,,,,,42.84,2240.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,203.50,358.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,35.09,1833.46,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,2.85,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,inpatient,1,EA,3.86000,3.66000,The Alliance,PPO Network,,3.21,,,,,,,2.12,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,PPO Network,,3.21,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,inpatient,60,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,outpatient,60,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,inpatient,60,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,outpatient,60,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,inpatient,60,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,outpatient,60,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,inpatient,60,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,outpatient,60,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,inpatient,60,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,outpatient,60,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,inpatient,,,1293.00000,1228.35000,The Alliance,PPO Network,90,1074.48,,,,,,,711.15,1254.21,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,outpatient,,,1293.00000,1228.35000,The Alliance,PPO Network,90,1074.48,,,,,,,121.54,5992.72,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,inpatient,50,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,4.20,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,outpatient,50,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,0.14409,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,inpatient,50,EA,6.54000,6.21000,The Alliance,PPO Network,,5.43,,,,,,,3.60,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,outpatient,50,EA,6.54000,6.21000,The Alliance,PPO Network,,5.43,,,,,,,0.14409,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,inpatient,50,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,3.55,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,outpatient,50,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,0.14409,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,inpatient,50,EA,8.96000,8.51000,The Alliance,PPO Network,,7.45,,,,,,,4.93,8.69,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,outpatient,50,EA,8.96000,8.51000,The Alliance,PPO Network,,7.45,,,,,,,0.14409,8.69,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,inpatient,500,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,outpatient,500,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,inpatient,500,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,outpatient,500,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,11.85,611.15,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,inpatient,1,EA,4.31000,4.10000,The Alliance,PPO Network,,3.58,,,,,,,2.37,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,outpatient,1,EA,4.31000,4.10000,The Alliance,PPO Network,,3.58,,,,,,,2.15,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,90,108.86,,,,,,,72.05,127.07,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,90,108.86,,,,,,,11.96,611.15,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,3.19,5.63,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,2.90,40.87,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,16.46,865.84,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,inpatient,1,EA,64.46000,61.24000,The Alliance,PPO Network,,53.57,,,,,,,35.45,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,outpatient,1,EA,64.46000,61.24000,The Alliance,PPO Network,,53.57,,,,,,,31.90,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,inpatient,1,EA,64.49000,61.26000,The Alliance,PPO Network,,53.59,,,,,,,35.47,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,outpatient,1,EA,64.49000,61.26000,The Alliance,PPO Network,,53.59,,,,,,,31.90,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,inpatient,1,EA,47.72000,45.33000,The Alliance,PPO Network,,39.66,,,,,,,26.25,46.29,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,outpatient,1,EA,47.72000,45.33000,The Alliance,PPO Network,,39.66,,,,,,,23.86,46.29,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,inpatient,1,EA,5.29000,5.02000,The Alliance,PPO Network,,4.40,,,,,,,2.91,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,outpatient,1,EA,5.29000,5.02000,The Alliance,PPO Network,,4.40,,,,,,,2.65,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,The Alliance,PPO Network,,4.71,,,,,,,3.12,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,PPO Network,,4.71,,,,,,,2.83,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,inpatient,1,EA,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.90,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.64,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.35,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.44,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,inpatient,,,32.40000,30.78000,The Alliance,PPO Network,90,26.92,,,,,,,17.82,31.43,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,outpatient,,,32.40000,30.78000,The Alliance,PPO Network,90,26.92,,,,,,,16.20,814.87,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,inpatient,1,mL,263.33000,250.17000,The Alliance,PPO Network,,218.83,,,,,,,144.83,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,outpatient,1,mL,263.33000,250.17000,The Alliance,PPO Network,,218.83,,,,,,,34.44,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,inpatient,1,mL,363.46000,345.29000,The Alliance,PPO Network,,302.04,,,,,,,199.90,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,outpatient,1,mL,363.46000,345.29000,The Alliance,PPO Network,,302.04,,,,,,,34.44,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,inpatient,1,mL,258.07000,245.16000,The Alliance,PPO Network,,214.46,,,,,,,141.94,250.33,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,outpatient,1,mL,258.07000,245.16000,The Alliance,PPO Network,,214.46,,,,,,,34.44,250.33,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.35,1018.59,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,inpatient,1,EA,238.67000,226.74000,The Alliance,PPO Network,,198.33,,,,,,,131.27,231.51,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,outpatient,1,EA,238.67000,226.74000,The Alliance,PPO Network,,198.33,,,,,,,31.90,231.51,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,inpatient,1,EA,93.35000,88.68000,The Alliance,PPO Network,,77.57,,,,,,,51.34,90.55,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,outpatient,1,EA,93.35000,88.68000,The Alliance,PPO Network,,77.57,,,,,,,27.10,90.55,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,inpatient,,,842.00000,799.90000,The Alliance,PPO Network,,699.70,,,,,,,463.10,816.74,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,PPO Network,,699.70,,,,,,,50.62,3666.93,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,inpatient,1,mL,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,17.80,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,inpatient,1,mL,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,4.37,7.70,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,outpatient,1,mL,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,3.97,17.80,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,24.08,1256.24,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,inpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,233.75,412.25,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,outpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,34.81,1680.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,inpatient,1,EA,26.51000,25.19000,The Alliance,PPO Network,,22.03,,,,,,,14.58,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,outpatient,1,EA,26.51000,25.19000,The Alliance,PPO Network,,22.03,,,,,,,13.26,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,inpatient,1,EA,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,12.51,22.07,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,outpatient,1,EA,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,11.38,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,inpatient,1,EA,8.66000,8.23000,The Alliance,PPO Network,,7.20,,,,,,,4.76,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,outpatient,1,EA,8.66000,8.23000,The Alliance,PPO Network,,7.20,,,,,,,0.14409,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,inpatient,1,EA,10.64000,10.10000,The Alliance,PPO Network,,8.84,,,,,,,5.85,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,outpatient,1,EA,10.64000,10.10000,The Alliance,PPO Network,,8.84,,,,,,,0.14409,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,0.14409,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,0.14409,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,inpatient,1,EA,6.05000,5.75000,The Alliance,PPO Network,,5.03,,,,,,,3.33,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,PPO Network,,5.03,,,,,,,0.14409,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,inpatient,1,EA,4.55000,4.32000,The Alliance,PPO Network,,3.78,,,,,,,2.50,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,outpatient,1,EA,4.55000,4.32000,The Alliance,PPO Network,,3.78,,,,,,,0.14409,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.14409,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.14409,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,inpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,0.14409,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,inpatient,1,EA,13.65000,12.97000,The Alliance,PPO Network,,11.34,,,,,,,7.51,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,outpatient,1,EA,13.65000,12.97000,The Alliance,PPO Network,,11.34,,,,,,,0.14409,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,inpatient,1,EA,13.11000,12.46000,The Alliance,PPO Network,,10.89,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,outpatient,1,EA,13.11000,12.46000,The Alliance,PPO Network,,10.89,,,,,,,0.14409,12.72,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,19.62,1052.52,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,49.50,87.30,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,,74.79,,,,,,,7.73,407.44,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,inpatient,5,EA,119.08000,113.13000,The Alliance,PPO Network,,98.96,,,,,,,65.49,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,outpatient,5,EA,119.08000,113.13000,The Alliance,PPO Network,,98.96,,,,,,,59.54,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,inpatient,5,EA,4.55000,4.32000,The Alliance,PPO Network,,3.78,,,,,,,2.50,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,outpatient,5,EA,4.55000,4.32000,The Alliance,PPO Network,,3.78,,,,,,,2.27,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,inpatient,5,EA,4.84000,4.60000,The Alliance,PPO Network,,4.02,,,,,,,2.66,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,outpatient,5,EA,4.84000,4.60000,The Alliance,PPO Network,,4.02,,,,,,,2.42,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,inpatient,5,EA,252.80000,240.16000,The Alliance,PPO Network,,210.08,,,,,,,139.04,245.22,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,outpatient,5,EA,252.80000,240.16000,The Alliance,PPO Network,,210.08,,,,,,,126.40,245.22,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,99.55,175.57,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,16.67,865.84,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,The Alliance,PPO Network,,2542.03,,,,,,,1682.45,2967.23,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,PPO Network,,2542.03,,,,,,,1538.48,4686.00,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,inpatient,1,EA,116.10000,110.29000,The Alliance,PPO Network,,96.48,,,,,,,63.85,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,outpatient,1,EA,116.10000,110.29000,The Alliance,PPO Network,,96.48,,,,,,,37.62,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,inpatient,1,EA,183.44000,174.27000,The Alliance,PPO Network,,152.44,,,,,,,100.89,177.94,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,outpatient,1,EA,183.44000,174.27000,The Alliance,PPO Network,,152.44,,,,,,,37.62,177.94,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,inpatient,10,EA,166.90000,158.56000,The Alliance,PPO Network,,138.69,,,,,,,91.80,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,outpatient,10,EA,166.90000,158.56000,The Alliance,PPO Network,,138.69,,,,,,,3.89,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,inpatient,10,EA,94.35000,89.64000,The Alliance,PPO Network,,78.40,,,,,,,51.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,outpatient,10,EA,94.35000,89.64000,The Alliance,PPO Network,,78.40,,,,,,,3.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,inpatient,10,EA,256.40000,243.58000,The Alliance,PPO Network,,213.07,,,,,,,141.02,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,outpatient,10,EA,256.40000,243.58000,The Alliance,PPO Network,,213.07,,,,,,,3.89,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,inpatient,10,EA,185.79000,176.50000,The Alliance,PPO Network,,154.39,,,,,,,102.18,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,outpatient,10,EA,185.79000,176.50000,The Alliance,PPO Network,,154.39,,,,,,,3.89,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,inpatient,10,EA,100.32000,95.31000,The Alliance,PPO Network,,83.37,,,,,,,55.18,97.31,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,outpatient,10,EA,100.32000,95.31000,The Alliance,PPO Network,,83.37,,,,,,,3.89,97.31,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,90,91.41,,,,,,,60.50,106.70,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,90,91.41,,,,,,,9.61,492.33,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,inpatient,1,GM,11.69000,11.11000,The Alliance,PPO Network,,9.71,,,,,,,6.43,11.34,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,outpatient,1,GM,11.69000,11.11000,The Alliance,PPO Network,,9.71,,,,,,,5.84,11.34,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,inpatient,,,475.00000,451.25000,The Alliance,PPO Network,TC,394.73,,,,,,,261.25,460.75,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,PPO Network,TC,394.73,,,,,,,237.50,3299.19,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,17.85,814.87,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,PPO Network,,220.22,,,,,,,145.75,257.05,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,PPO Network,,220.22,,,,,,,22.34,2082.45,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,inpatient,1,EA,3703.00000,3517.85000,The Alliance,PPO Network,,3077.19,,,,,,,2036.65,3591.91,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,outpatient,1,EA,3703.00000,3517.85000,The Alliance,PPO Network,,3077.19,,,,,,,43.29,3591.91,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,inpatient,1,EA,10.33000,9.82000,The Alliance,PPO Network,,8.58,,,,,,,5.68,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,PPO Network,,8.58,,,,,,,5.17,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,inpatient,1,EA,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,4.11,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,outpatient,1,EA,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,3.73,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,inpatient,1,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.48,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,inpatient,1,EA,9.19000,8.73000,The Alliance,PPO Network,,7.64,,,,,,,5.05,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,outpatient,1,EA,9.19000,8.73000,The Alliance,PPO Network,,7.64,,,,,,,4.59,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,inpatient,1,EA,4.67000,4.44000,The Alliance,PPO Network,,3.88,,,,,,,2.57,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,outpatient,1,EA,4.67000,4.44000,The Alliance,PPO Network,,3.88,,,,,,,2.33,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.58,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.25,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,The Alliance,PPO Network,,8.01,,,,,,,5.30,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,PPO Network,,8.01,,,,,,,4.82,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,inpatient,,,1160.00000,1102.00000,The Alliance,PPO Network,TC,963.96,,,,,,,638.00,1125.20,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,PPO Network,TC,963.96,,,,,,,580.00,10163.53,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,inpatient,,,603.00000,572.85000,The Alliance,PPO Network,,501.09,,,,,,,331.65,584.91,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,outpatient,,,603.00000,572.85000,The Alliance,PPO Network,,501.09,,,,,,,51.19,2410.69,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,inpatient,1,EA,28.05000,26.64000,The Alliance,PPO Network,,23.31,,,,,,,15.43,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,outpatient,1,EA,28.05000,26.64000,The Alliance,PPO Network,,23.31,,,,,,,2.48,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,inpatient,1,EA,13.47000,12.80000,The Alliance,PPO Network,,11.19,,,,,,,7.41,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,outpatient,1,EA,13.47000,12.80000,The Alliance,PPO Network,,11.19,,,,,,,2.48,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,10.13,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,2.48,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,9.04,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,2.48,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,2.48,13.79,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,inpatient,0.5,mL,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,7.64,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,outpatient,0.5,mL,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,0.33945,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,inpatient,0.5,mL,18.14000,17.23000,The Alliance,PPO Network,,15.07,,,,,,,9.98,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,outpatient,0.5,mL,18.14000,17.23000,The Alliance,PPO Network,,15.07,,,,,,,0.33945,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,inpatient,0.5,mL,9.67000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,outpatient,0.5,mL,9.67000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,0.33945,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,inpatient,0.5,mL,35.83000,34.04000,The Alliance,PPO Network,,29.77,,,,,,,19.71,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,outpatient,0.5,mL,35.83000,34.04000,The Alliance,PPO Network,,29.77,,,,,,,0.33945,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,inpatient,0.5,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,outpatient,0.5,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,0.33945,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,inpatient,0.5,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,outpatient,0.5,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,0.33945,24.52,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,The Alliance,PPO Network,90,191.55,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,PPO Network,90,191.55,,,,,,,45.08,679.08,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,11.26,594.19,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,inpatient,10,EA,173.44000,164.76000,The Alliance,PPO Network,,144.13,,,,,,,95.39,168.24,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,outpatient,10,EA,173.44000,164.76000,The Alliance,PPO Network,,144.13,,,,,,,86.72,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,inpatient,10,EA,142.92000,135.77000,The Alliance,PPO Network,,118.77,,,,,,,78.61,138.63,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,outpatient,10,EA,142.92000,135.77000,The Alliance,PPO Network,,118.77,,,,,,,71.46,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,inpatient,10,EA,94.26000,89.55000,The Alliance,PPO Network,,78.33,,,,,,,51.84,91.43,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,outpatient,10,EA,94.26000,89.55000,The Alliance,PPO Network,,78.33,,,,,,,47.13,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,inpatient,10,EA,71.43000,67.85000,The Alliance,PPO Network,,59.36,,,,,,,39.29,69.29,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,outpatient,10,EA,71.43000,67.85000,The Alliance,PPO Network,,59.36,,,,,,,35.72,340.40,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,inpatient,1,mL,211.33000,200.76000,The Alliance,PPO Network,,175.62,,,,,,,116.23,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,outpatient,1,mL,211.33000,200.76000,The Alliance,PPO Network,,175.62,,,,,,,3.89,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,3.89,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,inpatient,1,mL,165.90000,157.60000,The Alliance,PPO Network,,137.86,,,,,,,91.25,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,outpatient,1,mL,165.90000,157.60000,The Alliance,PPO Network,,137.86,,,,,,,3.89,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,inpatient,1,mL,259.60000,246.62000,The Alliance,PPO Network,,215.73,,,,,,,142.78,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,outpatient,1,mL,259.60000,246.62000,The Alliance,PPO Network,,215.73,,,,,,,3.89,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,inpatient,1,mL,187.77000,178.38000,The Alliance,PPO Network,,156.04,,,,,,,103.27,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,outpatient,1,mL,187.77000,178.38000,The Alliance,PPO Network,,156.04,,,,,,,3.89,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,inpatient,1,mL,188.08000,178.68000,The Alliance,PPO Network,,156.29,,,,,,,103.44,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,outpatient,1,mL,188.08000,178.68000,The Alliance,PPO Network,,156.29,,,,,,,3.89,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,inpatient,1,mL,101.57000,96.49000,The Alliance,PPO Network,,84.40,,,,,,,55.86,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,outpatient,1,mL,101.57000,96.49000,The Alliance,PPO Network,,84.40,,,,,,,3.89,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,inpatient,1,mL,124.82000,118.58000,The Alliance,PPO Network,,103.73,,,,,,,68.65,121.08,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,outpatient,1,mL,124.82000,118.58000,The Alliance,PPO Network,,103.73,,,,,,,3.89,121.08,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,264.00,465.60,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,28.92,2088.15,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,inpatient,1,EA,801.42000,761.35000,The Alliance,PPO Network,,665.98,,,,,,,440.78,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,outpatient,1,EA,801.42000,761.35000,The Alliance,PPO Network,,665.98,,,,,,,400.71,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,inpatient,1,EA,483.89000,459.70000,The Alliance,PPO Network,,402.11,,,,,,,266.14,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,outpatient,1,EA,483.89000,459.70000,The Alliance,PPO Network,,402.11,,,,,,,241.94,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,inpatient,1,EA,937.33000,890.47000,The Alliance,PPO Network,,778.92,,,,,,,515.53,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,outpatient,1,EA,937.33000,890.47000,The Alliance,PPO Network,,778.92,,,,,,,468.67,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,inpatient,1,EA,890.47000,845.94000,The Alliance,PPO Network,,739.98,,,,,,,489.76,863.76,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,outpatient,1,EA,890.47000,845.94000,The Alliance,PPO Network,,739.98,,,,,,,445.24,863.76,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,The Alliance,PPO Network,,956.48,,,,,,,633.05,1116.47,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,PPO Network,,956.48,,,,,,,633.05,3163.00,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,inpatient,,,3081.00000,2926.95000,The Alliance,PPO Network,,2560.31,,,,,,,1694.55,2988.57,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,outpatient,,,3081.00000,2926.95000,The Alliance,PPO Network,,2560.31,,,,,,,257.45,13462.44,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,inpatient,1,EA,8055.92000,7653.13000,The Alliance,PPO Network,,6694.47,,,,,,,4430.76,7814.24,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,outpatient,1,EA,8055.92000,7653.13000,The Alliance,PPO Network,,6694.47,,,,,,,41.85,7814.24,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,inpatient,,,333.00000,316.35000,The Alliance,PPO Network,,276.72,,,,,,,183.15,323.01,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,outpatient,,,333.00000,316.35000,The Alliance,PPO Network,,276.72,,,,,,,29.35,2438.99,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,79.75,140.65,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,79.75,5271.00,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.44,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,inpatient,10,EA,9.15000,8.69000,The Alliance,PPO Network,,7.60,,,,,,,5.03,8.88,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,outpatient,10,EA,9.15000,8.69000,The Alliance,PPO Network,,7.60,,,,,,,4.58,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,inpatient,10,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,outpatient,10,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,17.80,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,inpatient,1,EA,11830.90000,11239.36000,The Alliance,PPO Network,,9831.48,,,,,,,6506.99,11475.97,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,outpatient,1,EA,11830.90000,11239.36000,The Alliance,PPO Network,,9831.48,,,,,,,41.85,11475.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,inpatient,1,mL,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,outpatient,1,mL,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,0.33945,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,inpatient,1,mL,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,4.96,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,outpatient,1,mL,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,0.33945,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,inpatient,1,mL,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,3.51,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,outpatient,1,mL,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,0.33945,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,inpatient,1,mL,8.10000,7.70000,The Alliance,PPO Network,,6.73,,,,,,,4.46,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,outpatient,1,mL,8.10000,7.70000,The Alliance,PPO Network,,6.73,,,,,,,0.33945,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,inpatient,1,mL,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,0.33945,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,inpatient,1,mL,13.15000,12.49000,The Alliance,PPO Network,,10.93,,,,,,,7.23,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,outpatient,1,mL,13.15000,12.49000,The Alliance,PPO Network,,10.93,,,,,,,0.33945,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,0.33945,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,inpatient,1,mL,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,outpatient,1,mL,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,0.33945,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,inpatient,1,mL,10.65000,10.12000,The Alliance,PPO Network,,8.85,,,,,,,5.86,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,outpatient,1,mL,10.65000,10.12000,The Alliance,PPO Network,,8.85,,,,,,,0.33945,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,inpatient,1,mL,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,5.20,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,outpatient,1,mL,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,0.33945,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,0.33945,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,inpatient,1,mL,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,outpatient,1,mL,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,0.33945,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,inpatient,1,mL,12.17000,11.56000,The Alliance,PPO Network,,10.11,,,,,,,6.69,11.80,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,outpatient,1,mL,12.17000,11.56000,The Alliance,PPO Network,,10.11,,,,,,,0.33945,11.80,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,52.80,93.12,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,15.59,814.87,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,inpatient,0.4,EA,241.18000,229.12000,The Alliance,PPO Network,,200.42,,,,,,,132.65,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,outpatient,0.4,EA,241.18000,229.12000,The Alliance,PPO Network,,200.42,,,,,,,0.79980,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,inpatient,0.4,EA,113.78000,108.09000,The Alliance,PPO Network,,94.55,,,,,,,62.58,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,outpatient,0.4,EA,113.78000,108.09000,The Alliance,PPO Network,,94.55,,,,,,,0.79980,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,inpatient,0.4,EA,261.30000,248.24000,The Alliance,PPO Network,,217.14,,,,,,,143.72,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,outpatient,0.4,EA,261.30000,248.24000,The Alliance,PPO Network,,217.14,,,,,,,0.79980,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,inpatient,0.4,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,outpatient,0.4,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,inpatient,0.4,EA,26.46000,25.14000,The Alliance,PPO Network,,21.99,,,,,,,14.55,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,outpatient,0.4,EA,26.46000,25.14000,The Alliance,PPO Network,,21.99,,,,,,,0.79980,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,inpatient,0.4,EA,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,31.84,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,outpatient,0.4,EA,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,0.79980,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,inpatient,0.4,EA,70.55000,67.03000,The Alliance,PPO Network,,58.63,,,,,,,38.80,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,outpatient,0.4,EA,70.55000,67.03000,The Alliance,PPO Network,,58.63,,,,,,,0.79980,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,inpatient,0.4,EA,86.73000,82.39000,The Alliance,PPO Network,,72.07,,,,,,,47.70,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,outpatient,0.4,EA,86.73000,82.39000,The Alliance,PPO Network,,72.07,,,,,,,0.79980,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,inpatient,0.4,EA,61.62000,58.54000,The Alliance,PPO Network,,51.21,,,,,,,33.89,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,outpatient,0.4,EA,61.62000,58.54000,The Alliance,PPO Network,,51.21,,,,,,,0.79980,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,inpatient,0.4,EA,44.40000,42.18000,The Alliance,PPO Network,,36.90,,,,,,,24.42,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,outpatient,0.4,EA,44.40000,42.18000,The Alliance,PPO Network,,36.90,,,,,,,0.79980,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,inpatient,0.4,EA,62.73000,59.59000,The Alliance,PPO Network,,52.13,,,,,,,34.50,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,outpatient,0.4,EA,62.73000,59.59000,The Alliance,PPO Network,,52.13,,,,,,,0.79980,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,inpatient,0.4,EA,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,17.42,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,outpatient,0.4,EA,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,0.79980,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,inpatient,0.4,EA,29.07000,27.62000,The Alliance,PPO Network,,24.16,,,,,,,15.99,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,outpatient,0.4,EA,29.07000,27.62000,The Alliance,PPO Network,,24.16,,,,,,,0.79980,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,inpatient,0.4,EA,25.09000,23.84000,The Alliance,PPO Network,,20.85,,,,,,,13.80,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,outpatient,0.4,EA,25.09000,23.84000,The Alliance,PPO Network,,20.85,,,,,,,0.79980,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,inpatient,0.4,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,outpatient,0.4,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,0.79980,35.25,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,inpatient,1,EA,78.48000,74.56000,The Alliance,PPO Network,,65.22,,,,,,,43.16,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,outpatient,1,EA,78.48000,74.56000,The Alliance,PPO Network,,65.22,,,,,,,0.79980,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,inpatient,1,EA,67.53000,64.15000,The Alliance,PPO Network,,56.12,,,,,,,37.14,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,outpatient,1,EA,67.53000,64.15000,The Alliance,PPO Network,,56.12,,,,,,,0.79980,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,inpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.79980,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,inpatient,1,EA,31.73000,30.14000,The Alliance,PPO Network,,26.37,,,,,,,17.45,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,outpatient,1,EA,31.73000,30.14000,The Alliance,PPO Network,,26.37,,,,,,,0.79980,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,inpatient,1,EA,62.82000,59.68000,The Alliance,PPO Network,,52.20,,,,,,,34.55,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,outpatient,1,EA,62.82000,59.68000,The Alliance,PPO Network,,52.20,,,,,,,0.79980,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,inpatient,1,EA,70.63000,67.10000,The Alliance,PPO Network,,58.69,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,outpatient,1,EA,70.63000,67.10000,The Alliance,PPO Network,,58.69,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,inpatient,1,EA,21.05000,20.00000,The Alliance,PPO Network,,17.49,,,,,,,11.58,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,PPO Network,,17.49,,,,,,,0.79980,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,inpatient,1,EA,60.99000,57.94000,The Alliance,PPO Network,,50.68,,,,,,,33.54,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,outpatient,1,EA,60.99000,57.94000,The Alliance,PPO Network,,50.68,,,,,,,0.79980,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,inpatient,1,EA,27.71000,26.33000,The Alliance,PPO Network,,23.03,,,,,,,15.24,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,outpatient,1,EA,27.71000,26.33000,The Alliance,PPO Network,,23.03,,,,,,,0.79980,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,16.20,28.57,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,0.79980,28.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,inpatient,28.35,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,outpatient,28.35,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,inpatient,28.35,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,outpatient,28.35,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,inpatient,28.35,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,outpatient,28.35,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,inpatient,28.35,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,outpatient,28.35,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,108.35,191.09,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,98.50,212.44,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,inpatient,1,EA,30.18000,28.68000,The Alliance,PPO Network,,25.08,,,,,,,16.60,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,outpatient,1,EA,30.18000,28.68000,The Alliance,PPO Network,,25.08,,,,,,,2.48,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,inpatient,1,EA,50.50000,47.97000,The Alliance,PPO Network,,41.97,,,,,,,27.77,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,outpatient,1,EA,50.50000,47.97000,The Alliance,PPO Network,,41.97,,,,,,,2.48,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,2.48,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,2.48,30.65,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,inpatient,,,160.90000,152.85000,The Alliance,PPO Network,90,133.71,,,,,,,88.50,156.07,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,outpatient,,,160.90000,152.85000,The Alliance,PPO Network,90,133.71,,,,,,,5.90,424.40,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,inpatient,5,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.73,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,outpatient,5,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,0.14409,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,inpatient,5,EA,5.95000,5.66000,The Alliance,PPO Network,,4.94,,,,,,,3.27,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,outpatient,5,EA,5.95000,5.66000,The Alliance,PPO Network,,4.94,,,,,,,0.14409,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,inpatient,5,EA,4.35000,4.14000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,outpatient,5,EA,4.35000,4.14000,The Alliance,PPO Network,,3.61,,,,,,,0.14409,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,inpatient,5,EA,8.78000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,4.83,8.52,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,outpatient,5,EA,8.78000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,0.14409,8.52,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,104.50,212.44,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,inpatient,1,mL,1728.59000,1642.16000,The Alliance,PPO Network,,1436.46,,,,,,,950.72,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,outpatient,1,mL,1728.59000,1642.16000,The Alliance,PPO Network,,1436.46,,,,,,,0.99000,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,inpatient,1,mL,1728.57000,1642.14000,The Alliance,PPO Network,,1436.44,,,,,,,950.71,1676.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,outpatient,1,mL,1728.57000,1642.14000,The Alliance,PPO Network,,1436.44,,,,,,,0.99000,1676.71,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,PPO Network,TC,390.57,,,,,,,258.50,455.90,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,PPO Network,TC,390.57,,,,,,,215.60,3038.81,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,inpatient,1,mL,5.66000,5.38000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.49,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,outpatient,1,mL,5.66000,5.38000,The Alliance,PPO Network,,4.70,,,,,,,2.83,40.87,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,PPO Network,TC,395.56,,,,,,,261.80,461.72,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,PPO Network,TC,395.56,,,,,,,238.00,3910.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,inpatient,1,mL,52.80000,50.16000,The Alliance,PPO Network,,43.88,,,,,,,29.04,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,outpatient,1,mL,52.80000,50.16000,The Alliance,PPO Network,,43.88,,,,,,,1.42,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,inpatient,1,mL,49.77000,47.28000,The Alliance,PPO Network,,41.36,,,,,,,27.37,48.28,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,outpatient,1,mL,49.77000,47.28000,The Alliance,PPO Network,,41.36,,,,,,,1.42,48.28,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,inpatient,20,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,outpatient,20,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,inpatient,20,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,outpatient,20,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,inpatient,20,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,outpatient,20,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,inpatient,20,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,13.53,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,inpatient,,,351.00000,333.45000,The Alliance,PPO Network,,291.68,,,,,,,193.05,340.47,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,outpatient,,,351.00000,333.45000,The Alliance,PPO Network,,291.68,,,,,,,175.50,340.47,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,inpatient,,,839.00000,797.05000,The Alliance,PPO Network,TC,697.21,,,,,,,461.45,813.83,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,outpatient,,,839.00000,797.05000,The Alliance,PPO Network,TC,697.21,,,,,,,419.50,6479.64,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,inpatient,1,EA,16.22000,15.41000,The Alliance,PPO Network,,13.48,,,,,,,8.92,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,PPO Network,,13.48,,,,,,,0.33945,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,inpatient,1,EA,6.66000,6.33000,The Alliance,PPO Network,,5.53,,,,,,,3.66,6.46,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,outpatient,1,EA,6.66000,6.33000,The Alliance,PPO Network,,5.53,,,,,,,0.33945,6.46,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,PPO Network,,830.17,,,,,,,549.45,969.03,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,PPO Network,,830.17,,,,,,,549.45,5271.00,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,inpatient,1,mL,292.42000,277.80000,The Alliance,PPO Network,,243.00,,,,,,,160.83,283.65,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,outpatient,1,mL,292.42000,277.80000,The Alliance,PPO Network,,243.00,,,,,,,1.14,283.65,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,50.62,3666.93,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,90,235.17,,,,,,,155.65,274.51,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,90,235.17,,,,,,,25.18,1273.27,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,inpatient,,,545.00000,517.75000,The Alliance,PPO Network,,452.89,,,,,,,299.75,528.65,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,PPO Network,,452.89,,,,,,,299.75,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,inpatient,0.8,EA,261.61000,248.53000,The Alliance,PPO Network,,217.40,,,,,,,143.89,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,outpatient,0.8,EA,261.61000,248.53000,The Alliance,PPO Network,,217.40,,,,,,,0.79980,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,inpatient,0.8,EA,67.52000,64.14000,The Alliance,PPO Network,,56.11,,,,,,,37.14,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,outpatient,0.8,EA,67.52000,64.14000,The Alliance,PPO Network,,56.11,,,,,,,0.79980,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,inpatient,0.8,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,outpatient,0.8,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,0.79980,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,inpatient,0.8,EA,31.72000,30.13000,The Alliance,PPO Network,,26.36,,,,,,,17.45,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,outpatient,0.8,EA,31.72000,30.13000,The Alliance,PPO Network,,26.36,,,,,,,0.79980,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,inpatient,0.8,EA,62.80000,59.66000,The Alliance,PPO Network,,52.19,,,,,,,34.54,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,outpatient,0.8,EA,62.80000,59.66000,The Alliance,PPO Network,,52.19,,,,,,,0.79980,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,inpatient,0.8,EA,70.63000,67.09000,The Alliance,PPO Network,,58.69,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,outpatient,0.8,EA,70.63000,67.09000,The Alliance,PPO Network,,58.69,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,inpatient,0.8,EA,235.19000,223.43000,The Alliance,PPO Network,,195.44,,,,,,,129.35,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,outpatient,0.8,EA,235.19000,223.43000,The Alliance,PPO Network,,195.44,,,,,,,0.79980,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,inpatient,0.8,EA,62.41000,59.29000,The Alliance,PPO Network,,51.86,,,,,,,34.33,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,outpatient,0.8,EA,62.41000,59.29000,The Alliance,PPO Network,,51.86,,,,,,,0.79980,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,inpatient,0.8,EA,44.40000,42.18000,The Alliance,PPO Network,,36.90,,,,,,,24.42,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,outpatient,0.8,EA,44.40000,42.18000,The Alliance,PPO Network,,36.90,,,,,,,0.79980,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,inpatient,0.8,EA,20.30000,19.28000,The Alliance,PPO Network,,16.87,,,,,,,11.16,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,outpatient,0.8,EA,20.30000,19.28000,The Alliance,PPO Network,,16.87,,,,,,,0.79980,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,inpatient,0.8,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,16.08,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,outpatient,0.8,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,0.79980,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,inpatient,0.8,EA,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,31.28,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,outpatient,0.8,EA,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,0.79980,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,inpatient,0.8,EA,32.39000,30.77000,The Alliance,PPO Network,,26.92,,,,,,,17.81,31.42,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,outpatient,0.8,EA,32.39000,30.77000,The Alliance,PPO Network,,26.92,,,,,,,0.79980,31.42,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,9.32,16.43,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,2.48,16.43,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,inpatient,1,mL,1720.49000,1634.47000,The Alliance,PPO Network,,1429.73,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,outpatient,1,mL,1720.49000,1634.47000,The Alliance,PPO Network,,1429.73,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,inpatient,1,mL,1720.50000,1634.48000,The Alliance,PPO Network,,1429.74,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,outpatient,1,mL,1720.50000,1634.48000,The Alliance,PPO Network,,1429.74,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,inpatient,100,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,inpatient,100,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,inpatient,100,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,inpatient,100,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,outpatient,100,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.82500,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,282.15,497.61,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,256.50,4266.89,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,inpatient,1,EA,953.25000,905.59000,The Alliance,PPO Network,,792.15,,,,,,,524.29,924.65,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,outpatient,1,EA,953.25000,905.59000,The Alliance,PPO Network,,792.15,,,,,,,390.74,924.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,inpatient,0.6,EA,261.61000,248.53000,The Alliance,PPO Network,,217.40,,,,,,,143.89,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,outpatient,0.6,EA,261.61000,248.53000,The Alliance,PPO Network,,217.40,,,,,,,0.79980,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,inpatient,0.6,EA,67.53000,64.16000,The Alliance,PPO Network,,56.12,,,,,,,37.14,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,outpatient,0.6,EA,67.53000,64.16000,The Alliance,PPO Network,,56.12,,,,,,,0.79980,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,inpatient,0.6,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,outpatient,0.6,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,inpatient,0.6,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,outpatient,0.6,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,0.79980,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,inpatient,0.6,EA,62.83000,59.69000,The Alliance,PPO Network,,52.21,,,,,,,34.56,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,outpatient,0.6,EA,62.83000,59.69000,The Alliance,PPO Network,,52.21,,,,,,,0.79980,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,inpatient,0.6,EA,70.64000,67.10000,The Alliance,PPO Network,,58.70,,,,,,,38.85,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,outpatient,0.6,EA,70.64000,67.10000,The Alliance,PPO Network,,58.70,,,,,,,0.79980,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,inpatient,0.6,EA,62.15000,59.04000,The Alliance,PPO Network,,51.65,,,,,,,34.18,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,outpatient,0.6,EA,62.15000,59.04000,The Alliance,PPO Network,,51.65,,,,,,,0.79980,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,inpatient,0.6,EA,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,15.55,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,outpatient,0.6,EA,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,0.79980,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,inpatient,0.6,EA,30.65000,29.12000,The Alliance,PPO Network,,25.47,,,,,,,16.86,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,outpatient,0.6,EA,30.65000,29.12000,The Alliance,PPO Network,,25.47,,,,,,,0.79980,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,inpatient,0.6,EA,31.71000,30.12000,The Alliance,PPO Network,,26.35,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,outpatient,0.6,EA,31.71000,30.12000,The Alliance,PPO Network,,26.35,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,inpatient,0.6,EA,62.82000,59.68000,The Alliance,PPO Network,,52.20,,,,,,,34.55,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,outpatient,0.6,EA,62.82000,59.68000,The Alliance,PPO Network,,52.20,,,,,,,0.79980,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,inpatient,0.6,EA,30.55000,29.02000,The Alliance,PPO Network,,25.39,,,,,,,16.80,29.63,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,outpatient,0.6,EA,30.55000,29.02000,The Alliance,PPO Network,,25.39,,,,,,,0.79980,29.63,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,inpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,545.05,961.27,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,PPO Network,TC,823.52,,,,,,,495.50,6355.04,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,inpatient,0.3,EA,261.31000,248.25000,The Alliance,PPO Network,,217.15,,,,,,,143.72,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,outpatient,0.3,EA,261.31000,248.25000,The Alliance,PPO Network,,217.15,,,,,,,0.79980,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,inpatient,0.3,EA,67.57000,64.19000,The Alliance,PPO Network,,56.15,,,,,,,37.16,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,outpatient,0.3,EA,67.57000,64.19000,The Alliance,PPO Network,,56.15,,,,,,,0.79980,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,inpatient,0.3,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,outpatient,0.3,EA,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,inpatient,0.3,EA,21.55000,20.47000,The Alliance,PPO Network,,17.91,,,,,,,11.85,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,outpatient,0.3,EA,21.55000,20.47000,The Alliance,PPO Network,,17.91,,,,,,,0.79980,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,inpatient,0.3,EA,62.88000,59.74000,The Alliance,PPO Network,,52.25,,,,,,,34.58,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,outpatient,0.3,EA,62.88000,59.74000,The Alliance,PPO Network,,52.25,,,,,,,0.79980,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,inpatient,0.3,EA,21.57000,20.49000,The Alliance,PPO Network,,17.92,,,,,,,11.86,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,outpatient,0.3,EA,21.57000,20.49000,The Alliance,PPO Network,,17.92,,,,,,,0.79980,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,inpatient,0.3,EA,102.07000,96.96000,The Alliance,PPO Network,,84.82,,,,,,,56.14,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,outpatient,0.3,EA,102.07000,96.96000,The Alliance,PPO Network,,84.82,,,,,,,0.79980,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,inpatient,0.3,EA,31.71000,30.12000,The Alliance,PPO Network,,26.35,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,outpatient,0.3,EA,31.71000,30.12000,The Alliance,PPO Network,,26.35,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,inpatient,0.3,EA,29.18000,27.72000,The Alliance,PPO Network,,24.25,,,,,,,16.05,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,outpatient,0.3,EA,29.18000,27.72000,The Alliance,PPO Network,,24.25,,,,,,,0.79980,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,inpatient,0.3,EA,29.17000,27.71000,The Alliance,PPO Network,,24.24,,,,,,,16.04,28.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,outpatient,0.3,EA,29.17000,27.71000,The Alliance,PPO Network,,24.24,,,,,,,0.79980,28.29,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,inpatient,10,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,outpatient,10,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.33945,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.33945,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,inpatient,10,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,outpatient,10,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.33945,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,inpatient,10,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,outpatient,10,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,inpatient,10,EA,2.30000,2.18000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,outpatient,10,EA,2.30000,2.18000,The Alliance,PPO Network,,1.91,,,,,,,0.33945,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,inpatient,10,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,outpatient,10,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.33945,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,inpatient,10,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,outpatient,10,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.33945,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,inpatient,10,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,outpatient,10,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.33945,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,inpatient,10,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,outpatient,10,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.33945,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,inpatient,10,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.33945,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,inpatient,10,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,outpatient,10,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.33945,1.51,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,67.58,157.14,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,The Alliance,PPO Network,,674.38,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,PPO Network,,674.38,,,,,,,0.99000,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,The Alliance,PPO Network,,674.38,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,PPO Network,,674.38,,,,,,,0.99000,787.18,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,inpatient,2,EA,56.10000,53.30000,The Alliance,PPO Network,,46.62,,,,,,,30.86,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,outpatient,2,EA,56.10000,53.30000,The Alliance,PPO Network,,46.62,,,,,,,18.03,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,inpatient,2,EA,41.90000,39.81000,The Alliance,PPO Network,,34.82,,,,,,,23.05,40.64,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,outpatient,2,EA,41.90000,39.81000,The Alliance,PPO Network,,34.82,,,,,,,18.03,40.64,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,inpatient,1,EA,387.20000,367.84000,The Alliance,PPO Network,,321.76,,,,,,,212.96,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,outpatient,1,EA,387.20000,367.84000,The Alliance,PPO Network,,321.76,,,,,,,132.91,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,inpatient,1,EA,340.20000,323.19000,The Alliance,PPO Network,,282.71,,,,,,,187.11,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,outpatient,1,EA,340.20000,323.19000,The Alliance,PPO Network,,282.71,,,,,,,132.91,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,inpatient,1,EA,323.19000,307.03000,The Alliance,PPO Network,,268.57,,,,,,,177.75,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,outpatient,1,EA,323.19000,307.03000,The Alliance,PPO Network,,268.57,,,,,,,132.91,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,inpatient,1,EA,323.18000,307.02000,The Alliance,PPO Network,,268.56,,,,,,,177.75,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,outpatient,1,EA,323.18000,307.02000,The Alliance,PPO Network,,268.56,,,,,,,132.91,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,inpatient,1,EA,266.10000,252.80000,The Alliance,PPO Network,,221.13,,,,,,,146.35,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,outpatient,1,EA,266.10000,252.80000,The Alliance,PPO Network,,221.13,,,,,,,132.91,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,8.35,14.73,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,7.59,160.17,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,inpatient,1,EA,209.51000,199.03000,The Alliance,PPO Network,,174.10,,,,,,,115.23,203.22,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,outpatient,1,EA,209.51000,199.03000,The Alliance,PPO Network,,174.10,,,,,,,104.75,203.22,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,inpatient,1,mL,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.27,2.24,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,outpatient,1,mL,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,0.19995,2.24,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.82500,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,6.98,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,inpatient,1,mL,502.21000,477.10000,The Alliance,PPO Network,,417.34,,,,,,,276.22,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,outpatient,1,mL,502.21000,477.10000,The Alliance,PPO Network,,417.34,,,,,,,6.98,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,inpatient,1,mL,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,60.83,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,6.98,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,inpatient,1,mL,433.92000,412.22000,The Alliance,PPO Network,,360.59,,,,,,,238.66,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,outpatient,1,mL,433.92000,412.22000,The Alliance,PPO Network,,360.59,,,,,,,6.98,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,inpatient,1,mL,205.40000,195.13000,The Alliance,PPO Network,,170.69,,,,,,,112.97,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,outpatient,1,mL,205.40000,195.13000,The Alliance,PPO Network,,170.69,,,,,,,6.98,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,6.98,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,inpatient,1,mL,420.23000,399.22000,The Alliance,PPO Network,,349.21,,,,,,,231.13,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,outpatient,1,mL,420.23000,399.22000,The Alliance,PPO Network,,349.21,,,,,,,6.98,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,inpatient,1,mL,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,6.98,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,inpatient,1,mL,451.99000,429.39000,The Alliance,PPO Network,,375.60,,,,,,,248.59,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,outpatient,1,mL,451.99000,429.39000,The Alliance,PPO Network,,375.60,,,,,,,6.98,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,inpatient,1,mL,268.60000,255.17000,The Alliance,PPO Network,,223.21,,,,,,,147.73,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,outpatient,1,mL,268.60000,255.17000,The Alliance,PPO Network,,223.21,,,,,,,6.98,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,inpatient,1,mL,58.46000,55.54000,The Alliance,PPO Network,,48.58,,,,,,,32.15,56.71,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,outpatient,1,mL,58.46000,55.54000,The Alliance,PPO Network,,48.58,,,,,,,6.98,56.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,inpatient,1,EA,815.41000,774.64000,The Alliance,PPO Network,,677.61,,,,,,,448.48,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,outpatient,1,EA,815.41000,774.64000,The Alliance,PPO Network,,677.61,,,,,,,0.99000,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,inpatient,1,EA,815.42000,774.65000,The Alliance,PPO Network,,677.61,,,,,,,448.48,790.96,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,outpatient,1,EA,815.42000,774.65000,The Alliance,PPO Network,,677.61,,,,,,,0.99000,790.96,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,13.55,713.01,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,inpatient,1,mL,2952.26000,2804.64000,The Alliance,PPO Network,,2453.33,,,,,,,1623.74,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,outpatient,1,mL,2952.26000,2804.64000,The Alliance,PPO Network,,2453.33,,,,,,,58.56,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,inpatient,1,mL,3195.57000,3035.80000,The Alliance,PPO Network,,2655.52,,,,,,,1757.56,3099.70,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,outpatient,1,mL,3195.57000,3035.80000,The Alliance,PPO Network,,2655.52,,,,,,,58.56,3099.70,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,33.00,783.52,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,inpatient,,,830.00000,788.50000,The Alliance,PPO Network,TC,689.73,,,,,,,456.50,805.10,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,outpatient,,,830.00000,788.50000,The Alliance,PPO Network,TC,689.73,,,,,,,370.62,4895.01,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,inpatient,1,EA,250.17000,237.66000,The Alliance,PPO Network,,207.89,,,,,,,137.59,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,outpatient,1,EA,250.17000,237.66000,The Alliance,PPO Network,,207.89,,,,,,,7.86,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,inpatient,1,EA,295.08000,280.33000,The Alliance,PPO Network,,245.21,,,,,,,162.29,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,outpatient,1,EA,295.08000,280.33000,The Alliance,PPO Network,,245.21,,,,,,,7.86,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,inpatient,1,EA,351.81000,334.22000,The Alliance,PPO Network,,292.35,,,,,,,193.50,341.26,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,outpatient,1,EA,351.81000,334.22000,The Alliance,PPO Network,,292.35,,,,,,,7.86,341.26,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,inpatient,1,EA,321.74000,305.65000,The Alliance,PPO Network,,267.37,,,,,,,176.96,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,outpatient,1,EA,321.74000,305.65000,The Alliance,PPO Network,,267.37,,,,,,,0.79980,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,inpatient,1,EA,101.28000,96.21000,The Alliance,PPO Network,,84.16,,,,,,,55.70,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,outpatient,1,EA,101.28000,96.21000,The Alliance,PPO Network,,84.16,,,,,,,0.79980,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,inpatient,1,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,inpatient,1,EA,94.20000,89.49000,The Alliance,PPO Network,,78.28,,,,,,,51.81,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,outpatient,1,EA,94.20000,89.49000,The Alliance,PPO Network,,78.28,,,,,,,0.79980,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,inpatient,1,EA,92.59000,87.96000,The Alliance,PPO Network,,76.94,,,,,,,50.92,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,outpatient,1,EA,92.59000,87.96000,The Alliance,PPO Network,,76.94,,,,,,,0.79980,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,inpatient,1,EA,47.59000,45.21000,The Alliance,PPO Network,,39.55,,,,,,,26.17,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,outpatient,1,EA,47.59000,45.21000,The Alliance,PPO Network,,39.55,,,,,,,0.79980,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,inpatient,1,EA,44.11000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,24.26,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,0.79980,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,inpatient,1,EA,105.99000,100.69000,The Alliance,PPO Network,,88.08,,,,,,,58.29,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,outpatient,1,EA,105.99000,100.69000,The Alliance,PPO Network,,88.08,,,,,,,0.79980,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,inpatient,1,EA,55.30000,52.53000,The Alliance,PPO Network,,45.95,,,,,,,30.41,53.64,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,PPO Network,,45.95,,,,,,,0.79980,53.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,inpatient,10,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,outpatient,10,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.19995,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,inpatient,10,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,outpatient,10,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.19995,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,inpatient,10,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,outpatient,10,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.26400,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,inpatient,10,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.19995,1.75,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,inpatient,1,mL,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,367.95,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,outpatient,1,mL,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,65.26,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,inpatient,1,mL,507.12000,481.77000,The Alliance,PPO Network,,421.42,,,,,,,278.92,491.91,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,outpatient,1,mL,507.12000,481.77000,The Alliance,PPO Network,,421.42,,,,,,,65.26,491.91,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,5271.00,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,inpatient,2,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,outpatient,2,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.76570,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,inpatient,2,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,outpatient,2,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,0.76570,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,inpatient,2,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,outpatient,2,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.76570,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,inpatient,2,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,outpatient,2,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.76570,1.84,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,inpatient,2,EA,26.78000,25.44000,The Alliance,PPO Network,,22.25,,,,,,,14.73,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,outpatient,2,EA,26.78000,25.44000,The Alliance,PPO Network,,22.25,,,,,,,13.39,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,inpatient,2,EA,49.77000,47.28000,The Alliance,PPO Network,,41.36,,,,,,,27.37,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,outpatient,2,EA,49.77000,47.28000,The Alliance,PPO Network,,41.36,,,,,,,14.28,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,inpatient,2,EA,49.53000,47.06000,The Alliance,PPO Network,,41.16,,,,,,,27.24,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,outpatient,2,EA,49.53000,47.06000,The Alliance,PPO Network,,41.16,,,,,,,14.28,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,inpatient,2,EA,24.89000,23.64000,The Alliance,PPO Network,,20.68,,,,,,,13.69,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,outpatient,2,EA,24.89000,23.64000,The Alliance,PPO Network,,20.68,,,,,,,12.45,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,inpatient,2,EA,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,28.68,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,outpatient,2,EA,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,14.28,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,inpatient,2,EA,20.48000,19.45000,The Alliance,PPO Network,,17.02,,,,,,,11.26,19.87,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,outpatient,2,EA,20.48000,19.45000,The Alliance,PPO Network,,17.02,,,,,,,10.24,19.87,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,inpatient,5,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,outpatient,5,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.19995,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,inpatient,5,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,outpatient,5,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.19995,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,inpatient,5,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,outpatient,5,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.19995,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,inpatient,5,EA,1.79000,1.71000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,outpatient,5,EA,1.79000,1.71000,The Alliance,PPO Network,,1.49,,,,,,,0.19995,1.74,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,101.20,178.48,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,64.92,178.48,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,inpatient,1,mL,137.46000,130.59000,The Alliance,PPO Network,,114.23,,,,,,,75.60,133.34,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,outpatient,1,mL,137.46000,130.59000,The Alliance,PPO Network,,114.23,,,,,,,9.73,133.34,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,inpatient,1,EA,2685.99000,2551.69000,The Alliance,PPO Network,,2232.06,,,,,,,1477.29,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,outpatient,1,EA,2685.99000,2551.69000,The Alliance,PPO Network,,2232.06,,,,,,,31.18,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,inpatient,1,EA,1230.25000,1168.74000,The Alliance,PPO Network,,1022.34,,,,,,,676.64,1193.34,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,outpatient,1,EA,1230.25000,1168.74000,The Alliance,PPO Network,,1022.34,,,,,,,31.18,1193.34,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,inpatient,100,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,outpatient,100,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,inpatient,100,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,inpatient,100,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,outpatient,100,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,inpatient,10,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,outpatient,10,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.27217,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,inpatient,10,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,outpatient,10,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27217,0.53350,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,inpatient,1,mL,22.86000,21.72000,The Alliance,PPO Network,,19.00,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,outpatient,1,mL,22.86000,21.72000,The Alliance,PPO Network,,19.00,,,,,,,1.49,22.17,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,inpatient,1,mL,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,outpatient,1,mL,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,inpatient,,,403.00000,382.85000,The Alliance,PPO Network,,334.89,,,,,,,221.65,390.91,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,outpatient,,,403.00000,382.85000,The Alliance,PPO Network,,334.89,,,,,,,221.65,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,inpatient,0.8,EA,117.76000,111.87000,The Alliance,PPO Network,,97.86,,,,,,,64.77,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,outpatient,0.8,EA,117.76000,111.87000,The Alliance,PPO Network,,97.86,,,,,,,0.79980,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,inpatient,0.8,EA,101.27000,96.21000,The Alliance,PPO Network,,84.16,,,,,,,55.70,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,outpatient,0.8,EA,101.27000,96.21000,The Alliance,PPO Network,,84.16,,,,,,,0.79980,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,inpatient,0.8,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,outpatient,0.8,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,inpatient,0.8,EA,94.21000,89.50000,The Alliance,PPO Network,,78.29,,,,,,,51.82,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,outpatient,0.8,EA,94.21000,89.50000,The Alliance,PPO Network,,78.29,,,,,,,0.79980,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,inpatient,0.8,EA,289.24000,274.78000,The Alliance,PPO Network,,240.36,,,,,,,159.08,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,outpatient,0.8,EA,289.24000,274.78000,The Alliance,PPO Network,,240.36,,,,,,,0.79980,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,inpatient,0.8,EA,93.61000,88.93000,The Alliance,PPO Network,,77.79,,,,,,,51.49,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,outpatient,0.8,EA,93.61000,88.93000,The Alliance,PPO Network,,77.79,,,,,,,0.79980,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,inpatient,0.8,EA,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,26.18,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,outpatient,0.8,EA,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,0.79980,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,inpatient,0.8,EA,43.81000,41.62000,The Alliance,PPO Network,,36.41,,,,,,,24.10,42.50,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,outpatient,0.8,EA,43.81000,41.62000,The Alliance,PPO Network,,36.41,,,,,,,0.79980,42.50,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,inpatient,20,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,outpatient,20,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.27217,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,inpatient,20,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,outpatient,20,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.19995,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.19995,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.19995,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,inpatient,1,mL,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,outpatient,1,mL,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.19995,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,inpatient,1,mL,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,outpatient,1,mL,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.19995,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,0.19995,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,inpatient,10,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,outpatient,10,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,inpatient,10,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,outpatient,10,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,0.19995,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,inpatient,10,EA,3.65000,3.46000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,outpatient,10,EA,3.65000,3.46000,The Alliance,PPO Network,,3.03,,,,,,,0.19995,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,inpatient,10,EA,1.69000,1.61000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,outpatient,10,EA,1.69000,1.61000,The Alliance,PPO Network,,1.40,,,,,,,0.19995,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,inpatient,10,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,outpatient,10,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.19995,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,inpatient,10,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,outpatient,10,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,0.19995,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,inpatient,10,EA,8.76000,8.32000,The Alliance,PPO Network,,7.28,,,,,,,4.82,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,outpatient,10,EA,8.76000,8.32000,The Alliance,PPO Network,,7.28,,,,,,,0.19995,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,inpatient,10,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,outpatient,10,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.19995,0.52380,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,inpatient,1,EA,11.45000,10.87000,The Alliance,PPO Network,,9.51,,,,,,,6.30,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,outpatient,1,EA,11.45000,10.87000,The Alliance,PPO Network,,9.51,,,,,,,4.77,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,inpatient,1,EA,11.34000,10.78000,The Alliance,PPO Network,,9.42,,,,,,,6.24,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,PPO Network,,9.42,,,,,,,4.77,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,inpatient,1,EA,19.55000,18.57000,The Alliance,PPO Network,,16.25,,,,,,,10.75,18.96,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,outpatient,1,EA,19.55000,18.57000,The Alliance,PPO Network,,16.25,,,,,,,4.77,18.96,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,inpatient,1,EA,50.02000,47.52000,The Alliance,PPO Network,,41.57,,,,,,,27.51,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,outpatient,1,EA,50.02000,47.52000,The Alliance,PPO Network,,41.57,,,,,,,14.28,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,inpatient,1,EA,49.26000,46.80000,The Alliance,PPO Network,,40.94,,,,,,,27.09,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,outpatient,1,EA,49.26000,46.80000,The Alliance,PPO Network,,40.94,,,,,,,14.28,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,inpatient,1,EA,48.79000,46.35000,The Alliance,PPO Network,,40.54,,,,,,,26.83,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,outpatient,1,EA,48.79000,46.35000,The Alliance,PPO Network,,40.54,,,,,,,14.28,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,14.28,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,inpatient,1,EA,41.38000,39.31000,The Alliance,PPO Network,,34.39,,,,,,,22.76,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,outpatient,1,EA,41.38000,39.31000,The Alliance,PPO Network,,34.39,,,,,,,14.28,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,inpatient,1,EA,47.98000,45.58000,The Alliance,PPO Network,,39.87,,,,,,,26.39,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,outpatient,1,EA,47.98000,45.58000,The Alliance,PPO Network,,39.87,,,,,,,14.28,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,inpatient,1,EA,34.71000,32.97000,The Alliance,PPO Network,,28.84,,,,,,,19.09,33.67,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,outpatient,1,EA,34.71000,32.97000,The Alliance,PPO Network,,28.84,,,,,,,14.28,33.67,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,inpatient,2,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,outpatient,2,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,inpatient,2,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,outpatient,2,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.19995,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,inpatient,2,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,outpatient,2,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.19995,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,inpatient,2,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,outpatient,2,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.19995,1.92,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,inpatient,2,EA,61.91000,58.82000,The Alliance,PPO Network,,51.45,,,,,,,34.05,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,outpatient,2,EA,61.91000,58.82000,The Alliance,PPO Network,,51.45,,,,,,,25.99,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,inpatient,2,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,outpatient,2,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,25.99,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,inpatient,2,EA,74.26000,70.55000,The Alliance,PPO Network,,61.71,,,,,,,40.84,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,outpatient,2,EA,74.26000,70.55000,The Alliance,PPO Network,,61.71,,,,,,,25.99,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,inpatient,2,EA,86.90000,82.56000,The Alliance,PPO Network,,72.21,,,,,,,47.80,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,outpatient,2,EA,86.90000,82.56000,The Alliance,PPO Network,,72.21,,,,,,,25.99,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,inpatient,2,EA,184.58000,175.35000,The Alliance,PPO Network,,153.39,,,,,,,101.52,179.04,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,outpatient,2,EA,184.58000,175.35000,The Alliance,PPO Network,,153.39,,,,,,,25.99,179.04,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,inpatient,1,EA,1642.06000,1559.96000,The Alliance,PPO Network,,1364.55,,,,,,,903.13,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,outpatient,1,EA,1642.06000,1559.96000,The Alliance,PPO Network,,1364.55,,,,,,,6.50,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,inpatient,1,EA,1556.59000,1478.76000,The Alliance,PPO Network,,1293.53,,,,,,,856.12,1509.89,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,outpatient,1,EA,1556.59000,1478.76000,The Alliance,PPO Network,,1293.53,,,,,,,6.50,1509.89,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,13.53,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,13.53,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,182.05,321.07,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,95.80,4498.77,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,inpatient,30,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,outpatient,30,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,inpatient,30,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,inpatient,30,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.33945,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,inpatient,30,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,outpatient,30,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.33945,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,inpatient,30,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,outpatient,30,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.33945,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,inpatient,30,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,inpatient,1,mL,14.09000,13.39000,The Alliance,PPO Network,,11.71,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,outpatient,1,mL,14.09000,13.39000,The Alliance,PPO Network,,11.71,,,,,,,1.49,13.67,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,inpatient,1,EA,2916.40000,2770.58000,The Alliance,PPO Network,,2423.53,,,,,,,1604.02,2828.91,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,outpatient,1,EA,2916.40000,2770.58000,The Alliance,PPO Network,,2423.53,,,,,,,6.50,2828.91,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,inpatient,,,938.00000,891.10000,The Alliance,PPO Network,,779.48,,,,,,,515.90,909.86,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,outpatient,,,938.00000,891.10000,The Alliance,PPO Network,,779.48,,,,,,,515.90,4686.00,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,138.05,243.47,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,125.50,419.70,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,inpatient,,,1949.00000,1851.55000,The Alliance,PPO Network,,1619.62,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,PPO Network,,1619.62,,,,,,,1071.95,16988.00,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.14409,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,inpatient,1,mL,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.14409,0.36860,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,inpatient,3,EA,46.99000,44.64000,The Alliance,PPO Network,,39.05,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,outpatient,3,EA,46.99000,44.64000,The Alliance,PPO Network,,39.05,,,,,,,1.49,45.58,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,The Alliance,PPO Network,TC,2891.88,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,PPO Network,TC,2891.88,,,,,,,1609.99,3375.60,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,inpatient,1,mL,1612.59000,1531.96000,The Alliance,PPO Network,,1340.06,,,,,,,886.92,1564.21,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,PPO Network,,1340.06,,,,,,,13.34,1564.21,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,32.00,134.64,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,inpatient,1,mL,1294.64000,1229.91000,The Alliance,PPO Network,,1075.85,,,,,,,712.05,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,outpatient,1,mL,1294.64000,1229.91000,The Alliance,PPO Network,,1075.85,,,,,,,0.30000,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,inpatient,1,mL,1215.93000,1155.13000,The Alliance,PPO Network,,1010.44,,,,,,,668.76,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,outpatient,1,mL,1215.93000,1155.13000,The Alliance,PPO Network,,1010.44,,,,,,,0.30000,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,inpatient,1,mL,1294.63000,1229.90000,The Alliance,PPO Network,,1075.84,,,,,,,712.05,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,outpatient,1,mL,1294.63000,1229.90000,The Alliance,PPO Network,,1075.84,,,,,,,0.30000,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,inpatient,1,mL,1544.61000,1467.38000,The Alliance,PPO Network,,1283.57,,,,,,,849.54,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,outpatient,1,mL,1544.61000,1467.38000,The Alliance,PPO Network,,1283.57,,,,,,,0.30000,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,inpatient,1,mL,1544.29000,1467.07000,The Alliance,PPO Network,,1283.30,,,,,,,849.36,1497.96,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,outpatient,1,mL,1544.29000,1467.07000,The Alliance,PPO Network,,1283.30,,,,,,,0.30000,1497.96,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,inpatient,5,EA,6.69000,6.35000,The Alliance,PPO Network,,5.56,,,,,,,3.68,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,outpatient,5,EA,6.69000,6.35000,The Alliance,PPO Network,,5.56,,,,,,,2.17,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,inpatient,5,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.29,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,outpatient,5,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.08,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,inpatient,5,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,outpatient,5,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,inpatient,10,EA,26.99000,25.64000,The Alliance,PPO Network,,22.43,,,,,,,14.84,26.18,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,outpatient,10,EA,26.99000,25.64000,The Alliance,PPO Network,,22.43,,,,,,,1.49,26.18,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,inpatient,1,EA,8.99000,8.54000,The Alliance,PPO Network,,7.47,,,,,,,4.94,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,outpatient,1,EA,8.99000,8.54000,The Alliance,PPO Network,,7.47,,,,,,,4.50,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,inpatient,1,mL,1294.27000,1229.56000,The Alliance,PPO Network,,1075.54,,,,,,,711.85,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,outpatient,1,mL,1294.27000,1229.56000,The Alliance,PPO Network,,1075.54,,,,,,,0.30000,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,inpatient,1,mL,1275.16000,1211.40000,The Alliance,PPO Network,,1059.66,,,,,,,701.34,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,outpatient,1,mL,1275.16000,1211.40000,The Alliance,PPO Network,,1059.66,,,,,,,0.30000,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,inpatient,1,mL,1294.29000,1229.58000,The Alliance,PPO Network,,1075.55,,,,,,,711.86,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,outpatient,1,mL,1294.29000,1229.58000,The Alliance,PPO Network,,1075.55,,,,,,,0.30000,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,inpatient,1,mL,1551.93000,1474.33000,The Alliance,PPO Network,,1289.65,,,,,,,853.56,1505.37,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,outpatient,1,mL,1551.93000,1474.33000,The Alliance,PPO Network,,1289.65,,,,,,,0.30000,1505.37,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,inpatient,50,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,outpatient,50,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,inpatient,50,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,outpatient,50,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,inpatient,50,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,outpatient,50,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,inpatient,50,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,inpatient,50,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,outpatient,50,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,inpatient,50,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,inpatient,50,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,outpatient,50,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,inpatient,50,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,outpatient,50,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,inpatient,1,mL,5.23000,4.97000,The Alliance,PPO Network,,4.35,,,,,,,2.88,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,outpatient,1,mL,5.23000,4.97000,The Alliance,PPO Network,,4.35,,,,,,,0.76570,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,inpatient,1,mL,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,outpatient,1,mL,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.82500,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,PPO Network,90,168.69,,,,,,,111.65,196.91,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,PPO Network,90,168.69,,,,,,,17.85,814.87,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,558.11000,530.20000,The Alliance,PPO Network,,463.79,,,,,,,273.47,541.37,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,558.11000,530.20000,The Alliance,PPO Network,,463.79,,,,,,,256.17,558.11,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,3163.00,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,inpatient,,,635.00000,603.25000,The Alliance,PPO Network,,527.68,,,,,,,349.25,615.95,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,outpatient,,,635.00000,603.25000,The Alliance,PPO Network,,527.68,,,,,,,288.84,615.95,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,inpatient,1,mL,1885.86000,1791.57000,The Alliance,PPO Network,,1567.15,,,,,,,1037.22,1829.28,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,outpatient,1,mL,1885.86000,1791.57000,The Alliance,PPO Network,,1567.15,,,,,,,183.41,1829.28,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,inpatient,3,EA,14.09000,13.39000,The Alliance,PPO Network,,11.71,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,outpatient,3,EA,14.09000,13.39000,The Alliance,PPO Network,,11.71,,,,,,,1.49,13.67,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,inpatient,,,164.10000,155.89000,The Alliance,PPO Network,90,136.37,,,,,,,90.25,159.18,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,PPO Network,90,136.37,,,,,,,19.00,865.84,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,,203.59,,,,,,,134.75,237.65,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,,203.59,,,,,,,21.26,1103.49,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,inpatient,10,EA,22.86000,21.72000,The Alliance,PPO Network,,19.00,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,outpatient,10,EA,22.86000,21.72000,The Alliance,PPO Network,,19.00,,,,,,,1.49,22.17,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,inpatient,1,mL,14.10000,13.39000,The Alliance,PPO Network,,11.72,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,PPO Network,,11.72,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,1.49,14.77,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,inpatient,,,248.60000,236.17000,The Alliance,PPO Network,90,206.59,,,,,,,136.73,241.14,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,outpatient,,,248.60000,236.17000,The Alliance,PPO Network,90,206.59,,,,,,,22.12,1120.45,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.11,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.00,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.66,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.50,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.12,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.60,3.10,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,inpatient,1,mL,23.59000,22.41000,The Alliance,PPO Network,,19.60,,,,,,,12.97,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,outpatient,1,mL,23.59000,22.41000,The Alliance,PPO Network,,19.60,,,,,,,2.24,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,2.24,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,inpatient,1,mL,19.38000,18.41000,The Alliance,PPO Network,,16.10,,,,,,,10.66,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,outpatient,1,mL,19.38000,18.41000,The Alliance,PPO Network,,16.10,,,,,,,2.24,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,inpatient,1,mL,22.31000,21.19000,The Alliance,PPO Network,,18.54,,,,,,,12.27,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,PPO Network,,18.54,,,,,,,2.24,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,inpatient,1,mL,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,9.04,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,outpatient,1,mL,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,2.24,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,inpatient,1,mL,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,10.45,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,outpatient,1,mL,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,2.24,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,inpatient,1,mL,12.56000,11.93000,The Alliance,PPO Network,,10.44,,,,,,,6.91,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,outpatient,1,mL,12.56000,11.93000,The Alliance,PPO Network,,10.44,,,,,,,2.24,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,inpatient,1,mL,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,11.82,20.85,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,outpatient,1,mL,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,2.24,20.85,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,inpatient,2,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,outpatient,2,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,inpatient,2,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,outpatient,2,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,inpatient,2,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,outpatient,2,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,inpatient,2,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,outpatient,2,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,inpatient,2,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,outpatient,2,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,inpatient,2,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,outpatient,2,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.64350,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,6.47,339.51,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,inpatient,1,mL,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,199.43,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,outpatient,1,mL,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,7.86,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,inpatient,1,mL,325.82000,309.53000,The Alliance,PPO Network,,270.76,,,,,,,179.20,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,outpatient,1,mL,325.82000,309.53000,The Alliance,PPO Network,,270.76,,,,,,,7.86,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,inpatient,1,mL,577.02000,548.17000,The Alliance,PPO Network,,479.50,,,,,,,317.36,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,outpatient,1,mL,577.02000,548.17000,The Alliance,PPO Network,,479.50,,,,,,,7.86,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,inpatient,1,mL,458.13000,435.23000,The Alliance,PPO Network,,380.71,,,,,,,251.97,444.39,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,outpatient,1,mL,458.13000,435.23000,The Alliance,PPO Network,,380.71,,,,,,,7.86,444.39,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,33.00,783.52,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,inpatient,1,EA,6883.45000,6539.28000,The Alliance,PPO Network,,5720.15,,,,,,,3785.90,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,outpatient,1,EA,6883.45000,6539.28000,The Alliance,PPO Network,,5720.15,,,,,,,31.33,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,inpatient,1,EA,7635.88000,7254.08000,The Alliance,PPO Network,,6345.42,,,,,,,4199.73,7406.80,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,outpatient,1,EA,7635.88000,7254.08000,The Alliance,PPO Network,,6345.42,,,,,,,31.33,7406.80,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,56.40,158.11,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,inpatient,,,552.00000,524.40000,The Alliance,PPO Network,,458.71,,,,,,,303.60,535.44,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,outpatient,,,552.00000,524.40000,The Alliance,PPO Network,,458.71,,,,,,,303.60,5271.00,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,inpatient,10,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,outpatient,10,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,0.33945,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,inpatient,10,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,9.04,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,outpatient,10,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,0.33945,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,inpatient,10,EA,20.84000,19.80000,The Alliance,PPO Network,,17.32,,,,,,,11.46,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,outpatient,10,EA,20.84000,19.80000,The Alliance,PPO Network,,17.32,,,,,,,0.33945,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,inpatient,10,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,10.25,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,outpatient,10,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,0.33945,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,inpatient,10,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,8.26,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,0.33945,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,inpatient,10,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,7.39,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,outpatient,10,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,0.33945,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,inpatient,10,EA,19.09000,18.14000,The Alliance,PPO Network,,15.86,,,,,,,10.50,18.52,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,outpatient,10,EA,19.09000,18.14000,The Alliance,PPO Network,,15.86,,,,,,,0.33945,18.52,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,inpatient,5,EA,927.28000,880.91000,The Alliance,PPO Network,,770.57,,,,,,,510.00,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,outpatient,5,EA,927.28000,880.91000,The Alliance,PPO Network,,770.57,,,,,,,463.64,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,inpatient,5,EA,30.66000,29.13000,The Alliance,PPO Network,,25.48,,,,,,,16.86,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,outpatient,5,EA,30.66000,29.13000,The Alliance,PPO Network,,25.48,,,,,,,15.33,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,inpatient,5,EA,118.23000,112.32000,The Alliance,PPO Network,,98.25,,,,,,,65.03,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,outpatient,5,EA,118.23000,112.32000,The Alliance,PPO Network,,98.25,,,,,,,59.12,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,inpatient,5,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,170.94,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,outpatient,5,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,155.40,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,inpatient,5,EA,88.48000,84.06000,The Alliance,PPO Network,,73.53,,,,,,,48.66,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,outpatient,5,EA,88.48000,84.06000,The Alliance,PPO Network,,73.53,,,,,,,44.24,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,inpatient,5,EA,673.40000,639.73000,The Alliance,PPO Network,,559.60,,,,,,,370.37,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,outpatient,5,EA,673.40000,639.73000,The Alliance,PPO Network,,559.60,,,,,,,336.70,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,inpatient,5,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,outpatient,5,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,75.84,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,inpatient,5,EA,569.80000,541.31000,The Alliance,PPO Network,,473.50,,,,,,,313.39,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,outpatient,5,EA,569.80000,541.31000,The Alliance,PPO Network,,473.50,,,,,,,284.90,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,inpatient,5,EA,44.24000,42.03000,The Alliance,PPO Network,,36.76,,,,,,,24.33,42.91,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,outpatient,5,EA,44.24000,42.03000,The Alliance,PPO Network,,36.76,,,,,,,22.12,42.91,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,131.92,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.82500,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.31,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.21,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.10,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,inpatient,,,163.90000,155.70000,The Alliance,PPO Network,90,136.20,,,,,,,90.14,158.98,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,outpatient,,,163.90000,155.70000,The Alliance,PPO Network,90,136.20,,,,,,,14.59,729.98,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,inpatient,1,mL,23.97000,22.77000,The Alliance,PPO Network,,19.92,,,,,,,13.18,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,outpatient,1,mL,23.97000,22.77000,The Alliance,PPO Network,,19.92,,,,,,,2.24,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,inpatient,1,mL,23.98000,22.79000,The Alliance,PPO Network,,19.93,,,,,,,13.19,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,outpatient,1,mL,23.98000,22.79000,The Alliance,PPO Network,,19.93,,,,,,,2.24,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,inpatient,1,mL,23.26000,22.09000,The Alliance,PPO Network,,19.33,,,,,,,12.79,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,outpatient,1,mL,23.26000,22.09000,The Alliance,PPO Network,,19.33,,,,,,,2.24,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,inpatient,1,mL,27.13000,25.77000,The Alliance,PPO Network,,22.55,,,,,,,14.92,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,outpatient,1,mL,27.13000,25.77000,The Alliance,PPO Network,,22.55,,,,,,,2.24,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,inpatient,1,mL,34.13000,32.42000,The Alliance,PPO Network,,28.36,,,,,,,18.77,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,outpatient,1,mL,34.13000,32.42000,The Alliance,PPO Network,,28.36,,,,,,,2.24,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,inpatient,1,mL,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,12.63,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,outpatient,1,mL,22.97000,21.82000,The Alliance,PPO Network,,19.09,,,,,,,2.24,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,inpatient,1,mL,19.50000,18.52000,The Alliance,PPO Network,,16.20,,,,,,,10.72,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,outpatient,1,mL,19.50000,18.52000,The Alliance,PPO Network,,16.20,,,,,,,2.24,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,2.24,24.52,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.13,6.07,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,inpatient,1,mL,2209.91000,2099.41000,The Alliance,PPO Network,,1836.44,,,,,,,1215.45,2143.61,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,outpatient,1,mL,2209.91000,2099.41000,The Alliance,PPO Network,,1836.44,,,,,,,183.41,2143.61,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,inpatient,1,EA,3.06000,2.91000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,outpatient,1,EA,3.06000,2.91000,The Alliance,PPO Network,,2.54,,,,,,,1.53,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,inpatient,1,EA,3.05000,2.89000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,outpatient,1,EA,3.05000,2.89000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,inpatient,1,EA,3.04000,2.88000,The Alliance,PPO Network,,2.53,,,,,,,1.67,2.95,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,outpatient,1,EA,3.04000,2.88000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.95,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,inpatient,10,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,outpatient,10,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,inpatient,10,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,outpatient,10,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,inpatient,10,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,outpatient,10,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,inpatient,10,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,outpatient,10,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,inpatient,10,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,outpatient,10,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,inpatient,10,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,outpatient,10,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,inpatient,10,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,inpatient,10,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.79,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.63,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,inpatient,0.6,EA,20323.63000,19307.45000,The Alliance,PPO Network,,16888.94,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,outpatient,0.6,EA,20323.63000,19307.45000,The Alliance,PPO Network,,16888.94,,,,,,,30.97,19713.92,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,inpatient,1,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,2.18,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,0.33000,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,inpatient,1,EA,6.04000,5.73000,The Alliance,PPO Network,,5.02,,,,,,,3.32,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,outpatient,1,EA,6.04000,5.73000,The Alliance,PPO Network,,5.02,,,,,,,0.33000,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,inpatient,1,EA,9.51000,9.03000,The Alliance,PPO Network,,7.90,,,,,,,5.23,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,outpatient,1,EA,9.51000,9.03000,The Alliance,PPO Network,,7.90,,,,,,,0.33000,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,inpatient,1,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.58,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,0.33000,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,inpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,0.33000,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.33000,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,inpatient,1,EA,10.68000,10.15000,The Alliance,PPO Network,,8.88,,,,,,,5.87,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,PPO Network,,8.88,,,,,,,0.33000,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,0.33000,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,0.33000,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,6.52,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,0.33000,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,0.33000,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,0.33000,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,0.33000,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,inpatient,1,EA,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,3.25,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,PPO Network,,4.91,,,,,,,0.33000,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,0.33000,3.01,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,inpatient,5,EA,38.69000,36.76000,The Alliance,PPO Network,,32.15,,,,,,,21.28,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,outpatient,5,EA,38.69000,36.76000,The Alliance,PPO Network,,32.15,,,,,,,0.35222,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,inpatient,5,EA,23.26000,22.09000,The Alliance,PPO Network,,19.33,,,,,,,12.79,22.56,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,outpatient,5,EA,23.26000,22.09000,The Alliance,PPO Network,,19.33,,,,,,,0.35222,22.56,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,43.81,120.28,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,43.81,142.59,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,inpatient,1,EA,115.64000,109.85000,The Alliance,PPO Network,,96.10,,,,,,,63.60,112.17,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,outpatient,1,EA,115.64000,109.85000,The Alliance,PPO Network,,96.10,,,,,,,57.82,112.17,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,inpatient,3,EA,20.98000,19.93000,The Alliance,PPO Network,,17.43,,,,,,,11.54,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,outpatient,3,EA,20.98000,19.93000,The Alliance,PPO Network,,17.43,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,inpatient,3,EA,41.32000,39.26000,The Alliance,PPO Network,,34.34,,,,,,,22.73,40.08,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,outpatient,3,EA,41.32000,39.26000,The Alliance,PPO Network,,34.34,,,,,,,1.49,40.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,inpatient,20,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,outpatient,20,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,inpatient,20,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,outpatient,20,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,inpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,inpatient,20,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,outpatient,20,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,0.62439,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,inpatient,20,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,outpatient,20,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,inpatient,20,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,outpatient,20,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,inpatient,20,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,outpatient,20,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.62439,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,inpatient,20,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,inpatient,20,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,outpatient,20,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.62439,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,inpatient,20,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,outpatient,20,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,211.46,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,109.00,211.46,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,inpatient,10,EA,20.31000,19.29000,The Alliance,PPO Network,,16.88,,,,,,,11.17,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,outpatient,10,EA,20.31000,19.29000,The Alliance,PPO Network,,16.88,,,,,,,1.49,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,inpatient,10,EA,89.60000,85.12000,The Alliance,PPO Network,,74.46,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,outpatient,10,EA,89.60000,85.12000,The Alliance,PPO Network,,74.46,,,,,,,1.49,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,inpatient,10,EA,35.84000,34.05000,The Alliance,PPO Network,,29.78,,,,,,,19.71,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,outpatient,10,EA,35.84000,34.05000,The Alliance,PPO Network,,29.78,,,,,,,1.49,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,inpatient,10,EA,31.17000,29.61000,The Alliance,PPO Network,,25.90,,,,,,,17.14,30.23,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,outpatient,10,EA,31.17000,29.61000,The Alliance,PPO Network,,25.90,,,,,,,1.49,30.23,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,inpatient,1,EA,2.49000,2.37000,The Alliance,PPO Network,,2.07,,,,,,,1.37,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,outpatient,1,EA,2.49000,2.37000,The Alliance,PPO Network,,2.07,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.54,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.40,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.71500,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,42.50,82.45,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.00,36.40,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,inpatient,1,EA,16466.50000,15643.18000,The Alliance,PPO Network,,13683.66,,,,,,,9056.58,15972.50,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,outpatient,1,EA,16466.50000,15643.18000,The Alliance,PPO Network,,13683.66,,,,,,,22.06,15972.50,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,inpatient,,,467.00000,443.65000,The Alliance,PPO Network,,388.08,,,,,,,256.85,452.99,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,PPO Network,,388.08,,,,,,,230.94,3163.00,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,67.58,194.97,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,12.11,628.12,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,65.45,115.43,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,11.43,594.19,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,43.81,97.00,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,inpatient,1,mL,20323.63000,19307.45000,The Alliance,PPO Network,,16888.94,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,outpatient,1,mL,20323.63000,19307.45000,The Alliance,PPO Network,,16888.94,,,,,,,30.97,19713.92,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,inpatient,,,658.00000,625.10000,The Alliance,PPO Network,,546.80,,,,,,,361.90,638.26,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,PPO Network,,546.80,,,,,,,162.71,16444.87,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,TC,1106.06,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,TC,1106.06,,,,,,,644.24,2960.49,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,47.30,83.42,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,8.74,458.40,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,inpatient,,,317.00000,301.15000,The Alliance,PPO Network,,263.43,,,,,,,174.35,307.49,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,outpatient,,,317.00000,301.15000,The Alliance,PPO Network,,263.43,,,,,,,158.50,307.49,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,inpatient,,,754.00000,716.30000,The Alliance,PPO Network,,626.57,,,,,,,414.70,731.38,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,PPO Network,,626.57,,,,,,,414.70,5271.00,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,inpatient,2.5,EA,179.56000,170.58000,The Alliance,PPO Network,,149.21,,,,,,,98.76,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,outpatient,2.5,EA,179.56000,170.58000,The Alliance,PPO Network,,149.21,,,,,,,89.78,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,inpatient,2.5,EA,273.80000,260.11000,The Alliance,PPO Network,,227.53,,,,,,,150.59,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,outpatient,2.5,EA,273.80000,260.11000,The Alliance,PPO Network,,227.53,,,,,,,136.90,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,inpatient,2.5,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,outpatient,2.5,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,7.58,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,inpatient,2.5,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,outpatient,2.5,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,9.83,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,inpatient,2.5,EA,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,12.51,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,outpatient,2.5,EA,22.75000,21.61000,The Alliance,PPO Network,,18.91,,,,,,,11.38,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,inpatient,2.5,EA,13.13000,12.48000,The Alliance,PPO Network,,10.91,,,,,,,7.22,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,outpatient,2.5,EA,13.13000,12.48000,The Alliance,PPO Network,,10.91,,,,,,,6.57,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,inpatient,2.5,EA,13.52000,12.85000,The Alliance,PPO Network,,11.24,,,,,,,7.44,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,outpatient,2.5,EA,13.52000,12.85000,The Alliance,PPO Network,,11.24,,,,,,,6.76,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,inpatient,2.5,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,9.32,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,outpatient,2.5,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,8.47,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,inpatient,2.5,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,outpatient,2.5,EA,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.13,6.07,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,4.27,220.68,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,8.17,424.40,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,187.00,362.78,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,inpatient,2,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,outpatient,2,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,0.33000,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,inpatient,2,EA,8.90000,8.45000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,outpatient,2,EA,8.90000,8.45000,The Alliance,PPO Network,,7.40,,,,,,,0.33000,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,inpatient,2,EA,11.36000,10.79000,The Alliance,PPO Network,,9.44,,,,,,,6.25,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,outpatient,2,EA,11.36000,10.79000,The Alliance,PPO Network,,9.44,,,,,,,0.33000,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,inpatient,2,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,outpatient,2,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.33000,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,inpatient,2,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.33000,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,inpatient,2,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,outpatient,2,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,0.33000,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.33000,1.90,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,inpatient,,,1064.00000,1010.80000,The Alliance,PPO Network,90,884.18,,,,,,,585.20,1032.08,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,outpatient,,,1064.00000,1010.80000,The Alliance,PPO Network,90,884.18,,,,,,,94.71,4787.38,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,The Alliance,PPO Network,,102.69,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,PPO Network,,102.69,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,inpatient,1,EA,6.12000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.37,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,outpatient,1,EA,6.12000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.06,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,9.15,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,PPO Network,,13.83,,,,,,,8.32,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,inpatient,1,EA,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.45,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.04,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,inpatient,,,1733.00000,1646.35000,The Alliance,PPO Network,TC,1440.12,,,,,,,953.15,1681.01,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,outpatient,,,1733.00000,1646.35000,The Alliance,PPO Network,TC,1440.12,,,,,,,811.39,2210.07,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,PPO Network,,375.61,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,PPO Network,,375.61,,,,,,,200.06,438.44,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,inpatient,1,EA,73.95000,70.25000,The Alliance,PPO Network,,61.45,,,,,,,40.67,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,outpatient,1,EA,73.95000,70.25000,The Alliance,PPO Network,,61.45,,,,,,,36.98,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,inpatient,1,EA,1114.87000,1059.12000,The Alliance,PPO Network,,926.46,,,,,,,613.18,1081.42,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,outpatient,1,EA,1114.87000,1059.12000,The Alliance,PPO Network,,926.46,,,,,,,557.43,1081.42,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,The Alliance,PPO Network,TC,1790.81,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,PPO Network,TC,1790.81,,,,,,,1006.74,2960.49,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,inpatient,4,EA,7.18000,6.82000,The Alliance,PPO Network,,5.97,,,,,,,3.95,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,outpatient,4,EA,7.18000,6.82000,The Alliance,PPO Network,,5.97,,,,,,,0.62439,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,inpatient,4,EA,3.33000,3.17000,The Alliance,PPO Network,,2.77,,,,,,,1.83,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,outpatient,4,EA,3.33000,3.17000,The Alliance,PPO Network,,2.77,,,,,,,0.62439,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,inpatient,4,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,outpatient,4,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,0.62439,2.09,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,53.00,102.82,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,inpatient,1,EA,9777.53000,9288.66000,The Alliance,PPO Network,,8125.13,,,,,,,5377.64,9484.20,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,outpatient,1,EA,9777.53000,9288.66000,The Alliance,PPO Network,,8125.13,,,,,,,1737.10,9484.20,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,6.07,10.70,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,5.51,10.70,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,inpatient,,,181.10000,172.04000,The Alliance,PPO Network,90,150.49,,,,,,,99.61,175.67,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,outpatient,,,181.10000,172.04000,The Alliance,PPO Network,90,150.49,,,,,,,15.81,797.91,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,inpatient,,,1949.00000,1851.55000,The Alliance,PPO Network,,1619.62,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,PPO Network,,1619.62,,,,,,,1071.95,16988.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,inpatient,1,mL,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,outpatient,1,mL,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,inpatient,1,mL,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.85,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,outpatient,1,mL,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.59,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,inpatient,1,mL,6.24000,5.93000,The Alliance,PPO Network,,5.19,,,,,,,3.43,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,outpatient,1,mL,6.24000,5.93000,The Alliance,PPO Network,,5.19,,,,,,,3.12,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,inpatient,,,205.00000,194.75000,The Alliance,PPO Network,90,170.35,,,,,,,112.75,198.85,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,PPO Network,90,170.35,,,,,,,16.82,1018.59,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,inpatient,1,EA,43.58000,41.40000,The Alliance,PPO Network,,36.21,,,,,,,23.97,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,outpatient,1,EA,43.58000,41.40000,The Alliance,PPO Network,,36.21,,,,,,,21.79,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,inpatient,1,EA,47.47000,45.10000,The Alliance,PPO Network,,39.45,,,,,,,26.11,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,outpatient,1,EA,47.47000,45.10000,The Alliance,PPO Network,,39.45,,,,,,,23.73,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,inpatient,1,EA,19.63000,18.64000,The Alliance,PPO Network,,16.31,,,,,,,10.80,19.04,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,outpatient,1,EA,19.63000,18.64000,The Alliance,PPO Network,,16.31,,,,,,,9.81,19.04,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,90.75,160.05,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,13.25,696.05,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,inpatient,1,EA,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,45.19,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,outpatient,1,EA,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,5.45,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,inpatient,1,EA,59.88000,56.89000,The Alliance,PPO Network,,49.76,,,,,,,32.93,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,outpatient,1,EA,59.88000,56.89000,The Alliance,PPO Network,,49.76,,,,,,,5.45,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,inpatient,1,EA,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,121.66,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,5.45,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,inpatient,1,EA,55.62000,52.84000,The Alliance,PPO Network,,46.22,,,,,,,30.59,53.95,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,outpatient,1,EA,55.62000,52.84000,The Alliance,PPO Network,,46.22,,,,,,,5.45,53.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,inpatient,1,EA,1.83000,1.73000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,outpatient,1,EA,1.83000,1.73000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,inpatient,1,EA,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,outpatient,1,EA,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.47,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,243.10,428.74,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,172.82,489.94,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,inpatient,1,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,0.33000,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,inpatient,1,EA,11.50000,10.93000,The Alliance,PPO Network,,9.56,,,,,,,6.33,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,PPO Network,,9.56,,,,,,,0.33000,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,inpatient,1,EA,20.63000,19.60000,The Alliance,PPO Network,,17.14,,,,,,,11.35,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,outpatient,1,EA,20.63000,19.60000,The Alliance,PPO Network,,17.14,,,,,,,0.33000,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.33000,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,inpatient,1,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.96,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,0.33000,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,0.33000,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,0.33000,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.33000,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,0.33000,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,0.33000,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,0.33000,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,inpatient,1,EA,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,1.95,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,PPO Network,,2.94,,,,,,,0.33000,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,0.33000,10.42,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,5.45,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,inpatient,1,EA,75.84000,72.05000,The Alliance,PPO Network,,63.02,,,,,,,41.71,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,outpatient,1,EA,75.84000,72.05000,The Alliance,PPO Network,,63.02,,,,,,,5.45,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,5.45,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,inpatient,1,EA,48.66000,46.23000,The Alliance,PPO Network,,40.44,,,,,,,26.76,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,PPO Network,,40.44,,,,,,,5.45,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,inpatient,1,EA,72.87000,69.23000,The Alliance,PPO Network,,60.55,,,,,,,40.08,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,outpatient,1,EA,72.87000,69.23000,The Alliance,PPO Network,,60.55,,,,,,,5.45,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,inpatient,1,EA,66.55000,63.22000,The Alliance,PPO Network,,55.30,,,,,,,36.60,64.55,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,PPO Network,,55.30,,,,,,,5.45,64.55,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,inpatient,1,mL,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,outpatient,1,mL,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,19.75,38.31,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,inpatient,1,EA,11651.31000,11068.75000,The Alliance,PPO Network,,9682.24,,,,,,,6408.22,11301.77,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,outpatient,1,EA,11651.31000,11068.75000,The Alliance,PPO Network,,9682.24,,,,,,,155.42,11301.77,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,11.57,560.26,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,inpatient,100,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,inpatient,100,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,inpatient,100,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,outpatient,100,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,inpatient,100,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,inpatient,100,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,inpatient,100,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,inpatient,100,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,outpatient,100,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,inpatient,100,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,outpatient,100,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,inpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,3.23,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,inpatient,1,EA,298.62000,283.69000,The Alliance,PPO Network,,248.15,,,,,,,164.24,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,outpatient,1,EA,298.62000,283.69000,The Alliance,PPO Network,,248.15,,,,,,,11.25,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,inpatient,1,EA,273.45000,259.78000,The Alliance,PPO Network,,227.24,,,,,,,150.40,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,outpatient,1,EA,273.45000,259.78000,The Alliance,PPO Network,,227.24,,,,,,,11.25,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,inpatient,1,EA,290.12000,275.61000,The Alliance,PPO Network,,241.09,,,,,,,159.57,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,outpatient,1,EA,290.12000,275.61000,The Alliance,PPO Network,,241.09,,,,,,,11.25,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,inpatient,1,EA,322.97000,306.82000,The Alliance,PPO Network,,268.39,,,,,,,177.63,313.28,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,outpatient,1,EA,322.97000,306.82000,The Alliance,PPO Network,,268.39,,,,,,,11.25,313.28,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,inpatient,1,EA,23303.03000,22137.87000,The Alliance,PPO Network,,19364.82,,,,,,,12816.67,22603.94,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,outpatient,1,EA,23303.03000,22137.87000,The Alliance,PPO Network,,19364.82,,,,,,,155.42,22603.94,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,inpatient,30,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,outpatient,30,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,inpatient,30,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,inpatient,30,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,outpatient,30,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,inpatient,30,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.63,4.65,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,outpatient,30,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.40,4.65,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,90,164.54,,,,,,,108.90,192.06,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,90,164.54,,,,,,,16.84,848.80,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,inpatient,1,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,27.81,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,PPO Network,,42.02,,,,,,,5.45,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,5.45,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,inpatient,1,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,15.30,26.98,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,5.45,26.98,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,185.50,359.87,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,inpatient,1,EA,46.10000,43.80000,The Alliance,PPO Network,,38.31,,,,,,,25.36,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,outpatient,1,EA,46.10000,43.80000,The Alliance,PPO Network,,38.31,,,,,,,23.05,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,6.04,322.54,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,inpatient,40,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,outpatient,40,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,inpatient,40,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,outpatient,40,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,inpatient,40,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,outpatient,40,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,inpatient,40,EA,3.75000,3.56000,The Alliance,PPO Network,,3.12,,,,,,,2.06,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,outpatient,40,EA,3.75000,3.56000,The Alliance,PPO Network,,3.12,,,,,,,0.62439,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,inpatient,40,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,outpatient,40,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,inpatient,40,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,outpatient,40,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.62439,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,inpatient,40,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,outpatient,40,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.69720,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,inpatient,1,EA,248.72000,236.29000,The Alliance,PPO Network,,206.69,,,,,,,136.80,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,outpatient,1,EA,248.72000,236.29000,The Alliance,PPO Network,,206.69,,,,,,,5.45,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,inpatient,1,EA,272.36000,258.74000,The Alliance,PPO Network,,226.33,,,,,,,149.80,264.19,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,outpatient,1,EA,272.36000,258.74000,The Alliance,PPO Network,,226.33,,,,,,,5.45,264.19,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,2.54,135.79,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,inpatient,1,EA,62.02000,58.92000,The Alliance,PPO Network,,51.54,,,,,,,34.11,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,outpatient,1,EA,62.02000,58.92000,The Alliance,PPO Network,,51.54,,,,,,,31.01,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,inpatient,1,EA,94.91000,90.17000,The Alliance,PPO Network,,78.87,,,,,,,52.20,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,outpatient,1,EA,94.91000,90.17000,The Alliance,PPO Network,,78.87,,,,,,,47.45,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,inpatient,1,mL,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,outpatient,1,mL,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,3.23,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,inpatient,3,EA,5.65000,5.36000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,outpatient,3,EA,5.65000,5.36000,The Alliance,PPO Network,,4.70,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,inpatient,3,EA,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,outpatient,3,EA,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,inpatient,3,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,outpatient,3,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,0.13485,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,inpatient,3,EA,8.27000,7.86000,The Alliance,PPO Network,,6.87,,,,,,,4.55,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,outpatient,3,EA,8.27000,7.86000,The Alliance,PPO Network,,6.87,,,,,,,0.13485,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,inpatient,3,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,outpatient,3,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,inpatient,3,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.22,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,outpatient,3,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,0.13485,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,inpatient,3,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,outpatient,3,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.13485,1.64,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,16.07,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,inpatient,1,EA,6.81000,6.47000,The Alliance,PPO Network,,5.66,,,,,,,3.75,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,outpatient,1,EA,6.81000,6.47000,The Alliance,PPO Network,,5.66,,,,,,,3.40,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,inpatient,1,EA,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,3.12,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,2.84,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,inpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.94,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,PPO Network,,4.45,,,,,,,2.67,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,inpatient,1,EA,1.87000,1.78000,The Alliance,PPO Network,,1.55,,,,,,,1.03,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,PPO Network,,1.55,,,,,,,0.93500,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,inpatient,1,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.36,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.24,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,inpatient,1,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,inpatient,5,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,outpatient,5,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,0.08005,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,inpatient,5,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,0.08005,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,inpatient,5,EA,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,outpatient,5,EA,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,0.08005,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,inpatient,5,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,outpatient,5,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,0.08005,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,inpatient,5,EA,2.46000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,outpatient,5,EA,2.46000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,0.08005,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,inpatient,5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,0.08005,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,inpatient,5,EA,3.92000,3.72000,The Alliance,PPO Network,,3.26,,,,,,,2.16,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,outpatient,5,EA,3.92000,3.72000,The Alliance,PPO Network,,3.26,,,,,,,0.08005,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,inpatient,5,EA,21.12000,20.06000,The Alliance,PPO Network,,17.55,,,,,,,11.62,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,outpatient,5,EA,21.12000,20.06000,The Alliance,PPO Network,,17.55,,,,,,,0.08005,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,inpatient,5,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,outpatient,5,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.08005,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,inpatient,5,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,0.08005,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,inpatient,5,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,outpatient,5,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,0.08005,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,inpatient,5,EA,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,outpatient,5,EA,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,0.08005,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,inpatient,5,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,outpatient,5,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,0.08005,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,inpatient,5,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.08005,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,inpatient,5,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.08005,1.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,inpatient,1,mL,33272.80000,31609.16000,The Alliance,PPO Network,,27649.70,,,,,,,18300.04,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,outpatient,1,mL,33272.80000,31609.16000,The Alliance,PPO Network,,27649.70,,,,,,,36.66,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,inpatient,1,mL,36335.60000,34518.82000,The Alliance,PPO Network,,30194.88,,,,,,,19984.58,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,outpatient,1,mL,36335.60000,34518.82000,The Alliance,PPO Network,,30194.88,,,,,,,36.66,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,inpatient,1,mL,33792.11000,32102.50000,The Alliance,PPO Network,,28081.24,,,,,,,18585.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,outpatient,1,mL,33792.11000,32102.50000,The Alliance,PPO Network,,28081.24,,,,,,,36.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,inpatient,1,mL,11961.94000,11363.85000,The Alliance,PPO Network,,9940.37,,,,,,,6579.07,11603.08,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,outpatient,1,mL,11961.94000,11363.85000,The Alliance,PPO Network,,9940.37,,,,,,,36.66,11603.08,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,inpatient,1,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,inpatient,1,EA,9.41000,8.94000,The Alliance,PPO Network,,7.82,,,,,,,5.18,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,outpatient,1,EA,9.41000,8.94000,The Alliance,PPO Network,,7.82,,,,,,,4.71,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,inpatient,1,EA,31.20000,29.64000,The Alliance,PPO Network,,25.93,,,,,,,17.16,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,outpatient,1,EA,31.20000,29.64000,The Alliance,PPO Network,,25.93,,,,,,,15.60,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.60,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,inpatient,1,EA,15535.12000,14758.37000,The Alliance,PPO Network,,12909.68,,,,,,,8544.32,15069.07,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,outpatient,1,EA,15535.12000,14758.37000,The Alliance,PPO Network,,12909.68,,,,,,,155.42,15069.07,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,inpatient,1,mL,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,outpatient,1,mL,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.08005,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.08005,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,inpatient,1,mL,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.08005,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.08005,0.39770,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,inpatient,5,EA,11.32000,10.75000,The Alliance,PPO Network,,9.41,,,,,,,6.23,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,outpatient,5,EA,11.32000,10.75000,The Alliance,PPO Network,,9.41,,,,,,,5.66,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,inpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,inpatient,1,mL,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,inpatient,30,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.41,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,outpatient,30,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.19,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,inpatient,30,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,outpatient,30,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,inpatient,30,EA,4.27000,4.06000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,outpatient,30,EA,4.27000,4.06000,The Alliance,PPO Network,,3.55,,,,,,,2.13,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,inpatient,30,EA,4.01000,3.81000,The Alliance,PPO Network,,3.33,,,,,,,2.21,3.89,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,outpatient,30,EA,4.01000,3.81000,The Alliance,PPO Network,,3.33,,,,,,,2.00,3.89,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,inpatient,1,EA,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,inpatient,1,EA,23.83000,22.64000,The Alliance,PPO Network,,19.80,,,,,,,13.11,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,outpatient,1,EA,23.83000,22.64000,The Alliance,PPO Network,,19.80,,,,,,,11.91,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,inpatient,1,EA,85.13000,80.87000,The Alliance,PPO Network,,70.74,,,,,,,46.82,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,outpatient,1,EA,85.13000,80.87000,The Alliance,PPO Network,,70.74,,,,,,,42.56,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,11.06,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,inpatient,1,EA,102.70000,97.56000,The Alliance,PPO Network,,85.34,,,,,,,56.48,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,PPO Network,,85.34,,,,,,,51.35,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,31.60,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,23.46,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,21.33,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,inpatient,1,EA,92.43000,87.81000,The Alliance,PPO Network,,76.81,,,,,,,50.84,89.66,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,outpatient,1,EA,92.43000,87.81000,The Alliance,PPO Network,,76.81,,,,,,,46.22,89.66,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,inpatient,5,EA,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.90,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,outpatient,5,EA,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.73,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,inpatient,5,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,outpatient,5,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,inpatient,5,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.58,4.55,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.35,4.55,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,The Alliance,PPO Network,,36.33,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,PPO Network,,36.33,,,,,,,21.86,42.41,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,The Alliance,PPO Network,,61.34,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,PPO Network,,61.34,,,,,,,36.91,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,The Alliance,PPO Network,,61.34,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,PPO Network,,61.34,,,,,,,36.91,71.61,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,inpatient,1,EA,4.98000,4.74000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,inpatient,,,193.00000,183.35000,The Alliance,PPO Network,,160.38,,,,,,,106.15,187.21,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,PPO Network,,160.38,,,,,,,14.69,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,inpatient,5,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,outpatient,5,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.53,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,inpatient,5,EA,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.39,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,outpatient,5,EA,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.26,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,inpatient,5,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,outpatient,5,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,inpatient,5,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,3.09,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,outpatient,5,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,2.81,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,inpatient,1,mL,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,inpatient,1,mL,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,outpatient,1,mL,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,inpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.55,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.31,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,inpatient,1,mL,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,inpatient,1,GM,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,outpatient,1,GM,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,inpatient,1,GM,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,outpatient,1,GM,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,inpatient,1,GM,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,outpatient,1,GM,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,inpatient,1,GM,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,outpatient,1,GM,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,inpatient,1,EA,4701.43000,4466.36000,The Alliance,PPO Network,,3906.89,,,,,,,2585.79,4560.39,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,outpatient,1,EA,4701.43000,4466.36000,The Alliance,PPO Network,,3906.89,,,,,,,155.42,4560.39,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,inpatient,50,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,outpatient,50,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,inpatient,50,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,outpatient,50,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,inpatient,50,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,outpatient,50,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,inpatient,50,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,inpatient,50,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,inpatient,50,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,inpatient,50,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,outpatient,50,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,inpatient,50,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,outpatient,50,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,inpatient,50,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,inpatient,50,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,3.23,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,61.05,107.67,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,55.50,107.67,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,inpatient,1,mL,21.71000,20.62000,The Alliance,PPO Network,,18.04,,,,,,,11.94,21.06,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,outpatient,1,mL,21.71000,20.62000,The Alliance,PPO Network,,18.04,,,,,,,10.86,21.06,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,inpatient,1,EA,21.40000,20.33000,The Alliance,PPO Network,,17.78,,,,,,,11.77,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,outpatient,1,EA,21.40000,20.33000,The Alliance,PPO Network,,17.78,,,,,,,10.70,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,inpatient,1,EA,5.76000,5.47000,The Alliance,PPO Network,,4.79,,,,,,,3.17,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,outpatient,1,EA,5.76000,5.47000,The Alliance,PPO Network,,4.79,,,,,,,2.88,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,inpatient,1,EA,9.33000,8.86000,The Alliance,PPO Network,,7.75,,,,,,,5.13,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,outpatient,1,EA,9.33000,8.86000,The Alliance,PPO Network,,7.75,,,,,,,4.67,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,inpatient,1,EA,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,4.27,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,3.88,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,inpatient,50,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,outpatient,50,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,inpatient,50,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,outpatient,50,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,inpatient,50,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,outpatient,50,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,inpatient,50,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,inpatient,50,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.87,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,outpatient,50,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.70,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,inpatient,50,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,outpatient,50,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,inpatient,50,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,outpatient,50,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,inpatient,50,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,outpatient,50,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,inpatient,50,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,outpatient,50,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,inpatient,30,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,outpatient,30,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,inpatient,30,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,outpatient,30,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,inpatient,30,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,inpatient,30,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,outpatient,30,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,inpatient,30,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,outpatient,30,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,inpatient,20,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,outpatient,20,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,inpatient,20,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,inpatient,20,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,outpatient,20,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,inpatient,20,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,outpatient,20,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,inpatient,20,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,outpatient,20,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,inpatient,20,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,outpatient,20,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,inpatient,20,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,inpatient,20,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,outpatient,20,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,inpatient,5,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,outpatient,5,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,inpatient,5,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,inpatient,5,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,outpatient,5,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,inpatient,5,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,outpatient,5,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,inpatient,5,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,outpatient,5,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,inpatient,5,EA,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,outpatient,5,EA,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,inpatient,5,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,outpatient,5,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,inpatient,5,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,outpatient,5,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,inpatient,5,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,outpatient,5,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,inpatient,5,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,outpatient,5,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,inpatient,5,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,outpatient,5,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,inpatient,1,EA,7754.97000,7367.22000,The Alliance,PPO Network,,6444.38,,,,,,,4265.23,7522.32,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,outpatient,1,EA,7754.97000,7367.22000,The Alliance,PPO Network,,6444.38,,,,,,,1737.10,7522.32,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,inpatient,50,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,inpatient,50,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,outpatient,50,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,inpatient,50,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,outpatient,50,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,inpatient,2,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,outpatient,2,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,inpatient,2,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,outpatient,2,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,inpatient,2,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,outpatient,2,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,inpatient,2,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,outpatient,2,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,inpatient,2,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,outpatient,2,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,inpatient,2,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,outpatient,2,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,inpatient,1,mL,2.03000,1.92000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,outpatient,1,mL,2.03000,1.92000,The Alliance,PPO Network,,1.69,,,,,,,1.01,1.97,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,inpatient,1,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,1.59,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,3.23,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,inpatient,1,EA,9.47000,8.99000,The Alliance,PPO Network,,7.87,,,,,,,5.21,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,outpatient,1,EA,9.47000,8.99000,The Alliance,PPO Network,,7.87,,,,,,,4.74,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,inpatient,1,EA,22.15000,21.04000,The Alliance,PPO Network,,18.41,,,,,,,12.18,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,outpatient,1,EA,22.15000,21.04000,The Alliance,PPO Network,,18.41,,,,,,,11.07,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,inpatient,1,EA,20.38000,19.36000,The Alliance,PPO Network,,16.94,,,,,,,11.21,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,outpatient,1,EA,20.38000,19.36000,The Alliance,PPO Network,,16.94,,,,,,,10.19,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,inpatient,1,EA,57.42000,54.55000,The Alliance,PPO Network,,47.72,,,,,,,31.58,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,outpatient,1,EA,57.42000,54.55000,The Alliance,PPO Network,,47.72,,,,,,,28.71,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,4.37,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,3.97,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,4.96,8.74,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,4.50,8.74,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,inpatient,10,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,inpatient,1,mL,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,inpatient,1,EA,4.48000,4.25000,The Alliance,PPO Network,,3.72,,,,,,,2.46,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,outpatient,1,EA,4.48000,4.25000,The Alliance,PPO Network,,3.72,,,,,,,2.24,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.87,5.06,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,PPO Network,,4.34,,,,,,,2.61,5.06,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,inpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,55.55,97.97,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,10.50,492.33,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,inpatient,1,EA,3945.28000,3748.02000,The Alliance,PPO Network,,3278.53,,,,,,,2169.90,3826.92,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,outpatient,1,EA,3945.28000,3748.02000,The Alliance,PPO Network,,3278.53,,,,,,,1737.10,3826.92,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,inpatient,,,1981.00000,1881.95000,The Alliance,PPO Network,TC,1646.21,,,,,,,1089.55,1921.57,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,outpatient,,,1981.00000,1881.95000,The Alliance,PPO Network,TC,1646.21,,,,,,,931.15,2210.07,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,8.19,424.40,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,inpatient,1,mL,997.15000,947.29000,The Alliance,PPO Network,,828.63,,,,,,,548.43,967.24,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,outpatient,1,mL,997.15000,947.29000,The Alliance,PPO Network,,828.63,,,,,,,498.57,967.24,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,inpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,inpatient,1,EA,2.24000,2.12000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.15,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,TC,182.82,,,,,,,121.00,213.40,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,TC,182.82,,,,,,,110.00,213.40,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,6.89,356.54,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,14.32,679.08,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,inpatient,300,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,outpatient,300,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.50,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,inpatient,300,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,outpatient,300,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,inpatient,300,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,outpatient,300,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,inpatient,300,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,outpatient,300,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,inpatient,300,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,outpatient,300,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,inpatient,300,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,outpatient,300,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,inpatient,300,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,outpatient,300,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,5.76,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,90,304.15,,,,,,,201.30,355.02,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,90,304.15,,,,,,,35.33,1646.71,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,13.39,833.98,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,inpatient,1,EA,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,inpatient,1,EA,4.98000,4.74000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,inpatient,1,EA,1.86000,1.76000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.00465,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.00465,0.07760,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,inpatient,1,mL,12.70000,12.07000,The Alliance,PPO Network,,10.55,,,,,,,6.99,12.32,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,outpatient,1,mL,12.70000,12.07000,The Alliance,PPO Network,,10.55,,,,,,,0.22165,12.32,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,inpatient,1,EA,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,PPO Network,TC,226.86,,,,,,,150.15,264.81,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,PPO Network,TC,226.86,,,,,,,136.50,1499.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,inpatient,1,EA,440.47000,418.45000,The Alliance,PPO Network,,366.03,,,,,,,242.26,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,outpatient,1,EA,440.47000,418.45000,The Alliance,PPO Network,,366.03,,,,,,,220.24,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,inpatient,1,EA,19.56000,18.58000,The Alliance,PPO Network,,16.25,,,,,,,10.76,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,outpatient,1,EA,19.56000,18.58000,The Alliance,PPO Network,,16.25,,,,,,,9.78,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,inpatient,1,EA,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,10.22,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,9.29,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,inpatient,1,EA,30.43000,28.91000,The Alliance,PPO Network,,25.29,,,,,,,16.74,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,outpatient,1,EA,30.43000,28.91000,The Alliance,PPO Network,,25.29,,,,,,,15.21,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.34,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,inpatient,50,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,inpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,107.25,189.15,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,17.03,882.80,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,TC,1350.38,,,,,,,893.75,1576.25,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,TC,1350.38,,,,,,,812.50,9133.75,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,inpatient,1,EA,11.72000,11.14000,The Alliance,PPO Network,,9.74,,,,,,,6.45,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,outpatient,1,EA,11.72000,11.14000,The Alliance,PPO Network,,9.74,,,,,,,5.86,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,inpatient,,,205.00000,194.75000,The Alliance,PPO Network,,170.35,,,,,,,112.75,198.85,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,PPO Network,,170.35,,,,,,,18.52,967.70,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,4.27,220.68,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,inpatient,1,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,2.11,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,inpatient,1,EA,5.39000,5.12000,The Alliance,PPO Network,,4.48,,,,,,,2.96,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,PPO Network,,4.48,,,,,,,2.11,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,inpatient,1,EA,6.01000,5.71000,The Alliance,PPO Network,,4.99,,,,,,,3.31,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,outpatient,1,EA,6.01000,5.71000,The Alliance,PPO Network,,4.99,,,,,,,2.11,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,2.11,9.96,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,TC,164.54,,,,,,,108.90,192.06,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,TC,164.54,,,,,,,88.31,1126.22,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,PPO Network,TC,68.14,,,,,,,45.10,79.54,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,PPO Network,TC,68.14,,,,,,,41.00,515.07,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,2.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,1397.87,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,inpatient,,,306.10000,290.80000,The Alliance,PPO Network,90,254.37,,,,,,,168.35,296.92,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,outpatient,,,306.10000,290.80000,The Alliance,PPO Network,90,254.37,,,,,,,27.54,1290.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,18.50,442.00,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1425.05,2513.27,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1295.50,12902.54,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,4.31,220.68,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,inpatient,300,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,outpatient,300,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,inpatient,300,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,outpatient,300,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,inpatient,100,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,inpatient,100,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,outpatient,100,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,inpatient,100,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,outpatient,100,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,inpatient,100,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,outpatient,100,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,inpatient,100,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,outpatient,100,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,The Alliance,PPO Network,TC,2878.58,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,PPO Network,TC,2878.58,,,,,,,1611.84,3360.08,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,inpatient,1,EA,2.24000,2.12000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,inpatient,1,mL,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,inpatient,1,mL,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,outpatient,1,mL,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,inpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,44.55,78.57,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,40.50,134.64,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,177.65,313.31,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,161.50,2815.39,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,4.06,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,The Alliance,PPO Network,,19.46,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,PPO Network,,19.46,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,6.61,339.51,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,6.70,356.54,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,inpatient,,,2973.00000,2824.35000,The Alliance,PPO Network,,2470.56,,,,,,,1635.15,2883.81,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,outpatient,,,2973.00000,2824.35000,The Alliance,PPO Network,,2470.56,,,,,,,636.00,37399.48,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,inpatient,30,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,outpatient,30,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,2.61,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,inpatient,1,mL,166.31000,158.00000,The Alliance,PPO Network,,138.20,,,,,,,91.47,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,outpatient,1,mL,166.31000,158.00000,The Alliance,PPO Network,,138.20,,,,,,,0.94620,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,inpatient,1,mL,173.64000,164.96000,The Alliance,PPO Network,,144.29,,,,,,,95.50,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,outpatient,1,mL,173.64000,164.96000,The Alliance,PPO Network,,144.29,,,,,,,0.94620,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,78.21,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,0.94620,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,inpatient,1,mL,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,95.59,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,0.94620,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,inpatient,1,mL,257.67000,244.78000,The Alliance,PPO Network,,214.12,,,,,,,141.72,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,outpatient,1,mL,257.67000,244.78000,The Alliance,PPO Network,,214.12,,,,,,,0.94620,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,inpatient,1,mL,257.40000,244.53000,The Alliance,PPO Network,,213.90,,,,,,,141.57,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,outpatient,1,mL,257.40000,244.53000,The Alliance,PPO Network,,213.90,,,,,,,0.94620,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,inpatient,1,mL,193.96000,184.26000,The Alliance,PPO Network,,161.18,,,,,,,106.68,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,outpatient,1,mL,193.96000,184.26000,The Alliance,PPO Network,,161.18,,,,,,,0.94620,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,inpatient,1,mL,115.78000,109.99000,The Alliance,PPO Network,,96.21,,,,,,,63.68,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,outpatient,1,mL,115.78000,109.99000,The Alliance,PPO Network,,96.21,,,,,,,0.94620,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,inpatient,1,mL,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,121.66,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,outpatient,1,mL,221.20000,210.14000,The Alliance,PPO Network,,183.82,,,,,,,0.94620,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,inpatient,1,mL,193.05000,183.40000,The Alliance,PPO Network,,160.42,,,,,,,106.18,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,outpatient,1,mL,193.05000,183.40000,The Alliance,PPO Network,,160.42,,,,,,,0.94620,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,inpatient,1,mL,108.69000,103.25000,The Alliance,PPO Network,,90.32,,,,,,,59.78,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,outpatient,1,mL,108.69000,103.25000,The Alliance,PPO Network,,90.32,,,,,,,0.94620,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,inpatient,1,mL,108.67000,103.24000,The Alliance,PPO Network,,90.30,,,,,,,59.77,105.41,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,outpatient,1,mL,108.67000,103.24000,The Alliance,PPO Network,,90.30,,,,,,,0.94620,105.41,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,inpatient,500,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,outpatient,500,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,3.75,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,inpatient,500,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,outpatient,500,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,3.75,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,inpatient,1,EA,23.42000,22.24000,The Alliance,PPO Network,,19.46,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,outpatient,1,EA,23.42000,22.24000,The Alliance,PPO Network,,19.46,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,The Alliance,PPO Network,,19.46,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,PPO Network,,19.46,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,inpatient,1,EA,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,outpatient,1,EA,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,inpatient,50,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,outpatient,50,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,3.75,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,inpatient,50,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,outpatient,50,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,3.75,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,PPO Network,,309.96,,,,,,,186.50,361.81,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,TC,30.75,,,,,,,18.50,442.00,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,inpatient,1,mL,19.43000,18.46000,The Alliance,PPO Network,,16.15,,,,,,,10.69,18.85,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,outpatient,1,mL,19.43000,18.46000,The Alliance,PPO Network,,16.15,,,,,,,9.71,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,inpatient,1,mL,11.57000,10.99000,The Alliance,PPO Network,,9.61,,,,,,,6.36,11.22,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,outpatient,1,mL,11.57000,10.99000,The Alliance,PPO Network,,9.61,,,,,,,5.79,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,inpatient,1,mL,8.35000,7.93000,The Alliance,PPO Network,,6.94,,,,,,,4.59,8.10,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,outpatient,1,mL,8.35000,7.93000,The Alliance,PPO Network,,6.94,,,,,,,4.17,25.89,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,95.70,168.78,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,15.49,814.87,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,inpatient,1,EA,45.82000,43.53000,The Alliance,PPO Network,,38.08,,,,,,,25.20,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,outpatient,1,EA,45.82000,43.53000,The Alliance,PPO Network,,38.08,,,,,,,0.66805,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.66805,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,0.66805,18.39,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,2.11,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,2.11,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,inpatient,1,mL,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,inpatient,1,mL,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,11.52,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,outpatient,1,mL,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,2.11,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,inpatient,1,mL,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,outpatient,1,mL,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,2.11,6.29,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,inpatient,1,mL,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.57,2.76,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,outpatient,1,mL,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.43,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.47,4.28,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,inpatient,1,mL,18.20000,17.29000,The Alliance,PPO Network,,15.12,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,PPO Network,,15.12,,,,,,,9.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,inpatient,1,mL,12.20000,11.59000,The Alliance,PPO Network,,10.14,,,,,,,6.71,11.83,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,outpatient,1,mL,12.20000,11.59000,The Alliance,PPO Network,,10.14,,,,,,,6.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,inpatient,1,mL,8.33000,7.91000,The Alliance,PPO Network,,6.92,,,,,,,4.58,8.08,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,outpatient,1,mL,8.33000,7.91000,The Alliance,PPO Network,,6.92,,,,,,,4.17,25.89,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,inpatient,,,286.43000,272.11000,The Alliance,PPO Network,,238.02,,,,,,,157.54,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,outpatient,,,286.43000,272.11000,The Alliance,PPO Network,,238.02,,,,,,,143.22,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,inpatient,1,mL,572.85000,544.21000,The Alliance,PPO Network,,476.04,,,,,,,315.07,555.66,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,outpatient,1,mL,572.85000,544.21000,The Alliance,PPO Network,,476.04,,,,,,,187.18,555.66,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,inpatient,1,EA,24.86000,23.62000,The Alliance,PPO Network,,20.66,,,,,,,13.67,24.11,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,outpatient,1,EA,24.86000,23.62000,The Alliance,PPO Network,,20.66,,,,,,,12.43,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,inpatient,1,EA,370.86000,352.32000,The Alliance,PPO Network,,308.18,,,,,,,203.97,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,outpatient,1,EA,370.86000,352.32000,The Alliance,PPO Network,,308.18,,,,,,,32.99,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,inpatient,1,EA,95.97000,91.17000,The Alliance,PPO Network,,79.75,,,,,,,52.78,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,outpatient,1,EA,95.97000,91.17000,The Alliance,PPO Network,,79.75,,,,,,,32.99,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,inpatient,1,EA,21.68000,20.60000,The Alliance,PPO Network,,18.02,,,,,,,11.92,21.03,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,outpatient,1,EA,21.68000,20.60000,The Alliance,PPO Network,,18.02,,,,,,,10.84,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,inpatient,1,EA,62.44000,59.32000,The Alliance,PPO Network,,51.89,,,,,,,34.34,60.57,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,outpatient,1,EA,62.44000,59.32000,The Alliance,PPO Network,,51.89,,,,,,,31.22,60.57,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,inpatient,30,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,inpatient,30,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,inpatient,30,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.51,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.01,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,inpatient,1,EA,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,2.57,4.54,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,2.34,4.54,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,inpatient,1,EA,92.08000,87.48000,The Alliance,PPO Network,,76.52,,,,,,,50.64,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,outpatient,1,EA,92.08000,87.48000,The Alliance,PPO Network,,76.52,,,,,,,0.66805,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,0.66805,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,inpatient,1,EA,212.08000,201.47000,The Alliance,PPO Network,,176.24,,,,,,,116.64,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,outpatient,1,EA,212.08000,201.47000,The Alliance,PPO Network,,176.24,,,,,,,0.66805,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,inpatient,1,EA,86.25000,81.93000,The Alliance,PPO Network,,71.67,,,,,,,47.44,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,outpatient,1,EA,86.25000,81.93000,The Alliance,PPO Network,,71.67,,,,,,,0.66805,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,inpatient,1,EA,32.77000,31.13000,The Alliance,PPO Network,,27.23,,,,,,,18.02,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,outpatient,1,EA,32.77000,31.13000,The Alliance,PPO Network,,27.23,,,,,,,0.66805,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,inpatient,1,EA,177.91000,169.01000,The Alliance,PPO Network,,147.84,,,,,,,97.85,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,outpatient,1,EA,177.91000,169.01000,The Alliance,PPO Network,,147.84,,,,,,,0.66805,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,inpatient,1,EA,87.82000,83.43000,The Alliance,PPO Network,,72.98,,,,,,,48.30,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,PPO Network,,72.98,,,,,,,0.66805,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,inpatient,1,EA,91.64000,87.06000,The Alliance,PPO Network,,76.15,,,,,,,50.40,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,outpatient,1,EA,91.64000,87.06000,The Alliance,PPO Network,,76.15,,,,,,,0.66805,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,inpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,0.66805,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,10.25,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,0.66805,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,0.66805,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,0.66805,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,inpatient,1,EA,18.17000,17.26000,The Alliance,PPO Network,,15.10,,,,,,,9.99,17.62,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,outpatient,1,EA,18.17000,17.26000,The Alliance,PPO Network,,15.10,,,,,,,0.66805,17.62,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,inpatient,,,188.80000,179.36000,The Alliance,PPO Network,90,156.89,,,,,,,103.84,183.14,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,outpatient,,,188.80000,179.36000,The Alliance,PPO Network,90,156.89,,,,,,,16.80,848.80,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,inpatient,1,EA,5.74000,5.45000,The Alliance,PPO Network,,4.77,,,,,,,3.16,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,outpatient,1,EA,5.74000,5.45000,The Alliance,PPO Network,,4.77,,,,,,,2.87,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.32,6.44,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,inpatient,1,EA,9.63000,9.15000,The Alliance,PPO Network,,8.00,,,,,,,5.30,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,outpatient,1,EA,9.63000,9.15000,The Alliance,PPO Network,,8.00,,,,,,,0.31155,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,inpatient,1,EA,8.80000,8.36000,The Alliance,PPO Network,,7.31,,,,,,,4.84,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,PPO Network,,7.31,,,,,,,0.31155,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,5.18,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,0.31155,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.31155,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,0.31155,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,inpatient,1,EA,8.75000,8.32000,The Alliance,PPO Network,,7.27,,,,,,,4.81,8.49,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,outpatient,1,EA,8.75000,8.32000,The Alliance,PPO Network,,7.27,,,,,,,0.31155,8.49,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,inpatient,1,EA,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,outpatient,1,EA,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,inpatient,1,EA,133.19000,126.53000,The Alliance,PPO Network,,110.68,,,,,,,73.25,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,outpatient,1,EA,133.19000,126.53000,The Alliance,PPO Network,,110.68,,,,,,,2.53,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,inpatient,1,EA,262.28000,249.17000,The Alliance,PPO Network,,217.95,,,,,,,144.25,254.41,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,outpatient,1,EA,262.28000,249.17000,The Alliance,PPO Network,,217.95,,,,,,,2.53,254.41,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,inpatient,1,EA,5.38000,5.11000,The Alliance,PPO Network,,4.47,,,,,,,2.96,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,outpatient,1,EA,5.38000,5.11000,The Alliance,PPO Network,,4.47,,,,,,,2.69,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,inpatient,1,EA,9.83000,9.34000,The Alliance,PPO Network,,8.17,,,,,,,5.41,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,outpatient,1,EA,9.83000,9.34000,The Alliance,PPO Network,,8.17,,,,,,,4.92,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,TC,198.61,,,,,,,131.45,231.83,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,TC,198.61,,,,,,,119.50,2142.86,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,inpatient,1,EA,19.37000,18.40000,The Alliance,PPO Network,,16.10,,,,,,,10.65,18.79,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,outpatient,1,EA,19.37000,18.40000,The Alliance,PPO Network,,16.10,,,,,,,9.69,18.79,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,inpatient,1,EA,224.08000,212.87000,The Alliance,PPO Network,,186.21,,,,,,,123.24,217.36,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,PPO Network,,186.21,,,,,,,112.04,217.36,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,4.12,390.47,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,inpatient,1,EA,149.72000,142.23000,The Alliance,PPO Network,,124.42,,,,,,,82.35,145.23,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,outpatient,1,EA,149.72000,142.23000,The Alliance,PPO Network,,124.42,,,,,,,0.26000,145.23,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,inpatient,1,EA,62.79000,59.65000,The Alliance,PPO Network,,52.18,,,,,,,34.53,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,outpatient,1,EA,62.79000,59.65000,The Alliance,PPO Network,,52.18,,,,,,,31.39,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,inpatient,1,EA,196.71000,186.87000,The Alliance,PPO Network,,163.47,,,,,,,108.19,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,outpatient,1,EA,196.71000,186.87000,The Alliance,PPO Network,,163.47,,,,,,,98.36,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,36.93,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,33.58,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,inpatient,1,EA,169.96000,161.46000,The Alliance,PPO Network,,141.24,,,,,,,93.48,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,outpatient,1,EA,169.96000,161.46000,The Alliance,PPO Network,,141.24,,,,,,,84.98,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,inpatient,1,EA,169.86000,161.37000,The Alliance,PPO Network,,141.15,,,,,,,93.42,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,outpatient,1,EA,169.86000,161.37000,The Alliance,PPO Network,,141.15,,,,,,,84.93,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,inpatient,1,EA,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,95.59,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,86.90,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,inpatient,1,EA,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,28.68,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,outpatient,1,EA,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,26.07,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,inpatient,1,EA,44.32000,42.10000,The Alliance,PPO Network,,36.83,,,,,,,24.38,42.99,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,outpatient,1,EA,44.32000,42.10000,The Alliance,PPO Network,,36.83,,,,,,,22.16,42.99,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,inpatient,1,GM,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,outpatient,1,GM,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,inpatient,1,GM,1.36000,1.30000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,outpatient,1,GM,1.36000,1.30000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,inpatient,45,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,outpatient,45,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,inpatient,45,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,outpatient,45,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,inpatient,45,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,outpatient,45,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,inpatient,45,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,outpatient,45,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,inpatient,1,EA,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,3.12,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,2.84,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.54,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.31,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,inpatient,1,EA,3.85000,3.65000,The Alliance,PPO Network,,3.20,,,,,,,2.12,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,outpatient,1,EA,3.85000,3.65000,The Alliance,PPO Network,,3.20,,,,,,,1.93,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.57,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.77,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.52,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,inpatient,1,mL,82.30000,78.18000,The Alliance,PPO Network,,68.39,,,,,,,45.27,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,outpatient,1,mL,82.30000,78.18000,The Alliance,PPO Network,,68.39,,,,,,,7.86,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,inpatient,1,mL,74.07000,70.36000,The Alliance,PPO Network,,61.55,,,,,,,40.74,71.85,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,outpatient,1,mL,74.07000,70.36000,The Alliance,PPO Network,,61.55,,,,,,,7.86,71.85,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,inpatient,1,mL,10.61000,10.08000,The Alliance,PPO Network,,8.82,,,,,,,5.84,10.29,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,outpatient,1,mL,10.61000,10.08000,The Alliance,PPO Network,,8.82,,,,,,,3.62,10.29,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,inpatient,1,EA,32.92000,31.27000,The Alliance,PPO Network,,27.36,,,,,,,18.11,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,outpatient,1,EA,32.92000,31.27000,The Alliance,PPO Network,,27.36,,,,,,,0.26000,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,inpatient,1,EA,20.41000,19.39000,The Alliance,PPO Network,,16.96,,,,,,,11.23,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,outpatient,1,EA,20.41000,19.39000,The Alliance,PPO Network,,16.96,,,,,,,0.26000,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,13.21,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,0.26000,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,inpatient,1,EA,36.81000,34.97000,The Alliance,PPO Network,,30.59,,,,,,,20.25,35.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,outpatient,1,EA,36.81000,34.97000,The Alliance,PPO Network,,30.59,,,,,,,0.26000,35.71,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,4.75,254.68,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,inpatient,1,EA,262.63000,249.50000,The Alliance,PPO Network,,218.25,,,,,,,144.45,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,outpatient,1,EA,262.63000,249.50000,The Alliance,PPO Network,,218.25,,,,,,,0.26000,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,inpatient,1,EA,138.98000,132.03000,The Alliance,PPO Network,,115.49,,,,,,,76.44,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,PPO Network,,115.49,,,,,,,0.26000,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,inpatient,1,EA,132.37000,125.75000,The Alliance,PPO Network,,110.00,,,,,,,72.80,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,outpatient,1,EA,132.37000,125.75000,The Alliance,PPO Network,,110.00,,,,,,,0.26000,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,inpatient,1,EA,102.70000,97.56000,The Alliance,PPO Network,,85.34,,,,,,,56.48,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,PPO Network,,85.34,,,,,,,0.26000,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,inpatient,1,EA,108.14000,102.73000,The Alliance,PPO Network,,89.86,,,,,,,59.48,104.90,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,outpatient,1,EA,108.14000,102.73000,The Alliance,PPO Network,,89.86,,,,,,,0.26000,104.90,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,inpatient,5,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,inpatient,1,EA,20.44000,19.42000,The Alliance,PPO Network,,16.99,,,,,,,11.24,19.83,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,outpatient,1,EA,20.44000,19.42000,The Alliance,PPO Network,,16.99,,,,,,,0.26000,19.83,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,5.78,305.58,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,95.70,168.78,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,14.55,763.98,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,inpatient,1,EA,1.37000,1.31000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,outpatient,1,EA,1.37000,1.31000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,inpatient,1,EA,31.54000,29.96000,The Alliance,PPO Network,,26.21,,,,,,,17.35,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,outpatient,1,EA,31.54000,29.96000,The Alliance,PPO Network,,26.21,,,,,,,15.77,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,3.49,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,inpatient,1,EA,62.32000,59.20000,The Alliance,PPO Network,,51.79,,,,,,,34.28,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,outpatient,1,EA,62.32000,59.20000,The Alliance,PPO Network,,51.79,,,,,,,0.12000,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,inpatient,1,EA,62.33000,59.21000,The Alliance,PPO Network,,51.80,,,,,,,34.28,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,outpatient,1,EA,62.33000,59.21000,The Alliance,PPO Network,,51.80,,,,,,,0.12000,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,inpatient,1,EA,45.19000,42.93000,The Alliance,PPO Network,,37.55,,,,,,,24.85,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,outpatient,1,EA,45.19000,42.93000,The Alliance,PPO Network,,37.55,,,,,,,0.12000,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,inpatient,1,EA,51.57000,48.99000,The Alliance,PPO Network,,42.85,,,,,,,28.36,50.02,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,outpatient,1,EA,51.57000,48.99000,The Alliance,PPO Network,,42.85,,,,,,,0.12000,50.02,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,16.94,882.80,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,inpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,inpatient,2,EA,5.30000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,2.92,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,outpatient,2,EA,5.30000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,1.60,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,inpatient,2,EA,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,2.37,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,outpatient,2,EA,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,1.60,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,inpatient,2,EA,5.29000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,2.91,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,outpatient,2,EA,5.29000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,1.60,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,inpatient,2,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,outpatient,2,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,1.88,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,inpatient,2,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.60,3.38,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,inpatient,1,mL,56.56000,53.73000,The Alliance,PPO Network,,47.00,,,,,,,31.11,54.86,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,outpatient,1,mL,56.56000,53.73000,The Alliance,PPO Network,,47.00,,,,,,,7.86,54.86,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,8.65,458.40,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.82,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.66,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.14,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.04,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,inpatient,1,EA,1.43000,1.35000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,PPO Network,,1.19,,,,,,,0.71500,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.12,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,inpatient,5,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,outpatient,5,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,inpatient,5,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,outpatient,5,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,inpatient,5,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,outpatient,5,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,1.82,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,inpatient,5,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,outpatient,5,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,inpatient,5,EA,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,outpatient,5,EA,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,inpatient,5,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,outpatient,5,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.01,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,inpatient,5,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,outpatient,5,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,inpatient,5,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,outpatient,5,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,inpatient,5,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,outpatient,5,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,inpatient,5,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,inpatient,5,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,outpatient,5,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,inpatient,1,EA,9.67000,9.18000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,PPO Network,,8.04,,,,,,,0.36823,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.36823,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,0.36823,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,inpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,inpatient,1,EA,5.88000,5.58000,The Alliance,PPO Network,,4.89,,,,,,,3.23,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,outpatient,1,EA,5.88000,5.58000,The Alliance,PPO Network,,4.89,,,,,,,0.36823,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.36823,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.36823,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,0.36823,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,inpatient,1,EA,5.28000,5.02000,The Alliance,PPO Network,,4.39,,,,,,,2.90,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,outpatient,1,EA,5.28000,5.02000,The Alliance,PPO Network,,4.39,,,,,,,0.36823,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.36823,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,inpatient,5,EA,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,outpatient,5,EA,3.48000,3.31000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,inpatient,5,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,outpatient,5,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,inpatient,5,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,The Alliance,PPO Network,,14.48,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,PPO Network,,14.48,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,The Alliance,PPO Network,,14.48,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,PPO Network,,14.48,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,inpatient,1,EA,7.18000,6.82000,The Alliance,PPO Network,,5.97,,,,,,,3.95,6.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,outpatient,1,EA,7.18000,6.82000,The Alliance,PPO Network,,5.97,,,,,,,3.59,6.96,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,inpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,inpatient,,,25.30000,24.04000,The Alliance,PPO Network,,21.02,,,,,,,13.91,24.54,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,outpatient,,,25.30000,24.04000,The Alliance,PPO Network,,21.02,,,,,,,12.65,24.54,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,53.00,788.42,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,inpatient,1,EA,9.04000,8.59000,The Alliance,PPO Network,,7.51,,,,,,,4.97,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,outpatient,1,EA,9.04000,8.59000,The Alliance,PPO Network,,7.51,,,,,,,0.12000,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,inpatient,1,EA,35.92000,34.13000,The Alliance,PPO Network,,29.85,,,,,,,19.76,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,outpatient,1,EA,35.92000,34.13000,The Alliance,PPO Network,,29.85,,,,,,,0.12000,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,inpatient,1,EA,35.90000,34.10000,The Alliance,PPO Network,,29.83,,,,,,,19.75,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,outpatient,1,EA,35.90000,34.10000,The Alliance,PPO Network,,29.83,,,,,,,0.12000,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,inpatient,1,EA,27.49000,26.12000,The Alliance,PPO Network,,22.84,,,,,,,15.12,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,outpatient,1,EA,27.49000,26.12000,The Alliance,PPO Network,,22.84,,,,,,,0.12000,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,inpatient,1,EA,27.99000,26.59000,The Alliance,PPO Network,,23.26,,,,,,,15.39,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,outpatient,1,EA,27.99000,26.59000,The Alliance,PPO Network,,23.26,,,,,,,0.12000,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,inpatient,1,EA,30.46000,28.94000,The Alliance,PPO Network,,25.31,,,,,,,16.75,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,outpatient,1,EA,30.46000,28.94000,The Alliance,PPO Network,,25.31,,,,,,,0.12000,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,inpatient,1,EA,30.45000,28.92000,The Alliance,PPO Network,,25.30,,,,,,,16.75,29.54,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,outpatient,1,EA,30.45000,28.92000,The Alliance,PPO Network,,25.30,,,,,,,0.12000,29.54,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.39,288.61,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,inpatient,1,EA,569.80000,541.31000,The Alliance,PPO Network,,473.50,,,,,,,313.39,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,outpatient,1,EA,569.80000,541.31000,The Alliance,PPO Network,,473.50,,,,,,,28.27,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,inpatient,1,EA,2907.20000,2761.84000,The Alliance,PPO Network,,2415.88,,,,,,,1598.96,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,outpatient,1,EA,2907.20000,2761.84000,The Alliance,PPO Network,,2415.88,,,,,,,28.27,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,inpatient,1,EA,2907.11000,2761.75000,The Alliance,PPO Network,,2415.81,,,,,,,1598.91,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,outpatient,1,EA,2907.11000,2761.75000,The Alliance,PPO Network,,2415.81,,,,,,,28.27,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,356.12,628.08,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,28.27,628.08,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,45.10,79.54,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,4.05,339.51,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,7.48,356.54,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,inpatient,1,EA,5.16000,4.90000,The Alliance,PPO Network,,4.29,,,,,,,2.84,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,PPO Network,,4.29,,,,,,,2.58,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.90,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.73,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,inpatient,1,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,2.05,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,1.86,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,inpatient,,,161.35000,153.28000,The Alliance,PPO Network,,134.08,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,outpatient,,,161.35000,153.28000,The Alliance,PPO Network,,134.08,,,,,,,80.67,185.08,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,inpatient,1,EA,161.35000,153.28000,The Alliance,PPO Network,,134.08,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,outpatient,1,EA,161.35000,153.28000,The Alliance,PPO Network,,134.08,,,,,,,80.67,185.08,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,inpatient,1,EA,6.15000,5.84000,The Alliance,PPO Network,,5.11,,,,,,,3.38,5.97,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,outpatient,1,EA,6.15000,5.84000,The Alliance,PPO Network,,5.11,,,,,,,3.08,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,inpatient,1,EA,7.89000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.65,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,outpatient,1,EA,7.89000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.94,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.54,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,inpatient,1,EA,10.88000,10.34000,The Alliance,PPO Network,,9.04,,,,,,,5.98,10.55,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,outpatient,1,EA,10.88000,10.34000,The Alliance,PPO Network,,9.04,,,,,,,5.44,10.55,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,inpatient,1,EA,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,4.01,7.08,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,outpatient,1,EA,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,3.65,7.69,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,inpatient,1,EA,17.65000,16.77000,The Alliance,PPO Network,,14.67,,,,,,,9.71,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,outpatient,1,EA,17.65000,16.77000,The Alliance,PPO Network,,14.67,,,,,,,7.18,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,inpatient,1,EA,8.05000,7.65000,The Alliance,PPO Network,,6.69,,,,,,,4.43,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,outpatient,1,EA,8.05000,7.65000,The Alliance,PPO Network,,6.69,,,,,,,4.03,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,inpatient,1,EA,8.41000,7.99000,The Alliance,PPO Network,,6.99,,,,,,,4.63,8.16,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,outpatient,1,EA,8.41000,7.99000,The Alliance,PPO Network,,6.99,,,,,,,4.21,8.16,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,108.35,191.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,98.50,212.44,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,inpatient,1,EA,12.55000,11.92000,The Alliance,PPO Network,,10.43,,,,,,,6.90,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,outpatient,1,EA,12.55000,11.92000,The Alliance,PPO Network,,10.43,,,,,,,6.28,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,The Alliance,PPO Network,,5.43,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,PPO Network,,5.43,,,,,,,3.27,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,The Alliance,PPO Network,,5.43,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,PPO Network,,5.43,,,,,,,3.27,6.33,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,inpatient,1,EA,217.79000,206.90000,The Alliance,PPO Network,,180.98,,,,,,,119.78,211.26,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,outpatient,1,EA,217.79000,206.90000,The Alliance,PPO Network,,180.98,,,,,,,0.26000,211.26,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,inpatient,100,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,inpatient,100,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,outpatient,100,EA,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,inpatient,100,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,inpatient,100,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,inpatient,100,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,inpatient,100,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,outpatient,100,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,inpatient,100,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,inpatient,100,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,outpatient,100,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,39.60,69.84,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,5.99,1216.68,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,inpatient,1,EA,15.06000,14.31000,The Alliance,PPO Network,,12.51,,,,,,,8.28,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,outpatient,1,EA,15.06000,14.31000,The Alliance,PPO Network,,12.51,,,,,,,7.53,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,inpatient,1,EA,4.07000,3.86000,The Alliance,PPO Network,,3.38,,,,,,,2.24,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,outpatient,1,EA,4.07000,3.86000,The Alliance,PPO Network,,3.38,,,,,,,2.04,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,6.64,339.51,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,inpatient,30,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,outpatient,30,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,inpatient,30,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,outpatient,30,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,inpatient,30,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,outpatient,30,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,inpatient,,,656.00000,623.20000,The Alliance,PPO Network,,545.14,,,,,,,360.80,636.32,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,outpatient,,,656.00000,623.20000,The Alliance,PPO Network,,545.14,,,,,,,360.80,5271.00,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,inpatient,1,EA,630.07000,598.57000,The Alliance,PPO Network,,523.59,,,,,,,346.54,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,outpatient,1,EA,630.07000,598.57000,The Alliance,PPO Network,,523.59,,,,,,,28.27,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,28.27,376.85,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,34.92,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,33.55,59.17,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,4.75,254.68,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,inpatient,1,EA,7.85000,7.46000,The Alliance,PPO Network,,6.52,,,,,,,4.32,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,PPO Network,,6.52,,,,,,,3.92,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,4.90,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,inpatient,1,EA,9.82000,9.33000,The Alliance,PPO Network,,8.16,,,,,,,5.40,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,outpatient,1,EA,9.82000,9.33000,The Alliance,PPO Network,,8.16,,,,,,,4.91,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,inpatient,1,mL,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,outpatient,1,mL,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,7.69,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,inpatient,1,EA,5.70000,5.42000,The Alliance,PPO Network,,4.74,,,,,,,3.13,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,outpatient,1,EA,5.70000,5.42000,The Alliance,PPO Network,,4.74,,,,,,,2.85,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,inpatient,1,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,inpatient,1,EA,9.88000,9.39000,The Alliance,PPO Network,,8.21,,,,,,,5.43,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,outpatient,1,EA,9.88000,9.39000,The Alliance,PPO Network,,8.21,,,,,,,4.94,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,inpatient,1,EA,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,3.28,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,2.98,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,inpatient,1,EA,8.65000,8.22000,The Alliance,PPO Network,,7.19,,,,,,,4.76,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,PPO Network,,7.19,,,,,,,4.33,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,inpatient,1,EA,3.50000,3.32000,The Alliance,PPO Network,,2.91,,,,,,,1.93,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,PPO Network,,2.91,,,,,,,1.75,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,inpatient,,,760.00000,722.00000,The Alliance,PPO Network,TC,631.56,,,,,,,418.00,737.20,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,outpatient,,,760.00000,722.00000,The Alliance,PPO Network,TC,631.56,,,,,,,380.00,7351.18,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,inpatient,1,EA,11.63000,11.05000,The Alliance,PPO Network,,9.66,,,,,,,6.40,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,outpatient,1,EA,11.63000,11.05000,The Alliance,PPO Network,,9.66,,,,,,,5.82,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,inpatient,1,EA,14.54000,13.81000,The Alliance,PPO Network,,12.08,,,,,,,8.00,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,outpatient,1,EA,14.54000,13.81000,The Alliance,PPO Network,,12.08,,,,,,,7.27,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,3.07,5.41,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,2.79,5.41,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,inpatient,1,mL,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,inpatient,1,mL,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,outpatient,1,mL,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,inpatient,1,mL,2.57000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,outpatient,1,mL,2.57000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,inpatient,1,mL,3.86000,3.67000,The Alliance,PPO Network,,3.21,,,,,,,2.12,3.74,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,outpatient,1,mL,3.86000,3.67000,The Alliance,PPO Network,,3.21,,,,,,,1.93,3.74,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,The Alliance,PPO Network,TC,2109.91,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,PPO Network,TC,2109.91,,,,,,,1269.50,2462.83,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,inpatient,1,EA,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.39,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,outpatient,1,EA,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.26,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,The Alliance,PPO Network,TC,2872.77,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,PPO Network,TC,2872.77,,,,,,,1371.65,3353.29,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,inpatient,,,3007.00000,2856.65000,The Alliance,PPO Network,TC,2498.82,,,,,,,1653.85,2916.79,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,outpatient,,,3007.00000,2856.65000,The Alliance,PPO Network,TC,2498.82,,,,,,,1329.46,2916.79,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,inpatient,1,mL,5.47000,5.19000,The Alliance,PPO Network,,4.55,,,,,,,3.01,5.31,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,PPO Network,,4.55,,,,,,,2.73,7.69,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,The Alliance,PPO Network,TC,4142.53,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,PPO Network,TC,4142.53,,,,,,,1487.04,4835.45,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,inpatient,1,EA,3.62000,3.43000,The Alliance,PPO Network,,3.01,,,,,,,1.99,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,outpatient,1,EA,3.62000,3.43000,The Alliance,PPO Network,,3.01,,,,,,,1.81,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,inpatient,1,EA,2.55000,2.43000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,outpatient,1,EA,2.55000,2.43000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,inpatient,1,EA,1636.88000,1555.04000,The Alliance,PPO Network,,1360.25,,,,,,,900.28,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,outpatient,1,EA,1636.88000,1555.04000,The Alliance,PPO Network,,1360.25,,,,,,,28.27,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,inpatient,1,EA,1636.83000,1554.99000,The Alliance,PPO Network,,1360.21,,,,,,,900.26,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,outpatient,1,EA,1636.83000,1554.99000,The Alliance,PPO Network,,1360.21,,,,,,,28.27,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,inpatient,1,EA,471.38000,447.81000,The Alliance,PPO Network,,391.72,,,,,,,259.26,457.24,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,outpatient,1,EA,471.38000,447.81000,The Alliance,PPO Network,,391.72,,,,,,,28.27,457.24,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,PPO Network,TC,4169.96,,,,,,,1487.04,4867.46,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,inpatient,3,EA,183.41000,174.24000,The Alliance,PPO Network,,152.41,,,,,,,100.88,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,outpatient,3,EA,183.41000,174.24000,The Alliance,PPO Network,,152.41,,,,,,,91.70,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,inpatient,3,EA,35.81000,34.02000,The Alliance,PPO Network,,29.76,,,,,,,19.70,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,outpatient,3,EA,35.81000,34.02000,The Alliance,PPO Network,,29.76,,,,,,,17.91,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,inpatient,3,EA,36.87000,35.02000,The Alliance,PPO Network,,30.64,,,,,,,20.28,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,outpatient,3,EA,36.87000,35.02000,The Alliance,PPO Network,,30.64,,,,,,,18.43,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,inpatient,3,EA,26.64000,25.31000,The Alliance,PPO Network,,22.14,,,,,,,14.65,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,outpatient,3,EA,26.64000,25.31000,The Alliance,PPO Network,,22.14,,,,,,,13.32,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,inpatient,3,EA,53.75000,51.06000,The Alliance,PPO Network,,44.67,,,,,,,29.56,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,outpatient,3,EA,53.75000,51.06000,The Alliance,PPO Network,,44.67,,,,,,,26.88,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,inpatient,3,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,outpatient,3,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,20.54,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,inpatient,3,EA,70.51000,66.98000,The Alliance,PPO Network,,58.59,,,,,,,38.78,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,outpatient,3,EA,70.51000,66.98000,The Alliance,PPO Network,,58.59,,,,,,,35.26,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,inpatient,3,EA,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,11.59,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,outpatient,3,EA,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,10.54,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,inpatient,3,EA,35.26000,33.49000,The Alliance,PPO Network,,29.30,,,,,,,19.39,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,outpatient,3,EA,35.26000,33.49000,The Alliance,PPO Network,,29.30,,,,,,,17.63,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,inpatient,3,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,outpatient,3,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,inpatient,3,EA,12.22000,11.61000,The Alliance,PPO Network,,10.15,,,,,,,6.72,11.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,outpatient,3,EA,12.22000,11.61000,The Alliance,PPO Network,,10.15,,,,,,,6.11,11.85,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.31,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,The Alliance,PPO Network,TC,3370.54,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,PPO Network,TC,3370.54,,,,,,,1487.04,3934.32,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,inpatient,1,mL,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,2.24,12.26,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,inpatient,,,4381.00000,4161.95000,The Alliance,PPO Network,TC,3640.61,,,,,,,2409.55,4249.57,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,outpatient,,,4381.00000,4161.95000,The Alliance,PPO Network,TC,3640.61,,,,,,,1487.04,4249.57,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,The Alliance,PPO Network,TC,1435.97,,,,,,,950.40,1676.16,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,PPO Network,TC,1435.97,,,,,,,864.00,2032.87,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,1016.40,1792.56,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,924.00,2032.87,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,The Alliance,PPO Network,TC,2502.14,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,PPO Network,TC,2502.14,,,,,,,1129.95,2920.67,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.18,271.65,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,The Alliance,PPO Network,TC,2841.19,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,PPO Network,TC,2841.19,,,,,,,1353.88,3316.43,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,inpatient,,,4352.00000,4134.40000,The Alliance,PPO Network,TC,3616.51,,,,,,,2393.60,4221.44,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,PPO Network,TC,3616.51,,,,,,,1487.04,4221.44,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,The Alliance,PPO Network,TC,2934.26,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,PPO Network,TC,2934.26,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,inpatient,,,1560.00000,1482.00000,The Alliance,PPO Network,TC,1296.36,,,,,,,858.00,1513.20,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,outpatient,,,1560.00000,1482.00000,The Alliance,PPO Network,TC,1296.36,,,,,,,608.47,2032.87,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,16.91,1211.55,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,PPO Network,TC,3015.70,,,,,,,1214.33,3520.13,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,inpatient,,,3032.00000,2880.40000,The Alliance,PPO Network,TC,2519.59,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,PPO Network,TC,2519.59,,,,,,,1329.46,2941.04,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,The Alliance,PPO Network,,3.34,,,,,,,2.21,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,PPO Network,,3.34,,,,,,,2.01,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.77,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.52,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,inpatient,1,EA,3.95000,3.76000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,outpatient,1,EA,3.95000,3.76000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,inpatient,,,2867.00000,2723.65000,The Alliance,PPO Network,TC,2382.48,,,,,,,1576.85,2780.99,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,outpatient,,,2867.00000,2723.65000,The Alliance,PPO Network,TC,2382.48,,,,,,,902.40,2780.99,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,inpatient,1,EA,6.73000,6.39000,The Alliance,PPO Network,,5.59,,,,,,,3.70,6.53,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,PPO Network,,5.59,,,,,,,3.37,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,inpatient,1,EA,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.69,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.17,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,inpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.54,8.80,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,The Alliance,PPO Network,TC,2882.74,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,PPO Network,TC,2882.74,,,,,,,1375.22,3364.93,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,inpatient,,,2725.00000,2588.75000,The Alliance,PPO Network,TC,2264.47,,,,,,,1498.75,2643.25,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,outpatient,,,2725.00000,2588.75000,The Alliance,PPO Network,TC,2264.47,,,,,,,1329.46,2643.25,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,1272.04,4844.18,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,The Alliance,PPO Network,TC,3309.87,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,PPO Network,TC,3309.87,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,inpatient,,,4145.00000,3937.75000,The Alliance,PPO Network,TC,3444.49,,,,,,,2279.75,4020.65,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,outpatient,,,4145.00000,3937.75000,The Alliance,PPO Network,TC,3444.49,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,The Alliance,PPO Network,TC,2677.48,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,PPO Network,TC,2677.48,,,,,,,1318.80,3125.34,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,The Alliance,PPO Network,TC,2981.63,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,PPO Network,TC,2981.63,,,,,,,1328.10,3480.36,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,116.05,204.67,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,28.00,1341.13,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,The Alliance,PPO Network,TC,1870.58,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,PPO Network,TC,1870.58,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,inpatient,,,3500.00000,3325.00000,The Alliance,PPO Network,TC,2908.50,,,,,,,1925.00,3395.00,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,outpatient,,,3500.00000,3325.00000,The Alliance,PPO Network,TC,2908.50,,,,,,,1487.04,3395.00,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,828.00,2032.87,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,inpatient,,,5051.00000,4798.45000,The Alliance,PPO Network,TC,4197.38,,,,,,,2778.05,4899.47,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,outpatient,,,5051.00000,4798.45000,The Alliance,PPO Network,TC,4197.38,,,,,,,1487.04,4899.47,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1127.62,2942.98,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,The Alliance,PPO Network,TC,3070.55,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,PPO Network,TC,3070.55,,,,,,,1487.04,3584.15,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,inpatient,,,2339.00000,2222.05000,The Alliance,PPO Network,TC,1943.71,,,,,,,1286.45,2268.83,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,outpatient,,,2339.00000,2222.05000,The Alliance,PPO Network,TC,1943.71,,,,,,,989.10,2268.83,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,inpatient,1,EA,2.03000,1.92000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,outpatient,1,EA,2.03000,1.92000,The Alliance,PPO Network,,1.69,,,,,,,1.01,1.97,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,inpatient,,,4202.00000,3991.90000,The Alliance,PPO Network,TC,3491.86,,,,,,,2311.10,4075.94,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,outpatient,,,4202.00000,3991.90000,The Alliance,PPO Network,TC,3491.86,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,The Alliance,PPO Network,TC,2948.39,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,PPO Network,TC,2948.39,,,,,,,1353.60,3441.56,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,The Alliance,PPO Network,TC,2174.73,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,PPO Network,TC,2174.73,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,TC,2738.98,,,,,,,1812.80,3197.12,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,TC,2738.98,,,,,,,1487.04,4345.33,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,inpatient,1,EA,44.30000,42.09000,The Alliance,PPO Network,,36.81,,,,,,,24.36,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,outpatient,1,EA,44.30000,42.09000,The Alliance,PPO Network,,36.81,,,,,,,22.15,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,inpatient,1,EA,48.68000,46.25000,The Alliance,PPO Network,,40.45,,,,,,,26.77,47.22,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,outpatient,1,EA,48.68000,46.25000,The Alliance,PPO Network,,40.45,,,,,,,24.34,47.22,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,inpatient,2,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.53,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.30,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,inpatient,2,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,outpatient,2,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,inpatient,2,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,outpatient,2,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,The Alliance,PPO Network,TC,2966.67,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,PPO Network,TC,2966.67,,,,,,,1487.04,3462.90,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4235.00000,4023.25000,The Alliance,PPO Network,TC,3519.28,,,,,,,2329.25,4107.95,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4235.00000,4023.25000,The Alliance,PPO Network,TC,3519.28,,,,,,,1929.64,4107.95,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,inpatient,,,978.00000,929.10000,The Alliance,PPO Network,,812.72,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,PPO Network,,812.72,,,,,,,537.90,3163.00,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,inpatient,30,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,outpatient,30,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,TC,1376.14,,,,,,,828.00,2032.87,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,PPO Network,TC,393.06,,,,,,,260.15,458.81,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,PPO Network,TC,393.06,,,,,,,179.69,2032.87,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,inpatient,,,2936.00000,2789.20000,The Alliance,PPO Network,TC,2439.82,,,,,,,1614.80,2847.92,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,outpatient,,,2936.00000,2789.20000,The Alliance,PPO Network,TC,2439.82,,,,,,,1468.00,2847.92,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,inpatient,20,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,outpatient,20,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,7.69,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,inpatient,,,2082.00000,1977.90000,The Alliance,PPO Network,TC,1730.14,,,,,,,1145.10,2019.54,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,outpatient,,,2082.00000,1977.90000,The Alliance,PPO Network,TC,1730.14,,,,,,,862.95,2032.87,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,The Alliance,PPO Network,90,182.16,,,,,,,120.56,212.62,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,PPO Network,90,182.16,,,,,,,11.91,594.19,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,The Alliance,PPO Network,TC,3619.01,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,PPO Network,TC,3619.01,,,,,,,1487.04,4224.35,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,PPO Network,TC,2497.16,,,,,,,1128.45,2914.85,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,inpatient,1,EA,85.92000,81.62000,The Alliance,PPO Network,,71.40,,,,,,,47.26,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,outpatient,1,EA,85.92000,81.62000,The Alliance,PPO Network,,71.40,,,,,,,42.96,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,inpatient,1,EA,94.42000,89.70000,The Alliance,PPO Network,,78.46,,,,,,,51.93,91.59,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,outpatient,1,EA,94.42000,89.70000,The Alliance,PPO Network,,78.46,,,,,,,47.21,91.59,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,inpatient,,,4289.00000,4074.55000,The Alliance,PPO Network,TC,3564.16,,,,,,,2358.95,4160.33,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,outpatient,,,4289.00000,4074.55000,The Alliance,PPO Network,TC,3564.16,,,,,,,1487.04,4160.33,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5104.10000,4848.90000,The Alliance,PPO Network,,4241.51,,,,,,,2501.01,4950.98,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5104.10000,4848.90000,The Alliance,PPO Network,,4241.51,,,,,,,2342.78,5104.10,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,inpatient,,,343.00000,325.85000,The Alliance,PPO Network,,285.03,,,,,,,188.65,332.71,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,PPO Network,,285.03,,,,,,,35.09,1833.46,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,The Alliance,PPO Network,TC,1883.88,,,,,,,1246.85,2198.99,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,PPO Network,TC,1883.88,,,,,,,484.28,2198.99,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,inpatient,,,12277.00000,11663.15000,The Alliance,PPO Network,TC,10202.19,,,,,,,6752.35,11908.69,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,outpatient,,,12277.00000,11663.15000,The Alliance,PPO Network,TC,10202.19,,,,,,,4549.00,11908.69,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,231.00,407.40,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,41.68,1952.29,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,The Alliance,PPO Network,TC,2868.61,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,PPO Network,TC,2868.61,,,,,,,1382.32,3348.44,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,inpatient,,,1408.00000,1337.60000,The Alliance,PPO Network,,1170.05,,,,,,,774.40,1365.76,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,outpatient,,,1408.00000,1337.60000,The Alliance,PPO Network,,1170.05,,,,,,,750.19,3163.00,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,PPO Network,TC,2521.25,,,,,,,1329.46,2942.98,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,The Alliance,PPO Network,TC,3255.86,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,PPO Network,TC,3255.86,,,,,,,1246.80,3800.46,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,The Alliance,PPO Network,,5.17,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,PPO Network,,5.17,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,inpatient,,,3032.00000,2880.40000,The Alliance,PPO Network,TC,2519.59,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,PPO Network,TC,2519.59,,,,,,,1153.12,2941.04,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,inpatient,,,2960.00000,2812.00000,The Alliance,PPO Network,TC,2459.76,,,,,,,1628.00,2871.20,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,outpatient,,,2960.00000,2812.00000,The Alliance,PPO Network,TC,2459.76,,,,,,,1360.59,7180.14,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,inpatient,5,EA,20.10000,19.09000,The Alliance,PPO Network,,16.70,,,,,,,11.05,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,outpatient,5,EA,20.10000,19.09000,The Alliance,PPO Network,,16.70,,,,,,,3.00,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,inpatient,5,EA,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.85,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,outpatient,5,EA,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.59,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,inpatient,5,EA,24.12000,22.91000,The Alliance,PPO Network,,20.04,,,,,,,13.27,23.40,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,outpatient,5,EA,24.12000,22.91000,The Alliance,PPO Network,,20.04,,,,,,,3.00,23.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,inpatient,,,920.00000,874.00000,The Alliance,PPO Network,TC,764.52,,,,,,,506.00,892.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,outpatient,,,920.00000,874.00000,The Alliance,PPO Network,TC,764.52,,,,,,,288.68,2535.29,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,inpatient,1,EA,28.43000,27.01000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,PPO Network,,23.63,,,,,,,0.23870,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.23870,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,0.23870,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.23870,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.23870,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.23870,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.23870,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.23870,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.23870,1.84,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,inpatient,1,EA,71.61000,68.03000,The Alliance,PPO Network,,59.51,,,,,,,39.39,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,outpatient,1,EA,71.61000,68.03000,The Alliance,PPO Network,,59.51,,,,,,,35.80,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,inpatient,1,EA,71.60000,68.02000,The Alliance,PPO Network,,59.50,,,,,,,39.38,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,outpatient,1,EA,71.60000,68.02000,The Alliance,PPO Network,,59.50,,,,,,,35.80,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,inpatient,1,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,39.10,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,PPO Network,,59.08,,,,,,,35.55,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,inpatient,1,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,38.24,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,34.76,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,19.75,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,inpatient,1,EA,71.73000,68.15000,The Alliance,PPO Network,,59.61,,,,,,,39.45,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,outpatient,1,EA,71.73000,68.15000,The Alliance,PPO Network,,59.61,,,,,,,35.87,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,inpatient,1,EA,91.29000,86.73000,The Alliance,PPO Network,,75.86,,,,,,,50.21,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,outpatient,1,EA,91.29000,86.73000,The Alliance,PPO Network,,75.86,,,,,,,45.65,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,inpatient,1,EA,68.57000,65.14000,The Alliance,PPO Network,,56.98,,,,,,,37.71,66.51,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,outpatient,1,EA,68.57000,65.14000,The Alliance,PPO Network,,56.98,,,,,,,34.28,66.51,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,inpatient,,,4361.00000,4142.95000,The Alliance,PPO Network,TC,3623.99,,,,,,,2398.55,4230.17,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,PPO Network,TC,3623.99,,,,,,,1487.04,4230.17,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,inpatient,1,mL,270.61000,257.08000,The Alliance,PPO Network,,224.88,,,,,,,148.84,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,outpatient,1,mL,270.61000,257.08000,The Alliance,PPO Network,,224.88,,,,,,,135.31,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,inpatient,1,mL,270.60000,257.07000,The Alliance,PPO Network,,224.87,,,,,,,148.83,262.48,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,outpatient,1,mL,270.60000,257.07000,The Alliance,PPO Network,,224.87,,,,,,,135.30,262.48,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,2.36,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,2.15,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,inpatient,,,4739.00000,4502.05000,The Alliance,PPO Network,TC,3938.11,,,,,,,2606.45,4596.83,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,outpatient,,,4739.00000,4502.05000,The Alliance,PPO Network,TC,3938.11,,,,,,,2369.50,8022.25,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,156.75,276.45,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,142.50,417.31,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,inpatient,,,3038.00000,2886.10000,The Alliance,PPO Network,TC,2524.58,,,,,,,1670.90,2946.86,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,outpatient,,,3038.00000,2886.10000,The Alliance,PPO Network,TC,2524.58,,,,,,,1329.46,2946.86,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,90,218.14,,,,,,,144.38,254.62,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,90,218.14,,,,,,,19.37,984.66,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,inpatient,,,2932.00000,2785.40000,The Alliance,PPO Network,TC,2436.49,,,,,,,1612.60,2844.04,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,outpatient,,,2932.00000,2785.40000,The Alliance,PPO Network,TC,2436.49,,,,,,,1466.00,2844.04,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1488.32,7180.14,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2150.56,7180.14,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,1288.05,4844.18,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,inpatient,1,EA,3.24000,3.08000,The Alliance,PPO Network,,2.69,,,,,,,1.78,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,outpatient,1,EA,3.24000,3.08000,The Alliance,PPO Network,,2.69,,,,,,,1.62,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,inpatient,1,EA,2.08000,1.98000,The Alliance,PPO Network,,1.73,,,,,,,1.14,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,outpatient,1,EA,2.08000,1.98000,The Alliance,PPO Network,,1.73,,,,,,,1.04,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,inpatient,10,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,outpatient,10,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,inpatient,10,EA,15.98000,15.18000,The Alliance,PPO Network,,13.28,,,,,,,8.79,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,outpatient,10,EA,15.98000,15.18000,The Alliance,PPO Network,,13.28,,,,,,,7.99,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,inpatient,10,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.99,3.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,outpatient,10,EA,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.80,3.50,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,inpatient,,,196.50000,186.67000,The Alliance,PPO Network,90,163.29,,,,,,,108.08,190.60,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,PPO Network,90,163.29,,,,,,,17.47,882.80,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,PPO Network,TC,2153.12,,,,,,,1295.50,2513.27,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,inpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,218.35,385.09,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,outpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,198.50,385.09,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,The Alliance,PPO Network,TC,2963.35,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,PPO Network,TC,2963.35,,,,,,,1321.12,3459.02,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,0.23870,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.23870,1.23,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,inpatient,1,EA,5.07000,4.81000,The Alliance,PPO Network,,4.21,,,,,,,2.79,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,outpatient,1,EA,5.07000,4.81000,The Alliance,PPO Network,,4.21,,,,,,,2.54,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,inpatient,4,EA,11.39000,10.82000,The Alliance,PPO Network,,9.47,,,,,,,6.26,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,outpatient,4,EA,11.39000,10.82000,The Alliance,PPO Network,,9.47,,,,,,,5.70,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,inpatient,4,EA,17.76000,16.87000,The Alliance,PPO Network,,14.76,,,,,,,9.77,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,outpatient,4,EA,17.76000,16.87000,The Alliance,PPO Network,,14.76,,,,,,,8.88,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,inpatient,4,EA,14.24000,13.52000,The Alliance,PPO Network,,11.83,,,,,,,7.83,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,outpatient,4,EA,14.24000,13.52000,The Alliance,PPO Network,,11.83,,,,,,,7.12,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,inpatient,4,EA,6.90000,6.56000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,outpatient,4,EA,6.90000,6.56000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,inpatient,4,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.61,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,outpatient,4,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.29,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,inpatient,4,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,outpatient,4,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,inpatient,4,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.57,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,outpatient,4,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.15,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,inpatient,4,EA,13.79000,13.10000,The Alliance,PPO Network,,11.46,,,,,,,7.58,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,outpatient,4,EA,13.79000,13.10000,The Alliance,PPO Network,,11.46,,,,,,,6.89,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,inpatient,4,EA,10.10000,9.59000,The Alliance,PPO Network,,8.39,,,,,,,5.55,9.80,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,outpatient,4,EA,10.10000,9.59000,The Alliance,PPO Network,,8.39,,,,,,,5.05,9.80,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,PPO Network,,371.46,,,,,,,245.85,433.59,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,PPO Network,,371.46,,,,,,,223.50,433.59,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,76.45,134.83,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,12.92,679.08,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,185.90,327.86,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,39.26,1850.43,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,36.85,64.99,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,5.79,271.65,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,220.19,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,3163.00,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,inpatient,,,192.80000,183.16000,The Alliance,PPO Network,90,160.22,,,,,,,106.04,187.02,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,outpatient,,,192.80000,183.16000,The Alliance,PPO Network,90,160.22,,,,,,,19.00,865.84,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,inpatient,,,416.00000,395.20000,The Alliance,PPO Network,,345.70,,,,,,,228.80,403.52,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,PPO Network,,345.70,,,,,,,37.73,1969.25,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,4.01,7.08,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,2.79,7.08,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.23,2.16,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.11,2.16,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,The Alliance,PPO Network,,5531.14,,,,,,,3660.80,6456.32,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,PPO Network,,5531.14,,,,,,,2074.81,6456.32,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,inpatient,1,GM,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.97,3.48,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,outpatient,1,GM,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.79,3.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,inpatient,1,mL,291.38000,276.81000,The Alliance,PPO Network,,242.14,,,,,,,160.26,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,outpatient,1,mL,291.38000,276.81000,The Alliance,PPO Network,,242.14,,,,,,,145.69,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,39.50,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,inpatient,1,mL,23.61000,22.42000,The Alliance,PPO Network,,19.62,,,,,,,12.99,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,outpatient,1,mL,23.61000,22.42000,The Alliance,PPO Network,,19.62,,,,,,,11.80,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,inpatient,1,mL,37.76000,35.87000,The Alliance,PPO Network,,31.38,,,,,,,20.77,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,outpatient,1,mL,37.76000,35.87000,The Alliance,PPO Network,,31.38,,,,,,,18.88,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,inpatient,1,mL,22.14000,21.03000,The Alliance,PPO Network,,18.40,,,,,,,12.18,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,outpatient,1,mL,22.14000,21.03000,The Alliance,PPO Network,,18.40,,,,,,,11.07,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,inpatient,1,mL,25.68000,24.39000,The Alliance,PPO Network,,21.34,,,,,,,14.12,24.91,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,outpatient,1,mL,25.68000,24.39000,The Alliance,PPO Network,,21.34,,,,,,,12.84,24.91,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,11.53,594.19,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,inpatient,1,GM,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,outpatient,1,GM,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,11.53,594.19,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,inpatient,1,EA,10.42000,9.90000,The Alliance,PPO Network,,8.66,,,,,,,5.73,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,outpatient,1,EA,10.42000,9.90000,The Alliance,PPO Network,,8.66,,,,,,,5.21,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,inpatient,1,EA,8.10000,7.70000,The Alliance,PPO Network,,6.73,,,,,,,4.46,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,outpatient,1,EA,8.10000,7.70000,The Alliance,PPO Network,,6.73,,,,,,,4.05,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,inpatient,1,EA,7.29000,6.93000,The Alliance,PPO Network,,6.06,,,,,,,4.01,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,outpatient,1,EA,7.29000,6.93000,The Alliance,PPO Network,,6.06,,,,,,,3.65,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.73,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.48,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,inpatient,1,EA,11.28000,10.72000,The Alliance,PPO Network,,9.37,,,,,,,6.20,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,outpatient,1,EA,11.28000,10.72000,The Alliance,PPO Network,,9.37,,,,,,,5.64,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,inpatient,1,EA,12.18000,11.58000,The Alliance,PPO Network,,10.12,,,,,,,6.70,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,outpatient,1,EA,12.18000,11.58000,The Alliance,PPO Network,,10.12,,,,,,,6.09,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.14,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.04,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,inpatient,1,EA,4.45000,4.23000,The Alliance,PPO Network,,3.70,,,,,,,2.45,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,PPO Network,,3.70,,,,,,,2.23,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,inpatient,,,978.00000,929.10000,The Alliance,PPO Network,,812.72,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,PPO Network,,812.72,,,,,,,537.90,3163.00,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,inpatient,1,EA,6.96000,6.62000,The Alliance,PPO Network,,5.78,,,,,,,3.83,6.75,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,outpatient,1,EA,6.96000,6.62000,The Alliance,PPO Network,,5.78,,,,,,,3.48,6.75,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,inpatient,1,EA,35.25000,33.49000,The Alliance,PPO Network,,29.29,,,,,,,19.39,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,outpatient,1,EA,35.25000,33.49000,The Alliance,PPO Network,,29.29,,,,,,,17.62,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,inpatient,1,EA,39.17000,37.21000,The Alliance,PPO Network,,32.55,,,,,,,21.54,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,outpatient,1,EA,39.17000,37.21000,The Alliance,PPO Network,,32.55,,,,,,,19.59,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,inpatient,1,EA,25.65000,24.36000,The Alliance,PPO Network,,21.32,,,,,,,14.11,24.88,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,outpatient,1,EA,25.65000,24.36000,The Alliance,PPO Network,,21.32,,,,,,,12.82,24.88,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,The Alliance,PPO Network,,3.43,,,,,,,2.27,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,PPO Network,,3.43,,,,,,,2.06,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,inpatient,1,mL,6.36000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,3.50,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,outpatient,1,mL,6.36000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,0.13795,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,inpatient,1,mL,8.06000,7.66000,The Alliance,PPO Network,,6.70,,,,,,,4.43,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,PPO Network,,6.70,,,,,,,0.13795,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,inpatient,1,mL,7.68000,7.29000,The Alliance,PPO Network,,6.38,,,,,,,4.22,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,outpatient,1,mL,7.68000,7.29000,The Alliance,PPO Network,,6.38,,,,,,,0.13795,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,0.13795,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,inpatient,1,mL,6.71000,6.38000,The Alliance,PPO Network,,5.58,,,,,,,3.69,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,outpatient,1,mL,6.71000,6.38000,The Alliance,PPO Network,,5.58,,,,,,,0.13795,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,inpatient,1,mL,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.32,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,outpatient,1,mL,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,0.13795,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,inpatient,1,mL,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,0.13795,6.44,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,inpatient,15,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,outpatient,15,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,inpatient,1,mL,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,outpatient,1,mL,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,inpatient,1,mL,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,2.85,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,3.19,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,2.90,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,inpatient,1,mL,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,3.20,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,2.90,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,inpatient,1,mL,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,outpatient,1,mL,1.27000,1.20000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,90,130.47,,,,,,,86.35,152.29,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,90,130.47,,,,,,,13.68,696.05,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,28.50,70.98,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,inpatient,,,988.00000,938.60000,The Alliance,PPO Network,90,821.03,,,,,,,543.40,958.36,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,outpatient,,,988.00000,938.60000,The Alliance,PPO Network,90,821.03,,,,,,,14.72,958.36,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,inpatient,,,293.00000,278.35000,The Alliance,PPO Network,,243.48,,,,,,,161.15,284.21,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,outpatient,,,293.00000,278.35000,The Alliance,PPO Network,,243.48,,,,,,,146.50,284.21,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,75.00,155.84,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,inpatient,,,1190.00000,1130.50000,The Alliance,PPO Network,,988.89,,,,,,,654.50,1154.30,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,outpatient,,,1190.00000,1130.50000,The Alliance,PPO Network,,988.89,,,,,,,595.00,1154.30,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,inpatient,1,EA,287.54000,273.16000,The Alliance,PPO Network,,238.95,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,outpatient,1,EA,287.54000,273.16000,The Alliance,PPO Network,,238.95,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,inpatient,1,EA,287.54000,273.17000,The Alliance,PPO Network,,238.95,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,outpatient,1,EA,287.54000,273.17000,The Alliance,PPO Network,,238.95,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,inpatient,1,EA,284.90000,270.65000,The Alliance,PPO Network,,236.75,,,,,,,156.69,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,PPO Network,,236.75,,,,,,,142.45,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,inpatient,1,EA,288.79000,274.35000,The Alliance,PPO Network,,239.98,,,,,,,158.83,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,outpatient,1,EA,288.79000,274.35000,The Alliance,PPO Network,,239.98,,,,,,,144.40,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,inpatient,1,EA,366.61000,348.28000,The Alliance,PPO Network,,304.65,,,,,,,201.64,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,outpatient,1,EA,366.61000,348.28000,The Alliance,PPO Network,,304.65,,,,,,,183.31,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,inpatient,1,EA,121.38000,115.31000,The Alliance,PPO Network,,100.87,,,,,,,66.76,117.74,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,outpatient,1,EA,121.38000,115.31000,The Alliance,PPO Network,,100.87,,,,,,,60.69,117.74,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,The Alliance,PPO Network,,2.27,,,,,,,1.50,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,PPO Network,,2.27,,,,,,,1.36,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,inpatient,1,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,outpatient,1,EA,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,inpatient,1,EA,7.17000,6.81000,The Alliance,PPO Network,,5.96,,,,,,,3.94,6.95,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,outpatient,1,EA,7.17000,6.81000,The Alliance,PPO Network,,5.96,,,,,,,3.58,6.95,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,inpatient,1,EA,1787.36000,1697.99000,The Alliance,PPO Network,,1485.30,,,,,,,983.05,1733.74,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,outpatient,1,EA,1787.36000,1697.99000,The Alliance,PPO Network,,1485.30,,,,,,,409.52,1733.74,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,672.00,1303.68,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,inpatient,10,EA,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,3.25,5.72,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,outpatient,10,EA,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,2.08,5.72,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,2.34,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,2.34,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,inpatient,1,EA,6.60000,6.27000,The Alliance,PPO Network,,5.48,,,,,,,3.63,6.40,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,outpatient,1,EA,6.60000,6.27000,The Alliance,PPO Network,,5.48,,,,,,,3.30,6.40,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,inpatient,15,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.30,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,outpatient,15,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.18,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,inpatient,15,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,outpatient,15,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,inpatient,15,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,outpatient,15,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,inpatient,15,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,outpatient,15,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,inpatient,1,EA,11.41000,10.84000,The Alliance,PPO Network,,9.48,,,,,,,6.28,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,PPO Network,,9.48,,,,,,,5.71,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,inpatient,1,EA,19.03000,18.08000,The Alliance,PPO Network,,15.81,,,,,,,10.47,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,outpatient,1,EA,19.03000,18.08000,The Alliance,PPO Network,,15.81,,,,,,,9.52,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,inpatient,1,EA,11.30000,10.74000,The Alliance,PPO Network,,9.39,,,,,,,6.21,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,outpatient,1,EA,11.30000,10.74000,The Alliance,PPO Network,,9.39,,,,,,,5.65,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,inpatient,1,EA,10.04000,9.54000,The Alliance,PPO Network,,8.34,,,,,,,5.52,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,outpatient,1,EA,10.04000,9.54000,The Alliance,PPO Network,,8.34,,,,,,,5.02,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,182.50,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,90,303.31,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,90,303.31,,,,,,,182.50,354.05,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,inpatient,5,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,outpatient,5,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,inpatient,5,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,outpatient,5,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,inpatient,5,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,outpatient,5,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,inpatient,5,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,outpatient,5,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,inpatient,5,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,outpatient,5,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,The Alliance,PPO Network,,5316.74,,,,,,,3518.90,6206.06,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,PPO Network,,5316.74,,,,,,,1914.61,6206.06,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,inpatient,1,EA,86.53000,82.20000,The Alliance,PPO Network,,71.91,,,,,,,47.59,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,outpatient,1,EA,86.53000,82.20000,The Alliance,PPO Network,,71.91,,,,,,,0.91450,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,inpatient,1,EA,84.85000,80.60000,The Alliance,PPO Network,,70.51,,,,,,,46.67,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,outpatient,1,EA,84.85000,80.60000,The Alliance,PPO Network,,70.51,,,,,,,0.91450,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,0.91450,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,inpatient,1,EA,39.10000,37.15000,The Alliance,PPO Network,,32.49,,,,,,,21.50,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,outpatient,1,EA,39.10000,37.15000,The Alliance,PPO Network,,32.49,,,,,,,0.91450,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,inpatient,1,EA,31.41000,29.84000,The Alliance,PPO Network,,26.10,,,,,,,17.28,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,outpatient,1,EA,31.41000,29.84000,The Alliance,PPO Network,,26.10,,,,,,,0.91450,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,0.91450,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,inpatient,1,EA,21.19000,20.13000,The Alliance,PPO Network,,17.61,,,,,,,11.65,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,outpatient,1,EA,21.19000,20.13000,The Alliance,PPO Network,,17.61,,,,,,,0.91450,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,0.91450,9.96,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,5271.00,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,inpatient,2,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,outpatient,2,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.13330,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,inpatient,2,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,outpatient,2,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.13330,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,inpatient,2,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,outpatient,2,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.13330,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,inpatient,2,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,outpatient,2,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,0.13330,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,inpatient,2,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,outpatient,2,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.13330,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,inpatient,2,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.13330,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,inpatient,2,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,outpatient,2,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,0.13330,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,inpatient,2,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,outpatient,2,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.13330,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,inpatient,2,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,outpatient,2,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.13330,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,inpatient,2,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,outpatient,2,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.13330,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,inpatient,2,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.13330,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,inpatient,2,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,outpatient,2,EA,2.77000,2.63000,The Alliance,PPO Network,,2.30,,,,,,,0.13330,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,inpatient,2,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.13330,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,inpatient,2,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,outpatient,2,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.13330,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,inpatient,2,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,outpatient,2,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,0.13330,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,inpatient,2,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,outpatient,2,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,0.13330,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,inpatient,2,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,outpatient,2,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,0.13330,3.01,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,inpatient,60,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,outpatient,60,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,inpatient,60,EA,27.49000,26.12000,The Alliance,PPO Network,,22.84,,,,,,,15.12,26.67,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,outpatient,60,EA,27.49000,26.12000,The Alliance,PPO Network,,22.84,,,,,,,13.74,26.67,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,inpatient,1,EA,5474.37000,5200.65000,The Alliance,PPO Network,,4549.20,,,,,,,3010.90,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,outpatient,1,EA,5474.37000,5200.65000,The Alliance,PPO Network,,4549.20,,,,,,,212.20,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,inpatient,1,EA,7150.48000,6792.96000,The Alliance,PPO Network,,5942.05,,,,,,,3932.76,6935.97,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,outpatient,1,EA,7150.48000,6792.96000,The Alliance,PPO Network,,5942.05,,,,,,,212.20,6935.97,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,133.10,234.74,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,11.98,628.12,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,inpatient,1,EA,0.62000,0.58000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,outpatient,1,EA,0.62000,0.58000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,inpatient,1,mL,461.19000,438.14000,The Alliance,PPO Network,,383.25,,,,,,,253.65,447.35,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,outpatient,1,mL,461.19000,438.14000,The Alliance,PPO Network,,383.25,,,,,,,78.46,447.35,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,inpatient,60,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,outpatient,60,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,inpatient,60,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,outpatient,60,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,inpatient,60,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,outpatient,60,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,inpatient,60,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,outpatient,60,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,inpatient,60,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,outpatient,60,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,inpatient,60,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,outpatient,60,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,inpatient,1,EA,5.11000,4.85000,The Alliance,PPO Network,,4.25,,,,,,,2.81,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,outpatient,1,EA,5.11000,4.85000,The Alliance,PPO Network,,4.25,,,,,,,2.56,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.43,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.30,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,inpatient,1,EA,6455.15000,6132.39000,The Alliance,PPO Network,,5364.23,,,,,,,3550.33,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,outpatient,1,EA,6455.15000,6132.39000,The Alliance,PPO Network,,5364.23,,,,,,,212.20,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,inpatient,1,EA,9368.36000,8899.95000,The Alliance,PPO Network,,7785.11,,,,,,,5152.60,9087.31,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,outpatient,1,EA,9368.36000,8899.95000,The Alliance,PPO Network,,7785.11,,,,,,,212.20,9087.31,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,inpatient,1,EA,5.45000,5.17000,The Alliance,PPO Network,,4.53,,,,,,,3.00,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,outpatient,1,EA,5.45000,5.17000,The Alliance,PPO Network,,4.53,,,,,,,2.73,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,inpatient,1,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.40,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.19,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,The Alliance,PPO Network,,4.71,,,,,,,3.12,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,PPO Network,,4.71,,,,,,,2.83,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,inpatient,1,EA,7.28000,6.91000,The Alliance,PPO Network,,6.05,,,,,,,4.00,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,outpatient,1,EA,7.28000,6.91000,The Alliance,PPO Network,,6.05,,,,,,,3.64,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,3.09,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,2.81,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,inpatient,1,EA,33.81000,32.12000,The Alliance,PPO Network,,28.10,,,,,,,18.60,32.80,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,outpatient,1,EA,33.81000,32.12000,The Alliance,PPO Network,,28.10,,,,,,,16.91,32.80,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,inpatient,15,EA,14.15000,13.44000,The Alliance,PPO Network,,11.76,,,,,,,7.78,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,outpatient,15,EA,14.15000,13.44000,The Alliance,PPO Network,,11.76,,,,,,,7.08,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.13330,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.13330,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,inpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.13330,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.13330,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,inpatient,1,mL,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.13330,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,0.13330,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,inpatient,1,mL,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,outpatient,1,mL,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,0.13330,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.13330,1.53,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,27.39,1290.24,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,18.70,32.98,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,3.66,203.72,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,inpatient,,,22948.00000,21800.60000,The Alliance,PPO Network,,19069.79,,,,,,,12621.40,22259.56,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,outpatient,,,22948.00000,21800.60000,The Alliance,PPO Network,,19069.79,,,,,,,4607.00,22259.56,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,4.23,203.72,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,15.92,831.84,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,inpatient,5,EA,81.26000,77.19000,The Alliance,PPO Network,,67.53,,,,,,,44.69,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,outpatient,5,EA,81.26000,77.19000,The Alliance,PPO Network,,67.53,,,,,,,40.63,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,inpatient,5,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,outpatient,5,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,20.54,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,inpatient,5,EA,40.75000,38.71000,The Alliance,PPO Network,,33.86,,,,,,,22.41,39.53,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,outpatient,5,EA,40.75000,38.71000,The Alliance,PPO Network,,33.86,,,,,,,20.38,39.53,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,,1020.47,,,,,,,675.40,1191.16,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,,1020.47,,,,,,,523.04,11041.20,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,PPO Network,TC,735.43,,,,,,,486.75,858.45,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,PPO Network,TC,735.43,,,,,,,442.50,858.45,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,4.26,254.68,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,199.65,352.11,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,41.63,352.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,PPO Network,,4.50,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,inpatient,1,EA,5.62000,5.33000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,inpatient,1,EA,9666.09000,9182.79000,The Alliance,PPO Network,,8032.52,,,,,,,5316.35,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,outpatient,1,EA,9666.09000,9182.79000,The Alliance,PPO Network,,8032.52,,,,,,,212.20,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,inpatient,1,EA,12876.34000,12232.52000,The Alliance,PPO Network,,10700.24,,,,,,,7081.99,12490.05,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,outpatient,1,EA,12876.34000,12232.52000,The Alliance,PPO Network,,10700.24,,,,,,,212.20,12490.05,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,inpatient,1,EA,45.60000,43.32000,The Alliance,PPO Network,,37.89,,,,,,,25.08,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,outpatient,1,EA,45.60000,43.32000,The Alliance,PPO Network,,37.89,,,,,,,22.80,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,4.26,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,3.87,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.35,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,inpatient,1,EA,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,3.02,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,PPO Network,,4.57,,,,,,,2.75,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,inpatient,1,EA,5.46000,5.19000,The Alliance,PPO Network,,4.54,,,,,,,3.00,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,outpatient,1,EA,5.46000,5.19000,The Alliance,PPO Network,,4.54,,,,,,,2.73,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.35,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,inpatient,1,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.87,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.70,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,inpatient,1,EA,2.27000,2.15000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,outpatient,1,EA,2.27000,2.15000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.53,2.71,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.40,2.71,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,67.50,1137.41,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,inpatient,,,36445.00000,34622.75000,The Alliance,PPO Network,,30285.79,,,,,,,20044.75,35351.65,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,outpatient,,,36445.00000,34622.75000,The Alliance,PPO Network,,30285.79,,,,,,,4607.00,35351.65,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,inpatient,5,EA,183.67000,174.48000,The Alliance,PPO Network,,152.63,,,,,,,101.02,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,outpatient,5,EA,183.67000,174.48000,The Alliance,PPO Network,,152.63,,,,,,,91.83,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,inpatient,5,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,5.29,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,outpatient,5,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,4.80,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,inpatient,5,EA,24.99000,23.74000,The Alliance,PPO Network,,20.77,,,,,,,13.74,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,outpatient,5,EA,24.99000,23.74000,The Alliance,PPO Network,,20.77,,,,,,,12.49,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,inpatient,5,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,outpatient,5,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,inpatient,5,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,outpatient,5,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.40,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,inpatient,5,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,outpatient,5,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,13.43,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,inpatient,5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,inpatient,5,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,outpatient,5,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,inpatient,5,EA,4.46000,4.23000,The Alliance,PPO Network,,3.71,,,,,,,2.45,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,outpatient,5,EA,4.46000,4.23000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,inpatient,5,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.41,4.26,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,outpatient,5,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.19,4.26,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,inpatient,1,EA,15.87000,15.08000,The Alliance,PPO Network,,13.19,,,,,,,8.73,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,outpatient,1,EA,15.87000,15.08000,The Alliance,PPO Network,,13.19,,,,,,,7.93,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,inpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,8.43,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,PPO Network,,12.74,,,,,,,7.67,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,inpatient,1,EA,24.33000,23.12000,The Alliance,PPO Network,,20.22,,,,,,,13.38,23.60,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,outpatient,1,EA,24.33000,23.12000,The Alliance,PPO Network,,20.22,,,,,,,12.16,23.60,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,inpatient,1,EA,38.67000,36.74000,The Alliance,PPO Network,,32.13,,,,,,,21.27,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,outpatient,1,EA,38.67000,36.74000,The Alliance,PPO Network,,32.13,,,,,,,19.34,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,The Alliance,PPO Network,,8.73,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,PPO Network,,8.73,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,inpatient,15,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,outpatient,15,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,The Alliance,PPO Network,,8.73,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,PPO Network,,8.73,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,inpatient,15,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,outpatient,15,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.21,4.28,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,inpatient,1,EA,659.69000,626.71000,The Alliance,PPO Network,,548.20,,,,,,,362.83,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,outpatient,1,EA,659.69000,626.71000,The Alliance,PPO Network,,548.20,,,,,,,4.35,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,inpatient,1,EA,659.70000,626.71000,The Alliance,PPO Network,,548.21,,,,,,,362.83,639.91,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,outpatient,1,EA,659.70000,626.71000,The Alliance,PPO Network,,548.21,,,,,,,4.35,639.91,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,3273.75,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,5271.00,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.21,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.10,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,inpatient,15,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,outpatient,15,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,inpatient,15,EA,4.59000,4.36000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,outpatient,15,EA,4.59000,4.36000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,inpatient,15,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,outpatient,15,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,inpatient,15,EA,3.15000,2.99000,The Alliance,PPO Network,,2.62,,,,,,,1.73,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,outpatient,15,EA,3.15000,2.99000,The Alliance,PPO Network,,2.62,,,,,,,1.57,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,inpatient,1,EA,285.49000,271.21000,The Alliance,PPO Network,,237.24,,,,,,,157.02,276.93,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,outpatient,1,EA,285.49000,271.21000,The Alliance,PPO Network,,237.24,,,,,,,142.75,276.93,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,inpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,44.55,78.57,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,outpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,44.55,5271.00,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,inpatient,1,EA,2.41000,2.29000,The Alliance,PPO Network,,2.00,,,,,,,1.33,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,PPO Network,,2.00,,,,,,,1.21,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,inpatient,,,13836.00000,13144.20000,The Alliance,PPO Network,,11497.72,,,,,,,7609.80,13420.92,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,outpatient,,,13836.00000,13144.20000,The Alliance,PPO Network,,11497.72,,,,,,,4607.00,13420.92,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,inpatient,5,EA,10.59000,10.06000,The Alliance,PPO Network,,8.80,,,,,,,5.82,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,outpatient,5,EA,10.59000,10.06000,The Alliance,PPO Network,,8.80,,,,,,,5.29,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,inpatient,5,EA,12.92000,12.27000,The Alliance,PPO Network,,10.74,,,,,,,7.11,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,outpatient,5,EA,12.92000,12.27000,The Alliance,PPO Network,,10.74,,,,,,,6.46,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,inpatient,5,EA,12.27000,11.66000,The Alliance,PPO Network,,10.20,,,,,,,6.75,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,outpatient,5,EA,12.27000,11.66000,The Alliance,PPO Network,,10.20,,,,,,,6.13,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,inpatient,5,EA,14.21000,13.50000,The Alliance,PPO Network,,11.81,,,,,,,7.82,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,outpatient,5,EA,14.21000,13.50000,The Alliance,PPO Network,,11.81,,,,,,,7.11,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,3.22,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,2.93,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,4607.00,52373.21,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,The Alliance,PPO Network,,147.43,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,PPO Network,,147.43,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,inpatient,1,EA,120.63000,114.60000,The Alliance,PPO Network,,100.24,,,,,,,66.35,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,outpatient,1,EA,120.63000,114.60000,The Alliance,PPO Network,,100.24,,,,,,,60.31,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,The Alliance,PPO Network,,147.43,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,PPO Network,,147.43,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,inpatient,1,EA,122.44000,116.32000,The Alliance,PPO Network,,101.75,,,,,,,67.34,118.77,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,outpatient,1,EA,122.44000,116.32000,The Alliance,PPO Network,,101.75,,,,,,,61.22,118.77,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,inpatient,,,21293.00000,20228.35000,The Alliance,PPO Network,,17694.48,,,,,,,11711.15,20654.21,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,outpatient,,,21293.00000,20228.35000,The Alliance,PPO Network,,17694.48,,,,,,,4607.00,20654.21,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,inpatient,1,EA,422.19000,401.08000,The Alliance,PPO Network,,350.84,,,,,,,232.20,409.52,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,outpatient,1,EA,422.19000,401.08000,The Alliance,PPO Network,,350.84,,,,,,,4.35,409.52,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,6.61,339.51,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,inpatient,,,10089.00000,9584.55000,The Alliance,PPO Network,,8383.96,,,,,,,5548.95,9786.33,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,outpatient,,,10089.00000,9584.55000,The Alliance,PPO Network,,8383.96,,,,,,,4607.00,9786.33,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,inpatient,1,EA,47.99000,45.59000,The Alliance,PPO Network,,39.88,,,,,,,26.39,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,outpatient,1,EA,47.99000,45.59000,The Alliance,PPO Network,,39.88,,,,,,,24.00,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,inpatient,1,EA,30.22000,28.71000,The Alliance,PPO Network,,25.11,,,,,,,16.62,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,outpatient,1,EA,30.22000,28.71000,The Alliance,PPO Network,,25.11,,,,,,,15.11,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,inpatient,1,EA,25.22000,23.96000,The Alliance,PPO Network,,20.96,,,,,,,13.87,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,outpatient,1,EA,25.22000,23.96000,The Alliance,PPO Network,,20.96,,,,,,,12.61,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,inpatient,1,EA,32.24000,30.62000,The Alliance,PPO Network,,26.79,,,,,,,17.73,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,outpatient,1,EA,32.24000,30.62000,The Alliance,PPO Network,,26.79,,,,,,,16.12,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,inpatient,1,EA,25.28000,24.01000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,outpatient,1,EA,25.28000,24.01000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,inpatient,1,EA,35.97000,34.17000,The Alliance,PPO Network,,29.89,,,,,,,19.78,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,outpatient,1,EA,35.97000,34.17000,The Alliance,PPO Network,,29.89,,,,,,,17.98,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,inpatient,1,EA,5.85000,5.55000,The Alliance,PPO Network,,4.86,,,,,,,3.22,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,outpatient,1,EA,5.85000,5.55000,The Alliance,PPO Network,,4.86,,,,,,,2.92,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,inpatient,1,EA,27.40000,26.03000,The Alliance,PPO Network,,22.77,,,,,,,15.07,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,outpatient,1,EA,27.40000,26.03000,The Alliance,PPO Network,,22.77,,,,,,,13.70,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,inpatient,1,EA,5.43000,5.15000,The Alliance,PPO Network,,4.51,,,,,,,2.99,5.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,outpatient,1,EA,5.43000,5.15000,The Alliance,PPO Network,,4.51,,,,,,,2.71,5.27,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,6.82,356.54,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,inpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,PPO Network,GO,117.17,,,,,,,77.55,136.77,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,PPO Network,GO,117.17,,,,,,,70.50,264.00,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,inpatient,1,EA,2595.50000,2465.73000,The Alliance,PPO Network,,2156.86,,,,,,,1427.53,2517.64,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,outpatient,1,EA,2595.50000,2465.73000,The Alliance,PPO Network,,2156.86,,,,,,,40.56,2517.64,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,PPO Network,GO,81.44,,,,,,,53.90,95.06,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,PPO Network,GO,81.44,,,,,,,49.00,264.00,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,inpatient,60,mL,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,3.49,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,outpatient,60,mL,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,3.17,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,inpatient,60,mL,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,outpatient,60,mL,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.00,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,inpatient,60,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,outpatient,60,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,inpatient,60,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,outpatient,60,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,inpatient,60,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,outpatient,60,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,inpatient,60,mL,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,outpatient,60,mL,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,inpatient,60,mL,5.28000,5.02000,The Alliance,PPO Network,,4.39,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,outpatient,60,mL,5.28000,5.02000,The Alliance,PPO Network,,4.39,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,inpatient,60,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,outpatient,60,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,inpatient,60,mL,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,outpatient,60,mL,0.93000,0.89000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,GO,71.47,,,,,,,47.30,83.42,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,GO,71.47,,,,,,,43.00,264.00,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,The Alliance,PPO Network,,3081.97,,,,,,,1817.29,3597.49,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,PPO Network,,3081.97,,,,,,,1702.32,3708.75,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,126.65,264.00,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,inpatient,,,213.20000,202.54000,The Alliance,PPO Network,GO,177.17,,,,,,,117.26,206.80,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,outpatient,,,213.20000,202.54000,The Alliance,PPO Network,GO,177.17,,,,,,,106.60,264.00,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,GO,95.56,,,,,,,63.25,111.55,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,GO,95.56,,,,,,,57.50,264.00,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,126.65,264.00,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,GO,103.04,,,,,,,68.20,120.28,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,GO,103.04,,,,,,,62.00,264.00,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,GO,126.31,,,,,,,83.60,147.44,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,GO,126.31,,,,,,,76.00,264.00,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,PPO Network,,757.04,,,,,,,501.05,5271.00,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,PPO Network,GO,211.91,,,,,,,126.65,264.00,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,GO,92.24,,,,,,,61.05,107.67,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,GO,92.24,,,,,,,55.50,264.00,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,GO,95.56,,,,,,,63.25,111.55,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,GO,95.56,,,,,,,57.50,264.00,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,GO,47.37,,,,,,,31.35,55.29,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,GO,47.37,,,,,,,28.50,264.00,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,90,158.72,,,,,,,105.05,185.27,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,90,158.72,,,,,,,17.00,865.84,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,inpatient,1,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,outpatient,1,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,5.69,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,inpatient,1,EA,10.90000,10.36000,The Alliance,PPO Network,,9.06,,,,,,,6.00,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,outpatient,1,EA,10.90000,10.36000,The Alliance,PPO Network,,9.06,,,,,,,5.45,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,8.90,458.40,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,GO,88.09,,,,,,,58.30,102.82,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,GO,88.09,,,,,,,53.00,264.00,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,inpatient,1,EA,686.35000,652.03000,The Alliance,PPO Network,,570.36,,,,,,,377.49,665.76,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,outpatient,1,EA,686.35000,652.03000,The Alliance,PPO Network,,570.36,,,,,,,0.07595,665.76,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,14.86,713.01,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,GO,71.47,,,,,,,47.30,83.42,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,GO,71.47,,,,,,,43.00,264.00,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,inpatient,1,EA,24.43000,23.21000,The Alliance,PPO Network,,20.30,,,,,,,13.44,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,outpatient,1,EA,24.43000,23.21000,The Alliance,PPO Network,,20.30,,,,,,,12.21,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,inpatient,1,EA,40.62000,38.59000,The Alliance,PPO Network,,33.76,,,,,,,22.34,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,outpatient,1,EA,40.62000,38.59000,The Alliance,PPO Network,,33.76,,,,,,,20.31,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,inpatient,1,EA,55.18000,52.42000,The Alliance,PPO Network,,45.85,,,,,,,30.35,53.52,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,outpatient,1,EA,55.18000,52.42000,The Alliance,PPO Network,,45.85,,,,,,,27.59,53.52,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,inpatient,,,184.10000,174.89000,The Alliance,PPO Network,90,152.99,,,,,,,101.25,178.58,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,PPO Network,90,152.99,,,,,,,92.05,1137.41,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,inpatient,1,mL,853.63000,810.95000,The Alliance,PPO Network,,709.37,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,PPO Network,,709.37,,,,,,,172.55,828.02,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,GO,83.93,,,,,,,55.55,97.97,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,GO,83.93,,,,,,,50.50,264.00,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,inpatient,1,mL,303.44000,288.27000,The Alliance,PPO Network,,252.16,,,,,,,166.89,294.34,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,outpatient,1,mL,303.44000,288.27000,The Alliance,PPO Network,,252.16,,,,,,,62.23,294.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,inpatient,1,EA,7.65000,7.26000,The Alliance,PPO Network,,6.36,,,,,,,4.21,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,PPO Network,,6.36,,,,,,,3.83,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,inpatient,1,EA,5.66000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,2.83,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,inpatient,1,EA,16.85000,16.01000,The Alliance,PPO Network,,14.00,,,,,,,9.27,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,outpatient,1,EA,16.85000,16.01000,The Alliance,PPO Network,,14.00,,,,,,,8.43,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,The Alliance,PPO Network,,14.38,,,,,,,9.52,16.78,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,PPO Network,,14.38,,,,,,,8.65,16.78,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,inpatient,1,EA,66.39000,63.07000,The Alliance,PPO Network,,55.17,,,,,,,36.51,64.40,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,outpatient,1,EA,66.39000,63.07000,The Alliance,PPO Network,,55.17,,,,,,,33.20,64.40,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,inpatient,,,3486.00000,3311.70000,The Alliance,PPO Network,TC,2896.87,,,,,,,1917.30,3381.42,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,outpatient,,,3486.00000,3311.70000,The Alliance,PPO Network,TC,2896.87,,,,,,,1598.89,3381.42,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,inpatient,1,EA,31.42000,29.85000,The Alliance,PPO Network,,26.11,,,,,,,17.28,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,outpatient,1,EA,31.42000,29.85000,The Alliance,PPO Network,,26.11,,,,,,,15.71,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,inpatient,1,EA,32.23000,30.62000,The Alliance,PPO Network,,26.78,,,,,,,17.73,31.26,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,outpatient,1,EA,32.23000,30.62000,The Alliance,PPO Network,,26.78,,,,,,,16.11,31.26,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,inpatient,1,EA,1372.70000,1304.06000,The Alliance,PPO Network,,1140.71,,,,,,,754.99,1331.52,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,outpatient,1,EA,1372.70000,1304.06000,The Alliance,PPO Network,,1140.71,,,,,,,0.07595,1331.52,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,inpatient,,,143.70000,136.51000,The Alliance,PPO Network,90,119.41,,,,,,,79.03,139.39,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,outpatient,,,143.70000,136.51000,The Alliance,PPO Network,90,119.41,,,,,,,14.93,679.08,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,inpatient,1,mL,343.87000,326.68000,The Alliance,PPO Network,,285.76,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,PPO Network,,285.76,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,inpatient,1,mL,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,5.95,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,outpatient,1,mL,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,0.07595,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,inpatient,1,mL,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,9.56,16.86,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,outpatient,1,mL,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,0.07595,16.86,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,GO,91.41,,,,,,,60.50,106.70,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,GO,91.41,,,,,,,55.00,264.00,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,13.36,696.05,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,86.35,152.29,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,21.21,1001.63,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.72045,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,0.72045,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.72045,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,inpatient,1,mL,178.67000,169.73000,The Alliance,PPO Network,,148.47,,,,,,,98.27,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,outpatient,1,mL,178.67000,169.73000,The Alliance,PPO Network,,148.47,,,,,,,0.72045,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,inpatient,1,mL,154.58000,146.85000,The Alliance,PPO Network,,128.46,,,,,,,85.02,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,outpatient,1,mL,154.58000,146.85000,The Alliance,PPO Network,,128.46,,,,,,,0.72045,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,0.72045,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,0.72045,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,inpatient,1,mL,286.30000,271.98000,The Alliance,PPO Network,,237.92,,,,,,,157.47,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,outpatient,1,mL,286.30000,271.98000,The Alliance,PPO Network,,237.92,,,,,,,0.72045,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,45.19,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,0.72045,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,0.72045,5.52,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,inpatient,1,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,inpatient,1,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,inpatient,1,EA,1.36000,1.30000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,outpatient,1,EA,1.36000,1.30000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,195.94,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,inpatient,500,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,outpatient,500,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.12,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,PPO Network,,1.69,,,,,,,1.01,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,inpatient,1,EA,5.73000,5.44000,The Alliance,PPO Network,,4.76,,,,,,,3.15,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,outpatient,1,EA,5.73000,5.44000,The Alliance,PPO Network,,4.76,,,,,,,2.87,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,The Alliance,PPO Network,90,396.39,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,PPO Network,90,396.39,,,,,,,22.97,1087.31,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,The Alliance,PPO Network,,396.39,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,PPO Network,,396.39,,,,,,,22.97,1087.31,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,inpatient,1,mL,5.46000,5.19000,The Alliance,PPO Network,,4.54,,,,,,,3.00,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,outpatient,1,mL,5.46000,5.19000,The Alliance,PPO Network,,4.54,,,,,,,0.17611,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,0.17611,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,inpatient,1,mL,4.51000,4.28000,The Alliance,PPO Network,,3.75,,,,,,,2.48,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,PPO Network,,3.75,,,,,,,0.17611,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,inpatient,1,mL,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,inpatient,1,mL,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,4.10,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,0.17611,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,inpatient,1,mL,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,0.17611,2.33,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,inpatient,1,EA,45.34000,43.07000,The Alliance,PPO Network,,37.68,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,PPO Network,,37.68,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,inpatient,,,1058.00000,1005.10000,The Alliance,PPO Network,,879.20,,,,,,,581.90,1026.26,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,outpatient,,,1058.00000,1005.10000,The Alliance,PPO Network,,879.20,,,,,,,529.00,42186.85,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,inpatient,1,mL,295.86000,281.06000,The Alliance,PPO Network,,245.86,,,,,,,162.72,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,outpatient,1,mL,295.86000,281.06000,The Alliance,PPO Network,,245.86,,,,,,,62.23,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,inpatient,1,mL,261.75000,248.66000,The Alliance,PPO Network,,217.51,,,,,,,143.96,253.90,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,outpatient,1,mL,261.75000,248.66000,The Alliance,PPO Network,,217.51,,,,,,,62.23,253.90,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,inpatient,,,4243.50000,4031.32000,The Alliance,PPO Network,,3526.35,,,,,,,2079.32,4116.19,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,PPO Network,,3526.35,,,,,,,1947.77,4116.19,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,inpatient,,,169.00000,160.55000,The Alliance,PPO Network,GO,140.44,,,,,,,92.95,163.93,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,PPO Network,GO,140.44,,,,,,,84.50,264.00,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,inpatient,1,mL,5334.01000,5067.31000,The Alliance,PPO Network,,4432.56,,,,,,,2933.71,5173.99,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,outpatient,1,mL,5334.01000,5067.31000,The Alliance,PPO Network,,4432.56,,,,,,,15.08,5173.99,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,inpatient,1,mL,65.43000,62.16000,The Alliance,PPO Network,,54.37,,,,,,,35.99,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,outpatient,1,mL,65.43000,62.16000,The Alliance,PPO Network,,54.37,,,,,,,32.72,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,inpatient,1,mL,59.25000,56.29000,The Alliance,PPO Network,,49.24,,,,,,,32.59,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,outpatient,1,mL,59.25000,56.29000,The Alliance,PPO Network,,49.24,,,,,,,29.62,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,inpatient,1,mL,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,28.24,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,25.68,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,inpatient,1,mL,61.40000,58.33000,The Alliance,PPO Network,,51.02,,,,,,,33.77,59.56,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,outpatient,1,mL,61.40000,58.33000,The Alliance,PPO Network,,51.02,,,,,,,30.70,59.56,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,15.05,780.94,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,inpatient,,,215.00000,204.25000,The Alliance,PPO Network,,178.66,,,,,,,118.25,208.55,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,PPO Network,,178.66,,,,,,,17.98,933.70,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,inpatient,1,EA,13.12000,12.47000,The Alliance,PPO Network,,10.90,,,,,,,7.22,12.73,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,PPO Network,,10.90,,,,,,,6.56,12.73,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,inpatient,,,264.90000,251.65000,The Alliance,PPO Network,90,220.13,,,,,,,145.69,256.95,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,outpatient,,,264.90000,251.65000,The Alliance,PPO Network,90,220.13,,,,,,,19.00,865.84,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,inpatient,120,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,outpatient,120,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,inpatient,120,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,inpatient,120,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,outpatient,120,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,inpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,130.90,230.86,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,outpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,20.26,230.86,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,inpatient,1,EA,1.84000,1.74000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,outpatient,1,EA,1.84000,1.74000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,The Alliance,PPO Network,,4.11,,,,,,,2.72,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,PPO Network,,4.11,,,,,,,2.47,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.90,3.36,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,PPO Network,,2.88,,,,,,,1.73,3.36,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,The Alliance,PPO Network,,36.59,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,PPO Network,,36.59,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,inpatient,1,EA,28.43000,27.01000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,PPO Network,,23.63,,,,,,,14.21,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,inpatient,1,EA,29.57000,28.10000,The Alliance,PPO Network,,24.57,,,,,,,16.26,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,outpatient,1,EA,29.57000,28.10000,The Alliance,PPO Network,,24.57,,,,,,,14.79,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,inpatient,1,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,12.86,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,outpatient,1,EA,23.38000,22.21000,The Alliance,PPO Network,,19.43,,,,,,,11.69,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,inpatient,1,EA,32.62000,30.99000,The Alliance,PPO Network,,27.11,,,,,,,17.94,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,outpatient,1,EA,32.62000,30.99000,The Alliance,PPO Network,,27.11,,,,,,,16.31,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,inpatient,1,EA,25.14000,23.88000,The Alliance,PPO Network,,20.89,,,,,,,13.83,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,outpatient,1,EA,25.14000,23.88000,The Alliance,PPO Network,,20.89,,,,,,,12.57,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,inpatient,1,mL,10069.36000,9565.89000,The Alliance,PPO Network,,8367.64,,,,,,,5538.15,9767.28,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,outpatient,1,mL,10069.36000,9565.89000,The Alliance,PPO Network,,8367.64,,,,,,,5034.68,46899.70,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,inpatient,15,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,outpatient,15,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,inpatient,15,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,outpatient,15,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,inpatient,15,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,outpatient,15,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,inpatient,15,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,outpatient,15,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,inpatient,15,EA,1.21000,1.14000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,outpatient,15,EA,1.21000,1.14000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,TC,3268.32,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,TC,3268.32,,,,,,,1966.50,3815.01,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,inpatient,30,EA,18.43000,17.51000,The Alliance,PPO Network,,15.32,,,,,,,10.14,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,outpatient,30,EA,18.43000,17.51000,The Alliance,PPO Network,,15.32,,,,,,,9.21,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,inpatient,30,EA,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.92,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,outpatient,30,EA,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.56,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,inpatient,30,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,6.37,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,outpatient,30,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,5.79,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,inpatient,30,EA,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,outpatient,30,EA,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,8.90,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,inpatient,30,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,outpatient,30,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,inpatient,30,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,8.11,14.31,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,outpatient,30,EA,14.75000,14.01000,The Alliance,PPO Network,,12.26,,,,,,,7.38,14.31,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,inpatient,1,mL,3.33000,3.17000,The Alliance,PPO Network,,2.77,,,,,,,1.83,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,outpatient,1,mL,3.33000,3.17000,The Alliance,PPO Network,,2.77,,,,,,,1.67,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,inpatient,1,mL,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.56,2.75,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.42,2.75,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,The Alliance,PPO Network,,100.55,,,,,,,66.55,117.37,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,PPO Network,,100.55,,,,,,,11.54,543.22,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,203.50,358.90,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,41.28,2156.01,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,inpatient,1,mL,343.87000,326.68000,The Alliance,PPO Network,,285.76,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,PPO Network,,285.76,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.07595,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,0.07595,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,inpatient,1,mL,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,outpatient,1,mL,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,0.07595,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,inpatient,1,mL,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,0.07595,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,inpatient,1,mL,15.58000,14.80000,The Alliance,PPO Network,,12.95,,,,,,,8.57,15.11,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,outpatient,1,mL,15.58000,14.80000,The Alliance,PPO Network,,12.95,,,,,,,0.07595,15.11,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,inpatient,,,3021.00000,2869.95000,The Alliance,PPO Network,TC,2510.45,,,,,,,1661.55,2930.37,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,outpatient,,,3021.00000,2869.95000,The Alliance,PPO Network,TC,2510.45,,,,,,,1390.09,2930.37,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,inpatient,1,EA,6.08000,5.77000,The Alliance,PPO Network,,5.05,,,,,,,3.34,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,outpatient,1,EA,6.08000,5.77000,The Alliance,PPO Network,,5.05,,,,,,,1.07,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,1.07,30.65,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,inpatient,1,EA,3.68000,3.49000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,outpatient,1,EA,3.68000,3.49000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,inpatient,1,EA,14.71000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,8.09,14.27,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,outpatient,1,EA,14.71000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,7.36,14.27,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,21.45,37.83,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,3.58,186.75,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,inpatient,1,EA,2094.27000,1989.56000,The Alliance,PPO Network,,1740.34,,,,,,,1151.85,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,outpatient,1,EA,2094.27000,1989.56000,The Alliance,PPO Network,,1740.34,,,,,,,3.73,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,3.73,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,inpatient,1,EA,261.69000,248.61000,The Alliance,PPO Network,,217.46,,,,,,,143.93,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,outpatient,1,EA,261.69000,248.61000,The Alliance,PPO Network,,217.46,,,,,,,3.73,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,inpatient,1,EA,411.81000,391.22000,The Alliance,PPO Network,,342.21,,,,,,,226.50,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,outpatient,1,EA,411.81000,391.22000,The Alliance,PPO Network,,342.21,,,,,,,3.73,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,inpatient,1,EA,38.55000,36.62000,The Alliance,PPO Network,,32.04,,,,,,,21.20,37.39,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,outpatient,1,EA,38.55000,36.62000,The Alliance,PPO Network,,32.04,,,,,,,3.73,37.39,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,inpatient,1,mL,29.56000,28.09000,The Alliance,PPO Network,,24.56,,,,,,,16.26,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,outpatient,1,mL,29.56000,28.09000,The Alliance,PPO Network,,24.56,,,,,,,14.78,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,inpatient,1,mL,11.33000,10.76000,The Alliance,PPO Network,,9.42,,,,,,,6.23,10.99,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,outpatient,1,mL,11.33000,10.76000,The Alliance,PPO Network,,9.42,,,,,,,5.67,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.26,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,17.87,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,inpatient,1,EA,59.38000,56.41000,The Alliance,PPO Network,,49.34,,,,,,,32.66,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,outpatient,1,EA,59.38000,56.41000,The Alliance,PPO Network,,49.34,,,,,,,17.87,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,inpatient,1,EA,4.43000,4.21000,The Alliance,PPO Network,,3.68,,,,,,,2.44,4.30,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,PPO Network,,3.68,,,,,,,2.21,23.04,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,inpatient,30,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,outpatient,30,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,inpatient,30,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.11,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.00,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,2.04,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,1.85,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,inpatient,1,EA,40.20000,38.19000,The Alliance,PPO Network,,33.41,,,,,,,22.11,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,outpatient,1,EA,40.20000,38.19000,The Alliance,PPO Network,,33.41,,,,,,,1.20,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,inpatient,1,EA,13.78000,13.09000,The Alliance,PPO Network,,11.45,,,,,,,7.58,13.37,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,outpatient,1,EA,13.78000,13.09000,The Alliance,PPO Network,,11.45,,,,,,,1.20,13.37,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,inpatient,1,EA,374.26000,355.54000,The Alliance,PPO Network,,311.01,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,PPO Network,,311.01,,,,,,,123.22,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,156.42,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,123.22,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,inpatient,1,EA,432.25000,410.63000,The Alliance,PPO Network,,359.20,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,PPO Network,,359.20,,,,,,,123.22,419.28,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,The Alliance,PPO Network,,5.45,,,,,,,3.61,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,PPO Network,,5.45,,,,,,,3.28,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.61,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.29,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,inpatient,1,EA,6.25000,5.94000,The Alliance,PPO Network,,5.19,,,,,,,3.44,6.06,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,outpatient,1,EA,6.25000,5.94000,The Alliance,PPO Network,,5.19,,,,,,,3.12,6.06,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,inpatient,,,1466.00000,1392.70000,The Alliance,PPO Network,,1218.25,,,,,,,806.30,1422.02,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,PPO Network,,1218.25,,,,,,,162.71,7221.66,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,inpatient,1,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.96,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,0.00310,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,inpatient,1,EA,16.68000,15.85000,The Alliance,PPO Network,,13.86,,,,,,,9.17,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,outpatient,1,EA,16.68000,15.85000,The Alliance,PPO Network,,13.86,,,,,,,0.00310,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,0.00310,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.00310,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.00310,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,inpatient,1,EA,7.84000,7.44000,The Alliance,PPO Network,,6.52,,,,,,,4.31,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,outpatient,1,EA,7.84000,7.44000,The Alliance,PPO Network,,6.52,,,,,,,0.00310,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.00310,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,inpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,PPO Network,,6.83,,,,,,,0.00310,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,inpatient,1,EA,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.45,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,0.00310,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,inpatient,1,EA,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,outpatient,1,EA,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,0.00310,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,inpatient,1,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,0.00310,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,inpatient,1,EA,12.33000,11.71000,The Alliance,PPO Network,,10.25,,,,,,,6.78,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,PPO Network,,10.25,,,,,,,0.00310,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,0.00310,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,inpatient,1,EA,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,0.00310,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,0.00310,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,0.00310,4.91,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,inpatient,2,EA,359.05000,341.10000,The Alliance,PPO Network,,298.37,,,,,,,197.48,348.28,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,outpatient,2,EA,359.05000,341.10000,The Alliance,PPO Network,,298.37,,,,,,,29.30,348.28,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,7940.90,14004.86,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,4549.00,14004.86,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,inpatient,1,EA,8369.01000,7950.56000,The Alliance,PPO Network,,6954.65,,,,,,,4602.96,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,outpatient,1,EA,8369.01000,7950.56000,The Alliance,PPO Network,,6954.65,,,,,,,3.73,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,inpatient,1,EA,1289.41000,1224.94000,The Alliance,PPO Network,,1071.50,,,,,,,709.18,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,outpatient,1,EA,1289.41000,1224.94000,The Alliance,PPO Network,,1071.50,,,,,,,3.73,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,inpatient,1,EA,1179.64000,1120.66000,The Alliance,PPO Network,,980.28,,,,,,,648.80,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,outpatient,1,EA,1179.64000,1120.66000,The Alliance,PPO Network,,980.28,,,,,,,3.73,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,inpatient,1,EA,2053.87000,1951.18000,The Alliance,PPO Network,,1706.77,,,,,,,1129.63,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,outpatient,1,EA,2053.87000,1951.18000,The Alliance,PPO Network,,1706.77,,,,,,,3.73,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,712.25,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,3.73,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,inpatient,1,EA,166.28000,157.97000,The Alliance,PPO Network,,138.18,,,,,,,91.45,161.29,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,outpatient,1,EA,166.28000,157.97000,The Alliance,PPO Network,,138.18,,,,,,,3.73,161.29,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,inpatient,100,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,inpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,15.03,780.94,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,inpatient,2,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,outpatient,2,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,21.00,264.00,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,inpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,PPO Network,,4.10,,,,,,,2.46,4.78,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,inpatient,1,EA,16.04000,15.24000,The Alliance,PPO Network,,13.33,,,,,,,8.82,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,outpatient,1,EA,16.04000,15.24000,The Alliance,PPO Network,,13.33,,,,,,,8.02,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,inpatient,1,EA,5.16000,4.90000,The Alliance,PPO Network,,4.29,,,,,,,2.84,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,PPO Network,,4.29,,,,,,,2.58,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,10.27,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,inpatient,1,EA,15.48000,14.71000,The Alliance,PPO Network,,12.86,,,,,,,8.51,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,outpatient,1,EA,15.48000,14.71000,The Alliance,PPO Network,,12.86,,,,,,,7.74,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,8.35,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,7.59,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,inpatient,1,EA,14.16000,13.45000,The Alliance,PPO Network,,11.77,,,,,,,7.79,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,outpatient,1,EA,14.16000,13.45000,The Alliance,PPO Network,,11.77,,,,,,,7.08,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,inpatient,1,EA,9.39000,8.92000,The Alliance,PPO Network,,7.80,,,,,,,5.16,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,PPO Network,,7.80,,,,,,,4.70,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,inpatient,1,EA,14.06000,13.36000,The Alliance,PPO Network,,11.68,,,,,,,7.73,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,PPO Network,,11.68,,,,,,,7.03,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.90,13.94,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.18,13.94,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,inpatient,1,EA,1.92000,1.82000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,outpatient,1,EA,1.92000,1.82000,The Alliance,PPO Network,,1.60,,,,,,,0.96000,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,inpatient,10,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,outpatient,10,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,0.00310,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,inpatient,10,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,2.05,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,outpatient,10,EA,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,0.00310,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.00310,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,inpatient,10,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,outpatient,10,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.00310,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,inpatient,10,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,outpatient,10,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.00310,1.64,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,inpatient,,,14531.00000,13804.45000,The Alliance,PPO Network,TC,12075.26,,,,,,,7992.05,14095.07,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,outpatient,,,14531.00000,13804.45000,The Alliance,PPO Network,TC,12075.26,,,,,,,4549.00,14095.07,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,5.78,271.65,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,TC,12009.61,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,TC,12009.61,,,,,,,4549.00,14018.44,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,15.30,713.01,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,inpatient,1,EA,4.30000,4.08000,The Alliance,PPO Network,,3.57,,,,,,,2.37,4.17,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,PPO Network,,3.57,,,,,,,2.15,50.75,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,inpatient,1,EA,83.28000,79.11000,The Alliance,PPO Network,,69.21,,,,,,,45.80,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,outpatient,1,EA,83.28000,79.11000,The Alliance,PPO Network,,69.21,,,,,,,41.64,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,inpatient,1,EA,55.30000,52.53000,The Alliance,PPO Network,,45.95,,,,,,,30.41,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,PPO Network,,45.95,,,,,,,27.65,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,inpatient,1,EA,68.95000,65.50000,The Alliance,PPO Network,,57.30,,,,,,,37.92,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,outpatient,1,EA,68.95000,65.50000,The Alliance,PPO Network,,57.30,,,,,,,34.48,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,inpatient,1,EA,67.94000,64.54000,The Alliance,PPO Network,,56.46,,,,,,,37.37,65.90,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,outpatient,1,EA,67.94000,64.54000,The Alliance,PPO Network,,56.46,,,,,,,33.97,65.90,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,inpatient,2,EA,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,10.13,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,outpatient,2,EA,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,9.21,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,inpatient,2,EA,16.48000,15.66000,The Alliance,PPO Network,,13.69,,,,,,,9.06,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,outpatient,2,EA,16.48000,15.66000,The Alliance,PPO Network,,13.69,,,,,,,8.24,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,inpatient,2,EA,16.99000,16.14000,The Alliance,PPO Network,,14.12,,,,,,,9.34,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,outpatient,2,EA,16.99000,16.14000,The Alliance,PPO Network,,14.12,,,,,,,8.49,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,inpatient,2,EA,13.59000,12.91000,The Alliance,PPO Network,,11.29,,,,,,,7.47,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,outpatient,2,EA,13.59000,12.91000,The Alliance,PPO Network,,11.29,,,,,,,6.79,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,inpatient,2,EA,15.99000,15.19000,The Alliance,PPO Network,,13.29,,,,,,,8.79,15.51,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,outpatient,2,EA,15.99000,15.19000,The Alliance,PPO Network,,13.29,,,,,,,8.00,15.51,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,inpatient,30,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,outpatient,30,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,inpatient,30,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,outpatient,30,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,inpatient,30,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,outpatient,30,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,inpatient,1,mL,853.63000,810.95000,The Alliance,PPO Network,,709.37,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,PPO Network,,709.37,,,,,,,172.55,828.02,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.85,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.60,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,The Alliance,PPO Network,,3.43,,,,,,,2.27,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,PPO Network,,3.43,,,,,,,2.06,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,inpatient,2,EA,6.93000,6.58000,The Alliance,PPO Network,,5.76,,,,,,,3.81,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,outpatient,2,EA,6.93000,6.58000,The Alliance,PPO Network,,5.76,,,,,,,3.46,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,inpatient,2,EA,123.69000,117.51000,The Alliance,PPO Network,,102.79,,,,,,,68.03,119.98,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,outpatient,2,EA,123.69000,117.51000,The Alliance,PPO Network,,102.79,,,,,,,61.84,119.98,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,PPO Network,,141.27,,,,,,,93.50,164.90,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,PPO Network,,141.27,,,,,,,13.25,696.05,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,122.40,495.67,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,PPO Network,,200.27,,,,,,,132.55,233.77,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,PPO Network,,200.27,,,,,,,24.91,2082.45,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,inpatient,1,mL,19.60000,18.62000,The Alliance,PPO Network,,16.29,,,,,,,10.78,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,outpatient,1,mL,19.60000,18.62000,The Alliance,PPO Network,,16.29,,,,,,,9.80,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,inpatient,1,mL,16.11000,15.31000,The Alliance,PPO Network,,13.39,,,,,,,8.86,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,outpatient,1,mL,16.11000,15.31000,The Alliance,PPO Network,,13.39,,,,,,,8.05,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,inpatient,1,mL,16.61000,15.78000,The Alliance,PPO Network,,13.80,,,,,,,9.14,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,outpatient,1,mL,16.61000,15.78000,The Alliance,PPO Network,,13.80,,,,,,,8.30,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,inpatient,1,mL,13.28000,12.62000,The Alliance,PPO Network,,11.04,,,,,,,7.30,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,outpatient,1,mL,13.28000,12.62000,The Alliance,PPO Network,,11.04,,,,,,,6.64,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,inpatient,1,mL,15.63000,14.85000,The Alliance,PPO Network,,12.99,,,,,,,8.60,15.16,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,outpatient,1,mL,15.63000,14.85000,The Alliance,PPO Network,,12.99,,,,,,,7.82,15.16,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,inpatient,1,mL,151.84000,144.25000,The Alliance,PPO Network,,126.18,,,,,,,83.51,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,outpatient,1,mL,151.84000,144.25000,The Alliance,PPO Network,,126.18,,,,,,,43.80,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,inpatient,1,mL,167.67000,159.29000,The Alliance,PPO Network,,139.33,,,,,,,92.22,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,outpatient,1,mL,167.67000,159.29000,The Alliance,PPO Network,,139.33,,,,,,,43.80,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,inpatient,1,mL,106.18000,100.87000,The Alliance,PPO Network,,88.24,,,,,,,58.40,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,outpatient,1,mL,106.18000,100.87000,The Alliance,PPO Network,,88.24,,,,,,,43.80,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,inpatient,1,mL,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,95.59,168.59,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,43.80,168.59,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,inpatient,5,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,outpatient,5,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,inpatient,5,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,outpatient,5,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,1.09,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,inpatient,,,510.82000,485.28000,The Alliance,PPO Network,,424.49,,,,,,,280.95,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,outpatient,,,510.82000,485.28000,The Alliance,PPO Network,,424.49,,,,,,,255.41,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,inpatient,1,mL,1021.64000,970.56000,The Alliance,PPO Network,,848.98,,,,,,,561.90,990.99,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,outpatient,1,mL,1021.64000,970.56000,The Alliance,PPO Network,,848.98,,,,,,,399.88,990.99,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,inpatient,1,EA,5.13000,4.87000,The Alliance,PPO Network,,4.26,,,,,,,2.82,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,PPO Network,,4.26,,,,,,,2.56,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.50,288.61,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6366.00000,6047.70000,The Alliance,PPO Network,TC,5290.15,,,,,,,3501.30,6175.02,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6366.00000,6047.70000,The Alliance,PPO Network,TC,5290.15,,,,,,,1929.64,6175.02,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,inpatient,1,EA,41.77000,39.68000,The Alliance,PPO Network,,34.71,,,,,,,22.97,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,outpatient,1,EA,41.77000,39.68000,The Alliance,PPO Network,,34.71,,,,,,,20.89,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,inpatient,1,EA,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.77,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,outpatient,1,EA,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.60,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,inpatient,,,41.50000,39.42000,The Alliance,PPO Network,90,34.49,,,,,,,22.82,40.26,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,outpatient,,,41.50000,39.42000,The Alliance,PPO Network,90,34.49,,,,,,,3.70,186.75,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,inpatient,1,mL,1207.45000,1147.08000,The Alliance,PPO Network,,1003.39,,,,,,,664.10,1171.23,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,outpatient,1,mL,1207.45000,1147.08000,The Alliance,PPO Network,,1003.39,,,,,,,16.89,1171.23,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,inpatient,2,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,outpatient,2,EA,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,3.79,7.35,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,inpatient,,,762.00000,723.90000,The Alliance,PPO Network,,633.22,,,,,,,419.10,739.14,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,outpatient,,,762.00000,723.90000,The Alliance,PPO Network,,633.22,,,,,,,419.10,5271.00,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,661.50,1309.50,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,619.65,1350.00,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,inpatient,2,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,outpatient,2,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,0.80910,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,inpatient,2,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,outpatient,2,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,0.80910,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,inpatient,2,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,outpatient,2,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,inpatient,1,EA,160.78000,152.74000,The Alliance,PPO Network,,133.61,,,,,,,88.43,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,outpatient,1,EA,160.78000,152.74000,The Alliance,PPO Network,,133.61,,,,,,,1.20,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,inpatient,1,EA,159.99000,151.99000,The Alliance,PPO Network,,132.95,,,,,,,87.99,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,PPO Network,,132.95,,,,,,,1.20,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,inpatient,1,EA,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,95.59,168.59,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,PPO Network,,144.43,,,,,,,1.20,168.59,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.71500,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,inpatient,1,EA,26.02000,24.71000,The Alliance,PPO Network,,21.62,,,,,,,14.31,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,outpatient,1,EA,26.02000,24.71000,The Alliance,PPO Network,,21.62,,,,,,,13.01,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,inpatient,1,EA,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,14.08,24.83,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,outpatient,1,EA,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,12.80,24.83,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,inpatient,1,EA,12.84000,12.19000,The Alliance,PPO Network,,10.67,,,,,,,7.06,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,PPO Network,,10.67,,,,,,,1.73,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,inpatient,1,EA,32.55000,30.92000,The Alliance,PPO Network,,27.05,,,,,,,17.90,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,outpatient,1,EA,32.55000,30.92000,The Alliance,PPO Network,,27.05,,,,,,,1.73,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,inpatient,1,EA,37.72000,35.83000,The Alliance,PPO Network,,31.35,,,,,,,20.75,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,outpatient,1,EA,37.72000,35.83000,The Alliance,PPO Network,,31.35,,,,,,,1.73,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,inpatient,1,EA,33.04000,31.39000,The Alliance,PPO Network,,27.46,,,,,,,18.17,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,outpatient,1,EA,33.04000,31.39000,The Alliance,PPO Network,,27.46,,,,,,,1.73,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,inpatient,1,EA,43.77000,41.58000,The Alliance,PPO Network,,36.37,,,,,,,24.07,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,outpatient,1,EA,43.77000,41.58000,The Alliance,PPO Network,,36.37,,,,,,,1.73,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.95,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,1.73,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,1.73,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,inpatient,1,EA,36.59000,34.76000,The Alliance,PPO Network,,30.41,,,,,,,20.12,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,outpatient,1,EA,36.59000,34.76000,The Alliance,PPO Network,,30.41,,,,,,,1.73,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,inpatient,1,EA,23.18000,22.02000,The Alliance,PPO Network,,19.26,,,,,,,12.75,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,outpatient,1,EA,23.18000,22.02000,The Alliance,PPO Network,,19.26,,,,,,,1.73,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,inpatient,1,EA,18.01000,17.11000,The Alliance,PPO Network,,14.97,,,,,,,9.91,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,PPO Network,,14.97,,,,,,,1.73,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,inpatient,1,EA,43.83000,41.64000,The Alliance,PPO Network,,36.42,,,,,,,24.11,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,outpatient,1,EA,43.83000,41.64000,The Alliance,PPO Network,,36.42,,,,,,,1.73,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,inpatient,1,EA,36.43000,34.61000,The Alliance,PPO Network,,30.27,,,,,,,20.04,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,outpatient,1,EA,36.43000,34.61000,The Alliance,PPO Network,,30.27,,,,,,,1.73,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,1.73,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,inpatient,1,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,8.92,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,PPO Network,,13.47,,,,,,,1.73,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,inpatient,1,EA,23.07000,21.91000,The Alliance,PPO Network,,19.17,,,,,,,12.69,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,outpatient,1,EA,23.07000,21.91000,The Alliance,PPO Network,,19.17,,,,,,,1.73,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,inpatient,1,EA,16.12000,15.31000,The Alliance,PPO Network,,13.40,,,,,,,8.87,15.64,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,PPO Network,,13.40,,,,,,,1.73,15.64,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,inpatient,237,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,outpatient,237,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,inpatient,237,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,outpatient,237,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,inpatient,237,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,outpatient,237,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,inpatient,237,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,outpatient,237,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,inpatient,,,14477.00000,13753.15000,The Alliance,PPO Network,TC,12030.39,,,,,,,7962.35,14042.69,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,outpatient,,,14477.00000,13753.15000,The Alliance,PPO Network,TC,12030.39,,,,,,,4549.00,14042.69,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,57.20,100.88,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,52.00,967.70,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,4.76,237.65,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,inpatient,1,EA,10.26000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.64,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,outpatient,1,EA,10.26000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96000,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,inpatient,1,EA,62.55000,59.42000,The Alliance,PPO Network,,51.98,,,,,,,34.40,60.67,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,outpatient,1,EA,62.55000,59.42000,The Alliance,PPO Network,,51.98,,,,,,,31.27,60.67,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,30.80,54.32,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,4.27,220.68,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,inpatient,20,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,outpatient,20,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,inpatient,20,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,outpatient,20,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,inpatient,20,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,outpatient,20,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,inpatient,,,522.00000,495.90000,The Alliance,PPO Network,,433.78,,,,,,,287.10,506.34,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,PPO Network,,433.78,,,,,,,287.10,5271.00,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,inpatient,17,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,outpatient,17,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,inpatient,17,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,outpatient,17,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,inpatient,17,EA,4.92000,4.67000,The Alliance,PPO Network,,4.09,,,,,,,2.71,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,outpatient,17,EA,4.92000,4.67000,The Alliance,PPO Network,,4.09,,,,,,,2.46,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,inpatient,17,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,outpatient,17,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,inpatient,17,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,outpatient,17,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,inpatient,17,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,outpatient,17,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,inpatient,17,EA,6.49000,6.16000,The Alliance,PPO Network,,5.39,,,,,,,3.57,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,outpatient,17,EA,6.49000,6.16000,The Alliance,PPO Network,,5.39,,,,,,,3.25,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,inpatient,17,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,outpatient,17,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,inpatient,17,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,outpatient,17,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,inpatient,17,EA,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,2.93,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,outpatient,17,EA,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,2.66,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,inpatient,17,EA,4.22000,4.01000,The Alliance,PPO Network,,3.51,,,,,,,2.32,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,outpatient,17,EA,4.22000,4.01000,The Alliance,PPO Network,,3.51,,,,,,,2.11,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,inpatient,17,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,outpatient,17,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,inpatient,17,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,outpatient,17,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,inpatient,17,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.96,3.46,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,outpatient,17,EA,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.78,3.46,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,inpatient,,,130.70000,124.16000,The Alliance,PPO Network,90,108.61,,,,,,,71.89,126.78,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,outpatient,,,130.70000,124.16000,The Alliance,PPO Network,90,108.61,,,,,,,8.72,441.37,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,inpatient,30,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,0.00620,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,inpatient,30,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,outpatient,30,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.00620,1.90,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,inpatient,,,206.80000,196.46000,The Alliance,PPO Network,90,171.85,,,,,,,113.74,200.60,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,outpatient,,,206.80000,196.46000,The Alliance,PPO Network,90,171.85,,,,,,,25.05,1256.24,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,4.74,254.68,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,inpatient,1,EA,154.75000,147.01000,The Alliance,PPO Network,,128.60,,,,,,,85.11,150.11,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,outpatient,1,EA,154.75000,147.01000,The Alliance,PPO Network,,128.60,,,,,,,77.38,150.11,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,230.00,446.20,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,100.10,176.54,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,91.00,1595.82,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,inpatient,1,EA,35.55000,33.77000,The Alliance,PPO Network,,29.54,,,,,,,19.55,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,PPO Network,,29.54,,,,,,,17.77,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,9.56,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,8.69,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,inpatient,1,EA,31.57000,29.99000,The Alliance,PPO Network,,26.23,,,,,,,17.36,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,outpatient,1,EA,31.57000,29.99000,The Alliance,PPO Network,,26.23,,,,,,,15.79,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,14.22,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,inpatient,1,EA,30.21000,28.70000,The Alliance,PPO Network,,25.10,,,,,,,16.62,29.30,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,outpatient,1,EA,30.21000,28.70000,The Alliance,PPO Network,,25.10,,,,,,,15.11,29.30,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,inpatient,15,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,outpatient,15,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,4.73,220.68,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,inpatient,30,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,outpatient,30,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,0.43227,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,inpatient,30,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,outpatient,30,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,0.43227,2.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,1132.00000,1075.40000,The Alliance,PPO Network,,940.69,,,,,,,622.60,1098.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,PPO Network,,940.69,,,,,,,566.00,1098.04,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,2386.00000,2266.70000,The Alliance,PPO Network,,1982.77,,,,,,,1312.30,2314.42,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,2386.00000,2266.70000,The Alliance,PPO Network,,1982.77,,,,,,,462.52,2314.42,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.00620,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.00620,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.00620,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.00620,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.00620,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.00620,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.00620,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.00620,0.26190,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,inpatient,1,EA,273.97000,260.27000,The Alliance,PPO Network,,227.67,,,,,,,150.68,265.75,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,outpatient,1,EA,273.97000,260.27000,The Alliance,PPO Network,,227.67,,,,,,,136.99,265.75,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,inpatient,1,EA,48.35000,45.93000,The Alliance,PPO Network,,40.18,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,PPO Network,,40.18,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.30,2.53,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.06640,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.06640,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.06640,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.06640,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.06640,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.06640,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.06640,0.40740,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,7.85,763.98,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,inpatient,1,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,inpatient,15,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,inpatient,15,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,outpatient,15,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,inpatient,15,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,outpatient,15,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,inpatient,15,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,outpatient,15,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,inpatient,15,EA,2.93000,2.79000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,outpatient,15,EA,2.93000,2.79000,The Alliance,PPO Network,,2.43,,,,,,,1.47,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,inpatient,15,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,outpatient,15,EA,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.78,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,inpatient,15,EA,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,outpatient,15,EA,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,inpatient,15,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,outpatient,15,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,96.80,170.72,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,19.38,1018.59,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,inpatient,,,6058.00000,5755.10000,The Alliance,PPO Network,TC,5034.20,,,,,,,3331.90,5876.26,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,outpatient,,,6058.00000,5755.10000,The Alliance,PPO Network,TC,5034.20,,,,,,,1929.64,5876.26,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,inpatient,30,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,outpatient,30,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,inpatient,4000,EA,40.07000,38.07000,The Alliance,PPO Network,,33.30,,,,,,,22.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,outpatient,4000,EA,40.07000,38.07000,The Alliance,PPO Network,,33.30,,,,,,,20.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,inpatient,4000,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,outpatient,4000,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,55.94,98.65,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,6.75,339.51,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,inpatient,1,mL,29.09000,27.64000,The Alliance,PPO Network,,24.17,,,,,,,16.00,28.22,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,outpatient,1,mL,29.09000,27.64000,The Alliance,PPO Network,,24.17,,,,,,,14.54,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,47.40,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,13.43,472.00,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,4.48,237.65,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,inpatient,,,1267.00000,1203.65000,The Alliance,PPO Network,,1052.88,,,,,,,696.85,1228.99,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,outpatient,,,1267.00000,1203.65000,The Alliance,PPO Network,,1052.88,,,,,,,668.09,3163.00,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.00620,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.00620,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,0.00620,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.00620,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,inpatient,1,EA,0.61000,0.57000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,outpatient,1,EA,0.61000,0.57000,The Alliance,PPO Network,,0.50691,,,,,,,0.00620,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.00620,0.24250,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,110.00,194.00,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,20.86,1086.52,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,75.35,132.89,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,12.01,628.12,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,inpatient,1,EA,1.14000,1.09000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,outpatient,1,EA,1.14000,1.09000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,inpatient,1,EA,2.06000,1.95000,The Alliance,PPO Network,,1.71,,,,,,,1.13,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,PPO Network,,1.71,,,,,,,1.03,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,inpatient,,,264.28000,251.07000,The Alliance,PPO Network,,219.62,,,,,,,145.35,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,outpatient,,,264.28000,251.07000,The Alliance,PPO Network,,219.62,,,,,,,132.14,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,inpatient,0.5,EA,528.55000,502.12000,The Alliance,PPO Network,,439.23,,,,,,,290.70,512.69,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,outpatient,0.5,EA,528.55000,502.12000,The Alliance,PPO Network,,439.23,,,,,,,206.88,512.69,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,inpatient,30,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,outpatient,30,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,inpatient,30,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,outpatient,30,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,0.43227,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,inpatient,30,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,inpatient,30,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,inpatient,30,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,inpatient,30,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,inpatient,30,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,inpatient,30,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,outpatient,30,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,0.43227,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,inpatient,30,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.79680,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,inpatient,1,EA,48.35000,45.93000,The Alliance,PPO Network,,40.18,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,PPO Network,,40.18,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,inpatient,1,EA,58.39000,55.47000,The Alliance,PPO Network,,48.52,,,,,,,32.11,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,outpatient,1,EA,58.39000,55.47000,The Alliance,PPO Network,,48.52,,,,,,,29.20,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.30,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,inpatient,1,EA,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,3.21,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,2.92,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,inpatient,1,EA,2.25000,2.13000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,outpatient,1,EA,2.25000,2.13000,The Alliance,PPO Network,,1.87,,,,,,,1.12,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,inpatient,1,EA,5.52000,5.24000,The Alliance,PPO Network,,4.59,,,,,,,3.04,5.35,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,outpatient,1,EA,5.52000,5.24000,The Alliance,PPO Network,,4.59,,,,,,,2.76,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,inpatient,1,EA,6.74000,6.40000,The Alliance,PPO Network,,5.60,,,,,,,3.71,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,outpatient,1,EA,6.74000,6.40000,The Alliance,PPO Network,,5.60,,,,,,,3.37,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,inpatient,1,EA,10.16000,9.65000,The Alliance,PPO Network,,8.44,,,,,,,5.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,outpatient,1,EA,10.16000,9.65000,The Alliance,PPO Network,,8.44,,,,,,,4.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,inpatient,,,173.90000,165.20000,The Alliance,PPO Network,90,144.51,,,,,,,95.64,168.68,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,PPO Network,90,144.51,,,,,,,15.20,763.98,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,inpatient,15,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,outpatient,15,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,inpatient,15,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,inpatient,15,EA,7.88000,7.48000,The Alliance,PPO Network,,6.55,,,,,,,4.33,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,outpatient,15,EA,7.88000,7.48000,The Alliance,PPO Network,,6.55,,,,,,,3.94,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,inpatient,15,EA,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,3.51,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,outpatient,15,EA,6.38000,6.06000,The Alliance,PPO Network,,5.30,,,,,,,3.19,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,inpatient,15,EA,10.10000,9.60000,The Alliance,PPO Network,,8.39,,,,,,,5.55,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,outpatient,15,EA,10.10000,9.60000,The Alliance,PPO Network,,8.39,,,,,,,5.05,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,inpatient,15,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,outpatient,15,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,inpatient,1,EA,1154.70000,1096.96000,The Alliance,PPO Network,,959.56,,,,,,,635.09,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,outpatient,1,EA,1154.70000,1096.96000,The Alliance,PPO Network,,959.56,,,,,,,436.51,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,inpatient,1,EA,1087.28000,1032.92000,The Alliance,PPO Network,,903.53,,,,,,,598.00,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,outpatient,1,EA,1087.28000,1032.92000,The Alliance,PPO Network,,903.53,,,,,,,436.51,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,inpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,213.68,376.85,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,PPO Network,,322.84,,,,,,,194.25,745.84,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,inpatient,10,EA,16.66000,15.82000,The Alliance,PPO Network,,13.84,,,,,,,9.16,16.16,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,outpatient,10,EA,16.66000,15.82000,The Alliance,PPO Network,,13.84,,,,,,,8.33,16.16,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,inpatient,,,147.30000,139.94000,The Alliance,PPO Network,90,122.41,,,,,,,81.02,142.88,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,PPO Network,90,122.41,,,,,,,2.79,142.88,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,inpatient,10,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,outpatient,10,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,inpatient,10,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.87,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,outpatient,10,EA,3.40000,3.23000,The Alliance,PPO Network,,2.83,,,,,,,1.70,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,inpatient,10,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,outpatient,10,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,inpatient,10,EA,3.27000,3.11000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,outpatient,10,EA,3.27000,3.11000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,inpatient,1,EA,27.53000,26.15000,The Alliance,PPO Network,,22.88,,,,,,,15.14,26.70,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,outpatient,1,EA,27.53000,26.15000,The Alliance,PPO Network,,22.88,,,,,,,13.77,26.70,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,inpatient,,,785.00000,745.75000,The Alliance,PPO Network,,652.34,,,,,,,431.75,761.45,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,PPO Network,,652.34,,,,,,,392.50,1692.33,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,56.10,98.94,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,10.74,1471.29,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,inpatient,118,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,outpatient,118,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,inpatient,1,mL,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.14409,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,inpatient,1,mL,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.14409,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.14409,0.55290,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,24.20,42.68,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,3.94,203.72,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,inpatient,1,EA,31.98000,30.38000,The Alliance,PPO Network,,26.58,,,,,,,17.59,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,outpatient,1,EA,31.98000,30.38000,The Alliance,PPO Network,,26.58,,,,,,,15.99,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.29,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.08,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,inpatient,5,EA,59.96000,56.97000,The Alliance,PPO Network,,49.83,,,,,,,32.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,outpatient,5,EA,59.96000,56.97000,The Alliance,PPO Network,,49.83,,,,,,,29.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,inpatient,5,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,15.30,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,outpatient,5,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,13.90,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,inpatient,5,EA,27.97000,26.57000,The Alliance,PPO Network,,23.24,,,,,,,15.38,27.13,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,outpatient,5,EA,27.97000,26.57000,The Alliance,PPO Network,,23.24,,,,,,,13.98,27.13,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,PPO Network,GP,148.75,,,,,,,98.45,173.63,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,PPO Network,GP,148.75,,,,,,,89.50,264.00,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,3.50,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,3.19,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,inpatient,1,EA,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,outpatient,1,EA,1.88000,1.78000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,The Alliance,PPO Network,,25.59,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,PPO Network,,25.59,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,inpatient,1,EA,4.52000,4.30000,The Alliance,PPO Network,,3.76,,,,,,,2.49,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,outpatient,1,EA,4.52000,4.30000,The Alliance,PPO Network,,3.76,,,,,,,2.26,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.32,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,PPO Network,,5.02,,,,,,,3.02,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,inpatient,1,EA,1.69000,1.61000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,outpatient,1,EA,1.69000,1.61000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,140.80,248.32,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,27.22,1392.10,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,2.28,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,2.07,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,inpatient,1,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,inpatient,1,EA,11.34000,10.78000,The Alliance,PPO Network,,9.42,,,,,,,6.24,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,PPO Network,,9.42,,,,,,,5.67,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,inpatient,1,EA,10.83000,10.29000,The Alliance,PPO Network,,9.00,,,,,,,5.96,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,outpatient,1,EA,10.83000,10.29000,The Alliance,PPO Network,,9.00,,,,,,,5.42,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96000,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.00620,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.00620,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,inpatient,1,EA,1.42000,1.34000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,outpatient,1,EA,1.42000,1.34000,The Alliance,PPO Network,,1.18,,,,,,,0.00620,1.38,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,inpatient,30,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,outpatient,30,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,inpatient,30,EA,45.29000,43.03000,The Alliance,PPO Network,,37.64,,,,,,,24.91,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,outpatient,30,EA,45.29000,43.03000,The Alliance,PPO Network,,37.64,,,,,,,22.64,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,inpatient,30,EA,35.01000,33.26000,The Alliance,PPO Network,,29.09,,,,,,,19.26,33.96,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,outpatient,30,EA,35.01000,33.26000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.96,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,15.32,797.91,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,inpatient,2,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,outpatient,2,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,4.85,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,inpatient,2,EA,11.46000,10.89000,The Alliance,PPO Network,,9.52,,,,,,,6.30,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,outpatient,2,EA,11.46000,10.89000,The Alliance,PPO Network,,9.52,,,,,,,4.03,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,inpatient,2,EA,7.31000,6.94000,The Alliance,PPO Network,,6.07,,,,,,,4.02,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,outpatient,2,EA,7.31000,6.94000,The Alliance,PPO Network,,6.07,,,,,,,3.65,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,inpatient,2,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,outpatient,2,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,4.03,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,inpatient,2,EA,8.37000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.60,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,outpatient,2,EA,8.37000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.03,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,inpatient,2,EA,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,4.00,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,3.63,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,inpatient,2,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,16.08,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,outpatient,2,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,4.03,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,inpatient,2,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,4.03,27.59,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,inpatient,1,mL,9.78000,9.29000,The Alliance,PPO Network,,8.13,,,,,,,5.38,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,outpatient,1,mL,9.78000,9.29000,The Alliance,PPO Network,,8.13,,,,,,,2.17,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,inpatient,1,mL,7.05000,6.69000,The Alliance,PPO Network,,5.86,,,,,,,3.88,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,outpatient,1,mL,7.05000,6.69000,The Alliance,PPO Network,,5.86,,,,,,,2.17,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,inpatient,1,mL,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,3.40,6.00,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,2.17,6.00,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,inpatient,1,EA,5.66000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.49,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,2.14,5.49,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,inpatient,1,EA,17.88000,16.98000,The Alliance,PPO Network,,14.86,,,,,,,9.83,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,outpatient,1,EA,17.88000,16.98000,The Alliance,PPO Network,,14.86,,,,,,,8.94,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,inpatient,1,EA,2.63000,2.49000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,outpatient,1,EA,2.63000,2.49000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,inpatient,15,EA,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,4.73,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,outpatient,15,EA,8.60000,8.17000,The Alliance,PPO Network,,7.15,,,,,,,4.30,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,inpatient,15,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,4.06,7.16,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,outpatient,15,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,3.69,7.16,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,18.39,967.70,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,The Alliance,PPO Network,,22.54,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,PPO Network,,22.54,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,inpatient,1,EA,24.66000,23.42000,The Alliance,PPO Network,,20.49,,,,,,,13.56,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,outpatient,1,EA,24.66000,23.42000,The Alliance,PPO Network,,20.49,,,,,,,12.33,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,GP,50.69,,,,,,,33.55,59.17,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,GP,50.69,,,,,,,30.50,264.00,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,PPO Network,,160.05,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,PPO Network,,160.05,,,,,,,16.59,865.84,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,PPO Network,90,160.05,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,PPO Network,90,160.05,,,,,,,16.59,865.84,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,inpatient,20,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,outpatient,20,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,inpatient,20,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,outpatient,20,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,inpatient,20,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,inpatient,20,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,outpatient,20,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,inpatient,20,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,outpatient,20,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.14409,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,inpatient,20,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,outpatient,20,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,inpatient,20,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,outpatient,20,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,inpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,inpatient,20,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,outpatient,20,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.14409,0.85360,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,GP,88.09,,,,,,,58.30,102.82,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,GP,88.09,,,,,,,53.00,264.00,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.42,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.10,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.40,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.09,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.22,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.02,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,The Alliance,PPO Network,,6.02,,,,,,,3.98,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,PPO Network,,6.02,,,,,,,3.62,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.63,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.40,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,inpatient,1,EA,7.25000,6.89000,The Alliance,PPO Network,,6.02,,,,,,,3.99,7.03,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,PPO Network,,6.02,,,,,,,3.62,7.03,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,13.84,729.98,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,72.60,128.04,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,11.61,611.15,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,GP,44.04,,,,,,,29.15,51.41,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,GP,44.04,,,,,,,26.50,264.00,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.53,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.00620,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.00620,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.00620,0.22310,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,inpatient,1,EA,9.73000,9.25000,The Alliance,PPO Network,,8.09,,,,,,,5.35,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,outpatient,1,EA,9.73000,9.25000,The Alliance,PPO Network,,8.09,,,,,,,4.87,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.65,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,PPO Network,GP,78.11,,,,,,,51.70,91.18,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,PPO Network,GP,78.11,,,,,,,47.00,264.00,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,397.10,700.34,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,397.10,3163.00,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,4.00,186.75,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,4.29,203.72,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,GP,52.35,,,,,,,34.65,61.11,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,GP,52.35,,,,,,,31.50,264.00,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,18.39,967.70,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,PPO Network,GP,225.20,,,,,,,149.05,262.87,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,PPO Network,GP,225.20,,,,,,,126.65,264.00,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,GP,113.85,,,,,,,75.35,132.89,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,GP,113.85,,,,,,,68.50,264.00,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,GP,91.41,,,,,,,60.50,106.70,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,GP,91.41,,,,,,,55.00,264.00,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,GP,218.55,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,GP,218.55,,,,,,,126.65,264.00,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,GP,34.90,,,,,,,23.10,40.74,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,GP,34.90,,,,,,,21.00,264.00,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,PPO Network,,844.30,,,,,,,558.80,985.52,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,PPO Network,,844.30,,,,,,,558.80,5271.00,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,inpatient,1,EA,17.19000,16.33000,The Alliance,PPO Network,,14.28,,,,,,,9.45,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,outpatient,1,EA,17.19000,16.33000,The Alliance,PPO Network,,14.28,,,,,,,1.73,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,inpatient,1,EA,48.57000,46.14000,The Alliance,PPO Network,,40.36,,,,,,,26.71,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,outpatient,1,EA,48.57000,46.14000,The Alliance,PPO Network,,40.36,,,,,,,1.73,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,inpatient,1,EA,44.05000,41.85000,The Alliance,PPO Network,,36.61,,,,,,,24.23,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,PPO Network,,36.61,,,,,,,1.73,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,inpatient,1,EA,21.69000,20.61000,The Alliance,PPO Network,,18.02,,,,,,,11.93,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,outpatient,1,EA,21.69000,20.61000,The Alliance,PPO Network,,18.02,,,,,,,1.73,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,inpatient,1,EA,49.30000,46.83000,The Alliance,PPO Network,,40.97,,,,,,,27.11,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,outpatient,1,EA,49.30000,46.83000,The Alliance,PPO Network,,40.97,,,,,,,1.73,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,inpatient,1,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,outpatient,1,EA,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,1.73,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,inpatient,1,EA,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,11.82,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,1.73,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,inpatient,1,EA,48.24000,45.83000,The Alliance,PPO Network,,40.09,,,,,,,26.53,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,outpatient,1,EA,48.24000,45.83000,The Alliance,PPO Network,,40.09,,,,,,,1.73,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,1.73,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,13.21,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,1.73,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,inpatient,1,EA,55.49000,52.72000,The Alliance,PPO Network,,46.11,,,,,,,30.52,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,outpatient,1,EA,55.49000,52.72000,The Alliance,PPO Network,,46.11,,,,,,,1.73,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,inpatient,1,EA,43.39000,41.22000,The Alliance,PPO Network,,36.06,,,,,,,23.86,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,outpatient,1,EA,43.39000,41.22000,The Alliance,PPO Network,,36.06,,,,,,,1.73,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,inpatient,1,EA,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,25.38,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,outpatient,1,EA,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,1.73,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,inpatient,1,EA,33.43000,31.76000,The Alliance,PPO Network,,27.78,,,,,,,18.39,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,outpatient,1,EA,33.43000,31.76000,The Alliance,PPO Network,,27.78,,,,,,,1.73,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,inpatient,1,EA,21.33000,20.26000,The Alliance,PPO Network,,17.73,,,,,,,11.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,outpatient,1,EA,21.33000,20.26000,The Alliance,PPO Network,,17.73,,,,,,,1.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,inpatient,1,EA,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,15.90,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,outpatient,1,EA,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,1.73,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,1.73,18.39,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,GP,89.75,,,,,,,59.40,104.76,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,GP,89.75,,,,,,,54.00,264.00,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,GP,71.47,,,,,,,47.30,83.42,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,GP,71.47,,,,,,,43.00,264.00,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,inpatient,1,EA,2.11000,2.01000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,outpatient,1,EA,2.11000,2.01000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,inpatient,,,2160.00000,2052.00000,The Alliance,PPO Network,,1794.96,,,,,,,1188.00,2095.20,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,outpatient,,,2160.00000,2052.00000,The Alliance,PPO Network,,1794.96,,,,,,,255.05,12002.48,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,inpatient,,,3096.00000,2941.20000,The Alliance,PPO Network,TC,2572.78,,,,,,,1702.80,3003.12,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,PPO Network,TC,2572.78,,,,,,,1428.78,3003.12,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,inpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,2.08,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,PPO Network,,3.14,,,,,,,0.73040,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.73040,1.60,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,PPO Network,GP,81.44,,,,,,,53.90,95.06,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,PPO Network,GP,81.44,,,,,,,49.00,264.00,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,inpatient,,,1881.00000,1786.95000,The Alliance,PPO Network,TC,1563.11,,,,,,,1034.55,1824.57,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,outpatient,,,1881.00000,1786.95000,The Alliance,PPO Network,TC,1563.11,,,,,,,885.12,2210.07,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,72.60,128.04,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,11.53,594.19,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,inpatient,1,EA,48.03000,45.63000,The Alliance,PPO Network,,39.91,,,,,,,26.42,46.59,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,outpatient,1,EA,48.03000,45.63000,The Alliance,PPO Network,,39.91,,,,,,,19.48,46.59,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.00620,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.00620,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.00620,0.22310,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,inpatient,,,166.60000,158.27000,The Alliance,PPO Network,90,138.44,,,,,,,91.63,161.60,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,PPO Network,90,138.44,,,,,,,14.83,746.94,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.67,186.75,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,inpatient,,,743.00000,705.85000,The Alliance,PPO Network,,617.43,,,,,,,408.65,720.71,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,PPO Network,,617.43,,,,,,,408.65,3163.00,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,216.70,382.18,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,197.00,382.18,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,GP,69.80,,,,,,,46.20,81.48,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,GP,69.80,,,,,,,42.00,264.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,5.51,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,10.77,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,5.51,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,inpatient,1,EA,31.82000,30.23000,The Alliance,PPO Network,,26.44,,,,,,,17.50,30.87,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,outpatient,1,EA,31.82000,30.23000,The Alliance,PPO Network,,26.44,,,,,,,5.51,30.87,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,PPO Network,GP,117.17,,,,,,,77.55,136.77,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,PPO Network,GP,117.17,,,,,,,70.50,264.00,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,inpatient,0.5,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,outpatient,0.5,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,inpatient,0.5,EA,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,3.39,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,outpatient,0.5,EA,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,3.08,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,inpatient,0.5,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,outpatient,0.5,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,The Alliance,PPO Network,,25.59,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,PPO Network,,25.59,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,273.50,1232.72,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,GP,71.47,,,,,,,47.30,83.42,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,GP,71.47,,,,,,,43.00,264.00,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,The Alliance,PPO Network,TC,2712.38,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,PPO Network,TC,2712.38,,,,,,,1527.07,3166.08,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,152.90,269.66,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,139.00,269.66,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,inpatient,1,EA,45.52000,43.24000,The Alliance,PPO Network,,37.83,,,,,,,25.04,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,outpatient,1,EA,45.52000,43.24000,The Alliance,PPO Network,,37.83,,,,,,,22.76,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,inpatient,1,EA,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.34,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.12,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,inpatient,1,EA,3.90000,3.71000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,inpatient,1,EA,4.37000,4.16000,The Alliance,PPO Network,,3.63,,,,,,,2.40,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,outpatient,1,EA,4.37000,4.16000,The Alliance,PPO Network,,3.63,,,,,,,2.19,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.12,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,GP,103.04,,,,,,,68.20,120.28,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,GP,103.04,,,,,,,62.00,264.00,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,inpatient,1,EA,0.23000,0.21000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,outpatient,1,EA,0.23000,0.21000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,31.84,56.16,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,PPO Network,,48.11,,,,,,,28.95,56.16,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,3163.00,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,62.50,121.25,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,inpatient,,,2360.00000,2242.00000,The Alliance,PPO Network,TC,1961.16,,,,,,,1298.00,2289.20,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,outpatient,,,2360.00000,2242.00000,The Alliance,PPO Network,TC,1961.16,,,,,,,1087.81,2289.20,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,GP,218.55,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,GP,218.55,,,,,,,126.65,264.00,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,107.25,189.15,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,97.50,1714.64,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,inpatient,1,EA,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,inpatient,1,EA,55.27000,52.50000,The Alliance,PPO Network,,45.93,,,,,,,30.40,53.61,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,outpatient,1,EA,55.27000,52.50000,The Alliance,PPO Network,,45.93,,,,,,,27.64,53.61,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,GP,92.24,,,,,,,61.05,107.67,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,GP,92.24,,,,,,,55.50,264.00,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,GP,95.56,,,,,,,63.25,111.55,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,GP,95.56,,,,,,,57.50,264.00,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,inpatient,,,893.00000,848.35000,The Alliance,PPO Network,TC,742.08,,,,,,,491.15,866.21,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,PPO Network,TC,742.08,,,,,,,437.23,1232.72,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,PPO Network,,81.44,,,,,,,53.90,95.06,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,PPO Network,,81.44,,,,,,,8.68,458.40,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,GP,83.93,,,,,,,55.55,97.97,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,GP,83.93,,,,,,,50.50,264.00,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,inpatient,1,EA,12.28000,11.66000,The Alliance,PPO Network,,10.20,,,,,,,6.75,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,outpatient,1,EA,12.28000,11.66000,The Alliance,PPO Network,,10.20,,,,,,,6.14,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,The Alliance,PPO Network,,17.33,,,,,,,11.47,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,PPO Network,,17.33,,,,,,,10.43,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,inpatient,1,EA,12.22000,11.61000,The Alliance,PPO Network,,10.15,,,,,,,6.72,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,outpatient,1,EA,12.22000,11.61000,The Alliance,PPO Network,,10.15,,,,,,,6.11,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,inpatient,1,EA,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.69,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,outpatient,1,EA,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.45,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,inpatient,1,EA,19.31000,18.34000,The Alliance,PPO Network,,16.05,,,,,,,10.62,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,outpatient,1,EA,19.31000,18.34000,The Alliance,PPO Network,,16.05,,,,,,,9.65,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,1.82,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,inpatient,,,1923.00000,1826.85000,The Alliance,PPO Network,TC,1598.01,,,,,,,1057.65,1865.31,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,outpatient,,,1923.00000,1826.85000,The Alliance,PPO Network,TC,1598.01,,,,,,,905.36,2210.07,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,TC,449.57,,,,,,,297.55,524.77,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,TC,449.57,,,,,,,270.50,1232.72,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.86,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.69,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,inpatient,1,EA,22.91000,21.76000,The Alliance,PPO Network,,19.04,,,,,,,12.60,22.22,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,PPO Network,,19.04,,,,,,,11.46,22.22,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,The Alliance,PPO Network,,106.62,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,PPO Network,,106.62,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,The Alliance,PPO Network,90,106.62,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,PPO Network,90,106.62,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,inpatient,1,EA,38.14000,36.23000,The Alliance,PPO Network,,31.69,,,,,,,20.98,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,outpatient,1,EA,38.14000,36.23000,The Alliance,PPO Network,,31.69,,,,,,,19.07,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,inpatient,2,EA,40.56000,38.53000,The Alliance,PPO Network,,33.71,,,,,,,22.31,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,outpatient,2,EA,40.56000,38.53000,The Alliance,PPO Network,,33.71,,,,,,,20.28,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,inpatient,2,EA,53.34000,50.67000,The Alliance,PPO Network,,44.33,,,,,,,29.34,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,outpatient,2,EA,53.34000,50.67000,The Alliance,PPO Network,,44.33,,,,,,,26.67,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,inpatient,2,EA,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,17.26,30.44,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,outpatient,2,EA,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,15.69,30.44,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,56.40,1426.03,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,34.10,60.14,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,5.57,288.61,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,inpatient,1,EA,20.17000,19.17000,The Alliance,PPO Network,,16.76,,,,,,,11.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,outpatient,1,EA,20.17000,19.17000,The Alliance,PPO Network,,16.76,,,,,,,10.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,inpatient,,,221.00000,209.95000,The Alliance,PPO Network,,183.65,,,,,,,121.55,214.37,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,outpatient,,,221.00000,209.95000,The Alliance,PPO Network,,183.65,,,,,,,121.55,5271.00,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,28.50,55.29,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,inpatient,1,mL,296.89000,282.04000,The Alliance,PPO Network,,246.72,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,PPO Network,,246.72,,,,,,,75.93,287.98,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,290.95,513.13,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,173.99,513.13,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,inpatient,1,EA,317.28000,301.41000,The Alliance,PPO Network,,263.66,,,,,,,174.50,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,outpatient,1,EA,317.28000,301.41000,The Alliance,PPO Network,,263.66,,,,,,,158.64,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,inpatient,1,EA,259.49000,246.51000,The Alliance,PPO Network,,215.64,,,,,,,142.72,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,outpatient,1,EA,259.49000,246.51000,The Alliance,PPO Network,,215.64,,,,,,,129.75,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,inpatient,1,EA,317.48000,301.61000,The Alliance,PPO Network,,263.83,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,PPO Network,,263.83,,,,,,,158.74,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,inpatient,1,EA,317.48000,301.61000,The Alliance,PPO Network,,263.83,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,PPO Network,,263.83,,,,,,,158.74,307.96,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,GP,101.38,,,,,,,67.10,118.34,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,GP,101.38,,,,,,,61.00,264.00,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,inpatient,1,EA,105.16000,99.91000,The Alliance,PPO Network,,87.39,,,,,,,57.84,102.01,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,outpatient,1,EA,105.16000,99.91000,The Alliance,PPO Network,,87.39,,,,,,,52.58,102.01,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,1137.41,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,inpatient,5,EA,162.90000,154.76000,The Alliance,PPO Network,,135.37,,,,,,,89.59,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,outpatient,5,EA,162.90000,154.76000,The Alliance,PPO Network,,135.37,,,,,,,4.63,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,inpatient,5,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,outpatient,5,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,4.63,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,inpatient,5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,4.63,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,inpatient,5,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,outpatient,5,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,4.63,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,inpatient,5,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,outpatient,5,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,4.63,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,inpatient,5,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,outpatient,5,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,4.63,18.39,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,565.00000,536.75000,The Alliance,PPO Network,,469.51,,,,,,,310.75,548.05,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,565.00000,536.75000,The Alliance,PPO Network,,469.51,,,,,,,242.89,548.05,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,264.00,465.60,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,240.00,465.60,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,6.47,339.51,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,5.67,288.61,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,10.13,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,PPO Network,,15.31,,,,,,,9.21,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.92,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,PPO Network,,2.90,,,,,,,1.75,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,The Alliance,PPO Network,,14.38,,,,,,,9.52,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,PPO Network,,14.38,,,,,,,8.65,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,The Alliance,PPO Network,,9.65,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,PPO Network,,9.65,,,,,,,5.80,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,The Alliance,PPO Network,,9.65,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,PPO Network,,9.65,,,,,,,5.80,11.26,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,inpatient,1,mL,369.91000,351.42000,The Alliance,PPO Network,,307.40,,,,,,,203.45,358.81,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,outpatient,1,mL,369.91000,351.42000,The Alliance,PPO Network,,307.40,,,,,,,74.45,358.81,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,inpatient,1,EA,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,11.59,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,outpatient,1,EA,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,10.54,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,PPO Network,,2.56,,,,,,,1.54,2.99,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,,108.03,,,,,,,71.50,126.10,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,,108.03,,,,,,,71.50,5271.00,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,89.24,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,3163.00,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,inpatient,1,EA,193.55000,183.87000,The Alliance,PPO Network,,160.84,,,,,,,106.45,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,outpatient,1,EA,193.55000,183.87000,The Alliance,PPO Network,,160.84,,,,,,,96.78,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,inpatient,1,EA,203.22000,193.06000,The Alliance,PPO Network,,168.88,,,,,,,111.77,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,outpatient,1,EA,203.22000,193.06000,The Alliance,PPO Network,,168.88,,,,,,,101.61,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,inpatient,1,EA,193.68000,184.00000,The Alliance,PPO Network,,160.95,,,,,,,106.52,187.87,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,outpatient,1,EA,193.68000,184.00000,The Alliance,PPO Network,,160.95,,,,,,,96.84,187.87,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,PPO Network,,552.62,,,,,,,365.75,645.05,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,PPO Network,,552.62,,,,,,,365.75,4686.00,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,inpatient,1,mL,296.89000,282.04000,The Alliance,PPO Network,,246.72,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,PPO Network,,246.72,,,,,,,75.93,287.98,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,inpatient,,,114.40000,108.68000,The Alliance,PPO Network,90,95.07,,,,,,,62.92,110.97,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,outpatient,,,114.40000,108.68000,The Alliance,PPO Network,90,95.07,,,,,,,10.18,509.30,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,inpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,inpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,4.06,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,GP,95.56,,,,,,,63.25,111.55,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,GP,95.56,,,,,,,57.50,264.00,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,inpatient,,,234.90000,223.16000,The Alliance,PPO Network,90,195.20,,,,,,,129.19,227.85,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,outpatient,,,234.90000,223.16000,The Alliance,PPO Network,90,195.20,,,,,,,20.91,1052.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,inpatient,1,mL,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,outpatient,1,mL,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,inpatient,1,mL,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,inpatient,1,mL,2.27000,2.15000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,outpatient,1,mL,2.27000,2.15000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,inpatient,1,mL,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,outpatient,1,mL,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,inpatient,1,mL,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,inpatient,1,mL,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,outpatient,1,mL,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,inpatient,1,mL,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.12,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,GP,47.37,,,,,,,31.35,55.29,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,GP,47.37,,,,,,,28.50,264.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,inpatient,2,EA,919.61000,873.63000,The Alliance,PPO Network,,764.20,,,,,,,505.79,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,outpatient,2,EA,919.61000,873.63000,The Alliance,PPO Network,,764.20,,,,,,,266.44,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,inpatient,2,EA,965.58000,917.30000,The Alliance,PPO Network,,802.40,,,,,,,531.07,936.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,outpatient,2,EA,965.58000,917.30000,The Alliance,PPO Network,,802.40,,,,,,,266.44,936.61,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,inpatient,1,mL,335.14000,318.38000,The Alliance,PPO Network,,278.50,,,,,,,184.33,325.09,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,outpatient,1,mL,335.14000,318.38000,The Alliance,PPO Network,,278.50,,,,,,,74.45,325.09,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,inpatient,1,EA,8.42000,8.00000,The Alliance,PPO Network,,7.00,,,,,,,4.63,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,outpatient,1,EA,8.42000,8.00000,The Alliance,PPO Network,,7.00,,,,,,,4.21,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,30.00,58.20,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,30.00,58.20,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,inpatient,1,EA,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,8.41,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,outpatient,1,EA,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,7.65,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,inpatient,1,mL,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.08525,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.08525,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,inpatient,1,mL,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,inpatient,1,mL,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,1.63,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,0.08525,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,inpatient,1,mL,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,outpatient,1,mL,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.08525,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,inpatient,1,mL,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.08525,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,inpatient,30,EA,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,outpatient,30,EA,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,inpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,inpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,0.08525,2.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,30.00,58.20,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,9.58,492.33,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,2.38,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,2.17,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,inpatient,5,EA,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,outpatient,5,EA,3.25000,3.08000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,inpatient,5,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,inpatient,5,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,outpatient,5,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,inpatient,5,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,inpatient,5,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,outpatient,5,EA,4.76000,4.52000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,inpatient,5,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,outpatient,5,EA,3.07000,2.91000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,inpatient,5,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,inpatient,5,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,outpatient,5,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,inpatient,5,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,outpatient,5,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,inpatient,5,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,outpatient,5,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,inpatient,5,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,inpatient,5,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.67,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,PPO Network,,2.52,,,,,,,1.51,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,inpatient,5,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,outpatient,5,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,inpatient,5,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,outpatient,5,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,inpatient,5,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,outpatient,5,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,inpatient,5,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,inpatient,5,EA,3.71000,3.53000,The Alliance,PPO Network,,3.08,,,,,,,2.04,3.60,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,outpatient,5,EA,3.71000,3.53000,The Alliance,PPO Network,,3.08,,,,,,,1.85,3.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,inpatient,1,EA,462.47000,439.35000,The Alliance,PPO Network,,384.31,,,,,,,254.36,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,outpatient,1,EA,462.47000,439.35000,The Alliance,PPO Network,,384.31,,,,,,,231.24,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,inpatient,1,EA,396.27000,376.46000,The Alliance,PPO Network,,329.30,,,,,,,217.95,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,outpatient,1,EA,396.27000,376.46000,The Alliance,PPO Network,,329.30,,,,,,,198.13,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,inpatient,1,EA,399.12000,379.16000,The Alliance,PPO Network,,331.67,,,,,,,219.52,387.15,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,outpatient,1,EA,399.12000,379.16000,The Alliance,PPO Network,,331.67,,,,,,,199.56,387.15,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,11.98,628.12,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,inpatient,20,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,outpatient,20,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.08525,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,inpatient,20,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,outpatient,20,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.08525,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,inpatient,20,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.08525,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,inpatient,20,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,outpatient,20,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.08525,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,inpatient,20,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,outpatient,20,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,inpatient,20,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,outpatient,20,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.08525,1.32,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,62.70,110.58,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,PPO Network,,94.73,,,,,,,14.48,679.08,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,PPO Network,,749.56,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,PPO Network,,749.56,,,,,,,200.06,874.94,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,The Alliance,PPO Network,TC,796.10,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,PPO Network,TC,796.10,,,,,,,384.16,1329.46,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,inpatient,400,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,outpatient,400,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,inpatient,400,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,outpatient,400,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,TC,61.49,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,TC,61.49,,,,,,,37.00,442.00,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,inpatient,1,EA,172.07000,163.47000,The Alliance,PPO Network,,142.99,,,,,,,94.64,166.91,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,outpatient,1,EA,172.07000,163.47000,The Alliance,PPO Network,,142.99,,,,,,,86.03,166.91,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,inpatient,250,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,outpatient,250,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,inpatient,250,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,outpatient,250,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,inpatient,250,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,outpatient,250,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,inpatient,250,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,outpatient,250,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,inpatient,250,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,outpatient,250,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,inpatient,28,EA,25.82000,24.53000,The Alliance,PPO Network,,21.46,,,,,,,14.20,25.05,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,outpatient,28,EA,25.82000,24.53000,The Alliance,PPO Network,,21.46,,,,,,,12.91,25.05,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.29,4.04,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,PPO Network,,3.47,,,,,,,2.08,4.04,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,13.91,662.12,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,inpatient,1,EA,29.01000,27.56000,The Alliance,PPO Network,,24.11,,,,,,,15.96,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,PPO Network,,24.11,,,,,,,14.51,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.65,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,5339.00000,5072.05000,The Alliance,PPO Network,,4436.71,,,,,,,2936.45,5178.83,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,5339.00000,5072.05000,The Alliance,PPO Network,,4436.71,,,,,,,416.78,5178.83,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,69.33,3666.93,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,inpatient,1,EA,33.84000,32.15000,The Alliance,PPO Network,,28.12,,,,,,,18.61,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,outpatient,1,EA,33.84000,32.15000,The Alliance,PPO Network,,28.12,,,,,,,16.92,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,inpatient,1,EA,31.84000,30.25000,The Alliance,PPO Network,,26.46,,,,,,,17.51,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,outpatient,1,EA,31.84000,30.25000,The Alliance,PPO Network,,26.46,,,,,,,15.92,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,inpatient,1,GM,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,outpatient,1,GM,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,inpatient,1,GM,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,outpatient,1,GM,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,inpatient,1,GM,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,outpatient,1,GM,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,inpatient,1,GM,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,outpatient,1,GM,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,inpatient,1,EA,14.60000,13.87000,The Alliance,PPO Network,,12.13,,,,,,,8.03,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,outpatient,1,EA,14.60000,13.87000,The Alliance,PPO Network,,12.13,,,,,,,7.30,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,inpatient,,,913.00000,867.35000,The Alliance,PPO Network,TC,758.70,,,,,,,502.15,885.61,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,outpatient,,,913.00000,867.35000,The Alliance,PPO Network,TC,758.70,,,,,,,455.68,2210.07,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,The Alliance,PPO Network,,50.16,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,PPO Network,,50.16,,,,,,,30.18,58.55,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,inpatient,10,EA,37.19000,35.33000,The Alliance,PPO Network,,30.90,,,,,,,20.45,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,outpatient,10,EA,37.19000,35.33000,The Alliance,PPO Network,,30.90,,,,,,,0.08525,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,inpatient,10,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,outpatient,10,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.08525,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,inpatient,10,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,outpatient,10,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,0.08525,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,inpatient,10,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,outpatient,10,EA,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.08525,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,inpatient,10,EA,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,outpatient,10,EA,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,0.08525,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,inpatient,10,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,outpatient,10,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.08525,1.13,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,2.70,135.79,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,inpatient,200,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,outpatient,200,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.08525,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,inpatient,200,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,outpatient,200,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,inpatient,200,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,outpatient,200,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,inpatient,200,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,outpatient,200,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,inpatient,200,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,outpatient,200,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.08525,1.11,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,inpatient,1,EA,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,4.12,7.27,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,3.75,7.27,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,inpatient,,,296.20000,281.39000,The Alliance,PPO Network,90,246.14,,,,,,,162.91,287.31,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,PPO Network,90,246.14,,,,,,,26.38,1341.13,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,inpatient,1,EA,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,outpatient,1,EA,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,90.75,160.05,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,12.88,679.08,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,inpatient,50,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,inpatient,50,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,outpatient,50,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,inpatient,1,EA,56.35000,53.53000,The Alliance,PPO Network,,46.83,,,,,,,30.99,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,outpatient,1,EA,56.35000,53.53000,The Alliance,PPO Network,,46.83,,,,,,,28.18,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,inpatient,1,EA,34.93000,33.19000,The Alliance,PPO Network,,29.03,,,,,,,19.21,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,outpatient,1,EA,34.93000,33.19000,The Alliance,PPO Network,,29.03,,,,,,,17.46,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,inpatient,1,EA,58.08000,55.18000,The Alliance,PPO Network,,48.26,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,outpatient,1,EA,58.08000,55.18000,The Alliance,PPO Network,,48.26,,,,,,,29.04,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,inpatient,1,EA,51.07000,48.51000,The Alliance,PPO Network,,42.44,,,,,,,28.09,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,outpatient,1,EA,51.07000,48.51000,The Alliance,PPO Network,,42.44,,,,,,,25.54,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,inpatient,1,EA,42.19000,40.08000,The Alliance,PPO Network,,35.06,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,PPO Network,,35.06,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,inpatient,1,EA,42.19000,40.08000,The Alliance,PPO Network,,35.06,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,PPO Network,,35.06,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,inpatient,1,EA,67.30000,63.93000,The Alliance,PPO Network,,55.93,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,PPO Network,,55.93,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,inpatient,1,EA,67.30000,63.93000,The Alliance,PPO Network,,55.93,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,PPO Network,,55.93,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,inpatient,1,EA,60.57000,57.54000,The Alliance,PPO Network,,50.33,,,,,,,33.31,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,outpatient,1,EA,60.57000,57.54000,The Alliance,PPO Network,,50.33,,,,,,,30.29,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,inpatient,1,EA,50.72000,48.18000,The Alliance,PPO Network,,42.15,,,,,,,27.90,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,outpatient,1,EA,50.72000,48.18000,The Alliance,PPO Network,,42.15,,,,,,,25.36,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,inpatient,1,EA,30.02000,28.52000,The Alliance,PPO Network,,24.95,,,,,,,16.51,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,PPO Network,,24.95,,,,,,,15.01,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,inpatient,1,EA,58.08000,55.17000,The Alliance,PPO Network,,48.26,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,outpatient,1,EA,58.08000,55.17000,The Alliance,PPO Network,,48.26,,,,,,,29.04,56.34,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,inpatient,1,EA,333.36000,316.69000,The Alliance,PPO Network,,277.02,,,,,,,183.35,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,outpatient,1,EA,333.36000,316.69000,The Alliance,PPO Network,,277.02,,,,,,,166.68,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,PPO Network,,22.84,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,PPO Network,,24.21,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,The Alliance,PPO Network,,3.64,,,,,,,2.41,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,PPO Network,,3.64,,,,,,,2.19,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,inpatient,1,EA,283.39000,269.22000,The Alliance,PPO Network,,235.50,,,,,,,155.86,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,outpatient,1,EA,283.39000,269.22000,The Alliance,PPO Network,,235.50,,,,,,,141.69,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,inpatient,1,EA,353.87000,336.18000,The Alliance,PPO Network,,294.07,,,,,,,194.63,343.25,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,outpatient,1,EA,353.87000,336.18000,The Alliance,PPO Network,,294.07,,,,,,,176.94,343.25,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,inpatient,,,205.00000,194.75000,The Alliance,PPO Network,,170.35,,,,,,,112.75,198.85,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,outpatient,,,205.00000,194.75000,The Alliance,PPO Network,,170.35,,,,,,,7.57,198.85,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.51,288.61,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,PPO Network,,213.57,,,,,,,141.35,249.29,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,PPO Network,,213.57,,,,,,,21.73,1137.41,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,11.53,574.73,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,inpatient,50,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,outpatient,50,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,inpatient,50,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,outpatient,50,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,inpatient,50,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,outpatient,50,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,inpatient,50,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,outpatient,50,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,inpatient,50,EA,1.37000,1.31000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,outpatient,50,EA,1.37000,1.31000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,inpatient,50,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,outpatient,50,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,inpatient,1,EA,6621.21000,6290.15000,The Alliance,PPO Network,,5502.23,,,,,,,3641.67,6422.57,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,outpatient,1,EA,6621.21000,6290.15000,The Alliance,PPO Network,,5502.23,,,,,,,31.08,6422.57,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,12.05,628.12,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,8.61,458.40,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,inpatient,100,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,outpatient,100,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.08525,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,inpatient,100,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,inpatient,100,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,outpatient,100,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,inpatient,100,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,outpatient,100,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.08525,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,inpatient,100,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,outpatient,100,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,inpatient,100,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.08525,1.18,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,inpatient,,,18565.90000,17637.60000,The Alliance,PPO Network,,15428.26,,,,,,,9097.29,18008.92,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,outpatient,,,18565.90000,17637.60000,The Alliance,PPO Network,,15428.26,,,,,,,8521.75,18565.90,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,inpatient,133,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,outpatient,133,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,inpatient,133,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,outpatient,133,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,inpatient,133,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,outpatient,133,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,inpatient,1,EA,49.86000,47.37000,The Alliance,PPO Network,,41.43,,,,,,,27.42,48.36,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,outpatient,1,EA,49.86000,47.37000,The Alliance,PPO Network,,41.43,,,,,,,24.93,48.36,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,4.81,254.68,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,4.27,220.68,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,inpatient,120,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,outpatient,120,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,inpatient,120,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,outpatient,120,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,inpatient,50,EA,6.13000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.37,5.95,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,outpatient,50,EA,6.13000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.06,5.95,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,inpatient,10,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,outpatient,10,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,inpatient,10,EA,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,outpatient,10,EA,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,2.89,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,inpatient,10,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.88,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,outpatient,10,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.71,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,inpatient,10,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,outpatient,10,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,inpatient,1,EA,15.92000,15.13000,The Alliance,PPO Network,,13.23,,,,,,,8.76,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,outpatient,1,EA,15.92000,15.13000,The Alliance,PPO Network,,13.23,,,,,,,7.96,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,inpatient,1,EA,22.30000,21.18000,The Alliance,PPO Network,,18.53,,,,,,,12.27,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,outpatient,1,EA,22.30000,21.18000,The Alliance,PPO Network,,18.53,,,,,,,11.15,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,inpatient,1,EA,23.50000,22.33000,The Alliance,PPO Network,,19.53,,,,,,,12.93,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,outpatient,1,EA,23.50000,22.33000,The Alliance,PPO Network,,19.53,,,,,,,11.75,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,inpatient,1,EA,13.15000,12.49000,The Alliance,PPO Network,,10.93,,,,,,,7.23,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,outpatient,1,EA,13.15000,12.49000,The Alliance,PPO Network,,10.93,,,,,,,6.58,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,inpatient,1,EA,20.33000,19.32000,The Alliance,PPO Network,,16.89,,,,,,,11.18,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,outpatient,1,EA,20.33000,19.32000,The Alliance,PPO Network,,16.89,,,,,,,10.16,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,inpatient,1,EA,16.17000,15.36000,The Alliance,PPO Network,,13.44,,,,,,,8.89,15.68,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,outpatient,1,EA,16.17000,15.36000,The Alliance,PPO Network,,13.44,,,,,,,8.09,15.68,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,inpatient,30,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,inpatient,30,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,outpatient,30,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,inpatient,30,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,outpatient,30,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,inpatient,1,mL,5.10000,4.84000,The Alliance,PPO Network,,4.24,,,,,,,2.81,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,outpatient,1,mL,5.10000,4.84000,The Alliance,PPO Network,,4.24,,,,,,,2.55,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,inpatient,1,mL,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.44,4.31,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,outpatient,1,mL,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.22,4.31,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,12.31,628.12,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,inpatient,1,GM,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,outpatient,1,GM,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,inpatient,30,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,outpatient,30,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,inpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,inpatient,15,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,outpatient,15,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,inpatient,15,EA,9.38000,8.91000,The Alliance,PPO Network,,7.79,,,,,,,5.16,9.10,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,outpatient,15,EA,9.38000,8.91000,The Alliance,PPO Network,,7.79,,,,,,,4.69,9.10,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,5.06,254.68,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,inpatient,500,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,outpatient,500,EA,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.15000,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,inpatient,500,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,outpatient,500,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.15000,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,inpatient,50,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,outpatient,50,EA,1.44000,1.36000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,inpatient,50,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,outpatient,50,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,inpatient,1,mL,987.52000,938.14000,The Alliance,PPO Network,,820.63,,,,,,,543.14,957.89,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,outpatient,1,mL,987.52000,938.14000,The Alliance,PPO Network,,820.63,,,,,,,493.76,957.89,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,inpatient,,,359.60000,341.62000,The Alliance,PPO Network,90,298.83,,,,,,,197.78,348.81,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,outpatient,,,359.60000,341.62000,The Alliance,PPO Network,90,298.83,,,,,,,32.01,1612.78,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,inpatient,1,mL,426.59000,405.26000,The Alliance,PPO Network,,354.50,,,,,,,234.62,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,outpatient,1,mL,426.59000,405.26000,The Alliance,PPO Network,,354.50,,,,,,,213.29,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,inpatient,1,mL,360.24000,342.23000,The Alliance,PPO Network,,299.36,,,,,,,198.13,349.43,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,outpatient,1,mL,360.24000,342.23000,The Alliance,PPO Network,,299.36,,,,,,,180.12,349.43,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,14.39,746.94,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,inpatient,45,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,outpatient,45,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,inpatient,45,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,outpatient,45,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,inpatient,45,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,outpatient,45,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,inpatient,45,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,outpatient,45,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17034.50000,16182.77000,The Alliance,PPO Network,,14155.67,,,,,,,8346.91,16523.47,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17034.50000,16182.77000,The Alliance,PPO Network,,14155.67,,,,,,,7818.84,17034.50,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,inpatient,60,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,outpatient,60,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,inpatient,60,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,inpatient,60,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,108.35,191.09,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,PPO Network,,163.71,,,,,,,98.50,212.44,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,39.60,69.84,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,5.99,1216.68,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,inpatient,10,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,outpatient,10,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,inpatient,10,EA,6.12000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.37,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,outpatient,10,EA,6.12000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.06,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,inpatient,10,EA,6.06000,5.76000,The Alliance,PPO Network,,5.04,,,,,,,3.33,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,outpatient,10,EA,6.06000,5.76000,The Alliance,PPO Network,,5.04,,,,,,,3.03,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,inpatient,10,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,inpatient,10,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,inpatient,10,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,outpatient,10,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,inpatient,10,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,inpatient,10,EA,6.30000,5.99000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,outpatient,10,EA,6.30000,5.99000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,inpatient,10,EA,10.45000,9.93000,The Alliance,PPO Network,,8.68,,,,,,,5.75,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,outpatient,10,EA,10.45000,9.93000,The Alliance,PPO Network,,8.68,,,,,,,5.22,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,inpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,inpatient,1,EA,5.04000,4.79000,The Alliance,PPO Network,,4.19,,,,,,,2.77,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,outpatient,1,EA,5.04000,4.79000,The Alliance,PPO Network,,4.19,,,,,,,2.52,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.13,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,inpatient,1,EA,53.17000,50.51000,The Alliance,PPO Network,,44.18,,,,,,,29.24,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,outpatient,1,EA,53.17000,50.51000,The Alliance,PPO Network,,44.18,,,,,,,26.59,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,The Alliance,PPO Network,,3.34,,,,,,,2.21,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,PPO Network,,3.34,,,,,,,2.01,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,TC,438.77,,,,,,,290.40,512.16,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,TC,438.77,,,,,,,177.63,3723.67,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,inpatient,,,427.00000,405.65000,The Alliance,PPO Network,TC,354.84,,,,,,,234.85,414.19,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,PPO Network,TC,354.84,,,,,,,121.00,3027.62,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2771.00000,2632.45000,The Alliance,PPO Network,QN,2302.70,,,,,,,1524.05,2687.87,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2771.00000,2632.45000,The Alliance,PPO Network,QN,2302.70,,,,,,,1385.50,2687.87,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,inpatient,1,EA,8.95000,8.51000,The Alliance,PPO Network,,7.44,,,,,,,4.92,8.68,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,outpatient,1,EA,8.95000,8.51000,The Alliance,PPO Network,,7.44,,,,,,,2.17,8.68,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,16.07,763.98,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,GN,275.06,,,,,,,182.05,321.07,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,GN,275.06,,,,,,,126.65,321.07,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,inpatient,1,mL,123.44000,117.27000,The Alliance,PPO Network,,102.58,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,PPO Network,,102.58,,,,,,,61.72,119.74,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,inpatient,1,EA,12.01000,11.41000,The Alliance,PPO Network,,9.98,,,,,,,6.61,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,PPO Network,,9.98,,,,,,,6.00,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,inpatient,1,EA,16.88000,16.04000,The Alliance,PPO Network,,14.03,,,,,,,9.28,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,outpatient,1,EA,16.88000,16.04000,The Alliance,PPO Network,,14.03,,,,,,,8.44,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,inpatient,,,582.00000,552.90000,The Alliance,PPO Network,GN,483.64,,,,,,,320.10,564.54,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,PPO Network,GN,483.64,,,,,,,126.65,564.54,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,inpatient,1,mL,22.59000,21.46000,The Alliance,PPO Network,,18.77,,,,,,,12.42,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,PPO Network,,18.77,,,,,,,11.29,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,inpatient,1,mL,14.17000,13.46000,The Alliance,PPO Network,,11.78,,,,,,,7.79,13.74,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,outpatient,1,mL,14.17000,13.46000,The Alliance,PPO Network,,11.78,,,,,,,7.08,13.74,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,inpatient,,,662.00000,628.90000,The Alliance,PPO Network,GN,550.12,,,,,,,364.10,642.14,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,outpatient,,,662.00000,628.90000,The Alliance,PPO Network,GN,550.12,,,,,,,126.65,642.14,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,inpatient,,,192.60000,182.97000,The Alliance,PPO Network,90,160.05,,,,,,,105.93,186.82,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,PPO Network,90,160.05,,,,,,,11.91,594.19,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,PPO Network,GN,197.78,,,,,,,130.90,230.86,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,PPO Network,GN,197.78,,,,,,,119.00,264.00,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,GN,219.38,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,GN,219.38,,,,,,,126.65,264.00,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,GN,219.38,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,GN,219.38,,,,,,,126.65,264.00,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,PPO Network,,371.46,,,,,,,245.85,433.59,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,PPO Network,,371.46,,,,,,,49.49,3666.93,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,PPO Network,GN,280.05,,,,,,,185.35,326.89,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,PPO Network,GN,280.05,,,,,,,126.65,326.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,QW,30.75,,,,,,,20.35,35.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,QW,30.75,,,,,,,16.53,780.94,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,inpatient,1,mL,447.36000,425.00000,The Alliance,PPO Network,,371.76,,,,,,,246.05,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,outpatient,1,mL,447.36000,425.00000,The Alliance,PPO Network,,371.76,,,,,,,223.68,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,inpatient,1,mL,485.51000,461.23000,The Alliance,PPO Network,,403.46,,,,,,,267.03,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,outpatient,1,mL,485.51000,461.23000,The Alliance,PPO Network,,403.46,,,,,,,242.75,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,inpatient,1,mL,669.82000,636.33000,The Alliance,PPO Network,,556.62,,,,,,,368.40,649.73,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,outpatient,1,mL,669.82000,636.33000,The Alliance,PPO Network,,556.62,,,,,,,334.91,649.73,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,71.50,1256.24,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,71.00,137.74,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,inpatient,1,mL,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,inpatient,,,447.00000,424.65000,The Alliance,PPO Network,GN,371.46,,,,,,,245.85,433.59,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,PPO Network,GN,371.46,,,,,,,126.65,433.59,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,GN,152.07,,,,,,,100.65,177.51,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,GN,152.07,,,,,,,91.50,264.00,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1443.75000,1371.56000,The Alliance,PPO Network,,1199.76,,,,,,,707.44,1400.44,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,PPO Network,,1199.76,,,,,,,662.68,1443.75,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,GN,88.92,,,,,,,58.85,103.79,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,GN,88.92,,,,,,,53.50,264.00,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,inpatient,,,202.80000,192.66000,The Alliance,PPO Network,90,168.53,,,,,,,111.54,196.72,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,outpatient,,,202.80000,192.66000,The Alliance,PPO Network,90,168.53,,,,,,,17.85,814.87,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,GN,215.23,,,,,,,142.45,251.23,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,GN,215.23,,,,,,,126.65,264.00,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,inpatient,,,683.00000,648.85000,The Alliance,PPO Network,GN,567.57,,,,,,,375.65,662.51,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,PPO Network,GN,567.57,,,,,,,126.65,662.51,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,PPO Network,GN,844.30,,,,,,,558.80,985.52,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,PPO Network,GN,844.30,,,,,,,126.65,985.52,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,inpatient,,,579.00000,550.05000,The Alliance,PPO Network,GN,481.15,,,,,,,318.45,561.63,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,PPO Network,GN,481.15,,,,,,,126.65,561.63,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,PPO Network,GN,375.61,,,,,,,248.60,438.44,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,PPO Network,GN,375.61,,,,,,,126.65,438.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,4.86,254.68,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,5.25,356.54,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,PPO Network,GN,390.57,,,,,,,258.50,455.90,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,PPO Network,GN,390.57,,,,,,,126.65,455.90,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,inpatient,5,EA,3.96000,3.77000,The Alliance,PPO Network,,3.29,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,outpatient,5,EA,3.96000,3.77000,The Alliance,PPO Network,,3.29,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,inpatient,5,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,outpatient,5,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,inpatient,5,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,outpatient,5,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,1.92,3.72,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,inpatient,,,1727.00000,1640.65000,The Alliance,PPO Network,TC,1435.14,,,,,,,949.85,1675.19,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,outpatient,,,1727.00000,1640.65000,The Alliance,PPO Network,TC,1435.14,,,,,,,863.50,1675.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,inpatient,10,EA,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.77,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,outpatient,10,EA,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.60,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,inpatient,10,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.57,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,outpatient,10,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.43,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,inpatient,10,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,outpatient,10,EA,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,inpatient,10,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.42,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,outpatient,10,EA,2.59000,2.46000,The Alliance,PPO Network,,2.15,,,,,,,1.29,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,inpatient,10,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,outpatient,10,EA,3.28000,3.11000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,inpatient,10,EA,2.98000,2.83000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.89,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,outpatient,10,EA,2.98000,2.83000,The Alliance,PPO Network,,2.48,,,,,,,1.49,2.89,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,3.12,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,inpatient,1,EA,18.47000,17.55000,The Alliance,PPO Network,,15.35,,,,,,,10.16,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,outpatient,1,EA,18.47000,17.55000,The Alliance,PPO Network,,15.35,,,,,,,3.12,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,inpatient,1,EA,19.28000,18.31000,The Alliance,PPO Network,,16.02,,,,,,,10.60,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,PPO Network,,16.02,,,,,,,3.12,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,inpatient,1,EA,35.42000,33.65000,The Alliance,PPO Network,,29.43,,,,,,,19.48,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,outpatient,1,EA,35.42000,33.65000,The Alliance,PPO Network,,29.43,,,,,,,3.12,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,inpatient,1,EA,17.15000,16.29000,The Alliance,PPO Network,,14.25,,,,,,,9.43,16.64,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,outpatient,1,EA,17.15000,16.29000,The Alliance,PPO Network,,14.25,,,,,,,3.12,16.64,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,170.50,300.70,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,155.00,1239.81,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,inpatient,1,EA,24.50000,23.28000,The Alliance,PPO Network,,20.36,,,,,,,13.47,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,outpatient,1,EA,24.50000,23.28000,The Alliance,PPO Network,,20.36,,,,,,,12.25,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,inpatient,1,EA,1.25000,1.18000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,outpatient,1,EA,1.25000,1.18000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,inpatient,1,EA,1.82000,1.72000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,outpatient,1,EA,1.82000,1.72000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,inpatient,1,EA,1.87000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.03,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,outpatient,1,EA,1.87000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93500,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,inpatient,5,EA,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,165.11,291.19,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,outpatient,5,EA,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,150.10,291.19,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,The Alliance,PPO Network,,63.63,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,PPO Network,,63.63,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,inpatient,0.5,EA,153.14000,145.48000,The Alliance,PPO Network,,127.26,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,outpatient,0.5,EA,153.14000,145.48000,The Alliance,PPO Network,,127.26,,,,,,,60.56,148.55,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,inpatient,1,EA,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,14.43,25.44,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,outpatient,1,EA,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,13.12,25.44,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,The Alliance,PPO Network,,431.29,,,,,,,285.45,503.43,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,PPO Network,,431.29,,,,,,,48.58,503.43,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,inpatient,30,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,outpatient,30,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,PPO Network,GN,314.12,,,,,,,207.90,366.66,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,PPO Network,GN,314.12,,,,,,,126.65,366.66,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.24015,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.24015,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,inpatient,1,EA,4.10000,3.89000,The Alliance,PPO Network,,3.41,,,,,,,2.25,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,PPO Network,,3.41,,,,,,,0.24015,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.44,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,0.24015,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.24015,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,0.24015,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.24015,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,inpatient,1,EA,6.26000,5.95000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,outpatient,1,EA,6.26000,5.95000,The Alliance,PPO Network,,5.20,,,,,,,0.24015,6.07,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,157.00,304.58,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,PPO Network,GN,403.04,,,,,,,266.75,470.45,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,PPO Network,GN,403.04,,,,,,,126.65,470.45,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,14.18,746.94,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,151.25,266.75,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,25.47,1324.17,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,inpatient,,,294.00000,279.30000,The Alliance,PPO Network,,244.31,,,,,,,161.70,285.18,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,outpatient,,,294.00000,279.30000,The Alliance,PPO Network,,244.31,,,,,,,161.70,5271.00,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,inpatient,,,5159.00000,4901.05000,The Alliance,PPO Network,,4287.13,,,,,,,2837.45,5004.23,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,outpatient,,,5159.00000,4901.05000,The Alliance,PPO Network,,4287.13,,,,,,,1475.05,17574.00,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,inpatient,,,454.00000,431.30000,The Alliance,PPO Network,GN,377.27,,,,,,,249.70,440.38,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,PPO Network,GN,377.27,,,,,,,126.65,440.38,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,inpatient,1,mL,4070.06000,3866.55000,The Alliance,PPO Network,,3382.22,,,,,,,2238.53,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,outpatient,1,mL,4070.06000,3866.55000,The Alliance,PPO Network,,3382.22,,,,,,,32.29,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,inpatient,1,mL,3296.38000,3131.56000,The Alliance,PPO Network,,2739.29,,,,,,,1813.01,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,outpatient,1,mL,3296.38000,3131.56000,The Alliance,PPO Network,,2739.29,,,,,,,32.29,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,inpatient,1,mL,2714.00000,2578.30000,The Alliance,PPO Network,,2255.33,,,,,,,1492.70,2632.58,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,outpatient,1,mL,2714.00000,2578.30000,The Alliance,PPO Network,,2255.33,,,,,,,32.29,2632.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,0.24015,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,inpatient,1,EA,18.87000,17.93000,The Alliance,PPO Network,,15.68,,,,,,,10.38,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,outpatient,1,EA,18.87000,17.93000,The Alliance,PPO Network,,15.68,,,,,,,0.24015,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,inpatient,1,EA,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,10.22,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,0.24015,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,0.24015,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,0.24015,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,inpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,2.65,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,PPO Network,,4.00,,,,,,,0.24015,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,inpatient,1,EA,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.24015,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,0.24015,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.24015,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,0.24015,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,inpatient,1,EA,4.72000,4.49000,The Alliance,PPO Network,,3.92,,,,,,,2.60,4.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,outpatient,1,EA,4.72000,4.49000,The Alliance,PPO Network,,3.92,,,,,,,0.24015,4.58,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,inpatient,1,mL,150.10000,142.60000,The Alliance,PPO Network,,124.73,,,,,,,82.56,145.60,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,PPO Network,,124.73,,,,,,,75.05,145.60,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,21.23,1103.49,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,inpatient,0.5,EA,47.34000,44.97000,The Alliance,PPO Network,,39.34,,,,,,,26.04,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,outpatient,0.5,EA,47.34000,44.97000,The Alliance,PPO Network,,39.34,,,,,,,23.67,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,inpatient,0.5,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,outpatient,0.5,EA,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,75.84,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,inpatient,0.5,EA,352.92000,335.28000,The Alliance,PPO Network,,293.28,,,,,,,194.11,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,outpatient,0.5,EA,352.92000,335.28000,The Alliance,PPO Network,,293.28,,,,,,,176.46,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,inpatient,0.5,EA,352.91000,335.27000,The Alliance,PPO Network,,293.27,,,,,,,194.10,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,outpatient,0.5,EA,352.91000,335.27000,The Alliance,PPO Network,,293.27,,,,,,,176.46,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,inpatient,0.5,EA,164.32000,156.10000,The Alliance,PPO Network,,136.55,,,,,,,90.38,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,outpatient,0.5,EA,164.32000,156.10000,The Alliance,PPO Network,,136.55,,,,,,,82.16,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,inpatient,0.5,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,38.24,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,outpatient,0.5,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,34.76,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,inpatient,0.5,EA,309.68000,294.20000,The Alliance,PPO Network,,257.34,,,,,,,170.32,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,outpatient,0.5,EA,309.68000,294.20000,The Alliance,PPO Network,,257.34,,,,,,,154.84,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,inpatient,0.5,EA,20.22000,19.21000,The Alliance,PPO Network,,16.80,,,,,,,11.12,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,outpatient,0.5,EA,20.22000,19.21000,The Alliance,PPO Network,,16.80,,,,,,,10.11,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,inpatient,0.5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,outpatient,0.5,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,21.34,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,inpatient,1,EA,6.02000,5.72000,The Alliance,PPO Network,,5.00,,,,,,,3.31,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,outpatient,1,EA,6.02000,5.72000,The Alliance,PPO Network,,5.00,,,,,,,3.01,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,inpatient,1,EA,5.48000,5.21000,The Alliance,PPO Network,,4.55,,,,,,,3.01,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,outpatient,1,EA,5.48000,5.21000,The Alliance,PPO Network,,4.55,,,,,,,2.74,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,inpatient,1,EA,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,5.25,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,outpatient,1,EA,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,4.77,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,3.15,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,2.86,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,200.75,354.05,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,182.50,743.46,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,inpatient,,,422.00000,400.90000,The Alliance,PPO Network,,350.68,,,,,,,232.10,409.34,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,PPO Network,,350.68,,,,,,,200.06,409.34,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,The Alliance,PPO Network,,795.27,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,PPO Network,,795.27,,,,,,,478.50,1267.58,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,5.77,305.58,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,4.40,237.65,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,4.40,237.65,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,inpatient,1,EA,4.49000,4.26000,The Alliance,PPO Network,,3.73,,,,,,,2.47,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,outpatient,1,EA,4.49000,4.26000,The Alliance,PPO Network,,3.73,,,,,,,2.25,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,inpatient,2,EA,15.72000,14.93000,The Alliance,PPO Network,,13.06,,,,,,,8.65,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,outpatient,2,EA,15.72000,14.93000,The Alliance,PPO Network,,13.06,,,,,,,2.72,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,inpatient,2,EA,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,outpatient,2,EA,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,2.72,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,inpatient,2,EA,10.39000,9.87000,The Alliance,PPO Network,,8.63,,,,,,,5.71,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,outpatient,2,EA,10.39000,9.87000,The Alliance,PPO Network,,8.63,,,,,,,2.72,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,inpatient,2,EA,10.93000,10.39000,The Alliance,PPO Network,,9.08,,,,,,,6.01,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,outpatient,2,EA,10.93000,10.39000,The Alliance,PPO Network,,9.08,,,,,,,2.72,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,inpatient,2,EA,9.65000,9.17000,The Alliance,PPO Network,,8.02,,,,,,,5.31,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,outpatient,2,EA,9.65000,9.17000,The Alliance,PPO Network,,8.02,,,,,,,2.72,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,inpatient,2,EA,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,outpatient,2,EA,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,2.72,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,inpatient,2,EA,13.49000,12.81000,The Alliance,PPO Network,,11.21,,,,,,,7.42,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,outpatient,2,EA,13.49000,12.81000,The Alliance,PPO Network,,11.21,,,,,,,2.72,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,inpatient,2,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,2.72,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,inpatient,2,EA,14.83000,14.09000,The Alliance,PPO Network,,12.32,,,,,,,8.16,14.39,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,outpatient,2,EA,14.83000,14.09000,The Alliance,PPO Network,,12.32,,,,,,,2.72,14.39,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,The Alliance,PPO Network,,13.96,,,,,,,9.24,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,PPO Network,,13.96,,,,,,,8.40,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,The Alliance,PPO Network,,8.01,,,,,,,5.30,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,PPO Network,,8.01,,,,,,,4.82,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,inpatient,1,EA,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.93,5.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.67,5.17,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,24.11,1137.41,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,inpatient,,,173.90000,165.20000,The Alliance,PPO Network,90,144.51,,,,,,,95.64,168.68,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,PPO Network,90,144.51,,,,,,,15.49,780.94,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,inpatient,1,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,2.19,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,inpatient,1,EA,62.25000,59.14000,The Alliance,PPO Network,,51.73,,,,,,,34.24,60.38,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,outpatient,1,EA,62.25000,59.14000,The Alliance,PPO Network,,51.73,,,,,,,2.19,60.38,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,16.06,831.84,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,inpatient,,,819.00000,778.05000,The Alliance,PPO Network,,680.59,,,,,,,450.45,794.43,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,PPO Network,,680.59,,,,,,,450.45,3163.00,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,47.30,83.42,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,11.13,696.05,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,inpatient,1,mL,10.44000,9.92000,The Alliance,PPO Network,,8.68,,,,,,,5.74,10.13,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,outpatient,1,mL,10.44000,9.92000,The Alliance,PPO Network,,8.68,,,,,,,5.22,10.13,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,6.01,305.58,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,inpatient,1,EA,226.79000,215.45000,The Alliance,PPO Network,,188.46,,,,,,,124.73,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,outpatient,1,EA,226.79000,215.45000,The Alliance,PPO Network,,188.46,,,,,,,113.39,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,inpatient,1,EA,227.93000,216.53000,The Alliance,PPO Network,,189.41,,,,,,,125.36,221.09,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,outpatient,1,EA,227.93000,216.53000,The Alliance,PPO Network,,189.41,,,,,,,113.97,221.09,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,inpatient,,,2006.00000,1905.70000,The Alliance,PPO Network,TC,1666.99,,,,,,,1103.30,1945.82,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,outpatient,,,2006.00000,1905.70000,The Alliance,PPO Network,TC,1666.99,,,,,,,957.00,2210.07,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,16.62,882.80,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,inpatient,,,495.00000,470.25000,The Alliance,PPO Network,,411.35,,,,,,,272.25,480.15,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,outpatient,,,495.00000,470.25000,The Alliance,PPO Network,,411.35,,,,,,,46.98,2461.58,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,inpatient,,,1987.00000,1887.65000,The Alliance,PPO Network,TC,1651.20,,,,,,,1092.85,1927.39,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,outpatient,,,1987.00000,1887.65000,The Alliance,PPO Network,TC,1651.20,,,,,,,960.65,2210.07,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,inpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,47.85,84.39,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,5.50,288.61,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,inpatient,1,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,15.30,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,13.90,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,inpatient,1,EA,64.09000,60.89000,The Alliance,PPO Network,,53.26,,,,,,,35.25,62.17,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,outpatient,1,EA,64.09000,60.89000,The Alliance,PPO Network,,53.26,,,,,,,32.05,62.17,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,187.21,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,PPO Network,TC,666.46,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,PPO Network,TC,666.46,,,,,,,389.35,2210.07,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,inpatient,2,EA,14.52000,13.79000,The Alliance,PPO Network,,12.07,,,,,,,7.99,14.08,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,outpatient,2,EA,14.52000,13.79000,The Alliance,PPO Network,,12.07,,,,,,,7.26,14.08,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.57,2.76,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.43,2.76,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,19.16,1646.71,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,14.14,746.94,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,inpatient,1,EA,3.04000,2.89000,The Alliance,PPO Network,,2.53,,,,,,,1.67,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,outpatient,1,EA,3.04000,2.89000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,inpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,227.15,400.61,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,35.09,1833.46,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,9.02,475.37,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,The Alliance,PPO Network,TC,2620.14,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,PPO Network,TC,2620.14,,,,,,,1479.13,3058.41,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,5.88,305.58,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,100.10,176.54,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,16.80,882.80,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,inpatient,2,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,outpatient,2,EA,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,1.92,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,inpatient,2,EA,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,9.52,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,2.47,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,inpatient,2,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,outpatient,2,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,inpatient,2,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.70,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,outpatient,2,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,1.91,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,inpatient,2,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,outpatient,2,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,inpatient,2,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.95,5.20,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,outpatient,2,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.47,5.20,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,inpatient,,,2168.00000,2059.60000,The Alliance,PPO Network,TC,1801.61,,,,,,,1192.40,2102.96,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,outpatient,,,2168.00000,2059.60000,The Alliance,PPO Network,TC,1801.61,,,,,,,1050.98,2210.07,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,The Alliance,PPO Network,TC,2092.46,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,PPO Network,TC,2092.46,,,,,,,1163.40,2442.46,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.97,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,PPO Network,,9.02,,,,,,,5.43,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,inpatient,1,EA,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,4.90,8.64,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,outpatient,1,EA,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,4.46,8.64,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,inpatient,1,EA,1681.35000,1597.28000,The Alliance,PPO Network,,1397.20,,,,,,,924.74,1630.91,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,outpatient,1,EA,1681.35000,1597.28000,The Alliance,PPO Network,,1397.20,,,,,,,577.05,1630.91,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,PPO Network,,474.50,,,,,,,314.05,553.87,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,PPO Network,,474.50,,,,,,,70.04,6756.70,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,90,130.47,,,,,,,86.35,152.29,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,90,130.47,,,,,,,17.85,814.87,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,inpatient,1,EA,23.76000,22.57000,The Alliance,PPO Network,,19.74,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,outpatient,1,EA,23.76000,22.57000,The Alliance,PPO Network,,19.74,,,,,,,11.88,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,The Alliance,PPO Network,,19.74,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,PPO Network,,19.74,,,,,,,11.88,23.05,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,inpatient,5,EA,64.51000,61.28000,The Alliance,PPO Network,,53.61,,,,,,,35.48,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,outpatient,5,EA,64.51000,61.28000,The Alliance,PPO Network,,53.61,,,,,,,32.26,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,inpatient,5,EA,7.34000,6.98000,The Alliance,PPO Network,,6.10,,,,,,,4.04,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,outpatient,5,EA,7.34000,6.98000,The Alliance,PPO Network,,6.10,,,,,,,3.67,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,inpatient,5,EA,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,4.09,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,outpatient,5,EA,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,3.71,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,inpatient,5,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,outpatient,5,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,4.90,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,inpatient,5,EA,9.79000,9.30000,The Alliance,PPO Network,,8.14,,,,,,,5.38,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,outpatient,5,EA,9.79000,9.30000,The Alliance,PPO Network,,8.14,,,,,,,4.89,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,inpatient,1,EA,2662.25000,2529.14000,The Alliance,PPO Network,,2212.33,,,,,,,1464.24,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,outpatient,1,EA,2662.25000,2529.14000,The Alliance,PPO Network,,2212.33,,,,,,,1.97,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,inpatient,1,EA,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,199.43,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,PPO Network,,301.32,,,,,,,1.97,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,inpatient,1,EA,608.65000,578.22000,The Alliance,PPO Network,,505.79,,,,,,,334.76,590.39,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,outpatient,1,EA,608.65000,578.22000,The Alliance,PPO Network,,505.79,,,,,,,1.97,590.39,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.87,356.54,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,11.53,543.65,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,101.75,179.45,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,15.91,831.84,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,inpatient,2,EA,3.67000,3.48000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,outpatient,2,EA,3.67000,3.48000,The Alliance,PPO Network,,3.05,,,,,,,1.83,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,inpatient,2,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,outpatient,2,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,inpatient,2,EA,55.42000,52.65000,The Alliance,PPO Network,,46.05,,,,,,,30.48,53.76,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,outpatient,2,EA,55.42000,52.65000,The Alliance,PPO Network,,46.05,,,,,,,27.71,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,inpatient,2,EA,33.79000,32.10000,The Alliance,PPO Network,,28.08,,,,,,,18.58,32.78,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,outpatient,2,EA,33.79000,32.10000,The Alliance,PPO Network,,28.08,,,,,,,16.89,88.11,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,136.95,241.53,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,25.81,1341.13,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,inpatient,1,EA,10.52000,10.00000,The Alliance,PPO Network,,8.74,,,,,,,5.79,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,outpatient,1,EA,10.52000,10.00000,The Alliance,PPO Network,,8.74,,,,,,,5.26,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.00,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,inpatient,1,EA,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.89,5.10,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,outpatient,1,EA,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.63,5.10,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,5.79,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,5.79,333.61,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,inpatient,0.5,EA,261.85000,248.76000,The Alliance,PPO Network,,217.60,,,,,,,144.02,253.99,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,outpatient,0.5,EA,261.85000,248.76000,The Alliance,PPO Network,,217.60,,,,,,,130.93,253.99,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,inpatient,5,EA,114.66000,108.93000,The Alliance,PPO Network,,95.28,,,,,,,63.06,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,outpatient,5,EA,114.66000,108.93000,The Alliance,PPO Network,,95.28,,,,,,,57.33,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,inpatient,5,EA,109.85000,104.36000,The Alliance,PPO Network,,91.29,,,,,,,60.42,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,outpatient,5,EA,109.85000,104.36000,The Alliance,PPO Network,,91.29,,,,,,,54.92,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,inpatient,5,EA,134.53000,127.81000,The Alliance,PPO Network,,111.79,,,,,,,73.99,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,outpatient,5,EA,134.53000,127.81000,The Alliance,PPO Network,,111.79,,,,,,,67.27,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,inpatient,5,EA,119.69000,113.71000,The Alliance,PPO Network,,99.46,,,,,,,65.83,116.10,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,outpatient,5,EA,119.69000,113.71000,The Alliance,PPO Network,,99.46,,,,,,,59.84,116.10,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,19.75,38.31,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,267.30,471.42,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,70.04,7707.36,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,inpatient,1,EA,20.31000,19.30000,The Alliance,PPO Network,,16.88,,,,,,,11.17,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,outpatient,1,EA,20.31000,19.30000,The Alliance,PPO Network,,16.88,,,,,,,10.15,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,inpatient,1,EA,35.69000,33.91000,The Alliance,PPO Network,,29.66,,,,,,,19.63,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,outpatient,1,EA,35.69000,33.91000,The Alliance,PPO Network,,29.66,,,,,,,17.84,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,The Alliance,PPO Network,,26.55,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,PPO Network,,26.55,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,inpatient,1,EA,7.99000,7.59000,The Alliance,PPO Network,,6.64,,,,,,,4.39,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,outpatient,1,EA,7.99000,7.59000,The Alliance,PPO Network,,6.64,,,,,,,4.00,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,inpatient,1,EA,38.08000,36.17000,The Alliance,PPO Network,,31.64,,,,,,,20.94,36.94,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,outpatient,1,EA,38.08000,36.17000,The Alliance,PPO Network,,31.64,,,,,,,19.04,36.94,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,PPO Network,90,479.49,,,,,,,317.35,559.69,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,PPO Network,90,479.49,,,,,,,70.04,7690.40,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,inpatient,,,5977.00000,5678.15000,The Alliance,PPO Network,TC,4966.89,,,,,,,3287.35,5797.69,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,outpatient,,,5977.00000,5678.15000,The Alliance,PPO Network,TC,4966.89,,,,,,,2988.50,7180.14,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,inpatient,2,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,outpatient,2,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,inpatient,2,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,3.55,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,outpatient,2,EA,6.45000,6.12000,The Alliance,PPO Network,,5.36,,,,,,,3.23,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,PPO Network,,1.49,,,,,,,0.89500,1.74,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,inpatient,1,mL,13.87000,13.17000,The Alliance,PPO Network,,11.53,,,,,,,7.63,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,outpatient,1,mL,13.87000,13.17000,The Alliance,PPO Network,,11.53,,,,,,,6.93,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,inpatient,1,mL,6.31000,6.00000,The Alliance,PPO Network,,5.24,,,,,,,3.47,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,outpatient,1,mL,6.31000,6.00000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,inpatient,1,mL,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,inpatient,1,mL,9.70000,9.22000,The Alliance,PPO Network,,8.06,,,,,,,5.33,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,outpatient,1,mL,9.70000,9.22000,The Alliance,PPO Network,,8.06,,,,,,,4.85,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,inpatient,1,mL,21.93000,20.84000,The Alliance,PPO Network,,18.22,,,,,,,12.06,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,outpatient,1,mL,21.93000,20.84000,The Alliance,PPO Network,,18.22,,,,,,,10.96,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,inpatient,1,mL,9.23000,8.77000,The Alliance,PPO Network,,7.67,,,,,,,5.08,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,outpatient,1,mL,9.23000,8.77000,The Alliance,PPO Network,,7.67,,,,,,,4.62,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.15,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,inpatient,1,mL,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,inpatient,1,mL,107.83000,102.44000,The Alliance,PPO Network,,89.61,,,,,,,59.31,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,outpatient,1,mL,107.83000,102.44000,The Alliance,PPO Network,,89.61,,,,,,,1.97,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,inpatient,1,mL,118.50000,112.57000,The Alliance,PPO Network,,98.47,,,,,,,65.17,114.94,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,outpatient,1,mL,118.50000,112.57000,The Alliance,PPO Network,,98.47,,,,,,,1.97,114.94,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,inpatient,1,EA,19.58000,18.60000,The Alliance,PPO Network,,16.27,,,,,,,10.77,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,outpatient,1,EA,19.58000,18.60000,The Alliance,PPO Network,,16.27,,,,,,,9.79,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,inpatient,1,EA,56.44000,53.62000,The Alliance,PPO Network,,46.90,,,,,,,31.04,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,outpatient,1,EA,56.44000,53.62000,The Alliance,PPO Network,,46.90,,,,,,,28.22,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,inpatient,1,EA,0.78000,0.75000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,outpatient,1,EA,0.78000,0.75000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,inpatient,1,EA,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,outpatient,1,EA,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,TC,153.74,,,,,,,101.75,179.45,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,TC,153.74,,,,,,,92.50,2210.07,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,inpatient,3.5,EA,223.32000,212.15000,The Alliance,PPO Network,,185.58,,,,,,,122.83,216.62,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,outpatient,3.5,EA,223.32000,212.15000,The Alliance,PPO Network,,185.58,,,,,,,111.66,216.62,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,90,39.06,,,,,,,25.85,45.59,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,90,39.06,,,,,,,4.08,203.72,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,inpatient,1,mL,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,inpatient,1,mL,4.51000,4.28000,The Alliance,PPO Network,,3.75,,,,,,,2.48,4.37,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,PPO Network,,3.75,,,,,,,2.25,4.37,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,inpatient,1,EA,7235.17000,6873.41000,The Alliance,PPO Network,,6012.43,,,,,,,3979.34,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,outpatient,1,EA,7235.17000,6873.41000,The Alliance,PPO Network,,6012.43,,,,,,,171.94,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,inpatient,1,EA,11815.83000,11225.04000,The Alliance,PPO Network,,9818.95,,,,,,,6498.71,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,outpatient,1,EA,11815.83000,11225.04000,The Alliance,PPO Network,,9818.95,,,,,,,171.94,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,inpatient,1,EA,15764.79000,14976.55000,The Alliance,PPO Network,,13100.54,,,,,,,8670.63,15291.85,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,PPO Network,,13100.54,,,,,,,171.94,15291.85,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,inpatient,,,142.40000,135.28000,The Alliance,PPO Network,90,118.33,,,,,,,78.32,138.13,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,PPO Network,90,118.33,,,,,,,12.32,628.12,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,inpatient,5,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,outpatient,5,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,inpatient,5,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,outpatient,5,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,inpatient,5,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,outpatient,5,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,PPO Network,,31.95,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,inpatient,1,EA,38.84000,36.90000,The Alliance,PPO Network,,32.28,,,,,,,21.36,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,outpatient,1,EA,38.84000,36.90000,The Alliance,PPO Network,,32.28,,,,,,,19.42,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,inpatient,1,EA,37.34000,35.47000,The Alliance,PPO Network,,31.03,,,,,,,20.54,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,outpatient,1,EA,37.34000,35.47000,The Alliance,PPO Network,,31.03,,,,,,,18.67,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,inpatient,1,EA,14.20000,13.49000,The Alliance,PPO Network,,11.80,,,,,,,7.81,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,outpatient,1,EA,14.20000,13.49000,The Alliance,PPO Network,,11.80,,,,,,,7.10,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,The Alliance,PPO Network,,4.05,,,,,,,2.68,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,PPO Network,,4.05,,,,,,,2.44,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,The Alliance,PPO Network,,26.55,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,PPO Network,,26.55,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,inpatient,1,EA,10.65000,10.12000,The Alliance,PPO Network,,8.85,,,,,,,5.86,10.33,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,outpatient,1,EA,10.65000,10.12000,The Alliance,PPO Network,,8.85,,,,,,,5.33,10.33,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,inpatient,1,EA,252.80000,240.16000,The Alliance,PPO Network,,210.08,,,,,,,139.04,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,outpatient,1,EA,252.80000,240.16000,The Alliance,PPO Network,,210.08,,,,,,,2.47,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,inpatient,1,EA,218.47000,207.54000,The Alliance,PPO Network,,181.55,,,,,,,120.16,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,outpatient,1,EA,218.47000,207.54000,The Alliance,PPO Network,,181.55,,,,,,,2.47,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,inpatient,1,EA,263.86000,250.67000,The Alliance,PPO Network,,219.27,,,,,,,145.12,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,outpatient,1,EA,263.86000,250.67000,The Alliance,PPO Network,,219.27,,,,,,,2.47,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,inpatient,1,EA,245.53000,233.26000,The Alliance,PPO Network,,204.04,,,,,,,135.04,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,outpatient,1,EA,245.53000,233.26000,The Alliance,PPO Network,,204.04,,,,,,,2.47,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,inpatient,1,EA,243.32000,231.15000,The Alliance,PPO Network,,202.20,,,,,,,133.83,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,outpatient,1,EA,243.32000,231.15000,The Alliance,PPO Network,,202.20,,,,,,,2.47,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,inpatient,1,EA,244.43000,232.20000,The Alliance,PPO Network,,203.12,,,,,,,134.44,237.10,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,outpatient,1,EA,244.43000,232.20000,The Alliance,PPO Network,,203.12,,,,,,,2.47,237.10,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,396.00,698.40,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,360.00,4496.60,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,60.50,106.70,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,10.63,543.22,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.67,186.75,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,inpatient,2.5,EA,200.57000,190.54000,The Alliance,PPO Network,,166.67,,,,,,,110.31,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,outpatient,2.5,EA,200.57000,190.54000,The Alliance,PPO Network,,166.67,,,,,,,100.28,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,inpatient,2.5,EA,209.17000,198.71000,The Alliance,PPO Network,,173.82,,,,,,,115.04,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,outpatient,2.5,EA,209.17000,198.71000,The Alliance,PPO Network,,173.82,,,,,,,104.58,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,inpatient,2.5,EA,158.96000,151.01000,The Alliance,PPO Network,,132.10,,,,,,,87.43,154.19,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,outpatient,2.5,EA,158.96000,151.01000,The Alliance,PPO Network,,132.10,,,,,,,79.48,154.19,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,79.75,140.65,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,12.76,662.12,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,inpatient,1,EA,6411.37000,6090.80000,The Alliance,PPO Network,,5327.85,,,,,,,3526.25,6219.03,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,outpatient,1,EA,6411.37000,6090.80000,The Alliance,PPO Network,,5327.85,,,,,,,383.07,6219.03,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,inpatient,15,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,outpatient,15,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,inpatient,15,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,outpatient,15,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,The Alliance,PPO Network,TC,2724.02,,,,,,,1802.90,3179.66,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,PPO Network,TC,2724.02,,,,,,,1489.61,7180.14,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,5.56,254.68,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,12.47,594.19,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,inpatient,1,EA,6835.14000,6493.38000,The Alliance,PPO Network,,5680.00,,,,,,,3759.33,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,outpatient,1,EA,6835.14000,6493.38000,The Alliance,PPO Network,,5680.00,,,,,,,1.85,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,inpatient,1,EA,906.50000,861.18000,The Alliance,PPO Network,,753.30,,,,,,,498.57,879.30,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,outpatient,1,EA,906.50000,861.18000,The Alliance,PPO Network,,753.30,,,,,,,1.85,879.30,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,inpatient,5,EA,7.64000,7.26000,The Alliance,PPO Network,,6.35,,,,,,,4.20,7.41,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,outpatient,5,EA,7.64000,7.26000,The Alliance,PPO Network,,6.35,,,,,,,1.35,7.41,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,110.00,194.00,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,11.53,594.19,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,14.39,746.94,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,inpatient,1,EA,1924.24000,1828.03000,The Alliance,PPO Network,,1599.04,,,,,,,1058.33,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,outpatient,1,EA,1924.24000,1828.03000,The Alliance,PPO Network,,1599.04,,,,,,,1.85,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,inpatient,1,EA,276.50000,262.68000,The Alliance,PPO Network,,229.77,,,,,,,152.07,268.20,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,outpatient,1,EA,276.50000,262.68000,The Alliance,PPO Network,,229.77,,,,,,,1.85,268.20,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.14,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.04,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,3.95,203.72,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,4686.00,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,inpatient,,,215.00000,204.25000,The Alliance,PPO Network,,178.66,,,,,,,118.25,208.55,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,PPO Network,,178.66,,,,,,,118.25,3163.00,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,3.48,169.79,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,inpatient,15,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,outpatient,15,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,inpatient,15,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,outpatient,15,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,inpatient,15,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,outpatient,15,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,64.90,114.46,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,59.00,6094.58,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,inpatient,,,794.00000,754.30000,The Alliance,PPO Network,TC,659.81,,,,,,,436.70,770.18,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,outpatient,,,794.00000,754.30000,The Alliance,PPO Network,TC,659.81,,,,,,,313.12,770.18,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,170.50,300.70,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,155.00,1239.81,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,inpatient,,,335.80000,319.01000,The Alliance,PPO Network,,279.05,,,,,,,184.69,325.73,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,outpatient,,,335.80000,319.01000,The Alliance,PPO Network,,279.05,,,,,,,23.25,325.73,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,4.52,237.65,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,134.20,236.68,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,20.81,1086.52,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,200.75,354.05,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,35.09,1833.46,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,inpatient,1,EA,29.58000,28.10000,The Alliance,PPO Network,,24.58,,,,,,,16.27,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,outpatient,1,EA,29.58000,28.10000,The Alliance,PPO Network,,24.58,,,,,,,1.35,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,inpatient,1,EA,25.56000,24.29000,The Alliance,PPO Network,,21.24,,,,,,,14.06,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,outpatient,1,EA,25.56000,24.29000,The Alliance,PPO Network,,21.24,,,,,,,1.35,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,1.35,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,inpatient,1,EA,28.09000,26.69000,The Alliance,PPO Network,,23.34,,,,,,,15.45,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,outpatient,1,EA,28.09000,26.69000,The Alliance,PPO Network,,23.34,,,,,,,1.35,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,inpatient,1,EA,16.59000,15.76000,The Alliance,PPO Network,,13.79,,,,,,,9.12,16.09,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,outpatient,1,EA,16.59000,15.76000,The Alliance,PPO Network,,13.79,,,,,,,1.35,16.09,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,inpatient,1,EA,1.74000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,outpatient,1,EA,1.74000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.74,305.58,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,The Alliance,PPO Network,,5.76,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,PPO Network,,5.76,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,The Alliance,PPO Network,,5.76,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,PPO Network,,5.76,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,6.37,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,5.79,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,inpatient,1,EA,9.27000,8.81000,The Alliance,PPO Network,,7.70,,,,,,,5.10,8.99,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,outpatient,1,EA,9.27000,8.81000,The Alliance,PPO Network,,7.70,,,,,,,4.63,8.99,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,PPO Network,TC,599.98,,,,,,,397.10,700.34,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,PPO Network,TC,599.98,,,,,,,361.00,700.34,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,14.41,746.94,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,107.25,189.15,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,56.40,189.15,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,90,124.65,,,,,,,82.50,145.50,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,90,124.65,,,,,,,17.85,814.87,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,TC,280.88,,,,,,,185.90,327.86,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,TC,280.88,,,,,,,169.00,584.87,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,inpatient,1,mL,1601.79000,1521.70000,The Alliance,PPO Network,,1331.09,,,,,,,880.98,1553.74,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,outpatient,1,mL,1601.79000,1521.70000,The Alliance,PPO Network,,1331.09,,,,,,,13.12,1553.74,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,inpatient,1,EA,30.15000,28.64000,The Alliance,PPO Network,,25.05,,,,,,,16.58,29.25,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,outpatient,1,EA,30.15000,28.64000,The Alliance,PPO Network,,25.05,,,,,,,15.07,29.25,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,5.08,254.68,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,PPO Network,,179.50,,,,,,,118.80,209.52,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,PPO Network,,179.50,,,,,,,20.81,1086.52,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,inpatient,1,mL,389.56000,370.08000,The Alliance,PPO Network,,323.72,,,,,,,214.26,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,outpatient,1,mL,389.56000,370.08000,The Alliance,PPO Network,,323.72,,,,,,,24.51,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,inpatient,1,mL,2444.96000,2322.71000,The Alliance,PPO Network,,2031.76,,,,,,,1344.73,2371.61,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,outpatient,1,mL,2444.96000,2322.71000,The Alliance,PPO Network,,2031.76,,,,,,,24.51,2371.61,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,inpatient,15,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,outpatient,15,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,inpatient,80,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,outpatient,80,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,inpatient,80,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,inpatient,80,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,outpatient,80,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,The Alliance,PPO Network,TC,2785.51,,,,,,,1843.60,3251.44,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,PPO Network,TC,2785.51,,,,,,,1676.00,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,inpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,PPO Network,,285.81,,,,,,,5.79,333.61,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,PPO Network,90,224.37,,,,,,,148.50,261.90,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,PPO Network,90,224.37,,,,,,,32.70,2665.30,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,inpatient,,,83.60000,79.42000,The Alliance,PPO Network,90,69.47,,,,,,,45.98,81.09,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,PPO Network,90,69.47,,,,,,,8.17,662.12,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,3.17,169.79,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,inpatient,,,5196.00000,4936.20000,The Alliance,PPO Network,90,4317.88,,,,,,,2857.80,5040.12,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,outpatient,,,5196.00000,4936.20000,The Alliance,PPO Network,90,4317.88,,,,,,,533.12,27787.37,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,457.05,806.07,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,384.16,806.07,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,inpatient,,,729.00000,692.55000,The Alliance,PPO Network,TC,605.80,,,,,,,400.95,707.13,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,outpatient,,,729.00000,692.55000,The Alliance,PPO Network,TC,605.80,,,,,,,364.50,707.13,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,PPO Network,TC,346.53,,,,,,,229.35,404.49,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,PPO Network,TC,346.53,,,,,,,208.50,584.87,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,inpatient,60,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,outpatient,60,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,inpatient,60,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,outpatient,60,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,inpatient,60,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,outpatient,60,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,282.15,497.61,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,215.27,548.00,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,inpatient,1,mL,246.06000,233.75000,The Alliance,PPO Network,,204.48,,,,,,,135.33,238.68,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,outpatient,1,mL,246.06000,233.75000,The Alliance,PPO Network,,204.48,,,,,,,13.29,238.68,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,The Alliance,PPO Network,TC,929.89,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,PPO Network,TC,929.89,,,,,,,384.16,1085.43,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,382.80,675.12,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,348.00,675.12,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,inpatient,,,38.00000,36.10000,The Alliance,PPO Network,,31.58,,,,,,,20.90,36.86,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,PPO Network,,31.58,,,,,,,3.05,152.82,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,15.50,814.87,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,PPO Network,TC,482.81,,,,,,,319.55,563.57,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,PPO Network,TC,482.81,,,,,,,290.50,584.87,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,584.87,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,inpatient,1,EA,25.18000,23.92000,The Alliance,PPO Network,,20.92,,,,,,,13.85,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,outpatient,1,EA,25.18000,23.92000,The Alliance,PPO Network,,20.92,,,,,,,12.59,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,inpatient,1,EA,12.70000,12.07000,The Alliance,PPO Network,,10.55,,,,,,,6.99,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,outpatient,1,EA,12.70000,12.07000,The Alliance,PPO Network,,10.55,,,,,,,6.35,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,inpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.70,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.70,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,30.25,53.35,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,5.67,254.68,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,154.77,548.00,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,13.54,713.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,inpatient,15,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,outpatient,15,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,inpatient,15,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,outpatient,15,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,inpatient,15,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,outpatient,15,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,inpatient,15,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,outpatient,15,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,inpatient,,,850.00000,807.50000,The Alliance,PPO Network,TC,706.35,,,,,,,467.50,824.50,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,PPO Network,TC,706.35,,,,,,,384.16,824.50,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,inpatient,,,641.00000,608.95000,The Alliance,PPO Network,TC,532.67,,,,,,,352.55,621.77,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,outpatient,,,641.00000,608.95000,The Alliance,PPO Network,TC,532.67,,,,,,,320.50,621.77,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,PPO Network,TC,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,PPO Network,TC,860.92,,,,,,,384.16,1004.92,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,inpatient,,,963.00000,914.85000,The Alliance,PPO Network,TC,800.25,,,,,,,529.65,934.11,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,outpatient,,,963.00000,914.85000,The Alliance,PPO Network,TC,800.25,,,,,,,384.16,934.11,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,PPO Network,TC,789.45,,,,,,,522.50,921.50,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,PPO Network,TC,789.45,,,,,,,384.16,921.50,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,inpatient,15,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,outpatient,15,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,inpatient,15,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,outpatient,15,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,inpatient,15,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,outpatient,15,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,inpatient,15,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,outpatient,15,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,inpatient,15,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,outpatient,15,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,inpatient,15,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,outpatient,15,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,567.05,1000.07,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,384.16,1000.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,inpatient,5,EA,20.05000,19.04000,The Alliance,PPO Network,,16.66,,,,,,,11.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,outpatient,5,EA,20.05000,19.04000,The Alliance,PPO Network,,16.66,,,,,,,10.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,inpatient,5,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,outpatient,5,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,inpatient,5,EA,10.93000,10.38000,The Alliance,PPO Network,,9.08,,,,,,,6.01,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,outpatient,5,EA,10.93000,10.38000,The Alliance,PPO Network,,9.08,,,,,,,5.46,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,inpatient,5,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,outpatient,5,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,inpatient,5,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,outpatient,5,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.12,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,inpatient,5,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,outpatient,5,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,inpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,inpatient,,,706.00000,670.70000,The Alliance,PPO Network,TC,586.69,,,,,,,388.30,684.82,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,PPO Network,TC,586.69,,,,,,,353.00,684.82,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,13.54,713.01,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,inpatient,1,mL,25.54000,24.26000,The Alliance,PPO Network,,21.22,,,,,,,14.05,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,outpatient,1,mL,25.54000,24.26000,The Alliance,PPO Network,,21.22,,,,,,,12.77,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,inpatient,1,mL,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,6.52,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,outpatient,1,mL,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,5.92,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.32,12.26,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,inpatient,1,EA,16.60000,15.77000,The Alliance,PPO Network,,13.79,,,,,,,9.13,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,outpatient,1,EA,16.60000,15.77000,The Alliance,PPO Network,,13.79,,,,,,,8.30,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,The Alliance,PPO Network,,22.00,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,PPO Network,,22.00,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,inpatient,1,EA,9.77000,9.28000,The Alliance,PPO Network,,8.12,,,,,,,5.37,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,outpatient,1,EA,9.77000,9.28000,The Alliance,PPO Network,,8.12,,,,,,,4.88,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,The Alliance,PPO Network,,17.09,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,PPO Network,,17.09,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,inpatient,1,EA,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,8.38,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,outpatient,1,EA,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,7.62,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,inpatient,1,EA,12.83000,12.19000,The Alliance,PPO Network,,10.66,,,,,,,7.06,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,outpatient,1,EA,12.83000,12.19000,The Alliance,PPO Network,,10.66,,,,,,,6.42,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,inpatient,1,EA,19.91000,18.91000,The Alliance,PPO Network,,16.55,,,,,,,10.95,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,outpatient,1,EA,19.91000,18.91000,The Alliance,PPO Network,,16.55,,,,,,,9.96,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,inpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.95,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.13,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,inpatient,1,EA,16.62000,15.79000,The Alliance,PPO Network,,13.81,,,,,,,9.14,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,outpatient,1,EA,16.62000,15.79000,The Alliance,PPO Network,,13.81,,,,,,,8.31,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,13.43,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,inpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,6.07,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,5.51,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,inpatient,1,EA,12.51000,11.89000,The Alliance,PPO Network,,10.40,,,,,,,6.88,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,outpatient,1,EA,12.51000,11.89000,The Alliance,PPO Network,,10.40,,,,,,,6.25,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,9.04,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,8.21,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,inpatient,1,EA,6.54000,6.21000,The Alliance,PPO Network,,5.43,,,,,,,3.60,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,outpatient,1,EA,6.54000,6.21000,The Alliance,PPO Network,,5.43,,,,,,,3.27,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,19.75,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,inpatient,1,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,8.26,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,7.50,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,inpatient,1,EA,58.52000,55.59000,The Alliance,PPO Network,,48.63,,,,,,,32.19,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,outpatient,1,EA,58.52000,55.59000,The Alliance,PPO Network,,48.63,,,,,,,29.26,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,inpatient,1,EA,91.70000,87.12000,The Alliance,PPO Network,,76.20,,,,,,,50.44,88.95,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,outpatient,1,EA,91.70000,87.12000,The Alliance,PPO Network,,76.20,,,,,,,45.85,88.95,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,The Alliance,PPO Network,TC,1161.74,,,,,,,768.90,1356.06,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,PPO Network,TC,1161.74,,,,,,,384.16,1356.06,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,384.16,867.18,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,7.20,339.51,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,The Alliance,PPO Network,,38194.89,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,PPO Network,,38194.89,,,,,,,157.68,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,inpatient,1,mL,52901.43000,50256.36000,The Alliance,PPO Network,,43961.09,,,,,,,29095.79,51314.39,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,outpatient,1,mL,52901.43000,50256.36000,The Alliance,PPO Network,,43961.09,,,,,,,157.68,51314.39,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,36.26,1833.46,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,145.20,256.08,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,110.28,548.00,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,inpatient,1,mL,16.99000,16.14000,The Alliance,PPO Network,,14.12,,,,,,,9.34,16.48,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,outpatient,1,mL,16.99000,16.14000,The Alliance,PPO Network,,14.12,,,,,,,7.96,16.48,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,inpatient,1,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,10.81,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,outpatient,1,EA,19.66000,18.67000,The Alliance,PPO Network,,16.34,,,,,,,3.02,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,3.02,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,inpatient,1,EA,51.45000,48.88000,The Alliance,PPO Network,,42.75,,,,,,,28.30,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,outpatient,1,EA,51.45000,48.88000,The Alliance,PPO Network,,42.75,,,,,,,3.02,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,inpatient,1,EA,11.80000,11.21000,The Alliance,PPO Network,,9.81,,,,,,,6.49,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,outpatient,1,EA,11.80000,11.21000,The Alliance,PPO Network,,9.81,,,,,,,3.02,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,3.02,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,inpatient,1,EA,50.69000,48.15000,The Alliance,PPO Network,,42.12,,,,,,,27.88,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,outpatient,1,EA,50.69000,48.15000,The Alliance,PPO Network,,42.12,,,,,,,3.02,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,inpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,9.04,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,PPO Network,,13.65,,,,,,,3.02,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,3.02,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,inpatient,1,EA,50.24000,47.73000,The Alliance,PPO Network,,41.75,,,,,,,27.63,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,outpatient,1,EA,50.24000,47.73000,The Alliance,PPO Network,,41.75,,,,,,,3.02,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,inpatient,1,EA,13.59000,12.91000,The Alliance,PPO Network,,11.29,,,,,,,7.47,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,outpatient,1,EA,13.59000,12.91000,The Alliance,PPO Network,,11.29,,,,,,,3.02,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,inpatient,1,EA,8.80000,8.36000,The Alliance,PPO Network,,7.31,,,,,,,4.84,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,PPO Network,,7.31,,,,,,,3.02,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,inpatient,1,EA,16.42000,15.60000,The Alliance,PPO Network,,13.65,,,,,,,9.03,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,outpatient,1,EA,16.42000,15.60000,The Alliance,PPO Network,,13.65,,,,,,,3.02,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,3.02,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,inpatient,1,EA,18.93000,17.98000,The Alliance,PPO Network,,15.73,,,,,,,10.41,18.36,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,PPO Network,,15.73,,,,,,,3.02,18.36,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,2522.85,4449.39,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,1538.48,4686.00,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,inpatient,,,1068.00000,1014.60000,The Alliance,PPO Network,TC,887.51,,,,,,,587.40,1035.96,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,outpatient,,,1068.00000,1014.60000,The Alliance,PPO Network,TC,887.51,,,,,,,384.16,1035.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,inpatient,1,EA,23.41000,22.24000,The Alliance,PPO Network,,19.45,,,,,,,12.88,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,outpatient,1,EA,23.41000,22.24000,The Alliance,PPO Network,,19.45,,,,,,,11.71,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,6.52,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,5.92,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,inpatient,1,EA,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,outpatient,1,EA,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,inpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,2.04,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,PPO Network,,3.07,,,,,,,1.85,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.86,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.69,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.90,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.18,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,6.38,11.25,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,5.80,11.25,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,inpatient,,,613.00000,582.35000,The Alliance,PPO Network,TC,509.40,,,,,,,337.15,594.61,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,PPO Network,TC,509.40,,,,,,,306.50,594.61,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,31.28,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,3.14,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,3.14,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,inpatient,1,mL,27.71000,26.32000,The Alliance,PPO Network,,23.03,,,,,,,15.24,26.88,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,outpatient,1,mL,27.71000,26.32000,The Alliance,PPO Network,,23.03,,,,,,,3.14,26.88,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,inpatient,1,EA,25.79000,24.50000,The Alliance,PPO Network,,21.43,,,,,,,14.18,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,outpatient,1,EA,25.79000,24.50000,The Alliance,PPO Network,,21.43,,,,,,,3.02,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,3.02,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,3.02,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,inpatient,1,EA,7.81000,7.41000,The Alliance,PPO Network,,6.49,,,,,,,4.30,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,outpatient,1,EA,7.81000,7.41000,The Alliance,PPO Network,,6.49,,,,,,,3.02,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,inpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,3.02,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,inpatient,1,EA,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.90,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,PPO Network,,4.39,,,,,,,2.64,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,inpatient,1,EA,25.41000,24.14000,The Alliance,PPO Network,,21.12,,,,,,,13.98,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,outpatient,1,EA,25.41000,24.14000,The Alliance,PPO Network,,21.12,,,,,,,3.02,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,inpatient,1,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,7.39,13.03,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,PPO Network,,11.16,,,,,,,3.02,13.03,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,The Alliance,PPO Network,,10.40,,,,,,,6.89,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,PPO Network,,10.40,,,,,,,6.26,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,inpatient,1,EA,44.47000,42.25000,The Alliance,PPO Network,,36.95,,,,,,,24.46,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,outpatient,1,EA,44.47000,42.25000,The Alliance,PPO Network,,36.95,,,,,,,22.23,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,8.17,679.08,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,TC,2132.35,,,,,,,1411.30,2489.02,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,TC,2132.35,,,,,,,1283.00,2489.02,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,3.14,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,3.14,91.96,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,73.15,129.01,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,PPO Network,TC,110.52,,,,,,,66.50,584.87,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,inpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,3.02,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,inpatient,1,EA,285.22000,270.96000,The Alliance,PPO Network,,237.02,,,,,,,156.87,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,outpatient,1,EA,285.22000,270.96000,The Alliance,PPO Network,,237.02,,,,,,,3.02,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,inpatient,1,EA,63.17000,60.01000,The Alliance,PPO Network,,52.49,,,,,,,34.74,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,outpatient,1,EA,63.17000,60.01000,The Alliance,PPO Network,,52.49,,,,,,,3.02,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,inpatient,1,EA,217.76000,206.87000,The Alliance,PPO Network,,180.96,,,,,,,119.77,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,outpatient,1,EA,217.76000,206.87000,The Alliance,PPO Network,,180.96,,,,,,,3.02,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,inpatient,1,EA,95.12000,90.36000,The Alliance,PPO Network,,79.04,,,,,,,52.32,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,outpatient,1,EA,95.12000,90.36000,The Alliance,PPO Network,,79.04,,,,,,,3.02,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,inpatient,1,EA,157.97000,150.07000,The Alliance,PPO Network,,131.27,,,,,,,86.88,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,outpatient,1,EA,157.97000,150.07000,The Alliance,PPO Network,,131.27,,,,,,,3.02,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,inpatient,1,EA,251.22000,238.66000,The Alliance,PPO Network,,208.76,,,,,,,138.17,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,outpatient,1,EA,251.22000,238.66000,The Alliance,PPO Network,,208.76,,,,,,,3.02,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,inpatient,1,EA,281.02000,266.97000,The Alliance,PPO Network,,233.53,,,,,,,154.56,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,outpatient,1,EA,281.02000,266.97000,The Alliance,PPO Network,,233.53,,,,,,,3.02,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,inpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,3.02,91.96,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,inpatient,,,372.00000,353.40000,The Alliance,PPO Network,,309.13,,,,,,,204.60,360.84,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,outpatient,,,372.00000,353.40000,The Alliance,PPO Network,,309.13,,,,,,,35.09,1833.46,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,PPO Network,,639.04,,,,,,,422.95,745.93,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,PPO Network,,639.04,,,,,,,384.50,745.93,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,inpatient,1,EA,37.70000,35.81000,The Alliance,PPO Network,,31.33,,,,,,,20.73,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,outpatient,1,EA,37.70000,35.81000,The Alliance,PPO Network,,31.33,,,,,,,18.85,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,PPO Network,,2.13,,,,,,,1.28,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,The Alliance,PPO Network,,6.86,,,,,,,4.54,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,PPO Network,,6.86,,,,,,,4.12,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,inpatient,1,EA,12.21000,11.60000,The Alliance,PPO Network,,10.15,,,,,,,6.72,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,outpatient,1,EA,12.21000,11.60000,The Alliance,PPO Network,,10.15,,,,,,,6.11,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1475.05,4686.00,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,inpatient,,,888.00000,843.60000,The Alliance,PPO Network,TC,737.93,,,,,,,488.40,861.36,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,outpatient,,,888.00000,843.60000,The Alliance,PPO Network,TC,737.93,,,,,,,384.16,861.36,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,548.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,inpatient,1,EA,30.62000,29.09000,The Alliance,PPO Network,,25.45,,,,,,,16.84,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,outpatient,1,EA,30.62000,29.09000,The Alliance,PPO Network,,25.45,,,,,,,3.02,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,3.02,27.59,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,inpatient,1,EA,36.27000,34.45000,The Alliance,PPO Network,,30.14,,,,,,,19.95,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,outpatient,1,EA,36.27000,34.45000,The Alliance,PPO Network,,30.14,,,,,,,18.14,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,90,132.30,,,,,,,87.56,154.42,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,90,132.30,,,,,,,14.18,713.01,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,28.10,1476.99,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,inpatient,1,EA,5.20000,4.94000,The Alliance,PPO Network,,4.32,,,,,,,2.86,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,outpatient,1,EA,5.20000,4.94000,The Alliance,PPO Network,,4.32,,,,,,,2.60,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,inpatient,1,EA,9.74000,9.26000,The Alliance,PPO Network,,8.09,,,,,,,5.36,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,outpatient,1,EA,9.74000,9.26000,The Alliance,PPO Network,,8.09,,,,,,,4.87,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,5.82,271.65,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,inpatient,,,892.00000,847.40000,The Alliance,PPO Network,,741.25,,,,,,,490.60,865.24,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,PPO Network,,741.25,,,,,,,446.00,865.24,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,inpatient,2,EA,46.41000,44.09000,The Alliance,PPO Network,,38.57,,,,,,,25.53,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,outpatient,2,EA,46.41000,44.09000,The Alliance,PPO Network,,38.57,,,,,,,23.20,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,inpatient,2,EA,28.92000,27.47000,The Alliance,PPO Network,,24.03,,,,,,,15.91,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,outpatient,2,EA,28.92000,27.47000,The Alliance,PPO Network,,24.03,,,,,,,14.46,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,inpatient,2,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,outpatient,2,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,inpatient,2,EA,50.80000,48.26000,The Alliance,PPO Network,,42.21,,,,,,,27.94,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,outpatient,2,EA,50.80000,48.26000,The Alliance,PPO Network,,42.21,,,,,,,25.40,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,inpatient,2,EA,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,4.00,7.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,3.63,7.05,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,15.08,780.94,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,inpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,10.77,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,PPO Network,,16.28,,,,,,,9.79,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,inpatient,1,EA,4.56000,4.33000,The Alliance,PPO Network,,3.79,,,,,,,2.51,4.42,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,outpatient,1,EA,4.56000,4.33000,The Alliance,PPO Network,,3.79,,,,,,,2.28,4.42,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,PPO Network,TC,649.84,,,,,,,430.10,758.54,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,PPO Network,TC,649.84,,,,,,,384.16,758.54,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,548.00,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,inpatient,,,296.20000,281.39000,The Alliance,PPO Network,90,246.14,,,,,,,162.91,287.31,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,PPO Network,90,246.14,,,,,,,26.94,1358.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,inpatient,0.5,EA,29.99000,28.49000,The Alliance,PPO Network,,24.92,,,,,,,16.49,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,outpatient,0.5,EA,29.99000,28.49000,The Alliance,PPO Network,,24.92,,,,,,,3.79,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,inpatient,0.5,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,outpatient,0.5,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,3.79,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,inpatient,0.5,EA,154.73000,147.00000,The Alliance,PPO Network,,128.58,,,,,,,85.10,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,outpatient,0.5,EA,154.73000,147.00000,The Alliance,PPO Network,,128.58,,,,,,,3.79,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,inpatient,0.5,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,outpatient,0.5,EA,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,3.79,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,inpatient,0.5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,outpatient,0.5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,3.79,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,inpatient,0.5,EA,156.29000,148.48000,The Alliance,PPO Network,,129.88,,,,,,,85.96,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,outpatient,0.5,EA,156.29000,148.48000,The Alliance,PPO Network,,129.88,,,,,,,3.79,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,inpatient,0.5,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,outpatient,0.5,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,3.79,38.31,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,inpatient,1,EA,3.75000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,2.06,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,outpatient,1,EA,3.75000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,1.88,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,inpatient,1,EA,7.04000,6.69000,The Alliance,PPO Network,,5.85,,,,,,,3.87,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,PPO Network,,5.85,,,,,,,3.52,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.74,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,inpatient,1,EA,6.52000,6.19000,The Alliance,PPO Network,,5.42,,,,,,,3.59,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,outpatient,1,EA,6.52000,6.19000,The Alliance,PPO Network,,5.42,,,,,,,3.26,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,PPO Network,TC,751.22,,,,,,,497.20,876.88,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,PPO Network,TC,751.22,,,,,,,384.16,876.88,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,inpatient,,,164.80000,156.56000,The Alliance,PPO Network,90,136.95,,,,,,,90.64,159.86,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,outpatient,,,164.80000,156.56000,The Alliance,PPO Network,90,136.95,,,,,,,19.61,1052.52,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,The Alliance,PPO Network,,5.45,,,,,,,3.61,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,PPO Network,,5.45,,,,,,,3.28,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.62,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,PPO Network,,3.96,,,,,,,2.38,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,13.75,24.25,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,12.50,24.25,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,inpatient,60,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,outpatient,60,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,inpatient,60,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,outpatient,60,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,inpatient,30,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,outpatient,30,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,90,122.99,,,,,,,81.40,143.56,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,90,122.99,,,,,,,17.93,1850.43,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,inpatient,1,EA,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.99,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,outpatient,1,EA,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.81,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,3.50,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,PPO Network,,5.29,,,,,,,3.19,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,inpatient,1,EA,6.80000,6.46000,The Alliance,PPO Network,,5.65,,,,,,,3.74,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,outpatient,1,EA,6.80000,6.46000,The Alliance,PPO Network,,5.65,,,,,,,3.40,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,inpatient,,,162.60000,154.47000,The Alliance,PPO Network,90,135.12,,,,,,,89.43,157.72,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,PPO Network,90,135.12,,,,,,,16.32,797.91,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,151.25,266.75,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,137.50,1430.78,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,166.10,292.94,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,101.94,1193.49,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,inpatient,1,EA,154.74000,147.00000,The Alliance,PPO Network,,128.59,,,,,,,85.11,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,outpatient,1,EA,154.74000,147.00000,The Alliance,PPO Network,,128.59,,,,,,,3.79,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,inpatient,1,EA,151.66000,144.08000,The Alliance,PPO Network,,126.03,,,,,,,83.41,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,outpatient,1,EA,151.66000,144.08000,The Alliance,PPO Network,,126.03,,,,,,,3.79,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,inpatient,1,EA,152.44000,144.82000,The Alliance,PPO Network,,126.68,,,,,,,83.84,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,outpatient,1,EA,152.44000,144.82000,The Alliance,PPO Network,,126.68,,,,,,,3.79,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,inpatient,1,EA,150.13000,142.63000,The Alliance,PPO Network,,124.76,,,,,,,82.57,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,outpatient,1,EA,150.13000,142.63000,The Alliance,PPO Network,,124.76,,,,,,,3.79,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,inpatient,1,EA,135.14000,128.39000,The Alliance,PPO Network,,112.30,,,,,,,74.33,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,outpatient,1,EA,135.14000,128.39000,The Alliance,PPO Network,,112.30,,,,,,,3.79,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,inpatient,1,EA,135.15000,128.40000,The Alliance,PPO Network,,112.31,,,,,,,74.33,131.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,outpatient,1,EA,135.15000,128.40000,The Alliance,PPO Network,,112.31,,,,,,,3.79,131.10,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,TC,96.40,,,,,,,63.80,112.52,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,TC,96.40,,,,,,,58.00,896.81,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,inpatient,1,EA,3.76000,3.58000,The Alliance,PPO Network,,3.12,,,,,,,2.07,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,outpatient,1,EA,3.76000,3.58000,The Alliance,PPO Network,,3.12,,,,,,,1.88,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,The Alliance,PPO Network,,5.87,,,,,,,3.88,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,PPO Network,,5.87,,,,,,,3.53,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,2.02,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,inpatient,1,EA,255.96000,243.16000,The Alliance,PPO Network,,212.70,,,,,,,140.78,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,PPO Network,,212.70,,,,,,,2.02,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,inpatient,1,EA,409.34000,388.88000,The Alliance,PPO Network,,340.16,,,,,,,225.14,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,outpatient,1,EA,409.34000,388.88000,The Alliance,PPO Network,,340.16,,,,,,,2.02,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,inpatient,1,EA,72.68000,69.05000,The Alliance,PPO Network,,60.40,,,,,,,39.97,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,outpatient,1,EA,72.68000,69.05000,The Alliance,PPO Network,,60.40,,,,,,,2.02,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,2.02,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,inpatient,1,EA,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,outpatient,1,EA,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,2.02,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,inpatient,1,EA,272.22000,258.61000,The Alliance,PPO Network,,226.21,,,,,,,149.72,264.05,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,outpatient,1,EA,272.22000,258.61000,The Alliance,PPO Network,,226.21,,,,,,,2.02,264.05,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,9.09,29.10,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,inpatient,1,EA,21.87000,20.77000,The Alliance,PPO Network,,18.17,,,,,,,12.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,outpatient,1,EA,21.87000,20.77000,The Alliance,PPO Network,,18.17,,,,,,,1.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,inpatient,1,EA,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,12.15,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,1.03,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,inpatient,1,EA,15.09000,14.33000,The Alliance,PPO Network,,12.54,,,,,,,8.30,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,PPO Network,,12.54,,,,,,,1.03,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,inpatient,1,EA,8.63000,8.20000,The Alliance,PPO Network,,7.17,,,,,,,4.75,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,PPO Network,,7.17,,,,,,,1.03,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,inpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,1.03,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,inpatient,1,EA,21.84000,20.74000,The Alliance,PPO Network,,18.15,,,,,,,12.01,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,outpatient,1,EA,21.84000,20.74000,The Alliance,PPO Network,,18.15,,,,,,,1.03,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,inpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,1.03,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,inpatient,1,EA,11.25000,10.69000,The Alliance,PPO Network,,9.35,,,,,,,6.19,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,outpatient,1,EA,11.25000,10.69000,The Alliance,PPO Network,,9.35,,,,,,,1.03,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,inpatient,1,EA,8.65000,8.22000,The Alliance,PPO Network,,7.19,,,,,,,4.76,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,PPO Network,,7.19,,,,,,,1.03,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,1.03,5.45,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,inpatient,,,865.00000,821.75000,The Alliance,PPO Network,TC,718.82,,,,,,,475.75,839.05,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,outpatient,,,865.00000,821.75000,The Alliance,PPO Network,TC,718.82,,,,,,,384.16,839.05,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,The Alliance,PPO Network,TC,265.09,,,,,,,175.45,309.43,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,PPO Network,TC,265.09,,,,,,,159.50,3015.65,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,2.25,118.82,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,157.00,1786.85,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,inpatient,1,EA,26.49000,25.17000,The Alliance,PPO Network,,22.01,,,,,,,14.57,25.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,outpatient,1,EA,26.49000,25.17000,The Alliance,PPO Network,,22.01,,,,,,,3.02,25.70,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,inpatient,1,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,outpatient,1,EA,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.15,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,The Alliance,PPO Network,,5.07,,,,,,,3.35,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,PPO Network,,5.07,,,,,,,3.05,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.93,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.75,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1082.00000,1027.90000,The Alliance,PPO Network,TC,899.14,,,,,,,595.10,1049.54,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1082.00000,1027.90000,The Alliance,PPO Network,TC,899.14,,,,,,,384.16,1049.54,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,inpatient,,,723.00000,686.85000,The Alliance,PPO Network,TC,600.81,,,,,,,397.65,701.31,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,outpatient,,,723.00000,686.85000,The Alliance,PPO Network,TC,600.81,,,,,,,361.50,3665.88,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,129.80,228.92,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,118.00,1964.22,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,189.20,333.68,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,172.00,1786.85,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,25.31,2286.16,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1631.25000,1549.69000,The Alliance,PPO Network,,1355.57,,,,,,,799.31,1582.31,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,PPO Network,,1355.57,,,,,,,748.74,1631.25,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,TC,247.64,,,,,,,149.00,1569.27,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,11.67,611.15,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,inpatient,,,170.10000,161.60000,The Alliance,PPO Network,90,141.35,,,,,,,93.56,165.00,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,PPO Network,90,141.35,,,,,,,14.87,746.94,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,21.45,37.83,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,3.64,169.79,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,The Alliance,PPO Network,TC,1504.94,,,,,,,996.05,1756.67,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,PPO Network,TC,1504.94,,,,,,,905.50,8808.48,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,inpatient,,,157.10000,149.24000,The Alliance,PPO Network,90,130.55,,,,,,,86.41,152.39,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,outpatient,,,157.10000,149.24000,The Alliance,PPO Network,90,130.55,,,,,,,13.99,713.01,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,inpatient,,,134.80000,128.06000,The Alliance,PPO Network,90,112.02,,,,,,,74.14,130.76,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,outpatient,,,134.80000,128.06000,The Alliance,PPO Network,90,112.02,,,,,,,12.00,611.15,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,PPO Network,TC,260.93,,,,,,,136.98,1331.91,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,154.55,272.57,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,140.50,1569.27,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,37.78,66.64,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,8.17,882.80,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,inpatient,,,369.00000,350.55000,The Alliance,PPO Network,TC,306.64,,,,,,,202.95,357.93,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,PPO Network,TC,306.64,,,,,,,184.50,1865.95,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,inpatient,,,208.30000,197.88000,The Alliance,PPO Network,90,173.10,,,,,,,114.56,202.05,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,outpatient,,,208.30000,197.88000,The Alliance,PPO Network,90,173.10,,,,,,,16.32,797.91,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.40,2.46,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.27,2.46,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,inpatient,1,EA,5.39000,5.12000,The Alliance,PPO Network,,4.48,,,,,,,2.96,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,PPO Network,,4.48,,,,,,,2.69,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,PPO Network,,8.40,,,,,,,5.05,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,111.13,1094.55,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,TC,229.36,,,,,,,138.00,1371.46,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,111.13,1094.55,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,90,29.09,,,,,,,19.25,33.95,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,90,29.09,,,,,,,17.50,2020.22,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,The Alliance,PPO Network,TC,179.50,,,,,,,118.80,209.52,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,PPO Network,TC,179.50,,,,,,,108.00,1193.49,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,187.00,329.80,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,170.00,1786.85,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,126.50,1331.91,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,inpatient,,,1120.00000,1064.00000,The Alliance,PPO Network,TC,930.72,,,,,,,616.00,1086.40,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,outpatient,,,1120.00000,1064.00000,The Alliance,PPO Network,TC,930.72,,,,,,,560.00,5663.55,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,inpatient,,,498.00000,473.10000,The Alliance,PPO Network,TC,413.84,,,,,,,273.90,483.06,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,PPO Network,TC,413.84,,,,,,,247.55,2380.22,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,TC,166.20,,,,,,,110.00,194.00,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,TC,166.20,,,,,,,100.00,1094.55,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,189.20,333.68,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,PPO Network,TC,285.86,,,,,,,160.92,1569.27,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,2.06,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,1.87,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,The Alliance,PPO Network,,5.83,,,,,,,3.86,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,PPO Network,,5.83,,,,,,,3.50,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,inpatient,,,532.00000,505.40000,The Alliance,PPO Network,TC,442.09,,,,,,,292.60,516.04,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,PPO Network,TC,442.09,,,,,,,128.10,1813.71,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,409.20,721.68,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,PPO Network,TC,618.26,,,,,,,372.00,4002.11,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,inpatient,,,755.00000,717.25000,The Alliance,PPO Network,TC,627.40,,,,,,,415.25,732.35,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,outpatient,,,755.00000,717.25000,The Alliance,PPO Network,TC,627.40,,,,,,,377.50,3764.75,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,TC,137.95,,,,,,,91.30,161.02,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,TC,137.95,,,,,,,83.00,857.19,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,181.50,320.10,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,165.00,1648.36,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,PPO Network,TC,267.58,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,PPO Network,TC,267.58,,,,,,,161.00,1628.59,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,158.40,279.36,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,144.00,1549.49,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,inpatient,1,mL,47.56000,45.18000,The Alliance,PPO Network,,39.52,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,PPO Network,,39.52,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,inpatient,1,mL,24.33000,23.12000,The Alliance,PPO Network,,20.22,,,,,,,13.38,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,outpatient,1,mL,24.33000,23.12000,The Alliance,PPO Network,,20.22,,,,,,,12.16,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,inpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,12.58,26.05,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,TC,184.48,,,,,,,111.00,1094.55,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,inpatient,,,379.00000,360.05000,The Alliance,PPO Network,TC,314.95,,,,,,,208.45,367.63,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,PPO Network,TC,314.95,,,,,,,189.50,1925.27,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,The Alliance,PPO Network,TC,200.27,,,,,,,132.55,233.77,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,PPO Network,TC,200.27,,,,,,,120.50,1213.27,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,134.75,237.65,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,122.23,1213.27,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,PPO Network,TC,220.22,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,PPO Network,TC,220.22,,,,,,,132.50,1430.78,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,187.00,329.80,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,170.00,1786.85,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,PPO Network,TC,226.03,,,,,,,149.60,263.84,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,PPO Network,TC,226.03,,,,,,,125.88,1213.27,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,187.00,329.80,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,TC,282.54,,,,,,,166.47,1628.59,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,115.50,1252.81,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,PPO Network,TC,177.83,,,,,,,117.70,207.58,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,PPO Network,TC,177.83,,,,,,,107.00,1233.04,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,PPO Network,TC,693.88,,,,,,,459.25,809.95,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,PPO Network,TC,693.88,,,,,,,417.50,3942.79,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,inpatient,,,1073.00000,1019.35000,The Alliance,PPO Network,TC,891.66,,,,,,,590.15,1040.81,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,PPO Network,TC,891.66,,,,,,,536.50,5960.23,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,inpatient,,,282.00000,267.90000,The Alliance,PPO Network,,234.34,,,,,,,155.10,273.54,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,outpatient,,,282.00000,267.90000,The Alliance,PPO Network,,234.34,,,,,,,29.60,1544.85,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,TC,228.53,,,,,,,137.50,1509.95,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,254.10,448.14,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,PPO Network,TC,383.92,,,,,,,203.31,1945.04,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,282.15,497.61,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,234.65,2261.57,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,PPO Network,TC,252.62,,,,,,,167.20,294.88,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,PPO Network,TC,252.62,,,,,,,152.00,1569.27,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,TC,205.26,,,,,,,135.85,239.59,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,TC,205.26,,,,,,,123.50,1233.04,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,inpatient,,,287.00000,272.65000,The Alliance,PPO Network,TC,238.50,,,,,,,157.85,278.39,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,PPO Network,TC,238.50,,,,,,,143.50,1470.40,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,inpatient,,,862.00000,818.90000,The Alliance,PPO Network,TC,716.32,,,,,,,474.10,836.14,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,PPO Network,TC,716.32,,,,,,,431.00,4417.51,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,137.50,242.50,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,125.00,1331.91,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,154.55,272.57,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,140.50,1549.49,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,TC,240.16,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,TC,240.16,,,,,,,144.50,1509.95,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,inpatient,240,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,outpatient,240,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,inpatient,240,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,outpatient,240,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,119.35,210.49,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,108.50,1173.72,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,inpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,137.50,242.50,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,PPO Network,TC,207.75,,,,,,,125.00,1252.81,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,TC,173.68,,,,,,,114.95,202.73,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,TC,173.68,,,,,,,104.50,1114.32,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,154.55,272.57,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,140.50,1391.23,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,134.75,237.65,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,122.50,1292.36,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,PPO Network,TC,231.85,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,PPO Network,TC,231.85,,,,,,,101.94,1074.77,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,1470.40,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,The Alliance,PPO Network,TC,853.44,,,,,,,564.85,996.19,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,PPO Network,TC,853.44,,,,,,,513.50,5169.06,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,166.10,292.94,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,144.32,1391.23,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,675.95,1192.13,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,606.90,5742.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,189.75,334.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,TC,286.69,,,,,,,172.50,1687.91,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,PPO Network,TC,253.46,,,,,,,167.75,295.85,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,PPO Network,TC,253.46,,,,,,,152.50,1628.59,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,161.50,1648.36,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,PPO Network,TC,237.67,,,,,,,157.30,277.42,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,PPO Network,TC,237.67,,,,,,,142.47,1391.23,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,TC,230.19,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,TC,230.19,,,,,,,120.38,1173.72,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,144.65,255.11,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,129.58,1272.59,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,PPO Network,TC,481.98,,,,,,,319.00,562.60,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,PPO Network,TC,481.98,,,,,,,290.00,5821.82,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,TC,152.07,,,,,,,100.65,177.51,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,TC,152.07,,,,,,,74.29,738.55,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,102.30,180.42,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,TC,154.57,,,,,,,93.00,1074.77,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,The Alliance,PPO Network,TC,970.61,,,,,,,642.40,1132.96,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,PPO Network,TC,970.61,,,,,,,278.89,2676.90,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,PPO Network,TC,295.00,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,PPO Network,TC,295.00,,,,,,,159.07,1549.49,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,The Alliance,PPO Network,TC,744.58,,,,,,,492.80,869.12,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,PPO Network,TC,744.58,,,,,,,448.00,4437.28,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,57.20,100.88,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,11.39,594.19,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,120.38,1173.72,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,inpatient,30,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,outpatient,30,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,PPO Network,TC,670.62,,,,,,,443.85,782.79,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,PPO Network,TC,670.62,,,,,,,403.50,5149.29,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,inpatient,1,mL,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,18.84,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,outpatient,1,mL,34.25000,32.54000,The Alliance,PPO Network,,28.46,,,,,,,8.33,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,inpatient,1,mL,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,inpatient,1,mL,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,4.09,7.21,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,outpatient,1,mL,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,3.71,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,15.80,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,145.20,256.08,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,TC,219.38,,,,,,,132.00,1331.91,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,inpatient,,,411.00000,390.45000,The Alliance,PPO Network,TC,341.54,,,,,,,226.05,398.67,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,outpatient,,,411.00000,390.45000,The Alliance,PPO Network,TC,341.54,,,,,,,205.50,2043.99,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,PPO Network,TC,511.06,,,,,,,338.25,596.55,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,PPO Network,TC,511.06,,,,,,,307.50,3329.66,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,PPO Network,TC,669.79,,,,,,,443.30,781.82,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,PPO Network,TC,669.79,,,,,,,403.00,5188.83,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,PPO Network,TC,274.23,,,,,,,153.52,1470.40,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,118.50,1233.04,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,144.65,255.11,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,131.50,1668.14,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,TC,210.24,,,,,,,125.88,1213.27,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,inpatient,1,EA,15.25000,14.48000,The Alliance,PPO Network,,12.67,,,,,,,8.39,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,PPO Network,,12.67,,,,,,,7.62,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,inpatient,1,EA,9.68000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,outpatient,1,EA,9.68000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,4.84,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,inpatient,1,EA,8.79000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,4.83,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,outpatient,1,EA,8.79000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,4.39,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,The Alliance,PPO Network,,7.27,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,PPO Network,,7.27,,,,,,,4.38,8.49,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,PPO Network,TC,195.28,,,,,,,129.25,227.95,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,PPO Network,TC,195.28,,,,,,,117.50,1233.04,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,inpatient,20,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,outpatient,20,EA,4.32000,4.11000,The Alliance,PPO Network,,3.59,,,,,,,2.16,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,inpatient,20,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,3.04,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,outpatient,20,EA,5.53000,5.25000,The Alliance,PPO Network,,4.60,,,,,,,2.35,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,inpatient,20,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,outpatient,20,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,inpatient,,,1106.00000,1050.70000,The Alliance,PPO Network,TC,919.09,,,,,,,608.30,1072.82,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,outpatient,,,1106.00000,1050.70000,The Alliance,PPO Network,TC,919.09,,,,,,,553.00,5703.10,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,inpatient,,,312.00000,296.40000,The Alliance,PPO Network,TC,259.27,,,,,,,171.60,302.64,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,PPO Network,TC,259.27,,,,,,,156.00,1549.49,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,2.15,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,PPO Network,,3.24,,,,,,,1.95,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,inpatient,1,EA,7.31000,6.94000,The Alliance,PPO Network,,6.07,,,,,,,4.02,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,outpatient,1,EA,7.31000,6.94000,The Alliance,PPO Network,,6.07,,,,,,,3.65,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,inpatient,,,564.00000,535.80000,The Alliance,PPO Network,TC,468.68,,,,,,,310.20,547.08,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,PPO Network,TC,468.68,,,,,,,282.00,2835.16,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,PPO Network,TC,236.84,,,,,,,156.75,276.45,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,PPO Network,TC,236.84,,,,,,,142.50,1450.63,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,inpatient,1,EA,5.99000,5.69000,The Alliance,PPO Network,,4.98,,,,,,,3.29,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,outpatient,1,EA,5.99000,5.69000,The Alliance,PPO Network,,4.98,,,,,,,3.00,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,2.14,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,1.95,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.63,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.40,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,inpatient,1,EA,5.69000,5.41000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,outpatient,1,EA,5.69000,5.41000,The Alliance,PPO Network,,4.73,,,,,,,2.85,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,2.07,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,1.88,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,inpatient,1,EA,7.62000,7.24000,The Alliance,PPO Network,,6.33,,,,,,,4.19,7.39,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,outpatient,1,EA,7.62000,7.24000,The Alliance,PPO Network,,6.33,,,,,,,3.81,7.39,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,TC,295.84,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,TC,295.84,,,,,,,178.00,2024.21,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,inpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,253.00,446.20,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,PPO Network,TC,382.26,,,,,,,230.00,2340.67,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,inpatient,,,740.00000,703.00000,The Alliance,PPO Network,TC,614.94,,,,,,,407.00,717.80,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,PPO Network,TC,614.94,,,,,,,370.00,3725.20,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,inpatient,,,582.00000,552.90000,The Alliance,PPO Network,TC,483.64,,,,,,,320.10,564.54,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,PPO Network,TC,483.64,,,,,,,238.63,3015.65,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,140.80,248.32,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,TC,212.74,,,,,,,77.99,1015.45,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,inpatient,1,mL,477.84000,453.95000,The Alliance,PPO Network,,397.09,,,,,,,262.81,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,outpatient,1,mL,477.84000,453.95000,The Alliance,PPO Network,,397.09,,,,,,,8.33,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,inpatient,1,mL,63.69000,60.51000,The Alliance,PPO Network,,52.93,,,,,,,35.03,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,outpatient,1,mL,63.69000,60.51000,The Alliance,PPO Network,,52.93,,,,,,,8.33,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,inpatient,1,mL,21.94000,20.85000,The Alliance,PPO Network,,18.23,,,,,,,12.07,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,outpatient,1,mL,21.94000,20.85000,The Alliance,PPO Network,,18.23,,,,,,,8.33,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,inpatient,1,mL,113.76000,108.07000,The Alliance,PPO Network,,94.53,,,,,,,62.57,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,PPO Network,,94.53,,,,,,,8.33,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,8.33,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,8.33,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,inpatient,1,mL,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,20.86,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,PPO Network,,31.51,,,,,,,8.33,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,inpatient,1,mL,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,15.30,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,8.33,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,inpatient,1,mL,42.75000,40.61000,The Alliance,PPO Network,,35.53,,,,,,,23.51,41.47,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,outpatient,1,mL,42.75000,40.61000,The Alliance,PPO Network,,35.53,,,,,,,8.33,41.47,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,TC,145.43,,,,,,,96.25,169.75,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,TC,145.43,,,,,,,87.50,876.96,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,PPO Network,TC,389.74,,,,,,,257.95,454.93,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,PPO Network,TC,389.74,,,,,,,234.50,2439.54,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,119.35,210.49,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,PPO Network,TC,180.33,,,,,,,108.50,1193.49,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,73.70,129.98,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,67.00,129.98,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,inpatient,,,336.00000,319.20000,The Alliance,PPO Network,TC,279.22,,,,,,,184.80,325.92,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,outpatient,,,336.00000,319.20000,The Alliance,PPO Network,TC,279.22,,,,,,,157.22,1529.72,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,166.10,292.94,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,TC,250.96,,,,,,,151.00,1509.95,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,TC,191.96,,,,,,,115.50,1213.27,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,inpatient,,,2119.00000,2013.05000,The Alliance,PPO Network,TC,1760.89,,,,,,,1165.45,2055.43,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,outpatient,,,2119.00000,2013.05000,The Alliance,PPO Network,TC,1760.89,,,,,,,942.37,19073.89,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,129.80,228.92,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,PPO Network,TC,196.12,,,,,,,118.00,1292.36,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,TC,77.28,,,,,,,51.15,90.21,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,TC,77.28,,,,,,,46.50,3015.65,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,27.50,134.64,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,24.50,47.53,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,inpatient,,,465.80000,442.51000,The Alliance,PPO Network,TC,387.08,,,,,,,256.19,451.83,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,outpatient,,,465.80000,442.51000,The Alliance,PPO Network,TC,387.08,,,,,,,232.90,1820.00,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,4.20,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,inpatient,1,mL,20.10000,19.10000,The Alliance,PPO Network,,16.70,,,,,,,11.05,19.50,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,outpatient,1,mL,20.10000,19.10000,The Alliance,PPO Network,,16.70,,,,,,,10.05,35.77,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,inpatient,1,mL,17.85000,16.96000,The Alliance,PPO Network,,14.83,,,,,,,9.82,17.31,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,outpatient,1,mL,17.85000,16.96000,The Alliance,PPO Network,,14.83,,,,,,,8.93,35.77,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,inpatient,,,2163.00000,2054.85000,The Alliance,PPO Network,,1797.45,,,,,,,1189.65,2098.11,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,PPO Network,,1797.45,,,,,,,1189.65,7803.00,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,inpatient,1,mL,165.78000,157.49000,The Alliance,PPO Network,,137.76,,,,,,,91.18,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,outpatient,1,mL,165.78000,157.49000,The Alliance,PPO Network,,137.76,,,,,,,82.89,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,inpatient,1,mL,20.24000,19.22000,The Alliance,PPO Network,,16.82,,,,,,,11.13,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,outpatient,1,mL,20.24000,19.22000,The Alliance,PPO Network,,16.82,,,,,,,10.12,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,inpatient,1,mL,20.26000,19.24000,The Alliance,PPO Network,,16.84,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,outpatient,1,mL,20.26000,19.24000,The Alliance,PPO Network,,16.84,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,inpatient,1,mL,20.26000,19.25000,The Alliance,PPO Network,,16.84,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,outpatient,1,mL,20.26000,19.25000,The Alliance,PPO Network,,16.84,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,8.85,17.17,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,inpatient,1,EA,4748.76000,4511.33000,The Alliance,PPO Network,,3946.22,,,,,,,2611.82,4606.30,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,outpatient,1,EA,4748.76000,4511.33000,The Alliance,PPO Network,,3946.22,,,,,,,11.00,4606.30,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,inpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,204.05,359.87,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,outpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,185.50,359.87,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,62.14,3038.81,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,62.14,3038.81,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,inpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,PPO Network,,671.24,,,,,,,33.00,783.52,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,inpatient,1,mL,7.05000,6.70000,The Alliance,PPO Network,,5.86,,,,,,,3.88,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,outpatient,1,mL,7.05000,6.70000,The Alliance,PPO Network,,5.86,,,,,,,0.01550,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,inpatient,1,mL,4.50000,4.28000,The Alliance,PPO Network,,3.74,,,,,,,2.48,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,outpatient,1,mL,4.50000,4.28000,The Alliance,PPO Network,,3.74,,,,,,,0.01550,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,inpatient,1,mL,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,4.26,7.51,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,outpatient,1,mL,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,0.01550,7.51,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,inpatient,1,EA,1951.28000,1853.72000,The Alliance,PPO Network,,1621.51,,,,,,,1073.20,1892.74,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,outpatient,1,EA,1951.28000,1853.72000,The Alliance,PPO Network,,1621.51,,,,,,,25.05,1892.74,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,inpatient,10,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,outpatient,10,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,inpatient,10,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,inpatient,10,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,outpatient,10,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,5.39,288.61,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,inpatient,,,383.00000,363.85000,The Alliance,PPO Network,,318.27,,,,,,,210.65,371.51,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,PPO Network,,318.27,,,,,,,191.50,2122.08,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.93,203.72,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,inpatient,1,EA,3584.37000,3405.15000,The Alliance,PPO Network,,2978.61,,,,,,,1971.40,3476.84,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,outpatient,1,EA,3584.37000,3405.15000,The Alliance,PPO Network,,2978.61,,,,,,,76.18,3476.84,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,inpatient,1,mL,5.55000,5.27000,The Alliance,PPO Network,,4.61,,,,,,,3.05,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,outpatient,1,mL,5.55000,5.27000,The Alliance,PPO Network,,4.61,,,,,,,0.11207,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,inpatient,1,mL,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,0.11207,10.73,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.39,288.61,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,2.99,152.82,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,24.20,42.68,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,4.00,186.75,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,3.93,203.72,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,26.07,1222.31,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,4.72,254.68,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,inpatient,1,mL,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,5.23,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,inpatient,,,169.00000,160.55000,The Alliance,PPO Network,,140.44,,,,,,,92.95,163.93,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,PPO Network,,140.44,,,,,,,26.07,1222.31,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,4.27,220.68,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,GY,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,GY,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,inpatient,1,mL,1.06000,1.01000,The Alliance,PPO Network,GY,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,outpatient,1,mL,1.06000,1.01000,The Alliance,PPO Network,GY,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,inpatient,1,mL,0.91000,0.86000,The Alliance,PPO Network,GY,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,PPO Network,GY,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,4.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,inpatient,1,EA,7470.42000,7096.90000,The Alliance,PPO Network,,6207.92,,,,,,,4108.73,7246.31,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,outpatient,1,EA,7470.42000,7096.90000,The Alliance,PPO Network,,6207.92,,,,,,,11.00,7246.31,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,inpatient,1,EA,254.92000,242.17000,The Alliance,PPO Network,,211.84,,,,,,,140.21,247.27,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,outpatient,1,EA,254.92000,242.17000,The Alliance,PPO Network,,211.84,,,,,,,127.46,247.27,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,5.18,271.65,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,34.10,60.14,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,5.39,288.61,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,5.60,288.61,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,inpatient,,,568.00000,539.60000,The Alliance,PPO Network,TC,472.01,,,,,,,312.40,550.96,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,PPO Network,TC,472.01,,,,,,,158.62,1499.73,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,inpatient,,,2478.00000,2354.10000,The Alliance,PPO Network,,2059.22,,,,,,,1362.90,2403.66,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,outpatient,,,2478.00000,2354.10000,The Alliance,PPO Network,,2059.22,,,,,,,162.71,16444.87,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,6.04,322.54,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,The Alliance,PPO Network,TC,1172.54,,,,,,,776.05,1368.67,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,PPO Network,TC,1172.54,,,,,,,705.50,1368.67,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,107.25,189.15,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,19.63,1018.59,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,GO,30.75,,,,,,,20.35,35.89,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,GO,30.75,,,,,,,18.50,264.00,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,2910.60,5133.24,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,1388.02,5133.24,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,3038.81,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,146.85,258.99,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,TC,221.88,,,,,,,133.50,1470.40,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,inpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,44.55,78.57,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,PPO Network,,67.31,,,,,,,40.50,134.64,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,97.00,212.44,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,The Alliance,PPO Network,TC,959.80,,,,,,,635.25,1120.35,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,PPO Network,TC,959.80,,,,,,,577.50,1120.35,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,inpatient,1,mL,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,outpatient,1,mL,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,inpatient,1,mL,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,outpatient,1,mL,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,TC,373.95,,,,,,,247.50,436.50,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,TC,373.95,,,,,,,225.00,492.80,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,177.51,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,16.80,882.80,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,inpatient,1,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,outpatient,1,EA,0.45000,0.42000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.08005,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.08005,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.08005,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,inpatient,1,mL,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.08005,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,inpatient,1,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.08005,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.08005,0.64990,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,30.80,54.32,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,5.18,271.65,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,15.05,780.94,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,5.37,305.58,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,inpatient,1,mL,1043.05000,990.90000,The Alliance,PPO Network,,866.77,,,,,,,573.68,1011.76,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,outpatient,1,mL,1043.05000,990.90000,The Alliance,PPO Network,,866.77,,,,,,,85.25,1011.76,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,inpatient,1,mL,977.93000,929.03000,The Alliance,PPO Network,,812.66,,,,,,,537.86,948.59,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,outpatient,1,mL,977.93000,929.03000,The Alliance,PPO Network,,812.66,,,,,,,85.25,948.59,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,151.25,266.75,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,62.14,3038.81,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,30.80,54.32,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,5.18,271.65,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,4.24,254.68,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,15.32,797.91,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,4.29,203.72,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,224.40,395.76,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,37.27,1833.46,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,6.47,339.51,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,5.60,288.61,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,inpatient,1,EA,1320.90000,1254.86000,The Alliance,PPO Network,,1097.67,,,,,,,726.50,1281.27,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,outpatient,1,EA,1320.90000,1254.86000,The Alliance,PPO Network,,1097.67,,,,,,,5.71,1281.27,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,77.53,1052.52,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,212.44,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,inpatient,1,mL,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,outpatient,1,mL,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,8.85,17.17,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,5.38,458.40,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,5.56,254.68,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.18,271.65,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,2.25,118.82,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,56.65,99.91,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,8.62,458.40,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,inpatient,1,EA,635.07000,603.31000,The Alliance,PPO Network,,527.74,,,,,,,349.29,616.02,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,PPO Network,,527.74,,,,,,,4.24,616.02,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,392.70,5858.00,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,5271.00,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,5271.00,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,inpatient,1,mL,12.99000,12.34000,The Alliance,PPO Network,,10.79,,,,,,,7.14,12.60,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,outpatient,1,mL,12.99000,12.34000,The Alliance,PPO Network,,10.79,,,,,,,6.50,12.60,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,26.11,147.44,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,inpatient,,,77.07000,73.22000,The Alliance,PPO Network,,64.05,,,,,,,42.39,74.76,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,PPO Network,,64.05,,,,,,,25.05,74.76,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,62.50,121.25,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,182.05,321.07,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,29.35,2438.99,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2195.00000,2085.25000,The Alliance,PPO Network,TC,1824.05,,,,,,,1207.25,2129.15,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2195.00000,2085.25000,The Alliance,PPO Network,TC,1824.05,,,,,,,1097.50,2210.07,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,The Alliance,PPO Network,TC,1667.82,,,,,,,1103.85,1946.79,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,PPO Network,TC,1667.82,,,,,,,940.41,2960.49,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,5115.55,9021.97,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,4467.66,9021.97,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,The Alliance,PPO Network,TC,2886.89,,,,,,,1910.70,3369.78,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,PPO Network,TC,2886.89,,,,,,,1364.86,7180.14,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,The Alliance,PPO Network,TC,1809.92,,,,,,,1197.90,2112.66,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,PPO Network,TC,1809.92,,,,,,,1036.23,2210.07,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,TC,1023.79,,,,,,,677.60,1195.04,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,TC,1023.79,,,,,,,466.73,2210.07,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,inpatient,,,1038.00000,986.10000,The Alliance,PPO Network,TC,862.58,,,,,,,570.90,1006.86,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,outpatient,,,1038.00000,986.10000,The Alliance,PPO Network,TC,862.58,,,,,,,84.70,1006.86,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,The Alliance,PPO Network,TC,1826.54,,,,,,,1208.90,2132.06,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,PPO Network,TC,1826.54,,,,,,,1047.28,2210.07,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,11015.00,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,3612.55,10015.25,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,TC,1608.82,,,,,,,1064.80,1877.92,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,TC,1608.82,,,,,,,918.26,2960.49,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,PPO Network,TC,620.76,,,,,,,410.85,724.59,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,PPO Network,TC,620.76,,,,,,,282.87,724.59,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,The Alliance,PPO Network,TC,1002.19,,,,,,,663.30,1169.82,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,PPO Network,TC,1002.19,,,,,,,455.68,2210.07,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5343.33,11015.00,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,inpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,PPO Network,,3977.17,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,inpatient,,,4662.00000,4428.90000,The Alliance,PPO Network,,3874.12,,,,,,,2564.10,4522.14,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,outpatient,,,4662.00000,4428.90000,The Alliance,PPO Network,,3874.12,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5343.33,11015.00,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,72.50,1820.00,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,The Alliance,PPO Network,TC,3036.47,,,,,,,2009.70,3544.38,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,PPO Network,TC,3036.47,,,,,,,1487.04,3544.38,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,inpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,166.65,293.91,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,outpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,78.72,293.91,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,14.69,25.90,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,5.25,254.68,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,inpatient,1,mL,503.59000,478.41000,The Alliance,PPO Network,,418.48,,,,,,,276.97,488.48,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,outpatient,1,mL,503.59000,478.41000,The Alliance,PPO Network,,418.48,,,,,,,5.86,488.48,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,3.09,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,PPO Network,,4.66,,,,,,,2.81,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,inpatient,1,EA,2.35000,2.24000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,outpatient,1,EA,2.35000,2.24000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,152.35,268.69,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,62.14,3038.81,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,14.55,763.98,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,inpatient,1,mL,10785.83000,10246.53000,The Alliance,PPO Network,,8963.02,,,,,,,5932.21,10462.26,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,outpatient,1,mL,10785.83000,10246.53000,The Alliance,PPO Network,,8963.02,,,,,,,168.13,10462.26,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,inpatient,1,mL,4534.31000,4307.59000,The Alliance,PPO Network,,3768.01,,,,,,,2493.87,4398.28,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,outpatient,1,mL,4534.31000,4307.59000,The Alliance,PPO Network,,3768.01,,,,,,,59.70,4398.28,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,inpatient,1,mL,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,inpatient,1,mL,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,outpatient,1,mL,2.17000,2.07000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,inpatient,,,740.00000,703.00000,The Alliance,PPO Network,90,614.94,,,,,,,407.00,717.80,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,PPO Network,90,614.94,,,,,,,67.54,3412.32,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,inpatient,,,815.00000,774.25000,The Alliance,PPO Network,90,677.26,,,,,,,448.25,790.55,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,outpatient,,,815.00000,774.25000,The Alliance,PPO Network,90,677.26,,,,,,,12.45,1539.22,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,inpatient,,,106.20000,100.89000,The Alliance,PPO Network,90,88.25,,,,,,,58.41,103.01,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,outpatient,,,106.20000,100.89000,The Alliance,PPO Network,90,88.25,,,,,,,53.10,103.01,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,inpatient,,,1376.00000,1307.20000,The Alliance,PPO Network,90,1143.46,,,,,,,756.80,1334.72,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,outpatient,,,1376.00000,1307.20000,The Alliance,PPO Network,90,1143.46,,,,,,,132.74,7792.26,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,inpatient,,,5754.00000,5466.30000,The Alliance,PPO Network,TC,4781.57,,,,,,,3164.70,5581.38,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,outpatient,,,5754.00000,5466.30000,The Alliance,PPO Network,TC,4781.57,,,,,,,1631.86,5581.38,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,inpatient,,,4909.00000,4663.55000,The Alliance,PPO Network,,4079.38,,,,,,,2699.95,4761.73,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,outpatient,,,4909.00000,4663.55000,The Alliance,PPO Network,,4079.38,,,,,,,2699.95,7803.00,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,TC,2391.62,,,,,,,1582.90,2791.66,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,PPO Network,TC,2391.62,,,,,,,1114.22,2791.66,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,The Alliance,PPO Network,TC,4304.58,,,,,,,2849.00,5024.60,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,PPO Network,TC,4304.58,,,,,,,1273.18,5024.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,The Alliance,PPO Network,,1562.28,,,,,,,1034.00,1823.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,PPO Network,,1562.28,,,,,,,81.69,1823.60,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,inpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,158.76,314.28,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,148.72,324.00,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,inpatient,,,70906.00000,67360.70000,The Alliance,PPO Network,,58922.89,,,,,,,38998.30,68778.82,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,outpatient,,,70906.00000,67360.70000,The Alliance,PPO Network,,58922.89,,,,,,,6083.48,68778.82,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,inpatient,,,1634.00000,1552.30000,The Alliance,PPO Network,TC,1357.85,,,,,,,898.70,1584.98,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,outpatient,,,1634.00000,1552.30000,The Alliance,PPO Network,TC,1357.85,,,,,,,671.89,1584.98,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,69.00,212.44,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,inpatient,,,5032.00000,4780.40000,The Alliance,PPO Network,,4181.59,,,,,,,2767.60,4881.04,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,outpatient,,,5032.00000,4780.40000,The Alliance,PPO Network,,4181.59,,,,,,,2516.00,5156.10,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,inpatient,,,2892.00000,2747.40000,The Alliance,PPO Network,,2403.25,,,,,,,1590.60,2805.24,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,outpatient,,,2892.00000,2747.40000,The Alliance,PPO Network,,2403.25,,,,,,,1446.00,18061.43,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,inpatient,,,589.00000,559.55000,The Alliance,PPO Network,,489.46,,,,,,,323.95,571.33,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,outpatient,,,589.00000,559.55000,The Alliance,PPO Network,,489.46,,,,,,,288.84,1203.43,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,The Alliance,PPO Network,,854.27,,,,,,,503.72,997.16,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,PPO Network,,854.27,,,,,,,325.11,1028.00,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,TC,3864.98,,,,,,,2558.05,4511.47,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,TC,3864.98,,,,,,,380.83,4511.47,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,inpatient,,,2232.00000,2120.40000,The Alliance,PPO Network,TC,1854.79,,,,,,,1227.60,2165.04,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,outpatient,,,2232.00000,2120.40000,The Alliance,PPO Network,TC,1854.79,,,,,,,837.18,2210.07,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,PPO Network,,735.43,,,,,,,486.75,858.45,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,PPO Network,,735.43,,,,,,,122.40,858.45,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,122.40,5271.00,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,inpatient,1,mL,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,outpatient,1,mL,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,inpatient,1,mL,55.71000,52.93000,The Alliance,PPO Network,,46.30,,,,,,,30.64,54.04,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,outpatient,1,mL,55.71000,52.93000,The Alliance,PPO Network,,46.30,,,,,,,27.86,54.04,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,218.35,385.09,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,218.35,5271.00,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,37.00,71.78,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.19,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,PPO Network,,1.79,,,,,,,1.08,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,inpatient,1,GM,316.85000,301.01000,The Alliance,PPO Network,,263.30,,,,,,,174.27,307.34,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,outpatient,1,GM,316.85000,301.01000,The Alliance,PPO Network,,263.30,,,,,,,158.43,307.34,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,inpatient,,,504.00000,478.80000,The Alliance,PPO Network,,418.82,,,,,,,277.20,488.88,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,outpatient,,,504.00000,478.80000,The Alliance,PPO Network,,418.82,,,,,,,252.00,488.88,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,inpatient,,,1145.00000,1087.75000,The Alliance,PPO Network,,951.50,,,,,,,629.75,1110.65,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,outpatient,,,1145.00000,1087.75000,The Alliance,PPO Network,,951.50,,,,,,,629.75,5271.00,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1183.05,2086.47,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1183.05,5271.00,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,20.35,35.89,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,18.50,35.89,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,inpatient,,,1103.00000,1047.85000,The Alliance,PPO Network,,916.59,,,,,,,606.65,1069.91,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,outpatient,,,1103.00000,1047.85000,The Alliance,PPO Network,,916.59,,,,,,,606.65,5271.00,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,190.85,336.59,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,173.50,336.59,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,inpatient,,,1542.00000,1464.90000,The Alliance,PPO Network,,1281.40,,,,,,,848.10,1495.74,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,outpatient,,,1542.00000,1464.90000,The Alliance,PPO Network,,1281.40,,,,,,,848.10,5271.00,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,inpatient,,,1023.00000,971.85000,The Alliance,PPO Network,,850.11,,,,,,,562.65,992.31,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,outpatient,,,1023.00000,971.85000,The Alliance,PPO Network,,850.11,,,,,,,562.65,5271.00,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,23.25,197.88,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,The Alliance,PPO Network,,63.63,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,PPO Network,,63.63,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,inpatient,1,mL,153.14000,145.48000,The Alliance,PPO Network,,127.26,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,outpatient,1,mL,153.14000,145.48000,The Alliance,PPO Network,,127.26,,,,,,,60.56,148.55,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,PPO Network,,271.74,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,PPO Network,,271.74,,,,,,,179.85,3163.00,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,inpatient,,,1375.00000,1306.25000,The Alliance,PPO Network,TC,1142.62,,,,,,,756.25,1333.75,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,PPO Network,TC,1142.62,,,,,,,384.29,6707.24,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,inpatient,,,2192.00000,2082.40000,The Alliance,PPO Network,,1821.55,,,,,,,1205.60,2126.24,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,outpatient,,,2192.00000,2082.40000,The Alliance,PPO Network,,1821.55,,,,,,,1205.60,5271.00,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,inpatient,1,mL,7.93000,7.54000,The Alliance,PPO Network,,6.59,,,,,,,4.36,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,PPO Network,,6.59,,,,,,,0.19995,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,inpatient,1,mL,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,0.19995,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,inpatient,1,mL,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,outpatient,1,mL,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,0.19995,3.15,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,inpatient,1,mL,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,3.20,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,0.33945,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,inpatient,1,mL,6.47000,6.14000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,outpatient,1,mL,6.47000,6.14000,The Alliance,PPO Network,,5.38,,,,,,,0.33945,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,inpatient,1,mL,12.23000,11.62000,The Alliance,PPO Network,,10.16,,,,,,,6.73,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,outpatient,1,mL,12.23000,11.62000,The Alliance,PPO Network,,10.16,,,,,,,0.33945,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,inpatient,1,mL,6.03000,5.73000,The Alliance,PPO Network,,5.01,,,,,,,3.32,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,outpatient,1,mL,6.03000,5.73000,The Alliance,PPO Network,,5.01,,,,,,,0.33945,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,inpatient,1,mL,7.93000,7.54000,The Alliance,PPO Network,,6.59,,,,,,,4.36,7.69,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,PPO Network,,6.59,,,,,,,0.33945,7.69,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,3.24,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,295.90,521.86,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,269.00,521.86,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,inpatient,,,3127.00000,2970.65000,The Alliance,PPO Network,,2598.54,,,,,,,1719.85,3033.19,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,outpatient,,,3127.00000,2970.65000,The Alliance,PPO Network,,2598.54,,,,,,,1563.50,3388.98,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,inpatient,,,2098.00000,1993.10000,The Alliance,PPO Network,,1743.44,,,,,,,1153.90,2035.06,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,outpatient,,,2098.00000,1993.10000,The Alliance,PPO Network,,1743.44,,,,,,,1049.00,2035.06,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,inpatient,1,GM,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,outpatient,1,GM,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,218.35,385.09,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,PPO Network,,329.91,,,,,,,218.35,5271.00,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,inpatient,1,mL,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.39,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,inpatient,1,EA,126.59000,120.26000,The Alliance,PPO Network,,105.20,,,,,,,69.62,122.79,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,outpatient,1,EA,126.59000,120.26000,The Alliance,PPO Network,,105.20,,,,,,,63.30,122.79,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,inpatient,1,EA,0.97000,0.93000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,outpatient,1,EA,0.97000,0.93000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.43,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.30,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,inpatient,1,EA,7.14000,6.78000,The Alliance,PPO Network,,5.93,,,,,,,3.93,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,PPO Network,,5.93,,,,,,,3.57,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,inpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.74,3.37,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,inpatient,1,EA,3.34000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.24,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,outpatient,1,EA,3.34000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.67,3.24,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,3.25,5.72,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,PPO Network,,4.90,,,,,,,2.95,5.72,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,inpatient,1,mL,13.23000,12.57000,The Alliance,PPO Network,,10.99,,,,,,,7.28,12.83,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,outpatient,1,mL,13.23000,12.57000,The Alliance,PPO Network,,10.99,,,,,,,6.62,12.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,inpatient,1,mL,31.25000,29.69000,The Alliance,PPO Network,,25.97,,,,,,,17.19,30.31,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,outpatient,1,mL,31.25000,29.69000,The Alliance,PPO Network,,25.97,,,,,,,15.62,39.57,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.03,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,inpatient,1,GM,154.10000,146.40000,The Alliance,PPO Network,,128.06,,,,,,,84.75,149.48,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,outpatient,1,GM,154.10000,146.40000,The Alliance,PPO Network,,128.06,,,,,,,77.05,149.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,inpatient,1,EA,149.05000,141.60000,The Alliance,PPO Network,,123.86,,,,,,,81.98,144.58,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,outpatient,1,EA,149.05000,141.60000,The Alliance,PPO Network,,123.86,,,,,,,74.53,144.58,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,inpatient,1,GM,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,inpatient,1,GM,13.38000,12.71000,The Alliance,PPO Network,,11.12,,,,,,,7.36,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,outpatient,1,GM,13.38000,12.71000,The Alliance,PPO Network,,11.12,,,,,,,0.11935,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,inpatient,1,GM,10.01000,9.51000,The Alliance,PPO Network,,8.32,,,,,,,5.51,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,outpatient,1,GM,10.01000,9.51000,The Alliance,PPO Network,,8.32,,,,,,,0.11935,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,inpatient,1,GM,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,inpatient,1,GM,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,outpatient,1,GM,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.11935,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,inpatient,1,GM,12.25000,11.64000,The Alliance,PPO Network,,10.18,,,,,,,6.74,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,outpatient,1,GM,12.25000,11.64000,The Alliance,PPO Network,,10.18,,,,,,,0.11935,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,inpatient,1,GM,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,outpatient,1,GM,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,0.11935,4.10,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,inpatient,1,EA,8081.09000,7677.04000,The Alliance,PPO Network,,6715.39,,,,,,,4444.60,7838.66,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,outpatient,1,EA,8081.09000,7677.04000,The Alliance,PPO Network,,6715.39,,,,,,,4040.55,8747.08,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,inpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,31.64,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,1.82,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,83.12,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,inpatient,1,mL,2.06000,1.96000,The Alliance,PPO Network,,1.71,,,,,,,1.13,2.00,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,outpatient,1,mL,2.06000,1.96000,The Alliance,PPO Network,,1.71,,,,,,,1.03,88.11,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,63.20,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,inpatient,1,EA,264.15000,250.94000,The Alliance,PPO Network,,219.51,,,,,,,145.28,256.23,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,outpatient,1,EA,264.15000,250.94000,The Alliance,PPO Network,,219.51,,,,,,,132.07,256.23,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,inpatient,1,EA,4.43000,4.21000,The Alliance,PPO Network,,3.68,,,,,,,2.44,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,PPO Network,,3.68,,,,,,,2.21,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,inpatient,1,EA,6.31000,5.99000,The Alliance,PPO Network,,5.24,,,,,,,3.47,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,outpatient,1,EA,6.31000,5.99000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,inpatient,1,mL,23.23000,22.07000,The Alliance,PPO Network,,19.30,,,,,,,12.78,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,outpatient,1,mL,23.23000,22.07000,The Alliance,PPO Network,,19.30,,,,,,,11.62,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,inpatient,1,mL,33.95000,32.25000,The Alliance,PPO Network,,28.21,,,,,,,18.67,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,outpatient,1,mL,33.95000,32.25000,The Alliance,PPO Network,,28.21,,,,,,,16.98,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,inpatient,1,mL,9.47000,8.99000,The Alliance,PPO Network,,7.87,,,,,,,5.21,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,outpatient,1,mL,9.47000,8.99000,The Alliance,PPO Network,,7.87,,,,,,,4.74,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,inpatient,1,mL,26.76000,25.43000,The Alliance,PPO Network,,22.24,,,,,,,14.72,25.96,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,outpatient,1,mL,26.76000,25.43000,The Alliance,PPO Network,,22.24,,,,,,,13.38,25.96,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,inpatient,,,3442.00000,3269.90000,The Alliance,PPO Network,,2860.30,,,,,,,1893.10,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,outpatient,,,3442.00000,3269.90000,The Alliance,PPO Network,,2860.30,,,,,,,1343.28,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,712.25,1256.15,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,647.50,1885.25,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,inpatient,1,mL,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,inpatient,1,mL,2.18000,2.08000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,outpatient,1,mL,2.18000,2.08000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,inpatient,1,mL,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,inpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.11935,0.61110,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,4.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,inpatient,1,mL,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,outpatient,1,mL,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,inpatient,1,EA,11533.00000,10956.35000,The Alliance,PPO Network,,9583.92,,,,,,,6343.15,11187.01,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,outpatient,1,EA,11533.00000,10956.35000,The Alliance,PPO Network,,9583.92,,,,,,,230.26,11187.01,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,inpatient,1,mL,40.61000,38.58000,The Alliance,PPO Network,,33.75,,,,,,,22.34,39.39,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,outpatient,1,mL,40.61000,38.58000,The Alliance,PPO Network,,33.75,,,,,,,20.30,39.39,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,inpatient,1,EA,1.86000,1.76000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,8.57,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,inpatient,1,mL,540.41000,513.39000,The Alliance,PPO Network,,449.08,,,,,,,297.23,524.20,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,outpatient,1,mL,540.41000,513.39000,The Alliance,PPO Network,,449.08,,,,,,,270.20,524.20,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,1.02,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,inpatient,1,mL,42.81000,40.67000,The Alliance,PPO Network,,35.58,,,,,,,23.55,41.53,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,outpatient,1,mL,42.81000,40.67000,The Alliance,PPO Network,,35.58,,,,,,,21.41,41.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,inpatient,1,EA,15.50000,14.73000,The Alliance,PPO Network,,12.88,,,,,,,8.53,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,outpatient,1,EA,15.50000,14.73000,The Alliance,PPO Network,,12.88,,,,,,,7.75,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,inpatient,1,EA,12.28000,11.67000,The Alliance,PPO Network,,10.20,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,PPO Network,,10.20,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,inpatient,1,EA,8.46000,8.04000,The Alliance,PPO Network,,7.03,,,,,,,4.65,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,PPO Network,,7.03,,,,,,,0.78449,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,inpatient,1,EA,10.58000,10.05000,The Alliance,PPO Network,,8.79,,,,,,,5.82,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,outpatient,1,EA,10.58000,10.05000,The Alliance,PPO Network,,8.79,,,,,,,0.78449,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,0.78449,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,0.78449,6.90,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,inpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,inpatient,1,EA,12.26000,11.65000,The Alliance,PPO Network,,10.19,,,,,,,6.74,11.89,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,PPO Network,,10.19,,,,,,,4.09,11.89,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,inpatient,1,mL,16.95000,16.10000,The Alliance,PPO Network,,14.09,,,,,,,9.32,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,outpatient,1,mL,16.95000,16.10000,The Alliance,PPO Network,,14.09,,,,,,,0.59830,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,inpatient,1,mL,13.45000,12.77000,The Alliance,PPO Network,,11.18,,,,,,,7.40,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,outpatient,1,mL,13.45000,12.77000,The Alliance,PPO Network,,11.18,,,,,,,0.59830,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,inpatient,1,mL,16.54000,15.72000,The Alliance,PPO Network,,13.74,,,,,,,9.10,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,outpatient,1,mL,16.54000,15.72000,The Alliance,PPO Network,,13.74,,,,,,,0.59830,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,0.59830,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,inpatient,1,mL,20.44000,19.42000,The Alliance,PPO Network,,16.99,,,,,,,11.24,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,outpatient,1,mL,20.44000,19.42000,The Alliance,PPO Network,,16.99,,,,,,,0.59830,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,inpatient,1,mL,20.65000,19.61000,The Alliance,PPO Network,,17.16,,,,,,,11.36,20.03,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,PPO Network,,17.16,,,,,,,0.59830,20.03,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,inpatient,1,EA,19.82000,18.82000,The Alliance,PPO Network,,16.47,,,,,,,10.90,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,outpatient,1,EA,19.82000,18.82000,The Alliance,PPO Network,,16.47,,,,,,,9.91,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,inpatient,1,EA,12.31000,11.69000,The Alliance,PPO Network,,10.23,,,,,,,6.77,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,outpatient,1,EA,12.31000,11.69000,The Alliance,PPO Network,,10.23,,,,,,,6.16,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,inpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,inpatient,1,EA,11.08000,10.53000,The Alliance,PPO Network,,9.21,,,,,,,6.09,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,outpatient,1,EA,11.08000,10.53000,The Alliance,PPO Network,,9.21,,,,,,,5.54,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,inpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,4.07,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,inpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,2.74,4.84,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,PPO Network,,4.15,,,,,,,1.54,4.84,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,11.26,21.83,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,inpatient,1,EA,8343.84000,7926.65000,The Alliance,PPO Network,,6933.73,,,,,,,4589.11,8093.52,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,outpatient,1,EA,8343.84000,7926.65000,The Alliance,PPO Network,,6933.73,,,,,,,709.27,8093.52,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,inpatient,1,mL,17.85000,16.95000,The Alliance,PPO Network,,14.83,,,,,,,9.82,17.31,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,outpatient,1,mL,17.85000,16.95000,The Alliance,PPO Network,,14.83,,,,,,,8.93,17.31,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,inpatient,1,EA,494.41000,469.68000,The Alliance,PPO Network,,410.85,,,,,,,271.93,479.58,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,outpatient,1,EA,494.41000,469.68000,The Alliance,PPO Network,,410.85,,,,,,,0.73160,479.58,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,inpatient,1,EA,15.58000,14.80000,The Alliance,PPO Network,,12.95,,,,,,,8.57,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,outpatient,1,EA,15.58000,14.80000,The Alliance,PPO Network,,12.95,,,,,,,7.79,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.04803,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,83.12,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,inpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,2.28,4.02,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,PPO Network,,3.44,,,,,,,1.49,4.02,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,inpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,inpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,PPO Network,,3.02,,,,,,,1.82,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,inpatient,1,EA,93.95000,89.25000,The Alliance,PPO Network,,78.07,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,outpatient,1,EA,93.95000,89.25000,The Alliance,PPO Network,,78.07,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,inpatient,1,EA,29.95000,28.45000,The Alliance,PPO Network,,24.89,,,,,,,16.47,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,outpatient,1,EA,29.95000,28.45000,The Alliance,PPO Network,,24.89,,,,,,,14.97,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,inpatient,1,mL,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,inpatient,1,mL,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,inpatient,1,mL,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,outpatient,1,mL,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,inpatient,1,mL,67.32000,63.95000,The Alliance,PPO Network,,55.94,,,,,,,37.03,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,outpatient,1,mL,67.32000,63.95000,The Alliance,PPO Network,,55.94,,,,,,,33.66,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,inpatient,1,mL,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,inpatient,1,mL,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,outpatient,1,mL,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.35,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.04,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,inpatient,1,mL,10.92000,10.38000,The Alliance,PPO Network,,9.07,,,,,,,6.01,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,outpatient,1,mL,10.92000,10.38000,The Alliance,PPO Network,,9.07,,,,,,,5.46,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,inpatient,1,mL,6.02000,5.72000,The Alliance,PPO Network,,5.00,,,,,,,3.31,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,outpatient,1,mL,6.02000,5.72000,The Alliance,PPO Network,,5.00,,,,,,,3.01,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,inpatient,1,mL,16.59000,15.76000,The Alliance,PPO Network,,13.79,,,,,,,9.12,16.09,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,outpatient,1,mL,16.59000,15.76000,The Alliance,PPO Network,,13.79,,,,,,,8.29,16.09,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,inpatient,1,EA,1.64000,1.55000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,outpatient,1,EA,1.64000,1.55000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,inpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.75900,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,PPO Network,,1.15,,,,,,,0.69000,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,inpatient,1,EA,18.36000,17.44000,The Alliance,PPO Network,,15.26,,,,,,,10.10,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,PPO Network,,15.26,,,,,,,9.18,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,inpatient,1,EA,25.47000,24.20000,The Alliance,PPO Network,,21.17,,,,,,,14.01,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,outpatient,1,EA,25.47000,24.20000,The Alliance,PPO Network,,21.17,,,,,,,12.73,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,inpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,inpatient,1,EA,20.34000,19.32000,The Alliance,PPO Network,,16.90,,,,,,,11.19,19.73,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,outpatient,1,EA,20.34000,19.32000,The Alliance,PPO Network,,16.90,,,,,,,10.17,19.73,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,inpatient,1,EA,800.41000,760.39000,The Alliance,PPO Network,,665.14,,,,,,,440.23,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,outpatient,1,EA,800.41000,760.39000,The Alliance,PPO Network,,665.14,,,,,,,22.62,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,inpatient,1,EA,659.80000,626.81000,The Alliance,PPO Network,,548.29,,,,,,,362.89,640.01,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,outpatient,1,EA,659.80000,626.81000,The Alliance,PPO Network,,548.29,,,,,,,22.62,640.01,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,inpatient,1,EA,8073.00000,7669.35000,The Alliance,PPO Network,,6708.66,,,,,,,4440.15,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,outpatient,1,EA,8073.00000,7669.35000,The Alliance,PPO Network,,6708.66,,,,,,,4.54,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,inpatient,1,EA,1258.61000,1195.68000,The Alliance,PPO Network,,1045.90,,,,,,,692.24,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,outpatient,1,EA,1258.61000,1195.68000,The Alliance,PPO Network,,1045.90,,,,,,,4.54,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,inpatient,1,EA,8253.21000,7840.55000,The Alliance,PPO Network,,6858.42,,,,,,,4539.27,8005.61,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,outpatient,1,EA,8253.21000,7840.55000,The Alliance,PPO Network,,6858.42,,,,,,,4.54,8005.61,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,156.42,275.87,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,0.73160,275.87,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,inpatient,1,mL,11.66000,11.08000,The Alliance,PPO Network,,9.69,,,,,,,6.41,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,outpatient,1,mL,11.66000,11.08000,The Alliance,PPO Network,,9.69,,,,,,,0.93155,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,inpatient,1,mL,19.36000,18.39000,The Alliance,PPO Network,,16.09,,,,,,,10.65,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,outpatient,1,mL,19.36000,18.39000,The Alliance,PPO Network,,16.09,,,,,,,0.93155,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,inpatient,1,mL,8.71000,8.28000,The Alliance,PPO Network,,7.24,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,PPO Network,,7.24,,,,,,,0.93155,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,inpatient,1,mL,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,10.13,17.86,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,0.93155,17.86,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,inpatient,1,EA,1024.57000,973.34000,The Alliance,PPO Network,,851.42,,,,,,,563.51,993.83,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,outpatient,1,EA,1024.57000,973.34000,The Alliance,PPO Network,,851.42,,,,,,,104.95,993.83,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,inpatient,1,EA,2067.60000,1964.22000,The Alliance,PPO Network,,1718.18,,,,,,,1137.18,2005.57,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,outpatient,1,EA,2067.60000,1964.22000,The Alliance,PPO Network,,1718.18,,,,,,,996.39,2005.57,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,2.61,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,inpatient,1,mL,149.33000,141.87000,The Alliance,PPO Network,,124.09,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,PPO Network,,124.09,,,,,,,74.67,290.17,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,inpatient,1,mL,9.36000,8.90000,The Alliance,PPO Network,,7.78,,,,,,,5.15,9.08,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,outpatient,1,mL,9.36000,8.90000,The Alliance,PPO Network,,7.78,,,,,,,4.68,9.08,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,inpatient,1,mL,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.90,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.50,2.90,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,inpatient,1,GM,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,outpatient,1,GM,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,inpatient,1,mL,177.67000,168.78000,The Alliance,PPO Network,,147.64,,,,,,,97.72,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,outpatient,1,mL,177.67000,168.78000,The Alliance,PPO Network,,147.64,,,,,,,5.86,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,inpatient,1,mL,187.70000,178.32000,The Alliance,PPO Network,,155.98,,,,,,,103.23,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,outpatient,1,mL,187.70000,178.32000,The Alliance,PPO Network,,155.98,,,,,,,5.86,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,inpatient,1,mL,119.78000,113.79000,The Alliance,PPO Network,,99.54,,,,,,,65.88,116.19,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,outpatient,1,mL,119.78000,113.79000,The Alliance,PPO Network,,99.54,,,,,,,5.86,116.19,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.57,2.76,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.43,2.76,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,inpatient,1,EA,2.71000,2.58000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,outpatient,1,EA,2.71000,2.58000,The Alliance,PPO Network,,2.25,,,,,,,1.35,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,inpatient,1,EA,83.83000,79.64000,The Alliance,PPO Network,,69.66,,,,,,,46.11,81.32,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,outpatient,1,EA,83.83000,79.64000,The Alliance,PPO Network,,69.66,,,,,,,41.91,81.32,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,3.15,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,2.86,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,9.69,17.09,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,PPO Network,,14.64,,,,,,,8.81,17.09,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,inpatient,1,mL,73.39000,69.72000,The Alliance,PPO Network,,60.99,,,,,,,40.36,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,outpatient,1,mL,73.39000,69.72000,The Alliance,PPO Network,,60.99,,,,,,,36.70,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,inpatient,1,mL,26.33000,25.02000,The Alliance,PPO Network,,21.88,,,,,,,14.48,25.54,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,outpatient,1,mL,26.33000,25.02000,The Alliance,PPO Network,,21.88,,,,,,,13.16,25.54,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,inpatient,1,EA,12.28000,11.67000,The Alliance,PPO Network,,10.20,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,PPO Network,,10.20,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,PPO Network,,18.71,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,inpatient,1,mL,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,inpatient,1,GM,193.93000,184.24000,The Alliance,PPO Network,,161.16,,,,,,,106.66,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,outpatient,1,GM,193.93000,184.24000,The Alliance,PPO Network,,161.16,,,,,,,96.97,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,inpatient,1,GM,247.45000,235.08000,The Alliance,PPO Network,,205.63,,,,,,,136.10,240.03,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,outpatient,1,GM,247.45000,235.08000,The Alliance,PPO Network,,205.63,,,,,,,123.72,240.03,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,4.31,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,inpatient,1,EA,41.65000,39.57000,The Alliance,PPO Network,,34.61,,,,,,,22.91,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,outpatient,1,EA,41.65000,39.57000,The Alliance,PPO Network,,34.61,,,,,,,20.82,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,2.38,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,2.17,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,inpatient,1,mL,230.68000,219.15000,The Alliance,PPO Network,,191.70,,,,,,,126.87,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,outpatient,1,mL,230.68000,219.15000,The Alliance,PPO Network,,191.70,,,,,,,83.42,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,inpatient,1,mL,277.83000,263.94000,The Alliance,PPO Network,,230.88,,,,,,,152.81,269.50,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,outpatient,1,mL,277.83000,263.94000,The Alliance,PPO Network,,230.88,,,,,,,83.42,269.50,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,PPO Network,,37.60,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.35,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,PPO Network,,3.55,,,,,,,2.13,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,inpatient,1,EA,5.49000,5.21000,The Alliance,PPO Network,,4.56,,,,,,,3.02,5.33,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,PPO Network,,4.56,,,,,,,2.75,5.33,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,inpatient,1,GM,63.71000,60.52000,The Alliance,PPO Network,,52.94,,,,,,,35.04,61.80,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,outpatient,1,GM,63.71000,60.52000,The Alliance,PPO Network,,52.94,,,,,,,31.86,61.80,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,inpatient,1,mL,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,10.61,22.93,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,inpatient,1,EA,530.95000,504.40000,The Alliance,PPO Network,,441.22,,,,,,,292.02,515.02,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,PPO Network,,441.22,,,,,,,224.97,515.02,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,inpatient,1,mL,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,inpatient,1,mL,12.49000,11.87000,The Alliance,PPO Network,,10.38,,,,,,,6.87,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,outpatient,1,mL,12.49000,11.87000,The Alliance,PPO Network,,10.38,,,,,,,1.85,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,inpatient,1,mL,7.51000,7.13000,The Alliance,PPO Network,,6.24,,,,,,,4.13,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,outpatient,1,mL,7.51000,7.13000,The Alliance,PPO Network,,6.24,,,,,,,1.85,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,inpatient,1,mL,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,inpatient,1,mL,9.59000,9.11000,The Alliance,PPO Network,,7.97,,,,,,,5.27,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,outpatient,1,mL,9.59000,9.11000,The Alliance,PPO Network,,7.97,,,,,,,1.85,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,inpatient,1,mL,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,inpatient,1,mL,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,outpatient,1,mL,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,inpatient,1,GM,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,inpatient,1,GM,17.98000,17.08000,The Alliance,PPO Network,,14.94,,,,,,,9.89,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,outpatient,1,GM,17.98000,17.08000,The Alliance,PPO Network,,14.94,,,,,,,8.99,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,inpatient,1,GM,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,outpatient,1,GM,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,inpatient,1,EA,511.78000,486.19000,The Alliance,PPO Network,,425.29,,,,,,,281.48,496.43,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,outpatient,1,EA,511.78000,486.19000,The Alliance,PPO Network,,425.29,,,,,,,255.89,496.43,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,inpatient,1,EA,157.08000,149.23000,The Alliance,PPO Network,,130.53,,,,,,,86.39,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,outpatient,1,EA,157.08000,149.23000,The Alliance,PPO Network,,130.53,,,,,,,33.41,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,inpatient,1,EA,180.75000,171.71000,The Alliance,PPO Network,,150.20,,,,,,,99.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,outpatient,1,EA,180.75000,171.71000,The Alliance,PPO Network,,150.20,,,,,,,33.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,inpatient,1,EA,121.63000,115.55000,The Alliance,PPO Network,,101.07,,,,,,,66.90,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,outpatient,1,EA,121.63000,115.55000,The Alliance,PPO Network,,101.07,,,,,,,33.41,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,inpatient,1,EA,159.45000,151.48000,The Alliance,PPO Network,,132.50,,,,,,,87.70,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,outpatient,1,EA,159.45000,151.48000,The Alliance,PPO Network,,132.50,,,,,,,33.41,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,inpatient,1,EA,104.66000,99.43000,The Alliance,PPO Network,,86.97,,,,,,,57.56,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,outpatient,1,EA,104.66000,99.43000,The Alliance,PPO Network,,86.97,,,,,,,33.41,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,inpatient,1,EA,96.95000,92.10000,The Alliance,PPO Network,,80.57,,,,,,,53.32,94.04,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,outpatient,1,EA,96.95000,92.10000,The Alliance,PPO Network,,80.57,,,,,,,33.41,94.04,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,inpatient,1,mL,17.10000,16.25000,The Alliance,PPO Network,,14.21,,,,,,,9.40,16.59,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,outpatient,1,mL,17.10000,16.25000,The Alliance,PPO Network,,14.21,,,,,,,8.55,16.59,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,inpatient,1,EA,12.01000,11.41000,The Alliance,PPO Network,,9.98,,,,,,,6.61,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,PPO Network,,9.98,,,,,,,6.00,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,inpatient,1,GM,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,outpatient,1,GM,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,inpatient,1,GM,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,outpatient,1,GM,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,inpatient,1,GM,124.12000,117.92000,The Alliance,PPO Network,,103.14,,,,,,,68.27,120.40,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,outpatient,1,GM,124.12000,117.92000,The Alliance,PPO Network,,103.14,,,,,,,62.06,120.40,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,inpatient,1,GM,9.43000,8.96000,The Alliance,PPO Network,,7.84,,,,,,,5.19,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,outpatient,1,GM,9.43000,8.96000,The Alliance,PPO Network,,7.84,,,,,,,4.71,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.23,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.11,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.53,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.40,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,inpatient,1,mL,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,11.59,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,outpatient,1,mL,21.07000,20.01000,The Alliance,PPO Network,,17.51,,,,,,,10.54,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,inpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,PPO Network,,21.01,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,inpatient,1,mL,40.82000,38.78000,The Alliance,PPO Network,,33.92,,,,,,,22.45,39.60,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,outpatient,1,mL,40.82000,38.78000,The Alliance,PPO Network,,33.92,,,,,,,20.41,39.60,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,inpatient,1,EA,2.87000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,outpatient,1,EA,2.87000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.44,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.43,6.04,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.12,6.04,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,inpatient,1,EA,4700.21000,4465.20000,The Alliance,PPO Network,,3905.87,,,,,,,2585.12,4559.20,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,outpatient,1,EA,4700.21000,4465.20000,The Alliance,PPO Network,,3905.87,,,,,,,56.01,4559.20,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,inpatient,1,EA,3.71000,3.53000,The Alliance,PPO Network,,3.08,,,,,,,2.04,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,outpatient,1,EA,3.71000,3.53000,The Alliance,PPO Network,,3.08,,,,,,,1.85,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.56,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.33,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,inpatient,1,EA,5.58000,5.31000,The Alliance,PPO Network,,4.64,,,,,,,3.07,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,outpatient,1,EA,5.58000,5.31000,The Alliance,PPO Network,,4.64,,,,,,,2.79,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.12,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.56,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,inpatient,1,EA,142.79000,135.65000,The Alliance,PPO Network,,118.66,,,,,,,78.53,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,outpatient,1,EA,142.79000,135.65000,The Alliance,PPO Network,,118.66,,,,,,,0.05000,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,inpatient,1,EA,17.12000,16.26000,The Alliance,PPO Network,,14.23,,,,,,,9.42,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,outpatient,1,EA,17.12000,16.26000,The Alliance,PPO Network,,14.23,,,,,,,0.05000,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,inpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,0.05000,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,0.05000,3.12,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,inpatient,1,EA,27.33000,25.96000,The Alliance,PPO Network,,22.71,,,,,,,15.03,26.51,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,outpatient,1,EA,27.33000,25.96000,The Alliance,PPO Network,,22.71,,,,,,,13.66,26.51,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,inpatient,1,EA,251.66000,239.08000,The Alliance,PPO Network,,209.13,,,,,,,138.41,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,outpatient,1,EA,251.66000,239.08000,The Alliance,PPO Network,,209.13,,,,,,,0.23715,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,inpatient,1,EA,1245.79000,1183.50000,The Alliance,PPO Network,,1035.25,,,,,,,685.18,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,outpatient,1,EA,1245.79000,1183.50000,The Alliance,PPO Network,,1035.25,,,,,,,0.23715,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,inpatient,1,EA,1424.50000,1353.27000,The Alliance,PPO Network,,1183.76,,,,,,,783.48,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,outpatient,1,EA,1424.50000,1353.27000,The Alliance,PPO Network,,1183.76,,,,,,,0.23715,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,0.23715,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,inpatient,1,EA,226.21000,214.90000,The Alliance,PPO Network,,187.98,,,,,,,124.42,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,outpatient,1,EA,226.21000,214.90000,The Alliance,PPO Network,,187.98,,,,,,,0.23715,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,inpatient,1,EA,295.71000,280.93000,The Alliance,PPO Network,,245.74,,,,,,,162.64,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,outpatient,1,EA,295.71000,280.93000,The Alliance,PPO Network,,245.74,,,,,,,0.23715,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,inpatient,1,EA,1315.72000,1249.93000,The Alliance,PPO Network,,1093.36,,,,,,,723.65,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,outpatient,1,EA,1315.72000,1249.93000,The Alliance,PPO Network,,1093.36,,,,,,,0.23715,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,inpatient,1,EA,280.13000,266.13000,The Alliance,PPO Network,,232.79,,,,,,,154.07,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,outpatient,1,EA,280.13000,266.13000,The Alliance,PPO Network,,232.79,,,,,,,0.23715,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,inpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,8.35,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,PPO Network,,12.62,,,,,,,0.23715,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,inpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,156.42,275.87,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,PPO Network,,236.34,,,,,,,0.23715,275.87,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,inpatient,1,mL,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,1.84,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,inpatient,1,mL,265.48000,252.20000,The Alliance,PPO Network,,220.61,,,,,,,146.01,257.52,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,outpatient,1,mL,265.48000,252.20000,The Alliance,PPO Network,,220.61,,,,,,,1.84,257.52,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,inpatient,1,mL,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,inpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,2.38,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,PPO Network,,3.59,,,,,,,2.16,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,inpatient,1,EA,6.45000,6.13000,The Alliance,PPO Network,,5.36,,,,,,,3.55,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,outpatient,1,EA,6.45000,6.13000,The Alliance,PPO Network,,5.36,,,,,,,3.23,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,inpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,inpatient,1,GM,6.43000,6.11000,The Alliance,PPO Network,,5.34,,,,,,,3.54,6.24,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,outpatient,1,GM,6.43000,6.11000,The Alliance,PPO Network,,5.34,,,,,,,3.21,6.24,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,inpatient,1,GM,93.82000,89.13000,The Alliance,PPO Network,,77.96,,,,,,,51.60,91.01,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,outpatient,1,GM,93.82000,89.13000,The Alliance,PPO Network,,77.96,,,,,,,46.91,91.01,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,inpatient,1,EA,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.53,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,outpatient,1,EA,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.21,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.85,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,PPO Network,,2.80,,,,,,,1.69,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,2.13,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,PPO Network,,3.22,,,,,,,1.94,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,inpatient,1,EA,2.70000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,outpatient,1,EA,2.70000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.35,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.88,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.71,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,inpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,inpatient,1,mL,30.17000,28.66000,The Alliance,PPO Network,,25.07,,,,,,,16.59,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,outpatient,1,mL,30.17000,28.66000,The Alliance,PPO Network,,25.07,,,,,,,15.09,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,PPO Network,,2.66,,,,,,,1.60,3.10,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,inpatient,1,mL,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.69,4.75,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.45,4.86,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,inpatient,1,mL,146.16000,138.85000,The Alliance,PPO Network,,121.46,,,,,,,80.39,141.78,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,outpatient,1,mL,146.16000,138.85000,The Alliance,PPO Network,,121.46,,,,,,,73.08,141.78,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,inpatient,1,EA,406.81000,386.47000,The Alliance,PPO Network,,338.06,,,,,,,223.75,394.61,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,outpatient,1,EA,406.81000,386.47000,The Alliance,PPO Network,,338.06,,,,,,,203.41,394.61,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,inpatient,1,EA,10.92000,10.38000,The Alliance,PPO Network,,9.07,,,,,,,6.01,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,outpatient,1,EA,10.92000,10.38000,The Alliance,PPO Network,,9.07,,,,,,,5.46,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,6.38,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,5.80,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,inpatient,1,mL,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,0.06404,3.12,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,inpatient,1,mL,43.04000,40.89000,The Alliance,PPO Network,,35.77,,,,,,,23.67,41.75,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,outpatient,1,mL,43.04000,40.89000,The Alliance,PPO Network,,35.77,,,,,,,6.48,41.75,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,inpatient,1,EA,6.33000,6.01000,The Alliance,PPO Network,,5.26,,,,,,,3.48,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,outpatient,1,EA,6.33000,6.01000,The Alliance,PPO Network,,5.26,,,,,,,1.28,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,inpatient,1,EA,24.61000,23.38000,The Alliance,PPO Network,,20.45,,,,,,,13.54,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,outpatient,1,EA,24.61000,23.38000,The Alliance,PPO Network,,20.45,,,,,,,1.28,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,1.28,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,1.28,4.91,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,inpatient,1,mL,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,3.22,5.68,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,outpatient,1,mL,5.86000,5.57000,The Alliance,PPO Network,,4.87,,,,,,,2.93,5.68,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,inpatient,1,mL,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,inpatient,1,mL,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.40,4.24,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,outpatient,1,mL,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.19,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,inpatient,1,mL,8.34000,7.93000,The Alliance,PPO Network,,6.93,,,,,,,4.59,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,PPO Network,,6.93,,,,,,,3.38,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,inpatient,1,mL,8.47000,8.05000,The Alliance,PPO Network,,7.04,,,,,,,4.66,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,outpatient,1,mL,8.47000,8.05000,The Alliance,PPO Network,,7.04,,,,,,,3.38,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,inpatient,1,mL,4.56000,4.34000,The Alliance,PPO Network,,3.79,,,,,,,2.51,4.42,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,outpatient,1,mL,4.56000,4.34000,The Alliance,PPO Network,,3.79,,,,,,,2.28,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,inpatient,1,mL,3.31000,3.14000,The Alliance,PPO Network,,2.75,,,,,,,1.82,3.21,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,outpatient,1,mL,3.31000,3.14000,The Alliance,PPO Network,,2.75,,,,,,,1.66,4.86,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,inpatient,1,mL,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,inpatient,1,GM,10.36000,9.84000,The Alliance,PPO Network,,8.61,,,,,,,5.70,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,outpatient,1,GM,10.36000,9.84000,The Alliance,PPO Network,,8.61,,,,,,,5.18,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,inpatient,1,GM,8.28000,7.86000,The Alliance,PPO Network,,6.88,,,,,,,4.55,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,outpatient,1,GM,8.28000,7.86000,The Alliance,PPO Network,,6.88,,,,,,,4.14,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,inpatient,1,GM,4.48000,4.25000,The Alliance,PPO Network,,3.72,,,,,,,2.46,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,outpatient,1,GM,4.48000,4.25000,The Alliance,PPO Network,,3.72,,,,,,,2.24,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,inpatient,1,GM,10.34000,9.83000,The Alliance,PPO Network,,8.59,,,,,,,5.69,10.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,outpatient,1,GM,10.34000,9.83000,The Alliance,PPO Network,,8.59,,,,,,,5.17,10.03,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,5.39,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,PPO Network,,8.14,,,,,,,4.90,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,PPO Network,,4.30,,,,,,,2.58,5.01,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,inpatient,1,EA,27.93000,26.54000,The Alliance,PPO Network,,23.21,,,,,,,15.36,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,outpatient,1,EA,27.93000,26.54000,The Alliance,PPO Network,,23.21,,,,,,,13.96,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,inpatient,1,EA,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,45.76,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,41.60,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,inpatient,1,EA,27.65000,26.27000,The Alliance,PPO Network,,22.98,,,,,,,15.21,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,outpatient,1,EA,27.65000,26.27000,The Alliance,PPO Network,,22.98,,,,,,,13.82,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,inpatient,1,EA,17.89000,16.99000,The Alliance,PPO Network,,14.87,,,,,,,9.84,17.35,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,outpatient,1,EA,17.89000,16.99000,The Alliance,PPO Network,,14.87,,,,,,,8.95,17.35,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,inpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,inpatient,1,EA,2.48000,2.35000,The Alliance,PPO Network,,2.06,,,,,,,1.36,2.41,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,outpatient,1,EA,2.48000,2.35000,The Alliance,PPO Network,,2.06,,,,,,,1.24,2.41,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,inpatient,1,GM,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,outpatient,1,GM,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,inpatient,1,EA,24.16000,22.96000,The Alliance,PPO Network,,20.08,,,,,,,13.29,23.44,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,outpatient,1,EA,24.16000,22.96000,The Alliance,PPO Network,,20.08,,,,,,,12.08,23.44,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,inpatient,1,EA,7.03000,6.68000,The Alliance,PPO Network,,5.84,,,,,,,3.87,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,outpatient,1,EA,7.03000,6.68000,The Alliance,PPO Network,,5.84,,,,,,,3.52,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,inpatient,1,EA,15.83000,15.04000,The Alliance,PPO Network,,13.15,,,,,,,8.71,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,outpatient,1,EA,15.83000,15.04000,The Alliance,PPO Network,,13.15,,,,,,,7.92,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,inpatient,1,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.19,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.22,8.19,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,inpatient,1,EA,18.30000,17.38000,The Alliance,PPO Network,,15.21,,,,,,,10.06,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,outpatient,1,EA,18.30000,17.38000,The Alliance,PPO Network,,15.21,,,,,,,1.86,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,inpatient,1,EA,59.37000,56.40000,The Alliance,PPO Network,,49.34,,,,,,,32.65,57.59,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,outpatient,1,EA,59.37000,56.40000,The Alliance,PPO Network,,49.34,,,,,,,1.86,57.59,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,2.36,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,PPO Network,,3.56,,,,,,,2.15,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,inpatient,1,EA,2.89000,2.75000,The Alliance,PPO Network,,2.40,,,,,,,1.59,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,outpatient,1,EA,2.89000,2.75000,The Alliance,PPO Network,,2.40,,,,,,,1.45,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,inpatient,1,mL,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,1.33,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,inpatient,1,mL,31.44000,29.87000,The Alliance,PPO Network,,26.13,,,,,,,17.29,30.50,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,outpatient,1,mL,31.44000,29.87000,The Alliance,PPO Network,,26.13,,,,,,,1.33,30.50,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,inpatient,1,EA,414.40000,393.68000,The Alliance,PPO Network,,344.37,,,,,,,227.92,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,outpatient,1,EA,414.40000,393.68000,The Alliance,PPO Network,,344.37,,,,,,,50.35,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,50.35,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,inpatient,1,EA,100.11000,95.10000,The Alliance,PPO Network,,83.19,,,,,,,55.06,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,outpatient,1,EA,100.11000,95.10000,The Alliance,PPO Network,,83.19,,,,,,,50.05,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,inpatient,1,EA,153.86000,146.17000,The Alliance,PPO Network,,127.86,,,,,,,84.62,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,outpatient,1,EA,153.86000,146.17000,The Alliance,PPO Network,,127.86,,,,,,,50.35,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,inpatient,1,EA,515.41000,489.64000,The Alliance,PPO Network,,428.31,,,,,,,283.48,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,outpatient,1,EA,515.41000,489.64000,The Alliance,PPO Network,,428.31,,,,,,,50.35,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,inpatient,1,EA,751.10000,713.54000,The Alliance,PPO Network,,624.16,,,,,,,413.11,728.57,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,outpatient,1,EA,751.10000,713.54000,The Alliance,PPO Network,,624.16,,,,,,,50.35,728.57,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,inpatient,1,mL,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,outpatient,1,mL,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,The Alliance,PPO Network,,14.15,,,,,,,9.37,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,PPO Network,,14.15,,,,,,,8.52,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,The Alliance,PPO Network,,11.33,,,,,,,7.50,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,PPO Network,,11.33,,,,,,,6.82,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,3.64,6.41,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,PPO Network,,5.49,,,,,,,3.31,6.41,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,inpatient,1,EA,30.94000,29.39000,The Alliance,PPO Network,,25.71,,,,,,,17.02,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,outpatient,1,EA,30.94000,29.39000,The Alliance,PPO Network,,25.71,,,,,,,1.86,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,inpatient,1,EA,67.73000,64.35000,The Alliance,PPO Network,,56.28,,,,,,,37.25,65.70,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,outpatient,1,EA,67.73000,64.35000,The Alliance,PPO Network,,56.28,,,,,,,1.86,65.70,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,inpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.12,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,inpatient,1,EA,9.24000,8.77000,The Alliance,PPO Network,,7.68,,,,,,,5.08,8.96,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,PPO Network,,7.68,,,,,,,3.12,8.96,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,2.71,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,inpatient,20,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,outpatient,20,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,3.83,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,inpatient,20,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,outpatient,20,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,3.83,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,inpatient,1,EA,12.12000,11.51000,The Alliance,PPO Network,,10.07,,,,,,,6.67,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,outpatient,1,EA,12.12000,11.51000,The Alliance,PPO Network,,10.07,,,,,,,6.06,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.68,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.44,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.44,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.31,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,inpatient,1,EA,10.66000,10.13000,The Alliance,PPO Network,,8.86,,,,,,,5.86,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,outpatient,1,EA,10.66000,10.13000,The Alliance,PPO Network,,8.86,,,,,,,5.33,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,inpatient,1,EA,443.95000,421.75000,The Alliance,PPO Network,,368.92,,,,,,,244.17,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,outpatient,1,EA,443.95000,421.75000,The Alliance,PPO Network,,368.92,,,,,,,173.64,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,inpatient,1,EA,8136.71000,7729.88000,The Alliance,PPO Network,,6761.61,,,,,,,4475.19,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,outpatient,1,EA,8136.71000,7729.88000,The Alliance,PPO Network,,6761.61,,,,,,,173.64,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,inpatient,1,EA,6780.60000,6441.57000,The Alliance,PPO Network,,5634.68,,,,,,,3729.33,6577.18,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,outpatient,1,EA,6780.60000,6441.57000,The Alliance,PPO Network,,5634.68,,,,,,,173.64,6577.18,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,inpatient,1,mL,91.29000,86.72000,The Alliance,PPO Network,,75.86,,,,,,,50.21,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,outpatient,1,mL,91.29000,86.72000,The Alliance,PPO Network,,75.86,,,,,,,43.34,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,inpatient,1,mL,78.87000,74.93000,The Alliance,PPO Network,,65.54,,,,,,,43.38,76.50,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,outpatient,1,mL,78.87000,74.93000,The Alliance,PPO Network,,65.54,,,,,,,39.44,76.50,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,inpatient,1,mL,9.87000,9.38000,The Alliance,PPO Network,,8.20,,,,,,,5.43,9.57,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,outpatient,1,mL,9.87000,9.38000,The Alliance,PPO Network,,8.20,,,,,,,4.93,9.57,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,inpatient,1,EA,8.44000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,outpatient,1,EA,8.44000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.22,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,inpatient,1,EA,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,28.24,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,outpatient,1,EA,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,25.68,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,inpatient,1,EA,9.88000,9.38000,The Alliance,PPO Network,,8.21,,,,,,,5.43,9.58,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,PPO Network,,8.21,,,,,,,4.94,9.58,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,1.28,6.13,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,inpatient,1,mL,4.12000,3.91000,The Alliance,PPO Network,,3.42,,,,,,,2.27,4.00,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,outpatient,1,mL,4.12000,3.91000,The Alliance,PPO Network,,3.42,,,,,,,2.06,4.00,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,inpatient,1,EA,9.49000,9.02000,The Alliance,PPO Network,,7.89,,,,,,,5.22,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,outpatient,1,EA,9.49000,9.02000,The Alliance,PPO Network,,7.89,,,,,,,4.75,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,The Alliance,PPO Network,,8.69,,,,,,,5.75,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,PPO Network,,8.69,,,,,,,5.23,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,inpatient,1,EA,9.23000,8.77000,The Alliance,PPO Network,,7.67,,,,,,,5.08,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,outpatient,1,EA,9.23000,8.77000,The Alliance,PPO Network,,7.67,,,,,,,4.62,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,inpatient,1,EA,21.79000,20.70000,The Alliance,PPO Network,,18.11,,,,,,,11.98,21.14,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,outpatient,1,EA,21.79000,20.70000,The Alliance,PPO Network,,18.11,,,,,,,10.89,21.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,inpatient,1,EA,76.88000,73.03000,The Alliance,PPO Network,,63.89,,,,,,,42.28,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,outpatient,1,EA,76.88000,73.03000,The Alliance,PPO Network,,63.89,,,,,,,38.44,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,inpatient,1,EA,64.06000,60.86000,The Alliance,PPO Network,,53.23,,,,,,,35.23,62.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,outpatient,1,EA,64.06000,60.86000,The Alliance,PPO Network,,53.23,,,,,,,32.03,62.14,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.73,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.39,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,inpatient,1,EA,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,4.49,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,outpatient,1,EA,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,4.08,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,inpatient,1,EA,22.28000,21.16000,The Alliance,PPO Network,,18.51,,,,,,,12.25,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,outpatient,1,EA,22.28000,21.16000,The Alliance,PPO Network,,18.51,,,,,,,11.14,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,inpatient,1,EA,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,2.69,4.74,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,outpatient,1,EA,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,2.44,4.74,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,inpatient,1,mL,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,outpatient,1,mL,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,0.06045,1.84,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,inpatient,1,EA,122.99000,116.84000,The Alliance,PPO Network,,102.20,,,,,,,67.64,119.30,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,outpatient,1,EA,122.99000,116.84000,The Alliance,PPO Network,,102.20,,,,,,,61.49,119.30,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,inpatient,50,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,inpatient,50,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,inpatient,50,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,inpatient,50,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,outpatient,50,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,inpatient,50,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,inpatient,50,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,outpatient,50,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,2.76,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,PPO Network,,2.30,,,,,,,1.39,2.69,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.35,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.06404,0.92150,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,inpatient,1,GM,6.83000,6.49000,The Alliance,PPO Network,,5.68,,,,,,,3.76,6.63,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,outpatient,1,GM,6.83000,6.49000,The Alliance,PPO Network,,5.68,,,,,,,3.42,6.63,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,inpatient,1,GM,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,outpatient,1,GM,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,inpatient,1,EA,7.08000,6.72000,The Alliance,PPO Network,,5.88,,,,,,,3.89,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,outpatient,1,EA,7.08000,6.72000,The Alliance,PPO Network,,5.88,,,,,,,3.54,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,inpatient,1,EA,10.38000,9.86000,The Alliance,PPO Network,,8.63,,,,,,,5.71,10.07,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,outpatient,1,EA,10.38000,9.86000,The Alliance,PPO Network,,8.63,,,,,,,5.19,10.07,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,inpatient,1,EA,17.09000,16.24000,The Alliance,PPO Network,,14.20,,,,,,,9.40,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,outpatient,1,EA,17.09000,16.24000,The Alliance,PPO Network,,14.20,,,,,,,8.54,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,inpatient,1,EA,10.50000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.78,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,outpatient,1,EA,10.50000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.25,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,inpatient,1,EA,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,3.49,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,3.17,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,inpatient,1,EA,18.34000,17.42000,The Alliance,PPO Network,,15.24,,,,,,,10.09,17.79,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,outpatient,1,EA,18.34000,17.42000,The Alliance,PPO Network,,15.24,,,,,,,9.17,17.79,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,inpatient,1,mL,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,2.37,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,outpatient,1,mL,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,2.15,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,inpatient,1,mL,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,outpatient,1,mL,1.50000,1.42000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,inpatient,1,mL,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,inpatient,1,mL,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,inpatient,1,mL,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,2.03,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,inpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,4.75,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,inpatient,1,GM,7.87000,7.47000,The Alliance,PPO Network,,6.54,,,,,,,4.33,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,outpatient,1,GM,7.87000,7.47000,The Alliance,PPO Network,,6.54,,,,,,,3.94,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,inpatient,1,GM,6.56000,6.23000,The Alliance,PPO Network,,5.45,,,,,,,3.61,6.36,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,outpatient,1,GM,6.56000,6.23000,The Alliance,PPO Network,,5.45,,,,,,,3.28,6.36,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,inpatient,1,mL,46.93000,44.58000,The Alliance,PPO Network,,39.00,,,,,,,25.81,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,outpatient,1,mL,46.93000,44.58000,The Alliance,PPO Network,,39.00,,,,,,,23.46,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,inpatient,1,mL,43.17000,41.01000,The Alliance,PPO Network,,35.87,,,,,,,23.74,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,outpatient,1,mL,43.17000,41.01000,The Alliance,PPO Network,,35.87,,,,,,,21.59,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,inpatient,1,mL,42.74000,40.60000,The Alliance,PPO Network,,35.52,,,,,,,23.51,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,outpatient,1,mL,42.74000,40.60000,The Alliance,PPO Network,,35.52,,,,,,,21.37,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,inpatient,1,mL,32.38000,30.76000,The Alliance,PPO Network,,26.91,,,,,,,17.81,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,outpatient,1,mL,32.38000,30.76000,The Alliance,PPO Network,,26.91,,,,,,,16.19,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,inpatient,1,mL,15.72000,14.93000,The Alliance,PPO Network,,13.06,,,,,,,8.65,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,outpatient,1,mL,15.72000,14.93000,The Alliance,PPO Network,,13.06,,,,,,,7.86,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,inpatient,1,GM,19.34000,18.37000,The Alliance,PPO Network,,16.07,,,,,,,10.64,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,outpatient,1,GM,19.34000,18.37000,The Alliance,PPO Network,,16.07,,,,,,,9.67,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,7.77,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,inpatient,1,EA,158.63000,150.70000,The Alliance,PPO Network,,131.82,,,,,,,87.25,153.87,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,outpatient,1,EA,158.63000,150.70000,The Alliance,PPO Network,,131.82,,,,,,,7.77,153.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,inpatient,1,GM,18.19000,17.28000,The Alliance,PPO Network,,15.12,,,,,,,10.00,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,outpatient,1,GM,18.19000,17.28000,The Alliance,PPO Network,,15.12,,,,,,,9.10,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,inpatient,1,GM,26.20000,24.89000,The Alliance,PPO Network,,21.77,,,,,,,14.41,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,outpatient,1,GM,26.20000,24.89000,The Alliance,PPO Network,,21.77,,,,,,,13.10,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,inpatient,1,GM,13.79000,13.10000,The Alliance,PPO Network,,11.46,,,,,,,7.58,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,outpatient,1,GM,13.79000,13.10000,The Alliance,PPO Network,,11.46,,,,,,,6.89,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,inpatient,1,GM,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,outpatient,1,GM,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,inpatient,1,GM,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,outpatient,1,GM,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,inpatient,1,GM,6.55000,6.22000,The Alliance,PPO Network,,5.44,,,,,,,3.60,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,outpatient,1,GM,6.55000,6.22000,The Alliance,PPO Network,,5.44,,,,,,,3.27,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,inpatient,1,GM,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,outpatient,1,GM,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,inpatient,1,GM,8.15000,7.74000,The Alliance,PPO Network,,6.77,,,,,,,4.48,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,outpatient,1,GM,8.15000,7.74000,The Alliance,PPO Network,,6.77,,,,,,,4.08,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,inpatient,1,GM,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,outpatient,1,GM,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,inpatient,1,GM,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,4.32,7.62,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,outpatient,1,GM,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,3.93,7.62,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,EA,8.63000,8.20000,The Alliance,PPO Network,,7.17,,,,,,,4.75,8.37,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,PPO Network,,7.17,,,,,,,1.28,8.37,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,inpatient,1,mL,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,outpatient,1,mL,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.76415,1.61,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,inpatient,1,mL,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,outpatient,1,mL,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.34,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,inpatient,1,mL,7.34000,6.97000,The Alliance,PPO Network,,6.10,,,,,,,4.04,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,outpatient,1,mL,7.34000,6.97000,The Alliance,PPO Network,,6.10,,,,,,,3.67,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,inpatient,1,mL,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,4.00,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,outpatient,1,mL,7.27000,6.90000,The Alliance,PPO Network,,6.04,,,,,,,3.63,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,inpatient,1,mL,7.99000,7.60000,The Alliance,PPO Network,,6.64,,,,,,,4.39,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,outpatient,1,mL,7.99000,7.60000,The Alliance,PPO Network,,6.64,,,,,,,4.00,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,inpatient,1,mL,2.88000,2.74000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,outpatient,1,mL,2.88000,2.74000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,inpatient,1,mL,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.32,6.44,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.05,9.81,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,inpatient,1,mL,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.79,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,outpatient,1,mL,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.54,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,inpatient,1,mL,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,outpatient,1,mL,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,inpatient,1,GM,193.54000,183.86000,The Alliance,PPO Network,,160.83,,,,,,,106.45,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,outpatient,1,GM,193.54000,183.86000,The Alliance,PPO Network,,160.83,,,,,,,96.77,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,inpatient,1,GM,223.33000,212.16000,The Alliance,PPO Network,,185.59,,,,,,,122.83,216.63,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,outpatient,1,GM,223.33000,212.16000,The Alliance,PPO Network,,185.59,,,,,,,111.67,216.63,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,inpatient,1,mL,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,inpatient,1,mL,30.48000,28.95000,The Alliance,PPO Network,,25.33,,,,,,,16.76,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,outpatient,1,mL,30.48000,28.95000,The Alliance,PPO Network,,25.33,,,,,,,15.24,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,inpatient,1,mL,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,outpatient,1,mL,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,inpatient,1,mL,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.96,3.45,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,outpatient,1,mL,3.56000,3.38000,The Alliance,PPO Network,,2.96,,,,,,,1.78,3.45,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,inpatient,1,EA,195.57000,185.79000,The Alliance,PPO Network,,162.52,,,,,,,107.56,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,outpatient,1,EA,195.57000,185.79000,The Alliance,PPO Network,,162.52,,,,,,,97.78,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,inpatient,1,EA,398.19000,378.28000,The Alliance,PPO Network,,330.90,,,,,,,219.00,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,outpatient,1,EA,398.19000,378.28000,The Alliance,PPO Network,,330.90,,,,,,,199.09,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,inpatient,1,EA,195.79000,186.00000,The Alliance,PPO Network,,162.70,,,,,,,107.68,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,outpatient,1,EA,195.79000,186.00000,The Alliance,PPO Network,,162.70,,,,,,,97.89,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,inpatient,1,EA,97.90000,93.00000,The Alliance,PPO Network,,81.35,,,,,,,53.84,94.96,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,outpatient,1,EA,97.90000,93.00000,The Alliance,PPO Network,,81.35,,,,,,,48.95,94.96,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,inpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,inpatient,1,GM,21.61000,20.53000,The Alliance,PPO Network,,17.96,,,,,,,11.89,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,outpatient,1,GM,21.61000,20.53000,The Alliance,PPO Network,,17.96,,,,,,,10.80,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,inpatient,1,GM,15.06000,14.31000,The Alliance,PPO Network,,12.51,,,,,,,8.28,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,outpatient,1,GM,15.06000,14.31000,The Alliance,PPO Network,,12.51,,,,,,,7.53,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,inpatient,1,GM,13.12000,12.46000,The Alliance,PPO Network,,10.90,,,,,,,7.22,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,outpatient,1,GM,13.12000,12.46000,The Alliance,PPO Network,,10.90,,,,,,,6.56,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,inpatient,1,GM,11.48000,10.91000,The Alliance,PPO Network,,9.54,,,,,,,6.31,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,outpatient,1,GM,11.48000,10.91000,The Alliance,PPO Network,,9.54,,,,,,,5.74,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,inpatient,1,GM,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,outpatient,1,GM,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,inpatient,1,GM,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.44,2.54,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,outpatient,1,GM,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.31,2.54,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,inpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,5.69,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,inpatient,1,mL,8.15000,7.75000,The Alliance,PPO Network,,6.77,,,,,,,4.48,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,outpatient,1,mL,8.15000,7.75000,The Alliance,PPO Network,,6.77,,,,,,,4.08,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,inpatient,1,mL,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,7.30,12.87,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,outpatient,1,mL,13.27000,12.61000,The Alliance,PPO Network,,11.03,,,,,,,6.63,12.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,inpatient,1,GM,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,8.36,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,outpatient,1,GM,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,7.60,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,inpatient,1,GM,21.89000,20.79000,The Alliance,PPO Network,,18.19,,,,,,,12.04,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,outpatient,1,GM,21.89000,20.79000,The Alliance,PPO Network,,18.19,,,,,,,10.95,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,inpatient,1,GM,11.17000,10.61000,The Alliance,PPO Network,,9.28,,,,,,,6.14,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,outpatient,1,GM,11.17000,10.61000,The Alliance,PPO Network,,9.28,,,,,,,5.58,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,inpatient,1,GM,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,outpatient,1,GM,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,inpatient,1,GM,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,outpatient,1,GM,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,inpatient,1,GM,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,outpatient,1,GM,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,inpatient,1,mL,99.81000,94.82000,The Alliance,PPO Network,,82.94,,,,,,,54.90,96.82,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,outpatient,1,mL,99.81000,94.82000,The Alliance,PPO Network,,82.94,,,,,,,49.91,96.82,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,inpatient,1,mL,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,outpatient,1,mL,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,inpatient,1,EA,10.87000,10.33000,The Alliance,PPO Network,,9.03,,,,,,,5.98,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,outpatient,1,EA,10.87000,10.33000,The Alliance,PPO Network,,9.03,,,,,,,5.43,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,inpatient,1,EA,8.36000,7.94000,The Alliance,PPO Network,,6.95,,,,,,,4.60,8.11,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,outpatient,1,EA,8.36000,7.94000,The Alliance,PPO Network,,6.95,,,,,,,4.18,8.11,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,inpatient,1,mL,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,outpatient,1,mL,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,The Alliance,PPO Network,,17.71,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,PPO Network,,17.71,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,inpatient,1,EA,21.57000,20.49000,The Alliance,PPO Network,,17.92,,,,,,,11.86,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,outpatient,1,EA,21.57000,20.49000,The Alliance,PPO Network,,17.92,,,,,,,10.79,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,The Alliance,PPO Network,,17.71,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,PPO Network,,17.71,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,inpatient,1,EA,21.32000,20.25000,The Alliance,PPO Network,,17.72,,,,,,,11.73,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,outpatient,1,EA,21.32000,20.25000,The Alliance,PPO Network,,17.72,,,,,,,10.66,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,inpatient,1,mL,801.86000,761.77000,The Alliance,PPO Network,,666.35,,,,,,,441.02,777.80,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,outpatient,1,mL,801.86000,761.77000,The Alliance,PPO Network,,666.35,,,,,,,3.00,777.80,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,inpatient,1,mL,23.90000,22.71000,The Alliance,PPO Network,,19.86,,,,,,,13.14,23.18,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,outpatient,1,mL,23.90000,22.71000,The Alliance,PPO Network,,19.86,,,,,,,11.95,23.18,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.40,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,PPO Network,,2.12,,,,,,,1.27,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.79,4.92,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,PPO Network,,4.21,,,,,,,2.54,4.92,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,inpatient,1,mL,10.43000,9.91000,The Alliance,PPO Network,,8.67,,,,,,,5.74,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,outpatient,1,mL,10.43000,9.91000,The Alliance,PPO Network,,8.67,,,,,,,5.21,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,inpatient,1,EA,140.98000,133.93000,The Alliance,PPO Network,,117.15,,,,,,,77.54,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,outpatient,1,EA,140.98000,133.93000,The Alliance,PPO Network,,117.15,,,,,,,70.49,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,inpatient,1,EA,141.13000,134.08000,The Alliance,PPO Network,,117.28,,,,,,,77.62,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,outpatient,1,EA,141.13000,134.08000,The Alliance,PPO Network,,117.28,,,,,,,70.56,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,inpatient,1,EA,43.75000,41.56000,The Alliance,PPO Network,,36.36,,,,,,,24.06,42.44,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,outpatient,1,EA,43.75000,41.56000,The Alliance,PPO Network,,36.36,,,,,,,21.88,42.44,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,inpatient,1,EA,5.54000,5.26000,The Alliance,PPO Network,,4.60,,,,,,,3.05,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,outpatient,1,EA,5.54000,5.26000,The Alliance,PPO Network,,4.60,,,,,,,2.77,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.86,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.69,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,inpatient,1,EA,63.57000,60.39000,The Alliance,PPO Network,,52.83,,,,,,,34.96,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,outpatient,1,EA,63.57000,60.39000,The Alliance,PPO Network,,52.83,,,,,,,31.79,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,PPO Network,,18.13,,,,,,,10.91,21.17,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,inpatient,1,mL,375.55000,356.77000,The Alliance,PPO Network,,312.08,,,,,,,206.55,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,outpatient,1,mL,375.55000,356.77000,The Alliance,PPO Network,,312.08,,,,,,,13.96,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,inpatient,1,mL,335.74000,318.95000,The Alliance,PPO Network,,279.00,,,,,,,184.66,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,outpatient,1,mL,335.74000,318.95000,The Alliance,PPO Network,,279.00,,,,,,,13.96,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,165.11,291.19,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,13.96,291.19,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,The Alliance,PPO Network,,5.90,,,,,,,3.90,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,PPO Network,,5.90,,,,,,,3.55,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,inpatient,1,EA,3.26000,3.10000,The Alliance,PPO Network,,2.71,,,,,,,1.79,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,outpatient,1,EA,3.26000,3.10000,The Alliance,PPO Network,,2.71,,,,,,,1.63,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.20,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.20,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,inpatient,1,EA,25.93000,24.63000,The Alliance,PPO Network,,21.55,,,,,,,14.26,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,outpatient,1,EA,25.93000,24.63000,The Alliance,PPO Network,,21.55,,,,,,,3.14,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,inpatient,1,EA,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,13.56,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,outpatient,1,EA,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,3.14,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,inpatient,1,EA,13.89000,13.20000,The Alliance,PPO Network,,11.54,,,,,,,7.64,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,outpatient,1,EA,13.89000,13.20000,The Alliance,PPO Network,,11.54,,,,,,,3.14,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,inpatient,1,EA,9.72000,9.24000,The Alliance,PPO Network,,8.08,,,,,,,5.35,9.43,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,outpatient,1,EA,9.72000,9.24000,The Alliance,PPO Network,,8.08,,,,,,,3.14,9.43,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,inpatient,1,mL,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,10.35,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,outpatient,1,mL,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,9.41,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,inpatient,1,mL,22.36000,21.24000,The Alliance,PPO Network,,18.58,,,,,,,12.30,21.69,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,outpatient,1,mL,22.36000,21.24000,The Alliance,PPO Network,,18.58,,,,,,,11.18,21.69,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,inpatient,1,GM,31.85000,30.26000,The Alliance,PPO Network,,26.47,,,,,,,17.52,30.89,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,outpatient,1,GM,31.85000,30.26000,The Alliance,PPO Network,,26.47,,,,,,,15.93,30.89,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,inpatient,1,GM,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,outpatient,1,GM,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,inpatient,1,EA,11.53000,10.96000,The Alliance,PPO Network,,9.58,,,,,,,6.34,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,outpatient,1,EA,11.53000,10.96000,The Alliance,PPO Network,,9.58,,,,,,,5.76,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.56,2.75,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,PPO Network,,2.35,,,,,,,1.42,2.75,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.91300,1.61,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,PPO Network,,1.38,,,,,,,0.83000,1.61,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,inpatient,1,mL,105.97000,100.67000,The Alliance,PPO Network,,88.06,,,,,,,58.28,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,outpatient,1,mL,105.97000,100.67000,The Alliance,PPO Network,,88.06,,,,,,,19.76,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,inpatient,1,mL,103.60000,98.42000,The Alliance,PPO Network,,86.09,,,,,,,56.98,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,outpatient,1,mL,103.60000,98.42000,The Alliance,PPO Network,,86.09,,,,,,,19.76,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,inpatient,1,mL,54.12000,51.41000,The Alliance,PPO Network,,44.97,,,,,,,29.77,52.50,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,outpatient,1,mL,54.12000,51.41000,The Alliance,PPO Network,,44.97,,,,,,,19.76,52.50,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,inpatient,1,mL,38.34000,36.43000,The Alliance,PPO Network,,31.86,,,,,,,21.09,37.19,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,outpatient,1,mL,38.34000,36.43000,The Alliance,PPO Network,,31.86,,,,,,,19.17,37.19,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,inpatient,1,mL,383.32000,364.15000,The Alliance,PPO Network,,318.54,,,,,,,210.83,371.82,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,outpatient,1,mL,383.32000,364.15000,The Alliance,PPO Network,,318.54,,,,,,,191.66,873.48,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,inpatient,1,EA,43.43000,41.26000,The Alliance,PPO Network,,36.09,,,,,,,23.89,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,outpatient,1,EA,43.43000,41.26000,The Alliance,PPO Network,,36.09,,,,,,,1.77,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,1.77,12.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,4.75,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,inpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,4.75,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,inpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,14.77,26.05,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,PPO Network,,22.32,,,,,,,1.26,26.05,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,inpatient,1,EA,11.14000,10.59000,The Alliance,PPO Network,,9.26,,,,,,,6.13,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,PPO Network,,9.26,,,,,,,1.15,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,inpatient,1,EA,9.73000,9.24000,The Alliance,PPO Network,,8.09,,,,,,,5.35,9.44,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,outpatient,1,EA,9.73000,9.24000,The Alliance,PPO Network,,8.09,,,,,,,1.15,9.44,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,inpatient,1,mL,36.86000,35.01000,The Alliance,PPO Network,,30.63,,,,,,,20.27,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,outpatient,1,mL,36.86000,35.01000,The Alliance,PPO Network,,30.63,,,,,,,3.14,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,inpatient,1,mL,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,8.20,14.45,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,outpatient,1,mL,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,3.14,14.45,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,inpatient,1,mL,36.06000,34.25000,The Alliance,PPO Network,,29.97,,,,,,,19.83,34.98,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,outpatient,1,mL,36.06000,34.25000,The Alliance,PPO Network,,29.97,,,,,,,18.03,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,inpatient,1,mL,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,9.33,16.46,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,outpatient,1,mL,16.97000,16.12000,The Alliance,PPO Network,,14.10,,,,,,,8.48,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,inpatient,1,mL,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,7.64,13.48,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,outpatient,1,mL,13.90000,13.21000,The Alliance,PPO Network,,11.55,,,,,,,6.95,119.94,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,inpatient,1,mL,16.03000,15.23000,The Alliance,PPO Network,,13.32,,,,,,,8.82,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,outpatient,1,mL,16.03000,15.23000,The Alliance,PPO Network,,13.32,,,,,,,8.02,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,inpatient,1,mL,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,5.53,9.76,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,outpatient,1,mL,10.06000,9.56000,The Alliance,PPO Network,,8.36,,,,,,,5.03,9.76,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,inpatient,1,EA,88.48000,84.06000,The Alliance,PPO Network,,73.53,,,,,,,48.66,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,outpatient,1,EA,88.48000,84.06000,The Alliance,PPO Network,,73.53,,,,,,,18.24,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,inpatient,1,EA,32.01000,30.41000,The Alliance,PPO Network,,26.60,,,,,,,17.61,31.05,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,PPO Network,,26.60,,,,,,,16.00,31.05,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,inpatient,1,EA,405.06000,384.81000,The Alliance,PPO Network,,336.60,,,,,,,222.78,392.91,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,outpatient,1,EA,405.06000,384.81000,The Alliance,PPO Network,,336.60,,,,,,,202.53,392.91,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,inpatient,1,mL,29.93000,28.43000,The Alliance,PPO Network,,24.87,,,,,,,16.46,29.03,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,outpatient,1,mL,29.93000,28.43000,The Alliance,PPO Network,,24.87,,,,,,,14.96,29.03,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,inpatient,1,mL,43.19000,41.03000,The Alliance,PPO Network,,35.89,,,,,,,23.75,41.89,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,outpatient,1,mL,43.19000,41.03000,The Alliance,PPO Network,,35.89,,,,,,,3.14,41.89,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,inpatient,1,EA,7.04000,6.69000,The Alliance,PPO Network,,5.85,,,,,,,3.87,6.83,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,PPO Network,,5.85,,,,,,,1.77,6.83,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,inpatient,1,mL,89.25000,84.79000,The Alliance,PPO Network,,74.17,,,,,,,49.09,86.57,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,outpatient,1,mL,89.25000,84.79000,The Alliance,PPO Network,,74.17,,,,,,,44.62,3007.94,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,inpatient,1,EA,11.50000,10.93000,The Alliance,PPO Network,,9.56,,,,,,,6.33,11.15,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,PPO Network,,9.56,,,,,,,5.75,11.15,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,inpatient,1,mL,417.74000,396.85000,The Alliance,PPO Network,,347.14,,,,,,,229.76,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,outpatient,1,mL,417.74000,396.85000,The Alliance,PPO Network,,347.14,,,,,,,24.87,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,inpatient,1,mL,459.10000,436.15000,The Alliance,PPO Network,,381.51,,,,,,,252.50,445.33,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,outpatient,1,mL,459.10000,436.15000,The Alliance,PPO Network,,381.51,,,,,,,24.87,445.33,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,2.76,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.40,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.27,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,inpatient,1,EA,23.67000,22.48000,The Alliance,PPO Network,,19.67,,,,,,,13.02,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,outpatient,1,EA,23.67000,22.48000,The Alliance,PPO Network,,19.67,,,,,,,1.77,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,inpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,13.21,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,PPO Network,,19.96,,,,,,,1.77,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,inpatient,1,EA,5.32000,5.05000,The Alliance,PPO Network,,4.42,,,,,,,2.93,5.16,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,outpatient,1,EA,5.32000,5.05000,The Alliance,PPO Network,,4.42,,,,,,,1.77,5.16,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,inpatient,1,EA,3353.56000,3185.88000,The Alliance,PPO Network,,2786.81,,,,,,,1844.46,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,outpatient,1,EA,3353.56000,3185.88000,The Alliance,PPO Network,,2786.81,,,,,,,302.92,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,inpatient,1,EA,3885.76000,3691.47000,The Alliance,PPO Network,,3229.07,,,,,,,2137.17,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,outpatient,1,EA,3885.76000,3691.47000,The Alliance,PPO Network,,3229.07,,,,,,,302.92,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,inpatient,1,EA,1610.02000,1529.52000,The Alliance,PPO Network,,1337.93,,,,,,,885.51,1561.72,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,outpatient,1,EA,1610.02000,1529.52000,The Alliance,PPO Network,,1337.93,,,,,,,302.92,1561.72,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.14,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,PPO Network,,1.73,,,,,,,1.04,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,inpatient,1,mL,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,outpatient,1,mL,1.71000,1.63000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.34,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,inpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,inpatient,1,EA,1973.81000,1875.12000,The Alliance,PPO Network,,1640.24,,,,,,,1085.60,1914.60,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,outpatient,1,EA,1973.81000,1875.12000,The Alliance,PPO Network,,1640.24,,,,,,,4.36,1914.60,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,inpatient,1,mL,1535.35000,1458.58000,The Alliance,PPO Network,,1275.88,,,,,,,844.44,1489.29,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,outpatient,1,mL,1535.35000,1458.58000,The Alliance,PPO Network,,1275.88,,,,,,,767.67,1489.29,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,inpatient,1,EA,12.03000,11.43000,The Alliance,PPO Network,,10.00,,,,,,,6.62,11.67,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,outpatient,1,EA,12.03000,11.43000,The Alliance,PPO Network,,10.00,,,,,,,6.01,11.67,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,inpatient,1,EA,11.51000,10.94000,The Alliance,PPO Network,,9.56,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,PPO Network,,9.56,,,,,,,5.75,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,inpatient,1,EA,11.51000,10.94000,The Alliance,PPO Network,,9.56,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,PPO Network,,9.56,,,,,,,5.75,11.16,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,inpatient,1,mL,28.47000,27.05000,The Alliance,PPO Network,,23.66,,,,,,,15.66,27.62,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,outpatient,1,mL,28.47000,27.05000,The Alliance,PPO Network,,23.66,,,,,,,3.89,27.62,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,The Alliance,PPO Network,,5.99,,,,,,,3.97,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,PPO Network,,5.99,,,,,,,3.60,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,PPO Network,,5.18,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,The Alliance,PPO Network,,14.15,,,,,,,9.37,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,PPO Network,,14.15,,,,,,,8.52,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,PPO Network,,1.72,,,,,,,1.03,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,inpatient,1,EA,19.28000,18.31000,The Alliance,PPO Network,,16.02,,,,,,,10.60,18.70,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,PPO Network,,16.02,,,,,,,9.64,18.70,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,inpatient,1,EA,2.88000,2.74000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,outpatient,1,EA,2.88000,2.74000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.00,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.82,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.66,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,The Alliance,PPO Network,,14.40,,,,,,,9.53,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,PPO Network,,14.40,,,,,,,8.66,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,inpatient,1,EA,7.44000,7.07000,The Alliance,PPO Network,,6.18,,,,,,,4.09,7.22,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,outpatient,1,EA,7.44000,7.07000,The Alliance,PPO Network,,6.18,,,,,,,3.72,7.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.57,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.43,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,inpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,1.88,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,inpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,2.38,4.20,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,PPO Network,,3.60,,,,,,,1.88,4.20,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.34,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,PPO Network,,10.55,,,,,,,6.34,12.31,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,inpatient,1,EA,43.56000,41.39000,The Alliance,PPO Network,,36.20,,,,,,,23.96,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,outpatient,1,EA,43.56000,41.39000,The Alliance,PPO Network,,36.20,,,,,,,21.78,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,inpatient,1,EA,23.96000,22.76000,The Alliance,PPO Network,,19.91,,,,,,,13.18,23.24,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,outpatient,1,EA,23.96000,22.76000,The Alliance,PPO Network,,19.91,,,,,,,11.98,23.24,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,inpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.54,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,PPO Network,,3.83,,,,,,,2.31,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,inpatient,1,EA,9.22000,8.75000,The Alliance,PPO Network,,7.66,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,PPO Network,,7.66,,,,,,,4.61,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,inpatient,1,EA,9.22000,8.75000,The Alliance,PPO Network,,7.66,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,PPO Network,,7.66,,,,,,,4.61,8.94,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,inpatient,1,EA,40.08000,38.08000,The Alliance,PPO Network,,33.31,,,,,,,22.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,outpatient,1,EA,40.08000,38.08000,The Alliance,PPO Network,,33.31,,,,,,,20.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,inpatient,1,EA,20.55000,19.52000,The Alliance,PPO Network,,17.08,,,,,,,11.30,19.93,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,outpatient,1,EA,20.55000,19.52000,The Alliance,PPO Network,,17.08,,,,,,,10.28,19.93,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,inpatient,1,EA,1420.64000,1349.61000,The Alliance,PPO Network,,1180.55,,,,,,,781.35,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,outpatient,1,EA,1420.64000,1349.61000,The Alliance,PPO Network,,1180.55,,,,,,,32.09,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,inpatient,1,EA,1187.54000,1128.16000,The Alliance,PPO Network,,986.85,,,,,,,653.15,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,outpatient,1,EA,1187.54000,1128.16000,The Alliance,PPO Network,,986.85,,,,,,,32.09,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,inpatient,1,EA,1033.41000,981.74000,The Alliance,PPO Network,,858.76,,,,,,,568.38,1002.41,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,outpatient,1,EA,1033.41000,981.74000,The Alliance,PPO Network,,858.76,,,,,,,32.09,1002.41,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,inpatient,1,mL,501.16000,476.11000,The Alliance,PPO Network,,416.46,,,,,,,275.64,486.13,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,PPO Network,,416.46,,,,,,,3.00,486.13,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,inpatient,1,EA,73.47000,69.80000,The Alliance,PPO Network,,61.05,,,,,,,40.41,71.27,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,outpatient,1,EA,73.47000,69.80000,The Alliance,PPO Network,,61.05,,,,,,,1.26,71.27,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,inpatient,1,EA,608.34000,577.92000,The Alliance,PPO Network,,505.53,,,,,,,334.59,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,outpatient,1,EA,608.34000,577.92000,The Alliance,PPO Network,,505.53,,,,,,,32.09,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,inpatient,1,EA,710.33000,674.82000,The Alliance,PPO Network,,590.28,,,,,,,390.68,689.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,outpatient,1,EA,710.33000,674.82000,The Alliance,PPO Network,,590.28,,,,,,,32.09,689.02,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.74250,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,PPO Network,,1.12,,,,,,,0.67500,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,inpatient,1,GM,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,outpatient,1,GM,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,inpatient,1,GM,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,outpatient,1,GM,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,inpatient,1,GM,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,outpatient,1,GM,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,inpatient,1,mL,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,inpatient,1,mL,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,2.69,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,0.14415,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.14415,1.22,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,inpatient,1,mL,11.35000,10.79000,The Alliance,PPO Network,,9.43,,,,,,,6.24,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,outpatient,1,mL,11.35000,10.79000,The Alliance,PPO Network,,9.43,,,,,,,5.67,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,inpatient,1,mL,11.53000,10.95000,The Alliance,PPO Network,,9.58,,,,,,,6.34,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,outpatient,1,mL,11.53000,10.95000,The Alliance,PPO Network,,9.58,,,,,,,5.76,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,inpatient,1,mL,15.13000,14.38000,The Alliance,PPO Network,,12.57,,,,,,,8.32,14.68,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,outpatient,1,mL,15.13000,14.38000,The Alliance,PPO Network,,12.57,,,,,,,7.57,14.68,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,inpatient,1,mL,34.06000,32.36000,The Alliance,PPO Network,,28.30,,,,,,,18.73,33.04,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,outpatient,1,mL,34.06000,32.36000,The Alliance,PPO Network,,28.30,,,,,,,17.03,33.04,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,inpatient,1,EA,583.45000,554.28000,The Alliance,PPO Network,,484.85,,,,,,,320.90,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,outpatient,1,EA,583.45000,554.28000,The Alliance,PPO Network,,484.85,,,,,,,291.73,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,inpatient,1,EA,375.39000,356.62000,The Alliance,PPO Network,,311.95,,,,,,,206.46,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,outpatient,1,EA,375.39000,356.62000,The Alliance,PPO Network,,311.95,,,,,,,187.69,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,inpatient,1,EA,331.20000,314.64000,The Alliance,PPO Network,,275.23,,,,,,,182.16,321.26,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,outpatient,1,EA,331.20000,314.64000,The Alliance,PPO Network,,275.23,,,,,,,165.60,321.26,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,inpatient,1,EA,17147.50000,16290.12000,The Alliance,PPO Network,,14249.57,,,,,,,9431.12,16633.08,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,outpatient,1,EA,17147.50000,16290.12000,The Alliance,PPO Network,,14249.57,,,,,,,255.09,16633.08,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,inpatient,1,mL,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,4.05,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,outpatient,1,mL,7.37000,7.00000,The Alliance,PPO Network,,6.12,,,,,,,3.69,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,inpatient,1,mL,6.27000,5.95000,The Alliance,PPO Network,,5.21,,,,,,,3.45,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,outpatient,1,mL,6.27000,5.95000,The Alliance,PPO Network,,5.21,,,,,,,3.13,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,inpatient,1,mL,7.48000,7.10000,The Alliance,PPO Network,,6.22,,,,,,,4.11,7.26,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,outpatient,1,mL,7.48000,7.10000,The Alliance,PPO Network,,6.22,,,,,,,3.74,7.26,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,inpatient,1,EA,692.13000,657.52000,The Alliance,PPO Network,,575.16,,,,,,,380.67,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,outpatient,1,EA,692.13000,657.52000,The Alliance,PPO Network,,575.16,,,,,,,346.06,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,inpatient,1,EA,445.31000,423.05000,The Alliance,PPO Network,,370.05,,,,,,,244.92,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,outpatient,1,EA,445.31000,423.05000,The Alliance,PPO Network,,370.05,,,,,,,222.66,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,inpatient,1,EA,785.75000,746.47000,The Alliance,PPO Network,,652.96,,,,,,,432.16,762.18,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,outpatient,1,EA,785.75000,746.47000,The Alliance,PPO Network,,652.96,,,,,,,392.88,762.18,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,2.24,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.68,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,inpatient,1,mL,2.91000,2.77000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,inpatient,1,GM,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.85,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,outpatient,1,GM,5.19000,4.93000,The Alliance,PPO Network,,4.31,,,,,,,2.60,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,inpatient,1,GM,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,outpatient,1,GM,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,inpatient,1,GM,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,outpatient,1,GM,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,inpatient,1,GM,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,outpatient,1,GM,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,inpatient,1,GM,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,outpatient,1,GM,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,inpatient,1,GM,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,outpatient,1,GM,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,inpatient,1,GM,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,outpatient,1,GM,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,inpatient,1,GM,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,outpatient,1,GM,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,inpatient,1,GM,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,outpatient,1,GM,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,inpatient,1,mL,4537.21000,4310.35000,The Alliance,PPO Network,,3770.42,,,,,,,2495.47,4401.09,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,outpatient,1,mL,4537.21000,4310.35000,The Alliance,PPO Network,,3770.42,,,,,,,155.39,4401.09,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,inpatient,1,EA,8.94000,8.49000,The Alliance,PPO Network,,7.43,,,,,,,4.92,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,outpatient,1,EA,8.94000,8.49000,The Alliance,PPO Network,,7.43,,,,,,,4.47,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,inpatient,1,EA,23.81000,22.62000,The Alliance,PPO Network,,19.79,,,,,,,13.10,23.10,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,outpatient,1,EA,23.81000,22.62000,The Alliance,PPO Network,,19.79,,,,,,,11.90,23.10,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,inpatient,1,mL,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,outpatient,1,mL,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,inpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,8.10,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,2.24,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,inpatient,1,mL,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,284.90,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,PPO Network,,430.46,,,,,,,0.60838,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,inpatient,1,mL,312.84000,297.20000,The Alliance,PPO Network,,259.97,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,PPO Network,,259.97,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,0.60838,76.63,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,inpatient,1,EA,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,6.57,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,5.97,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,6.52,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,5.92,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,inpatient,1,EA,17.17000,16.31000,The Alliance,PPO Network,,14.27,,,,,,,9.44,16.65,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,PPO Network,,14.27,,,,,,,8.59,16.65,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,inpatient,1,EA,12.67000,12.04000,The Alliance,PPO Network,,10.53,,,,,,,6.97,12.29,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,outpatient,1,EA,12.67000,12.04000,The Alliance,PPO Network,,10.53,,,,,,,6.33,12.29,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.46,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,PPO Network,,5.24,,,,,,,3.15,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,inpatient,1,EA,11.14000,10.59000,The Alliance,PPO Network,,9.26,,,,,,,6.13,10.81,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,PPO Network,,9.26,,,,,,,5.57,10.81,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,inpatient,1,EA,34.50000,32.78000,The Alliance,PPO Network,,28.67,,,,,,,18.98,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,outpatient,1,EA,34.50000,32.78000,The Alliance,PPO Network,,28.67,,,,,,,2.29,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,inpatient,1,EA,5.33000,5.07000,The Alliance,PPO Network,,4.43,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,PPO Network,,4.43,,,,,,,2.29,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,inpatient,1,EA,14.93000,14.18000,The Alliance,PPO Network,,12.41,,,,,,,8.21,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,outpatient,1,EA,14.93000,14.18000,The Alliance,PPO Network,,12.41,,,,,,,2.29,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,inpatient,1,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.40,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,PPO Network,,3.63,,,,,,,2.19,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,inpatient,1,EA,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,8.95,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,2.29,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,inpatient,1,EA,6.24000,5.92000,The Alliance,PPO Network,,5.19,,,,,,,3.43,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,outpatient,1,EA,6.24000,5.92000,The Alliance,PPO Network,,5.19,,,,,,,2.29,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,inpatient,1,EA,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.29,5.17,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,inpatient,1,mL,22.88000,21.74000,The Alliance,PPO Network,,19.01,,,,,,,12.58,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,outpatient,1,mL,22.88000,21.74000,The Alliance,PPO Network,,19.01,,,,,,,11.44,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,inpatient,1,mL,23.28000,22.11000,The Alliance,PPO Network,,19.35,,,,,,,12.80,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,outpatient,1,mL,23.28000,22.11000,The Alliance,PPO Network,,19.35,,,,,,,11.64,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,inpatient,1,mL,23.77000,22.58000,The Alliance,PPO Network,,19.75,,,,,,,13.07,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,outpatient,1,mL,23.77000,22.58000,The Alliance,PPO Network,,19.75,,,,,,,11.88,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,inpatient,1,mL,6.66000,6.33000,The Alliance,PPO Network,,5.53,,,,,,,3.66,6.46,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,outpatient,1,mL,6.66000,6.33000,The Alliance,PPO Network,,5.53,,,,,,,3.33,6.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,inpatient,1,mL,1490.77000,1416.23000,The Alliance,PPO Network,,1238.83,,,,,,,819.92,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,outpatient,1,mL,1490.77000,1416.23000,The Alliance,PPO Network,,1238.83,,,,,,,0.60838,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,inpatient,1,mL,312.84000,297.20000,The Alliance,PPO Network,,259.97,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,PPO Network,,259.97,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,inpatient,1,mL,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,36.93,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,outpatient,1,mL,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,0.60838,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,inpatient,1,mL,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,0.60838,153.26,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,The Alliance,PPO Network,,5.90,,,,,,,3.90,6.89,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,PPO Network,,5.90,,,,,,,3.55,6.89,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,inpatient,1,EA,4.93000,4.69000,The Alliance,PPO Network,,4.10,,,,,,,2.71,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,outpatient,1,EA,4.93000,4.69000,The Alliance,PPO Network,,4.10,,,,,,,2.46,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,PPO Network,,2.13,,,,,,,1.28,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.28,2.48,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,inpatient,1,mL,29.02000,27.57000,The Alliance,PPO Network,,24.12,,,,,,,15.96,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,outpatient,1,mL,29.02000,27.57000,The Alliance,PPO Network,,24.12,,,,,,,14.51,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,inpatient,1,mL,34.10000,32.39000,The Alliance,PPO Network,,28.34,,,,,,,18.75,33.08,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,outpatient,1,mL,34.10000,32.39000,The Alliance,PPO Network,,28.34,,,,,,,17.05,33.08,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,1.18,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,1.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,inpatient,1,EA,103.29000,98.13000,The Alliance,PPO Network,,85.83,,,,,,,56.81,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,outpatient,1,EA,103.29000,98.13000,The Alliance,PPO Network,,85.83,,,,,,,51.65,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.21,8.18,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,inpatient,1,EA,256.92000,244.08000,The Alliance,PPO Network,,213.50,,,,,,,141.31,249.21,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,outpatient,1,EA,256.92000,244.08000,The Alliance,PPO Network,,213.50,,,,,,,128.46,249.21,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,inpatient,1,mL,563.15000,534.99000,The Alliance,PPO Network,,467.98,,,,,,,309.73,546.26,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,outpatient,1,mL,563.15000,534.99000,The Alliance,PPO Network,,467.98,,,,,,,281.57,546.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,inpatient,1,EA,16.22000,15.41000,The Alliance,PPO Network,,13.48,,,,,,,8.92,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,PPO Network,,13.48,,,,,,,8.11,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,inpatient,1,EA,2.33000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,outpatient,1,EA,2.33000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,inpatient,1,mL,692.18000,657.57000,The Alliance,PPO Network,,575.20,,,,,,,380.70,671.41,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,outpatient,1,mL,692.18000,657.57000,The Alliance,PPO Network,,575.20,,,,,,,7.68,671.41,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,inpatient,1,EA,36.05000,34.24000,The Alliance,PPO Network,,29.96,,,,,,,19.83,34.97,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,outpatient,1,EA,36.05000,34.24000,The Alliance,PPO Network,,29.96,,,,,,,18.02,34.97,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,inpatient,1,EA,175.38000,166.61000,The Alliance,PPO Network,,145.74,,,,,,,96.46,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,outpatient,1,EA,175.38000,166.61000,The Alliance,PPO Network,,145.74,,,,,,,4.35,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,inpatient,1,EA,681.25000,647.19000,The Alliance,PPO Network,,566.12,,,,,,,374.69,660.81,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,outpatient,1,EA,681.25000,647.19000,The Alliance,PPO Network,,566.12,,,,,,,4.35,660.81,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,inpatient,1,mL,10.99000,10.44000,The Alliance,PPO Network,,9.13,,,,,,,6.04,10.66,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,PPO Network,,9.13,,,,,,,0.58280,10.66,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,PPO Network,,2.56,,,,,,,1.54,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,inpatient,1,EA,4.10000,3.89000,The Alliance,PPO Network,,3.41,,,,,,,2.25,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,PPO Network,,3.41,,,,,,,2.05,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,inpatient,1,GM,45.93000,43.64000,The Alliance,PPO Network,,38.17,,,,,,,25.26,44.55,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,outpatient,1,GM,45.93000,43.64000,The Alliance,PPO Network,,38.17,,,,,,,22.96,44.55,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,inpatient,1,mL,108.82000,103.38000,The Alliance,PPO Network,,90.43,,,,,,,59.85,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,outpatient,1,mL,108.82000,103.38000,The Alliance,PPO Network,,90.43,,,,,,,54.41,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,inpatient,1,mL,164.17000,155.96000,The Alliance,PPO Network,,136.43,,,,,,,90.29,159.24,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,outpatient,1,mL,164.17000,155.96000,The Alliance,PPO Network,,136.43,,,,,,,82.08,159.24,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,inpatient,1,mL,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,outpatient,1,mL,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,inpatient,1,mL,1.14000,1.09000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,outpatient,1,mL,1.14000,1.09000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,inpatient,1,mL,2.42000,2.30000,The Alliance,PPO Network,,2.01,,,,,,,1.33,2.35,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,outpatient,1,mL,2.42000,2.30000,The Alliance,PPO Network,,2.01,,,,,,,1.21,2.35,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,inpatient,,,173.44000,164.77000,The Alliance,PPO Network,,144.13,,,,,,,95.39,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,PPO Network,,144.13,,,,,,,86.72,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,inpatient,1,mL,346.88000,329.54000,The Alliance,PPO Network,,288.26,,,,,,,190.78,336.47,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,PPO Network,,288.26,,,,,,,137.83,336.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,inpatient,1,EA,60.28000,57.26000,The Alliance,PPO Network,,50.09,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,PPO Network,,50.09,,,,,,,30.14,58.47,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,inpatient,1,EA,2.68000,2.54000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,outpatient,1,EA,2.68000,2.54000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,inpatient,1,EA,15.76000,14.98000,The Alliance,PPO Network,,13.10,,,,,,,8.67,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,outpatient,1,EA,15.76000,14.98000,The Alliance,PPO Network,,13.10,,,,,,,7.88,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,The Alliance,PPO Network,,19.32,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,PPO Network,,19.32,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,The Alliance,PPO Network,,19.32,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,PPO Network,,19.32,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,inpatient,1,EA,12.77000,12.13000,The Alliance,PPO Network,,10.61,,,,,,,7.02,12.39,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,PPO Network,,10.61,,,,,,,6.38,12.39,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,The Alliance,PPO Network,,5.42,,,,,,,3.59,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,PPO Network,,5.42,,,,,,,3.26,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,inpatient,1,mL,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,inpatient,1,GM,25.64000,24.36000,The Alliance,PPO Network,,21.31,,,,,,,14.10,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,outpatient,1,GM,25.64000,24.36000,The Alliance,PPO Network,,21.31,,,,,,,12.82,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,inpatient,1,GM,26.37000,25.05000,The Alliance,PPO Network,,21.91,,,,,,,14.50,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,outpatient,1,GM,26.37000,25.05000,The Alliance,PPO Network,,21.91,,,,,,,13.19,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,inpatient,1,GM,21.11000,20.05000,The Alliance,PPO Network,,17.54,,,,,,,11.61,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,outpatient,1,GM,21.11000,20.05000,The Alliance,PPO Network,,17.54,,,,,,,10.55,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,inpatient,1,GM,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,10.35,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,outpatient,1,GM,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,9.41,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,inpatient,1,GM,21.14000,20.08000,The Alliance,PPO Network,,17.57,,,,,,,11.63,20.51,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,outpatient,1,GM,21.14000,20.08000,The Alliance,PPO Network,,17.57,,,,,,,10.57,20.51,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,inpatient,1,EA,1675.10000,1591.35000,The Alliance,PPO Network,,1392.01,,,,,,,921.30,1624.85,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,outpatient,1,EA,1675.10000,1591.35000,The Alliance,PPO Network,,1392.01,,,,,,,837.55,1624.85,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,inpatient,1,EA,729.64000,693.16000,The Alliance,PPO Network,,606.33,,,,,,,401.30,707.75,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,outpatient,1,EA,729.64000,693.16000,The Alliance,PPO Network,,606.33,,,,,,,364.82,707.75,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,inpatient,1,mL,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,inpatient,1,EA,24.37000,23.15000,The Alliance,PPO Network,,20.25,,,,,,,13.40,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,PPO Network,,20.25,,,,,,,12.19,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,The Alliance,PPO Network,,8.30,,,,,,,5.49,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,PPO Network,,8.30,,,,,,,5.00,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,inpatient,1,EA,6.40000,6.08000,The Alliance,PPO Network,,5.32,,,,,,,3.52,6.21,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,outpatient,1,EA,6.40000,6.08000,The Alliance,PPO Network,,5.32,,,,,,,3.20,6.21,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,inpatient,1,mL,9.05000,8.60000,The Alliance,PPO Network,,7.52,,,,,,,4.98,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,outpatient,1,mL,9.05000,8.60000,The Alliance,PPO Network,,7.52,,,,,,,4.53,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,inpatient,1,mL,3.18000,3.03000,The Alliance,PPO Network,,2.64,,,,,,,1.75,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,outpatient,1,mL,3.18000,3.03000,The Alliance,PPO Network,,2.64,,,,,,,1.59,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,inpatient,1,mL,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,inpatient,1,mL,16.78000,15.94000,The Alliance,PPO Network,,13.94,,,,,,,9.23,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,outpatient,1,mL,16.78000,15.94000,The Alliance,PPO Network,,13.94,,,,,,,8.39,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,inpatient,1,mL,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.65,5.15,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,inpatient,1,EA,58.67000,55.73000,The Alliance,PPO Network,,48.75,,,,,,,32.27,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,outpatient,1,EA,58.67000,55.73000,The Alliance,PPO Network,,48.75,,,,,,,29.34,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,The Alliance,PPO Network,,43.53,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,PPO Network,,43.53,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,inpatient,1,EA,60.28000,57.26000,The Alliance,PPO Network,,50.09,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,PPO Network,,50.09,,,,,,,30.14,58.47,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,inpatient,1,mL,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,inpatient,1,mL,10.99000,10.44000,The Alliance,PPO Network,,9.13,,,,,,,6.04,10.66,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,PPO Network,,9.13,,,,,,,0.43710,10.66,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,inpatient,1,EA,9527.85000,9051.46000,The Alliance,PPO Network,,7917.64,,,,,,,5240.32,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,outpatient,1,EA,9527.85000,9051.46000,The Alliance,PPO Network,,7917.64,,,,,,,4763.93,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,inpatient,1,EA,7866.00000,7472.70000,The Alliance,PPO Network,,6536.65,,,,,,,4326.30,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,outpatient,1,EA,7866.00000,7472.70000,The Alliance,PPO Network,,6536.65,,,,,,,3933.00,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,inpatient,1,EA,7863.93000,7470.73000,The Alliance,PPO Network,,6534.93,,,,,,,4325.16,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,outpatient,1,EA,7863.93000,7470.73000,The Alliance,PPO Network,,6534.93,,,,,,,3931.97,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,inpatient,1,EA,2067.86000,1964.46000,The Alliance,PPO Network,,1718.39,,,,,,,1137.32,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,outpatient,1,EA,2067.86000,1964.46000,The Alliance,PPO Network,,1718.39,,,,,,,1033.93,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,inpatient,1,EA,4370.00000,4151.50000,The Alliance,PPO Network,,3631.47,,,,,,,2403.50,4238.90,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,outpatient,1,EA,4370.00000,4151.50000,The Alliance,PPO Network,,3631.47,,,,,,,2185.00,4238.90,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,inpatient,1,EA,53.76000,51.07000,The Alliance,PPO Network,,44.67,,,,,,,29.57,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,outpatient,1,EA,53.76000,51.07000,The Alliance,PPO Network,,44.67,,,,,,,26.88,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,The Alliance,PPO Network,,43.53,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,PPO Network,,43.53,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,inpatient,1,EA,99.17000,94.21000,The Alliance,PPO Network,,82.41,,,,,,,54.54,96.19,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,outpatient,1,EA,99.17000,94.21000,The Alliance,PPO Network,,82.41,,,,,,,49.59,96.19,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,3.79,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,inpatient,1,mL,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.26,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,inpatient,1,mL,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,8.26,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,outpatient,1,mL,15.01000,14.26000,The Alliance,PPO Network,,12.47,,,,,,,7.50,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,inpatient,1,mL,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,4.90,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,4.46,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,inpatient,1,mL,1.87000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.03,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,outpatient,1,mL,1.87000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93500,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,inpatient,1,mL,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,inpatient,1,EA,238.04000,226.14000,The Alliance,PPO Network,,197.81,,,,,,,130.92,230.90,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,outpatient,1,EA,238.04000,226.14000,The Alliance,PPO Network,,197.81,,,,,,,118.51,230.90,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,inpatient,1,mL,15.31000,14.54000,The Alliance,PPO Network,,12.72,,,,,,,8.42,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,outpatient,1,mL,15.31000,14.54000,The Alliance,PPO Network,,12.72,,,,,,,7.66,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,inpatient,1,mL,14.71000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,8.09,14.27,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,outpatient,1,mL,14.71000,13.97000,The Alliance,PPO Network,,12.22,,,,,,,7.36,14.27,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.80300,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,PPO Network,,1.21,,,,,,,0.73000,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,The Alliance,PPO Network,,9.88,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,PPO Network,,9.88,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,The Alliance,PPO Network,,9.88,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,PPO Network,,9.88,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,inpatient,1,mL,7.83000,7.44000,The Alliance,PPO Network,,6.51,,,,,,,4.31,7.60,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,outpatient,1,mL,7.83000,7.44000,The Alliance,PPO Network,,6.51,,,,,,,3.92,7.60,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,inpatient,1,mL,553.63000,525.95000,The Alliance,PPO Network,,460.07,,,,,,,304.50,537.02,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,outpatient,1,mL,553.63000,525.95000,The Alliance,PPO Network,,460.07,,,,,,,276.81,857.21,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,inpatient,1,GM,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.45,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,outpatient,1,GM,8.09000,7.69000,The Alliance,PPO Network,,6.72,,,,,,,4.04,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,inpatient,1,GM,11.75000,11.16000,The Alliance,PPO Network,,9.76,,,,,,,6.46,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,outpatient,1,GM,11.75000,11.16000,The Alliance,PPO Network,,9.76,,,,,,,5.88,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,inpatient,1,GM,25.64000,24.35000,The Alliance,PPO Network,,21.31,,,,,,,14.10,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,outpatient,1,GM,25.64000,24.35000,The Alliance,PPO Network,,21.31,,,,,,,12.82,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,inpatient,1,GM,5.45000,5.18000,The Alliance,PPO Network,,4.53,,,,,,,3.00,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,outpatient,1,GM,5.45000,5.18000,The Alliance,PPO Network,,4.53,,,,,,,2.73,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,inpatient,1,GM,7.44000,7.06000,The Alliance,PPO Network,,6.18,,,,,,,4.09,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,outpatient,1,GM,7.44000,7.06000,The Alliance,PPO Network,,6.18,,,,,,,3.72,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,inpatient,1,GM,12.44000,11.81000,The Alliance,PPO Network,,10.34,,,,,,,6.84,12.07,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,outpatient,1,GM,12.44000,11.81000,The Alliance,PPO Network,,10.34,,,,,,,6.22,12.07,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,inpatient,1,EA,5520.00000,5244.00000,The Alliance,PPO Network,,4587.12,,,,,,,3036.00,5354.40,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,outpatient,1,EA,5520.00000,5244.00000,The Alliance,PPO Network,,4587.12,,,,,,,2.65,5354.40,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,inpatient,1,mL,104.79000,99.55000,The Alliance,PPO Network,,87.08,,,,,,,57.63,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,outpatient,1,mL,104.79000,99.55000,The Alliance,PPO Network,,87.08,,,,,,,7.68,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,inpatient,1,mL,168.93000,160.49000,The Alliance,PPO Network,,140.38,,,,,,,92.91,163.86,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,outpatient,1,mL,168.93000,160.49000,The Alliance,PPO Network,,140.38,,,,,,,7.68,163.86,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,inpatient,1,EA,116.01000,110.21000,The Alliance,PPO Network,,96.40,,,,,,,63.81,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,outpatient,1,EA,116.01000,110.21000,The Alliance,PPO Network,,96.40,,,,,,,58.01,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,inpatient,1,EA,34.32000,32.60000,The Alliance,PPO Network,,28.52,,,,,,,18.88,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,outpatient,1,EA,34.32000,32.60000,The Alliance,PPO Network,,28.52,,,,,,,17.16,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,inpatient,1,EA,12.10000,11.49000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,outpatient,1,EA,12.10000,11.49000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,inpatient,1,mL,801.35000,761.28000,The Alliance,PPO Network,,665.92,,,,,,,440.74,777.31,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,outpatient,1,mL,801.35000,761.28000,The Alliance,PPO Network,,665.92,,,,,,,400.68,777.31,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,inpatient,1,EA,34.56000,32.84000,The Alliance,PPO Network,,28.72,,,,,,,19.01,33.52,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,outpatient,1,EA,34.56000,32.84000,The Alliance,PPO Network,,28.72,,,,,,,17.28,33.52,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,1.58,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,inpatient,1,mL,7.69000,7.31000,The Alliance,PPO Network,,6.39,,,,,,,4.23,7.46,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,outpatient,1,mL,7.69000,7.31000,The Alliance,PPO Network,,6.39,,,,,,,1.30,7.46,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,inpatient,1,EA,77.24000,73.38000,The Alliance,PPO Network,,64.19,,,,,,,42.48,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,outpatient,1,EA,77.24000,73.38000,The Alliance,PPO Network,,64.19,,,,,,,38.62,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,inpatient,1,EA,63.07000,59.91000,The Alliance,PPO Network,,52.41,,,,,,,34.69,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,outpatient,1,EA,63.07000,59.91000,The Alliance,PPO Network,,52.41,,,,,,,31.54,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,11.85,22.99,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,PPO Network,,2.85,,,,,,,1.72,3.33,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,inpatient,1,EA,37.51000,35.63000,The Alliance,PPO Network,,31.17,,,,,,,20.63,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,outpatient,1,EA,37.51000,35.63000,The Alliance,PPO Network,,31.17,,,,,,,18.75,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,inpatient,1,EA,11.92000,11.33000,The Alliance,PPO Network,,9.91,,,,,,,6.56,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,outpatient,1,EA,11.92000,11.33000,The Alliance,PPO Network,,9.91,,,,,,,5.96,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,inpatient,1,EA,2.98000,2.83000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,outpatient,1,EA,2.98000,2.83000,The Alliance,PPO Network,,2.48,,,,,,,1.49,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,The Alliance,PPO Network,,10.97,,,,,,,7.26,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,PPO Network,,10.97,,,,,,,6.60,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,The Alliance,PPO Network,,3.87,,,,,,,2.56,4.52,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,PPO Network,,3.87,,,,,,,2.33,4.52,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,inpatient,1,mL,118.23000,112.32000,The Alliance,PPO Network,,98.25,,,,,,,65.03,114.68,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,outpatient,1,mL,118.23000,112.32000,The Alliance,PPO Network,,98.25,,,,,,,11.32,114.68,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,inpatient,1,mL,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,1.58,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,inpatient,1,mL,78.39000,74.47000,The Alliance,PPO Network,,65.14,,,,,,,43.11,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,outpatient,1,mL,78.39000,74.47000,The Alliance,PPO Network,,65.14,,,,,,,0.79980,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,inpatient,1,mL,67.57000,64.19000,The Alliance,PPO Network,,56.15,,,,,,,37.16,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,outpatient,1,mL,67.57000,64.19000,The Alliance,PPO Network,,56.15,,,,,,,0.79980,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,inpatient,1,mL,28.06000,26.66000,The Alliance,PPO Network,,23.32,,,,,,,15.43,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,outpatient,1,mL,28.06000,26.66000,The Alliance,PPO Network,,23.32,,,,,,,0.79980,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,inpatient,1,mL,34.60000,32.87000,The Alliance,PPO Network,,28.75,,,,,,,19.03,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,outpatient,1,mL,34.60000,32.87000,The Alliance,PPO Network,,28.75,,,,,,,0.79980,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,inpatient,1,mL,74.18000,70.47000,The Alliance,PPO Network,,61.64,,,,,,,40.80,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,outpatient,1,mL,74.18000,70.47000,The Alliance,PPO Network,,61.64,,,,,,,0.79980,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,inpatient,1,mL,37.46000,35.58000,The Alliance,PPO Network,,31.13,,,,,,,20.60,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,outpatient,1,mL,37.46000,35.58000,The Alliance,PPO Network,,31.13,,,,,,,0.79980,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,inpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,PPO Network,,39.39,,,,,,,0.79980,45.98,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.93,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,PPO Network,,2.91,,,,,,,1.75,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,inpatient,1,mL,19.45000,18.48000,The Alliance,PPO Network,,16.16,,,,,,,10.70,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,outpatient,1,mL,19.45000,18.48000,The Alliance,PPO Network,,16.16,,,,,,,9.72,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,inpatient,1,mL,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.73,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,outpatient,1,mL,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.39,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,inpatient,1,EA,42.99000,40.84000,The Alliance,PPO Network,,35.72,,,,,,,23.64,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,outpatient,1,EA,42.99000,40.84000,The Alliance,PPO Network,,35.72,,,,,,,21.50,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,inpatient,1,EA,13.66000,12.98000,The Alliance,PPO Network,,11.35,,,,,,,7.51,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,outpatient,1,EA,13.66000,12.98000,The Alliance,PPO Network,,11.35,,,,,,,6.83,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.88,3.32,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.71,3.32,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,inpatient,1,EA,286.94000,272.59000,The Alliance,PPO Network,,238.45,,,,,,,157.82,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,outpatient,1,EA,286.94000,272.59000,The Alliance,PPO Network,,238.45,,,,,,,143.47,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,4.37,7.70,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,PPO Network,,6.60,,,,,,,3.97,7.70,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,inpatient,1,EA,38.47000,36.54000,The Alliance,PPO Network,,31.97,,,,,,,21.16,37.32,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,outpatient,1,EA,38.47000,36.54000,The Alliance,PPO Network,,31.97,,,,,,,19.23,37.32,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,inpatient,1,EA,198.21000,188.30000,The Alliance,PPO Network,,164.71,,,,,,,109.02,192.26,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,outpatient,1,EA,198.21000,188.30000,The Alliance,PPO Network,,164.71,,,,,,,99.11,192.26,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,inpatient,1,EA,8.69000,8.25000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,outpatient,1,EA,8.69000,8.25000,The Alliance,PPO Network,,7.22,,,,,,,4.34,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,The Alliance,PPO Network,,3.64,,,,,,,2.41,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,PPO Network,,3.64,,,,,,,2.19,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,inpatient,1,EA,6.28000,5.96000,The Alliance,PPO Network,,5.22,,,,,,,3.45,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,PPO Network,,5.22,,,,,,,3.14,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,PPO Network,,5.52,,,,,,,3.32,6.44,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.24,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,PPO Network,,1.87,,,,,,,1.12,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,PPO Network,,1.91,,,,,,,1.15,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,inpatient,1,EA,4.00000,3.80000,The Alliance,PPO Network,,3.32,,,,,,,2.20,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,outpatient,1,EA,4.00000,3.80000,The Alliance,PPO Network,,3.32,,,,,,,2.00,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,inpatient,1,EA,3.75000,3.56000,The Alliance,PPO Network,,3.12,,,,,,,2.06,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,outpatient,1,EA,3.75000,3.56000,The Alliance,PPO Network,,3.12,,,,,,,1.88,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,inpatient,1,EA,4.89000,4.64000,The Alliance,PPO Network,,4.06,,,,,,,2.69,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,outpatient,1,EA,4.89000,4.64000,The Alliance,PPO Network,,4.06,,,,,,,2.44,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,inpatient,1,mL,6.75000,6.41000,The Alliance,PPO Network,,5.61,,,,,,,3.71,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,outpatient,1,mL,6.75000,6.41000,The Alliance,PPO Network,,5.61,,,,,,,3.38,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,inpatient,1,EA,165.58000,157.30000,The Alliance,PPO Network,,137.60,,,,,,,91.07,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,outpatient,1,EA,165.58000,157.30000,The Alliance,PPO Network,,137.60,,,,,,,82.79,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,inpatient,1,EA,179.07000,170.11000,The Alliance,PPO Network,,148.81,,,,,,,98.49,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,outpatient,1,EA,179.07000,170.11000,The Alliance,PPO Network,,148.81,,,,,,,89.53,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,31.60,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,inpatient,1,EA,329.03000,312.58000,The Alliance,PPO Network,,273.42,,,,,,,180.97,319.16,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,outpatient,1,EA,329.03000,312.58000,The Alliance,PPO Network,,273.42,,,,,,,164.51,319.16,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,inpatient,1,mL,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,outpatient,1,mL,2.14000,2.04000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,inpatient,1,mL,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.29,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,outpatient,1,mL,2.35000,2.23000,The Alliance,PPO Network,,1.95,,,,,,,1.18,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,inpatient,1,mL,1.84000,1.74000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,outpatient,1,mL,1.84000,1.74000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,inpatient,1,EA,10.41000,9.89000,The Alliance,PPO Network,,8.65,,,,,,,5.73,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,outpatient,1,EA,10.41000,9.89000,The Alliance,PPO Network,,8.65,,,,,,,5.21,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,4.96,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,PPO Network,,7.49,,,,,,,4.50,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,inpatient,1,mL,49.30000,46.83000,The Alliance,PPO Network,,40.97,,,,,,,27.11,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,outpatient,1,mL,49.30000,46.83000,The Alliance,PPO Network,,40.97,,,,,,,12.06,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,inpatient,1,mL,75.84000,72.05000,The Alliance,PPO Network,,63.02,,,,,,,41.71,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,outpatient,1,mL,75.84000,72.05000,The Alliance,PPO Network,,63.02,,,,,,,12.06,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,inpatient,1,mL,97.94000,93.04000,The Alliance,PPO Network,,81.39,,,,,,,53.87,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,outpatient,1,mL,97.94000,93.04000,The Alliance,PPO Network,,81.39,,,,,,,12.06,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,inpatient,1,mL,76.47000,72.65000,The Alliance,PPO Network,,63.55,,,,,,,42.06,74.18,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,outpatient,1,mL,76.47000,72.65000,The Alliance,PPO Network,,63.55,,,,,,,12.06,74.18,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,5.94,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,inpatient,1,mL,154.05000,146.35000,The Alliance,PPO Network,,128.02,,,,,,,84.73,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,outpatient,1,mL,154.05000,146.35000,The Alliance,PPO Network,,128.02,,,,,,,1.15,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,inpatient,1,mL,308.10000,292.70000,The Alliance,PPO Network,,256.03,,,,,,,169.46,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,outpatient,1,mL,308.10000,292.70000,The Alliance,PPO Network,,256.03,,,,,,,1.15,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,inpatient,1,mL,468.96000,445.51000,The Alliance,PPO Network,,389.71,,,,,,,257.93,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,outpatient,1,mL,468.96000,445.51000,The Alliance,PPO Network,,389.71,,,,,,,1.15,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,inpatient,1,mL,160.32000,152.30000,The Alliance,PPO Network,,133.23,,,,,,,88.18,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,outpatient,1,mL,160.32000,152.30000,The Alliance,PPO Network,,133.23,,,,,,,1.15,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,inpatient,1,mL,305.46000,290.19000,The Alliance,PPO Network,,253.84,,,,,,,168.00,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,outpatient,1,mL,305.46000,290.19000,The Alliance,PPO Network,,253.84,,,,,,,1.15,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,inpatient,1,mL,308.09000,292.68000,The Alliance,PPO Network,,256.02,,,,,,,169.45,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,outpatient,1,mL,308.09000,292.68000,The Alliance,PPO Network,,256.02,,,,,,,1.15,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,inpatient,1,mL,564.92000,536.68000,The Alliance,PPO Network,,469.45,,,,,,,310.71,547.97,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,outpatient,1,mL,564.92000,536.68000,The Alliance,PPO Network,,469.45,,,,,,,1.15,547.97,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,inpatient,1,EA,284.90000,270.65000,The Alliance,PPO Network,,236.75,,,,,,,156.69,276.35,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,PPO Network,,236.75,,,,,,,71.65,276.35,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,inpatient,1,mL,60.69000,57.66000,The Alliance,PPO Network,,50.43,,,,,,,33.38,58.87,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,outpatient,1,mL,60.69000,57.66000,The Alliance,PPO Network,,50.43,,,,,,,7.43,58.87,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,inpatient,1,EA,9.92000,9.42000,The Alliance,PPO Network,,8.24,,,,,,,5.46,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,outpatient,1,EA,9.92000,9.42000,The Alliance,PPO Network,,8.24,,,,,,,4.96,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,inpatient,1,EA,14.06000,13.36000,The Alliance,PPO Network,,11.68,,,,,,,7.73,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,PPO Network,,11.68,,,,,,,7.03,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,inpatient,1,EA,6.76000,6.42000,The Alliance,PPO Network,,5.62,,,,,,,3.72,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,outpatient,1,EA,6.76000,6.42000,The Alliance,PPO Network,,5.62,,,,,,,3.38,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.51,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.10,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,inpatient,1,EA,6.44000,6.12000,The Alliance,PPO Network,,5.35,,,,,,,3.54,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,outpatient,1,EA,6.44000,6.12000,The Alliance,PPO Network,,5.35,,,,,,,3.22,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,inpatient,1,EA,8.51000,8.09000,The Alliance,PPO Network,,7.07,,,,,,,4.68,8.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,outpatient,1,EA,8.51000,8.09000,The Alliance,PPO Network,,7.07,,,,,,,4.25,8.25,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.54,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.04,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.03,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.63,4.65,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.40,4.65,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,inpatient,1,mL,5.92000,5.63000,The Alliance,PPO Network,,4.92,,,,,,,3.26,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,outpatient,1,mL,5.92000,5.63000,The Alliance,PPO Network,,4.92,,,,,,,1.65,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,1.65,7.62,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,inpatient,1,GM,83.93000,79.73000,The Alliance,PPO Network,,69.75,,,,,,,46.16,81.41,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,outpatient,1,GM,83.93000,79.73000,The Alliance,PPO Network,,69.75,,,,,,,41.97,81.41,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,inpatient,1,EA,645.01000,612.76000,The Alliance,PPO Network,,536.00,,,,,,,354.76,625.66,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,outpatient,1,EA,645.01000,612.76000,The Alliance,PPO Network,,536.00,,,,,,,322.50,625.66,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,inpatient,1,mL,30.84000,29.30000,The Alliance,PPO Network,,25.63,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,outpatient,1,mL,30.84000,29.30000,The Alliance,PPO Network,,25.63,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,inpatient,1,mL,30.84000,29.29000,The Alliance,PPO Network,,25.63,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,outpatient,1,mL,30.84000,29.29000,The Alliance,PPO Network,,25.63,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,inpatient,1,mL,25.38000,24.11000,The Alliance,PPO Network,,21.09,,,,,,,13.96,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,outpatient,1,mL,25.38000,24.11000,The Alliance,PPO Network,,21.09,,,,,,,2.63,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,inpatient,1,mL,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,outpatient,1,mL,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,2.63,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,inpatient,1,mL,25.37000,24.11000,The Alliance,PPO Network,,21.08,,,,,,,13.95,24.61,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,outpatient,1,mL,25.37000,24.11000,The Alliance,PPO Network,,21.08,,,,,,,2.63,24.61,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,inpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,inpatient,1,mL,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,outpatient,1,mL,0.95000,0.91000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,63.16,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,inpatient,1,mL,5.98000,5.68000,The Alliance,PPO Network,,4.97,,,,,,,3.29,5.80,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,outpatient,1,mL,5.98000,5.68000,The Alliance,PPO Network,,4.97,,,,,,,2.99,63.16,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.48,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,inpatient,1,mL,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,15.30,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,PPO Network,,23.11,,,,,,,13.90,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,inpatient,1,mL,6.52000,6.19000,The Alliance,PPO Network,,5.42,,,,,,,3.59,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,outpatient,1,mL,6.52000,6.19000,The Alliance,PPO Network,,5.42,,,,,,,3.26,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,inpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,3.19,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,PPO Network,,4.82,,,,,,,2.90,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,inpatient,1,mL,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.92,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,outpatient,1,mL,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.56,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,inpatient,1,mL,6.93000,6.58000,The Alliance,PPO Network,,5.76,,,,,,,3.81,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,outpatient,1,mL,6.93000,6.58000,The Alliance,PPO Network,,5.76,,,,,,,3.46,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,inpatient,1,mL,19.74000,18.75000,The Alliance,PPO Network,,16.40,,,,,,,10.86,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,PPO Network,,16.40,,,,,,,9.87,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,inpatient,1,mL,4.85000,4.61000,The Alliance,PPO Network,,4.03,,,,,,,2.67,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,outpatient,1,mL,4.85000,4.61000,The Alliance,PPO Network,,4.03,,,,,,,2.42,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,inpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.56,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,PPO Network,,8.40,,,,,,,5.05,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,inpatient,1,EA,1.87000,1.78000,The Alliance,PPO Network,,1.55,,,,,,,1.03,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,PPO Network,,1.55,,,,,,,0.93500,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,inpatient,1,EA,7.24000,6.88000,The Alliance,PPO Network,,6.02,,,,,,,3.98,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,outpatient,1,EA,7.24000,6.88000,The Alliance,PPO Network,,6.02,,,,,,,3.62,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,inpatient,1,GM,101.02000,95.97000,The Alliance,PPO Network,,83.95,,,,,,,55.56,97.99,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,outpatient,1,GM,101.02000,95.97000,The Alliance,PPO Network,,83.95,,,,,,,50.51,97.99,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,inpatient,1,mL,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,outpatient,1,mL,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,inpatient,1,mL,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,inpatient,1,mL,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.47,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,outpatient,1,mL,2.67000,2.53000,The Alliance,PPO Network,,2.22,,,,,,,1.33,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,inpatient,1,mL,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,outpatient,1,mL,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,inpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,inpatient,1,mL,48.94000,46.49000,The Alliance,PPO Network,,40.67,,,,,,,26.92,47.47,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,outpatient,1,mL,48.94000,46.49000,The Alliance,PPO Network,,40.67,,,,,,,24.47,47.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,inpatient,1,EA,288.41000,273.99000,The Alliance,PPO Network,,239.67,,,,,,,158.63,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,outpatient,1,EA,288.41000,273.99000,The Alliance,PPO Network,,239.67,,,,,,,144.21,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,inpatient,1,EA,191.20000,181.64000,The Alliance,PPO Network,,158.89,,,,,,,105.16,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,outpatient,1,EA,191.20000,181.64000,The Alliance,PPO Network,,158.89,,,,,,,95.60,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,inpatient,1,EA,220.57000,209.54000,The Alliance,PPO Network,,183.29,,,,,,,121.31,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,outpatient,1,EA,220.57000,209.54000,The Alliance,PPO Network,,183.29,,,,,,,110.28,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,94.80,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,inpatient,1,EA,253.81000,241.12000,The Alliance,PPO Network,,210.92,,,,,,,139.60,246.20,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,outpatient,1,EA,253.81000,241.12000,The Alliance,PPO Network,,210.92,,,,,,,126.91,246.20,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,inpatient,1,mL,114.91000,109.16000,The Alliance,PPO Network,,95.49,,,,,,,63.20,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,outpatient,1,mL,114.91000,109.16000,The Alliance,PPO Network,,95.49,,,,,,,1.15,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,inpatient,1,mL,214.56000,203.84000,The Alliance,PPO Network,,178.30,,,,,,,118.01,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,outpatient,1,mL,214.56000,203.84000,The Alliance,PPO Network,,178.30,,,,,,,1.15,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,inpatient,1,mL,229.50000,218.02000,The Alliance,PPO Network,,190.71,,,,,,,126.22,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,outpatient,1,mL,229.50000,218.02000,The Alliance,PPO Network,,190.71,,,,,,,1.15,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,inpatient,1,mL,231.07000,219.51000,The Alliance,PPO Network,,192.02,,,,,,,127.09,224.14,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,outpatient,1,mL,231.07000,219.51000,The Alliance,PPO Network,,192.02,,,,,,,1.15,224.14,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,inpatient,1,mL,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.54,9.78,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,outpatient,1,mL,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.04,9.78,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,inpatient,1,GM,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,outpatient,1,GM,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.16,8.07,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,inpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,34.98,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,inpatient,,,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,12.50,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,outpatient,,,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,11.36,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,inpatient,1,mL,45.44000,43.17000,The Alliance,PPO Network,,37.76,,,,,,,24.99,44.08,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,outpatient,1,mL,45.44000,43.17000,The Alliance,PPO Network,,37.76,,,,,,,22.72,44.08,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,inpatient,1,EA,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,9.73,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,2.42,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,inpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,inpatient,1,EA,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,5.95,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,outpatient,1,EA,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,2.42,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,inpatient,1,mL,22.59000,21.46000,The Alliance,PPO Network,,18.77,,,,,,,12.42,21.91,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,PPO Network,,18.77,,,,,,,11.29,21.91,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,65.37,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.54,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.40,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.27,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,4.27,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,3.88,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,inpatient,1,mL,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.99,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,outpatient,1,mL,3.61000,3.43000,The Alliance,PPO Network,,3.00,,,,,,,1.80,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,inpatient,1,mL,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,outpatient,1,mL,5.31000,5.05000,The Alliance,PPO Network,,4.41,,,,,,,2.65,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,PPO Network,,2.11,,,,,,,1.27,2.46,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.00,34.98,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,inpatient,,,52.92000,50.27000,The Alliance,PPO Network,,43.98,,,,,,,29.11,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,outpatient,,,52.92000,50.27000,The Alliance,PPO Network,,43.98,,,,,,,26.46,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,inpatient,1,mL,105.83000,100.54000,The Alliance,PPO Network,,87.94,,,,,,,58.21,102.66,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,outpatient,1,mL,105.83000,100.54000,The Alliance,PPO Network,,87.94,,,,,,,45.95,102.66,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.57,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,PPO Network,,2.38,,,,,,,1.43,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,The Alliance,PPO Network,,4.05,,,,,,,2.68,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,PPO Network,,4.05,,,,,,,2.44,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,inpatient,1,EA,5.48000,5.20000,The Alliance,PPO Network,,4.55,,,,,,,3.01,5.32,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,outpatient,1,EA,5.48000,5.20000,The Alliance,PPO Network,,4.55,,,,,,,2.74,5.32,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,inpatient,,,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,6.54,11.54,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,outpatient,,,11.90000,11.30000,The Alliance,PPO Network,,9.89,,,,,,,5.95,46.30,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,inpatient,1,EA,23.79000,22.60000,The Alliance,PPO Network,,19.77,,,,,,,13.08,23.08,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,PPO Network,,19.77,,,,,,,11.89,46.30,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,inpatient,1,mL,351.72000,334.14000,The Alliance,PPO Network,,292.28,,,,,,,193.45,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,outpatient,1,mL,351.72000,334.14000,The Alliance,PPO Network,,292.28,,,,,,,1.15,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,inpatient,1,mL,666.20000,632.89000,The Alliance,PPO Network,,553.61,,,,,,,366.41,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,outpatient,1,mL,666.20000,632.89000,The Alliance,PPO Network,,553.61,,,,,,,1.15,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,inpatient,1,mL,354.77000,337.03000,The Alliance,PPO Network,,294.81,,,,,,,195.12,344.13,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,outpatient,1,mL,354.77000,337.03000,The Alliance,PPO Network,,294.81,,,,,,,1.15,344.13,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,inpatient,1,GM,68.84000,65.40000,The Alliance,PPO Network,,57.21,,,,,,,37.86,66.77,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,outpatient,1,GM,68.84000,65.40000,The Alliance,PPO Network,,57.21,,,,,,,34.42,66.77,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,inpatient,1,GM,17.05000,16.19000,The Alliance,PPO Network,,14.17,,,,,,,9.38,16.54,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,outpatient,1,GM,17.05000,16.19000,The Alliance,PPO Network,,14.17,,,,,,,8.53,16.54,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,inpatient,1,mL,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,inpatient,1,EA,2212.30000,2101.69000,The Alliance,PPO Network,,1838.42,,,,,,,1216.77,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,outpatient,1,EA,2212.30000,2101.69000,The Alliance,PPO Network,,1838.42,,,,,,,5.18,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,inpatient,1,EA,1874.56000,1780.84000,The Alliance,PPO Network,,1557.76,,,,,,,1031.01,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,outpatient,1,EA,1874.56000,1780.84000,The Alliance,PPO Network,,1557.76,,,,,,,5.18,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,inpatient,1,EA,2390.57000,2271.04000,The Alliance,PPO Network,,1986.56,,,,,,,1314.81,2318.85,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,outpatient,1,EA,2390.57000,2271.04000,The Alliance,PPO Network,,1986.56,,,,,,,5.18,2318.85,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,inpatient,1,mL,882.96000,838.81000,The Alliance,PPO Network,,733.74,,,,,,,485.63,856.47,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,outpatient,1,mL,882.96000,838.81000,The Alliance,PPO Network,,733.74,,,,,,,441.48,856.47,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,inpatient,1,mL,84.66000,80.42000,The Alliance,PPO Network,,70.35,,,,,,,46.56,82.12,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,outpatient,1,mL,84.66000,80.42000,The Alliance,PPO Network,,70.35,,,,,,,27.10,82.12,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,inpatient,1,mL,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,inpatient,1,mL,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.24,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.67,3.24,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,2.64,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,inpatient,1,mL,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,2.14,3.77,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,outpatient,1,mL,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,1.95,3.77,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,inpatient,1,GM,15.35000,14.58000,The Alliance,PPO Network,,12.76,,,,,,,8.44,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,outpatient,1,GM,15.35000,14.58000,The Alliance,PPO Network,,12.76,,,,,,,7.67,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,inpatient,1,GM,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,5.25,9.25,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,outpatient,1,GM,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,4.77,9.25,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.61,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,PPO Network,,6.96,,,,,,,4.19,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,inpatient,1,mL,24.27000,23.06000,The Alliance,PPO Network,,20.17,,,,,,,13.35,23.54,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,outpatient,1,mL,24.27000,23.06000,The Alliance,PPO Network,,20.17,,,,,,,12.13,23.54,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,inpatient,1,mL,290.44000,275.91000,The Alliance,PPO Network,,241.36,,,,,,,159.74,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,outpatient,1,mL,290.44000,275.91000,The Alliance,PPO Network,,241.36,,,,,,,145.22,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,inpatient,1,mL,590.83000,561.29000,The Alliance,PPO Network,,490.98,,,,,,,324.96,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,outpatient,1,mL,590.83000,561.29000,The Alliance,PPO Network,,490.98,,,,,,,295.42,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,inpatient,1,mL,657.21000,624.35000,The Alliance,PPO Network,,546.14,,,,,,,361.47,637.49,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,outpatient,1,mL,657.21000,624.35000,The Alliance,PPO Network,,546.14,,,,,,,328.61,637.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,inpatient,1,mL,52.05000,49.44000,The Alliance,PPO Network,,43.25,,,,,,,28.63,50.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,outpatient,1,mL,52.05000,49.44000,The Alliance,PPO Network,,43.25,,,,,,,26.02,72.23,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,inpatient,1,EA,216.14000,205.34000,The Alliance,PPO Network,,179.61,,,,,,,118.88,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,outpatient,1,EA,216.14000,205.34000,The Alliance,PPO Network,,179.61,,,,,,,49.73,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,inpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,65.37,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,inpatient,1,EA,154.73000,146.99000,The Alliance,PPO Network,,128.58,,,,,,,85.10,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,outpatient,1,EA,154.73000,146.99000,The Alliance,PPO Network,,128.58,,,,,,,49.73,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,inpatient,1,EA,139.04000,132.09000,The Alliance,PPO Network,,115.54,,,,,,,76.47,134.87,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,outpatient,1,EA,139.04000,132.09000,The Alliance,PPO Network,,115.54,,,,,,,49.73,134.87,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,inpatient,1,mL,3.67000,3.48000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,outpatient,1,mL,3.67000,3.48000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,inpatient,1,EA,295.90000,281.10000,The Alliance,PPO Network,,245.89,,,,,,,162.75,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,outpatient,1,EA,295.90000,281.10000,The Alliance,PPO Network,,245.89,,,,,,,147.95,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,inpatient,1,EA,17.25000,16.39000,The Alliance,PPO Network,,14.33,,,,,,,9.49,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,outpatient,1,EA,17.25000,16.39000,The Alliance,PPO Network,,14.33,,,,,,,8.62,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,inpatient,1,EA,10.77000,10.23000,The Alliance,PPO Network,,8.95,,,,,,,5.92,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,outpatient,1,EA,10.77000,10.23000,The Alliance,PPO Network,,8.95,,,,,,,5.38,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,inpatient,1,EA,138.44000,131.51000,The Alliance,PPO Network,,115.04,,,,,,,76.14,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,outpatient,1,EA,138.44000,131.51000,The Alliance,PPO Network,,115.04,,,,,,,69.22,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,inpatient,1,EA,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.85,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,outpatient,1,EA,5.18000,4.92000,The Alliance,PPO Network,,4.30,,,,,,,2.59,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,inpatient,1,EA,3.86000,3.66000,The Alliance,PPO Network,,3.21,,,,,,,2.12,3.74,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,PPO Network,,3.21,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,inpatient,1,GM,18.18000,17.27000,The Alliance,PPO Network,,15.11,,,,,,,10.00,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,outpatient,1,GM,18.18000,17.27000,The Alliance,PPO Network,,15.11,,,,,,,9.09,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,inpatient,1,GM,12.78000,12.14000,The Alliance,PPO Network,,10.62,,,,,,,7.03,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,outpatient,1,GM,12.78000,12.14000,The Alliance,PPO Network,,10.62,,,,,,,6.39,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,inpatient,1,GM,24.03000,22.83000,The Alliance,PPO Network,,19.97,,,,,,,13.22,23.31,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,outpatient,1,GM,24.03000,22.83000,The Alliance,PPO Network,,19.97,,,,,,,12.02,23.31,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,inpatient,1,EA,873.90000,830.21000,The Alliance,PPO Network,,726.21,,,,,,,480.64,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,outpatient,1,EA,873.90000,830.21000,The Alliance,PPO Network,,726.21,,,,,,,436.95,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,inpatient,1,EA,13.82000,13.12000,The Alliance,PPO Network,,11.48,,,,,,,7.60,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,outpatient,1,EA,13.82000,13.12000,The Alliance,PPO Network,,11.48,,,,,,,6.91,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,inpatient,1,EA,38.82000,36.88000,The Alliance,PPO Network,,32.26,,,,,,,21.35,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,PPO Network,,32.26,,,,,,,19.41,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,inpatient,1,EA,248.13000,235.72000,The Alliance,PPO Network,,206.20,,,,,,,136.47,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,outpatient,1,EA,248.13000,235.72000,The Alliance,PPO Network,,206.20,,,,,,,124.06,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,inpatient,1,EA,411.72000,391.14000,The Alliance,PPO Network,,342.14,,,,,,,226.45,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,outpatient,1,EA,411.72000,391.14000,The Alliance,PPO Network,,342.14,,,,,,,205.86,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,inpatient,1,EA,60.61000,57.58000,The Alliance,PPO Network,,50.37,,,,,,,33.34,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,outpatient,1,EA,60.61000,57.58000,The Alliance,PPO Network,,50.37,,,,,,,30.30,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,inpatient,1,EA,12.77000,12.13000,The Alliance,PPO Network,,10.61,,,,,,,7.02,12.39,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,PPO Network,,10.61,,,,,,,6.38,12.39,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,inpatient,1,mL,669.10000,635.64000,The Alliance,PPO Network,,556.02,,,,,,,368.00,649.03,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,outpatient,1,mL,669.10000,635.64000,The Alliance,PPO Network,,556.02,,,,,,,30.77,649.03,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.36,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,inpatient,1,GM,18.68000,17.75000,The Alliance,PPO Network,,15.52,,,,,,,10.27,18.12,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,outpatient,1,GM,18.68000,17.75000,The Alliance,PPO Network,,15.52,,,,,,,9.34,18.12,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,inpatient,100,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,outpatient,100,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,inpatient,100,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,outpatient,100,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,inpatient,100,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,4.32,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,inpatient,,,52.65000,50.02000,The Alliance,PPO Network,,43.75,,,,,,,28.96,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,outpatient,,,52.65000,50.02000,The Alliance,PPO Network,,43.75,,,,,,,26.32,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,inpatient,1,mL,105.30000,100.03000,The Alliance,PPO Network,,87.50,,,,,,,57.91,102.14,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,outpatient,1,mL,105.30000,100.03000,The Alliance,PPO Network,,87.50,,,,,,,52.65,102.14,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,inpatient,1,EA,1369.95000,1301.46000,The Alliance,PPO Network,,1138.43,,,,,,,753.47,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,outpatient,1,EA,1369.95000,1301.46000,The Alliance,PPO Network,,1138.43,,,,,,,684.98,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,inpatient,1,EA,1025.64000,974.36000,The Alliance,PPO Network,,852.31,,,,,,,564.10,994.87,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,outpatient,1,EA,1025.64000,974.36000,The Alliance,PPO Network,,852.31,,,,,,,512.82,994.87,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,inpatient,1,EA,119.29000,113.33000,The Alliance,PPO Network,,99.13,,,,,,,65.61,115.71,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,outpatient,1,EA,119.29000,113.33000,The Alliance,PPO Network,,99.13,,,,,,,31.90,115.71,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,inpatient,1,EA,7.59000,7.21000,The Alliance,PPO Network,,6.31,,,,,,,4.17,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,outpatient,1,EA,7.59000,7.21000,The Alliance,PPO Network,,6.31,,,,,,,3.79,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,PPO Network,,0.85593,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,inpatient,1,GM,19.63000,18.65000,The Alliance,PPO Network,,16.31,,,,,,,10.80,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,outpatient,1,GM,19.63000,18.65000,The Alliance,PPO Network,,16.31,,,,,,,9.81,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,inpatient,1,GM,13.80000,13.11000,The Alliance,PPO Network,,11.47,,,,,,,7.59,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,outpatient,1,GM,13.80000,13.11000,The Alliance,PPO Network,,11.47,,,,,,,6.90,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,inpatient,1,GM,7.48000,7.10000,The Alliance,PPO Network,,6.22,,,,,,,4.11,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,outpatient,1,GM,7.48000,7.10000,The Alliance,PPO Network,,6.22,,,,,,,3.74,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,inpatient,1,GM,9.66000,9.18000,The Alliance,PPO Network,,8.03,,,,,,,5.31,9.37,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,outpatient,1,GM,9.66000,9.18000,The Alliance,PPO Network,,8.03,,,,,,,4.83,9.37,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,inpatient,1,mL,34.08000,32.38000,The Alliance,PPO Network,,28.32,,,,,,,18.74,33.06,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,outpatient,1,mL,34.08000,32.38000,The Alliance,PPO Network,,28.32,,,,,,,1.49,33.06,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,inpatient,1,mL,11.95000,11.35000,The Alliance,PPO Network,,9.93,,,,,,,6.57,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,outpatient,1,mL,11.95000,11.35000,The Alliance,PPO Network,,9.93,,,,,,,5.97,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,inpatient,1,mL,10.34000,9.82000,The Alliance,PPO Network,,8.59,,,,,,,5.69,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,outpatient,1,mL,10.34000,9.82000,The Alliance,PPO Network,,8.59,,,,,,,5.17,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,inpatient,1,mL,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.69,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,outpatient,1,mL,10.35000,9.83000,The Alliance,PPO Network,,8.60,,,,,,,5.17,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,inpatient,1,mL,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,inpatient,1,mL,805.95000,765.65000,The Alliance,PPO Network,,669.74,,,,,,,443.27,781.77,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,outpatient,1,mL,805.95000,765.65000,The Alliance,PPO Network,,669.74,,,,,,,30.77,781.77,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.82,3.21,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,PPO Network,,2.75,,,,,,,1.66,3.21,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,inpatient,1,mL,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,6.07,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,0.14409,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,inpatient,1,mL,7.57000,7.19000,The Alliance,PPO Network,,6.29,,,,,,,4.16,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,outpatient,1,mL,7.57000,7.19000,The Alliance,PPO Network,,6.29,,,,,,,0.14409,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,inpatient,1,mL,12.39000,11.77000,The Alliance,PPO Network,,10.30,,,,,,,6.81,12.02,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,outpatient,1,mL,12.39000,11.77000,The Alliance,PPO Network,,10.30,,,,,,,0.14409,12.02,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,inpatient,1,mL,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,inpatient,1,EA,10088.89000,9584.45000,The Alliance,PPO Network,,8383.87,,,,,,,5548.89,9786.22,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,outpatient,1,EA,10088.89000,9584.45000,The Alliance,PPO Network,,8383.87,,,,,,,5044.44,75174.64,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.97500,1.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,inpatient,1,mL,6.23000,5.91000,The Alliance,PPO Network,,5.18,,,,,,,3.43,6.04,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,outpatient,1,mL,6.23000,5.91000,The Alliance,PPO Network,,5.18,,,,,,,3.12,6.04,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.22,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,PPO Network,,3.36,,,,,,,2.02,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,1.92,3.72,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,inpatient,1,mL,11.89000,11.30000,The Alliance,PPO Network,,9.88,,,,,,,6.54,11.53,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,outpatient,1,mL,11.89000,11.30000,The Alliance,PPO Network,,9.88,,,,,,,5.95,11.53,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,inpatient,1,mL,170.43000,161.91000,The Alliance,PPO Network,,141.63,,,,,,,93.74,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,outpatient,1,mL,170.43000,161.91000,The Alliance,PPO Network,,141.63,,,,,,,85.22,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,inpatient,1,mL,38.40000,36.48000,The Alliance,PPO Network,,31.91,,,,,,,21.12,37.25,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,outpatient,1,mL,38.40000,36.48000,The Alliance,PPO Network,,31.91,,,,,,,19.20,37.25,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,inpatient,1,EA,31.01000,29.46000,The Alliance,PPO Network,,25.77,,,,,,,17.06,30.08,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,outpatient,1,EA,31.01000,29.46000,The Alliance,PPO Network,,25.77,,,,,,,15.51,30.08,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,inpatient,1,mL,117.24000,111.37000,The Alliance,PPO Network,,97.43,,,,,,,64.48,113.72,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,outpatient,1,mL,117.24000,111.37000,The Alliance,PPO Network,,97.43,,,,,,,58.62,113.72,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,1.02,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,PPO Network,,1.55,,,,,,,0.93000,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.44330,1.24,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,inpatient,1,mL,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,inpatient,1,mL,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,inpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,inpatient,1,GM,10.14000,9.63000,The Alliance,PPO Network,,8.43,,,,,,,5.58,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,outpatient,1,GM,10.14000,9.63000,The Alliance,PPO Network,,8.43,,,,,,,5.07,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,inpatient,1,GM,3.46000,3.28000,The Alliance,PPO Network,,2.88,,,,,,,1.90,3.36,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,outpatient,1,GM,3.46000,3.28000,The Alliance,PPO Network,,2.88,,,,,,,1.73,3.36,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,inpatient,1,mL,131.99000,125.39000,The Alliance,PPO Network,,109.68,,,,,,,72.59,128.03,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,outpatient,1,mL,131.99000,125.39000,The Alliance,PPO Network,,109.68,,,,,,,66.00,128.03,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,5.29,9.32,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,4.80,9.32,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,inpatient,1,mL,7009.02000,6658.57000,The Alliance,PPO Network,,5824.50,,,,,,,3854.96,6798.75,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,outpatient,1,mL,7009.02000,6658.57000,The Alliance,PPO Network,,5824.50,,,,,,,3504.51,6798.75,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.69,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,PPO Network,,2.55,,,,,,,1.53,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,inpatient,1,EA,39.75000,37.76000,The Alliance,PPO Network,,33.03,,,,,,,21.86,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,outpatient,1,EA,39.75000,37.76000,The Alliance,PPO Network,,33.03,,,,,,,19.88,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,inpatient,1,EA,14.82000,14.07000,The Alliance,PPO Network,,12.32,,,,,,,8.15,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,PPO Network,,12.32,,,,,,,7.41,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,8.20,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,7.45,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,inpatient,1,mL,22.54000,21.42000,The Alliance,PPO Network,,18.73,,,,,,,12.40,21.86,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,outpatient,1,mL,22.54000,21.42000,The Alliance,PPO Network,,18.73,,,,,,,11.27,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.48,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,inpatient,1,mL,10.50000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.78,10.19,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,outpatient,1,mL,10.50000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.25,40.47,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,inpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,4.17,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,PPO Network,,6.30,,,,,,,3.79,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,inpatient,1,mL,7.62000,7.24000,The Alliance,PPO Network,,6.33,,,,,,,4.19,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,outpatient,1,mL,7.62000,7.24000,The Alliance,PPO Network,,6.33,,,,,,,3.81,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,inpatient,1,mL,7.69000,7.30000,The Alliance,PPO Network,,6.39,,,,,,,4.23,7.46,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,outpatient,1,mL,7.69000,7.30000,The Alliance,PPO Network,,6.39,,,,,,,3.85,7.46,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,inpatient,1,EA,45.52000,43.25000,The Alliance,PPO Network,,37.83,,,,,,,25.04,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,outpatient,1,EA,45.52000,43.25000,The Alliance,PPO Network,,37.83,,,,,,,22.76,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,inpatient,1,EA,64.01000,60.81000,The Alliance,PPO Network,,53.19,,,,,,,35.21,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,outpatient,1,EA,64.01000,60.81000,The Alliance,PPO Network,,53.19,,,,,,,32.01,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,inpatient,1,EA,2.73000,2.59000,The Alliance,PPO Network,,2.27,,,,,,,1.50,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,outpatient,1,EA,2.73000,2.59000,The Alliance,PPO Network,,2.27,,,,,,,1.36,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,The Alliance,PPO Network,,102.69,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,PPO Network,,102.69,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.00465,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.00465,0.03880,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,inpatient,1,EA,19.26000,18.30000,The Alliance,PPO Network,,16.01,,,,,,,10.59,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,outpatient,1,EA,19.26000,18.30000,The Alliance,PPO Network,,16.01,,,,,,,9.63,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,inpatient,1,EA,1.78000,1.70000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.44330,0.95060,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,inpatient,1,GM,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,outpatient,1,GM,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,inpatient,1,GM,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,outpatient,1,GM,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,inpatient,1,GM,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,outpatient,1,GM,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,39.50,76.63,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.35,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.04,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,inpatient,1,mL,7.22000,6.86000,The Alliance,PPO Network,,6.00,,,,,,,3.97,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,outpatient,1,mL,7.22000,6.86000,The Alliance,PPO Network,,6.00,,,,,,,3.61,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,inpatient,1,mL,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,3.40,6.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,3.10,6.00,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.13485,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,inpatient,1,mL,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,inpatient,1,mL,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.13485,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,0.13485,2.55,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,inpatient,1,mL,274.18000,260.47000,The Alliance,PPO Network,,227.84,,,,,,,150.80,265.95,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,outpatient,1,mL,274.18000,260.47000,The Alliance,PPO Network,,227.84,,,,,,,137.09,265.95,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,inpatient,1,EA,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.34,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.22,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,inpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.64900,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,PPO Network,,0.98058,,,,,,,0.59000,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,inpatient,1,EA,4.78000,4.54000,The Alliance,PPO Network,,3.97,,,,,,,2.63,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,PPO Network,,3.97,,,,,,,2.39,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,inpatient,1,EA,6.06000,5.76000,The Alliance,PPO Network,,5.04,,,,,,,3.33,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,outpatient,1,EA,6.06000,5.76000,The Alliance,PPO Network,,5.04,,,,,,,3.03,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,inpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.27,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.16,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,inpatient,1,EA,2.12000,2.02000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,outpatient,1,EA,2.12000,2.02000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,inpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,inpatient,1,EA,13.08000,12.43000,The Alliance,PPO Network,,10.87,,,,,,,7.19,12.69,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,outpatient,1,EA,13.08000,12.43000,The Alliance,PPO Network,,10.87,,,,,,,6.54,12.69,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,inpatient,1,EA,21.51000,20.44000,The Alliance,PPO Network,,17.87,,,,,,,11.83,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,outpatient,1,EA,21.51000,20.44000,The Alliance,PPO Network,,17.87,,,,,,,10.76,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,inpatient,1,EA,37.94000,36.04000,The Alliance,PPO Network,,31.53,,,,,,,20.87,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,outpatient,1,EA,37.94000,36.04000,The Alliance,PPO Network,,31.53,,,,,,,18.97,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,inpatient,1,EA,34.11000,32.40000,The Alliance,PPO Network,,28.35,,,,,,,18.76,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,outpatient,1,EA,34.11000,32.40000,The Alliance,PPO Network,,28.35,,,,,,,17.05,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,inpatient,1,EA,17.55000,16.68000,The Alliance,PPO Network,,14.58,,,,,,,9.65,17.02,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,outpatient,1,EA,17.55000,16.68000,The Alliance,PPO Network,,14.58,,,,,,,8.78,17.02,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,inpatient,1,EA,8.28000,7.87000,The Alliance,PPO Network,,6.88,,,,,,,4.55,8.03,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,outpatient,1,EA,8.28000,7.87000,The Alliance,PPO Network,,6.88,,,,,,,4.14,8.03,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,inpatient,1,mL,8.12000,7.71000,The Alliance,PPO Network,,6.75,,,,,,,4.47,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,outpatient,1,mL,8.12000,7.71000,The Alliance,PPO Network,,6.75,,,,,,,4.06,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,inpatient,1,mL,4.90000,4.66000,The Alliance,PPO Network,,4.07,,,,,,,2.69,4.75,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,outpatient,1,mL,4.90000,4.66000,The Alliance,PPO Network,,4.07,,,,,,,2.45,4.75,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,inpatient,1,EA,26.97000,25.62000,The Alliance,PPO Network,,22.41,,,,,,,14.83,26.16,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,outpatient,1,EA,26.97000,25.62000,The Alliance,PPO Network,,22.41,,,,,,,13.48,26.16,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,inpatient,1,mL,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,inpatient,1,mL,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,outpatient,1,mL,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,inpatient,1,mL,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,inpatient,1,mL,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,PPO Network,,4.70,,,,,,,2.83,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,inpatient,1,mL,6.10000,5.79000,The Alliance,PPO Network,,5.07,,,,,,,3.35,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,outpatient,1,mL,6.10000,5.79000,The Alliance,PPO Network,,5.07,,,,,,,3.05,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,inpatient,1,mL,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,outpatient,1,mL,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,inpatient,1,EA,21.90000,20.80000,The Alliance,PPO Network,,18.20,,,,,,,12.04,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,outpatient,1,EA,21.90000,20.80000,The Alliance,PPO Network,,18.20,,,,,,,10.95,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,6.52,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,PPO Network,,9.85,,,,,,,5.92,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,2.17,3.83,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,PPO Network,,3.28,,,,,,,1.98,3.83,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,inpatient,1,mL,15.07000,14.32000,The Alliance,PPO Network,,12.52,,,,,,,8.29,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,outpatient,1,mL,15.07000,14.32000,The Alliance,PPO Network,,12.52,,,,,,,7.54,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,inpatient,1,mL,20.19000,19.18000,The Alliance,PPO Network,,16.78,,,,,,,11.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,outpatient,1,mL,20.19000,19.18000,The Alliance,PPO Network,,16.78,,,,,,,10.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,inpatient,1,mL,15.74000,14.95000,The Alliance,PPO Network,,13.08,,,,,,,8.66,15.27,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,outpatient,1,mL,15.74000,14.95000,The Alliance,PPO Network,,13.08,,,,,,,7.87,15.27,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,The Alliance,PPO Network,,29.67,,,,,,,19.64,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,PPO Network,,29.67,,,,,,,17.85,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,inpatient,1,EA,28.25000,26.84000,The Alliance,PPO Network,,23.48,,,,,,,15.54,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,outpatient,1,EA,28.25000,26.84000,The Alliance,PPO Network,,23.48,,,,,,,14.12,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,inpatient,1,EA,33.83000,32.14000,The Alliance,PPO Network,,28.11,,,,,,,18.61,32.82,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,outpatient,1,EA,33.83000,32.14000,The Alliance,PPO Network,,28.11,,,,,,,16.91,32.82,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,inpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,inpatient,1,mL,201.05000,191.00000,The Alliance,PPO Network,,167.07,,,,,,,110.58,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,outpatient,1,mL,201.05000,191.00000,The Alliance,PPO Network,,167.07,,,,,,,100.53,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,inpatient,1,mL,135.06000,128.31000,The Alliance,PPO Network,,112.23,,,,,,,74.28,131.01,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,outpatient,1,mL,135.06000,128.31000,The Alliance,PPO Network,,112.23,,,,,,,67.53,131.01,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,The Alliance,PPO Network,,1496.87,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,PPO Network,,1496.87,,,,,,,900.64,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,The Alliance,PPO Network,,1496.87,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,PPO Network,,1496.87,,,,,,,900.64,1747.25,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,3.23,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,inpatient,1,mL,54.06000,51.36000,The Alliance,PPO Network,,44.92,,,,,,,29.73,52.44,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,outpatient,1,mL,54.06000,51.36000,The Alliance,PPO Network,,44.92,,,,,,,27.03,52.44,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,inpatient,1,EA,51.38000,48.81000,The Alliance,PPO Network,,42.70,,,,,,,28.26,49.84,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,outpatient,1,EA,51.38000,48.81000,The Alliance,PPO Network,,42.70,,,,,,,25.69,49.84,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,inpatient,1,GM,12.42000,11.80000,The Alliance,PPO Network,,10.32,,,,,,,6.83,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,outpatient,1,GM,12.42000,11.80000,The Alliance,PPO Network,,10.32,,,,,,,6.21,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,7.54,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,7.54,14.64,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,inpatient,1,EA,37.22000,35.36000,The Alliance,PPO Network,,30.93,,,,,,,20.47,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,outpatient,1,EA,37.22000,35.36000,The Alliance,PPO Network,,30.93,,,,,,,18.61,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,inpatient,1,EA,40.94000,38.90000,The Alliance,PPO Network,,34.02,,,,,,,22.52,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,outpatient,1,EA,40.94000,38.90000,The Alliance,PPO Network,,34.02,,,,,,,20.47,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,2.14,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,PPO Network,,3.23,,,,,,,1.95,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.42,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,PPO Network,,5.16,,,,,,,3.10,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,The Alliance,PPO Network,,36.33,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,PPO Network,,36.33,,,,,,,21.86,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,inpatient,1,EA,28.51000,27.09000,The Alliance,PPO Network,,23.69,,,,,,,15.68,27.65,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,outpatient,1,EA,28.51000,27.09000,The Alliance,PPO Network,,23.69,,,,,,,14.26,27.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,inpatient,1,mL,16.68000,15.85000,The Alliance,PPO Network,,13.86,,,,,,,9.17,16.18,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,outpatient,1,mL,16.68000,15.85000,The Alliance,PPO Network,,13.86,,,,,,,8.34,25.89,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.61,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.29,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,inpatient,1,mL,6.70000,6.36000,The Alliance,PPO Network,,5.57,,,,,,,3.69,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,outpatient,1,mL,6.70000,6.36000,The Alliance,PPO Network,,5.57,,,,,,,3.35,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,2.89,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,inpatient,1,mL,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.91,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,outpatient,1,mL,3.47000,3.30000,The Alliance,PPO Network,,2.88,,,,,,,1.74,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,inpatient,1,mL,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,3.06,5.39,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,outpatient,1,mL,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,2.78,5.39,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,inpatient,1,mL,1032.80000,981.16000,The Alliance,PPO Network,,858.26,,,,,,,568.04,1001.82,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,outpatient,1,mL,1032.80000,981.16000,The Alliance,PPO Network,,858.26,,,,,,,516.40,8271.63,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,inpatient,1,mL,1186.38000,1127.06000,The Alliance,PPO Network,,985.88,,,,,,,652.51,1150.79,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,outpatient,1,mL,1186.38000,1127.06000,The Alliance,PPO Network,,985.88,,,,,,,593.19,8271.63,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,20.43,39.62,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,inpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,PPO Network,,14.08,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,inpatient,1,EA,21.59000,20.51000,The Alliance,PPO Network,,17.94,,,,,,,11.87,20.94,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,outpatient,1,EA,21.59000,20.51000,The Alliance,PPO Network,,17.94,,,,,,,0.43865,20.94,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,inpatient,1,EA,9.59000,9.11000,The Alliance,PPO Network,,7.97,,,,,,,5.27,9.30,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,outpatient,1,EA,9.59000,9.11000,The Alliance,PPO Network,,7.97,,,,,,,4.79,9.30,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,inpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,inpatient,1,mL,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,inpatient,,,386.68000,367.35000,The Alliance,PPO Network,,321.33,,,,,,,212.67,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,outpatient,,,386.68000,367.35000,The Alliance,PPO Network,,321.33,,,,,,,148.70,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,inpatient,1,mL,773.36000,734.69000,The Alliance,PPO Network,,642.66,,,,,,,425.35,750.16,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,outpatient,1,mL,773.36000,734.69000,The Alliance,PPO Network,,642.66,,,,,,,148.70,750.16,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,inpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,PPO Network,,4.14,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,inpatient,1,EA,2.74000,2.61000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,inpatient,1,EA,2.49000,2.36000,The Alliance,PPO Network,,2.07,,,,,,,1.37,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,outpatient,1,EA,2.49000,2.36000,The Alliance,PPO Network,,2.07,,,,,,,1.25,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,inpatient,1,EA,2.74000,2.61000,The Alliance,PPO Network,,2.28,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,PPO Network,,2.28,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,inpatient,1,EA,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,inpatient,1,EA,140.32000,133.31000,The Alliance,PPO Network,,116.61,,,,,,,77.18,136.11,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,outpatient,1,EA,140.32000,133.31000,The Alliance,PPO Network,,116.61,,,,,,,70.16,136.11,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,inpatient,1,EA,2.66000,2.52000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,inpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,inpatient,1,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.41,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.19,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,inpatient,1,EA,6.28000,5.96000,The Alliance,PPO Network,,5.22,,,,,,,3.45,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,PPO Network,,5.22,,,,,,,3.14,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,inpatient,1,EA,7.96000,7.56000,The Alliance,PPO Network,,6.61,,,,,,,4.38,7.72,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,outpatient,1,EA,7.96000,7.56000,The Alliance,PPO Network,,6.61,,,,,,,3.98,7.72,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,inpatient,5,EA,10.04000,9.54000,The Alliance,PPO Network,,8.34,,,,,,,5.52,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,outpatient,5,EA,10.04000,9.54000,The Alliance,PPO Network,,8.34,,,,,,,5.02,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,inpatient,5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,5.69,11.04,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,inpatient,1,EA,45.77000,43.48000,The Alliance,PPO Network,,38.03,,,,,,,25.17,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,outpatient,1,EA,45.77000,43.48000,The Alliance,PPO Network,,38.03,,,,,,,22.89,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.78,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,inpatient,1,EA,2.42000,2.30000,The Alliance,PPO Network,,2.01,,,,,,,1.33,2.35,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,outpatient,1,EA,2.42000,2.30000,The Alliance,PPO Network,,2.01,,,,,,,1.21,2.35,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,inpatient,1,mL,18.20000,17.29000,The Alliance,PPO Network,,15.12,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,PPO Network,,15.12,,,,,,,9.10,25.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,inpatient,1,EA,12.26000,11.65000,The Alliance,PPO Network,,10.19,,,,,,,6.74,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,PPO Network,,10.19,,,,,,,6.13,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,inpatient,1,EA,10.59000,10.06000,The Alliance,PPO Network,,8.80,,,,,,,5.82,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,outpatient,1,EA,10.59000,10.06000,The Alliance,PPO Network,,8.80,,,,,,,5.29,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,inpatient,1,EA,7.36000,6.99000,The Alliance,PPO Network,,6.12,,,,,,,4.05,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,outpatient,1,EA,7.36000,6.99000,The Alliance,PPO Network,,6.12,,,,,,,3.68,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,inpatient,1,EA,16.12000,15.31000,The Alliance,PPO Network,,13.40,,,,,,,8.87,15.64,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,PPO Network,,13.40,,,,,,,8.06,15.64,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,inpatient,1,mL,28.12000,26.72000,The Alliance,PPO Network,,23.37,,,,,,,15.47,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,outpatient,1,mL,28.12000,26.72000,The Alliance,PPO Network,,23.37,,,,,,,14.06,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,inpatient,1,mL,14.15000,13.44000,The Alliance,PPO Network,,11.76,,,,,,,7.78,13.73,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,outpatient,1,mL,14.15000,13.44000,The Alliance,PPO Network,,11.76,,,,,,,7.08,13.73,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,inpatient,1,mL,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,inpatient,1,EA,28.94000,27.50000,The Alliance,PPO Network,,24.05,,,,,,,15.92,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,outpatient,1,EA,28.94000,27.50000,The Alliance,PPO Network,,24.05,,,,,,,14.47,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,inpatient,1,EA,35.77000,33.98000,The Alliance,PPO Network,,29.72,,,,,,,19.67,34.70,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,outpatient,1,EA,35.77000,33.98000,The Alliance,PPO Network,,29.72,,,,,,,17.89,34.70,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.32,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.30,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.18,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,inpatient,1,EA,41.78000,39.69000,The Alliance,PPO Network,,34.72,,,,,,,22.98,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,outpatient,1,EA,41.78000,39.69000,The Alliance,PPO Network,,34.72,,,,,,,20.89,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,The Alliance,PPO Network,,13.96,,,,,,,9.24,16.30,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,PPO Network,,13.96,,,,,,,8.40,16.30,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,PPO Network,,24.47,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,20.43,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,The Alliance,PPO Network,,6.86,,,,,,,4.54,8.00,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,PPO Network,,6.86,,,,,,,4.12,8.00,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,inpatient,1,EA,37.02000,35.17000,The Alliance,PPO Network,,30.76,,,,,,,20.36,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,outpatient,1,EA,37.02000,35.17000,The Alliance,PPO Network,,30.76,,,,,,,18.51,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,inpatient,1,EA,13.95000,13.25000,The Alliance,PPO Network,,11.59,,,,,,,7.67,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,outpatient,1,EA,13.95000,13.25000,The Alliance,PPO Network,,11.59,,,,,,,6.97,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,inpatient,1,EA,122.37000,116.26000,The Alliance,PPO Network,,101.69,,,,,,,67.30,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,outpatient,1,EA,122.37000,116.26000,The Alliance,PPO Network,,101.69,,,,,,,61.19,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,inpatient,1,EA,48.95000,46.50000,The Alliance,PPO Network,,40.68,,,,,,,26.92,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,outpatient,1,EA,48.95000,46.50000,The Alliance,PPO Network,,40.68,,,,,,,24.48,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,inpatient,1,EA,18.49000,17.56000,The Alliance,PPO Network,,15.37,,,,,,,10.17,17.94,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,PPO Network,,15.37,,,,,,,9.24,17.94,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,9.56,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,8.69,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,inpatient,1,EA,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,9.73,17.17,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,PPO Network,,14.71,,,,,,,8.85,17.17,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,2.56,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,inpatient,1,EA,20.11000,19.11000,The Alliance,PPO Network,,16.71,,,,,,,11.06,19.51,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,outpatient,1,EA,20.11000,19.11000,The Alliance,PPO Network,,16.71,,,,,,,10.05,19.51,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,inpatient,1,mL,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,outpatient,1,mL,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,inpatient,1,EA,19.54000,18.57000,The Alliance,PPO Network,,16.24,,,,,,,10.75,18.95,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,outpatient,1,EA,19.54000,18.57000,The Alliance,PPO Network,,16.24,,,,,,,9.77,18.95,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,inpatient,1,EA,692.00000,657.40000,The Alliance,PPO Network,,575.05,,,,,,,380.60,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,outpatient,1,EA,692.00000,657.40000,The Alliance,PPO Network,,575.05,,,,,,,346.00,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,inpatient,1,EA,188.18000,178.77000,The Alliance,PPO Network,,156.38,,,,,,,103.50,182.53,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,outpatient,1,EA,188.18000,178.77000,The Alliance,PPO Network,,156.38,,,,,,,94.09,182.53,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,inpatient,1,mL,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.30,2.29,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,outpatient,1,mL,2.36000,2.24000,The Alliance,PPO Network,,1.96,,,,,,,1.18,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,inpatient,1,mL,3.36000,3.20000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,outpatient,1,mL,3.36000,3.20000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,inpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,inpatient,1,mL,19.18000,18.22000,The Alliance,PPO Network,,15.94,,,,,,,10.55,18.60,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,outpatient,1,mL,19.18000,18.22000,The Alliance,PPO Network,,15.94,,,,,,,9.59,18.60,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,inpatient,1,EA,5.51000,5.23000,The Alliance,PPO Network,,4.58,,,,,,,3.03,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,outpatient,1,EA,5.51000,5.23000,The Alliance,PPO Network,,4.58,,,,,,,2.75,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.95,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.50,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,inpatient,1,EA,7.78000,7.39000,The Alliance,PPO Network,,6.47,,,,,,,4.28,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,outpatient,1,EA,7.78000,7.39000,The Alliance,PPO Network,,6.47,,,,,,,3.89,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,inpatient,1,GM,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,outpatient,1,GM,0.22000,0.20000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,inpatient,1,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,38.24,67.43,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,PPO Network,,57.77,,,,,,,3.23,67.43,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,inpatient,1,EA,10.54000,10.01000,The Alliance,PPO Network,,8.76,,,,,,,5.80,10.22,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,outpatient,1,EA,10.54000,10.01000,The Alliance,PPO Network,,8.76,,,,,,,5.27,10.22,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,PPO Network,,0.95565,,,,,,,0.57500,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,inpatient,1,mL,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,outpatient,1,mL,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.35,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,inpatient,1,mL,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,PPO Network,,2.41,,,,,,,1.45,4.28,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,inpatient,1,mL,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,2.61,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,31.28,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,28.44,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,inpatient,1,mL,61.46000,58.39000,The Alliance,PPO Network,,51.07,,,,,,,33.80,59.62,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,outpatient,1,mL,61.46000,58.39000,The Alliance,PPO Network,,51.07,,,,,,,30.73,59.62,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,inpatient,1,EA,31.45000,29.88000,The Alliance,PPO Network,,26.13,,,,,,,17.30,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,outpatient,1,EA,31.45000,29.88000,The Alliance,PPO Network,,26.13,,,,,,,15.72,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,inpatient,1,EA,14.34000,13.63000,The Alliance,PPO Network,,11.92,,,,,,,7.89,13.91,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,outpatient,1,EA,14.34000,13.63000,The Alliance,PPO Network,,11.92,,,,,,,7.17,13.91,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,inpatient,,,241.67000,229.59000,The Alliance,PPO Network,,200.83,,,,,,,132.92,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,PPO Network,,200.83,,,,,,,120.83,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,inpatient,1,EA,483.34000,459.17000,The Alliance,PPO Network,,401.66,,,,,,,265.84,468.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,PPO Network,,401.66,,,,,,,187.18,468.84,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,inpatient,1,EA,669.20000,635.74000,The Alliance,PPO Network,,556.11,,,,,,,368.06,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,outpatient,1,EA,669.20000,635.74000,The Alliance,PPO Network,,556.11,,,,,,,108.03,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,inpatient,1,EA,3779.13000,3590.17000,The Alliance,PPO Network,,3140.46,,,,,,,2078.52,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,outpatient,1,EA,3779.13000,3590.17000,The Alliance,PPO Network,,3140.46,,,,,,,108.03,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,inpatient,1,EA,4600.00000,4370.00000,The Alliance,PPO Network,,3822.60,,,,,,,2530.00,4462.00,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,outpatient,1,EA,4600.00000,4370.00000,The Alliance,PPO Network,,3822.60,,,,,,,108.03,4462.00,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,5.18,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,4.71,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,inpatient,1,EA,14.55000,13.82000,The Alliance,PPO Network,,12.09,,,,,,,8.00,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,outpatient,1,EA,14.55000,13.82000,The Alliance,PPO Network,,12.09,,,,,,,7.28,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,inpatient,1,EA,40.76000,38.72000,The Alliance,PPO Network,,33.87,,,,,,,22.42,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,outpatient,1,EA,40.76000,38.72000,The Alliance,PPO Network,,33.87,,,,,,,20.38,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,inpatient,1,EA,16.38000,15.57000,The Alliance,PPO Network,,13.61,,,,,,,9.01,15.89,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,outpatient,1,EA,16.38000,15.57000,The Alliance,PPO Network,,13.61,,,,,,,8.19,15.89,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,inpatient,1,EA,20.97000,19.92000,The Alliance,PPO Network,,17.43,,,,,,,11.53,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,outpatient,1,EA,20.97000,19.92000,The Alliance,PPO Network,,17.43,,,,,,,0.36823,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,inpatient,1,EA,7.85000,7.46000,The Alliance,PPO Network,,6.52,,,,,,,4.32,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,PPO Network,,6.52,,,,,,,0.36823,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,inpatient,1,EA,8.95000,8.50000,The Alliance,PPO Network,,7.44,,,,,,,4.92,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,outpatient,1,EA,8.95000,8.50000,The Alliance,PPO Network,,7.44,,,,,,,0.36823,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,inpatient,1,EA,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,4.09,7.21,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,outpatient,1,EA,7.43000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,0.36823,7.21,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,inpatient,1,EA,54.15000,51.44000,The Alliance,PPO Network,,45.00,,,,,,,29.78,52.53,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,outpatient,1,EA,54.15000,51.44000,The Alliance,PPO Network,,45.00,,,,,,,27.07,52.53,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.25,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,PPO Network,,3.40,,,,,,,2.04,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,inpatient,1,mL,12.48000,11.86000,The Alliance,PPO Network,,10.37,,,,,,,6.86,12.11,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,outpatient,1,mL,12.48000,11.86000,The Alliance,PPO Network,,10.37,,,,,,,2.24,12.11,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,inpatient,1,mL,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,outpatient,1,mL,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,0.26000,4.10,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,inpatient,1,GM,19.83000,18.84000,The Alliance,PPO Network,,16.48,,,,,,,10.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,outpatient,1,GM,19.83000,18.84000,The Alliance,PPO Network,,16.48,,,,,,,9.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,inpatient,1,GM,11.68000,11.10000,The Alliance,PPO Network,,9.71,,,,,,,6.42,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,outpatient,1,GM,11.68000,11.10000,The Alliance,PPO Network,,9.71,,,,,,,5.84,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.09,7.93,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,inpatient,1,GM,5.01000,4.76000,The Alliance,PPO Network,,4.16,,,,,,,2.76,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,outpatient,1,GM,5.01000,4.76000,The Alliance,PPO Network,,4.16,,,,,,,2.50,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,inpatient,1,GM,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,outpatient,1,GM,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,inpatient,1,EA,9.03000,8.58000,The Alliance,PPO Network,,7.50,,,,,,,4.97,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,outpatient,1,EA,9.03000,8.58000,The Alliance,PPO Network,,7.50,,,,,,,4.51,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.75,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.59,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,2.02,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,PPO Network,,3.06,,,,,,,1.84,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,inpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,inpatient,1,GM,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,outpatient,1,GM,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,inpatient,1,EA,8.68000,8.24000,The Alliance,PPO Network,,7.21,,,,,,,4.77,8.42,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,outpatient,1,EA,8.68000,8.24000,The Alliance,PPO Network,,7.21,,,,,,,4.34,8.42,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,inpatient,1,mL,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.58300,1.03,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,PPO Network,,0.88086,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.31,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,PPO Network,,1.98,,,,,,,1.19,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,inpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.19995,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,inpatient,1,mL,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,4.90,8.64,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,PPO Network,,7.40,,,,,,,0.19995,8.64,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,inpatient,1,mL,6.74000,6.40000,The Alliance,PPO Network,,5.60,,,,,,,3.71,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,outpatient,1,mL,6.74000,6.40000,The Alliance,PPO Network,,5.60,,,,,,,3.37,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,inpatient,1,mL,6.67000,6.33000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,outpatient,1,mL,6.67000,6.33000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,inpatient,1,mL,68.41000,64.98000,The Alliance,PPO Network,,56.85,,,,,,,37.63,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,outpatient,1,mL,68.41000,64.98000,The Alliance,PPO Network,,56.85,,,,,,,29.60,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,inpatient,1,mL,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,inpatient,1,mL,142.39000,135.27000,The Alliance,PPO Network,,118.33,,,,,,,78.31,138.12,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,outpatient,1,mL,142.39000,135.27000,The Alliance,PPO Network,,118.33,,,,,,,29.60,138.12,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,inpatient,1,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,7.58,14.71,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,inpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,inpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,inpatient,1,EA,5.82000,5.53000,The Alliance,PPO Network,,4.84,,,,,,,3.20,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,outpatient,1,EA,5.82000,5.53000,The Alliance,PPO Network,,4.84,,,,,,,2.91,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,inpatient,1,EA,2.76000,2.63000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,outpatient,1,EA,2.76000,2.63000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.20,2.11,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,PPO Network,,1.81,,,,,,,1.09,2.11,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,inpatient,1,mL,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.90,3.35,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,outpatient,1,mL,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.73,3.35,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,inpatient,1,GM,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,outpatient,1,GM,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,inpatient,1,EA,32.55000,30.93000,The Alliance,PPO Network,,27.05,,,,,,,17.90,31.57,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,outpatient,1,EA,32.55000,30.93000,The Alliance,PPO Network,,27.05,,,,,,,16.27,31.57,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,inpatient,1,mL,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,8.25,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,outpatient,1,mL,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,7.50,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,inpatient,1,mL,13.24000,12.58000,The Alliance,PPO Network,,11.00,,,,,,,7.28,12.84,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,outpatient,1,mL,13.24000,12.58000,The Alliance,PPO Network,,11.00,,,,,,,6.62,12.84,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,2.17,3.82,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.82,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,inpatient,1,mL,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.69,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,PPO Network,,4.07,,,,,,,2.45,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,inpatient,1,mL,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,inpatient,1,mL,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,inpatient,1,mL,128.82000,122.38000,The Alliance,PPO Network,,107.05,,,,,,,70.85,124.96,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,outpatient,1,mL,128.82000,122.38000,The Alliance,PPO Network,,107.05,,,,,,,29.60,124.96,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,inpatient,1,GM,5.52000,5.24000,The Alliance,PPO Network,,4.59,,,,,,,3.04,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,outpatient,1,GM,5.52000,5.24000,The Alliance,PPO Network,,4.59,,,,,,,2.76,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,inpatient,1,GM,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,outpatient,1,GM,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,inpatient,1,GM,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,3.16,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,outpatient,1,GM,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,2.88,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,inpatient,1,GM,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.23,3.94,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,outpatient,1,GM,4.06000,3.86000,The Alliance,PPO Network,,3.37,,,,,,,2.03,3.94,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,inpatient,1,mL,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,outpatient,1,mL,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,inpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.73,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,PPO Network,,4.13,,,,,,,2.48,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.31,2.32,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.32,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,inpatient,1,mL,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,6.07,10.70,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,PPO Network,,9.17,,,,,,,5.51,10.70,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,inpatient,1,mL,19.99000,18.99000,The Alliance,PPO Network,,16.61,,,,,,,10.99,19.39,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,outpatient,1,mL,19.99000,18.99000,The Alliance,PPO Network,,16.61,,,,,,,9.99,19.39,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,inpatient,1,EA,6.34000,6.02000,The Alliance,PPO Network,,5.27,,,,,,,3.49,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,outpatient,1,EA,6.34000,6.02000,The Alliance,PPO Network,,5.27,,,,,,,3.17,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,3.16,5.58,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,2.88,5.58,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,inpatient,1,EA,13.86000,13.17000,The Alliance,PPO Network,,11.52,,,,,,,7.62,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,outpatient,1,EA,13.86000,13.17000,The Alliance,PPO Network,,11.52,,,,,,,0.58745,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,inpatient,1,EA,24.04000,22.84000,The Alliance,PPO Network,,19.98,,,,,,,13.22,23.32,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,PPO Network,,19.98,,,,,,,0.58745,23.32,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,inpatient,1,mL,27.27000,25.91000,The Alliance,PPO Network,,22.66,,,,,,,15.00,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,outpatient,1,mL,27.27000,25.91000,The Alliance,PPO Network,,22.66,,,,,,,0.23870,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,inpatient,1,mL,8.93000,8.49000,The Alliance,PPO Network,,7.42,,,,,,,4.91,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,outpatient,1,mL,8.93000,8.49000,The Alliance,PPO Network,,7.42,,,,,,,0.23870,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,inpatient,1,mL,8.94000,8.49000,The Alliance,PPO Network,,7.43,,,,,,,4.92,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,outpatient,1,mL,8.94000,8.49000,The Alliance,PPO Network,,7.43,,,,,,,0.23870,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,inpatient,1,mL,22.91000,21.77000,The Alliance,PPO Network,,19.04,,,,,,,12.60,22.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,outpatient,1,mL,22.91000,21.77000,The Alliance,PPO Network,,19.04,,,,,,,0.23870,22.22,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,inpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,3.18,5.62,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,PPO Network,,4.81,,,,,,,2.90,5.62,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,inpatient,1,EA,17.10000,16.25000,The Alliance,PPO Network,,14.21,,,,,,,9.40,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,outpatient,1,EA,17.10000,16.25000,The Alliance,PPO Network,,14.21,,,,,,,0.58745,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,inpatient,1,EA,11.55000,10.97000,The Alliance,PPO Network,,9.60,,,,,,,6.35,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,outpatient,1,EA,11.55000,10.97000,The Alliance,PPO Network,,9.60,,,,,,,0.58745,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,inpatient,1,EA,13.12000,12.47000,The Alliance,PPO Network,,10.90,,,,,,,7.22,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,PPO Network,,10.90,,,,,,,0.58745,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,inpatient,1,EA,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,0.58745,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.63080,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,inpatient,1,EA,11.77000,11.18000,The Alliance,PPO Network,,9.78,,,,,,,6.47,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,outpatient,1,EA,11.77000,11.18000,The Alliance,PPO Network,,9.78,,,,,,,0.58745,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,inpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,0.58745,4.44,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,inpatient,1,EA,16.30000,15.49000,The Alliance,PPO Network,,13.55,,,,,,,8.96,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,outpatient,1,EA,16.30000,15.49000,The Alliance,PPO Network,,13.55,,,,,,,8.15,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.44,2.54,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.31,2.54,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,The Alliance,PPO Network,,3.45,,,,,,,2.28,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,PPO Network,,3.45,,,,,,,2.08,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,inpatient,1,EA,12.79000,12.15000,The Alliance,PPO Network,,10.63,,,,,,,7.03,12.41,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,outpatient,1,EA,12.79000,12.15000,The Alliance,PPO Network,,10.63,,,,,,,6.39,12.41,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,14.37,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,inpatient,1,mL,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,14.37,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,inpatient,1,EA,1.65000,1.56000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,outpatient,1,EA,1.65000,1.56000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,inpatient,1,EA,39.82000,37.83000,The Alliance,PPO Network,,33.09,,,,,,,21.90,38.63,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,outpatient,1,EA,39.82000,37.83000,The Alliance,PPO Network,,33.09,,,,,,,19.91,38.63,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,inpatient,1,mL,11.10000,10.55000,The Alliance,PPO Network,,9.22,,,,,,,6.11,10.77,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,outpatient,1,mL,11.10000,10.55000,The Alliance,PPO Network,,9.22,,,,,,,4.77,10.77,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,inpatient,1,EA,16.69000,15.86000,The Alliance,PPO Network,,13.87,,,,,,,9.18,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,outpatient,1,EA,16.69000,15.86000,The Alliance,PPO Network,,13.87,,,,,,,8.35,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,inpatient,1,EA,43.24000,41.07000,The Alliance,PPO Network,,35.93,,,,,,,23.78,41.94,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,outpatient,1,EA,43.24000,41.07000,The Alliance,PPO Network,,35.93,,,,,,,21.62,41.94,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,inpatient,1,EA,96.21000,91.40000,The Alliance,PPO Network,,79.95,,,,,,,52.92,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,outpatient,1,EA,96.21000,91.40000,The Alliance,PPO Network,,79.95,,,,,,,48.10,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,inpatient,1,EA,23.30000,22.13000,The Alliance,PPO Network,,19.36,,,,,,,12.81,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,outpatient,1,EA,23.30000,22.13000,The Alliance,PPO Network,,19.36,,,,,,,11.65,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,inpatient,1,EA,31.97000,30.37000,The Alliance,PPO Network,,26.57,,,,,,,17.58,31.01,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,outpatient,1,EA,31.97000,30.37000,The Alliance,PPO Network,,26.57,,,,,,,15.98,31.01,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,3.55,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,The Alliance,PPO Network,,5.17,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,PPO Network,,5.17,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,inpatient,1,mL,69.35000,65.88000,The Alliance,PPO Network,,57.63,,,,,,,38.14,67.27,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,outpatient,1,mL,69.35000,65.88000,The Alliance,PPO Network,,57.63,,,,,,,34.67,67.27,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,inpatient,1,EA,15.09000,14.33000,The Alliance,PPO Network,,12.54,,,,,,,8.30,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,PPO Network,,12.54,,,,,,,7.54,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,3.09,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,PPO Network,,4.67,,,,,,,2.81,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,The Alliance,PPO Network,,2.27,,,,,,,1.50,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,PPO Network,,2.27,,,,,,,1.36,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,inpatient,1,EA,6.82000,6.48000,The Alliance,PPO Network,,5.67,,,,,,,3.75,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,outpatient,1,EA,6.82000,6.48000,The Alliance,PPO Network,,5.67,,,,,,,3.41,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,inpatient,1,EA,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.65,6.44,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,outpatient,1,EA,6.64000,6.30000,The Alliance,PPO Network,,5.52,,,,,,,3.32,6.44,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,inpatient,1,mL,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.34,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,outpatient,1,mL,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.22,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,inpatient,1,EA,11.37000,10.80000,The Alliance,PPO Network,,9.45,,,,,,,6.25,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,outpatient,1,EA,11.37000,10.80000,The Alliance,PPO Network,,9.45,,,,,,,5.68,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,inpatient,1,EA,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,3.28,5.79,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,2.98,5.79,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,inpatient,1,EA,45.02000,42.77000,The Alliance,PPO Network,,37.41,,,,,,,24.76,43.67,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,outpatient,1,EA,45.02000,42.77000,The Alliance,PPO Network,,37.41,,,,,,,22.51,43.67,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,inpatient,1,EA,29.46000,27.99000,The Alliance,PPO Network,,24.48,,,,,,,16.20,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,outpatient,1,EA,29.46000,27.99000,The Alliance,PPO Network,,24.48,,,,,,,14.73,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,inpatient,1,EA,77.26000,73.40000,The Alliance,PPO Network,,64.20,,,,,,,42.49,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,outpatient,1,EA,77.26000,73.40000,The Alliance,PPO Network,,64.20,,,,,,,38.63,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,inpatient,1,mL,37.52000,35.65000,The Alliance,PPO Network,,31.18,,,,,,,20.64,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,outpatient,1,mL,37.52000,35.65000,The Alliance,PPO Network,,31.18,,,,,,,14.28,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,inpatient,1,mL,29.64000,28.16000,The Alliance,PPO Network,,24.63,,,,,,,16.30,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,outpatient,1,mL,29.64000,28.16000,The Alliance,PPO Network,,24.63,,,,,,,14.28,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,inpatient,1,mL,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,12.17,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,outpatient,1,mL,22.12000,21.01000,The Alliance,PPO Network,,18.38,,,,,,,11.06,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,inpatient,1,mL,11.63000,11.05000,The Alliance,PPO Network,,9.66,,,,,,,6.40,11.28,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,outpatient,1,mL,11.63000,11.05000,The Alliance,PPO Network,,9.66,,,,,,,5.82,15.29,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,inpatient,1,mL,29.39000,27.92000,The Alliance,PPO Network,,24.42,,,,,,,16.16,28.51,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,outpatient,1,mL,29.39000,27.92000,The Alliance,PPO Network,,24.42,,,,,,,14.28,28.51,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,inpatient,1,EA,36.90000,35.06000,The Alliance,PPO Network,,30.66,,,,,,,20.30,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,outpatient,1,EA,36.90000,35.06000,The Alliance,PPO Network,,30.66,,,,,,,18.45,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,inpatient,1,EA,35.55000,33.77000,The Alliance,PPO Network,,29.54,,,,,,,19.55,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,PPO Network,,29.54,,,,,,,17.77,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,inpatient,1,EA,36.97000,35.12000,The Alliance,PPO Network,,30.72,,,,,,,20.33,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,outpatient,1,EA,36.97000,35.12000,The Alliance,PPO Network,,30.72,,,,,,,18.48,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,18.17,35.25,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,inpatient,1,GM,41.32000,39.25000,The Alliance,PPO Network,,34.34,,,,,,,22.73,40.08,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,outpatient,1,GM,41.32000,39.25000,The Alliance,PPO Network,,34.34,,,,,,,20.66,40.08,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,inpatient,1,GM,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,2.03,3.58,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,outpatient,1,GM,3.69000,3.50000,The Alliance,PPO Network,,3.07,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,inpatient,1,mL,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.23,2.16,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,outpatient,1,mL,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.11,2.16,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,inpatient,1,EA,11.81000,11.22000,The Alliance,PPO Network,,9.81,,,,,,,6.50,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,outpatient,1,EA,11.81000,11.22000,The Alliance,PPO Network,,9.81,,,,,,,5.91,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,inpatient,1,EA,6.29000,5.97000,The Alliance,PPO Network,,5.23,,,,,,,3.46,6.10,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,outpatient,1,EA,6.29000,5.97000,The Alliance,PPO Network,,5.23,,,,,,,3.15,6.10,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,inpatient,1,mL,5.47000,5.19000,The Alliance,PPO Network,,4.55,,,,,,,3.01,5.31,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,PPO Network,,4.55,,,,,,,2.73,5.31,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,inpatient,1,EA,158.82000,150.88000,The Alliance,PPO Network,,131.98,,,,,,,87.35,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,outpatient,1,EA,158.82000,150.88000,The Alliance,PPO Network,,131.98,,,,,,,1.44,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,inpatient,1,EA,124.79000,118.55000,The Alliance,PPO Network,,103.70,,,,,,,68.63,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,outpatient,1,EA,124.79000,118.55000,The Alliance,PPO Network,,103.70,,,,,,,1.44,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,inpatient,1,EA,80.71000,76.67000,The Alliance,PPO Network,,67.07,,,,,,,44.39,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,outpatient,1,EA,80.71000,76.67000,The Alliance,PPO Network,,67.07,,,,,,,1.44,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,inpatient,1,EA,104.91000,99.67000,The Alliance,PPO Network,,87.18,,,,,,,57.70,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,outpatient,1,EA,104.91000,99.67000,The Alliance,PPO Network,,87.18,,,,,,,1.44,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,1.44,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,inpatient,1,EA,111.99000,106.39000,The Alliance,PPO Network,,93.06,,,,,,,61.59,108.63,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,outpatient,1,EA,111.99000,106.39000,The Alliance,PPO Network,,93.06,,,,,,,1.44,108.63,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,inpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,inpatient,1,EA,6.36000,6.04000,The Alliance,PPO Network,,5.29,,,,,,,3.50,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,outpatient,1,EA,6.36000,6.04000,The Alliance,PPO Network,,5.29,,,,,,,3.18,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,The Alliance,PPO Network,,4.86,,,,,,,3.22,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,PPO Network,,4.86,,,,,,,2.92,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,inpatient,1,EA,7.81000,7.42000,The Alliance,PPO Network,,6.49,,,,,,,4.30,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,outpatient,1,EA,7.81000,7.42000,The Alliance,PPO Network,,6.49,,,,,,,3.90,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,inpatient,1,mL,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.77,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,0.13795,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,inpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,0.13795,2.91,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,inpatient,1,EA,7.11000,6.76000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,outpatient,1,EA,7.11000,6.76000,The Alliance,PPO Network,,5.91,,,,,,,3.56,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,inpatient,1,EA,7.60000,7.22000,The Alliance,PPO Network,,6.32,,,,,,,4.18,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,outpatient,1,EA,7.60000,7.22000,The Alliance,PPO Network,,6.32,,,,,,,3.80,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,inpatient,1,EA,6.75000,6.41000,The Alliance,PPO Network,,5.61,,,,,,,3.71,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,outpatient,1,EA,6.75000,6.41000,The Alliance,PPO Network,,5.61,,,,,,,3.38,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,The Alliance,PPO Network,,5.07,,,,,,,3.35,5.92,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,PPO Network,,5.07,,,,,,,3.05,5.92,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,inpatient,1,EA,20.67000,19.64000,The Alliance,PPO Network,,17.18,,,,,,,11.37,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,outpatient,1,EA,20.67000,19.64000,The Alliance,PPO Network,,17.18,,,,,,,10.34,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,inpatient,1,EA,13.02000,12.37000,The Alliance,PPO Network,,10.82,,,,,,,7.16,12.63,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,outpatient,1,EA,13.02000,12.37000,The Alliance,PPO Network,,10.82,,,,,,,6.51,12.63,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,inpatient,1,EA,6.07000,5.77000,The Alliance,PPO Network,,5.04,,,,,,,3.34,5.89,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,outpatient,1,EA,6.07000,5.77000,The Alliance,PPO Network,,5.04,,,,,,,3.04,5.89,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,inpatient,1,EA,8.07000,7.67000,The Alliance,PPO Network,,6.71,,,,,,,4.44,7.83,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,outpatient,1,EA,8.07000,7.67000,The Alliance,PPO Network,,6.71,,,,,,,4.04,7.83,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,inpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,inpatient,1,mL,46.48000,44.15000,The Alliance,PPO Network,,38.62,,,,,,,25.56,45.09,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,outpatient,1,mL,46.48000,44.15000,The Alliance,PPO Network,,38.62,,,,,,,23.24,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,inpatient,1,mL,51.07000,48.51000,The Alliance,PPO Network,,42.44,,,,,,,28.09,49.54,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,outpatient,1,mL,51.07000,48.51000,The Alliance,PPO Network,,42.44,,,,,,,25.54,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,inpatient,1,mL,41.78000,39.69000,The Alliance,PPO Network,,34.72,,,,,,,22.98,40.53,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,outpatient,1,mL,41.78000,39.69000,The Alliance,PPO Network,,34.72,,,,,,,20.89,123.35,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,inpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,inpatient,1,EA,10.68000,10.15000,The Alliance,PPO Network,,8.88,,,,,,,5.87,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,PPO Network,,8.88,,,,,,,5.34,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,5.29,9.32,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,PPO Network,,7.99,,,,,,,4.80,9.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,inpatient,1,mL,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,83.42,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,PPO Network,,126.05,,,,,,,0.91450,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,inpatient,1,mL,121.98000,115.88000,The Alliance,PPO Network,,101.37,,,,,,,67.09,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,outpatient,1,mL,121.98000,115.88000,The Alliance,PPO Network,,101.37,,,,,,,0.91450,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,inpatient,1,mL,314.03000,298.33000,The Alliance,PPO Network,,260.96,,,,,,,172.72,304.61,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,outpatient,1,mL,314.03000,298.33000,The Alliance,PPO Network,,260.96,,,,,,,0.91450,304.61,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,inpatient,1,EA,279.66000,265.68000,The Alliance,PPO Network,,232.40,,,,,,,153.81,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,outpatient,1,EA,279.66000,265.68000,The Alliance,PPO Network,,232.40,,,,,,,0.47275,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,inpatient,1,EA,233.84000,222.15000,The Alliance,PPO Network,,194.32,,,,,,,128.61,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,outpatient,1,EA,233.84000,222.15000,The Alliance,PPO Network,,194.32,,,,,,,0.47275,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,inpatient,1,EA,229.10000,217.64000,The Alliance,PPO Network,,190.38,,,,,,,126.00,222.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,outpatient,1,EA,229.10000,217.64000,The Alliance,PPO Network,,190.38,,,,,,,0.47275,222.23,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,The Alliance,PPO Network,,7.55,,,,,,,4.99,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,PPO Network,,7.55,,,,,,,4.54,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.57,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,PPO Network,,6.90,,,,,,,4.15,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,inpatient,1,EA,287.00000,272.65000,The Alliance,PPO Network,,238.50,,,,,,,157.85,278.39,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,outpatient,1,EA,287.00000,272.65000,The Alliance,PPO Network,,238.50,,,,,,,143.50,278.39,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,inpatient,1,EA,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.55,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,outpatient,1,EA,4.63000,4.40000,The Alliance,PPO Network,,3.85,,,,,,,2.31,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,inpatient,1,EA,9.26000,8.80000,The Alliance,PPO Network,,7.70,,,,,,,5.09,8.98,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,outpatient,1,EA,9.26000,8.80000,The Alliance,PPO Network,,7.70,,,,,,,4.63,8.98,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,inpatient,1,EA,41.11000,39.06000,The Alliance,PPO Network,,34.16,,,,,,,22.61,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,outpatient,1,EA,41.11000,39.06000,The Alliance,PPO Network,,34.16,,,,,,,20.55,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,inpatient,1,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.58,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,PPO Network,,3.90,,,,,,,2.35,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.78,3.13,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.13,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,inpatient,1,mL,13.34000,12.67000,The Alliance,PPO Network,,11.09,,,,,,,7.34,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,outpatient,1,mL,13.34000,12.67000,The Alliance,PPO Network,,11.09,,,,,,,0.91450,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,inpatient,1,mL,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,4.10,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,PPO Network,,6.20,,,,,,,0.91450,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,inpatient,1,mL,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,17.26,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,outpatient,1,mL,31.38000,29.81000,The Alliance,PPO Network,,26.08,,,,,,,0.91450,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,inpatient,1,mL,12.34000,11.73000,The Alliance,PPO Network,,10.25,,,,,,,6.79,11.97,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,outpatient,1,mL,12.34000,11.73000,The Alliance,PPO Network,,10.25,,,,,,,0.91450,11.97,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,inpatient,1,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,4.06,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,outpatient,1,EA,7.38000,7.01000,The Alliance,PPO Network,,6.13,,,,,,,3.69,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,inpatient,1,EA,8.84000,8.40000,The Alliance,PPO Network,,7.35,,,,,,,4.86,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,outpatient,1,EA,8.84000,8.40000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,The Alliance,PPO Network,,6.02,,,,,,,3.98,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,PPO Network,,6.02,,,,,,,3.62,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.81950,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,PPO Network,,1.24,,,,,,,0.74500,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,The Alliance,PPO Network,,7.61,,,,,,,5.04,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,PPO Network,,7.61,,,,,,,4.58,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,inpatient,1,EA,8.12000,7.72000,The Alliance,PPO Network,,6.75,,,,,,,4.47,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,outpatient,1,EA,8.12000,7.72000,The Alliance,PPO Network,,6.75,,,,,,,4.06,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.21,2.13,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.10,2.13,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,inpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.78,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,PPO Network,,7.22,,,,,,,4.34,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,inpatient,1,EA,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,140.80,248.32,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,outpatient,1,EA,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,128.00,248.32,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,The Alliance,PPO Network,,148.57,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,PPO Network,,148.57,,,,,,,89.39,173.43,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,inpatient,1,mL,19.62000,18.64000,The Alliance,PPO Network,,16.30,,,,,,,10.79,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,outpatient,1,mL,19.62000,18.64000,The Alliance,PPO Network,,16.30,,,,,,,9.81,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,inpatient,1,mL,8.01000,7.61000,The Alliance,PPO Network,,6.66,,,,,,,4.41,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,outpatient,1,mL,8.01000,7.61000,The Alliance,PPO Network,,6.66,,,,,,,4.00,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,inpatient,1,mL,6.69000,6.36000,The Alliance,PPO Network,,5.56,,,,,,,3.68,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,outpatient,1,mL,6.69000,6.36000,The Alliance,PPO Network,,5.56,,,,,,,3.35,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,inpatient,1,mL,31.50000,29.92000,The Alliance,PPO Network,,26.18,,,,,,,17.32,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,outpatient,1,mL,31.50000,29.92000,The Alliance,PPO Network,,26.18,,,,,,,15.75,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,inpatient,1,mL,19.63000,18.65000,The Alliance,PPO Network,,16.31,,,,,,,10.80,19.04,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,outpatient,1,mL,19.63000,18.65000,The Alliance,PPO Network,,16.31,,,,,,,9.81,19.04,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,The Alliance,PPO Network,,148.57,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,PPO Network,,148.57,,,,,,,89.39,173.43,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,inpatient,1,EA,4.90000,4.66000,The Alliance,PPO Network,,4.07,,,,,,,2.69,4.75,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,outpatient,1,EA,4.90000,4.66000,The Alliance,PPO Network,,4.07,,,,,,,2.45,4.75,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,inpatient,1,mL,5.08000,4.83000,The Alliance,PPO Network,,4.22,,,,,,,2.79,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,outpatient,1,mL,5.08000,4.83000,The Alliance,PPO Network,,4.22,,,,,,,2.54,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,inpatient,1,mL,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,outpatient,1,mL,2.09000,1.99000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,inpatient,1,mL,10.62000,10.09000,The Alliance,PPO Network,,8.83,,,,,,,5.84,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,outpatient,1,mL,10.62000,10.09000,The Alliance,PPO Network,,8.83,,,,,,,0.17611,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,inpatient,1,mL,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,2.93,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,outpatient,1,mL,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,0.17611,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,inpatient,1,mL,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,0.17611,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,0.17611,4.91,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,The Alliance,PPO Network,,280.00,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,PPO Network,,280.00,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,The Alliance,PPO Network,,280.00,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,PPO Network,,280.00,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,inpatient,1,EA,348.70000,331.27000,The Alliance,PPO Network,,289.77,,,,,,,191.78,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,outpatient,1,EA,348.70000,331.27000,The Alliance,PPO Network,,289.77,,,,,,,174.35,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,inpatient,1,EA,316.63000,300.80000,The Alliance,PPO Network,,263.12,,,,,,,174.15,307.13,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,outpatient,1,EA,316.63000,300.80000,The Alliance,PPO Network,,263.12,,,,,,,158.31,307.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,inpatient,1,EA,5.91000,5.61000,The Alliance,PPO Network,,4.91,,,,,,,3.25,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,outpatient,1,EA,5.91000,5.61000,The Alliance,PPO Network,,4.91,,,,,,,2.96,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,inpatient,1,EA,3.52000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,outpatient,1,EA,3.52000,3.35000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,inpatient,1,mL,7116.49000,6760.67000,The Alliance,PPO Network,,5913.80,,,,,,,3914.07,6903.00,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,outpatient,1,mL,7116.49000,6760.67000,The Alliance,PPO Network,,5913.80,,,,,,,719.87,6903.00,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,inpatient,1,mL,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,2.05,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,outpatient,1,mL,3.73000,3.54000,The Alliance,PPO Network,,3.10,,,,,,,1.86,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,inpatient,1,mL,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,4.23,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,inpatient,1,EA,9.67000,9.18000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,PPO Network,,8.04,,,,,,,4.83,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,inpatient,1,EA,8.54000,8.12000,The Alliance,PPO Network,,7.10,,,,,,,4.70,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,outpatient,1,EA,8.54000,8.12000,The Alliance,PPO Network,,7.10,,,,,,,4.27,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,inpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,PPO Network,,1.06,,,,,,,0.13795,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,inpatient,1,mL,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.13795,1.56,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,inpatient,1,mL,8.73000,8.29000,The Alliance,PPO Network,,7.25,,,,,,,4.80,8.47,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,outpatient,1,mL,8.73000,8.29000,The Alliance,PPO Network,,7.25,,,,,,,4.37,8.47,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,inpatient,1,mL,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,13.56,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,12.32,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,inpatient,1,mL,25.06000,23.81000,The Alliance,PPO Network,,20.82,,,,,,,13.78,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,outpatient,1,mL,25.06000,23.81000,The Alliance,PPO Network,,20.82,,,,,,,12.53,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,20.47,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,inpatient,1,mL,25.91000,24.62000,The Alliance,PPO Network,,21.53,,,,,,,14.25,25.13,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,outpatient,1,mL,25.91000,24.62000,The Alliance,PPO Network,,21.53,,,,,,,12.96,25.13,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,inpatient,1,EA,374.26000,355.54000,The Alliance,PPO Network,,311.01,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,PPO Network,,311.01,,,,,,,187.13,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,inpatient,1,EA,308.73000,293.30000,The Alliance,PPO Network,,256.55,,,,,,,169.80,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,outpatient,1,EA,308.73000,293.30000,The Alliance,PPO Network,,256.55,,,,,,,154.37,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,inpatient,1,EA,432.25000,410.63000,The Alliance,PPO Network,,359.20,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,PPO Network,,359.20,,,,,,,216.12,419.28,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,inpatient,1,EA,20.64000,19.61000,The Alliance,PPO Network,,17.15,,,,,,,11.35,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,outpatient,1,EA,20.64000,19.61000,The Alliance,PPO Network,,17.15,,,,,,,10.32,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,inpatient,1,EA,20.17000,19.16000,The Alliance,PPO Network,,16.76,,,,,,,11.09,19.56,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,outpatient,1,EA,20.17000,19.16000,The Alliance,PPO Network,,16.76,,,,,,,10.09,19.56,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,inpatient,1,EA,45.34000,43.07000,The Alliance,PPO Network,,37.68,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,PPO Network,,37.68,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,inpatient,1,EA,0.41000,0.38000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,outpatient,1,EA,0.41000,0.38000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,inpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,inpatient,1,EA,20.77000,19.73000,The Alliance,PPO Network,,17.26,,,,,,,11.42,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,outpatient,1,EA,20.77000,19.73000,The Alliance,PPO Network,,17.26,,,,,,,10.38,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,inpatient,1,EA,13.45000,12.78000,The Alliance,PPO Network,,11.18,,,,,,,7.40,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,outpatient,1,EA,13.45000,12.78000,The Alliance,PPO Network,,11.18,,,,,,,6.72,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,inpatient,1,EA,25.32000,24.06000,The Alliance,PPO Network,,21.04,,,,,,,13.93,24.56,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,outpatient,1,EA,25.32000,24.06000,The Alliance,PPO Network,,21.04,,,,,,,12.66,24.56,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,inpatient,1,GM,67.76000,64.37000,The Alliance,PPO Network,,56.31,,,,,,,37.27,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,outpatient,1,GM,67.76000,64.37000,The Alliance,PPO Network,,56.31,,,,,,,33.88,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,inpatient,1,GM,51.80000,49.21000,The Alliance,PPO Network,,43.05,,,,,,,28.49,50.25,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,outpatient,1,GM,51.80000,49.21000,The Alliance,PPO Network,,43.05,,,,,,,25.90,50.25,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,36.93,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,PPO Network,,55.80,,,,,,,33.58,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,inpatient,1,EA,5.06000,4.81000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,outpatient,1,EA,5.06000,4.81000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,inpatient,1,EA,22.94000,21.79000,The Alliance,PPO Network,,19.06,,,,,,,12.62,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,outpatient,1,EA,22.94000,21.79000,The Alliance,PPO Network,,19.06,,,,,,,11.47,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,inpatient,1,mL,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.96,3.46,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,outpatient,1,mL,3.57000,3.39000,The Alliance,PPO Network,,2.97,,,,,,,1.78,3.46,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,inpatient,1,GM,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,outpatient,1,GM,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,inpatient,1,EA,279.39000,265.42000,The Alliance,PPO Network,,232.17,,,,,,,153.66,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,outpatient,1,EA,279.39000,265.42000,The Alliance,PPO Network,,232.17,,,,,,,139.69,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,inpatient,1,EA,621.55000,590.47000,The Alliance,PPO Network,,516.51,,,,,,,341.85,602.90,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,outpatient,1,EA,621.55000,590.47000,The Alliance,PPO Network,,516.51,,,,,,,310.77,602.90,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,inpatient,1,mL,107.32000,101.96000,The Alliance,PPO Network,,89.18,,,,,,,59.03,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,outpatient,1,mL,107.32000,101.96000,The Alliance,PPO Network,,89.18,,,,,,,37.52,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,inpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,37.52,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,inpatient,1,EA,7.64000,7.26000,The Alliance,PPO Network,,6.35,,,,,,,4.20,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,outpatient,1,EA,7.64000,7.26000,The Alliance,PPO Network,,6.35,,,,,,,3.82,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,inpatient,1,mL,4.64000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.55,4.50,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.32,4.50,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,inpatient,1,EA,14.24000,13.53000,The Alliance,PPO Network,,11.83,,,,,,,7.83,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,outpatient,1,EA,14.24000,13.53000,The Alliance,PPO Network,,11.83,,,,,,,7.12,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,inpatient,1,EA,4.58000,4.36000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,outpatient,1,EA,4.58000,4.36000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.59,4.57,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,PPO Network,,3.91,,,,,,,2.35,4.57,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,inpatient,1,mL,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.46,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,outpatient,1,mL,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,0.01601,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,inpatient,1,mL,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,outpatient,1,mL,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.01601,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,inpatient,1,mL,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.01601,1.44,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,inpatient,1,mL,4.83000,4.58000,The Alliance,PPO Network,,4.01,,,,,,,2.66,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,outpatient,1,mL,4.83000,4.58000,The Alliance,PPO Network,,4.01,,,,,,,0.17611,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,inpatient,1,mL,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,PPO Network,,6.79,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,inpatient,1,mL,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,4.11,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,0.17611,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,inpatient,1,mL,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,1.77,3.11,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,PPO Network,,2.67,,,,,,,0.17611,3.11,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,inpatient,,,482.51000,458.38000,The Alliance,PPO Network,,400.97,,,,,,,265.38,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,outpatient,,,482.51000,458.38000,The Alliance,PPO Network,,400.97,,,,,,,51.13,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,inpatient,1,mL,965.01000,916.76000,The Alliance,PPO Network,,801.92,,,,,,,530.76,936.06,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,outpatient,1,mL,965.01000,916.76000,The Alliance,PPO Network,,801.92,,,,,,,51.13,936.06,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,inpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,inpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.78650,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,PPO Network,,1.19,,,,,,,0.53900,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,inpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,2.43,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,PPO Network,,3.66,,,,,,,0.53900,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,0.53900,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,inpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,inpatient,1,EA,21.70000,20.61000,The Alliance,PPO Network,,18.03,,,,,,,11.94,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,outpatient,1,EA,21.70000,20.61000,The Alliance,PPO Network,,18.03,,,,,,,1.73,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,inpatient,1,EA,21.71000,20.62000,The Alliance,PPO Network,,18.04,,,,,,,11.94,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,outpatient,1,EA,21.71000,20.62000,The Alliance,PPO Network,,18.04,,,,,,,1.73,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,inpatient,1,EA,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,12.81,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,outpatient,1,EA,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,1.73,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,inpatient,1,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,16.08,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,outpatient,1,EA,29.23000,27.77000,The Alliance,PPO Network,,24.29,,,,,,,1.73,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,1.73,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,inpatient,1,EA,29.22000,27.76000,The Alliance,PPO Network,,24.28,,,,,,,16.07,28.34,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,outpatient,1,EA,29.22000,27.76000,The Alliance,PPO Network,,24.28,,,,,,,1.73,28.34,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,inpatient,1,mL,50.03000,47.53000,The Alliance,PPO Network,,41.57,,,,,,,27.52,48.53,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,outpatient,1,mL,50.03000,47.53000,The Alliance,PPO Network,,41.57,,,,,,,1.68,48.53,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,The Alliance,PPO Network,,5.42,,,,,,,3.59,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,PPO Network,,5.42,,,,,,,3.26,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,inpatient,1,mL,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,inpatient,1,GM,31.50000,29.92000,The Alliance,PPO Network,,26.18,,,,,,,17.32,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,outpatient,1,GM,31.50000,29.92000,The Alliance,PPO Network,,26.18,,,,,,,15.75,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,inpatient,1,GM,25.68000,24.39000,The Alliance,PPO Network,,21.34,,,,,,,14.12,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,outpatient,1,GM,25.68000,24.39000,The Alliance,PPO Network,,21.34,,,,,,,12.84,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,inpatient,1,GM,26.72000,25.38000,The Alliance,PPO Network,,22.20,,,,,,,14.70,25.92,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,outpatient,1,GM,26.72000,25.38000,The Alliance,PPO Network,,22.20,,,,,,,13.36,25.92,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,inpatient,1,mL,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,0.27217,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.27217,1.77,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.34860,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,inpatient,1,mL,14.25000,13.53000,The Alliance,PPO Network,,11.84,,,,,,,7.84,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,outpatient,1,mL,14.25000,13.53000,The Alliance,PPO Network,,11.84,,,,,,,7.12,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,inpatient,1,mL,17.81000,16.92000,The Alliance,PPO Network,,14.80,,,,,,,9.80,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,outpatient,1,mL,17.81000,16.92000,The Alliance,PPO Network,,14.80,,,,,,,8.90,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,inpatient,1,mL,16.76000,15.92000,The Alliance,PPO Network,,13.93,,,,,,,9.22,16.26,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,outpatient,1,mL,16.76000,15.92000,The Alliance,PPO Network,,13.93,,,,,,,8.38,16.26,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,inpatient,1,EA,678.29000,644.37000,The Alliance,PPO Network,,563.66,,,,,,,373.06,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,outpatient,1,EA,678.29000,644.37000,The Alliance,PPO Network,,563.66,,,,,,,339.14,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,inpatient,1,EA,34.13000,32.42000,The Alliance,PPO Network,,28.36,,,,,,,18.77,33.11,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,outpatient,1,EA,34.13000,32.42000,The Alliance,PPO Network,,28.36,,,,,,,17.07,33.11,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,inpatient,1,mL,972.04000,923.43000,The Alliance,PPO Network,,807.77,,,,,,,534.62,942.88,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,outpatient,1,mL,972.04000,923.43000,The Alliance,PPO Network,,807.77,,,,,,,486.02,942.88,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,inpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,inpatient,1,EA,4.82000,4.58000,The Alliance,PPO Network,,4.01,,,,,,,2.65,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,outpatient,1,EA,4.82000,4.58000,The Alliance,PPO Network,,4.01,,,,,,,2.41,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.75,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.59,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,inpatient,1,EA,30.51000,28.98000,The Alliance,PPO Network,,25.35,,,,,,,16.78,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,outpatient,1,EA,30.51000,28.98000,The Alliance,PPO Network,,25.35,,,,,,,0.27217,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,inpatient,1,EA,22.79000,21.65000,The Alliance,PPO Network,,18.94,,,,,,,12.53,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,outpatient,1,EA,22.79000,21.65000,The Alliance,PPO Network,,18.94,,,,,,,0.27217,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,inpatient,1,EA,8.94000,8.50000,The Alliance,PPO Network,,7.43,,,,,,,4.92,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,outpatient,1,EA,8.94000,8.50000,The Alliance,PPO Network,,7.43,,,,,,,0.27217,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,inpatient,1,EA,23.98000,22.79000,The Alliance,PPO Network,,19.93,,,,,,,13.19,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,outpatient,1,EA,23.98000,22.79000,The Alliance,PPO Network,,19.93,,,,,,,0.27217,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,inpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,9.56,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,PPO Network,,14.44,,,,,,,0.27217,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,5.53,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,0.27217,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,inpatient,1,EA,17.06000,16.21000,The Alliance,PPO Network,,14.18,,,,,,,9.38,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,outpatient,1,EA,17.06000,16.21000,The Alliance,PPO Network,,14.18,,,,,,,0.27217,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,inpatient,1,EA,8.88000,8.44000,The Alliance,PPO Network,,7.38,,,,,,,4.88,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,outpatient,1,EA,8.88000,8.44000,The Alliance,PPO Network,,7.38,,,,,,,0.27217,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,inpatient,1,EA,10.33000,9.82000,The Alliance,PPO Network,,8.58,,,,,,,5.68,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,PPO Network,,8.58,,,,,,,0.27217,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,inpatient,1,EA,7.14000,6.78000,The Alliance,PPO Network,,5.93,,,,,,,3.93,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,PPO Network,,5.93,,,,,,,0.27217,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,inpatient,1,EA,4.78000,4.54000,The Alliance,PPO Network,,3.97,,,,,,,2.63,4.64,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,PPO Network,,3.97,,,,,,,0.27217,4.64,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,inpatient,1,EA,5.71000,5.42000,The Alliance,PPO Network,,4.75,,,,,,,3.14,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,PPO Network,,4.75,,,,,,,2.85,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,4.08,7.20,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,PPO Network,,6.17,,,,,,,3.71,7.20,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,inpatient,1,EA,36.01000,34.21000,The Alliance,PPO Network,,29.92,,,,,,,19.81,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,outpatient,1,EA,36.01000,34.21000,The Alliance,PPO Network,,29.92,,,,,,,18.00,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,inpatient,1,mL,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,outpatient,1,mL,1.24000,1.17000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,inpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,inpatient,1,mL,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,28.68,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,outpatient,1,mL,52.14000,49.53000,The Alliance,PPO Network,,43.33,,,,,,,26.07,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,inpatient,1,mL,35.71000,33.92000,The Alliance,PPO Network,,29.68,,,,,,,19.64,34.64,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,outpatient,1,mL,35.71000,33.92000,The Alliance,PPO Network,,29.68,,,,,,,17.86,34.64,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,inpatient,1,mL,43.32000,41.16000,The Alliance,PPO Network,,36.00,,,,,,,23.83,42.02,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,outpatient,1,mL,43.32000,41.16000,The Alliance,PPO Network,,36.00,,,,,,,21.66,42.02,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,PPO Network,,2.19,,,,,,,1.32,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,inpatient,1,mL,114.96000,109.22000,The Alliance,PPO Network,,95.53,,,,,,,63.23,111.51,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,outpatient,1,mL,114.96000,109.22000,The Alliance,PPO Network,,95.53,,,,,,,57.48,472.00,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,inpatient,1,mL,777.00000,738.15000,The Alliance,PPO Network,,645.69,,,,,,,427.35,753.69,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,outpatient,1,mL,777.00000,738.15000,The Alliance,PPO Network,,645.69,,,,,,,194.32,753.69,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,inpatient,1,EA,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,2.93,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,outpatient,1,EA,5.32000,5.06000,The Alliance,PPO Network,,4.42,,,,,,,2.66,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.33,4.10,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,PPO Network,,3.52,,,,,,,2.12,4.10,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,The Alliance,PPO Network,,29.67,,,,,,,19.64,34.63,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,PPO Network,,29.67,,,,,,,17.85,34.63,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,inpatient,1,EA,22.83000,21.69000,The Alliance,PPO Network,,18.97,,,,,,,12.56,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,outpatient,1,EA,22.83000,21.69000,The Alliance,PPO Network,,18.97,,,,,,,0.43227,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,inpatient,1,EA,48.81000,46.37000,The Alliance,PPO Network,,40.56,,,,,,,26.85,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,outpatient,1,EA,48.81000,46.37000,The Alliance,PPO Network,,40.56,,,,,,,0.43227,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,inpatient,1,EA,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,outpatient,1,EA,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,0.43227,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,inpatient,1,EA,44.24000,42.03000,The Alliance,PPO Network,,36.76,,,,,,,24.33,42.91,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,outpatient,1,EA,44.24000,42.03000,The Alliance,PPO Network,,36.76,,,,,,,0.43227,42.91,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,inpatient,1,mL,7537.53000,7160.66000,The Alliance,PPO Network,,6263.69,,,,,,,4145.64,7311.40,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,outpatient,1,mL,7537.53000,7160.66000,The Alliance,PPO Network,,6263.69,,,,,,,719.87,7311.40,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,The Alliance,PPO Network,,5.97,,,,,,,3.95,6.97,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,PPO Network,,5.97,,,,,,,3.60,6.97,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.46,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.44,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,PPO Network,,3.69,,,,,,,2.22,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,inpatient,1,EA,7.62000,7.23000,The Alliance,PPO Network,,6.33,,,,,,,4.19,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,outpatient,1,EA,7.62000,7.23000,The Alliance,PPO Network,,6.33,,,,,,,3.81,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.54,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,PPO Network,,8.38,,,,,,,5.04,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,inpatient,1,mL,7.82000,7.43000,The Alliance,PPO Network,,6.50,,,,,,,4.30,7.59,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,outpatient,1,mL,7.82000,7.43000,The Alliance,PPO Network,,6.50,,,,,,,3.91,7.59,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,inpatient,1,EA,6.65000,6.31000,The Alliance,PPO Network,,5.53,,,,,,,3.66,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,outpatient,1,EA,6.65000,6.31000,The Alliance,PPO Network,,5.53,,,,,,,3.33,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.77550,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,PPO Network,,1.17,,,,,,,0.70500,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.33550,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,PPO Network,,0.50691,,,,,,,0.30500,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,inpatient,1,mL,12088.99000,11484.54000,The Alliance,PPO Network,,10045.95,,,,,,,6648.94,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,outpatient,1,mL,12088.99000,11484.54000,The Alliance,PPO Network,,10045.95,,,,,,,38.71,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,inpatient,1,mL,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1518.00,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,outpatient,1,mL,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,38.71,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,inpatient,1,mL,1079.15000,1025.19000,The Alliance,PPO Network,,896.77,,,,,,,593.53,1046.78,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,outpatient,1,mL,1079.15000,1025.19000,The Alliance,PPO Network,,896.77,,,,,,,38.71,1046.78,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,inpatient,1,mL,15.36000,14.59000,The Alliance,PPO Network,,12.76,,,,,,,8.45,14.90,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,outpatient,1,mL,15.36000,14.59000,The Alliance,PPO Network,,12.76,,,,,,,7.68,14.90,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,inpatient,1,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.00620,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.00620,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.00620,0.37830,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,inpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.32,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,inpatient,1,mL,14.54000,13.81000,The Alliance,PPO Network,,12.08,,,,,,,8.00,14.10,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,outpatient,1,mL,14.54000,13.81000,The Alliance,PPO Network,,12.08,,,,,,,7.27,14.10,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.16,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,PPO Network,,2.78,,,,,,,1.67,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.39,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,inpatient,1,mL,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,3.12,5.51,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,outpatient,1,mL,5.68000,5.39000,The Alliance,PPO Network,,4.72,,,,,,,2.84,5.51,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,inpatient,1,EA,216.55000,205.73000,The Alliance,PPO Network,,179.95,,,,,,,119.10,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,outpatient,1,EA,216.55000,205.73000,The Alliance,PPO Network,,179.95,,,,,,,108.28,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,inpatient,1,EA,95.56000,90.78000,The Alliance,PPO Network,,79.41,,,,,,,52.56,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,outpatient,1,EA,95.56000,90.78000,The Alliance,PPO Network,,79.41,,,,,,,47.78,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,inpatient,1,EA,149.05000,141.59000,The Alliance,PPO Network,,123.86,,,,,,,81.98,144.58,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,outpatient,1,EA,149.05000,141.59000,The Alliance,PPO Network,,123.86,,,,,,,74.53,144.58,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,inpatient,1,EA,309.43000,293.96000,The Alliance,PPO Network,,257.14,,,,,,,170.19,300.15,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,outpatient,1,EA,309.43000,293.96000,The Alliance,PPO Network,,257.14,,,,,,,154.72,300.15,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,inpatient,1,EA,3.50000,3.32000,The Alliance,PPO Network,,2.91,,,,,,,1.93,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,PPO Network,,2.91,,,,,,,0.73040,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,inpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,inpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.73040,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,inpatient,1,EA,86.34000,82.02000,The Alliance,PPO Network,,71.75,,,,,,,47.49,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,outpatient,1,EA,86.34000,82.02000,The Alliance,PPO Network,,71.75,,,,,,,43.17,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,inpatient,1,EA,50.96000,48.41000,The Alliance,PPO Network,,42.35,,,,,,,28.03,49.43,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,outpatient,1,EA,50.96000,48.41000,The Alliance,PPO Network,,42.35,,,,,,,25.48,49.43,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,inpatient,1,EA,10.61000,10.08000,The Alliance,PPO Network,,8.82,,,,,,,5.84,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,outpatient,1,EA,10.61000,10.08000,The Alliance,PPO Network,,8.82,,,,,,,5.30,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,inpatient,1,EA,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.90,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,outpatient,1,EA,3.45000,3.28000,The Alliance,PPO Network,,2.87,,,,,,,1.73,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,The Alliance,PPO Network,,22.54,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,PPO Network,,22.54,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,inpatient,1,GM,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,outpatient,1,GM,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,inpatient,1,EA,23.14000,21.98000,The Alliance,PPO Network,,19.23,,,,,,,12.73,22.45,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,outpatient,1,EA,23.14000,21.98000,The Alliance,PPO Network,,19.23,,,,,,,11.57,22.45,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.79200,1.40,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,PPO Network,,1.20,,,,,,,0.72000,1.40,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,inpatient,1,EA,20.66000,19.63000,The Alliance,PPO Network,,17.17,,,,,,,11.36,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,outpatient,1,EA,20.66000,19.63000,The Alliance,PPO Network,,17.17,,,,,,,10.33,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,inpatient,1,EA,14.28000,13.57000,The Alliance,PPO Network,,11.87,,,,,,,7.85,13.85,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,outpatient,1,EA,14.28000,13.57000,The Alliance,PPO Network,,11.87,,,,,,,7.14,13.85,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,inpatient,1,EA,27.09000,25.73000,The Alliance,PPO Network,,22.51,,,,,,,14.90,26.28,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,outpatient,1,EA,27.09000,25.73000,The Alliance,PPO Network,,22.51,,,,,,,13.54,26.28,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.23,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,PPO Network,,1.85,,,,,,,1.11,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,PPO Network,,1.84,,,,,,,1.11,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,4.26,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,PPO Network,,6.43,,,,,,,3.87,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,inpatient,1,EA,10.76000,10.23000,The Alliance,PPO Network,,8.94,,,,,,,5.92,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,outpatient,1,EA,10.76000,10.23000,The Alliance,PPO Network,,8.94,,,,,,,5.38,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,inpatient,1,EA,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,3.21,5.66,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,PPO Network,,4.85,,,,,,,2.92,5.66,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,inpatient,1,EA,47426.37000,45055.05000,The Alliance,PPO Network,,39411.31,,,,,,,26084.50,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,outpatient,1,EA,47426.37000,45055.05000,The Alliance,PPO Network,,39411.31,,,,,,,23713.19,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,inpatient,1,EA,38000.00000,36100.00000,The Alliance,PPO Network,,31578.00,,,,,,,20900.00,36860.00,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,outpatient,1,EA,38000.00000,36100.00000,The Alliance,PPO Network,,31578.00,,,,,,,19000.00,36860.00,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.10,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.76,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,PPO Network,,4.17,,,,,,,2.51,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.77,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,PPO Network,,4.18,,,,,,,2.52,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,PPO Network,,6.81,,,,,,,4.10,7.95,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,inpatient,1,EA,18.52000,17.59000,The Alliance,PPO Network,,15.39,,,,,,,10.19,17.96,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,outpatient,1,EA,18.52000,17.59000,The Alliance,PPO Network,,15.39,,,,,,,9.26,17.96,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,inpatient,1,EA,9.35000,8.89000,The Alliance,PPO Network,,7.77,,,,,,,5.14,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,outpatient,1,EA,9.35000,8.89000,The Alliance,PPO Network,,7.77,,,,,,,4.67,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,inpatient,1,EA,18.11000,17.21000,The Alliance,PPO Network,,15.05,,,,,,,9.96,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,outpatient,1,EA,18.11000,17.21000,The Alliance,PPO Network,,15.05,,,,,,,9.05,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,inpatient,1,EA,2062.94000,1959.79000,The Alliance,PPO Network,,1714.30,,,,,,,1134.62,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,outpatient,1,EA,2062.94000,1959.79000,The Alliance,PPO Network,,1714.30,,,,,,,10.94,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,inpatient,1,EA,2387.67000,2268.29000,The Alliance,PPO Network,,1984.15,,,,,,,1313.22,2316.04,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,outpatient,1,EA,2387.67000,2268.29000,The Alliance,PPO Network,,1984.15,,,,,,,10.94,2316.04,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,inpatient,1,EA,43.45000,41.27000,The Alliance,PPO Network,,36.11,,,,,,,23.90,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,outpatient,1,EA,43.45000,41.27000,The Alliance,PPO Network,,36.11,,,,,,,21.73,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,inpatient,1,EA,75.34000,71.58000,The Alliance,PPO Network,,62.61,,,,,,,41.44,73.08,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,outpatient,1,EA,75.34000,71.58000,The Alliance,PPO Network,,62.61,,,,,,,37.67,73.08,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,inpatient,1,EA,256.79000,243.95000,The Alliance,PPO Network,,213.39,,,,,,,141.23,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,outpatient,1,EA,256.79000,243.95000,The Alliance,PPO Network,,213.39,,,,,,,128.40,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,inpatient,1,EA,35.71000,33.92000,The Alliance,PPO Network,,29.68,,,,,,,19.64,34.64,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,outpatient,1,EA,35.71000,33.92000,The Alliance,PPO Network,,29.68,,,,,,,17.86,34.64,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,inpatient,1,EA,10.73000,10.19000,The Alliance,PPO Network,,8.92,,,,,,,5.90,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,outpatient,1,EA,10.73000,10.19000,The Alliance,PPO Network,,8.92,,,,,,,5.37,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,18.12,35.15,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.90,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.18,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,inpatient,1,EA,4.22000,4.00000,The Alliance,PPO Network,,3.51,,,,,,,2.32,4.09,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,outpatient,1,EA,4.22000,4.00000,The Alliance,PPO Network,,3.51,,,,,,,2.11,4.09,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,inpatient,1,EA,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,outpatient,1,EA,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,inpatient,1,EA,12.91000,12.26000,The Alliance,PPO Network,,10.73,,,,,,,7.10,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,outpatient,1,EA,12.91000,12.26000,The Alliance,PPO Network,,10.73,,,,,,,6.46,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,inpatient,1,EA,6.89000,6.54000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.68,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,outpatient,1,EA,6.89000,6.54000,The Alliance,PPO Network,,5.73,,,,,,,3.44,6.68,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,inpatient,1,mL,789.60000,750.12000,The Alliance,PPO Network,,656.16,,,,,,,434.28,765.91,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,outpatient,1,mL,789.60000,750.12000,The Alliance,PPO Network,,656.16,,,,,,,394.80,765.91,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,inpatient,1,EA,63.19000,60.03000,The Alliance,PPO Network,,52.51,,,,,,,34.75,61.29,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,outpatient,1,EA,63.19000,60.03000,The Alliance,PPO Network,,52.51,,,,,,,31.59,61.29,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,inpatient,1,EA,46.75000,44.41000,The Alliance,PPO Network,,38.85,,,,,,,25.71,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,outpatient,1,EA,46.75000,44.41000,The Alliance,PPO Network,,38.85,,,,,,,23.38,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,inpatient,1,EA,1375.24000,1306.48000,The Alliance,PPO Network,,1142.82,,,,,,,756.38,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,outpatient,1,EA,1375.24000,1306.48000,The Alliance,PPO Network,,1142.82,,,,,,,10.94,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,inpatient,1,EA,1591.71000,1512.12000,The Alliance,PPO Network,,1322.71,,,,,,,875.44,1543.96,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,outpatient,1,EA,1591.71000,1512.12000,The Alliance,PPO Network,,1322.71,,,,,,,10.94,1543.96,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,inpatient,1,EA,2471.39000,2347.82000,The Alliance,PPO Network,,2053.73,,,,,,,1359.26,2397.25,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,outpatient,1,EA,2471.39000,2347.82000,The Alliance,PPO Network,,2053.73,,,,,,,376.48,2397.25,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,inpatient,1,EA,1664.33000,1581.12000,The Alliance,PPO Network,,1383.06,,,,,,,915.38,1614.40,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,outpatient,1,EA,1664.33000,1581.12000,The Alliance,PPO Network,,1383.06,,,,,,,43.79,1614.40,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,inpatient,1,EA,100.29000,95.28000,The Alliance,PPO Network,,83.34,,,,,,,55.16,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,outpatient,1,EA,100.29000,95.28000,The Alliance,PPO Network,,83.34,,,,,,,50.15,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,inpatient,1,EA,44.23000,42.01000,The Alliance,PPO Network,,36.76,,,,,,,24.33,42.90,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,outpatient,1,EA,44.23000,42.01000,The Alliance,PPO Network,,36.76,,,,,,,22.11,42.90,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,inpatient,1,mL,10.78000,10.24000,The Alliance,PPO Network,,8.96,,,,,,,5.93,10.46,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,outpatient,1,mL,10.78000,10.24000,The Alliance,PPO Network,,8.96,,,,,,,5.39,10.46,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,inpatient,1,EA,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,outpatient,1,EA,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,1.54,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,inpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,21.73,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,PPO Network,,32.82,,,,,,,1.54,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,inpatient,1,EA,42.55000,40.42000,The Alliance,PPO Network,,35.36,,,,,,,23.40,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,outpatient,1,EA,42.55000,40.42000,The Alliance,PPO Network,,35.36,,,,,,,1.54,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,inpatient,1,EA,43.10000,40.94000,The Alliance,PPO Network,,35.82,,,,,,,23.70,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,outpatient,1,EA,43.10000,40.94000,The Alliance,PPO Network,,35.82,,,,,,,1.54,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,inpatient,1,EA,43.87000,41.67000,The Alliance,PPO Network,,36.46,,,,,,,24.13,42.55,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,outpatient,1,EA,43.87000,41.67000,The Alliance,PPO Network,,36.46,,,,,,,1.54,42.55,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,inpatient,1,EA,33.47000,31.79000,The Alliance,PPO Network,,27.81,,,,,,,18.41,32.47,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,outpatient,1,EA,33.47000,31.79000,The Alliance,PPO Network,,27.81,,,,,,,16.73,32.47,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,inpatient,1,EA,223.47000,212.29000,The Alliance,PPO Network,,185.70,,,,,,,122.91,216.77,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,outpatient,1,EA,223.47000,212.29000,The Alliance,PPO Network,,185.70,,,,,,,111.73,216.77,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,inpatient,1,EA,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.66,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.51,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,inpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,4.70,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,PPO Network,,7.10,,,,,,,4.27,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,inpatient,1,EA,10.51000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.78,10.19,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,outpatient,1,EA,10.51000,9.98000,The Alliance,PPO Network,,8.73,,,,,,,5.25,10.19,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,PPO Network,,30.12,,,,,,,18.12,35.15,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,3.28,5.79,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,PPO Network,,4.96,,,,,,,2.98,5.79,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,inpatient,1,mL,37.82000,35.92000,The Alliance,PPO Network,,31.43,,,,,,,20.80,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,outpatient,1,mL,37.82000,35.92000,The Alliance,PPO Network,,31.43,,,,,,,18.91,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,inpatient,1,mL,3.18000,3.02000,The Alliance,PPO Network,,2.64,,,,,,,1.75,3.08,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,outpatient,1,mL,3.18000,3.02000,The Alliance,PPO Network,,2.64,,,,,,,1.59,3.08,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,inpatient,1,EA,12.36000,11.74000,The Alliance,PPO Network,,10.27,,,,,,,6.80,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,outpatient,1,EA,12.36000,11.74000,The Alliance,PPO Network,,10.27,,,,,,,6.18,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,The Alliance,PPO Network,,2.97,,,,,,,1.97,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,PPO Network,,2.97,,,,,,,1.79,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,inpatient,1,EA,40.98000,38.93000,The Alliance,PPO Network,,34.05,,,,,,,22.54,39.75,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,outpatient,1,EA,40.98000,38.93000,The Alliance,PPO Network,,34.05,,,,,,,20.49,39.75,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,inpatient,1,EA,641.04000,608.99000,The Alliance,PPO Network,,532.70,,,,,,,352.57,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,outpatient,1,EA,641.04000,608.99000,The Alliance,PPO Network,,532.70,,,,,,,56.09,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,inpatient,1,EA,565.96000,537.66000,The Alliance,PPO Network,,470.31,,,,,,,311.28,548.98,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,outpatient,1,EA,565.96000,537.66000,The Alliance,PPO Network,,470.31,,,,,,,56.09,548.98,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.89100,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,PPO Network,,1.35,,,,,,,0.81000,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,inpatient,1,EA,53.51000,50.83000,The Alliance,PPO Network,,44.47,,,,,,,29.43,51.90,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,outpatient,1,EA,53.51000,50.83000,The Alliance,PPO Network,,44.47,,,,,,,26.75,51.90,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,The Alliance,PPO Network,,5.97,,,,,,,3.95,6.97,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,PPO Network,,5.97,,,,,,,3.60,6.97,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,inpatient,1,EA,5.29000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,2.91,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,outpatient,1,EA,5.29000,5.03000,The Alliance,PPO Network,,4.40,,,,,,,2.65,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,inpatient,1,EA,7.70000,7.32000,The Alliance,PPO Network,,6.40,,,,,,,4.24,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,outpatient,1,EA,7.70000,7.32000,The Alliance,PPO Network,,6.40,,,,,,,3.85,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,inpatient,1,EA,5.01000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.76,4.86,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,outpatient,1,EA,5.01000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.50,4.86,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,inpatient,1,mL,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,outpatient,1,mL,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,inpatient,1,EA,11.15000,10.59000,The Alliance,PPO Network,,9.27,,,,,,,6.13,10.82,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,outpatient,1,EA,11.15000,10.59000,The Alliance,PPO Network,,9.27,,,,,,,5.58,10.82,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,inpatient,1,mL,839.47000,797.49000,The Alliance,PPO Network,,697.60,,,,,,,461.71,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,outpatient,1,mL,839.47000,797.49000,The Alliance,PPO Network,,697.60,,,,,,,266.44,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,inpatient,1,mL,881.44000,837.37000,The Alliance,PPO Network,,732.48,,,,,,,484.79,855.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,outpatient,1,mL,881.44000,837.37000,The Alliance,PPO Network,,732.48,,,,,,,266.44,855.00,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,inpatient,1,EA,40.61000,38.58000,The Alliance,PPO Network,,33.75,,,,,,,22.34,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,outpatient,1,EA,40.61000,38.58000,The Alliance,PPO Network,,33.75,,,,,,,20.30,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,inpatient,1,mL,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,outpatient,1,mL,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,1.54,89.63,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,inpatient,1,mL,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,outpatient,1,mL,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,3.10,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,PPO Network,,4.69,,,,,,,2.82,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,inpatient,1,mL,101.37000,96.30000,The Alliance,PPO Network,,84.24,,,,,,,55.75,98.33,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,outpatient,1,mL,101.37000,96.30000,The Alliance,PPO Network,,84.24,,,,,,,50.69,98.33,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,inpatient,1,GM,24.73000,23.49000,The Alliance,PPO Network,,20.55,,,,,,,13.60,23.99,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,outpatient,1,GM,24.73000,23.49000,The Alliance,PPO Network,,20.55,,,,,,,12.37,23.99,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,inpatient,1,mL,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,5.25,9.25,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,outpatient,1,mL,9.54000,9.06000,The Alliance,PPO Network,,7.93,,,,,,,4.77,9.25,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,inpatient,1,EA,57.87000,54.97000,The Alliance,PPO Network,,48.09,,,,,,,31.83,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,outpatient,1,EA,57.87000,54.97000,The Alliance,PPO Network,,48.09,,,,,,,28.93,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,inpatient,1,EA,46.74000,44.40000,The Alliance,PPO Network,,38.84,,,,,,,25.71,45.34,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,outpatient,1,EA,46.74000,44.40000,The Alliance,PPO Network,,38.84,,,,,,,23.37,45.34,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,inpatient,1,EA,402.97000,382.82000,The Alliance,PPO Network,,334.87,,,,,,,221.63,390.88,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,outpatient,1,EA,402.97000,382.82000,The Alliance,PPO Network,,334.87,,,,,,,201.49,390.88,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.49500,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,PPO Network,,0.74790,,,,,,,0.45000,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,inpatient,1,EA,89.24000,84.77000,The Alliance,PPO Network,,74.16,,,,,,,49.08,86.56,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,outpatient,1,EA,89.24000,84.77000,The Alliance,PPO Network,,74.16,,,,,,,44.62,86.56,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,inpatient,1,mL,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,outpatient,1,mL,1.32000,1.26000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,inpatient,1,mL,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.11,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,outpatient,1,mL,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.00,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,inpatient,1,mL,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,outpatient,1,mL,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,inpatient,1,mL,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,outpatient,1,mL,1.07000,1.01000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,inpatient,1,EA,250.10000,237.60000,The Alliance,PPO Network,,207.83,,,,,,,137.56,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,outpatient,1,EA,250.10000,237.60000,The Alliance,PPO Network,,207.83,,,,,,,125.05,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,inpatient,1,EA,190.56000,181.03000,The Alliance,PPO Network,,158.36,,,,,,,104.81,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,outpatient,1,EA,190.56000,181.03000,The Alliance,PPO Network,,158.36,,,,,,,95.28,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,The Alliance,PPO Network,,129.20,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,PPO Network,,129.20,,,,,,,77.74,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,The Alliance,PPO Network,,129.20,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,PPO Network,,129.20,,,,,,,77.74,150.82,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,inpatient,1,GM,9.26000,8.80000,The Alliance,PPO Network,,7.70,,,,,,,5.09,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,outpatient,1,GM,9.26000,8.80000,The Alliance,PPO Network,,7.70,,,,,,,4.63,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.94,14.00,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.21,14.00,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,inpatient,1,mL,1627.34000,1545.97000,The Alliance,PPO Network,,1352.32,,,,,,,895.04,1578.52,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,outpatient,1,mL,1627.34000,1545.97000,The Alliance,PPO Network,,1352.32,,,,,,,813.67,1578.52,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,inpatient,1,mL,121.66000,115.58000,The Alliance,PPO Network,,101.10,,,,,,,66.91,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,outpatient,1,mL,121.66000,115.58000,The Alliance,PPO Network,,101.10,,,,,,,60.83,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,inpatient,1,mL,123.44000,117.27000,The Alliance,PPO Network,,102.58,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,PPO Network,,102.58,,,,,,,61.72,119.74,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,inpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.79750,1.41,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,PPO Network,,1.20,,,,,,,0.72500,1.41,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,inpatient,1,mL,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,outpatient,1,mL,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,inpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,inpatient,1,mL,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,outpatient,1,mL,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,inpatient,1,mL,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,inpatient,1,mL,3.85000,3.66000,The Alliance,PPO Network,,3.20,,,,,,,2.12,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,outpatient,1,mL,3.85000,3.66000,The Alliance,PPO Network,,3.20,,,,,,,1.93,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,inpatient,1,mL,0.41000,0.38000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,outpatient,1,mL,0.41000,0.38000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,2.51,4.43,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,2.29,4.43,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,inpatient,1,EA,70.34000,66.82000,The Alliance,PPO Network,,58.45,,,,,,,38.69,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,outpatient,1,EA,70.34000,66.82000,The Alliance,PPO Network,,58.45,,,,,,,35.17,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,inpatient,1,EA,26.05000,24.74000,The Alliance,PPO Network,,21.65,,,,,,,14.33,25.27,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,outpatient,1,EA,26.05000,24.74000,The Alliance,PPO Network,,21.65,,,,,,,13.03,25.27,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,inpatient,1,EA,2.43000,2.30000,The Alliance,PPO Network,,2.02,,,,,,,1.34,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,outpatient,1,EA,2.43000,2.30000,The Alliance,PPO Network,,2.02,,,,,,,1.22,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,inpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.27,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,PPO Network,,1.92,,,,,,,1.16,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,inpatient,1,mL,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,0.43650,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,inpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,inpatient,1,mL,10.20000,9.69000,The Alliance,PPO Network,,8.48,,,,,,,5.61,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,outpatient,1,mL,10.20000,9.69000,The Alliance,PPO Network,,8.48,,,,,,,5.10,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,inpatient,1,mL,10.76000,10.22000,The Alliance,PPO Network,,8.94,,,,,,,5.92,10.44,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,outpatient,1,mL,10.76000,10.22000,The Alliance,PPO Network,,8.94,,,,,,,5.38,10.44,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,inpatient,1,GM,41.98000,39.88000,The Alliance,PPO Network,,34.89,,,,,,,23.09,40.72,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,outpatient,1,GM,41.98000,39.88000,The Alliance,PPO Network,,34.89,,,,,,,20.99,40.72,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,inpatient,1,EA,122.59000,116.46000,The Alliance,PPO Network,,101.87,,,,,,,67.42,118.91,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,outpatient,1,EA,122.59000,116.46000,The Alliance,PPO Network,,101.87,,,,,,,0.57636,118.91,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,inpatient,1,mL,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,inpatient,1,mL,3.53000,3.36000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.42,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,outpatient,1,mL,3.53000,3.36000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.42,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,inpatient,1,EA,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.22,3.91,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.02,3.91,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,inpatient,1,EA,177.91000,169.02000,The Alliance,PPO Network,,147.84,,,,,,,97.85,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,outpatient,1,EA,177.91000,169.02000,The Alliance,PPO Network,,147.84,,,,,,,88.95,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,inpatient,1,mL,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.79,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,outpatient,1,mL,6.90000,6.55000,The Alliance,PPO Network,,5.73,,,,,,,3.45,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,inpatient,1,mL,13.21000,12.55000,The Alliance,PPO Network,,10.98,,,,,,,7.27,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,outpatient,1,mL,13.21000,12.55000,The Alliance,PPO Network,,10.98,,,,,,,6.61,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,inpatient,1,mL,6.29000,5.97000,The Alliance,PPO Network,,5.23,,,,,,,3.46,6.10,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,outpatient,1,mL,6.29000,5.97000,The Alliance,PPO Network,,5.23,,,,,,,3.15,6.10,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,inpatient,1,GM,21.95000,20.85000,The Alliance,PPO Network,,18.24,,,,,,,12.07,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,outpatient,1,GM,21.95000,20.85000,The Alliance,PPO Network,,18.24,,,,,,,10.97,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,The Alliance,PPO Network,,22.35,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,PPO Network,,22.35,,,,,,,13.45,26.08,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,inpatient,1,EA,24.28000,23.06000,The Alliance,PPO Network,,20.18,,,,,,,13.35,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,outpatient,1,EA,24.28000,23.06000,The Alliance,PPO Network,,20.18,,,,,,,12.14,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,inpatient,1,EA,5.66000,5.38000,The Alliance,PPO Network,,4.70,,,,,,,3.11,5.49,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,outpatient,1,EA,5.66000,5.38000,The Alliance,PPO Network,,4.70,,,,,,,2.83,5.49,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,PPO Network,,4.65,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,The Alliance,PPO Network,,4.65,,,,,,,3.07,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,PPO Network,,4.65,,,,,,,2.79,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.77000,1.36,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,PPO Network,,1.16,,,,,,,0.70000,1.36,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,inpatient,1,EA,716.81000,680.97000,The Alliance,PPO Network,,595.67,,,,,,,394.25,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,outpatient,1,EA,716.81000,680.97000,The Alliance,PPO Network,,595.67,,,,,,,1.91,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,inpatient,1,EA,828.93000,787.48000,The Alliance,PPO Network,,688.84,,,,,,,455.91,804.06,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,outpatient,1,EA,828.93000,787.48000,The Alliance,PPO Network,,688.84,,,,,,,1.91,804.06,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,3.16,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,2.88,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,inpatient,1,mL,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,outpatient,1,mL,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,1.92,3.72,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,inpatient,1,EA,19.45000,18.47000,The Alliance,PPO Network,,16.16,,,,,,,10.70,18.87,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,outpatient,1,EA,19.45000,18.47000,The Alliance,PPO Network,,16.16,,,,,,,9.72,18.87,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,The Alliance,PPO Network,,7.21,,,,,,,4.77,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,PPO Network,,7.21,,,,,,,4.34,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,inpatient,1,EA,18.49000,17.57000,The Alliance,PPO Network,,15.37,,,,,,,10.17,17.94,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,outpatient,1,EA,18.49000,17.57000,The Alliance,PPO Network,,15.37,,,,,,,9.24,17.94,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,The Alliance,PPO Network,,22.35,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,PPO Network,,22.35,,,,,,,13.45,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,inpatient,1,GM,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.79,10.21,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,outpatient,1,GM,10.53000,10.01000,The Alliance,PPO Network,,8.75,,,,,,,5.26,10.21,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,inpatient,1,EA,30.81000,29.27000,The Alliance,PPO Network,,25.60,,,,,,,16.95,29.89,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,outpatient,1,EA,30.81000,29.27000,The Alliance,PPO Network,,25.60,,,,,,,0.57636,29.89,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,inpatient,1,mL,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,36.50,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,0.04650,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,0.04650,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,inpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,31.28,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,PPO Network,,47.27,,,,,,,0.04650,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,inpatient,1,mL,58.43000,55.51000,The Alliance,PPO Network,,48.56,,,,,,,32.14,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,outpatient,1,mL,58.43000,55.51000,The Alliance,PPO Network,,48.56,,,,,,,0.04650,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,inpatient,1,mL,58.59000,55.66000,The Alliance,PPO Network,,48.69,,,,,,,32.22,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,outpatient,1,mL,58.59000,55.66000,The Alliance,PPO Network,,48.69,,,,,,,0.04650,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,inpatient,1,mL,51.29000,48.72000,The Alliance,PPO Network,,42.62,,,,,,,28.21,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,outpatient,1,mL,51.29000,48.72000,The Alliance,PPO Network,,42.62,,,,,,,0.04650,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,inpatient,1,mL,57.67000,54.79000,The Alliance,PPO Network,,47.92,,,,,,,31.72,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,outpatient,1,mL,57.67000,54.79000,The Alliance,PPO Network,,47.92,,,,,,,0.04650,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,inpatient,1,mL,60.83000,57.79000,The Alliance,PPO Network,,50.55,,,,,,,33.46,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,outpatient,1,mL,60.83000,57.79000,The Alliance,PPO Network,,50.55,,,,,,,0.04650,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,inpatient,1,mL,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,23.46,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,outpatient,1,mL,42.66000,40.53000,The Alliance,PPO Network,,35.45,,,,,,,0.04650,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,0.04650,39.85,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,inpatient,1,mL,1493.82000,1419.13000,The Alliance,PPO Network,,1241.36,,,,,,,821.60,1449.01,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,outpatient,1,mL,1493.82000,1419.13000,The Alliance,PPO Network,,1241.36,,,,,,,48.92,1449.01,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,inpatient,1,EA,20.76000,19.72000,The Alliance,PPO Network,,17.25,,,,,,,11.42,20.14,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,outpatient,1,EA,20.76000,19.72000,The Alliance,PPO Network,,17.25,,,,,,,10.38,20.14,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,inpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,inpatient,1,GM,183.72000,174.54000,The Alliance,PPO Network,,152.67,,,,,,,101.05,178.21,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,outpatient,1,GM,183.72000,174.54000,The Alliance,PPO Network,,152.67,,,,,,,91.86,178.21,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,inpatient,1,mL,533.15000,506.50000,The Alliance,PPO Network,,443.05,,,,,,,293.23,517.16,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,outpatient,1,mL,533.15000,506.50000,The Alliance,PPO Network,,443.05,,,,,,,262.23,517.16,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,8.20,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,PPO Network,,12.38,,,,,,,7.45,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,inpatient,1,EA,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.92,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,outpatient,1,EA,7.12000,6.76000,The Alliance,PPO Network,,5.92,,,,,,,3.56,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,inpatient,1,EA,132.04000,125.43000,The Alliance,PPO Network,,109.73,,,,,,,72.62,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,outpatient,1,EA,132.04000,125.43000,The Alliance,PPO Network,,109.73,,,,,,,66.02,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,8.07,14.24,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,7.34,14.24,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,7.57,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,6.88,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,inpatient,1,EA,307.01000,291.66000,The Alliance,PPO Network,,255.13,,,,,,,168.86,297.80,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,outpatient,1,EA,307.01000,291.66000,The Alliance,PPO Network,,255.13,,,,,,,153.50,297.80,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,inpatient,1,EA,904.51000,859.28000,The Alliance,PPO Network,,751.65,,,,,,,497.48,877.37,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,outpatient,1,EA,904.51000,859.28000,The Alliance,PPO Network,,751.65,,,,,,,452.25,877.37,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,inpatient,1,mL,47.20000,44.84000,The Alliance,PPO Network,,39.22,,,,,,,25.96,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,outpatient,1,mL,47.20000,44.84000,The Alliance,PPO Network,,39.22,,,,,,,0.08060,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,inpatient,1,mL,42.95000,40.80000,The Alliance,PPO Network,,35.69,,,,,,,23.62,41.66,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,outpatient,1,mL,42.95000,40.80000,The Alliance,PPO Network,,35.69,,,,,,,0.08060,41.66,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,inpatient,1,EA,21.04000,19.99000,The Alliance,PPO Network,,17.48,,,,,,,11.57,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,outpatient,1,EA,21.04000,19.99000,The Alliance,PPO Network,,17.48,,,,,,,10.52,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,The Alliance,PPO Network,,19.74,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,PPO Network,,19.74,,,,,,,11.88,23.05,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,inpatient,1,mL,26.54000,25.22000,The Alliance,PPO Network,,22.05,,,,,,,14.60,25.74,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,outpatient,1,mL,26.54000,25.22000,The Alliance,PPO Network,,22.05,,,,,,,13.27,25.74,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,39.66,229.89,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,inpatient,1,EA,904.31000,859.09000,The Alliance,PPO Network,,751.48,,,,,,,497.37,877.18,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,outpatient,1,EA,904.31000,859.09000,The Alliance,PPO Network,,751.48,,,,,,,452.15,877.18,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,The Alliance,PPO Network,,47.13,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,PPO Network,,47.13,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,inpatient,1,mL,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,52.64,110.03,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,inpatient,1,mL,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.13,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,inpatient,1,mL,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,outpatient,1,mL,2.32000,2.20000,The Alliance,PPO Network,,1.93,,,,,,,1.16,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.15,4.06,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,inpatient,1,EA,61.04000,57.99000,The Alliance,PPO Network,,50.72,,,,,,,33.57,59.21,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,outpatient,1,EA,61.04000,57.99000,The Alliance,PPO Network,,50.72,,,,,,,30.52,59.21,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,The Alliance,PPO Network,,4.36,,,,,,,2.89,5.09,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,PPO Network,,4.36,,,,,,,2.62,5.09,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,inpatient,1,GM,26.25000,24.94000,The Alliance,PPO Network,,21.81,,,,,,,14.44,25.46,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,outpatient,1,GM,26.25000,24.94000,The Alliance,PPO Network,,21.81,,,,,,,13.12,25.46,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,inpatient,1,mL,100.25000,95.24000,The Alliance,PPO Network,,83.31,,,,,,,55.14,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,outpatient,1,mL,100.25000,95.24000,The Alliance,PPO Network,,83.31,,,,,,,50.12,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,inpatient,1,mL,64.08000,60.88000,The Alliance,PPO Network,,53.25,,,,,,,35.24,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,outpatient,1,mL,64.08000,60.88000,The Alliance,PPO Network,,53.25,,,,,,,32.04,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,inpatient,1,mL,73.53000,69.86000,The Alliance,PPO Network,,61.10,,,,,,,40.44,71.32,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,outpatient,1,mL,73.53000,69.86000,The Alliance,PPO Network,,61.10,,,,,,,36.77,71.32,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,inpatient,1,EA,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,2.37,4.18,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,outpatient,1,EA,4.31000,4.09000,The Alliance,PPO Network,,3.58,,,,,,,2.15,4.18,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,inpatient,1,EA,20.06000,19.06000,The Alliance,PPO Network,,16.67,,,,,,,11.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,outpatient,1,EA,20.06000,19.06000,The Alliance,PPO Network,,16.67,,,,,,,10.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,inpatient,1,EA,27.01000,25.66000,The Alliance,PPO Network,,22.45,,,,,,,14.86,26.20,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,outpatient,1,EA,27.01000,25.66000,The Alliance,PPO Network,,22.45,,,,,,,13.51,26.20,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,inpatient,1,mL,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,outpatient,1,mL,12.11000,11.51000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,inpatient,1,mL,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.47,2.85,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.86,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,PPO Network,,2.81,,,,,,,1.69,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,inpatient,1,EA,23.22000,22.06000,The Alliance,PPO Network,,19.30,,,,,,,12.77,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,outpatient,1,EA,23.22000,22.06000,The Alliance,PPO Network,,19.30,,,,,,,11.61,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,inpatient,1,EA,8.59000,8.16000,The Alliance,PPO Network,,7.14,,,,,,,4.72,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,outpatient,1,EA,8.59000,8.16000,The Alliance,PPO Network,,7.14,,,,,,,4.29,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.72600,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,PPO Network,,1.10,,,,,,,0.66000,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,inpatient,1,EA,4.83000,4.59000,The Alliance,PPO Network,,4.01,,,,,,,2.66,4.69,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,PPO Network,,4.01,,,,,,,2.42,4.69,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.30,4.06,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,PPO Network,,3.48,,,,,,,2.10,4.06,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,inpatient,1,mL,3283.73000,3119.54000,The Alliance,PPO Network,,2728.78,,,,,,,1806.05,3185.22,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,outpatient,1,mL,3283.73000,3119.54000,The Alliance,PPO Network,,2728.78,,,,,,,1641.87,3185.22,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,inpatient,1,EA,950.25000,902.73000,The Alliance,PPO Network,,789.66,,,,,,,522.64,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,outpatient,1,EA,950.25000,902.73000,The Alliance,PPO Network,,789.66,,,,,,,365.89,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,inpatient,1,EA,1541.05000,1464.00000,The Alliance,PPO Network,,1280.61,,,,,,,847.58,1494.82,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,outpatient,1,EA,1541.05000,1464.00000,The Alliance,PPO Network,,1280.61,,,,,,,365.89,1494.82,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,inpatient,1,EA,112.97000,107.32000,The Alliance,PPO Network,,93.88,,,,,,,62.13,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,outpatient,1,EA,112.97000,107.32000,The Alliance,PPO Network,,93.88,,,,,,,56.48,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,inpatient,1,EA,122.45000,116.33000,The Alliance,PPO Network,,101.76,,,,,,,67.35,118.78,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,outpatient,1,EA,122.45000,116.33000,The Alliance,PPO Network,,101.76,,,,,,,61.23,118.78,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.73,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,PPO Network,,5.63,,,,,,,3.39,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,inpatient,1,EA,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,60.83,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,55.30,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,inpatient,1,mL,30.03000,28.53000,The Alliance,PPO Network,,24.95,,,,,,,16.52,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,outpatient,1,mL,30.03000,28.53000,The Alliance,PPO Network,,24.95,,,,,,,1.35,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,inpatient,1,mL,27.40000,26.03000,The Alliance,PPO Network,,22.77,,,,,,,15.07,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,outpatient,1,mL,27.40000,26.03000,The Alliance,PPO Network,,22.77,,,,,,,1.35,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,inpatient,1,mL,22.16000,21.06000,The Alliance,PPO Network,,18.41,,,,,,,12.19,21.50,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,outpatient,1,mL,22.16000,21.06000,The Alliance,PPO Network,,18.41,,,,,,,1.35,21.50,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,inpatient,1,EA,72.11000,68.51000,The Alliance,PPO Network,,59.92,,,,,,,39.66,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,outpatient,1,EA,72.11000,68.51000,The Alliance,PPO Network,,59.92,,,,,,,36.05,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,inpatient,1,EA,101.10000,96.04000,The Alliance,PPO Network,,84.01,,,,,,,55.60,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,outpatient,1,EA,101.10000,96.04000,The Alliance,PPO Network,,84.01,,,,,,,50.55,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,inpatient,1,EA,84.98000,80.73000,The Alliance,PPO Network,,70.62,,,,,,,46.74,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,outpatient,1,EA,84.98000,80.73000,The Alliance,PPO Network,,70.62,,,,,,,42.49,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,inpatient,1,EA,86.99000,82.64000,The Alliance,PPO Network,,72.29,,,,,,,47.84,84.38,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,outpatient,1,EA,86.99000,82.64000,The Alliance,PPO Network,,72.29,,,,,,,43.49,84.38,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,inpatient,1,GM,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.39,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,outpatient,1,GM,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.26,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,inpatient,1,GM,2.30000,2.18000,The Alliance,PPO Network,,1.91,,,,,,,1.26,2.23,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,outpatient,1,GM,2.30000,2.18000,The Alliance,PPO Network,,1.91,,,,,,,1.15,2.23,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.57,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,PPO Network,,2.37,,,,,,,1.43,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,inpatient,1,EA,690.86000,656.31000,The Alliance,PPO Network,,574.10,,,,,,,379.97,670.13,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,outpatient,1,EA,690.86000,656.31000,The Alliance,PPO Network,,574.10,,,,,,,0.57636,670.13,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,inpatient,1,EA,12.76000,12.12000,The Alliance,PPO Network,,10.60,,,,,,,7.02,12.38,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,outpatient,1,EA,12.76000,12.12000,The Alliance,PPO Network,,10.60,,,,,,,6.38,12.38,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,The Alliance,PPO Network,,5.87,,,,,,,3.88,6.85,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,PPO Network,,5.87,,,,,,,3.53,6.85,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,inpatient,1,EA,486.88000,462.54000,The Alliance,PPO Network,,404.60,,,,,,,267.78,472.27,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,outpatient,1,EA,486.88000,462.54000,The Alliance,PPO Network,,404.60,,,,,,,243.44,472.27,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,inpatient,1,GM,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,outpatient,1,GM,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,inpatient,1,GM,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.89,5.10,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,outpatient,1,GM,5.26000,5.00000,The Alliance,PPO Network,,4.37,,,,,,,2.63,5.10,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,inpatient,1,mL,11.32000,10.76000,The Alliance,PPO Network,,9.41,,,,,,,6.23,10.98,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,outpatient,1,mL,11.32000,10.76000,The Alliance,PPO Network,,9.41,,,,,,,5.66,10.98,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,inpatient,1,EA,5.89000,5.59000,The Alliance,PPO Network,,4.89,,,,,,,3.24,5.71,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,outpatient,1,EA,5.89000,5.59000,The Alliance,PPO Network,,4.89,,,,,,,2.94,5.71,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,1.07,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,PPO Network,,1.61,,,,,,,0.97000,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.59400,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,PPO Network,,0.89748,,,,,,,0.54000,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,inpatient,1,GM,26.57000,25.24000,The Alliance,PPO Network,,22.08,,,,,,,14.61,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,outpatient,1,GM,26.57000,25.24000,The Alliance,PPO Network,,22.08,,,,,,,13.29,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,inpatient,1,GM,10.25000,9.74000,The Alliance,PPO Network,,8.52,,,,,,,5.64,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,outpatient,1,GM,10.25000,9.74000,The Alliance,PPO Network,,8.52,,,,,,,5.12,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,inpatient,1,GM,9.74000,9.25000,The Alliance,PPO Network,,8.09,,,,,,,5.36,9.45,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,outpatient,1,GM,9.74000,9.25000,The Alliance,PPO Network,,8.09,,,,,,,4.87,9.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,inpatient,1,mL,82.81000,78.67000,The Alliance,PPO Network,,68.82,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,PPO Network,,68.82,,,,,,,22.94,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,inpatient,1,mL,82.81000,78.67000,The Alliance,PPO Network,,68.82,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,PPO Network,,68.82,,,,,,,22.94,80.33,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,inpatient,1,EA,3.53000,3.36000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.42,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,outpatient,1,EA,3.53000,3.36000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,PPO Network,,13.52,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,inpatient,1,EA,12.80000,12.16000,The Alliance,PPO Network,,10.64,,,,,,,7.04,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,outpatient,1,EA,12.80000,12.16000,The Alliance,PPO Network,,10.64,,,,,,,6.40,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,inpatient,1,EA,23.45000,22.27000,The Alliance,PPO Network,,19.49,,,,,,,12.90,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,outpatient,1,EA,23.45000,22.27000,The Alliance,PPO Network,,19.49,,,,,,,11.72,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,inpatient,1,mL,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.66,2.93,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,outpatient,1,mL,3.02000,2.87000,The Alliance,PPO Network,,2.51,,,,,,,1.51,5.89,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,inpatient,1,EA,1283.15000,1219.00000,The Alliance,PPO Network,,1066.30,,,,,,,705.73,1244.66,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,outpatient,1,EA,1283.15000,1219.00000,The Alliance,PPO Network,,1066.30,,,,,,,641.58,1244.66,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,inpatient,1,GM,3.99000,3.79000,The Alliance,PPO Network,,3.32,,,,,,,2.19,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,outpatient,1,GM,3.99000,3.79000,The Alliance,PPO Network,,3.32,,,,,,,2.00,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,inpatient,1,GM,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,outpatient,1,GM,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,inpatient,1,EA,405.34000,385.07000,The Alliance,PPO Network,,336.84,,,,,,,222.94,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,outpatient,1,EA,405.34000,385.07000,The Alliance,PPO Network,,336.84,,,,,,,0.46810,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,inpatient,1,EA,404.04000,383.84000,The Alliance,PPO Network,,335.76,,,,,,,222.22,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,outpatient,1,EA,404.04000,383.84000,The Alliance,PPO Network,,335.76,,,,,,,0.46810,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,inpatient,1,EA,271.95000,258.35000,The Alliance,PPO Network,,225.99,,,,,,,149.57,263.79,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,PPO Network,,225.99,,,,,,,0.46810,263.79,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,inpatient,1,mL,75.14000,71.39000,The Alliance,PPO Network,,62.44,,,,,,,41.33,72.89,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,outpatient,1,mL,75.14000,71.39000,The Alliance,PPO Network,,62.44,,,,,,,37.57,72.89,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,inpatient,1,mL,38.43000,36.51000,The Alliance,PPO Network,,31.94,,,,,,,21.14,37.28,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,outpatient,1,mL,38.43000,36.51000,The Alliance,PPO Network,,31.94,,,,,,,19.21,37.28,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,inpatient,1,EA,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.97,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,outpatient,1,EA,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.79,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,inpatient,1,EA,4.22000,4.01000,The Alliance,PPO Network,,3.51,,,,,,,2.32,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,outpatient,1,EA,4.22000,4.01000,The Alliance,PPO Network,,3.51,,,,,,,2.11,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,inpatient,1,EA,6.71000,6.37000,The Alliance,PPO Network,,5.58,,,,,,,3.69,6.51,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,outpatient,1,EA,6.71000,6.37000,The Alliance,PPO Network,,5.58,,,,,,,3.35,6.51,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,inpatient,1,EA,89.14000,84.68000,The Alliance,PPO Network,,74.08,,,,,,,49.03,86.47,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,outpatient,1,EA,89.14000,84.68000,The Alliance,PPO Network,,74.08,,,,,,,44.57,86.47,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,inpatient,1,GM,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,outpatient,1,GM,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,inpatient,1,mL,40.04000,38.04000,The Alliance,PPO Network,,33.27,,,,,,,22.02,38.84,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,outpatient,1,mL,40.04000,38.04000,The Alliance,PPO Network,,33.27,,,,,,,20.02,38.84,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,The Alliance,PPO Network,,22.00,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,PPO Network,,22.00,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,The Alliance,PPO Network,,17.09,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,PPO Network,,17.09,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,inpatient,1,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.95,5.20,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.68,5.20,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,inpatient,1,mL,16.20000,15.39000,The Alliance,PPO Network,,13.46,,,,,,,8.91,15.71,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,outpatient,1,mL,16.20000,15.39000,The Alliance,PPO Network,,13.46,,,,,,,8.10,15.71,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,inpatient,1,EA,43.61000,41.43000,The Alliance,PPO Network,,36.24,,,,,,,23.99,42.30,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,outpatient,1,EA,43.61000,41.43000,The Alliance,PPO Network,,36.24,,,,,,,7.96,42.30,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.10,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,PPO Network,,1.66,,,,,,,1.00,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.88,3.32,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.71,3.32,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,inpatient,1,EA,190.55000,181.02000,The Alliance,PPO Network,,158.35,,,,,,,104.80,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,outpatient,1,EA,190.55000,181.02000,The Alliance,PPO Network,,158.35,,,,,,,1.25,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,inpatient,1,EA,388.34000,368.93000,The Alliance,PPO Network,,322.71,,,,,,,213.59,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,outpatient,1,EA,388.34000,368.93000,The Alliance,PPO Network,,322.71,,,,,,,1.25,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,inpatient,1,EA,386.40000,367.08000,The Alliance,PPO Network,,321.10,,,,,,,212.52,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,outpatient,1,EA,386.40000,367.08000,The Alliance,PPO Network,,321.10,,,,,,,1.25,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,1.25,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,inpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,1.25,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,inpatient,1,EA,316.16000,300.35000,The Alliance,PPO Network,,262.73,,,,,,,173.89,306.68,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,outpatient,1,EA,316.16000,300.35000,The Alliance,PPO Network,,262.73,,,,,,,1.25,306.68,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,inpatient,1,EA,203.60000,193.42000,The Alliance,PPO Network,,169.19,,,,,,,111.98,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,outpatient,1,EA,203.60000,193.42000,The Alliance,PPO Network,,169.19,,,,,,,5.03,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,inpatient,1,EA,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,81.69,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,PPO Network,,123.42,,,,,,,5.03,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,inpatient,1,EA,103.62000,98.44000,The Alliance,PPO Network,,86.11,,,,,,,56.99,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,outpatient,1,EA,103.62000,98.44000,The Alliance,PPO Network,,86.11,,,,,,,5.03,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,inpatient,1,EA,62.92000,59.77000,The Alliance,PPO Network,,52.29,,,,,,,34.61,61.03,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,outpatient,1,EA,62.92000,59.77000,The Alliance,PPO Network,,52.29,,,,,,,5.03,61.03,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,inpatient,1,EA,79.88000,75.88000,The Alliance,PPO Network,,66.38,,,,,,,43.93,77.48,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,outpatient,1,EA,79.88000,75.88000,The Alliance,PPO Network,,66.38,,,,,,,39.94,77.48,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,inpatient,1,EA,279.35000,265.38000,The Alliance,PPO Network,,232.14,,,,,,,153.64,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,outpatient,1,EA,279.35000,265.38000,The Alliance,PPO Network,,232.14,,,,,,,139.68,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,inpatient,1,EA,65.31000,62.04000,The Alliance,PPO Network,,54.27,,,,,,,35.92,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,outpatient,1,EA,65.31000,62.04000,The Alliance,PPO Network,,54.27,,,,,,,32.66,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,6.37,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,PPO Network,,9.63,,,,,,,5.79,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,inpatient,1,EA,50.36000,47.85000,The Alliance,PPO Network,,41.85,,,,,,,27.70,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,outpatient,1,EA,50.36000,47.85000,The Alliance,PPO Network,,41.85,,,,,,,25.18,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,inpatient,1,EA,12.54000,11.92000,The Alliance,PPO Network,,10.42,,,,,,,6.90,12.16,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,outpatient,1,EA,12.54000,11.92000,The Alliance,PPO Network,,10.42,,,,,,,6.27,12.16,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,inpatient,1,EA,2.44000,2.31000,The Alliance,PPO Network,,2.03,,,,,,,1.34,2.37,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,outpatient,1,EA,2.44000,2.31000,The Alliance,PPO Network,,2.03,,,,,,,1.22,2.37,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,inpatient,1,mL,1495.72000,1420.94000,The Alliance,PPO Network,,1242.94,,,,,,,822.65,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,outpatient,1,mL,1495.72000,1420.94000,The Alliance,PPO Network,,1242.94,,,,,,,747.86,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,inpatient,1,mL,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,94.80,183.91,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,inpatient,,,150.51000,142.98000,The Alliance,PPO Network,,125.07,,,,,,,82.78,145.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,outpatient,,,150.51000,142.98000,The Alliance,PPO Network,,125.07,,,,,,,75.25,147.29,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,inpatient,1,EA,301.02000,285.97000,The Alliance,PPO Network,,250.15,,,,,,,165.56,291.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,outpatient,1,EA,301.02000,285.97000,The Alliance,PPO Network,,250.15,,,,,,,147.29,291.99,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,inpatient,1,mL,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,inpatient,1,mL,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.50,7.93,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,outpatient,1,mL,8.18000,7.77000,The Alliance,PPO Network,,6.80,,,,,,,4.09,7.93,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,7.07,13.71,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,inpatient,1,mL,482.37000,458.26000,The Alliance,PPO Network,,400.85,,,,,,,265.30,467.90,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,outpatient,1,mL,482.37000,458.26000,The Alliance,PPO Network,,400.85,,,,,,,10.13,467.90,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,inpatient,1,EA,23.06000,21.91000,The Alliance,PPO Network,,19.16,,,,,,,12.68,22.37,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,outpatient,1,EA,23.06000,21.91000,The Alliance,PPO Network,,19.16,,,,,,,11.53,22.37,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,inpatient,1,GM,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,outpatient,1,GM,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,inpatient,1,GM,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,1.81,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,outpatient,1,GM,3.29000,3.13000,The Alliance,PPO Network,,2.73,,,,,,,1.65,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,inpatient,1,GM,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,outpatient,1,GM,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,inpatient,1,EA,277.41000,263.54000,The Alliance,PPO Network,,230.53,,,,,,,152.58,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,outpatient,1,EA,277.41000,263.54000,The Alliance,PPO Network,,230.53,,,,,,,138.71,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,The Alliance,PPO Network,,14.40,,,,,,,9.53,16.81,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,PPO Network,,14.40,,,,,,,8.66,16.81,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,inpatient,1,EA,64.78000,61.54000,The Alliance,PPO Network,,53.83,,,,,,,35.63,62.84,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,outpatient,1,EA,64.78000,61.54000,The Alliance,PPO Network,,53.83,,,,,,,32.39,62.84,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,inpatient,1,GM,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,inpatient,1,EA,11.16000,10.61000,The Alliance,PPO Network,,9.27,,,,,,,6.14,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,outpatient,1,EA,11.16000,10.61000,The Alliance,PPO Network,,9.27,,,,,,,5.58,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,31.60,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,inpatient,1,EA,30.02000,28.52000,The Alliance,PPO Network,,24.95,,,,,,,16.51,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,PPO Network,,24.95,,,,,,,15.01,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,5.18,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,PPO Network,,7.83,,,,,,,4.71,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,inpatient,1,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.36,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.24,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,inpatient,1,EA,3.72000,3.54000,The Alliance,PPO Network,,3.09,,,,,,,2.05,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,outpatient,1,EA,3.72000,3.54000,The Alliance,PPO Network,,3.09,,,,,,,1.86,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,inpatient,1,EA,140.09000,133.09000,The Alliance,PPO Network,,116.41,,,,,,,77.05,135.89,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,outpatient,1,EA,140.09000,133.09000,The Alliance,PPO Network,,116.41,,,,,,,70.05,135.89,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,inpatient,1,EA,53.19000,50.53000,The Alliance,PPO Network,,44.20,,,,,,,29.25,51.59,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,outpatient,1,EA,53.19000,50.53000,The Alliance,PPO Network,,44.20,,,,,,,26.59,51.59,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,inpatient,1,mL,8.06000,7.66000,The Alliance,PPO Network,,6.70,,,,,,,4.43,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,PPO Network,,6.70,,,,,,,4.03,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,4.29,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,inpatient,1,EA,30.27000,28.76000,The Alliance,PPO Network,,25.15,,,,,,,16.65,29.36,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,outpatient,1,EA,30.27000,28.76000,The Alliance,PPO Network,,25.15,,,,,,,15.13,29.36,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,inpatient,1,EA,37.52000,35.65000,The Alliance,PPO Network,,31.18,,,,,,,20.64,36.39,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,outpatient,1,EA,37.52000,35.65000,The Alliance,PPO Network,,31.18,,,,,,,18.76,36.39,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,inpatient,1,EA,126.72000,120.39000,The Alliance,PPO Network,,105.30,,,,,,,69.70,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,outpatient,1,EA,126.72000,120.39000,The Alliance,PPO Network,,105.30,,,,,,,63.36,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,inpatient,1,EA,13.26000,12.60000,The Alliance,PPO Network,,11.02,,,,,,,7.29,12.86,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,outpatient,1,EA,13.26000,12.60000,The Alliance,PPO Network,,11.02,,,,,,,6.63,12.86,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,inpatient,1,EA,4.96000,4.71000,The Alliance,PPO Network,,4.12,,,,,,,2.73,4.81,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,outpatient,1,EA,4.96000,4.71000,The Alliance,PPO Network,,4.12,,,,,,,2.48,4.81,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.82500,1.46,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,PPO Network,,1.25,,,,,,,0.75000,1.46,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,inpatient,1,EA,162.76000,154.62000,The Alliance,PPO Network,,135.25,,,,,,,89.52,157.88,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,outpatient,1,EA,162.76000,154.62000,The Alliance,PPO Network,,135.25,,,,,,,81.38,157.88,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,inpatient,1,EA,23.65000,22.47000,The Alliance,PPO Network,,19.65,,,,,,,13.01,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,outpatient,1,EA,23.65000,22.47000,The Alliance,PPO Network,,19.65,,,,,,,11.82,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,inpatient,1,EA,13.88000,13.19000,The Alliance,PPO Network,,11.53,,,,,,,7.63,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,outpatient,1,EA,13.88000,13.19000,The Alliance,PPO Network,,11.53,,,,,,,6.94,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.38,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,PPO Network,,2.08,,,,,,,1.25,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,inpatient,1,EA,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.34,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,PPO Network,,2.03,,,,,,,1.22,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,inpatient,1,EA,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,10.35,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,outpatient,1,EA,18.82000,17.88000,The Alliance,PPO Network,,15.64,,,,,,,9.41,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,inpatient,1,mL,44.32000,42.10000,The Alliance,PPO Network,,36.83,,,,,,,24.38,42.99,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,outpatient,1,mL,44.32000,42.10000,The Alliance,PPO Network,,36.83,,,,,,,22.16,42.99,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.63,4.65,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,PPO Network,,3.98,,,,,,,2.40,4.65,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,inpatient,1,EA,24.78000,23.54000,The Alliance,PPO Network,,20.59,,,,,,,13.63,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,outpatient,1,EA,24.78000,23.54000,The Alliance,PPO Network,,20.59,,,,,,,12.39,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,inpatient,1,EA,69.38000,65.91000,The Alliance,PPO Network,,57.65,,,,,,,38.16,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,outpatient,1,EA,69.38000,65.91000,The Alliance,PPO Network,,57.65,,,,,,,34.69,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,11.85,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,inpatient,1,EA,18.99000,18.04000,The Alliance,PPO Network,,15.78,,,,,,,10.44,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,outpatient,1,EA,18.99000,18.04000,The Alliance,PPO Network,,15.78,,,,,,,9.49,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,inpatient,1,EA,104.09000,98.88000,The Alliance,PPO Network,,86.50,,,,,,,57.25,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,outpatient,1,EA,104.09000,98.88000,The Alliance,PPO Network,,86.50,,,,,,,52.05,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,inpatient,1,EA,100.16000,95.15000,The Alliance,PPO Network,,83.23,,,,,,,55.09,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,outpatient,1,EA,100.16000,95.15000,The Alliance,PPO Network,,83.23,,,,,,,50.08,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,The Alliance,PPO Network,,5.83,,,,,,,3.86,6.80,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,PPO Network,,5.83,,,,,,,3.50,6.80,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,inpatient,1,mL,47.56000,45.18000,The Alliance,PPO Network,,39.52,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,PPO Network,,39.52,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,inpatient,1,mL,17.89000,16.99000,The Alliance,PPO Network,,14.87,,,,,,,9.84,17.35,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,outpatient,1,mL,17.89000,16.99000,The Alliance,PPO Network,,14.87,,,,,,,8.95,17.35,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,5.53,9.75,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,PPO Network,,8.35,,,,,,,5.03,9.75,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,inpatient,1,EA,18.22000,17.31000,The Alliance,PPO Network,,15.14,,,,,,,10.02,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,outpatient,1,EA,18.22000,17.31000,The Alliance,PPO Network,,15.14,,,,,,,9.11,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,inpatient,1,EA,14.92000,14.17000,The Alliance,PPO Network,,12.40,,,,,,,8.21,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,outpatient,1,EA,14.92000,14.17000,The Alliance,PPO Network,,12.40,,,,,,,7.46,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,inpatient,1,EA,26.25000,24.94000,The Alliance,PPO Network,,21.81,,,,,,,14.44,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,outpatient,1,EA,26.25000,24.94000,The Alliance,PPO Network,,21.81,,,,,,,13.12,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,The Alliance,PPO Network,,3.45,,,,,,,2.28,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,PPO Network,,3.45,,,,,,,2.08,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.56,6.29,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,PPO Network,,5.38,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,inpatient,1,EA,40.35000,38.34000,The Alliance,PPO Network,,33.53,,,,,,,22.19,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,outpatient,1,EA,40.35000,38.34000,The Alliance,PPO Network,,33.53,,,,,,,20.18,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,inpatient,1,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.48,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,PPO Network,,2.24,,,,,,,1.34,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,inpatient,1,EA,8.78000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,4.83,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,outpatient,1,EA,8.78000,8.35000,The Alliance,PPO Network,,7.30,,,,,,,4.39,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,The Alliance,PPO Network,,7.27,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,PPO Network,,7.27,,,,,,,4.38,8.49,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,inpatient,1,mL,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,13.00,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,PPO Network,,19.64,,,,,,,11.82,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,inpatient,1,mL,35.57000,33.79000,The Alliance,PPO Network,,29.56,,,,,,,19.56,34.50,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,outpatient,1,mL,35.57000,33.79000,The Alliance,PPO Network,,29.56,,,,,,,17.79,34.50,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,inpatient,1,GM,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,25.38,44.76,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,outpatient,1,GM,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,23.07,44.76,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,inpatient,1,EA,15.86000,15.07000,The Alliance,PPO Network,,13.18,,,,,,,8.72,15.38,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,outpatient,1,EA,15.86000,15.07000,The Alliance,PPO Network,,13.18,,,,,,,7.93,15.38,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,PPO Network,,1.53,,,,,,,0.92000,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.68,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,PPO Network,,2.54,,,,,,,1.53,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,inpatient,1,EA,8.49000,8.06000,The Alliance,PPO Network,,7.06,,,,,,,4.67,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,PPO Network,,7.06,,,,,,,4.25,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,50.05,88.27,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,8.08,424.40,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,111.65,196.91,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,11.61,611.15,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,inpatient,,,1089.00000,1034.55000,The Alliance,PPO Network,,904.96,,,,,,,598.95,1056.33,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,outpatient,,,1089.00000,1034.55000,The Alliance,PPO Network,,904.96,,,,,,,544.50,1056.33,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,405.35,714.89,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,368.50,714.89,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.63085,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.63085,1.29,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1825.74,3614.22,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1710.23,3726.00,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1084.39,2362.50,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1420.03,3093.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,43.12,85.36,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,40.39,88.00,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6488.42,14136.00,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1290.94,2812.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1290.94,2812.50,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,105.00,228.75,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,9533.43,20770.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,38.19,83.20,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,9533.43,20770.00,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6488.42,14136.00,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2358.25,4668.37,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2209.05,4812.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,9988.76,21762.00,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,The Alliance,PPO Network,,1087.57,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,PPO Network,,1087.57,,,,,,,600.72,1308.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.68000,180.20000,The Alliance,PPO Network,,157.62,,,,,,,92.94,183.99,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.68000,180.20000,The Alliance,PPO Network,,157.62,,,,,,,87.06,189.68,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,The Alliance,PPO Network,,1087.57,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,PPO Network,,1087.57,,,,,,,600.72,1308.75,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,387.28,843.75,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,247.50000,235.12000,The Alliance,PPO Network,,205.67,,,,,,,121.28,240.07,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,247.50000,235.12000,The Alliance,PPO Network,,205.67,,,,,,,113.60,247.50,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,122.20,241.90,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,114.47,249.38,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,PPO Network,,18084.22,,,,,,,9988.76,21762.00,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,321.56,636.56,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,301.22,656.25,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,PPO Network,,11747.02,,,,,,,6488.42,14136.00,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,967.59,2108.03,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,93.10,184.30,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,87.21,190.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,The Alliance,PPO Network,,1470.87,,,,,,,867.30,1716.90,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,PPO Network,,1470.87,,,,,,,812.43,1770.00,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13020.00000,12369.00000,The Alliance,PPO Network,,10819.62,,,,,,,6379.80,12629.40,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13020.00000,12369.00000,The Alliance,PPO Network,,10819.62,,,,,,,5976.18,13020.00,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13485.00000,12810.75000,The Alliance,PPO Network,,11206.03,,,,,,,6607.65,13080.45,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13485.00000,12810.75000,The Alliance,PPO Network,,11206.03,,,,,,,6189.61,13485.00,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3296.47,6525.68,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3087.92,6727.50,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1266.64000,1203.31000,The Alliance,PPO Network,,1052.58,,,,,,,620.65,1228.64,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1266.64000,1203.31000,The Alliance,PPO Network,,1052.58,,,,,,,581.39,1266.64,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,284.01,618.75,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3476.25000,3302.44000,The Alliance,PPO Network,,2888.76,,,,,,,1703.36,3371.96,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3476.25000,3302.44000,The Alliance,PPO Network,,2888.76,,,,,,,1595.60,3476.25,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5126.70000,4870.36000,The Alliance,PPO Network,,4260.29,,,,,,,2512.08,4972.90,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5126.70000,4870.36000,The Alliance,PPO Network,,4260.29,,,,,,,2353.16,5126.70,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,45.32000,43.05000,The Alliance,PPO Network,,37.66,,,,,,,22.21,43.96,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,45.32000,43.05000,The Alliance,PPO Network,,37.66,,,,,,,20.80,45.32,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,The Alliance,PPO Network,,4241.94,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,PPO Network,,4241.94,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,PPO Network,,566.53,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,The Alliance,PPO Network,,4241.94,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,PPO Network,,4241.94,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,PPO Network,,721.51,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,The Alliance,PPO Network,,618.42,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,PPO Network,,618.42,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,The Alliance,PPO Network,,1551.89,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,PPO Network,,1551.89,,,,,,,857.18,1867.50,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,702.86000,667.72000,The Alliance,PPO Network,,584.08,,,,,,,344.40,681.77,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,702.86000,667.72000,The Alliance,PPO Network,,584.08,,,,,,,322.61,702.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,The Alliance,PPO Network,,618.42,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,PPO Network,,618.42,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4936.95000,4690.10000,The Alliance,PPO Network,,4102.61,,,,,,,2419.11,4788.84,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4936.95000,4690.10000,The Alliance,PPO Network,,4102.61,,,,,,,2266.06,4936.95,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,The Alliance,PPO Network,,1551.89,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,PPO Network,,1551.89,,,,,,,857.18,1867.50,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,The Alliance,PPO Network,,1059.53,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,PPO Network,,1059.53,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,The Alliance,PPO Network,,1059.53,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,PPO Network,,1059.53,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,18.95,37.52,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,90.88000,86.34000,The Alliance,PPO Network,,75.52,,,,,,,44.53,88.15,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,90.88000,86.34000,The Alliance,PPO Network,,75.52,,,,,,,41.71,90.88,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,The Alliance,PPO Network,,7874.94,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,PPO Network,,7874.94,,,,,,,4349.70,9476.46,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,49.00,97.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,45.90,100.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,91.88,181.88,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,86.06,187.50,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,687.15000,652.79000,The Alliance,PPO Network,,571.02,,,,,,,336.70,666.54,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,687.15000,652.79000,The Alliance,PPO Network,,571.02,,,,,,,315.40,687.15,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2620.28,5187.07,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,PPO Network,,292.02,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6520.50000,6194.47000,The Alliance,PPO Network,,5418.54,,,,,,,3195.05,6324.89,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6520.50000,6194.47000,The Alliance,PPO Network,,5418.54,,,,,,,2992.91,6520.50,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,485.25000,460.99000,The Alliance,PPO Network,,403.24,,,,,,,237.77,470.69,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,485.25000,460.99000,The Alliance,PPO Network,,403.24,,,,,,,222.73,485.25,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,757.50000,719.62000,The Alliance,PPO Network,,629.48,,,,,,,371.18,734.77,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,757.50000,719.62000,The Alliance,PPO Network,,629.48,,,,,,,347.69,757.50,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,8558.74,18646.50,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,431.25000,409.69000,The Alliance,PPO Network,,358.37,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,PPO Network,,358.37,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,The Alliance,PPO Network,,4137.01,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,PPO Network,,4137.01,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,The Alliance,PPO Network,,4137.01,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,PPO Network,,4137.01,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,The Alliance,PPO Network,,5303.86,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,PPO Network,,5303.86,,,,,,,2929.57,6382.50,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2497.50000,2372.62000,The Alliance,PPO Network,,2075.42,,,,,,,1223.78,2422.57,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2497.50000,2372.62000,The Alliance,PPO Network,,2075.42,,,,,,,1146.35,2497.50,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,The Alliance,PPO Network,,376.29,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,PPO Network,,376.29,,,,,,,207.84,452.81,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,The Alliance,PPO Network,,5303.86,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,PPO Network,,5303.86,,,,,,,2929.57,6382.50,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,The Alliance,PPO Network,,376.29,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,PPO Network,,376.29,,,,,,,207.84,452.81,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,38.56,84.00,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,495.72,1080.00,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,318.35,630.20,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,287.45,626.25,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,PPO Network,,539.89,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4648.88,9202.88,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4354.76,9487.50,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,666.00000,632.70000,The Alliance,PPO Network,,553.45,,,,,,,326.34,646.02,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,666.00000,632.70000,The Alliance,PPO Network,,553.45,,,,,,,305.69,666.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,643.12,1273.12,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,78.40000,74.48000,The Alliance,PPO Network,,65.15,,,,,,,38.42,76.05,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,PPO Network,,65.15,,,,,,,35.99,78.40,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,205.80,407.40,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,,349.02,,,,,,,192.78,420.00,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,746.29000,708.98000,The Alliance,PPO Network,,620.17,,,,,,,365.68,723.90,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,746.29000,708.98000,The Alliance,PPO Network,,620.17,,,,,,,342.55,746.29,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,661.50,1309.50,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,619.65,1350.00,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,643.12,1273.12,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,The Alliance,PPO Network,,1611.10,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,PPO Network,,1611.10,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,47.68000,45.30000,The Alliance,PPO Network,,39.62,,,,,,,23.36,46.25,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,47.68000,45.30000,The Alliance,PPO Network,,39.62,,,,,,,21.89,47.68,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3479.63000,3305.65000,The Alliance,PPO Network,,2891.57,,,,,,,1705.02,3375.24,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3479.63000,3305.65000,The Alliance,PPO Network,,2891.57,,,,,,,1597.15,3479.63,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1162.50000,1104.38000,The Alliance,PPO Network,,966.04,,,,,,,569.62,1127.62,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1162.50000,1104.38000,The Alliance,PPO Network,,966.04,,,,,,,533.59,1162.50,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9970.50000,9471.98000,The Alliance,PPO Network,,8285.49,,,,,,,4885.55,9671.39,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9970.50000,9471.98000,The Alliance,PPO Network,,8285.49,,,,,,,4576.46,9970.50,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,The Alliance,PPO Network,,1304.15,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,PPO Network,,1304.15,,,,,,,720.35,1569.38,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,96.44000,91.62000,The Alliance,PPO Network,,80.14,,,,,,,47.26,93.55,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,96.44000,91.62000,The Alliance,PPO Network,,80.14,,,,,,,44.27,96.44,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,3851.19,8390.40,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9270.15000,8806.64000,The Alliance,PPO Network,,7703.49,,,,,,,4542.37,8992.05,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9270.15000,8806.64000,The Alliance,PPO Network,,7703.49,,,,,,,4255.00,9270.15,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,38.56,84.00,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,498.26000,473.35000,The Alliance,PPO Network,,414.05,,,,,,,244.15,483.31,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,498.26000,473.35000,The Alliance,PPO Network,,414.05,,,,,,,228.70,498.26,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,431.25000,409.69000,The Alliance,PPO Network,,358.37,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,PPO Network,,358.37,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,The Alliance,PPO Network,,1611.10,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,PPO Network,,1611.10,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,The Alliance,PPO Network,,7712.10,,,,,,,4547.44,9002.08,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,PPO Network,,7712.10,,,,,,,4259.75,9280.50,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,3851.19,8390.40,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,119.76000,113.77000,The Alliance,PPO Network,,99.52,,,,,,,58.68,116.17,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,119.76000,113.77000,The Alliance,PPO Network,,99.52,,,,,,,54.97,119.76,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3660.00000,3477.00000,The Alliance,PPO Network,,3041.46,,,,,,,1793.40,3550.20,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3660.00000,3477.00000,The Alliance,PPO Network,,3041.46,,,,,,,1679.94,3660.00,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,The Alliance,PPO Network,,147.95,,,,,,,87.24,172.70,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,PPO Network,,147.95,,,,,,,81.72,178.04,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,176.38,384.26,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,247.43000,235.06000,The Alliance,PPO Network,,205.61,,,,,,,121.24,240.01,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,247.43000,235.06000,The Alliance,PPO Network,,205.61,,,,,,,113.57,247.43,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,PPO Network,,313.56,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,510.00000,484.50000,The Alliance,PPO Network,,423.81,,,,,,,249.90,494.70,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,510.00000,484.50000,The Alliance,PPO Network,,423.81,,,,,,,234.09,510.00,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,37.61,74.46,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,35.23,76.76,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2124.00000,2017.80000,The Alliance,PPO Network,,1765.04,,,,,,,1040.76,2060.28,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2124.00000,2017.80000,The Alliance,PPO Network,,1765.04,,,,,,,974.92,2124.00,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,93.40000,88.73000,The Alliance,PPO Network,,77.62,,,,,,,45.77,90.60,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,93.40000,88.73000,The Alliance,PPO Network,,77.62,,,,,,,42.87,93.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,The Alliance,PPO Network,,1697.14,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,PPO Network,,1697.14,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,320.59000,304.56000,The Alliance,PPO Network,,266.41,,,,,,,157.09,310.97,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,320.59000,304.56000,The Alliance,PPO Network,,266.41,,,,,,,147.15,320.59,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,305.33000,290.06000,The Alliance,PPO Network,,253.73,,,,,,,149.61,296.17,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,305.33000,290.06000,The Alliance,PPO Network,,253.73,,,,,,,140.15,305.33,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,836.25000,794.44000,The Alliance,PPO Network,,694.92,,,,,,,409.76,811.16,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,836.25000,794.44000,The Alliance,PPO Network,,694.92,,,,,,,383.84,836.25,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,The Alliance,PPO Network,,14941.38,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,PPO Network,,14941.38,,,,,,,8252.82,17980.00,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,The Alliance,PPO Network,,14941.38,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,PPO Network,,14941.38,,,,,,,8252.82,17980.00,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,The Alliance,PPO Network,,670.77,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,PPO Network,,670.77,,,,,,,370.50,807.19,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,903.75000,858.56000,The Alliance,PPO Network,,751.02,,,,,,,442.84,876.64,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,903.75000,858.56000,The Alliance,PPO Network,,751.02,,,,,,,414.82,903.75,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,The Alliance,PPO Network,,431.54,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,PPO Network,,431.54,,,,,,,238.36,519.30,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3120.00000,2964.00000,The Alliance,PPO Network,,2592.72,,,,,,,1528.80,3026.40,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,PPO Network,,2592.72,,,,,,,1432.08,3120.00,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,416.25000,395.44000,The Alliance,PPO Network,,345.90,,,,,,,203.96,403.76,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,416.25000,395.44000,The Alliance,PPO Network,,345.90,,,,,,,191.06,416.25,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,921.79000,875.70000,The Alliance,PPO Network,,766.01,,,,,,,451.68,894.14,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,921.79000,875.70000,The Alliance,PPO Network,,766.01,,,,,,,423.10,921.79,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1561.17,3401.25,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2891.25000,2746.69000,The Alliance,PPO Network,,2402.63,,,,,,,1416.71,2804.51,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2891.25000,2746.69000,The Alliance,PPO Network,,2402.63,,,,,,,1327.08,2891.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,The Alliance,PPO Network,,138.08,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,PPO Network,,138.08,,,,,,,76.27,166.16,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13104.65,28550.44,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,inpatient,,,47250.00000,44887.50000,The Alliance,PPO Network,,39264.75,,,,,,,23152.50,45832.50,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,outpatient,,,47250.00000,44887.50000,The Alliance,PPO Network,,39264.75,,,,,,,21687.75,47250.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,The Alliance,PPO Network,,1815.22,,,,,,,1070.35,2118.85,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,PPO Network,,1815.22,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13104.65,28550.44,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,PPO Network,,23725.42,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,PPO Network,,2826.44,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,The Alliance,PPO Network,,1697.14,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,PPO Network,,1697.14,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,5137.91000,4881.01000,The Alliance,PPO Network,,4269.60,,,,,,,2517.58,4983.77,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,5137.91000,4881.01000,The Alliance,PPO Network,,4269.60,,,,,,,2358.30,5137.91,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,191.25000,181.69000,The Alliance,PPO Network,,158.93,,,,,,,93.71,185.51,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,191.25000,181.69000,The Alliance,PPO Network,,158.93,,,,,,,87.78,191.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2137.79,4657.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,The Alliance,PPO Network,,8694.34,,,,,,,5126.62,10148.62,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,PPO Network,,8694.34,,,,,,,4802.29,10148.62,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11082.50000,10528.38000,The Alliance,PPO Network,,9209.56,,,,,,,5430.43,10750.02,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11082.50000,10528.38000,The Alliance,PPO Network,,9209.56,,,,,,,5086.87,10750.02,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,The Alliance,PPO Network,,16938.12,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,PPO Network,,16938.12,,,,,,,9355.71,20382.81,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,98.97,215.63,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,24570.00000,23341.50000,The Alliance,PPO Network,,20417.67,,,,,,,12039.30,23832.90,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,24570.00000,23341.50000,The Alliance,PPO Network,,20417.67,,,,,,,11277.63,24570.00,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,92.95,202.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9842.50000,9350.38000,The Alliance,PPO Network,,8179.12,,,,,,,4822.82,9547.23,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9842.50000,9350.38000,The Alliance,PPO Network,,8179.12,,,,,,,4517.71,9547.23,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,637.50000,605.62000,The Alliance,PPO Network,,529.76,,,,,,,312.38,618.38,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,PPO Network,,529.76,,,,,,,292.61,637.50,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11173.92,24344.05,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,46200.00000,43890.00000,The Alliance,PPO Network,,38392.20,,,,,,,22638.00,44814.00,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,46200.00000,43890.00000,The Alliance,PPO Network,,38392.20,,,,,,,21205.80,46200.00,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,22575.00000,21446.25000,The Alliance,PPO Network,,18759.83,,,,,,,11061.75,21897.75,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,22575.00000,21446.25000,The Alliance,PPO Network,,18759.83,,,,,,,10361.92,22575.00,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11532.00000,10955.40000,The Alliance,PPO Network,,9583.09,,,,,,,5650.68,11186.04,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11532.00000,10955.40000,The Alliance,PPO Network,,9583.09,,,,,,,5293.19,11186.04,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,33.89,73.84,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,431.63000,410.05000,The Alliance,PPO Network,,358.68,,,,,,,211.50,418.68,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,431.63000,410.05000,The Alliance,PPO Network,,358.68,,,,,,,198.12,431.63,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,The Alliance,PPO Network,,8501.13,,,,,,,5012.70,9923.10,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,PPO Network,,8501.13,,,,,,,4695.57,10230.00,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11780.00000,11191.00000,The Alliance,PPO Network,,9789.18,,,,,,,5772.20,11426.60,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11780.00000,11191.00000,The Alliance,PPO Network,,9789.18,,,,,,,5407.02,11426.60,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,The Alliance,PPO Network,,613.90,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,PPO Network,,613.90,,,,,,,339.09,738.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,29.28000,27.82000,The Alliance,PPO Network,,24.33,,,,,,,14.35,28.40,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,29.28000,27.82000,The Alliance,PPO Network,,24.33,,,,,,,13.44,29.28,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,217.50000,206.62000,The Alliance,PPO Network,,180.74,,,,,,,106.58,210.97,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,217.50000,206.62000,The Alliance,PPO Network,,180.74,,,,,,,99.83,217.50,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,9513.90000,9038.20000,The Alliance,PPO Network,,7906.05,,,,,,,4661.81,9228.48,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,9513.90000,9038.20000,The Alliance,PPO Network,,7906.05,,,,,,,4366.88,9513.90,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,541.50000,514.42000,The Alliance,PPO Network,,449.99,,,,,,,265.33,525.25,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,541.50000,514.42000,The Alliance,PPO Network,,449.99,,,,,,,248.55,541.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,33.89,73.84,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,881.25000,837.19000,The Alliance,PPO Network,,732.32,,,,,,,431.81,854.81,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,881.25000,837.19000,The Alliance,PPO Network,,732.32,,,,,,,404.49,881.25,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,128.20000,121.79000,The Alliance,PPO Network,,106.53,,,,,,,62.82,124.35,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,128.20000,121.79000,The Alliance,PPO Network,,106.53,,,,,,,58.84,128.20,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,77.64000,73.76000,The Alliance,PPO Network,,64.52,,,,,,,38.04,75.31,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.64000,73.76000,The Alliance,PPO Network,,64.52,,,,,,,35.64,77.64,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,The Alliance,PPO Network,,328.77,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,PPO Network,,328.77,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,PPO Network,,69.14,,,,,,,38.19,83.20,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.85000,253.51000,The Alliance,PPO Network,,221.75,,,,,,,130.76,258.84,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.85000,253.51000,The Alliance,PPO Network,,221.75,,,,,,,122.48,266.85,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,69.72000,66.23000,The Alliance,PPO Network,,57.94,,,,,,,34.16,67.63,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,PPO Network,,57.94,,,,,,,32.00,69.72,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,The Alliance,PPO Network,,4598.59,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,PPO Network,,4598.59,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,94.96000,90.21000,The Alliance,PPO Network,,78.91,,,,,,,46.53,92.11,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,94.96000,90.21000,The Alliance,PPO Network,,78.91,,,,,,,43.59,94.96,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,46.72000,44.38000,The Alliance,PPO Network,,38.82,,,,,,,22.89,45.32,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,46.72000,44.38000,The Alliance,PPO Network,,38.82,,,,,,,21.44,46.72,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,The Alliance,PPO Network,,4598.59,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,PPO Network,,4598.59,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,58.84000,55.90000,The Alliance,PPO Network,,48.90,,,,,,,28.83,57.07,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,58.84000,55.90000,The Alliance,PPO Network,,48.90,,,,,,,27.01,58.84,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,The Alliance,PPO Network,,3681.16,,,,,,,2170.60,4296.91,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,PPO Network,,3681.16,,,,,,,2033.28,4429.80,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3397.09000,3227.24000,The Alliance,PPO Network,,2822.98,,,,,,,1664.57,3295.18,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3397.09000,3227.24000,The Alliance,PPO Network,,2822.98,,,,,,,1559.26,3397.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2006.21000,1905.90000,The Alliance,PPO Network,,1667.16,,,,,,,983.04,1946.02,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,PPO Network,,1667.16,,,,,,,920.85,2006.21,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8752.62000,8314.99000,The Alliance,PPO Network,,7273.43,,,,,,,4288.78,8490.04,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8752.62000,8314.99000,The Alliance,PPO Network,,7273.43,,,,,,,4017.45,8752.62,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.83000,274.39000,The Alliance,PPO Network,,240.02,,,,,,,141.53,280.17,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.83000,274.39000,The Alliance,PPO Network,,240.02,,,,,,,132.57,288.83,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,The Alliance,PPO Network,,3681.16,,,,,,,2170.60,4296.91,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,PPO Network,,3681.16,,,,,,,2033.28,4429.80,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,59.44000,56.47000,The Alliance,PPO Network,,49.39,,,,,,,29.13,57.66,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,59.44000,56.47000,The Alliance,PPO Network,,49.39,,,,,,,27.28,59.44,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,The Alliance,PPO Network,,47117.70,,,,,,,27783.00,54999.00,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,PPO Network,,47117.70,,,,,,,26025.30,56700.00,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,183.32,399.38,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,46.60,101.52,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,67.75,147.60,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,162.40000,154.28000,The Alliance,PPO Network,,134.95,,,,,,,79.58,157.53,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,162.40000,154.28000,The Alliance,PPO Network,,134.95,,,,,,,74.54,162.40,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9953.60000,9455.92000,The Alliance,PPO Network,,8271.44,,,,,,,4877.26,9654.99,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9953.60000,9455.92000,The Alliance,PPO Network,,8271.44,,,,,,,4568.70,9953.60,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,606.38000,576.06000,The Alliance,PPO Network,,503.90,,,,,,,297.13,588.19,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,606.38000,576.06000,The Alliance,PPO Network,,503.90,,,,,,,278.33,606.38,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,The Alliance,PPO Network,,183.86,,,,,,,108.41,214.61,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,PPO Network,,183.86,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,177.68000,168.80000,The Alliance,PPO Network,,147.65,,,,,,,87.06,172.35,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,177.68000,168.80000,The Alliance,PPO Network,,147.65,,,,,,,81.56,177.68,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,131.64000,125.06000,The Alliance,PPO Network,,109.39,,,,,,,64.50,127.69,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,131.64000,125.06000,The Alliance,PPO Network,,109.39,,,,,,,60.42,131.64,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,59.56000,56.58000,The Alliance,PPO Network,,49.49,,,,,,,29.18,57.77,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,59.56000,56.58000,The Alliance,PPO Network,,49.49,,,,,,,27.34,59.56,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,189.20000,179.74000,The Alliance,PPO Network,,157.23,,,,,,,92.71,183.52,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,PPO Network,,157.23,,,,,,,86.84,189.20,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,137.96000,131.06000,The Alliance,PPO Network,,114.64,,,,,,,67.60,133.82,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,137.96000,131.06000,The Alliance,PPO Network,,114.64,,,,,,,63.32,137.96,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,440.63000,418.60000,The Alliance,PPO Network,,366.16,,,,,,,215.91,427.41,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,440.63000,418.60000,The Alliance,PPO Network,,366.16,,,,,,,202.25,440.63,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1049.63000,997.15000,The Alliance,PPO Network,,872.24,,,,,,,514.32,1018.14,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1049.63000,997.15000,The Alliance,PPO Network,,872.24,,,,,,,481.78,1049.63,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,164.80000,156.56000,The Alliance,PPO Network,,136.95,,,,,,,80.75,159.86,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,164.80000,156.56000,The Alliance,PPO Network,,136.95,,,,,,,75.64,164.80,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.46000,1745.59000,The Alliance,PPO Network,,1526.93,,,,,,,900.36,1782.34,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.46000,1745.59000,The Alliance,PPO Network,,1526.93,,,,,,,843.39,1837.46,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,78.95,172.00,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,2850.39,6210.00,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4142.31000,3935.19000,The Alliance,PPO Network,,3442.26,,,,,,,2029.73,4018.04,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4142.31000,3935.19000,The Alliance,PPO Network,,3442.26,,,,,,,1901.32,4142.31,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,764.24,1615.05,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3225.00000,3063.75000,The Alliance,PPO Network,,2679.97,,,,,,,1580.25,3128.25,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3225.00000,3063.75000,The Alliance,PPO Network,,2679.97,,,,,,,1480.28,3225.00,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,The Alliance,PPO Network,,1118.73,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,PPO Network,,1118.73,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,The Alliance,PPO Network,,1118.73,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,PPO Network,,1118.73,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2625.00000,2493.75000,The Alliance,PPO Network,,2181.38,,,,,,,1286.25,2546.25,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,PPO Network,,2181.38,,,,,,,1204.88,2625.00,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4227.56000,4016.18000,The Alliance,PPO Network,,3513.10,,,,,,,2071.50,4100.73,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4227.56000,4016.18000,The Alliance,PPO Network,,3513.10,,,,,,,1940.45,4227.56,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7900.50000,7505.47000,The Alliance,PPO Network,,6565.32,,,,,,,3871.24,7663.48,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7900.50000,7505.47000,The Alliance,PPO Network,,6565.32,,,,,,,3626.33,7900.50,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2733.75000,2597.06000,The Alliance,PPO Network,,2271.75,,,,,,,1339.54,2651.74,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2733.75000,2597.06000,The Alliance,PPO Network,,2271.75,,,,,,,1254.79,2733.75,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2572.50000,2443.88000,The Alliance,PPO Network,,2137.75,,,,,,,1260.53,2495.32,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2572.50000,2443.88000,The Alliance,PPO Network,,2137.75,,,,,,,1180.78,2572.50,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.00000,572.85000,The Alliance,PPO Network,,501.09,,,,,,,295.47,584.91,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.00000,572.85000,The Alliance,PPO Network,,501.09,,,,,,,276.78,603.00,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,The Alliance,PPO Network,,2927.59,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,PPO Network,,2927.59,,,,,,,1617.04,3522.97,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,The Alliance,PPO Network,,3813.62,,,,,,,2248.70,4451.51,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,PPO Network,,3813.62,,,,,,,2106.44,4589.19,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,The Alliance,PPO Network,,3813.62,,,,,,,2248.70,4451.51,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,PPO Network,,3813.62,,,,,,,2106.44,4589.19,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,PPO Network,,3473.02,,,,,,,1918.31,4179.33,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4305.84000,4090.55000,The Alliance,PPO Network,,3578.15,,,,,,,2109.86,4176.66,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4305.84000,4090.55000,The Alliance,PPO Network,,3578.15,,,,,,,1976.38,4305.84,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,The Alliance,PPO Network,,201.87,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,PPO Network,,201.87,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,315.00000,299.25000,The Alliance,PPO Network,,261.76,,,,,,,154.35,305.55,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,315.00000,299.25000,The Alliance,PPO Network,,261.76,,,,,,,144.59,315.00,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,The Alliance,PPO Network,,201.87,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,PPO Network,,201.87,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,The Alliance,PPO Network,,216.98,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,PPO Network,,216.98,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4692.00000,4457.40000,The Alliance,PPO Network,,3899.05,,,,,,,2299.08,4551.24,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,PPO Network,,3899.05,,,,,,,2153.63,4692.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,The Alliance,PPO Network,,3069.51,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,PPO Network,,3069.51,,,,,,,1695.43,3693.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.52000,42.29000,The Alliance,PPO Network,,37.00,,,,,,,21.81,43.18,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.52000,42.29000,The Alliance,PPO Network,,37.00,,,,,,,20.43,44.52,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2644.53,5761.50,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,900.38,1782.38,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,2051.96000,1949.36000,The Alliance,PPO Network,,1705.18,,,,,,,1005.46,1990.40,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,2051.96000,1949.36000,The Alliance,PPO Network,,1705.18,,,,,,,941.85,2051.96,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,The Alliance,PPO Network,,3069.51,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,PPO Network,,3069.51,,,,,,,1695.43,3693.75,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,499.16,1087.50,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,The Alliance,PPO Network,,3334.26,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,PPO Network,,3334.26,,,,,,,1841.67,4012.35,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,455.70,902.10,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,426.87,930.00,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,PPO Network,,8543.51,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8521.50000,8095.42000,The Alliance,PPO Network,,7081.37,,,,,,,4175.53,8265.85,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,PPO Network,,7081.37,,,,,,,3911.37,8521.50,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2644.53,5761.50,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,187.20000,177.84000,The Alliance,PPO Network,,155.56,,,,,,,91.73,181.58,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,187.20000,177.84000,The Alliance,PPO Network,,155.56,,,,,,,85.92,187.20,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,PPO Network,,4787.81,,,,,,,2644.53,5761.50,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,PPO Network,,772.83,,,,,,,426.87,930.00,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,The Alliance,PPO Network,,981.62,,,,,,,578.81,1145.81,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,PPO Network,,981.62,,,,,,,542.19,1181.25,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,The Alliance,PPO Network,,3334.26,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,PPO Network,,3334.26,,,,,,,1841.67,4012.35,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3904.68000,3709.45000,The Alliance,PPO Network,,3244.79,,,,,,,1913.29,3787.54,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3904.68000,3709.45000,The Alliance,PPO Network,,3244.79,,,,,,,1792.25,3904.68,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,693.75000,659.06000,The Alliance,PPO Network,,576.51,,,,,,,339.94,672.94,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,PPO Network,,576.51,,,,,,,318.43,693.75,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,639.45,1265.85,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,599.00,1305.00,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,PPO Network,,520.41,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1717.50000,1631.62000,The Alliance,PPO Network,,1427.24,,,,,,,841.58,1665.97,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1717.50000,1631.62000,The Alliance,PPO Network,,1427.24,,,,,,,788.33,1717.50,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13934.50000,13237.77000,The Alliance,PPO Network,,11579.57,,,,,,,6827.90,13516.47,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13934.50000,13237.77000,The Alliance,PPO Network,,11579.57,,,,,,,6395.94,13934.50,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,13.77,30.00,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1097.25000,1042.39000,The Alliance,PPO Network,,911.81,,,,,,,537.65,1064.33,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1097.25000,1042.39000,The Alliance,PPO Network,,911.81,,,,,,,503.64,1097.25,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,The Alliance,PPO Network,,458.09,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,PPO Network,,458.09,,,,,,,253.02,551.25,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1383.88,3015.00,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,222.04,483.75,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,The Alliance,PPO Network,,458.09,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,PPO Network,,458.09,,,,,,,253.02,551.25,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,667.50000,634.12000,The Alliance,PPO Network,,554.69,,,,,,,327.07,647.48,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,667.50000,634.12000,The Alliance,PPO Network,,554.69,,,,,,,306.38,667.50,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5796.00000,5506.20000,The Alliance,PPO Network,,4816.48,,,,,,,2840.04,5622.12,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5796.00000,5506.20000,The Alliance,PPO Network,,4816.48,,,,,,,2660.36,5796.00,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,35.23,76.76,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,14.54,31.68,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2255.03000,2142.28000,The Alliance,PPO Network,,1873.93,,,,,,,1104.96,2187.38,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2255.03000,2142.28000,The Alliance,PPO Network,,1873.93,,,,,,,1035.06,2255.03,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,4731.14,10307.50,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,4731.14,10307.50,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,PPO Network,,1386.73,,,,,,,765.96,1668.75,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,PPO Network,,23609.18,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2454.50,5347.50,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,The Alliance,PPO Network,,9740.23,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,PPO Network,,9740.23,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,The Alliance,PPO Network,,10842.80,,,,,,,6393.47,12656.46,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,PPO Network,,10842.80,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4661.42,10155.60,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8745.75000,8308.46000,The Alliance,PPO Network,,7267.72,,,,,,,4285.42,8483.38,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,PPO Network,,7267.72,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,4856.36,10580.30,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6244.50000,5932.27000,The Alliance,PPO Network,,5189.18,,,,,,,3059.80,6057.16,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6244.50000,5932.27000,The Alliance,PPO Network,,5189.18,,,,,,,2866.23,6244.50,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,The Alliance,PPO Network,,10842.80,,,,,,,6393.47,12656.46,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,PPO Network,,10842.80,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,The Alliance,PPO Network,,9740.23,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,PPO Network,,9740.23,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2527.30,5003.02,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2367.41,5157.75,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6192.75000,5883.11000,The Alliance,PPO Network,,5146.18,,,,,,,3034.45,6006.97,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6192.75000,5883.11000,The Alliance,PPO Network,,5146.18,,,,,,,2842.47,6192.75,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6882.75000,6538.61000,The Alliance,PPO Network,,5719.57,,,,,,,3372.55,6676.27,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6882.75000,6538.61000,The Alliance,PPO Network,,5719.57,,,,,,,3159.18,6882.75,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.50000,363.38000,The Alliance,PPO Network,,317.86,,,,,,,187.43,371.02,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,PPO Network,,317.86,,,,,,,175.57,382.50,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,843.41,1837.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,188.68000,179.25000,The Alliance,PPO Network,,156.79,,,,,,,92.45,183.02,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,188.68000,179.25000,The Alliance,PPO Network,,156.79,,,,,,,86.60,188.68,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,716.62,1418.62,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,671.29,1462.50,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,1586.25000,1506.94000,The Alliance,PPO Network,,1318.17,,,,,,,777.26,1538.66,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1586.25000,1506.94000,The Alliance,PPO Network,,1318.17,,,,,,,728.09,1586.25,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1053.40,2295.00,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1053.40,2295.00,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,213.00,421.66,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,PPO Network,,361.24,,,,,,,199.53,434.70,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2676.38000,2542.56000,The Alliance,PPO Network,,2224.07,,,,,,,1311.43,2596.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2676.38000,2542.56000,The Alliance,PPO Network,,2224.07,,,,,,,1228.46,2676.38,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,78.95,172.00,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,16861.49000,16018.42000,The Alliance,PPO Network,,14011.90,,,,,,,8262.13,16355.65,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16861.49000,16018.42000,The Alliance,PPO Network,,14011.90,,,,,,,7739.42,16861.49,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,629.05,1245.27,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,589.26,1283.78,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.69000,839.51000,The Alliance,PPO Network,,734.35,,,,,,,433.01,857.18,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.69000,839.51000,The Alliance,PPO Network,,734.35,,,,,,,405.61,883.69,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,59.56,129.76,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,198.37,349.86,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,349.86,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,926.25000,879.94000,The Alliance,PPO Network,,769.71,,,,,,,453.86,898.46,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,926.25000,879.94000,The Alliance,PPO Network,,769.71,,,,,,,425.15,926.25,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,31.21,68.00,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,303.75000,288.56000,The Alliance,PPO Network,,252.42,,,,,,,148.84,294.64,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,303.75000,288.56000,The Alliance,PPO Network,,252.42,,,,,,,139.42,303.75,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,The Alliance,PPO Network,,3081.97,,,,,,,1817.29,3597.49,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,PPO Network,,3081.97,,,,,,,1702.32,3708.75,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,3966.79,8642.25,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,3966.79,8642.25,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8040.81,17518.10,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,37537.50,66202.50,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,34125.00,66202.50,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,297.00000,282.15000,The Alliance,PPO Network,,246.81,,,,,,,145.53,288.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,297.00000,282.15000,The Alliance,PPO Network,,246.81,,,,,,,136.32,297.00,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1176.15000,1117.34000,The Alliance,PPO Network,,977.38,,,,,,,576.31,1140.87,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1176.15000,1117.34000,The Alliance,PPO Network,,977.38,,,,,,,539.85,1176.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,13.86,27.43,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,12.98,28.28,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,31326.75,68250.00,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8040.81,17518.10,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,PPO Network,,1907.14,,,,,,,1053.40,2295.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,41.48000,39.41000,The Alliance,PPO Network,,34.47,,,,,,,20.33,40.24,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,41.48000,39.41000,The Alliance,PPO Network,,34.47,,,,,,,19.04,41.48,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,9.33,441.37,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,inpatient,,,1234.00000,1172.30000,The Alliance,PPO Network,,1025.45,,,,,,,678.70,1196.98,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,PPO Network,,1025.45,,,,,,,617.00,1196.98,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,822.25,1450.15,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,747.50,1450.15,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,,1360.35,,,,,,,900.35,1587.89,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,,1360.35,,,,,,,520.63,1587.89,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,The Alliance,PPO Network,TC,976.42,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,PPO Network,TC,976.42,,,,,,,587.50,1139.75,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,The Alliance,PPO Network,TC,2121.54,,,,,,,1404.15,2476.41,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,PPO Network,TC,2121.54,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,The Alliance,PPO Network,,2233.73,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,PPO Network,,2233.73,,,,,,,1344.00,2607.36,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,The Alliance,PPO Network,TC,2000.22,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,PPO Network,TC,2000.22,,,,,,,1203.50,2334.79,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,inpatient,1,mL,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,12.81,22.59,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,outpatient,1,mL,23.29000,22.12000,The Alliance,PPO Network,,19.35,,,,,,,11.64,22.59,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,inpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,73.70,129.98,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,67.00,264.00,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,inpatient,1,mL,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,outpatient,1,mL,1.47000,1.39000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,122.40,5271.00,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,PPO Network,TC,766.18,,,,,,,507.10,894.34,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,PPO Network,TC,766.18,,,,,,,391.31,29731.35,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,TC,3275.80,,,,,,,2168.10,3823.74,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,TC,3275.80,,,,,,,356.27,17311.25,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,The Alliance,PPO Network,TC,2847.84,,,,,,,1884.85,3324.19,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,PPO Network,TC,2847.84,,,,,,,1713.50,3324.19,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,378.42,17311.25,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,491.70,867.18,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,361.82,8543.92,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,inpatient,,,17686.00000,16801.70000,The Alliance,PPO Network,TC,14697.07,,,,,,,9727.30,17155.42,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,outpatient,,,17686.00000,16801.70000,The Alliance,PPO Network,TC,14697.07,,,,,,,8843.00,52322.00,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,The Alliance,PPO Network,TC,785.29,,,,,,,519.75,916.65,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,PPO Network,TC,785.29,,,,,,,383.91,8543.92,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,13.75,24.25,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,12.50,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,13.75,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,12.50,24.25,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,inpatient,1,mL,42.94000,40.80000,The Alliance,PPO Network,,35.68,,,,,,,23.62,41.65,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,outpatient,1,mL,42.94000,40.80000,The Alliance,PPO Network,,35.68,,,,,,,21.47,78.87,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,132.00,232.80,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,120.00,584.87,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,14.39,746.94,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,inpatient,,,572.00000,543.40000,The Alliance,PPO Network,,475.33,,,,,,,314.60,554.84,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,outpatient,,,572.00000,543.40000,The Alliance,PPO Network,,475.33,,,,,,,70.04,6756.70,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,inpatient,1,mL,1767.80000,1679.41000,The Alliance,PPO Network,,1469.04,,,,,,,972.29,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,outpatient,1,mL,1767.80000,1679.41000,The Alliance,PPO Network,,1469.04,,,,,,,883.90,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,inpatient,1,mL,738.15000,701.24000,The Alliance,PPO Network,,613.40,,,,,,,405.98,716.01,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,outpatient,1,mL,738.15000,701.24000,The Alliance,PPO Network,,613.40,,,,,,,369.07,716.01,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,inpatient,,,361.00000,342.95000,The Alliance,PPO Network,,299.99,,,,,,,198.55,350.17,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,outpatient,,,361.00000,342.95000,The Alliance,PPO Network,,299.99,,,,,,,77.53,1052.52,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,inpatient,,,1962.00000,1863.90000,The Alliance,PPO Network,,1630.42,,,,,,,1079.10,1903.14,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,outpatient,,,1962.00000,1863.90000,The Alliance,PPO Network,,1630.42,,,,,,,1079.10,4686.00,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,inpatient,1,mL,204.86000,194.62000,The Alliance,PPO Network,,170.24,,,,,,,112.67,198.71,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,outpatient,1,mL,204.86000,194.62000,The Alliance,PPO Network,,170.24,,,,,,,102.43,198.71,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,inpatient,,,4230.00000,4018.50000,The Alliance,PPO Network,,3515.13,,,,,,,2326.50,4103.10,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,outpatient,,,4230.00000,4018.50000,The Alliance,PPO Network,,3515.13,,,,,,,2115.00,4103.10,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,inpatient,1,mL,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,3.15,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,outpatient,1,mL,5.72000,5.43000,The Alliance,PPO Network,,4.75,,,,,,,2.86,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,290.40,512.16,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,264.00,689.02,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,inpatient,,,6076.00000,5772.20000,The Alliance,PPO Network,,5049.16,,,,,,,3341.80,5893.72,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,outpatient,,,6076.00000,5772.20000,The Alliance,PPO Network,,5049.16,,,,,,,1801.27,5982.26,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,TC,991.38,,,,,,,656.15,1157.21,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,TC,991.38,,,,,,,404.21,17311.25,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,inpatient,,,1482.00000,1407.90000,The Alliance,PPO Network,,1231.54,,,,,,,815.10,1437.54,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,PPO Network,,1231.54,,,,,,,815.10,4686.00,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,inpatient,1,EA,6.73000,6.39000,The Alliance,PPO Network,,5.59,,,,,,,3.70,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,PPO Network,,5.59,,,,,,,3.37,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,inpatient,1,EA,6.67000,6.33000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,outpatient,1,EA,6.67000,6.33000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.95,8.73,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.50,8.73,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,484.00000,459.80000,The Alliance,PPO Network,,402.20,,,,,,,266.20,469.48,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,484.00000,459.80000,The Alliance,PPO Network,,402.20,,,,,,,63.95,788.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,inpatient,1,GM,5.94000,5.64000,The Alliance,PPO Network,,4.94,,,,,,,3.27,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,outpatient,1,GM,5.94000,5.64000,The Alliance,PPO Network,,4.94,,,,,,,2.97,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,inpatient,1,GM,5.09000,4.84000,The Alliance,PPO Network,,4.23,,,,,,,2.80,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,outpatient,1,GM,5.09000,4.84000,The Alliance,PPO Network,,4.23,,,,,,,2.54,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,inpatient,1,GM,4.94000,4.70000,The Alliance,PPO Network,,4.11,,,,,,,2.72,4.79,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,outpatient,1,GM,4.94000,4.70000,The Alliance,PPO Network,,4.11,,,,,,,2.47,4.79,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,The Alliance,PPO Network,,100.55,,,,,,,66.55,117.37,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,PPO Network,,100.55,,,,,,,11.54,543.22,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,inpatient,1,mL,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.66,2.92,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,outpatient,1,mL,3.01000,2.86000,The Alliance,PPO Network,,2.50,,,,,,,1.50,2.92,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,inpatient,,,303.50000,288.32000,The Alliance,PPO Network,90,252.21,,,,,,,166.93,294.39,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,outpatient,,,303.50000,288.32000,The Alliance,PPO Network,90,252.21,,,,,,,12.40,628.12,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,inpatient,,,1482.00000,1407.90000,The Alliance,PPO Network,,1231.54,,,,,,,815.10,1437.54,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,PPO Network,,1231.54,,,,,,,483.55,3163.00,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,inpatient,1,mL,348.87000,331.43000,The Alliance,PPO Network,,289.91,,,,,,,191.88,338.40,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,outpatient,1,mL,348.87000,331.43000,The Alliance,PPO Network,,289.91,,,,,,,174.44,338.40,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.48,339.51,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,inpatient,,,164.10000,155.89000,The Alliance,PPO Network,90,136.37,,,,,,,90.25,159.18,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,PPO Network,90,136.37,,,,,,,19.88,1103.49,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,10.25,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,9.32,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,inpatient,1,EA,13.00000,12.35000,The Alliance,PPO Network,,10.80,,,,,,,7.15,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,outpatient,1,EA,13.00000,12.35000,The Alliance,PPO Network,,10.80,,,,,,,6.50,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,3.07,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,PPO Network,,4.64,,,,,,,2.79,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,inpatient,1,EA,34.76000,33.03000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,outpatient,1,EA,34.76000,33.03000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,inpatient,,,3378.00000,3209.10000,The Alliance,PPO Network,,2807.12,,,,,,,1857.90,3276.66,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,outpatient,,,3378.00000,3209.10000,The Alliance,PPO Network,,2807.12,,,,,,,1689.00,3276.66,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,inpatient,,,1370.00000,1301.50000,The Alliance,PPO Network,TC,1138.47,,,,,,,753.50,1328.90,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,outpatient,,,1370.00000,1301.50000,The Alliance,PPO Network,TC,1138.47,,,,,,,413.96,17311.25,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,inpatient,,,243.00000,230.85000,The Alliance,PPO Network,,201.93,,,,,,,133.65,235.71,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,PPO Network,,201.93,,,,,,,121.50,278.37,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,PPO Network,TC,814.38,,,,,,,539.00,950.60,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,PPO Network,TC,814.38,,,,,,,384.16,950.60,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,inpatient,1,mL,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.24,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,25159.00000,23901.05000,The Alliance,PPO Network,,20907.13,,,,,,,13837.45,24404.23,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,25159.00000,23901.05000,The Alliance,PPO Network,,20907.13,,,,,,,772.64,24404.23,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,8.17,696.05,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,2708.00,5253.52,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,inpatient,1,EA,41.89000,39.79000,The Alliance,PPO Network,,34.81,,,,,,,23.04,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,outpatient,1,EA,41.89000,39.79000,The Alliance,PPO Network,,34.81,,,,,,,20.95,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,inpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,14.22,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,inpatient,1,EA,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,29.55,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,outpatient,1,EA,53.72000,51.03000,The Alliance,PPO Network,,44.64,,,,,,,26.86,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,inpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,17.38,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,inpatient,,,335.00000,318.25000,The Alliance,PPO Network,,278.38,,,,,,,184.25,324.95,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,PPO Network,,278.38,,,,,,,167.50,324.95,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,inpatient,,,1040.00000,988.00000,The Alliance,PPO Network,,864.24,,,,,,,572.00,1008.80,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,outpatient,,,1040.00000,988.00000,The Alliance,PPO Network,,864.24,,,,,,,520.00,1008.80,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,inpatient,,,6048.00000,5745.60000,The Alliance,PPO Network,,5025.89,,,,,,,3326.40,5866.56,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,outpatient,,,6048.00000,5745.60000,The Alliance,PPO Network,,5025.89,,,,,,,1556.56,5866.56,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,inpatient,,,6019.00000,5718.05000,The Alliance,PPO Network,,5001.79,,,,,,,3310.45,5838.43,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,outpatient,,,6019.00000,5718.05000,The Alliance,PPO Network,,5001.79,,,,,,,1556.56,5838.43,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,inpatient,,,4922.00000,4675.90000,The Alliance,PPO Network,,4090.18,,,,,,,2707.10,4774.34,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,outpatient,,,4922.00000,4675.90000,The Alliance,PPO Network,,4090.18,,,,,,,2461.00,4774.34,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,inpatient,,,7244.00000,6881.80000,The Alliance,PPO Network,,6019.76,,,,,,,3984.20,7026.68,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,outpatient,,,7244.00000,6881.80000,The Alliance,PPO Network,,6019.76,,,,,,,1556.56,7026.68,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,PPO Network,90,147.09,,,,,,,97.35,171.69,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,PPO Network,90,147.09,,,,,,,17.43,882.80,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,70.28000,66.77000,The Alliance,PPO Network,,58.40,,,,,,,34.44,68.17,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,70.28000,66.77000,The Alliance,PPO Network,,58.40,,,,,,,32.26,70.28,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,23.25,63.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,inpatient,1,mL,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,PPO Network,,1.90,,,,,,,1.15,2.22,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,5.18,271.65,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,224.40,395.76,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,204.00,5271.00,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,inpatient,,,168.70000,160.26000,The Alliance,PPO Network,90,140.19,,,,,,,92.78,163.64,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,outpatient,,,168.70000,160.26000,The Alliance,PPO Network,90,140.19,,,,,,,10.22,509.30,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,31.50,264.00,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,inpatient,1,mL,8.61000,8.18000,The Alliance,PPO Network,,7.15,,,,,,,4.74,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,outpatient,1,mL,8.61000,8.18000,The Alliance,PPO Network,,7.15,,,,,,,4.30,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,76.45,134.83,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,PPO Network,,115.51,,,,,,,12.92,679.08,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1741.85,3071.99,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1488.32,7180.14,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,inpatient,,,57.50000,54.62000,The Alliance,PPO Network,90,47.78,,,,,,,31.62,55.77,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,outpatient,,,57.50000,54.62000,The Alliance,PPO Network,90,47.78,,,,,,,28.75,1137.41,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.12,271.65,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,6.48,339.51,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,38.16000,36.25000,The Alliance,PPO Network,,31.71,,,,,,,18.70,37.02,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,38.16000,36.25000,The Alliance,PPO Network,,31.71,,,,,,,17.52,38.16,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,77.53,1052.52,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,60.50,106.70,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,55.00,106.70,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,4.81,254.68,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,2.54,135.79,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,5.06,254.68,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,inpatient,,,1172.00000,1113.40000,The Alliance,PPO Network,TC,973.93,,,,,,,644.60,1136.84,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,PPO Network,TC,973.93,,,,,,,405.63,4412.20,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,86.79,153.07,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,14.05,713.01,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,inpatient,1,EA,4.50000,4.28000,The Alliance,PPO Network,,3.74,,,,,,,2.48,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,outpatient,1,EA,4.50000,4.28000,The Alliance,PPO Network,,3.74,,,,,,,2.25,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,inpatient,1,GM,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,5.95,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,outpatient,1,GM,10.81000,10.27000,The Alliance,PPO Network,,8.98,,,,,,,5.41,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,inpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.26,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,PPO Network,,1.90,,,,,,,1.15,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.67100,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,PPO Network,,1.01,,,,,,,0.61000,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,1.39,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,4.88,254.68,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,inpatient,1,EA,2578.99000,2450.04000,The Alliance,PPO Network,,2143.14,,,,,,,1418.44,2501.62,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,outpatient,1,EA,2578.99000,2450.04000,The Alliance,PPO Network,,2143.14,,,,,,,81.70,2501.62,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.90,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.50,2.90,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,inpatient,1,mL,7.28000,6.92000,The Alliance,PPO Network,,6.05,,,,,,,4.00,7.06,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,outpatient,1,mL,7.28000,6.92000,The Alliance,PPO Network,,6.05,,,,,,,3.64,7.06,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,inpatient,1,EA,2310.25000,2194.74000,The Alliance,PPO Network,,1919.82,,,,,,,1270.64,2240.94,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,outpatient,1,EA,2310.25000,2194.74000,The Alliance,PPO Network,,1919.82,,,,,,,19.81,2240.94,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,The Alliance,PPO Network,90,223.21,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,PPO Network,90,223.21,,,,,,,24.43,1205.34,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,4.91,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,inpatient,1,mL,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,PPO Network,,5.41,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,inpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,PPO Network,,6.53,,,,,,,1.65,7.62,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.23,2.17,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,PPO Network,,1.86,,,,,,,1.12,2.17,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,8.30,14.64,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,PPO Network,,12.54,,,,,,,7.54,14.64,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,inpatient,1,mL,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,PPO Network,,1.45,,,,,,,0.87500,1.70,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,4.32,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,inpatient,1,mL,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,0.46480,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.46480,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,inpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.46480,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,inpatient,1,mL,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,PPO Network,,1.11,,,,,,,0.46480,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,inpatient,1,EA,237.78000,225.89000,The Alliance,PPO Network,,197.60,,,,,,,130.78,230.65,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,outpatient,1,EA,237.78000,225.89000,The Alliance,PPO Network,,197.60,,,,,,,118.89,230.65,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,,1655.35,,,,,,,1095.60,1932.24,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,PPO Network,,1655.35,,,,,,,100.97,1932.24,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2502.50,4413.50,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2150.56,7180.14,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,inpatient,1,EA,483.76000,459.57000,The Alliance,PPO Network,,402.00,,,,,,,266.07,469.25,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,outpatient,1,EA,483.76000,459.57000,The Alliance,PPO Network,,402.00,,,,,,,241.88,469.25,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,7.34,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,inpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,PPO Network,,12.20,,,,,,,7.34,14.24,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,inpatient,1,EA,40.03000,38.03000,The Alliance,PPO Network,,33.26,,,,,,,22.02,38.83,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,outpatient,1,EA,40.03000,38.03000,The Alliance,PPO Network,,33.26,,,,,,,20.02,38.83,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,The Alliance,PPO Network,TC,3915.67,,,,,,,2591.60,4570.64,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,PPO Network,TC,3915.67,,,,,,,2210.90,23155.09,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,134.64,472.39,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,inpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,inpatient,1,mL,54.93000,52.19000,The Alliance,PPO Network,,45.65,,,,,,,30.21,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,outpatient,1,mL,54.93000,52.19000,The Alliance,PPO Network,,45.65,,,,,,,27.46,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,14.22,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,inpatient,1,mL,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.82,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,outpatient,1,mL,14.22000,13.51000,The Alliance,PPO Network,,11.82,,,,,,,7.11,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,inpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,inpatient,1,mL,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,60.83,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,0.91450,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,inpatient,1,mL,157.02000,149.17000,The Alliance,PPO Network,,130.48,,,,,,,86.36,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,outpatient,1,mL,157.02000,149.17000,The Alliance,PPO Network,,130.48,,,,,,,0.91450,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,inpatient,1,mL,105.95000,100.65000,The Alliance,PPO Network,,88.04,,,,,,,58.27,102.77,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,outpatient,1,mL,105.95000,100.65000,The Alliance,PPO Network,,88.04,,,,,,,0.91450,102.77,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,99.55,175.57,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,16.26,848.80,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,2.07,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,PPO Network,,3.12,,,,,,,1.88,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,inpatient,1,GM,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,outpatient,1,GM,1.72000,1.63000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,inpatient,1,GM,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,outpatient,1,GM,1.72000,1.64000,The Alliance,PPO Network,,1.43,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,inpatient,1,mL,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,inpatient,1,mL,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.53,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,outpatient,1,mL,2.78000,2.64000,The Alliance,PPO Network,,2.31,,,,,,,1.30,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,inpatient,1,mL,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,3.39,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,outpatient,1,mL,6.16000,5.85000,The Alliance,PPO Network,,5.12,,,,,,,1.30,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,inpatient,1,mL,6.98000,6.63000,The Alliance,PPO Network,,5.80,,,,,,,3.84,6.77,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,outpatient,1,mL,6.98000,6.63000,The Alliance,PPO Network,,5.80,,,,,,,1.30,6.77,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,2.76,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,inpatient,1,mL,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,inpatient,1,mL,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,outpatient,1,mL,1.11000,1.06000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,inpatient,1,mL,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,inpatient,,,869.00000,825.55000,The Alliance,PPO Network,,722.14,,,,,,,477.95,842.93,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,PPO Network,,722.14,,,,,,,434.50,1820.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,inpatient,1,mL,16.53000,15.70000,The Alliance,PPO Network,,13.74,,,,,,,9.09,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,outpatient,1,mL,16.53000,15.70000,The Alliance,PPO Network,,13.74,,,,,,,8.27,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,inpatient,1,mL,12.05000,11.45000,The Alliance,PPO Network,,10.01,,,,,,,6.63,11.69,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,outpatient,1,mL,12.05000,11.45000,The Alliance,PPO Network,,10.01,,,,,,,6.03,11.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,67.50,1595.82,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,inpatient,1,EA,34.43000,32.71000,The Alliance,PPO Network,,28.61,,,,,,,18.94,33.40,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,outpatient,1,EA,34.43000,32.71000,The Alliance,PPO Network,,28.61,,,,,,,17.21,33.40,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,inpatient,,,790.00000,750.50000,The Alliance,PPO Network,TC,656.49,,,,,,,434.50,766.30,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,PPO Network,TC,656.49,,,,,,,268.62,3270.26,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,The Alliance,PPO Network,,3588.26,,,,,,,2374.90,4188.46,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,PPO Network,,3588.26,,,,,,,1031.39,4188.46,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,PPO Network,TC,280.05,,,,,,,185.35,326.89,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,PPO Network,TC,280.05,,,,,,,168.50,326.89,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,inpatient,1,GM,1.65000,1.56000,The Alliance,PPO Network,,1.37,,,,,,,0.90750,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,outpatient,1,GM,1.65000,1.56000,The Alliance,PPO Network,,1.37,,,,,,,0.82500,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,inpatient,1,GM,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,outpatient,1,GM,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,inpatient,1,GM,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,outpatient,1,GM,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,inpatient,1,mL,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,2.69,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,PPO Network,,4.06,,,,,,,2.44,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,inpatient,1,mL,11.91000,11.32000,The Alliance,PPO Network,,9.90,,,,,,,6.55,11.55,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,outpatient,1,mL,11.91000,11.32000,The Alliance,PPO Network,,9.90,,,,,,,5.96,11.55,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,The Alliance,PPO Network,TC,3902.38,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,PPO Network,TC,3902.38,,,,,,,595.74,17311.25,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,2.34,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,inpatient,,,1047.00000,994.65000,The Alliance,PPO Network,TC,870.06,,,,,,,575.85,1015.59,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,outpatient,,,1047.00000,994.65000,The Alliance,PPO Network,TC,870.06,,,,,,,447.16,29731.35,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,The Alliance,PPO Network,,10.97,,,,,,,7.26,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,PPO Network,,10.97,,,,,,,6.60,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,inpatient,1,EA,135.69000,128.91000,The Alliance,PPO Network,,112.76,,,,,,,74.63,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,outpatient,1,EA,135.69000,128.91000,The Alliance,PPO Network,,112.76,,,,,,,67.84,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,PPO Network,,7.01,,,,,,,4.21,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,inpatient,1,EA,13.73000,13.04000,The Alliance,PPO Network,,11.41,,,,,,,7.55,13.32,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,outpatient,1,EA,13.73000,13.04000,The Alliance,PPO Network,,11.41,,,,,,,6.87,13.32,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,79.75,140.65,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,,120.50,,,,,,,12.05,574.73,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,inpatient,1,EA,387.28000,367.92000,The Alliance,PPO Network,,321.83,,,,,,,213.00,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,outpatient,1,EA,387.28000,367.92000,The Alliance,PPO Network,,321.83,,,,,,,6.30,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,inpatient,1,EA,546.90000,519.56000,The Alliance,PPO Network,,454.47,,,,,,,300.80,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,outpatient,1,EA,546.90000,519.56000,The Alliance,PPO Network,,454.47,,,,,,,6.30,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,inpatient,1,EA,140.13000,133.12000,The Alliance,PPO Network,,116.45,,,,,,,77.07,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,outpatient,1,EA,140.13000,133.12000,The Alliance,PPO Network,,116.45,,,,,,,6.30,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,inpatient,1,EA,493.01000,468.36000,The Alliance,PPO Network,,409.69,,,,,,,271.16,478.22,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,outpatient,1,EA,493.01000,468.36000,The Alliance,PPO Network,,409.69,,,,,,,6.30,478.22,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,The Alliance,PPO Network,,5.99,,,,,,,3.97,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,PPO Network,,5.99,,,,,,,3.60,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.65,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,PPO Network,,5.51,,,,,,,3.31,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,inpatient,1,EA,5.83000,5.54000,The Alliance,PPO Network,,4.84,,,,,,,3.21,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,outpatient,1,EA,5.83000,5.54000,The Alliance,PPO Network,,4.84,,,,,,,2.92,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,inpatient,1,EA,21.16000,20.10000,The Alliance,PPO Network,,17.58,,,,,,,11.64,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,outpatient,1,EA,21.16000,20.10000,The Alliance,PPO Network,,17.58,,,,,,,10.58,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,3.06,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,PPO Network,,4.62,,,,,,,2.78,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,inpatient,1,GM,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,6.57,11.58,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,outpatient,1,GM,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,5.97,11.58,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,439.81,17311.25,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,inpatient,1,EA,23.40000,22.23000,The Alliance,PPO Network,,19.45,,,,,,,12.87,22.70,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,outpatient,1,EA,23.40000,22.23000,The Alliance,PPO Network,,19.45,,,,,,,11.70,22.70,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,inpatient,1,EA,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,3.40,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,outpatient,1,EA,6.19000,5.88000,The Alliance,PPO Network,,5.14,,,,,,,3.10,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,inpatient,1,EA,60150.20000,57142.69000,The Alliance,PPO Network,,49984.82,,,,,,,33082.61,58345.69,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,outpatient,1,EA,60150.20000,57142.69000,The Alliance,PPO Network,,49984.82,,,,,,,30075.10,58345.69,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,inpatient,1,EA,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,outpatient,1,EA,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,312.03,631.01,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,inpatient,1,mL,113.76000,108.07000,The Alliance,PPO Network,,94.53,,,,,,,62.57,110.35,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,PPO Network,,94.53,,,,,,,7.57,110.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,inpatient,1,mL,67.86000,64.47000,The Alliance,PPO Network,,56.39,,,,,,,37.32,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,outpatient,1,mL,67.86000,64.47000,The Alliance,PPO Network,,56.39,,,,,,,1.42,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,inpatient,1,mL,71.93000,68.34000,The Alliance,PPO Network,,59.77,,,,,,,39.56,69.77,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,outpatient,1,mL,71.93000,68.34000,The Alliance,PPO Network,,59.77,,,,,,,1.42,69.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,inpatient,1,mL,46.99000,44.64000,The Alliance,PPO Network,,39.05,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,outpatient,1,mL,46.99000,44.64000,The Alliance,PPO Network,,39.05,,,,,,,23.50,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,7.62,14.77,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,177.51,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,91.50,1544.85,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,inpatient,1,mL,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,inpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.78,4.91,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,PPO Network,,4.20,,,,,,,2.53,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,inpatient,1,mL,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.02,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,PPO Network,,2.58,,,,,,,1.55,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,inpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,PPO Network,,3.67,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,inpatient,1,mL,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.71,3.01,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,outpatient,1,mL,3.10000,2.94000,The Alliance,PPO Network,,2.58,,,,,,,1.55,5.23,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,inpatient,1,mL,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,126.07,4371.88,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,inpatient,,,953.00000,905.35000,The Alliance,PPO Network,TC,791.94,,,,,,,524.15,924.41,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,PPO Network,TC,791.94,,,,,,,354.42,3685.66,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,281.05,495.67,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,122.40,495.67,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,inpatient,,,563.00000,534.85000,The Alliance,PPO Network,90,467.85,,,,,,,309.65,546.11,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,PPO Network,90,467.85,,,,,,,70.04,6094.58,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,154.55,272.57,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,62.14,3038.81,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,,4470.78,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,,4470.78,,,,,,,759.53,35735.73,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,inpatient,,,320.70000,304.66000,The Alliance,PPO Network,90,266.50,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,PPO Network,90,266.50,,,,,,,154.60,9082.50,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,inpatient,,,320.70000,304.66000,The Alliance,PPO Network,90,266.50,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,PPO Network,90,266.50,,,,,,,160.35,13920.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,inpatient,,,972.00000,923.40000,The Alliance,PPO Network,90,807.73,,,,,,,534.60,942.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,outpatient,,,972.00000,923.40000,The Alliance,PPO Network,90,807.73,,,,,,,486.00,8610.62,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,PPO Network,TC,332.40,,,,,,,220.00,388.00,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,PPO Network,TC,332.40,,,,,,,200.00,3536.91,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,158.40,279.36,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,144.00,2342.52,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,TC,147.92,,,,,,,97.90,172.66,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,TC,147.92,,,,,,,67.83,848.80,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,inpatient,,,325.00000,308.75000,The Alliance,PPO Network,TC,270.07,,,,,,,178.75,315.25,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,PPO Network,TC,270.07,,,,,,,162.50,2993.62,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,inpatient,,,1919.00000,1823.05000,The Alliance,PPO Network,,1594.69,,,,,,,1055.45,1861.43,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,outpatient,,,1919.00000,1823.05000,The Alliance,PPO Network,,1594.69,,,,,,,959.50,1861.43,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,The Alliance,PPO Network,TC,407.19,,,,,,,269.50,475.30,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,PPO Network,TC,407.19,,,,,,,245.00,475.30,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,inpatient,,,1014.00000,963.30000,The Alliance,PPO Network,TC,842.63,,,,,,,557.70,983.58,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,outpatient,,,1014.00000,963.30000,The Alliance,PPO Network,TC,842.63,,,,,,,384.16,983.58,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,TC,1384.45,,,,,,,916.30,1616.02,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,TC,1384.45,,,,,,,833.00,10812.84,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,128.70,226.98,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,20.05,1052.52,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,128.70,226.98,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,20.05,1052.52,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,8.17,679.08,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,1037.00000,985.15000,The Alliance,PPO Network,,861.75,,,,,,,570.35,1005.89,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,1037.00000,985.15000,The Alliance,PPO Network,,861.75,,,,,,,213.76,1005.89,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,inpatient,,,3274.00000,3110.30000,The Alliance,PPO Network,TC,2720.69,,,,,,,1800.70,3175.78,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,outpatient,,,3274.00000,3110.30000,The Alliance,PPO Network,TC,2720.69,,,,,,,1487.04,3175.78,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,inpatient,,,29288.00000,27823.60000,The Alliance,PPO Network,,24338.33,,,,,,,14351.12,28409.36,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,outpatient,,,29288.00000,27823.60000,The Alliance,PPO Network,,24338.33,,,,,,,13443.19,29288.00,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.28,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.49,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,PPO Network,,2.25,,,,,,,1.35,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,The Alliance,PPO Network,,2.57,,,,,,,1.70,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,PPO Network,,2.57,,,,,,,1.54,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,183.32,399.38,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.56100,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,PPO Network,,0.84762,,,,,,,0.51000,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,inpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,inpatient,1,mL,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,outpatient,1,mL,1.56000,1.49000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.81,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,inpatient,1,mL,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.47,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,outpatient,1,mL,2.68000,2.55000,The Alliance,PPO Network,,2.23,,,,,,,1.34,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,inpatient,1,mL,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.95150,1.68,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,outpatient,1,mL,1.73000,1.64000,The Alliance,PPO Network,,1.44,,,,,,,0.86500,1.68,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,GO,215.23,,,,,,,142.45,251.23,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,GO,215.23,,,,,,,126.65,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,GO,85.59,,,,,,,56.65,99.91,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,GO,85.59,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,GP,85.59,,,,,,,56.65,99.91,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,GP,85.59,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,GP,215.23,,,,,,,142.45,251.23,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,GP,215.23,,,,,,,126.65,264.00,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,163.52,356.25,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,inpatient,,,5390.00000,5120.50000,The Alliance,PPO Network,,4479.09,,,,,,,2964.50,5228.30,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,outpatient,,,5390.00000,5120.50000,The Alliance,PPO Network,,4479.09,,,,,,,2964.50,5271.00,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,inpatient,1,mL,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.91,10.42,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,outpatient,1,mL,10.74000,10.21000,The Alliance,PPO Network,,8.92,,,,,,,5.37,10.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,The Alliance,PPO Network,TC,2148.97,,,,,,,1422.30,2508.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,PPO Network,TC,2148.97,,,,,,,1293.00,13397.25,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,inpatient,1,mL,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,19.12,33.72,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,outpatient,1,mL,34.76000,33.02000,The Alliance,PPO Network,,28.89,,,,,,,3.49,33.72,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,PPO Network,TC,602.48,,,,,,,398.75,703.25,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,PPO Network,TC,602.48,,,,,,,237.91,17311.25,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,inpatient,,,919.00000,873.05000,The Alliance,PPO Network,TC,763.69,,,,,,,505.45,891.43,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,outpatient,,,919.00000,873.05000,The Alliance,PPO Network,TC,763.69,,,,,,,389.46,8543.92,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,1.58,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,inpatient,1,mL,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,inpatient,1,mL,24.07000,22.86000,The Alliance,PPO Network,,20.00,,,,,,,13.24,23.35,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,outpatient,1,mL,24.07000,22.86000,The Alliance,PPO Network,,20.00,,,,,,,12.04,23.35,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,inpatient,1,mL,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,0.88270,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,inpatient,1,mL,14.10000,13.39000,The Alliance,PPO Network,,11.72,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,PPO Network,,11.72,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,inpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,PPO Network,,12.66,,,,,,,1.49,14.77,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2084.29000,1980.08000,The Alliance,PPO Network,,1732.04,,,,,,,1021.30,2021.76,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2084.29000,1980.08000,The Alliance,PPO Network,,1732.04,,,,,,,956.69,2084.29,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,163.52,356.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,307.13000,291.77000,The Alliance,PPO Network,,255.23,,,,,,,150.49,297.92,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,307.13000,291.77000,The Alliance,PPO Network,,255.23,,,,,,,140.97,307.13,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,The Alliance,PPO Network,,12824.50,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,PPO Network,,12824.50,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2500.84000,2375.80000,The Alliance,PPO Network,,2078.20,,,,,,,1225.41,2425.81,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2500.84000,2375.80000,The Alliance,PPO Network,,2078.20,,,,,,,1147.89,2500.84,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,The Alliance,PPO Network,,8294.09,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,PPO Network,,8294.09,,,,,,,4581.21,9980.85,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,9.88,184.30,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,38.16,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,2115.00000,2009.25000,The Alliance,PPO Network,,1757.57,,,,,,,1163.25,2051.55,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,2115.00000,2009.25000,The Alliance,PPO Network,,1757.57,,,,,,,802.34,2051.55,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,PPO Network,,8580.08,,,,,,,3612.55,10015.25,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,The Alliance,PPO Network,TC,1204.95,,,,,,,797.50,1406.50,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,PPO Network,TC,1204.95,,,,,,,723.58,29731.35,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,500.59,29731.35,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,The Alliance,PPO Network,TC,8910.81,,,,,,,5897.65,10401.31,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,PPO Network,TC,8910.81,,,,,,,5057.86,51844.17,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,inpatient,,,1400.00000,1330.00000,The Alliance,PPO Network,TC,1163.40,,,,,,,770.00,1358.00,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,outpatient,,,1400.00000,1330.00000,The Alliance,PPO Network,TC,1163.40,,,,,,,450.12,4834.29,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,inpatient,,,1399.00000,1329.05000,The Alliance,PPO Network,TC,1162.57,,,,,,,769.45,1357.03,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,outpatient,,,1399.00000,1329.05000,The Alliance,PPO Network,TC,1162.57,,,,,,,282.87,4511.07,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,1007.60,1777.04,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,916.00,1777.04,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,PPO Network,TC,828.51,,,,,,,548.35,967.09,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,PPO Network,TC,828.51,,,,,,,384.16,1329.46,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,382.25,674.15,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,298.87,674.15,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,The Alliance,PPO Network,,3997.94,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,PPO Network,,3997.94,,,,,,,1285.85,4666.67,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,,90.58,,,,,,,59.95,105.73,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,,90.58,,,,,,,11.57,560.26,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,inpatient,,,484.20000,459.99000,The Alliance,PPO Network,90,402.37,,,,,,,266.31,469.67,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,PPO Network,90,402.37,,,,,,,44.27,2240.90,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,152.35,268.69,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,60.36,268.69,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,2.25,118.82,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,2.25,118.82,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,3.93,203.72,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,inpatient,,,1122.00000,1065.90000,The Alliance,PPO Network,,932.38,,,,,,,617.10,1088.34,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,outpatient,,,1122.00000,1065.90000,The Alliance,PPO Network,,932.38,,,,,,,415.12,1088.34,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,158.95,280.33,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,25.81,1341.13,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,27.50,48.50,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,5.08,254.68,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,inpatient,,,9216.00000,8755.20000,The Alliance,PPO Network,,7658.50,,,,,,,5068.80,8939.52,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,PPO Network,,7658.50,,,,,,,3500.91,8939.52,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,3509.55,6189.57,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,1637.45,6189.57,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,16.07,763.98,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,99.55,175.57,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,13.73,713.01,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,inpatient,,,271.10000,257.54000,The Alliance,PPO Network,90,225.28,,,,,,,149.10,262.97,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,outpatient,,,271.10000,257.54000,The Alliance,PPO Network,90,225.28,,,,,,,8.91,458.40,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,PPO Network,,570.07,,,,,,,377.30,665.42,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,PPO Network,,570.07,,,,,,,314.95,665.42,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,97.35,171.69,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,38.57,1832.89,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,inpatient,,,94.30000,89.58000,The Alliance,PPO Network,90,78.36,,,,,,,51.87,91.47,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,outpatient,,,94.30000,89.58000,The Alliance,PPO Network,90,78.36,,,,,,,47.15,4702.48,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,GP,63.16,,,,,,,41.80,73.72,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,GP,63.16,,,,,,,38.00,264.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,3163.00,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,587.06,3163.00,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,inpatient,,,371.50000,352.92000,The Alliance,PPO Network,,308.72,,,,,,,204.32,360.36,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,PPO Network,,308.72,,,,,,,185.75,360.36,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,12.09,628.12,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,2.25,118.82,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,inpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,outpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,134.64,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,433.40,764.36,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,327.36,764.36,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,inpatient,1,EA,8.81000,8.37000,The Alliance,PPO Network,,7.32,,,,,,,4.85,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,PPO Network,,7.32,,,,,,,4.41,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,inpatient,1,EA,11.12000,10.57000,The Alliance,PPO Network,,9.24,,,,,,,6.12,10.79,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,outpatient,1,EA,11.12000,10.57000,The Alliance,PPO Network,,9.24,,,,,,,5.56,10.79,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,inpatient,1,mL,43.92000,41.73000,The Alliance,PPO Network,,36.50,,,,,,,24.16,42.60,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,outpatient,1,mL,43.92000,41.73000,The Alliance,PPO Network,,36.50,,,,,,,21.96,83.21,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,143.55,253.17,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,13.25,696.05,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,The Alliance,PPO Network,,3100.67,,,,,,,1828.31,3619.31,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,PPO Network,,3100.67,,,,,,,1712.64,3731.25,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,inpatient,,,1441.00000,1368.95000,The Alliance,PPO Network,,1197.47,,,,,,,792.55,1397.77,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,outpatient,,,1441.00000,1368.95000,The Alliance,PPO Network,,1197.47,,,,,,,792.55,4686.00,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,inpatient,,,1616.00000,1535.20000,The Alliance,PPO Network,,1342.90,,,,,,,888.80,1567.52,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,outpatient,,,1616.00000,1535.20000,The Alliance,PPO Network,,1342.90,,,,,,,888.80,5271.00,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,PPO Network,90,177.83,,,,,,,117.70,207.58,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,PPO Network,90,177.83,,,,,,,21.00,1069.56,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4467.75000,4244.36000,The Alliance,PPO Network,,3712.70,,,,,,,2189.20,4333.72,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,PPO Network,,3712.70,,,,,,,2050.70,4467.75,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,224.40,395.76,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,204.00,26177.94,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,inpatient,,,484.20000,459.99000,The Alliance,PPO Network,90,402.37,,,,,,,266.31,469.67,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,PPO Network,90,402.37,,,,,,,44.27,2240.90,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,inpatient,1,mL,29.77000,28.29000,The Alliance,PPO Network,,24.74,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,PPO Network,,24.74,,,,,,,14.88,73.49,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,inpatient,1,mL,29.78000,28.29000,The Alliance,PPO Network,,24.75,,,,,,,16.38,28.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,outpatient,1,mL,29.78000,28.29000,The Alliance,PPO Network,,24.75,,,,,,,14.89,73.49,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,90.03,158.79,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,20.36,1120.45,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,52.50,264.00,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,inpatient,,,351.00000,333.45000,The Alliance,PPO Network,,291.68,,,,,,,193.05,340.47,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,outpatient,,,351.00000,333.45000,The Alliance,PPO Network,,291.68,,,,,,,115.36,6026.72,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.06,254.68,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,49.50,264.00,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,417.10,17311.25,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.17,2.06,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,PPO Network,,1.76,,,,,,,1.06,2.06,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,30.80,54.32,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,22.80,54.32,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,143.55,253.17,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,25.47,1324.17,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,26.40,46.56,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,6.41,1590.11,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,The Alliance,PPO Network,TC,4295.44,,,,,,,2842.95,5013.93,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,PPO Network,TC,4295.44,,,,,,,2584.50,5271.00,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1084.39,2362.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,inpatient,1,mL,29.77000,28.29000,The Alliance,PPO Network,,24.74,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,PPO Network,,24.74,,,,,,,14.88,73.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,inpatient,,,130.40000,123.88000,The Alliance,PPO Network,90,108.36,,,,,,,71.72,126.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,outpatient,,,130.40000,123.88000,The Alliance,PPO Network,90,108.36,,,,,,,12.41,628.12,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,inpatient,,,454.10000,431.40000,The Alliance,PPO Network,90,377.36,,,,,,,249.75,440.48,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,outpatient,,,454.10000,431.40000,The Alliance,PPO Network,90,377.36,,,,,,,52.89,2410.69,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,inpatient,,,192.50000,182.88000,The Alliance,PPO Network,90,159.97,,,,,,,105.88,186.72,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,outpatient,,,192.50000,182.88000,The Alliance,PPO Network,90,159.97,,,,,,,17.60,882.80,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,36.26,1833.46,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,The Alliance,PPO Network,,1470.87,,,,,,,867.30,1716.90,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,PPO Network,,1470.87,,,,,,,812.43,1770.00,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,PPO Network,,14557.54,,,,,,,8040.81,17518.10,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,14201.10000,13491.04000,The Alliance,PPO Network,,11801.11,,,,,,,6958.54,13775.07,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,14201.10000,13491.04000,The Alliance,PPO Network,,11801.11,,,,,,,6518.30,14201.10,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,34.10,60.14,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,31.00,264.00,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,717.75,1265.85,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,126.07,6798.73,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,90,127.14,,,,,,,84.15,148.41,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,90,127.14,,,,,,,15.53,780.94,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,PPO Network,90,208.58,,,,,,,138.05,243.47,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,PPO Network,90,208.58,,,,,,,12.40,628.12,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,218.24,384.90,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,36.26,1833.46,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,113.30,199.82,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,18.37,967.70,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,22.91,1035.56,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3505.20000,3329.94000,The Alliance,PPO Network,,2912.82,,,,,,,1717.55,3400.04,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3505.20000,3329.94000,The Alliance,PPO Network,,2912.82,,,,,,,1608.89,3505.20,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,inpatient,1,EA,169.94000,161.45000,The Alliance,PPO Network,,141.22,,,,,,,93.47,164.84,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,outpatient,1,EA,169.94000,161.45000,The Alliance,PPO Network,,141.22,,,,,,,84.97,164.84,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,inpatient,1,EA,13.76000,13.08000,The Alliance,PPO Network,,11.43,,,,,,,7.57,13.35,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,outpatient,1,EA,13.76000,13.08000,The Alliance,PPO Network,,11.43,,,,,,,0.73160,13.35,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,351.45000,333.88000,The Alliance,PPO Network,,292.05,,,,,,,172.21,340.91,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,351.45000,333.88000,The Alliance,PPO Network,,292.05,,,,,,,161.32,351.45,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,PPO Network,,0.73128,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,inpatient,,,1354.00000,1286.30000,The Alliance,PPO Network,TC,1125.17,,,,,,,744.70,1313.38,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,outpatient,,,1354.00000,1286.30000,The Alliance,PPO Network,TC,1125.17,,,,,,,384.16,1313.38,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5168.10000,4909.70000,The Alliance,PPO Network,,4294.69,,,,,,,2532.37,5013.06,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5168.10000,4909.70000,The Alliance,PPO Network,,4294.69,,,,,,,2372.16,5168.10,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,inpatient,,,1356.00000,1288.20000,The Alliance,PPO Network,,1126.84,,,,,,,745.80,1315.32,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,outpatient,,,1356.00000,1288.20000,The Alliance,PPO Network,,1126.84,,,,,,,227.78,5858.00,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,90,169.52,,,,,,,112.20,197.88,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,90,169.52,,,,,,,18.65,950.66,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,13.25,696.05,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,13.25,696.05,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,inpatient,,,158.30000,150.38000,The Alliance,PPO Network,90,131.55,,,,,,,87.06,153.55,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,PPO Network,90,131.55,,,,,,,19.26,882.80,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,36.26,1833.46,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,90,189.47,,,,,,,125.40,221.16,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,90,189.47,,,,,,,12.38,628.12,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,90.75,160.05,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,PPO Network,,137.12,,,,,,,13.25,696.05,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,24.89,1137.41,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,85.80,151.32,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,16.46,865.84,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,218.24,384.90,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,36.26,1833.46,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,218.24,384.90,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,PPO Network,90,329.74,,,,,,,50.62,3666.93,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,6.47,339.51,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,PPO Network,90,137.12,,,,,,,90.75,160.05,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,PPO Network,90,137.12,,,,,,,15.09,763.98,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,inpatient,,,5028.00000,4776.60000,The Alliance,PPO Network,90,4178.27,,,,,,,2765.40,4877.16,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,outpatient,,,5028.00000,4776.60000,The Alliance,PPO Network,90,4178.27,,,,,,,430.66,21780.96,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,The Alliance,PPO Network,90,327.00,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,PPO Network,90,327.00,,,,,,,43.79,1986.29,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,The Alliance,PPO Network,90,327.00,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,PPO Network,90,327.00,,,,,,,43.79,1986.29,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,129.67,6518.98,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,inpatient,,,149.70000,142.21000,The Alliance,PPO Network,90,124.40,,,,,,,82.33,145.21,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,outpatient,,,149.70000,142.21000,The Alliance,PPO Network,90,124.40,,,,,,,13.33,679.08,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,78.10,137.74,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,PPO Network,,118.00,,,,,,,14.86,137.74,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,273.46,482.28,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,44.27,2240.90,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,inpatient,,,160.20000,152.19000,The Alliance,PPO Network,90,133.13,,,,,,,88.11,155.39,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,outpatient,,,160.20000,152.19000,The Alliance,PPO Network,90,133.13,,,,,,,14.65,746.94,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,inpatient,,,460.60000,437.57000,The Alliance,PPO Network,90,382.76,,,,,,,253.33,446.78,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,outpatient,,,460.60000,437.57000,The Alliance,PPO Network,90,382.76,,,,,,,42.11,2122.08,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,inpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,inpatient,1,GM,379.18000,360.22000,The Alliance,PPO Network,,315.10,,,,,,,208.55,367.80,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,outpatient,1,GM,379.18000,360.22000,The Alliance,PPO Network,,315.10,,,,,,,189.59,367.80,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,inpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.19800,0.34920,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,PPO Network,,0.29916,,,,,,,0.18000,0.34920,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,inpatient,1,EA,15.47000,14.69000,The Alliance,PPO Network,,12.86,,,,,,,8.51,15.01,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,outpatient,1,EA,15.47000,14.69000,The Alliance,PPO Network,,12.86,,,,,,,7.74,15.01,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.44,2.53,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.30,2.53,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,inpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,inpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,2.00,3.52,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,PPO Network,,3.02,,,,,,,1.02,3.52,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,inpatient,1,EA,10.18000,9.67000,The Alliance,PPO Network,,8.46,,,,,,,5.60,9.87,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,outpatient,1,EA,10.18000,9.67000,The Alliance,PPO Network,,8.46,,,,,,,5.09,9.87,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,inpatient,1,EA,3.16000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,outpatient,1,EA,3.16000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,inpatient,1,mL,1421.20000,1350.14000,The Alliance,PPO Network,,1181.02,,,,,,,781.66,1378.56,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,outpatient,1,mL,1421.20000,1350.14000,The Alliance,PPO Network,,1181.02,,,,,,,0.37000,1378.56,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,inpatient,1,EA,3.93000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,2.16,3.81,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,outpatient,1,EA,3.93000,3.74000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.81,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.29150,0.51410,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,PPO Network,,0.44043,,,,,,,0.26500,0.51410,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.57,3.05,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.96800,1.71,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,PPO Network,,1.46,,,,,,,0.88000,1.71,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,inpatient,1,EA,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.17,2.07,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,PPO Network,,1.77,,,,,,,1.06,2.07,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,inpatient,1,EA,40.37000,38.36000,The Alliance,PPO Network,,33.55,,,,,,,22.20,39.16,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,outpatient,1,EA,40.37000,38.36000,The Alliance,PPO Network,,33.55,,,,,,,20.18,39.16,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,inpatient,1,mL,301.09000,286.03000,The Alliance,PPO Network,,250.21,,,,,,,165.60,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,outpatient,1,mL,301.09000,286.03000,The Alliance,PPO Network,,250.21,,,,,,,92.50,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,inpatient,1,mL,305.62000,290.34000,The Alliance,PPO Network,,253.97,,,,,,,168.09,296.45,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,outpatient,1,mL,305.62000,290.34000,The Alliance,PPO Network,,253.97,,,,,,,92.50,296.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,inpatient,1,mL,14.59000,13.86000,The Alliance,PPO Network,,12.12,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,PPO Network,,12.12,,,,,,,7.29,73.49,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,inpatient,1,EA,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.80,4.94,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.54,4.94,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,1.08,1.91,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,PPO Network,,1.64,,,,,,,0.98500,1.91,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.22,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,PPO Network,,3.61,,,,,,,2.17,4.22,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,inpatient,1,EA,8.72000,8.28000,The Alliance,PPO Network,,7.25,,,,,,,4.80,8.46,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,outpatient,1,EA,8.72000,8.28000,The Alliance,PPO Network,,7.25,,,,,,,4.36,8.46,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,inpatient,1,mL,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.92,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,PPO Network,,4.41,,,,,,,2.65,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,inpatient,1,mL,16.35000,15.54000,The Alliance,PPO Network,,13.59,,,,,,,8.99,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,outpatient,1,mL,16.35000,15.54000,The Alliance,PPO Network,,13.59,,,,,,,3.62,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,inpatient,1,mL,6.68000,6.35000,The Alliance,PPO Network,,5.55,,,,,,,3.67,6.48,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,outpatient,1,mL,6.68000,6.35000,The Alliance,PPO Network,,5.55,,,,,,,3.34,6.48,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,inpatient,1,EA,890.96000,846.41000,The Alliance,PPO Network,,740.39,,,,,,,490.03,864.23,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,outpatient,1,EA,890.96000,846.41000,The Alliance,PPO Network,,740.39,,,,,,,445.48,864.23,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,inpatient,1,mL,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,outpatient,1,mL,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,inpatient,1,GM,11.29000,10.72000,The Alliance,PPO Network,,9.38,,,,,,,6.21,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,outpatient,1,GM,11.29000,10.72000,The Alliance,PPO Network,,9.38,,,,,,,5.64,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,inpatient,1,GM,13.50000,12.82000,The Alliance,PPO Network,,11.22,,,,,,,7.42,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,outpatient,1,GM,13.50000,12.82000,The Alliance,PPO Network,,11.22,,,,,,,6.75,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,inpatient,1,GM,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,outpatient,1,GM,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,inpatient,1,mL,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.21,2.13,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,PPO Network,,1.83,,,,,,,1.10,2.13,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.00620,0.23280,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,inpatient,,,2143.00000,2035.85000,The Alliance,PPO Network,,1780.83,,,,,,,1178.65,2078.71,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,outpatient,,,2143.00000,2035.85000,The Alliance,PPO Network,,1780.83,,,,,,,1178.65,4686.00,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,124.80000,118.56000,The Alliance,PPO Network,,103.71,,,,,,,61.15,121.06,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,124.80000,118.56000,The Alliance,PPO Network,,103.71,,,,,,,57.28,124.80,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,90,176.17,,,,,,,116.60,205.64,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,90,176.17,,,,,,,18.53,933.70,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,62.14,3038.81,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,7.33,1284.54,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,inpatient,,,876.00000,832.20000,The Alliance,PPO Network,,727.96,,,,,,,481.80,849.72,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,outpatient,,,876.00000,832.20000,The Alliance,PPO Network,,727.96,,,,,,,18.40,865.84,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,411.55,17311.25,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,inpatient,,,959.00000,911.05000,The Alliance,PPO Network,90,796.93,,,,,,,527.45,930.23,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,outpatient,,,959.00000,911.05000,The Alliance,PPO Network,90,796.93,,,,,,,59.93,3038.81,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,The Alliance,PPO Network,TC,2630.95,,,,,,,1741.30,3071.02,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,PPO Network,TC,2630.95,,,,,,,418.96,17311.25,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,4.95,254.68,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,13.38,679.08,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,inpatient,,,129.20000,122.74000,The Alliance,PPO Network,90,107.37,,,,,,,71.06,125.32,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,outpatient,,,129.20000,122.74000,The Alliance,PPO Network,90,107.37,,,,,,,11.81,594.19,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,inpatient,,,170.50000,161.98000,The Alliance,PPO Network,90,141.69,,,,,,,93.78,165.38,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,outpatient,,,170.50000,161.98000,The Alliance,PPO Network,90,141.69,,,,,,,15.18,763.98,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,90,84.76,,,,,,,56.10,98.94,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,90,84.76,,,,,,,17.85,814.87,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,PPO Network,90,798.59,,,,,,,528.55,932.17,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,PPO Network,90,798.59,,,,,,,87.93,4447.87,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,inpatient,,,413.30000,392.64000,The Alliance,PPO Network,90,343.45,,,,,,,227.31,400.90,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,outpatient,,,413.30000,392.64000,The Alliance,PPO Network,90,343.45,,,,,,,37.79,1918.36,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,inpatient,,,192.00000,182.40000,The Alliance,PPO Network,90,159.55,,,,,,,105.60,186.24,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,PPO Network,90,159.55,,,,,,,17.50,882.80,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,257.95,454.93,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,122.40,454.93,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,inpatient,,,1007.00000,956.65000,The Alliance,PPO Network,,836.82,,,,,,,553.85,976.79,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,outpatient,,,1007.00000,956.65000,The Alliance,PPO Network,,836.82,,,,,,,503.50,8610.62,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,90,1233.20,,,,,,,816.20,1439.48,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,90,1233.20,,,,,,,143.40,8250.66,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,15.29,780.94,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,The Alliance,PPO Network,,1900.91,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,PPO Network,,1900.91,,,,,,,1049.96,2287.50,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,inpatient,,,2733.00000,2596.35000,The Alliance,PPO Network,90,2271.12,,,,,,,1503.15,2651.01,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,outpatient,,,2733.00000,2596.35000,The Alliance,PPO Network,90,2271.12,,,,,,,264.01,15261.97,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,74.91,132.11,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,12.45,1539.22,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,17.85,814.87,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,inpatient,,,416.90000,396.05000,The Alliance,PPO Network,90,346.44,,,,,,,229.29,404.39,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,outpatient,,,416.90000,396.05000,The Alliance,PPO Network,90,346.44,,,,,,,137.00,6451.13,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,inpatient,,,386.00000,366.70000,The Alliance,PPO Network,,320.77,,,,,,,212.30,374.42,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,PPO Network,,320.77,,,,,,,193.00,446.00,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1475.00000,1401.25000,The Alliance,PPO Network,,1225.72,,,,,,,811.25,1430.75,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,PPO Network,,1225.72,,,,,,,162.71,8693.45,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1422.00000,1350.90000,The Alliance,PPO Network,90,1181.68,,,,,,,782.10,1379.34,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1422.00000,1350.90000,The Alliance,PPO Network,90,1181.68,,,,,,,533.12,8693.45,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,inpatient,,,65.80000,62.51000,The Alliance,PPO Network,90,54.68,,,,,,,36.19,63.83,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,outpatient,,,65.80000,62.51000,The Alliance,PPO Network,90,54.68,,,,,,,32.90,1850.43,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,inpatient,,,227.60000,216.22000,The Alliance,PPO Network,90,189.14,,,,,,,125.18,220.77,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,outpatient,,,227.60000,216.22000,The Alliance,PPO Network,90,189.14,,,,,,,54.46,2682.34,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,inpatient,,,461.00000,437.95000,The Alliance,PPO Network,90,383.09,,,,,,,253.55,447.17,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,outpatient,,,461.00000,437.95000,The Alliance,PPO Network,90,383.09,,,,,,,42.11,2122.08,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,90,206.92,,,,,,,136.95,241.53,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,90,206.92,,,,,,,22.72,1154.38,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,inpatient,,,630.00000,598.50000,The Alliance,PPO Network,,523.53,,,,,,,346.50,611.10,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,PPO Network,,523.53,,,,,,,18.37,967.70,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,35.09,1833.46,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,PPO Network,90,491.12,,,,,,,325.05,573.27,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,PPO Network,90,491.12,,,,,,,295.50,4462.27,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,inpatient,,,148.10000,140.70000,The Alliance,PPO Network,90,123.07,,,,,,,81.45,143.66,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,outpatient,,,148.10000,140.70000,The Alliance,PPO Network,90,123.07,,,,,,,15.06,763.98,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,24.20,42.68,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,22.00,42.68,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,inpatient,,,1743.00000,1655.85000,The Alliance,PPO Network,,1448.43,,,,,,,958.65,1690.71,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,outpatient,,,1743.00000,1655.85000,The Alliance,PPO Network,,1448.43,,,,,,,50.73,11449.71,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,The Alliance,PPO Network,90,191.55,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,PPO Network,90,191.55,,,,,,,45.08,679.08,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,inpatient,,,299.70000,284.71000,The Alliance,PPO Network,90,249.05,,,,,,,164.84,290.71,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,outpatient,,,299.70000,284.71000,The Alliance,PPO Network,90,249.05,,,,,,,18.98,967.70,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2282.18,4517.77,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2137.79,4657.50,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.80000,534.66000,The Alliance,PPO Network,,467.69,,,,,,,275.77,545.92,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.80000,534.66000,The Alliance,PPO Network,,467.69,,,,,,,258.33,562.80,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,104.14,226.88,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,13.77,30.00,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,inpatient,,,196.50000,186.67000,The Alliance,PPO Network,90,163.29,,,,,,,108.08,190.60,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,PPO Network,90,163.29,,,,,,,98.25,9523.86,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,inpatient,,,440.20000,418.19000,The Alliance,PPO Network,90,365.81,,,,,,,242.11,426.99,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,outpatient,,,440.20000,418.19000,The Alliance,PPO Network,90,365.81,,,,,,,19.60,984.66,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,90,126.31,,,,,,,83.60,147.44,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,90,126.31,,,,,,,76.00,241.38,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,90.03,158.79,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,20.36,1120.45,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,14.61,679.08,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,inpatient,,,569.00000,540.55000,The Alliance,PPO Network,,472.84,,,,,,,312.95,551.93,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,PPO Network,,472.84,,,,,,,35.09,1833.46,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,inpatient,,,216.20000,205.39000,The Alliance,PPO Network,90,179.66,,,,,,,118.91,209.71,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,PPO Network,90,179.66,,,,,,,8.17,645.08,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,inpatient,,,383.80000,364.61000,The Alliance,PPO Network,,318.94,,,,,,,211.09,372.29,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,outpatient,,,383.80000,364.61000,The Alliance,PPO Network,,318.94,,,,,,,33.94,1765.53,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,inpatient,,,220.40000,209.38000,The Alliance,PPO Network,90,183.15,,,,,,,121.22,213.79,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,outpatient,,,220.40000,209.38000,The Alliance,PPO Network,90,183.15,,,,,,,20.36,1120.45,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,248.05,437.47,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,37.73,1969.25,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,90,169.52,,,,,,,112.20,197.88,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,90,169.52,,,,,,,18.66,950.66,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,90,1360.35,,,,,,,900.35,1587.89,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,90,1360.35,,,,,,,149.66,7571.58,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,inpatient,,,1818.00000,1727.10000,The Alliance,PPO Network,90,1510.76,,,,,,,999.90,1763.46,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1818.00000,1727.10000,The Alliance,PPO Network,90,1510.76,,,,,,,175.54,10101.09,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,273.46,482.28,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,PPO Network,90,413.17,,,,,,,44.27,2240.90,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,inpatient,,,102.40000,97.28000,The Alliance,PPO Network,90,85.09,,,,,,,56.32,99.33,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,outpatient,,,102.40000,97.28000,The Alliance,PPO Network,90,85.09,,,,,,,3.40,492.33,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,inpatient,,,156.70000,148.86000,The Alliance,PPO Network,90,130.22,,,,,,,86.19,152.00,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,outpatient,,,156.70000,148.86000,The Alliance,PPO Network,90,130.22,,,,,,,5.90,424.40,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,The Alliance,PPO Network,90,137.12,,,,,,,90.75,160.05,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,PPO Network,90,137.12,,,,,,,15.09,763.98,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,33.47,1578.85,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,TC,2107.42,,,,,,,1394.80,2459.92,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,TC,2107.42,,,,,,,990.94,2459.92,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,inpatient,1,mL,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.43,2.52,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,outpatient,1,mL,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.30,2.52,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,392.70,5858.00,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,inpatient,,,2201.00000,2090.95000,The Alliance,PPO Network,,1829.03,,,,,,,1210.55,2134.97,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,outpatient,,,2201.00000,2090.95000,The Alliance,PPO Network,,1829.03,,,,,,,1210.55,7803.00,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,inpatient,,,248.10000,235.70000,The Alliance,PPO Network,90,206.17,,,,,,,136.46,240.66,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,outpatient,,,248.10000,235.70000,The Alliance,PPO Network,90,206.17,,,,,,,22.69,1154.38,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.58,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,inpatient,1,mL,3285.02000,3120.77000,The Alliance,PPO Network,,2729.85,,,,,,,1806.76,3186.47,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,outpatient,1,mL,3285.02000,3120.77000,The Alliance,PPO Network,,2729.85,,,,,,,28.70,3186.47,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,inpatient,,,49.30000,46.83000,The Alliance,PPO Network,90,40.97,,,,,,,27.11,47.82,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,PPO Network,90,40.97,,,,,,,24.65,1527.89,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,8.17,645.08,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,83.98,148.12,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,18.40,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,,121.66,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,,121.66,,,,,,,17.27,814.87,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,PPO Network,,132.63,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,PPO Network,,132.63,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.30000,129.49000,The Alliance,PPO Network,90,113.27,,,,,,,74.97,132.21,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.30000,129.49000,The Alliance,PPO Network,90,113.27,,,,,,,12.45,1539.22,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,90,108.86,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,90,108.86,,,,,,,14.99,780.94,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,14.99,780.94,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,inpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,133.10,234.74,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,PPO Network,,201.10,,,,,,,21.41,1120.45,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,83.98,148.12,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,18.40,865.84,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,PPO Network,,132.63,,,,,,,87.78,154.81,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,PPO Network,,132.63,,,,,,,19.88,1103.49,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,16.07,763.98,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,5.35,271.65,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,inpatient,,,52.40000,49.78000,The Alliance,PPO Network,90,43.54,,,,,,,28.82,50.83,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,outpatient,,,52.40000,49.78000,The Alliance,PPO Network,90,43.54,,,,,,,4.79,237.65,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,24.89,1137.41,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,775.50,1367.70,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,129.67,6518.98,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,inpatient,,,777.00000,738.15000,The Alliance,PPO Network,90,645.69,,,,,,,427.35,753.69,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,PPO Network,90,645.69,,,,,,,70.88,3582.03,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.14409,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,inpatient,1,mL,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,outpatient,1,mL,1.03000,0.97000,The Alliance,PPO Network,,0.85593,,,,,,,0.14409,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,inpatient,1,mL,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,PPO Network,,1.45,,,,,,,0.14409,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,inpatient,1,mL,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,outpatient,1,mL,1.33000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.14409,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,inpatient,1,mL,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,PPO Network,,0.93072,,,,,,,0.14409,1.09,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,,48.53,,,,,,,32.12,56.65,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,,48.53,,,,,,,7.27,373.51,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,inpatient,,,135.40000,128.63000,The Alliance,PPO Network,,112.52,,,,,,,74.47,131.34,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,outpatient,,,135.40000,128.63000,The Alliance,PPO Network,,112.52,,,,,,,11.98,628.12,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,PPO Network,TC,761.20,,,,,,,503.80,888.52,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,PPO Network,TC,761.20,,,,,,,384.16,888.52,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,366.85,646.99,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,333.50,646.99,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,548.35,967.09,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,384.16,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,366.85,646.99,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,333.50,2161.00,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,548.35,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,498.50,2161.00,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,inpatient,,,2025.00000,1923.75000,The Alliance,PPO Network,,1682.78,,,,,,,1113.75,1964.25,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,outpatient,,,2025.00000,1923.75000,The Alliance,PPO Network,,1682.78,,,,,,,1012.50,1964.25,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,inpatient,,,4212.00000,4001.40000,The Alliance,PPO Network,,3500.17,,,,,,,2316.60,4085.64,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,outpatient,,,4212.00000,4001.40000,The Alliance,PPO Network,,3500.17,,,,,,,542.77,4085.64,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,366.85,646.99,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,333.50,646.99,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,inpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,548.35,967.09,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,PPO Network,,828.51,,,,,,,498.50,967.09,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1290.94,2812.50,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,13.82,645.08,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,128.32,279.56,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,31.90,56.26,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,8.17,696.05,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,130.90,285.19,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,inpatient,1,EA,1.54000,1.47000,The Alliance,PPO Network,,1.28,,,,,,,0.84700,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,outpatient,1,EA,1.54000,1.47000,The Alliance,PPO Network,,1.28,,,,,,,0.77000,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,31.90,56.26,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,8.17,696.05,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,20.36,1120.45,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,0.24250,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,inpatient,,,640.00000,608.00000,The Alliance,PPO Network,TC,531.84,,,,,,,352.00,620.80,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,outpatient,,,640.00000,608.00000,The Alliance,PPO Network,TC,531.84,,,,,,,320.00,620.80,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,inpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.46200,0.81480,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,PPO Network,,0.69804,,,,,,,0.42000,0.81480,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,44.12000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,21.62,42.80,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,44.12000,41.91000,The Alliance,PPO Network,,36.66,,,,,,,20.25,44.12,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,inpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.97350,1.72,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,PPO Network,,1.47,,,,,,,0.88500,1.72,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,90,119.66,,,,,,,79.20,139.68,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,90,119.66,,,,,,,8.17,882.80,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,inpatient,1,mL,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.72050,1.27,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,PPO Network,,1.09,,,,,,,0.65500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,inpatient,1,mL,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.61600,1.09,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,PPO Network,,0.93072,,,,,,,0.56000,7.69,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,361.82,17311.25,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,182.60,322.04,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,166.00,1692.33,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,31.90,56.26,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,90,48.20,,,,,,,8.17,696.05,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,11.98,628.12,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2810.00000,2669.50000,The Alliance,PPO Network,90,2335.11,,,,,,,1545.50,2725.70,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2810.00000,2669.50000,The Alliance,PPO Network,90,2335.11,,,,,,,608.00,54562.77,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2066.00000,1962.70000,The Alliance,PPO Network,90,1716.85,,,,,,,1136.30,2004.02,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2066.00000,1962.70000,The Alliance,PPO Network,90,1716.85,,,,,,,608.00,54562.77,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,inpatient,,,214.70000,203.96000,The Alliance,PPO Network,90,178.42,,,,,,,118.08,208.26,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,PPO Network,90,178.42,,,,,,,26.72,1273.27,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,PPO Network,90,1171.71,,,,,,,129.67,6518.98,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,inpatient,,,157.60000,149.72000,The Alliance,PPO Network,90,130.97,,,,,,,86.68,152.87,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,outpatient,,,157.60000,149.72000,The Alliance,PPO Network,90,130.97,,,,,,,9.19,458.40,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,inpatient,,,152.80000,145.16000,The Alliance,PPO Network,90,126.98,,,,,,,84.04,148.22,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,outpatient,,,152.80000,145.16000,The Alliance,PPO Network,90,126.98,,,,,,,13.97,713.01,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,inpatient,,,208.80000,198.36000,The Alliance,PPO Network,90,173.51,,,,,,,114.84,202.54,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,outpatient,,,208.80000,198.36000,The Alliance,PPO Network,90,173.51,,,,,,,15.49,780.94,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,PPO Network,90,144.59,,,,,,,95.70,168.78,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,PPO Network,90,144.59,,,,,,,15.49,780.94,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,,338.55,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,,338.55,,,,,,,203.70,3727.42,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,203.70,3727.42,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,PPO Network,90,126.89,,,,,,,83.98,148.12,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,PPO Network,90,126.89,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,17.85,814.87,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,inpatient,,,153.10000,145.44000,The Alliance,PPO Network,90,127.23,,,,,,,84.20,148.51,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,outpatient,,,153.10000,145.44000,The Alliance,PPO Network,90,127.23,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,17.85,814.87,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,26.50,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,126.65,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,126.65,264.00,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,inpatient,,,257.80000,244.91000,The Alliance,PPO Network,90,214.23,,,,,,,141.79,250.07,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,outpatient,,,257.80000,244.91000,The Alliance,PPO Network,90,214.23,,,,,,,23.57,1188.38,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,inpatient,,,149.40000,141.93000,The Alliance,PPO Network,,124.15,,,,,,,82.17,144.92,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,outpatient,,,149.40000,141.93000,The Alliance,PPO Network,,124.15,,,,,,,29.28,1527.89,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,inpatient,,,101.90000,96.81000,The Alliance,PPO Network,90,84.68,,,,,,,56.05,98.84,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,PPO Network,90,84.68,,,,,,,9.32,475.37,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,inpatient,,,131.80000,125.21000,The Alliance,PPO Network,90,109.53,,,,,,,72.49,127.85,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,outpatient,,,131.80000,125.21000,The Alliance,PPO Network,90,109.53,,,,,,,14.80,679.08,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,90,173.68,,,,,,,114.95,202.73,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,90,173.68,,,,,,,20.18,967.70,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1775.03,3513.82,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,The Alliance,PPO Network,,1145.95,,,,,,,758.45,1337.63,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,PPO Network,,1145.95,,,,,,,115.36,6026.72,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,The Alliance,PPO Network,,1900.91,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,PPO Network,,1900.91,,,,,,,1049.96,2287.50,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,inpatient,,,339.20000,322.24000,The Alliance,PPO Network,90,281.88,,,,,,,186.56,329.02,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,outpatient,,,339.20000,322.24000,The Alliance,PPO Network,90,281.88,,,,,,,18.72,882.80,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,inpatient,,,3791.00000,3601.45000,The Alliance,PPO Network,,3150.32,,,,,,,1857.59,3677.27,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,outpatient,,,3791.00000,3601.45000,The Alliance,PPO Network,,3150.32,,,,,,,1040.32,3791.00,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1533.19000,1456.53000,The Alliance,PPO Network,,1274.08,,,,,,,751.26,1487.19,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1533.19000,1456.53000,The Alliance,PPO Network,,1274.08,,,,,,,703.73,1533.19,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,246.14,536.25,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,246.14,536.25,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,297.55,524.77,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,212.82,1232.72,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,14.54,31.68,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,54.00,264.00,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,,1885.54,,,,,,,1247.95,2200.93,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,,1885.54,,,,,,,384.16,3015.65,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,90,129.64,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,90,129.64,,,,,,,13.89,696.05,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4481.55000,4257.47000,The Alliance,PPO Network,,3724.17,,,,,,,2195.96,4347.10,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4481.55000,4257.47000,The Alliance,PPO Network,,3724.17,,,,,,,2057.03,4481.55,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,inpatient,1,EA,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.22,3.91,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,PPO Network,,3.35,,,,,,,2.02,3.91,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,42.23,92.00,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,inpatient,1,mL,8.95000,8.50000,The Alliance,PPO Network,,7.44,,,,,,,4.92,8.68,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,outpatient,1,mL,8.95000,8.50000,The Alliance,PPO Network,,7.44,,,,,,,4.47,8.68,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,The Alliance,PPO Network,,11592.45,,,,,,,6835.50,13531.50,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,PPO Network,,11592.45,,,,,,,6403.05,13950.00,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,967.50000,919.12000,The Alliance,PPO Network,,803.99,,,,,,,474.07,938.48,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,967.50000,919.12000,The Alliance,PPO Network,,803.99,,,,,,,444.08,967.50,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,1042.50000,990.38000,The Alliance,PPO Network,,866.32,,,,,,,510.82,1011.23,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1042.50000,990.38000,The Alliance,PPO Network,,866.32,,,,,,,478.51,1042.50,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,The Alliance,PPO Network,,2772.22,,,,,,,1834.80,3235.92,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,PPO Network,,2772.22,,,,,,,295.69,3235.92,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,The Alliance,PPO Network,,3162.79,,,,,,,2093.30,3691.82,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,PPO Network,,3162.79,,,,,,,295.69,3691.82,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,The Alliance,PPO Network,,2915.15,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,PPO Network,,2915.15,,,,,,,295.69,3402.76,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,The Alliance,PPO Network,TC,3589.92,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,PPO Network,TC,3589.92,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3612.00000,3431.40000,The Alliance,PPO Network,TC,3001.57,,,,,,,1986.60,3503.64,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3612.00000,3431.40000,The Alliance,PPO Network,TC,3001.57,,,,,,,1806.00,3503.64,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,PPO Network,TC,271.74,,,,,,,179.85,317.19,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,PPO Network,TC,271.74,,,,,,,163.50,317.19,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,,1491.64,,,,,,,987.25,1741.15,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,,1491.64,,,,,,,295.69,1741.15,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,The Alliance,PPO Network,TC,1317.97,,,,,,,872.30,1538.42,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,PPO Network,TC,1317.97,,,,,,,793.00,1538.42,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,PPO Network,TC,346.53,,,,,,,229.35,404.49,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,PPO Network,TC,346.53,,,,,,,208.50,404.49,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,,2813.77,,,,,,,1862.30,3284.42,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,,2813.77,,,,,,,503.83,3284.42,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,820.60,1447.24,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,746.00,1447.24,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,,1376.14,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,PPO Network,,1376.14,,,,,,,828.00,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,,1384.45,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,PPO Network,,1384.45,,,,,,,503.83,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,The Alliance,PPO Network,,3653.08,,,,,,,2417.80,4264.12,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,PPO Network,,3653.08,,,,,,,966.05,4264.12,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,inpatient,1,EA,5074.51000,4820.79000,The Alliance,PPO Network,,4216.92,,,,,,,2790.98,4922.27,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,outpatient,1,EA,5074.51000,4820.79000,The Alliance,PPO Network,,4216.92,,,,,,,2537.26,4922.27,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.10000,227.14000,The Alliance,PPO Network,,198.69,,,,,,,117.16,231.93,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.10000,227.14000,The Alliance,PPO Network,,198.69,,,,,,,109.75,239.10,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,inpatient,1,EA,3.52000,3.34000,The Alliance,PPO Network,,2.93,,,,,,,1.94,3.41,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,outpatient,1,EA,3.52000,3.34000,The Alliance,PPO Network,,2.93,,,,,,,1.76,3.41,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.68,4.72,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.44,4.72,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,inpatient,1,EA,52.04000,49.44000,The Alliance,PPO Network,,43.25,,,,,,,28.62,50.48,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,outpatient,1,EA,52.04000,49.44000,The Alliance,PPO Network,,43.25,,,,,,,26.02,50.48,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.11,1.95,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,PPO Network,,1.67,,,,,,,1.00,1.95,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,inpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,inpatient,1,EA,2.75000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.51,2.67,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.67,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,inpatient,1,EA,8.15000,7.74000,The Alliance,PPO Network,,6.77,,,,,,,4.48,7.91,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,outpatient,1,EA,8.15000,7.74000,The Alliance,PPO Network,,6.77,,,,,,,4.08,7.91,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,389.87,849.38,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1853.00000,1760.35000,The Alliance,PPO Network,90,1539.84,,,,,,,1019.15,1797.41,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1853.00000,1760.35000,The Alliance,PPO Network,90,1539.84,,,,,,,169.42,8573.20,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,The Alliance,PPO Network,90,96.48,,,,,,,63.85,112.62,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,PPO Network,90,96.48,,,,,,,12.82,645.08,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,inpatient,,,521.00000,494.95000,The Alliance,PPO Network,TC,432.95,,,,,,,286.55,505.37,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,PPO Network,TC,432.95,,,,,,,121.00,3027.62,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,382.25,674.15,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,298.87,3487.84,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,The Alliance,PPO Network,TC,2096.61,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,PPO Network,TC,2096.61,,,,,,,1226.87,11271.02,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,394.96,17311.25,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,inpatient,,,736.00000,699.20000,The Alliance,PPO Network,TC,611.62,,,,,,,404.80,713.92,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,outpatient,,,736.00000,699.20000,The Alliance,PPO Network,TC,611.62,,,,,,,368.00,11266.81,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,52.25,92.15,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,,78.94,,,,,,,9.30,492.33,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.57230,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1332.19,2637.19,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1247.91,2718.75,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,104.14,226.88,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,16.32,80.51,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,32.85,679.08,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,90,295.84,,,,,,,195.80,345.32,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,90,295.84,,,,,,,178.00,345.32,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,,1553.14,,,,,,,1027.95,1812.93,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,PPO Network,,1553.14,,,,,,,172.18,1812.93,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,inpatient,1,EA,16.52000,15.69000,The Alliance,PPO Network,,13.73,,,,,,,9.09,16.02,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,outpatient,1,EA,16.52000,15.69000,The Alliance,PPO Network,,13.73,,,,,,,8.26,16.02,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,The Alliance,PPO Network,,50.16,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,PPO Network,,50.16,,,,,,,30.18,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,inpatient,1,EA,11.31000,10.75000,The Alliance,PPO Network,,9.40,,,,,,,6.22,10.97,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,outpatient,1,EA,11.31000,10.75000,The Alliance,PPO Network,,9.40,,,,,,,5.66,10.97,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,inpatient,,,971.00000,922.45000,The Alliance,PPO Network,90,806.90,,,,,,,534.05,941.87,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,PPO Network,90,806.90,,,,,,,485.50,8610.62,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,inpatient,,,203.50000,193.32000,The Alliance,PPO Network,90,169.11,,,,,,,111.92,197.40,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,outpatient,,,203.50000,193.32000,The Alliance,PPO Network,90,169.11,,,,,,,25.31,2286.16,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,PPO Network,,331.88,,,,,,,183.32,399.38,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,PPO Network,,1963.24,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,inpatient,1,EA,1113.31000,1057.65000,The Alliance,PPO Network,,925.16,,,,,,,612.32,1079.91,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,outpatient,1,EA,1113.31000,1057.65000,The Alliance,PPO Network,,925.16,,,,,,,55.09,1079.91,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,inpatient,1,mL,7201.88000,6841.78000,The Alliance,PPO Network,,5984.76,,,,,,,3961.03,6985.82,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,outpatient,1,mL,7201.88000,6841.78000,The Alliance,PPO Network,,5984.76,,,,,,,103.71,6985.82,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,inpatient,1,EA,3.36000,3.20000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,outpatient,1,EA,3.36000,3.20000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,GO,103.04,,,,,,,68.20,120.28,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,GO,103.04,,,,,,,62.00,264.00,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,inpatient,,,168.30000,159.88000,The Alliance,PPO Network,90,139.86,,,,,,,92.56,163.25,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,outpatient,,,168.30000,159.88000,The Alliance,PPO Network,90,139.86,,,,,,,16.02,814.87,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,PPO Network,90,632.39,,,,,,,418.55,738.17,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,PPO Network,90,632.39,,,,,,,50.62,3666.93,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,inpatient,1,EA,153.61000,145.93000,The Alliance,PPO Network,,127.65,,,,,,,84.49,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,outpatient,1,EA,153.61000,145.93000,The Alliance,PPO Network,,127.65,,,,,,,2.39,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,inpatient,1,EA,207.93000,197.53000,The Alliance,PPO Network,,172.79,,,,,,,114.36,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,outpatient,1,EA,207.93000,197.53000,The Alliance,PPO Network,,172.79,,,,,,,2.39,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,inpatient,1,EA,227.52000,216.14000,The Alliance,PPO Network,,189.07,,,,,,,125.14,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,outpatient,1,EA,227.52000,216.14000,The Alliance,PPO Network,,189.07,,,,,,,2.39,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,inpatient,1,EA,75.90000,72.11000,The Alliance,PPO Network,,63.07,,,,,,,41.74,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,outpatient,1,EA,75.90000,72.11000,The Alliance,PPO Network,,63.07,,,,,,,2.39,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,inpatient,1,EA,90.66000,86.13000,The Alliance,PPO Network,,75.34,,,,,,,49.86,87.94,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,outpatient,1,EA,90.66000,86.13000,The Alliance,PPO Network,,75.34,,,,,,,2.39,87.94,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,160.60,283.24,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,160.60,3163.00,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,inpatient,,,624.00000,592.80000,The Alliance,PPO Network,,518.54,,,,,,,343.20,605.28,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,outpatient,,,624.00000,592.80000,The Alliance,PPO Network,,518.54,,,,,,,343.20,5271.00,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,,426.30,,,,,,,282.15,497.61,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,,426.30,,,,,,,256.50,497.61,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,inpatient,,,4933.00000,4686.35000,The Alliance,PPO Network,,4099.32,,,,,,,2713.15,4785.01,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,outpatient,,,4933.00000,4686.35000,The Alliance,PPO Network,,4099.32,,,,,,,2466.50,4785.01,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,inpatient,,,673.00000,639.35000,The Alliance,PPO Network,TC,559.26,,,,,,,370.15,652.81,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,outpatient,,,673.00000,639.35000,The Alliance,PPO Network,TC,559.26,,,,,,,336.50,3685.66,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,PPO Network,TC,593.33,,,,,,,392.70,692.58,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,PPO Network,TC,593.33,,,,,,,297.11,692.58,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,inpatient,,,1255.00000,1192.25000,The Alliance,PPO Network,TC,1042.90,,,,,,,690.25,1217.35,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,outpatient,,,1255.00000,1192.25000,The Alliance,PPO Network,TC,1042.90,,,,,,,627.50,7087.64,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,PPO Network,TC,334.06,,,,,,,221.10,389.94,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,PPO Network,TC,334.06,,,,,,,221.10,6003.00,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,The Alliance,PPO Network,,457.88,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,PPO Network,,457.88,,,,,,,100.97,584.87,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,The Alliance,PPO Network,,243.48,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,PPO Network,,243.48,,,,,,,100.97,584.87,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,TC,73.13,,,,,,,48.40,85.36,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,TC,73.13,,,,,,,44.00,548.00,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,The Alliance,PPO Network,TC,3019.85,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,PPO Network,TC,3019.85,,,,,,,1396.56,3524.98,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,,2015.17,,,,,,,1333.75,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,,2015.17,,,,,,,1212.50,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1320.00000,1254.00000,The Alliance,PPO Network,,1096.92,,,,,,,726.00,1280.40,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,PPO Network,,1096.92,,,,,,,660.00,2161.00,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,inpatient,,,869.00000,825.55000,The Alliance,PPO Network,,722.14,,,,,,,477.95,842.93,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,PPO Network,,722.14,,,,,,,477.95,3163.00,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,inpatient,,,1383.00000,1313.85000,The Alliance,PPO Network,,1149.27,,,,,,,760.65,1341.51,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,PPO Network,,1149.27,,,,,,,384.16,1341.51,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,22.50,163.43,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,PPO Network,,781.97,,,,,,,517.55,912.77,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,PPO Network,,781.97,,,,,,,517.55,3163.00,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,3163.00,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,PPO Network,,781.97,,,,,,,517.55,912.77,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,PPO Network,,781.97,,,,,,,517.55,3163.00,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,3163.00,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,TC,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,TC,994.71,,,,,,,658.35,7621.00,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,TC,132.96,,,,,,,88.00,155.20,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,TC,132.96,,,,,,,88.00,3163.00,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,177.65,313.31,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,TC,268.41,,,,,,,177.65,4686.00,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,The Alliance,PPO Network,,2834.54,,,,,,,1876.05,3308.67,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,PPO Network,,2834.54,,,,,,,1538.48,4686.00,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,PPO Network,,994.71,,,,,,,658.35,4686.00,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,The Alliance,PPO Network,,956.48,,,,,,,633.05,1116.47,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,PPO Network,,956.48,,,,,,,633.05,3163.00,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,The Alliance,PPO Network,,4766.62,,,,,,,3154.80,5563.92,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,PPO Network,,4766.62,,,,,,,1538.48,5563.92,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,4686.00,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,TC,1625.44,,,,,,,1075.80,1897.32,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,TC,1625.44,,,,,,,384.16,1897.32,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,inpatient,,,3829.00000,3637.55000,The Alliance,PPO Network,TC,3181.90,,,,,,,2105.95,3714.13,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,outpatient,,,3829.00000,3637.55000,The Alliance,PPO Network,TC,3181.90,,,,,,,1329.46,3714.13,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,1007.60,1777.04,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,PPO Network,TC,1522.39,,,,,,,916.00,1777.04,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,inpatient,,,667.00000,633.65000,The Alliance,PPO Network,TC,554.28,,,,,,,366.85,646.99,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,PPO Network,TC,554.28,,,,,,,333.50,4081.21,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,53.41,94.19,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,48.55,3038.81,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,90,4470.78,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,90,4470.78,,,,,,,759.53,35735.73,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,inpatient,,,154.60000,146.87000,The Alliance,PPO Network,90,128.47,,,,,,,85.03,149.96,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,PPO Network,90,128.47,,,,,,,21.69,186.79,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,inpatient,,,158.40000,150.48000,The Alliance,PPO Network,90,131.63,,,,,,,87.12,153.65,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,outpatient,,,158.40000,150.48000,The Alliance,PPO Network,90,131.63,,,,,,,14.91,885.37,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,inpatient,,,174.60000,165.87000,The Alliance,PPO Network,90,145.09,,,,,,,96.03,169.36,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,outpatient,,,174.60000,165.87000,The Alliance,PPO Network,90,145.09,,,,,,,15.55,780.94,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,inpatient,,,72.30000,68.68000,The Alliance,PPO Network,90,60.08,,,,,,,39.77,70.13,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,outpatient,,,72.30000,68.68000,The Alliance,PPO Network,90,60.08,,,,,,,36.15,70.13,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,inpatient,,,97.60000,92.72000,The Alliance,PPO Network,90,81.11,,,,,,,53.68,94.67,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,outpatient,,,97.60000,92.72000,The Alliance,PPO Network,90,81.11,,,,,,,5.68,288.61,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,52.80,93.12,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,11.13,696.05,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,inpatient,,,397.00000,377.15000,The Alliance,PPO Network,90,329.91,,,,,,,218.35,385.09,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,outpatient,,,397.00000,377.15000,The Alliance,PPO Network,90,329.91,,,,,,,43.07,1952.29,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,10.38,950.66,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,inpatient,,,162.80000,154.66000,The Alliance,PPO Network,90,135.29,,,,,,,89.54,157.92,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,PPO Network,90,135.29,,,,,,,17.43,882.80,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,24.89,1137.41,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,inpatient,,,276.50000,262.68000,The Alliance,PPO Network,90,229.77,,,,,,,152.07,268.20,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,outpatient,,,276.50000,262.68000,The Alliance,PPO Network,90,229.77,,,,,,,138.25,19453.17,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,3.93,203.72,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1018.98,2220.00,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,The Alliance,PPO Network,,7153.04,,,,,,,4217.80,8349.52,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,PPO Network,,7153.04,,,,,,,3950.96,8607.75,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,The Alliance,PPO Network,,2542.03,,,,,,,1682.45,2967.23,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,PPO Network,,2542.03,,,,,,,1306.65,2967.23,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,The Alliance,PPO Network,TC,1878.89,,,,,,,1243.55,2193.17,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,PPO Network,TC,1878.89,,,,,,,866.42,2193.17,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,The Alliance,PPO Network,TC,2761.41,,,,,,,1827.65,3223.31,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,PPO Network,TC,2761.41,,,,,,,383.91,10740.24,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,The Alliance,PPO Network,TC,69.14,,,,,,,45.76,80.70,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,PPO Network,TC,69.14,,,,,,,41.60,484.28,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,417.10,17311.25,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,382.25,674.15,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,298.87,1820.00,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,875.89000,832.10000,The Alliance,PPO Network,,727.86,,,,,,,429.19,849.61,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,875.89000,832.10000,The Alliance,PPO Network,,727.86,,,,,,,402.03,875.89,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,589.26,1283.78,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,471.23000,447.67000,The Alliance,PPO Network,,391.59,,,,,,,230.90,457.09,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,471.23000,447.67000,The Alliance,PPO Network,,391.59,,,,,,,216.29,471.23,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,41.80,73.72,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,38.00,264.00,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,inpatient,,,636.00000,604.20000,The Alliance,PPO Network,,528.52,,,,,,,349.80,616.92,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,outpatient,,,636.00000,604.20000,The Alliance,PPO Network,,528.52,,,,,,,126.65,616.92,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,29.50,264.00,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,inpatient,,,507.00000,481.65000,The Alliance,PPO Network,,421.32,,,,,,,278.85,491.79,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,PPO Network,,421.32,,,,,,,126.65,491.79,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,54.00,264.00,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,264.00,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,264.00,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,21.00,264.00,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,inpatient,,,69.60000,66.12000,The Alliance,PPO Network,,57.84,,,,,,,38.28,67.51,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,outpatient,,,69.60000,66.12000,The Alliance,PPO Network,,57.84,,,,,,,34.80,264.00,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,GP,82.27,,,,,,,54.45,96.03,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,GP,82.27,,,,,,,49.50,264.00,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,GO,29.09,,,,,,,19.25,33.95,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,GO,29.09,,,,,,,17.50,264.00,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,199.65,352.11,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,119.56,352.11,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,56.40,248.32,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.79,3.16,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,PPO Network,,2.71,,,,,,,1.63,3.16,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,inpatient,,,438.50000,416.58000,The Alliance,PPO Network,90,364.39,,,,,,,241.18,425.35,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,outpatient,,,438.50000,416.58000,The Alliance,PPO Network,90,364.39,,,,,,,24.89,1137.41,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,inpatient,,,307.50000,292.12000,The Alliance,PPO Network,90,255.53,,,,,,,169.12,298.27,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,outpatient,,,307.50000,292.12000,The Alliance,PPO Network,90,255.53,,,,,,,24.89,1137.41,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,inpatient,,,454.90000,432.15000,The Alliance,PPO Network,90,378.02,,,,,,,250.19,441.25,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,outpatient,,,454.90000,432.15000,The Alliance,PPO Network,90,378.02,,,,,,,18.98,967.70,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.93,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,PPO Network,,1.65,,,,,,,0.99500,1.93,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,inpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,90,4470.78,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,PPO Network,90,4470.78,,,,,,,759.53,35735.73,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,The Alliance,PPO Network,90,139.77,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,PPO Network,90,139.77,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,The Alliance,PPO Network,90,225.12,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,PPO Network,90,225.12,,,,,,,135.45,19453.17,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,inpatient,,,110.60000,105.07000,The Alliance,PPO Network,90,91.91,,,,,,,60.83,107.28,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,outpatient,,,110.60000,105.07000,The Alliance,PPO Network,90,91.91,,,,,,,45.08,679.08,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,inpatient,,,286.80000,272.46000,The Alliance,PPO Network,90,238.33,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,PPO Network,90,238.33,,,,,,,12.45,1539.22,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,inpatient,,,286.80000,272.46000,The Alliance,PPO Network,90,238.33,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,PPO Network,90,238.33,,,,,,,17.85,814.87,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,23.10,40.74,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,21.00,264.00,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,GO,34.90,,,,,,,21.00,264.00,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,inpatient,,,154.60000,146.87000,The Alliance,PPO Network,90,128.47,,,,,,,85.03,149.96,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,PPO Network,90,128.47,,,,,,,27.11,1289.24,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,90,113.02,,,,,,,74.80,131.92,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,90,113.02,,,,,,,12.40,628.12,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,inpatient,,,668.00000,634.60000,The Alliance,PPO Network,90,555.11,,,,,,,367.40,647.96,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,outpatient,,,668.00000,634.60000,The Alliance,PPO Network,90,555.11,,,,,,,20.36,1120.45,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,inpatient,,,305.90000,290.60000,The Alliance,PPO Network,90,254.20,,,,,,,168.25,296.72,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,outpatient,,,305.90000,290.60000,The Alliance,PPO Network,90,254.20,,,,,,,13.80,696.05,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,inpatient,,,320.40000,304.38000,The Alliance,PPO Network,90,266.25,,,,,,,176.22,310.79,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,outpatient,,,320.40000,304.38000,The Alliance,PPO Network,90,266.25,,,,,,,12.45,1539.22,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,inpatient,,,146.60000,139.27000,The Alliance,PPO Network,90,121.82,,,,,,,80.63,142.20,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,outpatient,,,146.60000,139.27000,The Alliance,PPO Network,90,121.82,,,,,,,14.96,679.08,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,90,149.58,,,,,,,99.00,174.60,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,90,149.58,,,,,,,13.69,628.12,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,90,1360.35,,,,,,,900.35,1587.89,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,PPO Network,90,1360.35,,,,,,,149.66,7571.58,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,90,124.65,,,,,,,82.50,145.50,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,90,124.65,,,,,,,13.68,696.05,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.14409,0.76630,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,inpatient,,,935.00000,888.25000,The Alliance,PPO Network,,776.99,,,,,,,514.25,906.95,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,outpatient,,,935.00000,888.25000,The Alliance,PPO Network,,776.99,,,,,,,514.25,5271.00,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,inpatient,1,EA,64.97000,61.72000,The Alliance,PPO Network,,53.99,,,,,,,35.73,63.02,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,outpatient,1,EA,64.97000,61.72000,The Alliance,PPO Network,,53.99,,,,,,,7.77,63.02,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,8.17,628.12,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,inpatient,1,EA,1.89000,1.79000,The Alliance,PPO Network,,1.57,,,,,,,1.04,1.83,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,outpatient,1,EA,1.89000,1.79000,The Alliance,PPO Network,,1.57,,,,,,,0.94500,1.83,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,154.55,272.57,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,50.62,3666.93,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,35.09,1833.46,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,The Alliance,PPO Network,,14.72,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,PPO Network,,14.72,,,,,,,8.86,17.18,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,35.09,1833.46,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,inpatient,,,284.40000,270.18000,The Alliance,PPO Network,90,236.34,,,,,,,156.42,275.87,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,outpatient,,,284.40000,270.18000,The Alliance,PPO Network,90,236.34,,,,,,,12.05,1786.28,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,The Alliance,PPO Network,90,139.77,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,PPO Network,90,139.77,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,The Alliance,PPO Network,90,225.12,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,PPO Network,90,225.12,,,,,,,135.45,19453.17,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,The Alliance,PPO Network,90,266.58,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,PPO Network,90,266.58,,,,,,,30.85,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,The Alliance,PPO Network,,266.58,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,PPO Network,,266.58,,,,,,,30.85,311.18,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,TC,978.09,,,,,,,647.35,1141.69,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,TC,978.09,,,,,,,519.48,5638.86,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,221.10,389.94,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,201.00,389.94,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,inpatient,1,EA,2.66000,2.52000,The Alliance,PPO Network,,2.21,,,,,,,1.46,2.58,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,PPO Network,,2.21,,,,,,,1.33,2.58,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,The Alliance,PPO Network,,14.72,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,PPO Network,,14.72,,,,,,,8.86,17.18,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,inpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.64350,1.13,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,PPO Network,,0.97227,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.29700,0.52380,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,PPO Network,,0.44874,,,,,,,0.27000,0.52380,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,59.56,129.76,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,4856.36,10580.30,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,inpatient,1,GM,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,outpatient,1,GM,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,14.22,27.59,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,inpatient,1,EA,21.96000,20.86000,The Alliance,PPO Network,,18.25,,,,,,,12.08,21.30,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,outpatient,1,EA,21.96000,20.86000,The Alliance,PPO Network,,18.25,,,,,,,10.98,21.30,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,inpatient,1,GM,205.53000,195.25000,The Alliance,PPO Network,,170.80,,,,,,,113.04,199.36,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,outpatient,1,GM,205.53000,195.25000,The Alliance,PPO Network,,170.80,,,,,,,102.77,199.36,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,inpatient,1,GM,313.19000,297.53000,The Alliance,PPO Network,,260.26,,,,,,,172.25,303.79,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,outpatient,1,GM,313.19000,297.53000,The Alliance,PPO Network,,260.26,,,,,,,156.59,303.79,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,inpatient,1,EA,25.01000,23.76000,The Alliance,PPO Network,,20.78,,,,,,,13.76,24.26,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,outpatient,1,EA,25.01000,23.76000,The Alliance,PPO Network,,20.78,,,,,,,12.51,24.26,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,inpatient,1,EA,14.17000,13.46000,The Alliance,PPO Network,,11.78,,,,,,,7.79,13.74,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,outpatient,1,EA,14.17000,13.46000,The Alliance,PPO Network,,11.78,,,,,,,7.08,13.74,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,inpatient,,,1965.00000,1866.75000,The Alliance,PPO Network,,1632.91,,,,,,,1080.75,1906.05,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,PPO Network,,1632.91,,,,,,,1080.75,7304.63,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,inpatient,,,1280.00000,1216.00000,The Alliance,PPO Network,,1063.68,,,,,,,704.00,1241.60,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,PPO Network,,1063.68,,,,,,,704.00,4686.00,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,inpatient,,,592.00000,562.40000,The Alliance,PPO Network,,491.95,,,,,,,325.60,574.24,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,outpatient,,,592.00000,562.40000,The Alliance,PPO Network,,491.95,,,,,,,296.00,574.24,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,1.02,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,PPO Network,,1.54,,,,,,,0.92500,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.75350,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,PPO Network,,1.14,,,,,,,0.68500,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,1.08,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,PPO Network,,1.63,,,,,,,0.98000,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,inpatient,1,EA,1.57000,1.50000,The Alliance,PPO Network,,1.30,,,,,,,0.86350,1.52,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,outpatient,1,EA,1.57000,1.50000,The Alliance,PPO Network,,1.30,,,,,,,0.78500,1.52,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,inpatient,1,mL,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,outpatient,1,mL,1.93000,1.83000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,1.87,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,28.50,70.98,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,237.49000,225.62000,The Alliance,PPO Network,,197.35,,,,,,,116.37,230.37,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,237.49000,225.62000,The Alliance,PPO Network,,197.35,,,,,,,109.01,237.49,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2315.94,5045.63,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2315.94,5045.63,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,,1021.30,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,,1021.30,,,,,,,148.57,1447.00,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,PPO Network,90,632.39,,,,,,,418.55,738.17,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,PPO Network,90,632.39,,,,,,,380.50,6088.74,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.80500,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,inpatient,1,EA,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,outpatient,1,EA,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,21.34,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,inpatient,1,EA,34.14000,32.44000,The Alliance,PPO Network,,28.37,,,,,,,18.78,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,outpatient,1,EA,34.14000,32.44000,The Alliance,PPO Network,,28.37,,,,,,,17.07,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,inpatient,1,EA,32.01000,30.41000,The Alliance,PPO Network,,26.60,,,,,,,17.61,31.05,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,PPO Network,,26.60,,,,,,,16.00,31.05,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,86.35,152.29,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,13.05,679.08,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,90,152.90,,,,,,,101.20,178.48,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,90,152.90,,,,,,,16.80,848.80,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.00000,203.30000,The Alliance,PPO Network,90,177.83,,,,,,,117.70,207.58,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,PPO Network,90,177.83,,,,,,,19.60,984.66,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,PPO Network,90,217.72,,,,,,,144.10,254.14,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,PPO Network,90,217.72,,,,,,,24.43,1205.34,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,PPO Network,90,117.17,,,,,,,77.55,136.77,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,PPO Network,90,117.17,,,,,,,12.51,628.12,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.90,17.46,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,0.63085,17.46,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,4686.00,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,inpatient,1,mL,2753.58000,2615.90000,The Alliance,PPO Network,,2288.22,,,,,,,1514.47,2670.97,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,outpatient,1,mL,2753.58000,2615.90000,The Alliance,PPO Network,,2288.22,,,,,,,40.56,2670.97,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.44550,0.78570,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,PPO Network,,0.67311,,,,,,,0.40500,0.78570,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,inpatient,,,453.80000,431.11000,The Alliance,PPO Network,90,377.11,,,,,,,249.59,440.19,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,outpatient,,,453.80000,431.11000,The Alliance,PPO Network,90,377.11,,,,,,,17.43,882.80,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,The Alliance,PPO Network,90,126.89,,,,,,,83.98,148.12,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,PPO Network,90,126.89,,,,,,,19.00,865.84,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,80.52,142.01,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,PPO Network,90,121.66,,,,,,,17.85,814.87,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,74.91,132.11,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,12.45,1539.22,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,577.50,1018.50,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,525.00,1180.23,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,The Alliance,PPO Network,,25314.42,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,PPO Network,,25314.42,,,,,,,13982.33,30462.60,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1368.75000,1300.31000,The Alliance,PPO Network,,1137.43,,,,,,,670.69,1327.69,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1368.75000,1300.31000,The Alliance,PPO Network,,1137.43,,,,,,,628.26,1368.75,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,33159.00000,31501.05000,The Alliance,PPO Network,,27555.13,,,,,,,16247.91,32164.23,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,33159.00000,31501.05000,The Alliance,PPO Network,,27555.13,,,,,,,15219.98,33159.00,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,PPO Network,,8792.23,,,,,,,4856.36,10580.30,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,276.10,486.94,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,62.14,3038.81,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,22.91,1035.56,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,inpatient,,,234.30000,222.58000,The Alliance,PPO Network,90,194.70,,,,,,,128.87,227.27,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,outpatient,,,234.30000,222.58000,The Alliance,PPO Network,90,194.70,,,,,,,117.15,1137.41,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,The Alliance,PPO Network,90,96.48,,,,,,,63.85,112.62,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,PPO Network,90,96.48,,,,,,,12.82,645.08,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,inpatient,,,228.40000,216.98000,The Alliance,PPO Network,90,189.80,,,,,,,125.62,221.55,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,PPO Network,90,189.80,,,,,,,8.17,526.26,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,438.35,773.09,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,100.97,773.09,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,inpatient,1,EA,271.76000,258.17000,The Alliance,PPO Network,,225.83,,,,,,,149.47,263.61,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,outpatient,1,EA,271.76000,258.17000,The Alliance,PPO Network,,225.83,,,,,,,135.88,263.61,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,inpatient,1,mL,222.19000,211.08000,The Alliance,PPO Network,,184.64,,,,,,,122.20,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,outpatient,1,mL,222.19000,211.08000,The Alliance,PPO Network,,184.64,,,,,,,64.92,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,inpatient,1,mL,150.10000,142.60000,The Alliance,PPO Network,,124.73,,,,,,,82.56,145.60,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,PPO Network,,124.73,,,,,,,64.92,145.60,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,2.19,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,PPO Network,,3.31,,,,,,,1.99,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,inpatient,1,EA,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,3.20,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,PPO Network,,4.83,,,,,,,2.90,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,inpatient,1,EA,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,5.20,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,outpatient,1,EA,9.45000,8.98000,The Alliance,PPO Network,,7.85,,,,,,,4.72,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,inpatient,1,mL,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,2049.30,3614.22,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,outpatient,1,mL,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1863.00,3614.22,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,497.20,876.88,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,268.42,876.88,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,inpatient,,,658.00000,625.10000,The Alliance,PPO Network,90,546.80,,,,,,,361.90,638.26,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,PPO Network,90,546.80,,,,,,,18.72,882.80,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,3163.00,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,257.95,454.93,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,257.95,3163.00,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,inpatient,,,3369.00000,3200.55000,The Alliance,PPO Network,,2799.64,,,,,,,1852.95,3267.93,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,outpatient,,,3369.00000,3200.55000,The Alliance,PPO Network,,2799.64,,,,,,,1852.95,5271.00,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,The Alliance,PPO Network,,3.42,,,,,,,2.27,4.00,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,PPO Network,,3.42,,,,,,,2.06,4.00,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,inpatient,1,GM,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,outpatient,1,GM,0.94000,0.89000,The Alliance,PPO Network,,0.78114,,,,,,,0.47000,0.91180,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,The Alliance,PPO Network,TC,1379.46,,,,,,,913.00,1610.20,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,PPO Network,TC,1379.46,,,,,,,426.30,17311.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1475.05,3963.00,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1475.05,4686.00,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,inpatient,,,2762.00000,2623.90000,The Alliance,PPO Network,,2295.22,,,,,,,1519.10,2679.14,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,outpatient,,,2762.00000,2623.90000,The Alliance,PPO Network,,2295.22,,,,,,,1519.10,6003.00,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,The Alliance,PPO Network,,844.30,,,,,,,558.80,985.52,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,PPO Network,,844.30,,,,,,,558.80,5271.00,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.78,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,PPO Network,90,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,PPO Network,90,860.92,,,,,,,94.71,4787.38,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,inpatient,,,1965.00000,1866.75000,The Alliance,PPO Network,TC,1632.91,,,,,,,1080.75,1906.05,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,PPO Network,TC,1632.91,,,,,,,1080.75,4686.00,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,78.40,155.20,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,73.44,160.00,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,163.52,356.25,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,876.23000,832.42000,The Alliance,PPO Network,,728.15,,,,,,,429.35,849.94,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,PPO Network,,728.15,,,,,,,402.19,876.23,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1140.19000,1083.18000,The Alliance,PPO Network,,947.50,,,,,,,558.69,1105.98,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1140.19000,1083.18000,The Alliance,PPO Network,,947.50,,,,,,,523.35,1140.19,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12400.00,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,inpatient,,,457.00000,434.15000,The Alliance,PPO Network,,379.77,,,,,,,251.35,443.29,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,outpatient,,,457.00000,434.15000,The Alliance,PPO Network,,379.77,,,,,,,228.50,443.29,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,36.30,145.50,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.91850,1.62,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,PPO Network,,1.39,,,,,,,0.83500,1.62,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1931.25000,1834.69000,The Alliance,PPO Network,,1604.87,,,,,,,946.31,1873.31,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1931.25000,1834.69000,The Alliance,PPO Network,,1604.87,,,,,,,886.44,1931.25,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,49.20000,46.74000,The Alliance,PPO Network,,40.89,,,,,,,24.11,47.72,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,49.20000,46.74000,The Alliance,PPO Network,,40.89,,,,,,,22.58,49.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,1.07,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,99.66,175.76,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,21.69,186.79,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,3163.00,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,The Alliance,PPO Network,,3887.07,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,PPO Network,,3887.07,,,,,,,2147.01,4677.58,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,inpatient,1,GM,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,outpatient,1,GM,0.14000,0.14000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,inpatient,1,EA,11.69000,11.11000,The Alliance,PPO Network,,9.71,,,,,,,6.43,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,outpatient,1,EA,11.69000,11.11000,The Alliance,PPO Network,,9.71,,,,,,,5.84,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,inpatient,1,EA,28.38000,26.96000,The Alliance,PPO Network,,23.58,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,PPO Network,,23.58,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,10.01,19.41,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,TC,349.02,,,,,,,231.00,407.40,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,TC,349.02,,,,,,,210.00,2162.63,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,158.40,279.36,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,144.00,1509.95,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,130.35,229.89,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,112.98,1134.10,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,The Alliance,PPO Network,TC,3060.57,,,,,,,2025.65,3572.51,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,PPO Network,TC,3060.57,,,,,,,1841.50,3572.51,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,264.00,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,264.00,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,126.65,267.72,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,510.40,900.16,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,464.00,900.16,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,5271.00,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,inpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,391.60,690.64,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,outpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,391.60,5271.00,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,73.07,159.20,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1150.20000,1092.69000,The Alliance,PPO Network,,955.82,,,,,,,563.60,1115.69,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1150.20000,1092.69000,The Alliance,PPO Network,,955.82,,,,,,,527.94,1150.20,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1751.25000,1663.69000,The Alliance,PPO Network,,1455.29,,,,,,,858.11,1698.71,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1751.25000,1663.69000,The Alliance,PPO Network,,1455.29,,,,,,,803.82,1751.25,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,967.59,2108.03,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,103.50,200.79,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,946.09000,898.79000,The Alliance,PPO Network,,786.20,,,,,,,463.58,917.71,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,946.09000,898.79000,The Alliance,PPO Network,,786.20,,,,,,,434.26,946.09,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,73.07,159.20,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,8.17,882.80,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,inpatient,,,162.60000,154.47000,The Alliance,PPO Network,90,135.12,,,,,,,89.43,157.72,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,PPO Network,90,135.12,,,,,,,14.87,746.94,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,inpatient,,,176.30000,167.49000,The Alliance,PPO Network,90,146.51,,,,,,,96.97,171.01,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,outpatient,,,176.30000,167.49000,The Alliance,PPO Network,90,146.51,,,,,,,16.11,814.87,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,inpatient,,,210.20000,199.69000,The Alliance,PPO Network,90,174.68,,,,,,,115.61,203.89,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,PPO Network,90,174.68,,,,,,,19.62,1052.52,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,968.06,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,PPO Network,,829.34,,,,,,,548.90,3163.00,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,inpatient,,,1134.00000,1077.30000,The Alliance,PPO Network,,942.35,,,,,,,623.70,1099.98,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,PPO Network,,942.35,,,,,,,567.00,1099.98,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,672.00,1820.00,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,2.76,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,inpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,2.76,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,14.67,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,The Alliance,PPO Network,,283.78,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,PPO Network,,283.78,,,,,,,170.75,331.25,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,inpatient,1,mL,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,outpatient,1,mL,3.17000,3.01000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,inpatient,1,GM,7.76000,7.37000,The Alliance,PPO Network,,6.45,,,,,,,4.27,7.53,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,outpatient,1,GM,7.76000,7.37000,The Alliance,PPO Network,,6.45,,,,,,,3.88,7.53,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.40700,0.71780,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,PPO Network,,0.61494,,,,,,,0.37000,0.71780,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.15950,0.28130,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,PPO Network,,0.24099,,,,,,,0.14500,0.28130,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,inpatient,1,mL,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,28.24,49.81,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,PPO Network,,42.67,,,,,,,25.68,49.81,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,inpatient,1,mL,492.10000,467.50000,The Alliance,PPO Network,,408.94,,,,,,,270.65,477.34,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,outpatient,1,mL,492.10000,467.50000,The Alliance,PPO Network,,408.94,,,,,,,246.05,477.34,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,inpatient,1,mL,705.23000,669.97000,The Alliance,PPO Network,,586.05,,,,,,,387.88,684.07,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,outpatient,1,mL,705.23000,669.97000,The Alliance,PPO Network,,586.05,,,,,,,352.62,684.07,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,inpatient,1,mL,117.73000,111.84000,The Alliance,PPO Network,,97.83,,,,,,,64.75,114.20,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,outpatient,1,mL,117.73000,111.84000,The Alliance,PPO Network,,97.83,,,,,,,58.87,114.20,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,inpatient,1,mL,42.98000,40.83000,The Alliance,PPO Network,,35.72,,,,,,,23.64,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,outpatient,1,mL,42.98000,40.83000,The Alliance,PPO Network,,35.72,,,,,,,0.91450,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,inpatient,1,mL,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,13.56,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,PPO Network,,20.48,,,,,,,0.91450,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,inpatient,1,mL,62.81000,59.67000,The Alliance,PPO Network,,52.20,,,,,,,34.55,60.93,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,outpatient,1,mL,62.81000,59.67000,The Alliance,PPO Network,,52.20,,,,,,,0.91450,60.93,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,inpatient,1,mL,33.52000,31.85000,The Alliance,PPO Network,,27.86,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,PPO Network,,27.86,,,,,,,1.49,32.51,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,inpatient,1,mL,198.20000,188.29000,The Alliance,PPO Network,,164.70,,,,,,,109.01,192.25,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,outpatient,1,mL,198.20000,188.29000,The Alliance,PPO Network,,164.70,,,,,,,17.37,192.25,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,inpatient,1,GM,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,outpatient,1,GM,0.04000,0.03000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,90,152.07,,,,,,,100.65,177.51,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,90,152.07,,,,,,,18.52,882.80,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,7.69,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,7.69,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,13.53,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,13.53,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,inpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.60500,1.07,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,PPO Network,,0.91410,,,,,,,0.55000,4.31,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,,1041.24,,,,,,,689.15,1215.41,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,,1041.24,,,,,,,626.50,1215.41,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,inpatient,,,244.20000,231.99000,The Alliance,PPO Network,90,202.93,,,,,,,134.31,236.87,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,outpatient,,,244.20000,231.99000,The Alliance,PPO Network,90,202.93,,,,,,,12.40,628.12,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,303.60000,288.42000,The Alliance,PPO Network,,252.29,,,,,,,148.76,294.49,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,303.60000,288.42000,The Alliance,PPO Network,,252.29,,,,,,,139.35,303.60,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,302.10000,287.00000,The Alliance,PPO Network,,251.05,,,,,,,148.03,293.04,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,302.10000,287.00000,The Alliance,PPO Network,,251.05,,,,,,,138.66,302.10,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,inpatient,1,mL,96.92000,92.07000,The Alliance,PPO Network,,80.54,,,,,,,53.31,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,outpatient,1,mL,96.92000,92.07000,The Alliance,PPO Network,,80.54,,,,,,,48.46,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,inpatient,1,mL,96.91000,92.07000,The Alliance,PPO Network,,80.53,,,,,,,53.30,94.00,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,outpatient,1,mL,96.91000,92.07000,The Alliance,PPO Network,,80.53,,,,,,,48.45,94.00,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,54.00,264.00,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,3851.19,8390.40,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,4761.02,10372.60,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,inpatient,,,3818.00000,3627.10000,The Alliance,PPO Network,,3172.76,,,,,,,2099.90,3703.46,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,outpatient,,,3818.00000,3627.10000,The Alliance,PPO Network,,3172.76,,,,,,,569.17,3703.46,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,inpatient,1,EA,25.76000,24.47000,The Alliance,PPO Network,,21.41,,,,,,,14.17,24.99,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,outpatient,1,EA,25.76000,24.47000,The Alliance,PPO Network,,21.41,,,,,,,12.88,24.99,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,29.10,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,138.00,325.26,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,185.90,327.86,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,148.57,327.86,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,23.25,197.88,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,83.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,58.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,inpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,106.70,188.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,97.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,147.40,259.96,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,134.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,PPO Network,,327.41,,,,,,,216.70,382.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,PPO Network,,327.41,,,,,,,197.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,inpatient,,,516.00000,490.20000,The Alliance,PPO Network,,428.80,,,,,,,283.80,500.52,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,outpatient,,,516.00000,490.20000,The Alliance,PPO Network,,428.80,,,,,,,258.00,500.52,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,inpatient,,,454.00000,431.30000,The Alliance,PPO Network,TC,377.27,,,,,,,249.70,440.38,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,PPO Network,TC,377.27,,,,,,,227.00,2320.90,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,inpatient,,,601.00000,570.95000,The Alliance,PPO Network,TC,499.43,,,,,,,330.55,582.97,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,outpatient,,,601.00000,570.95000,The Alliance,PPO Network,TC,499.43,,,,,,,284.63,3099.68,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,inpatient,,,1218.00000,1157.10000,The Alliance,PPO Network,,1012.16,,,,,,,669.90,1181.46,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,outpatient,,,1218.00000,1157.10000,The Alliance,PPO Network,,1012.16,,,,,,,669.90,5271.00,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,3163.00,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,293.70,517.98,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,267.00,3586.71,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,PPO Network,TC,78.94,,,,,,,47.50,860.53,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,238.70,420.98,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,217.00,488.81,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,inpatient,,,1280.00000,1216.00000,The Alliance,PPO Network,90,1063.68,,,,,,,704.00,1241.60,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,PPO Network,90,1063.68,,,,,,,377.60,6141.84,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,inpatient,,,1161.00000,1102.95000,The Alliance,PPO Network,90,964.79,,,,,,,638.55,1126.17,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,outpatient,,,1161.00000,1102.95000,The Alliance,PPO Network,90,964.79,,,,,,,389.13,6047.82,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,inpatient,1,EA,2.06000,1.95000,The Alliance,PPO Network,,1.71,,,,,,,1.13,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,PPO Network,,1.71,,,,,,,1.03,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,inpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,432.00000,410.40000,The Alliance,PPO Network,,358.99,,,,,,,237.60,419.04,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,432.00000,410.40000,The Alliance,PPO Network,,358.99,,,,,,,98.39,1078.91,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,164.45,290.03,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,62.14,3038.81,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,90,2738.98,,,,,,,1812.80,3197.12,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,90,2738.98,,,,,,,533.12,19453.17,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,inpatient,,,2336.00000,2219.20000,The Alliance,PPO Network,90,1941.22,,,,,,,1284.80,2265.92,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,outpatient,,,2336.00000,2219.20000,The Alliance,PPO Network,90,1941.22,,,,,,,234.70,11238.50,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,inpatient,,,2681.00000,2546.95000,The Alliance,PPO Network,90,2227.91,,,,,,,1474.55,2600.57,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,outpatient,,,2681.00000,2546.95000,The Alliance,PPO Network,90,2227.91,,,,,,,304.81,14345.24,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,inpatient,1,GM,14.97000,14.22000,The Alliance,PPO Network,,12.44,,,,,,,8.23,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,outpatient,1,GM,14.97000,14.22000,The Alliance,PPO Network,,12.44,,,,,,,7.49,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,inpatient,1,mL,5334.14000,5067.43000,The Alliance,PPO Network,,4432.67,,,,,,,2933.78,5174.12,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,outpatient,1,mL,5334.14000,5067.43000,The Alliance,PPO Network,,4432.67,,,,,,,15.08,5174.12,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,inpatient,1,mL,29.43000,27.96000,The Alliance,PPO Network,,24.46,,,,,,,16.19,28.55,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,outpatient,1,mL,29.43000,27.96000,The Alliance,PPO Network,,24.46,,,,,,,1.49,28.55,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,inpatient,1,EA,795.93000,756.14000,The Alliance,PPO Network,,661.42,,,,,,,437.76,772.05,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,outpatient,1,EA,795.93000,756.14000,The Alliance,PPO Network,,661.42,,,,,,,10.94,772.05,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,inpatient,,,22663.00000,21529.85000,The Alliance,PPO Network,,18832.95,,,,,,,12464.65,21983.11,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,outpatient,,,22663.00000,21529.85000,The Alliance,PPO Network,,18832.95,,,,,,,1519.65,21983.11,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,74.34,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,29.50,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,34.50,66.93,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,67.58,393.82,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,The Alliance,PPO Network,,761.20,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,PPO Network,,761.20,,,,,,,314.95,888.52,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,The Alliance,PPO Network,,732.11,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,PPO Network,,732.11,,,,,,,314.95,854.57,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,PPO Network,,599.98,,,,,,,314.95,700.34,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,67.58,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,,339.05,,,,,,,67.58,395.76,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,67.58,471.42,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,122.40,238.62,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,122.40,267.72,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,126.07,4371.88,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,The Alliance,PPO Network,,25314.42,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,PPO Network,,25314.42,,,,,,,13982.33,30462.60,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,The Alliance,PPO Network,,271.74,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,PPO Network,,271.74,,,,,,,179.85,3163.00,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,281.60,496.64,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,100.97,2190.64,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,100.97,584.87,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,100.97,584.87,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,inpatient,,,1004.00000,953.80000,The Alliance,PPO Network,,834.32,,,,,,,552.20,973.88,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,PPO Network,,834.32,,,,,,,100.97,973.88,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,83.61,484.28,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,35.41,103.79,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,245.30,432.62,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,56.40,432.62,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,The Alliance,PPO Network,,437.11,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,PPO Network,,437.11,,,,,,,146.17,2313.59,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,10.00,30.07,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,PPO Network,,598.32,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,PPO Network,,598.32,,,,,,,360.00,6037.79,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,inpatient,,,974.00000,925.30000,The Alliance,PPO Network,,809.39,,,,,,,535.70,944.78,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,PPO Network,,809.39,,,,,,,122.37,944.78,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,104.50,212.44,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,43.81,120.28,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,PPO Network,,375.61,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,PPO Network,,375.61,,,,,,,200.06,438.44,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,43.81,97.00,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,131.92,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,67.58,194.97,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,43.81,142.59,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,PPO Network,,308.30,,,,,,,185.50,359.87,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,56.40,158.11,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,187.00,362.78,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,275.62,545.62,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,153.47,545.62,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,inpatient,,,207.20000,196.84000,The Alliance,PPO Network,,172.18,,,,,,,113.96,200.98,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,outpatient,,,207.20000,196.84000,The Alliance,PPO Network,,172.18,,,,,,,103.60,212.44,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,The Alliance,PPO Network,,3070.55,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,PPO Network,,3070.55,,,,,,,339.11,3584.15,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,190.85,336.59,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,173.50,336.59,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,The Alliance,PPO Network,,922.41,,,,,,,610.50,1076.70,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,PPO Network,,922.41,,,,,,,100.97,1076.70,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,166.65,293.91,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,35.41,293.91,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,122.40,495.67,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,inpatient,,,877.00000,833.15000,The Alliance,PPO Network,,728.79,,,,,,,482.35,850.69,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,outpatient,,,877.00000,833.15000,The Alliance,PPO Network,,728.79,,,,,,,188.67,850.69,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,PPO Network,,749.56,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,PPO Network,,749.56,,,,,,,200.06,874.94,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,3163.00,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,37.00,442.00,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,26.40,46.56,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,24.00,46.56,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,37.27,101.85,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,The Alliance,PPO Network,,929.89,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,PPO Network,,929.89,,,,,,,100.97,1085.43,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,107.25,189.15,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,PPO Network,,162.04,,,,,,,56.40,5271.00,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,83.61,1553.42,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,83.61,2009.44,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,83.61,1811.63,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,83.61,2113.62,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,100.97,2811.23,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,The Alliance,PPO Network,,267.58,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,PPO Network,,267.58,,,,,,,83.61,2168.71,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,The Alliance,PPO Network,,220.22,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,PPO Network,,220.22,,,,,,,83.61,1930.27,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,83.61,1550.26,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,PPO Network,,268.41,,,,,,,83.61,2147.86,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,PPO Network,,274.23,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,PPO Network,,274.23,,,,,,,100.97,2113.62,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,83.61,1533.65,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,83.61,1965.59,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,inpatient,,,353.00000,335.35000,The Alliance,PPO Network,,293.34,,,,,,,194.15,342.41,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,PPO Network,,293.34,,,,,,,100.97,1772.08,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,PPO Network,,229.36,,,,,,,83.61,1850.10,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,83.61,1732.53,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,100.97,1755.46,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,100.97,1574.27,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,100.97,2277.19,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,PPO Network,,295.00,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,PPO Network,,295.00,,,,,,,100.97,2192.71,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,83.61,1811.63,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,81.50,158.11,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,138.60,244.44,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,126.00,244.44,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,inpatient,,,687.00000,652.65000,The Alliance,PPO Network,,570.90,,,,,,,377.85,666.39,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,outpatient,,,687.00000,652.65000,The Alliance,PPO Network,,570.90,,,,,,,343.50,666.39,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,95.15,167.81,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,86.50,308.32,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,inpatient,,,1230.00000,1168.50000,The Alliance,PPO Network,,1022.13,,,,,,,676.50,1193.10,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,outpatient,,,1230.00000,1168.50000,The Alliance,PPO Network,,1022.13,,,,,,,615.00,1193.10,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,inpatient,,,235.00000,223.25000,The Alliance,PPO Network,,195.28,,,,,,,129.25,227.95,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,PPO Network,,195.28,,,,,,,117.50,277.40,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,PPO Network,,517.71,,,,,,,342.65,604.31,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,PPO Network,,517.71,,,,,,,311.50,2139.65,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,101.75,179.45,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,92.50,179.45,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,inpatient,,,248.00000,235.60000,The Alliance,PPO Network,,206.09,,,,,,,136.40,240.56,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,outpatient,,,248.00000,235.60000,The Alliance,PPO Network,,206.09,,,,,,,124.00,277.40,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,89.00,172.66,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,inpatient,,,901.00000,855.95000,The Alliance,PPO Network,,748.73,,,,,,,495.55,873.97,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,outpatient,,,901.00000,855.95000,The Alliance,PPO Network,,748.73,,,,,,,227.78,873.97,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,inpatient,,,309.00000,293.55000,The Alliance,PPO Network,,256.78,,,,,,,169.95,299.73,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,outpatient,,,309.00000,293.55000,The Alliance,PPO Network,,256.78,,,,,,,154.50,317.72,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,33.55,59.17,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,30.50,62.04,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,211.46,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,109.00,417.31,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,inpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.00,9.70,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,inpatient,,,428.00000,406.60000,The Alliance,PPO Network,,355.67,,,,,,,235.40,415.16,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,PPO Network,,355.67,,,,,,,214.00,531.90,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,340.45,600.43,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,309.50,2989.39,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,PPO Network,,781.14,,,,,,,517.00,911.80,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,PPO Network,,781.14,,,,,,,470.00,3999.66,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,288.20,508.28,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,262.00,1692.33,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,TC,70.64,,,,,,,46.75,82.45,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,TC,70.64,,,,,,,42.50,82.45,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,169.40,298.76,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,154.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,inpatient,,,596.00000,566.20000,The Alliance,PPO Network,,495.28,,,,,,,327.80,578.12,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,outpatient,,,596.00000,566.20000,The Alliance,PPO Network,,495.28,,,,,,,298.00,1692.33,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,113.85,200.79,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,103.50,200.79,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,inpatient,,,728.00000,691.60000,The Alliance,PPO Network,,604.97,,,,,,,400.40,706.16,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,outpatient,,,728.00000,691.60000,The Alliance,PPO Network,,604.97,,,,,,,364.00,2989.39,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,inpatient,,,506.00000,480.70000,The Alliance,PPO Network,,420.49,,,,,,,278.30,490.82,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,PPO Network,,420.49,,,,,,,253.00,734.90,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,inpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,95.70,168.78,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,PPO Network,,144.59,,,,,,,87.00,168.78,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,inpatient,,,376.00000,357.20000,The Alliance,PPO Network,,312.46,,,,,,,206.80,364.72,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,outpatient,,,376.00000,357.20000,The Alliance,PPO Network,,312.46,,,,,,,188.00,1692.33,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,inpatient,,,22.37000,21.25000,The Alliance,PPO Network,,18.59,,,,,,,12.30,21.70,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,outpatient,,,22.37000,21.25000,The Alliance,PPO Network,,18.59,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,inpatient,,,838.00000,796.10000,The Alliance,PPO Network,,696.38,,,,,,,460.90,812.86,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,outpatient,,,838.00000,796.10000,The Alliance,PPO Network,,696.38,,,,,,,419.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,229.35,404.49,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,208.50,1692.33,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,inpatient,,,1210.00000,1149.50000,The Alliance,PPO Network,,1005.51,,,,,,,665.50,1173.70,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,outpatient,,,1210.00000,1149.50000,The Alliance,PPO Network,,1005.51,,,,,,,605.00,1692.33,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,101.75,179.45,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,92.50,242.55,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,77.00,210.12,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,74.00,207.54,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,152.35,268.69,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,138.50,417.31,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,inpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,52.80,93.12,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,PPO Network,,79.78,,,,,,,48.00,93.12,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,inpatient,,,272.00000,258.40000,The Alliance,PPO Network,,226.03,,,,,,,149.60,263.84,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,PPO Network,,226.03,,,,,,,136.00,317.72,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,inpatient,,,427.00000,405.65000,The Alliance,PPO Network,,354.84,,,,,,,234.85,414.19,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,PPO Network,,354.84,,,,,,,213.50,639.36,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,182.05,321.07,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,,275.06,,,,,,,165.50,321.07,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,inpatient,,,1189.00000,1129.55000,The Alliance,PPO Network,,988.06,,,,,,,653.95,1153.33,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,outpatient,,,1189.00000,1129.55000,The Alliance,PPO Network,,988.06,,,,,,,594.50,1692.33,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,283.25,499.55,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,PPO Network,,427.96,,,,,,,257.50,2989.39,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,inpatient,,,326.00000,309.70000,The Alliance,PPO Network,,270.91,,,,,,,179.30,316.22,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,outpatient,,,326.00000,309.70000,The Alliance,PPO Network,,270.91,,,,,,,163.00,1692.33,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,inpatient,,,313.00000,297.35000,The Alliance,PPO Network,,260.10,,,,,,,172.15,303.61,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,outpatient,,,313.00000,297.35000,The Alliance,PPO Network,,260.10,,,,,,,156.50,734.90,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,inpatient,,,1879.00000,1785.05000,The Alliance,PPO Network,,1561.45,,,,,,,1033.45,1822.63,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,outpatient,,,1879.00000,1785.05000,The Alliance,PPO Network,,1561.45,,,,,,,939.50,2989.39,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,319.00,562.60,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,290.00,1692.33,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,114.50,1692.33,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,inpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,145.20,256.08,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,PPO Network,,219.38,,,,,,,132.00,1910.62,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,inpatient,,,384.00000,364.80000,The Alliance,PPO Network,,319.10,,,,,,,211.20,372.48,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,outpatient,,,384.00000,364.80000,The Alliance,PPO Network,,319.10,,,,,,,192.00,372.48,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,160.60,283.24,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,146.00,734.90,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,inpatient,,,258.00000,245.10000,The Alliance,PPO Network,,214.40,,,,,,,141.90,250.26,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,outpatient,,,258.00000,245.10000,The Alliance,PPO Network,,214.40,,,,,,,129.00,909.48,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,inpatient,,,429.00000,407.55000,The Alliance,PPO Network,,356.50,,,,,,,235.95,416.13,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,outpatient,,,429.00000,407.55000,The Alliance,PPO Network,,356.50,,,,,,,214.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,inpatient,,,404.00000,383.80000,The Alliance,PPO Network,,335.72,,,,,,,222.20,391.88,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,outpatient,,,404.00000,383.80000,The Alliance,PPO Network,,335.72,,,,,,,202.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,138.60,244.44,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,126.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,inpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,205.70,362.78,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,PPO Network,,310.79,,,,,,,187.00,734.90,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,inpatient,,,471.50000,447.92000,The Alliance,PPO Network,,391.82,,,,,,,259.32,457.36,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,outpatient,,,471.50000,447.92000,The Alliance,PPO Network,,391.82,,,,,,,235.75,1910.62,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,290.40,512.16,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,264.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,404.25,712.95,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,367.50,1692.33,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,inpatient,,,362.00000,343.90000,The Alliance,PPO Network,,300.82,,,,,,,199.10,351.14,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,outpatient,,,362.00000,343.90000,The Alliance,PPO Network,,300.82,,,,,,,181.00,1692.33,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,238.70,420.98,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,217.00,1692.33,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,PPO Network,,387.25,,,,,,,256.30,452.02,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,PPO Network,,387.25,,,,,,,233.00,1547.18,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,inpatient,,,1517.00000,1441.15000,The Alliance,PPO Network,,1260.63,,,,,,,834.35,1471.49,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,outpatient,,,1517.00000,1441.15000,The Alliance,PPO Network,,1260.63,,,,,,,758.50,2989.39,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,inpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,38.50,67.90,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,PPO Network,,58.17,,,,,,,35.00,134.61,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,inpatient,,,638.00000,606.10000,The Alliance,PPO Network,,530.18,,,,,,,350.90,618.86,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,outpatient,,,638.00000,606.10000,The Alliance,PPO Network,,530.18,,,,,,,319.00,618.86,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,inpatient,,,759.00000,721.05000,The Alliance,PPO Network,,630.73,,,,,,,417.45,736.23,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,outpatient,,,759.00000,721.05000,The Alliance,PPO Network,,630.73,,,,,,,379.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,inpatient,,,1270.00000,1206.50000,The Alliance,PPO Network,,1055.37,,,,,,,698.50,1231.90,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,outpatient,,,1270.00000,1206.50000,The Alliance,PPO Network,,1055.37,,,,,,,635.00,2989.39,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,195.80,345.32,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,178.00,734.90,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,213.40,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,PPO Network,,465.36,,,,,,,308.00,543.20,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,PPO Network,,465.36,,,,,,,280.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,inpatient,,,961.00000,912.95000,The Alliance,PPO Network,,798.59,,,,,,,528.55,932.17,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,PPO Network,,798.59,,,,,,,480.50,2989.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,inpatient,,,587.00000,557.65000,The Alliance,PPO Network,,487.80,,,,,,,322.85,569.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,outpatient,,,587.00000,557.65000,The Alliance,PPO Network,,487.80,,,,,,,293.50,734.90,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,inpatient,,,631.00000,599.45000,The Alliance,PPO Network,,524.36,,,,,,,347.05,612.07,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,outpatient,,,631.00000,599.45000,The Alliance,PPO Network,,524.36,,,,,,,315.50,1692.33,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,PPO Network,,225.20,,,,,,,149.05,262.87,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,PPO Network,,225.20,,,,,,,135.50,417.31,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,62.00,207.54,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,inpatient,,,478.00000,454.10000,The Alliance,PPO Network,,397.22,,,,,,,262.90,463.66,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,outpatient,,,478.00000,454.10000,The Alliance,PPO Network,,397.22,,,,,,,239.00,734.90,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,PPO Network,,280.05,,,,,,,185.35,326.89,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,PPO Network,,280.05,,,,,,,168.50,1231.54,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,inpatient,,,462.00000,438.90000,The Alliance,PPO Network,,383.92,,,,,,,254.10,448.14,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,PPO Network,,383.92,,,,,,,231.00,448.14,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,33.00,134.61,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,55.55,97.97,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,50.50,134.61,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,inpatient,,,1192.00000,1132.40000,The Alliance,PPO Network,,990.55,,,,,,,655.60,1156.24,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,outpatient,,,1192.00000,1132.40000,The Alliance,PPO Network,,990.55,,,,,,,596.00,1692.33,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,inpatient,,,1513.00000,1437.35000,The Alliance,PPO Network,,1257.30,,,,,,,832.15,1467.61,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,outpatient,,,1513.00000,1437.35000,The Alliance,PPO Network,,1257.30,,,,,,,756.50,2989.39,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,inpatient,,,584.00000,554.80000,The Alliance,PPO Network,,485.30,,,,,,,321.20,566.48,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,PPO Network,,485.30,,,,,,,292.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,inpatient,,,444.00000,421.80000,The Alliance,PPO Network,,368.96,,,,,,,244.20,430.68,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,outpatient,,,444.00000,421.80000,The Alliance,PPO Network,,368.96,,,,,,,222.00,734.90,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,inpatient,,,819.00000,778.05000,The Alliance,PPO Network,,680.59,,,,,,,450.45,794.43,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,PPO Network,,680.59,,,,,,,409.50,1692.33,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,inpatient,,,1535.00000,1458.25000,The Alliance,PPO Network,,1275.59,,,,,,,844.25,1488.95,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,PPO Network,,1275.59,,,,,,,767.50,2989.39,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,inpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,191.95,338.53,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,PPO Network,,290.02,,,,,,,174.50,734.90,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,inpatient,,,1061.00000,1007.95000,The Alliance,PPO Network,,881.69,,,,,,,583.55,1029.17,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,outpatient,,,1061.00000,1007.95000,The Alliance,PPO Network,,881.69,,,,,,,530.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,inpatient,,,1183.00000,1123.85000,The Alliance,PPO Network,,983.07,,,,,,,650.65,1147.51,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,outpatient,,,1183.00000,1123.85000,The Alliance,PPO Network,,983.07,,,,,,,591.50,1692.33,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,inpatient,,,1394.00000,1324.30000,The Alliance,PPO Network,,1158.41,,,,,,,766.70,1352.18,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,outpatient,,,1394.00000,1324.30000,The Alliance,PPO Network,,1158.41,,,,,,,697.00,1692.33,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,inpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,,1060.36,,,,,,,701.80,1237.72,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,PPO Network,,1060.36,,,,,,,638.00,2039.65,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,inpatient,,,652.00000,619.40000,The Alliance,PPO Network,,541.81,,,,,,,358.60,632.44,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,outpatient,,,652.00000,619.40000,The Alliance,PPO Network,,541.81,,,,,,,227.78,632.44,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,134.61,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,213.40,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,79.00,308.32,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,23.50,96.61,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,,203.59,,,,,,,134.75,237.65,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,,203.59,,,,,,,122.50,237.65,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,276.10,486.94,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,251.00,734.90,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,inpatient,,,335.00000,318.25000,The Alliance,PPO Network,,278.38,,,,,,,184.25,324.95,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,PPO Network,,278.38,,,,,,,167.50,734.90,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,inpatient,,,457.00000,434.15000,The Alliance,PPO Network,,379.77,,,,,,,251.35,443.29,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,outpatient,,,457.00000,434.15000,The Alliance,PPO Network,,379.77,,,,,,,228.50,2989.39,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,inpatient,,,305.00000,289.75000,The Alliance,PPO Network,,253.46,,,,,,,167.75,295.85,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,PPO Network,,253.46,,,,,,,152.50,1692.33,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,156.75,276.45,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,142.50,417.31,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,TH,129.64,,,,,,,85.80,151.32,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,TH,129.64,,,,,,,78.00,151.32,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,187.00,329.80,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,170.00,417.31,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,inpatient,,,1490.00000,1415.50000,The Alliance,PPO Network,,1238.19,,,,,,,819.50,1445.30,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,outpatient,,,1490.00000,1415.50000,The Alliance,PPO Network,,1238.19,,,,,,,745.00,2989.39,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,203.50,358.90,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,185.00,952.28,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,inpatient,,,1922.00000,1825.90000,The Alliance,PPO Network,,1597.18,,,,,,,1057.10,1864.34,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,outpatient,,,1922.00000,1825.90000,The Alliance,PPO Network,,1597.18,,,,,,,961.00,1981.40,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,inpatient,,,386.00000,366.70000,The Alliance,PPO Network,,320.77,,,,,,,212.30,374.42,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,PPO Network,,320.77,,,,,,,193.00,417.31,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,76.50,148.41,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,154.00,271.60,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,140.00,271.60,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,76.00,207.54,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,inpatient,,,219.00000,208.05000,The Alliance,PPO Network,,181.99,,,,,,,120.45,212.43,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,PPO Network,,181.99,,,,,,,109.50,308.32,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,207.54,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,inpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,42.90,75.66,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,PPO Network,,64.82,,,,,,,39.00,75.66,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,inpatient,,,355.00000,337.25000,The Alliance,PPO Network,,295.00,,,,,,,195.25,344.35,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,PPO Network,,295.00,,,,,,,148.57,344.35,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,92.40,162.96,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,84.00,308.32,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,143.55,253.17,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,122.40,253.17,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,PPO Network,,814.38,,,,,,,539.00,950.60,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,PPO Network,,814.38,,,,,,,490.00,1231.54,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,The Alliance,PPO Network,TC,2873.60,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,PPO Network,TC,2873.60,,,,,,,1609.99,3354.26,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,20.00,38.80,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,,90.58,,,,,,,59.95,105.73,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,,90.58,,,,,,,54.50,207.54,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,inpatient,,,1375.00000,1306.25000,The Alliance,PPO Network,,1142.62,,,,,,,756.25,1333.75,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,PPO Network,,1142.62,,,,,,,687.50,1692.33,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,inpatient,,,341.00000,323.95000,The Alliance,PPO Network,,283.37,,,,,,,187.55,330.77,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,outpatient,,,341.00000,323.95000,The Alliance,PPO Network,,283.37,,,,,,,122.40,330.77,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,134.20,236.68,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,122.00,417.31,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,inpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,100.65,177.51,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,PPO Network,,152.07,,,,,,,91.50,177.51,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,64.90,114.46,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,59.00,114.46,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,44.50,207.54,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,inpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,36.85,64.99,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,PPO Network,,55.68,,,,,,,33.50,64.99,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,inpatient,,,302.00000,286.90000,The Alliance,PPO Network,,250.96,,,,,,,166.10,292.94,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,PPO Network,,250.96,,,,,,,151.00,292.94,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,PPO Network,,620.76,,,,,,,410.85,724.59,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,PPO Network,,620.76,,,,,,,373.50,734.90,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,90.20,159.08,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,82.00,207.54,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,34.92,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,295.90,521.86,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,269.00,521.86,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,inpatient,,,248.00000,235.60000,The Alliance,PPO Network,,206.09,,,,,,,136.40,240.56,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,outpatient,,,248.00000,235.60000,The Alliance,PPO Network,,206.09,,,,,,,124.00,240.56,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,TC,2015.17,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,PPO Network,TC,2015.17,,,,,,,1212.50,2352.25,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,inpatient,,,416.00000,395.20000,The Alliance,PPO Network,,345.70,,,,,,,228.80,403.52,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,PPO Network,,345.70,,,,,,,208.00,416.79,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,inpatient,,,549.00000,521.55000,The Alliance,PPO Network,,456.22,,,,,,,301.95,532.53,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,outpatient,,,549.00000,521.55000,The Alliance,PPO Network,,456.22,,,,,,,274.50,532.53,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,317.72,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,inpatient,,,718.00000,682.10000,The Alliance,PPO Network,,596.66,,,,,,,394.90,696.46,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,outpatient,,,718.00000,682.10000,The Alliance,PPO Network,,596.66,,,,,,,359.00,696.46,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,inpatient,,,213.00000,202.35000,The Alliance,PPO Network,,177.00,,,,,,,117.15,206.61,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,outpatient,,,213.00000,202.35000,The Alliance,PPO Network,,177.00,,,,,,,106.50,207.54,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,inpatient,,,565.00000,536.75000,The Alliance,PPO Network,,469.51,,,,,,,310.75,548.05,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,outpatient,,,565.00000,536.75000,The Alliance,PPO Network,,469.51,,,,,,,282.50,548.05,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,195.50,645.77,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,93.00,207.54,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,438.35,773.09,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,398.50,773.09,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,TC,88.09,,,,,,,58.30,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,TC,88.09,,,,,,,53.00,102.82,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,111.65,196.91,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,PPO Network,,168.69,,,,,,,101.50,207.54,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,inpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,243.10,428.74,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,outpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,221.00,428.74,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,119.31,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,391.60,690.64,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,PPO Network,,591.67,,,,,,,356.00,690.64,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,33.00,64.02,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,55.55,97.97,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,50.50,97.97,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,inpatient,,,314.00000,298.30000,The Alliance,PPO Network,,260.93,,,,,,,172.70,304.58,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,PPO Network,,260.93,,,,,,,157.00,417.31,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,104.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,65.50,127.07,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,139.70,246.38,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,127.00,246.38,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,PPO Network,,21.61,,,,,,,14.30,25.22,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,PPO Network,,21.61,,,,,,,13.00,62.04,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,inpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,159.50,281.30,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,outpatient,,,290.00000,275.50000,The Alliance,PPO Network,,240.99,,,,,,,145.00,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,inpatient,,,159.00000,151.05000,The Alliance,PPO Network,,132.13,,,,,,,87.45,154.23,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,outpatient,,,159.00000,151.05000,The Alliance,PPO Network,,132.13,,,,,,,79.50,154.23,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,220.19,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,113.50,220.19,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,207.54,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,inpatient,,,188.00000,178.60000,The Alliance,PPO Network,,156.23,,,,,,,103.40,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,PPO Network,,156.23,,,,,,,94.00,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,109.61,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,164.81,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,inpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,216.31,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,111.50,216.31,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,23.00,44.62,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,245.41,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,inpatient,,,946.00000,898.70000,The Alliance,PPO Network,,786.13,,,,,,,520.30,917.62,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,outpatient,,,946.00000,898.70000,The Alliance,PPO Network,,786.13,,,,,,,473.00,917.62,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,178.20,314.28,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,162.00,314.28,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,144.65,255.11,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,131.50,255.11,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,164.45,290.03,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,149.50,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,58.30,102.82,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,,88.09,,,,,,,53.00,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,38.50,74.69,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,95.50,317.72,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,inpatient,,,362.00000,343.90000,The Alliance,PPO Network,,300.82,,,,,,,199.10,351.14,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,outpatient,,,362.00000,343.90000,The Alliance,PPO Network,,300.82,,,,,,,181.00,351.14,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,319.00,562.60,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,290.00,562.60,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,231.83,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,inpatient,,,296.00000,281.20000,The Alliance,PPO Network,,245.98,,,,,,,162.80,287.12,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,outpatient,,,296.00000,281.20000,The Alliance,PPO Network,,245.98,,,,,,,148.00,416.79,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,inpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,48.95,86.33,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,PPO Network,,73.96,,,,,,,44.50,86.33,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,inpatient,,,644.00000,611.80000,The Alliance,PPO Network,,535.16,,,,,,,354.20,624.68,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,outpatient,,,644.00000,611.80000,The Alliance,PPO Network,,535.16,,,,,,,322.00,624.68,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,197.88,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,49.50,96.03,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,inpatient,,,1540.00000,1463.00000,The Alliance,PPO Network,,1279.74,,,,,,,847.00,1493.80,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,outpatient,,,1540.00000,1463.00000,The Alliance,PPO Network,,1279.74,,,,,,,770.00,1493.80,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,76.50,148.41,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,inpatient,,,1074.00000,1020.30000,The Alliance,PPO Network,,892.49,,,,,,,590.70,1041.78,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,outpatient,,,1074.00000,1020.30000,The Alliance,PPO Network,,892.49,,,,,,,537.00,3686.08,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,264.55,466.57,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,240.50,466.57,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,46.50,90.21,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,inpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,80.85,142.59,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,PPO Network,,122.16,,,,,,,73.50,142.59,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,inpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,86.35,152.29,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,PPO Network,,130.47,,,,,,,78.50,152.29,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,99.55,175.57,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,90.50,417.31,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,41.50,80.51,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,83.50,207.54,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,81.00,157.14,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,116.05,204.67,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,105.50,207.54,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,89.24,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,46.00,89.24,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,85.80,151.32,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,78.00,151.32,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,83.00,416.79,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,197.88,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,147.40,259.96,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,134.00,259.96,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,inpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,243.10,428.74,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,outpatient,,,442.00000,419.90000,The Alliance,PPO Network,,367.30,,,,,,,221.00,428.74,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2078.89000,1974.95000,The Alliance,PPO Network,,1727.56,,,,,,,1018.66,2016.52,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2078.89000,1974.95000,The Alliance,PPO Network,,1727.56,,,,,,,954.21,2078.89,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,inpatient,,,11128.16000,10571.75000,The Alliance,PPO Network,,9247.50,,,,,,,5452.80,10794.32,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,outpatient,,,11128.16000,10571.75000,The Alliance,PPO Network,,9247.50,,,,,,,5107.83,11128.16,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,inpatient,1,mL,97.37000,92.50000,The Alliance,PPO Network,,80.91,,,,,,,53.55,94.45,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,outpatient,1,mL,97.37000,92.50000,The Alliance,PPO Network,,80.91,,,,,,,1.49,94.45,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,inpatient,1,mL,486.83000,462.49000,The Alliance,PPO Network,,404.56,,,,,,,267.76,472.23,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,outpatient,1,mL,486.83000,462.49000,The Alliance,PPO Network,,404.56,,,,,,,100.30,472.23,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,inpatient,1,EA,5750.00000,5462.50000,The Alliance,PPO Network,,4778.25,,,,,,,3162.50,5577.50,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,outpatient,1,EA,5750.00000,5462.50000,The Alliance,PPO Network,,4778.25,,,,,,,131.56,5577.50,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,inpatient,1,mL,1421.18000,1350.13000,The Alliance,PPO Network,,1181.00,,,,,,,781.65,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,outpatient,1,mL,1421.18000,1350.13000,The Alliance,PPO Network,,1181.00,,,,,,,0.37000,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,inpatient,1,mL,2524.14000,2397.93000,The Alliance,PPO Network,,2097.56,,,,,,,1388.28,2448.42,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,outpatient,1,mL,2524.14000,2397.93000,The Alliance,PPO Network,,2097.56,,,,,,,0.37000,2448.42,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,41.36000,39.29000,The Alliance,PPO Network,,34.37,,,,,,,20.27,40.12,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,41.36000,39.29000,The Alliance,PPO Network,,34.37,,,,,,,18.98,41.36,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,214.03,423.70,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,200.49,436.80,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,35.09,1833.46,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,2.31,12.33,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.25,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,1.09,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,PPO Network,,1.65,,,,,,,0.99000,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,PPO Network,,0.42381,,,,,,,0.25500,0.49470,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,TC,190.30,,,,,,,125.95,222.13,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,TC,190.30,,,,,,,114.50,1153.87,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,inpatient,,,218.90000,207.95000,The Alliance,PPO Network,90,181.91,,,,,,,120.39,212.33,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,outpatient,,,218.90000,207.95000,The Alliance,PPO Network,90,181.91,,,,,,,19.99,1018.59,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,The Alliance,PPO Network,90,182.16,,,,,,,120.56,212.62,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,PPO Network,90,182.16,,,,,,,11.91,594.19,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,inpatient,,,161.60000,153.52000,The Alliance,PPO Network,90,134.29,,,,,,,88.88,156.75,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,PPO Network,90,134.29,,,,,,,14.96,679.08,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,inpatient,,,240.30000,228.28000,The Alliance,PPO Network,90,199.69,,,,,,,132.16,233.09,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,outpatient,,,240.30000,228.28000,The Alliance,PPO Network,90,199.69,,,,,,,21.97,1103.49,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,PPO Network,90,174.26,,,,,,,115.33,203.41,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,PPO Network,90,174.26,,,,,,,24.89,1137.41,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,90,129.64,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,90,129.64,,,,,,,13.89,696.05,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,90,71.47,,,,,,,47.30,83.42,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,90,71.47,,,,,,,5.11,254.68,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,90,74.79,,,,,,,49.50,87.30,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,90,74.79,,,,,,,7.27,373.51,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,inpatient,,,295.70000,280.91000,The Alliance,PPO Network,90,245.73,,,,,,,162.63,286.83,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,outpatient,,,295.70000,280.91000,The Alliance,PPO Network,90,245.73,,,,,,,9.61,492.33,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,inpatient,,,161.60000,153.52000,The Alliance,PPO Network,90,134.29,,,,,,,88.88,156.75,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,PPO Network,90,134.29,,,,,,,17.60,882.80,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,inpatient,,,99.50000,94.52000,The Alliance,PPO Network,90,82.68,,,,,,,54.73,96.52,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,outpatient,,,99.50000,94.52000,The Alliance,PPO Network,90,82.68,,,,,,,49.75,1137.41,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,inpatient,,,2343.00000,2225.85000,The Alliance,PPO Network,90,1947.03,,,,,,,1288.65,2272.71,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,outpatient,,,2343.00000,2225.85000,The Alliance,PPO Network,90,1947.03,,,,,,,214.21,10831.07,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,188.60000,179.17000,The Alliance,PPO Network,,156.73,,,,,,,92.41,182.94,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,188.60000,179.17000,The Alliance,PPO Network,,156.73,,,,,,,86.57,188.60,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1496.25000,1421.44000,The Alliance,PPO Network,,1243.38,,,,,,,733.16,1451.36,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1496.25000,1421.44000,The Alliance,PPO Network,,1243.38,,,,,,,686.78,1496.25,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,PPO Network,TC,217.72,,,,,,,144.10,254.14,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,PPO Network,TC,217.72,,,,,,,131.00,1331.91,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,inpatient,,,13067.00000,12413.65000,The Alliance,PPO Network,,10858.68,,,,,,,7186.85,12674.99,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,outpatient,,,13067.00000,12413.65000,The Alliance,PPO Network,,10858.68,,,,,,,4314.91,12674.99,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,27.24000,25.88000,The Alliance,PPO Network,,22.64,,,,,,,14.98,26.42,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,27.24000,25.88000,The Alliance,PPO Network,,22.64,,,,,,,13.62,26.42,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,inpatient,,,191.30000,181.74000,The Alliance,PPO Network,90,158.97,,,,,,,105.22,185.56,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,outpatient,,,191.30000,181.74000,The Alliance,PPO Network,90,158.97,,,,,,,17.47,882.80,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,inpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,inpatient,1,mL,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,outpatient,1,mL,0.15000,0.15000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.27217,1.22,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.18,2.09,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,PPO Network,,1.79,,,,,,,1.07,2.09,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,24.89,1137.41,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,11.85,22.99,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,inpatient,1,EA,2450.87000,2328.32000,The Alliance,PPO Network,,2036.67,,,,,,,1347.98,2377.34,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,outpatient,1,EA,2450.87000,2328.32000,The Alliance,PPO Network,,2036.67,,,,,,,19.06,2377.34,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,inpatient,1,EA,5991.52000,5691.95000,The Alliance,PPO Network,,4978.95,,,,,,,3295.34,5811.77,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,outpatient,1,EA,5991.52000,5691.95000,The Alliance,PPO Network,,4978.95,,,,,,,75.86,5811.77,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.20,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,PPO Network,,1.82,,,,,,,1.09,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,inpatient,1,EA,149.44000,141.96000,The Alliance,PPO Network,,124.18,,,,,,,82.19,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,outpatient,1,EA,149.44000,141.96000,The Alliance,PPO Network,,124.18,,,,,,,74.72,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.67650,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,PPO Network,,1.02,,,,,,,0.61500,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,inpatient,1,EA,22.44000,21.31000,The Alliance,PPO Network,,18.65,,,,,,,12.34,21.77,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,outpatient,1,EA,22.44000,21.31000,The Alliance,PPO Network,,18.65,,,,,,,11.22,21.77,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,inpatient,1,mL,5333.95000,5067.25000,The Alliance,PPO Network,,4432.51,,,,,,,2933.67,5173.93,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,outpatient,1,mL,5333.95000,5067.25000,The Alliance,PPO Network,,4432.51,,,,,,,15.08,5173.93,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,PPO Network,TC,825.18,,,,,,,546.15,963.21,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,PPO Network,TC,825.18,,,,,,,420.81,17311.25,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6744.75000,6407.51000,The Alliance,PPO Network,,5604.89,,,,,,,3304.93,6542.41,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6744.75000,6407.51000,The Alliance,PPO Network,,5604.89,,,,,,,3095.84,6744.75,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,21.07,41.71,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,21.50,81.82,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,11.36,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,inpatient,1,mL,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,10.25,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,outpatient,1,mL,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,9.32,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,inpatient,1,mL,20.05000,19.05000,The Alliance,PPO Network,,16.66,,,,,,,11.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,outpatient,1,mL,20.05000,19.05000,The Alliance,PPO Network,,16.66,,,,,,,10.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,inpatient,1,mL,9.60000,9.12000,The Alliance,PPO Network,,7.98,,,,,,,5.28,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,outpatient,1,mL,9.60000,9.12000,The Alliance,PPO Network,,7.98,,,,,,,4.80,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,PPO Network,,18.88,,,,,,,11.36,22.04,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,The Alliance,PPO Network,,40.29,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,PPO Network,,40.29,,,,,,,24.24,47.03,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,inpatient,1,mL,104.41000,99.19000,The Alliance,PPO Network,,86.76,,,,,,,57.43,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,outpatient,1,mL,104.41000,99.19000,The Alliance,PPO Network,,86.76,,,,,,,52.20,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,inpatient,1,mL,95.21000,90.45000,The Alliance,PPO Network,,79.12,,,,,,,52.37,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,outpatient,1,mL,95.21000,90.45000,The Alliance,PPO Network,,79.12,,,,,,,47.60,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,inpatient,1,mL,122.77000,116.63000,The Alliance,PPO Network,,102.02,,,,,,,67.52,119.09,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,outpatient,1,mL,122.77000,116.63000,The Alliance,PPO Network,,102.02,,,,,,,61.38,119.09,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,inpatient,,,521.00000,494.95000,The Alliance,PPO Network,,432.95,,,,,,,286.55,505.37,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,outpatient,,,521.00000,494.95000,The Alliance,PPO Network,,432.95,,,,,,,286.55,5271.00,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,inpatient,1,mL,107.11000,101.75000,The Alliance,PPO Network,,89.01,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,PPO Network,,89.01,,,,,,,53.55,103.90,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,742.50,1309.50,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,,1121.85,,,,,,,742.50,5271.00,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,PPO Network,TC,2999.91,,,,,,,550.38,17311.25,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,inpatient,,,2929.00000,2782.55000,The Alliance,PPO Network,,2434.00,,,,,,,1610.95,2841.13,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,outpatient,,,2929.00000,2782.55000,The Alliance,PPO Network,,2434.00,,,,,,,1610.95,5271.00,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,122.40,3163.00,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,The Alliance,PPO Network,TC,1689.42,,,,,,,1118.15,1972.01,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,PPO Network,TC,1689.42,,,,,,,909.00,5271.00,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,inpatient,,,738.00000,701.10000,The Alliance,PPO Network,TC,613.28,,,,,,,405.90,715.86,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,PPO Network,TC,613.28,,,,,,,369.00,715.86,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,790.55,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,5271.00,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1653.75,3273.75,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1549.12,3375.00,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,inpatient,1,mL,107.11000,101.75000,The Alliance,PPO Network,,89.01,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,PPO Network,,89.01,,,,,,,1.49,103.90,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,inpatient,1,GM,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.59,2.81,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,outpatient,1,GM,2.90000,2.75000,The Alliance,PPO Network,,2.41,,,,,,,1.45,2.81,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,The Alliance,PPO Network,,571.73,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,PPO Network,,571.73,,,,,,,314.95,667.36,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,inpatient,1,EA,24.48000,23.25000,The Alliance,PPO Network,,20.34,,,,,,,13.46,23.75,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,outpatient,1,EA,24.48000,23.25000,The Alliance,PPO Network,,20.34,,,,,,,12.24,23.75,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.90200,1.59,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,PPO Network,,1.36,,,,,,,0.82000,1.59,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,inpatient,1,mL,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,14.46,80.87,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,inpatient,1,GM,184.32000,175.11000,The Alliance,PPO Network,,153.17,,,,,,,101.38,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,outpatient,1,GM,184.32000,175.11000,The Alliance,PPO Network,,153.17,,,,,,,92.16,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,inpatient,1,GM,131.67000,125.08000,The Alliance,PPO Network,,109.42,,,,,,,72.42,127.72,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,outpatient,1,GM,131.67000,125.08000,The Alliance,PPO Network,,109.42,,,,,,,65.83,127.72,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,inpatient,1,mL,285.68000,271.39000,The Alliance,PPO Network,,237.40,,,,,,,157.12,277.11,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,outpatient,1,mL,285.68000,271.39000,The Alliance,PPO Network,,237.40,,,,,,,0.76000,277.11,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,inpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.01550,0.17460,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,inpatient,1,mL,1762.49000,1674.37000,The Alliance,PPO Network,,1464.63,,,,,,,969.37,1709.62,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,outpatient,1,mL,1762.49000,1674.37000,The Alliance,PPO Network,,1464.63,,,,,,,266.44,1709.62,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,The Alliance,PPO Network,,237.87,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,PPO Network,,237.87,,,,,,,143.12,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,The Alliance,PPO Network,,237.87,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,PPO Network,,237.87,,,,,,,143.12,277.66,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,inpatient,1,mL,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.42350,0.74690,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,PPO Network,,0.63987,,,,,,,0.38500,0.74690,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,inpatient,1,GM,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,outpatient,1,GM,0.64000,0.61000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,The Alliance,PPO Network,,18058.29,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,PPO Network,,18058.29,,,,,,,9974.44,21730.80,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,110.00,194.00,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,83.61,1614.89,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1881.86000,1787.77000,The Alliance,PPO Network,,1563.83,,,,,,,922.11,1825.40,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1881.86000,1787.77000,The Alliance,PPO Network,,1563.83,,,,,,,863.77,1881.86,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,6.86,13.58,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.00,13.58,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,inpatient,,,30.90000,29.35000,The Alliance,PPO Network,,25.68,,,,,,,17.00,29.97,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,outpatient,,,30.90000,29.35000,The Alliance,PPO Network,,25.68,,,,,,,15.45,29.97,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,154.55,272.57,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,TC,233.51,,,,,,,140.50,1569.27,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,7443.72000,7071.53000,The Alliance,PPO Network,,6185.73,,,,,,,3647.42,7220.41,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,7443.72000,7071.53000,The Alliance,PPO Network,,6185.73,,,,,,,3416.67,7443.72,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.91000,363.76000,The Alliance,PPO Network,,318.20,,,,,,,187.63,371.42,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.91000,363.76000,The Alliance,PPO Network,,318.20,,,,,,,175.76,382.91,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,inpatient,1,mL,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,2.57,4.54,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,outpatient,1,mL,4.68000,4.44000,The Alliance,PPO Network,,3.89,,,,,,,0.08005,4.54,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,inpatient,1,EA,26.01000,24.71000,The Alliance,PPO Network,,21.61,,,,,,,14.31,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,outpatient,1,EA,26.01000,24.71000,The Alliance,PPO Network,,21.61,,,,,,,13.01,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,inpatient,1,EA,17.32000,16.45000,The Alliance,PPO Network,,14.39,,,,,,,9.53,16.80,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,PPO Network,,14.39,,,,,,,8.66,16.80,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,The Alliance,PPO Network,,8276.88,,,,,,,4880.47,9661.35,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,PPO Network,,8276.88,,,,,,,4571.71,9960.15,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,PPO Network,TC,227.69,,,,,,,150.70,265.78,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,PPO Network,TC,227.69,,,,,,,137.00,1509.95,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,21.50,62.04,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,514.50,1018.50,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,481.95,1050.00,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,135.30,238.62,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,25.25,1324.17,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,130.90,230.86,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,119.00,230.86,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,inpatient,1,mL,8182.76000,7773.62000,The Alliance,PPO Network,,6799.87,,,,,,,4500.52,7937.28,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,outpatient,1,mL,8182.76000,7773.62000,The Alliance,PPO Network,,6799.87,,,,,,,12.96,7937.28,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,inpatient,1,EA,254.49000,241.77000,The Alliance,PPO Network,,211.48,,,,,,,139.97,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,outpatient,1,EA,254.49000,241.77000,The Alliance,PPO Network,,211.48,,,,,,,127.25,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,inpatient,1,EA,197.29000,187.43000,The Alliance,PPO Network,,163.95,,,,,,,108.51,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,outpatient,1,EA,197.29000,187.43000,The Alliance,PPO Network,,163.95,,,,,,,98.64,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,inpatient,1,EA,330.51000,313.98000,The Alliance,PPO Network,,274.65,,,,,,,181.78,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,outpatient,1,EA,330.51000,313.98000,The Alliance,PPO Network,,274.65,,,,,,,165.25,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,inpatient,1,EA,251.01000,238.46000,The Alliance,PPO Network,,208.59,,,,,,,138.06,243.48,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,outpatient,1,EA,251.01000,238.46000,The Alliance,PPO Network,,208.59,,,,,,,125.50,243.48,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,inpatient,1,EA,167.34000,158.97000,The Alliance,PPO Network,,139.06,,,,,,,92.04,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,outpatient,1,EA,167.34000,158.97000,The Alliance,PPO Network,,139.06,,,,,,,83.67,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,inpatient,1,EA,169.66000,161.18000,The Alliance,PPO Network,,140.99,,,,,,,93.31,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,outpatient,1,EA,169.66000,161.18000,The Alliance,PPO Network,,140.99,,,,,,,84.83,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,inpatient,1,EA,131.53000,124.95000,The Alliance,PPO Network,,109.30,,,,,,,72.34,127.58,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,outpatient,1,EA,131.53000,124.95000,The Alliance,PPO Network,,109.30,,,,,,,65.77,127.58,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,inpatient,1,EA,237.52000,225.65000,The Alliance,PPO Network,,197.38,,,,,,,130.64,230.39,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,outpatient,1,EA,237.52000,225.65000,The Alliance,PPO Network,,197.38,,,,,,,118.76,230.39,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,inpatient,1,mL,8229.81000,7818.32000,The Alliance,PPO Network,,6838.97,,,,,,,4526.40,7982.92,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,outpatient,1,mL,8229.81000,7818.32000,The Alliance,PPO Network,,6838.97,,,,,,,12.96,7982.92,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,inpatient,1,GM,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,outpatient,1,GM,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,The Alliance,PPO Network,,225.20,,,,,,,149.05,262.87,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,PPO Network,,225.20,,,,,,,135.50,417.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,70.56,139.68,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,66.10,144.00,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,inpatient,1,GM,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,4.11,7.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,outpatient,1,GM,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,3.73,7.25,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,inpatient,1,GM,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,outpatient,1,GM,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,inpatient,1,EA,21.38000,20.31000,The Alliance,PPO Network,,17.77,,,,,,,11.76,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,outpatient,1,EA,21.38000,20.31000,The Alliance,PPO Network,,17.77,,,,,,,10.69,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,inpatient,1,EA,11.79000,11.20000,The Alliance,PPO Network,,9.80,,,,,,,6.48,11.44,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,outpatient,1,EA,11.79000,11.20000,The Alliance,PPO Network,,9.80,,,,,,,5.89,11.44,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,inpatient,1,mL,35308.12000,33542.71000,The Alliance,PPO Network,,29341.05,,,,,,,19419.47,34248.88,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,outpatient,1,mL,35308.12000,33542.71000,The Alliance,PPO Network,,29341.05,,,,,,,3638.86,34248.88,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,PPO Network,,0.72297,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,inpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.43,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,PPO Network,,2.16,,,,,,,1.30,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,inpatient,,,451.40000,428.83000,The Alliance,PPO Network,90,375.11,,,,,,,248.27,437.86,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,outpatient,,,451.40000,428.83000,The Alliance,PPO Network,90,375.11,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,inpatient,,,124.60000,118.37000,The Alliance,PPO Network,90,103.54,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,PPO Network,90,103.54,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,inpatient,,,124.60000,118.37000,The Alliance,PPO Network,90,103.54,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,PPO Network,90,103.54,,,,,,,12.45,1539.22,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,inpatient,,,176.70000,167.86000,The Alliance,PPO Network,90,146.84,,,,,,,97.19,171.40,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,outpatient,,,176.70000,167.86000,The Alliance,PPO Network,90,146.84,,,,,,,21.79,984.66,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,90,113.85,,,,,,,75.35,132.89,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,90,113.85,,,,,,,13.69,696.05,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,inpatient,,,332.20000,315.59000,The Alliance,PPO Network,90,276.06,,,,,,,182.71,322.23,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,outpatient,,,332.20000,315.59000,The Alliance,PPO Network,90,276.06,,,,,,,35.97,1680.71,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,inpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,50.05,88.27,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,PPO Network,,75.62,,,,,,,45.50,88.27,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,inpatient,1,mL,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,outpatient,1,mL,650.53000,618.00000,The Alliance,PPO Network,,540.59,,,,,,,312.03,631.01,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,55.55,97.97,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,,83.93,,,,,,,55.55,5271.00,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,20.37,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,48.19,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,inpatient,1,mL,3.13000,2.98000,The Alliance,PPO Network,,2.60,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,outpatient,1,mL,3.13000,2.98000,The Alliance,PPO Network,,2.60,,,,,,,1.56,3.04,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,The Alliance,PPO Network,,3887.07,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,PPO Network,,3887.07,,,,,,,2147.01,4677.58,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,73.07,159.20,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2790.71000,2651.17000,The Alliance,PPO Network,,2319.08,,,,,,,1367.45,2706.99,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2790.71000,2651.17000,The Alliance,PPO Network,,2319.08,,,,,,,1280.94,2790.71,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,790.55,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,PPO Network,,677.26,,,,,,,448.25,5271.00,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,inpatient,,,3561.00000,3382.95000,The Alliance,PPO Network,,2959.19,,,,,,,1958.55,3454.17,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,outpatient,,,3561.00000,3382.95000,The Alliance,PPO Network,,2959.19,,,,,,,1958.55,5271.00,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,inpatient,,,319.00000,303.05000,The Alliance,PPO Network,,265.09,,,,,,,175.45,309.43,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,outpatient,,,319.00000,303.05000,The Alliance,PPO Network,,265.09,,,,,,,175.45,5271.00,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,inpatient,,,966.00000,917.70000,The Alliance,PPO Network,,802.75,,,,,,,531.30,937.02,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,outpatient,,,966.00000,917.70000,The Alliance,PPO Network,,802.75,,,,,,,531.30,5271.00,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.61,6.37,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,PPO Network,,5.46,,,,,,,3.29,6.37,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,9.32000,8.85000,The Alliance,PPO Network,,7.74,,,,,,,5.13,9.04,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,9.32000,8.85000,The Alliance,PPO Network,,7.74,,,,,,,4.66,9.04,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.87,8.58,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.58,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,inpatient,1,EA,38.05000,36.14000,The Alliance,PPO Network,,31.62,,,,,,,20.93,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,outpatient,1,EA,38.05000,36.14000,The Alliance,PPO Network,,31.62,,,,,,,19.02,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,inpatient,1,EA,44.05000,41.85000,The Alliance,PPO Network,,36.61,,,,,,,24.23,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,PPO Network,,36.61,,,,,,,22.02,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1858.06,3678.20,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1740.51,3791.96,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1740.51,3791.96,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1018.98,2220.00,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,691.90,1220.26,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,629.00,7964.98,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,inpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.61050,1.08,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,PPO Network,,0.92241,,,,,,,0.55500,1.49,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,90,2738.98,,,,,,,1812.80,3197.12,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,PPO Network,90,2738.98,,,,,,,533.12,19453.17,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,26.40,46.56,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,4.28,220.68,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.29100,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4706.00000,4470.70000,The Alliance,PPO Network,90,3910.69,,,,,,,2588.30,4564.82,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4706.00000,4470.70000,The Alliance,PPO Network,90,3910.69,,,,,,,597.91,28130.22,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,PPO Network,90,830.17,,,,,,,549.45,969.03,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,PPO Network,90,830.17,,,,,,,499.50,8610.62,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.00620,0.46560,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,inpatient,1,GM,66.56000,63.23000,The Alliance,PPO Network,,55.31,,,,,,,36.61,64.56,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,outpatient,1,GM,66.56000,63.23000,The Alliance,PPO Network,,55.31,,,,,,,33.28,64.56,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,inpatient,,,510.69000,485.16000,The Alliance,PPO Network,,424.38,,,,,,,280.88,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,outpatient,,,510.69000,485.16000,The Alliance,PPO Network,,424.38,,,,,,,255.34,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,inpatient,1,mL,1021.38000,970.31000,The Alliance,PPO Network,,848.77,,,,,,,561.76,990.74,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,outpatient,1,mL,1021.38000,970.31000,The Alliance,PPO Network,,848.77,,,,,,,273.14,990.74,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,inpatient,1,GM,29.41000,27.94000,The Alliance,PPO Network,,24.44,,,,,,,16.18,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,outpatient,1,GM,29.41000,27.94000,The Alliance,PPO Network,,24.44,,,,,,,14.71,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,inpatient,1,GM,46.98000,44.64000,The Alliance,PPO Network,,39.04,,,,,,,25.84,45.57,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,outpatient,1,GM,46.98000,44.64000,The Alliance,PPO Network,,39.04,,,,,,,23.49,45.57,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,inpatient,1,mL,108.46000,103.04000,The Alliance,PPO Network,,90.13,,,,,,,59.65,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,outpatient,1,mL,108.46000,103.04000,The Alliance,PPO Network,,90.13,,,,,,,54.23,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,inpatient,1,mL,93.71000,89.02000,The Alliance,PPO Network,,77.87,,,,,,,51.54,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,outpatient,1,mL,93.71000,89.02000,The Alliance,PPO Network,,77.87,,,,,,,46.85,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,inpatient,1,mL,92.53000,87.90000,The Alliance,PPO Network,,76.89,,,,,,,50.89,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,outpatient,1,mL,92.53000,87.90000,The Alliance,PPO Network,,76.89,,,,,,,46.27,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,inpatient,1,mL,97.51000,92.63000,The Alliance,PPO Network,,81.03,,,,,,,53.63,94.58,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,outpatient,1,mL,97.51000,92.63000,The Alliance,PPO Network,,81.03,,,,,,,48.76,94.58,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,The Alliance,PPO Network,TC,1299.68,,,,,,,860.20,1517.08,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,PPO Network,TC,1299.68,,,,,,,782.00,1820.00,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,inpatient,,,352.80000,335.16000,The Alliance,PPO Network,,293.18,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,outpatient,,,352.80000,335.16000,The Alliance,PPO Network,,293.18,,,,,,,176.40,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,inpatient,1,EA,352.80000,335.16000,The Alliance,PPO Network,,293.18,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,outpatient,1,EA,352.80000,335.16000,The Alliance,PPO Network,,293.18,,,,,,,176.40,342.22,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,inpatient,1,GM,83.98000,79.78000,The Alliance,PPO Network,,69.79,,,,,,,46.19,81.46,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,outpatient,1,GM,83.98000,79.78000,The Alliance,PPO Network,,69.79,,,,,,,41.99,81.46,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,14647.50000,13915.12000,The Alliance,PPO Network,,12172.07,,,,,,,7177.27,14208.08,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,14647.50000,13915.12000,The Alliance,PPO Network,,12172.07,,,,,,,6723.20,14208.08,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1046.52,2280.00,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,The Alliance,PPO Network,TC,1368.66,,,,,,,905.85,1597.59,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,PPO Network,TC,1368.66,,,,,,,574.33,17311.25,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,The Alliance,PPO Network,TC,2394.11,,,,,,,1584.55,2794.57,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,PPO Network,TC,2394.11,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,The Alliance,PPO Network,TC,3667.20,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,PPO Network,TC,3667.20,,,,,,,498.74,29731.35,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,1002.10,1767.34,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,911.00,1964.22,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,The Alliance,PPO Network,,18058.29,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,PPO Network,,18058.29,,,,,,,9974.44,21730.80,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,inpatient,,,2209.00000,2098.55000,The Alliance,PPO Network,TC,1835.68,,,,,,,1214.95,2142.73,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,outpatient,,,2209.00000,2098.55000,The Alliance,PPO Network,TC,1835.68,,,,,,,1104.50,14176.04,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,inpatient,,,6409.00000,6088.55000,The Alliance,PPO Network,,5325.88,,,,,,,3524.95,6216.73,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,outpatient,,,6409.00000,6088.55000,The Alliance,PPO Network,,5325.88,,,,,,,2786.18,11015.00,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,5271.00,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,inpatient,1,mL,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,outpatient,1,mL,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,0.59830,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,inpatient,1,mL,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,outpatient,1,mL,17.30000,16.44000,The Alliance,PPO Network,,14.38,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,0.59830,7.66,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00550,0.00970,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,PPO Network,,0.00831,,,,,,,0.00500,0.00970,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,inpatient,1,mL,38.69000,36.75000,The Alliance,PPO Network,,32.15,,,,,,,21.28,37.53,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,outpatient,1,mL,38.69000,36.75000,The Alliance,PPO Network,,32.15,,,,,,,0.35222,37.53,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,inpatient,1,mL,20.65000,19.61000,The Alliance,PPO Network,,17.16,,,,,,,11.36,20.03,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,PPO Network,,17.16,,,,,,,10.32,20.03,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,inpatient,1,EA,3.39000,3.22000,The Alliance,PPO Network,,2.82,,,,,,,1.86,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,outpatient,1,EA,3.39000,3.22000,The Alliance,PPO Network,,2.82,,,,,,,1.70,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,inpatient,1,EA,4.45000,4.23000,The Alliance,PPO Network,,3.70,,,,,,,2.45,4.32,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,PPO Network,,3.70,,,,,,,2.23,4.32,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,inpatient,1,mL,17.68000,16.80000,The Alliance,PPO Network,,14.69,,,,,,,9.72,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,outpatient,1,mL,17.68000,16.80000,The Alliance,PPO Network,,14.69,,,,,,,8.84,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,inpatient,1,mL,11.12000,10.57000,The Alliance,PPO Network,,9.24,,,,,,,6.12,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,outpatient,1,mL,11.12000,10.57000,The Alliance,PPO Network,,9.24,,,,,,,5.56,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,inpatient,1,mL,34.01000,32.31000,The Alliance,PPO Network,,28.26,,,,,,,18.71,32.99,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,outpatient,1,mL,34.01000,32.31000,The Alliance,PPO Network,,28.26,,,,,,,17.00,32.99,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,inpatient,1,EA,170.64000,162.11000,The Alliance,PPO Network,,141.80,,,,,,,93.85,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,outpatient,1,EA,170.64000,162.11000,The Alliance,PPO Network,,141.80,,,,,,,85.32,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,inpatient,1,EA,197.50000,187.62000,The Alliance,PPO Network,,164.12,,,,,,,108.62,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,outpatient,1,EA,197.50000,187.62000,The Alliance,PPO Network,,164.12,,,,,,,98.75,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,inpatient,1,EA,71.08000,67.53000,The Alliance,PPO Network,,59.07,,,,,,,39.09,68.95,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,outpatient,1,EA,71.08000,67.53000,The Alliance,PPO Network,,59.07,,,,,,,35.54,68.95,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,inpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.40,5.99,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,PPO Network,,5.14,,,,,,,3.09,5.99,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,The Alliance,PPO Network,,942.70,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,PPO Network,,942.70,,,,,,,0.29000,1100.39,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,inpatient,1,EA,68.99000,65.54000,The Alliance,PPO Network,,57.33,,,,,,,37.94,66.92,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,outpatient,1,EA,68.99000,65.54000,The Alliance,PPO Network,,57.33,,,,,,,34.49,66.92,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,inpatient,1,mL,27.94000,26.55000,The Alliance,PPO Network,,23.22,,,,,,,15.37,27.10,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,outpatient,1,mL,27.94000,26.55000,The Alliance,PPO Network,,23.22,,,,,,,13.97,27.10,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,0.08525,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,inpatient,1,mL,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.90,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,0.08525,2.90,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,inpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,inpatient,1,EA,86.43000,82.10000,The Alliance,PPO Network,,71.82,,,,,,,47.54,83.84,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,outpatient,1,EA,86.43000,82.10000,The Alliance,PPO Network,,71.82,,,,,,,43.22,83.84,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,165.11,291.19,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,114.64,291.19,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,188.29,372.73,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,PPO Network,,319.32,,,,,,,176.38,384.26,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,The Alliance,PPO Network,,613.90,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,PPO Network,,613.90,,,,,,,339.09,738.75,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,764.24,1615.05,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,73.07,159.20,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,inpatient,1,mL,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,PPO Network,,24.02,,,,,,,14.46,80.87,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,inpatient,1,GM,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,outpatient,1,GM,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.45,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,inpatient,1,GM,7.65000,7.27000,The Alliance,PPO Network,,6.36,,,,,,,4.21,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,outpatient,1,GM,7.65000,7.27000,The Alliance,PPO Network,,6.36,,,,,,,3.83,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,inpatient,1,GM,7.42000,7.04000,The Alliance,PPO Network,,6.17,,,,,,,4.08,7.20,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,outpatient,1,GM,7.42000,7.04000,The Alliance,PPO Network,,6.17,,,,,,,3.71,7.20,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,inpatient,1,EA,3324.53000,3158.31000,The Alliance,PPO Network,,2762.68,,,,,,,1828.49,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,outpatient,1,EA,3324.53000,3158.31000,The Alliance,PPO Network,,2762.68,,,,,,,138.67,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,inpatient,1,EA,11037.06000,10485.21000,The Alliance,PPO Network,,9171.80,,,,,,,6070.38,10705.95,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,outpatient,1,EA,11037.06000,10485.21000,The Alliance,PPO Network,,9171.80,,,,,,,138.67,10705.95,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,inpatient,1,mL,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,7.98,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,inpatient,1,mL,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,7.98,1004.92,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,inpatient,1,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,2.18,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,PPO Network,,3.29,,,,,,,1.98,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,3.95,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,inpatient,1,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,4.06,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,outpatient,1,EA,7.39000,7.02000,The Alliance,PPO Network,,6.14,,,,,,,3.69,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,inpatient,1,EA,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,2.15,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,PPO Network,,3.25,,,,,,,1.96,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,PPO Network,,2.86,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.79,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,PPO Network,,2.70,,,,,,,1.62,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.68,4.72,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,PPO Network,,4.05,,,,,,,2.44,4.72,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,The Alliance,PPO Network,,98.51,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,PPO Network,,98.51,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,The Alliance,PPO Network,,98.51,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,PPO Network,,98.51,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,inpatient,1,EA,212.90000,202.26000,The Alliance,PPO Network,,176.92,,,,,,,117.09,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,outpatient,1,EA,212.90000,202.26000,The Alliance,PPO Network,,176.92,,,,,,,106.45,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,inpatient,1,EA,169.34000,160.87000,The Alliance,PPO Network,,140.72,,,,,,,93.14,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,outpatient,1,EA,169.34000,160.87000,The Alliance,PPO Network,,140.72,,,,,,,84.67,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,inpatient,1,EA,71.12000,67.57000,The Alliance,PPO Network,,59.10,,,,,,,39.12,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,outpatient,1,EA,71.12000,67.57000,The Alliance,PPO Network,,59.10,,,,,,,35.56,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,inpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,63.20,122.61,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,20.00,38.80,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.69850,1.23,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.63500,1.23,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,inpatient,1,mL,4.64000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.55,4.50,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.32,4.50,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,inpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.14409,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,0.14409,5.61,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,26.40,46.56,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,4.40,237.65,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.46000,839.29000,The Alliance,PPO Network,,734.16,,,,,,,432.90,856.96,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.46000,839.29000,The Alliance,PPO Network,,734.16,,,,,,,405.51,883.46,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6693.00000,6358.35000,The Alliance,PPO Network,,5561.88,,,,,,,3279.57,6492.21,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6693.00000,6358.35000,The Alliance,PPO Network,,5561.88,,,,,,,3072.09,6693.00,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,565.01000,536.76000,The Alliance,PPO Network,,469.52,,,,,,,276.85,548.06,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,565.01000,536.76000,The Alliance,PPO Network,,469.52,,,,,,,259.34,565.01,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,312.86000,297.22000,The Alliance,PPO Network,,259.99,,,,,,,153.30,303.47,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,312.86000,297.22000,The Alliance,PPO Network,,259.99,,,,,,,143.60,312.86,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,The Alliance,PPO Network,TC,1066.17,,,,,,,705.65,1244.51,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,PPO Network,TC,1066.17,,,,,,,584.87,1820.00,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,PPO Network,,4192.92,,,,,,,2315.94,5045.63,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,688.69000,654.26000,The Alliance,PPO Network,,572.30,,,,,,,337.46,668.03,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,688.69000,654.26000,The Alliance,PPO Network,,572.30,,,,,,,316.11,688.69,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,inpatient,1,mL,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.26950,0.47530,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,outpatient,1,mL,0.49000,0.46000,The Alliance,PPO Network,,0.40719,,,,,,,0.24500,10.52,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.75500,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.49,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,PPO Network,,2.24,,,,,,,1.35,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,PPO Network,,2.39,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,PPO Network,,0.68973,,,,,,,0.41500,0.80510,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,PPO Network,TC,142.10,,,,,,,94.05,165.87,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,PPO Network,TC,142.10,,,,,,,85.50,165.87,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,inpatient,1,mL,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,10.86,19.16,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,outpatient,1,mL,19.75000,18.76000,The Alliance,PPO Network,,16.41,,,,,,,9.88,19.16,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,inpatient,1,mL,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.93500,1.65,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,outpatient,1,mL,1.70000,1.62000,The Alliance,PPO Network,,1.41,,,,,,,0.85000,7.69,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,The Alliance,PPO Network,TC,243.48,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,PPO Network,TC,243.48,,,,,,,146.50,584.87,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,382.25,674.15,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,298.87,1820.00,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,The Alliance,PPO Network,TC,457.88,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,PPO Network,TC,457.88,,,,,,,275.50,584.87,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,inpatient,1,GM,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,60.83,107.28,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,outpatient,1,GM,110.60000,105.07000,The Alliance,PPO Network,,91.91,,,,,,,55.30,107.28,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,inpatient,1,mL,435.00000,413.25000,The Alliance,PPO Network,,361.49,,,,,,,239.25,421.95,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,outpatient,1,mL,435.00000,413.25000,The Alliance,PPO Network,,361.49,,,,,,,217.50,421.95,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,inpatient,,,27.90000,26.50000,The Alliance,PPO Network,,23.18,,,,,,,15.35,27.06,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,outpatient,,,27.90000,26.50000,The Alliance,PPO Network,,23.18,,,,,,,13.95,27.06,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,inpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,PPO Network,,0.15789,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.85800,1.51,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,PPO Network,,1.30,,,,,,,0.78000,1.51,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,128.32,279.56,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,17.75,38.68,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,inpatient,,,12.60000,11.97000,The Alliance,PPO Network,90,10.47,,,,,,,6.93,12.22,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,outpatient,,,12.60000,11.97000,The Alliance,PPO Network,90,10.47,,,,,,,5.35,271.65,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.58,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,inpatient,1,mL,3.27000,3.11000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,outpatient,1,mL,3.27000,3.11000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.56,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,PPO Network,,2.36,,,,,,,1.42,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,inpatient,1,mL,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.24,2.19,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,PPO Network,,1.88,,,,,,,1.13,2.19,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,inpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,PPO Network,,0.24930,,,,,,,0.15000,0.81340,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,inpatient,1,mL,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,PPO Network,,115.30,,,,,,,69.38,134.59,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,873.75000,830.06000,The Alliance,PPO Network,,726.09,,,,,,,428.14,847.54,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,873.75000,830.06000,The Alliance,PPO Network,,726.09,,,,,,,401.05,873.75,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,800.63000,760.60000,The Alliance,PPO Network,,665.32,,,,,,,392.31,776.61,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,800.63000,760.60000,The Alliance,PPO Network,,665.32,,,,,,,367.49,800.63,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,54.36000,51.64000,The Alliance,PPO Network,,45.17,,,,,,,26.64,52.73,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,54.36000,51.64000,The Alliance,PPO Network,,45.17,,,,,,,24.95,54.36,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,72.32,143.17,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,56.84,112.52,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,53.24,116.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,inpatient,,,1944.00000,1846.80000,The Alliance,PPO Network,TC,1615.46,,,,,,,1069.20,1885.68,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,PPO Network,TC,1615.46,,,,,,,797.92,1885.68,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,The Alliance,PPO Network,,670.77,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,PPO Network,,670.77,,,,,,,370.50,807.19,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,387.28,843.75,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,The Alliance,PPO Network,,1304.15,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,PPO Network,,1304.15,,,,,,,720.35,1569.38,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,19.58,63.05,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,56.40,248.32,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.40920,2.21,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,372.50,1820.00,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,inpatient,,,2602.00000,2471.90000,The Alliance,PPO Network,TC,2162.26,,,,,,,1431.10,2523.94,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,PPO Network,TC,2162.26,,,,,,,384.16,2523.94,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,The Alliance,PPO Network,,2468.90,,,,,,,1634.05,2881.87,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,PPO Network,,2468.90,,,,,,,581.10,2881.87,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,inpatient,,,812.00000,771.40000,The Alliance,PPO Network,TC,674.77,,,,,,,446.60,787.64,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,outpatient,,,812.00000,771.40000,The Alliance,PPO Network,TC,674.77,,,,,,,406.00,4081.21,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,5115.55,9021.97,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,4467.66,9021.97,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,691.90,1220.26,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,384.16,1220.26,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,372.50,792.37,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,inpatient,,,7033.00000,6681.35000,The Alliance,PPO Network,TC,5844.42,,,,,,,3868.15,6822.01,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,outpatient,,,7033.00000,6681.35000,The Alliance,PPO Network,TC,5844.42,,,,,,,3383.38,7180.14,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,TC,129.64,,,,,,,85.80,151.32,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,TC,129.64,,,,,,,78.00,8022.25,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,The Alliance,PPO Network,TC,3923.98,,,,,,,2597.10,4580.34,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,PPO Network,TC,3923.98,,,,,,,2288.22,7180.14,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,The Alliance,PPO Network,,2468.90,,,,,,,1634.05,2881.87,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,PPO Network,,2468.90,,,,,,,657.58,2881.87,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,288.20,508.28,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,257.95,2630.66,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,inpatient,1,mL,1762.48000,1674.36000,The Alliance,PPO Network,,1464.62,,,,,,,969.36,1709.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,outpatient,1,mL,1762.48000,1674.36000,The Alliance,PPO Network,,1464.62,,,,,,,266.44,1709.61,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,inpatient,1,mL,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,2.71,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,inpatient,1,mL,185.02000,175.77000,The Alliance,PPO Network,,153.75,,,,,,,101.76,179.47,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,outpatient,1,mL,185.02000,175.77000,The Alliance,PPO Network,,153.75,,,,,,,32.41,179.47,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,72.00,260.45,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,inpatient,1,mL,7691.77000,7307.18000,The Alliance,PPO Network,,6391.86,,,,,,,4230.47,7461.02,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,outpatient,1,mL,7691.77000,7307.18000,The Alliance,PPO Network,,6391.86,,,,,,,3845.89,7461.02,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,inpatient,,,94.40000,89.68000,The Alliance,PPO Network,90,78.45,,,,,,,51.92,91.57,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,outpatient,,,94.40000,89.68000,The Alliance,PPO Network,90,78.45,,,,,,,47.20,3038.81,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,inpatient,,,2215.00000,2104.25000,The Alliance,PPO Network,,1840.66,,,,,,,1218.25,2148.55,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,outpatient,,,2215.00000,2104.25000,The Alliance,PPO Network,,1840.66,,,,,,,1107.50,2148.55,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,43.81,161.02,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,inpatient,,,882.84000,838.70000,The Alliance,PPO Network,,733.64,,,,,,,485.56,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,outpatient,,,882.84000,838.70000,The Alliance,PPO Network,,733.64,,,,,,,393.87,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,inpatient,1,EA,998.46000,948.54000,The Alliance,PPO Network,,829.72,,,,,,,549.15,968.51,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,outpatient,1,EA,998.46000,948.54000,The Alliance,PPO Network,,829.72,,,,,,,393.87,968.51,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,inpatient,,,430.57000,409.04000,The Alliance,PPO Network,,357.80,,,,,,,236.81,417.65,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,outpatient,,,430.57000,409.04000,The Alliance,PPO Network,,357.80,,,,,,,215.28,417.65,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,inpatient,,,2328.75000,2212.31000,The Alliance,PPO Network,,1935.19,,,,,,,1280.81,2258.89,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,2328.75000,2212.31000,The Alliance,PPO Network,,1935.19,,,,,,,376.51,2258.89,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,41.00,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,TC,2866.95,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,TC,2866.95,,,,,,,1591.55,3346.50,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,108.90,192.06,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,99.00,192.06,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,20.35,35.89,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,18.50,264.00,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,inpatient,,,1236.00000,1174.20000,The Alliance,PPO Network,,1027.12,,,,,,,679.80,1198.92,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,outpatient,,,1236.00000,1174.20000,The Alliance,PPO Network,,1027.12,,,,,,,314.95,1198.92,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,inpatient,,,561.00000,532.95000,The Alliance,PPO Network,TC,466.19,,,,,,,308.55,544.17,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,outpatient,,,561.00000,532.95000,The Alliance,PPO Network,TC,466.19,,,,,,,168.00,544.17,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,inpatient,,,40.55000,38.52000,The Alliance,PPO Network,,33.70,,,,,,,22.30,39.33,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,outpatient,,,40.55000,38.52000,The Alliance,PPO Network,,33.70,,,,,,,20.27,39.33,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,The Alliance,PPO Network,,117.17,,,,,,,77.55,136.77,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,PPO Network,,117.17,,,,,,,70.50,264.00,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,183.56,323.74,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,163.27,323.74,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,inpatient,,,744.63000,707.40000,The Alliance,PPO Network,,618.79,,,,,,,409.55,722.29,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,outpatient,,,744.63000,707.40000,The Alliance,PPO Network,,618.79,,,,,,,372.31,722.29,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,TC,2325.14,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,PPO Network,TC,2325.14,,,,,,,979.11,2714.06,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,inpatient,,,3.39000,3.22000,The Alliance,PPO Network,,2.82,,,,,,,1.86,3.29,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,outpatient,,,3.39000,3.22000,The Alliance,PPO Network,,2.82,,,,,,,1.70,3.29,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,inpatient,,,24.82000,23.58000,The Alliance,PPO Network,,20.63,,,,,,,13.65,24.08,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,outpatient,,,24.82000,23.58000,The Alliance,PPO Network,,20.63,,,,,,,7.57,24.08,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,inpatient,,,95.07000,90.32000,The Alliance,PPO Network,,79.00,,,,,,,52.29,92.22,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,outpatient,,,95.07000,90.32000,The Alliance,PPO Network,,79.00,,,,,,,35.64,92.22,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,The Alliance,PPO Network,TC,182.65,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,PPO Network,TC,182.65,,,,,,,109.90,213.21,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,47.06,111.55,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,inpatient,,,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,outpatient,,,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.62500,1.21,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,36.30,145.50,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,inpatient,,,710.00000,674.50000,The Alliance,PPO Network,,590.01,,,,,,,390.50,688.70,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,outpatient,,,710.00000,674.50000,The Alliance,PPO Network,,590.01,,,,,,,122.40,688.70,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,186.45,328.83,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,56.40,328.83,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,The Alliance,PPO Network,,3588.26,,,,,,,2374.90,4188.46,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,PPO Network,,3588.26,,,,,,,1031.39,4188.46,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,inpatient,,,5.24000,4.98000,The Alliance,PPO Network,,4.35,,,,,,,2.88,5.08,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,outpatient,,,5.24000,4.98000,The Alliance,PPO Network,,4.35,,,,,,,2.62,5.08,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,75.00,155.84,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,The Alliance,PPO Network,,5316.74,,,,,,,3518.90,6206.06,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,PPO Network,,5316.74,,,,,,,1914.61,6206.06,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,inpatient,,,115.43000,109.66000,The Alliance,PPO Network,,95.92,,,,,,,63.49,111.97,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,outpatient,,,115.43000,109.66000,The Alliance,PPO Network,,95.92,,,,,,,57.47,111.97,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,5.83,41.71,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,The Alliance,PPO Network,TC,2840.36,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,PPO Network,TC,2840.36,,,,,,,1578.65,3315.46,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,107.80,190.12,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,39.18,190.12,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,inpatient,,,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,26.18,46.17,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,17.81,46.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,inpatient,,,254.81000,242.07000,The Alliance,PPO Network,,211.75,,,,,,,140.15,247.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,outpatient,,,254.81000,242.07000,The Alliance,PPO Network,,211.75,,,,,,,102.07,247.17,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,49.87,87.95,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,45.34,87.95,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,inpatient,,,59.60000,56.62000,The Alliance,PPO Network,,49.53,,,,,,,32.78,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,PPO Network,,49.53,,,,,,,22.93,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,inpatient,,,28.13000,26.72000,The Alliance,PPO Network,,23.38,,,,,,,15.47,27.29,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,outpatient,,,28.13000,26.72000,The Alliance,PPO Network,,23.38,,,,,,,13.42,27.29,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,inpatient,,,41.60000,39.52000,The Alliance,PPO Network,,34.57,,,,,,,22.88,40.35,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,PPO Network,,34.57,,,,,,,9.78,40.35,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,2910.60,5133.24,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,1388.02,5133.24,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,The Alliance,PPO Network,,5531.14,,,,,,,3660.80,6456.32,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,PPO Network,,5531.14,,,,,,,2074.81,6456.32,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,21.41,37.76,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,12.21,37.76,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,inpatient,,,259.13000,246.17000,The Alliance,PPO Network,,215.34,,,,,,,142.52,251.36,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,outpatient,,,259.13000,246.17000,The Alliance,PPO Network,,215.34,,,,,,,79.20,251.36,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,inpatient,,,55.73000,52.94000,The Alliance,PPO Network,,46.31,,,,,,,30.65,54.06,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,outpatient,,,55.73000,52.94000,The Alliance,PPO Network,,46.31,,,,,,,26.83,54.06,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,inpatient,,,83.07000,78.92000,The Alliance,PPO Network,,69.03,,,,,,,45.69,80.58,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,outpatient,,,83.07000,78.92000,The Alliance,PPO Network,,69.03,,,,,,,19.47,80.58,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,inpatient,,,42.67000,40.54000,The Alliance,PPO Network,,35.46,,,,,,,23.47,41.39,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,outpatient,,,42.67000,40.54000,The Alliance,PPO Network,,35.46,,,,,,,19.37,41.39,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,inpatient,,,77.07000,73.22000,The Alliance,PPO Network,,64.05,,,,,,,42.39,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,PPO Network,,64.05,,,,,,,38.53,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,inpatient,,,216.94000,206.09000,The Alliance,PPO Network,,180.28,,,,,,,119.32,210.43,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,outpatient,,,216.94000,206.09000,The Alliance,PPO Network,,180.28,,,,,,,89.94,210.43,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,inpatient,,,40.28000,38.27000,The Alliance,PPO Network,,33.47,,,,,,,22.15,39.07,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,outpatient,,,40.28000,38.27000,The Alliance,PPO Network,,33.47,,,,,,,7.86,39.07,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,45.80,172.66,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,inpatient,,,61.47000,58.40000,The Alliance,PPO Network,,51.08,,,,,,,33.81,59.63,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,outpatient,,,61.47000,58.40000,The Alliance,PPO Network,,51.08,,,,,,,17.39,59.63,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,inpatient,,,30.67000,29.14000,The Alliance,PPO Network,,25.49,,,,,,,16.87,29.75,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,outpatient,,,30.67000,29.14000,The Alliance,PPO Network,,25.49,,,,,,,8.69,29.75,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,549.28,20208.37,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,inpatient,,,85.33000,81.06000,The Alliance,PPO Network,,70.91,,,,,,,46.93,82.77,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,outpatient,,,85.33000,81.06000,The Alliance,PPO Network,,70.91,,,,,,,38.77,82.77,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,inpatient,,,30.40000,28.88000,The Alliance,PPO Network,,25.26,,,,,,,14.90,29.49,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,PPO Network,,25.26,,,,,,,13.95,30.40,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,inpatient,,,2245.00000,2132.75000,The Alliance,PPO Network,,1865.60,,,,,,,1234.75,2177.65,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,outpatient,,,2245.00000,2132.75000,The Alliance,PPO Network,,1865.60,,,,,,,1122.50,2177.65,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,inpatient,,,4544.00000,4316.80000,The Alliance,PPO Network,,3776.06,,,,,,,2226.56,4407.68,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,outpatient,,,4544.00000,4316.80000,The Alliance,PPO Network,,3776.06,,,,,,,2085.70,4544.00,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,inpatient,,,97.73000,92.84000,The Alliance,PPO Network,,81.21,,,,,,,53.75,94.80,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,outpatient,,,97.73000,92.84000,The Alliance,PPO Network,,81.21,,,,,,,22.03,94.80,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,85.80,151.32,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,27.63,151.32,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,11.62,45.59,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.90,17.46,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,7.75,17.46,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,inpatient,,,41.60000,39.52000,The Alliance,PPO Network,,34.57,,,,,,,22.88,40.35,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,PPO Network,,34.57,,,,,,,8.17,40.35,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,inpatient,,,38.53000,36.60000,The Alliance,PPO Network,,32.02,,,,,,,21.19,37.37,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,outpatient,,,38.53000,36.60000,The Alliance,PPO Network,,32.02,,,,,,,12.54,37.37,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,inpatient,,,50.53000,48.00000,The Alliance,PPO Network,,41.99,,,,,,,27.79,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,outpatient,,,50.53000,48.00000,The Alliance,PPO Network,,41.99,,,,,,,13.09,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,inpatient,,,23.60000,22.42000,The Alliance,PPO Network,,19.61,,,,,,,12.98,22.89,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,outpatient,,,23.60000,22.42000,The Alliance,PPO Network,,19.61,,,,,,,5.79,22.89,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,53.50,264.00,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,21.34,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,inpatient,,,19.47000,18.50000,The Alliance,PPO Network,,16.18,,,,,,,10.71,18.89,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,PPO Network,,16.18,,,,,,,4.54,18.89,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,3853.00000,3660.35000,The Alliance,PPO Network,,3201.84,,,,,,,2119.15,3737.41,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,3853.00000,3660.35000,The Alliance,PPO Network,,3201.84,,,,,,,1040.32,3737.41,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,inpatient,,,75805.34000,72015.07000,The Alliance,PPO Network,,62994.24,,,,,,,41692.94,73531.18,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,outpatient,,,75805.34000,72015.07000,The Alliance,PPO Network,,62994.24,,,,,,,37902.67,94648.39,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,The Alliance,PPO Network,TC,1790.81,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,PPO Network,TC,1790.81,,,,,,,1006.74,2960.49,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,inpatient,,,19.47000,18.50000,The Alliance,PPO Network,,16.18,,,,,,,10.71,18.89,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,PPO Network,,16.18,,,,,,,6.12,18.89,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,7.66,156.25,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,37.27,149.38,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,21.41,37.76,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,9.04,37.76,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,inpatient,,,42.76000,40.62000,The Alliance,PPO Network,,35.53,,,,,,,23.52,41.48,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,outpatient,,,42.76000,40.62000,The Alliance,PPO Network,,35.53,,,,,,,21.38,41.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,inpatient,,,357.20000,339.34000,The Alliance,PPO Network,,296.83,,,,,,,196.46,346.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,outpatient,,,357.20000,339.34000,The Alliance,PPO Network,,296.83,,,,,,,178.60,346.48,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,9.88,184.30,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,PPO Network,TC,307.47,,,,,,,203.50,358.90,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,PPO Network,TC,307.47,,,,,,,181.22,1865.95,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,inpatient,,,2901.00000,2755.95000,The Alliance,PPO Network,TC,2410.73,,,,,,,1595.55,2813.97,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,PPO Network,TC,2410.73,,,,,,,1390.65,14479.11,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,inpatient,,,4368.00000,4149.60000,The Alliance,PPO Network,TC,3629.81,,,,,,,2402.40,4236.96,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,outpatient,,,4368.00000,4149.60000,The Alliance,PPO Network,TC,3629.81,,,,,,,2181.80,4236.96,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,148.57,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,The Alliance,PPO Network,,13379.10,,,,,,,8855.00,15617.00,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,PPO Network,,13379.10,,,,,,,966.05,15617.00,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,The Alliance,PPO Network,,10.40,,,,,,,6.89,12.14,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,PPO Network,,10.40,,,,,,,6.26,12.14,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,382.80,675.12,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,348.00,675.12,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,548.00,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,The Alliance,PPO Network,,1022.96,,,,,,,677.05,1194.07,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,PPO Network,,1022.96,,,,,,,615.50,1194.07,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,290.40,512.16,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,,438.77,,,,,,,264.00,689.02,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,TC,155.40,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,TC,155.40,,,,,,,93.50,181.39,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,TC,13790.44,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,TC,13790.44,,,,,,,7955.77,82746.35,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,TC,1106.06,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,TC,1106.06,,,,,,,644.24,2960.49,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,inpatient,,,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,23.32,46.17,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,PPO Network,,39.56,,,,,,,2.83,46.17,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,The Alliance,PPO Network,,1022.96,,,,,,,677.05,1194.07,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,PPO Network,,1022.96,,,,,,,615.50,1194.07,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,21.41,37.76,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,19.46,37.76,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,TC,49.03,,,,,,,32.45,57.23,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,TC,49.03,,,,,,,29.50,57.23,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,496.88000,472.04000,The Alliance,PPO Network,,412.91,,,,,,,273.28,481.97,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,496.88000,472.04000,The Alliance,PPO Network,,412.91,,,,,,,143.61,874.50,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,The Alliance,PPO Network,TC,2878.58,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,PPO Network,TC,2878.58,,,,,,,1611.84,3360.08,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,433.40,764.36,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,394.00,4298.79,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,8.36,14.74,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,15.20000,14.44000,The Alliance,PPO Network,,12.63,,,,,,,7.60,14.74,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,740.63000,703.60000,The Alliance,PPO Network,,615.46,,,,,,,407.35,718.41,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,740.63000,703.60000,The Alliance,PPO Network,,615.46,,,,,,,143.61,874.50,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,395.31000,375.54000,The Alliance,PPO Network,,328.50,,,,,,,217.42,383.45,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,395.31000,375.54000,The Alliance,PPO Network,,328.50,,,,,,,143.61,874.50,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,TC,139.61,,,,,,,92.40,162.96,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,TC,139.61,,,,,,,84.00,162.96,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,238.63000,226.70000,The Alliance,PPO Network,,198.30,,,,,,,131.25,231.47,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,238.63000,226.70000,The Alliance,PPO Network,,198.30,,,,,,,119.31,874.50,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,PPO Network,TC,388.91,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,PPO Network,TC,388.91,,,,,,,234.00,2419.76,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,307.27000,291.91000,The Alliance,PPO Network,,255.34,,,,,,,169.00,298.05,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,307.27000,291.91000,The Alliance,PPO Network,,255.34,,,,,,,143.61,874.50,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,PPO Network,TC,1885.54,,,,,,,1134.50,2200.93,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,33.56000,31.88000,The Alliance,PPO Network,,27.89,,,,,,,16.44,32.55,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,PPO Network,,27.89,,,,,,,11.56,32.55,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,42.52000,40.39000,The Alliance,PPO Network,,35.33,,,,,,,20.83,41.24,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,42.52000,40.39000,The Alliance,PPO Network,,35.33,,,,,,,11.56,41.24,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,421.88000,400.79000,The Alliance,PPO Network,,350.58,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,PPO Network,,350.58,,,,,,,157.76,409.22,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,703.13000,667.97000,The Alliance,PPO Network,,584.30,,,,,,,386.72,682.04,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,703.13000,667.97000,The Alliance,PPO Network,,584.30,,,,,,,157.76,682.04,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,TC,87.25,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,TC,87.25,,,,,,,52.50,4496.60,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,464.06,818.44,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,157.76,818.44,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,52,373.95,,,,,,,247.50,436.50,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,52,373.95,,,,,,,225.00,492.80,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,inpatient,,,18.48000,17.56000,The Alliance,PPO Network,,15.36,,,,,,,9.06,17.93,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,outpatient,,,18.48000,17.56000,The Alliance,PPO Network,,15.36,,,,,,,8.48,17.93,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,148.24,261.44,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,134.76,874.50,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,358.80000,340.86000,The Alliance,PPO Network,,298.16,,,,,,,197.34,348.04,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,358.80000,340.86000,The Alliance,PPO Network,,298.16,,,,,,,157.76,348.04,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,TC,134.62,,,,,,,89.10,157.14,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,TC,134.62,,,,,,,81.00,2210.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,inpatient,,,60.90000,57.85000,The Alliance,PPO Network,TC,50.61,,,,,,,33.49,59.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,outpatient,,,60.90000,57.85000,The Alliance,PPO Network,TC,50.61,,,,,,,30.45,59.07,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,TC,506.08,,,,,,,334.95,590.73,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,TC,506.08,,,,,,,304.50,590.73,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.66,3.22,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,inpatient,1,EA,3695.71000,3510.92000,The Alliance,PPO Network,,3071.14,,,,,,,2032.64,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,outpatient,1,EA,3695.71000,3510.92000,The Alliance,PPO Network,,3071.14,,,,,,,12.12,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,inpatient,1,EA,3270.72000,3107.18000,The Alliance,PPO Network,,2717.97,,,,,,,1798.90,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,outpatient,1,EA,3270.72000,3107.18000,The Alliance,PPO Network,,2717.97,,,,,,,12.12,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,inpatient,1,EA,3314.32000,3148.61000,The Alliance,PPO Network,,2754.20,,,,,,,1822.88,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,outpatient,1,EA,3314.32000,3148.61000,The Alliance,PPO Network,,2754.20,,,,,,,12.12,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,inpatient,1,EA,3634.14000,3452.43000,The Alliance,PPO Network,,3019.97,,,,,,,1998.78,3525.12,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,outpatient,1,EA,3634.14000,3452.43000,The Alliance,PPO Network,,3019.97,,,,,,,12.12,3525.12,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,269.85000,256.36000,The Alliance,PPO Network,,224.25,,,,,,,132.23,261.75,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,269.85000,256.36000,The Alliance,PPO Network,,224.25,,,,,,,123.86,269.85,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,The Alliance,PPO Network,,328.77,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,PPO Network,,328.77,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,30261.00000,28747.95000,The Alliance,PPO Network,,25146.89,,,,,,,14827.89,29353.17,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30261.00000,28747.95000,The Alliance,PPO Network,,25146.89,,,,,,,13889.80,30261.00,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,160.60,283.24,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,55.26,283.24,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,35.50,68.87,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,58.39000,55.47000,The Alliance,PPO Network,,48.52,,,,,,,32.11,56.64,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,58.39000,55.47000,The Alliance,PPO Network,,48.52,,,,,,,29.20,56.64,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,52.36000,49.74000,The Alliance,PPO Network,,43.51,,,,,,,28.80,50.79,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,PPO Network,,43.51,,,,,,,26.18,50.79,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,23.00,44.62,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,18.70,32.98,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,17.00,32.98,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,inpatient,,,209.81000,199.32000,The Alliance,PPO Network,,174.35,,,,,,,102.81,203.52,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,outpatient,,,209.81000,199.32000,The Alliance,PPO Network,,174.35,,,,,,,104.91,203.52,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,13.07000,12.42000,The Alliance,PPO Network,,10.86,,,,,,,7.19,12.68,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,13.07000,12.42000,The Alliance,PPO Network,,10.86,,,,,,,2.63,12.68,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,inpatient,,,172.04000,163.44000,The Alliance,PPO Network,,142.97,,,,,,,84.30,166.88,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,outpatient,,,172.04000,163.44000,The Alliance,PPO Network,,142.97,,,,,,,86.02,180.06,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,14.00,27.16,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,PPO Network,NU,13.30,,,,,,,8.80,15.52,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,PPO Network,NU,13.30,,,,,,,8.00,16.05,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,The Alliance,PPO Network,,61.60,,,,,,,36.32,71.91,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,PPO Network,,61.60,,,,,,,37.06,71.91,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,17.00000,16.15000,The Alliance,PPO Network,NU,14.13,,,,,,,9.35,16.49,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,PPO Network,NU,14.13,,,,,,,8.50,16.49,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,472.50000,448.88000,The Alliance,PPO Network,,392.65,,,,,,,231.53,458.32,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,PPO Network,,392.65,,,,,,,216.88,458.32,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,inpatient,,,65.73000,62.44000,The Alliance,PPO Network,,54.62,,,,,,,36.15,63.76,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,outpatient,,,65.73000,62.44000,The Alliance,PPO Network,,54.62,,,,,,,32.87,63.76,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,The Alliance,PPO Network,,26.70,,,,,,,17.67,31.17,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,PPO Network,,26.70,,,,,,,16.07,31.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,15.64000,14.86000,The Alliance,PPO Network,,13.00,,,,,,,8.60,15.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,15.64000,14.86000,The Alliance,PPO Network,,13.00,,,,,,,7.82,15.17,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,144.31000,137.09000,The Alliance,PPO Network,,119.92,,,,,,,79.37,139.98,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,144.31000,137.09000,The Alliance,PPO Network,,119.92,,,,,,,72.16,139.98,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,82.93000,78.78000,The Alliance,PPO Network,,68.91,,,,,,,45.61,80.44,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,82.93000,78.78000,The Alliance,PPO Network,,68.91,,,,,,,41.47,80.44,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,inpatient,,,1245.79000,1183.50000,The Alliance,PPO Network,,1035.25,,,,,,,610.44,1208.42,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,outpatient,,,1245.79000,1183.50000,The Alliance,PPO Network,,1035.25,,,,,,,622.89,1208.42,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,167.80000,159.41000,The Alliance,PPO Network,,139.44,,,,,,,92.29,162.77,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,167.80000,159.41000,The Alliance,PPO Network,,139.44,,,,,,,83.90,162.77,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,95.46000,90.69000,The Alliance,PPO Network,,79.33,,,,,,,46.78,92.60,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,95.46000,90.69000,The Alliance,PPO Network,,79.33,,,,,,,47.73,232.52,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,inpatient,,,31.33000,29.76000,The Alliance,PPO Network,,26.04,,,,,,,15.35,30.39,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,outpatient,,,31.33000,29.76000,The Alliance,PPO Network,,26.04,,,,,,,15.66,90.87,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,inpatient,,,306.76000,291.42000,The Alliance,PPO Network,,254.92,,,,,,,150.31,297.56,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,PPO Network,,254.92,,,,,,,153.38,630.65,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,The Alliance,PPO Network,,26.70,,,,,,,17.67,31.17,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,PPO Network,,26.70,,,,,,,16.07,31.17,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,257.76000,244.87000,The Alliance,PPO Network,,214.20,,,,,,,126.30,250.03,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,257.76000,244.87000,The Alliance,PPO Network,,214.20,,,,,,,81.64,250.03,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,50.06000,47.56000,The Alliance,PPO Network,NU,41.60,,,,,,,27.53,48.56,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,50.06000,47.56000,The Alliance,PPO Network,NU,41.60,,,,,,,25.03,75.83,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,25.77000,24.48000,The Alliance,PPO Network,,21.41,,,,,,,14.17,25.00,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,25.77000,24.48000,The Alliance,PPO Network,,21.41,,,,,,,12.88,25.00,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,45.34,87.95,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,64.53000,61.30000,The Alliance,PPO Network,,53.62,,,,,,,35.49,62.59,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,64.53000,61.30000,The Alliance,PPO Network,,53.62,,,,,,,32.27,62.59,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.80,15.52,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.00,17.60,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,38.27000,36.36000,The Alliance,PPO Network,,31.80,,,,,,,18.75,37.12,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,38.27000,36.36000,The Alliance,PPO Network,,31.80,,,,,,,19.14,102.20,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,127.79000,121.40000,The Alliance,PPO Network,,106.19,,,,,,,70.28,123.96,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,127.79000,121.40000,The Alliance,PPO Network,,106.19,,,,,,,63.90,123.96,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,31.56000,29.98000,The Alliance,PPO Network,,26.23,,,,,,,15.46,30.61,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,31.56000,29.98000,The Alliance,PPO Network,,26.23,,,,,,,14.49,30.61,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,inpatient,,,94.13000,89.42000,The Alliance,PPO Network,,78.22,,,,,,,51.77,91.31,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,outpatient,,,94.13000,89.42000,The Alliance,PPO Network,,78.22,,,,,,,47.06,91.31,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,196.16000,186.35000,The Alliance,PPO Network,NU,163.01,,,,,,,107.89,190.28,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,196.16000,186.35000,The Alliance,PPO Network,NU,163.01,,,,,,,56.49,190.28,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,20.00,43.75,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,inpatient,,,78.37000,74.45000,The Alliance,PPO Network,,65.13,,,,,,,43.10,76.02,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,outpatient,,,78.37000,74.45000,The Alliance,PPO Network,,65.13,,,,,,,39.19,76.02,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,64.42000,61.20000,The Alliance,PPO Network,,53.53,,,,,,,31.57,62.49,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,64.42000,61.20000,The Alliance,PPO Network,,53.53,,,,,,,32.21,62.49,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,inpatient,,,13.82000,13.13000,The Alliance,PPO Network,,11.48,,,,,,,7.60,13.41,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,outpatient,,,13.82000,13.13000,The Alliance,PPO Network,,11.48,,,,,,,2.09,13.41,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,90.20,159.08,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,82.00,159.08,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,NU,83.10,,,,,,,55.00,97.00,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,NU,83.10,,,,,,,14.99,97.00,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,33.00,64.02,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,15.68,31.04,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,38.21,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,53.73000,51.04000,The Alliance,PPO Network,,44.65,,,,,,,29.55,52.12,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,53.73000,51.04000,The Alliance,PPO Network,,44.65,,,,,,,26.86,52.12,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,29.70,52.38,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,54.00000,51.30000,The Alliance,PPO Network,,44.87,,,,,,,27.00,52.38,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,2.63,6.47,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,33.92000,32.22000,The Alliance,PPO Network,,28.19,,,,,,,18.66,32.90,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,33.92000,32.22000,The Alliance,PPO Network,,28.19,,,,,,,16.96,32.90,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,inpatient,,,96.88000,92.04000,The Alliance,PPO Network,,80.51,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,PPO Network,,80.51,,,,,,,48.44,93.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.94000,188.99000,The Alliance,PPO Network,,165.32,,,,,,,97.48,192.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.94000,188.99000,The Alliance,PPO Network,,165.32,,,,,,,91.31,192.97,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,11.21000,10.65000,The Alliance,PPO Network,,9.32,,,,,,,6.17,10.87,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,11.21000,10.65000,The Alliance,PPO Network,,9.32,,,,,,,5.61,10.87,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,76.89000,73.05000,The Alliance,PPO Network,,63.90,,,,,,,37.68,74.58,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,76.89000,73.05000,The Alliance,PPO Network,,63.90,,,,,,,38.45,74.58,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,1.73,6.47,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,45.56000,43.28000,The Alliance,PPO Network,,37.86,,,,,,,22.32,44.19,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,45.56000,43.28000,The Alliance,PPO Network,,37.86,,,,,,,22.78,121.81,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,197.06000,187.21000,The Alliance,PPO Network,,163.76,,,,,,,96.56,191.15,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,197.06000,187.21000,The Alliance,PPO Network,,163.76,,,,,,,77.37,191.15,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,247.54000,235.16000,The Alliance,PPO Network,,205.71,,,,,,,136.15,240.11,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,247.54000,235.16000,The Alliance,PPO Network,,205.71,,,,,,,123.77,240.11,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,12.00,26.40,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,inpatient,,,96.88000,92.04000,The Alliance,PPO Network,,80.51,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,PPO Network,,80.51,,,,,,,48.44,93.97,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,inpatient,,,1579.84000,1500.85000,The Alliance,PPO Network,,1312.85,,,,,,,774.12,1532.44,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,outpatient,,,1579.84000,1500.85000,The Alliance,PPO Network,,1312.85,,,,,,,789.92,1532.44,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,46.20,81.48,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,42.00,81.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,inpatient,,,608.74000,578.30000,The Alliance,PPO Network,,505.86,,,,,,,298.28,590.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,PPO Network,,505.86,,,,,,,206.75,590.48,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,inpatient,,,179.66000,170.68000,The Alliance,PPO Network,,149.30,,,,,,,98.81,174.27,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,outpatient,,,179.66000,170.68000,The Alliance,PPO Network,,149.30,,,,,,,1.71,174.27,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,44.00,77.60,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,40.00,77.60,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,11.00000,10.45000,The Alliance,PPO Network,,9.14,,,,,,,6.05,10.67,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,11.00000,10.45000,The Alliance,PPO Network,,9.14,,,,,,,5.50,10.67,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,27.44,54.32,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,PPO Network,,46.54,,,,,,,28.00,92.45,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,29.10,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,92.48000,87.86000,The Alliance,PPO Network,,76.85,,,,,,,50.86,89.71,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,92.48000,87.86000,The Alliance,PPO Network,,76.85,,,,,,,46.24,89.71,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,55.84,98.47,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,50.76,98.47,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,inpatient,,,223.09000,211.94000,The Alliance,PPO Network,,185.39,,,,,,,109.31,216.40,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,outpatient,,,223.09000,211.94000,The Alliance,PPO Network,,185.39,,,,,,,111.55,216.40,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,218.81000,207.87000,The Alliance,PPO Network,,181.83,,,,,,,107.22,212.25,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,218.81000,207.87000,The Alliance,PPO Network,,181.83,,,,,,,100.43,212.25,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,inpatient,,,8.67000,8.24000,The Alliance,PPO Network,,7.20,,,,,,,4.77,8.41,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,outpatient,,,8.67000,8.24000,The Alliance,PPO Network,,7.20,,,,,,,2.72,8.41,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,118.34,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,18.15,32.01,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,16.50,36.30,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,inpatient,,,24.93000,23.68000,The Alliance,PPO Network,,20.72,,,,,,,13.71,24.18,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,outpatient,,,24.93000,23.68000,The Alliance,PPO Network,,20.72,,,,,,,12.46,25.71,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,44.06000,41.86000,The Alliance,PPO Network,,36.61,,,,,,,24.23,42.74,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,44.06000,41.86000,The Alliance,PPO Network,,36.61,,,,,,,22.03,42.74,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,185.09000,175.84000,The Alliance,PPO Network,,153.81,,,,,,,90.69,179.54,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,185.09000,175.84000,The Alliance,PPO Network,,153.81,,,,,,,92.55,179.54,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,183.56,323.74,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,166.88,323.74,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.90,17.46,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.00,17.46,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,inpatient,,,241.12000,229.06000,The Alliance,PPO Network,,200.37,,,,,,,118.15,233.89,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,outpatient,,,241.12000,229.06000,The Alliance,PPO Network,,200.37,,,,,,,120.56,233.89,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,22.55,39.77,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,41.00000,38.95000,The Alliance,PPO Network,,34.07,,,,,,,20.50,39.77,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,inpatient,,,19.20000,18.24000,The Alliance,PPO Network,,15.96,,,,,,,10.56,18.62,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,outpatient,,,19.20000,18.24000,The Alliance,PPO Network,,15.96,,,,,,,9.60,19.71,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,300.00000,285.00000,The Alliance,PPO Network,,249.30,,,,,,,147.00,291.00,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,300.00000,285.00000,The Alliance,PPO Network,,249.30,,,,,,,150.00,449.21,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,inpatient,,,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,10.22,18.02,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,outpatient,,,18.58000,17.65000,The Alliance,PPO Network,,15.44,,,,,,,9.29,18.02,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,11.00,19.40,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,10.00,19.40,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,inpatient,,,208.28000,197.87000,The Alliance,PPO Network,,173.08,,,,,,,102.06,202.03,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,outpatient,,,208.28000,197.87000,The Alliance,PPO Network,,173.08,,,,,,,101.76,202.03,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,67.80000,64.41000,The Alliance,PPO Network,,56.34,,,,,,,37.29,65.77,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,67.80000,64.41000,The Alliance,PPO Network,,56.34,,,,,,,33.90,65.77,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,206.25000,195.94000,The Alliance,PPO Network,,171.39,,,,,,,113.44,200.06,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,206.25000,195.94000,The Alliance,PPO Network,,171.39,,,,,,,103.12,200.06,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,inpatient,,,53.07000,50.42000,The Alliance,PPO Network,,44.10,,,,,,,26.00,51.48,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,outpatient,,,53.07000,50.42000,The Alliance,PPO Network,,44.10,,,,,,,26.54,54.64,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,79.96000,75.96000,The Alliance,PPO Network,,66.45,,,,,,,43.98,77.56,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,79.96000,75.96000,The Alliance,PPO Network,,66.45,,,,,,,39.98,77.56,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,106.89000,101.55000,The Alliance,PPO Network,,88.83,,,,,,,52.38,103.68,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,106.89000,101.55000,The Alliance,PPO Network,,88.83,,,,,,,39.47,103.68,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,53.14000,50.48000,The Alliance,PPO Network,,44.16,,,,,,,29.23,51.55,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,53.14000,50.48000,The Alliance,PPO Network,,44.16,,,,,,,26.57,51.55,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,196.04000,186.24000,The Alliance,PPO Network,,162.91,,,,,,,107.82,190.16,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,196.04000,186.24000,The Alliance,PPO Network,,162.91,,,,,,,98.02,190.16,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,2.63,6.47,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,The Alliance,PPO Network,TC,69.14,,,,,,,45.76,80.70,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,PPO Network,TC,69.14,,,,,,,41.60,484.28,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,62.92000,59.77000,The Alliance,PPO Network,,52.29,,,,,,,30.83,61.03,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,62.92000,59.77000,The Alliance,PPO Network,,52.29,,,,,,,28.88,61.03,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,14.40000,13.68000,The Alliance,PPO Network,,11.97,,,,,,,7.92,13.97,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,14.40000,13.68000,The Alliance,PPO Network,,11.97,,,,,,,7.20,13.97,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,14.65000,13.92000,The Alliance,PPO Network,,12.17,,,,,,,7.18,14.21,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,14.65000,13.92000,The Alliance,PPO Network,,12.17,,,,,,,6.72,14.21,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,72.00,139.68,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,128.32,279.56,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3590.14000,3410.63000,The Alliance,PPO Network,,2983.41,,,,,,,1759.17,3482.44,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3590.14000,3410.63000,The Alliance,PPO Network,,2983.41,,,,,,,1647.87,3590.14,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20057.00000,19054.15000,The Alliance,PPO Network,,16667.37,,,,,,,9827.93,19455.29,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20057.00000,19054.15000,The Alliance,PPO Network,,16667.37,,,,,,,9206.16,20057.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13068.64000,12415.21000,The Alliance,PPO Network,,10860.04,,,,,,,6403.63,12676.58,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13068.64000,12415.21000,The Alliance,PPO Network,,10860.04,,,,,,,5998.51,12676.58,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,51.09,119.31,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.42900,0.75660,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,PPO Network,,0.64818,,,,,,,0.39000,0.75660,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,2871.77,6256.58,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,PPO Network,,61.36,,,,,,,33.89,73.84,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,PPO Network,,122.66,,,,,,,67.75,147.60,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3499.34,6927.26,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3277.95,6927.26,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9004.50000,8554.27000,The Alliance,PPO Network,,7482.74,,,,,,,4412.20,8734.36,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9004.50000,8554.27000,The Alliance,PPO Network,,7482.74,,,,,,,4133.07,8734.36,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,inpatient,1,mL,971.25000,922.69000,The Alliance,PPO Network,,807.11,,,,,,,534.19,942.11,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,outpatient,1,mL,971.25000,922.69000,The Alliance,PPO Network,,807.11,,,,,,,485.62,1101.64,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,486.94,963.94,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,456.13,993.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,42.41,92.40,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,inpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,39.50,264.00,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,42.20000,40.09000,The Alliance,PPO Network,,35.07,,,,,,,20.68,40.93,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,42.20000,40.09000,The Alliance,PPO Network,,35.07,,,,,,,19.37,42.20,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,231.49,504.34,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,The Alliance,PPO Network,,474.50,,,,,,,314.05,553.87,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,PPO Network,,474.50,,,,,,,212.82,1232.72,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,inpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,41.25,72.75,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,PPO Network,,62.33,,,,,,,37.50,264.00,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,inpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,77.50,150.35,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,inpatient,,,533.00000,506.35000,The Alliance,PPO Network,,442.92,,,,,,,293.15,517.01,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,outpatient,,,533.00000,506.35000,The Alliance,PPO Network,,442.92,,,,,,,266.50,1547.18,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,PPO Network,,97.23,,,,,,,64.35,113.49,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,PPO Network,,97.23,,,,,,,58.50,134.64,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,PPO Network,,227.69,,,,,,,150.70,265.78,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,PPO Network,,227.69,,,,,,,137.00,277.40,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,113.85,200.79,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,103.50,200.79,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,144.65,255.11,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,131.50,1910.62,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,141.50,1547.18,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,inpatient,,,491.00000,466.45000,The Alliance,PPO Network,,408.02,,,,,,,270.05,476.27,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,outpatient,,,491.00000,466.45000,The Alliance,PPO Network,,408.02,,,,,,,245.50,476.27,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,231.83,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,154.55,272.57,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,140.50,1910.62,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,inpatient,,,358.00000,340.10000,The Alliance,PPO Network,,297.50,,,,,,,196.90,347.26,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,outpatient,,,358.00000,340.10000,The Alliance,PPO Network,,297.50,,,,,,,179.00,531.90,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,inpatient,,,724.00000,687.80000,The Alliance,PPO Network,,601.64,,,,,,,398.20,702.28,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,outpatient,,,724.00000,687.80000,The Alliance,PPO Network,,601.64,,,,,,,362.00,1692.33,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,95.15,167.81,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,86.50,210.12,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,141.50,274.51,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,164.45,290.03,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,149.50,697.17,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,25.50,49.47,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,130.90,230.86,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,119.00,242.55,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,inpatient,,,470.00000,446.50000,The Alliance,PPO Network,,390.57,,,,,,,258.50,455.90,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,PPO Network,,390.57,,,,,,,235.00,1692.33,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,inpatient,,,632.00000,600.40000,The Alliance,PPO Network,,525.19,,,,,,,347.60,613.04,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,outpatient,,,632.00000,600.40000,The Alliance,PPO Network,,525.19,,,,,,,316.00,3999.66,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,408.37,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,210.50,2139.65,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,inpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,37.95,66.93,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,PPO Network,,57.34,,,,,,,34.50,134.64,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,inpatient,,,773.00000,734.35000,The Alliance,PPO Network,,642.36,,,,,,,425.15,749.81,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,outpatient,,,773.00000,734.35000,The Alliance,PPO Network,,642.36,,,,,,,386.50,1692.33,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,405.35,714.89,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,368.50,1692.33,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,PPO Network,,148.75,,,,,,,98.45,173.63,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,PPO Network,,148.75,,,,,,,89.50,909.48,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,PPO Network,,816.87,,,,,,,540.65,953.51,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,PPO Network,,816.87,,,,,,,491.50,1692.33,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,41.80,73.72,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,38.00,73.72,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,163.90,289.06,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,149.00,1547.18,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,inpatient,,,316.00000,300.20000,The Alliance,PPO Network,,262.60,,,,,,,173.80,306.52,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,PPO Network,,262.60,,,,,,,158.00,531.90,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,83.00,909.48,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,inpatient,,,352.00000,334.40000,The Alliance,PPO Network,,292.51,,,,,,,193.60,341.44,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,PPO Network,,292.51,,,,,,,176.00,697.17,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,inpatient,,,389.00000,369.55000,The Alliance,PPO Network,,323.26,,,,,,,213.95,377.33,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,outpatient,,,389.00000,369.55000,The Alliance,PPO Network,,323.26,,,,,,,194.50,377.33,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,136.95,241.53,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,124.50,254.03,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,201.85,355.99,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,183.50,355.99,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,inpatient,,,418.00000,397.10000,The Alliance,PPO Network,,347.36,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,outpatient,,,418.00000,397.10000,The Alliance,PPO Network,,347.36,,,,,,,209.00,723.34,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,151.25,266.75,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,137.50,266.75,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,inpatient,,,443.00000,420.85000,The Alliance,PPO Network,,368.13,,,,,,,243.65,429.71,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,PPO Network,,368.13,,,,,,,221.50,723.34,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,inpatient,,,341.00000,323.95000,The Alliance,PPO Network,,283.37,,,,,,,187.55,330.77,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,outpatient,,,341.00000,323.95000,The Alliance,PPO Network,,283.37,,,,,,,170.50,330.77,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,inpatient,,,418.00000,397.10000,The Alliance,PPO Network,,347.36,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,outpatient,,,418.00000,397.10000,The Alliance,PPO Network,,347.36,,,,,,,209.00,405.46,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,inpatient,,,951.00000,903.45000,The Alliance,PPO Network,,790.28,,,,,,,523.05,922.47,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,outpatient,,,951.00000,903.45000,The Alliance,PPO Network,,790.28,,,,,,,227.78,922.47,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,594.00,1047.60,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,227.78,1047.60,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,inpatient,,,622.00000,590.90000,The Alliance,PPO Network,,516.88,,,,,,,342.10,603.34,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,outpatient,,,622.00000,590.90000,The Alliance,PPO Network,,516.88,,,,,,,227.78,603.34,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,inpatient,,,932.00000,885.40000,The Alliance,PPO Network,,774.49,,,,,,,512.60,904.04,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,PPO Network,,774.49,,,,,,,227.78,904.04,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,288.20,508.28,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,227.78,508.28,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,inpatient,,,1550.00000,1472.50000,The Alliance,PPO Network,,1288.05,,,,,,,852.50,1503.50,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,outpatient,,,1550.00000,1472.50000,The Alliance,PPO Network,,1288.05,,,,,,,775.00,1671.62,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,inpatient,,,1494.00000,1419.30000,The Alliance,PPO Network,,1241.51,,,,,,,821.70,1449.18,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,PPO Network,,1241.51,,,,,,,227.78,1449.18,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,inpatient,,,866.00000,822.70000,The Alliance,PPO Network,,719.65,,,,,,,476.30,840.02,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,outpatient,,,866.00000,822.70000,The Alliance,PPO Network,,719.65,,,,,,,227.78,840.02,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,inpatient,,,419.00000,398.05000,The Alliance,PPO Network,,348.19,,,,,,,230.45,406.43,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,outpatient,,,419.00000,398.05000,The Alliance,PPO Network,,348.19,,,,,,,209.50,406.43,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,inpatient,,,1476.00000,1402.20000,The Alliance,PPO Network,,1226.56,,,,,,,811.80,1431.72,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,outpatient,,,1476.00000,1402.20000,The Alliance,PPO Network,,1226.56,,,,,,,227.78,1431.72,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,PPO Network,,649.84,,,,,,,430.10,758.54,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,PPO Network,,649.84,,,,,,,227.78,758.54,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,inpatient,,,1017.00000,966.15000,The Alliance,PPO Network,,845.13,,,,,,,559.35,986.49,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,outpatient,,,1017.00000,966.15000,The Alliance,PPO Network,,845.13,,,,,,,227.78,986.49,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,227.78,882.70,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,inpatient,,,912.00000,866.40000,The Alliance,PPO Network,,757.87,,,,,,,501.60,884.64,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,outpatient,,,912.00000,866.40000,The Alliance,PPO Network,,757.87,,,,,,,227.78,884.64,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,inpatient,,,872.00000,828.40000,The Alliance,PPO Network,,724.63,,,,,,,479.60,845.84,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,outpatient,,,872.00000,828.40000,The Alliance,PPO Network,,724.63,,,,,,,227.78,845.84,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,inpatient,,,563.00000,534.85000,The Alliance,PPO Network,,467.85,,,,,,,309.65,546.11,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,PPO Network,,467.85,,,,,,,227.78,546.11,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,inpatient,,,927.00000,880.65000,The Alliance,PPO Network,,770.34,,,,,,,509.85,899.19,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,outpatient,,,927.00000,880.65000,The Alliance,PPO Network,,770.34,,,,,,,227.78,899.19,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,inpatient,,,743.00000,705.85000,The Alliance,PPO Network,,617.43,,,,,,,408.65,720.71,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,PPO Network,,617.43,,,,,,,227.78,720.71,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,inpatient,,,789.00000,749.55000,The Alliance,PPO Network,,655.66,,,,,,,433.95,765.33,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,outpatient,,,789.00000,749.55000,The Alliance,PPO Network,,655.66,,,,,,,227.78,765.33,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,227.78,722.65,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,inpatient,,,985.00000,935.75000,The Alliance,PPO Network,,818.53,,,,,,,541.75,955.45,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,outpatient,,,985.00000,935.75000,The Alliance,PPO Network,,818.53,,,,,,,227.78,955.45,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,227.78,882.70,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,inpatient,,,424.00000,402.80000,The Alliance,PPO Network,,352.34,,,,,,,233.20,411.28,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,outpatient,,,424.00000,402.80000,The Alliance,PPO Network,,352.34,,,,,,,212.00,411.28,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,90.20,159.08,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,82.00,159.08,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,inpatient,,,800.00000,760.00000,The Alliance,PPO Network,,664.80,,,,,,,440.00,776.00,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,outpatient,,,800.00000,760.00000,The Alliance,PPO Network,,664.80,,,,,,,227.78,776.00,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,PPO Network,,479.49,,,,,,,317.35,559.69,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,PPO Network,,479.49,,,,,,,283.85,559.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,inpatient,,,777.00000,738.15000,The Alliance,PPO Network,,645.69,,,,,,,427.35,753.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,PPO Network,,645.69,,,,,,,227.78,753.69,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,144.00,317.72,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,inpatient,,,644.00000,611.80000,The Alliance,PPO Network,,535.16,,,,,,,354.20,624.68,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,outpatient,,,644.00000,611.80000,The Alliance,PPO Network,,535.16,,,,,,,322.00,3321.00,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,213.40,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,124.30,219.22,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,113.00,219.22,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,72.00,139.68,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,113.30,199.82,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,103.00,909.48,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,inpatient,,,744.00000,706.80000,The Alliance,PPO Network,,618.26,,,,,,,409.20,721.68,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,PPO Network,,618.26,,,,,,,372.00,2139.65,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,PPO Network,,552.62,,,,,,,365.75,645.05,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,PPO Network,,552.62,,,,,,,332.50,2139.65,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,inpatient,,,630.00000,598.50000,The Alliance,PPO Network,,523.53,,,,,,,346.50,611.10,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,PPO Network,,523.53,,,,,,,227.78,611.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,inpatient,,,1130.00000,1073.50000,The Alliance,PPO Network,,939.03,,,,,,,621.50,1096.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,PPO Network,,939.03,,,,,,,565.00,2139.65,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,inpatient,,,317.00000,301.15000,The Alliance,PPO Network,,263.43,,,,,,,174.35,307.49,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,outpatient,,,317.00000,301.15000,The Alliance,PPO Network,,263.43,,,,,,,158.50,909.48,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,inpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,32.45,57.23,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,PPO Network,,49.03,,,,,,,29.50,96.61,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,inpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,113.30,199.82,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,PPO Network,,171.19,,,,,,,103.00,207.54,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,inpatient,,,274.00000,260.30000,The Alliance,PPO Network,,227.69,,,,,,,150.70,265.78,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,PPO Network,,227.69,,,,,,,137.00,265.78,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,inpatient,,,409.00000,388.55000,The Alliance,PPO Network,,339.88,,,,,,,224.95,396.73,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,PPO Network,,339.88,,,,,,,204.50,531.90,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,inpatient,,,531.00000,504.45000,The Alliance,PPO Network,,441.26,,,,,,,292.05,515.07,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,outpatient,,,531.00000,504.45000,The Alliance,PPO Network,,441.26,,,,,,,265.50,3321.00,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,248.05,437.47,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,225.50,2436.76,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,inpatient,,,381.00000,361.95000,The Alliance,PPO Network,,316.61,,,,,,,209.55,369.57,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,outpatient,,,381.00000,361.95000,The Alliance,PPO Network,,316.61,,,,,,,188.67,369.57,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,inpatient,,,613.00000,582.35000,The Alliance,PPO Network,,509.40,,,,,,,337.15,594.61,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,PPO Network,,509.40,,,,,,,306.50,1011.64,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,inpatient,,,422.00000,400.90000,The Alliance,PPO Network,,350.68,,,,,,,232.10,409.34,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,PPO Network,,350.68,,,,,,,211.00,1910.62,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,521.95,920.53,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,474.50,920.53,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,PPO Network,,217.72,,,,,,,144.10,254.14,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,PPO Network,,217.72,,,,,,,131.00,254.14,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,inpatient,,,456.00000,433.20000,The Alliance,PPO Network,,378.94,,,,,,,250.80,442.32,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,outpatient,,,456.00000,433.20000,The Alliance,PPO Network,,378.94,,,,,,,228.00,442.32,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,PPO Network,,464.53,,,,,,,307.45,542.23,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,PPO Network,,464.53,,,,,,,279.50,1547.18,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,inpatient,,,405.00000,384.75000,The Alliance,PPO Network,,336.56,,,,,,,222.75,392.85,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,PPO Network,,336.56,,,,,,,122.40,392.85,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,297.55,524.77,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,270.50,734.90,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,215.05,379.27,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,195.50,379.27,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,inpatient,,,552.00000,524.40000,The Alliance,PPO Network,,458.71,,,,,,,303.60,535.44,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,outpatient,,,552.00000,524.40000,The Alliance,PPO Network,,458.71,,,,,,,276.00,1547.18,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,inpatient,,,359.00000,341.05000,The Alliance,PPO Network,,298.33,,,,,,,197.45,348.23,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,outpatient,,,359.00000,341.05000,The Alliance,PPO Network,,298.33,,,,,,,179.50,734.90,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,PPO Network,,825.18,,,,,,,546.15,963.21,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,PPO Network,,825.18,,,,,,,546.15,4686.00,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,inpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,,1681.94,,,,,,,1113.20,1963.28,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,PPO Network,,1681.94,,,,,,,1012.00,5156.10,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,PPO Network,,693.88,,,,,,,459.25,809.95,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,PPO Network,,693.88,,,,,,,227.78,809.95,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,inpatient,,,914.00000,868.30000,The Alliance,PPO Network,,759.53,,,,,,,502.70,886.58,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,outpatient,,,914.00000,868.30000,The Alliance,PPO Network,,759.53,,,,,,,457.00,3999.66,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,212.85,375.39,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,193.50,3321.00,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,inpatient,,,1333.00000,1266.35000,The Alliance,PPO Network,,1107.72,,,,,,,733.15,1293.01,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,PPO Network,,1107.72,,,,,,,666.50,2989.39,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,inpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,154.55,272.57,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,PPO Network,,233.51,,,,,,,140.50,272.57,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,210.12,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,inpatient,,,1611.00000,1530.45000,The Alliance,PPO Network,,1338.74,,,,,,,886.05,1562.67,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,outpatient,,,1611.00000,1530.45000,The Alliance,PPO Network,,1338.74,,,,,,,805.50,3387.36,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,inpatient,,,607.00000,576.65000,The Alliance,PPO Network,,504.42,,,,,,,333.85,588.79,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,outpatient,,,607.00000,576.65000,The Alliance,PPO Network,,504.42,,,,,,,303.50,1547.18,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,271.15,478.21,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,246.50,952.28,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,22.37000,21.25000,The Alliance,PPO Network,,18.59,,,,,,,12.30,21.70,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,22.37000,21.25000,The Alliance,PPO Network,,18.59,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,inpatient,,,426.00000,404.70000,The Alliance,PPO Network,,354.01,,,,,,,234.30,413.22,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,outpatient,,,426.00000,404.70000,The Alliance,PPO Network,,354.01,,,,,,,213.00,734.90,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,inpatient,,,727.00000,690.65000,The Alliance,PPO Network,,604.14,,,,,,,399.85,705.19,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,outpatient,,,727.00000,690.65000,The Alliance,PPO Network,,604.14,,,,,,,363.50,1692.33,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,inpatient,,,1005.00000,954.75000,The Alliance,PPO Network,,835.15,,,,,,,552.75,974.85,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,PPO Network,,835.15,,,,,,,502.50,2139.65,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,124.30,219.22,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,113.00,3387.36,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,183.00,355.02,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,The Alliance,PPO Network,TC,8243.52,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,PPO Network,TC,8243.52,,,,,,,484.28,9622.40,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,inpatient,,,389.00000,369.55000,The Alliance,PPO Network,,323.26,,,,,,,213.95,377.33,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,outpatient,,,389.00000,369.55000,The Alliance,PPO Network,,323.26,,,,,,,194.50,1547.18,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,inpatient,,,1199.00000,1139.05000,The Alliance,PPO Network,,996.37,,,,,,,659.45,1163.03,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,outpatient,,,1199.00000,1139.05000,The Alliance,PPO Network,,996.37,,,,,,,227.78,1163.03,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,inpatient,,,1657.00000,1574.15000,The Alliance,PPO Network,,1376.97,,,,,,,911.35,1607.29,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,outpatient,,,1657.00000,1574.15000,The Alliance,PPO Network,,1376.97,,,,,,,828.50,1692.33,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,inpatient,,,864.00000,820.80000,The Alliance,PPO Network,,717.98,,,,,,,475.20,838.08,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,outpatient,,,864.00000,820.80000,The Alliance,PPO Network,,717.98,,,,,,,227.78,838.08,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,99.00,174.60,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,90.00,308.32,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,148.50,261.90,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,135.00,723.34,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,72.60,128.04,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,66.00,723.34,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,inpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,70.95,125.13,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,PPO Network,,107.20,,,,,,,64.50,207.54,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,195.80,345.32,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,178.00,345.32,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,inpatient,,,873.00000,829.35000,The Alliance,PPO Network,,725.46,,,,,,,480.15,846.81,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,outpatient,,,873.00000,829.35000,The Alliance,PPO Network,,725.46,,,,,,,436.50,6854.91,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,72.00,308.32,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,inpatient,,,230.00000,218.50000,The Alliance,PPO Network,,191.13,,,,,,,126.50,223.10,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,outpatient,,,230.00000,218.50000,The Alliance,PPO Network,,191.13,,,,,,,115.00,417.31,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,inpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,135.30,238.62,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,PPO Network,,204.43,,,,,,,123.00,238.62,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,271.15,478.21,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,246.50,2989.39,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,PPO Network,,196.12,,,,,,,129.80,228.92,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,PPO Network,,196.12,,,,,,,118.00,417.31,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,inpatient,,,1256.00000,1193.20000,The Alliance,PPO Network,,1043.74,,,,,,,690.80,1218.32,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,outpatient,,,1256.00000,1193.20000,The Alliance,PPO Network,,1043.74,,,,,,,628.00,2989.39,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,158.95,280.33,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,144.50,723.34,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,101.75,179.45,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,92.50,179.45,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,114.00,1910.62,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,inpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,468.60,826.44,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,PPO Network,,708.01,,,,,,,426.00,826.44,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,115.50,203.70,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,105.00,203.70,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,110.00,194.00,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,,166.20,,,,,,,100.00,194.00,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,154.00,271.60,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,140.00,271.60,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,inpatient,,,741.00000,703.95000,The Alliance,PPO Network,,615.77,,,,,,,407.55,718.77,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,outpatient,,,741.00000,703.95000,The Alliance,PPO Network,,615.77,,,,,,,370.50,3287.55,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,95.15,167.81,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,86.50,308.32,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,510.40,900.16,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,464.00,2864.41,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,207.54,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,inpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,504.90,890.46,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,outpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,227.78,890.46,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,163.90,289.06,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,149.00,317.72,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,500.50,882.70,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,455.00,1671.62,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,97.00,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,inpatient,,,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,8.25,14.55,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,outpatient,,,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,7.50,25.57,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,155.65,274.51,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,141.50,639.36,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,inpatient,,,1518.00000,1442.10000,The Alliance,PPO Network,,1261.46,,,,,,,834.90,1472.46,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,PPO Network,,1261.46,,,,,,,520.92,1472.46,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,inpatient,,,423.00000,401.85000,The Alliance,PPO Network,,351.51,,,,,,,232.65,410.31,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,outpatient,,,423.00000,401.85000,The Alliance,PPO Network,,351.51,,,,,,,211.50,1547.18,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,118.50,317.72,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,91.00,308.32,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,220.19,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,113.50,734.90,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,inpatient,,,377.00000,358.15000,The Alliance,PPO Network,,313.29,,,,,,,207.35,365.69,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,outpatient,,,377.00000,358.15000,The Alliance,PPO Network,,313.29,,,,,,,188.50,3321.00,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,inpatient,,,967.00000,918.65000,The Alliance,PPO Network,,803.58,,,,,,,531.85,937.99,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,outpatient,,,967.00000,918.65000,The Alliance,PPO Network,,803.58,,,,,,,483.50,3321.00,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,1622.56,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,inpatient,,,851.00000,808.45000,The Alliance,PPO Network,,707.18,,,,,,,468.05,825.47,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,outpatient,,,851.00000,808.45000,The Alliance,PPO Network,,707.18,,,,,,,425.50,2139.65,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,20.37,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,The Alliance,PPO Network,TC,3036.47,,,,,,,2009.70,3544.38,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,PPO Network,TC,3036.47,,,,,,,1487.04,3544.38,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,57.20,100.88,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,52.00,207.54,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,133.50,734.90,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,inpatient,,,738.00000,701.10000,The Alliance,PPO Network,,613.28,,,,,,,405.90,715.86,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,PPO Network,,613.28,,,,,,,369.00,715.86,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,inpatient,,,1153.00000,1095.35000,The Alliance,PPO Network,,958.14,,,,,,,634.15,1118.41,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,outpatient,,,1153.00000,1095.35000,The Alliance,PPO Network,,958.14,,,,,,,576.50,2989.39,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,inpatient,,,1367.00000,1298.65000,The Alliance,PPO Network,,1135.98,,,,,,,751.85,1325.99,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,outpatient,,,1367.00000,1298.65000,The Alliance,PPO Network,,1135.98,,,,,,,520.92,1325.99,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,inpatient,,,1426.00000,1354.70000,The Alliance,PPO Network,,1185.01,,,,,,,784.30,1383.22,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,outpatient,,,1426.00000,1354.70000,The Alliance,PPO Network,,1185.01,,,,,,,713.00,3388.98,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,inpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,102.30,180.42,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,PPO Network,,154.57,,,,,,,93.00,207.54,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,81.00,157.14,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,inpatient,,,1130.25000,1073.74000,The Alliance,PPO Network,,939.24,,,,,,,621.64,1096.34,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,outpatient,,,1130.25000,1073.74000,The Alliance,PPO Network,,939.24,,,,,,,565.12,1671.62,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,inpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,10.45,18.43,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,PPO Network,,15.79,,,,,,,9.50,18.43,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,inpatient,,,693.00000,658.35000,The Alliance,PPO Network,,575.88,,,,,,,381.15,672.21,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,outpatient,,,693.00000,658.35000,The Alliance,PPO Network,,575.88,,,,,,,283.85,672.21,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,114.50,1011.64,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,325.05,573.27,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,295.50,1692.33,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,inpatient,,,739.00000,702.05000,The Alliance,PPO Network,,614.11,,,,,,,406.45,716.83,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,outpatient,,,739.00000,702.05000,The Alliance,PPO Network,,614.11,,,,,,,369.50,2989.39,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,108.90,192.06,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,99.00,416.79,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,inpatient,,,765.00000,726.75000,The Alliance,PPO Network,,635.72,,,,,,,420.75,742.05,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,outpatient,,,765.00000,726.75000,The Alliance,PPO Network,,635.72,,,,,,,227.78,742.05,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,inpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,187.00,329.80,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,PPO Network,,282.54,,,,,,,170.00,417.31,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,inpatient,,,982.00000,932.90000,The Alliance,PPO Network,,816.04,,,,,,,540.10,952.54,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,outpatient,,,982.00000,932.90000,The Alliance,PPO Network,,816.04,,,,,,,491.00,952.54,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,201.85,355.99,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,183.50,645.77,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,147.50,346.44,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,inpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,97.90,172.66,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,PPO Network,,147.92,,,,,,,89.00,172.66,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,inpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,128.70,226.98,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,PPO Network,,194.45,,,,,,,117.00,417.31,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,inpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.90,17.46,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,PPO Network,,14.96,,,,,,,9.00,62.04,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,196.35,346.29,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,178.50,346.29,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,inpatient,,,931.00000,884.45000,The Alliance,PPO Network,,773.66,,,,,,,512.05,903.07,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,outpatient,,,931.00000,884.45000,The Alliance,PPO Network,,773.66,,,,,,,465.50,2864.41,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,21.00,40.74,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,inpatient,,,2601.00000,2470.95000,The Alliance,PPO Network,,2161.43,,,,,,,1430.55,2522.97,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,outpatient,,,2601.00000,2470.95000,The Alliance,PPO Network,,2161.43,,,,,,,1300.50,2522.97,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,inpatient,,,741.00000,703.95000,The Alliance,PPO Network,,615.77,,,,,,,407.55,718.77,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,outpatient,,,741.00000,703.95000,The Alliance,PPO Network,,615.77,,,,,,,370.50,2139.65,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,inpatient,,,377.00000,358.15000,The Alliance,PPO Network,,313.29,,,,,,,207.35,365.69,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,outpatient,,,377.00000,358.15000,The Alliance,PPO Network,,313.29,,,,,,,188.50,531.90,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,57.50,111.55,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,31.04,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,33.00,64.02,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,21.45,37.83,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,19.50,207.54,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,The Alliance,PPO Network,TC,3060.57,,,,,,,2025.65,3572.51,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,PPO Network,TC,3060.57,,,,,,,1841.50,3572.51,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,96.80,170.72,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,88.00,416.79,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,200.20,353.08,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,182.00,1547.18,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,433.40,764.36,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,394.00,1011.64,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,inpatient,1,EA,9729.00000,9242.55000,The Alliance,PPO Network,,8084.80,,,,,,,5350.95,9437.13,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,outpatient,1,EA,9729.00000,9242.55000,The Alliance,PPO Network,,8084.80,,,,,,,365.89,9437.13,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,inpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,PPO Network,,0.37395,,,,,,,0.22500,1.39,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3562.99,7762.50,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,2850.39,6210.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4354.76,9487.50,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2137.79,4517.77,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,inpatient,,,182.80000,173.66000,The Alliance,PPO Network,90,151.91,,,,,,,100.54,177.32,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,outpatient,,,182.80000,173.66000,The Alliance,PPO Network,90,151.91,,,,,,,16.72,848.80,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,2.25,118.82,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,90,1041.24,,,,,,,689.15,1215.41,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,90,1041.24,,,,,,,119.20,6026.72,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,56.40,1714.64,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,inpatient,1,EA,26.02000,24.72000,The Alliance,PPO Network,,21.62,,,,,,,14.31,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,outpatient,1,EA,26.02000,24.72000,The Alliance,PPO Network,,21.62,,,,,,,13.01,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,inpatient,1,EA,6233.30000,5921.63000,The Alliance,PPO Network,,5179.87,,,,,,,3428.32,6046.30,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,outpatient,1,EA,6233.30000,5921.63000,The Alliance,PPO Network,,5179.87,,,,,,,155.42,6046.30,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3562.99,7762.50,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7.48000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,3.67,7.26,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7.48000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,3.43,7.48,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,124.85,220.19,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,,188.64,,,,,,,113.50,254.03,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,The Alliance,PPO Network,GP,50.86,,,,,,,33.66,59.36,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,PPO Network,GP,50.86,,,,,,,30.60,264.00,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,The Alliance,PPO Network,GP,33.57,,,,,,,22.22,39.19,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,PPO Network,GP,33.57,,,,,,,20.20,264.00,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,inpatient,1,mL,18.80000,17.86000,The Alliance,PPO Network,,15.62,,,,,,,10.34,18.24,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,outpatient,1,mL,18.80000,17.86000,The Alliance,PPO Network,,15.62,,,,,,,9.40,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,inpatient,1,mL,23.51000,22.33000,The Alliance,PPO Network,,19.54,,,,,,,12.93,22.80,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,outpatient,1,mL,23.51000,22.33000,The Alliance,PPO Network,,19.54,,,,,,,11.76,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,inpatient,1,mL,7.29000,6.93000,The Alliance,PPO Network,,6.06,,,,,,,4.01,7.07,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,outpatient,1,mL,7.29000,6.93000,The Alliance,PPO Network,,6.06,,,,,,,3.65,25.89,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,inpatient,1,mL,451.78000,429.19000,The Alliance,PPO Network,,375.43,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,PPO Network,,375.43,,,,,,,28.85,438.23,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,1256.40,5253.52,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,inpatient,,,8064.00000,7660.80000,The Alliance,PPO Network,,6701.18,,,,,,,4435.20,7822.08,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,outpatient,,,8064.00000,7660.80000,The Alliance,PPO Network,,6701.18,,,,,,,1256.40,7822.08,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,PPO Network,,464.53,,,,,,,307.45,542.23,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,PPO Network,,464.53,,,,,,,279.50,697.17,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,The Alliance,PPO Network,TC,1987.75,,,,,,,1315.60,2320.24,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,PPO Network,TC,1987.75,,,,,,,979.11,2320.24,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.68000,47.20000,The Alliance,PPO Network,,41.28,,,,,,,24.34,48.19,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.68000,47.20000,The Alliance,PPO Network,,41.28,,,,,,,22.80,49.68,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,The Alliance,PPO Network,,13379.10,,,,,,,8855.00,15617.00,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,PPO Network,,13379.10,,,,,,,966.05,15617.00,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,717.75,1265.85,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,126.07,6798.73,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,PPO Network,,3726.20,,,,,,,148.57,4349.48,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,inpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,PPO Network,,7147.43,,,,,,,503.83,8342.97,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,inpatient,1,mL,267.19000,253.83000,The Alliance,PPO Network,,222.03,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,PPO Network,,222.03,,,,,,,31.18,259.17,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,308.32,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,PPO Network,,1526.96,,,,,,,843.41,1837.50,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1046.52,2280.00,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,139.65,276.45,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,285.00000,270.75000,The Alliance,PPO Network,,236.84,,,,,,,130.81,285.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,The Alliance,PPO Network,TC,755.38,,,,,,,499.95,881.73,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,PPO Network,TC,755.38,,,,,,,359.37,881.73,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,260.25,567.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,inpatient,1,EA,11.13000,10.57000,The Alliance,PPO Network,,9.25,,,,,,,6.12,10.80,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,outpatient,1,EA,11.13000,10.57000,The Alliance,PPO Network,,9.25,,,,,,,5.57,10.80,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,39.20,77.60,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,36.72,80.00,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,inpatient,,,4020.00000,3819.00000,The Alliance,PPO Network,TC,3340.62,,,,,,,2211.00,3899.40,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,outpatient,,,4020.00000,3819.00000,The Alliance,PPO Network,TC,3340.62,,,,,,,2010.00,3899.40,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,The Alliance,PPO Network,TC,2586.07,,,,,,,1711.60,3018.64,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,PPO Network,TC,2586.07,,,,,,,1334.13,14413.40,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,5271.00,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.23000,103.77000,The Alliance,PPO Network,,90.77,,,,,,,60.08,105.95,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.23000,103.77000,The Alliance,PPO Network,,90.77,,,,,,,51.64,105.95,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.92000,100.62000,The Alliance,PPO Network,,88.02,,,,,,,58.26,102.74,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.92000,100.62000,The Alliance,PPO Network,,88.02,,,,,,,51.64,102.74,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,The Alliance,PPO Network,,63.36,,,,,,,41.93,73.95,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,PPO Network,,63.36,,,,,,,38.12,73.95,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,The Alliance,PPO Network,,61.51,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,PPO Network,,61.51,,,,,,,37.01,71.80,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.22000,103.76000,The Alliance,PPO Network,,90.76,,,,,,,60.07,105.94,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.22000,103.76000,The Alliance,PPO Network,,90.76,,,,,,,51.64,105.94,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,The Alliance,PPO Network,,61.51,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,PPO Network,,61.51,,,,,,,37.01,71.80,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,48.19,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,PPO Network,TC,3781.05,,,,,,,2150.56,7180.14,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,73.93000,70.23000,The Alliance,PPO Network,,61.44,,,,,,,40.66,71.71,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,73.93000,70.23000,The Alliance,PPO Network,,61.44,,,,,,,36.97,71.71,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,46.75,82.45,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,85.00000,80.75000,The Alliance,PPO Network,,70.64,,,,,,,42.50,82.45,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,568.00000,539.60000,The Alliance,PPO Network,,472.01,,,,,,,312.40,550.96,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,568.00000,539.60000,The Alliance,PPO Network,,472.01,,,,,,,9.09,550.96,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,28.50,55.29,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,124.30,219.22,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,113.00,219.22,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,inpatient,,,19.50000,18.52000,The Alliance,PPO Network,,16.20,,,,,,,10.72,18.91,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,outpatient,,,19.50000,18.52000,The Alliance,PPO Network,,16.20,,,,,,,2.83,18.91,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,inpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,11.00,19.40,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,10.00,19.40,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,The Alliance,PPO Network,TC,2310.18,,,,,,,1529.00,2696.60,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,PPO Network,TC,2310.18,,,,,,,1390.00,2696.60,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,inpatient,,,40.42000,38.40000,The Alliance,PPO Network,,33.59,,,,,,,22.23,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,outpatient,,,40.42000,38.40000,The Alliance,PPO Network,,33.59,,,,,,,20.21,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,inpatient,,,57.77000,54.88000,The Alliance,PPO Network,,48.01,,,,,,,31.77,56.04,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,outpatient,,,57.77000,54.88000,The Alliance,PPO Network,,48.01,,,,,,,28.89,56.04,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,inpatient,,,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,1.38,2.43,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,outpatient,,,2.51000,2.38000,The Alliance,PPO Network,,2.09,,,,,,,0.37000,2.43,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,548.00,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,inpatient,,,189.20000,179.74000,The Alliance,PPO Network,TC,157.23,,,,,,,104.06,183.52,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,outpatient,,,189.20000,179.74000,The Alliance,PPO Network,TC,157.23,,,,,,,94.60,183.52,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,PPO Network,TC,462.87,,,,,,,306.35,540.29,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,PPO Network,TC,462.87,,,,,,,278.50,5271.00,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,inpatient,,,1070.00000,1016.50000,The Alliance,PPO Network,,889.17,,,,,,,588.50,1037.90,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,outpatient,,,1070.00000,1016.50000,The Alliance,PPO Network,,889.17,,,,,,,535.00,3823.86,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,4.25000,4.04000,The Alliance,PPO Network,,3.53,,,,,,,2.34,4.12,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,4.25000,4.04000,The Alliance,PPO Network,,3.53,,,,,,,2.12,4.12,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,inpatient,,,1846.00000,1753.70000,The Alliance,PPO Network,,1534.03,,,,,,,1015.30,1790.62,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,outpatient,,,1846.00000,1753.70000,The Alliance,PPO Network,,1534.03,,,,,,,923.00,1790.62,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,250.00000,237.50000,The Alliance,PPO Network,,207.75,,,,,,,137.50,242.50,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,250.00000,237.50000,The Alliance,PPO Network,,207.75,,,,,,,125.00,242.50,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,264.00,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,57.75,101.85,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,,87.25,,,,,,,52.50,264.00,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1067.00000,1013.65000,The Alliance,PPO Network,,886.68,,,,,,,586.85,1034.99,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1067.00000,1013.65000,The Alliance,PPO Network,,886.68,,,,,,,211.37,1034.99,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,inpatient,,,1300.00000,1235.00000,The Alliance,PPO Network,,1080.30,,,,,,,715.00,1261.00,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,outpatient,,,1300.00000,1235.00000,The Alliance,PPO Network,,1080.30,,,,,,,50.73,7472.50,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,inpatient,,,751.00000,713.45000,The Alliance,PPO Network,TC,624.08,,,,,,,413.05,728.47,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,outpatient,,,751.00000,713.45000,The Alliance,PPO Network,TC,624.08,,,,,,,375.50,728.47,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,84.15,148.41,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,,127.14,,,,,,,76.50,148.41,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,inpatient,,,38.20000,36.29000,The Alliance,PPO Network,,31.74,,,,,,,21.01,37.05,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,outpatient,,,38.20000,36.29000,The Alliance,PPO Network,,31.74,,,,,,,19.10,37.05,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,inpatient,,,157.20000,149.34000,The Alliance,PPO Network,TC,130.63,,,,,,,86.46,152.48,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,outpatient,,,157.20000,149.34000,The Alliance,PPO Network,TC,130.63,,,,,,,78.60,152.48,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,TC,50.69,,,,,,,33.55,59.17,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,TC,50.69,,,,,,,30.50,548.00,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1129.00000,1072.55000,The Alliance,PPO Network,,938.20,,,,,,,553.21,1095.13,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,PPO Network,,938.20,,,,,,,440.69,1095.13,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,,4150.01,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,,4150.01,,,,,,,1272.04,4844.18,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,inpatient,,,957.00000,909.15000,The Alliance,PPO Network,TC,795.27,,,,,,,526.35,928.29,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,outpatient,,,957.00000,909.15000,The Alliance,PPO Network,TC,795.27,,,,,,,384.16,928.29,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,129.50,251.23,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,81.00,325.26,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,61.50,119.31,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,inpatient,,,84.70000,80.47000,The Alliance,PPO Network,,70.39,,,,,,,46.59,82.16,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,outpatient,,,84.70000,80.47000,The Alliance,PPO Network,,70.39,,,,,,,42.35,82.16,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,197.00,382.18,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,inpatient,,,98.00000,93.10000,The Alliance,PPO Network,,81.44,,,,,,,53.90,95.06,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,outpatient,,,98.00000,93.10000,The Alliance,PPO Network,,81.44,,,,,,,49.00,95.06,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,549.28,20181.52,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,inpatient,,,902.00000,856.90000,The Alliance,PPO Network,52,749.56,,,,,,,496.10,874.94,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,PPO Network,52,749.56,,,,,,,257.00,874.94,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,The Alliance,PPO Network,TC,3923.98,,,,,,,2597.10,4580.34,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,PPO Network,TC,3923.98,,,,,,,2288.22,7180.14,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,The Alliance,PPO Network,,431.29,,,,,,,285.45,503.43,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,PPO Network,,431.29,,,,,,,48.58,503.43,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,PPO Network,TC,327.41,,,,,,,197.00,382.18,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,5.87,113.69,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,290.95,513.13,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,173.99,513.13,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,227.15,400.61,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,33.63,400.61,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,200.75,354.05,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,182.50,743.46,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,187.21,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,170.50,300.70,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,155.00,1239.81,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,,264.26,,,,,,,154.77,548.00,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,73.70,129.98,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,67.00,129.98,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,The Alliance,PPO Network,TC,168.69,,,,,,,111.65,196.91,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,PPO Network,TC,168.69,,,,,,,101.50,1035.23,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,111.10,195.94,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,TC,167.86,,,,,,,101.00,548.00,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,TC,1625.44,,,,,,,1075.80,1897.32,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,PPO Network,TC,1625.44,,,,,,,384.16,1897.32,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,The Alliance,PPO Network,TC,853.44,,,,,,,564.85,996.19,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,PPO Network,TC,853.44,,,,,,,513.50,5169.06,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,5115.55,9021.97,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,PPO Network,TC,7729.13,,,,,,,4467.66,9021.97,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,The Alliance,PPO Network,TC,922.41,,,,,,,610.50,1076.70,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,PPO Network,TC,922.41,,,,,,,384.16,1076.70,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,90.60000,86.07000,The Alliance,PPO Network,,75.29,,,,,,,44.39,87.88,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,90.60000,86.07000,The Alliance,PPO Network,,75.29,,,,,,,41.59,90.60,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,248.06,491.06,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,232.37,506.25,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,24.50,48.50,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,22.95,50.00,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,The Alliance,PPO Network,TC,2891.88,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,PPO Network,TC,2891.88,,,,,,,1609.99,3375.60,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,321.56,636.56,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,301.22,656.25,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,23870.00000,22676.50000,The Alliance,PPO Network,,19835.97,,,,,,,11696.30,23153.90,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,23870.00000,22676.50000,The Alliance,PPO Network,,19835.97,,,,,,,10956.33,23870.00,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,PPO Network,,4500.70,,,,,,,2708.00,5253.52,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,inpatient,,,326.80000,310.46000,The Alliance,PPO Network,90,271.57,,,,,,,179.74,317.00,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,outpatient,,,326.80000,310.46000,The Alliance,PPO Network,90,271.57,,,,,,,36.26,1833.46,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,inpatient,,,331.00000,314.45000,The Alliance,PPO Network,90,275.06,,,,,,,182.05,321.07,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,PPO Network,90,275.06,,,,,,,27.54,1290.24,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,PPO Network,TC,514.39,,,,,,,340.45,600.43,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,PPO Network,TC,514.39,,,,,,,309.50,600.43,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,inpatient,,,244.40000,232.18000,The Alliance,PPO Network,90,203.10,,,,,,,134.42,237.07,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,outpatient,,,244.40000,232.18000,The Alliance,PPO Network,90,203.10,,,,,,,14.59,729.98,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,inpatient,,,529.00000,502.55000,The Alliance,PPO Network,90,439.60,,,,,,,290.95,513.13,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,outpatient,,,529.00000,502.55000,The Alliance,PPO Network,90,439.60,,,,,,,12.45,1539.22,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,41.63,73.43,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,6.92,356.54,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,93.50,207.54,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,inpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,51.15,90.21,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,PPO Network,,77.28,,,,,,,46.50,134.64,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,143.55,253.17,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,130.50,308.32,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,inpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,292.60,516.04,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,266.00,645.77,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,75.00,145.50,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,inpatient,,,126.70000,120.36000,The Alliance,PPO Network,TC,105.29,,,,,,,69.69,122.90,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,outpatient,,,126.70000,120.36000,The Alliance,PPO Network,TC,105.29,,,,,,,63.35,122.90,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,95.50,185.27,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,,199.44,,,,,,,132.00,232.80,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,,199.44,,,,,,,120.00,232.80,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,inpatient,,,476.00000,452.20000,The Alliance,PPO Network,,395.56,,,,,,,261.80,461.72,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,PPO Network,,395.56,,,,,,,238.00,723.34,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,95.50,185.27,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,inpatient,1,mL,451.78000,429.19000,The Alliance,PPO Network,,375.43,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,PPO Network,,375.43,,,,,,,28.85,438.23,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,inpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.70,13.58,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,outpatient,,,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.00,31.12,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,inpatient,,,27.00000,25.65000,The Alliance,PPO Network,,22.44,,,,,,,14.85,26.19,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,PPO Network,,22.44,,,,,,,13.50,31.12,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,93.50,264.00,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,inpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,298.65,526.71,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,271.50,979.27,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,inpatient,,,415.00000,394.25000,The Alliance,PPO Network,,344.87,,,,,,,228.25,402.55,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,outpatient,,,415.00000,394.25000,The Alliance,PPO Network,,344.87,,,,,,,149.83,402.55,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,22.50,134.64,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,inpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,125.40,221.16,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,PPO Network,,189.47,,,,,,,114.00,723.34,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,18.15,32.01,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,16.50,32.01,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,317.72,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,99.50,734.90,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,113.85,200.79,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,103.50,308.32,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,inpatient,,,890.00000,845.50000,The Alliance,PPO Network,,739.59,,,,,,,489.50,863.30,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,PPO Network,,739.59,,,,,,,227.78,863.30,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,25.50,49.47,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,23.50,45.59,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,inpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,,1026.29,,,,,,,679.25,1197.95,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,PPO Network,,1026.29,,,,,,,227.78,1197.95,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,116.60,205.64,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,,176.17,,,,,,,106.00,734.90,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,inpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,28.05,49.47,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,PPO Network,,42.38,,,,,,,25.50,49.47,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,inpatient,,,893.00000,848.35000,The Alliance,PPO Network,,742.08,,,,,,,491.15,866.21,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,PPO Network,,742.08,,,,,,,227.78,866.21,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,inpatient,,,467.00000,443.65000,The Alliance,PPO Network,,388.08,,,,,,,256.85,452.99,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,PPO Network,,388.08,,,,,,,233.50,1011.64,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1534.00000,1457.30000,The Alliance,PPO Network,,1274.75,,,,,,,843.70,1487.98,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1534.00000,1457.30000,The Alliance,PPO Network,,1274.75,,,,,,,767.00,2161.00,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,14.00,96.61,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,inpatient,,,330.00000,313.50000,The Alliance,PPO Network,,274.23,,,,,,,181.50,320.10,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,PPO Network,,274.23,,,,,,,165.00,416.79,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,inpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,138.60,244.44,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,PPO Network,,209.41,,,,,,,126.00,734.90,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,inpatient,,,1077.00000,1023.15000,The Alliance,PPO Network,,894.99,,,,,,,592.35,1044.69,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,outpatient,,,1077.00000,1023.15000,The Alliance,PPO Network,,894.99,,,,,,,538.50,1044.69,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,569.80,1004.92,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,PPO Network,,860.92,,,,,,,569.80,5271.00,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,inpatient,,,956.00000,908.20000,The Alliance,PPO Network,,794.44,,,,,,,525.80,927.32,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,outpatient,,,956.00000,908.20000,The Alliance,PPO Network,,794.44,,,,,,,227.78,927.32,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,inpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,203.50,358.90,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,PPO Network,,307.47,,,,,,,185.00,358.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,PPO Network,,252.62,,,,,,,167.20,294.88,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,PPO Network,,252.62,,,,,,,152.00,294.88,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,inpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,319.00,562.60,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,PPO Network,,481.98,,,,,,,283.85,562.60,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,inpatient,,,694.00000,659.30000,The Alliance,PPO Network,,576.71,,,,,,,381.70,673.18,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,outpatient,,,694.00000,659.30000,The Alliance,PPO Network,,576.71,,,,,,,283.85,673.18,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,96.80,170.72,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,88.00,207.54,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,238.70,420.98,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,217.00,420.98,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,114.50,308.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,inpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,195.80,345.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,PPO Network,,295.84,,,,,,,178.00,345.32,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,392.70,692.58,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,PPO Network,,593.33,,,,,,,227.78,692.58,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,inpatient,,,912.00000,866.40000,The Alliance,PPO Network,,757.87,,,,,,,501.60,884.64,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,outpatient,,,912.00000,866.40000,The Alliance,PPO Network,,757.87,,,,,,,227.78,884.64,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,212.85,375.39,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,PPO Network,,321.60,,,,,,,193.50,417.31,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,inpatient,,,236.00000,224.20000,The Alliance,PPO Network,,196.12,,,,,,,129.80,228.92,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,PPO Network,,196.12,,,,,,,118.00,531.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,inpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,147.40,259.96,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,PPO Network,,222.71,,,,,,,134.00,259.96,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,inpatient,,,1431.00000,1359.45000,The Alliance,PPO Network,,1189.16,,,,,,,787.05,1388.07,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,PPO Network,,1189.16,,,,,,,227.78,1388.07,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,inpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,158.95,280.33,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,PPO Network,,240.16,,,,,,,144.50,416.79,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,inpatient,,,965.00000,916.75000,The Alliance,PPO Network,,801.91,,,,,,,530.75,936.05,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,outpatient,,,965.00000,916.75000,The Alliance,PPO Network,,801.91,,,,,,,227.78,936.05,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,114.50,254.03,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,inpatient,,,382.00000,362.90000,The Alliance,PPO Network,,317.44,,,,,,,210.10,370.54,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,outpatient,,,382.00000,362.90000,The Alliance,PPO Network,,317.44,,,,,,,191.00,417.31,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,129.50,308.32,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,HP,191.96,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,HP,191.96,,,,,,,115.50,224.07,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,inpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,12.10,21.34,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,PPO Network,,18.28,,,,,,,11.00,31.12,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,inpatient,,,326.00000,309.70000,The Alliance,PPO Network,,270.91,,,,,,,179.30,316.22,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,outpatient,,,326.00000,309.70000,The Alliance,PPO Network,,270.91,,,,,,,163.00,316.22,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,48.50,94.09,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,inpatient,,,458.00000,435.10000,The Alliance,PPO Network,,380.60,,,,,,,251.90,444.26,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,outpatient,,,458.00000,435.10000,The Alliance,PPO Network,,380.60,,,,,,,229.00,444.26,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,inpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,190.85,336.59,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,PPO Network,,288.36,,,,,,,173.50,336.59,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,inpatient,,,1005.00000,954.75000,The Alliance,PPO Network,,835.15,,,,,,,552.75,974.85,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,PPO Network,,835.15,,,,,,,502.50,974.85,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,inpatient,,,378.00000,359.10000,The Alliance,PPO Network,,314.12,,,,,,,207.90,366.66,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,PPO Network,,314.12,,,,,,,189.00,1231.54,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,inpatient,,,787.00000,747.65000,The Alliance,PPO Network,,654.00,,,,,,,432.85,763.39,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,outpatient,,,787.00000,747.65000,The Alliance,PPO Network,,654.00,,,,,,,393.50,763.39,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,15.50,30.07,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,inpatient,,,37.65000,35.77000,The Alliance,PPO Network,,31.29,,,,,,,20.71,36.52,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,outpatient,,,37.65000,35.77000,The Alliance,PPO Network,,31.29,,,,,,,18.82,242.55,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,inpatient,,,1455.00000,1382.25000,The Alliance,PPO Network,,1209.11,,,,,,,800.25,1411.35,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,outpatient,,,1455.00000,1382.25000,The Alliance,PPO Network,,1209.11,,,,,,,668.09,1411.35,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,734.90,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,inpatient,,,377.50000,358.62000,The Alliance,PPO Network,,313.70,,,,,,,207.62,366.18,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,outpatient,,,377.50000,358.62000,The Alliance,PPO Network,,313.70,,,,,,,188.75,952.28,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,408.37,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,210.50,408.37,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,113.85,200.79,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,,172.02,,,,,,,103.50,254.03,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,57.50,419.70,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,295.90,521.86,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,269.00,521.86,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,87.75000,83.36000,The Alliance,PPO Network,,72.92,,,,,,,48.26,85.12,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,87.75000,83.36000,The Alliance,PPO Network,,72.92,,,,,,,43.88,85.12,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,inpatient,,,304.00000,288.80000,The Alliance,PPO Network,,252.62,,,,,,,167.20,294.88,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,PPO Network,,252.62,,,,,,,152.00,645.77,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,308.32,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,190.30,335.62,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,173.00,417.31,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,330.00,582.00,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,300.00,723.34,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,inpatient,,,719.00000,683.05000,The Alliance,PPO Network,,597.49,,,,,,,395.45,697.43,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,outpatient,,,719.00000,683.05000,The Alliance,PPO Network,,597.49,,,,,,,359.50,825.21,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,PPO Network,,603.31,,,,,,,399.30,704.22,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,PPO Network,,603.31,,,,,,,363.00,825.21,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,inpatient,,,482.00000,457.90000,The Alliance,PPO Network,,400.54,,,,,,,265.10,467.54,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,outpatient,,,482.00000,457.90000,The Alliance,PPO Network,,400.54,,,,,,,241.00,467.54,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,inpatient,,,786.00000,746.70000,The Alliance,PPO Network,,653.17,,,,,,,432.30,762.42,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,outpatient,,,786.00000,746.70000,The Alliance,PPO Network,,653.17,,,,,,,393.00,762.42,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,inpatient,,,217.00000,206.15000,The Alliance,PPO Network,,180.33,,,,,,,119.35,210.49,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,PPO Network,,180.33,,,,,,,108.50,531.90,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,206.25,363.75,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,187.50,363.75,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,inpatient,,,466.00000,442.70000,The Alliance,PPO Network,,387.25,,,,,,,256.30,452.02,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,PPO Network,,387.25,,,,,,,233.00,452.02,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,inpatient,,,423.00000,401.85000,The Alliance,PPO Network,,351.51,,,,,,,232.65,410.31,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,outpatient,,,423.00000,401.85000,The Alliance,PPO Network,,351.51,,,,,,,188.67,410.31,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,inpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,84.70,149.38,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,PPO Network,,127.97,,,,,,,77.00,202.77,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,inpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,72.05,127.07,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,PPO Network,,108.86,,,,,,,65.50,207.54,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,inpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,23.10,40.74,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,PPO Network,,34.90,,,,,,,21.00,417.31,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,HP,151.24,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,HP,151.24,,,,,,,91.00,176.54,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,inpatient,,,139.00000,132.05000,The Alliance,PPO Network,HP,115.51,,,,,,,76.45,134.83,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,PPO Network,HP,115.51,,,,,,,69.50,134.83,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,HP,118.83,,,,,,,78.65,138.71,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,HP,118.83,,,,,,,71.50,138.71,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,HP,151.24,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,HP,151.24,,,,,,,91.00,176.54,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,PPO Network,,598.32,,,,,,,396.00,698.40,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,PPO Network,,598.32,,,,,,,360.00,734.90,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,186.45,328.83,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,169.50,328.83,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,PPO Network,,237.67,,,,,,,157.30,277.42,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,PPO Network,,237.67,,,,,,,143.00,417.31,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,inpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,211.75,373.45,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,184.34,373.45,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,inpatient,,,968.00000,919.60000,The Alliance,PPO Network,,804.41,,,,,,,532.40,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,outpatient,,,968.00000,919.60000,The Alliance,PPO Network,,804.41,,,,,,,384.16,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,inpatient,,,849.00000,806.55000,The Alliance,PPO Network,,705.52,,,,,,,466.95,823.53,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,PPO Network,,705.52,,,,,,,384.16,823.53,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,PPO Network,,538.49,,,,,,,356.40,628.56,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,PPO Network,,538.49,,,,,,,324.00,645.77,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,inpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,248.05,437.47,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,PPO Network,,374.78,,,,,,,225.50,1692.33,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,inpatient,,,315.00000,299.25000,The Alliance,PPO Network,,261.76,,,,,,,173.25,305.55,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,PPO Network,,261.76,,,,,,,157.50,305.55,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,HP,53.18,,,,,,,35.20,62.08,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,HP,53.18,,,,,,,32.00,62.08,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,HP,43.21,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,HP,43.21,,,,,,,26.00,50.44,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,134.20,236.68,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,PPO Network,,202.76,,,,,,,122.00,417.31,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,inpatient,,,652.00000,619.40000,The Alliance,PPO Network,,541.81,,,,,,,358.60,632.44,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,outpatient,,,652.00000,619.40000,The Alliance,PPO Network,,541.81,,,,,,,326.00,639.36,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,105.05,185.27,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,,158.72,,,,,,,95.50,277.40,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,inpatient,,,889.00000,844.55000,The Alliance,PPO Network,,738.76,,,,,,,488.95,862.33,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,outpatient,,,889.00000,844.55000,The Alliance,PPO Network,,738.76,,,,,,,444.50,862.33,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,inpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,497.20,876.88,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,452.00,876.88,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,389.40,686.76,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,354.00,1692.33,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,HP,113.02,,,,,,,74.80,131.92,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,HP,113.02,,,,,,,68.00,131.92,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,inpatient,,,987.00000,937.65000,The Alliance,PPO Network,,820.20,,,,,,,542.85,957.39,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,outpatient,,,987.00000,937.65000,The Alliance,PPO Network,,820.20,,,,,,,493.50,1692.33,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,inpatient,,,639.00000,607.05000,The Alliance,PPO Network,,531.01,,,,,,,351.45,619.83,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,outpatient,,,639.00000,607.05000,The Alliance,PPO Network,,531.01,,,,,,,319.50,1011.64,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,The Alliance,PPO Network,,1523.22,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,The Alliance,PPO Network,,1523.22,,,,,,,916.50,1778.01,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,inpatient,,,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,outpatient,,,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,7.58,25.57,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,65.45,115.43,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,,98.89,,,,,,,59.50,416.79,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,inpatient,,,492.00000,467.40000,The Alliance,PPO Network,,408.85,,,,,,,270.60,477.24,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,outpatient,,,492.00000,467.40000,The Alliance,PPO Network,,408.85,,,,,,,246.00,1011.64,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,HP,49.86,,,,,,,33.00,58.20,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,HP,49.86,,,,,,,30.00,58.20,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,155.65,274.51,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,141.50,417.31,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,242.55,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,HP,43.21,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,HP,43.21,,,,,,,26.00,50.44,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,104.00,417.31,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,183.70,323.98,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,167.00,531.90,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,inpatient,,,198.50000,188.57000,The Alliance,PPO Network,,164.95,,,,,,,109.17,192.54,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,outpatient,,,198.50000,188.57000,The Alliance,PPO Network,,164.95,,,,,,,99.25,645.77,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,inpatient,,,1511.00000,1435.45000,The Alliance,PPO Network,,1255.64,,,,,,,831.05,1465.67,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,outpatient,,,1511.00000,1435.45000,The Alliance,PPO Network,,1255.64,,,,,,,755.50,1910.62,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,inpatient,,,368.00000,349.60000,The Alliance,PPO Network,,305.81,,,,,,,202.40,356.96,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,outpatient,,,368.00000,349.60000,The Alliance,PPO Network,,305.81,,,,,,,184.00,356.96,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,inpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,178.20,314.28,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,162.00,734.90,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,inpatient,,,622.00000,590.90000,The Alliance,PPO Network,,516.88,,,,,,,342.10,603.34,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,outpatient,,,622.00000,590.90000,The Alliance,PPO Network,,516.88,,,,,,,227.78,603.34,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.65450,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,PPO Network,,0.98889,,,,,,,0.59500,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,inpatient,1,EA,6.69000,6.36000,The Alliance,PPO Network,,5.56,,,,,,,3.68,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,outpatient,1,EA,6.69000,6.36000,The Alliance,PPO Network,,5.56,,,,,,,3.35,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.15,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,PPO Network,,1.74,,,,,,,1.04,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,inpatient,1,mL,70300.00000,66785.00000,The Alliance,PPO Network,,58419.30,,,,,,,38665.00,68191.00,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,PPO Network,,58419.30,,,,,,,346.19,68191.00,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,251.25000,238.69000,The Alliance,PPO Network,,208.79,,,,,,,123.11,243.71,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,251.25000,238.69000,The Alliance,PPO Network,,208.79,,,,,,,115.32,251.25,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,PPO Network,,32.14,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.50,9.70,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,PPO Network,,8.31,,,,,,,5.00,9.70,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,5271.00,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,The Alliance,PPO Network,,265.79,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,PPO Network,,265.79,,,,,,,146.81,319.84,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,214.03,423.70,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,200.49,436.80,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,inpatient,1,mL,34526.48000,32800.15000,The Alliance,PPO Network,,28691.50,,,,,,,18989.56,33490.69,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,outpatient,1,mL,34526.48000,32800.15000,The Alliance,PPO Network,,28691.50,,,,,,,141.00,33490.69,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,5.11,9.01,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,PPO Network,,7.72,,,,,,,4.64,9.01,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,inpatient,1,mL,267.19000,253.83000,The Alliance,PPO Network,,222.03,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,PPO Network,,222.03,,,,,,,31.18,259.17,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,The Alliance,PPO Network,,741.67,,,,,,,437.32,865.73,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,PPO Network,,741.67,,,,,,,409.66,892.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,116.86,231.34,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,109.47,238.50,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,TC,3268.32,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,TC,3268.32,,,,,,,1966.50,3815.01,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9780.75000,9291.71000,The Alliance,PPO Network,,8127.80,,,,,,,4792.57,9487.33,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9780.75000,9291.71000,The Alliance,PPO Network,,8127.80,,,,,,,4489.36,9780.75,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,231.49,504.34,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,inpatient,1,EA,7882.93000,7488.79000,The Alliance,PPO Network,,6550.71,,,,,,,4335.61,7646.44,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,outpatient,1,EA,7882.93000,7488.79000,The Alliance,PPO Network,,6550.71,,,,,,,43.25,7646.44,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,1327.58000,1261.20000,The Alliance,PPO Network,,1103.22,,,,,,,730.17,1287.75,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,PPO Network,,1103.22,,,,,,,663.79,1287.75,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,152.81,332.93,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,152.81,332.93,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,152.81,332.93,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,TC,44.04,,,,,,,29.15,51.41,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,TC,44.04,,,,,,,26.50,51.41,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,96.25,169.75,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,51.31,2438.63,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,inpatient,1,EA,29396.04000,27926.24000,The Alliance,PPO Network,,24428.11,,,,,,,16167.82,28514.16,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,outpatient,1,EA,29396.04000,27926.24000,The Alliance,PPO Network,,24428.11,,,,,,,359.09,28514.16,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,inpatient,1,mL,1417.48000,1346.61000,The Alliance,PPO Network,,1177.93,,,,,,,779.61,1374.96,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,outpatient,1,mL,1417.48000,1346.61000,The Alliance,PPO Network,,1177.93,,,,,,,24.13,1374.96,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1383.88,3015.00,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,1002.10,1767.34,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,PPO Network,TC,1514.08,,,,,,,484.28,2161.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,550.80,1200.00,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,TC,93.07,,,,,,,61.60,108.64,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,TC,93.07,,,,,,,42.95,484.28,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,84.28,166.84,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,78.95,172.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,PPO Network,,7884.11,,,,,,,4354.76,9487.50,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,83.60,147.44,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,76.00,264.00,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,The Alliance,PPO Network,TC,8243.52,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,PPO Network,TC,8243.52,,,,,,,484.28,9622.40,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,inpatient,,,456.00000,433.20000,The Alliance,PPO Network,,378.94,,,,,,,250.80,442.32,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,outpatient,,,456.00000,433.20000,The Alliance,PPO Network,,378.94,,,,,,,250.80,5271.00,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,inpatient,1,EA,40006.82000,38006.48000,The Alliance,PPO Network,,33245.67,,,,,,,22003.75,38806.62,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,outpatient,1,EA,40006.82000,38006.48000,The Alliance,PPO Network,,33245.67,,,,,,,2698.05,38806.62,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,inpatient,1,mL,9841.58000,9349.50000,The Alliance,PPO Network,,8178.35,,,,,,,5412.87,9546.33,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,outpatient,1,mL,9841.58000,9349.50000,The Alliance,PPO Network,,8178.35,,,,,,,73.55,9546.33,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,inpatient,1,GM,2.34000,2.23000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,outpatient,1,GM,2.34000,2.23000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,inpatient,1,mL,271.28000,257.72000,The Alliance,PPO Network,,225.43,,,,,,,149.20,263.14,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,outpatient,1,mL,271.28000,257.72000,The Alliance,PPO Network,,225.43,,,,,,,135.64,263.14,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,TC,2107.42,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,PPO Network,TC,2107.42,,,,,,,990.94,2459.92,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.38000,179.91000,The Alliance,PPO Network,,157.37,,,,,,,92.80,183.70,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.38000,179.91000,The Alliance,PPO Network,,157.37,,,,,,,86.93,189.38,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,inpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.88,3.31,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,PPO Network,,2.83,,,,,,,1.71,3.31,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,TC,12009.61,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,TC,12009.61,,,,,,,4549.00,14018.44,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.63085,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.63085,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.40920,2.21,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,2.79,7.08,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.40920,0.97000,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,26.95,47.53,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,49.00000,46.55000,The Alliance,PPO Network,,40.72,,,,,,,22.80,47.53,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.40920,0.97000,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,PPO Network,,6.07,,,,,,,2.79,7.08,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,0.40920,2.21,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2137.79,4657.50,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,PPO Network,,4.28,,,,,,,2.58,5.00,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,907.50000,862.12000,The Alliance,PPO Network,,754.13,,,,,,,444.68,880.27,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,907.50000,862.12000,The Alliance,PPO Network,,754.13,,,,,,,416.54,907.50,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,inpatient,,,1334.00000,1267.30000,The Alliance,PPO Network,,1108.55,,,,,,,733.70,1293.98,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,outpatient,,,1334.00000,1267.30000,The Alliance,PPO Network,,1108.55,,,,,,,667.00,1692.33,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,inpatient,,,474.00000,450.30000,The Alliance,PPO Network,,393.89,,,,,,,260.70,459.78,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,PPO Network,,393.89,,,,,,,237.00,1801.19,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,inpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.37950,0.66930,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,PPO Network,,0.57339,,,,,,,0.34500,0.66930,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,inpatient,,,396.80000,376.96000,The Alliance,PPO Network,,329.74,,,,,,,218.24,384.90,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,PPO Network,,329.74,,,,,,,23.25,384.90,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2797.00000,2657.15000,The Alliance,PPO Network,90,2324.31,,,,,,,1538.35,2713.09,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2797.00000,2657.15000,The Alliance,PPO Network,90,2324.31,,,,,,,266.02,13462.44,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,inpatient,,,177.50000,168.62000,The Alliance,PPO Network,90,147.50,,,,,,,97.62,172.18,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,outpatient,,,177.50000,168.62000,The Alliance,PPO Network,90,147.50,,,,,,,11.91,594.19,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,78.05,137.64,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,70.95,1137.41,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,inpatient,,,147.90000,140.50000,The Alliance,PPO Network,90,122.90,,,,,,,81.34,143.46,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,outpatient,,,147.90000,140.50000,The Alliance,PPO Network,90,122.90,,,,,,,73.95,1137.41,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,inpatient,,,166.60000,158.27000,The Alliance,PPO Network,90,138.44,,,,,,,91.63,161.60,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,PPO Network,90,138.44,,,,,,,11.91,594.19,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,90,184.48,,,,,,,122.10,215.34,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,90,184.48,,,,,,,63.40,3038.81,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,The Alliance,PPO Network,TC,1778.34,,,,,,,1177.00,2075.80,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,PPO Network,TC,1778.34,,,,,,,1070.00,2075.80,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,90,93.90,,,,,,,62.15,109.61,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,90,93.90,,,,,,,56.50,788.42,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,inpatient,,,65.50000,62.22000,The Alliance,PPO Network,90,54.43,,,,,,,36.02,63.53,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,PPO Network,90,54.43,,,,,,,4.57,373.51,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,inpatient,,,130.00000,123.50000,The Alliance,PPO Network,90,108.03,,,,,,,71.50,126.10,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,PPO Network,90,108.03,,,,,,,8.13,407.44,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,The Alliance,PPO Network,TC,693.88,,,,,,,459.25,809.95,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,PPO Network,TC,693.88,,,,,,,417.50,3942.79,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,7.65,25.57,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,inpatient,1,mL,33.71000,32.03000,The Alliance,PPO Network,,28.01,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,outpatient,1,mL,33.71000,32.03000,The Alliance,PPO Network,,28.01,,,,,,,16.86,83.21,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,281.28000,267.22000,The Alliance,PPO Network,,233.74,,,,,,,154.70,272.84,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,281.28000,267.22000,The Alliance,PPO Network,,233.74,,,,,,,140.64,272.84,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,137.46000,130.59000,The Alliance,PPO Network,,114.23,,,,,,,75.60,133.34,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,137.46000,130.59000,The Alliance,PPO Network,,114.23,,,,,,,68.73,192.52,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,79.20,139.68,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,PPO Network,,119.66,,,,,,,72.00,260.45,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,148.24,261.44,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,101.38,261.44,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,inpatient,,,45.60000,43.32000,The Alliance,PPO Network,90,37.89,,,,,,,25.08,44.23,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,PPO Network,90,37.89,,,,,,,5.17,254.68,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,inpatient,,,62.40000,59.28000,The Alliance,PPO Network,90,51.85,,,,,,,34.32,60.53,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,outpatient,,,62.40000,59.28000,The Alliance,PPO Network,90,51.85,,,,,,,6.92,356.54,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,inpatient,,,45.20000,42.94000,The Alliance,PPO Network,90,37.56,,,,,,,24.86,43.84,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,outpatient,,,45.20000,42.94000,The Alliance,PPO Network,90,37.56,,,,,,,5.02,254.68,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,inpatient,,,44.20000,41.99000,The Alliance,PPO Network,90,36.73,,,,,,,24.31,42.87,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,outpatient,,,44.20000,41.99000,The Alliance,PPO Network,90,36.73,,,,,,,4.90,254.68,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,inpatient,,,2.00000,1.90000,The Alliance,PPO Network,90,1.66,,,,,,,1.10,1.94,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,outpatient,,,2.00000,1.90000,The Alliance,PPO Network,90,1.66,,,,,,,1.00,1.94,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,The Alliance,PPO Network,90,295.50,,,,,,,195.58,344.93,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,PPO Network,90,295.50,,,,,,,12.45,1539.22,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,The Alliance,PPO Network,90,295.50,,,,,,,195.58,344.93,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,PPO Network,90,295.50,,,,,,,12.45,1539.22,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,inpatient,,,112.20000,106.59000,The Alliance,PPO Network,90,93.24,,,,,,,61.71,108.83,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,outpatient,,,112.20000,106.59000,The Alliance,PPO Network,90,93.24,,,,,,,4.90,373.51,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,inpatient,,,383.70000,364.52000,The Alliance,PPO Network,90,318.85,,,,,,,211.03,372.19,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,outpatient,,,383.70000,364.52000,The Alliance,PPO Network,90,318.85,,,,,,,127.80,6468.09,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,inpatient,,,6329.00000,6012.55000,The Alliance,PPO Network,90,5259.40,,,,,,,3480.95,6139.13,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,outpatient,,,6329.00000,6012.55000,The Alliance,PPO Network,90,5259.40,,,,,,,2520.00,6139.13,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,inpatient,,,297.00000,282.15000,The Alliance,PPO Network,,246.81,,,,,,,163.35,288.09,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,outpatient,,,297.00000,282.15000,The Alliance,PPO Network,,246.81,,,,,,,148.50,2139.65,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,The Alliance,PPO Network,TC,1556.46,,,,,,,1030.15,1816.81,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,PPO Network,TC,1556.46,,,,,,,936.50,1820.00,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,281.05,495.67,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,PPO Network,,424.64,,,,,,,122.40,495.67,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,inpatient,,,287.00000,272.65000,The Alliance,PPO Network,,238.50,,,,,,,157.85,278.39,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,PPO Network,,238.50,,,,,,,143.50,417.31,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,inpatient,,,91836.00000,87244.20000,The Alliance,PPO Network,,76315.72,,,,,,,50509.80,89080.92,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,outpatient,,,91836.00000,87244.20000,The Alliance,PPO Network,,76315.72,,,,,,,45918.00,93760.51,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,inpatient,,,969.00000,920.55000,The Alliance,PPO Network,TC,805.24,,,,,,,532.95,939.93,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,outpatient,,,969.00000,920.55000,The Alliance,PPO Network,TC,805.24,,,,,,,484.50,5445.97,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,The Alliance,PPO Network,,7771.39,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,PPO Network,,7771.39,,,,,,,4292.50,9351.85,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,449.25,978.75,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,43.52000,41.34000,The Alliance,PPO Network,,36.17,,,,,,,21.32,42.21,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,43.52000,41.34000,The Alliance,PPO Network,,36.17,,,,,,,19.98,43.52,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,inpatient,1,GM,9.60000,9.12000,The Alliance,PPO Network,,7.98,,,,,,,5.28,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,outpatient,1,GM,9.60000,9.12000,The Alliance,PPO Network,,7.98,,,,,,,4.80,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,inpatient,1,GM,6.88000,6.54000,The Alliance,PPO Network,,5.72,,,,,,,3.78,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,outpatient,1,GM,6.88000,6.54000,The Alliance,PPO Network,,5.72,,,,,,,3.44,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,inpatient,1,GM,9.67000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,outpatient,1,GM,9.67000,9.19000,The Alliance,PPO Network,,8.04,,,,,,,4.83,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,inpatient,1,GM,9.68000,9.20000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.39,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,outpatient,1,GM,9.68000,9.20000,The Alliance,PPO Network,,8.04,,,,,,,4.84,9.39,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,inpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,34.76,61.30,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,PPO Network,,52.52,,,,,,,1.28,61.30,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4936.75,9772.75,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4624.43,10075.00,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,inpatient,,,135.60000,128.82000,The Alliance,PPO Network,90,112.68,,,,,,,74.58,131.53,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,outpatient,,,135.60000,128.82000,The Alliance,PPO Network,90,112.68,,,,,,,12.40,628.12,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,inpatient,,,629.80000,598.31000,The Alliance,PPO Network,90,523.36,,,,,,,346.39,610.91,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,outpatient,,,629.80000,598.31000,The Alliance,PPO Network,90,523.36,,,,,,,20.36,1120.45,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,inpatient,,,223.90000,212.70000,The Alliance,PPO Network,90,186.06,,,,,,,123.14,217.18,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,outpatient,,,223.90000,212.70000,The Alliance,PPO Network,90,186.06,,,,,,,8.37,373.51,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,3.24,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,24.89,1137.41,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,563.00000,534.85000,The Alliance,PPO Network,,467.85,,,,,,,309.65,546.11,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,563.00000,534.85000,The Alliance,PPO Network,,467.85,,,,,,,158.39,546.11,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,TC,3275.80,,,,,,,2168.10,3823.74,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,PPO Network,TC,3275.80,,,,,,,356.27,17311.25,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,inpatient,,,9708.00000,9222.60000,The Alliance,PPO Network,TC,8067.35,,,,,,,5339.40,9416.76,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,outpatient,,,9708.00000,9222.60000,The Alliance,PPO Network,TC,8067.35,,,,,,,4854.00,17574.00,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,inpatient,,,10317.00000,9801.15000,The Alliance,PPO Network,TC,8573.43,,,,,,,5674.35,10007.49,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,outpatient,,,10317.00000,9801.15000,The Alliance,PPO Network,TC,8573.43,,,,,,,5158.50,17574.00,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,987.13000,937.77000,The Alliance,PPO Network,,820.31,,,,,,,542.92,957.52,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,987.13000,937.77000,The Alliance,PPO Network,,820.31,,,,,,,240.68,957.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,224.25000,213.04000,The Alliance,PPO Network,,186.35,,,,,,,123.34,217.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,224.25000,213.04000,The Alliance,PPO Network,,186.35,,,,,,,77.18,217.52,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1186.00000,1126.70000,The Alliance,PPO Network,,985.57,,,,,,,652.30,1150.42,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1186.00000,1126.70000,The Alliance,PPO Network,,985.57,,,,,,,158.39,1150.42,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,PPO Network,TC,603.31,,,,,,,399.30,704.22,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,PPO Network,TC,603.31,,,,,,,363.00,704.22,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,inpatient,,,8822.00000,8380.90000,The Alliance,PPO Network,TC,7331.08,,,,,,,4852.10,8557.34,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,outpatient,,,8822.00000,8380.90000,The Alliance,PPO Network,TC,7331.08,,,,,,,4411.00,17574.00,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,32.00,62.08,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,128.00000,121.60000,The Alliance,PPO Network,,106.37,,,,,,,70.40,124.16,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,128.00000,121.60000,The Alliance,PPO Network,,106.37,,,,,,,64.00,124.16,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,The Alliance,PPO Network,,795.27,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,PPO Network,,795.27,,,,,,,478.50,1267.58,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,The Alliance,PPO Network,TC,2785.51,,,,,,,1843.60,3251.44,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,PPO Network,TC,2785.51,,,,,,,1676.00,7180.14,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,62.50,121.25,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,2302.85,4061.39,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,PPO Network,TC,3479.40,,,,,,,361.82,17311.25,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,The Alliance,PPO Network,TC,785.29,,,,,,,519.75,916.65,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,PPO Network,TC,785.29,,,,,,,383.91,8543.92,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,TC,991.38,,,,,,,656.15,1157.21,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,TC,991.38,,,,,,,404.21,17311.25,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,98.24000,93.33000,The Alliance,PPO Network,,81.64,,,,,,,54.03,95.29,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,98.24000,93.33000,The Alliance,PPO Network,,81.64,,,,,,,49.12,95.29,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,288.75,509.25,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.68,509.25,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,112.49000,106.87000,The Alliance,PPO Network,,93.48,,,,,,,61.87,109.12,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,112.49000,106.87000,The Alliance,PPO Network,,93.48,,,,,,,51.64,109.12,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,412.50,727.50,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,240.68,727.50,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,504.90,890.46,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,240.68,890.46,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,241.88000,229.79000,The Alliance,PPO Network,,201.00,,,,,,,133.03,234.62,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,241.88000,229.79000,The Alliance,PPO Network,,201.00,,,,,,,51.64,234.62,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,137.16,241.90,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,51.64,241.90,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,The Alliance,PPO Network,,63.36,,,,,,,41.93,73.95,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,PPO Network,,63.36,,,,,,,38.12,73.95,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,684.00000,649.80000,The Alliance,PPO Network,,568.40,,,,,,,376.20,663.48,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,684.00000,649.80000,The Alliance,PPO Network,,568.40,,,,,,,240.68,663.48,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,125.49000,119.22000,The Alliance,PPO Network,,104.28,,,,,,,69.02,121.73,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,125.49000,119.22000,The Alliance,PPO Network,,104.28,,,,,,,51.64,121.73,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,325.05,573.27,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,240.68,573.27,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.93000,100.63000,The Alliance,PPO Network,,88.03,,,,,,,58.26,102.75,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.93000,100.63000,The Alliance,PPO Network,,88.03,,,,,,,51.64,102.75,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,115.05000,109.30000,The Alliance,PPO Network,,95.61,,,,,,,63.28,111.60,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,115.05000,109.30000,The Alliance,PPO Network,,95.61,,,,,,,51.64,111.60,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,123.23000,117.07000,The Alliance,PPO Network,,102.40,,,,,,,67.78,119.53,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,123.23000,117.07000,The Alliance,PPO Network,,102.40,,,,,,,51.64,119.53,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,PPO Network,,88.07,,,,,,,51.64,102.80,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,inpatient,,,757.00000,719.15000,The Alliance,PPO Network,,629.07,,,,,,,416.35,734.29,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,outpatient,,,757.00000,719.15000,The Alliance,PPO Network,,629.07,,,,,,,416.35,5271.00,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,288.20,508.28,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,TC,435.44,,,,,,,257.95,2630.66,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,inpatient,,,641.00000,608.95000,The Alliance,PPO Network,,532.67,,,,,,,352.55,621.77,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,outpatient,,,641.00000,608.95000,The Alliance,PPO Network,,532.67,,,,,,,352.55,5271.00,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1207.50000,1147.12000,The Alliance,PPO Network,,1003.43,,,,,,,664.12,1171.28,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1207.50000,1147.12000,The Alliance,PPO Network,,1003.43,,,,,,,158.39,1171.28,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,412.50,727.50,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,158.39,727.50,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,288.75,509.25,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,158.39,509.25,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,309.38,545.62,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,158.39,545.62,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,893.55000,848.87000,The Alliance,PPO Network,,742.54,,,,,,,491.45,866.74,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,893.55000,848.87000,The Alliance,PPO Network,,742.54,,,,,,,158.39,866.74,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,219.94000,208.94000,The Alliance,PPO Network,,182.77,,,,,,,120.97,213.34,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,219.94000,208.94000,The Alliance,PPO Network,,182.77,,,,,,,109.97,213.34,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,158.70000,150.76000,The Alliance,PPO Network,,131.88,,,,,,,87.28,153.94,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,158.70000,150.76000,The Alliance,PPO Network,,131.88,,,,,,,79.35,192.52,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,inpatient,,,706.00000,670.70000,The Alliance,PPO Network,TC,586.69,,,,,,,388.30,684.82,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,PPO Network,TC,586.69,,,,,,,353.00,5271.00,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,PPO Network,TC,440.43,,,,,,,291.50,514.10,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,PPO Network,TC,440.43,,,,,,,265.00,514.10,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,PPO Network,TC,287.53,,,,,,,190.30,335.62,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,PPO Network,TC,287.53,,,,,,,173.00,5271.00,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,TC,39.89,,,,,,,26.40,46.56,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,TC,39.89,,,,,,,24.00,46.56,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,PPO Network,TC,342.37,,,,,,,226.60,399.64,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,PPO Network,TC,342.37,,,,,,,127.30,1245.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,The Alliance,PPO Network,TC,1965.32,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,PPO Network,TC,1965.32,,,,,,,979.11,2294.05,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,101.20,178.48,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,92.00,178.48,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,691.90,1220.26,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,PPO Network,TC,1045.40,,,,,,,629.00,1220.26,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,PPO Network,TC,1020.47,,,,,,,614.00,1191.16,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,inpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,TC,978.09,,,,,,,647.35,1141.69,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,PPO Network,TC,978.09,,,,,,,588.50,1141.69,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,inpatient,,,1416.00000,1345.20000,The Alliance,PPO Network,TC,1176.70,,,,,,,778.80,1373.52,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,PPO Network,TC,1176.70,,,,,,,708.00,1373.52,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,inpatient,,,2287.00000,2172.65000,The Alliance,PPO Network,TC,1900.50,,,,,,,1257.85,2218.39,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,PPO Network,TC,1900.50,,,,,,,1143.50,2218.39,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,The Alliance,PPO Network,TC,1652.86,,,,,,,1093.95,1929.33,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,PPO Network,TC,1652.86,,,,,,,994.50,1929.33,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,inpatient,,,170.00000,161.50000,The Alliance,PPO Network,TC,141.27,,,,,,,93.50,164.90,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,PPO Network,TC,141.27,,,,,,,85.00,164.90,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,PPO Network,TC,275.89,,,,,,,182.60,322.04,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,PPO Network,TC,275.89,,,,,,,166.00,322.04,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,TC,176.17,,,,,,,116.60,205.64,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,TC,176.17,,,,,,,106.00,205.64,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,58.13,1226.08,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,58.13,412.25,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,687.00000,652.65000,The Alliance,PPO Network,,570.90,,,,,,,377.85,666.39,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,687.00000,652.65000,The Alliance,PPO Network,,570.90,,,,,,,211.37,666.39,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,211.37,436.50,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,211.37,1226.08,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,58.13,436.50,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,455.21000,432.45000,The Alliance,PPO Network,,378.28,,,,,,,250.37,441.55,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,455.21000,432.45000,The Alliance,PPO Network,,378.28,,,,,,,211.37,441.55,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,424.00000,402.80000,The Alliance,PPO Network,,352.34,,,,,,,233.20,411.28,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,424.00000,402.80000,The Alliance,PPO Network,,352.34,,,,,,,211.37,411.28,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,PPO Network,,353.18,,,,,,,211.37,412.25,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,684.20,1206.68,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,PPO Network,TC,1033.76,,,,,,,584.87,1820.00,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,TC,182.82,,,,,,,121.00,213.40,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,TC,182.82,,,,,,,110.00,213.40,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,537.00000,510.15000,The Alliance,PPO Network,,446.25,,,,,,,295.35,520.89,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,537.00000,510.15000,The Alliance,PPO Network,,446.25,,,,,,,240.68,520.89,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,366.85,646.99,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,667.00000,633.65000,The Alliance,PPO Network,,554.28,,,,,,,240.68,646.99,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,The Alliance,PPO Network,TC,3019.85,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,PPO Network,TC,3019.85,,,,,,,1396.56,3524.98,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,The Alliance,PPO Network,TC,2934.26,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,PPO Network,TC,2934.26,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,The Alliance,PPO Network,52,1435.97,,,,,,,950.40,1676.16,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,PPO Network,52,1435.97,,,,,,,864.00,2032.87,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,1759.50000,1671.52000,The Alliance,PPO Network,,1462.14,,,,,,,967.73,1706.71,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,1759.50000,1671.52000,The Alliance,PPO Network,,1462.14,,,,,,,101.38,1706.71,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,149.25000,141.79000,The Alliance,PPO Network,,124.03,,,,,,,82.09,144.77,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,149.25000,141.79000,The Alliance,PPO Network,,124.03,,,,,,,74.62,144.77,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,615.25000,584.49000,The Alliance,PPO Network,,511.27,,,,,,,338.39,596.79,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,615.25000,584.49000,The Alliance,PPO Network,,511.27,,,,,,,101.38,596.79,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,239.49000,227.52000,The Alliance,PPO Network,,199.02,,,,,,,131.72,232.31,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,239.49000,227.52000,The Alliance,PPO Network,,199.02,,,,,,,101.38,232.31,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,518.75000,492.81000,The Alliance,PPO Network,,431.08,,,,,,,285.31,503.19,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,518.75000,492.81000,The Alliance,PPO Network,,431.08,,,,,,,101.38,503.19,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,inpatient,,,1928.00000,1831.60000,The Alliance,PPO Network,TC,1602.17,,,,,,,1060.40,1870.16,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,outpatient,,,1928.00000,1831.60000,The Alliance,PPO Network,TC,1602.17,,,,,,,909.00,5271.00,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,PPO Network,TC,172.02,,,,,,,103.50,200.79,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,TC,73.13,,,,,,,48.40,85.36,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,TC,73.13,,,,,,,44.00,85.36,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,The Alliance,PPO Network,TC,744.58,,,,,,,492.80,869.12,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,PPO Network,TC,744.58,,,,,,,448.00,4437.28,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,200.75,354.05,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,PPO Network,,303.31,,,,,,,182.50,743.46,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,672.00,1303.68,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,inpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,178.20,314.28,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,PPO Network,,269.24,,,,,,,122.37,314.28,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,433.40,764.36,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,TC,654.83,,,,,,,327.36,764.36,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,396.00,698.40,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,PPO Network,TC,598.32,,,,,,,360.00,4496.60,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,PPO Network,TC,264.26,,,,,,,154.77,548.00,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,PPO Network,TC,742.91,,,,,,,384.16,867.18,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,inpatient,,,731.00000,694.45000,The Alliance,PPO Network,TC,607.46,,,,,,,402.05,709.07,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,outpatient,,,731.00000,694.45000,The Alliance,PPO Network,TC,607.46,,,,,,,365.50,709.07,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,282.15,497.61,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,PPO Network,TC,426.30,,,,,,,234.65,2261.57,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,PPO Network,TC,669.79,,,,,,,443.30,781.82,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,PPO Network,TC,669.79,,,,,,,403.00,5188.83,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,516.38,1125.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,449.25,978.75,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,212.73,421.12,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,199.27,434.14,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1024.14,2231.25,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,inpatient,,,52.60000,49.97000,The Alliance,PPO Network,90,43.71,,,,,,,28.93,51.02,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,PPO Network,90,43.71,,,,,,,26.30,3186.14,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,inpatient,,,52.60000,49.97000,The Alliance,PPO Network,90,43.71,,,,,,,28.93,51.02,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,PPO Network,90,43.71,,,,,,,26.30,1052.52,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,inpatient,,,147.20000,139.84000,The Alliance,PPO Network,90,122.32,,,,,,,80.96,142.78,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,outpatient,,,147.20000,139.84000,The Alliance,PPO Network,90,122.32,,,,,,,17.27,865.84,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,inpatient,,,367.40000,349.03000,The Alliance,PPO Network,90,305.31,,,,,,,202.07,356.38,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,outpatient,,,367.40000,349.03000,The Alliance,PPO Network,90,305.31,,,,,,,16.67,848.80,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,78.05,137.64,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,16.67,848.80,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,inpatient,,,257.00000,244.15000,The Alliance,PPO Network,90,213.57,,,,,,,141.35,249.29,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,PPO Network,90,213.57,,,,,,,25.31,2286.16,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,inpatient,,,45.70000,43.42000,The Alliance,PPO Network,90,37.98,,,,,,,25.14,44.33,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.70000,43.42000,The Alliance,PPO Network,90,37.98,,,,,,,5.35,271.65,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.32,4.08,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,PPO Network,,3.50,,,,,,,2.10,4.08,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,790.00000,750.50000,The Alliance,PPO Network,,656.49,,,,,,,434.50,766.30,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,790.00000,750.50000,The Alliance,PPO Network,,656.49,,,,,,,58.13,766.30,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,22.50,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,43.13000,40.97000,The Alliance,PPO Network,,35.84,,,,,,,23.72,41.84,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,43.13000,40.97000,The Alliance,PPO Network,,35.84,,,,,,,21.57,41.84,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,35.41,120.28,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,inpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,130.90,230.86,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,PPO Network,,197.78,,,,,,,119.00,230.86,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,67.50,130.95,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,78.65,138.71,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,,118.83,,,,,,,71.50,308.32,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,inpatient,,,1527.00000,1450.65000,The Alliance,PPO Network,,1268.94,,,,,,,839.85,1481.19,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,outpatient,,,1527.00000,1450.65000,The Alliance,PPO Network,,1268.94,,,,,,,763.50,3938.79,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,inpatient,,,5740.00000,5453.00000,The Alliance,PPO Network,,4769.94,,,,,,,3157.00,5567.80,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,outpatient,,,5740.00000,5453.00000,The Alliance,PPO Network,,4769.94,,,,,,,2870.00,5646.22,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,220.00,388.00,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,200.00,388.00,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,inpatient,,,592.00000,562.40000,The Alliance,PPO Network,,491.95,,,,,,,325.60,574.24,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,outpatient,,,592.00000,562.40000,The Alliance,PPO Network,,491.95,,,,,,,296.00,1547.18,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,80.00,220.07,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,109.61,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,183.70,323.98,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,167.00,323.98,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,inpatient,,,307.00000,291.65000,The Alliance,PPO Network,,255.12,,,,,,,168.85,297.79,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,PPO Network,,255.12,,,,,,,23.25,297.79,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,inpatient,,,885.00000,840.75000,The Alliance,PPO Network,,735.43,,,,,,,486.75,858.45,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,PPO Network,,735.43,,,,,,,442.50,1820.00,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,22.51,39.70,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,40.93000,38.88000,The Alliance,PPO Network,,34.01,,,,,,,20.46,39.70,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,184.30,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,45.20000,42.94000,The Alliance,PPO Network,,37.56,,,,,,,24.86,43.84,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,45.20000,42.94000,The Alliance,PPO Network,,37.56,,,,,,,22.60,43.84,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,20.00,264.00,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,inpatient,,,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,8.25,14.55,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,PPO Network,,12.46,,,,,,,7.50,264.00,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,inpatient,,,7.00000,6.65000,The Alliance,PPO Network,,5.82,,,,,,,3.85,6.79,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,outpatient,,,7.00000,6.65000,The Alliance,PPO Network,,5.82,,,,,,,3.50,264.00,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,28.29,264.00,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,inpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,227.15,400.61,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,206.50,400.61,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,inpatient,,,369.00000,350.55000,The Alliance,PPO Network,,306.64,,,,,,,202.95,357.93,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,PPO Network,,306.64,,,,,,,184.50,357.93,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,183.00,1692.33,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,180.95,319.13,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,164.50,929.91,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,inpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,68.75,121.25,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,PPO Network,,103.88,,,,,,,62.50,121.25,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,109.61,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,255.20,450.08,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,232.00,450.08,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,382.25,674.15,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,347.50,2139.65,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,7.33,12.93,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,6.67,12.93,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,inpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,104.50,184.30,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,PPO Network,,157.89,,,,,,,95.00,207.54,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,The Alliance,PPO Network,,14.63,,,,,,,9.68,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,PPO Network,,14.63,,,,,,,8.80,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,inpatient,1,EA,19.94000,18.94000,The Alliance,PPO Network,,16.57,,,,,,,10.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,outpatient,1,EA,19.94000,18.94000,The Alliance,PPO Network,,16.57,,,,,,,9.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,inpatient,1,EA,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,11.82,20.85,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,PPO Network,,17.86,,,,,,,10.74,20.85,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,31.21,68.00,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,The Alliance,PPO Network,,7874.94,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,PPO Network,,7874.94,,,,,,,4349.70,9476.46,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,46.20,81.48,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,42.00,81.48,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,inpatient,,,2010.00000,1909.50000,The Alliance,PPO Network,,1670.31,,,,,,,1105.50,1949.70,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,outpatient,,,2010.00000,1909.50000,The Alliance,PPO Network,,1670.31,,,,,,,1005.00,3823.86,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,48.19,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,83.50,909.48,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,inpatient,,,554.00000,526.30000,The Alliance,PPO Network,,460.37,,,,,,,304.70,537.38,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,outpatient,,,554.00000,526.30000,The Alliance,PPO Network,,460.37,,,,,,,277.00,3823.86,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,41.00,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,124.30,219.22,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,113.00,277.40,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,72.60,128.04,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,66.00,128.04,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,inpatient,,,1836.00000,1744.20000,The Alliance,PPO Network,,1525.72,,,,,,,1009.80,1780.92,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,outpatient,,,1836.00000,1744.20000,The Alliance,PPO Network,,1525.72,,,,,,,918.00,3388.98,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,inpatient,,,388.00000,368.60000,The Alliance,PPO Network,,322.43,,,,,,,213.40,376.36,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,outpatient,,,388.00000,368.60000,The Alliance,PPO Network,,322.43,,,,,,,194.00,376.36,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,693.00,1222.20,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,384.16,1692.33,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,inpatient,,,671.00000,637.45000,The Alliance,PPO Network,,557.60,,,,,,,369.05,650.87,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,outpatient,,,671.00000,637.45000,The Alliance,PPO Network,,557.60,,,,,,,335.50,1692.33,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,PPO Network,,97.23,,,,,,,64.35,113.49,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,PPO Network,,97.23,,,,,,,58.50,113.49,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,inpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,221.10,389.94,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,PPO Network,,334.06,,,,,,,201.00,389.94,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,inpatient,,,1672.00000,1588.40000,The Alliance,PPO Network,,1389.43,,,,,,,919.60,1621.84,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,outpatient,,,1672.00000,1588.40000,The Alliance,PPO Network,,1389.43,,,,,,,836.00,2382.20,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,inpatient,,,1238.00000,1176.10000,The Alliance,PPO Network,,1028.78,,,,,,,680.90,1200.86,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,outpatient,,,1238.00000,1176.10000,The Alliance,PPO Network,,1028.78,,,,,,,680.90,7803.00,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,inpatient,,,1131.00000,1074.45000,The Alliance,PPO Network,,939.86,,,,,,,622.05,1097.07,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,outpatient,,,1131.00000,1074.45000,The Alliance,PPO Network,,939.86,,,,,,,565.50,2989.39,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,inpatient,,,482.00000,457.90000,The Alliance,PPO Network,,400.54,,,,,,,265.10,467.54,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,outpatient,,,482.00000,457.90000,The Alliance,PPO Network,,400.54,,,,,,,241.00,1692.33,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,inpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,201.85,355.99,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,PPO Network,,304.98,,,,,,,183.50,3387.36,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,166.65,293.91,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,151.50,1692.33,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,inpatient,,,1582.00000,1502.90000,The Alliance,PPO Network,,1314.64,,,,,,,870.10,1534.54,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,outpatient,,,1582.00000,1502.90000,The Alliance,PPO Network,,1314.64,,,,,,,791.00,2989.39,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,inpatient,,,639.00000,607.05000,The Alliance,PPO Network,,531.01,,,,,,,351.45,619.83,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,outpatient,,,639.00000,607.05000,The Alliance,PPO Network,,531.01,,,,,,,319.50,1801.19,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,inpatient,,,388.00000,368.60000,The Alliance,PPO Network,,322.43,,,,,,,213.40,376.36,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,outpatient,,,388.00000,368.60000,The Alliance,PPO Network,,322.43,,,,,,,194.00,683.50,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,inpatient,,,1510.00000,1434.50000,The Alliance,PPO Network,,1254.81,,,,,,,830.50,1464.70,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,outpatient,,,1510.00000,1434.50000,The Alliance,PPO Network,,1254.81,,,,,,,755.00,1692.33,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,166.65,293.91,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,PPO Network,,251.79,,,,,,,151.50,1692.33,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,inpatient,,,337.00000,320.15000,The Alliance,PPO Network,,280.05,,,,,,,185.35,326.89,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,PPO Network,,280.05,,,,,,,168.50,326.89,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,inpatient,,,862.00000,818.90000,The Alliance,PPO Network,,716.32,,,,,,,474.10,836.14,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,PPO Network,,716.32,,,,,,,379.37,836.14,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,inpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,,1608.82,,,,,,,1064.80,1877.92,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,PPO Network,,1608.82,,,,,,,968.00,2161.00,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,264.55,466.57,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,240.50,723.34,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,,1233.20,,,,,,,816.20,1439.48,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,,1233.20,,,,,,,742.00,2989.39,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,inpatient,,,935.00000,888.25000,The Alliance,PPO Network,,776.99,,,,,,,514.25,906.95,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,outpatient,,,935.00000,888.25000,The Alliance,PPO Network,,776.99,,,,,,,283.85,906.95,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,inpatient,,,485.00000,460.75000,The Alliance,PPO Network,,403.04,,,,,,,266.75,470.45,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,PPO Network,,403.04,,,,,,,242.50,1692.33,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,inpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,257.40,453.96,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,227.78,453.96,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,inpatient,,,557.00000,529.15000,The Alliance,PPO Network,,462.87,,,,,,,306.35,540.29,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,PPO Network,,462.87,,,,,,,278.50,1801.19,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,inpatient,,,1528.00000,1451.60000,The Alliance,PPO Network,,1269.77,,,,,,,840.40,1482.16,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,outpatient,,,1528.00000,1451.60000,The Alliance,PPO Network,,1269.77,,,,,,,764.00,1671.62,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,inpatient,,,858.00000,815.10000,The Alliance,PPO Network,,713.00,,,,,,,471.90,832.26,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,outpatient,,,858.00000,815.10000,The Alliance,PPO Network,,713.00,,,,,,,227.78,832.26,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,inpatient,,,826.00000,784.70000,The Alliance,PPO Network,,686.41,,,,,,,454.30,801.22,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,outpatient,,,826.00000,784.70000,The Alliance,PPO Network,,686.41,,,,,,,227.78,801.22,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,inpatient,,,685.00000,650.75000,The Alliance,PPO Network,,569.24,,,,,,,376.75,664.45,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,outpatient,,,685.00000,650.75000,The Alliance,PPO Network,,569.24,,,,,,,342.50,3602.42,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,inpatient,,,1094.00000,1039.30000,The Alliance,PPO Network,,909.11,,,,,,,601.70,1061.18,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,outpatient,,,1094.00000,1039.30000,The Alliance,PPO Network,,909.11,,,,,,,227.78,1061.18,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,522.50,921.50,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,227.78,921.50,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,inpatient,,,1329.00000,1262.55000,The Alliance,PPO Network,,1104.40,,,,,,,730.95,1289.13,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,outpatient,,,1329.00000,1262.55000,The Alliance,PPO Network,,1104.40,,,,,,,664.50,1671.62,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,inpatient,,,683.00000,648.85000,The Alliance,PPO Network,,567.57,,,,,,,375.65,662.51,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,PPO Network,,567.57,,,,,,,341.50,3602.42,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,inpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,504.90,890.46,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,outpatient,,,918.00000,872.10000,The Alliance,PPO Network,,762.86,,,,,,,459.00,890.46,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,inpatient,,,1879.00000,1785.05000,The Alliance,PPO Network,,1561.45,,,,,,,1033.45,1822.63,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,outpatient,,,1879.00000,1785.05000,The Alliance,PPO Network,,1561.45,,,,,,,939.50,3602.42,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,inpatient,,,754.00000,716.30000,The Alliance,PPO Network,,626.57,,,,,,,414.70,731.38,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,PPO Network,,626.57,,,,,,,377.00,1692.33,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,inpatient,,,1288.00000,1223.60000,The Alliance,PPO Network,,1070.33,,,,,,,708.40,1249.36,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,outpatient,,,1288.00000,1223.60000,The Alliance,PPO Network,,1070.33,,,,,,,644.00,1671.62,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,inpatient,,,588.00000,558.60000,The Alliance,PPO Network,,488.63,,,,,,,323.40,570.36,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,outpatient,,,588.00000,558.60000,The Alliance,PPO Network,,488.63,,,,,,,294.00,1692.33,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,153.45,270.63,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,139.50,1692.33,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,313.50,552.90,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,285.00,3321.00,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,inpatient,,,993.00000,943.35000,The Alliance,PPO Network,,825.18,,,,,,,546.15,963.21,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,PPO Network,,825.18,,,,,,,496.50,3387.36,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,inpatient,,,789.00000,749.55000,The Alliance,PPO Network,,655.66,,,,,,,433.95,765.33,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,outpatient,,,789.00000,749.55000,The Alliance,PPO Network,,655.66,,,,,,,394.50,3602.42,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,inpatient,,,1302.00000,1236.90000,The Alliance,PPO Network,,1081.96,,,,,,,716.10,1262.94,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,PPO Network,,1081.96,,,,,,,651.00,1692.33,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,75.35,132.89,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,68.50,132.89,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,46.20,81.48,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,,69.80,,,,,,,42.00,81.48,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,inpatient,,,842.00000,799.90000,The Alliance,PPO Network,,699.70,,,,,,,463.10,816.74,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,PPO Network,,699.70,,,,,,,421.00,3602.42,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,inpatient,,,1475.00000,1401.25000,The Alliance,PPO Network,,1225.72,,,,,,,811.25,1430.75,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,PPO Network,,1225.72,,,,,,,737.50,1671.62,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,inpatient,,,1269.00000,1205.55000,The Alliance,PPO Network,,1054.54,,,,,,,697.95,1230.93,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,outpatient,,,1269.00000,1205.55000,The Alliance,PPO Network,,1054.54,,,,,,,634.50,1692.33,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,inpatient,,,382.00000,362.90000,The Alliance,PPO Network,,317.44,,,,,,,210.10,370.54,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,outpatient,,,382.00000,362.90000,The Alliance,PPO Network,,317.44,,,,,,,191.00,1692.33,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,inpatient,,,1539.00000,1462.05000,The Alliance,PPO Network,,1278.91,,,,,,,846.45,1492.83,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,outpatient,,,1539.00000,1462.05000,The Alliance,PPO Network,,1278.91,,,,,,,520.92,1492.83,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,inpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,190.30,335.62,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,173.00,1910.62,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,inpatient,,,1118.00000,1062.10000,The Alliance,PPO Network,,929.06,,,,,,,614.90,1084.46,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,outpatient,,,1118.00000,1062.10000,The Alliance,PPO Network,,929.06,,,,,,,559.00,2436.76,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,PPO Network,,440.43,,,,,,,291.50,514.10,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,PPO Network,,440.43,,,,,,,265.00,514.10,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,23.50,96.61,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,inpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,91.85,161.99,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,PPO Network,,138.78,,,,,,,83.50,346.44,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,inpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,125.95,222.13,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,PPO Network,,190.30,,,,,,,114.50,3321.00,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,PPO Network,,666.46,,,,,,,441.10,777.94,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,PPO Network,,666.46,,,,,,,401.00,3602.42,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,inpatient,,,811.00000,770.45000,The Alliance,PPO Network,,673.94,,,,,,,446.05,786.67,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,outpatient,,,811.00000,770.45000,The Alliance,PPO Network,,673.94,,,,,,,405.50,786.67,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,inpatient,,,171.25000,162.69000,The Alliance,PPO Network,,142.31,,,,,,,94.19,166.11,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,outpatient,,,171.25000,162.69000,The Alliance,PPO Network,,142.31,,,,,,,85.62,979.27,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,37.27,197.88,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,inpatient,,,985.00000,935.75000,The Alliance,PPO Network,,818.53,,,,,,,541.75,955.45,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,outpatient,,,985.00000,935.75000,The Alliance,PPO Network,,818.53,,,,,,,492.50,3602.42,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,inpatient,,,405.25000,384.99000,The Alliance,PPO Network,,336.76,,,,,,,222.89,393.09,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,outpatient,,,405.25000,384.99000,The Alliance,PPO Network,,336.76,,,,,,,202.62,979.27,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,inpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,,991.38,,,,,,,656.15,1157.21,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,PPO Network,,991.38,,,,,,,596.50,1910.62,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,inpatient,,,1308.00000,1242.60000,The Alliance,PPO Network,,1086.95,,,,,,,719.40,1268.76,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,outpatient,,,1308.00000,1242.60000,The Alliance,PPO Network,,1086.95,,,,,,,654.00,2139.65,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,inpatient,,,1330.00000,1263.50000,The Alliance,PPO Network,,1105.23,,,,,,,731.50,1290.10,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,outpatient,,,1330.00000,1263.50000,The Alliance,PPO Network,,1105.23,,,,,,,665.00,3602.42,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,89.65,158.11,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,,135.45,,,,,,,81.50,313.26,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,inpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,143.55,253.17,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,PPO Network,,216.89,,,,,,,130.50,1547.18,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,139.70,246.38,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,127.00,417.31,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,inpatient,,,620.00000,589.00000,The Alliance,PPO Network,,515.22,,,,,,,341.00,601.40,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,outpatient,,,620.00000,589.00000,The Alliance,PPO Network,,515.22,,,,,,,310.00,1692.33,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,inpatient,,,857.00000,814.15000,The Alliance,PPO Network,,712.17,,,,,,,471.35,831.29,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,outpatient,,,857.00000,814.15000,The Alliance,PPO Network,,712.17,,,,,,,428.50,1910.62,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,56.65,99.91,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,51.50,313.26,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,inpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,433.40,764.36,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,PPO Network,,654.83,,,,,,,394.00,3287.55,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,inpatient,,,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,367.95,648.93,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,outpatient,,,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,334.50,648.93,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,229.35,404.49,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,208.50,1692.33,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,inpatient,,,948.00000,900.60000,The Alliance,PPO Network,,787.79,,,,,,,521.40,919.56,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,outpatient,,,948.00000,900.60000,The Alliance,PPO Network,,787.79,,,,,,,474.00,3287.55,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,U6,191.96,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,U6,191.96,,,,,,,115.50,224.07,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,37.00,313.26,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,404.25,712.95,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,367.50,2139.65,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,inpatient,,,849.00000,806.55000,The Alliance,PPO Network,,705.52,,,,,,,466.95,823.53,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,PPO Network,,705.52,,,,,,,424.50,2989.39,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,inpatient,,,284.00000,269.80000,The Alliance,PPO Network,,236.00,,,,,,,156.20,275.48,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,PPO Network,,236.00,,,,,,,142.00,308.32,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,inpatient,,,1631.00000,1549.45000,The Alliance,PPO Network,,1355.36,,,,,,,897.05,1582.07,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,outpatient,,,1631.00000,1549.45000,The Alliance,PPO Network,,1355.36,,,,,,,815.50,1671.62,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,inpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,122.10,215.34,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,PPO Network,,184.48,,,,,,,111.00,215.34,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,inpatient,,,1107.00000,1051.65000,The Alliance,PPO Network,,919.92,,,,,,,608.85,1073.79,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,outpatient,,,1107.00000,1051.65000,The Alliance,PPO Network,,919.92,,,,,,,553.50,1692.33,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,inpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,119.90,211.46,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,PPO Network,,181.16,,,,,,,109.00,3321.00,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,57.20,100.88,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,52.00,313.26,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,inpatient,,,379.00000,360.05000,The Alliance,PPO Network,,314.95,,,,,,,208.45,367.63,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,PPO Network,,314.95,,,,,,,189.50,3387.36,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,inpatient,,,459.00000,436.05000,The Alliance,PPO Network,,381.43,,,,,,,252.45,445.23,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,PPO Network,,381.43,,,,,,,229.50,445.23,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,inpatient,,,1281.00000,1216.95000,The Alliance,PPO Network,,1064.51,,,,,,,704.55,1242.57,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,PPO Network,,1064.51,,,,,,,640.50,1692.33,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,717.75,1265.85,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,652.50,1692.33,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,inpatient,,,1432.00000,1360.40000,The Alliance,PPO Network,,1189.99,,,,,,,787.60,1389.04,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,outpatient,,,1432.00000,1360.40000,The Alliance,PPO Network,,1189.99,,,,,,,716.00,1692.33,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,inpatient,,,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,220.00,388.00,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,200.00,3387.36,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,inpatient,,,1509.00000,1433.55000,The Alliance,PPO Network,,1253.98,,,,,,,829.95,1463.73,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,outpatient,,,1509.00000,1433.55000,The Alliance,PPO Network,,1253.98,,,,,,,227.78,1463.73,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,inpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,,1491.64,,,,,,,987.25,1741.15,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,PPO Network,,1491.64,,,,,,,897.50,3602.42,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,inpatient,,,1181.00000,1121.95000,The Alliance,PPO Network,,981.41,,,,,,,649.55,1145.57,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,outpatient,,,1181.00000,1121.95000,The Alliance,PPO Network,,981.41,,,,,,,590.50,2989.39,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,inpatient,,,1020.00000,969.00000,The Alliance,PPO Network,,847.62,,,,,,,561.00,989.40,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,PPO Network,,847.62,,,,,,,510.00,3602.42,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,90.00,264.00,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,inpatient,,,1245.00000,1182.75000,The Alliance,PPO Network,,1034.60,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,outpatient,,,1245.00000,1182.75000,The Alliance,PPO Network,,1034.60,,,,,,,622.50,1692.33,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,inpatient,,,1245.00000,1182.75000,The Alliance,PPO Network,,1034.60,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,outpatient,,,1245.00000,1182.75000,The Alliance,PPO Network,,1034.60,,,,,,,622.50,2989.39,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,inpatient,,,407.00000,386.65000,The Alliance,PPO Network,,338.22,,,,,,,223.85,394.79,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,outpatient,,,407.00000,386.65000,The Alliance,PPO Network,,338.22,,,,,,,203.50,3387.36,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,438.35,773.09,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,398.50,3602.42,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,288.20,508.28,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,,435.44,,,,,,,262.00,1547.18,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,inpatient,,,752.00000,714.40000,The Alliance,PPO Network,,624.91,,,,,,,413.60,729.44,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,outpatient,,,752.00000,714.40000,The Alliance,PPO Network,,624.91,,,,,,,188.67,729.44,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,inpatient,,,966.00000,917.70000,The Alliance,PPO Network,,802.75,,,,,,,531.30,937.02,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,outpatient,,,966.00000,917.70000,The Alliance,PPO Network,,802.75,,,,,,,531.30,4686.00,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,inpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,,1106.06,,,,,,,732.05,1291.07,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,PPO Network,,1106.06,,,,,,,665.50,1692.33,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,PPO Network,,329.08,,,,,,,217.80,384.12,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,PPO Network,,329.08,,,,,,,198.00,3387.36,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,90.00,264.00,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,inpatient,,,1181.00000,1121.95000,The Alliance,PPO Network,,981.41,,,,,,,649.55,1145.57,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,outpatient,,,1181.00000,1121.95000,The Alliance,PPO Network,,981.41,,,,,,,590.50,1671.62,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,inpatient,,,681.00000,646.95000,The Alliance,PPO Network,,565.91,,,,,,,374.55,660.57,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,outpatient,,,681.00000,646.95000,The Alliance,PPO Network,,565.91,,,,,,,340.50,2436.76,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,inpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,340.45,600.43,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,PPO Network,,514.39,,,,,,,309.50,3321.00,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,inpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,148.50,261.90,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,PPO Network,,224.37,,,,,,,135.00,929.91,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,61.05,107.67,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,55.50,107.67,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,inpatient,,,739.00000,702.05000,The Alliance,PPO Network,,614.11,,,,,,,406.45,716.83,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,outpatient,,,739.00000,702.05000,The Alliance,PPO Network,,614.11,,,,,,,369.50,3387.36,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,inpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,151.25,266.75,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,PPO Network,,228.53,,,,,,,137.50,266.75,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,inpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,25.85,45.59,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,PPO Network,,39.06,,,,,,,23.50,264.00,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,93.50,264.00,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,90.00,264.00,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,inpatient,,,1359.00000,1291.05000,The Alliance,PPO Network,,1129.33,,,,,,,747.45,1318.23,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,outpatient,,,1359.00000,1291.05000,The Alliance,PPO Network,,1129.33,,,,,,,679.50,1692.33,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,inpatient,,,1905.00000,1809.75000,The Alliance,PPO Network,,1583.06,,,,,,,1047.75,1847.85,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,outpatient,,,1905.00000,1809.75000,The Alliance,PPO Network,,1583.06,,,,,,,952.50,1910.62,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,26.50,264.00,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,31.04,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,U6,155.40,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,U6,155.40,,,,,,,93.50,264.00,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,500.50,882.70,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,455.00,3387.36,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,243.50,2436.76,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,inpatient,,,1589.00000,1509.55000,The Alliance,PPO Network,,1320.46,,,,,,,873.95,1541.33,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,outpatient,,,1589.00000,1509.55000,The Alliance,PPO Network,,1320.46,,,,,,,794.50,3823.86,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,inpatient,,,1623.00000,1541.85000,The Alliance,PPO Network,,1348.71,,,,,,,892.65,1574.31,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,outpatient,,,1623.00000,1541.85000,The Alliance,PPO Network,,1348.71,,,,,,,811.50,1671.62,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,inpatient,,,437.00000,415.15000,The Alliance,PPO Network,,363.15,,,,,,,240.35,423.89,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,outpatient,,,437.00000,415.15000,The Alliance,PPO Network,,363.15,,,,,,,218.50,3387.36,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,inpatient,,,887.00000,842.65000,The Alliance,PPO Network,,737.10,,,,,,,487.85,860.39,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,outpatient,,,887.00000,842.65000,The Alliance,PPO Network,,737.10,,,,,,,443.50,1671.62,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,inpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,74.25,130.95,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,PPO Network,,112.19,,,,,,,67.50,130.95,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,inpatient,,,577.00000,548.15000,The Alliance,PPO Network,,479.49,,,,,,,317.35,559.69,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,PPO Network,,479.49,,,,,,,288.50,2864.41,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,inpatient,,,627.00000,595.65000,The Alliance,PPO Network,,521.04,,,,,,,344.85,608.19,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,outpatient,,,627.00000,595.65000,The Alliance,PPO Network,,521.04,,,,,,,313.50,2989.39,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,inpatient,,,851.00000,808.45000,The Alliance,PPO Network,,707.18,,,,,,,468.05,825.47,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,outpatient,,,851.00000,808.45000,The Alliance,PPO Network,,707.18,,,,,,,425.50,3387.36,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,inpatient,,,2092.00000,1987.40000,The Alliance,PPO Network,,1738.45,,,,,,,1150.60,2029.24,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,outpatient,,,2092.00000,1987.40000,The Alliance,PPO Network,,1738.45,,,,,,,1046.00,2989.39,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,264.00,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,92.40,162.96,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,84.00,554.21,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,inpatient,,,659.00000,626.05000,The Alliance,PPO Network,,547.63,,,,,,,362.45,639.23,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,outpatient,,,659.00000,626.05000,The Alliance,PPO Network,,547.63,,,,,,,227.78,639.23,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,inpatient,,,1744.00000,1656.80000,The Alliance,PPO Network,,1449.26,,,,,,,959.20,1691.68,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,outpatient,,,1744.00000,1656.80000,The Alliance,PPO Network,,1449.26,,,,,,,872.00,1910.62,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,26.50,264.00,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,inpatient,,,1895.00000,1800.25000,The Alliance,PPO Network,,1574.74,,,,,,,1042.25,1838.15,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,PPO Network,,1574.74,,,,,,,947.50,1910.62,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,The Alliance,PPO Network,,369.80,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,PPO Network,,369.80,,,,,,,222.50,697.17,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,264.00,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,93.50,264.00,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,inpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,276.10,486.94,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,PPO Network,,417.16,,,,,,,251.00,486.94,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,PPO Network,,211.91,,,,,,,140.25,247.35,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,PPO Network,,211.91,,,,,,,127.50,247.35,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,254.03,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,inpatient,,,202.00000,191.90000,The Alliance,PPO Network,,167.86,,,,,,,111.10,195.94,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,PPO Network,,167.86,,,,,,,101.00,308.32,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,inpatient,,,1078.00000,1024.10000,The Alliance,PPO Network,,895.82,,,,,,,592.90,1045.66,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,outpatient,,,1078.00000,1024.10000,The Alliance,PPO Network,,895.82,,,,,,,539.00,6178.88,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,inpatient,,,672.00000,638.40000,The Alliance,PPO Network,,558.43,,,,,,,369.60,651.84,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,PPO Network,,558.43,,,,,,,336.00,651.84,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,63.50,264.00,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,inpatient,,,556.00000,528.20000,The Alliance,PPO Network,,462.04,,,,,,,305.80,539.32,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,PPO Network,,462.04,,,,,,,278.00,1547.18,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,189.75,334.65,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,172.50,334.65,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,7940.90,14004.86,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,4549.00,14004.86,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,160.60,283.24,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,,242.65,,,,,,,146.00,283.24,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,23.00,979.27,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,92.40,162.96,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,84.00,308.32,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,inpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,264.55,466.57,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,outpatient,,,481.00000,456.95000,The Alliance,PPO Network,,399.71,,,,,,,240.50,1801.19,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,129.50,1547.18,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,139.70,246.38,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,PPO Network,,211.07,,,,,,,127.00,246.38,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,inpatient,,,412.00000,391.40000,The Alliance,PPO Network,,342.37,,,,,,,226.60,399.64,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,PPO Network,,342.37,,,,,,,206.00,1801.19,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,inpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,189.75,334.65,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,PPO Network,,286.69,,,,,,,172.50,1011.64,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,inpatient,,,498.00000,473.10000,The Alliance,PPO Network,,413.84,,,,,,,273.90,483.06,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,PPO Network,,413.84,,,,,,,249.00,2139.65,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,inpatient,,,1153.00000,1095.35000,The Alliance,PPO Network,,958.14,,,,,,,634.15,1118.41,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,outpatient,,,1153.00000,1095.35000,The Alliance,PPO Network,,958.14,,,,,,,576.50,2989.39,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,inpatient,,,1321.00000,1254.95000,The Alliance,PPO Network,,1097.75,,,,,,,726.55,1281.37,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,outpatient,,,1321.00000,1254.95000,The Alliance,PPO Network,,1097.75,,,,,,,660.50,1910.62,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,inpatient,,,1152.00000,1094.40000,The Alliance,PPO Network,,957.31,,,,,,,633.60,1117.44,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,outpatient,,,1152.00000,1094.40000,The Alliance,PPO Network,,957.31,,,,,,,576.00,1117.44,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,PPO Network,,155.40,,,,,,,93.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,382.25,674.15,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,347.50,674.15,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,28.13,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,144.53,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,inpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,,1023.79,,,,,,,677.60,1195.04,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,PPO Network,,1023.79,,,,,,,581.24,1195.04,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,inpatient,,,102.75000,97.61000,The Alliance,PPO Network,,85.39,,,,,,,56.51,99.67,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,outpatient,,,102.75000,97.61000,The Alliance,PPO Network,,85.39,,,,,,,51.38,99.67,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,inpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,121.00,213.40,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,PPO Network,,182.82,,,,,,,110.00,723.34,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,96.25,169.75,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,87.50,254.03,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,inpatient,,,1135.00000,1078.25000,The Alliance,PPO Network,,943.18,,,,,,,624.25,1100.95,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,outpatient,,,1135.00000,1078.25000,The Alliance,PPO Network,,943.18,,,,,,,567.50,2436.76,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,inpatient,,,11.00000,10.45000,The Alliance,PPO Network,,9.14,,,,,,,6.05,10.67,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,PPO Network,,9.14,,,,,,,5.50,62.04,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,522.50,921.50,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,475.00,1671.62,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,22.50,264.00,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,183.00,1692.33,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,672.00,1692.33,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,inpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,200.20,353.08,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,PPO Network,,302.48,,,,,,,182.00,3851.00,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,PPO Network,,517.71,,,,,,,342.65,604.31,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,PPO Network,,517.71,,,,,,,311.50,3851.00,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,inpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,271.15,478.21,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,outpatient,,,493.00000,468.35000,The Alliance,PPO Network,,409.68,,,,,,,246.50,531.90,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,21.50,41.71,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,inpatient,,,1187.00000,1127.65000,The Alliance,PPO Network,,986.40,,,,,,,652.85,1151.39,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,outpatient,,,1187.00000,1127.65000,The Alliance,PPO Network,,986.40,,,,,,,593.50,3388.98,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,,37.40,,,,,,,22.50,264.00,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,inpatient,,,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,712.25,1256.15,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,outpatient,,,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,647.50,3387.36,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,inpatient,,,134.25000,127.54000,The Alliance,PPO Network,,111.56,,,,,,,73.84,130.22,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,outpatient,,,134.25000,127.54000,The Alliance,PPO Network,,111.56,,,,,,,67.12,130.22,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,73.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,264.00,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,inpatient,,,343.00000,325.85000,The Alliance,PPO Network,,285.03,,,,,,,188.65,332.71,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,PPO Network,,285.03,,,,,,,171.50,2382.20,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,inpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,56.65,99.91,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,PPO Network,,85.59,,,,,,,51.50,1787.56,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,inpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.95,8.73,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,outpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.50,1062.65,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,118.34,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,inpatient,,,724.00000,687.80000,The Alliance,PPO Network,,601.64,,,,,,,398.20,702.28,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,outpatient,,,724.00000,687.80000,The Alliance,PPO Network,,601.64,,,,,,,362.00,702.28,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,183.00,1692.33,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,inpatient,,,473.00000,449.35000,The Alliance,PPO Network,,393.06,,,,,,,260.15,458.81,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,PPO Network,,393.06,,,,,,,236.50,1801.19,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,The Alliance,PPO Network,,1401.07,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,The Alliance,PPO Network,,1401.07,,,,,,,843.00,1692.33,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,inpatient,,,390.00000,370.50000,The Alliance,PPO Network,,324.09,,,,,,,214.50,378.30,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,outpatient,,,390.00000,370.50000,The Alliance,PPO Network,,324.09,,,,,,,195.00,1547.18,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,201.30,355.02,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,PPO Network,,304.15,,,,,,,183.00,1692.33,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,U6,93.07,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,U6,93.07,,,,,,,56.00,264.00,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,inpatient,,,610.00000,579.50000,The Alliance,PPO Network,,506.91,,,,,,,335.50,591.70,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,outpatient,,,610.00000,579.50000,The Alliance,PPO Network,,506.91,,,,,,,305.00,2864.41,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,inpatient,,,1234.00000,1172.30000,The Alliance,PPO Network,,1025.45,,,,,,,678.70,1196.98,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,PPO Network,,1025.45,,,,,,,617.00,1196.98,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,510.40,900.16,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,464.00,3999.66,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,inpatient,,,2738.00000,2601.10000,The Alliance,PPO Network,,2275.28,,,,,,,1505.90,2655.86,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,outpatient,,,2738.00000,2601.10000,The Alliance,PPO Network,,2275.28,,,,,,,1369.00,2989.39,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,inpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,186.45,328.83,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,PPO Network,,281.71,,,,,,,169.50,645.77,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,The Alliance,PPO Network,,1401.07,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,The Alliance,PPO Network,,1401.07,,,,,,,843.00,1692.33,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,inpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,61.05,107.67,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,PPO Network,,92.24,,,,,,,55.50,264.00,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,inpatient,,,1729.00000,1642.55000,The Alliance,PPO Network,,1436.80,,,,,,,950.95,1677.13,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,outpatient,,,1729.00000,1642.55000,The Alliance,PPO Network,,1436.80,,,,,,,864.50,2436.76,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,196.35,346.29,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,178.50,2139.65,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,inpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,95.15,167.81,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,PPO Network,,143.76,,,,,,,86.50,723.34,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,inpatient,,,218.50000,207.57000,The Alliance,PPO Network,,181.57,,,,,,,120.17,211.94,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,outpatient,,,218.50000,207.57000,The Alliance,PPO Network,,181.57,,,,,,,109.25,250.56,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,The Alliance,PPO Network,U6,257.61,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,PPO Network,U6,257.61,,,,,,,155.00,300.70,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,inpatient,,,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,367.95,648.93,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,outpatient,,,669.00000,635.55000,The Alliance,PPO Network,,555.94,,,,,,,334.50,648.93,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,inpatient,,,986.00000,936.70000,The Alliance,PPO Network,,819.37,,,,,,,542.30,956.42,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,outpatient,,,986.00000,936.70000,The Alliance,PPO Network,,819.37,,,,,,,493.00,1671.62,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,inpatient,,,1876.00000,1782.20000,The Alliance,PPO Network,,1558.96,,,,,,,1031.80,1819.72,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,outpatient,,,1876.00000,1782.20000,The Alliance,PPO Network,,1558.96,,,,,,,938.00,1819.72,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,inpatient,,,1296.00000,1231.20000,The Alliance,PPO Network,,1076.98,,,,,,,712.80,1257.12,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,outpatient,,,1296.00000,1231.20000,The Alliance,PPO Network,,1076.98,,,,,,,648.00,2989.39,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,inpatient,,,1056.00000,1003.20000,The Alliance,PPO Network,,877.54,,,,,,,580.80,1024.32,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,outpatient,,,1056.00000,1003.20000,The Alliance,PPO Network,,877.54,,,,,,,528.00,1547.18,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,inpatient,,,1132.00000,1075.40000,The Alliance,PPO Network,,940.69,,,,,,,622.60,1098.04,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,PPO Network,,940.69,,,,,,,566.00,1671.62,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,inpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,500.50,882.70,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,outpatient,,,910.00000,864.50000,The Alliance,PPO Network,,756.21,,,,,,,455.00,3287.55,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,inpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,,1350.38,,,,,,,893.75,1576.25,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,PPO Network,,1350.38,,,,,,,812.50,1910.62,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,inpatient,,,1856.00000,1763.20000,The Alliance,PPO Network,,1542.34,,,,,,,1020.80,1800.32,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,outpatient,,,1856.00000,1763.20000,The Alliance,PPO Network,,1542.34,,,,,,,928.00,7461.59,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,inpatient,,,1318.00000,1252.10000,The Alliance,PPO Network,,1095.26,,,,,,,724.90,1278.46,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,outpatient,,,1318.00000,1252.10000,The Alliance,PPO Network,,1095.26,,,,,,,659.00,2436.76,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,inpatient,,,1896.00000,1801.20000,The Alliance,PPO Network,,1575.58,,,,,,,1042.80,1839.12,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,outpatient,,,1896.00000,1801.20000,The Alliance,PPO Network,,1575.58,,,,,,,948.00,1910.62,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,inpatient,,,1556.00000,1478.20000,The Alliance,PPO Network,,1293.04,,,,,,,855.80,1509.32,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,PPO Network,,1293.04,,,,,,,778.00,3287.55,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,24.02,97.00,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,inpatient,,,1493.00000,1418.35000,The Alliance,PPO Network,,1240.68,,,,,,,821.15,1448.21,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,outpatient,,,1493.00000,1418.35000,The Alliance,PPO Network,,1240.68,,,,,,,520.92,1448.21,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,inpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,281.60,496.64,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,PPO Network,,425.47,,,,,,,256.00,1692.33,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,inpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1183.05,2086.47,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,PPO Network,,1787.48,,,,,,,1075.50,2436.76,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,255.20,450.08,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,232.00,3851.00,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,inpatient,,,3133.00000,2976.35000,The Alliance,PPO Network,,2603.52,,,,,,,1723.15,3039.01,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,outpatient,,,3133.00000,2976.35000,The Alliance,PPO Network,,2603.52,,,,,,,1566.50,3039.01,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,inpatient,,,2190.00000,2080.50000,The Alliance,PPO Network,,1819.89,,,,,,,1204.50,2124.30,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,outpatient,,,2190.00000,2080.50000,The Alliance,PPO Network,,1819.89,,,,,,,1095.00,3602.42,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,inpatient,,,307.00000,291.65000,The Alliance,PPO Network,,255.12,,,,,,,168.85,297.79,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,outpatient,,,307.00000,291.65000,The Alliance,PPO Network,,255.12,,,,,,,153.50,952.28,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,inpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,372.35,656.69,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,outpatient,,,677.00000,643.15000,The Alliance,PPO Network,,562.59,,,,,,,338.50,2139.65,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,inpatient,,,1549.00000,1471.55000,The Alliance,PPO Network,,1287.22,,,,,,,851.95,1502.53,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,outpatient,,,1549.00000,1471.55000,The Alliance,PPO Network,,1287.22,,,,,,,774.50,1692.33,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,inpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,115.50,203.70,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,PPO Network,,174.51,,,,,,,37.27,4190.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,35.75,63.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,,54.02,,,,,,,32.50,63.05,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,57.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,U6,123.82,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,U6,123.82,,,,,,,74.50,264.00,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,inpatient,,,255.00000,242.25000,The Alliance,PPO Network,,211.91,,,,,,,140.25,247.35,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,PPO Network,,211.91,,,,,,,127.50,1231.54,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,24.02,61.11,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,inpatient,,,4100.00000,3895.00000,The Alliance,PPO Network,,3407.10,,,,,,,2255.00,3977.00,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,outpatient,,,4100.00000,3895.00000,The Alliance,PPO Network,,3407.10,,,,,,,919.67,3977.00,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,inpatient,,,2189.00000,2079.55000,The Alliance,PPO Network,,1819.06,,,,,,,1203.95,2123.33,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,outpatient,,,2189.00000,2079.55000,The Alliance,PPO Network,,1819.06,,,,,,,1094.50,2382.20,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,138.05,243.47,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,125.50,346.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,inpatient,,,752.00000,714.40000,The Alliance,PPO Network,,624.91,,,,,,,413.60,729.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,outpatient,,,752.00000,714.40000,The Alliance,PPO Network,,624.91,,,,,,,376.00,729.44,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,255.20,450.08,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,PPO Network,,385.58,,,,,,,232.00,450.08,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,inpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,229.35,404.49,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,PPO Network,,346.53,,,,,,,208.50,404.49,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,inpatient,,,1423.00000,1351.85000,The Alliance,PPO Network,,1182.51,,,,,,,782.65,1380.31,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,outpatient,,,1423.00000,1351.85000,The Alliance,PPO Network,,1182.51,,,,,,,711.50,1910.62,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,inpatient,,,1107.00000,1051.65000,The Alliance,PPO Network,,919.92,,,,,,,608.85,1073.79,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,outpatient,,,1107.00000,1051.65000,The Alliance,PPO Network,,919.92,,,,,,,553.50,1671.62,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,inpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,171.05,301.67,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,PPO Network,,258.44,,,,,,,155.50,417.31,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,inpatient,,,1763.00000,1674.85000,The Alliance,PPO Network,,1465.05,,,,,,,969.65,1710.11,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,outpatient,,,1763.00000,1674.85000,The Alliance,PPO Network,,1465.05,,,,,,,881.50,1910.62,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,PPO Network,,482.81,,,,,,,319.55,563.57,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,PPO Network,,482.81,,,,,,,290.50,1692.33,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,inpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,45.10,79.54,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,PPO Network,,68.14,,,,,,,24.02,79.54,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,inpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,138.05,243.47,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,PPO Network,,208.58,,,,,,,125.50,308.32,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,inpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,438.35,773.09,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,PPO Network,,662.31,,,,,,,398.50,3387.36,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,inpatient,,,21.92000,20.82000,The Alliance,PPO Network,,18.22,,,,,,,12.06,21.26,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,outpatient,,,21.92000,20.82000,The Alliance,PPO Network,,18.22,,,,,,,10.96,242.55,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,U6,186.14,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,U6,186.14,,,,,,,112.00,264.00,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,PPO Network,,781.14,,,,,,,517.00,911.80,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,PPO Network,,781.14,,,,,,,470.00,3387.36,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,inpatient,,,715.00000,679.25000,The Alliance,PPO Network,,594.16,,,,,,,393.25,693.55,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,outpatient,,,715.00000,679.25000,The Alliance,PPO Network,,594.16,,,,,,,357.50,1547.18,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,inpatient,,,269.00000,255.55000,The Alliance,PPO Network,,223.54,,,,,,,147.95,260.93,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,PPO Network,,223.54,,,,,,,134.50,2139.65,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,inpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,183.70,323.98,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,outpatient,,,334.00000,317.30000,The Alliance,PPO Network,,277.55,,,,,,,167.00,323.98,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,inpatient,,,1317.00000,1251.15000,The Alliance,PPO Network,,1094.43,,,,,,,724.35,1277.49,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,outpatient,,,1317.00000,1251.15000,The Alliance,PPO Network,,1094.43,,,,,,,658.50,2436.76,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,99.50,2139.65,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,645.77,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,521.95,920.53,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,474.50,920.53,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,inpatient,,,647.00000,614.65000,The Alliance,PPO Network,,537.66,,,,,,,355.85,627.59,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,outpatient,,,647.00000,614.65000,The Alliance,PPO Network,,537.66,,,,,,,323.50,1910.62,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,inpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,371.25,654.75,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,outpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,337.50,1671.62,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,inpatient,,,1585.00000,1505.75000,The Alliance,PPO Network,,1317.13,,,,,,,871.75,1537.45,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,outpatient,,,1585.00000,1505.75000,The Alliance,PPO Network,,1317.13,,,,,,,792.50,1671.62,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,inpatient,,,2916.00000,2770.20000,The Alliance,PPO Network,,2423.20,,,,,,,1603.80,2828.52,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,outpatient,,,2916.00000,2770.20000,The Alliance,PPO Network,,2423.20,,,,,,,1458.00,2989.39,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,199.65,352.11,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,PPO Network,,301.65,,,,,,,181.50,639.36,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,inpatient,,,1196.00000,1136.20000,The Alliance,PPO Network,,993.88,,,,,,,657.80,1160.12,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,outpatient,,,1196.00000,1136.20000,The Alliance,PPO Network,,993.88,,,,,,,598.00,6178.88,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,inpatient,,,813.00000,772.35000,The Alliance,PPO Network,,675.60,,,,,,,447.15,788.61,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,outpatient,,,813.00000,772.35000,The Alliance,PPO Network,,675.60,,,,,,,406.50,3388.98,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,inpatient,,,1452.00000,1379.40000,The Alliance,PPO Network,,1206.61,,,,,,,798.60,1408.44,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,outpatient,,,1452.00000,1379.40000,The Alliance,PPO Network,,1206.61,,,,,,,726.00,1910.62,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,inpatient,,,1837.00000,1745.15000,The Alliance,PPO Network,,1526.55,,,,,,,1010.35,1781.89,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,PPO Network,,1526.55,,,,,,,918.50,2436.76,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,inpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,101.75,179.45,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,PPO Network,,153.74,,,,,,,92.50,179.45,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,inpatient,,,1274.00000,1210.30000,The Alliance,PPO Network,,1058.69,,,,,,,700.70,1235.78,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,outpatient,,,1274.00000,1210.30000,The Alliance,PPO Network,,1058.69,,,,,,,637.00,3287.55,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,inpatient,,,1271.00000,1207.45000,The Alliance,PPO Network,,1056.20,,,,,,,699.05,1232.87,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,outpatient,,,1271.00000,1207.45000,The Alliance,PPO Network,,1056.20,,,,,,,635.50,1671.62,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,inpatient,,,536.00000,509.20000,The Alliance,PPO Network,,445.42,,,,,,,294.80,519.92,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,PPO Network,,445.42,,,,,,,268.00,2382.20,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,inpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,124.30,219.22,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,PPO Network,,187.81,,,,,,,113.00,219.22,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,inpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,116.05,204.67,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,PPO Network,,175.34,,,,,,,23.25,204.67,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,inpatient,,,1298.00000,1233.10000,The Alliance,PPO Network,,1078.64,,,,,,,713.90,1259.06,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,PPO Network,,1078.64,,,,,,,649.00,1910.62,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,inpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,164.45,290.03,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,PPO Network,,248.47,,,,,,,149.50,1547.18,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,inpatient,,,782.00000,742.90000,The Alliance,PPO Network,,649.84,,,,,,,430.10,758.54,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,PPO Network,,649.84,,,,,,,391.00,758.54,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,inpatient,,,443.00000,420.85000,The Alliance,PPO Network,,368.13,,,,,,,243.65,429.71,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,PPO Network,,368.13,,,,,,,221.50,429.71,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,44.00,308.32,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,PPO Network,,257.61,,,,,,,152.56,300.70,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,inpatient,,,725.00000,688.75000,The Alliance,PPO Network,,602.48,,,,,,,398.75,703.25,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,PPO Network,,602.48,,,,,,,362.50,2139.65,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,inpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,155.65,274.51,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,PPO Network,,235.17,,,,,,,141.50,277.40,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,inpatient,,,1355.00000,1287.25000,The Alliance,PPO Network,,1126.01,,,,,,,745.25,1314.35,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,PPO Network,,1126.01,,,,,,,677.50,3388.98,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,PPO Network,TC,2631.78,,,,,,,1488.32,7180.14,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,inpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,295.90,521.86,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,PPO Network,,447.08,,,,,,,269.00,639.36,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,245.30,432.62,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,223.00,432.62,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,inpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,521.95,920.53,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,outpatient,,,949.00000,901.55000,The Alliance,PPO Network,,788.62,,,,,,,474.50,3387.36,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,inpatient,,,436.00000,414.20000,The Alliance,PPO Network,,362.32,,,,,,,239.80,422.92,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,outpatient,,,436.00000,414.20000,The Alliance,PPO Network,,362.32,,,,,,,218.00,3387.36,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,inpatient,,,1437.00000,1365.15000,The Alliance,PPO Network,,1194.15,,,,,,,790.35,1393.89,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,outpatient,,,1437.00000,1365.15000,The Alliance,PPO Network,,1194.15,,,,,,,718.50,1910.62,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,inpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,153.45,270.63,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,PPO Network,,231.85,,,,,,,139.50,312.24,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,inpatient,,,521.00000,494.95000,The Alliance,PPO Network,,432.95,,,,,,,286.55,505.37,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,PPO Network,,432.95,,,,,,,260.50,639.36,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,inpatient,1,mL,87.06000,82.71000,The Alliance,PPO Network,,72.35,,,,,,,47.88,84.45,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,outpatient,1,mL,87.06000,82.71000,The Alliance,PPO Network,,72.35,,,,,,,43.53,84.45,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,PPO Network,,0.17451,,,,,,,0.10500,0.20370,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,inpatient,,,1579.00000,1500.05000,The Alliance,PPO Network,90,1312.15,,,,,,,868.45,1531.63,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1579.00000,1500.05000,The Alliance,PPO Network,90,1312.15,,,,,,,109.60,6451.13,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,inpatient,,,361.10000,343.04000,The Alliance,PPO Network,90,300.07,,,,,,,198.60,350.27,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,outpatient,,,361.10000,343.04000,The Alliance,PPO Network,90,300.07,,,,,,,180.55,350.27,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,inpatient,,,2880.00000,2736.00000,The Alliance,PPO Network,90,2393.28,,,,,,,1584.00,2793.60,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,outpatient,,,2880.00000,2736.00000,The Alliance,PPO Network,90,2393.28,,,,,,,304.33,15397.76,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,inpatient,1,EA,1348.98000,1281.53000,The Alliance,PPO Network,,1121.00,,,,,,,741.94,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,outpatient,1,EA,1348.98000,1281.53000,The Alliance,PPO Network,,1121.00,,,,,,,6.35,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,inpatient,1,EA,1552.65000,1475.02000,The Alliance,PPO Network,,1290.25,,,,,,,853.96,1506.07,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,outpatient,1,EA,1552.65000,1475.02000,The Alliance,PPO Network,,1290.25,,,,,,,6.35,1506.07,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,90,139.61,,,,,,,92.40,162.96,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,90,139.61,,,,,,,14.94,763.98,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,inpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,82.67,145.79,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,PPO Network,90,124.90,,,,,,,17.85,823.21,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,The Alliance,PPO Network,90,1962.82,,,,,,,1299.10,2291.14,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,PPO Network,90,1962.82,,,,,,,215.88,10915.96,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,90,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,90,1893.02,,,,,,,208.21,10525.49,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,TC,2132.35,,,,,,,1411.30,2489.02,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,TC,2132.35,,,,,,,1283.00,2489.02,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,inpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,1.74,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,PPO Network,,2.63,,,,,,,0.27125,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.27125,6.13,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,inpatient,1,mL,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,2.54,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,outpatient,1,mL,4.62000,4.39000,The Alliance,PPO Network,,3.84,,,,,,,1.06,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,inpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.53350,0.94090,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,PPO Network,,0.80607,,,,,,,0.48500,1.18,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,The Alliance,PPO Network,TC,265.09,,,,,,,175.45,309.43,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,PPO Network,TC,265.09,,,,,,,159.50,3015.65,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,inpatient,,,36.27000,34.46000,The Alliance,PPO Network,,30.14,,,,,,,19.95,35.18,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,outpatient,,,36.27000,34.46000,The Alliance,PPO Network,,30.14,,,,,,,15.58,35.18,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,516.38,1125.00,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,824.89000,783.65000,The Alliance,PPO Network,,685.48,,,,,,,404.20,800.14,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,824.89000,783.65000,The Alliance,PPO Network,,685.48,,,,,,,378.62,824.89,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,PPO Network,,26.33,,,,,,,14.54,31.68,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,264.00,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,inpatient,,,167.90000,159.50000,The Alliance,PPO Network,90,139.52,,,,,,,92.34,162.86,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,outpatient,,,167.90000,159.50000,The Alliance,PPO Network,90,139.52,,,,,,,17.73,899.77,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,86.79,153.07,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,17.71,933.70,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,90,68.97,,,,,,,45.65,80.51,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,90,68.97,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,inpatient,,,80.10000,76.09000,The Alliance,PPO Network,90,66.56,,,,,,,44.05,77.70,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,outpatient,,,80.10000,76.09000,The Alliance,PPO Network,90,66.56,,,,,,,4.57,271.65,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,inpatient,,,452.70000,430.06000,The Alliance,PPO Network,90,376.19,,,,,,,248.99,439.12,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,outpatient,,,452.70000,430.06000,The Alliance,PPO Network,90,376.19,,,,,,,30.85,439.12,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,inpatient,,,308.60000,293.17000,The Alliance,PPO Network,90,256.45,,,,,,,169.73,299.34,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,outpatient,,,308.60000,293.17000,The Alliance,PPO Network,90,256.45,,,,,,,17.85,814.87,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,inpatient,,,400.10000,380.10000,The Alliance,PPO Network,90,332.48,,,,,,,220.06,388.10,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,outpatient,,,400.10000,380.10000,The Alliance,PPO Network,90,332.48,,,,,,,19.26,882.80,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.27500,0.53350,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.16,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.51,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,PPO Network,,8.33,,,,,,,5.01,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,136.95,241.53,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,124.50,241.53,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,inpatient,,,1035.00000,983.25000,The Alliance,PPO Network,,860.09,,,,,,,569.25,1003.95,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,PPO Network,,860.09,,,,,,,227.78,1003.95,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,inpatient,,,514.00000,488.30000,The Alliance,PPO Network,,427.13,,,,,,,282.70,498.58,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,outpatient,,,514.00000,488.30000,The Alliance,PPO Network,,427.13,,,,,,,227.78,498.58,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,inpatient,,,625.00000,593.75000,The Alliance,PPO Network,,519.38,,,,,,,343.75,606.25,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,outpatient,,,625.00000,593.75000,The Alliance,PPO Network,,519.38,,,,,,,312.50,3387.36,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,513.38000,487.71000,The Alliance,PPO Network,,426.62,,,,,,,251.56,497.98,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,513.38000,487.71000,The Alliance,PPO Network,,426.62,,,,,,,235.64,513.38,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,PPO Network,,639.04,,,,,,,422.95,745.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,PPO Network,,639.04,,,,,,,384.50,2039.65,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,12.05,1539.22,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,inpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,292.60,516.04,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,outpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,63.95,788.42,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,90,239.33,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,90,239.33,,,,,,,26.32,1324.17,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,inpatient,,,284.90000,270.65000,The Alliance,PPO Network,90,236.75,,,,,,,156.69,276.35,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,outpatient,,,284.90000,270.65000,The Alliance,PPO Network,90,236.75,,,,,,,26.67,1341.13,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,90,239.33,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,90,239.33,,,,,,,52.99,2682.34,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,112.31,198.07,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,90,169.69,,,,,,,18.72,882.80,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,11764.50000,11176.27000,The Alliance,PPO Network,,9776.30,,,,,,,5764.60,11411.57,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11764.50000,11176.27000,The Alliance,PPO Network,,9776.30,,,,,,,5399.91,11764.50,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,The Alliance,PPO Network,TC,12085.23,,,,,,,7998.65,14106.71,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,PPO Network,TC,12085.23,,,,,,,4549.00,14106.71,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,The Alliance,PPO Network,,8177.70,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,PPO Network,,8177.70,,,,,,,4516.93,9840.80,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.84000,47.35000,The Alliance,PPO Network,,41.42,,,,,,,24.42,48.34,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.84000,47.35000,The Alliance,PPO Network,,41.42,,,,,,,22.88,49.84,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,PPO Network,,419.11,,,,,,,231.49,504.34,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,The Alliance,PPO Network,TC,236.84,,,,,,,156.75,276.45,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,PPO Network,TC,236.84,,,,,,,142.50,1450.63,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,The Alliance,PPO Network,,12.71,,,,,,,7.65,25.57,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,inpatient,1,mL,541.98000,514.88000,The Alliance,PPO Network,,450.39,,,,,,,298.09,525.72,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,outpatient,1,mL,541.98000,514.88000,The Alliance,PPO Network,,450.39,,,,,,,270.99,94648.39,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,inpatient,,,892.00000,847.40000,The Alliance,PPO Network,,741.25,,,,,,,490.60,865.24,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,PPO Network,,741.25,,,,,,,227.78,865.24,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,inpatient,,,1366.00000,1297.70000,The Alliance,PPO Network,,1135.15,,,,,,,751.30,1325.02,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,outpatient,,,1366.00000,1297.70000,The Alliance,PPO Network,,1135.15,,,,,,,683.00,6178.88,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,inpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,0.14409,9.20,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,254.36000,241.64000,The Alliance,PPO Network,,211.37,,,,,,,124.64,246.73,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,254.36000,241.64000,The Alliance,PPO Network,,211.37,,,,,,,116.75,254.36,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,inpatient,,,4631.00000,4399.45000,The Alliance,PPO Network,,3848.36,,,,,,,2547.05,4492.07,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,outpatient,,,4631.00000,4399.45000,The Alliance,PPO Network,,3848.36,,,,,,,2315.50,4492.07,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,4455.00,7857.00,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,4050.00,7857.00,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,inpatient,1,EA,12.60000,11.97000,The Alliance,PPO Network,,10.47,,,,,,,6.93,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,outpatient,1,EA,12.60000,11.97000,The Alliance,PPO Network,,10.47,,,,,,,6.30,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,inpatient,1,EA,28.38000,26.96000,The Alliance,PPO Network,,23.58,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,PPO Network,,23.58,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,inpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,PPO Network,,16.63,,,,,,,10.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,inpatient,1,EA,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,outpatient,1,EA,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.45,8.63,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,PPO Network,,1066.82,,,,,,,589.26,1283.78,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,inpatient,1,mL,1142.71000,1085.57000,The Alliance,PPO Network,,949.59,,,,,,,628.49,1108.43,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,outpatient,1,mL,1142.71000,1085.57000,The Alliance,PPO Network,,949.59,,,,,,,0.76000,1108.43,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,PPO Network,,8565.53,,,,,,,4731.14,10307.50,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,76.00,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1093.31,2164.31,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1024.14,2231.25,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,inpatient,1,mL,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,6.57,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,outpatient,1,mL,11.94000,11.35000,The Alliance,PPO Network,,9.92,,,,,,,5.97,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,inpatient,1,mL,11.08000,10.53000,The Alliance,PPO Network,,9.21,,,,,,,6.09,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,outpatient,1,mL,11.08000,10.53000,The Alliance,PPO Network,,9.21,,,,,,,5.54,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,inpatient,1,mL,43.42000,41.25000,The Alliance,PPO Network,,36.08,,,,,,,23.88,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,outpatient,1,mL,43.42000,41.25000,The Alliance,PPO Network,,36.08,,,,,,,21.71,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,inpatient,1,mL,13.51000,12.84000,The Alliance,PPO Network,,11.23,,,,,,,7.43,13.10,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,outpatient,1,mL,13.51000,12.84000,The Alliance,PPO Network,,11.23,,,,,,,6.75,13.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,0.37830,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,inpatient,1,mL,162.98000,154.83000,The Alliance,PPO Network,,135.44,,,,,,,89.64,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,outpatient,1,mL,162.98000,154.83000,The Alliance,PPO Network,,135.44,,,,,,,81.49,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,inpatient,1,mL,184.83000,175.59000,The Alliance,PPO Network,,153.59,,,,,,,101.66,179.29,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,outpatient,1,mL,184.83000,175.59000,The Alliance,PPO Network,,153.59,,,,,,,92.42,179.29,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,inpatient,1,mL,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.41,4.26,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,outpatient,1,mL,4.39000,4.17000,The Alliance,PPO Network,,3.65,,,,,,,2.19,4.26,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,inpatient,,,1048.00000,995.60000,The Alliance,PPO Network,,870.89,,,,,,,576.40,1016.56,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,outpatient,,,1048.00000,995.60000,The Alliance,PPO Network,,870.89,,,,,,,524.00,6178.88,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,337.50000,320.62000,The Alliance,PPO Network,,280.46,,,,,,,165.38,327.38,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,PPO Network,,280.46,,,,,,,154.91,337.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,36.30,145.50,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,275.62,545.62,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,258.19,562.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.80850,1.43,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,PPO Network,,1.22,,,,,,,0.73500,1.43,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,inpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.51150,0.90210,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,PPO Network,,0.77283,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,inpatient,1,mL,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,outpatient,1,mL,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,0.14409,2.99,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,The Alliance,PPO Network,TC,1689.42,,,,,,,1118.15,1972.01,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,PPO Network,TC,1689.42,,,,,,,909.00,5271.00,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,TC,908.28,,,,,,,601.15,1060.21,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,TC,908.28,,,,,,,546.50,1060.21,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,inpatient,,,539.00000,512.05000,The Alliance,PPO Network,TC,447.91,,,,,,,296.45,522.83,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,outpatient,,,539.00000,512.05000,The Alliance,PPO Network,TC,447.91,,,,,,,269.50,522.83,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,inpatient,,,210.40000,199.88000,The Alliance,PPO Network,90,174.84,,,,,,,115.72,204.09,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,outpatient,,,210.40000,199.88000,The Alliance,PPO Network,90,174.84,,,,,,,12.00,611.15,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,inpatient,,,291.00000,276.45000,The Alliance,PPO Network,90,241.82,,,,,,,160.05,282.27,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,PPO Network,90,241.82,,,,,,,12.41,628.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,35.23,76.76,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,inpatient,,,134.90000,128.16000,The Alliance,PPO Network,90,112.10,,,,,,,74.19,130.85,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,outpatient,,,134.90000,128.16000,The Alliance,PPO Network,90,112.10,,,,,,,15.83,797.91,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,inpatient,1,EA,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,42.22,74.46,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,outpatient,1,EA,76.76000,72.92000,The Alliance,PPO Network,,63.79,,,,,,,7.82,74.46,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,inpatient,,,188.40000,178.98000,The Alliance,PPO Network,90,156.56,,,,,,,103.62,182.75,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,outpatient,,,188.40000,178.98000,The Alliance,PPO Network,90,156.56,,,,,,,22.12,1120.45,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,inpatient,,,363.00000,344.85000,The Alliance,PPO Network,90,301.65,,,,,,,199.65,352.11,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,PPO Network,90,301.65,,,,,,,36.26,1833.46,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,inpatient,1,mL,1400.41000,1330.39000,The Alliance,PPO Network,,1163.74,,,,,,,770.23,1358.40,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,outpatient,1,mL,1400.41000,1330.39000,The Alliance,PPO Network,,1163.74,,,,,,,700.21,1358.40,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1383.88,3015.00,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.80000,197.41000,The Alliance,PPO Network,90,172.68,,,,,,,114.29,201.57,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.80000,197.41000,The Alliance,PPO Network,90,172.68,,,,,,,19.88,1103.49,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,inpatient,,,162.90000,154.76000,The Alliance,PPO Network,90,135.37,,,,,,,89.59,158.01,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,outpatient,,,162.90000,154.76000,The Alliance,PPO Network,90,135.37,,,,,,,19.14,967.70,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,The Alliance,PPO Network,TC,4653.60,,,,,,,3080.00,5432.00,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,PPO Network,TC,4653.60,,,,,,,2751.30,21823.18,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,inpatient,1,mL,1673.67000,1589.99000,The Alliance,PPO Network,,1390.82,,,,,,,920.52,1623.46,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,outpatient,1,mL,1673.67000,1589.99000,The Alliance,PPO Network,,1390.82,,,,,,,54.67,1623.46,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,inpatient,,,472.50000,448.88000,The Alliance,PPO Network,90,392.65,,,,,,,259.88,458.32,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,outpatient,,,472.50000,448.88000,The Alliance,PPO Network,90,392.65,,,,,,,35.07,1765.53,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,PPO Network,,78.11,,,,,,,51.70,91.18,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,PPO Network,,78.11,,,,,,,9.77,458.40,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,The Alliance,PPO Network,,1019.01,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,PPO Network,,1019.01,,,,,,,562.85,1226.25,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,The Alliance,PPO Network,TC,1888.86,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,PPO Network,TC,1888.86,,,,,,,1136.50,2204.81,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,370.70,653.78,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,63.40,3038.81,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,inpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,36.13,63.73,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,PPO Network,90,54.60,,,,,,,8.17,679.08,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,317.40000,301.53000,The Alliance,PPO Network,,263.76,,,,,,,174.57,307.88,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,317.40000,301.53000,The Alliance,PPO Network,,263.76,,,,,,,155.27,307.88,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.35200,0.62080,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,PPO Network,,0.53184,,,,,,,0.32000,0.62080,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,144.38,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,131.25,254.62,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,PPO Network,,4551.57,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,inpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.34860,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,3.24,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,10.86,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,491.00000,466.45000,The Alliance,PPO Network,,408.02,,,,,,,270.05,476.27,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,491.00000,466.45000,The Alliance,PPO Network,,408.02,,,,,,,63.95,788.42,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,56.40,1426.03,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,The Alliance,PPO Network,,8276.88,,,,,,,4880.47,9661.35,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,PPO Network,,8276.88,,,,,,,4571.71,9960.15,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26931.87000,25585.28000,The Alliance,PPO Network,,22380.38,,,,,,,13196.62,26123.91,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26931.87000,25585.28000,The Alliance,PPO Network,,22380.38,,,,,,,12361.73,26931.87,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6722.33000,6386.21000,The Alliance,PPO Network,,5586.26,,,,,,,3293.94,6520.66,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6722.33000,6386.21000,The Alliance,PPO Network,,5586.26,,,,,,,3085.55,6722.33,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,The Alliance,PPO Network,,8027.46,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,PPO Network,,8027.46,,,,,,,4433.94,9660.00,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,inpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,292.60,516.04,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,outpatient,,,532.00000,505.40000,The Alliance,PPO Network,,442.09,,,,,,,266.00,516.04,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1515.94,3000.94,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1420.03,3093.75,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3087.92,6727.50,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1024.14,2231.25,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,The Alliance,PPO Network,TC,2898.53,,,,,,,1918.40,3383.36,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,PPO Network,TC,2898.53,,,,,,,1648.68,3383.36,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,The Alliance,PPO Network,,603.31,,,,,,,399.30,704.22,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,PPO Network,,603.31,,,,,,,100.97,704.22,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,The Alliance,PPO Network,,283.78,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,PPO Network,,283.78,,,,,,,170.75,331.25,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4232.12000,4020.51000,The Alliance,PPO Network,,3516.89,,,,,,,2073.74,4105.16,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4232.12000,4020.51000,The Alliance,PPO Network,,3516.89,,,,,,,1942.54,4232.12,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,10.86,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,inpatient,,,42.42000,40.30000,The Alliance,PPO Network,,35.25,,,,,,,23.33,41.15,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,outpatient,,,42.42000,40.30000,The Alliance,PPO Network,,35.25,,,,,,,21.21,47.59,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,inpatient,0.5,EA,84.84000,80.60000,The Alliance,PPO Network,,70.50,,,,,,,46.66,82.29,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,outpatient,0.5,EA,84.84000,80.60000,The Alliance,PPO Network,,70.50,,,,,,,42.42,82.29,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,inpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,94.05,165.87,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,PPO Network,,142.10,,,,,,,12.05,628.12,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,The Alliance,PPO Network,TC,465.36,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,PPO Network,TC,465.36,,,,,,,280.00,3015.65,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2916.11,5772.71,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2731.62,5951.25,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,310.01000,294.51000,The Alliance,PPO Network,,257.62,,,,,,,151.90,300.71,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,310.01000,294.51000,The Alliance,PPO Network,,257.62,,,,,,,142.29,310.01,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,319.30000,303.34000,The Alliance,PPO Network,,265.34,,,,,,,175.62,309.72,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,319.30000,303.34000,The Alliance,PPO Network,,265.34,,,,,,,155.27,309.72,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,224.07,395.18,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,PPO Network,90,338.55,,,,,,,36.26,1833.46,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,PPO Network,,0.31578,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,inpatient,1,GM,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,outpatient,1,GM,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,inpatient,1,EA,3070.66000,2917.13000,The Alliance,PPO Network,,2551.72,,,,,,,1688.86,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,outpatient,1,EA,3070.66000,2917.13000,The Alliance,PPO Network,,2551.72,,,,,,,155.42,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,inpatient,1,EA,3116.66000,2960.83000,The Alliance,PPO Network,,2589.94,,,,,,,1714.16,3023.16,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,outpatient,1,EA,3116.66000,2960.83000,The Alliance,PPO Network,,2589.94,,,,,,,155.42,3023.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,inpatient,1,EA,33331.78000,31665.19000,The Alliance,PPO Network,,27698.71,,,,,,,18332.48,32331.83,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,outpatient,1,EA,33331.78000,31665.19000,The Alliance,PPO Network,,27698.71,,,,,,,136.23,32331.83,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,inpatient,1,EA,13.13000,12.47000,The Alliance,PPO Network,,10.91,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,PPO Network,,10.91,,,,,,,6.57,12.74,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,128.57000,122.14000,The Alliance,PPO Network,,106.84,,,,,,,70.71,124.71,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,128.57000,122.14000,The Alliance,PPO Network,,106.84,,,,,,,64.28,124.71,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,The Alliance,PPO Network,TC,755.38,,,,,,,499.95,881.73,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,PPO Network,TC,755.38,,,,,,,359.37,881.73,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,PPO Network,,232.31,,,,,,,128.32,279.56,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,The Alliance,PPO Network,,20286.79,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,PPO Network,,20286.79,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,The Alliance,PPO Network,,20286.79,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,PPO Network,,20286.79,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,The Alliance,PPO Network,,21909.73,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,PPO Network,,21909.73,,,,,,,12101.76,26365.50,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,15500.00000,14725.00000,The Alliance,PPO Network,,12880.50,,,,,,,7595.00,15035.00,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,15500.00000,14725.00000,The Alliance,PPO Network,,12880.50,,,,,,,7114.50,15500.00,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,2871.77,6256.58,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,PPO Network,,5199.22,,,,,,,2871.77,6256.58,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,The Alliance,PPO Network,,21909.73,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,PPO Network,,21909.73,,,,,,,12101.76,26365.50,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,27825.00000,26433.75000,The Alliance,PPO Network,,23122.58,,,,,,,13634.25,26990.25,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,27825.00000,26433.75000,The Alliance,PPO Network,,23122.58,,,,,,,12771.67,27825.00,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,PPO Network,TC,4150.01,,,,,,,1288.05,4844.18,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.28,2.49,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,inpatient,1,EA,2442.69000,2320.56000,The Alliance,PPO Network,,2029.88,,,,,,,1343.48,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,outpatient,1,EA,2442.69000,2320.56000,The Alliance,PPO Network,,2029.88,,,,,,,10.94,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,inpatient,1,EA,2827.18000,2685.82000,The Alliance,PPO Network,,2349.39,,,,,,,1554.95,2742.36,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,outpatient,1,EA,2827.18000,2685.82000,The Alliance,PPO Network,,2349.39,,,,,,,10.94,2742.36,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,inpatient,1,EA,21354.33000,20286.61000,The Alliance,PPO Network,,17745.45,,,,,,,11744.88,20713.70,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,outpatient,1,EA,21354.33000,20286.61000,The Alliance,PPO Network,,17745.45,,,,,,,1737.10,20713.70,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,321.56,636.56,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,PPO Network,,545.34,,,,,,,301.22,656.25,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,99.22,196.43,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,PPO Network,,168.28,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,The Alliance,PPO Network,,3100.67,,,,,,,1828.31,3619.31,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,PPO Network,,3100.67,,,,,,,1712.64,3731.25,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,inpatient,1,GM,297.08000,282.23000,The Alliance,PPO Network,,246.87,,,,,,,163.39,288.17,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,outpatient,1,GM,297.08000,282.23000,The Alliance,PPO Network,,246.87,,,,,,,148.54,288.17,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,39270.00000,37306.50000,The Alliance,PPO Network,,32633.37,,,,,,,19242.30,38091.90,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,39270.00000,37306.50000,The Alliance,PPO Network,,32633.37,,,,,,,18024.93,39270.00,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,inpatient,1,EA,3774.55000,3585.83000,The Alliance,PPO Network,,3136.65,,,,,,,2076.00,3661.31,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,outpatient,1,EA,3774.55000,3585.83000,The Alliance,PPO Network,,3136.65,,,,,,,4.24,3661.31,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2442.77,4835.69,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2288.23,4985.25,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,inpatient,1,EA,9775.80000,9287.01000,The Alliance,PPO Network,,8123.69,,,,,,,5376.69,9482.53,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,outpatient,1,EA,9775.80000,9287.01000,The Alliance,PPO Network,,8123.69,,,,,,,163.21,9482.53,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,inpatient,1,EA,13.13000,12.47000,The Alliance,PPO Network,,10.91,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,PPO Network,,10.91,,,,,,,6.57,12.74,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,inpatient,1,mL,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.52,4.44,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,outpatient,1,mL,4.58000,4.35000,The Alliance,PPO Network,,3.81,,,,,,,2.29,4.44,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,inpatient,,,10207.00000,9696.65000,The Alliance,PPO Network,90,8482.02,,,,,,,5613.85,9900.79,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,outpatient,,,10207.00000,9696.65000,The Alliance,PPO Network,90,8482.02,,,,,,,608.00,54562.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28637.91000,27206.01000,The Alliance,PPO Network,,23798.10,,,,,,,14032.58,27778.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28637.91000,27206.01000,The Alliance,PPO Network,,23798.10,,,,,,,13144.80,28637.91,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,inpatient,,,1024.00000,972.80000,The Alliance,PPO Network,TC,850.94,,,,,,,563.20,993.28,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,outpatient,,,1024.00000,972.80000,The Alliance,PPO Network,TC,850.94,,,,,,,433.70,17311.25,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,The Alliance,PPO Network,TC,2618.48,,,,,,,1733.05,3056.47,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,PPO Network,TC,2618.48,,,,,,,1575.50,3056.47,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,PPO Network,,3368.67,,,,,,,1860.67,4053.75,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,90,934.88,,,,,,,618.75,1091.25,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,90,934.88,,,,,,,83.09,5856.94,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,90,93.90,,,,,,,62.15,109.61,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,90,93.90,,,,,,,56.50,8610.62,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,421.88000,400.79000,The Alliance,PPO Network,,350.58,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,PPO Network,,350.58,,,,,,,155.27,409.22,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,PPO Network,,276.66,,,,,,,152.81,332.93,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,inpatient,,,6126.00000,5819.70000,The Alliance,PPO Network,TC,5090.71,,,,,,,3369.30,5942.22,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,outpatient,,,6126.00000,5819.70000,The Alliance,PPO Network,TC,5090.71,,,,,,,3063.00,5942.22,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,110.25,218.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,103.28,225.00,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,4.27,7.54,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,PPO Network,,6.46,,,,,,,3.88,7.54,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,238.70,420.98,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,,360.65,,,,,,,217.00,488.81,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,inpatient,1,mL,2194.08000,2084.37000,The Alliance,PPO Network,,1823.28,,,,,,,1206.74,2128.26,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,outpatient,1,mL,2194.08000,2084.37000,The Alliance,PPO Network,,1823.28,,,,,,,63.39,2128.26,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,TC,129.64,,,,,,,85.80,151.32,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,TC,129.64,,,,,,,78.00,8022.25,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,inpatient,,,53550.00000,50872.50000,The Alliance,PPO Network,,44500.05,,,,,,,26239.50,51943.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,53550.00000,50872.50000,The Alliance,PPO Network,,44500.05,,,,,,,24579.45,53550.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,inpatient,,,714.00000,678.30000,The Alliance,PPO Network,90,593.33,,,,,,,392.70,692.58,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,PPO Network,90,593.33,,,,,,,36.26,1833.46,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,inpatient,,,1525.00000,1448.75000,The Alliance,PPO Network,90,1267.28,,,,,,,838.75,1479.25,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,outpatient,,,1525.00000,1448.75000,The Alliance,PPO Network,90,1267.28,,,,,,,19.00,1479.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,The Alliance,PPO Network,,47.13,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,PPO Network,,47.13,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,inpatient,1,mL,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,52.64,110.03,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,inpatient,1,EA,11.46000,10.88000,The Alliance,PPO Network,,9.52,,,,,,,6.30,11.12,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,outpatient,1,EA,11.46000,10.88000,The Alliance,PPO Network,,9.52,,,,,,,5.73,11.12,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,inpatient,1,EA,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,85.25,150.35,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,outpatient,1,EA,155.00000,147.25000,The Alliance,PPO Network,,128.81,,,,,,,77.50,150.35,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.39050,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,PPO Network,,0.59001,,,,,,,0.35500,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.23100,0.40740,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,PPO Network,,0.34902,,,,,,,0.21000,0.40740,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4487.78,9777.30,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,424.06000,402.86000,The Alliance,PPO Network,,352.39,,,,,,,233.23,411.34,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,424.06000,402.86000,The Alliance,PPO Network,,352.39,,,,,,,158.39,411.34,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,80.12000,76.11000,The Alliance,PPO Network,,66.58,,,,,,,39.26,77.72,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,80.12000,76.11000,The Alliance,PPO Network,,66.58,,,,,,,36.78,80.12,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,31326.75,68250.00,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,inpatient,1,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,4.20,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,outpatient,1,EA,7.63000,7.25000,The Alliance,PPO Network,,6.34,,,,,,,3.81,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,inpatient,1,EA,31.40000,29.83000,The Alliance,PPO Network,,26.09,,,,,,,17.27,30.46,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,outpatient,1,EA,31.40000,29.83000,The Alliance,PPO Network,,26.09,,,,,,,15.70,30.46,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,152.51,301.91,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,142.86,311.25,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,inpatient,,,984.00000,934.80000,The Alliance,PPO Network,,817.70,,,,,,,541.20,954.48,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,outpatient,,,984.00000,934.80000,The Alliance,PPO Network,,817.70,,,,,,,200.06,954.48,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,26.40,46.56,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,PPO Network,,39.89,,,,,,,4.28,220.68,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,657.80000,624.91000,The Alliance,PPO Network,,546.63,,,,,,,361.79,638.07,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,657.80000,624.91000,The Alliance,PPO Network,,546.63,,,,,,,240.68,638.07,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,inpatient,1,GM,10.04000,9.53000,The Alliance,PPO Network,,8.34,,,,,,,5.52,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,outpatient,1,GM,10.04000,9.53000,The Alliance,PPO Network,,8.34,,,,,,,5.02,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24404.10000,23183.89000,The Alliance,PPO Network,,20279.81,,,,,,,11958.01,23671.98,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,PPO Network,,20279.81,,,,,,,11201.48,24404.10,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,The Alliance,PPO Network,,6593.98,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,PPO Network,,6593.98,,,,,,,3642.16,7935.00,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,495.00000,470.25000,The Alliance,PPO Network,,411.35,,,,,,,242.55,480.15,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,495.00000,470.25000,The Alliance,PPO Network,,411.35,,,,,,,227.21,495.00,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,267.75000,254.36000,The Alliance,PPO Network,,222.50,,,,,,,131.20,259.72,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,267.75000,254.36000,The Alliance,PPO Network,,222.50,,,,,,,122.90,267.75,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,The Alliance,PPO Network,,21783.50,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,PPO Network,,21783.50,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4487.78,9777.30,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,220.50,436.50,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,206.55,450.00,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,182.60,322.04,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,PPO Network,,275.89,,,,,,,166.00,325.26,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,PPO Network,,695.55,,,,,,,460.35,811.89,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,PPO Network,,695.55,,,,,,,122.40,811.89,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,inpatient,,,1310.00000,1244.50000,The Alliance,PPO Network,TC,1088.61,,,,,,,720.50,1270.70,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,outpatient,,,1310.00000,1244.50000,The Alliance,PPO Network,TC,1088.61,,,,,,,655.00,1270.70,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,inpatient,,,1538.00000,1461.10000,The Alliance,PPO Network,TC,1278.08,,,,,,,845.90,1491.86,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,outpatient,,,1538.00000,1461.10000,The Alliance,PPO Network,TC,1278.08,,,,,,,769.00,1491.86,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,The Alliance,PPO Network,,570.07,,,,,,,377.30,665.42,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,PPO Network,,570.07,,,,,,,122.40,665.42,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,inpatient,,,200.00000,190.00000,The Alliance,PPO Network,TC,166.20,,,,,,,110.00,194.00,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,PPO Network,TC,166.20,,,,,,,100.00,194.00,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,inpatient,,,1812.00000,1721.40000,The Alliance,PPO Network,TC,1505.77,,,,,,,996.60,1757.64,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,outpatient,,,1812.00000,1721.40000,The Alliance,PPO Network,TC,1505.77,,,,,,,906.00,1757.64,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,822.25,1450.15,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,747.50,1450.15,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,,908.28,,,,,,,601.15,1060.21,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,PPO Network,,908.28,,,,,,,295.69,1060.21,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,The Alliance,PPO Network,,835.99,,,,,,,553.30,975.82,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,PPO Network,,835.99,,,,,,,503.00,975.82,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,inpatient,1,mL,25.54000,24.27000,The Alliance,PPO Network,,21.22,,,,,,,14.05,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,outpatient,1,mL,25.54000,24.27000,The Alliance,PPO Network,,21.22,,,,,,,12.77,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,inpatient,1,mL,12.79000,12.15000,The Alliance,PPO Network,,10.63,,,,,,,7.03,12.41,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,outpatient,1,mL,12.79000,12.15000,The Alliance,PPO Network,,10.63,,,,,,,6.39,12.41,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,inpatient,1,mL,2462.57000,2339.44000,The Alliance,PPO Network,,2046.40,,,,,,,1354.41,2388.69,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,outpatient,1,mL,2462.57000,2339.44000,The Alliance,PPO Network,,2046.40,,,,,,,1231.29,2388.69,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,inpatient,1,EA,1284.64000,1220.41000,The Alliance,PPO Network,,1067.54,,,,,,,706.55,1246.10,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,outpatient,1,EA,1284.64000,1220.41000,The Alliance,PPO Network,,1067.54,,,,,,,5.31,1246.10,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,inpatient,1,mL,2259.81000,2146.82000,The Alliance,PPO Network,,1877.90,,,,,,,1242.90,2192.02,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,outpatient,1,mL,2259.81000,2146.82000,The Alliance,PPO Network,,1877.90,,,,,,,63.39,2192.02,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,inpatient,1,EA,1367.29000,1298.92000,The Alliance,PPO Network,,1136.22,,,,,,,752.01,1326.27,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,outpatient,1,EA,1367.29000,1298.92000,The Alliance,PPO Network,,1136.22,,,,,,,11.25,1326.27,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,inpatient,1,mL,7668.27000,7284.86000,The Alliance,PPO Network,,6372.33,,,,,,,4217.55,7438.22,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,outpatient,1,mL,7668.27000,7284.86000,The Alliance,PPO Network,,6372.33,,,,,,,3834.14,7438.22,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,45.19,79.70,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,6.35,79.70,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,inpatient,,,59.20000,56.24000,The Alliance,PPO Network,,49.20,,,,,,,32.56,57.42,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,outpatient,,,59.20000,56.24000,The Alliance,PPO Network,,49.20,,,,,,,29.60,57.42,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1433.85000,1362.16000,The Alliance,PPO Network,,1191.53,,,,,,,702.59,1390.83,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1433.85000,1362.16000,The Alliance,PPO Network,,1191.53,,,,,,,658.14,1433.85,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,The Alliance,PPO Network,,138.08,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,PPO Network,,138.08,,,,,,,76.27,166.16,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,408.37,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,5271.00,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,10.86,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,,256.53,,,,,,,151.26,299.44,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,,256.53,,,,,,,141.69,308.70,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,inpatient,,,8474.00000,8050.30000,The Alliance,PPO Network,,7041.89,,,,,,,4660.70,8219.78,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,outpatient,,,8474.00000,8050.30000,The Alliance,PPO Network,,7041.89,,,,,,,295.69,8219.78,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,497.20,876.88,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,PPO Network,,751.22,,,,,,,268.42,876.88,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,inpatient,,,48.67000,46.24000,The Alliance,PPO Network,,40.44,,,,,,,26.77,47.21,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,outpatient,,,48.67000,46.24000,The Alliance,PPO Network,,40.44,,,,,,,11.05,47.21,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,inpatient,,,106.68000,101.35000,The Alliance,PPO Network,,88.65,,,,,,,58.67,103.48,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,outpatient,,,106.68000,101.35000,The Alliance,PPO Network,,88.65,,,,,,,53.34,103.48,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,inpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,1.39,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,inpatient,1,EA,34.59000,32.86000,The Alliance,PPO Network,,28.74,,,,,,,19.02,33.55,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,PPO Network,,28.74,,,,,,,17.30,33.55,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.17050,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,PPO Network,,0.25761,,,,,,,0.15500,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07700,0.13580,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,PPO Network,,0.11634,,,,,,,0.07000,0.13580,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.83,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,PPO Network,,4.27,,,,,,,2.57,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,inpatient,1,EA,15.15000,14.40000,The Alliance,PPO Network,,12.59,,,,,,,8.33,14.70,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,outpatient,1,EA,15.15000,14.40000,The Alliance,PPO Network,,12.59,,,,,,,7.58,14.70,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,inpatient,1,mL,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.57,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,inpatient,1,mL,4.46000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.45,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,outpatient,1,mL,4.46000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,inpatient,1,mL,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.44000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,outpatient,1,mL,0.80000,0.76000,The Alliance,PPO Network,,0.66480,,,,,,,0.40000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,inpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,PPO Network,TC,612.45,,,,,,,405.35,714.89,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,PPO Network,TC,612.45,,,,,,,368.50,714.89,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,inpatient,1,mL,61.62000,58.54000,The Alliance,PPO Network,,51.21,,,,,,,33.89,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,outpatient,1,mL,61.62000,58.54000,The Alliance,PPO Network,,51.21,,,,,,,18.70,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,inpatient,1,mL,38.30000,36.38000,The Alliance,PPO Network,,31.83,,,,,,,21.07,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,outpatient,1,mL,38.30000,36.38000,The Alliance,PPO Network,,31.83,,,,,,,18.70,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,inpatient,1,mL,132.81000,126.17000,The Alliance,PPO Network,,110.37,,,,,,,73.05,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,outpatient,1,mL,132.81000,126.17000,The Alliance,PPO Network,,110.37,,,,,,,18.70,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,inpatient,1,mL,38.87000,36.92000,The Alliance,PPO Network,,32.30,,,,,,,21.38,37.70,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,outpatient,1,mL,38.87000,36.92000,The Alliance,PPO Network,,32.30,,,,,,,18.70,37.70,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.95700,1.69,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,PPO Network,,1.45,,,,,,,0.87000,1.69,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,The Alliance,PPO Network,,40.29,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,PPO Network,,40.29,,,,,,,24.24,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,inpatient,1,EA,41.87000,39.78000,The Alliance,PPO Network,,34.79,,,,,,,23.03,40.61,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,outpatient,1,EA,41.87000,39.78000,The Alliance,PPO Network,,34.79,,,,,,,20.93,40.61,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,50.96,100.88,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,47.74,104.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,inpatient,,,1740.00000,1653.00000,The Alliance,PPO Network,,1445.94,,,,,,,957.00,1687.80,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,outpatient,,,1740.00000,1653.00000,The Alliance,PPO Network,,1445.94,,,,,,,384.16,1692.33,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,78.95,172.00,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,542.90000,515.76000,The Alliance,PPO Network,,451.15,,,,,,,298.60,526.61,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,542.90000,515.76000,The Alliance,PPO Network,,451.15,,,,,,,158.39,526.61,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,48.40,85.36,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,44.00,85.36,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,408.37,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,PPO Network,,349.85,,,,,,,231.55,5271.00,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,The Alliance,PPO Network,,1702.97,,,,,,,1127.12,1987.82,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,PPO Network,,1702.97,,,,,,,595.10,1987.82,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,967.59,2108.03,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,PPO Network,,360.77,,,,,,,199.27,434.14,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,236.44,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.65,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,PPO Network,,2.49,,,,,,,1.50,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,PPO Network,,3.54,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,1.05,1.85,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,PPO Network,,1.59,,,,,,,0.95500,1.85,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,0.70810,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,inpatient,1,EA,33.88000,32.19000,The Alliance,PPO Network,,28.15,,,,,,,18.63,32.86,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,outpatient,1,EA,33.88000,32.19000,The Alliance,PPO Network,,28.15,,,,,,,16.94,32.86,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,inpatient,1,mL,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,2.06,3.63,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,outpatient,1,mL,3.74000,3.55000,The Alliance,PPO Network,,3.11,,,,,,,1.87,3.63,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,inpatient,1,EA,8541.32000,8114.25000,The Alliance,PPO Network,,7097.84,,,,,,,4697.73,8285.08,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,outpatient,1,EA,8541.32000,8114.25000,The Alliance,PPO Network,,7097.84,,,,,,,155.42,8285.08,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,inpatient,1,EA,33.71000,32.03000,The Alliance,PPO Network,,28.01,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,outpatient,1,EA,33.71000,32.03000,The Alliance,PPO Network,,28.01,,,,,,,16.86,83.21,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,3273.75,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,5271.00,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,502.50000,477.38000,The Alliance,PPO Network,,417.58,,,,,,,246.22,487.43,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,502.50000,477.38000,The Alliance,PPO Network,,417.58,,,,,,,230.65,502.50,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,PPO Network,,142.93,,,,,,,78.95,172.00,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35.16000,33.40000,The Alliance,PPO Network,,29.22,,,,,,,17.23,34.11,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,PPO Network,,29.22,,,,,,,16.14,35.16,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,10.86,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,10.86,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.71500,1.26,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,PPO Network,,1.08,,,,,,,0.65000,1.26,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.06404,1.21,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,inpatient,1,mL,2421.77000,2300.69000,The Alliance,PPO Network,,2012.49,,,,,,,1331.97,2349.12,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,outpatient,1,mL,2421.77000,2300.69000,The Alliance,PPO Network,,2012.49,,,,,,,62.97,2349.12,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,TC,3864.98,,,,,,,2558.05,4511.47,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,PPO Network,TC,3864.98,,,,,,,380.83,4511.47,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,90,109.69,,,,,,,72.60,128.04,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,90,109.69,,,,,,,14.00,713.01,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,inpatient,,,117.00000,111.15000,The Alliance,PPO Network,90,97.23,,,,,,,64.35,113.49,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,PPO Network,90,97.23,,,,,,,12.38,628.12,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,90,47.37,,,,,,,31.35,55.29,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,90,47.37,,,,,,,8.17,662.12,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,90,109.69,,,,,,,72.60,128.04,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,90,109.69,,,,,,,19.00,865.84,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,90,105.54,,,,,,,69.85,123.19,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,90,105.54,,,,,,,17.85,814.87,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,The Alliance,PPO Network,90,132.63,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,PPO Network,90,132.63,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,90,98.06,,,,,,,64.90,114.46,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,90,98.06,,,,,,,12.45,1539.22,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.85,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,PPO Network,,2.79,,,,,,,1.68,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.32,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.31,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,PPO Network,,1.99,,,,,,,1.20,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,inpatient,1,EA,6.77000,6.43000,The Alliance,PPO Network,,5.63,,,,,,,3.72,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,outpatient,1,EA,6.77000,6.43000,The Alliance,PPO Network,,5.63,,,,,,,3.38,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.77,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,PPO Network,,2.68,,,,,,,1.61,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,PPO Network,,1.27,,,,,,,0.76500,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1012.50000,961.88000,The Alliance,PPO Network,,841.39,,,,,,,496.12,982.12,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1012.50000,961.88000,The Alliance,PPO Network,,841.39,,,,,,,464.74,1012.50,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,91.23,198.75,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.25000,252.94000,The Alliance,PPO Network,,221.25,,,,,,,130.46,258.26,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.25000,252.94000,The Alliance,PPO Network,,221.25,,,,,,,122.21,266.25,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,220.50,436.50,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,206.55,450.00,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,25.48,50.44,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,23.87,52.00,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,17.64,34.92,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,42.23,92.00,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,459.38,909.38,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,430.31,937.50,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,inpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,PPO Network,,1.04,,,,,,,0.11780,1.21,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,inpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,inpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,The Alliance,PPO Network,,1141.35,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,PPO Network,,1141.35,,,,,,,91.02,1332.27,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,inpatient,1,mL,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,PPO Network,,3.04,,,,,,,1.83,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,inpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,PPO Network,,2.42,,,,,,,1.46,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,inpatient,1,mL,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.44,2.53,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,outpatient,1,mL,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.30,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,inpatient,1,mL,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,PPO Network,,2.44,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,inpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,PPO Network,,2.44,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,inpatient,1,mL,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.36,2.41,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,outpatient,1,mL,2.48000,2.36000,The Alliance,PPO Network,,2.06,,,,,,,1.24,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,inpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,35.24,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,inpatient,,,49.36000,46.89000,The Alliance,PPO Network,,41.02,,,,,,,27.15,47.88,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,outpatient,,,49.36000,46.89000,The Alliance,PPO Network,,41.02,,,,,,,24.68,47.88,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,352.50000,334.88000,The Alliance,PPO Network,,292.93,,,,,,,193.88,341.93,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,PPO Network,,292.93,,,,,,,47.62,341.93,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,inpatient,,,261.94000,248.84000,The Alliance,PPO Network,,217.67,,,,,,,128.35,254.08,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,outpatient,,,261.94000,248.84000,The Alliance,PPO Network,,217.67,,,,,,,130.34,254.08,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,inpatient,,,245.10000,232.84000,The Alliance,PPO Network,RR,203.68,,,,,,,134.81,237.75,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,outpatient,,,245.10000,232.84000,The Alliance,PPO Network,RR,203.68,,,,,,,122.55,346.38,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,inpatient,,,228.95000,217.50000,The Alliance,PPO Network,RR,190.26,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,PPO Network,RR,190.26,,,,,,,114.47,242.15,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,inpatient,,,52.36000,49.74000,The Alliance,PPO Network,,43.51,,,,,,,28.80,50.79,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,PPO Network,,43.51,,,,,,,26.18,50.79,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,The Alliance,PPO Network,UE,2537.45,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,PPO Network,UE,2537.45,,,,,,,1526.74,2961.89,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,inpatient,,,6.24000,5.93000,The Alliance,PPO Network,,5.19,,,,,,,3.43,6.05,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,outpatient,,,6.24000,5.93000,The Alliance,PPO Network,,5.19,,,,,,,0.41800,6.05,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,,1033.75,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,,1033.75,,,,,,,621.99,1206.66,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,inpatient,,,515.78000,489.99000,The Alliance,PPO Network,RR,428.61,,,,,,,283.68,500.31,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,outpatient,,,515.78000,489.99000,The Alliance,PPO Network,RR,428.61,,,,,,,257.89,545.53,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,NU,1033.75,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,NU,1033.75,,,,,,,621.99,1206.66,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,50.82,89.63,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,46.20,89.63,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,228.95000,217.50000,The Alliance,PPO Network,,190.26,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,PPO Network,,190.26,,,,,,,114.47,222.08,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,60.76000,57.72000,The Alliance,PPO Network,,50.49,,,,,,,33.42,58.94,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,60.76000,57.72000,The Alliance,PPO Network,,50.49,,,,,,,30.38,58.94,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,,1033.75,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,,1033.75,,,,,,,621.99,1206.66,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,29.00,56.26,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,inpatient,,,69.72000,66.23000,The Alliance,PPO Network,NU,57.94,,,,,,,38.35,67.63,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,PPO Network,NU,57.94,,,,,,,34.86,74.36,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,inpatient,,,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.40,4.23,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,outpatient,,,4.36000,4.14000,The Alliance,PPO Network,,3.62,,,,,,,2.18,5.11,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,inpatient,,,51.33000,48.76000,The Alliance,PPO Network,,42.66,,,,,,,28.23,49.79,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,outpatient,,,51.33000,48.76000,The Alliance,PPO Network,,42.66,,,,,,,25.66,49.79,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,inpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,163.90,289.06,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,outpatient,,,298.00000,283.10000,The Alliance,PPO Network,,247.64,,,,,,,149.00,289.06,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,The Alliance,PPO Network,UE,5717.44,,,,,,,3784.10,6673.78,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,PPO Network,UE,5717.44,,,,,,,3440.09,6673.78,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,NU,80.61,,,,,,,53.35,94.09,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,NU,80.61,,,,,,,43.58,94.09,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,inpatient,,,6.80000,6.46000,The Alliance,PPO Network,,5.65,,,,,,,3.74,6.60,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,outpatient,,,6.80000,6.46000,The Alliance,PPO Network,,5.65,,,,,,,3.40,6.60,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,The Alliance,PPO Network,NU,2537.45,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,PPO Network,NU,2537.45,,,,,,,1526.74,2961.89,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,37.24,73.72,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,34.88,73.72,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,inpatient,,,920.00000,874.00000,The Alliance,PPO Network,,764.52,,,,,,,506.00,892.40,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,outpatient,,,920.00000,874.00000,The Alliance,PPO Network,,764.52,,,,,,,460.00,892.40,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,PPO Network,,307.95,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,PPO Network,,307.95,,,,,,,185.29,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,PPO Network,NU,307.95,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,PPO Network,NU,307.95,,,,,,,177.13,359.46,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,121.07000,115.02000,The Alliance,PPO Network,,100.61,,,,,,,66.59,117.44,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,121.07000,115.02000,The Alliance,PPO Network,,100.61,,,,,,,60.53,117.44,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,30.00,58.20,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,7.33,12.93,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,6.67,12.93,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,inpatient,,,336.75000,319.91000,The Alliance,PPO Network,NU,279.84,,,,,,,185.21,326.65,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,outpatient,,,336.75000,319.91000,The Alliance,PPO Network,NU,279.84,,,,,,,114.55,326.65,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,inpatient,,,30.40000,28.88000,The Alliance,PPO Network,,25.26,,,,,,,16.72,29.49,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,PPO Network,,25.26,,,,,,,15.20,31.25,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,PPO Network,,307.95,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,PPO Network,,307.95,,,,,,,185.29,359.46,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,inpatient,,,30380.00000,28861.00000,The Alliance,PPO Network,NU,25245.78,,,,,,,14886.20,29468.60,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,outpatient,,,30380.00000,28861.00000,The Alliance,PPO Network,NU,25245.78,,,,,,,12765.57,30380.00,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,93.29000,88.63000,The Alliance,PPO Network,,77.52,,,,,,,51.31,90.49,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,PPO Network,,77.52,,,,,,,46.65,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,inpatient,,,93.29000,88.63000,The Alliance,PPO Network,RR,77.52,,,,,,,51.31,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,PPO Network,RR,77.52,,,,,,,46.65,98.67,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,The Alliance,PPO Network,,5717.44,,,,,,,3784.10,6673.78,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,PPO Network,,5717.44,,,,,,,3440.09,6673.78,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,inpatient,,,12.13000,11.52000,The Alliance,PPO Network,,10.08,,,,,,,6.67,11.77,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,outpatient,,,12.13000,11.52000,The Alliance,PPO Network,,10.08,,,,,,,6.07,12.52,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,UE,1033.75,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,PPO Network,UE,1033.75,,,,,,,621.99,1206.66,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,inpatient,,,33.36000,31.69000,The Alliance,PPO Network,,27.72,,,,,,,18.35,32.36,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,outpatient,,,33.36000,31.69000,The Alliance,PPO Network,,27.72,,,,,,,16.68,51.01,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,inpatient,,,217.88000,206.99000,The Alliance,PPO Network,NU,181.06,,,,,,,119.83,211.34,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,outpatient,,,217.88000,206.99000,The Alliance,PPO Network,NU,181.06,,,,,,,108.94,211.34,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.60,11.64,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.00,12.41,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,40.13000,38.12000,The Alliance,PPO Network,NU,33.35,,,,,,,22.07,38.93,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,40.13000,38.12000,The Alliance,PPO Network,NU,33.35,,,,,,,20.07,38.93,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,inpatient,,,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,9.69,19.18,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,outpatient,,,19.77000,18.78000,The Alliance,PPO Network,,16.43,,,,,,,9.88,22.52,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,inpatient,,,80.09000,76.09000,The Alliance,PPO Network,NU,66.55,,,,,,,44.05,77.69,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,outpatient,,,80.09000,76.09000,The Alliance,PPO Network,NU,66.55,,,,,,,28.30,77.69,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,256.72000,243.88000,The Alliance,PPO Network,,213.33,,,,,,,141.20,249.02,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,256.72000,243.88000,The Alliance,PPO Network,,213.33,,,,,,,128.36,249.02,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,inpatient,,,575.26000,546.50000,The Alliance,PPO Network,,478.04,,,,,,,316.39,558.00,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,outpatient,,,575.26000,546.50000,The Alliance,PPO Network,,478.04,,,,,,,286.24,558.00,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,27.78000,26.39000,The Alliance,PPO Network,,23.09,,,,,,,15.28,26.95,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,PPO Network,,23.09,,,,,,,13.89,26.95,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,45.73000,43.44000,The Alliance,PPO Network,,38.00,,,,,,,25.15,44.36,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,45.73000,43.44000,The Alliance,PPO Network,,38.00,,,,,,,22.86,44.36,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,85.52000,81.24000,The Alliance,PPO Network,NU,71.07,,,,,,,47.04,82.95,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,85.52000,81.24000,The Alliance,PPO Network,NU,71.07,,,,,,,42.76,86.57,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,inpatient,,,938.00000,891.10000,The Alliance,PPO Network,NU,779.48,,,,,,,515.90,909.86,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,outpatient,,,938.00000,891.10000,The Alliance,PPO Network,NU,779.48,,,,,,,469.00,909.86,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,7.33,12.93,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,3.01,12.93,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,107.80,190.12,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,98.00,190.12,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,inpatient,,,197.20000,187.34000,The Alliance,PPO Network,,163.87,,,,,,,96.63,191.28,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,outpatient,,,197.20000,187.34000,The Alliance,PPO Network,,163.87,,,,,,,81.91,191.28,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,inpatient,,,27.78000,26.39000,The Alliance,PPO Network,RR,23.09,,,,,,,15.28,26.95,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,PPO Network,RR,23.09,,,,,,,13.89,29.38,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,7.33,12.93,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,PPO Network,,11.08,,,,,,,6.67,12.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,inpatient,,,352.50000,334.88000,The Alliance,PPO Network,,292.93,,,,,,,193.88,341.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,PPO Network,,292.93,,,,,,,176.25,341.93,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,inpatient,,,40.53000,38.50000,The Alliance,PPO Network,,33.68,,,,,,,22.29,39.31,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,outpatient,,,40.53000,38.50000,The Alliance,PPO Network,,33.68,,,,,,,20.27,41.68,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,inpatient,,,3400.00000,3230.00000,The Alliance,PPO Network,,2825.40,,,,,,,1870.00,3298.00,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,outpatient,,,3400.00000,3230.00000,The Alliance,PPO Network,,2825.40,,,,,,,1700.00,3298.00,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,inpatient,,,382.22000,363.11000,The Alliance,PPO Network,,317.62,,,,,,,187.29,370.75,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,outpatient,,,382.22000,363.11000,The Alliance,PPO Network,,317.62,,,,,,,190.18,370.75,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,inpatient,,,51.87000,49.28000,The Alliance,PPO Network,,43.10,,,,,,,28.53,50.31,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,outpatient,,,51.87000,49.28000,The Alliance,PPO Network,,43.10,,,,,,,25.93,50.31,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,31.04,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,472.50000,448.88000,The Alliance,PPO Network,,392.65,,,,,,,259.88,458.32,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,PPO Network,,392.65,,,,,,,236.25,751.69,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,inpatient,,,107.52000,102.14000,The Alliance,PPO Network,,89.35,,,,,,,52.68,104.29,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,outpatient,,,107.52000,102.14000,The Alliance,PPO Network,,89.35,,,,,,,53.76,183.28,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.93,5.17,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,5.33000,5.06000,The Alliance,PPO Network,,4.43,,,,,,,2.67,5.17,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,inpatient,,,305.06000,289.81000,The Alliance,PPO Network,,253.50,,,,,,,149.48,295.91,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,outpatient,,,305.06000,289.81000,The Alliance,PPO Network,,253.50,,,,,,,151.81,295.91,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,95.96000,91.16000,The Alliance,PPO Network,,79.74,,,,,,,52.78,93.08,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,95.96000,91.16000,The Alliance,PPO Network,,79.74,,,,,,,47.98,93.08,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,195.94,345.56,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,178.12,345.56,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,inpatient,,,45.21000,42.95000,The Alliance,PPO Network,,37.57,,,,,,,24.87,43.85,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,outpatient,,,45.21000,42.95000,The Alliance,PPO Network,,37.57,,,,,,,22.61,43.85,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,436.07000,414.27000,The Alliance,PPO Network,NU,362.37,,,,,,,239.84,422.99,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,436.07000,414.27000,The Alliance,PPO Network,NU,362.37,,,,,,,67.27,422.99,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,inpatient,,,12.40000,11.78000,The Alliance,PPO Network,,10.30,,,,,,,6.82,12.03,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,outpatient,,,12.40000,11.78000,The Alliance,PPO Network,,10.30,,,,,,,6.20,12.71,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,29.10,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,inpatient,,,245.44000,233.17000,The Alliance,PPO Network,,203.96,,,,,,,120.27,238.08,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,outpatient,,,245.44000,233.17000,The Alliance,PPO Network,,203.96,,,,,,,122.72,238.08,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,inpatient,,,2021.78000,1920.69000,The Alliance,PPO Network,NU,1680.10,,,,,,,1111.98,1961.13,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,outpatient,,,2021.78000,1920.69000,The Alliance,PPO Network,NU,1680.10,,,,,,,1010.89,1961.13,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,66.67000,63.34000,The Alliance,PPO Network,NU,55.40,,,,,,,36.67,64.67,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,66.67000,63.34000,The Alliance,PPO Network,NU,55.40,,,,,,,21.38,64.67,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,inpatient,,,3430.67000,3259.14000,The Alliance,PPO Network,,2850.89,,,,,,,1681.03,3327.75,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,outpatient,,,3430.67000,3259.14000,The Alliance,PPO Network,,2850.89,,,,,,,1707.07,3327.75,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,inpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,39.60,69.84,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,outpatient,,,72.00000,68.40000,The Alliance,PPO Network,,59.83,,,,,,,36.00,69.84,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,inpatient,,,1941.00000,1843.95000,The Alliance,PPO Network,,1612.97,,,,,,,951.09,1882.77,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,outpatient,,,1941.00000,1843.95000,The Alliance,PPO Network,,1612.97,,,,,,,699.50,1882.77,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,292.69000,278.06000,The Alliance,PPO Network,NU,243.23,,,,,,,160.98,283.91,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,292.69000,278.06000,The Alliance,PPO Network,NU,243.23,,,,,,,67.27,283.91,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,0.94600,6.47,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,inpatient,,,7.28000,6.92000,The Alliance,PPO Network,,6.05,,,,,,,4.00,7.06,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,outpatient,,,7.28000,6.92000,The Alliance,PPO Network,,6.05,,,,,,,1.18,7.06,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,inpatient,,,69.07000,65.62000,The Alliance,PPO Network,,57.40,,,,,,,33.84,67.00,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,outpatient,,,69.07000,65.62000,The Alliance,PPO Network,,57.40,,,,,,,34.53,80.76,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,inpatient,,,976.08000,927.28000,The Alliance,PPO Network,,811.12,,,,,,,478.28,946.80,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,outpatient,,,976.08000,927.28000,The Alliance,PPO Network,,811.12,,,,,,,485.68,946.80,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,inpatient,,,14.34000,13.62000,The Alliance,PPO Network,,11.92,,,,,,,7.89,13.91,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,outpatient,,,14.34000,13.62000,The Alliance,PPO Network,,11.92,,,,,,,4.88,13.91,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,6.47,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,inpatient,,,11.87000,11.28000,The Alliance,PPO Network,,9.86,,,,,,,6.53,11.51,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,outpatient,,,11.87000,11.28000,The Alliance,PPO Network,,9.86,,,,,,,5.93,12.01,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,33.00,72.60,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.55550,0.97970,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.01000,0.96000,The Alliance,PPO Network,,0.83931,,,,,,,0.50500,0.97970,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,inpatient,,,1219.00000,1158.05000,The Alliance,PPO Network,,1012.99,,,,,,,597.31,1182.43,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,outpatient,,,1219.00000,1158.05000,The Alliance,PPO Network,,1012.99,,,,,,,559.52,1182.43,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,inpatient,,,20.24000,19.23000,The Alliance,PPO Network,,16.82,,,,,,,11.13,19.63,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,outpatient,,,20.24000,19.23000,The Alliance,PPO Network,,16.82,,,,,,,8.86,19.63,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,inpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,44.00,77.60,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,PPO Network,,66.48,,,,,,,4.97,77.60,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,NU,84.76,,,,,,,56.10,98.94,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,NU,84.76,,,,,,,51.00,98.94,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,inpatient,,,916.18000,870.37000,The Alliance,PPO Network,,761.35,,,,,,,448.93,888.69,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,outpatient,,,916.18000,870.37000,The Alliance,PPO Network,,761.35,,,,,,,455.88,888.69,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,inpatient,,,1431.00000,1359.45000,The Alliance,PPO Network,,1189.16,,,,,,,701.19,1388.07,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,PPO Network,,1189.16,,,,,,,508.43,1388.07,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,341.25000,324.19000,The Alliance,PPO Network,,283.58,,,,,,,187.69,331.01,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,341.25000,324.19000,The Alliance,PPO Network,,283.58,,,,,,,170.62,751.69,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,inpatient,,,139.36000,132.39000,The Alliance,PPO Network,NU,115.81,,,,,,,76.65,135.18,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,outpatient,,,139.36000,132.39000,The Alliance,PPO Network,NU,115.81,,,,,,,63.78,135.18,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,inpatient,,,176.52000,167.69000,The Alliance,PPO Network,NU,146.69,,,,,,,97.09,171.22,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,outpatient,,,176.52000,167.69000,The Alliance,PPO Network,NU,146.69,,,,,,,55.44,171.22,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,inpatient,,,49.62000,47.14000,The Alliance,PPO Network,NU,41.23,,,,,,,27.29,48.13,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,outpatient,,,49.62000,47.14000,The Alliance,PPO Network,NU,41.23,,,,,,,24.81,48.13,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,inpatient,,,364.24000,346.03000,The Alliance,PPO Network,NU,302.68,,,,,,,200.33,353.31,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,outpatient,,,364.24000,346.03000,The Alliance,PPO Network,NU,302.68,,,,,,,182.12,353.31,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,45.00000,42.75000,The Alliance,PPO Network,NU,37.40,,,,,,,24.75,43.65,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,PPO Network,NU,37.40,,,,,,,17.89,43.65,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,inpatient,,,13.00000,12.35000,The Alliance,PPO Network,,10.80,,,,,,,7.15,12.61,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,outpatient,,,13.00000,12.35000,The Alliance,PPO Network,,10.80,,,,,,,6.50,12.61,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,306.75000,291.41000,The Alliance,PPO Network,NU,254.91,,,,,,,168.71,297.55,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,306.75000,291.41000,The Alliance,PPO Network,NU,254.91,,,,,,,63.78,297.55,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,inpatient,,,7.73000,7.34000,The Alliance,PPO Network,,6.42,,,,,,,4.25,7.50,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,outpatient,,,7.73000,7.34000,The Alliance,PPO Network,,6.42,,,,,,,3.87,7.90,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,inpatient,,,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,4.99,8.80,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,outpatient,,,9.07000,8.62000,The Alliance,PPO Network,,7.54,,,,,,,3.33,8.80,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,The Alliance,PPO Network,UE,307.95,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,PPO Network,UE,307.95,,,,,,,132.85,359.46,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,31.04,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.97900,1.73,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.78000,1.69000,The Alliance,PPO Network,,1.48,,,,,,,0.89000,1.73,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,inpatient,,,6478.28000,6154.37000,The Alliance,PPO Network,,5383.45,,,,,,,3174.36,6283.93,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,outpatient,,,6478.28000,6154.37000,The Alliance,PPO Network,,5383.45,,,,,,,3223.54,6283.93,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,inpatient,,,461.88000,438.79000,The Alliance,PPO Network,NU,383.82,,,,,,,254.03,448.02,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,outpatient,,,461.88000,438.79000,The Alliance,PPO Network,NU,383.82,,,,,,,116.46,448.02,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,inpatient,1,mL,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.51700,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,PPO Network,,0.78114,,,,,,,0.19995,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.19995,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,inpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,PPO Network,,0.71466,,,,,,,0.19995,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.19995,0.76630,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,inpatient,1,mL,70.06000,66.56000,The Alliance,PPO Network,,58.22,,,,,,,38.53,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,outpatient,1,mL,70.06000,66.56000,The Alliance,PPO Network,,58.22,,,,,,,6.30,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,inpatient,1,mL,47.36000,44.99000,The Alliance,PPO Network,,39.36,,,,,,,26.05,45.94,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,outpatient,1,mL,47.36000,44.99000,The Alliance,PPO Network,,39.36,,,,,,,6.30,45.94,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,3725.18000,3538.92000,The Alliance,PPO Network,,3095.62,,,,,,,1825.34,3613.42,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,3725.18000,3538.92000,The Alliance,PPO Network,,3095.62,,,,,,,1709.86,3725.18,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,inpatient,,,1687.00000,1602.65000,The Alliance,PPO Network,90,1401.90,,,,,,,927.85,1636.39,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,outpatient,,,1687.00000,1602.65000,The Alliance,PPO Network,90,1401.90,,,,,,,162.98,8131.76,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,inpatient,,,2238.00000,2126.10000,The Alliance,PPO Network,90,1859.78,,,,,,,1230.90,2170.86,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,outpatient,,,2238.00000,2126.10000,The Alliance,PPO Network,90,1859.78,,,,,,,204.58,10355.70,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,10.86,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,inpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,inpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.62700,1.11,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,PPO Network,,0.94734,,,,,,,0.57000,1.11,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,inpatient,1,mL,78.08000,74.18000,The Alliance,PPO Network,,64.88,,,,,,,42.94,75.74,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,outpatient,1,mL,78.08000,74.18000,The Alliance,PPO Network,,64.88,,,,,,,39.04,75.74,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,405.56000,385.28000,The Alliance,PPO Network,,337.02,,,,,,,198.72,393.39,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,405.56000,385.28000,The Alliance,PPO Network,,337.02,,,,,,,186.15,405.56,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,118.34,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,inpatient,,,779.00000,740.05000,The Alliance,PPO Network,,647.35,,,,,,,428.45,755.63,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,outpatient,,,779.00000,740.05000,The Alliance,PPO Network,,647.35,,,,,,,389.50,6858.56,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.13200,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,PPO Network,,0.19944,,,,,,,0.12000,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,The Alliance,PPO Network,,854.27,,,,,,,503.72,997.16,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,PPO Network,,854.27,,,,,,,325.11,1028.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,TC,1186.67,,,,,,,785.40,1385.16,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,TC,1186.67,,,,,,,463.75,17311.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1755.00000,1667.25000,The Alliance,PPO Network,,1458.40,,,,,,,859.95,1702.35,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1755.00000,1667.25000,The Alliance,PPO Network,,1458.40,,,,,,,805.54,1755.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2454.50,5347.50,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,The Alliance,PPO Network,,4.11,,,,,,,2.72,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,PPO Network,,4.11,,,,,,,2.47,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,inpatient,1,EA,8.22000,7.80000,The Alliance,PPO Network,,6.83,,,,,,,4.52,7.97,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,outpatient,1,EA,8.22000,7.80000,The Alliance,PPO Network,,6.83,,,,,,,4.11,7.97,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,inpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,0.33945,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,inpatient,1,mL,6.86000,6.51000,The Alliance,PPO Network,,5.70,,,,,,,3.77,6.65,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,outpatient,1,mL,6.86000,6.51000,The Alliance,PPO Network,,5.70,,,,,,,0.33945,6.65,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,905.96000,860.66000,The Alliance,PPO Network,,752.85,,,,,,,443.92,878.78,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,905.96000,860.66000,The Alliance,PPO Network,,752.85,,,,,,,415.84,905.96,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,The Alliance,PPO Network,,757.25,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,PPO Network,,757.25,,,,,,,418.26,911.25,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,inpatient,,,4079.00000,3875.05000,The Alliance,PPO Network,TC,3389.65,,,,,,,2243.45,3956.63,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,outpatient,,,4079.00000,3875.05000,The Alliance,PPO Network,TC,3389.65,,,,,,,2039.50,52322.00,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,inpatient,,,1952.00000,1854.40000,The Alliance,PPO Network,TC,1622.11,,,,,,,1073.60,1893.44,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,PPO Network,TC,1622.11,,,,,,,976.00,52322.00,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.90,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,PPO Network,,4.38,,,,,,,2.63,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,inpatient,1,EA,35.83000,34.04000,The Alliance,PPO Network,,29.77,,,,,,,19.71,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,outpatient,1,EA,35.83000,34.04000,The Alliance,PPO Network,,29.77,,,,,,,17.91,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,inpatient,1,EA,13.44000,12.77000,The Alliance,PPO Network,,11.17,,,,,,,7.39,13.04,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,outpatient,1,EA,13.44000,12.77000,The Alliance,PPO Network,,11.17,,,,,,,6.72,13.04,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,28350.00000,26932.50000,The Alliance,PPO Network,,23558.85,,,,,,,13891.50,27499.50,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,28350.00000,26932.50000,The Alliance,PPO Network,,23558.85,,,,,,,13012.65,27499.50,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,inpatient,,,2371.00000,2252.45000,The Alliance,PPO Network,,1970.30,,,,,,,1304.05,2299.87,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,PPO Network,,1970.30,,,,,,,1304.05,5271.00,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,inpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,577.50,1018.50,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,PPO Network,,872.55,,,,,,,280.29,5858.00,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,3810.53000,3620.00000,The Alliance,PPO Network,,3166.55,,,,,,,1867.16,3696.21,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,3810.53000,3620.00000,The Alliance,PPO Network,,3166.55,,,,,,,1749.03,3810.53,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11005.00000,10454.75000,The Alliance,PPO Network,,9145.16,,,,,,,5392.45,10674.85,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11005.00000,10454.75000,The Alliance,PPO Network,,9145.16,,,,,,,5051.30,11005.00,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,275.62,545.62,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,258.19,562.50,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,The Alliance,PPO Network,,431.54,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,PPO Network,,431.54,,,,,,,238.36,519.30,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,inpatient,1,EA,265.32000,252.05000,The Alliance,PPO Network,,220.48,,,,,,,145.93,257.36,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,outpatient,1,EA,265.32000,252.05000,The Alliance,PPO Network,,220.48,,,,,,,132.66,257.36,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,inpatient,1,EA,15105.00000,14349.75000,The Alliance,PPO Network,,12552.25,,,,,,,8307.75,14651.85,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,outpatient,1,EA,15105.00000,14349.75000,The Alliance,PPO Network,,12552.25,,,,,,,206.13,14651.85,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,inpatient,,,1046.00000,993.70000,The Alliance,PPO Network,,869.23,,,,,,,512.54,1014.62,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,PPO Network,,869.23,,,,,,,523.00,1014.62,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,19.30,80.87,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,19.30,80.87,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,The Alliance,PPO Network,,30.41,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,PPO Network,,30.41,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,inpatient,1,EA,26.11000,24.81000,The Alliance,PPO Network,,21.70,,,,,,,14.36,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,outpatient,1,EA,26.11000,24.81000,The Alliance,PPO Network,,21.70,,,,,,,13.05,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,inpatient,1,EA,9.68000,9.20000,The Alliance,PPO Network,,8.04,,,,,,,5.32,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,outpatient,1,EA,9.68000,9.20000,The Alliance,PPO Network,,8.04,,,,,,,4.84,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,inpatient,1,EA,21.05000,20.00000,The Alliance,PPO Network,,17.49,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,PPO Network,,17.49,,,,,,,10.53,20.42,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,PPO Network,,10.84,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,PPO Network,,33.95,,,,,,,20.43,39.62,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,74.91,132.11,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,16.01,814.87,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,inpatient,,,710.00000,674.50000,The Alliance,PPO Network,,590.01,,,,,,,390.50,688.70,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,outpatient,,,710.00000,674.50000,The Alliance,PPO Network,,590.01,,,,,,,390.50,5271.00,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,29696.15,52373.21,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,PPO Network,,44868.18,,,,,,,4607.00,52373.21,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,189.20000,179.74000,The Alliance,PPO Network,,157.23,,,,,,,92.71,183.52,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,PPO Network,,157.23,,,,,,,86.84,189.20,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30690.00000,29155.50000,The Alliance,PPO Network,,25503.39,,,,,,,15038.10,29769.30,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30690.00000,29155.50000,The Alliance,PPO Network,,25503.39,,,,,,,14086.71,30690.00,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,97.02,192.06,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,90.88,198.00,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,424.88000,403.64000,The Alliance,PPO Network,,353.08,,,,,,,208.19,412.13,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,424.88000,403.64000,The Alliance,PPO Network,,353.08,,,,,,,195.02,424.88,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1328.81,2895.00,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1747.46000,1660.09000,The Alliance,PPO Network,,1452.14,,,,,,,856.26,1695.04,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1747.46000,1660.09000,The Alliance,PPO Network,,1452.14,,,,,,,802.08,1747.46,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,9642.75000,9160.61000,The Alliance,PPO Network,,8013.13,,,,,,,4724.95,9353.47,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,9642.75000,9160.61000,The Alliance,PPO Network,,8013.13,,,,,,,4426.02,9642.75,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,The Alliance,PPO Network,,757.25,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,PPO Network,,757.25,,,,,,,418.26,911.25,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,235.20,465.60,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,220.32,480.00,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,PPO Network,,0.09141,,,,,,,0.05500,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,23.25,197.88,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12220.20000,11609.19000,The Alliance,PPO Network,,10154.99,,,,,,,5987.90,11853.59,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12220.20000,11609.19000,The Alliance,PPO Network,,10154.99,,,,,,,5609.07,12220.20,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,PPO Network,,56715.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,9136.78,18087.10,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,PPO Network,,15495.24,,,,,,,8558.74,18646.50,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.40000,227.43000,The Alliance,PPO Network,,198.94,,,,,,,117.31,232.22,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.40000,227.43000,The Alliance,PPO Network,,198.94,,,,,,,109.88,239.40,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,inpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,75.90,133.86,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,PPO Network,,114.68,,,,,,,69.00,133.86,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,inpatient,1,mL,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.30250,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,PPO Network,,0.45705,,,,,,,0.08525,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,inpatient,1,mL,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,outpatient,1,mL,1.53000,1.45000,The Alliance,PPO Network,,1.27,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,inpatient,1,mL,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.08525,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,inpatient,1,mL,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.83050,1.46,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,outpatient,1,mL,1.51000,1.44000,The Alliance,PPO Network,,1.25,,,,,,,0.08525,1.46,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,inpatient,1,mL,119.99000,113.99000,The Alliance,PPO Network,,99.71,,,,,,,65.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,outpatient,1,mL,119.99000,113.99000,The Alliance,PPO Network,,99.71,,,,,,,59.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,inpatient,1,mL,134.30000,127.59000,The Alliance,PPO Network,,111.60,,,,,,,73.86,130.27,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,outpatient,1,mL,134.30000,127.59000,The Alliance,PPO Network,,111.60,,,,,,,67.15,130.27,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,inpatient,1,mL,2.45000,2.32000,The Alliance,PPO Network,,2.04,,,,,,,1.35,2.38,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,outpatient,1,mL,2.45000,2.32000,The Alliance,PPO Network,,2.04,,,,,,,1.23,2.38,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,inpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,59.61,105.14,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,PPO Network,,90.07,,,,,,,54.20,105.14,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,1.49,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,inpatient,1,mL,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,8.90,17.27,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,10625.41,21033.97,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3490.74000,3316.20000,The Alliance,PPO Network,,2900.80,,,,,,,1710.46,3386.02,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3490.74000,3316.20000,The Alliance,PPO Network,,2900.80,,,,,,,1602.25,3490.74,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,72.60000,68.97000,The Alliance,PPO Network,,60.33,,,,,,,35.57,70.42,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,72.60000,68.97000,The Alliance,PPO Network,,60.33,,,,,,,33.32,72.60,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,39.47,86.00,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,355.69000,337.91000,The Alliance,PPO Network,,295.58,,,,,,,174.29,345.02,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,355.69000,337.91000,The Alliance,PPO Network,,295.58,,,,,,,163.26,355.69,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,25668.00000,24384.60000,The Alliance,PPO Network,,21330.11,,,,,,,12577.32,24897.96,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,25668.00000,24384.60000,The Alliance,PPO Network,,21330.11,,,,,,,11781.61,25668.00,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,39.47,86.00,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,277.12,603.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1653.75,3273.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1549.12,3375.00,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,53.16000,50.50000,The Alliance,PPO Network,,44.18,,,,,,,26.05,51.57,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,53.16000,50.50000,The Alliance,PPO Network,,44.18,,,,,,,24.40,53.16,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,53.41,94.19,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,21.69,1289.24,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,90.20,159.08,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,,136.28,,,,,,,14.91,885.37,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,158.40,279.36,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,,239.33,,,,,,,144.00,1137.41,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,13.82,823.21,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,97.35,171.69,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,14.91,885.37,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,96.80,170.72,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,,146.26,,,,,,,14.91,885.37,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,inpatient,1,EA,2.95000,2.81000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,outpatient,1,EA,2.95000,2.81000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.63,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,PPO Network,,2.46,,,,,,,1.48,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,577.50000,548.62000,The Alliance,PPO Network,,479.90,,,,,,,282.98,560.17,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,577.50000,548.62000,The Alliance,PPO Network,,479.90,,,,,,,41.23,560.17,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,126.04000,119.74000,The Alliance,PPO Network,,104.74,,,,,,,69.32,122.26,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,126.04000,119.74000,The Alliance,PPO Network,,104.74,,,,,,,63.02,122.26,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.11,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,PPO Network,,1.68,,,,,,,1.01,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,inpatient,1,EA,2.04000,1.94000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,outpatient,1,EA,2.04000,1.94000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.44,2.53,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,PPO Network,,2.17,,,,,,,1.30,2.53,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,The Alliance,PPO Network,TC,1172.54,,,,,,,776.05,1368.67,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,PPO Network,TC,1172.54,,,,,,,705.50,1368.67,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,The Alliance,PPO Network,,30.41,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,PPO Network,,30.41,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,inpatient,1,EA,26.10000,24.80000,The Alliance,PPO Network,,21.69,,,,,,,14.36,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,outpatient,1,EA,26.10000,24.80000,The Alliance,PPO Network,,21.69,,,,,,,13.05,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,inpatient,1,EA,3.55000,3.38000,The Alliance,PPO Network,,2.95,,,,,,,1.95,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,outpatient,1,EA,3.55000,3.38000,The Alliance,PPO Network,,2.95,,,,,,,1.77,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,inpatient,1,EA,21.05000,19.99000,The Alliance,PPO Network,,17.49,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,outpatient,1,EA,21.05000,19.99000,The Alliance,PPO Network,,17.49,,,,,,,10.53,20.42,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,199.44000,189.47000,The Alliance,PPO Network,,165.73,,,,,,,109.69,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,199.44000,189.47000,The Alliance,PPO Network,,165.73,,,,,,,99.72,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,250.65000,238.12000,The Alliance,PPO Network,,208.29,,,,,,,137.86,243.13,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,250.65000,238.12000,The Alliance,PPO Network,,208.29,,,,,,,125.33,243.13,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,inpatient,,,2750.00000,2612.50000,The Alliance,PPO Network,,2285.25,,,,,,,1347.50,2667.50,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,outpatient,,,2750.00000,2612.50000,The Alliance,PPO Network,,2285.25,,,,,,,1262.25,2667.50,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,37.27,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,122.40,327.86,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,37.27,161.02,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,693.75000,659.06000,The Alliance,PPO Network,,576.51,,,,,,,339.94,672.94,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,PPO Network,,576.51,,,,,,,318.43,693.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,inpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,PPO Network,,280.88,,,,,,,122.40,327.86,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,TC,29.92,,,,,,,19.80,34.92,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,TC,29.92,,,,,,,18.00,34.92,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,inpatient,1,EA,106.41000,101.09000,The Alliance,PPO Network,,88.43,,,,,,,58.53,103.22,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,outpatient,1,EA,106.41000,101.09000,The Alliance,PPO Network,,88.43,,,,,,,53.20,103.22,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,inpatient,,,713.00000,677.35000,The Alliance,PPO Network,TC,592.50,,,,,,,392.15,691.61,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,outpatient,,,713.00000,677.35000,The Alliance,PPO Network,TC,592.50,,,,,,,356.50,691.61,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,The Alliance,PPO Network,TC,1371.98,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,PPO Network,TC,1371.98,,,,,,,805.84,2210.07,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,293.70,517.98,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,267.00,517.98,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,60.50,106.70,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,PPO Network,,91.41,,,,,,,55.00,106.70,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,TC,1893.02,,,,,,,979.11,2209.66,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,1016.40,1792.56,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,PPO Network,TC,1535.69,,,,,,,924.00,1820.00,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,284.01,618.75,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,inpatient,,,781.00000,741.95000,The Alliance,PPO Network,90,649.01,,,,,,,429.55,757.57,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,outpatient,,,781.00000,741.95000,The Alliance,PPO Network,90,649.01,,,,,,,12.05,1786.28,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,inpatient,,,126.20000,119.89000,The Alliance,PPO Network,90,104.87,,,,,,,69.41,122.41,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,outpatient,,,126.20000,119.89000,The Alliance,PPO Network,90,104.87,,,,,,,11.52,577.23,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,inpatient,,,971.00000,922.45000,The Alliance,PPO Network,90,806.90,,,,,,,534.05,941.87,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,PPO Network,90,806.90,,,,,,,143.40,8250.66,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,90,1233.20,,,,,,,816.20,1439.48,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,PPO Network,90,1233.20,,,,,,,664.97,8610.62,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,inpatient,1,EA,4864.22000,4621.01000,The Alliance,PPO Network,,4042.17,,,,,,,2675.32,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,outpatient,1,EA,4864.22000,4621.01000,The Alliance,PPO Network,,4042.17,,,,,,,7.24,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,inpatient,1,EA,4120.10000,3914.10000,The Alliance,PPO Network,,3423.80,,,,,,,2266.05,3996.50,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,outpatient,1,EA,4120.10000,3914.10000,The Alliance,PPO Network,,3423.80,,,,,,,7.24,3996.50,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,inpatient,1,mL,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.88,3.32,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,outpatient,1,mL,3.42000,3.25000,The Alliance,PPO Network,,2.84,,,,,,,1.71,3.32,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,inpatient,1,mL,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,1.63,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,PPO Network,,2.47,,,,,,,1.49,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,4721.18,10285.80,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,237.04,469.24,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,222.04,483.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,PPO Network,,32278.72,,,,,,,17829.04,38843.22,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,982.50000,933.38000,The Alliance,PPO Network,,816.46,,,,,,,481.43,953.02,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,PPO Network,,816.46,,,,,,,450.97,982.50,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,The Alliance,PPO Network,,1702.97,,,,,,,1127.12,1987.82,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,PPO Network,,1702.97,,,,,,,595.10,1987.82,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,inpatient,,,36.64000,34.81000,The Alliance,PPO Network,,30.45,,,,,,,20.15,35.54,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,outpatient,,,36.64000,34.81000,The Alliance,PPO Network,,30.45,,,,,,,18.32,35.54,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,inpatient,1,EA,7781.61000,7392.53000,The Alliance,PPO Network,,6466.52,,,,,,,4279.89,7548.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,outpatient,1,EA,7781.61000,7392.53000,The Alliance,PPO Network,,6466.52,,,,,,,136.23,7548.16,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,inpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,21.45,37.83,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,PPO Network,,32.41,,,,,,,19.50,37.83,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,inpatient,,,184.60000,175.37000,The Alliance,PPO Network,90,153.40,,,,,,,101.53,179.06,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,outpatient,,,184.60000,175.37000,The Alliance,PPO Network,90,153.40,,,,,,,16.88,848.80,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,23.00,979.27,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,inpatient,1,EA,5033.44000,4781.76000,The Alliance,PPO Network,,4182.79,,,,,,,2768.39,4882.44,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,outpatient,1,EA,5033.44000,4781.76000,The Alliance,PPO Network,,4182.79,,,,,,,36.26,4882.44,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,The Alliance,PPO Network,TC,2724.02,,,,,,,1802.90,3179.66,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,PPO Network,TC,2724.02,,,,,,,1489.61,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,PPO Network,,0.88917,,,,,,,0.53500,1.04,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,inpatient,1,EA,42.44000,40.32000,The Alliance,PPO Network,,35.27,,,,,,,23.34,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,outpatient,1,EA,42.44000,40.32000,The Alliance,PPO Network,,35.27,,,,,,,21.22,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,inpatient,1,EA,6.86000,6.51000,The Alliance,PPO Network,,5.70,,,,,,,3.77,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,outpatient,1,EA,6.86000,6.51000,The Alliance,PPO Network,,5.70,,,,,,,3.43,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,inpatient,1,EA,38.63000,36.70000,The Alliance,PPO Network,,32.10,,,,,,,21.25,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,outpatient,1,EA,38.63000,36.70000,The Alliance,PPO Network,,32.10,,,,,,,19.32,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.77,6.64,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,PPO Network,,5.69,,,,,,,3.42,6.64,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.66500,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,inpatient,1,EA,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,15.55,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,outpatient,1,EA,28.28000,26.87000,The Alliance,PPO Network,,23.50,,,,,,,14.14,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.29,2.27,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.27,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25659.63000,24376.65000,The Alliance,PPO Network,,21323.15,,,,,,,12573.22,24889.84,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25659.63000,24376.65000,The Alliance,PPO Network,,21323.15,,,,,,,11777.77,25659.63,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,30.87,61.11,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,28.92,63.00,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,76.44,151.32,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,71.60,156.00,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,510.40,900.16,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,PPO Network,,771.17,,,,,,,510.40,3163.00,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,inpatient,,,303.00000,287.85000,The Alliance,PPO Network,TC,251.79,,,,,,,166.65,293.91,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,PPO Network,TC,251.79,,,,,,,151.50,293.91,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,,1239.85,,,,,,,820.60,1447.24,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,,1239.85,,,,,,,746.00,2139.65,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,90,53.18,,,,,,,35.20,62.08,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,90,53.18,,,,,,,8.72,441.37,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,inpatient,,,286.00000,271.70000,The Alliance,PPO Network,,237.67,,,,,,,157.30,277.42,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,PPO Network,,237.67,,,,,,,143.00,4855.31,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4661.42,10155.60,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2030.96000,1929.41000,The Alliance,PPO Network,,1687.73,,,,,,,995.17,1970.03,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2030.96000,1929.41000,The Alliance,PPO Network,,1687.73,,,,,,,932.21,2030.96,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2715.00000,2579.25000,The Alliance,PPO Network,,2256.16,,,,,,,1330.35,2633.55,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,PPO Network,,2256.16,,,,,,,1246.18,2715.00,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,273.79,541.99,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,256.47,558.75,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,64.40000,61.18000,The Alliance,PPO Network,,53.52,,,,,,,31.56,62.47,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,64.40000,61.18000,The Alliance,PPO Network,,53.52,,,,,,,29.56,64.40,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5558.02,11002.61,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5206.39,11342.90,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2906.25000,2760.94000,The Alliance,PPO Network,,2415.09,,,,,,,1424.06,2819.06,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2906.25000,2760.94000,The Alliance,PPO Network,,2415.09,,,,,,,1333.97,2906.25,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,163.68000,155.50000,The Alliance,PPO Network,,136.02,,,,,,,90.02,158.77,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,163.68000,155.50000,The Alliance,PPO Network,,136.02,,,,,,,81.84,192.52,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.80,3.18,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,PPO Network,,2.73,,,,,,,1.64,3.18,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,inpatient,1,mL,992.83000,943.19000,The Alliance,PPO Network,,825.04,,,,,,,546.06,963.05,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,outpatient,1,mL,992.83000,943.19000,The Alliance,PPO Network,,825.04,,,,,,,114.64,963.05,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,727.50000,691.12000,The Alliance,PPO Network,,604.55,,,,,,,356.48,705.67,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,727.50000,691.12000,The Alliance,PPO Network,,604.55,,,,,,,333.92,727.50,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,PPO Network,,897.48,,,,,,,495.72,1080.00,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,626.53,1365.00,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,inpatient,1,mL,2.33000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.28,2.26,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,outpatient,1,mL,2.33000,2.22000,The Alliance,PPO Network,,1.94,,,,,,,1.17,2.26,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,The Alliance,PPO Network,TC,2847.84,,,,,,,1884.85,3324.19,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,PPO Network,TC,2847.84,,,,,,,1713.50,3324.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,inpatient,,,7997.10000,7597.24000,The Alliance,PPO Network,,6645.59,,,,,,,3918.58,7757.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,PPO Network,,6645.59,,,,,,,2236.93,7997.10,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1488.71000,1414.27000,The Alliance,PPO Network,,1237.12,,,,,,,729.47,1444.05,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1488.71000,1414.27000,The Alliance,PPO Network,,1237.12,,,,,,,683.32,1488.71,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,inpatient,,,805.00000,764.75000,The Alliance,PPO Network,TC,668.96,,,,,,,442.75,780.85,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,outpatient,,,805.00000,764.75000,The Alliance,PPO Network,TC,668.96,,,,,,,318.45,780.85,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,inpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,97.35,171.69,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,PPO Network,,147.09,,,,,,,97.35,3163.00,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,PPO Network,,44.08,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,459.38,909.38,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,430.31,937.50,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2786.25000,2646.94000,The Alliance,PPO Network,,2315.37,,,,,,,1365.26,2702.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2786.25000,2646.94000,The Alliance,PPO Network,,2315.37,,,,,,,1278.89,2786.25,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,The Alliance,PPO Network,,16938.12,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,PPO Network,,16938.12,,,,,,,9355.71,20382.81,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,182.97,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,0.95060,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,inpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,2.10,3.71,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,PPO Network,,3.17,,,,,,,1.91,3.71,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,PPO Network,,420.69,,,,,,,232.37,506.25,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,17.99,35.62,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,16.85,36.72,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70.56000,67.03000,The Alliance,PPO Network,,58.64,,,,,,,34.57,68.44,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,PPO Network,,58.64,,,,,,,32.39,70.56,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1420.03,3093.75,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,30.29,66.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,588.00,1164.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,550.80,1200.00,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,233.36,461.96,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,218.60,476.25,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,372.60000,353.97000,The Alliance,PPO Network,,309.63,,,,,,,204.93,361.42,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,372.60000,353.97000,The Alliance,PPO Network,,309.63,,,,,,,157.76,361.42,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,227.15,400.61,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,PPO Network,,343.20,,,,,,,157.76,400.61,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,inpatient,,,941.00000,893.95000,The Alliance,PPO Network,TC,781.97,,,,,,,517.55,912.77,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,PPO Network,TC,781.97,,,,,,,470.50,912.77,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,The Alliance,PPO Network,,1815.22,,,,,,,1070.35,2118.85,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,PPO Network,,1815.22,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,inpatient,,,2117.00000,2011.15000,The Alliance,PPO Network,TC,1759.23,,,,,,,1164.35,2053.49,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,outpatient,,,2117.00000,2011.15000,The Alliance,PPO Network,TC,1759.23,,,,,,,1058.50,11495.30,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,inpatient,,,2717.00000,2581.15000,The Alliance,PPO Network,TC,2257.83,,,,,,,1494.35,2635.49,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,outpatient,,,2717.00000,2581.15000,The Alliance,PPO Network,TC,2257.83,,,,,,,1358.50,17311.25,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,inpatient,1,EA,6485.63000,6161.35000,The Alliance,PPO Network,,5389.56,,,,,,,3567.10,6291.06,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,outpatient,1,EA,6485.63000,6161.35000,The Alliance,PPO Network,,5389.56,,,,,,,7.24,6291.06,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,inpatient,1,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.66550,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,PPO Network,,1.01,,,,,,,0.60500,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,1.16,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,inpatient,1,mL,2392.75000,2273.11000,The Alliance,PPO Network,,1988.38,,,,,,,1316.01,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,outpatient,1,mL,2392.75000,2273.11000,The Alliance,PPO Network,,1988.38,,,,,,,12.00,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,inpatient,1,mL,2460.93000,2337.88000,The Alliance,PPO Network,,2045.03,,,,,,,1353.51,2387.10,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,outpatient,1,mL,2460.93000,2337.88000,The Alliance,PPO Network,,2045.03,,,,,,,12.00,2387.10,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9528.90000,9052.46000,The Alliance,PPO Network,,7918.52,,,,,,,4669.16,9243.03,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9528.90000,9052.46000,The Alliance,PPO Network,,7918.52,,,,,,,4373.77,9528.90,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,330.75,654.75,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,309.82,675.00,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,The Alliance,PPO Network,,1652.86,,,,,,,1093.95,1929.33,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,PPO Network,,1652.86,,,,,,,122.40,1929.33,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,The Alliance,PPO Network,,8177.70,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,PPO Network,,8177.70,,,,,,,4516.93,9840.80,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,445.31000,423.04000,The Alliance,PPO Network,,370.05,,,,,,,244.92,431.95,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,445.31000,423.04000,The Alliance,PPO Network,,370.05,,,,,,,143.61,874.50,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.56,4.51,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,PPO Network,,3.86,,,,,,,2.33,4.51,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,inpatient,1,GM,77.47000,73.60000,The Alliance,PPO Network,,64.38,,,,,,,42.61,75.15,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,outpatient,1,GM,77.47000,73.60000,The Alliance,PPO Network,,64.38,,,,,,,38.73,75.15,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,The Alliance,PPO Network,TC,2310.18,,,,,,,1529.00,2696.60,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,PPO Network,TC,2310.18,,,,,,,1390.00,2696.60,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,385.56,840.00,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,PPO Network,,84.36,,,,,,,46.60,101.52,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,264.00,465.60,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,264.00,5271.00,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,PPO Network,,188.54,,,,,,,104.14,226.88,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,inpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,154.00,271.60,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,PPO Network,,232.68,,,,,,,126.65,271.60,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,PPO Network,90,94.73,,,,,,,62.70,110.58,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,PPO Network,90,94.73,,,,,,,13.35,679.08,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,inpatient,,,10.00000,9.50000,The Alliance,PPO Network,90,8.31,,,,,,,5.50,9.70,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,PPO Network,90,8.31,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,inpatient,,,191.00000,181.45000,The Alliance,PPO Network,90,158.72,,,,,,,105.05,185.27,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,PPO Network,90,158.72,,,,,,,17.01,865.84,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,PPO Network,90,51.52,,,,,,,34.10,60.14,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,PPO Network,90,51.52,,,,,,,5.35,271.65,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,inpatient,,,176.90000,168.06000,The Alliance,PPO Network,90,147.00,,,,,,,97.30,171.59,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,outpatient,,,176.90000,168.06000,The Alliance,PPO Network,90,147.00,,,,,,,15.27,780.94,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,inpatient,,,98.20000,93.29000,The Alliance,PPO Network,90,81.60,,,,,,,54.01,95.25,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,outpatient,,,98.20000,93.29000,The Alliance,PPO Network,90,81.60,,,,,,,8.17,679.08,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,inpatient,,,178.30000,169.38000,The Alliance,PPO Network,90,148.17,,,,,,,98.06,172.95,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,outpatient,,,178.30000,169.38000,The Alliance,PPO Network,90,148.17,,,,,,,16.37,831.84,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,inpatient,,,582.00000,552.90000,The Alliance,PPO Network,90,483.64,,,,,,,320.10,564.54,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,outpatient,,,582.00000,552.90000,The Alliance,PPO Network,90,483.64,,,,,,,291.00,839.96,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,inpatient,,,343.70000,326.52000,The Alliance,PPO Network,90,285.61,,,,,,,189.03,333.39,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,outpatient,,,343.70000,326.52000,The Alliance,PPO Network,90,285.61,,,,,,,19.00,865.84,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,222.04,483.75,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,18.36,40.00,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,643.12,1273.12,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,602.44,1312.50,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,279.53,609.00,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,2995.31000,2845.54000,The Alliance,PPO Network,,2489.10,,,,,,,1467.70,2905.45,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,2995.31000,2845.54000,The Alliance,PPO Network,,2489.10,,,,,,,1374.85,2995.31,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,548.10000,520.70000,The Alliance,PPO Network,,455.47,,,,,,,301.45,531.66,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,548.10000,520.70000,The Alliance,PPO Network,,455.47,,,,,,,211.37,531.66,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,PPO Network,TC,766.18,,,,,,,507.10,894.34,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,PPO Network,TC,766.18,,,,,,,391.31,29731.35,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,inpatient,1,mL,9.14000,8.69000,The Alliance,PPO Network,,7.60,,,,,,,5.03,8.87,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,outpatient,1,mL,9.14000,8.69000,The Alliance,PPO Network,,7.60,,,,,,,1.49,8.87,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,The Alliance,PPO Network,,1029.61,,,,,,,681.45,1201.83,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,PPO Network,,1029.61,,,,,,,498.67,1201.83,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,2.51,4.43,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,1.49,4.43,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,331.88000,315.29000,The Alliance,PPO Network,,275.79,,,,,,,162.62,321.92,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,331.88000,315.29000,The Alliance,PPO Network,,275.79,,,,,,,152.33,331.88,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,The Alliance,PPO Network,,1727.65,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,PPO Network,,1727.65,,,,,,,954.26,2079.00,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.75000,359.81000,The Alliance,PPO Network,,314.74,,,,,,,185.59,367.39,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.75000,359.81000,The Alliance,PPO Network,,314.74,,,,,,,173.85,378.75,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,900.00000,855.00000,The Alliance,PPO Network,,747.90,,,,,,,441.00,873.00,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,900.00000,855.00000,The Alliance,PPO Network,,747.90,,,,,,,413.10,900.00,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,The Alliance,PPO Network,,7153.04,,,,,,,4217.80,8349.52,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,PPO Network,,7153.04,,,,,,,3950.96,8607.75,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,550.80,1200.00,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1887.98000,1793.58000,The Alliance,PPO Network,,1568.91,,,,,,,925.11,1831.34,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1887.98000,1793.58000,The Alliance,PPO Network,,1568.91,,,,,,,866.58,1887.98,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,PPO Network,,698.04,,,,,,,385.56,840.00,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,PPO Network,,705.83,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4661.42,10155.60,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,5271.00,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,inpatient,,,94.00000,89.30000,The Alliance,PPO Network,,78.11,,,,,,,51.70,91.18,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,outpatient,,,94.00000,89.30000,The Alliance,PPO Network,,78.11,,,,,,,51.70,5271.00,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,PPO Network,,176.07,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,218.60,476.25,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,inpatient,,,117.80000,111.91000,The Alliance,PPO Network,90,97.89,,,,,,,64.79,114.27,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,outpatient,,,117.80000,111.91000,The Alliance,PPO Network,90,97.89,,,,,,,14.65,984.66,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,The Alliance,PPO Network,,1029.61,,,,,,,681.45,1201.83,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,PPO Network,,1029.61,,,,,,,498.67,1201.83,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,inpatient,,,73500.00000,69825.00000,The Alliance,PPO Network,,61078.50,,,,,,,36015.00,71295.00,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,outpatient,,,73500.00000,69825.00000,The Alliance,PPO Network,,61078.50,,,,,,,33736.50,73500.00,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,inpatient,,,5128.00000,4871.60000,The Alliance,PPO Network,,4261.37,,,,,,,2820.40,4974.16,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,outpatient,,,5128.00000,4871.60000,The Alliance,PPO Network,,4261.37,,,,,,,384.16,4974.16,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,The Alliance,PPO Network,,5733.90,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,PPO Network,,5733.90,,,,,,,3167.10,6900.00,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,626.53,1365.00,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,The Alliance,PPO Network,,3653.08,,,,,,,2417.80,4264.12,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,PPO Network,,3653.08,,,,,,,966.05,4264.12,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,The Alliance,PPO Network,,369.80,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,PPO Network,,369.80,,,,,,,244.75,3163.00,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,488.05000,463.65000,The Alliance,PPO Network,,405.57,,,,,,,268.43,473.41,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,488.05000,463.65000,The Alliance,PPO Network,,405.57,,,,,,,158.39,473.41,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,inpatient,,,120.40000,114.38000,The Alliance,PPO Network,90,100.05,,,,,,,66.22,116.79,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,outpatient,,,120.40000,114.38000,The Alliance,PPO Network,90,100.05,,,,,,,60.20,1137.41,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10064.34000,9561.12000,The Alliance,PPO Network,,8363.47,,,,,,,4931.53,9762.41,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10064.34000,9561.12000,The Alliance,PPO Network,,8363.47,,,,,,,4619.53,10064.34,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,50.96,100.88,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,47.74,104.00,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11169.30000,10610.83000,The Alliance,PPO Network,,9281.69,,,,,,,5472.96,10834.22,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11169.30000,10610.83000,The Alliance,PPO Network,,9281.69,,,,,,,5126.71,11169.30,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4623.00000,4391.85000,The Alliance,PPO Network,,3841.71,,,,,,,2265.27,4484.31,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4623.00000,4391.85000,The Alliance,PPO Network,,3841.71,,,,,,,2121.96,4623.00,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,988.88000,939.44000,The Alliance,PPO Network,,821.76,,,,,,,484.55,959.21,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,988.88000,939.44000,The Alliance,PPO Network,,821.76,,,,,,,453.90,988.88,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,TC,1116.86,,,,,,,672.00,1820.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,inpatient,,,707.00000,671.65000,The Alliance,PPO Network,,587.52,,,,,,,388.85,685.79,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,outpatient,,,707.00000,671.65000,The Alliance,PPO Network,,587.52,,,,,,,353.50,697.17,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,765.00000,726.75000,The Alliance,PPO Network,,635.72,,,,,,,374.85,742.05,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,765.00000,726.75000,The Alliance,PPO Network,,635.72,,,,,,,351.13,765.00,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.64000,99.41000,The Alliance,PPO Network,,86.96,,,,,,,51.27,101.50,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.64000,99.41000,The Alliance,PPO Network,,86.96,,,,,,,48.03,104.64,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,381.56000,362.48000,The Alliance,PPO Network,,317.08,,,,,,,186.96,370.11,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,381.56000,362.48000,The Alliance,PPO Network,,317.08,,,,,,,175.14,381.56,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1669.61,3637.50,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,inpatient,,,837.00000,795.15000,The Alliance,PPO Network,TC,695.55,,,,,,,460.35,811.89,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,PPO Network,TC,695.55,,,,,,,418.50,811.89,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1024.14,2231.25,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3912.30000,3716.68000,The Alliance,PPO Network,,3251.12,,,,,,,1917.03,3794.93,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3912.30000,3716.68000,The Alliance,PPO Network,,3251.12,,,,,,,1795.75,3912.30,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,The Alliance,PPO Network,,19021.59,,,,,,,11216.10,22203.30,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,PPO Network,,19021.59,,,,,,,10506.51,22890.00,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,509.06000,483.61000,The Alliance,PPO Network,,423.03,,,,,,,279.98,493.79,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,509.06000,483.61000,The Alliance,PPO Network,,423.03,,,,,,,44.30,493.79,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,241.50000,229.42000,The Alliance,PPO Network,,200.69,,,,,,,118.33,234.25,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,241.50000,229.42000,The Alliance,PPO Network,,200.69,,,,,,,120.75,485.24,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,The Alliance,PPO Network,,315.36,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,PPO Network,,315.36,,,,,,,157.76,368.12,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,inpatient,,,922.00000,875.90000,The Alliance,PPO Network,,766.18,,,,,,,507.10,894.34,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,PPO Network,,766.18,,,,,,,379.37,894.34,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10192.80000,9683.16000,The Alliance,PPO Network,,8470.22,,,,,,,4994.47,9887.02,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,PPO Network,,8470.22,,,,,,,4678.50,10192.80,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12077.43,26312.49,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,12555.00000,11927.25000,The Alliance,PPO Network,,10433.20,,,,,,,6151.95,12178.35,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12555.00000,11927.25000,The Alliance,PPO Network,,10433.20,,,,,,,5762.74,12178.35,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,The Alliance,PPO Network,,372.70,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,PPO Network,,372.70,,,,,,,205.86,448.50,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,inpatient,1,GM,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.64,4.66,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,outpatient,1,GM,4.80000,4.56000,The Alliance,PPO Network,,3.99,,,,,,,2.40,4.66,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,inpatient,1,GM,59.25000,56.29000,The Alliance,PPO Network,,49.24,,,,,,,32.59,57.47,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,outpatient,1,GM,59.25000,56.29000,The Alliance,PPO Network,,49.24,,,,,,,29.62,57.47,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,inpatient,1,EA,12.89000,12.25000,The Alliance,PPO Network,,10.71,,,,,,,7.09,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,outpatient,1,EA,12.89000,12.25000,The Alliance,PPO Network,,10.71,,,,,,,0.26000,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,inpatient,1,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,8.34,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,PPO Network,,12.61,,,,,,,0.26000,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,inpatient,1,EA,19.21000,18.25000,The Alliance,PPO Network,,15.96,,,,,,,10.57,18.63,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,outpatient,1,EA,19.21000,18.25000,The Alliance,PPO Network,,15.96,,,,,,,0.26000,18.63,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,inpatient,,,471.00000,447.45000,The Alliance,PPO Network,,391.40,,,,,,,259.05,456.87,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,outpatient,,,471.00000,447.45000,The Alliance,PPO Network,,391.40,,,,,,,37.73,1969.25,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,0.48500,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,249.71,14445.56,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,PPO Network,,7937.71,,,,,,,549.28,20208.37,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,The Alliance,PPO Network,TC,1263.12,,,,,,,836.00,1474.40,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,PPO Network,TC,1263.12,,,,,,,726.61,7529.89,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,The Alliance,PPO Network,,1229.05,,,,,,,813.45,1434.63,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,PPO Network,,1229.05,,,,,,,347.60,8423.93,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,245.30,432.62,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,PPO Network,,370.63,,,,,,,34.43,1799.53,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,inpatient,,,1208.00000,1147.60000,The Alliance,PPO Network,,1003.85,,,,,,,664.40,1171.76,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,outpatient,,,1208.00000,1147.60000,The Alliance,PPO Network,,1003.85,,,,,,,604.00,1171.76,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,inpatient,,,1957.00000,1859.15000,The Alliance,PPO Network,TC,1626.27,,,,,,,1076.35,1898.29,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,outpatient,,,1957.00000,1859.15000,The Alliance,PPO Network,TC,1626.27,,,,,,,978.50,2032.87,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,inpatient,,,1952.00000,1854.40000,The Alliance,PPO Network,TC,1622.11,,,,,,,1073.60,1893.44,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,PPO Network,TC,1622.11,,,,,,,976.00,2032.87,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,99.55,175.57,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,,150.41,,,,,,,90.50,317.72,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,64.90,114.46,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,59.00,619.83,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,The Alliance,PPO Network,,5733.90,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,PPO Network,,5733.90,,,,,,,3167.10,6900.00,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,740.51,1465.91,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,693.66,1511.25,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24370.50000,23151.97000,The Alliance,PPO Network,,20251.89,,,,,,,11941.55,23639.38,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24370.50000,23151.97000,The Alliance,PPO Network,,20251.89,,,,,,,11186.06,24370.50,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,The Alliance,PPO Network,,21783.50,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,PPO Network,,21783.50,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,5905.03,12865.00,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1927.17,3815.01,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1805.25,3933.00,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,The Alliance,PPO Network,,315.36,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,PPO Network,,315.36,,,,,,,157.76,368.12,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,inpatient,,,452.00000,429.40000,The Alliance,PPO Network,TC,375.61,,,,,,,248.60,438.44,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,PPO Network,TC,375.61,,,,,,,226.00,438.44,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,inpatient,,,23.07000,21.92000,The Alliance,PPO Network,,19.17,,,,,,,12.69,22.38,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,outpatient,,,23.07000,21.92000,The Alliance,PPO Network,,19.17,,,,,,,11.54,23.80,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,2.02,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,PPO Network,,3.05,,,,,,,1.83,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,inpatient,1,EA,17.16000,16.30000,The Alliance,PPO Network,,14.26,,,,,,,9.44,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,outpatient,1,EA,17.16000,16.30000,The Alliance,PPO Network,,14.26,,,,,,,8.58,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,3.38,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,10.40000,9.88000,The Alliance,PPO Network,,8.64,,,,,,,5.72,10.09,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,10.40000,9.88000,The Alliance,PPO Network,,8.64,,,,,,,5.20,10.66,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,70.44000,66.92000,The Alliance,PPO Network,,58.54,,,,,,,38.74,68.33,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,70.44000,66.92000,The Alliance,PPO Network,,58.54,,,,,,,35.22,68.33,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,99.47000,94.50000,The Alliance,PPO Network,,82.66,,,,,,,48.74,96.49,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,99.47000,94.50000,The Alliance,PPO Network,,82.66,,,,,,,49.73,639.03,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,87.25000,82.89000,The Alliance,PPO Network,,72.50,,,,,,,47.99,84.63,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,87.25000,82.89000,The Alliance,PPO Network,,72.50,,,,,,,43.62,84.63,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,78.40000,74.48000,The Alliance,PPO Network,,65.15,,,,,,,43.12,76.05,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,PPO Network,,65.15,,,,,,,39.20,76.05,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,11.78000,11.19000,The Alliance,PPO Network,,9.79,,,,,,,6.48,11.43,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,11.78000,11.19000,The Alliance,PPO Network,,9.79,,,,,,,5.89,11.43,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,69.33000,65.86000,The Alliance,PPO Network,,57.61,,,,,,,38.13,67.25,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,69.33000,65.86000,The Alliance,PPO Network,,57.61,,,,,,,34.66,67.25,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,36.13000,34.32000,The Alliance,PPO Network,,30.02,,,,,,,19.87,35.05,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,36.13000,34.32000,The Alliance,PPO Network,,30.02,,,,,,,18.07,35.05,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,153.40000,145.73000,The Alliance,PPO Network,,127.48,,,,,,,84.37,148.80,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,153.40000,145.73000,The Alliance,PPO Network,,127.48,,,,,,,76.70,148.80,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.53000,29.00000,The Alliance,PPO Network,,25.37,,,,,,,16.79,29.61,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,PPO Network,,25.37,,,,,,,15.27,29.61,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,81.40,143.56,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,PPO Network,,122.99,,,,,,,74.00,143.56,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,209.31000,198.84000,The Alliance,PPO Network,,173.94,,,,,,,115.12,203.03,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,209.31000,198.84000,The Alliance,PPO Network,,173.94,,,,,,,104.66,203.03,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,160.90000,152.85000,The Alliance,PPO Network,,133.71,,,,,,,88.50,156.07,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,160.90000,152.85000,The Alliance,PPO Network,,133.71,,,,,,,80.45,156.07,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,40.67000,38.64000,The Alliance,PPO Network,,33.80,,,,,,,22.37,39.45,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,40.67000,38.64000,The Alliance,PPO Network,,33.80,,,,,,,20.34,39.45,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,49.47000,47.00000,The Alliance,PPO Network,,41.11,,,,,,,27.21,47.99,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,49.47000,47.00000,The Alliance,PPO Network,,41.11,,,,,,,24.73,47.99,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,370.50000,351.97000,The Alliance,PPO Network,,307.89,,,,,,,203.78,359.38,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,370.50000,351.97000,The Alliance,PPO Network,,307.89,,,,,,,185.25,359.38,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.20000,41.04000,The Alliance,PPO Network,,35.90,,,,,,,23.76,41.90,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.20000,41.04000,The Alliance,PPO Network,,35.90,,,,,,,21.60,41.90,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,59.60000,56.62000,The Alliance,PPO Network,,49.53,,,,,,,32.78,57.81,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,PPO Network,,49.53,,,,,,,29.80,57.81,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.80,15.52,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.00,15.52,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,182.76000,173.62000,The Alliance,PPO Network,,151.87,,,,,,,100.52,177.28,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,182.76000,173.62000,The Alliance,PPO Network,,151.87,,,,,,,91.38,177.28,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,15.60000,14.82000,The Alliance,PPO Network,NU,12.96,,,,,,,8.58,15.13,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,15.60000,14.82000,The Alliance,PPO Network,NU,12.96,,,,,,,7.80,16.05,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,80.44000,76.42000,The Alliance,PPO Network,,66.85,,,,,,,39.42,78.03,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,80.44000,76.42000,The Alliance,PPO Network,,66.85,,,,,,,40.22,349.06,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,29.60000,28.12000,The Alliance,PPO Network,,24.60,,,,,,,14.50,28.71,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,29.60000,28.12000,The Alliance,PPO Network,,24.60,,,,,,,14.80,28.71,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,inpatient,,,20.27000,19.26000,The Alliance,PPO Network,,16.84,,,,,,,11.15,19.66,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,outpatient,,,20.27000,19.26000,The Alliance,PPO Network,,16.84,,,,,,,10.13,19.66,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.68000,92.80000,The Alliance,PPO Network,,81.17,,,,,,,53.72,94.75,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.68000,92.80000,The Alliance,PPO Network,,81.17,,,,,,,48.84,94.75,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,78.80000,74.86000,The Alliance,PPO Network,,65.48,,,,,,,38.61,76.44,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,78.80000,74.86000,The Alliance,PPO Network,,65.48,,,,,,,39.40,76.44,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,The Alliance,PPO Network,,53.58,,,,,,,35.46,62.55,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,PPO Network,,53.58,,,,,,,32.24,62.55,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,89.56000,85.08000,The Alliance,PPO Network,,74.42,,,,,,,49.26,86.87,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,89.56000,85.08000,The Alliance,PPO Network,,74.42,,,,,,,44.78,86.87,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,671.26000,637.70000,The Alliance,PPO Network,,557.82,,,,,,,369.19,651.12,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,671.26000,637.70000,The Alliance,PPO Network,,557.82,,,,,,,335.63,651.12,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,104.10000,98.89000,The Alliance,PPO Network,,86.51,,,,,,,57.26,100.98,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,104.10000,98.89000,The Alliance,PPO Network,,86.51,,,,,,,52.05,100.98,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,inpatient,,,66.50000,63.17000,The Alliance,PPO Network,NU,55.26,,,,,,,36.58,64.50,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,outpatient,,,66.50000,63.17000,The Alliance,PPO Network,NU,55.26,,,,,,,33.25,64.50,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,100.08000,95.08000,The Alliance,PPO Network,,83.17,,,,,,,49.04,97.08,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,100.08000,95.08000,The Alliance,PPO Network,,83.17,,,,,,,50.04,232.52,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,inpatient,,,30.53000,29.00000,The Alliance,PPO Network,,25.37,,,,,,,16.79,29.61,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,PPO Network,,25.37,,,,,,,15.27,29.61,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,19.97000,18.97000,The Alliance,PPO Network,,16.60,,,,,,,9.79,19.37,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,19.97000,18.97000,The Alliance,PPO Network,,16.60,,,,,,,9.17,19.37,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,20.30000,19.28000,The Alliance,PPO Network,,16.87,,,,,,,11.16,19.69,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,20.30000,19.28000,The Alliance,PPO Network,,16.87,,,,,,,10.15,19.69,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,23.33000,22.16000,The Alliance,PPO Network,,19.39,,,,,,,12.83,22.63,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,23.33000,22.16000,The Alliance,PPO Network,,19.39,,,,,,,2.63,22.63,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,268.98000,255.53000,The Alliance,PPO Network,,223.52,,,,,,,147.94,260.91,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,268.98000,255.53000,The Alliance,PPO Network,,223.52,,,,,,,134.49,260.91,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,21.70000,20.61000,The Alliance,PPO Network,,18.03,,,,,,,11.94,21.05,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,21.70000,20.61000,The Alliance,PPO Network,,18.03,,,,,,,10.85,21.05,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,321.94000,305.84000,The Alliance,PPO Network,NU,267.53,,,,,,,177.07,312.28,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,321.94000,305.84000,The Alliance,PPO Network,NU,267.53,,,,,,,70.83,312.28,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,79.20000,75.24000,The Alliance,PPO Network,,65.82,,,,,,,43.56,76.82,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,79.20000,75.24000,The Alliance,PPO Network,,65.82,,,,,,,39.60,76.82,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,276.53000,262.70000,The Alliance,PPO Network,,229.80,,,,,,,152.09,268.23,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,276.53000,262.70000,The Alliance,PPO Network,,229.80,,,,,,,138.26,268.23,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,401.25000,381.19000,The Alliance,PPO Network,,333.44,,,,,,,220.69,389.21,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,401.25000,381.19000,The Alliance,PPO Network,,333.44,,,,,,,200.62,389.21,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,58.00,112.52,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,359.81000,341.82000,The Alliance,PPO Network,,299.00,,,,,,,197.90,349.02,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,359.81000,341.82000,The Alliance,PPO Network,,299.00,,,,,,,179.91,349.02,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,702.00000,666.90000,The Alliance,PPO Network,,583.36,,,,,,,386.10,680.94,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,702.00000,666.90000,The Alliance,PPO Network,,583.36,,,,,,,351.00,680.94,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,inpatient,,,251.80000,239.21000,The Alliance,PPO Network,,209.25,,,,,,,123.38,244.25,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,outpatient,,,251.80000,239.21000,The Alliance,PPO Network,,209.25,,,,,,,115.58,244.25,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,96.04,190.12,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,89.96,190.12,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,233.36,461.96,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,218.60,461.96,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,73.50,145.50,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,68.85,145.50,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,517.50000,491.62000,The Alliance,PPO Network,,430.04,,,,,,,253.57,501.98,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,517.50000,491.62000,The Alliance,PPO Network,,430.04,,,,,,,237.53,501.98,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,13.80000,13.11000,The Alliance,PPO Network,,11.47,,,,,,,7.59,13.39,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,13.80000,13.11000,The Alliance,PPO Network,,11.47,,,,,,,6.90,13.39,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,351.10000,333.54000,The Alliance,PPO Network,,291.76,,,,,,,193.10,340.57,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,351.10000,333.54000,The Alliance,PPO Network,,291.76,,,,,,,175.55,340.57,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,22.00,38.80,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,PPO Network,,33.24,,,,,,,20.00,38.80,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,inpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,142.45,251.23,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,PPO Network,,215.23,,,,,,,129.50,251.23,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,137.16,241.90,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,PPO Network,,207.23,,,,,,,124.69,241.90,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,181.40000,172.33000,The Alliance,PPO Network,,150.74,,,,,,,88.89,175.96,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,181.40000,172.33000,The Alliance,PPO Network,,150.74,,,,,,,83.26,175.96,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,inpatient,,,18.56000,17.63000,The Alliance,PPO Network,,15.42,,,,,,,9.09,18.00,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,outpatient,,,18.56000,17.63000,The Alliance,PPO Network,,15.42,,,,,,,8.52,18.00,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,195.08000,185.33000,The Alliance,PPO Network,,162.11,,,,,,,95.59,189.23,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,195.08000,185.33000,The Alliance,PPO Network,,162.11,,,,,,,89.54,189.23,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,275.62,545.62,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,PPO Network,,467.44,,,,,,,105.37,545.62,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,59.90000,56.90000,The Alliance,PPO Network,,49.78,,,,,,,29.35,58.10,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,59.90000,56.90000,The Alliance,PPO Network,,49.78,,,,,,,29.95,65.22,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,584.33000,555.11000,The Alliance,PPO Network,,485.58,,,,,,,321.38,566.80,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,584.33000,555.11000,The Alliance,PPO Network,,485.58,,,,,,,292.17,566.80,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,inpatient,,,356.30000,338.48000,The Alliance,PPO Network,,296.09,,,,,,,195.97,345.61,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,outpatient,,,356.30000,338.48000,The Alliance,PPO Network,,296.09,,,,,,,178.15,345.61,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,152.51,301.91,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,PPO Network,,258.65,,,,,,,142.86,301.91,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,97.39,192.79,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,PPO Network,,165.16,,,,,,,91.23,192.79,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,55.07000,52.32000,The Alliance,PPO Network,,45.76,,,,,,,30.29,53.42,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,55.07000,52.32000,The Alliance,PPO Network,,45.76,,,,,,,27.54,53.42,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,926.00000,879.70000,The Alliance,PPO Network,,769.51,,,,,,,509.30,898.22,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,926.00000,879.70000,The Alliance,PPO Network,,769.51,,,,,,,463.00,898.22,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,596.00000,566.20000,The Alliance,PPO Network,,495.28,,,,,,,292.04,578.12,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,596.00000,566.20000,The Alliance,PPO Network,,495.28,,,,,,,273.56,578.12,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,228.79000,217.35000,The Alliance,PPO Network,,190.12,,,,,,,125.83,221.93,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,228.79000,217.35000,The Alliance,PPO Network,,190.12,,,,,,,114.39,221.93,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,263.81000,250.62000,The Alliance,PPO Network,NU,219.23,,,,,,,145.10,255.90,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,263.81000,250.62000,The Alliance,PPO Network,NU,219.23,,,,,,,62.66,255.90,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,87.08000,82.73000,The Alliance,PPO Network,,72.36,,,,,,,42.67,84.47,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,87.08000,82.73000,The Alliance,PPO Network,,72.36,,,,,,,43.54,135.57,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,76.44,151.32,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,71.60,151.32,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,25.10000,23.84000,The Alliance,PPO Network,,20.86,,,,,,,13.80,24.35,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,25.10000,23.84000,The Alliance,PPO Network,,20.86,,,,,,,12.55,24.35,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,100.44000,95.42000,The Alliance,PPO Network,,83.47,,,,,,,49.22,97.43,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,100.44000,95.42000,The Alliance,PPO Network,,83.47,,,,,,,39.47,97.43,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,98.67000,93.74000,The Alliance,PPO Network,,81.99,,,,,,,54.27,95.71,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,98.67000,93.74000,The Alliance,PPO Network,,81.99,,,,,,,49.34,95.71,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,507.00000,481.65000,The Alliance,PPO Network,,421.32,,,,,,,278.85,491.79,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,PPO Network,,421.32,,,,,,,253.50,491.79,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,The Alliance,PPO Network,,142.27,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,PPO Network,,142.27,,,,,,,85.60,166.06,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,159.90000,151.90000,The Alliance,PPO Network,,132.88,,,,,,,87.94,155.10,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,159.90000,151.90000,The Alliance,PPO Network,,132.88,,,,,,,44.30,155.10,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,231.38000,219.81000,The Alliance,PPO Network,,192.28,,,,,,,113.38,224.44,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,231.38000,219.81000,The Alliance,PPO Network,,192.28,,,,,,,106.20,224.44,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,104.00,201.76,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,107.80,190.12,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,PPO Network,,162.88,,,,,,,98.00,190.12,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,39.80000,37.81000,The Alliance,PPO Network,,33.07,,,,,,,21.89,38.61,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,39.80000,37.81000,The Alliance,PPO Network,,33.07,,,,,,,19.90,38.61,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,193.71000,184.02000,The Alliance,PPO Network,,160.97,,,,,,,94.92,187.90,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,193.71000,184.02000,The Alliance,PPO Network,,160.97,,,,,,,88.91,187.90,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,101.20,178.48,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,,152.90,,,,,,,92.00,178.48,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,The Alliance,PPO Network,,61.60,,,,,,,40.77,71.91,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,PPO Network,,61.60,,,,,,,37.06,71.91,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,inpatient,,,333.00000,316.35000,The Alliance,PPO Network,,276.72,,,,,,,183.15,323.01,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,outpatient,,,333.00000,316.35000,The Alliance,PPO Network,,276.72,,,,,,,166.50,323.01,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.00,7.76,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,2.63,6.47,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,21.41,37.76,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,PPO Network,,32.35,,,,,,,2.63,37.76,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,41.33000,39.26000,The Alliance,PPO Network,,34.35,,,,,,,22.73,40.09,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,41.33000,39.26000,The Alliance,PPO Network,,34.35,,,,,,,20.66,40.09,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,21.47000,20.40000,The Alliance,PPO Network,,17.84,,,,,,,10.52,20.83,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,21.47000,20.40000,The Alliance,PPO Network,,17.84,,,,,,,9.85,20.83,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,197.33000,187.46000,The Alliance,PPO Network,,163.98,,,,,,,108.53,191.41,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,197.33000,187.46000,The Alliance,PPO Network,,163.98,,,,,,,98.67,191.41,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,267.68000,254.30000,The Alliance,PPO Network,,222.44,,,,,,,131.16,259.65,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,267.68000,254.30000,The Alliance,PPO Network,,222.44,,,,,,,122.87,259.65,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.44000,28.92000,The Alliance,PPO Network,,25.30,,,,,,,16.74,29.53,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.44000,28.92000,The Alliance,PPO Network,,25.30,,,,,,,15.22,29.53,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.27,6.47,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.33,65.22,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,163.54,323.74,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,PPO Network,,277.35,,,,,,,153.19,323.74,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,51.63000,49.05000,The Alliance,PPO Network,,42.90,,,,,,,25.30,50.08,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,51.63000,49.05000,The Alliance,PPO Network,,42.90,,,,,,,23.70,50.08,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,14.08,24.83,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,PPO Network,,21.27,,,,,,,12.80,24.83,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,,150.58,,,,,,,88.79,175.76,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,,150.58,,,,,,,39.47,175.76,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,254.66000,241.93000,The Alliance,PPO Network,,211.62,,,,,,,140.06,247.02,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,254.66000,241.93000,The Alliance,PPO Network,,211.62,,,,,,,127.33,247.02,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.33000,92.46000,The Alliance,PPO Network,,80.88,,,,,,,53.53,94.41,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.33000,92.46000,The Alliance,PPO Network,,80.88,,,,,,,48.66,94.41,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,16.40000,15.58000,The Alliance,PPO Network,,13.63,,,,,,,8.04,15.91,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.40000,15.58000,The Alliance,PPO Network,,13.63,,,,,,,8.20,36.65,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,645.11000,612.85000,The Alliance,PPO Network,,536.09,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,PPO Network,,536.09,,,,,,,217.19,625.76,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,694.00000,659.30000,The Alliance,PPO Network,,576.71,,,,,,,381.70,673.18,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,694.00000,659.30000,The Alliance,PPO Network,,576.71,,,,,,,347.00,673.18,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,67.73000,64.34000,The Alliance,PPO Network,,56.28,,,,,,,37.25,65.70,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,67.73000,64.34000,The Alliance,PPO Network,,56.28,,,,,,,33.87,65.70,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,56.84,112.52,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,58.00,112.52,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,15.70000,14.91000,The Alliance,PPO Network,,13.05,,,,,,,8.63,15.23,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,15.70000,14.91000,The Alliance,PPO Network,,13.05,,,,,,,7.85,15.23,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,363.75,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,184.19000,174.98000,The Alliance,PPO Network,,153.06,,,,,,,90.25,178.66,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,184.19000,174.98000,The Alliance,PPO Network,,153.06,,,,,,,77.73,178.66,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,399.94000,379.94000,The Alliance,PPO Network,,332.35,,,,,,,195.97,387.94,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,PPO Network,,332.35,,,,,,,199.97,387.94,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,131.96000,125.36000,The Alliance,PPO Network,,109.66,,,,,,,72.58,128.00,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,131.96000,125.36000,The Alliance,PPO Network,,109.66,,,,,,,65.98,128.00,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,347.50,674.15,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,381.20000,362.14000,The Alliance,PPO Network,,316.78,,,,,,,209.66,369.76,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,381.20000,362.14000,The Alliance,PPO Network,,316.78,,,,,,,190.60,369.76,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,inpatient,,,2903.00000,2757.85000,The Alliance,PPO Network,,2412.39,,,,,,,1422.47,2815.91,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,outpatient,,,2903.00000,2757.85000,The Alliance,PPO Network,,2412.39,,,,,,,1332.48,2815.91,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,The Alliance,PPO Network,,53.58,,,,,,,35.46,62.55,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,PPO Network,,53.58,,,,,,,32.24,62.55,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,62.72000,59.58000,The Alliance,PPO Network,,52.12,,,,,,,34.50,60.84,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,62.72000,59.58000,The Alliance,PPO Network,,52.12,,,,,,,31.36,60.84,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,108.80000,103.36000,The Alliance,PPO Network,,90.41,,,,,,,59.84,105.54,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,108.80000,103.36000,The Alliance,PPO Network,,90.41,,,,,,,54.40,105.54,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,179.28000,170.32000,The Alliance,PPO Network,,148.98,,,,,,,98.60,173.90,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,179.28000,170.32000,The Alliance,PPO Network,,148.98,,,,,,,89.64,173.90,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,88.50000,84.08000,The Alliance,PPO Network,,73.54,,,,,,,48.67,85.84,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,88.50000,84.08000,The Alliance,PPO Network,,73.54,,,,,,,44.25,85.84,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,40.70,71.78,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,74.00000,70.30000,The Alliance,PPO Network,,61.49,,,,,,,37.00,71.78,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.36000,41.19000,The Alliance,PPO Network,,36.03,,,,,,,23.85,42.06,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.36000,41.19000,The Alliance,PPO Network,,36.03,,,,,,,21.68,42.06,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,49.88000,47.39000,The Alliance,PPO Network,,41.45,,,,,,,27.43,48.38,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,49.88000,47.39000,The Alliance,PPO Network,,41.45,,,,,,,24.94,48.38,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,386.21000,366.90000,The Alliance,PPO Network,,320.94,,,,,,,212.42,374.62,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,386.21000,366.90000,The Alliance,PPO Network,,320.94,,,,,,,193.10,374.62,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,77.00,135.80,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,70.00,135.80,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.99,3.51,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,3.62000,3.44000,The Alliance,PPO Network,,3.01,,,,,,,1.81,3.51,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,326.25000,309.94000,The Alliance,PPO Network,,271.11,,,,,,,179.44,316.46,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,326.25000,309.94000,The Alliance,PPO Network,,271.11,,,,,,,163.12,316.46,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,356.81000,338.97000,The Alliance,PPO Network,NU,296.51,,,,,,,196.25,346.11,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,356.81000,338.97000,The Alliance,PPO Network,NU,296.51,,,,,,,62.66,346.11,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,104.83000,99.59000,The Alliance,PPO Network,,87.11,,,,,,,57.66,101.69,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,104.83000,99.59000,The Alliance,PPO Network,,87.11,,,,,,,52.41,101.69,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,560.66,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,110.25,218.25,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,67.53,218.25,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,314.21000,298.50000,The Alliance,PPO Network,,261.11,,,,,,,153.96,304.78,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,314.21000,298.50000,The Alliance,PPO Network,,261.11,,,,,,,113.78,304.78,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,29.47000,28.00000,The Alliance,PPO Network,,24.49,,,,,,,14.44,28.59,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,29.47000,28.00000,The Alliance,PPO Network,,24.49,,,,,,,11.56,28.59,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,1683.30000,1599.13000,The Alliance,PPO Network,,1398.82,,,,,,,925.82,1632.80,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,1683.30000,1599.13000,The Alliance,PPO Network,,1398.82,,,,,,,841.65,1632.80,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,92.30000,87.68000,The Alliance,PPO Network,,76.70,,,,,,,50.77,89.53,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,92.30000,87.68000,The Alliance,PPO Network,,76.70,,,,,,,46.15,89.53,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,58.68000,55.75000,The Alliance,PPO Network,,48.76,,,,,,,32.27,56.92,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,58.68000,55.75000,The Alliance,PPO Network,,48.76,,,,,,,29.34,56.92,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,33.00,58.20,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,,49.86,,,,,,,30.00,58.20,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,6.92,13.71,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,14.13000,13.42000,The Alliance,PPO Network,,11.74,,,,,,,6.49,13.71,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.80,15.52,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,PPO Network,,13.30,,,,,,,8.00,15.52,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,608.74000,578.30000,The Alliance,PPO Network,,505.86,,,,,,,334.81,590.48,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,PPO Network,,505.86,,,,,,,304.37,590.48,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,51.20000,48.64000,The Alliance,PPO Network,,42.55,,,,,,,28.16,49.66,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,PPO Network,,42.55,,,,,,,25.60,49.66,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,inpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,PPO Network,,75.35,,,,,,,45.34,98.18,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,39.52000,37.54000,The Alliance,PPO Network,,32.84,,,,,,,19.36,38.33,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,PPO Network,,32.84,,,,,,,19.76,65.22,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,192.18000,182.57000,The Alliance,PPO Network,NU,159.70,,,,,,,105.70,186.41,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,192.18000,182.57000,The Alliance,PPO Network,NU,159.70,,,,,,,62.66,186.41,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,The Alliance,PPO Network,,142.27,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,PPO Network,,142.27,,,,,,,85.60,166.06,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,57.96000,55.06000,The Alliance,PPO Network,,48.16,,,,,,,31.88,56.22,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,57.96000,55.06000,The Alliance,PPO Network,,48.16,,,,,,,28.98,56.22,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,95.32000,90.55000,The Alliance,PPO Network,,79.21,,,,,,,46.71,92.46,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,95.32000,90.55000,The Alliance,PPO Network,,79.21,,,,,,,47.66,103.42,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.95,8.73,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.50,8.73,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,335.63000,318.85000,The Alliance,PPO Network,,278.91,,,,,,,184.60,325.56,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,335.63000,318.85000,The Alliance,PPO Network,,278.91,,,,,,,167.81,325.56,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,18.15,32.01,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,16.50,32.01,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,645.11000,612.85000,The Alliance,PPO Network,,536.09,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,PPO Network,,536.09,,,,,,,217.19,625.76,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,436.46000,414.64000,The Alliance,PPO Network,,362.70,,,,,,,240.05,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,PPO Network,,362.70,,,,,,,218.23,423.37,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,inpatient,,,51.48000,48.91000,The Alliance,PPO Network,,42.78,,,,,,,28.31,49.94,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,outpatient,,,51.48000,48.91000,The Alliance,PPO Network,,42.78,,,,,,,25.74,49.94,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,,577.54,,,,,,,347.50,674.15,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,inpatient,,,29.04000,27.59000,The Alliance,PPO Network,,24.13,,,,,,,14.23,28.17,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,outpatient,,,29.04000,27.59000,The Alliance,PPO Network,,24.13,,,,,,,13.33,28.17,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,145.36000,138.09000,The Alliance,PPO Network,,120.79,,,,,,,71.23,141.00,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,145.36000,138.09000,The Alliance,PPO Network,,120.79,,,,,,,72.68,141.00,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,11.20000,10.64000,The Alliance,PPO Network,,9.31,,,,,,,6.16,10.86,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,11.20000,10.64000,The Alliance,PPO Network,,9.31,,,,,,,2.63,10.86,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,inpatient,1,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,PPO Network,,44.52,,,,,,,26.79,78.87,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,PPO Network,90,296.67,,,,,,,196.35,346.29,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,PPO Network,90,296.67,,,,,,,28.07,346.29,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,446.70000,424.36000,The Alliance,PPO Network,,371.21,,,,,,,245.69,433.30,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,446.70000,424.36000,The Alliance,PPO Network,,371.21,,,,,,,63.95,788.42,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,inpatient,1,mL,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.50050,0.88270,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,outpatient,1,mL,0.91000,0.87000,The Alliance,PPO Network,,0.75621,,,,,,,0.45500,1.49,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,inpatient,,,2376.00000,2257.20000,The Alliance,PPO Network,,1974.46,,,,,,,1306.80,2304.72,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,outpatient,,,2376.00000,2257.20000,The Alliance,PPO Network,,1974.46,,,,,,,1306.80,7803.00,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,455.36000,432.59000,The Alliance,PPO Network,,378.40,,,,,,,250.45,441.70,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,455.36000,432.59000,The Alliance,PPO Network,,378.40,,,,,,,36.03,441.70,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,148.24,261.44,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,PPO Network,,223.98,,,,,,,36.03,261.44,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,inpatient,,,176.02000,167.22000,The Alliance,PPO Network,,146.27,,,,,,,96.81,170.74,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,outpatient,,,176.02000,167.22000,The Alliance,PPO Network,,146.27,,,,,,,88.01,170.74,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,inpatient,,,3030.00000,2878.50000,The Alliance,PPO Network,TC,2517.93,,,,,,,1666.50,2939.10,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,outpatient,,,3030.00000,2878.50000,The Alliance,PPO Network,TC,2517.93,,,,,,,1515.00,2939.10,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,78.40,155.20,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,73.44,160.00,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,38272.50000,36358.88000,The Alliance,PPO Network,,31804.45,,,,,,,18753.53,37124.32,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,38272.50000,36358.88000,The Alliance,PPO Network,,31804.45,,,,,,,17567.08,38272.50,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,inpatient,,,981.00000,931.95000,The Alliance,PPO Network,,815.21,,,,,,,539.55,951.57,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,outpatient,,,981.00000,931.95000,The Alliance,PPO Network,,815.21,,,,,,,539.55,5271.00,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,PPO Network,,17.45,,,,,,,10.50,74.34,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,419.33000,398.36000,The Alliance,PPO Network,NU,348.46,,,,,,,230.63,406.75,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,419.33000,398.36000,The Alliance,PPO Network,NU,348.46,,,,,,,62.66,406.75,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,inpatient,1,EA,34562.60000,32834.47000,The Alliance,PPO Network,,28721.52,,,,,,,19009.43,33525.72,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,outpatient,1,EA,34562.60000,32834.47000,The Alliance,PPO Network,,28721.52,,,,,,,3772.85,33525.72,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,The Alliance,PPO Network,,8694.34,,,,,,,5126.62,10148.62,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,PPO Network,,8694.34,,,,,,,4802.29,10462.50,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,The Alliance,PPO Network,,182.65,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,PPO Network,,182.65,,,,,,,109.90,213.21,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30132.00000,28625.40000,The Alliance,PPO Network,,25039.69,,,,,,,14764.68,29228.04,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,PPO Network,,25039.69,,,,,,,13830.59,30132.00,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,TC,90.58,,,,,,,59.95,105.73,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,TC,90.58,,,,,,,54.50,105.73,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,inpatient,1,EA,5576.35000,5297.53000,The Alliance,PPO Network,,4633.95,,,,,,,3066.99,5409.06,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,outpatient,1,EA,5576.35000,5297.53000,The Alliance,PPO Network,,4633.95,,,,,,,30.00,5409.06,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,308.32,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,inpatient,1,EA,3147.55000,2990.17000,The Alliance,PPO Network,,2615.61,,,,,,,1731.15,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,outpatient,1,EA,3147.55000,2990.17000,The Alliance,PPO Network,,2615.61,,,,,,,14.08,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,inpatient,1,EA,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1518.00,2677.20,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,outpatient,1,EA,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,14.08,2677.20,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,550.80,1200.00,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,inpatient,,,11573.00000,10994.35000,The Alliance,PPO Network,,9617.16,,,,,,,6365.15,11225.81,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,outpatient,,,11573.00000,10994.35000,The Alliance,PPO Network,,9617.16,,,,,,,4607.00,11225.81,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2612.86,5692.50,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27304.80000,25939.56000,The Alliance,PPO Network,,22690.29,,,,,,,13379.35,26485.66,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27304.80000,25939.56000,The Alliance,PPO Network,,22690.29,,,,,,,12532.90,27304.80,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,The Alliance,PPO Network,,730.45,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,PPO Network,,730.45,,,,,,,96.44,2659.05,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,inpatient,1,GM,1230.25000,1168.74000,The Alliance,PPO Network,,1022.34,,,,,,,676.64,1193.34,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,outpatient,1,GM,1230.25000,1168.74000,The Alliance,PPO Network,,1022.34,,,,,,,615.12,1193.34,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,inpatient,1,mL,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,3.62,153.26,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,inpatient,1,EA,111.42000,105.85000,The Alliance,PPO Network,,92.59,,,,,,,61.28,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,outpatient,1,EA,111.42000,105.85000,The Alliance,PPO Network,,92.59,,,,,,,12.72,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,inpatient,1,EA,130.19000,123.68000,The Alliance,PPO Network,,108.19,,,,,,,71.60,126.28,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,outpatient,1,EA,130.19000,123.68000,The Alliance,PPO Network,,108.19,,,,,,,12.72,126.28,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,1.04,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,PPO Network,,1.58,,,,,,,0.95000,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,PPO Network,,1.72,,,,,,,1.03,2.01,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,inpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.66000,1.16,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,PPO Network,,0.99720,,,,,,,0.60000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,inpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,3.13,5.52,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,PPO Network,,4.73,,,,,,,2.85,15.80,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,inpatient,1,EA,736.75000,699.91000,The Alliance,PPO Network,,612.24,,,,,,,405.21,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,outpatient,1,EA,736.75000,699.91000,The Alliance,PPO Network,,612.24,,,,,,,368.38,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,inpatient,1,EA,769.75000,731.26000,The Alliance,PPO Network,,639.66,,,,,,,423.36,746.66,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,outpatient,1,EA,769.75000,731.26000,The Alliance,PPO Network,,639.66,,,,,,,384.88,746.66,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,The Alliance,PPO Network,,1417.89,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,PPO Network,,1417.89,,,,,,,783.17,1706.25,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,5939.18,12939.40,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,156.19,309.19,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,PPO Network,,264.88,,,,,,,146.31,318.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,18699.66,40740.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,116.86,231.34,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,109.47,238.50,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,The Alliance,PPO Network,,183.86,,,,,,,108.41,214.61,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,PPO Network,,183.86,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,230.10000,218.59000,The Alliance,PPO Network,,191.21,,,,,,,112.75,223.20,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,230.10000,218.59000,The Alliance,PPO Network,,191.21,,,,,,,105.62,230.10,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,PPO Network,,445.62,,,,,,,246.14,536.25,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,79.75,140.65,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,PPO Network,TC,120.50,,,,,,,72.50,1820.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,inpatient,,,68.34000,64.92000,The Alliance,PPO Network,,56.79,,,,,,,37.59,66.29,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,outpatient,,,68.34000,64.92000,The Alliance,PPO Network,,56.79,,,,,,,34.17,137.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,inpatient,1,EA,136.68000,129.85000,The Alliance,PPO Network,,113.58,,,,,,,75.17,132.58,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,outpatient,1,EA,136.68000,129.85000,The Alliance,PPO Network,,113.58,,,,,,,68.34,137.03,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,inpatient,1,EA,269.42000,255.95000,The Alliance,PPO Network,,223.89,,,,,,,148.18,261.34,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,outpatient,1,EA,269.42000,255.95000,The Alliance,PPO Network,,223.89,,,,,,,134.71,261.34,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,inpatient,1,EA,1846.15000,1753.84000,The Alliance,PPO Network,,1534.15,,,,,,,1015.38,1790.77,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,outpatient,1,EA,1846.15000,1753.84000,The Alliance,PPO Network,,1534.15,,,,,,,14.79,1790.77,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,inpatient,1,GM,66.04000,62.74000,The Alliance,PPO Network,,54.88,,,,,,,36.32,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,outpatient,1,GM,66.04000,62.74000,The Alliance,PPO Network,,54.88,,,,,,,33.02,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,inpatient,1,GM,115.79000,110.00000,The Alliance,PPO Network,,96.22,,,,,,,63.68,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,outpatient,1,GM,115.79000,110.00000,The Alliance,PPO Network,,96.22,,,,,,,57.90,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,inpatient,1,GM,18.26000,17.35000,The Alliance,PPO Network,,15.17,,,,,,,10.04,17.71,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,outpatient,1,GM,18.26000,17.35000,The Alliance,PPO Network,,15.17,,,,,,,9.13,17.71,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,inpatient,1,mL,129.01000,122.56000,The Alliance,PPO Network,,107.21,,,,,,,70.96,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,outpatient,1,mL,129.01000,122.56000,The Alliance,PPO Network,,107.21,,,,,,,64.50,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,inpatient,1,mL,112.05000,106.45000,The Alliance,PPO Network,,93.11,,,,,,,61.63,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,outpatient,1,mL,112.05000,106.45000,The Alliance,PPO Network,,93.11,,,,,,,56.02,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,inpatient,1,mL,80.89000,76.85000,The Alliance,PPO Network,,67.22,,,,,,,44.49,78.46,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,outpatient,1,mL,80.89000,76.85000,The Alliance,PPO Network,,67.22,,,,,,,40.45,78.46,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,inpatient,1,mL,12896.29000,12251.47000,The Alliance,PPO Network,,10716.82,,,,,,,7092.96,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,outpatient,1,mL,12896.29000,12251.47000,The Alliance,PPO Network,,10716.82,,,,,,,388.83,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,inpatient,1,mL,11683.35000,11099.18000,The Alliance,PPO Network,,9708.86,,,,,,,6425.84,11332.85,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,outpatient,1,mL,11683.35000,11099.18000,The Alliance,PPO Network,,9708.86,,,,,,,388.83,11332.85,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,inpatient,1,mL,728.31000,691.89000,The Alliance,PPO Network,,605.23,,,,,,,400.57,706.46,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,outpatient,1,mL,728.31000,691.89000,The Alliance,PPO Network,,605.23,,,,,,,364.15,2397.95,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,inpatient,1,mL,1149.90000,1092.40000,The Alliance,PPO Network,,955.57,,,,,,,632.45,1115.40,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,outpatient,1,mL,1149.90000,1092.40000,The Alliance,PPO Network,,955.57,,,,,,,574.95,2397.95,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,inpatient,1,mL,81.79000,77.70000,The Alliance,PPO Network,,67.97,,,,,,,44.98,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,outpatient,1,mL,81.79000,77.70000,The Alliance,PPO Network,,67.97,,,,,,,40.90,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,inpatient,1,mL,75.33000,71.57000,The Alliance,PPO Network,,62.60,,,,,,,41.43,73.07,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,outpatient,1,mL,75.33000,71.57000,The Alliance,PPO Network,,62.60,,,,,,,37.66,73.07,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,inpatient,1,mL,2474.98000,2351.23000,The Alliance,PPO Network,,2056.71,,,,,,,1361.24,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,outpatient,1,mL,2474.98000,2351.23000,The Alliance,PPO Network,,2056.71,,,,,,,3.33,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,inpatient,1,mL,2500.42000,2375.40000,The Alliance,PPO Network,,2077.85,,,,,,,1375.23,2425.41,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,outpatient,1,mL,2500.42000,2375.40000,The Alliance,PPO Network,,2077.85,,,,,,,3.33,2425.41,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,inpatient,1,mL,49140.33000,46683.32000,The Alliance,PPO Network,,40835.61,,,,,,,27027.18,47666.12,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,outpatient,1,mL,49140.33000,46683.32000,The Alliance,PPO Network,,40835.61,,,,,,,36.66,47666.12,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,inpatient,1,mL,414.62000,393.89000,The Alliance,PPO Network,,344.55,,,,,,,228.04,402.18,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,outpatient,1,mL,414.62000,393.89000,The Alliance,PPO Network,,344.55,,,,,,,29.30,402.18,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,inpatient,1,mL,32751.19000,31113.63000,The Alliance,PPO Network,,27216.24,,,,,,,18013.15,31768.65,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,outpatient,1,mL,32751.19000,31113.63000,The Alliance,PPO Network,,27216.24,,,,,,,126.24,31768.65,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1944.08,3848.47,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,PPO Network,,3296.99,,,,,,,1821.08,3967.50,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.44,6.07,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,PPO Network,,5.20,,,,,,,3.13,6.07,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.06045,1.89,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,inpatient,1,mL,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,2.05,3.61,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,outpatient,1,mL,3.72000,3.53000,The Alliance,PPO Network,,3.09,,,,,,,1.86,3.61,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,inpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,132.00,232.80,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,PPO Network,TC,199.44,,,,,,,120.00,1272.59,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,inpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,216.31,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,outpatient,,,223.00000,211.85000,The Alliance,PPO Network,,185.31,,,,,,,122.65,5271.00,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3296.47,6525.68,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3087.92,6727.50,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,inpatient,1,EA,6334.20000,6017.49000,The Alliance,PPO Network,,5263.72,,,,,,,3483.81,6144.17,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,outpatient,1,EA,6334.20000,6017.49000,The Alliance,PPO Network,,5263.72,,,,,,,36.66,6144.17,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,inpatient,1,EA,8023.11000,7621.96000,The Alliance,PPO Network,,6667.20,,,,,,,4412.71,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,outpatient,1,EA,8023.11000,7621.96000,The Alliance,PPO Network,,6667.20,,,,,,,41.96,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,inpatient,1,EA,22092.57000,20987.94000,The Alliance,PPO Network,,18358.93,,,,,,,12150.91,21429.79,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,outpatient,1,EA,22092.57000,20987.94000,The Alliance,PPO Network,,18358.93,,,,,,,41.96,21429.79,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,inpatient,1,EA,3037.03000,2885.18000,The Alliance,PPO Network,,2523.77,,,,,,,1670.37,2945.92,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,outpatient,1,EA,3037.03000,2885.18000,The Alliance,PPO Network,,2523.77,,,,,,,43.25,2945.92,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,inpatient,1,mL,2458.76000,2335.82000,The Alliance,PPO Network,,2043.23,,,,,,,1352.32,2385.00,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,outpatient,1,mL,2458.76000,2335.82000,The Alliance,PPO Network,,2043.23,,,,,,,7.68,2385.00,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,inpatient,1,mL,3612.56000,3431.94000,The Alliance,PPO Network,,3002.04,,,,,,,1986.91,3504.18,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,outpatient,1,mL,3612.56000,3431.94000,The Alliance,PPO Network,,3002.04,,,,,,,19.85,3504.18,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,inpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.48,6.74,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,inpatient,,,548.00000,520.60000,The Alliance,PPO Network,,455.39,,,,,,,301.40,531.56,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,outpatient,,,548.00000,520.60000,The Alliance,PPO Network,,455.39,,,,,,,274.00,531.56,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,inpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,1.41,2.49,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,PPO Network,,2.14,,,,,,,0.08525,2.49,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,inpatient,1,mL,2.93000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.84,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,outpatient,1,mL,2.93000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,0.08525,2.84,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,inpatient,1,mL,399.99000,379.99000,The Alliance,PPO Network,,332.39,,,,,,,219.99,387.99,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,outpatient,1,mL,399.99000,379.99000,The Alliance,PPO Network,,332.39,,,,,,,82.86,387.99,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,inpatient,1,mL,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,220.00,388.00,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,outpatient,1,mL,400.00000,380.00000,The Alliance,PPO Network,,332.40,,,,,,,82.86,388.00,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,inpatient,1,mL,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,PPO Network,,5.33,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,inpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.91,3.38,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,PPO Network,,2.89,,,,,,,1.74,5.23,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,26.50,219.71,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,55.44,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,inpatient,1,mL,13220.83000,12559.79000,The Alliance,PPO Network,,10986.51,,,,,,,7271.46,12824.21,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,PPO Network,,10986.51,,,,,,,136.04,12824.21,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.14409,0.92150,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,inpatient,1,EA,56.21000,53.40000,The Alliance,PPO Network,,46.71,,,,,,,30.92,54.52,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,outpatient,1,EA,56.21000,53.40000,The Alliance,PPO Network,,46.71,,,,,,,28.11,54.52,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,473.00000,449.35000,The Alliance,PPO Network,,393.06,,,,,,,260.15,458.81,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,473.00000,449.35000,The Alliance,PPO Network,,393.06,,,,,,,63.95,788.42,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,78.21,137.93,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,37.52,137.93,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.36850,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,PPO Network,,0.55677,,,,,,,0.33500,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,TC,24.93,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,TC,24.93,,,,,,,15.00,29.10,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,inpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,382.80,675.12,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,PPO Network,TC,578.38,,,,,,,348.00,675.12,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,inpatient,,,71.65000,68.07000,The Alliance,PPO Network,,59.54,,,,,,,39.41,69.50,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,outpatient,,,71.65000,68.07000,The Alliance,PPO Network,,59.54,,,,,,,35.83,69.50,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,741.08,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,PPO Network,,634.88,,,,,,,420.20,4686.00,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,PPO Network,TC,830.17,,,,,,,549.45,969.03,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,PPO Network,TC,830.17,,,,,,,422.60,17311.25,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,inpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,41.71,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,outpatient,,,43.00000,40.85000,The Alliance,PPO Network,,35.73,,,,,,,23.65,5271.00,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,5271.00,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,inpatient,,,94.77000,90.03000,The Alliance,PPO Network,,78.75,,,,,,,52.12,91.93,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,outpatient,,,94.77000,90.03000,The Alliance,PPO Network,,78.75,,,,,,,52.12,5858.00,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,inpatient,1,mL,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,13.04,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,PPO Network,,19.69,,,,,,,11.85,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,inpatient,1,mL,7.81000,7.41000,The Alliance,PPO Network,,6.49,,,,,,,4.30,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,outpatient,1,mL,7.81000,7.41000,The Alliance,PPO Network,,6.49,,,,,,,3.90,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,inpatient,1,mL,14.71000,13.98000,The Alliance,PPO Network,,12.22,,,,,,,8.09,14.27,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,outpatient,1,mL,14.71000,13.98000,The Alliance,PPO Network,,12.22,,,,,,,7.36,14.27,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,The Alliance,PPO Network,TC,2586.07,,,,,,,1711.60,3018.64,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,PPO Network,TC,2586.07,,,,,,,1334.13,14413.40,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,,13790.44,,,,,,,9127.25,16097.15,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,PPO Network,,13790.44,,,,,,,1299.22,106944.98,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1804.69,3182.81,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1640.62,3182.81,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,The Alliance,PPO Network,,6593.98,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,PPO Network,,6593.98,,,,,,,3642.16,7935.00,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,PPO Network,,2438.37,,,,,,,1346.83,2934.26,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1845.00000,1752.75000,The Alliance,PPO Network,,1533.19,,,,,,,904.05,1789.65,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1845.00000,1752.75000,The Alliance,PPO Network,,1533.19,,,,,,,846.86,1845.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,360.00000,342.00000,The Alliance,PPO Network,,299.16,,,,,,,176.40,349.20,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,360.00000,342.00000,The Alliance,PPO Network,,299.16,,,,,,,165.24,360.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,98.97,215.63,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,116.86,231.34,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,109.47,238.50,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1713.75000,1628.06000,The Alliance,PPO Network,,1424.13,,,,,,,839.74,1662.34,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1713.75000,1628.06000,The Alliance,PPO Network,,1424.13,,,,,,,786.61,1713.75,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,inpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.45100,0.79540,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,PPO Network,,0.68142,,,,,,,0.41000,0.79540,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,41.80,73.72,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,6.47,339.51,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,inpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.30,2.30,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,PPO Network,,1.97,,,,,,,1.19,2.30,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,inpatient,1,EA,76.72000,72.89000,The Alliance,PPO Network,,63.75,,,,,,,42.20,74.42,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,outpatient,1,EA,76.72000,72.89000,The Alliance,PPO Network,,63.75,,,,,,,0.26000,74.42,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,inpatient,1,EA,4092.00000,3887.40000,The Alliance,PPO Network,,3400.45,,,,,,,2250.60,3969.24,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,outpatient,1,EA,4092.00000,3887.40000,The Alliance,PPO Network,,3400.45,,,,,,,15.55,3969.24,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,PPO Network,TC,632.39,,,,,,,418.55,738.17,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,PPO Network,TC,632.39,,,,,,,380.50,4635.02,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,inpatient,1,EA,34.64000,32.91000,The Alliance,PPO Network,,28.79,,,,,,,19.05,33.60,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,outpatient,1,EA,34.64000,32.91000,The Alliance,PPO Network,,28.79,,,,,,,17.32,33.60,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,inpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,130.35,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,PPO Network,,196.95,,,,,,,2.55,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,inpatient,1,EA,1548.82000,1471.38000,The Alliance,PPO Network,,1287.07,,,,,,,851.85,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,outpatient,1,EA,1548.82000,1471.38000,The Alliance,PPO Network,,1287.07,,,,,,,2.55,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,inpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,356.12,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,PPO Network,,538.07,,,,,,,2.55,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,inpatient,1,EA,738.15000,701.24000,The Alliance,PPO Network,,613.40,,,,,,,405.98,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,outpatient,1,EA,738.15000,701.24000,The Alliance,PPO Network,,613.40,,,,,,,2.55,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,inpatient,1,EA,582.75000,553.61000,The Alliance,PPO Network,,484.27,,,,,,,320.51,565.27,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,outpatient,1,EA,582.75000,553.61000,The Alliance,PPO Network,,484.27,,,,,,,2.55,565.27,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,929.91,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,inpatient,,,421.00000,399.95000,The Alliance,PPO Network,90,349.85,,,,,,,231.55,408.37,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,PPO Network,90,349.85,,,,,,,28.00,1341.13,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,inpatient,,,105.00000,99.75000,The Alliance,PPO Network,90,87.25,,,,,,,57.75,101.85,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,PPO Network,90,87.25,,,,,,,5.35,271.65,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,inpatient,,,116.30000,110.48000,The Alliance,PPO Network,90,96.65,,,,,,,63.97,112.81,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,PPO Network,90,96.65,,,,,,,4.57,271.65,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,inpatient,,,84.60000,80.37000,The Alliance,PPO Network,90,70.30,,,,,,,46.53,82.06,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,outpatient,,,84.60000,80.37000,The Alliance,PPO Network,90,70.30,,,,,,,20.20,305.58,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,267.85,472.39,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,PPO Network,,404.70,,,,,,,63.95,788.42,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,inpatient,1,EA,6.13000,5.83000,The Alliance,PPO Network,,5.09,,,,,,,3.37,5.95,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,outpatient,1,EA,6.13000,5.83000,The Alliance,PPO Network,,5.09,,,,,,,3.06,5.95,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,inpatient,,,11828.00000,11236.60000,The Alliance,PPO Network,TC,9829.07,,,,,,,6505.40,11473.16,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,PPO Network,TC,9829.07,,,,,,,1929.64,11473.16,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,The Alliance,PPO Network,TC,632.39,,,,,,,418.55,738.17,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,PPO Network,TC,632.39,,,,,,,380.50,4635.02,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,inpatient,,,2963.00000,2814.85000,The Alliance,PPO Network,,2462.25,,,,,,,1629.65,2874.11,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,outpatient,,,2963.00000,2814.85000,The Alliance,PPO Network,,2462.25,,,,,,,1538.48,4686.00,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,676.99000,643.14000,The Alliance,PPO Network,,562.58,,,,,,,331.73,656.68,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,676.99000,643.14000,The Alliance,PPO Network,,562.58,,,,,,,310.74,676.99,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,PPO Network,,0.73959,,,,,,,0.44500,0.86330,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,174.56,345.56,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,163.52,356.25,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,820.60,1447.24,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,PPO Network,TC,1239.85,,,,,,,820.60,6003.00,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,The Alliance,PPO Network,,1727.65,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,PPO Network,,1727.65,,,,,,,954.26,2079.00,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,103.97,7859.04,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,PPO Network,,107.83,,,,,,,59.56,129.76,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,PPO Network,TC,538.49,,,,,,,356.40,628.56,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,PPO Network,TC,538.49,,,,,,,324.00,2941.42,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,2850.39,6210.00,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,PPO Network,,1854.17,,,,,,,1024.14,2231.25,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2388.60000,2269.17000,The Alliance,PPO Network,,1984.93,,,,,,,1170.41,2316.94,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2388.60000,2269.17000,The Alliance,PPO Network,,1984.93,,,,,,,1096.37,2388.60,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,The Alliance,PPO Network,,265.79,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,PPO Network,,265.79,,,,,,,146.81,319.84,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3296.47,6525.68,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,PPO Network,,5590.55,,,,,,,3087.92,6727.50,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,The Alliance,PPO Network,,830.17,,,,,,,549.45,969.03,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,PPO Network,,830.17,,,,,,,422.60,17311.25,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,The Alliance,PPO Network,,5012.59,,,,,,,3317.60,5851.04,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,PPO Network,,5012.59,,,,,,,2194.62,5851.04,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,The Alliance,PPO Network,,7203.94,,,,,,,4767.95,8408.93,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,PPO Network,,7203.94,,,,,,,4334.50,8408.93,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,inpatient,,,137.23000,130.37000,The Alliance,PPO Network,,114.04,,,,,,,75.48,133.11,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,outpatient,,,137.23000,130.37000,The Alliance,PPO Network,,114.04,,,,,,,68.61,133.11,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,PPO Network,,0.60663,,,,,,,0.36500,4.31,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,inpatient,1,GM,31.19000,29.63000,The Alliance,PPO Network,,25.92,,,,,,,17.15,30.25,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,outpatient,1,GM,31.19000,29.63000,The Alliance,PPO Network,,25.92,,,,,,,15.60,30.25,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,inpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,The Alliance,PPO Network,TC,8910.81,,,,,,,5897.65,10401.31,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,PPO Network,TC,8910.81,,,,,,,5057.86,51844.17,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,inpatient,1,EA,288.61000,274.18000,The Alliance,PPO Network,,239.83,,,,,,,158.74,279.95,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,outpatient,1,EA,288.61000,274.18000,The Alliance,PPO Network,,239.83,,,,,,,144.31,279.95,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,PPO Network,,1557.29,,,,,,,937.00,1817.78,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,The Alliance,PPO Network,TC,2712.38,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,PPO Network,TC,2712.38,,,,,,,1527.07,3166.08,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3487.31000,3312.94000,The Alliance,PPO Network,,2897.95,,,,,,,1708.78,3382.69,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3487.31000,3312.94000,The Alliance,PPO Network,,2897.95,,,,,,,1600.68,3487.31,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1342.24,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,898.32,1778.30,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2276.25000,2162.44000,The Alliance,PPO Network,,1891.56,,,,,,,1115.36,2207.96,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2276.25000,2162.44000,The Alliance,PPO Network,,1891.56,,,,,,,1044.80,2276.25,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12077.43,26312.49,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,The Alliance,PPO Network,,372.70,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,PPO Network,,372.70,,,,,,,205.86,448.50,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,The Alliance,PPO Network,,5012.59,,,,,,,3317.60,5851.04,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,PPO Network,,5012.59,,,,,,,2194.62,5851.04,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1383.88,3015.00,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,inpatient,,,3408.00000,3237.60000,The Alliance,PPO Network,TC,2832.05,,,,,,,1874.40,3305.76,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,outpatient,,,3408.00000,3237.60000,The Alliance,PPO Network,TC,2832.05,,,,,,,1704.00,3305.76,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,inpatient,1,EA,19551.00000,18573.45000,The Alliance,PPO Network,,16246.88,,,,,,,10753.05,18964.47,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,outpatient,1,EA,19551.00000,18573.45000,The Alliance,PPO Network,,16246.88,,,,,,,2.65,18964.47,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10121.50000,9615.42000,The Alliance,PPO Network,,8410.97,,,,,,,4959.53,9817.85,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10121.50000,9615.42000,The Alliance,PPO Network,,8410.97,,,,,,,4645.77,10121.50,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,inpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,37.40,65.96,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,PPO Network,,56.51,,,,,,,5.99,1216.68,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,5.83,44.62,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,inpatient,1,EA,250.52000,238.00000,The Alliance,PPO Network,,208.18,,,,,,,137.79,243.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,outpatient,1,EA,250.52000,238.00000,The Alliance,PPO Network,,208.18,,,,,,,125.26,243.00,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,inpatient,1,EA,90046.64000,85544.31000,The Alliance,PPO Network,,74828.76,,,,,,,49525.65,87345.24,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,outpatient,1,EA,90046.64000,85544.31000,The Alliance,PPO Network,,74828.76,,,,,,,45023.32,87345.24,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,inpatient,1,EA,1289.61000,1225.13000,The Alliance,PPO Network,,1071.67,,,,,,,709.29,1250.92,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,outpatient,1,EA,1289.61000,1225.13000,The Alliance,PPO Network,,1071.67,,,,,,,5.19,1250.92,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,inpatient,1,mL,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,2.58,4.56,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,outpatient,1,mL,4.70000,4.46000,The Alliance,PPO Network,,3.91,,,,,,,1.49,4.56,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.14300,0.25220,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,PPO Network,,0.21606,,,,,,,0.13000,0.25220,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,inpatient,,,6.70000,6.36000,The Alliance,PPO Network,,5.57,,,,,,,3.69,6.50,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,outpatient,,,6.70000,6.36000,The Alliance,PPO Network,,5.57,,,,,,,3.35,6.50,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,inpatient,,,1803.00000,1712.85000,The Alliance,PPO Network,,1498.29,,,,,,,991.65,1748.91,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,outpatient,,,1803.00000,1712.85000,The Alliance,PPO Network,,1498.29,,,,,,,283.85,1748.91,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,inpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,413.44,818.44,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,PPO Network,,701.16,,,,,,,421.88,818.44,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,inpatient,1,EA,51.13000,48.57000,The Alliance,PPO Network,,42.49,,,,,,,28.12,49.60,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,outpatient,1,EA,51.13000,48.57000,The Alliance,PPO Network,,42.49,,,,,,,25.57,49.60,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,inpatient,1,mL,2753.56000,2615.88000,The Alliance,PPO Network,,2288.21,,,,,,,1514.46,2670.95,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,outpatient,1,mL,2753.56000,2615.88000,The Alliance,PPO Network,,2288.21,,,,,,,40.56,2670.95,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,inpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,PPO Network,,1.75,,,,,,,0.00620,2.05,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,inpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,83.98,148.12,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,152.70000,145.06000,The Alliance,PPO Network,,126.89,,,,,,,33.32,148.12,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,inpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,4.95,8.73,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,PPO Network,,7.48,,,,,,,3.96,8.73,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,inpatient,1,mL,51.13000,48.57000,The Alliance,PPO Network,,42.49,,,,,,,28.12,49.60,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,outpatient,1,mL,51.13000,48.57000,The Alliance,PPO Network,,42.49,,,,,,,25.57,49.60,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,inpatient,1,mL,4909.73000,4664.25000,The Alliance,PPO Network,,4079.99,,,,,,,2700.35,4762.44,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,PPO Network,,4079.99,,,,,,,225.19,4762.44,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,25.30,44.62,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,23.00,44.62,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,0.43000,18.39,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,inpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,50.60,89.24,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,PPO Network,,76.45,,,,,,,46.00,1714.64,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,inpatient,1,EA,8520.12000,8094.11000,The Alliance,PPO Network,,7080.22,,,,,,,4686.07,8264.52,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,outpatient,1,EA,8520.12000,8094.11000,The Alliance,PPO Network,,7080.22,,,,,,,2.65,8264.52,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,inpatient,1,mL,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,4.12,7.27,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,outpatient,1,mL,7.49000,7.11000,The Alliance,PPO Network,,6.22,,,,,,,3.75,7.27,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,inpatient,1,mL,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.50,2.64,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,PPO Network,,2.26,,,,,,,1.02,2.64,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,inpatient,,,322.90000,306.75000,The Alliance,PPO Network,,268.33,,,,,,,177.59,313.21,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,outpatient,,,322.90000,306.75000,The Alliance,PPO Network,,268.33,,,,,,,23.25,313.21,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,153.86,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,inpatient,1,mL,147.89000,140.49000,The Alliance,PPO Network,,122.90,,,,,,,81.34,143.45,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,outpatient,1,mL,147.89000,140.49000,The Alliance,PPO Network,,122.90,,,,,,,64.92,143.45,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,453.75000,431.06000,The Alliance,PPO Network,,377.07,,,,,,,222.34,440.14,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,453.75000,431.06000,The Alliance,PPO Network,,377.07,,,,,,,208.27,440.14,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,400.12,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,80.00,155.20,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,39.52000,37.54000,The Alliance,PPO Network,,32.84,,,,,,,19.36,38.33,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,PPO Network,,32.84,,,,,,,18.14,39.52,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,The Alliance,PPO Network,,3188.05,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,PPO Network,,3188.05,,,,,,,1760.91,3836.40,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,PPO Network,,1298.85,,,,,,,103.97,7859.04,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,9953.19,21684.50,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,The Alliance,PPO Network,,3188.05,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,PPO Network,,3188.05,,,,,,,1760.91,3836.40,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,17391.00000,16521.45000,The Alliance,PPO Network,,14451.92,,,,,,,8521.59,16869.27,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,17391.00000,16521.45000,The Alliance,PPO Network,,14451.92,,,,,,,7982.47,17391.00,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,The Alliance,PPO Network,,7712.10,,,,,,,4547.44,9002.08,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,PPO Network,,7712.10,,,,,,,4259.75,9280.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,inpatient,1,mL,1032.24000,980.63000,The Alliance,PPO Network,,857.79,,,,,,,567.73,1001.27,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,outpatient,1,mL,1032.24000,980.63000,The Alliance,PPO Network,,857.79,,,,,,,347.32,1001.27,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,inpatient,1,mL,453.41000,430.74000,The Alliance,PPO Network,,376.78,,,,,,,249.38,439.81,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,outpatient,1,mL,453.41000,430.74000,The Alliance,PPO Network,,376.78,,,,,,,114.48,439.81,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,inpatient,1,mL,20.79000,19.75000,The Alliance,PPO Network,,17.28,,,,,,,11.43,20.17,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,outpatient,1,mL,20.79000,19.75000,The Alliance,PPO Network,,17.28,,,,,,,6.35,20.17,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,7334.70000,6967.96000,The Alliance,PPO Network,,6095.14,,,,,,,3594.00,7114.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,7334.70000,6967.96000,The Alliance,PPO Network,,6095.14,,,,,,,3366.63,7334.70,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,3086.00000,2931.70000,The Alliance,PPO Network,,2564.47,,,,,,,1697.30,2993.42,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,3086.00000,2931.70000,The Alliance,PPO Network,,2564.47,,,,,,,557.65,2993.42,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,inpatient,1,mL,299.83000,284.84000,The Alliance,PPO Network,,249.16,,,,,,,164.91,290.84,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,outpatient,1,mL,299.83000,284.84000,The Alliance,PPO Network,,249.16,,,,,,,114.64,290.84,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,152.35,268.69,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,,230.19,,,,,,,62.14,3038.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,290.95,513.13,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,PPO Network,,439.60,,,,,,,63.95,788.42,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,673.00000,639.35000,The Alliance,PPO Network,,559.26,,,,,,,370.15,652.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,673.00000,639.35000,The Alliance,PPO Network,,559.26,,,,,,,98.39,1078.91,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,inpatient,,,1508.00000,1432.60000,The Alliance,PPO Network,,1253.15,,,,,,,829.40,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,outpatient,,,1508.00000,1432.60000,The Alliance,PPO Network,,1253.15,,,,,,,132.80,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1840.00000,1748.00000,The Alliance,PPO Network,,1529.04,,,,,,,1012.00,1784.80,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1840.00000,1748.00000,The Alliance,PPO Network,,1529.04,,,,,,,172.18,1784.80,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,inpatient,,,350.40000,332.88000,The Alliance,PPO Network,90,291.18,,,,,,,192.72,339.89,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,outpatient,,,350.40000,332.88000,The Alliance,PPO Network,90,291.18,,,,,,,63.40,3038.81,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1383.41000,1314.24000,The Alliance,PPO Network,,1149.61,,,,,,,677.87,1341.91,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1383.41000,1314.24000,The Alliance,PPO Network,,1149.61,,,,,,,634.99,1383.41,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,81.96000,77.86000,The Alliance,PPO Network,,68.11,,,,,,,40.16,79.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,81.96000,77.86000,The Alliance,PPO Network,,68.11,,,,,,,37.62,81.96,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,288.60000,274.17000,The Alliance,PPO Network,,239.83,,,,,,,141.41,279.94,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,288.60000,274.17000,The Alliance,PPO Network,,239.83,,,,,,,132.47,288.60,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,34469.40000,32745.93000,The Alliance,PPO Network,,28644.07,,,,,,,16890.01,33435.32,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,PPO Network,,28644.07,,,,,,,15821.45,33435.32,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,The Alliance,PPO Network,,9809.79,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,PPO Network,,9809.79,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,1927.18,4198.65,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,PPO Network,TC,454.56,,,,,,,273.50,1232.72,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,1927.18,4198.65,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,The Alliance,PPO Network,,11592.45,,,,,,,6835.50,13531.50,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,PPO Network,,11592.45,,,,,,,6403.05,13950.00,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5558.02,11002.61,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5206.39,11342.90,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1653.75,3273.75,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1549.12,3375.00,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10741.50000,10204.42000,The Alliance,PPO Network,,8926.19,,,,,,,5263.34,10419.25,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10741.50000,10204.42000,The Alliance,PPO Network,,8926.19,,,,,,,4930.35,10741.50,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,PPO Network,,21865.68,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2343.75000,2226.56000,The Alliance,PPO Network,,1947.66,,,,,,,1148.44,2273.44,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,PPO Network,,1947.66,,,,,,,1075.78,2343.75,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1515.94,3000.94,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,PPO Network,,2570.91,,,,,,,1420.03,3093.75,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,The Alliance,PPO Network,,8501.13,,,,,,,5012.70,9923.10,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,PPO Network,,8501.13,,,,,,,4695.57,9923.10,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2568.75000,2440.31000,The Alliance,PPO Network,,2134.63,,,,,,,1258.69,2491.69,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2568.75000,2440.31000,The Alliance,PPO Network,,2134.63,,,,,,,1179.06,2568.75,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,286.88000,272.54000,The Alliance,PPO Network,,238.40,,,,,,,140.57,278.27,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,286.88000,272.54000,The Alliance,PPO Network,,238.40,,,,,,,131.68,286.88,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,29826.53000,28335.20000,The Alliance,PPO Network,,24785.85,,,,,,,14615.00,28931.73,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,29826.53000,28335.20000,The Alliance,PPO Network,,24785.85,,,,,,,13690.38,29826.53,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13814.10000,13123.40000,The Alliance,PPO Network,,11479.52,,,,,,,6768.91,13399.68,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13814.10000,13123.40000,The Alliance,PPO Network,,11479.52,,,,,,,6340.67,13814.10,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,The Alliance,PPO Network,,3876.12,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,PPO Network,,3876.12,,,,,,,2140.96,4664.40,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,inpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,118.60,209.16,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,PPO Network,,179.19,,,,,,,107.81,209.16,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,inpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.14415,0.57230,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,inpatient,1,EA,2879.90000,2735.90000,The Alliance,PPO Network,,2393.20,,,,,,,1583.94,2793.50,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,outpatient,1,EA,2879.90000,2735.90000,The Alliance,PPO Network,,2393.20,,,,,,,11.00,2793.50,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,inpatient,1,mL,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,12.15,21.43,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,outpatient,1,mL,22.09000,20.98000,The Alliance,PPO Network,,18.36,,,,,,,11.04,37.80,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,inpatient,1,EA,14.82000,14.07000,The Alliance,PPO Network,,12.32,,,,,,,8.15,14.38,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,PPO Network,,12.32,,,,,,,7.41,14.38,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,inpatient,1,EA,4547.65000,4320.27000,The Alliance,PPO Network,,3779.10,,,,,,,2501.21,4411.22,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,outpatient,1,EA,4547.65000,4320.27000,The Alliance,PPO Network,,3779.10,,,,,,,2113.24,4411.22,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,4229.70000,4018.21000,The Alliance,PPO Network,,3514.88,,,,,,,2072.55,4102.81,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,PPO Network,,3514.88,,,,,,,1941.43,4229.70,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,20528.18,43381.99,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,The Alliance,PPO Network,,9809.79,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,PPO Network,,9809.79,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,66.64,131.92,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,62.42,136.00,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1328.81,2895.00,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,The Alliance,PPO Network,,109.59,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,PPO Network,,109.59,,,,,,,60.53,131.88,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,The Alliance,PPO Network,,109.59,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,PPO Network,,109.59,,,,,,,60.53,131.88,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.34860,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,PPO Network,,18019.82,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,inpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.46,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,PPO Network,,2.20,,,,,,,1.32,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,inpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,PPO Network,,3.19,,,,,,,1.92,3.72,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,inpatient,1,mL,436.17000,414.36000,The Alliance,PPO Network,,362.46,,,,,,,239.89,423.08,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,outpatient,1,mL,436.17000,414.36000,The Alliance,PPO Network,,362.46,,,,,,,218.09,423.08,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,inpatient,1,mL,1265.76000,1202.47000,The Alliance,PPO Network,,1051.85,,,,,,,696.17,1227.79,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,outpatient,1,mL,1265.76000,1202.47000,The Alliance,PPO Network,,1051.85,,,,,,,632.88,1227.79,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,3.02,15.33,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,395.06,782.06,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,PPO Network,,669.99,,,,,,,370.07,806.25,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,The Alliance,PPO Network,,25925.21,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,PPO Network,,25925.21,,,,,,,14319.70,31197.60,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10551.84000,10024.25000,The Alliance,PPO Network,,8768.58,,,,,,,5170.40,10235.28,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10551.84000,10024.25000,The Alliance,PPO Network,,8768.58,,,,,,,4843.29,10551.84,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,4027.90,7973.60,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,PPO Network,,6830.99,,,,,,,3773.08,8220.21,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,inpatient,1,mL,33.52000,31.85000,The Alliance,PPO Network,,27.86,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,PPO Network,,27.86,,,,,,,1.49,32.51,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,inpatient,1,EA,82.92000,78.77000,The Alliance,PPO Network,,68.91,,,,,,,45.61,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,outpatient,1,EA,82.92000,78.77000,The Alliance,PPO Network,,68.91,,,,,,,0.76415,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,inpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.62150,1.10,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,PPO Network,,0.93903,,,,,,,0.56500,1.10,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.31900,0.56260,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,PPO Network,,0.48198,,,,,,,0.29000,0.56260,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,4721.18,10285.80,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,inpatient,1,EA,62.19000,59.08000,The Alliance,PPO Network,,51.68,,,,,,,34.20,60.32,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,outpatient,1,EA,62.19000,59.08000,The Alliance,PPO Network,,51.68,,,,,,,7.82,60.32,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,PPO Network,,8547.50,,,,,,,4721.18,10285.80,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,14312.70000,13597.07000,The Alliance,PPO Network,,11893.85,,,,,,,7013.22,13883.32,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,14312.70000,13597.07000,The Alliance,PPO Network,,11893.85,,,,,,,6569.53,14312.70,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,inpatient,1,mL,1746.98000,1659.63000,The Alliance,PPO Network,,1451.74,,,,,,,960.84,1694.57,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,outpatient,1,mL,1746.98000,1659.63000,The Alliance,PPO Network,,1451.74,,,,,,,873.49,1694.57,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,inpatient,1,mL,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.58,2.78,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,outpatient,1,mL,2.87000,2.73000,The Alliance,PPO Network,,2.38,,,,,,,1.44,2.78,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,inpatient,1,mL,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.75,3.09,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,outpatient,1,mL,3.19000,3.03000,The Alliance,PPO Network,,2.65,,,,,,,1.59,3.09,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,inpatient,1,mL,3836.56000,3644.73000,The Alliance,PPO Network,,3188.18,,,,,,,2110.11,3721.46,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,outpatient,1,mL,3836.56000,3644.73000,The Alliance,PPO Network,,3188.18,,,,,,,1918.28,3721.46,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,4.06,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3360.00000,3192.00000,The Alliance,PPO Network,,2792.16,,,,,,,1646.40,3259.20,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3360.00000,3192.00000,The Alliance,PPO Network,,2792.16,,,,,,,1542.24,3360.00,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,712.50000,676.88000,The Alliance,PPO Network,,592.09,,,,,,,349.12,691.12,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,712.50000,676.88000,The Alliance,PPO Network,,592.09,,,,,,,327.04,712.50,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,inpatient,1,mL,69.71000,66.22000,The Alliance,PPO Network,,57.93,,,,,,,38.34,67.62,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,outpatient,1,mL,69.71000,66.22000,The Alliance,PPO Network,,57.93,,,,,,,7.57,67.62,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,inpatient,1,mL,379.44000,360.46000,The Alliance,PPO Network,,315.31,,,,,,,208.69,368.06,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,PPO Network,,315.31,,,,,,,1.16,368.06,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,inpatient,,,155.60000,147.82000,The Alliance,PPO Network,90,129.30,,,,,,,85.58,150.93,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,outpatient,,,155.60000,147.82000,The Alliance,PPO Network,90,129.30,,,,,,,19.00,865.84,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,15.55,780.94,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,inpatient,,,257.50000,244.62000,The Alliance,PPO Network,90,213.98,,,,,,,141.62,249.78,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,outpatient,,,257.50000,244.62000,The Alliance,PPO Network,90,213.98,,,,,,,30.26,1527.89,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,88.99,156.95,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,19.00,865.84,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,137.72,242.89,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,30.59,1544.85,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,inpatient,,,211.80000,201.21000,The Alliance,PPO Network,90,176.01,,,,,,,116.49,205.45,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,outpatient,,,211.80000,201.21000,The Alliance,PPO Network,90,176.01,,,,,,,24.89,1137.41,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,inpatient,,,101.60000,96.52000,The Alliance,PPO Network,90,84.43,,,,,,,55.88,98.55,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,outpatient,,,101.60000,96.52000,The Alliance,PPO Network,90,84.43,,,,,,,9.64,98.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,inpatient,,,511.00000,485.45000,The Alliance,PPO Network,90,424.64,,,,,,,281.05,495.67,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,PPO Network,90,424.64,,,,,,,50.66,2563.44,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,inpatient,,,130.20000,123.69000,The Alliance,PPO Network,90,108.20,,,,,,,71.61,126.29,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,outpatient,,,130.20000,123.69000,The Alliance,PPO Network,90,108.20,,,,,,,12.45,1539.22,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,536.80,946.72,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,119.20,6026.72,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,inpatient,,,73.30000,69.63000,The Alliance,PPO Network,90,60.91,,,,,,,40.31,71.10,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,outpatient,,,73.30000,69.63000,The Alliance,PPO Network,90,60.91,,,,,,,8.35,424.40,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,inpatient,,,23.40000,22.23000,The Alliance,PPO Network,90,19.45,,,,,,,12.87,22.70,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,outpatient,,,23.40000,22.23000,The Alliance,PPO Network,90,19.45,,,,,,,4.57,271.65,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,inpatient,,,458.30000,435.38000,The Alliance,PPO Network,90,380.85,,,,,,,252.06,444.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,outpatient,,,458.30000,435.38000,The Alliance,PPO Network,90,380.85,,,,,,,50.66,2563.44,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,inpatient,,,5277.00000,5013.15000,The Alliance,PPO Network,90,4385.19,,,,,,,2902.35,5118.69,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,outpatient,,,5277.00000,5013.15000,The Alliance,PPO Network,90,4385.19,,,,,,,480.00,28232.08,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,15.80,780.94,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,inpatient,,,65.30000,62.03000,The Alliance,PPO Network,90,54.26,,,,,,,35.91,63.34,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,outpatient,,,65.30000,62.03000,The Alliance,PPO Network,90,54.26,,,,,,,17.33,882.80,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,inpatient,,,118.10000,112.19000,The Alliance,PPO Network,90,98.14,,,,,,,64.95,114.56,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,outpatient,,,118.10000,112.19000,The Alliance,PPO Network,90,98.14,,,,,,,13.89,696.05,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,inpatient,,,579.00000,550.05000,The Alliance,PPO Network,TC,481.15,,,,,,,318.45,561.63,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,PPO Network,TC,481.15,,,,,,,121.00,3027.62,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,53.52,94.38,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,4.57,271.65,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,The Alliance,PPO Network,,2811.27,,,,,,,1860.65,3281.51,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,PPO Network,,2811.27,,,,,,,370.62,4872.27,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,163.24,287.90,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,12.40,628.12,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,PPO Network,90,511.06,,,,,,,338.25,596.55,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,PPO Network,90,511.06,,,,,,,307.50,3186.14,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,The Alliance,PPO Network,90,168.28,,,,,,,111.38,196.43,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,PPO Network,90,168.28,,,,,,,77.53,1052.52,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,389.40,686.76,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,259.66,15261.97,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,inpatient,,,132.40000,125.78000,The Alliance,PPO Network,90,110.02,,,,,,,72.82,128.43,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,outpatient,,,132.40000,125.78000,The Alliance,PPO Network,90,110.02,,,,,,,8.17,780.94,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,inpatient,,,194.30000,184.58000,The Alliance,PPO Network,90,161.46,,,,,,,106.86,188.47,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,outpatient,,,194.30000,184.58000,The Alliance,PPO Network,90,161.46,,,,,,,8.94,458.40,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,12.00,23.28,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,inpatient,,,645.00000,612.75000,The Alliance,PPO Network,90,536.00,,,,,,,354.75,625.65,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,outpatient,,,645.00000,612.75000,The Alliance,PPO Network,90,536.00,,,,,,,12.45,1539.22,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,inpatient,,,174.70000,165.96000,The Alliance,PPO Network,90,145.18,,,,,,,96.08,169.46,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,outpatient,,,174.70000,165.96000,The Alliance,PPO Network,90,145.18,,,,,,,12.40,628.12,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,90,83.10,,,,,,,55.00,97.00,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,90,83.10,,,,,,,50.00,1137.41,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,inpatient,,,116.90000,111.06000,The Alliance,PPO Network,90,97.14,,,,,,,64.30,113.39,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,outpatient,,,116.90000,111.06000,The Alliance,PPO Network,90,97.14,,,,,,,12.40,628.12,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,69.96,123.38,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,12.40,628.12,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1075.00000,1021.25000,The Alliance,PPO Network,90,893.33,,,,,,,591.25,1042.75,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1075.00000,1021.25000,The Alliance,PPO Network,90,893.33,,,,,,,126.29,6383.20,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,207.24,365.50,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,44.27,2240.90,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,169.78,299.44,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,12.40,628.12,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,inpatient,,,160.40000,152.38000,The Alliance,PPO Network,90,133.29,,,,,,,88.22,155.59,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,outpatient,,,160.40000,152.38000,The Alliance,PPO Network,90,133.29,,,,,,,12.29,628.12,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,inpatient,,,101.00000,95.95000,The Alliance,PPO Network,90,83.93,,,,,,,55.55,97.97,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,PPO Network,90,83.93,,,,,,,8.17,594.19,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,90,131.30,,,,,,,86.90,153.26,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,90,131.30,,,,,,,79.00,1137.41,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,inpatient,,,38.00000,36.10000,The Alliance,PPO Network,90,31.58,,,,,,,20.90,36.86,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,PPO Network,90,31.58,,,,,,,19.00,3038.81,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,The Alliance,PPO Network,90,130.80,,,,,,,86.57,152.68,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,PPO Network,90,130.80,,,,,,,20.36,1120.45,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,The Alliance,PPO Network,90,130.80,,,,,,,86.57,152.68,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,PPO Network,90,130.80,,,,,,,20.36,1120.45,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3810.00000,3619.50000,The Alliance,PPO Network,TC,3166.11,,,,,,,2095.50,3695.70,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3810.00000,3619.50000,The Alliance,PPO Network,TC,3166.11,,,,,,,533.12,16173.22,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,inpatient,,,396.00000,376.20000,The Alliance,PPO Network,TC,329.08,,,,,,,217.80,384.12,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,PPO Network,TC,329.08,,,,,,,127.30,1245.05,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,inpatient,,,432.00000,410.40000,The Alliance,PPO Network,,358.99,,,,,,,237.60,419.04,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,outpatient,,,432.00000,410.40000,The Alliance,PPO Network,,358.99,,,,,,,142.63,6772.31,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,inpatient,,,952.00000,904.40000,The Alliance,PPO Network,,791.11,,,,,,,523.60,923.44,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,outpatient,,,952.00000,904.40000,The Alliance,PPO Network,,791.11,,,,,,,329.46,4329.05,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,inpatient,,,171.80000,163.21000,The Alliance,PPO Network,90,142.77,,,,,,,94.49,166.65,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,outpatient,,,171.80000,163.21000,The Alliance,PPO Network,90,142.77,,,,,,,21.00,1069.56,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.40000,303.43000,The Alliance,PPO Network,90,265.42,,,,,,,175.67,309.82,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.40000,303.43000,The Alliance,PPO Network,90,265.42,,,,,,,8.94,458.40,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,inpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,50.82,89.63,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,outpatient,,,92.40000,87.78000,The Alliance,PPO Network,,76.78,,,,,,,6.48,339.51,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,536.80,946.72,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,119.20,6026.72,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,91.80,161.89,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,8.94,458.40,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,inpatient,,,655.00000,622.25000,The Alliance,PPO Network,,544.30,,,,,,,360.25,635.35,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,outpatient,,,655.00000,622.25000,The Alliance,PPO Network,,544.30,,,,,,,161.92,9523.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,inpatient,,,2638.00000,2506.10000,The Alliance,PPO Network,90,2192.18,,,,,,,1450.90,2558.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,outpatient,,,2638.00000,2506.10000,The Alliance,PPO Network,90,2192.18,,,,,,,195.07,14107.52,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,inpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,404.25,712.95,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,PPO Network,,610.78,,,,,,,367.50,28232.08,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,inpatient,,,43.30000,41.13000,The Alliance,PPO Network,90,35.98,,,,,,,23.82,42.00,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,outpatient,,,43.30000,41.13000,The Alliance,PPO Network,90,35.98,,,,,,,4.91,254.68,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,inpatient,,,113.40000,107.73000,The Alliance,PPO Network,90,94.24,,,,,,,62.37,110.00,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,PPO Network,90,94.24,,,,,,,8.17,679.08,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,inpatient,,,255.30000,242.54000,The Alliance,PPO Network,90,212.15,,,,,,,140.41,247.64,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,outpatient,,,255.30000,242.54000,The Alliance,PPO Network,90,212.15,,,,,,,20.36,1120.45,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,86.79,153.07,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,PPO Network,90,131.13,,,,,,,17.71,933.70,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,inpatient,,,227.90000,216.50000,The Alliance,PPO Network,90,189.38,,,,,,,125.34,221.06,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,outpatient,,,227.90000,216.50000,The Alliance,PPO Network,90,189.38,,,,,,,113.95,1137.41,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,inpatient,,,105.70000,100.41000,The Alliance,PPO Network,90,87.84,,,,,,,58.13,102.53,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,outpatient,,,105.70000,100.41000,The Alliance,PPO Network,90,87.84,,,,,,,8.94,458.40,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,69.96,123.38,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,12.40,628.12,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,inpatient,,,119.40000,113.43000,The Alliance,PPO Network,90,99.22,,,,,,,65.67,115.82,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,outpatient,,,119.40000,113.43000,The Alliance,PPO Network,90,99.22,,,,,,,14.59,729.98,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,inpatient,,,855.00000,812.25000,The Alliance,PPO Network,,710.50,,,,,,,470.25,829.35,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,outpatient,,,855.00000,812.25000,The Alliance,PPO Network,,710.50,,,,,,,142.63,6772.31,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,The Alliance,PPO Network,90,101.63,,,,,,,67.27,118.63,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,PPO Network,90,101.63,,,,,,,12.40,628.12,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,90.03,158.79,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,PPO Network,90,136.03,,,,,,,20.36,1120.45,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,inpatient,,,199.20000,189.24000,The Alliance,PPO Network,90,165.54,,,,,,,109.56,193.22,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,outpatient,,,199.20000,189.24000,The Alliance,PPO Network,90,165.54,,,,,,,20.36,1120.45,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1635.00000,1553.25000,The Alliance,PPO Network,90,1358.68,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,PPO Network,90,1358.68,,,,,,,157.98,9082.50,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,inpatient,,,95.20000,90.44000,The Alliance,PPO Network,90,79.11,,,,,,,52.36,92.34,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,outpatient,,,95.20000,90.44000,The Alliance,PPO Network,90,79.11,,,,,,,11.17,560.26,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,inpatient,,,74.80000,71.06000,The Alliance,PPO Network,90,62.16,,,,,,,41.14,72.56,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,outpatient,,,74.80000,71.06000,The Alliance,PPO Network,90,62.16,,,,,,,8.35,424.40,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,inpatient,,,111.80000,106.21000,The Alliance,PPO Network,90,92.91,,,,,,,61.49,108.45,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,outpatient,,,111.80000,106.21000,The Alliance,PPO Network,90,92.91,,,,,,,12.40,628.12,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,inpatient,,,20708.00000,19672.60000,The Alliance,PPO Network,90,17208.35,,,,,,,11389.40,20086.76,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,outpatient,,,20708.00000,19672.60000,The Alliance,PPO Network,90,17208.35,,,,,,,8569.96,115186.20,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,The Alliance,PPO Network,,2811.27,,,,,,,1860.65,3281.51,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,PPO Network,,2811.27,,,,,,,370.62,4872.27,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2812.00000,2671.40000,The Alliance,PPO Network,TC,2336.77,,,,,,,1546.60,2727.64,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,PPO Network,TC,2336.77,,,,,,,533.12,16173.22,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,inpatient,,,170.40000,161.88000,The Alliance,PPO Network,90,141.60,,,,,,,93.72,165.29,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,outpatient,,,170.40000,161.88000,The Alliance,PPO Network,90,141.60,,,,,,,12.40,628.12,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,inpatient,,,213.50000,202.82000,The Alliance,PPO Network,90,177.42,,,,,,,117.42,207.09,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,outpatient,,,213.50000,202.82000,The Alliance,PPO Network,90,177.42,,,,,,,26.09,1324.17,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,inpatient,,,241.80000,229.71000,The Alliance,PPO Network,90,200.94,,,,,,,132.99,234.55,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,outpatient,,,241.80000,229.71000,The Alliance,PPO Network,90,200.94,,,,,,,45.08,679.08,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,PPO Network,90,816.87,,,,,,,540.65,953.51,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,PPO Network,90,816.87,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,inpatient,,,459.10000,436.14000,The Alliance,PPO Network,90,381.51,,,,,,,252.50,445.33,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,outpatient,,,459.10000,436.14000,The Alliance,PPO Network,90,381.51,,,,,,,25.31,2286.16,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,inpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,69.96,123.38,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,PPO Network,90,105.70,,,,,,,14.94,763.98,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,inpatient,,,334.30000,317.58000,The Alliance,PPO Network,90,277.80,,,,,,,183.87,324.27,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,outpatient,,,334.30000,317.58000,The Alliance,PPO Network,90,277.80,,,,,,,24.89,1137.41,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,inpatient,,,226.40000,215.08000,The Alliance,PPO Network,90,188.14,,,,,,,124.52,219.61,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,outpatient,,,226.40000,215.08000,The Alliance,PPO Network,90,188.14,,,,,,,27.67,1392.10,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,inpatient,,,158.90000,150.96000,The Alliance,PPO Network,90,132.05,,,,,,,87.39,154.13,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,outpatient,,,158.90000,150.96000,The Alliance,PPO Network,90,132.05,,,,,,,10.38,950.66,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,55.83,98.45,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,PPO Network,90,84.35,,,,,,,12.40,628.12,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,90,1219.91,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,90,1219.91,,,,,,,179.44,8692.03,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,36.26,1833.46,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,inpatient,,,623.00000,591.85000,The Alliance,PPO Network,90,517.71,,,,,,,342.65,604.31,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,PPO Network,90,517.71,,,,,,,38.99,1969.25,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,inpatient,,,700.00000,665.00000,The Alliance,PPO Network,90,581.70,,,,,,,385.00,679.00,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,outpatient,,,700.00000,665.00000,The Alliance,PPO Network,90,581.70,,,,,,,66.55,3361.35,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,The Alliance,PPO Network,TC,708.84,,,,,,,469.15,827.41,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,PPO Network,TC,708.84,,,,,,,426.50,7351.18,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1483.00000,1408.85000,The Alliance,PPO Network,90,1232.37,,,,,,,815.65,1438.51,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,PPO Network,90,1232.37,,,,,,,143.40,8250.66,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,inpatient,,,1635.00000,1553.25000,The Alliance,PPO Network,90,1358.68,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,PPO Network,90,1358.68,,,,,,,116.74,9082.50,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,inpatient,,,4042.00000,3839.90000,The Alliance,PPO Network,TC,3358.90,,,,,,,2223.10,3920.74,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,PPO Network,TC,3358.90,,,,,,,1836.07,19225.77,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,The Alliance,PPO Network,90,129.47,,,,,,,85.69,151.13,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,PPO Network,90,129.47,,,,,,,12.45,1539.22,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,36.26,1833.46,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,The Alliance,PPO Network,90,123.24,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,PPO Network,90,123.24,,,,,,,12.40,628.12,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,207.24,365.50,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,44.27,2240.90,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,inpatient,,,85.70000,81.41000,The Alliance,PPO Network,90,71.22,,,,,,,47.13,83.13,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,outpatient,,,85.70000,81.41000,The Alliance,PPO Network,90,71.22,,,,,,,12.40,628.12,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,inpatient,,,10203.00000,9692.85000,The Alliance,PPO Network,90,8478.69,,,,,,,5611.65,9896.91,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,outpatient,,,10203.00000,9692.85000,The Alliance,PPO Network,90,8478.69,,,,,,,928.00,9896.91,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,12.45,1539.22,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,19.88,1103.49,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,inpatient,,,108.70000,103.26000,The Alliance,PPO Network,90,90.33,,,,,,,59.78,105.44,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,outpatient,,,108.70000,103.26000,The Alliance,PPO Network,90,90.33,,,,,,,8.17,526.26,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,PPO Network,,511.06,,,,,,,338.25,596.55,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,PPO Network,,511.06,,,,,,,17.90,933.70,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,inpatient,,,205.30000,195.04000,The Alliance,PPO Network,90,170.60,,,,,,,112.92,199.14,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,outpatient,,,205.30000,195.04000,The Alliance,PPO Network,90,170.60,,,,,,,19.26,882.80,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,inpatient,,,203.40000,193.23000,The Alliance,PPO Network,90,169.03,,,,,,,111.87,197.30,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,outpatient,,,203.40000,193.23000,The Alliance,PPO Network,90,169.03,,,,,,,15.10,679.08,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,4.75,254.68,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,inpatient,,,660.00000,627.00000,The Alliance,PPO Network,,548.46,,,,,,,363.00,640.20,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,outpatient,,,660.00000,627.00000,The Alliance,PPO Network,,548.46,,,,,,,35.91,891.44,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,inpatient,,,181.00000,171.95000,The Alliance,PPO Network,TC,150.41,,,,,,,99.55,175.57,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,PPO Network,TC,150.41,,,,,,,90.50,2993.62,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,The Alliance,PPO Network,90,123.24,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,PPO Network,90,123.24,,,,,,,12.40,628.12,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4707.00000,4471.65000,The Alliance,PPO Network,90,3911.52,,,,,,,2588.85,4565.79,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4707.00000,4471.65000,The Alliance,PPO Network,90,3911.52,,,,,,,210.00,26177.94,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,inpatient,,,236.40000,224.58000,The Alliance,PPO Network,90,196.45,,,,,,,130.02,229.31,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,outpatient,,,236.40000,224.58000,The Alliance,PPO Network,90,196.45,,,,,,,28.87,1459.96,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,inpatient,,,212.80000,202.16000,The Alliance,PPO Network,90,176.84,,,,,,,117.04,206.42,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,outpatient,,,212.80000,202.16000,The Alliance,PPO Network,90,176.84,,,,,,,24.99,1256.24,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,inpatient,,,172.80000,164.16000,The Alliance,PPO Network,90,143.60,,,,,,,95.04,167.62,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,outpatient,,,172.80000,164.16000,The Alliance,PPO Network,90,143.60,,,,,,,45.08,679.08,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4895.00000,4650.25000,The Alliance,PPO Network,90,4067.74,,,,,,,2692.25,4748.15,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4895.00000,4650.25000,The Alliance,PPO Network,90,4067.74,,,,,,,210.00,26177.94,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,inpatient,,,319.60000,303.62000,The Alliance,PPO Network,90,265.59,,,,,,,175.78,310.01,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,outpatient,,,319.60000,303.62000,The Alliance,PPO Network,90,265.59,,,,,,,9.83,611.15,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,114.02,201.08,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,19.88,1103.49,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,inpatient,,,78.80000,74.86000,The Alliance,PPO Network,90,65.48,,,,,,,43.34,76.44,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,PPO Network,90,65.48,,,,,,,8.17,696.05,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,inpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,18.15,32.01,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,PPO Network,,27.42,,,,,,,3.48,169.79,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,inpatient,,,154.30000,146.58000,The Alliance,PPO Network,90,128.22,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,PPO Network,90,128.22,,,,,,,17.85,814.87,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,inpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,140.80,248.32,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,PPO Network,,212.74,,,,,,,128.00,1833.46,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,inpatient,,,672.00000,638.40000,The Alliance,PPO Network,TC,558.43,,,,,,,369.60,651.84,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,PPO Network,TC,558.43,,,,,,,336.00,4266.89,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,90,360.65,,,,,,,238.70,420.98,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,90,360.65,,,,,,,12.45,1539.22,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,99.66,175.76,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,20.36,1120.45,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1355.00000,1287.25000,The Alliance,PPO Network,TC,1126.01,,,,,,,745.25,1314.35,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,PPO Network,TC,1126.01,,,,,,,664.97,7351.18,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.10000,46.64000,The Alliance,PPO Network,90,40.80,,,,,,,27.00,47.63,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.10000,46.64000,The Alliance,PPO Network,90,40.80,,,,,,,4.49,220.68,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,169.78,299.44,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,12.45,1539.22,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,inpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,90,989.72,,,,,,,655.05,1155.27,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,PPO Network,90,989.72,,,,,,,70.04,7350.89,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,inpatient,,,290.50000,275.97000,The Alliance,PPO Network,90,241.41,,,,,,,159.78,281.79,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,outpatient,,,290.50000,275.97000,The Alliance,PPO Network,90,241.41,,,,,,,28.73,1459.96,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,inpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,297.55,524.77,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,PPO Network,,449.57,,,,,,,70.04,7350.89,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,inpatient,,,80.90000,76.86000,The Alliance,PPO Network,90,67.23,,,,,,,44.49,78.47,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,outpatient,,,80.90000,76.86000,The Alliance,PPO Network,90,67.23,,,,,,,8.17,424.40,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,19.88,1103.49,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,inpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,39.05,68.87,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,outpatient,,,71.00000,67.45000,The Alliance,PPO Network,,59.00,,,,,,,9.74,68.87,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,inpatient,,,184.30000,175.08000,The Alliance,PPO Network,,153.15,,,,,,,101.36,178.77,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,outpatient,,,184.30000,175.08000,The Alliance,PPO Network,,153.15,,,,,,,9.83,611.15,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,inpatient,,,199.30000,189.34000,The Alliance,PPO Network,90,165.62,,,,,,,109.61,193.32,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,outpatient,,,199.30000,189.34000,The Alliance,PPO Network,90,165.62,,,,,,,19.88,1103.49,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,inpatient,,,65.00000,61.75000,The Alliance,PPO Network,90,54.02,,,,,,,35.75,63.05,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,PPO Network,90,54.02,,,,,,,5.93,305.58,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,99.66,175.76,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,20.36,1120.45,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,inpatient,,,60.00000,57.00000,The Alliance,PPO Network,90,49.86,,,,,,,33.00,58.20,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,PPO Network,90,49.86,,,,,,,5.48,271.65,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,inpatient,,,81.30000,77.24000,The Alliance,PPO Network,90,67.56,,,,,,,44.72,78.86,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,outpatient,,,81.30000,77.24000,The Alliance,PPO Network,90,67.56,,,,,,,7.44,373.51,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,TC,2407.41,,,,,,,1593.35,2810.09,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,TC,2407.41,,,,,,,533.12,16173.22,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,inpatient,,,44.40000,42.18000,The Alliance,PPO Network,90,36.90,,,,,,,24.42,43.07,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,outpatient,,,44.40000,42.18000,The Alliance,PPO Network,90,36.90,,,,,,,4.06,203.72,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,inpatient,,,106.50000,101.17000,The Alliance,PPO Network,90,88.50,,,,,,,58.58,103.31,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,outpatient,,,106.50000,101.17000,The Alliance,PPO Network,90,88.50,,,,,,,12.51,628.12,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,inpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,267.30,471.42,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,outpatient,,,486.00000,461.70000,The Alliance,PPO Network,,403.87,,,,,,,35.91,891.44,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,inpatient,,,530.00000,503.50000,The Alliance,PPO Network,90,440.43,,,,,,,291.50,514.10,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,PPO Network,90,440.43,,,,,,,100.54,7096.21,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,5.35,271.65,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,90,435.44,,,,,,,288.20,508.28,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,90,435.44,,,,,,,12.45,1539.22,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,inpatient,,,2799.00000,2659.05000,The Alliance,PPO Network,90,2325.97,,,,,,,1539.45,2715.03,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,outpatient,,,2799.00000,2659.05000,The Alliance,PPO Network,90,2325.97,,,,,,,266.02,13462.44,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,inpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,40.15,70.81,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,PPO Network,,60.66,,,,,,,6.47,339.51,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,inpatient,,,379.70000,360.71000,The Alliance,PPO Network,90,315.53,,,,,,,208.84,368.31,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,outpatient,,,379.70000,360.71000,The Alliance,PPO Network,90,315.53,,,,,,,46.38,2105.11,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,inpatient,,,556.00000,528.20000,The Alliance,PPO Network,,462.04,,,,,,,305.80,539.32,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,PPO Network,,462.04,,,,,,,278.00,539.32,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,inpatient,,,33.00000,31.35000,The Alliance,PPO Network,90,27.42,,,,,,,18.15,32.01,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,PPO Network,90,27.42,,,,,,,4.57,271.65,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,58.35,102.92,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,inpatient,,,56.80000,53.96000,The Alliance,PPO Network,90,47.20,,,,,,,31.24,55.10,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,outpatient,,,56.80000,53.96000,The Alliance,PPO Network,90,47.20,,,,,,,4.24,254.68,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,The Alliance,PPO Network,90,359.66,,,,,,,238.04,419.82,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,PPO Network,90,359.66,,,,,,,52.89,2410.69,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,inpatient,,,201.60000,191.52000,The Alliance,PPO Network,,167.53,,,,,,,110.88,195.55,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,outpatient,,,201.60000,191.52000,The Alliance,PPO Network,,167.53,,,,,,,18.54,967.70,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,inpatient,,,154.30000,146.58000,The Alliance,PPO Network,90,128.22,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,PPO Network,90,128.22,,,,,,,14.59,729.98,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,58.35,102.92,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,12.45,628.12,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,inpatient,,,211.70000,201.11000,The Alliance,PPO Network,90,175.92,,,,,,,116.44,205.35,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,outpatient,,,211.70000,201.11000,The Alliance,PPO Network,90,175.92,,,,,,,24.88,1256.24,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,inpatient,,,49.60000,47.12000,The Alliance,PPO Network,90,41.22,,,,,,,27.28,48.11,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,outpatient,,,49.60000,47.12000,The Alliance,PPO Network,90,41.22,,,,,,,24.80,1052.52,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,inpatient,,,142.10000,134.99000,The Alliance,PPO Network,90,118.09,,,,,,,78.16,137.84,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,outpatient,,,142.10000,134.99000,The Alliance,PPO Network,90,118.09,,,,,,,13.00,662.12,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,inpatient,,,164.70000,156.46000,The Alliance,PPO Network,,136.87,,,,,,,90.58,159.76,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,outpatient,,,164.70000,156.46000,The Alliance,PPO Network,,136.87,,,,,,,15.78,763.98,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,inpatient,,,175.10000,166.34000,The Alliance,PPO Network,90,145.51,,,,,,,96.31,169.85,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,outpatient,,,175.10000,166.34000,The Alliance,PPO Network,90,145.51,,,,,,,21.79,984.66,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,The Alliance,PPO Network,TC,2148.97,,,,,,,1422.30,2508.42,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,PPO Network,TC,2148.97,,,,,,,1293.00,13397.25,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,inpatient,,,101.90000,96.81000,The Alliance,PPO Network,90,84.68,,,,,,,56.05,98.84,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,PPO Network,90,84.68,,,,,,,12.45,628.12,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,inpatient,,,259.70000,246.71000,The Alliance,PPO Network,90,215.81,,,,,,,142.84,251.91,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,outpatient,,,259.70000,246.71000,The Alliance,PPO Network,90,215.81,,,,,,,30.51,1544.85,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,90,98.89,,,,,,,65.45,115.43,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,90,98.89,,,,,,,6.85,339.51,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,inpatient,,,153.70000,146.01000,The Alliance,PPO Network,90,127.72,,,,,,,84.53,149.09,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,outpatient,,,153.70000,146.01000,The Alliance,PPO Network,90,127.72,,,,,,,14.05,713.01,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,PPO Network,90,66.31,,,,,,,43.89,77.41,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,PPO Network,90,66.31,,,,,,,4.57,271.65,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,inpatient,,,77.70000,73.82000,The Alliance,PPO Network,,64.57,,,,,,,42.73,75.37,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,outpatient,,,77.70000,73.82000,The Alliance,PPO Network,,64.57,,,,,,,6.87,356.54,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,90,1219.91,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,90,1219.91,,,,,,,179.44,8692.03,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,inpatient,,,145.40000,138.13000,The Alliance,PPO Network,90,120.83,,,,,,,79.97,141.04,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,outpatient,,,145.40000,138.13000,The Alliance,PPO Network,90,120.83,,,,,,,72.70,1137.41,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,inpatient,,,2846.00000,2703.70000,The Alliance,PPO Network,90,2365.03,,,,,,,1565.30,2760.62,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,outpatient,,,2846.00000,2703.70000,The Alliance,PPO Network,90,2365.03,,,,,,,139.23,15227.97,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,inpatient,,,455.80000,433.01000,The Alliance,PPO Network,,378.77,,,,,,,250.69,442.13,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,outpatient,,,455.80000,433.01000,The Alliance,PPO Network,,378.77,,,,,,,109.60,6451.13,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,inpatient,,,792.00000,752.40000,The Alliance,PPO Network,90,658.15,,,,,,,435.60,768.24,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,outpatient,,,792.00000,752.40000,The Alliance,PPO Network,90,658.15,,,,,,,12.45,1539.22,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,inpatient,,,712.00000,676.40000,The Alliance,PPO Network,90,591.67,,,,,,,391.60,690.64,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,PPO Network,90,591.67,,,,,,,36.26,1833.46,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,37.56,66.25,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,8.35,424.40,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,inpatient,,,193.40000,183.73000,The Alliance,PPO Network,90,160.72,,,,,,,106.37,187.60,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,outpatient,,,193.40000,183.73000,The Alliance,PPO Network,90,160.72,,,,,,,45.08,679.08,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,inpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,207.24,365.50,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,PPO Network,90,313.12,,,,,,,44.27,2240.90,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,90,2407.41,,,,,,,1593.35,2810.09,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,90,2407.41,,,,,,,329.51,15625.93,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,inpatient,,,121.30000,115.23000,The Alliance,PPO Network,90,100.80,,,,,,,66.72,117.66,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,outpatient,,,121.30000,115.23000,The Alliance,PPO Network,90,100.80,,,,,,,14.25,645.08,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,24.89,1137.41,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,inpatient,,,85.30000,81.03000,The Alliance,PPO Network,90,70.88,,,,,,,46.91,82.74,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,outpatient,,,85.30000,81.03000,The Alliance,PPO Network,90,70.88,,,,,,,10.02,509.30,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,88.99,156.95,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,14.05,713.01,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,58.30,102.82,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,10.66,543.22,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,37.56,66.25,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,8.35,424.40,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,inpatient,,,238.60000,226.67000,The Alliance,PPO Network,,198.28,,,,,,,131.23,231.44,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,outpatient,,,238.60000,226.67000,The Alliance,PPO Network,,198.28,,,,,,,24.11,1137.41,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,inpatient,,,143.00000,135.85000,The Alliance,PPO Network,90,118.83,,,,,,,78.65,138.71,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,PPO Network,90,118.83,,,,,,,16.80,848.80,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,inpatient,,,122.60000,116.47000,The Alliance,PPO Network,,101.88,,,,,,,67.43,118.92,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,outpatient,,,122.60000,116.47000,The Alliance,PPO Network,,101.88,,,,,,,5.51,288.61,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,inpatient,,,5712.00000,5426.40000,The Alliance,PPO Network,90,4746.67,,,,,,,3141.60,5540.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,outpatient,,,5712.00000,5426.40000,The Alliance,PPO Network,90,4746.67,,,,,,,270.25,31763.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,90,172.85,,,,,,,114.40,201.76,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,90,172.85,,,,,,,24.43,1205.34,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,inpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,389.40,686.76,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,PPO Network,,588.35,,,,,,,354.00,686.76,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2794.00000,2654.30000,The Alliance,PPO Network,TC,2321.81,,,,,,,1536.70,2710.18,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2794.00000,2654.30000,The Alliance,PPO Network,TC,2321.81,,,,,,,533.12,16173.22,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,inpatient,,,103.50000,98.32000,The Alliance,PPO Network,90,86.01,,,,,,,56.92,100.39,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,outpatient,,,103.50000,98.32000,The Alliance,PPO Network,90,86.01,,,,,,,12.16,611.15,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,inpatient,,,275.40000,261.63000,The Alliance,PPO Network,90,228.86,,,,,,,151.47,267.14,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,outpatient,,,275.40000,261.63000,The Alliance,PPO Network,90,228.86,,,,,,,23.08,2082.45,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,91.80,161.89,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,19.60,984.66,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,QW,90.58,,,,,,,59.95,105.73,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,QW,90.58,,,,,,,9.71,509.30,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2906.00000,2760.70000,The Alliance,PPO Network,TC,2414.89,,,,,,,1598.30,2818.82,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2906.00000,2760.70000,The Alliance,PPO Network,TC,2414.89,,,,,,,533.12,16173.22,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,163.24,287.90,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,36.26,1833.46,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,inpatient,,,5428.00000,5156.60000,The Alliance,PPO Network,90,4510.67,,,,,,,2985.40,5265.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,outpatient,,,5428.00000,5156.60000,The Alliance,PPO Network,90,4510.67,,,,,,,230.26,30184.37,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,5.68,372.96,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,inpatient,,,398.80000,378.86000,The Alliance,PPO Network,90,331.40,,,,,,,219.34,386.84,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,outpatient,,,398.80000,378.86000,The Alliance,PPO Network,90,331.40,,,,,,,50.66,2563.44,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,inpatient,,,162.80000,154.66000,The Alliance,PPO Network,,135.29,,,,,,,89.54,157.92,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,PPO Network,,135.29,,,,,,,9.30,492.33,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,169.78,299.44,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,36.26,1833.46,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,inpatient,,,282.30000,268.18000,The Alliance,PPO Network,90,234.59,,,,,,,155.26,273.83,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,outpatient,,,282.30000,268.18000,The Alliance,PPO Network,90,234.59,,,,,,,25.78,1307.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2560.00000,2432.00000,The Alliance,PPO Network,90,2127.36,,,,,,,1408.00,2483.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2560.00000,2432.00000,The Alliance,PPO Network,90,2127.36,,,,,,,266.02,13462.44,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,inpatient,,,184.00000,174.80000,The Alliance,PPO Network,90,152.90,,,,,,,101.20,178.48,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,PPO Network,90,152.90,,,,,,,20.36,1120.45,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,The Alliance,PPO Network,90,6325.57,,,,,,,4186.60,7383.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,PPO Network,90,6325.57,,,,,,,516.91,42339.61,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,inpatient,,,1098.00000,1043.10000,The Alliance,PPO Network,90,912.44,,,,,,,603.90,1065.06,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,outpatient,,,1098.00000,1043.10000,The Alliance,PPO Network,90,912.44,,,,,,,73.92,5873.90,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,inpatient,,,1721.00000,1634.95000,The Alliance,PPO Network,90,1430.15,,,,,,,946.55,1669.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,outpatient,,,1721.00000,1634.95000,The Alliance,PPO Network,90,1430.15,,,,,,,177.33,9574.83,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,inpatient,,,92.90000,88.25000,The Alliance,PPO Network,90,77.20,,,,,,,51.09,90.11,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,outpatient,,,92.90000,88.25000,The Alliance,PPO Network,90,77.20,,,,,,,46.45,90.11,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,inpatient,,,283.10000,268.94000,The Alliance,PPO Network,90,235.26,,,,,,,155.71,274.61,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,outpatient,,,283.10000,268.94000,The Alliance,PPO Network,90,235.26,,,,,,,34.58,1578.85,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,inpatient,,,209.70000,199.21000,The Alliance,PPO Network,,174.26,,,,,,,115.33,203.41,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,PPO Network,,174.26,,,,,,,24.11,1137.41,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,96.36,169.94,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,PPO Network,90,145.59,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,inpatient,,,5721.00000,5434.95000,The Alliance,PPO Network,90,4754.15,,,,,,,3146.55,5549.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,outpatient,,,5721.00000,5434.95000,The Alliance,PPO Network,90,4754.15,,,,,,,625.03,31831.15,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,inpatient,,,119.00000,113.05000,The Alliance,PPO Network,TC,98.89,,,,,,,65.45,115.43,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,PPO Network,TC,98.89,,,,,,,59.50,7351.18,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,inpatient,,,134.60000,127.87000,The Alliance,PPO Network,90,111.85,,,,,,,74.03,130.56,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,outpatient,,,134.60000,127.87000,The Alliance,PPO Network,90,111.85,,,,,,,15.10,679.08,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,The Alliance,PPO Network,90,101.63,,,,,,,67.27,118.63,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,PPO Network,90,101.63,,,,,,,12.40,628.12,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,inpatient,,,983.00000,933.85000,The Alliance,PPO Network,90,816.87,,,,,,,540.65,953.51,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,PPO Network,90,816.87,,,,,,,36.26,1833.46,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,inpatient,,,654.00000,621.30000,The Alliance,PPO Network,90,543.47,,,,,,,359.70,634.38,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,outpatient,,,654.00000,621.30000,The Alliance,PPO Network,90,543.47,,,,,,,76.81,3802.79,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,inpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,56.10,98.94,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,PPO Network,,84.76,,,,,,,11.89,645.08,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,inpatient,,,204.20000,193.99000,The Alliance,PPO Network,,169.69,,,,,,,112.31,198.07,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,PPO Network,,169.69,,,,,,,24.11,1137.41,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,90,1352.04,,,,,,,894.85,1578.19,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,90,1352.04,,,,,,,164.96,9048.50,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,The Alliance,PPO Network,90,104.04,,,,,,,68.86,121.44,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,PPO Network,90,104.04,,,,,,,62.60,8610.62,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,inpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,163.24,287.90,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,PPO Network,90,246.64,,,,,,,36.26,1833.46,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,inpatient,,,216.20000,205.39000,The Alliance,PPO Network,90,179.66,,,,,,,118.91,209.71,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,PPO Network,90,179.66,,,,,,,108.10,1137.41,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,28.00,1341.13,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,The Alliance,PPO Network,90,77.78,,,,,,,51.48,90.79,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,PPO Network,90,77.78,,,,,,,4.57,271.65,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,24.91,1137.41,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,169.78,299.44,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,36.26,1833.46,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,inpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,PPO Network,90,319.52,,,,,,,5.35,372.96,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,inpatient,,,84.00000,79.80000,The Alliance,PPO Network,90,69.80,,,,,,,46.20,81.48,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,PPO Network,90,69.80,,,,,,,10.66,543.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,inpatient,,,618.00000,587.10000,The Alliance,PPO Network,90,513.56,,,,,,,339.90,599.46,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,outpatient,,,618.00000,587.10000,The Alliance,PPO Network,90,513.56,,,,,,,36.26,1833.46,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,inpatient,,,345.50000,328.22000,The Alliance,PPO Network,90,287.11,,,,,,,190.03,335.13,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,outpatient,,,345.50000,328.22000,The Alliance,PPO Network,90,287.11,,,,,,,20.36,1120.45,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,90,360.65,,,,,,,238.70,420.98,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,90,360.65,,,,,,,12.45,1539.22,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,inpatient,,,431.20000,409.64000,The Alliance,PPO Network,90,358.33,,,,,,,237.16,418.26,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,outpatient,,,431.20000,409.64000,The Alliance,PPO Network,90,358.33,,,,,,,50.66,2563.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,The Alliance,PPO Network,90,104.04,,,,,,,68.86,121.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,PPO Network,90,104.04,,,,,,,62.60,8610.62,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,90,1352.04,,,,,,,894.85,1578.19,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,PPO Network,90,1352.04,,,,,,,164.96,9048.50,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,inpatient,,,109.40000,103.93000,The Alliance,PPO Network,90,90.91,,,,,,,60.17,106.12,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,outpatient,,,109.40000,103.93000,The Alliance,PPO Network,90,90.91,,,,,,,11.16,560.26,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,The Alliance,PPO Network,TC,427.96,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,PPO Network,TC,427.96,,,,,,,138.83,1411.00,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,inpatient,,,285.50000,271.22000,The Alliance,PPO Network,90,237.25,,,,,,,157.03,276.94,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,outpatient,,,285.50000,271.22000,The Alliance,PPO Network,90,237.25,,,,,,,36.26,1833.46,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,PPO Network,90,84.10,,,,,,,55.66,98.16,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,PPO Network,90,84.10,,,,,,,50.60,1137.41,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,12.45,1539.22,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,inpatient,,,3228.00000,3066.60000,The Alliance,PPO Network,90,2682.47,,,,,,,1775.40,3131.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,outpatient,,,3228.00000,3066.60000,The Alliance,PPO Network,90,2682.47,,,,,,,103.62,17961.21,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,12.45,1539.22,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,The Alliance,PPO Network,,116.17,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,PPO Network,,116.17,,,,,,,12.05,1786.28,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,The Alliance,PPO Network,90,116.17,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,PPO Network,90,116.17,,,,,,,12.05,1786.28,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,inpatient,,,58.30000,55.38000,The Alliance,PPO Network,90,48.45,,,,,,,32.06,56.55,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,outpatient,,,58.30000,55.38000,The Alliance,PPO Network,90,48.45,,,,,,,6.85,339.51,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,inpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,37.56,66.25,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,PPO Network,90,56.76,,,,,,,8.35,424.40,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,inpatient,,,100.50000,95.47000,The Alliance,PPO Network,,83.52,,,,,,,55.27,97.48,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,outpatient,,,100.50000,95.47000,The Alliance,PPO Network,,83.52,,,,,,,50.25,97.48,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,inpatient,,,4214.00000,4003.30000,The Alliance,PPO Network,90,3501.83,,,,,,,2317.70,4087.58,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4214.00000,4003.30000,The Alliance,PPO Network,90,3501.83,,,,,,,282.88,13309.69,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,The Alliance,PPO Network,TC,709.67,,,,,,,469.70,828.38,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,PPO Network,TC,709.67,,,,,,,427.00,7351.18,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,90,2407.41,,,,,,,1593.35,2810.09,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,PPO Network,90,2407.41,,,,,,,329.51,15625.93,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,inpatient,,,2602.00000,2471.90000,The Alliance,PPO Network,90,2162.26,,,,,,,1431.10,2523.94,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,PPO Network,90,2162.26,,,,,,,236.63,13920.84,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,inpatient,,,5275.00000,5011.25000,The Alliance,PPO Network,90,4383.52,,,,,,,2901.25,5116.75,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,outpatient,,,5275.00000,5011.25000,The Alliance,PPO Network,90,4383.52,,,,,,,2637.50,5605.44,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,inpatient,,,1456.00000,1383.20000,The Alliance,PPO Network,90,1209.94,,,,,,,800.80,1412.32,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,outpatient,,,1456.00000,1383.20000,The Alliance,PPO Network,90,1209.94,,,,,,,132.74,7792.26,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,inpatient,,,1483.00000,1408.85000,The Alliance,PPO Network,90,1232.37,,,,,,,815.65,1438.51,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,PPO Network,90,1232.37,,,,,,,140.32,8250.66,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,20.35,35.89,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,,30.75,,,,,,,18.50,35.89,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,inpatient,,,321.00000,304.95000,The Alliance,PPO Network,90,266.75,,,,,,,176.55,311.37,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,outpatient,,,321.00000,304.95000,The Alliance,PPO Network,90,266.75,,,,,,,14.19,713.01,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,The Alliance,PPO Network,TC,709.67,,,,,,,469.70,828.38,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,PPO Network,TC,709.67,,,,,,,427.00,7351.18,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,The Alliance,PPO Network,90,636.55,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,PPO Network,90,636.55,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,536.80,946.72,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,PPO Network,90,811.06,,,,,,,119.20,6026.72,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,inpatient,,,152.40000,144.78000,The Alliance,PPO Network,,126.64,,,,,,,83.82,147.83,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,outpatient,,,152.40000,144.78000,The Alliance,PPO Network,,126.64,,,,,,,15.00,713.01,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,inpatient,,,134.50000,127.77000,The Alliance,PPO Network,90,111.77,,,,,,,73.97,130.47,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,outpatient,,,134.50000,127.77000,The Alliance,PPO Network,90,111.77,,,,,,,14.93,679.08,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,inpatient,,,153.50000,145.82000,The Alliance,PPO Network,90,127.56,,,,,,,84.42,148.90,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,outpatient,,,153.50000,145.82000,The Alliance,PPO Network,90,127.56,,,,,,,76.75,1137.41,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,inpatient,,,154.10000,146.39000,The Alliance,PPO Network,,128.06,,,,,,,84.75,149.48,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,outpatient,,,154.10000,146.39000,The Alliance,PPO Network,,128.06,,,,,,,13.05,679.08,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,inpatient,,,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.45,8.63,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.20000,53.39000,The Alliance,PPO Network,,46.70,,,,,,,30.91,54.51,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.20000,53.39000,The Alliance,PPO Network,,46.70,,,,,,,5.18,271.65,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,inpatient,,,1567.00000,1488.65000,The Alliance,PPO Network,90,1302.18,,,,,,,861.85,1519.99,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,outpatient,,,1567.00000,1488.65000,The Alliance,PPO Network,90,1302.18,,,,,,,185.20,8708.99,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,inpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,196.35,346.29,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,PPO Network,,296.67,,,,,,,35.09,1833.46,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,87.23,153.84,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,PPO Network,90,131.80,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,The Alliance,PPO Network,90,636.55,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,PPO Network,90,636.55,,,,,,,12.45,1539.22,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,inpatient,,,217.80000,206.91000,The Alliance,PPO Network,,180.99,,,,,,,119.79,211.27,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,outpatient,,,217.80000,206.91000,The Alliance,PPO Network,,180.99,,,,,,,14.28,780.94,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,inpatient,,,179.00000,170.05000,The Alliance,PPO Network,90,148.75,,,,,,,98.45,173.63,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,PPO Network,90,148.75,,,,,,,89.50,1137.41,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,37.78,66.64,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,,57.09,,,,,,,8.17,679.08,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,inpatient,,,11319.00000,10753.05000,The Alliance,PPO Network,90,9406.09,,,,,,,6225.45,10979.43,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,outpatient,,,11319.00000,10753.05000,The Alliance,PPO Network,90,9406.09,,,,,,,1287.00,60538.53,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,PPO Network,,113.18,,,,,,,74.91,132.11,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,PPO Network,,113.18,,,,,,,12.05,1539.22,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,inpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,169.78,299.44,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,PPO Network,90,256.53,,,,,,,28.07,299.44,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,inpatient,,,8234.00000,7822.30000,The Alliance,PPO Network,90,6842.45,,,,,,,4528.70,7986.98,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,outpatient,,,8234.00000,7822.30000,The Alliance,PPO Network,90,6842.45,,,,,,,936.00,44037.28,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,inpatient,,,340.70000,323.66000,The Alliance,PPO Network,90,283.12,,,,,,,187.38,330.48,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,PPO Network,90,283.12,,,,,,,20.36,1120.45,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,inpatient,,,193.00000,183.35000,The Alliance,PPO Network,,160.38,,,,,,,106.15,187.21,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,PPO Network,,160.38,,,,,,,20.26,1052.52,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,The Alliance,PPO Network,TC,730.45,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,PPO Network,TC,730.45,,,,,,,96.44,1292.36,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,inpatient,,,170.10000,161.60000,The Alliance,PPO Network,,141.35,,,,,,,93.56,165.00,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,PPO Network,,141.35,,,,,,,14.39,746.94,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,53.52,94.38,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,inpatient,,,63.80000,60.61000,The Alliance,PPO Network,,53.02,,,,,,,35.09,61.89,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,outpatient,,,63.80000,60.61000,The Alliance,PPO Network,,53.02,,,,,,,5.50,288.61,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,inpatient,,,382.00000,362.90000,The Alliance,PPO Network,90,317.44,,,,,,,210.10,370.54,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,outpatient,,,382.00000,362.90000,The Alliance,PPO Network,90,317.44,,,,,,,152.01,370.54,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,inpatient,,,3120.00000,2964.00000,The Alliance,PPO Network,TC,2592.72,,,,,,,1716.00,3026.40,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,PPO Network,TC,2592.72,,,,,,,1560.00,14719.32,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,3.48,169.79,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,inpatient,,,61.50000,58.42000,The Alliance,PPO Network,,51.11,,,,,,,33.83,59.66,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,outpatient,,,61.50000,58.42000,The Alliance,PPO Network,,51.11,,,,,,,30.75,59.66,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,inpatient,,,1700.00000,1615.00000,The Alliance,PPO Network,90,1412.70,,,,,,,935.00,1649.00,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,outpatient,,,1700.00000,1615.00000,The Alliance,PPO Network,90,1412.70,,,,,,,154.60,9082.50,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,inpatient,,,846.00000,803.70000,The Alliance,PPO Network,90,703.03,,,,,,,465.30,820.62,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,outpatient,,,846.00000,803.70000,The Alliance,PPO Network,90,703.03,,,,,,,423.00,820.62,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,5.35,271.65,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,inpatient,,,280.70000,266.66000,The Alliance,PPO Network,90,233.26,,,,,,,154.38,272.28,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,outpatient,,,280.70000,266.66000,The Alliance,PPO Network,90,233.26,,,,,,,8.35,424.40,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,PPO Network,,46.62,,,,,,,30.86,54.42,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,PPO Network,,46.62,,,,,,,28.05,54.42,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,inpatient,,,155.70000,147.92000,The Alliance,PPO Network,90,129.39,,,,,,,85.64,151.03,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,outpatient,,,155.70000,147.92000,The Alliance,PPO Network,90,129.39,,,,,,,19.00,865.84,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,inpatient,,,105.50000,100.22000,The Alliance,PPO Network,90,87.67,,,,,,,58.02,102.33,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,outpatient,,,105.50000,100.22000,The Alliance,PPO Network,90,87.67,,,,,,,8.37,373.51,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,58.35,102.92,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,PPO Network,90,88.17,,,,,,,12.45,1539.22,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,inpatient,,,2324.00000,2207.80000,The Alliance,PPO Network,90,1931.24,,,,,,,1278.20,2254.28,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,outpatient,,,2324.00000,2207.80000,The Alliance,PPO Network,90,1931.24,,,,,,,274.83,12936.18,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,inpatient,,,2548.00000,2420.60000,The Alliance,PPO Network,90,2117.39,,,,,,,1401.40,2471.56,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,outpatient,,,2548.00000,2420.60000,The Alliance,PPO Network,90,2117.39,,,,,,,301.35,14175.45,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,inpatient,,,730.00000,693.50000,The Alliance,PPO Network,90,606.63,,,,,,,401.50,708.10,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,outpatient,,,730.00000,693.50000,The Alliance,PPO Network,90,606.63,,,,,,,85.76,3904.65,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,The Alliance,PPO Network,90,359.66,,,,,,,238.04,419.82,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,PPO Network,90,359.66,,,,,,,52.89,2410.69,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,inpatient,,,665.00000,631.75000,The Alliance,PPO Network,90,552.62,,,,,,,365.75,645.05,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,PPO Network,90,552.62,,,,,,,52.77,2410.69,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,inpatient,,,114.00000,108.30000,The Alliance,PPO Network,TC,94.73,,,,,,,62.70,110.58,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,PPO Network,TC,94.73,,,,,,,57.00,7351.18,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1382.00000,1312.90000,The Alliance,PPO Network,,1148.44,,,,,,,760.10,1340.54,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1382.00000,1312.90000,The Alliance,PPO Network,,1148.44,,,,,,,122.22,6383.20,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,inpatient,,,408.00000,387.60000,The Alliance,PPO Network,90,339.05,,,,,,,224.40,395.76,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,PPO Network,90,339.05,,,,,,,5.68,395.76,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,inpatient,,,233.40000,221.73000,The Alliance,PPO Network,90,193.96,,,,,,,128.37,226.40,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,outpatient,,,233.40000,221.73000,The Alliance,PPO Network,90,193.96,,,,,,,21.69,226.40,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,The Alliance,PPO Network,90,277.39,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,PPO Network,90,277.39,,,,,,,166.90,19453.17,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,90,63.99,,,,,,,42.35,74.69,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,90,63.99,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,inpatient,,,120.70000,114.66000,The Alliance,PPO Network,,100.30,,,,,,,66.39,117.08,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,outpatient,,,120.70000,114.66000,The Alliance,PPO Network,,100.30,,,,,,,10.63,543.22,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,inpatient,,,806.00000,765.70000,The Alliance,PPO Network,90,669.79,,,,,,,443.30,781.82,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,PPO Network,90,669.79,,,,,,,94.71,4787.38,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,inpatient,,,569.00000,540.55000,The Alliance,PPO Network,,472.84,,,,,,,312.95,551.93,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,PPO Network,,472.84,,,,,,,284.50,551.93,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2393.00000,2273.35000,The Alliance,PPO Network,90,1988.58,,,,,,,1316.15,2321.21,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2393.00000,2273.35000,The Alliance,PPO Network,90,1988.58,,,,,,,282.88,13309.69,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,inpatient,,,252.90000,240.26000,The Alliance,PPO Network,90,210.16,,,,,,,139.09,245.31,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,outpatient,,,252.90000,240.26000,The Alliance,PPO Network,90,210.16,,,,,,,24.89,1137.41,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,12.45,1539.22,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,The Alliance,PPO Network,90,277.39,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,PPO Network,90,277.39,,,,,,,166.90,19453.17,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,inpatient,,,590.40000,560.88000,The Alliance,PPO Network,90,490.62,,,,,,,324.72,572.69,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,outpatient,,,590.40000,560.88000,The Alliance,PPO Network,90,490.62,,,,,,,295.20,572.69,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4864.00000,4620.80000,The Alliance,PPO Network,90,4041.98,,,,,,,2675.20,4718.08,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4864.00000,4620.80000,The Alliance,PPO Network,90,4041.98,,,,,,,597.91,28130.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,PPO Network,90,438.77,,,,,,,12.45,1539.22,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,PPO Network,90,205.26,,,,,,,25.31,2286.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,inpatient,,,934.00000,887.30000,The Alliance,PPO Network,,776.15,,,,,,,513.70,905.98,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,outpatient,,,934.00000,887.30000,The Alliance,PPO Network,,776.15,,,,,,,467.00,8610.62,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,,1186.67,,,,,,,785.40,1385.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,PPO Network,,1186.67,,,,,,,143.40,8250.66,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,99.66,175.76,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,20.36,1120.45,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,inpatient,,,250.50000,237.98000,The Alliance,PPO Network,90,208.17,,,,,,,137.78,242.99,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,outpatient,,,250.50000,237.98000,The Alliance,PPO Network,90,208.17,,,,,,,24.89,1137.41,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,inpatient,,,220.90000,209.85000,The Alliance,PPO Network,90,183.57,,,,,,,121.50,214.27,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,outpatient,,,220.90000,209.85000,The Alliance,PPO Network,90,183.57,,,,,,,8.35,424.40,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,The Alliance,PPO Network,90,6325.57,,,,,,,4186.60,7383.64,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,PPO Network,90,6325.57,,,,,,,516.91,42339.61,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,inpatient,,,2501.00000,2375.95000,The Alliance,PPO Network,90,2078.33,,,,,,,1375.55,2425.97,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,outpatient,,,2501.00000,2375.95000,The Alliance,PPO Network,90,2078.33,,,,,,,175.10,13920.84,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,inpatient,,,27.00000,25.65000,The Alliance,PPO Network,,22.44,,,,,,,14.85,26.19,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,PPO Network,,22.44,,,,,,,2.25,118.82,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,PPO Network,90,270.49,,,,,,,12.45,1539.22,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,QW,29.09,,,,,,,19.25,33.95,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,QW,29.09,,,,,,,16.53,780.94,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,inpatient,,,96.60000,91.77000,The Alliance,PPO Network,90,80.27,,,,,,,53.13,93.70,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,outpatient,,,96.60000,91.77000,The Alliance,PPO Network,90,80.27,,,,,,,48.30,1137.41,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,inpatient,,,263.80000,250.61000,The Alliance,PPO Network,90,219.22,,,,,,,145.09,255.89,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,outpatient,,,263.80000,250.61000,The Alliance,PPO Network,90,219.22,,,,,,,131.90,3072.74,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,inpatient,,,37.10000,35.24000,The Alliance,PPO Network,90,30.83,,,,,,,20.41,35.99,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,outpatient,,,37.10000,35.24000,The Alliance,PPO Network,90,30.83,,,,,,,4.55,237.65,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,inpatient,,,233.70000,222.01000,The Alliance,PPO Network,,194.20,,,,,,,128.53,226.69,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,outpatient,,,233.70000,222.01000,The Alliance,PPO Network,,194.20,,,,,,,20.67,1086.52,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1574.00000,1495.30000,The Alliance,PPO Network,,1307.99,,,,,,,865.70,1526.78,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1574.00000,1495.30000,The Alliance,PPO Network,,1307.99,,,,,,,157.98,9082.50,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,21.21,1001.63,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,inpatient,,,291.20000,276.64000,The Alliance,PPO Network,,241.99,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,PPO Network,,241.99,,,,,,,145.60,13920.84,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,The Alliance,PPO Network,TC,708.84,,,,,,,469.15,827.41,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,PPO Network,TC,708.84,,,,,,,426.50,7351.18,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,inpatient,,,291.20000,276.64000,The Alliance,PPO Network,,241.99,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,PPO Network,,241.99,,,,,,,145.60,8708.99,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,inpatient,,,26.00000,24.70000,The Alliance,PPO Network,,21.61,,,,,,,14.30,25.22,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,PPO Network,,21.61,,,,,,,2.37,118.82,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,5.35,271.65,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,3526.00000,3349.70000,The Alliance,PPO Network,90,2930.11,,,,,,,1939.30,3420.22,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,3526.00000,3349.70000,The Alliance,PPO Network,90,2930.11,,,,,,,1458.73,3420.22,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,6.23,322.54,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,3.28,152.82,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,inpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,114.02,201.08,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,PPO Network,90,172.27,,,,,,,11.91,594.19,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,inpatient,,,98.10000,93.19000,The Alliance,PPO Network,90,81.52,,,,,,,53.95,95.16,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,outpatient,,,98.10000,93.19000,The Alliance,PPO Network,90,81.52,,,,,,,9.32,475.37,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,inpatient,,,283.60000,269.42000,The Alliance,PPO Network,,235.67,,,,,,,155.98,275.09,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,outpatient,,,283.60000,269.42000,The Alliance,PPO Network,,235.67,,,,,,,20.36,1120.45,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,inpatient,,,438.90000,416.96000,The Alliance,PPO Network,,364.73,,,,,,,241.40,425.73,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,outpatient,,,438.90000,416.96000,The Alliance,PPO Network,,364.73,,,,,,,219.45,425.73,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,inpatient,,,123.40000,117.23000,The Alliance,PPO Network,90,102.55,,,,,,,67.87,119.70,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,outpatient,,,123.40000,117.23000,The Alliance,PPO Network,90,102.55,,,,,,,28.73,1459.96,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,inpatient,,,12.10000,11.49000,The Alliance,PPO Network,,10.06,,,,,,,6.66,11.74,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,outpatient,,,12.10000,11.49000,The Alliance,PPO Network,,10.06,,,,,,,6.05,11.74,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,PPO Network,90,46.62,,,,,,,30.86,54.42,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,PPO Network,90,46.62,,,,,,,4.91,254.68,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,inpatient,,,49.30000,46.83000,The Alliance,PPO Network,90,40.97,,,,,,,27.11,47.82,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,PPO Network,90,40.97,,,,,,,5.67,254.68,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,inpatient,,,320.60000,304.57000,The Alliance,PPO Network,90,266.42,,,,,,,176.33,310.98,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,outpatient,,,320.60000,304.57000,The Alliance,PPO Network,90,266.42,,,,,,,16.59,831.84,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.80000,58.71000,The Alliance,PPO Network,90,51.36,,,,,,,33.99,59.95,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.80000,58.71000,The Alliance,PPO Network,90,51.36,,,,,,,5.35,271.65,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,inpatient,,,116.30000,110.48000,The Alliance,PPO Network,90,96.65,,,,,,,63.97,112.81,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,PPO Network,90,96.65,,,,,,,58.15,1137.41,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,inpatient,,,425.70000,404.41000,The Alliance,PPO Network,90,353.76,,,,,,,234.13,412.93,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,outpatient,,,425.70000,404.41000,The Alliance,PPO Network,90,353.76,,,,,,,24.89,1137.41,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,90,90.58,,,,,,,59.95,105.73,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,90,90.58,,,,,,,8.17,679.08,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,inpatient,,,75.10000,71.34000,The Alliance,PPO Network,90,62.41,,,,,,,41.30,72.85,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,outpatient,,,75.10000,71.34000,The Alliance,PPO Network,90,62.41,,,,,,,8.94,458.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,The Alliance,PPO Network,TC,1229.05,,,,,,,813.45,1434.63,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,PPO Network,TC,1229.05,,,,,,,401.07,4167.07,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,inpatient,,,153.00000,145.35000,The Alliance,PPO Network,90,127.14,,,,,,,84.15,148.41,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,outpatient,,,153.00000,145.35000,The Alliance,PPO Network,90,127.14,,,,,,,63.32,148.41,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,inpatient,,,49.70000,47.22000,The Alliance,PPO Network,90,41.30,,,,,,,27.34,48.21,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,outpatient,,,49.70000,47.22000,The Alliance,PPO Network,90,41.30,,,,,,,6.08,305.58,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,inpatient,,,59.50000,56.52000,The Alliance,PPO Network,90,49.44,,,,,,,32.73,57.72,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,outpatient,,,59.50000,56.52000,The Alliance,PPO Network,90,49.44,,,,,,,14.93,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,inpatient,,,271.50000,257.92000,The Alliance,PPO Network,90,225.62,,,,,,,149.32,263.36,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,outpatient,,,271.50000,257.92000,The Alliance,PPO Network,90,225.62,,,,,,,20.36,1120.45,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,inpatient,,,292.10000,277.50000,The Alliance,PPO Network,90,242.74,,,,,,,160.66,283.34,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,outpatient,,,292.10000,277.50000,The Alliance,PPO Network,90,242.74,,,,,,,24.89,1137.41,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,inpatient,,,903.00000,857.85000,The Alliance,PPO Network,90,750.39,,,,,,,496.65,875.91,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,outpatient,,,903.00000,857.85000,The Alliance,PPO Network,90,750.39,,,,,,,19.88,1103.49,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,inpatient,,,78.80000,74.86000,The Alliance,PPO Network,90,65.48,,,,,,,43.34,76.44,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,PPO Network,90,65.48,,,,,,,8.17,882.80,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,5.23,254.68,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,137.72,242.89,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,inpatient,,,59.40000,56.43000,The Alliance,PPO Network,90,49.36,,,,,,,32.67,57.62,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,outpatient,,,59.40000,56.43000,The Alliance,PPO Network,90,49.36,,,,,,,5.35,271.65,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,inpatient,,,179.50000,170.52000,The Alliance,PPO Network,90,149.16,,,,,,,98.72,174.12,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,outpatient,,,179.50000,170.52000,The Alliance,PPO Network,90,149.16,,,,,,,21.94,1103.49,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2812.00000,2671.40000,The Alliance,PPO Network,,2336.77,,,,,,,1546.60,2727.64,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,PPO Network,,2336.77,,,,,,,282.88,13309.69,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.30000,303.34000,The Alliance,PPO Network,90,265.34,,,,,,,175.62,309.72,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.30000,303.34000,The Alliance,PPO Network,90,265.34,,,,,,,8.94,458.40,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,The Alliance,PPO Network,90,77.78,,,,,,,51.48,90.79,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,PPO Network,90,77.78,,,,,,,4.57,271.65,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,5.97,271.65,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,The Alliance,PPO Network,90,123.65,,,,,,,81.84,144.34,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,PPO Network,90,123.65,,,,,,,19.26,882.80,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,inpatient,,,5074.00000,4820.30000,The Alliance,PPO Network,90,4216.49,,,,,,,2790.70,4921.78,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,outpatient,,,5074.00000,4820.30000,The Alliance,PPO Network,90,4216.49,,,,,,,480.56,28232.08,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,inpatient,,,78.90000,74.96000,The Alliance,PPO Network,90,65.57,,,,,,,43.40,76.53,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,outpatient,,,78.90000,74.96000,The Alliance,PPO Network,90,65.57,,,,,,,39.45,3038.81,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,inpatient,,,57.70000,54.81000,The Alliance,PPO Network,90,47.95,,,,,,,31.73,55.97,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,outpatient,,,57.70000,54.81000,The Alliance,PPO Network,90,47.95,,,,,,,15.06,763.98,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,inpatient,,,210.20000,199.69000,The Alliance,PPO Network,90,174.68,,,,,,,115.61,203.89,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,PPO Network,90,174.68,,,,,,,8.17,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,99.66,175.76,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,PPO Network,90,150.58,,,,,,,20.36,1120.45,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,29.15,51.41,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,53.00000,50.35000,The Alliance,PPO Network,,44.04,,,,,,,5.87,113.69,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,inpatient,,,227.00000,215.65000,The Alliance,PPO Network,90,188.64,,,,,,,124.85,220.19,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,PPO Network,90,188.64,,,,,,,26.67,1341.13,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,53.52,94.38,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,PPO Network,90,80.86,,,,,,,4.57,271.65,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,The Alliance,PPO Network,90,168.28,,,,,,,111.38,196.43,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,PPO Network,90,168.28,,,,,,,77.53,1052.52,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,inpatient,,,141.20000,134.14000,The Alliance,PPO Network,90,117.34,,,,,,,77.66,136.96,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,outpatient,,,141.20000,134.14000,The Alliance,PPO Network,90,117.34,,,,,,,8.17,679.08,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,inpatient,,,637.00000,605.15000,The Alliance,PPO Network,,529.35,,,,,,,350.35,617.89,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,outpatient,,,637.00000,605.15000,The Alliance,PPO Network,,529.35,,,,,,,90.57,4617.66,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,inpatient,,,31.30000,29.74000,The Alliance,PPO Network,90,26.01,,,,,,,17.21,30.36,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,outpatient,,,31.30000,29.74000,The Alliance,PPO Network,90,26.01,,,,,,,3.09,152.82,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,inpatient,,,576.00000,547.20000,The Alliance,PPO Network,90,478.66,,,,,,,316.80,558.72,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,outpatient,,,576.00000,547.20000,The Alliance,PPO Network,90,478.66,,,,,,,288.00,558.72,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,5.00,254.68,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,inpatient,,,248.90000,236.45000,The Alliance,PPO Network,90,206.84,,,,,,,136.90,241.43,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,outpatient,,,248.90000,236.45000,The Alliance,PPO Network,90,206.84,,,,,,,17.85,814.87,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,inpatient,,,329.50000,313.02000,The Alliance,PPO Network,90,273.81,,,,,,,181.22,319.62,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,outpatient,,,329.50000,313.02000,The Alliance,PPO Network,90,273.81,,,,,,,16.44,831.84,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,57.20,100.88,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,12.05,1539.22,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,The Alliance,PPO Network,90,511.06,,,,,,,338.25,596.55,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,PPO Network,90,511.06,,,,,,,307.50,3186.14,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,inpatient,,,86.90000,82.56000,The Alliance,PPO Network,90,72.21,,,,,,,47.80,84.29,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,outpatient,,,86.90000,82.56000,The Alliance,PPO Network,90,72.21,,,,,,,10.82,831.84,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,The Alliance,PPO Network,,1962.82,,,,,,,1299.10,2291.14,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,PPO Network,,1962.82,,,,,,,208.92,10915.96,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,inpatient,,,238.40000,226.48000,The Alliance,PPO Network,90,198.11,,,,,,,131.12,231.25,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,outpatient,,,238.40000,226.48000,The Alliance,PPO Network,90,198.11,,,,,,,19.70,1273.27,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,inpatient,,,253.30000,240.64000,The Alliance,PPO Network,90,210.49,,,,,,,139.31,245.70,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,outpatient,,,253.30000,240.64000,The Alliance,PPO Network,90,210.49,,,,,,,20.36,1120.45,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,inpatient,,,1837.00000,1745.15000,The Alliance,PPO Network,90,1526.55,,,,,,,1010.35,1781.89,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,PPO Network,90,1526.55,,,,,,,648.20,8708.99,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,inpatient,,,18.00000,17.10000,The Alliance,PPO Network,90,14.96,,,,,,,9.90,17.46,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,PPO Network,90,14.96,,,,,,,3.70,186.75,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,6.92,356.54,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,inpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,41.80,73.72,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,PPO Network,,63.16,,,,,,,8.61,407.44,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,The Alliance,PPO Network,90,129.47,,,,,,,85.69,151.13,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,PPO Network,90,129.47,,,,,,,12.45,1539.22,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,inpatient,,,111.90000,106.31000,The Alliance,PPO Network,90,92.99,,,,,,,61.55,108.54,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,outpatient,,,111.90000,106.31000,The Alliance,PPO Network,90,92.99,,,,,,,11.13,696.05,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,10.42,177.63,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,inpatient,,,109.70000,104.22000,The Alliance,PPO Network,90,91.16,,,,,,,60.34,106.41,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,outpatient,,,109.70000,104.22000,The Alliance,PPO Network,90,91.16,,,,,,,12.89,594.19,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,inpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,74.91,132.11,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,PPO Network,90,113.18,,,,,,,7.27,2581.26,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,inpatient,,,145.60000,138.32000,The Alliance,PPO Network,90,120.99,,,,,,,80.08,141.23,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,outpatient,,,145.60000,138.32000,The Alliance,PPO Network,90,120.99,,,,,,,17.01,865.84,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,inpatient,,,165.50000,157.22000,The Alliance,PPO Network,90,137.53,,,,,,,91.03,160.53,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,outpatient,,,165.50000,157.22000,The Alliance,PPO Network,90,137.53,,,,,,,7.06,1018.59,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,inpatient,,,273.70000,260.02000,The Alliance,PPO Network,90,227.44,,,,,,,150.53,265.49,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,outpatient,,,273.70000,260.02000,The Alliance,PPO Network,90,227.44,,,,,,,21.01,1086.52,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,PPO Network,90,22.19,,,,,,,5.25,254.68,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,41.63,73.43,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,37.85,73.43,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,inpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,PPO Network,90,19.36,,,,,,,4.89,220.68,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,inpatient,,,318.30000,302.38000,The Alliance,PPO Network,90,264.51,,,,,,,175.06,308.75,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,outpatient,,,318.30000,302.38000,The Alliance,PPO Network,90,264.51,,,,,,,16.59,831.84,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,inpatient,,,128.00000,121.60000,The Alliance,PPO Network,90,106.37,,,,,,,70.40,124.16,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,outpatient,,,128.00000,121.60000,The Alliance,PPO Network,90,106.37,,,,,,,15.03,763.98,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,The Alliance,PPO Network,,123.65,,,,,,,81.84,144.34,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,PPO Network,,123.65,,,,,,,18.64,882.80,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,,1893.02,,,,,,,1252.90,2209.66,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,PPO Network,,1893.02,,,,,,,201.50,10525.49,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,inpatient,,,4578.00000,4349.10000,The Alliance,PPO Network,TC,3804.32,,,,,,,2517.90,4440.66,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,outpatient,,,4578.00000,4349.10000,The Alliance,PPO Network,TC,3804.32,,,,,,,533.12,24865.24,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,inpatient,,,144.40000,137.18000,The Alliance,PPO Network,90,120.00,,,,,,,79.42,140.07,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,outpatient,,,144.40000,137.18000,The Alliance,PPO Network,90,120.00,,,,,,,16.32,797.91,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,91.80,161.89,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,PPO Network,90,138.69,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,inpatient,,,276.10000,262.30000,The Alliance,PPO Network,90,229.44,,,,,,,151.85,267.82,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,outpatient,,,276.10000,262.30000,The Alliance,PPO Network,90,229.44,,,,,,,24.89,1137.41,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,inpatient,,,57.20000,54.34000,The Alliance,PPO Network,,47.53,,,,,,,31.46,55.48,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,outpatient,,,57.20000,54.34000,The Alliance,PPO Network,,47.53,,,,,,,28.60,55.48,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,PPO Network,,66.31,,,,,,,43.89,77.41,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,PPO Network,,66.31,,,,,,,39.90,77.41,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,inpatient,,,398.70000,378.76000,The Alliance,PPO Network,,331.32,,,,,,,219.28,386.74,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,outpatient,,,398.70000,378.76000,The Alliance,PPO Network,,331.32,,,,,,,144.13,2223.94,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,inpatient,,,65.50000,62.22000,The Alliance,PPO Network,90,54.43,,,,,,,36.02,63.53,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,PPO Network,90,54.43,,,,,,,19.26,882.80,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.94,14.00,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,PPO Network,,11.99,,,,,,,7.21,14.00,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,inpatient,1,GM,8.13000,7.73000,The Alliance,PPO Network,,6.76,,,,,,,4.47,7.89,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,outpatient,1,GM,8.13000,7.73000,The Alliance,PPO Network,,6.76,,,,,,,4.07,7.89,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,PPO Network,,1.50,,,,,,,0.90500,1.76,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,inpatient,1,mL,45.79000,43.50000,The Alliance,PPO Network,,38.05,,,,,,,25.18,44.42,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,outpatient,1,mL,45.79000,43.50000,The Alliance,PPO Network,,38.05,,,,,,,22.89,78.87,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,inpatient,1,mL,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.13,1.99,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,outpatient,1,mL,2.05000,1.95000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.99,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.39600,0.69840,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,PPO Network,,0.59832,,,,,,,0.36000,0.69840,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,inpatient,1,mL,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,25.38,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,outpatient,1,mL,46.14000,43.83000,The Alliance,PPO Network,,38.34,,,,,,,23.07,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,inpatient,1,mL,24.67000,23.44000,The Alliance,PPO Network,,20.50,,,,,,,13.57,23.93,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,outpatient,1,mL,24.67000,23.44000,The Alliance,PPO Network,,20.50,,,,,,,12.34,23.93,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,inpatient,1,mL,122.89000,116.74000,The Alliance,PPO Network,,102.12,,,,,,,67.59,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,outpatient,1,mL,122.89000,116.74000,The Alliance,PPO Network,,102.12,,,,,,,61.45,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,inpatient,1,mL,112.07000,106.47000,The Alliance,PPO Network,,93.13,,,,,,,61.64,108.71,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,outpatient,1,mL,112.07000,106.47000,The Alliance,PPO Network,,93.13,,,,,,,56.03,108.71,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,inpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,2.16,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,PPO Network,,3.27,,,,,,,1.97,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,inpatient,1,mL,4.47000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.46,4.34,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,outpatient,1,mL,4.47000,4.24000,The Alliance,PPO Network,,3.71,,,,,,,2.23,4.34,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,PPO Network,,15.76,,,,,,,9.48,18.39,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.84,3.25,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,PPO Network,,2.78,,,,,,,1.68,3.25,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,inpatient,1,mL,28.33000,26.92000,The Alliance,PPO Network,,23.54,,,,,,,15.58,27.48,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,outpatient,1,mL,28.33000,26.92000,The Alliance,PPO Network,,23.54,,,,,,,0.40920,27.48,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,inpatient,1,EA,16163.08000,15354.93000,The Alliance,PPO Network,,13431.52,,,,,,,8889.69,15678.19,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,outpatient,1,EA,16163.08000,15354.93000,The Alliance,PPO Network,,13431.52,,,,,,,8081.54,15678.19,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,inpatient,1,mL,30.39000,28.87000,The Alliance,PPO Network,,25.25,,,,,,,16.71,29.48,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,PPO Network,,25.25,,,,,,,0.12000,29.48,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,inpatient,1,mL,286.22000,271.90000,The Alliance,PPO Network,,237.85,,,,,,,157.42,277.63,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,outpatient,1,mL,286.22000,271.90000,The Alliance,PPO Network,,237.85,,,,,,,17.37,277.63,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1821.00000,1729.95000,The Alliance,PPO Network,TC,1513.25,,,,,,,1001.55,1766.37,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1821.00000,1729.95000,The Alliance,PPO Network,TC,1513.25,,,,,,,484.28,2161.00,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,inpatient,,,77.40000,73.53000,The Alliance,PPO Network,90,64.32,,,,,,,42.57,75.08,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,outpatient,,,77.40000,73.53000,The Alliance,PPO Network,90,64.32,,,,,,,38.70,1137.41,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,inpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,165.11,291.19,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,PPO Network,,249.47,,,,,,,39.83,291.19,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,inpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.41,2.48,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,PPO Network,,2.13,,,,,,,1.21,2.48,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,464.18000,440.97000,The Alliance,PPO Network,,385.73,,,,,,,255.30,450.25,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,464.18000,440.97000,The Alliance,PPO Network,,385.73,,,,,,,158.39,450.25,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,,1041.24,,,,,,,689.15,1215.41,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,PPO Network,,1041.24,,,,,,,626.50,1215.41,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,The Alliance,PPO Network,,10863.41,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,PPO Network,,10863.41,,,,,,,6000.37,13072.70,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,The Alliance,PPO Network,,8586.52,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,PPO Network,,8586.52,,,,,,,4742.73,10332.75,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,The Alliance,PPO Network,,8586.52,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,PPO Network,,8586.52,,,,,,,4742.73,10332.75,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,18511.22,40329.45,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,The Alliance,PPO Network,,8027.46,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,PPO Network,,8027.46,,,,,,,4433.94,9660.00,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,2848.81,6206.55,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.11207,0.32980,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,inpatient,,,698.00000,663.10000,The Alliance,PPO Network,,580.04,,,,,,,383.90,677.06,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,outpatient,,,698.00000,663.10000,The Alliance,PPO Network,,580.04,,,,,,,50.73,677.06,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,inpatient,1,EA,4155.55000,3947.77000,The Alliance,PPO Network,,3453.26,,,,,,,2285.55,4030.88,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,outpatient,1,EA,4155.55000,3947.77000,The Alliance,PPO Network,,3453.26,,,,,,,155.42,4030.88,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,inpatient,,,192.00000,182.40000,The Alliance,PPO Network,,159.55,,,,,,,105.60,186.24,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,outpatient,,,192.00000,182.40000,The Alliance,PPO Network,,159.55,,,,,,,19.31,186.24,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,inpatient,,,1804.00000,1713.80000,The Alliance,PPO Network,,1499.12,,,,,,,992.20,1749.88,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,outpatient,,,1804.00000,1713.80000,The Alliance,PPO Network,,1499.12,,,,,,,902.00,1749.88,percent of total billed charges,
ROOM/BED   ICU-CRITICAL CARE,82445,CDM,200,RC,,,,,facility,inpatient,,,4204.00000,3993.80000,The Alliance,PPO Network,,3493.52,,,,,,,2312.20,4077.88,percent of total billed charges,
ROOM/BED   MED-SURG,82446,CDM,111,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,The Alliance,PPO Network,,1676.13,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   HOME RECOVERY,82448,CDM,161,RC,,,,,facility,inpatient,,,1805.00000,1714.75000,The Alliance,PPO Network,,1499.95,,,,,,,992.75,1750.85,percent of total billed charges,
ROOM/BED   NICU LEVEL 4,82449,CDM,174,RC,,,,,facility,inpatient,,,8326.00000,7909.70000,The Alliance,PPO Network,,6918.91,,,,,,,4579.30,8076.22,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 2,82450,CDM,172,RC,,,,,facility,inpatient,,,2073.00000,1969.35000,The Alliance,PPO Network,,1722.66,,,,,,,1140.15,2010.81,percent of total billed charges,
ROOM/BED   NEWBORN,82451,CDM,170,RC,,,,,facility,inpatient,,,1779.00000,1690.05000,The Alliance,PPO Network,,1478.35,,,,,,,978.45,1725.63,percent of total billed charges,
ROOM/BED   NICU LEVEL 2,82452,CDM,172,RC,,,,,facility,inpatient,,,5606.00000,5325.70000,The Alliance,PPO Network,,4658.59,,,,,,,3083.30,5437.82,percent of total billed charges,
ROOM/BED   NICU LEVEL 3,82453,CDM,173,RC,,,,,facility,inpatient,,,7149.00000,6791.55000,The Alliance,PPO Network,,5940.82,,,,,,,3931.95,6934.53,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 4,82454,CDM,174,RC,,,,,facility,inpatient,,,3875.00000,3681.25000,The Alliance,PPO Network,,3220.12,,,,,,,2131.25,3758.75,percent of total billed charges,
ROOM/BED   PICU,82455,CDM,203,RC,,,,,facility,inpatient,,,5446.00000,5173.70000,The Alliance,PPO Network,,4525.63,,,,,,,2995.30,5282.62,percent of total billed charges,
ROOM/BED   REHAB,82456,CDM,118,RC,,,,,facility,inpatient,,,1724.00000,1637.80000,The Alliance,PPO Network,,1432.64,,,,,,,948.20,2638.00,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 3,82457,CDM,173,RC,,,,,facility,inpatient,,,2969.00000,2820.55000,The Alliance,PPO Network,,2467.24,,,,,,,1632.95,2879.93,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,47.30,83.42,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,43.00,6456.00,percent of total billed charges,
ROOM/BED   WOMEN'S HEALTH,82459,CDM,112,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,The Alliance,PPO Network,,1676.13,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   TELEMETRY,82460,CDM,110,RC,,,,,facility,inpatient,,,2054.00000,1951.30000,The Alliance,PPO Network,,1706.87,,,,,,,1129.70,1992.38,percent of total billed charges,
ROOM/BED   SWING BED,82461,CDM,120,RC,,,,,facility,inpatient,,,1052.00000,999.40000,The Alliance,PPO Network,,874.21,,,,,,,578.60,1020.44,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,The Alliance,PPO Network,TC,3536.74,,,,,,,2340.80,4128.32,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,PPO Network,TC,3536.74,,,,,,,2128.00,4128.32,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,inpatient,1,mL,730.38000,693.86000,The Alliance,PPO Network,,606.95,,,,,,,401.71,708.47,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,PPO Network,,606.95,,,,,,,5.98,708.47,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,inpatient,,,2454.00000,2331.30000,The Alliance,PPO Network,TC,2039.27,,,,,,,1349.70,2380.38,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,outpatient,,,2454.00000,2331.30000,The Alliance,PPO Network,TC,2039.27,,,,,,,1227.00,5271.00,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,inpatient,,,7396.00000,7026.20000,The Alliance,PPO Network,TC,6146.08,,,,,,,4067.80,7174.12,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,outpatient,,,7396.00000,7026.20000,The Alliance,PPO Network,TC,6146.08,,,,,,,3698.00,17574.00,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,inpatient,,,555.00000,527.25000,The Alliance,PPO Network,,461.20,,,,,,,305.25,538.35,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,outpatient,,,555.00000,527.25000,The Alliance,PPO Network,,461.20,,,,,,,277.50,538.35,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,inpatient,1,mL,20.30000,19.29000,The Alliance,PPO Network,,16.87,,,,,,,11.16,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,outpatient,1,mL,20.30000,19.29000,The Alliance,PPO Network,,16.87,,,,,,,0.92000,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,inpatient,1,mL,89.60000,85.12000,The Alliance,PPO Network,,74.46,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,outpatient,1,mL,89.60000,85.12000,The Alliance,PPO Network,,74.46,,,,,,,0.92000,86.91,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,inpatient,1,EA,2370.47000,2251.95000,The Alliance,PPO Network,,1969.86,,,,,,,1303.76,2299.36,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,outpatient,1,EA,2370.47000,2251.95000,The Alliance,PPO Network,,1969.86,,,,,,,1185.23,2299.36,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,46.35,319.35,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,inpatient,,,394.00000,374.30000,The Alliance,PPO Network,,327.41,,,,,,,216.70,382.18,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,outpatient,,,394.00000,374.30000,The Alliance,PPO Network,,327.41,,,,,,,35.09,382.18,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,inpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,110.55,194.97,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,outpatient,,,201.00000,190.95000,The Alliance,PPO Network,,167.03,,,,,,,18.05,194.97,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,96.25,169.75,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,,145.43,,,,,,,24.08,169.75,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,inpatient,,,522.00000,495.90000,The Alliance,PPO Network,,433.78,,,,,,,287.10,506.34,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,PPO Network,,433.78,,,,,,,50.73,506.34,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,The Alliance,PPO Network,TC,666.46,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,PPO Network,TC,666.46,,,,,,,389.35,2210.07,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,The Alliance,PPO Network,,304.86,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,PPO Network,,304.86,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,The Alliance,PPO Network,,10863.41,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,PPO Network,,10863.41,,,,,,,6000.37,13072.70,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1342.24,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,25.79,50.03,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,The Alliance,PPO Network,TC,3915.67,,,,,,,2591.60,4570.64,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,PPO Network,TC,3915.67,,,,,,,2210.90,23155.09,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,1667.31,67198.78,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,The Alliance,PPO Network,,25925.21,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,PPO Network,,25925.21,,,,,,,14319.70,31197.60,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30271.50000,28757.92000,The Alliance,PPO Network,,25155.62,,,,,,,14833.03,29363.35,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,PPO Network,,25155.62,,,,,,,13894.62,30271.50,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,inpatient,1,mL,19494.00000,18519.30000,The Alliance,PPO Network,,16199.51,,,,,,,10721.70,18909.18,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,outpatient,1,mL,19494.00000,18519.30000,The Alliance,PPO Network,,16199.51,,,,,,,55.30,18909.18,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,mL,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,mL,3.32000,3.16000,The Alliance,PPO Network,,2.76,,,,,,,1.28,3.22,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,18511.22,40329.45,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,20528.18,44723.70,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,144.65,255.11,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,TC,218.55,,,,,,,131.50,1668.14,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,inpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,108.90,192.06,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,PPO Network,,164.54,,,,,,,99.00,723.34,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,TC,126.31,,,,,,,83.60,147.44,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,TC,126.31,,,,,,,76.00,548.00,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,inpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,146.85,258.99,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,PPO Network,,221.88,,,,,,,133.50,929.91,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,PPO Network,,151.24,,,,,,,91.00,308.32,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,19.28000,18.32000,The Alliance,PPO Network,,16.02,,,,,,,10.60,18.70,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,19.28000,18.32000,The Alliance,PPO Network,,16.02,,,,,,,9.64,18.70,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,inpatient,,,571.56000,542.98000,The Alliance,PPO Network,,474.97,,,,,,,314.36,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,outpatient,,,571.56000,542.98000,The Alliance,PPO Network,,474.97,,,,,,,285.78,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,inpatient,1,mL,1143.11000,1085.95000,The Alliance,PPO Network,,949.92,,,,,,,628.71,1108.82,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,outpatient,1,mL,1143.11000,1085.95000,The Alliance,PPO Network,,949.92,,,,,,,485.00,1108.82,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,inpatient,1,EA,205.24000,194.98000,The Alliance,PPO Network,,170.55,,,,,,,112.88,199.08,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,outpatient,1,EA,205.24000,194.98000,The Alliance,PPO Network,,170.55,,,,,,,102.62,199.08,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,inpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,190.30,335.62,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,outpatient,,,346.00000,328.70000,The Alliance,PPO Network,,287.53,,,,,,,28.27,335.62,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1611.00000,1530.45000,The Alliance,PPO Network,,1338.74,,,,,,,886.05,1562.67,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1611.00000,1530.45000,The Alliance,PPO Network,,1338.74,,,,,,,805.50,1692.33,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,The Alliance,PPO Network,,23429.63,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,PPO Network,,23429.63,,,,,,,12941.28,28194.50,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,The Alliance,PPO Network,,23429.63,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,PPO Network,,23429.63,,,,,,,12941.28,28194.50,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,The Alliance,PPO Network,,216.98,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,PPO Network,,216.98,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,8814.75000,8374.01000,The Alliance,PPO Network,,7325.06,,,,,,,4319.23,8550.31,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,8814.75000,8374.01000,The Alliance,PPO Network,,7325.06,,,,,,,4045.97,8814.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,PPO Network,,2373.34,,,,,,,249.71,14445.56,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,131.45,231.83,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,PPO Network,,198.61,,,,,,,119.50,734.90,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,56.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,inpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,169.40,298.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,PPO Network,,255.95,,,,,,,56.40,298.76,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,PPO Network,,125.48,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,PPO Network,,210.24,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,PPO Network,,99.72,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,PPO Network,,169.52,,,,,,,102.00,197.88,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,inpatient,1,EA,3362.49000,3194.36000,The Alliance,PPO Network,,2794.23,,,,,,,1849.37,3261.62,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,outpatient,1,EA,3362.49000,3194.36000,The Alliance,PPO Network,,2794.23,,,,,,,161.96,3261.62,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,inpatient,1,mL,22.42000,21.30000,The Alliance,PPO Network,,18.63,,,,,,,12.33,21.75,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,outpatient,1,mL,22.42000,21.30000,The Alliance,PPO Network,,18.63,,,,,,,1.35,21.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.64,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,PPO Network,,2.48,,,,,,,1.50,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7193.25000,6833.59000,The Alliance,PPO Network,,5977.59,,,,,,,3524.69,6977.45,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7193.25000,6833.59000,The Alliance,PPO Network,,5977.59,,,,,,,3301.70,7193.25,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1406.25000,1335.94000,The Alliance,PPO Network,,1168.59,,,,,,,689.06,1364.06,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1406.25000,1335.94000,The Alliance,PPO Network,,1168.59,,,,,,,645.47,1406.25,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,PPO Network,,2210.04,,,,,,,1220.71,2659.50,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,PPO Network,,6.91,,,,,,,4.16,8.07,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,inpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,PPO Network,TC,1021.30,,,,,,,316.68,1447.00,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,The Alliance,PPO Network,TC,3985.48,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,PPO Network,TC,3985.48,,,,,,,1929.64,4652.12,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6365.00000,6046.75000,The Alliance,PPO Network,TC,5289.31,,,,,,,3500.75,6174.05,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6365.00000,6046.75000,The Alliance,PPO Network,TC,5289.31,,,,,,,1929.64,6174.05,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,152.90,269.66,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,PPO Network,,231.02,,,,,,,139.00,269.66,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,The Alliance,PPO Network,TC,1201.63,,,,,,,795.30,1402.62,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,PPO Network,TC,1201.63,,,,,,,316.68,1447.00,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,inpatient,1,mL,4864.58000,4621.36000,The Alliance,PPO Network,,4042.47,,,,,,,2675.52,4718.64,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,outpatient,1,mL,4864.58000,4621.36000,The Alliance,PPO Network,,4042.47,,,,,,,18.30,4718.64,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,The Alliance,PPO Network,TC,814.38,,,,,,,539.00,950.60,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,PPO Network,TC,814.38,,,,,,,384.16,950.60,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,inpatient,1,mL,110.58000,105.05000,The Alliance,PPO Network,,91.89,,,,,,,60.82,107.26,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,outpatient,1,mL,110.58000,105.05000,The Alliance,PPO Network,,91.89,,,,,,,55.29,107.26,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,The Alliance,PPO Network,,47117.70,,,,,,,27783.00,54999.00,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,PPO Network,,47117.70,,,,,,,26025.30,56700.00,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,inpatient,,,241.67000,229.59000,The Alliance,PPO Network,,200.83,,,,,,,132.92,234.42,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,PPO Network,,200.83,,,,,,,120.83,240.53,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,inpatient,1,EA,483.34000,459.17000,The Alliance,PPO Network,,401.66,,,,,,,265.84,468.84,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,PPO Network,,401.66,,,,,,,240.53,468.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,inpatient,,,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,62.39,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,outpatient,,,113.43000,107.76000,The Alliance,PPO Network,,94.26,,,,,,,56.72,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,inpatient,1,mL,226.86000,215.52000,The Alliance,PPO Network,,188.52,,,,,,,124.77,220.05,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,outpatient,1,mL,226.86000,215.52000,The Alliance,PPO Network,,188.52,,,,,,,113.43,220.05,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,PPO Network,,1.32,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,inpatient,1,GM,8.39000,7.97000,The Alliance,PPO Network,,6.97,,,,,,,4.61,8.14,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,outpatient,1,GM,8.39000,7.97000,The Alliance,PPO Network,,6.97,,,,,,,4.20,8.14,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,The Alliance,PPO Network,QW,30.75,,,,,,,20.35,35.89,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,PPO Network,QW,30.75,,,,,,,16.53,780.94,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,inpatient,,,1895.00000,1800.25000,The Alliance,PPO Network,,1574.74,,,,,,,1042.25,1838.15,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,PPO Network,,1574.74,,,,,,,12.05,10344.80,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,inpatient,,,506.00000,480.70000,The Alliance,PPO Network,RT,420.49,,,,,,,278.30,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,PPO Network,RT,420.49,,,,,,,253.00,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,RT,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,RT,2049.25,,,,,,,1233.00,2392.02,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,847.16000,804.80000,The Alliance,PPO Network,,703.99,,,,,,,415.11,821.75,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,847.16000,804.80000,The Alliance,PPO Network,,703.99,,,,,,,388.85,847.16,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,The Alliance,PPO Network,,7203.94,,,,,,,4767.95,8408.93,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,PPO Network,,7203.94,,,,,,,4334.50,8408.93,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,4416.00000,4195.20000,The Alliance,PPO Network,,3669.70,,,,,,,2163.84,4283.52,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4416.00000,4195.20000,The Alliance,PPO Network,,3669.70,,,,,,,2026.94,4416.00,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,1.39,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,6555.00000,6227.25000,The Alliance,PPO Network,,5447.20,,,,,,,3211.95,6358.35,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,PPO Network,,5447.20,,,,,,,3008.74,6555.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1466.00000,1392.70000,The Alliance,PPO Network,,1218.25,,,,,,,806.30,1422.02,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,PPO Network,,1218.25,,,,,,,128.29,6705.74,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1290.94,2812.50,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.08250,0.14550,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,PPO Network,,0.12465,,,,,,,0.07500,0.14550,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,inpatient,1,EA,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.70,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,outpatient,1,EA,14.00000,13.30000,The Alliance,PPO Network,,11.63,,,,,,,7.00,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,inpatient,1,EA,13.21000,12.55000,The Alliance,PPO Network,,10.98,,,,,,,7.27,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,outpatient,1,EA,13.21000,12.55000,The Alliance,PPO Network,,10.98,,,,,,,6.61,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.90,13.94,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,PPO Network,,11.94,,,,,,,7.18,13.94,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.15400,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,PPO Network,,0.23268,,,,,,,0.14000,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,inpatient,,,152.78000,145.14000,The Alliance,PPO Network,,126.96,,,,,,,84.03,148.20,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,outpatient,,,152.78000,145.14000,The Alliance,PPO Network,,126.96,,,,,,,76.39,195.41,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,inpatient,1,mL,76.39000,72.57000,The Alliance,PPO Network,,63.48,,,,,,,42.01,74.10,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,outpatient,1,mL,76.39000,72.57000,The Alliance,PPO Network,,63.48,,,,,,,38.20,195.41,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,PPO Network,,2337.19,,,,,,,1290.94,2812.50,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,inpatient,1,EA,2588.14000,2458.73000,The Alliance,PPO Network,,2150.74,,,,,,,1423.48,2510.50,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,PPO Network,,2150.74,,,,,,,1294.07,2510.50,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,inpatient,1,mL,66.57000,63.24000,The Alliance,PPO Network,,55.32,,,,,,,36.61,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,outpatient,1,mL,66.57000,63.24000,The Alliance,PPO Network,,55.32,,,,,,,0.77000,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,inpatient,1,mL,60.38000,57.36000,The Alliance,PPO Network,,50.18,,,,,,,33.21,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,outpatient,1,mL,60.38000,57.36000,The Alliance,PPO Network,,50.18,,,,,,,0.77000,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,inpatient,1,mL,69.89000,66.40000,The Alliance,PPO Network,,58.08,,,,,,,38.44,67.79,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,outpatient,1,mL,69.89000,66.40000,The Alliance,PPO Network,,58.08,,,,,,,0.77000,67.79,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14399.50000,13679.52000,The Alliance,PPO Network,,11965.98,,,,,,,7055.76,13967.51,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14399.50000,13679.52000,The Alliance,PPO Network,,11965.98,,,,,,,6609.37,14399.50,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,inpatient,,,606.00000,575.70000,The Alliance,PPO Network,,503.59,,,,,,,333.30,587.82,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,outpatient,,,606.00000,575.70000,The Alliance,PPO Network,,503.59,,,,,,,303.00,587.82,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.40000,203.68000,The Alliance,PPO Network,90,178.17,,,,,,,117.92,207.97,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.40000,203.68000,The Alliance,PPO Network,90,178.17,,,,,,,19.60,984.66,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,inpatient,,,136.80000,129.96000,The Alliance,PPO Network,90,113.68,,,,,,,75.24,132.70,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,outpatient,,,136.80000,129.96000,The Alliance,PPO Network,90,113.68,,,,,,,12.51,628.12,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1100.00000,1045.00000,The Alliance,PPO Network,,914.10,,,,,,,605.00,1067.00,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1100.00000,1045.00000,The Alliance,PPO Network,,914.10,,,,,,,158.39,1067.00,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,inpatient,,,117.28000,111.42000,The Alliance,PPO Network,,97.46,,,,,,,57.47,113.76,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,outpatient,,,117.28000,111.42000,The Alliance,PPO Network,,97.46,,,,,,,58.64,113.76,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,inpatient,,,71282.00000,67717.90000,The Alliance,PPO Network,,59235.34,,,,,,,39205.10,69143.54,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,PPO Network,,59235.34,,,,,,,35641.00,74614.73,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,822.25,1450.15,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,PPO Network,TC,1242.35,,,,,,,747.50,1450.15,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,The Alliance,PPO Network,,1523.22,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,The Alliance,PPO Network,,1523.22,,,,,,,916.50,1778.01,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,inpatient,,,82.50000,78.38000,The Alliance,PPO Network,,68.56,,,,,,,45.38,80.03,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,outpatient,,,82.50000,78.38000,The Alliance,PPO Network,,68.56,,,,,,,20.89,80.03,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,,1166.72,,,,,,,772.20,1361.88,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,,1166.72,,,,,,,702.00,1361.88,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13175.00000,12516.25000,The Alliance,PPO Network,,10948.42,,,,,,,6455.75,12779.75,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13175.00000,12516.25000,The Alliance,PPO Network,,10948.42,,,,,,,6047.32,12779.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,inpatient,,,1069.00000,1015.55000,The Alliance,PPO Network,,888.34,,,,,,,587.95,1036.93,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,outpatient,,,1069.00000,1015.55000,The Alliance,PPO Network,,888.34,,,,,,,247.20,1036.93,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,The Alliance,PPO Network,,147.95,,,,,,,87.24,172.70,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,PPO Network,,147.95,,,,,,,81.72,178.04,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2389.84000,2270.35000,The Alliance,PPO Network,,1985.96,,,,,,,1171.02,2318.14,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2389.84000,2270.35000,The Alliance,PPO Network,,1985.96,,,,,,,1096.94,2389.84,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,631.13000,599.57000,The Alliance,PPO Network,,524.47,,,,,,,309.25,612.20,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,631.13000,599.57000,The Alliance,PPO Network,,524.47,,,,,,,289.69,631.13,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9305.77,20274.00,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9305.77,20274.00,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,21296.39000,20231.57000,The Alliance,PPO Network,,17697.30,,,,,,,10435.23,20657.50,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,PPO Network,,17697.30,,,,,,,10648.19,27182.63,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,inpatient,,,784.00000,744.80000,The Alliance,PPO Network,TC,651.50,,,,,,,431.20,760.48,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,outpatient,,,784.00000,744.80000,The Alliance,PPO Network,TC,651.50,,,,,,,384.16,760.48,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,inpatient,,,175.00000,166.25000,The Alliance,PPO Network,QW,145.43,,,,,,,96.25,169.75,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,PPO Network,QW,145.43,,,,,,,22.48,1052.52,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,The Alliance,PPO Network,TC,1263.12,,,,,,,836.00,1474.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,PPO Network,TC,1263.12,,,,,,,726.61,7529.89,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9305.77,20274.00,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,The Alliance,PPO Network,,19021.59,,,,,,,11216.10,22203.30,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,PPO Network,,19021.59,,,,,,,10506.51,22890.00,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2789.32,5521.73,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2612.86,5692.50,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,34353.61000,32635.93000,The Alliance,PPO Network,,28547.85,,,,,,,16833.27,33323.00,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,34353.61000,32635.93000,The Alliance,PPO Network,,28547.85,,,,,,,17176.81,34353.61,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,inpatient,1,mL,619.01000,588.06000,The Alliance,PPO Network,,514.40,,,,,,,340.46,600.44,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,outpatient,1,mL,619.01000,588.06000,The Alliance,PPO Network,,514.40,,,,,,,97.70,600.44,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,inpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.43450,0.76630,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,PPO Network,,0.65649,,,,,,,0.39500,0.76630,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.37400,0.65960,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,PPO Network,,0.56508,,,,,,,0.34000,0.65960,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,645.77,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,The Alliance,PPO Network,,324.92,,,,,,,195.50,645.77,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,The Alliance,PPO Network,,480.32,,,,,,,289.00,1622.56,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,136.95,241.53,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,PPO Network,,206.92,,,,,,,124.50,254.03,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,279.23000,265.27000,The Alliance,PPO Network,,232.04,,,,,,,136.82,270.85,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,279.23000,265.27000,The Alliance,PPO Network,,232.04,,,,,,,128.17,279.23,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,The Alliance,PPO Network,TC,2092.46,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,PPO Network,TC,2092.46,,,,,,,1163.40,2442.46,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.01000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,0.01940,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,inpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,2.02,15.33,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,inpatient,1,mL,515.41000,489.64000,The Alliance,PPO Network,,428.31,,,,,,,283.48,499.95,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,outpatient,1,mL,515.41000,489.64000,The Alliance,PPO Network,,428.31,,,,,,,257.70,499.95,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,PPO Network,,0.04155,,,,,,,0.02500,0.04850,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,inpatient,1,mL,96.55000,91.72000,The Alliance,PPO Network,,80.23,,,,,,,53.10,93.65,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,outpatient,1,mL,96.55000,91.72000,The Alliance,PPO Network,,80.23,,,,,,,48.27,93.65,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,inpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,331.10,583.94,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,280.29,3163.00,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,40880.70000,38836.66000,The Alliance,PPO Network,,33971.86,,,,,,,20031.54,39654.28,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,40880.70000,38836.66000,The Alliance,PPO Network,,33971.86,,,,,,,18764.24,40880.70,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,116.86,231.34,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,109.47,238.50,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,134.06,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,121.88,236.44,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,64.90,114.46,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,,98.06,,,,,,,59.00,619.83,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1675.00000,1591.25000,The Alliance,PPO Network,,1391.92,,,,,,,921.25,1624.75,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1675.00000,1591.25000,The Alliance,PPO Network,,1391.92,,,,,,,837.50,1692.33,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18331.42000,17414.85000,The Alliance,PPO Network,,15233.41,,,,,,,8982.40,17781.48,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18331.42000,17414.85000,The Alliance,PPO Network,,15233.41,,,,,,,8414.12,18331.42,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,inpatient,,,2290.00000,2175.50000,The Alliance,PPO Network,,1902.99,,,,,,,1259.50,2221.30,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,outpatient,,,2290.00000,2175.50000,The Alliance,PPO Network,,1902.99,,,,,,,232.94,12375.92,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,712.25,1256.15,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,PPO Network,,1076.14,,,,,,,20.89,1256.15,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,3163.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9357.04000,8889.19000,The Alliance,PPO Network,,7775.70,,,,,,,4584.95,9076.33,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9357.04000,8889.19000,The Alliance,PPO Network,,7775.70,,,,,,,4294.88,9357.04,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,7036.72000,6684.88000,The Alliance,PPO Network,,5847.51,,,,,,,3447.99,6825.62,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,7036.72000,6684.88000,The Alliance,PPO Network,,5847.51,,,,,,,3229.85,7036.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,582.19000,553.08000,The Alliance,PPO Network,,483.80,,,,,,,320.20,564.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,582.19000,553.08000,The Alliance,PPO Network,,483.80,,,,,,,240.68,564.72,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,inpatient,1,mL,25103.16000,23848.00000,The Alliance,PPO Network,,20860.73,,,,,,,13806.74,24350.07,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,outpatient,1,mL,25103.16000,23848.00000,The Alliance,PPO Network,,20860.73,,,,,,,74.86,24350.07,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,inpatient,1,EA,18.49000,17.56000,The Alliance,PPO Network,,15.37,,,,,,,10.17,17.94,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,PPO Network,,15.37,,,,,,,1.28,17.94,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,inpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,11.30,19.92,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,PPO Network,,17.07,,,,,,,10.27,19.92,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,inpatient,,,588.75000,559.31000,The Alliance,PPO Network,,489.25,,,,,,,323.81,571.09,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,outpatient,,,588.75000,559.31000,The Alliance,PPO Network,,489.25,,,,,,,132.04,571.09,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,PPO Network,,0.09972,,,,,,,0.06000,0.11640,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,inpatient,1,EA,39.92000,37.92000,The Alliance,PPO Network,,33.17,,,,,,,21.96,38.72,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,outpatient,1,EA,39.92000,37.92000,The Alliance,PPO Network,,33.17,,,,,,,19.96,38.72,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,PPO Network,,21768.04,,,,,,,12023.50,26195.00,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,inpatient,1,EA,51.56000,48.98000,The Alliance,PPO Network,,42.85,,,,,,,28.36,50.01,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,outpatient,1,EA,51.56000,48.98000,The Alliance,PPO Network,,42.85,,,,,,,7.77,50.01,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,inpatient,1,EA,29.86000,28.37000,The Alliance,PPO Network,,24.81,,,,,,,16.42,28.96,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,outpatient,1,EA,29.86000,28.37000,The Alliance,PPO Network,,24.81,,,,,,,6.12,28.96,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,inpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,86.90,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,PPO Network,,131.30,,,,,,,0.04803,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,inpatient,1,EA,717.43000,681.56000,The Alliance,PPO Network,,596.18,,,,,,,394.59,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,outpatient,1,EA,717.43000,681.56000,The Alliance,PPO Network,,596.18,,,,,,,0.04803,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,inpatient,1,EA,169.28000,160.82000,The Alliance,PPO Network,,140.67,,,,,,,93.10,164.20,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,outpatient,1,EA,169.28000,160.82000,The Alliance,PPO Network,,140.67,,,,,,,0.04803,164.20,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,inpatient,1,mL,1202.80000,1142.66000,The Alliance,PPO Network,,999.53,,,,,,,661.54,1166.72,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,outpatient,1,mL,1202.80000,1142.66000,The Alliance,PPO Network,,999.53,,,,,,,3.00,1166.72,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,inpatient,1,EA,36.67000,34.84000,The Alliance,PPO Network,,30.47,,,,,,,20.17,35.57,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,outpatient,1,EA,36.67000,34.84000,The Alliance,PPO Network,,30.47,,,,,,,18.34,35.57,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,The Alliance,PPO Network,,36.59,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,PPO Network,,36.59,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,PPO Network,,5.06,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,PPO Network,,10.50,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.41800,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,PPO Network,,0.63156,,,,,,,0.38000,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,2.18,3.85,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,PPO Network,,3.30,,,,,,,1.99,3.85,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,inpatient,,,1380.75000,1311.71000,The Alliance,PPO Network,,1147.40,,,,,,,759.41,1339.33,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,outpatient,,,1380.75000,1311.71000,The Alliance,PPO Network,,1147.40,,,,,,,690.38,1339.33,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,The Alliance,PPO Network,,981.62,,,,,,,578.81,1145.81,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,PPO Network,,981.62,,,,,,,542.19,1181.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,123.75,218.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,PPO Network,,186.97,,,,,,,112.50,218.25,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,144.65,255.11,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,PPO Network,,218.55,,,,,,,100.97,2441.08,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,372.50,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,PPO Network,,619.10,,,,,,,372.50,929.91,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,inpatient,,,2449.00000,2326.55000,The Alliance,PPO Network,LT,2035.12,,,,,,,1346.95,2375.53,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,outpatient,,,2449.00000,2326.55000,The Alliance,PPO Network,LT,2035.12,,,,,,,1224.50,2375.53,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,inpatient,,,1281.00000,1216.95000,The Alliance,PPO Network,LT,1064.51,,,,,,,704.55,1242.57,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,PPO Network,LT,1064.51,,,,,,,640.50,1242.57,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,75.00,308.32,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,257.95,454.93,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,PPO Network,,389.74,,,,,,,234.50,454.93,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,The Alliance,PPO Network,TC,2620.14,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,PPO Network,TC,2620.14,,,,,,,1479.13,3058.41,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,inpatient,1,EA,343.71000,326.53000,The Alliance,PPO Network,,285.62,,,,,,,189.04,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,outpatient,1,EA,343.71000,326.53000,The Alliance,PPO Network,,285.62,,,,,,,171.85,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,inpatient,1,EA,309.79000,294.30000,The Alliance,PPO Network,,257.44,,,,,,,170.38,300.50,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,outpatient,1,EA,309.79000,294.30000,The Alliance,PPO Network,,257.44,,,,,,,154.90,300.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,The Alliance,PPO Network,,942.70,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,PPO Network,,942.70,,,,,,,0.29000,1100.39,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,inpatient,1,mL,12429.17000,11807.71000,The Alliance,PPO Network,,10328.64,,,,,,,6836.04,12056.29,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,outpatient,1,mL,12429.17000,11807.71000,The Alliance,PPO Network,,10328.64,,,,,,,132.04,12056.29,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,inpatient,,,169.40000,160.93000,The Alliance,PPO Network,90,140.77,,,,,,,93.17,164.32,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,outpatient,,,169.40000,160.93000,The Alliance,PPO Network,90,140.77,,,,,,,15.49,780.94,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2612.86,5692.50,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,PPO Network,,4730.47,,,,,,,2612.86,5692.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,76.32000,72.50000,The Alliance,PPO Network,,63.42,,,,,,,37.40,74.03,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,PPO Network,,63.42,,,,,,,35.03,76.32,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1352.40,2677.20,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1266.84,2760.00,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1352.40,2677.20,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,PPO Network,,2293.56,,,,,,,1266.84,2760.00,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2620.28,5187.07,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,PPO Network,,4443.77,,,,,,,2454.50,5347.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,inpatient,,,136.51000,129.68000,The Alliance,PPO Network,,113.44,,,,,,,75.08,132.41,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,outpatient,,,136.51000,129.68000,The Alliance,PPO Network,,113.44,,,,,,,68.25,144.20,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,inpatient,1,EA,273.02000,259.37000,The Alliance,PPO Network,,226.88,,,,,,,150.16,264.83,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,outpatient,1,EA,273.02000,259.37000,The Alliance,PPO Network,,226.88,,,,,,,136.51,264.83,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,75.35,132.89,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,68.50,264.00,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,33.55,59.17,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,PPO Network,,50.69,,,,,,,30.50,264.00,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,The Alliance,PPO Network,GO,33.57,,,,,,,22.22,39.19,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,PPO Network,GO,33.57,,,,,,,20.20,264.00,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,The Alliance,PPO Network,GO,50.86,,,,,,,33.66,59.36,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,PPO Network,GO,50.86,,,,,,,30.60,264.00,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,382.25,674.15,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,PPO Network,TC,577.54,,,,,,,298.87,3487.84,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,inpatient,,,2470.00000,2346.50000,The Alliance,PPO Network,TC,2052.57,,,,,,,1358.50,2395.90,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,outpatient,,,2470.00000,2346.50000,The Alliance,PPO Network,TC,2052.57,,,,,,,1235.00,2395.90,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,inpatient,,,3096.00000,2941.20000,The Alliance,PPO Network,,2572.78,,,,,,,1702.80,3003.12,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,PPO Network,,2572.78,,,,,,,1548.00,6178.88,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,inpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,PPO Network,,4.80,,,,,,,0.14409,5.61,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,inpatient,,,214.12000,203.41000,The Alliance,PPO Network,,177.93,,,,,,,117.77,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,outpatient,,,214.12000,203.41000,The Alliance,PPO Network,,177.93,,,,,,,107.06,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,inpatient,1,mL,428.24000,406.83000,The Alliance,PPO Network,,355.87,,,,,,,235.53,415.39,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,outpatient,1,mL,428.24000,406.83000,The Alliance,PPO Network,,355.87,,,,,,,214.12,415.39,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,2.29,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,inpatient,,,113.40000,107.73000,The Alliance,PPO Network,90,94.24,,,,,,,62.37,110.00,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,PPO Network,90,94.24,,,,,,,13.33,679.08,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,inpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,137.72,242.89,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,PPO Network,90,208.08,,,,,,,22.91,1035.56,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,inpatient,1,mL,11.48000,10.91000,The Alliance,PPO Network,,9.54,,,,,,,6.31,11.14,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,outpatient,1,mL,11.48000,10.91000,The Alliance,PPO Network,,9.54,,,,,,,3.62,11.14,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,inpatient,1,EA,156.07000,148.27000,The Alliance,PPO Network,,129.69,,,,,,,85.84,151.39,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,outpatient,1,EA,156.07000,148.27000,The Alliance,PPO Network,,129.69,,,,,,,78.03,151.39,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,inpatient,,,123.97000,117.77000,The Alliance,PPO Network,,103.02,,,,,,,68.18,120.25,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,outpatient,,,123.97000,117.77000,The Alliance,PPO Network,,103.02,,,,,,,23.25,120.25,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,inpatient,1,mL,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.80,3.17,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,outpatient,1,mL,3.27000,3.10000,The Alliance,PPO Network,,2.72,,,,,,,1.64,3.17,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,The Alliance,PPO Network,,741.67,,,,,,,437.32,865.73,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,PPO Network,,741.67,,,,,,,409.66,892.50,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,inpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,0.01000,2.55,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.18150,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,PPO Network,,0.27423,,,,,,,0.16500,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,inpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,PPO Network,,0.49860,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,inpatient,1,mL,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,inpatient,1,EA,57.15000,54.29000,The Alliance,PPO Network,,47.49,,,,,,,31.43,55.44,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,PPO Network,,47.49,,,,,,,3.02,55.44,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3198.75000,3038.81000,The Alliance,PPO Network,,2658.16,,,,,,,1567.39,3102.79,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3198.75000,3038.81000,The Alliance,PPO Network,,2658.16,,,,,,,1468.23,3198.75,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3168.75000,3010.31000,The Alliance,PPO Network,,2633.23,,,,,,,1552.69,3073.69,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3168.75000,3010.31000,The Alliance,PPO Network,,2633.23,,,,,,,1454.46,3168.75,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,506.93000,481.58000,The Alliance,PPO Network,,421.26,,,,,,,248.40,491.72,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,506.93000,481.58000,The Alliance,PPO Network,,421.26,,,,,,,232.68,491.72,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,179.60000,170.62000,The Alliance,PPO Network,,149.25,,,,,,,88.00,174.21,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,179.60000,170.62000,The Alliance,PPO Network,,149.25,,,,,,,82.44,174.21,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,382.50000,363.38000,The Alliance,PPO Network,,317.86,,,,,,,187.43,371.02,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,PPO Network,,317.86,,,,,,,175.57,382.50,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3499.34,6927.26,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3277.95,7141.50,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2916.11,5772.71,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2731.62,5951.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2043.75000,1941.56000,The Alliance,PPO Network,,1698.36,,,,,,,1001.44,1982.44,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,PPO Network,,1698.36,,,,,,,938.08,2043.75,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,inpatient,1,EA,10207.88000,9697.49000,The Alliance,PPO Network,,8482.75,,,,,,,5614.33,9901.64,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,outpatient,1,EA,10207.88000,9697.49000,The Alliance,PPO Network,,8482.75,,,,,,,376.48,9901.64,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.53,2.71,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,PPO Network,,2.32,,,,,,,1.40,2.71,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,inpatient,1,EA,53.80000,51.11000,The Alliance,PPO Network,,44.71,,,,,,,29.59,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,outpatient,1,EA,53.80000,51.11000,The Alliance,PPO Network,,44.71,,,,,,,0.76415,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,inpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.32450,0.57230,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,PPO Network,,0.49029,,,,,,,0.29500,0.81340,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,25.79,50.03,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,inpatient,1,EA,64.37000,61.15000,The Alliance,PPO Network,,53.49,,,,,,,35.40,62.44,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,PPO Network,,53.49,,,,,,,32.19,62.44,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,inpatient,1,EA,61.33000,58.26000,The Alliance,PPO Network,,50.97,,,,,,,33.73,59.49,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,outpatient,1,EA,61.33000,58.26000,The Alliance,PPO Network,,50.97,,,,,,,30.66,59.49,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,inpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92950,1.64,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84500,1.64,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,inpatient,1,mL,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.70950,1.25,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,outpatient,1,mL,1.29000,1.22000,The Alliance,PPO Network,,1.07,,,,,,,0.64500,1.25,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.07150,0.12610,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,PPO Network,,0.10803,,,,,,,0.06500,0.12610,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,inpatient,1,mL,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.88000,1.55,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,outpatient,1,mL,1.60000,1.52000,The Alliance,PPO Network,,1.33,,,,,,,0.80000,18.34,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,inpatient,1,mL,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,inpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,PPO Network,,0.54015,,,,,,,0.32500,0.63050,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,inpatient,1,mL,95.59000,90.81000,The Alliance,PPO Network,,79.44,,,,,,,52.57,92.72,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,outpatient,1,mL,95.59000,90.81000,The Alliance,PPO Network,,79.44,,,,,,,47.80,92.72,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,inpatient,1,EA,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,3.49,6.16,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,PPO Network,,5.28,,,,,,,2.14,6.16,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,inpatient,1,mL,4.34000,4.12000,The Alliance,PPO Network,,3.61,,,,,,,2.39,4.21,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,outpatient,1,mL,4.34000,4.12000,The Alliance,PPO Network,,3.61,,,,,,,0.33945,4.21,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,264.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,29.92000,28.42000,The Alliance,PPO Network,,24.86,,,,,,,14.66,29.02,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,29.92000,28.42000,The Alliance,PPO Network,,24.86,,,,,,,13.73,29.92,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,821.25000,780.19000,The Alliance,PPO Network,,682.46,,,,,,,402.41,796.61,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,821.25000,780.19000,The Alliance,PPO Network,,682.46,,,,,,,376.95,821.25,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,52.32000,49.70000,The Alliance,PPO Network,,43.48,,,,,,,25.64,50.75,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,52.32000,49.70000,The Alliance,PPO Network,,43.48,,,,,,,24.01,52.32,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,44.64000,42.41000,The Alliance,PPO Network,,37.10,,,,,,,21.87,43.30,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,44.64000,42.41000,The Alliance,PPO Network,,37.10,,,,,,,20.49,44.64,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,46.08000,43.78000,The Alliance,PPO Network,,38.29,,,,,,,22.58,44.70,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,46.08000,43.78000,The Alliance,PPO Network,,38.29,,,,,,,21.15,46.08,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,inpatient,,,308.50000,293.08000,The Alliance,PPO Network,90,256.36,,,,,,,169.68,299.25,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,outpatient,,,308.50000,293.08000,The Alliance,PPO Network,90,256.36,,,,,,,28.07,299.25,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,inpatient,1,GM,13.05000,12.40000,The Alliance,PPO Network,,10.84,,,,,,,7.18,12.66,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,outpatient,1,GM,13.05000,12.40000,The Alliance,PPO Network,,10.84,,,,,,,6.53,12.66,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,inpatient,1,mL,42.10000,40.00000,The Alliance,PPO Network,,34.99,,,,,,,23.16,40.84,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,outpatient,1,mL,42.10000,40.00000,The Alliance,PPO Network,,34.99,,,,,,,21.05,40.84,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,inpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,PPO Network,,3.42,,,,,,,2.06,3.99,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,inpatient,1,mL,15.52000,14.74000,The Alliance,PPO Network,,12.90,,,,,,,8.54,15.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,outpatient,1,mL,15.52000,14.74000,The Alliance,PPO Network,,12.90,,,,,,,7.76,15.05,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,inpatient,1,mL,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.63250,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,outpatient,1,mL,1.15000,1.09000,The Alliance,PPO Network,,0.95565,,,,,,,0.08525,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,inpatient,1,mL,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,outpatient,1,mL,3.59000,3.41000,The Alliance,PPO Network,,2.98,,,,,,,0.08525,3.48,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,24.68000,23.45000,The Alliance,PPO Network,,20.51,,,,,,,13.57,23.94,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,24.68000,23.45000,The Alliance,PPO Network,,20.51,,,,,,,12.34,23.94,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,The Alliance,PPO Network,,2364.02,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,PPO Network,,2364.02,,,,,,,1305.76,2844.79,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,The Alliance,PPO Network,,2927.59,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,PPO Network,,2927.59,,,,,,,1617.04,3522.97,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,PPO Network,,8124.94,,,,,,,4487.78,9777.30,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.82500,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,The Alliance,PPO Network,,38194.89,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,PPO Network,,38194.89,,,,,,,157.68,44583.68,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6486.00000,6161.70000,The Alliance,PPO Network,,5389.87,,,,,,,3178.14,6291.42,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6486.00000,6161.70000,The Alliance,PPO Network,,5389.87,,,,,,,2977.07,6486.00,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,The Alliance,PPO Network,,47.35,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,PPO Network,,47.35,,,,,,,28.49,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,The Alliance,PPO Network,,47.35,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,PPO Network,,47.35,,,,,,,28.49,55.27,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,PPO Network,,5518.88,,,,,,,3048.33,6641.25,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,18511.22,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,20528.18,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,PPO Network,,37165.39,,,,,,,20528.18,43381.99,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,The Alliance,PPO Network,TC,538.49,,,,,,,356.40,628.56,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,PPO Network,TC,538.49,,,,,,,324.00,2941.42,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,33730.20000,32043.69000,The Alliance,PPO Network,,28029.80,,,,,,,16527.80,32718.29,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,33730.20000,32043.69000,The Alliance,PPO Network,,28029.80,,,,,,,15482.16,33730.20,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,4761.02,10372.60,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,13658.95,27039.14,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,12794.81,27875.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,The Alliance,PPO Network,,1417.89,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,PPO Network,,1417.89,,,,,,,783.17,1706.25,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,229.32,453.96,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,214.81,468.00,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12130.22,26427.50,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,PPO Network,,1844.82,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1701.49,3368.26,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1593.85,3472.43,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1875.00000,1781.25000,The Alliance,PPO Network,,1558.12,,,,,,,918.75,1818.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1875.00000,1781.25000,The Alliance,PPO Network,,1558.12,,,,,,,860.62,1875.00,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.75000,274.31000,The Alliance,PPO Network,,239.95,,,,,,,141.49,280.09,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.75000,274.31000,The Alliance,PPO Network,,239.95,,,,,,,132.54,288.75,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,PPO Network,,106.93,,,,,,,59.06,128.68,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.86000,359.92000,The Alliance,PPO Network,,314.83,,,,,,,185.64,367.49,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.86000,359.92000,The Alliance,PPO Network,,314.83,,,,,,,173.90,378.86,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,The Alliance,PPO Network,,7771.39,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,PPO Network,,7771.39,,,,,,,4292.50,9351.85,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1672.50000,1588.88000,The Alliance,PPO Network,,1389.85,,,,,,,819.52,1622.33,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1672.50000,1588.88000,The Alliance,PPO Network,,1389.85,,,,,,,767.68,1672.50,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,PPO Network,,20941.20,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,28138.24000,26731.33000,The Alliance,PPO Network,,23382.88,,,,,,,13787.74,27294.09,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,28138.24000,26731.33000,The Alliance,PPO Network,,23382.88,,,,,,,12915.45,28138.24,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,18698.80000,17763.86000,The Alliance,PPO Network,,15538.70,,,,,,,9162.41,18137.84,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,18698.80000,17763.86000,The Alliance,PPO Network,,15538.70,,,,,,,8582.75,18698.80,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2981.25000,2832.19000,The Alliance,PPO Network,,2477.42,,,,,,,1460.81,2891.81,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2981.25000,2832.19000,The Alliance,PPO Network,,2477.42,,,,,,,1368.39,2981.25,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,5789.10000,5499.65000,The Alliance,PPO Network,,4810.74,,,,,,,2836.66,5615.43,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,5789.10000,5499.65000,The Alliance,PPO Network,,4810.74,,,,,,,2657.20,5789.10,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,The Alliance,PPO Network,,304.86,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,PPO Network,,304.86,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,27830.25000,26438.74000,The Alliance,PPO Network,,23126.94,,,,,,,13636.82,26995.34,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,27830.25000,26438.74000,The Alliance,PPO Network,,23126.94,,,,,,,12774.08,26995.34,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,1927.18,4198.65,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,1927.18,4198.65,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2873.85,5689.05,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2692.03,5865.00,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,PPO Network,,36.56,,,,,,,20.20,44.00,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,898.32,1778.30,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3915.41000,3719.64000,The Alliance,PPO Network,,3253.71,,,,,,,1918.55,3797.95,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3915.41000,3719.64000,The Alliance,PPO Network,,3253.71,,,,,,,1797.17,3915.41,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,10260.30000,9747.28000,The Alliance,PPO Network,,8526.31,,,,,,,5027.55,9952.49,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,10260.30000,9747.28000,The Alliance,PPO Network,,8526.31,,,,,,,4709.48,10260.30,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,30.04000,28.54000,The Alliance,PPO Network,,24.96,,,,,,,14.72,29.14,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,30.04000,28.54000,The Alliance,PPO Network,,24.96,,,,,,,13.79,30.04,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,TC,2813.77,,,,,,,1862.30,3284.42,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,PPO Network,TC,2813.77,,,,,,,1693.00,3284.42,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,34.10,60.14,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,PPO Network,,51.52,,,,,,,31.00,264.00,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,84.28000,80.07000,The Alliance,PPO Network,,70.04,,,,,,,41.30,81.75,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,84.28000,80.07000,The Alliance,PPO Network,,70.04,,,,,,,38.68,84.28,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,PPO Network,,8265.42,,,,,,,4565.37,9946.35,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,8125.15,14329.81,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,PPO Network,,12276.36,,,,,,,1667.31,67198.78,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,PPO Network,,6307.29,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,337.50000,320.62000,The Alliance,PPO Network,,280.46,,,,,,,165.38,327.38,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,PPO Network,,280.46,,,,,,,154.91,337.50,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,3777.75000,3588.86000,The Alliance,PPO Network,,3139.31,,,,,,,1851.10,3664.42,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,PPO Network,,3139.31,,,,,,,1733.99,3777.75,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,inpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,TC,1166.72,,,,,,,772.20,1361.88,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,PPO Network,TC,1166.72,,,,,,,227.70,3600.87,percent of total billed charges,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,inpatient,,,71282.00000,67717.90000,The Alliance,PPO Network,,59235.34,,,,,,,39205.10,69143.54,percent of total billed charges,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,PPO Network,,59235.34,,,,,,,35641.00,74614.73,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,inpatient,,,2612.00000,2481.40000,The Alliance,PPO Network,,2170.57,,,,,,,1436.60,2533.64,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,outpatient,,,2612.00000,2481.40000,The Alliance,PPO Network,,2170.57,,,,,,,1436.60,7803.00,percent of total billed charges,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,inpatient,,,3855.00000,3662.25000,The Alliance,PPO Network,,3203.51,,,,,,,2120.25,3739.35,percent of total billed charges,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,outpatient,,,3855.00000,3662.25000,The Alliance,PPO Network,,3203.51,,,,,,,471.52,3739.35,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.11207,0.29100,percent of total billed charges,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,inpatient,,,1944.00000,1846.80000,The Alliance,PPO Network,TC,1615.46,,,,,,,1069.20,1885.68,percent of total billed charges,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,PPO Network,TC,1615.46,,,,,,,384.16,1885.68,percent of total billed charges,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,155.20,percent of total billed charges,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,88.00,3163.00,percent of total billed charges,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,982.50000,933.38000,The Alliance,PPO Network,,816.46,,,,,,,481.43,953.02,percent of total billed charges,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,PPO Network,,816.46,,,,,,,450.97,982.50,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,inpatient,,,194.68000,184.95000,The Alliance,PPO Network,,161.78,,,,,,,107.07,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,outpatient,,,194.68000,184.95000,The Alliance,PPO Network,,161.78,,,,,,,97.34,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,inpatient,1,mL,389.35000,369.88000,The Alliance,PPO Network,,323.55,,,,,,,214.14,377.67,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,outpatient,1,mL,389.35000,369.88000,The Alliance,PPO Network,,323.55,,,,,,,194.68,377.67,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,165.55,349.86,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,473.44000,449.77000,The Alliance,PPO Network,,393.43,,,,,,,231.99,459.24,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,473.44000,449.77000,The Alliance,PPO Network,,393.43,,,,,,,217.31,473.44,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,273.79,541.99,percent of total billed charges,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,153.47,541.99,percent of total billed charges,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,inpatient,1,EA,1677.88000,1593.99000,The Alliance,PPO Network,,1394.32,,,,,,,922.83,1627.54,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,outpatient,1,EA,1677.88000,1593.99000,The Alliance,PPO Network,,1394.32,,,,,,,18.21,1627.54,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,inpatient,1,EA,1476.30000,1402.48000,The Alliance,PPO Network,,1226.81,,,,,,,811.97,1432.01,percent of total billed charges,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,outpatient,1,EA,1476.30000,1402.48000,The Alliance,PPO Network,,1226.81,,,,,,,18.21,1432.01,percent of total billed charges,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,214.03,423.70,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,PPO Network,,362.98,,,,,,,200.49,436.80,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,11492.32000,10917.70000,The Alliance,PPO Network,,9550.12,,,,,,,5631.24,11147.55,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11492.32000,10917.70000,The Alliance,PPO Network,,9550.12,,,,,,,5274.97,11492.32,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,inpatient,1,mL,591.22000,561.66000,The Alliance,PPO Network,,491.30,,,,,,,325.17,573.48,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,PPO Network,,491.30,,,,,,,9.09,573.48,percent of total billed charges,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,PPO Network,,6866.35,,,,,,,3792.60,8262.75,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,PPO Network,,28.25,,,,,,,15.61,34.00,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,inpatient,1,EA,2061.77000,1958.68000,The Alliance,PPO Network,,1713.33,,,,,,,1133.97,1999.92,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,outpatient,1,EA,2061.77000,1958.68000,The Alliance,PPO Network,,1713.33,,,,,,,1030.88,1999.92,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,inpatient,,,184.10000,174.89000,The Alliance,PPO Network,,152.99,,,,,,,101.25,178.58,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,PPO Network,,152.99,,,,,,,92.05,205.31,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,inpatient,1,mL,368.20000,349.79000,The Alliance,PPO Network,,305.97,,,,,,,202.51,357.15,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,outpatient,1,mL,368.20000,349.79000,The Alliance,PPO Network,,305.97,,,,,,,184.10,357.15,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,inpatient,1,mL,591.22000,561.66000,The Alliance,PPO Network,,491.30,,,,,,,325.17,573.48,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,PPO Network,,491.30,,,,,,,9.09,573.48,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,inpatient,1,EA,8551.17000,8123.61000,The Alliance,PPO Network,,7106.02,,,,,,,4703.14,8294.63,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,outpatient,1,EA,8551.17000,8123.61000,The Alliance,PPO Network,,7106.02,,,,,,,36.66,8294.63,percent of total billed charges,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,inpatient,,,953.00000,905.35000,The Alliance,PPO Network,TC,791.94,,,,,,,524.15,924.41,percent of total billed charges,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,PPO Network,TC,791.94,,,,,,,354.42,3685.66,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,inpatient,1,EA,2588.14000,2458.73000,The Alliance,PPO Network,,2150.74,,,,,,,1423.48,2510.50,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,PPO Network,,2150.74,,,,,,,1294.07,2510.50,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,inpatient,1,mL,138.09000,131.19000,The Alliance,PPO Network,,114.75,,,,,,,75.95,133.95,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,outpatient,1,mL,138.09000,131.19000,The Alliance,PPO Network,,114.75,,,,,,,7.15,133.95,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,inpatient,1,mL,155.95000,148.15000,The Alliance,PPO Network,,129.59,,,,,,,85.77,151.27,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,outpatient,1,mL,155.95000,148.15000,The Alliance,PPO Network,,129.59,,,,,,,7.15,151.27,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,inpatient,1,mL,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,69.52,122.61,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,outpatient,1,mL,126.40000,120.08000,The Alliance,PPO Network,,105.04,,,,,,,7.15,122.61,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,inpatient,1,mL,162.68000,154.54000,The Alliance,PPO Network,,135.19,,,,,,,89.47,157.80,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,outpatient,1,mL,162.68000,154.54000,The Alliance,PPO Network,,135.19,,,,,,,7.15,157.80,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,inpatient,1,mL,139.04000,132.09000,The Alliance,PPO Network,,115.54,,,,,,,76.47,134.87,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,outpatient,1,mL,139.04000,132.09000,The Alliance,PPO Network,,115.54,,,,,,,7.15,134.87,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,inpatient,1,mL,132.72000,126.08000,The Alliance,PPO Network,,110.29,,,,,,,73.00,128.74,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,outpatient,1,mL,132.72000,126.08000,The Alliance,PPO Network,,110.29,,,,,,,7.15,128.74,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,inpatient,1,mL,85.32000,81.05000,The Alliance,PPO Network,,70.90,,,,,,,46.93,82.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,outpatient,1,mL,85.32000,81.05000,The Alliance,PPO Network,,70.90,,,,,,,7.15,82.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,inpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,52.14,91.96,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,PPO Network,,78.78,,,,,,,7.15,91.96,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,inpatient,1,mL,123.46000,117.29000,The Alliance,PPO Network,,102.60,,,,,,,67.90,119.76,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,outpatient,1,mL,123.46000,117.29000,The Alliance,PPO Network,,102.60,,,,,,,7.15,119.76,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,inpatient,,,317.36000,301.49000,The Alliance,PPO Network,,263.73,,,,,,,174.55,307.84,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,outpatient,,,317.36000,301.49000,The Alliance,PPO Network,,263.73,,,,,,,158.68,307.84,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,inpatient,1,mL,634.72000,602.98000,The Alliance,PPO Network,,527.45,,,,,,,349.10,615.68,percent of total billed charges,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,outpatient,1,mL,634.72000,602.98000,The Alliance,PPO Network,,527.45,,,,,,,275.21,615.68,percent of total billed charges,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,inpatient,1,mL,117.25000,111.39000,The Alliance,PPO Network,,97.43,,,,,,,64.49,113.73,percent of total billed charges,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,outpatient,1,mL,117.25000,111.39000,The Alliance,PPO Network,,97.43,,,,,,,58.62,113.73,percent of total billed charges,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,inpatient,1,EA,12040.81000,11438.77000,The Alliance,PPO Network,,10005.91,,,,,,,6622.45,11679.59,percent of total billed charges,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,outpatient,1,EA,12040.81000,11438.77000,The Alliance,PPO Network,,10005.91,,,,,,,73.16,11679.59,percent of total billed charges,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,PPO Network,,2958.69,,,,,,,3.00,3453.59,percent of total billed charges,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,inpatient,,,3536.25000,3359.44000,The Alliance,PPO Network,,2938.62,,,,,,,1732.76,3430.16,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,PPO Network,,2938.62,,,,,,,1768.12,3430.16,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,inpatient,1,mL,38.54000,36.61000,The Alliance,PPO Network,,32.03,,,,,,,21.20,37.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,outpatient,1,mL,38.54000,36.61000,The Alliance,PPO Network,,32.03,,,,,,,0.04650,37.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,inpatient,1,mL,24.96000,23.72000,The Alliance,PPO Network,,20.74,,,,,,,13.73,24.21,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,outpatient,1,mL,24.96000,23.72000,The Alliance,PPO Network,,20.74,,,,,,,0.04650,24.21,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,inpatient,1,mL,25.63000,24.35000,The Alliance,PPO Network,,21.30,,,,,,,14.10,24.86,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,outpatient,1,mL,25.63000,24.35000,The Alliance,PPO Network,,21.30,,,,,,,0.04650,24.86,percent of total billed charges,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,inpatient,1,mL,485.62000,461.34000,The Alliance,PPO Network,,403.55,,,,,,,267.09,471.05,percent of total billed charges,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,outpatient,1,mL,485.62000,461.34000,The Alliance,PPO Network,,403.55,,,,,,,0.91760,471.05,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,inpatient,1,mL,2502.32000,2377.20000,The Alliance,PPO Network,,2079.43,,,,,,,1376.28,2427.25,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,outpatient,1,mL,2502.32000,2377.20000,The Alliance,PPO Network,,2079.43,,,,,,,3.33,2427.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2043.75000,1941.56000,The Alliance,PPO Network,,1698.36,,,,,,,1001.44,1982.44,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,PPO Network,,1698.36,,,,,,,938.08,2043.75,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,inpatient,,,19.40000,18.43000,The Alliance,PPO Network,,16.12,,,,,,,9.51,18.82,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,outpatient,,,19.40000,18.43000,The Alliance,PPO Network,,16.12,,,,,,,9.70,51.01,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,inpatient,1,mL,62.37000,59.25000,The Alliance,PPO Network,,51.83,,,,,,,34.30,60.50,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,outpatient,1,mL,62.37000,59.25000,The Alliance,PPO Network,,51.83,,,,,,,0.12000,60.50,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,inpatient,1,mL,212.86000,202.21000,The Alliance,PPO Network,,176.89,,,,,,,117.07,206.47,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,outpatient,1,mL,212.86000,202.21000,The Alliance,PPO Network,,176.89,,,,,,,106.43,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,inpatient,1,mL,244.90000,232.66000,The Alliance,PPO Network,,203.51,,,,,,,134.69,237.55,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,PPO Network,,203.51,,,,,,,109.28,249.68,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,inpatient,1,mL,30.54000,29.02000,The Alliance,PPO Network,,25.38,,,,,,,16.80,29.62,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,outpatient,1,mL,30.54000,29.02000,The Alliance,PPO Network,,25.38,,,,,,,15.27,83.21,percent of total billed charges,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,inpatient,1,mL,256.88000,244.04000,The Alliance,PPO Network,,213.47,,,,,,,141.28,249.17,percent of total billed charges,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,outpatient,1,mL,256.88000,244.04000,The Alliance,PPO Network,,213.47,,,,,,,128.44,249.17,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,inpatient,,,700.93000,665.88000,The Alliance,PPO Network,,582.47,,,,,,,385.51,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,outpatient,,,700.93000,665.88000,The Alliance,PPO Network,,582.47,,,,,,,331.10,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,inpatient,1,mL,1401.86000,1331.77000,The Alliance,PPO Network,,1164.95,,,,,,,771.02,1359.80,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,outpatient,1,mL,1401.86000,1331.77000,The Alliance,PPO Network,,1164.95,,,,,,,331.10,1359.80,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,6387.40,12644.43,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,PPO Network,,10832.50,,,,,,,5983.29,13035.50,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,13658.95,27039.14,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,12794.81,27875.40,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,inpatient,1,mL,4909.73000,4664.25000,The Alliance,PPO Network,,4079.99,,,,,,,2700.35,4762.44,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,PPO Network,,4079.99,,,,,,,225.19,4762.44,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,inpatient,1,EA,2155.06000,2047.31000,The Alliance,PPO Network,,1790.85,,,,,,,1185.28,2090.41,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,outpatient,1,EA,2155.06000,2047.31000,The Alliance,PPO Network,,1790.85,,,,,,,1077.53,2090.41,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,inpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,47.85,84.39,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,outpatient,,,87.00000,82.65000,The Alliance,PPO Network,,72.30,,,,,,,43.50,84.39,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,inpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.62,2.86,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,PPO Network,,2.45,,,,,,,1.48,2.86,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,inpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,63.80,112.52,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,outpatient,,,116.00000,110.20000,The Alliance,PPO Network,,96.40,,,,,,,58.00,112.52,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.34000,356.57000,The Alliance,PPO Network,,311.91,,,,,,,183.92,364.08,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.34000,356.57000,The Alliance,PPO Network,,311.91,,,,,,,172.28,375.34,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,229.32,453.96,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,PPO Network,,388.91,,,,,,,214.81,468.00,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,PPO Network,,8622.46,,,,,,,4762.59,10376.01,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,674.25,2392.02,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,323.55000,307.37000,The Alliance,PPO Network,,268.87,,,,,,,158.54,313.84,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,PPO Network,,268.87,,,,,,,148.51,323.55,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1858.06,3678.20,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,PPO Network,,3151.12,,,,,,,1740.51,3791.96,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1745.03000,1657.78000,The Alliance,PPO Network,,1450.12,,,,,,,855.06,1692.68,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1745.03000,1657.78000,The Alliance,PPO Network,,1450.12,,,,,,,800.97,1745.03,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,91.88,181.88,percent of total billed charges,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,86.06,187.50,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,PPO Network,,8619.63,,,,,,,4761.02,10372.60,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3041.25000,2889.19000,The Alliance,PPO Network,,2527.28,,,,,,,1490.21,2950.01,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3041.25000,2889.19000,The Alliance,PPO Network,,2527.28,,,,,,,1395.93,3041.25,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,136.34,269.90,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,PPO Network,,231.23,,,,,,,127.72,278.25,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9300.00000,8835.00000,The Alliance,PPO Network,,7728.30,,,,,,,4557.00,9021.00,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9300.00000,8835.00000,The Alliance,PPO Network,,7728.30,,,,,,,4268.70,9300.00,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,47.62,2280.00,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,PPO Network,,12625.47,,,,,,,6973.63,15193.10,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,PPO Network,TC,289.19,,,,,,,191.40,337.56,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,PPO Network,TC,289.19,,,,,,,144.10,548.00,percent of total billed charges,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,inpatient,,,76.60000,72.77000,The Alliance,PPO Network,90,63.65,,,,,,,42.13,74.30,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,outpatient,,,76.60000,72.77000,The Alliance,PPO Network,90,63.65,,,,,,,4.57,271.65,percent of total billed charges,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,inpatient,1,mL,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.54,2.72,percent of total billed charges,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,outpatient,1,mL,2.80000,2.66000,The Alliance,PPO Network,,2.33,,,,,,,1.40,2.72,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,826.88,1636.88,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,PPO Network,,1402.31,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,inpatient,1,mL,8.34000,7.93000,The Alliance,PPO Network,,6.93,,,,,,,4.59,8.09,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,PPO Network,,6.93,,,,,,,0.17611,8.09,percent of total billed charges,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,4467.75000,4244.36000,The Alliance,PPO Network,,3712.70,,,,,,,2189.20,4333.72,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,PPO Network,,3712.70,,,,,,,2050.70,4467.75,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
VISIT EST PAT LEVEL 1 .,83777,CDM,510,RC,99211,CPT,,,facility,inpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,58.85,103.79,percent of total billed charges,
VISIT EST PAT LEVEL 1 .,83777,CDM,510,RC,99211,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,PPO Network,,88.92,,,,,,,53.50,103.79,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,inpatient,1,GM,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,outpatient,1,GM,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,inpatient,1,GM,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,2.01,3.54,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,outpatient,1,GM,3.65000,3.47000,The Alliance,PPO Network,,3.03,,,,,,,1.82,3.54,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,inpatient,1,EA,5037.00000,4785.15000,The Alliance,PPO Network,,4185.75,,,,,,,2770.35,4885.89,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,outpatient,1,EA,5037.00000,4785.15000,The Alliance,PPO Network,,4185.75,,,,,,,34.48,4885.89,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,inpatient,1,EA,84884.40000,80640.18000,The Alliance,PPO Network,,70538.94,,,,,,,46686.42,82337.87,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,outpatient,1,EA,84884.40000,80640.18000,The Alliance,PPO Network,,70538.94,,,,,,,34.48,82337.87,percent of total billed charges,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,inpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,1155.00,2037.00,percent of total billed charges,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,PPO Network,TC,1745.10,,,,,,,980.94,2210.07,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,inpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,106.70,188.18,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,outpatient,,,194.00000,184.30000,The Alliance,PPO Network,,161.21,,,,,,,19.57,188.18,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,inpatient,,,122.40000,116.28000,The Alliance,PPO Network,90,101.71,,,,,,,67.32,118.73,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,outpatient,,,122.40000,116.28000,The Alliance,PPO Network,90,101.71,,,,,,,6.69,339.51,percent of total billed charges,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,inpatient,,,186.10000,176.79000,The Alliance,PPO Network,90,154.65,,,,,,,102.36,180.52,percent of total billed charges,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,outpatient,,,186.10000,176.79000,The Alliance,PPO Network,90,154.65,,,,,,,93.05,1137.41,percent of total billed charges,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,41.63,73.43,percent of total billed charges,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,37.85,1137.41,percent of total billed charges,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,inpatient,1,mL,26.42000,25.10000,The Alliance,PPO Network,,21.96,,,,,,,14.53,25.63,percent of total billed charges,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,outpatient,1,mL,26.42000,25.10000,The Alliance,PPO Network,,21.96,,,,,,,13.21,25.63,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,inpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.53,4.46,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,PPO Network,,3.82,,,,,,,2.30,4.46,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.17600,0.31040,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,PPO Network,,0.26592,,,,,,,0.16000,0.31040,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,inpatient,1,EA,64.37000,61.15000,The Alliance,PPO Network,,53.49,,,,,,,35.40,62.44,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,PPO Network,,53.49,,,,,,,32.19,62.44,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,inpatient,,,457.32000,434.45000,The Alliance,PPO Network,,380.03,,,,,,,251.53,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,outpatient,,,457.32000,434.45000,The Alliance,PPO Network,,380.03,,,,,,,228.66,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,inpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,2.51,4.43,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,PPO Network,,3.80,,,,,,,2.29,4.43,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,7940.90,14004.86,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,PPO Network,TC,11997.98,,,,,,,4549.00,14004.86,percent of total billed charges,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,PS,12009.61,,,,,,,7948.60,14018.44,percent of total billed charges,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,PPO Network,PS,12009.61,,,,,,,4549.00,14018.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7279.50000,6915.52000,The Alliance,PPO Network,,6049.26,,,,,,,3566.95,7061.11,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,PPO Network,,6049.26,,,,,,,3341.29,7279.50,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7279.50000,6915.52000,The Alliance,PPO Network,,6049.26,,,,,,,3566.95,7061.11,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,PPO Network,,6049.26,,,,,,,3341.29,7279.50,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,716.62,1418.62,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,671.29,1462.50,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,530.63000,504.10000,The Alliance,PPO Network,,440.95,,,,,,,260.01,514.71,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,530.63000,504.10000,The Alliance,PPO Network,,440.95,,,,,,,243.56,530.63,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,inpatient,1,EA,278.53000,264.60000,The Alliance,PPO Network,,231.46,,,,,,,153.19,270.17,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,outpatient,1,EA,278.53000,264.60000,The Alliance,PPO Network,,231.46,,,,,,,37.62,270.17,percent of total billed charges,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,50.04000,47.54000,The Alliance,PPO Network,,41.58,,,,,,,27.52,48.54,percent of total billed charges,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,50.04000,47.54000,The Alliance,PPO Network,,41.58,,,,,,,0.22165,48.54,percent of total billed charges,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,inpatient,,,828.75000,787.31000,The Alliance,PPO Network,,688.69,,,,,,,406.09,803.89,percent of total billed charges,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,outpatient,,,828.75000,787.31000,The Alliance,PPO Network,,688.69,,,,,,,245.60,803.89,percent of total billed charges,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,inpatient,1,EA,18525.59000,17599.31000,The Alliance,PPO Network,,15394.77,,,,,,,10189.07,17969.82,percent of total billed charges,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,outpatient,1,EA,18525.59000,17599.31000,The Alliance,PPO Network,,15394.77,,,,,,,236.62,17969.82,percent of total billed charges,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,PPO Network,,16847.69,,,,,,,9305.77,20274.00,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,inpatient,1,mL,2334.42000,2217.70000,The Alliance,PPO Network,,1939.90,,,,,,,1283.93,2264.39,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,outpatient,1,mL,2334.42000,2217.70000,The Alliance,PPO Network,,1939.90,,,,,,,248.50,2264.39,percent of total billed charges,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,32130.00000,30523.50000,The Alliance,PPO Network,,26700.03,,,,,,,15743.70,31166.10,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,32130.00000,30523.50000,The Alliance,PPO Network,,26700.03,,,,,,,14747.67,32130.00,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,PPO Network,,33513.77,,,,,,,18511.22,40329.45,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,716.62,1418.62,percent of total billed charges,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,PPO Network,,1215.34,,,,,,,671.29,1462.50,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,inpatient,1,EA,48.98000,46.53000,The Alliance,PPO Network,,40.70,,,,,,,26.94,47.51,percent of total billed charges,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,outpatient,1,EA,48.98000,46.53000,The Alliance,PPO Network,,40.70,,,,,,,24.49,47.51,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,inpatient,1,EA,74.26000,70.55000,The Alliance,PPO Network,,61.71,,,,,,,40.84,72.03,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,outpatient,1,EA,74.26000,70.55000,The Alliance,PPO Network,,61.71,,,,,,,37.13,72.03,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,inpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,19.99,35.25,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,PPO Network,,30.20,,,,,,,18.17,35.25,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,inpatient,,,518.56000,492.63000,The Alliance,PPO Network,,430.92,,,,,,,285.21,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,outpatient,,,518.56000,492.63000,The Alliance,PPO Network,,430.92,,,,,,,0.01000,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,inpatient,1,mL,1037.12000,985.26000,The Alliance,PPO Network,,861.85,,,,,,,570.42,1006.01,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,outpatient,1,mL,1037.12000,985.26000,The Alliance,PPO Network,,861.85,,,,,,,0.01000,1006.01,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,inpatient,1,mL,4.57000,4.35000,The Alliance,PPO Network,,3.80,,,,,,,2.51,4.43,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,outpatient,1,mL,4.57000,4.35000,The Alliance,PPO Network,,3.80,,,,,,,2.11,4.43,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,inpatient,1,mL,2.91000,2.77000,The Alliance,PPO Network,,2.42,,,,,,,1.60,2.82,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,PPO Network,,2.42,,,,,,,1.46,2.82,percent of total billed charges,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,inpatient,1,EA,12538.10000,11911.19000,The Alliance,PPO Network,,10419.16,,,,,,,6895.95,12161.96,percent of total billed charges,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,outpatient,1,EA,12538.10000,11911.19000,The Alliance,PPO Network,,10419.16,,,,,,,188.65,12161.96,percent of total billed charges,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,30271.50000,28757.92000,The Alliance,PPO Network,,25155.62,,,,,,,14833.03,29363.35,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,PPO Network,,25155.62,,,,,,,13894.62,30271.50,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,19659.70,42831.60,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,inpatient,1,mL,5172.56000,4913.93000,The Alliance,PPO Network,,4298.40,,,,,,,2844.91,5017.38,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,outpatient,1,mL,5172.56000,4913.93000,The Alliance,PPO Network,,4298.40,,,,,,,12.35,5017.38,percent of total billed charges,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9632.40000,9150.78000,The Alliance,PPO Network,,8004.52,,,,,,,4719.88,9343.43,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9632.40000,9150.78000,The Alliance,PPO Network,,8004.52,,,,,,,4421.27,9632.40,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,235.20,465.60,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,220.32,480.00,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,105.00,228.75,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,PPO Network,,20229.91,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,363.23000,345.07000,The Alliance,PPO Network,,301.84,,,,,,,177.98,352.33,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,363.23000,345.07000,The Alliance,PPO Network,,301.84,,,,,,,166.72,363.23,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,370.05000,351.55000,The Alliance,PPO Network,,307.51,,,,,,,181.32,358.95,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,370.05000,351.55000,The Alliance,PPO Network,,307.51,,,,,,,169.85,370.05,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,13330.00000,12663.50000,The Alliance,PPO Network,,11077.23,,,,,,,6531.70,12930.10,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,13330.00000,12663.50000,The Alliance,PPO Network,,11077.23,,,,,,,6118.47,13330.00,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,PPO Network,,3489.08,,,,,,,1927.18,4198.65,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,inpatient,1,mL,8213.96000,7803.27000,The Alliance,PPO Network,,6825.80,,,,,,,4517.68,7967.54,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,outpatient,1,mL,8213.96000,7803.27000,The Alliance,PPO Network,,6825.80,,,,,,,12.96,7967.54,percent of total billed charges,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,34469.40000,32745.93000,The Alliance,PPO Network,,28644.07,,,,,,,16890.01,33435.32,percent of total billed charges,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,PPO Network,,28644.07,,,,,,,15821.45,34469.40,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,74.80000,71.06000,The Alliance,PPO Network,,62.16,,,,,,,36.65,72.56,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,74.80000,71.06000,The Alliance,PPO Network,,62.16,,,,,,,34.33,74.80,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,750.75,1324.05,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,PPO Network,,1134.32,,,,,,,682.50,1324.05,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,inpatient,1,EA,15764.79000,14976.55000,The Alliance,PPO Network,,13100.54,,,,,,,8670.63,15291.85,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,PPO Network,,13100.54,,,,,,,171.94,15291.85,percent of total billed charges,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,inpatient,1,mL,9512.59000,9036.96000,The Alliance,PPO Network,,7904.96,,,,,,,5231.92,9227.21,percent of total billed charges,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,outpatient,1,mL,9512.59000,9036.96000,The Alliance,PPO Network,,7904.96,,,,,,,118.62,9227.21,percent of total billed charges,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,inpatient,1,mL,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,14.43,25.44,percent of total billed charges,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,PPO Network,,21.80,,,,,,,0.40920,25.44,percent of total billed charges,
INJ NON-CMP SCHLEROSANT;SNG VN-TECH,83999,CDM,510,RC,36465,CPT,,,facility,inpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,180.95,319.13,percent of total billed charges,
INJ NON-CMP SCHLEROSANT;SNG VN-TECH,83999,CDM,510,RC,36465,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,PPO Network,,273.40,,,,,,,164.50,1910.62,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,inpatient,1,EA,34.59000,32.86000,The Alliance,PPO Network,,28.74,,,,,,,19.02,33.55,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,PPO Network,,28.74,,,,,,,17.30,33.55,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,8414.55000,7993.82000,The Alliance,PPO Network,,6992.49,,,,,,,4123.13,8162.11,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,8414.55000,7993.82000,The Alliance,PPO Network,,6992.49,,,,,,,3862.28,8414.55,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,19659.70,42831.60,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,220.50,436.50,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,PPO Network,,373.95,,,,,,,206.55,450.00,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.47300,0.83420,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,PPO Network,,0.71466,,,,,,,0.43000,0.83420,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12130.22,26427.50,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,3489.78000,3315.29000,The Alliance,PPO Network,,2900.01,,,,,,,1709.99,3385.09,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,3489.78000,3315.29000,The Alliance,PPO Network,,2900.01,,,,,,,1601.81,3489.78,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,PPO Network,,35593.06,,,,,,,19659.70,42831.60,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,273.79,541.99,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,PPO Network,,464.32,,,,,,,153.47,541.99,percent of total billed charges,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,21296.39000,20231.57000,The Alliance,PPO Network,,17697.30,,,,,,,10435.23,20657.50,percent of total billed charges,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,PPO Network,,17697.30,,,,,,,10648.19,27182.63,percent of total billed charges,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,inpatient,,,556.38000,528.56000,The Alliance,PPO Network,,462.35,,,,,,,306.01,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,PPO Network,,462.35,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,inpatient,1,mL,2225.52000,2114.24000,The Alliance,PPO Network,,1849.41,,,,,,,1224.04,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,outpatient,1,mL,2225.52000,2114.24000,The Alliance,PPO Network,,1849.41,,,,,,,1112.76,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,inpatient,,,556.38000,528.56000,The Alliance,PPO Network,,462.35,,,,,,,306.01,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,PPO Network,,462.35,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,inpatient,1,mL,1112.76000,1057.12000,The Alliance,PPO Network,,924.70,,,,,,,612.02,1079.38,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,outpatient,1,mL,1112.76000,1057.12000,The Alliance,PPO Network,,924.70,,,,,,,556.38,1079.38,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,inpatient,,,6705.11000,6369.85000,The Alliance,PPO Network,NU,5571.95,,,,,,,3687.81,6503.96,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,outpatient,,,6705.11000,6369.85000,The Alliance,PPO Network,NU,5571.95,,,,,,,3352.55,6503.96,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1327.58000,1261.20000,The Alliance,PPO Network,,1103.22,,,,,,,650.51,1287.75,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,PPO Network,,1103.22,,,,,,,609.36,1327.58,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
"BX,SFT TISS-UPR ARM/ELBOW;SUPR-TECH",84032,CDM,510,RC,24065,CPT,,,facility,inpatient,,,704.50000,669.28000,The Alliance,PPO Network,,585.44,,,,,,,387.48,683.37,percent of total billed charges,
"BX,SFT TISS-UPR ARM/ELBOW;SUPR-TECH",84032,CDM,510,RC,24065,CPT,,,facility,outpatient,,,704.50000,669.28000,The Alliance,PPO Network,,585.44,,,,,,,352.25,1692.33,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,inpatient,,,4200.00000,3990.00000,The Alliance,PPO Network,,3490.20,,,,,,,2310.00,4074.00,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,outpatient,,,4200.00000,3990.00000,The Alliance,PPO Network,,3490.20,,,,,,,2100.00,4158.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,PPO Network,,190.09,,,,,,,105.00,228.75,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,16998.91000,16148.96000,The Alliance,PPO Network,,14126.09,,,,,,,8329.47,16488.94,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,PPO Network,,14126.09,,,,,,,7802.50,16998.91,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,inpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.69,8.27,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,PPO Network,,7.09,,,,,,,4.26,8.27,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,inpatient,1,EA,15.67000,14.88000,The Alliance,PPO Network,,13.02,,,,,,,8.62,15.20,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,outpatient,1,EA,15.67000,14.88000,The Alliance,PPO Network,,13.02,,,,,,,7.83,15.20,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,24.80000,23.56000,The Alliance,PPO Network,,20.61,,,,,,,12.15,24.06,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,24.80000,23.56000,The Alliance,PPO Network,,20.61,,,,,,,11.38,24.80,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,412.24000,391.63000,The Alliance,PPO Network,,342.57,,,,,,,202.00,399.87,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,412.24000,391.63000,The Alliance,PPO Network,,342.57,,,,,,,206.12,399.87,percent of total billed charges,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,4229.70000,4018.21000,The Alliance,PPO Network,,3514.88,,,,,,,2072.55,4102.81,percent of total billed charges,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,PPO Network,,3514.88,,,,,,,1941.43,4229.70,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,366.26000,347.95000,The Alliance,PPO Network,,304.36,,,,,,,179.47,355.27,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,366.26000,347.95000,The Alliance,PPO Network,,304.36,,,,,,,113.78,355.27,percent of total billed charges,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,2.63,6.47,percent of total billed charges,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,3.67,6.47,percent of total billed charges,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,PPO Network,,5.54,,,,,,,2.63,6.47,percent of total billed charges,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,43.12,85.36,percent of total billed charges,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,PPO Network,,73.13,,,,,,,40.39,85.36,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,52.27000,49.66000,The Alliance,PPO Network,,43.44,,,,,,,28.75,50.70,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,52.27000,49.66000,The Alliance,PPO Network,,43.44,,,,,,,2.63,50.70,percent of total billed charges,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,62.67000,59.54000,The Alliance,PPO Network,,52.08,,,,,,,34.47,60.79,percent of total billed charges,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,62.67000,59.54000,The Alliance,PPO Network,,52.08,,,,,,,2.63,60.79,percent of total billed charges,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,inpatient,,,337.88000,320.99000,The Alliance,PPO Network,NU,280.78,,,,,,,185.83,327.74,percent of total billed charges,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,outpatient,,,337.88000,320.99000,The Alliance,PPO Network,NU,280.78,,,,,,,62.66,327.74,percent of total billed charges,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,135.60000,128.82000,The Alliance,PPO Network,,112.68,,,,,,,66.44,131.53,percent of total billed charges,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,135.60000,128.82000,The Alliance,PPO Network,,112.68,,,,,,,67.80,315.32,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,The Alliance,PPO Network,TC,620.76,,,,,,,410.85,724.59,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,PPO Network,TC,620.76,,,,,,,282.87,724.59,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,1.73,23.28,percent of total billed charges,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2771.25000,2632.69000,The Alliance,PPO Network,,2302.91,,,,,,,1357.91,2688.11,percent of total billed charges,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2771.25000,2632.69000,The Alliance,PPO Network,,2302.91,,,,,,,1272.00,2771.25,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1701.49,3368.26,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1593.85,3472.43,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,inpatient,,,151.70000,144.11000,The Alliance,PPO Network,90,126.06,,,,,,,83.44,147.15,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,outpatient,,,151.70000,144.11000,The Alliance,PPO Network,90,126.06,,,,,,,17.85,814.87,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,79.60000,75.62000,The Alliance,PPO Network,,66.15,,,,,,,39.00,77.21,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,PPO Network,,66.15,,,,,,,36.54,79.60,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,PPO Network,,1894.68,,,,,,,1046.52,2280.00,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,inpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,13.20,23.28,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,PPO Network,,19.94,,,,,,,12.00,264.00,percent of total billed charges,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,130.35,229.89,percent of total billed charges,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,112.98,1134.10,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,inpatient,1,mL,2500.41000,2375.39000,The Alliance,PPO Network,,2077.84,,,,,,,1375.23,2425.40,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,outpatient,1,mL,2500.41000,2375.39000,The Alliance,PPO Network,,2077.84,,,,,,,3.33,2425.40,percent of total billed charges,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30132.00000,28625.40000,The Alliance,PPO Network,,25039.69,,,,,,,14764.68,29228.04,percent of total billed charges,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,PPO Network,,25039.69,,,,,,,13830.59,30132.00,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1600.31000,1520.29000,The Alliance,PPO Network,,1329.86,,,,,,,784.15,1552.30,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1600.31000,1520.29000,The Alliance,PPO Network,,1329.86,,,,,,,440.69,1600.31,percent of total billed charges,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,798.75000,758.81000,The Alliance,PPO Network,,663.76,,,,,,,391.39,774.79,percent of total billed charges,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,798.75000,758.81000,The Alliance,PPO Network,,663.76,,,,,,,366.63,798.75,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,862.50000,819.38000,The Alliance,PPO Network,,716.74,,,,,,,422.62,836.62,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,862.50000,819.38000,The Alliance,PPO Network,,716.74,,,,,,,395.89,862.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,inpatient,1,mL,2890.18000,2745.67000,The Alliance,PPO Network,,2401.74,,,,,,,1589.60,2803.47,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,outpatient,1,mL,2890.18000,2745.67000,The Alliance,PPO Network,,2401.74,,,,,,,73.05,2803.47,percent of total billed charges,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,inpatient,1,mL,70300.00000,66785.00000,The Alliance,PPO Network,,58419.30,,,,,,,38665.00,68191.00,percent of total billed charges,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,PPO Network,,58419.30,,,,,,,790.04,68191.00,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,inpatient,1,EA,673.40000,639.73000,The Alliance,PPO Network,,559.60,,,,,,,370.37,653.20,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,outpatient,1,EA,673.40000,639.73000,The Alliance,PPO Network,,559.60,,,,,,,5.31,653.20,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,0.19995,3.68,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,inpatient,1,mL,9.04000,8.59000,The Alliance,PPO Network,,7.51,,,,,,,4.97,8.77,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,outpatient,1,mL,9.04000,8.59000,The Alliance,PPO Network,,7.51,,,,,,,0.19995,8.77,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1631.25000,1549.69000,The Alliance,PPO Network,,1355.57,,,,,,,799.31,1582.31,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,PPO Network,,1355.57,,,,,,,748.74,1631.25,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24404.10000,23183.89000,The Alliance,PPO Network,,20279.81,,,,,,,11958.01,23671.98,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,PPO Network,,20279.81,,,,,,,11201.48,24404.10,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3532.50000,3355.88000,The Alliance,PPO Network,,2935.51,,,,,,,1730.92,3426.53,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3532.50000,3355.88000,The Alliance,PPO Network,,2935.51,,,,,,,1621.42,3532.50,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,inpatient,1,mL,1881.95000,1787.86000,The Alliance,PPO Network,,1563.90,,,,,,,1035.07,1825.49,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,outpatient,1,mL,1881.95000,1787.86000,The Alliance,PPO Network,,1563.90,,,,,,,197.65,1825.49,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,inpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.53900,0.95060,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,PPO Network,,0.81438,,,,,,,0.49000,1.58,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CORNEAL HYSTER AIR STIM UNI/BI-TECH,84172,CDM,510,RC,92145,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,TC,23.27,,,,,,,15.40,27.16,percent of total billed charges,
CORNEAL HYSTER AIR STIM UNI/BI-TECH,84172,CDM,510,RC,92145,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,TC,23.27,,,,,,,14.00,27.16,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,PPO Network,,31355.96,,,,,,,17319.36,37732.80,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,PPO Network,,285.04,,,,,,,157.44,343.01,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,245.70000,233.42000,The Alliance,PPO Network,,204.18,,,,,,,120.39,238.33,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,245.70000,233.42000,The Alliance,PPO Network,,204.18,,,,,,,112.78,245.70,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,PPO Network,,335.08,,,,,,,221.77,391.12,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,PPO Network,,335.08,,,,,,,201.61,398.00,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,787.50000,748.12000,The Alliance,PPO Network,,654.41,,,,,,,385.88,763.88,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,787.50000,748.12000,The Alliance,PPO Network,,654.41,,,,,,,361.46,787.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,PPO Network,,335.08,,,,,,,221.77,391.12,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,PPO Network,,335.08,,,,,,,201.61,398.00,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,876.23000,832.42000,The Alliance,PPO Network,,728.15,,,,,,,429.35,849.94,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,PPO Network,,728.15,,,,,,,402.19,876.23,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,323.55000,307.37000,The Alliance,PPO Network,,268.87,,,,,,,158.54,313.84,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,PPO Network,,268.87,,,,,,,148.51,323.55,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,645.04,1276.91,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12400.00,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,inpatient,,,647.36000,614.99000,The Alliance,PPO Network,,537.96,,,,,,,317.21,627.94,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,outpatient,,,647.36000,614.99000,The Alliance,PPO Network,,537.96,,,,,,,2.81,647.36,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9566.51000,9088.18000,The Alliance,PPO Network,,7949.77,,,,,,,4687.59,9279.51,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9566.51000,9088.18000,The Alliance,PPO Network,,7949.77,,,,,,,4391.03,9566.51,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,762.49000,724.37000,The Alliance,PPO Network,,633.63,,,,,,,373.62,739.62,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,762.49000,724.37000,The Alliance,PPO Network,,633.63,,,,,,,349.98,762.49,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,1031.25000,979.69000,The Alliance,PPO Network,,856.97,,,,,,,567.19,1000.31,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,PPO Network,,856.97,,,,,,,44.30,1000.31,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,inpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,367.50,727.50,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,PPO Network,,623.25,,,,,,,344.25,750.00,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,inpatient,1,EA,5157.98000,4900.08000,The Alliance,PPO Network,,4286.28,,,,,,,2836.89,5003.24,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,outpatient,1,EA,5157.98000,4900.08000,The Alliance,PPO Network,,4286.28,,,,,,,81.70,5003.24,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,inpatient,1,mL,8.74000,8.30000,The Alliance,PPO Network,,7.26,,,,,,,4.81,8.48,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,outpatient,1,mL,8.74000,8.30000,The Alliance,PPO Network,,7.26,,,,,,,0.77000,8.48,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,inpatient,,,1402.00000,1331.90000,The Alliance,PPO Network,TC,1165.06,,,,,,,771.10,1359.94,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,outpatient,,,1402.00000,1331.90000,The Alliance,PPO Network,TC,1165.06,,,,,,,316.68,1447.00,percent of total billed charges,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,153.47,454.69,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,17.99,35.62,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,16.85,36.72,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,179.80000,170.81000,The Alliance,PPO Network,,149.41,,,,,,,98.89,174.41,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,179.80000,170.81000,The Alliance,PPO Network,,149.41,,,,,,,89.90,174.41,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,inpatient,1,mL,12430.84000,11809.30000,The Alliance,PPO Network,,10330.03,,,,,,,6836.96,12057.91,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,outpatient,1,mL,12430.84000,11809.30000,The Alliance,PPO Network,,10330.03,,,,,,,27.99,12057.91,percent of total billed charges,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,358.31,709.31,percent of total billed charges,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,PPO Network,,607.67,,,,,,,335.64,731.25,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,PPO Network,,20265.85,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,16817.50000,15976.62000,The Alliance,PPO Network,,13975.34,,,,,,,8240.58,16312.98,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16817.50000,15976.62000,The Alliance,PPO Network,,13975.34,,,,,,,7719.23,16817.50,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,77.64,150.62,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4936.75,9772.75,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4624.43,10075.00,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,898.32,1778.30,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,PPO Network,,1523.47,,,,,,,841.48,1833.30,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,inpatient,,,1089.74000,1035.25000,The Alliance,PPO Network,,905.57,,,,,,,599.36,1057.05,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,outpatient,,,1089.74000,1035.25000,The Alliance,PPO Network,,905.57,,,,,,,332.44,1057.05,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2006.21000,1905.90000,The Alliance,PPO Network,,1667.16,,,,,,,983.04,1946.02,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,PPO Network,,1667.16,,,,,,,920.85,2006.21,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,inpatient,,,118.00000,112.10000,The Alliance,PPO Network,TC,98.06,,,,,,,64.90,114.46,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,PPO Network,TC,98.06,,,,,,,59.00,548.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,inpatient,,,3492.00000,3317.40000,The Alliance,PPO Network,,2901.85,,,,,,,1920.60,3387.24,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,outpatient,,,3492.00000,3317.40000,The Alliance,PPO Network,,2901.85,,,,,,,1920.60,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,inpatient,,,6918.00000,6572.10000,The Alliance,PPO Network,,5748.86,,,,,,,3804.90,6710.46,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,outpatient,,,6918.00000,6572.10000,The Alliance,PPO Network,,5748.86,,,,,,,3804.90,6710.46,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,inpatient,1,EA,9557.99000,9080.09000,The Alliance,PPO Network,,7942.69,,,,,,,5256.89,9271.25,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,outpatient,1,EA,9557.99000,9080.09000,The Alliance,PPO Network,,7942.69,,,,,,,41.40,9271.25,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,inpatient,1,EA,387.46000,368.09000,The Alliance,PPO Network,,321.98,,,,,,,213.10,375.84,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,outpatient,1,EA,387.46000,368.09000,The Alliance,PPO Network,,321.98,,,,,,,0.39525,375.84,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,inpatient,1,EA,484.33000,460.11000,The Alliance,PPO Network,,402.48,,,,,,,266.38,469.80,percent of total billed charges,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,outpatient,1,EA,484.33000,460.11000,The Alliance,PPO Network,,402.48,,,,,,,0.39525,469.80,percent of total billed charges,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,inpatient,1,EA,295.46000,280.69000,The Alliance,PPO Network,,245.53,,,,,,,162.50,286.60,percent of total billed charges,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,outpatient,1,EA,295.46000,280.69000,The Alliance,PPO Network,,245.53,,,,,,,0.39525,286.60,percent of total billed charges,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.16500,0.29100,percent of total billed charges,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,PPO Network,,0.24930,,,,,,,0.11207,0.29100,percent of total billed charges,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1202.00000,1141.90000,The Alliance,PPO Network,,998.86,,,,,,,661.10,1165.94,percent of total billed charges,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1202.00000,1141.90000,The Alliance,PPO Network,,998.86,,,,,,,211.37,1165.94,percent of total billed charges,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,211.75,373.45,percent of total billed charges,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,385.00000,365.75000,The Alliance,PPO Network,,319.94,,,,,,,192.50,373.45,percent of total billed charges,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,inpatient,,,104.55000,99.32000,The Alliance,PPO Network,,86.88,,,,,,,57.50,101.41,percent of total billed charges,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,104.55000,99.32000,The Alliance,PPO Network,,86.88,,,,,,,33.32,101.41,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,218.60,476.25,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10192.80000,9683.16000,The Alliance,PPO Network,,8470.22,,,,,,,4994.47,9887.02,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,PPO Network,,8470.22,,,,,,,4678.50,10192.80,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,inpatient,,,350.60000,333.07000,The Alliance,PPO Network,90,291.35,,,,,,,192.83,340.08,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,PPO Network,90,291.35,,,,,,,17.85,814.87,percent of total billed charges,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,inpatient,,,350.60000,333.07000,The Alliance,PPO Network,90,291.35,,,,,,,192.83,340.08,percent of total billed charges,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,PPO Network,90,291.35,,,,,,,12.45,1539.22,percent of total billed charges,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,inpatient,,,581.00000,551.95000,The Alliance,PPO Network,90,482.81,,,,,,,319.55,563.57,percent of total billed charges,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,PPO Network,90,482.81,,,,,,,12.45,1539.22,percent of total billed charges,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,RT,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,RT,2049.25,,,,,,,451.27,2392.02,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,inpatient,1,mL,71288.00000,67723.60000,The Alliance,PPO Network,,59240.33,,,,,,,39208.40,69149.36,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,outpatient,1,mL,71288.00000,67723.60000,The Alliance,PPO Network,,59240.33,,,,,,,217.09,69149.36,percent of total billed charges,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,126.79,250.99,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,PPO Network,,215.02,,,,,,,118.77,258.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,222.94000,211.79000,The Alliance,PPO Network,,185.26,,,,,,,109.24,216.25,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,222.94000,211.79000,The Alliance,PPO Network,,185.26,,,,,,,102.33,222.94,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,22.54,44.62,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,PPO Network,,38.23,,,,,,,21.11,46.00,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4936.75,9772.75,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,PPO Network,,8372.33,,,,,,,4624.43,10075.00,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,899.63000,854.65000,The Alliance,PPO Network,,747.59,,,,,,,440.82,872.64,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,PPO Network,,747.59,,,,,,,412.93,899.63,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1118.81,2437.50,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,393.75000,374.06000,The Alliance,PPO Network,,327.21,,,,,,,192.94,381.94,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,393.75000,374.06000,The Alliance,PPO Network,,327.21,,,,,,,180.73,393.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,inpatient,1,EA,23519.66000,22343.68000,The Alliance,PPO Network,,19544.84,,,,,,,12935.81,22814.07,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,outpatient,1,EA,23519.66000,22343.68000,The Alliance,PPO Network,,19544.84,,,,,,,1737.10,22814.07,percent of total billed charges,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,inpatient,,,1769.00000,1680.55000,The Alliance,PPO Network,LT,1470.04,,,,,,,972.95,1715.93,percent of total billed charges,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,outpatient,,,1769.00000,1680.55000,The Alliance,PPO Network,LT,1470.04,,,,,,,493.80,1715.93,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,inpatient,1,mL,770.52000,732.00000,The Alliance,PPO Network,,640.30,,,,,,,423.79,747.40,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,outpatient,1,mL,770.52000,732.00000,The Alliance,PPO Network,,640.30,,,,,,,32.40,747.40,percent of total billed charges,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1194.38,2364.38,percent of total billed charges,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1218.75,2437.50,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,370.70,653.78,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,63.40,3038.81,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,370.70,653.78,percent of total billed charges,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,PPO Network,90,560.09,,,,,,,63.40,3038.81,percent of total billed charges,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,130.35,229.89,percent of total billed charges,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,PPO Network,TC,196.95,,,,,,,112.98,1134.10,percent of total billed charges,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,338.78000,321.84000,The Alliance,PPO Network,,281.53,,,,,,,166.00,328.62,percent of total billed charges,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,338.78000,321.84000,The Alliance,PPO Network,,281.53,,,,,,,155.50,338.78,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,349.86,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5165.13,11253.00,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,10524.50000,9998.27000,The Alliance,PPO Network,,8745.86,,,,,,,5157.01,10208.76,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,PPO Network,,8745.86,,,,,,,4830.75,10524.50,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,15.40,27.16,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,PPO Network,,23.27,,,,,,,2.25,118.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1927.17,3815.01,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1805.25,3933.00,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,724.02,1276.91,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,PPO Network,,1093.93,,,,,,,47.62,1276.91,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,PPO Network,,1751.77,,,,,,,967.59,2108.03,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18910.00000,17964.50000,The Alliance,PPO Network,,15714.21,,,,,,,9265.90,18342.70,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,PPO Network,,15714.21,,,,,,,8679.69,18910.00,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,PPO Network,,5157.64,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,104.80000,99.56000,The Alliance,PPO Network,,87.09,,,,,,,51.35,101.66,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.80000,99.56000,The Alliance,PPO Network,,87.09,,,,,,,48.10,104.80,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,PPO Network,,218.14,,,,,,,120.49,262.50,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,inpatient,1,EA,2224.81000,2113.57000,The Alliance,PPO Network,,1848.82,,,,,,,1223.65,2158.07,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,outpatient,1,EA,2224.81000,2113.57000,The Alliance,PPO Network,,1848.82,,,,,,,9.17,2158.07,percent of total billed charges,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,inpatient,1,mL,8182.59000,7773.46000,The Alliance,PPO Network,,6799.73,,,,,,,4500.42,7937.11,percent of total billed charges,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,outpatient,1,mL,8182.59000,7773.46000,The Alliance,PPO Network,,6799.73,,,,,,,12.96,7937.11,percent of total billed charges,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,inpatient,1,GM,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.34,4.12,percent of total billed charges,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,outpatient,1,GM,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.12,4.12,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,inpatient,1,EA,1061.90000,1008.81000,The Alliance,PPO Network,,882.44,,,,,,,584.04,1030.04,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,outpatient,1,EA,1061.90000,1008.81000,The Alliance,PPO Network,,882.44,,,,,,,530.95,1030.04,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,inpatient,1,EA,44.74000,42.50000,The Alliance,PPO Network,,37.18,,,,,,,24.61,43.40,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,outpatient,1,EA,44.74000,42.50000,The Alliance,PPO Network,,37.18,,,,,,,22.37,43.40,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,inpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,PPO Network,,32.08,,,,,,,19.30,80.87,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,1.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,inpatient,1,EA,15.25000,14.48000,The Alliance,PPO Network,,12.67,,,,,,,8.39,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,PPO Network,,12.67,,,,,,,7.62,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,inpatient,1,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.95,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,PPO Network,,4.45,,,,,,,2.68,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,6.38,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,PPO Network,,9.64,,,,,,,5.80,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,inpatient,1,EA,5.13000,4.87000,The Alliance,PPO Network,,4.26,,,,,,,2.82,4.98,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,PPO Network,,4.26,,,,,,,2.56,4.98,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.73700,1.30,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,PPO Network,,1.11,,,,,,,0.67000,1.30,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,218.90,386.06,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,35.09,1662.04,percent of total billed charges,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,218.90,386.06,percent of total billed charges,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,35.09,1662.04,percent of total billed charges,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,inpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,218.90,386.06,percent of total billed charges,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,PPO Network,,330.74,,,,,,,35.09,1662.04,percent of total billed charges,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1071.00000,1017.45000,The Alliance,PPO Network,,890.00,,,,,,,589.05,1038.87,percent of total billed charges,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1071.00000,1017.45000,The Alliance,PPO Network,,890.00,,,,,,,535.50,1038.87,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,inpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,74.69,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,PPO Network,,63.99,,,,,,,42.35,5271.00,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,5271.00,percent of total billed charges,
NASAL VALVE RPR W/RADIOFRQ SUBCUTAN/SUBMUC REMODL 30469-TECH,84355,CDM,510,RC,30469,CPT,,,facility,inpatient,,,4602.00000,4371.90000,The Alliance,PPO Network,,3824.26,,,,,,,2531.10,4463.94,percent of total billed charges,
NASAL VALVE RPR W/RADIOFRQ SUBCUTAN/SUBMUC REMODL 30469-TECH,84355,CDM,510,RC,30469,CPT,,,facility,outpatient,,,4602.00000,4371.90000,The Alliance,PPO Network,,3824.26,,,,,,,2301.00,6178.88,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,inpatient,1,mL,821.60000,780.52000,The Alliance,PPO Network,,682.75,,,,,,,451.88,796.95,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,outpatient,1,mL,821.60000,780.52000,The Alliance,PPO Network,,682.75,,,,,,,69.52,796.95,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,inpatient,1,mL,5980.00000,5681.00000,The Alliance,PPO Network,,4969.38,,,,,,,3289.00,5800.60,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,PPO Network,,4969.38,,,,,,,141.17,5800.60,percent of total billed charges,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,inpatient,,,19270.00000,18306.50000,The Alliance,PPO Network,,16013.37,,,,,,,10598.50,18691.90,percent of total billed charges,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,outpatient,,,19270.00000,18306.50000,The Alliance,PPO Network,,16013.37,,,,,,,9635.00,18691.90,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,inpatient,1,mL,5980.00000,5681.00000,The Alliance,PPO Network,,4969.38,,,,,,,3289.00,5800.60,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,PPO Network,,4969.38,,,,,,,141.17,5800.60,percent of total billed charges,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,57.80000,54.91000,The Alliance,PPO Network,,48.03,,,,,,,31.79,56.07,percent of total billed charges,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,PPO Network,,48.03,,,,,,,28.90,88.70,percent of total billed charges,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,inpatient,1,mL,928.08000,881.68000,The Alliance,PPO Network,,771.23,,,,,,,510.44,900.24,percent of total billed charges,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,outpatient,1,mL,928.08000,881.68000,The Alliance,PPO Network,,771.23,,,,,,,6.68,900.24,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,inpatient,1,mL,367.88000,349.49000,The Alliance,PPO Network,,305.71,,,,,,,202.33,356.84,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,outpatient,1,mL,367.88000,349.49000,The Alliance,PPO Network,,305.71,,,,,,,29.30,356.84,percent of total billed charges,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,inpatient,1,EA,1767.52000,1679.14000,The Alliance,PPO Network,,1468.81,,,,,,,972.14,1714.49,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,outpatient,1,EA,1767.52000,1679.14000,The Alliance,PPO Network,,1468.81,,,,,,,1.18,1714.49,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,inpatient,1,EA,3123.40000,2967.23000,The Alliance,PPO Network,,2595.55,,,,,,,1717.87,3029.70,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,outpatient,1,EA,3123.40000,2967.23000,The Alliance,PPO Network,,2595.55,,,,,,,1.18,3029.70,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,inpatient,1,EA,6578.00000,6249.10000,The Alliance,PPO Network,,5466.32,,,,,,,3617.90,6380.66,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,outpatient,1,EA,6578.00000,6249.10000,The Alliance,PPO Network,,5466.32,,,,,,,1.18,6380.66,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,29.92,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,29.92,219.71,percent of total billed charges,
"INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS 46500-TECH",84415,CDM,510,RC,46500,CPT,,,facility,inpatient,,,358.00000,340.10000,The Alliance,PPO Network,,297.50,,,,,,,196.90,347.26,percent of total billed charges,
"INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS 46500-TECH",84415,CDM,510,RC,46500,CPT,,,facility,outpatient,,,358.00000,340.10000,The Alliance,PPO Network,,297.50,,,,,,,179.00,952.28,percent of total billed charges,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,inpatient,,,1697.40000,1612.53000,The Alliance,PPO Network,,1410.54,,,,,,,933.57,1646.48,percent of total billed charges,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,outpatient,,,1697.40000,1612.53000,The Alliance,PPO Network,,1410.54,,,,,,,511.55,1711.73,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,inpatient,1,mL,162.95000,154.81000,The Alliance,PPO Network,,135.41,,,,,,,89.62,158.06,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,outpatient,1,mL,162.95000,154.81000,The Alliance,PPO Network,,135.41,,,,,,,81.47,158.06,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,inpatient,1,mL,110.25000,104.74000,The Alliance,PPO Network,,91.62,,,,,,,60.64,106.94,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,outpatient,1,mL,110.25000,104.74000,The Alliance,PPO Network,,91.62,,,,,,,0.60838,106.94,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,inpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,PPO Network,,188.23,,,,,,,26.50,219.71,percent of total billed charges,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2527.30,5003.02,percent of total billed charges,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2367.41,5157.75,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2527.30,5003.02,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,PPO Network,,4286.09,,,,,,,2367.41,5157.75,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27900.00,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,inpatient,,,403.22000,383.06000,The Alliance,PPO Network,JW,335.08,,,,,,,221.77,391.12,percent of total billed charges,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,PPO Network,JW,335.08,,,,,,,201.61,398.00,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,inpatient,,,1467.00000,1393.65000,The Alliance,PPO Network,GN,1219.08,,,,,,,806.85,1422.99,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,outpatient,,,1467.00000,1393.65000,The Alliance,PPO Network,GN,1219.08,,,,,,,126.65,1422.99,percent of total billed charges,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,inpatient,,,68.20000,64.79000,The Alliance,PPO Network,90,56.67,,,,,,,37.51,66.15,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,PPO Network,90,56.67,,,,,,,6.23,322.54,percent of total billed charges,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,30.25,53.35,percent of total billed charges,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,5.23,254.68,percent of total billed charges,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,5.97,271.65,percent of total billed charges,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,inpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,41.63,73.43,percent of total billed charges,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,PPO Network,90,62.91,,,,,,,6.92,356.54,percent of total billed charges,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,32.12,56.65,percent of total billed charges,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,PPO Network,90,48.53,,,,,,,5.35,271.65,percent of total billed charges,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,inpatient,,,48.70000,46.26000,The Alliance,PPO Network,90,40.47,,,,,,,26.79,47.24,percent of total billed charges,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,outpatient,,,48.70000,46.26000,The Alliance,PPO Network,90,40.47,,,,,,,4.89,220.68,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,inpatient,1,mL,730.38000,693.86000,The Alliance,PPO Network,,606.95,,,,,,,401.71,708.47,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,PPO Network,,606.95,,,,,,,5.98,708.47,percent of total billed charges,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,inpatient,,,152.20000,144.59000,The Alliance,PPO Network,90,126.48,,,,,,,83.71,147.63,percent of total billed charges,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,outpatient,,,152.20000,144.59000,The Alliance,PPO Network,90,126.48,,,,,,,76.10,1137.41,percent of total billed charges,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,inpatient,1,mL,2539.73000,2412.75000,The Alliance,PPO Network,,2110.52,,,,,,,1396.85,2463.54,percent of total billed charges,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,outpatient,1,mL,2539.73000,2412.75000,The Alliance,PPO Network,,2110.52,,,,,,,14.84,2463.54,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,inpatient,1,mL,1612.59000,1531.96000,The Alliance,PPO Network,,1340.06,,,,,,,886.92,1564.21,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,PPO Network,,1340.06,,,,,,,13.34,1564.21,percent of total billed charges,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.45,2.55,percent of total billed charges,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,PPO Network,,2.19,,,,,,,1.31,2.55,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17866.91000,16973.56000,The Alliance,PPO Network,,14847.40,,,,,,,8754.79,17330.90,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17866.91000,16973.56000,The Alliance,PPO Network,,14847.40,,,,,,,8200.91,17866.91,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,691.00000,656.45000,The Alliance,PPO Network,,574.22,,,,,,,380.05,670.27,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,691.00000,656.45000,The Alliance,PPO Network,,574.22,,,,,,,211.37,670.27,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,444.19000,421.98000,The Alliance,PPO Network,,369.12,,,,,,,217.65,430.86,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,444.19000,421.98000,The Alliance,PPO Network,,369.12,,,,,,,203.88,444.19,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,9098.81,18011.93,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,8523.17,18569.00,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,inpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.26350,1.35,percent of total billed charges,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05500,0.09700,percent of total billed charges,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,PPO Network,,0.08310,,,,,,,0.05000,0.09700,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,inpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,PPO Network,,0.03324,,,,,,,0.02000,0.03880,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,PPO Network,,5877.25,,,,,,,3246.28,7072.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,183.75,363.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,PPO Network,,311.62,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2715.00000,2579.25000,The Alliance,PPO Network,,2256.16,,,,,,,1330.35,2633.55,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,PPO Network,,2256.16,,,,,,,1246.18,2715.00,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,237.04,469.24,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,483.75,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.76450,1.35,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,PPO Network,,1.16,,,,,,,0.69500,1.35,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,79.60000,75.62000,The Alliance,PPO Network,,66.15,,,,,,,39.00,77.21,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,PPO Network,,66.15,,,,,,,36.54,79.60,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1135.28000,1078.52000,The Alliance,PPO Network,,943.42,,,,,,,556.29,1101.22,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1135.28000,1078.52000,The Alliance,PPO Network,,943.42,,,,,,,521.09,1135.28,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,inpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,88.99,156.95,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,PPO Network,90,134.46,,,,,,,19.00,865.84,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.60000,357.77000,The Alliance,PPO Network,90,312.95,,,,,,,207.13,365.30,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.60000,357.77000,The Alliance,PPO Network,90,312.95,,,,,,,44.27,2240.90,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,inpatient,,,1518.00000,1442.10000,The Alliance,PPO Network,90,1261.46,,,,,,,834.90,1472.46,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,PPO Network,90,1261.46,,,,,,,162.98,8131.76,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,inpatient,,,1741.00000,1653.95000,The Alliance,PPO Network,90,1446.77,,,,,,,957.55,1688.77,percent of total billed charges,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,outpatient,,,1741.00000,1653.95000,The Alliance,PPO Network,90,1446.77,,,,,,,204.58,10355.70,percent of total billed charges,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,inpatient,1,mL,1455.84000,1383.05000,The Alliance,PPO Network,,1209.80,,,,,,,800.71,1412.16,percent of total billed charges,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,outpatient,1,mL,1455.84000,1383.05000,The Alliance,PPO Network,,1209.80,,,,,,,36.96,1412.16,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,inpatient,1,mL,329.98000,313.48000,The Alliance,PPO Network,,274.21,,,,,,,181.49,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,PPO Network,,274.21,,,,,,,1.33,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,inpatient,1,mL,329.98000,313.48000,The Alliance,PPO Network,,274.21,,,,,,,181.49,320.08,percent of total billed charges,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,PPO Network,,274.21,,,,,,,1.33,320.08,percent of total billed charges,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,inpatient,,,574.00000,545.30000,The Alliance,PPO Network,90,476.99,,,,,,,315.70,556.78,percent of total billed charges,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,outpatient,,,574.00000,545.30000,The Alliance,PPO Network,90,476.99,,,,,,,67.54,3412.32,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,inpatient,,,212.00000,201.40000,The Alliance,PPO Network,90,176.17,,,,,,,116.60,205.64,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,PPO Network,90,176.17,,,,,,,24.91,1137.41,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,inpatient,,,250.60000,238.07000,The Alliance,PPO Network,90,208.25,,,,,,,137.83,243.08,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,outpatient,,,250.60000,238.07000,The Alliance,PPO Network,90,208.25,,,,,,,28.00,1341.13,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,inpatient,,,45.60000,43.32000,The Alliance,PPO Network,90,37.89,,,,,,,25.08,44.23,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,PPO Network,90,37.89,,,,,,,5.35,271.65,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,inpatient,,,48.40000,45.98000,The Alliance,PPO Network,90,40.22,,,,,,,26.62,46.95,percent of total billed charges,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,PPO Network,90,40.22,,,,,,,5.68,288.61,percent of total billed charges,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,PPO Network,,4085.40,,,,,,,2256.56,4916.25,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,inpatient,1,mL,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.88550,1.56,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,PPO Network,,1.34,,,,,,,0.22165,1.56,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,inpatient,40,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,outpatient,40,EA,0.27000,0.26000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,3.83,percent of total billed charges,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,inpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,37.78,66.64,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,PPO Network,90,57.09,,,,,,,4.57,373.51,percent of total billed charges,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,86.68000,82.35000,The Alliance,PPO Network,,72.03,,,,,,,42.47,84.08,percent of total billed charges,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,86.68000,82.35000,The Alliance,PPO Network,,72.03,,,,,,,39.79,86.68,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,17.99,35.62,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,PPO Network,,30.51,,,,,,,16.85,36.72,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1310.63000,1245.10000,The Alliance,PPO Network,,1089.13,,,,,,,642.21,1271.31,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1310.63000,1245.10000,The Alliance,PPO Network,,1089.13,,,,,,,601.58,1310.63,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,18699.66,40740.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1607.81,3182.81,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,PPO Network,,2726.72,,,,,,,1506.09,3281.25,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,24.50,48.50,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,PPO Network,,41.55,,,,,,,22.95,50.00,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2873.85,5689.05,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2692.03,5865.00,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,inpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18910.00000,17964.50000,The Alliance,PPO Network,,15714.21,,,,,,,9265.90,18342.70,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,PPO Network,,15714.21,,,,,,,8679.69,18910.00,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,,2132.35,,,,,,,1411.30,2489.02,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,PPO Network,,2132.35,,,,,,,381.55,2489.02,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,inpatient,1,mL,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.64,8.19,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,outpatient,1,mL,8.44000,8.02000,The Alliance,PPO Network,,7.01,,,,,,,4.22,8.19,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,inpatient,1,mL,776.38000,737.56000,The Alliance,PPO Network,,645.17,,,,,,,427.01,753.09,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,outpatient,1,mL,776.38000,737.56000,The Alliance,PPO Network,,645.17,,,,,,,33.00,753.09,percent of total billed charges,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,inpatient,1,mL,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.19,2.10,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,PPO Network,,1.80,,,,,,,1.08,2.10,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,inpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,58.30,102.82,percent of total billed charges,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,PPO Network,90,88.09,,,,,,,8.17,679.08,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,inpatient,1,EA,18.33000,17.41000,The Alliance,PPO Network,,15.23,,,,,,,10.08,17.78,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,PPO Network,,15.23,,,,,,,1.54,17.78,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,inpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,7.57,13.35,percent of total billed charges,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,PPO Network,,11.43,,,,,,,1.54,13.35,percent of total billed charges,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,15510.66000,14735.13000,The Alliance,PPO Network,,12889.36,,,,,,,7600.22,15045.34,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,PPO Network,,12889.36,,,,,,,7119.39,15510.66,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1927.17,3815.01,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1805.25,3933.00,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,53.56000,50.88000,The Alliance,PPO Network,,44.51,,,,,,,26.24,51.95,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,53.56000,50.88000,The Alliance,PPO Network,,44.51,,,,,,,24.58,53.56,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1567.50000,1489.12000,The Alliance,PPO Network,,1302.59,,,,,,,862.12,1520.47,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1567.50000,1489.12000,The Alliance,PPO Network,,1302.59,,,,,,,783.75,1520.47,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,6258.30000,5945.38000,The Alliance,PPO Network,,5200.65,,,,,,,3066.57,6070.55,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,6258.30000,5945.38000,The Alliance,PPO Network,,5200.65,,,,,,,2872.56,6258.30,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1690.50,3346.50,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1583.55,3450.00,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,inpatient,,,1938.64000,1841.71000,The Alliance,PPO Network,,1611.01,,,,,,,1066.25,1880.48,percent of total billed charges,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1938.64000,1841.71000,The Alliance,PPO Network,,1611.01,,,,,,,142.07,1880.48,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,inpatient,1,EA,25.15000,23.90000,The Alliance,PPO Network,,20.90,,,,,,,13.83,24.40,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,outpatient,1,EA,25.15000,23.90000,The Alliance,PPO Network,,20.90,,,,,,,12.57,24.40,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
APPL SK GRF > 100 SQ CM 1ST 100 15277-TECH,84641,CDM,510,RC,15277,CPT,,,facility,inpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,331.10,583.94,percent of total billed charges,
APPL SK GRF > 100 SQ CM 1ST 100 15277-TECH,84641,CDM,510,RC,15277,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,PPO Network,,500.26,,,,,,,301.00,1910.62,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4573.00000,4344.35000,The Alliance,PPO Network,90,3800.16,,,,,,,2515.15,4435.81,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,PPO Network,90,3800.16,,,,,,,210.00,26177.94,percent of total billed charges,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,90,934.88,,,,,,,618.75,1091.25,percent of total billed charges,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,90,934.88,,,,,,,109.60,6451.13,percent of total billed charges,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,inpatient,,,5957.00000,5659.15000,The Alliance,PPO Network,90,4950.27,,,,,,,3276.35,5778.29,percent of total billed charges,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,outpatient,,,5957.00000,5659.15000,The Alliance,PPO Network,90,4950.27,,,,,,,2537.50,5778.29,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,inpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,36.30,64.02,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,PPO Network,,54.85,,,,,,,5.86,305.58,percent of total billed charges,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,inpatient,1,mL,41610.00000,39529.50000,The Alliance,PPO Network,,34577.91,,,,,,,22885.50,40361.70,percent of total billed charges,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,outpatient,1,mL,41610.00000,39529.50000,The Alliance,PPO Network,,34577.91,,,,,,,141.91,40361.70,percent of total billed charges,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,inpatient,1,EA,2516.97000,2391.12000,The Alliance,PPO Network,,2091.60,,,,,,,1384.33,2441.46,percent of total billed charges,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,outpatient,1,EA,2516.97000,2391.12000,The Alliance,PPO Network,,2091.60,,,,,,,28.52,2441.46,percent of total billed charges,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,77.64,150.62,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,inpatient,1,mL,260.44000,247.42000,The Alliance,PPO Network,,216.43,,,,,,,143.24,252.63,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,outpatient,1,mL,260.44000,247.42000,The Alliance,PPO Network,,216.43,,,,,,,130.22,252.63,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,inpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,1.93,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,PPO Network,,2.92,,,,,,,1.75,3.40,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,inpatient,1,mL,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.91,6.90,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,PPO Network,,5.91,,,,,,,3.56,6.90,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,38.40000,36.48000,The Alliance,PPO Network,,31.91,,,,,,,18.82,37.25,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,38.40000,36.48000,The Alliance,PPO Network,,31.91,,,,,,,17.63,38.40,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,inpatient,1,mL,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,1.28,2.25,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,outpatient,1,mL,2.32000,2.21000,The Alliance,PPO Network,,1.93,,,,,,,0.22165,2.25,percent of total billed charges,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,inpatient,1,mL,18.09000,17.19000,The Alliance,PPO Network,,15.03,,,,,,,9.95,17.55,percent of total billed charges,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,outpatient,1,mL,18.09000,17.19000,The Alliance,PPO Network,,15.03,,,,,,,0.22165,17.55,percent of total billed charges,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,inpatient,1,EA,200.98000,190.93000,The Alliance,PPO Network,,167.01,,,,,,,110.54,194.95,percent of total billed charges,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,outpatient,1,EA,200.98000,190.93000,The Alliance,PPO Network,,167.01,,,,,,,3.62,194.95,percent of total billed charges,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,10177.30,20146.90,percent of total billed charges,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,9533.43,20770.00,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2358.25,4668.37,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2209.05,4812.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4573.00000,4344.35000,The Alliance,PPO Network,90,3800.16,,,,,,,2515.15,4435.81,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,PPO Network,90,3800.16,,,,,,,210.00,26177.94,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,inpatient,,,3575.00000,3396.25000,The Alliance,PPO Network,90,2970.82,,,,,,,1966.25,3467.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,outpatient,,,3575.00000,3396.25000,The Alliance,PPO Network,90,2970.82,,,,,,,103.64,20473.75,percent of total billed charges,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,25160.53000,23902.50000,The Alliance,PPO Network,,20908.40,,,,,,,12328.66,24405.71,percent of total billed charges,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,PPO Network,,20908.40,,,,,,,11548.68,25160.53,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,inpatient,,,288.33000,273.91000,The Alliance,PPO Network,,239.60,,,,,,,158.58,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,outpatient,,,288.33000,273.91000,The Alliance,PPO Network,,239.60,,,,,,,144.16,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,inpatient,1,mL,576.66000,547.83000,The Alliance,PPO Network,,479.20,,,,,,,317.16,559.36,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,outpatient,1,mL,576.66000,547.83000,The Alliance,PPO Network,,479.20,,,,,,,145.98,559.36,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,71400.00000,67830.00000,The Alliance,PPO Network,,59333.40,,,,,,,34986.00,69258.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,PPO Network,,59333.40,,,,,,,32772.60,71400.00,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,inpatient,1,EA,432.53000,410.90000,The Alliance,PPO Network,,359.43,,,,,,,237.89,419.55,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,outpatient,1,EA,432.53000,410.90000,The Alliance,PPO Network,,359.43,,,,,,,216.26,419.55,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,1.00,1.77,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,PPO Network,,1.51,,,,,,,0.91000,1.77,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,277.83,549.99,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,260.25,567.00,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,inpatient,,,2163.00000,2054.85000,The Alliance,PPO Network,,1797.45,,,,,,,1189.65,2098.11,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,PPO Network,,1797.45,,,,,,,1189.65,7803.00,percent of total billed charges,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,inpatient,,,9216.00000,8755.20000,The Alliance,PPO Network,,7658.50,,,,,,,5068.80,8939.52,percent of total billed charges,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,PPO Network,,7658.50,,,,,,,2988.68,8939.52,percent of total billed charges,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,inpatient,,,1035.00000,983.25000,The Alliance,PPO Network,,860.09,,,,,,,569.25,1003.95,percent of total billed charges,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,PPO Network,,860.09,,,,,,,376.51,1003.95,percent of total billed charges,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,inpatient,,,421.60000,400.52000,The Alliance,PPO Network,,350.35,,,,,,,231.88,408.95,percent of total billed charges,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,outpatient,,,421.60000,400.52000,The Alliance,PPO Network,,350.35,,,,,,,113.74,408.95,percent of total billed charges,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,inpatient,1,mL,1604.51000,1524.28000,The Alliance,PPO Network,,1333.35,,,,,,,882.48,1556.37,percent of total billed charges,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,outpatient,1,mL,1604.51000,1524.28000,The Alliance,PPO Network,,1333.35,,,,,,,33.27,1556.37,percent of total billed charges,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,inpatient,1,mL,10593.45000,10063.78000,The Alliance,PPO Network,,8803.16,,,,,,,5826.40,10275.65,percent of total billed charges,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,outpatient,1,mL,10593.45000,10063.78000,The Alliance,PPO Network,,8803.16,,,,,,,33.27,10275.65,percent of total billed charges,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1745.62,3455.62,percent of total billed charges,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1635.19,3562.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,PPO Network,,9660.38,,,,,,,5335.88,11625.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1927.17,3815.01,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,PPO Network,,3268.32,,,,,,,1805.25,3933.00,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,The Alliance,PPO Network,JW,360.65,,,,,,,238.70,420.98,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,PPO Network,JW,360.65,,,,,,,217.00,488.81,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,inpatient,,,316.60000,300.77000,The Alliance,PPO Network,90,263.09,,,,,,,174.13,307.10,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,PPO Network,90,263.09,,,,,,,36.26,1833.46,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,inpatient,,,316.60000,300.77000,The Alliance,PPO Network,90,263.09,,,,,,,174.13,307.10,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,PPO Network,90,263.09,,,,,,,36.26,1833.46,percent of total billed charges,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8173.05000,7764.40000,The Alliance,PPO Network,,6791.80,,,,,,,4004.79,7927.86,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,PPO Network,,6791.80,,,,,,,3751.43,8173.05,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,inpatient,1,mL,150.22000,142.71000,The Alliance,PPO Network,,124.83,,,,,,,82.62,145.71,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,outpatient,1,mL,150.22000,142.71000,The Alliance,PPO Network,,124.83,,,,,,,48.42,145.71,percent of total billed charges,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,inpatient,,,79.80000,75.81000,The Alliance,PPO Network,90,66.31,,,,,,,43.89,77.41,percent of total billed charges,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,PPO Network,90,66.31,,,,,,,10.03,509.30,percent of total billed charges,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8521.50000,8095.42000,The Alliance,PPO Network,,7081.37,,,,,,,4175.53,8265.85,percent of total billed charges,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,PPO Network,,7081.37,,,,,,,3911.37,8521.50,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,15391.50000,14621.92000,The Alliance,PPO Network,,12790.34,,,,,,,7541.84,14929.75,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,15391.50000,14621.92000,The Alliance,PPO Network,,12790.34,,,,,,,7064.70,15391.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,inpatient,1,mL,1762.49000,1674.36000,The Alliance,PPO Network,,1464.63,,,,,,,969.37,1709.62,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,outpatient,1,mL,1762.49000,1674.36000,The Alliance,PPO Network,,1464.63,,,,,,,266.44,1709.62,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,inpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,22.59,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,PPO Network,,34.14,,,,,,,20.54,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,inpatient,1,mL,46.94000,44.59000,The Alliance,PPO Network,,39.01,,,,,,,25.82,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,outpatient,1,mL,46.94000,44.59000,The Alliance,PPO Network,,39.01,,,,,,,23.47,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,inpatient,1,mL,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.61,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,outpatient,1,mL,2.92000,2.78000,The Alliance,PPO Network,,2.43,,,,,,,1.46,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,inpatient,1,mL,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,36.50,64.37,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,PPO Network,,55.15,,,,,,,33.18,64.37,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,inpatient,1,mL,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,PPO Network,,14.79,,,,,,,8.90,17.27,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,inpatient,,,371.50000,352.92000,The Alliance,PPO Network,,308.72,,,,,,,204.32,360.36,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,PPO Network,,308.72,,,,,,,185.75,360.36,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,3851.19,8390.40,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5558.02,11002.61,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,PPO Network,,9425.95,,,,,,,5206.39,11342.90,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,13.73,713.01,percent of total billed charges,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,inpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,67.65,119.31,percent of total billed charges,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,PPO Network,,102.21,,,,,,,13.73,713.01,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,inpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.48,6.13,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,0.25616,6.13,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,inpatient,1,mL,44.13000,41.93000,The Alliance,PPO Network,,36.67,,,,,,,24.27,42.81,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,outpatient,1,mL,44.13000,41.93000,The Alliance,PPO Network,,36.67,,,,,,,22.07,80.87,percent of total billed charges,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,inpatient,1,mL,2518.47000,2392.54000,The Alliance,PPO Network,,2092.85,,,,,,,1385.16,2442.92,percent of total billed charges,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,outpatient,1,mL,2518.47000,2392.54000,The Alliance,PPO Network,,2092.85,,,,,,,243.82,2442.92,percent of total billed charges,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.28600,0.50440,percent of total billed charges,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,PPO Network,,0.43212,,,,,,,0.26000,0.50440,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,5520.00000,5244.00000,The Alliance,PPO Network,,4587.12,,,,,,,2704.80,5354.40,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,5520.00000,5244.00000,The Alliance,PPO Network,,4587.12,,,,,,,2533.68,5520.00,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30450.00000,28927.50000,The Alliance,PPO Network,,25303.95,,,,,,,14920.50,29536.50,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30450.00000,28927.50000,The Alliance,PPO Network,,25303.95,,,,,,,13976.55,30450.00,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1477.35,2924.55,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,PPO Network,,2505.47,,,,,,,1383.88,3015.00,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,2.08,3.68,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,PPO Network,,3.15,,,,,,,1.90,3.68,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,inpatient,1,mL,9246.90000,8784.55000,The Alliance,PPO Network,,7684.17,,,,,,,5085.80,8969.49,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,outpatient,1,mL,9246.90000,8784.55000,The Alliance,PPO Network,,7684.17,,,,,,,494.43,8969.49,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,inpatient,1,mL,9459.55000,8986.57000,The Alliance,PPO Network,,7860.89,,,,,,,5202.75,9175.76,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,outpatient,1,mL,9459.55000,8986.57000,The Alliance,PPO Network,,7860.89,,,,,,,494.43,9175.76,percent of total billed charges,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.22000,0.38800,percent of total billed charges,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,PPO Network,,0.33240,,,,,,,0.20000,0.38800,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,42.14,83.42,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,PPO Network,,71.47,,,,,,,39.47,86.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,inpatient,,,95.22000,90.46000,The Alliance,PPO Network,,79.13,,,,,,,52.37,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,outpatient,,,95.22000,90.46000,The Alliance,PPO Network,,79.13,,,,,,,47.61,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,inpatient,1,mL,190.45000,180.93000,The Alliance,PPO Network,,158.26,,,,,,,104.75,184.74,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,outpatient,1,mL,190.45000,180.93000,The Alliance,PPO Network,,158.26,,,,,,,95.22,184.74,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,inpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.68200,1.20,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,PPO Network,,1.03,,,,,,,0.62000,1.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,inpatient,1,EA,63.52000,60.34000,The Alliance,PPO Network,,52.79,,,,,,,34.94,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,outpatient,1,EA,63.52000,60.34000,The Alliance,PPO Network,,52.79,,,,,,,9.78,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,inpatient,1,EA,57.15000,54.29000,The Alliance,PPO Network,,47.49,,,,,,,31.43,55.44,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,PPO Network,,47.49,,,,,,,9.78,55.44,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,inpatient,1,EA,27.73000,26.34000,The Alliance,PPO Network,,23.04,,,,,,,15.25,26.90,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,outpatient,1,EA,27.73000,26.34000,The Alliance,PPO Network,,23.04,,,,,,,0.91000,26.90,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,inpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,10.25,18.08,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,PPO Network,,15.49,,,,,,,0.91000,18.08,percent of total billed charges,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,PPO Network,,8439.30,,,,,,,4661.42,10155.60,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,50.96,100.88,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,PPO Network,,86.42,,,,,,,47.74,104.00,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1775.03,3513.82,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1662.73,3622.50,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1775.03,3513.82,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,277.83,549.99,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,PPO Network,,471.18,,,,,,,260.25,567.00,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,PPO Network,,233.72,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,inpatient,1,mL,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.52800,0.93120,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,outpatient,1,mL,0.96000,0.91000,The Alliance,PPO Network,,0.79776,,,,,,,0.48000,0.93120,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,inpatient,1,mL,39932.98000,37936.33000,The Alliance,PPO Network,,33184.31,,,,,,,21963.14,38734.99,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,outpatient,1,mL,39932.98000,37936.33000,The Alliance,PPO Network,,33184.31,,,,,,,19966.49,38734.99,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,inpatient,1,mL,20.22000,19.21000,The Alliance,PPO Network,,16.80,,,,,,,11.12,19.61,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,outpatient,1,mL,20.22000,19.21000,The Alliance,PPO Network,,16.80,,,,,,,10.11,19.61,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.25850,0.45590,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,PPO Network,,0.39057,,,,,,,0.23500,0.45590,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,inpatient,1,EA,26.29000,24.98000,The Alliance,PPO Network,,21.85,,,,,,,14.46,25.50,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,outpatient,1,EA,26.29000,24.98000,The Alliance,PPO Network,,21.85,,,,,,,13.14,25.50,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,inpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.34100,0.60140,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,PPO Network,,0.51522,,,,,,,0.31000,0.60140,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,1646.25000,1563.94000,The Alliance,PPO Network,,1368.03,,,,,,,806.66,1596.86,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1646.25000,1563.94000,The Alliance,PPO Network,,1368.03,,,,,,,755.63,1646.25,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.80,93.98,percent of total billed charges,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04950,0.08730,percent of total billed charges,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,PPO Network,,0.07479,,,,,,,0.04500,0.08730,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3796.02,7514.57,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3555.86,7746.98,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,264.00,465.60,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,PPO Network,,398.88,,,,,,,240.00,465.60,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8173.05000,7764.40000,The Alliance,PPO Network,,6791.80,,,,,,,4004.79,7927.86,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,PPO Network,,6791.80,,,,,,,3751.43,8173.05,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,inpatient,,,4073.00000,3869.35000,The Alliance,PPO Network,90,3384.66,,,,,,,2240.15,3950.81,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4073.00000,3869.35000,The Alliance,PPO Network,90,3384.66,,,,,,,282.88,13309.69,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,inpatient,1,EA,406.91000,386.57000,The Alliance,PPO Network,,338.14,,,,,,,223.80,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,PPO Network,,338.14,,,,,,,203.46,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,inpatient,1,EA,406.91000,386.57000,The Alliance,PPO Network,,338.14,,,,,,,223.80,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,PPO Network,,338.14,,,,,,,203.46,394.70,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,,1.11,,,,,,,0.63085,1.29,percent of total billed charges,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,PPO Network,,10752.64,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,inpatient,,,35.16000,33.40000,The Alliance,PPO Network,,29.22,,,,,,,17.23,34.11,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,PPO Network,,29.22,,,,,,,17.58,72.27,percent of total billed charges,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,PPO Network,,9124.55,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,inpatient,1,mL,309.57000,294.09000,The Alliance,PPO Network,,257.25,,,,,,,170.26,300.28,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,outpatient,1,mL,309.57000,294.09000,The Alliance,PPO Network,,257.25,,,,,,,154.78,300.28,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,inpatient,1,GM,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,outpatient,1,GM,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,inpatient,1,GM,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.30800,0.54320,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,PPO Network,,0.46536,,,,,,,0.28000,0.54320,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,inpatient,,,11828.00000,11236.60000,The Alliance,PPO Network,52,9829.07,,,,,,,6505.40,11473.16,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,PPO Network,52,9829.07,,,,,,,1929.64,11473.16,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,5936.70,10470.18,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,1929.64,10470.18,percent of total billed charges,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,23436.00000,22264.20000,The Alliance,PPO Network,,19475.32,,,,,,,11483.64,22732.92,percent of total billed charges,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,PPO Network,,19475.32,,,,,,,10757.12,23436.00,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.83600,1.47,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,PPO Network,,1.26,,,,,,,0.76000,1.47,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,21.64000,20.56000,The Alliance,PPO Network,,17.98,,,,,,,11.90,20.99,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,21.64000,20.56000,The Alliance,PPO Network,,17.98,,,,,,,10.82,20.99,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.80,93.98,percent of total billed charges,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,inpatient,,,940.00000,893.00000,The Alliance,PPO Network,90,781.14,,,,,,,517.00,911.80,percent of total billed charges,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,PPO Network,90,781.14,,,,,,,470.00,911.80,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,inpatient,1,mL,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,104.28,183.91,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,PPO Network,,157.56,,,,,,,64.03,183.91,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,inpatient,,,584.00000,554.80000,The Alliance,PPO Network,90,485.30,,,,,,,321.20,566.48,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,PPO Network,90,485.30,,,,,,,292.00,3186.14,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,inpatient,,,187.80000,178.41000,The Alliance,PPO Network,90,156.06,,,,,,,103.29,182.17,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,outpatient,,,187.80000,178.41000,The Alliance,PPO Network,90,156.06,,,,,,,77.53,1052.52,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,inpatient,,,278.30000,264.38000,The Alliance,PPO Network,90,231.27,,,,,,,153.06,269.95,percent of total billed charges,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,outpatient,,,278.30000,264.38000,The Alliance,PPO Network,90,231.27,,,,,,,125.97,1861.90,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,inpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,53.41,94.19,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,PPO Network,90,80.69,,,,,,,8.17,611.15,percent of total billed charges,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,inpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,78.05,137.64,percent of total billed charges,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,PPO Network,90,117.92,,,,,,,17.85,823.21,percent of total billed charges,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,inpatient,,,510.50000,484.97000,The Alliance,PPO Network,90,424.23,,,,,,,280.77,495.19,percent of total billed charges,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,outpatient,,,510.50000,484.97000,The Alliance,PPO Network,90,424.23,,,,,,,63.40,3038.81,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,inpatient,,,104.20000,98.99000,The Alliance,PPO Network,90,86.59,,,,,,,57.31,101.07,percent of total billed charges,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,outpatient,,,104.20000,98.99000,The Alliance,PPO Network,90,86.59,,,,,,,8.17,662.12,percent of total billed charges,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,inpatient,,,524.00000,497.80000,The Alliance,PPO Network,90,435.44,,,,,,,288.20,508.28,percent of total billed charges,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,PPO Network,90,435.44,,,,,,,22.91,1035.56,percent of total billed charges,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,inpatient,,,123.90000,117.70000,The Alliance,PPO Network,90,102.96,,,,,,,68.14,120.18,percent of total billed charges,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,PPO Network,90,102.96,,,,,,,15.58,780.94,percent of total billed charges,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,inpatient,,,245.20000,232.94000,The Alliance,PPO Network,90,203.76,,,,,,,134.86,237.84,percent of total billed charges,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,outpatient,,,245.20000,232.94000,The Alliance,PPO Network,90,203.76,,,,,,,30.84,1561.82,percent of total billed charges,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,inpatient,,,153.20000,145.54000,The Alliance,PPO Network,90,127.31,,,,,,,84.26,148.60,percent of total billed charges,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,outpatient,,,153.20000,145.54000,The Alliance,PPO Network,90,127.31,,,,,,,19.26,882.80,percent of total billed charges,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,inpatient,,,19344.00000,18376.80000,The Alliance,PPO Network,90,16074.86,,,,,,,10639.20,18763.68,percent of total billed charges,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,outpatient,,,19344.00000,18376.80000,The Alliance,PPO Network,90,16074.86,,,,,,,8569.96,115186.20,percent of total billed charges,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,inpatient,,,3556.00000,3378.20000,The Alliance,PPO Network,,2955.04,,,,,,,1955.80,3449.32,percent of total billed charges,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,outpatient,,,3556.00000,3378.20000,The Alliance,PPO Network,,2955.04,,,,,,,416.78,21780.96,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1004.00000,953.80000,The Alliance,PPO Network,90,834.32,,,,,,,552.20,973.88,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,PPO Network,90,834.32,,,,,,,126.29,6383.20,percent of total billed charges,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,inpatient,,,235.20000,223.44000,The Alliance,PPO Network,90,195.45,,,,,,,129.36,228.14,percent of total billed charges,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,PPO Network,90,195.45,,,,,,,19.26,882.80,percent of total billed charges,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,inpatient,,,108.40000,102.98000,The Alliance,PPO Network,90,90.08,,,,,,,59.62,105.15,percent of total billed charges,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,outpatient,,,108.40000,102.98000,The Alliance,PPO Network,90,90.08,,,,,,,42.13,2003.75,percent of total billed charges,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,inpatient,,,126.80000,120.46000,The Alliance,PPO Network,90,105.37,,,,,,,69.74,123.00,percent of total billed charges,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,outpatient,,,126.80000,120.46000,The Alliance,PPO Network,90,105.37,,,,,,,14.59,729.98,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,inpatient,,,76.40000,72.58000,The Alliance,PPO Network,90,63.49,,,,,,,42.02,74.11,percent of total billed charges,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,PPO Network,90,63.49,,,,,,,9.61,492.33,percent of total billed charges,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,inpatient,,,235.20000,223.44000,The Alliance,PPO Network,90,195.45,,,,,,,129.36,228.14,percent of total billed charges,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,PPO Network,90,195.45,,,,,,,17.85,814.87,percent of total billed charges,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,inpatient,,,380.20000,361.19000,The Alliance,PPO Network,90,315.95,,,,,,,209.11,368.79,percent of total billed charges,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,outpatient,,,380.20000,361.19000,The Alliance,PPO Network,90,315.95,,,,,,,30.85,368.79,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,inpatient,,,76.40000,72.58000,The Alliance,PPO Network,90,63.49,,,,,,,42.02,74.11,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,PPO Network,90,63.49,,,,,,,9.61,492.33,percent of total billed charges,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,inpatient,,,99.30000,94.33000,The Alliance,PPO Network,90,82.52,,,,,,,54.62,96.32,percent of total billed charges,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,outpatient,,,99.30000,94.33000,The Alliance,PPO Network,90,82.52,,,,,,,12.05,574.73,percent of total billed charges,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,inpatient,,,97.90000,93.00000,The Alliance,PPO Network,90,81.35,,,,,,,53.84,94.96,percent of total billed charges,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,outpatient,,,97.90000,93.00000,The Alliance,PPO Network,90,81.35,,,,,,,8.17,645.08,percent of total billed charges,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,inpatient,,,147.30000,139.94000,The Alliance,PPO Network,90,122.41,,,,,,,81.02,142.88,percent of total billed charges,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,PPO Network,90,122.41,,,,,,,17.71,933.70,percent of total billed charges,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,inpatient,,,94.70000,89.97000,The Alliance,PPO Network,90,78.70,,,,,,,52.09,91.86,percent of total billed charges,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,outpatient,,,94.70000,89.97000,The Alliance,PPO Network,90,78.70,,,,,,,11.53,543.65,percent of total billed charges,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,inpatient,,,3830.00000,3638.50000,The Alliance,PPO Network,90,3182.73,,,,,,,2106.50,3715.10,percent of total billed charges,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,outpatient,,,3830.00000,3638.50000,The Alliance,PPO Network,90,3182.73,,,,,,,1631.60,3715.10,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,inpatient,,,461.90000,438.80000,The Alliance,PPO Network,90,383.84,,,,,,,254.04,448.04,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,outpatient,,,461.90000,438.80000,The Alliance,PPO Network,90,383.84,,,,,,,19.26,882.80,percent of total billed charges,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,90,82.27,,,,,,,54.45,96.03,percent of total billed charges,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,90,82.27,,,,,,,11.53,574.73,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,inpatient,1,GM,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.41250,0.72750,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,outpatient,1,GM,0.75000,0.71000,The Alliance,PPO Network,,0.62325,,,,,,,0.37500,0.72750,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,inpatient,1,GM,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,6.26,11.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,outpatient,1,GM,11.38000,10.81000,The Alliance,PPO Network,,9.46,,,,,,,5.69,11.04,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,PPO Network,,2461.84,,,,,,,1359.79,2962.50,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,4111.30,8138.69,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,PPO Network,,6972.42,,,,,,,3851.19,8390.40,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.09350,0.16490,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,PPO Network,,0.14127,,,,,,,0.08500,0.16490,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2756.25000,2618.44000,The Alliance,PPO Network,,2290.44,,,,,,,1350.56,2673.56,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,PPO Network,,2290.44,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4361.00000,4142.95000,The Alliance,PPO Network,,3623.99,,,,,,,2398.55,4230.17,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,PPO Network,,3623.99,,,,,,,339.11,4230.17,percent of total billed charges,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4352.00000,4134.40000,The Alliance,PPO Network,,3616.51,,,,,,,2393.60,4221.44,percent of total billed charges,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,PPO Network,,3616.51,,,,,,,339.11,4221.44,percent of total billed charges,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,inpatient,,,769.00000,730.55000,The Alliance,PPO Network,TC,639.04,,,,,,,422.95,745.93,percent of total billed charges,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,PPO Network,TC,639.04,,,,,,,384.50,745.93,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,2522.85,4449.39,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,PPO Network,,3811.80,,,,,,,1308.97,4449.39,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10385.00000,9865.75000,The Alliance,PPO Network,,8629.93,,,,,,,5088.65,10073.45,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10385.00000,9865.75000,The Alliance,PPO Network,,8629.93,,,,,,,4766.72,10385.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30287.00000,28772.65000,The Alliance,PPO Network,,25168.50,,,,,,,14840.63,29378.39,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,PPO Network,,25168.50,,,,,,,13901.73,30287.00,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,inpatient,1,EA,7.25000,6.89000,The Alliance,PPO Network,,6.02,,,,,,,3.99,7.03,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,PPO Network,,6.02,,,,,,,3.62,7.03,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,inpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,19.80,34.92,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,PPO Network,,29.92,,,,,,,18.00,38.16,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,inpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,45.19,79.70,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,PPO Network,,68.27,,,,,,,41.08,79.70,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,inpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04400,0.07760,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,PPO Network,,0.06648,,,,,,,0.04000,0.07760,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,inpatient,1,mL,9633.00000,9151.35000,The Alliance,PPO Network,,8005.02,,,,,,,5298.15,9344.01,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,outpatient,1,mL,9633.00000,9151.35000,The Alliance,PPO Network,,8005.02,,,,,,,189.75,9344.01,percent of total billed charges,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,inpatient,1,mL,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.80,4.94,percent of total billed charges,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,outpatient,1,mL,5.09000,4.83000,The Alliance,PPO Network,,4.23,,,,,,,2.39,4.94,percent of total billed charges,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,15510.66000,14735.13000,The Alliance,PPO Network,,12889.36,,,,,,,7600.22,15045.34,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,PPO Network,,12889.36,,,,,,,7119.39,15510.66,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,422.74000,401.60000,The Alliance,PPO Network,,351.30,,,,,,,207.14,410.06,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,422.74000,401.60000,The Alliance,PPO Network,,351.30,,,,,,,194.04,422.74,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,24800.00000,23560.00000,The Alliance,PPO Network,,20608.80,,,,,,,12152.00,24056.00,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,24800.00000,23560.00000,The Alliance,PPO Network,,20608.80,,,,,,,11383.20,24800.00,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2606.25000,2475.94000,The Alliance,PPO Network,,2165.79,,,,,,,1277.06,2528.06,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2606.25000,2475.94000,The Alliance,PPO Network,,2165.79,,,,,,,1196.27,2606.25,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,418.54000,397.61000,The Alliance,PPO Network,,347.81,,,,,,,205.08,405.98,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,418.54000,397.61000,The Alliance,PPO Network,,347.81,,,,,,,192.11,418.54,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,145.60000,138.32000,The Alliance,PPO Network,,120.99,,,,,,,71.34,141.23,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,145.60000,138.32000,The Alliance,PPO Network,,120.99,,,,,,,66.83,145.60,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.36,143.36,percent of total billed charges,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5779.41000,5490.44000,The Alliance,PPO Network,,4802.69,,,,,,,2831.91,5606.03,percent of total billed charges,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5779.41000,5490.44000,The Alliance,PPO Network,,4802.69,,,,,,,2652.75,5779.41,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.36,143.36,percent of total billed charges,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,34.24000,32.53000,The Alliance,PPO Network,,28.45,,,,,,,16.78,33.21,percent of total billed charges,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,34.24000,32.53000,The Alliance,PPO Network,,28.45,,,,,,,17.12,36.65,percent of total billed charges,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,25.72000,24.43000,The Alliance,PPO Network,,21.37,,,,,,,12.60,24.95,percent of total billed charges,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,PPO Network,,21.37,,,,,,,11.81,24.95,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.06,71.39,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,PPO Network,,61.16,,,,,,,36.80,93.98,percent of total billed charges,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,PPO Network,,42.86,,,,,,,25.79,50.03,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,inpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.13750,0.24250,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,PPO Network,,0.20775,,,,,,,0.12500,2.34,percent of total billed charges,
ALLERG IMMUNOTH-3-TECH,84996,CDM,510,RC,95147,CPT,,,facility,inpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,31.35,55.29,percent of total billed charges,
ALLERG IMMUNOTH-3-TECH,84996,CDM,510,RC,95147,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,PPO Network,,47.37,,,,,,,28.50,74.34,percent of total billed charges,
ALLERG IMMUNOTH-5-TECH,84997,CDM,510,RC,95149,CPT,,,facility,inpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,62.15,109.61,percent of total billed charges,
ALLERG IMMUNOTH-5-TECH,84997,CDM,510,RC,95149,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,PPO Network,,93.90,,,,,,,56.50,109.61,percent of total billed charges,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,inpatient,1,mL,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,outpatient,1,mL,1.48000,1.40000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.87,5.05,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,PPO Network,,4.33,,,,,,,2.60,5.05,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,inpatient,1,EA,10.45000,9.92000,The Alliance,PPO Network,,8.68,,,,,,,5.75,10.14,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,outpatient,1,EA,10.45000,9.92000,The Alliance,PPO Network,,8.68,,,,,,,5.22,10.14,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,inpatient,1,GM,67.78000,64.39000,The Alliance,PPO Network,,56.33,,,,,,,37.28,65.75,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,outpatient,1,GM,67.78000,64.39000,The Alliance,PPO Network,,56.33,,,,,,,33.89,65.75,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,inpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,1.07,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,PPO Network,,1.62,,,,,,,0.97500,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,inpatient,1,mL,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.55,2.73,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,outpatient,1,mL,2.81000,2.67000,The Alliance,PPO Network,,2.34,,,,,,,1.41,2.73,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,inpatient,1,EA,7019.54000,6668.56000,The Alliance,PPO Network,,5833.24,,,,,,,3860.75,6808.95,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,outpatient,1,EA,7019.54000,6668.56000,The Alliance,PPO Network,,5833.24,,,,,,,28.62,6808.95,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,inpatient,1,mL,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.26400,0.46560,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,PPO Network,,0.39888,,,,,,,0.24000,1.86,percent of total billed charges,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,inpatient,1,mL,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,10.13,17.86,percent of total billed charges,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,PPO Network,,15.30,,,,,,,4.77,17.86,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,18699.66,40740.00,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,13671.00,27063.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,PPO Network,,23184.90,,,,,,,12806.10,27063.00,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2325.00000,2208.75000,The Alliance,PPO Network,,1932.08,,,,,,,1278.75,2255.25,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2325.00000,2208.75000,The Alliance,PPO Network,,1932.08,,,,,,,1162.50,2255.25,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,inpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,4.07,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1669.61,3637.50,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,PPO Network,,2259.28,,,,,,,1247.91,2718.75,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,inpatient,1,GM,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,inpatient,1,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,170.94,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,PPO Network,,258.27,,,,,,,155.40,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,inpatient,1,EA,1244.56000,1182.33000,The Alliance,PPO Network,,1034.23,,,,,,,684.51,1207.22,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,outpatient,1,EA,1244.56000,1182.33000,The Alliance,PPO Network,,1034.23,,,,,,,622.28,1207.22,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,inpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.39,2.45,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,PPO Network,,2.10,,,,,,,1.26,10.56,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,inpatient,1,mL,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,1.03,1.82,percent of total billed charges,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,outpatient,1,mL,1.88000,1.79000,The Alliance,PPO Network,,1.56,,,,,,,0.94000,10.56,percent of total billed charges,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,inpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,5.21,9.20,percent of total billed charges,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,PPO Network,,7.88,,,,,,,4.74,9.20,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03300,0.05820,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,PPO Network,,0.04986,,,,,,,0.03000,0.05820,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,inpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.38500,0.67900,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,PPO Network,,0.58170,,,,,,,0.35000,0.67900,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.31350,0.55290,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,PPO Network,,0.47367,,,,,,,0.28500,0.55290,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,inpatient,1,mL,59.16000,56.20000,The Alliance,PPO Network,,49.16,,,,,,,32.54,57.39,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,outpatient,1,mL,59.16000,56.20000,The Alliance,PPO Network,,49.16,,,,,,,1.35,57.39,percent of total billed charges,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,inpatient,1,mL,379.44000,360.46000,The Alliance,PPO Network,,315.31,,,,,,,208.69,368.06,percent of total billed charges,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,PPO Network,,315.31,,,,,,,1.16,368.06,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,inpatient,1,EA,9.95000,9.46000,The Alliance,PPO Network,,8.27,,,,,,,5.47,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,PPO Network,,8.27,,,,,,,4.97,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,inpatient,1,EA,4.33000,4.12000,The Alliance,PPO Network,,3.60,,,,,,,2.38,4.20,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,outpatient,1,EA,4.33000,4.12000,The Alliance,PPO Network,,3.60,,,,,,,2.17,4.20,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,inpatient,1,EA,2377.67000,2258.79000,The Alliance,PPO Network,,1975.84,,,,,,,1307.72,2306.34,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,outpatient,1,EA,2377.67000,2258.79000,The Alliance,PPO Network,,1975.84,,,,,,,230.26,2306.34,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,inpatient,1,EA,1087.80000,1033.41000,The Alliance,PPO Network,,903.96,,,,,,,598.29,1055.17,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,outpatient,1,EA,1087.80000,1033.41000,The Alliance,PPO Network,,903.96,,,,,,,5.19,1055.17,percent of total billed charges,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,inpatient,1,mL,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,1.44,2.54,percent of total billed charges,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,outpatient,1,mL,2.62000,2.49000,The Alliance,PPO Network,,2.18,,,,,,,0.50685,2.54,percent of total billed charges,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,6.08,10.73,percent of total billed charges,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,PPO Network,,9.19,,,,,,,5.53,10.73,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,inpatient,1,mL,11.46000,10.88000,The Alliance,PPO Network,,9.52,,,,,,,6.30,11.12,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,outpatient,1,mL,11.46000,10.88000,The Alliance,PPO Network,,9.52,,,,,,,5.73,11.12,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,inpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.52250,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,PPO Network,,0.78945,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.55000,0.97000,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,PPO Network,,0.83100,,,,,,,0.50000,0.97000,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,inpatient,1,mL,39.15000,37.19000,The Alliance,PPO Network,,32.53,,,,,,,21.53,37.98,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,outpatient,1,mL,39.15000,37.19000,The Alliance,PPO Network,,32.53,,,,,,,19.57,37.98,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,inpatient,1,mL,100.36000,95.34000,The Alliance,PPO Network,,83.40,,,,,,,55.20,97.35,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,outpatient,1,mL,100.36000,95.34000,The Alliance,PPO Network,,83.40,,,,,,,50.18,97.35,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,PPO Network,,0.02493,,,,,,,0.01500,0.02910,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,inpatient,1,EA,14.92000,14.18000,The Alliance,PPO Network,,12.40,,,,,,,8.21,14.47,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,outpatient,1,EA,14.92000,14.18000,The Alliance,PPO Network,,12.40,,,,,,,7.46,14.47,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,PPO Network,,0.14958,,,,,,,0.09000,0.17460,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.57750,1.02,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,PPO Network,,0.87255,,,,,,,0.52500,1.02,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.22,2.14,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,PPO Network,,1.84,,,,,,,1.10,2.14,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1701.49,3368.26,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1593.85,3472.43,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.42,2.50,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,PPO Network,,2.14,,,,,,,1.29,2.50,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,inpatient,1,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.70400,1.24,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,PPO Network,,1.06,,,,,,,0.64000,1.24,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,inpatient,1,EA,56.51000,53.69000,The Alliance,PPO Network,,46.96,,,,,,,31.08,54.81,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,outpatient,1,EA,56.51000,53.69000,The Alliance,PPO Network,,46.96,,,,,,,28.25,54.81,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,inpatient,1,EA,12.02000,11.42000,The Alliance,PPO Network,,9.99,,,,,,,6.61,11.66,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,outpatient,1,EA,12.02000,11.42000,The Alliance,PPO Network,,9.99,,,,,,,6.01,11.66,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1669.61,3637.50,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,inpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,PPO Network,,4.16,,,,,,,0.03202,4.85,percent of total billed charges,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.21,14.28,percent of total billed charges,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.36,143.36,percent of total billed charges,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,76.32000,72.50000,The Alliance,PPO Network,,63.42,,,,,,,41.98,74.03,percent of total billed charges,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,PPO Network,,63.42,,,,,,,38.16,74.03,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,inpatient,,,582.12000,553.01000,The Alliance,PPO Network,,483.74,,,,,,,320.17,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,outpatient,,,582.12000,553.01000,The Alliance,PPO Network,,483.74,,,,,,,291.06,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,inpatient,1,EA,582.12000,553.01000,The Alliance,PPO Network,,483.74,,,,,,,320.17,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,outpatient,1,EA,582.12000,553.01000,The Alliance,PPO Network,,483.74,,,,,,,291.06,564.66,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.19250,0.33950,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,PPO Network,,0.29085,,,,,,,0.17500,0.33950,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,1.45,percent of total billed charges,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,inpatient,1,GM,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,87.60000,83.22000,The Alliance,PPO Network,,72.80,,,,,,,42.92,84.97,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,87.60000,83.22000,The Alliance,PPO Network,,72.80,,,,,,,40.21,87.60,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,inpatient,1,EA,36.75000,34.91000,The Alliance,PPO Network,,30.54,,,,,,,20.21,35.65,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,outpatient,1,EA,36.75000,34.91000,The Alliance,PPO Network,,30.54,,,,,,,0.98580,35.65,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,inpatient,1,mL,616.69000,585.86000,The Alliance,PPO Network,,512.47,,,,,,,339.18,598.19,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,outpatient,1,mL,616.69000,585.86000,The Alliance,PPO Network,,512.47,,,,,,,308.35,598.19,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,inpatient,1,GM,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,7.24,12.77,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,outpatient,1,GM,13.17000,12.51000,The Alliance,PPO Network,,10.94,,,,,,,6.58,12.77,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1342.24,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,85.80,151.32,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,PPO Network,,129.64,,,,,,,78.00,151.32,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,inpatient,,,850.00000,807.50000,The Alliance,PPO Network,TC,706.35,,,,,,,467.50,824.50,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,PPO Network,TC,706.35,,,,,,,384.16,824.50,percent of total billed charges,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.85250,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,PPO Network,,1.29,,,,,,,0.77500,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.23650,0.41710,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,PPO Network,,0.35733,,,,,,,0.21500,0.41710,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.54450,0.96030,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,PPO Network,,0.82269,,,,,,,0.49500,0.96030,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,inpatient,1,mL,2944.76000,2797.52000,The Alliance,PPO Network,,2447.10,,,,,,,1619.62,2856.42,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,outpatient,1,mL,2944.76000,2797.52000,The Alliance,PPO Network,,2447.10,,,,,,,1472.38,3261.31,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,inpatient,1,EA,23.79000,22.60000,The Alliance,PPO Network,,19.77,,,,,,,13.08,23.08,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,PPO Network,,19.77,,,,,,,11.89,46.30,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,inpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,43.45,76.63,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,PPO Network,,65.65,,,,,,,39.50,76.63,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,inpatient,1,mL,571.35000,542.79000,The Alliance,PPO Network,,474.79,,,,,,,314.24,554.21,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,outpatient,1,mL,571.35000,542.79000,The Alliance,PPO Network,,474.79,,,,,,,7.57,554.21,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.50600,0.89240,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,PPO Network,,0.76452,,,,,,,0.46000,0.89240,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,92400.00000,87780.00000,The Alliance,PPO Network,,76784.40,,,,,,,45276.00,89628.00,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92400.00000,87780.00000,The Alliance,PPO Network,,76784.40,,,,,,,42411.60,92400.00,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,434.11,859.36,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,PPO Network,,736.22,,,,,,,406.65,885.94,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4151.56000,3943.98000,The Alliance,PPO Network,,3449.95,,,,,,,2034.26,4027.01,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4151.56000,3943.98000,The Alliance,PPO Network,,3449.95,,,,,,,1905.57,4151.56,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3649.24000,3466.78000,The Alliance,PPO Network,,3032.52,,,,,,,1788.13,3539.76,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3649.24000,3466.78000,The Alliance,PPO Network,,3032.52,,,,,,,1675.00,3649.24,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,inpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.21450,0.37830,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,PPO Network,,0.32409,,,,,,,0.19500,1.86,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,inpatient,1,mL,20.98000,19.93000,The Alliance,PPO Network,,17.43,,,,,,,11.54,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,outpatient,1,mL,20.98000,19.93000,The Alliance,PPO Network,,17.43,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,inpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,4.34,7.66,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,PPO Network,,6.56,,,,,,,1.49,7.66,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,inpatient,,,147.06000,139.71000,The Alliance,PPO Network,,122.21,,,,,,,80.88,142.65,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,outpatient,,,147.06000,139.71000,The Alliance,PPO Network,,122.21,,,,,,,73.53,244.12,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,inpatient,1,mL,1164.72000,1106.48000,The Alliance,PPO Network,,967.88,,,,,,,640.60,1129.78,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,outpatient,1,mL,1164.72000,1106.48000,The Alliance,PPO Network,,967.88,,,,,,,227.94,1129.78,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,inpatient,,,320.07000,304.07000,The Alliance,PPO Network,,265.98,,,,,,,176.04,310.47,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,outpatient,,,320.07000,304.07000,The Alliance,PPO Network,,265.98,,,,,,,160.03,310.47,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,inpatient,1,mL,640.14000,608.13000,The Alliance,PPO Network,,531.96,,,,,,,352.08,620.94,percent of total billed charges,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,outpatient,1,mL,640.14000,608.13000,The Alliance,PPO Network,,531.96,,,,,,,250.56,620.94,percent of total billed charges,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,inpatient,1,mL,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,outpatient,1,mL,0.66000,0.62000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,inpatient,1,mL,39900.00000,37905.00000,The Alliance,PPO Network,,33156.90,,,,,,,21945.00,38703.00,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,outpatient,1,mL,39900.00000,37905.00000,The Alliance,PPO Network,,33156.90,,,,,,,105.90,38703.00,percent of total billed charges,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,PPO Network,,2972.90,,,,,,,1642.07,3577.50,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,inpatient,1,mL,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.94050,1.66,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,PPO Network,,1.42,,,,,,,0.85500,2.61,percent of total billed charges,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,inpatient,,,1077.53000,1023.65000,The Alliance,PPO Network,,895.43,,,,,,,592.64,1045.20,percent of total billed charges,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1077.53000,1023.65000,The Alliance,PPO Network,,895.43,,,,,,,142.07,1045.20,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,30.25,53.35,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,,45.70,,,,,,,4.90,373.51,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,39.42,111.55,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1620.67,3208.28,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,PPO Network,,2748.53,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,29862.00000,28368.90000,The Alliance,PPO Network,,24815.32,,,,,,,14632.38,28966.14,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,29862.00000,28368.90000,The Alliance,PPO Network,,24815.32,,,,,,,13706.66,28966.14,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,inpatient,1,mL,1346.15000,1278.84000,The Alliance,PPO Network,,1118.65,,,,,,,740.38,1305.77,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,outpatient,1,mL,1346.15000,1278.84000,The Alliance,PPO Network,,1118.65,,,,,,,673.08,1305.77,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,330.75,654.75,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,PPO Network,,560.92,,,,,,,309.82,675.00,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,inpatient,1,mL,2390.85000,2271.31000,The Alliance,PPO Network,,1986.80,,,,,,,1314.97,2319.12,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,outpatient,1,mL,2390.85000,2271.31000,The Alliance,PPO Network,,1986.80,,,,,,,1195.42,2319.12,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,100.20000,95.19000,The Alliance,PPO Network,,83.27,,,,,,,49.10,97.19,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,100.20000,95.19000,The Alliance,PPO Network,,83.27,,,,,,,50.10,97.19,percent of total billed charges,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,151.92000,144.32000,The Alliance,PPO Network,,126.25,,,,,,,74.44,147.36,percent of total billed charges,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,151.92000,144.32000,The Alliance,PPO Network,,126.25,,,,,,,75.96,639.03,percent of total billed charges,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,13.52000,12.84000,The Alliance,PPO Network,,11.24,,,,,,,6.62,13.11,percent of total billed charges,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,13.52000,12.84000,The Alliance,PPO Network,,11.24,,,,,,,6.76,121.81,percent of total billed charges,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,inpatient,1,mL,49.61000,47.13000,The Alliance,PPO Network,,41.23,,,,,,,27.29,48.12,percent of total billed charges,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,outpatient,1,mL,49.61000,47.13000,The Alliance,PPO Network,,41.23,,,,,,,24.80,48.12,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,inpatient,1,mL,73.08000,69.42000,The Alliance,PPO Network,,60.73,,,,,,,40.19,70.89,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,outpatient,1,mL,73.08000,69.42000,The Alliance,PPO Network,,60.73,,,,,,,36.54,70.89,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,16071.54,31815.09,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,PPO Network,,27256.02,,,,,,,15054.77,32799.06,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6551.55000,6223.97000,The Alliance,PPO Network,,5444.34,,,,,,,3210.26,6355.00,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6551.55000,6223.97000,The Alliance,PPO Network,,5444.34,,,,,,,3007.16,6551.55,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,91.88,181.88,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,86.06,187.50,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,831.19,1465.91,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,755.62,1465.91,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,555.04000,527.29000,The Alliance,PPO Network,,461.24,,,,,,,305.27,538.39,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,555.04000,527.29000,The Alliance,PPO Network,,461.24,,,,,,,277.52,538.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,inpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,1.86,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,inpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.86,percent of total billed charges,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,PPO Network,,132.96,,,,,,,73.44,160.00,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,inpatient,,,584.10000,554.90000,The Alliance,PPO Network,,485.39,,,,,,,321.25,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,outpatient,,,584.10000,554.90000,The Alliance,PPO Network,,485.39,,,,,,,292.05,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,inpatient,1,EA,584.10000,554.90000,The Alliance,PPO Network,,485.39,,,,,,,321.25,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,outpatient,1,EA,584.10000,554.90000,The Alliance,PPO Network,,485.39,,,,,,,292.05,566.58,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,PPO Network,JW,1.11,,,,,,,0.22165,1.29,percent of total billed charges,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,25.72000,24.43000,The Alliance,PPO Network,,21.37,,,,,,,12.60,24.95,percent of total billed charges,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,PPO Network,,21.37,,,,,,,11.81,24.95,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,inpatient,,,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,8.95,15.79,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,8.14,15.79,percent of total billed charges,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,inpatient,,,123.90000,117.70000,The Alliance,PPO Network,90,102.96,,,,,,,68.14,120.18,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,PPO Network,90,102.96,,,,,,,15.58,780.94,percent of total billed charges,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,inpatient,,,329.20000,312.74000,The Alliance,PPO Network,90,273.57,,,,,,,181.06,319.32,percent of total billed charges,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,outpatient,,,329.20000,312.74000,The Alliance,PPO Network,90,273.57,,,,,,,36.26,1833.46,percent of total billed charges,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,inpatient,,,49.50000,47.02000,The Alliance,PPO Network,90,41.13,,,,,,,27.23,48.02,percent of total billed charges,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,PPO Network,90,41.13,,,,,,,6.23,322.54,percent of total billed charges,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,inpatient,,,47.50000,45.12000,The Alliance,PPO Network,90,39.47,,,,,,,26.12,46.08,percent of total billed charges,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,outpatient,,,47.50000,45.12000,The Alliance,PPO Network,90,39.47,,,,,,,5.97,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,inpatient,,,47.20000,44.84000,The Alliance,PPO Network,90,39.22,,,,,,,25.96,45.78,percent of total billed charges,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,outpatient,,,47.20000,44.84000,The Alliance,PPO Network,90,39.22,,,,,,,5.94,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,inpatient,,,41.70000,39.62000,The Alliance,PPO Network,90,34.65,,,,,,,22.93,40.45,percent of total billed charges,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,outpatient,,,41.70000,39.62000,The Alliance,PPO Network,90,34.65,,,,,,,5.25,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,inpatient,,,119.70000,113.72000,The Alliance,PPO Network,90,99.47,,,,,,,65.83,116.11,percent of total billed charges,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,outpatient,,,119.70000,113.72000,The Alliance,PPO Network,90,99.47,,,,,,,15.06,763.98,percent of total billed charges,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,inpatient,,,228.40000,216.98000,The Alliance,PPO Network,90,189.80,,,,,,,125.62,221.55,percent of total billed charges,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,PPO Network,90,189.80,,,,,,,28.73,1459.96,percent of total billed charges,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,inpatient,,,44.70000,42.47000,The Alliance,PPO Network,90,37.15,,,,,,,24.59,43.36,percent of total billed charges,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,outpatient,,,44.70000,42.47000,The Alliance,PPO Network,90,37.15,,,,,,,22.35,1137.41,percent of total billed charges,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,inpatient,,,45.80000,43.51000,The Alliance,PPO Network,90,38.06,,,,,,,25.19,44.43,percent of total billed charges,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,outpatient,,,45.80000,43.51000,The Alliance,PPO Network,90,38.06,,,,,,,5.75,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,inpatient,,,56.10000,53.30000,The Alliance,PPO Network,90,46.62,,,,,,,30.86,54.42,percent of total billed charges,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,PPO Network,90,46.62,,,,,,,7.05,356.54,percent of total billed charges,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,inpatient,,,45.10000,42.84000,The Alliance,PPO Network,90,37.48,,,,,,,24.80,43.75,percent of total billed charges,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,outpatient,,,45.10000,42.84000,The Alliance,PPO Network,90,37.48,,,,,,,5.67,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,inpatient,,,41.60000,39.52000,The Alliance,PPO Network,90,34.57,,,,,,,22.88,40.35,percent of total billed charges,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,outpatient,,,41.60000,39.52000,The Alliance,PPO Network,90,34.57,,,,,,,5.23,254.68,percent of total billed charges,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,inpatient,,,118.80000,112.86000,The Alliance,PPO Network,90,98.72,,,,,,,65.34,115.24,percent of total billed charges,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,outpatient,,,118.80000,112.86000,The Alliance,PPO Network,90,98.72,,,,,,,14.93,679.08,percent of total billed charges,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,inpatient,,,38.90000,36.95000,The Alliance,PPO Network,90,32.33,,,,,,,21.39,37.73,percent of total billed charges,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,outpatient,,,38.90000,36.95000,The Alliance,PPO Network,90,32.33,,,,,,,4.89,220.68,percent of total billed charges,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,inpatient,,,42.50000,40.38000,The Alliance,PPO Network,90,35.32,,,,,,,23.38,41.23,percent of total billed charges,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,outpatient,,,42.50000,40.38000,The Alliance,PPO Network,90,35.32,,,,,,,5.35,271.65,percent of total billed charges,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,inpatient,,,29.40000,27.93000,The Alliance,PPO Network,90,24.43,,,,,,,16.17,28.52,percent of total billed charges,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,outpatient,,,29.40000,27.93000,The Alliance,PPO Network,90,24.43,,,,,,,3.70,186.75,percent of total billed charges,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,inpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,30.25,53.35,percent of total billed charges,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,PPO Network,90,45.70,,,,,,,6.92,356.54,percent of total billed charges,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,inpatient,,,327.60000,311.22000,The Alliance,PPO Network,90,272.24,,,,,,,180.18,317.77,percent of total billed charges,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,outpatient,,,327.60000,311.22000,The Alliance,PPO Network,90,272.24,,,,,,,17.85,814.87,percent of total billed charges,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,23961.00000,22762.95000,The Alliance,PPO Network,,19911.59,,,,,,,11740.89,23242.17,percent of total billed charges,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,23961.00000,22762.95000,The Alliance,PPO Network,,19911.59,,,,,,,10998.10,23242.17,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,24862.00000,23618.90000,The Alliance,PPO Network,,20660.32,,,,,,,13674.10,24116.14,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,24862.00000,23618.90000,The Alliance,PPO Network,,20660.32,,,,,,,12431.00,24116.14,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,inpatient,,,164.00000,155.80000,The Alliance,PPO Network,TC,136.28,,,,,,,90.20,159.08,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,PPO Network,TC,136.28,,,,,,,90.20,3163.00,percent of total billed charges,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,0.89000,0.85000,The Alliance,PPO Network,JW,0.73959,,,,,,,0.48950,0.86330,percent of total billed charges,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,PPO Network,JW,0.73959,,,,,,,0.22165,0.86330,percent of total billed charges,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,344.77,2392.02,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,inpatient,,,1133.00000,1076.35000,The Alliance,PPO Network,TC,941.52,,,,,,,623.15,1099.01,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,outpatient,,,1133.00000,1076.35000,The Alliance,PPO Network,TC,941.52,,,,,,,566.50,8017.30,percent of total billed charges,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,inpatient,,,6363.00000,6044.85000,The Alliance,PPO Network,,5287.65,,,,,,,3499.65,6172.11,percent of total billed charges,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,outpatient,,,6363.00000,6044.85000,The Alliance,PPO Network,,5287.65,,,,,,,83.61,6172.11,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,inpatient,1,mL,8.97000,8.52000,The Alliance,PPO Network,,7.45,,,,,,,4.93,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,outpatient,1,mL,8.97000,8.52000,The Alliance,PPO Network,,7.45,,,,,,,4.49,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,inpatient,1,mL,8.64000,8.21000,The Alliance,PPO Network,,7.18,,,,,,,4.75,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,outpatient,1,mL,8.64000,8.21000,The Alliance,PPO Network,,7.18,,,,,,,4.32,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,inpatient,1,mL,8.07000,7.67000,The Alliance,PPO Network,,6.71,,,,,,,4.44,7.83,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,outpatient,1,mL,8.07000,7.67000,The Alliance,PPO Network,,6.71,,,,,,,4.04,7.83,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,inpatient,1,mL,19684.00000,18699.80000,The Alliance,PPO Network,,16357.40,,,,,,,10826.20,19093.48,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,outpatient,1,mL,19684.00000,18699.80000,The Alliance,PPO Network,,16357.40,,,,,,,72.40,19093.48,percent of total billed charges,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,inpatient,1,mL,5752.33000,5464.72000,The Alliance,PPO Network,,4780.19,,,,,,,3163.78,5579.76,percent of total billed charges,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,outpatient,1,mL,5752.33000,5464.72000,The Alliance,PPO Network,,4780.19,,,,,,,18.10,5579.76,percent of total billed charges,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12130.22,26427.50,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,70.56000,67.03000,The Alliance,PPO Network,,58.64,,,,,,,34.57,68.44,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,PPO Network,,58.64,,,,,,,32.39,70.56,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12400.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12400.00,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2625.00000,2493.75000,The Alliance,PPO Network,,2181.38,,,,,,,1286.25,2546.25,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,PPO Network,,2181.38,,,,,,,1204.88,2625.00,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,308.32,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,191.40,337.56,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,144.10,548.00,percent of total billed charges,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,inpatient,,,233.19000,221.53000,The Alliance,PPO Network,,193.78,,,,,,,128.25,226.19,percent of total billed charges,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,outpatient,,,233.19000,221.53000,The Alliance,PPO Network,,193.78,,,,,,,6.95,226.19,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,865.71,5858.00,percent of total billed charges,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,inpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,89.10,157.14,percent of total billed charges,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,PPO Network,,134.62,,,,,,,81.00,344.85,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1285.85,2518.12,percent of total billed charges,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,4242.12000,4030.01000,The Alliance,PPO Network,,3525.20,,,,,,,2333.17,4114.86,percent of total billed charges,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,4242.12000,4030.01000,The Alliance,PPO Network,,3525.20,,,,,,,683.80,4114.86,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,3777.75000,3588.86000,The Alliance,PPO Network,,3139.31,,,,,,,1851.10,3664.42,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,PPO Network,,3139.31,,,,,,,1733.99,3777.75,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,inpatient,,,1416.00000,1345.20000,The Alliance,PPO Network,,1176.70,,,,,,,778.80,1373.52,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,PPO Network,,1176.70,,,,,,,122.40,1373.52,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,PPO Network,,886.48,,,,,,,489.64,1066.76,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3499.34,6927.26,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,PPO Network,,5934.59,,,,,,,3277.95,7141.50,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,514.09000,488.39000,The Alliance,PPO Network,,427.21,,,,,,,251.90,498.67,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,514.09000,488.39000,The Alliance,PPO Network,,427.21,,,,,,,235.97,514.09,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,1909.84,3368.26,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,PPO Network,,2885.59,,,,,,,11.35,3368.26,percent of total billed charges,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1476.56000,1402.73000,The Alliance,PPO Network,,1227.02,,,,,,,723.51,1432.26,percent of total billed charges,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1476.56000,1402.73000,The Alliance,PPO Network,,1227.02,,,,,,,677.74,1476.56,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,5936.70,10470.18,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,PPO Network,TC,8969.81,,,,,,,1929.64,10470.18,percent of total billed charges,
INJ NON-CMP SCHLEROSANT MLT VN-TECH,85278,CDM,510,RC,36466,CPT,,,facility,inpatient,,,419.00000,398.05000,The Alliance,PPO Network,,348.19,,,,,,,230.45,406.43,percent of total billed charges,
INJ NON-CMP SCHLEROSANT MLT VN-TECH,85278,CDM,510,RC,36466,CPT,,,facility,outpatient,,,419.00000,398.05000,The Alliance,PPO Network,,348.19,,,,,,,209.50,1910.62,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,inpatient,,,101.80000,96.71000,The Alliance,PPO Network,90,84.60,,,,,,,55.99,98.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,outpatient,,,101.80000,96.71000,The Alliance,PPO Network,90,84.60,,,,,,,8.17,645.08,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,inpatient,,,83.60000,79.42000,The Alliance,PPO Network,90,69.47,,,,,,,45.98,81.09,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,PPO Network,90,69.47,,,,,,,8.17,526.26,percent of total billed charges,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,inpatient,,,121.50000,115.42000,The Alliance,PPO Network,90,100.97,,,,,,,66.83,117.86,percent of total billed charges,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,outpatient,,,121.50000,115.42000,The Alliance,PPO Network,90,100.97,,,,,,,15.27,780.94,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,inpatient,,,139.90000,132.90000,The Alliance,PPO Network,90,116.26,,,,,,,76.94,135.70,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,outpatient,,,139.90000,132.90000,The Alliance,PPO Network,90,116.26,,,,,,,17.60,882.80,percent of total billed charges,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,PPO Network,,1823.01,,,,,,,1006.93,2193.75,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,38850.00000,36907.50000,The Alliance,PPO Network,,32284.35,,,,,,,19036.50,37684.50,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,38850.00000,36907.50000,The Alliance,PPO Network,,32284.35,,,,,,,17832.15,38850.00,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,inpatient,1,mL,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,outpatient,1,mL,0.85000,0.80000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,inpatient,1,mL,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.46750,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,outpatient,1,mL,0.85000,0.81000,The Alliance,PPO Network,,0.70635,,,,,,,0.42500,0.82450,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.25,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,PPO Network,,1.89,,,,,,,1.14,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.04000,1.94000,The Alliance,PPO Network,,1.70,,,,,,,1.12,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.04000,1.94000,The Alliance,PPO Network,,1.70,,,,,,,1.02,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.60,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.00,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.92400,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.68000,1.60000,The Alliance,PPO Network,,1.40,,,,,,,0.84000,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.31,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,4.20000,3.99000,The Alliance,PPO Network,,3.49,,,,,,,2.10,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,13.75,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,12.50,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.98,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.60000,3.42000,The Alliance,PPO Network,,2.99,,,,,,,1.80,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.52,2.68,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.76000,2.62000,The Alliance,PPO Network,,2.29,,,,,,,1.38,2.68,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,inpatient,,,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.89,8.63,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,PPO Network,,7.40,,,,,,,4.45,20.67,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.39,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.52000,2.39000,The Alliance,PPO Network,,2.09,,,,,,,1.26,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.92000,1.82000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.92000,1.82000,The Alliance,PPO Network,,1.60,,,,,,,0.96000,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.99000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.80000,1.71000,The Alliance,PPO Network,,1.50,,,,,,,0.90000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.40,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,PPO Network,,6.65,,,,,,,4.00,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,inpatient,,,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.30,5.82,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,6.00000,5.70000,The Alliance,PPO Network,,4.99,,,,,,,3.00,5.82,percent of total billed charges,
DRY NEEDLING;1-2 MUSCLES-TECH,85313,CDM,510,RC,20560,CPT,,,facility,inpatient,,,10.10000,9.59000,The Alliance,PPO Network,,8.39,,,,,,,5.55,9.80,percent of total billed charges,
DRY NEEDLING;1-2 MUSCLES-TECH,85313,CDM,510,RC,20560,CPT,,,facility,outpatient,,,10.10000,9.59000,The Alliance,PPO Network,,8.39,,,,,,,5.05,25.57,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,441.38,778.42,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,47.62,778.42,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,inpatient,1,EA,48514.58000,46088.85000,The Alliance,PPO Network,,40315.62,,,,,,,26683.02,47059.14,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,outpatient,1,EA,48514.58000,46088.85000,The Alliance,PPO Network,,40315.62,,,,,,,216.74,47059.14,percent of total billed charges,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,inpatient,1,mL,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.81400,1.44,percent of total billed charges,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,PPO Network,,1.23,,,,,,,0.74000,1.44,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,inpatient,,,105.90000,100.61000,The Alliance,PPO Network,90,88.00,,,,,,,58.24,102.72,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,PPO Network,90,88.00,,,,,,,8.17,679.08,percent of total billed charges,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,inpatient,,,1002.00000,951.90000,The Alliance,PPO Network,90,832.66,,,,,,,551.10,971.94,percent of total billed charges,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,outpatient,,,1002.00000,951.90000,The Alliance,PPO Network,90,832.66,,,,,,,426.69,971.94,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,inpatient,,,163.00000,154.85000,The Alliance,PPO Network,90,135.45,,,,,,,89.65,158.11,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,PPO Network,90,135.45,,,,,,,8.17,763.98,percent of total billed charges,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,90,105.54,,,,,,,69.85,123.19,percent of total billed charges,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,90,105.54,,,,,,,16.61,763.98,percent of total billed charges,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,inpatient,,,277.20000,263.34000,The Alliance,PPO Network,90,230.35,,,,,,,152.46,268.88,percent of total billed charges,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,PPO Network,90,230.35,,,,,,,36.26,1833.46,percent of total billed charges,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,inpatient,,,105.90000,100.61000,The Alliance,PPO Network,90,88.00,,,,,,,58.24,102.72,percent of total billed charges,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,PPO Network,90,88.00,,,,,,,13.31,679.08,percent of total billed charges,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,20150.00000,19142.50000,The Alliance,PPO Network,,16744.65,,,,,,,9873.50,19545.50,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,20150.00000,19142.50000,The Alliance,PPO Network,,16744.65,,,,,,,9248.85,20150.00,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,inpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.69,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,PPO Network,,2.56,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.69300,1.22,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,PPO Network,,1.05,,,,,,,0.63000,1.22,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,3.10,6.13,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,6.32000,6.00000,The Alliance,PPO Network,,5.25,,,,,,,2.90,6.32,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,inpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,91.30,161.02,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,PPO Network,,137.95,,,,,,,83.00,161.02,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6070.28000,5766.77000,The Alliance,PPO Network,,5044.40,,,,,,,2974.44,5888.17,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6070.28000,5766.77000,The Alliance,PPO Network,,5044.40,,,,,,,2786.26,6070.28,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1775.03,3513.82,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,PPO Network,,3010.30,,,,,,,1662.73,3622.50,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,1774.50000,1685.77000,The Alliance,PPO Network,,1474.61,,,,,,,975.98,1721.27,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1774.50000,1685.77000,The Alliance,PPO Network,,1474.61,,,,,,,887.25,1721.27,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1959.38,3455.62,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,PPO Network,,2960.44,,,,,,,1781.25,3455.62,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,825.00000,783.75000,The Alliance,PPO Network,,685.58,,,,,,,453.75,800.25,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,825.00000,783.75000,The Alliance,PPO Network,,685.58,,,,,,,412.50,800.25,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1650.00,2910.00,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1500.00,2910.00,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,35.20,62.08,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,PPO Network,,53.18,,,,,,,32.00,62.08,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,131.18,231.34,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,PPO Network,,198.19,,,,,,,119.25,231.34,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,845.37,3163.00,percent of total billed charges,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1475.05,4686.00,percent of total billed charges,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,360.68,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1548.45,percent of total billed charges,
OPHTHALMSCPY XTND OPTIC NERV/MACUL 92202-TECH,85368,CDM,510,RC,92202,CPT,,,facility,inpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.60,11.64,percent of total billed charges,
OPHTHALMSCPY XTND OPTIC NERV/MACUL 92202-TECH,85368,CDM,510,RC,92202,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,PPO Network,,9.97,,,,,,,6.00,62.04,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,740.51,1465.91,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,PPO Network,,1255.85,,,,,,,693.66,1511.25,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,inpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,PPO Network,,133.79,,,,,,,80.50,264.00,percent of total billed charges,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52500.00000,49875.00000,The Alliance,PPO Network,,43627.50,,,,,,,25725.00,50925.00,percent of total billed charges,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52500.00000,49875.00000,The Alliance,PPO Network,,43627.50,,,,,,,24097.50,52500.00,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34639.50000,32907.53000,The Alliance,PPO Network,,28785.42,,,,,,,16973.35,33600.32,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34639.50000,32907.53000,The Alliance,PPO Network,,28785.42,,,,,,,15899.53,34639.50,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2358.25,4668.37,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2209.05,4812.75,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2358.25,4668.37,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,PPO Network,,3999.40,,,,,,,2209.05,4812.75,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,inpatient,,,57750.00000,54862.50000,The Alliance,PPO Network,,47990.25,,,,,,,28297.50,56017.50,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,57750.00000,54862.50000,The Alliance,PPO Network,,47990.25,,,,,,,26507.25,57750.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,inpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,158.40,279.36,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,PPO Network,TC,239.33,,,,,,,144.00,1509.95,percent of total billed charges,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1374.98000,1306.23000,The Alliance,PPO Network,,1142.61,,,,,,,673.74,1333.73,percent of total billed charges,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,PPO Network,,1142.61,,,,,,,440.69,1374.98,percent of total billed charges,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,inpatient,,,8798.00000,8358.10000,The Alliance,PPO Network,TC,7311.14,,,,,,,4838.90,8534.06,percent of total billed charges,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,outpatient,,,8798.00000,8358.10000,The Alliance,PPO Network,TC,7311.14,,,,,,,4399.00,8534.06,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,inpatient,,,387.00000,367.65000,The Alliance,PPO Network,TC,321.60,,,,,,,212.85,375.39,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,PPO Network,TC,321.60,,,,,,,193.50,375.39,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,99.50,264.00,percent of total billed charges,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,inpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,457.05,806.07,percent of total billed charges,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,PPO Network,TC,690.56,,,,,,,415.50,806.07,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,99.50,264.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,GP,83.10,,,,,,,55.00,97.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,GP,83.10,,,,,,,50.00,264.00,percent of total billed charges,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,41.50,264.00,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,inpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,109.45,193.03,percent of total billed charges,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,PPO Network,,165.37,,,,,,,99.50,264.00,percent of total billed charges,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,inpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,45.65,80.51,percent of total billed charges,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,PPO Network,,68.97,,,,,,,41.50,264.00,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,GO,83.10,,,,,,,55.00,97.00,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,GO,83.10,,,,,,,50.00,264.00,percent of total billed charges,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,inpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,55.00,97.00,percent of total billed charges,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,PPO Network,,83.10,,,,,,,50.00,264.00,percent of total billed charges,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,inpatient,1,mL,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,1.06,1.87,percent of total billed charges,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,PPO Network,,1.60,,,,,,,0.96500,7.69,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,inpatient,1,mL,9.16000,8.71000,The Alliance,PPO Network,,7.61,,,,,,,5.04,8.89,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,outpatient,1,mL,9.16000,8.71000,The Alliance,PPO Network,,7.61,,,,,,,4.58,8.89,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,inpatient,1,mL,7.17000,6.81000,The Alliance,PPO Network,,5.96,,,,,,,3.94,6.95,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,outpatient,1,mL,7.17000,6.81000,The Alliance,PPO Network,,5.96,,,,,,,2.50,6.95,percent of total billed charges,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,7400.25000,7030.24000,The Alliance,PPO Network,,6149.61,,,,,,,3626.12,7178.24,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,PPO Network,,6149.61,,,,,,,3396.71,7400.25,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,10177.30,20146.90,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,PPO Network,,17259.87,,,,,,,9533.43,20146.90,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3796.02,7514.57,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3555.86,7746.98,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,284.10000,269.90000,The Alliance,PPO Network,,236.09,,,,,,,156.25,275.58,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,284.10000,269.90000,The Alliance,PPO Network,,236.09,,,,,,,77.18,275.58,percent of total billed charges,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1340.62,2364.38,percent of total billed charges,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,PPO Network,,2025.56,,,,,,,1218.75,2364.38,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,12.25,24.25,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,PPO Network,,20.77,,,,,,,11.47,25.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,71400.00000,67830.00000,The Alliance,PPO Network,,59333.40,,,,,,,34986.00,69258.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,PPO Network,,59333.40,,,,,,,32772.60,71400.00,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,726.83,2392.02,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,inpatient,1,mL,1315.72000,1249.93000,The Alliance,PPO Network,,1093.36,,,,,,,723.65,1276.25,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,outpatient,1,mL,1315.72000,1249.93000,The Alliance,PPO Network,,1093.36,,,,,,,72.40,1276.25,percent of total billed charges,
APP CAST CYLINDER-TECH,85500,CDM,510,RC,29365,CPT,,,facility,inpatient,,,350.00000,332.50000,The Alliance,PPO Network,,290.85,,,,,,,192.50,339.50,percent of total billed charges,
APP CAST CYLINDER-TECH,85500,CDM,510,RC,29365,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,PPO Network,,290.85,,,,,,,175.00,339.50,percent of total billed charges,
APP HIP SPICA CST 1 1/2 OR BTH-TECH,85501,CDM,510,RC,29325,CPT,,,facility,inpatient,,,776.00000,737.20000,The Alliance,PPO Network,,644.86,,,,,,,426.80,752.72,percent of total billed charges,
APP HIP SPICA CST 1 1/2 OR BTH-TECH,85501,CDM,510,RC,29325,CPT,,,facility,outpatient,,,776.00000,737.20000,The Alliance,PPO Network,,644.86,,,,,,,252.18,752.72,percent of total billed charges,
APPLY HAND/WRIST CAST-TECH,85502,CDM,510,RC,29085,CPT,,,facility,inpatient,,,273.00000,259.35000,The Alliance,PPO Network,,226.86,,,,,,,150.15,264.81,percent of total billed charges,
APPLY HAND/WRIST CAST-TECH,85502,CDM,510,RC,29085,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,PPO Network,,226.86,,,,,,,136.50,264.81,percent of total billed charges,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,257.25,509.25,percent of total billed charges,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,,436.27,,,,,,,240.97,525.00,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,inpatient,,,142.40000,135.28000,The Alliance,PPO Network,,118.33,,,,,,,78.32,138.13,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,PPO Network,,118.33,,,,,,,12.05,628.12,percent of total billed charges,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,349.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,inpatient,,,725.63000,689.35000,The Alliance,PPO Network,,603.00,,,,,,,399.10,703.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,outpatient,,,725.63000,689.35000,The Alliance,PPO Network,,603.00,,,,,,,362.81,703.86,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,50.34,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,45.76,88.77,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,546.56,963.94,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,PPO Network,,825.81,,,,,,,44.30,963.94,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,inpatient,1,mL,173.36000,164.69000,The Alliance,PPO Network,,144.06,,,,,,,95.35,168.16,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,outpatient,1,mL,173.36000,164.69000,The Alliance,PPO Network,,144.06,,,,,,,73.55,168.16,percent of total billed charges,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,inpatient,1,mL,3408.61000,3238.18000,The Alliance,PPO Network,,2832.55,,,,,,,1874.74,3306.35,percent of total billed charges,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,outpatient,1,mL,3408.61000,3238.18000,The Alliance,PPO Network,,2832.55,,,,,,,39.50,3306.35,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,inpatient,1,mL,21.52000,20.44000,The Alliance,PPO Network,,17.88,,,,,,,11.84,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,outpatient,1,mL,21.52000,20.44000,The Alliance,PPO Network,,17.88,,,,,,,10.76,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,inpatient,1,mL,21.27000,20.20000,The Alliance,PPO Network,,17.68,,,,,,,11.70,20.63,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,outpatient,1,mL,21.27000,20.20000,The Alliance,PPO Network,,17.68,,,,,,,10.63,20.63,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,inpatient,,,420.60000,399.57000,The Alliance,PPO Network,90,349.52,,,,,,,231.33,407.98,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,PPO Network,90,349.52,,,,,,,52.89,2410.69,percent of total billed charges,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,inpatient,,,260.10000,247.10000,The Alliance,PPO Network,90,216.14,,,,,,,143.06,252.30,percent of total billed charges,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,PPO Network,90,216.14,,,,,,,117.50,1643.57,percent of total billed charges,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,90,146.26,,,,,,,96.80,170.72,percent of total billed charges,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,90,146.26,,,,,,,20.36,1120.45,percent of total billed charges,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,inpatient,,,420.60000,399.57000,The Alliance,PPO Network,90,349.52,,,,,,,231.33,407.98,percent of total billed charges,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,PPO Network,90,349.52,,,,,,,52.89,2410.69,percent of total billed charges,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,inpatient,,,260.10000,247.10000,The Alliance,PPO Network,90,216.14,,,,,,,143.06,252.30,percent of total billed charges,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,PPO Network,90,216.14,,,,,,,117.50,1643.57,percent of total billed charges,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,inpatient,,,176.00000,167.20000,The Alliance,PPO Network,90,146.26,,,,,,,96.80,170.72,percent of total billed charges,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,PPO Network,90,146.26,,,,,,,20.36,1120.45,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,825.00,1455.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,750.00,1455.00,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,inpatient,1,EA,1169.88000,1111.38000,The Alliance,PPO Network,,972.17,,,,,,,643.43,1134.78,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,outpatient,1,EA,1169.88000,1111.38000,The Alliance,PPO Network,,972.17,,,,,,,155.42,1134.78,percent of total billed charges,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,inpatient,,,532.14000,505.53000,The Alliance,PPO Network,90,442.21,,,,,,,292.68,516.18,percent of total billed charges,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,outpatient,,,532.14000,505.53000,The Alliance,PPO Network,90,442.21,,,,,,,69.60,3514.18,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,inpatient,,,1050.30000,997.78000,The Alliance,PPO Network,,872.80,,,,,,,577.66,1018.79,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,outpatient,,,1050.30000,997.78000,The Alliance,PPO Network,,872.80,,,,,,,525.15,3999.66,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,inpatient,,,915.50000,869.72000,The Alliance,PPO Network,,760.78,,,,,,,503.52,888.03,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,outpatient,,,915.50000,869.72000,The Alliance,PPO Network,,760.78,,,,,,,457.75,3999.66,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,TC,5302.61,,,,,,,3509.55,6189.57,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,TC,5302.61,,,,,,,2786.18,6189.57,percent of total billed charges,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,PPO Network,,5805.37,,,,,,,3842.30,6776.42,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,256.50000,243.67000,The Alliance,PPO Network,,213.15,,,,,,,125.69,248.81,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,256.50000,243.67000,The Alliance,PPO Network,,213.15,,,,,,,117.73,256.50,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,3273.75,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,PPO Network,,2804.62,,,,,,,1856.25,5271.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,5271.00,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,inpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.18,2.08,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,PPO Network,,1.78,,,,,,,1.07,3.53,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,204.75000,194.51000,The Alliance,PPO Network,,170.15,,,,,,,100.33,198.61,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,204.75000,194.51000,The Alliance,PPO Network,,170.15,,,,,,,93.98,204.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,3675.00000,3491.25000,The Alliance,PPO Network,,3053.93,,,,,,,2021.25,3564.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,3675.00000,3491.25000,The Alliance,PPO Network,,3053.93,,,,,,,1837.50,3564.75,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,50.34,88.77,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,PPO Network,,76.05,,,,,,,45.76,88.77,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,1513.80000,1438.11000,The Alliance,PPO Network,,1257.97,,,,,,,832.59,1468.39,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1513.80000,1438.11000,The Alliance,PPO Network,,1257.97,,,,,,,47.62,1468.39,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,inpatient,,,1494.00000,1419.30000,The Alliance,PPO Network,TC,1241.51,,,,,,,821.70,1449.18,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,PPO Network,TC,1241.51,,,,,,,747.00,2210.07,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,inpatient,1,mL,12.96000,12.31000,The Alliance,PPO Network,,10.77,,,,,,,7.13,12.57,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,outpatient,1,mL,12.96000,12.31000,The Alliance,PPO Network,,10.77,,,,,,,6.48,25.89,percent of total billed charges,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17084.19000,16229.98000,The Alliance,PPO Network,,14196.96,,,,,,,8371.25,16571.66,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,PPO Network,,14196.96,,,,,,,7841.64,17084.19,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,77.60000,73.72000,The Alliance,PPO Network,,64.49,,,,,,,38.02,75.27,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.60000,73.72000,The Alliance,PPO Network,,64.49,,,,,,,35.62,77.60,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,inpatient,1,mL,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,3320.62,5856.38,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,outpatient,1,mL,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,3018.75,5856.38,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,inpatient,,,4690.00000,4455.50000,The Alliance,PPO Network,,3897.39,,,,,,,2298.10,4549.30,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,outpatient,,,4690.00000,4455.50000,The Alliance,PPO Network,,3897.39,,,,,,,2152.71,4690.00,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,inpatient,,,42710.00000,40574.50000,The Alliance,PPO Network,,35492.01,,,,,,,23490.50,41428.70,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,outpatient,,,42710.00000,40574.50000,The Alliance,PPO Network,,35492.01,,,,,,,4095.00,41428.70,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,inpatient,1,EA,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.34,4.12,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,PPO Network,,3.53,,,,,,,2.12,4.12,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,899.63000,854.65000,The Alliance,PPO Network,,747.59,,,,,,,440.82,872.64,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,PPO Network,,747.59,,,,,,,412.93,899.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,PPO Network,,236.99,,,,,,,130.90,285.19,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,inpatient,,,325.01000,308.76000,The Alliance,PPO Network,,270.08,,,,,,,159.25,315.26,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,outpatient,,,325.01000,308.76000,The Alliance,PPO Network,,270.08,,,,,,,149.18,325.01,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,567.05,1000.07,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,PPO Network,TC,856.76,,,,,,,384.16,1000.07,percent of total billed charges,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,3698.33000,3513.41000,The Alliance,PPO Network,,3073.31,,,,,,,1812.18,3587.38,percent of total billed charges,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,3698.33000,3513.41000,The Alliance,PPO Network,,3073.31,,,,,,,1697.53,3698.33,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,417.15000,396.29000,The Alliance,PPO Network,,346.65,,,,,,,204.40,404.64,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,417.15000,396.29000,The Alliance,PPO Network,,346.65,,,,,,,191.47,417.15,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,PPO Network,,243.07,,,,,,,134.26,292.50,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3553.98000,3376.28000,The Alliance,PPO Network,,2953.36,,,,,,,1741.45,3447.36,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3553.98000,3376.28000,The Alliance,PPO Network,,2953.36,,,,,,,1631.28,3553.98,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6934.50000,6587.77000,The Alliance,PPO Network,,5762.57,,,,,,,3397.91,6726.47,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6934.50000,6587.77000,The Alliance,PPO Network,,5762.57,,,,,,,3182.94,6934.50,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,PPO Network,,517.30,,,,,,,285.73,622.50,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,inpatient,,,109.00000,103.55000,The Alliance,PPO Network,TC,90.58,,,,,,,59.95,105.73,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,PPO Network,TC,90.58,,,,,,,41.10,484.28,percent of total billed charges,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,inpatient,,,4471.00000,4247.45000,The Alliance,PPO Network,TC,3715.40,,,,,,,2459.05,4336.87,percent of total billed charges,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,PPO Network,TC,3715.40,,,,,,,1523.24,17311.25,percent of total billed charges,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,,2049.25,,,,,,,280.29,3163.00,percent of total billed charges,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5165.13,11253.00,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,68.60,135.80,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,PPO Network,,116.34,,,,,,,64.26,140.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,PPO Network,,23880.45,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,PPO Network,,9894.80,,,,,,,5465.36,11907.10,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20398.96000,19379.01000,The Alliance,PPO Network,,16951.54,,,,,,,9995.49,19786.99,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,PPO Network,,16951.54,,,,,,,9363.12,20398.96,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,6076.00,12028.00,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,PPO Network,,10304.40,,,,,,,5691.60,12028.00,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,inpatient,,,138.70000,131.76000,The Alliance,PPO Network,90,115.26,,,,,,,76.28,134.54,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,outpatient,,,138.70000,131.76000,The Alliance,PPO Network,90,115.26,,,,,,,14.22,713.01,percent of total billed charges,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,inpatient,,,94.60000,89.87000,The Alliance,PPO Network,90,78.61,,,,,,,52.03,91.76,percent of total billed charges,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,outpatient,,,94.60000,89.87000,The Alliance,PPO Network,90,78.61,,,,,,,12.38,628.12,percent of total billed charges,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,inpatient,,,51.10000,48.55000,The Alliance,PPO Network,90,42.46,,,,,,,28.11,49.57,percent of total billed charges,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,PPO Network,90,42.46,,,,,,,6.69,339.51,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,inpatient,,,51.10000,48.55000,The Alliance,PPO Network,90,42.46,,,,,,,28.11,49.57,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,PPO Network,90,42.46,,,,,,,6.69,339.51,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,inpatient,,,111.70000,106.11000,The Alliance,PPO Network,90,92.82,,,,,,,61.44,108.35,percent of total billed charges,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,outpatient,,,111.70000,106.11000,The Alliance,PPO Network,90,92.82,,,,,,,9.02,662.12,percent of total billed charges,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,inpatient,,,405.00000,384.75000,The Alliance,PPO Network,,336.56,,,,,,,222.75,392.85,percent of total billed charges,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,PPO Network,,336.56,,,,,,,35.09,1833.46,percent of total billed charges,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,inpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,405.35,714.89,percent of total billed charges,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,PPO Network,,612.45,,,,,,,61.98,3242.53,percent of total billed charges,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,inpatient,,,176.50000,167.67000,The Alliance,PPO Network,90,146.67,,,,,,,97.08,171.21,percent of total billed charges,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,outpatient,,,176.50000,167.67000,The Alliance,PPO Network,90,146.67,,,,,,,23.08,2082.45,percent of total billed charges,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1545.94,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,67200.00000,63840.00000,The Alliance,PPO Network,,55843.20,,,,,,,32928.00,65184.00,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,67200.00000,63840.00000,The Alliance,PPO Network,,55843.20,,,,,,,30844.80,67200.00,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,5658.00000,5375.10000,The Alliance,PPO Network,,4701.80,,,,,,,2772.42,5488.26,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5658.00000,5375.10000,The Alliance,PPO Network,,4701.80,,,,,,,2597.02,5658.00,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1545.94,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1500.00,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,inpatient,1,mL,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.25300,0.44620,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,outpatient,1,mL,0.46000,0.44000,The Alliance,PPO Network,,0.38226,,,,,,,0.23000,0.44620,percent of total billed charges,
COMPR AUDIOMETRY EVAL UNI-TECH,85636,CDM,510,RC,92557,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
COMPR AUDIOMETRY EVAL UNI-TECH,85636,CDM,510,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,26.00,163.43,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,inpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,28.60,50.44,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,PPO Network,,43.21,,,,,,,26.00,163.43,percent of total billed charges,
ASSESSMENT OF TINNITUS-TECH,85638,CDM,510,RC,92625,CPT,,,facility,inpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,53.35,94.09,percent of total billed charges,
ASSESSMENT OF TINNITUS-TECH,85638,CDM,510,RC,92625,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,PPO Network,,80.61,,,,,,,48.50,163.43,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS PR-TECH,85641,CDM,510,RC,92603,CPT,,,facility,inpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,114.95,202.73,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS PR-TECH,85641,CDM,510,RC,92603,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,PPO Network,,173.68,,,,,,,104.50,202.73,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS RP-TECH,85642,CDM,510,RC,92604,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
DIAG ANALYS COCH IMPL >7YRS RP-TECH,85642,CDM,510,RC,92604,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,62.00,163.43,percent of total billed charges,
EVAL AUD REHAB STAT 1ST HR-TECH,85643,CDM,510,RC,92626,CPT,,,facility,inpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,68.20,120.28,percent of total billed charges,
EVAL AUD REHAB STAT 1ST HR-TECH,85643,CDM,510,RC,92626,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,PPO Network,,103.04,,,,,,,62.00,163.43,percent of total billed charges,
EVAL AUD REHAB-TECH,85644,CDM,510,RC,92627,CPT,,,facility,inpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,17.05,30.07,percent of total billed charges,
EVAL AUD REHAB-TECH,85644,CDM,510,RC,92627,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,PPO Network,,25.76,,,,,,,15.50,30.07,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST UNI-TECH,85645,CDM,510,RC,92567,CPT,,,facility,inpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,11.00,19.40,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST UNI-TECH,85645,CDM,510,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,10.00,41.00,percent of total billed charges,
TYMPANOMETRY/REFLEX MEASUREMT-TECH,85646,CDM,510,RC,92550,CPT,,,facility,inpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,15.95,28.13,percent of total billed charges,
TYMPANOMETRY/REFLEX MEASUREMT-TECH,85646,CDM,510,RC,92550,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,PPO Network,,24.10,,,,,,,14.50,163.43,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,inpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,11.00,19.40,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,PPO Network,,16.62,,,,,,,10.00,41.00,percent of total billed charges,
VISUAL REINFORCEMENT AUDIOMETR-TECH,85648,CDM,510,RC,92579,CPT,,,facility,inpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,31.90,56.26,percent of total billed charges,
VISUAL REINFORCEMENT AUDIOMETR-TECH,85648,CDM,510,RC,92579,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,PPO Network,,48.20,,,,,,,29.00,163.43,percent of total billed charges,
ELECTROCOCHLEOGRAPHY-TECH,85649,CDM,510,RC,92584,CPT,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,54.45,96.03,percent of total billed charges,
ELECTROCOCHLEOGRAPHY-TECH,85649,CDM,510,RC,92584,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,,82.27,,,,,,,49.50,163.43,percent of total billed charges,
AEP HEARING STATUS W/INTRP/RPT-TECH,85650,CDM,510,RC,92651,CPT,,,facility,inpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,74.80,131.92,percent of total billed charges,
AEP HEARING STATUS W/INTRP/RPT-TECH,85650,CDM,510,RC,92651,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,PPO Network,,113.02,,,,,,,68.00,325.26,percent of total billed charges,
AEP THRESHOLD ESTIMATION-TECH,85651,CDM,510,RC,92652,CPT,,,facility,inpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,82.50,145.50,percent of total billed charges,
AEP THRESHOLD ESTIMATION-TECH,85651,CDM,510,RC,92652,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,PPO Network,,124.65,,,,,,,75.00,325.26,percent of total billed charges,
AEP NEURODIAGNOSTIC INTRP/RPT-TECH,85652,CDM,510,RC,92653,CPT,,,facility,inpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,72.60,128.04,percent of total billed charges,
AEP NEURODIAGNOSTIC INTRP/RPT-TECH,85652,CDM,510,RC,92653,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,PPO Network,,109.69,,,,,,,66.00,325.26,percent of total billed charges,
CERVICAL VEMP TESING W/I&R-TECH,85653,CDM,510,RC,92517,CPT,,,facility,inpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,59.40,104.76,percent of total billed charges,
CERVICAL VEMP TESING W/I&R-TECH,85653,CDM,510,RC,92517,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,PPO Network,,89.75,,,,,,,54.00,163.43,percent of total billed charges,
CERVICAL & OCULAR VEMP TESTING W/I&R-TECH,85654,CDM,510,RC,92519,CPT,,,facility,inpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,92.40,162.96,percent of total billed charges,
CERVICAL & OCULAR VEMP TESTING W/I&R-TECH,85654,CDM,510,RC,92519,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,PPO Network,,139.61,,,,,,,84.00,325.26,percent of total billed charges,
ALLERG IMMUNOTH-2- TECH,85655,CDM,510,RC,95146,CPT,,,facility,inpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,34.65,61.11,percent of total billed charges,
ALLERG IMMUNOTH-2- TECH,85655,CDM,510,RC,95146,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,PPO Network,,52.35,,,,,,,31.50,61.11,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,inpatient,,,544.00000,516.80000,The Alliance,PPO Network,,452.06,,,,,,,299.20,527.68,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,PPO Network,,452.06,,,,,,,299.20,4686.00,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,15174.50000,14415.77000,The Alliance,PPO Network,,12610.01,,,,,,,7435.51,14719.26,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,15174.50000,14415.77000,The Alliance,PPO Network,,12610.01,,,,,,,6965.10,15174.50,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,inpatient,,,1374.98000,1306.23000,The Alliance,PPO Network,,1142.61,,,,,,,673.74,1333.73,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,PPO Network,,1142.61,,,,,,,440.69,1374.98,percent of total billed charges,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,inpatient,1,EA,291.05000,276.50000,The Alliance,PPO Network,,241.86,,,,,,,160.08,282.32,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,outpatient,1,EA,291.05000,276.50000,The Alliance,PPO Network,,241.86,,,,,,,145.53,282.32,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,inpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,,1219.91,,,,,,,807.40,1423.96,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,PPO Network,,1219.91,,,,,,,734.00,1801.19,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,inpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,298.65,526.71,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,PPO Network,,451.23,,,,,,,271.50,526.71,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1479.03,3681.15,percent of total billed charges,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2846.25,5019.75,percent of total billed charges,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2587.50,5019.75,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,202.01000,191.91000,The Alliance,PPO Network,,167.87,,,,,,,98.98,195.95,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,202.01000,191.91000,The Alliance,PPO Network,,167.87,,,,,,,92.72,202.01,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,inpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.78100,1.38,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,PPO Network,,1.18,,,,,,,0.71000,1.38,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,PPO Network,,0.54846,,,,,,,0.33000,0.64020,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,inpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,TC,2049.25,,,,,,,1356.30,2392.02,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,PPO Network,TC,2049.25,,,,,,,1233.00,2392.02,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,inpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,1.83,3.22,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,PPO Network,,2.76,,,,,,,0.78449,3.22,percent of total billed charges,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,PPO Network,,3085.09,,,,,,,1704.04,3712.50,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20017.48000,19016.61000,The Alliance,PPO Network,,16634.53,,,,,,,9808.57,19416.96,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20017.48000,19016.61000,The Alliance,PPO Network,,16634.53,,,,,,,9188.02,20017.48,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,inpatient,1,EA,1437.45000,1365.58000,The Alliance,PPO Network,,1194.52,,,,,,,790.60,1394.33,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,outpatient,1,EA,1437.45000,1365.58000,The Alliance,PPO Network,,1194.52,,,,,,,96.37,1394.33,percent of total billed charges,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,inpatient,1,EA,1131.92000,1075.32000,The Alliance,PPO Network,,940.63,,,,,,,622.56,1097.96,percent of total billed charges,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,outpatient,1,EA,1131.92000,1075.32000,The Alliance,PPO Network,,940.63,,,,,,,4.01,1097.96,percent of total billed charges,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,inpatient,,,3050.00000,2897.50000,The Alliance,PPO Network,,2534.55,,,,,,,1677.50,2958.50,percent of total billed charges,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,outpatient,,,3050.00000,2897.50000,The Alliance,PPO Network,,2534.55,,,,,,,148.57,2958.50,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,inpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.27500,0.48500,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,PPO Network,,0.41550,,,,,,,0.25000,13.53,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,195.94,345.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,178.12,345.56,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,inpatient,1,EA,2435.92000,2314.12000,The Alliance,PPO Network,,2024.25,,,,,,,1339.76,2362.84,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,outpatient,1,EA,2435.92000,2314.12000,The Alliance,PPO Network,,2024.25,,,,,,,44.59,2362.84,percent of total billed charges,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,inpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,223.30,393.82,percent of total billed charges,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,PPO Network,,337.39,,,,,,,35.09,1833.46,percent of total billed charges,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,inpatient,,,414.00000,393.30000,The Alliance,PPO Network,90,344.03,,,,,,,227.70,401.58,percent of total billed charges,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,outpatient,,,414.00000,393.30000,The Alliance,PPO Network,90,344.03,,,,,,,36.26,1833.46,percent of total billed charges,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,inpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,75.35,132.89,percent of total billed charges,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,PPO Network,,113.85,,,,,,,12.00,628.12,percent of total billed charges,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,91.88,181.88,percent of total billed charges,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,PPO Network,,155.81,,,,,,,86.06,187.50,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,inpatient,1,GM,2.73000,2.59000,The Alliance,PPO Network,,2.27,,,,,,,1.50,2.65,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,outpatient,1,GM,2.73000,2.59000,The Alliance,PPO Network,,2.27,,,,,,,1.36,2.65,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.20350,0.35890,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,PPO Network,,0.30747,,,,,,,0.18500,0.35890,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,inpatient,,,4398.75000,4178.81000,The Alliance,PPO Network,,3655.36,,,,,,,2419.31,4266.79,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,4398.75000,4178.81000,The Alliance,PPO Network,,3655.36,,,,,,,47.06,4266.79,percent of total billed charges,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,40.16000,38.15000,The Alliance,PPO Network,,33.37,,,,,,,19.68,38.96,percent of total billed charges,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,40.16000,38.15000,The Alliance,PPO Network,,33.37,,,,,,,20.08,143.36,percent of total billed charges,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1455.00,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,848.59000,806.16000,The Alliance,PPO Network,,705.18,,,,,,,415.81,823.13,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,848.59000,806.16000,The Alliance,PPO Network,,705.18,,,,,,,389.50,848.59,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,inpatient,1,EA,6927.88000,6581.48000,The Alliance,PPO Network,,5757.07,,,,,,,3810.33,6720.04,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,outpatient,1,EA,6927.88000,6581.48000,The Alliance,PPO Network,,5757.07,,,,,,,3463.94,6720.04,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,inpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,2990.51,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,PPO Network,,2561.97,,,,,,,1695.65,5271.00,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,inpatient,,,315.50000,299.72000,The Alliance,PPO Network,90,262.18,,,,,,,173.53,306.04,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,PPO Network,90,262.18,,,,,,,12.45,1539.22,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,inpatient,,,315.50000,299.72000,The Alliance,PPO Network,90,262.18,,,,,,,173.53,306.04,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,PPO Network,90,262.18,,,,,,,25.31,2286.16,percent of total billed charges,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,inpatient,,,146.80000,139.46000,The Alliance,PPO Network,90,121.99,,,,,,,80.74,142.40,percent of total billed charges,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,outpatient,,,146.80000,139.46000,The Alliance,PPO Network,90,121.99,,,,,,,12.80,645.08,percent of total billed charges,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,inpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,158.56,279.65,percent of total billed charges,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,PPO Network,90,239.58,,,,,,,36.26,1833.46,percent of total billed charges,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4952.48000,4704.86000,The Alliance,PPO Network,,4115.51,,,,,,,2723.86,4803.91,percent of total billed charges,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,PPO Network,,4115.51,,,,,,,2476.24,4803.91,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,inpatient,5,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.68,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,outpatient,5,EA,3.05000,2.90000,The Alliance,PPO Network,,2.53,,,,,,,1.52,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,inpatient,5,EA,3.46000,3.28000,The Alliance,PPO Network,,2.88,,,,,,,1.90,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,outpatient,5,EA,3.46000,3.28000,The Alliance,PPO Network,,2.88,,,,,,,1.73,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,inpatient,5,EA,6.10000,5.79000,The Alliance,PPO Network,,5.07,,,,,,,3.35,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,outpatient,5,EA,6.10000,5.79000,The Alliance,PPO Network,,5.07,,,,,,,3.05,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,inpatient,5,EA,6.13000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.37,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,outpatient,5,EA,6.13000,5.82000,The Alliance,PPO Network,,5.09,,,,,,,3.06,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,inpatient,5,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.82,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,outpatient,5,EA,6.95000,6.60000,The Alliance,PPO Network,,5.78,,,,,,,3.48,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,inpatient,5,EA,6.11000,5.81000,The Alliance,PPO Network,,5.08,,,,,,,3.36,5.93,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,outpatient,5,EA,6.11000,5.81000,The Alliance,PPO Network,,5.08,,,,,,,3.06,5.93,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,inpatient,1,mL,13220.83000,12559.79000,The Alliance,PPO Network,,10986.51,,,,,,,7271.46,12824.21,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,PPO Network,,10986.51,,,,,,,136.04,12824.21,percent of total billed charges,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,inpatient,,,559.00000,531.05000,The Alliance,PPO Network,TC,464.53,,,,,,,307.45,542.23,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,PPO Network,TC,464.53,,,,,,,279.50,4345.33,percent of total billed charges,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,inpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,3509.55,6189.57,percent of total billed charges,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,PPO Network,,5302.61,,,,,,,1556.56,6189.57,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,inpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,inpatient,1,mL,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.65,9.96,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,outpatient,1,mL,10.27000,9.76000,The Alliance,PPO Network,,8.53,,,,,,,5.13,9.96,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,28140.00000,26733.00000,The Alliance,PPO Network,,23384.34,,,,,,,13788.60,27295.80,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,28140.00000,26733.00000,The Alliance,PPO Network,,23384.34,,,,,,,12916.26,27295.80,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,PPO Network,,1383.62,,,,,,,764.24,1615.05,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,inpatient,,,54600.00000,51870.00000,The Alliance,PPO Network,,45372.60,,,,,,,26754.00,52962.00,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,outpatient,,,54600.00000,51870.00000,The Alliance,PPO Network,,45372.60,,,,,,,25061.40,54600.00,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,3320.62,5856.38,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,3018.75,5856.38,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,24645.00000,23412.75000,The Alliance,PPO Network,,20479.99,,,,,,,12076.05,23905.65,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,PPO Network,,20479.99,,,,,,,11312.06,24645.00,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,479.40000,455.43000,The Alliance,PPO Network,,398.38,,,,,,,234.91,465.02,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,PPO Network,,398.38,,,,,,,220.04,479.40,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,PPO Network,,782.74,,,,,,,432.35,941.93,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1455.00,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,inpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,522.50,921.50,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,PPO Network,,789.45,,,,,,,114.10,6772.31,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,inpatient,1,mL,82.19000,78.08000,The Alliance,PPO Network,,68.30,,,,,,,45.20,79.72,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,outpatient,1,mL,82.19000,78.08000,The Alliance,PPO Network,,68.30,,,,,,,41.09,81.54,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,inpatient,1,EA,44799.32000,42559.35000,The Alliance,PPO Network,,37228.23,,,,,,,24639.63,43455.34,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,outpatient,1,EA,44799.32000,42559.35000,The Alliance,PPO Network,,37228.23,,,,,,,1737.10,43455.34,percent of total billed charges,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,777.68000,738.80000,The Alliance,PPO Network,,646.25,,,,,,,381.06,754.35,percent of total billed charges,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,PPO Network,,646.25,,,,,,,356.96,777.68,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,inpatient,,,3115.00000,2959.25000,The Alliance,PPO Network,,2588.57,,,,,,,1713.25,3021.55,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,outpatient,,,3115.00000,2959.25000,The Alliance,PPO Network,,2588.57,,,,,,,314.95,3021.55,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,inpatient,,,501.00000,475.95000,The Alliance,PPO Network,,416.33,,,,,,,275.55,485.97,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,outpatient,,,501.00000,475.95000,The Alliance,PPO Network,,416.33,,,,,,,275.55,4686.00,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,inpatient,1,EA,874.01000,830.31000,The Alliance,PPO Network,,726.30,,,,,,,480.71,847.79,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,outpatient,1,EA,874.01000,830.31000,The Alliance,PPO Network,,726.30,,,,,,,437.00,847.79,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,inpatient,1,EA,1575.00000,1496.25000,The Alliance,PPO Network,,1308.83,,,,,,,866.25,1527.75,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,outpatient,1,EA,1575.00000,1496.25000,The Alliance,PPO Network,,1308.83,,,,,,,787.50,1527.75,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,inpatient,1,EA,513.56000,487.88000,The Alliance,PPO Network,,426.77,,,,,,,282.46,498.15,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,outpatient,1,EA,513.56000,487.88000,The Alliance,PPO Network,,426.77,,,,,,,256.78,498.15,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,inpatient,1,EA,663.39000,630.22000,The Alliance,PPO Network,,551.28,,,,,,,364.86,643.49,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,outpatient,1,EA,663.39000,630.22000,The Alliance,PPO Network,,551.28,,,,,,,331.69,643.49,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,inpatient,1,EA,1575.27000,1496.50000,The Alliance,PPO Network,,1309.05,,,,,,,866.40,1528.01,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,outpatient,1,EA,1575.27000,1496.50000,The Alliance,PPO Network,,1309.05,,,,,,,787.63,1528.01,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,inpatient,,,1135.60000,1078.82000,The Alliance,PPO Network,90,943.68,,,,,,,624.58,1101.53,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,PPO Network,90,943.68,,,,,,,70.04,6756.70,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,inpatient,,,1135.60000,1078.82000,The Alliance,PPO Network,90,943.68,,,,,,,624.58,1101.53,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,PPO Network,90,943.68,,,,,,,70.04,6756.70,percent of total billed charges,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,inpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,201.76,percent of total billed charges,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,PPO Network,,172.85,,,,,,,114.40,3163.00,percent of total billed charges,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,inpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,74.48,147.44,percent of total billed charges,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,PPO Network,,126.31,,,,,,,33.34,152.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,PPO Network,,2405.74,,,,,,,1328.81,2895.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,PPO Network,,1286.76,,,,,,,710.74,1502.00,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,inpatient,1,mL,647.15000,614.79000,The Alliance,PPO Network,,537.78,,,,,,,355.93,627.74,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,outpatient,1,mL,647.15000,614.79000,The Alliance,PPO Network,,537.78,,,,,,,0.30000,627.74,percent of total billed charges,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87.48000,83.11000,The Alliance,PPO Network,,72.70,,,,,,,42.87,84.86,percent of total billed charges,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87.48000,83.11000,The Alliance,PPO Network,,72.70,,,,,,,40.15,87.48,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,299.89000,284.90000,The Alliance,PPO Network,,249.21,,,,,,,146.95,290.89,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,299.89000,284.90000,The Alliance,PPO Network,,249.21,,,,,,,137.65,299.89,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1828.43000,1737.01000,The Alliance,PPO Network,,1519.43,,,,,,,895.93,1773.58,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1828.43000,1737.01000,The Alliance,PPO Network,,1519.43,,,,,,,839.25,1828.43,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4110.81000,3905.27000,The Alliance,PPO Network,,3416.08,,,,,,,2014.30,3987.49,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4110.81000,3905.27000,The Alliance,PPO Network,,3416.08,,,,,,,1886.86,4110.81,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,inpatient,,,350.00000,332.50000,The Alliance,PPO Network,90,290.85,,,,,,,192.50,339.50,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,PPO Network,90,290.85,,,,,,,175.00,339.50,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,PPO Network,,145.13,,,,,,,80.16,174.64,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,386.10000,366.80000,The Alliance,PPO Network,,320.85,,,,,,,189.19,374.52,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,386.10000,366.80000,The Alliance,PPO Network,,320.85,,,,,,,177.22,386.10,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1518.75000,1442.81000,The Alliance,PPO Network,,1262.08,,,,,,,744.19,1473.19,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1518.75000,1442.81000,The Alliance,PPO Network,,1262.08,,,,,,,697.11,1518.75,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.14850,0.26190,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,PPO Network,,0.22437,,,,,,,0.13500,0.26190,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,inpatient,,,3183.75000,3024.56000,The Alliance,PPO Network,,2645.70,,,,,,,1560.04,3088.24,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,3183.75000,3024.56000,The Alliance,PPO Network,,2645.70,,,,,,,1461.34,3183.75,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,47.62,469.24,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8280.00000,7866.00000,The Alliance,PPO Network,,6880.68,,,,,,,4057.20,8031.60,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,PPO Network,,6880.68,,,,,,,3800.52,8280.00,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2340.75000,2223.71000,The Alliance,PPO Network,,1945.16,,,,,,,1146.97,2270.53,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2340.75000,2223.71000,The Alliance,PPO Network,,1945.16,,,,,,,1074.40,2340.75,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,inpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.86900,1.53,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,PPO Network,,1.31,,,,,,,0.73040,1.53,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,inpatient,1,mL,83.36000,79.19000,The Alliance,PPO Network,,69.27,,,,,,,45.85,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,outpatient,1,mL,83.36000,79.19000,The Alliance,PPO Network,,69.27,,,,,,,1.49,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,inpatient,1,mL,19.90000,18.90000,The Alliance,PPO Network,,16.54,,,,,,,10.95,19.30,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,outpatient,1,mL,19.90000,18.90000,The Alliance,PPO Network,,16.54,,,,,,,1.49,19.30,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2418.75000,2297.81000,The Alliance,PPO Network,,2009.98,,,,,,,1185.19,2346.19,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2418.75000,2297.81000,The Alliance,PPO Network,,2009.98,,,,,,,1110.21,2418.75,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,15.96,81.35,percent of total billed charges,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,inpatient,1,GM,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.74800,1.32,percent of total billed charges,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,outpatient,1,GM,1.36000,1.29000,The Alliance,PPO Network,,1.13,,,,,,,0.68000,1.32,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,PPO Network,,29666.70,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,45150.00000,42892.50000,The Alliance,PPO Network,,37519.65,,,,,,,22123.50,43795.50,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,45150.00000,42892.50000,The Alliance,PPO Network,,37519.65,,,,,,,20723.85,45150.00,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,294.00,582.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,,498.60,,,,,,,275.40,600.00,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,16709.00000,15873.55000,The Alliance,PPO Network,,13885.18,,,,,,,8187.41,16207.73,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,16709.00000,15873.55000,The Alliance,PPO Network,,13885.18,,,,,,,7669.43,16709.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7109.10000,6753.65000,The Alliance,PPO Network,,5907.66,,,,,,,3483.46,6895.83,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,PPO Network,,5907.66,,,,,,,3263.08,7109.10,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2632.50000,2500.88000,The Alliance,PPO Network,,2187.61,,,,,,,1289.92,2553.53,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2632.50000,2500.88000,The Alliance,PPO Network,,2187.61,,,,,,,1208.32,2632.50,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,739.20,1303.68,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,PPO Network,,1116.86,,,,,,,739.20,4686.00,percent of total billed charges,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4310.77,8533.58,percent of total billed charges,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,PPO Network,,7310.72,,,,,,,4038.05,8797.50,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,479.59,949.39,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,PPO Network,,813.34,,,,,,,449.25,978.75,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,711.11,1407.71,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,PPO Network,,1205.99,,,,,,,666.12,1451.25,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,19.25,33.95,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,,29.09,,,,,,,17.50,33.95,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,inpatient,1,EA,635.07000,603.31000,The Alliance,PPO Network,,527.74,,,,,,,349.29,616.02,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,PPO Network,,527.74,,,,,,,4.24,616.02,percent of total billed charges,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,inpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.17000,0.32980,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,inpatient,1,mL,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.61,4.60,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,PPO Network,,3.94,,,,,,,2.37,5.99,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,inpatient,1,mL,31.63000,30.05000,The Alliance,PPO Network,,26.28,,,,,,,17.40,30.68,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,outpatient,1,mL,31.63000,30.05000,The Alliance,PPO Network,,26.28,,,,,,,15.81,81.35,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,15.96,81.35,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,inpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,17.56,30.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,PPO Network,,26.53,,,,,,,15.96,81.35,percent of total billed charges,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,inpatient,,,29629.15000,28147.69000,The Alliance,PPO Network,,24621.82,,,,,,,14518.28,28740.28,percent of total billed charges,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,outpatient,,,29629.15000,28147.69000,The Alliance,PPO Network,,24621.82,,,,,,,10900.23,28740.28,percent of total billed charges,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,inpatient,1,mL,71250.00000,67687.50000,The Alliance,PPO Network,,59208.75,,,,,,,39187.50,69112.50,percent of total billed charges,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,outpatient,1,mL,71250.00000,67687.50000,The Alliance,PPO Network,,59208.75,,,,,,,319.74,69112.50,percent of total billed charges,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,inpatient,1,mL,1095.57000,1040.79000,The Alliance,PPO Network,,910.42,,,,,,,602.56,1062.70,percent of total billed charges,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,outpatient,1,mL,1095.57000,1040.79000,The Alliance,PPO Network,,910.42,,,,,,,17.84,1062.70,percent of total billed charges,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,588.00,1164.00,percent of total billed charges,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,PPO Network,,997.20,,,,,,,550.80,1200.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4952.48000,4704.86000,The Alliance,PPO Network,,4115.51,,,,,,,2426.72,4803.91,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,PPO Network,,4115.51,,,,,,,2273.19,4952.48,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,PPO Network,,330.32,,,,,,,182.45,397.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,1443.75000,1371.56000,The Alliance,PPO Network,,1199.76,,,,,,,707.44,1400.44,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,PPO Network,,1199.76,,,,,,,662.68,1443.75,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,inpatient,,,1031.25000,979.69000,The Alliance,PPO Network,,856.97,,,,,,,505.31,1000.31,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,PPO Network,,856.97,,,,,,,515.62,1031.25,percent of total billed charges,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,897.53000,852.65000,The Alliance,PPO Network,,745.85,,,,,,,439.79,870.60,percent of total billed charges,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,897.53000,852.65000,The Alliance,PPO Network,,745.85,,,,,,,411.97,897.53,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4798.95000,4559.00000,The Alliance,PPO Network,,3987.93,,,,,,,2351.49,4654.98,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4798.95000,4559.00000,The Alliance,PPO Network,,3987.93,,,,,,,2202.72,4798.95,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1455.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1470.00,2910.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,PPO Network,,2493.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03850,0.06790,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,PPO Network,,0.05817,,,,,,,0.03500,0.06790,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,inpatient,,,2371.00000,2252.45000,The Alliance,PPO Network,,1970.30,,,,,,,1304.05,2299.87,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,PPO Network,,1970.30,,,,,,,1304.05,5271.00,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3796.02,7514.57,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,PPO Network,,6437.74,,,,,,,3555.86,7746.98,percent of total billed charges,
RMVL/BIVLV HIP SPICA/MINERVA/RISSER 29710-TECH,85858,CDM,510,RC,29710,CPT,,,facility,inpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,191.40,337.56,percent of total billed charges,
RMVL/BIVLV HIP SPICA/MINERVA/RISSER 29710-TECH,85858,CDM,510,RC,29710,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,PPO Network,,289.19,,,,,,,174.00,337.56,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2873.85,5689.05,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,PPO Network,,4873.81,,,,,,,2692.03,5865.00,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,16.32000,15.50000,The Alliance,PPO Network,,13.56,,,,,,,8.00,15.83,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.32000,15.50000,The Alliance,PPO Network,,13.56,,,,,,,8.16,36.65,percent of total billed charges,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1318.46000,1252.54000,The Alliance,PPO Network,,1095.64,,,,,,,646.05,1278.91,percent of total billed charges,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1318.46000,1252.54000,The Alliance,PPO Network,,1095.64,,,,,,,605.17,1318.46,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,PPO Network,,395.76,,,,,,,218.60,476.25,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,643.12,1273.12,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,PPO Network,,1090.69,,,,,,,602.44,1312.50,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.57200,1.01,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,PPO Network,,0.86424,,,,,,,0.52000,1.01,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,inpatient,1,mL,208.56000,198.13000,The Alliance,PPO Network,,173.31,,,,,,,114.71,202.30,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,outpatient,1,mL,208.56000,198.13000,The Alliance,PPO Network,,173.31,,,,,,,104.28,202.30,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8624.83000,8193.59000,The Alliance,PPO Network,,7167.23,,,,,,,4226.17,8366.09,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,PPO Network,,7167.23,,,,,,,3958.80,8624.83,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8624.83000,8193.59000,The Alliance,PPO Network,,7167.23,,,,,,,4226.17,8366.09,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,PPO Network,,7167.23,,,,,,,3958.80,8624.83,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8745.75000,8308.46000,The Alliance,PPO Network,,7267.72,,,,,,,4285.42,8483.38,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,PPO Network,,7267.72,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2916.11,5772.71,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,PPO Network,,4945.49,,,,,,,2731.62,5951.25,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,inpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,8.10,14.28,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,PPO Network,,12.23,,,,,,,7.36,14.28,percent of total billed charges,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,33390.00000,31720.50000,The Alliance,PPO Network,,27747.09,,,,,,,16361.10,32388.30,percent of total billed charges,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,33390.00000,31720.50000,The Alliance,PPO Network,,27747.09,,,,,,,15326.01,32388.30,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1825.74,3614.22,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,PPO Network,,3096.31,,,,,,,1710.23,3726.00,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,31395.00000,29825.25000,The Alliance,PPO Network,,26089.24,,,,,,,15383.55,30453.15,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,31395.00000,29825.25000,The Alliance,PPO Network,,26089.24,,,,,,,14410.31,31395.00,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32970.00000,31321.50000,The Alliance,PPO Network,,27398.07,,,,,,,16155.30,31980.90,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,PPO Network,,27398.07,,,,,,,15133.23,32970.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,inpatient,,,39.04000,37.09000,The Alliance,PPO Network,,32.44,,,,,,,21.47,37.87,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,39.04000,37.09000,The Alliance,PPO Network,,32.44,,,,,,,19.52,37.87,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,229.69,454.69,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,PPO Network,,389.53,,,,,,,215.16,468.75,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,inpatient,1,mL,438.62000,416.69000,The Alliance,PPO Network,,364.49,,,,,,,241.24,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,PPO Network,,364.49,,,,,,,43.62,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,inpatient,1,mL,438.62000,416.69000,The Alliance,PPO Network,,364.49,,,,,,,241.24,425.46,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,PPO Network,,364.49,,,,,,,43.62,425.46,percent of total billed charges,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,inpatient,1,mL,823.62000,782.44000,The Alliance,PPO Network,,684.43,,,,,,,452.99,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,PPO Network,,684.43,,,,,,,0.41000,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,inpatient,1,mL,823.62000,782.44000,The Alliance,PPO Network,,684.43,,,,,,,452.99,798.91,percent of total billed charges,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,PPO Network,,684.43,,,,,,,0.41000,798.91,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,inpatient,1,EA,6037.62000,5735.73000,The Alliance,PPO Network,,5017.26,,,,,,,3320.69,5856.49,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,outpatient,1,EA,6037.62000,5735.73000,The Alliance,PPO Network,,5017.26,,,,,,,44.59,5856.49,percent of total billed charges,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,inpatient,1,mL,5333.84000,5067.15000,The Alliance,PPO Network,,4432.42,,,,,,,2933.61,5173.82,percent of total billed charges,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,outpatient,1,mL,5333.84000,5067.15000,The Alliance,PPO Network,,4432.42,,,,,,,15.08,5173.82,percent of total billed charges,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1893.75000,1799.06000,The Alliance,PPO Network,,1573.71,,,,,,,927.94,1836.94,percent of total billed charges,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1893.75000,1799.06000,The Alliance,PPO Network,,1573.71,,,,,,,869.23,1893.75,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,459.38,909.38,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,PPO Network,,779.06,,,,,,,430.31,937.50,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,551.25,1091.25,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,PPO Network,,934.88,,,,,,,516.38,1125.00,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,7997.10000,7597.24000,The Alliance,PPO Network,,6645.59,,,,,,,3918.58,7757.19,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,PPO Network,,6645.59,,,,,,,3670.67,7997.10,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2442.77,4835.69,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,PPO Network,,4142.74,,,,,,,2288.23,4985.25,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,51282.00000,48717.90000,The Alliance,PPO Network,,42615.34,,,,,,,25128.18,49743.54,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,51282.00000,48717.90000,The Alliance,PPO Network,,42615.34,,,,,,,23538.44,51282.00,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,775.39000,736.62000,The Alliance,PPO Network,,644.35,,,,,,,379.94,752.13,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,775.39000,736.62000,The Alliance,PPO Network,,644.35,,,,,,,355.90,775.39,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,1581.25000,1502.19000,The Alliance,PPO Network,,1314.02,,,,,,,869.69,1533.81,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1581.25000,1502.19000,The Alliance,PPO Network,,1314.02,,,,,,,790.62,1533.81,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,984.38000,935.16000,The Alliance,PPO Network,,818.02,,,,,,,541.41,954.85,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,984.38000,935.16000,The Alliance,PPO Network,,818.02,,,,,,,492.19,954.85,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,inpatient,,,1433.75000,1362.06000,The Alliance,PPO Network,,1191.45,,,,,,,788.56,1390.74,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1433.75000,1362.06000,The Alliance,PPO Network,,1191.45,,,,,,,716.88,1390.74,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,inpatient,1,mL,139.42000,132.45000,The Alliance,PPO Network,,115.86,,,,,,,76.68,135.24,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,outpatient,1,mL,139.42000,132.45000,The Alliance,PPO Network,,115.86,,,,,,,7.57,135.24,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,inpatient,1,mL,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.63800,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,PPO Network,,0.96396,,,,,,,0.58000,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,inpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.59950,1.06,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,PPO Network,,0.90579,,,,,,,0.54500,1.06,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,inpatient,,,262.00000,248.90000,The Alliance,PPO Network,TC,217.72,,,,,,,144.10,254.14,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,PPO Network,TC,217.72,,,,,,,131.00,1331.91,percent of total billed charges,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,inpatient,1,EA,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,11.52,20.32,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,10.47,20.32,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,17633.23000,16751.57000,The Alliance,PPO Network,,14653.21,,,,,,,8640.28,17104.23,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17633.23000,16751.57000,The Alliance,PPO Network,,14653.21,,,,,,,8093.65,17633.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,3025.99,5990.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,PPO Network,,5131.84,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,393.23,778.42,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,368.35,802.50,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,393.23,778.42,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,PPO Network,,666.88,,,,,,,368.35,802.50,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.34650,0.61110,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,PPO Network,,0.52353,,,,,,,0.31500,0.61110,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,inpatient,,,21312.50000,20246.88000,The Alliance,PPO Network,,17710.69,,,,,,,10443.12,20673.12,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,PPO Network,,17710.69,,,,,,,9782.44,21312.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,inpatient,1,mL,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.89650,1.58,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,outpatient,1,mL,1.63000,1.55000,The Alliance,PPO Network,,1.35,,,,,,,0.81500,1.58,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,24180.00000,22971.00000,The Alliance,PPO Network,,20093.58,,,,,,,11848.20,23454.60,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24180.00000,22971.00000,The Alliance,PPO Network,,20093.58,,,,,,,11098.62,24180.00,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,inpatient,,,1123.13000,1066.97000,The Alliance,PPO Network,,933.32,,,,,,,550.33,1089.44,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,1123.13000,1066.97000,The Alliance,PPO Network,,933.32,,,,,,,515.52,1123.13,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,277.12,603.75,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.12650,0.22310,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,PPO Network,,0.19113,,,,,,,0.11500,0.22310,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,inpatient,1,mL,10018.32000,9517.40000,The Alliance,PPO Network,,8325.22,,,,,,,5510.08,9717.77,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,outpatient,1,mL,10018.32000,9517.40000,The Alliance,PPO Network,,8325.22,,,,,,,189.75,9717.77,percent of total billed charges,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,inpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,16.50,29.10,percent of total billed charges,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,PPO Network,,24.93,,,,,,,15.00,29.10,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,inpatient,,,94.90000,90.16000,The Alliance,PPO Network,,78.86,,,,,,,52.20,92.05,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,outpatient,,,94.90000,90.16000,The Alliance,PPO Network,,78.86,,,,,,,47.45,92.05,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.11000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,PPO Network,,0.16620,,,,,,,0.10000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.12100,0.21340,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,PPO Network,,0.18282,,,,,,,0.11000,0.21340,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.73,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,PPO Network,,2.61,,,,,,,1.57,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.72,3.03,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,PPO Network,,2.59,,,,,,,1.56,3.03,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,inpatient,1,mL,12.80000,12.16000,The Alliance,PPO Network,,10.64,,,,,,,7.04,12.42,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,outpatient,1,mL,12.80000,12.16000,The Alliance,PPO Network,,10.64,,,,,,,6.40,48.87,percent of total billed charges,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,inpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,293.70,517.98,percent of total billed charges,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,PPO Network,TC,443.75,,,,,,,267.00,3586.71,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,7400.25000,7030.24000,The Alliance,PPO Network,,6149.61,,,,,,,3626.12,7178.24,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,PPO Network,,6149.61,,,,,,,3396.71,7400.25,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,8452.50000,8029.88000,The Alliance,PPO Network,,7024.03,,,,,,,4141.73,8198.92,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,8452.50000,8029.88000,The Alliance,PPO Network,,7024.03,,,,,,,3879.70,8452.50,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,inpatient,1,mL,27.97000,26.57000,The Alliance,PPO Network,,23.24,,,,,,,15.38,27.13,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,outpatient,1,mL,27.97000,26.57000,The Alliance,PPO Network,,23.24,,,,,,,13.98,27.13,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,PPO Network,,3698.37,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,PPO Network,,296.04,,,,,,,163.52,356.25,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1500.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1500.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,735.00,1455.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,PPO Network,,1246.50,,,,,,,688.50,1500.00,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,13658.95,27039.14,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,PPO Network,,23164.46,,,,,,,12794.81,27875.40,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,30870.00,61110.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,PPO Network,,52353.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,523.69,1036.69,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,PPO Network,,888.13,,,,,,,490.56,1068.75,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,748.13000,710.72000,The Alliance,PPO Network,,621.70,,,,,,,366.58,725.69,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,748.13000,710.72000,The Alliance,PPO Network,,621.70,,,,,,,343.39,748.13,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3510.00000,3334.50000,The Alliance,PPO Network,,2916.81,,,,,,,1719.90,3404.70,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3510.00000,3334.50000,The Alliance,PPO Network,,2916.81,,,,,,,1611.09,3510.00,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,inpatient,,,737.50000,700.62000,The Alliance,PPO Network,TC,612.86,,,,,,,405.62,715.38,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,outpatient,,,737.50000,700.62000,The Alliance,PPO Network,TC,612.86,,,,,,,368.75,7351.18,percent of total billed charges,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1535.00000,1458.25000,The Alliance,PPO Network,,1275.59,,,,,,,844.25,1488.95,percent of total billed charges,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,PPO Network,,1275.59,,,,,,,128.29,6705.74,percent of total billed charges,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,inpatient,1,EA,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,11.52,20.32,percent of total billed charges,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,PPO Network,,17.41,,,,,,,10.47,20.32,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,inpatient,,,108.90000,103.46000,The Alliance,PPO Network,90,90.50,,,,,,,59.90,105.63,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,outpatient,,,108.90000,103.46000,The Alliance,PPO Network,90,90.50,,,,,,,14.25,645.08,percent of total billed charges,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1383.75,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,PPO Network,,501.72,,,,,,,277.12,603.75,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,inpatient,,,22.49000,21.37000,The Alliance,PPO Network,,18.69,,,,,,,12.37,21.82,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,outpatient,,,22.49000,21.37000,The Alliance,PPO Network,,18.69,,,,,,,11.24,37.10,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,inpatient,1,mL,44.98000,42.73000,The Alliance,PPO Network,,37.38,,,,,,,24.74,43.63,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,outpatient,1,mL,44.98000,42.73000,The Alliance,PPO Network,,37.38,,,,,,,22.49,43.63,percent of total billed charges,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,12477.50000,11853.62000,The Alliance,PPO Network,,10368.80,,,,,,,6113.98,12103.17,percent of total billed charges,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,12477.50000,11853.62000,The Alliance,PPO Network,,10368.80,,,,,,,5727.17,12477.50,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1383.75,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,41160.00000,39102.00000,The Alliance,PPO Network,,34203.96,,,,,,,20168.40,39925.20,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,41160.00000,39102.00000,The Alliance,PPO Network,,34203.96,,,,,,,18892.44,39925.20,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,inpatient,,,114.90000,109.16000,The Alliance,PPO Network,90,95.48,,,,,,,63.20,111.45,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,outpatient,,,114.90000,109.16000,The Alliance,PPO Network,90,95.48,,,,,,,15.03,763.98,percent of total billed charges,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,inpatient,,,855.60000,812.82000,The Alliance,PPO Network,90,711.00,,,,,,,470.58,829.93,percent of total billed charges,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,outpatient,,,855.60000,812.82000,The Alliance,PPO Network,90,711.00,,,,,,,35.09,1662.04,percent of total billed charges,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,inpatient,1,mL,50.24000,47.73000,The Alliance,PPO Network,,41.75,,,,,,,27.63,48.73,percent of total billed charges,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,outpatient,1,mL,50.24000,47.73000,The Alliance,PPO Network,,41.75,,,,,,,0.41000,48.73,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,3.16,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,PPO Network,,4.78,,,,,,,2.88,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,inpatient,1,EA,8.58000,8.15000,The Alliance,PPO Network,,7.13,,,,,,,4.72,8.32,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,outpatient,1,EA,8.58000,8.15000,The Alliance,PPO Network,,7.13,,,,,,,4.29,8.32,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,inpatient,1,EA,17.17000,16.31000,The Alliance,PPO Network,,14.27,,,,,,,9.44,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,PPO Network,,14.27,,,,,,,8.59,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,inpatient,1,EA,25.75000,24.47000,The Alliance,PPO Network,,21.40,,,,,,,14.16,24.98,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,outpatient,1,EA,25.75000,24.47000,The Alliance,PPO Network,,21.40,,,,,,,12.88,24.98,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5654.55000,5371.82000,The Alliance,PPO Network,,4698.93,,,,,,,2770.73,5484.91,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5654.55000,5371.82000,The Alliance,PPO Network,,4698.93,,,,,,,2595.44,5654.55,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4183.13000,3973.97000,The Alliance,PPO Network,,3476.18,,,,,,,2049.73,4057.64,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4183.13000,3973.97000,The Alliance,PPO Network,,3476.18,,,,,,,1920.06,4183.13,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2475.00000,2351.25000,The Alliance,PPO Network,,2056.72,,,,,,,1212.75,2400.75,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2475.00000,2351.25000,The Alliance,PPO Network,,2056.72,,,,,,,1136.03,2475.00,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4544.06,8995.39,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,PPO Network,,7706.36,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,19957.80000,18959.91000,The Alliance,PPO Network,,16584.93,,,,,,,9779.32,19359.07,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,19957.80000,18959.91000,The Alliance,PPO Network,,16584.93,,,,,,,9160.63,19957.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1383.75,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,inpatient,,,83.49000,79.32000,The Alliance,PPO Network,,69.38,,,,,,,45.92,80.99,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,PPO Network,,69.38,,,,,,,41.74,138.59,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,inpatient,1,mL,166.98000,158.63000,The Alliance,PPO Network,,138.76,,,,,,,91.84,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,PPO Network,,138.76,,,,,,,83.49,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,inpatient,,,83.49000,79.32000,The Alliance,PPO Network,,69.38,,,,,,,45.92,80.99,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,PPO Network,,69.38,,,,,,,41.74,138.59,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,inpatient,1,mL,166.98000,158.63000,The Alliance,PPO Network,,138.76,,,,,,,91.84,161.97,percent of total billed charges,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,PPO Network,,138.76,,,,,,,83.49,161.97,percent of total billed charges,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,inpatient,1,mL,4383.75000,4164.57000,The Alliance,PPO Network,,3642.90,,,,,,,2411.06,4252.24,percent of total billed charges,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,outpatient,1,mL,4383.75000,4164.57000,The Alliance,PPO Network,,3642.90,,,,,,,1080.88,4252.24,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,PPO Network,,10690.82,,,,,,,5905.03,12865.00,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,inpatient,,,98.00000,93.10000,The Alliance,PPO Network,90,81.44,,,,,,,53.90,95.06,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,PPO Network,90,81.44,,,,,,,12.82,645.08,percent of total billed charges,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,inpatient,,,90.00000,85.50000,The Alliance,PPO Network,90,74.79,,,,,,,49.50,87.30,percent of total billed charges,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,PPO Network,90,74.79,,,,,,,11.77,594.19,percent of total billed charges,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,inpatient,,,420.00000,399.00000,The Alliance,PPO Network,TC,349.02,,,,,,,231.00,407.40,percent of total billed charges,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,PPO Network,TC,349.02,,,,,,,210.00,2162.63,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,inpatient,,,36.49000,34.67000,The Alliance,PPO Network,,30.32,,,,,,,20.07,35.40,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,outpatient,,,36.49000,34.67000,The Alliance,PPO Network,,30.32,,,,,,,18.25,61.17,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,inpatient,1,mL,72.98000,69.33000,The Alliance,PPO Network,,60.65,,,,,,,40.14,70.79,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,outpatient,1,mL,72.98000,69.33000,The Alliance,PPO Network,,60.65,,,,,,,36.49,70.79,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3803.62,7529.62,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3562.99,7762.50,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3803.62,7529.62,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,PPO Network,,6450.64,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,24645.00000,23412.75000,The Alliance,PPO Network,,20479.99,,,,,,,12076.05,23905.65,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,PPO Network,,20479.99,,,,,,,11312.06,24645.00,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,36372.00000,34553.40000,The Alliance,PPO Network,,30225.13,,,,,,,17822.28,35280.84,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,36372.00000,34553.40000,The Alliance,PPO Network,,30225.13,,,,,,,16694.75,36372.00,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1256.25000,1193.44000,The Alliance,PPO Network,,1043.94,,,,,,,615.56,1218.56,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1256.25000,1193.44000,The Alliance,PPO Network,,1043.94,,,,,,,576.62,1256.25,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,PPO Network,,763.48,,,,,,,421.71,918.75,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,532.88,1054.88,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,44688.00000,42453.60000,The Alliance,PPO Network,,37135.73,,,,,,,21897.12,43347.36,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,44688.00000,42453.60000,The Alliance,PPO Network,,37135.73,,,,,,,20511.79,44688.00,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4243.50000,4031.32000,The Alliance,PPO Network,,3526.35,,,,,,,2079.32,4116.19,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,PPO Network,,3526.35,,,,,,,1947.77,4243.50,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,3536.25000,3359.44000,The Alliance,PPO Network,,2938.62,,,,,,,1732.76,3430.16,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,PPO Network,,2938.62,,,,,,,1623.14,3536.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,PPO Network,,8887.55,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1383.75,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,inpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,85.40,150.62,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,PPO Network,,129.04,,,,,,,77.64,150.62,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,915.56000,869.78000,The Alliance,PPO Network,,760.83,,,,,,,448.62,888.09,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,915.56000,869.78000,The Alliance,PPO Network,,760.83,,,,,,,420.24,915.56,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,inpatient,,,932.00000,885.40000,The Alliance,PPO Network,TC,774.49,,,,,,,512.60,904.04,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,PPO Network,TC,774.49,,,,,,,466.00,904.04,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,inpatient,1,mL,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,4.11,7.25,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,PPO Network,,6.21,,,,,,,3.73,7.25,percent of total billed charges,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,331.50000,314.92000,The Alliance,PPO Network,,275.48,,,,,,,162.44,321.56,percent of total billed charges,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,331.50000,314.92000,The Alliance,PPO Network,,275.48,,,,,,,152.16,331.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,inpatient,,,66150.00000,62842.50000,The Alliance,PPO Network,,54970.65,,,,,,,32413.50,64165.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,outpatient,,,66150.00000,62842.50000,The Alliance,PPO Network,,54970.65,,,,,,,30362.85,64165.50,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1856.25000,1763.44000,The Alliance,PPO Network,,1542.54,,,,,,,909.56,1800.56,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1856.25000,1763.44000,The Alliance,PPO Network,,1542.54,,,,,,,852.02,1856.25,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,415.12,5858.00,percent of total billed charges,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,90,1121.85,,,,,,,742.50,1309.50,percent of total billed charges,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,90,1121.85,,,,,,,675.00,1309.50,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,50.10,88.37,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,11.91,594.19,percent of total billed charges,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,5271.00,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,220.50,3163.00,percent of total billed charges,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,inpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,2518.12,percent of total billed charges,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,PPO Network,,2157.28,,,,,,,1427.80,5271.00,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,4692.00000,4457.40000,The Alliance,PPO Network,,3899.05,,,,,,,2299.08,4551.24,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,PPO Network,,3899.05,,,,,,,2153.63,4692.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1859.55,3681.15,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,PPO Network,,3153.64,,,,,,,1741.90,3795.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,PPO Network,,712.07,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,PPO Network,,342.79,,,,,,,189.34,412.50,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2484.38000,2360.16000,The Alliance,PPO Network,,2064.52,,,,,,,1217.35,2409.85,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2484.38000,2360.16000,The Alliance,PPO Network,,2064.52,,,,,,,1140.33,2484.38,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2925.00000,2778.75000,The Alliance,PPO Network,,2430.68,,,,,,,1433.25,2837.25,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2925.00000,2778.75000,The Alliance,PPO Network,,2430.68,,,,,,,1342.58,2925.00,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,inpatient,,,1477.00000,1403.15000,The Alliance,PPO Network,TC,1227.39,,,,,,,812.35,1432.69,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,outpatient,,,1477.00000,1403.15000,The Alliance,PPO Network,TC,1227.39,,,,,,,738.50,1432.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,inpatient,,,277.00000,263.15000,The Alliance,PPO Network,TC,230.19,,,,,,,152.35,268.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,PPO Network,TC,230.19,,,,,,,138.50,268.69,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,inpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,134.75,237.65,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,PPO Network,TC,203.59,,,,,,,122.50,237.65,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,inpatient,,,201.10000,191.04000,The Alliance,PPO Network,90,167.11,,,,,,,110.61,195.07,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,outpatient,,,201.10000,191.04000,The Alliance,PPO Network,90,167.11,,,,,,,16.91,1211.55,percent of total billed charges,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,inpatient,,,167.70000,159.31000,The Alliance,PPO Network,90,139.36,,,,,,,92.23,162.67,percent of total billed charges,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,outpatient,,,167.70000,159.31000,The Alliance,PPO Network,90,139.36,,,,,,,21.94,1103.49,percent of total billed charges,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,inpatient,,,277.20000,263.34000,The Alliance,PPO Network,,230.35,,,,,,,152.46,268.88,percent of total billed charges,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,PPO Network,,230.35,,,,,,,35.09,1833.46,percent of total billed charges,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,90,1121.85,,,,,,,742.50,1309.50,percent of total billed charges,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,PPO Network,90,1121.85,,,,,,,675.00,4687.50,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,10524.50000,9998.27000,The Alliance,PPO Network,,8745.86,,,,,,,5157.01,10208.76,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,PPO Network,,8745.86,,,,,,,4830.75,10524.50,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,inpatient,,,533.61000,506.93000,The Alliance,PPO Network,,443.43,,,,,,,293.49,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,outpatient,,,533.61000,506.93000,The Alliance,PPO Network,,443.43,,,,,,,266.81,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,inpatient,1,EA,533.61000,506.93000,The Alliance,PPO Network,,443.43,,,,,,,293.49,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,outpatient,1,EA,533.61000,506.93000,The Alliance,PPO Network,,443.43,,,,,,,266.81,517.60,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,349.86,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3550.05,7027.65,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,PPO Network,,6020.60,,,,,,,3325.45,7245.00,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,6399.89000,6079.90000,The Alliance,PPO Network,,5318.31,,,,,,,3135.95,6207.89,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,6399.89000,6079.90000,The Alliance,PPO Network,,5318.31,,,,,,,2937.55,6399.89,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,468.56,927.56,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,PPO Network,,794.64,,,,,,,438.92,956.25,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,inpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,3.24,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,inpatient,1,EA,42.84000,40.70000,The Alliance,PPO Network,,35.60,,,,,,,23.56,41.55,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,outpatient,1,EA,42.84000,40.70000,The Alliance,PPO Network,,35.60,,,,,,,0.05000,41.55,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,inpatient,1,EA,19.09000,18.13000,The Alliance,PPO Network,,15.86,,,,,,,10.50,18.52,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,outpatient,1,EA,19.09000,18.13000,The Alliance,PPO Network,,15.86,,,,,,,0.05000,18.52,percent of total billed charges,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,inpatient,,,3245.00000,3082.75000,The Alliance,PPO Network,,2696.59,,,,,,,1784.75,3147.65,percent of total billed charges,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,PPO Network,,2696.59,,,,,,,1784.75,5271.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,7139.30,14132.90,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,PPO Network,,12107.67,,,,,,,6687.63,14570.00,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,inpatient,1,mL,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.16,2.04,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,outpatient,1,mL,2.10000,1.99000,The Alliance,PPO Network,,1.75,,,,,,,1.05,2.04,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,inpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,8.69,15.33,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,PPO Network,,13.13,,,,,,,7.90,15.33,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2535.75,5019.75,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,PPO Network,,4300.43,,,,,,,2375.32,5175.00,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,65.66,129.98,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,PPO Network,,111.35,,,,,,,61.51,134.00,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,PPO Network,GP,670.62,,,,,,,443.85,782.79,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,PPO Network,GP,670.62,,,,,,,126.65,782.79,percent of total billed charges,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,inpatient,,,710.00000,674.50000,The Alliance,PPO Network,GO,590.01,,,,,,,390.50,688.70,percent of total billed charges,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,PPO Network,GO,590.01,,,,,,,126.65,688.70,percent of total billed charges,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,inpatient,,,710.00000,674.50000,The Alliance,PPO Network,GP,590.01,,,,,,,390.50,688.70,percent of total billed charges,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,PPO Network,GP,590.01,,,,,,,126.65,688.70,percent of total billed charges,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,inpatient,,,807.00000,766.65000,The Alliance,PPO Network,G0,670.62,,,,,,,443.85,782.79,percent of total billed charges,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,PPO Network,G0,670.62,,,,,,,126.65,782.79,percent of total billed charges,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,866.25000,822.94000,The Alliance,PPO Network,,719.85,,,,,,,424.46,840.26,percent of total billed charges,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,866.25000,822.94000,The Alliance,PPO Network,,719.85,,,,,,,397.61,866.25,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3195.98000,3036.18000,The Alliance,PPO Network,,2655.86,,,,,,,1566.03,3100.10,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3195.98000,3036.18000,The Alliance,PPO Network,,2655.86,,,,,,,1466.95,3195.98,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,479.40000,455.43000,The Alliance,PPO Network,,398.38,,,,,,,234.91,465.02,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,PPO Network,,398.38,,,,,,,220.04,479.40,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08800,0.15520,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,PPO Network,,0.13296,,,,,,,0.08000,0.15520,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,inpatient,,,1576.91000,1498.06000,The Alliance,PPO Network,,1310.41,,,,,,,867.30,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,PPO Network,,1310.41,,,,,,,671.22,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,inpatient,,,1576.91000,1498.06000,The Alliance,PPO Network,JW,1310.41,,,,,,,867.30,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,PPO Network,JW,1310.41,,,,,,,788.46,1529.60,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,inpatient,1,EA,364.23000,346.02000,The Alliance,PPO Network,,302.68,,,,,,,200.33,353.30,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,outpatient,1,EA,364.23000,346.02000,The Alliance,PPO Network,,302.68,,,,,,,182.12,353.30,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,inpatient,1,mL,1585.11000,1505.85000,The Alliance,PPO Network,,1317.23,,,,,,,871.81,1537.56,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,outpatient,1,mL,1585.11000,1505.85000,The Alliance,PPO Network,,1317.23,,,,,,,652.75,1537.56,percent of total billed charges,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,inpatient,1,mL,13617.45000,12936.58000,The Alliance,PPO Network,,11316.10,,,,,,,7489.60,13208.93,percent of total billed charges,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,outpatient,1,mL,13617.45000,12936.58000,The Alliance,PPO Network,,11316.10,,,,,,,229.11,13208.93,percent of total billed charges,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,2850.39,6023.70,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1144.20000,1086.99000,The Alliance,PPO Network,90,950.83,,,,,,,629.31,1109.87,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,PPO Network,90,950.83,,,,,,,149.66,7571.58,percent of total billed charges,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,50.10,88.37,percent of total billed charges,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,11.91,594.19,percent of total billed charges,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,inpatient,,,1695.50000,1610.72000,The Alliance,PPO Network,90,1408.96,,,,,,,932.52,1644.63,percent of total billed charges,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1695.50000,1610.72000,The Alliance,PPO Network,90,1408.96,,,,,,,175.54,10101.09,percent of total billed charges,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1144.20000,1086.99000,The Alliance,PPO Network,90,950.83,,,,,,,629.31,1109.87,percent of total billed charges,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,PPO Network,90,950.83,,,,,,,149.66,7571.58,percent of total billed charges,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1295.30000,1230.53000,The Alliance,PPO Network,90,1076.39,,,,,,,712.41,1256.44,percent of total billed charges,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,PPO Network,90,1076.39,,,,,,,169.42,8573.20,percent of total billed charges,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1295.30000,1230.53000,The Alliance,PPO Network,90,1076.39,,,,,,,712.41,1256.44,percent of total billed charges,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,PPO Network,90,1076.39,,,,,,,169.42,8573.20,percent of total billed charges,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,inpatient,1,EA,7168.24000,6809.83000,The Alliance,PPO Network,,5956.81,,,,,,,3942.53,6953.19,percent of total billed charges,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,outpatient,1,EA,7168.24000,6809.83000,The Alliance,PPO Network,,5956.81,,,,,,,31.33,6953.19,percent of total billed charges,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,inpatient,1,mL,1585.12000,1505.86000,The Alliance,PPO Network,,1317.23,,,,,,,871.82,1537.57,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,outpatient,1,mL,1585.12000,1505.86000,The Alliance,PPO Network,,1317.23,,,,,,,652.75,1537.57,percent of total billed charges,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,inpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,PPO Network,,0.01662,,,,,,,0.01000,4.06,percent of total billed charges,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2343.75000,2226.56000,The Alliance,PPO Network,,1947.66,,,,,,,1289.06,2273.44,percent of total billed charges,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,PPO Network,,1947.66,,,,,,,1171.88,2273.44,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,8280.00000,7866.00000,The Alliance,PPO Network,,6880.68,,,,,,,4554.00,8031.60,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,PPO Network,,6880.68,,,,,,,4140.00,8031.60,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,7759.05000,7371.10000,The Alliance,PPO Network,,6447.77,,,,,,,3801.93,7526.28,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,PPO Network,,6447.77,,,,,,,3561.40,7759.05,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,inpatient,,,21312.50000,20246.88000,The Alliance,PPO Network,,17710.69,,,,,,,10443.12,20673.12,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,PPO Network,,17710.69,,,,,,,9782.44,21312.50,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,4753.24,8382.98,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,PPO Network,,7181.71,,,,,,,4321.12,8382.98,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5765.30000,5477.04000,The Alliance,PPO Network,,4790.96,,,,,,,2825.00,5592.34,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5765.30000,5477.04000,The Alliance,PPO Network,,4790.96,,,,,,,2646.27,5765.30,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,231.75000,220.16000,The Alliance,PPO Network,,192.58,,,,,,,113.56,224.80,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,231.75000,220.16000,The Alliance,PPO Network,,192.58,,,,,,,106.37,231.75,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,inpatient,1,mL,31.13000,29.57000,The Alliance,PPO Network,,25.87,,,,,,,17.12,30.20,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,outpatient,1,mL,31.13000,29.57000,The Alliance,PPO Network,,25.87,,,,,,,15.56,30.20,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,inpatient,1,mL,5333.61000,5066.93000,The Alliance,PPO Network,,4432.23,,,,,,,2933.49,5173.60,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,outpatient,1,mL,5333.61000,5066.93000,The Alliance,PPO Network,,4432.23,,,,,,,15.08,5173.60,percent of total billed charges,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32970.00000,31321.50000,The Alliance,PPO Network,,27398.07,,,,,,,16155.30,31980.90,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,PPO Network,,27398.07,,,,,,,15133.23,32970.00,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,777.68000,738.80000,The Alliance,PPO Network,,646.25,,,,,,,381.06,754.35,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,PPO Network,,646.25,,,,,,,356.96,777.68,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,639.45,1265.85,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,599.00,1305.00,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25160.53000,23902.50000,The Alliance,PPO Network,,20908.40,,,,,,,12328.66,24405.71,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,PPO Network,,20908.40,,,,,,,11548.68,25160.53,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1781.25000,1692.19000,The Alliance,PPO Network,,1480.22,,,,,,,872.81,1727.81,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1781.25000,1692.19000,The Alliance,PPO Network,,1480.22,,,,,,,817.59,1781.25,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,153.47,600.19,percent of total billed charges,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,inpatient,1,mL,1796.53000,1706.70000,The Alliance,PPO Network,,1492.92,,,,,,,988.09,1742.63,percent of total billed charges,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,outpatient,1,mL,1796.53000,1706.70000,The Alliance,PPO Network,,1492.92,,,,,,,74.86,1742.63,percent of total billed charges,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20398.96000,19379.01000,The Alliance,PPO Network,,16951.54,,,,,,,9995.49,19786.99,percent of total billed charges,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,PPO Network,,16951.54,,,,,,,9363.12,20398.96,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,inpatient,1,mL,72.68000,69.05000,The Alliance,PPO Network,,60.40,,,,,,,39.97,70.50,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,outpatient,1,mL,72.68000,69.05000,The Alliance,PPO Network,,60.40,,,,,,,36.34,70.50,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,inpatient,1,mL,20263.50000,19250.32000,The Alliance,PPO Network,,16838.97,,,,,,,11144.92,19655.60,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,outpatient,1,mL,20263.50000,19250.32000,The Alliance,PPO Network,,16838.97,,,,,,,481.57,19655.60,percent of total billed charges,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30287.00000,28772.65000,The Alliance,PPO Network,,25168.50,,,,,,,14840.63,29378.39,percent of total billed charges,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,PPO Network,,25168.50,,,,,,,13901.73,30287.00,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1782.38,3528.38,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,PPO Network,,3022.76,,,,,,,1669.61,3637.50,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,inpatient,1,EA,11110.82000,10555.28000,The Alliance,PPO Network,,9233.09,,,,,,,6110.95,10777.50,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,outpatient,1,EA,11110.82000,10555.28000,The Alliance,PPO Network,,9233.09,,,,,,,161.96,10777.50,percent of total billed charges,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,1114.70,1965.93,percent of total billed charges,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,1013.37,1965.93,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,inpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,1.01,1.78,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,PPO Network,,1.52,,,,,,,0.91500,1.78,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,PPO Network,,990.97,,,,,,,547.36,1192.50,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,PPO Network,,5160.51,,,,,,,2850.39,6210.00,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5165.13,11253.00,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17084.19000,16229.98000,The Alliance,PPO Network,,14196.96,,,,,,,8371.25,16571.66,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,PPO Network,,14196.96,,,,,,,7841.64,17084.19,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1302.00000,1236.90000,The Alliance,PPO Network,,1081.96,,,,,,,637.98,1262.94,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,PPO Network,,1081.96,,,,,,,597.62,1302.00,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,930.27,2026.73,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,inpatient,1,EA,161.86000,153.76000,The Alliance,PPO Network,,134.51,,,,,,,89.02,157.00,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,outpatient,1,EA,161.86000,153.76000,The Alliance,PPO Network,,134.51,,,,,,,80.93,157.00,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,inpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.24200,0.42680,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,PPO Network,,0.36564,,,,,,,0.22000,0.42680,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6555.00000,6227.25000,The Alliance,PPO Network,,5447.20,,,,,,,3211.95,6358.35,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,PPO Network,,5447.20,,,,,,,3008.74,6555.00,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10036.05000,9534.25000,The Alliance,PPO Network,,8339.96,,,,,,,4917.66,9734.97,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10036.05000,9534.25000,The Alliance,PPO Network,,8339.96,,,,,,,4606.55,10036.05,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,7759.05000,7371.10000,The Alliance,PPO Network,,6447.77,,,,,,,3801.93,7526.28,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,PPO Network,,6447.77,,,,,,,3561.40,7759.05,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,288.75,509.25,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,17.85,814.87,percent of total billed charges,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,inpatient,,,225.00000,213.75000,The Alliance,PPO Network,90,186.97,,,,,,,123.75,218.25,percent of total billed charges,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,PPO Network,90,186.97,,,,,,,11.91,594.19,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,288.75,509.25,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,262.50,509.25,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,inpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,50.10,88.37,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,PPO Network,90,75.70,,,,,,,11.91,594.19,percent of total billed charges,
INS VAG RAD AFTERLOADING APPAR 57156 TECH,86263,CDM,510,RC,57156,CPT,,,facility,inpatient,,,404.75000,384.51000,The Alliance,PPO Network,,336.35,,,,,,,222.61,392.61,percent of total billed charges,
INS VAG RAD AFTERLOADING APPAR 57156 TECH,86263,CDM,510,RC,57156,CPT,,,facility,outpatient,,,404.75000,384.51000,The Alliance,PPO Network,,336.35,,,,,,,202.38,392.61,percent of total billed charges,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,inpatient,,,600.00000,570.00000,The Alliance,PPO Network,90,498.60,,,,,,,330.00,582.00,percent of total billed charges,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,PPO Network,90,498.60,,,,,,,43.15,2190.01,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,inpatient,,,534.80000,508.06000,The Alliance,PPO Network,90,444.42,,,,,,,294.14,518.76,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,outpatient,,,534.80000,508.06000,The Alliance,PPO Network,90,444.42,,,,,,,24.89,1137.41,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,inpatient,,,133.70000,127.01000,The Alliance,PPO Network,90,111.10,,,,,,,73.53,129.69,percent of total billed charges,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,outpatient,,,133.70000,127.01000,The Alliance,PPO Network,90,111.10,,,,,,,5.35,271.65,percent of total billed charges,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,inpatient,,,225.00000,213.75000,The Alliance,PPO Network,90,186.97,,,,,,,123.75,218.25,percent of total billed charges,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,PPO Network,90,186.97,,,,,,,24.89,1137.41,percent of total billed charges,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,48.52000,46.09000,The Alliance,PPO Network,,40.32,,,,,,,23.77,47.06,percent of total billed charges,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,48.52000,46.09000,The Alliance,PPO Network,,40.32,,,,,,,22.27,48.52,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,617.40,1222.20,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,PPO Network,,1047.06,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,inpatient,,,2246.25000,2133.94000,The Alliance,PPO Network,,1866.63,,,,,,,1100.66,2178.86,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,2246.25000,2133.94000,The Alliance,PPO Network,,1866.63,,,,,,,1031.03,2246.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,inpatient,,,68.20000,64.79000,The Alliance,PPO Network,,56.67,,,,,,,37.51,66.15,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,PPO Network,,56.67,,,,,,,37.51,5271.00,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,inpatient,1,EA,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,8.95,15.79,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,PPO Network,,13.53,,,,,,,8.14,15.79,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,PPO Network,GO,119.75,,,,,,,79.25,139.78,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,PPO Network,GO,119.75,,,,,,,72.05,264.00,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,GO,242.65,,,,,,,160.60,283.24,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,GO,242.65,,,,,,,126.65,283.24,percent of total billed charges,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,PPO Network,GO,101.88,,,,,,,67.43,118.92,percent of total billed charges,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,PPO Network,GO,101.88,,,,,,,61.30,264.00,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,PPO Network,GP,119.75,,,,,,,79.25,139.78,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,PPO Network,GP,119.75,,,,,,,72.05,264.00,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,GP,242.65,,,,,,,160.60,283.24,percent of total billed charges,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,GP,242.65,,,,,,,126.65,283.24,percent of total billed charges,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,PPO Network,GP,101.88,,,,,,,67.43,118.92,percent of total billed charges,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,PPO Network,GP,101.88,,,,,,,61.30,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,inpatient,,,144.10000,136.89000,The Alliance,PPO Network,GN,119.75,,,,,,,79.25,139.78,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,PPO Network,GN,119.75,,,,,,,72.05,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,inpatient,,,292.00000,277.40000,The Alliance,PPO Network,GN,242.65,,,,,,,160.60,283.24,percent of total billed charges,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,PPO Network,GN,242.65,,,,,,,126.65,283.24,percent of total billed charges,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,inpatient,,,122.60000,116.47000,The Alliance,PPO Network,GN,101.88,,,,,,,67.43,118.92,percent of total billed charges,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,PPO Network,GN,101.88,,,,,,,61.30,264.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,500.74000,475.70000,The Alliance,PPO Network,,416.11,,,,,,,245.36,485.72,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,PPO Network,,416.11,,,,,,,229.84,500.74,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,2910.60,5133.24,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,PPO Network,,4397.65,,,,,,,1388.02,5133.24,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1041.00000,988.95000,The Alliance,PPO Network,,865.07,,,,,,,510.09,1009.77,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1041.00000,988.95000,The Alliance,PPO Network,,865.07,,,,,,,477.82,1041.00,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,PPO Network,,33854.94,,,,,,,18699.66,39517.80,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9455.00000,8982.25000,The Alliance,PPO Network,,7857.10,,,,,,,4632.95,9171.35,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9455.00000,8982.25000,The Alliance,PPO Network,,7857.10,,,,,,,4339.85,9455.00,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,10617.50000,10086.62000,The Alliance,PPO Network,,8823.14,,,,,,,5202.57,10298.98,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,PPO Network,,8823.14,,,,,,,4873.43,10617.50,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,113.92,225.53,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,PPO Network,,193.21,,,,,,,106.72,232.50,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2756.25000,2618.44000,The Alliance,PPO Network,,2290.44,,,,,,,1350.56,2673.56,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,PPO Network,,2290.44,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,1873.91000,1780.21000,The Alliance,PPO Network,,1557.22,,,,,,,918.22,1817.69,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1873.91000,1780.21000,The Alliance,PPO Network,,1557.22,,,,,,,860.12,1873.91,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,90,1328.77,,,,,,,879.45,1551.03,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,90,1328.77,,,,,,,161.92,9523.86,percent of total billed charges,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,inpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,90,1328.77,,,,,,,879.45,1551.03,percent of total billed charges,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,PPO Network,90,1328.77,,,,,,,161.92,9523.86,percent of total billed charges,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,inpatient,,,74.60000,70.87000,The Alliance,PPO Network,90,61.99,,,,,,,41.03,72.36,percent of total billed charges,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,outpatient,,,74.60000,70.87000,The Alliance,PPO Network,90,61.99,,,,,,,3.40,492.33,percent of total billed charges,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,inpatient,,,35.00000,33.25000,The Alliance,PPO Network,90,29.09,,,,,,,19.25,33.95,percent of total billed charges,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,PPO Network,90,29.09,,,,,,,17.50,2020.22,percent of total billed charges,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,55.94,98.65,percent of total billed charges,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,45.08,679.08,percent of total billed charges,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,inpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,55.94,98.65,percent of total billed charges,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,PPO Network,90,84.51,,,,,,,45.08,679.08,percent of total billed charges,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,inpatient,,,427.50000,406.12000,The Alliance,PPO Network,90,355.25,,,,,,,235.12,414.68,percent of total billed charges,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,outpatient,,,427.50000,406.12000,The Alliance,PPO Network,90,355.25,,,,,,,35.09,1969.25,percent of total billed charges,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,inpatient,,,312.60000,296.97000,The Alliance,PPO Network,90,259.77,,,,,,,171.93,303.22,percent of total billed charges,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,outpatient,,,312.60000,296.97000,The Alliance,PPO Network,90,259.77,,,,,,,45.08,679.08,percent of total billed charges,
EXN TMR THIGH/KNE SUBQ>=3CM-TECH,86367,CDM,510,RC,27337,CPT,,,facility,inpatient,,,1188.00000,1128.60000,The Alliance,PPO Network,,987.23,,,,,,,653.40,1152.36,percent of total billed charges,
EXN TMR THIGH/KNE SUBQ>=3CM-TECH,86367,CDM,510,RC,27337,CPT,,,facility,outpatient,,,1188.00000,1128.60000,The Alliance,PPO Network,,987.23,,,,,,,594.00,2989.39,percent of total billed charges,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,inpatient,1,EA,135.25000,128.49000,The Alliance,PPO Network,,112.39,,,,,,,74.39,131.19,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,outpatient,1,EA,135.25000,128.49000,The Alliance,PPO Network,,112.39,,,,,,,9.78,131.19,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,inpatient,1,EA,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1897.50,3346.50,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,outpatient,1,EA,3450.00000,3277.50000,The Alliance,PPO Network,,2866.95,,,,,,,1567.49,3346.50,percent of total billed charges,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,inpatient,1,EA,28500.00000,27075.00000,The Alliance,PPO Network,,23683.50,,,,,,,15675.00,27645.00,percent of total billed charges,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,outpatient,1,EA,28500.00000,27075.00000,The Alliance,PPO Network,,23683.50,,,,,,,1567.49,27645.00,percent of total billed charges,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,inpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,17.38,30.65,percent of total billed charges,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,PPO Network,,26.26,,,,,,,15.80,30.65,percent of total billed charges,
ROOM/BED   INTERMEDIATE CARE,86380,CDM,206,RC,,,,,facility,inpatient,,,2465.00000,2341.75000,The Alliance,PPO Network,,2048.41,,,,,,,1355.75,2391.05,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,930.27,2026.73,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8350.38000,7932.86000,The Alliance,PPO Network,,6939.17,,,,,,,4091.69,8099.87,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8350.38000,7932.86000,The Alliance,PPO Network,,6939.17,,,,,,,3832.82,8350.38,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,26.88000,25.54000,The Alliance,PPO Network,,22.34,,,,,,,13.17,26.07,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,26.88000,25.54000,The Alliance,PPO Network,,22.34,,,,,,,12.34,26.88,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3631.24000,3449.68000,The Alliance,PPO Network,,3017.56,,,,,,,1779.31,3522.30,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3631.24000,3449.68000,The Alliance,PPO Network,,3017.56,,,,,,,1666.74,3631.24,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,inpatient,1,EA,159.99000,151.99000,The Alliance,PPO Network,,132.95,,,,,,,87.99,155.19,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,PPO Network,,132.95,,,,,,,80.00,155.19,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,inpatient,,,4042.00000,3839.90000,The Alliance,PPO Network,,3358.90,,,,,,,2223.10,3920.74,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,PPO Network,,3358.90,,,,,,,1836.07,25313.80,percent of total billed charges,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1228.13000,1166.72000,The Alliance,PPO Network,,1020.58,,,,,,,601.78,1191.29,percent of total billed charges,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1228.13000,1166.72000,The Alliance,PPO Network,,1020.58,,,,,,,563.71,1228.13,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2311.39000,2195.82000,The Alliance,PPO Network,,1920.77,,,,,,,1132.58,2242.05,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2311.39000,2195.82000,The Alliance,PPO Network,,1920.77,,,,,,,1060.93,2311.39,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,PPO Network,,8314.16,,,,,,,4592.30,10005.00,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,532.88,1054.88,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,PPO Network,,903.71,,,,,,,499.16,1087.50,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,993.10,1965.93,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,PPO Network,,1684.21,,,,,,,930.27,2026.73,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,inpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,78.21,137.93,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,PPO Network,,118.17,,,,,,,2.53,137.93,percent of total billed charges,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,280.78000,266.74000,The Alliance,PPO Network,,233.33,,,,,,,154.43,272.36,percent of total billed charges,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,280.78000,266.74000,The Alliance,PPO Network,,233.33,,,,,,,51.64,272.36,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,73.00,264.00,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,73.00,264.00,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,126.65,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,126.65,286.15,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,inpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,80.30,141.62,percent of total billed charges,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,PPO Network,,121.33,,,,,,,73.00,264.00,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,inpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,162.25,286.15,percent of total billed charges,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,PPO Network,,245.15,,,,,,,126.65,286.15,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,inpatient,1,mL,15.29000,14.53000,The Alliance,PPO Network,,12.71,,,,,,,8.41,14.83,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,outpatient,1,mL,15.29000,14.53000,The Alliance,PPO Network,,12.71,,,,,,,7.64,14.83,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,inpatient,1,mL,13763.10000,13074.94000,The Alliance,PPO Network,,11437.14,,,,,,,7569.70,13350.21,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,outpatient,1,mL,13763.10000,13074.94000,The Alliance,PPO Network,,11437.14,,,,,,,185.31,13350.21,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,inpatient,1,mL,13762.90000,13074.75000,The Alliance,PPO Network,,11436.97,,,,,,,7569.60,13350.01,percent of total billed charges,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,outpatient,1,mL,13762.90000,13074.75000,The Alliance,PPO Network,,11436.97,,,,,,,185.31,13350.01,percent of total billed charges,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,inpatient,1,mL,840.20000,798.19000,The Alliance,PPO Network,,698.21,,,,,,,462.11,814.99,percent of total billed charges,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,outpatient,1,mL,840.20000,798.19000,The Alliance,PPO Network,,698.21,,,,,,,7.86,814.99,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,inpatient,,,26565.00000,25236.75000,The Alliance,PPO Network,,22075.51,,,,,,,13016.85,25768.05,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,outpatient,,,26565.00000,25236.75000,The Alliance,PPO Network,,22075.51,,,,,,,12193.33,25768.05,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4653.95,9212.91,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,PPO Network,,7892.71,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2958.38,5856.38,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,PPO Network,,5017.16,,,,,,,2771.21,6037.50,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5633.85000,5352.16000,The Alliance,PPO Network,,4681.73,,,,,,,2760.59,5464.83,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5633.85000,5352.16000,The Alliance,PPO Network,,4681.73,,,,,,,2585.94,5633.85,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,inpatient,1,mL,8.84000,8.40000,The Alliance,PPO Network,,7.35,,,,,,,4.86,8.57,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,outpatient,1,mL,8.84000,8.40000,The Alliance,PPO Network,,7.35,,,,,,,4.42,8.57,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,500.74000,475.70000,The Alliance,PPO Network,,416.11,,,,,,,245.36,485.72,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,PPO Network,,416.11,,,,,,,229.84,500.74,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,668.09,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,inpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1485.00,2619.00,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,PPO Network,,2243.70,,,,,,,1350.00,2619.00,percent of total billed charges,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,128.96000,122.51000,The Alliance,PPO Network,,107.17,,,,,,,70.93,125.09,percent of total billed charges,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,128.96000,122.51000,The Alliance,PPO Network,,107.17,,,,,,,64.48,125.09,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,inpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,695.20,1226.08,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,PPO Network,,1050.38,,,,,,,632.00,1226.08,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,PPO Network,,7013.13,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,358.95,710.58,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,PPO Network,,608.76,,,,,,,336.25,732.56,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,127.05,224.07,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,PPO Network,,191.96,,,,,,,115.50,224.07,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,PPO Network,,1269.81,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,10617.50000,10086.62000,The Alliance,PPO Network,,8823.14,,,,,,,5202.57,10298.98,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,PPO Network,,8823.14,,,,,,,4873.43,10617.50,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,inpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,15.64,27.59,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,PPO Network,,23.63,,,,,,,3.49,27.59,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,105.60000,100.32000,The Alliance,PPO Network,,87.75,,,,,,,51.74,102.43,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,105.60000,100.32000,The Alliance,PPO Network,,87.75,,,,,,,48.47,105.60,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,,10.56,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,JW,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,JW,10.56,,,,,,,2.31,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,The Alliance,PPO Network,JW,10.56,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,PPO Network,JW,10.56,,,,,,,2.31,12.33,percent of total billed charges,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2366.70,4685.10,percent of total billed charges,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,PPO Network,,4013.73,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,2028.60,4015.80,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,PPO Network,,3440.34,,,,,,,1900.26,4140.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,119.44,236.44,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,PPO Network,,473.67,,,,,,,261.63,570.00,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,4194.64,8303.68,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,PPO Network,,7113.77,,,,,,,3929.26,8560.49,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5513.97,10915.41,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,PPO Network,,9351.24,,,,,,,5165.13,11253.00,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2171.96000,2063.36000,The Alliance,PPO Network,,1804.90,,,,,,,1064.26,2106.80,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2171.96000,2063.36000,The Alliance,PPO Network,,1804.90,,,,,,,996.93,2171.96,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,23436.00000,22264.20000,The Alliance,PPO Network,,19475.32,,,,,,,11483.64,22732.92,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,PPO Network,,19475.32,,,,,,,10757.12,23436.00,percent of total billed charges,
CPR- TECH,86472,CDM,510,RC,92950,CPT,,,facility,inpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,325.05,573.27,percent of total billed charges,
CPR- TECH,86472,CDM,510,RC,92950,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,PPO Network,,491.12,,,,,,,295.50,573.27,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,inpatient,1,EA,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,2561.62,4517.77,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,outpatient,1,EA,4657.50000,4424.62000,The Alliance,PPO Network,,3870.38,,,,,,,212.36,4517.77,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,678.04,1342.24,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,PPO Network,,1149.90,,,,,,,635.14,1383.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7109.10000,6753.65000,The Alliance,PPO Network,,5907.66,,,,,,,3483.46,6895.83,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,PPO Network,,5907.66,,,,,,,3263.08,7109.10,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,PPO Network,,149.58,,,,,,,82.62,180.00,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,33.56000,31.88000,The Alliance,PPO Network,,27.89,,,,,,,16.44,32.55,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,PPO Network,,27.89,,,,,,,16.78,92.45,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,inpatient,1,mL,2420.87000,2299.83000,The Alliance,PPO Network,,2011.74,,,,,,,1331.48,2348.24,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,outpatient,1,mL,2420.87000,2299.83000,The Alliance,PPO Network,,2011.74,,,,,,,1210.43,4602.85,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,inpatient,1,mL,2420.88000,2299.83000,The Alliance,PPO Network,,2011.75,,,,,,,1331.48,2348.25,percent of total billed charges,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,outpatient,1,mL,2420.88000,2299.83000,The Alliance,PPO Network,,2011.75,,,,,,,1210.44,4602.85,percent of total billed charges,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,PPO Network,,8277.01,,,,,,,4571.78,9960.30,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1016.03000,965.23000,The Alliance,PPO Network,,844.32,,,,,,,497.85,985.55,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1016.03000,965.23000,The Alliance,PPO Network,,844.32,,,,,,,466.36,1016.03,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,PPO Network,,1324.41,,,,,,,731.53,1593.75,percent of total billed charges,
90837 PSYCHOTHERAPY 60 MIN-APNP TECH,86485,CDM,510,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,123.20,217.28,percent of total billed charges,
90837 PSYCHOTHERAPY 60 MIN-APNP TECH,86485,CDM,510,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,PPO Network,,186.14,,,,,,,112.00,217.28,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,inpatient,,,4764.17000,4525.96000,The Alliance,PPO Network,,3959.03,,,,,,,2620.29,4621.24,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,4764.17000,4525.96000,The Alliance,PPO Network,,3959.03,,,,,,,2382.09,4621.24,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,266.44,527.44,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,PPO Network,,451.86,,,,,,,249.58,543.75,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,inpatient,,,99.00000,94.05000,The Alliance,PPO Network,TC,82.27,,,,,,,54.45,96.03,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,PPO Network,TC,82.27,,,,,,,49.50,96.03,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,inpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,334.95,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,PPO Network,,506.08,,,,,,,282.87,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,inpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,69.85,123.19,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,PPO Network,,105.54,,,,,,,23.25,134.70,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,inpatient,,,84.10000,79.89000,The Alliance,PPO Network,90,69.89,,,,,,,46.26,81.58,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,outpatient,,,84.10000,79.89000,The Alliance,PPO Network,90,69.89,,,,,,,4.57,271.65,percent of total billed charges,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,inpatient,,,194.10000,184.39000,The Alliance,PPO Network,,161.30,,,,,,,106.75,188.28,percent of total billed charges,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,outpatient,,,194.10000,184.39000,The Alliance,PPO Network,,161.30,,,,,,,22.97,1087.31,percent of total billed charges,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,PPO Network,,84.10,,,,,,,55.66,98.16,percent of total billed charges,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,PPO Network,,84.10,,,,,,,11.98,628.12,percent of total billed charges,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,inpatient,,,101.20000,96.14000,The Alliance,PPO Network,,84.10,,,,,,,55.66,98.16,percent of total billed charges,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,PPO Network,,84.10,,,,,,,11.98,628.12,percent of total billed charges,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,10540.00000,10013.00000,The Alliance,PPO Network,,8758.74,,,,,,,5164.60,10223.80,percent of total billed charges,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,10540.00000,10013.00000,The Alliance,PPO Network,,8758.74,,,,,,,4837.86,10540.00,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,inpatient,,,26090.40000,24785.88000,The Alliance,PPO Network,,21681.12,,,,,,,12784.30,25307.69,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,outpatient,,,26090.40000,24785.88000,The Alliance,PPO Network,,21681.12,,,,,,,11975.49,26090.40,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11466.90000,10893.55000,The Alliance,PPO Network,,9528.99,,,,,,,5618.78,11122.89,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11466.90000,10893.55000,The Alliance,PPO Network,,9528.99,,,,,,,5263.31,11466.90,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,61.12000,58.06000,The Alliance,PPO Network,,50.79,,,,,,,29.95,59.29,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,61.12000,58.06000,The Alliance,PPO Network,,50.79,,,,,,,30.56,93.98,percent of total billed charges,
BIOPSY EXTRAOCULAR MUSCLE 67346-TECH,86510,CDM,510,RC,67346,CPT,,,facility,inpatient,,,547.00000,519.65000,The Alliance,PPO Network,,454.56,,,,,,,300.85,530.59,percent of total billed charges,
BIOPSY EXTRAOCULAR MUSCLE 67346-TECH,86510,CDM,510,RC,67346,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,PPO Network,,454.56,,,,,,,273.50,3938.79,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,16998.91000,16148.96000,The Alliance,PPO Network,,14126.09,,,,,,,8329.47,16488.94,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,PPO Network,,14126.09,,,,,,,7802.50,16998.91,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,PPO Network,,0.28254,,,,,,,0.11207,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,inpatient,,,0.34000,0.32000,The Alliance,PPO Network,JW,0.28254,,,,,,,0.18700,0.32980,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,PPO Network,JW,0.28254,,,,,,,0.11207,0.32980,percent of total billed charges,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,inpatient,1,mL,7608.04000,7227.63000,The Alliance,PPO Network,,6322.28,,,,,,,4184.42,7379.80,percent of total billed charges,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,outpatient,1,mL,7608.04000,7227.63000,The Alliance,PPO Network,,6322.28,,,,,,,23.16,7379.80,percent of total billed charges,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,inpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.22550,0.39770,percent of total billed charges,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,PPO Network,,0.34071,,,,,,,0.20500,0.39770,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,264.00,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,inpatient,,,296.50000,281.68000,The Alliance,PPO Network,90,246.39,,,,,,,163.07,287.61,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,outpatient,,,296.50000,281.68000,The Alliance,PPO Network,90,246.39,,,,,,,36.26,1833.46,percent of total billed charges,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,PPO Network,,21252.83,,,,,,,11738.92,25575.00,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,639.45,1265.85,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,PPO Network,,1084.45,,,,,,,599.00,1305.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,4226.25,8366.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,PPO Network,,7167.38,,,,,,,3958.88,8625.00,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,67.10,118.34,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,PPO Network,,101.38,,,,,,,61.00,118.34,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,134.06,236.44,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,PPO Network,,202.56,,,,,,,121.88,236.44,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,inpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,4455.00,7857.00,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,PPO Network,,6731.10,,,,,,,1285.85,7857.00,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,288.75,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,262.50,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,inpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,288.75,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,PPO Network,90,436.27,,,,,,,262.50,509.25,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,inpatient,,,545.93000,518.63000,The Alliance,PPO Network,,453.67,,,,,,,300.26,529.55,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,outpatient,,,545.93000,518.63000,The Alliance,PPO Network,,453.67,,,,,,,272.96,529.55,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,198.37,349.86,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,PPO Network,,299.73,,,,,,,47.62,349.86,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,9098.81,18011.93,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,8523.17,18569.00,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,inpatient,,,5985.75000,5686.46000,The Alliance,PPO Network,,4974.16,,,,,,,2933.02,5806.18,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,outpatient,,,5985.75000,5686.46000,The Alliance,PPO Network,,4974.16,,,,,,,2747.46,5985.75,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,87.56,154.42,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,PPO Network,,132.30,,,,,,,79.60,154.42,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1561.88,3091.88,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,PPO Network,,2648.81,,,,,,,1463.06,3187.50,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,5783.37000,5494.20000,The Alliance,PPO Network,,4805.98,,,,,,,3180.85,5609.87,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,5783.37000,5494.20000,The Alliance,PPO Network,,4805.98,,,,,,,2891.68,5609.87,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-MD-TECH,86538,CDM,510,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,81.95,144.53,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-MD-TECH,86538,CDM,510,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,PPO Network,,123.82,,,,,,,74.50,167.82,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,inpatient,1,mL,1408.47000,1338.04000,The Alliance,PPO Network,,1170.44,,,,,,,774.66,1366.22,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,outpatient,1,mL,1408.47000,1338.04000,The Alliance,PPO Network,,1170.44,,,,,,,22.21,1366.22,percent of total billed charges,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4602.30000,4372.19000,The Alliance,PPO Network,,3824.51,,,,,,,2255.13,4464.23,percent of total billed charges,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4602.30000,4372.19000,The Alliance,PPO Network,,3824.51,,,,,,,2112.46,4602.30,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,PPO Network,,21961.25,,,,,,,12130.22,26427.50,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,303.19,600.19,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,PPO Network,,514.18,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1102.50,2182.50,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,PPO Network,,1869.75,,,,,,,1032.75,2250.00,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,266.06,469.24,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,PPO Network,,402.00,,,,,,,241.88,469.24,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,61.60,108.64,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,PPO Network,,93.07,,,,,,,56.00,264.00,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,inpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,63.25,111.55,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,PPO Network,,95.56,,,,,,,57.50,264.00,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,PPO Network,,1791.84,,,,,,,989.72,2156.25,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,9098.81,18011.93,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,PPO Network,,15430.84,,,,,,,8523.17,18569.00,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,23932.00000,22735.40000,The Alliance,PPO Network,,19887.49,,,,,,,13162.60,23214.04,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,23932.00000,22735.40000,The Alliance,PPO Network,,19887.49,,,,,,,11966.00,23214.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,inpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,17.60,31.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,PPO Network,,26.59,,,,,,,16.00,31.04,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,inpatient,,,94.00000,89.30000,The Alliance,PPO Network,GO,78.11,,,,,,,51.70,91.18,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,PPO Network,GO,78.11,,,,,,,47.00,264.00,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,inpatient,,,353.00000,335.35000,The Alliance,PPO Network,90,293.34,,,,,,,194.15,342.41,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,PPO Network,90,293.34,,,,,,,35.09,1969.25,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,inpatient,,,43.80000,41.61000,The Alliance,PPO Network,90,36.40,,,,,,,24.09,42.49,percent of total billed charges,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,outpatient,,,43.80000,41.61000,The Alliance,PPO Network,90,36.40,,,,,,,5.35,271.65,percent of total billed charges,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,inpatient,,,1055.10000,1002.34000,The Alliance,PPO Network,90,876.79,,,,,,,580.30,1023.45,percent of total billed charges,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,outpatient,,,1055.10000,1002.34000,The Alliance,PPO Network,90,876.79,,,,,,,73.92,5873.90,percent of total billed charges,
MS-DRG 42.00: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,001,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,509930.73,,,,,,,176868.23,544634.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,002,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,199489.63,,,,,,,69192.49,213065.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",003,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,387976.25,,,,,,,134568.61,414379.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",004,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,255795.39,,,,,,,88722.00,273203.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,005,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,192786.09,,,,,,,66867.38,205906.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LIVER TRANSPLANT WITHOUT MCC,006,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,87785.07,,,,,,,30448.04,93759.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LUNG TRANSPLANT,007,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,236584.49,,,,,,,82058.75,252685.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,008,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,98500.23,,,,,,,34164.56,105203.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PANCREAS TRANSPLANT,010,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,144335.22,,,,,,,50062.32,154157.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",011,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,97681.98,,,,,,,33880.75,104329.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",012,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,74289.28,,,,,,,25767.06,79345.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",013,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,47972.95,,,,,,,16639.30,51237.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLOGENEIC BONE MARROW TRANSPLANT,014,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,237181.89,,,,,,,82265.96,253323.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,016,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,109267.90,,,,,,,37899.30,116704.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,017,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,109267.90,,,,,,,37899.30,116704.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,018,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,682714.82,,,,,,,236797.96,729176.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,019,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,143507.91,,,,,,,49775.37,153274.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,020,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,145930.09,,,,,,,50615.50,155861.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,021,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,100060.71,,,,,,,34705.81,106870.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,022,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63910.83,,,,,,,22167.32,68260.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,023,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,103279.43,,,,,,,35822.22,110308.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,024,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,68822.18,,,,,,,23870.80,73505.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,025,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,80962.05,,,,,,,28081.49,86471.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,026,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55369.84,,,,,,,19204.89,59138.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,027,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,44674.58,,,,,,,15495.27,47714.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITH MCC,028,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,110057.19,,,,,,,38173.07,117547.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,029,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,60766.34,,,,,,,21076.66,64901.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITHOUT CC/MCC,030,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40286.42,,,,,,,13973.24,43028.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC,031,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,75862.43,,,,,,,26312.70,81025.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC,032,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38660.77,,,,,,,13409.39,41291.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,033,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28883.34,,,,,,,10018.11,30848.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITH MCC,034,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,70397.14,,,,,,,24417.07,75188.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITH CC,035,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41180.70,,,,,,,14283.43,43983.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,036,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33184.61,,,,,,,11510.00,35442.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH MCC,037,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,60118.25,,,,,,,20851.87,64209.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH CC,038,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29169.36,,,,,,,10117.32,31154.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,039,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20604.83,,,,,,,7146.74,22007.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",040,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,68286.33,,,,,,,23684.95,72933.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",041,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40880.19,,,,,,,14179.20,43662.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",042,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31817.83,,,,,,,11035.94,33983.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITH CC/MCC,052,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36432.29,,,,,,,12636.45,38911.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,053,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16680.10,,,,,,,5785.45,17815.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITH MCC,054,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27138.21,,,,,,,9412.82,28985.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,055,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19750.37,,,,,,,6850.37,21094.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,056,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45331.72,,,,,,,15723.20,48416.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,057,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24156.64,,,,,,,8378.67,25800.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,058,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33416.33,,,,,,,11590.37,35690.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,059,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22150.83,,,,,,,7682.96,23658.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,060,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16155.12,,,,,,,5603.36,17254.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",061,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48939.65,,,,,,,16974.60,52270.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",062,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32239.63,,,,,,,11182.24,34433.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",063,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25431.09,,,,,,,8820.71,27161.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,064,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36010.49,,,,,,,12490.15,38461.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,065,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18408.94,,,,,,,6385.10,19661.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,066,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12460.29,,,,,,,4321.82,13308.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,067,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26338.05,,,,,,,9135.29,28130.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,068,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15957.79,,,,,,,5534.92,17043.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,069,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14484.21,,,,,,,5023.81,15469.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,070,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31477.50,,,,,,,10917.89,33619.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,071,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19078.75,,,,,,,6617.42,20377.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,072,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13580.87,,,,,,,4710.49,14505.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,073,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27980.00,,,,,,,9704.79,29884.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,074,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18870.57,,,,,,,6545.21,20154.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC,075,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31180.61,,,,,,,10814.92,33302.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC,076,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16598.64,,,,,,,5757.20,17728.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITH MCC,077,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27992.67,,,,,,,9709.19,29897.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITH CC,078,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18064.98,,,,,,,6265.80,19294.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,079,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12069.27,,,,,,,4186.20,12890.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITH MCC,080,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35985.14,,,,,,,12481.36,38434.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,081,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16379.59,,,,,,,5681.22,17494.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,082,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42002.58,,,,,,,14568.49,44861.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,083,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25170.41,,,,,,,8730.30,26883.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,084,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17308.28,,,,,,,6003.33,18486.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,085,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41021.40,,,,,,,14228.17,43813.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,086,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23743.89,,,,,,,8235.51,25359.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,087,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16003.05,,,,,,,5550.62,17092.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITH MCC,088,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25537.90,,,,,,,8857.76,27275.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITH CC,089,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19408.23,,,,,,,6731.70,20729.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITHOUT CC/MCC,090,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15519.70,,,,,,,5382.97,16575.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,091,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32999.96,,,,,,,11445.95,35245.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,092,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19165.65,,,,,,,6647.56,20469.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,093,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14288.70,,,,,,,4956.00,15261.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,094,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,66052.42,,,,,,,22910.12,70547.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,095,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43396.51,,,,,,,15051.97,46349.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,096,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43396.51,,,,,,,15051.97,46349.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,097,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,64892.01,,,,,,,22507.64,69308.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,098,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39270.84,,,,,,,13620.99,41943.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,099,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25222.91,,,,,,,8748.50,26939.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEIZURES WITH MCC,100,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35939.89,,,,,,,12465.66,38385.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16685.54,,,,,,,5787.34,17821.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEADACHES WITH MCC,102,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20990.43,,,,,,,7280.48,22418.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15391.17,,,,,,,5338.39,16438.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40851.23,,,,,,,14169.15,43631.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21399.56,,,,,,,7422.38,22855.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27715.69,,,,,,,9613.12,29601.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30206.67,,,,,,,10477.11,32262.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19525.90,,,,,,,6772.51,20854.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21057.41,,,,,,,7303.71,22490.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12279.26,,,,,,,4259.03,13114.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14540.33,,,,,,,5043.28,15529.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23604.50,,,,,,,8187.16,25210.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14947.65,,,,,,,5184.55,15964.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43648.14,,,,,,,15139.25,46618.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17708.35,,,,,,,6142.10,18913.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25318.86,,,,,,,8781.78,27041.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14726.79,,,,,,,5107.95,15729.02,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24855.42,,,,,,,8621.04,26546.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,76561.21,,,,,,,26555.07,81771.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38894.30,,,,,,,13490.39,41541.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28465.16,,,,,,,9873.07,30402.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,59774.30,,,,,,,20732.57,63842.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31801.54,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21448.43,,,,,,,7439.34,22908.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41530.09,,,,,,,14404.61,44356.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22534.61,,,,,,,7816.08,24068.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14495.07,,,,,,,5027.58,15481.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DYSEQUILIBRIUM,149,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13531.99,,,,,,,4693.54,14452.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25021.97,,,,,,,8678.81,26724.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13722.07,,,,,,,4759.47,14655.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20543.28,,,,,,,7125.39,21941.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12883.91,,,,,,,4468.75,13760.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29440.91,,,,,,,10211.51,31444.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16900.96,,,,,,,5862.06,18051.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12172.46,,,,,,,4221.99,13000.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29643.66,,,,,,,10281.83,31661.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17027.68,,,,,,,5906.01,18186.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11940.74,,,,,,,4141.62,12753.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,83440.35,,,,,,,28941.08,89118.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45565.25,,,,,,,15804.20,48666.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33743.99,,,,,,,11704.02,36040.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,69701.98,,,,,,,24175.96,74445.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33077.80,,,,,,,11472.95,35328.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24509.65,,,,,,,8501.11,26177.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55550.87,,,,,,,19267.68,59331.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25508.94,,,,,,,8847.71,27244.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14744.89,,,,,,,5114.23,15748.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29263.50,,,,,,,10149.97,31255.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17959.99,,,,,,,6229.38,19182.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13933.88,,,,,,,4832.93,14882.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31640.42,,,,,,,10974.40,33793.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20099.76,,,,,,,6971.55,21467.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15161.26,,,,,,,5258.65,16193.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28734.89,,,,,,,9966.63,30690.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19335.81,,,,,,,6706.58,20651.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14078.70,,,,,,,4883.16,15036.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28602.74,,,,,,,9920.79,30549.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18175.41,,,,,,,6304.10,19412.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13291.22,,,,,,,4610.03,14195.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22400.65,,,,,,,7769.61,23925.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20329.67,,,,,,,7051.30,21713.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15552.29,,,,,,,5394.27,16610.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11716.26,,,,,,,4063.76,12513.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23854.32,,,,,,,8273.81,25477.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14844.46,,,,,,,5148.76,15854.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11272.74,,,,,,,3909.92,12039.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34107.86,,,,,,,11830.23,36429.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17921.97,,,,,,,6216.19,19141.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12679.34,,,,,,,4397.80,13542.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31957.23,,,,,,,11084.29,34132.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20049.07,,,,,,,6953.97,21413.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12257.54,,,,,,,4251.50,13091.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17500.17,,,,,,,6069.89,18691.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12610.55,,,,,,,4373.94,13468.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14681.53,,,,,,,5092.25,15680.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34174.84,,,,,,,11853.46,36500.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16397.70,,,,,,,5687.50,17513.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,117075.72,,,,,,,40607.43,125043.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48584.83,,,,,,,16851.53,51891.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,197212.27,,,,,,,68402.59,210633.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,191797.66,,,,,,,66524.55,204850.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,174713.86,,,,,,,60599.08,186604.02,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,116907.36,,,,,,,40549.03,124863.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,107700.18,,,,,,,37355.54,115029.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,140071.96,,,,,,,48583.62,149604.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,95886.16,,,,,,,33257.88,102411.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,83139.84,,,,,,,28836.85,88797.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,90212.68,,,,,,,31290.05,96352.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,56233.35,,,,,,,19504.40,60060.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,153403.01,,,,,,,53207.46,163842.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,110585.80,,,,,,,38356.41,118111.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,141500.29,,,,,,,49079.03,151130.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,96311.58,,,,,,,33405.44,102866.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,106521.67,,,,,,,36946.78,113771.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,74441.35,,,,,,,25819.80,79507.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,91183.00,,,,,,,31626.60,97388.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,52719.56,,,,,,,18285.65,56307.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27333.72,,,,,,,9480.63,29193.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,61405.38,,,,,,,21298.30,65584.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40782.44,,,,,,,14145.29,43557.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32670.48,,,,,,,11331.68,34893.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,88465.74,,,,,,,30684.13,94486.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41865.00,,,,,,,14520.77,44714.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28287.75,,,,,,,9811.54,30212.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62100.53,,,,,,,21539.42,66326.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,46216.96,,,,,,,16030.24,49362.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31669.39,,,,,,,10984.45,33824.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,47366.50,,,,,,,16428.95,50590.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30661.05,,,,,,,10634.71,32747.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16146.07,,,,,,,5600.22,17244.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,50787.97,,,,,,,17615.68,54244.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31819.64,,,,,,,11036.57,33985.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,61662.44,,,,,,,21387.47,65858.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34352.25,,,,,,,11914.99,36690.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27476.73,,,,,,,9530.24,29346.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48554.06,,,,,,,16840.86,51858.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63271.80,,,,,,,21945.67,67577.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,64577.02,,,,,,,22398.38,68971.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,108451.45,,,,,,,37616.12,115832.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,85169.18,,,,,,,29540.72,90965.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,120703.56,,,,,,,41865.74,128918.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,75321.15,,,,,,,26124.96,80447.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,92922.70,,,,,,,32230.01,99246.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62353.97,,,,,,,21627.32,66597.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45297.33,,,,,,,15711.27,48380.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,70788.16,,,,,,,24552.70,75605.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,56499.46,,,,,,,19596.70,60344.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,127933.90,,,,,,,44373.56,136640.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,112137.22,,,,,,,38894.52,119768.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,84213.35,,,,,,,29209.19,89944.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,90574.74,,,,,,,31415.63,96738.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,58009.25,,,,,,,20120.37,61957.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29714.26,,,,,,,10306.32,31736.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16687.35,,,,,,,5787.96,17823.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13126.49,,,,,,,4552.89,14019.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35398.61,,,,,,,12277.92,37807.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13414.32,,,,,,,4652.73,14327.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10163.02,,,,,,,3525.02,10854.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40067.37,,,,,,,13897.27,42794.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19726.84,,,,,,,6842.21,21069.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,49448.34,,,,,,,17151.04,52813.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28543.00,,,,,,,9900.07,30485.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17722.84,,,,,,,6147.12,18928.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23620.79,,,,,,,8192.81,25228.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15590.30,,,,,,,5407.46,16651.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,9933.12,,,,,,,3445.28,10609.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22230.48,,,,,,,7710.59,23743.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14297.75,,,,,,,4959.14,15270.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29659.96,,,,,,,10287.48,31678.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12751.75,,,,,,,4422.91,13619.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,7996.10,,,,,,,2773.43,8540.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29283.41,,,,,,,10156.88,31276.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19381.07,,,,,,,6722.28,20700.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12914.68,,,,,,,4479.43,13793.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21059.22,,,,,,,7304.34,22492.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12172.46,,,,,,,4221.99,13000.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21267.40,,,,,,,7376.55,22714.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13589.92,,,,,,,4713.63,14514.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27107.43,,,,,,,9402.15,28952.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16770.62,,,,,,,5816.85,17911.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21830.41,,,,,,,7571.82,23316.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13383.55,,,,,,,4642.05,14294.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10128.63,,,,,,,3513.09,10817.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANGINA PECTORIS,311,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12641.32,,,,,,,4384.61,13501.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15773.14,,,,,,,5470.88,16846.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEST PAIN,313,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12914.68,,,,,,,4479.43,13793.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38984.81,,,,,,,13521.79,41637.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17420.52,,,,,,,6042.26,18606.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12358.92,,,,,,,4286.66,13200.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,111992.40,,,,,,,38844.29,119614.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,79522.86,,,,,,,27582.31,84934.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41904.82,,,,,,,14534.59,44756.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51535.62,,,,,,,17875.00,55042.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32751.95,,,,,,,11359.93,34980.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,77107.92,,,,,,,26744.69,82355.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,57840.90,,,,,,,20061.97,61777.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51812.60,,,,,,,17971.07,55338.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,91945.14,,,,,,,31890.95,98202.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43955.89,,,,,,,15245.99,46947.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28847.13,,,,,,,10005.56,30810.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,83127.17,,,,,,,28832.45,88784.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42790.06,,,,,,,14841.63,45702.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29888.05,,,,,,,10366.60,31922.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62793.88,,,,,,,21779.90,67067.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38474.31,,,,,,,13344.72,41092.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30025.64,,,,,,,10414.32,32069.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,65594.41,,,,,,,22751.26,70058.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38238.97,,,,,,,13263.09,40841.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27789.92,,,,,,,9638.86,29681.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48778.53,,,,,,,16918.71,52098.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26949.94,,,,,,,9347.52,28784.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22543.67,,,,,,,7819.22,24077.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42846.18,,,,,,,14861.09,45762.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22789.87,,,,,,,7904.61,24340.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15946.93,,,,,,,5531.15,17032.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43785.73,,,,,,,15186.97,46765.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27235.96,,,,,,,9446.73,29089.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19960.37,,,,,,,6923.20,21318.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,53096.10,,,,,,,18416.25,56709.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30795.01,,,,,,,10681.17,32890.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24134.92,,,,,,,8371.14,25777.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,77221.97,,,,,,,26784.25,82477.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40767.96,,,,,,,14140.27,43542.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24531.38,,,,,,,8508.65,26200.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30232.01,,,,,,,10485.90,32289.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18421.61,,,,,,,6389.49,19675.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12635.89,,,,,,,4382.73,13495.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31644.04,,,,,,,10975.66,33797.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18633.42,,,,,,,6462.96,19901.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13131.92,,,,,,,4554.77,14025.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38222.67,,,,,,,13257.44,40823.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22243.16,,,,,,,7714.98,23756.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15984.95,,,,,,,5544.34,17072.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32914.87,,,,,,,11416.44,35154.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17847.75,,,,,,,6190.45,19062.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11526.18,,,,,,,3997.83,12310.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34835.60,,,,,,,12082.64,37206.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19715.98,,,,,,,6838.44,21057.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13564.58,,,,,,,4704.84,14487.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22885.81,,,,,,,7937.89,24443.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15742.37,,,,,,,5460.20,16813.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29413.75,,,,,,,10202.09,31415.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17967.23,,,,,,,6231.89,19189.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12134.44,,,,,,,4208.80,12960.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26609.60,,,,,,,9229.47,28420.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14511.36,,,,,,,5033.23,15498.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,9905.96,,,,,,,3435.86,10580.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23253.30,,,,,,,8065.35,24835.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14125.77,,,,,,,4899.49,15087.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29978.57,,,,,,,10397.99,32018.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17040.35,,,,,,,5910.41,18200.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11520.75,,,,,,,3995.94,12304.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,44855.61,,,,,,,15558.06,47908.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27393.46,,,,,,,9501.35,29257.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20344.15,,,,,,,7056.32,21728.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,70822.56,,,,,,,24564.63,75642.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,98275.76,,,,,,,34086.71,104963.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,50840.47,,,,,,,17633.89,54300.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38664.39,,,,,,,13410.65,41295.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63384.03,,,,,,,21984.60,67697.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37952.94,,,,,,,13163.88,40535.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28079.56,,,,,,,9739.33,29990.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,49537.05,,,,,,,17181.80,52908.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38588.35,,,,,,,13384.28,41214.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30096.24,,,,,,,10438.81,32144.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63429.29,,,,,,,22000.29,67745.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35809.54,,,,,,,12420.45,38246.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24804.73,,,,,,,8603.46,26492.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43021.78,,,,,,,14922.00,45949.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30022.02,,,,,,,10413.06,32065.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23852.51,,,,,,,8273.19,25475.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63894.54,,,,,,,22161.66,68242.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29645.47,,,,,,,10282.46,31663.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26600.55,,,,,,,9226.33,28410.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,73632.14,,,,,,,25539.13,78643.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41334.58,,,,,,,14336.80,44147.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27983.62,,,,,,,9706.05,29888.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,189636.17,,,,,,,65774.84,202541.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,128580.18,,,,,,,44597.72,137330.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,99640.72,,,,,,,34560.14,106421.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,150989.88,,,,,,,52370.47,161265.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,99032.46,,,,,,,34349.17,105772.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35465.59,,,,,,,12301.15,37879.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19366.59,,,,,,,6717.25,20684.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12608.74,,,,,,,4373.31,13466.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33030.73,,,,,,,11456.63,35278.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20414.75,,,,,,,7080.81,21804.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14214.48,,,,,,,4930.26,15181.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30117.96,,,,,,,10446.34,32167.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15572.20,,,,,,,5401.18,16631.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11135.16,,,,,,,3862.20,11892.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34221.91,,,,,,,11869.79,36550.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17491.12,,,,,,,6066.75,18681.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12720.98,,,,,,,4412.24,13586.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30492.69,,,,,,,10576.32,32567.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19632.70,,,,,,,6809.56,20968.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14433.52,,,,,,,5006.23,15415.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,121375.18,,,,,,,42098.69,129635.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,73923.60,,,,,,,25640.22,78954.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,93232.26,,,,,,,32337.38,99577.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55865.86,,,,,,,19376.94,59667.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,153317.93,,,,,,,53177.95,163751.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,103900.36,,,,,,,36037.58,110971.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,78168.75,,,,,,,27112.64,83488.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,111092.68,,,,,,,38532.22,118653.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51843.37,,,,,,,17981.75,55371.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,97774.30,,,,,,,33912.78,104428.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,53378.51,,,,,,,18514.20,57011.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31428.62,,,,,,,10900.94,33567.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,92227.54,,,,,,,31988.90,98504.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62006.40,,,,,,,21506.77,66226.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,47489.60,,,,,,,16471.65,50721.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,59173.28,,,,,,,20524.11,63200.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34133.21,,,,,,,11839.02,36456.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,87931.70,,,,,,,30498.90,93915.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,52448.01,,,,,,,18191.46,56017.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42857.04,,,,,,,14864.86,45773.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,81186.52,,,,,,,28159.35,86711.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39053.60,,,,,,,13545.65,41711.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21055.60,,,,,,,7303.08,22488.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62256.22,,,,,,,21593.42,66493.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42335.68,,,,,,,14684.03,45216.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32147.31,,,,,,,11150.21,34335.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,53240.92,,,,,,,18466.48,56864.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37561.91,,,,,,,13028.26,40118.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28718.60,,,,,,,9960.98,30673.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,46130.06,,,,,,,16000.10,49269.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,58278.99,,,,,,,20213.92,62245.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38394.65,,,,,,,13317.09,41007.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28606.36,,,,,,,9922.05,30553.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35579.64,,,,,,,12340.71,38001.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22418.76,,,,,,,7775.89,23944.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,64287.37,,,,,,,22297.92,68662.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,43465.30,,,,,,,15075.83,46423.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34131.40,,,,,,,11838.39,36454.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63733.42,,,,,,,22105.78,68070.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35717.22,,,,,,,12388.43,38147.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24305.09,,,,,,,8430.16,25959.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45708.26,,,,,,,15853.80,48818.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21013.96,,,,,,,7288.64,22444.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,57362.98,,,,,,,19896.21,61266.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32308.42,,,,,,,11206.10,34507.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25293.51,,,,,,,8772.99,27014.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,47911.40,,,,,,,16617.95,51172.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31770.76,,,,,,,11019.61,33932.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31770.76,,,,,,,11019.61,33932.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27138.21,,,,,,,9412.82,28985.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35087.23,,,,,,,12169.92,37475.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23363.73,,,,,,,8103.65,24953.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ARTHROSCOPY,509,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31801.54,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51740.18,,,,,,,17945.96,55261.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35503.60,,,,,,,12314.34,37919.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29106.00,,,,,,,10095.35,31086.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27255.88,,,,,,,9453.63,29110.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18457.82,,,,,,,6402.05,19713.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55981.72,,,,,,,19417.12,59791.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36417.81,,,,,,,12631.43,38896.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27022.35,,,,,,,9372.64,28861.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,64881.15,,,,,,,22503.87,69296.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35697.31,,,,,,,12381.52,38126.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25945.22,,,,,,,8999.04,27710.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,52764.81,,,,,,,18301.35,56355.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38162.93,,,,,,,13236.72,40760.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27605.26,,,,,,,9574.82,29483.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14735.84,,,,,,,5111.09,15738.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24075.18,,,,,,,8350.42,25713.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14679.72,,,,,,,5091.63,15678.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16636.66,,,,,,,5770.38,17768.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12156.16,,,,,,,4216.34,12983.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36611.51,,,,,,,12698.61,39103.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23427.09,,,,,,,8125.63,25021.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15838.31,,,,,,,5493.48,16916.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33763.91,,,,,,,11710.93,36061.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19205.47,,,,,,,6661.37,20512.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13680.44,,,,,,,4745.03,14611.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45744.47,,,,,,,15866.36,48857.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20957.84,,,,,,,7269.18,22384.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13508.46,,,,,,,4685.38,14427.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36470.30,,,,,,,12649.64,38952.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21815.93,,,,,,,7566.80,23300.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15606.60,,,,,,,5413.11,16668.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30890.96,,,,,,,10714.45,32993.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17447.67,,,,,,,6051.68,18635.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23642.52,,,,,,,8200.35,25251.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15108.76,,,,,,,5240.44,16136.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24377.50,,,,,,,8455.28,26036.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14781.10,,,,,,,5126.79,15787.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28054.22,,,,,,,9730.54,29963.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15637.37,,,,,,,5423.78,16701.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33604.60,,,,,,,11655.67,35891.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20613.89,,,,,,,7149.88,22016.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14801.01,,,,,,,5133.70,15808.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26493.74,,,,,,,9189.29,28296.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16180.46,,,,,,,5612.15,17281.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28407.23,,,,,,,9852.98,30340.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18459.63,,,,,,,6402.68,19715.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13542.85,,,,,,,4697.31,14464.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,54493.65,,,,,,,18900.99,58202.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30309.85,,,,,,,10512.90,32372.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20680.87,,,,,,,7173.11,22088.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,111481.89,,,,,,,38667.22,119068.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62725.08,,,,,,,21756.04,66993.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36146.26,,,,,,,12537.24,38606.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,97671.12,,,,,,,33876.99,104318.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48204.67,,,,,,,16719.67,51485.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30601.31,,,,,,,10613.99,32683.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,59004.92,,,,,,,20465.71,63020.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32096.62,,,,,,,11132.63,34280.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26053.84,,,,,,,9036.71,27826.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31701.97,,,,,,,10995.75,33859.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29737.80,,,,,,,10314.48,31761.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37064.08,,,,,,,12855.59,39586.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35936.27,,,,,,,12464.41,38381.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37225.20,,,,,,,12911.47,39758.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22134.54,,,,,,,7677.31,23640.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15364.02,,,,,,,5328.97,16409.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38289.66,,,,,,,13280.67,40895.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19571.15,,,,,,,6788.21,20903.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31801.54,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19531.33,,,,,,,6774.39,20860.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15476.25,,,,,,,5367.90,16529.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17317.33,,,,,,,6006.47,18495.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10852.75,,,,,,,3764.25,11591.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CELLULITIS WITH MCC,602,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26596.93,,,,,,,9225.08,28406.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15945.12,,,,,,,5530.53,17030.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26895.63,,,,,,,9328.68,28726.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16721.74,,,,,,,5799.89,17859.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29151.26,,,,,,,10111.04,31135.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15644.61,,,,,,,5426.30,16709.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41256.74,,,,,,,14309.80,44064.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25941.60,,,,,,,8997.78,27707.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,69968.10,,,,,,,24268.26,74729.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34967.75,,,,,,,12128.48,37347.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22540.05,,,,,,,7817.96,24074.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,49357.83,,,,,,,17119.64,52716.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28910.49,,,,,,,10027.53,30877.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26462.97,,,,,,,9178.61,28263.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,67741.43,,,,,,,23495.95,72351.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34627.42,,,,,,,12010.44,36983.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18159.12,,,,,,,6298.45,19394.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51903.11,,,,,,,18002.47,55435.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27322.86,,,,,,,9476.87,29182.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22934.69,,,,,,,7954.84,24495.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,71429.01,,,,,,,24774.98,76290.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40715.46,,,,,,,14122.06,43486.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25367.73,,,,,,,8798.74,27094.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITH MCC,637,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26363.40,,,,,,,9144.08,28157.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITH CC,638,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16604.07,,,,,,,5759.08,17734.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11343.34,,,,,,,3934.41,12115.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24040.78,,,,,,,8338.49,25676.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14145.68,,,,,,,4906.40,15108.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22467.63,,,,,,,7792.84,23996.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30002.10,,,,,,,10406.16,32043.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18707.64,,,,,,,6488.70,19980.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14096.81,,,,,,,4889.44,15056.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,83405.95,,,,,,,28929.15,89082.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62862.67,,,,,,,21803.76,67140.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55601.55,,,,,,,19285.26,59385.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,100916.98,,,,,,,35002.81,107784.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,51088.48,,,,,,,17719.91,54565.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37605.36,,,,,,,13043.33,40164.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,58979.57,,,,,,,20456.92,62993.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33094.09,,,,,,,11478.61,35346.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27226.91,,,,,,,9443.59,29079.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,46783.58,,,,,,,16226.77,49967.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24258.02,,,,,,,8413.83,25908.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18584.54,,,,,,,6446.00,19849.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,56474.12,,,,,,,19587.91,60317.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27650.52,,,,,,,9590.52,29532.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19547.62,,,,,,,6780.04,20877.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,62158.46,,,,,,,21559.51,66388.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29821.07,,,,,,,10343.37,31850.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18606.26,,,,,,,6453.54,19872.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,52793.78,,,,,,,18311.39,56386.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28014.39,,,,,,,9716.72,29920.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17301.04,,,,,,,6000.82,18478.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31204.14,,,,,,,10823.08,33327.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19811.92,,,,,,,6871.72,21160.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,75844.33,,,,,,,26306.42,81005.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41788.97,,,,,,,14494.40,44632.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28336.63,,,,,,,9828.49,30265.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27188.90,,,,,,,9430.40,29039.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16091.76,,,,,,,5581.39,17186.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10995.76,,,,,,,3813.85,11744.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34136.83,,,,,,,11840.27,36460.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19057.03,,,,,,,6609.88,20353.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13110.19,,,,,,,4547.24,14002.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21185.94,,,,,,,7348.29,22627.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14529.47,,,,,,,5039.51,15518.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URINARY STONES WITH MCC,693,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26618.65,,,,,,,9232.61,28430.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14145.68,,,,,,,4906.40,15108.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20416.56,,,,,,,7081.44,21806.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12523.66,,,,,,,4343.80,13375.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL STRICTURE,697,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18135.59,,,,,,,6290.28,19369.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30429.33,,,,,,,10554.34,32500.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18463.25,,,,,,,6403.93,19719.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12567.10,,,,,,,4358.87,13422.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35130.68,,,,,,,12184.99,37521.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26837.70,,,,,,,9308.59,28664.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40679.25,,,,,,,14109.50,43447.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27179.84,,,,,,,9427.26,29029.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34587.59,,,,,,,11996.62,36941.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19362.97,,,,,,,6716.00,20680.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26176.94,,,,,,,9079.41,27958.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17011.39,,,,,,,5900.36,18169.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40882.00,,,,,,,14179.82,43664.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25693.59,,,,,,,8911.76,27442.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33590.12,,,,,,,11650.65,35876.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22301.09,,,,,,,7735.08,23818.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31298.28,,,,,,,10855.73,33428.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20327.86,,,,,,,7050.67,21711.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13189.85,,,,,,,4574.87,14087.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22856.85,,,,,,,7927.84,24412.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13475.87,,,,,,,4674.07,14392.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26600.55,,,,,,,9226.33,28410.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14791.96,,,,,,,5130.56,15798.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19929.59,,,,,,,6912.53,21285.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10986.71,,,,,,,3810.71,11734.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38066.99,,,,,,,13203.44,40657.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21975.23,,,,,,,7622.06,23470.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,71282.37,,,,,,,24724.12,76133.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36177.04,,,,,,,12547.92,38639.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27460.44,,,,,,,9524.59,29329.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,72066.23,,,,,,,24996.00,76970.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32916.68,,,,,,,11417.07,35156.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24866.28,,,,,,,8624.81,26558.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33068.75,,,,,,,11469.81,35319.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21700.07,,,,,,,7526.61,23176.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35373.26,,,,,,,12269.13,37780.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18551.95,,,,,,,6434.70,19814.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30315.28,,,,,,,10514.78,32378.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17291.99,,,,,,,5997.68,18468.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24661.72,,,,,,,8553.86,26340.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,46861.43,,,,,,,16253.77,50050.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23343.82,,,,,,,8096.75,24932.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32753.76,,,,,,,11360.56,34982.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20096.14,,,,,,,6970.30,21463.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17288.37,,,,,,,5996.43,18464.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25621.18,,,,,,,8886.64,27364.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18452.39,,,,,,,6400.17,19708.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11585.92,,,,,,,4018.55,12374.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17842.32,,,,,,,6188.56,19056.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11475.49,,,,,,,3980.25,12256.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19846.32,,,,,,,6883.65,19846.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25154.12,,,,,,,8724.64,26865.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19478.83,,,,,,,6756.18,20804.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12916.49,,,,,,,4480.05,13795.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16922.68,,,,,,,5869.59,18074.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33347.54,,,,,,,8998.34,33347.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19605.55,,,,,,,6800.14,19605.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15812.97,,,,,,,5484.69,15988.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29252.64,,,,,,,8998.34,29252.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19221.77,,,,,,,6667.02,19221.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16377.78,,,,,,,5680.59,16377.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32632.47,,,,,,,1190.71,34363.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,107618.71,,,,,,,2010.29,114942.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,73496.37,,,,,,,2010.29,77394.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,44346.92,,,,,,,1985.00,46698.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,75498.56,,,,,,,2010.29,79502.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26723.65,,,,,,,1190.71,28140.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NORMAL NEWBORN,795,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,3616.98,,,,,,,808.00,3616.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23110.29,,,,,,,5336.77,23110.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17527.32,,,,,,,5336.77,17527.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17527.32,,,,,,,5336.77,17527.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,86076.14,,,,,,,29855.30,91934.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,52748.52,,,,,,,18295.70,56338.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29719.70,,,,,,,10308.20,31742.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,64895.63,,,,,,,22508.89,69312.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32223.34,,,,,,,11176.59,34416.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20014.68,,,,,,,6942.04,21376.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18066.79,,,,,,,5336.77,18066.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13099.33,,,,,,,4543.47,13099.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11537.04,,,,,,,4001.59,11537.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,41461.30,,,,,,,14380.75,44282.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22420.57,,,,,,,7776.52,23946.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17230.44,,,,,,,5976.33,18403.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25469.11,,,,,,,8833.90,27202.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16707.26,,,,,,,5794.87,17844.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COAGULATION DISORDERS,813,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28023.44,,,,,,,9719.86,29930.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,37844.32,,,,,,,13126.21,40419.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18394.46,,,,,,,6380.07,19646.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11937.12,,,,,,,4140.36,12749.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,45892.92,,,,,,,15917.85,49016.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23316.66,,,,,,,8087.33,24903.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14781.10,,,,,,,5126.79,15787.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,105401.10,,,,,,,36558.11,112574.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,40413.14,,,,,,,14017.20,43163.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20704.40,,,,,,,7181.27,22113.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,84712.99,,,,,,,29382.49,90478.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39815.74,,,,,,,13809.99,42525.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22281.17,,,,,,,7728.17,23797.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,86450.88,,,,,,,29985.27,92334.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,42721.27,,,,,,,14817.77,45628.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29017.30,,,,,,,10064.58,30992.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,55826.03,,,,,,,19363.12,59625.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26475.64,,,,,,,9183.01,28277.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20836.55,,,,,,,7227.11,22254.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13530.18,,,,,,,4692.91,14450.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,9409.94,,,,,,,3263.81,10050.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,100060.71,,,,,,,34705.81,106870.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38666.20,,,,,,,13411.28,41297.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23003.48,,,,,,,7978.70,24568.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,90645.34,,,,,,,31440.11,96814.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36716.50,,,,,,,12735.03,39215.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,24808.35,,,,,,,8604.72,26496.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,57730.47,,,,,,,20023.67,61659.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,28385.50,,,,,,,9845.44,30317.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19042.55,,,,,,,6604.86,20338.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34274.41,,,,,,,11888.00,36606.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21636.71,,,,,,,7504.64,23109.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15148.59,,,,,,,5254.25,16179.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,46231.44,,,,,,,16035.26,49377.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23003.48,,,,,,,7978.70,24568.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14824.55,,,,,,,5141.86,15833.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RADIOTHERAPY,849,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48354.92,,,,,,,16771.79,51645.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,166763.03,,,,,,,57841.35,178112.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,90538.53,,,,,,,31403.07,96700.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36171.60,,,,,,,12546.03,38633.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29428.24,,,,,,,10207.11,31430.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,81673.49,,,,,,,28328.25,87231.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39444.63,,,,,,,13681.27,42129.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23323.91,,,,,,,8089.84,24911.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33285.99,,,,,,,11545.16,35551.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18101.19,,,,,,,6278.35,19333.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16256.49,,,,,,,5638.53,17362.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26718.22,,,,,,,9267.15,28536.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16017.53,,,,,,,5555.64,17107.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38818.26,,,,,,,13464.02,41460.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19009.96,,,,,,,6593.56,20303.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,13026.92,,,,,,,4518.35,13913.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,125933.52,,,,,,,43679.73,134503.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35519.90,,,,,,,12319.99,37937.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18664.19,,,,,,,6473.63,19934.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,71137.55,,,,,,,24673.88,75978.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17353.54,,,,,,,6019.03,18534.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16547.95,,,,,,,5739.62,17674.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,17415.09,,,,,,,6040.38,18600.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33561.15,,,,,,,11640.60,35845.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30235.63,,,,,,,10487.15,32293.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PSYCHOSES,885,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25517.99,,,,,,,8850.85,27254.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32522.04,,,,,,,11280.19,34735.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,21531.71,,,,,,,7468.22,22997.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,11298.08,,,,,,,3918.71,12066.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26211.33,,,,,,,9091.34,27995.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,32237.82,,,,,,,11181.61,34431.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,15970.47,,,,,,,5539.32,17057.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,80205.34,,,,,,,27819.03,85663.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,34352.25,,,,,,,11914.99,36690.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22069.37,,,,,,,7654.71,23571.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,69897.49,,,,,,,24243.77,74654.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29837.36,,,,,,,10349.02,31867.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39509.80,,,,,,,13703.88,42198.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,72116.92,,,,,,,25013.58,77024.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,36515.56,,,,,,,12665.33,39000.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,22960.03,,,,,,,7963.63,24522.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29296.08,,,,,,,10161.28,31289.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16589.59,,,,,,,5754.06,17718.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31461.20,,,,,,,10912.24,33602.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12022.20,,,,,,,4169.87,12840.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,29683.49,,,,,,,10295.65,31703.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16013.91,,,,,,,5554.39,17103.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,33012.63,,,,,,,11450.35,35259.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18390.84,,,,,,,6378.82,19642.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,12449.43,,,,,,,4318.06,13296.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30583.21,,,,,,,10607.71,32664.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18463.25,,,,,,,6403.93,19719.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,429453.85,,,,,,,148955.02,458680.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,120908.13,,,,,,,41936.69,129136.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,57574.78,,,,,,,19969.67,61493.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,78329.87,,,,,,,27168.52,83660.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38845.42,,,,,,,13473.44,41489.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,39761.43,,,,,,,13791.15,42467.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,57458.92,,,,,,,19929.49,61369.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,38222.67,,,,,,,13257.44,40823.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,35378.69,,,,,,,12271.01,37786.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27634.23,,,,,,,3075.00,29514.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20212.00,,,,,,,3075.00,21587.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,23284.08,,,,,,,3075.00,24868.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,14382.83,,,,,,,3075.00,15361.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,19533.14,,,,,,,3075.00,20862.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10610.17,,,,,,,3075.00,11332.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,10264.40,,,,,,,3075.00,10962.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,123612.71,,,,,,,3075.00,132025.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,69196.91,,,,,,,3075.00,73906.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,135124.41,,,,,,,46867.57,144320.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,74399.71,,,,,,,25805.36,79462.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,47862.52,,,,,,,16601.00,51119.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,49180.42,,,,,,,17058.11,52527.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,27156.31,,,,,,,9419.10,29004.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,16520.80,,,,,,,5730.20,17645.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,114488.80,,,,,,,39710.16,122280.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,48032.69,,,,,,,16660.02,51301.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,54059.18,,,,,,,18750.29,57738.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,25731.60,,,,,,,8924.94,27482.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,18157.31,,,,,,,6297.82,19393.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,26102.72,,,,,,,9053.66,27879.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,86059.85,,,,,,,29849.65,91916.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,44321.57,,,,,,,15372.83,47337.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,30199.42,,,,,,,10474.60,32254.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,63409.38,,,,,,,21993.39,67724.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,31064.75,,,,,,,10774.73,33178.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier,,20918.02,,,,,,,7255.36,22341.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,548.00,,,,,,,72.50,548.00,fee schedule,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,548.00,,,,,,,172.50,548.00,fee schedule,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier,,471.79,,,,,,,440.69,1551.03,fee schedule,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,,638.55,,,,,,,619.65,1309.50,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Premier,,1098.79,,,,,,,1026.39,2813.97,fee schedule,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier,,2640.00,,,,,,,813.50,3163.00,case rate,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Premier,,2971.00,,,,,,,691.50,4686.00,case rate,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2548.19,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Premier,TC,1645.00,,,,,,,1132.50,2197.05,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2547.22,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2245.55,per diem,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier,TC,1645.00,,,,,,,495.50,1820.00,per diem,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,TC,1645.00,,,,,,,71.00,1820.00,per diem,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier,TC,1645.00,,,,,,,935.50,1964.22,per diem,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Premier,TC,1645.00,,,,,,,1264.00,2452.16,per diem,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2515.21,per diem,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Premier,TC,1645.00,,,,,,,732.50,1820.00,per diem,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,2522.00,per diem,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Premier,TC,1645.00,,,,,,,896.50,1820.00,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Premier,TC,1645.00,,,,,,,1153.50,2237.79,per diem,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2209.66,per diem,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier,TC,1645.00,,,,,,,934.50,1964.22,per diem,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2234.88,per diem,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier,TC,1645.00,,,,,,,622.00,1820.00,per diem,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,3313.52,per diem,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2292.11,per diem,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,outpatient,,,7626.00000,7244.70000,The Alliance,Premier,,3607.10,,,,,,,3500.33,7397.22,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier,TC,1213.27,,,,,,,114.83,1213.27,fee schedule,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,,70.19,,,,,,,49.50,96.03,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier,TC,548.00,,,,,,,384.16,921.50,fee schedule,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier,TC,2857.27,,,,,,,2015.00,3909.10,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,548.00,,,,,,,133.50,584.87,fee schedule,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,,70.19,,,,,,,23.25,96.03,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier,,38281.04,,,,,,,4607.00,52373.21,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,TC,548.00,,,,,,,215.27,548.00,fee schedule,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,outpatient,1,mL,1.09000,1.03000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Premier,,1.93,,,,,,,1.36,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2245.55,per diem,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2547.22,per diem,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2548.19,per diem,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,2198.99,per diem,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier,TC,1866.00,,,,,,,1214.33,3520.13,per diem,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Premier,TC,1866.00,,,,,,,1353.88,3316.43,per diem,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier,TC,1866.00,,,,,,,1128.45,2914.85,per diem,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Premier,TC,1866.00,,,,,,,1375.22,3364.93,per diem,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier,TC,1866.00,,,,,,,1214.33,3520.13,per diem,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Premier,TC,1866.00,,,,,,,1308.50,2538.49,per diem,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3863.51,per diem,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Premier,TC,1866.00,,,,,,,1321.12,3459.02,per diem,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier,TC,1866.00,,,,,,,1130.78,2914.85,per diem,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Premier,TC,1866.00,,,,,,,1269.50,2462.83,per diem,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Premier,TC,1866.00,,,,,,,1125.50,2183.47,per diem,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4224.35,per diem,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4835.45,per diem,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,718.77,,,,,,,68.74,718.77,fee schedule,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3934.32,per diem,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Premier,TC,1866.00,,,,,,,1353.60,3441.56,per diem,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,TC,548.00,,,,,,,154.77,548.00,fee schedule,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1767.08,,,,,,,172.50,1767.08,fee schedule,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3462.90,per diem,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2942.98,per diem,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Premier,TC,1866.00,,,,,,,1371.65,3353.29,per diem,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,TC,1272.59,,,,,,,129.58,1272.59,fee schedule,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier,TC,1866.00,,,,,,,179.69,2032.87,per diem,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,718.77,,,,,,,68.74,718.77,fee schedule,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,TC,1371.46,,,,,,,138.00,1371.46,fee schedule,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Premier,TC,1866.00,,,,,,,1129.95,2920.67,per diem,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier,TC,1569.27,,,,,,,160.92,1569.27,fee schedule,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,TC,1094.55,,,,,,,111.00,1094.55,fee schedule,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Premier,TC,1866.00,,,,,,,1382.32,3348.44,per diem,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier,TC,548.00,,,,,,,231.00,548.00,fee schedule,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Premier,TC,1866.00,,,,,,,1318.80,3125.34,per diem,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,TC,1391.23,,,,,,,140.50,1391.23,fee schedule,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Premier,TC,1866.00,,,,,,,1328.10,3480.36,per diem,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Premier,TC,1866.00,,,,,,,1246.80,3800.46,per diem,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier,TC,1866.00,,,,,,,1295.50,2513.27,per diem,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier,,225.09,,,,,,,153.75,298.27,fee schedule,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3802.00000,3611.90000,The Alliance,Premier,TC,2695.62,,,,,,,1901.00,3687.94,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier,TC,486.37,,,,,,,343.00,665.42,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Premier,TC,2365.22,,,,,,,1668.00,3235.92,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Premier,TC,346.70,,,,,,,244.50,474.33,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Premier,TC,322.60,,,,,,,227.50,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,outpatient,,,550.00000,522.50000,The Alliance,Premier,TC,389.95,,,,,,,275.00,533.50,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,QW,254.68,,,,,,,4.81,2209.66,fee schedule,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Premier,TC,713.25,,,,,,,503.00,975.82,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier,,137.55,,,,,,,97.00,212.44,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Premier,QW,414.06,,,,,,,292.00,566.48,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier,,232.82,,,,,,,225.92,477.44,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,28.80000,27.36000,The Alliance,Premier,,13.62,,,,,,,13.22,27.94,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier,QW,572.16,,,,,,,403.50,782.79,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Premier,TC,2698.45,,,,,,,1903.00,3691.82,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12028.00,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier,,8.51,,,,,,,6.00,11.64,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Premier,,6.62,,,,,,,6.43,13.58,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,17.04000,16.19000,The Alliance,Premier,,8.06,,,,,,,7.82,16.53,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,30.36000,28.84000,The Alliance,Premier,,14.36,,,,,,,13.94,29.45,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,outpatient,,,1105.00000,1049.75000,The Alliance,Premier,,783.45,,,,,,,314.95,1071.85,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier,,315.32,,,,,,,246.10,477.44,fee schedule,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,19.87,,,,,,,19.28,40.74,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier,,315.32,,,,,,,246.10,477.44,fee schedule,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,Premier,,920.28,,,,,,,314.95,1259.06,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,10.92000,10.37000,The Alliance,Premier,,36.65,,,,,,,5.46,36.65,fee schedule,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,11.15000,10.59000,The Alliance,Premier,,102.20,,,,,,,5.58,102.20,fee schedule,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Premier,,487.79,,,,,,,314.95,667.36,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,191.40000,181.83000,The Alliance,Premier,,90.53,,,,,,,87.85,185.66,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.10000,39.99000,The Alliance,Premier,,19.91,,,,,,,19.32,40.84,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,44.80000,42.56000,The Alliance,Premier,,21.19,,,,,,,20.56,43.46,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,264.38000,251.16000,The Alliance,Premier,,135.57,,,,,,,126.64,256.45,fee schedule,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,outpatient,,,386.93000,367.58000,The Alliance,Premier,,278.56,,,,,,,193.47,375.32,fee schedule,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,,67.98,,,,,,,64.92,129.01,fee schedule,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Premier,,12.05,,,,,,,8.50,16.49,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,106.56000,101.23000,The Alliance,Premier,,92.45,,,,,,,53.28,103.36,fee schedule,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,1374.00000,1305.30000,The Alliance,Premier,,285.11,,,,,,,266.32,1332.78,fee schedule,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Premier,TC,3942.79,,,,,,,308.00,3942.79,fee schedule,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier,TC,1450.63,,,,,,,146.17,1450.63,fee schedule,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Premier,,349.06,,,,,,,326.06,1136.84,fee schedule,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,26.52000,25.19000,The Alliance,Premier,,12.54,,,,,,,12.17,25.72,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Premier,TC,2487.17,,,,,,,1754.00,3402.76,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Premier,TC,3062.88,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,TC,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,TC,48.92,,,,,,,34.50,5271.00,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Premier,,121.81,,,,,,,67.04,130.06,fee schedule,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Premier,,121.81,,,,,,,67.04,130.06,fee schedule,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,44.14,,,,,,,26.00,50.44,fee schedule,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,203.72,,,,,,,3.66,203.72,fee schedule,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,2640.00,,,,,,,1857.46,5271.00,case rate,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,25.78000,24.49000,The Alliance,Premier,,65.22,,,,,,,12.89,65.22,fee schedule,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,outpatient,,,204.99000,194.74000,The Alliance,Premier,,241.40,,,,,,,102.50,241.40,fee schedule,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,outpatient,,,309.37000,293.90000,The Alliance,Premier,,436.36,,,,,,,154.69,436.36,fee schedule,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,133.16,,,,,,,99.38,192.79,fee schedule,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,259.91000,246.91000,The Alliance,Premier,,107.02,,,,,,,99.97,252.11,fee schedule,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,14.48000,13.76000,The Alliance,Premier,,102.20,,,,,,,7.24,102.20,fee schedule,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,35.60000,33.82000,The Alliance,Premier,,65.22,,,,,,,17.80,65.22,fee schedule,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,outpatient,,,215.44000,204.67000,The Alliance,Premier,,115.18,,,,,,,107.59,208.98,fee schedule,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Premier,,121.81,,,,,,,37.02,121.81,fee schedule,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,39.87000,37.88000,The Alliance,Premier,,70.48,,,,,,,19.93,70.48,fee schedule,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,17.24000,16.38000,The Alliance,Premier,,70.48,,,,,,,8.62,70.48,fee schedule,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Premier,,142.65,,,,,,,60.94,142.65,fee schedule,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,270.94000,257.39000,The Alliance,Premier,,117.51,,,,,,,109.77,262.81,fee schedule,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,38.29,,,,,,,27.00,74.34,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,133.16,,,,,,,99.38,192.79,fee schedule,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,33.95,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Premier,,274.91,,,,,,,116.50,274.91,fee schedule,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Premier,,121.81,,,,,,,37.02,121.81,fee schedule,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier,,112.02,,,,,,,79.00,153.26,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,59.94,,,,,,,21.00,59.94,fee schedule,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,outpatient,,,1751.00000,1663.45000,The Alliance,Premier,,994.35,,,,,,,875.50,1698.47,fee schedule,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Premier,,385.86,,,,,,,360.44,818.68,fee schedule,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,13.46000,12.79000,The Alliance,Premier,,102.20,,,,,,,6.73,102.20,fee schedule,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,9.55,33.95,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,76.13000,72.32000,The Alliance,Premier,,36.01,,,,,,,34.94,73.85,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,outpatient,,,1117.64000,1061.76000,The Alliance,Premier,,570.66,,,,,,,553.79,1084.11,fee schedule,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Premier,,87.92,,,,,,,81.64,193.84,fee schedule,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Premier,,315.32,,,,,,,45.90,315.32,fee schedule,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Premier,,87.92,,,,,,,60.94,118.22,fee schedule,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,260.63000,247.60000,The Alliance,Premier,,87.92,,,,,,,81.64,252.81,fee schedule,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier,,45.41,,,,,,,44.06,93.12,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Premier,,303.54,,,,,,,220.51,432.02,fee schedule,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Premier,,315.32,,,,,,,45.90,315.32,fee schedule,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,Premier,,1160.68,,,,,,,666.50,1293.01,fee schedule,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Premier,,75.77,,,,,,,73.53,155.39,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Premier,,142.65,,,,,,,99.92,193.84,fee schedule,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,74.34,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier,,13.47,,,,,,,9.50,79.34,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,33.95,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,100.68,,,,,,,60.36,137.74,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,104.93,,,,,,,74.00,150.74,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,109.89,,,,,,,38.65,150.35,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,65.23,,,,,,,38.65,89.24,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,109.89,,,,,,,77.50,153.86,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,488.00000,463.60000,The Alliance,Premier,,345.99,,,,,,,242.89,473.36,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,664.00000,630.80000,The Alliance,Premier,,470.78,,,,,,,332.00,644.08,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Premier,,538.84,,,,,,,380.00,737.20,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Premier,,238.22,,,,,,,137.04,325.92,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier,,345.28,,,,,,,134.64,472.39,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,outpatient,,,458.00000,435.10000,The Alliance,Premier,,324.72,,,,,,,141.69,444.26,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,80.12,,,,,,,56.50,109.61,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier,,206.32,,,,,,,128.93,282.27,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,outpatient,,,748.00000,710.60000,The Alliance,Premier,,530.33,,,,,,,374.00,725.56,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,100.68,,,,,,,14.86,137.74,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,outpatient,,,828.00000,786.60000,The Alliance,Premier,,587.05,,,,,,,377.09,803.16,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier,,119.82,,,,,,,64.42,163.93,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier,,2040.50,,,,,,,558.00,2791.66,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,,204.19,,,,,,,38.65,279.36,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Premier,,451.63,,,,,,,318.50,617.89,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Premier,,259.49,,,,,,,172.82,489.94,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Premier,TC,3299.19,,,,,,,232.00,3299.19,fee schedule,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Premier,,302.74,,,,,,,213.50,414.19,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,8.53000,8.10000,The Alliance,Premier,,4.03,,,,,,,3.92,8.27,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Premier,,1795.05,,,,,,,1401.50,2718.91,fee schedule,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Premier,,877.13,,,,,,,814.56,2718.91,fee schedule,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,188.20000,178.79000,The Alliance,Premier,,72.71,,,,,,,67.53,182.55,fee schedule,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,,112.80,,,,,,,90.50,175.57,fee schedule,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier,,540.52,,,,,,,504.90,1155.27,fee schedule,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Premier,,285.11,,,,,,,266.32,600.43,fee schedule,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier,,264.46,,,,,,,186.50,361.81,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier,,112.80,,,,,,,105.37,233.77,fee schedule,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,429.00000,407.55000,The Alliance,Premier,,349.06,,,,,,,214.50,416.13,fee schedule,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier,TC,2142.86,,,,,,,119.50,2142.86,fee schedule,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,outpatient,,,227.15000,215.79000,The Alliance,Premier,,219.70,,,,,,,113.58,220.34,fee schedule,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier,,72.71,,,,,,,67.53,168.78,fee schedule,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,outpatient,,,170.20000,161.69000,The Alliance,Premier,,56.40,,,,,,,52.68,165.09,fee schedule,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,outpatient,,,200.35000,190.33000,The Alliance,Premier,,196.24,,,,,,,100.17,196.24,fee schedule,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Premier,,569.51,,,,,,,220.51,569.51,fee schedule,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,outpatient,,,1817.00000,1726.15000,The Alliance,Premier,,1163.63,,,,,,,908.50,1762.49,fee schedule,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,,72.32,,,,,,,37.27,98.94,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,outpatient,,,1373.08000,1304.43000,The Alliance,Premier,,1616.93,,,,,,,686.54,1616.93,fee schedule,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,outpatient,,,269.63000,256.15000,The Alliance,Premier,,112.50,,,,,,,105.09,261.54,fee schedule,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,outpatient,,,260.06000,247.06000,The Alliance,Premier,,113.64,,,,,,,106.15,252.26,fee schedule,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,138.45000,131.53000,The Alliance,Premier,,196.91,,,,,,,69.22,196.91,fee schedule,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,,135.57,,,,,,,65.00,135.57,fee schedule,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Premier,,103.42,,,,,,,35.63,103.42,fee schedule,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,13.26000,12.60000,The Alliance,Premier,,65.22,,,,,,,6.63,65.22,fee schedule,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier,,349.06,,,,,,,272.50,528.65,fee schedule,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Premier,,51.77,,,,,,,35.63,69.12,fee schedule,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,outpatient,,,3043.38000,2891.21000,The Alliance,Premier,,1621.19,,,,,,,1514.36,2952.08,fee schedule,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Premier,,540.64,,,,,,,422.00,818.68,fee schedule,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,outpatient,,,821.00000,779.95000,The Alliance,Premier,,407.80,,,,,,,380.93,796.37,fee schedule,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,outpatient,,,36.53000,34.70000,The Alliance,Premier,,130.31,,,,,,,18.27,130.31,fee schedule,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier,,385.86,,,,,,,301.00,583.94,fee schedule,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,,269.05,,,,,,,114.00,269.05,fee schedule,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,outpatient,,,801.35000,761.28000,The Alliance,Premier,,943.67,,,,,,,400.68,943.67,fee schedule,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,outpatient,,,773.00000,734.35000,The Alliance,Premier,,495.35,,,,,,,386.50,749.81,fee schedule,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,217.71,,,,,,,104.50,217.71,fee schedule,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,71.04000,67.49000,The Alliance,Premier,,33.60,,,,,,,32.61,68.91,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,outpatient,,,362.51000,344.38000,The Alliance,Premier,,364.14,,,,,,,181.25,364.14,fee schedule,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,82.83,,,,,,,29.00,82.83,fee schedule,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,outpatient,,,31.14000,29.58000,The Alliance,Premier,,82.94,,,,,,,15.57,82.94,fee schedule,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,outpatient,,,817.43000,776.56000,The Alliance,Premier,,572.78,,,,,,,408.71,792.91,fee schedule,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Premier,,341.50,,,,,,,145.00,341.50,fee schedule,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,outpatient,,,2833.00000,2691.35000,The Alliance,Premier,,1298.33,,,,,,,1212.77,2748.01,fee schedule,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,outpatient,,,1335.00000,1268.25000,The Alliance,Premier,,855.16,,,,,,,667.50,1294.95,fee schedule,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Premier,,24.22,,,,,,,23.50,49.66,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,1062.65,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,outpatient,,,760.40000,722.38000,The Alliance,Premier,,405.08,,,,,,,378.38,737.59,fee schedule,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Premier,,341.50,,,,,,,145.00,341.50,fee schedule,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Premier,,639.03,,,,,,,271.50,639.03,fee schedule,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Premier,,630.65,,,,,,,153.38,630.65,fee schedule,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,50.00,97.00,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Premier,,358.73,,,,,,,87.25,358.73,fee schedule,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,430.17,,,,,,,23.25,430.17,fee schedule,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,293.70000,279.02000,The Alliance,Premier,,196.91,,,,,,,146.85,284.89,fee schedule,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,outpatient,,,2541.00000,2413.95000,The Alliance,Premier,,1201.89,,,,,,,1166.32,2464.77,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,outpatient,,,384.09000,364.89000,The Alliance,Premier,,487.84,,,,,,,192.04,487.84,fee schedule,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Premier,,59.54,,,,,,,55.62,188.63,fee schedule,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Premier,,12.11,,,,,,,11.75,24.83,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Premier,,41.05,,,,,,,28.95,56.16,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Premier,,358.73,,,,,,,87.25,358.73,fee schedule,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier,,197.10,,,,,,,139.00,269.66,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Premier,,59.54,,,,,,,55.62,188.63,fee schedule,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier,,485.24,,,,,,,301.00,583.94,fee schedule,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,outpatient,,,148.65000,141.22000,The Alliance,Premier,,70.31,,,,,,,68.23,144.19,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier,,134.06,,,,,,,33.40,134.06,fee schedule,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,outpatient,,,40.48000,38.46000,The Alliance,Premier,,313.88,,,,,,,20.24,313.88,fee schedule,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,outpatient,,,80.27000,76.26000,The Alliance,Premier,,64.71,,,,,,,40.13,77.86,fee schedule,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,outpatient,,,14393.00000,13673.35000,The Alliance,Premier,,6038.91,,,,,,,5640.97,13961.21,fee schedule,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,,58.78,,,,,,,44.50,86.33,fee schedule,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,outpatient,,,42.80000,40.66000,The Alliance,Premier,,32.80,,,,,,,21.40,41.52,fee schedule,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Premier,,232.52,,,,,,,199.97,387.94,fee schedule,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,outpatient,,,89.33000,84.86000,The Alliance,Premier,,91.99,,,,,,,44.66,91.99,fee schedule,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,outpatient,,,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.30,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,41.83,,,,,,,5.87,113.69,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier,,332.52,,,,,,,56.40,454.93,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,outpatient,,,1327.00000,1260.65000,The Alliance,Premier,,940.84,,,,,,,314.95,1287.19,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,outpatient,,,5.78000,5.49000,The Alliance,Premier,,0.51150,,,,,,,0.31000,5.61,fee schedule,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,outpatient,,,77.20000,73.34000,The Alliance,Premier,,54.73,,,,,,,38.60,550.14,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,outpatient,,,56.50000,53.67000,The Alliance,Premier,,33.50,,,,,,,28.25,54.80,fee schedule,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,114.56000,108.83000,The Alliance,Premier,,72.71,,,,,,,57.28,111.12,fee schedule,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,91.53000,86.95000,The Alliance,Premier,,72.71,,,,,,,45.77,95.58,fee schedule,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,302.81000,287.67000,The Alliance,Premier,,196.91,,,,,,,151.41,293.73,fee schedule,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,70.48,,,,,,,3.33,70.48,fee schedule,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Premier,TC,2640.00,,,,,,,1781.00,5271.00,case rate,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,outpatient,,,51.73000,49.14000,The Alliance,Premier,,24.47,,,,,,,23.74,50.18,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Premier,,384.08,,,,,,,372.71,812.00,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier,,315.32,,,,,,,246.10,477.44,fee schedule,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,50.00,97.00,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,outpatient,,,3214.00000,3053.30000,The Alliance,Premier,,2059.62,,,,,,,1607.00,3117.58,fee schedule,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Premier,,560.97,,,,,,,438.00,849.72,fee schedule,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,44.77000,42.53000,The Alliance,Premier,,121.81,,,,,,,22.39,121.81,fee schedule,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,31.60000,30.02000,The Alliance,Premier,,14.95,,,,,,,14.50,30.65,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Premier,,107.02,,,,,,,99.97,423.37,fee schedule,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,outpatient,,,2171.00000,2062.45000,The Alliance,Premier,,1390.91,,,,,,,1085.50,2105.87,fee schedule,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Premier,,1378.09,,,,,,,1075.50,2086.47,fee schedule,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,outpatient,,,55.45000,52.68000,The Alliance,Premier,,102.20,,,,,,,27.73,102.20,fee schedule,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Premier,,0.86250,,,,,,,0.80300,1.94,fee schedule,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier,,137.93,,,,,,,133.85,298.27,fee schedule,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,57.29000,54.43000,The Alliance,Premier,,315.32,,,,,,,28.64,315.32,fee schedule,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Premier,,260.20,,,,,,,56.40,355.99,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,outpatient,,,711.00000,675.45000,The Alliance,Premier,,504.10,,,,,,,314.95,689.67,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,57.91000,55.01000,The Alliance,Premier,,79.22,,,,,,,28.95,93.98,fee schedule,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Premier,,315.32,,,,,,,28.90,315.32,fee schedule,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,381.46000,362.39000,The Alliance,Premier,,449.21,,,,,,,190.73,449.21,fee schedule,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier,,92.45,,,,,,,86.36,301.91,fee schedule,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,29.96000,28.46000,The Alliance,Premier,,92.45,,,,,,,14.98,92.45,fee schedule,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier,,247.44,,,,,,,122.40,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,,43.25,,,,,,,30.50,134.64,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,113.44,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,,135.42,,,,,,,56.40,185.27,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,52,113.44,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,52,135.42,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,,135.42,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,52,135.42,,,,,,,95.50,185.27,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier,,246.73,,,,,,,148.57,337.56,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier,,327.56,,,,,,,231.00,448.14,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,outpatient,,,2008.00000,1907.60000,The Alliance,Premier,,1423.67,,,,,,,87.16,1947.76,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,33.95,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier,,85.08,,,,,,,56.40,116.40,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier,,58.14,,,,,,,41.00,79.54,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,21.98,,,,,,,15.50,30.07,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Premier,,191.43,,,,,,,56.40,261.90,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,60.27,,,,,,,42.50,554.21,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,41.56000,39.48000,The Alliance,Premier,,19.66,,,,,,,19.08,41.56,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,505.88000,480.59000,The Alliance,Premier,,239.28,,,,,,,232.20,505.88,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Premier,,301.54,,,,,,,292.61,637.50,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,Premier,TC,801.17,,,,,,,565.00,1096.10,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,Premier,TC,336.07,,,,,,,237.00,459.78,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Premier,TC,1025.21,,,,,,,723.00,1402.62,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier,TC,223.34,,,,,,,157.50,305.55,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Premier,TC,423.98,,,,,,,299.00,580.06,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier,,254.68,,,,,,,3.63,254.68,fee schedule,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,TC,442.00,,,,,,,37.00,442.00,per diem,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,TC,37.58,,,,,,,26.50,51.41,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier,TC,18.43,,,,,,,13.00,25.22,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,TC,92.17,,,,,,,65.00,126.10,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,outpatient,,,4627.00000,4395.65000,The Alliance,Premier,TC,3280.54,,,,,,,2313.50,4488.19,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,TC,21.27,,,,,,,15.00,29.10,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Premier,TC,1435.02,,,,,,,864.82,2960.49,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier,,1645.00,,,,,,,169.04,2714.06,per diem,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Premier,TC,2720.43,,,,,,,1626.53,3721.89,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier,,1645.00,,,,,,,169.04,2292.11,per diem,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier,TC,386.40,,,,,,,272.50,528.65,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,52,442.00,,,,,,,37.00,442.00,per diem,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier,TC,1174.10,,,,,,,828.00,1606.32,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,TC,442.00,,,,,,,18.50,442.00,per diem,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,TC,442.00,,,,,,,18.50,442.00,per diem,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier,TC,1181.19,,,,,,,833.00,1616.02,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier,TC,192.14,,,,,,,135.50,262.87,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier,TC,347.41,,,,,,,245.00,475.30,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier,TC,217.66,,,,,,,153.50,297.79,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier,TC,367.97,,,,,,,259.50,503.43,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,Premier,TC,224.04,,,,,,,158.00,306.52,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier,TC,477.87,,,,,,,337.00,653.78,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier,TC,844.42,,,,,,,595.50,1155.27,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier,TC,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier,TC,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1360.00000,1292.00000,The Alliance,Premier,TC,964.24,,,,,,,680.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier,TC,870.65,,,,,,,614.00,1191.16,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier,TC,176.54,,,,,,,124.50,241.53,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Premier,TC,2363.10,,,,,,,1666.50,3233.01,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Premier,TC,904.68,,,,,,,638.00,1237.72,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier,TC,2857.27,,,,,,,2015.00,3909.10,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Premier,TC,1810.08,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Premier,TC,833.08,,,,,,,587.50,1139.75,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier,TC,1608.72,,,,,,,1134.50,2200.93,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,TC,150.31,,,,,,,106.00,205.64,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier,TC,182.21,,,,,,,128.50,249.29,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Premier,TC,1905.79,,,,,,,1344.00,2607.36,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Premier,TC,937.00,,,,,,,282.00,5271.00,case rate,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Premier,TC,937.00,,,,,,,909.00,5271.00,case rate,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier,TC,13.47,,,,,,,9.50,18.43,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,outpatient,,,2018.00000,1917.10000,The Alliance,Premier,TC,937.00,,,,,,,909.00,5271.00,case rate,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Premier,TC,1706.56,,,,,,,1203.50,2334.79,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,Premier,TC,155.27,,,,,,,109.50,212.43,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Premier,,937.00,,,,,,,503.83,5271.00,case rate,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,TC,239.64,,,,,,,169.00,327.86,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,TC,54.59,,,,,,,38.50,74.69,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier,TC,1295.34,,,,,,,913.50,1772.19,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Premier,TC,2009.31,,,,,,,1132.05,2748.98,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,Premier,TC,1635.52,,,,,,,134.50,1635.52,fee schedule,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Premier,TC,1805.11,,,,,,,1400.30,5271.00,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier,TC,1160.63,,,,,,,818.50,1587.89,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier,TC,130.46,,,,,,,92.00,178.48,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Premier,TC,160.23,,,,,,,113.00,219.22,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier,TC,78.70,,,,,,,55.50,107.67,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,115.57,,,,,,,81.50,554.21,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,outpatient,,,3396.00000,3226.20000,The Alliance,Premier,TC,2407.76,,,,,,,1698.00,3294.12,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,TC,92.17,,,,,,,65.00,126.10,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,TC,31.91,,,,,,,22.50,43.65,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Premier,TC,666.46,,,,,,,470.00,911.80,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Premier,TC,556.57,,,,,,,392.50,761.45,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier,TC,1866.00,,,,,,,1128.45,2914.85,per diem,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Premier,TC,681.35,,,,,,,480.50,932.17,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Premier,TC,337.48,,,,,,,238.00,461.72,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,TC,548.00,,,,,,,47.50,860.53,fee schedule,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier,TC,8.51,,,,,,,6.00,11.64,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Premier,TC,804.01,,,,,,,567.00,1099.98,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,outpatient,,,285.90000,271.60000,The Alliance,Premier,TC,202.70,,,,,,,142.95,277.32,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Premier,TC,108.12,,,,,,,76.25,147.93,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,TC,1430.78,,,,,,,118.53,1430.78,fee schedule,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,outpatient,,,2216.00000,2105.20000,The Alliance,Premier,TC,1571.14,,,,,,,1108.00,2149.52,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,outpatient,,,80.70000,76.66000,The Alliance,Premier,,57.22,,,,,,,40.35,91.97,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier,TC,371.52,,,,,,,262.00,508.28,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,TC,109.89,,,,,,,77.50,150.35,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier,TC,98.55,,,,,,,69.50,134.83,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier,,1645.00,,,,,,,169.04,3313.52,per diem,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,outpatient,,,375.50000,356.72000,The Alliance,Premier,TC,266.23,,,,,,,187.75,364.24,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier,TC,326.14,,,,,,,230.00,446.20,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,outpatient,,,6252.00000,5939.40000,The Alliance,Premier,TC,4432.67,,,,,,,3126.00,6064.44,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Premier,TC,108.12,,,,,,,76.25,147.93,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Premier,TC,9.22,,,,,,,6.50,12.61,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,outpatient,,,1150.00000,1092.50000,The Alliance,Premier,TC,815.35,,,,,,,575.00,1115.50,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier,TC,7652.95,,,,,,,5397.00,10470.18,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Premier,TC,346.70,,,,,,,244.50,474.33,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,outpatient,,,5814.00000,5523.30000,The Alliance,Premier,TC,7206.00,,,,,,,377.14,7206.00,per diem,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier,TC,162.36,,,,,,,114.50,222.13,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,TC,131.87,,,,,,,93.00,180.42,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Premier,TC,221.21,,,,,,,156.00,302.64,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier,TC,142.51,,,,,,,100.50,194.97,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier,TC,386.40,,,,,,,272.50,528.65,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,2024.90,,,,,,,1404.95,2770.32,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Premier,TC,760.76,,,,,,,536.50,1040.81,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,2024.90,,,,,,,1399.96,2770.32,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier,,1534.28,,,,,,,1047.39,2099.08,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,2024.90,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,1108.17,,,,,,,761.71,1516.11,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,2024.90,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,1108.17,,,,,,,765.41,1516.11,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,Premier,TC,201.36,,,,,,,142.00,275.48,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,1108.17,,,,,,,763.56,1516.11,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,TC,181.50,,,,,,,128.00,248.32,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier,TC,170.16,,,,,,,120.00,232.80,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Premier,TC,249.57,,,,,,,176.00,341.44,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier,,1534.28,,,,,,,1056.58,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier,,1534.28,,,,,,,1049.24,2099.08,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,,4020.73,,,,,,,172.50,4020.73,fee schedule,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,TC,195.68,,,,,,,138.00,267.72,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,TC,30.49,,,,,,,21.50,41.71,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier,TC,404.84,,,,,,,285.50,1232.72,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier,TC,871.36,,,,,,,614.50,1192.13,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier,TC,383.57,,,,,,,270.50,1232.72,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1767.08,,,,,,,172.50,1767.08,fee schedule,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier,TC,1272.65,,,,,,,897.50,1741.15,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Premier,TC,3400.36,,,,,,,2398.00,4652.12,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier,TC,1272.65,,,,,,,897.50,1741.15,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier,TC,222.63,,,,,,,157.00,304.58,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,718.77,,,,,,,68.74,718.77,fee schedule,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier,TC,10.63,,,,,,,7.50,14.55,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,TC,30.49,,,,,,,21.50,41.71,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier,TC,1412.33,,,,,,,996.00,1932.24,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,TC,19.85,,,,,,,14.00,27.16,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier,TC,2400.67,,,,,,,1693.00,3284.42,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier,,1412.33,,,,,,,100.97,1932.24,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier,TC,183.63,,,,,,,129.50,1145.46,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,TC,157.40,,,,,,,111.00,215.34,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Premier,TC,1124.47,,,,,,,793.00,1538.42,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier,TC,1057.83,,,,,,,746.00,1447.24,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier,TC,659.37,,,,,,,465.00,902.10,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,TC,87.92,,,,,,,62.00,120.28,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier,TC,2024.21,,,,,,,178.00,2024.21,fee schedule,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,TC,63.10,,,,,,,44.50,86.33,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,outpatient,,,617.00000,586.15000,The Alliance,Premier,TC,437.45,,,,,,,297.28,598.49,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier,TC,5742.65,,,,,,,606.90,5742.65,fee schedule,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Premier,TC,442.00,,,,,,,214.00,467.89,per diem,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier,TC,442.00,,,,,,,257.00,595.98,per diem,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,outpatient,,,465.00000,441.75000,The Alliance,Premier,TC,329.69,,,,,,,232.50,2134.86,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,Premier,,735.99,,,,,,,714.20,1556.00,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,outpatient,,,12133.00000,11526.35000,The Alliance,Premier,,8602.30,,,,,,,6066.50,11769.01,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,9.09,29.10,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1094.55,,,,,,,111.13,1094.55,fee schedule,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,TC,1272.59,,,,,,,129.58,1272.59,fee schedule,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,548.00,,,,,,,133.50,584.87,fee schedule,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,TC,548.00,,,,,,,66.50,584.87,fee schedule,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Premier,TC,818.89,,,,,,,577.50,1120.35,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,outpatient,,,4144.00000,3936.80000,The Alliance,Premier,,2938.10,,,,,,,280.29,4019.68,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,548.00,,,,,,,101.00,548.00,fee schedule,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1155.27,fee schedule,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,TC,1569.27,,,,,,,149.00,1569.27,fee schedule,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,TC,1114.32,,,,,,,104.50,1114.32,fee schedule,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier,TC,1193.49,,,,,,,108.00,1193.49,fee schedule,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier,TC,1430.78,,,,,,,132.50,1430.78,fee schedule,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,TC,1371.46,,,,,,,138.00,1371.46,fee schedule,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,TC,225.46,,,,,,,154.77,308.46,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,4666.67,per diem,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,TC,1094.55,,,,,,,111.00,1094.55,fee schedule,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,outpatient,1,EA,10866.46000,10323.14000,The Alliance,Premier,,7.41,,,,,,,4.49,10540.47,fee schedule,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,outpatient,1,mL,1294.48000,1229.75000,The Alliance,Premier,,18.20,,,,,,,11.03,1255.65,fee schedule,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,outpatient,1,mL,781.97000,742.88000,The Alliance,Premier,,29.77,,,,,,,24.87,758.51,fee schedule,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1331.91,,,,,,,126.50,1331.91,fee schedule,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1329.46,fee schedule,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier,TC,1628.59,,,,,,,161.00,1628.59,fee schedule,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Premier,,9.52,,,,,,,6.71,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier,,3.96,,,,,,,2.79,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,outpatient,120,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,outpatient,120,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,outpatient,120,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,outpatient,120,EA,0.58000,0.56000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,outpatient,1,mL,17.06000,16.21000,The Alliance,Premier,,0.14850,,,,,,,0.14409,16.55,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,outpatient,1,mL,20.10000,19.09000,The Alliance,Premier,,0.14850,,,,,,,0.14409,19.50,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,outpatient,1,mL,22.75000,21.61000,The Alliance,Premier,,0.14850,,,,,,,0.14409,22.07,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Premier,,0.14850,,,,,,,0.14409,25.44,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,outpatient,1,mL,14.49000,13.77000,The Alliance,Premier,,0.14850,,,,,,,0.14409,14.06,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,outpatient,1,EA,0.83000,0.78000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier,TC,1331.91,,,,,,,125.00,1331.91,fee schedule,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,TC,1430.78,,,,,,,137.50,1430.78,fee schedule,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier,TC,1173.72,,,,,,,108.50,1173.72,fee schedule,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,TC,1173.72,,,,,,,120.38,1173.72,fee schedule,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,TC,1648.36,,,,,,,161.50,1648.36,fee schedule,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1094.55,,,,,,,111.13,1094.55,fee schedule,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,TC,1233.04,,,,,,,123.50,1233.04,fee schedule,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier,TC,593.43,,,,,,,418.50,811.89,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,TC,548.00,,,,,,,66.50,584.87,fee schedule,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1356.06,fee schedule,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Premier,TC,548.00,,,,,,,247.28,568.42,fee schedule,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1000.07,fee schedule,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,806.07,fee schedule,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier,TC,1193.49,,,,,,,101.94,1193.49,fee schedule,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,TC,1430.78,,,,,,,135.13,1430.78,fee schedule,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Premier,TC,8808.48,,,,,,,905.50,8808.48,fee schedule,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier,TC,1628.59,,,,,,,151.73,1628.59,fee schedule,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier,TC,1786.85,,,,,,,172.00,1786.85,fee schedule,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Premier,TC,1628.59,,,,,,,152.50,1628.59,fee schedule,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,TC,1074.77,,,,,,,93.00,1074.77,fee schedule,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,TC,1786.85,,,,,,,170.00,1786.85,fee schedule,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,TC,1549.49,,,,,,,144.00,1549.49,fee schedule,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,TC,1015.45,,,,,,,77.99,1015.45,fee schedule,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier,TC,5149.29,,,,,,,403.50,5149.29,fee schedule,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier,TC,1509.95,,,,,,,144.50,1509.95,fee schedule,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,TC,1628.59,,,,,,,166.47,1628.59,fee schedule,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,TC,876.96,,,,,,,87.50,876.96,fee schedule,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier,TC,1213.27,,,,,,,120.50,1213.27,fee schedule,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier,TC,1509.95,,,,,,,151.00,1509.95,fee schedule,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier,TC,4002.11,,,,,,,372.00,4002.11,fee schedule,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Premier,TC,1569.27,,,,,,,152.00,1569.27,fee schedule,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier,TC,1648.36,,,,,,,165.00,1648.36,fee schedule,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier,TC,3329.66,,,,,,,307.50,3329.66,fee schedule,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1213.27,,,,,,,115.50,1213.27,fee schedule,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,TC,1490.17,,,,,,,46.50,3015.65,fee schedule,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Premier,TC,5821.82,,,,,,,290.00,5821.82,fee schedule,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier,TC,1292.36,,,,,,,122.50,1292.36,fee schedule,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Premier,TC,2676.90,,,,,,,278.89,2676.90,fee schedule,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier,TC,1233.04,,,,,,,117.50,1233.04,fee schedule,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,outpatient,,,1544.00000,1466.80000,The Alliance,Premier,,1094.70,,,,,,,772.00,7180.14,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Premier,,1.02,,,,,,,0.93155,8.45,fee schedule,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier,,22788.40,,,,,,,549.28,22788.40,fee schedule,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Premier,,30205.49,,,,,,,549.28,30205.49,fee schedule,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Premier,,7299.84,,,,,,,237.91,17311.25,fee schedule,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier,,7209.59,,,,,,,103.97,7209.59,fee schedule,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Premier,,1544.20,,,,,,,381.55,2210.07,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Premier,,1422.96,,,,,,,511.11,2960.49,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Premier,,3664.82,,,,,,,2584.50,5013.93,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Premier,,580.02,,,,,,,562.85,1226.25,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Premier,,202.21,,,,,,,196.22,427.50,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier,,3182.11,,,,,,,3087.92,6727.50,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Premier,,258.08,,,,,,,182.00,456.63,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Premier,,2472.99,,,,,,,511.11,3383.36,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Premier,,2463.07,,,,,,,1239.61,7180.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Premier,,6855.66,,,,,,,371.02,10740.24,fee schedule,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,0.62700,,,,,,,0.60838,61.30,fee schedule,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Premier,,5983.16,,,,,,,383.91,10740.24,fee schedule,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,Premier,,2234.06,,,,,,,1733.05,5271.00,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,outpatient,,,2262.00000,2148.90000,The Alliance,Premier,,15808.09,,,,,,,1131.00,15808.09,fee schedule,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier,,2203.00,,,,,,,2137.79,4657.50,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Premier,,1345.59,,,,,,,1305.76,2844.79,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Premier,,7299.62,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Premier,,4720.94,,,,,,,4581.21,9980.85,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4205.10000,3994.85000,The Alliance,Premier,,1989.01,,,,,,,1930.14,4205.10,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,outpatient,1,mL,78.92000,74.98000,The Alliance,Premier,,23.30,,,,,,,14.12,76.55,fee schedule,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier,,20208.37,,,,,,,549.28,20208.37,fee schedule,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier,,20181.52,,,,,,,549.28,20181.52,fee schedule,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier,,106944.98,,,,,,,1299.22,106944.98,fee schedule,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier,,2641.73,,,,,,,1863.00,3614.22,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Premier,,352.37,,,,,,,248.50,7984.62,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Premier,,352.37,,,,,,,248.50,7984.62,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Premier,,873.49,,,,,,,381.55,2210.07,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier,TC,1488.90,,,,,,,1050.00,2037.00,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,outpatient,,,2184.00000,2074.80000,The Alliance,Premier,TC,1548.46,,,,,,,1092.00,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier,TC,1295.34,,,,,,,913.50,1772.19,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,TC,53.88,,,,,,,38.00,73.72,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,outpatient,,,2153.00000,2045.35000,The Alliance,Premier,TC,1526.48,,,,,,,1076.50,2088.41,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier,,1372.62,,,,,,,511.11,2960.49,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Premier,,15253.35,,,,,,,1923.03,17311.25,fee schedule,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Premier,,14613.37,,,,,,,1226.87,14613.37,fee schedule,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Premier,,4736.20,,,,,,,359.37,4736.20,fee schedule,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier,,12150.98,,,,,,,833.00,12150.98,fee schedule,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,outpatient,,,1702.00000,1616.90000,The Alliance,Premier,,1206.72,,,,,,,381.55,2210.07,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Premier,TC,800.46,,,,,,,564.50,1095.13,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,,8349.45,,,,,,,417.10,17311.25,fee schedule,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,outpatient,,,9110.00000,8654.50000,The Alliance,Premier,,7206.00,,,,,,,381.55,8836.70,per diem,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier,,7810.26,,,,,,,519.48,7810.26,fee schedule,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,Premier,,1603.05,,,,,,,1243.55,5271.00,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,Premier,,10533.78,,,,,,,990.94,10533.78,fee schedule,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,outpatient,,,45977.00000,43678.15000,The Alliance,Premier,,58409.77,,,,,,,5651.91,58409.77,fee schedule,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,outpatient,,,962.00000,913.90000,The Alliance,Premier,,10786.37,,,,,,,249.71,10786.37,fee schedule,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,7859.04,,,,,,,103.97,7859.04,fee schedule,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,14445.56,,,,,,,249.71,14445.56,fee schedule,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,outpatient,,,3724.00000,3537.80000,The Alliance,Premier,,2640.32,,,,,,,103.97,3612.28,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier,,383.57,,,,,,,126.07,524.77,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Premier,,855.05,,,,,,,381.55,2210.07,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier,,88.69,,,,,,,86.06,187.50,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Premier,,235.82,,,,,,,228.84,498.56,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Premier,,235.82,,,,,,,228.84,498.56,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier,,5080.96,,,,,,,100.97,5080.96,fee schedule,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier,,5323.40,,,,,,,234.00,5323.40,fee schedule,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,outpatient,,,5332.00000,5065.40000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Premier,,24628.72,,,,,,,2800.00,24628.72,fee schedule,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier,,7581.44,,,,,,,138.83,7581.44,fee schedule,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier,,401.76,,,,,,,389.87,849.38,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier,,401.76,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier,,8286.06,,,,,,,8040.81,17518.10,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier,,67198.78,,,,,,,1667.31,67198.78,fee schedule,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Premier,,1332.92,,,,,,,81.69,1823.60,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier,,529.62,,,,,,,282.87,724.59,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,TC,63.10,,,,,,,44.50,86.33,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,6772.18,,,,,,,52.50,6772.18,fee schedule,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,outpatient,1,mL,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier,,3679.58,,,,,,,101.50,3679.58,fee schedule,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier,,548.00,,,,,,,327.36,764.36,fee schedule,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,9.88,184.30,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier,,548.00,,,,,,,149.44,548.00,fee schedule,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Premier,,1558.38,,,,,,,381.55,2210.07,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier,,548.00,,,,,,,295.69,1897.32,fee schedule,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Premier,,6407.26,,,,,,,457.64,29731.35,fee schedule,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,,6972.92,,,,,,,361.82,17311.25,fee schedule,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,outpatient,,,4753.00000,4515.35000,The Alliance,Premier,,6628.38,,,,,,,431.85,6628.38,fee schedule,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier,,4040.81,,,,,,,280.00,4040.81,fee schedule,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,,8383.61,,,,,,,500.59,29731.35,fee schedule,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,,8698.76,,,,,,,439.81,17311.25,fee schedule,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Premier,,9600.80,,,,,,,498.74,29731.35,fee schedule,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,,7979.60,,,,,,,411.55,17311.25,fee schedule,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,,7308.84,,,,,,,394.96,17311.25,fee schedule,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Premier,,9076.23,,,,,,,574.33,17311.25,fee schedule,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Premier,,9864.94,,,,,,,595.74,17311.25,fee schedule,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,,9465.00,,,,,,,378.42,17311.25,fee schedule,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier,,7658.22,,,,,,,356.27,17311.25,fee schedule,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Premier,,7565.59,,,,,,,418.96,17311.25,fee schedule,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier,,5633.78,,,,,,,227.70,5633.78,fee schedule,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Premier,,13784.72,,,,,,,723.58,29731.35,fee schedule,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,outpatient,,,4226.00000,4014.70000,The Alliance,Premier,,11109.75,,,,,,,960.76,17311.25,fee schedule,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,,9128.16,,,,,,,550.38,17311.25,fee schedule,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier,,8066.77,,,,,,,463.75,17311.25,fee schedule,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Premier,,7684.61,,,,,,,426.30,17311.25,fee schedule,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,,9019.14,,,,,,,417.10,17311.25,fee schedule,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,548.00,,,,,,,72.50,548.00,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier,,2.24,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,2.24,,,,,,,0.01000,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,2.24,,,,,,,0.01000,2.24,fee schedule,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1866.00,,,,,,,172.50,2032.87,per diem,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1866.00,,,,,,,172.50,2032.87,per diem,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1866.00,,,,,,,172.50,2032.87,per diem,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,,1544.85,,,,,,,87.50,1544.85,fee schedule,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier,,679.08,,,,,,,12.90,679.08,fee schedule,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,548.00,,,,,,,72.50,548.00,fee schedule,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,458.40,,,,,,,5.38,458.40,fee schedule,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,9.98,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier,90,1426.03,,,,,,,12.50,1426.03,fee schedule,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier,,0.04950,,,,,,,0.04803,3.22,fee schedule,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,outpatient,1,mL,5.53000,5.25000,The Alliance,Premier,,0.04950,,,,,,,0.04803,5.36,fee schedule,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,outpatient,,,3479.00000,3305.05000,The Alliance,Premier,TC,2466.61,,,,,,,1628.38,3374.63,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,outpatient,10,EA,3.56000,3.38000,The Alliance,Premier,,0.04950,,,,,,,0.04803,3.45,fee schedule,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,outpatient,10,EA,5.94000,5.64000,The Alliance,Premier,,0.04950,,,,,,,0.04803,5.76,fee schedule,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,outpatient,10,EA,1.36000,1.29000,The Alliance,Premier,,0.04950,,,,,,,0.04803,1.32,fee schedule,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier,,2.55,,,,,,,1.80,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,74.34,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,63.05,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.08250,,,,,,,0.08000,0.36860,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,outpatient,1,mL,0.26000,0.24000,The Alliance,Premier,,0.08250,,,,,,,0.08000,0.25220,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Premier,,0.08250,,,,,,,0.08000,0.87300,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Premier,,0.08250,,,,,,,0.08000,1.09,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier,,0.08250,,,,,,,0.08000,0.29100,fee schedule,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier,,2020.22,,,,,,,38.62,2020.22,fee schedule,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,outpatient,1,EA,1.39000,1.33000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,outpatient,1,mL,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,633.75000,602.06000,The Alliance,Premier,,299.76,,,,,,,290.89,633.75,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,outpatient,1,EA,0.43000,0.40000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier,,14.67,,,,,,,2.10,14.67,fee schedule,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,outpatient,1,EA,45.56000,43.28000,The Alliance,Premier,,32.30,,,,,,,22.78,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,outpatient,1,mL,7855.65000,7462.87000,The Alliance,Premier,,4027.16,,,,,,,2440.70,7619.98,fee schedule,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,outpatient,1,EA,47.27000,44.91000,The Alliance,Premier,,33.51,,,,,,,1.13,45.85,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,373.51,,,,,,,7.27,373.51,fee schedule,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier,,2640.00,,,,,,,548.90,3163.00,case rate,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,outpatient,1,EA,333.18000,316.52000,The Alliance,Premier,,236.22,,,,,,,166.59,323.18,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier,,1697.68,,,,,,,32.62,1697.68,fee schedule,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,outpatient,15,EA,38.63000,36.70000,The Alliance,Premier,,27.39,,,,,,,19.32,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,outpatient,1,EA,3284.86000,3120.62000,The Alliance,Premier,,73.41,,,,,,,44.49,3186.31,fee schedule,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Premier,,10.64,,,,,,,7.50,14.56,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,outpatient,8,EA,8.97000,8.53000,The Alliance,Premier,,6.36,,,,,,,4.49,8.70,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,outpatient,30,EA,1.48000,1.40000,The Alliance,Premier,,14.67,,,,,,,0.74000,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Premier,,14.67,,,,,,,0.47500,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,outpatient,30,EA,2.40000,2.28000,The Alliance,Premier,,14.67,,,,,,,1.20,14.67,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,outpatient,30,EA,19.80000,18.81000,The Alliance,Premier,,0.61050,,,,,,,0.59237,19.21,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,outpatient,30,EA,15.80000,15.01000,The Alliance,Premier,,0.61050,,,,,,,0.59237,15.33,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,outpatient,30,EA,4.37000,4.15000,The Alliance,Premier,,0.61050,,,,,,,0.59237,4.24,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,outpatient,30,EA,19.75000,18.76000,The Alliance,Premier,,0.61050,,,,,,,0.59237,19.16,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,outpatient,30,EA,21.80000,20.71000,The Alliance,Premier,,0.61050,,,,,,,0.59237,21.15,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier,,0.61050,,,,,,,0.59237,5.44,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Premier,,0.61050,,,,,,,0.59237,6.13,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,outpatient,30,EA,3.89000,3.69000,The Alliance,Premier,,0.61050,,,,,,,0.59237,3.77,fee schedule,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,outpatient,5,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,865.84,,,,,,,18.40,865.84,fee schedule,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Premier,,3.32,,,,,,,2.34,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Premier,90,577.23,,,,,,,12.70,577.23,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Premier,,87.58,,,,,,,1.83,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier,,87.58,,,,,,,2.85,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier,,87.58,,,,,,,1.46,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,outpatient,1,mL,2.43000,2.31000,The Alliance,Premier,,87.58,,,,,,,1.22,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,87.58,,,,,,,1.10,88.11,fee schedule,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,63.05,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,319.05,,,,,,,247.50,5271.00,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,outpatient,3,EA,0.15000,0.14000,The Alliance,Premier,,0.33000,,,,,,,0.07500,0.33000,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Premier,,0.33000,,,,,,,0.26500,0.51410,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Premier,,0.33000,,,,,,,0.26500,0.51410,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Premier,,0.33000,,,,,,,0.16000,0.33000,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Premier,,0.33000,,,,,,,0.21000,0.40740,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Premier,,0.33000,,,,,,,0.30070,0.65960,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Premier,,0.33000,,,,,,,0.30070,0.65960,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Premier,,0.33000,,,,,,,0.21000,0.40740,fee schedule,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Premier,,2495.58,,,,,,,47.63,2495.58,fee schedule,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,outpatient,30,EA,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Premier,,10.53,,,,,,,7.42,14.40,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Premier,90,882.80,,,,,,,17.43,882.80,fee schedule,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,outpatient,1,EA,5.93000,5.63000,The Alliance,Premier,,4.20,,,,,,,2.96,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.78,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,outpatient,1,EA,4.29000,4.08000,The Alliance,Premier,,3.04,,,,,,,2.15,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Premier,,2.41,,,,,,,1.70,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,outpatient,1,EA,1.48000,1.40000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,outpatient,30,EA,26.39000,25.07000,The Alliance,Premier,,18.71,,,,,,,1.13,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,outpatient,30,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,1.13,22.99,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,outpatient,1,mL,10.42000,9.90000,The Alliance,Premier,,14.67,,,,,,,5.21,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,outpatient,1,mL,11.07000,10.51000,The Alliance,Premier,,14.67,,,,,,,5.54,14.67,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier,,87.58,,,,,,,0.36500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,outpatient,1,mL,0.52000,0.50000,The Alliance,Premier,,87.58,,,,,,,0.26000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier,,87.58,,,,,,,0.21000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,87.58,,,,,,,0.29000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,87.58,,,,,,,0.29500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,87.58,,,,,,,0.29500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Premier,,87.58,,,,,,,0.44000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,87.58,,,,,,,0.18500,88.11,fee schedule,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,outpatient,0.5,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,outpatient,,,3438.00000,3266.10000,The Alliance,Premier,TC,2437.54,,,,,,,1436.74,7180.14,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Premier,,8.09,,,,,,,5.71,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Premier,,6.02,,,,,,,4.25,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier,,7.82,,,,,,,5.51,10.70,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Premier,,0.13200,,,,,,,0.08500,0.16490,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,outpatient,3,EA,0.21000,0.20000,The Alliance,Premier,,0.13200,,,,,,,0.10500,0.20370,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.31040,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,outpatient,3,EA,0.26000,0.25000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.25220,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Premier,,0.13200,,,,,,,0.08500,0.16490,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,outpatient,3,EA,0.30000,0.29000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.29100,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,outpatient,3,EA,0.40000,0.38000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.38800,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,outpatient,3,EA,0.31000,0.29000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.30070,fee schedule,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,509.30,,,,,,,9.71,509.30,fee schedule,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,outpatient,,,266.10000,252.80000,The Alliance,Premier,90,1459.96,,,,,,,31.89,1459.96,fee schedule,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,outpatient,2,EA,5.72000,5.43000,The Alliance,Premier,,4.06,,,,,,,2.86,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,outpatient,2,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,4.27,10.73,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,275.45,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Premier,,184.82,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Premier,,558.80,,,,,,,1.13,764.51,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Premier,,28.43,,,,,,,27.59,101.15,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,outpatient,1,EA,138.91000,131.97000,The Alliance,Premier,,28.43,,,,,,,27.59,134.74,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,outpatient,1,EA,125.45000,119.18000,The Alliance,Premier,,28.43,,,,,,,27.59,121.69,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,outpatient,1,EA,99.54000,94.56000,The Alliance,Premier,,28.43,,,,,,,27.59,96.55,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,28.43,,,,,,,27.59,122.61,fee schedule,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,outpatient,,,210.90000,200.35000,The Alliance,Premier,90,149.53,,,,,,,14.72,204.57,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,254.68,,,,,,,4.95,254.68,fee schedule,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,outpatient,,,496.00000,471.20000,The Alliance,Premier,,351.66,,,,,,,248.00,481.12,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,48.19,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,outpatient,20,EA,7.63000,7.25000,The Alliance,Premier,,0.26400,,,,,,,0.25616,7.40,fee schedule,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,1409.06,,,,,,,16.95,1409.06,fee schedule,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Premier,,2122.08,,,,,,,40.75,2122.08,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,outpatient,2,EA,25.28000,24.02000,The Alliance,Premier,,0.75900,,,,,,,0.59830,24.52,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,outpatient,2,EA,9.48000,9.01000,The Alliance,Premier,,0.75900,,,,,,,0.59830,9.20,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Premier,,0.75900,,,,,,,0.59830,16.78,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,outpatient,2,EA,25.12000,23.87000,The Alliance,Premier,,0.75900,,,,,,,0.59830,24.37,fee schedule,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,outpatient,,,420.10000,399.10000,The Alliance,Premier,,297.85,,,,,,,50.73,407.50,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,outpatient,1,mL,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,outpatient,1,mL,1.74000,1.66000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,90,509.30,,,,,,,9.98,509.30,fee schedule,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier,,345.28,,,,,,,63.95,788.42,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier,,0.13200,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.61110,fee schedule,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,,780.94,,,,,,,14.78,780.94,fee schedule,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,outpatient,10,EA,2.67000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.13,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,outpatient,10,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.21,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,outpatient,10,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.13,3.83,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,outpatient,,,17.60000,16.72000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Premier,90,933.70,,,,,,,17.71,933.70,fee schedule,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,outpatient,,,174.80000,166.06000,The Alliance,Premier,90,780.94,,,,,,,15.58,780.94,fee schedule,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,outpatient,,,179.20000,170.24000,The Alliance,Premier,90,407.44,,,,,,,7.97,407.44,fee schedule,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,763.98,,,,,,,14.57,763.98,fee schedule,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,outpatient,,,194.80000,185.06000,The Alliance,Premier,90,882.80,,,,,,,17.57,882.80,fee schedule,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,outpatient,1,EA,378.88000,359.94000,The Alliance,Premier,,268.63,,,,,,,189.44,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,outpatient,1,EA,280.60000,266.57000,The Alliance,Premier,,198.95,,,,,,,140.30,272.18,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,90,885.37,,,,,,,14.91,885.37,fee schedule,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,,1137.41,,,,,,,47.50,1137.41,fee schedule,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,outpatient,1,EA,13388.43000,12719.00000,The Alliance,Premier,,155.35,,,,,,,94.15,12986.78,fee schedule,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,outpatient,1,EA,16720.68000,15884.65000,The Alliance,Premier,,155.35,,,,,,,94.15,16219.06,fee schedule,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier,,882.80,,,,,,,16.77,882.80,fee schedule,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,271.65,,,,,,,5.30,271.65,fee schedule,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,696.05,,,,,,,13.44,696.05,fee schedule,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,outpatient,1,EA,28.62000,27.19000,The Alliance,Premier,,20.29,,,,,,,14.31,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,outpatient,355,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,outpatient,,,399.70000,379.71000,The Alliance,Premier,90,916.73,,,,,,,20.26,916.73,fee schedule,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,outpatient,1,EA,7.52000,7.15000,The Alliance,Premier,,5.33,,,,,,,3.76,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,outpatient,1,EA,67.88000,64.48000,The Alliance,Premier,,48.13,,,,,,,33.94,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,outpatient,1,EA,18.85000,17.91000,The Alliance,Premier,,13.36,,,,,,,9.43,18.28,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,outpatient,1,EA,456.75000,433.91000,The Alliance,Premier,,155.35,,,,,,,94.15,443.05,fee schedule,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,outpatient,,,327.70000,311.32000,The Alliance,Premier,90,1324.17,,,,,,,26.33,1324.17,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,outpatient,9,EA,1.69000,1.60000,The Alliance,Premier,,0.84150,,,,,,,0.50685,1.64,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,outpatient,9,EA,2.72000,2.58000,The Alliance,Premier,,0.84150,,,,,,,0.50685,2.64,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,outpatient,9,EA,1.47000,1.39000,The Alliance,Premier,,0.84150,,,,,,,0.50685,1.43,fee schedule,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,outpatient,80,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,outpatient,1,EA,9108.37000,8652.95000,The Alliance,Premier,,155.35,,,,,,,94.15,8835.12,fee schedule,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,outpatient,1,EA,0.21000,0.19000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier,,271.65,,,,,,,4.57,301.67,fee schedule,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,outpatient,1,EA,5.05000,4.80000,The Alliance,Premier,,3.58,,,,,,,2.52,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,548.00,,,,,,,76.00,548.00,fee schedule,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,outpatient,20,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,outpatient,20,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,outpatient,20,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier,,13.94,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier,,13.70,,,,,,,2.48,18.34,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,outpatient,3,EA,0.80000,0.76000,The Alliance,Premier,,0.84150,,,,,,,0.40000,0.84150,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Premier,,0.84150,,,,,,,0.50685,2.05,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Premier,,0.84150,,,,,,,0.50685,2.05,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,outpatient,3,EA,1.84000,1.75000,The Alliance,Premier,,0.84150,,,,,,,0.50685,1.78,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,outpatient,3,EA,1.41000,1.34000,The Alliance,Premier,,0.84150,,,,,,,0.50685,1.37,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,outpatient,3,EA,4.04000,3.83000,The Alliance,Premier,,0.84150,,,,,,,0.50685,3.92,fee schedule,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,outpatient,1,EA,1.31000,1.25000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71500,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Premier,QN,1128.02,,,,,,,795.50,1543.27,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier,,2.62,,,,,,,1.85,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier,,13.94,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,outpatient,30,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Premier,,10.63,,,,,,,7.50,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Premier,,10.63,,,,,,,7.50,14.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier,,2.03,,,,,,,1.43,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Premier,HI,172.29,,,,,,,121.50,235.71,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,Premier,,4617.66,,,,,,,90.57,4617.66,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Premier,,2.46,,,,,,,2.39,23.64,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,outpatient,1,EA,13.27000,12.61000,The Alliance,Premier,,2.46,,,,,,,2.39,12.87,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier,,2.46,,,,,,,2.39,16.86,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,outpatient,1,EA,25.12000,23.87000,The Alliance,Premier,,2.46,,,,,,,2.39,24.37,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,outpatient,1,EA,8.61000,8.18000,The Alliance,Premier,,2.46,,,,,,,2.39,8.35,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier,,2.46,,,,,,,2.39,14.87,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,2.46,,,,,,,2.39,9.20,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Premier,,2.46,,,,,,,2.39,15.72,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Premier,,2.46,,,,,,,2.39,9.65,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,outpatient,1,EA,12.72000,12.08000,The Alliance,Premier,,2.46,,,,,,,2.39,12.34,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,outpatient,1,EA,46.02000,43.72000,The Alliance,Premier,,2.46,,,,,,,2.39,44.64,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,outpatient,1,EA,24.08000,22.88000,The Alliance,Premier,,2.46,,,,,,,2.39,23.36,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier,,2.46,,,,,,,2.39,27.59,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,outpatient,1,EA,50.40000,47.88000,The Alliance,Premier,,2.46,,,,,,,2.39,48.89,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,outpatient,1,EA,16.92000,16.08000,The Alliance,Premier,,2.46,,,,,,,2.39,16.41,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,outpatient,1,EA,19.75000,18.76000,The Alliance,Premier,,2.46,,,,,,,2.39,19.16,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,outpatient,1,EA,17.85000,16.96000,The Alliance,Premier,,2.46,,,,,,,2.39,17.31,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,outpatient,1,EA,12.50000,11.88000,The Alliance,Premier,,2.46,,,,,,,2.39,12.12,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,outpatient,1,EA,25.82000,24.53000,The Alliance,Premier,,2.46,,,,,,,2.39,25.05,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,outpatient,1,EA,16.75000,15.91000,The Alliance,Premier,,2.46,,,,,,,2.39,16.25,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier,,2.46,,,,,,,2.39,16.14,fee schedule,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,339.51,,,,,,,6.48,339.51,fee schedule,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,outpatient,80,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,outpatient,80,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,outpatient,80,EA,4.23000,4.02000,The Alliance,Premier,,3.00,,,,,,,2.12,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,outpatient,80,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,outpatient,80,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,outpatient,80,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,outpatient,80,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,outpatient,80,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,outpatient,80,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Premier,QN,1128.02,,,,,,,795.50,1543.27,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,339.51,,,,,,,6.48,339.51,fee schedule,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Premier,,277.22,,,,,,,63.95,788.42,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,outpatient,75,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,outpatient,75,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,outpatient,75,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,outpatient,75,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,outpatient,75,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Premier,,0.80850,,,,,,,0.78449,7.15,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,outpatient,1,EA,8.91000,8.46000,The Alliance,Premier,,0.80850,,,,,,,0.78449,8.64,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,outpatient,1,EA,11.14000,10.58000,The Alliance,Premier,,0.80850,,,,,,,0.78449,10.81,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Premier,,0.80850,,,,,,,0.78449,7.27,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Premier,,0.80850,,,,,,,0.78449,7.54,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Premier,,0.80850,,,,,,,0.78449,5.21,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,0.80850,,,,,,,0.78449,3.68,fee schedule,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Premier,,56.30,,,,,,,54.63,147.13,fee schedule,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,814.87,,,,,,,17.27,814.87,fee schedule,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,1596.38,,,,,,,1549.12,3375.00,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,outpatient,1,EA,20.82000,19.78000,The Alliance,Premier,,0.80850,,,,,,,0.78449,20.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,outpatient,1,EA,22.45000,21.32000,The Alliance,Premier,,0.80850,,,,,,,0.78449,21.78,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,outpatient,1,EA,347.11000,329.76000,The Alliance,Premier,,0.80850,,,,,,,0.78449,336.70,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,outpatient,1,EA,42.35000,40.23000,The Alliance,Premier,,0.80850,,,,,,,0.78449,41.08,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,outpatient,1,EA,87.84000,83.45000,The Alliance,Premier,,0.80850,,,,,,,0.78449,85.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,0.80850,,,,,,,0.78449,22.99,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,0.80850,,,,,,,0.78449,33.72,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,outpatient,1,EA,22.45000,21.33000,The Alliance,Premier,,0.80850,,,,,,,0.78449,21.78,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,0.80850,,,,,,,0.78449,15.33,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.80850,,,,,,,0.78449,9.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,outpatient,1,EA,22.47000,21.34000,The Alliance,Premier,,0.80850,,,,,,,0.78449,21.80,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,outpatient,1,EA,24.98000,23.73000,The Alliance,Premier,,0.80850,,,,,,,0.78449,24.23,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,outpatient,1,EA,11.23000,10.67000,The Alliance,Premier,,0.80850,,,,,,,0.78449,10.89,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,outpatient,1,EA,21.83000,20.74000,The Alliance,Premier,,0.80850,,,,,,,0.78449,21.18,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,outpatient,1,EA,17.46000,16.59000,The Alliance,Premier,,0.80850,,,,,,,0.78449,16.94,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,outpatient,1,EA,45.28000,43.02000,The Alliance,Premier,,0.80850,,,,,,,0.78449,43.92,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,outpatient,1,EA,218.29000,207.38000,The Alliance,Premier,,0.80850,,,,,,,0.78449,211.74,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,0.80850,,,,,,,0.78449,15.33,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,0.80850,,,,,,,0.78449,18.39,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,outpatient,1,EA,15.31000,14.54000,The Alliance,Premier,,0.80850,,,,,,,0.78449,14.85,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.80850,,,,,,,0.78449,9.20,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,0.80850,,,,,,,0.78449,10.73,fee schedule,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,138.96,,,,,,,98.00,190.12,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,577.23,,,,,,,11.16,577.23,fee schedule,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,933.70,,,,,,,17.93,933.70,fee schedule,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,90,1137.41,,,,,,,51.50,1137.41,fee schedule,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,outpatient,1,EA,87.62000,83.24000,The Alliance,Premier,,62.12,,,,,,,43.81,84.99,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,outpatient,50,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,outpatient,50,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,outpatient,50,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,outpatient,50,EA,57.64000,54.76000,The Alliance,Premier,,40.87,,,,,,,28.82,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,outpatient,50,EA,0.42000,0.39000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier,,1137.41,,,,,,,57.00,1137.41,fee schedule,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,,763.98,,,,,,,14.60,763.98,fee schedule,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,outpatient,1,mL,302.21000,287.10000,The Alliance,Premier,,1.22,,,,,,,0.74000,293.14,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Premier,,1.22,,,,,,,0.74000,502.46,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,outpatient,1,mL,281.47000,267.40000,The Alliance,Premier,,1.22,,,,,,,0.74000,273.03,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,outpatient,1,mL,528.36000,501.94000,The Alliance,Premier,,1.22,,,,,,,0.74000,512.51,fee schedule,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Premier,,3.78,,,,,,,2.67,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier,,2.03,,,,,,,1.43,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier,,3.37,,,,,,,2.38,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,3.50,,,,,,,2.46,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,outpatient,1,EA,5.12000,4.86000,The Alliance,Premier,,3.63,,,,,,,2.56,4.97,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,outpatient,,,172.20000,163.59000,The Alliance,Premier,90,1137.41,,,,,,,86.10,1137.41,fee schedule,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,2122.08,,,,,,,61.00,2122.08,fee schedule,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,outpatient,1,EA,132.86000,126.22000,The Alliance,Premier,,94.20,,,,,,,66.43,128.87,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier,,882.80,,,,,,,16.87,882.80,fee schedule,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,outpatient,,,224.30000,213.08000,The Alliance,Premier,90,984.66,,,,,,,19.60,984.66,fee schedule,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,outpatient,,,1022.00000,970.90000,The Alliance,Premier,,937.00,,,,,,,280.29,3163.00,case rate,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1117.00000,1061.15000,The Alliance,Premier,,937.00,,,,,,,280.29,3163.00,case rate,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,937.00,,,,,,,74.80,3163.00,case rate,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,937.00,,,,,,,280.29,3163.00,case rate,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier,,2.45,,,,,,,1.73,3.36,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier,,22.20,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier,,22.20,,,,,,,15.65,30.37,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,outpatient,,,339.80000,322.81000,The Alliance,Premier,90,1527.89,,,,,,,30.26,1527.89,fee schedule,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier,,22.20,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier,,22.20,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,outpatient,1,EA,19.43000,18.46000,The Alliance,Premier,,13.78,,,,,,,9.71,18.85,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,outpatient,1,EA,277.92000,264.03000,The Alliance,Premier,,4.49,,,,,,,4.35,269.58,fee schedule,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,outpatient,1,EA,277.92000,264.02000,The Alliance,Premier,,4.49,,,,,,,4.35,269.58,fee schedule,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier,,2640.00,,,,,,,548.90,3163.00,case rate,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Premier,,2.64,,,,,,,1.86,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,outpatient,1,EA,31.53000,29.95000,The Alliance,Premier,,22.35,,,,,,,15.77,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier,,66.61,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Premier,,18.41,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,outpatient,1,EA,76.37000,72.55000,The Alliance,Premier,,54.15,,,,,,,38.19,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,outpatient,1,EA,35.86000,34.06000,The Alliance,Premier,,25.42,,,,,,,17.93,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier,,66.61,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,outpatient,1,EA,29.53000,28.05000,The Alliance,Premier,,20.94,,,,,,,14.77,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,outpatient,1,EA,26.67000,25.34000,The Alliance,Premier,,18.91,,,,,,,13.34,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier,,3.27,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,outpatient,1,EA,26.45000,25.13000,The Alliance,Premier,,18.75,,,,,,,13.22,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,outpatient,1,EA,70.70000,67.17000,The Alliance,Premier,,50.13,,,,,,,35.35,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,outpatient,1,EA,3.78000,3.60000,The Alliance,Premier,,2.68,,,,,,,1.89,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier,,3.27,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier,,66.61,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Premier,,18.41,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,outpatient,1,EA,17.97000,17.07000,The Alliance,Premier,,12.74,,,,,,,8.98,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,937.00,,,,,,,74.80,3163.00,case rate,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,outpatient,1,EA,4.46000,4.23000,The Alliance,Premier,,3.16,,,,,,,2.23,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier,,2.88,,,,,,,2.03,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,outpatient,1,EA,4.94000,4.70000,The Alliance,Premier,,3.50,,,,,,,2.47,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,outpatient,1,EA,53.59000,50.91000,The Alliance,Premier,,0.11550,,,,,,,0.11207,51.98,fee schedule,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,outpatient,1,EA,39.69000,37.71000,The Alliance,Premier,,0.11550,,,,,,,0.11207,38.50,fee schedule,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Premier,,0.11550,,,,,,,0.11207,17.81,fee schedule,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,outpatient,1,EA,15.63000,14.85000,The Alliance,Premier,,11.08,,,,,,,7.82,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,outpatient,1,EA,15.88000,15.09000,The Alliance,Premier,,11.26,,,,,,,7.94,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,outpatient,1,EA,15.76000,14.97000,The Alliance,Premier,,11.17,,,,,,,7.88,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Premier,,1.80,,,,,,,1.27,2.46,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier,,2082.45,,,,,,,22.34,2082.45,fee schedule,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,937.00,,,,,,,89.10,3163.00,case rate,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier,,148.89,,,,,,,115.50,5271.00,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,780.94,,,,,,,8.17,780.94,fee schedule,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,90,628.12,,,,,,,12.38,628.12,fee schedule,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier,,548.00,,,,,,,384.16,1060.21,fee schedule,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,117.69,,,,,,,43.81,161.02,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,outpatient,1,EA,58.40000,55.48000,The Alliance,Premier,,41.41,,,,,,,29.20,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,outpatient,1,EA,47.24000,44.88000,The Alliance,Premier,,33.49,,,,,,,23.62,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,outpatient,1,GM,15.81000,15.02000,The Alliance,Premier,,11.21,,,,,,,7.91,15.34,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,outpatient,60,EA,3.69000,3.50000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,outpatient,1,EA,35.04000,33.29000,The Alliance,Premier,,24.84,,,,,,,17.52,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier,,14.56,,,,,,,10.27,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,outpatient,1,EA,21.24000,20.17000,The Alliance,Premier,,15.06,,,,,,,10.62,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier,,7.61,,,,,,,5.37,10.42,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,outpatient,10,EA,2.95000,2.80000,The Alliance,Premier,,0.11550,,,,,,,0.11207,2.86,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,outpatient,10,EA,2.92000,2.78000,The Alliance,Premier,,0.11550,,,,,,,0.11207,2.83,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,outpatient,10,EA,5.30000,5.04000,The Alliance,Premier,,0.11550,,,,,,,0.11207,5.14,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,outpatient,10,EA,3.29000,3.13000,The Alliance,Premier,,0.11550,,,,,,,0.11207,3.19,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier,,0.11550,,,,,,,0.11207,3.07,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Premier,,0.11550,,,,,,,0.11207,2.75,fee schedule,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,outpatient,1,mL,28.25000,26.84000,The Alliance,Premier,,1.30,,,,,,,1.06,27.40,fee schedule,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,outpatient,1,mL,10.13000,9.63000,The Alliance,Premier,,1.30,,,,,,,1.06,9.83,fee schedule,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier,TC,397.04,,,,,,,280.00,543.20,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,,48.71,,,,,,,34.35,66.64,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,outpatient,1,EA,1587.93000,1508.53000,The Alliance,Premier,,92.42,,,,,,,56.01,1540.29,fee schedule,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,outpatient,30,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,outpatient,30,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,937.00,,,,,,,38.50,3163.00,case rate,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,4.31,,,,,,,3.44,9.20,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,4.31,,,,,,,3.44,18.39,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,outpatient,1,EA,9.25000,8.79000,The Alliance,Premier,,4.31,,,,,,,3.44,8.97,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier,,4.31,,,,,,,3.44,19.00,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,4.31,,,,,,,3.44,10.73,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,outpatient,1,EA,23.48000,22.30000,The Alliance,Premier,,4.31,,,,,,,3.44,22.78,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,outpatient,1,EA,217.44000,206.57000,The Alliance,Premier,,4.31,,,,,,,3.44,210.92,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Premier,,4.31,,,,,,,3.44,14.40,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,4.31,,,,,,,3.44,15.33,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,outpatient,1,EA,10.98000,10.43000,The Alliance,Premier,,4.31,,,,,,,3.44,10.65,fee schedule,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,outpatient,15,EA,5.51000,5.24000,The Alliance,Premier,,3.91,,,,,,,2.75,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,outpatient,15,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,outpatient,15,EA,4.44000,4.21000,The Alliance,Premier,,3.15,,,,,,,2.22,4.31,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,outpatient,,,180.30000,171.28000,The Alliance,Premier,90,1137.41,,,,,,,90.15,1137.41,fee schedule,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,outpatient,,,1903.00000,1807.85000,The Alliance,Premier,90,8573.20,,,,,,,169.42,8573.20,fee schedule,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier,,345.28,,,,,,,63.95,788.42,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,outpatient,1,EA,10.91000,10.36000,The Alliance,Premier,,7.74,,,,,,,5.46,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,outpatient,1,EA,6.72000,6.38000,The Alliance,Premier,,4.76,,,,,,,3.36,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,outpatient,1,EA,4.45000,4.22000,The Alliance,Premier,,3.16,,,,,,,2.23,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Premier,,1.95,,,,,,,1.38,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Premier,,3.81,,,,,,,2.69,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Premier,,3.89,,,,,,,2.75,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,3.50,,,,,,,2.46,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier,,1.98,,,,,,,1.40,2.71,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier,,937.00,,,,,,,113.85,3163.00,case rate,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,outpatient,,,63.50000,60.32000,The Alliance,Premier,,45.02,,,,,,,28.29,61.59,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier,,3.53,,,,,,,0.73500,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,3.53,,,,,,,0.71000,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,3.53,,,,,,,1.07,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,3.53,,,,,,,0.53500,3.53,fee schedule,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,outpatient,1,EA,56.72000,53.89000,The Alliance,Premier,,40.21,,,,,,,28.36,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,outpatient,5,EA,57.46000,54.59000,The Alliance,Premier,,40.74,,,,,,,28.73,55.74,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,outpatient,1,EA,31.16000,29.60000,The Alliance,Premier,,4.31,,,,,,,3.44,30.23,fee schedule,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,2234.00000,2122.30000,The Alliance,Premier,QN,1583.91,,,,,,,1117.00,2166.98,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,outpatient,3.5,EA,19.66000,18.67000,The Alliance,Premier,,13.94,,,,,,,9.83,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,outpatient,3.5,EA,12.55000,11.92000,The Alliance,Premier,,8.90,,,,,,,6.28,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,outpatient,3.5,EA,20.69000,19.66000,The Alliance,Premier,,14.67,,,,,,,10.35,20.07,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Premier,,150.18,,,,,,,91.02,1332.27,fee schedule,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,outpatient,1,GM,89.11000,84.66000,The Alliance,Premier,,63.18,,,,,,,44.55,86.44,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Premier,,2.52,,,,,,,1.77,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Premier,,4.05,,,,,,,2.85,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,outpatient,1,EA,4.69000,4.46000,The Alliance,Premier,,3.33,,,,,,,2.35,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,780.94,,,,,,,15.05,780.94,fee schedule,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,848.80,,,,,,,16.18,848.80,fee schedule,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,outpatient,45,EA,3.77000,3.58000,The Alliance,Premier,,2.67,,,,,,,1.89,3.66,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,outpatient,3.5,EA,7.75000,7.36000,The Alliance,Premier,,5.49,,,,,,,3.88,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,outpatient,3.5,EA,8.82000,8.38000,The Alliance,Premier,,6.25,,,,,,,4.41,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,outpatient,3.5,EA,6.08000,5.77000,The Alliance,Premier,,4.31,,,,,,,3.04,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,outpatient,3.5,EA,7.36000,6.99000,The Alliance,Premier,,5.22,,,,,,,3.68,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,outpatient,3.5,EA,6.45000,6.12000,The Alliance,Premier,,4.57,,,,,,,3.23,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,outpatient,3.5,EA,5.87000,5.57000,The Alliance,Premier,,4.16,,,,,,,2.94,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,outpatient,3.5,EA,2.48000,2.36000,The Alliance,Premier,,1.76,,,,,,,1.24,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,outpatient,3.5,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,outpatient,3.5,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,outpatient,3.5,EA,2.80000,2.66000,The Alliance,Premier,,1.99,,,,,,,1.40,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,outpatient,3.5,EA,4.72000,4.49000,The Alliance,Premier,,3.35,,,,,,,2.36,4.58,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,0.11550,,,,,,,0.11207,24.52,fee schedule,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,outpatient,1,mL,35.49000,33.71000,The Alliance,Premier,,0.11550,,,,,,,0.11207,34.43,fee schedule,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Premier,,0.11550,,,,,,,0.11207,36.78,fee schedule,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,outpatient,3.5,EA,39.53000,37.55000,The Alliance,Premier,,28.03,,,,,,,19.77,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,outpatient,3.5,EA,36.07000,34.26000,The Alliance,Premier,,25.57,,,,,,,18.04,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,outpatient,3.5,EA,39.91000,37.91000,The Alliance,Premier,,28.30,,,,,,,19.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,outpatient,3.5,EA,41.14000,39.09000,The Alliance,Premier,,29.17,,,,,,,20.57,39.91,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,outpatient,1,mL,146.15000,138.84000,The Alliance,Premier,,290.10,,,,,,,73.08,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,outpatient,1,mL,135.88000,129.09000,The Alliance,Premier,,290.10,,,,,,,67.94,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Premier,,290.10,,,,,,,74.67,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,outpatient,1,mL,160.62000,152.59000,The Alliance,Premier,,290.10,,,,,,,80.31,290.17,fee schedule,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,outpatient,15,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,outpatient,15,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,outpatient,15,EA,13.41000,12.74000,The Alliance,Premier,,9.51,,,,,,,6.71,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,outpatient,1,EA,295.97000,281.17000,The Alliance,Premier,,0.34650,,,,,,,0.33621,287.09,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,outpatient,1,EA,806.22000,765.90000,The Alliance,Premier,,0.34650,,,,,,,0.33621,782.03,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,outpatient,1,EA,700.52000,665.49000,The Alliance,Premier,,0.34650,,,,,,,0.33621,679.50,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Premier,,0.34650,,,,,,,0.33621,301.48,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier,,0.34650,,,,,,,0.33621,502.46,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,outpatient,1,EA,453.25000,430.59000,The Alliance,Premier,,0.34650,,,,,,,0.33621,439.65,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,outpatient,1,EA,1036.00000,984.20000,The Alliance,Premier,,0.34650,,,,,,,0.33621,1004.92,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,outpatient,1,EA,1515.77000,1439.98000,The Alliance,Premier,,0.34650,,,,,,,0.33621,1470.30,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,outpatient,1,EA,543.90000,516.70000,The Alliance,Premier,,0.34650,,,,,,,0.33621,527.58,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Premier,,0.34650,,,,,,,0.33621,251.23,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,outpatient,1,EA,123.24000,117.08000,The Alliance,Premier,,0.34650,,,,,,,0.33621,119.54,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,outpatient,1,EA,142.20000,135.09000,The Alliance,Premier,,0.34650,,,,,,,0.33621,137.93,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,outpatient,1,mL,36.50000,34.67000,The Alliance,Premier,,290.10,,,,,,,18.25,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,outpatient,1,mL,33.97000,32.27000,The Alliance,Premier,,290.10,,,,,,,16.98,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,outpatient,1,mL,37.33000,35.47000,The Alliance,Premier,,290.10,,,,,,,18.66,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,outpatient,1,mL,40.11000,38.11000,The Alliance,Premier,,290.10,,,,,,,20.05,290.17,fee schedule,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,outpatient,59.2,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,outpatient,1,mL,34.32000,32.61000,The Alliance,Premier,,24.33,,,,,,,17.16,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,outpatient,1,mL,27.68000,26.29000,The Alliance,Premier,,19.63,,,,,,,13.84,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,outpatient,1,mL,28.04000,26.64000,The Alliance,Premier,,19.88,,,,,,,14.02,27.20,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,373.51,,,,,,,7.30,373.51,fee schedule,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,,882.80,,,,,,,16.87,882.80,fee schedule,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Premier,90,1969.25,,,,,,,38.99,1969.25,fee schedule,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,1216.68,,,,,,,5.99,1216.68,fee schedule,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Premier,,3963.00,,,,,,,180.95,4686.00,case rate,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,outpatient,8,EA,302.57000,287.44000,The Alliance,Premier,,214.52,,,,,,,151.28,293.49,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,outpatient,5,EA,5.78000,5.49000,The Alliance,Premier,,4.10,,,,,,,2.89,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,outpatient,5,EA,27.09000,25.73000,The Alliance,Premier,,19.21,,,,,,,13.54,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,outpatient,5,EA,23.29000,22.12000,The Alliance,Premier,,16.51,,,,,,,11.64,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,outpatient,5,EA,18.42000,17.50000,The Alliance,Premier,,13.06,,,,,,,9.21,17.87,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,outpatient,56,EA,225.62000,214.34000,The Alliance,Premier,,159.96,,,,,,,112.81,218.85,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,outpatient,10,EA,98.13000,93.22000,The Alliance,Premier,,69.57,,,,,,,49.06,95.19,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,186.75,,,,,,,3.80,186.75,fee schedule,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,outpatient,1,EA,2511.99000,2386.39000,The Alliance,Premier,,6.42,,,,,,,3.89,2436.63,fee schedule,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,outpatient,30,EA,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,outpatient,30,EA,3.67000,3.49000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,outpatient,30,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,outpatient,30,EA,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,outpatient,30,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,outpatient,30,EA,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,outpatient,30,EA,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,outpatient,,,2632.00000,2500.40000,The Alliance,Premier,,3963.00,,,,,,,1447.60,4686.00,case rate,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Premier,90,526.26,,,,,,,8.17,526.26,fee schedule,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,,2640.00,,,,,,,658.35,3163.00,case rate,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,1324.17,,,,,,,8.17,1324.17,fee schedule,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,254.68,,,,,,,4.70,254.68,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,outpatient,1,EA,93.93000,89.23000,The Alliance,Premier,,4.41,,,,,,,3.84,91.11,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Premier,,4.41,,,,,,,3.84,101.15,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,outpatient,1,EA,114.01000,108.31000,The Alliance,Premier,,4.41,,,,,,,3.84,110.59,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,outpatient,1,EA,86.30000,81.98000,The Alliance,Premier,,4.41,,,,,,,3.84,83.71,fee schedule,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,,48.71,,,,,,,34.35,66.64,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Premier,,120.53,,,,,,,73.05,500.54,fee schedule,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,outpatient,1,EA,187.86000,178.47000,The Alliance,Premier,,4.41,,,,,,,3.84,182.22,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,outpatient,1,EA,231.66000,220.08000,The Alliance,Premier,,4.41,,,,,,,3.84,224.71,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,outpatient,1,EA,172.60000,163.97000,The Alliance,Premier,,4.41,,,,,,,3.84,167.42,fee schedule,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier,,595.56,,,,,,,420.00,814.80,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,509.30,,,,,,,11.00,509.30,fee schedule,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,90,899.77,,,,,,,17.69,899.77,fee schedule,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,152.82,,,,,,,3.02,152.82,fee schedule,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,1426.03,,,,,,,37.27,1426.03,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,outpatient,1,EA,295.84000,281.05000,The Alliance,Premier,,34.48,,,,,,,33.41,286.96,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,outpatient,1,EA,274.80000,261.06000,The Alliance,Premier,,34.48,,,,,,,33.41,266.56,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,outpatient,1,EA,231.41000,219.84000,The Alliance,Premier,,34.48,,,,,,,33.41,224.47,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,outpatient,1,EA,210.74000,200.20000,The Alliance,Premier,,34.48,,,,,,,33.41,204.42,fee schedule,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier,,2640.00,,,,,,,420.20,3163.00,case rate,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,outpatient,2.5,EA,122.58000,116.45000,The Alliance,Premier,,86.91,,,,,,,61.29,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,outpatient,2.5,EA,136.13000,129.33000,The Alliance,Premier,,96.52,,,,,,,68.06,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,outpatient,2.5,EA,132.04000,125.44000,The Alliance,Premier,,93.62,,,,,,,66.02,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,outpatient,2.5,EA,66.74000,63.40000,The Alliance,Premier,,47.32,,,,,,,33.37,64.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,outpatient,5,EA,23.64000,22.45000,The Alliance,Premier,,11.37,,,,,,,10.61,22.93,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,outpatient,5,EA,34.78000,33.04000,The Alliance,Premier,,11.37,,,,,,,10.61,33.74,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,outpatient,5,EA,25.44000,24.17000,The Alliance,Premier,,11.37,,,,,,,10.61,24.68,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,outpatient,5,EA,18.05000,17.15000,The Alliance,Premier,,11.37,,,,,,,9.03,17.51,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Premier,,11.37,,,,,,,10.61,24.52,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,outpatient,5,EA,24.79000,23.55000,The Alliance,Premier,,11.37,,,,,,,10.61,24.05,fee schedule,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,outpatient,1,EA,84.57000,80.34000,The Alliance,Premier,,59.96,,,,,,,42.28,82.03,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,outpatient,15,EA,3.55000,3.37000,The Alliance,Premier,,2.52,,,,,,,1.77,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,outpatient,15,EA,4.62000,4.38000,The Alliance,Premier,,3.28,,,,,,,2.31,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,outpatient,15,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Premier,,34.32,,,,,,,24.20,46.95,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,152.82,,,,,,,2.99,152.82,fee schedule,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,90,628.12,,,,,,,12.38,628.12,fee schedule,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,outpatient,237,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,outpatient,237,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Premier,TC,1435.02,,,,,,,864.82,2960.49,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier,,1222.31,,,,,,,26.07,1222.31,fee schedule,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1737.00000,1650.15000,The Alliance,Premier,TC,1231.53,,,,,,,868.50,2210.07,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Premier,,258.08,,,,,,,182.00,456.63,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,203.72,,,,,,,3.83,203.72,fee schedule,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,,152.82,,,,,,,2.99,152.82,fee schedule,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier,TC,1719.33,,,,,,,1212.50,2352.25,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,203.72,,,,,,,3.83,203.72,fee schedule,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,,763.98,,,,,,,13.37,763.98,fee schedule,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,outpatient,,,1888.00000,1793.60000,The Alliance,Premier,TC,1338.59,,,,,,,875.87,2210.07,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,outpatient,5,EA,32.06000,30.46000,The Alliance,Premier,,22.73,,,,,,,16.03,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,outpatient,5,EA,32.22000,30.61000,The Alliance,Premier,,22.84,,,,,,,16.11,31.25,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1444.00000,1371.80000,The Alliance,Premier,,8250.66,,,,,,,143.40,8250.66,fee schedule,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Premier,,120.53,,,,,,,73.05,500.54,fee schedule,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,441.37,,,,,,,8.46,441.37,fee schedule,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier,,1086.52,,,,,,,20.81,1086.52,fee schedule,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,outpatient,1,GM,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,outpatient,1,GM,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,outpatient,1,GM,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14106.71,per diem,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,outpatient,,,733.00000,696.35000,The Alliance,Premier,,2440.34,,,,,,,236.07,2440.34,fee schedule,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Premier,TC,2451.72,,,,,,,1609.99,3354.26,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Premier,,2206.26,,,,,,,2140.96,4664.40,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier,,6.43,,,,,,,4.54,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Premier,,5.37,,,,,,,3.79,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,outpatient,1,EA,7.46000,7.08000,The Alliance,Premier,,5.29,,,,,,,3.73,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,outpatient,1,EA,7.92000,7.53000,The Alliance,Premier,,5.62,,,,,,,3.96,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,1324.17,,,,,,,8.17,1324.17,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,outpatient,2,EA,9.20000,8.74000,The Alliance,Premier,,2.11,,,,,,,1.85,8.92,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,outpatient,2,EA,14.00000,13.30000,The Alliance,Premier,,2.11,,,,,,,1.85,13.58,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,outpatient,2,EA,1.31000,1.25000,The Alliance,Premier,,2.11,,,,,,,0.65500,2.11,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,outpatient,2,EA,16.21000,15.40000,The Alliance,Premier,,2.11,,,,,,,1.85,15.72,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,outpatient,2,EA,14.70000,13.97000,The Alliance,Premier,,2.11,,,,,,,1.85,14.26,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Premier,,2.11,,,,,,,1.85,7.66,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,outpatient,2,EA,10.06000,9.56000,The Alliance,Premier,,2.11,,,,,,,1.85,9.76,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,outpatient,2,EA,4.71000,4.48000,The Alliance,Premier,,2.11,,,,,,,1.85,4.57,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,outpatient,2,EA,14.75000,14.01000,The Alliance,Premier,,2.11,,,,,,,1.85,14.31,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Premier,,2.11,,,,,,,0.79000,2.11,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,outpatient,2,EA,3.05000,2.90000,The Alliance,Premier,,2.11,,,,,,,1.52,2.96,fee schedule,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,,407.44,,,,,,,7.75,407.44,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,outpatient,10,EA,1.06000,1.00000,The Alliance,Premier,,1.01,,,,,,,0.53000,1.03,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,outpatient,10,EA,0.58000,0.55000,The Alliance,Premier,,1.01,,,,,,,0.29000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,outpatient,10,EA,1.04000,0.98000,The Alliance,Premier,,1.01,,,,,,,0.52000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,outpatient,10,EA,0.78000,0.74000,The Alliance,Premier,,1.01,,,,,,,0.39000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier,,1.01,,,,,,,0.61000,1.53,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Premier,,1.01,,,,,,,0.51500,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,outpatient,10,EA,0.87000,0.82000,The Alliance,Premier,,1.01,,,,,,,0.43500,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,outpatient,10,EA,1.05000,1.00000,The Alliance,Premier,,1.01,,,,,,,0.52500,1.02,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,1.01,,,,,,,0.47500,1.01,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,outpatient,30,EA,0.24000,0.22000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.23280,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,outpatient,30,EA,0.52000,0.49000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.50440,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.26190,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.53350,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.75660,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,outpatient,30,EA,0.76000,0.73000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.73720,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.31040,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.20370,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,outpatient,30,EA,0.18000,0.17000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.17460,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,outpatient,30,EA,0.49000,0.47000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.47530,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.24250,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,outpatient,30,EA,0.51000,0.48000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.49470,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,outpatient,30,EA,0.73000,0.69000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.70810,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,outpatient,30,EA,0.69000,0.65000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.66930,fee schedule,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Premier,QN,769.97,,,,,,,543.00,1053.42,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,90,458.40,,,,,,,8.17,458.40,fee schedule,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,113.44,,,,,,,80.00,155.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,8.33,,,,,,,7.27,18.39,fee schedule,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,outpatient,1,EA,26.07000,24.76000,The Alliance,Premier,,8.33,,,,,,,7.27,25.29,fee schedule,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,8.33,,,,,,,4.74,9.20,fee schedule,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier,,1662.04,,,,,,,35.09,1662.04,fee schedule,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,outpatient,5,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,outpatient,5,EA,9.16000,8.71000,The Alliance,Premier,,6.49,,,,,,,4.58,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,outpatient,5,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,outpatient,5,EA,3.86000,3.67000,The Alliance,Premier,,2.74,,,,,,,1.93,3.74,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.18430,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.34920,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.19400,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.68870,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.49470,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,outpatient,4,EA,1.66000,1.58000,The Alliance,Premier,,1.01,,,,,,,0.61000,1.61,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,outpatient,4,EA,1.33000,1.26000,The Alliance,Premier,,1.01,,,,,,,0.61000,1.29,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,outpatient,4,EA,2.39000,2.27000,The Alliance,Premier,,1.01,,,,,,,0.61000,2.32,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,outpatient,4,EA,1.80000,1.71000,The Alliance,Premier,,1.01,,,,,,,0.61000,1.75,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,outpatient,4,EA,2.46000,2.33000,The Alliance,Premier,,1.01,,,,,,,0.61000,2.39,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,outpatient,4,EA,2.16000,2.06000,The Alliance,Premier,,1.01,,,,,,,0.61000,2.10,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,outpatient,4,EA,2.05000,1.95000,The Alliance,Premier,,1.01,,,,,,,0.61000,1.99,fee schedule,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,1237.50000,1175.62000,The Alliance,Premier,,585.34,,,,,,,568.01,1237.50,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Premier,QN,769.97,,,,,,,543.00,1053.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier,,2.88,,,,,,,2.03,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,outpatient,1,EA,12.10000,11.50000,The Alliance,Premier,,8.58,,,,,,,6.05,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Premier,,2.92,,,,,,,2.06,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier,,2.96,,,,,,,2.08,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Premier,,4.15,,,,,,,2.93,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,outpatient,1,EA,8.33000,7.92000,The Alliance,Premier,,5.91,,,,,,,4.17,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,outpatient,1,EA,10.00000,9.50000,The Alliance,Premier,,7.09,,,,,,,5.00,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Premier,,4.15,,,,,,,2.92,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier,,7.70,,,,,,,5.43,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,outpatient,30,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,outpatient,30,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,outpatient,30,EA,1.03000,0.97000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.76630,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,outpatient,10,EA,0.38000,0.36000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.36860,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,outpatient,10,EA,0.73000,0.69000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.70810,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,outpatient,10,EA,1.50000,1.42000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.46,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.80510,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,outpatient,10,EA,1.66000,1.57000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.61,fee schedule,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Premier,90,1205.34,,,,,,,24.43,1205.34,fee schedule,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier,90,713.01,,,,,,,14.05,713.01,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.76630,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.21,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.61110,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.06,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.80510,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,outpatient,10,EA,1.50000,1.43000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.46,fee schedule,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,Premier,,1833.46,,,,,,,37.27,1833.46,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.45590,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.29100,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.43650,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.76630,fee schedule,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,outpatient,1,EA,11.31000,10.74000,The Alliance,Premier,,8.02,,,,,,,5.66,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,outpatient,1,EA,4.73000,4.49000,The Alliance,Premier,,3.35,,,,,,,2.37,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,outpatient,1,EA,7.99000,7.60000,The Alliance,Premier,,5.66,,,,,,,4.00,7.75,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,outpatient,1,mL,2.16000,2.05000,The Alliance,Premier,,1.53,,,,,,,1.08,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,outpatient,1,mL,5.43000,5.16000,The Alliance,Premier,,3.85,,,,,,,2.71,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,outpatient,1,mL,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97500,1.89,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,outpatient,1,EA,4.35000,4.14000,The Alliance,Premier,,3.08,,,,,,,2.17,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier,,3963.00,,,,,,,420.20,4686.00,case rate,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.61110,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.21340,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.23280,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,outpatient,1,mL,0.64000,0.60000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.62080,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.68870,fee schedule,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,outpatient,1,EA,5.95000,5.66000,The Alliance,Premier,,4.22,,,,,,,2.98,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier,,3.79,,,,,,,2.67,5.19,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Premier,,0.06600,,,,,,,0.06404,1.66,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,outpatient,50,EA,6.32000,6.00000,The Alliance,Premier,,0.06600,,,,,,,0.06404,6.13,fee schedule,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,outpatient,,,4181.00000,3971.95000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,outpatient,2,EA,50.16000,47.66000,The Alliance,Premier,,35.56,,,,,,,25.08,48.66,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier,90,1392.10,,,,,,,27.68,1392.10,fee schedule,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,,3963.00,,,,,,,658.35,4686.00,case rate,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Premier,TC,2720.43,,,,,,,1626.53,3721.89,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,outpatient,1,EA,21473.80000,20400.11000,The Alliance,Premier,,426.56,,,,,,,258.52,20829.59,fee schedule,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Premier,,3963.00,,,,,,,1538.48,5563.92,case rate,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier,,2.29,,,,,,,1.61,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier,,2.12,,,,,,,1.50,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Premier,,2.14,,,,,,,1.51,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier,,2.17,,,,,,,1.53,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,outpatient,1.5,EA,94.13000,89.42000,The Alliance,Premier,,66.74,,,,,,,47.06,91.31,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier,,3963.00,,,,,,,1538.48,6189.57,case rate,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,271.65,,,,,,,5.16,271.65,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,outpatient,10,EA,3.17000,3.01000,The Alliance,Premier,,0.06600,,,,,,,0.06404,3.07,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier,,0.06600,,,,,,,0.06404,3.07,fee schedule,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Premier,TC,1170.56,,,,,,,805.84,2210.07,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier,,1018.59,,,,,,,19.63,1018.59,fee schedule,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,outpatient,1,EA,8.55000,8.13000,The Alliance,Premier,,6.06,,,,,,,4.28,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,outpatient,1,EA,10.63000,10.10000,The Alliance,Premier,,7.54,,,,,,,5.32,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,outpatient,1,EA,5.44000,5.17000,The Alliance,Premier,,3.86,,,,,,,2.72,5.28,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,outpatient,10,EA,2.14000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,outpatient,10,EA,2.70000,2.56000,The Alliance,Premier,,1.91,,,,,,,1.35,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Premier,,935.88,,,,,,,726.00,5271.00,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,outpatient,1,EA,5.42000,5.15000,The Alliance,Premier,,3.84,,,,,,,2.71,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Premier,,3.30,,,,,,,2.33,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Premier,,2.07,,,,,,,1.46,2.83,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier,TC,386.40,,,,,,,272.50,528.65,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,outpatient,,,8368.00000,7949.60000,The Alliance,Premier,90,885.37,,,,,,,14.91,8116.96,fee schedule,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier,,1.84,,,,,,,1.29,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier,,3.26,,,,,,,2.30,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,outpatient,1,EA,308.21000,292.80000,The Alliance,Premier,,218.52,,,,,,,154.10,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,outpatient,1,EA,766.64000,728.31000,The Alliance,Premier,,543.55,,,,,,,383.32,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,outpatient,1,EA,357.42000,339.55000,The Alliance,Premier,,253.41,,,,,,,178.71,346.70,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,outpatient,30,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,outpatient,30,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,,475.37,,,,,,,9.22,475.37,fee schedule,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier,TC,327.56,,,,,,,231.00,448.14,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier,,2.97,,,,,,,2.10,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Premier,,2.75,,,,,,,1.94,3.76,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier,,1086.52,,,,,,,7.34,1086.52,fee schedule,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Premier,,3.15,,,,,,,2.22,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Premier,,2.00,,,,,,,1.41,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier,,1.63,,,,,,,1.15,2.23,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,outpatient,10,EA,0.66000,0.63000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.64020,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,outpatient,10,EA,0.62000,0.59000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.60140,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,outpatient,10,EA,1.04000,0.99000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.01,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.69840,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Premier,,0.01650,,,,,,,0.01550,1.75,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,outpatient,10,EA,2.07000,1.97000,The Alliance,Premier,,0.01650,,,,,,,0.01550,2.01,fee schedule,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,3963.00,,,,,,,174.90,4686.00,case rate,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,outpatient,1,EA,9.52000,9.04000,The Alliance,Premier,,6.75,,,,,,,4.76,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier,,2.86,,,,,,,2.02,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier,,3.08,,,,,,,2.17,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,outpatient,3.7,EA,256.63000,243.79000,The Alliance,Premier,,181.95,,,,,,,128.31,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,outpatient,3.7,EA,50.82000,48.28000,The Alliance,Premier,,36.03,,,,,,,25.41,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,outpatient,3.7,EA,63.94000,60.75000,The Alliance,Premier,,45.33,,,,,,,31.97,62.02,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,outpatient,222,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,outpatient,222,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,outpatient,222,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,outpatient,222,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,outpatient,222,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,outpatient,1,EA,244.62000,232.38000,The Alliance,Premier,,173.44,,,,,,,122.31,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,outpatient,1,EA,917.98000,872.08000,The Alliance,Premier,,650.85,,,,,,,458.99,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,outpatient,1,EA,826.18000,784.87000,The Alliance,Premier,,585.76,,,,,,,413.09,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,89.62,,,,,,,63.20,122.61,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Premier,,7.95,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Premier,,3.42,,,,,,,2.42,4.69,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,outpatient,1,mL,3.48000,3.31000,The Alliance,Premier,,3.48,,,,,,,1.74,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,outpatient,1,mL,2.50000,2.38000,The Alliance,Premier,,3.48,,,,,,,1.25,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,outpatient,1,mL,5.26000,5.00000,The Alliance,Premier,,3.48,,,,,,,2.63,5.10,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Premier,,3.48,,,,,,,1.32,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,outpatient,1,mL,3.11000,2.96000,The Alliance,Premier,,3.48,,,,,,,1.55,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier,,3.48,,,,,,,2.85,5.52,fee schedule,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,outpatient,12,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,outpatient,12,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,outpatient,12,EA,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,outpatient,12,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,outpatient,12,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,outpatient,12,EA,2.32000,2.21000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,outpatient,12,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,outpatient,,,298.50000,283.58000,The Alliance,Premier,90,1324.17,,,,,,,26.09,1324.17,fee schedule,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,322.54,,,,,,,6.03,322.54,fee schedule,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,713.01,,,,,,,13.68,713.01,fee schedule,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,outpatient,15,EA,11.52000,10.94000,The Alliance,Premier,,8.17,,,,,,,5.76,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,outpatient,15,EA,10.06000,9.56000,The Alliance,Premier,,7.13,,,,,,,5.03,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,outpatient,15,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,outpatient,15,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,outpatient,15,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,outpatient,15,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,outpatient,15,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,outpatient,15,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,outpatient,1,EA,15.20000,14.44000,The Alliance,Premier,,10.78,,,,,,,7.60,14.74,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,outpatient,1,mL,10.52000,10.00000,The Alliance,Premier,,7.46,,,,,,,5.26,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Premier,,14.00,,,,,,,9.87,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,outpatient,1,mL,17.91000,17.01000,The Alliance,Premier,,12.70,,,,,,,8.96,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,outpatient,1,mL,5.67000,5.38000,The Alliance,Premier,,4.02,,,,,,,2.83,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,outpatient,1,mL,32.79000,31.15000,The Alliance,Premier,,23.25,,,,,,,16.39,31.81,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,,763.98,,,,,,,14.57,763.98,fee schedule,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,outpatient,1,EA,874.67000,830.94000,The Alliance,Premier,,3.75,,,,,,,3.63,848.43,fee schedule,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,outpatient,1,mL,17567.59000,16689.21000,The Alliance,Premier,,374.71,,,,,,,227.10,17040.56,fee schedule,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Premier,TC,249.57,,,,,,,176.00,341.44,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Premier,90,696.05,,,,,,,13.69,696.05,fee schedule,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier,,984.66,,,,,,,18.96,984.66,fee schedule,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Premier,,7.95,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier,,2.19,,,,,,,0.14500,2.19,fee schedule,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Premier,,2.19,,,,,,,0.22500,2.19,fee schedule,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier,,2.19,,,,,,,0.27500,2.19,fee schedule,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier,,1645.00,,,,,,,166.00,1820.00,per diem,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,outpatient,1,EA,3597.38000,3417.51000,The Alliance,Premier,,90.90,,,,,,,55.09,3489.46,fee schedule,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier,TC,1488.90,,,,,,,980.94,2210.07,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,outpatient,1,EA,24.39000,23.17000,The Alliance,Premier,,17.29,,,,,,,12.20,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,outpatient,1,EA,23.23000,22.07000,The Alliance,Premier,,16.47,,,,,,,11.62,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Premier,,2.70,,,,,,,1.91,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,outpatient,1,EA,3.47000,3.29000,The Alliance,Premier,,2.46,,,,,,,1.74,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Premier,,5.26,,,,,,,3.71,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier,,1.95,,,,,,,1.38,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,1324.17,,,,,,,8.17,1324.17,fee schedule,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Premier,90,628.12,,,,,,,8.17,628.12,fee schedule,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier,,2.79,,,,,,,1.97,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,outpatient,1,mL,2.13000,2.02000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,outpatient,,,1010.55000,960.02000,The Alliance,Premier,,477.99,,,,,,,463.84,1010.55,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,outpatient,1,EA,5931.95000,5635.36000,The Alliance,Premier,,90.90,,,,,,,55.09,5753.99,fee schedule,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1419.00000,1348.05000,The Alliance,Premier,,1006.07,,,,,,,621.36,1376.43,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier,,3963.00,,,,,,,1333.75,4686.00,case rate,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,outpatient,1,EA,62.57000,59.44000,The Alliance,Premier,,8.46,,,,,,,7.77,60.69,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,8.46,,,,,,,7.77,30.65,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,outpatient,1,EA,63.04000,59.89000,The Alliance,Premier,,8.46,,,,,,,7.77,61.15,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,8.46,,,,,,,7.77,18.39,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Premier,,8.46,,,,,,,7.77,42.79,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,outpatient,1,EA,20.26000,19.24000,The Alliance,Premier,,8.46,,,,,,,7.77,19.65,fee schedule,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier,,3.70,,,,,,,2.61,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,outpatient,1,EA,5.80000,5.51000,The Alliance,Premier,,4.11,,,,,,,2.90,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier,,4.08,,,,,,,2.88,5.58,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,outpatient,,,1182.00000,1122.90000,The Alliance,Premier,,838.04,,,,,,,650.10,5271.00,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,outpatient,1,EA,46.64000,44.31000,The Alliance,Premier,,1.39,,,,,,,1.28,45.24,fee schedule,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,outpatient,60,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,outpatient,60,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,TC,1840.56,,,,,,,1189.19,2518.12,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,407.44,,,,,,,7.77,407.44,fee schedule,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Premier,,186.00,,,,,,,119.56,264.81,per diem,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Premier,,10.75,,,,,,,7.58,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,288.61,,,,,,,5.60,288.61,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier,,1.39,,,,,,,1.28,3.22,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Premier,,1.39,,,,,,,1.28,4.19,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,1.39,,,,,,,1.28,3.22,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,1.39,,,,,,,1.28,4.60,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,1.39,,,,,,,1.28,4.91,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier,,1.39,,,,,,,1.28,2.82,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,1.39,,,,,,,1.28,5.05,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,outpatient,1,EA,4.52000,4.29000,The Alliance,Premier,,1.39,,,,,,,1.28,4.38,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier,,1.39,,,,,,,1.28,4.63,fee schedule,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,outpatient,,,54.50000,51.77000,The Alliance,Premier,90,679.08,,,,,,,13.30,679.08,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier,,1.39,,,,,,,1.28,26.05,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,outpatient,1,EA,34.92000,33.17000,The Alliance,Premier,,1.39,,,,,,,1.28,33.87,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier,,1.39,,,,,,,1.28,45.98,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier,,1.39,,,,,,,1.28,36.78,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Premier,,1.39,,,,,,,1.28,147.13,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,outpatient,1,EA,39.63000,37.65000,The Alliance,Premier,,1.39,,,,,,,1.28,38.44,fee schedule,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,outpatient,1,EA,3686.90000,3502.55000,The Alliance,Premier,,2.62,,,,,,,2.55,3576.29,fee schedule,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,645.08,,,,,,,12.32,645.08,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,0.79200,,,,,,,0.76415,7.66,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier,,0.79200,,,,,,,0.76415,4.67,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,outpatient,1,EA,12.32000,11.71000,The Alliance,Premier,,0.79200,,,,,,,0.76415,11.95,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,outpatient,1,EA,14.73000,13.99000,The Alliance,Premier,,0.79200,,,,,,,0.76415,14.29,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,outpatient,1,EA,11.06000,10.50000,The Alliance,Premier,,0.79200,,,,,,,0.76415,10.73,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Premier,,0.79200,,,,,,,0.76415,7.35,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.79200,,,,,,,0.76415,9.20,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier,,0.79200,,,,,,,0.76415,4.66,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier,,0.79200,,,,,,,0.76415,21.46,fee schedule,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,outpatient,1,EA,19.34000,18.37000,The Alliance,Premier,,13.71,,,,,,,9.67,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier,,2.27,,,,,,,1.60,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,outpatient,1,EA,4.46000,4.24000,The Alliance,Premier,,3.16,,,,,,,2.23,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier,,3.17,,,,,,,2.23,4.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.79200,,,,,,,0.76415,9.20,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,outpatient,1,EA,9.14000,8.68000,The Alliance,Premier,,0.79200,,,,,,,0.76415,8.87,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,outpatient,1,EA,24.82000,23.58000,The Alliance,Premier,,0.79200,,,,,,,0.76415,24.08,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,outpatient,1,EA,28.19000,26.78000,The Alliance,Premier,,0.79200,,,,,,,0.76415,27.34,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Premier,,0.79200,,,,,,,0.76415,13.48,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,outpatient,1,EA,6.97000,6.62000,The Alliance,Premier,,0.79200,,,,,,,0.76415,6.76,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,outpatient,1,EA,7.41000,7.04000,The Alliance,Premier,,0.79200,,,,,,,0.76415,7.19,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier,,0.79200,,,,,,,0.76415,13.79,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,0.79200,,,,,,,0.76415,33.72,fee schedule,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier,,649.44,,,,,,,314.95,888.52,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,8.46,,,,,,,7.77,18.39,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,outpatient,1,EA,31.44000,29.87000,The Alliance,Premier,,8.46,,,,,,,7.77,30.50,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,8.46,,,,,,,4.74,9.20,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Premier,,8.46,,,,,,,7.77,21.43,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,outpatient,1,EA,10.14000,9.64000,The Alliance,Premier,,8.46,,,,,,,5.07,9.84,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,0.79200,,,,,,,0.76415,4.60,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,0.79200,,,,,,,0.76415,2.96,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier,,0.79200,,,,,,,0.76415,2.59,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,outpatient,1,EA,31.76000,30.17000,The Alliance,Premier,,2.03,,,,,,,1.86,30.81,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,2.03,,,,,,,1.86,30.65,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Premier,,2.03,,,,,,,1.86,30.04,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,outpatient,1,EA,16.61000,15.78000,The Alliance,Premier,,2.03,,,,,,,1.86,16.11,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,outpatient,1,EA,44.65000,42.42000,The Alliance,Premier,,2.03,,,,,,,1.86,43.31,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,outpatient,1,EA,31.28000,29.72000,The Alliance,Premier,,2.03,,,,,,,1.86,30.34,fee schedule,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,outpatient,1,EA,4.73000,4.50000,The Alliance,Premier,,3.35,,,,,,,2.37,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,outpatient,1,EA,4.91000,4.66000,The Alliance,Premier,,3.48,,,,,,,2.46,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,outpatient,1,EA,4.86000,4.62000,The Alliance,Premier,,3.45,,,,,,,2.43,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,254.68,,,,,,,4.72,254.68,fee schedule,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,outpatient,1,EA,9.90000,9.41000,The Alliance,Premier,,7.02,,,,,,,4.95,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Premier,,30.25,,,,,,,21.33,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Premier,,14.79,,,,,,,10.43,20.23,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier,,154.56,,,,,,,119.90,5271.00,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Premier,,0.79200,,,,,,,0.76415,2.34,fee schedule,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Premier,,0.79200,,,,,,,0.76415,5.45,fee schedule,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,outpatient,120,mL,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,outpatient,120,mL,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Premier,,129.48,,,,,,,24.91,129.48,fee schedule,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,outpatient,1,EA,38.10000,36.19000,The Alliance,Premier,,27.01,,,,,,,19.05,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,3.50,,,,,,,2.46,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,outpatient,1,EA,6.39000,6.07000,The Alliance,Premier,,4.53,,,,,,,3.19,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Premier,,2.79,,,,,,,1.97,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,outpatient,100,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,outpatient,100,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,outpatient,100,EA,25.98000,24.68000,The Alliance,Premier,,18.42,,,,,,,12.99,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,outpatient,,,2419.00000,2298.05000,The Alliance,Premier,,1715.07,,,,,,,1330.45,5271.00,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,outpatient,1,mL,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier,,1.44,,,,,,,1.01,1.97,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier,,3.79,,,,,,,2.67,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Premier,,3.61,,,,,,,2.54,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier,,3.94,,,,,,,2.78,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier,,7.70,,,,,,,5.43,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Premier,,4.12,,,,,,,2.90,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,662.12,,,,,,,8.17,662.12,fee schedule,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Premier,,1273.27,,,,,,,26.72,1273.27,fee schedule,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,outpatient,,,35.20000,33.44000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,outpatient,2,EA,47.59000,45.21000,The Alliance,Premier,,44.67,,,,,,,23.80,48.21,fee schedule,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,outpatient,2,EA,52.30000,49.68000,The Alliance,Premier,,44.67,,,,,,,26.15,50.73,fee schedule,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Premier,90,882.80,,,,,,,17.43,882.80,fee schedule,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Premier,,624.63,,,,,,,314.95,854.57,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier,TC,3547.16,,,,,,,304.21,3547.16,fee schedule,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier,,344.57,,,,,,,67.58,471.42,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,560.26,,,,,,,10.74,560.26,fee schedule,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,,150.31,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier,,511.90,,,,,,,314.95,700.34,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,outpatient,2,EA,2573.64000,2444.96000,The Alliance,Premier,,1824.71,,,,,,,835.80,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,outpatient,2,EA,3600.65000,3420.62000,The Alliance,Premier,,2552.86,,,,,,,835.80,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,outpatient,2,EA,2626.01000,2494.71000,The Alliance,Premier,,1861.84,,,,,,,835.80,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,outpatient,2,EA,3601.91000,3421.82000,The Alliance,Premier,,2553.75,,,,,,,835.80,3493.85,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,,131.87,,,,,,,67.58,180.42,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,254.68,,,,,,,5.00,254.68,fee schedule,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,90,611.15,,,,,,,8.17,611.15,fee schedule,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,outpatient,1,EA,18.13000,17.22000,The Alliance,Premier,,12.85,,,,,,,9.06,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Premier,,8.47,,,,,,,5.97,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Premier,,12.28,,,,,,,8.66,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier,,6.05,,,,,,,4.27,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,outpatient,1,EA,17.40000,16.53000,The Alliance,Premier,,12.34,,,,,,,8.70,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,Premier,,8.74,,,,,,,6.17,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,outpatient,1,EA,20.14000,19.13000,The Alliance,Premier,,14.28,,,,,,,10.07,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,outpatient,1,EA,3.17000,3.01000,The Alliance,Premier,,2.25,,,,,,,1.58,3.07,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,outpatient,1,EA,6.62000,6.29000,The Alliance,Premier,,4.69,,,,,,,3.31,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.78,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,outpatient,1,EA,16.31000,15.49000,The Alliance,Premier,,2.03,,,,,,,1.86,15.82,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,outpatient,1,EA,19.05000,18.10000,The Alliance,Premier,,2.03,,,,,,,1.86,18.48,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,2.03,,,,,,,1.86,18.39,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Premier,,2.03,,,,,,,1.86,17.47,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Premier,,2.03,,,,,,,1.86,21.82,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,2.03,,,,,,,1.86,8.58,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Premier,,2.03,,,,,,,1.86,17.78,fee schedule,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Premier,,5.88,,,,,,,4.15,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,outpatient,1,EA,13.54000,12.87000,The Alliance,Premier,,9.60,,,,,,,6.77,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier,,4.62,,,,,,,3.25,6.31,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,outpatient,50,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,outpatient,50,EA,1.85000,1.75000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,outpatient,50,EA,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,outpatient,50,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,outpatient,50,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,outpatient,50,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,,458.40,,,,,,,9.81,458.40,fee schedule,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,271.65,,,,,,,5.75,271.65,fee schedule,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,407.44,,,,,,,7.87,407.44,fee schedule,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,237.65,,,,,,,4.60,237.65,fee schedule,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,,289.27,,,,,,,67.58,395.76,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,outpatient,1,mL,3.54000,3.36000,The Alliance,Premier,,0.06600,,,,,,,0.06045,3.43,fee schedule,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,outpatient,1,mL,104.95000,99.70000,The Alliance,Premier,,74.41,,,,,,,52.48,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,outpatient,1,mL,94.45000,89.73000,The Alliance,Premier,,66.97,,,,,,,47.23,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,outpatient,1,mL,86.63000,82.30000,The Alliance,Premier,,61.42,,,,,,,43.31,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,outpatient,1,mL,73.73000,70.05000,The Alliance,Premier,,52.27,,,,,,,36.87,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,outpatient,1,mL,48.60000,46.17000,The Alliance,Premier,,34.46,,,,,,,24.30,47.14,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier,,2.46,,,,,,,1.74,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier,,4.28,,,,,,,3.02,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Premier,,4.29,,,,,,,3.02,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,1137.41,,,,,,,24.09,1137.41,fee schedule,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier,,3.83,,,,,,,0.04500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,3.83,,,,,,,0.03500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,3.83,,,,,,,0.04500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,3.83,,,,,,,0.03500,3.83,fee schedule,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,outpatient,,,1316.00000,1250.20000,The Alliance,Premier,,6807.60,,,,,,,144.61,6807.60,fee schedule,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Premier,,3.06,,,,,,,2.16,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Premier,,1578.85,,,,,,,33.47,1578.85,fee schedule,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Premier,,6518.98,,,,,,,125.49,6518.98,fee schedule,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,outpatient,1,EA,6.49000,6.17000,The Alliance,Premier,,4.60,,,,,,,3.25,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier,,1.98,,,,,,,1.40,2.71,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,outpatient,,,2292.00000,2177.40000,The Alliance,Premier,,12426.88,,,,,,,248.52,12426.88,fee schedule,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,outpatient,10,EA,9.91000,9.41000,The Alliance,Premier,,7.03,,,,,,,4.96,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,outpatient,10,EA,10.62000,10.09000,The Alliance,Premier,,7.53,,,,,,,5.31,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,outpatient,10,EA,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,outpatient,10,EA,4.17000,3.96000,The Alliance,Premier,,2.96,,,,,,,2.08,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,outpatient,10,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,outpatient,10,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,Premier,,3582.03,,,,,,,68.60,3582.03,fee schedule,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,outpatient,,,84.40000,80.18000,The Alliance,Premier,90,1052.52,,,,,,,10.23,1052.52,fee schedule,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,628.12,,,,,,,11.89,628.12,fee schedule,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,220.68,,,,,,,4.35,220.68,fee schedule,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,90,1086.52,,,,,,,17.00,1086.52,fee schedule,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Premier,,15.82,,,,,,,11.15,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Premier,,2.47,,,,,,,1.75,3.39,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier,,287.85,,,,,,,67.58,393.82,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier,,13.06,,,,,,,9.21,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Premier,,12.48,,,,,,,8.80,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Premier,,3.68,,,,,,,2.60,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,outpatient,1,EA,15.74000,14.95000,The Alliance,Premier,,11.16,,,,,,,7.87,15.27,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,outpatient,1,EA,15.49000,14.71000,The Alliance,Premier,,10.98,,,,,,,7.75,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,outpatient,1,EA,52.90000,50.26000,The Alliance,Premier,,37.51,,,,,,,26.45,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,outpatient,1,EA,36.26000,34.45000,The Alliance,Premier,,25.71,,,,,,,1.63,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier,,1.64,,,,,,,1.16,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,outpatient,1,EA,84.97000,80.72000,The Alliance,Premier,,60.24,,,,,,,1.63,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,outpatient,1,EA,81.63000,77.55000,The Alliance,Premier,,57.88,,,,,,,1.63,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,outpatient,1,EA,17.91000,17.01000,The Alliance,Premier,,12.70,,,,,,,1.63,17.37,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier,,1799.53,,,,,,,34.43,1799.53,fee schedule,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,,6003.00,,,,,,,100.65,6003.00,case rate,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,outpatient,,,151.40000,143.83000,The Alliance,Premier,90,1459.96,,,,,,,28.73,1459.96,fee schedule,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Premier,,129.48,,,,,,,24.91,129.48,fee schedule,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Premier,,0.06600,,,,,,,0.06045,3.27,fee schedule,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier,,15.47,,,,,,,10.91,21.17,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Premier,,2.76,,,,,,,0.79000,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,outpatient,6,EA,2.33000,2.21000,The Alliance,Premier,,2.76,,,,,,,1.17,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Premier,,2.76,,,,,,,0.79000,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,outpatient,6,EA,2.29000,2.18000,The Alliance,Premier,,2.76,,,,,,,1.15,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,outpatient,6,EA,2.77000,2.63000,The Alliance,Premier,,2.76,,,,,,,1.39,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,outpatient,6,EA,2.92000,2.77000,The Alliance,Premier,,2.76,,,,,,,1.46,2.83,fee schedule,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,outpatient,1,EA,41.98000,39.89000,The Alliance,Premier,,29.76,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,outpatient,1,EA,25.85000,24.56000,The Alliance,Premier,,18.33,,,,,,,12.93,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,outpatient,1,EA,30.74000,29.20000,The Alliance,Premier,,21.79,,,,,,,15.37,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,outpatient,1,EA,65.64000,62.35000,The Alliance,Premier,,46.54,,,,,,,32.82,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,outpatient,1,EA,41.98000,39.88000,The Alliance,Premier,,29.76,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,outpatient,1,EA,45.08000,42.83000,The Alliance,Premier,,31.96,,,,,,,22.54,43.73,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,outpatient,1,EA,12.69000,12.05000,The Alliance,Premier,,9.00,,,,,,,6.34,12.31,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,outpatient,15,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,outpatient,15,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,outpatient,15,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,outpatient,15,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,outpatient,15,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier,,160.94,,,,,,,113.50,220.19,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,outpatient,10,EA,13.27000,12.61000,The Alliance,Premier,,29.16,,,,,,,6.63,29.16,fee schedule,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,outpatient,10,EA,7.90000,7.50000,The Alliance,Premier,,29.16,,,,,,,3.95,29.16,fee schedule,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,outpatient,10,EA,9.90000,9.41000,The Alliance,Premier,,29.16,,,,,,,4.95,29.16,fee schedule,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier,,628.12,,,,,,,12.00,628.12,fee schedule,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,outpatient,40,EA,6.86000,6.52000,The Alliance,Premier,,4.86,,,,,,,3.43,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,outpatient,40,EA,8.24000,7.82000,The Alliance,Premier,,5.84,,,,,,,4.12,7.99,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,outpatient,1,EA,83.73000,79.55000,The Alliance,Premier,,59.36,,,,,,,41.87,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,outpatient,1,EA,52.59000,49.96000,The Alliance,Premier,,37.29,,,,,,,26.30,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,outpatient,1,EA,83.82000,79.63000,The Alliance,Premier,,59.43,,,,,,,41.91,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,outpatient,1,EA,207.99000,197.59000,The Alliance,Premier,,147.46,,,,,,,104.00,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,outpatient,1,EA,60.92000,57.87000,The Alliance,Premier,,43.19,,,,,,,30.46,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,outpatient,1,EA,41.91000,39.81000,The Alliance,Premier,,29.71,,,,,,,20.95,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,outpatient,1,EA,25.98000,24.68000,The Alliance,Premier,,18.42,,,,,,,12.99,25.20,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,outpatient,6,EA,2.25000,2.13000,The Alliance,Premier,,2.76,,,,,,,1.12,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Premier,,2.76,,,,,,,0.67500,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,outpatient,6,EA,2.50000,2.38000,The Alliance,Premier,,2.76,,,,,,,1.25,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Premier,,2.76,,,,,,,0.67500,2.76,fee schedule,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,937.00,,,,,,,122.40,5271.00,case rate,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,outpatient,30,EA,0.49000,0.46000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,outpatient,30,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier,,15.47,,,,,,,10.91,21.17,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,outpatient,1,EA,20.37000,19.35000,The Alliance,Premier,,14.44,,,,,,,10.19,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier,,746.94,,,,,,,14.39,746.94,fee schedule,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,outpatient,,,1930.00000,1833.50000,The Alliance,Premier,90,7690.40,,,,,,,70.04,7690.40,fee schedule,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,outpatient,1,EA,1.63000,1.54000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier,,1.67,,,,,,,1.18,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,outpatient,1,EA,17.74000,16.85000,The Alliance,Premier,,12.58,,,,,,,8.87,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Premier,,10.75,,,,,,,7.58,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier,,10.87,,,,,,,7.67,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,outpatient,1,EA,14.19000,13.48000,The Alliance,Premier,,10.06,,,,,,,7.09,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,outpatient,1,EA,16.25000,15.43000,The Alliance,Premier,,11.52,,,,,,,8.12,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Premier,,6.25,,,,,,,4.41,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier,,2.94,,,,,,,2.07,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,outpatient,1,EA,11.76000,11.17000,The Alliance,Premier,,8.34,,,,,,,5.88,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,outpatient,1,EA,29.36000,27.89000,The Alliance,Premier,,20.82,,,,,,,14.68,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,outpatient,1,EA,22.06000,20.96000,The Alliance,Premier,,15.64,,,,,,,11.03,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier,,1.53,,,,,,,1.08,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier,,2.28,,,,,,,1.61,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,outpatient,1,EA,5.49000,5.22000,The Alliance,Premier,,3.89,,,,,,,2.75,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Premier,,6.15,,,,,,,4.34,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier,,2.88,,,,,,,2.03,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier,,2.56,,,,,,,1.80,3.50,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,outpatient,1,mL,141.01000,133.96000,The Alliance,Premier,,99.98,,,,,,,70.50,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,outpatient,1,mL,174.20000,165.49000,The Alliance,Premier,,123.51,,,,,,,87.10,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,outpatient,1,mL,193.55000,183.87000,The Alliance,Premier,,137.23,,,,,,,96.78,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,outpatient,1,mL,232.26000,220.65000,The Alliance,Premier,,164.67,,,,,,,116.13,225.29,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,645.08,,,,,,,12.41,645.08,fee schedule,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,outpatient,42.5,EA,47.41000,45.04000,The Alliance,Premier,,33.61,,,,,,,23.70,45.99,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,848.80,,,,,,,16.30,848.80,fee schedule,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier,,1714.64,,,,,,,145.50,1714.64,fee schedule,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,outpatient,,,6254.85000,5942.11000,The Alliance,Premier,,2958.54,,,,,,,2870.98,6254.85,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,662.12,,,,,,,9.02,662.12,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier,,3.22,,,,,,,0.48500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier,,3.22,,,,,,,0.63500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,3.22,,,,,,,0.47500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier,,3.22,,,,,,,0.65000,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,3.22,,,,,,,0.63000,4.75,fee schedule,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,87.21,,,,,,,61.50,212.44,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,outpatient,,,1859.00000,1766.05000,The Alliance,Premier,TC,1645.00,,,,,,,929.50,1820.00,per diem,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,outpatient,,,3545.00000,3367.75000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,3438.65,per diem,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,outpatient,1,EA,103.18000,98.02000,The Alliance,Premier,,11.50,,,,,,,11.16,100.08,fee schedule,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,outpatient,1,EA,94.74000,90.00000,The Alliance,Premier,,11.50,,,,,,,11.16,91.90,fee schedule,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,11.50,,,,,,,11.16,38.31,fee schedule,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,,441.94,,,,,,,10.56,441.94,fee schedule,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,1833.46,,,,,,,37.50,1833.46,fee schedule,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,7417.50000,7046.62000,The Alliance,Premier,,3508.48,,,,,,,3404.63,7417.50,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Premier,,690.57,,,,,,,487.00,944.78,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,3.83,,,,,,,0.02500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,3.83,,,,,,,0.02500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,3.83,,,,,,,0.02000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier,,3.83,,,,,,,0.03500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,3.83,,,,,,,0.05500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier,,3.83,,,,,,,0.03000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier,,3.83,,,,,,,0.02000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,3.83,,,,,,,0.20000,3.83,fee schedule,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,271.65,,,,,,,5.12,271.65,fee schedule,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,865.84,,,,,,,16.71,865.84,fee schedule,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,628.12,,,,,,,8.17,628.12,fee schedule,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,1544.85,,,,,,,36.50,1544.85,fee schedule,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,outpatient,1,EA,276.04000,262.24000,The Alliance,Premier,,46.23,,,,,,,44.86,267.76,fee schedule,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,outpatient,1,EA,253.43000,240.76000,The Alliance,Premier,,46.23,,,,,,,44.86,245.83,fee schedule,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,outpatient,118,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,outpatient,118,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,outpatient,118,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,outpatient,118,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,645.08,,,,,,,13.82,645.08,fee schedule,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier,TC,1645.00,,,,,,,495.50,1820.00,per diem,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier,,2725.19,,,,,,,2644.53,5761.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,outpatient,,,2650.00000,2517.50000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,2570.50,per diem,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Premier,TC,1645.00,,,,,,,1070.00,2075.80,per diem,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Premier,,4209.00,,,,,,,800.09,4686.00,case rate,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,outpatient,,,1950.00000,1852.50000,The Alliance,Premier,TC,1645.00,,,,,,,975.00,1891.50,per diem,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,outpatient,,,29.20000,27.74000,The Alliance,Premier,90,611.15,,,,,,,9.83,611.15,fee schedule,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier,,492.33,,,,,,,9.46,492.33,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier,,2.76,,,,,,,1.97,3.81,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,outpatient,1,mL,9.57000,9.10000,The Alliance,Premier,,2.76,,,,,,,2.50,9.28,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,outpatient,1,mL,96.78000,91.94000,The Alliance,Premier,,2.76,,,,,,,2.50,93.88,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,outpatient,1,mL,9.80000,9.31000,The Alliance,Premier,,2.76,,,,,,,2.50,9.51,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Premier,,2.76,,,,,,,1.67,3.24,fee schedule,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,679.08,,,,,,,12.95,679.08,fee schedule,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,Premier,TC,1645.00,,,,,,,510.00,1820.00,per diem,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,,1284.54,,,,,,,7.33,1284.54,fee schedule,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,outpatient,1,mL,9.11000,8.65000,The Alliance,Premier,,6.46,,,,,,,4.55,8.84,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2234.88,per diem,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,outpatient,,,2144.00000,2036.80000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2079.68,per diem,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2294.05,per diem,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,424.40,,,,,,,8.06,424.40,fee schedule,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,339.51,,,,,,,6.51,339.51,fee schedule,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1081.00000,1026.95000,The Alliance,Premier,TC,1645.00,,,,,,,540.50,1820.00,per diem,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,TC,1645.00,,,,,,,99.00,1820.00,per diem,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,882.80,,,,,,,8.17,882.80,fee schedule,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Premier,TC,35.10,,,,,,,24.75,484.28,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Premier,TC,1645.00,,,,,,,896.50,1820.00,per diem,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Premier,TC,1645.00,,,,,,,732.50,1820.00,per diem,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2714.06,per diem,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,outpatient,120,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier,TC,1645.00,,,,,,,306.02,1820.00,per diem,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,2522.00,per diem,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2292.11,per diem,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Premier,,174.41,,,,,,,122.40,238.62,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,outpatient,,,2299.00000,2184.05000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2230.03,per diem,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Premier,,394.91,,,,,,,278.50,540.29,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2245.55,per diem,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier,,543.22,,,,,,,10.32,543.22,fee schedule,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier,TC,1645.00,,,,,,,934.50,1964.22,per diem,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier,TC,1645.00,,,,,,,935.50,1820.00,per diem,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,594.19,,,,,,,8.17,594.19,fee schedule,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,TC,1645.00,,,,,,,71.00,1820.00,per diem,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier,TC,1645.00,,,,,,,911.00,1964.22,per diem,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Premier,TC,1645.00,,,,,,,1264.00,2452.16,per diem,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,,229.01,,,,,,,161.50,313.31,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier,,162.36,,,,,,,60.36,222.13,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier,TC,1645.00,,,,,,,623.00,1820.00,per diem,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,outpatient,,,2196.00000,2086.20000,The Alliance,Premier,TC,1645.00,,,,,,,1098.00,2130.12,per diem,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Premier,,6026.72,,,,,,,115.36,6026.72,fee schedule,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,outpatient,,,2621.00000,2489.95000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,2542.37,per diem,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2548.19,per diem,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,679.08,,,,,,,14.61,679.08,fee schedule,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Premier,TC,1645.00,,,,,,,936.50,1820.00,per diem,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,,1018.59,,,,,,,19.60,1018.59,fee schedule,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,,3963.00,,,,,,,658.35,4686.00,case rate,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2209.66,per diem,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier,TC,1645.00,,,,,,,924.00,1820.00,per diem,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,outpatient,,,1776.00000,1687.20000,The Alliance,Premier,TC,1645.00,,,,,,,837.93,1820.00,per diem,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2320.24,per diem,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier,TC,1645.00,,,,,,,935.50,1964.22,per diem,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,outpatient,,,2319.00000,2203.05000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2249.43,per diem,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier,TC,1645.00,,,,,,,623.00,1820.00,per diem,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier,,1052.52,,,,,,,20.05,1052.52,fee schedule,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,,424.40,,,,,,,8.07,424.40,fee schedule,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier,,356.54,,,,,,,7.36,356.54,fee schedule,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,3313.52,per diem,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,492.33,,,,,,,9.47,492.33,fee schedule,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Premier,TC,1645.00,,,,,,,782.00,1820.00,per diem,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier,,458.40,,,,,,,8.62,458.40,fee schedule,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier,TC,1645.00,,,,,,,622.00,1820.00,per diem,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,1069.56,,,,,,,20.32,1069.56,fee schedule,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier,,424.40,,,,,,,8.08,424.40,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,outpatient,1,EA,1451.33000,1378.77000,The Alliance,Premier,,1.02,,,,,,,0.62000,1407.79,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,outpatient,1,EA,958.30000,910.38000,The Alliance,Premier,,1.02,,,,,,,0.62000,929.55,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,outpatient,1,EA,1897.17000,1802.32000,The Alliance,Premier,,1.02,,,,,,,0.62000,1840.25,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,outpatient,1,EA,1750.45000,1662.93000,The Alliance,Premier,,1.02,,,,,,,0.62000,1697.94,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,outpatient,1,EA,655.27000,622.51000,The Alliance,Premier,,1.02,,,,,,,0.62000,635.61,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,outpatient,1,EA,932.40000,885.78000,The Alliance,Premier,,1.02,,,,,,,0.62000,904.43,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,outpatient,1,EA,1707.46000,1622.08000,The Alliance,Premier,,1.02,,,,,,,0.62000,1656.24,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,outpatient,1,EA,1750.53000,1663.00000,The Alliance,Premier,,1.02,,,,,,,0.62000,1698.01,fee schedule,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,,424.40,,,,,,,8.09,424.40,fee schedule,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,543.22,,,,,,,10.32,543.22,fee schedule,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,560.26,,,,,,,10.80,560.26,fee schedule,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,outpatient,,,2404.00000,2283.80000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2331.88,per diem,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,662.12,,,,,,,12.52,662.12,fee schedule,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,outpatient,,,634.00000,602.30000,The Alliance,Premier,TC,3899.16,,,,,,,177.63,3899.16,fee schedule,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier,,950.66,,,,,,,18.05,950.66,fee schedule,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,outpatient,1,mL,5.89000,5.60000,The Alliance,Premier,,4.18,,,,,,,2.94,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Premier,,4.23,,,,,,,2.98,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Premier,,4.18,,,,,,,2.95,5.72,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Premier,TC,1645.00,,,,,,,1132.50,2197.05,per diem,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2515.21,per diem,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier,,797.91,,,,,,,14.01,797.91,fee schedule,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier,TC,1645.00,,,,,,,924.00,1820.00,per diem,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,outpatient,1,EA,725.69000,689.41000,The Alliance,Premier,,1.02,,,,,,,0.62000,703.92,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,outpatient,1,EA,479.15000,455.19000,The Alliance,Premier,,1.02,,,,,,,0.62000,464.78,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,outpatient,1,EA,948.59000,901.16000,The Alliance,Premier,,1.02,,,,,,,0.62000,920.13,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,outpatient,1,EA,877.73000,833.84000,The Alliance,Premier,,1.02,,,,,,,0.62000,851.40,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,outpatient,1,EA,466.20000,442.89000,The Alliance,Premier,,1.02,,,,,,,0.62000,452.21,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,outpatient,1,EA,311.63000,296.05000,The Alliance,Premier,,1.02,,,,,,,0.62000,302.28,fee schedule,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,865.84,,,,,,,18.52,865.84,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Premier,,1.34,,,,,,,1.26,2.81,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,outpatient,1,mL,3.30000,3.14000,The Alliance,Premier,,1.34,,,,,,,1.26,3.20,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,1.34,,,,,,,1.26,3.07,fee schedule,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,outpatient,2,EA,69.77000,66.28000,The Alliance,Premier,,49.47,,,,,,,34.88,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,outpatient,2,EA,37.30000,35.44000,The Alliance,Premier,,26.45,,,,,,,18.65,36.18,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier,,543.22,,,,,,,10.32,543.22,fee schedule,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Premier,TC,1645.00,,,,,,,1136.50,2204.81,per diem,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier,,3254.22,,,,,,,50.73,3254.22,fee schedule,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,TC,905.54,,,,,,,76.50,905.54,fee schedule,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,outpatient,1,EA,15.71000,14.92000,The Alliance,Premier,,11.14,,,,,,,7.86,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,outpatient,1,EA,27.95000,26.56000,The Alliance,Premier,,19.82,,,,,,,13.97,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,outpatient,1,EA,10.35000,9.84000,The Alliance,Premier,,7.34,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Premier,,7.34,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,outpatient,1,EA,6.83000,6.48000,The Alliance,Premier,,4.84,,,,,,,3.42,6.63,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,outpatient,1,EA,5.53000,5.26000,The Alliance,Premier,,1.27,,,,,,,1.15,5.36,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Premier,,1.27,,,,,,,1.15,8.21,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier,,1.27,,,,,,,1.15,3.37,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier,,1.27,,,,,,,1.15,3.37,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.27,,,,,,,1.15,2.36,fee schedule,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier,,407.44,,,,,,,7.71,407.44,fee schedule,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,,492.33,,,,,,,9.44,492.33,fee schedule,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,967.70,,,,,,,12.68,967.70,fee schedule,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,outpatient,1,EA,34.00000,32.30000,The Alliance,Premier,,24.11,,,,,,,17.00,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier,,8.59,,,,,,,6.05,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,outpatient,1,EA,14.74000,14.01000,The Alliance,Premier,,10.45,,,,,,,7.37,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,outpatient,1,EA,14.75000,14.01000,The Alliance,Premier,,10.46,,,,,,,7.38,14.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,outpatient,2,EA,53.31000,50.64000,The Alliance,Premier,,37.80,,,,,,,26.66,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,outpatient,2,EA,18.68000,17.74000,The Alliance,Premier,,13.24,,,,,,,9.34,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,outpatient,2,EA,229.42000,217.95000,The Alliance,Premier,,162.66,,,,,,,114.71,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,outpatient,2,EA,18.88000,17.94000,The Alliance,Premier,,13.39,,,,,,,9.44,18.31,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2548.19,per diem,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier,,1.82,,,,,,,1.28,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,outpatient,1,EA,4.99000,4.75000,The Alliance,Premier,,3.54,,,,,,,2.50,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier,,2.40,,,,,,,1.69,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Premier,,4.44,,,,,,,3.13,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier,,2.27,,,,,,,1.60,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Premier,,14.96,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,outpatient,1,EA,10.45000,9.93000,The Alliance,Premier,,7.41,,,,,,,5.22,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,outpatient,1,EA,9.53000,9.05000,The Alliance,Premier,,6.76,,,,,,,4.76,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,outpatient,1,EA,37.86000,35.96000,The Alliance,Premier,,26.84,,,,,,,18.93,36.72,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,outpatient,1,mL,4.01000,3.81000,The Alliance,Premier,,1.34,,,,,,,1.26,3.89,fee schedule,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2547.22,per diem,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,outpatient,,,2887.00000,2742.65000,The Alliance,Premier,90,54562.77,,,,,,,608.00,54562.77,fee schedule,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Premier,TC,1645.00,,,,,,,1143.50,2218.39,per diem,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,,424.40,,,,,,,8.08,424.40,fee schedule,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,outpatient,,,3088.00000,2933.60000,The Alliance,Premier,TC,1645.00,,,,,,,1285.85,2995.36,per diem,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,TC,413.21,,,,,,,30.28,413.21,fee schedule,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Premier,TC,1645.00,,,,,,,1153.50,2237.79,per diem,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,696.05,,,,,,,8.42,696.05,fee schedule,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,0.3,EA,8010.90000,7610.35000,The Alliance,Premier,,4.95,,,,,,,3.00,7770.57,fee schedule,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier,,4.95,,,,,,,3.00,7770.57,fee schedule,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,,1018.59,,,,,,,7.06,1018.59,fee schedule,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,288.61,,,,,,,5.57,288.61,fee schedule,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,outpatient,1,EA,6472.37000,6148.75000,The Alliance,Premier,,4588.91,,,,,,,3236.18,6278.20,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Premier,,115.24,,,,,,,69.84,292.61,fee schedule,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Premier,,115.24,,,,,,,69.84,336.14,fee schedule,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,outpatient,1,EA,44.48000,42.25000,The Alliance,Premier,,3.42,,,,,,,3.14,43.15,fee schedule,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Premier,,3.42,,,,,,,3.14,37.66,fee schedule,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,441.37,,,,,,,8.41,441.37,fee schedule,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,outpatient,1,mL,3994.25000,3794.54000,The Alliance,Premier,,48.25,,,,,,,29.24,3874.42,fee schedule,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,outpatient,1,mL,4108.08000,3902.67000,The Alliance,Premier,,48.25,,,,,,,29.24,3984.84,fee schedule,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier,,4.95,,,,,,,3.00,7770.57,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Premier,,4.95,,,,,,,3.00,486.13,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,0.4,EA,2004.66000,1904.43000,The Alliance,Premier,,4.95,,,,,,,3.00,1944.52,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Premier,,4.95,,,,,,,3.00,1944.52,fee schedule,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Premier,,14.96,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,1453.11,,,,,,,25.45,1453.11,fee schedule,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,492.33,,,,,,,3.40,492.33,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Premier,,2.62,,,,,,,2.55,251.23,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,outpatient,1,EA,2460.50000,2337.48000,The Alliance,Premier,,2.62,,,,,,,2.55,2386.68,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,outpatient,1,EA,1554.00000,1476.30000,The Alliance,Premier,,2.62,,,,,,,2.55,1507.38,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier,,2.62,,,,,,,2.55,628.08,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,outpatient,1,EA,971.25000,922.69000,The Alliance,Premier,,2.62,,,,,,,2.55,942.11,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,outpatient,1,EA,3935.30000,3738.53000,The Alliance,Premier,,2.62,,,,,,,2.55,3817.24,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,outpatient,1,EA,1023.05000,971.90000,The Alliance,Premier,,2.62,,,,,,,2.55,992.36,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier,,2.62,,,,,,,2.55,502.46,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,outpatient,1,EA,512.82000,487.18000,The Alliance,Premier,,2.62,,,,,,,2.55,497.44,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,outpatient,1,EA,2432.29000,2310.68000,The Alliance,Premier,,2.62,,,,,,,2.55,2359.32,fee schedule,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,outpatient,0.5,EA,3560.40000,3382.38000,The Alliance,Premier,,4.95,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier,,4.95,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,outpatient,0.42,EA,1193.25000,1133.59000,The Alliance,Premier,,4.95,,,,,,,3.00,1157.45,fee schedule,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,outpatient,1,mL,1193.24000,1133.58000,The Alliance,Premier,,4.95,,,,,,,3.00,1157.44,fee schedule,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Premier,,2.51,,,,,,,1.77,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier,,4.95,,,,,,,3.00,7770.57,fee schedule,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,outpatient,1,EA,12.93000,12.28000,The Alliance,Premier,,3.27,,,,,,,1.77,12.54,fee schedule,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier,,2358.02,,,,,,,2288.23,4985.25,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,339.51,,,,,,,6.63,339.51,fee schedule,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,outpatient,500,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,outpatient,500,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,679.08,,,,,,,12.95,679.08,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier,,0.19800,,,,,,,0.14415,2.97,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,0.19800,,,,,,,0.14415,2.39,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,outpatient,1,EA,8.31000,7.90000,The Alliance,Premier,,0.19800,,,,,,,0.14415,8.06,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,0.19800,,,,,,,0.14415,2.64,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,0.19800,,,,,,,0.14415,2.38,fee schedule,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,outpatient,3.5,EA,206.04000,195.74000,The Alliance,Premier,,146.08,,,,,,,103.02,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,outpatient,3.5,EA,244.89000,232.65000,The Alliance,Premier,,173.63,,,,,,,122.44,237.54,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,outpatient,1,mL,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,outpatient,1,mL,4.29000,4.07000,The Alliance,Premier,,0.19800,,,,,,,0.14415,4.16,fee schedule,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.98940,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,outpatient,1,EA,79.95000,75.95000,The Alliance,Premier,,0.04950,,,,,,,0.04803,77.55,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,outpatient,1,EA,1061.15000,1008.09000,The Alliance,Premier,,0.04950,,,,,,,0.04803,1029.32,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier,,0.04950,,,,,,,0.04803,229.89,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,outpatient,1,EA,252.14000,239.53000,The Alliance,Premier,,0.04950,,,,,,,0.04803,244.58,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Premier,,0.04950,,,,,,,0.04803,76.63,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,outpatient,1,EA,1153.79000,1096.10000,The Alliance,Premier,,0.04950,,,,,,,0.04803,1119.18,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,outpatient,1,EA,323.78000,307.59000,The Alliance,Premier,,0.04950,,,,,,,0.04803,314.07,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,outpatient,1,EA,1153.82000,1096.13000,The Alliance,Premier,,0.04950,,,,,,,0.04803,1119.21,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier,,0.04950,,,,,,,0.04803,91.96,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier,,0.04950,,,,,,,0.04803,183.91,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,outpatient,1,EA,58.74000,55.81000,The Alliance,Premier,,0.04950,,,,,,,0.04803,56.98,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,outpatient,1,EA,1061.41000,1008.34000,The Alliance,Premier,,0.04950,,,,,,,0.04803,1029.57,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Premier,,4.95,,,,,,,3.00,1944.52,fee schedule,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,outpatient,1,EA,40.14000,38.13000,The Alliance,Premier,,28.46,,,,,,,20.07,38.94,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,outpatient,,,2468.00000,2344.60000,The Alliance,Premier,,1749.81,,,,,,,1234.00,2393.96,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,outpatient,5,EA,0.59000,0.56000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.57230,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,outpatient,5,EA,0.66000,0.62000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.64020,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,outpatient,5,EA,0.72000,0.68000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.69840,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,outpatient,5,EA,0.29000,0.27000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.28130,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Premier,,0.19800,,,,,,,0.14415,1.19,fee schedule,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,0.3,EA,3560.40000,3382.38000,The Alliance,Premier,,4.95,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier,,4.95,,,,,,,3.00,3453.59,fee schedule,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,outpatient,1,mL,4321.88000,4105.78000,The Alliance,Premier,,48.25,,,,,,,29.24,4192.22,fee schedule,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Premier,,3305.11,,,,,,,37.27,3305.11,fee schedule,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier,,1154.38,,,,,,,22.23,1154.38,fee schedule,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,outpatient,1,EA,1265.09000,1201.83000,The Alliance,Premier,,7.19,,,,,,,4.36,1227.14,fee schedule,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier,,1.53,,,,,,,1.08,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Premier,,158.87,,,,,,,112.04,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,outpatient,1,EA,196.46000,186.63000,The Alliance,Premier,,139.29,,,,,,,98.23,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Premier,,181.48,,,,,,,127.98,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Premier,,156.83,,,,,,,110.60,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,outpatient,1,EA,280.10000,266.10000,The Alliance,Premier,,198.59,,,,,,,140.05,271.70,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,outpatient,2,EA,20.54000,19.51000,The Alliance,Premier,,14.56,,,,,,,10.27,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,outpatient,2,EA,66.36000,63.04000,The Alliance,Premier,,47.05,,,,,,,33.18,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,outpatient,2,EA,11.38000,10.81000,The Alliance,Premier,,8.07,,,,,,,5.69,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,outpatient,2,EA,56.25000,53.44000,The Alliance,Premier,,39.88,,,,,,,28.12,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Premier,,16.58,,,,,,,11.69,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,outpatient,2,EA,50.56000,48.03000,The Alliance,Premier,,35.85,,,,,,,25.28,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,outpatient,2,EA,30.16000,28.65000,The Alliance,Premier,,21.38,,,,,,,15.08,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,outpatient,2,EA,8.30000,7.88000,The Alliance,Premier,,5.88,,,,,,,4.15,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,outpatient,2,EA,5.53000,5.25000,The Alliance,Premier,,3.92,,,,,,,2.77,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,outpatient,2,EA,26.61000,25.28000,The Alliance,Premier,,18.87,,,,,,,13.30,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,14.22,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,outpatient,2,EA,8.53000,8.11000,The Alliance,Premier,,6.05,,,,,,,4.26,8.27,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,outpatient,,,293.20000,278.54000,The Alliance,Premier,90,1324.17,,,,,,,26.11,1324.17,fee schedule,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,outpatient,3.5,EA,15.03000,14.28000,The Alliance,Premier,,10.66,,,,,,,7.51,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,outpatient,3.5,EA,14.35000,13.63000,The Alliance,Premier,,10.17,,,,,,,7.17,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,outpatient,3.5,EA,16.25000,15.44000,The Alliance,Premier,,11.52,,,,,,,8.12,15.76,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,outpatient,1,mL,4.52000,4.29000,The Alliance,Premier,,0.19800,,,,,,,0.14415,4.38,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,outpatient,1,EA,4.51000,4.29000,The Alliance,Premier,,0.19800,,,,,,,0.14415,4.37,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Premier,,0.19800,,,,,,,0.14415,13.48,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,0.19800,,,,,,,0.14415,22.99,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Premier,,0.19800,,,,,,,0.14415,5.36,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,outpatient,1,EA,16.56000,15.73000,The Alliance,Premier,,0.19800,,,,,,,0.14415,16.06,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,outpatient,1,EA,18.26000,17.35000,The Alliance,Premier,,0.19800,,,,,,,0.14415,17.71,fee schedule,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,outpatient,1,EA,3.30000,3.14000,The Alliance,Premier,,2.34,,,,,,,1.65,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier,,4789.16,,,,,,,50.73,4789.16,fee schedule,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,outpatient,,,503.00000,477.85000,The Alliance,Premier,,356.63,,,,,,,251.50,487.91,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,3.54,,,,,,,2.50,4.85,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,outpatient,1,EA,1328.67000,1262.24000,The Alliance,Premier,,8198.16,,,,,,,664.34,8365.47,fee schedule,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,outpatient,1,EA,9519.93000,9043.93000,The Alliance,Premier,,8198.16,,,,,,,4759.97,9234.33,fee schedule,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,outpatient,2.5,EA,48.01000,45.61000,The Alliance,Premier,,34.04,,,,,,,24.00,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,outpatient,2.5,EA,13.27000,12.61000,The Alliance,Premier,,9.41,,,,,,,6.63,12.87,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,outpatient,1,mL,105.09000,99.83000,The Alliance,Premier,,74.51,,,,,,,52.55,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,outpatient,1,mL,47.94000,45.55000,The Alliance,Premier,,33.99,,,,,,,23.97,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,outpatient,1,mL,63.92000,60.72000,The Alliance,Premier,,45.32,,,,,,,31.96,62.00,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier,TC,367.97,,,,,,,259.50,503.43,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier,,4.95,,,,,,,3.00,7770.57,fee schedule,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,outpatient,1,mL,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,outpatient,1,mL,0.75000,0.72000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,outpatient,1,mL,2.59000,2.46000,The Alliance,Premier,,1.84,,,,,,,1.29,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,outpatient,,,293.80000,279.11000,The Alliance,Premier,,208.30,,,,,,,146.90,284.99,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,outpatient,1,EA,7.66000,7.28000,The Alliance,Premier,,5.43,,,,,,,3.83,7.43,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,outpatient,1,EA,0.18000,0.18000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,outpatient,2,EA,53.18000,50.53000,The Alliance,Premier,,10.18,,,,,,,8.97,51.58,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,outpatient,2,EA,38.88000,36.94000,The Alliance,Premier,,10.18,,,,,,,8.97,37.71,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,outpatient,2,EA,38.89000,36.95000,The Alliance,Premier,,10.18,,,,,,,8.97,37.72,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,outpatient,2,EA,38.55000,36.62000,The Alliance,Premier,,10.18,,,,,,,8.97,37.39,fee schedule,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,outpatient,1,mL,124.51000,118.28000,The Alliance,Premier,,88.28,,,,,,,62.26,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,outpatient,1,mL,77.82000,73.93000,The Alliance,Premier,,55.17,,,,,,,38.91,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,outpatient,1,mL,124.50000,118.28000,The Alliance,Premier,,88.27,,,,,,,62.25,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,outpatient,1,mL,113.46000,107.79000,The Alliance,Premier,,80.44,,,,,,,56.73,110.06,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,outpatient,1,EA,8.02000,7.62000,The Alliance,Premier,,5.69,,,,,,,4.01,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,outpatient,1,EA,8.74000,8.30000,The Alliance,Premier,,6.20,,,,,,,4.37,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,outpatient,1,EA,7.94000,7.55000,The Alliance,Premier,,5.63,,,,,,,3.97,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Premier,,7.42,,,,,,,5.23,10.15,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,outpatient,2,EA,8.69000,8.26000,The Alliance,Premier,,6.60,,,,,,,4.34,8.43,fee schedule,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,outpatient,2,EA,9.45000,8.98000,The Alliance,Premier,,6.60,,,,,,,4.72,9.17,fee schedule,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,outpatient,2,EA,133.60000,126.92000,The Alliance,Premier,,6.60,,,,,,,6.40,129.59,fee schedule,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,outpatient,1,EA,5.43000,5.16000,The Alliance,Premier,,3.85,,,,,,,2.71,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Premier,,3.96,,,,,,,2.79,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,outpatient,1,EA,6.56000,6.23000,The Alliance,Premier,,4.65,,,,,,,3.28,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier,,3.28,,,,,,,2.31,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,outpatient,1,GM,0.55000,0.53000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,outpatient,1,GM,0.56000,0.54000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,outpatient,1,GM,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,outpatient,1,EA,36.06000,34.26000,The Alliance,Premier,,25.57,,,,,,,18.03,34.98,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Premier,,3435.48,,,,,,,23.25,3435.48,fee schedule,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,,696.05,,,,,,,13.28,696.05,fee schedule,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,outpatient,,,2211.00000,2100.45000,The Alliance,Premier,,1567.60,,,,,,,1105.50,2144.67,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Premier,,2.65,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.83,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier,,3.25,,,,,,,2.29,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,outpatient,1,mL,137.78000,130.89000,The Alliance,Premier,,97.69,,,,,,,68.89,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,outpatient,1,mL,113.36000,107.69000,The Alliance,Premier,,80.37,,,,,,,56.68,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,outpatient,1,mL,110.52000,105.00000,The Alliance,Premier,,78.36,,,,,,,55.26,107.20,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier,,3.06,,,,,,,2.16,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Premier,,2.07,,,,,,,1.46,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier,,3.37,,,,,,,2.38,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier,,2.97,,,,,,,2.10,4.06,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,outpatient,1,EA,2.47000,2.35000,The Alliance,Premier,,1.75,,,,,,,1.24,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier,,1.67,,,,,,,1.18,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Premier,,2.65,,,,,,,1.87,3.63,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Premier,,6.49,,,,,,,4.58,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Premier,,6.44,,,,,,,4.54,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,outpatient,1,EA,12.30000,11.69000,The Alliance,Premier,,8.72,,,,,,,6.15,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Premier,,7.08,,,,,,,5.00,9.69,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier,,6.30,,,,,,,6.12,36.78,fee schedule,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,outpatient,1,EA,51.86000,49.26000,The Alliance,Premier,,6.30,,,,,,,6.12,50.30,fee schedule,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,6.30,,,,,,,6.12,30.65,fee schedule,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,outpatient,50,EA,43.92000,41.73000,The Alliance,Premier,,1225.79,,,,,,,21.96,1225.79,fee schedule,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,outpatient,120,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,outpatient,120,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.46480,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,outpatient,25,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,outpatient,25,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,outpatient,25,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,outpatient,25,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,outpatient,25,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,outpatient,25,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,outpatient,25,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,outpatient,25,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,outpatient,25,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,outpatient,,,4574.00000,4345.30000,The Alliance,Premier,,3242.97,,,,,,,970.83,4436.78,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,outpatient,10,EA,23.95000,22.76000,The Alliance,Premier,,16.98,,,,,,,11.97,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,outpatient,10,EA,10.74000,10.20000,The Alliance,Premier,,7.61,,,,,,,5.37,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,outpatient,10,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,outpatient,10,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,outpatient,1,EA,1357.11000,1289.25000,The Alliance,Premier,,962.19,,,,,,,678.55,1316.40,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,outpatient,10,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.46480,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,outpatient,10,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,outpatient,5,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,outpatient,5,EA,2.16000,2.05000,The Alliance,Premier,,1.53,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,outpatient,5,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,outpatient,5,EA,1.77000,1.69000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,outpatient,5,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Premier,,1.49,,,,,,,1.02,5.33,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,outpatient,1,EA,3.70000,3.52000,The Alliance,Premier,,1.49,,,,,,,1.02,3.59,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier,,1.49,,,,,,,0.88000,1.71,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,outpatient,1,EA,9.51000,9.04000,The Alliance,Premier,,1.49,,,,,,,1.02,9.22,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier,,1.49,,,,,,,1.02,2.51,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,1.49,,,,,,,1.02,4.91,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier,,1.49,,,,,,,1.02,7.97,fee schedule,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97500,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97500,1.89,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,outpatient,1,EA,48.51000,46.08000,The Alliance,Premier,,34.39,,,,,,,24.25,47.05,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,1.09,,,,,,,0.09000,1.18,fee schedule,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,outpatient,1,mL,0.17000,0.17000,The Alliance,Premier,,1.09,,,,,,,0.08500,1.18,fee schedule,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,outpatient,1,EA,20.00000,19.00000,The Alliance,Premier,,14.18,,,,,,,10.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier,,14.19,,,,,,,10.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,outpatient,1,EA,19.92000,18.93000,The Alliance,Premier,,14.12,,,,,,,9.96,19.32,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Premier,,122.97,,,,,,,47.59,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Premier,,245.94,,,,,,,47.59,336.47,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Premier,,4.66,,,,,,,3.29,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,outpatient,1,EA,2.98000,2.84000,The Alliance,Premier,,2.11,,,,,,,1.49,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier,,3.34,,,,,,,2.35,4.57,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Premier,,115.24,,,,,,,69.84,292.61,fee schedule,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Premier,,115.24,,,,,,,69.84,336.14,fee schedule,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier,TC,548.00,,,,,,,120.00,584.87,fee schedule,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier,TC,844.42,,,,,,,595.50,1155.27,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier,,23.28,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,outpatient,1,EA,9.92000,9.43000,The Alliance,Premier,,7.03,,,,,,,4.96,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,outpatient,1,EA,17.26000,16.40000,The Alliance,Premier,,12.24,,,,,,,8.63,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Premier,,7.00,,,,,,,4.94,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier,,15.33,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier,,9.34,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,outpatient,10,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,outpatient,1,EA,13.23000,12.57000,The Alliance,Premier,,9.38,,,,,,,6.62,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Premier,TC,1296.05,,,,,,,914.00,1773.16,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier,,23.28,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier,,11.80,,,,,,,8.32,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier,,12.49,,,,,,,8.81,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier,,15.33,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier,,9.34,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier,,12.49,,,,,,,8.81,17.09,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,,713.01,,,,,,,13.74,713.01,fee schedule,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,outpatient,1,mL,118.72000,112.79000,The Alliance,Premier,,84.17,,,,,,,59.36,115.16,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,outpatient,3,EA,92.78000,88.14000,The Alliance,Premier,,65.78,,,,,,,46.39,99.28,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,outpatient,3,EA,178.30000,169.38000,The Alliance,Premier,,126.41,,,,,,,89.15,172.95,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,478.13000,454.22000,The Alliance,Premier,,338.99,,,,,,,239.06,463.79,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,797.91,,,,,,,17.14,797.91,fee schedule,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,937.00,,,,,,,41.25,3163.00,case rate,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,797.91,,,,,,,8.17,797.91,fee schedule,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,outpatient,1,EA,18.61000,17.68000,The Alliance,Premier,,13.19,,,,,,,9.30,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,outpatient,1,EA,7.97000,7.57000,The Alliance,Premier,,5.65,,,,,,,3.98,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier,,4.62,,,,,,,3.25,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,outpatient,1,EA,10.30000,9.79000,The Alliance,Premier,,7.30,,,,,,,5.15,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,outpatient,1,EA,6.91000,6.57000,The Alliance,Premier,,4.90,,,,,,,3.46,6.70,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier,TC,192.14,,,,,,,135.50,262.87,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,outpatient,1,EA,34.68000,32.94000,The Alliance,Premier,,24.59,,,,,,,17.34,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,outpatient,1,EA,42.03000,39.93000,The Alliance,Premier,,29.80,,,,,,,21.02,40.77,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,outpatient,1,EA,2.90000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,outpatient,1,EA,9.90000,9.40000,The Alliance,Premier,,7.02,,,,,,,4.95,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Premier,,2.52,,,,,,,1.77,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,outpatient,1,EA,6.90000,6.56000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier,,8.59,,,,,,,6.05,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,outpatient,1,EA,7.51000,7.13000,The Alliance,Premier,,5.32,,,,,,,3.75,7.28,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,outpatient,,,1034.00000,982.30000,The Alliance,Premier,TC,733.11,,,,,,,517.00,1002.98,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Premier,,15.95,,,,,,,11.25,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Premier,,3.59,,,,,,,2.54,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier,,3.26,,,,,,,2.30,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,outpatient,1,EA,4.15000,3.95000,The Alliance,Premier,,2.94,,,,,,,2.08,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier,,3.96,,,,,,,2.79,5.41,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,outpatient,,,2031.00000,1929.45000,The Alliance,Premier,TC,1439.98,,,,,,,1015.50,1970.07,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,outpatient,1,EA,107.57000,102.19000,The Alliance,Premier,,14.88,,,,,,,12.72,104.34,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,outpatient,1,EA,29.74000,28.25000,The Alliance,Premier,,14.88,,,,,,,12.72,28.85,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,14.88,,,,,,,12.72,38.31,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,outpatient,1,EA,70.42000,66.90000,The Alliance,Premier,,14.88,,,,,,,12.72,68.31,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Premier,,14.88,,,,,,,12.72,39.69,fee schedule,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Premier,TC,3017.50,,,,,,,2128.00,4128.32,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,outpatient,1,EA,20.26000,19.25000,The Alliance,Premier,,14.36,,,,,,,10.13,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Premier,,2.13,,,,,,,1.50,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,outpatient,,,1568.00000,1489.60000,The Alliance,Premier,TC,1111.71,,,,,,,784.00,1520.96,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier,TC,1213.27,,,,,,,114.83,1213.27,fee schedule,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,40.41,,,,,,,31.35,5271.00,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,outpatient,1,EA,5.68000,5.40000,The Alliance,Premier,,4.03,,,,,,,2.84,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier,,3.79,,,,,,,2.67,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Premier,,2.00,,,,,,,1.41,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Premier,,2.37,,,,,,,1.67,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,outpatient,1,EA,2.65000,2.51000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Premier,,9.66,,,,,,,6.82,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Premier,,16.29,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Premier,,3.22,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier,,1.84,,,,,,,1.29,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier,,23.28,,,,,,,16.42,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,outpatient,1,EA,16.31000,15.50000,The Alliance,Premier,,11.56,,,,,,,8.15,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,outpatient,1,EA,14.62000,13.88000,The Alliance,Premier,,10.37,,,,,,,7.31,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Premier,,12.03,,,,,,,8.48,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier,,15.33,,,,,,,10.81,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier,,9.34,,,,,,,6.58,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Premier,,12.03,,,,,,,8.48,16.46,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Premier,TC,904.68,,,,,,,638.00,1237.72,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Premier,TC,1296.05,,,,,,,914.00,1773.16,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier,,292.82,,,,,,,33.63,400.61,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,outpatient,1,EA,10.60000,10.07000,The Alliance,Premier,,7.52,,,,,,,5.30,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier,,7.10,,,,,,,5.01,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier,,3.41,,,,,,,2.40,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,outpatient,1,EA,4.08000,3.88000,The Alliance,Premier,,2.89,,,,,,,2.04,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier,,4.40,,,,,,,3.10,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier,,3.30,,,,,,,2.33,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier,,4.38,,,,,,,3.09,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Premier,,343.16,,,,,,,242.00,572.69,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier,,950.66,,,,,,,18.14,950.66,fee schedule,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier,TC,1295.34,,,,,,,913.50,1772.19,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Premier,TC,2123.08,,,,,,,201.46,2123.08,fee schedule,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Premier,TC,548.00,,,,,,,247.28,568.42,fee schedule,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier,,1375.13,,,,,,,85.50,1375.13,fee schedule,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier,TC,1298.89,,,,,,,916.00,1777.04,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,outpatient,1,mL,209.51000,199.03000,The Alliance,Premier,,180.31,,,,,,,104.75,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,outpatient,1,mL,188.56000,179.13000,The Alliance,Premier,,180.31,,,,,,,94.28,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Premier,,180.31,,,,,,,109.28,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier,,180.31,,,,,,,71.10,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,outpatient,1,mL,306.20000,290.89000,The Alliance,Premier,,180.31,,,,,,,109.28,297.01,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,outpatient,1,mL,323.48000,307.31000,The Alliance,Premier,,180.31,,,,,,,109.28,313.78,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,outpatient,1,mL,214.34000,203.63000,The Alliance,Premier,,180.31,,,,,,,107.17,249.68,fee schedule,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier,,679.08,,,,,,,13.12,679.08,fee schedule,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,outpatient,,,742.00000,704.90000,The Alliance,Premier,,961.00,,,,,,,262.92,1172.00,case rate,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,outpatient,,,1496.00000,1421.20000,The Alliance,Premier,TC,1060.66,,,,,,,748.00,1451.12,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Premier,TC,2363.10,,,,,,,1666.50,3233.01,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,797.91,,,,,,,15.29,797.91,fee schedule,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,TC,1430.78,,,,,,,135.13,1430.78,fee schedule,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Premier,TC,1805.11,,,,,,,1273.00,2469.62,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,outpatient,,,2109.00000,2003.55000,The Alliance,Premier,,3010.00,,,,,,,582.16,3515.00,case rate,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,696.05,,,,,,,8.17,696.05,fee schedule,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,outpatient,,,2224.00000,2112.80000,The Alliance,Premier,TC,14719.32,,,,,,,1112.00,14719.32,fee schedule,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier,TC,1628.59,,,,,,,151.73,1628.59,fee schedule,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier,TC,870.65,,,,,,,614.00,1191.16,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Premier,,3.11,,,,,,,2.19,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Premier,,7.78,,,,,,,5.49,10.64,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,outpatient,1,EA,5030.77000,4779.23000,The Alliance,Premier,,13.00,,,,,,,7.88,4879.85,fee schedule,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,696.05,,,,,,,8.17,696.05,fee schedule,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Premier,,385.70,,,,,,,272.00,572.69,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Premier,,3010.00,,,,,,,404.33,3515.00,case rate,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,outpatient,,,2660.00000,2527.00000,The Alliance,Premier,,15261.97,,,,,,,264.01,15261.97,fee schedule,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier,,2.38,,,,,,,1.68,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,outpatient,1,EA,6.16000,5.85000,The Alliance,Premier,,4.37,,,,,,,3.08,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,outpatient,1,EA,150.45000,142.92000,The Alliance,Premier,,106.67,,,,,,,75.22,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Premier,,16.29,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,outpatient,1,EA,25.25000,23.99000,The Alliance,Premier,,17.90,,,,,,,12.62,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Premier,,3.05,,,,,,,2.15,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Premier,,3.22,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Premier,,3.00,,,,,,,2.12,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,outpatient,1,EA,3.30000,3.13000,The Alliance,Premier,,2.34,,,,,,,1.65,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Premier,,2.74,,,,,,,1.94,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier,,10.56,,,,,,,7.45,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,outpatient,1,mL,1.25000,1.18000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier,,112.23,,,,,,,79.15,153.55,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,outpatient,1,EA,79.03000,75.08000,The Alliance,Premier,,56.03,,,,,,,39.52,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,outpatient,1,EA,89.66000,85.18000,The Alliance,Premier,,63.57,,,,,,,44.83,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier,,33.61,,,,,,,23.70,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,outpatient,1,EA,115.04000,109.28000,The Alliance,Premier,,81.56,,,,,,,57.52,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,outpatient,1,EA,62.15000,59.05000,The Alliance,Premier,,44.06,,,,,,,31.07,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Premier,,98.54,,,,,,,69.49,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Premier,,78.42,,,,,,,55.30,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,outpatient,1,EA,91.77000,87.18000,The Alliance,Premier,,65.06,,,,,,,45.88,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Premier,,34.50,,,,,,,24.33,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,outpatient,1,EA,32.58000,30.95000,The Alliance,Premier,,23.10,,,,,,,16.29,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,outpatient,1,EA,24.62000,23.39000,The Alliance,Premier,,17.46,,,,,,,12.31,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,outpatient,1,EA,32.90000,31.26000,The Alliance,Premier,,23.33,,,,,,,16.45,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,outpatient,1,EA,35.20000,33.44000,The Alliance,Premier,,24.96,,,,,,,17.60,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,outpatient,1,EA,59.44000,56.47000,The Alliance,Premier,,42.14,,,,,,,29.72,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Premier,,62.26,,,,,,,43.91,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier,TC,217.66,,,,,,,153.50,297.79,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,outpatient,1,EA,6707.63000,6372.25000,The Alliance,Premier,,13.00,,,,,,,7.88,6506.40,fee schedule,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,696.05,,,,,,,8.17,696.05,fee schedule,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,outpatient,2,EA,11.29000,10.72000,The Alliance,Premier,,8.00,,,,,,,5.64,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Premier,,3.26,,,,,,,2.30,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,outpatient,2,EA,14.98000,14.23000,The Alliance,Premier,,10.62,,,,,,,7.49,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Premier,,6.95,,,,,,,4.90,9.51,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier,TC,1608.72,,,,,,,1134.50,2200.93,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,outpatient,20,mL,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,outpatient,20,mL,2.86000,2.71000,The Alliance,Premier,,2.03,,,,,,,1.43,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,outpatient,5,EA,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Premier,,515.00,,,,,,,150.37,585.00,case rate,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier,,577.84,,,,,,,407.50,790.55,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,outpatient,1,EA,26.39000,25.07000,The Alliance,Premier,,18.71,,,,,,,13.20,25.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,515.00,,,,,,,83.61,585.00,case rate,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,275.45,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,outpatient,1,EA,511.80000,486.21000,The Alliance,Premier,,362.87,,,,,,,1.13,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Premier,,184.82,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Premier,,558.80,,,,,,,1.13,764.51,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier,TC,2857.27,,,,,,,2015.00,3909.10,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,outpatient,1,EA,59.06000,56.11000,The Alliance,Premier,,26.73,,,,,,,24.92,57.29,fee schedule,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,outpatient,1,EA,51.19000,48.63000,The Alliance,Premier,,26.73,,,,,,,24.92,49.65,fee schedule,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,outpatient,1,EA,74.01000,70.31000,The Alliance,Premier,,26.73,,,,,,,24.92,71.79,fee schedule,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier,,2.62,,,,,,,2.50,7.35,fee schedule,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,outpatient,1,mL,12.05000,11.44000,The Alliance,Premier,,2.62,,,,,,,2.50,11.69,fee schedule,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,outpatient,1,EA,8.14000,7.74000,The Alliance,Premier,,5.77,,,,,,,4.07,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,outpatient,1,EA,3.84000,3.64000,The Alliance,Premier,,2.72,,,,,,,1.92,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Premier,,2.89,,,,,,,2.04,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier,,373.51,,,,,,,7.01,373.51,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,outpatient,1,EA,142.64000,135.51000,The Alliance,Premier,,26.73,,,,,,,24.92,138.36,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,outpatient,1,EA,146.56000,139.23000,The Alliance,Premier,,26.73,,,,,,,24.92,142.16,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,outpatient,1,EA,148.01000,140.61000,The Alliance,Premier,,26.73,,,,,,,24.92,143.57,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier,,3.70,,,,,,,2.61,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Premier,,20.76,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Premier,,20.76,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,outpatient,1,EA,19.85000,18.86000,The Alliance,Premier,,14.07,,,,,,,9.93,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,outpatient,1,EA,26.70000,25.37000,The Alliance,Premier,,18.93,,,,,,,13.35,25.90,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,outpatient,1,mL,2.07000,1.96000,The Alliance,Premier,,4.49,,,,,,,1.03,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,4.49,,,,,,,2.21,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,outpatient,1,mL,4.49000,4.27000,The Alliance,Premier,,4.49,,,,,,,2.25,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,4.49,,,,,,,0.47500,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,outpatient,1,mL,4.35000,4.13000,The Alliance,Premier,,4.49,,,,,,,2.17,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier,,4.49,,,,,,,2.10,5.23,fee schedule,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,outpatient,10,EA,3.25000,3.08000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,outpatient,1,EA,121.79000,115.70000,The Alliance,Premier,,2.62,,,,,,,2.50,118.14,fee schedule,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,outpatient,1,EA,36.03000,34.23000,The Alliance,Premier,,25.55,,,,,,,18.02,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,outpatient,1,EA,27.49000,26.11000,The Alliance,Premier,,19.49,,,,,,,13.74,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Premier,,7.78,,,,,,,5.49,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier,,6.95,,,,,,,4.90,9.51,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,,70.19,,,,,,,49.50,96.03,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,526.26,,,,,,,8.17,526.26,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Premier,,0.46200,,,,,,,0.43710,3.22,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,outpatient,10,EA,3.84000,3.65000,The Alliance,Premier,,0.46200,,,,,,,0.43710,3.72,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier,,0.46200,,,,,,,0.43710,1.53,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,outpatient,10,EA,1.39000,1.32000,The Alliance,Premier,,0.46200,,,,,,,0.43710,1.35,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,outpatient,10,EA,4.98000,4.73000,The Alliance,Premier,,0.46200,,,,,,,0.43710,4.83,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,outpatient,10,EA,0.86000,0.82000,The Alliance,Premier,,0.46200,,,,,,,0.43000,0.83420,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,outpatient,10,EA,2.21000,2.10000,The Alliance,Premier,,0.46200,,,,,,,0.43710,2.14,fee schedule,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,outpatient,1,mL,1825.95000,1734.65000,The Alliance,Premier,,172.56,,,,,,,104.58,1771.17,fee schedule,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Premier,,17.68,,,,,,,12.46,24.18,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,984.66,,,,,,,18.79,984.66,fee schedule,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,,1459.96,,,,,,,27.94,1459.96,fee schedule,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,outpatient,20,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier,,14.88,,,,,,,5.00,15.24,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,outpatient,1,EA,333.23000,316.57000,The Alliance,Premier,,14.88,,,,,,,14.23,323.23,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,outpatient,1,EA,349.86000,332.36000,The Alliance,Premier,,14.88,,,,,,,14.23,339.36,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,14.88,,,,,,,14.23,122.61,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,outpatient,1,EA,274.88000,261.14000,The Alliance,Premier,,14.88,,,,,,,14.23,266.63,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,outpatient,1,EA,303.21000,288.05000,The Alliance,Premier,,14.88,,,,,,,14.23,294.11,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,outpatient,1,EA,359.49000,341.52000,The Alliance,Premier,,14.88,,,,,,,14.23,348.71,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier,,14.88,,,,,,,14.23,183.91,fee schedule,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,outpatient,1,EA,22.90000,21.75000,The Alliance,Premier,,16.24,,,,,,,11.45,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,outpatient,1,EA,25.83000,24.54000,The Alliance,Premier,,18.31,,,,,,,12.91,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,outpatient,1,EA,31.38000,29.81000,The Alliance,Premier,,22.25,,,,,,,15.69,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,outpatient,1,EA,47.49000,45.11000,The Alliance,Premier,,33.67,,,,,,,23.75,46.07,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,outpatient,1,EA,33.11000,31.46000,The Alliance,Premier,,23.47,,,,,,,16.55,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Premier,,17.04,,,,,,,12.02,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,outpatient,57,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,outpatient,57,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier,,112.23,,,,,,,79.15,153.55,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,outpatient,50,EA,7.45000,7.08000,The Alliance,Premier,,5.28,,,,,,,3.73,7.23,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,outpatient,1,GM,13.52000,12.84000,The Alliance,Premier,,9.59,,,,,,,6.76,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,outpatient,1,GM,13.47000,12.80000,The Alliance,Premier,,9.55,,,,,,,6.74,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,outpatient,1,GM,13.72000,13.04000,The Alliance,Premier,,9.73,,,,,,,6.86,13.31,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Premier,,933.70,,,,,,,17.93,933.70,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,outpatient,1,mL,5.91000,5.62000,The Alliance,Premier,,0.46200,,,,,,,0.43710,5.73,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Premier,,0.46200,,,,,,,0.43710,1.73,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,0.46200,,,,,,,0.43710,1.84,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Premier,,0.46200,,,,,,,0.43710,3.96,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Premier,,0.46200,,,,,,,0.43710,1.13,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Premier,,0.46200,,,,,,,0.43710,3.96,fee schedule,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,,1018.59,,,,,,,19.35,1018.59,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,outpatient,20,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,1256.24,,,,,,,24.18,1256.24,fee schedule,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,outpatient,20,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,outpatient,20,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,outpatient,20,EA,4.49000,4.27000,The Alliance,Premier,,3.18,,,,,,,2.25,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,outpatient,20,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,outpatient,20,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,outpatient,20,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,,679.08,,,,,,,12.87,679.08,fee schedule,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,outpatient,,,189.60000,180.12000,The Alliance,Premier,90,848.80,,,,,,,16.88,848.80,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,outpatient,1,EA,240.56000,228.53000,The Alliance,Premier,,123.83,,,,,,,102.24,233.34,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,outpatient,1,EA,287.19000,272.83000,The Alliance,Premier,,123.83,,,,,,,102.24,278.57,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier,,123.83,,,,,,,102.24,502.46,fee schedule,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,outpatient,1,mL,10.74000,10.20000,The Alliance,Premier,,7.61,,,,,,,5.37,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,outpatient,1,mL,11.65000,11.07000,The Alliance,Premier,,8.26,,,,,,,5.83,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Premier,,937.00,,,,,,,50.05,3163.00,case rate,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,outpatient,10,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,outpatient,10,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,outpatient,10,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,outpatient,10,EA,3.49000,3.32000,The Alliance,Premier,,2.47,,,,,,,1.75,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,outpatient,10,EA,3.10000,2.94000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Premier,,17.68,,,,,,,12.46,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier,,4.44,,,,,,,3.13,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,outpatient,1,mL,12.40000,11.78000,The Alliance,Premier,,8.79,,,,,,,6.20,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Premier,,5.94,,,,,,,4.19,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,outpatient,1,mL,2.28000,2.17000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,outpatient,1,mL,1384.36000,1315.14000,The Alliance,Premier,,12.67,,,,,,,7.68,1342.83,fee schedule,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,outpatient,100,EA,89.81000,85.32000,The Alliance,Premier,,63.68,,,,,,,44.91,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,outpatient,100,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,outpatient,100,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,outpatient,100,EA,2.20000,2.09000,The Alliance,Premier,,1.56,,,,,,,1.10,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,outpatient,100,EA,2.30000,2.19000,The Alliance,Premier,,1.63,,,,,,,1.15,2.23,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier,,933.70,,,,,,,17.90,933.70,fee schedule,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Premier,,233.26,,,,,,,164.50,3321.00,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Premier,,3089.77,,,,,,,53.70,3089.77,fee schedule,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier,,2.38,,,,,,,1.68,3.25,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Premier,,3446.25,,,,,,,66.70,3446.25,fee schedule,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,outpatient,1,mL,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,outpatient,250,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier,,933.70,,,,,,,17.90,933.70,fee schedule,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Premier,,916.73,,,,,,,17.65,916.73,fee schedule,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,outpatient,2,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,outpatient,2,EA,1.51000,1.43000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,outpatient,2,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,outpatient,2,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,outpatient,2,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,outpatient,2,EA,1.15000,1.10000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,outpatient,2,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,,1205.34,,,,,,,22.94,1205.34,fee schedule,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier,90,950.66,,,,,,,20.41,950.66,fee schedule,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,,933.70,,,,,,,9.84,933.70,fee schedule,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier,,1205.34,,,,,,,22.94,1205.34,fee schedule,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,outpatient,1,EA,48.88000,46.43000,The Alliance,Premier,,34.66,,,,,,,24.44,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,outpatient,1,EA,51.32000,48.76000,The Alliance,Premier,,36.39,,,,,,,25.66,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,outpatient,1,EA,30.07000,28.57000,The Alliance,Premier,,21.32,,,,,,,15.04,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,outpatient,1,EA,34.89000,33.14000,The Alliance,Premier,,24.74,,,,,,,17.45,33.84,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,outpatient,1,EA,8.50000,8.08000,The Alliance,Premier,,6.03,,,,,,,4.25,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Premier,,7.17,,,,,,,5.05,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Premier,,6.55,,,,,,,4.62,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier,,933.70,,,,,,,17.90,933.70,fee schedule,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,outpatient,8,EA,6.38000,6.06000,The Alliance,Premier,,4.52,,,,,,,3.19,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,outpatient,8,EA,6.18000,5.87000,The Alliance,Premier,,4.38,,,,,,,3.09,5.99,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,outpatient,,,315.40000,299.63000,The Alliance,Premier,90,1205.34,,,,,,,23.70,1205.34,fee schedule,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,outpatient,50,EA,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,outpatient,,,154.40000,146.68000,The Alliance,Premier,90,882.80,,,,,,,18.72,882.80,fee schedule,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,outpatient,1,EA,141.09000,134.04000,The Alliance,Premier,,100.03,,,,,,,70.55,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,outpatient,1,EA,132.34000,125.72000,The Alliance,Premier,,93.83,,,,,,,66.17,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,outpatient,1,EA,110.28000,104.77000,The Alliance,Premier,,78.19,,,,,,,55.14,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,outpatient,1,EA,109.02000,103.57000,The Alliance,Premier,,77.30,,,,,,,54.51,105.75,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,outpatient,1,EA,101.66000,96.57000,The Alliance,Premier,,72.08,,,,,,,50.83,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,outpatient,1,EA,63.26000,60.10000,The Alliance,Premier,,44.85,,,,,,,31.63,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,outpatient,1,EA,39.09000,37.13000,The Alliance,Premier,,27.71,,,,,,,19.55,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,outpatient,1,EA,39.10000,37.14000,The Alliance,Premier,,27.72,,,,,,,19.55,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,outpatient,1,EA,19.48000,18.51000,The Alliance,Premier,,13.81,,,,,,,9.74,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Premier,,29.01,,,,,,,20.46,39.69,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,outpatient,1,EA,321.99000,305.89000,The Alliance,Premier,,228.29,,,,,,,161.00,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Premier,,2.65,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,outpatient,50,EA,1.35000,1.28000,The Alliance,Premier,,1.58,,,,,,,0.67500,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,outpatient,50,EA,1.38000,1.31000,The Alliance,Premier,,1.58,,,,,,,0.69000,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Premier,,1.58,,,,,,,0.79000,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Premier,,1.58,,,,,,,0.30500,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Premier,,1.58,,,,,,,0.79000,1.58,fee schedule,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,outpatient,1,EA,4.16000,3.95000,The Alliance,Premier,,2.95,,,,,,,2.08,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,984.66,,,,,,,6.82,984.66,fee schedule,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,outpatient,1,EA,22.53000,21.40000,The Alliance,Premier,,15.97,,,,,,,11.27,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier,,9.76,,,,,,,6.88,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,outpatient,1,EA,14.43000,13.71000,The Alliance,Premier,,10.23,,,,,,,7.21,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier,,7.13,,,,,,,5.03,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,outpatient,1,EA,14.84000,14.10000,The Alliance,Premier,,10.52,,,,,,,7.42,14.39,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,outpatient,1,EA,0.04000,0.03000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Premier,,1.58,,,,,,,0.61500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,outpatient,5,EA,1.46000,1.39000,The Alliance,Premier,,1.58,,,,,,,0.73000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,outpatient,5,EA,0.88000,0.84000,The Alliance,Premier,,1.58,,,,,,,0.44000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,outpatient,5,EA,1.52000,1.44000,The Alliance,Premier,,1.58,,,,,,,0.76000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,outpatient,5,EA,1.21000,1.15000,The Alliance,Premier,,1.58,,,,,,,0.60500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,outpatient,5,EA,1.90000,1.80000,The Alliance,Premier,,1.58,,,,,,,0.95000,1.84,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,outpatient,5,EA,1.22000,1.16000,The Alliance,Premier,,1.58,,,,,,,0.61000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,outpatient,5,EA,0.83000,0.79000,The Alliance,Premier,,1.58,,,,,,,0.41500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,outpatient,5,EA,1.17000,1.11000,The Alliance,Premier,,1.58,,,,,,,0.58500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,outpatient,5,EA,1.54000,1.46000,The Alliance,Premier,,1.58,,,,,,,0.77000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Premier,,1.58,,,,,,,0.79000,1.58,fee schedule,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,outpatient,1,EA,87.08000,82.73000,The Alliance,Premier,,61.74,,,,,,,43.54,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,outpatient,1,EA,87.09000,82.74000,The Alliance,Premier,,61.75,,,,,,,43.55,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,outpatient,1,EA,134.90000,128.16000,The Alliance,Premier,,95.64,,,,,,,67.45,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,outpatient,1,EA,43.32000,41.16000,The Alliance,Premier,,30.71,,,,,,,21.66,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,outpatient,1,EA,61.30000,58.24000,The Alliance,Premier,,43.46,,,,,,,30.65,59.46,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,,189.30,,,,,,,146.85,5271.00,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier,,713.01,,,,,,,13.63,713.01,fee schedule,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,271.65,,,,,,,5.88,271.65,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,outpatient,1,mL,99.43000,94.46000,The Alliance,Premier,,0.62700,,,,,,,0.60838,96.45,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,outpatient,1,mL,97.76000,92.87000,The Alliance,Premier,,0.62700,,,,,,,0.60838,94.83,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,0.62700,,,,,,,0.60838,61.30,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,outpatient,1,mL,113.48000,107.80000,The Alliance,Premier,,0.62700,,,,,,,0.60838,110.08,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,outpatient,1,mL,189.13000,179.67000,The Alliance,Premier,,0.62700,,,,,,,0.60838,183.46,fee schedule,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier,,356.54,,,,,,,6.89,356.54,fee schedule,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier,TC,4457.06,,,,,,,360.00,4457.06,fee schedule,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,outpatient,,,256.60000,243.77000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier,,1035.56,,,,,,,22.17,1035.56,fee schedule,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Premier,,10.34,,,,,,,7.29,73.49,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,outpatient,30,EA,0.03000,0.02000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,outpatient,30,EA,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,outpatient,1,mL,221.87000,210.78000,The Alliance,Premier,,0.51150,,,,,,,0.31000,215.21,fee schedule,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,outpatient,1,mL,221.86000,210.77000,The Alliance,Premier,,0.51150,,,,,,,0.31000,215.20,fee schedule,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,,526.26,,,,,,,10.18,526.26,fee schedule,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier,,3361.35,,,,,,,64.41,3361.35,fee schedule,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,outpatient,1,EA,40.02000,38.02000,The Alliance,Premier,,28.37,,,,,,,20.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Premier,,21.96,,,,,,,15.48,30.04,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,,241.06,,,,,,,38.65,329.80,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,outpatient,2,EA,2.82000,2.68000,The Alliance,Premier,,1.58,,,,,,,1.30,2.74,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,outpatient,2,EA,2.43000,2.31000,The Alliance,Premier,,1.58,,,,,,,1.22,2.36,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,outpatient,2,EA,2.53000,2.40000,The Alliance,Premier,,1.58,,,,,,,1.26,2.45,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,outpatient,2,EA,3.36000,3.19000,The Alliance,Premier,,1.58,,,,,,,1.30,3.26,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,outpatient,2,EA,3.62000,3.44000,The Alliance,Premier,,1.58,,,,,,,1.30,3.51,fee schedule,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,outpatient,,,964.00000,915.80000,The Alliance,Premier,,4230.40,,,,,,,295.54,4230.40,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,2.84,,,,,,,0.52500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier,,2.84,,,,,,,0.94000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,2.84,,,,,,,0.87000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier,,2.84,,,,,,,0.94000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier,,2.84,,,,,,,0.46500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier,,2.84,,,,,,,0.37500,3.67,fee schedule,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Premier,,47.18,,,,,,,33.27,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,outpatient,1,EA,73.10000,69.44000,The Alliance,Premier,,51.83,,,,,,,36.55,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,outpatient,1,EA,38.24000,36.32000,The Alliance,Premier,,27.11,,,,,,,19.12,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Premier,,58.99,,,,,,,41.60,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,outpatient,1,EA,66.36000,63.04000,The Alliance,Premier,,47.05,,,,,,,33.18,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,outpatient,1,EA,52.68000,50.05000,The Alliance,Premier,,37.35,,,,,,,26.34,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,outpatient,1,EA,76.35000,72.53000,The Alliance,Premier,,54.13,,,,,,,38.17,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Premier,,35.85,,,,,,,25.28,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,outpatient,1,EA,46.36000,44.04000,The Alliance,Premier,,32.87,,,,,,,23.18,44.97,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,outpatient,1,EA,2.06000,1.96000,The Alliance,Premier,,1.46,,,,,,,1.03,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Premier,,5.23,,,,,,,3.69,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,outpatient,1,EA,10.43000,9.90000,The Alliance,Premier,,7.39,,,,,,,5.21,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,outpatient,30,EA,7.68000,7.29000,The Alliance,Premier,,5.45,,,,,,,3.84,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,outpatient,30,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,outpatient,1,mL,281.66000,267.58000,The Alliance,Premier,,118.22,,,,,,,71.65,273.21,fee schedule,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,outpatient,1,mL,171.83000,163.23000,The Alliance,Premier,,118.22,,,,,,,71.65,166.68,fee schedule,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,outpatient,1,mL,352.08000,334.48000,The Alliance,Premier,,118.22,,,,,,,71.65,341.52,fee schedule,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,763.98,,,,,,,14.70,763.98,fee schedule,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,,984.66,,,,,,,13.65,984.66,fee schedule,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Premier,,8.84,,,,,,,6.24,73.49,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Premier,,8.84,,,,,,,6.24,73.49,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,outpatient,100,EA,0.59000,0.56000,The Alliance,Premier,,3.73,,,,,,,0.29500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,outpatient,100,EA,0.23000,0.22000,The Alliance,Premier,,3.73,,,,,,,0.11500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,outpatient,100,EA,0.12000,0.11000,The Alliance,Premier,,3.73,,,,,,,0.06000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,3.73,,,,,,,0.09500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,outpatient,100,EA,0.13000,0.12000,The Alliance,Premier,,3.73,,,,,,,0.06500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,outpatient,100,EA,0.28000,0.27000,The Alliance,Premier,,3.73,,,,,,,0.14000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,3.73,,,,,,,0.09500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Premier,,3.73,,,,,,,0.07000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,outpatient,100,EA,0.47000,0.45000,The Alliance,Premier,,3.73,,,,,,,0.23500,5.94,fee schedule,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier,,1.01,,,,,,,0.71500,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Premier,,4.69,,,,,,,3.31,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,outpatient,1,EA,34.79000,33.05000,The Alliance,Premier,,24.67,,,,,,,17.39,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,outpatient,1,EA,28.96000,27.52000,The Alliance,Premier,,20.53,,,,,,,14.48,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,outpatient,1,EA,15.79000,15.00000,The Alliance,Premier,,11.20,,,,,,,7.89,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Premier,,23.14,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Premier,,23.14,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier,,25.77,,,,,,,18.17,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Premier,,9.10,,,,,,,6.42,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,2.84,,,,,,,0.87000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,outpatient,1,mL,1.62000,1.54000,The Alliance,Premier,,2.84,,,,,,,0.81000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier,,2.84,,,,,,,0.46500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier,,2.84,,,,,,,0.37500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier,,2.84,,,,,,,0.94000,3.67,fee schedule,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,outpatient,,,195.10000,185.34000,The Alliance,Premier,90,882.80,,,,,,,17.36,882.80,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Premier,,1.19,,,,,,,1.15,29.48,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,outpatient,1,mL,291.73000,277.14000,The Alliance,Premier,,1.19,,,,,,,1.15,282.98,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,outpatient,1,mL,148.52000,141.09000,The Alliance,Premier,,1.19,,,,,,,1.15,144.06,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Premier,,1.19,,,,,,,1.15,147.13,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,outpatient,1,mL,157.10000,149.25000,The Alliance,Premier,,1.19,,,,,,,1.15,152.39,fee schedule,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,outpatient,1,EA,5.56000,5.29000,The Alliance,Premier,,3.94,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier,,2.98,,,,,,,2.10,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier,,3.17,,,,,,,2.23,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier,,2.48,,,,,,,1.75,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,outpatient,1,EA,5.37000,5.11000,The Alliance,Premier,,3.81,,,,,,,2.69,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier,,3.94,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Premier,,4.19,,,,,,,2.96,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,outpatient,1,EA,55.82000,53.03000,The Alliance,Premier,,39.58,,,,,,,27.91,54.15,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier,,2.31,,,,,,,1.63,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier,,2.29,,,,,,,1.61,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,outpatient,1,EA,3.99000,3.79000,The Alliance,Premier,,2.83,,,,,,,2.00,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Premier,,2.89,,,,,,,2.04,3.96,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,outpatient,1,EA,2.97000,2.82000,The Alliance,Premier,,2.11,,,,,,,1.49,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,outpatient,1,EA,2.96000,2.82000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,TC,1075.26,,,,,,,47.50,1075.26,fee schedule,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,outpatient,4,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,outpatient,4,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,0.64740,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,outpatient,4,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.64740,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,outpatient,4,EA,2.29000,2.18000,The Alliance,Premier,,1.62,,,,,,,0.64740,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,outpatient,4,EA,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,outpatient,4,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,0.64740,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,outpatient,4,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,outpatient,4,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,outpatient,4,EA,1.12000,1.06000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,outpatient,1,mL,4.03000,3.83000,The Alliance,Premier,,2.84,,,,,,,2.02,3.91,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Premier,,2.84,,,,,,,0.54000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier,,2.84,,,,,,,0.43500,3.67,fee schedule,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,outpatient,1,mL,2655.14000,2522.38000,The Alliance,Premier,,1882.49,,,,,,,6.03,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,outpatient,1,mL,1849.97000,1757.47000,The Alliance,Premier,,1311.63,,,,,,,6.03,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,outpatient,1,mL,1856.17000,1763.36000,The Alliance,Premier,,1316.02,,,,,,,6.03,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,outpatient,1,mL,1702.49000,1617.37000,The Alliance,Premier,,1207.07,,,,,,,6.03,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,outpatient,1,mL,2300.00000,2185.00000,The Alliance,Premier,,1630.70,,,,,,,6.03,2231.00,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Premier,,3.33,,,,,,,2.35,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,outpatient,5,EA,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,outpatient,16,EA,2.69000,2.56000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,outpatient,16,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,outpatient,16,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,outpatient,16,EA,3.56000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.78,3.45,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,outpatient,100,mL,0.63000,0.60000,The Alliance,Premier,,3.73,,,,,,,0.31500,5.94,fee schedule,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,21.98,,,,,,,10.00,30.07,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,3186.14,,,,,,,285.00,3186.14,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,outpatient,1,EA,866.69000,823.36000,The Alliance,Premier,,0.18150,,,,,,,0.17611,840.69,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,outpatient,1,EA,829.37000,787.90000,The Alliance,Premier,,0.18150,,,,,,,0.17611,804.49,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,outpatient,1,EA,205.40000,195.13000,The Alliance,Premier,,0.18150,,,,,,,0.17611,199.24,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Premier,,0.18150,,,,,,,0.17611,76.63,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier,,0.18150,,,,,,,0.17611,91.96,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,outpatient,1,EA,748.82000,711.38000,The Alliance,Premier,,0.18150,,,,,,,0.17611,726.36,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,outpatient,1,EA,259.69000,246.70000,The Alliance,Premier,,0.18150,,,,,,,0.17611,251.90,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,outpatient,1,EA,780.03000,741.03000,The Alliance,Premier,,0.18150,,,,,,,0.17611,756.63,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,outpatient,1,EA,256.53000,243.70000,The Alliance,Premier,,0.18150,,,,,,,0.17611,248.83,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Premier,,0.18150,,,,,,,0.17611,515.02,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,outpatient,1,EA,454.54000,431.82000,The Alliance,Premier,,0.18150,,,,,,,0.17611,440.90,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Premier,,0.18150,,,,,,,0.17611,263.79,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,outpatient,1,EA,714.37000,678.66000,The Alliance,Premier,,0.18150,,,,,,,0.17611,692.94,fee schedule,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Premier,TC,122.66,,,,,,,86.50,167.81,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,458.40,,,,,,,9.72,458.40,fee schedule,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,373.51,,,,,,,7.20,373.51,fee schedule,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier,TC,1450.63,,,,,,,146.17,1450.63,fee schedule,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier,TC,1635.52,,,,,,,118.00,1635.52,fee schedule,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier,,63.10,,,,,,,44.50,210.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,967.70,,,,,,,18.54,967.70,fee schedule,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,outpatient,2.5,EA,45.50000,43.23000,The Alliance,Premier,,32.26,,,,,,,22.75,44.13,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,outpatient,1,mL,6.61000,6.28000,The Alliance,Premier,,4.69,,,,,,,0.64740,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,outpatient,1,mL,5.40000,5.13000,The Alliance,Premier,,3.83,,,,,,,0.64740,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,0.64740,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,0.64740,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,0.64740,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.64740,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,0.64740,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,outpatient,1,mL,4.29000,4.08000,The Alliance,Premier,,3.04,,,,,,,0.64740,4.16,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,outpatient,12,EA,72.11000,68.50000,The Alliance,Premier,,51.13,,,,,,,36.05,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,outpatient,12,EA,46.87000,44.53000,The Alliance,Premier,,33.23,,,,,,,23.43,45.46,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,outpatient,2,EA,43.15000,40.99000,The Alliance,Premier,,30.59,,,,,,,21.57,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,outpatient,2,EA,63.88000,60.69000,The Alliance,Premier,,45.29,,,,,,,31.94,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,outpatient,2,EA,2.31000,2.19000,The Alliance,Premier,,1.64,,,,,,,1.16,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,outpatient,2,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Premier,,16.58,,,,,,,11.69,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,outpatient,2,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,outpatient,2,EA,2.94000,2.79000,The Alliance,Premier,,2.08,,,,,,,1.47,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,outpatient,2,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,11.85,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,outpatient,2,EA,7.78000,7.39000,The Alliance,Premier,,5.52,,,,,,,3.89,7.55,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,823.21,,,,,,,17.27,823.21,fee schedule,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Premier,,24.28,,,,,,,17.12,33.22,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,outpatient,1,mL,5.36000,5.09000,The Alliance,Premier,,4.88,,,,,,,2.68,5.20,fee schedule,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,outpatient,1,mL,5.38000,5.11000,The Alliance,Premier,,4.88,,,,,,,2.69,5.22,fee schedule,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier,,1052.52,,,,,,,77.53,1052.52,fee schedule,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,509.30,,,,,,,9.70,509.30,fee schedule,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,outpatient,,,137.20000,130.34000,The Alliance,Premier,90,780.94,,,,,,,16.62,780.94,fee schedule,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier,TC,4298.79,,,,,,,394.00,4298.79,fee schedule,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,outpatient,10.6,EA,2.59000,2.46000,The Alliance,Premier,,1.84,,,,,,,1.29,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,outpatient,10.6,EA,60.98000,57.93000,The Alliance,Premier,,43.23,,,,,,,30.49,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,outpatient,10.6,EA,39.63000,37.65000,The Alliance,Premier,,28.10,,,,,,,19.82,38.44,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Premier,,2.15,,,,,,,1.65,4.66,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Premier,,2.15,,,,,,,1.65,4.66,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Premier,,2.15,,,,,,,1.65,6.31,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier,,2.15,,,,,,,1.65,7.62,fee schedule,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,outpatient,1,GM,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,outpatient,100,EA,53.57000,50.89000,The Alliance,Premier,,78.87,,,,,,,26.79,78.87,fee schedule,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier,,899.77,,,,,,,16.37,899.77,fee schedule,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,outpatient,2,EA,8.55000,8.12000,The Alliance,Premier,,4.32,,,,,,,3.82,8.29,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Premier,,4.32,,,,,,,1.74,4.32,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,outpatient,2,EA,2.72000,2.58000,The Alliance,Premier,,4.32,,,,,,,1.36,4.32,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,outpatient,2,EA,6.32000,6.00000,The Alliance,Premier,,4.32,,,,,,,3.16,6.13,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,outpatient,1,EA,1919.06000,1823.11000,The Alliance,Premier,,4.88,,,,,,,4.61,1861.49,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,outpatient,1,EA,145.14000,137.88000,The Alliance,Premier,,4.88,,,,,,,4.61,140.79,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,outpatient,1,EA,157.65000,149.77000,The Alliance,Premier,,4.88,,,,,,,4.61,152.92,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,outpatient,1,EA,156.74000,148.90000,The Alliance,Premier,,4.88,,,,,,,4.61,152.04,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Premier,,4.88,,,,,,,4.61,351.72,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,outpatient,1,EA,154.84000,147.10000,The Alliance,Premier,,4.88,,,,,,,4.61,150.19,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Premier,,4.88,,,,,,,4.61,144.06,fee schedule,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,outpatient,1,mL,3.92000,3.72000,The Alliance,Premier,,2.84,,,,,,,1.96,3.80,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Premier,,2.84,,,,,,,0.54000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Premier,,2.84,,,,,,,0.44000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier,,2.84,,,,,,,1.04,3.67,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier,,4.32,,,,,,,2.31,4.48,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,outpatient,1,EA,2.87000,2.73000,The Alliance,Premier,,4.32,,,,,,,1.44,4.32,fee schedule,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Premier,TC,3942.79,,,,,,,308.00,3942.79,fee schedule,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier,,574.73,,,,,,,12.05,574.73,fee schedule,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,outpatient,50,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,outpatient,50,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,outpatient,50,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,outpatient,50,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,outpatient,50,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,outpatient,50,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,outpatient,,,614.00000,583.30000,The Alliance,Premier,,1861.90,,,,,,,125.97,1861.90,fee schedule,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,,1001.63,,,,,,,19.04,1001.63,fee schedule,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Premier,,916.73,,,,,,,17.63,916.73,fee schedule,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Premier,90,1018.59,,,,,,,14.48,1018.59,fee schedule,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier,,4.28,,,,,,,3.02,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.03,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Premier,,78.87,,,,,,,26.79,78.87,fee schedule,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Premier,,2.54,,,,,,,1.79,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,577.23,,,,,,,10.50,577.23,fee schedule,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,TC,2446.05,,,,,,,1591.55,3346.50,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,50.34,,,,,,,35.50,68.87,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier,,13.94,,,,,,,9.83,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Premier,,24.28,,,,,,,17.12,33.22,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,645.08,,,,,,,7.15,645.08,fee schedule,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier,,15.60,,,,,,,11.00,81.87,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,outpatient,5,EA,9.70000,9.22000,The Alliance,Premier,,6.88,,,,,,,4.85,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,outpatient,5,EA,22.57000,21.44000,The Alliance,Premier,,16.00,,,,,,,11.29,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,outpatient,5,EA,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Premier,TC,2009.31,,,,,,,1132.05,2748.98,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,outpatient,1,mL,5.36000,5.10000,The Alliance,Premier,,4.88,,,,,,,2.68,5.20,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,outpatient,1,mL,5.61000,5.32000,The Alliance,Premier,,4.88,,,,,,,2.81,5.44,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier,,4.88,,,,,,,2.31,4.95,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier,,4.88,,,,,,,1.50,4.95,fee schedule,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Premier,90,746.94,,,,,,,13.88,746.94,fee schedule,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,1539.22,,,,,,,12.05,1539.22,fee schedule,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,outpatient,10,EA,16.13000,15.33000,The Alliance,Premier,,11.44,,,,,,,8.06,15.65,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,outpatient,1,EA,383.81000,364.62000,The Alliance,Premier,,4.88,,,,,,,4.61,372.30,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,outpatient,1,EA,31.35000,29.78000,The Alliance,Premier,,4.88,,,,,,,4.61,30.41,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,4.88,,,,,,,4.61,122.61,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier,,4.88,,,,,,,4.61,36.78,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Premier,,4.88,,,,,,,4.61,28.14,fee schedule,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,outpatient,1,EA,3.14000,2.99000,The Alliance,Premier,,2.23,,,,,,,1.57,3.05,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,outpatient,15,EA,8.32000,7.91000,The Alliance,Premier,,5.90,,,,,,,4.16,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,outpatient,15,EA,6.87000,6.52000,The Alliance,Premier,,4.87,,,,,,,3.44,6.66,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,,848.80,,,,,,,16.38,848.80,fee schedule,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,outpatient,10,EA,25.01000,23.76000,The Alliance,Premier,,17.73,,,,,,,12.51,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,outpatient,10,EA,38.33000,36.41000,The Alliance,Premier,,27.18,,,,,,,19.16,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,outpatient,10,EA,2.51000,2.38000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Premier,,10.64,,,,,,,7.50,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,outpatient,10,EA,4.49000,4.27000,The Alliance,Premier,,3.18,,,,,,,2.25,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,outpatient,10,EA,15.17000,14.41000,The Alliance,Premier,,10.76,,,,,,,7.58,14.71,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,outpatient,1,EA,1566.95000,1488.60000,The Alliance,Premier,,1211.35,,,,,,,734.15,1519.94,fee schedule,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,outpatient,1,EA,2451.28000,2328.72000,The Alliance,Premier,,1211.35,,,,,,,734.15,2377.74,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,outpatient,200,mL,53.57000,50.89000,The Alliance,Premier,,78.87,,,,,,,26.79,78.87,fee schedule,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,254.68,,,,,,,4.75,254.68,fee schedule,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,203.72,,,,,,,3.92,203.72,fee schedule,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,574.73,,,,,,,11.53,574.73,fee schedule,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier,,967.70,,,,,,,18.58,967.70,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,outpatient,1,EA,727.27000,690.91000,The Alliance,Premier,,323.05,,,,,,,195.79,705.45,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,outpatient,1,EA,730.51000,693.98000,The Alliance,Premier,,323.05,,,,,,,195.79,708.59,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,outpatient,1,EA,725.20000,688.94000,The Alliance,Premier,,323.05,,,,,,,195.79,703.44,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,outpatient,1,EA,410.23000,389.72000,The Alliance,Premier,,323.05,,,,,,,195.79,397.92,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,outpatient,1,EA,444.44000,422.22000,The Alliance,Premier,,323.05,,,,,,,195.79,431.11,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,outpatient,1,EA,724.68000,688.45000,The Alliance,Premier,,323.05,,,,,,,195.79,702.94,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,outpatient,1,EA,441.85000,419.76000,The Alliance,Premier,,323.05,,,,,,,195.79,428.59,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,outpatient,1,EA,273.01000,259.36000,The Alliance,Premier,,323.05,,,,,,,136.50,323.05,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,outpatient,1,EA,441.60000,419.52000,The Alliance,Premier,,323.05,,,,,,,195.79,428.35,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,outpatient,1,EA,419.58000,398.60000,The Alliance,Premier,,323.05,,,,,,,195.79,406.99,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,outpatient,1,mL,57.32000,54.46000,The Alliance,Premier,,0.37950,,,,,,,0.36823,55.60,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier,,0.37950,,,,,,,0.36823,30.65,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,0.37950,,,,,,,0.36823,61.30,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,outpatient,1,mL,29.61000,28.13000,The Alliance,Premier,,0.37950,,,,,,,0.36823,28.72,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,1.39,,,,,,,1.20,4.91,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,outpatient,1,EA,65.21000,61.95000,The Alliance,Premier,,1.39,,,,,,,1.20,63.25,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier,,1.39,,,,,,,1.20,6.90,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,1.39,,,,,,,1.20,3.38,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Premier,,1.39,,,,,,,1.20,18.36,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,1.39,,,,,,,1.20,2.70,fee schedule,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.82,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,outpatient,,,147.70000,140.31000,The Alliance,Premier,,104.72,,,,,,,36.30,143.27,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Premier,,4.32,,,,,,,2.17,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Premier,,4.32,,,,,,,0.70500,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Premier,,4.32,,,,,,,2.17,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,outpatient,2,EA,6.43000,6.11000,The Alliance,Premier,,4.32,,,,,,,3.21,6.24,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,outpatient,2,EA,1.91000,1.82000,The Alliance,Premier,,4.32,,,,,,,0.95500,4.32,fee schedule,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,390.47,,,,,,,7.52,390.47,fee schedule,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,outpatient,10,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.64740,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,outpatient,10,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,outpatient,10,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,outpatient,10,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,outpatient,10,EA,7.38000,7.01000,The Alliance,Premier,,5.23,,,,,,,0.64740,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.64740,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,outpatient,10,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.64740,1.29,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,outpatient,12,EA,40.91000,38.87000,The Alliance,Premier,,29.01,,,,,,,20.45,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,outpatient,12,EA,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,outpatient,12,EA,72.80000,69.16000,The Alliance,Premier,,51.62,,,,,,,36.40,70.62,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,,373.51,,,,,,,4.90,373.51,fee schedule,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,118.82,,,,,,,2.37,118.82,fee schedule,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,679.08,,,,,,,12.87,679.08,fee schedule,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,1.93,,,,,,,1.36,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.58,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Premier,,0.70950,,,,,,,0.43000,7.97,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier,,0.70950,,,,,,,0.43000,39.85,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,outpatient,1,mL,8.60000,8.17000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Premier,,0.70950,,,,,,,0.43000,6.90,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Premier,,0.70950,,,,,,,0.43000,2.06,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,outpatient,1,mL,22.27000,21.15000,The Alliance,Premier,,0.70950,,,,,,,0.43000,21.60,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,0.70950,,,,,,,0.43000,7.66,fee schedule,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,,611.15,,,,,,,11.84,611.15,fee schedule,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,outpatient,1,EA,6103.28000,5798.12000,The Alliance,Premier,,1211.35,,,,,,,734.15,5920.18,fee schedule,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1278.00000,1214.10000,The Alliance,Premier,,6705.74,,,,,,,128.29,6705.74,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,outpatient,1,mL,5.44000,5.17000,The Alliance,Premier,,4.88,,,,,,,2.72,5.28,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier,,4.88,,,,,,,2.31,4.95,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Premier,,4.88,,,,,,,1.32,4.95,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,outpatient,1,mL,2.70000,2.57000,The Alliance,Premier,,4.88,,,,,,,1.35,4.95,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Premier,,52.26,,,,,,,29.59,57.41,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Premier,,52.26,,,,,,,49.09,114.83,fee schedule,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,outpatient,10,EA,15.54000,14.76000,The Alliance,Premier,,11.02,,,,,,,7.77,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,outpatient,10,EA,8.44000,8.02000,The Alliance,Premier,,5.98,,,,,,,4.22,8.19,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,outpatient,4,EA,1.28000,1.21000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,outpatient,4,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier,,3514.18,,,,,,,67.36,3514.18,fee schedule,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,outpatient,,,4882.00000,4637.90000,The Alliance,Premier,TC,3461.34,,,,,,,2091.58,4735.54,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,118.82,,,,,,,2.37,118.82,fee schedule,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,733.05000,696.40000,The Alliance,Premier,,346.73,,,,,,,336.47,733.05,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,outpatient,,,22.90000,21.75000,The Alliance,Premier,,16.24,,,,,,,11.45,22.21,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,outpatient,1,EA,1.77000,1.69000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,outpatient,1,mL,414.52000,393.79000,The Alliance,Premier,,293.89,,,,,,,207.26,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,outpatient,1,mL,378.56000,359.63000,The Alliance,Premier,,268.40,,,,,,,189.28,367.20,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.58,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,outpatient,1,EA,24.19000,22.98000,The Alliance,Premier,,0.70950,,,,,,,0.43000,23.46,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier,,0.70950,,,,,,,0.43000,21.46,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier,,0.70950,,,,,,,0.43000,35.25,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.70950,,,,,,,0.43000,1.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier,,0.70950,,,,,,,0.43000,2.99,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.27,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,outpatient,1,EA,23.47000,22.30000,The Alliance,Premier,,0.70950,,,,,,,0.43000,22.77,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,outpatient,1,EA,8.60000,8.17000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier,,0.70950,,,,,,,0.43000,8.28,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Premier,,0.70950,,,,,,,0.43000,22.22,fee schedule,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,outpatient,1,mL,458.17000,435.26000,The Alliance,Premier,,324.84,,,,,,,229.09,444.42,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,645.08,,,,,,,12.39,645.08,fee schedule,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,560.26,,,,,,,10.74,560.26,fee schedule,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,152.82,,,,,,,3.28,152.82,fee schedule,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,outpatient,10,EA,4.89000,4.64000,The Alliance,Premier,,3.47,,,,,,,2.44,4.74,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Premier,,119.92,,,,,,,69.38,134.59,fee schedule,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Premier,,119.92,,,,,,,69.38,134.59,fee schedule,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier,,679.08,,,,,,,13.09,679.08,fee schedule,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,outpatient,1,mL,75.21000,71.45000,The Alliance,Premier,,7.72,,,,,,,7.15,72.95,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,outpatient,1,mL,88.73000,84.30000,The Alliance,Premier,,7.72,,,,,,,7.15,86.07,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier,,7.72,,,,,,,7.15,76.63,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,outpatient,1,mL,67.43000,64.06000,The Alliance,Premier,,7.72,,,,,,,7.15,65.41,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,outpatient,1,mL,67.31000,63.94000,The Alliance,Premier,,7.72,,,,,,,7.15,65.29,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,7.72,,,,,,,7.15,61.30,fee schedule,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,outpatient,,,231.53000,219.95000,The Alliance,Premier,,164.15,,,,,,,115.77,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,outpatient,1,mL,231.53000,219.95000,The Alliance,Premier,,164.15,,,,,,,115.77,224.58,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,424.40,,,,,,,8.17,424.40,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,outpatient,,,146.22000,138.91000,The Alliance,Premier,,116.13,,,,,,,73.11,141.83,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,outpatient,1,mL,146.22000,138.91000,The Alliance,Premier,,116.13,,,,,,,73.11,141.83,fee schedule,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,797.91,,,,,,,8.17,797.91,fee schedule,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,outpatient,1,mL,3.68000,3.50000,The Alliance,Premier,,0.36300,,,,,,,0.33945,3.57,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier,,0.36300,,,,,,,0.33945,2.57,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,outpatient,1,mL,5.50000,5.22000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.33,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,outpatient,1,mL,4.00000,3.80000,The Alliance,Premier,,0.36300,,,,,,,0.33945,3.88,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Premier,,0.36300,,,,,,,0.33945,2.96,fee schedule,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,543.22,,,,,,,10.33,543.22,fee schedule,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier,QN,18.43,,,,,,,13.00,25.22,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,266.06,,,,,,,258.19,562.50,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Premier,,1901.39,,,,,,,38.30,1901.39,fee schedule,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,509.30,,,,,,,9.71,509.30,fee schedule,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier,,628.12,,,,,,,12.05,628.12,fee schedule,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,outpatient,,,254.90000,242.16000,The Alliance,Premier,90,1154.38,,,,,,,22.69,1154.38,fee schedule,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,713.01,,,,,,,13.52,713.01,fee schedule,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,outpatient,1,EA,1.21000,1.14000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier,,1.87,,,,,,,1.32,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,746.94,,,,,,,14.27,746.94,fee schedule,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,611.15,,,,,,,11.77,611.15,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,outpatient,,,139.34000,132.37000,The Alliance,Premier,,116.13,,,,,,,69.67,135.16,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,outpatient,1,EA,139.34000,132.37000,The Alliance,Premier,,116.13,,,,,,,69.67,135.16,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,outpatient,1,mL,10.40000,9.88000,The Alliance,Premier,,0.36300,,,,,,,0.33945,10.09,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.61,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,outpatient,1,mL,24.11000,22.91000,The Alliance,Premier,,0.36300,,,,,,,0.33945,23.39,fee schedule,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,662.12,,,,,,,12.58,662.12,fee schedule,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,outpatient,,,276.60000,262.77000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,407.44,,,,,,,8.61,407.44,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,,645.08,,,,,,,13.79,645.08,fee schedule,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,373.51,,,,,,,8.00,373.51,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier,,8.56,,,,,,,6.82,45.98,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,outpatient,1,EA,134.16000,127.46000,The Alliance,Premier,,8.56,,,,,,,6.82,130.14,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier,,8.56,,,,,,,6.82,27.59,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,8.56,,,,,,,1.90,8.56,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier,,8.56,,,,,,,6.82,43.89,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Premier,,8.56,,,,,,,3.83,8.56,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,8.56,,,,,,,5.53,10.73,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier,,8.56,,,,,,,6.82,36.78,fee schedule,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier,,3038.81,,,,,,,58.00,3038.81,fee schedule,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,outpatient,,,392.00000,372.40000,The Alliance,Premier,,277.93,,,,,,,196.00,380.24,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,90,1590.11,,,,,,,6.41,1590.11,fee schedule,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Premier,TC,2423.36,,,,,,,1578.65,3315.46,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,746.94,,,,,,,14.38,746.94,fee schedule,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,outpatient,,,301.21000,286.15000,The Alliance,Premier,,271.29,,,,,,,150.60,292.17,fee schedule,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,outpatient,1,mL,301.21000,286.15000,The Alliance,Premier,,271.29,,,,,,,150.60,292.17,fee schedule,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,outpatient,1,EA,36.47000,34.64000,The Alliance,Premier,,25.86,,,,,,,18.23,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier,,25.77,,,,,,,18.17,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,outpatient,1,EA,3.48000,3.31000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,outpatient,1,EA,34.63000,32.90000,The Alliance,Premier,,24.55,,,,,,,17.32,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Premier,,6.66,,,,,,,4.70,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,outpatient,1,EA,151.75000,144.17000,The Alliance,Premier,,107.59,,,,,,,75.88,147.20,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Premier,,1137.41,,,,,,,24.06,1137.41,fee schedule,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,Premier,TC,4012.21,,,,,,,233.00,4012.21,fee schedule,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,,1018.59,,,,,,,19.35,1018.59,fee schedule,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier,,441.37,,,,,,,9.09,441.37,fee schedule,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,outpatient,28.35,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,outpatient,28.35,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,outpatient,28.35,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,outpatient,28.35,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier,,2240.90,,,,,,,42.84,2240.90,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Premier,,52.26,,,,,,,29.59,57.41,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Premier,,52.26,,,,,,,49.09,114.83,fee schedule,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,outpatient,30,EA,7.80000,7.41000,The Alliance,Premier,,5.53,,,,,,,3.90,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,outpatient,30,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,outpatient,30,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,outpatient,30,EA,7.30000,6.93000,The Alliance,Premier,,5.18,,,,,,,3.65,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,outpatient,30,EA,1.59000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,outpatient,30,EA,6.64000,6.31000,The Alliance,Premier,,4.71,,,,,,,3.32,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,outpatient,30,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,outpatient,30,EA,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,outpatient,30,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,100.68,,,,,,,71.00,137.74,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier,,4447.87,,,,,,,85.10,4447.87,fee schedule,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,outpatient,,,217.70000,206.81000,The Alliance,Premier,90,1341.13,,,,,,,26.67,1341.13,fee schedule,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,outpatient,1,EA,10.30000,9.78000,The Alliance,Premier,,7.30,,,,,,,5.15,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,outpatient,1,EA,0.94000,0.90000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,outpatient,1,mL,5.92000,5.62000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.74,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,outpatient,1,mL,8.09000,7.69000,The Alliance,Premier,,0.14850,,,,,,,0.14409,7.85,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,outpatient,1,mL,10.97000,10.42000,The Alliance,Premier,,0.14850,,,,,,,0.14409,10.64,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,outpatient,1,mL,5.84000,5.55000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.66,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier,,0.14850,,,,,,,0.14409,11.04,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,outpatient,1,mL,13.11000,12.46000,The Alliance,Premier,,0.14850,,,,,,,0.14409,12.72,fee schedule,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,outpatient,1,mL,133.27000,126.60000,The Alliance,Premier,,0.59400,,,,,,,0.56420,129.27,fee schedule,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,outpatient,1,mL,176.33000,167.51000,The Alliance,Premier,,0.59400,,,,,,,0.56420,171.04,fee schedule,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,696.05,,,,,,,13.19,696.05,fee schedule,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,outpatient,1,mL,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,outpatient,1,mL,6.21000,5.90000,The Alliance,Premier,,4.40,,,,,,,3.10,6.02,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,458.40,,,,,,,8.89,458.40,fee schedule,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,Premier,,2240.90,,,,,,,42.84,2240.90,fee schedule,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Premier,,2.75,,,,,,,1.94,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier,,4.03,,,,,,,2.85,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Premier,,2.74,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,outpatient,60,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,outpatient,60,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,outpatient,60,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,outpatient,60,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,outpatient,60,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,outpatient,,,1293.00000,1228.35000,The Alliance,Premier,90,5992.72,,,,,,,121.54,5992.72,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,outpatient,50,EA,7.63000,7.25000,The Alliance,Premier,,0.14850,,,,,,,0.14409,7.40,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,outpatient,50,EA,6.54000,6.21000,The Alliance,Premier,,0.14850,,,,,,,0.14409,6.34,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,outpatient,50,EA,6.45000,6.12000,The Alliance,Premier,,0.14850,,,,,,,0.14409,6.26,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,outpatient,50,EA,8.96000,8.51000,The Alliance,Premier,,0.14850,,,,,,,0.14409,8.69,fee schedule,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,outpatient,500,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,outpatient,500,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier,,611.15,,,,,,,11.85,611.15,fee schedule,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,outpatient,1,EA,4.31000,4.10000,The Alliance,Premier,,3.06,,,,,,,2.15,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,90,611.15,,,,,,,11.96,611.15,fee schedule,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier,,38.77,,,,,,,2.90,40.87,fee schedule,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier,,865.84,,,,,,,16.46,865.84,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,outpatient,1,EA,64.46000,61.24000,The Alliance,Premier,,34.98,,,,,,,31.90,62.53,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,outpatient,1,EA,64.49000,61.26000,The Alliance,Premier,,34.98,,,,,,,31.90,62.56,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,outpatient,1,EA,47.72000,45.33000,The Alliance,Premier,,34.98,,,,,,,23.86,46.29,fee schedule,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,outpatient,1,EA,5.29000,5.02000,The Alliance,Premier,,3.75,,,,,,,2.65,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Premier,,4.02,,,,,,,2.83,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Premier,,3.74,,,,,,,2.64,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier,,1.92,,,,,,,1.35,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier,,3.25,,,,,,,2.29,4.44,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,outpatient,,,32.40000,30.78000,The Alliance,Premier,90,814.87,,,,,,,16.20,814.87,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,outpatient,1,mL,263.33000,250.17000,The Alliance,Premier,,50.82,,,,,,,34.44,255.43,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,outpatient,1,mL,363.46000,345.29000,The Alliance,Premier,,50.82,,,,,,,34.44,352.56,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,outpatient,1,mL,258.07000,245.16000,The Alliance,Premier,,50.82,,,,,,,34.44,250.33,fee schedule,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,1018.59,,,,,,,19.35,1018.59,fee schedule,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,63.05,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,outpatient,1,EA,238.67000,226.74000,The Alliance,Premier,,34.98,,,,,,,31.90,231.51,fee schedule,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,outpatient,1,EA,93.35000,88.68000,The Alliance,Premier,,27.93,,,,,,,27.10,90.55,fee schedule,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,Premier,,3666.93,,,,,,,50.62,3666.93,fee schedule,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Premier,,17.80,,,,,,,0.96500,17.80,fee schedule,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,outpatient,1,mL,7.94000,7.54000,The Alliance,Premier,,17.80,,,,,,,3.97,17.80,fee schedule,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier,,1256.24,,,,,,,24.08,1256.24,fee schedule,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier,,1680.71,,,,,,,34.81,1680.71,fee schedule,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,outpatient,1,EA,26.51000,25.19000,The Alliance,Premier,,18.80,,,,,,,13.26,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,outpatient,1,EA,22.75000,21.61000,The Alliance,Premier,,16.13,,,,,,,11.38,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,outpatient,1,EA,8.66000,8.23000,The Alliance,Premier,,0.14850,,,,,,,0.14409,8.40,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,outpatient,1,EA,10.64000,10.10000,The Alliance,Premier,,0.14850,,,,,,,0.14409,10.32,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,0.14850,,,,,,,0.14409,4.60,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,0.14850,,,,,,,0.14409,4.78,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.87,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,outpatient,1,EA,4.55000,4.32000,The Alliance,Premier,,0.14850,,,,,,,0.14409,4.41,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.14850,,,,,,,0.14409,9.20,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,0.14850,,,,,,,0.14409,15.33,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier,,0.14850,,,,,,,0.14409,4.62,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,outpatient,1,EA,13.65000,12.97000,The Alliance,Premier,,0.14850,,,,,,,0.14409,13.24,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,outpatient,1,EA,13.11000,12.46000,The Alliance,Premier,,0.14850,,,,,,,0.14409,12.72,fee schedule,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,1052.52,,,,,,,19.62,1052.52,fee schedule,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier,,407.44,,,,,,,7.73,407.44,fee schedule,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,outpatient,5,EA,119.08000,113.13000,The Alliance,Premier,,84.43,,,,,,,59.54,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,outpatient,5,EA,4.55000,4.32000,The Alliance,Premier,,3.23,,,,,,,2.27,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,outpatient,5,EA,4.84000,4.60000,The Alliance,Premier,,3.43,,,,,,,2.42,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,outpatient,5,EA,252.80000,240.16000,The Alliance,Premier,,179.24,,,,,,,126.40,245.22,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,,865.84,,,,,,,16.67,865.84,fee schedule,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,outpatient,1,EA,116.10000,110.29000,The Alliance,Premier,,38.77,,,,,,,37.62,112.62,fee schedule,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,outpatient,1,EA,183.44000,174.27000,The Alliance,Premier,,38.77,,,,,,,37.62,177.94,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,outpatient,10,EA,166.90000,158.56000,The Alliance,Premier,,6.42,,,,,,,3.89,161.89,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,outpatient,10,EA,94.35000,89.64000,The Alliance,Premier,,6.42,,,,,,,3.89,91.52,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,outpatient,10,EA,256.40000,243.58000,The Alliance,Premier,,6.42,,,,,,,3.89,248.71,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,outpatient,10,EA,185.79000,176.50000,The Alliance,Premier,,6.42,,,,,,,3.89,180.22,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,outpatient,10,EA,100.32000,95.31000,The Alliance,Premier,,6.42,,,,,,,3.89,97.31,fee schedule,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,90,492.33,,,,,,,9.61,492.33,fee schedule,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,outpatient,1,GM,11.69000,11.11000,The Alliance,Premier,,8.29,,,,,,,5.84,11.34,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Premier,TC,3299.19,,,,,,,237.50,3299.19,fee schedule,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier,,2082.45,,,,,,,22.34,2082.45,fee schedule,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,outpatient,1,EA,3703.00000,3517.85000,The Alliance,Premier,,71.43,,,,,,,43.29,3591.91,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Premier,,7.32,,,,,,,5.17,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,outpatient,1,EA,7.47000,7.10000,The Alliance,Premier,,5.30,,,,,,,3.73,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier,,2.82,,,,,,,1.99,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,Premier,,4.93,,,,,,,3.48,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,outpatient,1,EA,9.19000,8.73000,The Alliance,Premier,,6.52,,,,,,,4.59,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,outpatient,1,EA,4.67000,4.44000,The Alliance,Premier,,3.31,,,,,,,2.33,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier,,4.62,,,,,,,3.25,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Premier,,6.83,,,,,,,4.82,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Premier,TC,10163.53,,,,,,,580.00,10163.53,fee schedule,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Premier,,2410.69,,,,,,,51.19,2410.69,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,outpatient,1,EA,28.05000,26.64000,The Alliance,Premier,,2.71,,,,,,,2.48,27.21,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,outpatient,1,EA,13.47000,12.80000,The Alliance,Premier,,2.71,,,,,,,2.48,13.07,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier,,2.71,,,,,,,2.48,17.87,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier,,2.71,,,,,,,2.48,15.94,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier,,2.71,,,,,,,2.48,13.79,fee schedule,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,outpatient,0.5,mL,13.90000,13.21000,The Alliance,Premier,,0.36300,,,,,,,0.33945,13.48,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,outpatient,0.5,mL,18.14000,17.23000,The Alliance,Premier,,0.36300,,,,,,,0.33945,17.60,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,outpatient,0.5,mL,9.67000,9.19000,The Alliance,Premier,,0.36300,,,,,,,0.33945,9.38,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,outpatient,0.5,mL,35.83000,34.04000,The Alliance,Premier,,0.36300,,,,,,,0.33945,34.76,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,outpatient,0.5,mL,26.86000,25.52000,The Alliance,Premier,,0.36300,,,,,,,0.33945,26.05,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,outpatient,0.5,mL,25.28000,24.02000,The Alliance,Premier,,0.36300,,,,,,,0.33945,24.52,fee schedule,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,594.19,,,,,,,11.26,594.19,fee schedule,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,outpatient,10,EA,173.44000,164.76000,The Alliance,Premier,,122.97,,,,,,,86.72,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,outpatient,10,EA,142.92000,135.77000,The Alliance,Premier,,101.33,,,,,,,71.46,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,outpatient,10,EA,94.26000,89.55000,The Alliance,Premier,,66.83,,,,,,,47.13,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,outpatient,10,EA,71.43000,67.85000,The Alliance,Premier,,50.64,,,,,,,35.72,340.40,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,outpatient,1,mL,211.33000,200.76000,The Alliance,Premier,,6.42,,,,,,,3.89,204.99,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,6.42,,,,,,,3.89,61.30,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,outpatient,1,mL,165.90000,157.60000,The Alliance,Premier,,6.42,,,,,,,3.89,160.92,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,outpatient,1,mL,259.60000,246.62000,The Alliance,Premier,,6.42,,,,,,,3.89,251.81,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,outpatient,1,mL,187.77000,178.38000,The Alliance,Premier,,6.42,,,,,,,3.89,182.14,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,outpatient,1,mL,188.08000,178.68000,The Alliance,Premier,,6.42,,,,,,,3.89,182.44,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,outpatient,1,mL,101.57000,96.49000,The Alliance,Premier,,6.42,,,,,,,3.89,98.52,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,outpatient,1,mL,124.82000,118.58000,The Alliance,Premier,,6.42,,,,,,,3.89,121.08,fee schedule,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,2088.15,,,,,,,28.92,2088.15,fee schedule,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,outpatient,1,EA,801.42000,761.35000,The Alliance,Premier,,568.21,,,,,,,400.71,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,outpatient,1,EA,483.89000,459.70000,The Alliance,Premier,,343.08,,,,,,,241.94,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,outpatient,1,EA,937.33000,890.47000,The Alliance,Premier,,664.57,,,,,,,468.67,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,outpatient,1,EA,890.47000,845.94000,The Alliance,Premier,,631.34,,,,,,,445.24,863.76,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Premier,,816.06,,,,,,,633.05,3163.00,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,outpatient,,,3081.00000,2926.95000,The Alliance,Premier,,13462.44,,,,,,,257.45,13462.44,fee schedule,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,outpatient,1,EA,8055.92000,7653.13000,The Alliance,Premier,,69.05,,,,,,,41.85,7814.24,fee schedule,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Premier,,2438.99,,,,,,,29.35,2438.99,fee schedule,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,,102.81,,,,,,,79.75,5271.00,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier,,17.80,,,,,,,1.44,17.80,fee schedule,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,outpatient,10,EA,9.15000,8.69000,The Alliance,Premier,,17.80,,,,,,,4.58,17.80,fee schedule,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,outpatient,10,EA,2.40000,2.28000,The Alliance,Premier,,17.80,,,,,,,1.20,17.80,fee schedule,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,outpatient,1,EA,11830.90000,11239.36000,The Alliance,Premier,,69.05,,,,,,,41.85,11475.97,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,outpatient,1,mL,3.81000,3.62000,The Alliance,Premier,,0.36300,,,,,,,0.33945,3.70,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,outpatient,1,mL,9.01000,8.56000,The Alliance,Premier,,0.36300,,,,,,,0.33945,8.74,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,outpatient,1,mL,6.38000,6.06000,The Alliance,Premier,,0.36300,,,,,,,0.33945,6.19,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,outpatient,1,mL,8.10000,7.70000,The Alliance,Premier,,0.36300,,,,,,,0.33945,7.86,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Premier,,0.36300,,,,,,,0.33945,7.97,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,outpatient,1,mL,13.15000,12.49000,The Alliance,Premier,,0.36300,,,,,,,0.33945,12.76,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier,,0.36300,,,,,,,0.33945,3.71,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,outpatient,1,mL,4.27000,4.05000,The Alliance,Premier,,0.36300,,,,,,,0.33945,4.14,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,outpatient,1,mL,10.65000,10.12000,The Alliance,Premier,,0.36300,,,,,,,0.33945,10.33,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,outpatient,1,mL,9.45000,8.98000,The Alliance,Premier,,0.36300,,,,,,,0.33945,9.17,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.82,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,outpatient,1,mL,4.98000,4.73000,The Alliance,Premier,,0.36300,,,,,,,0.33945,4.83,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,outpatient,1,mL,12.17000,11.56000,The Alliance,Premier,,0.36300,,,,,,,0.33945,11.80,fee schedule,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier,,814.87,,,,,,,15.59,814.87,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,outpatient,0.4,EA,241.18000,229.12000,The Alliance,Premier,,0.94050,,,,,,,0.79980,233.94,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,outpatient,0.4,EA,113.78000,108.09000,The Alliance,Premier,,0.94050,,,,,,,0.79980,110.37,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,outpatient,0.4,EA,261.30000,248.24000,The Alliance,Premier,,0.94050,,,,,,,0.79980,253.46,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,outpatient,0.4,EA,47.40000,45.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,outpatient,0.4,EA,26.46000,25.14000,The Alliance,Premier,,0.94050,,,,,,,0.79980,25.67,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,outpatient,0.4,EA,57.90000,55.00000,The Alliance,Premier,,0.94050,,,,,,,0.79980,56.16,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,outpatient,0.4,EA,70.55000,67.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.43,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,outpatient,0.4,EA,86.73000,82.39000,The Alliance,Premier,,0.94050,,,,,,,0.79980,84.13,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,outpatient,0.4,EA,61.62000,58.54000,The Alliance,Premier,,0.94050,,,,,,,0.79980,59.77,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,outpatient,0.4,EA,44.40000,42.18000,The Alliance,Premier,,0.94050,,,,,,,0.79980,43.07,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,outpatient,0.4,EA,62.73000,59.59000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.85,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,outpatient,0.4,EA,31.68000,30.10000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.73,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,outpatient,0.4,EA,29.07000,27.62000,The Alliance,Premier,,0.94050,,,,,,,0.79980,28.20,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,outpatient,0.4,EA,25.09000,23.84000,The Alliance,Premier,,0.94050,,,,,,,0.79980,24.34,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,outpatient,0.4,EA,36.34000,34.52000,The Alliance,Premier,,0.94050,,,,,,,0.79980,35.25,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,outpatient,1,EA,78.48000,74.56000,The Alliance,Premier,,0.94050,,,,,,,0.79980,76.13,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,outpatient,1,EA,67.53000,64.15000,The Alliance,Premier,,0.94050,,,,,,,0.79980,65.50,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,45.98,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,outpatient,1,EA,31.73000,30.14000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.78,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,outpatient,1,EA,62.82000,59.68000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.94,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,outpatient,1,EA,70.63000,67.10000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.51,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Premier,,0.94050,,,,,,,0.79980,20.42,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,outpatient,1,EA,60.99000,57.94000,The Alliance,Premier,,0.94050,,,,,,,0.79980,59.16,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,outpatient,1,EA,27.71000,26.33000,The Alliance,Premier,,0.94050,,,,,,,0.79980,26.88,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier,,0.94050,,,,,,,0.79980,28.57,fee schedule,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,outpatient,28.35,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,outpatient,28.35,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,outpatient,28.35,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,outpatient,28.35,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier,,139.67,,,,,,,98.50,212.44,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,outpatient,1,EA,30.18000,28.68000,The Alliance,Premier,,2.71,,,,,,,2.48,29.27,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,outpatient,1,EA,50.50000,47.97000,The Alliance,Premier,,2.71,,,,,,,2.48,48.98,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,2.71,,,,,,,2.48,33.72,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,2.71,,,,,,,2.48,30.65,fee schedule,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Premier,90,424.40,,,,,,,5.90,424.40,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,outpatient,5,EA,6.78000,6.44000,The Alliance,Premier,,0.14850,,,,,,,0.14409,6.58,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,outpatient,5,EA,5.95000,5.66000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.77,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,outpatient,5,EA,4.35000,4.14000,The Alliance,Premier,,0.14850,,,,,,,0.14409,4.22,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,outpatient,5,EA,8.78000,8.35000,The Alliance,Premier,,0.14850,,,,,,,0.14409,8.52,fee schedule,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,148.18,,,,,,,104.50,212.44,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,outpatient,1,mL,1728.59000,1642.16000,The Alliance,Premier,,1.63,,,,,,,0.99000,1676.73,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,outpatient,1,mL,1728.57000,1642.14000,The Alliance,Premier,,1.63,,,,,,,0.99000,1676.71,fee schedule,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Premier,TC,3038.81,,,,,,,215.60,3038.81,fee schedule,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,outpatient,1,mL,5.66000,5.38000,The Alliance,Premier,,38.77,,,,,,,2.83,40.87,fee schedule,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Premier,TC,3910.35,,,,,,,238.00,3910.35,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,outpatient,1,mL,52.80000,50.16000,The Alliance,Premier,,2.46,,,,,,,1.42,51.22,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,outpatient,1,mL,49.77000,47.28000,The Alliance,Premier,,2.46,,,,,,,1.42,48.28,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,outpatient,20,EA,1.16000,1.10000,The Alliance,Premier,,13.17,,,,,,,0.58000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,outpatient,20,EA,1.10000,1.04000,The Alliance,Premier,,13.17,,,,,,,0.55000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,outpatient,20,EA,1.08000,1.03000,The Alliance,Premier,,13.17,,,,,,,0.54000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Premier,,13.17,,,,,,,0.51000,13.53,fee schedule,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Premier,,248.86,,,,,,,175.50,340.47,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,outpatient,,,839.00000,797.05000,The Alliance,Premier,TC,6479.64,,,,,,,419.50,6479.64,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Premier,,0.36300,,,,,,,0.33945,15.73,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,outpatient,1,EA,6.66000,6.33000,The Alliance,Premier,,0.36300,,,,,,,0.33945,6.46,fee schedule,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier,,708.29,,,,,,,549.45,5271.00,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,outpatient,1,mL,292.42000,277.80000,The Alliance,Premier,,1.88,,,,,,,1.14,283.65,fee schedule,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier,,3666.93,,,,,,,50.62,3666.93,fee schedule,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Premier,90,1273.27,,,,,,,25.18,1273.27,fee schedule,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier,,386.40,,,,,,,299.75,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,outpatient,0.8,EA,261.61000,248.53000,The Alliance,Premier,,0.94050,,,,,,,0.79980,253.76,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,outpatient,0.8,EA,67.52000,64.14000,The Alliance,Premier,,0.94050,,,,,,,0.79980,65.49,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,outpatient,0.8,EA,37.92000,36.02000,The Alliance,Premier,,0.94050,,,,,,,0.79980,36.78,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,outpatient,0.8,EA,31.72000,30.13000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.77,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,outpatient,0.8,EA,62.80000,59.66000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.92,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,outpatient,0.8,EA,70.63000,67.09000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.51,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,outpatient,0.8,EA,235.19000,223.43000,The Alliance,Premier,,0.94050,,,,,,,0.79980,228.13,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,outpatient,0.8,EA,62.41000,59.29000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.54,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,outpatient,0.8,EA,44.40000,42.18000,The Alliance,Premier,,0.94050,,,,,,,0.79980,43.07,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,outpatient,0.8,EA,20.30000,19.28000,The Alliance,Premier,,0.94050,,,,,,,0.79980,19.69,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,outpatient,0.8,EA,29.23000,27.77000,The Alliance,Premier,,0.94050,,,,,,,0.79980,28.35,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,outpatient,0.8,EA,56.88000,54.04000,The Alliance,Premier,,0.94050,,,,,,,0.79980,55.17,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,outpatient,0.8,EA,32.39000,30.77000,The Alliance,Premier,,0.94050,,,,,,,0.79980,31.42,fee schedule,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier,,2.71,,,,,,,2.48,16.43,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,outpatient,1,mL,1720.49000,1634.47000,The Alliance,Premier,,1.63,,,,,,,0.99000,1668.88,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,outpatient,1,mL,1720.50000,1634.48000,The Alliance,Premier,,1.63,,,,,,,0.99000,1668.88,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Premier,,0.82500,,,,,,,0.05000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier,,0.82500,,,,,,,0.10000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Premier,,0.82500,,,,,,,0.13000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Premier,,0.82500,,,,,,,0.05000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,outpatient,100,EA,0.26000,0.24000,The Alliance,Premier,,0.82500,,,,,,,0.13000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier,,0.82500,,,,,,,0.10000,0.82500,fee schedule,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,TC,4266.89,,,,,,,256.50,4266.89,fee schedule,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,outpatient,1,EA,953.25000,905.59000,The Alliance,Premier,,644.72,,,,,,,390.74,924.65,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,outpatient,0.6,EA,261.61000,248.53000,The Alliance,Premier,,0.94050,,,,,,,0.79980,253.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,outpatient,0.6,EA,67.53000,64.16000,The Alliance,Premier,,0.94050,,,,,,,0.79980,65.50,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,outpatient,0.6,EA,47.40000,45.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,outpatient,0.6,EA,31.60000,30.02000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.65,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,outpatient,0.6,EA,62.83000,59.69000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.95,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,outpatient,0.6,EA,70.64000,67.10000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.52,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,outpatient,0.6,EA,62.15000,59.04000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.29,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,outpatient,0.6,EA,28.28000,26.87000,The Alliance,Premier,,0.94050,,,,,,,0.79980,27.43,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,outpatient,0.6,EA,30.65000,29.12000,The Alliance,Premier,,0.94050,,,,,,,0.79980,29.73,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,outpatient,0.6,EA,31.71000,30.12000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,outpatient,0.6,EA,62.82000,59.68000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.94,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,outpatient,0.6,EA,30.55000,29.02000,The Alliance,Premier,,0.94050,,,,,,,0.79980,29.63,fee schedule,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier,TC,6355.04,,,,,,,495.50,6355.04,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,outpatient,0.3,EA,261.31000,248.25000,The Alliance,Premier,,0.94050,,,,,,,0.79980,253.47,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,outpatient,0.3,EA,67.57000,64.19000,The Alliance,Premier,,0.94050,,,,,,,0.79980,65.54,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,outpatient,0.3,EA,47.40000,45.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,outpatient,0.3,EA,21.55000,20.47000,The Alliance,Premier,,0.94050,,,,,,,0.79980,20.90,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,outpatient,0.3,EA,62.88000,59.74000,The Alliance,Premier,,0.94050,,,,,,,0.79980,60.99,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,outpatient,0.3,EA,21.57000,20.49000,The Alliance,Premier,,0.94050,,,,,,,0.79980,20.92,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,outpatient,0.3,EA,102.07000,96.96000,The Alliance,Premier,,0.94050,,,,,,,0.79980,99.01,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,outpatient,0.3,EA,31.71000,30.12000,The Alliance,Premier,,0.94050,,,,,,,0.79980,30.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,outpatient,0.3,EA,29.18000,27.72000,The Alliance,Premier,,0.94050,,,,,,,0.79980,28.30,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,outpatient,0.3,EA,29.17000,27.71000,The Alliance,Premier,,0.94050,,,,,,,0.79980,28.29,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,outpatient,10,EA,0.91000,0.87000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.88270,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.08,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,outpatient,10,EA,1.14000,1.08000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.11,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,outpatient,10,EA,0.56000,0.53000,The Alliance,Premier,,0.36300,,,,,,,0.28000,0.54320,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,outpatient,10,EA,2.30000,2.18000,The Alliance,Premier,,0.36300,,,,,,,0.33945,2.23,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,outpatient,10,EA,0.85000,0.80000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.82450,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,outpatient,10,EA,0.68000,0.64000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.65960,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,outpatient,10,EA,1.18000,1.12000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.14,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,outpatient,10,EA,1.31000,1.24000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.27,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.21,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,outpatient,10,EA,1.56000,1.49000,The Alliance,Premier,,0.36300,,,,,,,0.33945,1.51,fee schedule,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,114.86,,,,,,,67.58,157.14,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Premier,,1.63,,,,,,,0.99000,787.18,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Premier,,1.63,,,,,,,0.99000,787.18,fee schedule,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,outpatient,2,EA,56.10000,53.30000,The Alliance,Premier,,29.75,,,,,,,18.03,54.42,fee schedule,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,outpatient,2,EA,41.90000,39.81000,The Alliance,Premier,,29.75,,,,,,,18.03,40.64,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,outpatient,1,EA,387.20000,367.84000,The Alliance,Premier,,160.17,,,,,,,132.91,375.58,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,outpatient,1,EA,340.20000,323.19000,The Alliance,Premier,,160.17,,,,,,,132.91,329.99,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,outpatient,1,EA,323.19000,307.03000,The Alliance,Premier,,160.17,,,,,,,132.91,313.49,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,outpatient,1,EA,323.18000,307.02000,The Alliance,Premier,,160.17,,,,,,,132.91,313.48,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,outpatient,1,EA,266.10000,252.80000,The Alliance,Premier,,160.17,,,,,,,132.91,258.12,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier,,160.17,,,,,,,7.59,160.17,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,outpatient,1,EA,209.51000,199.03000,The Alliance,Premier,,160.17,,,,,,,104.75,203.22,fee schedule,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,outpatient,1,mL,2.31000,2.19000,The Alliance,Premier,,0.26400,,,,,,,0.19995,2.24,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier,,0.82500,,,,,,,0.05500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.82500,,,,,,,0.10000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.82500,,,,,,,0.12500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.82500,,,,,,,0.06000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.82500,,,,,,,0.12500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.82500,,,,,,,0.05500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.82500,,,,,,,0.10000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,0.82500,,,,,,,0.09000,0.82500,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier,,11.52,,,,,,,6.98,45.98,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,outpatient,1,mL,502.21000,477.10000,The Alliance,Premier,,11.52,,,,,,,6.98,487.14,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Premier,,11.52,,,,,,,6.98,107.28,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,outpatient,1,mL,433.92000,412.22000,The Alliance,Premier,,11.52,,,,,,,6.98,420.90,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,outpatient,1,mL,205.40000,195.13000,The Alliance,Premier,,11.52,,,,,,,6.98,199.24,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,11.52,,,,,,,6.98,61.30,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,outpatient,1,mL,420.23000,399.22000,The Alliance,Premier,,11.52,,,,,,,6.98,407.62,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Premier,,11.52,,,,,,,6.98,251.23,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,outpatient,1,mL,451.99000,429.39000,The Alliance,Premier,,11.52,,,,,,,6.98,438.43,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,outpatient,1,mL,268.60000,255.17000,The Alliance,Premier,,11.52,,,,,,,6.98,260.54,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,outpatient,1,mL,58.46000,55.54000,The Alliance,Premier,,11.52,,,,,,,6.98,56.71,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,outpatient,1,EA,815.41000,774.64000,The Alliance,Premier,,1.63,,,,,,,0.99000,790.95,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,outpatient,1,EA,815.42000,774.65000,The Alliance,Premier,,1.63,,,,,,,0.99000,790.96,fee schedule,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier,,713.01,,,,,,,13.55,713.01,fee schedule,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,outpatient,1,mL,2952.26000,2804.64000,The Alliance,Premier,,96.62,,,,,,,58.56,2863.69,fee schedule,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,outpatient,1,mL,3195.57000,3035.80000,The Alliance,Premier,,96.62,,,,,,,58.56,3099.70,fee schedule,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier,,54.45,,,,,,,33.00,783.52,fee schedule,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,outpatient,,,830.00000,788.50000,The Alliance,Premier,TC,4895.01,,,,,,,370.62,4895.01,fee schedule,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,outpatient,1,EA,250.17000,237.66000,The Alliance,Premier,,177.37,,,,,,,7.86,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,outpatient,1,EA,295.08000,280.33000,The Alliance,Premier,,209.21,,,,,,,7.86,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,outpatient,1,EA,351.81000,334.22000,The Alliance,Premier,,249.43,,,,,,,7.86,341.26,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,outpatient,1,EA,321.74000,305.65000,The Alliance,Premier,,0.94050,,,,,,,0.79980,312.09,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,outpatient,1,EA,101.28000,96.21000,The Alliance,Premier,,0.94050,,,,,,,0.79980,98.24,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.97,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,outpatient,1,EA,94.20000,89.49000,The Alliance,Premier,,0.94050,,,,,,,0.79980,91.37,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,outpatient,1,EA,92.59000,87.96000,The Alliance,Premier,,0.94050,,,,,,,0.79980,89.81,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,outpatient,1,EA,47.59000,45.21000,The Alliance,Premier,,0.94050,,,,,,,0.79980,46.16,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Premier,,0.94050,,,,,,,0.79980,42.79,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,outpatient,1,EA,105.99000,100.69000,The Alliance,Premier,,0.94050,,,,,,,0.79980,102.81,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Premier,,0.94050,,,,,,,0.79980,53.64,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,outpatient,10,EA,0.59000,0.56000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.57230,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,outpatient,10,EA,0.70000,0.66000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.67900,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,outpatient,10,EA,0.04000,0.03000,The Alliance,Premier,,0.26400,,,,,,,0.02000,0.26400,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.75,fee schedule,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,outpatient,1,mL,669.00000,635.55000,The Alliance,Premier,,107.68,,,,,,,65.26,648.93,fee schedule,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,outpatient,1,mL,507.12000,481.77000,The Alliance,Premier,,107.68,,,,,,,65.26,491.91,fee schedule,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier,,109.19,,,,,,,84.70,5271.00,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,outpatient,2,EA,1.82000,1.73000,The Alliance,Premier,,0.82500,,,,,,,0.76570,1.77,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,outpatient,2,EA,2.50000,2.37000,The Alliance,Premier,,0.82500,,,,,,,0.76570,2.42,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,outpatient,2,EA,1.77000,1.68000,The Alliance,Premier,,0.82500,,,,,,,0.76570,1.72,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,outpatient,2,EA,1.90000,1.80000,The Alliance,Premier,,0.82500,,,,,,,0.76570,1.84,fee schedule,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,outpatient,2,EA,26.78000,25.44000,The Alliance,Premier,,18.99,,,,,,,13.39,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,outpatient,2,EA,49.77000,47.28000,The Alliance,Premier,,35.29,,,,,,,14.28,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,outpatient,2,EA,49.53000,47.06000,The Alliance,Premier,,35.12,,,,,,,14.28,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,outpatient,2,EA,24.89000,23.64000,The Alliance,Premier,,17.65,,,,,,,12.45,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,outpatient,2,EA,52.14000,49.53000,The Alliance,Premier,,36.97,,,,,,,14.28,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,outpatient,2,EA,20.48000,19.45000,The Alliance,Premier,,14.52,,,,,,,10.24,19.87,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,outpatient,5,EA,0.64000,0.61000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.62080,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,outpatient,5,EA,0.61000,0.58000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.59170,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,outpatient,5,EA,0.88000,0.83000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.85360,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,outpatient,5,EA,1.79000,1.71000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.74,fee schedule,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier,,67.98,,,,,,,64.92,178.48,fee schedule,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,outpatient,1,mL,137.46000,130.59000,The Alliance,Premier,,16.05,,,,,,,9.73,133.34,fee schedule,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,0.82500,,,,,,,0.29500,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier,,0.82500,,,,,,,0.62000,1.20,fee schedule,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,outpatient,1,EA,2685.99000,2551.69000,The Alliance,Premier,,51.45,,,,,,,31.18,2605.41,fee schedule,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,outpatient,1,EA,1230.25000,1168.74000,The Alliance,Premier,,51.45,,,,,,,31.18,1193.34,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,outpatient,100,EA,0.11000,0.11000,The Alliance,Premier,,0.28050,,,,,,,0.05500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Premier,,0.28050,,,,,,,0.08000,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,outpatient,100,EA,0.17000,0.16000,The Alliance,Premier,,0.28050,,,,,,,0.08500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,outpatient,10,EA,0.94000,0.89000,The Alliance,Premier,,0.28050,,,,,,,0.27217,0.91180,fee schedule,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,outpatient,10,EA,0.55000,0.53000,The Alliance,Premier,,0.28050,,,,,,,0.27217,0.53350,fee schedule,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,outpatient,1,mL,22.86000,21.72000,The Alliance,Premier,,16.21,,,,,,,1.49,22.17,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,outpatient,1,mL,0.02000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,outpatient,,,403.00000,382.85000,The Alliance,Premier,,285.73,,,,,,,221.65,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,outpatient,0.8,EA,117.76000,111.87000,The Alliance,Premier,,0.94050,,,,,,,0.79980,114.23,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,outpatient,0.8,EA,101.27000,96.21000,The Alliance,Premier,,0.94050,,,,,,,0.79980,98.23,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,outpatient,0.8,EA,71.10000,67.54000,The Alliance,Premier,,0.94050,,,,,,,0.79980,68.97,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,outpatient,0.8,EA,94.21000,89.50000,The Alliance,Premier,,0.94050,,,,,,,0.79980,91.38,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,outpatient,0.8,EA,289.24000,274.78000,The Alliance,Premier,,0.94050,,,,,,,0.79980,280.56,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,outpatient,0.8,EA,93.61000,88.93000,The Alliance,Premier,,0.94050,,,,,,,0.79980,90.80,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,outpatient,0.8,EA,47.60000,45.22000,The Alliance,Premier,,0.94050,,,,,,,0.79980,46.17,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,outpatient,0.8,EA,43.81000,41.62000,The Alliance,Premier,,0.94050,,,,,,,0.79980,42.50,fee schedule,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,outpatient,20,EA,0.80000,0.76000,The Alliance,Premier,,0.28050,,,,,,,0.27217,0.77600,fee schedule,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,outpatient,20,EA,0.36000,0.35000,The Alliance,Premier,,0.28050,,,,,,,0.18000,0.34920,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.41,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.99910,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.84390,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,outpatient,1,mL,1.80000,1.71000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.75,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,outpatient,1,mL,0.74000,0.71000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.71780,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,0.26400,,,,,,,0.19995,24.52,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,outpatient,10,EA,2.14000,2.03000,The Alliance,Premier,,0.26400,,,,,,,0.19995,2.08,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,outpatient,10,EA,2.18000,2.07000,The Alliance,Premier,,0.26400,,,,,,,0.19995,2.11,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,outpatient,10,EA,3.65000,3.46000,The Alliance,Premier,,0.26400,,,,,,,0.19995,3.54,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,outpatient,10,EA,1.69000,1.61000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.64,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,outpatient,10,EA,1.86000,1.77000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.80,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,outpatient,10,EA,2.91000,2.76000,The Alliance,Premier,,0.26400,,,,,,,0.19995,2.82,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,outpatient,10,EA,8.76000,8.32000,The Alliance,Premier,,0.26400,,,,,,,0.19995,8.50,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,outpatient,10,EA,0.54000,0.51000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.52380,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,outpatient,1,EA,11.45000,10.87000,The Alliance,Premier,,5.79,,,,,,,4.77,11.11,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Premier,,5.79,,,,,,,4.77,11.00,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,outpatient,1,EA,19.55000,18.57000,The Alliance,Premier,,5.79,,,,,,,4.77,18.96,fee schedule,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,outpatient,1,EA,50.02000,47.52000,The Alliance,Premier,,35.46,,,,,,,14.28,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,outpatient,1,EA,49.26000,46.80000,The Alliance,Premier,,34.93,,,,,,,14.28,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,outpatient,1,EA,48.79000,46.35000,The Alliance,Premier,,34.59,,,,,,,14.28,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,14.28,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,outpatient,1,EA,41.38000,39.31000,The Alliance,Premier,,29.34,,,,,,,14.28,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,outpatient,1,EA,47.98000,45.58000,The Alliance,Premier,,34.02,,,,,,,14.28,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,outpatient,1,EA,34.71000,32.97000,The Alliance,Premier,,24.61,,,,,,,14.28,33.67,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,outpatient,2,EA,2.14000,2.04000,The Alliance,Premier,,0.26400,,,,,,,0.19995,2.08,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,outpatient,2,EA,1.47000,1.40000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.43,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,outpatient,2,EA,1.43000,1.36000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.39,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,outpatient,2,EA,1.98000,1.88000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.92,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,outpatient,2,EA,61.91000,58.82000,The Alliance,Premier,,28.50,,,,,,,25.99,60.05,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,outpatient,2,EA,94.80000,90.06000,The Alliance,Premier,,28.50,,,,,,,25.99,91.96,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,outpatient,2,EA,74.26000,70.55000,The Alliance,Premier,,28.50,,,,,,,25.99,72.03,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,outpatient,2,EA,86.90000,82.56000,The Alliance,Premier,,28.50,,,,,,,25.99,84.29,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,outpatient,2,EA,184.58000,175.35000,The Alliance,Premier,,28.50,,,,,,,25.99,179.04,fee schedule,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,outpatient,1,EA,1642.06000,1559.96000,The Alliance,Premier,,10.72,,,,,,,6.50,1592.80,fee schedule,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,outpatient,1,EA,1556.59000,1478.76000,The Alliance,Premier,,10.72,,,,,,,6.50,1509.89,fee schedule,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier,,13.17,,,,,,,0.25000,13.53,fee schedule,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,13.17,,,,,,,0.09000,13.53,fee schedule,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier,,4498.77,,,,,,,95.80,4498.77,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,outpatient,30,EA,0.66000,0.62000,The Alliance,Premier,,0.36300,,,,,,,0.33000,0.64020,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Premier,,0.36300,,,,,,,0.30500,0.59170,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.69840,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,outpatient,30,EA,0.75000,0.71000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.72750,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,outpatient,30,EA,0.77000,0.73000,The Alliance,Premier,,0.36300,,,,,,,0.33945,0.74690,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Premier,,0.36300,,,,,,,0.30500,0.59170,fee schedule,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,outpatient,1,mL,14.09000,13.39000,The Alliance,Premier,,9.99,,,,,,,1.49,13.67,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,outpatient,1,EA,2916.40000,2770.58000,The Alliance,Premier,,10.72,,,,,,,6.50,2828.91,fee schedule,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Premier,,3963.00,,,,,,,515.90,4686.00,case rate,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier,,177.96,,,,,,,125.50,419.70,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Premier,,11405.00,,,,,,,1071.95,16988.00,case rate,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.50440,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.30070,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.36860,fee schedule,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,outpatient,3,EA,46.99000,44.64000,The Alliance,Premier,,33.32,,,,,,,1.49,45.58,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Premier,TC,2467.32,,,,,,,1609.99,3375.60,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Premier,,22.01,,,,,,,13.34,1564.21,fee schedule,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,45.38,,,,,,,32.00,134.64,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,outpatient,1,mL,1294.64000,1229.91000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1255.80,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,outpatient,1,mL,1215.93000,1155.13000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1179.45,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,outpatient,1,mL,1294.63000,1229.90000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1255.79,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,outpatient,1,mL,1544.61000,1467.38000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1498.27,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,outpatient,1,mL,1544.29000,1467.07000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1497.96,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,outpatient,5,EA,6.69000,6.35000,The Alliance,Premier,,2.71,,,,,,,2.17,6.49,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,outpatient,5,EA,4.17000,3.96000,The Alliance,Premier,,2.71,,,,,,,2.08,4.04,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,outpatient,5,EA,3.69000,3.50000,The Alliance,Premier,,2.71,,,,,,,1.84,3.58,fee schedule,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,outpatient,10,EA,26.99000,25.64000,The Alliance,Premier,,19.14,,,,,,,1.49,26.18,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,outpatient,1,EA,8.99000,8.54000,The Alliance,Premier,,6.37,,,,,,,4.50,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,outpatient,1,mL,1294.27000,1229.56000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1255.44,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,outpatient,1,mL,1275.16000,1211.40000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1236.91,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,outpatient,1,mL,1294.29000,1229.58000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1255.46,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,outpatient,1,mL,1551.93000,1474.33000,The Alliance,Premier,,0.49500,,,,,,,0.30000,1505.37,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,outpatient,50,EA,0.28000,0.27000,The Alliance,Premier,,0.82500,,,,,,,0.14000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier,,0.82500,,,,,,,0.40000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,outpatient,50,EA,1.02000,0.97000,The Alliance,Premier,,0.82500,,,,,,,0.51000,0.98940,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,outpatient,50,EA,1.06000,1.01000,The Alliance,Premier,,0.82500,,,,,,,0.53000,1.03,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Premier,,0.82500,,,,,,,0.21500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,outpatient,50,EA,1.01000,0.96000,The Alliance,Premier,,0.82500,,,,,,,0.50500,0.97970,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Premier,,0.82500,,,,,,,0.30500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier,,0.82500,,,,,,,0.40000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,outpatient,50,EA,0.79000,0.75000,The Alliance,Premier,,0.82500,,,,,,,0.39500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,outpatient,50,EA,0.33000,0.31000,The Alliance,Premier,,0.82500,,,,,,,0.16500,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,outpatient,1,mL,5.23000,4.97000,The Alliance,Premier,,0.82500,,,,,,,0.76570,5.07,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier,,0.82500,,,,,,,0.35000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,outpatient,1,mL,0.69000,0.65000,The Alliance,Premier,,0.82500,,,,,,,0.34500,0.82500,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,558.11000,530.20000,The Alliance,Premier,,263.99,,,,,,,256.17,558.11,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,937.00,,,,,,,59.40,3163.00,case rate,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,outpatient,,,635.00000,603.25000,The Alliance,Premier,,450.21,,,,,,,288.84,615.95,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,outpatient,1,mL,1885.86000,1791.57000,The Alliance,Premier,,302.63,,,,,,,183.41,1829.28,fee schedule,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,outpatient,3,EA,14.09000,13.39000,The Alliance,Premier,,9.99,,,,,,,1.49,13.67,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier,,1103.49,,,,,,,21.26,1103.49,fee schedule,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,outpatient,10,EA,22.86000,21.72000,The Alliance,Premier,,16.21,,,,,,,1.49,22.17,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Premier,,10.00,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier,,10.80,,,,,,,1.49,14.77,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,outpatient,,,248.60000,236.17000,The Alliance,Premier,90,1120.45,,,,,,,22.12,1120.45,fee schedule,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier,,1.43,,,,,,,1.00,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Premier,,2.13,,,,,,,1.50,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier,,1.95,,,,,,,1.38,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.12,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier,,2.27,,,,,,,1.60,3.10,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,outpatient,1,mL,23.59000,22.41000,The Alliance,Premier,,2.31,,,,,,,2.24,22.88,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier,,2.31,,,,,,,2.24,12.26,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,outpatient,1,mL,19.38000,18.41000,The Alliance,Premier,,2.31,,,,,,,2.24,18.80,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Premier,,2.31,,,,,,,2.24,21.64,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,outpatient,1,mL,16.43000,15.61000,The Alliance,Premier,,2.31,,,,,,,2.24,15.94,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,outpatient,1,mL,19.00000,18.05000,The Alliance,Premier,,2.31,,,,,,,2.24,18.43,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,2.31,,,,,,,2.21,4.29,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,outpatient,1,mL,12.56000,11.93000,The Alliance,Premier,,2.31,,,,,,,2.24,12.18,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,outpatient,1,mL,21.49000,20.41000,The Alliance,Premier,,2.31,,,,,,,2.24,20.85,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,outpatient,2,EA,0.29000,0.28000,The Alliance,Premier,,0.64350,,,,,,,0.14500,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,outpatient,2,EA,0.22000,0.21000,The Alliance,Premier,,0.64350,,,,,,,0.11000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,outpatient,2,EA,0.32000,0.30000,The Alliance,Premier,,0.64350,,,,,,,0.16000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,outpatient,2,EA,0.38000,0.36000,The Alliance,Premier,,0.64350,,,,,,,0.19000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,outpatient,2,EA,0.51000,0.48000,The Alliance,Premier,,0.64350,,,,,,,0.25500,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,outpatient,2,EA,0.39000,0.37000,The Alliance,Premier,,0.64350,,,,,,,0.19500,0.64350,fee schedule,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,outpatient,1,mL,362.60000,344.47000,The Alliance,Premier,,257.08,,,,,,,7.86,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,outpatient,1,mL,325.82000,309.53000,The Alliance,Premier,,231.01,,,,,,,7.86,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,outpatient,1,mL,577.02000,548.17000,The Alliance,Premier,,409.11,,,,,,,7.86,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,outpatient,1,mL,458.13000,435.23000,The Alliance,Premier,,324.81,,,,,,,7.86,444.39,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier,,54.45,,,,,,,33.00,783.52,fee schedule,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,outpatient,1,EA,6883.45000,6539.28000,The Alliance,Premier,,51.69,,,,,,,31.33,6676.95,fee schedule,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,outpatient,1,EA,7635.88000,7254.08000,The Alliance,Premier,,51.69,,,,,,,31.33,7406.80,fee schedule,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,115.57,,,,,,,56.40,158.11,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,outpatient,,,552.00000,524.40000,The Alliance,Premier,,391.37,,,,,,,303.60,5271.00,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,outpatient,10,EA,4.27000,4.05000,The Alliance,Premier,,0.36300,,,,,,,0.33945,4.14,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,outpatient,10,EA,16.43000,15.61000,The Alliance,Premier,,0.36300,,,,,,,0.33945,15.94,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,outpatient,10,EA,20.84000,19.80000,The Alliance,Premier,,0.36300,,,,,,,0.33945,20.21,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,outpatient,10,EA,18.64000,17.71000,The Alliance,Premier,,0.36300,,,,,,,0.33945,18.08,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Premier,,0.36300,,,,,,,0.33945,14.56,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,outpatient,10,EA,13.43000,12.76000,The Alliance,Premier,,0.36300,,,,,,,0.33945,13.03,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,outpatient,10,EA,19.09000,18.14000,The Alliance,Premier,,0.36300,,,,,,,0.33945,18.52,fee schedule,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,outpatient,5,EA,927.28000,880.91000,The Alliance,Premier,,657.44,,,,,,,463.64,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,outpatient,5,EA,30.66000,29.13000,The Alliance,Premier,,21.74,,,,,,,15.33,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,outpatient,5,EA,118.23000,112.32000,The Alliance,Premier,,83.83,,,,,,,59.12,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,outpatient,5,EA,310.80000,295.26000,The Alliance,Premier,,220.36,,,,,,,155.40,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,outpatient,5,EA,88.48000,84.06000,The Alliance,Premier,,62.73,,,,,,,44.24,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,outpatient,5,EA,673.40000,639.73000,The Alliance,Premier,,477.44,,,,,,,336.70,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,outpatient,5,EA,151.68000,144.10000,The Alliance,Premier,,107.54,,,,,,,75.84,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,outpatient,5,EA,569.80000,541.31000,The Alliance,Premier,,403.99,,,,,,,284.90,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,outpatient,5,EA,44.24000,42.03000,The Alliance,Premier,,31.37,,,,,,,22.12,42.91,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,96.42,,,,,,,68.00,131.92,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.36300,,,,,,,0.01000,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.36300,,,,,,,0.01500,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.36300,,,,,,,0.02000,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.36300,,,,,,,0.01500,0.36520,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.82500,,,,,,,0.02000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier,,0.82500,,,,,,,0.02000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.82500,,,,,,,0.02000,0.82500,fee schedule,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier,,1.69,,,,,,,1.20,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier,,1.56,,,,,,,1.10,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,outpatient,,,163.90000,155.70000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,outpatient,1,mL,23.97000,22.77000,The Alliance,Premier,,2.31,,,,,,,2.24,23.25,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,outpatient,1,mL,23.98000,22.79000,The Alliance,Premier,,2.31,,,,,,,2.24,23.26,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,outpatient,1,mL,23.26000,22.09000,The Alliance,Premier,,2.31,,,,,,,2.24,22.56,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,outpatient,1,mL,27.13000,25.77000,The Alliance,Premier,,2.31,,,,,,,2.24,26.32,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,outpatient,1,mL,34.13000,32.42000,The Alliance,Premier,,2.31,,,,,,,2.24,33.11,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,outpatient,1,mL,22.97000,21.82000,The Alliance,Premier,,2.31,,,,,,,2.24,22.28,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,outpatient,1,mL,19.50000,18.52000,The Alliance,Premier,,2.31,,,,,,,2.24,18.91,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,2.31,,,,,,,2.24,24.52,fee schedule,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Premier,,4.44,,,,,,,3.13,6.07,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,outpatient,1,mL,2209.91000,2099.41000,The Alliance,Premier,,302.63,,,,,,,183.41,2143.61,fee schedule,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,outpatient,1,EA,3.06000,2.91000,The Alliance,Premier,,2.17,,,,,,,1.53,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,outpatient,1,EA,3.05000,2.89000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,outpatient,1,EA,3.04000,2.88000,The Alliance,Premier,,2.16,,,,,,,1.52,2.95,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,outpatient,10,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,outpatient,10,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,outpatient,10,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,outpatient,10,EA,1.68000,1.59000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,outpatient,10,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,outpatient,10,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier,,2.31,,,,,,,1.63,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,outpatient,0.6,EA,20323.63000,19307.45000,The Alliance,Premier,,96.36,,,,,,,30.97,19713.92,fee schedule,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.84,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,outpatient,1,EA,6.04000,5.73000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.86,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,outpatient,1,EA,9.51000,9.03000,The Alliance,Premier,,0.57750,,,,,,,0.33000,9.22,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Premier,,0.57750,,,,,,,0.33000,4.55,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.25,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,0.57750,,,,,,,0.33000,1.66,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Premier,,0.57750,,,,,,,0.33000,10.36,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.22,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.52,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier,,0.57750,,,,,,,0.33000,11.49,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,0.57750,,,,,,,0.33000,2.42,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,0.57750,,,,,,,0.33000,4.29,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.71,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.73,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.01,fee schedule,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,outpatient,5,EA,38.69000,36.76000,The Alliance,Premier,,0.36300,,,,,,,0.35222,37.53,fee schedule,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,outpatient,5,EA,23.26000,22.09000,The Alliance,Premier,,0.36300,,,,,,,0.35222,22.56,fee schedule,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,,87.92,,,,,,,43.81,120.28,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier,,104.22,,,,,,,43.81,142.59,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,outpatient,1,EA,115.64000,109.85000,The Alliance,Premier,,81.99,,,,,,,57.82,112.17,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,outpatient,3,EA,20.98000,19.93000,The Alliance,Premier,,14.87,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,outpatient,3,EA,41.32000,39.26000,The Alliance,Premier,,29.30,,,,,,,1.49,40.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,outpatient,20,EA,1.11000,1.05000,The Alliance,Premier,,0.64350,,,,,,,0.55500,1.08,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,outpatient,20,EA,0.63000,0.59000,The Alliance,Premier,,0.64350,,,,,,,0.31500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier,,0.64350,,,,,,,0.26500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,outpatient,20,EA,3.95000,3.75000,The Alliance,Premier,,0.64350,,,,,,,0.62439,3.83,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,outpatient,20,EA,0.32000,0.30000,The Alliance,Premier,,0.64350,,,,,,,0.16000,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,outpatient,20,EA,0.33000,0.32000,The Alliance,Premier,,0.64350,,,,,,,0.16500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,outpatient,20,EA,1.74000,1.65000,The Alliance,Premier,,0.64350,,,,,,,0.62439,1.69,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Premier,,0.64350,,,,,,,0.39500,0.76630,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,outpatient,20,EA,1.26000,1.20000,The Alliance,Premier,,0.64350,,,,,,,0.62439,1.22,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,outpatient,20,EA,0.99000,0.94000,The Alliance,Premier,,0.64350,,,,,,,0.49500,0.96030,fee schedule,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier,,154.56,,,,,,,109.00,211.46,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,outpatient,10,EA,20.31000,19.29000,The Alliance,Premier,,14.40,,,,,,,1.49,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,outpatient,10,EA,89.60000,85.12000,The Alliance,Premier,,63.53,,,,,,,1.49,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,outpatient,10,EA,35.84000,34.05000,The Alliance,Premier,,25.41,,,,,,,1.49,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,outpatient,10,EA,31.17000,29.61000,The Alliance,Premier,,22.10,,,,,,,1.49,30.23,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,outpatient,1,EA,2.49000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Premier,,1.99,,,,,,,1.40,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier,,1.01,,,,,,,0.71500,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,60.27,,,,,,,42.50,82.45,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier,,36.40,,,,,,,5.00,36.40,fee schedule,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,outpatient,1,EA,16466.50000,15643.18000,The Alliance,Premier,,36.40,,,,,,,22.06,15972.50,fee schedule,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,Premier,,937.00,,,,,,,230.94,3163.00,case rate,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier,,142.51,,,,,,,67.58,194.97,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier,,628.12,,,,,,,12.11,628.12,fee schedule,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier,,594.19,,,,,,,11.43,594.19,fee schedule,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,43.81,97.00,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,outpatient,1,mL,20323.63000,19307.45000,The Alliance,Premier,,96.36,,,,,,,30.97,19713.92,fee schedule,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Premier,,16444.87,,,,,,,162.71,16444.87,fee schedule,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Premier,TC,943.68,,,,,,,644.24,2960.49,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,458.40,,,,,,,8.74,458.40,fee schedule,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,outpatient,,,317.00000,301.15000,The Alliance,Premier,,224.75,,,,,,,158.50,307.49,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,Premier,,534.59,,,,,,,414.70,5271.00,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,outpatient,2.5,EA,179.56000,170.58000,The Alliance,Premier,,127.31,,,,,,,89.78,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,outpatient,2.5,EA,273.80000,260.11000,The Alliance,Premier,,194.12,,,,,,,136.90,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,outpatient,2.5,EA,15.17000,14.41000,The Alliance,Premier,,10.76,,,,,,,7.58,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,outpatient,2.5,EA,19.66000,18.67000,The Alliance,Premier,,13.94,,,,,,,9.83,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,outpatient,2.5,EA,22.75000,21.61000,The Alliance,Premier,,16.13,,,,,,,11.38,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,outpatient,2.5,EA,13.13000,12.48000,The Alliance,Premier,,9.31,,,,,,,6.57,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,outpatient,2.5,EA,13.52000,12.85000,The Alliance,Premier,,9.59,,,,,,,6.76,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,outpatient,2.5,EA,16.94000,16.09000,The Alliance,Premier,,12.01,,,,,,,8.47,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,outpatient,2.5,EA,6.26000,5.94000,The Alliance,Premier,,4.44,,,,,,,3.13,6.07,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,220.68,,,,,,,4.27,220.68,fee schedule,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,424.40,,,,,,,8.17,424.40,fee schedule,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,Premier,,265.17,,,,,,,187.00,362.78,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,outpatient,2,EA,5.17000,4.91000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.01,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,outpatient,2,EA,8.90000,8.45000,The Alliance,Premier,,0.57750,,,,,,,0.33000,8.63,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,outpatient,2,EA,11.36000,10.79000,The Alliance,Premier,,0.57750,,,,,,,0.33000,11.02,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,outpatient,2,EA,1.63000,1.55000,The Alliance,Premier,,0.57750,,,,,,,0.33000,1.58,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.07,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,outpatient,2,EA,2.24000,2.13000,The Alliance,Premier,,0.57750,,,,,,,0.33000,2.17,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier,,0.57750,,,,,,,0.33000,1.90,fee schedule,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,outpatient,,,1064.00000,1010.80000,The Alliance,Premier,90,4787.38,,,,,,,94.71,4787.38,fee schedule,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Premier,,87.61,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,outpatient,1,EA,6.12000,5.82000,The Alliance,Premier,,4.34,,,,,,,3.06,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier,,11.80,,,,,,,8.32,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,Premier,,5.74,,,,,,,4.04,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,outpatient,,,1733.00000,1646.35000,The Alliance,Premier,TC,1228.70,,,,,,,811.39,2210.07,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier,,320.47,,,,,,,200.06,438.44,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,outpatient,1,EA,73.95000,70.25000,The Alliance,Premier,,52.43,,,,,,,36.98,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,outpatient,1,EA,1114.87000,1059.12000,The Alliance,Premier,,790.44,,,,,,,557.43,1081.42,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Premier,TC,1527.89,,,,,,,1006.74,2960.49,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,outpatient,4,EA,7.18000,6.82000,The Alliance,Premier,,0.64350,,,,,,,0.62439,6.96,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,outpatient,4,EA,3.33000,3.17000,The Alliance,Premier,,0.64350,,,,,,,0.62439,3.23,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,outpatient,4,EA,2.15000,2.04000,The Alliance,Premier,,0.64350,,,,,,,0.62439,2.09,fee schedule,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,75.15,,,,,,,53.00,102.82,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,outpatient,1,EA,9777.53000,9288.66000,The Alliance,Premier,,2866.22,,,,,,,1737.10,9484.20,fee schedule,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier,,7.82,,,,,,,5.51,10.70,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,outpatient,,,181.10000,172.04000,The Alliance,Premier,90,797.91,,,,,,,15.81,797.91,fee schedule,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Premier,,11405.00,,,,,,,1071.95,16988.00,case rate,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,outpatient,1,mL,5.25000,4.98000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,outpatient,1,mL,5.18000,4.92000,The Alliance,Premier,,3.67,,,,,,,2.59,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,outpatient,1,mL,6.24000,5.93000,The Alliance,Premier,,4.42,,,,,,,3.12,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier,90,1018.59,,,,,,,16.82,1018.59,fee schedule,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,outpatient,1,EA,43.58000,41.40000,The Alliance,Premier,,30.90,,,,,,,21.79,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,outpatient,1,EA,47.47000,45.10000,The Alliance,Premier,,33.66,,,,,,,23.73,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,outpatient,1,EA,19.63000,18.64000,The Alliance,Premier,,13.92,,,,,,,9.81,19.04,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,outpatient,1,EA,82.16000,78.05000,The Alliance,Premier,,6.52,,,,,,,5.45,79.70,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,outpatient,1,EA,59.88000,56.89000,The Alliance,Premier,,6.52,,,,,,,5.45,58.08,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Premier,,6.52,,,,,,,5.45,214.56,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,outpatient,1,EA,55.62000,52.84000,The Alliance,Premier,,6.52,,,,,,,5.45,53.95,fee schedule,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,outpatient,1,EA,1.83000,1.73000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,outpatient,1,EA,2.94000,2.80000,The Alliance,Premier,,2.08,,,,,,,1.47,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,442.00000,419.90000,The Alliance,Premier,,313.38,,,,,,,172.82,489.94,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.36,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Premier,,0.57750,,,,,,,0.33000,11.15,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,outpatient,1,EA,20.63000,19.60000,The Alliance,Premier,,0.57750,,,,,,,0.33000,20.01,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.57750,,,,,,,0.33000,4.85,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.46,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier,,0.57750,,,,,,,0.33000,13.79,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier,,0.57750,,,,,,,0.33000,5.82,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,0.57750,,,,,,,0.33000,15.33,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier,,0.57750,,,,,,,0.33000,2.67,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,0.57750,,,,,,,0.33000,4.78,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier,,0.57750,,,,,,,0.33000,4.07,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Premier,,0.57750,,,,,,,0.33000,3.43,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier,,0.57750,,,,,,,0.33000,10.42,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,6.52,,,,,,,5.45,30.65,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,outpatient,1,EA,75.84000,72.05000,The Alliance,Premier,,6.52,,,,,,,5.45,73.56,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,6.52,,,,,,,5.45,122.61,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Premier,,6.52,,,,,,,5.45,47.20,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,outpatient,1,EA,72.87000,69.23000,The Alliance,Premier,,6.52,,,,,,,5.45,70.68,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Premier,,6.52,,,,,,,5.45,64.55,fee schedule,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,outpatient,1,mL,39.50000,37.52000,The Alliance,Premier,,28.01,,,,,,,19.75,38.31,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,outpatient,1,EA,11651.31000,11068.75000,The Alliance,Premier,,256.44,,,,,,,155.42,11301.77,fee schedule,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,560.26,,,,,,,11.57,560.26,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Premier,,3.23,,,,,,,0.03500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Premier,,3.23,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,3.23,,,,,,,0.09500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,outpatient,100,EA,0.18000,0.17000,The Alliance,Premier,,3.23,,,,,,,0.09000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Premier,,3.23,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,3.23,,,,,,,0.09500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Premier,,3.23,,,,,,,0.17500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Premier,,3.23,,,,,,,0.08000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,outpatient,100,EA,0.40000,0.38000,The Alliance,Premier,,3.23,,,,,,,0.20000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,outpatient,100,EA,0.66000,0.63000,The Alliance,Premier,,3.23,,,,,,,0.33000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier,,3.23,,,,,,,0.10000,3.23,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,outpatient,1,EA,298.62000,283.69000,The Alliance,Premier,,12.71,,,,,,,11.25,289.66,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,outpatient,1,EA,273.45000,259.78000,The Alliance,Premier,,12.71,,,,,,,11.25,265.25,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,outpatient,1,EA,290.12000,275.61000,The Alliance,Premier,,12.71,,,,,,,11.25,281.42,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,outpatient,1,EA,322.97000,306.82000,The Alliance,Premier,,12.71,,,,,,,11.25,313.28,fee schedule,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,outpatient,1,EA,23303.03000,22137.87000,The Alliance,Premier,,256.44,,,,,,,155.42,22603.94,fee schedule,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,outpatient,30,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,outpatient,30,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,outpatient,30,EA,4.79000,4.55000,The Alliance,Premier,,3.40,,,,,,,2.40,4.65,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,90,848.80,,,,,,,16.84,848.80,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Premier,,6.52,,,,,,,5.45,49.04,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,6.52,,,,,,,5.45,61.30,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Premier,,6.52,,,,,,,5.45,26.98,fee schedule,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier,,263.04,,,,,,,185.50,359.87,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,outpatient,1,EA,46.10000,43.80000,The Alliance,Premier,,32.68,,,,,,,23.05,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,322.54,,,,,,,6.04,322.54,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,outpatient,40,EA,1.04000,0.98000,The Alliance,Premier,,0.64350,,,,,,,0.52000,1.01,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,outpatient,40,EA,0.53000,0.50000,The Alliance,Premier,,0.64350,,,,,,,0.26500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,outpatient,40,EA,0.54000,0.51000,The Alliance,Premier,,0.64350,,,,,,,0.27000,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,outpatient,40,EA,3.75000,3.56000,The Alliance,Premier,,0.64350,,,,,,,0.62439,3.64,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,outpatient,40,EA,0.37000,0.35000,The Alliance,Premier,,0.64350,,,,,,,0.18500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,outpatient,40,EA,1.98000,1.88000,The Alliance,Premier,,0.64350,,,,,,,0.62439,1.92,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,outpatient,40,EA,0.32000,0.30000,The Alliance,Premier,,0.64350,,,,,,,0.16000,0.69720,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,outpatient,1,EA,248.72000,236.29000,The Alliance,Premier,,6.52,,,,,,,5.45,241.26,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,outpatient,1,EA,272.36000,258.74000,The Alliance,Premier,,6.52,,,,,,,5.45,264.19,fee schedule,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,135.79,,,,,,,2.54,135.79,fee schedule,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,outpatient,1,EA,62.02000,58.92000,The Alliance,Premier,,43.97,,,,,,,31.01,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,outpatient,1,EA,94.91000,90.17000,The Alliance,Premier,,67.29,,,,,,,47.45,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,3.23,,,,,,,1.26,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier,,3.23,,,,,,,0.51500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,outpatient,1,mL,2.69000,2.55000,The Alliance,Premier,,3.23,,,,,,,1.34,3.23,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,outpatient,3,EA,5.65000,5.36000,The Alliance,Premier,,0.14850,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,outpatient,3,EA,5.65000,5.37000,The Alliance,Premier,,0.14850,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,outpatient,3,EA,4.27000,4.05000,The Alliance,Premier,,0.14850,,,,,,,0.13485,4.14,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,outpatient,3,EA,8.27000,7.86000,The Alliance,Premier,,0.14850,,,,,,,0.13485,8.02,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,outpatient,3,EA,2.94000,2.79000,The Alliance,Premier,,0.14850,,,,,,,0.13485,2.85,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,outpatient,3,EA,4.04000,3.84000,The Alliance,Premier,,0.14850,,,,,,,0.13485,3.92,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,outpatient,3,EA,1.69000,1.60000,The Alliance,Premier,,0.14850,,,,,,,0.13485,1.64,fee schedule,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,763.98,,,,,,,16.07,763.98,fee schedule,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,outpatient,1,EA,6.81000,6.47000,The Alliance,Premier,,4.83,,,,,,,3.40,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Premier,,4.03,,,,,,,2.84,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier,,3.79,,,,,,,2.67,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Premier,,1.33,,,,,,,0.93500,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Premier,,1.76,,,,,,,1.24,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier,,3.54,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier,,2.38,,,,,,,1.68,3.26,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,outpatient,5,EA,2.45000,2.33000,The Alliance,Premier,,0.08250,,,,,,,0.08005,2.38,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Premier,,0.08250,,,,,,,0.08005,2.26,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,outpatient,5,EA,6.64000,6.30000,The Alliance,Premier,,0.08250,,,,,,,0.08005,6.44,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,outpatient,5,EA,2.53000,2.40000,The Alliance,Premier,,0.08250,,,,,,,0.08005,2.45,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,outpatient,5,EA,2.46000,2.33000,The Alliance,Premier,,0.08250,,,,,,,0.08005,2.39,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Premier,,0.08250,,,,,,,0.08005,11.04,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,outpatient,5,EA,3.92000,3.72000,The Alliance,Premier,,0.08250,,,,,,,0.08005,3.80,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,outpatient,5,EA,21.12000,20.06000,The Alliance,Premier,,0.08250,,,,,,,0.08005,20.49,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,outpatient,5,EA,1.89000,1.80000,The Alliance,Premier,,0.08250,,,,,,,0.08005,1.83,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Premier,,0.08250,,,,,,,0.08005,1.96,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,outpatient,5,EA,5.06000,4.80000,The Alliance,Premier,,0.08250,,,,,,,0.08005,4.91,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,outpatient,5,EA,21.00000,19.95000,The Alliance,Premier,,0.08250,,,,,,,0.08005,20.37,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,outpatient,5,EA,4.99000,4.74000,The Alliance,Premier,,0.08250,,,,,,,0.08005,4.84,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.73720,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Premier,,0.08250,,,,,,,0.08005,1.53,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,outpatient,1,mL,33272.80000,31609.16000,The Alliance,Premier,,60.49,,,,,,,36.66,32274.62,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,outpatient,1,mL,36335.60000,34518.82000,The Alliance,Premier,,60.49,,,,,,,36.66,35245.53,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,outpatient,1,mL,33792.11000,32102.50000,The Alliance,Premier,,60.49,,,,,,,36.66,32778.35,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,outpatient,1,mL,11961.94000,11363.85000,The Alliance,Premier,,60.49,,,,,,,36.66,11603.08,fee schedule,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,outpatient,1,EA,9.41000,8.94000,The Alliance,Premier,,6.67,,,,,,,4.71,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,outpatient,1,EA,31.20000,29.64000,The Alliance,Premier,,22.12,,,,,,,15.60,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier,,1.96,,,,,,,1.39,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier,,2.27,,,,,,,1.60,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,outpatient,1,EA,15535.12000,14758.37000,The Alliance,Premier,,256.44,,,,,,,155.42,15069.07,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,outpatient,1,mL,0.58000,0.56000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.56260,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.53350,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.63050,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.39770,fee schedule,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,outpatient,5,EA,11.32000,10.75000,The Alliance,Premier,,8.03,,,,,,,5.66,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Premier,,2.08,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,outpatient,30,EA,4.39000,4.17000,The Alliance,Premier,,3.11,,,,,,,2.19,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,outpatient,30,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,outpatient,30,EA,4.27000,4.06000,The Alliance,Premier,,3.03,,,,,,,2.13,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,outpatient,30,EA,4.01000,3.81000,The Alliance,Premier,,2.84,,,,,,,2.00,3.89,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,outpatient,1,EA,23.83000,22.64000,The Alliance,Premier,,16.90,,,,,,,11.91,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,outpatient,1,EA,85.13000,80.87000,The Alliance,Premier,,60.36,,,,,,,42.56,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier,,15.68,,,,,,,11.06,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Premier,,72.81,,,,,,,51.35,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,44.81,,,,,,,31.60,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Premier,,30.25,,,,,,,21.33,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,outpatient,1,EA,92.43000,87.81000,The Alliance,Premier,,65.53,,,,,,,46.22,89.66,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,outpatient,5,EA,3.45000,3.28000,The Alliance,Premier,,2.45,,,,,,,1.73,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,outpatient,5,EA,3.60000,3.42000,The Alliance,Premier,,2.55,,,,,,,1.80,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Premier,,3.33,,,,,,,2.35,4.55,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier,,3.54,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Premier,,31.00,,,,,,,21.86,42.41,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Premier,,52.34,,,,,,,36.91,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Premier,,52.34,,,,,,,36.91,71.61,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Premier,,763.98,,,,,,,14.69,763.98,fee schedule,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,outpatient,5,EA,3.06000,2.90000,The Alliance,Premier,,2.17,,,,,,,1.53,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,outpatient,5,EA,2.52000,2.39000,The Alliance,Premier,,1.79,,,,,,,1.26,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,outpatient,5,EA,3.98000,3.78000,The Alliance,Premier,,2.82,,,,,,,1.99,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,outpatient,5,EA,5.61000,5.33000,The Alliance,Premier,,3.98,,,,,,,2.81,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,outpatient,1,mL,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier,,3.28,,,,,,,2.31,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,outpatient,1,GM,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,outpatient,1,GM,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,outpatient,1,GM,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,outpatient,1,GM,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,outpatient,1,EA,4701.43000,4466.36000,The Alliance,Premier,,256.44,,,,,,,155.42,4560.39,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,outpatient,50,EA,0.10000,0.09000,The Alliance,Premier,,3.23,,,,,,,0.05000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,outpatient,50,EA,0.09000,0.09000,The Alliance,Premier,,3.23,,,,,,,0.04500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,outpatient,50,EA,0.27000,0.25000,The Alliance,Premier,,3.23,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Premier,,3.23,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Premier,,3.23,,,,,,,0.23000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Premier,,3.23,,,,,,,0.12000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,outpatient,50,EA,0.38000,0.36000,The Alliance,Premier,,3.23,,,,,,,0.19000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,outpatient,50,EA,0.44000,0.42000,The Alliance,Premier,,3.23,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Premier,,3.23,,,,,,,0.33500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Premier,,3.23,,,,,,,0.23000,3.23,fee schedule,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier,,78.70,,,,,,,55.50,107.67,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,outpatient,1,mL,21.71000,20.62000,The Alliance,Premier,,15.39,,,,,,,10.86,21.06,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,outpatient,1,EA,21.40000,20.33000,The Alliance,Premier,,15.17,,,,,,,10.70,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,outpatient,1,EA,5.76000,5.47000,The Alliance,Premier,,4.08,,,,,,,2.88,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,outpatient,1,EA,9.33000,8.86000,The Alliance,Premier,,6.61,,,,,,,4.67,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Premier,,5.51,,,,,,,3.88,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier,,3.27,,,,,,,2.31,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,outpatient,50,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,outpatient,50,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,outpatient,50,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,outpatient,50,EA,3.40000,3.23000,The Alliance,Premier,,2.41,,,,,,,1.70,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,outpatient,50,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,outpatient,50,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,outpatient,50,EA,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,outpatient,50,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,outpatient,30,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,outpatient,30,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,outpatient,30,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,outpatient,30,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,outpatient,20,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,outpatient,20,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,outpatient,20,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,outpatient,20,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,outpatient,20,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,outpatient,20,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,outpatient,5,EA,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,outpatient,5,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,outpatient,5,EA,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,outpatient,5,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,outpatient,5,EA,2.17000,2.07000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,outpatient,5,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,outpatient,5,EA,2.27000,2.16000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,outpatient,5,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,outpatient,5,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,outpatient,5,EA,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,outpatient,1,EA,7754.97000,7367.22000,The Alliance,Premier,,2866.22,,,,,,,1737.10,7522.32,fee schedule,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,outpatient,50,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,outpatient,50,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,outpatient,2,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,outpatient,2,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,outpatient,2,EA,3.51000,3.33000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,outpatient,2,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,outpatient,2,EA,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,outpatient,2,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,outpatient,1,mL,2.03000,1.92000,The Alliance,Premier,,1.44,,,,,,,1.01,1.97,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Premier,,3.23,,,,,,,0.02500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,3.23,,,,,,,0.14000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,3.23,,,,,,,0.11000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,3.23,,,,,,,0.38000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier,,3.23,,,,,,,1.59,21.46,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,3.23,,,,,,,0.06500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,3.23,,,,,,,0.11500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,3.23,,,,,,,0.07000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,3.23,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,3.23,,,,,,,0.29500,3.23,fee schedule,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,outpatient,1,EA,9.47000,8.99000,The Alliance,Premier,,6.71,,,,,,,4.74,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,outpatient,1,EA,22.15000,21.04000,The Alliance,Premier,,15.70,,,,,,,11.07,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,outpatient,1,EA,20.38000,19.36000,The Alliance,Premier,,14.45,,,,,,,10.19,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,outpatient,1,EA,57.42000,54.55000,The Alliance,Premier,,40.71,,,,,,,28.71,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Premier,,5.63,,,,,,,3.97,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Premier,,6.39,,,,,,,4.50,8.74,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,outpatient,1,EA,4.48000,4.25000,The Alliance,Premier,,3.18,,,,,,,2.24,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier,,3.70,,,,,,,2.61,5.06,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier,,3.54,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier,,492.33,,,,,,,10.50,492.33,fee schedule,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,outpatient,1,EA,3945.28000,3748.02000,The Alliance,Premier,,2866.22,,,,,,,1737.10,3826.92,fee schedule,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,outpatient,,,1981.00000,1881.95000,The Alliance,Premier,TC,1404.53,,,,,,,931.15,2210.07,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,,424.40,,,,,,,8.19,424.40,fee schedule,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,outpatient,1,mL,997.15000,947.29000,The Alliance,Premier,,706.98,,,,,,,498.57,967.24,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Premier,,2.08,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier,,3.54,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier,,1.63,,,,,,,1.15,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,TC,155.98,,,,,,,110.00,213.40,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,356.54,,,,,,,6.89,356.54,fee schedule,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,679.08,,,,,,,14.32,679.08,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,outpatient,300,EA,4.99000,4.74000,The Alliance,Premier,,5.73,,,,,,,2.50,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,outpatient,300,EA,0.84000,0.80000,The Alliance,Premier,,5.73,,,,,,,0.42000,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,outpatient,300,EA,0.63000,0.60000,The Alliance,Premier,,5.73,,,,,,,0.31500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,outpatient,300,EA,0.19000,0.18000,The Alliance,Premier,,5.73,,,,,,,0.09500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,outpatient,300,EA,0.65000,0.62000,The Alliance,Premier,,5.73,,,,,,,0.32500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,outpatient,300,EA,0.29000,0.27000,The Alliance,Premier,,5.73,,,,,,,0.14500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,outpatient,300,EA,0.11000,0.10000,The Alliance,Premier,,5.73,,,,,,,0.05500,5.76,fee schedule,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Premier,90,1646.71,,,,,,,35.33,1646.71,fee schedule,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,833.98,,,,,,,13.39,833.98,fee schedule,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,outpatient,1,mL,12.70000,12.07000,The Alliance,Premier,,0.24750,,,,,,,0.22165,12.32,fee schedule,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Premier,TC,1499.73,,,,,,,136.50,1499.73,fee schedule,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,outpatient,1,EA,440.47000,418.45000,The Alliance,Premier,,312.29,,,,,,,220.24,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,outpatient,1,EA,19.56000,18.58000,The Alliance,Premier,,13.87,,,,,,,9.78,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Premier,,13.17,,,,,,,9.29,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,outpatient,1,EA,30.43000,28.91000,The Alliance,Premier,,21.57,,,,,,,15.21,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Premier,,6.16,,,,,,,4.34,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier,,882.80,,,,,,,17.03,882.80,fee schedule,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Premier,TC,9133.75,,,,,,,812.50,9133.75,fee schedule,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,outpatient,1,EA,11.72000,11.14000,The Alliance,Premier,,8.31,,,,,,,5.86,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier,,967.70,,,,,,,18.52,967.70,fee schedule,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier,,220.68,,,,,,,4.27,220.68,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Premier,,2.18,,,,,,,2.11,8.19,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Premier,,2.18,,,,,,,2.11,5.23,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,outpatient,1,EA,6.01000,5.71000,The Alliance,Premier,,2.18,,,,,,,2.11,5.83,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,2.18,,,,,,,0.93000,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier,,2.18,,,,,,,2.04,3.97,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,2.18,,,,,,,1.19,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier,,2.18,,,,,,,2.11,9.96,fee schedule,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,TC,1126.22,,,,,,,88.31,1126.22,fee schedule,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier,TC,515.07,,,,,,,41.00,515.07,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier,,2.24,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,2.24,,,,,,,0.01000,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,2.24,,,,,,,0.01000,2.24,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,1397.87,,,,,,,133.50,1397.87,fee schedule,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,outpatient,,,306.10000,290.80000,The Alliance,Premier,90,1290.24,,,,,,,27.54,1290.24,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,TC,442.00,,,,,,,18.50,442.00,per diem,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier,TC,12902.54,,,,,,,1295.50,12902.54,fee schedule,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,220.68,,,,,,,4.31,220.68,fee schedule,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,outpatient,300,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,outpatient,300,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,outpatient,100,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,outpatient,100,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,outpatient,100,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,outpatient,100,EA,3.10000,2.94000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Premier,TC,2455.98,,,,,,,1611.84,3360.08,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,outpatient,1,mL,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier,,57.43,,,,,,,40.50,134.64,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,TC,2815.39,,,,,,,161.50,2815.39,fee schedule,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,4.06,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,4.06,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,4.06,,,,,,,0.01500,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,4.06,,,,,,,0.01500,4.06,fee schedule,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Premier,,16.60,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,339.51,,,,,,,6.61,339.51,fee schedule,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,356.54,,,,,,,6.70,356.54,fee schedule,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,outpatient,,,2973.00000,2824.35000,The Alliance,Premier,,37399.48,,,,,,,636.00,37399.48,fee schedule,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,outpatient,30,EA,3.32000,3.16000,The Alliance,Premier,,2.18,,,,,,,1.66,3.22,fee schedule,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier,,2.18,,,,,,,0.79000,2.61,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,outpatient,1,mL,166.31000,158.00000,The Alliance,Premier,,117.91,,,,,,,0.94620,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,outpatient,1,mL,173.64000,164.96000,The Alliance,Premier,,123.11,,,,,,,0.94620,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier,,100.82,,,,,,,0.94620,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Premier,,123.22,,,,,,,0.94620,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,outpatient,1,mL,257.67000,244.78000,The Alliance,Premier,,182.69,,,,,,,0.94620,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,outpatient,1,mL,257.40000,244.53000,The Alliance,Premier,,182.50,,,,,,,0.94620,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,outpatient,1,mL,193.96000,184.26000,The Alliance,Premier,,137.52,,,,,,,0.94620,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,outpatient,1,mL,115.78000,109.99000,The Alliance,Premier,,82.09,,,,,,,0.94620,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,outpatient,1,mL,221.20000,210.14000,The Alliance,Premier,,156.83,,,,,,,0.94620,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,outpatient,1,mL,193.05000,183.40000,The Alliance,Premier,,136.87,,,,,,,0.94620,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,outpatient,1,mL,108.69000,103.25000,The Alliance,Premier,,77.06,,,,,,,0.94620,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,outpatient,1,mL,108.67000,103.24000,The Alliance,Premier,,77.05,,,,,,,0.94620,105.41,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,outpatient,500,EA,0.40000,0.38000,The Alliance,Premier,,3.70,,,,,,,0.20000,3.75,fee schedule,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,outpatient,500,EA,0.12000,0.11000,The Alliance,Premier,,3.70,,,,,,,0.06000,3.75,fee schedule,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,outpatient,1,EA,23.42000,22.24000,The Alliance,Premier,,16.60,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Premier,,16.60,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,outpatient,1,EA,0.87000,0.82000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,outpatient,50,EA,0.19000,0.18000,The Alliance,Premier,,3.70,,,,,,,0.09500,3.75,fee schedule,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,outpatient,50,EA,0.34000,0.32000,The Alliance,Premier,,3.70,,,,,,,0.17000,3.75,fee schedule,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier,,264.46,,,,,,,186.50,361.81,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,TC,442.00,,,,,,,18.50,442.00,per diem,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,outpatient,1,mL,19.43000,18.46000,The Alliance,Premier,,25.89,,,,,,,9.71,25.89,fee schedule,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,outpatient,1,mL,11.57000,10.99000,The Alliance,Premier,,25.89,,,,,,,5.79,25.89,fee schedule,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,outpatient,1,mL,8.35000,7.93000,The Alliance,Premier,,25.89,,,,,,,4.17,25.89,fee schedule,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier,,814.87,,,,,,,15.49,814.87,fee schedule,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,outpatient,1,EA,45.82000,43.53000,The Alliance,Premier,,0.72600,,,,,,,0.66805,44.45,fee schedule,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,0.72600,,,,,,,0.66805,9.20,fee schedule,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,0.72600,,,,,,,0.66805,18.39,fee schedule,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,2.19,,,,,,,2.11,7.66,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,2.19,,,,,,,2.11,6.13,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Premier,,2.19,,,,,,,1.99,3.86,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier,,2.19,,,,,,,1.74,3.38,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,outpatient,1,mL,20.95000,19.90000,The Alliance,Premier,,2.19,,,,,,,2.11,20.32,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,outpatient,1,mL,6.48000,6.15000,The Alliance,Premier,,2.19,,,,,,,2.11,6.29,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,outpatient,1,mL,2.85000,2.71000,The Alliance,Premier,,3.73,,,,,,,1.43,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier,,3.73,,,,,,,1.47,4.28,fee schedule,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Premier,,25.89,,,,,,,9.10,25.89,fee schedule,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,outpatient,1,mL,12.20000,11.59000,The Alliance,Premier,,25.89,,,,,,,6.10,25.89,fee schedule,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,outpatient,1,mL,8.33000,7.91000,The Alliance,Premier,,25.89,,,,,,,4.17,25.89,fee schedule,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,outpatient,,,286.43000,272.11000,The Alliance,Premier,,203.08,,,,,,,143.22,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,outpatient,1,mL,572.85000,544.21000,The Alliance,Premier,,406.15,,,,,,,187.18,555.66,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,outpatient,1,EA,24.86000,23.62000,The Alliance,Premier,,36.40,,,,,,,12.43,36.40,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,outpatient,1,EA,370.86000,352.32000,The Alliance,Premier,,36.40,,,,,,,32.99,359.73,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,outpatient,1,EA,95.97000,91.17000,The Alliance,Premier,,36.40,,,,,,,32.99,93.09,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,outpatient,1,EA,21.68000,20.60000,The Alliance,Premier,,36.40,,,,,,,10.84,36.40,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,outpatient,1,EA,62.44000,59.32000,The Alliance,Premier,,36.40,,,,,,,31.22,60.57,fee schedule,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier,,7.10,,,,,,,5.01,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Premier,,3.32,,,,,,,2.34,4.54,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,outpatient,1,EA,92.08000,87.48000,The Alliance,Premier,,0.72600,,,,,,,0.66805,89.32,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,0.72600,,,,,,,0.66805,18.39,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,outpatient,1,EA,212.08000,201.47000,The Alliance,Premier,,0.72600,,,,,,,0.66805,205.72,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,outpatient,1,EA,86.25000,81.93000,The Alliance,Premier,,0.72600,,,,,,,0.66805,83.66,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,outpatient,1,EA,32.77000,31.13000,The Alliance,Premier,,0.72600,,,,,,,0.66805,31.79,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,outpatient,1,EA,177.91000,169.01000,The Alliance,Premier,,0.72600,,,,,,,0.66805,172.57,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Premier,,0.72600,,,,,,,0.66805,85.19,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,outpatient,1,EA,91.64000,87.06000,The Alliance,Premier,,0.72600,,,,,,,0.66805,88.89,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier,,0.72600,,,,,,,0.66805,36.78,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier,,0.72600,,,,,,,0.66805,18.08,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,0.72600,,,,,,,0.66805,33.72,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,0.72600,,,,,,,0.66805,61.30,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,outpatient,1,EA,18.17000,17.26000,The Alliance,Premier,,0.72600,,,,,,,0.66805,17.62,fee schedule,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,outpatient,,,188.80000,179.36000,The Alliance,Premier,90,848.80,,,,,,,16.80,848.80,fee schedule,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,outpatient,1,EA,5.74000,5.45000,The Alliance,Premier,,4.07,,,,,,,2.87,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Premier,,4.71,,,,,,,3.32,6.44,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,outpatient,1,EA,9.63000,9.15000,The Alliance,Premier,,0.33000,,,,,,,0.31155,9.34,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Premier,,0.33000,,,,,,,0.31155,8.54,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier,,0.33000,,,,,,,0.31155,9.14,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.33000,,,,,,,0.31155,0.62080,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,0.33000,,,,,,,0.31155,3.52,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,outpatient,1,EA,8.75000,8.32000,The Alliance,Premier,,0.33000,,,,,,,0.31155,8.49,fee schedule,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,outpatient,1,EA,2.04000,1.93000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,outpatient,1,EA,133.19000,126.53000,The Alliance,Premier,,2.85,,,,,,,2.53,129.19,fee schedule,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,outpatient,1,EA,262.28000,249.17000,The Alliance,Premier,,2.85,,,,,,,2.53,254.41,fee schedule,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,outpatient,1,EA,5.38000,5.11000,The Alliance,Premier,,3.81,,,,,,,2.69,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,outpatient,1,EA,9.83000,9.34000,The Alliance,Premier,,6.97,,,,,,,4.92,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier,TC,2142.86,,,,,,,119.50,2142.86,fee schedule,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,outpatient,1,EA,19.37000,18.40000,The Alliance,Premier,,13.73,,,,,,,9.69,18.79,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Premier,,158.87,,,,,,,112.04,217.36,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,390.47,,,,,,,4.12,390.47,fee schedule,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,outpatient,1,EA,149.72000,142.23000,The Alliance,Premier,,0.42900,,,,,,,0.26000,145.23,fee schedule,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,outpatient,1,EA,62.79000,59.65000,The Alliance,Premier,,44.52,,,,,,,31.39,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,outpatient,1,EA,196.71000,186.87000,The Alliance,Premier,,139.47,,,,,,,98.36,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Premier,,47.61,,,,,,,33.58,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,outpatient,1,EA,169.96000,161.46000,The Alliance,Premier,,120.50,,,,,,,84.98,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,outpatient,1,EA,169.86000,161.37000,The Alliance,Premier,,120.43,,,,,,,84.93,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Premier,,123.22,,,,,,,86.90,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,outpatient,1,EA,52.14000,49.53000,The Alliance,Premier,,36.97,,,,,,,26.07,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,outpatient,1,EA,44.32000,42.10000,The Alliance,Premier,,31.42,,,,,,,22.16,42.99,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,outpatient,1,GM,3.90000,3.70000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,outpatient,1,GM,1.36000,1.30000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,outpatient,45,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,outpatient,45,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,outpatient,45,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,outpatient,45,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Premier,,4.03,,,,,,,2.84,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier,,3.28,,,,,,,2.31,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,outpatient,1,EA,3.85000,3.65000,The Alliance,Premier,,2.73,,,,,,,1.93,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier,,2.23,,,,,,,1.57,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Premier,,2.75,,,,,,,1.94,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier,,3.57,,,,,,,2.52,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,outpatient,1,mL,82.30000,78.18000,The Alliance,Premier,,58.35,,,,,,,7.86,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,outpatient,1,mL,74.07000,70.36000,The Alliance,Premier,,52.52,,,,,,,7.86,71.85,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,outpatient,1,mL,10.61000,10.08000,The Alliance,Premier,,3.73,,,,,,,3.62,10.29,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,outpatient,1,EA,32.92000,31.27000,The Alliance,Premier,,0.42900,,,,,,,0.26000,31.93,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,outpatient,1,EA,20.41000,19.39000,The Alliance,Premier,,0.42900,,,,,,,0.26000,19.80,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier,,0.42900,,,,,,,0.26000,23.30,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,outpatient,1,EA,36.81000,34.97000,The Alliance,Premier,,0.42900,,,,,,,0.26000,35.71,fee schedule,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,254.68,,,,,,,4.75,254.68,fee schedule,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,outpatient,1,EA,262.63000,249.50000,The Alliance,Premier,,0.42900,,,,,,,0.26000,254.75,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Premier,,0.42900,,,,,,,0.26000,134.81,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,outpatient,1,EA,132.37000,125.75000,The Alliance,Premier,,0.42900,,,,,,,0.26000,128.40,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Premier,,0.42900,,,,,,,0.26000,99.62,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,outpatient,1,EA,108.14000,102.73000,The Alliance,Premier,,0.42900,,,,,,,0.26000,104.90,fee schedule,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,outpatient,1,EA,20.44000,19.42000,The Alliance,Premier,,0.42900,,,,,,,0.26000,19.83,fee schedule,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,305.58,,,,,,,5.78,305.58,fee schedule,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier,,763.98,,,,,,,14.55,763.98,fee schedule,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,outpatient,1,EA,1.37000,1.31000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,outpatient,1,EA,31.54000,29.96000,The Alliance,Premier,,22.36,,,,,,,15.77,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier,,2.55,,,,,,,1.80,3.49,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,outpatient,1,EA,62.32000,59.20000,The Alliance,Premier,,0.19800,,,,,,,0.12000,60.45,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,outpatient,1,EA,62.33000,59.21000,The Alliance,Premier,,0.19800,,,,,,,0.12000,60.46,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,outpatient,1,EA,45.19000,42.93000,The Alliance,Premier,,0.19800,,,,,,,0.12000,43.83,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,outpatient,1,EA,51.57000,48.99000,The Alliance,Premier,,0.19800,,,,,,,0.12000,50.02,fee schedule,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,882.80,,,,,,,16.94,882.80,fee schedule,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier,,1.65,,,,,,,0.98000,1.90,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier,,1.65,,,,,,,0.98000,1.90,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,outpatient,2,EA,5.30000,5.03000,The Alliance,Premier,,1.65,,,,,,,1.60,5.14,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,outpatient,2,EA,4.31000,4.09000,The Alliance,Premier,,1.65,,,,,,,1.60,4.18,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,outpatient,2,EA,5.29000,5.03000,The Alliance,Premier,,1.65,,,,,,,1.60,5.13,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,outpatient,2,EA,0.71000,0.68000,The Alliance,Premier,,1.65,,,,,,,0.35500,1.88,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Premier,,1.65,,,,,,,1.60,3.38,fee schedule,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,outpatient,1,mL,56.56000,53.73000,The Alliance,Premier,,40.10,,,,,,,7.86,54.86,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,,458.40,,,,,,,8.65,458.40,fee schedule,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier,,2.68,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.04,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71500,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Premier,,1.96,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.12,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,outpatient,5,EA,1.70000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,outpatient,5,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,outpatient,5,EA,3.65000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.82,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,outpatient,5,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,outpatient,5,EA,2.04000,1.93000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,outpatient,5,EA,2.03000,1.93000,The Alliance,Premier,,1.44,,,,,,,1.01,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,outpatient,5,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,outpatient,5,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,outpatient,5,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,outpatient,5,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Premier,,0.37950,,,,,,,0.36823,9.38,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.37950,,,,,,,0.36823,0.92150,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier,,0.37950,,,,,,,0.36823,3.49,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier,,0.37950,,,,,,,0.36823,3.50,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier,,0.37950,,,,,,,0.36823,3.50,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,outpatient,1,EA,5.88000,5.58000,The Alliance,Premier,,0.37950,,,,,,,0.36823,5.70,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.37950,,,,,,,0.35000,0.67900,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.37950,,,,,,,0.24000,0.46560,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.37950,,,,,,,0.36823,0.95060,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.37950,,,,,,,0.36823,0.97970,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier,,0.37950,,,,,,,0.36823,2.63,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.37950,,,,,,,0.32500,0.63050,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.37950,,,,,,,0.35000,0.67900,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,outpatient,1,EA,5.28000,5.02000,The Alliance,Premier,,0.37950,,,,,,,0.36823,5.12,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.37950,,,,,,,0.36823,1.26,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier,,0.37950,,,,,,,0.34000,0.65960,fee schedule,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier,,2.68,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Premier,,1.96,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,outpatient,5,EA,3.48000,3.31000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,outpatient,5,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Premier,,12.35,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Premier,,12.35,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,outpatient,1,EA,7.18000,6.82000,The Alliance,Premier,,5.09,,,,,,,3.59,6.96,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,outpatient,,,25.30000,24.04000,The Alliance,Premier,,17.94,,,,,,,12.65,24.54,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,75.15,,,,,,,53.00,788.42,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,outpatient,1,EA,9.04000,8.59000,The Alliance,Premier,,0.19800,,,,,,,0.12000,8.77,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,outpatient,1,EA,35.92000,34.13000,The Alliance,Premier,,0.19800,,,,,,,0.12000,34.84,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,outpatient,1,EA,35.90000,34.10000,The Alliance,Premier,,0.19800,,,,,,,0.12000,34.82,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,outpatient,1,EA,27.49000,26.12000,The Alliance,Premier,,0.19800,,,,,,,0.12000,26.67,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,outpatient,1,EA,27.99000,26.59000,The Alliance,Premier,,0.19800,,,,,,,0.12000,27.15,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,outpatient,1,EA,30.46000,28.94000,The Alliance,Premier,,0.19800,,,,,,,0.12000,29.55,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,outpatient,1,EA,30.45000,28.92000,The Alliance,Premier,,0.19800,,,,,,,0.12000,29.54,fee schedule,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,outpatient,1,EA,569.80000,541.31000,The Alliance,Premier,,46.65,,,,,,,28.27,552.71,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,outpatient,1,EA,2907.20000,2761.84000,The Alliance,Premier,,46.65,,,,,,,28.27,2819.98,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,outpatient,1,EA,2907.11000,2761.75000,The Alliance,Premier,,46.65,,,,,,,28.27,2819.90,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier,,46.65,,,,,,,28.27,628.08,fee schedule,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier,,339.51,,,,,,,4.05,339.51,fee schedule,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier,,356.54,,,,,,,7.48,356.54,fee schedule,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Premier,,2.74,,,,,,,1.94,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Premier,,3.66,,,,,,,2.58,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier,,2.55,,,,,,,1.80,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier,,2.45,,,,,,,1.73,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Premier,,2.64,,,,,,,1.86,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,outpatient,,,161.35000,153.28000,The Alliance,Premier,,114.40,,,,,,,80.67,185.08,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,outpatient,1,EA,161.35000,153.28000,The Alliance,Premier,,114.40,,,,,,,80.67,185.08,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier,,7.51,,,,,,,2.58,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,outpatient,1,EA,6.15000,5.84000,The Alliance,Premier,,7.51,,,,,,,3.08,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,outpatient,1,EA,7.89000,7.50000,The Alliance,Premier,,7.51,,,,,,,3.94,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier,,7.51,,,,,,,4.54,8.80,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,outpatient,1,EA,10.88000,10.34000,The Alliance,Premier,,7.51,,,,,,,5.44,10.55,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,outpatient,1,EA,7.30000,6.93000,The Alliance,Premier,,7.51,,,,,,,3.65,7.69,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,outpatient,1,EA,17.65000,16.77000,The Alliance,Premier,,7.51,,,,,,,7.18,17.12,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,outpatient,1,EA,8.05000,7.65000,The Alliance,Premier,,7.51,,,,,,,4.03,7.81,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,outpatient,1,EA,8.41000,7.99000,The Alliance,Premier,,7.51,,,,,,,4.21,8.16,fee schedule,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier,,139.67,,,,,,,98.50,212.44,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,outpatient,1,EA,12.55000,11.92000,The Alliance,Premier,,8.90,,,,,,,6.28,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier,,1.39,,,,,,,0.98000,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Premier,,4.63,,,,,,,3.27,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Premier,,4.63,,,,,,,3.27,6.33,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,outpatient,1,EA,217.79000,206.90000,The Alliance,Premier,,0.42900,,,,,,,0.26000,211.26,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Premier,,0.04950,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,outpatient,100,EA,0.04000,0.03000,The Alliance,Premier,,0.04950,,,,,,,0.02000,0.04980,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Premier,,0.04950,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Premier,,0.04950,,,,,,,0.03000,0.05820,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Premier,,0.04950,,,,,,,0.03000,0.05820,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,outpatient,100,EA,0.05000,0.05000,The Alliance,Premier,,0.04950,,,,,,,0.02500,0.04980,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Premier,,0.04950,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,outpatient,100,EA,0.08000,0.08000,The Alliance,Premier,,0.04950,,,,,,,0.04000,0.07760,fee schedule,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier,,1216.68,,,,,,,5.99,1216.68,fee schedule,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,outpatient,1,EA,15.06000,14.31000,The Alliance,Premier,,10.68,,,,,,,7.53,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,outpatient,1,EA,4.07000,3.86000,The Alliance,Premier,,2.89,,,,,,,2.04,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier,,339.51,,,,,,,6.64,339.51,fee schedule,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,outpatient,30,mL,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,outpatient,30,mL,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,outpatient,30,mL,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,outpatient,,,656.00000,623.20000,The Alliance,Premier,,465.10,,,,,,,360.80,5271.00,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,outpatient,1,EA,630.07000,598.57000,The Alliance,Premier,,46.65,,,,,,,28.27,611.17,fee schedule,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,46.65,,,,,,,28.27,376.85,fee schedule,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,25.52,,,,,,,18.00,34.92,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,,254.68,,,,,,,4.75,254.68,fee schedule,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Premier,,5.57,,,,,,,3.92,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier,,6.95,,,,,,,4.90,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,outpatient,1,EA,9.82000,9.33000,The Alliance,Premier,,6.96,,,,,,,4.91,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,outpatient,1,mL,2.02000,1.92000,The Alliance,Premier,,7.51,,,,,,,1.01,7.69,fee schedule,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,outpatient,1,EA,5.70000,5.42000,The Alliance,Premier,,4.04,,,,,,,2.85,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Premier,,3.34,,,,,,,2.35,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,outpatient,1,EA,9.88000,9.39000,The Alliance,Premier,,7.00,,,,,,,4.94,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Premier,,4.23,,,,,,,2.98,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Premier,,6.13,,,,,,,4.33,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Premier,,2.48,,,,,,,1.75,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Premier,TC,7351.18,,,,,,,380.00,7351.18,fee schedule,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,outpatient,1,EA,11.63000,11.05000,The Alliance,Premier,,8.25,,,,,,,5.82,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,outpatient,1,EA,14.54000,13.81000,The Alliance,Premier,,10.31,,,,,,,7.27,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier,,3.96,,,,,,,2.79,5.41,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,outpatient,1,mL,3.90000,3.70000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,outpatient,1,mL,2.57000,2.45000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,outpatient,1,mL,3.86000,3.67000,The Alliance,Premier,,2.74,,,,,,,1.93,3.74,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Premier,TC,1866.00,,,,,,,1269.50,2462.83,per diem,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,outpatient,1,EA,2.52000,2.39000,The Alliance,Premier,,1.79,,,,,,,1.26,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Premier,TC,1866.00,,,,,,,1371.65,3353.29,per diem,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier,TC,1866.00,,,,,,,1130.78,2914.85,per diem,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,outpatient,,,3007.00000,2856.65000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2916.79,per diem,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Premier,,7.51,,,,,,,2.73,7.69,fee schedule,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4835.45,per diem,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,outpatient,1,EA,3.62000,3.43000,The Alliance,Premier,,2.57,,,,,,,1.81,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,outpatient,1,EA,2.55000,2.43000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,outpatient,1,EA,1636.88000,1555.04000,The Alliance,Premier,,46.65,,,,,,,28.27,1587.77,fee schedule,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,outpatient,1,EA,1636.83000,1554.99000,The Alliance,Premier,,46.65,,,,,,,28.27,1587.73,fee schedule,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,outpatient,1,EA,471.38000,447.81000,The Alliance,Premier,,46.65,,,,,,,28.27,457.24,fee schedule,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4867.46,per diem,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,outpatient,3,EA,183.41000,174.24000,The Alliance,Premier,,130.04,,,,,,,91.70,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,outpatient,3,EA,35.81000,34.02000,The Alliance,Premier,,25.39,,,,,,,17.91,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,outpatient,3,EA,36.87000,35.02000,The Alliance,Premier,,26.14,,,,,,,18.43,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,outpatient,3,EA,26.64000,25.31000,The Alliance,Premier,,18.89,,,,,,,13.32,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,outpatient,3,EA,53.75000,51.06000,The Alliance,Premier,,38.11,,,,,,,26.88,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,outpatient,3,EA,41.08000,39.03000,The Alliance,Premier,,29.13,,,,,,,20.54,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,outpatient,3,EA,70.51000,66.98000,The Alliance,Premier,,49.99,,,,,,,35.26,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,outpatient,3,EA,21.07000,20.01000,The Alliance,Premier,,14.94,,,,,,,10.54,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,outpatient,3,EA,35.26000,33.49000,The Alliance,Premier,,25.00,,,,,,,17.63,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,outpatient,3,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,outpatient,3,EA,12.22000,11.61000,The Alliance,Premier,,8.66,,,,,,,6.11,11.85,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier,,1.69,,,,,,,1.20,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3934.32,per diem,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier,,2.31,,,,,,,0.99000,2.61,fee schedule,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Premier,,2.31,,,,,,,1.05,2.61,fee schedule,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier,,2.31,,,,,,,2.24,12.26,fee schedule,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,outpatient,,,4381.00000,4161.95000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4249.57,per diem,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Premier,TC,1866.00,,,,,,,864.00,2032.87,per diem,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier,TC,1866.00,,,,,,,924.00,2032.87,per diem,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Premier,TC,1866.00,,,,,,,1129.95,2920.67,per diem,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Premier,TC,1866.00,,,,,,,1353.88,3316.43,per diem,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4221.44,per diem,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Premier,TC,1866.00,,,,,,,1339.64,3425.07,per diem,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,outpatient,,,1560.00000,1482.00000,The Alliance,Premier,TC,1866.00,,,,,,,608.47,2032.87,per diem,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,1211.55,,,,,,,16.91,1211.55,fee schedule,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier,TC,1866.00,,,,,,,1214.33,3520.13,per diem,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2941.04,per diem,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Premier,,2.85,,,,,,,2.01,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier,,3.57,,,,,,,2.52,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,outpatient,1,EA,3.95000,3.76000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,outpatient,,,2867.00000,2723.65000,The Alliance,Premier,TC,1866.00,,,,,,,902.40,2780.99,per diem,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier,,7.51,,,,,,,2.58,7.69,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Premier,,7.51,,,,,,,3.37,7.69,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Premier,,7.51,,,,,,,5.17,10.04,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier,,7.51,,,,,,,4.54,8.80,fee schedule,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Premier,TC,1866.00,,,,,,,1375.22,3364.93,per diem,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,outpatient,,,2725.00000,2588.75000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2643.25,per diem,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier,TC,1866.00,,,,,,,1272.04,4844.18,per diem,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3863.51,per diem,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,outpatient,,,4145.00000,3937.75000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4345.33,per diem,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Premier,TC,1866.00,,,,,,,1318.80,3125.34,per diem,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Premier,TC,1866.00,,,,,,,1328.10,3480.36,per diem,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Premier,,1341.13,,,,,,,28.00,1341.13,fee schedule,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Premier,TC,1866.00,,,,,,,1125.50,2183.47,per diem,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,outpatient,,,3500.00000,3325.00000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3395.00,per diem,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier,TC,1866.00,,,,,,,828.00,2032.87,per diem,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,outpatient,,,5051.00000,4798.45000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4899.47,per diem,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier,TC,1866.00,,,,,,,1127.62,2942.98,per diem,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3584.15,per diem,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,outpatient,,,2339.00000,2222.05000,The Alliance,Premier,TC,1866.00,,,,,,,989.10,2268.83,per diem,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,outpatient,1,EA,2.03000,1.92000,The Alliance,Premier,,1.44,,,,,,,1.01,1.97,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,outpatient,,,4202.00000,3991.90000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4345.33,per diem,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Premier,TC,1866.00,,,,,,,1353.60,3441.56,per diem,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Premier,TC,1866.00,,,,,,,1308.50,2538.49,per diem,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4345.33,per diem,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,outpatient,1,EA,44.30000,42.09000,The Alliance,Premier,,31.41,,,,,,,22.15,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,outpatient,1,EA,48.68000,46.25000,The Alliance,Premier,,34.51,,,,,,,24.34,47.22,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Premier,,3.26,,,,,,,2.30,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,outpatient,2,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,outpatient,2,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3462.90,per diem,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4235.00000,4023.25000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,4107.95,per diem,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Premier,,2640.00,,,,,,,537.90,3163.00,case rate,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,outpatient,30,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier,TC,1866.00,,,,,,,828.00,2032.87,per diem,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier,TC,1866.00,,,,,,,179.69,2032.87,per diem,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,outpatient,,,2936.00000,2789.20000,The Alliance,Premier,TC,1866.00,,,,,,,1468.00,2847.92,per diem,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,outpatient,20,EA,1.83000,1.74000,The Alliance,Premier,,7.51,,,,,,,0.91500,7.69,fee schedule,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,outpatient,,,2082.00000,1977.90000,The Alliance,Premier,TC,1866.00,,,,,,,862.95,2032.87,per diem,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4224.35,per diem,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier,TC,1866.00,,,,,,,1128.45,2914.85,per diem,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,outpatient,1,EA,85.92000,81.62000,The Alliance,Premier,,60.92,,,,,,,42.96,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,outpatient,1,EA,94.42000,89.70000,The Alliance,Premier,,66.94,,,,,,,47.21,91.59,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,outpatient,,,4289.00000,4074.55000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4160.33,per diem,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5104.10000,4848.90000,The Alliance,Premier,,2414.24,,,,,,,2342.78,5104.10,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,2198.99,per diem,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,outpatient,,,12277.00000,11663.15000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,11908.69,per diem,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,,1952.29,,,,,,,41.68,1952.29,fee schedule,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Premier,TC,1866.00,,,,,,,1382.32,3348.44,per diem,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,outpatient,,,1408.00000,1337.60000,The Alliance,Premier,,2640.00,,,,,,,750.19,3163.00,case rate,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2942.98,per diem,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Premier,TC,1866.00,,,,,,,1246.80,3800.46,per diem,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Premier,,4.41,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Premier,TC,1866.00,,,,,,,1153.12,2941.04,per diem,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,outpatient,,,2960.00000,2812.00000,The Alliance,Premier,TC,2098.64,,,,,,,1360.59,7180.14,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,outpatient,5,EA,20.10000,19.09000,The Alliance,Premier,,3.60,,,,,,,3.00,19.50,fee schedule,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,outpatient,5,EA,5.18000,4.92000,The Alliance,Premier,,3.60,,,,,,,2.59,5.02,fee schedule,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,outpatient,5,EA,24.12000,22.91000,The Alliance,Premier,,3.60,,,,,,,3.00,23.40,fee schedule,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Premier,TC,2535.29,,,,,,,288.68,2535.29,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Premier,,0.26400,,,,,,,0.23870,27.58,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.68,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.97,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.22,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.26400,,,,,,,0.23870,0.55290,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.40,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.50,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.26400,,,,,,,0.23870,0.50440,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.84,fee schedule,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,outpatient,1,EA,71.61000,68.03000,The Alliance,Premier,,50.77,,,,,,,35.80,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,outpatient,1,EA,71.60000,68.02000,The Alliance,Premier,,50.76,,,,,,,35.80,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Premier,,50.41,,,,,,,35.55,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Premier,,49.29,,,,,,,34.76,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,28.01,,,,,,,19.75,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,outpatient,1,EA,71.73000,68.15000,The Alliance,Premier,,50.86,,,,,,,35.87,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,outpatient,1,EA,91.29000,86.73000,The Alliance,Premier,,64.72,,,,,,,45.65,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,outpatient,1,EA,68.57000,65.14000,The Alliance,Premier,,48.62,,,,,,,34.28,66.51,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,4230.17,per diem,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,outpatient,1,mL,270.61000,257.08000,The Alliance,Premier,,191.86,,,,,,,135.31,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,outpatient,1,mL,270.60000,257.07000,The Alliance,Premier,,191.86,,,,,,,135.30,262.48,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Premier,,3.04,,,,,,,2.15,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,outpatient,,,4739.00000,4502.05000,The Alliance,Premier,TC,7206.00,,,,,,,2369.50,8022.25,per diem,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier,,202.06,,,,,,,142.50,417.31,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,outpatient,,,3038.00000,2886.10000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,2946.86,per diem,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,90,984.66,,,,,,,19.37,984.66,fee schedule,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,outpatient,,,2932.00000,2785.40000,The Alliance,Premier,TC,1866.00,,,,,,,1466.00,2844.04,per diem,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier,TC,2245.40,,,,,,,1488.32,7180.14,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier,TC,3225.95,,,,,,,2150.56,7180.14,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier,TC,1866.00,,,,,,,1288.05,4844.18,per diem,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,outpatient,1,EA,3.24000,3.08000,The Alliance,Premier,,2.30,,,,,,,1.62,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,outpatient,1,EA,2.08000,1.98000,The Alliance,Premier,,1.47,,,,,,,1.04,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,outpatient,10,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,outpatient,10,EA,15.98000,15.18000,The Alliance,Premier,,11.33,,,,,,,7.99,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,outpatient,10,EA,3.61000,3.43000,The Alliance,Premier,,2.56,,,,,,,1.80,3.50,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Premier,90,882.80,,,,,,,17.47,882.80,fee schedule,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier,TC,1866.00,,,,,,,1295.50,2513.27,per diem,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier,,281.47,,,,,,,198.50,385.09,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Premier,TC,1866.00,,,,,,,1321.12,3459.02,per diem,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,0.26400,,,,,,,0.23870,3.38,fee schedule,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.26400,,,,,,,0.23870,1.23,fee schedule,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,outpatient,1,EA,5.07000,4.81000,The Alliance,Premier,,3.59,,,,,,,2.54,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier,,3.84,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,outpatient,4,EA,11.39000,10.82000,The Alliance,Premier,,8.08,,,,,,,5.70,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,outpatient,4,EA,17.76000,16.87000,The Alliance,Premier,,12.59,,,,,,,8.88,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,outpatient,4,EA,14.24000,13.52000,The Alliance,Premier,,10.10,,,,,,,7.12,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,outpatient,4,EA,6.90000,6.56000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,outpatient,4,EA,6.57000,6.24000,The Alliance,Premier,,4.66,,,,,,,3.29,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,outpatient,4,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,outpatient,4,EA,8.30000,7.88000,The Alliance,Premier,,5.88,,,,,,,4.15,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,outpatient,4,EA,13.79000,13.10000,The Alliance,Premier,,9.78,,,,,,,6.89,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,outpatient,4,EA,10.10000,9.59000,The Alliance,Premier,,7.16,,,,,,,5.05,9.80,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier,,316.92,,,,,,,223.50,433.59,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier,,679.08,,,,,,,12.92,679.08,fee schedule,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,,1850.43,,,,,,,39.26,1850.43,fee schedule,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier,,271.65,,,,,,,5.79,271.65,fee schedule,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier,,937.00,,,,,,,124.85,3163.00,case rate,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,outpatient,,,192.80000,183.16000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,Premier,,1969.25,,,,,,,37.73,1969.25,fee schedule,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier,,2.87,,,,,,,2.79,7.08,fee schedule,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier,,1.58,,,,,,,1.11,2.16,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Premier,,4719.10,,,,,,,2074.81,6456.32,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,outpatient,1,GM,3.59000,3.41000,The Alliance,Premier,,2.55,,,,,,,1.79,3.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,outpatient,1,mL,291.38000,276.81000,The Alliance,Premier,,206.59,,,,,,,145.69,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier,,56.01,,,,,,,39.50,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,outpatient,1,mL,23.61000,22.42000,The Alliance,Premier,,16.74,,,,,,,11.80,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,outpatient,1,mL,37.76000,35.87000,The Alliance,Premier,,26.77,,,,,,,18.88,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,outpatient,1,mL,22.14000,21.03000,The Alliance,Premier,,15.70,,,,,,,11.07,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,outpatient,1,mL,25.68000,24.39000,The Alliance,Premier,,18.21,,,,,,,12.84,24.91,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,outpatient,1,GM,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,outpatient,1,EA,10.42000,9.90000,The Alliance,Premier,,7.39,,,,,,,5.21,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,outpatient,1,EA,8.10000,7.70000,The Alliance,Premier,,5.74,,,,,,,4.05,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,outpatient,1,EA,7.29000,6.93000,The Alliance,Premier,,5.17,,,,,,,3.65,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier,,3.52,,,,,,,2.48,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,outpatient,1,EA,11.28000,10.72000,The Alliance,Premier,,8.00,,,,,,,5.64,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,outpatient,1,EA,12.18000,11.58000,The Alliance,Premier,,8.64,,,,,,,6.09,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.04,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Premier,,3.16,,,,,,,2.23,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Premier,,2640.00,,,,,,,537.90,3163.00,case rate,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,outpatient,1,EA,6.96000,6.62000,The Alliance,Premier,,4.93,,,,,,,3.48,6.75,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,outpatient,1,EA,35.25000,33.49000,The Alliance,Premier,,24.99,,,,,,,17.62,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,outpatient,1,EA,39.17000,37.21000,The Alliance,Premier,,27.77,,,,,,,19.59,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,outpatient,1,EA,25.65000,24.36000,The Alliance,Premier,,18.19,,,,,,,12.82,24.88,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier,,4.70,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Premier,,2.93,,,,,,,2.06,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier,,3.84,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier,,3.84,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,outpatient,1,mL,6.36000,6.05000,The Alliance,Premier,,0.14850,,,,,,,0.13795,6.17,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Premier,,0.14850,,,,,,,0.13795,7.82,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,outpatient,1,mL,7.68000,7.29000,The Alliance,Premier,,0.14850,,,,,,,0.13795,7.45,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier,,0.14850,,,,,,,0.13795,8.58,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,outpatient,1,mL,6.71000,6.38000,The Alliance,Premier,,0.14850,,,,,,,0.13795,6.51,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,outpatient,1,mL,6.04000,5.74000,The Alliance,Premier,,0.14850,,,,,,,0.13795,5.86,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Premier,,0.14850,,,,,,,0.13795,6.44,fee schedule,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,outpatient,15,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,outpatient,1,mL,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier,,4.03,,,,,,,2.85,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier,,4.11,,,,,,,2.90,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Premier,,4.12,,,,,,,2.90,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,outpatient,1,mL,1.27000,1.20000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier,90,696.05,,,,,,,13.68,696.05,fee schedule,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,40.41,,,,,,,28.50,70.98,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,outpatient,,,988.00000,938.60000,The Alliance,Premier,90,700.49,,,,,,,14.72,958.36,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier,,207.74,,,,,,,146.50,284.21,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,75.00,155.84,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,outpatient,,,1190.00000,1130.50000,The Alliance,Premier,,843.71,,,,,,,595.00,1154.30,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,outpatient,1,EA,287.54000,273.16000,The Alliance,Premier,,203.87,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,outpatient,1,EA,287.54000,273.17000,The Alliance,Premier,,203.87,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Premier,,201.99,,,,,,,142.45,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,outpatient,1,EA,288.79000,274.35000,The Alliance,Premier,,204.75,,,,,,,144.40,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,outpatient,1,EA,366.61000,348.28000,The Alliance,Premier,,259.93,,,,,,,183.31,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,outpatient,1,EA,121.38000,115.31000,The Alliance,Premier,,86.06,,,,,,,60.69,117.74,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.36,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier,,3.34,,,,,,,2.35,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,outpatient,1,EA,2.14000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,outpatient,1,EA,7.17000,6.81000,The Alliance,Premier,,5.08,,,,,,,3.58,6.95,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,outpatient,1,EA,1787.36000,1697.99000,The Alliance,Premier,,675.71,,,,,,,409.52,1733.74,fee schedule,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier,TC,952.90,,,,,,,672.00,1303.68,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,outpatient,10,EA,5.90000,5.60000,The Alliance,Premier,,2.34,,,,,,,2.08,5.72,fee schedule,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,2.34,,,,,,,0.11000,2.34,fee schedule,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,2.34,,,,,,,0.14000,2.34,fee schedule,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,outpatient,1,EA,6.60000,6.27000,The Alliance,Premier,,4.68,,,,,,,3.30,6.40,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,outpatient,15,EA,2.36000,2.24000,The Alliance,Premier,,1.67,,,,,,,1.18,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,outpatient,15,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,outpatient,15,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,outpatient,15,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Premier,,8.09,,,,,,,5.71,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,outpatient,1,EA,19.03000,18.08000,The Alliance,Premier,,13.49,,,,,,,9.52,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,outpatient,1,EA,11.30000,10.74000,The Alliance,Premier,,8.01,,,,,,,5.65,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,outpatient,1,EA,10.04000,9.54000,The Alliance,Premier,,7.12,,,,,,,5.02,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,,258.79,,,,,,,182.50,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,90,258.79,,,,,,,182.50,354.05,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,outpatient,5,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,outpatient,5,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,outpatient,5,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,outpatient,5,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,outpatient,5,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Premier,,4536.18,,,,,,,1914.61,6206.06,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,outpatient,1,EA,86.53000,82.20000,The Alliance,Premier,,1.01,,,,,,,0.91450,83.93,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,outpatient,1,EA,84.85000,80.60000,The Alliance,Premier,,1.01,,,,,,,0.91450,82.30,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier,,1.01,,,,,,,0.91450,19.92,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,outpatient,1,EA,39.10000,37.15000,The Alliance,Premier,,1.01,,,,,,,0.91450,37.93,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,outpatient,1,EA,31.41000,29.84000,The Alliance,Premier,,1.01,,,,,,,0.91450,30.47,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier,,1.01,,,,,,,0.91450,10.42,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,outpatient,1,EA,21.19000,20.13000,The Alliance,Premier,,1.01,,,,,,,0.91450,20.55,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier,,1.01,,,,,,,0.91450,9.96,fee schedule,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,75.15,,,,,,,58.30,5271.00,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,outpatient,2,EA,1.52000,1.44000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.47,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,outpatient,2,EA,0.95000,0.90000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.92150,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,outpatient,2,EA,0.50000,0.47000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.48500,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,outpatient,2,EA,2.03000,1.93000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.97,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,outpatient,2,EA,1.50000,1.43000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.46,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Premier,,0.14850,,,,,,,0.13330,3.07,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,outpatient,2,EA,2.05000,1.95000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.99,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,outpatient,2,EA,0.58000,0.55000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.56260,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,outpatient,2,EA,1.45000,1.38000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.41,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,outpatient,2,EA,0.73000,0.69000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.70810,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.69,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,outpatient,2,EA,2.77000,2.63000,The Alliance,Premier,,0.14850,,,,,,,0.13330,2.69,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.53,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,outpatient,2,EA,1.19000,1.13000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.15,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,outpatient,2,EA,3.56000,3.38000,The Alliance,Premier,,0.14850,,,,,,,0.13330,3.45,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,outpatient,2,EA,3.79000,3.60000,The Alliance,Premier,,0.14850,,,,,,,0.13330,3.68,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,outpatient,2,EA,3.10000,2.94000,The Alliance,Premier,,0.14850,,,,,,,0.13330,3.01,fee schedule,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,outpatient,60,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,outpatient,60,EA,27.49000,26.12000,The Alliance,Premier,,19.49,,,,,,,13.74,26.67,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,outpatient,1,EA,5474.37000,5200.65000,The Alliance,Premier,,350.13,,,,,,,212.20,5310.14,fee schedule,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,outpatient,1,EA,7150.48000,6792.96000,The Alliance,Premier,,350.13,,,,,,,212.20,6935.97,fee schedule,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,outpatient,1,EA,0.62000,0.58000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,outpatient,1,mL,461.19000,438.14000,The Alliance,Premier,,129.46,,,,,,,78.46,447.35,fee schedule,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,outpatient,60,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,outpatient,60,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,outpatient,60,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,outpatient,60,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,outpatient,60,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,outpatient,60,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,outpatient,1,EA,5.11000,4.85000,The Alliance,Premier,,3.62,,,,,,,2.56,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier,,1.84,,,,,,,1.30,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,outpatient,1,EA,6455.15000,6132.39000,The Alliance,Premier,,350.13,,,,,,,212.20,6261.50,fee schedule,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,outpatient,1,EA,9368.36000,8899.95000,The Alliance,Premier,,350.13,,,,,,,212.20,9087.31,fee schedule,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,outpatient,1,EA,5.45000,5.17000,The Alliance,Premier,,3.86,,,,,,,2.73,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Premier,,3.10,,,,,,,2.19,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Premier,,4.02,,,,,,,2.83,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,outpatient,1,EA,7.28000,6.91000,The Alliance,Premier,,5.16,,,,,,,3.64,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier,,3.98,,,,,,,2.81,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,outpatient,1,EA,33.81000,32.12000,The Alliance,Premier,,23.97,,,,,,,16.91,32.80,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,outpatient,15,EA,14.15000,13.44000,The Alliance,Premier,,10.03,,,,,,,7.08,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.20,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.19,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.84390,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.14850,,,,,,,0.13330,0.76630,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.34,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier,,0.14850,,,,,,,0.13330,2.30,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,outpatient,1,mL,3.20000,3.04000,The Alliance,Premier,,0.14850,,,,,,,0.13330,3.10,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,0.14850,,,,,,,0.13330,1.53,fee schedule,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,,1290.24,,,,,,,27.39,1290.24,fee schedule,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,203.72,,,,,,,3.66,203.72,fee schedule,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,outpatient,,,22948.00000,21800.60000,The Alliance,Premier,,16270.13,,,,,,,4607.00,22259.56,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,203.72,,,,,,,4.23,203.72,fee schedule,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,831.84,,,,,,,15.92,831.84,fee schedule,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,outpatient,5,EA,81.26000,77.19000,The Alliance,Premier,,57.61,,,,,,,40.63,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,outpatient,5,EA,41.08000,39.03000,The Alliance,Premier,,29.13,,,,,,,20.54,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,outpatient,5,EA,40.75000,38.71000,The Alliance,Premier,,28.89,,,,,,,20.38,39.53,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier,,11041.20,,,,,,,523.04,11041.20,fee schedule,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier,TC,627.47,,,,,,,442.50,858.45,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,254.68,,,,,,,4.26,254.68,fee schedule,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier,,257.37,,,,,,,41.63,352.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier,,4.70,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier,,3.84,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,outpatient,1,EA,9666.09000,9182.79000,The Alliance,Premier,,350.13,,,,,,,212.20,9376.11,fee schedule,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,outpatient,1,EA,12876.34000,12232.52000,The Alliance,Premier,,350.13,,,,,,,212.20,12490.05,fee schedule,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,outpatient,1,EA,45.60000,43.32000,The Alliance,Premier,,32.33,,,,,,,22.80,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Premier,,5.49,,,,,,,3.87,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier,,1.91,,,,,,,1.35,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Premier,,3.90,,,,,,,2.75,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,outpatient,1,EA,5.46000,5.19000,The Alliance,Premier,,3.87,,,,,,,2.73,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier,,1.91,,,,,,,1.35,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Premier,,2.41,,,,,,,1.70,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,outpatient,1,EA,2.27000,2.15000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier,,1.39,,,,,,,0.98000,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier,,1.98,,,,,,,1.40,2.71,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier,,1137.41,,,,,,,67.50,1137.41,fee schedule,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,outpatient,,,36445.00000,34622.75000,The Alliance,Premier,,25839.51,,,,,,,4607.00,35351.65,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,outpatient,5,EA,183.67000,174.48000,The Alliance,Premier,,130.22,,,,,,,91.83,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,outpatient,5,EA,9.61000,9.13000,The Alliance,Premier,,6.81,,,,,,,4.80,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,outpatient,5,EA,24.99000,23.74000,The Alliance,Premier,,17.72,,,,,,,12.49,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,outpatient,5,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,outpatient,5,EA,4.80000,4.56000,The Alliance,Premier,,3.40,,,,,,,2.40,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,outpatient,5,EA,26.86000,25.52000,The Alliance,Premier,,19.04,,,,,,,13.43,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,outpatient,5,EA,4.77000,4.53000,The Alliance,Premier,,3.38,,,,,,,2.38,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,outpatient,5,EA,4.46000,4.23000,The Alliance,Premier,,3.16,,,,,,,2.23,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,outpatient,5,EA,4.39000,4.17000,The Alliance,Premier,,3.11,,,,,,,2.19,4.26,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,outpatient,1,EA,15.87000,15.08000,The Alliance,Premier,,11.25,,,,,,,7.93,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier,,10.87,,,,,,,7.67,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,outpatient,1,EA,24.33000,23.12000,The Alliance,Premier,,17.25,,,,,,,12.16,23.60,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,outpatient,1,EA,38.67000,36.74000,The Alliance,Premier,,27.42,,,,,,,19.34,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Premier,,7.45,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,outpatient,15,EA,3.29000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Premier,,7.45,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,outpatient,15,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,2.21,4.28,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,outpatient,1,EA,659.69000,626.71000,The Alliance,Premier,,4.49,,,,,,,4.35,639.90,fee schedule,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,outpatient,1,EA,659.70000,626.71000,The Alliance,Premier,,4.49,,,,,,,4.35,639.91,fee schedule,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,2392.88,,,,,,,1856.25,5271.00,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier,,1.56,,,,,,,1.10,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,outpatient,15,EA,4.09000,3.88000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,outpatient,15,EA,4.59000,4.36000,The Alliance,Premier,,3.25,,,,,,,2.29,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,outpatient,15,EA,3.66000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.83,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,outpatient,15,EA,3.15000,2.99000,The Alliance,Premier,,2.23,,,,,,,1.57,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,outpatient,1,EA,285.49000,271.21000,The Alliance,Premier,,202.41,,,,,,,142.75,276.93,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier,,57.43,,,,,,,44.55,5271.00,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Premier,,1.71,,,,,,,1.21,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier,,4.11,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier,,4.11,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,outpatient,,,13836.00000,13144.20000,The Alliance,Premier,,9809.72,,,,,,,4607.00,13420.92,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,outpatient,5,EA,10.59000,10.06000,The Alliance,Premier,,7.51,,,,,,,5.29,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,outpatient,5,EA,12.92000,12.27000,The Alliance,Premier,,9.16,,,,,,,6.46,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,outpatient,5,EA,12.27000,11.66000,The Alliance,Premier,,8.70,,,,,,,6.13,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,outpatient,5,EA,14.21000,13.50000,The Alliance,Premier,,10.07,,,,,,,7.11,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Premier,,4.15,,,,,,,2.93,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier,,38281.04,,,,,,,4607.00,52373.21,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Premier,,125.78,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,outpatient,1,EA,120.63000,114.60000,The Alliance,Premier,,85.53,,,,,,,60.31,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Premier,,125.78,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,outpatient,1,EA,122.44000,116.32000,The Alliance,Premier,,86.81,,,,,,,61.22,118.77,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,outpatient,,,21293.00000,20228.35000,The Alliance,Premier,,15096.74,,,,,,,4607.00,20654.21,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,outpatient,1,EA,422.19000,401.08000,The Alliance,Premier,,4.49,,,,,,,4.35,409.52,fee schedule,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,339.51,,,,,,,6.61,339.51,fee schedule,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier,,4953.07,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier,,5742.90,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,outpatient,,,10089.00000,9584.55000,The Alliance,Premier,,7153.10,,,,,,,4607.00,9786.33,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,outpatient,1,EA,47.99000,45.59000,The Alliance,Premier,,34.02,,,,,,,24.00,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,outpatient,1,EA,30.22000,28.71000,The Alliance,Premier,,21.43,,,,,,,15.11,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier,,5.83,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,outpatient,1,EA,25.22000,23.96000,The Alliance,Premier,,17.88,,,,,,,12.61,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,outpatient,1,EA,32.24000,30.62000,The Alliance,Premier,,22.86,,,,,,,16.12,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,outpatient,1,EA,25.28000,24.01000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,outpatient,1,EA,35.97000,34.17000,The Alliance,Premier,,25.50,,,,,,,17.98,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,outpatient,1,EA,5.85000,5.55000,The Alliance,Premier,,4.15,,,,,,,2.92,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,outpatient,1,EA,27.40000,26.03000,The Alliance,Premier,,19.43,,,,,,,13.70,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,outpatient,1,EA,5.43000,5.15000,The Alliance,Premier,,3.85,,,,,,,2.71,5.27,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,356.54,,,,,,,6.82,356.54,fee schedule,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier,GO,186.00,,,,,,,70.50,264.00,per diem,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,outpatient,1,EA,2595.50000,2465.73000,The Alliance,Premier,,66.92,,,,,,,40.56,2517.64,fee schedule,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier,GO,186.00,,,,,,,49.00,264.00,per diem,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,outpatient,60,mL,6.35000,6.03000,The Alliance,Premier,,4.50,,,,,,,3.17,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,outpatient,60,mL,8.00000,7.60000,The Alliance,Premier,,5.67,,,,,,,4.00,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,outpatient,60,mL,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,outpatient,60,mL,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,outpatient,60,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,outpatient,60,mL,5.28000,5.01000,The Alliance,Premier,,3.74,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,outpatient,60,mL,5.28000,5.02000,The Alliance,Premier,,3.74,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,outpatient,60,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,outpatient,60,mL,0.93000,0.89000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,GO,186.00,,,,,,,43.00,264.00,per diem,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Premier,,1754.24,,,,,,,1702.32,3708.75,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier,GO,186.00,,,,,,,126.65,264.00,per diem,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,outpatient,,,213.20000,202.54000,The Alliance,Premier,GO,186.00,,,,,,,106.60,264.00,per diem,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,GO,186.00,,,,,,,57.50,264.00,per diem,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier,GO,186.00,,,,,,,126.65,264.00,per diem,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,GO,186.00,,,,,,,62.00,264.00,per diem,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,GO,186.00,,,,,,,76.00,264.00,per diem,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier,,645.90,,,,,,,501.05,5271.00,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier,GO,186.00,,,,,,,126.65,264.00,per diem,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier,GO,186.00,,,,,,,55.50,264.00,per diem,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,GO,186.00,,,,,,,57.50,264.00,per diem,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,GO,186.00,,,,,,,28.50,264.00,per diem,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,90,865.84,,,,,,,17.00,865.84,fee schedule,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,outpatient,1,EA,11.38000,10.81000,The Alliance,Premier,,8.07,,,,,,,5.69,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,outpatient,1,EA,10.90000,10.36000,The Alliance,Premier,,7.73,,,,,,,5.45,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier,,458.40,,,,,,,8.90,458.40,fee schedule,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,GO,186.00,,,,,,,53.00,264.00,per diem,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,outpatient,1,EA,686.35000,652.03000,The Alliance,Premier,,0.14850,,,,,,,0.07595,665.76,fee schedule,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,713.01,,,,,,,14.86,713.01,fee schedule,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,GO,186.00,,,,,,,43.00,264.00,per diem,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,outpatient,1,EA,24.43000,23.21000,The Alliance,Premier,,17.32,,,,,,,12.21,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,outpatient,1,EA,40.62000,38.59000,The Alliance,Premier,,28.80,,,,,,,20.31,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,outpatient,1,EA,55.18000,52.42000,The Alliance,Premier,,39.12,,,,,,,27.59,53.52,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Premier,90,1137.41,,,,,,,92.05,1137.41,fee schedule,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Premier,,284.71,,,,,,,172.55,828.02,fee schedule,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier,GO,186.00,,,,,,,50.50,264.00,per diem,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,outpatient,1,mL,303.44000,288.27000,The Alliance,Premier,,215.14,,,,,,,62.23,294.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Premier,,5.42,,,,,,,3.83,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Premier,,4.01,,,,,,,2.83,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,outpatient,1,EA,16.85000,16.01000,The Alliance,Premier,,11.95,,,,,,,8.43,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Premier,,12.27,,,,,,,8.65,16.78,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,outpatient,1,EA,66.39000,63.07000,The Alliance,Premier,,47.07,,,,,,,33.20,64.40,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,outpatient,,,3486.00000,3311.70000,The Alliance,Premier,TC,2471.57,,,,,,,1598.89,3381.42,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,outpatient,1,EA,31.42000,29.85000,The Alliance,Premier,,22.28,,,,,,,15.71,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,outpatient,1,EA,32.23000,30.62000,The Alliance,Premier,,22.85,,,,,,,16.11,31.26,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,outpatient,1,EA,1372.70000,1304.06000,The Alliance,Premier,,0.14850,,,,,,,0.07595,1331.52,fee schedule,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,outpatient,,,143.70000,136.51000,The Alliance,Premier,90,679.08,,,,,,,14.93,679.08,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Premier,,0.14850,,,,,,,0.07595,333.55,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier,,0.14850,,,,,,,0.07595,15.33,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,0.14850,,,,,,,0.07595,3.07,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,0.14850,,,,,,,0.07595,7.66,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,outpatient,1,mL,10.81000,10.27000,The Alliance,Premier,,0.14850,,,,,,,0.07595,10.49,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier,,0.14850,,,,,,,0.07595,11.04,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.14850,,,,,,,0.07595,6.13,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,outpatient,1,mL,17.38000,16.51000,The Alliance,Premier,,0.14850,,,,,,,0.07595,16.86,fee schedule,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,GO,186.00,,,,,,,55.00,264.00,per diem,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier,,696.05,,,,,,,13.36,696.05,fee schedule,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier,,1001.63,,,,,,,21.21,1001.63,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier,,0.74250,,,,,,,0.72045,45.98,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier,,0.74250,,,,,,,0.72045,30.65,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,0.74250,,,,,,,0.72045,9.20,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,outpatient,1,mL,178.67000,169.73000,The Alliance,Premier,,0.74250,,,,,,,0.72045,173.31,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,outpatient,1,mL,154.58000,146.85000,The Alliance,Premier,,0.74250,,,,,,,0.72045,149.94,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,0.74250,,,,,,,0.72045,3.68,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier,,0.74250,,,,,,,0.72045,11.04,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,outpatient,1,mL,286.30000,271.98000,The Alliance,Premier,,0.74250,,,,,,,0.72045,277.71,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier,,0.74250,,,,,,,0.72045,79.70,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier,,0.74250,,,,,,,0.72045,5.52,fee schedule,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,outpatient,1,EA,1.36000,1.30000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,143.22,,,,,,,101.00,195.94,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,outpatient,500,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier,,1.44,,,,,,,1.01,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,outpatient,1,EA,5.73000,5.44000,The Alliance,Premier,,4.06,,,,,,,2.87,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Premier,90,1087.31,,,,,,,22.97,1087.31,fee schedule,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Premier,,1087.31,,,,,,,22.97,1087.31,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.18150,,,,,,,0.17611,6.13,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,outpatient,1,mL,5.46000,5.19000,The Alliance,Premier,,0.18150,,,,,,,0.17611,5.30,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier,,0.18150,,,,,,,0.17611,6.07,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Premier,,0.18150,,,,,,,0.17611,4.37,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Premier,,0.18150,,,,,,,0.17611,7.92,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Premier,,0.18150,,,,,,,0.17611,7.24,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Premier,,0.18150,,,,,,,0.17611,2.33,fee schedule,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Premier,,32.15,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,outpatient,,,1058.00000,1005.10000,The Alliance,Premier,,42186.85,,,,,,,529.00,42186.85,fee schedule,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,outpatient,1,mL,295.86000,281.06000,The Alliance,Premier,,209.76,,,,,,,62.23,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,outpatient,1,mL,261.75000,248.66000,The Alliance,Premier,,185.58,,,,,,,62.23,253.90,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Premier,,2007.18,,,,,,,1947.77,4116.19,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier,GO,186.00,,,,,,,84.50,264.00,per diem,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,outpatient,1,mL,5334.01000,5067.31000,The Alliance,Premier,,24.88,,,,,,,15.08,5173.99,fee schedule,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,outpatient,1,mL,65.43000,62.16000,The Alliance,Premier,,46.39,,,,,,,32.72,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,outpatient,1,mL,59.25000,56.29000,The Alliance,Premier,,42.01,,,,,,,29.62,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Premier,,36.41,,,,,,,25.68,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,outpatient,1,mL,61.40000,58.33000,The Alliance,Premier,,43.53,,,,,,,30.70,59.56,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,780.94,,,,,,,15.05,780.94,fee schedule,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Premier,,933.70,,,,,,,17.98,933.70,fee schedule,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Premier,,9.30,,,,,,,6.56,12.73,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,outpatient,,,264.90000,251.65000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,outpatient,120,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,outpatient,120,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier,,168.74,,,,,,,20.26,230.86,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,outpatient,1,EA,1.84000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Premier,,3.50,,,,,,,2.47,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier,,2.45,,,,,,,1.73,3.36,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Premier,,31.22,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Premier,,20.16,,,,,,,14.21,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier,,5.83,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,outpatient,1,EA,29.57000,28.10000,The Alliance,Premier,,20.97,,,,,,,14.79,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,outpatient,1,EA,23.38000,22.21000,The Alliance,Premier,,16.58,,,,,,,11.69,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,outpatient,1,EA,32.62000,30.99000,The Alliance,Premier,,23.13,,,,,,,16.31,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,outpatient,1,EA,25.14000,23.88000,The Alliance,Premier,,17.82,,,,,,,12.57,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,outpatient,1,mL,10069.36000,9565.89000,The Alliance,Premier,,46899.70,,,,,,,5034.68,46899.70,fee schedule,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,outpatient,15,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,outpatient,15,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,outpatient,15,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,outpatient,15,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,outpatient,15,EA,1.21000,1.14000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,TC,2788.50,,,,,,,1966.50,3815.01,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,outpatient,30,EA,18.43000,17.51000,The Alliance,Premier,,13.07,,,,,,,9.21,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,outpatient,30,EA,7.12000,6.76000,The Alliance,Premier,,5.05,,,,,,,3.56,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,outpatient,30,EA,11.59000,11.01000,The Alliance,Premier,,8.22,,,,,,,5.79,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,outpatient,30,EA,17.80000,16.91000,The Alliance,Premier,,12.62,,,,,,,8.90,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,outpatient,30,EA,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,outpatient,30,EA,14.75000,14.01000,The Alliance,Premier,,10.46,,,,,,,7.38,14.31,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,outpatient,1,mL,3.33000,3.17000,The Alliance,Premier,,2.36,,,,,,,1.67,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Premier,,543.22,,,,,,,11.54,543.22,fee schedule,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier,,2156.01,,,,,,,41.28,2156.01,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Premier,,0.14850,,,,,,,0.07595,333.55,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier,,0.14850,,,,,,,0.07595,15.33,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,0.14850,,,,,,,0.07595,9.20,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,0.14850,,,,,,,0.07595,3.07,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,0.14850,,,,,,,0.07595,7.66,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier,,0.14850,,,,,,,0.07595,26.05,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier,,0.14850,,,,,,,0.07595,11.04,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.14850,,,,,,,0.07595,6.13,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,outpatient,1,mL,15.17000,14.41000,The Alliance,Premier,,0.14850,,,,,,,0.07595,14.71,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Premier,,0.14850,,,,,,,0.07595,3.83,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,outpatient,1,mL,15.58000,14.80000,The Alliance,Premier,,0.14850,,,,,,,0.07595,15.11,fee schedule,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,outpatient,,,3021.00000,2869.95000,The Alliance,Premier,TC,2141.89,,,,,,,1390.09,2930.37,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,outpatient,1,EA,6.08000,5.77000,The Alliance,Premier,,1.11,,,,,,,1.07,5.90,fee schedule,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,1.11,,,,,,,1.07,30.65,fee schedule,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,outpatient,1,EA,3.68000,3.49000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,outpatient,1,EA,14.71000,13.97000,The Alliance,Premier,,10.43,,,,,,,7.36,14.27,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Premier,,186.75,,,,,,,3.58,186.75,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,outpatient,1,EA,2094.27000,1989.56000,The Alliance,Premier,,6.15,,,,,,,3.73,2031.44,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier,,6.15,,,,,,,3.73,91.96,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,outpatient,1,EA,261.69000,248.61000,The Alliance,Premier,,6.15,,,,,,,3.73,253.84,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,outpatient,1,EA,411.81000,391.22000,The Alliance,Premier,,6.15,,,,,,,3.73,399.46,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,6.15,,,,,,,3.73,376.85,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,outpatient,1,EA,38.55000,36.62000,The Alliance,Premier,,6.15,,,,,,,3.73,37.39,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,outpatient,1,mL,29.56000,28.09000,The Alliance,Premier,,18.41,,,,,,,14.78,28.67,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,outpatient,1,mL,11.33000,10.76000,The Alliance,Premier,,18.41,,,,,,,5.67,23.04,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier,,18.41,,,,,,,4.26,23.04,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,18.41,,,,,,,17.87,122.61,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,outpatient,1,EA,59.38000,56.41000,The Alliance,Premier,,18.41,,,,,,,17.87,57.60,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Premier,,18.41,,,,,,,2.21,23.04,fee schedule,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,outpatient,30,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier,,1.43,,,,,,,1.00,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier,,2.62,,,,,,,1.85,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,outpatient,1,EA,40.20000,38.19000,The Alliance,Premier,,1.45,,,,,,,1.20,38.99,fee schedule,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,outpatient,1,EA,13.78000,13.09000,The Alliance,Premier,,1.45,,,,,,,1.20,13.37,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Premier,,135.91,,,,,,,123.22,363.03,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier,,135.91,,,,,,,123.22,275.87,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Premier,,135.91,,,,,,,123.22,419.28,fee schedule,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Premier,,4.65,,,,,,,3.28,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Premier,,4.66,,,,,,,3.29,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,outpatient,1,EA,6.25000,5.94000,The Alliance,Premier,,4.43,,,,,,,3.12,6.06,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Premier,,7221.66,,,,,,,162.71,7221.66,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,outpatient,2,EA,359.05000,341.10000,The Alliance,Premier,,48.34,,,,,,,29.30,348.28,fee schedule,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14004.86,per diem,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,outpatient,1,EA,8369.01000,7950.56000,The Alliance,Premier,,6.15,,,,,,,3.73,8117.94,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,outpatient,1,EA,1289.41000,1224.94000,The Alliance,Premier,,6.15,,,,,,,3.73,1250.73,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,outpatient,1,EA,1179.64000,1120.66000,The Alliance,Premier,,6.15,,,,,,,3.73,1144.25,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,outpatient,1,EA,2053.87000,1951.18000,The Alliance,Premier,,6.15,,,,,,,3.73,1992.25,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier,,6.15,,,,,,,3.73,1256.15,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,6.15,,,,,,,3.73,376.85,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,outpatient,1,EA,166.28000,157.97000,The Alliance,Premier,,6.15,,,,,,,3.73,161.29,fee schedule,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier,,780.94,,,,,,,15.03,780.94,fee schedule,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,outpatient,2,EA,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,GO,186.00,,,,,,,21.00,264.00,per diem,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier,,3.50,,,,,,,2.46,4.78,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,outpatient,1,EA,16.04000,15.24000,The Alliance,Premier,,11.37,,,,,,,8.02,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Premier,,3.66,,,,,,,2.58,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier,,14.56,,,,,,,10.27,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,outpatient,1,EA,15.48000,14.71000,The Alliance,Premier,,10.98,,,,,,,7.74,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier,,10.77,,,,,,,7.59,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,outpatient,1,EA,14.16000,13.45000,The Alliance,Premier,,10.04,,,,,,,7.08,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Premier,,6.66,,,,,,,4.70,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Premier,,9.97,,,,,,,7.03,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier,,10.19,,,,,,,7.18,13.94,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,outpatient,1,EA,1.92000,1.82000,The Alliance,Premier,,1.36,,,,,,,0.96000,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,outpatient,,,14531.00000,13804.45000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14095.07,per diem,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,271.65,,,,,,,5.78,271.65,fee schedule,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14018.44,per diem,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Premier,,713.01,,,,,,,15.30,713.01,fee schedule,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Premier,,45.14,,,,,,,2.15,50.75,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,outpatient,1,EA,83.28000,79.11000,The Alliance,Premier,,45.14,,,,,,,41.64,80.78,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Premier,,45.14,,,,,,,27.65,53.64,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,outpatient,1,EA,68.95000,65.50000,The Alliance,Premier,,45.14,,,,,,,34.48,66.88,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,outpatient,1,EA,67.94000,64.54000,The Alliance,Premier,,45.14,,,,,,,33.97,65.90,fee schedule,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,outpatient,2,EA,18.41000,17.49000,The Alliance,Premier,,13.05,,,,,,,9.21,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,outpatient,2,EA,16.48000,15.66000,The Alliance,Premier,,11.68,,,,,,,8.24,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,outpatient,2,EA,16.99000,16.14000,The Alliance,Premier,,12.05,,,,,,,8.49,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,outpatient,2,EA,13.59000,12.91000,The Alliance,Premier,,9.64,,,,,,,6.79,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,outpatient,2,EA,15.99000,15.19000,The Alliance,Premier,,11.34,,,,,,,8.00,15.51,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,outpatient,30,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,outpatient,30,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,outpatient,30,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Premier,,284.71,,,,,,,172.55,828.02,fee schedule,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Premier,,3.68,,,,,,,2.60,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Premier,,2.93,,,,,,,2.06,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,outpatient,2,EA,6.93000,6.58000,The Alliance,Premier,,4.91,,,,,,,3.46,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,outpatient,2,EA,123.69000,117.51000,The Alliance,Premier,,87.70,,,,,,,61.84,119.98,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier,,362.30,,,,,,,122.40,495.67,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier,,2082.45,,,,,,,24.91,2082.45,fee schedule,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,outpatient,1,mL,19.60000,18.62000,The Alliance,Premier,,13.90,,,,,,,9.80,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,outpatient,1,mL,16.11000,15.31000,The Alliance,Premier,,11.42,,,,,,,8.05,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,outpatient,1,mL,16.61000,15.78000,The Alliance,Premier,,11.78,,,,,,,8.30,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,outpatient,1,mL,13.28000,12.62000,The Alliance,Premier,,9.42,,,,,,,6.64,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,outpatient,1,mL,15.63000,14.85000,The Alliance,Premier,,11.08,,,,,,,7.82,15.16,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,outpatient,1,mL,151.84000,144.25000,The Alliance,Premier,,45.14,,,,,,,43.80,147.28,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,outpatient,1,mL,167.67000,159.29000,The Alliance,Premier,,45.14,,,,,,,43.80,162.64,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,outpatient,1,mL,106.18000,100.87000,The Alliance,Premier,,45.14,,,,,,,43.80,102.99,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Premier,,45.14,,,,,,,43.80,168.59,fee schedule,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,outpatient,5,EA,1.15000,1.09000,The Alliance,Premier,,1.09,,,,,,,0.57500,1.12,fee schedule,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,outpatient,5,EA,0.86000,0.82000,The Alliance,Premier,,1.09,,,,,,,0.43000,1.09,fee schedule,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,outpatient,,,510.82000,485.28000,The Alliance,Premier,,425.68,,,,,,,255.41,495.50,fee schedule,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,outpatient,1,mL,1021.64000,970.56000,The Alliance,Premier,,425.68,,,,,,,399.88,990.99,fee schedule,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Premier,,3.64,,,,,,,2.56,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Premier,,29.02,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Premier,,29.02,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,288.61,,,,,,,5.50,288.61,fee schedule,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6366.00000,6047.70000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,6175.02,per diem,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,outpatient,1,EA,41.77000,39.68000,The Alliance,Premier,,29.61,,,,,,,20.89,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,outpatient,1,EA,3.21000,3.05000,The Alliance,Premier,,2.28,,,,,,,1.60,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,outpatient,,,41.50000,39.42000,The Alliance,Premier,90,186.75,,,,,,,3.70,186.75,fee schedule,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,outpatient,1,mL,1207.45000,1147.08000,The Alliance,Premier,,27.87,,,,,,,16.89,1171.23,fee schedule,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,outpatient,2,EA,7.58000,7.20000,The Alliance,Premier,,5.37,,,,,,,3.79,7.35,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,outpatient,,,762.00000,723.90000,The Alliance,Premier,,540.26,,,,,,,419.10,5271.00,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,,638.55,,,,,,,619.65,1350.00,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,outpatient,2,EA,2.15000,2.04000,The Alliance,Premier,,1.09,,,,,,,0.80910,2.09,fee schedule,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,outpatient,2,EA,2.00000,1.90000,The Alliance,Premier,,1.09,,,,,,,0.80910,1.94,fee schedule,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,outpatient,2,EA,1.39000,1.32000,The Alliance,Premier,,1.09,,,,,,,0.69500,1.35,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,outpatient,1,EA,160.78000,152.74000,The Alliance,Premier,,1.45,,,,,,,1.20,155.96,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Premier,,1.45,,,,,,,1.20,155.19,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Premier,,1.45,,,,,,,1.20,168.59,fee schedule,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier,,1.01,,,,,,,0.71500,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,outpatient,1,EA,26.02000,24.71000,The Alliance,Premier,,18.45,,,,,,,13.01,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,outpatient,1,EA,25.60000,24.32000,The Alliance,Premier,,18.15,,,,,,,12.80,24.83,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Premier,,1.83,,,,,,,1.73,12.45,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,outpatient,1,EA,32.55000,30.92000,The Alliance,Premier,,1.83,,,,,,,1.73,31.57,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,outpatient,1,EA,37.72000,35.83000,The Alliance,Premier,,1.83,,,,,,,1.73,36.59,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,outpatient,1,EA,33.04000,31.39000,The Alliance,Premier,,1.83,,,,,,,1.73,32.05,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,outpatient,1,EA,43.77000,41.58000,The Alliance,Premier,,1.83,,,,,,,1.73,42.46,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier,,1.83,,,,,,,1.73,15.78,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,1.83,,,,,,,1.73,33.72,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,outpatient,1,EA,36.59000,34.76000,The Alliance,Premier,,1.83,,,,,,,1.73,35.49,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,outpatient,1,EA,23.18000,22.02000,The Alliance,Premier,,1.83,,,,,,,1.73,22.48,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Premier,,1.83,,,,,,,1.73,17.47,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,outpatient,1,EA,43.83000,41.64000,The Alliance,Premier,,1.83,,,,,,,1.73,42.52,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,outpatient,1,EA,36.43000,34.61000,The Alliance,Premier,,1.83,,,,,,,1.73,35.34,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,1.83,,,,,,,1.73,12.26,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Premier,,1.83,,,,,,,1.73,15.72,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,outpatient,1,EA,23.07000,21.91000,The Alliance,Premier,,1.83,,,,,,,1.73,22.38,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Premier,,1.83,,,,,,,1.73,15.64,fee schedule,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,outpatient,237,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,outpatient,237,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,outpatient,237,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,outpatient,237,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,outpatient,,,14477.00000,13753.15000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14042.69,per diem,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,967.70,,,,,,,52.00,967.70,fee schedule,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,237.65,,,,,,,4.76,237.65,fee schedule,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,outpatient,1,EA,10.26000,9.75000,The Alliance,Premier,,7.27,,,,,,,5.13,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Premier,,1.36,,,,,,,0.96000,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,outpatient,1,EA,62.55000,59.42000,The Alliance,Premier,,44.35,,,,,,,31.27,60.67,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,220.68,,,,,,,4.27,220.68,fee schedule,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,outpatient,20,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,outpatient,20,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,outpatient,20,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Premier,,370.10,,,,,,,287.10,5271.00,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,outpatient,17,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,outpatient,17,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,outpatient,17,EA,4.92000,4.67000,The Alliance,Premier,,3.49,,,,,,,2.46,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,outpatient,17,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,outpatient,17,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,outpatient,17,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,outpatient,17,EA,6.49000,6.16000,The Alliance,Premier,,4.60,,,,,,,3.25,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,outpatient,17,EA,4.76000,4.52000,The Alliance,Premier,,3.37,,,,,,,2.38,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,outpatient,17,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,outpatient,17,EA,5.32000,5.06000,The Alliance,Premier,,3.77,,,,,,,2.66,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,outpatient,17,EA,4.22000,4.01000,The Alliance,Premier,,2.99,,,,,,,2.11,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,outpatient,17,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,outpatient,17,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,outpatient,17,EA,3.57000,3.39000,The Alliance,Premier,,2.53,,,,,,,1.78,3.46,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,outpatient,,,130.70000,124.16000,The Alliance,Premier,90,441.37,,,,,,,8.72,441.37,fee schedule,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,outpatient,,,206.80000,196.46000,The Alliance,Premier,90,1256.24,,,,,,,25.05,1256.24,fee schedule,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,254.68,,,,,,,4.74,254.68,fee schedule,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,outpatient,1,EA,154.75000,147.01000,The Alliance,Premier,,109.72,,,,,,,77.38,150.11,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier,TC,326.14,,,,,,,230.00,446.20,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,,1595.82,,,,,,,91.00,1595.82,fee schedule,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Premier,,25.20,,,,,,,17.77,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier,,12.32,,,,,,,8.69,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,outpatient,1,EA,31.57000,29.99000,The Alliance,Premier,,22.38,,,,,,,15.79,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,14.22,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,outpatient,1,EA,30.21000,28.70000,The Alliance,Premier,,21.42,,,,,,,15.11,29.30,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,outpatient,15,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,220.68,,,,,,,4.73,220.68,fee schedule,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,outpatient,30,EA,2.07000,1.96000,The Alliance,Premier,,0.44550,,,,,,,0.43227,2.01,fee schedule,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,outpatient,30,EA,2.10000,2.00000,The Alliance,Premier,,0.44550,,,,,,,0.43227,2.04,fee schedule,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,Premier,,802.59,,,,,,,566.00,1098.04,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,2386.00000,2266.70000,The Alliance,Premier,,1691.67,,,,,,,462.52,2314.42,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,outpatient,1,EA,273.97000,260.27000,The Alliance,Premier,,194.24,,,,,,,136.99,265.75,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Premier,,34.28,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier,,1.85,,,,,,,1.30,2.53,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.06640,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.06640,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.06640,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier,,0.95715,,,,,,,0.06640,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier,,0.44667,,,,,,,0.06640,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.06640,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.06640,0.40740,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,763.98,,,,,,,7.85,763.98,fee schedule,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,outpatient,15,EA,1.70000,1.61000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,outpatient,15,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,outpatient,15,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,outpatient,15,EA,2.93000,2.79000,The Alliance,Premier,,2.08,,,,,,,1.47,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,outpatient,15,EA,3.56000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.78,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,outpatient,15,EA,2.90000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,outpatient,15,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier,,1018.59,,,,,,,19.38,1018.59,fee schedule,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,outpatient,,,6058.00000,5755.10000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,5876.26,per diem,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,outpatient,30,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,outpatient,4000,EA,40.07000,38.07000,The Alliance,Premier,,28.41,,,,,,,20.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,outpatient,4000,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier,90,339.51,,,,,,,6.75,339.51,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,outpatient,1,mL,29.09000,27.64000,The Alliance,Premier,,320.63,,,,,,,14.54,472.00,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier,,320.63,,,,,,,47.40,472.00,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier,,320.63,,,,,,,13.43,472.00,fee schedule,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,237.65,,,,,,,4.48,237.65,fee schedule,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,outpatient,,,1267.00000,1203.65000,The Alliance,Premier,,937.00,,,,,,,668.09,3163.00,case rate,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,,1086.52,,,,,,,20.86,1086.52,fee schedule,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier,,628.12,,,,,,,12.01,628.12,fee schedule,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,outpatient,1,EA,1.14000,1.09000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Premier,,1.46,,,,,,,1.03,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,outpatient,,,264.28000,251.07000,The Alliance,Premier,,220.23,,,,,,,132.14,256.35,fee schedule,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,outpatient,0.5,EA,528.55000,502.12000,The Alliance,Premier,,220.23,,,,,,,206.88,512.69,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,outpatient,30,EA,0.69000,0.66000,The Alliance,Premier,,0.44550,,,,,,,0.34500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,outpatient,30,EA,2.30000,2.19000,The Alliance,Premier,,0.44550,,,,,,,0.43227,2.23,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Premier,,0.44550,,,,,,,0.26500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Premier,,0.44550,,,,,,,0.17500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Premier,,0.44550,,,,,,,0.28500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Premier,,0.44550,,,,,,,0.13500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Premier,,0.44550,,,,,,,0.20000,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,outpatient,30,EA,3.79000,3.60000,The Alliance,Premier,,0.44550,,,,,,,0.43227,3.68,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Premier,,0.44550,,,,,,,0.26500,0.79680,fee schedule,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Premier,,34.28,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,outpatient,1,EA,58.39000,55.47000,The Alliance,Premier,,41.40,,,,,,,29.20,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier,,1.85,,,,,,,1.30,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,4.74,,,,,,,1.39,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,4.74,,,,,,,1.36,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Premier,,4.74,,,,,,,2.92,5.66,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,outpatient,1,EA,2.25000,2.13000,The Alliance,Premier,,4.74,,,,,,,1.12,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,outpatient,1,EA,5.52000,5.24000,The Alliance,Premier,,4.74,,,,,,,2.76,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,outpatient,1,EA,6.74000,6.40000,The Alliance,Premier,,4.74,,,,,,,3.37,6.54,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,outpatient,1,EA,10.16000,9.65000,The Alliance,Premier,,4.74,,,,,,,4.59,9.86,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,4.74,,,,,,,1.56,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.74,,,,,,,3.16,6.13,fee schedule,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Premier,90,763.98,,,,,,,15.20,763.98,fee schedule,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,outpatient,15,EA,3.12000,2.96000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,outpatient,15,EA,7.88000,7.48000,The Alliance,Premier,,5.59,,,,,,,3.94,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,outpatient,15,EA,6.38000,6.06000,The Alliance,Premier,,4.52,,,,,,,3.19,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,outpatient,15,EA,10.10000,9.60000,The Alliance,Premier,,7.16,,,,,,,5.05,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,outpatient,15,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,outpatient,1,EA,1154.70000,1096.96000,The Alliance,Premier,,720.24,,,,,,,436.51,1120.06,fee schedule,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,outpatient,1,EA,1087.28000,1032.92000,The Alliance,Premier,,720.24,,,,,,,436.51,1054.66,fee schedule,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier,,720.24,,,,,,,194.25,745.84,fee schedule,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,outpatient,10,EA,16.66000,15.82000,The Alliance,Premier,,11.81,,,,,,,8.33,16.16,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Premier,90,135.79,,,,,,,2.79,142.88,fee schedule,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,outpatient,10,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,outpatient,10,EA,3.40000,3.23000,The Alliance,Premier,,2.41,,,,,,,1.70,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,outpatient,10,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,outpatient,10,EA,3.27000,3.11000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,outpatient,1,EA,27.53000,26.15000,The Alliance,Premier,,19.52,,,,,,,13.77,26.70,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Premier,,556.57,,,,,,,392.50,1692.33,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,,1471.29,,,,,,,10.74,1471.29,fee schedule,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,outpatient,118,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.87300,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.68870,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.89240,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.85360,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.36860,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.55290,fee schedule,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,203.72,,,,,,,3.94,203.72,fee schedule,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,outpatient,1,EA,31.98000,30.38000,The Alliance,Premier,,22.67,,,,,,,15.99,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier,,2.96,,,,,,,2.08,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,outpatient,5,EA,59.96000,56.97000,The Alliance,Premier,,42.51,,,,,,,29.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,outpatient,5,EA,27.81000,26.42000,The Alliance,Premier,,19.72,,,,,,,13.90,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,outpatient,5,EA,27.97000,26.57000,The Alliance,Premier,,19.83,,,,,,,13.98,27.13,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Premier,GP,186.00,,,,,,,89.50,264.00,per diem,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Premier,,4.52,,,,,,,3.19,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,outpatient,1,EA,1.88000,1.78000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Premier,,21.84,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,outpatient,1,EA,4.52000,4.30000,The Alliance,Premier,,3.20,,,,,,,2.26,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier,,4.28,,,,,,,3.02,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,outpatient,1,EA,1.69000,1.61000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,,1392.10,,,,,,,27.22,1392.10,fee schedule,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier,,2.94,,,,,,,2.07,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Premier,,3.34,,,,,,,2.35,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Premier,,8.04,,,,,,,5.67,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,outpatient,1,EA,10.83000,10.29000,The Alliance,Premier,,7.68,,,,,,,5.42,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Premier,,1.36,,,,,,,0.96000,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,outpatient,30,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,outpatient,30,EA,45.29000,43.03000,The Alliance,Premier,,32.11,,,,,,,22.64,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,outpatient,30,EA,35.01000,33.26000,The Alliance,Premier,,24.82,,,,,,,17.50,33.96,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,797.91,,,,,,,15.32,797.91,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,outpatient,2,EA,3.95000,3.75000,The Alliance,Premier,,4.16,,,,,,,1.98,4.85,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,outpatient,2,EA,11.46000,10.89000,The Alliance,Premier,,4.16,,,,,,,4.03,11.12,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,outpatient,2,EA,7.31000,6.94000,The Alliance,Premier,,4.16,,,,,,,3.65,7.09,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,outpatient,2,EA,14.22000,13.51000,The Alliance,Premier,,4.16,,,,,,,4.03,13.79,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,outpatient,2,EA,8.37000,7.96000,The Alliance,Premier,,4.16,,,,,,,4.03,8.12,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Premier,,4.16,,,,,,,3.63,7.05,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,outpatient,2,EA,29.23000,27.77000,The Alliance,Premier,,4.16,,,,,,,4.03,28.35,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Premier,,4.16,,,,,,,4.03,27.59,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,outpatient,1,mL,9.78000,9.29000,The Alliance,Premier,,2.71,,,,,,,2.17,9.49,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,outpatient,1,mL,7.05000,6.69000,The Alliance,Premier,,2.71,,,,,,,2.17,6.84,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Premier,,2.71,,,,,,,2.17,6.00,fee schedule,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Premier,,4.01,,,,,,,2.14,5.49,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,outpatient,1,EA,17.88000,16.98000,The Alliance,Premier,,12.68,,,,,,,8.94,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,outpatient,1,EA,2.63000,2.49000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,outpatient,15,EA,8.60000,8.17000,The Alliance,Premier,,6.10,,,,,,,4.30,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Premier,,5.24,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Premier,,5.24,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,outpatient,15,EA,7.38000,7.01000,The Alliance,Premier,,5.23,,,,,,,3.69,7.16,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,967.70,,,,,,,18.39,967.70,fee schedule,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Premier,,19.23,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,outpatient,1,EA,24.66000,23.42000,The Alliance,Premier,,17.48,,,,,,,12.33,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,GP,186.00,,,,,,,30.50,264.00,per diem,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier,,865.84,,,,,,,16.59,865.84,fee schedule,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier,90,865.84,,,,,,,16.59,865.84,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,outpatient,20,EA,0.68000,0.64000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,outpatient,20,EA,0.90000,0.86000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.87300,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,outpatient,20,EA,0.95000,0.90000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,outpatient,20,EA,0.82000,0.78000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.79540,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,outpatient,20,EA,0.92000,0.88000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.89240,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,outpatient,20,EA,0.31000,0.29000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.30070,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.36860,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,outpatient,20,EA,0.88000,0.84000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.85360,fee schedule,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,GP,186.00,,,,,,,53.00,264.00,per diem,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier,,4.40,,,,,,,3.10,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier,,4.38,,,,,,,3.09,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier,,2.86,,,,,,,2.02,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Premier,,5.13,,,,,,,3.62,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier,,3.40,,,,,,,2.40,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Premier,,5.14,,,,,,,3.62,7.03,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,,729.98,,,,,,,13.84,729.98,fee schedule,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier,,611.15,,,,,,,11.61,611.15,fee schedule,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,GP,186.00,,,,,,,26.50,264.00,per diem,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier,,2.17,,,,,,,1.53,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier,,3.38,,,,,,,2.38,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,outpatient,1,EA,9.73000,9.25000,The Alliance,Premier,,6.90,,,,,,,4.87,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Premier,,3.76,,,,,,,2.65,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier,GP,186.00,,,,,,,47.00,264.00,per diem,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier,,2640.00,,,,,,,397.10,3163.00,case rate,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,186.75,,,,,,,4.00,186.75,fee schedule,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,203.72,,,,,,,4.29,203.72,fee schedule,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,GP,186.00,,,,,,,31.50,264.00,per diem,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,967.70,,,,,,,18.39,967.70,fee schedule,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier,GP,186.00,,,,,,,126.65,264.00,per diem,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier,GP,186.00,,,,,,,68.50,264.00,per diem,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,GP,186.00,,,,,,,55.00,264.00,per diem,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,GP,186.00,,,,,,,126.65,264.00,per diem,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,GP,186.00,,,,,,,21.00,264.00,per diem,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier,,720.34,,,,,,,558.80,5271.00,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,outpatient,1,EA,17.19000,16.33000,The Alliance,Premier,,1.83,,,,,,,1.73,16.67,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,outpatient,1,EA,48.57000,46.14000,The Alliance,Premier,,1.83,,,,,,,1.73,47.11,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Premier,,1.83,,,,,,,1.73,42.73,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,outpatient,1,EA,21.69000,20.61000,The Alliance,Premier,,1.83,,,,,,,1.73,21.04,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,outpatient,1,EA,49.30000,46.83000,The Alliance,Premier,,1.83,,,,,,,1.73,47.82,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,outpatient,1,EA,41.08000,39.03000,The Alliance,Premier,,1.83,,,,,,,1.73,39.85,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Premier,,1.83,,,,,,,1.73,20.85,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,outpatient,1,EA,48.24000,45.83000,The Alliance,Premier,,1.83,,,,,,,1.73,46.79,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier,,1.83,,,,,,,1.73,19.92,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier,,1.83,,,,,,,1.73,23.30,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,outpatient,1,EA,55.49000,52.72000,The Alliance,Premier,,1.83,,,,,,,1.73,53.83,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,outpatient,1,EA,43.39000,41.22000,The Alliance,Premier,,1.83,,,,,,,1.73,42.09,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,outpatient,1,EA,46.14000,43.83000,The Alliance,Premier,,1.83,,,,,,,1.73,44.76,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,outpatient,1,EA,33.43000,31.76000,The Alliance,Premier,,1.83,,,,,,,1.73,32.43,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,outpatient,1,EA,21.33000,20.26000,The Alliance,Premier,,1.83,,,,,,,1.73,20.69,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,outpatient,1,EA,28.91000,27.47000,The Alliance,Premier,,1.83,,,,,,,1.73,28.04,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,1.83,,,,,,,1.73,18.39,fee schedule,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,GP,186.00,,,,,,,54.00,264.00,per diem,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,GP,186.00,,,,,,,43.00,264.00,per diem,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,outpatient,1,EA,2.11000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,outpatient,,,2160.00000,2052.00000,The Alliance,Premier,,12002.48,,,,,,,255.05,12002.48,fee schedule,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,Premier,TC,2195.06,,,,,,,1428.78,3003.12,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier,,2.68,,,,,,,0.73040,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.73040,1.60,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier,GP,186.00,,,,,,,49.00,264.00,per diem,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,outpatient,,,1881.00000,1786.95000,The Alliance,Premier,TC,1333.63,,,,,,,885.12,2210.07,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,outpatient,1,EA,48.03000,45.63000,The Alliance,Premier,,21.12,,,,,,,19.48,46.59,fee schedule,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Premier,90,746.94,,,,,,,14.83,746.94,fee schedule,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,186.75,,,,,,,3.67,186.75,fee schedule,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,Premier,,2640.00,,,,,,,408.65,3163.00,case rate,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier,TC,279.35,,,,,,,197.00,382.18,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,GP,186.00,,,,,,,42.00,264.00,per diem,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,5.51,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier,,13.89,,,,,,,5.51,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,outpatient,1,EA,31.82000,30.23000,The Alliance,Premier,,22.56,,,,,,,5.51,30.87,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier,GP,186.00,,,,,,,70.50,264.00,per diem,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,outpatient,0.5,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,outpatient,0.5,EA,6.16000,5.85000,The Alliance,Premier,,4.37,,,,,,,3.08,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,outpatient,0.5,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Premier,,21.84,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier,TC,387.82,,,,,,,273.50,1232.72,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,GP,186.00,,,,,,,43.00,264.00,per diem,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Premier,TC,2314.18,,,,,,,1527.07,3166.08,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier,,197.10,,,,,,,139.00,269.66,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,outpatient,1,EA,45.52000,43.24000,The Alliance,Premier,,32.27,,,,,,,22.76,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Premier,,3.01,,,,,,,2.12,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,outpatient,1,EA,4.37000,4.16000,The Alliance,Premier,,3.10,,,,,,,2.19,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier,,2.28,,,,,,,1.61,3.12,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,GP,186.00,,,,,,,62.00,264.00,per diem,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,outpatient,1,EA,0.23000,0.21000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Premier,,41.05,,,,,,,28.95,56.16,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,33.95,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,937.00,,,,,,,127.05,3163.00,case rate,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,88.62,,,,,,,62.50,121.25,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,outpatient,,,2360.00000,2242.00000,The Alliance,Premier,TC,1673.24,,,,,,,1087.81,2289.20,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,GP,186.00,,,,,,,126.65,264.00,per diem,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier,,1714.64,,,,,,,97.50,1714.64,fee schedule,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,outpatient,1,EA,55.27000,52.50000,The Alliance,Premier,,39.19,,,,,,,27.64,53.61,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier,GP,186.00,,,,,,,55.50,264.00,per diem,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,GP,186.00,,,,,,,57.50,264.00,per diem,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,Premier,TC,633.14,,,,,,,437.23,1232.72,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier,,458.40,,,,,,,8.68,458.40,fee schedule,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier,GP,186.00,,,,,,,50.50,264.00,per diem,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,outpatient,1,EA,12.28000,11.66000,The Alliance,Premier,,8.71,,,,,,,6.14,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Premier,,14.79,,,,,,,10.43,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,outpatient,1,EA,12.22000,11.61000,The Alliance,Premier,,8.66,,,,,,,6.11,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,outpatient,1,EA,4.90000,4.65000,The Alliance,Premier,,3.47,,,,,,,2.45,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,outpatient,1,EA,19.31000,18.34000,The Alliance,Premier,,13.69,,,,,,,9.65,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.82,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,outpatient,,,1923.00000,1826.85000,The Alliance,Premier,TC,1363.41,,,,,,,905.36,2210.07,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier,TC,383.57,,,,,,,270.50,1232.72,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier,,2.40,,,,,,,1.69,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Premier,,16.24,,,,,,,11.46,22.22,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Premier,,763.98,,,,,,,14.60,763.98,fee schedule,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Premier,90,763.98,,,,,,,14.60,763.98,fee schedule,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,outpatient,1,EA,38.14000,36.23000,The Alliance,Premier,,27.04,,,,,,,19.07,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,outpatient,2,EA,40.56000,38.53000,The Alliance,Premier,,28.76,,,,,,,20.28,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,outpatient,2,EA,53.34000,50.67000,The Alliance,Premier,,37.82,,,,,,,26.67,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,outpatient,2,EA,31.38000,29.81000,The Alliance,Premier,,22.25,,,,,,,15.69,30.44,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,1426.03,,,,,,,56.40,1426.03,fee schedule,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier,,288.61,,,,,,,5.57,288.61,fee schedule,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,outpatient,1,EA,20.17000,19.17000,The Alliance,Premier,,14.30,,,,,,,10.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,outpatient,,,221.00000,209.95000,The Alliance,Premier,,156.69,,,,,,,121.55,5271.00,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,40.41,,,,,,,28.50,55.29,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Premier,,125.28,,,,,,,75.93,287.98,fee schedule,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier,,375.06,,,,,,,173.99,513.13,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,outpatient,1,EA,317.28000,301.41000,The Alliance,Premier,,224.95,,,,,,,158.64,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,outpatient,1,EA,259.49000,246.51000,The Alliance,Premier,,183.98,,,,,,,129.75,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Premier,,225.09,,,,,,,158.74,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Premier,,225.09,,,,,,,158.74,307.96,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,GP,186.00,,,,,,,61.00,264.00,per diem,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,outpatient,1,EA,105.16000,99.91000,The Alliance,Premier,,74.56,,,,,,,52.58,102.01,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,1137.41,,,,,,,32.50,1137.41,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,outpatient,5,EA,162.90000,154.76000,The Alliance,Premier,,4.77,,,,,,,4.63,158.01,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,outpatient,5,EA,12.64000,12.01000,The Alliance,Premier,,4.77,,,,,,,4.63,12.26,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Premier,,4.77,,,,,,,4.63,15.33,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,outpatient,5,EA,94.80000,90.06000,The Alliance,Premier,,4.77,,,,,,,4.63,91.96,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,outpatient,5,EA,28.44000,27.02000,The Alliance,Premier,,4.77,,,,,,,4.63,27.59,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,outpatient,5,EA,18.96000,18.01000,The Alliance,Premier,,4.77,,,,,,,4.63,18.39,fee schedule,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,565.00000,536.75000,The Alliance,Premier,,400.58,,,,,,,242.89,548.05,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,340.32,,,,,,,240.00,465.60,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,288.61,,,,,,,5.67,288.61,fee schedule,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier,,13.06,,,,,,,9.21,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Premier,,2.47,,,,,,,1.75,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Premier,,12.27,,,,,,,8.65,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Premier,,8.23,,,,,,,5.80,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Premier,,8.23,,,,,,,5.80,11.26,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,outpatient,1,mL,369.91000,351.42000,The Alliance,Premier,,122.84,,,,,,,74.45,358.81,fee schedule,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,outpatient,1,EA,21.07000,20.01000,The Alliance,Premier,,14.94,,,,,,,10.54,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.54,2.99,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,,92.17,,,,,,,71.50,5271.00,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,937.00,,,,,,,50.60,3163.00,case rate,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,outpatient,1,EA,193.55000,183.87000,The Alliance,Premier,,137.23,,,,,,,96.78,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,outpatient,1,EA,203.22000,193.06000,The Alliance,Premier,,144.08,,,,,,,101.61,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,outpatient,1,EA,193.68000,184.00000,The Alliance,Premier,,137.32,,,,,,,96.84,187.87,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Premier,,3963.00,,,,,,,365.75,4686.00,case rate,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Premier,,125.28,,,,,,,75.93,287.98,fee schedule,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,outpatient,,,114.40000,108.68000,The Alliance,Premier,90,509.30,,,,,,,10.18,509.30,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier,,4.06,,,,,,,0.00500,4.06,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,4.06,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier,,4.06,,,,,,,0.01000,4.06,fee schedule,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,GP,186.00,,,,,,,57.50,264.00,per diem,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,outpatient,,,234.90000,223.16000,The Alliance,Premier,90,1052.52,,,,,,,20.91,1052.52,fee schedule,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,outpatient,1,mL,3.25000,3.08000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,outpatient,1,mL,2.27000,2.15000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,outpatient,1,mL,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,outpatient,1,mL,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Premier,,2.28,,,,,,,1.61,3.12,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,GP,186.00,,,,,,,28.50,264.00,per diem,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,outpatient,2,EA,919.61000,873.63000,The Alliance,Premier,,439.63,,,,,,,266.44,892.02,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,outpatient,2,EA,965.58000,917.30000,The Alliance,Premier,,439.63,,,,,,,266.44,936.61,fee schedule,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,outpatient,1,mL,335.14000,318.38000,The Alliance,Premier,,122.84,,,,,,,74.45,325.09,fee schedule,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Premier,,14.02,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,outpatient,1,EA,8.42000,8.00000,The Alliance,Premier,,5.97,,,,,,,4.21,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,30.00,58.20,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,30.00,58.20,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,outpatient,1,EA,15.30000,14.54000,The Alliance,Premier,,10.85,,,,,,,7.65,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.66930,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.81480,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.22,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.88,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,outpatient,1,mL,0.67000,0.63000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.64990,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.87300,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,outpatient,30,EA,2.29000,2.17000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.22,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.53,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.14,fee schedule,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,30.00,58.20,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,,492.33,,,,,,,9.58,492.33,fee schedule,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier,,3.07,,,,,,,2.17,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,outpatient,5,EA,3.25000,3.08000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,outpatient,5,EA,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,outpatient,5,EA,4.76000,4.52000,The Alliance,Premier,,3.37,,,,,,,2.38,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,outpatient,5,EA,3.07000,2.91000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,outpatient,5,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,outpatient,5,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,outpatient,5,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Premier,,2.15,,,,,,,1.51,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,outpatient,5,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,outpatient,5,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,outpatient,5,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,outpatient,5,EA,3.71000,3.53000,The Alliance,Premier,,2.63,,,,,,,1.85,3.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,outpatient,1,EA,462.47000,439.35000,The Alliance,Premier,,327.89,,,,,,,231.24,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,outpatient,1,EA,396.27000,376.46000,The Alliance,Premier,,280.96,,,,,,,198.13,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,outpatient,1,EA,399.12000,379.16000,The Alliance,Premier,,282.98,,,,,,,199.56,387.15,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,outpatient,20,EA,1.38000,1.31000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.34,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,outpatient,20,EA,1.16000,1.11000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.13,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.54320,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,outpatient,20,EA,1.42000,1.35000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.38,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,outpatient,20,EA,1.53000,1.45000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.48,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,outpatient,20,EA,1.36000,1.29000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.32,fee schedule,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier,,679.08,,,,,,,14.48,679.08,fee schedule,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier,,639.52,,,,,,,200.06,874.94,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1329.46,fee schedule,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Premier,,19.48,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier,,20.65,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,outpatient,400,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,outpatient,400,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,TC,442.00,,,,,,,37.00,442.00,per diem,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,outpatient,1,EA,172.07000,163.47000,The Alliance,Premier,,122.00,,,,,,,86.03,166.91,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,outpatient,250,EA,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,outpatient,250,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,outpatient,250,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,outpatient,250,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,outpatient,250,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,outpatient,28,EA,25.82000,24.53000,The Alliance,Premier,,18.31,,,,,,,12.91,25.05,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier,,20.65,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier,,2.96,,,,,,,2.08,4.04,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,662.12,,,,,,,13.91,662.12,fee schedule,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Premier,,20.57,,,,,,,14.51,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Premier,,3.76,,,,,,,2.65,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,5339.00000,5072.05000,The Alliance,Premier,,3785.35,,,,,,,416.78,5178.83,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,3666.93,,,,,,,69.33,3666.93,fee schedule,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,outpatient,1,EA,33.84000,32.15000,The Alliance,Premier,,23.99,,,,,,,16.92,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,outpatient,1,EA,31.84000,30.25000,The Alliance,Premier,,22.57,,,,,,,15.92,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,outpatient,1,GM,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,outpatient,1,GM,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,outpatient,1,GM,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,outpatient,1,GM,0.77000,0.74000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,outpatient,1,EA,14.60000,13.87000,The Alliance,Premier,,10.35,,,,,,,7.30,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,outpatient,,,913.00000,867.35000,The Alliance,Premier,TC,647.32,,,,,,,455.68,2210.07,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Premier,,42.80,,,,,,,30.18,58.55,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,outpatient,10,EA,37.19000,35.33000,The Alliance,Premier,,0.09900,,,,,,,0.08525,36.07,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,outpatient,10,EA,1.11000,1.05000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.08,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.53,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,outpatient,10,EA,3.48000,3.30000,The Alliance,Premier,,0.09900,,,,,,,0.08525,3.38,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,outpatient,10,EA,1.95000,1.85000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.89,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,outpatient,10,EA,3.59000,3.41000,The Alliance,Premier,,0.09900,,,,,,,0.08525,3.48,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,outpatient,10,EA,1.17000,1.12000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.13,fee schedule,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,135.79,,,,,,,2.70,135.79,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,outpatient,200,EA,0.63000,0.59000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.61110,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,outpatient,200,EA,1.22000,1.16000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.18,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,outpatient,200,EA,0.95000,0.90000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.92150,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,outpatient,200,EA,1.28000,1.22000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.24,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,outpatient,200,EA,1.14000,1.08000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.11,fee schedule,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Premier,,5.31,,,,,,,3.75,7.27,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Premier,90,1341.13,,,,,,,26.38,1341.13,fee schedule,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,outpatient,1,EA,2.17000,2.07000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier,,679.08,,,,,,,12.88,679.08,fee schedule,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,outpatient,50,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,outpatient,1,EA,56.35000,53.53000,The Alliance,Premier,,39.95,,,,,,,28.18,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,outpatient,1,EA,34.93000,33.19000,The Alliance,Premier,,24.77,,,,,,,17.46,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,outpatient,1,EA,58.08000,55.18000,The Alliance,Premier,,41.18,,,,,,,29.04,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,outpatient,1,EA,51.07000,48.51000,The Alliance,Premier,,36.21,,,,,,,25.54,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Premier,,29.91,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Premier,,29.91,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Premier,,47.72,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Premier,,47.72,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,outpatient,1,EA,60.57000,57.54000,The Alliance,Premier,,42.94,,,,,,,30.29,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,outpatient,1,EA,50.72000,48.18000,The Alliance,Premier,,35.96,,,,,,,25.36,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Premier,,21.28,,,,,,,15.01,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,outpatient,1,EA,58.08000,55.17000,The Alliance,Premier,,41.18,,,,,,,29.04,56.34,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,outpatient,1,EA,333.36000,316.69000,The Alliance,Premier,,236.35,,,,,,,166.68,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Premier,,19.48,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier,,20.65,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Premier,,3.11,,,,,,,2.19,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,outpatient,1,EA,283.39000,269.22000,The Alliance,Premier,,224.35,,,,,,,141.69,274.89,fee schedule,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,outpatient,1,EA,353.87000,336.18000,The Alliance,Premier,,224.35,,,,,,,176.94,343.25,fee schedule,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier,,8.20,,,,,,,7.57,198.85,fee schedule,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,288.61,,,,,,,5.51,288.61,fee schedule,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier,,1137.41,,,,,,,21.73,1137.41,fee schedule,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier,,574.73,,,,,,,11.53,574.73,fee schedule,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,outpatient,50,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,outpatient,50,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,outpatient,50,EA,0.55000,0.53000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,outpatient,50,EA,1.26000,1.19000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,outpatient,50,EA,1.37000,1.31000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,outpatient,50,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,outpatient,1,EA,6621.21000,6290.15000,The Alliance,Premier,,51.28,,,,,,,31.08,6422.57,fee schedule,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,628.12,,,,,,,12.05,628.12,fee schedule,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,458.40,,,,,,,8.61,458.40,fee schedule,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,outpatient,100,EA,0.78000,0.74000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.75660,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.18,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,outpatient,100,EA,0.95000,0.90000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.92150,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,outpatient,100,EA,1.26000,1.20000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.22,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,outpatient,100,EA,1.28000,1.22000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.24,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.18,fee schedule,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,outpatient,,,18565.90000,17637.60000,The Alliance,Premier,,8781.67,,,,,,,8521.75,18565.90,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,outpatient,133,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,outpatient,133,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,outpatient,133,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,outpatient,1,EA,49.86000,47.37000,The Alliance,Premier,,35.35,,,,,,,24.93,48.36,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,254.68,,,,,,,4.81,254.68,fee schedule,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,220.68,,,,,,,4.27,220.68,fee schedule,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,outpatient,120,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,outpatient,120,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,outpatient,50,EA,6.13000,5.82000,The Alliance,Premier,,4.35,,,,,,,3.06,5.95,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,outpatient,10,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,outpatient,10,EA,5.78000,5.49000,The Alliance,Premier,,4.10,,,,,,,2.89,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,outpatient,10,EA,3.42000,3.25000,The Alliance,Premier,,2.42,,,,,,,1.71,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,outpatient,10,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,outpatient,1,EA,15.92000,15.13000,The Alliance,Premier,,11.29,,,,,,,7.96,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,outpatient,1,EA,22.30000,21.18000,The Alliance,Premier,,15.81,,,,,,,11.15,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,outpatient,1,EA,23.50000,22.33000,The Alliance,Premier,,16.66,,,,,,,11.75,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,outpatient,1,EA,13.15000,12.49000,The Alliance,Premier,,9.32,,,,,,,6.58,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,outpatient,1,EA,20.33000,19.32000,The Alliance,Premier,,14.41,,,,,,,10.16,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,outpatient,1,EA,16.17000,15.36000,The Alliance,Premier,,11.46,,,,,,,8.09,15.68,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,outpatient,30,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,outpatient,30,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,outpatient,1,mL,5.10000,4.84000,The Alliance,Premier,,3.62,,,,,,,2.55,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,outpatient,1,mL,4.44000,4.22000,The Alliance,Premier,,3.15,,,,,,,2.22,4.31,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,628.12,,,,,,,12.31,628.12,fee schedule,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,outpatient,1,GM,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,outpatient,30,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,outpatient,15,EA,10.27000,9.76000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,outpatient,15,EA,9.38000,8.91000,The Alliance,Premier,,6.65,,,,,,,4.69,9.10,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,254.68,,,,,,,5.06,254.68,fee schedule,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,outpatient,500,EA,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.15000,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,outpatient,500,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.15000,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,outpatient,50,EA,1.44000,1.36000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,outpatient,50,EA,0.92000,0.88000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,outpatient,1,mL,987.52000,938.14000,The Alliance,Premier,,700.15,,,,,,,493.76,957.89,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,outpatient,,,359.60000,341.62000,The Alliance,Premier,90,1612.78,,,,,,,32.01,1612.78,fee schedule,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,outpatient,1,mL,426.59000,405.26000,The Alliance,Premier,,302.45,,,,,,,213.29,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,outpatient,1,mL,360.24000,342.23000,The Alliance,Premier,,255.41,,,,,,,180.12,349.43,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier,,746.94,,,,,,,14.39,746.94,fee schedule,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,outpatient,45,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,outpatient,45,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,outpatient,45,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,outpatient,45,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17034.50000,16182.77000,The Alliance,Premier,,8057.32,,,,,,,7818.84,17034.50,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,outpatient,60,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier,,139.67,,,,,,,98.50,212.44,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier,,1216.68,,,,,,,5.99,1216.68,fee schedule,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,outpatient,10,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,outpatient,10,EA,6.12000,5.82000,The Alliance,Premier,,4.34,,,,,,,3.06,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,outpatient,10,EA,6.06000,5.76000,The Alliance,Premier,,4.30,,,,,,,3.03,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,outpatient,10,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,outpatient,10,EA,6.30000,5.99000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,outpatient,10,EA,10.45000,9.93000,The Alliance,Premier,,7.41,,,,,,,5.22,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,outpatient,1,EA,5.04000,4.79000,The Alliance,Premier,,3.57,,,,,,,2.52,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Premier,,3.03,,,,,,,2.13,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,outpatient,1,EA,53.17000,50.51000,The Alliance,Premier,,37.70,,,,,,,26.59,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Premier,,2.85,,,,,,,2.01,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,TC,3723.67,,,,,,,177.63,3723.67,fee schedule,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Premier,TC,3027.62,,,,,,,121.00,3027.62,fee schedule,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2771.00000,2632.45000,The Alliance,Premier,QN,1964.64,,,,,,,1385.50,2687.87,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,outpatient,1,EA,8.95000,8.51000,The Alliance,Premier,,6.35,,,,,,,2.17,8.68,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,763.98,,,,,,,16.07,763.98,fee schedule,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier,GN,186.00,,,,,,,126.65,321.07,per diem,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Premier,,87.52,,,,,,,61.72,119.74,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Premier,,8.52,,,,,,,6.00,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,outpatient,1,EA,16.88000,16.04000,The Alliance,Premier,,11.97,,,,,,,8.44,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier,GN,186.00,,,,,,,126.65,564.54,per diem,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Premier,,16.02,,,,,,,11.29,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,outpatient,1,mL,14.17000,13.46000,The Alliance,Premier,,10.05,,,,,,,7.08,13.74,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,outpatient,,,662.00000,628.90000,The Alliance,Premier,GN,186.00,,,,,,,126.65,642.14,per diem,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier,GN,186.00,,,,,,,119.00,264.00,per diem,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,GN,186.00,,,,,,,126.65,264.00,per diem,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,GN,186.00,,,,,,,126.65,264.00,per diem,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier,,3666.93,,,,,,,49.49,3666.93,fee schedule,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Premier,GN,186.00,,,,,,,126.65,326.89,per diem,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,QW,780.94,,,,,,,16.53,780.94,fee schedule,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,outpatient,1,mL,447.36000,425.00000,The Alliance,Premier,,317.18,,,,,,,223.68,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,outpatient,1,mL,485.51000,461.23000,The Alliance,Premier,,344.23,,,,,,,242.75,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,outpatient,1,mL,669.82000,636.33000,The Alliance,Premier,,474.90,,,,,,,334.91,649.73,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,1256.24,,,,,,,71.50,1256.24,fee schedule,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,100.68,,,,,,,71.00,137.74,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier,GN,186.00,,,,,,,126.65,433.59,per diem,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,GN,186.00,,,,,,,91.50,264.00,per diem,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Premier,,682.89,,,,,,,662.68,1443.75,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier,GN,186.00,,,,,,,53.50,264.00,per diem,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,outpatient,,,202.80000,192.66000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier,GN,186.00,,,,,,,126.65,264.00,per diem,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,Premier,GN,186.00,,,,,,,126.65,662.51,per diem,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier,GN,186.00,,,,,,,126.65,985.52,per diem,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Premier,GN,186.00,,,,,,,126.65,561.63,per diem,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier,GN,186.00,,,,,,,126.65,438.44,per diem,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,254.68,,,,,,,4.86,254.68,fee schedule,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,356.54,,,,,,,5.25,356.54,fee schedule,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Premier,GN,186.00,,,,,,,126.65,455.90,per diem,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,outpatient,5,EA,3.96000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,outpatient,5,EA,3.96000,3.76000,The Alliance,Premier,,2.81,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,outpatient,5,EA,3.84000,3.65000,The Alliance,Premier,,2.72,,,,,,,1.92,3.72,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,outpatient,,,1727.00000,1640.65000,The Alliance,Premier,TC,1224.44,,,,,,,863.50,1675.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,outpatient,10,EA,3.21000,3.05000,The Alliance,Premier,,2.28,,,,,,,1.60,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,outpatient,10,EA,2.86000,2.72000,The Alliance,Premier,,2.03,,,,,,,1.43,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,outpatient,10,EA,2.26000,2.15000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,outpatient,10,EA,2.59000,2.46000,The Alliance,Premier,,1.84,,,,,,,1.29,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier,,2.03,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,outpatient,10,EA,3.28000,3.11000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier,,2.03,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,outpatient,10,EA,2.98000,2.83000,The Alliance,Premier,,2.11,,,,,,,1.49,2.89,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier,,3.78,,,,,,,3.12,13.79,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,outpatient,1,EA,18.47000,17.55000,The Alliance,Premier,,3.78,,,,,,,3.12,17.92,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Premier,,3.78,,,,,,,3.12,18.70,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,outpatient,1,EA,35.42000,33.65000,The Alliance,Premier,,3.78,,,,,,,3.12,34.36,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,outpatient,1,EA,17.15000,16.29000,The Alliance,Premier,,3.78,,,,,,,3.12,16.64,fee schedule,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier,,219.79,,,,,,,155.00,1239.81,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,outpatient,1,EA,24.50000,23.28000,The Alliance,Premier,,17.37,,,,,,,12.25,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,outpatient,1,EA,1.25000,1.18000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,outpatient,1,EA,1.82000,1.72000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,outpatient,1,EA,1.87000,1.77000,The Alliance,Premier,,1.33,,,,,,,0.93500,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,outpatient,5,EA,300.20000,285.19000,The Alliance,Premier,,212.84,,,,,,,150.10,291.19,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Premier,,65.52,,,,,,,38.28,74.27,fee schedule,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,outpatient,0.5,EA,153.14000,145.48000,The Alliance,Premier,,65.52,,,,,,,60.56,148.55,fee schedule,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,outpatient,1,EA,26.23000,24.92000,The Alliance,Premier,,18.60,,,,,,,13.12,25.44,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier,,367.97,,,,,,,48.58,503.43,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,outpatient,30,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Premier,GN,186.00,,,,,,,126.65,366.66,per diem,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,0.24750,,,,,,,0.24015,1.45,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,0.24750,,,,,,,0.24015,1.42,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Premier,,0.24750,,,,,,,0.24015,3.98,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier,,0.24750,,,,,,,0.24015,2.54,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.24750,,,,,,,0.24015,1.13,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,0.24750,,,,,,,0.24015,3.38,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.24750,,,,,,,0.24015,0.90210,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,outpatient,1,EA,6.26000,5.95000,The Alliance,Premier,,0.24750,,,,,,,0.24015,6.07,fee schedule,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier,TC,222.63,,,,,,,157.00,304.58,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Premier,GN,186.00,,,,,,,126.65,470.45,per diem,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,746.94,,,,,,,14.18,746.94,fee schedule,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,,1324.17,,,,,,,25.47,1324.17,fee schedule,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,outpatient,,,294.00000,279.30000,The Alliance,Premier,,208.45,,,,,,,161.70,5271.00,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,outpatient,,,5159.00000,4901.05000,The Alliance,Premier,,17537.00,,,,,,,1475.05,17574.00,case rate,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Premier,GN,186.00,,,,,,,126.65,440.38,per diem,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,outpatient,1,mL,4070.06000,3866.55000,The Alliance,Premier,,53.28,,,,,,,32.29,3947.96,fee schedule,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,outpatient,1,mL,3296.38000,3131.56000,The Alliance,Premier,,53.28,,,,,,,32.29,3197.49,fee schedule,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,outpatient,1,mL,2714.00000,2578.30000,The Alliance,Premier,,53.28,,,,,,,32.29,2632.58,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier,,0.24750,,,,,,,0.24015,2.67,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,outpatient,1,EA,18.87000,17.93000,The Alliance,Premier,,0.24750,,,,,,,0.24015,18.30,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Premier,,0.24750,,,,,,,0.24015,18.02,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier,,0.24750,,,,,,,0.24015,2.81,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier,,0.24750,,,,,,,0.24015,4.19,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier,,0.24750,,,,,,,0.24015,4.67,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Premier,,0.24750,,,,,,,0.24015,2.21,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,0.24750,,,,,,,0.24015,3.52,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.24750,,,,,,,0.24015,0.58200,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier,,0.24750,,,,,,,0.24015,3.40,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,outpatient,1,EA,4.72000,4.49000,The Alliance,Premier,,0.24750,,,,,,,0.24015,4.58,fee schedule,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Premier,,106.42,,,,,,,75.05,145.60,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,,1103.49,,,,,,,21.23,1103.49,fee schedule,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,outpatient,0.5,EA,47.34000,44.97000,The Alliance,Premier,,33.56,,,,,,,23.67,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,outpatient,0.5,EA,151.68000,144.10000,The Alliance,Premier,,107.54,,,,,,,75.84,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,outpatient,0.5,EA,352.92000,335.28000,The Alliance,Premier,,250.22,,,,,,,176.46,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,outpatient,0.5,EA,352.91000,335.27000,The Alliance,Premier,,250.21,,,,,,,176.46,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,outpatient,0.5,EA,164.32000,156.10000,The Alliance,Premier,,116.50,,,,,,,82.16,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,outpatient,0.5,EA,69.52000,66.04000,The Alliance,Premier,,49.29,,,,,,,34.76,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,outpatient,0.5,EA,309.68000,294.20000,The Alliance,Premier,,219.56,,,,,,,154.84,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,outpatient,0.5,EA,20.22000,19.21000,The Alliance,Premier,,14.34,,,,,,,10.11,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,outpatient,0.5,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier,,15.60,,,,,,,11.00,21.34,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier,,2.98,,,,,,,2.10,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,outpatient,1,EA,6.02000,5.72000,The Alliance,Premier,,4.27,,,,,,,3.01,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,outpatient,1,EA,5.48000,5.21000,The Alliance,Premier,,3.89,,,,,,,2.74,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,outpatient,1,EA,9.54000,9.06000,The Alliance,Premier,,6.76,,,,,,,4.77,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Premier,,4.06,,,,,,,2.86,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,,258.79,,,,,,,182.50,743.46,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,Premier,,299.20,,,,,,,200.06,409.34,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier,,678.51,,,,,,,478.50,1267.58,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,305.58,,,,,,,5.77,305.58,fee schedule,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,237.65,,,,,,,4.40,237.65,fee schedule,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,237.65,,,,,,,4.40,237.65,fee schedule,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,outpatient,1,EA,4.49000,4.26000,The Alliance,Premier,,3.18,,,,,,,2.25,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,outpatient,2,EA,15.72000,14.93000,The Alliance,Premier,,2.95,,,,,,,2.72,15.25,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,outpatient,2,EA,10.11000,9.61000,The Alliance,Premier,,2.95,,,,,,,2.72,9.81,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,outpatient,2,EA,10.39000,9.87000,The Alliance,Premier,,2.95,,,,,,,2.72,10.08,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,outpatient,2,EA,10.93000,10.39000,The Alliance,Premier,,2.95,,,,,,,2.72,10.60,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,outpatient,2,EA,9.65000,9.17000,The Alliance,Premier,,2.95,,,,,,,2.72,9.36,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,outpatient,2,EA,8.90000,8.46000,The Alliance,Premier,,2.95,,,,,,,2.72,8.63,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,outpatient,2,EA,13.49000,12.81000,The Alliance,Premier,,2.95,,,,,,,2.72,13.09,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Premier,,2.95,,,,,,,2.72,9.51,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,outpatient,2,EA,14.83000,14.09000,The Alliance,Premier,,2.95,,,,,,,2.72,14.39,fee schedule,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Premier,,11.91,,,,,,,8.40,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Premier,,6.83,,,,,,,4.82,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Premier,,3.78,,,,,,,2.67,5.17,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier,,1.87,,,,,,,1.32,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,1137.41,,,,,,,24.11,1137.41,fee schedule,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Premier,90,780.94,,,,,,,15.49,780.94,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Premier,,4.52,,,,,,,2.06,4.52,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier,,4.52,,,,,,,1.91,4.52,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,4.52,,,,,,,2.19,12.26,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,outpatient,1,EA,62.25000,59.14000,The Alliance,Premier,,4.52,,,,,,,2.19,60.38,fee schedule,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,831.84,,,,,,,16.06,831.84,fee schedule,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,Premier,,937.00,,,,,,,450.45,3163.00,case rate,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,696.05,,,,,,,11.13,696.05,fee schedule,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,outpatient,1,mL,10.44000,9.92000,The Alliance,Premier,,7.40,,,,,,,5.22,10.13,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,305.58,,,,,,,6.01,305.58,fee schedule,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,outpatient,1,EA,226.79000,215.45000,The Alliance,Premier,,160.79,,,,,,,113.39,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,outpatient,1,EA,227.93000,216.53000,The Alliance,Premier,,161.60,,,,,,,113.97,221.09,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,outpatient,,,2006.00000,1905.70000,The Alliance,Premier,TC,1422.25,,,,,,,957.00,2210.07,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,882.80,,,,,,,16.62,882.80,fee schedule,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Premier,,2461.58,,,,,,,46.98,2461.58,fee schedule,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,outpatient,,,1987.00000,1887.65000,The Alliance,Premier,TC,1408.78,,,,,,,960.65,2210.07,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier,,288.61,,,,,,,5.50,288.61,fee schedule,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Premier,,19.72,,,,,,,13.90,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,outpatient,1,EA,64.09000,60.89000,The Alliance,Premier,,45.44,,,,,,,32.05,62.17,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,96.42,,,,,,,68.00,187.21,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Premier,TC,568.62,,,,,,,389.35,2210.07,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,outpatient,2,EA,14.52000,13.79000,The Alliance,Premier,,10.29,,,,,,,7.26,14.08,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier,,2.02,,,,,,,1.43,2.76,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,1646.71,,,,,,,19.16,1646.71,fee schedule,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,,746.94,,,,,,,14.14,746.94,fee schedule,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,outpatient,1,EA,3.04000,2.89000,The Alliance,Premier,,2.16,,,,,,,1.52,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier,,1.39,,,,,,,0.98000,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,475.37,,,,,,,9.02,475.37,fee schedule,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Premier,TC,2235.48,,,,,,,1479.13,3058.41,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,305.58,,,,,,,5.88,305.58,fee schedule,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,,882.80,,,,,,,16.80,882.80,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,outpatient,2,EA,3.84000,3.65000,The Alliance,Premier,,4.06,,,,,,,1.92,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Premier,,4.06,,,,,,,2.47,16.78,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,outpatient,2,EA,3.13000,2.97000,The Alliance,Premier,,4.06,,,,,,,1.56,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,outpatient,2,EA,3.81000,3.62000,The Alliance,Premier,,4.06,,,,,,,1.91,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,outpatient,2,EA,2.84000,2.70000,The Alliance,Premier,,4.06,,,,,,,1.42,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,outpatient,2,EA,5.36000,5.09000,The Alliance,Premier,,4.06,,,,,,,2.47,5.20,fee schedule,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,outpatient,,,2168.00000,2059.60000,The Alliance,Premier,TC,1537.11,,,,,,,1050.98,2210.07,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Premier,TC,1785.26,,,,,,,1163.40,2442.46,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier,,7.70,,,,,,,5.43,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,outpatient,1,EA,8.91000,8.47000,The Alliance,Premier,,6.32,,,,,,,4.46,8.64,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,outpatient,1,EA,1681.35000,1597.28000,The Alliance,Premier,,952.13,,,,,,,577.05,1630.91,fee schedule,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier,,6756.70,,,,,,,70.04,6756.70,fee schedule,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,outpatient,1,EA,23.76000,22.57000,The Alliance,Premier,,16.85,,,,,,,11.88,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Premier,,16.85,,,,,,,11.88,23.05,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,outpatient,5,EA,64.51000,61.28000,The Alliance,Premier,,45.74,,,,,,,32.26,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,outpatient,5,EA,7.34000,6.98000,The Alliance,Premier,,5.20,,,,,,,3.67,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,outpatient,5,EA,7.43000,7.05000,The Alliance,Premier,,5.27,,,,,,,3.71,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,outpatient,5,EA,9.80000,9.31000,The Alliance,Premier,,6.95,,,,,,,4.90,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,outpatient,5,EA,9.79000,9.30000,The Alliance,Premier,,6.94,,,,,,,4.89,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,outpatient,1,EA,2662.25000,2529.14000,The Alliance,Premier,,2.21,,,,,,,1.97,2582.38,fee schedule,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Premier,,2.21,,,,,,,1.97,351.72,fee schedule,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,outpatient,1,EA,608.65000,578.22000,The Alliance,Premier,,2.21,,,,,,,1.97,590.39,fee schedule,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,356.54,,,,,,,6.87,356.54,fee schedule,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,543.65,,,,,,,11.53,543.65,fee schedule,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Premier,,831.84,,,,,,,15.91,831.84,fee schedule,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,outpatient,2,EA,3.67000,3.48000,The Alliance,Premier,,88.11,,,,,,,1.83,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,outpatient,2,EA,3.60000,3.42000,The Alliance,Premier,,88.11,,,,,,,1.80,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,outpatient,2,EA,55.42000,52.65000,The Alliance,Premier,,88.11,,,,,,,27.71,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,outpatient,2,EA,33.79000,32.10000,The Alliance,Premier,,88.11,,,,,,,16.89,88.11,fee schedule,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier,,1341.13,,,,,,,25.81,1341.13,fee schedule,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,outpatient,1,EA,10.52000,10.00000,The Alliance,Premier,,7.46,,,,,,,5.26,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier,,4.25,,,,,,,3.00,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,outpatient,1,EA,5.26000,5.00000,The Alliance,Premier,,3.73,,,,,,,2.63,5.10,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier,,9.55,,,,,,,5.79,333.61,fee schedule,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier,,9.55,,,,,,,5.79,333.61,fee schedule,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,outpatient,0.5,EA,261.85000,248.76000,The Alliance,Premier,,185.65,,,,,,,130.93,253.99,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,outpatient,5,EA,114.66000,108.93000,The Alliance,Premier,,81.29,,,,,,,57.33,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,outpatient,5,EA,109.85000,104.36000,The Alliance,Premier,,77.88,,,,,,,54.92,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,outpatient,5,EA,134.53000,127.81000,The Alliance,Premier,,95.38,,,,,,,67.27,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,outpatient,5,EA,119.69000,113.71000,The Alliance,Premier,,84.86,,,,,,,59.84,116.10,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,28.01,,,,,,,19.75,38.31,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier,,7707.36,,,,,,,70.04,7707.36,fee schedule,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier,,27.26,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,outpatient,1,EA,20.31000,19.30000,The Alliance,Premier,,14.40,,,,,,,10.15,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,outpatient,1,EA,35.69000,33.91000,The Alliance,Premier,,25.30,,,,,,,17.84,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Premier,,22.65,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,outpatient,1,EA,7.99000,7.59000,The Alliance,Premier,,5.66,,,,,,,4.00,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,outpatient,1,EA,38.08000,36.17000,The Alliance,Premier,,27.00,,,,,,,19.04,36.94,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,Premier,90,7690.40,,,,,,,70.04,7690.40,fee schedule,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,outpatient,,,5977.00000,5678.15000,The Alliance,Premier,TC,4237.69,,,,,,,2988.50,7180.14,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,outpatient,2,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,outpatient,2,EA,6.45000,6.12000,The Alliance,Premier,,4.57,,,,,,,3.23,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Premier,,1.27,,,,,,,0.89500,1.74,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,outpatient,1,mL,13.87000,13.17000,The Alliance,Premier,,9.83,,,,,,,6.93,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,outpatient,1,mL,6.31000,6.00000,The Alliance,Premier,,4.47,,,,,,,3.15,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,outpatient,1,mL,9.70000,9.22000,The Alliance,Premier,,6.88,,,,,,,4.85,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,outpatient,1,mL,21.93000,20.84000,The Alliance,Premier,,15.55,,,,,,,10.96,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,outpatient,1,mL,9.23000,8.77000,The Alliance,Premier,,6.54,,,,,,,4.62,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier,,1.62,,,,,,,1.15,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,outpatient,1,mL,107.83000,102.44000,The Alliance,Premier,,2.21,,,,,,,1.97,104.60,fee schedule,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,outpatient,1,mL,118.50000,112.57000,The Alliance,Premier,,2.21,,,,,,,1.97,114.94,fee schedule,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,outpatient,1,EA,19.58000,18.60000,The Alliance,Premier,,13.88,,,,,,,9.79,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,outpatient,1,EA,56.44000,53.62000,The Alliance,Premier,,40.02,,,,,,,28.22,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,outpatient,1,EA,0.78000,0.75000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,outpatient,1,EA,1.50000,1.42000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Premier,TC,131.16,,,,,,,92.50,2210.07,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,outpatient,3.5,EA,223.32000,212.15000,The Alliance,Premier,,158.33,,,,,,,111.66,216.62,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,90,203.72,,,,,,,4.08,203.72,fee schedule,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Premier,,3.20,,,,,,,2.25,4.37,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,outpatient,1,EA,7235.17000,6873.41000,The Alliance,Premier,,283.70,,,,,,,171.94,7018.11,fee schedule,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,outpatient,1,EA,11815.83000,11225.04000,The Alliance,Premier,,283.70,,,,,,,171.94,11461.36,fee schedule,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Premier,,283.70,,,,,,,171.94,15291.85,fee schedule,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Premier,90,628.12,,,,,,,12.32,628.12,fee schedule,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,outpatient,5,EA,1.88000,1.79000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,outpatient,5,EA,3.27000,3.10000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,outpatient,5,EA,3.29000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier,,27.26,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier,,27.26,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,outpatient,1,EA,38.84000,36.90000,The Alliance,Premier,,27.54,,,,,,,19.42,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,outpatient,1,EA,37.34000,35.47000,The Alliance,Premier,,26.47,,,,,,,18.67,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,outpatient,1,EA,14.20000,13.49000,The Alliance,Premier,,10.07,,,,,,,7.10,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Premier,,3.45,,,,,,,2.44,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Premier,,22.65,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,outpatient,1,EA,10.65000,10.12000,The Alliance,Premier,,7.55,,,,,,,5.33,10.33,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,outpatient,1,EA,252.80000,240.16000,The Alliance,Premier,,4.06,,,,,,,2.47,245.22,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,outpatient,1,EA,218.47000,207.54000,The Alliance,Premier,,4.06,,,,,,,2.47,211.92,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,outpatient,1,EA,263.86000,250.67000,The Alliance,Premier,,4.06,,,,,,,2.47,255.94,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,outpatient,1,EA,245.53000,233.26000,The Alliance,Premier,,4.06,,,,,,,2.47,238.16,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,outpatient,1,EA,243.32000,231.15000,The Alliance,Premier,,4.06,,,,,,,2.47,236.02,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,outpatient,1,EA,244.43000,232.20000,The Alliance,Premier,,4.06,,,,,,,2.47,237.10,fee schedule,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier,TC,4496.60,,,,,,,360.00,4496.60,fee schedule,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,,543.22,,,,,,,10.63,543.22,fee schedule,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,186.75,,,,,,,3.67,186.75,fee schedule,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,outpatient,2.5,EA,200.57000,190.54000,The Alliance,Premier,,142.20,,,,,,,100.28,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,outpatient,2.5,EA,209.17000,198.71000,The Alliance,Premier,,148.30,,,,,,,104.58,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,outpatient,2.5,EA,158.96000,151.01000,The Alliance,Premier,,112.70,,,,,,,79.48,154.19,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,,662.12,,,,,,,12.76,662.12,fee schedule,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,outpatient,1,EA,6411.37000,6090.80000,The Alliance,Premier,,632.07,,,,,,,383.07,6219.03,fee schedule,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,outpatient,15,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,outpatient,15,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Premier,TC,2324.10,,,,,,,1489.61,7180.14,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,254.68,,,,,,,5.56,254.68,fee schedule,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,594.19,,,,,,,12.47,594.19,fee schedule,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,outpatient,1,EA,6835.14000,6493.38000,The Alliance,Premier,,3.05,,,,,,,1.85,6630.09,fee schedule,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,outpatient,1,EA,906.50000,861.18000,The Alliance,Premier,,3.05,,,,,,,1.85,879.30,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,outpatient,5,EA,7.64000,7.26000,The Alliance,Premier,,1.42,,,,,,,1.35,7.41,fee schedule,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,,594.19,,,,,,,11.53,594.19,fee schedule,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,746.94,,,,,,,14.39,746.94,fee schedule,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,outpatient,1,EA,1924.24000,1828.03000,The Alliance,Premier,,3.05,,,,,,,1.85,1866.51,fee schedule,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,outpatient,1,EA,276.50000,262.68000,The Alliance,Premier,,3.05,,,,,,,1.85,268.20,fee schedule,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.04,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,203.72,,,,,,,3.95,203.72,fee schedule,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,,3963.00,,,,,,,658.35,4686.00,case rate,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Premier,,2640.00,,,,,,,118.25,3163.00,case rate,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,169.79,,,,,,,3.48,169.79,fee schedule,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,outpatient,15,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,outpatient,15,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,outpatient,15,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,,6094.58,,,,,,,59.00,6094.58,fee schedule,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,outpatient,,,794.00000,754.30000,The Alliance,Premier,TC,562.95,,,,,,,313.12,770.18,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier,,219.79,,,,,,,155.00,1239.81,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,outpatient,,,335.80000,319.01000,The Alliance,Premier,,238.08,,,,,,,23.25,325.73,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,237.65,,,,,,,4.52,237.65,fee schedule,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,Premier,,1086.52,,,,,,,20.81,1086.52,fee schedule,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,outpatient,1,EA,29.58000,28.10000,The Alliance,Premier,,1.42,,,,,,,1.35,28.69,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,outpatient,1,EA,25.56000,24.29000,The Alliance,Premier,,1.42,,,,,,,1.35,24.79,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier,,1.42,,,,,,,1.35,26.05,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,outpatient,1,EA,28.09000,26.69000,The Alliance,Premier,,1.42,,,,,,,1.35,27.25,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,outpatient,1,EA,16.59000,15.76000,The Alliance,Premier,,1.42,,,,,,,1.35,16.09,fee schedule,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,outpatient,1,EA,1.74000,1.66000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,305.58,,,,,,,5.74,305.58,fee schedule,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Premier,,4.91,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Premier,,4.91,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Premier,,8.22,,,,,,,5.79,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,outpatient,1,EA,9.27000,8.81000,The Alliance,Premier,,6.57,,,,,,,4.63,8.99,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier,TC,548.00,,,,,,,361.00,700.34,fee schedule,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,746.94,,,,,,,14.41,746.94,fee schedule,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier,,138.25,,,,,,,56.40,189.15,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,TC,548.00,,,,,,,169.00,584.87,fee schedule,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,outpatient,1,mL,1601.79000,1521.70000,The Alliance,Premier,,21.65,,,,,,,13.12,1553.74,fee schedule,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,outpatient,1,EA,30.15000,28.64000,The Alliance,Premier,,21.38,,,,,,,15.07,29.25,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier,,254.68,,,,,,,5.08,254.68,fee schedule,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier,,1086.52,,,,,,,20.81,1086.52,fee schedule,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,outpatient,1,mL,389.56000,370.08000,The Alliance,Premier,,40.44,,,,,,,24.51,377.87,fee schedule,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,outpatient,1,mL,2444.96000,2322.71000,The Alliance,Premier,,40.44,,,,,,,24.51,2371.61,fee schedule,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,outpatient,15,EA,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,outpatient,80,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,outpatient,80,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Premier,TC,2376.57,,,,,,,1676.00,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier,,9.55,,,,,,,5.79,333.61,fee schedule,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Premier,90,2665.30,,,,,,,32.70,2665.30,fee schedule,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Premier,90,662.12,,,,,,,8.17,662.12,fee schedule,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,169.79,,,,,,,3.17,169.79,fee schedule,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,outpatient,,,5196.00000,4936.20000,The Alliance,Premier,90,27787.37,,,,,,,533.12,27787.37,fee schedule,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,806.07,fee schedule,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,outpatient,,,729.00000,692.55000,The Alliance,Premier,TC,548.00,,,,,,,364.50,707.13,fee schedule,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Premier,TC,548.00,,,,,,,208.50,584.87,fee schedule,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,outpatient,60,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,outpatient,60,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,outpatient,60,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,TC,548.00,,,,,,,215.27,548.00,fee schedule,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,outpatient,1,mL,246.06000,233.75000,The Alliance,Premier,,21.93,,,,,,,13.29,238.68,fee schedule,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1085.43,fee schedule,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier,TC,548.00,,,,,,,348.00,675.12,fee schedule,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Premier,,152.82,,,,,,,3.05,152.82,fee schedule,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier,,814.87,,,,,,,15.50,814.87,fee schedule,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Premier,TC,548.00,,,,,,,290.50,584.87,fee schedule,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,548.00,,,,,,,133.50,584.87,fee schedule,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,outpatient,1,EA,25.18000,23.92000,The Alliance,Premier,,17.85,,,,,,,12.59,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,outpatient,1,EA,12.70000,12.07000,The Alliance,Premier,,9.00,,,,,,,6.35,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Premier,,2.70,,,,,,,1.91,3.70,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,90,254.68,,,,,,,5.67,254.68,fee schedule,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,TC,548.00,,,,,,,154.77,548.00,fee schedule,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,713.01,,,,,,,13.54,713.01,fee schedule,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,outpatient,15,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,outpatient,15,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,outpatient,15,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,outpatient,15,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Premier,TC,548.00,,,,,,,384.16,824.50,fee schedule,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Premier,TC,548.00,,,,,,,320.50,621.77,fee schedule,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1004.92,fee schedule,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,outpatient,,,963.00000,914.85000,The Alliance,Premier,TC,548.00,,,,,,,384.16,934.11,fee schedule,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier,TC,548.00,,,,,,,384.16,921.50,fee schedule,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,outpatient,15,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,outpatient,15,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,outpatient,15,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,outpatient,15,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,outpatient,15,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,outpatient,15,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1000.07,fee schedule,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,outpatient,5,EA,20.05000,19.04000,The Alliance,Premier,,14.22,,,,,,,10.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,outpatient,5,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,outpatient,5,EA,10.93000,10.38000,The Alliance,Premier,,7.75,,,,,,,5.46,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,outpatient,5,EA,2.28000,2.16000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,outpatient,5,EA,4.23000,4.02000,The Alliance,Premier,,3.00,,,,,,,2.12,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,outpatient,5,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Premier,TC,548.00,,,,,,,353.00,684.82,fee schedule,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,713.01,,,,,,,13.54,713.01,fee schedule,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,outpatient,1,mL,25.54000,24.26000,The Alliance,Premier,,18.11,,,,,,,12.77,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,outpatient,1,mL,11.85000,11.26000,The Alliance,Premier,,8.40,,,,,,,5.92,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,6.32,12.26,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,outpatient,1,EA,16.60000,15.77000,The Alliance,Premier,,11.77,,,,,,,8.30,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Premier,,18.77,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,outpatient,1,EA,9.77000,9.28000,The Alliance,Premier,,6.93,,,,,,,4.88,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Premier,,14.58,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,outpatient,1,EA,15.23000,14.47000,The Alliance,Premier,,10.80,,,,,,,7.62,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,outpatient,1,EA,12.83000,12.19000,The Alliance,Premier,,9.10,,,,,,,6.42,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,outpatient,1,EA,19.91000,18.91000,The Alliance,Premier,,14.12,,,,,,,9.96,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier,,11.54,,,,,,,8.13,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,outpatient,1,EA,16.62000,15.79000,The Alliance,Premier,,11.78,,,,,,,8.31,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier,,19.04,,,,,,,13.43,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier,,7.82,,,,,,,5.51,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,outpatient,1,EA,12.51000,11.89000,The Alliance,Premier,,8.87,,,,,,,6.25,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier,,11.65,,,,,,,8.21,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,outpatient,1,EA,6.54000,6.21000,The Alliance,Premier,,4.64,,,,,,,3.27,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,28.01,,,,,,,19.75,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Premier,,10.64,,,,,,,7.50,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,outpatient,1,EA,58.52000,55.59000,The Alliance,Premier,,41.49,,,,,,,29.26,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,outpatient,1,EA,91.70000,87.12000,The Alliance,Premier,,65.02,,,,,,,45.85,88.95,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1356.06,fee schedule,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier,TC,548.00,,,,,,,384.16,867.18,fee schedule,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,339.51,,,,,,,7.20,339.51,fee schedule,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Premier,,32587.46,,,,,,,157.68,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,outpatient,1,mL,52901.43000,50256.36000,The Alliance,Premier,,37507.11,,,,,,,157.68,51314.39,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,TC,548.00,,,,,,,110.28,548.00,fee schedule,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,outpatient,1,mL,16.99000,16.14000,The Alliance,Premier,,8.73,,,,,,,7.96,16.48,fee schedule,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,outpatient,1,EA,19.66000,18.67000,The Alliance,Premier,,13.94,,,,,,,3.02,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,3.02,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,outpatient,1,EA,51.45000,48.88000,The Alliance,Premier,,36.48,,,,,,,3.02,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,outpatient,1,EA,11.80000,11.21000,The Alliance,Premier,,8.37,,,,,,,3.02,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,3.02,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,outpatient,1,EA,50.69000,48.15000,The Alliance,Premier,,35.94,,,,,,,3.02,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier,,11.65,,,,,,,3.02,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,3.02,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,outpatient,1,EA,50.24000,47.73000,The Alliance,Premier,,35.62,,,,,,,3.02,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,outpatient,1,EA,13.59000,12.91000,The Alliance,Premier,,9.64,,,,,,,3.02,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Premier,,6.24,,,,,,,3.02,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,outpatient,1,EA,16.42000,15.60000,The Alliance,Premier,,11.64,,,,,,,3.02,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,3.02,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Premier,,13.42,,,,,,,3.02,18.36,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,outpatient,,,1068.00000,1014.60000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1035.96,fee schedule,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,outpatient,1,EA,23.41000,22.24000,The Alliance,Premier,,16.60,,,,,,,11.71,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier,,8.40,,,,,,,5.92,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,outpatient,1,EA,1.03000,0.97000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier,,2.62,,,,,,,1.85,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier,,2.40,,,,,,,1.69,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier,,10.19,,,,,,,7.18,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier,,8.22,,,,,,,5.80,11.25,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,Premier,TC,548.00,,,,,,,306.50,594.61,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier,,3.23,,,,,,,3.14,55.17,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,3.23,,,,,,,3.14,61.30,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,outpatient,1,mL,27.71000,26.32000,The Alliance,Premier,,3.23,,,,,,,3.14,26.88,fee schedule,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,outpatient,1,EA,25.79000,24.50000,The Alliance,Premier,,18.29,,,,,,,3.02,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,3.02,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,3.02,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,outpatient,1,EA,7.81000,7.41000,The Alliance,Premier,,5.54,,,,,,,3.02,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier,,15.68,,,,,,,3.02,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Premier,,3.74,,,,,,,2.64,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,outpatient,1,EA,25.41000,24.14000,The Alliance,Premier,,18.02,,,,,,,3.02,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Premier,,9.52,,,,,,,3.02,13.03,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Premier,,8.88,,,,,,,6.26,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,outpatient,1,EA,44.47000,42.25000,The Alliance,Premier,,31.53,,,,,,,22.23,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier,TC,1819.29,,,,,,,1283.00,2489.02,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier,,3.23,,,,,,,3.14,76.63,fee schedule,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier,,3.23,,,,,,,3.14,91.96,fee schedule,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier,TC,548.00,,,,,,,66.50,584.87,fee schedule,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,89.62,,,,,,,3.02,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,outpatient,1,EA,285.22000,270.96000,The Alliance,Premier,,202.22,,,,,,,3.02,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,outpatient,1,EA,63.17000,60.01000,The Alliance,Premier,,44.79,,,,,,,3.02,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,outpatient,1,EA,217.76000,206.87000,The Alliance,Premier,,154.39,,,,,,,3.02,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,outpatient,1,EA,95.12000,90.36000,The Alliance,Premier,,67.44,,,,,,,3.02,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,outpatient,1,EA,157.97000,150.07000,The Alliance,Premier,,112.00,,,,,,,3.02,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,outpatient,1,EA,251.22000,238.66000,The Alliance,Premier,,178.11,,,,,,,3.02,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,outpatient,1,EA,281.02000,266.97000,The Alliance,Premier,,199.24,,,,,,,3.02,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier,,67.21,,,,,,,3.02,91.96,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,outpatient,,,372.00000,353.40000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Premier,,545.22,,,,,,,384.50,745.93,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,outpatient,1,EA,37.70000,35.81000,The Alliance,Premier,,26.73,,,,,,,18.85,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Premier,,5.85,,,,,,,4.12,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,outpatient,1,EA,12.21000,11.60000,The Alliance,Premier,,8.66,,,,,,,6.11,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,3963.00,,,,,,,1475.05,4686.00,case rate,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,outpatient,,,888.00000,843.60000,The Alliance,Premier,TC,548.00,,,,,,,384.16,861.36,fee schedule,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,548.00,,,,,,,101.00,548.00,fee schedule,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,outpatient,1,EA,30.62000,29.09000,The Alliance,Premier,,21.71,,,,,,,3.02,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,3.02,27.59,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,outpatient,1,EA,36.27000,34.45000,The Alliance,Premier,,25.72,,,,,,,18.14,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,90,713.01,,,,,,,14.18,713.01,fee schedule,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,,1476.99,,,,,,,28.10,1476.99,fee schedule,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,outpatient,1,EA,5.20000,4.94000,The Alliance,Premier,,3.69,,,,,,,2.60,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,outpatient,1,EA,9.74000,9.26000,The Alliance,Premier,,6.91,,,,,,,4.87,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,271.65,,,,,,,5.82,271.65,fee schedule,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,Premier,,632.43,,,,,,,446.00,865.24,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,outpatient,2,EA,46.41000,44.09000,The Alliance,Premier,,32.90,,,,,,,23.20,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,outpatient,2,EA,28.92000,27.47000,The Alliance,Premier,,20.50,,,,,,,14.46,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,outpatient,2,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,outpatient,2,EA,50.80000,48.26000,The Alliance,Premier,,36.02,,,,,,,25.40,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Premier,,5.15,,,,,,,3.63,7.05,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,780.94,,,,,,,15.08,780.94,fee schedule,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier,,13.89,,,,,,,9.79,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,outpatient,1,EA,4.56000,4.33000,The Alliance,Premier,,3.23,,,,,,,2.28,4.42,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,Premier,TC,548.00,,,,,,,384.16,758.54,fee schedule,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,548.00,,,,,,,101.00,548.00,fee schedule,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Premier,90,1358.10,,,,,,,26.94,1358.10,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,outpatient,0.5,EA,29.99000,28.49000,The Alliance,Premier,,4.69,,,,,,,3.79,29.09,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,outpatient,0.5,EA,26.86000,25.52000,The Alliance,Premier,,4.69,,,,,,,3.79,26.05,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,outpatient,0.5,EA,154.73000,147.00000,The Alliance,Premier,,4.69,,,,,,,3.79,150.09,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,outpatient,0.5,EA,37.92000,36.02000,The Alliance,Premier,,4.69,,,,,,,3.79,36.78,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,outpatient,0.5,EA,11.38000,10.81000,The Alliance,Premier,,4.69,,,,,,,3.79,11.04,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,outpatient,0.5,EA,156.29000,148.48000,The Alliance,Premier,,4.69,,,,,,,3.79,151.60,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,outpatient,0.5,EA,39.50000,37.52000,The Alliance,Premier,,4.69,,,,,,,3.79,38.31,fee schedule,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,outpatient,1,EA,3.75000,3.57000,The Alliance,Premier,,2.66,,,,,,,1.88,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Premier,,4.99,,,,,,,3.52,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier,,2.46,,,,,,,1.74,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,outpatient,1,EA,6.52000,6.19000,The Alliance,Premier,,4.62,,,,,,,3.26,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier,TC,548.00,,,,,,,384.16,876.88,fee schedule,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Premier,90,1052.52,,,,,,,19.61,1052.52,fee schedule,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Premier,,4.65,,,,,,,3.28,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier,,3.38,,,,,,,2.38,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,outpatient,60,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,outpatient,60,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,outpatient,30,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,90,1850.43,,,,,,,17.93,1850.43,fee schedule,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,outpatient,1,EA,3.62000,3.44000,The Alliance,Premier,,2.57,,,,,,,1.81,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Premier,,4.52,,,,,,,3.19,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,outpatient,1,EA,6.80000,6.46000,The Alliance,Premier,,4.82,,,,,,,3.40,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Premier,90,797.91,,,,,,,16.32,797.91,fee schedule,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,TC,1430.78,,,,,,,137.50,1430.78,fee schedule,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier,TC,1193.49,,,,,,,101.94,1193.49,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,outpatient,1,EA,154.74000,147.00000,The Alliance,Premier,,4.69,,,,,,,3.79,150.10,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,outpatient,1,EA,151.66000,144.08000,The Alliance,Premier,,4.69,,,,,,,3.79,147.11,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,outpatient,1,EA,152.44000,144.82000,The Alliance,Premier,,4.69,,,,,,,3.79,147.87,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,outpatient,1,EA,150.13000,142.63000,The Alliance,Premier,,4.69,,,,,,,3.79,145.63,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,outpatient,1,EA,135.14000,128.39000,The Alliance,Premier,,4.69,,,,,,,3.79,131.09,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,outpatient,1,EA,135.15000,128.40000,The Alliance,Premier,,4.69,,,,,,,3.79,131.10,fee schedule,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,TC,896.81,,,,,,,58.00,896.81,fee schedule,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,outpatient,1,EA,3.76000,3.58000,The Alliance,Premier,,2.67,,,,,,,1.88,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Premier,,5.01,,,,,,,3.53,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier,,2.08,,,,,,,2.02,153.26,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Premier,,2.08,,,,,,,2.02,248.28,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,outpatient,1,EA,409.34000,388.88000,The Alliance,Premier,,2.08,,,,,,,2.02,397.06,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,outpatient,1,EA,72.68000,69.05000,The Alliance,Premier,,2.08,,,,,,,2.02,70.50,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier,,2.08,,,,,,,2.02,229.89,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,outpatient,1,EA,73.00000,69.35000,The Alliance,Premier,,2.08,,,,,,,2.02,70.81,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,outpatient,1,EA,272.22000,258.61000,The Alliance,Premier,,2.08,,,,,,,2.02,264.05,fee schedule,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,9.09,29.10,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,outpatient,1,EA,21.87000,20.77000,The Alliance,Premier,,1.57,,,,,,,1.03,21.21,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Premier,,1.57,,,,,,,1.03,21.43,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Premier,,1.57,,,,,,,1.03,14.64,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Premier,,1.57,,,,,,,1.03,8.37,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier,,1.57,,,,,,,1.03,10.42,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,outpatient,1,EA,21.84000,20.74000,The Alliance,Premier,,1.57,,,,,,,1.03,21.18,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier,,1.57,,,,,,,1.03,13.79,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,outpatient,1,EA,11.25000,10.69000,The Alliance,Premier,,1.57,,,,,,,1.03,10.91,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Premier,,1.57,,,,,,,1.03,8.39,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,1.57,,,,,,,1.03,5.45,fee schedule,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,outpatient,,,865.00000,821.75000,The Alliance,Premier,TC,548.00,,,,,,,384.16,839.05,fee schedule,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier,TC,1826.40,,,,,,,159.50,3015.65,fee schedule,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier,TC,1786.85,,,,,,,157.00,1786.85,fee schedule,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,outpatient,1,EA,26.49000,25.17000,The Alliance,Premier,,18.78,,,,,,,3.02,25.70,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,outpatient,1,EA,2.29000,2.18000,The Alliance,Premier,,1.62,,,,,,,1.15,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Premier,,4.32,,,,,,,3.05,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier,,2.48,,,,,,,1.75,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1082.00000,1027.90000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1049.54,fee schedule,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,outpatient,,,723.00000,686.85000,The Alliance,Premier,TC,3665.88,,,,,,,361.50,3665.88,fee schedule,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier,TC,1331.91,,,,,,,118.00,1964.22,fee schedule,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier,TC,1786.85,,,,,,,172.00,1786.85,fee schedule,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,2286.16,,,,,,,25.31,2286.16,fee schedule,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Premier,,771.58,,,,,,,748.74,1631.25,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,TC,1569.27,,,,,,,149.00,1569.27,fee schedule,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,611.15,,,,,,,11.67,611.15,fee schedule,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Premier,90,746.94,,,,,,,14.87,746.94,fee schedule,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Premier,,169.79,,,,,,,3.64,169.79,fee schedule,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Premier,TC,8808.48,,,,,,,905.50,8808.48,fee schedule,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,outpatient,,,157.10000,149.24000,The Alliance,Premier,90,713.01,,,,,,,13.99,713.01,fee schedule,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,outpatient,,,134.80000,128.06000,The Alliance,Premier,90,611.15,,,,,,,12.00,611.15,fee schedule,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier,TC,1331.91,,,,,,,136.98,1331.91,fee schedule,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,TC,1569.27,,,,,,,140.50,1569.27,fee schedule,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,90,882.80,,,,,,,8.17,882.80,fee schedule,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,Premier,TC,1865.95,,,,,,,184.50,1865.95,fee schedule,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,outpatient,,,208.30000,197.88000,The Alliance,Premier,90,797.91,,,,,,,16.32,797.91,fee schedule,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Premier,,1.80,,,,,,,1.27,2.46,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Premier,,3.82,,,,,,,2.69,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Premier,,7.17,,,,,,,5.05,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1094.55,,,,,,,111.13,1094.55,fee schedule,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,TC,1371.46,,,,,,,138.00,1371.46,fee schedule,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1094.55,,,,,,,111.13,1094.55,fee schedule,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,90,2020.22,,,,,,,17.50,2020.22,fee schedule,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier,TC,1193.49,,,,,,,108.00,1193.49,fee schedule,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,TC,1786.85,,,,,,,170.00,1786.85,fee schedule,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1331.91,,,,,,,126.50,1331.91,fee schedule,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,outpatient,,,1120.00000,1064.00000,The Alliance,Premier,TC,5663.55,,,,,,,560.00,5663.55,fee schedule,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,Premier,TC,2380.22,,,,,,,247.55,2380.22,fee schedule,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,TC,1094.55,,,,,,,100.00,1094.55,fee schedule,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier,TC,1569.27,,,,,,,160.92,1569.27,fee schedule,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Premier,,2.65,,,,,,,1.87,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Premier,,4.97,,,,,,,3.50,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier,TC,1813.71,,,,,,,128.10,1813.71,fee schedule,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier,TC,4002.11,,,,,,,372.00,4002.11,fee schedule,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,outpatient,,,755.00000,717.25000,The Alliance,Premier,TC,3764.75,,,,,,,377.50,3764.75,fee schedule,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,TC,857.19,,,,,,,83.00,857.19,fee schedule,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier,TC,1648.36,,,,,,,165.00,1648.36,fee schedule,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier,TC,1628.59,,,,,,,161.00,1628.59,fee schedule,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,TC,1549.49,,,,,,,144.00,1549.49,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Premier,,12.97,,,,,,,12.58,46.13,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,outpatient,1,mL,24.33000,23.12000,The Alliance,Premier,,12.97,,,,,,,12.16,23.60,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier,,12.97,,,,,,,12.58,26.05,fee schedule,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,TC,1094.55,,,,,,,111.00,1094.55,fee schedule,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,Premier,TC,1925.27,,,,,,,189.50,1925.27,fee schedule,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier,TC,1213.27,,,,,,,120.50,1213.27,fee schedule,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier,TC,1213.27,,,,,,,122.23,1213.27,fee schedule,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier,TC,1430.78,,,,,,,132.50,1430.78,fee schedule,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,TC,1786.85,,,,,,,170.00,1786.85,fee schedule,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier,TC,1628.59,,,,,,,166.47,1628.59,fee schedule,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1252.81,,,,,,,115.50,1252.81,fee schedule,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier,TC,1233.04,,,,,,,107.00,1233.04,fee schedule,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Premier,TC,3942.79,,,,,,,417.50,3942.79,fee schedule,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Premier,TC,5960.23,,,,,,,536.50,5960.23,fee schedule,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,outpatient,,,282.00000,267.90000,The Alliance,Premier,,1544.85,,,,,,,29.60,1544.85,fee schedule,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,TC,1509.95,,,,,,,137.50,1509.95,fee schedule,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier,TC,1945.04,,,,,,,203.31,1945.04,fee schedule,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,TC,2261.57,,,,,,,234.65,2261.57,fee schedule,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Premier,TC,1569.27,,,,,,,152.00,1569.27,fee schedule,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,TC,1233.04,,,,,,,123.50,1233.04,fee schedule,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,Premier,TC,1470.40,,,,,,,143.50,1470.40,fee schedule,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,Premier,TC,4417.51,,,,,,,431.00,4417.51,fee schedule,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier,TC,1331.91,,,,,,,125.00,1331.91,fee schedule,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,TC,1549.49,,,,,,,140.50,1549.49,fee schedule,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier,TC,1509.95,,,,,,,144.50,1509.95,fee schedule,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,outpatient,240,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,outpatient,240,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier,TC,1173.72,,,,,,,108.50,1173.72,fee schedule,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier,TC,1252.81,,,,,,,125.00,1252.81,fee schedule,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,TC,1114.32,,,,,,,104.50,1114.32,fee schedule,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,TC,1391.23,,,,,,,140.50,1391.23,fee schedule,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier,TC,1292.36,,,,,,,122.50,1292.36,fee schedule,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Premier,TC,1074.77,,,,,,,101.94,1074.77,fee schedule,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,1470.40,,,,,,,133.50,1470.40,fee schedule,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Premier,TC,5169.06,,,,,,,513.50,5169.06,fee schedule,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier,TC,1391.23,,,,,,,144.32,1391.23,fee schedule,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier,TC,5742.65,,,,,,,606.90,5742.65,fee schedule,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier,TC,1687.91,,,,,,,172.50,1687.91,fee schedule,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Premier,TC,1628.59,,,,,,,152.50,1628.59,fee schedule,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,TC,1648.36,,,,,,,161.50,1648.36,fee schedule,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Premier,TC,1391.23,,,,,,,142.47,1391.23,fee schedule,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,TC,1173.72,,,,,,,120.38,1173.72,fee schedule,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,TC,1272.59,,,,,,,129.58,1272.59,fee schedule,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Premier,TC,5821.82,,,,,,,290.00,5821.82,fee schedule,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,TC,738.55,,,,,,,74.29,738.55,fee schedule,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,TC,1074.77,,,,,,,93.00,1074.77,fee schedule,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Premier,TC,2676.90,,,,,,,278.89,2676.90,fee schedule,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Premier,TC,1549.49,,,,,,,159.07,1549.49,fee schedule,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Premier,TC,4437.28,,,,,,,448.00,4437.28,fee schedule,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,594.19,,,,,,,11.39,594.19,fee schedule,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,TC,1173.72,,,,,,,120.38,1173.72,fee schedule,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,outpatient,30,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier,TC,5149.29,,,,,,,403.50,5149.29,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,outpatient,1,mL,34.25000,32.54000,The Alliance,Premier,,8.58,,,,,,,8.33,33.22,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,8.58,,,,,,,4.74,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Premier,,8.58,,,,,,,5.53,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,outpatient,1,mL,7.43000,7.05000,The Alliance,Premier,,8.58,,,,,,,3.71,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier,,8.58,,,,,,,0.61000,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier,,8.58,,,,,,,0.49500,15.80,fee schedule,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,TC,1331.91,,,,,,,132.00,1331.91,fee schedule,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,outpatient,,,411.00000,390.45000,The Alliance,Premier,TC,2043.99,,,,,,,205.50,2043.99,fee schedule,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier,TC,3329.66,,,,,,,307.50,3329.66,fee schedule,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier,TC,5188.83,,,,,,,403.00,5188.83,fee schedule,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier,TC,1470.40,,,,,,,153.52,1470.40,fee schedule,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier,TC,1233.04,,,,,,,118.50,1233.04,fee schedule,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,TC,1668.14,,,,,,,131.50,1668.14,fee schedule,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,TC,1213.27,,,,,,,125.88,1213.27,fee schedule,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Premier,,10.81,,,,,,,7.62,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,outpatient,1,EA,9.68000,9.19000,The Alliance,Premier,,6.86,,,,,,,4.84,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,outpatient,1,EA,8.79000,8.35000,The Alliance,Premier,,6.23,,,,,,,4.39,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Premier,,6.20,,,,,,,4.38,8.49,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier,TC,1233.04,,,,,,,117.50,1233.04,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,outpatient,20,EA,4.32000,4.11000,The Alliance,Premier,,2.49,,,,,,,2.16,4.19,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,outpatient,20,EA,5.53000,5.25000,The Alliance,Premier,,2.49,,,,,,,2.35,5.36,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,outpatient,20,EA,4.61000,4.38000,The Alliance,Premier,,2.49,,,,,,,2.31,4.47,fee schedule,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,outpatient,,,1106.00000,1050.70000,The Alliance,Premier,TC,5703.10,,,,,,,553.00,5703.10,fee schedule,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Premier,TC,1549.49,,,,,,,156.00,1549.49,fee schedule,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Premier,,2.77,,,,,,,1.95,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,outpatient,1,EA,7.31000,6.94000,The Alliance,Premier,,5.18,,,,,,,3.65,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Premier,TC,2835.16,,,,,,,282.00,2835.16,fee schedule,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier,TC,1450.63,,,,,,,142.50,1450.63,fee schedule,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier,,3.08,,,,,,,2.17,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,outpatient,1,EA,5.99000,5.69000,The Alliance,Premier,,4.25,,,,,,,3.00,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Premier,,2.76,,,,,,,1.95,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier,,3.40,,,,,,,2.40,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,outpatient,1,EA,5.69000,5.41000,The Alliance,Premier,,4.03,,,,,,,2.85,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Premier,,2.67,,,,,,,1.88,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,outpatient,1,EA,7.62000,7.24000,The Alliance,Premier,,5.40,,,,,,,3.81,7.39,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier,TC,2024.21,,,,,,,178.00,2024.21,fee schedule,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier,TC,2340.67,,,,,,,230.00,2340.67,fee schedule,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Premier,TC,3725.20,,,,,,,370.00,3725.20,fee schedule,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier,TC,1892.80,,,,,,,238.63,3015.65,fee schedule,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,TC,1015.45,,,,,,,77.99,1015.45,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,outpatient,1,mL,477.84000,453.95000,The Alliance,Premier,,8.58,,,,,,,8.33,463.50,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,outpatient,1,mL,63.69000,60.51000,The Alliance,Premier,,8.58,,,,,,,8.33,61.78,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,outpatient,1,mL,21.94000,20.85000,The Alliance,Premier,,8.58,,,,,,,8.33,21.28,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Premier,,8.58,,,,,,,8.33,110.35,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier,,8.58,,,,,,,8.33,27.59,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier,,8.58,,,,,,,8.33,45.98,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Premier,,8.58,,,,,,,8.33,36.78,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Premier,,8.58,,,,,,,8.33,26.98,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,outpatient,1,mL,42.75000,40.61000,The Alliance,Premier,,8.58,,,,,,,8.33,41.47,fee schedule,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,TC,876.96,,,,,,,87.50,876.96,fee schedule,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier,TC,2439.54,,,,,,,234.50,2439.54,fee schedule,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier,TC,1193.49,,,,,,,108.50,1193.49,fee schedule,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier,,95.01,,,,,,,67.00,129.98,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Premier,TC,1529.72,,,,,,,157.22,1529.72,fee schedule,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier,TC,1509.95,,,,,,,151.00,1509.95,fee schedule,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,TC,1213.27,,,,,,,115.50,1213.27,fee schedule,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,outpatient,,,2119.00000,2013.05000,The Alliance,Premier,TC,19073.89,,,,,,,942.37,19073.89,fee schedule,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier,TC,1292.36,,,,,,,118.00,1292.36,fee schedule,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier,TC,1490.17,,,,,,,46.50,3015.65,fee schedule,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,38.99,,,,,,,27.50,134.64,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,34.74,,,,,,,24.50,47.53,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,outpatient,,,465.80000,442.51000,The Alliance,Premier,TC,1645.00,,,,,,,232.90,1820.00,per diem,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier,,2.84,,,,,,,0.33500,4.20,fee schedule,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,outpatient,1,mL,20.10000,19.10000,The Alliance,Premier,,31.09,,,,,,,10.05,35.77,fee schedule,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,outpatient,1,mL,17.85000,16.96000,The Alliance,Premier,,31.09,,,,,,,8.93,35.77,fee schedule,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Premier,,7803.00,,,,,,,1189.65,7803.00,case rate,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,outpatient,1,mL,165.78000,157.49000,The Alliance,Premier,,117.54,,,,,,,82.89,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,outpatient,1,mL,20.24000,19.22000,The Alliance,Premier,,14.35,,,,,,,10.12,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,outpatient,1,mL,20.26000,19.24000,The Alliance,Premier,,14.36,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,outpatient,1,mL,20.26000,19.25000,The Alliance,Premier,,14.36,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Premier,,12.55,,,,,,,8.85,17.17,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,outpatient,1,EA,4748.76000,4511.33000,The Alliance,Premier,,18.15,,,,,,,11.00,4606.30,fee schedule,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier,,263.04,,,,,,,185.50,359.87,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier,,54.45,,,,,,,33.00,783.52,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,outpatient,1,mL,7.05000,6.70000,The Alliance,Premier,,0.01650,,,,,,,0.01550,6.84,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,outpatient,1,mL,4.50000,4.28000,The Alliance,Premier,,0.01650,,,,,,,0.01550,4.37,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,outpatient,1,mL,7.74000,7.35000,The Alliance,Premier,,0.01650,,,,,,,0.01550,7.51,fee schedule,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,outpatient,1,EA,1951.28000,1853.72000,The Alliance,Premier,,41.33,,,,,,,25.05,1892.74,fee schedule,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,outpatient,10,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,outpatient,10,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Premier,,2122.08,,,,,,,191.50,2122.08,fee schedule,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,outpatient,1,EA,3584.37000,3405.15000,The Alliance,Premier,,125.70,,,,,,,76.18,3476.84,fee schedule,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,outpatient,1,mL,5.55000,5.27000,The Alliance,Premier,,0.11550,,,,,,,0.11207,5.38,fee schedule,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Premier,,0.11550,,,,,,,0.11207,10.73,fee schedule,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,152.82,,,,,,,2.99,152.82,fee schedule,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,186.75,,,,,,,4.00,186.75,fee schedule,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,1222.31,,,,,,,26.07,1222.31,fee schedule,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,254.68,,,,,,,4.72,254.68,fee schedule,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Premier,,4.49,,,,,,,1.23,5.23,fee schedule,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier,,1222.31,,,,,,,26.07,1222.31,fee schedule,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier,,220.68,,,,,,,4.27,220.68,fee schedule,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier,GY,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,outpatient,1,mL,1.06000,1.01000,The Alliance,Premier,GY,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Premier,GY,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier,,2.84,,,,,,,0.41000,4.20,fee schedule,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,outpatient,1,EA,7470.42000,7096.90000,The Alliance,Premier,,18.15,,,,,,,11.00,7246.31,fee schedule,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,outpatient,1,EA,254.92000,242.17000,The Alliance,Premier,,180.74,,,,,,,127.46,247.27,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier,,288.61,,,,,,,5.39,288.61,fee schedule,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,288.61,,,,,,,5.60,288.61,fee schedule,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier,TC,1499.73,,,,,,,158.62,1499.73,fee schedule,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,outpatient,,,2478.00000,2354.10000,The Alliance,Premier,,16444.87,,,,,,,162.71,16444.87,fee schedule,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,322.54,,,,,,,6.04,322.54,fee schedule,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Premier,TC,1000.40,,,,,,,705.50,1368.67,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier,,1018.59,,,,,,,19.63,1018.59,fee schedule,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,GO,186.00,,,,,,,18.50,264.00,per diem,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier,,3752.03,,,,,,,1388.02,5133.24,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,3038.81,,,,,,,61.00,3038.81,fee schedule,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,TC,1470.40,,,,,,,133.50,1470.40,fee schedule,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier,,57.43,,,,,,,40.50,134.64,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier,,137.55,,,,,,,97.00,212.44,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Premier,TC,818.89,,,,,,,577.50,1120.35,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,outpatient,1,mL,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,outpatient,1,mL,2.67000,2.54000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,TC,442.00,,,,,,,225.00,492.80,per diem,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,,882.80,,,,,,,16.80,882.80,fee schedule,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,outpatient,1,EA,0.45000,0.42000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.65960,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.92150,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.33950,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.87300,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Premier,,0.08250,,,,,,,0.08005,1.04,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier,,0.08250,,,,,,,0.08005,0.64990,fee schedule,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,780.94,,,,,,,15.05,780.94,fee schedule,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,305.58,,,,,,,5.37,305.58,fee schedule,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,outpatient,1,mL,1043.05000,990.90000,The Alliance,Premier,,140.66,,,,,,,85.25,1011.76,fee schedule,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,outpatient,1,mL,977.93000,929.03000,The Alliance,Premier,,140.66,,,,,,,85.25,948.59,fee schedule,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,254.68,,,,,,,4.24,254.68,fee schedule,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier,,797.91,,,,,,,15.32,797.91,fee schedule,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,203.72,,,,,,,4.29,203.72,fee schedule,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,,1833.46,,,,,,,37.27,1833.46,fee schedule,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier,,288.61,,,,,,,5.60,288.61,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,outpatient,1,EA,1320.90000,1254.86000,The Alliance,Premier,,9.42,,,,,,,5.71,1281.27,fee schedule,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier,,1052.52,,,,,,,77.53,1052.52,fee schedule,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,87.21,,,,,,,61.50,212.44,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,outpatient,1,mL,2.66000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Premier,,12.55,,,,,,,8.85,17.17,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,458.40,,,,,,,5.38,458.40,fee schedule,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,254.68,,,,,,,5.56,254.68,fee schedule,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,,458.40,,,,,,,8.62,458.40,fee schedule,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Premier,,7.00,,,,,,,4.24,616.02,fee schedule,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier,,937.00,,,,,,,392.70,5858.00,case rate,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,62.39,,,,,,,48.40,5271.00,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,62.39,,,,,,,48.40,5271.00,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,outpatient,1,mL,12.99000,12.34000,The Alliance,Premier,,8.33,,,,,,,6.50,12.60,fee schedule,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,27.96,,,,,,,26.11,147.44,fee schedule,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Premier,,26.82,,,,,,,25.05,74.76,fee schedule,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,88.62,,,,,,,62.50,121.25,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier,,2438.99,,,,,,,29.35,2438.99,fee schedule,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2195.00000,2085.25000,The Alliance,Premier,TC,1556.26,,,,,,,1097.50,2210.07,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Premier,TC,1422.96,,,,,,,940.41,2960.49,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier,TC,6594.41,,,,,,,4467.66,9021.97,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Premier,TC,2463.07,,,,,,,1364.86,7180.14,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Premier,TC,1544.20,,,,,,,1036.23,2210.07,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Premier,TC,873.49,,,,,,,466.73,2210.07,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,outpatient,,,1038.00000,986.10000,The Alliance,Premier,TC,735.94,,,,,,,84.70,1006.86,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Premier,TC,1558.38,,,,,,,1047.28,2210.07,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,8404.00,,,,,,,2632.30,11015.00,case rate,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier,,7803.00,,,,,,,3612.55,10015.25,case rate,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier,TC,1372.62,,,,,,,918.26,2960.49,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier,TC,529.62,,,,,,,282.87,724.59,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Premier,TC,855.05,,,,,,,455.68,2210.07,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier,,8404.00,,,,,,,5343.33,11015.00,case rate,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier,,7803.00,,,,,,,1801.27,7803.00,case rate,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,outpatient,,,4662.00000,4428.90000,The Alliance,Premier,,7803.00,,,,,,,1801.27,7803.00,case rate,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier,,8404.00,,,,,,,5343.33,11015.00,case rate,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,1645.00,,,,,,,72.50,1820.00,per diem,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3544.38,per diem,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier,,214.83,,,,,,,78.72,293.91,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier,90,254.68,,,,,,,5.25,254.68,fee schedule,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,outpatient,1,mL,503.59000,478.41000,The Alliance,Premier,,9.67,,,,,,,5.86,488.48,fee schedule,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier,,3.98,,,,,,,2.81,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,outpatient,1,EA,2.35000,2.24000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,763.98,,,,,,,14.55,763.98,fee schedule,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,outpatient,1,mL,10785.83000,10246.53000,The Alliance,Premier,,277.41,,,,,,,168.13,10462.26,fee schedule,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,outpatient,1,mL,4534.31000,4307.59000,The Alliance,Premier,,98.50,,,,,,,59.70,4398.28,fee schedule,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,outpatient,1,mL,2.17000,2.07000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Premier,90,3412.32,,,,,,,67.54,3412.32,fee schedule,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,outpatient,,,106.20000,100.89000,The Alliance,Premier,90,75.30,,,,,,,53.10,103.01,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,outpatient,,,1376.00000,1307.20000,The Alliance,Premier,90,7792.26,,,,,,,132.74,7792.26,fee schedule,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,outpatient,,,5754.00000,5466.30000,The Alliance,Premier,TC,4079.59,,,,,,,1631.86,5581.38,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,outpatient,,,4909.00000,4663.55000,The Alliance,Premier,,7803.00,,,,,,,2699.95,7803.00,case rate,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier,TC,2040.50,,,,,,,1114.22,2791.66,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Premier,TC,3672.62,,,,,,,1273.18,5024.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Premier,,1332.92,,,,,,,81.69,1823.60,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Premier,,153.25,,,,,,,148.72,324.00,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,outpatient,,,70906.00000,67360.70000,The Alliance,Premier,,65769.77,,,,,,,6083.48,68778.82,fee schedule,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,outpatient,,,1634.00000,1552.30000,The Alliance,Premier,TC,1158.51,,,,,,,671.89,1584.98,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,97.84,,,,,,,69.00,212.44,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,outpatient,,,5032.00000,4780.40000,The Alliance,Premier,,3567.69,,,,,,,2516.00,5156.10,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,outpatient,,,2892.00000,2747.40000,The Alliance,Premier,,18061.43,,,,,,,1446.00,18061.43,fee schedule,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,outpatient,,,589.00000,559.55000,The Alliance,Premier,,417.60,,,,,,,288.84,1203.43,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Premier,,486.24,,,,,,,325.11,1028.00,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier,TC,3297.56,,,,,,,380.83,4511.47,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,outpatient,,,2232.00000,2120.40000,The Alliance,Premier,TC,1582.49,,,,,,,837.18,2210.07,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier,,627.47,,,,,,,122.40,858.45,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,937.00,,,,,,,122.40,5271.00,case rate,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,outpatient,1,mL,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,outpatient,1,mL,55.71000,52.93000,The Alliance,Premier,,39.50,,,,,,,27.86,54.04,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier,,281.47,,,,,,,218.35,5271.00,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,52.47,,,,,,,37.00,71.78,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier,,1.53,,,,,,,1.08,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,outpatient,1,GM,316.85000,301.01000,The Alliance,Premier,,224.65,,,,,,,158.43,307.34,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,outpatient,,,504.00000,478.80000,The Alliance,Premier,,357.34,,,,,,,252.00,488.88,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,outpatient,,,1145.00000,1087.75000,The Alliance,Premier,,811.80,,,,,,,629.75,5271.00,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Premier,,1525.06,,,,,,,1183.05,5271.00,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,,26.23,,,,,,,18.50,35.89,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,outpatient,,,1103.00000,1047.85000,The Alliance,Premier,,782.03,,,,,,,606.65,5271.00,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier,,246.02,,,,,,,173.50,336.59,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,outpatient,,,1542.00000,1464.90000,The Alliance,Premier,,1093.28,,,,,,,848.10,5271.00,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,outpatient,,,1023.00000,971.85000,The Alliance,Premier,,725.31,,,,,,,562.65,5271.00,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,144.64,,,,,,,23.25,197.88,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Premier,,65.52,,,,,,,38.28,74.27,fee schedule,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,outpatient,1,mL,153.14000,145.48000,The Alliance,Premier,,65.52,,,,,,,60.56,148.55,fee schedule,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier,,937.00,,,,,,,179.85,3163.00,case rate,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,Premier,TC,6707.24,,,,,,,384.29,6707.24,fee schedule,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,outpatient,,,2192.00000,2082.40000,The Alliance,Premier,,1554.13,,,,,,,1205.60,5271.00,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Premier,,0.26400,,,,,,,0.19995,7.69,fee schedule,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Premier,,0.26400,,,,,,,0.19995,3.19,fee schedule,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,outpatient,1,mL,3.25000,3.09000,The Alliance,Premier,,0.26400,,,,,,,0.19995,3.15,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.64,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,outpatient,1,mL,6.47000,6.14000,The Alliance,Premier,,0.36300,,,,,,,0.33945,6.28,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,outpatient,1,mL,12.23000,11.62000,The Alliance,Premier,,0.36300,,,,,,,0.33945,11.86,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,outpatient,1,mL,6.03000,5.73000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.85,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Premier,,0.36300,,,,,,,0.33945,7.69,fee schedule,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,3.24,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Premier,,381.44,,,,,,,269.00,521.86,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,outpatient,,,3127.00000,2970.65000,The Alliance,Premier,,2217.04,,,,,,,1563.50,3388.98,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,outpatient,,,2098.00000,1993.10000,The Alliance,Premier,,1487.48,,,,,,,1049.00,2035.06,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,outpatient,1,GM,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier,,281.47,,,,,,,218.35,5271.00,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Premier,,1.39,,,,,,,0.69000,1.39,fee schedule,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier,,1.39,,,,,,,1.07,2.09,fee schedule,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,outpatient,1,EA,126.59000,120.26000,The Alliance,Premier,,89.75,,,,,,,63.30,122.79,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,outpatient,1,EA,0.97000,0.93000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier,,1.84,,,,,,,1.30,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Premier,,5.06,,,,,,,3.57,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier,,2.46,,,,,,,1.74,3.37,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,outpatient,1,EA,3.34000,3.18000,The Alliance,Premier,,2.37,,,,,,,1.67,3.24,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Premier,,4.18,,,,,,,2.95,5.72,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,outpatient,1,mL,13.23000,12.57000,The Alliance,Premier,,9.38,,,,,,,6.62,12.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier,,2.58,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier,,2.58,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,outpatient,1,mL,31.25000,29.69000,The Alliance,Premier,,37.32,,,,,,,15.62,39.57,fee schedule,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier,,1.47,,,,,,,1.03,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,outpatient,1,GM,154.10000,146.40000,The Alliance,Premier,,109.26,,,,,,,77.05,149.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,outpatient,1,EA,149.05000,141.60000,The Alliance,Premier,,105.68,,,,,,,74.53,144.58,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Premier,,0.13200,,,,,,,0.11935,16.46,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,outpatient,1,GM,13.38000,12.71000,The Alliance,Premier,,0.13200,,,,,,,0.11935,12.98,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,outpatient,1,GM,10.01000,9.51000,The Alliance,Premier,,0.13200,,,,,,,0.11935,9.71,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Premier,,0.13200,,,,,,,0.11935,16.46,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,outpatient,1,GM,6.32000,6.00000,The Alliance,Premier,,0.13200,,,,,,,0.11935,6.13,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,outpatient,1,GM,12.25000,11.64000,The Alliance,Premier,,0.13200,,,,,,,0.11935,11.88,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,outpatient,1,GM,4.23000,4.02000,The Alliance,Premier,,0.13200,,,,,,,0.11935,4.10,fee schedule,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,outpatient,1,EA,8081.09000,7677.04000,The Alliance,Premier,,5729.49,,,,,,,4040.55,8747.08,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,28.43,,,,,,,0.47500,31.64,fee schedule,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.82,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier,,2.58,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,56.30,,,,,,,0.23500,83.12,fee schedule,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,outpatient,1,mL,2.06000,1.96000,The Alliance,Premier,,87.58,,,,,,,1.03,88.11,fee schedule,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,89.62,,,,,,,63.20,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,outpatient,1,EA,264.15000,250.94000,The Alliance,Premier,,187.28,,,,,,,132.07,256.23,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Premier,,3.14,,,,,,,2.21,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,outpatient,1,EA,6.31000,5.99000,The Alliance,Premier,,4.47,,,,,,,3.15,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,outpatient,1,mL,23.23000,22.07000,The Alliance,Premier,,16.47,,,,,,,11.62,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,outpatient,1,mL,33.95000,32.25000,The Alliance,Premier,,24.07,,,,,,,16.98,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,outpatient,1,mL,9.47000,8.99000,The Alliance,Premier,,6.71,,,,,,,4.74,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,outpatient,1,mL,26.76000,25.43000,The Alliance,Premier,,18.97,,,,,,,13.38,25.96,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,outpatient,,,3442.00000,3269.90000,The Alliance,Premier,,2440.38,,,,,,,1343.28,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier,,918.15,,,,,,,647.50,1885.25,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,outpatient,1,mL,2.18000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier,,0.13200,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier,,0.13200,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.13200,,,,,,,0.11935,0.61110,fee schedule,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier,,4.31,,,,,,,0.36500,4.31,fee schedule,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,outpatient,1,mL,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,outpatient,1,EA,11533.00000,10956.35000,The Alliance,Premier,,379.93,,,,,,,230.26,11187.01,fee schedule,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,outpatient,1,mL,40.61000,38.58000,The Alliance,Premier,,28.79,,,,,,,20.30,39.39,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,8.56,,,,,,,0.79000,8.57,fee schedule,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,outpatient,1,mL,540.41000,513.39000,The Alliance,Premier,,383.15,,,,,,,270.20,524.20,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,1.02,,,,,,,0.30000,1.02,fee schedule,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,outpatient,1,mL,42.81000,40.67000,The Alliance,Premier,,30.35,,,,,,,21.41,41.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,outpatient,1,EA,15.50000,14.73000,The Alliance,Premier,,10.99,,,,,,,7.75,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Premier,,8.71,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier,,15.96,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Premier,,0.80850,,,,,,,0.78449,8.21,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,outpatient,1,EA,10.58000,10.05000,The Alliance,Premier,,0.80850,,,,,,,0.78449,10.26,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,0.80850,,,,,,,0.78449,1.99,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier,,0.80850,,,,,,,0.78449,6.90,fee schedule,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Premier,,6.75,,,,,,,4.09,11.89,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,outpatient,1,mL,16.95000,16.10000,The Alliance,Premier,,0.75900,,,,,,,0.59830,16.44,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,outpatient,1,mL,13.45000,12.77000,The Alliance,Premier,,0.75900,,,,,,,0.59830,13.05,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,outpatient,1,mL,16.54000,15.72000,The Alliance,Premier,,0.75900,,,,,,,0.59830,16.04,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier,,0.75900,,,,,,,0.59830,9.81,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,outpatient,1,mL,20.44000,19.42000,The Alliance,Premier,,0.75900,,,,,,,0.59830,19.83,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Premier,,0.75900,,,,,,,0.59830,20.03,fee schedule,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,outpatient,1,EA,19.82000,18.82000,The Alliance,Premier,,14.05,,,,,,,9.91,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,outpatient,1,EA,12.31000,11.69000,The Alliance,Premier,,8.73,,,,,,,6.16,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,outpatient,1,EA,11.08000,10.53000,The Alliance,Premier,,7.86,,,,,,,5.54,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier,,2.98,,,,,,,2.10,4.07,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier,,2.54,,,,,,,1.54,4.84,fee schedule,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier,,15.96,,,,,,,11.26,21.83,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,outpatient,1,EA,8343.84000,7926.65000,The Alliance,Premier,,5915.78,,,,,,,709.27,8093.52,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,outpatient,1,mL,17.85000,16.95000,The Alliance,Premier,,12.66,,,,,,,8.93,17.31,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,outpatient,1,EA,494.41000,469.68000,The Alliance,Premier,,0.79200,,,,,,,0.73160,479.58,fee schedule,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,outpatient,1,EA,15.58000,14.80000,The Alliance,Premier,,11.05,,,,,,,7.79,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier,,2.58,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.04950,,,,,,,0.04803,0.31040,fee schedule,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,56.30,,,,,,,0.16000,83.12,fee schedule,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier,,2.46,,,,,,,1.49,4.02,fee schedule,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier,,2.58,,,,,,,1.82,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,outpatient,1,EA,93.95000,89.25000,The Alliance,Premier,,66.61,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,outpatient,1,EA,29.95000,28.45000,The Alliance,Premier,,21.23,,,,,,,14.97,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier,,3.27,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,outpatient,1,mL,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,outpatient,1,mL,67.32000,63.95000,The Alliance,Premier,,47.73,,,,,,,33.66,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,outpatient,1,mL,22.00000,20.90000,The Alliance,Premier,,15.60,,,,,,,11.00,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.04,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,outpatient,1,mL,10.92000,10.38000,The Alliance,Premier,,7.74,,,,,,,5.46,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,outpatient,1,mL,6.02000,5.72000,The Alliance,Premier,,4.27,,,,,,,3.01,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,outpatient,1,mL,16.59000,15.76000,The Alliance,Premier,,11.76,,,,,,,8.29,16.09,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,outpatient,1,EA,1.64000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier,,0.97842,,,,,,,0.69000,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Premier,,13.02,,,,,,,9.18,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,outpatient,1,EA,25.47000,24.20000,The Alliance,Premier,,18.06,,,,,,,12.73,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier,,32.08,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,outpatient,1,EA,20.34000,19.32000,The Alliance,Premier,,14.42,,,,,,,10.17,19.73,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,outpatient,1,EA,800.41000,760.39000,The Alliance,Premier,,37.32,,,,,,,22.62,776.40,fee schedule,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,outpatient,1,EA,659.80000,626.81000,The Alliance,Premier,,37.32,,,,,,,22.62,640.01,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,outpatient,1,EA,8073.00000,7669.35000,The Alliance,Premier,,7.49,,,,,,,4.54,7830.81,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,outpatient,1,EA,1258.61000,1195.68000,The Alliance,Premier,,7.49,,,,,,,4.54,1220.85,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,outpatient,1,EA,8253.21000,7840.55000,The Alliance,Premier,,7.49,,,,,,,4.54,8005.61,fee schedule,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier,,0.79200,,,,,,,0.73160,275.87,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,outpatient,1,mL,11.66000,11.08000,The Alliance,Premier,,1.02,,,,,,,0.93155,11.31,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,outpatient,1,mL,19.36000,18.39000,The Alliance,Premier,,1.02,,,,,,,0.93155,18.78,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Premier,,1.02,,,,,,,0.93155,8.45,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Premier,,1.02,,,,,,,0.93155,17.86,fee schedule,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,outpatient,1,EA,1024.57000,973.34000,The Alliance,Premier,,173.17,,,,,,,104.95,993.83,fee schedule,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,outpatient,1,EA,2067.60000,1964.22000,The Alliance,Premier,,1644.04,,,,,,,996.39,2005.57,fee schedule,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,2.46,,,,,,,0.47500,2.61,fee schedule,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Premier,,290.10,,,,,,,74.67,290.17,fee schedule,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,outpatient,1,mL,9.36000,8.90000,The Alliance,Premier,,6.64,,,,,,,4.68,9.08,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Premier,,2.12,,,,,,,1.50,2.90,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,outpatient,1,GM,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,outpatient,1,mL,177.67000,168.78000,The Alliance,Premier,,9.67,,,,,,,5.86,172.34,fee schedule,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,outpatient,1,mL,187.70000,178.32000,The Alliance,Premier,,9.67,,,,,,,5.86,182.07,fee schedule,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,outpatient,1,mL,119.78000,113.79000,The Alliance,Premier,,9.67,,,,,,,5.86,116.19,fee schedule,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier,,2.02,,,,,,,1.43,2.76,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,outpatient,1,EA,2.71000,2.58000,The Alliance,Premier,,1.92,,,,,,,1.35,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,outpatient,1,EA,83.83000,79.64000,The Alliance,Premier,,59.44,,,,,,,41.91,81.32,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Premier,,4.06,,,,,,,2.86,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier,,12.49,,,,,,,8.81,17.09,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,outpatient,1,mL,73.39000,69.72000,The Alliance,Premier,,52.03,,,,,,,36.70,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,outpatient,1,mL,26.33000,25.02000,The Alliance,Premier,,18.67,,,,,,,13.16,25.54,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Premier,,8.71,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier,,15.96,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,outpatient,1,GM,193.93000,184.24000,The Alliance,Premier,,137.50,,,,,,,96.97,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,outpatient,1,GM,247.45000,235.08000,The Alliance,Premier,,175.44,,,,,,,123.72,240.03,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,4.31,,,,,,,0.16000,4.31,fee schedule,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,outpatient,1,EA,41.65000,39.57000,The Alliance,Premier,,29.53,,,,,,,20.82,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier,,3.07,,,,,,,2.17,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,outpatient,1,mL,230.68000,219.15000,The Alliance,Premier,,110.88,,,,,,,83.42,223.76,fee schedule,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,outpatient,1,mL,277.83000,263.94000,The Alliance,Premier,,110.88,,,,,,,83.42,269.50,fee schedule,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier,,32.08,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Premier,,3.03,,,,,,,2.13,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Premier,,3.89,,,,,,,2.75,5.33,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,outpatient,1,GM,63.71000,60.52000,The Alliance,Premier,,45.17,,,,,,,31.86,61.80,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Premier,,11.37,,,,,,,10.61,22.93,fee schedule,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Premier,,376.44,,,,,,,224.97,515.02,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Premier,,2.11,,,,,,,1.85,11.54,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,outpatient,1,mL,12.49000,11.87000,The Alliance,Premier,,2.11,,,,,,,1.85,12.12,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,outpatient,1,mL,7.51000,7.13000,The Alliance,Premier,,2.11,,,,,,,1.85,7.28,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Premier,,2.11,,,,,,,1.85,11.54,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,outpatient,1,mL,9.59000,9.11000,The Alliance,Premier,,2.11,,,,,,,1.85,9.30,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier,,2.11,,,,,,,1.66,3.22,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Premier,,2.11,,,,,,,1.45,2.81,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,outpatient,1,mL,3.44000,3.27000,The Alliance,Premier,,2.11,,,,,,,1.72,3.34,fee schedule,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,outpatient,1,GM,17.98000,17.08000,The Alliance,Premier,,12.75,,,,,,,8.99,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,outpatient,1,GM,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,outpatient,1,EA,511.78000,486.19000,The Alliance,Premier,,362.85,,,,,,,255.89,496.43,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,outpatient,1,EA,157.08000,149.23000,The Alliance,Premier,,34.48,,,,,,,33.41,152.37,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,outpatient,1,EA,180.75000,171.71000,The Alliance,Premier,,34.48,,,,,,,33.41,175.33,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,outpatient,1,EA,121.63000,115.55000,The Alliance,Premier,,34.48,,,,,,,33.41,117.98,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,outpatient,1,EA,159.45000,151.48000,The Alliance,Premier,,34.48,,,,,,,33.41,154.67,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,outpatient,1,EA,104.66000,99.43000,The Alliance,Premier,,34.48,,,,,,,33.41,101.52,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,outpatient,1,EA,96.95000,92.10000,The Alliance,Premier,,34.48,,,,,,,33.41,94.04,fee schedule,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,outpatient,1,mL,17.10000,16.25000,The Alliance,Premier,,12.12,,,,,,,8.55,16.59,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Premier,,8.52,,,,,,,6.00,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,outpatient,1,GM,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,outpatient,1,GM,1.53000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,outpatient,1,GM,124.12000,117.92000,The Alliance,Premier,,88.00,,,,,,,62.06,120.40,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,outpatient,1,GM,9.43000,8.96000,The Alliance,Premier,,6.69,,,,,,,4.71,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier,,1.58,,,,,,,1.11,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier,,1.98,,,,,,,1.40,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,outpatient,1,mL,21.07000,20.01000,The Alliance,Premier,,14.94,,,,,,,10.54,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier,,17.92,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,outpatient,1,mL,40.82000,38.78000,The Alliance,Premier,,28.94,,,,,,,20.41,39.60,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,outpatient,1,EA,2.87000,2.72000,The Alliance,Premier,,2.03,,,,,,,1.44,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier,,4.42,,,,,,,3.12,6.04,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,outpatient,1,EA,4700.21000,4465.20000,The Alliance,Premier,,92.42,,,,,,,56.01,4559.20,fee schedule,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,outpatient,1,EA,3.71000,3.53000,The Alliance,Premier,,2.63,,,,,,,1.85,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier,,3.30,,,,,,,2.33,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,outpatient,1,EA,5.58000,5.31000,The Alliance,Premier,,3.96,,,,,,,2.79,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.12,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Premier,,3.33,,,,,,,2.35,4.56,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier,,2.82,,,,,,,1.99,3.86,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,outpatient,1,EA,142.79000,135.65000,The Alliance,Premier,,0.08250,,,,,,,0.05000,138.51,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,outpatient,1,EA,17.12000,16.26000,The Alliance,Premier,,0.08250,,,,,,,0.05000,16.61,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier,,0.08250,,,,,,,0.05000,3.49,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier,,0.08250,,,,,,,0.05000,3.12,fee schedule,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,outpatient,1,EA,27.33000,25.96000,The Alliance,Premier,,19.38,,,,,,,13.66,26.51,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,outpatient,1,EA,251.66000,239.08000,The Alliance,Premier,,0.28050,,,,,,,0.23715,244.11,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,outpatient,1,EA,1245.79000,1183.50000,The Alliance,Premier,,0.28050,,,,,,,0.23715,1208.42,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,outpatient,1,EA,1424.50000,1353.27000,The Alliance,Premier,,0.28050,,,,,,,0.23715,1381.77,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier,,0.28050,,,,,,,0.23715,229.89,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,outpatient,1,EA,226.21000,214.90000,The Alliance,Premier,,0.28050,,,,,,,0.23715,219.42,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,outpatient,1,EA,295.71000,280.93000,The Alliance,Premier,,0.28050,,,,,,,0.23715,286.84,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,outpatient,1,EA,1315.72000,1249.93000,The Alliance,Premier,,0.28050,,,,,,,0.23715,1276.25,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,outpatient,1,EA,280.13000,266.13000,The Alliance,Premier,,0.28050,,,,,,,0.23715,271.73,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier,,0.28050,,,,,,,0.23715,14.73,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier,,0.28050,,,,,,,0.23715,275.87,fee schedule,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Premier,,3.04,,,,,,,1.84,251.23,fee schedule,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,outpatient,1,mL,265.48000,252.20000,The Alliance,Premier,,3.04,,,,,,,1.84,257.52,fee schedule,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier,,3.06,,,,,,,2.16,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,outpatient,1,EA,6.45000,6.13000,The Alliance,Premier,,4.57,,,,,,,3.23,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,outpatient,1,GM,6.43000,6.11000,The Alliance,Premier,,4.56,,,,,,,3.21,6.24,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,outpatient,1,GM,93.82000,89.13000,The Alliance,Premier,,66.52,,,,,,,46.91,91.01,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,outpatient,1,EA,6.41000,6.09000,The Alliance,Premier,,4.54,,,,,,,3.21,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier,,2.39,,,,,,,1.69,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Premier,,2.75,,,,,,,1.94,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,outpatient,1,EA,2.70000,2.56000,The Alliance,Premier,,1.91,,,,,,,1.35,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier,,2.42,,,,,,,1.71,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,outpatient,1,mL,30.17000,28.66000,The Alliance,Premier,,21.39,,,,,,,15.09,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier,,2.27,,,,,,,1.60,3.10,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,3.48,,,,,,,2.21,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Premier,,3.48,,,,,,,2.45,4.86,fee schedule,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,outpatient,1,mL,146.16000,138.85000,The Alliance,Premier,,103.63,,,,,,,73.08,141.78,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,outpatient,1,EA,406.81000,386.47000,The Alliance,Premier,,288.43,,,,,,,203.41,394.61,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,outpatient,1,EA,10.92000,10.38000,The Alliance,Premier,,7.74,,,,,,,5.46,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier,,8.22,,,,,,,5.80,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier,,3.40,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Premier,,0.06600,,,,,,,0.06404,3.12,fee schedule,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,outpatient,1,mL,43.04000,40.89000,The Alliance,Premier,,6.81,,,,,,,6.48,41.75,fee schedule,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,outpatient,1,EA,6.33000,6.01000,The Alliance,Premier,,1.39,,,,,,,1.28,6.14,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,outpatient,1,EA,24.61000,23.38000,The Alliance,Premier,,1.39,,,,,,,1.28,23.87,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,1.39,,,,,,,1.28,4.29,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,1.39,,,,,,,1.28,4.91,fee schedule,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,outpatient,1,mL,5.86000,5.57000,The Alliance,Premier,,4.15,,,,,,,2.93,5.68,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Premier,,3.48,,,,,,,2.60,5.05,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,outpatient,1,mL,4.37000,4.15000,The Alliance,Premier,,3.48,,,,,,,2.19,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Premier,,3.48,,,,,,,3.38,8.09,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,outpatient,1,mL,8.47000,8.05000,The Alliance,Premier,,3.48,,,,,,,3.38,8.22,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,outpatient,1,mL,4.56000,4.34000,The Alliance,Premier,,3.48,,,,,,,2.28,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier,,3.48,,,,,,,1.50,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,outpatient,1,mL,3.31000,3.14000,The Alliance,Premier,,3.48,,,,,,,1.66,4.86,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Premier,,1.39,,,,,,,1.23,2.38,fee schedule,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,outpatient,1,GM,10.36000,9.84000,The Alliance,Premier,,7.35,,,,,,,5.18,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,outpatient,1,GM,8.28000,7.86000,The Alliance,Premier,,5.87,,,,,,,4.14,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,outpatient,1,GM,4.48000,4.25000,The Alliance,Premier,,3.18,,,,,,,2.24,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,outpatient,1,GM,10.34000,9.83000,The Alliance,Premier,,7.33,,,,,,,5.17,10.03,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier,,3.40,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier,,6.95,,,,,,,4.90,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier,,3.67,,,,,,,2.58,5.01,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,outpatient,1,EA,27.93000,26.54000,The Alliance,Premier,,19.80,,,,,,,13.96,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Premier,,58.99,,,,,,,41.60,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,outpatient,1,EA,27.65000,26.27000,The Alliance,Premier,,19.60,,,,,,,13.82,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,outpatient,1,EA,17.89000,16.99000,The Alliance,Premier,,12.68,,,,,,,8.95,17.35,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,outpatient,1,EA,2.48000,2.35000,The Alliance,Premier,,1.76,,,,,,,1.24,2.41,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,outpatient,1,GM,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,outpatient,1,EA,24.16000,22.96000,The Alliance,Premier,,17.13,,,,,,,12.08,23.44,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,outpatient,1,EA,7.03000,6.68000,The Alliance,Premier,,4.98,,,,,,,3.52,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,outpatient,1,EA,15.83000,15.04000,The Alliance,Premier,,11.22,,,,,,,7.92,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Premier,,5.98,,,,,,,4.22,8.19,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,outpatient,1,EA,18.30000,17.38000,The Alliance,Premier,,2.03,,,,,,,1.86,17.75,fee schedule,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,outpatient,1,EA,59.37000,56.40000,The Alliance,Premier,,2.03,,,,,,,1.86,57.59,fee schedule,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Premier,,3.04,,,,,,,2.15,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,outpatient,1,EA,2.89000,2.75000,The Alliance,Premier,,2.05,,,,,,,1.45,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,1.33,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,outpatient,1,mL,31.44000,29.87000,The Alliance,Premier,,22.29,,,,,,,1.33,30.50,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,outpatient,1,EA,414.40000,393.68000,The Alliance,Premier,,66.63,,,,,,,50.35,401.97,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier,,66.63,,,,,,,50.35,183.91,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,outpatient,1,EA,100.11000,95.10000,The Alliance,Premier,,66.63,,,,,,,50.05,97.11,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,outpatient,1,EA,153.86000,146.17000,The Alliance,Premier,,66.63,,,,,,,50.35,149.24,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,outpatient,1,EA,515.41000,489.64000,The Alliance,Premier,,66.63,,,,,,,50.35,499.95,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,outpatient,1,EA,751.10000,713.54000,The Alliance,Premier,,66.63,,,,,,,50.35,728.57,fee schedule,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,outpatient,1,mL,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Premier,,12.07,,,,,,,8.52,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Premier,,9.66,,,,,,,6.82,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Premier,,4.69,,,,,,,3.31,6.41,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,outpatient,1,EA,30.94000,29.39000,The Alliance,Premier,,2.03,,,,,,,1.86,30.01,fee schedule,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,outpatient,1,EA,67.73000,64.35000,The Alliance,Premier,,2.03,,,,,,,1.86,65.70,fee schedule,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier,,3.78,,,,,,,3.12,6.90,fee schedule,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Premier,,3.78,,,,,,,3.12,8.96,fee schedule,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,2.71,,,,,,,0.23500,2.71,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,outpatient,20,EA,1.90000,1.80000,The Alliance,Premier,,3.83,,,,,,,0.95000,3.83,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,outpatient,20,EA,0.39000,0.37000,The Alliance,Premier,,3.83,,,,,,,0.19500,3.83,fee schedule,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,outpatient,1,EA,12.12000,11.51000,The Alliance,Premier,,8.59,,,,,,,6.06,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier,,3.45,,,,,,,2.44,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier,,1.86,,,,,,,1.31,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,outpatient,1,EA,10.66000,10.13000,The Alliance,Premier,,7.56,,,,,,,5.33,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,outpatient,1,EA,443.95000,421.75000,The Alliance,Premier,,286.51,,,,,,,173.64,430.63,fee schedule,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,outpatient,1,EA,8136.71000,7729.88000,The Alliance,Premier,,286.51,,,,,,,173.64,7892.61,fee schedule,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,outpatient,1,EA,6780.60000,6441.57000,The Alliance,Premier,,286.51,,,,,,,173.64,6577.18,fee schedule,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,outpatient,1,mL,91.29000,86.72000,The Alliance,Premier,,44.67,,,,,,,43.34,88.55,fee schedule,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,outpatient,1,mL,78.87000,74.93000,The Alliance,Premier,,44.67,,,,,,,39.44,76.50,fee schedule,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,outpatient,1,mL,9.87000,9.38000,The Alliance,Premier,,7.00,,,,,,,4.93,9.57,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,outpatient,1,EA,8.44000,8.01000,The Alliance,Premier,,5.98,,,,,,,4.22,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,outpatient,1,EA,51.35000,48.78000,The Alliance,Premier,,36.41,,,,,,,25.68,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Premier,,7.00,,,,,,,4.94,9.58,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,1.39,,,,,,,1.28,6.13,fee schedule,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,outpatient,1,mL,4.12000,3.91000,The Alliance,Premier,,2.92,,,,,,,2.06,4.00,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,outpatient,1,EA,9.49000,9.02000,The Alliance,Premier,,6.73,,,,,,,4.75,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Premier,,7.42,,,,,,,5.23,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,outpatient,1,EA,9.23000,8.77000,The Alliance,Premier,,6.54,,,,,,,4.62,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,outpatient,1,EA,21.79000,20.70000,The Alliance,Premier,,15.45,,,,,,,10.89,21.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,outpatient,1,EA,76.88000,73.03000,The Alliance,Premier,,54.51,,,,,,,38.44,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,outpatient,1,EA,64.06000,60.86000,The Alliance,Premier,,45.42,,,,,,,32.03,62.14,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Premier,,4.81,,,,,,,3.39,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,outpatient,1,EA,8.17000,7.76000,The Alliance,Premier,,5.79,,,,,,,4.08,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,outpatient,1,EA,22.28000,21.16000,The Alliance,Premier,,15.80,,,,,,,11.14,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,outpatient,1,EA,4.89000,4.65000,The Alliance,Premier,,3.47,,,,,,,2.44,4.74,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,outpatient,1,mL,1.90000,1.81000,The Alliance,Premier,,0.06600,,,,,,,0.06045,1.84,fee schedule,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,outpatient,1,EA,122.99000,116.84000,The Alliance,Premier,,87.20,,,,,,,61.49,119.30,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Premier,,2.76,,,,,,,0.14500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Premier,,2.76,,,,,,,0.55000,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Premier,,2.76,,,,,,,0.33500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,outpatient,50,EA,0.75000,0.71000,The Alliance,Premier,,2.76,,,,,,,0.37500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Premier,,2.76,,,,,,,0.21500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,outpatient,50,EA,0.42000,0.40000,The Alliance,Premier,,2.76,,,,,,,0.21000,2.76,fee schedule,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier,,1.96,,,,,,,1.39,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier,,1.96,,,,,,,1.39,2.69,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier,,1.92,,,,,,,1.35,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.06600,,,,,,,0.06404,0.92150,fee schedule,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,outpatient,1,GM,6.83000,6.49000,The Alliance,Premier,,4.84,,,,,,,3.42,6.63,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,outpatient,1,GM,3.91000,3.71000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,outpatient,1,EA,7.08000,6.72000,The Alliance,Premier,,5.02,,,,,,,3.54,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,outpatient,1,EA,10.38000,9.86000,The Alliance,Premier,,7.36,,,,,,,5.19,10.07,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,outpatient,1,EA,17.09000,16.24000,The Alliance,Premier,,12.12,,,,,,,8.54,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,outpatient,1,EA,10.50000,9.98000,The Alliance,Premier,,7.44,,,,,,,5.25,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Premier,,4.50,,,,,,,3.17,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,outpatient,1,EA,18.34000,17.42000,The Alliance,Premier,,13.00,,,,,,,9.17,17.79,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,outpatient,1,mL,4.31000,4.09000,The Alliance,Premier,,3.06,,,,,,,2.15,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,outpatient,1,mL,1.50000,1.42000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Premier,,2.03,,,,,,,0.32500,2.03,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier,,3.22,,,,,,,0.48500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier,,3.22,,,,,,,0.63500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier,,3.22,,,,,,,0.88500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,3.22,,,,,,,0.95000,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier,,3.22,,,,,,,0.57000,4.75,fee schedule,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,outpatient,1,GM,7.87000,7.47000,The Alliance,Premier,,5.58,,,,,,,3.94,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,outpatient,1,GM,6.56000,6.23000,The Alliance,Premier,,4.65,,,,,,,3.28,6.36,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,outpatient,1,mL,46.93000,44.58000,The Alliance,Premier,,33.27,,,,,,,23.46,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,outpatient,1,mL,43.17000,41.01000,The Alliance,Premier,,30.61,,,,,,,21.59,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,outpatient,1,mL,42.74000,40.60000,The Alliance,Premier,,30.30,,,,,,,21.37,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,outpatient,1,mL,32.38000,30.76000,The Alliance,Premier,,22.96,,,,,,,16.19,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,outpatient,1,mL,15.72000,14.93000,The Alliance,Premier,,11.15,,,,,,,7.86,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,outpatient,1,GM,19.34000,18.37000,The Alliance,Premier,,13.71,,,,,,,9.67,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier,,8.46,,,,,,,7.77,153.26,fee schedule,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,outpatient,1,EA,158.63000,150.70000,The Alliance,Premier,,8.46,,,,,,,7.77,153.87,fee schedule,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,outpatient,1,GM,18.19000,17.28000,The Alliance,Premier,,12.90,,,,,,,9.10,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,outpatient,1,GM,26.20000,24.89000,The Alliance,Premier,,18.58,,,,,,,13.10,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,outpatient,1,GM,13.79000,13.10000,The Alliance,Premier,,9.78,,,,,,,6.89,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,outpatient,1,GM,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,outpatient,1,GM,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,outpatient,1,GM,6.55000,6.22000,The Alliance,Premier,,4.64,,,,,,,3.27,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,outpatient,1,GM,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,outpatient,1,GM,8.15000,7.74000,The Alliance,Premier,,5.78,,,,,,,4.08,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,outpatient,1,GM,0.87000,0.82000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,outpatient,1,GM,7.86000,7.47000,The Alliance,Premier,,5.57,,,,,,,3.93,7.62,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Premier,,1.39,,,,,,,1.28,8.37,fee schedule,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,outpatient,1,mL,1.66000,1.58000,The Alliance,Premier,,0.79200,,,,,,,0.76415,1.61,fee schedule,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,outpatient,1,mL,8.69000,8.26000,The Alliance,Premier,,6.16,,,,,,,4.34,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,outpatient,1,mL,7.34000,6.97000,The Alliance,Premier,,5.20,,,,,,,3.67,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,outpatient,1,mL,7.27000,6.90000,The Alliance,Premier,,5.15,,,,,,,3.63,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,outpatient,1,mL,7.99000,7.60000,The Alliance,Premier,,5.66,,,,,,,4.00,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,outpatient,1,mL,2.88000,2.74000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Premier,,4.71,,,,,,,3.32,6.44,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier,,7.17,,,,,,,5.05,9.81,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,outpatient,1,mL,5.07000,4.82000,The Alliance,Premier,,3.59,,,,,,,2.54,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,outpatient,1,mL,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,outpatient,1,GM,193.54000,183.86000,The Alliance,Premier,,137.22,,,,,,,96.77,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,outpatient,1,GM,223.33000,212.16000,The Alliance,Premier,,158.34,,,,,,,111.67,216.63,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,outpatient,1,mL,30.48000,28.95000,The Alliance,Premier,,21.61,,,,,,,15.24,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,outpatient,1,mL,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,outpatient,1,mL,3.56000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.78,3.45,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,outpatient,1,EA,195.57000,185.79000,The Alliance,Premier,,138.66,,,,,,,97.78,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,outpatient,1,EA,398.19000,378.28000,The Alliance,Premier,,282.32,,,,,,,199.09,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,outpatient,1,EA,195.79000,186.00000,The Alliance,Premier,,138.82,,,,,,,97.89,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,outpatient,1,EA,97.90000,93.00000,The Alliance,Premier,,69.41,,,,,,,48.95,94.96,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,outpatient,1,GM,21.61000,20.53000,The Alliance,Premier,,15.32,,,,,,,10.80,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,outpatient,1,GM,15.06000,14.31000,The Alliance,Premier,,10.68,,,,,,,7.53,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,outpatient,1,GM,13.12000,12.46000,The Alliance,Premier,,9.30,,,,,,,6.56,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,outpatient,1,GM,11.48000,10.91000,The Alliance,Premier,,8.14,,,,,,,5.74,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,outpatient,1,GM,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,outpatient,1,GM,2.62000,2.49000,The Alliance,Premier,,1.86,,,,,,,1.31,2.54,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier,,8.07,,,,,,,5.69,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,outpatient,1,mL,8.15000,7.75000,The Alliance,Premier,,5.78,,,,,,,4.08,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,outpatient,1,mL,13.27000,12.61000,The Alliance,Premier,,9.41,,,,,,,6.63,12.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,outpatient,1,GM,15.20000,14.44000,The Alliance,Premier,,10.78,,,,,,,7.60,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,outpatient,1,GM,21.89000,20.79000,The Alliance,Premier,,15.52,,,,,,,10.95,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,outpatient,1,GM,11.17000,10.61000,The Alliance,Premier,,7.92,,,,,,,5.58,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,outpatient,1,GM,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,outpatient,1,GM,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,outpatient,1,GM,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,outpatient,1,mL,99.81000,94.82000,The Alliance,Premier,,70.77,,,,,,,49.91,96.82,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,outpatient,1,mL,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,outpatient,1,EA,10.87000,10.33000,The Alliance,Premier,,7.71,,,,,,,5.43,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,outpatient,1,EA,8.36000,7.94000,The Alliance,Premier,,5.93,,,,,,,4.18,8.11,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,outpatient,1,mL,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Premier,,15.11,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,outpatient,1,EA,21.57000,20.49000,The Alliance,Premier,,15.29,,,,,,,10.79,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Premier,,15.11,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,outpatient,1,EA,21.32000,20.25000,The Alliance,Premier,,15.12,,,,,,,10.66,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,outpatient,1,mL,801.86000,761.77000,The Alliance,Premier,,4.95,,,,,,,3.00,777.80,fee schedule,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,outpatient,1,mL,23.90000,22.71000,The Alliance,Premier,,16.95,,,,,,,11.95,23.18,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier,,1.81,,,,,,,1.27,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Premier,,3.59,,,,,,,2.54,4.92,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,outpatient,1,mL,10.43000,9.91000,The Alliance,Premier,,7.39,,,,,,,5.21,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,outpatient,1,EA,140.98000,133.93000,The Alliance,Premier,,99.95,,,,,,,70.49,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,outpatient,1,EA,141.13000,134.08000,The Alliance,Premier,,100.06,,,,,,,70.56,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,outpatient,1,EA,43.75000,41.56000,The Alliance,Premier,,31.02,,,,,,,21.88,42.44,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,outpatient,1,EA,5.54000,5.26000,The Alliance,Premier,,3.93,,,,,,,2.77,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier,,2.40,,,,,,,1.69,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,outpatient,1,EA,63.57000,60.39000,The Alliance,Premier,,45.07,,,,,,,31.79,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier,,15.47,,,,,,,10.91,21.17,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,outpatient,1,mL,375.55000,356.77000,The Alliance,Premier,,24.29,,,,,,,13.96,364.28,fee schedule,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,outpatient,1,mL,335.74000,318.95000,The Alliance,Premier,,24.29,,,,,,,13.96,325.67,fee schedule,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier,,24.29,,,,,,,13.96,291.19,fee schedule,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Premier,,5.03,,,,,,,3.55,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,outpatient,1,EA,3.26000,3.10000,The Alliance,Premier,,2.31,,,,,,,1.63,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier,,1.61,,,,,,,1.14,2.20,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,outpatient,1,EA,25.93000,24.63000,The Alliance,Premier,,3.42,,,,,,,3.14,25.15,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,outpatient,1,EA,24.65000,23.42000,The Alliance,Premier,,3.42,,,,,,,3.14,23.91,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,outpatient,1,EA,13.89000,13.20000,The Alliance,Premier,,3.42,,,,,,,3.14,13.47,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,outpatient,1,EA,9.72000,9.24000,The Alliance,Premier,,3.42,,,,,,,3.14,9.43,fee schedule,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,outpatient,1,mL,18.82000,17.88000,The Alliance,Premier,,13.34,,,,,,,9.41,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,outpatient,1,mL,22.36000,21.24000,The Alliance,Premier,,15.85,,,,,,,11.18,21.69,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,outpatient,1,GM,31.85000,30.26000,The Alliance,Premier,,22.58,,,,,,,15.93,30.89,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,outpatient,1,GM,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,outpatient,1,EA,11.53000,10.96000,The Alliance,Premier,,8.17,,,,,,,5.76,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83000,1.61,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,outpatient,1,mL,105.97000,100.67000,The Alliance,Premier,,32.60,,,,,,,19.76,102.79,fee schedule,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,outpatient,1,mL,103.60000,98.42000,The Alliance,Premier,,32.60,,,,,,,19.76,100.49,fee schedule,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,outpatient,1,mL,54.12000,51.41000,The Alliance,Premier,,32.60,,,,,,,19.76,52.50,fee schedule,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,outpatient,1,mL,38.34000,36.43000,The Alliance,Premier,,27.18,,,,,,,19.17,37.19,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,1.93,,,,,,,1.36,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,outpatient,1,mL,383.32000,364.15000,The Alliance,Premier,,873.48,,,,,,,191.66,873.48,fee schedule,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,outpatient,1,EA,43.43000,41.26000,The Alliance,Premier,,3.27,,,,,,,1.77,42.13,fee schedule,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,3.27,,,,,,,1.77,12.26,fee schedule,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,3.22,,,,,,,0.87000,4.75,fee schedule,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier,,3.22,,,,,,,0.65000,4.75,fee schedule,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier,,1.34,,,,,,,1.26,26.05,fee schedule,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Premier,,1.27,,,,,,,1.15,10.81,fee schedule,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,outpatient,1,EA,9.73000,9.24000,The Alliance,Premier,,1.27,,,,,,,1.15,9.44,fee schedule,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,outpatient,1,mL,36.86000,35.01000,The Alliance,Premier,,3.42,,,,,,,3.14,35.75,fee schedule,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,outpatient,1,mL,14.90000,14.15000,The Alliance,Premier,,3.42,,,,,,,3.14,14.45,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,outpatient,1,mL,36.06000,34.25000,The Alliance,Premier,,119.94,,,,,,,18.03,119.94,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,outpatient,1,mL,16.97000,16.12000,The Alliance,Premier,,119.94,,,,,,,8.48,119.94,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,outpatient,1,mL,13.90000,13.21000,The Alliance,Premier,,119.94,,,,,,,6.95,119.94,fee schedule,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,outpatient,1,mL,16.03000,15.23000,The Alliance,Premier,,11.37,,,,,,,8.02,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,outpatient,1,mL,10.06000,9.56000,The Alliance,Premier,,7.13,,,,,,,5.03,9.76,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,outpatient,1,EA,88.48000,84.06000,The Alliance,Premier,,18.79,,,,,,,18.24,85.83,fee schedule,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Premier,,18.79,,,,,,,16.00,31.05,fee schedule,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,outpatient,1,EA,405.06000,384.81000,The Alliance,Premier,,287.19,,,,,,,202.53,392.91,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,outpatient,1,mL,29.93000,28.43000,The Alliance,Premier,,21.22,,,,,,,14.96,29.03,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,outpatient,1,mL,43.19000,41.03000,The Alliance,Premier,,3.42,,,,,,,3.14,41.89,fee schedule,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Premier,,3.27,,,,,,,1.77,6.83,fee schedule,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,outpatient,1,mL,89.25000,84.79000,The Alliance,Premier,,2985.58,,,,,,,44.62,3007.94,fee schedule,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Premier,,8.15,,,,,,,5.75,11.15,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,outpatient,1,mL,417.74000,396.85000,The Alliance,Premier,,29.77,,,,,,,24.87,405.21,fee schedule,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,outpatient,1,mL,459.10000,436.15000,The Alliance,Premier,,29.77,,,,,,,24.87,445.33,fee schedule,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,2.76,,,,,,,0.16000,2.76,fee schedule,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier,,1.80,,,,,,,1.27,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,outpatient,1,EA,23.67000,22.48000,The Alliance,Premier,,3.27,,,,,,,1.77,22.96,fee schedule,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier,,3.27,,,,,,,1.77,23.30,fee schedule,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,outpatient,1,EA,5.32000,5.05000,The Alliance,Premier,,3.27,,,,,,,1.77,5.16,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,outpatient,1,EA,3353.56000,3185.88000,The Alliance,Premier,,499.82,,,,,,,302.92,3252.95,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,outpatient,1,EA,3885.76000,3691.47000,The Alliance,Premier,,499.82,,,,,,,302.92,3769.19,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,outpatient,1,EA,1610.02000,1529.52000,The Alliance,Premier,,499.82,,,,,,,302.92,1561.72,fee schedule,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.04,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,outpatient,1,mL,1.71000,1.63000,The Alliance,Premier,,1.34,,,,,,,0.85500,1.66,fee schedule,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,1.34,,,,,,,0.63000,1.34,fee schedule,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,outpatient,1,EA,1973.81000,1875.12000,The Alliance,Premier,,7.19,,,,,,,4.36,1914.60,fee schedule,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,outpatient,1,mL,1535.35000,1458.58000,The Alliance,Premier,,1088.56,,,,,,,767.67,1489.29,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,outpatient,1,EA,12.03000,11.43000,The Alliance,Premier,,8.53,,,,,,,6.01,11.67,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Premier,,8.16,,,,,,,5.75,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Premier,,8.16,,,,,,,5.75,11.16,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,outpatient,1,mL,28.47000,27.05000,The Alliance,Premier,,6.42,,,,,,,3.89,27.62,fee schedule,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier,,4.42,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Premier,,5.11,,,,,,,3.60,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier,,4.42,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Premier,,12.07,,,,,,,8.52,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Premier,,1.47,,,,,,,1.03,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Premier,,13.67,,,,,,,9.64,18.70,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,outpatient,1,EA,2.88000,2.74000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier,,4.25,,,,,,,3.00,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Premier,,12.29,,,,,,,8.66,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,outpatient,1,EA,7.44000,7.07000,The Alliance,Premier,,5.27,,,,,,,3.72,7.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier,,2.02,,,,,,,1.43,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier,,3.10,,,,,,,1.88,5.52,fee schedule,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier,,3.10,,,,,,,1.88,4.20,fee schedule,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Premier,,9.00,,,,,,,6.34,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Premier,,9.00,,,,,,,6.34,12.31,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,outpatient,1,EA,43.56000,41.39000,The Alliance,Premier,,30.88,,,,,,,21.78,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,outpatient,1,EA,23.96000,22.76000,The Alliance,Premier,,16.99,,,,,,,11.98,23.24,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier,,3.27,,,,,,,2.31,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Premier,,6.54,,,,,,,4.61,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Premier,,6.54,,,,,,,4.61,8.94,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,outpatient,1,EA,40.08000,38.08000,The Alliance,Premier,,28.42,,,,,,,20.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,outpatient,1,EA,20.55000,19.52000,The Alliance,Premier,,14.57,,,,,,,10.28,19.93,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,outpatient,1,EA,1420.64000,1349.61000,The Alliance,Premier,,52.95,,,,,,,32.09,1378.02,fee schedule,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,outpatient,1,EA,1187.54000,1128.16000,The Alliance,Premier,,52.95,,,,,,,32.09,1151.91,fee schedule,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,outpatient,1,EA,1033.41000,981.74000,The Alliance,Premier,,52.95,,,,,,,32.09,1002.41,fee schedule,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Premier,,4.95,,,,,,,3.00,486.13,fee schedule,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,outpatient,1,EA,73.47000,69.80000,The Alliance,Premier,,1.34,,,,,,,1.26,71.27,fee schedule,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,outpatient,1,EA,608.34000,577.92000,The Alliance,Premier,,52.95,,,,,,,32.09,590.09,fee schedule,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,outpatient,1,EA,710.33000,674.82000,The Alliance,Premier,,52.95,,,,,,,32.09,689.02,fee schedule,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier,,0.95715,,,,,,,0.67500,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,outpatient,1,GM,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,outpatient,1,GM,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,outpatient,1,GM,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Premier,,1.34,,,,,,,0.97000,1.88,fee schedule,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Premier,,0.19800,,,,,,,0.14415,4.74,fee schedule,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,0.19800,,,,,,,0.14415,1.22,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,outpatient,1,mL,11.35000,10.79000,The Alliance,Premier,,10.18,,,,,,,5.67,11.01,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,outpatient,1,mL,11.53000,10.95000,The Alliance,Premier,,10.18,,,,,,,5.76,11.18,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,outpatient,1,mL,15.13000,14.38000,The Alliance,Premier,,10.18,,,,,,,7.57,14.68,fee schedule,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,outpatient,1,mL,34.06000,32.36000,The Alliance,Premier,,24.15,,,,,,,17.03,33.04,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,outpatient,1,EA,583.45000,554.28000,The Alliance,Premier,,413.67,,,,,,,291.73,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,outpatient,1,EA,375.39000,356.62000,The Alliance,Premier,,266.15,,,,,,,187.69,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,outpatient,1,EA,331.20000,314.64000,The Alliance,Premier,,234.82,,,,,,,165.60,321.26,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,outpatient,1,EA,17147.50000,16290.12000,The Alliance,Premier,,420.90,,,,,,,255.09,16633.08,fee schedule,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,outpatient,1,mL,7.37000,7.00000,The Alliance,Premier,,5.23,,,,,,,3.69,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,outpatient,1,mL,6.27000,5.95000,The Alliance,Premier,,4.45,,,,,,,3.13,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,outpatient,1,mL,7.48000,7.10000,The Alliance,Premier,,5.30,,,,,,,3.74,7.26,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,outpatient,1,EA,692.13000,657.52000,The Alliance,Premier,,490.72,,,,,,,346.06,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,outpatient,1,EA,445.31000,423.05000,The Alliance,Premier,,315.72,,,,,,,222.66,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,outpatient,1,EA,785.75000,746.47000,The Alliance,Premier,,557.10,,,,,,,392.88,762.18,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,2.24,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,2.24,,,,,,,0.01500,2.24,fee schedule,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Premier,,2.38,,,,,,,1.68,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.28050,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,outpatient,1,GM,5.19000,4.93000,The Alliance,Premier,,3.68,,,,,,,2.60,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,outpatient,1,GM,0.24000,0.22000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,outpatient,1,GM,1.22000,1.15000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,outpatient,1,GM,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,outpatient,1,GM,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,outpatient,1,GM,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,outpatient,1,GM,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,outpatient,1,GM,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,outpatient,1,GM,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,outpatient,1,mL,4537.21000,4310.35000,The Alliance,Premier,,3216.88,,,,,,,155.39,4401.09,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,outpatient,1,EA,8.94000,8.49000,The Alliance,Premier,,6.34,,,,,,,4.47,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,outpatient,1,EA,23.81000,22.62000,The Alliance,Premier,,16.88,,,,,,,11.90,23.10,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,outpatient,1,mL,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier,,6.60,,,,,,,0.72500,8.10,fee schedule,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,2.24,,,,,,,0.01500,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,2.24,,,,,,,0.01500,2.24,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Premier,,0.62700,,,,,,,0.60838,502.46,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Premier,,0.62700,,,,,,,0.60838,303.45,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier,,0.62700,,,,,,,0.60838,76.63,fee schedule,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Premier,,8.47,,,,,,,5.97,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier,,8.40,,,,,,,5.92,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Premier,,12.17,,,,,,,8.59,16.65,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,outpatient,1,EA,12.67000,12.04000,The Alliance,Premier,,8.98,,,,,,,6.33,12.29,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier,,4.47,,,,,,,3.15,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Premier,,7.90,,,,,,,5.57,10.81,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,outpatient,1,EA,34.50000,32.78000,The Alliance,Premier,,2.77,,,,,,,2.29,33.47,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Premier,,2.77,,,,,,,2.29,5.17,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,outpatient,1,EA,14.93000,14.18000,The Alliance,Premier,,2.77,,,,,,,2.29,14.48,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Premier,,2.77,,,,,,,2.19,4.24,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Premier,,2.77,,,,,,,2.29,15.79,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,outpatient,1,EA,6.24000,5.92000,The Alliance,Premier,,2.77,,,,,,,2.29,6.05,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Premier,,2.77,,,,,,,2.29,5.17,fee schedule,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,outpatient,1,mL,22.88000,21.74000,The Alliance,Premier,,16.22,,,,,,,11.44,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,outpatient,1,mL,23.28000,22.11000,The Alliance,Premier,,16.51,,,,,,,11.64,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,outpatient,1,mL,23.77000,22.58000,The Alliance,Premier,,16.85,,,,,,,11.88,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,outpatient,1,mL,6.66000,6.33000,The Alliance,Premier,,4.72,,,,,,,3.33,6.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,outpatient,1,mL,1490.77000,1416.23000,The Alliance,Premier,,0.62700,,,,,,,0.60838,1446.05,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Premier,,0.62700,,,,,,,0.60838,303.45,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,outpatient,1,mL,67.15000,63.79000,The Alliance,Premier,,0.62700,,,,,,,0.60838,65.14,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Premier,,0.62700,,,,,,,0.60838,153.26,fee schedule,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Premier,,5.03,,,,,,,3.55,6.89,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,outpatient,1,EA,4.93000,4.69000,The Alliance,Premier,,3.50,,,,,,,2.46,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier,,1.82,,,,,,,1.28,2.48,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,outpatient,1,mL,29.02000,27.57000,The Alliance,Premier,,20.58,,,,,,,14.51,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,outpatient,1,mL,34.10000,32.39000,The Alliance,Premier,,24.18,,,,,,,17.05,33.08,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,1.09,,,,,,,0.10500,1.18,fee schedule,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier,,1.09,,,,,,,0.12000,1.18,fee schedule,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,outpatient,1,EA,103.29000,98.13000,The Alliance,Premier,,73.23,,,,,,,51.65,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Premier,,5.98,,,,,,,4.21,8.18,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,outpatient,1,EA,256.92000,244.08000,The Alliance,Premier,,182.16,,,,,,,128.46,249.21,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,outpatient,1,mL,563.15000,534.99000,The Alliance,Premier,,399.27,,,,,,,281.57,546.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Premier,,11.50,,,,,,,8.11,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,outpatient,1,EA,2.33000,2.22000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,outpatient,1,mL,692.18000,657.57000,The Alliance,Premier,,12.67,,,,,,,7.68,671.41,fee schedule,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,outpatient,1,EA,36.05000,34.24000,The Alliance,Premier,,25.56,,,,,,,18.02,34.97,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,outpatient,1,EA,175.38000,166.61000,The Alliance,Premier,,4.49,,,,,,,4.35,170.12,fee schedule,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,outpatient,1,EA,681.25000,647.19000,The Alliance,Premier,,4.49,,,,,,,4.35,660.81,fee schedule,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Premier,,0.61050,,,,,,,0.58280,10.66,fee schedule,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.54,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Premier,,2.91,,,,,,,2.05,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,outpatient,1,GM,45.93000,43.64000,The Alliance,Premier,,32.56,,,,,,,22.96,44.55,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,outpatient,1,mL,108.82000,103.38000,The Alliance,Premier,,91.01,,,,,,,54.41,105.56,fee schedule,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,outpatient,1,mL,164.17000,155.96000,The Alliance,Premier,,91.01,,,,,,,82.08,159.24,fee schedule,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,outpatient,1,mL,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,outpatient,1,mL,1.14000,1.09000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,outpatient,1,mL,2.42000,2.30000,The Alliance,Premier,,1.72,,,,,,,1.21,2.35,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Premier,,122.97,,,,,,,86.72,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Premier,,245.94,,,,,,,137.83,336.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Premier,,42.74,,,,,,,30.14,58.47,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,outpatient,1,EA,2.68000,2.54000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,outpatient,1,EA,15.76000,14.98000,The Alliance,Premier,,11.17,,,,,,,7.88,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Premier,,16.48,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Premier,,16.48,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Premier,,9.05,,,,,,,6.38,12.39,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Premier,,4.62,,,,,,,3.26,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,outpatient,1,GM,25.64000,24.36000,The Alliance,Premier,,18.18,,,,,,,12.82,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,outpatient,1,GM,26.37000,25.05000,The Alliance,Premier,,18.70,,,,,,,13.19,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,outpatient,1,GM,21.11000,20.05000,The Alliance,Premier,,14.97,,,,,,,10.55,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,outpatient,1,GM,18.82000,17.88000,The Alliance,Premier,,13.34,,,,,,,9.41,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,outpatient,1,GM,21.14000,20.08000,The Alliance,Premier,,14.99,,,,,,,10.57,20.51,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,outpatient,1,EA,1675.10000,1591.35000,The Alliance,Premier,,1187.65,,,,,,,837.55,1624.85,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,outpatient,1,EA,729.64000,693.16000,The Alliance,Premier,,517.31,,,,,,,364.82,707.75,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Premier,,17.28,,,,,,,12.19,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Premier,,7.08,,,,,,,5.00,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,outpatient,1,EA,6.40000,6.08000,The Alliance,Premier,,4.54,,,,,,,3.20,6.21,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,outpatient,1,mL,9.05000,8.60000,The Alliance,Premier,,6.42,,,,,,,4.53,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,outpatient,1,mL,3.18000,3.03000,The Alliance,Premier,,2.25,,,,,,,1.59,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,outpatient,1,mL,16.78000,15.94000,The Alliance,Premier,,11.90,,,,,,,8.39,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Premier,,3.76,,,,,,,2.65,5.15,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,outpatient,1,EA,58.67000,55.73000,The Alliance,Premier,,41.60,,,,,,,29.34,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Premier,,37.14,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Premier,,42.74,,,,,,,30.14,58.47,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Premier,,0.46200,,,,,,,0.43500,0.84390,fee schedule,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Premier,,0.46200,,,,,,,0.43710,10.66,fee schedule,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,outpatient,1,EA,9527.85000,9051.46000,The Alliance,Premier,,6755.25,,,,,,,4763.93,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,outpatient,1,EA,7866.00000,7472.70000,The Alliance,Premier,,5576.99,,,,,,,3933.00,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,outpatient,1,EA,7863.93000,7470.73000,The Alliance,Premier,,5575.53,,,,,,,3931.97,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,outpatient,1,EA,2067.86000,1964.46000,The Alliance,Premier,,1466.11,,,,,,,1033.93,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,outpatient,1,EA,4370.00000,4151.50000,The Alliance,Premier,,3098.33,,,,,,,2185.00,4238.90,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,outpatient,1,EA,53.76000,51.07000,The Alliance,Premier,,38.12,,,,,,,26.88,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Premier,,37.14,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,outpatient,1,EA,99.17000,94.21000,The Alliance,Premier,,70.31,,,,,,,49.59,96.19,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier,,5.37,,,,,,,3.79,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Premier,,6.05,,,,,,,4.26,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,outpatient,1,mL,15.01000,14.26000,The Alliance,Premier,,10.64,,,,,,,7.50,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Premier,,6.32,,,,,,,4.46,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,outpatient,1,mL,1.87000,1.77000,The Alliance,Premier,,1.33,,,,,,,0.93500,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,outpatient,1,EA,238.04000,226.14000,The Alliance,Premier,,125.00,,,,,,,118.51,230.90,fee schedule,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,outpatient,1,mL,15.31000,14.54000,The Alliance,Premier,,8.84,,,,,,,7.66,14.85,fee schedule,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,outpatient,1,mL,14.71000,13.97000,The Alliance,Premier,,8.84,,,,,,,7.36,14.27,fee schedule,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73000,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Premier,,8.43,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Premier,,8.43,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,outpatient,1,mL,7.83000,7.44000,The Alliance,Premier,,5.55,,,,,,,3.92,7.60,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,outpatient,1,mL,553.63000,525.95000,The Alliance,Premier,,857.21,,,,,,,276.81,857.21,fee schedule,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,outpatient,1,GM,8.09000,7.69000,The Alliance,Premier,,5.74,,,,,,,4.04,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,outpatient,1,GM,11.75000,11.16000,The Alliance,Premier,,8.33,,,,,,,5.88,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,outpatient,1,GM,25.64000,24.35000,The Alliance,Premier,,18.18,,,,,,,12.82,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,outpatient,1,GM,5.45000,5.18000,The Alliance,Premier,,3.86,,,,,,,2.73,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,outpatient,1,GM,7.44000,7.06000,The Alliance,Premier,,5.27,,,,,,,3.72,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,outpatient,1,GM,12.44000,11.81000,The Alliance,Premier,,8.82,,,,,,,6.22,12.07,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,outpatient,1,EA,5520.00000,5244.00000,The Alliance,Premier,,4.37,,,,,,,2.65,5354.40,fee schedule,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,outpatient,1,mL,104.79000,99.55000,The Alliance,Premier,,12.67,,,,,,,7.68,101.65,fee schedule,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,outpatient,1,mL,168.93000,160.49000,The Alliance,Premier,,12.67,,,,,,,7.68,163.86,fee schedule,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,outpatient,1,EA,116.01000,110.21000,The Alliance,Premier,,82.25,,,,,,,58.01,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,outpatient,1,EA,34.32000,32.60000,The Alliance,Premier,,24.33,,,,,,,17.16,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,outpatient,1,EA,12.10000,11.49000,The Alliance,Premier,,8.58,,,,,,,6.05,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,outpatient,1,mL,801.35000,761.28000,The Alliance,Premier,,568.16,,,,,,,400.68,777.31,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,outpatient,1,EA,34.56000,32.84000,The Alliance,Premier,,24.50,,,,,,,17.28,33.52,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,1.58,,,,,,,0.08000,1.58,fee schedule,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,outpatient,1,mL,7.69000,7.31000,The Alliance,Premier,,1.58,,,,,,,1.30,7.46,fee schedule,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,outpatient,1,EA,77.24000,73.38000,The Alliance,Premier,,54.76,,,,,,,38.62,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,outpatient,1,EA,63.07000,59.91000,The Alliance,Premier,,44.72,,,,,,,31.54,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,11.85,22.99,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier,,2.43,,,,,,,1.72,3.33,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,outpatient,1,EA,37.51000,35.63000,The Alliance,Premier,,26.59,,,,,,,18.75,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,outpatient,1,EA,11.92000,11.33000,The Alliance,Premier,,8.45,,,,,,,5.96,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,outpatient,1,EA,2.98000,2.83000,The Alliance,Premier,,2.11,,,,,,,1.49,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Premier,,9.36,,,,,,,6.60,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Premier,,3.30,,,,,,,2.33,4.52,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,outpatient,1,mL,118.23000,112.32000,The Alliance,Premier,,12.72,,,,,,,11.32,114.68,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,1.58,,,,,,,0.50000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,1.58,,,,,,,0.87000,1.69,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Premier,,1.58,,,,,,,0.26500,1.58,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,outpatient,1,mL,78.39000,74.47000,The Alliance,Premier,,0.94050,,,,,,,0.79980,76.04,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,outpatient,1,mL,67.57000,64.19000,The Alliance,Premier,,0.94050,,,,,,,0.79980,65.54,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,outpatient,1,mL,28.06000,26.66000,The Alliance,Premier,,0.94050,,,,,,,0.79980,27.22,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,outpatient,1,mL,34.60000,32.87000,The Alliance,Premier,,0.94050,,,,,,,0.79980,33.56,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,outpatient,1,mL,74.18000,70.47000,The Alliance,Premier,,0.94050,,,,,,,0.79980,71.95,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,outpatient,1,mL,37.46000,35.58000,The Alliance,Premier,,0.94050,,,,,,,0.79980,36.34,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier,,0.94050,,,,,,,0.79980,45.98,fee schedule,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier,,2.48,,,,,,,1.75,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,outpatient,1,mL,19.45000,18.48000,The Alliance,Premier,,13.79,,,,,,,9.72,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,outpatient,1,mL,6.78000,6.44000,The Alliance,Premier,,4.81,,,,,,,3.39,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,outpatient,1,EA,42.99000,40.84000,The Alliance,Premier,,30.48,,,,,,,21.50,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,outpatient,1,EA,13.66000,12.98000,The Alliance,Premier,,9.68,,,,,,,6.83,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier,,2.42,,,,,,,1.71,3.32,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,outpatient,1,EA,286.94000,272.59000,The Alliance,Premier,,203.44,,,,,,,143.47,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Premier,,5.63,,,,,,,3.97,7.70,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,outpatient,1,EA,38.47000,36.54000,The Alliance,Premier,,27.28,,,,,,,19.23,37.32,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,outpatient,1,EA,198.21000,188.30000,The Alliance,Premier,,140.53,,,,,,,99.11,192.26,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,outpatient,1,EA,8.69000,8.25000,The Alliance,Premier,,6.16,,,,,,,4.34,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Premier,,3.11,,,,,,,2.19,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Premier,,4.45,,,,,,,3.14,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Premier,,4.71,,,,,,,3.32,6.44,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.12,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier,,1.63,,,,,,,1.15,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,outpatient,1,EA,4.00000,3.80000,The Alliance,Premier,,2.84,,,,,,,2.00,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,outpatient,1,EA,3.75000,3.56000,The Alliance,Premier,,2.66,,,,,,,1.88,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,outpatient,1,EA,4.89000,4.64000,The Alliance,Premier,,3.47,,,,,,,2.44,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,outpatient,1,mL,6.75000,6.41000,The Alliance,Premier,,4.79,,,,,,,3.38,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,outpatient,1,EA,165.58000,157.30000,The Alliance,Premier,,117.40,,,,,,,82.79,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,outpatient,1,EA,179.07000,170.11000,The Alliance,Premier,,126.96,,,,,,,89.53,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,44.81,,,,,,,31.60,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,outpatient,1,EA,329.03000,312.58000,The Alliance,Premier,,233.28,,,,,,,164.51,319.16,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,outpatient,1,mL,2.14000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,outpatient,1,mL,2.35000,2.23000,The Alliance,Premier,,1.67,,,,,,,1.18,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,outpatient,1,mL,1.84000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,outpatient,1,EA,10.41000,9.89000,The Alliance,Premier,,7.38,,,,,,,5.21,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Premier,,6.39,,,,,,,4.50,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,outpatient,1,mL,49.30000,46.83000,The Alliance,Premier,,12.42,,,,,,,12.06,47.82,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,outpatient,1,mL,75.84000,72.05000,The Alliance,Premier,,12.42,,,,,,,12.06,73.56,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,outpatient,1,mL,97.94000,93.04000,The Alliance,Premier,,12.42,,,,,,,12.06,95.00,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,outpatient,1,mL,76.47000,72.65000,The Alliance,Premier,,12.42,,,,,,,12.06,74.18,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier,,3.73,,,,,,,0.16500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,3.73,,,,,,,0.05500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,3.73,,,,,,,0.11000,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,3.73,,,,,,,0.03500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier,,3.73,,,,,,,0.05500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier,,3.73,,,,,,,0.04500,5.94,fee schedule,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,outpatient,1,mL,154.05000,146.35000,The Alliance,Premier,,1.19,,,,,,,1.15,149.43,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,outpatient,1,mL,308.10000,292.70000,The Alliance,Premier,,1.19,,,,,,,1.15,298.86,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,outpatient,1,mL,468.96000,445.51000,The Alliance,Premier,,1.19,,,,,,,1.15,454.89,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,outpatient,1,mL,160.32000,152.30000,The Alliance,Premier,,1.19,,,,,,,1.15,155.51,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,outpatient,1,mL,305.46000,290.19000,The Alliance,Premier,,1.19,,,,,,,1.15,296.30,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,outpatient,1,mL,308.09000,292.68000,The Alliance,Premier,,1.19,,,,,,,1.15,298.85,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,outpatient,1,mL,564.92000,536.68000,The Alliance,Premier,,1.19,,,,,,,1.15,547.97,fee schedule,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Premier,,118.22,,,,,,,71.65,276.35,fee schedule,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,outpatient,1,mL,60.69000,57.66000,The Alliance,Premier,,12.26,,,,,,,7.43,58.87,fee schedule,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,outpatient,1,EA,9.92000,9.42000,The Alliance,Premier,,7.03,,,,,,,4.96,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Premier,,9.97,,,,,,,7.03,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,outpatient,1,EA,6.76000,6.42000,The Alliance,Premier,,4.79,,,,,,,3.38,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier,,5.81,,,,,,,4.10,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier,,3.25,,,,,,,2.29,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,outpatient,1,EA,6.44000,6.12000,The Alliance,Premier,,4.57,,,,,,,3.22,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,outpatient,1,EA,8.51000,8.09000,The Alliance,Premier,,6.03,,,,,,,4.25,8.25,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Premier,,7.15,,,,,,,5.04,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier,,1.47,,,,,,,1.03,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier,,3.40,,,,,,,2.40,4.65,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.15,,,,,,,1.58,3.07,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,outpatient,1,mL,5.92000,5.63000,The Alliance,Premier,,2.15,,,,,,,1.65,5.74,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier,,2.15,,,,,,,1.65,7.62,fee schedule,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,outpatient,1,GM,83.93000,79.73000,The Alliance,Premier,,59.51,,,,,,,41.97,81.41,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,outpatient,1,EA,645.01000,612.76000,The Alliance,Premier,,457.31,,,,,,,322.50,625.66,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,outpatient,1,mL,30.84000,29.30000,The Alliance,Premier,,3.25,,,,,,,2.63,29.91,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,outpatient,1,mL,30.84000,29.29000,The Alliance,Premier,,3.25,,,,,,,2.63,29.91,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,outpatient,1,mL,25.38000,24.11000,The Alliance,Premier,,3.25,,,,,,,2.63,24.62,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,outpatient,1,mL,10.00000,9.50000,The Alliance,Premier,,3.25,,,,,,,2.63,9.70,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,outpatient,1,mL,25.37000,24.11000,The Alliance,Premier,,3.25,,,,,,,2.63,24.61,fee schedule,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,outpatient,1,mL,0.95000,0.91000,The Alliance,Premier,,25.71,,,,,,,0.47500,63.16,fee schedule,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,outpatient,1,mL,5.98000,5.68000,The Alliance,Premier,,25.71,,,,,,,2.99,63.16,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier,,4.93,,,,,,,3.48,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Premier,,19.72,,,,,,,13.90,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,outpatient,1,mL,6.52000,6.19000,The Alliance,Premier,,4.62,,,,,,,3.26,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier,,4.11,,,,,,,2.90,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,outpatient,1,mL,7.12000,6.76000,The Alliance,Premier,,5.05,,,,,,,3.56,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,outpatient,1,mL,6.93000,6.58000,The Alliance,Premier,,4.91,,,,,,,3.46,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Premier,,14.00,,,,,,,9.87,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,outpatient,1,mL,4.85000,4.61000,The Alliance,Premier,,3.44,,,,,,,2.42,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier,,7.17,,,,,,,5.05,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Premier,,1.33,,,,,,,0.93500,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,outpatient,1,EA,7.24000,6.88000,The Alliance,Premier,,5.13,,,,,,,3.62,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,outpatient,1,GM,101.02000,95.97000,The Alliance,Premier,,71.62,,,,,,,50.51,97.99,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,outpatient,1,mL,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,outpatient,1,mL,2.67000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,outpatient,1,mL,0.63000,0.59000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,outpatient,1,mL,48.94000,46.49000,The Alliance,Premier,,34.70,,,,,,,24.47,47.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,outpatient,1,EA,288.41000,273.99000,The Alliance,Premier,,204.48,,,,,,,144.21,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,outpatient,1,EA,191.20000,181.64000,The Alliance,Premier,,135.56,,,,,,,95.60,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,outpatient,1,EA,220.57000,209.54000,The Alliance,Premier,,156.38,,,,,,,110.28,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier,,134.43,,,,,,,94.80,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,outpatient,1,EA,253.81000,241.12000,The Alliance,Premier,,179.95,,,,,,,126.91,246.20,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,outpatient,1,mL,114.91000,109.16000,The Alliance,Premier,,1.19,,,,,,,1.15,111.46,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,outpatient,1,mL,214.56000,203.84000,The Alliance,Premier,,1.19,,,,,,,1.15,208.12,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,outpatient,1,mL,229.50000,218.02000,The Alliance,Premier,,1.19,,,,,,,1.15,222.62,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,outpatient,1,mL,231.07000,219.51000,The Alliance,Premier,,1.19,,,,,,,1.15,224.14,fee schedule,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,outpatient,1,mL,10.08000,9.58000,The Alliance,Premier,,7.15,,,,,,,5.04,9.78,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,outpatient,1,GM,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Premier,,5.90,,,,,,,4.16,8.07,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier,,34.98,,,,,,,1.09,34.98,fee schedule,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,outpatient,,,22.72000,21.58000,The Alliance,Premier,,16.11,,,,,,,11.36,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,outpatient,1,mL,45.44000,43.17000,The Alliance,Premier,,32.22,,,,,,,22.72,44.08,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Premier,,12.55,,,,,,,2.42,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,outpatient,1,EA,10.81000,10.27000,The Alliance,Premier,,7.66,,,,,,,2.42,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Premier,,16.02,,,,,,,11.29,21.91,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier,,65.37,,,,,,,1.66,65.37,fee schedule,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Premier,,1.99,,,,,,,1.40,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier,,1.80,,,,,,,1.27,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Premier,,5.51,,,,,,,3.88,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,outpatient,1,mL,3.61000,3.43000,The Alliance,Premier,,2.56,,,,,,,1.80,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,outpatient,1,mL,5.31000,5.05000,The Alliance,Premier,,3.76,,,,,,,2.65,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier,,1.80,,,,,,,1.27,2.46,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier,,34.98,,,,,,,3.00,34.98,fee schedule,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,outpatient,,,52.92000,50.27000,The Alliance,Premier,,37.52,,,,,,,26.46,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,outpatient,1,mL,105.83000,100.54000,The Alliance,Premier,,75.03,,,,,,,45.95,102.66,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier,,2.03,,,,,,,1.43,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Premier,,3.45,,,,,,,2.44,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,outpatient,1,EA,5.48000,5.20000,The Alliance,Premier,,3.89,,,,,,,2.74,5.32,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,outpatient,,,11.90000,11.30000,The Alliance,Premier,,8.44,,,,,,,5.95,46.30,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Premier,,16.87,,,,,,,11.89,46.30,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,outpatient,1,mL,351.72000,334.14000,The Alliance,Premier,,1.19,,,,,,,1.15,341.17,fee schedule,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,outpatient,1,mL,666.20000,632.89000,The Alliance,Premier,,1.19,,,,,,,1.15,646.21,fee schedule,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,outpatient,1,mL,354.77000,337.03000,The Alliance,Premier,,1.19,,,,,,,1.15,344.13,fee schedule,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,outpatient,1,GM,68.84000,65.40000,The Alliance,Premier,,48.81,,,,,,,34.42,66.77,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,outpatient,1,GM,17.05000,16.19000,The Alliance,Premier,,12.09,,,,,,,8.53,16.54,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,outpatient,1,EA,2212.30000,2101.69000,The Alliance,Premier,,1568.52,,,,,,,5.18,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,outpatient,1,EA,1874.56000,1780.84000,The Alliance,Premier,,1329.06,,,,,,,5.18,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,outpatient,1,EA,2390.57000,2271.04000,The Alliance,Premier,,1694.91,,,,,,,5.18,2318.85,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,outpatient,1,mL,882.96000,838.81000,The Alliance,Premier,,626.02,,,,,,,441.48,856.47,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,outpatient,1,mL,84.66000,80.42000,The Alliance,Premier,,27.93,,,,,,,27.10,82.12,fee schedule,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Premier,,2.37,,,,,,,1.67,3.24,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,1.93,,,,,,,1.36,2.64,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,outpatient,1,mL,3.89000,3.69000,The Alliance,Premier,,2.76,,,,,,,1.95,3.77,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,outpatient,1,GM,15.35000,14.58000,The Alliance,Premier,,10.88,,,,,,,7.67,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,outpatient,1,GM,9.54000,9.06000,The Alliance,Premier,,6.76,,,,,,,4.77,9.25,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Premier,,5.94,,,,,,,4.19,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,outpatient,1,mL,24.27000,23.06000,The Alliance,Premier,,17.21,,,,,,,12.13,23.54,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,outpatient,1,mL,290.44000,275.91000,The Alliance,Premier,,205.92,,,,,,,145.22,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,outpatient,1,mL,590.83000,561.29000,The Alliance,Premier,,418.90,,,,,,,295.42,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,outpatient,1,mL,657.21000,624.35000,The Alliance,Premier,,465.96,,,,,,,328.61,637.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,outpatient,1,mL,52.05000,49.44000,The Alliance,Premier,,61.13,,,,,,,26.02,72.23,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,outpatient,1,EA,216.14000,205.34000,The Alliance,Premier,,65.37,,,,,,,49.73,209.66,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier,,65.37,,,,,,,9.48,65.37,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,outpatient,1,EA,154.73000,146.99000,The Alliance,Premier,,65.37,,,,,,,49.73,150.09,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,outpatient,1,EA,139.04000,132.09000,The Alliance,Premier,,65.37,,,,,,,49.73,134.87,fee schedule,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,outpatient,1,mL,3.67000,3.48000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,outpatient,1,EA,295.90000,281.10000,The Alliance,Premier,,209.79,,,,,,,147.95,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,outpatient,1,EA,17.25000,16.39000,The Alliance,Premier,,12.23,,,,,,,8.62,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,outpatient,1,EA,10.77000,10.23000,The Alliance,Premier,,7.64,,,,,,,5.38,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,outpatient,1,EA,138.44000,131.51000,The Alliance,Premier,,98.15,,,,,,,69.22,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,outpatient,1,EA,5.18000,4.92000,The Alliance,Premier,,3.67,,,,,,,2.59,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Premier,,2.74,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,outpatient,1,GM,18.18000,17.27000,The Alliance,Premier,,12.89,,,,,,,9.09,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,outpatient,1,GM,12.78000,12.14000,The Alliance,Premier,,9.06,,,,,,,6.39,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,outpatient,1,GM,24.03000,22.83000,The Alliance,Premier,,17.04,,,,,,,12.02,23.31,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,outpatient,1,EA,873.90000,830.21000,The Alliance,Premier,,619.60,,,,,,,436.95,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,outpatient,1,EA,13.82000,13.12000,The Alliance,Premier,,9.80,,,,,,,6.91,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Premier,,27.52,,,,,,,19.41,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,outpatient,1,EA,248.13000,235.72000,The Alliance,Premier,,175.92,,,,,,,124.06,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,outpatient,1,EA,411.72000,391.14000,The Alliance,Premier,,291.91,,,,,,,205.86,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,outpatient,1,EA,60.61000,57.58000,The Alliance,Premier,,42.97,,,,,,,30.30,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Premier,,9.05,,,,,,,6.38,12.39,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,outpatient,1,mL,669.10000,635.64000,The Alliance,Premier,,50.77,,,,,,,30.77,649.03,fee schedule,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier,,1.93,,,,,,,1.36,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,outpatient,1,GM,18.68000,17.75000,The Alliance,Premier,,13.24,,,,,,,9.34,18.12,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier,,23.30,,,,,,,14.12,105.14,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,outpatient,100,EA,0.09000,0.08000,The Alliance,Premier,,4.32,,,,,,,0.04500,4.32,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,outpatient,100,EA,0.11000,0.10000,The Alliance,Premier,,4.32,,,,,,,0.05500,4.32,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Premier,,4.32,,,,,,,0.07000,4.32,fee schedule,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,outpatient,,,52.65000,50.02000,The Alliance,Premier,,37.33,,,,,,,26.32,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,outpatient,1,mL,105.30000,100.03000,The Alliance,Premier,,74.66,,,,,,,52.65,102.14,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,outpatient,1,EA,1369.95000,1301.46000,The Alliance,Premier,,971.29,,,,,,,684.98,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,outpatient,1,EA,1025.64000,974.36000,The Alliance,Premier,,727.18,,,,,,,512.82,994.87,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,outpatient,1,EA,119.29000,113.33000,The Alliance,Premier,,34.98,,,,,,,31.90,115.71,fee schedule,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,outpatient,1,EA,7.59000,7.21000,The Alliance,Premier,,5.38,,,,,,,3.79,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier,,0.73027,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,outpatient,1,GM,19.63000,18.65000,The Alliance,Premier,,13.92,,,,,,,9.81,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,outpatient,1,GM,13.80000,13.11000,The Alliance,Premier,,9.78,,,,,,,6.90,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,outpatient,1,GM,7.48000,7.10000,The Alliance,Premier,,5.30,,,,,,,3.74,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,outpatient,1,GM,9.66000,9.18000,The Alliance,Premier,,6.85,,,,,,,4.83,9.37,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,outpatient,1,mL,34.08000,32.38000,The Alliance,Premier,,24.16,,,,,,,1.49,33.06,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,outpatient,1,mL,11.95000,11.35000,The Alliance,Premier,,8.47,,,,,,,5.97,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,outpatient,1,mL,10.34000,9.82000,The Alliance,Premier,,7.33,,,,,,,5.17,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,outpatient,1,mL,10.35000,9.83000,The Alliance,Premier,,7.34,,,,,,,5.17,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,outpatient,1,mL,805.95000,765.65000,The Alliance,Premier,,50.77,,,,,,,30.77,781.77,fee schedule,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.21,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Premier,,0.14850,,,,,,,0.14409,10.70,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,outpatient,1,mL,7.57000,7.19000,The Alliance,Premier,,0.14850,,,,,,,0.14409,7.34,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,outpatient,1,mL,12.39000,11.77000,The Alliance,Premier,,0.14850,,,,,,,0.14409,12.02,fee schedule,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,outpatient,1,EA,10088.89000,9584.45000,The Alliance,Premier,,75174.64,,,,,,,5044.44,75174.64,fee schedule,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97500,1.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier,,23.30,,,,,,,14.12,105.14,fee schedule,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,outpatient,1,mL,6.23000,5.91000,The Alliance,Premier,,4.42,,,,,,,3.12,6.04,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier,,2.86,,,,,,,2.02,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier,,2.72,,,,,,,1.92,3.72,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,outpatient,1,mL,11.89000,11.30000,The Alliance,Premier,,8.43,,,,,,,5.95,11.53,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,outpatient,1,mL,170.43000,161.91000,The Alliance,Premier,,120.83,,,,,,,85.22,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,outpatient,1,mL,38.40000,36.48000,The Alliance,Premier,,27.23,,,,,,,19.20,37.25,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,outpatient,1,EA,31.01000,29.46000,The Alliance,Premier,,21.99,,,,,,,15.51,30.08,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,outpatient,1,mL,117.24000,111.37000,The Alliance,Premier,,83.12,,,,,,,58.62,113.72,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier,,1.32,,,,,,,0.93000,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier,,0.47850,,,,,,,0.44330,1.24,fee schedule,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Premier,,2.82,,,,,,,1.99,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,outpatient,1,GM,10.14000,9.63000,The Alliance,Premier,,7.19,,,,,,,5.07,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,outpatient,1,GM,3.46000,3.28000,The Alliance,Premier,,2.45,,,,,,,1.73,3.36,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,outpatient,1,mL,131.99000,125.39000,The Alliance,Premier,,93.58,,,,,,,66.00,128.03,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Premier,,6.81,,,,,,,4.80,9.32,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,outpatient,1,mL,7009.02000,6658.57000,The Alliance,Premier,,4969.40,,,,,,,3504.51,6798.75,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier,,2.18,,,,,,,1.53,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,outpatient,1,EA,39.75000,37.76000,The Alliance,Premier,,28.18,,,,,,,19.88,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Premier,,10.51,,,,,,,7.41,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier,,10.56,,,,,,,7.45,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,outpatient,1,mL,22.54000,21.42000,The Alliance,Premier,,40.08,,,,,,,11.27,40.47,fee schedule,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier,,40.08,,,,,,,3.48,40.47,fee schedule,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,outpatient,1,mL,10.50000,9.98000,The Alliance,Premier,,40.08,,,,,,,5.25,40.47,fee schedule,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier,,5.37,,,,,,,3.79,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,outpatient,1,mL,7.62000,7.24000,The Alliance,Premier,,5.40,,,,,,,3.81,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,outpatient,1,mL,7.69000,7.30000,The Alliance,Premier,,5.45,,,,,,,3.85,7.46,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,outpatient,1,EA,45.52000,43.25000,The Alliance,Premier,,32.27,,,,,,,22.76,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,outpatient,1,EA,64.01000,60.81000,The Alliance,Premier,,45.38,,,,,,,32.01,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,outpatient,1,EA,2.73000,2.59000,The Alliance,Premier,,1.94,,,,,,,1.36,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Premier,,87.61,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,outpatient,1,EA,19.26000,18.30000,The Alliance,Premier,,13.66,,,,,,,9.63,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier,,0.47850,,,,,,,0.44330,0.95060,fee schedule,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,outpatient,1,GM,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,outpatient,1,GM,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,outpatient,1,GM,79.00000,75.05000,The Alliance,Premier,,56.01,,,,,,,39.50,76.63,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.04,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,outpatient,1,mL,7.22000,6.86000,The Alliance,Premier,,5.12,,,,,,,3.61,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Premier,,4.39,,,,,,,3.10,6.00,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,0.14850,,,,,,,0.13485,1.22,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Premier,,0.14850,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier,,0.14850,,,,,,,0.13485,2.85,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Premier,,0.14850,,,,,,,0.13485,1.64,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier,,0.14850,,,,,,,0.13485,2.55,fee schedule,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,outpatient,1,mL,274.18000,260.47000,The Alliance,Premier,,194.39,,,,,,,137.09,265.95,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Premier,,1.73,,,,,,,1.22,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier,,0.83662,,,,,,,0.59000,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Premier,,3.39,,,,,,,2.39,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,outpatient,1,EA,6.06000,5.76000,The Alliance,Premier,,4.30,,,,,,,3.03,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier,,1.64,,,,,,,1.16,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,outpatient,1,EA,2.12000,2.02000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,outpatient,1,EA,13.08000,12.43000,The Alliance,Premier,,9.27,,,,,,,6.54,12.69,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,outpatient,1,EA,21.51000,20.44000,The Alliance,Premier,,15.25,,,,,,,10.76,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,outpatient,1,EA,37.94000,36.04000,The Alliance,Premier,,26.90,,,,,,,18.97,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,outpatient,1,EA,34.11000,32.40000,The Alliance,Premier,,24.18,,,,,,,17.05,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,outpatient,1,EA,17.55000,16.68000,The Alliance,Premier,,12.44,,,,,,,8.78,17.02,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Premier,,2.50,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Premier,,2.50,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,outpatient,1,EA,8.28000,7.87000,The Alliance,Premier,,5.87,,,,,,,4.14,8.03,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,outpatient,1,mL,8.12000,7.71000,The Alliance,Premier,,5.76,,,,,,,4.06,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,outpatient,1,mL,4.90000,4.66000,The Alliance,Premier,,3.47,,,,,,,2.45,4.75,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,outpatient,1,EA,26.97000,25.62000,The Alliance,Premier,,19.12,,,,,,,13.48,26.16,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,outpatient,1,mL,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Premier,,4.01,,,,,,,2.83,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,outpatient,1,mL,6.10000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.05,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,outpatient,1,mL,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,outpatient,1,EA,21.90000,20.80000,The Alliance,Premier,,15.53,,,,,,,10.95,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier,,8.40,,,,,,,5.92,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier,,2.80,,,,,,,1.98,3.83,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,outpatient,1,mL,15.07000,14.32000,The Alliance,Premier,,10.68,,,,,,,7.54,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,outpatient,1,mL,20.19000,19.18000,The Alliance,Premier,,14.31,,,,,,,10.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,outpatient,1,mL,15.74000,14.95000,The Alliance,Premier,,11.16,,,,,,,7.87,15.27,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Premier,,25.31,,,,,,,17.85,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,outpatient,1,EA,28.25000,26.84000,The Alliance,Premier,,20.03,,,,,,,14.12,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,outpatient,1,EA,33.83000,32.14000,The Alliance,Premier,,23.99,,,,,,,16.91,32.82,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,outpatient,1,mL,201.05000,191.00000,The Alliance,Premier,,142.54,,,,,,,100.53,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,outpatient,1,mL,135.06000,128.31000,The Alliance,Premier,,95.76,,,,,,,67.53,131.01,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Premier,,1277.11,,,,,,,900.64,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Premier,,1277.11,,,,,,,900.64,1747.25,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,3.23,,,,,,,1.10,3.23,fee schedule,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,outpatient,1,mL,54.06000,51.36000,The Alliance,Premier,,38.33,,,,,,,27.03,52.44,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,outpatient,1,EA,51.38000,48.81000,The Alliance,Premier,,36.43,,,,,,,25.69,49.84,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,outpatient,1,GM,12.42000,11.80000,The Alliance,Premier,,8.81,,,,,,,6.21,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier,,10.70,,,,,,,7.54,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier,,10.70,,,,,,,7.54,14.64,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,outpatient,1,EA,37.22000,35.36000,The Alliance,Premier,,26.39,,,,,,,18.61,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,outpatient,1,EA,40.94000,38.90000,The Alliance,Premier,,29.03,,,,,,,20.47,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Premier,,2.76,,,,,,,1.95,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier,,4.40,,,,,,,3.10,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Premier,,31.00,,,,,,,21.86,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,outpatient,1,EA,28.51000,27.09000,The Alliance,Premier,,20.21,,,,,,,14.26,27.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,outpatient,1,mL,16.68000,15.85000,The Alliance,Premier,,25.89,,,,,,,8.34,25.89,fee schedule,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Premier,,4.66,,,,,,,3.29,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,outpatient,1,mL,6.70000,6.36000,The Alliance,Premier,,4.75,,,,,,,3.35,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier,,4.10,,,,,,,2.89,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,outpatient,1,mL,3.47000,3.30000,The Alliance,Premier,,2.46,,,,,,,1.74,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,outpatient,1,mL,5.56000,5.28000,The Alliance,Premier,,3.94,,,,,,,2.78,5.39,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,outpatient,1,mL,1032.80000,981.16000,The Alliance,Premier,,8271.63,,,,,,,516.40,8271.63,fee schedule,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,outpatient,1,mL,1186.38000,1127.06000,The Alliance,Premier,,8271.63,,,,,,,593.19,8271.63,fee schedule,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier,,9.25,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier,,20.88,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier,,28.96,,,,,,,20.43,39.62,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier,,0.49500,,,,,,,0.43865,16.43,fee schedule,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier,,0.49500,,,,,,,0.43865,16.43,fee schedule,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,outpatient,1,EA,21.59000,20.51000,The Alliance,Premier,,0.49500,,,,,,,0.43865,20.94,fee schedule,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,outpatient,1,EA,9.59000,9.11000,The Alliance,Premier,,6.80,,,,,,,4.79,9.30,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Premier,,0.82500,,,,,,,0.58500,1.13,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier,,0.82500,,,,,,,0.73500,1.43,fee schedule,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,outpatient,,,386.68000,367.35000,The Alliance,Premier,,274.16,,,,,,,148.70,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,outpatient,1,mL,773.36000,734.69000,The Alliance,Premier,,548.31,,,,,,,148.70,750.16,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier,,3.53,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,outpatient,1,EA,2.49000,2.36000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Premier,,1.94,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,outpatient,1,EA,140.32000,133.31000,The Alliance,Premier,,99.49,,,,,,,70.16,136.11,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Premier,,3.11,,,,,,,2.19,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Premier,,4.45,,,,,,,3.14,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,outpatient,1,EA,7.96000,7.56000,The Alliance,Premier,,5.64,,,,,,,3.98,7.72,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,outpatient,5,EA,10.04000,9.54000,The Alliance,Premier,,7.12,,,,,,,5.02,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Premier,,8.07,,,,,,,5.69,11.04,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,outpatient,1,EA,45.77000,43.48000,The Alliance,Premier,,32.45,,,,,,,22.89,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier,,2.29,,,,,,,1.61,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,outpatient,1,EA,2.42000,2.30000,The Alliance,Premier,,1.72,,,,,,,1.21,2.35,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Premier,,25.89,,,,,,,9.10,25.89,fee schedule,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Premier,,8.69,,,,,,,6.13,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,outpatient,1,EA,10.59000,10.06000,The Alliance,Premier,,7.51,,,,,,,5.29,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,outpatient,1,EA,7.36000,6.99000,The Alliance,Premier,,5.22,,,,,,,3.68,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Premier,,11.43,,,,,,,8.06,15.64,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier,,1.13,,,,,,,0.80000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,outpatient,1,mL,28.12000,26.72000,The Alliance,Premier,,19.94,,,,,,,14.06,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,outpatient,1,mL,14.15000,13.44000,The Alliance,Premier,,10.03,,,,,,,7.08,13.73,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,outpatient,1,EA,28.94000,27.50000,The Alliance,Premier,,20.52,,,,,,,14.47,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,outpatient,1,EA,35.77000,33.98000,The Alliance,Premier,,25.36,,,,,,,17.89,34.70,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,6.32,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier,,1.67,,,,,,,1.18,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,outpatient,1,EA,41.78000,39.69000,The Alliance,Premier,,29.62,,,,,,,20.89,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Premier,,11.91,,,,,,,8.40,16.30,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier,,9.25,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier,,20.88,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier,,28.96,,,,,,,20.43,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Premier,,5.85,,,,,,,4.12,8.00,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,outpatient,1,EA,37.02000,35.17000,The Alliance,Premier,,26.25,,,,,,,18.51,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,outpatient,1,EA,13.95000,13.25000,The Alliance,Premier,,9.89,,,,,,,6.97,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,outpatient,1,EA,122.37000,116.26000,The Alliance,Premier,,86.76,,,,,,,61.19,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,outpatient,1,EA,48.95000,46.50000,The Alliance,Premier,,34.71,,,,,,,24.48,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Premier,,13.11,,,,,,,9.24,17.94,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier,,12.32,,,,,,,8.69,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Premier,,12.55,,,,,,,8.85,17.17,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier,,1.87,,,,,,,1.32,2.56,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,outpatient,1,EA,20.11000,19.11000,The Alliance,Premier,,14.26,,,,,,,10.05,19.51,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,outpatient,1,mL,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,outpatient,1,EA,19.54000,18.57000,The Alliance,Premier,,13.85,,,,,,,9.77,18.95,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,outpatient,1,EA,692.00000,657.40000,The Alliance,Premier,,490.63,,,,,,,346.00,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,outpatient,1,EA,188.18000,178.77000,The Alliance,Premier,,133.42,,,,,,,94.09,182.53,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,outpatient,1,mL,2.36000,2.24000,The Alliance,Premier,,2.18,,,,,,,1.18,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,outpatient,1,mL,3.36000,3.20000,The Alliance,Premier,,2.18,,,,,,,1.68,3.26,fee schedule,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.18,,,,,,,1.58,3.07,fee schedule,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,outpatient,1,mL,19.18000,18.22000,The Alliance,Premier,,13.60,,,,,,,9.59,18.60,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,outpatient,1,EA,5.51000,5.23000,The Alliance,Premier,,3.91,,,,,,,2.75,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Premier,,6.38,,,,,,,4.50,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,outpatient,1,EA,7.78000,7.39000,The Alliance,Premier,,5.52,,,,,,,3.89,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,outpatient,1,GM,0.22000,0.20000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Premier,,3.43,,,,,,,3.23,67.43,fee schedule,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,outpatient,1,EA,10.54000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.27,10.22,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier,,0.81535,,,,,,,0.57500,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier,,3.73,,,,,,,1.31,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,outpatient,1,mL,2.71000,2.57000,The Alliance,Premier,,3.73,,,,,,,1.35,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Premier,,3.73,,,,,,,1.45,4.28,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier,,2.31,,,,,,,0.25000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Premier,,2.31,,,,,,,0.47000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier,,2.31,,,,,,,0.25500,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier,,2.31,,,,,,,0.25000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Premier,,2.31,,,,,,,0.24000,2.61,fee schedule,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier,,37.80,,,,,,,28.44,55.17,fee schedule,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,outpatient,1,mL,61.46000,58.39000,The Alliance,Premier,,37.80,,,,,,,30.73,59.62,fee schedule,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,outpatient,1,EA,31.45000,29.88000,The Alliance,Premier,,22.30,,,,,,,15.72,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,outpatient,1,EA,14.34000,13.63000,The Alliance,Premier,,10.17,,,,,,,7.17,13.91,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Premier,,171.34,,,,,,,120.83,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Premier,,342.69,,,,,,,187.18,468.84,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,outpatient,1,EA,669.20000,635.74000,The Alliance,Premier,,178.25,,,,,,,108.03,649.12,fee schedule,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,outpatient,1,EA,3779.13000,3590.17000,The Alliance,Premier,,178.25,,,,,,,108.03,3665.76,fee schedule,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,outpatient,1,EA,4600.00000,4370.00000,The Alliance,Premier,,178.25,,,,,,,108.03,4462.00,fee schedule,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier,,6.68,,,,,,,4.71,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,outpatient,1,EA,14.55000,13.82000,The Alliance,Premier,,10.32,,,,,,,7.28,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,outpatient,1,EA,40.76000,38.72000,The Alliance,Premier,,28.90,,,,,,,20.38,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,outpatient,1,EA,16.38000,15.57000,The Alliance,Premier,,11.61,,,,,,,8.19,15.89,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,outpatient,1,EA,20.97000,19.92000,The Alliance,Premier,,0.37950,,,,,,,0.36823,20.34,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Premier,,0.37950,,,,,,,0.36823,7.61,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,outpatient,1,EA,8.95000,8.50000,The Alliance,Premier,,0.37950,,,,,,,0.36823,8.68,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,outpatient,1,EA,7.43000,7.05000,The Alliance,Premier,,0.37950,,,,,,,0.36823,7.21,fee schedule,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,outpatient,1,EA,54.15000,51.44000,The Alliance,Premier,,38.39,,,,,,,27.07,52.53,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier,,2.90,,,,,,,2.04,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,outpatient,1,mL,12.48000,11.86000,The Alliance,Premier,,2.31,,,,,,,2.24,12.11,fee schedule,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,outpatient,1,mL,4.23000,4.02000,The Alliance,Premier,,0.42900,,,,,,,0.26000,4.10,fee schedule,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,outpatient,1,GM,19.83000,18.84000,The Alliance,Premier,,14.06,,,,,,,9.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier,,5.80,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,outpatient,1,GM,11.68000,11.10000,The Alliance,Premier,,8.28,,,,,,,5.84,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier,,5.80,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier,,5.80,,,,,,,4.09,7.93,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,outpatient,1,GM,5.01000,4.76000,The Alliance,Premier,,3.55,,,,,,,2.50,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,outpatient,1,GM,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,outpatient,1,EA,9.03000,8.58000,The Alliance,Premier,,6.40,,,,,,,4.51,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Premier,,2.26,,,,,,,1.59,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier,,2.61,,,,,,,1.84,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,outpatient,1,GM,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,outpatient,1,EA,8.68000,8.24000,The Alliance,Premier,,6.15,,,,,,,4.34,8.42,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier,,0.75154,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier,,1.69,,,,,,,1.19,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier,,0.26400,,,,,,,0.19995,1.92,fee schedule,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Premier,,0.26400,,,,,,,0.19995,8.64,fee schedule,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,outpatient,1,mL,6.74000,6.40000,The Alliance,Premier,,4.78,,,,,,,3.37,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,outpatient,1,mL,6.67000,6.33000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,outpatient,1,mL,68.41000,64.98000,The Alliance,Premier,,48.84,,,,,,,29.60,66.36,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Premier,,48.84,,,,,,,26.86,52.11,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,outpatient,1,mL,142.39000,135.27000,The Alliance,Premier,,48.84,,,,,,,29.60,138.12,fee schedule,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Premier,,10.76,,,,,,,7.58,14.71,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,outpatient,1,EA,5.82000,5.53000,The Alliance,Premier,,4.13,,,,,,,2.91,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,outpatient,1,EA,2.76000,2.63000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier,,1.55,,,,,,,1.09,2.11,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,outpatient,1,mL,3.45000,3.28000,The Alliance,Premier,,2.45,,,,,,,1.73,3.35,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,outpatient,1,GM,0.46000,0.43000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,outpatient,1,EA,32.55000,30.93000,The Alliance,Premier,,23.08,,,,,,,16.27,31.57,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,outpatient,1,mL,15.00000,14.25000,The Alliance,Premier,,10.63,,,,,,,7.50,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,outpatient,1,mL,13.24000,12.58000,The Alliance,Premier,,9.39,,,,,,,6.62,12.84,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Premier,,2.79,,,,,,,1.97,3.82,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Premier,,3.47,,,,,,,2.45,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Premier,,48.84,,,,,,,26.86,52.11,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,outpatient,1,mL,128.82000,122.38000,The Alliance,Premier,,48.84,,,,,,,29.60,124.96,fee schedule,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,outpatient,1,GM,5.52000,5.24000,The Alliance,Premier,,3.91,,,,,,,2.76,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,outpatient,1,GM,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,outpatient,1,GM,5.75000,5.46000,The Alliance,Premier,,4.08,,,,,,,2.88,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,outpatient,1,GM,4.06000,3.86000,The Alliance,Premier,,2.88,,,,,,,2.03,3.94,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,outpatient,1,mL,1.96000,1.86000,The Alliance,Premier,,1.39,,,,,,,0.98000,1.90,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier,,3.52,,,,,,,2.48,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier,,1.69,,,,,,,1.20,2.32,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Premier,,7.82,,,,,,,5.51,10.70,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,outpatient,1,mL,19.99000,18.99000,The Alliance,Premier,,14.17,,,,,,,9.99,19.39,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,outpatient,1,EA,6.34000,6.02000,The Alliance,Premier,,4.50,,,,,,,3.17,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier,,4.08,,,,,,,2.88,5.58,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.61050,,,,,,,0.58000,1.13,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,outpatient,1,EA,13.86000,13.17000,The Alliance,Premier,,0.61050,,,,,,,0.58745,13.44,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.61050,,,,,,,0.58500,1.13,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Premier,,0.61050,,,,,,,0.58745,23.32,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,outpatient,1,mL,27.27000,25.91000,The Alliance,Premier,,0.26400,,,,,,,0.23870,26.45,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,outpatient,1,mL,8.93000,8.49000,The Alliance,Premier,,0.26400,,,,,,,0.23870,8.66,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,outpatient,1,mL,8.94000,8.49000,The Alliance,Premier,,0.26400,,,,,,,0.23870,8.67,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,outpatient,1,mL,22.91000,21.77000,The Alliance,Premier,,0.26400,,,,,,,0.23870,22.22,fee schedule,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier,,4.11,,,,,,,2.90,5.62,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,outpatient,1,EA,17.10000,16.25000,The Alliance,Premier,,0.61050,,,,,,,0.58745,16.59,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,outpatient,1,EA,11.55000,10.97000,The Alliance,Premier,,0.61050,,,,,,,0.58745,11.20,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Premier,,0.61050,,,,,,,0.58745,12.73,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,Premier,,0.61050,,,,,,,0.58745,5.15,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.61050,,,,,,,0.29500,0.63080,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,outpatient,1,EA,11.77000,11.18000,The Alliance,Premier,,0.61050,,,,,,,0.58745,11.42,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier,,0.61050,,,,,,,0.58745,4.44,fee schedule,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,outpatient,1,EA,16.30000,15.49000,The Alliance,Premier,,11.56,,,,,,,8.15,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier,,1.86,,,,,,,1.31,2.54,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Premier,,2.94,,,,,,,2.08,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,outpatient,1,EA,12.79000,12.15000,The Alliance,Premier,,9.07,,,,,,,6.39,12.41,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,14.37,,,,,,,0.29000,14.37,fee schedule,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Premier,,14.37,,,,,,,0.28000,14.37,fee schedule,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,outpatient,1,EA,1.65000,1.56000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,outpatient,1,EA,39.82000,37.83000,The Alliance,Premier,,28.23,,,,,,,19.91,38.63,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,outpatient,1,mL,11.10000,10.55000,The Alliance,Premier,,5.79,,,,,,,4.77,10.77,fee schedule,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,outpatient,1,EA,16.69000,15.86000,The Alliance,Premier,,11.83,,,,,,,8.35,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,outpatient,1,EA,43.24000,41.07000,The Alliance,Premier,,30.66,,,,,,,21.62,41.94,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,outpatient,1,EA,96.21000,91.40000,The Alliance,Premier,,68.21,,,,,,,48.10,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,outpatient,1,EA,23.30000,22.13000,The Alliance,Premier,,16.52,,,,,,,11.65,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,outpatient,1,EA,31.97000,30.37000,The Alliance,Premier,,22.67,,,,,,,15.98,31.01,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.83,3.55,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Premier,,4.41,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,outpatient,1,mL,69.35000,65.88000,The Alliance,Premier,,49.17,,,,,,,34.67,67.27,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Premier,,10.70,,,,,,,7.54,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier,,3.98,,,,,,,2.81,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Premier,,1.94,,,,,,,1.36,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,outpatient,1,EA,6.82000,6.48000,The Alliance,Premier,,4.84,,,,,,,3.41,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,outpatient,1,EA,6.64000,6.30000,The Alliance,Premier,,4.71,,,,,,,3.32,6.44,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,outpatient,1,mL,2.44000,2.32000,The Alliance,Premier,,1.73,,,,,,,1.22,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,outpatient,1,EA,11.37000,10.80000,The Alliance,Premier,,8.06,,,,,,,5.68,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Premier,,4.23,,,,,,,2.98,5.79,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,outpatient,1,EA,45.02000,42.77000,The Alliance,Premier,,31.92,,,,,,,22.51,43.67,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,outpatient,1,EA,29.46000,27.99000,The Alliance,Premier,,20.89,,,,,,,14.73,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,outpatient,1,EA,77.26000,73.40000,The Alliance,Premier,,54.78,,,,,,,38.63,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,outpatient,1,mL,37.52000,35.65000,The Alliance,Premier,,26.60,,,,,,,14.28,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,outpatient,1,mL,29.64000,28.16000,The Alliance,Premier,,21.01,,,,,,,14.28,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,outpatient,1,mL,22.12000,21.01000,The Alliance,Premier,,15.68,,,,,,,11.06,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,outpatient,1,mL,11.63000,11.05000,The Alliance,Premier,,8.25,,,,,,,5.82,15.29,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,outpatient,1,mL,29.39000,27.92000,The Alliance,Premier,,20.84,,,,,,,14.28,28.51,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,outpatient,1,EA,36.90000,35.06000,The Alliance,Premier,,26.16,,,,,,,18.45,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Premier,,25.20,,,,,,,17.77,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,outpatient,1,EA,36.97000,35.12000,The Alliance,Premier,,26.21,,,,,,,18.48,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier,,25.77,,,,,,,18.17,35.25,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,outpatient,1,GM,41.32000,39.25000,The Alliance,Premier,,29.30,,,,,,,20.66,40.08,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,outpatient,1,GM,3.69000,3.50000,The Alliance,Premier,,2.62,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,outpatient,1,mL,2.23000,2.12000,The Alliance,Premier,,1.58,,,,,,,1.11,2.16,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,outpatient,1,EA,11.81000,11.22000,The Alliance,Premier,,8.37,,,,,,,5.91,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,outpatient,1,EA,6.29000,5.97000,The Alliance,Premier,,4.46,,,,,,,3.15,6.10,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Premier,,3.88,,,,,,,2.73,5.31,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,outpatient,1,EA,158.82000,150.88000,The Alliance,Premier,,1.50,,,,,,,1.44,154.06,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,outpatient,1,EA,124.79000,118.55000,The Alliance,Premier,,1.50,,,,,,,1.44,121.05,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,outpatient,1,EA,80.71000,76.67000,The Alliance,Premier,,1.50,,,,,,,1.44,78.29,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,outpatient,1,EA,104.91000,99.67000,The Alliance,Premier,,1.50,,,,,,,1.44,101.76,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,1.50,,,,,,,1.44,61.30,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,outpatient,1,EA,111.99000,106.39000,The Alliance,Premier,,1.50,,,,,,,1.44,108.63,fee schedule,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,outpatient,1,EA,6.36000,6.04000,The Alliance,Premier,,4.51,,,,,,,3.18,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Premier,,4.15,,,,,,,2.92,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,outpatient,1,EA,7.81000,7.42000,The Alliance,Premier,,5.54,,,,,,,3.90,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Premier,,0.14850,,,,,,,0.13795,3.11,fee schedule,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier,,0.14850,,,,,,,0.13795,2.91,fee schedule,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,outpatient,1,EA,7.11000,6.76000,The Alliance,Premier,,5.04,,,,,,,3.56,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,outpatient,1,EA,7.60000,7.22000,The Alliance,Premier,,5.39,,,,,,,3.80,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,outpatient,1,EA,6.75000,6.41000,The Alliance,Premier,,4.79,,,,,,,3.38,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Premier,,4.32,,,,,,,3.05,5.92,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,outpatient,1,EA,20.67000,19.64000,The Alliance,Premier,,14.66,,,,,,,10.34,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,outpatient,1,EA,13.02000,12.37000,The Alliance,Premier,,9.23,,,,,,,6.51,12.63,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,outpatient,1,EA,6.07000,5.77000,The Alliance,Premier,,4.30,,,,,,,3.04,5.89,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,outpatient,1,EA,8.07000,7.67000,The Alliance,Premier,,5.72,,,,,,,4.04,7.83,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,outpatient,1,mL,46.48000,44.15000,The Alliance,Premier,,104.58,,,,,,,23.24,123.35,fee schedule,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,outpatient,1,mL,51.07000,48.51000,The Alliance,Premier,,104.58,,,,,,,25.54,123.35,fee schedule,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,outpatient,1,mL,41.78000,39.69000,The Alliance,Premier,,104.58,,,,,,,20.89,123.35,fee schedule,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Premier,,7.57,,,,,,,5.34,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Premier,,6.81,,,,,,,4.80,9.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Premier,,1.01,,,,,,,0.91450,147.13,fee schedule,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,outpatient,1,mL,121.98000,115.88000,The Alliance,Premier,,1.01,,,,,,,0.91450,118.32,fee schedule,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,outpatient,1,mL,314.03000,298.33000,The Alliance,Premier,,1.01,,,,,,,0.91450,304.61,fee schedule,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,outpatient,1,EA,279.66000,265.68000,The Alliance,Premier,,0.67650,,,,,,,0.47275,271.27,fee schedule,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,outpatient,1,EA,233.84000,222.15000,The Alliance,Premier,,0.67650,,,,,,,0.47275,226.82,fee schedule,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,outpatient,1,EA,229.10000,217.64000,The Alliance,Premier,,0.67650,,,,,,,0.47275,222.23,fee schedule,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Premier,,6.44,,,,,,,4.54,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Premier,,5.88,,,,,,,4.15,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,outpatient,1,EA,287.00000,272.65000,The Alliance,Premier,,203.48,,,,,,,143.50,278.39,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,outpatient,1,EA,4.63000,4.40000,The Alliance,Premier,,3.28,,,,,,,2.31,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,outpatient,1,EA,9.26000,8.80000,The Alliance,Premier,,6.57,,,,,,,4.63,8.98,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Premier,,2.07,,,,,,,1.46,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,outpatient,1,EA,41.11000,39.06000,The Alliance,Premier,,29.15,,,,,,,20.55,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Premier,,3.33,,,,,,,2.35,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier,,2.29,,,,,,,1.61,3.13,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,outpatient,1,mL,13.34000,12.67000,The Alliance,Premier,,1.01,,,,,,,0.91450,12.94,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Premier,,1.01,,,,,,,0.91450,7.24,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,outpatient,1,mL,31.38000,29.81000,The Alliance,Premier,,1.01,,,,,,,0.91450,30.44,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,outpatient,1,mL,12.34000,11.73000,The Alliance,Premier,,1.01,,,,,,,0.91450,11.97,fee schedule,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,outpatient,1,EA,7.38000,7.01000,The Alliance,Premier,,5.23,,,,,,,3.69,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,outpatient,1,EA,8.84000,8.40000,The Alliance,Premier,,6.27,,,,,,,4.42,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Premier,,5.13,,,,,,,3.62,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier,,1.06,,,,,,,0.74500,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Premier,,6.49,,,,,,,4.58,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,outpatient,1,EA,8.12000,7.72000,The Alliance,Premier,,5.76,,,,,,,4.06,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier,,1.56,,,,,,,1.10,2.13,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Premier,,6.16,,,,,,,4.34,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,outpatient,1,EA,256.00000,243.20000,The Alliance,Premier,,181.50,,,,,,,128.00,248.32,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Premier,,126.76,,,,,,,89.39,173.43,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,outpatient,1,mL,19.62000,18.64000,The Alliance,Premier,,13.91,,,,,,,9.81,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,outpatient,1,mL,8.01000,7.61000,The Alliance,Premier,,5.68,,,,,,,4.00,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,outpatient,1,mL,6.69000,6.36000,The Alliance,Premier,,4.74,,,,,,,3.35,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,outpatient,1,mL,31.50000,29.92000,The Alliance,Premier,,22.33,,,,,,,15.75,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,outpatient,1,mL,19.63000,18.65000,The Alliance,Premier,,13.92,,,,,,,9.81,19.04,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Premier,,126.76,,,,,,,89.39,173.43,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,outpatient,1,EA,4.90000,4.66000,The Alliance,Premier,,3.47,,,,,,,2.45,4.75,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,outpatient,1,mL,5.08000,4.83000,The Alliance,Premier,,3.60,,,,,,,2.54,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,outpatient,1,mL,2.09000,1.99000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.18150,,,,,,,0.17611,6.13,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,outpatient,1,mL,10.62000,10.09000,The Alliance,Premier,,0.18150,,,,,,,0.17611,10.30,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,outpatient,1,mL,5.32000,5.06000,The Alliance,Premier,,0.18150,,,,,,,0.17611,5.16,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Premier,,0.18150,,,,,,,0.17611,8.27,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,0.18150,,,,,,,0.17611,4.91,fee schedule,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Premier,,238.89,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Premier,,238.89,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,outpatient,1,EA,348.70000,331.27000,The Alliance,Premier,,247.23,,,,,,,174.35,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,outpatient,1,EA,316.63000,300.80000,The Alliance,Premier,,224.49,,,,,,,158.31,307.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,outpatient,1,EA,5.91000,5.61000,The Alliance,Premier,,4.19,,,,,,,2.96,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,outpatient,1,EA,3.52000,3.35000,The Alliance,Premier,,2.50,,,,,,,1.76,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,outpatient,1,mL,7116.49000,6760.67000,The Alliance,Premier,,5045.59,,,,,,,719.87,6903.00,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,outpatient,1,mL,3.73000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Premier,,3.09,,,,,,,2.18,4.23,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Premier,,6.86,,,,,,,4.83,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,outpatient,1,EA,8.54000,8.12000,The Alliance,Premier,,6.05,,,,,,,4.27,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier,,0.14850,,,,,,,0.13795,1.24,fee schedule,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Premier,,0.14850,,,,,,,0.13795,1.56,fee schedule,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,outpatient,1,mL,8.73000,8.29000,The Alliance,Premier,,6.19,,,,,,,4.37,8.47,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Premier,,15.59,,,,,,,12.32,23.91,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,outpatient,1,mL,25.06000,23.81000,The Alliance,Premier,,15.59,,,,,,,12.53,24.31,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,15.59,,,,,,,9.48,20.47,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,outpatient,1,mL,25.91000,24.62000,The Alliance,Premier,,15.59,,,,,,,12.96,25.13,fee schedule,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Premier,,265.35,,,,,,,187.13,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,outpatient,1,EA,308.73000,293.30000,The Alliance,Premier,,218.89,,,,,,,154.37,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Premier,,306.47,,,,,,,216.12,419.28,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,outpatient,1,EA,20.64000,19.61000,The Alliance,Premier,,14.63,,,,,,,10.32,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,outpatient,1,EA,20.17000,19.16000,The Alliance,Premier,,14.30,,,,,,,10.09,19.56,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Premier,,32.15,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,outpatient,1,EA,0.41000,0.38000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,outpatient,1,EA,20.77000,19.73000,The Alliance,Premier,,14.73,,,,,,,10.38,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,outpatient,1,EA,13.45000,12.78000,The Alliance,Premier,,9.54,,,,,,,6.72,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,outpatient,1,EA,25.32000,24.06000,The Alliance,Premier,,17.95,,,,,,,12.66,24.56,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,outpatient,1,GM,67.76000,64.37000,The Alliance,Premier,,48.04,,,,,,,33.88,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,outpatient,1,GM,51.80000,49.21000,The Alliance,Premier,,36.73,,,,,,,25.90,50.25,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Premier,,47.61,,,,,,,33.58,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,outpatient,1,EA,5.06000,4.81000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,outpatient,1,EA,22.94000,21.79000,The Alliance,Premier,,16.26,,,,,,,11.47,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,outpatient,1,mL,3.57000,3.39000,The Alliance,Premier,,2.53,,,,,,,1.78,3.46,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,outpatient,1,GM,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,outpatient,1,EA,279.39000,265.42000,The Alliance,Premier,,198.09,,,,,,,139.69,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,outpatient,1,EA,621.55000,590.47000,The Alliance,Premier,,440.68,,,,,,,310.77,602.90,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,outpatient,1,mL,107.32000,101.96000,The Alliance,Premier,,76.09,,,,,,,37.52,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,37.52,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,outpatient,1,EA,7.64000,7.26000,The Alliance,Premier,,5.42,,,,,,,3.82,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Premier,,3.29,,,,,,,2.32,4.50,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,outpatient,1,EA,14.24000,13.53000,The Alliance,Premier,,10.10,,,,,,,7.12,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,outpatient,1,EA,4.58000,4.36000,The Alliance,Premier,,3.25,,,,,,,2.29,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier,,3.34,,,,,,,2.35,4.57,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,outpatient,1,mL,4.47000,4.25000,The Alliance,Premier,,0.01650,,,,,,,0.01601,4.34,fee schedule,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,outpatient,1,mL,1.08000,1.02000,The Alliance,Premier,,0.01650,,,,,,,0.01601,1.05,fee schedule,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Premier,,0.01650,,,,,,,0.01601,1.44,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,outpatient,1,mL,4.83000,4.58000,The Alliance,Premier,,0.18150,,,,,,,0.17611,4.69,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Premier,,0.18150,,,,,,,0.17611,7.92,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Premier,,0.18150,,,,,,,0.17611,7.25,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Premier,,0.18150,,,,,,,0.17611,3.11,fee schedule,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,outpatient,,,482.51000,458.38000,The Alliance,Premier,,342.10,,,,,,,51.13,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,outpatient,1,mL,965.01000,916.76000,The Alliance,Premier,,684.19,,,,,,,51.13,936.06,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier,,1.01,,,,,,,0.53900,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier,,3.13,,,,,,,0.53900,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,0.53900,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,outpatient,1,EA,21.70000,20.61000,The Alliance,Premier,,1.83,,,,,,,1.73,21.05,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,outpatient,1,EA,21.71000,20.62000,The Alliance,Premier,,1.83,,,,,,,1.73,21.06,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,outpatient,1,EA,23.29000,22.12000,The Alliance,Premier,,1.83,,,,,,,1.73,22.59,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,outpatient,1,EA,29.23000,27.77000,The Alliance,Premier,,1.83,,,,,,,1.73,28.35,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,1.83,,,,,,,1.73,9.20,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,outpatient,1,EA,29.22000,27.76000,The Alliance,Premier,,1.83,,,,,,,1.73,28.34,fee schedule,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,outpatient,1,mL,50.03000,47.53000,The Alliance,Premier,,35.47,,,,,,,1.68,48.53,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Premier,,4.62,,,,,,,3.26,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,outpatient,1,GM,31.50000,29.92000,The Alliance,Premier,,22.33,,,,,,,15.75,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,outpatient,1,GM,25.68000,24.39000,The Alliance,Premier,,18.21,,,,,,,12.84,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,outpatient,1,GM,26.72000,25.38000,The Alliance,Premier,,18.94,,,,,,,13.36,25.92,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Premier,,0.28050,,,,,,,0.27217,3.05,fee schedule,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier,,0.28050,,,,,,,0.27217,1.77,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.28050,,,,,,,0.10500,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.28050,,,,,,,0.16000,0.34860,fee schedule,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,outpatient,1,mL,14.25000,13.53000,The Alliance,Premier,,10.10,,,,,,,7.12,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,outpatient,1,mL,17.81000,16.92000,The Alliance,Premier,,12.63,,,,,,,8.90,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,outpatient,1,mL,16.76000,15.92000,The Alliance,Premier,,11.88,,,,,,,8.38,16.26,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,outpatient,1,EA,678.29000,644.37000,The Alliance,Premier,,480.91,,,,,,,339.14,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,outpatient,1,EA,34.13000,32.42000,The Alliance,Premier,,24.20,,,,,,,17.07,33.11,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,outpatient,1,mL,972.04000,923.43000,The Alliance,Premier,,689.18,,,,,,,486.02,942.88,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,outpatient,1,EA,4.82000,4.58000,The Alliance,Premier,,3.42,,,,,,,2.41,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Premier,,2.26,,,,,,,1.59,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,outpatient,1,EA,30.51000,28.98000,The Alliance,Premier,,0.28050,,,,,,,0.27217,29.59,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,outpatient,1,EA,22.79000,21.65000,The Alliance,Premier,,0.28050,,,,,,,0.27217,22.11,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,outpatient,1,EA,8.94000,8.50000,The Alliance,Premier,,0.28050,,,,,,,0.27217,8.67,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,outpatient,1,EA,23.98000,22.79000,The Alliance,Premier,,0.28050,,,,,,,0.27217,23.26,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier,,0.28050,,,,,,,0.27217,16.86,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier,,0.28050,,,,,,,0.27217,9.75,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,outpatient,1,EA,17.06000,16.21000,The Alliance,Premier,,0.28050,,,,,,,0.27217,16.55,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,outpatient,1,EA,8.88000,8.44000,The Alliance,Premier,,0.28050,,,,,,,0.27217,8.61,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Premier,,0.28050,,,,,,,0.27217,10.02,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Premier,,0.28050,,,,,,,0.27217,6.93,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Premier,,0.28050,,,,,,,0.27217,4.64,fee schedule,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Premier,,4.05,,,,,,,2.85,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Premier,,5.26,,,,,,,3.71,7.20,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,outpatient,1,EA,36.01000,34.21000,The Alliance,Premier,,25.53,,,,,,,18.00,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,outpatient,1,mL,1.24000,1.17000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,outpatient,1,mL,52.14000,49.53000,The Alliance,Premier,,36.97,,,,,,,26.07,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,outpatient,1,mL,35.71000,33.92000,The Alliance,Premier,,25.32,,,,,,,17.86,34.64,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,outpatient,1,mL,43.32000,41.16000,The Alliance,Premier,,30.71,,,,,,,21.66,42.02,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier,,1.87,,,,,,,1.32,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,outpatient,1,mL,114.96000,109.22000,The Alliance,Premier,,320.63,,,,,,,57.48,472.00,fee schedule,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,outpatient,1,mL,777.00000,738.15000,The Alliance,Premier,,320.63,,,,,,,194.32,753.69,fee schedule,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,outpatient,1,EA,5.32000,5.06000,The Alliance,Premier,,3.77,,,,,,,2.66,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Premier,,3.00,,,,,,,2.12,4.10,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Premier,,25.31,,,,,,,17.85,34.63,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,outpatient,1,EA,22.83000,21.69000,The Alliance,Premier,,0.44550,,,,,,,0.43227,22.15,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,outpatient,1,EA,48.81000,46.37000,The Alliance,Premier,,0.44550,,,,,,,0.43227,47.35,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,outpatient,1,EA,41.00000,38.95000,The Alliance,Premier,,0.44550,,,,,,,0.43227,39.77,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,outpatient,1,EA,44.24000,42.03000,The Alliance,Premier,,0.44550,,,,,,,0.43227,42.91,fee schedule,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,outpatient,1,mL,7537.53000,7160.66000,The Alliance,Premier,,5344.11,,,,,,,719.87,7311.40,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Premier,,5.10,,,,,,,3.60,6.97,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier,,3.17,,,,,,,2.23,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Premier,,3.15,,,,,,,2.22,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,outpatient,1,EA,7.62000,7.23000,The Alliance,Premier,,5.40,,,,,,,3.81,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Premier,,7.15,,,,,,,5.04,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,outpatient,1,mL,7.82000,7.43000,The Alliance,Premier,,5.54,,,,,,,3.91,7.59,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,outpatient,1,EA,6.65000,6.31000,The Alliance,Premier,,4.71,,,,,,,3.33,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier,,0.99969,,,,,,,0.70500,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier,,0.43249,,,,,,,0.30500,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,outpatient,1,mL,12088.99000,11484.54000,The Alliance,Premier,,197.13,,,,,,,38.71,11726.32,fee schedule,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,outpatient,1,mL,2760.00000,2622.00000,The Alliance,Premier,,197.13,,,,,,,38.71,2677.20,fee schedule,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,outpatient,1,mL,1079.15000,1025.19000,The Alliance,Premier,,197.13,,,,,,,38.71,1046.78,fee schedule,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,outpatient,1,mL,15.36000,14.59000,The Alliance,Premier,,10.89,,,,,,,7.68,14.90,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,6.32,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,outpatient,1,mL,14.54000,13.81000,The Alliance,Premier,,10.31,,,,,,,7.27,14.10,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier,,1.64,,,,,,,1.16,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Premier,,2.37,,,,,,,1.67,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier,,1.97,,,,,,,1.39,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,outpatient,1,mL,5.68000,5.39000,The Alliance,Premier,,4.03,,,,,,,2.84,5.51,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,outpatient,1,EA,216.55000,205.73000,The Alliance,Premier,,153.53,,,,,,,108.28,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,outpatient,1,EA,95.56000,90.78000,The Alliance,Premier,,67.75,,,,,,,47.78,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,outpatient,1,EA,149.05000,141.59000,The Alliance,Premier,,105.68,,,,,,,74.53,144.58,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,outpatient,1,EA,309.43000,293.96000,The Alliance,Premier,,219.39,,,,,,,154.72,300.15,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Premier,,2.48,,,,,,,0.73040,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.73040,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,outpatient,1,EA,86.34000,82.02000,The Alliance,Premier,,61.22,,,,,,,43.17,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,outpatient,1,EA,50.96000,48.41000,The Alliance,Premier,,36.13,,,,,,,25.48,49.43,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,outpatient,1,EA,10.61000,10.08000,The Alliance,Premier,,7.52,,,,,,,5.30,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,outpatient,1,EA,3.45000,3.28000,The Alliance,Premier,,2.45,,,,,,,1.73,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Premier,,19.23,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,outpatient,1,GM,0.49000,0.46000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,outpatient,1,EA,23.14000,21.98000,The Alliance,Premier,,16.41,,,,,,,11.57,22.45,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier,,1.02,,,,,,,0.72000,1.40,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,outpatient,1,EA,20.66000,19.63000,The Alliance,Premier,,14.65,,,,,,,10.33,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,outpatient,1,EA,14.28000,13.57000,The Alliance,Premier,,10.12,,,,,,,7.14,13.85,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,outpatient,1,EA,27.09000,25.73000,The Alliance,Premier,,19.21,,,,,,,13.54,26.28,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier,,1.58,,,,,,,1.11,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier,,1.57,,,,,,,1.11,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Premier,,5.49,,,,,,,3.87,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,outpatient,1,EA,10.76000,10.23000,The Alliance,Premier,,7.63,,,,,,,5.38,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Premier,,4.14,,,,,,,2.92,5.66,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,outpatient,1,EA,47426.37000,45055.05000,The Alliance,Premier,,33625.30,,,,,,,23713.19,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,outpatient,1,EA,38000.00000,36100.00000,The Alliance,Premier,,26942.00,,,,,,,19000.00,36860.00,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier,,5.81,,,,,,,4.10,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier,,3.56,,,,,,,2.51,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier,,2.20,,,,,,,1.55,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier,,3.57,,,,,,,2.52,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier,,5.81,,,,,,,4.10,7.95,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,outpatient,1,EA,18.52000,17.59000,The Alliance,Premier,,13.13,,,,,,,9.26,17.96,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Premier,,14.02,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier,,1.21,,,,,,,0.85500,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,outpatient,1,EA,9.35000,8.89000,The Alliance,Premier,,6.63,,,,,,,4.67,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,outpatient,1,EA,18.11000,17.21000,The Alliance,Premier,,12.84,,,,,,,9.05,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,outpatient,1,EA,2062.94000,1959.79000,The Alliance,Premier,,18.05,,,,,,,10.94,2001.05,fee schedule,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,outpatient,1,EA,2387.67000,2268.29000,The Alliance,Premier,,18.05,,,,,,,10.94,2316.04,fee schedule,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,outpatient,1,EA,43.45000,41.27000,The Alliance,Premier,,30.81,,,,,,,21.73,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,outpatient,1,EA,75.34000,71.58000,The Alliance,Premier,,53.42,,,,,,,37.67,73.08,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,outpatient,1,EA,256.79000,243.95000,The Alliance,Premier,,182.06,,,,,,,128.40,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,outpatient,1,EA,35.71000,33.92000,The Alliance,Premier,,25.32,,,,,,,17.86,34.64,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,outpatient,1,EA,10.73000,10.19000,The Alliance,Premier,,7.61,,,,,,,5.37,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier,,25.69,,,,,,,18.12,35.15,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier,,10.19,,,,,,,7.18,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,outpatient,1,EA,4.22000,4.00000,The Alliance,Premier,,2.99,,,,,,,2.11,4.09,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,outpatient,1,EA,3.29000,3.13000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,outpatient,1,EA,12.91000,12.26000,The Alliance,Premier,,9.15,,,,,,,6.46,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,outpatient,1,EA,6.89000,6.54000,The Alliance,Premier,,4.89,,,,,,,3.44,6.68,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,outpatient,1,mL,789.60000,750.12000,The Alliance,Premier,,559.83,,,,,,,394.80,765.91,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,outpatient,1,EA,63.19000,60.03000,The Alliance,Premier,,44.80,,,,,,,31.59,61.29,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,outpatient,1,EA,46.75000,44.41000,The Alliance,Premier,,33.15,,,,,,,23.38,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,outpatient,1,EA,1375.24000,1306.48000,The Alliance,Premier,,18.05,,,,,,,10.94,1333.98,fee schedule,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,outpatient,1,EA,1591.71000,1512.12000,The Alliance,Premier,,18.05,,,,,,,10.94,1543.96,fee schedule,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,outpatient,1,EA,2471.39000,2347.82000,The Alliance,Premier,,621.19,,,,,,,376.48,2397.25,fee schedule,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,outpatient,1,EA,1664.33000,1581.12000,The Alliance,Premier,,1180.01,,,,,,,43.79,1614.40,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,outpatient,1,EA,100.29000,95.28000,The Alliance,Premier,,71.11,,,,,,,50.15,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,outpatient,1,EA,44.23000,42.01000,The Alliance,Premier,,31.36,,,,,,,22.11,42.90,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,outpatient,1,mL,10.78000,10.24000,The Alliance,Premier,,7.64,,,,,,,5.39,10.46,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,outpatient,1,EA,92.40000,87.78000,The Alliance,Premier,,1.58,,,,,,,1.54,89.63,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier,,1.58,,,,,,,1.54,38.31,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,outpatient,1,EA,42.55000,40.42000,The Alliance,Premier,,1.58,,,,,,,1.54,41.27,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,outpatient,1,EA,43.10000,40.94000,The Alliance,Premier,,1.58,,,,,,,1.54,41.81,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,outpatient,1,EA,43.87000,41.67000,The Alliance,Premier,,1.58,,,,,,,1.54,42.55,fee schedule,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,outpatient,1,EA,33.47000,31.79000,The Alliance,Premier,,23.73,,,,,,,16.73,32.47,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,outpatient,1,EA,223.47000,212.29000,The Alliance,Premier,,158.44,,,,,,,111.73,216.77,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Premier,,2.14,,,,,,,1.51,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier,,6.05,,,,,,,4.27,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,outpatient,1,EA,10.51000,9.98000,The Alliance,Premier,,7.45,,,,,,,5.25,10.19,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier,,25.69,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier,,25.69,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier,,25.69,,,,,,,18.12,35.15,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Premier,,4.23,,,,,,,2.98,5.79,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,outpatient,1,mL,37.82000,35.92000,The Alliance,Premier,,26.81,,,,,,,18.91,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,outpatient,1,mL,3.18000,3.02000,The Alliance,Premier,,2.25,,,,,,,1.59,3.08,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,outpatient,1,EA,12.36000,11.74000,The Alliance,Premier,,8.76,,,,,,,6.18,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Premier,,2.54,,,,,,,1.79,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,outpatient,1,EA,40.98000,38.93000,The Alliance,Premier,,29.05,,,,,,,20.49,39.75,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,outpatient,1,EA,641.04000,608.99000,The Alliance,Premier,,92.55,,,,,,,56.09,621.81,fee schedule,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,outpatient,1,EA,565.96000,537.66000,The Alliance,Premier,,92.55,,,,,,,56.09,548.98,fee schedule,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier,,1.15,,,,,,,0.81000,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,outpatient,1,EA,53.51000,50.83000,The Alliance,Premier,,37.94,,,,,,,26.75,51.90,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Premier,,5.10,,,,,,,3.60,6.97,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,outpatient,1,EA,5.29000,5.03000,The Alliance,Premier,,3.75,,,,,,,2.65,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,outpatient,1,EA,7.70000,7.32000,The Alliance,Premier,,5.46,,,,,,,3.85,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,outpatient,1,EA,5.01000,4.75000,The Alliance,Premier,,3.55,,,,,,,2.50,4.86,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,outpatient,1,mL,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,outpatient,1,EA,11.15000,10.59000,The Alliance,Premier,,7.91,,,,,,,5.58,10.82,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,outpatient,1,mL,839.47000,797.49000,The Alliance,Premier,,439.63,,,,,,,266.44,814.29,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,outpatient,1,mL,881.44000,837.37000,The Alliance,Premier,,439.63,,,,,,,266.44,855.00,fee schedule,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,outpatient,1,EA,40.61000,38.58000,The Alliance,Premier,,28.79,,,,,,,20.30,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,outpatient,1,mL,92.40000,87.78000,The Alliance,Premier,,1.58,,,,,,,1.54,89.63,fee schedule,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,outpatient,1,mL,3.36000,3.19000,The Alliance,Premier,,2.38,,,,,,,1.68,3.26,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier,,4.00,,,,,,,2.82,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,outpatient,1,mL,101.37000,96.30000,The Alliance,Premier,,71.87,,,,,,,50.69,98.33,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,outpatient,1,GM,24.73000,23.49000,The Alliance,Premier,,17.53,,,,,,,12.37,23.99,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,outpatient,1,mL,9.54000,9.06000,The Alliance,Premier,,6.76,,,,,,,4.77,9.25,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,outpatient,1,EA,57.87000,54.97000,The Alliance,Premier,,41.03,,,,,,,28.93,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,outpatient,1,EA,46.74000,44.40000,The Alliance,Premier,,33.14,,,,,,,23.37,45.34,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,outpatient,1,EA,402.97000,382.82000,The Alliance,Premier,,285.71,,,,,,,201.49,390.88,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier,,0.63810,,,,,,,0.45000,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,outpatient,1,EA,89.24000,84.77000,The Alliance,Premier,,63.27,,,,,,,44.62,86.56,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,outpatient,1,mL,1.32000,1.26000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,outpatient,1,mL,2.01000,1.91000,The Alliance,Premier,,1.43,,,,,,,1.00,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,outpatient,1,mL,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,outpatient,1,mL,1.07000,1.01000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,outpatient,1,EA,250.10000,237.60000,The Alliance,Premier,,177.32,,,,,,,125.05,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,outpatient,1,EA,190.56000,181.03000,The Alliance,Premier,,135.11,,,,,,,95.28,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Premier,,110.24,,,,,,,77.74,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Premier,,110.24,,,,,,,77.74,150.82,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,outpatient,1,GM,9.26000,8.80000,The Alliance,Premier,,6.57,,,,,,,4.63,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Premier,,10.23,,,,,,,7.21,14.00,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,outpatient,1,mL,1627.34000,1545.97000,The Alliance,Premier,,1153.78,,,,,,,813.67,1578.52,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,outpatient,1,mL,121.66000,115.58000,The Alliance,Premier,,86.26,,,,,,,60.83,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Premier,,87.52,,,,,,,61.72,119.74,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier,,1.03,,,,,,,0.72500,1.41,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,outpatient,1,mL,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,outpatient,1,mL,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,outpatient,1,mL,3.85000,3.66000,The Alliance,Premier,,2.73,,,,,,,1.93,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,outpatient,1,mL,0.41000,0.38000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier,,3.24,,,,,,,2.29,4.43,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,outpatient,1,EA,70.34000,66.82000,The Alliance,Premier,,49.87,,,,,,,35.17,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,outpatient,1,EA,26.05000,24.74000,The Alliance,Premier,,18.47,,,,,,,13.03,25.27,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier,,2.38,,,,,,,1.68,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,outpatient,1,EA,2.43000,2.30000,The Alliance,Premier,,1.72,,,,,,,1.22,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier,,1.64,,,,,,,1.16,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier,,0.31905,,,,,,,0.22500,0.43650,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,outpatient,1,mL,10.20000,9.69000,The Alliance,Premier,,7.23,,,,,,,5.10,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,outpatient,1,mL,10.76000,10.22000,The Alliance,Premier,,7.63,,,,,,,5.38,10.44,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,outpatient,1,GM,41.98000,39.88000,The Alliance,Premier,,29.76,,,,,,,20.99,40.72,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,outpatient,1,EA,122.59000,116.46000,The Alliance,Premier,,0.59400,,,,,,,0.57636,118.91,fee schedule,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,outpatient,1,mL,3.53000,3.36000,The Alliance,Premier,,2.50,,,,,,,1.76,3.42,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Premier,,2.86,,,,,,,2.02,3.91,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,outpatient,1,EA,177.91000,169.02000,The Alliance,Premier,,126.14,,,,,,,88.95,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,outpatient,1,mL,6.90000,6.55000,The Alliance,Premier,,4.89,,,,,,,3.45,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,outpatient,1,mL,13.21000,12.55000,The Alliance,Premier,,9.37,,,,,,,6.61,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,outpatient,1,mL,6.29000,5.97000,The Alliance,Premier,,4.46,,,,,,,3.15,6.10,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,outpatient,1,GM,21.95000,20.85000,The Alliance,Premier,,15.56,,,,,,,10.97,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Premier,,19.07,,,,,,,13.45,26.08,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,outpatient,1,EA,24.28000,23.06000,The Alliance,Premier,,17.21,,,,,,,12.14,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,outpatient,1,EA,5.66000,5.38000,The Alliance,Premier,,4.01,,,,,,,2.83,5.49,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier,,3.97,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Premier,,3.96,,,,,,,2.79,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier,,0.99260,,,,,,,0.70000,1.36,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,outpatient,1,EA,716.81000,680.97000,The Alliance,Premier,,3.15,,,,,,,1.91,695.31,fee schedule,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,outpatient,1,EA,828.93000,787.48000,The Alliance,Premier,,3.15,,,,,,,1.91,804.06,fee schedule,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier,,4.08,,,,,,,2.88,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,outpatient,1,mL,3.96000,3.76000,The Alliance,Premier,,2.81,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier,,2.72,,,,,,,1.92,3.72,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,outpatient,1,EA,19.45000,18.47000,The Alliance,Premier,,13.79,,,,,,,9.72,18.87,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Premier,,6.15,,,,,,,4.34,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,outpatient,1,EA,18.49000,17.57000,The Alliance,Premier,,13.11,,,,,,,9.24,17.94,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Premier,,19.07,,,,,,,13.45,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,outpatient,1,GM,10.53000,10.01000,The Alliance,Premier,,7.47,,,,,,,5.26,10.21,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,outpatient,1,EA,30.81000,29.27000,The Alliance,Premier,,0.59400,,,,,,,0.57636,29.89,fee schedule,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Premier,,0.04950,,,,,,,0.04650,64.37,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,0.04950,,,,,,,0.04650,61.30,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier,,0.04950,,,,,,,0.04650,55.17,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,outpatient,1,mL,58.43000,55.51000,The Alliance,Premier,,0.04950,,,,,,,0.04650,56.68,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,outpatient,1,mL,58.59000,55.66000,The Alliance,Premier,,0.04950,,,,,,,0.04650,56.83,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,outpatient,1,mL,51.29000,48.72000,The Alliance,Premier,,0.04950,,,,,,,0.04650,49.75,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,outpatient,1,mL,57.67000,54.79000,The Alliance,Premier,,0.04950,,,,,,,0.04650,55.94,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,outpatient,1,mL,60.83000,57.79000,The Alliance,Premier,,0.04950,,,,,,,0.04650,59.01,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,outpatient,1,mL,42.66000,40.53000,The Alliance,Premier,,0.04950,,,,,,,0.04650,41.38,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier,,0.04950,,,,,,,0.04650,39.85,fee schedule,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,outpatient,1,mL,1493.82000,1419.13000,The Alliance,Premier,,1059.12,,,,,,,48.92,1449.01,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,outpatient,1,EA,20.76000,19.72000,The Alliance,Premier,,14.72,,,,,,,10.38,20.14,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,outpatient,1,GM,183.72000,174.54000,The Alliance,Premier,,130.26,,,,,,,91.86,178.21,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,outpatient,1,mL,533.15000,506.50000,The Alliance,Premier,,432.68,,,,,,,262.23,517.16,fee schedule,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier,,10.56,,,,,,,7.45,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,outpatient,1,EA,7.12000,6.76000,The Alliance,Premier,,5.05,,,,,,,3.56,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier,,8.59,,,,,,,6.05,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,outpatient,1,EA,132.04000,125.43000,The Alliance,Premier,,93.62,,,,,,,66.02,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier,,10.41,,,,,,,7.34,14.24,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier,,9.76,,,,,,,6.88,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,outpatient,1,EA,307.01000,291.66000,The Alliance,Premier,,217.67,,,,,,,153.50,297.80,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,outpatient,1,EA,904.51000,859.28000,The Alliance,Premier,,641.30,,,,,,,452.25,877.37,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,outpatient,1,mL,47.20000,44.84000,The Alliance,Premier,,0.09900,,,,,,,0.08060,45.78,fee schedule,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,outpatient,1,mL,42.95000,40.80000,The Alliance,Premier,,0.09900,,,,,,,0.08060,41.66,fee schedule,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,outpatient,1,EA,21.04000,19.99000,The Alliance,Premier,,14.92,,,,,,,10.52,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Premier,,16.85,,,,,,,11.88,23.05,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,outpatient,1,mL,26.54000,25.22000,The Alliance,Premier,,18.82,,,,,,,13.27,25.74,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier,,51.73,,,,,,,39.66,229.89,fee schedule,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,outpatient,1,EA,904.31000,859.09000,The Alliance,Premier,,641.16,,,,,,,452.15,877.18,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Premier,,60.01,,,,,,,28.36,60.01,fee schedule,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Premier,,60.01,,,,,,,52.64,110.03,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Premier,,4.06,,,,,,,1.13,4.06,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,outpatient,1,mL,2.32000,2.20000,The Alliance,Premier,,4.06,,,,,,,1.16,4.06,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier,,4.06,,,,,,,1.15,4.06,fee schedule,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier,,1.95,,,,,,,1.38,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,outpatient,1,EA,61.04000,57.99000,The Alliance,Premier,,43.28,,,,,,,30.52,59.21,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Premier,,3.72,,,,,,,2.62,5.09,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,outpatient,1,GM,26.25000,24.94000,The Alliance,Premier,,18.61,,,,,,,13.12,25.46,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,outpatient,1,mL,100.25000,95.24000,The Alliance,Premier,,71.08,,,,,,,50.12,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,outpatient,1,mL,64.08000,60.88000,The Alliance,Premier,,45.43,,,,,,,32.04,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,outpatient,1,mL,73.53000,69.86000,The Alliance,Premier,,52.13,,,,,,,36.77,71.32,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,outpatient,1,EA,4.31000,4.09000,The Alliance,Premier,,3.06,,,,,,,2.15,4.18,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,outpatient,1,EA,20.06000,19.06000,The Alliance,Premier,,14.22,,,,,,,10.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,outpatient,1,EA,27.01000,25.66000,The Alliance,Premier,,19.15,,,,,,,13.51,26.20,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,outpatient,1,mL,12.11000,11.51000,The Alliance,Premier,,8.59,,,,,,,6.05,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Premier,,2.08,,,,,,,1.47,2.85,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier,,2.40,,,,,,,1.69,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,outpatient,1,EA,23.22000,22.06000,The Alliance,Premier,,16.46,,,,,,,11.61,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,outpatient,1,EA,8.59000,8.16000,The Alliance,Premier,,6.09,,,,,,,4.29,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier,,0.93588,,,,,,,0.66000,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Premier,,3.42,,,,,,,2.42,4.69,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier,,2.97,,,,,,,2.10,4.06,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,outpatient,1,mL,3283.73000,3119.54000,The Alliance,Premier,,2328.16,,,,,,,1641.87,3185.22,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,outpatient,1,EA,950.25000,902.73000,The Alliance,Premier,,673.73,,,,,,,365.89,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,outpatient,1,EA,1541.05000,1464.00000,The Alliance,Premier,,1092.60,,,,,,,365.89,1494.82,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,outpatient,1,EA,112.97000,107.32000,The Alliance,Premier,,80.10,,,,,,,56.48,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,outpatient,1,EA,122.45000,116.33000,The Alliance,Premier,,86.82,,,,,,,61.23,118.78,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Premier,,4.81,,,,,,,3.39,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Premier,,78.42,,,,,,,55.30,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,outpatient,1,mL,30.03000,28.53000,The Alliance,Premier,,1.42,,,,,,,1.35,29.13,fee schedule,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,outpatient,1,mL,27.40000,26.03000,The Alliance,Premier,,1.42,,,,,,,1.35,26.58,fee schedule,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,outpatient,1,mL,22.16000,21.06000,The Alliance,Premier,,1.42,,,,,,,1.35,21.50,fee schedule,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,outpatient,1,EA,72.11000,68.51000,The Alliance,Premier,,51.13,,,,,,,36.05,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,outpatient,1,EA,101.10000,96.04000,The Alliance,Premier,,71.68,,,,,,,50.55,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,outpatient,1,EA,84.98000,80.73000,The Alliance,Premier,,60.25,,,,,,,42.49,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,outpatient,1,EA,86.99000,82.64000,The Alliance,Premier,,61.68,,,,,,,43.49,84.38,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,outpatient,1,GM,2.52000,2.39000,The Alliance,Premier,,1.79,,,,,,,1.26,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,outpatient,1,GM,2.30000,2.18000,The Alliance,Premier,,1.63,,,,,,,1.15,2.23,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier,,2.02,,,,,,,1.43,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier,,1.74,,,,,,,1.23,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,outpatient,1,EA,690.86000,656.31000,The Alliance,Premier,,0.59400,,,,,,,0.57636,670.13,fee schedule,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,outpatient,1,EA,12.76000,12.12000,The Alliance,Premier,,9.05,,,,,,,6.38,12.38,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Premier,,5.01,,,,,,,3.53,6.85,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,outpatient,1,EA,486.88000,462.54000,The Alliance,Premier,,345.20,,,,,,,243.44,472.27,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,outpatient,1,GM,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,outpatient,1,GM,5.26000,5.00000,The Alliance,Premier,,3.73,,,,,,,2.63,5.10,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,outpatient,1,mL,11.32000,10.76000,The Alliance,Premier,,8.03,,,,,,,5.66,10.98,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier,,0.68773,,,,,,,0.48500,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,outpatient,1,EA,5.89000,5.59000,The Alliance,Premier,,4.18,,,,,,,2.94,5.71,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97000,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier,,0.76572,,,,,,,0.54000,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,outpatient,1,GM,26.57000,25.24000,The Alliance,Premier,,18.84,,,,,,,13.29,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,outpatient,1,GM,10.25000,9.74000,The Alliance,Premier,,7.27,,,,,,,5.12,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,outpatient,1,GM,9.74000,9.25000,The Alliance,Premier,,6.91,,,,,,,4.87,9.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Premier,,23.86,,,,,,,22.94,80.33,fee schedule,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Premier,,23.86,,,,,,,22.94,80.33,fee schedule,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier,,2.06,,,,,,,1.46,2.82,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,outpatient,1,EA,3.53000,3.36000,The Alliance,Premier,,2.50,,,,,,,1.76,3.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier,,11.54,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier,,11.54,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,outpatient,1,EA,12.80000,12.16000,The Alliance,Premier,,9.08,,,,,,,6.40,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,outpatient,1,EA,23.45000,22.27000,The Alliance,Premier,,16.63,,,,,,,11.72,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,outpatient,1,mL,3.02000,2.87000,The Alliance,Premier,,5.66,,,,,,,1.51,5.89,fee schedule,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,outpatient,1,EA,1283.15000,1219.00000,The Alliance,Premier,,909.75,,,,,,,641.58,1244.66,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,outpatient,1,GM,3.99000,3.79000,The Alliance,Premier,,2.83,,,,,,,2.00,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,outpatient,1,GM,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,outpatient,1,EA,405.34000,385.07000,The Alliance,Premier,,0.84150,,,,,,,0.46810,393.18,fee schedule,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,outpatient,1,EA,404.04000,383.84000,The Alliance,Premier,,0.84150,,,,,,,0.46810,391.92,fee schedule,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Premier,,0.84150,,,,,,,0.46810,263.79,fee schedule,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,outpatient,1,mL,75.14000,71.39000,The Alliance,Premier,,53.27,,,,,,,37.57,72.89,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,outpatient,1,mL,38.43000,36.51000,The Alliance,Premier,,27.25,,,,,,,19.21,37.28,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,outpatient,1,EA,3.59000,3.41000,The Alliance,Premier,,2.55,,,,,,,1.79,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,outpatient,1,EA,4.22000,4.01000,The Alliance,Premier,,2.99,,,,,,,2.11,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,outpatient,1,EA,6.71000,6.37000,The Alliance,Premier,,4.76,,,,,,,3.35,6.51,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,outpatient,1,EA,89.14000,84.68000,The Alliance,Premier,,63.20,,,,,,,44.57,86.47,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,outpatient,1,GM,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,outpatient,1,mL,40.04000,38.04000,The Alliance,Premier,,28.39,,,,,,,20.02,38.84,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Premier,,18.77,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Premier,,14.58,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Premier,,3.80,,,,,,,2.68,5.20,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,outpatient,1,mL,16.20000,15.39000,The Alliance,Premier,,11.49,,,,,,,8.10,15.71,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,outpatient,1,EA,43.61000,41.43000,The Alliance,Premier,,8.73,,,,,,,7.96,42.30,fee schedule,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier,,1.42,,,,,,,1.00,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier,,2.42,,,,,,,1.71,3.32,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,outpatient,1,EA,190.55000,181.02000,The Alliance,Premier,,1.29,,,,,,,1.25,184.83,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,outpatient,1,EA,388.34000,368.93000,The Alliance,Premier,,1.29,,,,,,,1.25,376.69,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,outpatient,1,EA,386.40000,367.08000,The Alliance,Premier,,1.29,,,,,,,1.25,374.81,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,1.29,,,,,,,1.25,122.61,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier,,1.29,,,,,,,1.25,183.91,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,outpatient,1,EA,316.16000,300.35000,The Alliance,Premier,,1.29,,,,,,,1.25,306.68,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,outpatient,1,EA,203.60000,193.42000,The Alliance,Premier,,5.18,,,,,,,5.03,197.49,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Premier,,5.18,,,,,,,5.03,144.06,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,outpatient,1,EA,103.62000,98.44000,The Alliance,Premier,,5.18,,,,,,,5.03,100.51,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,outpatient,1,EA,62.92000,59.77000,The Alliance,Premier,,5.18,,,,,,,5.03,61.03,fee schedule,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,outpatient,1,EA,79.88000,75.88000,The Alliance,Premier,,56.63,,,,,,,39.94,77.48,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,outpatient,1,EA,279.35000,265.38000,The Alliance,Premier,,198.06,,,,,,,139.68,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,outpatient,1,EA,65.31000,62.04000,The Alliance,Premier,,46.30,,,,,,,32.66,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Premier,,8.22,,,,,,,5.79,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,outpatient,1,EA,50.36000,47.85000,The Alliance,Premier,,35.71,,,,,,,25.18,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,outpatient,1,EA,12.54000,11.92000,The Alliance,Premier,,8.89,,,,,,,6.27,12.16,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,outpatient,1,EA,2.44000,2.31000,The Alliance,Premier,,1.73,,,,,,,1.22,2.37,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,outpatient,1,mL,1495.72000,1420.94000,The Alliance,Premier,,1060.47,,,,,,,747.86,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Premier,,134.43,,,,,,,94.80,183.91,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,outpatient,,,150.51000,142.98000,The Alliance,Premier,,106.71,,,,,,,75.25,147.29,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,outpatient,1,EA,301.02000,285.97000,The Alliance,Premier,,213.42,,,,,,,147.29,291.99,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,outpatient,1,mL,8.18000,7.77000,The Alliance,Premier,,5.80,,,,,,,4.09,7.93,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier,,10.02,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier,,10.02,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier,,10.02,,,,,,,7.07,13.71,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,outpatient,1,mL,482.37000,458.26000,The Alliance,Premier,,16.71,,,,,,,10.13,467.90,fee schedule,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,outpatient,1,EA,23.06000,21.91000,The Alliance,Premier,,16.35,,,,,,,11.53,22.37,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,outpatient,1,GM,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,outpatient,1,GM,3.29000,3.13000,The Alliance,Premier,,2.33,,,,,,,1.65,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,outpatient,1,GM,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,outpatient,1,EA,277.41000,263.54000,The Alliance,Premier,,196.68,,,,,,,138.71,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Premier,,12.29,,,,,,,8.66,16.81,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,outpatient,1,EA,64.78000,61.54000,The Alliance,Premier,,45.93,,,,,,,32.39,62.84,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,outpatient,1,EA,11.16000,10.61000,The Alliance,Premier,,7.91,,,,,,,5.58,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier,,44.81,,,,,,,31.60,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Premier,,21.28,,,,,,,15.01,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier,,6.68,,,,,,,4.71,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Premier,,1.76,,,,,,,1.24,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,outpatient,1,EA,3.72000,3.54000,The Alliance,Premier,,2.64,,,,,,,1.86,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,outpatient,1,EA,140.09000,133.09000,The Alliance,Premier,,99.32,,,,,,,70.05,135.89,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,outpatient,1,EA,53.19000,50.53000,The Alliance,Premier,,37.71,,,,,,,26.59,51.59,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Premier,,5.71,,,,,,,4.03,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,3.13,,,,,,,2.21,4.29,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,outpatient,1,EA,30.27000,28.76000,The Alliance,Premier,,21.46,,,,,,,15.13,29.36,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,outpatient,1,EA,37.52000,35.65000,The Alliance,Premier,,26.60,,,,,,,18.76,36.39,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,outpatient,1,EA,126.72000,120.39000,The Alliance,Premier,,89.84,,,,,,,63.36,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,outpatient,1,EA,13.26000,12.60000,The Alliance,Premier,,9.40,,,,,,,6.63,12.86,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,outpatient,1,EA,4.96000,4.71000,The Alliance,Premier,,3.52,,,,,,,2.48,4.81,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier,,1.06,,,,,,,0.75000,1.46,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,outpatient,1,EA,162.76000,154.62000,The Alliance,Premier,,115.40,,,,,,,81.38,157.88,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,outpatient,1,EA,23.65000,22.47000,The Alliance,Premier,,16.77,,,,,,,11.82,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,outpatient,1,EA,13.88000,13.19000,The Alliance,Premier,,9.84,,,,,,,6.94,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier,,1.77,,,,,,,1.25,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Premier,,1.73,,,,,,,1.22,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,outpatient,1,EA,18.82000,17.88000,The Alliance,Premier,,13.34,,,,,,,9.41,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,outpatient,1,mL,44.32000,42.10000,The Alliance,Premier,,31.42,,,,,,,22.16,42.99,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier,,3.40,,,,,,,2.40,4.65,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,outpatient,1,EA,24.78000,23.54000,The Alliance,Premier,,17.57,,,,,,,12.39,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,outpatient,1,EA,69.38000,65.91000,The Alliance,Premier,,49.19,,,,,,,34.69,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,11.85,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,outpatient,1,EA,18.99000,18.04000,The Alliance,Premier,,13.46,,,,,,,9.49,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,outpatient,1,EA,104.09000,98.88000,The Alliance,Premier,,73.80,,,,,,,52.05,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,outpatient,1,EA,100.16000,95.15000,The Alliance,Premier,,71.01,,,,,,,50.08,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Premier,,4.97,,,,,,,3.50,6.80,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Premier,,12.97,,,,,,,12.58,46.13,fee schedule,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,outpatient,1,mL,17.89000,16.99000,The Alliance,Premier,,12.97,,,,,,,8.95,17.35,fee schedule,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier,,7.13,,,,,,,5.03,9.75,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,outpatient,1,EA,18.22000,17.31000,The Alliance,Premier,,12.92,,,,,,,9.11,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,outpatient,1,EA,14.92000,14.17000,The Alliance,Premier,,10.58,,,,,,,7.46,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,outpatient,1,EA,26.25000,24.94000,The Alliance,Premier,,18.61,,,,,,,13.12,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Premier,,2.94,,,,,,,2.08,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier,,4.59,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,outpatient,1,EA,40.35000,38.34000,The Alliance,Premier,,28.61,,,,,,,20.18,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Premier,,1.91,,,,,,,1.34,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,outpatient,1,EA,8.78000,8.35000,The Alliance,Premier,,6.23,,,,,,,4.39,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Premier,,6.20,,,,,,,4.38,8.49,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Premier,,16.76,,,,,,,11.82,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,outpatient,1,mL,35.57000,33.79000,The Alliance,Premier,,25.22,,,,,,,17.79,34.50,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,outpatient,1,GM,46.14000,43.83000,The Alliance,Premier,,32.71,,,,,,,23.07,44.76,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,outpatient,1,EA,15.86000,15.07000,The Alliance,Premier,,11.24,,,,,,,7.93,15.38,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier,,1.30,,,,,,,0.92000,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier,,2.17,,,,,,,1.53,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Premier,,6.02,,,,,,,4.25,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Premier,,424.40,,,,,,,8.08,424.40,fee schedule,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier,,611.15,,,,,,,11.61,611.15,fee schedule,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,outpatient,,,1089.00000,1034.55000,The Alliance,Premier,,772.10,,,,,,,544.50,1056.33,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier,,522.53,,,,,,,368.50,714.89,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.74250,,,,,,,0.63085,1.29,fee schedule,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.74250,,,,,,,0.63085,1.29,fee schedule,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier,,1762.40,,,,,,,1710.23,3726.00,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier,,1117.46,,,,,,,1084.39,2362.50,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier,,1463.34,,,,,,,1420.03,3093.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,41.62,,,,,,,40.39,88.00,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier,,6686.33,,,,,,,6488.42,14136.00,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier,,1117.46,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier,,1330.31,,,,,,,1290.94,2812.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier,,1330.31,,,,,,,1290.94,2812.50,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier,,10293.43,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier,,108.20,,,,,,,105.00,228.75,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier,,9824.21,,,,,,,9533.43,20770.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier,,39.35,,,,,,,38.19,83.20,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier,,9824.21,,,,,,,9533.43,20770.00,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier,,6686.33,,,,,,,6488.42,14136.00,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier,,2276.43,,,,,,,2209.05,4812.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier,,10293.43,,,,,,,9988.76,21762.00,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Premier,,619.04,,,,,,,600.72,1308.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier,,10293.43,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.68000,180.20000,The Alliance,Premier,,89.72,,,,,,,87.06,189.68,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Premier,,619.04,,,,,,,600.72,1308.75,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier,,399.09,,,,,,,387.28,843.75,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,247.50000,235.12000,The Alliance,Premier,,117.07,,,,,,,113.60,247.50,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier,,10293.43,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier,,117.96,,,,,,,114.47,249.38,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier,,10293.43,,,,,,,9988.76,21762.00,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier,,310.41,,,,,,,301.22,656.25,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier,,6686.33,,,,,,,6488.42,14136.00,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier,,997.10,,,,,,,967.59,2108.03,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,89.87,,,,,,,87.21,190.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Premier,,837.21,,,,,,,812.43,1770.00,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13020.00000,12369.00000,The Alliance,Premier,,6158.46,,,,,,,5976.18,13020.00,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13485.00000,12810.75000,The Alliance,Premier,,6378.40,,,,,,,6189.61,13485.00,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier,,3182.11,,,,,,,3087.92,6727.50,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1266.64000,1203.31000,The Alliance,Premier,,599.12,,,,,,,581.39,1266.64,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,292.67,,,,,,,284.01,618.75,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3476.25000,3302.44000,The Alliance,Premier,,1644.27,,,,,,,1595.60,3476.25,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5126.70000,4870.36000,The Alliance,Premier,,2424.93,,,,,,,2353.16,5126.70,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,45.32000,43.05000,The Alliance,Premier,,21.44,,,,,,,20.80,45.32,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier,,514.39,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier,,381.36,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Premier,,2414.49,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier,,322.47,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Premier,,2414.49,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier,,381.36,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier,,381.36,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier,,410.68,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Premier,,352.00,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Premier,,883.33,,,,,,,857.18,1867.50,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,702.86000,667.72000,The Alliance,Premier,,332.45,,,,,,,322.61,702.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Premier,,352.00,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4936.95000,4690.10000,The Alliance,Premier,,2335.18,,,,,,,2266.06,4936.95,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Premier,,883.33,,,,,,,857.18,1867.50,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Premier,,603.08,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Premier,,603.08,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier,,18.30,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,90.88000,86.34000,The Alliance,Premier,,42.99,,,,,,,41.71,90.88,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Premier,,4482.37,,,,,,,4349.70,9476.46,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier,,470.04,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,47.30,,,,,,,45.90,100.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier,,88.69,,,,,,,86.06,187.50,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,687.15000,652.79000,The Alliance,Premier,,325.02,,,,,,,315.40,687.15,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier,,2529.37,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier,,166.22,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6520.50000,6194.47000,The Alliance,Premier,,3084.20,,,,,,,2992.91,6520.50,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,485.25000,460.99000,The Alliance,Premier,,229.52,,,,,,,222.73,485.25,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,757.50000,719.62000,The Alliance,Premier,,358.30,,,,,,,347.69,757.50,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier,,8819.79,,,,,,,8558.74,18646.50,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier,,1552.03,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Premier,,203.98,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier,,8819.79,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier,,1552.03,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Premier,,2354.76,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Premier,,2354.76,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Premier,,3018.92,,,,,,,2929.57,6382.50,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2497.50000,2372.62000,The Alliance,Premier,,1181.32,,,,,,,1146.35,2497.50,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Premier,,214.18,,,,,,,207.84,452.81,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier,,1285.97,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Premier,,3018.92,,,,,,,2929.57,6382.50,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier,,8819.79,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Premier,,214.18,,,,,,,207.84,452.81,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier,,307.30,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,,39.73,,,,,,,38.56,84.00,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Premier,,510.84,,,,,,,495.72,1080.00,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier,,307.30,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier,,296.22,,,,,,,287.45,626.25,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier,,307.30,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,94.01,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier,,296.22,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier,,4487.59,,,,,,,4354.76,9487.50,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,666.00000,632.70000,The Alliance,Premier,,315.02,,,,,,,305.69,666.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier,,620.81,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier,,1285.97,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Premier,,37.08,,,,,,,35.99,78.40,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier,,296.22,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,,198.66,,,,,,,192.78,420.00,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,746.29000,708.98000,The Alliance,Premier,,353.00,,,,,,,342.55,746.29,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,,638.55,,,,,,,619.65,1350.00,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier,,620.81,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Premier,,917.03,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,47.68000,45.30000,The Alliance,Premier,,22.55,,,,,,,21.89,47.68,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3479.63000,3305.65000,The Alliance,Premier,,1645.86,,,,,,,1597.15,3479.63,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1162.50000,1104.38000,The Alliance,Premier,,549.86,,,,,,,533.59,1162.50,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9970.50000,9471.98000,The Alliance,Premier,,4716.05,,,,,,,4576.46,9970.50,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Premier,,742.32,,,,,,,720.35,1569.38,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,96.44000,91.62000,The Alliance,Premier,,45.62,,,,,,,44.27,96.44,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier,,3968.66,,,,,,,3851.19,8390.40,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9270.15000,8806.64000,The Alliance,Premier,,4384.78,,,,,,,4255.00,9270.15,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,,39.73,,,,,,,38.56,84.00,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,498.26000,473.35000,The Alliance,Premier,,235.68,,,,,,,228.70,498.26,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Premier,,203.98,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Premier,,917.03,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Premier,,4389.68,,,,,,,4259.75,9280.50,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier,,3968.66,,,,,,,3851.19,8390.40,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,119.76000,113.77000,The Alliance,Premier,,56.65,,,,,,,54.97,119.76,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3660.00000,3477.00000,The Alliance,Premier,,1731.18,,,,,,,1679.94,3660.00,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Premier,,84.21,,,,,,,81.72,178.04,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier,,181.75,,,,,,,176.38,384.26,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,247.43000,235.06000,The Alliance,Premier,,117.03,,,,,,,113.57,247.43,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier,,205.61,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier,,178.48,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,510.00000,484.50000,The Alliance,Premier,,241.23,,,,,,,234.09,510.00,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier,,36.31,,,,,,,35.23,76.76,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2124.00000,2017.80000,The Alliance,Premier,,1004.65,,,,,,,974.92,2124.00,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,93.40000,88.73000,The Alliance,Premier,,44.18,,,,,,,42.87,93.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Premier,,966.00,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,320.59000,304.56000,The Alliance,Premier,,151.64,,,,,,,147.15,320.59,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,305.33000,290.06000,The Alliance,Premier,,144.42,,,,,,,140.15,305.33,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,836.25000,794.44000,The Alliance,Premier,,395.55,,,,,,,383.84,836.25,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Premier,,8504.54,,,,,,,8252.82,17980.00,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Premier,,8504.54,,,,,,,8252.82,17980.00,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Premier,,381.80,,,,,,,370.50,807.19,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,903.75000,858.56000,The Alliance,Premier,,427.47,,,,,,,414.82,903.75,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Premier,,245.63,,,,,,,238.36,519.30,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Premier,,1475.76,,,,,,,1432.08,3120.00,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,416.25000,395.44000,The Alliance,Premier,,196.89,,,,,,,191.06,416.25,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,921.79000,875.70000,The Alliance,Premier,,436.01,,,,,,,423.10,921.79,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,75.68,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier,,1608.79,,,,,,,1561.17,3401.25,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier,,13504.36,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2891.25000,2746.69000,The Alliance,Premier,,1367.56,,,,,,,1327.08,2891.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier,,1608.79,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Premier,,78.59,,,,,,,76.27,166.16,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier,,13504.36,,,,,,,13104.65,28550.44,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,outpatient,,,47250.00000,44887.50000,The Alliance,Premier,,22349.25,,,,,,,21687.75,47250.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,75.68,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Premier,,1033.21,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier,,13504.36,,,,,,,13104.65,28550.44,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier,,13504.36,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier,,1608.79,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Premier,,966.00,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,94.01,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,5137.91000,4881.01000,The Alliance,Premier,,2430.23,,,,,,,2358.30,5137.91,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,191.25000,181.69000,The Alliance,Premier,,90.46,,,,,,,87.78,191.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier,,2203.00,,,,,,,2137.79,4657.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Premier,,4948.76,,,,,,,4802.29,10148.62,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,,86.09,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11082.50000,10528.38000,The Alliance,Premier,,5242.02,,,,,,,5086.87,10750.02,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,,86.09,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Premier,,9641.07,,,,,,,9355.71,20382.81,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier,,101.99,,,,,,,98.97,215.63,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,24570.00000,23341.50000,The Alliance,Premier,,11621.61,,,,,,,11277.63,24570.00,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier,,95.78,,,,,,,92.95,202.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9842.50000,9350.38000,The Alliance,Premier,,4655.50,,,,,,,4517.71,9547.23,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Premier,,301.54,,,,,,,292.61,637.50,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier,,11514.74,,,,,,,11173.92,24344.05,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,46200.00000,43890.00000,The Alliance,Premier,,21852.60,,,,,,,21205.80,46200.00,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier,,11514.74,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,22575.00000,21446.25000,The Alliance,Premier,,10677.98,,,,,,,10361.92,22575.00,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11532.00000,10955.40000,The Alliance,Premier,,5454.64,,,,,,,5293.19,11186.04,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier,,34.93,,,,,,,33.89,73.84,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,431.63000,410.05000,The Alliance,Premier,,204.16,,,,,,,198.12,431.63,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Premier,,4838.79,,,,,,,4695.57,10230.00,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11780.00000,11191.00000,The Alliance,Premier,,5571.94,,,,,,,5407.02,11426.60,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Premier,,349.43,,,,,,,339.09,738.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,29.28000,27.82000,The Alliance,Premier,,13.85,,,,,,,13.44,29.28,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,217.50000,206.62000,The Alliance,Premier,,102.88,,,,,,,99.83,217.50,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,9513.90000,9038.20000,The Alliance,Premier,,4500.07,,,,,,,4366.88,9513.90,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,541.50000,514.42000,The Alliance,Premier,,256.13,,,,,,,248.55,541.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier,,34.93,,,,,,,33.89,73.84,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,881.25000,837.19000,The Alliance,Premier,,416.83,,,,,,,404.49,881.25,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,128.20000,121.79000,The Alliance,Premier,,60.64,,,,,,,58.84,128.20,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.64000,73.76000,The Alliance,Premier,,36.72,,,,,,,35.64,77.64,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Premier,,187.13,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier,,39.35,,,,,,,38.19,83.20,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.85000,253.51000,The Alliance,Premier,,126.22,,,,,,,122.48,266.85,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Premier,,32.98,,,,,,,32.00,69.72,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Premier,,2617.49,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,94.96000,90.21000,The Alliance,Premier,,44.92,,,,,,,43.59,94.96,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier,,310.41,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,46.72000,44.38000,The Alliance,Premier,,22.10,,,,,,,21.44,46.72,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier,,95.78,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Premier,,2617.49,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,58.84000,55.90000,The Alliance,Premier,,27.83,,,,,,,27.01,58.84,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Premier,,2095.30,,,,,,,2033.28,4429.80,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3397.09000,3227.24000,The Alliance,Premier,,1606.82,,,,,,,1559.26,3397.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Premier,,948.94,,,,,,,920.85,2006.21,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8752.62000,8314.99000,The Alliance,Premier,,4139.99,,,,,,,4017.45,8752.62,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier,,310.41,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.83000,274.39000,The Alliance,Premier,,136.62,,,,,,,132.57,288.83,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Premier,,2095.30,,,,,,,2033.28,4429.80,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,59.44000,56.47000,The Alliance,Premier,,28.12,,,,,,,27.28,59.44,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Premier,,26819.10,,,,,,,26025.30,56700.00,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier,,188.91,,,,,,,183.32,399.38,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier,,48.02,,,,,,,46.60,101.52,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier,,69.81,,,,,,,67.75,147.60,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,162.40000,154.28000,The Alliance,Premier,,76.82,,,,,,,74.54,162.40,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9953.60000,9455.92000,The Alliance,Premier,,4708.05,,,,,,,4568.70,9953.60,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,606.38000,576.06000,The Alliance,Premier,,286.82,,,,,,,278.33,606.38,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Premier,,104.65,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,177.68000,168.80000,The Alliance,Premier,,84.04,,,,,,,81.56,177.68,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,131.64000,125.06000,The Alliance,Premier,,62.27,,,,,,,60.42,131.64,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier,,69.81,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,17.03,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier,,69.81,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,17.03,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,17.03,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier,,181.75,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,59.56000,56.58000,The Alliance,Premier,,28.17,,,,,,,27.34,59.56,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier,,89.49,,,,,,,86.84,189.20,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,137.96000,131.06000,The Alliance,Premier,,65.26,,,,,,,63.32,137.96,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,440.63000,418.60000,The Alliance,Premier,,208.42,,,,,,,202.25,440.63,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1049.63000,997.15000,The Alliance,Premier,,496.47,,,,,,,481.78,1049.63,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Premier,,77.95,,,,,,,75.64,164.80,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.46000,1745.59000,The Alliance,Premier,,869.12,,,,,,,843.39,1837.46,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier,,81.36,,,,,,,78.95,172.00,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier,,2937.33,,,,,,,2850.39,6210.00,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4142.31000,3935.19000,The Alliance,Premier,,1959.31,,,,,,,1901.32,4142.31,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier,,787.54,,,,,,,764.24,1615.05,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3225.00000,3063.75000,The Alliance,Premier,,1525.42,,,,,,,1480.28,3225.00,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Premier,,636.78,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Premier,,636.78,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Premier,,1241.62,,,,,,,1204.88,2625.00,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4227.56000,4016.18000,The Alliance,Premier,,1999.64,,,,,,,1940.45,4227.56,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7900.50000,7505.47000,The Alliance,Premier,,3736.94,,,,,,,3626.33,7900.50,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier,,1976.82,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier,,1976.82,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier,,1976.82,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2733.75000,2597.06000,The Alliance,Premier,,1293.06,,,,,,,1254.79,2733.75,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2572.50000,2443.88000,The Alliance,Premier,,1216.79,,,,,,,1180.78,2572.50,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Premier,,285.22,,,,,,,276.78,603.00,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Premier,,1666.36,,,,,,,1617.04,3522.97,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Premier,,2170.69,,,,,,,2106.44,4589.19,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Premier,,2170.69,,,,,,,2106.44,4589.19,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier,,1976.82,,,,,,,1918.31,4179.33,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4305.84000,4090.55000,The Alliance,Premier,,2036.66,,,,,,,1976.38,4305.84,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Premier,,114.91,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier,,149.00,,,,,,,144.59,315.00,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Premier,,114.91,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Premier,,123.51,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Premier,,2219.32,,,,,,,2153.63,4692.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Premier,,1747.14,,,,,,,1695.43,3693.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.52000,42.29000,The Alliance,Premier,,21.06,,,,,,,20.43,44.52,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier,,439.89,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier,,2725.19,,,,,,,2644.53,5761.50,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier,,869.14,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,2051.96000,1949.36000,The Alliance,Premier,,970.58,,,,,,,941.85,2051.96,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier,,439.89,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Premier,,1747.14,,,,,,,1695.43,3693.75,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier,,4862.91,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier,,514.39,,,,,,,499.16,1087.50,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier,,4862.91,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Premier,,1897.84,,,,,,,1841.67,4012.35,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier,,439.89,,,,,,,426.87,930.00,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier,,4862.91,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Premier,,4030.67,,,,,,,3911.37,8521.50,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier,,2725.19,,,,,,,2644.53,5761.50,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,187.20000,177.84000,The Alliance,Premier,,88.55,,,,,,,85.92,187.20,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier,,2725.19,,,,,,,2644.53,5761.50,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier,,439.89,,,,,,,426.87,930.00,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Premier,,558.73,,,,,,,542.19,1181.25,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Premier,,1897.84,,,,,,,1841.67,4012.35,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3904.68000,3709.45000,The Alliance,Premier,,1846.91,,,,,,,1792.25,3904.68,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Premier,,328.14,,,,,,,318.43,693.75,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier,,617.26,,,,,,,599.00,1305.00,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier,,296.22,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1717.50000,1631.62000,The Alliance,Premier,,812.38,,,,,,,788.33,1717.50,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13934.50000,13237.77000,The Alliance,Premier,,6591.02,,,,,,,6395.94,13934.50,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,14.19,,,,,,,13.77,30.00,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1097.25000,1042.39000,The Alliance,Premier,,519.00,,,,,,,503.64,1097.25,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Premier,,260.74,,,,,,,253.02,551.25,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier,,1426.10,,,,,,,1383.88,3015.00,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier,,14.98,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,228.81,,,,,,,222.04,483.75,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Premier,,260.74,,,,,,,253.02,551.25,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,667.50000,634.12000,The Alliance,Premier,,315.73,,,,,,,306.38,667.50,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5796.00000,5506.20000,The Alliance,Premier,,2741.51,,,,,,,2660.36,5796.00,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier,,14.98,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier,,36.31,,,,,,,35.23,76.76,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier,,14.98,,,,,,,14.54,31.68,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2255.03000,2142.28000,The Alliance,Premier,,1066.63,,,,,,,1035.06,2255.03,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier,,4875.45,,,,,,,4731.14,10307.50,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier,,4875.45,,,,,,,4731.14,10307.50,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier,,789.32,,,,,,,765.96,1668.75,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier,,13438.20,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier,,2529.37,,,,,,,2454.50,5347.50,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Premier,,5544.08,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Premier,,6171.66,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier,,4803.60,,,,,,,4661.42,10155.60,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Premier,,4136.74,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier,,5004.48,,,,,,,4856.36,10580.30,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6244.50000,5932.27000,The Alliance,Premier,,2953.65,,,,,,,2866.23,6244.50,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Premier,,6171.66,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Premier,,5544.08,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier,,2439.62,,,,,,,2367.41,5157.75,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6192.75000,5883.11000,The Alliance,Premier,,2929.17,,,,,,,2842.47,6192.75,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6882.75000,6538.61000,The Alliance,Premier,,3255.54,,,,,,,3159.18,6882.75,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Premier,,180.92,,,,,,,175.57,382.50,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier,,869.14,,,,,,,843.41,1837.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,188.68000,179.25000,The Alliance,Premier,,89.25,,,,,,,86.60,188.68,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier,,691.76,,,,,,,671.29,1462.50,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier,,869.14,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1586.25000,1506.94000,The Alliance,Premier,,750.30,,,,,,,728.09,1586.25,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier,,205.61,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier,,1085.54,,,,,,,1053.40,2295.00,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier,,1085.54,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier,,1085.54,,,,,,,1053.40,2295.00,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier,,205.61,,,,,,,199.53,434.70,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier,,1085.54,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2676.38000,2542.56000,The Alliance,Premier,,1265.93,,,,,,,1228.46,2676.38,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier,,81.36,,,,,,,78.95,172.00,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16861.49000,16018.42000,The Alliance,Premier,,7975.48,,,,,,,7739.42,16861.49,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier,,61.38,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier,,607.23,,,,,,,589.26,1283.78,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.69000,839.51000,The Alliance,Premier,,417.99,,,,,,,405.61,883.69,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier,,61.38,,,,,,,59.56,129.76,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,255.72,,,,,,,47.62,349.86,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,926.25000,879.94000,The Alliance,Premier,,438.12,,,,,,,425.15,926.25,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,32.16,,,,,,,31.21,68.00,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,303.75000,288.56000,The Alliance,Premier,,143.67,,,,,,,139.42,303.75,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Premier,,1754.24,,,,,,,1702.32,3708.75,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier,,4087.78,,,,,,,3966.79,8642.25,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier,,4087.78,,,,,,,3966.79,8642.25,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier,,8286.06,,,,,,,8040.81,17518.10,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,48389.25,,,,,,,34125.00,66202.50,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,297.00000,282.15000,The Alliance,Premier,,140.48,,,,,,,136.32,297.00,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,32282.25,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1176.15000,1117.34000,The Alliance,Premier,,556.32,,,,,,,539.85,1176.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier,,239.46,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,28.28000,26.87000,The Alliance,Premier,,13.38,,,,,,,12.98,28.28,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,32282.25,,,,,,,31326.75,68250.00,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier,,8286.06,,,,,,,8040.81,17518.10,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier,,1085.54,,,,,,,1053.40,2295.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,41.48000,39.41000,The Alliance,Premier,,19.62,,,,,,,19.04,41.48,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,441.37,,,,,,,9.33,441.37,fee schedule,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,Premier,,874.91,,,,,,,617.00,1196.98,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier,TC,1059.95,,,,,,,747.50,1450.15,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier,,1160.63,,,,,,,520.63,1587.89,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Premier,TC,833.08,,,,,,,587.50,1139.75,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Premier,TC,1810.08,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Premier,,1905.79,,,,,,,1344.00,2607.36,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Premier,TC,1706.56,,,,,,,1203.50,2334.79,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,outpatient,1,mL,23.29000,22.12000,The Alliance,Premier,,16.51,,,,,,,11.64,22.59,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier,,186.00,,,,,,,67.00,264.00,per diem,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,outpatient,1,mL,1.47000,1.39000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,937.00,,,,,,,122.40,5271.00,case rate,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Premier,TC,4160.38,,,,,,,391.31,29731.35,fee schedule,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier,TC,3804.30,,,,,,,356.27,17311.25,fee schedule,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Premier,TC,2429.74,,,,,,,1713.50,3324.19,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,TC,4021.88,,,,,,,378.42,17311.25,fee schedule,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier,TC,4061.43,,,,,,,361.82,8543.92,fee schedule,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,outpatient,,,17686.00000,16801.70000,The Alliance,Premier,TC,46388.00,,,,,,,8843.00,52322.00,case rate,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Premier,TC,4120.75,,,,,,,383.91,8543.92,fee schedule,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier,,17.73,,,,,,,12.50,24.25,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,outpatient,1,mL,42.94000,40.80000,The Alliance,Premier,,78.87,,,,,,,21.47,78.87,fee schedule,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier,TC,548.00,,,,,,,120.00,584.87,fee schedule,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,746.94,,,,,,,14.39,746.94,fee schedule,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,outpatient,,,572.00000,543.40000,The Alliance,Premier,,6756.70,,,,,,,70.04,6756.70,fee schedule,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,outpatient,1,mL,1767.80000,1679.41000,The Alliance,Premier,,1253.37,,,,,,,883.90,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,outpatient,1,mL,738.15000,701.24000,The Alliance,Premier,,523.35,,,,,,,369.07,716.01,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,outpatient,,,361.00000,342.95000,The Alliance,Premier,,1052.52,,,,,,,77.53,1052.52,fee schedule,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,outpatient,,,1962.00000,1863.90000,The Alliance,Premier,,3963.00,,,,,,,1079.10,4686.00,case rate,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,outpatient,1,mL,204.86000,194.62000,The Alliance,Premier,,145.25,,,,,,,102.43,198.71,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,outpatient,,,4230.00000,4018.50000,The Alliance,Premier,,2999.07,,,,,,,2115.00,4103.10,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,outpatient,1,mL,5.72000,5.43000,The Alliance,Premier,,4.06,,,,,,,2.86,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,,374.35,,,,,,,264.00,689.02,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,outpatient,,,6076.00000,5772.20000,The Alliance,Premier,,3963.00,,,,,,,1801.27,5982.26,case rate,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Premier,TC,4298.79,,,,,,,404.21,17311.25,fee schedule,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Premier,,3963.00,,,,,,,815.10,4686.00,case rate,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Premier,,4.77,,,,,,,3.37,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,outpatient,1,EA,6.67000,6.33000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Premier,,6.38,,,,,,,4.50,8.73,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Premier,,343.16,,,,,,,63.95,788.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,outpatient,1,GM,5.94000,5.64000,The Alliance,Premier,,4.21,,,,,,,2.97,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,outpatient,1,GM,5.09000,4.84000,The Alliance,Premier,,3.61,,,,,,,2.54,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,outpatient,1,GM,4.94000,4.70000,The Alliance,Premier,,3.50,,,,,,,2.47,4.79,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Premier,,543.22,,,,,,,11.54,543.22,fee schedule,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,outpatient,1,mL,3.01000,2.86000,The Alliance,Premier,,2.13,,,,,,,1.50,2.92,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,outpatient,,,303.50000,288.32000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Premier,,937.00,,,,,,,483.55,3163.00,case rate,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,outpatient,1,mL,348.87000,331.43000,The Alliance,Premier,,262.22,,,,,,,174.44,338.40,fee schedule,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,339.51,,,,,,,6.48,339.51,fee schedule,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier,,13.22,,,,,,,9.32,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,outpatient,1,EA,13.00000,12.35000,The Alliance,Premier,,9.22,,,,,,,6.50,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier,,3.96,,,,,,,2.79,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,outpatient,1,EA,34.76000,33.03000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,outpatient,,,3378.00000,3209.10000,The Alliance,Premier,,2395.00,,,,,,,1689.00,3276.66,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,outpatient,,,1370.00000,1301.50000,The Alliance,Premier,TC,4384.66,,,,,,,413.96,17311.25,fee schedule,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Premier,,172.29,,,,,,,121.50,278.37,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Premier,TC,548.00,,,,,,,384.16,950.60,fee schedule,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.24,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,25159.00000,23901.05000,The Alliance,Premier,,17837.73,,,,,,,772.64,24404.23,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,696.05,,,,,,,8.17,696.05,fee schedule,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier,,3839.94,,,,,,,2708.00,5253.52,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,outpatient,1,EA,41.89000,39.79000,The Alliance,Premier,,29.70,,,,,,,20.95,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,14.22,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,outpatient,1,EA,53.72000,51.03000,The Alliance,Premier,,38.09,,,,,,,26.86,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,17.38,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,Premier,,237.51,,,,,,,167.50,324.95,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,outpatient,,,1040.00000,988.00000,The Alliance,Premier,,737.36,,,,,,,520.00,1008.80,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,outpatient,,,6048.00000,5745.60000,The Alliance,Premier,,4288.03,,,,,,,1556.56,5866.56,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,outpatient,,,6019.00000,5718.05000,The Alliance,Premier,,4267.47,,,,,,,1556.56,5838.43,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,outpatient,,,4922.00000,4675.90000,The Alliance,Premier,,3489.70,,,,,,,2461.00,4774.34,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,outpatient,,,7244.00000,6881.80000,The Alliance,Premier,,5136.00,,,,,,,1556.56,7026.68,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier,90,882.80,,,,,,,17.43,882.80,fee schedule,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,70.28000,66.77000,The Alliance,Premier,,33.24,,,,,,,32.26,70.28,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,23.25,63.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Premier,,1.62,,,,,,,1.15,2.22,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,,289.27,,,,,,,204.00,5271.00,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,outpatient,,,168.70000,160.26000,The Alliance,Premier,90,509.30,,,,,,,10.22,509.30,fee schedule,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,186.00,,,,,,,31.50,264.00,per diem,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,outpatient,1,mL,8.61000,8.18000,The Alliance,Premier,,6.10,,,,,,,4.30,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier,,679.08,,,,,,,12.92,679.08,fee schedule,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier,TC,2245.40,,,,,,,1488.32,7180.14,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,outpatient,,,57.50000,54.62000,The Alliance,Premier,90,1137.41,,,,,,,28.75,1137.41,fee schedule,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,271.65,,,,,,,5.12,271.65,fee schedule,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,339.51,,,,,,,6.48,339.51,fee schedule,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,38.16000,36.25000,The Alliance,Premier,,18.05,,,,,,,17.52,38.16,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier,,1052.52,,,,,,,77.53,1052.52,fee schedule,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,,77.99,,,,,,,55.00,106.70,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,254.68,,,,,,,4.81,254.68,fee schedule,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,135.79,,,,,,,2.54,135.79,fee schedule,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,254.68,,,,,,,5.06,254.68,fee schedule,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Premier,TC,4412.20,,,,,,,405.63,4412.20,fee schedule,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier,90,713.01,,,,,,,14.05,713.01,fee schedule,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,outpatient,1,EA,4.50000,4.28000,The Alliance,Premier,,3.19,,,,,,,2.25,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,outpatient,1,GM,10.81000,10.27000,The Alliance,Premier,,7.66,,,,,,,5.41,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier,,1.62,,,,,,,1.15,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier,,0.86498,,,,,,,0.61000,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier,,1.39,,,,,,,0.17500,1.39,fee schedule,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,254.68,,,,,,,4.88,254.68,fee schedule,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,outpatient,1,EA,2578.99000,2450.04000,The Alliance,Premier,,134.81,,,,,,,81.70,2501.62,fee schedule,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier,,2.12,,,,,,,1.50,2.90,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,outpatient,1,mL,7.28000,6.92000,The Alliance,Premier,,5.16,,,,,,,3.64,7.06,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,outpatient,1,EA,2310.25000,2194.74000,The Alliance,Premier,,1637.97,,,,,,,19.81,2240.94,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Premier,90,1205.34,,,,,,,24.43,1205.34,fee schedule,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,3.59,,,,,,,2.53,4.91,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Premier,,2.15,,,,,,,1.65,6.31,fee schedule,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier,,2.15,,,,,,,1.65,7.62,fee schedule,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier,,1.59,,,,,,,1.12,2.17,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier,,10.70,,,,,,,7.54,14.64,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Premier,,1.24,,,,,,,0.87500,1.70,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,4.32,,,,,,,0.06000,4.32,fee schedule,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,0.46480,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.46480,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.46480,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Premier,,0.95006,,,,,,,0.46480,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,outpatient,1,EA,237.78000,225.89000,The Alliance,Premier,,168.59,,,,,,,118.89,230.65,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier,,1412.33,,,,,,,100.97,1932.24,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier,TC,3225.95,,,,,,,2150.56,7180.14,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,outpatient,1,EA,483.76000,459.57000,The Alliance,Premier,,342.99,,,,,,,241.88,469.25,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier,,10.41,,,,,,,7.34,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier,,10.41,,,,,,,7.34,14.24,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,outpatient,1,EA,40.03000,38.03000,The Alliance,Premier,,28.38,,,,,,,20.02,38.83,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Premier,TC,23155.09,,,,,,,2210.90,23155.09,fee schedule,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier,,345.28,,,,,,,134.64,472.39,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier,,1.52,,,,,,,1.07,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,outpatient,1,mL,54.93000,52.19000,The Alliance,Premier,,38.95,,,,,,,27.46,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,14.22,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,outpatient,1,mL,14.22000,13.51000,The Alliance,Premier,,10.08,,,,,,,7.11,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Premier,,1.01,,,,,,,0.91450,107.28,fee schedule,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,outpatient,1,mL,157.02000,149.17000,The Alliance,Premier,,1.01,,,,,,,0.91450,152.31,fee schedule,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,outpatient,1,mL,105.95000,100.65000,The Alliance,Premier,,1.01,,,,,,,0.91450,102.77,fee schedule,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,,848.80,,,,,,,16.26,848.80,fee schedule,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Premier,,2.67,,,,,,,1.88,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Premier,,2.20,,,,,,,1.55,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,outpatient,1,GM,1.72000,1.63000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,outpatient,1,GM,1.72000,1.64000,The Alliance,Premier,,1.22,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,outpatient,1,mL,2.78000,2.64000,The Alliance,Premier,,1.58,,,,,,,1.30,2.70,fee schedule,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,outpatient,1,mL,6.16000,5.85000,The Alliance,Premier,,1.58,,,,,,,1.30,5.98,fee schedule,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,outpatient,1,mL,6.98000,6.63000,The Alliance,Premier,,1.58,,,,,,,1.30,6.77,fee schedule,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,2.76,,,,,,,0.20000,2.76,fee schedule,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier,,2.76,,,,,,,0.41000,2.76,fee schedule,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,2.76,,,,,,,0.46000,2.76,fee schedule,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier,,0.92879,,,,,,,0.65500,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Premier,,0.79408,,,,,,,0.56000,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,outpatient,1,mL,1.11000,1.06000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Premier,,1645.00,,,,,,,434.50,1820.00,per diem,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,outpatient,1,mL,16.53000,15.70000,The Alliance,Premier,,11.72,,,,,,,8.27,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,outpatient,1,mL,12.05000,11.45000,The Alliance,Premier,,8.54,,,,,,,6.03,11.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier,,1595.82,,,,,,,67.50,1595.82,fee schedule,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,outpatient,1,EA,34.43000,32.71000,The Alliance,Premier,,24.41,,,,,,,17.21,33.40,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier,TC,3270.26,,,,,,,268.62,3270.26,fee schedule,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Premier,,3061.46,,,,,,,1031.39,4188.46,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Premier,TC,238.93,,,,,,,168.50,326.89,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,outpatient,1,GM,1.65000,1.56000,The Alliance,Premier,,1.17,,,,,,,0.82500,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,outpatient,1,GM,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,outpatient,1,GM,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Premier,,3.47,,,,,,,2.44,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,outpatient,1,mL,11.91000,11.32000,The Alliance,Premier,,8.44,,,,,,,5.96,11.55,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Premier,TC,6211.06,,,,,,,595.74,17311.25,fee schedule,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,2.34,,,,,,,0.10500,2.34,fee schedule,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,outpatient,,,1047.00000,994.65000,The Alliance,Premier,TC,4773.51,,,,,,,447.16,29731.35,fee schedule,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Premier,,9.36,,,,,,,6.60,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,outpatient,1,EA,135.69000,128.91000,The Alliance,Premier,,96.20,,,,,,,67.84,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Premier,,5.98,,,,,,,4.21,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,outpatient,1,EA,13.73000,13.04000,The Alliance,Premier,,9.73,,,,,,,6.87,13.32,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,,574.73,,,,,,,12.05,574.73,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,outpatient,1,EA,387.28000,367.92000,The Alliance,Premier,,11.71,,,,,,,6.30,375.66,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,outpatient,1,EA,546.90000,519.56000,The Alliance,Premier,,11.71,,,,,,,6.30,530.49,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,outpatient,1,EA,140.13000,133.12000,The Alliance,Premier,,11.71,,,,,,,6.30,135.93,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,outpatient,1,EA,493.01000,468.36000,The Alliance,Premier,,11.71,,,,,,,6.30,478.22,fee schedule,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Premier,,5.11,,,,,,,3.60,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier,,4.70,,,,,,,3.31,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.83,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,outpatient,1,EA,5.83000,5.54000,The Alliance,Premier,,4.13,,,,,,,2.92,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,outpatient,1,EA,21.16000,20.10000,The Alliance,Premier,,15.00,,,,,,,10.58,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier,,3.94,,,,,,,2.78,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,outpatient,1,GM,11.94000,11.35000,The Alliance,Premier,,8.47,,,,,,,5.97,11.58,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,4701.11,,,,,,,439.81,17311.25,fee schedule,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,outpatient,1,EA,23.40000,22.23000,The Alliance,Premier,,16.59,,,,,,,11.70,22.70,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,outpatient,1,EA,6.19000,5.88000,The Alliance,Premier,,4.39,,,,,,,3.10,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,outpatient,1,EA,60150.20000,57142.69000,The Alliance,Premier,,42646.49,,,,,,,30075.10,58345.69,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Premier,,514.85,,,,,,,312.03,631.01,fee schedule,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,outpatient,1,EA,650.53000,618.00000,The Alliance,Premier,,514.85,,,,,,,312.03,631.01,fee schedule,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Premier,,8.20,,,,,,,7.57,110.35,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,outpatient,1,mL,67.86000,64.47000,The Alliance,Premier,,2.46,,,,,,,1.42,65.82,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,outpatient,1,mL,71.93000,68.34000,The Alliance,Premier,,2.46,,,,,,,1.42,69.77,fee schedule,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,outpatient,1,mL,46.99000,44.64000,The Alliance,Premier,,33.32,,,,,,,23.50,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier,,10.80,,,,,,,7.62,14.77,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,,1544.85,,,,,,,91.50,1544.85,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Premier,,4.49,,,,,,,3.21,6.22,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier,,4.49,,,,,,,2.53,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,4.49,,,,,,,1.90,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,4.49,,,,,,,3.16,6.13,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Premier,,4.49,,,,,,,1.55,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier,,4.49,,,,,,,2.21,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier,,4.49,,,,,,,0.82000,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,outpatient,1,mL,3.10000,2.94000,The Alliance,Premier,,4.49,,,,,,,1.55,5.23,fee schedule,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Premier,,4371.88,,,,,,,126.07,4371.88,fee schedule,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Premier,TC,3685.66,,,,,,,354.42,3685.66,fee schedule,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier,,362.30,,,,,,,122.40,495.67,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Premier,90,6094.58,,,,,,,70.04,6094.58,fee schedule,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier,,35735.73,,,,,,,759.53,35735.73,fee schedule,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Premier,90,9082.50,,,,,,,154.60,9082.50,fee schedule,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Premier,90,13920.84,,,,,,,160.35,13920.84,fee schedule,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,outpatient,,,972.00000,923.40000,The Alliance,Premier,90,8610.62,,,,,,,486.00,8610.62,fee schedule,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,Premier,TC,3536.91,,,,,,,200.00,3536.91,fee schedule,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,TC,1245.05,,,,,,,144.00,2342.52,fee schedule,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier,TC,848.80,,,,,,,67.83,848.80,fee schedule,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Premier,TC,2993.62,,,,,,,162.50,2993.62,fee schedule,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,outpatient,,,1919.00000,1823.05000,The Alliance,Premier,,1645.00,,,,,,,959.50,1861.43,per diem,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier,TC,347.41,,,,,,,245.00,475.30,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,outpatient,,,1014.00000,963.30000,The Alliance,Premier,TC,548.00,,,,,,,384.16,983.58,fee schedule,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier,TC,10812.84,,,,,,,833.00,10812.84,fee schedule,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Premier,,1052.52,,,,,,,20.05,1052.52,fee schedule,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Premier,,1052.52,,,,,,,20.05,1052.52,fee schedule,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,1037.00000,985.15000,The Alliance,Premier,,735.23,,,,,,,213.76,1005.89,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,outpatient,,,3274.00000,3110.30000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3175.78,per diem,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,outpatient,,,29288.00000,27823.60000,The Alliance,Premier,,13853.22,,,,,,,13443.19,29288.00,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier,,1.82,,,,,,,1.28,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier,,1.92,,,,,,,1.35,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Premier,,2.19,,,,,,,1.54,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier,,188.91,,,,,,,183.32,399.38,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier,,0.72318,,,,,,,0.51000,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,outpatient,1,mL,1.56000,1.49000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier,,2.57,,,,,,,1.81,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,outpatient,1,mL,2.68000,2.55000,The Alliance,Premier,,1.90,,,,,,,1.34,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,outpatient,1,mL,1.73000,1.64000,The Alliance,Premier,,1.23,,,,,,,0.86500,1.68,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,186.00,,,,,,,15.00,264.00,per diem,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier,GO,186.00,,,,,,,126.65,264.00,per diem,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,GO,186.00,,,,,,,51.50,264.00,per diem,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,GP,186.00,,,,,,,51.50,264.00,per diem,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier,GP,186.00,,,,,,,126.65,264.00,per diem,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,168.51,,,,,,,163.52,356.25,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,outpatient,,,5390.00000,5120.50000,The Alliance,Premier,,3821.51,,,,,,,2964.50,5271.00,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,outpatient,1,mL,10.74000,10.21000,The Alliance,Premier,,7.61,,,,,,,5.37,10.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Premier,TC,13397.25,,,,,,,1293.00,13397.25,fee schedule,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,outpatient,1,mL,34.76000,33.02000,The Alliance,Premier,,24.64,,,,,,,3.49,33.72,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Premier,TC,2413.76,,,,,,,237.91,17311.25,fee schedule,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,outpatient,,,919.00000,873.05000,The Alliance,Premier,TC,4160.38,,,,,,,389.46,8543.92,fee schedule,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,1.58,,,,,,,0.47500,1.58,fee schedule,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Premier,,1.58,,,,,,,0.84000,1.63,fee schedule,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,outpatient,1,mL,24.07000,22.86000,The Alliance,Premier,,17.07,,,,,,,12.04,23.35,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Premier,,0.64519,,,,,,,0.45500,0.88270,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Premier,,10.00,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier,,10.80,,,,,,,1.49,14.77,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2084.29000,1980.08000,The Alliance,Premier,,985.87,,,,,,,956.69,2084.29,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,168.51,,,,,,,163.52,356.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,307.13000,291.77000,The Alliance,Premier,,145.27,,,,,,,140.97,307.13,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Premier,,7299.62,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2500.84000,2375.80000,The Alliance,Premier,,1182.90,,,,,,,1147.89,2500.84,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Premier,,4720.94,,,,,,,4581.21,9980.85,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,9.88,184.30,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,25.52,,,,,,,18.00,38.16,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,2115.00000,2009.25000,The Alliance,Premier,,1499.54,,,,,,,802.34,2051.55,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier,,7803.00,,,,,,,3612.55,10015.25,case rate,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Premier,TC,7450.41,,,,,,,723.58,29731.35,fee schedule,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,TC,5334.02,,,,,,,500.59,29731.35,fee schedule,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Premier,TC,51844.17,,,,,,,5057.86,51844.17,fee schedule,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,outpatient,,,1400.00000,1330.00000,The Alliance,Premier,TC,4834.29,,,,,,,450.12,4834.29,fee schedule,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,outpatient,,,1399.00000,1329.05000,The Alliance,Premier,TC,4511.07,,,,,,,282.87,4511.07,fee schedule,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier,TC,1298.89,,,,,,,916.00,1777.04,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1329.46,fee schedule,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,,548.00,,,,,,,298.87,674.15,fee schedule,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Premier,,1645.00,,,,,,,1285.85,4666.67,per diem,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier,,560.26,,,,,,,11.57,560.26,fee schedule,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,,196.39,,,,,,,60.36,268.69,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,outpatient,,,1122.00000,1065.90000,The Alliance,Premier,,795.50,,,,,,,415.12,1088.34,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier,,1341.13,,,,,,,25.81,1341.13,fee schedule,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,254.68,,,,,,,5.08,254.68,fee schedule,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Premier,,7803.00,,,,,,,3500.91,8939.52,case rate,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier,,3963.00,,,,,,,1637.45,6189.57,case rate,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,763.98,,,,,,,16.07,763.98,fee schedule,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,,713.01,,,,,,,13.73,713.01,fee schedule,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,outpatient,,,271.10000,257.54000,The Alliance,Premier,90,458.40,,,,,,,8.91,458.40,fee schedule,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier,,486.37,,,,,,,314.95,665.42,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier,,1832.89,,,,,,,38.57,1832.89,fee schedule,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,outpatient,,,94.30000,89.58000,The Alliance,Premier,90,4702.48,,,,,,,47.15,4702.48,fee schedule,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,GP,186.00,,,,,,,38.00,264.00,per diem,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier,,937.00,,,,,,,38.50,3163.00,case rate,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,937.00,,,,,,,587.06,3163.00,case rate,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Premier,,263.39,,,,,,,185.75,360.36,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,628.12,,,,,,,12.09,628.12,fee schedule,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier,TC,548.00,,,,,,,327.36,764.36,fee schedule,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Premier,,6.25,,,,,,,4.41,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,outpatient,1,EA,11.12000,10.57000,The Alliance,Premier,,7.88,,,,,,,5.56,10.79,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,outpatient,1,mL,43.92000,41.73000,The Alliance,Premier,,83.21,,,,,,,21.96,83.21,fee schedule,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Premier,,1764.88,,,,,,,1712.64,3731.25,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,outpatient,,,1441.00000,1368.95000,The Alliance,Premier,,3963.00,,,,,,,792.55,4686.00,case rate,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,outpatient,,,1616.00000,1535.20000,The Alliance,Premier,,1145.74,,,,,,,888.80,5271.00,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier,90,1069.56,,,,,,,21.00,1069.56,fee schedule,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Premier,,2113.25,,,,,,,2050.70,4467.75,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,,26177.94,,,,,,,204.00,26177.94,fee schedule,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Premier,,21.11,,,,,,,14.88,73.49,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,outpatient,1,mL,29.78000,28.29000,The Alliance,Premier,,21.11,,,,,,,14.89,73.49,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,186.00,,,,,,,52.50,264.00,per diem,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Premier,,6026.72,,,,,,,115.36,6026.72,fee schedule,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,254.68,,,,,,,5.06,254.68,fee schedule,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,,186.00,,,,,,,49.50,264.00,per diem,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,4476.83,,,,,,,417.10,17311.25,fee schedule,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier,,1.50,,,,,,,1.06,2.06,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,24.25,,,,,,,22.80,54.32,fee schedule,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Premier,,1324.17,,,,,,,25.47,1324.17,fee schedule,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,,1590.11,,,,,,,6.41,1590.11,fee schedule,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Premier,TC,3664.82,,,,,,,2584.50,5271.00,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier,,1117.46,,,,,,,1084.39,2362.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Premier,,21.11,,,,,,,14.88,73.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,outpatient,,,130.40000,123.88000,The Alliance,Premier,90,628.12,,,,,,,12.41,628.12,fee schedule,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,outpatient,,,454.10000,431.40000,The Alliance,Premier,90,2410.69,,,,,,,52.89,2410.69,fee schedule,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,outpatient,,,192.50000,182.88000,The Alliance,Premier,90,882.80,,,,,,,17.60,882.80,fee schedule,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Premier,,837.21,,,,,,,812.43,1770.00,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier,,6120.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier,,8286.06,,,,,,,8040.81,17518.10,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,14201.10000,13491.04000,The Alliance,Premier,,6717.12,,,,,,,6518.30,14201.10,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier,,186.00,,,,,,,31.00,264.00,per diem,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier,,6798.73,,,,,,,126.07,6798.73,fee schedule,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,90,780.94,,,,,,,15.53,780.94,fee schedule,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,Premier,,967.70,,,,,,,18.37,967.70,fee schedule,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1035.56,,,,,,,22.91,1035.56,fee schedule,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3505.20000,3329.94000,The Alliance,Premier,,1657.96,,,,,,,1608.89,3505.20,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,outpatient,1,EA,169.94000,161.45000,The Alliance,Premier,,120.49,,,,,,,84.97,164.84,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,outpatient,1,EA,13.76000,13.08000,The Alliance,Premier,,0.79200,,,,,,,0.73160,13.35,fee schedule,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,351.45000,333.88000,The Alliance,Premier,,166.24,,,,,,,161.32,351.45,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier,,0.62392,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,outpatient,,,1354.00000,1286.30000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1313.38,fee schedule,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5168.10000,4909.70000,The Alliance,Premier,,2444.51,,,,,,,2372.16,5168.10,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,outpatient,,,1356.00000,1288.20000,The Alliance,Premier,,937.00,,,,,,,227.78,5858.00,case rate,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,90,950.66,,,,,,,18.65,950.66,fee schedule,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier,90,628.12,,,,,,,12.38,628.12,fee schedule,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier,,696.05,,,,,,,13.25,696.05,fee schedule,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,,865.84,,,,,,,16.46,865.84,fee schedule,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier,90,3666.93,,,,,,,50.62,3666.93,fee schedule,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier,90,763.98,,,,,,,15.09,763.98,fee schedule,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,outpatient,,,5028.00000,4776.60000,The Alliance,Premier,90,21780.96,,,,,,,430.66,21780.96,fee schedule,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Premier,90,1986.29,,,,,,,43.79,1986.29,fee schedule,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Premier,90,1986.29,,,,,,,43.79,1986.29,fee schedule,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier,90,6518.98,,,,,,,129.67,6518.98,fee schedule,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,outpatient,,,149.70000,142.21000,The Alliance,Premier,90,679.08,,,,,,,13.33,679.08,fee schedule,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier,,100.68,,,,,,,14.86,137.74,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Premier,90,746.94,,,,,,,14.65,746.94,fee schedule,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,outpatient,,,460.60000,437.57000,The Alliance,Premier,90,2122.08,,,,,,,42.11,2122.08,fee schedule,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,outpatient,1,GM,379.18000,360.22000,The Alliance,Premier,,268.84,,,,,,,189.59,367.80,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier,,0.25524,,,,,,,0.18000,0.34920,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,outpatient,1,EA,15.47000,14.69000,The Alliance,Premier,,10.97,,,,,,,7.74,15.01,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier,,1.85,,,,,,,1.30,2.53,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier,,1.49,,,,,,,1.02,3.52,fee schedule,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,outpatient,1,EA,10.18000,9.67000,The Alliance,Premier,,7.22,,,,,,,5.09,9.87,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,outpatient,1,EA,3.16000,3.01000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,outpatient,1,mL,1421.20000,1350.14000,The Alliance,Premier,,0.61050,,,,,,,0.37000,1378.56,fee schedule,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,outpatient,1,EA,3.93000,3.74000,The Alliance,Premier,,2.79,,,,,,,1.97,3.81,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier,,0.37577,,,,,,,0.26500,0.51410,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier,,2.23,,,,,,,1.57,3.05,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88000,1.71,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Premier,,1.51,,,,,,,1.06,2.07,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,outpatient,1,EA,40.37000,38.36000,The Alliance,Premier,,28.62,,,,,,,20.18,39.16,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,outpatient,1,mL,301.09000,286.03000,The Alliance,Premier,,213.47,,,,,,,92.50,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,outpatient,1,mL,305.62000,290.34000,The Alliance,Premier,,216.68,,,,,,,92.50,296.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Premier,,10.34,,,,,,,7.29,73.49,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Premier,,3.61,,,,,,,2.54,4.94,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Premier,,1.40,,,,,,,0.98500,1.91,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier,,3.08,,,,,,,2.17,4.22,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,outpatient,1,EA,8.72000,8.28000,The Alliance,Premier,,6.18,,,,,,,4.36,8.46,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Premier,,3.73,,,,,,,2.65,5.15,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,outpatient,1,mL,16.35000,15.54000,The Alliance,Premier,,3.73,,,,,,,3.62,15.86,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,outpatient,1,mL,6.68000,6.35000,The Alliance,Premier,,3.73,,,,,,,3.34,6.48,fee schedule,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,outpatient,1,EA,890.96000,846.41000,The Alliance,Premier,,631.69,,,,,,,445.48,864.23,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,outpatient,1,mL,1.16000,1.11000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,outpatient,1,GM,11.29000,10.72000,The Alliance,Premier,,8.00,,,,,,,5.64,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,outpatient,1,GM,13.50000,12.82000,The Alliance,Premier,,9.57,,,,,,,6.75,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,outpatient,1,GM,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier,,1.56,,,,,,,1.10,2.13,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,outpatient,,,2143.00000,2035.85000,The Alliance,Premier,,3963.00,,,,,,,1178.65,4686.00,case rate,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,124.80000,118.56000,The Alliance,Premier,,59.03,,,,,,,57.28,124.80,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,90,933.70,,,,,,,18.53,933.70,fee schedule,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier,,1284.54,,,,,,,7.33,1284.54,fee schedule,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Premier,,865.84,,,,,,,18.40,865.84,fee schedule,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,4417.51,,,,,,,411.55,17311.25,fee schedule,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,outpatient,,,959.00000,911.05000,The Alliance,Premier,90,3038.81,,,,,,,59.93,3038.81,fee schedule,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Premier,TC,4496.60,,,,,,,418.96,17311.25,fee schedule,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier,,254.68,,,,,,,4.95,254.68,fee schedule,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,679.08,,,,,,,13.38,679.08,fee schedule,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,outpatient,,,129.20000,122.74000,The Alliance,Premier,90,594.19,,,,,,,11.81,594.19,fee schedule,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,outpatient,,,170.50000,161.98000,The Alliance,Premier,90,763.98,,,,,,,15.18,763.98,fee schedule,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Premier,90,4447.87,,,,,,,87.93,4447.87,fee schedule,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,outpatient,,,413.30000,392.64000,The Alliance,Premier,90,1918.36,,,,,,,37.79,1918.36,fee schedule,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier,90,882.80,,,,,,,17.50,882.80,fee schedule,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier,,332.52,,,,,,,122.40,454.93,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,outpatient,,,1007.00000,956.65000,The Alliance,Premier,,8610.62,,,,,,,503.50,8610.62,fee schedule,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Premier,90,8250.66,,,,,,,143.40,8250.66,fee schedule,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,780.94,,,,,,,15.29,780.94,fee schedule,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Premier,,1081.99,,,,,,,1049.96,2287.50,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,outpatient,,,2733.00000,2596.35000,The Alliance,Premier,90,15261.97,,,,,,,264.01,15261.97,fee schedule,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,outpatient,,,416.90000,396.05000,The Alliance,Premier,90,6451.13,,,,,,,137.00,6451.13,fee schedule,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,,295.00,,,,,,,126.50,446.00,case rate,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,Premier,,295.00,,,,,,,193.00,446.00,case rate,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,Premier,,8693.45,,,,,,,162.71,8693.45,fee schedule,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1422.00000,1350.90000,The Alliance,Premier,90,8693.45,,,,,,,533.12,8693.45,fee schedule,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,outpatient,,,65.80000,62.51000,The Alliance,Premier,90,1850.43,,,,,,,32.90,1850.43,fee schedule,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,outpatient,,,227.60000,216.22000,The Alliance,Premier,90,2682.34,,,,,,,54.46,2682.34,fee schedule,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,outpatient,,,461.00000,437.95000,The Alliance,Premier,90,2122.08,,,,,,,42.11,2122.08,fee schedule,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier,90,1154.38,,,,,,,22.72,1154.38,fee schedule,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,Premier,,967.70,,,,,,,18.37,967.70,fee schedule,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Premier,90,4462.27,,,,,,,295.50,4462.27,fee schedule,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,outpatient,,,148.10000,140.70000,The Alliance,Premier,90,763.98,,,,,,,15.06,763.98,fee schedule,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,31.20,,,,,,,22.00,42.68,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,outpatient,,,1743.00000,1655.85000,The Alliance,Premier,,11449.71,,,,,,,50.73,11449.71,fee schedule,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,outpatient,,,299.70000,284.71000,The Alliance,Premier,90,967.70,,,,,,,18.98,967.70,fee schedule,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier,,3590.07,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier,,3590.07,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier,,2203.00,,,,,,,2137.79,4657.50,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier,,134.89,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier,,134.89,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.80000,534.66000,The Alliance,Premier,,266.20,,,,,,,258.33,562.80,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier,,107.31,,,,,,,104.14,226.88,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier,,181.75,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,14.19,,,,,,,13.77,30.00,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Premier,90,9523.86,,,,,,,98.25,9523.86,fee schedule,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,outpatient,,,440.20000,418.19000,The Alliance,Premier,90,984.66,,,,,,,19.60,984.66,fee schedule,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,90,107.77,,,,,,,76.00,241.38,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,679.08,,,,,,,14.61,679.08,fee schedule,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Premier,90,645.08,,,,,,,8.17,645.08,fee schedule,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,outpatient,,,383.80000,364.61000,The Alliance,Premier,,1765.53,,,,,,,33.94,1765.53,fee schedule,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,outpatient,,,220.40000,209.38000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Premier,,1969.25,,,,,,,37.73,1969.25,fee schedule,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,90,950.66,,,,,,,18.66,950.66,fee schedule,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier,90,7571.58,,,,,,,149.66,7571.58,fee schedule,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1818.00000,1727.10000,The Alliance,Premier,90,10101.09,,,,,,,175.54,10101.09,fee schedule,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,outpatient,,,102.40000,97.28000,The Alliance,Premier,90,492.33,,,,,,,3.40,492.33,fee schedule,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,outpatient,,,156.70000,148.86000,The Alliance,Premier,90,424.40,,,,,,,5.90,424.40,fee schedule,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier,90,763.98,,,,,,,15.09,763.98,fee schedule,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,1578.85,,,,,,,33.47,1578.85,fee schedule,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,outpatient,1,mL,2.60000,2.47000,The Alliance,Premier,,1.84,,,,,,,1.30,2.52,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier,,937.00,,,,,,,392.70,5858.00,case rate,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,outpatient,,,2201.00000,2090.95000,The Alliance,Premier,,7803.00,,,,,,,1210.55,7803.00,case rate,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,outpatient,,,248.10000,235.70000,The Alliance,Premier,90,1154.38,,,,,,,22.69,1154.38,fee schedule,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,1.58,,,,,,,0.62500,1.58,fee schedule,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,outpatient,1,mL,3285.02000,3120.77000,The Alliance,Premier,,47.35,,,,,,,28.70,3186.47,fee schedule,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Premier,90,1527.89,,,,,,,24.65,1527.89,fee schedule,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,645.08,,,,,,,8.17,645.08,fee schedule,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier,,865.84,,,,,,,18.40,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,,814.87,,,,,,,17.27,814.87,fee schedule,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier,,1103.49,,,,,,,19.88,1103.49,fee schedule,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.30000,129.49000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,90,780.94,,,,,,,14.99,780.94,fee schedule,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier,,780.94,,,,,,,14.99,780.94,fee schedule,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier,,1120.45,,,,,,,21.41,1120.45,fee schedule,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier,,865.84,,,,,,,18.40,865.84,fee schedule,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier,,1103.49,,,,,,,19.88,1103.49,fee schedule,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,763.98,,,,,,,16.07,763.98,fee schedule,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,outpatient,,,52.40000,49.78000,The Alliance,Premier,90,237.65,,,,,,,4.79,237.65,fee schedule,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier,90,6518.98,,,,,,,129.67,6518.98,fee schedule,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,Premier,90,3582.03,,,,,,,70.88,3582.03,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.67900,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,outpatient,1,mL,1.03000,0.97000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.99910,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Premier,,0.14850,,,,,,,0.14409,1.70,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,outpatient,1,mL,1.33000,1.27000,The Alliance,Premier,,0.14850,,,,,,,0.14409,1.29,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Premier,,0.14850,,,,,,,0.14409,1.09,fee schedule,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,,373.51,,,,,,,7.27,373.51,fee schedule,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,outpatient,,,135.40000,128.63000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier,TC,548.00,,,,,,,384.16,888.52,fee schedule,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier,,548.00,,,,,,,333.50,646.99,fee schedule,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier,,548.00,,,,,,,384.16,967.09,fee schedule,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier,,1866.00,,,,,,,333.50,2161.00,per diem,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier,,1866.00,,,,,,,498.50,2161.00,per diem,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,outpatient,,,2025.00000,1923.75000,The Alliance,Premier,,1645.00,,,,,,,1012.50,1964.25,per diem,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,outpatient,,,4212.00000,4001.40000,The Alliance,Premier,,2986.31,,,,,,,542.77,4085.64,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier,,472.90,,,,,,,333.50,646.99,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier,,706.87,,,,,,,498.50,967.09,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier,,1330.31,,,,,,,1290.94,2812.50,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,645.08,,,,,,,13.82,645.08,fee schedule,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier,,132.23,,,,,,,128.32,279.56,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,90,696.05,,,,,,,8.17,696.05,fee schedule,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier,,134.89,,,,,,,130.90,285.19,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,outpatient,1,EA,1.54000,1.47000,The Alliance,Premier,,1.09,,,,,,,0.77000,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,90,696.05,,,,,,,8.17,696.05,fee schedule,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,1120.45,,,,,,,20.36,1120.45,fee schedule,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,0.24250,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,outpatient,,,640.00000,608.00000,The Alliance,Premier,TC,548.00,,,,,,,320.00,620.80,fee schedule,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier,,0.59556,,,,,,,0.42000,0.81480,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,44.12000,41.91000,The Alliance,Premier,,20.87,,,,,,,20.25,44.12,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier,,1.25,,,,,,,0.88500,1.72,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,90,882.80,,,,,,,8.17,882.80,fee schedule,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,7.51,,,,,,,0.39500,7.69,fee schedule,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Premier,,7.51,,,,,,,0.65500,7.69,fee schedule,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Premier,,7.51,,,,,,,0.56000,7.69,fee schedule,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,3903.24,,,,,,,361.82,17311.25,fee schedule,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier,,548.00,,,,,,,166.00,1692.33,fee schedule,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,90,696.05,,,,,,,8.17,696.05,fee schedule,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2810.00000,2669.50000,The Alliance,Premier,90,54562.77,,,,,,,608.00,54562.77,fee schedule,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2066.00000,1962.70000,The Alliance,Premier,90,54562.77,,,,,,,608.00,54562.77,fee schedule,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Premier,90,1273.27,,,,,,,26.72,1273.27,fee schedule,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier,90,6518.98,,,,,,,129.67,6518.98,fee schedule,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,outpatient,,,157.60000,149.72000,The Alliance,Premier,90,458.40,,,,,,,9.19,458.40,fee schedule,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,outpatient,,,152.80000,145.16000,The Alliance,Premier,90,713.01,,,,,,,13.97,713.01,fee schedule,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,outpatient,,,208.80000,198.36000,The Alliance,Premier,90,780.94,,,,,,,15.49,780.94,fee schedule,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier,90,780.94,,,,,,,15.49,780.94,fee schedule,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,,288.85,,,,,,,203.70,3727.42,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,288.85,,,,,,,203.70,3727.42,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,outpatient,,,153.10000,145.44000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,186.00,,,,,,,26.50,264.00,per diem,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,,186.00,,,,,,,126.65,264.00,per diem,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,,186.00,,,,,,,126.65,264.00,per diem,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,outpatient,,,257.80000,244.91000,The Alliance,Premier,90,1188.38,,,,,,,23.57,1188.38,fee schedule,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,outpatient,,,149.40000,141.93000,The Alliance,Premier,,1527.89,,,,,,,29.28,1527.89,fee schedule,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Premier,90,475.37,,,,,,,9.32,475.37,fee schedule,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,outpatient,,,131.80000,125.21000,The Alliance,Premier,90,679.08,,,,,,,14.80,679.08,fee schedule,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,90,967.70,,,,,,,20.18,967.70,fee schedule,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier,,1713.44,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Premier,,6026.72,,,,,,,115.36,6026.72,fee schedule,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Premier,,1081.99,,,,,,,1049.96,2287.50,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,outpatient,,,339.20000,322.24000,The Alliance,Premier,90,882.80,,,,,,,18.72,882.80,fee schedule,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,outpatient,,,3791.00000,3601.45000,The Alliance,Premier,,1793.14,,,,,,,1040.32,3791.00,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.02000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1533.19000,1456.53000,The Alliance,Premier,,725.20,,,,,,,703.73,1533.19,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier,,253.65,,,,,,,246.14,536.25,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier,,253.65,,,,,,,246.14,536.25,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier,,383.57,,,,,,,212.82,1232.72,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier,,14.98,,,,,,,14.54,31.68,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,186.00,,,,,,,54.00,264.00,per diem,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier,,548.00,,,,,,,384.16,3015.65,fee schedule,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,90,696.05,,,,,,,13.89,696.05,fee schedule,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4481.55000,4257.47000,The Alliance,Premier,,2119.77,,,,,,,2057.03,4481.55,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Premier,,2.86,,,,,,,2.02,3.91,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,43.52,,,,,,,42.23,92.00,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,outpatient,1,mL,8.95000,8.50000,The Alliance,Premier,,6.35,,,,,,,4.47,8.68,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Premier,,6598.35,,,,,,,6403.05,13950.00,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,967.50000,919.12000,The Alliance,Premier,,457.63,,,,,,,444.08,967.50,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1042.50000,990.38000,The Alliance,Premier,,493.10,,,,,,,478.51,1042.50,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Premier,,2365.22,,,,,,,295.69,3235.92,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Premier,,2698.45,,,,,,,295.69,3691.82,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Premier,,2487.17,,,,,,,295.69,3402.76,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Premier,TC,3062.88,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3612.00000,3431.40000,The Alliance,Premier,TC,2560.91,,,,,,,1806.00,3503.64,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier,TC,231.84,,,,,,,163.50,317.19,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier,,1272.65,,,,,,,295.69,1741.15,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Premier,TC,1124.47,,,,,,,793.00,1538.42,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Premier,TC,295.65,,,,,,,208.50,404.49,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier,,2400.67,,,,,,,503.83,3284.42,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier,TC,1057.83,,,,,,,746.00,1447.24,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier,,1174.10,,,,,,,828.00,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier,,1181.19,,,,,,,503.83,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Premier,,3116.76,,,,,,,966.05,4264.12,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,outpatient,1,EA,5074.51000,4820.79000,The Alliance,Premier,,4197.42,,,,,,,2537.26,4922.27,fee schedule,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.10000,227.14000,The Alliance,Premier,,113.09,,,,,,,109.75,239.10,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,outpatient,1,EA,3.52000,3.34000,The Alliance,Premier,,2.50,,,,,,,1.76,3.41,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier,,3.45,,,,,,,2.44,4.72,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,outpatient,1,EA,52.04000,49.44000,The Alliance,Premier,,36.90,,,,,,,26.02,50.48,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier,,1.43,,,,,,,1.00,1.95,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Premier,,1.95,,,,,,,1.38,2.67,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,outpatient,1,EA,8.15000,7.74000,The Alliance,Premier,,5.78,,,,,,,4.08,7.91,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier,,401.76,,,,,,,389.87,849.38,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1853.00000,1760.35000,The Alliance,Premier,90,8573.20,,,,,,,169.42,8573.20,fee schedule,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Premier,90,645.08,,,,,,,12.82,645.08,fee schedule,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Premier,TC,3027.62,,,,,,,121.00,3027.62,fee schedule,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,TC,3487.84,,,,,,,298.87,3487.84,fee schedule,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Premier,TC,11271.02,,,,,,,1226.87,11271.02,fee schedule,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,4259.24,,,,,,,394.96,17311.25,fee schedule,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,outpatient,,,736.00000,699.20000,The Alliance,Premier,TC,4041.66,,,,,,,368.00,11266.81,fee schedule,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,,492.33,,,,,,,9.30,492.33,fee schedule,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.41831,,,,,,,0.29500,0.57230,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier,,1285.97,,,,,,,1247.91,2718.75,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier,,107.31,,,,,,,104.14,226.88,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,,17.48,,,,,,,16.32,80.51,fee schedule,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,679.08,,,,,,,32.85,679.08,fee schedule,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier,90,252.40,,,,,,,178.00,345.32,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier,,1325.12,,,,,,,172.18,1812.93,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,outpatient,1,EA,16.52000,15.69000,The Alliance,Premier,,11.71,,,,,,,8.26,16.02,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Premier,,42.80,,,,,,,30.18,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,outpatient,1,EA,11.31000,10.75000,The Alliance,Premier,,8.02,,,,,,,5.66,10.97,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Premier,90,8610.62,,,,,,,485.50,8610.62,fee schedule,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,outpatient,,,203.50000,193.32000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier,,188.91,,,,,,,183.32,399.38,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier,,1117.46,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,outpatient,1,EA,1113.31000,1057.65000,The Alliance,Premier,,90.90,,,,,,,55.09,1079.91,fee schedule,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,outpatient,1,mL,7201.88000,6841.78000,The Alliance,Premier,,171.12,,,,,,,103.71,6985.82,fee schedule,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,outpatient,1,EA,3.36000,3.20000,The Alliance,Premier,,2.38,,,,,,,1.68,3.26,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,GO,186.00,,,,,,,62.00,264.00,per diem,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,outpatient,,,168.30000,159.88000,The Alliance,Premier,90,814.87,,,,,,,16.02,814.87,fee schedule,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier,90,3666.93,,,,,,,50.62,3666.93,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,outpatient,1,EA,153.61000,145.93000,The Alliance,Premier,,2.46,,,,,,,2.39,149.00,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,outpatient,1,EA,207.93000,197.53000,The Alliance,Premier,,2.46,,,,,,,2.39,201.69,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,outpatient,1,EA,227.52000,216.14000,The Alliance,Premier,,2.46,,,,,,,2.39,220.69,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,outpatient,1,EA,75.90000,72.11000,The Alliance,Premier,,2.46,,,,,,,2.39,73.62,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,outpatient,1,EA,90.66000,86.13000,The Alliance,Premier,,2.46,,,,,,,2.39,87.94,fee schedule,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier,,2640.00,,,,,,,160.60,3163.00,case rate,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,outpatient,,,624.00000,592.80000,The Alliance,Premier,,442.42,,,,,,,343.20,5271.00,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,,363.72,,,,,,,256.50,497.61,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,outpatient,,,4933.00000,4686.35000,The Alliance,Premier,,3497.50,,,,,,,2466.50,4785.01,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Premier,TC,3685.66,,,,,,,336.50,3685.66,fee schedule,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier,TC,548.00,,,,,,,297.11,692.58,fee schedule,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,outpatient,,,1255.00000,1192.25000,The Alliance,Premier,TC,7087.64,,,,,,,627.50,7087.64,fee schedule,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier,TC,6003.00,,,,,,,221.10,6003.00,case rate,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Premier,,548.00,,,,,,,100.97,584.87,fee schedule,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier,,548.00,,,,,,,100.97,584.87,fee schedule,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,TC,548.00,,,,,,,44.00,548.00,fee schedule,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Premier,TC,1866.00,,,,,,,1396.56,3524.98,per diem,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier,,1866.00,,,,,,,1212.50,2352.25,per diem,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Premier,,1866.00,,,,,,,660.00,2161.00,per diem,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Premier,,2640.00,,,,,,,477.95,3163.00,case rate,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Premier,,548.00,,,,,,,384.16,1341.51,fee schedule,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,31.91,,,,,,,22.50,163.43,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier,,2640.00,,,,,,,517.55,3163.00,case rate,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,2640.00,,,,,,,409.75,3163.00,case rate,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier,,2640.00,,,,,,,517.55,3163.00,case rate,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,2640.00,,,,,,,409.75,3163.00,case rate,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,TC,6003.00,,,,,,,658.35,7621.00,case rate,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,TC,937.00,,,,,,,88.00,3163.00,case rate,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,TC,3963.00,,,,,,,177.65,4686.00,case rate,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier,,3963.00,,,,,,,658.35,4686.00,case rate,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Premier,,816.06,,,,,,,633.05,3163.00,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Premier,,3963.00,,,,,,,1538.48,5563.92,case rate,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,3963.00,,,,,,,174.90,4686.00,case rate,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1897.32,fee schedule,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,outpatient,,,3829.00000,3637.55000,The Alliance,Premier,TC,1866.00,,,,,,,1329.46,3714.13,per diem,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier,TC,1298.89,,,,,,,916.00,1777.04,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier,TC,4081.21,,,,,,,333.50,4081.21,fee schedule,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier,90,3038.81,,,,,,,48.55,3038.81,fee schedule,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier,90,35735.73,,,,,,,759.53,35735.73,fee schedule,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Premier,90,109.61,,,,,,,21.69,186.79,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,outpatient,,,158.40000,150.48000,The Alliance,Premier,90,885.37,,,,,,,14.91,885.37,fee schedule,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,outpatient,,,174.60000,165.87000,The Alliance,Premier,90,780.94,,,,,,,15.55,780.94,fee schedule,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,outpatient,,,72.30000,68.68000,The Alliance,Premier,90,51.26,,,,,,,36.15,70.13,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,outpatient,,,97.60000,92.72000,The Alliance,Premier,90,288.61,,,,,,,5.68,288.61,fee schedule,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier,,696.05,,,,,,,11.13,696.05,fee schedule,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier,90,1952.29,,,,,,,43.07,1952.29,fee schedule,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,950.66,,,,,,,10.38,950.66,fee schedule,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Premier,90,882.80,,,,,,,17.43,882.80,fee schedule,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,outpatient,,,276.50000,262.68000,The Alliance,Premier,90,19453.17,,,,,,,138.25,19453.17,fee schedule,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,203.72,,,,,,,3.93,203.72,fee schedule,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier,,1050.06,,,,,,,1018.98,2220.00,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Premier,,4071.47,,,,,,,3950.96,8607.75,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Premier,,2168.83,,,,,,,1306.65,2967.23,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Premier,TC,3566.94,,,,,,,383.91,10740.24,fee schedule,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier,TC,58.99,,,,,,,41.60,484.28,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,TC,4496.60,,,,,,,417.10,17311.25,fee schedule,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,TC,1645.00,,,,,,,298.87,1820.00,per diem,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,875.89000,832.10000,The Alliance,Premier,,414.30,,,,,,,402.03,875.89,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier,,607.23,,,,,,,589.26,1283.78,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,471.23000,447.67000,The Alliance,Premier,,222.89,,,,,,,216.29,471.23,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,186.00,,,,,,,38.00,264.00,per diem,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,outpatient,,,636.00000,604.20000,The Alliance,Premier,,186.00,,,,,,,126.65,616.92,per diem,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,,186.00,,,,,,,29.50,264.00,per diem,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Premier,,186.00,,,,,,,126.65,491.79,per diem,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,186.00,,,,,,,54.00,264.00,per diem,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,186.00,,,,,,,10.50,264.00,per diem,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,186.00,,,,,,,17.50,264.00,per diem,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,,186.00,,,,,,,21.00,264.00,per diem,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,outpatient,,,69.60000,66.12000,The Alliance,Premier,,186.00,,,,,,,34.80,264.00,per diem,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,GP,186.00,,,,,,,49.50,264.00,per diem,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,GO,186.00,,,,,,,17.50,264.00,per diem,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier,,186.00,,,,,,,119.56,352.11,per diem,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,,181.50,,,,,,,56.40,248.32,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier,,2.31,,,,,,,1.63,3.16,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,outpatient,,,438.50000,416.58000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,outpatient,,,454.90000,432.15000,The Alliance,Premier,90,967.70,,,,,,,18.98,967.70,fee schedule,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier,,1.41,,,,,,,0.99500,1.93,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier,90,35735.73,,,,,,,759.53,35735.73,fee schedule,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Premier,90,19453.17,,,,,,,135.45,19453.17,fee schedule,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,outpatient,,,110.60000,105.07000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,GO,186.00,,,,,,,21.00,264.00,per diem,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier,GO,186.00,,,,,,,21.00,264.00,per diem,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Premier,90,1289.24,,,,,,,27.11,1289.24,fee schedule,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,outpatient,,,668.00000,634.60000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,outpatient,,,305.90000,290.60000,The Alliance,Premier,90,696.05,,,,,,,13.80,696.05,fee schedule,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,outpatient,,,320.40000,304.38000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,outpatient,,,146.60000,139.27000,The Alliance,Premier,90,679.08,,,,,,,14.96,679.08,fee schedule,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,90,628.12,,,,,,,13.69,628.12,fee schedule,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier,90,7571.58,,,,,,,149.66,7571.58,fee schedule,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,90,696.05,,,,,,,13.68,696.05,fee schedule,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.76630,fee schedule,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,outpatient,,,935.00000,888.25000,The Alliance,Premier,,662.91,,,,,,,514.25,5271.00,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,outpatient,1,EA,64.97000,61.72000,The Alliance,Premier,,8.46,,,,,,,7.77,63.02,fee schedule,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,628.12,,,,,,,8.17,628.12,fee schedule,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,outpatient,1,EA,1.89000,1.79000,The Alliance,Premier,,1.34,,,,,,,0.94500,1.83,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,,3666.93,,,,,,,50.62,3666.93,fee schedule,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Premier,,12.56,,,,,,,8.86,17.18,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,outpatient,,,284.40000,270.18000,The Alliance,Premier,90,1786.28,,,,,,,12.05,1786.28,fee schedule,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Premier,90,19453.17,,,,,,,135.45,19453.17,fee schedule,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Premier,90,227.45,,,,,,,30.85,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Premier,,227.45,,,,,,,30.85,311.18,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier,TC,5638.86,,,,,,,519.48,5638.86,fee schedule,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier,,285.02,,,,,,,201.00,389.94,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Premier,,1.89,,,,,,,1.33,2.58,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Premier,,12.56,,,,,,,8.86,17.18,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier,,0.82953,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier,,0.38286,,,,,,,0.27000,0.52380,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier,,61.38,,,,,,,59.56,129.76,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier,,5004.48,,,,,,,4856.36,10580.30,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,outpatient,1,GM,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,14.22,27.59,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,outpatient,1,EA,21.96000,20.86000,The Alliance,Premier,,15.57,,,,,,,10.98,21.30,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,outpatient,1,GM,205.53000,195.25000,The Alliance,Premier,,145.72,,,,,,,102.77,199.36,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,outpatient,1,GM,313.19000,297.53000,The Alliance,Premier,,222.05,,,,,,,156.59,303.79,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,outpatient,1,EA,25.01000,23.76000,The Alliance,Premier,,17.73,,,,,,,12.51,24.26,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,outpatient,1,EA,14.17000,13.46000,The Alliance,Premier,,10.05,,,,,,,7.08,13.74,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Premier,,6003.00,,,,,,,1080.75,7304.63,case rate,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Premier,,3963.00,,,,,,,704.00,4686.00,case rate,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,outpatient,,,592.00000,562.40000,The Alliance,Premier,,419.73,,,,,,,296.00,574.24,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier,,1.31,,,,,,,0.92500,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier,,0.97133,,,,,,,0.68500,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier,,1.39,,,,,,,0.98000,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,outpatient,1,EA,1.57000,1.50000,The Alliance,Premier,,1.11,,,,,,,0.78500,1.52,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,outpatient,1,mL,1.93000,1.83000,The Alliance,Premier,,1.37,,,,,,,0.96500,1.87,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,,40.41,,,,,,,28.50,70.98,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,237.49000,225.62000,The Alliance,Premier,,112.33,,,,,,,109.01,237.49,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier,,2386.58,,,,,,,2315.94,5045.63,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier,,2386.58,,,,,,,2315.94,5045.63,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier,,487.00,,,,,,,148.57,1447.00,per diem,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier,90,6088.74,,,,,,,380.50,6088.74,fee schedule,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier,,1.14,,,,,,,0.80500,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,outpatient,1,EA,22.00000,20.90000,The Alliance,Premier,,15.60,,,,,,,11.00,21.34,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,outpatient,1,EA,34.14000,32.44000,The Alliance,Premier,,24.21,,,,,,,17.07,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Premier,,22.70,,,,,,,16.00,31.05,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier,,679.08,,,,,,,13.05,679.08,fee schedule,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier,90,848.80,,,,,,,16.80,848.80,fee schedule,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier,90,984.66,,,,,,,19.60,984.66,fee schedule,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier,90,1205.34,,,,,,,24.43,1205.34,fee schedule,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier,90,628.12,,,,,,,12.51,628.12,fee schedule,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier,,0.74250,,,,,,,0.63085,17.46,fee schedule,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier,,3963.00,,,,,,,125.95,4686.00,case rate,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,outpatient,1,mL,2753.58000,2615.90000,The Alliance,Premier,,66.92,,,,,,,40.56,2670.97,fee schedule,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier,,0.57429,,,,,,,0.40500,0.78570,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,outpatient,,,453.80000,431.11000,The Alliance,Premier,90,882.80,,,,,,,17.43,882.80,fee schedule,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier,,744.45,,,,,,,525.00,1180.23,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Premier,,14408.81,,,,,,,13982.33,30462.60,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1368.75000,1300.31000,The Alliance,Premier,,647.42,,,,,,,628.26,1368.75,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,33159.00000,31501.05000,The Alliance,Premier,,15684.21,,,,,,,15219.98,33159.00,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier,,5004.48,,,,,,,4856.36,10580.30,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1035.56,,,,,,,22.91,1035.56,fee schedule,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,outpatient,,,234.30000,222.58000,The Alliance,Premier,90,1137.41,,,,,,,117.15,1137.41,fee schedule,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Premier,90,645.08,,,,,,,12.82,645.08,fee schedule,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Premier,90,526.26,,,,,,,8.17,526.26,fee schedule,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Premier,,548.00,,,,,,,100.97,773.09,fee schedule,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,outpatient,1,EA,271.76000,258.17000,The Alliance,Premier,,192.68,,,,,,,135.88,263.61,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,outpatient,1,mL,222.19000,211.08000,The Alliance,Premier,,67.98,,,,,,,64.92,215.52,fee schedule,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Premier,,67.98,,,,,,,64.92,145.60,fee schedule,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier,,2.82,,,,,,,1.99,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Premier,,4.12,,,,,,,2.90,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,outpatient,1,EA,9.45000,8.98000,The Alliance,Premier,,6.70,,,,,,,4.72,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,outpatient,1,mL,3726.00000,3539.70000,The Alliance,Premier,,2641.73,,,,,,,1863.00,3614.22,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier,,640.94,,,,,,,268.42,876.88,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Premier,90,882.80,,,,,,,18.72,882.80,fee schedule,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,937.00,,,,,,,82.50,3163.00,case rate,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier,,937.00,,,,,,,257.95,3163.00,case rate,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,outpatient,,,3369.00000,3200.55000,The Alliance,Premier,,2388.62,,,,,,,1852.95,5271.00,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Premier,,2.92,,,,,,,2.06,4.00,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,outpatient,1,GM,0.94000,0.89000,The Alliance,Premier,,0.66646,,,,,,,0.47000,0.91180,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Premier,TC,4536.15,,,,,,,426.30,17311.25,fee schedule,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,3963.00,,,,,,,1475.05,3963.00,case rate,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,3963.00,,,,,,,1475.05,4686.00,case rate,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,outpatient,,,2762.00000,2623.90000,The Alliance,Premier,,6003.00,,,,,,,1519.10,6003.00,case rate,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier,,720.34,,,,,,,558.80,5271.00,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,3.78,,,,,,,1.58,3.78,fee schedule,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier,90,4787.38,,,,,,,94.71,4787.38,fee schedule,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Premier,TC,3963.00,,,,,,,1080.75,4686.00,case rate,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,75.68,,,,,,,73.44,160.00,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,168.51,,,,,,,163.52,356.25,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Premier,,414.46,,,,,,,402.19,876.23,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1140.19000,1083.18000,The Alliance,Premier,,539.31,,,,,,,523.35,1140.19,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12400.00,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,outpatient,,,457.00000,434.15000,The Alliance,Premier,,324.01,,,,,,,228.50,443.29,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,36.30,145.50,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier,,1.18,,,,,,,0.83500,1.62,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1931.25000,1834.69000,The Alliance,Premier,,913.48,,,,,,,886.44,1931.25,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,49.20000,46.74000,The Alliance,Premier,,23.27,,,,,,,22.58,49.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier,,0.77990,,,,,,,0.55000,1.07,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,90,128.47,,,,,,,21.69,186.79,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,937.00,,,,,,,114.95,3163.00,case rate,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Premier,,2212.50,,,,,,,2147.01,4677.58,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,outpatient,1,GM,0.14000,0.14000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,outpatient,1,EA,11.69000,11.11000,The Alliance,Premier,,8.29,,,,,,,5.84,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Premier,,20.12,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier,,14.19,,,,,,,10.01,19.41,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,TC,2162.63,,,,,,,210.00,2162.63,fee schedule,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,TC,1509.95,,,,,,,144.00,1509.95,fee schedule,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier,TC,1134.10,,,,,,,112.98,1134.10,fee schedule,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Premier,TC,2611.25,,,,,,,1841.50,3572.51,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,,186.00,,,,,,,110.00,264.00,per diem,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,,186.00,,,,,,,110.00,264.00,per diem,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,186.00,,,,,,,126.65,267.72,per diem,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Premier,,657.95,,,,,,,464.00,900.16,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier,,577.84,,,,,,,448.25,5271.00,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier,,504.81,,,,,,,391.60,5271.00,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier,,1050.06,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,,75.30,,,,,,,73.07,159.20,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1150.20000,1092.69000,The Alliance,Premier,,544.04,,,,,,,527.94,1150.20,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1751.25000,1663.69000,The Alliance,Premier,,828.34,,,,,,,803.82,1751.25,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier,,997.10,,,,,,,967.59,2108.03,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier,TC,146.76,,,,,,,103.50,200.79,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,946.09000,898.79000,The Alliance,Premier,,447.50,,,,,,,434.26,946.09,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,,75.30,,,,,,,73.07,159.20,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,882.80,,,,,,,8.17,882.80,fee schedule,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Premier,90,746.94,,,,,,,14.87,746.94,fee schedule,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,outpatient,,,176.30000,167.49000,The Alliance,Premier,90,814.87,,,,,,,16.11,814.87,fee schedule,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Premier,90,1052.52,,,,,,,19.62,1052.52,fee schedule,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier,,2640.00,,,,,,,548.90,3163.00,case rate,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Premier,,804.01,,,,,,,567.00,1099.98,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier,,1645.00,,,,,,,672.00,1820.00,per diem,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier,,2.76,,,,,,,0.22500,2.76,fee schedule,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier,,2.76,,,,,,,0.25000,2.76,fee schedule,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,14.67,,,,,,,0.52500,14.67,fee schedule,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Premier,,242.12,,,,,,,170.75,331.25,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,outpatient,1,mL,3.17000,3.01000,The Alliance,Premier,,2.25,,,,,,,1.58,3.07,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,outpatient,1,GM,7.76000,7.37000,The Alliance,Premier,,5.50,,,,,,,3.88,7.53,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier,,0.52466,,,,,,,0.37000,0.71780,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier,,0.20561,,,,,,,0.14500,0.28130,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Premier,,36.41,,,,,,,25.68,49.81,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,outpatient,1,mL,492.10000,467.50000,The Alliance,Premier,,348.90,,,,,,,246.05,477.34,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,outpatient,1,mL,705.23000,669.97000,The Alliance,Premier,,500.01,,,,,,,352.62,684.07,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,outpatient,1,mL,117.73000,111.84000,The Alliance,Premier,,83.47,,,,,,,58.87,114.20,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,outpatient,1,mL,42.98000,40.83000,The Alliance,Premier,,1.01,,,,,,,0.91450,41.69,fee schedule,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Premier,,1.01,,,,,,,0.91450,23.91,fee schedule,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,outpatient,1,mL,62.81000,59.67000,The Alliance,Premier,,1.01,,,,,,,0.91450,60.93,fee schedule,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Premier,,23.77,,,,,,,1.49,32.51,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,outpatient,1,mL,198.20000,188.29000,The Alliance,Premier,,28.66,,,,,,,17.37,192.25,fee schedule,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier,,61.38,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier,,3590.07,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,outpatient,1,GM,0.04000,0.03000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier,90,882.80,,,,,,,18.52,882.80,fee schedule,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,7.51,,,,,,,0.63000,7.69,fee schedule,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier,,7.51,,,,,,,0.73500,7.69,fee schedule,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,13.17,,,,,,,0.14000,13.53,fee schedule,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,13.17,,,,,,,0.06000,13.53,fee schedule,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier,,4.31,,,,,,,0.55000,4.31,fee schedule,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier,,888.38,,,,,,,626.50,1215.41,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,outpatient,,,244.20000,231.99000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier,,1793.60,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,303.60000,288.42000,The Alliance,Premier,,143.60,,,,,,,139.35,303.60,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,302.10000,287.00000,The Alliance,Premier,,142.89,,,,,,,138.66,302.10,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,outpatient,1,mL,96.92000,92.07000,The Alliance,Premier,,68.72,,,,,,,48.46,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,outpatient,1,mL,96.91000,92.07000,The Alliance,Premier,,68.71,,,,,,,48.45,94.00,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,186.00,,,,,,,54.00,264.00,per diem,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier,,3968.66,,,,,,,3851.19,8390.40,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier,,4906.24,,,,,,,4761.02,10372.60,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,outpatient,,,3818.00000,3627.10000,The Alliance,Premier,,2706.96,,,,,,,569.17,3703.46,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,outpatient,1,EA,25.76000,24.47000,The Alliance,Premier,,18.26,,,,,,,12.88,24.99,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,29.10,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,195.68,,,,,,,138.00,325.26,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,,239.64,,,,,,,148.57,327.86,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,144.64,,,,,,,23.25,197.88,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,295.00,,,,,,,83.00,446.00,case rate,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,295.00,,,,,,,58.00,446.00,case rate,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,295.00,,,,,,,32.50,446.00,case rate,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier,,295.00,,,,,,,97.00,446.00,case rate,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier,,295.00,,,,,,,134.00,446.00,case rate,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier,,295.00,,,,,,,197.00,446.00,case rate,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,outpatient,,,516.00000,490.20000,The Alliance,Premier,,295.00,,,,,,,258.00,500.52,case rate,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Premier,TC,2320.90,,,,,,,227.00,2320.90,fee schedule,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,outpatient,,,601.00000,570.95000,The Alliance,Premier,TC,3099.68,,,,,,,284.63,3099.68,fee schedule,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,outpatient,,,1218.00000,1157.10000,The Alliance,Premier,,863.56,,,,,,,669.90,5271.00,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,2640.00,,,,,,,409.75,3163.00,case rate,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier,TC,3586.71,,,,,,,267.00,3586.71,fee schedule,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier,TC,548.00,,,,,,,47.50,860.53,fee schedule,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier,,307.71,,,,,,,217.00,488.81,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Premier,90,6141.84,,,,,,,377.60,6141.84,fee schedule,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,outpatient,,,1161.00000,1102.95000,The Alliance,Premier,90,6047.82,,,,,,,389.13,6047.82,fee schedule,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Premier,,1.46,,,,,,,1.03,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Premier,,306.29,,,,,,,98.39,1078.91,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier,90,19453.17,,,,,,,533.12,19453.17,fee schedule,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,outpatient,,,2336.00000,2219.20000,The Alliance,Premier,90,11238.50,,,,,,,234.70,11238.50,fee schedule,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,outpatient,,,2681.00000,2546.95000,The Alliance,Premier,90,14345.24,,,,,,,304.81,14345.24,fee schedule,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,outpatient,1,GM,14.97000,14.22000,The Alliance,Premier,,10.61,,,,,,,7.49,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,outpatient,1,mL,5334.14000,5067.43000,The Alliance,Premier,,24.88,,,,,,,15.08,5174.12,fee schedule,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,outpatient,1,mL,29.43000,27.96000,The Alliance,Premier,,20.87,,,,,,,1.49,28.55,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,outpatient,1,EA,795.93000,756.14000,The Alliance,Premier,,18.05,,,,,,,10.94,772.05,fee schedule,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,outpatient,,,22663.00000,21529.85000,The Alliance,Premier,,16068.07,,,,,,,1519.65,21983.11,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,74.34,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier,,287.85,,,,,,,67.58,393.82,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier,,649.44,,,,,,,314.95,888.52,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,,150.31,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Premier,,624.63,,,,,,,314.95,854.57,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier,,511.90,,,,,,,314.95,700.34,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier,,131.87,,,,,,,67.58,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,,289.27,,,,,,,67.58,395.76,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier,,344.57,,,,,,,67.58,471.42,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Premier,,4371.88,,,,,,,126.07,4371.88,fee schedule,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Premier,,14408.81,,,,,,,13982.33,30462.60,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier,,937.00,,,,,,,179.85,3163.00,case rate,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier,,2190.64,,,,,,,100.97,2190.64,fee schedule,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,,548.00,,,,,,,100.97,584.87,fee schedule,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier,,363.01,,,,,,,100.97,584.87,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Premier,,548.00,,,,,,,100.97,973.88,fee schedule,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier,,247.44,,,,,,,83.61,484.28,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier,,75.86,,,,,,,35.41,103.79,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier,,316.21,,,,,,,56.40,432.62,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier,,2313.59,,,,,,,146.17,2313.59,fee schedule,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier,,21.98,,,,,,,10.00,30.07,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier,,6037.79,,,,,,,360.00,6037.79,fee schedule,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Premier,,690.57,,,,,,,122.37,944.78,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier,,148.18,,,,,,,104.50,212.44,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,,87.92,,,,,,,43.81,120.28,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier,,320.47,,,,,,,200.06,438.44,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,43.81,97.00,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,96.42,,,,,,,68.00,131.92,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier,,142.51,,,,,,,67.58,194.97,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier,,104.22,,,,,,,43.81,142.59,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier,,263.04,,,,,,,185.50,359.87,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,,115.57,,,,,,,56.40,158.11,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,164.30,,,,,,,153.47,545.62,fee schedule,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,outpatient,,,207.20000,196.84000,The Alliance,Premier,,146.90,,,,,,,103.60,212.44,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Premier,,1866.00,,,,,,,339.11,3584.15,per diem,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier,,246.02,,,,,,,173.50,336.59,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Premier,,548.00,,,,,,,100.97,1076.70,fee schedule,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier,,214.83,,,,,,,35.41,293.91,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier,,362.30,,,,,,,122.40,495.67,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier,,639.52,,,,,,,200.06,874.94,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,937.00,,,,,,,48.40,3163.00,case rate,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,442.00,,,,,,,37.00,442.00,per diem,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,,34.03,,,,,,,24.00,46.56,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,74.44,,,,,,,37.27,101.85,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Premier,,548.00,,,,,,,100.97,1085.43,fee schedule,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier,,937.00,,,,,,,56.40,5271.00,case rate,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,1553.42,,,,,,,83.61,1553.42,fee schedule,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier,,2009.44,,,,,,,83.61,2009.44,fee schedule,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,,1811.63,,,,,,,83.61,1811.63,fee schedule,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier,,2113.62,,,,,,,83.61,2113.62,fee schedule,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier,,2811.23,,,,,,,100.97,2811.23,fee schedule,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier,,2168.71,,,,,,,83.61,2168.71,fee schedule,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier,,1930.27,,,,,,,83.61,1930.27,fee schedule,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier,,1550.26,,,,,,,83.61,1550.26,fee schedule,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier,,2147.86,,,,,,,83.61,2147.86,fee schedule,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier,,2113.62,,,,,,,100.97,2113.62,fee schedule,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,,1533.65,,,,,,,83.61,1533.65,fee schedule,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,,1965.59,,,,,,,83.61,1965.59,fee schedule,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Premier,,1772.08,,,,,,,100.97,1772.08,fee schedule,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier,,1850.10,,,,,,,83.61,1850.10,fee schedule,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier,,1732.53,,,,,,,83.61,1732.53,fee schedule,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,,1755.46,,,,,,,100.97,1755.46,fee schedule,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Premier,,1574.27,,,,,,,100.97,1574.27,fee schedule,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier,,2277.19,,,,,,,100.97,2277.19,fee schedule,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Premier,,2192.71,,,,,,,100.97,2192.71,fee schedule,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier,,1811.63,,,,,,,83.61,1811.63,fee schedule,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Premier,TC,2451.72,,,,,,,1609.99,3354.26,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier,TC,1719.33,,,,,,,1212.50,2352.25,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Premier,,180.09,,,,,,,127.00,246.38,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,114.86,,,,,,,81.00,157.14,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2078.89000,1974.95000,The Alliance,Premier,,983.31,,,,,,,954.21,2078.89,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,outpatient,,,11128.16000,10571.75000,The Alliance,Premier,,5263.62,,,,,,,5107.83,11128.16,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,outpatient,1,mL,97.37000,92.50000,The Alliance,Premier,,69.04,,,,,,,1.49,94.45,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,outpatient,1,mL,486.83000,462.49000,The Alliance,Premier,,165.50,,,,,,,100.30,472.23,fee schedule,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,outpatient,1,EA,5750.00000,5462.50000,The Alliance,Premier,,4076.75,,,,,,,131.56,5577.50,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,outpatient,1,mL,1421.18000,1350.13000,The Alliance,Premier,,0.61050,,,,,,,0.37000,1378.54,fee schedule,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,outpatient,1,mL,2524.14000,2397.93000,The Alliance,Premier,,0.61050,,,,,,,0.37000,2448.42,fee schedule,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,41.36000,39.29000,The Alliance,Premier,,19.56,,,,,,,18.98,41.36,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier,,206.61,,,,,,,200.49,436.80,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,,2.43,,,,,,,2.31,12.33,fee schedule,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Premier,,1.78,,,,,,,1.25,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier,,1.40,,,,,,,0.99000,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier,,0.36159,,,,,,,0.25500,0.49470,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier,TC,1153.87,,,,,,,114.50,1153.87,fee schedule,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,outpatient,,,218.90000,207.95000,The Alliance,Premier,90,1018.59,,,,,,,19.99,1018.59,fee schedule,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Premier,90,679.08,,,,,,,14.96,679.08,fee schedule,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,outpatient,,,240.30000,228.28000,The Alliance,Premier,90,1103.49,,,,,,,21.97,1103.49,fee schedule,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,90,696.05,,,,,,,13.89,696.05,fee schedule,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,90,254.68,,,,,,,5.11,254.68,fee schedule,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier,90,373.51,,,,,,,7.27,373.51,fee schedule,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,outpatient,,,295.70000,280.91000,The Alliance,Premier,90,492.33,,,,,,,9.61,492.33,fee schedule,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Premier,90,882.80,,,,,,,17.60,882.80,fee schedule,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,outpatient,,,99.50000,94.52000,The Alliance,Premier,90,1137.41,,,,,,,49.75,1137.41,fee schedule,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,outpatient,,,2343.00000,2225.85000,The Alliance,Premier,90,10831.07,,,,,,,214.21,10831.07,fee schedule,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,188.60000,179.17000,The Alliance,Premier,,89.21,,,,,,,86.57,188.60,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1496.25000,1421.44000,The Alliance,Premier,,707.73,,,,,,,686.78,1496.25,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier,TC,1331.91,,,,,,,131.00,1331.91,fee schedule,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,outpatient,,,13067.00000,12413.65000,The Alliance,Premier,,9264.50,,,,,,,4314.91,12674.99,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,27.24000,25.88000,The Alliance,Premier,,19.31,,,,,,,13.62,26.42,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,outpatient,,,191.30000,181.74000,The Alliance,Premier,90,882.80,,,,,,,17.47,882.80,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier,,0.28050,,,,,,,0.06000,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,outpatient,1,mL,0.15000,0.15000,The Alliance,Premier,,0.28050,,,,,,,0.07500,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.28050,,,,,,,0.08000,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,0.28050,,,,,,,0.27217,1.22,fee schedule,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier,,1.52,,,,,,,1.07,2.09,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,11.85,22.99,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,outpatient,1,EA,2450.87000,2328.32000,The Alliance,Premier,,32.47,,,,,,,19.06,2377.34,fee schedule,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,outpatient,1,EA,5991.52000,5691.95000,The Alliance,Premier,,125.17,,,,,,,75.86,5811.77,fee schedule,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier,,1.55,,,,,,,1.09,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,outpatient,1,EA,149.44000,141.96000,The Alliance,Premier,,105.95,,,,,,,74.72,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier,,1.50,,,,,,,1.05,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier,,0.87207,,,,,,,0.61500,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,outpatient,1,EA,22.44000,21.31000,The Alliance,Premier,,15.91,,,,,,,11.22,21.77,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,outpatient,1,mL,5333.95000,5067.25000,The Alliance,Premier,,24.88,,,,,,,15.08,5173.93,fee schedule,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Premier,TC,4516.38,,,,,,,420.81,17311.25,fee schedule,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6744.75000,6407.51000,The Alliance,Premier,,3190.27,,,,,,,3095.84,6744.75,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,81.82,,,,,,,21.50,81.82,fee schedule,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Premier,,16.11,,,,,,,11.36,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,outpatient,1,mL,18.64000,17.71000,The Alliance,Premier,,13.22,,,,,,,9.32,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,outpatient,1,mL,20.05000,19.05000,The Alliance,Premier,,14.22,,,,,,,10.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,outpatient,1,mL,9.60000,9.12000,The Alliance,Premier,,6.81,,,,,,,4.80,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Premier,,16.11,,,,,,,11.36,22.04,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Premier,,34.37,,,,,,,24.24,47.03,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,outpatient,1,mL,104.41000,99.19000,The Alliance,Premier,,74.03,,,,,,,52.20,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,outpatient,1,mL,95.21000,90.45000,The Alliance,Premier,,67.50,,,,,,,47.60,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,outpatient,1,mL,122.77000,116.63000,The Alliance,Premier,,87.04,,,,,,,61.38,119.09,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Premier,,369.39,,,,,,,286.55,5271.00,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Premier,,75.94,,,,,,,53.55,103.90,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,,957.15,,,,,,,742.50,5271.00,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier,TC,5868.06,,,,,,,550.38,17311.25,fee schedule,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,outpatient,,,2929.00000,2782.55000,The Alliance,Premier,,2076.66,,,,,,,1610.95,5271.00,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Premier,TC,937.00,,,,,,,909.00,5271.00,case rate,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier,,4953.07,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,Premier,TC,523.24,,,,,,,369.00,715.86,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier,,577.84,,,,,,,448.25,5271.00,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,1596.38,,,,,,,1549.12,3375.00,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Premier,,75.94,,,,,,,1.49,103.90,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,outpatient,1,GM,2.90000,2.75000,The Alliance,Premier,,2.06,,,,,,,1.45,2.81,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Premier,,487.79,,,,,,,314.95,667.36,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,outpatient,1,EA,24.48000,23.25000,The Alliance,Premier,,17.36,,,,,,,12.24,23.75,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier,,1.16,,,,,,,0.82000,1.59,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Premier,,79.25,,,,,,,14.46,80.87,fee schedule,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,outpatient,1,GM,184.32000,175.11000,The Alliance,Premier,,130.68,,,,,,,92.16,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,outpatient,1,GM,131.67000,125.08000,The Alliance,Premier,,93.35,,,,,,,65.83,127.72,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,outpatient,1,mL,285.68000,271.39000,The Alliance,Premier,,1.25,,,,,,,0.76000,277.11,fee schedule,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier,,0.01650,,,,,,,0.01550,0.17460,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,outpatient,1,mL,1762.49000,1674.37000,The Alliance,Premier,,439.63,,,,,,,266.44,1709.62,fee schedule,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Premier,,202.95,,,,,,,143.12,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Premier,,202.95,,,,,,,143.12,277.66,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Premier,,0.54593,,,,,,,0.38500,0.74690,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,outpatient,1,GM,0.64000,0.61000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Premier,,10278.67,,,,,,,9974.44,21730.80,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,,1614.89,,,,,,,83.61,1614.89,fee schedule,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1881.86000,1787.77000,The Alliance,Premier,,890.12,,,,,,,863.77,1881.86,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Premier,,12.37,,,,,,,7.00,13.58,fee schedule,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier,TC,1569.27,,,,,,,140.50,1569.27,fee schedule,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,7443.72000,7071.53000,The Alliance,Premier,,3520.88,,,,,,,3416.67,7443.72,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.91000,363.76000,The Alliance,Premier,,181.12,,,,,,,175.76,382.91,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,outpatient,1,mL,4.68000,4.44000,The Alliance,Premier,,0.08250,,,,,,,0.08005,4.54,fee schedule,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,outpatient,1,EA,26.01000,24.71000,The Alliance,Premier,,18.44,,,,,,,13.01,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Premier,,12.28,,,,,,,8.66,16.80,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Premier,,4711.15,,,,,,,4571.71,9960.15,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,Premier,TC,1509.95,,,,,,,137.00,1509.95,fee schedule,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier,,496.65,,,,,,,481.95,1050.00,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Premier,,1324.17,,,,,,,25.25,1324.17,fee schedule,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier,,168.74,,,,,,,119.00,230.86,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,outpatient,1,mL,8182.76000,7773.62000,The Alliance,Premier,,21.38,,,,,,,12.96,7937.28,fee schedule,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,outpatient,1,EA,254.49000,241.77000,The Alliance,Premier,,180.43,,,,,,,127.25,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,outpatient,1,EA,197.29000,187.43000,The Alliance,Premier,,139.88,,,,,,,98.64,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,outpatient,1,EA,330.51000,313.98000,The Alliance,Premier,,234.33,,,,,,,165.25,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,outpatient,1,EA,251.01000,238.46000,The Alliance,Premier,,177.97,,,,,,,125.50,243.48,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,outpatient,1,EA,167.34000,158.97000,The Alliance,Premier,,118.64,,,,,,,83.67,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,outpatient,1,EA,169.66000,161.18000,The Alliance,Premier,,120.29,,,,,,,84.83,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,outpatient,1,EA,131.53000,124.95000,The Alliance,Premier,,93.25,,,,,,,65.77,127.58,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,outpatient,1,EA,237.52000,225.65000,The Alliance,Premier,,168.40,,,,,,,118.76,230.39,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,outpatient,1,mL,8229.81000,7818.32000,The Alliance,Premier,,21.38,,,,,,,12.96,7982.92,fee schedule,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,outpatient,1,GM,1.13000,1.08000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier,,192.14,,,,,,,135.50,417.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,68.11,,,,,,,66.10,144.00,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,outpatient,1,GM,7.47000,7.10000,The Alliance,Premier,,5.30,,,,,,,3.73,7.25,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,outpatient,1,GM,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,outpatient,1,EA,21.38000,20.31000,The Alliance,Premier,,15.16,,,,,,,10.69,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,outpatient,1,EA,11.79000,11.20000,The Alliance,Premier,,8.36,,,,,,,5.89,11.44,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,outpatient,1,mL,35308.12000,33542.71000,The Alliance,Premier,,6004.12,,,,,,,3638.86,34248.88,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier,,0.61683,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier,,1.84,,,,,,,1.30,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,outpatient,,,451.40000,428.83000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,outpatient,,,176.70000,167.86000,The Alliance,Premier,90,984.66,,,,,,,21.79,984.66,fee schedule,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier,90,696.05,,,,,,,13.69,696.05,fee schedule,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,outpatient,,,332.20000,315.59000,The Alliance,Premier,90,1680.71,,,,,,,35.97,1680.71,fee schedule,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Premier,,514.85,,,,,,,312.03,631.01,fee schedule,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,outpatient,1,mL,650.53000,618.00000,The Alliance,Premier,,514.85,,,,,,,312.03,631.01,fee schedule,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier,,71.61,,,,,,,55.55,5271.00,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,20.37,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,48.19,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,outpatient,1,mL,3.13000,2.98000,The Alliance,Premier,,2.22,,,,,,,1.56,3.04,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Premier,,2212.50,,,,,,,2147.01,4677.58,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,,75.30,,,,,,,73.07,159.20,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2790.71000,2651.17000,The Alliance,Premier,,1320.01,,,,,,,1280.94,2790.71,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier,,577.84,,,,,,,448.25,5271.00,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,outpatient,,,3561.00000,3382.95000,The Alliance,Premier,,2524.75,,,,,,,1958.55,5271.00,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier,,226.17,,,,,,,175.45,5271.00,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Premier,,684.89,,,,,,,531.30,5271.00,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Premier,,4.66,,,,,,,3.29,6.37,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,9.32000,8.85000,The Alliance,Premier,,6.61,,,,,,,4.66,9.04,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier,,6.27,,,,,,,4.42,8.58,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,outpatient,1,EA,38.05000,36.14000,The Alliance,Premier,,26.98,,,,,,,19.02,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Premier,,31.23,,,,,,,22.02,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier,,1793.60,,,,,,,1740.51,3791.96,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier,,1793.60,,,,,,,1740.51,3791.96,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier,,1050.06,,,,,,,1018.98,2220.00,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier,TC,7964.98,,,,,,,629.00,7964.98,fee schedule,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier,,0.78699,,,,,,,0.55500,1.49,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier,90,19453.17,,,,,,,533.12,19453.17,fee schedule,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,,220.68,,,,,,,4.28,220.68,fee schedule,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier,,0.21270,,,,,,,0.15000,0.29100,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4706.00000,4470.70000,The Alliance,Premier,90,28130.22,,,,,,,597.91,28130.22,fee schedule,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier,90,8610.62,,,,,,,499.50,8610.62,fee schedule,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,outpatient,1,GM,66.56000,63.23000,The Alliance,Premier,,47.19,,,,,,,33.28,64.56,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,outpatient,,,510.69000,485.16000,The Alliance,Premier,,362.08,,,,,,,255.34,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,outpatient,1,mL,1021.38000,970.31000,The Alliance,Premier,,724.16,,,,,,,273.14,990.74,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,outpatient,1,GM,29.41000,27.94000,The Alliance,Premier,,20.85,,,,,,,14.71,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,outpatient,1,GM,46.98000,44.64000,The Alliance,Premier,,33.31,,,,,,,23.49,45.57,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,outpatient,1,mL,108.46000,103.04000,The Alliance,Premier,,76.90,,,,,,,54.23,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,outpatient,1,mL,93.71000,89.02000,The Alliance,Premier,,66.44,,,,,,,46.85,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,outpatient,1,mL,92.53000,87.90000,The Alliance,Premier,,65.60,,,,,,,46.27,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,outpatient,1,mL,97.51000,92.63000,The Alliance,Premier,,69.13,,,,,,,48.76,94.58,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Premier,TC,1645.00,,,,,,,782.00,1820.00,per diem,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,outpatient,,,352.80000,335.16000,The Alliance,Premier,,250.14,,,,,,,176.40,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,outpatient,1,EA,352.80000,335.16000,The Alliance,Premier,,250.14,,,,,,,176.40,342.22,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,outpatient,1,GM,83.98000,79.78000,The Alliance,Premier,,59.54,,,,,,,41.99,81.46,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,14647.50000,13915.12000,The Alliance,Premier,,6928.27,,,,,,,6723.20,14208.08,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,1046.52,2280.00,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Premier,TC,5966.93,,,,,,,574.33,17311.25,fee schedule,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Premier,TC,4892.15,,,,,,,457.64,29731.35,fee schedule,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Premier,TC,5334.02,,,,,,,498.74,29731.35,fee schedule,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier,TC,1645.00,,,,,,,911.00,1964.22,per diem,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Premier,,10278.67,,,,,,,9974.44,21730.80,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,outpatient,,,2209.00000,2098.55000,The Alliance,Premier,TC,14176.04,,,,,,,1104.50,14176.04,fee schedule,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,outpatient,,,6409.00000,6088.55000,The Alliance,Premier,,6003.00,,,,,,,2786.18,11015.00,case rate,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,409.75,5271.00,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,outpatient,1,mL,20.54000,19.51000,The Alliance,Premier,,0.75900,,,,,,,0.59830,19.92,fee schedule,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,outpatient,1,mL,17.30000,16.44000,The Alliance,Premier,,0.75900,,,,,,,0.59830,16.78,fee schedule,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,0.75900,,,,,,,0.59830,7.66,fee schedule,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier,,0.00709,,,,,,,0.00500,0.00970,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,outpatient,1,mL,38.69000,36.75000,The Alliance,Premier,,0.36300,,,,,,,0.35222,37.53,fee schedule,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Premier,,14.64,,,,,,,10.32,20.03,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,outpatient,1,EA,3.39000,3.22000,The Alliance,Premier,,2.40,,,,,,,1.70,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Premier,,3.16,,,,,,,2.23,4.32,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,outpatient,1,mL,17.68000,16.80000,The Alliance,Premier,,12.54,,,,,,,8.84,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,outpatient,1,mL,11.12000,10.57000,The Alliance,Premier,,7.88,,,,,,,5.56,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,outpatient,1,mL,34.01000,32.31000,The Alliance,Premier,,24.11,,,,,,,17.00,32.99,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,outpatient,1,EA,170.64000,162.11000,The Alliance,Premier,,120.98,,,,,,,85.32,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,outpatient,1,EA,197.50000,187.62000,The Alliance,Premier,,140.03,,,,,,,98.75,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,outpatient,1,EA,71.08000,67.53000,The Alliance,Premier,,50.40,,,,,,,35.54,68.95,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier,,4.38,,,,,,,3.09,5.99,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Premier,,0.47850,,,,,,,0.29000,1100.39,fee schedule,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,outpatient,1,EA,68.99000,65.54000,The Alliance,Premier,,48.91,,,,,,,34.49,66.92,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,outpatient,1,mL,27.94000,26.55000,The Alliance,Premier,,19.81,,,,,,,13.97,27.10,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.75,fee schedule,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.90,fee schedule,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,outpatient,1,EA,86.43000,82.10000,The Alliance,Premier,,61.28,,,,,,,43.22,83.84,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier,,121.09,,,,,,,114.64,291.19,fee schedule,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier,,0.34741,,,,,,,0.24500,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier,,0.80117,,,,,,,0.56500,1.10,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier,,181.75,,,,,,,176.38,384.26,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Premier,,349.43,,,,,,,339.09,738.75,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier,,787.54,,,,,,,764.24,1615.05,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,,75.30,,,,,,,73.07,159.20,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Premier,,79.25,,,,,,,14.46,80.87,fee schedule,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,outpatient,1,GM,8.90000,8.46000,The Alliance,Premier,,6.31,,,,,,,4.45,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,outpatient,1,GM,7.65000,7.27000,The Alliance,Premier,,5.42,,,,,,,3.83,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,outpatient,1,GM,7.42000,7.04000,The Alliance,Premier,,5.26,,,,,,,3.71,7.20,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,outpatient,1,EA,3324.53000,3158.31000,The Alliance,Premier,,228.81,,,,,,,138.67,3224.79,fee schedule,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,outpatient,1,EA,11037.06000,10485.21000,The Alliance,Premier,,228.81,,,,,,,138.67,10705.95,fee schedule,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Premier,,13.17,,,,,,,7.98,1004.92,fee schedule,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Premier,,13.17,,,,,,,7.98,1004.92,fee schedule,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Premier,,2.81,,,,,,,1.98,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,3.95,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,outpatient,1,EA,7.39000,7.02000,The Alliance,Premier,,5.24,,,,,,,3.69,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Premier,,2.77,,,,,,,1.96,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier,,2.44,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier,,2.30,,,,,,,1.62,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier,,3.45,,,,,,,2.44,4.72,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Premier,,84.04,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Premier,,84.04,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,outpatient,1,EA,212.90000,202.26000,The Alliance,Premier,,150.95,,,,,,,106.45,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,outpatient,1,EA,169.34000,160.87000,The Alliance,Premier,,120.06,,,,,,,84.67,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,outpatient,1,EA,71.12000,67.57000,The Alliance,Premier,,50.42,,,,,,,35.56,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier,,89.62,,,,,,,63.20,122.61,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,28.36,,,,,,,20.00,38.80,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier,,0.90043,,,,,,,0.63500,1.23,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Premier,,3.29,,,,,,,2.32,4.50,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.56260,fee schedule,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.61,fee schedule,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,,237.65,,,,,,,4.40,237.65,fee schedule,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.46000,839.29000,The Alliance,Premier,,417.88,,,,,,,405.51,883.46,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier,,4487.59,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6693.00000,6358.35000,The Alliance,Premier,,3165.79,,,,,,,3072.09,6693.00,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,565.01000,536.76000,The Alliance,Premier,,267.25,,,,,,,259.34,565.01,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,312.86000,297.22000,The Alliance,Premier,,147.98,,,,,,,143.60,312.86,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier,,2386.58,,,,,,,2315.94,5045.63,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,688.69000,654.26000,The Alliance,Premier,,325.75,,,,,,,316.11,688.69,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier,,1793.60,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,outpatient,1,mL,0.49000,0.46000,The Alliance,Premier,,10.46,,,,,,,0.24500,10.52,fee schedule,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier,,1.07,,,,,,,0.75500,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier,,1.91,,,,,,,1.35,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier,,2.04,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier,,0.58847,,,,,,,0.41500,0.80510,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,outpatient,1,mL,19.75000,18.76000,The Alliance,Premier,,14.00,,,,,,,9.88,19.16,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,outpatient,1,mL,1.70000,1.62000,The Alliance,Premier,,7.51,,,,,,,0.85000,7.69,fee schedule,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier,TC,548.00,,,,,,,146.50,584.87,fee schedule,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,TC,1645.00,,,,,,,298.87,1820.00,per diem,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Premier,TC,548.00,,,,,,,275.50,584.87,fee schedule,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,outpatient,1,GM,110.60000,105.07000,The Alliance,Premier,,78.42,,,,,,,55.30,107.28,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,outpatient,1,mL,435.00000,413.25000,The Alliance,Premier,,308.42,,,,,,,217.50,421.95,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,outpatient,,,27.90000,26.50000,The Alliance,Premier,,19.78,,,,,,,13.95,27.06,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier,,0.63101,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier,,0.13471,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier,,1.11,,,,,,,0.78000,1.51,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier,,132.23,,,,,,,128.32,279.56,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier,,18.30,,,,,,,17.75,38.68,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,outpatient,,,12.60000,11.97000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,2.24,,,,,,,1.58,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,outpatient,1,mL,3.27000,3.11000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier,,2.01,,,,,,,1.42,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Premier,,1.60,,,,,,,1.13,2.19,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier,,0.79200,,,,,,,0.15000,0.81340,fee schedule,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Premier,,119.92,,,,,,,69.38,134.59,fee schedule,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Premier,,119.92,,,,,,,69.38,134.59,fee schedule,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,873.75000,830.06000,The Alliance,Premier,,413.28,,,,,,,401.05,873.75,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,800.63000,760.60000,The Alliance,Premier,,378.70,,,,,,,367.49,800.63,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,54.36000,51.64000,The Alliance,Premier,,25.71,,,,,,,24.95,54.36,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier,,69.81,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,17.03,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,54.87,,,,,,,53.24,116.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Premier,TC,1378.30,,,,,,,797.92,1885.68,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Premier,,381.80,,,,,,,370.50,807.19,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier,,399.09,,,,,,,387.28,843.75,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Premier,,742.32,,,,,,,720.35,1569.38,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,20.96,,,,,,,19.58,63.05,fee schedule,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,,181.50,,,,,,,56.40,248.32,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,0.42900,,,,,,,0.40920,2.21,fee schedule,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,1645.00,,,,,,,372.50,1820.00,per diem,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Premier,TC,548.00,,,,,,,384.16,2523.94,fee schedule,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Premier,,2106.44,,,,,,,581.10,2881.87,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Premier,TC,4081.21,,,,,,,406.00,4081.21,fee schedule,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier,TC,6594.41,,,,,,,4467.66,9021.97,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1220.26,fee schedule,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,372.50,792.37,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,outpatient,,,7033.00000,6681.35000,The Alliance,Premier,TC,4986.40,,,,,,,3383.38,7180.14,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,TC,7206.00,,,,,,,78.00,8022.25,per diem,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Premier,TC,3347.90,,,,,,,2288.22,7180.14,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Premier,,1645.00,,,,,,,657.58,2881.87,per diem,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier,TC,2630.66,,,,,,,257.95,2630.66,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,outpatient,1,mL,1762.48000,1674.36000,The Alliance,Premier,,439.63,,,,,,,266.44,1709.61,fee schedule,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Premier,,2.71,,,,,,,0.66500,2.71,fee schedule,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,outpatient,1,mL,185.02000,175.77000,The Alliance,Premier,,37.80,,,,,,,32.41,179.47,fee schedule,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,102.10,,,,,,,72.00,260.45,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,outpatient,1,mL,7691.77000,7307.18000,The Alliance,Premier,,5453.46,,,,,,,3845.89,7461.02,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,outpatient,,,94.40000,89.68000,The Alliance,Premier,90,3038.81,,,,,,,47.20,3038.81,fee schedule,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,outpatient,,,2215.00000,2104.25000,The Alliance,Premier,,1570.43,,,,,,,1107.50,2148.55,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,117.69,,,,,,,43.81,161.02,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,outpatient,,,882.84000,838.70000,The Alliance,Premier,,649.89,,,,,,,393.87,856.35,fee schedule,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,outpatient,1,EA,998.46000,948.54000,The Alliance,Premier,,649.89,,,,,,,393.87,968.51,fee schedule,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,outpatient,,,430.57000,409.04000,The Alliance,Premier,,305.27,,,,,,,215.28,417.65,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,2328.75000,2212.31000,The Alliance,Premier,,388.03,,,,,,,376.51,2258.89,fee schedule,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,41.00,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,TC,2446.05,,,,,,,1591.55,3346.50,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,,140.38,,,,,,,99.00,192.06,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,,186.00,,,,,,,18.50,264.00,per diem,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,outpatient,,,1236.00000,1174.20000,The Alliance,Premier,,876.32,,,,,,,314.95,1198.92,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,outpatient,,,561.00000,532.95000,The Alliance,Premier,TC,397.75,,,,,,,168.00,544.17,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,outpatient,,,40.55000,38.52000,The Alliance,Premier,,28.75,,,,,,,20.27,39.33,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier,,186.00,,,,,,,70.50,264.00,per diem,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier,,174.79,,,,,,,163.27,323.74,fee schedule,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,outpatient,,,744.63000,707.40000,The Alliance,Premier,,399.09,,,,,,,372.31,722.29,fee schedule,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2714.06,per diem,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,outpatient,,,3.39000,3.22000,The Alliance,Premier,,2.40,,,,,,,1.70,3.29,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,outpatient,,,24.82000,23.58000,The Alliance,Premier,,12.49,,,,,,,7.57,24.08,fee schedule,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,outpatient,,,95.07000,90.32000,The Alliance,Premier,,38.16,,,,,,,35.64,92.22,fee schedule,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Premier,TC,155.84,,,,,,,109.90,213.21,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,,49.99,,,,,,,47.06,111.55,fee schedule,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,outpatient,,,1.25000,1.19000,The Alliance,Premier,,0.88625,,,,,,,0.62500,1.21,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,36.30,145.50,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,Premier,,240.35,,,,,,,56.40,328.83,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Premier,,3061.46,,,,,,,1031.39,4188.46,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,outpatient,,,5.24000,4.98000,The Alliance,Premier,,2.82,,,,,,,2.62,5.08,fee schedule,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,75.00,155.84,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Premier,,4536.18,,,,,,,1914.61,6206.06,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,outpatient,,,115.43000,109.66000,The Alliance,Premier,,81.84,,,,,,,57.47,111.97,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,30.49,,,,,,,5.83,41.71,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Premier,TC,2423.36,,,,,,,1578.65,3315.46,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,41.94,,,,,,,39.18,190.12,fee schedule,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Premier,,19.07,,,,,,,17.81,46.17,fee schedule,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,outpatient,,,254.81000,242.07000,The Alliance,Premier,,109.27,,,,,,,102.07,247.17,fee schedule,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier,,54.64,,,,,,,45.34,87.95,fee schedule,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Premier,,24.55,,,,,,,22.93,57.81,fee schedule,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,outpatient,,,28.13000,26.72000,The Alliance,Premier,,14.36,,,,,,,13.42,27.29,fee schedule,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier,,10.46,,,,,,,9.78,40.35,fee schedule,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier,,3752.03,,,,,,,1388.02,5133.24,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Premier,,4719.10,,,,,,,2074.81,6456.32,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier,,13.08,,,,,,,12.21,37.76,fee schedule,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,outpatient,,,259.13000,246.17000,The Alliance,Premier,,84.79,,,,,,,79.20,251.36,fee schedule,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,outpatient,,,55.73000,52.94000,The Alliance,Premier,,28.73,,,,,,,26.83,54.06,fee schedule,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,outpatient,,,83.07000,78.92000,The Alliance,Premier,,20.84,,,,,,,19.47,80.58,fee schedule,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,outpatient,,,42.67000,40.54000,The Alliance,Premier,,20.73,,,,,,,19.37,41.39,fee schedule,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Premier,,48.17,,,,,,,38.53,74.76,fee schedule,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,outpatient,,,216.94000,206.09000,The Alliance,Premier,,96.28,,,,,,,89.94,210.43,fee schedule,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,outpatient,,,40.28000,38.27000,The Alliance,Premier,,28.56,,,,,,,7.86,39.07,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier,,49.04,,,,,,,45.80,172.66,fee schedule,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,outpatient,,,61.47000,58.40000,The Alliance,Premier,,18.62,,,,,,,17.39,59.63,fee schedule,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,outpatient,,,30.67000,29.14000,The Alliance,Premier,,9.30,,,,,,,8.69,29.75,fee schedule,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier,,20208.37,,,,,,,549.28,20208.37,fee schedule,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,outpatient,,,85.33000,81.06000,The Alliance,Premier,,41.52,,,,,,,38.77,82.77,fee schedule,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Premier,,14.38,,,,,,,13.95,30.40,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,outpatient,,,2245.00000,2132.75000,The Alliance,Premier,,1591.70,,,,,,,1122.50,2177.65,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,outpatient,,,4544.00000,4316.80000,The Alliance,Premier,,2149.31,,,,,,,2085.70,4544.00,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,outpatient,,,97.73000,92.84000,The Alliance,Premier,,23.59,,,,,,,22.03,94.80,fee schedule,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,,29.58,,,,,,,27.63,151.32,fee schedule,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,12.43,,,,,,,11.62,45.59,fee schedule,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier,,8.30,,,,,,,7.75,17.46,fee schedule,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier,,8.75,,,,,,,8.17,40.35,fee schedule,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,outpatient,,,38.53000,36.60000,The Alliance,Premier,,13.42,,,,,,,12.54,37.37,fee schedule,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,outpatient,,,50.53000,48.00000,The Alliance,Premier,,14.02,,,,,,,13.09,49.01,fee schedule,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,outpatient,,,23.60000,22.42000,The Alliance,Premier,,6.20,,,,,,,5.79,22.89,fee schedule,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier,,186.00,,,,,,,53.50,264.00,per diem,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier,,15.60,,,,,,,11.00,21.34,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Premier,,4.86,,,,,,,4.54,18.89,fee schedule,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,3853.00000,3660.35000,The Alliance,Premier,,2731.78,,,,,,,1040.32,3737.41,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,outpatient,,,75805.34000,72015.07000,The Alliance,Premier,,92310.85,,,,,,,37902.67,94648.39,fee schedule,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Premier,TC,1527.89,,,,,,,1006.74,2960.49,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Premier,,6.54,,,,,,,6.12,18.89,fee schedule,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,7.66,156.25,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier,,109.19,,,,,,,37.27,149.38,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier,,9.68,,,,,,,9.04,37.76,fee schedule,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,outpatient,,,42.76000,40.62000,The Alliance,Premier,,32.94,,,,,,,21.38,41.48,fee schedule,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,outpatient,,,357.20000,339.34000,The Alliance,Premier,,253.25,,,,,,,178.60,346.48,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,9.88,184.30,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier,TC,1865.95,,,,,,,181.22,1865.95,fee schedule,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Premier,TC,14479.11,,,,,,,1390.65,14479.11,fee schedule,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,outpatient,,,4368.00000,4149.60000,The Alliance,Premier,TC,3096.91,,,,,,,2181.80,4236.96,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,148.57,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Premier,,11414.90,,,,,,,966.05,15617.00,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Premier,,8.88,,,,,,,6.26,12.14,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier,TC,548.00,,,,,,,348.00,675.12,fee schedule,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,548.00,,,,,,,101.00,548.00,fee schedule,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Premier,,872.78,,,,,,,615.50,1194.07,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,,374.35,,,,,,,264.00,689.02,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,TC,132.58,,,,,,,93.50,181.39,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier,TC,82746.35,,,,,,,7955.77,82746.35,fee schedule,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Premier,TC,943.68,,,,,,,644.24,2960.49,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Premier,,3.02,,,,,,,2.83,46.17,fee schedule,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Premier,,872.78,,,,,,,615.50,1194.07,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier,,27.60,,,,,,,19.46,37.76,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier,TC,41.83,,,,,,,29.50,57.23,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,496.88000,472.04000,The Alliance,Premier,,874.50,,,,,,,143.61,874.50,fee schedule,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Premier,TC,2455.98,,,,,,,1611.84,3360.08,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier,TC,4298.79,,,,,,,394.00,4298.79,fee schedule,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,15.20000,14.44000,The Alliance,Premier,,10.78,,,,,,,7.60,14.74,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,740.63000,703.60000,The Alliance,Premier,,874.50,,,,,,,143.61,874.50,fee schedule,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,395.31000,375.54000,The Alliance,Premier,,874.50,,,,,,,143.61,874.50,fee schedule,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier,TC,119.11,,,,,,,84.00,162.96,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,238.63000,226.70000,The Alliance,Premier,,874.50,,,,,,,119.31,874.50,fee schedule,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier,TC,2419.76,,,,,,,234.00,2419.76,fee schedule,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,307.27000,291.91000,The Alliance,Premier,,874.50,,,,,,,143.61,874.50,fee schedule,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier,TC,1608.72,,,,,,,1134.50,2200.93,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Premier,,12.37,,,,,,,11.56,32.55,fee schedule,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,50.00,97.00,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,42.52000,40.39000,The Alliance,Premier,,12.37,,,,,,,11.56,41.24,fee schedule,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Premier,,162.59,,,,,,,157.76,409.22,fee schedule,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,703.13000,667.97000,The Alliance,Premier,,162.59,,,,,,,157.76,682.04,fee schedule,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,TC,4496.60,,,,,,,52.50,4496.60,fee schedule,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier,,162.59,,,,,,,157.76,818.44,fee schedule,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,52,442.00,,,,,,,225.00,492.80,per diem,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,outpatient,,,18.48000,17.56000,The Alliance,Premier,,8.74,,,,,,,8.48,17.93,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier,,874.50,,,,,,,134.76,874.50,fee schedule,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,358.80000,340.86000,The Alliance,Premier,,162.59,,,,,,,157.76,348.04,fee schedule,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,48.19,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,TC,114.86,,,,,,,81.00,2210.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,outpatient,,,60.90000,57.85000,The Alliance,Premier,TC,43.18,,,,,,,30.45,59.07,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,TC,431.78,,,,,,,304.50,590.73,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier,,2.35,,,,,,,1.66,3.22,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,outpatient,1,EA,3695.71000,3510.92000,The Alliance,Premier,,20.00,,,,,,,12.12,3584.84,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,outpatient,1,EA,3270.72000,3107.18000,The Alliance,Premier,,20.00,,,,,,,12.12,3172.60,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,outpatient,1,EA,3314.32000,3148.61000,The Alliance,Premier,,20.00,,,,,,,12.12,3214.89,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,outpatient,1,EA,3634.14000,3452.43000,The Alliance,Premier,,20.00,,,,,,,12.12,3525.12,fee schedule,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,269.85000,256.36000,The Alliance,Premier,,127.64,,,,,,,123.86,269.85,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Premier,,187.13,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30261.00000,28747.95000,The Alliance,Premier,,14313.45,,,,,,,13889.80,30261.00,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier,,59.17,,,,,,,55.26,283.24,fee schedule,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,58.39000,55.47000,The Alliance,Premier,,41.40,,,,,,,29.20,56.64,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Premier,,37.12,,,,,,,26.18,50.79,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,32.61,,,,,,,23.00,44.62,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,24.11,,,,,,,17.00,32.98,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,outpatient,,,209.81000,199.32000,The Alliance,Premier,,155.81,,,,,,,104.91,203.52,fee schedule,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,13.07000,12.42000,The Alliance,Premier,,2.82,,,,,,,2.63,12.68,fee schedule,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,outpatient,,,172.04000,163.44000,The Alliance,Premier,,180.06,,,,,,,86.02,180.06,fee schedule,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,19.85,,,,,,,14.00,27.16,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier,NU,16.05,,,,,,,8.00,16.05,fee schedule,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Premier,,40.68,,,,,,,37.06,71.91,fee schedule,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Premier,NU,16.05,,,,,,,8.50,16.49,fee schedule,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier,,223.49,,,,,,,216.88,458.32,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,outpatient,,,65.73000,62.44000,The Alliance,Premier,,46.60,,,,,,,32.87,63.76,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Premier,,22.78,,,,,,,16.07,31.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,15.64000,14.86000,The Alliance,Premier,,11.09,,,,,,,7.82,15.17,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,144.31000,137.09000,The Alliance,Premier,,102.32,,,,,,,72.16,139.98,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,82.93000,78.78000,The Alliance,Premier,,58.80,,,,,,,41.47,80.44,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,outpatient,,,1245.79000,1183.50000,The Alliance,Premier,,718.58,,,,,,,622.89,1208.42,fee schedule,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,167.80000,159.41000,The Alliance,Premier,,118.97,,,,,,,83.90,162.77,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,4.73,,,,,,,3.33,6.47,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,95.46000,90.69000,The Alliance,Premier,,232.52,,,,,,,47.73,232.52,fee schedule,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,outpatient,,,31.33000,29.76000,The Alliance,Premier,,90.87,,,,,,,15.66,90.87,fee schedule,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Premier,,630.65,,,,,,,153.38,630.65,fee schedule,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Premier,,22.78,,,,,,,16.07,31.17,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,257.76000,244.87000,The Alliance,Premier,,87.92,,,,,,,81.64,250.03,fee schedule,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,50.06000,47.56000,The Alliance,Premier,NU,75.83,,,,,,,25.03,75.83,fee schedule,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,25.77000,24.48000,The Alliance,Premier,,18.27,,,,,,,12.88,25.00,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier,,82.81,,,,,,,45.34,87.95,fee schedule,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,64.53000,61.30000,The Alliance,Premier,,45.75,,,,,,,32.27,62.59,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier,,11.34,,,,,,,8.00,17.60,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,38.27000,36.36000,The Alliance,Premier,,102.20,,,,,,,19.14,102.20,fee schedule,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,127.79000,121.40000,The Alliance,Premier,,90.60,,,,,,,63.90,123.96,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,31.56000,29.98000,The Alliance,Premier,,14.93,,,,,,,14.49,30.61,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,outpatient,,,94.13000,89.42000,The Alliance,Premier,,66.74,,,,,,,47.06,91.31,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,196.16000,186.35000,The Alliance,Premier,NU,58.21,,,,,,,56.49,190.28,fee schedule,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,43.75,,,,,,,20.00,43.75,fee schedule,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,outpatient,,,78.37000,74.45000,The Alliance,Premier,,55.56,,,,,,,39.19,76.02,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,64.42000,61.20000,The Alliance,Premier,,40.68,,,,,,,32.21,62.49,fee schedule,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,outpatient,,,13.82000,13.13000,The Alliance,Premier,,2.24,,,,,,,2.09,13.41,fee schedule,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,,116.28,,,,,,,82.00,159.08,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,NU,16.05,,,,,,,14.99,97.00,fee schedule,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,46.79,,,,,,,33.00,64.02,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,38.21,,,,,,,16.00,38.21,fee schedule,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,53.73000,51.04000,The Alliance,Premier,,38.09,,,,,,,26.86,52.12,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier,,38.29,,,,,,,27.00,52.38,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,2.82,,,,,,,2.63,6.47,fee schedule,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,33.92000,32.22000,The Alliance,Premier,,24.05,,,,,,,16.96,32.90,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Premier,,70.15,,,,,,,48.44,93.97,fee schedule,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.94000,188.99000,The Alliance,Premier,,94.10,,,,,,,91.31,192.97,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,11.21000,10.65000,The Alliance,Premier,,10.66,,,,,,,5.61,10.87,fee schedule,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,76.89000,73.05000,The Alliance,Premier,,43.75,,,,,,,38.45,74.58,fee schedule,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,1.85,,,,,,,1.73,6.47,fee schedule,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,45.56000,43.28000,The Alliance,Premier,,121.81,,,,,,,22.78,121.81,fee schedule,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,197.06000,187.21000,The Alliance,Premier,,82.83,,,,,,,77.37,191.15,fee schedule,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,247.54000,235.16000,The Alliance,Premier,,175.51,,,,,,,123.77,240.11,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,17.02,,,,,,,12.00,26.40,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Premier,,61.43,,,,,,,48.44,93.97,fee schedule,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,outpatient,,,1579.84000,1500.85000,The Alliance,Premier,,954.40,,,,,,,789.92,1532.44,fee schedule,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,,59.56,,,,,,,42.00,81.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Premier,,221.33,,,,,,,206.75,590.48,fee schedule,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,outpatient,,,179.66000,170.68000,The Alliance,Premier,,1.83,,,,,,,1.71,174.27,fee schedule,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier,,56.72,,,,,,,40.00,77.60,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier,,7.80,,,,,,,5.50,10.67,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier,,92.45,,,,,,,28.00,92.45,fee schedule,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,29.10,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,92.48000,87.86000,The Alliance,Premier,,65.57,,,,,,,46.24,89.71,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier,,71.98,,,,,,,50.76,98.47,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,outpatient,,,223.09000,211.94000,The Alliance,Premier,,130.65,,,,,,,111.55,216.40,fee schedule,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,218.81000,207.87000,The Alliance,Premier,,103.50,,,,,,,100.43,212.25,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,outpatient,,,8.67000,8.24000,The Alliance,Premier,,2.91,,,,,,,2.72,8.41,fee schedule,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,86.50,,,,,,,61.00,118.34,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier,,23.40,,,,,,,16.50,36.30,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,outpatient,,,24.93000,23.68000,The Alliance,Premier,,25.71,,,,,,,12.46,25.71,fee schedule,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,44.06000,41.86000,The Alliance,Premier,,31.24,,,,,,,22.03,42.74,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,185.09000,175.84000,The Alliance,Premier,,143.36,,,,,,,92.55,179.54,fee schedule,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier,,236.63,,,,,,,166.88,323.74,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier,,12.76,,,,,,,9.00,17.46,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,outpatient,,,241.12000,229.06000,The Alliance,Premier,,219.70,,,,,,,120.56,233.89,fee schedule,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier,,29.07,,,,,,,20.50,39.77,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,outpatient,,,19.20000,18.24000,The Alliance,Premier,,19.71,,,,,,,9.60,19.71,fee schedule,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,300.00000,285.00000,The Alliance,Premier,,449.21,,,,,,,150.00,449.21,fee schedule,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,outpatient,,,18.58000,17.65000,The Alliance,Premier,,15.61,,,,,,,9.29,18.02,fee schedule,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier,,14.18,,,,,,,10.00,19.40,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,outpatient,,,208.28000,197.87000,The Alliance,Premier,,109.58,,,,,,,101.76,202.03,fee schedule,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,67.80000,64.41000,The Alliance,Premier,,48.07,,,,,,,33.90,65.77,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,206.25000,195.94000,The Alliance,Premier,,146.23,,,,,,,103.12,200.06,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,outpatient,,,53.07000,50.42000,The Alliance,Premier,,54.64,,,,,,,26.54,54.64,fee schedule,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,79.96000,75.96000,The Alliance,Premier,,56.69,,,,,,,39.98,77.56,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,106.89000,101.55000,The Alliance,Premier,,40.68,,,,,,,39.47,103.68,fee schedule,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,53.14000,50.48000,The Alliance,Premier,,37.68,,,,,,,26.57,51.55,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,196.04000,186.24000,The Alliance,Premier,,138.99,,,,,,,98.02,190.16,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,2.82,,,,,,,2.63,6.47,fee schedule,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier,TC,58.99,,,,,,,41.60,484.28,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,62.92000,59.77000,The Alliance,Premier,,29.76,,,,,,,28.88,61.03,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,14.40000,13.68000,The Alliance,Premier,,10.21,,,,,,,7.20,13.97,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,14.65000,13.92000,The Alliance,Premier,,6.93,,,,,,,6.72,14.21,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,102.10,,,,,,,72.00,139.68,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier,,132.23,,,,,,,128.32,279.56,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3590.14000,3410.63000,The Alliance,Premier,,1698.14,,,,,,,1647.87,3590.14,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20057.00000,19054.15000,The Alliance,Premier,,9486.96,,,,,,,9206.16,20057.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13068.64000,12415.21000,The Alliance,Premier,,6181.47,,,,,,,5998.51,12676.58,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier,,239.46,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier,,239.46,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,87.21,,,,,,,51.09,119.31,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier,,0.55302,,,,,,,0.39000,0.75660,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier,,2959.36,,,,,,,2871.77,6256.58,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier,,34.93,,,,,,,33.89,73.84,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier,,69.81,,,,,,,67.75,147.60,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier,,3377.93,,,,,,,3277.95,6927.26,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9004.50000,8554.27000,The Alliance,Premier,,4259.13,,,,,,,4133.07,8734.36,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,outpatient,1,mL,971.25000,922.69000,The Alliance,Premier,,872.16,,,,,,,485.62,1101.64,fee schedule,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier,,470.04,,,,,,,456.13,993.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,43.71,,,,,,,42.41,92.40,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier,,186.00,,,,,,,39.50,264.00,per diem,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,42.20000,40.09000,The Alliance,Premier,,19.96,,,,,,,19.37,42.20,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier,,238.55,,,,,,,231.49,504.34,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier,,404.84,,,,,,,212.82,1232.72,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier,,186.00,,,,,,,37.50,264.00,per diem,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier,,109.89,,,,,,,77.50,150.35,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier,,85.08,,,,,,,60.00,116.40,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier,,48.92,,,,,,,34.50,134.64,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,,116.28,,,,,,,82.00,159.08,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Premier,,3963.00,,,,,,,546.15,4686.00,case rate,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,9622.40,per diem,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier,,10.63,,,,,,,7.50,25.57,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Premier,TC,1866.00,,,,,,,1487.04,3544.38,per diem,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier,,13.47,,,,,,,9.50,18.43,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,22.69,,,,,,,16.00,31.04,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Premier,TC,2611.25,,,,,,,1841.50,3572.51,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,outpatient,1,EA,9729.00000,9242.55000,The Alliance,Premier,,6897.86,,,,,,,365.89,9437.13,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier,,1.39,,,,,,,0.22500,1.39,fee schedule,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier,,3671.66,,,,,,,3562.99,7762.50,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier,,2937.33,,,,,,,2850.39,6210.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier,,4487.59,,,,,,,4354.76,9487.50,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier,,2203.00,,,,,,,2137.79,4517.77,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,outpatient,,,182.80000,173.66000,The Alliance,Premier,90,848.80,,,,,,,16.72,848.80,fee schedule,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier,90,6026.72,,,,,,,119.20,6026.72,fee schedule,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,1714.64,,,,,,,56.40,1714.64,fee schedule,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,,46.09,,,,,,,32.50,63.05,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,outpatient,1,EA,26.02000,24.72000,The Alliance,Premier,,18.45,,,,,,,13.01,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,outpatient,1,EA,6233.30000,5921.63000,The Alliance,Premier,,256.44,,,,,,,155.42,6046.30,fee schedule,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier,,3671.66,,,,,,,3562.99,7762.50,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7.48000,7.11000,The Alliance,Premier,,3.54,,,,,,,3.43,7.48,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier,,4487.59,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Premier,GP,186.00,,,,,,,30.60,264.00,per diem,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Premier,GP,186.00,,,,,,,20.20,264.00,per diem,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,outpatient,1,mL,18.80000,17.86000,The Alliance,Premier,,25.89,,,,,,,9.40,25.89,fee schedule,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,outpatient,1,mL,23.51000,22.33000,The Alliance,Premier,,25.89,,,,,,,11.76,25.89,fee schedule,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,outpatient,1,mL,7.29000,6.93000,The Alliance,Premier,,25.89,,,,,,,3.65,25.89,fee schedule,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Premier,,47.60,,,,,,,28.85,438.23,fee schedule,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier,,3839.94,,,,,,,1256.40,5253.52,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,outpatient,,,8064.00000,7660.80000,The Alliance,Premier,,5717.38,,,,,,,1256.40,7822.08,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2320.24,per diem,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.68000,47.20000,The Alliance,Premier,,23.50,,,,,,,22.80,49.68,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Premier,,11414.90,,,,,,,966.05,15617.00,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier,,6798.73,,,,,,,126.07,6798.73,fee schedule,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier,,3179.16,,,,,,,148.57,4349.48,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier,,6098.11,,,,,,,503.83,8342.97,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Premier,,51.45,,,,,,,31.18,259.17,fee schedule,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier,,869.14,,,,,,,843.41,1837.50,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,1046.52,2280.00,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier,,134.81,,,,,,,130.81,285.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Premier,TC,644.48,,,,,,,359.37,881.73,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier,,268.19,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier,,268.19,,,,,,,260.25,567.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,outpatient,1,EA,11.13000,10.57000,The Alliance,Premier,,7.89,,,,,,,5.57,10.80,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier,,37.84,,,,,,,36.72,80.00,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,outpatient,,,4020.00000,3819.00000,The Alliance,Premier,TC,2850.18,,,,,,,2010.00,3899.40,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Premier,TC,14413.40,,,,,,,1334.13,14413.40,fee schedule,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier,,118.40,,,,,,,91.85,5271.00,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.23000,103.77000,The Alliance,Premier,,77.44,,,,,,,51.64,105.95,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.92000,100.62000,The Alliance,Premier,,75.10,,,,,,,51.64,102.74,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Premier,,54.05,,,,,,,38.12,73.95,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Premier,,52.48,,,,,,,37.01,71.80,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.22000,103.76000,The Alliance,Premier,,77.44,,,,,,,51.64,105.94,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Premier,,52.48,,,,,,,37.01,71.80,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier,TC,3225.95,,,,,,,2150.56,7180.14,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,73.93000,70.23000,The Alliance,Premier,,52.42,,,,,,,36.97,71.71,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier,,60.27,,,,,,,42.50,82.45,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier,,402.71,,,,,,,9.09,550.96,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,outpatient,,,19.50000,18.52000,The Alliance,Premier,,3.02,,,,,,,2.83,18.91,fee schedule,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier,,14.18,,,,,,,10.00,19.40,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Premier,TC,1971.02,,,,,,,1390.00,2696.60,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,outpatient,,,2.51000,2.38000,The Alliance,Premier,,0.61050,,,,,,,0.37000,2.43,fee schedule,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,548.00,,,,,,,56.50,548.00,fee schedule,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier,TC,134.14,,,,,,,94.60,183.52,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Premier,TC,937.00,,,,,,,278.50,5271.00,case rate,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,4.25000,4.04000,The Alliance,Premier,,2.43,,,,,,,2.12,4.12,fee schedule,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,outpatient,,,1846.00000,1753.70000,The Alliance,Premier,,1308.81,,,,,,,923.00,1790.62,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier,,177.25,,,,,,,125.00,242.50,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,25.52,,,,,,,18.00,264.00,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,,74.44,,,,,,,52.50,264.00,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1067.00000,1013.65000,The Alliance,Premier,,224.70,,,,,,,211.37,1034.99,fee schedule,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,outpatient,,,1300.00000,1235.00000,The Alliance,Premier,,7472.50,,,,,,,50.73,7472.50,fee schedule,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,outpatient,,,751.00000,713.45000,The Alliance,Premier,TC,532.46,,,,,,,375.50,728.47,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,,108.48,,,,,,,76.50,148.41,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,outpatient,,,38.20000,36.29000,The Alliance,Premier,,27.08,,,,,,,19.10,37.05,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,outpatient,,,157.20000,149.34000,The Alliance,Premier,TC,111.45,,,,,,,78.60,152.48,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,TC,548.00,,,,,,,30.50,548.00,fee schedule,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Premier,,471.79,,,,,,,440.69,1095.13,fee schedule,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier,,1866.00,,,,,,,1272.04,4844.18,per diem,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier,TC,548.00,,,,,,,384.16,928.29,fee schedule,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,114.86,,,,,,,81.00,325.26,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,87.21,,,,,,,61.50,119.31,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,outpatient,,,84.70000,80.47000,The Alliance,Premier,,60.05,,,,,,,42.35,82.16,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier,TC,279.35,,,,,,,197.00,382.18,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier,,20181.52,,,,,,,549.28,20181.52,fee schedule,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier,52,442.00,,,,,,,257.00,874.94,per diem,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Premier,TC,3347.90,,,,,,,2288.22,7180.14,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier,,367.97,,,,,,,48.58,503.43,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier,TC,279.35,,,,,,,197.00,382.18,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,41.12,,,,,,,5.87,113.69,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier,,375.06,,,,,,,173.99,513.13,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier,,292.82,,,,,,,33.63,400.61,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,,258.79,,,,,,,182.50,743.46,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,96.42,,,,,,,68.00,187.21,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier,,219.79,,,,,,,155.00,1239.81,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,,548.00,,,,,,,154.77,548.00,fee schedule,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier,,95.01,,,,,,,67.00,129.98,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier,TC,1035.23,,,,,,,101.50,1035.23,fee schedule,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier,TC,548.00,,,,,,,101.00,548.00,fee schedule,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1897.32,fee schedule,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Premier,TC,5169.06,,,,,,,513.50,5169.06,fee schedule,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier,TC,6594.41,,,,,,,4467.66,9021.97,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1076.70,fee schedule,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Premier,,42.85,,,,,,,41.59,90.60,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier,,239.46,,,,,,,232.37,506.25,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,23.65,,,,,,,22.95,50.00,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Premier,TC,2467.32,,,,,,,1609.99,3375.60,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier,,310.41,,,,,,,301.22,656.25,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,23870.00000,22676.50000,The Alliance,Premier,,11290.51,,,,,,,10956.33,23870.00,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier,,3839.94,,,,,,,2708.00,5253.52,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,outpatient,,,326.80000,310.46000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier,90,1290.24,,,,,,,27.54,1290.24,fee schedule,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Premier,TC,548.00,,,,,,,309.50,600.43,fee schedule,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,outpatient,,,244.40000,232.18000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier,90,356.54,,,,,,,6.92,356.54,fee schedule,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,outpatient,,,126.70000,120.36000,The Alliance,Premier,TC,89.83,,,,,,,63.35,122.90,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Premier,,47.60,,,,,,,28.85,438.23,fee schedule,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,186.00,,,,,,,93.50,264.00,per diem,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1534.00000,1457.30000,The Alliance,Premier,,1866.00,,,,,,,767.00,2161.00,per diem,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,outpatient,,,1077.00000,1023.15000,The Alliance,Premier,,763.59,,,,,,,538.50,1044.69,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier,,734.52,,,,,,,569.80,5271.00,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,HP,163.78,,,,,,,115.50,224.07,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,Premier,,712.54,,,,,,,502.50,974.85,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier,,548.00,,,,,,,119.50,734.90,fee schedule,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,,81.53,,,,,,,57.50,419.70,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,HP,129.04,,,,,,,91.00,176.54,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier,HP,98.55,,,,,,,69.50,134.83,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,HP,101.39,,,,,,,71.50,138.71,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier,HP,129.04,,,,,,,91.00,176.54,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,outpatient,,,968.00000,919.60000,The Alliance,Premier,,548.00,,,,,,,384.16,938.96,fee schedule,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,Premier,,548.00,,,,,,,384.16,823.53,fee schedule,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Premier,,319.76,,,,,,,225.50,1692.33,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier,,223.34,,,,,,,157.50,305.55,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,HP,45.38,,,,,,,32.00,62.08,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,HP,36.87,,,,,,,26.00,50.44,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,HP,96.42,,,,,,,68.00,131.92,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,outpatient,,,15.17000,14.41000,The Alliance,Premier,,10.76,,,,,,,7.58,25.57,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,HP,42.54,,,,,,,30.00,58.20,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,HP,36.87,,,,,,,26.00,50.44,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier,,0.84371,,,,,,,0.59500,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,outpatient,1,EA,6.69000,6.36000,The Alliance,Premier,,4.74,,,,,,,3.35,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier,,1.48,,,,,,,1.04,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Premier,,571.21,,,,,,,346.19,68191.00,fee schedule,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,251.25000,238.69000,The Alliance,Premier,,118.84,,,,,,,115.32,251.25,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier,,18.30,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier,,7.09,,,,,,,5.00,9.70,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,132.58,,,,,,,102.85,5271.00,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Premier,,151.28,,,,,,,146.81,319.84,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier,,206.61,,,,,,,200.49,436.80,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,outpatient,1,mL,34526.48000,32800.15000,The Alliance,Premier,,232.65,,,,,,,141.00,33490.69,fee schedule,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier,,6.59,,,,,,,4.64,9.01,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Premier,,51.45,,,,,,,31.18,259.17,fee schedule,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Premier,,422.15,,,,,,,409.66,892.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier,,112.81,,,,,,,109.47,238.50,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,TC,2788.50,,,,,,,1966.50,3815.01,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9780.75000,9291.71000,The Alliance,Premier,,4626.29,,,,,,,4489.36,9780.75,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier,,238.55,,,,,,,231.49,504.34,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,outpatient,1,EA,7882.93000,7488.79000,The Alliance,Premier,,71.41,,,,,,,43.25,7646.44,fee schedule,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Premier,,941.25,,,,,,,663.79,1287.75,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier,,157.48,,,,,,,152.81,332.93,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier,,157.48,,,,,,,152.81,332.93,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier,,205.35,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier,,157.48,,,,,,,152.81,332.93,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,TC,37.58,,,,,,,26.50,51.41,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,,2438.63,,,,,,,51.31,2438.63,fee schedule,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,outpatient,1,EA,29396.04000,27926.24000,The Alliance,Premier,,592.50,,,,,,,359.09,28514.16,fee schedule,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,outpatient,1,mL,1417.48000,1346.61000,The Alliance,Premier,,39.81,,,,,,,24.13,1374.96,fee schedule,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier,,1426.10,,,,,,,1383.88,3015.00,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,2161.00,per diem,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier,,567.60,,,,,,,550.80,1200.00,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,TC,461.64,,,,,,,42.95,484.28,fee schedule,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier,,81.36,,,,,,,78.95,172.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier,,4487.59,,,,,,,4354.76,9487.50,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,186.00,,,,,,,76.00,264.00,per diem,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,9622.40,per diem,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,outpatient,,,456.00000,433.20000,The Alliance,Premier,,323.30,,,,,,,250.80,5271.00,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,outpatient,1,EA,40006.82000,38006.48000,The Alliance,Premier,,4451.78,,,,,,,2698.05,38806.62,fee schedule,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,outpatient,1,mL,9841.58000,9349.50000,The Alliance,Premier,,121.36,,,,,,,73.55,9546.33,fee schedule,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,outpatient,1,GM,2.34000,2.23000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,outpatient,1,mL,271.28000,257.72000,The Alliance,Premier,,192.34,,,,,,,135.64,263.14,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.38000,179.91000,The Alliance,Premier,,89.58,,,,,,,86.93,189.38,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier,,2.42,,,,,,,1.71,3.31,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14018.44,per diem,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.74250,,,,,,,0.63085,1.29,fee schedule,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.74250,,,,,,,0.63085,1.29,fee schedule,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,0.42900,,,,,,,0.40920,2.21,fee schedule,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier,,2.87,,,,,,,2.79,7.08,fee schedule,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,,2.43,,,,,,,2.31,12.33,fee schedule,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier,,0.42900,,,,,,,0.40920,0.97000,fee schedule,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier,,24.25,,,,,,,22.80,47.53,fee schedule,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,0.42900,,,,,,,0.40920,2.21,fee schedule,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier,,0.42900,,,,,,,0.40920,0.97000,fee schedule,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,0.42900,,,,,,,0.40920,2.21,fee schedule,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,,2.43,,,,,,,2.31,12.33,fee schedule,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,2.87,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier,,2.87,,,,,,,2.79,7.08,fee schedule,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,0.42900,,,,,,,0.40920,2.21,fee schedule,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier,,2203.00,,,,,,,2137.79,4657.50,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier,,3.65,,,,,,,2.58,5.00,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,907.50000,862.12000,The Alliance,Premier,,429.25,,,,,,,416.54,907.50,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier,,0.48921,,,,,,,0.34500,0.66930,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier,,281.33,,,,,,,23.25,384.90,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2797.00000,2657.15000,The Alliance,Premier,90,13462.44,,,,,,,266.02,13462.44,fee schedule,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,outpatient,,,177.50000,168.62000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier,90,1137.41,,,,,,,70.95,1137.41,fee schedule,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,outpatient,,,147.90000,140.50000,The Alliance,Premier,90,1137.41,,,,,,,73.95,1137.41,fee schedule,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Premier,TC,1645.00,,,,,,,1070.00,2075.80,per diem,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,90,80.12,,,,,,,56.50,788.42,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Premier,90,373.51,,,,,,,4.57,373.51,fee schedule,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier,90,407.44,,,,,,,8.13,407.44,fee schedule,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Premier,TC,3942.79,,,,,,,417.50,3942.79,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,outpatient,1,mL,33.71000,32.03000,The Alliance,Premier,,83.21,,,,,,,16.86,83.21,fee schedule,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,281.28000,267.22000,The Alliance,Premier,,166.19,,,,,,,140.64,272.84,fee schedule,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,137.46000,130.59000,The Alliance,Premier,,166.19,,,,,,,68.73,192.52,fee schedule,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier,,102.10,,,,,,,72.00,260.45,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier,,107.93,,,,,,,101.38,261.44,fee schedule,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Premier,90,254.68,,,,,,,5.17,254.68,fee schedule,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,outpatient,,,62.40000,59.28000,The Alliance,Premier,90,356.54,,,,,,,6.92,356.54,fee schedule,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Premier,90,254.68,,,,,,,5.02,254.68,fee schedule,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,outpatient,,,44.20000,41.99000,The Alliance,Premier,90,254.68,,,,,,,4.90,254.68,fee schedule,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Premier,90,1.42,,,,,,,1.00,1.94,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,outpatient,,,112.20000,106.59000,The Alliance,Premier,90,373.51,,,,,,,4.90,373.51,fee schedule,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,outpatient,,,383.70000,364.52000,The Alliance,Premier,90,6468.09,,,,,,,127.80,6468.09,fee schedule,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,outpatient,,,6329.00000,6012.55000,The Alliance,Premier,90,4487.26,,,,,,,2520.00,6139.13,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Premier,TC,1645.00,,,,,,,936.50,1820.00,per diem,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier,,268.19,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier,,362.30,,,,,,,122.40,495.67,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,outpatient,,,91836.00000,87244.20000,The Alliance,Premier,,65111.72,,,,,,,45918.00,93760.51,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,outpatient,,,969.00000,920.55000,The Alliance,Premier,TC,5445.97,,,,,,,484.50,5445.97,fee schedule,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Premier,,4423.43,,,,,,,4292.50,9351.85,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier,,462.95,,,,,,,449.25,978.75,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,43.52000,41.34000,The Alliance,Premier,,20.58,,,,,,,19.98,43.52,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,outpatient,1,GM,9.60000,9.12000,The Alliance,Premier,,6.81,,,,,,,4.80,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,outpatient,1,GM,6.88000,6.54000,The Alliance,Premier,,4.88,,,,,,,3.44,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,outpatient,1,GM,9.67000,9.19000,The Alliance,Premier,,6.86,,,,,,,4.83,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,outpatient,1,GM,9.68000,9.20000,The Alliance,Premier,,6.86,,,,,,,4.84,9.39,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier,,1.39,,,,,,,1.28,61.30,fee schedule,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier,,4765.48,,,,,,,4624.43,10075.00,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,outpatient,,,629.80000,598.31000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,outpatient,,,223.90000,212.70000,The Alliance,Premier,90,373.51,,,,,,,8.37,373.51,fee schedule,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,3.24,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Premier,,166.19,,,,,,,158.39,546.11,fee schedule,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier,TC,3804.30,,,,,,,356.27,17311.25,fee schedule,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,outpatient,,,9708.00000,9222.60000,The Alliance,Premier,TC,17537.00,,,,,,,4854.00,17574.00,case rate,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,outpatient,,,10317.00000,9801.15000,The Alliance,Premier,TC,17537.00,,,,,,,5158.50,17574.00,case rate,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,987.13000,937.77000,The Alliance,Premier,,248.04,,,,,,,240.68,957.52,fee schedule,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,224.25000,213.04000,The Alliance,Premier,,88.70,,,,,,,77.18,217.52,fee schedule,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1186.00000,1126.70000,The Alliance,Premier,,166.19,,,,,,,158.39,1150.42,fee schedule,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Premier,TC,514.73,,,,,,,363.00,704.22,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,outpatient,,,8822.00000,8380.90000,The Alliance,Premier,TC,17537.00,,,,,,,4411.00,17574.00,case rate,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,45.38,,,,,,,32.00,62.08,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Premier,,90.75,,,,,,,64.00,124.16,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier,,678.51,,,,,,,478.50,1267.58,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Premier,TC,2376.57,,,,,,,1676.00,7180.14,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier,,88.62,,,,,,,62.50,121.25,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier,TC,3903.24,,,,,,,361.82,17311.25,fee schedule,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Premier,TC,4120.75,,,,,,,383.91,8543.92,fee schedule,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Premier,TC,4298.79,,,,,,,404.21,17311.25,fee schedule,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,98.24000,93.33000,The Alliance,Premier,,69.65,,,,,,,49.12,95.29,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.04,,,,,,,240.68,509.25,fee schedule,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,112.49000,106.87000,The Alliance,Premier,,79.76,,,,,,,51.64,109.12,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,248.04,,,,,,,240.68,727.50,fee schedule,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,918.00000,872.10000,The Alliance,Premier,,248.04,,,,,,,240.68,890.46,fee schedule,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,241.88000,229.79000,The Alliance,Premier,,171.49,,,,,,,51.64,234.62,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier,,176.81,,,,,,,51.64,241.90,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Premier,,54.05,,,,,,,38.12,73.95,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,684.00000,649.80000,The Alliance,Premier,,248.04,,,,,,,240.68,663.48,fee schedule,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,125.49000,119.22000,The Alliance,Premier,,88.97,,,,,,,51.64,121.73,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Premier,,248.04,,,,,,,240.68,573.27,fee schedule,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.93000,100.63000,The Alliance,Premier,,75.10,,,,,,,51.64,102.75,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,115.05000,109.30000,The Alliance,Premier,,81.57,,,,,,,51.64,111.60,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,123.23000,117.07000,The Alliance,Premier,,87.37,,,,,,,51.64,119.53,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier,,75.14,,,,,,,51.64,102.80,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,outpatient,,,757.00000,719.15000,The Alliance,Premier,,536.71,,,,,,,416.35,5271.00,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier,TC,2630.66,,,,,,,257.95,2630.66,fee schedule,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Premier,,454.47,,,,,,,352.55,5271.00,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1207.50000,1147.12000,The Alliance,Premier,,166.19,,,,,,,158.39,1171.28,fee schedule,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,166.19,,,,,,,158.39,727.50,fee schedule,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,166.19,,,,,,,158.39,509.25,fee schedule,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,166.19,,,,,,,158.39,545.62,fee schedule,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,893.55000,848.87000,The Alliance,Premier,,166.19,,,,,,,158.39,866.74,fee schedule,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,219.94000,208.94000,The Alliance,Premier,,166.19,,,,,,,109.97,213.34,fee schedule,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,158.70000,150.76000,The Alliance,Premier,,166.19,,,,,,,79.35,192.52,fee schedule,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Premier,TC,937.00,,,,,,,353.00,5271.00,case rate,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier,TC,375.77,,,,,,,265.00,514.10,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Premier,TC,937.00,,,,,,,173.00,5271.00,case rate,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,TC,34.03,,,,,,,24.00,46.56,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Premier,TC,1245.05,,,,,,,127.30,1245.05,fee schedule,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2294.05,per diem,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier,TC,891.92,,,,,,,629.00,1220.26,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier,TC,870.65,,,,,,,614.00,1191.16,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier,TC,834.49,,,,,,,588.50,1141.69,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Premier,TC,1003.94,,,,,,,708.00,1373.52,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Premier,TC,1621.48,,,,,,,1143.50,2218.39,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Premier,TC,1410.20,,,,,,,994.50,1929.33,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier,TC,120.53,,,,,,,85.00,164.90,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,TC,150.31,,,,,,,106.00,205.64,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier,,147.15,,,,,,,58.13,1226.08,fee schedule,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier,,147.15,,,,,,,58.13,412.25,fee schedule,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,687.00000,652.65000,The Alliance,Premier,,224.70,,,,,,,211.37,666.39,fee schedule,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,224.70,,,,,,,211.37,436.50,fee schedule,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier,,224.70,,,,,,,211.37,1226.08,fee schedule,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,147.15,,,,,,,58.13,436.50,fee schedule,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,455.21000,432.45000,The Alliance,Premier,,224.70,,,,,,,211.37,441.55,fee schedule,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,424.00000,402.80000,The Alliance,Premier,,224.70,,,,,,,211.37,411.28,fee schedule,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier,,224.70,,,,,,,211.37,412.25,fee schedule,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier,TC,1645.00,,,,,,,584.87,1820.00,per diem,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier,TC,155.98,,,,,,,110.00,213.40,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,537.00000,510.15000,The Alliance,Premier,,248.04,,,,,,,240.68,520.89,fee schedule,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier,,248.04,,,,,,,240.68,646.99,fee schedule,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Premier,TC,1866.00,,,,,,,1396.56,3524.98,per diem,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Premier,TC,1866.00,,,,,,,1339.64,3425.07,per diem,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Premier,52,1866.00,,,,,,,864.00,2032.87,per diem,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,1759.50000,1671.52000,The Alliance,Premier,,107.93,,,,,,,101.38,1706.71,fee schedule,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,149.25000,141.79000,The Alliance,Premier,,107.93,,,,,,,74.62,144.77,fee schedule,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,615.25000,584.49000,The Alliance,Premier,,107.93,,,,,,,101.38,596.79,fee schedule,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,239.49000,227.52000,The Alliance,Premier,,107.93,,,,,,,101.38,232.31,fee schedule,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,518.75000,492.81000,The Alliance,Premier,,107.93,,,,,,,101.38,503.19,fee schedule,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,outpatient,,,1928.00000,1831.60000,The Alliance,Premier,TC,937.00,,,,,,,909.00,5271.00,case rate,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier,TC,146.76,,,,,,,103.50,200.79,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,TC,62.39,,,,,,,44.00,85.36,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Premier,TC,4437.28,,,,,,,448.00,4437.28,fee schedule,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier,,258.79,,,,,,,182.50,743.46,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier,TC,952.90,,,,,,,672.00,1303.68,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier,TC,548.00,,,,,,,327.36,764.36,fee schedule,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier,TC,4496.60,,,,,,,360.00,4496.60,fee schedule,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier,TC,548.00,,,,,,,154.77,548.00,fee schedule,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier,TC,548.00,,,,,,,384.16,867.18,fee schedule,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,outpatient,,,731.00000,694.45000,The Alliance,Premier,TC,518.28,,,,,,,365.50,709.07,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier,TC,2261.57,,,,,,,234.65,2261.57,fee schedule,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier,TC,5188.83,,,,,,,403.00,5188.83,fee schedule,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier,,532.12,,,,,,,516.38,1125.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier,,462.95,,,,,,,449.25,978.75,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier,,205.35,,,,,,,199.27,434.14,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier,,1.74,,,,,,,1.23,2.38,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier,,1055.38,,,,,,,1024.14,2231.25,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Premier,90,3186.14,,,,,,,26.30,3186.14,fee schedule,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Premier,90,1052.52,,,,,,,26.30,1052.52,fee schedule,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,outpatient,,,147.20000,139.84000,The Alliance,Premier,90,865.84,,,,,,,17.27,865.84,fee schedule,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,outpatient,,,367.40000,349.03000,The Alliance,Premier,90,848.80,,,,,,,16.67,848.80,fee schedule,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier,90,848.80,,,,,,,16.67,848.80,fee schedule,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.70000,43.42000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Premier,,2.98,,,,,,,2.10,4.08,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier,,147.15,,,,,,,58.13,766.30,fee schedule,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,31.91,,,,,,,22.50,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,43.13000,40.97000,The Alliance,Premier,,30.58,,,,,,,21.57,41.84,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,,87.92,,,,,,,35.41,120.28,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier,,95.72,,,,,,,67.50,130.95,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,113.44,,,,,,,80.00,220.07,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,80.12,,,,,,,56.50,109.61,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier,,217.66,,,,,,,23.25,297.79,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier,,1645.00,,,,,,,442.50,1820.00,per diem,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,40.93000,38.88000,The Alliance,Premier,,29.02,,,,,,,20.46,39.70,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier,,134.71,,,,,,,95.00,184.30,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Premier,,32.05,,,,,,,22.60,43.84,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,28.36,,,,,,,20.00,264.00,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier,,10.63,,,,,,,7.50,264.00,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,outpatient,,,7.00000,6.65000,The Alliance,Premier,,4.96,,,,,,,3.50,264.00,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,28.29,264.00,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier,,292.82,,,,,,,206.50,400.61,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,,80.12,,,,,,,56.50,109.61,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier,,9.45,,,,,,,6.67,12.93,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Premier,,12.48,,,,,,,8.80,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,outpatient,1,EA,19.94000,18.94000,The Alliance,Premier,,14.14,,,,,,,9.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Premier,,15.24,,,,,,,10.74,20.85,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,32.16,,,,,,,31.21,68.00,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Premier,,4482.37,,,,,,,4349.70,9476.46,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,41.00,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,548.00,,,,,,,384.16,1692.33,fee schedule,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Premier,,82.95,,,,,,,58.50,113.49,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,outpatient,,,1238.00000,1176.10000,The Alliance,Premier,,7803.00,,,,,,,680.90,7803.00,case rate,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier,,1866.00,,,,,,,968.00,2161.00,per diem,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Premier,,923.12,,,,,,,651.00,1692.33,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,,59.56,,,,,,,42.00,81.48,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,33.32,,,,,,,23.50,96.61,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier,,118.40,,,,,,,83.50,346.44,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,144.64,,,,,,,37.27,197.88,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,U6,163.78,,,,,,,115.50,224.07,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,127.62,,,,,,,90.00,264.00,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Premier,,3963.00,,,,,,,531.30,4686.00,case rate,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,127.62,,,,,,,90.00,264.00,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier,,33.32,,,,,,,23.50,264.00,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,132.58,,,,,,,93.50,264.00,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,127.62,,,,,,,90.00,264.00,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,37.58,,,,,,,26.50,264.00,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,22.69,,,,,,,16.00,31.04,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,U6,132.58,,,,,,,93.50,264.00,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,158.82,,,,,,,112.00,264.00,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier,,119.11,,,,,,,84.00,554.21,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,37.58,,,,,,,26.50,264.00,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,264.00,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,132.58,,,,,,,93.50,264.00,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,90.04,,,,,,,63.50,264.00,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14004.86,per diem,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Premier,,180.09,,,,,,,127.00,246.38,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier,,132.58,,,,,,,93.50,264.00,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier,,20.56,,,,,,,14.50,28.13,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier,,7.80,,,,,,,5.50,62.04,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,31.91,,,,,,,22.50,264.00,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,30.49,,,,,,,21.50,41.71,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,,31.91,,,,,,,22.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,103.51,,,,,,,73.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,264.00,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier,,1787.56,,,,,,,51.50,1787.56,fee schedule,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier,,6.38,,,,,,,4.50,1062.65,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,158.82,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,158.82,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,U6,79.41,,,,,,,56.00,264.00,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier,,78.70,,,,,,,55.50,264.00,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier,,85.08,,,,,,,60.00,116.40,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier,U6,219.79,,,,,,,155.00,300.70,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,70.90,,,,,,,24.02,97.00,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier,,4190.05,,,,,,,37.27,4190.05,fee schedule,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,,81.53,,,,,,,57.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,U6,105.64,,,,,,,74.50,264.00,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,44.67,,,,,,,24.02,61.11,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier,,177.96,,,,,,,125.50,346.44,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier,,58.14,,,,,,,24.02,79.54,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,U6,158.82,,,,,,,112.00,264.00,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Premier,,149.60,,,,,,,23.25,204.67,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,Premier,,314.09,,,,,,,221.50,429.71,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier,,219.79,,,,,,,152.56,300.70,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier,TC,2245.40,,,,,,,1488.32,7180.14,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,outpatient,1,mL,87.06000,82.71000,The Alliance,Premier,,61.73,,,,,,,43.53,84.45,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier,,0.14889,,,,,,,0.10500,0.20370,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1579.00000,1500.05000,The Alliance,Premier,90,6451.13,,,,,,,109.60,6451.13,fee schedule,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,outpatient,,,361.10000,343.04000,The Alliance,Premier,90,256.02,,,,,,,180.55,350.27,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,outpatient,,,2880.00000,2736.00000,The Alliance,Premier,90,15397.76,,,,,,,304.33,15397.76,fee schedule,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,outpatient,1,EA,1348.98000,1281.53000,The Alliance,Premier,,11.10,,,,,,,6.35,1308.51,fee schedule,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,outpatient,1,EA,1552.65000,1475.02000,The Alliance,Premier,,11.10,,,,,,,6.35,1506.07,fee schedule,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier,90,763.98,,,,,,,14.94,763.98,fee schedule,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier,90,823.21,,,,,,,17.85,823.21,fee schedule,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier,,470.04,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Premier,90,10915.96,,,,,,,215.88,10915.96,fee schedule,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,90,10525.49,,,,,,,208.21,10525.49,fee schedule,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier,TC,1819.29,,,,,,,1283.00,2489.02,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier,,0.28050,,,,,,,0.27125,3.07,fee schedule,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.28050,,,,,,,0.27125,6.13,fee schedule,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,outpatient,1,mL,4.62000,4.39000,The Alliance,Premier,,1.09,,,,,,,1.06,4.48,fee schedule,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier,,1.09,,,,,,,0.48500,1.18,fee schedule,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier,TC,1826.40,,,,,,,159.50,3015.65,fee schedule,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,outpatient,,,36.27000,34.46000,The Alliance,Premier,,16.68,,,,,,,15.58,35.18,fee schedule,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier,,532.12,,,,,,,516.38,1125.00,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,824.89000,783.65000,The Alliance,Premier,,390.17,,,,,,,378.62,824.89,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier,,14.98,,,,,,,14.54,31.68,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,158.82,,,,,,,112.00,264.00,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,outpatient,,,167.90000,159.50000,The Alliance,Premier,90,899.77,,,,,,,17.73,899.77,fee schedule,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier,90,933.70,,,,,,,17.71,933.70,fee schedule,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,outpatient,,,80.10000,76.09000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,outpatient,,,452.70000,430.06000,The Alliance,Premier,90,320.96,,,,,,,30.85,439.12,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,outpatient,,,308.60000,293.17000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,outpatient,,,400.10000,380.10000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Premier,,0.38995,,,,,,,0.27500,0.53350,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier,,4.48,,,,,,,3.16,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier,,7.10,,,,,,,5.01,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier,,462.95,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier,,462.95,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,513.38000,487.71000,The Alliance,Premier,,242.83,,,,,,,235.64,513.38,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,1539.22,,,,,,,12.05,1539.22,fee schedule,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier,,377.19,,,,,,,63.95,788.42,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,90,1324.17,,,,,,,26.32,1324.17,fee schedule,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,outpatient,,,284.90000,270.65000,The Alliance,Premier,90,1341.13,,,,,,,26.67,1341.13,fee schedule,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,90,2682.34,,,,,,,52.99,2682.34,fee schedule,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,90,882.80,,,,,,,18.72,882.80,fee schedule,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11764.50000,11176.27000,The Alliance,Premier,,5564.61,,,,,,,5399.91,11764.50,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14106.71,per diem,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Premier,,4654.70,,,,,,,4516.93,9840.80,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.84000,47.35000,The Alliance,Premier,,23.57,,,,,,,22.88,49.84,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier,,238.55,,,,,,,231.49,504.34,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier,TC,1450.63,,,,,,,142.50,1450.63,fee schedule,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,outpatient,1,mL,541.98000,514.88000,The Alliance,Premier,,92310.85,,,,,,,270.99,94648.39,fee schedule,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier,,0.14850,,,,,,,0.14409,9.20,fee schedule,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,254.36000,241.64000,The Alliance,Premier,,120.31,,,,,,,116.75,254.36,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,outpatient,,,4631.00000,4399.45000,The Alliance,Premier,,3283.38,,,,,,,2315.50,4492.07,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier,,5742.90,,,,,,,4050.00,7857.00,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,outpatient,1,EA,12.60000,11.97000,The Alliance,Premier,,8.93,,,,,,,6.30,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Premier,,20.12,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier,,14.19,,,,,,,10.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,outpatient,1,EA,8.90000,8.46000,The Alliance,Premier,,6.31,,,,,,,4.45,8.63,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier,,607.23,,,,,,,589.26,1283.78,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,outpatient,1,mL,1142.71000,1085.57000,The Alliance,Premier,,1.25,,,,,,,0.76000,1108.43,fee schedule,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier,,4875.45,,,,,,,4731.14,10307.50,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,76.00,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier,,1055.38,,,,,,,1024.14,2231.25,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,outpatient,1,mL,11.94000,11.35000,The Alliance,Premier,,8.47,,,,,,,5.97,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,outpatient,1,mL,11.08000,10.53000,The Alliance,Premier,,7.86,,,,,,,5.54,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,outpatient,1,mL,43.42000,41.25000,The Alliance,Premier,,30.78,,,,,,,21.71,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,outpatient,1,mL,13.51000,12.84000,The Alliance,Premier,,9.58,,,,,,,6.75,13.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Premier,,0.27651,,,,,,,0.19500,0.37830,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,outpatient,1,mL,162.98000,154.83000,The Alliance,Premier,,115.55,,,,,,,81.49,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,outpatient,1,mL,184.83000,175.59000,The Alliance,Premier,,131.04,,,,,,,92.42,179.29,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,outpatient,1,mL,4.39000,4.17000,The Alliance,Premier,,3.11,,,,,,,2.19,4.26,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Premier,,159.64,,,,,,,154.91,337.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,36.30,145.50,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,266.06,,,,,,,258.19,562.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier,,1.04,,,,,,,0.73500,1.43,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier,,0.65937,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,outpatient,1,mL,3.08000,2.93000,The Alliance,Premier,,0.14850,,,,,,,0.14409,2.99,fee schedule,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Premier,TC,937.00,,,,,,,909.00,5271.00,case rate,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier,TC,774.94,,,,,,,546.50,1060.21,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,outpatient,,,539.00000,512.05000,The Alliance,Premier,TC,382.15,,,,,,,269.50,522.83,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,outpatient,,,210.40000,199.88000,The Alliance,Premier,90,611.15,,,,,,,12.00,611.15,fee schedule,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier,90,628.12,,,,,,,12.41,628.12,fee schedule,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier,,36.31,,,,,,,35.23,76.76,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,outpatient,,,134.90000,128.16000,The Alliance,Premier,90,797.91,,,,,,,15.83,797.91,fee schedule,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,outpatient,1,EA,76.76000,72.92000,The Alliance,Premier,,8.37,,,,,,,7.82,74.46,fee schedule,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,outpatient,,,188.40000,178.98000,The Alliance,Premier,90,1120.45,,,,,,,22.12,1120.45,fee schedule,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,outpatient,1,mL,1400.41000,1330.39000,The Alliance,Premier,,992.89,,,,,,,700.21,1358.40,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier,,1426.10,,,,,,,1383.88,3015.00,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.80000,197.41000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,outpatient,,,162.90000,154.76000,The Alliance,Premier,90,967.70,,,,,,,19.14,967.70,fee schedule,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Premier,TC,21823.18,,,,,,,2751.30,21823.18,fee schedule,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,outpatient,1,mL,1673.67000,1589.99000,The Alliance,Premier,,90.21,,,,,,,54.67,1623.46,fee schedule,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier,90,1765.53,,,,,,,35.07,1765.53,fee schedule,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier,,458.40,,,,,,,9.77,458.40,fee schedule,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Premier,,580.02,,,,,,,562.85,1226.25,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Premier,TC,1645.00,,,,,,,1136.50,2204.81,per diem,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,317.40000,301.53000,The Alliance,Premier,,178.07,,,,,,,155.27,307.88,fee schedule,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Premier,,107.06,,,,,,,75.50,146.47,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier,,0.45376,,,,,,,0.32000,0.62080,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,186.11,,,,,,,131.25,254.62,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier,,2590.73,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01000,0.34860,fee schedule,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier,,0.28050,,,,,,,0.01500,0.34860,fee schedule,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,3.24,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,0.17725,,,,,,,0.12500,10.86,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,491.00000,466.45000,The Alliance,Premier,,348.12,,,,,,,63.95,788.42,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,1426.03,,,,,,,56.40,1426.03,fee schedule,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Premier,,4711.15,,,,,,,4571.71,9960.15,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26931.87000,25585.28000,The Alliance,Premier,,12738.77,,,,,,,12361.73,26931.87,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6722.33000,6386.21000,The Alliance,Premier,,3179.66,,,,,,,3085.55,6722.33,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Premier,,4569.18,,,,,,,4433.94,9660.00,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier,,377.19,,,,,,,266.00,516.04,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier,,1463.34,,,,,,,1420.03,3093.75,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier,,3182.11,,,,,,,3087.92,6727.50,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier,,1055.38,,,,,,,1024.14,2231.25,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Premier,TC,2472.99,,,,,,,1648.68,3383.36,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Premier,,514.73,,,,,,,100.97,704.22,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Premier,,242.12,,,,,,,170.75,331.25,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4232.12000,4020.51000,The Alliance,Premier,,2001.79,,,,,,,1942.54,4232.12,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,10.86,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,outpatient,,,42.42000,40.30000,The Alliance,Premier,,30.08,,,,,,,21.21,47.59,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,outpatient,0.5,EA,84.84000,80.60000,The Alliance,Premier,,60.15,,,,,,,42.42,82.29,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier,,628.12,,,,,,,12.05,628.12,fee schedule,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier,TC,2539.17,,,,,,,280.00,3015.65,fee schedule,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier,,2814.94,,,,,,,2731.62,5951.25,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,310.01000,294.51000,The Alliance,Premier,,146.63,,,,,,,142.29,310.01,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Premier,,178.07,,,,,,,155.27,309.72,fee schedule,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier,,0.26942,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,outpatient,1,GM,0.02000,0.02000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,outpatient,1,EA,3070.66000,2917.13000,The Alliance,Premier,,256.44,,,,,,,155.42,2978.54,fee schedule,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,outpatient,1,EA,3116.66000,2960.83000,The Alliance,Premier,,256.44,,,,,,,155.42,3023.16,fee schedule,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,outpatient,1,EA,33331.78000,31665.19000,The Alliance,Premier,,224.78,,,,,,,136.23,32331.83,fee schedule,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Premier,,9.31,,,,,,,6.57,12.74,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,128.57000,122.14000,The Alliance,Premier,,107.93,,,,,,,64.28,124.71,fee schedule,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Premier,TC,644.48,,,,,,,359.37,881.73,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier,,132.23,,,,,,,128.32,279.56,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Premier,,11547.11,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Premier,,11547.11,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Premier,,12470.88,,,,,,,12101.76,26365.50,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,15500.00000,14725.00000,The Alliance,Premier,,7331.50,,,,,,,7114.50,15500.00,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier,,2959.36,,,,,,,2871.77,6256.58,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier,,2959.36,,,,,,,2871.77,6256.58,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Premier,,12470.88,,,,,,,12101.76,26365.50,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,27825.00000,26433.75000,The Alliance,Premier,,13161.23,,,,,,,12771.67,27825.00,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier,TC,1866.00,,,,,,,1288.05,4844.18,per diem,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier,,1.82,,,,,,,1.28,2.49,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,outpatient,1,EA,2442.69000,2320.56000,The Alliance,Premier,,18.05,,,,,,,10.94,2369.41,fee schedule,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,outpatient,1,EA,2827.18000,2685.82000,The Alliance,Premier,,18.05,,,,,,,10.94,2742.36,fee schedule,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,outpatient,1,EA,21354.33000,20286.61000,The Alliance,Premier,,2866.22,,,,,,,1737.10,20713.70,fee schedule,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier,,310.41,,,,,,,301.22,656.25,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier,,95.78,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Premier,,1764.88,,,,,,,1712.64,3731.25,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,outpatient,1,GM,297.08000,282.23000,The Alliance,Premier,,210.63,,,,,,,148.54,288.17,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,39270.00000,37306.50000,The Alliance,Premier,,18574.71,,,,,,,18024.93,39270.00,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,outpatient,1,EA,3774.55000,3585.83000,The Alliance,Premier,,7.00,,,,,,,4.24,3661.31,fee schedule,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier,,2358.02,,,,,,,2288.23,4985.25,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,outpatient,1,EA,9775.80000,9287.01000,The Alliance,Premier,,269.30,,,,,,,163.21,9482.53,fee schedule,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Premier,,9.31,,,,,,,6.57,12.74,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,outpatient,1,mL,4.58000,4.35000,The Alliance,Premier,,3.25,,,,,,,2.29,4.44,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,outpatient,,,10207.00000,9696.65000,The Alliance,Premier,90,54562.77,,,,,,,608.00,54562.77,fee schedule,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28637.91000,27206.01000,The Alliance,Premier,,13545.73,,,,,,,13144.80,28637.91,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,outpatient,,,1024.00000,972.80000,The Alliance,Premier,TC,4635.02,,,,,,,433.70,17311.25,fee schedule,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier,,1917.42,,,,,,,1860.67,4053.75,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier,90,5856.94,,,,,,,83.09,5856.94,fee schedule,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier,90,8610.62,,,,,,,56.50,8610.62,fee schedule,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Premier,,178.07,,,,,,,155.27,409.22,fee schedule,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier,,157.48,,,,,,,152.81,332.93,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,outpatient,,,6126.00000,5819.70000,The Alliance,Premier,TC,4343.33,,,,,,,3063.00,5942.22,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier,,106.42,,,,,,,103.28,225.00,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Premier,,5.51,,,,,,,3.88,7.54,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier,,307.71,,,,,,,217.00,488.81,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,outpatient,1,mL,2194.08000,2084.37000,The Alliance,Premier,,104.59,,,,,,,63.39,2128.26,fee schedule,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,TC,7206.00,,,,,,,78.00,8022.25,per diem,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,53550.00000,50872.50000,The Alliance,Premier,,25329.15,,,,,,,24579.45,53550.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,outpatient,,,1525.00000,1448.75000,The Alliance,Premier,90,865.84,,,,,,,19.00,1479.25,fee schedule,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Premier,,60.01,,,,,,,28.36,60.01,fee schedule,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Premier,,60.01,,,,,,,52.64,110.03,fee schedule,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,outpatient,1,EA,11.46000,10.88000,The Alliance,Premier,,8.13,,,,,,,5.73,11.12,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,outpatient,1,EA,155.00000,147.25000,The Alliance,Premier,,109.89,,,,,,,77.50,150.35,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier,,0.50339,,,,,,,0.35500,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier,,0.29778,,,,,,,0.21000,0.40740,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier,,4624.66,,,,,,,4487.78,9777.30,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,424.06000,402.86000,The Alliance,Premier,,166.19,,,,,,,158.39,411.34,fee schedule,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,80.12000,76.11000,The Alliance,Premier,,37.90,,,,,,,36.78,80.12,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,32282.25,,,,,,,31326.75,68250.00,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,outpatient,1,EA,7.63000,7.25000,The Alliance,Premier,,5.41,,,,,,,3.81,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,outpatient,1,EA,31.40000,29.83000,The Alliance,Premier,,22.26,,,,,,,15.70,30.46,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier,,147.22,,,,,,,142.86,311.25,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,outpatient,,,984.00000,934.80000,The Alliance,Premier,,697.66,,,,,,,200.06,954.48,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier,,220.68,,,,,,,4.28,220.68,fee schedule,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,657.80000,624.91000,The Alliance,Premier,,248.04,,,,,,,240.68,638.07,fee schedule,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,outpatient,1,GM,10.04000,9.53000,The Alliance,Premier,,7.12,,,,,,,5.02,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Premier,,11543.14,,,,,,,11201.48,24404.10,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Premier,,3753.26,,,,,,,3642.16,7935.00,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Premier,,234.13,,,,,,,227.21,495.00,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,267.75000,254.36000,The Alliance,Premier,,126.65,,,,,,,122.90,267.75,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier,,6120.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Premier,,12399.03,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier,,4624.66,,,,,,,4487.78,9777.30,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,212.85,,,,,,,206.55,450.00,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier,,235.39,,,,,,,166.00,325.26,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier,,593.43,,,,,,,122.40,811.89,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,outpatient,,,1310.00000,1244.50000,The Alliance,Premier,TC,928.79,,,,,,,655.00,1270.70,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,outpatient,,,1538.00000,1461.10000,The Alliance,Premier,TC,1090.44,,,,,,,769.00,1491.86,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier,,486.37,,,,,,,122.40,665.42,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier,TC,141.80,,,,,,,100.00,194.00,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,outpatient,,,1812.00000,1721.40000,The Alliance,Premier,TC,1284.71,,,,,,,906.00,1757.64,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier,TC,1059.95,,,,,,,747.50,1450.15,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier,,774.94,,,,,,,295.69,1060.21,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Premier,,713.25,,,,,,,503.00,975.82,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,outpatient,1,mL,25.54000,24.27000,The Alliance,Premier,,18.11,,,,,,,12.77,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,outpatient,1,mL,12.79000,12.15000,The Alliance,Premier,,9.07,,,,,,,6.39,12.41,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,outpatient,1,mL,2462.57000,2339.44000,The Alliance,Premier,,1745.96,,,,,,,1231.29,2388.69,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,outpatient,1,EA,1284.64000,1220.41000,The Alliance,Premier,,8.76,,,,,,,5.31,1246.10,fee schedule,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,outpatient,1,mL,2259.81000,2146.82000,The Alliance,Premier,,104.59,,,,,,,63.39,2192.02,fee schedule,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,outpatient,1,EA,1367.29000,1298.92000,The Alliance,Premier,,12.71,,,,,,,11.25,1326.27,fee schedule,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,outpatient,1,mL,7668.27000,7284.86000,The Alliance,Premier,,5436.80,,,,,,,3834.14,7438.22,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier,,11.10,,,,,,,6.35,79.70,fee schedule,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,outpatient,,,59.20000,56.24000,The Alliance,Premier,,41.97,,,,,,,29.60,57.42,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,32282.25,,,,,,,31326.75,68250.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1433.85000,1362.16000,The Alliance,Premier,,678.21,,,,,,,658.14,1433.85,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Premier,,78.59,,,,,,,76.27,166.16,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier,,298.49,,,,,,,231.55,5271.00,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,10.86,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,,146.02,,,,,,,141.69,308.70,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,outpatient,,,8474.00000,8050.30000,The Alliance,Premier,,6008.07,,,,,,,295.69,8219.78,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier,,640.94,,,,,,,268.42,876.88,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,outpatient,,,48.67000,46.24000,The Alliance,Premier,,11.83,,,,,,,11.05,47.21,fee schedule,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,outpatient,,,106.68000,101.35000,The Alliance,Premier,,75.64,,,,,,,53.34,103.48,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier,,1.39,,,,,,,0.18500,1.39,fee schedule,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Premier,,24.52,,,,,,,17.30,33.55,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier,,0.21979,,,,,,,0.15500,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier,,0.09926,,,,,,,0.07000,0.13580,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier,,3.64,,,,,,,2.57,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,outpatient,1,EA,15.15000,14.40000,The Alliance,Premier,,10.74,,,,,,,7.58,14.70,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Premier,,2.23,,,,,,,1.57,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,outpatient,1,mL,4.46000,4.24000,The Alliance,Premier,,3.16,,,,,,,2.23,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,outpatient,1,mL,0.80000,0.76000,The Alliance,Premier,,0.56720,,,,,,,0.40000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier,TC,522.53,,,,,,,368.50,714.89,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,outpatient,1,mL,61.62000,58.54000,The Alliance,Premier,,19.27,,,,,,,18.70,59.77,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,outpatient,1,mL,38.30000,36.38000,The Alliance,Premier,,19.27,,,,,,,18.70,37.15,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,outpatient,1,mL,132.81000,126.17000,The Alliance,Premier,,19.27,,,,,,,18.70,128.83,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,outpatient,1,mL,38.87000,36.92000,The Alliance,Premier,,19.27,,,,,,,18.70,37.70,fee schedule,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier,,1.23,,,,,,,0.87000,1.69,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Premier,,34.37,,,,,,,24.24,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,outpatient,1,EA,41.87000,39.78000,The Alliance,Premier,,29.69,,,,,,,20.93,40.61,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,49.19,,,,,,,47.74,104.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,outpatient,,,1740.00000,1653.00000,The Alliance,Premier,,548.00,,,,,,,384.16,1692.33,fee schedule,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier,,81.36,,,,,,,78.95,172.00,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,542.90000,515.76000,The Alliance,Premier,,166.19,,,,,,,158.39,526.61,fee schedule,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,67.98,,,,,,,44.00,85.36,fee schedule,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier,,298.49,,,,,,,231.55,5271.00,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Premier,,1452.95,,,,,,,595.10,1987.82,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier,,997.10,,,,,,,967.59,2108.03,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier,,205.35,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier,,205.35,,,,,,,199.27,434.14,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,236.44,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier,,2.13,,,,,,,1.50,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier,,3.02,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier,,1.35,,,,,,,0.95500,1.85,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier,,0.51757,,,,,,,0.36500,0.70810,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,outpatient,1,EA,33.88000,32.19000,The Alliance,Premier,,24.02,,,,,,,16.94,32.86,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,outpatient,1,mL,3.74000,3.55000,The Alliance,Premier,,2.65,,,,,,,1.87,3.63,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,outpatient,1,EA,8541.32000,8114.25000,The Alliance,Premier,,256.44,,,,,,,155.42,8285.08,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,outpatient,1,EA,33.71000,32.03000,The Alliance,Premier,,83.21,,,,,,,16.86,83.21,fee schedule,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,2392.88,,,,,,,1856.25,5271.00,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,502.50000,477.38000,The Alliance,Premier,,237.68,,,,,,,230.65,502.50,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier,,81.36,,,,,,,78.95,172.00,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Premier,,16.63,,,,,,,16.14,35.16,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,10.86,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,10.86,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier,,0.92170,,,,,,,0.65000,1.26,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,0.06600,,,,,,,0.06404,1.21,fee schedule,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,outpatient,1,mL,2421.77000,2300.69000,The Alliance,Premier,,103.90,,,,,,,62.97,2349.12,fee schedule,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier,TC,3297.56,,,,,,,380.83,4511.47,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier,90,713.01,,,,,,,14.00,713.01,fee schedule,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Premier,90,628.12,,,,,,,12.38,628.12,fee schedule,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier,90,662.12,,,,,,,8.17,662.12,fee schedule,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier,,2.38,,,,,,,1.68,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier,,2.18,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier,,1.70,,,,,,,1.20,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier,,1.69,,,,,,,1.20,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,outpatient,1,EA,6.77000,6.43000,The Alliance,Premier,,4.80,,,,,,,3.38,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier,,2.28,,,,,,,1.61,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier,,1.08,,,,,,,0.76500,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1012.50000,961.88000,The Alliance,Premier,,478.91,,,,,,,464.74,1012.50,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,94.01,,,,,,,91.23,198.75,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.25000,252.94000,The Alliance,Premier,,125.94,,,,,,,122.21,266.25,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,212.85,,,,,,,206.55,450.00,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,24.60,,,,,,,23.87,52.00,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,17.03,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,43.52,,,,,,,42.23,92.00,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier,,443.44,,,,,,,430.31,937.50,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier,,0.13200,,,,,,,0.11780,1.21,fee schedule,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Premier,,150.18,,,,,,,91.02,1332.27,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Premier,,35.03,,,,,,,1.83,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier,,35.03,,,,,,,1.46,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,outpatient,1,mL,2.61000,2.48000,The Alliance,Premier,,35.03,,,,,,,1.30,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Premier,,35.03,,,,,,,1.47,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier,,35.03,,,,,,,1.47,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,outpatient,1,mL,2.48000,2.36000,The Alliance,Premier,,35.03,,,,,,,1.24,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier,,35.03,,,,,,,1.10,35.24,fee schedule,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,outpatient,,,49.36000,46.89000,The Alliance,Premier,,35.00,,,,,,,24.68,47.88,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Premier,,249.92,,,,,,,47.62,341.93,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,outpatient,,,261.94000,248.84000,The Alliance,Premier,,139.53,,,,,,,130.34,254.08,fee schedule,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,outpatient,,,245.10000,232.84000,The Alliance,Premier,RR,346.38,,,,,,,122.55,346.38,fee schedule,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Premier,RR,153.04,,,,,,,114.47,242.15,fee schedule,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Premier,,37.12,,,,,,,26.18,50.79,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Premier,UE,2164.92,,,,,,,1526.74,2961.89,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,outpatient,,,6.24000,5.93000,The Alliance,Premier,,0.44850,,,,,,,0.41800,6.05,fee schedule,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier,,881.98,,,,,,,621.99,1206.66,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,outpatient,,,515.78000,489.99000,The Alliance,Premier,RR,385.23,,,,,,,257.89,545.53,fee schedule,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier,NU,881.98,,,,,,,621.99,1206.66,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,73.31,,,,,,,46.20,89.63,fee schedule,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Premier,,162.33,,,,,,,114.47,222.08,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,60.76000,57.72000,The Alliance,Premier,,43.08,,,,,,,30.38,58.94,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier,,881.98,,,,,,,621.99,1206.66,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier,,41.12,,,,,,,29.00,56.26,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Premier,NU,74.36,,,,,,,34.86,74.36,fee schedule,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,outpatient,,,4.36000,4.14000,The Alliance,Premier,,5.11,,,,,,,2.18,5.11,fee schedule,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,outpatient,,,51.33000,48.76000,The Alliance,Premier,,36.39,,,,,,,25.66,49.79,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier,,211.28,,,,,,,149.00,289.06,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Premier,UE,4878.05,,,,,,,3440.09,6673.78,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier,NU,46.93,,,,,,,43.58,94.09,fee schedule,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,outpatient,,,6.80000,6.46000,The Alliance,Premier,,4.82,,,,,,,3.40,6.60,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Premier,NU,2164.92,,,,,,,1526.74,2961.89,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,35.95,,,,,,,34.88,73.72,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Premier,,652.28,,,,,,,460.00,892.40,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier,,262.74,,,,,,,185.29,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier,NU,190.74,,,,,,,177.13,359.46,fee schedule,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,121.07000,115.02000,The Alliance,Premier,,85.84,,,,,,,60.53,117.44,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,30.00,58.20,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier,,9.73,,,,,,,6.67,12.93,fee schedule,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,outpatient,,,336.75000,319.91000,The Alliance,Premier,NU,118.04,,,,,,,114.55,326.65,fee schedule,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Premier,,31.25,,,,,,,15.20,31.25,fee schedule,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier,,262.74,,,,,,,185.29,359.46,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,outpatient,,,30380.00000,28861.00000,The Alliance,Premier,NU,13154.48,,,,,,,12765.57,30380.00,fee schedule,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Premier,,66.14,,,,,,,46.65,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Premier,RR,58.95,,,,,,,46.65,98.67,fee schedule,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Premier,,4878.05,,,,,,,3440.09,6673.78,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,outpatient,,,12.13000,11.52000,The Alliance,Premier,,12.52,,,,,,,6.07,12.52,fee schedule,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier,UE,881.98,,,,,,,621.99,1206.66,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,outpatient,,,33.36000,31.69000,The Alliance,Premier,,51.01,,,,,,,16.68,51.01,fee schedule,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,outpatient,,,217.88000,206.99000,The Alliance,Premier,NU,124.67,,,,,,,108.94,211.34,fee schedule,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier,,12.41,,,,,,,6.00,12.41,fee schedule,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,40.13000,38.12000,The Alliance,Premier,NU,22.03,,,,,,,20.07,38.93,fee schedule,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,outpatient,,,19.77000,18.78000,The Alliance,Premier,,22.52,,,,,,,9.88,22.52,fee schedule,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,outpatient,,,80.09000,76.09000,The Alliance,Premier,NU,30.30,,,,,,,28.30,77.69,fee schedule,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,256.72000,243.88000,The Alliance,Premier,,182.01,,,,,,,128.36,249.02,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,outpatient,,,575.26000,546.50000,The Alliance,Premier,,306.44,,,,,,,286.24,558.00,fee schedule,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Premier,,19.70,,,,,,,13.89,26.95,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,45.73000,43.44000,The Alliance,Premier,,32.42,,,,,,,22.86,44.36,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,85.52000,81.24000,The Alliance,Premier,NU,65.72,,,,,,,42.76,86.57,fee schedule,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Premier,NU,665.04,,,,,,,469.00,909.86,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier,,3.23,,,,,,,3.01,12.93,fee schedule,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,138.96,,,,,,,98.00,190.12,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,outpatient,,,197.20000,187.34000,The Alliance,Premier,,87.69,,,,,,,81.91,191.28,fee schedule,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Premier,RR,19.08,,,,,,,13.89,29.38,fee schedule,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier,,9.45,,,,,,,6.67,12.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Premier,,249.92,,,,,,,176.25,341.93,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,outpatient,,,40.53000,38.50000,The Alliance,Premier,,41.68,,,,,,,20.27,41.68,fee schedule,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,outpatient,,,3400.00000,3230.00000,The Alliance,Premier,,2410.60,,,,,,,1700.00,3298.00,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,outpatient,,,382.22000,363.11000,The Alliance,Premier,,203.60,,,,,,,190.18,370.75,fee schedule,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,outpatient,,,51.87000,49.28000,The Alliance,Premier,,36.78,,,,,,,25.93,50.31,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,22.69,,,,,,,16.00,31.04,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier,,751.69,,,,,,,236.25,751.69,fee schedule,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,outpatient,,,107.52000,102.14000,The Alliance,Premier,,183.28,,,,,,,53.76,183.28,fee schedule,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,5.33000,5.06000,The Alliance,Premier,,3.78,,,,,,,2.67,5.17,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,outpatient,,,305.06000,289.81000,The Alliance,Premier,,162.52,,,,,,,151.81,295.91,fee schedule,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,95.96000,91.16000,The Alliance,Premier,,68.04,,,,,,,47.98,93.08,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,252.58,,,,,,,178.12,345.56,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,outpatient,,,45.21000,42.95000,The Alliance,Premier,,32.05,,,,,,,22.61,43.85,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,436.07000,414.27000,The Alliance,Premier,NU,69.32,,,,,,,67.27,422.99,fee schedule,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,outpatient,,,12.40000,11.78000,The Alliance,Premier,,12.71,,,,,,,6.20,12.71,fee schedule,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,29.10,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,outpatient,,,245.44000,233.17000,The Alliance,Premier,,154.77,,,,,,,122.72,238.08,fee schedule,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,outpatient,,,2021.78000,1920.69000,The Alliance,Premier,NU,1433.44,,,,,,,1010.89,1961.13,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,66.67000,63.34000,The Alliance,Premier,NU,22.03,,,,,,,21.38,64.67,fee schedule,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,outpatient,,,3430.67000,3259.14000,The Alliance,Premier,,1827.50,,,,,,,1707.07,3327.75,fee schedule,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier,,51.05,,,,,,,36.00,69.84,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,outpatient,,,1941.00000,1843.95000,The Alliance,Premier,,753.24,,,,,,,699.50,1882.77,fee schedule,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,292.69000,278.06000,The Alliance,Premier,NU,69.32,,,,,,,67.27,283.91,fee schedule,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,1.01,,,,,,,0.94600,6.47,fee schedule,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,outpatient,,,7.28000,6.92000,The Alliance,Premier,,1.26,,,,,,,1.18,7.06,fee schedule,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,outpatient,,,69.07000,65.62000,The Alliance,Premier,,80.76,,,,,,,34.53,80.76,fee schedule,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,outpatient,,,976.08000,927.28000,The Alliance,Premier,,519.95,,,,,,,485.68,946.80,fee schedule,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,outpatient,,,14.34000,13.62000,The Alliance,Premier,,5.23,,,,,,,4.88,13.91,fee schedule,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,4.90,,,,,,,3.33,6.47,fee schedule,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,outpatient,,,11.87000,11.28000,The Alliance,Premier,,12.01,,,,,,,5.93,12.01,fee schedule,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,46.79,,,,,,,33.00,72.60,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.01000,0.96000,The Alliance,Premier,,0.71609,,,,,,,0.50500,0.97970,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,outpatient,,,1219.00000,1158.05000,The Alliance,Premier,,576.59,,,,,,,559.52,1182.43,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,outpatient,,,20.24000,19.23000,The Alliance,Premier,,9.48,,,,,,,8.86,19.63,fee schedule,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier,,5.32,,,,,,,4.97,77.60,fee schedule,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,NU,55.76,,,,,,,51.00,98.94,fee schedule,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,outpatient,,,916.18000,870.37000,The Alliance,Premier,,488.05,,,,,,,455.88,888.69,fee schedule,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,Premier,,544.29,,,,,,,508.43,1388.07,fee schedule,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,341.25000,324.19000,The Alliance,Premier,,751.69,,,,,,,170.62,751.69,fee schedule,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,outpatient,,,139.36000,132.39000,The Alliance,Premier,NU,65.72,,,,,,,63.78,135.18,fee schedule,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,outpatient,,,176.52000,167.69000,The Alliance,Premier,NU,59.35,,,,,,,55.44,171.22,fee schedule,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,outpatient,,,49.62000,47.14000,The Alliance,Premier,NU,29.82,,,,,,,24.81,48.13,fee schedule,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,outpatient,,,364.24000,346.03000,The Alliance,Premier,NU,258.25,,,,,,,182.12,353.31,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier,NU,19.25,,,,,,,17.89,43.65,fee schedule,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Premier,,9.22,,,,,,,6.50,12.61,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,306.75000,291.41000,The Alliance,Premier,NU,65.72,,,,,,,63.78,297.55,fee schedule,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,outpatient,,,7.73000,7.34000,The Alliance,Premier,,7.90,,,,,,,3.87,7.90,fee schedule,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,outpatient,,,9.07000,8.62000,The Alliance,Premier,,3.56,,,,,,,3.33,8.80,fee schedule,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier,UE,143.06,,,,,,,132.85,359.46,fee schedule,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,22.69,,,,,,,16.00,31.04,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.78000,1.69000,The Alliance,Premier,,1.26,,,,,,,0.89000,1.73,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,outpatient,,,6478.28000,6154.37000,The Alliance,Premier,,3450.94,,,,,,,3223.54,6283.93,fee schedule,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,outpatient,,,461.88000,438.79000,The Alliance,Premier,NU,124.67,,,,,,,116.46,448.02,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.91180,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.92150,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.83420,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.26400,,,,,,,0.19995,0.76630,fee schedule,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,outpatient,1,mL,70.06000,66.56000,The Alliance,Premier,,11.71,,,,,,,6.30,67.96,fee schedule,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,outpatient,1,mL,47.36000,44.99000,The Alliance,Premier,,11.71,,,,,,,6.30,45.94,fee schedule,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,3725.18000,3538.92000,The Alliance,Premier,,1762.01,,,,,,,1709.86,3725.18,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,outpatient,,,1687.00000,1602.65000,The Alliance,Premier,90,8131.76,,,,,,,162.98,8131.76,fee schedule,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,outpatient,,,2238.00000,2126.10000,The Alliance,Premier,90,10355.70,,,,,,,204.58,10355.70,fee schedule,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,10.86,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier,,0.80826,,,,,,,0.57000,1.11,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,outpatient,1,mL,78.08000,74.18000,The Alliance,Premier,,55.36,,,,,,,39.04,75.74,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier,,2529.37,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,405.56000,385.28000,The Alliance,Premier,,191.83,,,,,,,186.15,405.56,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,86.50,,,,,,,61.00,118.34,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,outpatient,,,779.00000,740.05000,The Alliance,Premier,,6858.56,,,,,,,389.50,6858.56,fee schedule,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier,,0.17016,,,,,,,0.12000,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Premier,,486.24,,,,,,,325.11,1028.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier,TC,4918.70,,,,,,,463.75,17311.25,fee schedule,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1755.00000,1667.25000,The Alliance,Premier,,830.12,,,,,,,805.54,1755.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier,,2529.37,,,,,,,2454.50,5347.50,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Premier,,3.50,,,,,,,2.47,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,outpatient,1,EA,8.22000,7.80000,The Alliance,Premier,,5.83,,,,,,,4.11,7.97,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier,,0.36300,,,,,,,0.33945,5.82,fee schedule,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,outpatient,1,mL,6.86000,6.51000,The Alliance,Premier,,0.36300,,,,,,,0.33945,6.65,fee schedule,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,905.96000,860.66000,The Alliance,Premier,,428.52,,,,,,,415.84,905.96,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Premier,,431.02,,,,,,,418.26,911.25,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,outpatient,,,4079.00000,3875.05000,The Alliance,Premier,TC,46388.00,,,,,,,2039.50,52322.00,case rate,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Premier,TC,46388.00,,,,,,,976.00,52322.00,case rate,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier,,3.74,,,,,,,2.63,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,outpatient,1,EA,35.83000,34.04000,The Alliance,Premier,,25.40,,,,,,,17.91,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,outpatient,1,EA,13.44000,12.77000,The Alliance,Premier,,9.53,,,,,,,6.72,13.04,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,28350.00000,26932.50000,The Alliance,Premier,,13409.55,,,,,,,13012.65,27499.50,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Premier,,1681.04,,,,,,,1304.05,5271.00,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier,,937.00,,,,,,,280.29,5858.00,case rate,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,3810.53000,3620.00000,The Alliance,Premier,,1802.38,,,,,,,1749.03,3810.53,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11005.00000,10454.75000,The Alliance,Premier,,5205.36,,,,,,,5051.30,11005.00,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,266.06,,,,,,,258.19,562.50,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Premier,,245.63,,,,,,,238.36,519.30,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,outpatient,1,EA,265.32000,252.05000,The Alliance,Premier,,188.11,,,,,,,132.66,257.36,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,outpatient,1,EA,15105.00000,14349.75000,The Alliance,Premier,,340.11,,,,,,,206.13,14651.85,fee schedule,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Premier,,670.31,,,,,,,523.00,1014.62,fee schedule,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier,,79.25,,,,,,,19.30,80.87,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier,,79.25,,,,,,,19.30,80.87,fee schedule,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Premier,,25.95,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,outpatient,1,EA,26.11000,24.81000,The Alliance,Premier,,18.51,,,,,,,13.05,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,outpatient,1,EA,9.68000,9.20000,The Alliance,Premier,,6.86,,,,,,,4.84,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Premier,,14.92,,,,,,,10.53,20.42,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier,,9.25,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier,,28.96,,,,,,,20.43,39.62,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier,90,814.87,,,,,,,16.01,814.87,fee schedule,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier,,503.39,,,,,,,390.50,5271.00,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier,,38281.04,,,,,,,4607.00,52373.21,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier,,89.49,,,,,,,86.84,189.20,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30690.00000,29155.50000,The Alliance,Premier,,14516.37,,,,,,,14086.71,30690.00,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier,,93.65,,,,,,,90.88,198.00,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,424.88000,403.64000,The Alliance,Premier,,200.97,,,,,,,195.02,424.88,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier,,1369.34,,,,,,,1328.81,2895.00,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1747.46000,1660.09000,The Alliance,Premier,,826.55,,,,,,,802.08,1747.46,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,9642.75000,9160.61000,The Alliance,Premier,,4561.02,,,,,,,4426.02,9642.75,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Premier,,431.02,,,,,,,418.26,911.25,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,227.04,,,,,,,220.32,480.00,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier,,0.07799,,,,,,,0.05500,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier,,144.64,,,,,,,23.25,197.88,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12220.20000,11609.19000,The Alliance,Premier,,5780.15,,,,,,,5609.07,12220.20,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier,,32282.25,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier,,8819.79,,,,,,,8558.74,18646.50,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.40000,227.43000,The Alliance,Premier,,113.24,,,,,,,109.88,239.40,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier,,97.84,,,,,,,69.00,133.86,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Premier,,0.09900,,,,,,,0.08525,0.53350,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,outpatient,1,mL,1.53000,1.45000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.48,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.50,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,outpatient,1,mL,1.51000,1.44000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.46,fee schedule,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,outpatient,1,mL,119.99000,113.99000,The Alliance,Premier,,85.07,,,,,,,59.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,outpatient,1,mL,134.30000,127.59000,The Alliance,Premier,,95.22,,,,,,,67.15,130.27,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,outpatient,1,mL,2.45000,2.32000,The Alliance,Premier,,1.58,,,,,,,1.23,2.38,fee schedule,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier,,76.85,,,,,,,54.20,105.14,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,1.49,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Premier,,12.62,,,,,,,8.90,17.27,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier,,10256.77,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3490.74000,3316.20000,The Alliance,Premier,,1651.12,,,,,,,1602.25,3490.74,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,72.60000,68.97000,The Alliance,Premier,,34.34,,,,,,,33.32,72.60,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,40.68,,,,,,,39.47,86.00,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,355.69000,337.91000,The Alliance,Premier,,168.24,,,,,,,163.26,355.69,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,25668.00000,24384.60000,The Alliance,Premier,,12140.96,,,,,,,11781.61,25668.00,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,40.68,,,,,,,39.47,86.00,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier,,285.57,,,,,,,277.12,603.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,1596.38,,,,,,,1549.12,3375.00,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,53.16000,50.50000,The Alliance,Premier,,25.14,,,,,,,24.40,53.16,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier,90,1289.24,,,,,,,21.69,1289.24,fee schedule,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,,885.37,,,,,,,14.91,885.37,fee schedule,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,,1137.41,,,,,,,144.00,1137.41,fee schedule,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,823.21,,,,,,,13.82,823.21,fee schedule,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier,,885.37,,,,,,,14.91,885.37,fee schedule,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier,,885.37,,,,,,,14.91,885.37,fee schedule,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,outpatient,1,EA,2.95000,2.81000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier,,2.10,,,,,,,1.48,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Premier,,2.07,,,,,,,1.46,2.83,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,577.50000,548.62000,The Alliance,Premier,,44.14,,,,,,,41.23,560.17,fee schedule,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,126.04000,119.74000,The Alliance,Premier,,89.36,,,,,,,63.02,122.26,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Premier,,1.43,,,,,,,1.01,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,outpatient,1,EA,2.04000,1.94000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier,,1.85,,,,,,,1.30,2.53,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Premier,TC,1000.40,,,,,,,705.50,1368.67,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Premier,,25.95,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,outpatient,1,EA,26.10000,24.80000,The Alliance,Premier,,18.50,,,,,,,13.05,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,outpatient,1,EA,3.55000,3.38000,The Alliance,Premier,,2.52,,,,,,,1.77,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,outpatient,1,EA,21.05000,19.99000,The Alliance,Premier,,14.92,,,,,,,10.53,20.42,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,199.44000,189.47000,The Alliance,Premier,,141.40,,,,,,,99.72,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,250.65000,238.12000,The Alliance,Premier,,177.71,,,,,,,125.33,243.13,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,outpatient,,,2750.00000,2612.50000,The Alliance,Premier,,1300.75,,,,,,,1262.25,2667.50,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,117.69,,,,,,,37.27,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,,239.64,,,,,,,122.40,327.86,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,117.69,,,,,,,37.27,161.02,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Premier,,328.14,,,,,,,318.43,693.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier,,239.64,,,,,,,122.40,327.86,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,TC,25.52,,,,,,,18.00,34.92,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,outpatient,1,EA,106.41000,101.09000,The Alliance,Premier,,75.44,,,,,,,53.20,103.22,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,outpatient,,,713.00000,677.35000,The Alliance,Premier,TC,505.52,,,,,,,356.50,691.61,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Premier,TC,1170.56,,,,,,,805.84,2210.07,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier,TC,378.61,,,,,,,267.00,517.98,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier,,77.99,,,,,,,55.00,106.70,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,TC,1645.00,,,,,,,979.11,2209.66,per diem,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier,TC,1645.00,,,,,,,924.00,1820.00,per diem,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,292.67,,,,,,,284.01,618.75,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,outpatient,,,781.00000,741.95000,The Alliance,Premier,90,1786.28,,,,,,,12.05,1786.28,fee schedule,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,outpatient,,,126.20000,119.89000,The Alliance,Premier,90,577.23,,,,,,,11.52,577.23,fee schedule,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Premier,90,8250.66,,,,,,,143.40,8250.66,fee schedule,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Premier,90,8610.62,,,,,,,664.97,8610.62,fee schedule,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,outpatient,1,EA,4864.22000,4621.01000,The Alliance,Premier,,11.95,,,,,,,7.24,4718.29,fee schedule,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,outpatient,1,EA,4120.10000,3914.10000,The Alliance,Premier,,11.95,,,,,,,7.24,3996.50,fee schedule,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,outpatient,1,mL,3.42000,3.25000,The Alliance,Premier,,2.42,,,,,,,1.71,3.32,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Premier,,2.11,,,,,,,1.49,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier,,4865.18,,,,,,,4721.18,10285.80,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,228.81,,,,,,,222.04,483.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier,,18372.84,,,,,,,17829.04,38843.22,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Premier,,464.72,,,,,,,450.97,982.50,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Premier,,1452.95,,,,,,,595.10,1987.82,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,outpatient,,,36.64000,34.81000,The Alliance,Premier,,25.98,,,,,,,18.32,35.54,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,outpatient,1,EA,7781.61000,7392.53000,The Alliance,Premier,,224.78,,,,,,,136.23,7548.16,fee schedule,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,outpatient,,,184.60000,175.37000,The Alliance,Premier,90,848.80,,,,,,,16.88,848.80,fee schedule,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,outpatient,1,EA,5033.44000,4781.76000,The Alliance,Premier,,59.83,,,,,,,36.26,4882.44,fee schedule,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Premier,TC,2324.10,,,,,,,1489.61,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier,,0.75863,,,,,,,0.53500,1.04,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,outpatient,1,EA,42.44000,40.32000,The Alliance,Premier,,30.09,,,,,,,21.22,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,outpatient,1,EA,6.86000,6.51000,The Alliance,Premier,,4.86,,,,,,,3.43,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,outpatient,1,EA,38.63000,36.70000,The Alliance,Premier,,27.39,,,,,,,19.32,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier,,4.86,,,,,,,3.42,6.64,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier,,0.94297,,,,,,,0.66500,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,outpatient,1,EA,28.28000,26.87000,The Alliance,Premier,,20.05,,,,,,,14.14,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier,,1.66,,,,,,,1.17,2.27,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25659.63000,24376.65000,The Alliance,Premier,,12137.00,,,,,,,11777.77,25659.63,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier,,29.80,,,,,,,28.92,63.00,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,,73.79,,,,,,,71.60,156.00,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Premier,,2640.00,,,,,,,510.40,3163.00,case rate,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier,TC,214.83,,,,,,,151.50,293.91,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier,,1057.83,,,,,,,746.00,2139.65,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,90,441.37,,,,,,,8.72,441.37,fee schedule,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Premier,,4855.31,,,,,,,143.00,4855.31,fee schedule,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier,,4803.60,,,,,,,4661.42,10155.60,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2030.96000,1929.41000,The Alliance,Premier,,960.64,,,,,,,932.21,2030.96,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Premier,,1284.19,,,,,,,1246.18,2715.00,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier,,264.29,,,,,,,256.47,558.75,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,64.40000,61.18000,The Alliance,Premier,,30.46,,,,,,,29.56,64.40,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier,,5365.19,,,,,,,5206.39,11342.90,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2906.25000,2760.94000,The Alliance,Premier,,1374.66,,,,,,,1333.97,2906.25,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,163.68000,155.50000,The Alliance,Premier,,166.19,,,,,,,81.84,192.52,fee schedule,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier,,2.33,,,,,,,1.64,3.18,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,outpatient,1,mL,992.83000,943.19000,The Alliance,Premier,,121.09,,,,,,,114.64,963.05,fee schedule,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,727.50000,691.12000,The Alliance,Premier,,344.11,,,,,,,333.92,727.50,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Premier,,510.84,,,,,,,495.72,1080.00,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier,,645.64,,,,,,,626.53,1365.00,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,outpatient,1,mL,2.33000,2.22000,The Alliance,Premier,,1.65,,,,,,,1.17,2.26,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Premier,TC,2429.74,,,,,,,1713.50,3324.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Premier,,2394.74,,,,,,,2236.93,7997.10,fee schedule,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1488.71000,1414.27000,The Alliance,Premier,,704.16,,,,,,,683.32,1488.71,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,outpatient,,,805.00000,764.75000,The Alliance,Premier,TC,548.00,,,,,,,318.45,780.85,fee schedule,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier,,2640.00,,,,,,,97.35,3163.00,case rate,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier,,25.09,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier,,443.44,,,,,,,430.31,937.50,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2786.25000,2646.94000,The Alliance,Premier,,1317.90,,,,,,,1278.89,2786.25,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Premier,,9641.07,,,,,,,9355.71,20382.81,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,182.97,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier,,0.69482,,,,,,,0.49000,0.95060,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier,,2.71,,,,,,,1.91,3.71,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier,,239.46,,,,,,,232.37,506.25,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier,,17.37,,,,,,,16.85,36.72,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Premier,,33.37,,,,,,,32.39,70.56,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier,,1463.34,,,,,,,1420.03,3093.75,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,31.22,,,,,,,30.29,66.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier,,567.60,,,,,,,550.80,1200.00,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier,,225.27,,,,,,,218.60,476.25,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,372.60000,353.97000,The Alliance,Premier,,162.59,,,,,,,157.76,361.42,fee schedule,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier,,162.59,,,,,,,157.76,400.61,fee schedule,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier,TC,667.17,,,,,,,470.50,912.77,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Premier,,1033.21,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,outpatient,,,2117.00000,2011.15000,The Alliance,Premier,TC,11495.30,,,,,,,1058.50,11495.30,fee schedule,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,outpatient,,,2717.00000,2581.15000,The Alliance,Premier,TC,12563.69,,,,,,,1358.50,17311.25,fee schedule,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,outpatient,1,EA,6485.63000,6161.35000,The Alliance,Premier,,11.95,,,,,,,7.24,6291.06,fee schedule,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Premier,,0.85789,,,,,,,0.60500,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,0.85080,,,,,,,0.60000,1.16,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,outpatient,1,mL,2392.75000,2273.11000,The Alliance,Premier,,19.80,,,,,,,12.00,2320.97,fee schedule,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,outpatient,1,mL,2460.93000,2337.88000,The Alliance,Premier,,19.80,,,,,,,12.00,2387.10,fee schedule,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9528.90000,9052.46000,The Alliance,Premier,,4507.17,,,,,,,4373.77,9528.90,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Premier,,319.27,,,,,,,309.82,675.00,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Premier,,1410.20,,,,,,,122.40,1929.33,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Premier,,4654.70,,,,,,,4516.93,9840.80,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,445.31000,423.04000,The Alliance,Premier,,874.50,,,,,,,143.61,874.50,fee schedule,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier,,3.30,,,,,,,2.33,4.51,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,outpatient,1,GM,77.47000,73.60000,The Alliance,Premier,,54.93,,,,,,,38.73,75.15,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Premier,TC,1971.02,,,,,,,1390.00,2696.60,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier,,397.32,,,,,,,385.56,840.00,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier,,48.02,,,,,,,46.60,101.52,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,340.32,,,,,,,264.00,5271.00,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier,,107.31,,,,,,,104.14,226.88,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,Premier,,186.00,,,,,,,126.65,271.60,per diem,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier,90,679.08,,,,,,,13.35,679.08,fee schedule,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier,90,865.84,,,,,,,17.01,865.84,fee schedule,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,outpatient,,,176.90000,168.06000,The Alliance,Premier,90,780.94,,,,,,,15.27,780.94,fee schedule,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,outpatient,,,98.20000,93.29000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,outpatient,,,178.30000,169.38000,The Alliance,Premier,90,831.84,,,,,,,16.37,831.84,fee schedule,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier,90,412.64,,,,,,,291.00,839.96,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,outpatient,,,343.70000,326.52000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,228.81,,,,,,,222.04,483.75,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,18.92,,,,,,,18.36,40.00,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier,,620.81,,,,,,,602.44,1312.50,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,288.06,,,,,,,279.53,609.00,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,2995.31000,2845.54000,The Alliance,Premier,,1416.78,,,,,,,1374.85,2995.31,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,548.10000,520.70000,The Alliance,Premier,,224.70,,,,,,,211.37,531.66,fee schedule,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Premier,TC,4160.38,,,,,,,391.31,29731.35,fee schedule,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,outpatient,1,mL,9.14000,8.69000,The Alliance,Premier,,6.48,,,,,,,1.49,8.87,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Premier,,878.45,,,,,,,498.67,1201.83,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier,,3.24,,,,,,,1.49,4.43,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,331.88000,315.29000,The Alliance,Premier,,156.98,,,,,,,152.33,331.88,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Premier,,983.37,,,,,,,954.26,2079.00,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.75000,359.81000,The Alliance,Premier,,179.15,,,,,,,173.85,378.75,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,900.00000,855.00000,The Alliance,Premier,,425.70,,,,,,,413.10,900.00,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Premier,,4071.47,,,,,,,3950.96,8607.75,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier,,567.60,,,,,,,550.80,1200.00,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1887.98000,1793.58000,The Alliance,Premier,,893.01,,,,,,,866.58,1887.98,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier,,397.32,,,,,,,385.56,840.00,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier,,401.76,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier,,4803.60,,,,,,,4661.42,10155.60,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,25.52,,,,,,,19.80,5271.00,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier,,66.65,,,,,,,51.70,5271.00,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier,,100.22,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier,,225.27,,,,,,,218.60,476.25,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,outpatient,,,117.80000,111.91000,The Alliance,Premier,90,984.66,,,,,,,14.65,984.66,fee schedule,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Premier,,878.45,,,,,,,498.67,1201.83,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,outpatient,,,73500.00000,69825.00000,The Alliance,Premier,,34765.50,,,,,,,33736.50,73500.00,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,outpatient,,,5128.00000,4871.60000,The Alliance,Premier,,548.00,,,,,,,384.16,4974.16,fee schedule,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Premier,,3263.70,,,,,,,3167.10,6900.00,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier,,645.64,,,,,,,626.53,1365.00,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Premier,,3116.76,,,,,,,966.05,4264.12,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,Premier,,2640.00,,,,,,,244.75,3163.00,case rate,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,488.05000,463.65000,The Alliance,Premier,,166.19,,,,,,,158.39,473.41,fee schedule,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,outpatient,,,120.40000,114.38000,The Alliance,Premier,90,1137.41,,,,,,,60.20,1137.41,fee schedule,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10064.34000,9561.12000,The Alliance,Premier,,4760.43,,,,,,,4619.53,10064.34,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,49.19,,,,,,,47.74,104.00,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11169.30000,10610.83000,The Alliance,Premier,,5283.08,,,,,,,5126.71,11169.30,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4623.00000,4391.85000,The Alliance,Premier,,2186.68,,,,,,,2121.96,4623.00,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,988.88000,939.44000,The Alliance,Premier,,467.74,,,,,,,453.90,988.88,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier,TC,1645.00,,,,,,,672.00,1820.00,per diem,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,outpatient,,,707.00000,671.65000,The Alliance,Premier,,501.26,,,,,,,353.50,697.17,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,765.00000,726.75000,The Alliance,Premier,,361.85,,,,,,,351.13,765.00,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.64000,99.41000,The Alliance,Premier,,49.49,,,,,,,48.03,104.64,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,381.56000,362.48000,The Alliance,Premier,,180.48,,,,,,,175.14,381.56,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier,,1720.54,,,,,,,1669.61,3637.50,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier,TC,593.43,,,,,,,418.50,811.89,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier,,1055.38,,,,,,,1024.14,2231.25,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3912.30000,3716.68000,The Alliance,Premier,,1850.52,,,,,,,1795.75,3912.30,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Premier,,10826.97,,,,,,,10506.51,22890.00,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,509.06000,483.61000,The Alliance,Premier,,360.92,,,,,,,44.30,493.79,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,241.50000,229.42000,The Alliance,Premier,,485.24,,,,,,,120.75,485.24,fee schedule,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Premier,,162.59,,,,,,,157.76,368.12,fee schedule,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Premier,,4821.19,,,,,,,4678.50,10192.80,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier,,12445.81,,,,,,,12077.43,26312.49,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12555.00000,11927.25000,The Alliance,Premier,,5938.52,,,,,,,5762.74,12178.35,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Premier,,212.14,,,,,,,205.86,448.50,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,outpatient,1,GM,4.80000,4.56000,The Alliance,Premier,,3.40,,,,,,,2.40,4.66,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,outpatient,1,GM,59.25000,56.29000,The Alliance,Premier,,42.01,,,,,,,29.62,57.47,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,outpatient,1,EA,12.89000,12.25000,The Alliance,Premier,,0.42900,,,,,,,0.26000,12.50,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Premier,,0.42900,,,,,,,0.26000,14.71,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,outpatient,1,EA,19.21000,18.25000,The Alliance,Premier,,0.42900,,,,,,,0.26000,18.63,fee schedule,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,outpatient,,,471.00000,447.45000,The Alliance,Premier,,1969.25,,,,,,,37.73,1969.25,fee schedule,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier,,0.35450,,,,,,,0.25000,0.48500,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,14445.56,,,,,,,249.71,14445.56,fee schedule,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier,,20208.37,,,,,,,549.28,20208.37,fee schedule,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Premier,TC,7529.89,,,,,,,726.61,7529.89,fee schedule,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Premier,,8423.93,,,,,,,347.60,8423.93,fee schedule,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier,,1799.53,,,,,,,34.43,1799.53,fee schedule,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,outpatient,,,1208.00000,1147.60000,The Alliance,Premier,,856.47,,,,,,,604.00,1171.76,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,outpatient,,,1957.00000,1859.15000,The Alliance,Premier,TC,1866.00,,,,,,,978.50,2032.87,per diem,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Premier,TC,1866.00,,,,,,,976.00,2032.87,per diem,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier,,0.74250,,,,,,,0.44500,0.86330,fee schedule,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,,128.33,,,,,,,90.50,317.72,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,,619.83,,,,,,,59.00,619.83,fee schedule,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Premier,,3263.70,,,,,,,3167.10,6900.00,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier,,714.82,,,,,,,693.66,1511.25,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24370.50000,23151.97000,The Alliance,Premier,,11527.25,,,,,,,11186.06,24370.50,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Premier,,12399.03,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier,,6085.15,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier,,6085.15,,,,,,,5905.03,12865.00,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,,1860.31,,,,,,,1805.25,3933.00,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Premier,,162.59,,,,,,,157.76,368.12,fee schedule,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier,TC,320.47,,,,,,,226.00,438.44,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,outpatient,,,23.07000,21.92000,The Alliance,Premier,,23.80,,,,,,,11.54,23.80,fee schedule,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier,,2.60,,,,,,,1.83,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,outpatient,1,EA,17.16000,16.30000,The Alliance,Premier,,12.17,,,,,,,8.58,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier,,2.47,,,,,,,1.74,3.38,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,10.40000,9.88000,The Alliance,Premier,,10.66,,,,,,,5.20,10.66,fee schedule,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,70.44000,66.92000,The Alliance,Premier,,49.94,,,,,,,35.22,68.33,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,99.47000,94.50000,The Alliance,Premier,,639.03,,,,,,,49.73,639.03,fee schedule,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,87.25000,82.89000,The Alliance,Premier,,61.86,,,,,,,43.62,84.63,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Premier,,55.59,,,,,,,39.20,76.05,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,11.78000,11.19000,The Alliance,Premier,,8.35,,,,,,,5.89,11.43,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,69.33000,65.86000,The Alliance,Premier,,49.15,,,,,,,34.66,67.25,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,36.13000,34.32000,The Alliance,Premier,,25.62,,,,,,,18.07,35.05,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,153.40000,145.73000,The Alliance,Premier,,108.76,,,,,,,76.70,148.80,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Premier,,21.65,,,,,,,15.27,29.61,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier,,104.93,,,,,,,74.00,143.56,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,209.31000,198.84000,The Alliance,Premier,,148.40,,,,,,,104.66,203.03,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Premier,,114.08,,,,,,,80.45,156.07,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,40.67000,38.64000,The Alliance,Premier,,28.84,,,,,,,20.34,39.45,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,49.47000,47.00000,The Alliance,Premier,,35.07,,,,,,,24.73,47.99,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,370.50000,351.97000,The Alliance,Premier,,262.68,,,,,,,185.25,359.38,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.20000,41.04000,The Alliance,Premier,,30.63,,,,,,,21.60,41.90,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Premier,,42.26,,,,,,,29.80,57.81,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier,,11.34,,,,,,,8.00,15.52,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,182.76000,173.62000,The Alliance,Premier,,129.58,,,,,,,91.38,177.28,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,15.60000,14.82000,The Alliance,Premier,NU,16.05,,,,,,,7.80,16.05,fee schedule,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,80.44000,76.42000,The Alliance,Premier,,349.06,,,,,,,40.22,349.06,fee schedule,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,outpatient,,,20.27000,19.26000,The Alliance,Premier,,14.37,,,,,,,10.13,19.66,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.68000,92.80000,The Alliance,Premier,,69.26,,,,,,,48.84,94.75,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier,,40.68,,,,,,,39.40,76.44,fee schedule,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Premier,,45.72,,,,,,,32.24,62.55,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,89.56000,85.08000,The Alliance,Premier,,63.50,,,,,,,44.78,86.87,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,671.26000,637.70000,The Alliance,Premier,,475.92,,,,,,,335.63,651.12,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,104.10000,98.89000,The Alliance,Premier,,73.81,,,,,,,52.05,100.98,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,outpatient,,,66.50000,63.17000,The Alliance,Premier,NU,58.21,,,,,,,33.25,64.50,fee schedule,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,100.08000,95.08000,The Alliance,Premier,,232.52,,,,,,,50.04,232.52,fee schedule,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Premier,,21.65,,,,,,,15.27,29.61,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,19.97000,18.97000,The Alliance,Premier,,9.45,,,,,,,9.17,19.37,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,20.30000,19.28000,The Alliance,Premier,,14.39,,,,,,,10.15,19.69,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,23.33000,22.16000,The Alliance,Premier,,2.82,,,,,,,2.63,22.63,fee schedule,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,268.98000,255.53000,The Alliance,Premier,,190.71,,,,,,,134.49,260.91,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,21.70000,20.61000,The Alliance,Premier,,15.39,,,,,,,10.85,21.05,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,321.94000,305.84000,The Alliance,Premier,NU,75.83,,,,,,,70.83,312.28,fee schedule,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,79.20000,75.24000,The Alliance,Premier,,56.15,,,,,,,39.60,76.82,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,276.53000,262.70000,The Alliance,Premier,,196.06,,,,,,,138.26,268.23,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,401.25000,381.19000,The Alliance,Premier,,284.49,,,,,,,200.62,389.21,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,82.24,,,,,,,58.00,112.52,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,359.81000,341.82000,The Alliance,Premier,,255.11,,,,,,,179.91,349.02,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,702.00000,666.90000,The Alliance,Premier,,497.72,,,,,,,351.00,680.94,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,outpatient,,,251.80000,239.21000,The Alliance,Premier,,119.10,,,,,,,115.58,244.25,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,92.71,,,,,,,89.96,190.12,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier,,225.27,,,,,,,218.60,461.96,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,70.95,,,,,,,68.85,145.50,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,517.50000,491.62000,The Alliance,Premier,,244.78,,,,,,,237.53,501.98,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,13.80000,13.11000,The Alliance,Premier,,9.78,,,,,,,6.90,13.39,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,351.10000,333.54000,The Alliance,Premier,,248.93,,,,,,,175.55,340.57,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier,,28.36,,,,,,,20.00,38.80,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier,,183.63,,,,,,,129.50,251.23,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier,,176.81,,,,,,,124.69,241.90,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,181.40000,172.33000,The Alliance,Premier,,85.80,,,,,,,83.26,175.96,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,outpatient,,,18.56000,17.63000,The Alliance,Premier,,8.78,,,,,,,8.52,18.00,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,195.08000,185.33000,The Alliance,Premier,,92.27,,,,,,,89.54,189.23,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier,,112.80,,,,,,,105.37,545.62,fee schedule,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,59.90000,56.90000,The Alliance,Premier,,65.22,,,,,,,29.95,65.22,fee schedule,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,584.33000,555.11000,The Alliance,Premier,,414.29,,,,,,,292.17,566.80,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,outpatient,,,356.30000,338.48000,The Alliance,Premier,,252.62,,,,,,,178.15,345.61,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier,,147.22,,,,,,,142.86,301.91,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier,,94.01,,,,,,,91.23,192.79,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,55.07000,52.32000,The Alliance,Premier,,39.04,,,,,,,27.54,53.42,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,926.00000,879.70000,The Alliance,Premier,,656.53,,,,,,,463.00,898.22,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,596.00000,566.20000,The Alliance,Premier,,281.91,,,,,,,273.56,578.12,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,228.79000,217.35000,The Alliance,Premier,,162.21,,,,,,,114.39,221.93,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,263.81000,250.62000,The Alliance,Premier,NU,67.47,,,,,,,62.66,255.90,fee schedule,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,87.08000,82.73000,The Alliance,Premier,,135.57,,,,,,,43.54,135.57,fee schedule,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,,73.79,,,,,,,71.60,151.32,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,25.10000,23.84000,The Alliance,Premier,,17.80,,,,,,,12.55,24.35,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,100.44000,95.42000,The Alliance,Premier,,40.68,,,,,,,39.47,97.43,fee schedule,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,98.67000,93.74000,The Alliance,Premier,,69.96,,,,,,,49.34,95.71,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Premier,,359.46,,,,,,,253.50,491.79,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Premier,,117.51,,,,,,,85.60,166.06,fee schedule,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,159.90000,151.90000,The Alliance,Premier,,113.37,,,,,,,44.30,155.10,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,231.38000,219.81000,The Alliance,Premier,,109.44,,,,,,,106.20,224.44,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,,147.47,,,,,,,104.00,201.76,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier,,138.96,,,,,,,98.00,190.12,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,39.80000,37.81000,The Alliance,Premier,,28.22,,,,,,,19.90,38.61,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,193.71000,184.02000,The Alliance,Premier,,91.62,,,,,,,88.91,187.90,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier,,130.46,,,,,,,92.00,178.48,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Premier,,40.68,,,,,,,37.06,71.91,fee schedule,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Premier,,236.10,,,,,,,166.50,323.01,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,5.67,,,,,,,4.00,7.76,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,2.82,,,,,,,2.63,6.47,fee schedule,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier,,2.82,,,,,,,2.63,37.76,fee schedule,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,41.33000,39.26000,The Alliance,Premier,,29.30,,,,,,,20.66,40.09,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,21.47000,20.40000,The Alliance,Premier,,10.16,,,,,,,9.85,20.83,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,197.33000,187.46000,The Alliance,Premier,,139.91,,,,,,,98.67,191.41,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,267.68000,254.30000,The Alliance,Premier,,126.61,,,,,,,122.87,259.65,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.44000,28.92000,The Alliance,Premier,,21.58,,,,,,,15.22,29.53,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,65.22,,,,,,,3.33,65.22,fee schedule,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier,,157.86,,,,,,,153.19,323.74,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,51.63000,49.05000,The Alliance,Premier,,24.42,,,,,,,23.70,50.08,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Premier,,18.15,,,,,,,12.80,24.83,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,,40.68,,,,,,,39.47,175.76,fee schedule,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,254.66000,241.93000,The Alliance,Premier,,180.55,,,,,,,127.33,247.02,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.33000,92.46000,The Alliance,Premier,,69.01,,,,,,,48.66,94.41,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.40000,15.58000,The Alliance,Premier,,36.65,,,,,,,8.20,36.65,fee schedule,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Premier,,232.52,,,,,,,217.19,625.76,fee schedule,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,694.00000,659.30000,The Alliance,Premier,,492.05,,,,,,,347.00,673.18,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,67.73000,64.34000,The Alliance,Premier,,48.02,,,,,,,33.87,65.70,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,83.21,,,,,,,58.00,112.52,fee schedule,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,15.70000,14.91000,The Alliance,Premier,,11.13,,,,,,,7.85,15.23,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,363.75,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,184.19000,174.98000,The Alliance,Premier,,83.21,,,,,,,77.73,178.66,fee schedule,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Premier,,232.52,,,,,,,199.97,387.94,fee schedule,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,131.96000,125.36000,The Alliance,Premier,,93.56,,,,,,,65.98,128.00,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,,492.75,,,,,,,347.50,674.15,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,381.20000,362.14000,The Alliance,Premier,,270.27,,,,,,,190.60,369.76,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,outpatient,,,2903.00000,2757.85000,The Alliance,Premier,,1373.12,,,,,,,1332.48,2815.91,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Premier,,45.72,,,,,,,32.24,62.55,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,62.72000,59.58000,The Alliance,Premier,,44.47,,,,,,,31.36,60.84,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,108.80000,103.36000,The Alliance,Premier,,77.14,,,,,,,54.40,105.54,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,179.28000,170.32000,The Alliance,Premier,,127.11,,,,,,,89.64,173.90,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,88.50000,84.08000,The Alliance,Premier,,62.75,,,,,,,44.25,85.84,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier,,52.47,,,,,,,37.00,71.78,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.36000,41.19000,The Alliance,Premier,,30.74,,,,,,,21.68,42.06,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,49.88000,47.39000,The Alliance,Premier,,35.36,,,,,,,24.94,48.38,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,386.21000,366.90000,The Alliance,Premier,,273.82,,,,,,,193.10,374.62,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,99.26,,,,,,,70.00,135.80,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,3.62000,3.44000,The Alliance,Premier,,2.57,,,,,,,1.81,3.51,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,326.25000,309.94000,The Alliance,Premier,,231.31,,,,,,,163.12,316.46,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,356.81000,338.97000,The Alliance,Premier,NU,67.47,,,,,,,62.66,346.11,fee schedule,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,104.83000,99.59000,The Alliance,Premier,,74.32,,,,,,,52.41,101.69,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier,,409.80,,,,,,,289.00,560.66,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier,,72.71,,,,,,,67.53,218.25,fee schedule,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,314.21000,298.50000,The Alliance,Premier,,121.81,,,,,,,113.78,304.78,fee schedule,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,29.47000,28.00000,The Alliance,Premier,,12.37,,,,,,,11.56,28.59,fee schedule,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,1683.30000,1599.13000,The Alliance,Premier,,1193.46,,,,,,,841.65,1632.80,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,92.30000,87.68000,The Alliance,Premier,,65.44,,,,,,,46.15,89.53,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,58.68000,55.75000,The Alliance,Premier,,41.60,,,,,,,29.34,56.92,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,,42.54,,,,,,,30.00,58.20,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,14.13000,13.42000,The Alliance,Premier,,6.68,,,,,,,6.49,13.71,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier,,11.34,,,,,,,8.00,15.52,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Premier,,431.60,,,,,,,304.37,590.48,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Premier,,36.30,,,,,,,25.60,49.66,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier,,98.18,,,,,,,45.34,98.18,fee schedule,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Premier,,65.22,,,,,,,19.76,65.22,fee schedule,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,192.18000,182.57000,The Alliance,Premier,NU,67.47,,,,,,,62.66,186.41,fee schedule,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Premier,,117.51,,,,,,,85.60,166.06,fee schedule,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,57.96000,55.06000,The Alliance,Premier,,41.09,,,,,,,28.98,56.22,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,95.32000,90.55000,The Alliance,Premier,,103.42,,,,,,,47.66,103.42,fee schedule,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier,,6.38,,,,,,,4.50,8.73,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,335.63000,318.85000,The Alliance,Premier,,237.96,,,,,,,167.81,325.56,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier,,23.40,,,,,,,16.50,32.01,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Premier,,232.52,,,,,,,217.19,625.76,fee schedule,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Premier,,309.45,,,,,,,218.23,423.37,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,outpatient,,,51.48000,48.91000,The Alliance,Premier,,36.50,,,,,,,25.74,49.94,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,,492.75,,,,,,,347.50,674.15,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,outpatient,,,29.04000,27.59000,The Alliance,Premier,,13.74,,,,,,,13.33,28.17,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,145.36000,138.09000,The Alliance,Premier,,117.51,,,,,,,72.68,141.00,fee schedule,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,11.20000,10.64000,The Alliance,Premier,,2.82,,,,,,,2.63,10.86,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Premier,,78.87,,,,,,,26.79,78.87,fee schedule,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Premier,90,253.11,,,,,,,28.07,346.29,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,446.70000,424.36000,The Alliance,Premier,,316.71,,,,,,,63.95,788.42,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,outpatient,1,mL,0.91000,0.87000,The Alliance,Premier,,0.64519,,,,,,,0.45500,1.49,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,outpatient,,,2376.00000,2257.20000,The Alliance,Premier,,7803.00,,,,,,,1306.80,7803.00,case rate,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,455.36000,432.59000,The Alliance,Premier,,43.05,,,,,,,36.03,441.70,fee schedule,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier,,43.05,,,,,,,36.03,261.44,fee schedule,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,outpatient,,,176.02000,167.22000,The Alliance,Premier,,124.80,,,,,,,88.01,170.74,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,outpatient,,,3030.00000,2878.50000,The Alliance,Premier,TC,2148.27,,,,,,,1515.00,2939.10,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,75.68,,,,,,,73.44,160.00,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,38272.50000,36358.88000,The Alliance,Premier,,18102.89,,,,,,,17567.08,38272.50,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,outpatient,,,981.00000,931.95000,The Alliance,Premier,,695.53,,,,,,,539.55,5271.00,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier,,14.89,,,,,,,10.50,74.34,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,419.33000,398.36000,The Alliance,Premier,NU,67.47,,,,,,,62.66,406.75,fee schedule,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,outpatient,1,EA,34562.60000,32834.47000,The Alliance,Premier,,6225.20,,,,,,,3772.85,33525.72,fee schedule,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Premier,,4948.76,,,,,,,4802.29,10462.50,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Premier,,155.84,,,,,,,109.90,213.21,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier,,3671.66,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Premier,,14252.44,,,,,,,13830.59,30132.00,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier,TC,77.28,,,,,,,54.50,105.73,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,outpatient,1,EA,5576.35000,5297.53000,The Alliance,Premier,,49.50,,,,,,,30.00,5409.06,fee schedule,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,outpatient,1,EA,3147.55000,2990.17000,The Alliance,Premier,,23.23,,,,,,,14.08,3053.12,fee schedule,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,outpatient,1,EA,2760.00000,2622.00000,The Alliance,Premier,,23.23,,,,,,,14.08,2677.20,fee schedule,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier,,567.60,,,,,,,550.80,1200.00,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,outpatient,,,11573.00000,10994.35000,The Alliance,Premier,,8205.26,,,,,,,4607.00,11225.81,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier,,2692.55,,,,,,,2612.86,5692.50,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27304.80000,25939.56000,The Alliance,Premier,,12915.17,,,,,,,12532.90,27304.80,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Premier,,2659.05,,,,,,,96.44,2659.05,fee schedule,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,outpatient,1,GM,1230.25000,1168.74000,The Alliance,Premier,,872.25,,,,,,,615.12,1193.34,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Premier,,3.73,,,,,,,3.62,153.26,fee schedule,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,outpatient,1,EA,111.42000,105.85000,The Alliance,Premier,,14.88,,,,,,,12.72,108.08,fee schedule,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,outpatient,1,EA,130.19000,123.68000,The Alliance,Premier,,14.88,,,,,,,12.72,126.28,fee schedule,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier,,1.35,,,,,,,0.95000,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier,,1.47,,,,,,,1.03,2.01,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier,,8.58,,,,,,,0.60000,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier,,8.58,,,,,,,2.85,15.80,fee schedule,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,outpatient,1,EA,736.75000,699.91000,The Alliance,Premier,,522.36,,,,,,,368.38,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,outpatient,1,EA,769.75000,731.26000,The Alliance,Premier,,545.75,,,,,,,384.88,746.66,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Premier,,807.06,,,,,,,783.17,1706.25,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier,,6120.34,,,,,,,5939.18,12939.40,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,292.67,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier,,150.77,,,,,,,146.31,318.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier,,19270.02,,,,,,,18699.66,40740.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier,,112.81,,,,,,,109.47,238.50,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Premier,,104.65,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,230.10000,218.59000,The Alliance,Premier,,108.84,,,,,,,105.62,230.10,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier,,253.65,,,,,,,246.14,536.25,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier,TC,1645.00,,,,,,,72.50,1820.00,per diem,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,outpatient,,,68.34000,64.92000,The Alliance,Premier,,48.45,,,,,,,34.17,137.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,outpatient,1,EA,136.68000,129.85000,The Alliance,Premier,,96.91,,,,,,,68.34,137.03,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,outpatient,1,EA,269.42000,255.95000,The Alliance,Premier,,191.02,,,,,,,134.71,261.34,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,outpatient,1,EA,1846.15000,1753.84000,The Alliance,Premier,,1308.92,,,,,,,14.79,1790.77,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,outpatient,1,GM,66.04000,62.74000,The Alliance,Premier,,46.82,,,,,,,33.02,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,outpatient,1,GM,115.79000,110.00000,The Alliance,Premier,,82.10,,,,,,,57.90,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,outpatient,1,GM,18.26000,17.35000,The Alliance,Premier,,12.95,,,,,,,9.13,17.71,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,outpatient,1,mL,129.01000,122.56000,The Alliance,Premier,,91.47,,,,,,,64.50,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,outpatient,1,mL,112.05000,106.45000,The Alliance,Premier,,79.44,,,,,,,56.02,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,outpatient,1,mL,80.89000,76.85000,The Alliance,Premier,,57.35,,,,,,,40.45,78.46,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,outpatient,1,mL,12896.29000,12251.47000,The Alliance,Premier,,641.57,,,,,,,388.83,12509.40,fee schedule,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,outpatient,1,mL,11683.35000,11099.18000,The Alliance,Premier,,641.57,,,,,,,388.83,11332.85,fee schedule,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,outpatient,1,mL,728.31000,691.89000,The Alliance,Premier,,2271.70,,,,,,,364.15,2397.95,fee schedule,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,outpatient,1,mL,1149.90000,1092.40000,The Alliance,Premier,,2271.70,,,,,,,574.95,2397.95,fee schedule,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,outpatient,1,mL,81.79000,77.70000,The Alliance,Premier,,57.99,,,,,,,40.90,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,outpatient,1,mL,75.33000,71.57000,The Alliance,Premier,,53.41,,,,,,,37.66,73.07,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,outpatient,1,mL,2474.98000,2351.23000,The Alliance,Premier,,5.49,,,,,,,3.33,2400.73,fee schedule,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,outpatient,1,mL,2500.42000,2375.40000,The Alliance,Premier,,5.49,,,,,,,3.33,2425.41,fee schedule,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,outpatient,1,mL,49140.33000,46683.32000,The Alliance,Premier,,60.49,,,,,,,36.66,47666.12,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,outpatient,1,mL,414.62000,393.89000,The Alliance,Premier,,48.34,,,,,,,29.30,402.18,fee schedule,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,outpatient,1,mL,32751.19000,31113.63000,The Alliance,Premier,,208.30,,,,,,,126.24,31768.65,fee schedule,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier,,1876.63,,,,,,,1821.08,3967.50,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier,,4.44,,,,,,,3.13,6.07,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier,,0.06600,,,,,,,0.06045,1.89,fee schedule,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,outpatient,1,mL,3.72000,3.53000,The Alliance,Premier,,2.71,,,,,,,1.86,3.61,fee schedule,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier,TC,1272.59,,,,,,,120.00,1272.59,fee schedule,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier,,158.11,,,,,,,122.65,5271.00,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier,,3182.11,,,,,,,3087.92,6727.50,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,outpatient,1,EA,6334.20000,6017.49000,The Alliance,Premier,,60.49,,,,,,,36.66,6144.17,fee schedule,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,outpatient,1,EA,8023.11000,7621.96000,The Alliance,Premier,,69.23,,,,,,,41.96,7782.42,fee schedule,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,outpatient,1,EA,22092.57000,20987.94000,The Alliance,Premier,,69.23,,,,,,,41.96,21429.79,fee schedule,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,outpatient,1,EA,3037.03000,2885.18000,The Alliance,Premier,,71.41,,,,,,,43.25,2945.92,fee schedule,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,outpatient,1,mL,2458.76000,2335.82000,The Alliance,Premier,,12.67,,,,,,,7.68,2385.00,fee schedule,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,outpatient,1,mL,3612.56000,3431.94000,The Alliance,Premier,,32.75,,,,,,,19.85,3504.18,fee schedule,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier,,6.52,,,,,,,3.48,6.74,fee schedule,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.49,fee schedule,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,outpatient,1,mL,2.93000,2.78000,The Alliance,Premier,,0.09900,,,,,,,0.08525,2.84,fee schedule,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,outpatient,1,mL,399.99000,379.99000,The Alliance,Premier,,136.72,,,,,,,82.86,387.99,fee schedule,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,outpatient,1,mL,400.00000,380.00000,The Alliance,Premier,,136.72,,,,,,,82.86,388.00,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Premier,,4.49,,,,,,,3.21,6.22,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier,,4.49,,,,,,,1.74,5.23,fee schedule,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier,,43.73,,,,,,,26.50,219.71,fee schedule,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,46.23,,,,,,,0.69500,55.44,fee schedule,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Premier,,224.47,,,,,,,136.04,12824.21,fee schedule,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.14850,,,,,,,0.14409,0.92150,fee schedule,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,outpatient,1,EA,56.21000,53.40000,The Alliance,Premier,,39.85,,,,,,,28.11,54.52,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier,,335.36,,,,,,,63.95,788.42,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier,,100.82,,,,,,,37.52,137.93,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier,,0.47503,,,,,,,0.33500,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,TC,21.27,,,,,,,15.00,29.10,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier,TC,493.46,,,,,,,348.00,675.12,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,outpatient,,,71.65000,68.07000,The Alliance,Premier,,48.17,,,,,,,35.83,69.50,fee schedule,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier,,3963.00,,,,,,,420.20,4686.00,case rate,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier,TC,4555.93,,,,,,,422.60,17311.25,fee schedule,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier,,30.49,,,,,,,23.65,5271.00,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,2185.85,,,,,,,1695.65,5271.00,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,outpatient,,,94.77000,90.03000,The Alliance,Premier,,937.00,,,,,,,52.12,5858.00,case rate,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Premier,,16.80,,,,,,,11.85,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,outpatient,1,mL,7.81000,7.41000,The Alliance,Premier,,5.54,,,,,,,3.90,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,outpatient,1,mL,14.71000,13.98000,The Alliance,Premier,,10.43,,,,,,,7.36,14.27,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Premier,TC,14413.40,,,,,,,1334.13,14413.40,fee schedule,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier,,106944.98,,,,,,,1299.22,106944.98,fee schedule,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier,,2326.41,,,,,,,1640.62,3182.81,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Premier,,3753.26,,,,,,,3642.16,7935.00,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier,,1387.90,,,,,,,1346.83,2934.26,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1845.00000,1752.75000,The Alliance,Premier,,872.68,,,,,,,846.86,1845.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,360.00000,342.00000,The Alliance,Premier,,170.28,,,,,,,165.24,360.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier,,101.99,,,,,,,98.97,215.63,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier,,112.81,,,,,,,109.47,238.50,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier,,2935.70,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1713.75000,1628.06000,The Alliance,Premier,,810.60,,,,,,,786.61,1713.75,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Premier,,0.34032,,,,,,,0.24000,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier,,0.58138,,,,,,,0.41000,0.79540,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier,,1.68,,,,,,,1.19,2.30,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,outpatient,1,EA,76.72000,72.89000,The Alliance,Premier,,0.42900,,,,,,,0.26000,74.42,fee schedule,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,outpatient,1,EA,4092.00000,3887.40000,The Alliance,Premier,,25.66,,,,,,,15.55,3969.24,fee schedule,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier,TC,4635.02,,,,,,,380.50,4635.02,fee schedule,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,outpatient,1,EA,34.64000,32.91000,The Alliance,Premier,,24.56,,,,,,,17.32,33.60,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier,,2.62,,,,,,,2.55,229.89,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,outpatient,1,EA,1548.82000,1471.38000,The Alliance,Premier,,2.62,,,,,,,2.55,1502.36,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier,,2.62,,,,,,,2.55,628.08,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,outpatient,1,EA,738.15000,701.24000,The Alliance,Premier,,2.62,,,,,,,2.55,716.01,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,outpatient,1,EA,582.75000,553.61000,The Alliance,Premier,,2.62,,,,,,,2.55,565.27,fee schedule,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier,90,1341.13,,,,,,,28.00,1341.13,fee schedule,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,outpatient,,,84.60000,80.37000,The Alliance,Premier,90,305.58,,,,,,,20.20,305.58,fee schedule,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier,,345.28,,,,,,,63.95,788.42,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,outpatient,1,EA,6.13000,5.83000,The Alliance,Premier,,4.35,,,,,,,3.06,5.95,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,11473.16,per diem,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier,TC,4635.02,,,,,,,380.50,4635.02,fee schedule,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,outpatient,,,2963.00000,2814.85000,The Alliance,Premier,,3963.00,,,,,,,1538.48,4686.00,case rate,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,676.99000,643.14000,The Alliance,Premier,,320.22,,,,,,,310.74,676.99,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier,,0.74250,,,,,,,0.44500,0.86330,fee schedule,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,168.51,,,,,,,163.52,356.25,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier,TC,6003.00,,,,,,,820.60,6003.00,case rate,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Premier,,983.37,,,,,,,954.26,2079.00,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,7859.04,,,,,,,103.97,7859.04,fee schedule,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier,,61.38,,,,,,,59.56,129.76,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Premier,TC,2941.42,,,,,,,324.00,2941.42,fee schedule,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier,,2937.33,,,,,,,2850.39,6210.00,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier,,12445.81,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier,,1055.38,,,,,,,1024.14,2231.25,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2388.60000,2269.17000,The Alliance,Premier,,1129.81,,,,,,,1096.37,2388.60,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Premier,,151.28,,,,,,,146.81,319.84,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier,,3182.11,,,,,,,3087.92,6727.50,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier,,7684.23,,,,,,,422.60,17311.25,fee schedule,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Premier,,4276.69,,,,,,,2194.62,5851.04,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Premier,,6146.32,,,,,,,4334.50,8408.93,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,outpatient,,,137.23000,130.37000,The Alliance,Premier,,97.30,,,,,,,68.61,133.11,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier,,4.31,,,,,,,0.36500,4.31,fee schedule,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,outpatient,1,GM,31.19000,29.63000,The Alliance,Premier,,22.11,,,,,,,15.60,30.25,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Premier,TC,51844.17,,,,,,,5057.86,51844.17,fee schedule,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,outpatient,1,EA,288.61000,274.18000,The Alliance,Premier,,204.62,,,,,,,144.31,279.95,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier,,1328.67,,,,,,,937.00,1817.78,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Premier,TC,2314.18,,,,,,,1527.07,3166.08,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3487.31000,3312.94000,The Alliance,Premier,,1649.50,,,,,,,1600.68,3487.31,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1342.24,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier,,867.15,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2276.25000,2162.44000,The Alliance,Premier,,1076.67,,,,,,,1044.80,2276.25,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier,,12445.81,,,,,,,12077.43,26312.49,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Premier,,212.14,,,,,,,205.86,448.50,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Premier,,4276.69,,,,,,,2194.62,5851.04,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier,,1426.10,,,,,,,1383.88,3015.00,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,outpatient,,,3408.00000,3237.60000,The Alliance,Premier,TC,2416.27,,,,,,,1704.00,3305.76,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,outpatient,1,EA,19551.00000,18573.45000,The Alliance,Premier,,4.37,,,,,,,2.65,18964.47,fee schedule,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10121.50000,9615.42000,The Alliance,Premier,,4787.47,,,,,,,4645.77,10121.50,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier,,1216.68,,,,,,,5.99,1216.68,fee schedule,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,32.61,,,,,,,5.83,44.62,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,outpatient,1,EA,250.52000,238.00000,The Alliance,Premier,,177.62,,,,,,,125.26,243.00,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,outpatient,1,EA,90046.64000,85544.31000,The Alliance,Premier,,75174.64,,,,,,,45023.32,87345.24,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,outpatient,1,EA,1289.61000,1225.13000,The Alliance,Premier,,8.56,,,,,,,5.19,1250.92,fee schedule,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,outpatient,1,mL,4.70000,4.46000,The Alliance,Premier,,3.33,,,,,,,1.49,4.56,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier,,0.18434,,,,,,,0.13000,0.25220,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,outpatient,,,6.70000,6.36000,The Alliance,Premier,,4.75,,,,,,,3.35,6.50,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,outpatient,,,1803.00000,1712.85000,The Alliance,Premier,,1278.33,,,,,,,283.85,1748.91,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier,,625.12,,,,,,,421.88,818.44,fee schedule,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,outpatient,1,EA,51.13000,48.57000,The Alliance,Premier,,36.25,,,,,,,25.57,49.60,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,outpatient,1,mL,2753.56000,2615.88000,The Alliance,Premier,,66.92,,,,,,,40.56,2670.95,fee schedule,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier,,34.40,,,,,,,33.32,148.12,fee schedule,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier,,4.22,,,,,,,3.96,8.73,fee schedule,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,outpatient,1,mL,51.13000,48.57000,The Alliance,Premier,,36.25,,,,,,,25.57,49.60,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Premier,,371.56,,,,,,,225.19,4762.44,fee schedule,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,30.67,,,,,,,23.00,44.62,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,0.70950,,,,,,,0.43000,18.39,fee schedule,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier,,1714.64,,,,,,,46.00,1714.64,fee schedule,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,outpatient,1,EA,8520.12000,8094.11000,The Alliance,Premier,,4.37,,,,,,,2.65,8264.52,fee schedule,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,outpatient,1,mL,7.49000,7.11000,The Alliance,Premier,,5.31,,,,,,,3.75,7.27,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Premier,,1.49,,,,,,,1.02,2.64,fee schedule,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,outpatient,,,322.90000,306.75000,The Alliance,Premier,,228.94,,,,,,,23.25,313.21,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,153.86,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,outpatient,1,mL,147.89000,140.49000,The Alliance,Premier,,67.98,,,,,,,64.92,143.45,fee schedule,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,453.75000,431.06000,The Alliance,Premier,,214.62,,,,,,,208.27,440.14,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,400.12,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,113.44,,,,,,,80.00,155.20,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Premier,,18.69,,,,,,,18.14,39.52,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Premier,,1814.62,,,,,,,1760.91,3836.40,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier,,7859.04,,,,,,,103.97,7859.04,fee schedule,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier,,10256.77,,,,,,,9953.19,21684.50,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Premier,,1814.62,,,,,,,1760.91,3836.40,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,17391.00000,16521.45000,The Alliance,Premier,,8225.94,,,,,,,7982.47,17391.00,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Premier,,4389.68,,,,,,,4259.75,9280.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,outpatient,1,mL,1032.24000,980.63000,The Alliance,Premier,,731.86,,,,,,,347.32,1001.27,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,outpatient,1,mL,453.41000,430.74000,The Alliance,Premier,,188.89,,,,,,,114.48,439.81,fee schedule,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,outpatient,1,mL,20.79000,19.75000,The Alliance,Premier,,11.10,,,,,,,6.35,20.17,fee schedule,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,7334.70000,6967.96000,The Alliance,Premier,,3469.31,,,,,,,3366.63,7334.70,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,3086.00000,2931.70000,The Alliance,Premier,,2187.97,,,,,,,557.65,2993.42,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,outpatient,1,mL,299.83000,284.84000,The Alliance,Premier,,121.09,,,,,,,114.64,290.84,fee schedule,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,,3038.81,,,,,,,62.14,3038.81,fee schedule,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier,,375.06,,,,,,,63.95,788.42,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Premier,,477.16,,,,,,,98.39,1078.91,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,outpatient,,,1508.00000,1432.60000,The Alliance,Premier,,1069.17,,,,,,,132.80,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1840.00000,1748.00000,The Alliance,Premier,,1304.56,,,,,,,172.18,1784.80,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,outpatient,,,350.40000,332.88000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1383.41000,1314.24000,The Alliance,Premier,,654.35,,,,,,,634.99,1383.41,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,81.96000,77.86000,The Alliance,Premier,,38.77,,,,,,,37.62,81.96,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,288.60000,274.17000,The Alliance,Premier,,136.51,,,,,,,132.47,288.60,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Premier,,16304.03,,,,,,,15821.45,33435.32,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Premier,,5583.67,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier,,1985.96,,,,,,,1927.18,4198.65,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier,TC,387.82,,,,,,,273.50,1232.72,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier,,1985.96,,,,,,,1927.18,4198.65,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Premier,,6598.35,,,,,,,6403.05,13950.00,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier,,5365.19,,,,,,,5206.39,11342.90,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,1596.38,,,,,,,1549.12,3375.00,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10741.50000,10204.42000,The Alliance,Premier,,5080.73,,,,,,,4930.35,10741.50,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier,,12445.81,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Premier,,1108.59,,,,,,,1075.78,2343.75,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier,,1463.34,,,,,,,1420.03,3093.75,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Premier,,4838.79,,,,,,,4695.57,9923.10,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2568.75000,2440.31000,The Alliance,Premier,,1215.02,,,,,,,1179.06,2568.75,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,286.88000,272.54000,The Alliance,Premier,,135.69,,,,,,,131.68,286.88,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,29826.53000,28335.20000,The Alliance,Premier,,14107.95,,,,,,,13690.38,29826.53,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13814.10000,13123.40000,The Alliance,Premier,,6534.07,,,,,,,6340.67,13814.10,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Premier,,2206.26,,,,,,,2140.96,4664.40,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier,,152.88,,,,,,,107.81,209.16,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier,,0.19800,,,,,,,0.14415,0.57230,fee schedule,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,outpatient,1,EA,2879.90000,2735.90000,The Alliance,Premier,,18.15,,,,,,,11.00,2793.50,fee schedule,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,outpatient,1,mL,22.09000,20.98000,The Alliance,Premier,,37.80,,,,,,,11.04,37.80,fee schedule,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Premier,,10.51,,,,,,,7.41,14.38,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,outpatient,1,EA,4547.65000,4320.27000,The Alliance,Premier,,3486.85,,,,,,,2113.24,4411.22,fee schedule,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Premier,,2000.65,,,,,,,1941.43,4229.70,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier,,21154.31,,,,,,,20528.18,43381.99,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Premier,,5583.67,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,64.33,,,,,,,62.42,136.00,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier,,1369.34,,,,,,,1328.81,2895.00,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Premier,,62.38,,,,,,,60.53,131.88,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Premier,,62.38,,,,,,,60.53,131.88,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier,,0.28050,,,,,,,0.06500,0.34860,fee schedule,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.28050,,,,,,,0.08000,0.34860,fee schedule,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier,,10256.77,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier,,1.88,,,,,,,1.32,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier,,2.72,,,,,,,1.92,3.72,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,outpatient,1,mL,436.17000,414.36000,The Alliance,Premier,,309.24,,,,,,,218.09,423.08,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,outpatient,1,mL,1265.76000,1202.47000,The Alliance,Premier,,897.42,,,,,,,632.88,1227.79,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,3.02,15.33,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier,,381.36,,,,,,,370.07,806.25,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Premier,,14756.46,,,,,,,14319.70,31197.60,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10551.84000,10024.25000,The Alliance,Premier,,4991.02,,,,,,,4843.29,10551.84,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier,,3888.16,,,,,,,3773.08,8220.21,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Premier,,23.77,,,,,,,1.49,32.51,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,outpatient,1,EA,82.92000,78.77000,The Alliance,Premier,,0.79200,,,,,,,0.76415,80.43,fee schedule,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier,,0.79200,,,,,,,0.56500,1.10,fee schedule,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier,,0.41122,,,,,,,0.29000,0.56260,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier,,4865.18,,,,,,,4721.18,10285.80,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,outpatient,1,EA,62.19000,59.08000,The Alliance,Premier,,8.37,,,,,,,7.82,60.32,fee schedule,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier,,4865.18,,,,,,,4721.18,10285.80,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,14312.70000,13597.07000,The Alliance,Premier,,6769.91,,,,,,,6569.53,14312.70,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,outpatient,1,mL,1746.98000,1659.63000,The Alliance,Premier,,1238.61,,,,,,,873.49,1694.57,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,outpatient,1,mL,2.87000,2.73000,The Alliance,Premier,,2.03,,,,,,,1.44,2.78,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,outpatient,1,mL,3.19000,3.03000,The Alliance,Premier,,2.26,,,,,,,1.59,3.09,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,outpatient,1,mL,3836.56000,3644.73000,The Alliance,Premier,,2720.12,,,,,,,1918.28,3721.46,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,4.06,,,,,,,0.01500,4.06,fee schedule,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3360.00000,3192.00000,The Alliance,Premier,,1589.28,,,,,,,1542.24,3360.00,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,712.50000,676.88000,The Alliance,Premier,,337.01,,,,,,,327.04,712.50,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,outpatient,1,mL,69.71000,66.22000,The Alliance,Premier,,12.49,,,,,,,7.57,67.62,fee schedule,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Premier,,1.91,,,,,,,1.16,368.06,fee schedule,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,outpatient,,,155.60000,147.82000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,780.94,,,,,,,15.55,780.94,fee schedule,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,outpatient,,,257.50000,244.62000,The Alliance,Premier,90,1527.89,,,,,,,30.26,1527.89,fee schedule,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier,90,1544.85,,,,,,,30.59,1544.85,fee schedule,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,outpatient,,,211.80000,201.21000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,outpatient,,,101.60000,96.52000,The Alliance,Premier,90,72.03,,,,,,,9.64,98.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier,90,2563.44,,,,,,,50.66,2563.44,fee schedule,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,outpatient,,,130.20000,123.69000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier,90,6026.72,,,,,,,119.20,6026.72,fee schedule,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,outpatient,,,73.30000,69.63000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,outpatient,,,23.40000,22.23000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,outpatient,,,458.30000,435.38000,The Alliance,Premier,90,2563.44,,,,,,,50.66,2563.44,fee schedule,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,outpatient,,,5277.00000,5013.15000,The Alliance,Premier,90,28232.08,,,,,,,480.00,28232.08,fee schedule,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,780.94,,,,,,,15.80,780.94,fee schedule,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,outpatient,,,65.30000,62.03000,The Alliance,Premier,90,882.80,,,,,,,17.33,882.80,fee schedule,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,outpatient,,,118.10000,112.19000,The Alliance,Premier,90,696.05,,,,,,,13.89,696.05,fee schedule,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Premier,TC,3027.62,,,,,,,121.00,3027.62,fee schedule,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Premier,,4872.27,,,,,,,370.62,4872.27,fee schedule,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier,90,3186.14,,,,,,,307.50,3186.14,fee schedule,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier,90,1052.52,,,,,,,77.53,1052.52,fee schedule,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Premier,,15261.97,,,,,,,259.66,15261.97,fee schedule,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,outpatient,,,132.40000,125.78000,The Alliance,Premier,90,780.94,,,,,,,8.17,780.94,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,outpatient,,,194.30000,184.58000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,17.02,,,,,,,12.00,23.28,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,outpatient,,,645.00000,612.75000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,outpatient,,,174.70000,165.96000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,90,1137.41,,,,,,,50.00,1137.41,fee schedule,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,outpatient,,,116.90000,111.06000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1075.00000,1021.25000,The Alliance,Premier,90,6383.20,,,,,,,126.29,6383.20,fee schedule,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,outpatient,,,160.40000,152.38000,The Alliance,Premier,90,628.12,,,,,,,12.29,628.12,fee schedule,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier,90,594.19,,,,,,,8.17,594.19,fee schedule,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier,90,1137.41,,,,,,,79.00,1137.41,fee schedule,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Premier,90,3038.81,,,,,,,19.00,3038.81,fee schedule,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3810.00000,3619.50000,The Alliance,Premier,TC,16173.22,,,,,,,533.12,16173.22,fee schedule,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Premier,TC,1245.05,,,,,,,127.30,1245.05,fee schedule,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Premier,,6772.31,,,,,,,142.63,6772.31,fee schedule,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,outpatient,,,952.00000,904.40000,The Alliance,Premier,,4329.05,,,,,,,329.46,4329.05,fee schedule,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,outpatient,,,171.80000,163.21000,The Alliance,Premier,90,1069.56,,,,,,,21.00,1069.56,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.40000,303.43000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier,,339.51,,,,,,,6.48,339.51,fee schedule,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier,90,6026.72,,,,,,,119.20,6026.72,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,outpatient,,,655.00000,622.25000,The Alliance,Premier,,9523.86,,,,,,,161.92,9523.86,fee schedule,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,outpatient,,,2638.00000,2506.10000,The Alliance,Premier,90,14107.52,,,,,,,195.07,14107.52,fee schedule,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,Premier,,28232.08,,,,,,,367.50,28232.08,fee schedule,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,outpatient,,,43.30000,41.13000,The Alliance,Premier,90,254.68,,,,,,,4.91,254.68,fee schedule,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,outpatient,,,255.30000,242.54000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier,90,933.70,,,,,,,17.71,933.70,fee schedule,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,outpatient,,,227.90000,216.50000,The Alliance,Premier,90,1137.41,,,,,,,113.95,1137.41,fee schedule,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,outpatient,,,105.70000,100.41000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,outpatient,,,119.40000,113.43000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,outpatient,,,855.00000,812.25000,The Alliance,Premier,,6772.31,,,,,,,142.63,6772.31,fee schedule,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,outpatient,,,199.20000,189.24000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Premier,90,9082.50,,,,,,,157.98,9082.50,fee schedule,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,outpatient,,,95.20000,90.44000,The Alliance,Premier,90,560.26,,,,,,,11.17,560.26,fee schedule,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,outpatient,,,111.80000,106.21000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,outpatient,,,20708.00000,19672.60000,The Alliance,Premier,90,115186.20,,,,,,,8569.96,115186.20,fee schedule,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Premier,,4872.27,,,,,,,370.62,4872.27,fee schedule,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Premier,TC,16173.22,,,,,,,533.12,16173.22,fee schedule,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,outpatient,,,170.40000,161.88000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,outpatient,,,213.50000,202.82000,The Alliance,Premier,90,1324.17,,,,,,,26.09,1324.17,fee schedule,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,outpatient,,,241.80000,229.71000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,outpatient,,,459.10000,436.14000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier,90,763.98,,,,,,,14.94,763.98,fee schedule,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,outpatient,,,334.30000,317.58000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,outpatient,,,226.40000,215.08000,The Alliance,Premier,90,1392.10,,,,,,,27.67,1392.10,fee schedule,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,outpatient,,,158.90000,150.96000,The Alliance,Premier,90,950.66,,,,,,,10.38,950.66,fee schedule,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier,90,8692.03,,,,,,,179.44,8692.03,fee schedule,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,Premier,90,1969.25,,,,,,,38.99,1969.25,fee schedule,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,outpatient,,,700.00000,665.00000,The Alliance,Premier,90,3361.35,,,,,,,66.55,3361.35,fee schedule,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Premier,TC,7351.18,,,,,,,426.50,7351.18,fee schedule,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Premier,90,8250.66,,,,,,,143.40,8250.66,fee schedule,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Premier,90,9082.50,,,,,,,116.74,9082.50,fee schedule,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Premier,TC,19225.77,,,,,,,1836.07,19225.77,fee schedule,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,outpatient,,,85.70000,81.41000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,outpatient,,,10203.00000,9692.85000,The Alliance,Premier,90,7233.93,,,,,,,928.00,9896.91,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,outpatient,,,108.70000,103.26000,The Alliance,Premier,90,526.26,,,,,,,8.17,526.26,fee schedule,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier,,933.70,,,,,,,17.90,933.70,fee schedule,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,outpatient,,,205.30000,195.04000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,outpatient,,,203.40000,193.23000,The Alliance,Premier,90,679.08,,,,,,,15.10,679.08,fee schedule,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,254.68,,,,,,,4.75,254.68,fee schedule,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,outpatient,,,660.00000,627.00000,The Alliance,Premier,,467.94,,,,,,,35.91,891.44,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier,TC,2993.62,,,,,,,90.50,2993.62,fee schedule,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4707.00000,4471.65000,The Alliance,Premier,90,26177.94,,,,,,,210.00,26177.94,fee schedule,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,outpatient,,,236.40000,224.58000,The Alliance,Premier,90,1459.96,,,,,,,28.87,1459.96,fee schedule,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,outpatient,,,212.80000,202.16000,The Alliance,Premier,90,1256.24,,,,,,,24.99,1256.24,fee schedule,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,outpatient,,,172.80000,164.16000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4895.00000,4650.25000,The Alliance,Premier,90,26177.94,,,,,,,210.00,26177.94,fee schedule,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,outpatient,,,319.60000,303.62000,The Alliance,Premier,90,611.15,,,,,,,9.83,611.15,fee schedule,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier,90,696.05,,,,,,,8.17,696.05,fee schedule,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier,,169.79,,,,,,,3.48,169.79,fee schedule,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier,,1833.46,,,,,,,128.00,1833.46,fee schedule,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,Premier,TC,4266.89,,,,,,,336.00,4266.89,fee schedule,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,Premier,TC,7351.18,,,,,,,664.97,7351.18,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.10000,46.64000,The Alliance,Premier,90,220.68,,,,,,,4.49,220.68,fee schedule,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier,90,7350.89,,,,,,,70.04,7350.89,fee schedule,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,outpatient,,,290.50000,275.97000,The Alliance,Premier,90,1459.96,,,,,,,28.73,1459.96,fee schedule,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier,,7350.89,,,,,,,70.04,7350.89,fee schedule,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,outpatient,,,80.90000,76.86000,The Alliance,Premier,90,424.40,,,,,,,8.17,424.40,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier,,50.34,,,,,,,9.74,68.87,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,outpatient,,,184.30000,175.08000,The Alliance,Premier,,611.15,,,,,,,9.83,611.15,fee schedule,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,outpatient,,,199.30000,189.34000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier,90,305.58,,,,,,,5.93,305.58,fee schedule,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier,90,271.65,,,,,,,5.48,271.65,fee schedule,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,outpatient,,,81.30000,77.24000,The Alliance,Premier,90,373.51,,,,,,,7.44,373.51,fee schedule,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier,TC,16173.22,,,,,,,533.12,16173.22,fee schedule,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,outpatient,,,44.40000,42.18000,The Alliance,Premier,90,203.72,,,,,,,4.06,203.72,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,outpatient,,,106.50000,101.17000,The Alliance,Premier,90,628.12,,,,,,,12.51,628.12,fee schedule,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier,,344.57,,,,,,,35.91,891.44,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier,90,7096.21,,,,,,,100.54,7096.21,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,outpatient,,,2799.00000,2659.05000,The Alliance,Premier,90,13462.44,,,,,,,266.02,13462.44,fee schedule,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier,,339.51,,,,,,,6.47,339.51,fee schedule,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,outpatient,,,379.70000,360.71000,The Alliance,Premier,90,2105.11,,,,,,,46.38,2105.11,fee schedule,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,Premier,,394.20,,,,,,,278.00,539.32,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,outpatient,,,56.80000,53.96000,The Alliance,Premier,90,254.68,,,,,,,4.24,254.68,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Premier,90,2410.69,,,,,,,52.89,2410.69,fee schedule,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,outpatient,,,201.60000,191.52000,The Alliance,Premier,,967.70,,,,,,,18.54,967.70,fee schedule,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier,90,628.12,,,,,,,12.45,628.12,fee schedule,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,outpatient,,,211.70000,201.11000,The Alliance,Premier,90,1256.24,,,,,,,24.88,1256.24,fee schedule,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,outpatient,,,49.60000,47.12000,The Alliance,Premier,90,1052.52,,,,,,,24.80,1052.52,fee schedule,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,outpatient,,,142.10000,134.99000,The Alliance,Premier,90,662.12,,,,,,,13.00,662.12,fee schedule,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,outpatient,,,164.70000,156.46000,The Alliance,Premier,,763.98,,,,,,,15.78,763.98,fee schedule,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,outpatient,,,175.10000,166.34000,The Alliance,Premier,90,984.66,,,,,,,21.79,984.66,fee schedule,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Premier,TC,13397.25,,,,,,,1293.00,13397.25,fee schedule,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Premier,90,628.12,,,,,,,12.45,628.12,fee schedule,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,outpatient,,,259.70000,246.71000,The Alliance,Premier,90,1544.85,,,,,,,30.51,1544.85,fee schedule,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier,90,339.51,,,,,,,6.85,339.51,fee schedule,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,outpatient,,,153.70000,146.01000,The Alliance,Premier,90,713.01,,,,,,,14.05,713.01,fee schedule,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,outpatient,,,77.70000,73.82000,The Alliance,Premier,,356.54,,,,,,,6.87,356.54,fee schedule,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier,90,8692.03,,,,,,,179.44,8692.03,fee schedule,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,outpatient,,,145.40000,138.13000,The Alliance,Premier,90,1137.41,,,,,,,72.70,1137.41,fee schedule,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,outpatient,,,2846.00000,2703.70000,The Alliance,Premier,90,15227.97,,,,,,,139.23,15227.97,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,outpatient,,,455.80000,433.01000,The Alliance,Premier,,6451.13,,,,,,,109.60,6451.13,fee schedule,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,outpatient,,,792.00000,752.40000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,outpatient,,,193.40000,183.73000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier,90,15625.93,,,,,,,329.51,15625.93,fee schedule,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,outpatient,,,121.30000,115.23000,The Alliance,Premier,90,645.08,,,,,,,14.25,645.08,fee schedule,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,outpatient,,,85.30000,81.03000,The Alliance,Premier,90,509.30,,,,,,,10.02,509.30,fee schedule,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier,90,713.01,,,,,,,14.05,713.01,fee schedule,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,90,543.22,,,,,,,10.66,543.22,fee schedule,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,outpatient,,,238.60000,226.67000,The Alliance,Premier,,1137.41,,,,,,,24.11,1137.41,fee schedule,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier,90,848.80,,,,,,,16.80,848.80,fee schedule,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier,,288.61,,,,,,,5.51,288.61,fee schedule,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,outpatient,,,5712.00000,5426.40000,The Alliance,Premier,90,31763.22,,,,,,,270.25,31763.22,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,90,1205.34,,,,,,,24.43,1205.34,fee schedule,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Premier,,501.97,,,,,,,354.00,686.76,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2794.00000,2654.30000,The Alliance,Premier,TC,16173.22,,,,,,,533.12,16173.22,fee schedule,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,outpatient,,,103.50000,98.32000,The Alliance,Premier,90,611.15,,,,,,,12.16,611.15,fee schedule,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,outpatient,,,275.40000,261.63000,The Alliance,Premier,90,2082.45,,,,,,,23.08,2082.45,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier,90,984.66,,,,,,,19.60,984.66,fee schedule,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier,QW,509.30,,,,,,,9.71,509.30,fee schedule,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2906.00000,2760.70000,The Alliance,Premier,TC,16173.22,,,,,,,533.12,16173.22,fee schedule,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,outpatient,,,5428.00000,5156.60000,The Alliance,Premier,90,30184.37,,,,,,,230.26,30184.37,fee schedule,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier,90,288.61,,,,,,,5.68,372.96,fee schedule,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,outpatient,,,398.80000,378.86000,The Alliance,Premier,90,2563.44,,,,,,,50.66,2563.44,fee schedule,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Premier,,492.33,,,,,,,9.30,492.33,fee schedule,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,outpatient,,,282.30000,268.18000,The Alliance,Premier,90,1307.20,,,,,,,25.78,1307.20,fee schedule,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2560.00000,2432.00000,The Alliance,Premier,90,13462.44,,,,,,,266.02,13462.44,fee schedule,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Premier,90,42339.61,,,,,,,516.91,42339.61,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,outpatient,,,1098.00000,1043.10000,The Alliance,Premier,90,5873.90,,,,,,,73.92,5873.90,fee schedule,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,outpatient,,,1721.00000,1634.95000,The Alliance,Premier,90,9574.83,,,,,,,177.33,9574.83,fee schedule,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,outpatient,,,92.90000,88.25000,The Alliance,Premier,90,65.87,,,,,,,46.45,90.11,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,outpatient,,,283.10000,268.94000,The Alliance,Premier,90,1578.85,,,,,,,34.58,1578.85,fee schedule,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier,,1137.41,,,,,,,24.11,1137.41,fee schedule,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,outpatient,,,5721.00000,5434.95000,The Alliance,Premier,90,31831.15,,,,,,,625.03,31831.15,fee schedule,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier,TC,7351.18,,,,,,,59.50,7351.18,fee schedule,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,outpatient,,,134.60000,127.87000,The Alliance,Premier,90,679.08,,,,,,,15.10,679.08,fee schedule,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Premier,90,628.12,,,,,,,12.40,628.12,fee schedule,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,outpatient,,,654.00000,621.30000,The Alliance,Premier,90,3802.79,,,,,,,76.81,3802.79,fee schedule,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier,,645.08,,,,,,,11.89,645.08,fee schedule,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier,,1137.41,,,,,,,24.11,1137.41,fee schedule,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier,90,9048.50,,,,,,,164.96,9048.50,fee schedule,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Premier,90,8610.62,,,,,,,62.60,8610.62,fee schedule,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Premier,90,1137.41,,,,,,,108.10,1137.41,fee schedule,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier,90,1341.13,,,,,,,28.00,1341.13,fee schedule,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier,90,1137.41,,,,,,,24.91,1137.41,fee schedule,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier,90,271.65,,,,,,,5.35,372.96,fee schedule,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier,90,543.22,,,,,,,10.66,543.22,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,outpatient,,,618.00000,587.10000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,outpatient,,,345.50000,328.22000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,outpatient,,,431.20000,409.64000,The Alliance,Premier,90,2563.44,,,,,,,50.66,2563.44,fee schedule,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Premier,90,8610.62,,,,,,,62.60,8610.62,fee schedule,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier,90,9048.50,,,,,,,164.96,9048.50,fee schedule,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,outpatient,,,109.40000,103.93000,The Alliance,Premier,90,560.26,,,,,,,11.16,560.26,fee schedule,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier,TC,1411.00,,,,,,,138.83,1411.00,fee schedule,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,outpatient,,,285.50000,271.22000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier,90,1137.41,,,,,,,50.60,1137.41,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,outpatient,,,3228.00000,3066.60000,The Alliance,Premier,90,17961.21,,,,,,,103.62,17961.21,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Premier,,1786.28,,,,,,,12.05,1786.28,fee schedule,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Premier,90,1786.28,,,,,,,12.05,1786.28,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,outpatient,,,58.30000,55.38000,The Alliance,Premier,90,339.51,,,,,,,6.85,339.51,fee schedule,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,outpatient,,,100.50000,95.47000,The Alliance,Premier,,71.25,,,,,,,50.25,97.48,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4214.00000,4003.30000,The Alliance,Premier,90,13309.69,,,,,,,282.88,13309.69,fee schedule,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Premier,TC,7351.18,,,,,,,427.00,7351.18,fee schedule,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier,90,15625.93,,,,,,,329.51,15625.93,fee schedule,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Premier,90,13920.84,,,,,,,236.63,13920.84,fee schedule,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,outpatient,,,5275.00000,5011.25000,The Alliance,Premier,90,3739.97,,,,,,,2637.50,5605.44,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,outpatient,,,1456.00000,1383.20000,The Alliance,Premier,90,7792.26,,,,,,,132.74,7792.26,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Premier,90,8250.66,,,,,,,140.32,8250.66,fee schedule,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,,26.23,,,,,,,18.50,35.89,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,outpatient,,,321.00000,304.95000,The Alliance,Premier,90,713.01,,,,,,,14.19,713.01,fee schedule,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Premier,TC,7351.18,,,,,,,427.00,7351.18,fee schedule,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier,90,6026.72,,,,,,,119.20,6026.72,fee schedule,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,outpatient,,,152.40000,144.78000,The Alliance,Premier,,713.01,,,,,,,15.00,713.01,fee schedule,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,outpatient,,,134.50000,127.77000,The Alliance,Premier,90,679.08,,,,,,,14.93,679.08,fee schedule,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,outpatient,,,153.50000,145.82000,The Alliance,Premier,90,1137.41,,,,,,,76.75,1137.41,fee schedule,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,outpatient,,,154.10000,146.39000,The Alliance,Premier,,679.08,,,,,,,13.05,679.08,fee schedule,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Premier,,6.31,,,,,,,4.45,8.63,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.20000,53.39000,The Alliance,Premier,,271.65,,,,,,,5.18,271.65,fee schedule,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,outpatient,,,1567.00000,1488.65000,The Alliance,Premier,90,8708.99,,,,,,,185.20,8708.99,fee schedule,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,outpatient,,,217.80000,206.91000,The Alliance,Premier,,780.94,,,,,,,14.28,780.94,fee schedule,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Premier,90,1137.41,,,,,,,89.50,1137.41,fee schedule,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,,679.08,,,,,,,8.17,679.08,fee schedule,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,outpatient,,,11319.00000,10753.05000,The Alliance,Premier,90,60538.53,,,,,,,1287.00,60538.53,fee schedule,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier,,1539.22,,,,,,,12.05,1539.22,fee schedule,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier,90,218.87,,,,,,,28.07,299.44,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,outpatient,,,8234.00000,7822.30000,The Alliance,Premier,90,44037.28,,,,,,,936.00,44037.28,fee schedule,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Premier,,1052.52,,,,,,,20.26,1052.52,fee schedule,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Premier,TC,1292.36,,,,,,,96.44,1292.36,fee schedule,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Premier,,746.94,,,,,,,14.39,746.94,fee schedule,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,outpatient,,,63.80000,60.61000,The Alliance,Premier,,288.61,,,,,,,5.50,288.61,fee schedule,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,outpatient,,,382.00000,362.90000,The Alliance,Premier,90,270.84,,,,,,,152.01,370.54,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Premier,TC,14719.32,,,,,,,1560.00,14719.32,fee schedule,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,169.79,,,,,,,3.48,169.79,fee schedule,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,outpatient,,,61.50000,58.42000,The Alliance,Premier,,43.60,,,,,,,30.75,59.66,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,outpatient,,,1700.00000,1615.00000,The Alliance,Premier,90,9082.50,,,,,,,154.60,9082.50,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,outpatient,,,846.00000,803.70000,The Alliance,Premier,90,599.81,,,,,,,423.00,820.62,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,outpatient,,,280.70000,266.66000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier,,39.77,,,,,,,28.05,54.42,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,outpatient,,,155.70000,147.92000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,outpatient,,,105.50000,100.22000,The Alliance,Premier,90,373.51,,,,,,,8.37,373.51,fee schedule,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,outpatient,,,2324.00000,2207.80000,The Alliance,Premier,90,12936.18,,,,,,,274.83,12936.18,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,outpatient,,,2548.00000,2420.60000,The Alliance,Premier,90,14175.45,,,,,,,301.35,14175.45,fee schedule,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,outpatient,,,730.00000,693.50000,The Alliance,Premier,90,3904.65,,,,,,,85.76,3904.65,fee schedule,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Premier,90,2410.69,,,,,,,52.89,2410.69,fee schedule,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Premier,90,2410.69,,,,,,,52.77,2410.69,fee schedule,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier,TC,7351.18,,,,,,,57.00,7351.18,fee schedule,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1382.00000,1312.90000,The Alliance,Premier,,6383.20,,,,,,,122.22,6383.20,fee schedule,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier,90,288.61,,,,,,,5.68,395.76,fee schedule,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,outpatient,,,233.40000,221.73000,The Alliance,Premier,90,165.48,,,,,,,21.69,226.40,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Premier,90,19453.17,,,,,,,166.90,19453.17,fee schedule,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,outpatient,,,120.70000,114.66000,The Alliance,Premier,,543.22,,,,,,,10.63,543.22,fee schedule,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier,90,4787.38,,,,,,,94.71,4787.38,fee schedule,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Premier,,403.42,,,,,,,284.50,551.93,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2393.00000,2273.35000,The Alliance,Premier,90,13309.69,,,,,,,282.88,13309.69,fee schedule,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,outpatient,,,252.90000,240.26000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Premier,90,19453.17,,,,,,,166.90,19453.17,fee schedule,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,outpatient,,,590.40000,560.88000,The Alliance,Premier,90,418.59,,,,,,,295.20,572.69,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4864.00000,4620.80000,The Alliance,Premier,90,28130.22,,,,,,,597.91,28130.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,outpatient,,,934.00000,887.30000,The Alliance,Premier,,8610.62,,,,,,,467.00,8610.62,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier,,8250.66,,,,,,,143.40,8250.66,fee schedule,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,outpatient,,,250.50000,237.98000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,outpatient,,,220.90000,209.85000,The Alliance,Premier,90,424.40,,,,,,,8.35,424.40,fee schedule,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Premier,90,42339.61,,,,,,,516.91,42339.61,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,outpatient,,,2501.00000,2375.95000,The Alliance,Premier,90,13920.84,,,,,,,175.10,13920.84,fee schedule,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,QW,780.94,,,,,,,16.53,780.94,fee schedule,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,outpatient,,,96.60000,91.77000,The Alliance,Premier,90,1137.41,,,,,,,48.30,1137.41,fee schedule,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,outpatient,,,263.80000,250.61000,The Alliance,Premier,90,3072.74,,,,,,,131.90,3072.74,fee schedule,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,outpatient,,,37.10000,35.24000,The Alliance,Premier,90,237.65,,,,,,,4.55,237.65,fee schedule,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,outpatient,,,233.70000,222.01000,The Alliance,Premier,,1086.52,,,,,,,20.67,1086.52,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1574.00000,1495.30000,The Alliance,Premier,,9082.50,,,,,,,157.98,9082.50,fee schedule,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,1001.63,,,,,,,21.21,1001.63,fee schedule,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Premier,,13920.84,,,,,,,145.60,13920.84,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Premier,TC,7351.18,,,,,,,426.50,7351.18,fee schedule,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Premier,,8708.99,,,,,,,145.60,8708.99,fee schedule,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier,,118.82,,,,,,,2.37,118.82,fee schedule,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,3526.00000,3349.70000,The Alliance,Premier,90,2499.93,,,,,,,1458.73,3420.22,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier,90,322.54,,,,,,,6.23,322.54,fee schedule,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,152.82,,,,,,,3.28,152.82,fee schedule,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,outpatient,,,98.10000,93.19000,The Alliance,Premier,90,475.37,,,,,,,9.32,475.37,fee schedule,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,outpatient,,,283.60000,269.42000,The Alliance,Premier,,1120.45,,,,,,,20.36,1120.45,fee schedule,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,outpatient,,,438.90000,416.96000,The Alliance,Premier,,311.18,,,,,,,219.45,425.73,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,outpatient,,,123.40000,117.23000,The Alliance,Premier,90,1459.96,,,,,,,28.73,1459.96,fee schedule,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,outpatient,,,12.10000,11.49000,The Alliance,Premier,,8.58,,,,,,,6.05,11.74,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier,90,254.68,,,,,,,4.91,254.68,fee schedule,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Premier,90,254.68,,,,,,,5.67,254.68,fee schedule,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,outpatient,,,320.60000,304.57000,The Alliance,Premier,90,831.84,,,,,,,16.59,831.84,fee schedule,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.80000,58.71000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Premier,90,1137.41,,,,,,,58.15,1137.41,fee schedule,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,outpatient,,,425.70000,404.41000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,outpatient,,,75.10000,71.34000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Premier,TC,4167.07,,,,,,,401.07,4167.07,fee schedule,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier,90,108.48,,,,,,,63.32,148.41,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,outpatient,,,49.70000,47.22000,The Alliance,Premier,90,305.58,,,,,,,6.08,305.58,fee schedule,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,outpatient,,,59.50000,56.52000,The Alliance,Premier,90,679.08,,,,,,,14.93,679.08,fee schedule,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,outpatient,,,271.50000,257.92000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,outpatient,,,292.10000,277.50000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,outpatient,,,903.00000,857.85000,The Alliance,Premier,90,1103.49,,,,,,,19.88,1103.49,fee schedule,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier,90,882.80,,,,,,,8.17,882.80,fee schedule,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier,90,254.68,,,,,,,5.23,254.68,fee schedule,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,outpatient,,,59.40000,56.43000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,outpatient,,,179.50000,170.52000,The Alliance,Premier,90,1103.49,,,,,,,21.94,1103.49,fee schedule,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Premier,,13309.69,,,,,,,282.88,13309.69,fee schedule,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier,90,271.65,,,,,,,5.97,271.65,fee schedule,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,outpatient,,,5074.00000,4820.30000,The Alliance,Premier,90,28232.08,,,,,,,480.56,28232.08,fee schedule,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,outpatient,,,78.90000,74.96000,The Alliance,Premier,90,3038.81,,,,,,,39.45,3038.81,fee schedule,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,outpatient,,,57.70000,54.81000,The Alliance,Premier,90,763.98,,,,,,,15.06,763.98,fee schedule,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier,,37.58,,,,,,,5.87,113.69,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier,90,1341.13,,,,,,,26.67,1341.13,fee schedule,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier,90,1052.52,,,,,,,77.53,1052.52,fee schedule,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,outpatient,,,141.20000,134.14000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Premier,,4617.66,,,,,,,90.57,4617.66,fee schedule,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,outpatient,,,31.30000,29.74000,The Alliance,Premier,90,152.82,,,,,,,3.09,152.82,fee schedule,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,outpatient,,,576.00000,547.20000,The Alliance,Premier,90,408.38,,,,,,,288.00,558.72,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,254.68,,,,,,,5.00,254.68,fee schedule,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,outpatient,,,248.90000,236.45000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,outpatient,,,329.50000,313.02000,The Alliance,Premier,90,831.84,,,,,,,16.44,831.84,fee schedule,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,1539.22,,,,,,,12.05,1539.22,fee schedule,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier,90,3186.14,,,,,,,307.50,3186.14,fee schedule,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,outpatient,,,86.90000,82.56000,The Alliance,Premier,90,831.84,,,,,,,10.82,831.84,fee schedule,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Premier,,10915.96,,,,,,,208.92,10915.96,fee schedule,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,outpatient,,,238.40000,226.48000,The Alliance,Premier,90,1273.27,,,,,,,19.70,1273.27,fee schedule,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,outpatient,,,253.30000,240.64000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,Premier,90,8708.99,,,,,,,648.20,8708.99,fee schedule,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier,90,186.75,,,,,,,3.70,186.75,fee schedule,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier,90,356.54,,,,,,,6.92,356.54,fee schedule,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier,,407.44,,,,,,,8.61,407.44,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,outpatient,,,111.90000,106.31000,The Alliance,Premier,90,696.05,,,,,,,11.13,696.05,fee schedule,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,107.63,,,,,,,10.42,177.63,fee schedule,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,outpatient,,,109.70000,104.22000,The Alliance,Premier,90,594.19,,,,,,,12.89,594.19,fee schedule,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier,90,2581.26,,,,,,,7.27,2581.26,fee schedule,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Premier,90,865.84,,,,,,,17.01,865.84,fee schedule,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,outpatient,,,165.50000,157.22000,The Alliance,Premier,90,1018.59,,,,,,,7.06,1018.59,fee schedule,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,outpatient,,,273.70000,260.02000,The Alliance,Premier,90,1086.52,,,,,,,21.01,1086.52,fee schedule,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier,90,254.68,,,,,,,5.25,254.68,fee schedule,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier,90,53.67,,,,,,,37.85,73.43,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier,90,220.68,,,,,,,4.89,220.68,fee schedule,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,outpatient,,,318.30000,302.38000,The Alliance,Premier,90,831.84,,,,,,,16.59,831.84,fee schedule,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Premier,90,763.98,,,,,,,15.03,763.98,fee schedule,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Premier,,882.80,,,,,,,18.64,882.80,fee schedule,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier,,10525.49,,,,,,,201.50,10525.49,fee schedule,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,outpatient,,,4578.00000,4349.10000,The Alliance,Premier,TC,24865.24,,,,,,,533.12,24865.24,fee schedule,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,outpatient,,,144.40000,137.18000,The Alliance,Premier,90,797.91,,,,,,,16.32,797.91,fee schedule,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier,90,458.40,,,,,,,8.94,458.40,fee schedule,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,outpatient,,,276.10000,262.30000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,outpatient,,,57.20000,54.34000,The Alliance,Premier,,40.55,,,,,,,28.60,55.48,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier,,56.58,,,,,,,39.90,77.41,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,outpatient,,,398.70000,378.76000,The Alliance,Premier,,2223.94,,,,,,,144.13,2223.94,fee schedule,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Premier,,10.23,,,,,,,7.21,14.00,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Premier,,3.36,,,,,,,2.37,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,outpatient,1,GM,8.13000,7.73000,The Alliance,Premier,,5.76,,,,,,,4.07,7.89,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier,,1.28,,,,,,,0.90500,1.76,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,outpatient,1,mL,45.79000,43.50000,The Alliance,Premier,,78.87,,,,,,,22.89,78.87,fee schedule,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,outpatient,1,mL,2.05000,1.95000,The Alliance,Premier,,1.45,,,,,,,1.02,1.99,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier,,0.51048,,,,,,,0.36000,0.69840,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,outpatient,1,mL,46.14000,43.83000,The Alliance,Premier,,32.71,,,,,,,23.07,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,outpatient,1,mL,24.67000,23.44000,The Alliance,Premier,,17.49,,,,,,,12.34,23.93,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,outpatient,1,mL,122.89000,116.74000,The Alliance,Premier,,87.13,,,,,,,61.45,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,outpatient,1,mL,112.07000,106.47000,The Alliance,Premier,,79.46,,,,,,,56.03,108.71,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier,,2.79,,,,,,,1.97,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,1.79,,,,,,,1.26,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,outpatient,1,mL,4.47000,4.24000,The Alliance,Premier,,3.17,,,,,,,2.23,4.34,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier,,13.44,,,,,,,9.48,18.39,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Premier,,2.38,,,,,,,1.68,3.25,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,outpatient,1,mL,28.33000,26.92000,The Alliance,Premier,,0.42900,,,,,,,0.40920,27.48,fee schedule,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,outpatient,1,EA,16163.08000,15354.93000,The Alliance,Premier,,11459.62,,,,,,,8081.54,15678.19,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Premier,,0.19800,,,,,,,0.12000,29.48,fee schedule,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,outpatient,1,mL,286.22000,271.90000,The Alliance,Premier,,28.66,,,,,,,17.37,277.63,fee schedule,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1821.00000,1729.95000,The Alliance,Premier,TC,1866.00,,,,,,,484.28,2161.00,per diem,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,outpatient,,,77.40000,73.53000,The Alliance,Premier,90,1137.41,,,,,,,38.70,1137.41,fee schedule,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier,,65.72,,,,,,,39.83,291.19,fee schedule,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier,,2.00,,,,,,,1.21,2.48,fee schedule,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,464.18000,440.97000,The Alliance,Premier,,166.19,,,,,,,158.39,450.25,fee schedule,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier,,888.38,,,,,,,626.50,1215.41,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Premier,,6183.39,,,,,,,6000.37,13072.70,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Premier,,4887.39,,,,,,,4742.73,10332.75,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Premier,,4887.39,,,,,,,4742.73,10332.75,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier,,19075.83,,,,,,,18511.22,40329.45,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Premier,,4569.18,,,,,,,4433.94,9660.00,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier,,2935.70,,,,,,,2848.81,6206.55,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier,,0.11550,,,,,,,0.11207,0.32980,fee schedule,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,outpatient,,,698.00000,663.10000,The Alliance,Premier,,494.88,,,,,,,50.73,677.06,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,outpatient,1,EA,4155.55000,3947.77000,The Alliance,Premier,,256.44,,,,,,,155.42,4030.88,fee schedule,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier,,136.13,,,,,,,19.31,186.24,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,outpatient,,,1804.00000,1713.80000,The Alliance,Premier,,1279.04,,,,,,,902.00,1749.88,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,5765.00,,,,,,,43.00,6456.00,case rate,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Premier,TC,3017.50,,,,,,,2128.00,4128.32,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Premier,,9.87,,,,,,,5.98,708.47,fee schedule,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,outpatient,,,2454.00000,2331.30000,The Alliance,Premier,TC,1739.89,,,,,,,1227.00,5271.00,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,outpatient,,,7396.00000,7026.20000,The Alliance,Premier,TC,17537.00,,,,,,,3698.00,17574.00,case rate,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,outpatient,1,mL,20.30000,19.29000,The Alliance,Premier,,14.39,,,,,,,0.92000,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,outpatient,1,mL,89.60000,85.12000,The Alliance,Premier,,63.53,,,,,,,0.92000,86.91,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,outpatient,1,EA,2370.47000,2251.95000,The Alliance,Premier,,1680.66,,,,,,,1185.23,2299.36,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,113.44,,,,,,,46.35,319.35,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier,,279.35,,,,,,,35.09,382.18,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier,,142.51,,,,,,,18.05,194.97,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,,124.08,,,,,,,24.08,169.75,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Premier,,370.10,,,,,,,50.73,506.34,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Premier,TC,568.62,,,,,,,389.35,2210.07,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Premier,,173.52,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Premier,,6183.39,,,,,,,6000.37,13072.70,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1342.24,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier,,36.57,,,,,,,25.79,50.03,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Premier,TC,23155.09,,,,,,,2210.90,23155.09,fee schedule,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier,,67198.78,,,,,,,1667.31,67198.78,fee schedule,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Premier,,14756.46,,,,,,,14319.70,31197.60,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Premier,,14318.42,,,,,,,13894.62,30271.50,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,outpatient,1,mL,19494.00000,18519.30000,The Alliance,Premier,,91.25,,,,,,,55.30,18909.18,fee schedule,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,mL,3.32000,3.16000,The Alliance,Premier,,1.39,,,,,,,1.28,3.22,fee schedule,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier,,19075.83,,,,,,,18511.22,40329.45,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier,,21154.31,,,,,,,20528.18,44723.70,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,TC,1668.14,,,,,,,131.50,1668.14,fee schedule,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,TC,548.00,,,,,,,76.00,548.00,fee schedule,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,19.28000,18.32000,The Alliance,Premier,,13.67,,,,,,,9.64,18.70,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,outpatient,,,571.56000,542.98000,The Alliance,Premier,,516.28,,,,,,,285.78,554.41,fee schedule,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,outpatient,1,mL,1143.11000,1085.95000,The Alliance,Premier,,516.28,,,,,,,485.00,1108.82,fee schedule,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,outpatient,1,EA,205.24000,194.98000,The Alliance,Premier,,145.52,,,,,,,102.62,199.08,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Premier,,245.31,,,,,,,28.27,335.62,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Premier,,13336.00,,,,,,,12941.28,28194.50,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Premier,,13336.00,,,,,,,12941.28,28194.50,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Premier,,123.51,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,8814.75000,8374.01000,The Alliance,Premier,,4169.38,,,,,,,4045.97,8814.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier,,14445.56,,,,,,,249.71,14445.56,fee schedule,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier,,548.00,,,,,,,119.50,734.90,fee schedule,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,,147.47,,,,,,,56.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Premier,,218.37,,,,,,,56.40,298.76,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,outpatient,1,EA,3362.49000,3194.36000,The Alliance,Premier,,267.23,,,,,,,161.96,3261.62,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,outpatient,1,mL,22.42000,21.30000,The Alliance,Premier,,1.42,,,,,,,1.35,21.75,fee schedule,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier,,2.12,,,,,,,1.50,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7193.25000,6833.59000,The Alliance,Premier,,3402.41,,,,,,,3301.70,7193.25,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1406.25000,1335.94000,The Alliance,Premier,,665.16,,,,,,,645.47,1406.25,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier,,1257.94,,,,,,,1220.71,2659.50,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Premier,,5.90,,,,,,,4.16,8.07,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier,TC,487.00,,,,,,,316.68,1447.00,per diem,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,4652.12,per diem,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6365.00000,6046.75000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,6174.05,per diem,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier,,197.10,,,,,,,139.00,269.66,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Premier,TC,487.00,,,,,,,316.68,1447.00,per diem,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,outpatient,1,mL,4864.58000,4621.36000,The Alliance,Premier,,30.20,,,,,,,18.30,4718.64,fee schedule,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Premier,TC,548.00,,,,,,,384.16,950.60,fee schedule,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,outpatient,1,mL,110.58000,105.05000,The Alliance,Premier,,78.40,,,,,,,55.29,107.26,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Premier,,26819.10,,,,,,,26025.30,56700.00,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Premier,,171.34,,,,,,,120.83,240.53,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Premier,,342.69,,,,,,,240.53,468.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,outpatient,,,113.43000,107.76000,The Alliance,Premier,,80.42,,,,,,,56.72,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,outpatient,1,mL,226.86000,215.52000,The Alliance,Premier,,160.84,,,,,,,113.43,220.05,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Premier,,1.13,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,outpatient,1,GM,8.39000,7.97000,The Alliance,Premier,,5.95,,,,,,,4.20,8.14,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier,QW,780.94,,,,,,,16.53,780.94,fee schedule,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,Premier,,10344.80,,,,,,,12.05,10344.80,fee schedule,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,Premier,RT,358.75,,,,,,,253.00,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,RT,1748.39,,,,,,,1233.00,2392.02,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,847.16000,804.80000,The Alliance,Premier,,400.71,,,,,,,388.85,847.16,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Premier,,6146.32,,,,,,,4334.50,8408.93,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4416.00000,4195.20000,The Alliance,Premier,,2088.77,,,,,,,2026.94,4416.00,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,1.39,,,,,,,0.31500,1.39,fee schedule,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Premier,,3100.51,,,,,,,3008.74,6555.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Premier,,6705.74,,,,,,,128.29,6705.74,fee schedule,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier,,1330.31,,,,,,,1290.94,2812.50,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier,,0.10635,,,,,,,0.07500,0.14550,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,outpatient,1,EA,14.00000,13.30000,The Alliance,Premier,,9.93,,,,,,,7.00,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,outpatient,1,EA,13.21000,12.55000,The Alliance,Premier,,9.37,,,,,,,6.61,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier,,10.19,,,,,,,7.18,13.94,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier,,0.19852,,,,,,,0.14000,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,outpatient,,,152.78000,145.14000,The Alliance,Premier,,108.32,,,,,,,76.39,195.41,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,outpatient,1,mL,76.39000,72.57000,The Alliance,Premier,,54.16,,,,,,,38.20,195.41,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier,,1330.31,,,,,,,1290.94,2812.50,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Premier,,1834.99,,,,,,,1294.07,2510.50,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,outpatient,1,mL,66.57000,63.24000,The Alliance,Premier,,47.20,,,,,,,0.77000,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,outpatient,1,mL,60.38000,57.36000,The Alliance,Premier,,42.81,,,,,,,0.77000,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,outpatient,1,mL,69.89000,66.40000,The Alliance,Premier,,49.55,,,,,,,0.77000,67.79,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14399.50000,13679.52000,The Alliance,Premier,,6810.96,,,,,,,6609.37,14399.50,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,outpatient,,,606.00000,575.70000,The Alliance,Premier,,429.65,,,,,,,303.00,587.82,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.40000,203.68000,The Alliance,Premier,90,984.66,,,,,,,19.60,984.66,fee schedule,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,outpatient,,,136.80000,129.96000,The Alliance,Premier,90,628.12,,,,,,,12.51,628.12,fee schedule,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1100.00000,1045.00000,The Alliance,Premier,,166.19,,,,,,,158.39,1067.00,fee schedule,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,outpatient,,,117.28000,111.42000,The Alliance,Premier,,76.28,,,,,,,58.64,113.76,fee schedule,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Premier,,50538.94,,,,,,,35641.00,74614.73,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier,TC,1059.95,,,,,,,747.50,1450.15,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,outpatient,,,82.50000,78.38000,The Alliance,Premier,,34.47,,,,,,,20.89,80.03,fee schedule,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier,,995.44,,,,,,,702.00,1361.88,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13175.00000,12516.25000,The Alliance,Premier,,6231.77,,,,,,,6047.32,12779.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,outpatient,,,1069.00000,1015.55000,The Alliance,Premier,,757.92,,,,,,,247.20,1036.93,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Premier,,84.21,,,,,,,81.72,178.04,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2389.84000,2270.35000,The Alliance,Premier,,1130.39,,,,,,,1096.94,2389.84,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,631.13000,599.57000,The Alliance,Premier,,298.52,,,,,,,289.69,631.13,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier,,9589.60,,,,,,,9305.77,20274.00,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier,,9589.60,,,,,,,9305.77,20274.00,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Premier,,27182.63,,,,,,,10648.19,27182.63,fee schedule,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,outpatient,,,784.00000,744.80000,The Alliance,Premier,TC,548.00,,,,,,,384.16,760.48,fee schedule,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier,QW,1052.52,,,,,,,22.48,1052.52,fee schedule,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Premier,TC,7529.89,,,,,,,726.61,7529.89,fee schedule,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier,,9589.60,,,,,,,9305.77,20274.00,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Premier,,10826.97,,,,,,,10506.51,22890.00,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier,,2692.55,,,,,,,2612.86,5692.50,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,34353.61000,32635.93000,The Alliance,Premier,,27182.63,,,,,,,17176.81,34353.61,fee schedule,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,outpatient,1,mL,619.01000,588.06000,The Alliance,Premier,,161.21,,,,,,,97.70,600.44,fee schedule,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier,,0.56011,,,,,,,0.39500,0.76630,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Premier,,0.48212,,,,,,,0.34000,0.65960,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,279.23000,265.27000,The Alliance,Premier,,132.08,,,,,,,128.17,279.23,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Premier,TC,1785.26,,,,,,,1163.40,2442.46,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.01000,The Alliance,Premier,,0.01418,,,,,,,0.01000,0.01940,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier,,2.08,,,,,,,2.02,15.33,fee schedule,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,outpatient,1,mL,515.41000,489.64000,The Alliance,Premier,,365.43,,,,,,,257.70,499.95,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier,,0.03545,,,,,,,0.02500,0.04850,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,outpatient,1,mL,96.55000,91.72000,The Alliance,Premier,,68.45,,,,,,,48.27,93.65,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier,,937.00,,,,,,,280.29,3163.00,case rate,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,40880.70000,38836.66000,The Alliance,Premier,,19336.57,,,,,,,18764.24,40880.70,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier,,112.81,,,,,,,109.47,238.50,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,172.82,,,,,,,121.88,236.44,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,,619.83,,,,,,,59.00,619.83,fee schedule,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18331.42000,17414.85000,The Alliance,Premier,,8670.76,,,,,,,8414.12,18331.42,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,outpatient,,,2290.00000,2175.50000,The Alliance,Premier,,12375.92,,,,,,,232.94,12375.92,fee schedule,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier,,34.47,,,,,,,20.89,1256.15,fee schedule,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,937.00,,,,,,,127.05,3163.00,case rate,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9357.04000,8889.19000,The Alliance,Premier,,4425.88,,,,,,,4294.88,9357.04,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,7036.72000,6684.88000,The Alliance,Premier,,3328.37,,,,,,,3229.85,7036.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,582.19000,553.08000,The Alliance,Premier,,248.04,,,,,,,240.68,564.72,fee schedule,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,outpatient,1,mL,25103.16000,23848.00000,The Alliance,Premier,,123.52,,,,,,,74.86,24350.07,fee schedule,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Premier,,1.39,,,,,,,1.28,17.94,fee schedule,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier,,14.56,,,,,,,10.27,19.92,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,outpatient,,,588.75000,559.31000,The Alliance,Premier,,217.87,,,,,,,132.04,571.09,fee schedule,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier,,0.08508,,,,,,,0.06000,0.11640,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,outpatient,1,EA,39.92000,37.92000,The Alliance,Premier,,28.30,,,,,,,19.96,38.72,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier,,12390.24,,,,,,,12023.50,26195.00,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,outpatient,1,EA,51.56000,48.98000,The Alliance,Premier,,8.46,,,,,,,7.77,50.01,fee schedule,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,outpatient,1,EA,29.86000,28.37000,The Alliance,Premier,,6.30,,,,,,,6.12,28.96,fee schedule,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier,,0.04950,,,,,,,0.04803,153.26,fee schedule,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,outpatient,1,EA,717.43000,681.56000,The Alliance,Premier,,0.04950,,,,,,,0.04803,695.91,fee schedule,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,outpatient,1,EA,169.28000,160.82000,The Alliance,Premier,,0.04950,,,,,,,0.04803,164.20,fee schedule,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,outpatient,1,mL,1202.80000,1142.66000,The Alliance,Premier,,4.95,,,,,,,3.00,1166.72,fee schedule,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,outpatient,1,EA,36.67000,34.84000,The Alliance,Premier,,26.00,,,,,,,18.34,35.57,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Premier,,31.22,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier,,8.96,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier,,0.53884,,,,,,,0.38000,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier,,2.81,,,,,,,1.99,3.85,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Premier,,558.73,,,,,,,542.19,1181.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier,,159.53,,,,,,,112.50,218.25,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier,,2441.08,,,,,,,100.97,2441.08,fee schedule,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,372.50,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier,,528.21,,,,,,,372.50,929.91,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,outpatient,,,2449.00000,2326.55000,The Alliance,Premier,LT,1736.34,,,,,,,1224.50,2375.53,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,Premier,LT,908.23,,,,,,,640.50,1242.57,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier,,106.35,,,,,,,75.00,308.32,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier,,332.52,,,,,,,234.50,454.93,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Premier,TC,2235.48,,,,,,,1479.13,3058.41,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,outpatient,1,EA,343.71000,326.53000,The Alliance,Premier,,243.69,,,,,,,171.85,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,outpatient,1,EA,309.79000,294.30000,The Alliance,Premier,,219.64,,,,,,,154.90,300.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Premier,,0.47850,,,,,,,0.29000,1100.39,fee schedule,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,outpatient,1,mL,12429.17000,11807.71000,The Alliance,Premier,,217.87,,,,,,,132.04,12056.29,fee schedule,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,outpatient,,,169.40000,160.93000,The Alliance,Premier,90,780.94,,,,,,,15.49,780.94,fee schedule,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier,,2692.55,,,,,,,2612.86,5692.50,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,43.29,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier,,2692.55,,,,,,,2612.86,5692.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Premier,,36.10,,,,,,,35.03,76.32,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Premier,,1305.48,,,,,,,1266.84,2760.00,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Premier,,1305.48,,,,,,,1266.84,2760.00,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier,,2529.37,,,,,,,2454.50,5347.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,outpatient,,,136.51000,129.68000,The Alliance,Premier,,96.79,,,,,,,68.25,144.20,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,outpatient,1,EA,273.02000,259.37000,The Alliance,Premier,,193.57,,,,,,,136.51,264.83,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier,,186.00,,,,,,,68.50,264.00,per diem,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier,,186.00,,,,,,,30.50,264.00,per diem,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Premier,GO,186.00,,,,,,,20.20,264.00,per diem,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Premier,GO,186.00,,,,,,,30.60,264.00,per diem,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier,TC,3487.84,,,,,,,298.87,3487.84,fee schedule,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,outpatient,,,2470.00000,2346.50000,The Alliance,Premier,TC,1751.23,,,,,,,1235.00,2395.90,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier,,0.14850,,,,,,,0.14409,5.61,fee schedule,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,outpatient,,,214.12000,203.41000,The Alliance,Premier,,151.81,,,,,,,107.06,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,outpatient,1,mL,428.24000,406.83000,The Alliance,Premier,,303.62,,,,,,,214.12,415.39,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier,,2.28,,,,,,,0.22000,2.29,fee schedule,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Premier,90,679.08,,,,,,,13.33,679.08,fee schedule,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier,90,1035.56,,,,,,,22.91,1035.56,fee schedule,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,outpatient,1,mL,11.48000,10.91000,The Alliance,Premier,,3.73,,,,,,,3.62,11.14,fee schedule,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,outpatient,1,EA,156.07000,148.27000,The Alliance,Premier,,110.65,,,,,,,78.03,151.39,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,outpatient,,,123.97000,117.77000,The Alliance,Premier,,87.89,,,,,,,23.25,120.25,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,outpatient,1,mL,3.27000,3.10000,The Alliance,Premier,,2.32,,,,,,,1.64,3.17,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Premier,,422.15,,,,,,,409.66,892.50,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier,,0.01650,,,,,,,0.01000,2.55,fee schedule,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier,,0.23397,,,,,,,0.16500,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier,,0.42540,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Premier,,40.52,,,,,,,3.02,55.44,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3198.75000,3038.81000,The Alliance,Premier,,1513.01,,,,,,,1468.23,3198.75,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3168.75000,3010.31000,The Alliance,Premier,,1498.82,,,,,,,1454.46,3168.75,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,506.93000,481.58000,The Alliance,Premier,,239.78,,,,,,,232.68,491.72,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,179.60000,170.62000,The Alliance,Premier,,84.95,,,,,,,82.44,174.21,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Premier,,180.92,,,,,,,175.57,382.50,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier,,3377.93,,,,,,,3277.95,7141.50,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier,,2814.94,,,,,,,2731.62,5951.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Premier,,966.69,,,,,,,938.08,2043.75,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,outpatient,1,EA,10207.88000,9697.49000,The Alliance,Premier,,621.19,,,,,,,376.48,9901.64,fee schedule,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier,,1.98,,,,,,,1.40,2.71,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,outpatient,1,EA,53.80000,51.11000,The Alliance,Premier,,0.79200,,,,,,,0.76415,52.19,fee schedule,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier,,0.79200,,,,,,,0.29500,0.81340,fee schedule,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier,,36.57,,,,,,,25.79,50.03,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Premier,,45.64,,,,,,,32.19,62.44,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,outpatient,1,EA,61.33000,58.26000,The Alliance,Premier,,43.48,,,,,,,30.66,59.49,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier,,1.20,,,,,,,0.84500,1.64,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,outpatient,1,mL,1.29000,1.22000,The Alliance,Premier,,0.91461,,,,,,,0.64500,1.25,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier,,0.09217,,,,,,,0.06500,0.12610,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,outpatient,1,mL,1.60000,1.52000,The Alliance,Premier,,13.70,,,,,,,0.80000,18.34,fee schedule,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier,,0.46085,,,,,,,0.32500,0.63050,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,outpatient,1,mL,95.59000,90.81000,The Alliance,Premier,,67.77,,,,,,,47.80,92.72,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Premier,,4.50,,,,,,,2.14,6.16,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,outpatient,1,mL,4.34000,4.12000,The Alliance,Premier,,0.36300,,,,,,,0.33945,4.21,fee schedule,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier,,158.82,,,,,,,112.00,264.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,29.92000,28.42000,The Alliance,Premier,,14.15,,,,,,,13.73,29.92,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,821.25000,780.19000,The Alliance,Premier,,388.45,,,,,,,376.95,821.25,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,52.32000,49.70000,The Alliance,Premier,,24.75,,,,,,,24.01,52.32,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,44.64000,42.41000,The Alliance,Premier,,21.11,,,,,,,20.49,44.64,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,46.08000,43.78000,The Alliance,Premier,,21.80,,,,,,,21.15,46.08,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,outpatient,,,308.50000,293.08000,The Alliance,Premier,90,218.73,,,,,,,28.07,299.25,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,outpatient,1,GM,13.05000,12.40000,The Alliance,Premier,,9.25,,,,,,,6.53,12.66,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,outpatient,1,mL,42.10000,40.00000,The Alliance,Premier,,29.85,,,,,,,21.05,40.84,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier,,2.91,,,,,,,2.06,3.99,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,outpatient,1,mL,15.52000,14.74000,The Alliance,Premier,,11.00,,,,,,,7.76,15.05,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,outpatient,1,mL,1.15000,1.09000,The Alliance,Premier,,0.09900,,,,,,,0.08525,1.12,fee schedule,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,outpatient,1,mL,3.59000,3.41000,The Alliance,Premier,,0.09900,,,,,,,0.08525,3.48,fee schedule,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,24.68000,23.45000,The Alliance,Premier,,17.50,,,,,,,12.34,23.94,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Premier,,1345.59,,,,,,,1305.76,2844.79,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Premier,,1666.36,,,,,,,1617.04,3522.97,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier,,4624.66,,,,,,,4487.78,9777.30,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.82500,,,,,,,0.01500,0.82500,fee schedule,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Premier,,32587.46,,,,,,,157.68,44583.68,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6486.00000,6161.70000,The Alliance,Premier,,3067.88,,,,,,,2977.07,6486.00,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Premier,,40.40,,,,,,,28.49,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Premier,,40.40,,,,,,,28.49,55.27,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier,,3141.31,,,,,,,3048.33,6641.25,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier,,19075.83,,,,,,,18511.22,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier,,21154.31,,,,,,,20528.18,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier,,21154.31,,,,,,,20528.18,43381.99,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier,,20259.35,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Premier,TC,2941.42,,,,,,,324.00,2941.42,fee schedule,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier,,20259.35,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,33730.20000,32043.69000,The Alliance,Premier,,15954.38,,,,,,,15482.16,33730.20,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier,,4906.24,,,,,,,4761.02,10372.60,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier,,13185.06,,,,,,,12794.81,27875.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Premier,,807.06,,,,,,,783.17,1706.25,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier,,221.36,,,,,,,214.81,468.00,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier,,12500.21,,,,,,,12130.22,26427.50,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier,,1050.06,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier,,1642.46,,,,,,,1593.85,3472.43,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1875.00000,1781.25000,The Alliance,Premier,,886.88,,,,,,,860.62,1875.00,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.75000,274.31000,The Alliance,Premier,,136.58,,,,,,,132.54,288.75,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier,,60.87,,,,,,,59.06,128.68,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.86000,359.92000,The Alliance,Premier,,179.20,,,,,,,173.90,378.86,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Premier,,4423.43,,,,,,,4292.50,9351.85,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1672.50000,1588.88000,The Alliance,Premier,,791.09,,,,,,,767.68,1672.50,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier,,11919.60,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,28138.24000,26731.33000,The Alliance,Premier,,13309.39,,,,,,,12915.45,28138.24,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,18698.80000,17763.86000,The Alliance,Premier,,8844.53,,,,,,,8582.75,18698.80,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2981.25000,2832.19000,The Alliance,Premier,,1410.13,,,,,,,1368.39,2981.25,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,5789.10000,5499.65000,The Alliance,Premier,,2738.24,,,,,,,2657.20,5789.10,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Premier,,173.52,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,27830.25000,26438.74000,The Alliance,Premier,,13163.71,,,,,,,12774.08,26995.34,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier,,1985.96,,,,,,,1927.18,4198.65,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier,,1985.96,,,,,,,1927.18,4198.65,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier,,2774.14,,,,,,,2692.03,5865.00,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier,,20.81,,,,,,,20.20,44.00,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier,,867.15,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3915.41000,3719.64000,The Alliance,Premier,,1851.99,,,,,,,1797.17,3915.41,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,10260.30000,9747.28000,The Alliance,Premier,,4853.12,,,,,,,4709.48,10260.30,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,30.04000,28.54000,The Alliance,Premier,,14.21,,,,,,,13.79,30.04,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier,TC,2400.67,,,,,,,1693.00,3284.42,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier,,186.00,,,,,,,31.00,264.00,per diem,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,84.28000,80.07000,The Alliance,Premier,,39.86,,,,,,,38.68,84.28,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier,,4704.62,,,,,,,4565.37,9946.35,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier,,67198.78,,,,,,,1667.31,67198.78,fee schedule,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier,,3590.07,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Premier,,159.64,,,,,,,154.91,337.50,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Premier,,1786.88,,,,,,,1733.99,3777.75,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier,TC,3600.87,,,,,,,227.70,3600.87,fee schedule,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Premier,,50538.94,,,,,,,35641.00,74614.73,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,outpatient,,,2612.00000,2481.40000,The Alliance,Premier,,7803.00,,,,,,,1436.60,7803.00,case rate,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,outpatient,,,3855.00000,3662.25000,The Alliance,Premier,,2733.20,,,,,,,471.52,3739.35,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,1.29,fee schedule,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Premier,,0.11550,,,,,,,0.11207,0.29100,fee schedule,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1885.68,fee schedule,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,937.00,,,,,,,88.00,3163.00,case rate,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Premier,,464.72,,,,,,,450.97,982.50,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,outpatient,,,194.68000,184.95000,The Alliance,Premier,,138.03,,,,,,,97.34,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,outpatient,1,mL,389.35000,369.88000,The Alliance,Premier,,276.05,,,,,,,194.68,377.67,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,165.55,349.86,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,473.44000,449.77000,The Alliance,Premier,,223.94,,,,,,,217.31,473.44,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier,,164.30,,,,,,,153.47,541.99,fee schedule,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,outpatient,1,EA,1677.88000,1593.99000,The Alliance,Premier,,30.05,,,,,,,18.21,1627.54,fee schedule,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,outpatient,1,EA,1476.30000,1402.48000,The Alliance,Premier,,30.05,,,,,,,18.21,1432.01,fee schedule,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier,,206.61,,,,,,,200.49,436.80,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11492.32000,10917.70000,The Alliance,Premier,,5435.87,,,,,,,5274.97,11492.32,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Premier,,15.00,,,,,,,9.09,573.48,fee schedule,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier,,3908.28,,,,,,,3792.60,8262.75,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier,,16.08,,,,,,,15.61,34.00,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,outpatient,1,EA,2061.77000,1958.68000,The Alliance,Premier,,1461.79,,,,,,,1030.88,1999.92,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Premier,,130.53,,,,,,,92.05,205.31,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,outpatient,1,mL,368.20000,349.79000,The Alliance,Premier,,261.05,,,,,,,184.10,357.15,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Premier,,15.00,,,,,,,9.09,573.48,fee schedule,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,outpatient,1,EA,8551.17000,8123.61000,The Alliance,Premier,,60.49,,,,,,,36.66,8294.63,fee schedule,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Premier,TC,3685.66,,,,,,,354.42,3685.66,fee schedule,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Premier,,1834.99,,,,,,,1294.07,2510.50,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,outpatient,1,mL,138.09000,131.19000,The Alliance,Premier,,7.72,,,,,,,7.15,133.95,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,outpatient,1,mL,155.95000,148.15000,The Alliance,Premier,,7.72,,,,,,,7.15,151.27,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,outpatient,1,mL,126.40000,120.08000,The Alliance,Premier,,7.72,,,,,,,7.15,122.61,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,outpatient,1,mL,162.68000,154.54000,The Alliance,Premier,,7.72,,,,,,,7.15,157.80,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,outpatient,1,mL,139.04000,132.09000,The Alliance,Premier,,7.72,,,,,,,7.15,134.87,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,outpatient,1,mL,132.72000,126.08000,The Alliance,Premier,,7.72,,,,,,,7.15,128.74,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,outpatient,1,mL,85.32000,81.05000,The Alliance,Premier,,7.72,,,,,,,7.15,82.76,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier,,7.72,,,,,,,7.15,91.96,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,outpatient,1,mL,123.46000,117.29000,The Alliance,Premier,,7.72,,,,,,,7.15,119.76,fee schedule,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,outpatient,,,317.36000,301.49000,The Alliance,Premier,,292.97,,,,,,,158.68,307.84,fee schedule,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,outpatient,1,mL,634.72000,602.98000,The Alliance,Premier,,292.97,,,,,,,275.21,615.68,fee schedule,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,outpatient,1,mL,117.25000,111.39000,The Alliance,Premier,,77.40,,,,,,,58.62,113.73,fee schedule,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,outpatient,1,EA,12040.81000,11438.77000,The Alliance,Premier,,120.71,,,,,,,73.16,11679.59,fee schedule,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier,,4.95,,,,,,,3.00,3453.59,fee schedule,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Premier,,2394.74,,,,,,,1768.12,3430.16,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,outpatient,1,mL,38.54000,36.61000,The Alliance,Premier,,0.04950,,,,,,,0.04650,37.38,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,outpatient,1,mL,24.96000,23.72000,The Alliance,Premier,,0.04950,,,,,,,0.04650,24.21,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,outpatient,1,mL,25.63000,24.35000,The Alliance,Premier,,0.04950,,,,,,,0.04650,24.86,fee schedule,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,outpatient,1,mL,485.62000,461.34000,The Alliance,Premier,,1.07,,,,,,,0.91760,471.05,fee schedule,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,outpatient,1,mL,2502.32000,2377.20000,The Alliance,Premier,,5.49,,,,,,,3.33,2427.25,fee schedule,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Premier,,966.69,,,,,,,938.08,2043.75,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,outpatient,,,19.40000,18.43000,The Alliance,Premier,,51.01,,,,,,,9.70,51.01,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,outpatient,1,mL,62.37000,59.25000,The Alliance,Premier,,0.19800,,,,,,,0.12000,60.50,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,outpatient,1,mL,212.86000,202.21000,The Alliance,Premier,,180.31,,,,,,,106.43,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Premier,,180.31,,,,,,,109.28,249.68,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,outpatient,1,mL,30.54000,29.02000,The Alliance,Premier,,83.21,,,,,,,15.27,83.21,fee schedule,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,outpatient,1,mL,256.88000,244.04000,The Alliance,Premier,,182.13,,,,,,,128.44,249.17,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,outpatient,,,700.93000,665.88000,The Alliance,Premier,,496.96,,,,,,,331.10,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,outpatient,1,mL,1401.86000,1331.77000,The Alliance,Premier,,993.92,,,,,,,331.10,1359.80,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier,,6165.79,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier,,6165.79,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier,,6165.79,,,,,,,5983.29,13035.50,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier,,13185.06,,,,,,,12794.81,27875.40,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Premier,,371.56,,,,,,,225.19,4762.44,fee schedule,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,outpatient,1,EA,2155.06000,2047.31000,The Alliance,Premier,,1527.94,,,,,,,1077.53,2090.41,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier,,61.68,,,,,,,43.50,84.39,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier,,2.09,,,,,,,1.48,2.86,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier,,82.24,,,,,,,58.00,112.52,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.34000,356.57000,The Alliance,Premier,,177.54,,,,,,,172.28,375.34,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier,,221.36,,,,,,,214.81,468.00,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier,,4907.85,,,,,,,4762.59,10376.01,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,1748.39,,,,,,,674.25,2392.02,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Premier,,153.04,,,,,,,148.51,323.55,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier,,1793.60,,,,,,,1740.51,3791.96,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1745.03000,1657.78000,The Alliance,Premier,,825.40,,,,,,,800.97,1745.03,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier,,88.69,,,,,,,86.06,187.50,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier,,4906.24,,,,,,,4761.02,10372.60,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3041.25000,2889.19000,The Alliance,Premier,,1438.51,,,,,,,1395.93,3041.25,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier,,131.61,,,,,,,127.72,278.25,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9300.00000,8835.00000,The Alliance,Premier,,4398.90,,,,,,,4268.70,9300.00,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,47.62,2280.00,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier,,7186.34,,,,,,,6973.63,15193.10,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier,TC,548.00,,,,,,,144.10,548.00,fee schedule,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,outpatient,,,76.60000,72.77000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,outpatient,1,mL,2.80000,2.66000,The Alliance,Premier,,1.99,,,,,,,1.40,2.72,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier,,798.19,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Premier,,0.18150,,,,,,,0.17611,8.09,fee schedule,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Premier,,2113.25,,,,,,,2050.70,4467.75,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,outpatient,1,GM,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,outpatient,1,GM,3.65000,3.47000,The Alliance,Premier,,2.59,,,,,,,1.82,3.54,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,outpatient,1,EA,5037.00000,4785.15000,The Alliance,Premier,,56.89,,,,,,,34.48,4885.89,fee schedule,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,outpatient,1,EA,84884.40000,80640.18000,The Alliance,Premier,,56.89,,,,,,,34.48,82337.87,fee schedule,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier,TC,1488.90,,,,,,,980.94,2210.07,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier,,137.55,,,,,,,19.57,188.18,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,outpatient,,,122.40000,116.28000,The Alliance,Premier,90,339.51,,,,,,,6.69,339.51,fee schedule,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,outpatient,,,186.10000,176.79000,The Alliance,Premier,90,1137.41,,,,,,,93.05,1137.41,fee schedule,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier,90,1137.41,,,,,,,37.85,1137.41,fee schedule,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,outpatient,1,mL,26.42000,25.10000,The Alliance,Premier,,18.73,,,,,,,13.21,25.63,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier,,3.26,,,,,,,2.30,4.46,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Premier,,0.22688,,,,,,,0.16000,0.31040,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Premier,,45.64,,,,,,,32.19,62.44,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,outpatient,,,457.32000,434.45000,The Alliance,Premier,,324.24,,,,,,,228.66,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier,,3.24,,,,,,,2.29,4.43,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier,TC,7206.00,,,,,,,4549.00,14004.86,per diem,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier,PS,7206.00,,,,,,,4549.00,14018.44,per diem,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Premier,,3443.20,,,,,,,3341.29,7279.50,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Premier,,3443.20,,,,,,,3341.29,7279.50,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier,,691.76,,,,,,,671.29,1462.50,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,530.63000,504.10000,The Alliance,Premier,,250.99,,,,,,,243.56,530.63,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,outpatient,1,EA,278.53000,264.60000,The Alliance,Premier,,38.77,,,,,,,37.62,270.17,fee schedule,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,50.04000,47.54000,The Alliance,Premier,,0.24750,,,,,,,0.22165,48.54,fee schedule,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,outpatient,,,828.75000,787.31000,The Alliance,Premier,,262.92,,,,,,,245.60,803.89,fee schedule,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,outpatient,1,EA,18525.59000,17599.31000,The Alliance,Premier,,390.42,,,,,,,236.62,17969.82,fee schedule,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier,,9589.60,,,,,,,9305.77,20274.00,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,outpatient,1,mL,2334.42000,2217.70000,The Alliance,Premier,,410.02,,,,,,,248.50,2264.39,fee schedule,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,32130.00000,30523.50000,The Alliance,Premier,,15197.49,,,,,,,14747.67,32130.00,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier,,19075.83,,,,,,,18511.22,40329.45,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier,,691.76,,,,,,,671.29,1462.50,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,outpatient,1,EA,48.98000,46.53000,The Alliance,Premier,,34.73,,,,,,,24.49,47.51,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,outpatient,1,EA,74.26000,70.55000,The Alliance,Premier,,52.65,,,,,,,37.13,72.03,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier,,25.77,,,,,,,18.17,35.25,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,outpatient,,,518.56000,492.63000,The Alliance,Premier,,367.66,,,,,,,0.01000,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,outpatient,1,mL,1037.12000,985.26000,The Alliance,Premier,,735.32,,,,,,,0.01000,1006.01,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,outpatient,1,mL,4.57000,4.35000,The Alliance,Premier,,2.18,,,,,,,2.11,4.43,fee schedule,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Premier,,2.18,,,,,,,1.46,2.82,fee schedule,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,outpatient,1,EA,12538.10000,11911.19000,The Alliance,Premier,,311.27,,,,,,,188.65,12161.96,fee schedule,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Premier,,14318.42,,,,,,,13894.62,30271.50,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier,,20259.35,,,,,,,19659.70,42831.60,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,outpatient,1,mL,5172.56000,4913.93000,The Alliance,Premier,,20.38,,,,,,,12.35,5017.38,fee schedule,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9632.40000,9150.78000,The Alliance,Premier,,4556.13,,,,,,,4421.27,9632.40,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,227.04,,,,,,,220.32,480.00,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier,,108.20,,,,,,,105.00,228.75,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier,,11514.74,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,363.23000,345.07000,The Alliance,Premier,,171.81,,,,,,,166.72,363.23,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,370.05000,351.55000,The Alliance,Premier,,175.03,,,,,,,169.85,370.05,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,13330.00000,12663.50000,The Alliance,Premier,,6305.09,,,,,,,6118.47,13330.00,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier,,1985.96,,,,,,,1927.18,4198.65,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,outpatient,1,mL,8213.96000,7803.27000,The Alliance,Premier,,21.38,,,,,,,12.96,7967.54,fee schedule,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Premier,,16304.03,,,,,,,15821.45,34469.40,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Premier,,35.38,,,,,,,34.33,74.80,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier,,967.78,,,,,,,682.50,1324.05,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Premier,,283.70,,,,,,,171.94,15291.85,fee schedule,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,outpatient,1,mL,9512.59000,9036.96000,The Alliance,Premier,,135.15,,,,,,,118.62,9227.21,fee schedule,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Premier,,0.42900,,,,,,,0.40920,25.44,fee schedule,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Premier,,24.52,,,,,,,17.30,33.55,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,8414.55000,7993.82000,The Alliance,Premier,,3980.08,,,,,,,3862.28,8414.55,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier,,20259.35,,,,,,,19659.70,42831.60,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier,,212.85,,,,,,,206.55,450.00,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier,,0.60974,,,,,,,0.43000,0.83420,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier,,12500.21,,,,,,,12130.22,26427.50,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,3489.78000,3315.29000,The Alliance,Premier,,1650.67,,,,,,,1601.81,3489.78,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier,,20259.35,,,,,,,19659.70,42831.60,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier,,164.30,,,,,,,153.47,541.99,fee schedule,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Premier,,27182.63,,,,,,,10648.19,27182.63,fee schedule,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Premier,,394.47,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,outpatient,1,mL,2225.52000,2114.24000,The Alliance,Premier,,1577.89,,,,,,,1112.76,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Premier,,394.47,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,outpatient,1,mL,1112.76000,1057.12000,The Alliance,Premier,,788.95,,,,,,,556.38,1079.38,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,outpatient,,,6705.11000,6369.85000,The Alliance,Premier,NU,4753.92,,,,,,,3352.55,6503.96,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Premier,,627.95,,,,,,,609.36,1327.58,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,outpatient,,,4200.00000,3990.00000,The Alliance,Premier,,2977.80,,,,,,,2100.00,4158.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier,,108.20,,,,,,,105.00,228.75,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Premier,,8040.48,,,,,,,7802.50,16998.91,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier,,6.05,,,,,,,4.26,8.27,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,outpatient,1,EA,15.67000,14.88000,The Alliance,Premier,,11.11,,,,,,,7.83,15.20,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,24.80000,23.56000,The Alliance,Premier,,11.73,,,,,,,11.38,24.80,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,412.24000,391.63000,The Alliance,Premier,,315.32,,,,,,,206.12,399.87,fee schedule,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Premier,,2000.65,,,,,,,1941.43,4229.70,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,366.26000,347.95000,The Alliance,Premier,,121.81,,,,,,,113.78,355.27,fee schedule,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,2.82,,,,,,,2.63,6.47,fee schedule,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier,,2.82,,,,,,,2.63,6.47,fee schedule,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier,,41.62,,,,,,,40.39,85.36,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,52.27000,49.66000,The Alliance,Premier,,2.82,,,,,,,2.63,50.70,fee schedule,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,62.67000,59.54000,The Alliance,Premier,,2.82,,,,,,,2.63,60.79,fee schedule,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,outpatient,,,337.88000,320.99000,The Alliance,Premier,NU,67.47,,,,,,,62.66,327.74,fee schedule,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Premier,,315.32,,,,,,,67.80,315.32,fee schedule,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier,TC,529.62,,,,,,,282.87,724.59,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,1.85,,,,,,,1.73,23.28,fee schedule,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2771.25000,2632.69000,The Alliance,Premier,,1310.80,,,,,,,1272.00,2771.25,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier,,1642.46,,,,,,,1593.85,3472.43,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,outpatient,,,151.70000,144.11000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Premier,,37.65,,,,,,,36.54,79.60,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier,,1078.44,,,,,,,1046.52,2280.00,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier,,186.00,,,,,,,12.00,264.00,per diem,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier,TC,1134.10,,,,,,,112.98,1134.10,fee schedule,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,outpatient,1,mL,2500.41000,2375.39000,The Alliance,Premier,,5.49,,,,,,,3.33,2425.40,fee schedule,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Premier,,14252.44,,,,,,,13830.59,30132.00,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1600.31000,1520.29000,The Alliance,Premier,,471.79,,,,,,,440.69,1600.31,fee schedule,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,798.75000,758.81000,The Alliance,Premier,,377.81,,,,,,,366.63,798.75,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,862.50000,819.38000,The Alliance,Premier,,407.96,,,,,,,395.89,862.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,outpatient,1,mL,2890.18000,2745.67000,The Alliance,Premier,,120.53,,,,,,,73.05,2803.47,fee schedule,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Premier,,1303.57,,,,,,,790.04,68191.00,fee schedule,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,outpatient,1,EA,673.40000,639.73000,The Alliance,Premier,,8.76,,,,,,,5.31,653.20,fee schedule,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,0.26400,,,,,,,0.19995,3.68,fee schedule,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,outpatient,1,mL,9.04000,8.59000,The Alliance,Premier,,0.26400,,,,,,,0.19995,8.77,fee schedule,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Premier,,771.58,,,,,,,748.74,1631.25,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Premier,,11543.14,,,,,,,11201.48,24404.10,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3532.50000,3355.88000,The Alliance,Premier,,1670.87,,,,,,,1621.42,3532.50,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,outpatient,1,mL,1881.95000,1787.86000,The Alliance,Premier,,326.12,,,,,,,197.65,1825.49,fee schedule,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier,,1.58,,,,,,,0.49000,1.58,fee schedule,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier,,17847.61,,,,,,,17319.36,37732.80,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier,,162.24,,,,,,,157.44,343.01,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,245.70000,233.42000,The Alliance,Premier,,116.22,,,,,,,112.78,245.70,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier,,285.88,,,,,,,201.61,398.00,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,787.50000,748.12000,The Alliance,Premier,,372.49,,,,,,,361.46,787.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier,,285.88,,,,,,,201.61,398.00,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Premier,,414.46,,,,,,,402.19,876.23,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Premier,,153.04,,,,,,,148.51,323.55,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,622.66,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12400.00,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,outpatient,,,647.36000,614.99000,The Alliance,Premier,,3.00,,,,,,,2.81,647.36,fee schedule,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9566.51000,9088.18000,The Alliance,Premier,,4524.96,,,,,,,4391.03,9566.51,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,762.49000,724.37000,The Alliance,Premier,,360.66,,,,,,,349.98,762.49,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Premier,,731.16,,,,,,,44.30,1000.31,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier,,354.75,,,,,,,344.25,750.00,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,outpatient,1,EA,5157.98000,4900.08000,The Alliance,Premier,,134.81,,,,,,,81.70,5003.24,fee schedule,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,outpatient,1,mL,8.74000,8.30000,The Alliance,Premier,,6.20,,,,,,,0.77000,8.48,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,outpatient,,,1402.00000,1331.90000,The Alliance,Premier,TC,487.00,,,,,,,316.68,1447.00,per diem,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,164.30,,,,,,,153.47,454.69,fee schedule,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier,,17.37,,,,,,,16.85,36.72,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,179.80000,170.81000,The Alliance,Premier,,127.48,,,,,,,89.90,174.41,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,outpatient,1,mL,12430.84000,11809.30000,The Alliance,Premier,,46.18,,,,,,,27.99,12057.91,fee schedule,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier,,345.88,,,,,,,335.64,731.25,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier,,11535.19,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16817.50000,15976.62000,The Alliance,Premier,,7954.68,,,,,,,7719.23,16817.50,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier,,110.09,,,,,,,77.64,150.62,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier,,4765.48,,,,,,,4624.43,10075.00,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier,,867.15,,,,,,,841.48,1833.30,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,outpatient,,,1089.74000,1035.25000,The Alliance,Premier,,772.63,,,,,,,332.44,1057.05,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Premier,,948.94,,,,,,,920.85,2006.21,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier,TC,548.00,,,,,,,59.00,548.00,fee schedule,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,outpatient,,,3492.00000,3317.40000,The Alliance,Premier,,2475.83,,,,,,,1920.60,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,outpatient,,,6918.00000,6572.10000,The Alliance,Premier,,4904.86,,,,,,,3804.90,6710.46,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,outpatient,1,EA,9557.99000,9080.09000,The Alliance,Premier,,68.31,,,,,,,41.40,9271.25,fee schedule,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,outpatient,1,EA,387.46000,368.09000,The Alliance,Premier,,0.51150,,,,,,,0.39525,375.84,fee schedule,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,outpatient,1,EA,484.33000,460.11000,The Alliance,Premier,,0.51150,,,,,,,0.39525,469.80,fee schedule,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,outpatient,1,EA,295.46000,280.69000,The Alliance,Premier,,0.51150,,,,,,,0.39525,286.60,fee schedule,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Premier,,0.11550,,,,,,,0.11207,0.29100,fee schedule,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1202.00000,1141.90000,The Alliance,Premier,,224.70,,,,,,,211.37,1165.94,fee schedule,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier,,224.70,,,,,,,192.50,373.45,fee schedule,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,104.55000,99.32000,The Alliance,Premier,,34.40,,,,,,,33.32,101.41,fee schedule,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier,,225.27,,,,,,,218.60,476.25,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Premier,,4821.19,,,,,,,4678.50,10192.80,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,RT,1748.39,,,,,,,451.27,2392.02,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,outpatient,1,mL,71288.00000,67723.60000,The Alliance,Premier,,358.20,,,,,,,217.09,69149.36,fee schedule,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier,,122.39,,,,,,,118.77,258.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,222.94000,211.79000,The Alliance,Premier,,105.45,,,,,,,102.33,222.94,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier,,21.76,,,,,,,21.11,46.00,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier,,4765.48,,,,,,,4624.43,10075.00,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Premier,,425.52,,,,,,,412.93,899.63,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1152.94,,,,,,,1118.81,2437.50,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,393.75000,374.06000,The Alliance,Premier,,186.24,,,,,,,180.73,393.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,outpatient,1,EA,23519.66000,22343.68000,The Alliance,Premier,,2866.22,,,,,,,1737.10,22814.07,fee schedule,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,outpatient,,,1769.00000,1680.55000,The Alliance,Premier,LT,1254.22,,,,,,,493.80,1715.93,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,outpatient,1,mL,770.52000,732.00000,The Alliance,Premier,,53.46,,,,,,,32.40,747.40,fee schedule,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,2394.74,,,,,,,1218.75,2437.50,fee schedule,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier,TC,1134.10,,,,,,,112.98,1134.10,fee schedule,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,338.78000,321.84000,The Alliance,Premier,,160.24,,,,,,,155.50,338.78,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,255.72,,,,,,,47.62,349.86,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier,,5322.67,,,,,,,5165.13,11253.00,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Premier,,4978.09,,,,,,,4830.75,10524.50,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier,,118.82,,,,,,,2.25,118.82,fee schedule,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,,1860.31,,,,,,,1805.25,3933.00,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier,,933.33,,,,,,,47.62,1276.91,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier,,997.10,,,,,,,967.59,2108.03,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Premier,,8944.43,,,,,,,8679.69,18910.00,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier,,2935.70,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.80000,99.56000,The Alliance,Premier,,49.57,,,,,,,48.10,104.80,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier,,124.16,,,,,,,120.49,262.50,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,outpatient,1,EA,2224.81000,2113.57000,The Alliance,Premier,,15.13,,,,,,,9.17,2158.07,fee schedule,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,outpatient,1,mL,8182.59000,7773.46000,The Alliance,Premier,,21.38,,,,,,,12.96,7937.11,fee schedule,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,outpatient,1,GM,4.25000,4.03000,The Alliance,Premier,,3.01,,,,,,,2.12,4.12,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,outpatient,1,EA,1061.90000,1008.81000,The Alliance,Premier,,752.89,,,,,,,530.95,1030.04,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,outpatient,1,EA,44.74000,42.50000,The Alliance,Premier,,31.72,,,,,,,22.37,43.40,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier,,79.25,,,,,,,19.30,80.87,fee schedule,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier,,1.33,,,,,,,0.94000,1.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Premier,,10.81,,,,,,,7.62,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Premier,,3.80,,,,,,,2.68,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier,,8.22,,,,,,,5.80,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Premier,,3.64,,,,,,,2.56,4.98,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier,,0.95006,,,,,,,0.67000,1.30,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier,,1662.04,,,,,,,35.09,1662.04,fee schedule,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier,,1662.04,,,,,,,35.09,1662.04,fee schedule,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier,,1662.04,,,,,,,35.09,1662.04,fee schedule,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1071.00000,1017.45000,The Alliance,Premier,,759.34,,,,,,,535.50,1038.87,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier,,54.59,,,,,,,42.35,5271.00,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier,,76.57,,,,,,,59.40,5271.00,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,outpatient,1,mL,821.60000,780.52000,The Alliance,Premier,,114.71,,,,,,,69.52,796.95,fee schedule,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Premier,,232.93,,,,,,,141.17,5800.60,fee schedule,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,outpatient,,,19270.00000,18306.50000,The Alliance,Premier,,13662.43,,,,,,,9635.00,18691.90,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Premier,,232.93,,,,,,,141.17,5800.60,fee schedule,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Premier,,88.70,,,,,,,28.90,88.70,fee schedule,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,outpatient,1,mL,928.08000,881.68000,The Alliance,Premier,,11.02,,,,,,,6.68,900.24,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,outpatient,1,mL,367.88000,349.49000,The Alliance,Premier,,48.34,,,,,,,29.30,356.84,fee schedule,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,outpatient,1,EA,1767.52000,1679.14000,The Alliance,Premier,,1.95,,,,,,,1.18,1714.49,fee schedule,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,outpatient,1,EA,3123.40000,2967.23000,The Alliance,Premier,,1.95,,,,,,,1.18,3029.70,fee schedule,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,outpatient,1,EA,6578.00000,6249.10000,The Alliance,Premier,,1.95,,,,,,,1.18,6380.66,fee schedule,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier,,49.37,,,,,,,29.92,219.71,fee schedule,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier,,49.37,,,,,,,29.92,219.71,fee schedule,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,outpatient,,,1697.40000,1612.53000,The Alliance,Premier,,1203.46,,,,,,,511.55,1711.73,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,outpatient,1,mL,162.95000,154.81000,The Alliance,Premier,,115.53,,,,,,,81.47,158.06,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,outpatient,1,mL,110.25000,104.74000,The Alliance,Premier,,0.62700,,,,,,,0.60838,106.94,fee schedule,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier,,43.73,,,,,,,26.50,219.71,fee schedule,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier,,2439.62,,,,,,,2367.41,5157.75,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier,,2439.62,,,,,,,2367.41,5157.75,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27900.00,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,1.29,fee schedule,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier,JW,285.88,,,,,,,201.61,398.00,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,outpatient,,,1467.00000,1393.65000,The Alliance,Premier,GN,186.00,,,,,,,126.65,1422.99,per diem,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Premier,90,322.54,,,,,,,6.23,322.54,fee schedule,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,90,254.68,,,,,,,5.23,254.68,fee schedule,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,271.65,,,,,,,5.97,271.65,fee schedule,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier,90,356.54,,,,,,,6.92,356.54,fee schedule,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,outpatient,,,48.70000,46.26000,The Alliance,Premier,90,220.68,,,,,,,4.89,220.68,fee schedule,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Premier,,9.87,,,,,,,5.98,708.47,fee schedule,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,outpatient,,,152.20000,144.59000,The Alliance,Premier,90,1137.41,,,,,,,76.10,1137.41,fee schedule,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,outpatient,1,mL,2539.73000,2412.75000,The Alliance,Premier,,24.49,,,,,,,14.84,2463.54,fee schedule,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Premier,,22.01,,,,,,,13.34,1564.21,fee schedule,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier,,1.86,,,,,,,1.31,2.55,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17866.91000,16973.56000,The Alliance,Premier,,8451.05,,,,,,,8200.91,17866.91,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,691.00000,656.45000,The Alliance,Premier,,224.70,,,,,,,211.37,670.27,fee schedule,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,444.19000,421.98000,The Alliance,Premier,,210.10,,,,,,,203.88,444.19,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier,,8783.14,,,,,,,8523.17,18569.00,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier,,0.28050,,,,,,,0.26350,1.35,fee schedule,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier,,0.07090,,,,,,,0.05000,0.09700,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier,,0.02836,,,,,,,0.02000,0.03880,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier,,3345.29,,,,,,,3246.28,7072.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier,,177.38,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Premier,,1284.19,,,,,,,1246.18,2715.00,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,228.81,,,,,,,47.62,483.75,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier,,0.98551,,,,,,,0.69500,1.35,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Premier,,37.65,,,,,,,36.54,79.60,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1135.28000,1078.52000,The Alliance,Premier,,536.99,,,,,,,521.09,1135.28,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier,90,865.84,,,,,,,19.00,865.84,fee schedule,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.60000,357.77000,The Alliance,Premier,90,2240.90,,,,,,,44.27,2240.90,fee schedule,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,Premier,90,8131.76,,,,,,,162.98,8131.76,fee schedule,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,outpatient,,,1741.00000,1653.95000,The Alliance,Premier,90,10355.70,,,,,,,204.58,10355.70,fee schedule,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,outpatient,1,mL,1455.84000,1383.05000,The Alliance,Premier,,60.98,,,,,,,36.96,1412.16,fee schedule,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Premier,,2.19,,,,,,,1.33,320.08,fee schedule,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Premier,,2.19,,,,,,,1.33,320.08,fee schedule,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,outpatient,,,574.00000,545.30000,The Alliance,Premier,90,3412.32,,,,,,,67.54,3412.32,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier,90,1137.41,,,,,,,24.91,1137.41,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,outpatient,,,250.60000,238.07000,The Alliance,Premier,90,1341.13,,,,,,,28.00,1341.13,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Premier,90,288.61,,,,,,,5.68,288.61,fee schedule,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier,,2325.39,,,,,,,2256.56,4916.25,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Premier,,0.24750,,,,,,,0.22165,1.56,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,outpatient,40,EA,0.27000,0.26000,The Alliance,Premier,,3.83,,,,,,,0.13500,3.83,fee schedule,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier,90,373.51,,,,,,,4.57,373.51,fee schedule,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,86.68000,82.35000,The Alliance,Premier,,41.00,,,,,,,39.79,86.68,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier,,17.37,,,,,,,16.85,36.72,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1310.63000,1245.10000,The Alliance,Premier,,619.93,,,,,,,601.58,1310.63,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier,,19270.02,,,,,,,18699.66,40740.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier,,1552.03,,,,,,,1506.09,3281.25,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier,,23.65,,,,,,,22.95,50.00,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier,,2774.14,,,,,,,2692.03,5865.00,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Premier,,8944.43,,,,,,,8679.69,18910.00,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier,,1819.29,,,,,,,381.55,2489.02,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,outpatient,1,mL,8.44000,8.02000,The Alliance,Premier,,5.98,,,,,,,4.22,8.19,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,outpatient,1,mL,776.38000,737.56000,The Alliance,Premier,,54.45,,,,,,,33.00,753.09,fee schedule,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Premier,,1.54,,,,,,,1.08,2.10,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Premier,,1.58,,,,,,,1.54,17.78,fee schedule,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier,,1.58,,,,,,,1.54,13.35,fee schedule,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Premier,,7336.54,,,,,,,7119.39,15510.66,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,,1860.31,,,,,,,1805.25,3933.00,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,53.56000,50.88000,The Alliance,Premier,,25.33,,,,,,,24.58,53.56,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1567.50000,1489.12000,The Alliance,Premier,,1111.36,,,,,,,783.75,1520.47,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,6258.30000,5945.38000,The Alliance,Premier,,2960.18,,,,,,,2872.56,6258.30,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier,,1631.85,,,,,,,1583.55,3450.00,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1938.64000,1841.71000,The Alliance,Premier,,1374.50,,,,,,,142.07,1880.48,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,outpatient,1,EA,25.15000,23.90000,The Alliance,Premier,,17.83,,,,,,,12.57,24.40,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Premier,90,26177.94,,,,,,,210.00,26177.94,fee schedule,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier,90,6451.13,,,,,,,109.60,6451.13,fee schedule,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,outpatient,,,5957.00000,5659.15000,The Alliance,Premier,90,4223.51,,,,,,,2537.50,5778.29,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier,,305.58,,,,,,,5.86,305.58,fee schedule,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,outpatient,1,mL,41610.00000,39529.50000,The Alliance,Premier,,234.15,,,,,,,141.91,40361.70,fee schedule,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,outpatient,1,EA,2516.97000,2391.12000,The Alliance,Premier,,47.06,,,,,,,28.52,2441.46,fee schedule,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier,,110.09,,,,,,,77.64,150.62,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,outpatient,1,mL,260.44000,247.42000,The Alliance,Premier,,184.65,,,,,,,130.22,252.63,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier,,2.49,,,,,,,1.75,3.40,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Premier,,5.04,,,,,,,3.56,6.90,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,38.40000,36.48000,The Alliance,Premier,,18.16,,,,,,,17.63,38.40,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,outpatient,1,mL,2.32000,2.21000,The Alliance,Premier,,0.24750,,,,,,,0.22165,2.25,fee schedule,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,outpatient,1,mL,18.09000,17.19000,The Alliance,Premier,,0.24750,,,,,,,0.22165,17.55,fee schedule,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,outpatient,1,EA,200.98000,190.93000,The Alliance,Premier,,3.73,,,,,,,3.62,194.95,fee schedule,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier,,9824.21,,,,,,,9533.43,20770.00,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier,,2276.43,,,,,,,2209.05,4812.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Premier,90,26177.94,,,,,,,210.00,26177.94,fee schedule,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,outpatient,,,3575.00000,3396.25000,The Alliance,Premier,90,20473.75,,,,,,,103.64,20473.75,fee schedule,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Premier,,11900.93,,,,,,,11548.68,25160.53,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,outpatient,,,288.33000,273.91000,The Alliance,Premier,,204.43,,,,,,,144.16,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,outpatient,1,mL,576.66000,547.83000,The Alliance,Premier,,408.85,,,,,,,145.98,559.36,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Premier,,33772.20,,,,,,,32772.60,71400.00,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,outpatient,1,EA,432.53000,410.90000,The Alliance,Premier,,306.66,,,,,,,216.26,419.55,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier,,1.29,,,,,,,0.91000,1.77,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier,,268.19,,,,,,,260.25,567.00,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Premier,,7803.00,,,,,,,1189.65,7803.00,case rate,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Premier,,7803.00,,,,,,,2988.68,8939.52,case rate,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,Premier,,388.03,,,,,,,376.51,1003.95,fee schedule,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,outpatient,,,421.60000,400.52000,The Alliance,Premier,,117.22,,,,,,,113.74,408.95,fee schedule,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,outpatient,1,mL,1604.51000,1524.28000,The Alliance,Premier,,54.90,,,,,,,33.27,1556.37,fee schedule,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,outpatient,1,mL,10593.45000,10063.78000,The Alliance,Premier,,54.90,,,,,,,33.27,10275.65,fee schedule,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,1685.06,,,,,,,1635.19,3562.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier,,5498.62,,,,,,,5335.88,11625.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier,,1860.31,,,,,,,1805.25,3933.00,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier,JW,307.71,,,,,,,217.00,488.81,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Premier,,3865.85,,,,,,,3751.43,8173.05,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,outpatient,1,mL,150.22000,142.71000,The Alliance,Premier,,79.89,,,,,,,48.42,145.71,fee schedule,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier,90,509.30,,,,,,,10.03,509.30,fee schedule,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Premier,,4030.67,,,,,,,3911.37,8521.50,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,15391.50000,14621.92000,The Alliance,Premier,,7280.18,,,,,,,7064.70,15391.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,outpatient,1,mL,1762.49000,1674.36000,The Alliance,Premier,,439.63,,,,,,,266.44,1709.62,fee schedule,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier,,29.13,,,,,,,20.54,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,outpatient,1,mL,46.94000,44.59000,The Alliance,Premier,,33.28,,,,,,,23.47,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,outpatient,1,mL,2.92000,2.78000,The Alliance,Premier,,2.07,,,,,,,1.46,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Premier,,47.05,,,,,,,33.18,64.37,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Premier,,12.62,,,,,,,8.90,17.27,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Premier,,263.39,,,,,,,185.75,360.36,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier,,3968.66,,,,,,,3851.19,8390.40,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier,,5365.19,,,,,,,5206.39,11342.90,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier,,713.01,,,,,,,13.73,713.01,fee schedule,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier,,713.01,,,,,,,13.73,713.01,fee schedule,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier,,0.26400,,,,,,,0.25616,6.13,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,outpatient,1,mL,44.13000,41.93000,The Alliance,Premier,,79.25,,,,,,,22.07,80.87,fee schedule,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,outpatient,1,mL,2518.47000,2392.54000,The Alliance,Premier,,402.30,,,,,,,243.82,2442.92,fee schedule,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier,,0.36868,,,,,,,0.26000,0.50440,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,5520.00000,5244.00000,The Alliance,Premier,,2610.96,,,,,,,2533.68,5520.00,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30450.00000,28927.50000,The Alliance,Premier,,14402.85,,,,,,,13976.55,30450.00,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier,,1426.10,,,,,,,1383.88,3015.00,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier,,2.69,,,,,,,1.90,3.68,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,outpatient,1,mL,9246.90000,8784.55000,The Alliance,Premier,,815.81,,,,,,,494.43,8969.49,fee schedule,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,outpatient,1,mL,9459.55000,8986.57000,The Alliance,Premier,,815.81,,,,,,,494.43,9175.76,fee schedule,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier,,0.28360,,,,,,,0.20000,0.38800,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier,,40.68,,,,,,,39.47,86.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,outpatient,,,95.22000,90.46000,The Alliance,Premier,,67.51,,,,,,,47.61,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,outpatient,1,mL,190.45000,180.93000,The Alliance,Premier,,135.03,,,,,,,95.22,184.74,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier,,0.87916,,,,,,,0.62000,1.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,outpatient,1,EA,63.52000,60.34000,The Alliance,Premier,,45.04,,,,,,,9.78,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Premier,,40.52,,,,,,,9.78,55.44,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,outpatient,1,EA,27.73000,26.34000,The Alliance,Premier,,1.50,,,,,,,0.91000,26.90,fee schedule,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier,,1.50,,,,,,,0.91000,18.08,fee schedule,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier,,4803.60,,,,,,,4661.42,10155.60,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier,,49.19,,,,,,,47.74,104.00,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier,,1713.44,,,,,,,1662.73,3622.50,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier,,1713.44,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier,,268.19,,,,,,,260.25,567.00,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier,,133.03,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,outpatient,1,mL,0.96000,0.91000,The Alliance,Premier,,0.68064,,,,,,,0.48000,0.93120,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,outpatient,1,mL,39932.98000,37936.33000,The Alliance,Premier,,28312.48,,,,,,,19966.49,38734.99,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,outpatient,1,mL,20.22000,19.21000,The Alliance,Premier,,14.34,,,,,,,10.11,19.61,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier,,0.33323,,,,,,,0.23500,0.45590,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,outpatient,1,EA,26.29000,24.98000,The Alliance,Premier,,18.64,,,,,,,13.14,25.50,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier,,0.43958,,,,,,,0.31000,0.60140,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1646.25000,1563.94000,The Alliance,Premier,,778.68,,,,,,,755.63,1646.25,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier,,79.22,,,,,,,36.80,93.98,fee schedule,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier,,0.06381,,,,,,,0.04500,0.08730,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier,,3664.32,,,,,,,3555.86,7746.98,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier,,340.32,,,,,,,240.00,465.60,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Premier,,3865.85,,,,,,,3751.43,8173.05,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4073.00000,3869.35000,The Alliance,Premier,90,13309.69,,,,,,,282.88,13309.69,fee schedule,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Premier,,288.50,,,,,,,203.46,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Premier,,288.50,,,,,,,203.46,394.70,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,,0.74250,,,,,,,0.63085,1.29,fee schedule,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier,,6120.34,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Premier,,72.27,,,,,,,17.58,72.27,fee schedule,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier,,5193.63,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,outpatient,1,mL,309.57000,294.09000,The Alliance,Premier,,219.49,,,,,,,154.78,300.28,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,outpatient,1,GM,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Premier,,0.39704,,,,,,,0.28000,0.54320,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Premier,52,2410.00,,,,,,,1929.64,11473.16,per diem,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,10470.18,per diem,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Premier,,11085.23,,,,,,,10757.12,23436.00,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier,,1.08,,,,,,,0.76000,1.47,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,21.64000,20.56000,The Alliance,Premier,,15.34,,,,,,,10.82,20.99,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier,,79.22,,,,,,,36.80,93.98,fee schedule,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Premier,90,666.46,,,,,,,470.00,911.80,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Premier,,105.65,,,,,,,64.03,183.91,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Premier,90,3186.14,,,,,,,292.00,3186.14,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,outpatient,,,187.80000,178.41000,The Alliance,Premier,90,1052.52,,,,,,,77.53,1052.52,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,outpatient,,,278.30000,264.38000,The Alliance,Premier,90,1861.90,,,,,,,125.97,1861.90,fee schedule,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier,90,611.15,,,,,,,8.17,611.15,fee schedule,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier,90,823.21,,,,,,,17.85,823.21,fee schedule,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,outpatient,,,510.50000,484.97000,The Alliance,Premier,90,3038.81,,,,,,,63.40,3038.81,fee schedule,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,outpatient,,,104.20000,98.99000,The Alliance,Premier,90,662.12,,,,,,,8.17,662.12,fee schedule,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier,90,1035.56,,,,,,,22.91,1035.56,fee schedule,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Premier,90,780.94,,,,,,,15.58,780.94,fee schedule,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,outpatient,,,245.20000,232.94000,The Alliance,Premier,90,1561.82,,,,,,,30.84,1561.82,fee schedule,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,outpatient,,,153.20000,145.54000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,outpatient,,,19344.00000,18376.80000,The Alliance,Premier,90,115186.20,,,,,,,8569.96,115186.20,fee schedule,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,outpatient,,,3556.00000,3378.20000,The Alliance,Premier,,21780.96,,,,,,,416.78,21780.96,fee schedule,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Premier,90,6383.20,,,,,,,126.29,6383.20,fee schedule,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,outpatient,,,108.40000,102.98000,The Alliance,Premier,90,2003.75,,,,,,,42.13,2003.75,fee schedule,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,outpatient,,,126.80000,120.46000,The Alliance,Premier,90,729.98,,,,,,,14.59,729.98,fee schedule,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Premier,90,492.33,,,,,,,9.61,492.33,fee schedule,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,outpatient,,,380.20000,361.19000,The Alliance,Premier,90,269.56,,,,,,,30.85,368.79,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Premier,90,492.33,,,,,,,9.61,492.33,fee schedule,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,outpatient,,,99.30000,94.33000,The Alliance,Premier,90,574.73,,,,,,,12.05,574.73,fee schedule,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,outpatient,,,97.90000,93.00000,The Alliance,Premier,90,645.08,,,,,,,8.17,645.08,fee schedule,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Premier,90,933.70,,,,,,,17.71,933.70,fee schedule,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,outpatient,,,94.70000,89.97000,The Alliance,Premier,90,543.65,,,,,,,11.53,543.65,fee schedule,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,outpatient,,,3830.00000,3638.50000,The Alliance,Premier,90,2715.47,,,,,,,1631.60,3715.10,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,outpatient,,,461.90000,438.80000,The Alliance,Premier,90,882.80,,,,,,,19.26,882.80,fee schedule,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,90,574.73,,,,,,,11.53,574.73,fee schedule,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,outpatient,1,GM,0.75000,0.71000,The Alliance,Premier,,0.53175,,,,,,,0.37500,0.72750,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,outpatient,1,GM,11.38000,10.81000,The Alliance,Premier,,8.07,,,,,,,5.69,11.04,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier,,1401.26,,,,,,,1359.79,2962.50,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier,,3968.66,,,,,,,3851.19,8390.40,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier,,0.12053,,,,,,,0.08500,0.16490,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Premier,,1303.71,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Premier,,1866.00,,,,,,,339.11,4230.17,per diem,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Premier,,1866.00,,,,,,,339.11,4221.44,per diem,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Premier,TC,545.22,,,,,,,384.50,745.93,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier,,3252.18,,,,,,,1308.97,4449.39,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10385.00000,9865.75000,The Alliance,Premier,,4912.10,,,,,,,4766.72,10385.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Premier,,14325.75,,,,,,,13901.73,30287.00,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Premier,,5.14,,,,,,,3.62,7.03,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier,,25.52,,,,,,,18.00,38.16,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier,,58.25,,,,,,,41.08,79.70,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier,,0.05672,,,,,,,0.04000,0.07760,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,outpatient,1,mL,9633.00000,9151.35000,The Alliance,Premier,,313.09,,,,,,,189.75,9344.01,fee schedule,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,outpatient,1,mL,5.09000,4.83000,The Alliance,Premier,,2.46,,,,,,,2.39,4.94,fee schedule,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Premier,,7336.54,,,,,,,7119.39,15510.66,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,422.74000,401.60000,The Alliance,Premier,,199.96,,,,,,,194.04,422.74,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,24800.00000,23560.00000,The Alliance,Premier,,11730.40,,,,,,,11383.20,24800.00,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2606.25000,2475.94000,The Alliance,Premier,,1232.76,,,,,,,1196.27,2606.25,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier,,6085.15,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,418.54000,397.61000,The Alliance,Premier,,197.97,,,,,,,192.11,418.54,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Premier,,68.87,,,,,,,66.83,145.60,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier,,143.36,,,,,,,7.36,143.36,fee schedule,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5779.41000,5490.44000,The Alliance,Premier,,2733.66,,,,,,,2652.75,5779.41,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier,,143.36,,,,,,,7.36,143.36,fee schedule,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,34.24000,32.53000,The Alliance,Premier,,36.65,,,,,,,17.12,36.65,fee schedule,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Premier,,12.17,,,,,,,11.81,24.95,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier,,79.22,,,,,,,36.80,93.98,fee schedule,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier,,36.57,,,,,,,25.79,50.03,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier,,2.34,,,,,,,0.12500,2.34,fee schedule,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,outpatient,1,mL,1.48000,1.40000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier,,3.69,,,,,,,2.60,5.05,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,outpatient,1,EA,10.45000,9.92000,The Alliance,Premier,,7.41,,,,,,,5.22,10.14,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,outpatient,1,GM,67.78000,64.39000,The Alliance,Premier,,48.06,,,,,,,33.89,65.75,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier,,1.38,,,,,,,0.97500,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,outpatient,1,mL,2.81000,2.67000,The Alliance,Premier,,1.99,,,,,,,1.41,2.73,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,outpatient,1,EA,7019.54000,6668.56000,The Alliance,Premier,,47.22,,,,,,,28.62,6808.95,fee schedule,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Premier,,1.83,,,,,,,0.24000,1.86,fee schedule,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Premier,,5.79,,,,,,,4.77,17.86,fee schedule,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier,,19270.02,,,,,,,18699.66,40740.00,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier,,13196.70,,,,,,,12806.10,27063.00,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2325.00000,2208.75000,The Alliance,Premier,,1648.42,,,,,,,1162.50,2255.25,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier,,2.98,,,,,,,2.10,4.07,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier,,1720.54,,,,,,,1669.61,3637.50,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier,,1285.97,,,,,,,1247.91,2718.75,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Premier,,220.36,,,,,,,155.40,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,outpatient,1,EA,1244.56000,1182.33000,The Alliance,Premier,,882.39,,,,,,,622.28,1207.22,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier,,7.90,,,,,,,1.26,10.56,fee schedule,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,outpatient,1,mL,1.88000,1.79000,The Alliance,Premier,,7.90,,,,,,,0.94000,10.56,fee schedule,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier,,6.72,,,,,,,4.74,9.20,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier,,0.04254,,,,,,,0.03000,0.05820,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier,,0.49630,,,,,,,0.35000,0.67900,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier,,0.40413,,,,,,,0.28500,0.55290,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,outpatient,1,mL,59.16000,56.20000,The Alliance,Premier,,1.42,,,,,,,1.35,57.39,fee schedule,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Premier,,1.91,,,,,,,1.16,368.06,fee schedule,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Premier,,7.05,,,,,,,4.97,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,outpatient,1,EA,4.33000,4.12000,The Alliance,Premier,,3.07,,,,,,,2.17,4.20,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,outpatient,1,EA,2377.67000,2258.79000,The Alliance,Premier,,379.93,,,,,,,230.26,2306.34,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,outpatient,1,EA,1087.80000,1033.41000,The Alliance,Premier,,8.56,,,,,,,5.19,1055.17,fee schedule,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,outpatient,1,mL,2.62000,2.49000,The Alliance,Premier,,0.84150,,,,,,,0.50685,2.54,fee schedule,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier,,7.84,,,,,,,5.53,10.73,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,outpatient,1,mL,11.46000,10.88000,The Alliance,Premier,,8.13,,,,,,,5.73,11.12,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier,,0.67355,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier,,0.70900,,,,,,,0.50000,0.97000,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,outpatient,1,mL,39.15000,37.19000,The Alliance,Premier,,27.76,,,,,,,19.57,37.98,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,outpatient,1,mL,100.36000,95.34000,The Alliance,Premier,,71.16,,,,,,,50.18,97.35,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier,,0.02127,,,,,,,0.01500,0.02910,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,outpatient,1,EA,14.92000,14.18000,The Alliance,Premier,,10.58,,,,,,,7.46,14.47,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier,,0.12762,,,,,,,0.09000,0.17460,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier,,0.74445,,,,,,,0.52500,1.02,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier,,1.57,,,,,,,1.10,2.14,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier,,1642.46,,,,,,,1593.85,3472.43,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier,,1.83,,,,,,,1.29,2.50,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Premier,,0.90752,,,,,,,0.64000,1.24,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,outpatient,1,EA,56.51000,53.69000,The Alliance,Premier,,40.07,,,,,,,28.25,54.81,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,outpatient,1,EA,12.02000,11.42000,The Alliance,Premier,,8.52,,,,,,,6.01,11.66,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier,,1720.54,,,,,,,1669.61,3637.50,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier,,0.03300,,,,,,,0.03202,4.85,fee schedule,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier,,143.36,,,,,,,7.36,143.36,fee schedule,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Premier,,54.11,,,,,,,38.16,74.03,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,outpatient,,,582.12000,553.01000,The Alliance,Premier,,412.72,,,,,,,291.06,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,outpatient,1,EA,582.12000,553.01000,The Alliance,Premier,,412.72,,,,,,,291.06,564.66,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier,,0.24815,,,,,,,0.17500,0.33950,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,1.45,,,,,,,0.31500,1.45,fee schedule,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,87.60000,83.22000,The Alliance,Premier,,41.43,,,,,,,40.21,87.60,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,outpatient,1,EA,36.75000,34.91000,The Alliance,Premier,,1.35,,,,,,,0.98580,35.65,fee schedule,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,outpatient,1,mL,616.69000,585.86000,The Alliance,Premier,,437.23,,,,,,,308.35,598.19,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,outpatient,1,GM,13.17000,12.51000,The Alliance,Premier,,9.34,,,,,,,6.58,12.77,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1342.24,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier,,110.60,,,,,,,78.00,151.32,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Premier,TC,548.00,,,,,,,384.16,824.50,fee schedule,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier,,1.10,,,,,,,0.77500,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier,,0.30487,,,,,,,0.21500,0.41710,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier,,0.70191,,,,,,,0.49500,0.96030,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,outpatient,1,mL,2944.76000,2797.52000,The Alliance,Premier,,3261.31,,,,,,,1472.38,3261.31,fee schedule,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Premier,,16.87,,,,,,,11.89,46.30,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier,,56.01,,,,,,,39.50,76.63,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,outpatient,1,mL,571.35000,542.79000,The Alliance,Premier,,12.49,,,,,,,7.57,554.21,fee schedule,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier,,0.65228,,,,,,,0.46000,0.89240,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92400.00000,87780.00000,The Alliance,Premier,,43705.20,,,,,,,42411.60,92400.00,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier,,419.05,,,,,,,406.65,885.94,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4151.56000,3943.98000,The Alliance,Premier,,1963.69,,,,,,,1905.57,4151.56,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3649.24000,3466.78000,The Alliance,Premier,,1726.09,,,,,,,1675.00,3649.24,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier,,1.83,,,,,,,0.19500,1.86,fee schedule,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,outpatient,1,mL,20.98000,19.93000,The Alliance,Premier,,14.87,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier,,5.60,,,,,,,1.49,7.66,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,outpatient,,,147.06000,139.71000,The Alliance,Premier,,242.65,,,,,,,73.53,244.12,fee schedule,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,outpatient,1,mL,1164.72000,1106.48000,The Alliance,Premier,,242.65,,,,,,,227.94,1129.78,fee schedule,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,outpatient,,,320.07000,304.07000,The Alliance,Premier,,266.72,,,,,,,160.03,310.47,fee schedule,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,outpatient,1,mL,640.14000,608.13000,The Alliance,Premier,,266.72,,,,,,,250.56,620.94,fee schedule,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,outpatient,1,mL,0.66000,0.62000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,outpatient,1,mL,39900.00000,37905.00000,The Alliance,Premier,,174.74,,,,,,,105.90,38703.00,fee schedule,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier,,1692.16,,,,,,,1642.07,3577.50,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Premier,,2.18,,,,,,,0.85500,2.61,fee schedule,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1077.53000,1023.65000,The Alliance,Premier,,763.97,,,,,,,142.07,1045.20,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,,373.51,,,,,,,4.90,373.51,fee schedule,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,,81.53,,,,,,,39.42,111.55,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier,,1564.45,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,29862.00000,28368.90000,The Alliance,Premier,,14124.73,,,,,,,13706.66,28966.14,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,outpatient,1,mL,1346.15000,1278.84000,The Alliance,Premier,,954.42,,,,,,,673.08,1305.77,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Premier,,319.27,,,,,,,309.82,675.00,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,outpatient,1,mL,2390.85000,2271.31000,The Alliance,Premier,,1695.11,,,,,,,1195.42,2319.12,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,100.20000,95.19000,The Alliance,Premier,,82.83,,,,,,,50.10,97.19,fee schedule,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,151.92000,144.32000,The Alliance,Premier,,639.03,,,,,,,75.96,639.03,fee schedule,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,13.52000,12.84000,The Alliance,Premier,,121.81,,,,,,,6.76,121.81,fee schedule,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,outpatient,1,mL,49.61000,47.13000,The Alliance,Premier,,35.17,,,,,,,24.80,48.12,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,outpatient,1,mL,73.08000,69.42000,The Alliance,Premier,,51.81,,,,,,,36.54,70.89,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier,,15513.96,,,,,,,15054.77,32799.06,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6551.55000,6223.97000,The Alliance,Premier,,3098.88,,,,,,,3007.16,6551.55,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier,,88.69,,,,,,,86.06,187.50,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier,,1071.48,,,,,,,755.62,1465.91,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,555.04000,527.29000,The Alliance,Premier,,393.52,,,,,,,277.52,538.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier,,1.83,,,,,,,0.31500,1.86,fee schedule,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier,,1.83,,,,,,,0.63000,1.86,fee schedule,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier,,75.68,,,,,,,73.44,160.00,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,outpatient,,,584.10000,554.90000,The Alliance,Premier,,414.13,,,,,,,292.05,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,outpatient,1,EA,584.10000,554.90000,The Alliance,Premier,,414.13,,,,,,,292.05,566.58,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,1.29,fee schedule,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Premier,,12.17,,,,,,,11.81,24.95,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,16.28000,15.47000,The Alliance,Premier,,12.37,,,,,,,8.14,15.79,fee schedule,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Premier,90,780.94,,,,,,,15.58,780.94,fee schedule,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,outpatient,,,329.20000,312.74000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Premier,90,322.54,,,,,,,6.23,322.54,fee schedule,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,outpatient,,,47.50000,45.12000,The Alliance,Premier,90,271.65,,,,,,,5.97,271.65,fee schedule,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,outpatient,,,47.20000,44.84000,The Alliance,Premier,90,271.65,,,,,,,5.94,271.65,fee schedule,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,outpatient,,,41.70000,39.62000,The Alliance,Premier,90,254.68,,,,,,,5.25,254.68,fee schedule,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,outpatient,,,119.70000,113.72000,The Alliance,Premier,90,763.98,,,,,,,15.06,763.98,fee schedule,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Premier,90,1459.96,,,,,,,28.73,1459.96,fee schedule,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,outpatient,,,44.70000,42.47000,The Alliance,Premier,90,1137.41,,,,,,,22.35,1137.41,fee schedule,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,outpatient,,,45.80000,43.51000,The Alliance,Premier,90,254.68,,,,,,,5.75,254.68,fee schedule,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier,90,356.54,,,,,,,7.05,356.54,fee schedule,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,outpatient,,,45.10000,42.84000,The Alliance,Premier,90,254.68,,,,,,,5.67,254.68,fee schedule,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier,90,254.68,,,,,,,5.23,254.68,fee schedule,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,outpatient,,,118.80000,112.86000,The Alliance,Premier,90,679.08,,,,,,,14.93,679.08,fee schedule,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,outpatient,,,38.90000,36.95000,The Alliance,Premier,90,220.68,,,,,,,4.89,220.68,fee schedule,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,outpatient,,,42.50000,40.38000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,outpatient,,,29.40000,27.93000,The Alliance,Premier,90,186.75,,,,,,,3.70,186.75,fee schedule,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier,90,356.54,,,,,,,6.92,356.54,fee schedule,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,outpatient,,,327.60000,311.22000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,23961.00000,22762.95000,The Alliance,Premier,,11333.55,,,,,,,10998.10,23242.17,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,24862.00000,23618.90000,The Alliance,Premier,,17627.16,,,,,,,12431.00,24116.14,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier,TC,937.00,,,,,,,90.20,3163.00,case rate,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier,JW,0.24750,,,,,,,0.22165,0.86330,fee schedule,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,1748.39,,,,,,,344.77,2392.02,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,outpatient,,,1133.00000,1076.35000,The Alliance,Premier,TC,8017.30,,,,,,,566.50,8017.30,fee schedule,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,outpatient,,,6363.00000,6044.85000,The Alliance,Premier,,1866.00,,,,,,,83.61,6172.11,per diem,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,outpatient,1,mL,8.97000,8.52000,The Alliance,Premier,,6.36,,,,,,,4.49,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,outpatient,1,mL,8.64000,8.21000,The Alliance,Premier,,6.13,,,,,,,4.32,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,outpatient,1,mL,8.07000,7.67000,The Alliance,Premier,,5.72,,,,,,,4.04,7.83,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,outpatient,1,mL,19684.00000,18699.80000,The Alliance,Premier,,119.46,,,,,,,72.40,19093.48,fee schedule,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,outpatient,1,mL,5752.33000,5464.72000,The Alliance,Premier,,29.86,,,,,,,18.10,5579.76,fee schedule,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier,,12500.21,,,,,,,12130.22,26427.50,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Premier,,33.37,,,,,,,32.39,70.56,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12400.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12400.00,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Premier,,1241.62,,,,,,,1204.88,2625.00,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier,,96.42,,,,,,,68.00,308.32,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier,,548.00,,,,,,,144.10,548.00,fee schedule,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,outpatient,,,233.19000,221.53000,The Alliance,Premier,,165.33,,,,,,,6.95,226.19,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,2640.00,,,,,,,865.71,5858.00,case rate,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier,,114.86,,,,,,,81.00,344.85,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,1645.00,,,,,,,1285.85,2518.12,per diem,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,4242.12000,4030.01000,The Alliance,Premier,,3007.66,,,,,,,683.80,4114.86,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Premier,,1786.88,,,,,,,1733.99,3777.75,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Premier,,1003.94,,,,,,,122.40,1373.52,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier,,504.58,,,,,,,489.64,1066.76,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier,,3377.93,,,,,,,3277.95,7141.50,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,514.09000,488.39000,The Alliance,Premier,,243.16,,,,,,,235.97,514.09,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier,,18.73,,,,,,,11.35,3368.26,fee schedule,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1476.56000,1402.73000,The Alliance,Premier,,698.41,,,,,,,677.74,1476.56,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier,TC,2410.00,,,,,,,1929.64,10470.18,per diem,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,outpatient,,,101.80000,96.71000,The Alliance,Premier,90,645.08,,,,,,,8.17,645.08,fee schedule,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Premier,90,526.26,,,,,,,8.17,526.26,fee schedule,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,outpatient,,,121.50000,115.42000,The Alliance,Premier,90,780.94,,,,,,,15.27,780.94,fee schedule,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,outpatient,,,139.90000,132.90000,The Alliance,Premier,90,882.80,,,,,,,17.60,882.80,fee schedule,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier,,1037.64,,,,,,,1006.93,2193.75,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,38850.00000,36907.50000,The Alliance,Premier,,18376.05,,,,,,,17832.15,38850.00,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,outpatient,1,mL,0.85000,0.80000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,outpatient,1,mL,0.85000,0.81000,The Alliance,Premier,,0.60265,,,,,,,0.42500,0.82450,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier,,1.62,,,,,,,1.14,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.04000,1.94000,The Alliance,Premier,,1.45,,,,,,,1.02,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier,,8.51,,,,,,,6.00,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.68000,1.60000,The Alliance,Premier,,1.19,,,,,,,0.84000,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,4.20000,3.99000,The Alliance,Premier,,2.98,,,,,,,2.10,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier,,17.73,,,,,,,12.50,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.60000,3.42000,The Alliance,Premier,,2.55,,,,,,,1.80,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.76000,2.62000,The Alliance,Premier,,1.96,,,,,,,1.38,2.68,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Premier,,6.31,,,,,,,4.45,20.67,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.52000,2.39000,The Alliance,Premier,,1.79,,,,,,,1.26,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.92000,1.82000,The Alliance,Premier,,1.36,,,,,,,0.96000,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.80000,1.71000,The Alliance,Premier,,1.28,,,,,,,0.90000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier,,5.67,,,,,,,4.00,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,6.00000,5.70000,The Alliance,Premier,,4.25,,,,,,,3.00,5.82,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier,,568.97,,,,,,,47.62,778.42,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,outpatient,1,EA,48514.58000,46088.85000,The Alliance,Premier,,357.62,,,,,,,216.74,47059.14,fee schedule,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Premier,,1.05,,,,,,,0.74000,1.44,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Premier,90,679.08,,,,,,,8.17,679.08,fee schedule,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,outpatient,,,1002.00000,951.90000,The Alliance,Premier,90,710.42,,,,,,,426.69,971.94,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier,90,763.98,,,,,,,8.17,763.98,fee schedule,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,90,763.98,,,,,,,16.61,763.98,fee schedule,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Premier,90,679.08,,,,,,,13.31,679.08,fee schedule,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,20150.00000,19142.50000,The Alliance,Premier,,9530.95,,,,,,,9248.85,20150.00,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier,,2.18,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier,,0.89334,,,,,,,0.63000,1.22,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,6.32000,6.00000,The Alliance,Premier,,2.99,,,,,,,2.90,6.32,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier,,117.69,,,,,,,83.00,161.02,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6070.28000,5766.77000,The Alliance,Premier,,2871.24,,,,,,,2786.26,6070.28,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier,,1713.44,,,,,,,1662.73,3622.50,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1774.50000,1685.77000,The Alliance,Premier,,1258.12,,,,,,,887.25,1721.27,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier,,2525.81,,,,,,,1781.25,3455.62,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,825.00000,783.75000,The Alliance,Premier,,584.92,,,,,,,412.50,800.25,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,2127.00,,,,,,,1500.00,2910.00,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier,,45.38,,,,,,,32.00,62.08,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier,,169.10,,,,,,,119.25,231.34,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,2640.00,,,,,,,845.37,3163.00,case rate,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,3963.00,,,,,,,1475.05,4686.00,case rate,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,170.60,,,,,,,47.62,360.68,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1548.45,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier,,714.82,,,,,,,693.66,1511.25,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier,,186.00,,,,,,,80.50,264.00,per diem,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52500.00000,49875.00000,The Alliance,Premier,,24832.50,,,,,,,24097.50,52500.00,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34639.50000,32907.53000,The Alliance,Premier,,16384.48,,,,,,,15899.53,34639.50,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier,,2276.43,,,,,,,2209.05,4812.75,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier,,2276.43,,,,,,,2209.05,4812.75,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,57750.00000,54862.50000,The Alliance,Premier,,27315.75,,,,,,,26507.25,57750.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier,TC,1509.95,,,,,,,144.00,1509.95,fee schedule,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Premier,,471.79,,,,,,,440.69,1374.98,fee schedule,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,outpatient,,,8798.00000,8358.10000,The Alliance,Premier,TC,6237.78,,,,,,,4399.00,8534.06,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Premier,TC,274.38,,,,,,,193.50,375.39,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier,,186.00,,,,,,,99.50,264.00,per diem,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier,TC,589.18,,,,,,,415.50,806.07,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier,,186.00,,,,,,,99.50,264.00,per diem,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,GP,186.00,,,,,,,50.00,264.00,per diem,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,,186.00,,,,,,,41.50,264.00,per diem,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier,,186.00,,,,,,,99.50,264.00,per diem,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier,,186.00,,,,,,,41.50,264.00,per diem,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,GO,186.00,,,,,,,50.00,264.00,per diem,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier,,186.00,,,,,,,50.00,264.00,per diem,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Premier,,7.51,,,,,,,0.96500,7.69,fee schedule,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,outpatient,1,mL,9.16000,8.71000,The Alliance,Premier,,6.49,,,,,,,4.58,8.89,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,outpatient,1,mL,7.17000,6.81000,The Alliance,Premier,,2.62,,,,,,,2.50,6.95,fee schedule,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Premier,,3500.32,,,,,,,3396.71,7400.25,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier,,9824.21,,,,,,,9533.43,20146.90,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier,,3664.32,,,,,,,3555.86,7746.98,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,284.10000,269.90000,The Alliance,Premier,,88.70,,,,,,,77.18,275.58,fee schedule,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier,,1728.19,,,,,,,1218.75,2364.38,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier,,11.82,,,,,,,11.47,25.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Premier,,33772.20,,,,,,,32772.60,71400.00,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,1748.39,,,,,,,726.83,2392.02,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,outpatient,1,mL,1315.72000,1249.93000,The Alliance,Premier,,119.46,,,,,,,72.40,1276.25,fee schedule,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,,248.32,,,,,,,240.97,525.00,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Premier,,628.12,,,,,,,12.05,628.12,fee schedule,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,255.72,,,,,,,47.62,349.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,outpatient,,,725.63000,689.35000,The Alliance,Premier,,514.47,,,,,,,362.81,703.86,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,64.89,,,,,,,45.76,88.77,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier,,704.57,,,,,,,44.30,963.94,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,outpatient,1,mL,173.36000,164.69000,The Alliance,Premier,,121.36,,,,,,,73.55,168.16,fee schedule,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,outpatient,1,mL,3408.61000,3238.18000,The Alliance,Premier,,65.17,,,,,,,39.50,3306.35,fee schedule,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,outpatient,1,mL,21.52000,20.44000,The Alliance,Premier,,15.26,,,,,,,10.76,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,outpatient,1,mL,21.27000,20.20000,The Alliance,Premier,,15.08,,,,,,,10.63,20.63,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Premier,90,2410.69,,,,,,,52.89,2410.69,fee schedule,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Premier,90,1643.57,,,,,,,117.50,1643.57,fee schedule,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Premier,90,2410.69,,,,,,,52.89,2410.69,fee schedule,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Premier,90,1643.57,,,,,,,117.50,1643.57,fee schedule,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier,90,1120.45,,,,,,,20.36,1120.45,fee schedule,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,1063.50,,,,,,,750.00,1455.00,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,outpatient,1,EA,1169.88000,1111.38000,The Alliance,Premier,,256.44,,,,,,,155.42,1134.78,fee schedule,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,outpatient,,,532.14000,505.53000,The Alliance,Premier,90,3514.18,,,,,,,69.60,3514.18,fee schedule,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,outpatient,,,1050.30000,997.78000,The Alliance,Premier,,744.66,,,,,,,525.15,3999.66,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,outpatient,,,915.50000,869.72000,The Alliance,Premier,,649.09,,,,,,,457.75,3999.66,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier,TC,3963.00,,,,,,,2786.18,6189.57,case rate,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier,,4953.07,,,,,,,3842.30,6776.42,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,256.50000,243.67000,The Alliance,Premier,,121.32,,,,,,,117.73,256.50,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier,,2392.88,,,,,,,1856.25,5271.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1914.30,,,,,,,1485.00,5271.00,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier,,3.53,,,,,,,1.07,3.53,fee schedule,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,204.75000,194.51000,The Alliance,Premier,,96.85,,,,,,,93.98,204.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,3675.00000,3491.25000,The Alliance,Premier,,2605.57,,,,,,,1837.50,3564.75,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier,,64.89,,,,,,,45.76,88.77,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1513.80000,1438.11000,The Alliance,Premier,,1073.28,,,,,,,47.62,1468.39,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,Premier,TC,1059.25,,,,,,,747.00,2210.07,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,outpatient,1,mL,12.96000,12.31000,The Alliance,Premier,,25.89,,,,,,,6.48,25.89,fee schedule,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Premier,,8080.82,,,,,,,7841.64,17084.19,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.60000,73.72000,The Alliance,Premier,,36.70,,,,,,,35.62,77.60,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,outpatient,1,mL,6037.50000,5735.62000,The Alliance,Premier,,4280.59,,,,,,,3018.75,5856.38,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,outpatient,,,4690.00000,4455.50000,The Alliance,Premier,,2218.37,,,,,,,2152.71,4690.00,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,outpatient,,,42710.00000,40574.50000,The Alliance,Premier,,30281.39,,,,,,,4095.00,41428.70,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Premier,,3.01,,,,,,,2.12,4.12,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Premier,,425.52,,,,,,,412.93,899.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier,,134.89,,,,,,,130.90,285.19,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,outpatient,,,325.01000,308.76000,The Alliance,Premier,,153.73,,,,,,,149.18,325.01,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier,TC,548.00,,,,,,,384.16,1000.07,fee schedule,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,3698.33000,3513.41000,The Alliance,Premier,,1749.31,,,,,,,1697.53,3698.33,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,417.15000,396.29000,The Alliance,Premier,,197.31,,,,,,,191.47,417.15,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier,,138.35,,,,,,,134.26,292.50,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3553.98000,3376.28000,The Alliance,Premier,,1681.03,,,,,,,1631.28,3553.98,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6934.50000,6587.77000,The Alliance,Premier,,3280.02,,,,,,,3182.94,6934.50,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier,,294.44,,,,,,,285.73,622.50,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier,TC,441.87,,,,,,,41.10,484.28,fee schedule,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Premier,TC,12082.27,,,,,,,1523.24,17311.25,fee schedule,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,,937.00,,,,,,,280.29,3163.00,case rate,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier,,5322.67,,,,,,,5165.13,11253.00,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier,,66.22,,,,,,,64.26,140.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier,,13592.60,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier,,5632.06,,,,,,,5465.36,11907.10,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Premier,,9648.71,,,,,,,9363.12,20398.96,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier,,5865.20,,,,,,,5691.60,12028.00,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,outpatient,,,138.70000,131.76000,The Alliance,Premier,90,713.01,,,,,,,14.22,713.01,fee schedule,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,outpatient,,,94.60000,89.87000,The Alliance,Premier,90,628.12,,,,,,,12.38,628.12,fee schedule,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Premier,90,339.51,,,,,,,6.69,339.51,fee schedule,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Premier,90,339.51,,,,,,,6.69,339.51,fee schedule,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,outpatient,,,111.70000,106.11000,The Alliance,Premier,90,662.12,,,,,,,9.02,662.12,fee schedule,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier,,3242.53,,,,,,,61.98,3242.53,fee schedule,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,outpatient,,,176.50000,167.67000,The Alliance,Premier,90,2082.45,,,,,,,23.08,2082.45,fee schedule,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1545.94,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,67200.00000,63840.00000,The Alliance,Premier,,31785.60,,,,,,,30844.80,67200.00,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5658.00000,5375.10000,The Alliance,Premier,,2676.23,,,,,,,2597.02,5658.00,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1545.94,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1500.00,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,outpatient,1,mL,0.46000,0.44000,The Alliance,Premier,,0.32614,,,,,,,0.23000,0.44620,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier,,36.87,,,,,,,26.00,163.43,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier,,14.18,,,,,,,10.00,41.00,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Premier,,385.70,,,,,,,299.20,4686.00,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,15174.50000,14415.77000,The Alliance,Premier,,7177.54,,,,,,,6965.10,15174.50,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Premier,,471.79,,,,,,,440.69,1374.98,fee schedule,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,outpatient,1,EA,291.05000,276.50000,The Alliance,Premier,,206.35,,,,,,,145.53,282.32,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier,,1040.81,,,,,,,734.00,1801.19,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Premier,,384.99,,,,,,,271.50,526.71,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1583.37,,,,,,,1479.03,3681.15,fee schedule,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,3669.07,,,,,,,2587.50,5019.75,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,202.01000,191.91000,The Alliance,Premier,,95.55,,,,,,,92.72,202.01,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier,,1.01,,,,,,,0.71000,1.38,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier,,0.46794,,,,,,,0.33000,0.64020,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier,TC,1748.39,,,,,,,1233.00,2392.02,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier,,0.80850,,,,,,,0.78449,3.22,fee schedule,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier,,1756.01,,,,,,,1704.04,3712.50,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20017.48000,19016.61000,The Alliance,Premier,,9468.27,,,,,,,9188.02,20017.48,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,outpatient,1,EA,1437.45000,1365.58000,The Alliance,Premier,,167.46,,,,,,,96.37,1394.33,fee schedule,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,outpatient,1,EA,1131.92000,1075.32000,The Alliance,Premier,,6.62,,,,,,,4.01,1097.96,fee schedule,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,outpatient,,,3050.00000,2897.50000,The Alliance,Premier,,2162.45,,,,,,,148.57,2958.50,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier,,13.17,,,,,,,0.25000,13.53,fee schedule,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,252.58,,,,,,,178.12,345.56,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,outpatient,1,EA,2435.92000,2314.12000,The Alliance,Premier,,73.57,,,,,,,44.59,2362.84,fee schedule,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,outpatient,,,414.00000,393.30000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier,,628.12,,,,,,,12.00,628.12,fee schedule,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier,,88.69,,,,,,,86.06,187.50,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,outpatient,1,GM,2.73000,2.59000,The Alliance,Premier,,1.94,,,,,,,1.36,2.65,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier,,0.26233,,,,,,,0.18500,0.35890,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,4398.75000,4178.81000,The Alliance,Premier,,49.99,,,,,,,47.06,4266.79,fee schedule,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,40.16000,38.15000,The Alliance,Premier,,143.36,,,,,,,20.08,143.36,fee schedule,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1455.00,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,848.59000,806.16000,The Alliance,Premier,,401.38,,,,,,,389.50,848.59,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,outpatient,1,EA,6927.88000,6581.48000,The Alliance,Premier,,4911.87,,,,,,,3463.94,6720.04,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier,,2185.85,,,,,,,1695.65,5271.00,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Premier,90,1539.22,,,,,,,12.45,1539.22,fee schedule,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Premier,90,2286.16,,,,,,,25.31,2286.16,fee schedule,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,outpatient,,,146.80000,139.46000,The Alliance,Premier,90,645.08,,,,,,,12.80,645.08,fee schedule,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Premier,,3511.31,,,,,,,2476.24,4803.91,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,outpatient,5,EA,3.05000,2.90000,The Alliance,Premier,,2.16,,,,,,,1.52,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,outpatient,5,EA,3.46000,3.28000,The Alliance,Premier,,2.45,,,,,,,1.73,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,outpatient,5,EA,6.10000,5.79000,The Alliance,Premier,,4.32,,,,,,,3.05,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,outpatient,5,EA,6.13000,5.82000,The Alliance,Premier,,4.35,,,,,,,3.06,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,outpatient,5,EA,6.95000,6.60000,The Alliance,Premier,,4.93,,,,,,,3.48,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,outpatient,5,EA,6.11000,5.81000,The Alliance,Premier,,4.33,,,,,,,3.06,5.93,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Premier,,224.47,,,,,,,136.04,12824.21,fee schedule,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,Premier,TC,3626.34,,,,,,,279.50,4345.33,fee schedule,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier,,4524.13,,,,,,,1556.56,6189.57,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,outpatient,1,mL,10.27000,9.76000,The Alliance,Premier,,7.28,,,,,,,5.13,9.96,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,28140.00000,26733.00000,The Alliance,Premier,,13310.22,,,,,,,12916.26,27295.80,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier,,787.54,,,,,,,764.24,1615.05,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,outpatient,,,54600.00000,51870.00000,The Alliance,Premier,,25825.80,,,,,,,25061.40,54600.00,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,4280.59,,,,,,,3018.75,5856.38,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Premier,,11657.08,,,,,,,11312.06,24645.00,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Premier,,226.76,,,,,,,220.04,479.40,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier,,445.53,,,,,,,432.35,941.93,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1455.00,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier,,6772.31,,,,,,,114.10,6772.31,fee schedule,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,outpatient,1,mL,82.19000,78.08000,The Alliance,Premier,,79.89,,,,,,,41.09,81.54,fee schedule,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,outpatient,1,EA,44799.32000,42559.35000,The Alliance,Premier,,2866.22,,,,,,,1737.10,43455.34,fee schedule,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Premier,,367.84,,,,,,,356.96,777.68,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,outpatient,,,3115.00000,2959.25000,The Alliance,Premier,,2208.53,,,,,,,314.95,3021.55,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,outpatient,,,501.00000,475.95000,The Alliance,Premier,,355.21,,,,,,,275.55,4686.00,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,outpatient,1,EA,874.01000,830.31000,The Alliance,Premier,,619.67,,,,,,,437.00,847.79,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,outpatient,1,EA,1575.00000,1496.25000,The Alliance,Premier,,1116.67,,,,,,,787.50,1527.75,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,outpatient,1,EA,513.56000,487.88000,The Alliance,Premier,,364.11,,,,,,,256.78,498.15,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,outpatient,1,EA,663.39000,630.22000,The Alliance,Premier,,470.34,,,,,,,331.69,643.49,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,outpatient,1,EA,1575.27000,1496.50000,The Alliance,Premier,,1116.87,,,,,,,787.63,1528.01,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Premier,90,6756.70,,,,,,,70.04,6756.70,fee schedule,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Premier,90,6756.70,,,,,,,70.04,6756.70,fee schedule,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier,,937.00,,,,,,,114.40,3163.00,case rate,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier,,71.90,,,,,,,33.34,152.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier,,1369.34,,,,,,,1328.81,2895.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier,,732.42,,,,,,,710.74,1502.00,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,outpatient,1,mL,647.15000,614.79000,The Alliance,Premier,,0.49500,,,,,,,0.30000,627.74,fee schedule,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87.48000,83.11000,The Alliance,Premier,,41.38,,,,,,,40.15,87.48,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,299.89000,284.90000,The Alliance,Premier,,141.85,,,,,,,137.65,299.89,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1828.43000,1737.01000,The Alliance,Premier,,864.85,,,,,,,839.25,1828.43,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4110.81000,3905.27000,The Alliance,Premier,,1944.41,,,,,,,1886.86,4110.81,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,Premier,90,248.15,,,,,,,175.00,339.50,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier,,82.60,,,,,,,80.16,174.64,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,386.10000,366.80000,The Alliance,Premier,,182.63,,,,,,,177.22,386.10,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1518.75000,1442.81000,The Alliance,Premier,,718.37,,,,,,,697.11,1518.75,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier,,0.19143,,,,,,,0.13500,0.26190,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,3183.75000,3024.56000,The Alliance,Premier,,1505.91,,,,,,,1461.34,3183.75,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,47.62,469.24,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Premier,,3916.44,,,,,,,3800.52,8280.00,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2340.75000,2223.71000,The Alliance,Premier,,1107.17,,,,,,,1074.40,2340.75,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier,,1.12,,,,,,,0.73040,1.53,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,outpatient,1,mL,83.36000,79.19000,The Alliance,Premier,,59.10,,,,,,,1.49,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,outpatient,1,mL,19.90000,18.90000,The Alliance,Premier,,14.11,,,,,,,1.49,19.30,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2418.75000,2297.81000,The Alliance,Premier,,1144.07,,,,,,,1110.21,2418.75,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier,,79.83,,,,,,,15.96,81.35,fee schedule,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,outpatient,1,GM,1.36000,1.29000,The Alliance,Premier,,0.96424,,,,,,,0.68000,1.32,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier,,16886.10,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,45150.00000,42892.50000,The Alliance,Premier,,21355.95,,,,,,,20723.85,45150.00,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,,283.80,,,,,,,275.40,600.00,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,16709.00000,15873.55000,The Alliance,Premier,,7903.36,,,,,,,7669.43,16709.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Premier,,3362.60,,,,,,,3263.08,7109.10,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2632.50000,2500.88000,The Alliance,Premier,,1245.17,,,,,,,1208.32,2632.50,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier,,3963.00,,,,,,,739.20,4686.00,case rate,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier,,4161.22,,,,,,,4038.05,8797.50,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier,,462.95,,,,,,,449.25,978.75,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier,,686.44,,,,,,,666.12,1451.25,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,,24.82,,,,,,,17.50,33.95,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Premier,,7.00,,,,,,,4.24,616.02,fee schedule,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier,,0.24106,,,,,,,0.17000,0.32980,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Premier,,4.85,,,,,,,2.37,5.99,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,outpatient,1,mL,31.63000,30.05000,The Alliance,Premier,,79.83,,,,,,,15.81,81.35,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier,,79.83,,,,,,,15.96,81.35,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier,,79.83,,,,,,,15.96,81.35,fee schedule,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,outpatient,,,29629.15000,28147.69000,The Alliance,Premier,,11669.19,,,,,,,10900.23,28740.28,fee schedule,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,outpatient,1,mL,71250.00000,67687.50000,The Alliance,Premier,,527.57,,,,,,,319.74,69112.50,fee schedule,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,outpatient,1,mL,1095.57000,1040.79000,The Alliance,Premier,,29.44,,,,,,,17.84,1062.70,fee schedule,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier,,567.60,,,,,,,550.80,1200.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Premier,,2342.52,,,,,,,2273.19,4952.48,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier,,188.02,,,,,,,182.45,397.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Premier,,682.89,,,,,,,662.68,1443.75,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Premier,,943.70,,,,,,,515.62,1031.25,fee schedule,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,897.53000,852.65000,The Alliance,Premier,,424.53,,,,,,,411.97,897.53,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4798.95000,4559.00000,The Alliance,Premier,,2269.90,,,,,,,2202.72,4798.95,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1455.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier,,1419.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier,,0.04963,,,,,,,0.03500,0.06790,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Premier,,1681.04,,,,,,,1304.05,5271.00,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier,,3664.32,,,,,,,3555.86,7746.98,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier,,2774.14,,,,,,,2692.03,5865.00,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.32000,15.50000,The Alliance,Premier,,36.65,,,,,,,8.16,36.65,fee schedule,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1318.46000,1252.54000,The Alliance,Premier,,623.63,,,,,,,605.17,1318.46,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier,,225.27,,,,,,,218.60,476.25,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier,,620.81,,,,,,,602.44,1312.50,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier,,0.73736,,,,,,,0.52000,1.01,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,outpatient,1,mL,208.56000,198.13000,The Alliance,Premier,,147.87,,,,,,,104.28,202.30,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Premier,,4079.54,,,,,,,3958.80,8624.83,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Premier,,4079.54,,,,,,,3958.80,8624.83,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Premier,,4136.74,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier,,2814.94,,,,,,,2731.62,5951.25,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier,,12.37,,,,,,,7.36,14.28,fee schedule,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,33390.00000,31720.50000,The Alliance,Premier,,15793.47,,,,,,,15326.01,32388.30,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier,,1762.40,,,,,,,1710.23,3726.00,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,31395.00000,29825.25000,The Alliance,Premier,,14849.83,,,,,,,14410.31,31395.00,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Premier,,15594.81,,,,,,,15133.23,32970.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,39.04000,37.09000,The Alliance,Premier,,27.68,,,,,,,19.52,37.87,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier,,221.72,,,,,,,215.16,468.75,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Premier,,71.97,,,,,,,43.62,425.46,fee schedule,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Premier,,71.97,,,,,,,43.62,425.46,fee schedule,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Premier,,0.67650,,,,,,,0.41000,798.91,fee schedule,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Premier,,0.67650,,,,,,,0.41000,798.91,fee schedule,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,outpatient,1,EA,6037.62000,5735.73000,The Alliance,Premier,,73.57,,,,,,,44.59,5856.49,fee schedule,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,outpatient,1,mL,5333.84000,5067.15000,The Alliance,Premier,,24.88,,,,,,,15.08,5173.82,fee schedule,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1893.75000,1799.06000,The Alliance,Premier,,895.74,,,,,,,869.23,1893.75,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier,,443.44,,,,,,,430.31,937.50,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier,,532.12,,,,,,,516.38,1125.00,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Premier,,3782.63,,,,,,,3670.67,7997.10,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier,,2358.02,,,,,,,2288.23,4985.25,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,51282.00000,48717.90000,The Alliance,Premier,,24256.39,,,,,,,23538.44,51282.00,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,775.39000,736.62000,The Alliance,Premier,,366.76,,,,,,,355.90,775.39,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1581.25000,1502.19000,The Alliance,Premier,,1121.11,,,,,,,790.62,1533.81,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,984.38000,935.16000,The Alliance,Premier,,697.93,,,,,,,492.19,954.85,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1433.75000,1362.06000,The Alliance,Premier,,1016.53,,,,,,,716.88,1390.74,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,outpatient,1,mL,139.42000,132.45000,The Alliance,Premier,,12.49,,,,,,,7.57,135.24,fee schedule,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Premier,,0.82244,,,,,,,0.58000,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier,,0.77281,,,,,,,0.54500,1.06,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier,TC,1331.91,,,,,,,131.00,1331.91,fee schedule,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Premier,,14.85,,,,,,,10.47,20.32,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17633.23000,16751.57000,The Alliance,Premier,,8340.52,,,,,,,8093.65,17633.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier,,2921.01,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier,,379.58,,,,,,,368.35,802.50,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier,,379.58,,,,,,,368.35,802.50,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier,,0.44667,,,,,,,0.31500,0.61110,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Premier,,10080.81,,,,,,,9782.44,21312.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,outpatient,1,mL,1.63000,1.55000,The Alliance,Premier,,1.16,,,,,,,0.81500,1.58,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24180.00000,22971.00000,The Alliance,Premier,,11437.14,,,,,,,11098.62,24180.00,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,1123.13000,1066.97000,The Alliance,Premier,,531.24,,,,,,,515.52,1123.13,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier,,285.57,,,,,,,277.12,603.75,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier,,0.16307,,,,,,,0.11500,0.22310,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,outpatient,1,mL,10018.32000,9517.40000,The Alliance,Premier,,313.09,,,,,,,189.75,9717.77,fee schedule,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier,,21.27,,,,,,,15.00,29.10,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,outpatient,,,94.90000,90.16000,The Alliance,Premier,,67.28,,,,,,,47.45,92.05,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier,,0.14180,,,,,,,0.10000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier,,0.15598,,,,,,,0.11000,0.21340,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier,,2.23,,,,,,,1.57,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier,,2.21,,,,,,,1.56,3.03,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,outpatient,1,mL,12.80000,12.16000,The Alliance,Premier,,45.14,,,,,,,6.40,48.87,fee schedule,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier,TC,3586.71,,,,,,,267.00,3586.71,fee schedule,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Premier,,3500.32,,,,,,,3396.71,7400.25,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,8452.50000,8029.88000,The Alliance,Premier,,3998.03,,,,,,,3879.70,8452.50,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,outpatient,1,mL,27.97000,26.57000,The Alliance,Premier,,19.83,,,,,,,13.98,27.13,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier,,2105.09,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier,,168.51,,,,,,,163.52,356.25,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1500.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1500.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier,,709.50,,,,,,,688.50,1500.00,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier,,13185.06,,,,,,,12794.81,27875.40,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier,,29799.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier,,505.52,,,,,,,490.56,1068.75,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,748.13000,710.72000,The Alliance,Premier,,353.87,,,,,,,343.39,748.13,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3510.00000,3334.50000,The Alliance,Premier,,1660.23,,,,,,,1611.09,3510.00,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,outpatient,,,737.50000,700.62000,The Alliance,Premier,TC,7351.18,,,,,,,368.75,7351.18,fee schedule,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,Premier,,6705.74,,,,,,,128.29,6705.74,fee schedule,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Premier,,14.85,,,,,,,10.47,20.32,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,outpatient,,,108.90000,103.46000,The Alliance,Premier,90,645.08,,,,,,,14.25,645.08,fee schedule,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1383.75,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier,,285.57,,,,,,,277.12,603.75,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,outpatient,,,22.49000,21.37000,The Alliance,Premier,,36.88,,,,,,,11.24,37.10,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,outpatient,1,mL,44.98000,42.73000,The Alliance,Premier,,36.88,,,,,,,22.49,43.63,fee schedule,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,12477.50000,11853.62000,The Alliance,Premier,,5901.86,,,,,,,5727.17,12477.50,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1383.75,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,41160.00000,39102.00000,The Alliance,Premier,,19468.68,,,,,,,18892.44,39925.20,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,outpatient,,,114.90000,109.16000,The Alliance,Premier,90,763.98,,,,,,,15.03,763.98,fee schedule,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,outpatient,,,855.60000,812.82000,The Alliance,Premier,90,1662.04,,,,,,,35.09,1662.04,fee schedule,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,outpatient,1,mL,50.24000,47.73000,The Alliance,Premier,,0.67650,,,,,,,0.41000,48.73,fee schedule,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier,,4.08,,,,,,,2.88,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,outpatient,1,EA,8.58000,8.15000,The Alliance,Premier,,6.08,,,,,,,4.29,8.32,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Premier,,12.17,,,,,,,8.59,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,outpatient,1,EA,25.75000,24.47000,The Alliance,Premier,,18.26,,,,,,,12.88,24.98,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5654.55000,5371.82000,The Alliance,Premier,,2674.60,,,,,,,2595.44,5654.55,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4183.13000,3973.97000,The Alliance,Premier,,1978.62,,,,,,,1920.06,4183.13,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2475.00000,2351.25000,The Alliance,Premier,,1170.67,,,,,,,1136.03,2475.00,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier,,4386.41,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,19957.80000,18959.91000,The Alliance,Premier,,9440.04,,,,,,,9160.63,19957.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1383.75,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Premier,,137.76,,,,,,,41.74,138.59,fee schedule,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Premier,,137.76,,,,,,,83.49,161.97,fee schedule,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Premier,,137.76,,,,,,,41.74,138.59,fee schedule,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Premier,,137.76,,,,,,,83.49,161.97,fee schedule,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,outpatient,1,mL,4383.75000,4164.57000,The Alliance,Premier,,3108.08,,,,,,,1080.88,4252.24,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier,,6085.15,,,,,,,5905.03,12865.00,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier,90,645.08,,,,,,,12.82,645.08,fee schedule,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier,90,594.19,,,,,,,11.77,594.19,fee schedule,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier,TC,2162.63,,,,,,,210.00,2162.63,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,outpatient,,,36.49000,34.67000,The Alliance,Premier,,60.80,,,,,,,18.25,61.17,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,outpatient,1,mL,72.98000,69.33000,The Alliance,Premier,,60.80,,,,,,,36.49,70.79,fee schedule,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier,,3671.66,,,,,,,3562.99,7762.50,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier,,3671.66,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Premier,,11657.08,,,,,,,11312.06,24645.00,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,36372.00000,34553.40000,The Alliance,Premier,,17203.96,,,,,,,16694.75,36372.00,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1256.25000,1193.44000,The Alliance,Premier,,594.21,,,,,,,576.62,1256.25,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier,,434.57,,,,,,,421.71,918.75,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier,,514.39,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,44688.00000,42453.60000,The Alliance,Premier,,21137.42,,,,,,,20511.79,44688.00,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Premier,,2007.18,,,,,,,1947.77,4243.50,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Premier,,1672.65,,,,,,,1623.14,3536.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier,,5058.73,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1383.75,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier,,110.09,,,,,,,77.64,150.62,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,915.56000,869.78000,The Alliance,Premier,,433.06,,,,,,,420.24,915.56,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,Premier,TC,660.79,,,,,,,466.00,904.04,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Premier,,6.52,,,,,,,3.73,7.25,fee schedule,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,331.50000,314.92000,The Alliance,Premier,,156.80,,,,,,,152.16,331.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,outpatient,,,66150.00000,62842.50000,The Alliance,Premier,,31288.95,,,,,,,30362.85,64165.50,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1856.25000,1763.44000,The Alliance,Premier,,878.01,,,,,,,852.02,1856.25,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,937.00,,,,,,,415.12,5858.00,case rate,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,90,957.15,,,,,,,675.00,1309.50,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,1840.56,,,,,,,1427.80,5271.00,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,937.00,,,,,,,220.50,3163.00,case rate,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier,,1840.56,,,,,,,1427.80,5271.00,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Premier,,2219.32,,,,,,,2153.63,4692.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier,,1795.04,,,,,,,1741.90,3795.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier,,405.30,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier,,195.11,,,,,,,189.34,412.50,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2484.38000,2360.16000,The Alliance,Premier,,1175.11,,,,,,,1140.33,2484.38,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2925.00000,2778.75000,The Alliance,Premier,,1383.53,,,,,,,1342.58,2925.00,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,outpatient,,,1477.00000,1403.15000,The Alliance,Premier,TC,1047.19,,,,,,,738.50,1432.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier,TC,196.39,,,,,,,138.50,268.69,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier,TC,173.71,,,,,,,122.50,237.65,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,outpatient,,,201.10000,191.04000,The Alliance,Premier,90,1211.55,,,,,,,16.91,1211.55,fee schedule,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,outpatient,,,167.70000,159.31000,The Alliance,Premier,90,1103.49,,,,,,,21.94,1103.49,fee schedule,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Premier,,1833.46,,,,,,,35.09,1833.46,fee schedule,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier,90,957.15,,,,,,,675.00,4687.50,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Premier,,4978.09,,,,,,,4830.75,10524.50,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,outpatient,,,533.61000,506.93000,The Alliance,Premier,,378.33,,,,,,,266.81,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,outpatient,1,EA,533.61000,506.93000,The Alliance,Premier,,378.33,,,,,,,266.81,517.60,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,255.72,,,,,,,47.62,349.86,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier,,3426.89,,,,,,,3325.45,7245.00,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,6399.89000,6079.90000,The Alliance,Premier,,3027.15,,,,,,,2937.55,6399.89,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier,,452.31,,,,,,,438.92,956.25,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,3.24,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,outpatient,1,EA,42.84000,40.70000,The Alliance,Premier,,0.08250,,,,,,,0.05000,41.55,fee schedule,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,outpatient,1,EA,19.09000,18.13000,The Alliance,Premier,,0.08250,,,,,,,0.05000,18.52,fee schedule,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Premier,,2300.70,,,,,,,1784.75,5271.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier,,6891.61,,,,,,,6687.63,14570.00,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,outpatient,1,mL,2.10000,1.99000,The Alliance,Premier,,1.49,,,,,,,1.05,2.04,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier,,11.20,,,,,,,7.90,15.33,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier,,2447.78,,,,,,,2375.32,5175.00,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier,,63.38,,,,,,,61.51,134.00,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier,GP,186.00,,,,,,,126.65,782.79,per diem,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier,GO,186.00,,,,,,,126.65,688.70,per diem,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier,GP,186.00,,,,,,,126.65,688.70,per diem,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier,G0,186.00,,,,,,,126.65,782.79,per diem,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,866.25000,822.94000,The Alliance,Premier,,409.74,,,,,,,397.61,866.25,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3195.98000,3036.18000,The Alliance,Premier,,1511.70,,,,,,,1466.95,3195.98,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Premier,,226.76,,,,,,,220.04,479.40,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier,,0.11344,,,,,,,0.08000,0.15520,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Premier,,1118.03,,,,,,,671.22,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Premier,JW,1118.03,,,,,,,788.46,1529.60,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,outpatient,1,EA,364.23000,346.02000,The Alliance,Premier,,258.24,,,,,,,182.12,353.30,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,outpatient,1,mL,1585.11000,1505.85000,The Alliance,Premier,,1077.04,,,,,,,652.75,1537.56,fee schedule,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,outpatient,1,mL,13617.45000,12936.58000,The Alliance,Premier,,378.03,,,,,,,229.11,13208.93,fee schedule,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier,,2937.33,,,,,,,2850.39,6023.70,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Premier,90,7571.58,,,,,,,149.66,7571.58,fee schedule,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1695.50000,1610.72000,The Alliance,Premier,90,10101.09,,,,,,,175.54,10101.09,fee schedule,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Premier,90,7571.58,,,,,,,149.66,7571.58,fee schedule,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Premier,90,8573.20,,,,,,,169.42,8573.20,fee schedule,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Premier,90,8573.20,,,,,,,169.42,8573.20,fee schedule,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,outpatient,1,EA,7168.24000,6809.83000,The Alliance,Premier,,51.69,,,,,,,31.33,6953.19,fee schedule,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,outpatient,1,mL,1585.12000,1505.86000,The Alliance,Premier,,1077.04,,,,,,,652.75,1537.57,fee schedule,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier,,4.06,,,,,,,0.01000,4.06,fee schedule,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Premier,,1661.72,,,,,,,1171.88,2273.44,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Premier,,5870.52,,,,,,,4140.00,8031.60,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Premier,,3670.03,,,,,,,3561.40,7759.05,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Premier,,10080.81,,,,,,,9782.44,21312.50,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier,,6127.36,,,,,,,4321.12,8382.98,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5765.30000,5477.04000,The Alliance,Premier,,2726.99,,,,,,,2646.27,5765.30,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,231.75000,220.16000,The Alliance,Premier,,109.62,,,,,,,106.37,231.75,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,outpatient,1,mL,31.13000,29.57000,The Alliance,Premier,,22.07,,,,,,,15.56,30.20,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,outpatient,1,mL,5333.61000,5066.93000,The Alliance,Premier,,24.88,,,,,,,15.08,5173.60,fee schedule,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Premier,,15594.81,,,,,,,15133.23,32970.00,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Premier,,367.84,,,,,,,356.96,777.68,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier,,617.26,,,,,,,599.00,1305.00,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Premier,,11900.93,,,,,,,11548.68,25160.53,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1781.25000,1692.19000,The Alliance,Premier,,842.53,,,,,,,817.59,1781.25,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,164.30,,,,,,,153.47,600.19,fee schedule,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,outpatient,1,mL,1796.53000,1706.70000,The Alliance,Premier,,123.52,,,,,,,74.86,1742.63,fee schedule,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Premier,,9648.71,,,,,,,9363.12,20398.96,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,outpatient,1,mL,72.68000,69.05000,The Alliance,Premier,,51.53,,,,,,,36.34,70.50,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,outpatient,1,mL,20263.50000,19250.32000,The Alliance,Premier,,794.59,,,,,,,481.57,19655.60,fee schedule,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Premier,,14325.75,,,,,,,13901.73,30287.00,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier,,1720.54,,,,,,,1669.61,3637.50,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,outpatient,1,EA,11110.82000,10555.28000,The Alliance,Premier,,267.23,,,,,,,161.96,10777.50,fee schedule,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier,,1436.95,,,,,,,1013.37,1965.93,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier,,1.30,,,,,,,0.91500,1.78,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier,,564.05,,,,,,,547.36,1192.50,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier,,2937.33,,,,,,,2850.39,6210.00,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier,,5322.67,,,,,,,5165.13,11253.00,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Premier,,8080.82,,,,,,,7841.64,17084.19,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Premier,,615.85,,,,,,,597.62,1302.00,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier,,958.64,,,,,,,930.27,2026.73,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,outpatient,1,EA,161.86000,153.76000,The Alliance,Premier,,114.76,,,,,,,80.93,157.00,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier,,0.31196,,,,,,,0.22000,0.42680,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Premier,,3100.51,,,,,,,3008.74,6555.00,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10036.05000,9534.25000,The Alliance,Premier,,4747.05,,,,,,,4606.55,10036.05,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Premier,,3670.03,,,,,,,3561.40,7759.05,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,90,814.87,,,,,,,17.85,814.87,fee schedule,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,90,372.23,,,,,,,262.50,509.25,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier,90,594.19,,,,,,,11.91,594.19,fee schedule,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier,90,2190.01,,,,,,,43.15,2190.01,fee schedule,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,outpatient,,,534.80000,508.06000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,outpatient,,,133.70000,127.01000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier,90,1137.41,,,,,,,24.89,1137.41,fee schedule,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,48.52000,46.09000,The Alliance,Premier,,22.95,,,,,,,22.27,48.52,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier,,595.98,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,2246.25000,2133.94000,The Alliance,Premier,,1062.48,,,,,,,1031.03,2246.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Premier,,48.35,,,,,,,37.51,5271.00,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Premier,,11.54,,,,,,,8.14,15.79,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier,GO,186.00,,,,,,,72.05,264.00,per diem,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier,GO,186.00,,,,,,,126.65,283.24,per diem,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier,GO,186.00,,,,,,,61.30,264.00,per diem,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier,GP,186.00,,,,,,,72.05,264.00,per diem,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier,GP,186.00,,,,,,,126.65,283.24,per diem,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier,GP,186.00,,,,,,,61.30,264.00,per diem,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier,GN,186.00,,,,,,,72.05,264.00,per diem,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier,GN,186.00,,,,,,,126.65,283.24,per diem,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier,GN,186.00,,,,,,,61.30,264.00,per diem,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Premier,,236.85,,,,,,,229.84,500.74,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier,,3752.03,,,,,,,1388.02,5133.24,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1041.00000,988.95000,The Alliance,Premier,,492.39,,,,,,,477.82,1041.00,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier,,19270.02,,,,,,,18699.66,39517.80,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9455.00000,8982.25000,The Alliance,Premier,,4472.22,,,,,,,4339.85,9455.00,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Premier,,5022.08,,,,,,,4873.43,10617.50,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier,,109.97,,,,,,,106.72,232.50,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Premier,,1303.71,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1873.91000,1780.21000,The Alliance,Premier,,886.36,,,,,,,860.12,1873.91,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier,90,9523.86,,,,,,,161.92,9523.86,fee schedule,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier,90,9523.86,,,,,,,161.92,9523.86,fee schedule,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,outpatient,,,74.60000,70.87000,The Alliance,Premier,90,492.33,,,,,,,3.40,492.33,fee schedule,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier,90,2020.22,,,,,,,17.50,2020.22,fee schedule,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Premier,90,1969.25,,,,,,,35.09,1969.25,fee schedule,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,outpatient,,,312.60000,296.97000,The Alliance,Premier,90,679.08,,,,,,,45.08,679.08,fee schedule,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,outpatient,1,EA,135.25000,128.49000,The Alliance,Premier,,95.89,,,,,,,9.78,131.19,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,outpatient,1,EA,3450.00000,3277.50000,The Alliance,Premier,,2586.36,,,,,,,1567.49,3346.50,fee schedule,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,outpatient,1,EA,28500.00000,27075.00000,The Alliance,Premier,,2586.36,,,,,,,1567.49,27645.00,fee schedule,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier,,22.40,,,,,,,15.80,30.65,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier,,958.64,,,,,,,930.27,2026.73,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8350.38000,7932.86000,The Alliance,Premier,,3949.73,,,,,,,3832.82,8350.38,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,26.88000,25.54000,The Alliance,Premier,,12.71,,,,,,,12.34,26.88,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3631.24000,3449.68000,The Alliance,Premier,,1717.58,,,,,,,1666.74,3631.24,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Premier,,113.43,,,,,,,80.00,155.19,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Premier,,25313.80,,,,,,,1836.07,25313.80,fee schedule,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1228.13000,1166.72000,The Alliance,Premier,,580.91,,,,,,,563.71,1228.13,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2311.39000,2195.82000,The Alliance,Premier,,1093.29,,,,,,,1060.93,2311.39,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier,,4732.36,,,,,,,4592.30,10005.00,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier,,514.39,,,,,,,499.16,1087.50,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier,,958.64,,,,,,,930.27,2026.73,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier,,2.85,,,,,,,2.53,137.93,fee schedule,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,280.78000,266.74000,The Alliance,Premier,,199.07,,,,,,,51.64,272.36,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,186.00,,,,,,,73.00,264.00,per diem,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,186.00,,,,,,,73.00,264.00,per diem,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier,,186.00,,,,,,,126.65,286.15,per diem,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier,,186.00,,,,,,,126.65,286.15,per diem,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier,,186.00,,,,,,,73.00,264.00,per diem,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier,,186.00,,,,,,,126.65,286.15,per diem,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,outpatient,1,mL,15.29000,14.53000,The Alliance,Premier,,8.84,,,,,,,7.64,14.83,fee schedule,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,outpatient,1,mL,13763.10000,13074.94000,The Alliance,Premier,,305.76,,,,,,,185.31,13350.21,fee schedule,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,outpatient,1,mL,13762.90000,13074.75000,The Alliance,Premier,,305.76,,,,,,,185.31,13350.01,fee schedule,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,outpatient,1,mL,840.20000,798.19000,The Alliance,Premier,,595.70,,,,,,,7.86,814.99,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,outpatient,,,26565.00000,25236.75000,The Alliance,Premier,,12565.25,,,,,,,12193.33,25768.05,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier,,4492.48,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier,,2855.74,,,,,,,2771.21,6037.50,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5633.85000,5352.16000,The Alliance,Premier,,2664.81,,,,,,,2585.94,5633.85,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,outpatient,1,mL,8.84000,8.40000,The Alliance,Premier,,6.27,,,,,,,4.42,8.57,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Premier,,236.85,,,,,,,229.84,500.74,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1866.00,,,,,,,668.09,2619.00,per diem,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier,,1866.00,,,,,,,1350.00,2619.00,per diem,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,128.96000,122.51000,The Alliance,Premier,,91.43,,,,,,,64.48,125.09,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier,,896.18,,,,,,,632.00,1226.08,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier,,3991.83,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier,,346.50,,,,,,,336.25,732.56,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier,,163.78,,,,,,,115.50,224.07,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier,,722.77,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Premier,,5022.08,,,,,,,4873.43,10617.50,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier,,20.16,,,,,,,3.49,27.59,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,105.60000,100.32000,The Alliance,Premier,,49.95,,,,,,,48.47,105.60,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,,2.43,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,,2.43,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,JW,2.43,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier,JW,2.43,,,,,,,2.31,12.33,fee schedule,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier,,2284.59,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier,,1958.22,,,,,,,1900.26,4140.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,115.29,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier,,269.61,,,,,,,261.63,570.00,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier,,4049.11,,,,,,,3929.26,8560.49,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier,,5322.67,,,,,,,5165.13,11253.00,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2171.96000,2063.36000,The Alliance,Premier,,1027.34,,,,,,,996.93,2171.96,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Premier,,11085.23,,,,,,,10757.12,23436.00,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,outpatient,1,EA,4657.50000,4424.62000,The Alliance,Premier,,350.39,,,,,,,212.36,4517.77,fee schedule,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier,,654.51,,,,,,,635.14,1383.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Premier,,3362.60,,,,,,,3263.08,7109.10,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier,,85.14,,,,,,,82.62,180.00,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Premier,,92.45,,,,,,,16.78,92.45,fee schedule,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,outpatient,1,mL,2420.87000,2299.83000,The Alliance,Premier,,4571.44,,,,,,,1210.43,4602.85,fee schedule,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,outpatient,1,mL,2420.88000,2299.83000,The Alliance,Premier,,4571.44,,,,,,,1210.44,4602.85,fee schedule,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier,,4711.22,,,,,,,4571.78,9960.30,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1016.03000,965.23000,The Alliance,Premier,,480.58,,,,,,,466.36,1016.03,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier,,753.84,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,4764.17000,4525.96000,The Alliance,Premier,,3377.80,,,,,,,2382.09,4621.24,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier,,257.19,,,,,,,249.58,543.75,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier,TC,70.19,,,,,,,49.50,96.03,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier,,431.78,,,,,,,282.87,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier,,90.04,,,,,,,23.25,134.70,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,outpatient,,,84.10000,79.89000,The Alliance,Premier,90,271.65,,,,,,,4.57,271.65,fee schedule,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,outpatient,,,194.10000,184.39000,The Alliance,Premier,,1087.31,,,,,,,22.97,1087.31,fee schedule,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier,,628.12,,,,,,,11.98,628.12,fee schedule,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,10540.00000,10013.00000,The Alliance,Premier,,4985.42,,,,,,,4837.86,10540.00,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,outpatient,,,26090.40000,24785.88000,The Alliance,Premier,,12340.76,,,,,,,11975.49,26090.40,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11466.90000,10893.55000,The Alliance,Premier,,5423.84,,,,,,,5263.31,11466.90,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,61.12000,58.06000,The Alliance,Premier,,79.22,,,,,,,30.56,93.98,fee schedule,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Premier,,8040.48,,,,,,,7802.50,16998.91,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Premier,,0.11550,,,,,,,0.11207,0.32980,fee schedule,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Premier,JW,0.11550,,,,,,,0.11207,0.32980,fee schedule,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,outpatient,1,mL,7608.04000,7227.63000,The Alliance,Premier,,38.21,,,,,,,23.16,7379.80,fee schedule,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier,,0.29069,,,,,,,0.20500,0.39770,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier,,105.64,,,,,,,74.50,264.00,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,outpatient,,,296.50000,281.68000,The Alliance,Premier,90,1833.46,,,,,,,36.26,1833.46,fee schedule,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier,,12096.98,,,,,,,11738.92,25575.00,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier,,617.26,,,,,,,599.00,1305.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier,,4079.62,,,,,,,3958.88,8625.00,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier,,86.50,,,,,,,61.00,118.34,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier,,172.82,,,,,,,121.88,236.44,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier,,1645.00,,,,,,,1285.85,7857.00,per diem,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,90,372.23,,,,,,,262.50,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier,90,372.23,,,,,,,262.50,509.25,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,outpatient,,,545.93000,518.63000,The Alliance,Premier,,387.06,,,,,,,272.96,529.55,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier,,255.72,,,,,,,47.62,349.86,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier,,8783.14,,,,,,,8523.17,18569.00,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,outpatient,,,5985.75000,5686.46000,The Alliance,Premier,,2831.26,,,,,,,2747.46,5985.75,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier,,112.87,,,,,,,79.60,154.42,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier,,1507.69,,,,,,,1463.06,3187.50,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,5783.37000,5494.20000,The Alliance,Premier,,4100.41,,,,,,,2891.68,5609.87,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,outpatient,1,mL,1408.47000,1338.04000,The Alliance,Premier,,36.65,,,,,,,22.21,1366.22,fee schedule,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4602.30000,4372.19000,The Alliance,Premier,,2176.89,,,,,,,2112.46,4602.30,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier,,12500.21,,,,,,,12130.22,26427.50,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier,,292.67,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier,,1064.25,,,,,,,1032.75,2250.00,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier,,342.98,,,,,,,241.88,469.24,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier,,79.41,,,,,,,56.00,264.00,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier,,81.53,,,,,,,57.50,264.00,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier,,1019.91,,,,,,,989.72,2156.25,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier,,8783.14,,,,,,,8523.17,18569.00,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,23932.00000,22735.40000,The Alliance,Premier,,16967.79,,,,,,,11966.00,23214.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier,,22.69,,,,,,,16.00,31.04,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier,GO,186.00,,,,,,,47.00,264.00,per diem,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Premier,90,1969.25,,,,,,,35.09,1969.25,fee schedule,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,outpatient,,,43.80000,41.61000,The Alliance,Premier,90,271.65,,,,,,,5.35,271.65,fee schedule,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,outpatient,,,1055.10000,1002.34000,The Alliance,Premier,90,5873.90,,,,,,,73.92,5873.90,fee schedule,
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC,361,RC,29125,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF FINGER SPLINT; STATIC,361,RC,29130,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT),361,RC,29515,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,149.83,3163.00,case rate,
"CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD",361,RC,30901,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND),361,RC,29105,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,149.83,3163.00,case rate,
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES),361,RC,29505,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,149.83,3163.00,case rate,
"INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE",361,RC,10120,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,379.37,3163.00,case rate,
"REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL",361,RC,65205,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
"CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL",361,RC,30905,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
"SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",361,RC,12011,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,188.67,3163.00,case rate,
APPLICATION OF FINGER SPLINT; DYNAMIC,361,RC,29131,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,56.40,3163.00,case rate,
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC,361,RC,29126,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
"REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE",361,RC,30300,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,122.40,3163.00,case rate,
"CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA",361,RC,26770,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,227.78,3163.00,case rate,
"DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL (LESS THAN 5% TOTAL BODY SURFACE AREA)",361,RC,16020,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier,,937.00,,,,,,,188.67,3163.00,case rate,
MS-DRG 42.00: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,001,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,494635.35,,,,,,,176868.23,544634.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,002,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,193505.93,,,,,,,69192.49,213065.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",003,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,376338.90,,,,,,,134568.61,414379.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",004,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,248122.80,,,,,,,88722.00,273203.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,005,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,187003.46,,,,,,,66867.38,205906.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LIVER TRANSPLANT WITHOUT MCC,006,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,85151.95,,,,,,,30448.04,93759.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LUNG TRANSPLANT,007,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,229488.13,,,,,,,82058.75,252685.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,008,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,95545.72,,,,,,,34164.56,105203.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PANCREAS TRANSPLANT,010,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,140005.88,,,,,,,50062.32,154157.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",011,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,94752.00,,,,,,,33880.75,104329.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",012,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,72060.97,,,,,,,25767.06,79345.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",013,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46534.00,,,,,,,16639.30,51237.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLOGENEIC BONE MARROW TRANSPLANT,014,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,230067.61,,,,,,,82265.96,253323.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,016,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,105990.40,,,,,,,37899.30,116704.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,017,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,105990.40,,,,,,,37899.30,116704.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,018,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,662236.77,,,,,,,236797.96,729176.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,019,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,139203.39,,,,,,,49775.37,153274.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,020,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,141552.92,,,,,,,50615.50,155861.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,021,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,97059.39,,,,,,,34705.81,106870.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,022,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61993.82,,,,,,,22167.32,68260.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,023,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,100181.56,,,,,,,35822.22,110308.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,024,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,66757.85,,,,,,,23870.80,73505.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,025,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,78533.59,,,,,,,28081.49,86471.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,026,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,53709.02,,,,,,,19204.89,59138.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,027,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,43334.57,,,,,,,15495.27,47714.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITH MCC,028,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,106756.02,,,,,,,38173.07,117547.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,029,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,58943.65,,,,,,,21076.66,64901.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL PROCEDURES WITHOUT CC/MCC,030,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39078.02,,,,,,,13973.24,43028.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC,031,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,73586.94,,,,,,,26312.70,81025.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC,032,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37501.14,,,,,,,13409.39,41291.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,033,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28016.98,,,,,,,10018.11,30848.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITH MCC,034,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,68285.57,,,,,,,24417.07,75188.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITH CC,035,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39945.49,,,,,,,14283.43,43983.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,036,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32189.24,,,,,,,11510.00,35442.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH MCC,037,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,58315.00,,,,,,,20851.87,64209.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH CC,038,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28294.43,,,,,,,10117.32,31154.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,039,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19986.79,,,,,,,7146.74,22007.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",040,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,66238.08,,,,,,,23684.95,72933.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",041,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39653.99,,,,,,,14179.20,43662.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",042,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30863.46,,,,,,,11035.94,33983.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITH CC/MCC,052,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35339.50,,,,,,,12636.45,38911.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,053,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16179.78,,,,,,,5785.45,17815.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITH MCC,054,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26324.20,,,,,,,9412.82,28985.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,055,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19157.96,,,,,,,6850.37,21094.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,056,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,43972.00,,,,,,,15723.20,48416.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,057,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23432.06,,,,,,,8378.67,25800.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,058,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32414.00,,,,,,,11590.37,35690.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,059,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21486.42,,,,,,,7682.96,23658.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,060,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15670.54,,,,,,,5603.36,17254.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",061,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47471.70,,,,,,,16974.60,52270.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",062,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31272.60,,,,,,,11182.24,34433.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",063,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24668.29,,,,,,,8820.71,27161.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,064,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34930.35,,,,,,,12490.15,38461.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,065,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17856.76,,,,,,,6385.10,19661.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,066,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12086.55,,,,,,,4321.82,13308.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,067,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25548.04,,,,,,,9135.29,28130.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,068,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15479.14,,,,,,,5534.92,17043.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,069,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14049.76,,,,,,,5023.81,15469.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,070,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30533.33,,,,,,,10917.89,33619.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,071,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18506.48,,,,,,,6617.42,20377.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,072,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13173.51,,,,,,,4710.49,14505.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,073,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27140.74,,,,,,,9704.79,29884.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,074,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18304.54,,,,,,,6545.21,20154.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC,075,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30245.34,,,,,,,10814.92,33302.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC,076,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16100.76,,,,,,,5757.20,17728.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITH MCC,077,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27153.03,,,,,,,9709.19,29897.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITH CC,078,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17523.12,,,,,,,6265.80,19294.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,079,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11707.25,,,,,,,4186.20,12890.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITH MCC,080,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34905.77,,,,,,,12481.36,38434.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,081,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15888.29,,,,,,,5681.22,17494.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,082,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40742.71,,,,,,,14568.49,44861.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,083,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24415.42,,,,,,,8730.30,26883.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,084,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16789.12,,,,,,,6003.33,18486.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,085,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39790.96,,,,,,,14228.17,43813.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,086,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23031.70,,,,,,,8235.51,25359.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,087,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15523.04,,,,,,,5550.62,17092.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITH MCC,088,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24771.89,,,,,,,8857.76,27275.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITH CC,089,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18826.08,,,,,,,6731.70,20729.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCUSSION WITHOUT CC/MCC,090,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15054.19,,,,,,,5382.97,16575.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,091,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32010.12,,,,,,,11445.95,35245.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,092,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18590.77,,,,,,,6647.56,20469.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,093,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13860.11,,,,,,,4956.00,15261.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,094,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,64071.17,,,,,,,22910.12,70547.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,095,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42094.83,,,,,,,15051.97,46349.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,096,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42094.83,,,,,,,15051.97,46349.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,097,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,62945.58,,,,,,,22507.64,69308.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,098,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38092.91,,,,,,,13620.99,41943.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,099,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24466.35,,,,,,,8748.50,26939.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEIZURES WITH MCC,100,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34861.87,,,,,,,12465.66,38385.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEIZURES WITHOUT MCC,101,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16185.05,,,,,,,5787.34,17821.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEADACHES WITH MCC,102,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20360.82,,,,,,,7280.48,22418.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEADACHES WITHOUT MCC,103,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14929.51,,,,,,,5338.39,16438.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39625.90,,,,,,,14169.15,43631.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20757.68,,,,,,,7422.38,22855.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26884.36,,,,,,,9613.12,29601.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29300.62,,,,,,,10477.11,32262.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18940.22,,,,,,,6772.51,20854.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20425.79,,,,,,,7303.71,22490.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11910.95,,,,,,,4259.03,13114.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14104.19,,,,,,,5043.28,15529.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22896.48,,,,,,,8187.16,25210.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14499.29,,,,,,,5184.55,15964.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42338.92,,,,,,,15139.25,46618.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17177.19,,,,,,,6142.10,18913.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24559.42,,,,,,,8781.78,27041.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14285.06,,,,,,,5107.95,15729.02,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24109.88,,,,,,,8621.04,26546.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,74264.75,,,,,,,26555.07,81771.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37727.66,,,,,,,13490.39,41541.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27611.34,,,,,,,9873.07,30402.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,57981.36,,,,,,,20732.57,63842.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30847.65,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20805.09,,,,,,,7439.34,22908.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40284.40,,,,,,,14404.61,44356.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21858.69,,,,,,,7816.08,24068.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14060.29,,,,,,,5027.58,15481.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DYSEQUILIBRIUM,149,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13126.10,,,,,,,4693.54,14452.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EPISTAXIS WITH MCC,150,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24271.43,,,,,,,8678.81,26724.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13310.48,,,,,,,4759.47,14655.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19927.09,,,,,,,7125.39,21941.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12497.45,,,,,,,4468.75,13760.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28557.83,,,,,,,10211.51,31444.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16394.02,,,,,,,5862.06,18051.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11807.34,,,,,,,4221.99,13000.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28754.50,,,,,,,10281.83,31661.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16516.94,,,,,,,5906.01,18186.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11582.58,,,,,,,4141.62,12753.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,80937.55,,,,,,,28941.08,89118.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44198.52,,,,,,,15804.20,48666.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32731.84,,,,,,,11704.02,36040.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,67611.27,,,,,,,24175.96,74445.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32085.63,,,,,,,11472.95,35328.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23774.48,,,,,,,8501.11,26177.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,53884.62,,,,,,,19267.68,59331.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24743.80,,,,,,,8847.71,27244.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14302.62,,,,,,,5114.23,15748.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28385.74,,,,,,,10149.97,31255.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17421.28,,,,,,,6229.38,19182.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13515.93,,,,,,,4832.93,14882.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30691.37,,,,,,,10974.40,33793.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19496.87,,,,,,,6971.55,21467.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14706.50,,,,,,,5258.65,16193.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27872.99,,,,,,,9966.63,30690.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18755.84,,,,,,,6706.58,20651.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13656.41,,,,,,,4883.16,15036.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27744.80,,,,,,,9920.79,30549.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17630.24,,,,,,,6304.10,19412.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12892.55,,,,,,,4610.03,14195.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21728.74,,,,,,,7769.61,23925.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19719.88,,,,,,,7051.30,21713.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15085.80,,,,,,,5394.27,16610.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11364.83,,,,,,,4063.76,12513.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23138.81,,,,,,,8273.81,25477.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14399.20,,,,,,,5148.76,15854.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10934.61,,,,,,,3909.92,12039.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33084.80,,,,,,,11830.23,36429.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17384.40,,,,,,,6216.19,19141.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12299.02,,,,,,,4397.80,13542.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30998.67,,,,,,,11084.29,34132.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19447.70,,,,,,,6953.97,21413.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11889.88,,,,,,,4251.50,13091.73,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16975.25,,,,,,,6069.89,18691.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12232.30,,,,,,,4373.94,13468.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14241.16,,,,,,,5092.25,15680.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33149.77,,,,,,,11853.46,36500.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15905.85,,,,,,,5687.50,17513.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,113564.03,,,,,,,40607.43,125043.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47127.53,,,,,,,16851.53,51891.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,191296.88,,,,,,,68402.59,210633.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,186044.69,,,,,,,66524.55,204850.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,169473.32,,,,,,,60599.08,186604.02,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,113400.72,,,,,,,40549.03,124863.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,104469.71,,,,,,,37355.54,115029.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,135870.50,,,,,,,48583.62,149604.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,93010.05,,,,,,,33257.88,102411.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,80646.06,,,,,,,28836.85,88797.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,87506.75,,,,,,,31290.05,96352.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54546.63,,,,,,,19504.40,60060.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,148801.68,,,,,,,53207.46,163842.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,107268.77,,,,,,,38356.41,118111.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,137255.98,,,,,,,49079.03,151130.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,93422.71,,,,,,,33405.44,102866.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,103326.55,,,,,,,36946.78,113771.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,72208.48,,,,,,,25819.80,79507.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,88447.96,,,,,,,31626.60,97388.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51138.23,,,,,,,18285.65,56307.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26513.84,,,,,,,9480.63,29193.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,59563.52,,,,,,,21298.30,65584.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39559.17,,,,,,,14145.29,43557.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31690.53,,,,,,,11331.68,34893.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,85812.21,,,,,,,30684.13,94486.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40609.26,,,,,,,14520.77,44714.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27439.26,,,,,,,9811.54,30212.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60237.82,,,,,,,21539.42,66326.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44830.68,,,,,,,16030.24,49362.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30719.46,,,,,,,10984.45,33824.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,45945.74,,,,,,,16428.95,50590.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29741.37,,,,,,,10634.71,32747.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15661.76,,,,,,,5600.22,17244.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,49264.58,,,,,,,17615.68,54244.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30865.21,,,,,,,11036.57,33985.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,59812.87,,,,,,,21387.47,65858.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33321.86,,,,,,,11914.99,36690.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26652.57,,,,,,,9530.24,29346.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47097.68,,,,,,,16840.86,51858.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61373.96,,,,,,,21945.67,67577.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AICD LEAD PROCEDURES,265,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,62640.03,,,,,,,22398.38,68971.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,105198.45,,,,,,,37616.12,115832.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,82614.53,,,,,,,29540.72,90965.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,117083.06,,,,,,,41865.74,128918.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,73061.89,,,,,,,26124.96,80447.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,90135.48,,,,,,,32230.01,99246.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60483.66,,,,,,,21627.32,66597.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,43938.63,,,,,,,15711.27,48380.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,68664.87,,,,,,,24552.70,75605.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54804.76,,,,,,,19596.70,60344.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,124096.52,,,,,,,44373.56,136640.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,108773.66,,,,,,,38894.52,119768.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,81687.36,,,,,,,29209.19,89944.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,87857.95,,,,,,,31415.63,96738.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,56269.26,,,,,,,20120.37,61957.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28822.98,,,,,,,10306.32,31736.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16186.81,,,,,,,5787.96,17823.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12732.76,,,,,,,4552.89,14019.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34336.82,,,,,,,12277.92,37807.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13011.96,,,,,,,4652.73,14327.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9858.18,,,,,,,3525.02,10854.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38865.55,,,,,,,13897.27,42794.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19135.13,,,,,,,6842.21,21069.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47965.14,,,,,,,17151.04,52813.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27686.85,,,,,,,9900.07,30485.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17191.24,,,,,,,6147.12,18928.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22912.29,,,,,,,8192.81,25228.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15122.67,,,,,,,5407.46,16651.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9635.17,,,,,,,3445.28,10609.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21563.68,,,,,,,7710.59,23743.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13868.89,,,,,,,4959.14,15270.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28770.30,,,,,,,10287.48,31678.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12369.26,,,,,,,4422.91,13619.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,7756.25,,,,,,,2773.43,8540.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28405.06,,,,,,,10156.88,31276.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18799.74,,,,,,,6722.28,20700.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12527.30,,,,,,,4479.43,13793.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20427.55,,,,,,,7304.34,22492.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11807.34,,,,,,,4221.99,13000.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSION WITH MCC,304,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20629.49,,,,,,,7376.55,22714.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13182.29,,,,,,,4713.63,14514.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26294.34,,,,,,,9402.15,28952.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16267.58,,,,,,,5816.85,17911.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21175.60,,,,,,,7571.82,23316.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12982.11,,,,,,,4642.05,14294.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9824.82,,,,,,,3513.09,10817.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANGINA PECTORIS,311,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12262.15,,,,,,,4384.61,13501.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15300.03,,,,,,,5470.88,16846.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEST PAIN,313,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12527.30,,,,,,,4479.43,13793.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37815.46,,,,,,,13521.79,41637.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16897.99,,,,,,,6042.26,18606.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11988.21,,,,,,,4286.66,13200.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,108633.18,,,,,,,38844.29,119614.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,77137.57,,,,,,,27582.31,84934.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40647.89,,,,,,,14534.59,44756.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,49989.81,,,,,,,17875.00,55042.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31769.55,,,,,,,11359.93,34980.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,74795.06,,,,,,,26744.69,82355.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,56105.96,,,,,,,20061.97,61777.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,50258.48,,,,,,,17971.07,55338.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,89187.24,,,,,,,31890.95,98202.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42637.44,,,,,,,15245.99,46947.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27981.86,,,,,,,10005.56,30810.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,80633.76,,,,,,,28832.45,88784.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41506.57,,,,,,,14841.63,45702.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28991.56,,,,,,,10366.60,31922.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60910.37,,,,,,,21779.90,67067.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITH CC,333,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37320.27,,,,,,,13344.72,41092.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29125.02,,,,,,,10414.32,32069.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,63626.90,,,,,,,22751.26,70058.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37091.99,,,,,,,13263.09,40841.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26956.36,,,,,,,9638.86,29681.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47315.42,,,,,,,16918.71,52098.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26141.57,,,,,,,9347.52,28784.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21867.47,,,,,,,7819.22,24077.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41561.01,,,,,,,14861.09,45762.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22106.28,,,,,,,7904.61,24340.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15468.60,,,,,,,5531.15,17032.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42472.37,,,,,,,15186.97,46765.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26419.02,,,,,,,9446.73,29089.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19361.66,,,,,,,6923.20,21318.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51503.48,,,,,,,18416.25,56709.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29871.32,,,,,,,10681.17,32890.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23410.99,,,,,,,8371.14,25777.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,74905.69,,,,,,,26784.25,82477.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39545.12,,,,,,,14140.27,43542.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23795.56,,,,,,,8508.65,26200.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29325.20,,,,,,,10485.90,32289.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17869.06,,,,,,,6389.49,19675.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12256.88,,,,,,,4382.73,13495.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30694.88,,,,,,,10975.66,33797.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18074.51,,,,,,,6462.96,19901.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12738.02,,,,,,,4554.77,14025.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37076.18,,,,,,,13257.44,40823.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21575.97,,,,,,,7714.98,23756.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15505.48,,,,,,,5544.34,17072.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31927.59,,,,,,,11416.44,35154.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17312.40,,,,,,,6190.45,19062.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11180.45,,,,,,,3997.83,12310.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33790.71,,,,,,,12082.64,37206.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19124.60,,,,,,,6838.44,21057.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13157.71,,,,,,,4704.84,14487.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22199.35,,,,,,,7937.89,24443.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15270.18,,,,,,,5460.20,16813.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28531.49,,,,,,,10202.09,31415.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17428.30,,,,,,,6231.89,19189.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11770.47,,,,,,,4208.80,12960.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25811.44,,,,,,,9229.47,28420.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14076.10,,,,,,,5033.23,15498.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9608.83,,,,,,,3435.86,10580.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22555.82,,,,,,,8065.35,24835.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13702.07,,,,,,,4899.49,15087.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29079.36,,,,,,,10397.99,32018.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16529.23,,,,,,,5910.41,18200.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11175.18,,,,,,,3995.94,12304.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,43510.17,,,,,,,15558.06,47908.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26571.79,,,,,,,9501.35,29257.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19733.93,,,,,,,7056.32,21728.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,68698.23,,,,,,,24564.63,75642.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,95327.97,,,,,,,34086.71,104963.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,49315.50,,,,,,,17633.89,54300.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37504.65,,,,,,,13410.65,41295.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61482.83,,,,,,,21984.60,67697.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36814.54,,,,,,,13163.88,40535.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27237.32,,,,,,,9739.33,29990.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,48051.18,,,,,,,17181.80,52908.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37430.90,,,,,,,13384.28,41214.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29193.50,,,,,,,10438.81,32144.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61526.73,,,,,,,22000.29,67745.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34735.44,,,,,,,12420.45,38246.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24060.71,,,,,,,8603.46,26492.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41731.34,,,,,,,14922.00,45949.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29121.50,,,,,,,10413.06,32065.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23137.06,,,,,,,8273.19,25475.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61978.02,,,,,,,22161.66,68242.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28756.26,,,,,,,10282.46,31663.00,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25802.66,,,,,,,9226.33,28410.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,71423.54,,,,,,,25539.13,78643.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40094.75,,,,,,,14336.80,44147.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27144.25,,,,,,,9706.05,29888.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,183948.02,,,,,,,65774.84,202541.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,124723.41,,,,,,,44597.72,137330.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,96652.00,,,,,,,34560.14,106421.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,146460.94,,,,,,,52370.47,161265.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,96061.98,,,,,,,34349.17,105772.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34401.80,,,,,,,12301.15,37879.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18785.69,,,,,,,6717.25,20684.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12230.54,,,,,,,4373.31,13466.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32039.98,,,,,,,11456.63,35278.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19802.41,,,,,,,7080.81,21804.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13788.11,,,,,,,4930.26,15181.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29214.57,,,,,,,10446.34,32167.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15105.11,,,,,,,5401.18,16631.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10801.16,,,,,,,3862.20,11892.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33195.42,,,,,,,11869.79,36550.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16966.47,,,,,,,6066.75,18681.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12339.41,,,,,,,4412.24,13586.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29578.06,,,,,,,10576.32,32567.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19043.82,,,,,,,6809.56,20968.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14000.59,,,,,,,5006.23,15415.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,117734.53,,,,,,,42098.69,129635.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,71706.26,,,,,,,25640.22,78954.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,90435.76,,,,,,,32337.38,99577.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54190.16,,,,,,,19376.94,59667.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,148719.15,,,,,,,53177.95,163751.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,100783.86,,,,,,,36037.58,110971.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,75824.08,,,,,,,27112.64,83488.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,107760.45,,,,,,,38532.22,118653.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,50288.33,,,,,,,17981.75,55371.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,94841.56,,,,,,,33912.78,104428.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51777.42,,,,,,,18514.20,57011.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30485.92,,,,,,,10900.94,33567.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,89461.18,,,,,,,31988.90,98504.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60146.51,,,,,,,21506.77,66226.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46065.15,,,,,,,16471.65,50721.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,57398.37,,,,,,,20524.11,63200.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33109.38,,,,,,,11839.02,36456.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,85294.19,,,,,,,30498.90,93915.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,50874.83,,,,,,,18191.46,56017.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41571.54,,,,,,,14864.86,45773.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,78751.33,,,,,,,28159.35,86711.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37882.19,,,,,,,13545.65,41711.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20424.04,,,,,,,7303.08,22488.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60388.84,,,,,,,21593.42,66493.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41065.82,,,,,,,14684.03,45216.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31183.05,,,,,,,11150.21,34335.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51643.96,,,,,,,18466.48,56864.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36435.24,,,,,,,13028.26,40118.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27857.18,,,,,,,9960.98,30673.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44746.39,,,,,,,16000.10,49269.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,56530.91,,,,,,,20213.92,62245.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37243.00,,,,,,,13317.09,41007.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27748.31,,,,,,,9922.05,30553.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34512.42,,,,,,,12340.71,38001.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21746.30,,,,,,,7775.89,23944.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,62359.07,,,,,,,22297.92,68662.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42161.56,,,,,,,15075.83,46423.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33107.62,,,,,,,11838.39,36454.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61821.74,,,,,,,22105.78,68070.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34645.88,,,,,,,12388.43,38147.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23576.06,,,,,,,8430.16,25959.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44337.24,,,,,,,15853.80,48818.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20383.65,,,,,,,7288.64,22444.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,55642.37,,,,,,,19896.21,61266.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31339.33,,,,,,,11206.10,34507.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24534.83,,,,,,,8772.99,27014.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46474.30,,,,,,,16617.95,51172.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30817.80,,,,,,,11019.61,33932.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30817.80,,,,,,,11019.61,33932.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26324.20,,,,,,,9412.82,28985.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34034.79,,,,,,,12169.92,37475.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22662.94,,,,,,,8103.65,24953.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ARTHROSCOPY,509,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30847.65,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,50188.24,,,,,,,17945.96,55261.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34438.67,,,,,,,12314.34,37919.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28232.97,,,,,,,10095.35,31086.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26438.34,,,,,,,9453.63,29110.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17904.18,,,,,,,6402.05,19713.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54302.54,,,,,,,19417.12,59791.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35325.45,,,,,,,12631.43,38896.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26211.81,,,,,,,9372.64,28861.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,62935.04,,,,,,,22503.87,69296.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34626.56,,,,,,,12381.52,38126.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25166.99,,,,,,,8999.04,27710.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51182.13,,,,,,,18301.35,56355.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37018.24,,,,,,,13236.72,40760.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26777.24,,,,,,,9574.82,29483.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14293.84,,,,,,,5111.09,15738.69,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23353.04,,,,,,,8350.42,25713.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14239.40,,,,,,,5091.63,15678.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16137.64,,,,,,,5770.38,17768.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11791.54,,,,,,,4216.34,12983.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35513.34,,,,,,,12698.61,39103.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22724.40,,,,,,,8125.63,25021.42,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15363.24,,,,,,,5493.48,16916.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32751.16,,,,,,,11710.93,36061.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18629.40,,,,,,,6661.37,20512.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13270.09,,,,,,,4745.03,14611.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44372.36,,,,,,,15866.36,48857.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20329.21,,,,,,,7269.18,22384.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13103.27,,,,,,,4685.38,14427.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35376.38,,,,,,,12649.64,38952.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21161.56,,,,,,,7566.80,23300.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15138.48,,,,,,,5413.11,16668.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29964.38,,,,,,,10714.45,32993.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16924.33,,,,,,,6051.68,18635.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22933.36,,,,,,,8200.35,25251.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14655.58,,,,,,,5240.44,16136.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23646.30,,,,,,,8455.28,26036.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14337.74,,,,,,,5126.79,15787.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27212.73,,,,,,,9730.54,29963.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15168.33,,,,,,,5423.78,16701.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32596.63,,,,,,,11655.67,35891.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19995.57,,,,,,,7149.88,22016.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14357.06,,,,,,,5133.70,15808.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25699.06,,,,,,,9189.29,28296.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15695.13,,,,,,,5612.15,17281.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27555.15,,,,,,,9852.98,30340.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17905.93,,,,,,,6402.68,19715.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13136.64,,,,,,,4697.31,14464.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,52859.11,,,,,,,18900.99,58202.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29400.71,,,,,,,10512.90,32372.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20060.54,,,,,,,7173.11,22088.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,108137.99,,,,,,,38667.22,119068.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60843.64,,,,,,,21756.04,66993.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35062.05,,,,,,,12537.24,38606.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,94741.47,,,,,,,33876.99,104318.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46758.77,,,,,,,16719.67,51485.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29683.42,,,,,,,10613.99,32683.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,57235.06,,,,,,,20465.71,63020.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31133.88,,,,,,,11132.63,34280.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25272.35,,,,,,,9036.71,27826.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30751.07,,,,,,,10995.75,33859.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28845.81,,,,,,,10314.48,31761.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35952.34,,,,,,,12855.59,39586.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34858.36,,,,,,,12464.41,38381.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITH MCC,592,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36108.63,,,,,,,12911.47,39758.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITH CC,593,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21470.61,,,,,,,7677.31,23640.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14903.17,,,,,,,5328.97,16409.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37141.16,,,,,,,13280.67,40895.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18984.12,,,,,,,6788.21,20903.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30847.65,,,,,,,11030.29,33965.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18945.48,,,,,,,6774.39,20860.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15012.04,,,,,,,5367.90,16529.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16797.90,,,,,,,6006.47,18495.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10527.22,,,,,,,3764.25,11591.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CELLULITIS WITH MCC,602,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25799.15,,,,,,,9225.08,28406.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15466.85,,,,,,,5530.53,17030.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26088.89,,,,,,,9328.68,28726.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16220.17,,,,,,,5799.89,17859.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28276.87,,,,,,,10111.04,31135.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15175.35,,,,,,,5426.30,16709.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40019.24,,,,,,,14309.80,44064.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25163.48,,,,,,,8997.78,27707.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,67869.40,,,,,,,24268.26,74729.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33918.90,,,,,,,12128.48,37347.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21863.96,,,,,,,7817.96,24074.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47877.34,,,,,,,17119.64,52716.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28043.32,,,,,,,10027.53,30877.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25669.21,,,,,,,9178.61,28263.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,65709.52,,,,,,,23495.95,72351.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33588.77,,,,,,,12010.44,36983.99,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17614.44,,,,,,,6298.45,19394.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,50346.28,,,,,,,18002.47,55435.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26503.31,,,,,,,9476.87,29182.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22246.76,,,,,,,7954.84,24495.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,69286.49,,,,,,,24774.98,76290.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39494.20,,,,,,,14122.06,43486.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24606.83,,,,,,,8798.74,27094.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITH MCC,637,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25572.63,,,,,,,9144.08,28157.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITH CC,638,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16106.03,,,,,,,5759.08,17734.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11003.10,,,,,,,3934.41,12115.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23319.68,,,,,,,8338.49,25676.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13721.38,,,,,,,4906.40,15108.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21793.72,,,,,,,7792.84,23996.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29102.19,,,,,,,10406.16,32043.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18146.50,,,,,,,6488.70,19980.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13673.97,,,,,,,4889.44,15056.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,80904.19,,,,,,,28929.15,89082.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60977.10,,,,,,,21803.76,67140.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY TRANSPLANT,652,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,53933.78,,,,,,,19285.26,59385.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,97889.98,,,,,,,35002.81,107784.89,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,49556.08,,,,,,,17719.91,54565.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36477.39,,,,,,,13043.33,40164.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,57210.48,,,,,,,20456.92,62993.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32101.44,,,,,,,11478.61,35346.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26410.24,,,,,,,9443.59,29079.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,45380.31,,,,,,,16226.77,49967.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23530.40,,,,,,,8413.83,25908.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18027.10,,,,,,,6446.00,19849.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54780.18,,,,,,,19587.91,60317.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26821.14,,,,,,,9590.52,29532.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18961.29,,,,,,,6780.04,20877.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,60294.02,,,,,,,21559.51,66388.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITH CC,666,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28926.59,,,,,,,10343.37,31850.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18048.17,,,,,,,6453.54,19872.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51210.23,,,,,,,18311.39,56386.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27174.10,,,,,,,9716.72,29920.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16782.09,,,,,,,6000.82,18478.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30268.17,,,,,,,10823.08,33327.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19217.66,,,,,,,6871.72,21160.22,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,73569.38,,,,,,,26306.42,81005.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40535.50,,,,,,,14494.40,44632.91,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27486.67,,,,,,,9828.49,30265.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITH MCC,682,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26373.36,,,,,,,9430.40,29039.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITH CC,683,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15609.08,,,,,,,5581.39,17186.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10665.94,,,,,,,3813.85,11744.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33112.89,,,,,,,11840.27,36460.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18485.41,,,,,,,6609.88,20353.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12716.95,,,,,,,4547.24,14002.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20550.47,,,,,,,7348.29,22627.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14093.66,,,,,,,5039.51,15518.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URINARY STONES WITH MCC,693,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25820.22,,,,,,,9232.61,28430.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13721.38,,,,,,,4906.40,15108.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19804.17,,,,,,,7081.44,21806.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12148.01,,,,,,,4343.80,13375.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: URETHRAL STRICTURE,697,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17591.61,,,,,,,6290.28,19369.80,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29516.60,,,,,,,10554.34,32500.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17909.44,,,,,,,6403.93,19719.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12190.15,,,,,,,4358.87,13422.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34076.94,,,,,,,12184.99,37521.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26032.70,,,,,,,9308.59,28664.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39459.08,,,,,,,14109.50,43447.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26364.58,,,,,,,9427.26,29029.57,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33550.14,,,,,,,11996.62,36941.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18782.18,,,,,,,6716.00,20680.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25391.76,,,,,,,9079.41,27958.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16501.13,,,,,,,5900.36,18169.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39655.75,,,,,,,14179.82,43664.23,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24922.91,,,,,,,8911.76,27442.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32582.58,,,,,,,11650.65,35876.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21632.16,,,,,,,7735.08,23818.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30359.48,,,,,,,10855.73,33428.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19718.12,,,,,,,7050.67,21711.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12794.22,,,,,,,4574.87,14087.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22171.26,,,,,,,7927.84,24412.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13071.66,,,,,,,4674.07,14392.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25802.66,,,,,,,9226.33,28410.85,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14348.28,,,,,,,5130.56,15798.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19331.80,,,,,,,6912.53,21285.90,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10657.16,,,,,,,3810.71,11734.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36925.17,,,,,,,13203.44,40657.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21316.08,,,,,,,7622.06,23470.76,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,69144.26,,,,,,,24724.12,76133.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35091.90,,,,,,,12547.92,38639.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26636.76,,,,,,,9524.59,29329.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,69904.60,,,,,,,24996.00,76970.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31929.35,,,,,,,11417.07,35156.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24120.42,,,,,,,8624.81,26558.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32076.85,,,,,,,11469.81,35319.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21049.17,,,,,,,7526.61,23176.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34312.24,,,,,,,12269.13,37780.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17995.49,,,,,,,6434.70,19814.51,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29405.98,,,,,,,10514.78,32378.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16773.31,,,,,,,5997.68,18468.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,23921.99,,,,,,,8553.86,26340.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,45455.82,,,,,,,16253.77,50050.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22643.62,,,,,,,8096.75,24932.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31771.31,,,,,,,11360.56,34982.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19493.36,,,,,,,6970.30,21463.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16769.80,,,,,,,5996.43,18464.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24852.67,,,,,,,8886.64,27364.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17898.91,,,,,,,6400.17,19708.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11238.40,,,,,,,4018.55,12374.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17307.14,,,,,,,6188.56,19056.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11131.28,,,,,,,3980.25,12256.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19251.03,,,,,,,6883.65,19846.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24399.62,,,,,,,8724.64,26865.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18894.56,,,,,,,6756.18,20804.46,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12529.06,,,,,,,4480.05,13795.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ABORTION WITHOUT D&C,779,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16415.09,,,,,,,5869.59,18074.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32347.28,,,,,,,8998.34,33347.54,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19017.48,,,,,,,6800.14,19605.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15338.66,,,,,,,5484.69,15988.36,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28375.20,,,,,,,8998.34,29252.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18645.21,,,,,,,6667.02,19221.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15886.53,,,,,,,5680.59,16377.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31653.66,,,,,,,1190.71,34363.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,104390.69,,,,,,,2010.29,114942.71,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,71291.84,,,,,,,2010.29,77394.08,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,43016.73,,,,,,,1985.00,46698.75,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,73233.98,,,,,,,2010.29,79502.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25922.07,,,,,,,1190.71,28140.87,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NORMAL NEWBORN,795,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,3508.49,,,,,,,808.00,3616.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22417.10,,,,,,,5336.77,23110.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17001.59,,,,,,,5336.77,17527.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17001.59,,,,,,,5336.77,17527.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,83494.29,,,,,,,29855.30,91934.06,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,51166.33,,,,,,,18295.70,56338.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28828.25,,,,,,,10308.20,31742.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,62949.09,,,,,,,22508.89,69312.11,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31256.80,,,,,,,11176.59,34416.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19414.34,,,,,,,6942.04,21376.78,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17524.88,,,,,,,5336.77,18066.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12706.42,,,,,,,4543.47,13099.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11190.99,,,,,,,4001.59,11537.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,40217.67,,,,,,,14380.75,44282.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21748.06,,,,,,,7776.52,23946.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16713.61,,,,,,,5976.33,18403.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24705.16,,,,,,,8833.90,27202.41,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16206.12,,,,,,,5794.87,17844.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COAGULATION DISORDERS,813,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27182.88,,,,,,,9719.86,29930.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,36709.18,,,,,,,13126.21,40419.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17842.72,,,,,,,6380.07,19646.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11579.06,,,,,,,4140.36,12749.50,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44516.36,,,,,,,15917.85,49016.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22617.28,,,,,,,8087.33,24903.48,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14337.74,,,,,,,5126.79,15787.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,102239.59,,,,,,,36558.11,112574.17,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,39200.94,,,,,,,14017.20,43163.45,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20083.37,,,,,,,7181.27,22113.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,82172.02,,,,,,,29382.49,90478.13,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38621.46,,,,,,,13809.99,42525.40,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21612.85,,,,,,,7728.17,23797.52,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,83857.78,,,,,,,29985.27,92334.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,41439.84,,,,,,,14817.77,45628.67,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28146.92,,,,,,,10064.58,30992.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,54151.53,,,,,,,19363.12,59625.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25681.50,,,,,,,9183.01,28277.44,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20211.56,,,,,,,7227.11,22254.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13124.34,,,,,,,4692.91,14450.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9127.69,,,,,,,3263.81,10050.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,97059.39,,,,,,,34705.81,106870.35,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37506.40,,,,,,,13411.28,41297.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22313.49,,,,,,,7978.70,24568.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,87926.43,,,,,,,31440.11,96814.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35615.19,,,,,,,12735.03,39215.25,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24064.22,,,,,,,8604.72,26496.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,55998.84,,,,,,,20023.67,61659.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,27534.08,,,,,,,9845.44,30317.28,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18471.36,,,,,,,6604.86,20338.49,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33246.35,,,,,,,11888.00,36606.96,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20987.71,,,,,,,7504.64,23109.19,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14694.21,,,,,,,5254.25,16179.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,44844.73,,,,,,,16035.26,49377.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22313.49,,,,,,,7978.70,24568.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,14379.88,,,,,,,5141.86,15833.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: RADIOTHERAPY,849,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46904.52,,,,,,,16771.79,51645.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,161760.96,,,,,,,57841.35,178112.09,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,87822.83,,,,,,,31403.07,96700.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35086.64,,,,,,,12546.03,38633.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28545.54,,,,,,,10207.11,31430.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,79223.70,,,,,,,28328.25,87231.79,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38261.48,,,,,,,13681.27,42129.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22624.30,,,,,,,8089.84,24911.21,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32287.57,,,,,,,11545.16,35551.26,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17558.24,,,,,,,6278.35,19333.07,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15768.88,,,,,,,5638.53,17362.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25916.80,,,,,,,9267.15,28536.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15537.09,,,,,,,5555.64,17107.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37653.91,,,,,,,13464.02,41460.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18439.76,,,,,,,6593.56,20303.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12636.18,,,,,,,4518.35,13913.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,122156.14,,,,,,,43679.73,134503.93,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34454.48,,,,,,,12319.99,37937.20,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18104.36,,,,,,,6473.63,19934.38,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,69003.78,,,,,,,24673.88,75978.82,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16833.02,,,,,,,6019.03,18534.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DEPRESSIVE NEUROSES,881,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16051.60,,,,,,,5739.62,17674.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16892.72,,,,,,,6040.38,18600.27,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32554.48,,,,,,,11640.60,35845.16,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29328.71,,,,,,,10487.15,32293.32,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: PSYCHOSES,885,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24752.58,,,,,,,8850.85,27254.62,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31546.54,,,,,,,11280.19,34735.33,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20885.86,,,,,,,7468.22,22997.05,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10959.20,,,,,,,3918.71,12066.97,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25425.12,,,,,,,9091.34,27995.15,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,31270.85,,,,,,,11181.61,34431.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15491.43,,,,,,,5539.32,17057.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,77799.58,,,,,,,27819.03,85663.72,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,33321.86,,,,,,,11914.99,36690.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,21407.40,,,,,,,7654.71,23571.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,67800.92,,,,,,,24243.77,74654.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28942.39,,,,,,,10349.02,31867.95,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38324.70,,,,,,,13703.88,42198.64,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,69953.77,,,,,,,25013.58,77024.84,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,35420.28,,,,,,,12665.33,39000.63,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22271.35,,,,,,,7963.63,24522.58,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28417.35,,,,,,,10161.28,31289.83,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16091.98,,,,,,,5754.06,17718.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30517.52,,,,,,,10912.24,33602.30,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,11661.60,,,,,,,4169.87,12840.37,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,28793.13,,,,,,,10295.65,31703.60,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,15533.58,,,,,,,5554.39,17103.74,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,32022.42,,,,,,,11450.35,35259.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17839.20,,,,,,,6378.82,19642.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,12076.01,,,,,,,4318.06,13296.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29665.86,,,,,,,10607.71,32664.55,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17909.44,,,,,,,6403.93,19719.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,416572.37,,,,,,,148955.02,458680.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,117281.48,,,,,,,41936.69,129136.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,55847.82,,,,,,,19969.67,61493.03,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,75980.36,,,,,,,27168.52,83660.61,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37680.25,,,,,,,13473.44,41489.04,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE BURNS,935,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,38568.78,,,,,,,13791.15,42467.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,55735.44,,,,,,,19929.49,61369.29,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,37076.18,,,,,,,13257.44,40823.92,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,34317.51,,,,,,,12271.01,37786.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26805.34,,,,,,,3075.00,29514.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,19605.74,,,,,,,3075.00,21587.53,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,22585.67,,,,,,,3075.00,24868.68,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,13951.42,,,,,,,3075.00,15361.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,18947.24,,,,,,,3075.00,20862.47,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,10291.92,,,,,,,3075.00,11332.24,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,9956.52,,,,,,,3075.00,10962.94,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,119904.95,,,,,,,3075.00,132025.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
"MS-DRG 42.00: LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,67121.34,,,,,,,3075.00,73906.10,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,131071.35,,,,,,,46867.57,144320.31,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,72168.09,,,,,,,25805.36,79462.98,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46426.88,,,,,,,16601.00,51119.81,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,47705.25,,,,,,,17058.11,52527.39,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,26341.76,,,,,,,9419.10,29004.43,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,16025.26,,,,,,,5730.20,17645.12,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,111054.71,,,,,,,39710.16,122280.34,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,46591.95,,,,,,,16660.02,51301.56,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,52437.67,,,,,,,18750.29,57738.18,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,24959.78,,,,,,,8924.94,27482.77,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,17612.68,,,,,,,6297.82,19393.01,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,25319.76,,,,,,,9053.66,27879.14,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,83478.48,,,,,,,29849.65,91916.66,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,42992.15,,,,,,,15372.83,47337.88,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,29293.59,,,,,,,10474.60,32254.65,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,61507.41,,,,,,,21993.39,67724.70,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,30132.96,,,,,,,10774.73,33178.86,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,,,facility,inpatient,,,,,The Alliance,Premier SAS,,20290.58,,,,,,,7255.36,22341.59,case rate,"If charges exceed a DRG-specific outlier threshold, additional payment will be made at the applicable percent of charges above threshold in addition to the DRG case rate."
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,72.50,548.00,fee schedule,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,172.50,548.00,fee schedule,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier SAS,,457.84,,,,,,,440.69,1551.03,fee schedule,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,,619.65,,,,,,,619.65,1309.50,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Premier SAS,,1066.30,,,,,,,1026.39,2813.97,fee schedule,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier SAS,,2561.00,,,,,,,813.50,3163.00,case rate,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Premier SAS,,2882.00,,,,,,,691.50,4686.00,case rate,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2548.19,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1132.50,2197.05,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2547.22,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2245.55,per diem,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,495.50,1820.00,per diem,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,TC,1596.00,,,,,,,71.00,1820.00,per diem,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,935.50,1964.22,per diem,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1264.00,2452.16,per diem,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2515.21,per diem,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,732.50,1820.00,per diem,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,2522.00,per diem,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,896.50,1820.00,per diem,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1153.50,2237.79,per diem,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2209.66,per diem,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier SAS,TC,1596.00,,,,,,,934.50,1964.22,per diem,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2234.88,per diem,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,622.00,1820.00,per diem,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,3313.52,per diem,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2292.11,per diem,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,outpatient,,,7626.00000,7244.70000,The Alliance,Premier SAS,,3500.33,,,,,,,3500.33,7397.22,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier SAS,TC,152.96,,,,,,,114.83,1213.27,fee schedule,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,,68.11,,,,,,,49.50,96.03,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,921.50,fee schedule,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier SAS,TC,2772.64,,,,,,,2015.00,3909.10,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,532.00,,,,,,,133.50,584.87,fee schedule,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,,68.11,,,,,,,23.25,96.03,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier SAS,,37147.18,,,,,,,4607.00,52373.21,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,215.27,548.00,fee schedule,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,outpatient,1,mL,1.09000,1.03000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Premier SAS,,1.87,,,,,,,1.36,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2245.55,per diem,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2547.22,per diem,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2548.19,per diem,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,2198.99,per diem,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1214.33,3520.13,per diem,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1353.88,3316.43,per diem,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1128.45,2914.85,per diem,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1375.22,3364.93,per diem,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1214.33,3520.13,per diem,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1308.50,2538.49,per diem,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3863.51,per diem,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1321.12,3459.02,per diem,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1130.78,2914.85,per diem,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1269.50,2462.83,per diem,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1125.50,2183.47,per diem,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4224.35,per diem,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4835.45,per diem,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,90.62,,,,,,,68.74,718.77,fee schedule,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3934.32,per diem,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1353.60,3441.56,per diem,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,154.77,548.00,fee schedule,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,222.78,,,,,,,172.50,1767.08,fee schedule,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3462.90,per diem,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2942.98,per diem,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1371.65,3353.29,per diem,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,TC,160.44,,,,,,,129.58,1272.59,fee schedule,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier SAS,TC,1810.00,,,,,,,179.69,2032.87,per diem,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,90.62,,,,,,,68.74,718.77,fee schedule,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,TC,172.90,,,,,,,138.00,1371.46,fee schedule,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1129.95,2920.67,per diem,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier SAS,TC,197.84,,,,,,,160.92,1569.27,fee schedule,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.00,1094.55,fee schedule,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1382.32,3348.44,per diem,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,231.00,548.00,fee schedule,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1318.80,3125.34,per diem,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,TC,175.40,,,,,,,140.50,1391.23,fee schedule,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1328.10,3480.36,per diem,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1246.80,3800.46,per diem,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1295.50,2513.27,per diem,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier SAS,,218.43,,,,,,,153.75,298.27,fee schedule,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3802.00000,3611.90000,The Alliance,Premier SAS,TC,2615.78,,,,,,,1901.00,3687.94,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier SAS,TC,471.97,,,,,,,343.00,665.42,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Premier SAS,TC,2295.17,,,,,,,1668.00,3235.92,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Premier SAS,TC,336.43,,,,,,,244.50,474.33,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Premier SAS,TC,313.04,,,,,,,227.50,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,outpatient,,,550.00000,522.50000,The Alliance,Premier SAS,TC,378.40,,,,,,,275.00,533.50,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,QW,34.66,,,,,,,4.81,2209.66,fee schedule,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Premier SAS,TC,692.13,,,,,,,503.00,975.82,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier SAS,,133.47,,,,,,,97.00,212.44,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Premier SAS,QW,401.79,,,,,,,292.00,566.48,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier SAS,,225.92,,,,,,,225.92,477.44,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,28.80000,27.36000,The Alliance,Premier SAS,,13.22,,,,,,,13.22,27.94,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier SAS,QW,555.22,,,,,,,403.50,782.79,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Premier SAS,TC,2618.53,,,,,,,1903.00,3691.82,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12028.00,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier SAS,,8.26,,,,,,,6.00,11.64,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Premier SAS,,6.43,,,,,,,6.43,13.58,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,17.04000,16.19000,The Alliance,Premier SAS,,7.82,,,,,,,7.82,16.53,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,30.36000,28.84000,The Alliance,Premier SAS,,13.94,,,,,,,13.94,29.45,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,outpatient,,,1105.00000,1049.75000,The Alliance,Premier SAS,,760.24,,,,,,,314.95,1071.85,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier SAS,,306.00,,,,,,,246.10,477.44,fee schedule,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,19.28,,,,,,,19.28,40.74,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier SAS,,306.00,,,,,,,246.10,477.44,fee schedule,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,outpatient,,,1298.00000,1233.10000,The Alliance,Premier SAS,,893.02,,,,,,,314.95,1259.06,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,10.92000,10.37000,The Alliance,Premier SAS,,35.57,,,,,,,5.46,36.65,fee schedule,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,11.15000,10.59000,The Alliance,Premier SAS,,99.18,,,,,,,5.58,102.20,fee schedule,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Premier SAS,,473.34,,,,,,,314.95,667.36,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,191.40000,181.83000,The Alliance,Premier SAS,,87.85,,,,,,,87.85,185.66,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.10000,39.99000,The Alliance,Premier SAS,,19.32,,,,,,,19.32,40.84,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,44.80000,42.56000,The Alliance,Premier SAS,,20.56,,,,,,,20.56,43.46,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,264.38000,251.16000,The Alliance,Premier SAS,,131.57,,,,,,,126.64,256.45,fee schedule,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,outpatient,,,386.93000,367.58000,The Alliance,Premier SAS,,270.33,,,,,,,193.47,375.32,fee schedule,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,,65.96,,,,,,,64.92,129.01,fee schedule,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Premier SAS,,11.70,,,,,,,8.50,16.49,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,106.56000,101.23000,The Alliance,Premier SAS,,89.72,,,,,,,53.28,103.36,fee schedule,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,1374.00000,1305.30000,The Alliance,Premier SAS,,276.68,,,,,,,266.32,1332.78,fee schedule,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Premier SAS,TC,497.08,,,,,,,308.00,3942.79,fee schedule,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier SAS,TC,182.88,,,,,,,146.17,1450.63,fee schedule,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Premier SAS,,338.74,,,,,,,326.06,1136.84,fee schedule,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,26.52000,25.19000,The Alliance,Premier SAS,,12.17,,,,,,,12.17,25.72,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Premier SAS,TC,2413.50,,,,,,,1754.00,3402.76,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Premier SAS,TC,2972.16,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,TC,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,TC,47.47,,,,,,,34.50,5271.00,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Premier SAS,,118.21,,,,,,,67.04,130.06,fee schedule,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,134.08000,127.38000,The Alliance,Premier SAS,,118.21,,,,,,,67.04,130.06,fee schedule,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,42.83,,,,,,,26.00,50.44,fee schedule,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,27.72,,,,,,,3.66,203.72,fee schedule,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,2561.00,,,,,,,1857.46,5271.00,case rate,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,25.78000,24.49000,The Alliance,Premier SAS,,63.29,,,,,,,12.89,65.22,fee schedule,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,outpatient,,,204.99000,194.74000,The Alliance,Premier SAS,,234.26,,,,,,,102.50,241.40,fee schedule,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,outpatient,,,309.37000,293.90000,The Alliance,Premier SAS,,423.46,,,,,,,154.69,436.36,fee schedule,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,129.22,,,,,,,99.38,192.79,fee schedule,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,259.91000,246.91000,The Alliance,Premier SAS,,103.85,,,,,,,99.97,252.11,fee schedule,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,14.48000,13.76000,The Alliance,Premier SAS,,99.18,,,,,,,7.24,102.20,fee schedule,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,35.60000,33.82000,The Alliance,Premier SAS,,63.29,,,,,,,17.80,65.22,fee schedule,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,outpatient,,,215.44000,204.67000,The Alliance,Premier SAS,,111.78,,,,,,,107.59,208.98,fee schedule,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Premier SAS,,118.21,,,,,,,37.02,121.81,fee schedule,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,39.87000,37.88000,The Alliance,Premier SAS,,68.40,,,,,,,19.93,70.48,fee schedule,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,17.24000,16.38000,The Alliance,Premier SAS,,68.40,,,,,,,8.62,70.48,fee schedule,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Premier SAS,,138.43,,,,,,,60.94,142.65,fee schedule,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,270.94000,257.39000,The Alliance,Premier SAS,,114.03,,,,,,,109.77,262.81,fee schedule,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,37.15,,,,,,,27.00,74.34,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,129.22,,,,,,,99.38,192.79,fee schedule,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,33.95,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Premier SAS,,266.78,,,,,,,116.50,274.91,fee schedule,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,74.05000,70.35000,The Alliance,Premier SAS,,118.21,,,,,,,37.02,121.81,fee schedule,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier SAS,,108.70,,,,,,,79.00,153.26,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,58.17,,,,,,,21.00,59.94,fee schedule,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,outpatient,,,1751.00000,1663.45000,The Alliance,Premier SAS,,964.95,,,,,,,875.50,1698.47,fee schedule,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Premier SAS,,374.45,,,,,,,360.44,818.68,fee schedule,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,13.46000,12.79000,The Alliance,Premier SAS,,99.18,,,,,,,6.73,102.20,fee schedule,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,9.55,33.95,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,76.13000,72.32000,The Alliance,Premier SAS,,34.94,,,,,,,34.94,73.85,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,outpatient,,,1117.64000,1061.76000,The Alliance,Premier SAS,,553.79,,,,,,,553.79,1084.11,fee schedule,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Premier SAS,,85.32,,,,,,,81.64,193.84,fee schedule,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Premier SAS,,306.00,,,,,,,45.90,315.32,fee schedule,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,121.88000,115.79000,The Alliance,Premier SAS,,85.32,,,,,,,60.94,118.22,fee schedule,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,260.63000,247.60000,The Alliance,Premier SAS,,85.32,,,,,,,81.64,252.81,fee schedule,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier SAS,,44.06,,,,,,,44.06,93.12,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Premier SAS,,294.57,,,,,,,220.51,432.02,fee schedule,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,91.80000,87.21000,The Alliance,Premier SAS,,306.00,,,,,,,45.90,315.32,fee schedule,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,outpatient,,,1333.00000,1266.35000,The Alliance,Premier SAS,,1126.37,,,,,,,666.50,1293.01,fee schedule,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Premier SAS,,73.53,,,,,,,73.53,155.39,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,199.84000,189.85000,The Alliance,Premier SAS,,138.43,,,,,,,99.92,193.84,fee schedule,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,74.34,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier SAS,,13.07,,,,,,,9.50,79.34,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,33.95,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,97.70,,,,,,,60.36,137.74,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,101.82,,,,,,,74.00,150.74,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,106.64,,,,,,,38.65,150.35,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,63.30,,,,,,,38.65,89.24,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,106.64,,,,,,,77.50,153.86,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,488.00000,463.60000,The Alliance,Premier SAS,,335.74,,,,,,,242.89,473.36,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,664.00000,630.80000,The Alliance,Premier SAS,,456.83,,,,,,,332.00,644.08,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Premier SAS,,522.88,,,,,,,380.00,737.20,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Premier SAS,,231.17,,,,,,,137.04,325.92,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier SAS,,335.06,,,,,,,134.64,472.39,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,outpatient,,,458.00000,435.10000,The Alliance,Premier SAS,,315.10,,,,,,,141.69,444.26,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,77.74,,,,,,,56.50,109.61,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier SAS,,200.21,,,,,,,128.93,282.27,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,outpatient,,,748.00000,710.60000,The Alliance,Premier SAS,,514.62,,,,,,,374.00,725.56,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,97.70,,,,,,,14.86,137.74,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,outpatient,,,828.00000,786.60000,The Alliance,Premier SAS,,569.66,,,,,,,377.09,803.16,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier SAS,,116.27,,,,,,,64.42,163.93,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier SAS,,1980.06,,,,,,,558.00,2791.66,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,,198.14,,,,,,,38.65,279.36,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Premier SAS,,438.26,,,,,,,318.50,617.89,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Premier SAS,,251.81,,,,,,,172.82,489.94,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,outpatient,,,464.00000,440.80000,The Alliance,Premier SAS,TC,448.96,,,,,,,232.00,3299.19,fee schedule,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Premier SAS,,293.78,,,,,,,213.50,414.19,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,8.53000,8.10000,The Alliance,Premier SAS,,3.92,,,,,,,3.92,8.27,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Premier SAS,,1741.98,,,,,,,1401.50,2718.91,fee schedule,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,The Alliance,Premier SAS,,851.20,,,,,,,814.56,2718.91,fee schedule,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,188.20000,178.79000,The Alliance,Premier SAS,,70.56,,,,,,,67.53,182.55,fee schedule,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,,109.47,,,,,,,90.50,175.57,fee schedule,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier SAS,,524.54,,,,,,,504.90,1155.27,fee schedule,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Premier SAS,,276.68,,,,,,,266.32,600.43,fee schedule,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier SAS,,256.62,,,,,,,186.50,361.81,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier SAS,,109.47,,,,,,,105.37,233.77,fee schedule,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,429.00000,407.55000,The Alliance,Premier SAS,,338.74,,,,,,,214.50,416.13,fee schedule,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier SAS,TC,270.15,,,,,,,119.50,2142.86,fee schedule,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,outpatient,,,227.15000,215.79000,The Alliance,Premier SAS,,213.20,,,,,,,113.58,220.34,fee schedule,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier SAS,,70.56,,,,,,,67.53,168.78,fee schedule,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,outpatient,,,170.20000,161.69000,The Alliance,Premier SAS,,54.73,,,,,,,52.68,165.09,fee schedule,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,outpatient,,,200.35000,190.33000,The Alliance,Premier SAS,,190.43,,,,,,,100.17,196.24,fee schedule,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,outpatient,,,441.03000,418.98000,The Alliance,Premier SAS,,552.68,,,,,,,220.51,569.51,fee schedule,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,outpatient,,,1817.00000,1726.15000,The Alliance,Premier SAS,,1129.22,,,,,,,908.50,1762.49,fee schedule,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,,70.18,,,,,,,37.27,98.94,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,outpatient,,,1373.08000,1304.43000,The Alliance,Premier SAS,,1569.13,,,,,,,686.54,1616.93,fee schedule,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,outpatient,,,269.63000,256.15000,The Alliance,Premier SAS,,109.18,,,,,,,105.09,261.54,fee schedule,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,outpatient,,,260.06000,247.06000,The Alliance,Premier SAS,,110.28,,,,,,,106.15,252.26,fee schedule,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,138.45000,131.53000,The Alliance,Premier SAS,,191.09,,,,,,,69.22,196.91,fee schedule,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,,131.57,,,,,,,65.00,135.57,fee schedule,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Premier SAS,,100.36,,,,,,,35.63,103.42,fee schedule,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,13.26000,12.60000,The Alliance,Premier SAS,,63.29,,,,,,,6.63,65.22,fee schedule,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier SAS,,338.74,,,,,,,272.50,528.65,fee schedule,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,outpatient,,,71.26000,67.70000,The Alliance,Premier SAS,,50.24,,,,,,,35.63,69.12,fee schedule,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,outpatient,,,3043.38000,2891.21000,The Alliance,Premier SAS,,1573.26,,,,,,,1514.36,2952.08,fee schedule,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,outpatient,,,844.00000,801.80000,The Alliance,Premier SAS,,524.65,,,,,,,422.00,818.68,fee schedule,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,outpatient,,,821.00000,779.95000,The Alliance,Premier SAS,,395.74,,,,,,,380.93,796.37,fee schedule,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,outpatient,,,36.53000,34.70000,The Alliance,Premier SAS,,126.45,,,,,,,18.27,130.31,fee schedule,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier SAS,,374.45,,,,,,,301.00,583.94,fee schedule,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,,261.10,,,,,,,114.00,269.05,fee schedule,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,outpatient,,,801.35000,761.28000,The Alliance,Premier SAS,,915.77,,,,,,,400.68,943.67,fee schedule,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,outpatient,,,773.00000,734.35000,The Alliance,Premier SAS,,480.71,,,,,,,386.50,749.81,fee schedule,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,211.27,,,,,,,104.50,217.71,fee schedule,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,71.04000,67.49000,The Alliance,Premier SAS,,32.61,,,,,,,32.61,68.91,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,outpatient,,,362.51000,344.38000,The Alliance,Premier SAS,,353.37,,,,,,,181.25,364.14,fee schedule,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,80.39,,,,,,,29.00,82.83,fee schedule,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,outpatient,,,31.14000,29.58000,The Alliance,Premier SAS,,80.49,,,,,,,15.57,82.94,fee schedule,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,outpatient,,,817.43000,776.56000,The Alliance,Premier SAS,,555.85,,,,,,,408.71,792.91,fee schedule,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Premier SAS,,331.41,,,,,,,145.00,341.50,fee schedule,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,outpatient,,,2833.00000,2691.35000,The Alliance,Premier SAS,,1259.94,,,,,,,1212.77,2748.01,fee schedule,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,outpatient,,,1335.00000,1268.25000,The Alliance,Premier SAS,,829.88,,,,,,,667.50,1294.95,fee schedule,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Premier SAS,,23.50,,,,,,,23.50,49.66,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,1062.65,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,outpatient,,,760.40000,722.38000,The Alliance,Premier SAS,,393.10,,,,,,,378.38,737.59,fee schedule,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,outpatient,,,290.00000,275.50000,The Alliance,Premier SAS,,331.41,,,,,,,145.00,341.50,fee schedule,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Premier SAS,,620.14,,,,,,,271.50,639.03,fee schedule,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Premier SAS,,612.00,,,,,,,153.38,630.65,fee schedule,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,50.00,97.00,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Premier SAS,,348.13,,,,,,,87.25,358.73,fee schedule,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,58.54,,,,,,,23.25,430.17,fee schedule,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,293.70000,279.02000,The Alliance,Premier SAS,,191.09,,,,,,,146.85,284.89,fee schedule,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,outpatient,,,2541.00000,2413.95000,The Alliance,Premier SAS,,1166.32,,,,,,,1166.32,2464.77,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,outpatient,,,384.09000,364.89000,The Alliance,Premier SAS,,473.42,,,,,,,192.04,487.84,fee schedule,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Premier SAS,,57.78,,,,,,,55.62,188.63,fee schedule,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Premier SAS,,11.75,,,,,,,11.75,24.83,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Premier SAS,,39.84,,,,,,,28.95,56.16,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,outpatient,,,174.49000,165.77000,The Alliance,Premier SAS,,348.13,,,,,,,87.25,358.73,fee schedule,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier SAS,,191.26,,,,,,,139.00,269.66,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,The Alliance,Premier SAS,,57.78,,,,,,,55.62,188.63,fee schedule,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier SAS,,470.90,,,,,,,301.00,583.94,fee schedule,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,outpatient,,,148.65000,141.22000,The Alliance,Premier SAS,,68.23,,,,,,,68.23,144.19,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier SAS,,130.09,,,,,,,33.40,134.06,fee schedule,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,outpatient,,,40.48000,38.46000,The Alliance,Premier SAS,,304.60,,,,,,,20.24,313.88,fee schedule,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,outpatient,,,80.27000,76.26000,The Alliance,Premier SAS,,62.80,,,,,,,40.13,77.86,fee schedule,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,outpatient,,,14393.00000,13673.35000,The Alliance,Premier SAS,,5860.37,,,,,,,5640.97,13961.21,fee schedule,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,,57.04,,,,,,,44.50,86.33,fee schedule,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,outpatient,,,42.80000,40.66000,The Alliance,Premier SAS,,31.83,,,,,,,21.40,41.52,fee schedule,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Premier SAS,,225.64,,,,,,,199.97,387.94,fee schedule,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,outpatient,,,89.33000,84.86000,The Alliance,Premier SAS,,89.27,,,,,,,44.66,91.99,fee schedule,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,outpatient,,,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.30,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,40.59,,,,,,,5.87,113.69,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier SAS,,322.67,,,,,,,56.40,454.93,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,outpatient,,,1327.00000,1260.65000,The Alliance,Premier SAS,,912.98,,,,,,,314.95,1287.19,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,outpatient,,,5.78000,5.49000,The Alliance,Premier SAS,,0.49631,,,,,,,0.31000,5.61,fee schedule,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,outpatient,,,77.20000,73.34000,The Alliance,Premier SAS,,53.11,,,,,,,38.60,550.14,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,outpatient,,,56.50000,53.67000,The Alliance,Premier SAS,,32.51,,,,,,,28.25,54.80,fee schedule,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,114.56000,108.83000,The Alliance,Premier SAS,,70.56,,,,,,,57.28,111.12,fee schedule,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,91.53000,86.95000,The Alliance,Premier SAS,,70.56,,,,,,,45.77,95.58,fee schedule,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,302.81000,287.67000,The Alliance,Premier SAS,,191.09,,,,,,,151.41,293.73,fee schedule,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,68.40,,,,,,,3.33,70.48,fee schedule,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Premier SAS,TC,2561.00,,,,,,,1781.00,5271.00,case rate,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,outpatient,,,51.73000,49.14000,The Alliance,Premier SAS,,23.74,,,,,,,23.74,50.18,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Premier SAS,,372.71,,,,,,,372.71,812.00,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,The Alliance,Premier SAS,,306.00,,,,,,,246.10,477.44,fee schedule,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,50.00,97.00,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,outpatient,,,3214.00000,3053.30000,The Alliance,Premier SAS,,1998.72,,,,,,,1607.00,3117.58,fee schedule,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Premier SAS,,544.38,,,,,,,438.00,849.72,fee schedule,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,44.77000,42.53000,The Alliance,Premier SAS,,118.21,,,,,,,22.39,121.81,fee schedule,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,31.60000,30.02000,The Alliance,Premier SAS,,14.50,,,,,,,14.50,30.65,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Premier SAS,,103.85,,,,,,,99.97,423.37,fee schedule,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,outpatient,,,2171.00000,2062.45000,The Alliance,Premier SAS,,1349.79,,,,,,,1085.50,2105.87,fee schedule,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Premier SAS,,1337.35,,,,,,,1075.50,2086.47,fee schedule,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,outpatient,,,55.45000,52.68000,The Alliance,Premier SAS,,99.18,,,,,,,27.73,102.20,fee schedule,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Premier SAS,,0.83700,,,,,,,0.80300,1.94,fee schedule,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier SAS,,133.85,,,,,,,133.85,298.27,fee schedule,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,57.29000,54.43000,The Alliance,Premier SAS,,306.00,,,,,,,28.64,315.32,fee schedule,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,outpatient,,,367.00000,348.65000,The Alliance,Premier SAS,,252.50,,,,,,,56.40,355.99,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,outpatient,,,711.00000,675.45000,The Alliance,Premier SAS,,489.17,,,,,,,314.95,689.67,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,57.91000,55.01000,The Alliance,Premier SAS,,76.88,,,,,,,28.95,93.98,fee schedule,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Premier SAS,,306.00,,,,,,,28.90,315.32,fee schedule,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,381.46000,362.39000,The Alliance,Premier SAS,,435.93,,,,,,,190.73,449.21,fee schedule,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier SAS,,89.72,,,,,,,86.36,301.91,fee schedule,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,29.96000,28.46000,The Alliance,Premier SAS,,89.72,,,,,,,14.98,92.45,fee schedule,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier SAS,,240.11,,,,,,,122.40,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,,41.97,,,,,,,30.50,134.64,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,110.08,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,,131.41,,,,,,,56.40,185.27,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,52,110.08,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,52,131.41,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,,131.41,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,52,131.41,,,,,,,95.50,185.27,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier SAS,,239.42,,,,,,,148.57,337.56,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier SAS,,317.86,,,,,,,231.00,448.14,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,outpatient,,,2008.00000,1907.60000,The Alliance,Premier SAS,,1381.50,,,,,,,87.16,1947.76,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,33.95,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier SAS,,82.56,,,,,,,56.40,116.40,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier SAS,,56.42,,,,,,,41.00,79.54,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,21.33,,,,,,,15.50,30.07,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Premier SAS,,185.76,,,,,,,56.40,261.90,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,58.48,,,,,,,42.50,554.21,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,41.56000,39.48000,The Alliance,Premier SAS,,19.08,,,,,,,19.08,41.56,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,505.88000,480.59000,The Alliance,Premier SAS,,232.20,,,,,,,232.20,505.88,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Premier SAS,,292.61,,,,,,,292.61,637.50,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,outpatient,,,1130.00000,1073.50000,The Alliance,Premier SAS,TC,777.44,,,,,,,565.00,1096.10,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,outpatient,,,474.00000,450.30000,The Alliance,Premier SAS,TC,326.11,,,,,,,237.00,459.78,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Premier SAS,TC,994.85,,,,,,,723.00,1402.62,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier SAS,TC,216.72,,,,,,,157.50,305.55,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Premier SAS,TC,411.42,,,,,,,299.00,580.06,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier SAS,,34.66,,,,,,,3.63,254.68,fee schedule,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,TC,429.00,,,,,,,37.00,442.00,per diem,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,TC,36.46,,,,,,,26.50,51.41,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier SAS,TC,17.89,,,,,,,13.00,25.22,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,TC,89.44,,,,,,,65.00,126.10,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,outpatient,,,4627.00000,4395.65000,The Alliance,Premier SAS,TC,3183.38,,,,,,,2313.50,4488.19,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,TC,20.64,,,,,,,15.00,29.10,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Premier SAS,TC,1392.51,,,,,,,864.82,2960.49,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier SAS,,1596.00,,,,,,,169.04,2714.06,per diem,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Premier SAS,TC,2639.86,,,,,,,1626.53,3721.89,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier SAS,,1596.00,,,,,,,169.04,2292.11,per diem,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier SAS,TC,374.96,,,,,,,272.50,528.65,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,52,429.00,,,,,,,37.00,442.00,per diem,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier SAS,TC,1139.33,,,,,,,828.00,1606.32,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,TC,429.00,,,,,,,18.50,442.00,per diem,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,TC,429.00,,,,,,,18.50,442.00,per diem,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier SAS,TC,1146.21,,,,,,,833.00,1616.02,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier SAS,TC,186.45,,,,,,,135.50,262.87,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier SAS,TC,337.12,,,,,,,245.00,475.30,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier SAS,TC,211.22,,,,,,,153.50,297.79,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier SAS,TC,357.07,,,,,,,259.50,503.43,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,outpatient,,,316.00000,300.20000,The Alliance,Premier SAS,TC,217.41,,,,,,,158.00,306.52,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier SAS,TC,463.71,,,,,,,337.00,653.78,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier SAS,TC,819.41,,,,,,,595.50,1155.27,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier SAS,TC,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier SAS,TC,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1360.00000,1292.00000,The Alliance,Premier SAS,TC,935.68,,,,,,,680.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier SAS,TC,844.86,,,,,,,614.00,1191.16,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier SAS,TC,171.31,,,,,,,124.50,241.53,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Premier SAS,TC,2293.10,,,,,,,1666.50,3233.01,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Premier SAS,TC,877.89,,,,,,,638.00,1237.72,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier SAS,TC,2772.64,,,,,,,2015.00,3909.10,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Premier SAS,TC,1756.46,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Premier SAS,TC,808.40,,,,,,,587.50,1139.75,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier SAS,TC,1561.07,,,,,,,1134.50,2200.93,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,TC,145.86,,,,,,,106.00,205.64,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier SAS,TC,176.82,,,,,,,128.50,249.29,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Premier SAS,TC,1849.34,,,,,,,1344.00,2607.36,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Premier SAS,TC,909.00,,,,,,,282.00,5271.00,case rate,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Premier SAS,TC,909.00,,,,,,,909.00,5271.00,case rate,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier SAS,TC,13.07,,,,,,,9.50,18.43,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,outpatient,,,2018.00000,1917.10000,The Alliance,Premier SAS,TC,909.00,,,,,,,909.00,5271.00,case rate,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Premier SAS,TC,1656.02,,,,,,,1203.50,2334.79,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,outpatient,,,219.00000,208.05000,The Alliance,Premier SAS,TC,150.67,,,,,,,109.50,212.43,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,The Alliance,Premier SAS,,909.00,,,,,,,503.83,5271.00,case rate,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,TC,232.54,,,,,,,169.00,327.86,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,TC,52.98,,,,,,,38.50,74.69,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier SAS,TC,1256.98,,,,,,,913.50,1772.19,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Premier SAS,TC,1949.79,,,,,,,1132.05,2748.98,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,outpatient,,,269.00000,255.55000,The Alliance,Premier SAS,TC,222.57,,,,,,,134.50,1635.52,fee schedule,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Premier SAS,TC,1751.65,,,,,,,1400.30,5271.00,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier SAS,TC,1126.26,,,,,,,818.50,1587.89,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier SAS,TC,126.59,,,,,,,92.00,178.48,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,outpatient,,,226.00000,214.70000,The Alliance,Premier SAS,TC,155.49,,,,,,,113.00,219.22,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier SAS,TC,76.37,,,,,,,55.50,107.67,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,112.14,,,,,,,81.50,554.21,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,outpatient,,,3396.00000,3226.20000,The Alliance,Premier SAS,TC,2336.45,,,,,,,1698.00,3294.12,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,TC,89.44,,,,,,,65.00,126.10,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,TC,30.96,,,,,,,22.50,43.65,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Premier SAS,TC,646.72,,,,,,,470.00,911.80,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Premier SAS,TC,540.08,,,,,,,392.50,761.45,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1128.45,2914.85,per diem,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Premier SAS,TC,661.17,,,,,,,480.50,932.17,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Premier SAS,TC,327.49,,,,,,,238.00,461.72,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,TC,532.00,,,,,,,47.50,860.53,fee schedule,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier SAS,TC,8.26,,,,,,,6.00,11.64,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Premier SAS,TC,780.19,,,,,,,567.00,1099.98,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,outpatient,,,285.90000,271.60000,The Alliance,Premier SAS,TC,196.70,,,,,,,142.95,277.32,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Premier SAS,TC,104.92,,,,,,,76.25,147.93,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,TC,180.38,,,,,,,118.53,1430.78,fee schedule,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,outpatient,,,2216.00000,2105.20000,The Alliance,Premier SAS,TC,1524.61,,,,,,,1108.00,2149.52,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,outpatient,,,80.70000,76.66000,The Alliance,Premier SAS,,55.52,,,,,,,40.35,91.97,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier SAS,TC,360.51,,,,,,,262.00,508.28,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,TC,106.64,,,,,,,77.50,150.35,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier SAS,TC,95.63,,,,,,,69.50,134.83,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier SAS,,1596.00,,,,,,,169.04,3313.52,per diem,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,outpatient,,,375.50000,356.72000,The Alliance,Premier SAS,TC,258.34,,,,,,,187.75,364.24,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier SAS,TC,316.48,,,,,,,230.00,446.20,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,outpatient,,,6252.00000,5939.40000,The Alliance,Premier SAS,TC,4301.38,,,,,,,3126.00,6064.44,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,outpatient,,,152.50000,144.88000,The Alliance,Premier SAS,TC,104.92,,,,,,,76.25,147.93,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Premier SAS,TC,8.94,,,,,,,6.50,12.61,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,outpatient,,,1150.00000,1092.50000,The Alliance,Premier SAS,TC,791.20,,,,,,,575.00,1115.50,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier SAS,TC,7426.27,,,,,,,5397.00,10470.18,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,outpatient,,,489.00000,464.55000,The Alliance,Premier SAS,TC,336.43,,,,,,,244.50,474.33,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,outpatient,,,5814.00000,5523.30000,The Alliance,Premier SAS,TC,6990.00,,,,,,,377.14,7206.00,per diem,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier SAS,TC,157.55,,,,,,,114.50,222.13,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,TC,127.97,,,,,,,93.00,180.42,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Premier SAS,TC,214.66,,,,,,,156.00,302.64,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier SAS,TC,138.29,,,,,,,100.50,194.97,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier SAS,TC,374.96,,,,,,,272.50,528.65,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1964.93,,,,,,,1404.95,2770.32,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Premier SAS,TC,738.22,,,,,,,536.50,1040.81,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1964.93,,,,,,,1399.96,2770.32,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier SAS,,1488.83,,,,,,,1047.39,2099.08,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1964.93,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,1075.34,,,,,,,761.71,1516.11,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1964.93,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,1075.34,,,,,,,765.41,1516.11,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,outpatient,,,284.00000,269.80000,The Alliance,Premier SAS,TC,195.39,,,,,,,142.00,275.48,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,1075.34,,,,,,,763.56,1516.11,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,TC,176.13,,,,,,,128.00,248.32,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier SAS,TC,165.12,,,,,,,120.00,232.80,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Premier SAS,TC,242.18,,,,,,,176.00,341.44,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier SAS,,1488.83,,,,,,,1056.58,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,The Alliance,Premier SAS,,1488.83,,,,,,,1049.24,2099.08,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,,506.90,,,,,,,172.50,4020.73,fee schedule,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,TC,189.89,,,,,,,138.00,267.72,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,TC,29.58,,,,,,,21.50,41.71,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier SAS,TC,392.85,,,,,,,285.50,1232.72,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier SAS,TC,845.55,,,,,,,614.50,1192.13,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier SAS,TC,372.21,,,,,,,270.50,1232.72,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,222.78,,,,,,,172.50,1767.08,fee schedule,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier SAS,TC,1234.96,,,,,,,897.50,1741.15,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Premier SAS,TC,3299.65,,,,,,,2398.00,4652.12,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier SAS,TC,1234.96,,,,,,,897.50,1741.15,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier SAS,TC,216.03,,,,,,,157.00,304.58,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,90.62,,,,,,,68.74,718.77,fee schedule,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier SAS,TC,10.32,,,,,,,7.50,14.55,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,TC,29.58,,,,,,,21.50,41.71,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier SAS,TC,1370.50,,,,,,,996.00,1932.24,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,TC,19.26,,,,,,,14.00,27.16,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier SAS,TC,2329.57,,,,,,,1693.00,3284.42,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier SAS,,1370.50,,,,,,,100.97,1932.24,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier SAS,TC,178.19,,,,,,,129.50,1145.46,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,TC,152.74,,,,,,,111.00,215.34,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Premier SAS,TC,1091.17,,,,,,,793.00,1538.42,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier SAS,TC,1026.50,,,,,,,746.00,1447.24,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier SAS,TC,639.84,,,,,,,465.00,902.10,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,TC,85.31,,,,,,,62.00,120.28,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier SAS,TC,255.20,,,,,,,178.00,2024.21,fee schedule,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,TC,61.23,,,,,,,44.50,86.33,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,outpatient,,,617.00000,586.15000,The Alliance,Premier SAS,TC,424.50,,,,,,,297.28,598.49,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier SAS,TC,723.99,,,,,,,606.90,5742.65,fee schedule,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Premier SAS,TC,429.00,,,,,,,214.00,467.89,per diem,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier SAS,TC,429.00,,,,,,,257.00,595.98,per diem,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,outpatient,,,465.00000,441.75000,The Alliance,Premier SAS,TC,319.92,,,,,,,232.50,2134.86,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,outpatient,,,1556.00000,1478.20000,The Alliance,Premier SAS,,714.20,,,,,,,714.20,1556.00,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,outpatient,,,12133.00000,11526.35000,The Alliance,Premier SAS,,8347.50,,,,,,,6066.50,11769.01,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,9.09,29.10,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.13,1094.55,fee schedule,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,TC,160.44,,,,,,,129.58,1272.59,fee schedule,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,532.00,,,,,,,133.50,584.87,fee schedule,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,66.50,584.87,fee schedule,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Premier SAS,TC,794.64,,,,,,,577.50,1120.35,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,outpatient,,,4144.00000,3936.80000,The Alliance,Premier SAS,,2851.07,,,,,,,280.29,4019.68,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,101.00,548.00,fee schedule,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1155.27,fee schedule,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,TC,197.84,,,,,,,149.00,1569.27,fee schedule,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,TC,140.49,,,,,,,104.50,1114.32,fee schedule,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier SAS,TC,150.47,,,,,,,108.00,1193.49,fee schedule,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier SAS,TC,180.38,,,,,,,132.50,1430.78,fee schedule,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,TC,172.90,,,,,,,138.00,1371.46,fee schedule,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,TC,218.78,,,,,,,154.77,308.46,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,4666.67,per diem,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.00,1094.55,fee schedule,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,outpatient,1,EA,10866.46000,10323.14000,The Alliance,Premier SAS,,7.19,,,,,,,4.49,10540.47,fee schedule,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,outpatient,1,mL,1294.48000,1229.75000,The Alliance,Premier SAS,,17.66,,,,,,,11.03,1255.65,fee schedule,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,outpatient,1,mL,781.97000,742.88000,The Alliance,Premier SAS,,28.88,,,,,,,24.87,758.51,fee schedule,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,167.92,,,,,,,126.50,1331.91,fee schedule,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1329.46,fee schedule,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier SAS,TC,205.32,,,,,,,161.00,1628.59,fee schedule,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Premier SAS,,9.24,,,,,,,6.71,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier SAS,,3.84,,,,,,,2.79,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,outpatient,120,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,outpatient,120,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,outpatient,120,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,outpatient,120,EA,0.58000,0.56000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,outpatient,1,mL,17.06000,16.21000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,16.55,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,outpatient,1,mL,20.10000,19.09000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,19.50,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,outpatient,1,mL,22.75000,21.61000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,22.07,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,25.44,fee schedule,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,outpatient,1,mL,14.49000,13.77000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,14.06,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,outpatient,1,EA,0.83000,0.78000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier SAS,TC,167.92,,,,,,,125.00,1331.91,fee schedule,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,TC,180.38,,,,,,,137.50,1430.78,fee schedule,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier SAS,TC,147.97,,,,,,,108.50,1173.72,fee schedule,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,TC,147.97,,,,,,,120.38,1173.72,fee schedule,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,TC,207.81,,,,,,,161.50,1648.36,fee schedule,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.13,1094.55,fee schedule,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,TC,155.45,,,,,,,123.50,1233.04,fee schedule,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier SAS,TC,575.86,,,,,,,418.50,811.89,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,66.50,584.87,fee schedule,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1356.06,fee schedule,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Premier SAS,TC,532.00,,,,,,,247.28,568.42,fee schedule,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1000.07,fee schedule,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,806.07,fee schedule,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier SAS,TC,150.47,,,,,,,101.94,1193.49,fee schedule,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,TC,180.38,,,,,,,135.13,1430.78,fee schedule,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Premier SAS,TC,1110.50,,,,,,,905.50,8808.48,fee schedule,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier SAS,TC,205.32,,,,,,,151.73,1628.59,fee schedule,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier SAS,TC,225.27,,,,,,,172.00,1786.85,fee schedule,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Premier SAS,TC,205.32,,,,,,,152.50,1628.59,fee schedule,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,TC,135.50,,,,,,,93.00,1074.77,fee schedule,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,TC,225.27,,,,,,,170.00,1786.85,fee schedule,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,TC,195.35,,,,,,,144.00,1549.49,fee schedule,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,TC,128.02,,,,,,,77.99,1015.45,fee schedule,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier SAS,TC,649.18,,,,,,,403.50,5149.29,fee schedule,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier SAS,TC,190.36,,,,,,,144.50,1509.95,fee schedule,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,TC,205.32,,,,,,,166.47,1628.59,fee schedule,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,TC,110.56,,,,,,,87.50,876.96,fee schedule,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier SAS,TC,152.96,,,,,,,120.50,1213.27,fee schedule,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier SAS,TC,190.36,,,,,,,151.00,1509.95,fee schedule,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier SAS,TC,504.56,,,,,,,372.00,4002.11,fee schedule,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Premier SAS,TC,197.84,,,,,,,152.00,1569.27,fee schedule,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier SAS,TC,207.81,,,,,,,165.00,1648.36,fee schedule,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier SAS,TC,419.78,,,,,,,307.50,3329.66,fee schedule,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,152.96,,,,,,,115.50,1213.27,fee schedule,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,TC,187.87,,,,,,,46.50,3015.65,fee schedule,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Premier SAS,TC,733.97,,,,,,,290.00,5821.82,fee schedule,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier SAS,TC,162.93,,,,,,,122.50,1292.36,fee schedule,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Premier SAS,TC,337.48,,,,,,,278.89,2676.90,fee schedule,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier SAS,TC,155.45,,,,,,,117.50,1233.04,fee schedule,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,outpatient,,,1544.00000,1466.80000,The Alliance,Premier SAS,,1062.27,,,,,,,772.00,7180.14,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Premier SAS,,0.99262,,,,,,,0.93155,8.45,fee schedule,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier SAS,,2872.98,,,,,,,549.28,22788.40,fee schedule,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Premier SAS,,3808.07,,,,,,,549.28,30205.49,fee schedule,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Premier SAS,,920.31,,,,,,,237.91,17311.25,fee schedule,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier SAS,,908.93,,,,,,,103.97,7209.59,fee schedule,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Premier SAS,,1498.46,,,,,,,381.55,2210.07,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Premier SAS,,1380.82,,,,,,,511.11,2960.49,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Premier SAS,,3556.27,,,,,,,2584.50,5013.93,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Premier SAS,,562.85,,,,,,,562.85,1226.25,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Premier SAS,,196.22,,,,,,,196.22,427.50,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier SAS,,3087.92,,,,,,,3087.92,6727.50,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Premier SAS,,250.43,,,,,,,182.00,456.63,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Premier SAS,,2399.74,,,,,,,511.11,3383.36,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Premier SAS,,2390.11,,,,,,,1239.61,7180.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,outpatient,,,3562.00000,3383.90000,The Alliance,Premier SAS,,864.31,,,,,,,371.02,10740.24,fee schedule,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,61.30,fee schedule,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Premier SAS,,754.31,,,,,,,383.91,10740.24,fee schedule,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,The Alliance,Premier SAS,,2167.89,,,,,,,1733.05,5271.00,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,outpatient,,,2262.00000,2148.90000,The Alliance,Premier SAS,,1992.96,,,,,,,1131.00,15808.09,fee schedule,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier SAS,,2137.79,,,,,,,2137.79,4657.50,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Premier SAS,,1305.76,,,,,,,1305.76,2844.79,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Premier SAS,,7083.57,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Premier SAS,,4581.21,,,,,,,4581.21,9980.85,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4205.10000,3994.85000,The Alliance,Premier SAS,,1930.14,,,,,,,1930.14,4205.10,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,outpatient,1,mL,78.92000,74.98000,The Alliance,Premier SAS,,22.61,,,,,,,14.12,76.55,fee schedule,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier SAS,,2547.71,,,,,,,549.28,20208.37,fee schedule,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier SAS,,2544.33,,,,,,,549.28,20181.52,fee schedule,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier SAS,,13482.80,,,,,,,1299.22,106944.98,fee schedule,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier SAS,,2563.49,,,,,,,1863.00,3614.22,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Premier SAS,,341.94,,,,,,,248.50,7984.62,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,outpatient,,,497.00000,472.15000,The Alliance,Premier SAS,,341.94,,,,,,,248.50,7984.62,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Premier SAS,,847.62,,,,,,,381.55,2210.07,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier SAS,TC,1444.80,,,,,,,1050.00,2037.00,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,outpatient,,,2184.00000,2074.80000,The Alliance,Premier SAS,TC,1502.59,,,,,,,1092.00,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier SAS,TC,1256.98,,,,,,,913.50,1772.19,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,TC,52.29,,,,,,,38.00,73.72,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,outpatient,,,2153.00000,2045.35000,The Alliance,Premier SAS,TC,1481.26,,,,,,,1076.50,2088.41,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier SAS,,1331.97,,,,,,,511.11,2960.49,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Premier SAS,,1923.03,,,,,,,1923.03,17311.25,fee schedule,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Premier SAS,,1842.34,,,,,,,1226.87,14613.37,fee schedule,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Premier SAS,,597.10,,,,,,,359.37,4736.20,fee schedule,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier SAS,,1531.90,,,,,,,833.00,12150.98,fee schedule,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,outpatient,,,1702.00000,1616.90000,The Alliance,Premier SAS,,1170.98,,,,,,,381.55,2210.07,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Premier SAS,TC,776.75,,,,,,,564.50,1095.13,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,,1052.63,,,,,,,417.10,17311.25,fee schedule,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,outpatient,,,9110.00000,8654.50000,The Alliance,Premier SAS,,6990.00,,,,,,,381.55,8836.70,per diem,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier SAS,,984.66,,,,,,,519.48,7810.26,fee schedule,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,The Alliance,Premier SAS,,1555.57,,,,,,,1243.55,5271.00,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,The Alliance,Premier SAS,,1328.02,,,,,,,990.94,10533.78,fee schedule,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,outpatient,,,45977.00000,43678.15000,The Alliance,Premier SAS,,7363.85,,,,,,,5651.91,58409.77,fee schedule,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,outpatient,,,962.00000,913.90000,The Alliance,Premier SAS,,1359.86,,,,,,,249.71,10786.37,fee schedule,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,990.81,,,,,,,103.97,7859.04,fee schedule,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1821.18,,,,,,,249.71,14445.56,fee schedule,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,outpatient,,,3724.00000,3537.80000,The Alliance,Premier SAS,,2562.11,,,,,,,103.97,3612.28,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier SAS,,372.21,,,,,,,126.07,524.77,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Premier SAS,,829.73,,,,,,,381.55,2210.07,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier SAS,,86.06,,,,,,,86.06,187.50,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Premier SAS,,228.84,,,,,,,228.84,498.56,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,The Alliance,Premier SAS,,228.84,,,,,,,228.84,498.56,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier SAS,,640.57,,,,,,,100.97,5080.96,fee schedule,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier SAS,,671.13,,,,,,,234.00,5323.40,fee schedule,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,outpatient,,,5332.00000,5065.40000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Premier SAS,,3105.00,,,,,,,2800.00,24628.72,fee schedule,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,The Alliance,Premier SAS,,955.81,,,,,,,138.83,7581.44,fee schedule,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier SAS,,389.87,,,,,,,389.87,849.38,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier SAS,,389.87,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier SAS,,8040.81,,,,,,,8040.81,17518.10,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier SAS,,8471.90,,,,,,,1667.31,67198.78,fee schedule,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Premier SAS,,1293.44,,,,,,,81.69,1823.60,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier SAS,,513.94,,,,,,,282.87,724.59,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,TC,61.23,,,,,,,44.50,86.33,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,853.78,,,,,,,52.50,6772.18,fee schedule,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,outpatient,1,mL,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier SAS,,463.89,,,,,,,101.50,3679.58,fee schedule,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier SAS,,532.00,,,,,,,327.36,764.36,fee schedule,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,9.88,184.30,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier SAS,,532.00,,,,,,,149.44,548.00,fee schedule,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Premier SAS,,1512.22,,,,,,,381.55,2210.07,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier SAS,,532.00,,,,,,,295.69,1897.32,fee schedule,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Premier SAS,,807.78,,,,,,,457.64,29731.35,fee schedule,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,,879.09,,,,,,,361.82,17311.25,fee schedule,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,outpatient,,,4753.00000,4515.35000,The Alliance,Premier SAS,,835.65,,,,,,,431.85,6628.38,fee schedule,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier SAS,,509.43,,,,,,,280.00,4040.81,fee schedule,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,,1056.94,,,,,,,500.59,29731.35,fee schedule,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,,1096.67,,,,,,,439.81,17311.25,fee schedule,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Premier SAS,,1210.40,,,,,,,498.74,29731.35,fee schedule,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,,1006.01,,,,,,,411.55,17311.25,fee schedule,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,,921.44,,,,,,,394.96,17311.25,fee schedule,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Premier SAS,,1144.26,,,,,,,574.33,17311.25,fee schedule,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Premier SAS,,1243.70,,,,,,,595.74,17311.25,fee schedule,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,,1193.27,,,,,,,378.42,17311.25,fee schedule,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier SAS,,965.49,,,,,,,356.27,17311.25,fee schedule,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Premier SAS,,953.81,,,,,,,418.96,17311.25,fee schedule,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier SAS,,710.26,,,,,,,227.70,5633.78,fee schedule,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Premier SAS,,1737.87,,,,,,,723.58,29731.35,fee schedule,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,outpatient,,,4226.00000,4014.70000,The Alliance,Premier SAS,,1400.63,,,,,,,960.76,17311.25,fee schedule,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,,1150.81,,,,,,,550.38,17311.25,fee schedule,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier SAS,,1017.00,,,,,,,463.75,17311.25,fee schedule,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Premier SAS,,968.82,,,,,,,426.30,17311.25,fee schedule,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,,1137.06,,,,,,,417.10,17311.25,fee schedule,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,72.50,548.00,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier SAS,,2.18,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,2.18,,,,,,,0.01000,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,2.18,,,,,,,0.01000,2.24,fee schedule,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,172.50,2032.87,per diem,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,172.50,2032.87,per diem,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,172.50,2032.87,per diem,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,,210.23,,,,,,,87.50,1544.85,fee schedule,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier SAS,,92.41,,,,,,,12.90,679.08,fee schedule,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,72.50,548.00,fee schedule,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,62.38,,,,,,,5.38,458.40,fee schedule,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,9.98,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier SAS,90,194.06,,,,,,,12.50,1426.03,fee schedule,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,3.22,fee schedule,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,outpatient,1,mL,5.53000,5.25000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,5.36,fee schedule,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,outpatient,,,3479.00000,3305.05000,The Alliance,Premier SAS,TC,2393.55,,,,,,,1628.38,3374.63,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,outpatient,10,EA,3.56000,3.38000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,3.45,fee schedule,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,outpatient,10,EA,5.94000,5.64000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,5.76,fee schedule,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,outpatient,10,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,1.32,fee schedule,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,74.34,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,63.05,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08000,0.36860,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,outpatient,1,mL,0.26000,0.24000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08000,0.25220,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08000,0.87300,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08000,1.09,fee schedule,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08000,0.29100,fee schedule,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier SAS,,274.92,,,,,,,38.62,2020.22,fee schedule,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,outpatient,1,EA,1.39000,1.33000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,outpatient,1,mL,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,633.75000,602.06000,The Alliance,Premier SAS,,290.89,,,,,,,290.89,633.75,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,outpatient,1,EA,0.43000,0.40000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier SAS,,14.23,,,,,,,2.10,14.67,fee schedule,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,outpatient,1,EA,45.56000,43.28000,The Alliance,Premier SAS,,31.35,,,,,,,22.78,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,outpatient,1,mL,7855.65000,7462.87000,The Alliance,Premier SAS,,3907.56,,,,,,,2440.70,7619.98,fee schedule,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,outpatient,1,EA,47.27000,44.91000,The Alliance,Premier SAS,,32.52,,,,,,,1.13,45.85,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,50.83,,,,,,,7.27,373.51,fee schedule,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier SAS,,2561.00,,,,,,,548.90,3163.00,case rate,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,outpatient,1,EA,333.18000,316.52000,The Alliance,Premier SAS,,229.23,,,,,,,166.59,323.18,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier SAS,,231.02,,,,,,,32.62,1697.68,fee schedule,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,outpatient,15,EA,38.63000,36.70000,The Alliance,Premier SAS,,26.58,,,,,,,19.32,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,outpatient,1,EA,3284.86000,3120.62000,The Alliance,Premier SAS,,71.23,,,,,,,44.49,3186.31,fee schedule,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Premier SAS,,10.33,,,,,,,7.50,14.56,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,outpatient,8,EA,8.97000,8.53000,The Alliance,Premier SAS,,6.17,,,,,,,4.49,8.70,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,outpatient,30,EA,1.48000,1.40000,The Alliance,Premier SAS,,14.23,,,,,,,0.74000,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Premier SAS,,14.23,,,,,,,0.47500,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,outpatient,30,EA,2.40000,2.28000,The Alliance,Premier SAS,,14.23,,,,,,,1.20,14.67,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,outpatient,30,EA,19.80000,18.81000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,19.21,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,outpatient,30,EA,15.80000,15.01000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,15.33,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,outpatient,30,EA,4.37000,4.15000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,4.24,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,outpatient,30,EA,19.75000,18.76000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,19.16,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,outpatient,30,EA,21.80000,20.71000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,21.15,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,5.44,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,6.13,fee schedule,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,outpatient,30,EA,3.89000,3.69000,The Alliance,Premier SAS,,0.59237,,,,,,,0.59237,3.77,fee schedule,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,outpatient,5,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,117.83,,,,,,,18.40,865.84,fee schedule,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Premier SAS,,3.22,,,,,,,2.34,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Premier SAS,90,78.55,,,,,,,12.70,577.23,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Premier SAS,,84.98,,,,,,,1.83,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier SAS,,84.98,,,,,,,2.85,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier SAS,,84.98,,,,,,,1.46,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,outpatient,1,mL,2.43000,2.31000,The Alliance,Premier SAS,,84.98,,,,,,,1.22,88.11,fee schedule,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,84.98,,,,,,,1.10,88.11,fee schedule,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,63.05,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,309.60,,,,,,,247.50,5271.00,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,outpatient,3,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.32020,,,,,,,0.07500,0.33000,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.32020,,,,,,,0.26500,0.51410,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,outpatient,3,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.32020,,,,,,,0.26500,0.51410,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.32020,,,,,,,0.16000,0.33000,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.32020,,,,,,,0.21000,0.40740,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.32020,,,,,,,0.30070,0.65960,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,outpatient,3,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.32020,,,,,,,0.30070,0.65960,fee schedule,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,outpatient,3,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.32020,,,,,,,0.21000,0.40740,fee schedule,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Premier SAS,,339.61,,,,,,,47.63,2495.58,fee schedule,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,outpatient,30,EA,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Premier SAS,,10.22,,,,,,,7.42,14.40,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Premier SAS,90,120.13,,,,,,,17.43,882.80,fee schedule,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,outpatient,1,EA,5.93000,5.63000,The Alliance,Premier SAS,,4.08,,,,,,,2.96,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Premier SAS,,2.45,,,,,,,1.78,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,outpatient,1,EA,4.29000,4.08000,The Alliance,Premier SAS,,2.95,,,,,,,2.15,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Premier SAS,,2.34,,,,,,,1.70,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,outpatient,1,EA,1.48000,1.40000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,outpatient,30,EA,26.39000,25.07000,The Alliance,Premier SAS,,18.16,,,,,,,1.13,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,outpatient,30,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,1.13,22.99,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,outpatient,1,mL,10.42000,9.90000,The Alliance,Premier SAS,,14.23,,,,,,,5.21,14.67,fee schedule,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,outpatient,1,mL,11.07000,10.51000,The Alliance,Premier SAS,,14.23,,,,,,,5.54,14.67,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier SAS,,84.98,,,,,,,0.36500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,outpatient,1,mL,0.52000,0.50000,The Alliance,Premier SAS,,84.98,,,,,,,0.26000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier SAS,,84.98,,,,,,,0.21000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,84.98,,,,,,,0.29000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,84.98,,,,,,,0.29500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,84.98,,,,,,,0.29500,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Premier SAS,,84.98,,,,,,,0.44000,88.11,fee schedule,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,84.98,,,,,,,0.18500,88.11,fee schedule,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,outpatient,0.5,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,outpatient,,,3438.00000,3266.10000,The Alliance,Premier SAS,TC,2365.34,,,,,,,1436.74,7180.14,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Premier SAS,,7.85,,,,,,,5.71,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Premier SAS,,5.84,,,,,,,4.25,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier SAS,,7.59,,,,,,,5.51,10.70,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.12808,,,,,,,0.08500,0.16490,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,outpatient,3,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.12808,,,,,,,0.10500,0.20370,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,outpatient,3,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.31040,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,outpatient,3,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.25220,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,outpatient,3,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.12808,,,,,,,0.08500,0.16490,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,outpatient,3,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.29100,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,outpatient,3,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.38800,fee schedule,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,outpatient,3,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.30070,fee schedule,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,69.31,,,,,,,9.71,509.30,fee schedule,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,outpatient,,,266.10000,252.80000,The Alliance,Premier SAS,90,198.68,,,,,,,31.89,1459.96,fee schedule,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,outpatient,2,EA,5.72000,5.43000,The Alliance,Premier SAS,,3.94,,,,,,,2.86,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,outpatient,2,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,4.27,10.73,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,267.29,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Premier SAS,,179.34,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Premier SAS,,542.25,,,,,,,1.13,764.51,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Premier SAS,,27.59,,,,,,,27.59,101.15,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,outpatient,1,EA,138.91000,131.97000,The Alliance,Premier SAS,,27.59,,,,,,,27.59,134.74,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,outpatient,1,EA,125.45000,119.18000,The Alliance,Premier SAS,,27.59,,,,,,,27.59,121.69,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,outpatient,1,EA,99.54000,94.56000,The Alliance,Premier SAS,,27.59,,,,,,,27.59,96.55,fee schedule,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,27.59,,,,,,,27.59,122.61,fee schedule,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,outpatient,,,210.90000,200.35000,The Alliance,Premier SAS,90,145.10,,,,,,,14.72,204.57,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,34.66,,,,,,,4.95,254.68,fee schedule,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,outpatient,,,496.00000,471.20000,The Alliance,Premier SAS,,341.25,,,,,,,248.00,481.12,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,48.19,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,outpatient,20,EA,7.63000,7.25000,The Alliance,Premier SAS,,0.25616,,,,,,,0.25616,7.40,fee schedule,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,191.75,,,,,,,16.95,1409.06,fee schedule,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,outpatient,,,428.00000,406.60000,The Alliance,Premier SAS,,288.78,,,,,,,40.75,2122.08,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,outpatient,2,EA,25.28000,24.02000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,24.52,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,outpatient,2,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,9.20,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,16.78,fee schedule,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,outpatient,2,EA,25.12000,23.87000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,24.37,fee schedule,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,outpatient,,,420.10000,399.10000,The Alliance,Premier SAS,,289.03,,,,,,,50.73,407.50,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,outpatient,1,mL,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,outpatient,1,mL,1.74000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,90,69.31,,,,,,,9.98,509.30,fee schedule,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier SAS,,335.06,,,,,,,63.95,788.42,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.61110,fee schedule,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,,106.27,,,,,,,14.78,780.94,fee schedule,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,outpatient,10,EA,2.67000,2.53000,The Alliance,Premier SAS,,1.84,,,,,,,1.13,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,outpatient,10,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.21,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,outpatient,10,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.13,3.83,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,outpatient,,,17.60000,16.72000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Premier SAS,90,127.06,,,,,,,17.71,933.70,fee schedule,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,outpatient,,,174.80000,166.06000,The Alliance,Premier SAS,90,106.27,,,,,,,15.58,780.94,fee schedule,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,outpatient,,,179.20000,170.24000,The Alliance,Premier SAS,90,55.45,,,,,,,7.97,407.44,fee schedule,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,outpatient,,,59.80000,56.81000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,103.96,,,,,,,14.57,763.98,fee schedule,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,outpatient,,,194.80000,185.06000,The Alliance,Premier SAS,90,120.13,,,,,,,17.57,882.80,fee schedule,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,outpatient,1,EA,378.88000,359.94000,The Alliance,Premier SAS,,260.67,,,,,,,189.44,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,outpatient,1,EA,280.60000,266.57000,The Alliance,Premier SAS,,193.05,,,,,,,140.30,272.18,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,90,120.48,,,,,,,14.91,885.37,fee schedule,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,,154.78,,,,,,,47.50,1137.41,fee schedule,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,outpatient,1,EA,13388.43000,12719.00000,The Alliance,Premier SAS,,150.73,,,,,,,94.15,12986.78,fee schedule,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,outpatient,1,EA,16720.68000,15884.65000,The Alliance,Premier SAS,,150.73,,,,,,,94.15,16219.06,fee schedule,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier SAS,,120.13,,,,,,,16.77,882.80,fee schedule,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,36.97,,,,,,,5.30,271.65,fee schedule,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,94.72,,,,,,,13.44,696.05,fee schedule,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,outpatient,1,EA,28.62000,27.19000,The Alliance,Premier SAS,,19.69,,,,,,,14.31,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,outpatient,355,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,outpatient,,,399.70000,379.71000,The Alliance,Premier SAS,90,124.75,,,,,,,20.26,916.73,fee schedule,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,outpatient,1,EA,7.52000,7.15000,The Alliance,Premier SAS,,5.17,,,,,,,3.76,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,outpatient,1,EA,67.88000,64.48000,The Alliance,Premier SAS,,46.70,,,,,,,33.94,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,outpatient,1,EA,18.85000,17.91000,The Alliance,Premier SAS,,12.97,,,,,,,9.43,18.28,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,outpatient,1,EA,456.75000,433.91000,The Alliance,Premier SAS,,150.73,,,,,,,94.15,443.05,fee schedule,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,outpatient,,,327.70000,311.32000,The Alliance,Premier SAS,90,180.20,,,,,,,26.33,1324.17,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,outpatient,9,EA,1.69000,1.60000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,1.64,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,outpatient,9,EA,2.72000,2.58000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,2.64,fee schedule,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,outpatient,9,EA,1.47000,1.39000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,1.43,fee schedule,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,outpatient,80,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,outpatient,1,EA,9108.37000,8652.95000,The Alliance,Premier SAS,,150.73,,,,,,,94.15,8835.12,fee schedule,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,outpatient,1,EA,0.21000,0.19000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,301.67,fee schedule,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,outpatient,1,EA,5.05000,4.80000,The Alliance,Premier SAS,,3.47,,,,,,,2.52,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,532.00,,,,,,,76.00,548.00,fee schedule,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,outpatient,20,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,outpatient,20,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,outpatient,20,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier SAS,,13.53,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier SAS,,13.29,,,,,,,2.48,18.34,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,outpatient,3,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.81651,,,,,,,0.40000,0.84150,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,2.05,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,outpatient,3,EA,2.11000,2.00000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,2.05,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,outpatient,3,EA,1.84000,1.75000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,1.78,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,outpatient,3,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,1.37,fee schedule,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,outpatient,3,EA,4.04000,3.83000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,3.92,fee schedule,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,outpatient,1,EA,1.31000,1.25000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Premier SAS,,0.98384,,,,,,,0.71500,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,outpatient,50,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,outpatient,50,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,outpatient,50,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Premier SAS,QN,1094.61,,,,,,,795.50,1543.27,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier SAS,,2.55,,,,,,,1.85,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier SAS,,13.53,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,outpatient,30,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Premier SAS,,10.32,,,,,,,7.50,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,outpatient,1,EA,15.00000,14.25000,The Alliance,Premier SAS,,10.32,,,,,,,7.50,14.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.43,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Premier SAS,HI,167.18,,,,,,,121.50,235.71,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,outpatient,,,536.00000,509.20000,The Alliance,Premier SAS,,628.39,,,,,,,90.57,4617.66,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,23.64,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,outpatient,1,EA,13.27000,12.61000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,12.87,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,16.86,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,outpatient,1,EA,25.12000,23.87000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,24.37,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,outpatient,1,EA,8.61000,8.18000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,8.35,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,14.87,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,9.20,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,15.72,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,9.65,fee schedule,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,outpatient,1,EA,12.72000,12.08000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,12.34,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,outpatient,1,EA,46.02000,43.72000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,44.64,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,outpatient,1,EA,24.08000,22.88000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,23.36,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,27.59,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,outpatient,1,EA,50.40000,47.88000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,48.89,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,outpatient,1,EA,16.92000,16.08000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,16.41,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,outpatient,1,EA,19.75000,18.76000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,19.16,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,outpatient,1,EA,17.85000,16.96000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,17.31,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,outpatient,1,EA,12.50000,11.88000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,12.12,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,outpatient,1,EA,25.82000,24.53000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,25.05,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,outpatient,1,EA,16.75000,15.91000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,16.25,fee schedule,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,16.14,fee schedule,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,46.20,,,,,,,6.48,339.51,fee schedule,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,outpatient,80,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,outpatient,80,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,outpatient,80,EA,4.23000,4.02000,The Alliance,Premier SAS,,2.91,,,,,,,2.12,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,outpatient,80,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,outpatient,80,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,outpatient,80,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,outpatient,80,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,outpatient,80,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,outpatient,80,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,outpatient,80,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,The Alliance,Premier SAS,QN,1094.61,,,,,,,795.50,1543.27,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,46.20,,,,,,,6.48,339.51,fee schedule,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,391.00000,371.45000,The Alliance,Premier SAS,,269.01,,,,,,,63.95,788.42,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,outpatient,75,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,outpatient,75,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,outpatient,75,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,outpatient,75,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,outpatient,75,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,7.15,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,outpatient,1,EA,8.91000,8.46000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,8.64,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,outpatient,1,EA,11.14000,10.58000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,10.81,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,7.27,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,7.54,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,5.21,fee schedule,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,3.68,fee schedule,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Premier SAS,,54.63,,,,,,,54.63,147.13,fee schedule,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,110.89,,,,,,,17.27,814.87,fee schedule,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,1549.12,,,,,,,1549.12,3375.00,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,outpatient,1,EA,20.82000,19.78000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,20.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,outpatient,1,EA,22.45000,21.32000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,21.78,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,outpatient,1,EA,347.11000,329.76000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,336.70,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,outpatient,1,EA,42.35000,40.23000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,41.08,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,outpatient,1,EA,87.84000,83.45000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,85.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,22.99,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,33.72,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,outpatient,1,EA,22.45000,21.33000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,21.78,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,15.33,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,9.20,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,outpatient,1,EA,22.47000,21.34000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,21.80,fee schedule,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,outpatient,1,EA,24.98000,23.73000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,24.23,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,outpatient,1,EA,11.23000,10.67000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,10.89,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,outpatient,1,EA,21.83000,20.74000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,21.18,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,outpatient,1,EA,17.46000,16.59000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,16.94,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,outpatient,1,EA,45.28000,43.02000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,43.92,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,outpatient,1,EA,218.29000,207.38000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,211.74,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,15.33,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,18.39,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,outpatient,1,EA,15.31000,14.54000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,14.85,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,9.20,fee schedule,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,10.73,fee schedule,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,134.85,,,,,,,98.00,190.12,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,78.55,,,,,,,11.16,577.23,fee schedule,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,127.06,,,,,,,17.93,933.70,fee schedule,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,90,154.78,,,,,,,51.50,1137.41,fee schedule,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,outpatient,1,EA,87.62000,83.24000,The Alliance,Premier SAS,,60.28,,,,,,,43.81,84.99,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,outpatient,50,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,outpatient,50,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,outpatient,50,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,outpatient,50,EA,57.64000,54.76000,The Alliance,Premier SAS,,39.66,,,,,,,28.82,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,outpatient,50,EA,0.42000,0.39000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier SAS,,154.78,,,,,,,57.00,1137.41,fee schedule,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,,103.96,,,,,,,14.60,763.98,fee schedule,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,outpatient,1,mL,302.21000,287.10000,The Alliance,Premier SAS,,1.18,,,,,,,0.74000,293.14,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Premier SAS,,1.18,,,,,,,0.74000,502.46,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,outpatient,1,mL,281.47000,267.40000,The Alliance,Premier SAS,,1.18,,,,,,,0.74000,273.03,fee schedule,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,outpatient,1,mL,528.36000,501.94000,The Alliance,Premier SAS,,1.18,,,,,,,0.74000,512.51,fee schedule,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Premier SAS,,3.67,,,,,,,2.67,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.43,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier SAS,,3.27,,,,,,,2.38,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,3.39,,,,,,,2.46,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,outpatient,1,EA,5.12000,4.86000,The Alliance,Premier SAS,,3.52,,,,,,,2.56,4.97,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,outpatient,,,172.20000,163.59000,The Alliance,Premier SAS,90,154.78,,,,,,,86.10,1137.41,fee schedule,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,288.78,,,,,,,61.00,2122.08,fee schedule,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,outpatient,1,EA,132.86000,126.22000,The Alliance,Premier SAS,,91.41,,,,,,,66.43,128.87,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier SAS,,120.13,,,,,,,16.87,882.80,fee schedule,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,outpatient,,,224.30000,213.08000,The Alliance,Premier SAS,90,134.00,,,,,,,19.60,984.66,fee schedule,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,outpatient,,,1022.00000,970.90000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,3163.00,case rate,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1117.00000,1061.15000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,3163.00,case rate,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,909.00,,,,,,,74.80,3163.00,case rate,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,3163.00,case rate,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier SAS,,2.38,,,,,,,1.73,3.36,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier SAS,,21.54,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier SAS,,21.54,,,,,,,15.65,30.37,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,outpatient,,,339.80000,322.81000,The Alliance,Premier SAS,90,207.92,,,,,,,30.26,1527.89,fee schedule,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier SAS,,21.54,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,The Alliance,Premier SAS,,21.54,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,outpatient,1,EA,19.43000,18.46000,The Alliance,Premier SAS,,13.37,,,,,,,9.71,18.85,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,outpatient,1,EA,277.92000,264.03000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,269.58,fee schedule,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,outpatient,1,EA,277.92000,264.02000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,269.58,fee schedule,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier SAS,,2561.00,,,,,,,548.90,3163.00,case rate,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Premier SAS,,2.56,,,,,,,1.86,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,outpatient,1,EA,31.53000,29.95000,The Alliance,Premier SAS,,21.69,,,,,,,15.77,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier SAS,,64.64,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Premier SAS,,17.86,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,outpatient,1,EA,76.37000,72.55000,The Alliance,Premier SAS,,52.54,,,,,,,38.19,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,outpatient,1,EA,35.86000,34.06000,The Alliance,Premier SAS,,24.67,,,,,,,17.93,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier SAS,,64.64,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,outpatient,1,EA,29.53000,28.05000,The Alliance,Premier SAS,,20.32,,,,,,,14.77,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,outpatient,1,EA,26.67000,25.34000,The Alliance,Premier SAS,,18.35,,,,,,,13.34,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier SAS,,3.17,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,outpatient,1,EA,26.45000,25.13000,The Alliance,Premier SAS,,18.20,,,,,,,13.22,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,outpatient,1,EA,70.70000,67.17000,The Alliance,Premier SAS,,48.64,,,,,,,35.35,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,outpatient,1,EA,3.78000,3.60000,The Alliance,Premier SAS,,2.60,,,,,,,1.89,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier SAS,,3.17,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,outpatient,1,EA,93.95000,89.26000,The Alliance,Premier SAS,,64.64,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,outpatient,1,EA,25.96000,24.66000,The Alliance,Premier SAS,,17.86,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,outpatient,1,EA,17.97000,17.07000,The Alliance,Premier SAS,,12.36,,,,,,,8.98,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,909.00,,,,,,,74.80,3163.00,case rate,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,outpatient,1,EA,4.46000,4.23000,The Alliance,Premier SAS,,3.07,,,,,,,2.23,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier SAS,,2.79,,,,,,,2.03,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,outpatient,1,EA,4.94000,4.70000,The Alliance,Premier SAS,,3.40,,,,,,,2.47,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,outpatient,1,EA,53.59000,50.91000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,51.98,fee schedule,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,outpatient,1,EA,39.69000,37.71000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,38.50,fee schedule,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,17.81,fee schedule,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,outpatient,1,EA,15.63000,14.85000,The Alliance,Premier SAS,,10.75,,,,,,,7.82,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,outpatient,1,EA,15.88000,15.09000,The Alliance,Premier SAS,,10.93,,,,,,,7.94,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,outpatient,1,EA,15.76000,14.97000,The Alliance,Premier SAS,,10.84,,,,,,,7.88,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.46,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier SAS,,283.39,,,,,,,22.34,2082.45,fee schedule,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,909.00,,,,,,,89.10,3163.00,case rate,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier SAS,,144.48,,,,,,,115.50,5271.00,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,106.27,,,,,,,8.17,780.94,fee schedule,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,90,85.48,,,,,,,12.38,628.12,fee schedule,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,1060.21,fee schedule,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,114.21,,,,,,,43.81,161.02,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,outpatient,1,EA,58.40000,55.48000,The Alliance,Premier SAS,,40.18,,,,,,,29.20,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,outpatient,1,EA,47.24000,44.88000,The Alliance,Premier SAS,,32.50,,,,,,,23.62,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,outpatient,1,GM,15.81000,15.02000,The Alliance,Premier SAS,,10.88,,,,,,,7.91,15.34,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,outpatient,60,EA,3.69000,3.50000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,outpatient,1,EA,35.04000,33.29000,The Alliance,Premier SAS,,24.11,,,,,,,17.52,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier SAS,,14.13,,,,,,,10.27,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,outpatient,1,EA,21.24000,20.17000,The Alliance,Premier SAS,,14.61,,,,,,,10.62,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier SAS,,7.39,,,,,,,5.37,10.42,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,outpatient,10,EA,2.95000,2.80000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,2.86,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,outpatient,10,EA,2.92000,2.78000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,2.83,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,outpatient,10,EA,5.30000,5.04000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,5.14,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,outpatient,10,EA,3.29000,3.13000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,3.19,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,3.07,fee schedule,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,2.75,fee schedule,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,outpatient,1,mL,28.25000,26.84000,The Alliance,Premier SAS,,1.26,,,,,,,1.06,27.40,fee schedule,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,outpatient,1,mL,10.13000,9.63000,The Alliance,Premier SAS,,1.26,,,,,,,1.06,9.83,fee schedule,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier SAS,TC,385.28,,,,,,,280.00,543.20,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,,47.27,,,,,,,34.35,66.64,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,outpatient,1,EA,1587.93000,1508.53000,The Alliance,Premier SAS,,89.67,,,,,,,56.01,1540.29,fee schedule,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,outpatient,30,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,outpatient,30,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,909.00,,,,,,,38.50,3163.00,case rate,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,9.20,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,18.39,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,outpatient,1,EA,9.25000,8.79000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,8.97,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,19.00,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,10.73,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,outpatient,1,EA,23.48000,22.30000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,22.78,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,outpatient,1,EA,217.44000,206.57000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,210.92,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,outpatient,1,EA,14.85000,14.11000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,14.40,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,15.33,fee schedule,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,outpatient,1,EA,10.98000,10.43000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,10.65,fee schedule,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,outpatient,15,EA,5.51000,5.24000,The Alliance,Premier SAS,,3.79,,,,,,,2.75,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,outpatient,15,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,outpatient,15,EA,4.44000,4.21000,The Alliance,Premier SAS,,3.05,,,,,,,2.22,4.31,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,outpatient,,,180.30000,171.28000,The Alliance,Premier SAS,90,154.78,,,,,,,90.15,1137.41,fee schedule,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,outpatient,,,1903.00000,1807.85000,The Alliance,Premier SAS,90,1166.67,,,,,,,169.42,8573.20,fee schedule,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier SAS,,335.06,,,,,,,63.95,788.42,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,outpatient,1,EA,10.91000,10.36000,The Alliance,Premier SAS,,7.51,,,,,,,5.46,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,outpatient,1,EA,6.72000,6.38000,The Alliance,Premier SAS,,4.62,,,,,,,3.36,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,outpatient,1,EA,4.45000,4.22000,The Alliance,Premier SAS,,3.06,,,,,,,2.23,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Premier SAS,,1.89,,,,,,,1.38,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,outpatient,1,EA,5.37000,5.10000,The Alliance,Premier SAS,,3.69,,,,,,,2.69,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Premier SAS,,3.78,,,,,,,2.75,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,3.39,,,,,,,2.46,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier SAS,,1.92,,,,,,,1.40,2.71,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier SAS,,909.00,,,,,,,113.85,3163.00,case rate,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,outpatient,,,63.50000,60.32000,The Alliance,Premier SAS,,43.69,,,,,,,28.29,61.59,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier SAS,,3.43,,,,,,,0.73500,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,3.43,,,,,,,0.71000,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,3.43,,,,,,,1.07,3.53,fee schedule,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,3.43,,,,,,,0.53500,3.53,fee schedule,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,outpatient,1,EA,56.72000,53.89000,The Alliance,Premier SAS,,39.02,,,,,,,28.36,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,outpatient,5,EA,57.46000,54.59000,The Alliance,Premier SAS,,39.53,,,,,,,28.73,55.74,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,outpatient,1,EA,31.16000,29.60000,The Alliance,Premier SAS,,4.18,,,,,,,3.44,30.23,fee schedule,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,2234.00000,2122.30000,The Alliance,Premier SAS,QN,1536.99,,,,,,,1117.00,2166.98,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,outpatient,3.5,EA,19.66000,18.67000,The Alliance,Premier SAS,,13.53,,,,,,,9.83,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,outpatient,3.5,EA,12.55000,11.92000,The Alliance,Premier SAS,,8.63,,,,,,,6.28,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,outpatient,3.5,EA,20.69000,19.66000,The Alliance,Premier SAS,,14.23,,,,,,,10.35,20.07,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Premier SAS,,145.72,,,,,,,91.02,1332.27,fee schedule,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,outpatient,1,GM,89.11000,84.66000,The Alliance,Premier SAS,,61.31,,,,,,,44.55,86.44,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Premier SAS,,2.44,,,,,,,1.77,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Premier SAS,,3.93,,,,,,,2.85,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,outpatient,1,EA,4.69000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,106.27,,,,,,,15.05,780.94,fee schedule,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,115.51,,,,,,,16.18,848.80,fee schedule,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,outpatient,45,EA,3.77000,3.58000,The Alliance,Premier SAS,,2.59,,,,,,,1.89,3.66,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,outpatient,3.5,EA,7.75000,7.36000,The Alliance,Premier SAS,,5.33,,,,,,,3.88,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,outpatient,3.5,EA,8.82000,8.38000,The Alliance,Premier SAS,,6.07,,,,,,,4.41,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,outpatient,3.5,EA,6.08000,5.77000,The Alliance,Premier SAS,,4.18,,,,,,,3.04,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,outpatient,3.5,EA,7.36000,6.99000,The Alliance,Premier SAS,,5.06,,,,,,,3.68,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,outpatient,3.5,EA,6.45000,6.12000,The Alliance,Premier SAS,,4.44,,,,,,,3.23,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,outpatient,3.5,EA,5.87000,5.57000,The Alliance,Premier SAS,,4.04,,,,,,,2.94,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,outpatient,3.5,EA,2.48000,2.36000,The Alliance,Premier SAS,,1.71,,,,,,,1.24,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,outpatient,3.5,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,outpatient,3.5,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,outpatient,3.5,EA,2.80000,2.66000,The Alliance,Premier SAS,,1.93,,,,,,,1.40,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,outpatient,3.5,EA,4.72000,4.49000,The Alliance,Premier SAS,,3.25,,,,,,,2.36,4.58,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,24.52,fee schedule,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,outpatient,1,mL,35.49000,33.71000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,34.43,fee schedule,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,36.78,fee schedule,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,outpatient,3.5,EA,39.53000,37.55000,The Alliance,Premier SAS,,27.20,,,,,,,19.77,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,outpatient,3.5,EA,36.07000,34.26000,The Alliance,Premier SAS,,24.82,,,,,,,18.04,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,outpatient,3.5,EA,39.91000,37.91000,The Alliance,Premier SAS,,27.46,,,,,,,19.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,outpatient,3.5,EA,41.14000,39.09000,The Alliance,Premier SAS,,28.30,,,,,,,20.57,39.91,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,outpatient,1,mL,146.15000,138.84000,The Alliance,Premier SAS,,281.49,,,,,,,73.08,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,outpatient,1,mL,135.88000,129.09000,The Alliance,Premier SAS,,281.49,,,,,,,67.94,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Premier SAS,,281.49,,,,,,,74.67,290.17,fee schedule,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,outpatient,1,mL,160.62000,152.59000,The Alliance,Premier SAS,,281.49,,,,,,,80.31,290.17,fee schedule,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,outpatient,15,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,outpatient,15,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,outpatient,15,EA,13.41000,12.74000,The Alliance,Premier SAS,,9.23,,,,,,,6.71,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,outpatient,1,EA,295.97000,281.17000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,287.09,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,outpatient,1,EA,806.22000,765.90000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,782.03,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,outpatient,1,EA,700.52000,665.49000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,679.50,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,301.48,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,502.46,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,outpatient,1,EA,453.25000,430.59000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,439.65,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,outpatient,1,EA,1036.00000,984.20000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,1004.92,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,outpatient,1,EA,1515.77000,1439.98000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,1470.30,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,outpatient,1,EA,543.90000,516.70000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,527.58,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,251.23,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,outpatient,1,EA,123.24000,117.08000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,119.54,fee schedule,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,outpatient,1,EA,142.20000,135.09000,The Alliance,Premier SAS,,0.33621,,,,,,,0.33621,137.93,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,outpatient,1,mL,36.50000,34.67000,The Alliance,Premier SAS,,281.49,,,,,,,18.25,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,outpatient,1,mL,33.97000,32.27000,The Alliance,Premier SAS,,281.49,,,,,,,16.98,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,outpatient,1,mL,37.33000,35.47000,The Alliance,Premier SAS,,281.49,,,,,,,18.66,290.17,fee schedule,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,outpatient,1,mL,40.11000,38.11000,The Alliance,Premier SAS,,281.49,,,,,,,20.05,290.17,fee schedule,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,outpatient,59.2,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,outpatient,1,mL,34.32000,32.61000,The Alliance,Premier SAS,,23.61,,,,,,,17.16,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,outpatient,1,mL,27.68000,26.29000,The Alliance,Premier SAS,,19.04,,,,,,,13.84,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,outpatient,1,mL,28.04000,26.64000,The Alliance,Premier SAS,,19.29,,,,,,,14.02,27.20,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,50.83,,,,,,,7.30,373.51,fee schedule,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,,120.13,,,,,,,16.87,882.80,fee schedule,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Premier SAS,90,267.98,,,,,,,38.99,1969.25,fee schedule,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,165.57,,,,,,,5.99,1216.68,fee schedule,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Premier SAS,,3844.00,,,,,,,180.95,4686.00,case rate,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,outpatient,8,EA,302.57000,287.44000,The Alliance,Premier SAS,,208.17,,,,,,,151.28,293.49,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,outpatient,5,EA,5.78000,5.49000,The Alliance,Premier SAS,,3.98,,,,,,,2.89,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,outpatient,5,EA,27.09000,25.73000,The Alliance,Premier SAS,,18.64,,,,,,,13.54,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,outpatient,5,EA,23.29000,22.12000,The Alliance,Premier SAS,,16.02,,,,,,,11.64,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,outpatient,5,EA,18.42000,17.50000,The Alliance,Premier SAS,,12.67,,,,,,,9.21,17.87,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,outpatient,56,EA,225.62000,214.34000,The Alliance,Premier SAS,,155.23,,,,,,,112.81,218.85,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,outpatient,10,EA,98.13000,93.22000,The Alliance,Premier SAS,,67.51,,,,,,,49.06,95.19,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,25.41,,,,,,,3.80,186.75,fee schedule,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,outpatient,1,EA,2511.99000,2386.39000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,2436.63,fee schedule,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,outpatient,30,EA,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,outpatient,30,EA,3.67000,3.49000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,outpatient,30,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,outpatient,30,EA,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,outpatient,30,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,outpatient,30,EA,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,outpatient,30,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,outpatient,30,EA,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,outpatient,,,2632.00000,2500.40000,The Alliance,Premier SAS,,3844.00,,,,,,,1447.60,4686.00,case rate,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Premier SAS,90,71.62,,,,,,,8.17,526.26,fee schedule,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,,2561.00,,,,,,,658.35,3163.00,case rate,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,180.20,,,,,,,8.17,1324.17,fee schedule,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,34.66,,,,,,,4.70,254.68,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,outpatient,1,EA,93.93000,89.23000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,91.11,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,outpatient,1,EA,104.28000,99.07000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,101.15,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,outpatient,1,EA,114.01000,108.31000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,110.59,fee schedule,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,outpatient,1,EA,86.30000,81.98000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,83.71,fee schedule,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,,47.27,,,,,,,34.35,66.64,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Premier SAS,,116.95,,,,,,,73.05,500.54,fee schedule,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,outpatient,1,EA,187.86000,178.47000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,182.22,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,outpatient,1,EA,231.66000,220.08000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,224.71,fee schedule,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,outpatient,1,EA,172.60000,163.97000,The Alliance,Premier SAS,,4.27,,,,,,,3.84,167.42,fee schedule,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier SAS,,577.92,,,,,,,420.00,814.80,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,69.31,,,,,,,11.00,509.30,fee schedule,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,90,122.44,,,,,,,17.69,899.77,fee schedule,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,20.80,,,,,,,3.02,152.82,fee schedule,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,194.06,,,,,,,37.27,1426.03,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,outpatient,1,EA,295.84000,281.05000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,286.96,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,outpatient,1,EA,274.80000,261.06000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,266.56,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,outpatient,1,EA,231.41000,219.84000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,224.47,fee schedule,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,outpatient,1,EA,210.74000,200.20000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,204.42,fee schedule,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier SAS,,2561.00,,,,,,,420.20,3163.00,case rate,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,outpatient,2.5,EA,122.58000,116.45000,The Alliance,Premier SAS,,84.34,,,,,,,61.29,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,outpatient,2.5,EA,136.13000,129.33000,The Alliance,Premier SAS,,93.66,,,,,,,68.06,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,outpatient,2.5,EA,132.04000,125.44000,The Alliance,Premier SAS,,90.84,,,,,,,66.02,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,outpatient,2.5,EA,66.74000,63.40000,The Alliance,Premier SAS,,45.92,,,,,,,33.37,64.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,outpatient,5,EA,23.64000,22.45000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,22.93,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,outpatient,5,EA,34.78000,33.04000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,33.74,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,outpatient,5,EA,25.44000,24.17000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,24.68,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,outpatient,5,EA,18.05000,17.15000,The Alliance,Premier SAS,,11.03,,,,,,,9.03,17.51,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,24.52,fee schedule,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,outpatient,5,EA,24.79000,23.55000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,24.05,fee schedule,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,outpatient,1,EA,84.57000,80.34000,The Alliance,Premier SAS,,58.18,,,,,,,42.28,82.03,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,outpatient,15,EA,3.55000,3.37000,The Alliance,Premier SAS,,2.44,,,,,,,1.77,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,outpatient,15,EA,4.62000,4.38000,The Alliance,Premier SAS,,3.18,,,,,,,2.31,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,outpatient,15,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Premier SAS,,33.30,,,,,,,24.20,46.95,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,20.80,,,,,,,2.99,152.82,fee schedule,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,90,85.48,,,,,,,12.38,628.12,fee schedule,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,outpatient,237,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,outpatient,237,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,The Alliance,Premier SAS,TC,1392.51,,,,,,,864.82,2960.49,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier SAS,,166.34,,,,,,,26.07,1222.31,fee schedule,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1737.00000,1650.15000,The Alliance,Premier SAS,TC,1195.06,,,,,,,868.50,2210.07,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,The Alliance,Premier SAS,,250.43,,,,,,,182.00,456.63,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,27.72,,,,,,,3.83,203.72,fee schedule,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,,20.80,,,,,,,2.99,152.82,fee schedule,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier SAS,TC,1668.40,,,,,,,1212.50,2352.25,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,27.72,,,,,,,3.83,203.72,fee schedule,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,,103.96,,,,,,,13.37,763.98,fee schedule,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,outpatient,,,1888.00000,1793.60000,The Alliance,Premier SAS,TC,1298.94,,,,,,,875.87,2210.07,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,outpatient,5,EA,32.06000,30.46000,The Alliance,Premier SAS,,22.06,,,,,,,16.03,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,outpatient,5,EA,32.22000,30.61000,The Alliance,Premier SAS,,22.17,,,,,,,16.11,31.25,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1444.00000,1371.80000,The Alliance,Premier SAS,,1122.78,,,,,,,143.40,8250.66,fee schedule,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,outpatient,1,mL,516.02000,490.22000,The Alliance,Premier SAS,,116.95,,,,,,,73.05,500.54,fee schedule,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,60.06,,,,,,,8.46,441.37,fee schedule,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier SAS,,147.86,,,,,,,20.81,1086.52,fee schedule,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,outpatient,1,GM,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,outpatient,1,GM,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,outpatient,1,GM,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14106.71,per diem,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,outpatient,,,733.00000,696.35000,The Alliance,Premier SAS,,332.09,,,,,,,236.07,2440.34,fee schedule,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Premier SAS,TC,2379.10,,,,,,,1609.99,3354.26,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Premier SAS,,2140.96,,,,,,,2140.96,4664.40,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier SAS,,6.24,,,,,,,4.54,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Premier SAS,,5.22,,,,,,,3.79,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,outpatient,1,EA,7.46000,7.08000,The Alliance,Premier SAS,,5.13,,,,,,,3.73,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,outpatient,1,EA,7.92000,7.53000,The Alliance,Premier SAS,,5.45,,,,,,,3.96,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,180.20,,,,,,,8.17,1324.17,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,outpatient,2,EA,9.20000,8.74000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,8.92,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,outpatient,2,EA,14.00000,13.30000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,13.58,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,outpatient,2,EA,1.31000,1.25000,The Alliance,Premier SAS,,2.05,,,,,,,0.65500,2.11,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,outpatient,2,EA,16.21000,15.40000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,15.72,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,outpatient,2,EA,14.70000,13.97000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,14.26,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,7.66,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,outpatient,2,EA,10.06000,9.56000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,9.76,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,outpatient,2,EA,4.71000,4.48000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,4.57,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,outpatient,2,EA,14.75000,14.01000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,14.31,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Premier SAS,,2.05,,,,,,,0.79000,2.11,fee schedule,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,outpatient,2,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.05,,,,,,,1.52,2.96,fee schedule,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,,55.45,,,,,,,7.75,407.44,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,outpatient,10,EA,1.06000,1.00000,The Alliance,Premier SAS,,0.97661,,,,,,,0.53000,1.03,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,outpatient,10,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.97661,,,,,,,0.29000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,outpatient,10,EA,1.04000,0.98000,The Alliance,Premier SAS,,0.97661,,,,,,,0.52000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,outpatient,10,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.97661,,,,,,,0.39000,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,1.53,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.97661,,,,,,,0.51500,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,outpatient,10,EA,0.87000,0.82000,The Alliance,Premier SAS,,0.97661,,,,,,,0.43500,1.01,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,outpatient,10,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.97661,,,,,,,0.52500,1.02,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.97661,,,,,,,0.47500,1.01,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,outpatient,30,EA,0.24000,0.22000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.23280,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,outpatient,30,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.50440,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.26190,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.53350,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.75660,fee schedule,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,outpatient,30,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.73720,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.31040,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.20370,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,outpatient,30,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.17460,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,outpatient,30,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.47530,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,outpatient,30,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.24250,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,outpatient,30,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.49470,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,outpatient,30,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.70810,fee schedule,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,outpatient,30,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.66930,fee schedule,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Premier SAS,QN,747.17,,,,,,,543.00,1053.42,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,90,62.38,,,,,,,8.17,458.40,fee schedule,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,110.08,,,,,,,80.00,155.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,8.09,,,,,,,7.27,18.39,fee schedule,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,outpatient,1,EA,26.07000,24.76000,The Alliance,Premier SAS,,8.09,,,,,,,7.27,25.29,fee schedule,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,8.09,,,,,,,4.74,9.20,fee schedule,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier SAS,,226.17,,,,,,,35.09,1662.04,fee schedule,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,outpatient,5,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,outpatient,5,EA,9.16000,8.71000,The Alliance,Premier SAS,,6.30,,,,,,,4.58,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,outpatient,5,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,outpatient,5,EA,3.86000,3.67000,The Alliance,Premier SAS,,2.66,,,,,,,1.93,3.74,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.18430,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.34920,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.19400,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.68870,fee schedule,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.49470,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,outpatient,4,EA,1.66000,1.58000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,1.61,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,outpatient,4,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,1.29,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,outpatient,4,EA,2.39000,2.27000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,2.32,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,outpatient,4,EA,1.80000,1.71000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,1.75,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,outpatient,4,EA,2.46000,2.33000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,2.39,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,outpatient,4,EA,2.16000,2.06000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,2.10,fee schedule,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,outpatient,4,EA,2.05000,1.95000,The Alliance,Premier SAS,,0.97661,,,,,,,0.61000,1.99,fee schedule,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,1237.50000,1175.62000,The Alliance,Premier SAS,,568.01,,,,,,,568.01,1237.50,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,The Alliance,Premier SAS,QN,747.17,,,,,,,543.00,1053.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier SAS,,2.79,,,,,,,2.03,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,outpatient,1,EA,12.10000,11.50000,The Alliance,Premier SAS,,8.32,,,,,,,6.05,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier SAS,,2.87,,,,,,,2.08,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Premier SAS,,4.03,,,,,,,2.93,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,outpatient,1,EA,8.33000,7.92000,The Alliance,Premier SAS,,5.73,,,,,,,4.17,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,outpatient,1,EA,10.00000,9.50000,The Alliance,Premier SAS,,6.88,,,,,,,5.00,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Premier SAS,,4.02,,,,,,,2.92,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier SAS,,7.47,,,,,,,5.43,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,outpatient,30,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,outpatient,30,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,outpatient,30,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,outpatient,30,EA,1.03000,0.97000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.76630,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,outpatient,10,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.36860,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,outpatient,10,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.70810,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,outpatient,10,EA,1.50000,1.42000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.46,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.80510,fee schedule,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,outpatient,10,EA,1.66000,1.57000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.61,fee schedule,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Premier SAS,90,164.03,,,,,,,24.43,1205.34,fee schedule,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier SAS,90,97.03,,,,,,,14.05,713.01,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,outpatient,10,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.76630,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.21,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.61110,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.06,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,outpatient,10,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.80510,fee schedule,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,outpatient,10,EA,1.50000,1.43000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.46,fee schedule,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,outpatient,,,409.00000,388.55000,The Alliance,Premier SAS,,249.50,,,,,,,37.27,1833.46,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.45590,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.29100,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.43650,fee schedule,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.76630,fee schedule,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,outpatient,1,EA,11.31000,10.74000,The Alliance,Premier SAS,,7.78,,,,,,,5.66,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,outpatient,1,EA,4.73000,4.49000,The Alliance,Premier SAS,,3.25,,,,,,,2.37,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,outpatient,1,EA,7.99000,7.60000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.75,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,outpatient,1,mL,2.16000,2.05000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,outpatient,1,mL,5.43000,5.16000,The Alliance,Premier SAS,,3.74,,,,,,,2.71,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,outpatient,1,mL,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier SAS,,1.34,,,,,,,0.97500,1.89,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,outpatient,1,EA,4.35000,4.14000,The Alliance,Premier SAS,,2.99,,,,,,,2.17,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier SAS,,3844.00,,,,,,,420.20,4686.00,case rate,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.61110,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.21340,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.23280,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,outpatient,1,mL,0.64000,0.60000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.62080,fee schedule,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.68870,fee schedule,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,outpatient,1,EA,5.95000,5.66000,The Alliance,Premier SAS,,4.09,,,,,,,2.98,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier SAS,,3.68,,,,,,,2.67,5.19,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,1.66,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,outpatient,50,EA,6.32000,6.00000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,6.13,fee schedule,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,outpatient,,,4181.00000,3971.95000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,outpatient,2,EA,50.16000,47.66000,The Alliance,Premier SAS,,34.51,,,,,,,25.08,48.66,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier SAS,90,189.44,,,,,,,27.68,1392.10,fee schedule,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,,3844.00,,,,,,,658.35,4686.00,case rate,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,The Alliance,Premier SAS,TC,2639.86,,,,,,,1626.53,3721.89,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,outpatient,1,EA,21473.80000,20400.11000,The Alliance,Premier SAS,,413.89,,,,,,,258.52,20829.59,fee schedule,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,5563.92,case rate,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,outpatient,1.5,EA,94.13000,89.42000,The Alliance,Premier SAS,,64.76,,,,,,,47.06,91.31,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,6189.57,case rate,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,36.97,,,,,,,5.16,271.65,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,outpatient,10,EA,3.17000,3.01000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,3.07,fee schedule,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,3.07,fee schedule,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Premier SAS,TC,1135.89,,,,,,,805.84,2210.07,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier SAS,,138.61,,,,,,,19.63,1018.59,fee schedule,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,outpatient,1,EA,8.55000,8.13000,The Alliance,Premier SAS,,5.88,,,,,,,4.28,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,outpatient,1,EA,10.63000,10.10000,The Alliance,Premier SAS,,7.31,,,,,,,5.32,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,outpatient,1,EA,5.44000,5.17000,The Alliance,Premier SAS,,3.74,,,,,,,2.72,5.28,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,outpatient,10,EA,2.14000,2.04000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,outpatient,10,EA,2.70000,2.56000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,outpatient,10,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,outpatient,10,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Premier SAS,,908.16,,,,,,,726.00,5271.00,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,outpatient,1,EA,5.42000,5.15000,The Alliance,Premier SAS,,3.73,,,,,,,2.71,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Premier SAS,,3.21,,,,,,,2.33,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Premier SAS,,2.01,,,,,,,1.46,2.83,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier SAS,TC,374.96,,,,,,,272.50,528.65,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,outpatient,,,8368.00000,7949.60000,The Alliance,Premier SAS,90,120.48,,,,,,,14.91,8116.96,fee schedule,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier SAS,,3.16,,,,,,,2.30,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,outpatient,1,EA,308.21000,292.80000,The Alliance,Premier SAS,,212.05,,,,,,,154.10,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,outpatient,1,EA,766.64000,728.31000,The Alliance,Premier SAS,,527.45,,,,,,,383.32,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,outpatient,1,EA,357.42000,339.55000,The Alliance,Premier SAS,,245.90,,,,,,,178.71,346.70,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,outpatient,30,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,outpatient,30,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,,64.69,,,,,,,9.22,475.37,fee schedule,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier SAS,TC,317.86,,,,,,,231.00,448.14,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier SAS,,2.88,,,,,,,2.10,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Premier SAS,,2.67,,,,,,,1.94,3.76,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier SAS,,147.86,,,,,,,7.34,1086.52,fee schedule,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Premier SAS,,3.05,,,,,,,2.22,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Premier SAS,,1.94,,,,,,,1.41,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.23,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,outpatient,10,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.64020,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,outpatient,10,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.60140,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,outpatient,10,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.01,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.69840,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,1.75,fee schedule,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,outpatient,10,EA,2.07000,1.97000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,2.01,fee schedule,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,3844.00,,,,,,,174.90,4686.00,case rate,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,outpatient,1,EA,9.52000,9.04000,The Alliance,Premier SAS,,6.55,,,,,,,4.76,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier SAS,,2.78,,,,,,,2.02,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier SAS,,2.99,,,,,,,2.17,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,outpatient,3.7,EA,256.63000,243.79000,The Alliance,Premier SAS,,176.56,,,,,,,128.31,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,outpatient,3.7,EA,50.82000,48.28000,The Alliance,Premier SAS,,34.96,,,,,,,25.41,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,outpatient,3.7,EA,63.94000,60.75000,The Alliance,Premier SAS,,43.99,,,,,,,31.97,62.02,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,outpatient,222,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,outpatient,222,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,outpatient,222,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,outpatient,222,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,outpatient,222,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,outpatient,1,EA,244.62000,232.38000,The Alliance,Premier SAS,,168.30,,,,,,,122.31,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,outpatient,1,EA,917.98000,872.08000,The Alliance,Premier SAS,,631.57,,,,,,,458.99,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,outpatient,1,EA,826.18000,784.87000,The Alliance,Premier SAS,,568.41,,,,,,,413.09,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,86.96,,,,,,,63.20,122.61,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Premier SAS,,7.72,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Premier SAS,,3.32,,,,,,,2.42,4.69,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,outpatient,1,mL,3.48000,3.31000,The Alliance,Premier SAS,,3.38,,,,,,,1.74,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,outpatient,1,mL,2.50000,2.38000,The Alliance,Premier SAS,,3.38,,,,,,,1.25,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,outpatient,1,mL,5.26000,5.00000,The Alliance,Premier SAS,,3.38,,,,,,,2.63,5.10,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Premier SAS,,3.38,,,,,,,1.32,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,outpatient,1,mL,3.11000,2.96000,The Alliance,Premier SAS,,3.38,,,,,,,1.55,4.86,fee schedule,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier SAS,,3.38,,,,,,,2.85,5.52,fee schedule,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,outpatient,12,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,outpatient,12,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,outpatient,12,EA,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,outpatient,12,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,outpatient,12,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,outpatient,12,EA,2.32000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,outpatient,12,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,outpatient,,,298.50000,283.58000,The Alliance,Premier SAS,90,180.20,,,,,,,26.09,1324.17,fee schedule,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,43.89,,,,,,,6.03,322.54,fee schedule,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,97.03,,,,,,,13.68,713.01,fee schedule,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,outpatient,15,EA,11.52000,10.94000,The Alliance,Premier SAS,,7.93,,,,,,,5.76,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,outpatient,15,EA,10.06000,9.56000,The Alliance,Premier SAS,,6.92,,,,,,,5.03,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,outpatient,15,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,outpatient,15,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,outpatient,15,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,outpatient,15,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,outpatient,15,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,outpatient,15,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,outpatient,1,EA,15.20000,14.44000,The Alliance,Premier SAS,,10.46,,,,,,,7.60,14.74,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,outpatient,1,mL,10.52000,10.00000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Premier SAS,,13.58,,,,,,,9.87,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,outpatient,1,mL,17.91000,17.01000,The Alliance,Premier SAS,,12.32,,,,,,,8.96,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,outpatient,1,mL,5.67000,5.38000,The Alliance,Premier SAS,,3.90,,,,,,,2.83,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,outpatient,1,mL,32.79000,31.15000,The Alliance,Premier SAS,,22.56,,,,,,,16.39,31.81,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,,103.96,,,,,,,14.57,763.98,fee schedule,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,outpatient,1,EA,874.67000,830.94000,The Alliance,Premier SAS,,3.63,,,,,,,3.63,848.43,fee schedule,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,outpatient,1,mL,17567.59000,16689.21000,The Alliance,Premier SAS,,363.59,,,,,,,227.10,17040.56,fee schedule,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,The Alliance,Premier SAS,TC,242.18,,,,,,,176.00,341.44,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Premier SAS,90,94.72,,,,,,,13.69,696.05,fee schedule,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier SAS,,134.00,,,,,,,18.96,984.66,fee schedule,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,outpatient,1,EA,11.22000,10.66000,The Alliance,Premier SAS,,7.72,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier SAS,,2.13,,,,,,,0.14500,2.19,fee schedule,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,outpatient,1,mL,0.45000,0.42000,The Alliance,Premier SAS,,2.13,,,,,,,0.22500,2.19,fee schedule,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier SAS,,2.13,,,,,,,0.27500,2.19,fee schedule,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier SAS,,1596.00,,,,,,,166.00,1820.00,per diem,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,outpatient,1,EA,3597.38000,3417.51000,The Alliance,Premier SAS,,88.20,,,,,,,55.09,3489.46,fee schedule,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier SAS,TC,1444.80,,,,,,,980.94,2210.07,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,outpatient,1,EA,24.39000,23.17000,The Alliance,Premier SAS,,16.78,,,,,,,12.20,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,outpatient,1,EA,23.23000,22.07000,The Alliance,Premier SAS,,15.98,,,,,,,11.62,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Premier SAS,,2.62,,,,,,,1.91,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,outpatient,1,EA,3.47000,3.29000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Premier SAS,,5.10,,,,,,,3.71,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier SAS,,1.89,,,,,,,1.38,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,180.20,,,,,,,8.17,1324.17,fee schedule,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,outpatient,,,67.40000,64.03000,The Alliance,Premier SAS,90,85.48,,,,,,,8.17,628.12,fee schedule,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier SAS,,2.70,,,,,,,1.97,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,outpatient,1,mL,2.13000,2.02000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,outpatient,,,1010.55000,960.02000,The Alliance,Premier SAS,,463.84,,,,,,,463.84,1010.55,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,outpatient,1,EA,5931.95000,5635.36000,The Alliance,Premier SAS,,88.20,,,,,,,55.09,5753.99,fee schedule,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1419.00000,1348.05000,The Alliance,Premier SAS,,976.27,,,,,,,621.36,1376.43,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier SAS,,3844.00,,,,,,,1333.75,4686.00,case rate,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,outpatient,1,EA,62.57000,59.44000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,60.69,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,30.65,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,outpatient,1,EA,63.04000,59.89000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,61.15,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,18.39,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,42.79,fee schedule,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,outpatient,1,EA,20.26000,19.24000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,19.65,fee schedule,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier SAS,,3.59,,,,,,,2.61,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,outpatient,1,EA,5.80000,5.51000,The Alliance,Premier SAS,,3.99,,,,,,,2.90,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.58,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,outpatient,,,1182.00000,1122.90000,The Alliance,Premier SAS,,813.22,,,,,,,650.10,5271.00,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,outpatient,1,EA,46.64000,44.31000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,45.24,fee schedule,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,outpatient,60,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,outpatient,60,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,TC,1786.05,,,,,,,1189.19,2518.12,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,55.45,,,,,,,7.77,407.44,fee schedule,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Premier SAS,,180.00,,,,,,,119.56,264.81,per diem,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Premier SAS,,10.43,,,,,,,7.58,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,39.28,,,,,,,5.60,288.61,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,3.22,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.19,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,3.22,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.60,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.91,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,2.82,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,5.05,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,outpatient,1,EA,4.52000,4.29000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.38,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.63,fee schedule,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,outpatient,,,54.50000,51.77000,The Alliance,Premier SAS,90,92.41,,,,,,,13.30,679.08,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,26.05,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,outpatient,1,EA,34.92000,33.17000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,33.87,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,45.98,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,36.78,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,outpatient,1,EA,151.68000,144.10000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,147.13,fee schedule,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,outpatient,1,EA,39.63000,37.65000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,38.44,fee schedule,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,outpatient,1,EA,3686.90000,3502.55000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,3576.29,fee schedule,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,87.78,,,,,,,12.32,645.08,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,7.66,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,4.67,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,outpatient,1,EA,12.32000,11.71000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,11.95,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,outpatient,1,EA,14.73000,13.99000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,14.29,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,outpatient,1,EA,11.06000,10.50000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,10.73,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,outpatient,1,EA,7.58000,7.20000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,7.35,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,9.20,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,4.66,fee schedule,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,21.46,fee schedule,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,outpatient,1,EA,19.34000,18.37000,The Alliance,Premier SAS,,13.31,,,,,,,9.67,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier SAS,,2.20,,,,,,,1.60,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,outpatient,1,EA,4.46000,4.24000,The Alliance,Premier SAS,,3.07,,,,,,,2.23,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier SAS,,3.08,,,,,,,2.23,4.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,9.20,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,outpatient,1,EA,9.14000,8.68000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,8.87,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,outpatient,1,EA,24.82000,23.58000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,24.08,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,outpatient,1,EA,28.19000,26.78000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,27.34,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,13.48,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,outpatient,1,EA,6.97000,6.62000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,6.76,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,outpatient,1,EA,7.41000,7.04000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,7.19,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,13.79,fee schedule,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,33.72,fee schedule,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier SAS,,630.21,,,,,,,314.95,888.52,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,18.39,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,outpatient,1,EA,31.44000,29.87000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,30.50,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,8.21,,,,,,,4.74,9.20,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,21.43,fee schedule,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,outpatient,1,EA,10.14000,9.64000,The Alliance,Premier SAS,,8.21,,,,,,,5.07,9.84,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,4.60,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,2.96,fee schedule,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,2.59,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,outpatient,1,EA,31.76000,30.17000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,30.81,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,30.65,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,30.04,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,outpatient,1,EA,16.61000,15.78000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,16.11,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,outpatient,1,EA,44.65000,42.42000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,43.31,fee schedule,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,outpatient,1,EA,31.28000,29.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,30.34,fee schedule,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,outpatient,1,EA,4.73000,4.50000,The Alliance,Premier SAS,,3.25,,,,,,,2.37,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,outpatient,1,EA,4.91000,4.66000,The Alliance,Premier SAS,,3.38,,,,,,,2.46,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,outpatient,1,EA,4.86000,4.62000,The Alliance,Premier SAS,,3.34,,,,,,,2.43,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,34.66,,,,,,,4.72,254.68,fee schedule,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,outpatient,1,EA,9.90000,9.41000,The Alliance,Premier SAS,,6.81,,,,,,,4.95,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Premier SAS,,29.35,,,,,,,21.33,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Premier SAS,,14.35,,,,,,,10.43,20.23,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier SAS,,149.98,,,,,,,119.90,5271.00,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,2.34,fee schedule,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,5.45,fee schedule,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,outpatient,120,mL,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,outpatient,120,mL,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Premier SAS,,125.63,,,,,,,24.91,129.48,fee schedule,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,outpatient,1,EA,38.10000,36.19000,The Alliance,Premier SAS,,26.21,,,,,,,19.05,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,3.39,,,,,,,2.46,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,outpatient,1,EA,6.39000,6.07000,The Alliance,Premier SAS,,4.40,,,,,,,3.19,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Premier SAS,,2.71,,,,,,,1.97,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,outpatient,100,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,outpatient,100,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,outpatient,100,EA,25.98000,24.68000,The Alliance,Premier SAS,,17.87,,,,,,,12.99,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,outpatient,,,2419.00000,2298.05000,The Alliance,Premier SAS,,1664.27,,,,,,,1330.45,5271.00,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,outpatient,1,mL,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.01,1.97,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,outpatient,1,EA,1.27000,1.20000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier SAS,,3.68,,,,,,,2.67,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Premier SAS,,3.50,,,,,,,2.54,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier SAS,,3.83,,,,,,,2.78,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier SAS,,7.47,,,,,,,5.43,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Premier SAS,,4.00,,,,,,,2.90,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,90.10,,,,,,,8.17,662.12,fee schedule,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,outpatient,,,252.00000,239.40000,The Alliance,Premier SAS,,173.27,,,,,,,26.72,1273.27,fee schedule,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,outpatient,,,35.20000,33.44000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,outpatient,2,EA,47.59000,45.21000,The Alliance,Premier SAS,,43.34,,,,,,,23.80,48.21,fee schedule,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,outpatient,2,EA,52.30000,49.68000,The Alliance,Premier SAS,,43.34,,,,,,,26.15,50.73,fee schedule,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,outpatient,,,167.30000,158.94000,The Alliance,Premier SAS,90,120.13,,,,,,,17.43,882.80,fee schedule,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Premier SAS,,606.13,,,,,,,314.95,854.57,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier SAS,TC,447.20,,,,,,,304.21,3547.16,fee schedule,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier SAS,,334.37,,,,,,,67.58,471.42,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,76.24,,,,,,,10.74,560.26,fee schedule,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,,145.86,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier SAS,,496.74,,,,,,,314.95,700.34,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,outpatient,2,EA,2573.64000,2444.96000,The Alliance,Premier SAS,,1770.66,,,,,,,835.80,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,outpatient,2,EA,3600.65000,3420.62000,The Alliance,Premier SAS,,2477.25,,,,,,,835.80,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,outpatient,2,EA,2626.01000,2494.71000,The Alliance,Premier SAS,,1806.69,,,,,,,835.80,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,outpatient,2,EA,3601.91000,3421.82000,The Alliance,Premier SAS,,2478.11,,,,,,,835.80,3493.85,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,,127.97,,,,,,,67.58,180.42,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,34.66,,,,,,,5.00,254.68,fee schedule,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,90,83.17,,,,,,,8.17,611.15,fee schedule,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,outpatient,1,EA,18.13000,17.22000,The Alliance,Premier SAS,,12.47,,,,,,,9.06,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Premier SAS,,8.21,,,,,,,5.97,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Premier SAS,,11.92,,,,,,,8.66,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier SAS,,5.88,,,,,,,4.27,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,outpatient,1,EA,17.40000,16.53000,The Alliance,Premier SAS,,11.97,,,,,,,8.70,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,outpatient,1,EA,12.33000,11.71000,The Alliance,Premier SAS,,8.48,,,,,,,6.17,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,outpatient,1,EA,20.14000,19.13000,The Alliance,Premier SAS,,13.86,,,,,,,10.07,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,outpatient,1,EA,3.17000,3.01000,The Alliance,Premier SAS,,2.18,,,,,,,1.58,3.07,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,outpatient,1,EA,6.62000,6.29000,The Alliance,Premier SAS,,4.55,,,,,,,3.31,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,outpatient,1,EA,3.56000,3.38000,The Alliance,Premier SAS,,2.45,,,,,,,1.78,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,outpatient,1,EA,16.31000,15.49000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,15.82,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,outpatient,1,EA,19.05000,18.10000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,18.48,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,18.39,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,17.47,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,21.82,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,8.58,fee schedule,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,17.78,fee schedule,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Premier SAS,,5.71,,,,,,,4.15,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,outpatient,1,EA,13.54000,12.87000,The Alliance,Premier SAS,,9.32,,,,,,,6.77,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier SAS,,4.48,,,,,,,3.25,6.31,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,outpatient,50,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,outpatient,50,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,outpatient,50,EA,1.85000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,outpatient,50,EA,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,outpatient,50,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,outpatient,50,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,outpatient,50,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,,62.38,,,,,,,9.81,458.40,fee schedule,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,36.97,,,,,,,5.75,271.65,fee schedule,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,55.45,,,,,,,7.87,407.44,fee schedule,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,32.34,,,,,,,4.60,237.65,fee schedule,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,,280.70,,,,,,,67.58,395.76,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,outpatient,1,mL,3.54000,3.36000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06045,3.43,fee schedule,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,outpatient,1,mL,104.95000,99.70000,The Alliance,Premier SAS,,72.21,,,,,,,52.48,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,outpatient,1,mL,94.45000,89.73000,The Alliance,Premier SAS,,64.98,,,,,,,47.23,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,outpatient,1,mL,86.63000,82.30000,The Alliance,Premier SAS,,59.60,,,,,,,43.31,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,outpatient,1,mL,73.73000,70.05000,The Alliance,Premier SAS,,50.73,,,,,,,36.87,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,outpatient,1,mL,48.60000,46.17000,The Alliance,Premier SAS,,33.44,,,,,,,24.30,47.14,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier SAS,,4.16,,,,,,,3.02,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Premier SAS,,4.16,,,,,,,3.02,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,154.78,,,,,,,24.09,1137.41,fee schedule,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier SAS,,3.71,,,,,,,0.04500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,3.71,,,,,,,0.03500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,3.71,,,,,,,0.04500,3.83,fee schedule,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,3.71,,,,,,,0.03500,3.83,fee schedule,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,outpatient,,,1316.00000,1250.20000,The Alliance,Premier SAS,,926.40,,,,,,,144.61,6807.60,fee schedule,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,outpatient,1,EA,4.32000,4.11000,The Alliance,Premier SAS,,2.97,,,,,,,2.16,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Premier SAS,,214.85,,,,,,,33.47,1578.85,fee schedule,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Premier SAS,,887.12,,,,,,,125.49,6518.98,fee schedule,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,outpatient,1,EA,6.49000,6.17000,The Alliance,Premier SAS,,4.47,,,,,,,3.25,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier SAS,,1.92,,,,,,,1.40,2.71,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,outpatient,,,2292.00000,2177.40000,The Alliance,Premier SAS,,1691.09,,,,,,,248.52,12426.88,fee schedule,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,outpatient,10,EA,9.91000,9.41000,The Alliance,Premier SAS,,6.82,,,,,,,4.96,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,outpatient,10,EA,10.62000,10.09000,The Alliance,Premier SAS,,7.31,,,,,,,5.31,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,outpatient,10,EA,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,outpatient,10,EA,4.17000,3.96000,The Alliance,Premier SAS,,2.87,,,,,,,2.08,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,outpatient,10,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,outpatient,10,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,outpatient,,,890.00000,845.50000,The Alliance,Premier SAS,,487.45,,,,,,,68.60,3582.03,fee schedule,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,outpatient,,,84.40000,80.18000,The Alliance,Premier SAS,90,143.23,,,,,,,10.23,1052.52,fee schedule,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,85.48,,,,,,,11.89,628.12,fee schedule,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,30.03,,,,,,,4.35,220.68,fee schedule,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,90,147.86,,,,,,,17.00,1086.52,fee schedule,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Premier SAS,,15.35,,,,,,,11.15,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Premier SAS,,2.40,,,,,,,1.75,3.39,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier SAS,,279.33,,,,,,,67.58,393.82,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier SAS,,12.67,,,,,,,9.21,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Premier SAS,,12.11,,,,,,,8.80,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Premier SAS,,3.57,,,,,,,2.60,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,outpatient,1,EA,15.74000,14.95000,The Alliance,Premier SAS,,10.83,,,,,,,7.87,15.27,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,outpatient,1,EA,15.49000,14.71000,The Alliance,Premier SAS,,10.66,,,,,,,7.75,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,outpatient,1,EA,52.90000,50.26000,The Alliance,Premier SAS,,36.40,,,,,,,26.45,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,outpatient,1,EA,36.26000,34.45000,The Alliance,Premier SAS,,24.95,,,,,,,1.63,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier SAS,,1.59,,,,,,,1.16,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,outpatient,1,EA,84.97000,80.72000,The Alliance,Premier SAS,,58.46,,,,,,,1.63,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,outpatient,1,EA,81.63000,77.55000,The Alliance,Premier SAS,,56.16,,,,,,,1.63,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,outpatient,1,EA,17.91000,17.01000,The Alliance,Premier SAS,,12.32,,,,,,,1.63,17.37,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier SAS,,244.89,,,,,,,34.43,1799.53,fee schedule,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,,5823.00,,,,,,,100.65,6003.00,case rate,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,outpatient,,,151.40000,143.83000,The Alliance,Premier SAS,90,198.68,,,,,,,28.73,1459.96,fee schedule,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,outpatient,1,mL,49.82000,47.33000,The Alliance,Premier SAS,,125.63,,,,,,,24.91,129.48,fee schedule,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06045,3.27,fee schedule,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier SAS,,15.01,,,,,,,10.91,21.17,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Premier SAS,,2.67,,,,,,,0.79000,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,outpatient,6,EA,2.33000,2.21000,The Alliance,Premier SAS,,2.67,,,,,,,1.17,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,outpatient,6,EA,1.58000,1.50000,The Alliance,Premier SAS,,2.67,,,,,,,0.79000,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,outpatient,6,EA,2.29000,2.18000,The Alliance,Premier SAS,,2.67,,,,,,,1.15,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,outpatient,6,EA,2.77000,2.63000,The Alliance,Premier SAS,,2.67,,,,,,,1.39,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,outpatient,6,EA,2.92000,2.77000,The Alliance,Premier SAS,,2.67,,,,,,,1.46,2.83,fee schedule,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,outpatient,1,EA,41.98000,39.89000,The Alliance,Premier SAS,,28.88,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,outpatient,1,EA,25.85000,24.56000,The Alliance,Premier SAS,,17.78,,,,,,,12.93,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,outpatient,1,EA,30.74000,29.20000,The Alliance,Premier SAS,,21.15,,,,,,,15.37,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,outpatient,1,EA,65.64000,62.35000,The Alliance,Premier SAS,,45.16,,,,,,,32.82,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,outpatient,1,EA,41.98000,39.88000,The Alliance,Premier SAS,,28.88,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,outpatient,1,EA,45.08000,42.83000,The Alliance,Premier SAS,,31.02,,,,,,,22.54,43.73,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,outpatient,1,EA,12.69000,12.05000,The Alliance,Premier SAS,,8.73,,,,,,,6.34,12.31,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,outpatient,15,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,outpatient,15,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,outpatient,15,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,outpatient,15,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,outpatient,15,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier SAS,,156.18,,,,,,,113.50,220.19,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,outpatient,10,EA,13.27000,12.61000,The Alliance,Premier SAS,,28.29,,,,,,,6.63,29.16,fee schedule,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,outpatient,10,EA,7.90000,7.50000,The Alliance,Premier SAS,,28.29,,,,,,,3.95,29.16,fee schedule,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,outpatient,10,EA,9.90000,9.41000,The Alliance,Premier SAS,,28.29,,,,,,,4.95,29.16,fee schedule,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier SAS,,85.48,,,,,,,12.00,628.12,fee schedule,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,outpatient,40,EA,6.86000,6.52000,The Alliance,Premier SAS,,4.72,,,,,,,3.43,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,outpatient,40,EA,8.24000,7.82000,The Alliance,Premier SAS,,5.67,,,,,,,4.12,7.99,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,outpatient,1,EA,83.73000,79.55000,The Alliance,Premier SAS,,57.61,,,,,,,41.87,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,outpatient,1,EA,52.59000,49.96000,The Alliance,Premier SAS,,36.18,,,,,,,26.30,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,outpatient,1,EA,83.82000,79.63000,The Alliance,Premier SAS,,57.67,,,,,,,41.91,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,outpatient,1,EA,207.99000,197.59000,The Alliance,Premier SAS,,143.10,,,,,,,104.00,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,outpatient,1,EA,60.92000,57.87000,The Alliance,Premier SAS,,41.91,,,,,,,30.46,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,outpatient,1,EA,41.91000,39.81000,The Alliance,Premier SAS,,28.83,,,,,,,20.95,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,outpatient,1,EA,25.98000,24.68000,The Alliance,Premier SAS,,17.87,,,,,,,12.99,25.20,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,outpatient,6,EA,2.25000,2.13000,The Alliance,Premier SAS,,2.67,,,,,,,1.12,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Premier SAS,,2.67,,,,,,,0.67500,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,outpatient,6,EA,2.50000,2.38000,The Alliance,Premier SAS,,2.67,,,,,,,1.25,2.76,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,outpatient,6,EA,1.35000,1.28000,The Alliance,Premier SAS,,2.67,,,,,,,0.67500,2.76,fee schedule,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,909.00,,,,,,,122.40,5271.00,case rate,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,outpatient,30,EA,0.49000,0.46000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,outpatient,30,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier SAS,,15.01,,,,,,,10.91,21.17,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,outpatient,1,EA,20.37000,19.35000,The Alliance,Premier SAS,,14.01,,,,,,,10.19,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier SAS,,101.65,,,,,,,14.39,746.94,fee schedule,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,outpatient,,,1930.00000,1833.50000,The Alliance,Premier SAS,90,1046.53,,,,,,,70.04,7690.40,fee schedule,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,outpatient,1,EA,1.63000,1.54000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,outpatient,1,EA,17.74000,16.85000,The Alliance,Premier SAS,,12.21,,,,,,,8.87,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,outpatient,1,EA,15.16000,14.40000,The Alliance,Premier SAS,,10.43,,,,,,,7.58,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier SAS,,10.55,,,,,,,7.67,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,outpatient,1,EA,14.19000,13.48000,The Alliance,Premier SAS,,9.76,,,,,,,7.09,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,outpatient,1,EA,16.25000,15.43000,The Alliance,Premier SAS,,11.18,,,,,,,8.12,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Premier SAS,,6.06,,,,,,,4.41,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier SAS,,2.85,,,,,,,2.07,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,outpatient,1,EA,11.76000,11.17000,The Alliance,Premier SAS,,8.09,,,,,,,5.88,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,outpatient,1,EA,29.36000,27.89000,The Alliance,Premier SAS,,20.20,,,,,,,14.68,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,outpatient,1,EA,22.06000,20.96000,The Alliance,Premier SAS,,15.18,,,,,,,11.03,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,outpatient,1,EA,5.49000,5.22000,The Alliance,Premier SAS,,3.78,,,,,,,2.75,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Premier SAS,,5.97,,,,,,,4.34,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,The Alliance,Premier SAS,,2.79,,,,,,,2.03,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.50,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,outpatient,1,mL,141.01000,133.96000,The Alliance,Premier SAS,,97.01,,,,,,,70.50,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,outpatient,1,mL,174.20000,165.49000,The Alliance,Premier SAS,,119.85,,,,,,,87.10,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,outpatient,1,mL,193.55000,183.87000,The Alliance,Premier SAS,,133.16,,,,,,,96.78,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,outpatient,1,mL,232.26000,220.65000,The Alliance,Premier SAS,,159.79,,,,,,,116.13,225.29,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,87.78,,,,,,,12.41,645.08,fee schedule,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,outpatient,42.5,EA,47.41000,45.04000,The Alliance,Premier SAS,,32.62,,,,,,,23.70,45.99,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,115.51,,,,,,,16.30,848.80,fee schedule,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier SAS,,233.33,,,,,,,145.50,1714.64,fee schedule,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,outpatient,,,6254.85000,5942.11000,The Alliance,Premier SAS,,2870.98,,,,,,,2870.98,6254.85,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,90.10,,,,,,,9.02,662.12,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier SAS,,3.12,,,,,,,0.48500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier SAS,,3.12,,,,,,,0.63500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,3.12,,,,,,,0.47500,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier SAS,,3.12,,,,,,,0.65000,4.75,fee schedule,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,3.12,,,,,,,0.63000,4.75,fee schedule,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,84.62,,,,,,,61.50,212.44,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,outpatient,,,1859.00000,1766.05000,The Alliance,Premier SAS,TC,1596.00,,,,,,,929.50,1820.00,per diem,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,outpatient,,,3545.00000,3367.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,3438.65,per diem,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,outpatient,1,EA,103.18000,98.02000,The Alliance,Premier SAS,,11.16,,,,,,,11.16,100.08,fee schedule,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,outpatient,1,EA,94.74000,90.00000,The Alliance,Premier SAS,,11.16,,,,,,,11.16,91.90,fee schedule,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,11.16,,,,,,,11.16,38.31,fee schedule,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,,60.14,,,,,,,10.56,441.94,fee schedule,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,249.50,,,,,,,37.50,1833.46,fee schedule,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,7417.50000,7046.62000,The Alliance,Premier SAS,,3404.63,,,,,,,3404.63,7417.50,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Premier SAS,,670.11,,,,,,,487.00,944.78,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,3.71,,,,,,,0.02500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,3.71,,,,,,,0.02500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,3.71,,,,,,,0.02000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier SAS,,3.71,,,,,,,0.03500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,3.71,,,,,,,0.05500,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier SAS,,3.71,,,,,,,0.03000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier SAS,,3.71,,,,,,,0.02000,3.83,fee schedule,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,3.71,,,,,,,0.20000,3.83,fee schedule,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,36.97,,,,,,,5.12,271.65,fee schedule,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,117.83,,,,,,,16.71,865.84,fee schedule,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,85.48,,,,,,,8.17,628.12,fee schedule,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,210.23,,,,,,,36.50,1544.85,fee schedule,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,outpatient,1,EA,276.04000,262.24000,The Alliance,Premier SAS,,44.86,,,,,,,44.86,267.76,fee schedule,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,outpatient,1,EA,253.43000,240.76000,The Alliance,Premier SAS,,44.86,,,,,,,44.86,245.83,fee schedule,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,outpatient,118,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,outpatient,118,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,outpatient,118,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,outpatient,118,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,87.78,,,,,,,13.82,645.08,fee schedule,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,495.50,1820.00,per diem,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier SAS,,2644.53,,,,,,,2644.53,5761.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,outpatient,,,2650.00000,2517.50000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,2570.50,per diem,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1070.00,2075.80,per diem,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Premier SAS,,4082.00,,,,,,,800.09,4686.00,case rate,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,outpatient,,,1950.00000,1852.50000,The Alliance,Premier SAS,TC,1596.00,,,,,,,975.00,1891.50,per diem,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,outpatient,,,29.20000,27.74000,The Alliance,Premier SAS,90,83.17,,,,,,,9.83,611.15,fee schedule,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier SAS,,67.00,,,,,,,9.46,492.33,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier SAS,,2.67,,,,,,,1.97,3.81,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,outpatient,1,mL,9.57000,9.10000,The Alliance,Premier SAS,,2.67,,,,,,,2.50,9.28,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,outpatient,1,mL,96.78000,91.94000,The Alliance,Premier SAS,,2.67,,,,,,,2.50,93.88,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,outpatient,1,mL,9.80000,9.31000,The Alliance,Premier SAS,,2.67,,,,,,,2.50,9.51,fee schedule,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Premier SAS,,2.67,,,,,,,1.67,3.24,fee schedule,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,92.41,,,,,,,12.95,679.08,fee schedule,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1020.00000,969.00000,The Alliance,Premier SAS,TC,1596.00,,,,,,,510.00,1820.00,per diem,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,,174.80,,,,,,,7.33,1284.54,fee schedule,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,outpatient,1,mL,9.11000,8.65000,The Alliance,Premier SAS,,6.27,,,,,,,4.55,8.84,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2234.88,per diem,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,outpatient,,,2144.00000,2036.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2079.68,per diem,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2294.05,per diem,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,57.75,,,,,,,8.06,424.40,fee schedule,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,46.20,,,,,,,6.51,339.51,fee schedule,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1081.00000,1026.95000,The Alliance,Premier SAS,TC,1596.00,,,,,,,540.50,1820.00,per diem,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,99.00,1820.00,per diem,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,120.13,,,,,,,8.17,882.80,fee schedule,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Premier SAS,TC,34.06,,,,,,,24.75,484.28,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,896.50,1820.00,per diem,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,732.50,1820.00,per diem,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2714.06,per diem,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,outpatient,120,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,306.02,1820.00,per diem,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,2522.00,per diem,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2292.11,per diem,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Premier SAS,,169.25,,,,,,,122.40,238.62,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,outpatient,,,2299.00000,2184.05000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2230.03,per diem,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Premier SAS,,383.22,,,,,,,278.50,540.29,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2245.55,per diem,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier SAS,,73.92,,,,,,,10.32,543.22,fee schedule,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier SAS,TC,1596.00,,,,,,,934.50,1964.22,per diem,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,935.50,1820.00,per diem,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,80.86,,,,,,,8.17,594.19,fee schedule,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,TC,1596.00,,,,,,,71.00,1820.00,per diem,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier SAS,TC,1596.00,,,,,,,911.00,1964.22,per diem,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1264.00,2452.16,per diem,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,,222.22,,,,,,,161.50,313.31,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier SAS,,157.55,,,,,,,60.36,222.13,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,623.00,1820.00,per diem,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,outpatient,,,2196.00000,2086.20000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1098.00,2130.12,per diem,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Premier SAS,,820.13,,,,,,,115.36,6026.72,fee schedule,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,outpatient,,,2621.00000,2489.95000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,2542.37,per diem,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2548.19,per diem,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,92.41,,,,,,,14.61,679.08,fee schedule,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,936.50,1820.00,per diem,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,,138.61,,,,,,,19.60,1018.59,fee schedule,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,,3844.00,,,,,,,658.35,4686.00,case rate,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2209.66,per diem,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,924.00,1820.00,per diem,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,outpatient,,,1776.00000,1687.20000,The Alliance,Premier SAS,TC,1596.00,,,,,,,837.93,1820.00,per diem,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2320.24,per diem,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,The Alliance,Premier SAS,TC,1596.00,,,,,,,935.50,1964.22,per diem,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,outpatient,,,2319.00000,2203.05000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2249.43,per diem,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1246.00000,1183.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,623.00,1820.00,per diem,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier SAS,,143.23,,,,,,,20.05,1052.52,fee schedule,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,,57.75,,,,,,,8.07,424.40,fee schedule,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier SAS,,48.52,,,,,,,7.36,356.54,fee schedule,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,3313.52,per diem,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,67.00,,,,,,,9.47,492.33,fee schedule,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,782.00,1820.00,per diem,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier SAS,,62.38,,,,,,,8.62,458.40,fee schedule,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,622.00,1820.00,per diem,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,145.55,,,,,,,20.32,1069.56,fee schedule,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier SAS,,57.75,,,,,,,8.08,424.40,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,outpatient,1,EA,1451.33000,1378.77000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,1407.79,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,outpatient,1,EA,958.30000,910.38000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,929.55,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,outpatient,1,EA,1897.17000,1802.32000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,1840.25,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,outpatient,1,EA,1750.45000,1662.93000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,1697.94,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,outpatient,1,EA,655.27000,622.51000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,635.61,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,outpatient,1,EA,932.40000,885.78000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,904.43,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,outpatient,1,EA,1707.46000,1622.08000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,1656.24,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,outpatient,1,EA,1750.53000,1663.00000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,1698.01,fee schedule,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,,57.75,,,,,,,8.09,424.40,fee schedule,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,73.92,,,,,,,10.32,543.22,fee schedule,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,76.24,,,,,,,10.80,560.26,fee schedule,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,outpatient,,,2404.00000,2283.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2331.88,per diem,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,90.10,,,,,,,12.52,662.12,fee schedule,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,outpatient,,,634.00000,602.30000,The Alliance,Premier SAS,TC,530.61,,,,,,,177.63,3899.16,fee schedule,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier SAS,,129.37,,,,,,,18.05,950.66,fee schedule,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,outpatient,1,mL,5.89000,5.60000,The Alliance,Premier SAS,,4.05,,,,,,,2.94,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Premier SAS,,4.11,,,,,,,2.98,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Premier SAS,,4.06,,,,,,,2.95,5.72,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1132.50,2197.05,per diem,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2515.21,per diem,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier SAS,,108.58,,,,,,,14.01,797.91,fee schedule,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,924.00,1820.00,per diem,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,outpatient,1,EA,725.69000,689.41000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,703.92,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,outpatient,1,EA,479.15000,455.19000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,464.78,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,outpatient,1,EA,948.59000,901.16000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,920.13,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,outpatient,1,EA,877.73000,833.84000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,851.40,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,outpatient,1,EA,466.20000,442.89000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,452.21,fee schedule,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,outpatient,1,EA,311.63000,296.05000,The Alliance,Premier SAS,,0.99262,,,,,,,0.62000,302.28,fee schedule,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1237.00000,1175.15000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,117.83,,,,,,,18.52,865.84,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,2.81,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,outpatient,1,mL,3.30000,3.14000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,3.20,fee schedule,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,3.07,fee schedule,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,outpatient,2,EA,69.77000,66.28000,The Alliance,Premier SAS,,48.00,,,,,,,34.88,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,outpatient,2,EA,37.30000,35.44000,The Alliance,Premier SAS,,25.66,,,,,,,18.65,36.18,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier SAS,,73.92,,,,,,,10.32,543.22,fee schedule,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1136.50,2204.81,per diem,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier SAS,,442.84,,,,,,,50.73,3254.22,fee schedule,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,TC,123.23,,,,,,,76.50,905.54,fee schedule,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,outpatient,1,EA,15.71000,14.92000,The Alliance,Premier SAS,,10.81,,,,,,,7.86,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,outpatient,1,EA,27.95000,26.56000,The Alliance,Premier SAS,,19.23,,,,,,,13.97,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,outpatient,1,EA,10.35000,9.84000,The Alliance,Premier SAS,,7.12,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Premier SAS,,7.12,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,outpatient,1,EA,6.83000,6.48000,The Alliance,Premier SAS,,4.70,,,,,,,3.42,6.63,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,outpatient,1,EA,5.53000,5.26000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,5.36,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,8.21,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,3.37,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,3.37,fee schedule,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,2.36,fee schedule,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier SAS,,55.45,,,,,,,7.71,407.44,fee schedule,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,,67.00,,,,,,,9.44,492.33,fee schedule,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,131.69,,,,,,,12.68,967.70,fee schedule,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,outpatient,1,EA,34.00000,32.30000,The Alliance,Premier SAS,,23.39,,,,,,,17.00,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier SAS,,8.33,,,,,,,6.05,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,outpatient,1,EA,14.74000,14.01000,The Alliance,Premier SAS,,10.14,,,,,,,7.37,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,outpatient,1,EA,14.75000,14.01000,The Alliance,Premier SAS,,10.15,,,,,,,7.38,14.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,outpatient,2,EA,53.31000,50.64000,The Alliance,Premier SAS,,36.68,,,,,,,26.66,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,outpatient,2,EA,18.68000,17.74000,The Alliance,Premier SAS,,12.85,,,,,,,9.34,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,outpatient,2,EA,229.42000,217.95000,The Alliance,Premier SAS,,157.84,,,,,,,114.71,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,outpatient,2,EA,18.88000,17.94000,The Alliance,Premier SAS,,12.99,,,,,,,9.44,18.31,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2548.19,per diem,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier SAS,,1.76,,,,,,,1.28,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,outpatient,1,EA,4.99000,4.75000,The Alliance,Premier SAS,,3.43,,,,,,,2.50,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier SAS,,2.33,,,,,,,1.69,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier SAS,,2.20,,,,,,,1.60,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Premier SAS,,14.52,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,outpatient,1,EA,10.45000,9.93000,The Alliance,Premier SAS,,7.19,,,,,,,5.22,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,outpatient,1,EA,9.53000,9.05000,The Alliance,Premier SAS,,6.56,,,,,,,4.76,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,outpatient,1,EA,37.86000,35.96000,The Alliance,Premier SAS,,26.05,,,,,,,18.93,36.72,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,outpatient,1,mL,4.01000,3.81000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,3.89,fee schedule,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2547.22,per diem,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,outpatient,,,2887.00000,2742.65000,The Alliance,Premier SAS,90,7425.07,,,,,,,608.00,54562.77,fee schedule,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1143.50,2218.39,per diem,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,,57.75,,,,,,,8.08,424.40,fee schedule,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,outpatient,,,3088.00000,2933.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1285.85,2995.36,per diem,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,TC,56.23,,,,,,,30.28,413.21,fee schedule,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1153.50,2237.79,per diem,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,94.72,,,,,,,8.42,696.05,fee schedule,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,0.3,EA,8010.90000,7610.35000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,7770.57,fee schedule,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,7770.57,fee schedule,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,,138.61,,,,,,,7.06,1018.59,fee schedule,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,39.28,,,,,,,5.57,288.61,fee schedule,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,outpatient,1,EA,6472.37000,6148.75000,The Alliance,Premier SAS,,4452.99,,,,,,,3236.18,6278.20,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Premier SAS,,111.81,,,,,,,69.84,292.61,fee schedule,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Premier SAS,,111.81,,,,,,,69.84,336.14,fee schedule,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,outpatient,1,EA,44.48000,42.25000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,43.15,fee schedule,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,37.66,fee schedule,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,60.06,,,,,,,8.41,441.37,fee schedule,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,outpatient,1,mL,3994.25000,3794.54000,The Alliance,Premier SAS,,46.81,,,,,,,29.24,3874.42,fee schedule,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,outpatient,1,mL,4108.08000,3902.67000,The Alliance,Premier SAS,,46.81,,,,,,,29.24,3984.84,fee schedule,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,7770.57,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,486.13,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,0.4,EA,2004.66000,1904.43000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1944.52,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1944.52,fee schedule,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,The Alliance,Premier SAS,,14.52,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,197.74,,,,,,,25.45,1453.11,fee schedule,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,67.00,,,,,,,3.40,492.33,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,outpatient,1,EA,259.00000,246.05000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,251.23,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,outpatient,1,EA,2460.50000,2337.48000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,2386.68,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,outpatient,1,EA,1554.00000,1476.30000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,1507.38,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,628.08,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,outpatient,1,EA,971.25000,922.69000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,942.11,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,outpatient,1,EA,3935.30000,3738.53000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,3817.24,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,outpatient,1,EA,1023.05000,971.90000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,992.36,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,502.46,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,outpatient,1,EA,512.82000,487.18000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,497.44,fee schedule,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,outpatient,1,EA,2432.29000,2310.68000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,2359.32,fee schedule,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,outpatient,0.5,EA,3560.40000,3382.38000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,outpatient,0.42,EA,1193.25000,1133.59000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1157.45,fee schedule,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,outpatient,1,mL,1193.24000,1133.58000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1157.44,fee schedule,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Premier SAS,,2.44,,,,,,,1.77,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,7770.57,fee schedule,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,outpatient,1,EA,12.93000,12.28000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,12.54,fee schedule,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier SAS,,2288.23,,,,,,,2288.23,4985.25,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,46.20,,,,,,,6.63,339.51,fee schedule,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,outpatient,500,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,outpatient,500,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,92.41,,,,,,,12.95,679.08,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,2.97,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,2.39,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,outpatient,1,EA,8.31000,7.90000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,8.06,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,2.64,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,2.38,fee schedule,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,outpatient,3.5,EA,206.04000,195.74000,The Alliance,Premier SAS,,141.76,,,,,,,103.02,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,outpatient,3.5,EA,244.89000,232.65000,The Alliance,Premier SAS,,168.48,,,,,,,122.44,237.54,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,outpatient,1,mL,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,outpatient,1,mL,4.29000,4.07000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,4.16,fee schedule,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.98940,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,outpatient,1,EA,79.95000,75.95000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,77.55,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,outpatient,1,EA,1061.15000,1008.09000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,1029.32,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,229.89,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,outpatient,1,EA,252.14000,239.53000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,244.58,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,76.63,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,outpatient,1,EA,1153.79000,1096.10000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,1119.18,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,outpatient,1,EA,323.78000,307.59000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,314.07,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,outpatient,1,EA,1153.82000,1096.13000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,1119.21,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,91.96,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,183.91,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,outpatient,1,EA,58.74000,55.81000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,56.98,fee schedule,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,outpatient,1,EA,1061.41000,1008.34000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,1029.57,fee schedule,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1944.52,fee schedule,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,outpatient,1,EA,40.14000,38.13000,The Alliance,Premier SAS,,27.62,,,,,,,20.07,38.94,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,outpatient,,,2468.00000,2344.60000,The Alliance,Premier SAS,,1697.98,,,,,,,1234.00,2393.96,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,outpatient,5,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.57230,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,outpatient,5,EA,0.66000,0.62000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.64020,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,outpatient,5,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.69840,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,outpatient,5,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.28130,fee schedule,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,1.19,fee schedule,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,0.3,EA,3560.40000,3382.38000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,3453.59,fee schedule,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,3453.59,fee schedule,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,outpatient,1,mL,4321.88000,4105.78000,The Alliance,Premier SAS,,46.81,,,,,,,29.24,4192.22,fee schedule,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Premier SAS,,449.77,,,,,,,37.27,3305.11,fee schedule,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier SAS,,157.09,,,,,,,22.23,1154.38,fee schedule,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,outpatient,1,EA,1265.09000,1201.83000,The Alliance,Premier SAS,,6.98,,,,,,,4.36,1227.14,fee schedule,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Premier SAS,,154.17,,,,,,,112.04,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,outpatient,1,EA,196.46000,186.63000,The Alliance,Premier SAS,,135.16,,,,,,,98.23,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Premier SAS,,176.10,,,,,,,127.98,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Premier SAS,,152.19,,,,,,,110.60,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,outpatient,1,EA,280.10000,266.10000,The Alliance,Premier SAS,,192.71,,,,,,,140.05,271.70,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,outpatient,2,EA,20.54000,19.51000,The Alliance,Premier SAS,,14.13,,,,,,,10.27,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,outpatient,2,EA,66.36000,63.04000,The Alliance,Premier SAS,,45.66,,,,,,,33.18,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,outpatient,2,EA,11.38000,10.81000,The Alliance,Premier SAS,,7.83,,,,,,,5.69,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,outpatient,2,EA,56.25000,53.44000,The Alliance,Premier SAS,,38.70,,,,,,,28.12,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Premier SAS,,16.09,,,,,,,11.69,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,outpatient,2,EA,50.56000,48.03000,The Alliance,Premier SAS,,34.79,,,,,,,25.28,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,outpatient,2,EA,30.16000,28.65000,The Alliance,Premier SAS,,20.75,,,,,,,15.08,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,outpatient,2,EA,8.30000,7.88000,The Alliance,Premier SAS,,5.71,,,,,,,4.15,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,outpatient,2,EA,5.53000,5.25000,The Alliance,Premier SAS,,3.80,,,,,,,2.77,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,outpatient,2,EA,26.61000,25.28000,The Alliance,Premier SAS,,18.31,,,,,,,13.30,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,14.22,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,outpatient,2,EA,8.53000,8.11000,The Alliance,Premier SAS,,5.87,,,,,,,4.26,8.27,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,outpatient,,,293.20000,278.54000,The Alliance,Premier SAS,90,180.20,,,,,,,26.11,1324.17,fee schedule,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,outpatient,3.5,EA,15.03000,14.28000,The Alliance,Premier SAS,,10.34,,,,,,,7.51,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,outpatient,3.5,EA,14.35000,13.63000,The Alliance,Premier SAS,,9.87,,,,,,,7.17,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,outpatient,3.5,EA,16.25000,15.44000,The Alliance,Premier SAS,,11.18,,,,,,,8.12,15.76,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,outpatient,1,mL,4.52000,4.29000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,4.38,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,outpatient,1,EA,4.51000,4.29000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,4.37,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,outpatient,1,EA,13.90000,13.21000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,13.48,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,22.99,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,5.36,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,outpatient,1,EA,16.56000,15.73000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,16.06,fee schedule,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,outpatient,1,EA,18.26000,17.35000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,17.71,fee schedule,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,outpatient,1,EA,3.30000,3.14000,The Alliance,Premier SAS,,2.27,,,,,,,1.65,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier SAS,,651.72,,,,,,,50.73,4789.16,fee schedule,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,outpatient,,,503.00000,477.85000,The Alliance,Premier SAS,,346.06,,,,,,,251.50,487.91,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,3.44,,,,,,,2.50,4.85,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,outpatient,1,EA,1328.67000,1262.24000,The Alliance,Premier SAS,,7954.70,,,,,,,664.34,8365.47,fee schedule,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,outpatient,1,EA,9519.93000,9043.93000,The Alliance,Premier SAS,,7954.70,,,,,,,4759.97,9234.33,fee schedule,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,outpatient,2.5,EA,48.01000,45.61000,The Alliance,Premier SAS,,33.03,,,,,,,24.00,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,outpatient,2.5,EA,13.27000,12.61000,The Alliance,Premier SAS,,9.13,,,,,,,6.63,12.87,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,outpatient,1,mL,105.09000,99.83000,The Alliance,Premier SAS,,72.30,,,,,,,52.55,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,outpatient,1,mL,47.94000,45.55000,The Alliance,Premier SAS,,32.98,,,,,,,23.97,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,outpatient,1,mL,63.92000,60.72000,The Alliance,Premier SAS,,43.98,,,,,,,31.96,62.00,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier SAS,TC,357.07,,,,,,,259.50,503.43,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,7770.57,fee schedule,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,outpatient,1,mL,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,outpatient,1,mL,0.75000,0.72000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,outpatient,1,mL,2.59000,2.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,outpatient,,,293.80000,279.11000,The Alliance,Premier SAS,,202.13,,,,,,,146.90,284.99,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,outpatient,1,EA,7.66000,7.28000,The Alliance,Premier SAS,,5.27,,,,,,,3.83,7.43,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,outpatient,1,EA,0.18000,0.18000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,outpatient,2,EA,53.18000,50.53000,The Alliance,Premier SAS,,9.88,,,,,,,8.97,51.58,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,outpatient,2,EA,38.88000,36.94000,The Alliance,Premier SAS,,9.88,,,,,,,8.97,37.71,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,outpatient,2,EA,38.89000,36.95000,The Alliance,Premier SAS,,9.88,,,,,,,8.97,37.72,fee schedule,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,outpatient,2,EA,38.55000,36.62000,The Alliance,Premier SAS,,9.88,,,,,,,8.97,37.39,fee schedule,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,outpatient,1,mL,124.51000,118.28000,The Alliance,Premier SAS,,85.66,,,,,,,62.26,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,outpatient,1,mL,77.82000,73.93000,The Alliance,Premier SAS,,53.54,,,,,,,38.91,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,outpatient,1,mL,124.50000,118.28000,The Alliance,Premier SAS,,85.66,,,,,,,62.25,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,outpatient,1,mL,113.46000,107.79000,The Alliance,Premier SAS,,78.06,,,,,,,56.73,110.06,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,outpatient,1,EA,8.02000,7.62000,The Alliance,Premier SAS,,5.52,,,,,,,4.01,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,outpatient,1,EA,8.74000,8.30000,The Alliance,Premier SAS,,6.01,,,,,,,4.37,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,outpatient,1,EA,7.94000,7.55000,The Alliance,Premier SAS,,5.46,,,,,,,3.97,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Premier SAS,,7.20,,,,,,,5.23,10.15,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,outpatient,2,EA,8.69000,8.26000,The Alliance,Premier SAS,,6.40,,,,,,,4.34,8.43,fee schedule,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,outpatient,2,EA,9.45000,8.98000,The Alliance,Premier SAS,,6.40,,,,,,,4.72,9.17,fee schedule,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,outpatient,2,EA,133.60000,126.92000,The Alliance,Premier SAS,,6.40,,,,,,,6.40,129.59,fee schedule,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,outpatient,1,EA,5.43000,5.16000,The Alliance,Premier SAS,,3.74,,,,,,,2.71,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Premier SAS,,3.85,,,,,,,2.79,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,outpatient,1,EA,6.56000,6.23000,The Alliance,Premier SAS,,4.51,,,,,,,3.28,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier SAS,,3.18,,,,,,,2.31,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,outpatient,1,GM,0.55000,0.53000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,outpatient,1,GM,0.56000,0.54000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,outpatient,1,GM,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,outpatient,1,EA,36.06000,34.26000,The Alliance,Premier SAS,,24.81,,,,,,,18.03,34.98,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Premier SAS,,467.51,,,,,,,23.25,3435.48,fee schedule,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,,94.72,,,,,,,13.28,696.05,fee schedule,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,outpatient,,,2211.00000,2100.45000,The Alliance,Premier SAS,,1521.17,,,,,,,1105.50,2144.67,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Premier SAS,,2.57,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier SAS,,3.15,,,,,,,2.29,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,outpatient,1,mL,137.78000,130.89000,The Alliance,Premier SAS,,94.79,,,,,,,68.89,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,outpatient,1,mL,113.36000,107.69000,The Alliance,Premier SAS,,77.99,,,,,,,56.68,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,outpatient,1,mL,110.52000,105.00000,The Alliance,Premier SAS,,76.04,,,,,,,55.26,107.20,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier SAS,,2.97,,,,,,,2.16,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Premier SAS,,2.01,,,,,,,1.46,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier SAS,,3.27,,,,,,,2.38,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier SAS,,2.88,,,,,,,2.10,4.06,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,outpatient,1,EA,2.47000,2.35000,The Alliance,Premier SAS,,1.70,,,,,,,1.24,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Premier SAS,,2.57,,,,,,,1.87,3.63,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Premier SAS,,6.30,,,,,,,4.58,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Premier SAS,,6.25,,,,,,,4.54,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,outpatient,1,EA,12.30000,11.69000,The Alliance,Premier SAS,,8.46,,,,,,,6.15,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Premier SAS,,6.87,,,,,,,5.00,9.69,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier SAS,,6.12,,,,,,,6.12,36.78,fee schedule,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,outpatient,1,EA,51.86000,49.26000,The Alliance,Premier SAS,,6.12,,,,,,,6.12,50.30,fee schedule,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,6.12,,,,,,,6.12,30.65,fee schedule,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,outpatient,50,EA,43.92000,41.73000,The Alliance,Premier SAS,,1189.38,,,,,,,21.96,1225.79,fee schedule,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,outpatient,120,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,outpatient,120,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.46480,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,outpatient,25,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,outpatient,25,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,outpatient,25,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,outpatient,25,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,outpatient,25,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,outpatient,25,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,outpatient,25,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,outpatient,25,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,outpatient,25,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,outpatient,,,4574.00000,4345.30000,The Alliance,Premier SAS,,3146.91,,,,,,,970.83,4436.78,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,outpatient,10,EA,23.95000,22.76000,The Alliance,Premier SAS,,16.48,,,,,,,11.97,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,outpatient,10,EA,10.74000,10.20000,The Alliance,Premier SAS,,7.39,,,,,,,5.37,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,outpatient,10,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,outpatient,10,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,outpatient,1,EA,1357.11000,1289.25000,The Alliance,Premier SAS,,933.69,,,,,,,678.55,1316.40,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,outpatient,10,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.46480,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,outpatient,10,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,outpatient,10,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,outpatient,5,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,outpatient,5,EA,2.16000,2.05000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,outpatient,5,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,outpatient,5,EA,1.77000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,outpatient,5,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,5.33,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,outpatient,1,EA,3.70000,3.52000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,3.59,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier SAS,,1.44,,,,,,,0.88000,1.71,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,outpatient,1,EA,9.51000,9.04000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,9.22,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,2.51,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,4.91,fee schedule,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,7.97,fee schedule,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier SAS,,1.34,,,,,,,0.97500,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,The Alliance,Premier SAS,,1.34,,,,,,,0.97500,1.89,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,outpatient,1,EA,48.51000,46.08000,The Alliance,Premier SAS,,33.37,,,,,,,24.25,47.05,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,1.06,,,,,,,0.09000,1.18,fee schedule,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,outpatient,1,mL,0.17000,0.17000,The Alliance,Premier SAS,,1.06,,,,,,,0.08500,1.18,fee schedule,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,outpatient,1,EA,20.00000,19.00000,The Alliance,Premier SAS,,13.76,,,,,,,10.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier SAS,,13.77,,,,,,,10.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,outpatient,1,EA,19.92000,18.93000,The Alliance,Premier SAS,,13.70,,,,,,,9.96,19.32,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Premier SAS,,119.33,,,,,,,47.59,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Premier SAS,,238.65,,,,,,,47.59,336.47,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Premier SAS,,4.52,,,,,,,3.29,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,outpatient,1,EA,2.98000,2.84000,The Alliance,Premier SAS,,2.05,,,,,,,1.49,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier SAS,,3.24,,,,,,,2.35,4.57,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,outpatient,1,mL,301.66000,286.57000,The Alliance,Premier SAS,,111.81,,,,,,,69.84,292.61,fee schedule,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,outpatient,1,mL,346.54000,329.21000,The Alliance,Premier SAS,,111.81,,,,,,,69.84,336.14,fee schedule,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier SAS,TC,532.00,,,,,,,120.00,584.87,fee schedule,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier SAS,TC,819.41,,,,,,,595.50,1155.27,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier SAS,,22.59,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,outpatient,1,EA,9.92000,9.43000,The Alliance,Premier SAS,,6.82,,,,,,,4.96,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,outpatient,1,EA,17.26000,16.40000,The Alliance,Premier SAS,,11.87,,,,,,,8.63,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Premier SAS,,6.80,,,,,,,4.94,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier SAS,,14.87,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier SAS,,9.06,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,outpatient,10,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,outpatient,1,EA,13.23000,12.57000,The Alliance,Premier SAS,,9.10,,,,,,,6.62,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Premier SAS,TC,1257.66,,,,,,,914.00,1773.16,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier SAS,,22.59,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier SAS,,11.45,,,,,,,8.32,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier SAS,,12.12,,,,,,,8.81,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier SAS,,14.87,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier SAS,,9.06,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier SAS,,12.12,,,,,,,8.81,17.09,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,,97.03,,,,,,,13.74,713.01,fee schedule,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,outpatient,1,mL,118.72000,112.79000,The Alliance,Premier SAS,,81.68,,,,,,,59.36,115.16,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,outpatient,3,EA,92.78000,88.14000,The Alliance,Premier SAS,,63.83,,,,,,,46.39,99.28,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,outpatient,3,EA,178.30000,169.38000,The Alliance,Premier SAS,,122.67,,,,,,,89.15,172.95,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,478.13000,454.22000,The Alliance,Premier SAS,,328.95,,,,,,,239.06,463.79,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,108.58,,,,,,,17.14,797.91,fee schedule,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,909.00,,,,,,,41.25,3163.00,case rate,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,108.58,,,,,,,8.17,797.91,fee schedule,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,outpatient,1,EA,18.61000,17.68000,The Alliance,Premier SAS,,12.80,,,,,,,9.30,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,outpatient,1,EA,7.97000,7.57000,The Alliance,Premier SAS,,5.48,,,,,,,3.98,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier SAS,,4.48,,,,,,,3.25,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,outpatient,1,EA,10.30000,9.79000,The Alliance,Premier SAS,,7.09,,,,,,,5.15,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,outpatient,1,EA,6.91000,6.57000,The Alliance,Premier SAS,,4.75,,,,,,,3.46,6.70,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier SAS,TC,186.45,,,,,,,135.50,262.87,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,outpatient,1,EA,34.68000,32.94000,The Alliance,Premier SAS,,23.86,,,,,,,17.34,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,outpatient,1,EA,42.03000,39.93000,The Alliance,Premier SAS,,28.92,,,,,,,21.02,40.77,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,outpatient,1,EA,2.90000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,outpatient,1,EA,9.90000,9.40000,The Alliance,Premier SAS,,6.81,,,,,,,4.95,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,outpatient,1,EA,3.55000,3.37000,The Alliance,Premier SAS,,2.44,,,,,,,1.77,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,outpatient,1,EA,6.90000,6.56000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier SAS,,8.33,,,,,,,6.05,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,outpatient,1,EA,7.51000,7.13000,The Alliance,Premier SAS,,5.17,,,,,,,3.75,7.28,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,outpatient,,,1034.00000,982.30000,The Alliance,Premier SAS,TC,711.39,,,,,,,517.00,1002.98,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,outpatient,1,EA,22.50000,21.37000,The Alliance,Premier SAS,,15.48,,,,,,,11.25,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Premier SAS,,3.49,,,,,,,2.54,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier SAS,,3.16,,,,,,,2.30,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,outpatient,1,EA,4.15000,3.95000,The Alliance,Premier SAS,,2.86,,,,,,,2.08,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier SAS,,3.84,,,,,,,2.79,5.41,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,outpatient,,,2031.00000,1929.45000,The Alliance,Premier SAS,TC,1397.33,,,,,,,1015.50,1970.07,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,outpatient,1,EA,107.57000,102.19000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,104.34,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,outpatient,1,EA,29.74000,28.25000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,28.85,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,38.31,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,outpatient,1,EA,70.42000,66.90000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,68.31,fee schedule,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,39.69,fee schedule,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Premier SAS,TC,2928.13,,,,,,,2128.00,4128.32,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,outpatient,1,EA,20.26000,19.25000,The Alliance,Premier SAS,,13.94,,,,,,,10.13,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Premier SAS,,2.07,,,,,,,1.50,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,outpatient,,,1568.00000,1489.60000,The Alliance,Premier SAS,TC,1078.78,,,,,,,784.00,1520.96,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier SAS,TC,152.96,,,,,,,114.83,1213.27,fee schedule,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,39.22,,,,,,,31.35,5271.00,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,outpatient,1,EA,5.68000,5.40000,The Alliance,Premier SAS,,3.91,,,,,,,2.84,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier SAS,,3.68,,,,,,,2.67,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,The Alliance,Premier SAS,,1.94,,,,,,,1.41,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Premier SAS,,2.30,,,,,,,1.67,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,outpatient,1,EA,2.65000,2.51000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Premier SAS,,9.38,,,,,,,6.82,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Premier SAS,,15.80,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Premier SAS,,3.12,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,outpatient,1,EA,2.59000,2.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,The Alliance,Premier SAS,,22.59,,,,,,,16.42,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,outpatient,1,EA,16.31000,15.50000,The Alliance,Premier SAS,,11.22,,,,,,,8.15,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,outpatient,1,EA,14.62000,13.88000,The Alliance,Premier SAS,,10.06,,,,,,,7.31,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Premier SAS,,11.68,,,,,,,8.48,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,The Alliance,Premier SAS,,14.87,,,,,,,10.81,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,The Alliance,Premier SAS,,9.06,,,,,,,6.58,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,The Alliance,Premier SAS,,11.68,,,,,,,8.48,16.46,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,The Alliance,Premier SAS,TC,877.89,,,,,,,638.00,1237.72,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1828.00000,1736.60000,The Alliance,Premier SAS,TC,1257.66,,,,,,,914.00,1773.16,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier SAS,,284.14,,,,,,,33.63,400.61,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,outpatient,1,EA,10.60000,10.07000,The Alliance,Premier SAS,,7.29,,,,,,,5.30,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier SAS,,6.89,,,,,,,5.01,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier SAS,,3.31,,,,,,,2.40,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,outpatient,1,EA,4.08000,3.88000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier SAS,,4.27,,,,,,,3.10,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier SAS,,3.20,,,,,,,2.33,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier SAS,,4.25,,,,,,,3.09,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Premier SAS,,332.99,,,,,,,242.00,572.69,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier SAS,,129.37,,,,,,,18.14,950.66,fee schedule,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,The Alliance,Premier SAS,TC,1256.98,,,,,,,913.50,1772.19,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,outpatient,,,455.00000,432.25000,The Alliance,Premier SAS,TC,267.66,,,,,,,201.46,2123.08,fee schedule,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,The Alliance,Premier SAS,TC,532.00,,,,,,,247.28,568.42,fee schedule,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier SAS,,187.13,,,,,,,85.50,1375.13,fee schedule,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier SAS,TC,1260.42,,,,,,,916.00,1777.04,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,outpatient,1,mL,209.51000,199.03000,The Alliance,Premier SAS,,174.96,,,,,,,104.75,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,outpatient,1,mL,188.56000,179.13000,The Alliance,Premier SAS,,174.96,,,,,,,94.28,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Premier SAS,,174.96,,,,,,,109.28,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier SAS,,174.96,,,,,,,71.10,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,outpatient,1,mL,306.20000,290.89000,The Alliance,Premier SAS,,174.96,,,,,,,109.28,297.01,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,outpatient,1,mL,323.48000,307.31000,The Alliance,Premier SAS,,174.96,,,,,,,109.28,313.78,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,outpatient,1,mL,214.34000,203.63000,The Alliance,Premier SAS,,174.96,,,,,,,107.17,249.68,fee schedule,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier SAS,,92.41,,,,,,,13.12,679.08,fee schedule,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,outpatient,,,742.00000,704.90000,The Alliance,Premier SAS,,933.00,,,,,,,262.92,1172.00,case rate,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,outpatient,,,1496.00000,1421.20000,The Alliance,Premier SAS,TC,1029.25,,,,,,,748.00,1451.12,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,The Alliance,Premier SAS,TC,2293.10,,,,,,,1666.50,3233.01,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,108.58,,,,,,,15.29,797.91,fee schedule,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,TC,180.38,,,,,,,135.13,1430.78,fee schedule,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,outpatient,,,2546.00000,2418.70000,The Alliance,Premier SAS,TC,1751.65,,,,,,,1273.00,2469.62,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,outpatient,,,2109.00000,2003.55000,The Alliance,Premier SAS,,2920.00,,,,,,,582.16,3515.00,case rate,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,94.72,,,,,,,8.17,696.05,fee schedule,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,outpatient,,,2224.00000,2112.80000,The Alliance,Premier SAS,TC,2003.05,,,,,,,1112.00,14719.32,fee schedule,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier SAS,TC,205.32,,,,,,,151.73,1628.59,fee schedule,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier SAS,TC,844.86,,,,,,,614.00,1191.16,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Premier SAS,,3.02,,,,,,,2.19,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Premier SAS,,7.55,,,,,,,5.49,10.64,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,outpatient,1,EA,5030.77000,4779.23000,The Alliance,Premier SAS,,12.62,,,,,,,7.88,4879.85,fee schedule,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,94.72,,,,,,,8.17,696.05,fee schedule,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Premier SAS,,374.27,,,,,,,272.00,572.69,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Premier SAS,,2920.00,,,,,,,404.33,3515.00,case rate,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,outpatient,,,2660.00000,2527.00000,The Alliance,Premier SAS,,2076.90,,,,,,,264.01,15261.97,fee schedule,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier SAS,,2.30,,,,,,,1.68,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,outpatient,1,EA,6.16000,5.85000,The Alliance,Premier SAS,,4.24,,,,,,,3.08,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,outpatient,1,EA,150.45000,142.92000,The Alliance,Premier SAS,,103.51,,,,,,,75.22,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,The Alliance,Premier SAS,,15.80,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,outpatient,1,EA,25.25000,23.99000,The Alliance,Premier SAS,,17.37,,,,,,,12.62,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Premier SAS,,2.96,,,,,,,2.15,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,The Alliance,Premier SAS,,3.12,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Premier SAS,,2.91,,,,,,,2.12,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,outpatient,1,EA,3.30000,3.13000,The Alliance,Premier SAS,,2.27,,,,,,,1.65,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Premier SAS,,2.66,,,,,,,1.94,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier SAS,,10.25,,,,,,,7.45,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,outpatient,1,mL,1.25000,1.18000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier SAS,,108.91,,,,,,,79.15,153.55,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,outpatient,1,EA,79.03000,75.08000,The Alliance,Premier SAS,,54.37,,,,,,,39.52,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,outpatient,1,EA,89.66000,85.18000,The Alliance,Premier SAS,,61.69,,,,,,,44.83,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier SAS,,32.61,,,,,,,23.70,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,outpatient,1,EA,115.04000,109.28000,The Alliance,Premier SAS,,79.15,,,,,,,57.52,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,outpatient,1,EA,62.15000,59.05000,The Alliance,Premier SAS,,42.76,,,,,,,31.07,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Premier SAS,,95.62,,,,,,,69.49,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Premier SAS,,76.09,,,,,,,55.30,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,outpatient,1,EA,91.77000,87.18000,The Alliance,Premier SAS,,63.14,,,,,,,45.88,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Premier SAS,,33.48,,,,,,,24.33,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,outpatient,1,EA,32.58000,30.95000,The Alliance,Premier SAS,,22.42,,,,,,,16.29,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,outpatient,1,EA,24.62000,23.39000,The Alliance,Premier SAS,,16.94,,,,,,,12.31,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,outpatient,1,EA,32.90000,31.26000,The Alliance,Premier SAS,,22.64,,,,,,,16.45,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,outpatient,1,EA,35.20000,33.44000,The Alliance,Premier SAS,,24.22,,,,,,,17.60,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,outpatient,1,EA,59.44000,56.47000,The Alliance,Premier SAS,,40.89,,,,,,,29.72,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Premier SAS,,60.42,,,,,,,43.91,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier SAS,TC,211.22,,,,,,,153.50,297.79,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,outpatient,1,EA,6707.63000,6372.25000,The Alliance,Premier SAS,,12.62,,,,,,,7.88,6506.40,fee schedule,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,outpatient,,,188.00000,178.60000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,94.72,,,,,,,8.17,696.05,fee schedule,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,outpatient,2,EA,11.29000,10.72000,The Alliance,Premier SAS,,7.77,,,,,,,5.64,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Premier SAS,,3.16,,,,,,,2.30,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,outpatient,2,EA,14.98000,14.23000,The Alliance,Premier SAS,,10.31,,,,,,,7.49,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Premier SAS,,6.74,,,,,,,4.90,9.51,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier SAS,TC,1561.07,,,,,,,1134.50,2200.93,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,outpatient,20,mL,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,outpatient,20,mL,2.86000,2.71000,The Alliance,Premier SAS,,1.97,,,,,,,1.43,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,outpatient,5,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Premier SAS,,499.00,,,,,,,150.37,585.00,case rate,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier SAS,,560.72,,,,,,,407.50,790.55,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,outpatient,1,EA,26.39000,25.07000,The Alliance,Premier SAS,,18.16,,,,,,,13.20,25.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,499.00,,,,,,,83.61,585.00,case rate,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,267.29,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,outpatient,1,EA,511.80000,486.21000,The Alliance,Premier SAS,,352.12,,,,,,,1.13,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,outpatient,1,EA,260.67000,247.63000,The Alliance,Premier SAS,,179.34,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,outpatient,1,EA,788.15000,748.74000,The Alliance,Premier SAS,,542.25,,,,,,,1.13,764.51,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,The Alliance,Premier SAS,TC,2772.64,,,,,,,2015.00,3909.10,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,outpatient,1,EA,59.06000,56.11000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,57.29,fee schedule,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,outpatient,1,EA,51.19000,48.63000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,49.65,fee schedule,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,outpatient,1,EA,74.01000,70.31000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,71.79,fee schedule,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier SAS,,2.55,,,,,,,2.50,7.35,fee schedule,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,outpatient,1,mL,12.05000,11.44000,The Alliance,Premier SAS,,2.55,,,,,,,2.50,11.69,fee schedule,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,outpatient,1,EA,8.14000,7.74000,The Alliance,Premier SAS,,5.60,,,,,,,4.07,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,outpatient,1,EA,3.84000,3.64000,The Alliance,Premier SAS,,2.64,,,,,,,1.92,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier SAS,,50.83,,,,,,,7.01,373.51,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,outpatient,1,EA,142.64000,135.51000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,138.36,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,outpatient,1,EA,146.56000,139.23000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,142.16,fee schedule,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,outpatient,1,EA,148.01000,140.61000,The Alliance,Premier SAS,,25.94,,,,,,,24.92,143.57,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier SAS,,3.59,,,,,,,2.61,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Premier SAS,,20.14,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,The Alliance,Premier SAS,,20.14,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,outpatient,1,EA,19.85000,18.86000,The Alliance,Premier SAS,,13.66,,,,,,,9.93,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,outpatient,1,EA,26.70000,25.37000,The Alliance,Premier SAS,,18.37,,,,,,,13.35,25.90,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,outpatient,1,mL,2.07000,1.96000,The Alliance,Premier SAS,,4.35,,,,,,,1.03,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,4.35,,,,,,,2.21,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,outpatient,1,mL,4.49000,4.27000,The Alliance,Premier SAS,,4.35,,,,,,,2.25,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,4.35,,,,,,,0.47500,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,outpatient,1,mL,4.35000,4.13000,The Alliance,Premier SAS,,4.35,,,,,,,2.17,5.23,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier SAS,,4.35,,,,,,,2.10,5.23,fee schedule,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,outpatient,10,EA,3.25000,3.08000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,outpatient,1,EA,121.79000,115.70000,The Alliance,Premier SAS,,2.55,,,,,,,2.50,118.14,fee schedule,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,outpatient,1,EA,36.03000,34.23000,The Alliance,Premier SAS,,24.79,,,,,,,18.02,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,outpatient,1,EA,27.49000,26.11000,The Alliance,Premier SAS,,18.91,,,,,,,13.74,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,outpatient,1,EA,10.97000,10.42000,The Alliance,Premier SAS,,7.55,,,,,,,5.49,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier SAS,,6.74,,,,,,,4.90,9.51,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,,68.11,,,,,,,49.50,96.03,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,71.62,,,,,,,8.17,526.26,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,outpatient,10,EA,3.32000,3.15000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,3.22,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,outpatient,10,EA,3.84000,3.65000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,3.72,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,1.53,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,outpatient,10,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,1.35,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,outpatient,10,EA,4.98000,4.73000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,4.83,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,outpatient,10,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43000,0.83420,fee schedule,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,outpatient,10,EA,2.21000,2.10000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,2.14,fee schedule,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,outpatient,1,mL,1825.95000,1734.65000,The Alliance,Premier SAS,,167.43,,,,,,,104.58,1771.17,fee schedule,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Premier SAS,,17.15,,,,,,,12.46,24.18,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,134.00,,,,,,,18.79,984.66,fee schedule,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,,198.68,,,,,,,27.94,1459.96,fee schedule,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,outpatient,20,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier SAS,,14.44,,,,,,,5.00,15.24,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,outpatient,1,EA,333.23000,316.57000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,323.23,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,outpatient,1,EA,349.86000,332.36000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,339.36,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,122.61,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,outpatient,1,EA,274.88000,261.14000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,266.63,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,outpatient,1,EA,303.21000,288.05000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,294.11,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,outpatient,1,EA,359.49000,341.52000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,348.71,fee schedule,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier SAS,,14.44,,,,,,,14.23,183.91,fee schedule,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,outpatient,1,EA,22.90000,21.75000,The Alliance,Premier SAS,,15.76,,,,,,,11.45,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,outpatient,1,EA,25.83000,24.54000,The Alliance,Premier SAS,,17.77,,,,,,,12.91,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,outpatient,1,EA,31.38000,29.81000,The Alliance,Premier SAS,,21.59,,,,,,,15.69,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,outpatient,1,EA,47.49000,45.11000,The Alliance,Premier SAS,,32.67,,,,,,,23.75,46.07,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,outpatient,1,EA,33.11000,31.46000,The Alliance,Premier SAS,,22.78,,,,,,,16.55,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Premier SAS,,16.54,,,,,,,12.02,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,outpatient,57,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,outpatient,57,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier SAS,,108.91,,,,,,,79.15,153.55,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,outpatient,50,EA,7.45000,7.08000,The Alliance,Premier SAS,,5.13,,,,,,,3.73,7.23,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,outpatient,1,GM,13.52000,12.84000,The Alliance,Premier SAS,,9.30,,,,,,,6.76,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,outpatient,1,GM,13.47000,12.80000,The Alliance,Premier SAS,,9.27,,,,,,,6.74,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,outpatient,1,GM,13.72000,13.04000,The Alliance,Premier SAS,,9.44,,,,,,,6.86,13.31,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Premier SAS,,127.06,,,,,,,17.93,933.70,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,outpatient,1,mL,5.91000,5.62000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,5.73,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,1.73,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,1.84,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,3.96,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,1.13,fee schedule,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,outpatient,1,mL,4.08000,3.88000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,3.96,fee schedule,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,,138.61,,,,,,,19.35,1018.59,fee schedule,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,outpatient,20,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,170.95,,,,,,,24.18,1256.24,fee schedule,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,outpatient,20,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,outpatient,20,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,outpatient,20,EA,4.49000,4.27000,The Alliance,Premier SAS,,3.09,,,,,,,2.25,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,outpatient,20,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,outpatient,20,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,outpatient,20,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,,92.41,,,,,,,12.87,679.08,fee schedule,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,outpatient,,,189.60000,180.12000,The Alliance,Premier SAS,90,115.51,,,,,,,16.88,848.80,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,outpatient,1,EA,240.56000,228.53000,The Alliance,Premier SAS,,120.16,,,,,,,102.24,233.34,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,outpatient,1,EA,287.19000,272.83000,The Alliance,Premier SAS,,120.16,,,,,,,102.24,278.57,fee schedule,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,outpatient,1,EA,518.00000,492.10000,The Alliance,Premier SAS,,120.16,,,,,,,102.24,502.46,fee schedule,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,outpatient,1,mL,10.74000,10.20000,The Alliance,Premier SAS,,7.39,,,,,,,5.37,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,outpatient,1,mL,11.65000,11.07000,The Alliance,Premier SAS,,8.02,,,,,,,5.83,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Premier SAS,,909.00,,,,,,,50.05,3163.00,case rate,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,outpatient,10,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,outpatient,10,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,outpatient,10,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,outpatient,10,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,outpatient,10,EA,3.49000,3.32000,The Alliance,Premier SAS,,2.40,,,,,,,1.75,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,outpatient,10,EA,3.10000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,The Alliance,Premier SAS,,17.15,,,,,,,12.46,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,outpatient,1,mL,12.40000,11.78000,The Alliance,Premier SAS,,8.53,,,,,,,6.20,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Premier SAS,,5.77,,,,,,,4.19,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,outpatient,1,mL,2.28000,2.17000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,outpatient,1,mL,1384.36000,1315.14000,The Alliance,Premier SAS,,12.30,,,,,,,7.68,1342.83,fee schedule,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,outpatient,100,EA,89.81000,85.32000,The Alliance,Premier SAS,,61.79,,,,,,,44.91,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,outpatient,100,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,outpatient,100,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,outpatient,100,EA,2.20000,2.09000,The Alliance,Premier SAS,,1.51,,,,,,,1.10,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,outpatient,100,EA,2.30000,2.19000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.23,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier SAS,,127.06,,,,,,,17.90,933.70,fee schedule,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,outpatient,,,329.00000,312.55000,The Alliance,Premier SAS,,226.35,,,,,,,164.50,3321.00,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Premier SAS,,420.47,,,,,,,53.70,3089.77,fee schedule,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier SAS,,2.30,,,,,,,1.68,3.25,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,outpatient,,,598.00000,568.10000,The Alliance,Premier SAS,,468.98,,,,,,,66.70,3446.25,fee schedule,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,outpatient,1,mL,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,outpatient,250,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier SAS,,127.06,,,,,,,17.90,933.70,fee schedule,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,outpatient,,,233.00000,221.35000,The Alliance,Premier SAS,,124.75,,,,,,,17.65,916.73,fee schedule,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,outpatient,2,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,outpatient,2,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,outpatient,2,EA,1.51000,1.43000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,outpatient,2,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,outpatient,2,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,outpatient,2,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,outpatient,2,EA,1.15000,1.10000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,outpatient,2,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,,164.03,,,,,,,22.94,1205.34,fee schedule,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier SAS,90,129.37,,,,,,,20.41,950.66,fee schedule,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,,127.06,,,,,,,9.84,933.70,fee schedule,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier SAS,,164.03,,,,,,,22.94,1205.34,fee schedule,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,outpatient,1,EA,48.88000,46.43000,The Alliance,Premier SAS,,33.63,,,,,,,24.44,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,outpatient,1,EA,51.32000,48.76000,The Alliance,Premier SAS,,35.31,,,,,,,25.66,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,outpatient,1,EA,30.07000,28.57000,The Alliance,Premier SAS,,20.69,,,,,,,15.04,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,outpatient,1,EA,34.89000,33.14000,The Alliance,Premier SAS,,24.00,,,,,,,17.45,33.84,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,outpatient,1,EA,8.50000,8.08000,The Alliance,Premier SAS,,5.85,,,,,,,4.25,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Premier SAS,,6.96,,,,,,,5.05,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Premier SAS,,6.36,,,,,,,4.62,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier SAS,,127.06,,,,,,,17.90,933.70,fee schedule,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,outpatient,8,EA,6.38000,6.06000,The Alliance,Premier SAS,,4.39,,,,,,,3.19,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,outpatient,8,EA,6.18000,5.87000,The Alliance,Premier SAS,,4.25,,,,,,,3.09,5.99,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,outpatient,,,315.40000,299.63000,The Alliance,Premier SAS,90,164.03,,,,,,,23.70,1205.34,fee schedule,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,outpatient,50,EA,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,outpatient,,,154.40000,146.68000,The Alliance,Premier SAS,90,120.13,,,,,,,18.72,882.80,fee schedule,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,outpatient,1,EA,141.09000,134.04000,The Alliance,Premier SAS,,97.07,,,,,,,70.55,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,outpatient,1,EA,132.34000,125.72000,The Alliance,Premier SAS,,91.05,,,,,,,66.17,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,outpatient,1,EA,110.28000,104.77000,The Alliance,Premier SAS,,75.87,,,,,,,55.14,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,outpatient,1,EA,109.02000,103.57000,The Alliance,Premier SAS,,75.01,,,,,,,54.51,105.75,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,outpatient,1,EA,101.66000,96.57000,The Alliance,Premier SAS,,69.94,,,,,,,50.83,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,outpatient,1,EA,63.26000,60.10000,The Alliance,Premier SAS,,43.52,,,,,,,31.63,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,outpatient,1,EA,39.09000,37.13000,The Alliance,Premier SAS,,26.89,,,,,,,19.55,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,outpatient,1,EA,39.10000,37.14000,The Alliance,Premier SAS,,26.90,,,,,,,19.55,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,outpatient,1,EA,19.48000,18.51000,The Alliance,Premier SAS,,13.40,,,,,,,9.74,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,outpatient,1,EA,40.92000,38.88000,The Alliance,Premier SAS,,28.15,,,,,,,20.46,39.69,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,outpatient,1,EA,321.99000,305.89000,The Alliance,Premier SAS,,221.53,,,,,,,161.00,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,The Alliance,Premier SAS,,2.57,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,outpatient,50,EA,1.35000,1.28000,The Alliance,Premier SAS,,1.54,,,,,,,0.67500,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,outpatient,50,EA,1.38000,1.31000,The Alliance,Premier SAS,,1.54,,,,,,,0.69000,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.54,,,,,,,0.79000,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Premier SAS,,1.54,,,,,,,0.30500,1.58,fee schedule,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,outpatient,50,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.54,,,,,,,0.79000,1.58,fee schedule,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,outpatient,1,EA,4.16000,3.95000,The Alliance,Premier SAS,,2.86,,,,,,,2.08,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,134.00,,,,,,,6.82,984.66,fee schedule,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,outpatient,1,EA,22.53000,21.40000,The Alliance,Premier SAS,,15.50,,,,,,,11.27,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier SAS,,9.47,,,,,,,6.88,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,outpatient,1,EA,14.43000,13.71000,The Alliance,Premier SAS,,9.93,,,,,,,7.21,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier SAS,,6.91,,,,,,,5.03,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,outpatient,1,EA,14.84000,14.10000,The Alliance,Premier SAS,,10.21,,,,,,,7.42,14.39,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,outpatient,1,EA,0.04000,0.03000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,outpatient,5,EA,1.23000,1.17000,The Alliance,Premier SAS,,1.54,,,,,,,0.61500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,outpatient,5,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.54,,,,,,,0.73000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,outpatient,5,EA,0.88000,0.84000,The Alliance,Premier SAS,,1.54,,,,,,,0.44000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,outpatient,5,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.54,,,,,,,0.76000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,outpatient,5,EA,1.21000,1.15000,The Alliance,Premier SAS,,1.54,,,,,,,0.60500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,outpatient,5,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.54,,,,,,,0.95000,1.84,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,outpatient,5,EA,1.22000,1.16000,The Alliance,Premier SAS,,1.54,,,,,,,0.61000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,outpatient,5,EA,0.83000,0.79000,The Alliance,Premier SAS,,1.54,,,,,,,0.41500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,outpatient,5,EA,1.17000,1.11000,The Alliance,Premier SAS,,1.54,,,,,,,0.58500,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,outpatient,5,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.54,,,,,,,0.77000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.54,,,,,,,0.79000,1.58,fee schedule,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,outpatient,1,EA,87.08000,82.73000,The Alliance,Premier SAS,,59.91,,,,,,,43.54,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,outpatient,1,EA,87.09000,82.74000,The Alliance,Premier SAS,,59.92,,,,,,,43.55,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,outpatient,1,EA,134.90000,128.16000,The Alliance,Premier SAS,,92.81,,,,,,,67.45,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,outpatient,1,EA,43.32000,41.16000,The Alliance,Premier SAS,,29.80,,,,,,,21.66,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,outpatient,1,EA,61.30000,58.24000,The Alliance,Premier SAS,,42.17,,,,,,,30.65,59.46,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,,183.70,,,,,,,146.85,5271.00,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier SAS,,97.03,,,,,,,13.63,713.01,fee schedule,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,36.97,,,,,,,5.88,271.65,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,outpatient,1,mL,99.43000,94.46000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,96.45,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,outpatient,1,mL,97.76000,92.87000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,94.83,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,61.30,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,outpatient,1,mL,113.48000,107.80000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,110.08,fee schedule,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,outpatient,1,mL,189.13000,179.67000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,183.46,fee schedule,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier SAS,,48.52,,,,,,,6.89,356.54,fee schedule,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier SAS,TC,561.91,,,,,,,360.00,4457.06,fee schedule,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,outpatient,,,256.60000,243.77000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier SAS,,140.92,,,,,,,22.17,1035.56,fee schedule,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Premier SAS,,10.04,,,,,,,7.29,73.49,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,outpatient,30,EA,0.03000,0.02000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,outpatient,30,EA,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,outpatient,1,mL,221.87000,210.78000,The Alliance,Premier SAS,,0.49631,,,,,,,0.31000,215.21,fee schedule,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,outpatient,1,mL,221.86000,210.77000,The Alliance,Premier SAS,,0.49631,,,,,,,0.31000,215.20,fee schedule,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,,71.62,,,,,,,10.18,526.26,fee schedule,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier SAS,,457.42,,,,,,,64.41,3361.35,fee schedule,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,outpatient,1,EA,40.02000,38.02000,The Alliance,Premier SAS,,27.53,,,,,,,20.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,outpatient,1,EA,30.97000,29.42000,The Alliance,Premier SAS,,21.31,,,,,,,15.48,30.04,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,,233.92,,,,,,,38.65,329.80,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,outpatient,2,EA,2.82000,2.68000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,2.74,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,outpatient,2,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.54,,,,,,,1.22,2.36,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,outpatient,2,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.54,,,,,,,1.26,2.45,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,outpatient,2,EA,3.36000,3.19000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,3.26,fee schedule,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,outpatient,2,EA,3.62000,3.44000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,3.51,fee schedule,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,outpatient,,,964.00000,915.80000,The Alliance,Premier SAS,,575.69,,,,,,,295.54,4230.40,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,2.75,,,,,,,0.52500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier SAS,,2.75,,,,,,,0.94000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,2.75,,,,,,,0.87000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier SAS,,2.75,,,,,,,0.94000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier SAS,,2.75,,,,,,,0.46500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier SAS,,2.75,,,,,,,0.37500,3.67,fee schedule,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Premier SAS,,45.79,,,,,,,33.27,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,outpatient,1,EA,73.10000,69.44000,The Alliance,Premier SAS,,50.29,,,,,,,36.55,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,outpatient,1,EA,38.24000,36.32000,The Alliance,Premier SAS,,26.31,,,,,,,19.12,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Premier SAS,,57.24,,,,,,,41.60,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,outpatient,1,EA,66.36000,63.04000,The Alliance,Premier SAS,,45.66,,,,,,,33.18,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,outpatient,1,EA,52.68000,50.05000,The Alliance,Premier SAS,,36.24,,,,,,,26.34,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,outpatient,1,EA,76.35000,72.53000,The Alliance,Premier SAS,,52.53,,,,,,,38.17,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Premier SAS,,34.79,,,,,,,25.28,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,outpatient,1,EA,46.36000,44.04000,The Alliance,Premier SAS,,31.90,,,,,,,23.18,44.97,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,outpatient,1,EA,2.06000,1.96000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,outpatient,1,EA,7.37000,7.00000,The Alliance,Premier SAS,,5.07,,,,,,,3.69,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,outpatient,1,EA,10.43000,9.90000,The Alliance,Premier SAS,,7.18,,,,,,,5.21,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,outpatient,30,EA,7.68000,7.29000,The Alliance,Premier SAS,,5.28,,,,,,,3.84,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,outpatient,30,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,outpatient,1,mL,281.66000,267.58000,The Alliance,Premier SAS,,114.71,,,,,,,71.65,273.21,fee schedule,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,outpatient,1,mL,171.83000,163.23000,The Alliance,Premier SAS,,114.71,,,,,,,71.65,166.68,fee schedule,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,outpatient,1,mL,352.08000,334.48000,The Alliance,Premier SAS,,114.71,,,,,,,71.65,341.52,fee schedule,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,103.96,,,,,,,14.70,763.98,fee schedule,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,,134.00,,,,,,,13.65,984.66,fee schedule,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Premier SAS,,8.58,,,,,,,6.24,73.49,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,outpatient,1,mL,12.47000,11.85000,The Alliance,Premier SAS,,8.58,,,,,,,6.24,73.49,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,outpatient,100,EA,0.59000,0.56000,The Alliance,Premier SAS,,3.62,,,,,,,0.29500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,outpatient,100,EA,0.23000,0.22000,The Alliance,Premier SAS,,3.62,,,,,,,0.11500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,outpatient,100,EA,0.12000,0.11000,The Alliance,Premier SAS,,3.62,,,,,,,0.06000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,3.62,,,,,,,0.09500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,outpatient,100,EA,0.13000,0.12000,The Alliance,Premier SAS,,3.62,,,,,,,0.06500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,outpatient,100,EA,0.28000,0.27000,The Alliance,Premier SAS,,3.62,,,,,,,0.14000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,3.62,,,,,,,0.09500,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Premier SAS,,3.62,,,,,,,0.07000,5.94,fee schedule,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,outpatient,100,EA,0.47000,0.45000,The Alliance,Premier SAS,,3.62,,,,,,,0.23500,5.94,fee schedule,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier SAS,,0.98384,,,,,,,0.71500,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Premier SAS,,4.55,,,,,,,3.31,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,outpatient,1,EA,34.79000,33.05000,The Alliance,Premier SAS,,23.94,,,,,,,17.39,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,outpatient,1,EA,28.96000,27.52000,The Alliance,Premier SAS,,19.92,,,,,,,14.48,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,outpatient,1,EA,15.79000,15.00000,The Alliance,Premier SAS,,10.86,,,,,,,7.89,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Premier SAS,,22.46,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,The Alliance,Premier SAS,,22.46,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier SAS,,25.00,,,,,,,18.17,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Premier SAS,,8.83,,,,,,,6.42,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,2.75,,,,,,,0.87000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,outpatient,1,mL,1.62000,1.54000,The Alliance,Premier SAS,,2.75,,,,,,,0.81000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier SAS,,2.75,,,,,,,0.46500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier SAS,,2.75,,,,,,,0.37500,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,outpatient,1,mL,1.88000,1.78000,The Alliance,Premier SAS,,2.75,,,,,,,0.94000,3.67,fee schedule,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,outpatient,,,195.10000,185.34000,The Alliance,Premier SAS,90,120.13,,,,,,,17.36,882.80,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,29.48,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,outpatient,1,mL,291.73000,277.14000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,282.98,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,outpatient,1,mL,148.52000,141.09000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,144.06,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,147.13,fee schedule,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,outpatient,1,mL,157.10000,149.25000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,152.39,fee schedule,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,outpatient,1,EA,5.56000,5.29000,The Alliance,Premier SAS,,3.83,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier SAS,,2.89,,,,,,,2.10,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier SAS,,3.08,,,,,,,2.23,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,outpatient,1,EA,5.37000,5.11000,The Alliance,Premier SAS,,3.69,,,,,,,2.69,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier SAS,,3.83,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Premier SAS,,4.07,,,,,,,2.96,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,outpatient,1,EA,55.82000,53.03000,The Alliance,Premier SAS,,38.40,,,,,,,27.91,54.15,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.63,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,outpatient,1,EA,3.99000,3.79000,The Alliance,Premier SAS,,2.75,,,,,,,2.00,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,outpatient,1,EA,4.08000,3.87000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.96,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,outpatient,1,EA,2.97000,2.82000,The Alliance,Premier SAS,,2.04,,,,,,,1.49,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,outpatient,1,EA,2.96000,2.82000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,TC,146.32,,,,,,,47.50,1075.26,fee schedule,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,outpatient,4,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,outpatient,4,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,0.64740,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,outpatient,4,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.64740,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,outpatient,4,EA,2.29000,2.18000,The Alliance,Premier SAS,,1.58,,,,,,,0.64740,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,outpatient,4,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,outpatient,4,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,0.64740,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,outpatient,4,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,outpatient,4,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,outpatient,4,EA,1.12000,1.06000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,outpatient,1,mL,4.03000,3.83000,The Alliance,Premier SAS,,2.75,,,,,,,2.02,3.91,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Premier SAS,,2.75,,,,,,,0.54000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier SAS,,2.75,,,,,,,0.43500,3.67,fee schedule,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,outpatient,1,mL,2655.14000,2522.38000,The Alliance,Premier SAS,,1826.74,,,,,,,6.03,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,outpatient,1,mL,1849.97000,1757.47000,The Alliance,Premier SAS,,1272.78,,,,,,,6.03,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,outpatient,1,mL,1856.17000,1763.36000,The Alliance,Premier SAS,,1277.04,,,,,,,6.03,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,outpatient,1,mL,1702.49000,1617.37000,The Alliance,Premier SAS,,1171.31,,,,,,,6.03,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,outpatient,1,mL,2300.00000,2185.00000,The Alliance,Premier SAS,,1582.40,,,,,,,6.03,2231.00,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,outpatient,5,EA,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,outpatient,16,EA,2.69000,2.56000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,outpatient,16,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,outpatient,16,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,outpatient,16,EA,3.56000,3.38000,The Alliance,Premier SAS,,2.45,,,,,,,1.78,3.45,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,outpatient,100,mL,0.63000,0.60000,The Alliance,Premier SAS,,3.62,,,,,,,0.31500,5.94,fee schedule,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,21.33,,,,,,,10.00,30.07,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,433.58,,,,,,,285.00,3186.14,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,outpatient,1,EA,866.69000,823.36000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,840.69,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,outpatient,1,EA,829.37000,787.90000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,804.49,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,outpatient,1,EA,205.40000,195.13000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,199.24,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,outpatient,1,EA,79.00000,75.05000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,76.63,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,91.96,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,outpatient,1,EA,748.82000,711.38000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,726.36,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,outpatient,1,EA,259.69000,246.70000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,251.90,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,outpatient,1,EA,780.03000,741.03000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,756.63,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,outpatient,1,EA,256.53000,243.70000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,248.83,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,515.02,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,outpatient,1,EA,454.54000,431.82000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,440.90,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,263.79,fee schedule,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,outpatient,1,EA,714.37000,678.66000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,692.94,fee schedule,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,outpatient,,,173.00000,164.35000,The Alliance,Premier SAS,TC,119.02,,,,,,,86.50,167.81,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,62.38,,,,,,,9.72,458.40,fee schedule,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,50.83,,,,,,,7.20,373.51,fee schedule,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier SAS,TC,182.88,,,,,,,146.17,1450.63,fee schedule,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier SAS,TC,222.57,,,,,,,118.00,1635.52,fee schedule,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,The Alliance,Premier SAS,,61.23,,,,,,,44.50,210.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,131.69,,,,,,,18.54,967.70,fee schedule,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,outpatient,2.5,EA,45.50000,43.23000,The Alliance,Premier SAS,,31.30,,,,,,,22.75,44.13,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,outpatient,1,mL,6.61000,6.28000,The Alliance,Premier SAS,,4.55,,,,,,,0.64740,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,outpatient,1,mL,5.40000,5.13000,The Alliance,Premier SAS,,3.72,,,,,,,0.64740,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,0.64740,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,0.64740,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,0.64740,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.64740,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,0.64740,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,outpatient,1,mL,4.29000,4.08000,The Alliance,Premier SAS,,2.95,,,,,,,0.64740,4.16,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,outpatient,12,EA,72.11000,68.50000,The Alliance,Premier SAS,,49.61,,,,,,,36.05,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,outpatient,12,EA,46.87000,44.53000,The Alliance,Premier SAS,,32.25,,,,,,,23.43,45.46,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,outpatient,2,EA,43.15000,40.99000,The Alliance,Premier SAS,,29.69,,,,,,,21.57,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,outpatient,2,EA,63.88000,60.69000,The Alliance,Premier SAS,,43.95,,,,,,,31.94,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,outpatient,2,EA,2.31000,2.19000,The Alliance,Premier SAS,,1.59,,,,,,,1.16,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,outpatient,2,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,outpatient,2,EA,23.38000,22.21000,The Alliance,Premier SAS,,16.09,,,,,,,11.69,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,outpatient,2,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,outpatient,2,EA,2.94000,2.79000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,outpatient,2,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,11.85,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,outpatient,2,EA,7.78000,7.39000,The Alliance,Premier SAS,,5.35,,,,,,,3.89,7.55,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,112.03,,,,,,,17.27,823.21,fee schedule,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Premier SAS,,23.56,,,,,,,17.12,33.22,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,outpatient,1,mL,5.36000,5.09000,The Alliance,Premier SAS,,4.74,,,,,,,2.68,5.20,fee schedule,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,outpatient,1,mL,5.38000,5.11000,The Alliance,Premier SAS,,4.74,,,,,,,2.69,5.22,fee schedule,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier SAS,,143.23,,,,,,,77.53,1052.52,fee schedule,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,69.31,,,,,,,9.70,509.30,fee schedule,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,outpatient,,,137.20000,130.34000,The Alliance,Premier SAS,90,106.27,,,,,,,16.62,780.94,fee schedule,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier SAS,TC,541.96,,,,,,,394.00,4298.79,fee schedule,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,outpatient,10.6,EA,2.59000,2.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,outpatient,10.6,EA,60.98000,57.93000,The Alliance,Premier SAS,,41.95,,,,,,,30.49,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,outpatient,10.6,EA,39.63000,37.65000,The Alliance,Premier SAS,,27.27,,,,,,,19.82,38.44,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,4.66,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,outpatient,1,mL,4.80000,4.56000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,4.66,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,6.31,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,7.62,fee schedule,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,outpatient,1,GM,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,outpatient,100,EA,53.57000,50.89000,The Alliance,Premier SAS,,76.53,,,,,,,26.79,78.87,fee schedule,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier SAS,,122.44,,,,,,,16.37,899.77,fee schedule,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,outpatient,2,EA,8.55000,8.12000,The Alliance,Premier SAS,,4.19,,,,,,,3.82,8.29,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Premier SAS,,4.19,,,,,,,1.74,4.32,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,outpatient,2,EA,2.72000,2.58000,The Alliance,Premier SAS,,4.19,,,,,,,1.36,4.32,fee schedule,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,outpatient,2,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.19,,,,,,,3.16,6.13,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,outpatient,1,EA,1919.06000,1823.11000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,1861.49,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,outpatient,1,EA,145.14000,137.88000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,140.79,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,outpatient,1,EA,157.65000,149.77000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,152.92,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,outpatient,1,EA,156.74000,148.90000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,152.04,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,351.72,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,outpatient,1,EA,154.84000,147.10000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,150.19,fee schedule,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,144.06,fee schedule,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,outpatient,1,mL,3.92000,3.72000,The Alliance,Premier SAS,,2.75,,,,,,,1.96,3.80,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,outpatient,1,mL,1.08000,1.03000,The Alliance,Premier SAS,,2.75,,,,,,,0.54000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,outpatient,1,mL,0.88000,0.83000,The Alliance,Premier SAS,,2.75,,,,,,,0.44000,3.67,fee schedule,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier SAS,,2.75,,,,,,,1.04,3.67,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier SAS,,4.19,,,,,,,2.31,4.48,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,outpatient,1,EA,2.87000,2.73000,The Alliance,Premier SAS,,4.19,,,,,,,1.44,4.32,fee schedule,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,The Alliance,Premier SAS,TC,497.08,,,,,,,308.00,3942.79,fee schedule,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier SAS,,78.21,,,,,,,12.05,574.73,fee schedule,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,outpatient,50,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,outpatient,50,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,outpatient,50,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,outpatient,50,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,outpatient,50,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,outpatient,50,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,outpatient,,,614.00000,583.30000,The Alliance,Premier SAS,,253.37,,,,,,,125.97,1861.90,fee schedule,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,,136.30,,,,,,,19.04,1001.63,fee schedule,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,outpatient,,,189.00000,179.55000,The Alliance,Premier SAS,,124.75,,,,,,,17.63,916.73,fee schedule,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,outpatient,,,153.80000,146.11000,The Alliance,Premier SAS,90,138.61,,,,,,,14.48,1018.59,fee schedule,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier SAS,,4.16,,,,,,,3.02,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Premier SAS,,76.53,,,,,,,26.79,78.87,fee schedule,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Premier SAS,,2.46,,,,,,,1.79,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,78.55,,,,,,,10.50,577.23,fee schedule,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,TC,2373.60,,,,,,,1591.55,3346.50,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,48.85,,,,,,,35.50,68.87,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,outpatient,1,EA,19.66000,18.68000,The Alliance,Premier SAS,,13.53,,,,,,,9.83,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,The Alliance,Premier SAS,,23.56,,,,,,,17.12,33.22,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,87.78,,,,,,,7.15,645.08,fee schedule,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier SAS,,15.14,,,,,,,11.00,81.87,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,outpatient,5,EA,9.70000,9.22000,The Alliance,Premier SAS,,6.67,,,,,,,4.85,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,outpatient,5,EA,22.57000,21.44000,The Alliance,Premier SAS,,15.53,,,,,,,11.29,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,outpatient,5,EA,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,The Alliance,Premier SAS,TC,1949.79,,,,,,,1132.05,2748.98,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,outpatient,1,mL,5.36000,5.10000,The Alliance,Premier SAS,,4.74,,,,,,,2.68,5.20,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,outpatient,1,mL,5.61000,5.32000,The Alliance,Premier SAS,,4.74,,,,,,,2.81,5.44,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier SAS,,4.74,,,,,,,2.31,4.95,fee schedule,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier SAS,,4.74,,,,,,,1.50,4.95,fee schedule,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Premier SAS,90,101.65,,,,,,,13.88,746.94,fee schedule,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,209.46,,,,,,,12.05,1539.22,fee schedule,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,outpatient,10,EA,16.13000,15.33000,The Alliance,Premier SAS,,11.10,,,,,,,8.06,15.65,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,outpatient,1,EA,383.81000,364.62000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,372.30,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,outpatient,1,EA,31.35000,29.78000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,30.41,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,122.61,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,36.78,fee schedule,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Premier SAS,,4.74,,,,,,,4.61,28.14,fee schedule,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,outpatient,1,EA,3.14000,2.99000,The Alliance,Premier SAS,,2.16,,,,,,,1.57,3.05,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,outpatient,15,EA,8.32000,7.91000,The Alliance,Premier SAS,,5.72,,,,,,,4.16,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,outpatient,15,EA,6.87000,6.52000,The Alliance,Premier SAS,,4.73,,,,,,,3.44,6.66,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,,115.51,,,,,,,16.38,848.80,fee schedule,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,outpatient,10,EA,25.01000,23.76000,The Alliance,Premier SAS,,17.21,,,,,,,12.51,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,outpatient,10,EA,38.33000,36.41000,The Alliance,Premier SAS,,26.37,,,,,,,19.16,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,outpatient,10,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,outpatient,10,EA,2.51000,2.38000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Premier SAS,,10.33,,,,,,,7.50,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,outpatient,10,EA,4.49000,4.27000,The Alliance,Premier SAS,,3.09,,,,,,,2.25,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,outpatient,10,EA,15.17000,14.41000,The Alliance,Premier SAS,,10.44,,,,,,,7.58,14.71,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,outpatient,1,EA,1566.95000,1488.60000,The Alliance,Premier SAS,,1175.37,,,,,,,734.15,1519.94,fee schedule,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,outpatient,1,EA,2451.28000,2328.72000,The Alliance,Premier SAS,,1175.37,,,,,,,734.15,2377.74,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,outpatient,200,mL,53.57000,50.89000,The Alliance,Premier SAS,,76.53,,,,,,,26.79,78.87,fee schedule,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,34.66,,,,,,,4.75,254.68,fee schedule,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,27.72,,,,,,,3.92,203.72,fee schedule,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,78.21,,,,,,,11.53,574.73,fee schedule,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier SAS,,131.69,,,,,,,18.58,967.70,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,outpatient,1,EA,727.27000,690.91000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,705.45,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,outpatient,1,EA,730.51000,693.98000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,708.59,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,outpatient,1,EA,725.20000,688.94000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,703.44,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,outpatient,1,EA,410.23000,389.72000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,397.92,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,outpatient,1,EA,444.44000,422.22000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,431.11,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,outpatient,1,EA,724.68000,688.45000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,702.94,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,outpatient,1,EA,441.85000,419.76000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,428.59,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,outpatient,1,EA,273.01000,259.36000,The Alliance,Premier SAS,,313.46,,,,,,,136.50,323.05,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,outpatient,1,EA,441.60000,419.52000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,428.35,fee schedule,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,outpatient,1,EA,419.58000,398.60000,The Alliance,Premier SAS,,313.46,,,,,,,195.79,406.99,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,outpatient,1,mL,57.32000,54.46000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,55.60,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,30.65,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,61.30,fee schedule,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,outpatient,1,mL,29.61000,28.13000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,28.72,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,4.91,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,outpatient,1,EA,65.21000,61.95000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,63.25,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,6.90,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,3.38,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,18.36,fee schedule,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.34,,,,,,,1.20,2.70,fee schedule,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier SAS,,2.51,,,,,,,1.82,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,outpatient,,,147.70000,140.31000,The Alliance,Premier SAS,,101.62,,,,,,,36.30,143.27,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Premier SAS,,4.19,,,,,,,2.17,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,outpatient,2,EA,1.41000,1.34000,The Alliance,Premier SAS,,4.19,,,,,,,0.70500,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,outpatient,2,EA,4.35000,4.13000,The Alliance,Premier SAS,,4.19,,,,,,,2.17,4.32,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,outpatient,2,EA,6.43000,6.11000,The Alliance,Premier SAS,,4.19,,,,,,,3.21,6.24,fee schedule,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,outpatient,2,EA,1.91000,1.82000,The Alliance,Premier SAS,,4.19,,,,,,,0.95500,4.32,fee schedule,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,53.14,,,,,,,7.52,390.47,fee schedule,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,outpatient,10,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.64740,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,outpatient,10,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,outpatient,10,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,outpatient,10,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,outpatient,10,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,outpatient,10,EA,7.38000,7.01000,The Alliance,Premier SAS,,5.08,,,,,,,0.64740,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,outpatient,10,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.64740,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,outpatient,10,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.64740,1.29,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,outpatient,12,EA,40.91000,38.87000,The Alliance,Premier SAS,,28.15,,,,,,,20.45,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,outpatient,12,EA,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,outpatient,12,EA,72.80000,69.16000,The Alliance,Premier SAS,,50.09,,,,,,,36.40,70.62,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,,50.83,,,,,,,4.90,373.51,fee schedule,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,16.17,,,,,,,2.37,118.82,fee schedule,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,92.41,,,,,,,12.87,679.08,fee schedule,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,1.87,,,,,,,1.36,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.58,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,7.97,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,39.85,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,outpatient,1,mL,8.60000,8.17000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,6.90,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,2.06,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,outpatient,1,mL,22.27000,21.15000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,21.60,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,7.66,fee schedule,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,,83.17,,,,,,,11.84,611.15,fee schedule,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,outpatient,1,EA,6103.28000,5798.12000,The Alliance,Premier SAS,,1175.37,,,,,,,734.15,5920.18,fee schedule,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1278.00000,1214.10000,The Alliance,Premier SAS,,912.54,,,,,,,128.29,6705.74,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,outpatient,1,mL,5.44000,5.17000,The Alliance,Premier SAS,,4.74,,,,,,,2.72,5.28,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier SAS,,4.74,,,,,,,2.31,4.95,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,outpatient,1,mL,2.64000,2.51000,The Alliance,Premier SAS,,4.74,,,,,,,1.32,4.95,fee schedule,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,outpatient,1,mL,2.70000,2.57000,The Alliance,Premier SAS,,4.74,,,,,,,1.35,4.95,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Premier SAS,,50.70,,,,,,,29.59,57.41,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Premier SAS,,50.70,,,,,,,49.09,114.83,fee schedule,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,outpatient,10,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,outpatient,10,EA,15.54000,14.76000,The Alliance,Premier SAS,,10.69,,,,,,,7.77,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,outpatient,10,EA,8.44000,8.02000,The Alliance,Premier SAS,,5.81,,,,,,,4.22,8.19,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,outpatient,4,EA,1.28000,1.21000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,outpatient,4,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier SAS,,478.22,,,,,,,67.36,3514.18,fee schedule,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,outpatient,,,4882.00000,4637.90000,The Alliance,Premier SAS,TC,3358.82,,,,,,,2091.58,4735.54,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,16.17,,,,,,,2.37,118.82,fee schedule,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,733.05000,696.40000,The Alliance,Premier SAS,,336.47,,,,,,,336.47,733.05,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,outpatient,,,22.90000,21.75000,The Alliance,Premier SAS,,15.76,,,,,,,11.45,22.21,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,outpatient,1,EA,1.77000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,outpatient,1,mL,414.52000,393.79000,The Alliance,Premier SAS,,285.19,,,,,,,207.26,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,outpatient,1,mL,378.56000,359.63000,The Alliance,Premier SAS,,260.45,,,,,,,189.28,367.20,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.58,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,outpatient,1,EA,24.19000,22.98000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,23.46,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,21.46,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,35.25,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,1.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,2.99,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.27,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,outpatient,1,EA,23.47000,22.30000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,22.77,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,outpatient,1,EA,8.60000,8.17000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.34,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,8.28,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,22.22,fee schedule,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,outpatient,1,mL,458.17000,435.26000,The Alliance,Premier SAS,,315.22,,,,,,,229.09,444.42,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,87.78,,,,,,,12.39,645.08,fee schedule,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,76.24,,,,,,,10.74,560.26,fee schedule,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,20.80,,,,,,,3.28,152.82,fee schedule,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,outpatient,10,EA,4.89000,4.64000,The Alliance,Premier SAS,,3.36,,,,,,,2.44,4.74,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Premier SAS,,116.36,,,,,,,69.38,134.59,fee schedule,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Premier SAS,,116.36,,,,,,,69.38,134.59,fee schedule,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier SAS,,92.41,,,,,,,13.09,679.08,fee schedule,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,outpatient,1,mL,75.21000,71.45000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,72.95,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,outpatient,1,mL,88.73000,84.30000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,86.07,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,76.63,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,outpatient,1,mL,67.43000,64.06000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,65.41,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,outpatient,1,mL,67.31000,63.94000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,65.29,fee schedule,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,61.30,fee schedule,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,outpatient,,,231.53000,219.95000,The Alliance,Premier SAS,,159.29,,,,,,,115.77,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,outpatient,1,mL,231.53000,219.95000,The Alliance,Premier SAS,,159.29,,,,,,,115.77,224.58,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,57.75,,,,,,,8.17,424.40,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,outpatient,,,146.22000,138.91000,The Alliance,Premier SAS,,112.68,,,,,,,73.11,141.83,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,outpatient,1,mL,146.22000,138.91000,The Alliance,Premier SAS,,112.68,,,,,,,73.11,141.83,fee schedule,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,108.58,,,,,,,8.17,797.91,fee schedule,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,outpatient,1,mL,3.68000,3.50000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,3.57,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,2.57,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,outpatient,1,mL,5.50000,5.22000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.33,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,outpatient,1,mL,4.00000,3.80000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,3.88,fee schedule,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,2.96,fee schedule,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,73.92,,,,,,,10.33,543.22,fee schedule,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier SAS,QN,17.89,,,,,,,13.00,25.22,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,258.19,,,,,,,258.19,562.50,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Premier SAS,,258.75,,,,,,,38.30,1901.39,fee schedule,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,69.31,,,,,,,9.71,509.30,fee schedule,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,outpatient,,,126.00000,119.70000,The Alliance,Premier SAS,,85.48,,,,,,,12.05,628.12,fee schedule,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,outpatient,,,254.90000,242.16000,The Alliance,Premier SAS,90,157.09,,,,,,,22.69,1154.38,fee schedule,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,97.03,,,,,,,13.52,713.01,fee schedule,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,outpatient,1,EA,1.21000,1.14000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,101.65,,,,,,,14.27,746.94,fee schedule,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,83.17,,,,,,,11.77,611.15,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,outpatient,,,139.34000,132.37000,The Alliance,Premier SAS,,112.68,,,,,,,69.67,135.16,fee schedule,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,outpatient,1,EA,139.34000,132.37000,The Alliance,Premier SAS,,112.68,,,,,,,69.67,135.16,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,outpatient,1,mL,10.40000,9.88000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,10.09,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.61,fee schedule,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,outpatient,1,mL,24.11000,22.91000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,23.39,fee schedule,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,90.10,,,,,,,12.58,662.12,fee schedule,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,outpatient,,,276.60000,262.77000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,55.45,,,,,,,8.61,407.44,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,,87.78,,,,,,,13.79,645.08,fee schedule,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,50.83,,,,,,,8.00,373.51,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier SAS,,8.31,,,,,,,6.82,45.98,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,outpatient,1,EA,134.16000,127.46000,The Alliance,Premier SAS,,8.31,,,,,,,6.82,130.14,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier SAS,,8.31,,,,,,,6.82,27.59,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,8.31,,,,,,,1.90,8.56,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier SAS,,8.31,,,,,,,6.82,43.89,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Premier SAS,,8.31,,,,,,,3.83,8.56,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,8.31,,,,,,,5.53,10.73,fee schedule,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier SAS,,8.31,,,,,,,6.82,36.78,fee schedule,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,outpatient,,,311.00000,295.45000,The Alliance,Premier SAS,,413.53,,,,,,,58.00,3038.81,fee schedule,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,outpatient,,,392.00000,372.40000,The Alliance,Premier SAS,,269.70,,,,,,,196.00,380.24,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,90,216.39,,,,,,,6.41,1590.11,fee schedule,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Premier SAS,TC,2351.58,,,,,,,1578.65,3315.46,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,101.65,,,,,,,14.38,746.94,fee schedule,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,outpatient,,,301.21000,286.15000,The Alliance,Premier SAS,,263.24,,,,,,,150.60,292.17,fee schedule,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,outpatient,1,mL,301.21000,286.15000,The Alliance,Premier SAS,,263.24,,,,,,,150.60,292.17,fee schedule,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,outpatient,1,EA,36.47000,34.64000,The Alliance,Premier SAS,,25.09,,,,,,,18.23,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier SAS,,25.00,,,,,,,18.17,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,outpatient,1,EA,3.48000,3.31000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,outpatient,1,EA,34.63000,32.90000,The Alliance,Premier SAS,,23.83,,,,,,,17.32,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Premier SAS,,6.46,,,,,,,4.70,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,outpatient,1,EA,151.75000,144.17000,The Alliance,Premier SAS,,104.40,,,,,,,75.88,147.20,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Premier SAS,,154.78,,,,,,,24.06,1137.41,fee schedule,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,outpatient,,,466.00000,442.70000,The Alliance,Premier SAS,TC,545.99,,,,,,,233.00,4012.21,fee schedule,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,,138.61,,,,,,,19.35,1018.59,fee schedule,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier SAS,,60.06,,,,,,,9.09,441.37,fee schedule,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,outpatient,28.35,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,outpatient,28.35,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,outpatient,28.35,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,outpatient,28.35,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier SAS,,304.95,,,,,,,42.84,2240.90,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,The Alliance,Premier SAS,,50.70,,,,,,,29.59,57.41,fee schedule,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,The Alliance,Premier SAS,,50.70,,,,,,,49.09,114.83,fee schedule,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,outpatient,30,EA,7.80000,7.41000,The Alliance,Premier SAS,,5.37,,,,,,,3.90,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,outpatient,30,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,outpatient,30,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,outpatient,30,EA,7.30000,6.93000,The Alliance,Premier SAS,,5.02,,,,,,,3.65,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,outpatient,30,EA,1.59000,1.52000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,outpatient,30,EA,6.64000,6.31000,The Alliance,Premier SAS,,4.57,,,,,,,3.32,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,outpatient,30,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,outpatient,30,EA,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,outpatient,30,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,97.70,,,,,,,71.00,137.74,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier SAS,,605.28,,,,,,,85.10,4447.87,fee schedule,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,outpatient,,,217.70000,206.81000,The Alliance,Premier SAS,90,182.51,,,,,,,26.67,1341.13,fee schedule,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,outpatient,1,EA,10.30000,9.78000,The Alliance,Premier SAS,,7.09,,,,,,,5.15,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,outpatient,1,EA,0.94000,0.90000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,outpatient,1,mL,5.92000,5.62000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.74,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,outpatient,1,mL,8.09000,7.69000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,7.85,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,outpatient,1,mL,10.97000,10.42000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,10.64,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,outpatient,1,mL,5.84000,5.55000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.66,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,11.04,fee schedule,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,outpatient,1,mL,13.11000,12.46000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,12.72,fee schedule,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,outpatient,1,mL,133.27000,126.60000,The Alliance,Premier SAS,,0.57636,,,,,,,0.56420,129.27,fee schedule,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,outpatient,1,mL,176.33000,167.51000,The Alliance,Premier SAS,,0.57636,,,,,,,0.56420,171.04,fee schedule,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,94.72,,,,,,,13.19,696.05,fee schedule,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,outpatient,1,mL,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,outpatient,1,mL,6.21000,5.90000,The Alliance,Premier SAS,,4.27,,,,,,,3.10,6.02,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,62.38,,,,,,,8.89,458.40,fee schedule,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,outpatient,,,459.00000,436.05000,The Alliance,Premier SAS,,304.95,,,,,,,42.84,2240.90,fee schedule,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,The Alliance,Premier SAS,,2.67,,,,,,,1.94,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier SAS,,3.91,,,,,,,2.85,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Premier SAS,,2.66,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,outpatient,60,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,outpatient,60,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,outpatient,60,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,outpatient,60,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,outpatient,60,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,outpatient,,,1293.00000,1228.35000,The Alliance,Premier SAS,90,815.51,,,,,,,121.54,5992.72,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,outpatient,50,EA,7.63000,7.25000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,7.40,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,outpatient,50,EA,6.54000,6.21000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,6.34,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,outpatient,50,EA,6.45000,6.12000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,6.26,fee schedule,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,outpatient,50,EA,8.96000,8.51000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,8.69,fee schedule,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,outpatient,500,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,outpatient,500,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier SAS,,83.17,,,,,,,11.85,611.15,fee schedule,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,outpatient,1,EA,4.31000,4.10000,The Alliance,Premier SAS,,2.97,,,,,,,2.15,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,90,83.17,,,,,,,11.96,611.15,fee schedule,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier SAS,,37.62,,,,,,,2.90,40.87,fee schedule,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier SAS,,117.83,,,,,,,16.46,865.84,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,outpatient,1,EA,64.46000,61.24000,The Alliance,Premier SAS,,33.94,,,,,,,31.90,62.53,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,outpatient,1,EA,64.49000,61.26000,The Alliance,Premier SAS,,33.94,,,,,,,31.90,62.56,fee schedule,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,outpatient,1,EA,47.72000,45.33000,The Alliance,Premier SAS,,33.94,,,,,,,23.86,46.29,fee schedule,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,outpatient,1,EA,5.29000,5.02000,The Alliance,Premier SAS,,3.64,,,,,,,2.65,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Premier SAS,,3.90,,,,,,,2.83,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Premier SAS,,3.63,,,,,,,2.64,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier SAS,,3.15,,,,,,,2.29,4.44,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,outpatient,,,32.40000,30.78000,The Alliance,Premier SAS,90,110.89,,,,,,,16.20,814.87,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,outpatient,1,mL,263.33000,250.17000,The Alliance,Premier SAS,,49.31,,,,,,,34.44,255.43,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,outpatient,1,mL,363.46000,345.29000,The Alliance,Premier SAS,,49.31,,,,,,,34.44,352.56,fee schedule,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,outpatient,1,mL,258.07000,245.16000,The Alliance,Premier SAS,,49.31,,,,,,,34.44,250.33,fee schedule,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,138.61,,,,,,,19.35,1018.59,fee schedule,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,63.05,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,outpatient,1,EA,238.67000,226.74000,The Alliance,Premier SAS,,33.94,,,,,,,31.90,231.51,fee schedule,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,outpatient,1,EA,93.35000,88.68000,The Alliance,Premier SAS,,27.10,,,,,,,27.10,90.55,fee schedule,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,outpatient,,,842.00000,799.90000,The Alliance,Premier SAS,,499.01,,,,,,,50.62,3666.93,fee schedule,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Premier SAS,,17.27,,,,,,,0.96500,17.80,fee schedule,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,outpatient,1,mL,7.94000,7.54000,The Alliance,Premier SAS,,17.27,,,,,,,3.97,17.80,fee schedule,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier SAS,,170.95,,,,,,,24.08,1256.24,fee schedule,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier SAS,,228.72,,,,,,,34.81,1680.71,fee schedule,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,outpatient,1,EA,26.51000,25.19000,The Alliance,Premier SAS,,18.24,,,,,,,13.26,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,outpatient,1,EA,22.75000,21.61000,The Alliance,Premier SAS,,15.65,,,,,,,11.38,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,outpatient,1,EA,8.66000,8.23000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,8.40,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,outpatient,1,EA,10.64000,10.10000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,10.32,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,4.60,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,4.78,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,outpatient,1,EA,6.05000,5.75000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.87,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,outpatient,1,EA,4.55000,4.32000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,4.41,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,9.20,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,15.33,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,outpatient,1,EA,4.76000,4.52000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,4.62,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,outpatient,1,EA,13.65000,12.97000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,13.24,fee schedule,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,outpatient,1,EA,13.11000,12.46000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,12.72,fee schedule,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,143.23,,,,,,,19.62,1052.52,fee schedule,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier SAS,,55.45,,,,,,,7.73,407.44,fee schedule,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,outpatient,5,EA,119.08000,113.13000,The Alliance,Premier SAS,,81.93,,,,,,,59.54,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,outpatient,5,EA,4.55000,4.32000,The Alliance,Premier SAS,,3.13,,,,,,,2.27,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,outpatient,5,EA,4.84000,4.60000,The Alliance,Premier SAS,,3.33,,,,,,,2.42,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,outpatient,5,EA,252.80000,240.16000,The Alliance,Premier SAS,,173.93,,,,,,,126.40,245.22,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,,117.83,,,,,,,16.67,865.84,fee schedule,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,outpatient,1,EA,116.10000,110.29000,The Alliance,Premier SAS,,37.62,,,,,,,37.62,112.62,fee schedule,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,outpatient,1,EA,183.44000,174.27000,The Alliance,Premier SAS,,37.62,,,,,,,37.62,177.94,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,outpatient,10,EA,166.90000,158.56000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,161.89,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,outpatient,10,EA,94.35000,89.64000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,91.52,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,outpatient,10,EA,256.40000,243.58000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,248.71,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,outpatient,10,EA,185.79000,176.50000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,180.22,fee schedule,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,outpatient,10,EA,100.32000,95.31000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,97.31,fee schedule,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,90,67.00,,,,,,,9.61,492.33,fee schedule,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,outpatient,1,GM,11.69000,11.11000,The Alliance,Premier SAS,,8.04,,,,,,,5.84,11.34,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,outpatient,,,475.00000,451.25000,The Alliance,Premier SAS,TC,448.96,,,,,,,237.50,3299.19,fee schedule,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier SAS,,283.39,,,,,,,22.34,2082.45,fee schedule,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,outpatient,1,EA,3703.00000,3517.85000,The Alliance,Premier SAS,,69.31,,,,,,,43.29,3591.91,fee schedule,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Premier SAS,,7.11,,,,,,,5.17,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,outpatient,1,EA,7.47000,7.10000,The Alliance,Premier SAS,,5.14,,,,,,,3.73,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier SAS,,2.74,,,,,,,1.99,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,outpatient,1,EA,6.95000,6.60000,The Alliance,Premier SAS,,4.78,,,,,,,3.48,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,outpatient,1,EA,9.19000,8.73000,The Alliance,Premier SAS,,6.32,,,,,,,4.59,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,outpatient,1,EA,4.67000,4.44000,The Alliance,Premier SAS,,3.21,,,,,,,2.33,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,The Alliance,Premier SAS,,4.48,,,,,,,3.25,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Premier SAS,,6.63,,,,,,,4.82,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,outpatient,,,1160.00000,1102.00000,The Alliance,Premier SAS,TC,1383.08,,,,,,,580.00,10163.53,fee schedule,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Premier SAS,,328.05,,,,,,,51.19,2410.69,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,outpatient,1,EA,28.05000,26.64000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,27.21,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,outpatient,1,EA,13.47000,12.80000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,13.07,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,17.87,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,15.94,fee schedule,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,13.79,fee schedule,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,outpatient,0.5,mL,13.90000,13.21000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,13.48,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,outpatient,0.5,mL,18.14000,17.23000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,17.60,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,outpatient,0.5,mL,9.67000,9.19000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,9.38,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,outpatient,0.5,mL,35.83000,34.04000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,34.76,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,outpatient,0.5,mL,26.86000,25.52000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,26.05,fee schedule,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,outpatient,0.5,mL,25.28000,24.02000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,24.52,fee schedule,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,80.86,,,,,,,11.26,594.19,fee schedule,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,outpatient,10,EA,173.44000,164.76000,The Alliance,Premier SAS,,119.33,,,,,,,86.72,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,outpatient,10,EA,142.92000,135.77000,The Alliance,Premier SAS,,98.33,,,,,,,71.46,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,outpatient,10,EA,94.26000,89.55000,The Alliance,Premier SAS,,64.85,,,,,,,47.13,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,outpatient,10,EA,71.43000,67.85000,The Alliance,Premier SAS,,49.14,,,,,,,35.72,340.40,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,outpatient,1,mL,211.33000,200.76000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,204.99,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,61.30,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,outpatient,1,mL,165.90000,157.60000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,160.92,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,outpatient,1,mL,259.60000,246.62000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,251.81,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,outpatient,1,mL,187.77000,178.38000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,182.14,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,outpatient,1,mL,188.08000,178.68000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,182.44,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,outpatient,1,mL,101.57000,96.49000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,98.52,fee schedule,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,outpatient,1,mL,124.82000,118.58000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,121.08,fee schedule,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,284.16,,,,,,,28.92,2088.15,fee schedule,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,outpatient,1,EA,801.42000,761.35000,The Alliance,Premier SAS,,551.38,,,,,,,400.71,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,outpatient,1,EA,483.89000,459.70000,The Alliance,Premier SAS,,332.92,,,,,,,241.94,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,outpatient,1,EA,937.33000,890.47000,The Alliance,Premier SAS,,644.88,,,,,,,468.67,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,outpatient,1,EA,890.47000,845.94000,The Alliance,Premier SAS,,612.64,,,,,,,445.24,863.76,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Premier SAS,,791.89,,,,,,,633.05,3163.00,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,outpatient,,,3081.00000,2926.95000,The Alliance,Premier SAS,,1832.01,,,,,,,257.45,13462.44,fee schedule,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,outpatient,1,EA,8055.92000,7653.13000,The Alliance,Premier SAS,,67.00,,,,,,,41.85,7814.24,fee schedule,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Premier SAS,,331.90,,,,,,,29.35,2438.99,fee schedule,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,,99.76,,,,,,,79.75,5271.00,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier SAS,,17.27,,,,,,,1.44,17.80,fee schedule,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,outpatient,10,EA,9.15000,8.69000,The Alliance,Premier SAS,,17.27,,,,,,,4.58,17.80,fee schedule,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,outpatient,10,EA,2.40000,2.28000,The Alliance,Premier SAS,,17.27,,,,,,,1.20,17.80,fee schedule,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,outpatient,1,EA,11830.90000,11239.36000,The Alliance,Premier SAS,,67.00,,,,,,,41.85,11475.97,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,outpatient,1,mL,3.81000,3.62000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,3.70,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,outpatient,1,mL,9.01000,8.56000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,8.74,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,outpatient,1,mL,6.38000,6.06000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,6.19,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,outpatient,1,mL,8.10000,7.70000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,7.86,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,outpatient,1,mL,8.22000,7.81000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,7.97,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,outpatient,1,mL,13.15000,12.49000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,12.76,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,3.71,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,outpatient,1,mL,4.27000,4.05000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,4.14,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,outpatient,1,mL,10.65000,10.12000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,10.33,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,outpatient,1,mL,9.45000,8.98000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,9.17,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.82,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,outpatient,1,mL,4.98000,4.73000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,4.83,fee schedule,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,outpatient,1,mL,12.17000,11.56000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,11.80,fee schedule,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier SAS,,110.89,,,,,,,15.59,814.87,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,outpatient,0.4,EA,241.18000,229.12000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,233.94,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,outpatient,0.4,EA,113.78000,108.09000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,110.37,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,outpatient,0.4,EA,261.30000,248.24000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,253.46,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,outpatient,0.4,EA,47.40000,45.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,outpatient,0.4,EA,26.46000,25.14000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,25.67,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,outpatient,0.4,EA,57.90000,55.00000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,56.16,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,outpatient,0.4,EA,70.55000,67.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.43,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,outpatient,0.4,EA,86.73000,82.39000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,84.13,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,outpatient,0.4,EA,61.62000,58.54000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,59.77,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,outpatient,0.4,EA,44.40000,42.18000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,43.07,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,outpatient,0.4,EA,62.73000,59.59000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.85,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,outpatient,0.4,EA,31.68000,30.10000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.73,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,outpatient,0.4,EA,29.07000,27.62000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,28.20,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,outpatient,0.4,EA,25.09000,23.84000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,24.34,fee schedule,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,outpatient,0.4,EA,36.34000,34.52000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,35.25,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,outpatient,1,EA,78.48000,74.56000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,76.13,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,outpatient,1,EA,67.53000,64.15000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,65.50,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,outpatient,1,EA,47.40000,45.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,45.98,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,outpatient,1,EA,31.73000,30.14000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.78,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,outpatient,1,EA,62.82000,59.68000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.94,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,outpatient,1,EA,70.63000,67.10000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.51,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,20.42,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,outpatient,1,EA,60.99000,57.94000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,59.16,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,outpatient,1,EA,27.71000,26.33000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,26.88,fee schedule,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,28.57,fee schedule,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,outpatient,28.35,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,outpatient,28.35,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,outpatient,28.35,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,outpatient,28.35,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier SAS,,135.54,,,,,,,98.50,212.44,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,outpatient,1,EA,30.18000,28.68000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,29.27,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,outpatient,1,EA,50.50000,47.97000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,48.98,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,33.72,fee schedule,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,30.65,fee schedule,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Premier SAS,90,57.75,,,,,,,5.90,424.40,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,outpatient,5,EA,6.78000,6.44000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,6.58,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,outpatient,5,EA,5.95000,5.66000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.77,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,outpatient,5,EA,4.35000,4.14000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,4.22,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,outpatient,5,EA,8.78000,8.35000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,8.52,fee schedule,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,143.79,,,,,,,104.50,212.44,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,outpatient,1,mL,1728.59000,1642.16000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,1676.73,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,outpatient,1,mL,1728.57000,1642.14000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,1676.71,fee schedule,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Premier SAS,TC,413.53,,,,,,,215.60,3038.81,fee schedule,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,outpatient,1,mL,5.66000,5.38000,The Alliance,Premier SAS,,37.62,,,,,,,2.83,40.87,fee schedule,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,outpatient,,,476.00000,452.20000,The Alliance,Premier SAS,TC,532.13,,,,,,,238.00,3910.35,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,outpatient,1,mL,52.80000,50.16000,The Alliance,Premier SAS,,2.39,,,,,,,1.42,51.22,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,outpatient,1,mL,49.77000,47.28000,The Alliance,Premier SAS,,2.39,,,,,,,1.42,48.28,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,outpatient,20,EA,1.16000,1.10000,The Alliance,Premier SAS,,12.78,,,,,,,0.58000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,outpatient,20,EA,1.10000,1.04000,The Alliance,Premier SAS,,12.78,,,,,,,0.55000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,outpatient,20,EA,1.08000,1.03000,The Alliance,Premier SAS,,12.78,,,,,,,0.54000,13.53,fee schedule,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,outpatient,20,EA,1.02000,0.97000,The Alliance,Premier SAS,,12.78,,,,,,,0.51000,13.53,fee schedule,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Premier SAS,,241.49,,,,,,,175.50,340.47,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,outpatient,,,839.00000,797.05000,The Alliance,Premier SAS,TC,881.77,,,,,,,419.50,6479.64,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,15.73,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,outpatient,1,EA,6.66000,6.33000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,6.46,fee schedule,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier SAS,,687.31,,,,,,,549.45,5271.00,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,outpatient,1,mL,292.42000,277.80000,The Alliance,Premier SAS,,1.83,,,,,,,1.14,283.65,fee schedule,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier SAS,,499.01,,,,,,,50.62,3666.93,fee schedule,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,outpatient,,,283.00000,268.85000,The Alliance,Premier SAS,90,173.27,,,,,,,25.18,1273.27,fee schedule,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,outpatient,,,545.00000,517.75000,The Alliance,Premier SAS,,374.96,,,,,,,299.75,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,outpatient,0.8,EA,261.61000,248.53000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,253.76,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,outpatient,0.8,EA,67.52000,64.14000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,65.49,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,outpatient,0.8,EA,37.92000,36.02000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,36.78,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,outpatient,0.8,EA,31.72000,30.13000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.77,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,outpatient,0.8,EA,62.80000,59.66000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.92,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,outpatient,0.8,EA,70.63000,67.09000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.51,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,outpatient,0.8,EA,235.19000,223.43000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,228.13,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,outpatient,0.8,EA,62.41000,59.29000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.54,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,outpatient,0.8,EA,44.40000,42.18000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,43.07,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,outpatient,0.8,EA,20.30000,19.28000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,19.69,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,outpatient,0.8,EA,29.23000,27.77000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,28.35,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,outpatient,0.8,EA,56.88000,54.04000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,55.17,fee schedule,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,outpatient,0.8,EA,32.39000,30.77000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,31.42,fee schedule,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier SAS,,2.63,,,,,,,2.48,16.43,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,outpatient,1,mL,1720.49000,1634.47000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,1668.88,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,outpatient,1,mL,1720.50000,1634.48000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,1668.88,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.80050,,,,,,,0.05000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.80050,,,,,,,0.10000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.80050,,,,,,,0.13000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,outpatient,100,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.80050,,,,,,,0.05000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,outpatient,100,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.80050,,,,,,,0.13000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.80050,,,,,,,0.10000,0.82500,fee schedule,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,TC,580.65,,,,,,,256.50,4266.89,fee schedule,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,outpatient,1,EA,953.25000,905.59000,The Alliance,Premier SAS,,625.57,,,,,,,390.74,924.65,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,outpatient,0.6,EA,261.61000,248.53000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,253.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,outpatient,0.6,EA,67.53000,64.16000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,65.50,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,outpatient,0.6,EA,47.40000,45.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,outpatient,0.6,EA,31.60000,30.02000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.65,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,outpatient,0.6,EA,62.83000,59.69000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.95,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,outpatient,0.6,EA,70.64000,67.10000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.52,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,outpatient,0.6,EA,62.15000,59.04000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.29,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,outpatient,0.6,EA,28.28000,26.87000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,27.43,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,outpatient,0.6,EA,30.65000,29.12000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,29.73,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,outpatient,0.6,EA,31.71000,30.12000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,outpatient,0.6,EA,62.82000,59.68000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.94,fee schedule,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,outpatient,0.6,EA,30.55000,29.02000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,29.63,fee schedule,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,outpatient,,,991.00000,941.45000,The Alliance,Premier SAS,TC,864.81,,,,,,,495.50,6355.04,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,outpatient,0.3,EA,261.31000,248.25000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,253.47,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,outpatient,0.3,EA,67.57000,64.19000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,65.54,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,outpatient,0.3,EA,47.40000,45.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,45.98,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,outpatient,0.3,EA,21.55000,20.47000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,20.90,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,outpatient,0.3,EA,62.88000,59.74000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,60.99,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,outpatient,0.3,EA,21.57000,20.49000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,20.92,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,outpatient,0.3,EA,102.07000,96.96000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,99.01,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,outpatient,0.3,EA,31.71000,30.12000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,30.76,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,outpatient,0.3,EA,29.18000,27.72000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,28.30,fee schedule,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,outpatient,0.3,EA,29.17000,27.71000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,28.29,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,outpatient,10,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.88270,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.08,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,outpatient,10,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.11,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,outpatient,10,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.35222,,,,,,,0.28000,0.54320,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,outpatient,10,EA,2.30000,2.18000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,2.23,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,outpatient,10,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.82450,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,outpatient,10,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.65960,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,outpatient,10,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.14,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,outpatient,10,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.27,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,outpatient,10,EA,1.25000,1.19000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.21,fee schedule,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,outpatient,10,EA,1.56000,1.49000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,1.51,fee schedule,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,111.46,,,,,,,67.58,157.14,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,787.18,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,787.18,fee schedule,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,outpatient,2,EA,56.10000,53.30000,The Alliance,Premier SAS,,28.87,,,,,,,18.03,54.42,fee schedule,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,outpatient,2,EA,41.90000,39.81000,The Alliance,Premier SAS,,28.87,,,,,,,18.03,40.64,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,outpatient,1,EA,387.20000,367.84000,The Alliance,Premier SAS,,155.41,,,,,,,132.91,375.58,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,outpatient,1,EA,340.20000,323.19000,The Alliance,Premier SAS,,155.41,,,,,,,132.91,329.99,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,outpatient,1,EA,323.19000,307.03000,The Alliance,Premier SAS,,155.41,,,,,,,132.91,313.49,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,outpatient,1,EA,323.18000,307.02000,The Alliance,Premier SAS,,155.41,,,,,,,132.91,313.48,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,outpatient,1,EA,266.10000,252.80000,The Alliance,Premier SAS,,155.41,,,,,,,132.91,258.12,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier SAS,,155.41,,,,,,,7.59,160.17,fee schedule,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,outpatient,1,EA,209.51000,199.03000,The Alliance,Premier SAS,,155.41,,,,,,,104.75,203.22,fee schedule,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,outpatient,1,mL,2.31000,2.19000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,2.24,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier SAS,,0.80050,,,,,,,0.05500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.80050,,,,,,,0.10000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.80050,,,,,,,0.12500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.80050,,,,,,,0.06000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.80050,,,,,,,0.12500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.80050,,,,,,,0.05500,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.80050,,,,,,,0.10000,0.82500,fee schedule,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,0.80050,,,,,,,0.09000,0.82500,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,45.98,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,outpatient,1,mL,502.21000,477.10000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,487.14,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,107.28,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,outpatient,1,mL,433.92000,412.22000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,420.90,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,outpatient,1,mL,205.40000,195.13000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,199.24,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,61.30,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,outpatient,1,mL,420.23000,399.22000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,407.62,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,251.23,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,outpatient,1,mL,451.99000,429.39000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,438.43,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,outpatient,1,mL,268.60000,255.17000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,260.54,fee schedule,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,outpatient,1,mL,58.46000,55.54000,The Alliance,Premier SAS,,11.17,,,,,,,6.98,56.71,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,outpatient,1,EA,815.41000,774.64000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,790.95,fee schedule,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,outpatient,1,EA,815.42000,774.65000,The Alliance,Premier SAS,,1.58,,,,,,,0.99000,790.96,fee schedule,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier SAS,,97.03,,,,,,,13.55,713.01,fee schedule,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,outpatient,1,mL,2952.26000,2804.64000,The Alliance,Premier SAS,,93.75,,,,,,,58.56,2863.69,fee schedule,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,outpatient,1,mL,3195.57000,3035.80000,The Alliance,Premier SAS,,93.75,,,,,,,58.56,3099.70,fee schedule,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier SAS,,52.83,,,,,,,33.00,783.52,fee schedule,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,outpatient,,,830.00000,788.50000,The Alliance,Premier SAS,TC,666.13,,,,,,,370.62,4895.01,fee schedule,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,outpatient,1,EA,250.17000,237.66000,The Alliance,Premier SAS,,172.12,,,,,,,7.86,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,outpatient,1,EA,295.08000,280.33000,The Alliance,Premier SAS,,203.02,,,,,,,7.86,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,outpatient,1,EA,351.81000,334.22000,The Alliance,Premier SAS,,242.05,,,,,,,7.86,341.26,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,outpatient,1,EA,321.74000,305.65000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,312.09,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,outpatient,1,EA,101.28000,96.21000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,98.24,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.97,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,outpatient,1,EA,94.20000,89.49000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,91.37,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,outpatient,1,EA,92.59000,87.96000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,89.81,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,outpatient,1,EA,47.59000,45.21000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,46.16,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,outpatient,1,EA,44.11000,41.91000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,42.79,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,outpatient,1,EA,105.99000,100.69000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,102.81,fee schedule,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,53.64,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,outpatient,10,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.57230,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,outpatient,10,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.67900,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,outpatient,10,EA,0.04000,0.03000,The Alliance,Premier SAS,,0.25616,,,,,,,0.02000,0.26400,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,outpatient,10,EA,1.80000,1.71000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.75,fee schedule,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,outpatient,1,mL,669.00000,635.55000,The Alliance,Premier SAS,,104.48,,,,,,,65.26,648.93,fee schedule,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,outpatient,1,mL,507.12000,481.77000,The Alliance,Premier SAS,,104.48,,,,,,,65.26,491.91,fee schedule,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier SAS,,105.95,,,,,,,84.70,5271.00,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,outpatient,2,EA,1.82000,1.73000,The Alliance,Premier SAS,,0.80050,,,,,,,0.76570,1.77,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,outpatient,2,EA,2.50000,2.37000,The Alliance,Premier SAS,,0.80050,,,,,,,0.76570,2.42,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,outpatient,2,EA,1.77000,1.68000,The Alliance,Premier SAS,,0.80050,,,,,,,0.76570,1.72,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,outpatient,2,EA,1.90000,1.80000,The Alliance,Premier SAS,,0.80050,,,,,,,0.76570,1.84,fee schedule,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,outpatient,2,EA,26.78000,25.44000,The Alliance,Premier SAS,,18.42,,,,,,,13.39,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,outpatient,2,EA,49.77000,47.28000,The Alliance,Premier SAS,,34.24,,,,,,,14.28,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,outpatient,2,EA,49.53000,47.06000,The Alliance,Premier SAS,,34.08,,,,,,,14.28,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,outpatient,2,EA,24.89000,23.64000,The Alliance,Premier SAS,,17.12,,,,,,,12.45,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,outpatient,2,EA,52.14000,49.53000,The Alliance,Premier SAS,,35.87,,,,,,,14.28,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,outpatient,2,EA,20.48000,19.45000,The Alliance,Premier SAS,,14.09,,,,,,,10.24,19.87,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,outpatient,5,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.62080,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,outpatient,5,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.59170,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,outpatient,5,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.85360,fee schedule,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,outpatient,5,EA,1.79000,1.71000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.74,fee schedule,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier SAS,,65.96,,,,,,,64.92,178.48,fee schedule,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,outpatient,1,mL,137.46000,130.59000,The Alliance,Premier SAS,,15.58,,,,,,,9.73,133.34,fee schedule,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,0.80050,,,,,,,0.29500,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier SAS,,0.80050,,,,,,,0.62000,1.20,fee schedule,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,outpatient,1,EA,2685.99000,2551.69000,The Alliance,Premier SAS,,49.92,,,,,,,31.18,2605.41,fee schedule,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,outpatient,1,EA,1230.25000,1168.74000,The Alliance,Premier SAS,,49.92,,,,,,,31.18,1193.34,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,outpatient,100,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.27217,,,,,,,0.05500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.27217,,,,,,,0.08000,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,outpatient,100,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.27217,,,,,,,0.08500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,outpatient,10,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,0.91180,fee schedule,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,outpatient,10,EA,0.55000,0.53000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,0.53350,fee schedule,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,outpatient,1,mL,22.86000,21.72000,The Alliance,Premier SAS,,15.73,,,,,,,1.49,22.17,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,outpatient,1,mL,0.02000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,outpatient,,,403.00000,382.85000,The Alliance,Premier SAS,,277.26,,,,,,,221.65,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,outpatient,0.8,EA,117.76000,111.87000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,114.23,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,outpatient,0.8,EA,101.27000,96.21000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,98.23,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,outpatient,0.8,EA,71.10000,67.54000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,68.97,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,outpatient,0.8,EA,94.21000,89.50000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,91.38,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,outpatient,0.8,EA,289.24000,274.78000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,280.56,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,outpatient,0.8,EA,93.61000,88.93000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,90.80,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,outpatient,0.8,EA,47.60000,45.22000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,46.17,fee schedule,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,outpatient,0.8,EA,43.81000,41.62000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,42.50,fee schedule,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,outpatient,20,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,0.77600,fee schedule,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,outpatient,20,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.27217,,,,,,,0.18000,0.34920,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.41,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.99910,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.84390,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,outpatient,1,mL,1.80000,1.71000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.75,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,outpatient,1,mL,0.74000,0.71000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.71780,fee schedule,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,24.52,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,outpatient,10,EA,2.14000,2.03000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,2.08,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,outpatient,10,EA,2.18000,2.07000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,2.11,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,outpatient,10,EA,3.65000,3.46000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,3.54,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,outpatient,10,EA,1.69000,1.61000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.64,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,outpatient,10,EA,1.86000,1.77000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.80,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,outpatient,10,EA,2.91000,2.76000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,2.82,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,outpatient,10,EA,8.76000,8.32000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,8.50,fee schedule,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,outpatient,10,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.52380,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,outpatient,1,EA,11.45000,10.87000,The Alliance,Premier SAS,,5.62,,,,,,,4.77,11.11,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Premier SAS,,5.62,,,,,,,4.77,11.00,fee schedule,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,outpatient,1,EA,19.55000,18.57000,The Alliance,Premier SAS,,5.62,,,,,,,4.77,18.96,fee schedule,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,outpatient,1,EA,50.02000,47.52000,The Alliance,Premier SAS,,34.41,,,,,,,14.28,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,outpatient,1,EA,49.26000,46.80000,The Alliance,Premier SAS,,33.89,,,,,,,14.28,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,outpatient,1,EA,48.79000,46.35000,The Alliance,Premier SAS,,33.57,,,,,,,14.28,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,14.28,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,outpatient,1,EA,41.38000,39.31000,The Alliance,Premier SAS,,28.47,,,,,,,14.28,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,outpatient,1,EA,47.98000,45.58000,The Alliance,Premier SAS,,33.01,,,,,,,14.28,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,outpatient,1,EA,34.71000,32.97000,The Alliance,Premier SAS,,23.88,,,,,,,14.28,33.67,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,outpatient,2,EA,2.14000,2.04000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,2.08,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,outpatient,2,EA,1.47000,1.40000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.43,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,outpatient,2,EA,1.43000,1.36000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.39,fee schedule,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,outpatient,2,EA,1.98000,1.88000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.92,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,outpatient,2,EA,61.91000,58.82000,The Alliance,Premier SAS,,27.65,,,,,,,25.99,60.05,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,outpatient,2,EA,94.80000,90.06000,The Alliance,Premier SAS,,27.65,,,,,,,25.99,91.96,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,outpatient,2,EA,74.26000,70.55000,The Alliance,Premier SAS,,27.65,,,,,,,25.99,72.03,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,outpatient,2,EA,86.90000,82.56000,The Alliance,Premier SAS,,27.65,,,,,,,25.99,84.29,fee schedule,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,outpatient,2,EA,184.58000,175.35000,The Alliance,Premier SAS,,27.65,,,,,,,25.99,179.04,fee schedule,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,outpatient,1,EA,1642.06000,1559.96000,The Alliance,Premier SAS,,10.41,,,,,,,6.50,1592.80,fee schedule,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,outpatient,1,EA,1556.59000,1478.76000,The Alliance,Premier SAS,,10.41,,,,,,,6.50,1509.89,fee schedule,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier SAS,,12.78,,,,,,,0.25000,13.53,fee schedule,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,12.78,,,,,,,0.09000,13.53,fee schedule,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier SAS,,612.21,,,,,,,95.80,4498.77,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,outpatient,30,EA,0.66000,0.62000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33000,0.64020,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.35222,,,,,,,0.30500,0.59170,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.69840,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,outpatient,30,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.72750,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,outpatient,30,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,0.74690,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,outpatient,30,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.35222,,,,,,,0.30500,0.59170,fee schedule,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,outpatient,1,mL,14.09000,13.39000,The Alliance,Premier SAS,,9.69,,,,,,,1.49,13.67,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,outpatient,1,EA,2916.40000,2770.58000,The Alliance,Premier SAS,,10.41,,,,,,,6.50,2828.91,fee schedule,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Premier SAS,,3844.00,,,,,,,515.90,4686.00,case rate,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier SAS,,172.69,,,,,,,125.50,419.70,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Premier SAS,,11063.00,,,,,,,1071.95,16988.00,case rate,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.50440,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,outpatient,1,mL,0.31000,0.30000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.30070,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.36860,fee schedule,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,outpatient,3,EA,46.99000,44.64000,The Alliance,Premier SAS,,32.33,,,,,,,1.49,45.58,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Premier SAS,TC,2394.24,,,,,,,1609.99,3375.60,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Premier SAS,,21.36,,,,,,,13.34,1564.21,fee schedule,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,44.03,,,,,,,32.00,134.64,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,outpatient,1,mL,1294.64000,1229.91000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1255.80,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,outpatient,1,mL,1215.93000,1155.13000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1179.45,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,outpatient,1,mL,1294.63000,1229.90000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1255.79,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,outpatient,1,mL,1544.61000,1467.38000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1498.27,fee schedule,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,outpatient,1,mL,1544.29000,1467.07000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1497.96,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,outpatient,5,EA,6.69000,6.35000,The Alliance,Premier SAS,,2.63,,,,,,,2.17,6.49,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,outpatient,5,EA,4.17000,3.96000,The Alliance,Premier SAS,,2.63,,,,,,,2.08,4.04,fee schedule,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,outpatient,5,EA,3.69000,3.50000,The Alliance,Premier SAS,,2.63,,,,,,,1.84,3.58,fee schedule,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,outpatient,10,EA,26.99000,25.64000,The Alliance,Premier SAS,,18.57,,,,,,,1.49,26.18,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,outpatient,1,EA,8.99000,8.54000,The Alliance,Premier SAS,,6.19,,,,,,,4.50,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,outpatient,1,mL,1294.27000,1229.56000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1255.44,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,outpatient,1,mL,1275.16000,1211.40000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1236.91,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,outpatient,1,mL,1294.29000,1229.58000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1255.46,fee schedule,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,outpatient,1,mL,1551.93000,1474.33000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,1505.37,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,outpatient,50,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.80050,,,,,,,0.14000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.80050,,,,,,,0.40000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,outpatient,50,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.80050,,,,,,,0.51000,0.98940,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,outpatient,50,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.80050,,,,,,,0.53000,1.03,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.80050,,,,,,,0.21500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,outpatient,50,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.80050,,,,,,,0.50500,0.97970,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,outpatient,50,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.80050,,,,,,,0.30500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.80050,,,,,,,0.40000,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,outpatient,50,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.80050,,,,,,,0.39500,0.82500,fee schedule,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,outpatient,50,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.80050,,,,,,,0.16500,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,outpatient,1,mL,5.23000,4.97000,The Alliance,Premier SAS,,0.80050,,,,,,,0.76570,5.07,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier SAS,,0.80050,,,,,,,0.35000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,outpatient,1,mL,0.69000,0.65000,The Alliance,Premier SAS,,0.80050,,,,,,,0.34500,0.82500,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,558.11000,530.20000,The Alliance,Premier SAS,,256.17,,,,,,,256.17,558.11,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,909.00,,,,,,,59.40,3163.00,case rate,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,outpatient,,,635.00000,603.25000,The Alliance,Premier SAS,,436.88,,,,,,,288.84,615.95,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,outpatient,1,mL,1885.86000,1791.57000,The Alliance,Premier SAS,,293.64,,,,,,,183.41,1829.28,fee schedule,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,outpatient,3,EA,14.09000,13.39000,The Alliance,Premier SAS,,9.69,,,,,,,1.49,13.67,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier SAS,,150.17,,,,,,,21.26,1103.49,fee schedule,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,outpatient,10,EA,22.86000,21.72000,The Alliance,Premier SAS,,15.73,,,,,,,1.49,22.17,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Premier SAS,,9.70,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier SAS,,10.48,,,,,,,1.49,14.77,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,outpatient,,,248.60000,236.17000,The Alliance,Premier SAS,90,152.47,,,,,,,22.12,1120.45,fee schedule,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,The Alliance,Premier SAS,,2.07,,,,,,,1.50,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier SAS,,1.89,,,,,,,1.38,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.12,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier SAS,,2.20,,,,,,,1.60,3.10,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,outpatient,1,mL,23.59000,22.41000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,22.88,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,12.26,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,outpatient,1,mL,19.38000,18.41000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,18.80,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,outpatient,1,mL,22.31000,21.19000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,21.64,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,outpatient,1,mL,16.43000,15.61000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,15.94,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,outpatient,1,mL,19.00000,18.05000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,18.43,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,2.24,,,,,,,2.21,4.29,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,outpatient,1,mL,12.56000,11.93000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,12.18,fee schedule,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,outpatient,1,mL,21.49000,20.41000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,20.85,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,outpatient,2,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.62439,,,,,,,0.14500,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,outpatient,2,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.62439,,,,,,,0.11000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,outpatient,2,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.62439,,,,,,,0.16000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,outpatient,2,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.62439,,,,,,,0.19000,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,outpatient,2,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.62439,,,,,,,0.25500,0.64350,fee schedule,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,outpatient,2,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.62439,,,,,,,0.19500,0.64350,fee schedule,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,outpatient,1,mL,362.60000,344.47000,The Alliance,Premier SAS,,249.47,,,,,,,7.86,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,outpatient,1,mL,325.82000,309.53000,The Alliance,Premier SAS,,224.16,,,,,,,7.86,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,outpatient,1,mL,577.02000,548.17000,The Alliance,Premier SAS,,396.99,,,,,,,7.86,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,outpatient,1,mL,458.13000,435.23000,The Alliance,Premier SAS,,315.19,,,,,,,7.86,444.39,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier SAS,,52.83,,,,,,,33.00,783.52,fee schedule,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,outpatient,1,EA,6883.45000,6539.28000,The Alliance,Premier SAS,,50.16,,,,,,,31.33,6676.95,fee schedule,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,outpatient,1,EA,7635.88000,7254.08000,The Alliance,Premier SAS,,50.16,,,,,,,31.33,7406.80,fee schedule,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,112.14,,,,,,,56.40,158.11,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,outpatient,,,552.00000,524.40000,The Alliance,Premier SAS,,379.78,,,,,,,303.60,5271.00,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,outpatient,10,EA,4.27000,4.05000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,4.14,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,outpatient,10,EA,16.43000,15.61000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,15.94,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,outpatient,10,EA,20.84000,19.80000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,20.21,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,outpatient,10,EA,18.64000,17.71000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,18.08,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,outpatient,10,EA,15.01000,14.26000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,14.56,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,outpatient,10,EA,13.43000,12.76000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,13.03,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,outpatient,10,EA,19.09000,18.14000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,18.52,fee schedule,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,outpatient,5,EA,927.28000,880.91000,The Alliance,Premier SAS,,637.97,,,,,,,463.64,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,outpatient,5,EA,30.66000,29.13000,The Alliance,Premier SAS,,21.09,,,,,,,15.33,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,outpatient,5,EA,118.23000,112.32000,The Alliance,Premier SAS,,81.34,,,,,,,59.12,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,outpatient,5,EA,310.80000,295.26000,The Alliance,Premier SAS,,213.83,,,,,,,155.40,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,outpatient,5,EA,88.48000,84.06000,The Alliance,Premier SAS,,60.87,,,,,,,44.24,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,outpatient,5,EA,673.40000,639.73000,The Alliance,Premier SAS,,463.30,,,,,,,336.70,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,outpatient,5,EA,151.68000,144.10000,The Alliance,Premier SAS,,104.36,,,,,,,75.84,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,outpatient,5,EA,569.80000,541.31000,The Alliance,Premier SAS,,392.02,,,,,,,284.90,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,outpatient,5,EA,44.24000,42.03000,The Alliance,Premier SAS,,30.44,,,,,,,22.12,42.91,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,93.57,,,,,,,68.00,131.92,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.35222,,,,,,,0.01000,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.35222,,,,,,,0.01500,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.35222,,,,,,,0.02000,0.36520,fee schedule,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.35222,,,,,,,0.01500,0.36520,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.80050,,,,,,,0.02000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier SAS,,0.80050,,,,,,,0.02000,0.82500,fee schedule,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.80050,,,,,,,0.02000,0.82500,fee schedule,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier SAS,,1.64,,,,,,,1.20,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier SAS,,1.51,,,,,,,1.10,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,outpatient,,,163.90000,155.70000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,outpatient,1,mL,23.97000,22.77000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,23.25,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,outpatient,1,mL,23.98000,22.79000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,23.26,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,outpatient,1,mL,23.26000,22.09000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,22.56,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,outpatient,1,mL,27.13000,25.77000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,26.32,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,outpatient,1,mL,34.13000,32.42000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,33.11,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,outpatient,1,mL,22.97000,21.82000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,22.28,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,outpatient,1,mL,19.50000,18.52000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,18.91,fee schedule,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,24.52,fee schedule,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.07,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,outpatient,1,mL,2209.91000,2099.41000,The Alliance,Premier SAS,,293.64,,,,,,,183.41,2143.61,fee schedule,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,outpatient,1,EA,3.06000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,outpatient,1,EA,3.05000,2.89000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,outpatient,1,EA,3.04000,2.88000,The Alliance,Premier SAS,,2.09,,,,,,,1.52,2.95,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,outpatient,10,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,outpatient,10,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,outpatient,10,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,outpatient,10,EA,1.68000,1.59000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,outpatient,10,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,outpatient,10,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,outpatient,10,EA,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.63,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,outpatient,0.6,EA,20323.63000,19307.45000,The Alliance,Premier SAS,,93.50,,,,,,,30.97,19713.92,fee schedule,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.84,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,outpatient,1,EA,6.04000,5.73000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.86,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,outpatient,1,EA,9.51000,9.03000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,9.22,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,4.55,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,outpatient,1,EA,3.35000,3.18000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.25,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,1.66,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,10.36,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.22,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.52,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,11.49,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,2.42,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,4.29,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.71,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,outpatient,1,EA,5.91000,5.62000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.73,fee schedule,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.01,fee schedule,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,outpatient,5,EA,38.69000,36.76000,The Alliance,Premier SAS,,0.35222,,,,,,,0.35222,37.53,fee schedule,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,outpatient,5,EA,23.26000,22.09000,The Alliance,Premier SAS,,0.35222,,,,,,,0.35222,22.56,fee schedule,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,,85.31,,,,,,,43.81,120.28,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier SAS,,101.14,,,,,,,43.81,142.59,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,outpatient,1,EA,115.64000,109.85000,The Alliance,Premier SAS,,79.56,,,,,,,57.82,112.17,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,outpatient,3,EA,20.98000,19.93000,The Alliance,Premier SAS,,14.43,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,outpatient,3,EA,41.32000,39.26000,The Alliance,Premier SAS,,28.43,,,,,,,1.49,40.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,outpatient,20,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.62439,,,,,,,0.55500,1.08,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,outpatient,20,EA,0.63000,0.59000,The Alliance,Premier SAS,,0.62439,,,,,,,0.31500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,outpatient,20,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.62439,,,,,,,0.26500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,outpatient,20,EA,3.95000,3.75000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,3.83,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,outpatient,20,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.62439,,,,,,,0.16000,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,outpatient,20,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.62439,,,,,,,0.16500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,outpatient,20,EA,1.74000,1.65000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,1.69,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.62439,,,,,,,0.39500,0.76630,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,outpatient,20,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,1.22,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,outpatient,20,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.62439,,,,,,,0.49500,0.96030,fee schedule,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,outpatient,,,218.00000,207.10000,The Alliance,Premier SAS,,149.98,,,,,,,109.00,211.46,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,outpatient,10,EA,20.31000,19.29000,The Alliance,Premier SAS,,13.97,,,,,,,1.49,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,outpatient,10,EA,89.60000,85.12000,The Alliance,Premier SAS,,61.64,,,,,,,1.49,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,outpatient,10,EA,35.84000,34.05000,The Alliance,Premier SAS,,24.66,,,,,,,1.49,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,outpatient,10,EA,31.17000,29.61000,The Alliance,Premier SAS,,21.44,,,,,,,1.49,30.23,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,outpatient,1,EA,2.49000,2.37000,The Alliance,Premier SAS,,1.71,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Premier SAS,,1.93,,,,,,,1.40,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier SAS,,0.98384,,,,,,,0.71500,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,58.48,,,,,,,42.50,82.45,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier SAS,,35.32,,,,,,,5.00,36.40,fee schedule,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,outpatient,1,EA,16466.50000,15643.18000,The Alliance,Premier SAS,,35.32,,,,,,,22.06,15972.50,fee schedule,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,outpatient,,,467.00000,443.65000,The Alliance,Premier SAS,,909.00,,,,,,,230.94,3163.00,case rate,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier SAS,,138.29,,,,,,,67.58,194.97,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier SAS,,85.48,,,,,,,12.11,628.12,fee schedule,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier SAS,,80.86,,,,,,,11.43,594.19,fee schedule,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,43.81,97.00,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,outpatient,1,mL,20323.63000,19307.45000,The Alliance,Premier SAS,,93.50,,,,,,,30.97,19713.92,fee schedule,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Premier SAS,,2237.87,,,,,,,162.71,16444.87,fee schedule,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Premier SAS,TC,915.73,,,,,,,644.24,2960.49,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,62.38,,,,,,,8.74,458.40,fee schedule,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,outpatient,,,317.00000,301.15000,The Alliance,Premier SAS,,218.10,,,,,,,158.50,307.49,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,outpatient,,,754.00000,716.30000,The Alliance,Premier SAS,,518.75,,,,,,,414.70,5271.00,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,outpatient,2.5,EA,179.56000,170.58000,The Alliance,Premier SAS,,123.54,,,,,,,89.78,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,outpatient,2.5,EA,273.80000,260.11000,The Alliance,Premier SAS,,188.37,,,,,,,136.90,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,outpatient,2.5,EA,15.17000,14.41000,The Alliance,Premier SAS,,10.44,,,,,,,7.58,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,outpatient,2.5,EA,19.66000,18.67000,The Alliance,Premier SAS,,13.53,,,,,,,9.83,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,outpatient,2.5,EA,22.75000,21.61000,The Alliance,Premier SAS,,15.65,,,,,,,11.38,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,outpatient,2.5,EA,13.13000,12.48000,The Alliance,Premier SAS,,9.03,,,,,,,6.57,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,outpatient,2.5,EA,13.52000,12.85000,The Alliance,Premier SAS,,9.30,,,,,,,6.76,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,outpatient,2.5,EA,16.94000,16.09000,The Alliance,Premier SAS,,11.65,,,,,,,8.47,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,outpatient,2.5,EA,6.26000,5.94000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.07,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,30.03,,,,,,,4.27,220.68,fee schedule,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,57.75,,,,,,,8.17,424.40,fee schedule,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,The Alliance,Premier SAS,,257.31,,,,,,,187.00,362.78,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,outpatient,2,EA,5.17000,4.91000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.01,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,outpatient,2,EA,8.90000,8.45000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,8.63,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,outpatient,2,EA,11.36000,10.79000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,11.02,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,outpatient,2,EA,1.63000,1.55000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,1.58,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.07,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,outpatient,2,EA,2.24000,2.13000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,2.17,fee schedule,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,1.90,fee schedule,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,outpatient,,,1064.00000,1010.80000,The Alliance,Premier SAS,90,651.48,,,,,,,94.71,4787.38,fee schedule,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Premier SAS,,85.02,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,outpatient,1,EA,6.12000,5.82000,The Alliance,Premier SAS,,4.21,,,,,,,3.06,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,The Alliance,Premier SAS,,11.45,,,,,,,8.32,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,outpatient,1,EA,8.09000,7.69000,The Alliance,Premier SAS,,5.57,,,,,,,4.04,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,outpatient,,,1733.00000,1646.35000,The Alliance,Premier SAS,TC,1192.30,,,,,,,811.39,2210.07,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier SAS,,310.98,,,,,,,200.06,438.44,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,outpatient,1,EA,73.95000,70.25000,The Alliance,Premier SAS,,50.88,,,,,,,36.98,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,outpatient,1,EA,1114.87000,1059.12000,The Alliance,Premier SAS,,767.03,,,,,,,557.43,1081.42,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Premier SAS,TC,1482.64,,,,,,,1006.74,2960.49,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,outpatient,4,EA,7.18000,6.82000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,6.96,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,outpatient,4,EA,3.33000,3.17000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,3.23,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,outpatient,4,EA,2.15000,2.04000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,2.09,fee schedule,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,72.93,,,,,,,53.00,102.82,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,outpatient,1,EA,9777.53000,9288.66000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,9484.20,fee schedule,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier SAS,,7.59,,,,,,,5.51,10.70,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,outpatient,,,181.10000,172.04000,The Alliance,Premier SAS,90,108.58,,,,,,,15.81,797.91,fee schedule,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,outpatient,,,1949.00000,1851.55000,The Alliance,Premier SAS,,11063.00,,,,,,,1071.95,16988.00,case rate,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,outpatient,1,mL,5.25000,4.98000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,outpatient,1,mL,5.18000,4.92000,The Alliance,Premier SAS,,3.56,,,,,,,2.59,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,outpatient,1,mL,6.24000,5.93000,The Alliance,Premier SAS,,4.29,,,,,,,3.12,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier SAS,90,138.61,,,,,,,16.82,1018.59,fee schedule,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,outpatient,1,EA,43.58000,41.40000,The Alliance,Premier SAS,,29.98,,,,,,,21.79,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,outpatient,1,EA,47.47000,45.10000,The Alliance,Premier SAS,,32.66,,,,,,,23.73,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,outpatient,1,EA,19.63000,18.64000,The Alliance,Premier SAS,,13.51,,,,,,,9.81,19.04,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,outpatient,1,EA,82.16000,78.05000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,79.70,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,outpatient,1,EA,59.88000,56.89000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,58.08,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,outpatient,1,EA,221.20000,210.14000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,214.56,fee schedule,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,outpatient,1,EA,55.62000,52.84000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,53.95,fee schedule,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,outpatient,1,EA,1.83000,1.73000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,outpatient,1,EA,2.94000,2.80000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,442.00000,419.90000,The Alliance,Premier SAS,,304.10,,,,,,,172.82,489.94,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,outpatient,1,EA,5.53000,5.25000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.36,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,11.15,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,outpatient,1,EA,20.63000,19.60000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,20.01,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,4.85,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,outpatient,1,EA,3.57000,3.39000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.46,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,13.79,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,5.82,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,15.33,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,2.67,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,4.78,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,4.07,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,outpatient,1,EA,3.54000,3.36000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,3.43,fee schedule,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier SAS,,0.56035,,,,,,,0.33000,10.42,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,30.65,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,outpatient,1,EA,75.84000,72.05000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,73.56,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,122.61,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,outpatient,1,EA,48.66000,46.23000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,47.20,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,outpatient,1,EA,72.87000,69.23000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,70.68,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,outpatient,1,EA,66.55000,63.22000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,64.55,fee schedule,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,outpatient,1,mL,39.50000,37.52000,The Alliance,Premier SAS,,27.18,,,,,,,19.75,38.31,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,outpatient,1,EA,11651.31000,11068.75000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,11301.77,fee schedule,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,76.24,,,,,,,11.57,560.26,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Premier SAS,,3.14,,,,,,,0.03500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Premier SAS,,3.14,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,3.14,,,,,,,0.09500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,outpatient,100,EA,0.18000,0.17000,The Alliance,Premier SAS,,3.14,,,,,,,0.09000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,outpatient,100,EA,0.44000,0.41000,The Alliance,Premier SAS,,3.14,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,3.14,,,,,,,0.09500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Premier SAS,,3.14,,,,,,,0.17500,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,outpatient,100,EA,0.16000,0.15000,The Alliance,Premier SAS,,3.14,,,,,,,0.08000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,outpatient,100,EA,0.40000,0.38000,The Alliance,Premier SAS,,3.14,,,,,,,0.20000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,outpatient,100,EA,0.66000,0.63000,The Alliance,Premier SAS,,3.14,,,,,,,0.33000,3.23,fee schedule,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,outpatient,100,EA,0.20000,0.19000,The Alliance,Premier SAS,,3.14,,,,,,,0.10000,3.23,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,outpatient,1,EA,298.62000,283.69000,The Alliance,Premier SAS,,12.33,,,,,,,11.25,289.66,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,outpatient,1,EA,273.45000,259.78000,The Alliance,Premier SAS,,12.33,,,,,,,11.25,265.25,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,outpatient,1,EA,290.12000,275.61000,The Alliance,Premier SAS,,12.33,,,,,,,11.25,281.42,fee schedule,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,outpatient,1,EA,322.97000,306.82000,The Alliance,Premier SAS,,12.33,,,,,,,11.25,313.28,fee schedule,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,outpatient,1,EA,23303.03000,22137.87000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,22603.94,fee schedule,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,outpatient,30,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,outpatient,30,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,outpatient,30,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,outpatient,30,EA,4.79000,4.55000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.65,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,90,115.51,,,,,,,16.84,848.80,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,outpatient,1,EA,50.56000,48.03000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,49.04,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,61.30,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,26.98,fee schedule,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier SAS,,255.25,,,,,,,185.50,359.87,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,outpatient,1,EA,46.10000,43.80000,The Alliance,Premier SAS,,31.72,,,,,,,23.05,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,43.89,,,,,,,6.04,322.54,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,outpatient,40,EA,1.04000,0.98000,The Alliance,Premier SAS,,0.62439,,,,,,,0.52000,1.01,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,outpatient,40,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.62439,,,,,,,0.26500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,outpatient,40,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.62439,,,,,,,0.27000,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,outpatient,40,EA,3.75000,3.56000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,3.64,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,outpatient,40,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.62439,,,,,,,0.18500,0.69720,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,outpatient,40,EA,1.98000,1.88000,The Alliance,Premier SAS,,0.62439,,,,,,,0.62439,1.92,fee schedule,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,outpatient,40,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.62439,,,,,,,0.16000,0.69720,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,outpatient,1,EA,248.72000,236.29000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,241.26,fee schedule,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,outpatient,1,EA,272.36000,258.74000,The Alliance,Premier SAS,,6.32,,,,,,,5.45,264.19,fee schedule,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,18.48,,,,,,,2.54,135.79,fee schedule,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,outpatient,1,EA,62.02000,58.92000,The Alliance,Premier SAS,,42.67,,,,,,,31.01,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,outpatient,1,EA,94.91000,90.17000,The Alliance,Premier SAS,,65.30,,,,,,,47.45,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,3.14,,,,,,,1.26,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier SAS,,3.14,,,,,,,0.51500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,outpatient,1,mL,2.69000,2.55000,The Alliance,Premier SAS,,3.14,,,,,,,1.34,3.23,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,outpatient,3,EA,5.65000,5.36000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,outpatient,3,EA,5.65000,5.37000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,outpatient,3,EA,4.27000,4.05000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,4.14,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,outpatient,3,EA,8.27000,7.86000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,8.02,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,outpatient,3,EA,2.94000,2.79000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,2.85,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,outpatient,3,EA,4.04000,3.84000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,3.92,fee schedule,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,outpatient,3,EA,1.69000,1.60000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,1.64,fee schedule,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,103.96,,,,,,,16.07,763.98,fee schedule,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,outpatient,1,EA,6.81000,6.47000,The Alliance,Premier SAS,,4.69,,,,,,,3.40,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Premier SAS,,3.91,,,,,,,2.84,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,outpatient,1,EA,5.35000,5.08000,The Alliance,Premier SAS,,3.68,,,,,,,2.67,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Premier SAS,,1.29,,,,,,,0.93500,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Premier SAS,,1.71,,,,,,,1.24,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier SAS,,2.31,,,,,,,1.68,3.26,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,outpatient,5,EA,2.45000,2.33000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,2.38,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,2.26,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,outpatient,5,EA,6.64000,6.30000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,6.44,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,outpatient,5,EA,2.53000,2.40000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,2.45,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,outpatient,5,EA,2.46000,2.33000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,2.39,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,11.04,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,outpatient,5,EA,3.92000,3.72000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,3.80,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,outpatient,5,EA,21.12000,20.06000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,20.49,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,outpatient,5,EA,1.89000,1.80000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,1.83,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,1.96,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,outpatient,5,EA,5.06000,4.80000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,4.91,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,outpatient,5,EA,21.00000,19.95000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,20.37,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,outpatient,5,EA,4.99000,4.74000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,4.84,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.73720,fee schedule,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,outpatient,5,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,1.53,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,outpatient,1,mL,33272.80000,31609.16000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,32274.62,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,outpatient,1,mL,36335.60000,34518.82000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,35245.53,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,outpatient,1,mL,33792.11000,32102.50000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,32778.35,fee schedule,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,outpatient,1,mL,11961.94000,11363.85000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,11603.08,fee schedule,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,outpatient,1,EA,9.41000,8.94000,The Alliance,Premier SAS,,6.47,,,,,,,4.71,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,outpatient,1,EA,31.20000,29.64000,The Alliance,Premier SAS,,21.47,,,,,,,15.60,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier SAS,,2.20,,,,,,,1.60,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,outpatient,1,EA,15535.12000,14758.37000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,15069.07,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,outpatient,1,mL,0.58000,0.56000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.56260,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.53350,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.63050,fee schedule,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.39770,fee schedule,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,outpatient,5,EA,11.32000,10.75000,The Alliance,Premier SAS,,7.79,,,,,,,5.66,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,outpatient,1,EA,1.71000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,outpatient,30,EA,4.39000,4.17000,The Alliance,Premier SAS,,3.02,,,,,,,2.19,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,outpatient,30,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,outpatient,30,EA,4.27000,4.06000,The Alliance,Premier SAS,,2.94,,,,,,,2.13,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,outpatient,30,EA,4.01000,3.81000,The Alliance,Premier SAS,,2.76,,,,,,,2.00,3.89,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,outpatient,1,EA,23.83000,22.64000,The Alliance,Premier SAS,,16.40,,,,,,,11.91,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,outpatient,1,EA,85.13000,80.87000,The Alliance,Premier SAS,,58.57,,,,,,,42.56,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier SAS,,15.22,,,,,,,11.06,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Premier SAS,,70.66,,,,,,,51.35,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,43.48,,,,,,,31.60,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,The Alliance,Premier SAS,,29.35,,,,,,,21.33,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,outpatient,1,EA,92.43000,87.81000,The Alliance,Premier SAS,,63.59,,,,,,,46.22,89.66,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,outpatient,5,EA,3.45000,3.28000,The Alliance,Premier SAS,,2.37,,,,,,,1.73,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,outpatient,5,EA,3.60000,3.42000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,outpatient,5,EA,4.69000,4.45000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.55,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Premier SAS,,30.08,,,,,,,21.86,42.41,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Premier SAS,,50.79,,,,,,,36.91,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,The Alliance,Premier SAS,,50.79,,,,,,,36.91,71.61,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Premier SAS,,103.96,,,,,,,14.69,763.98,fee schedule,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,outpatient,5,EA,3.06000,2.90000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,outpatient,5,EA,2.52000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.26,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,outpatient,5,EA,3.98000,3.78000,The Alliance,Premier SAS,,2.74,,,,,,,1.99,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,outpatient,5,EA,5.61000,5.33000,The Alliance,Premier SAS,,3.86,,,,,,,2.81,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,outpatient,1,mL,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,outpatient,1,mL,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,outpatient,1,mL,4.63000,4.40000,The Alliance,Premier SAS,,3.19,,,,,,,2.31,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,outpatient,1,GM,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,outpatient,1,GM,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,outpatient,1,GM,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,outpatient,1,GM,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,outpatient,1,EA,4701.43000,4466.36000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,4560.39,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,outpatient,50,EA,0.10000,0.09000,The Alliance,Premier SAS,,3.14,,,,,,,0.05000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,outpatient,50,EA,0.09000,0.09000,The Alliance,Premier SAS,,3.14,,,,,,,0.04500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,outpatient,50,EA,0.27000,0.25000,The Alliance,Premier SAS,,3.14,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Premier SAS,,3.14,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Premier SAS,,3.14,,,,,,,0.23000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Premier SAS,,3.14,,,,,,,0.12000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,outpatient,50,EA,0.38000,0.36000,The Alliance,Premier SAS,,3.14,,,,,,,0.19000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,outpatient,50,EA,0.44000,0.42000,The Alliance,Premier SAS,,3.14,,,,,,,0.22000,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Premier SAS,,3.14,,,,,,,0.33500,3.23,fee schedule,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,outpatient,50,EA,0.46000,0.43000,The Alliance,Premier SAS,,3.14,,,,,,,0.23000,3.23,fee schedule,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier SAS,,76.37,,,,,,,55.50,107.67,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,outpatient,1,mL,21.71000,20.62000,The Alliance,Premier SAS,,14.94,,,,,,,10.86,21.06,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,outpatient,1,EA,21.40000,20.33000,The Alliance,Premier SAS,,14.72,,,,,,,10.70,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,outpatient,1,EA,5.76000,5.47000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,outpatient,1,EA,9.33000,8.86000,The Alliance,Premier SAS,,6.42,,,,,,,4.67,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,outpatient,1,EA,7.77000,7.38000,The Alliance,Premier SAS,,5.35,,,,,,,3.88,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier SAS,,3.17,,,,,,,2.31,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,outpatient,50,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,outpatient,50,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,outpatient,50,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,outpatient,50,EA,0.24000,0.22000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,outpatient,50,EA,3.40000,3.23000,The Alliance,Premier SAS,,2.34,,,,,,,1.70,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,outpatient,50,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,outpatient,50,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,outpatient,50,EA,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,outpatient,50,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,outpatient,30,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,outpatient,30,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,outpatient,30,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,outpatient,30,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,outpatient,30,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,outpatient,20,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,outpatient,20,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,outpatient,20,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,outpatient,20,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,outpatient,20,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,outpatient,20,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,outpatient,20,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,outpatient,5,EA,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,outpatient,5,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,outpatient,5,EA,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,outpatient,5,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,outpatient,5,EA,2.17000,2.07000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,outpatient,5,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,outpatient,5,EA,2.27000,2.16000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,outpatient,5,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,outpatient,5,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,outpatient,5,EA,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,outpatient,1,EA,7754.97000,7367.22000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,7522.32,fee schedule,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,outpatient,50,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,outpatient,50,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,outpatient,2,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,outpatient,2,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,outpatient,2,EA,3.51000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,outpatient,2,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,outpatient,2,EA,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,outpatient,2,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,outpatient,1,mL,2.03000,1.92000,The Alliance,Premier SAS,,1.40,,,,,,,1.01,1.97,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,outpatient,1,EA,0.05000,0.04000,The Alliance,Premier SAS,,3.14,,,,,,,0.02500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,3.14,,,,,,,0.14000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,3.14,,,,,,,0.11000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,3.14,,,,,,,0.38000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier SAS,,3.14,,,,,,,1.59,21.46,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,3.14,,,,,,,0.06500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,3.14,,,,,,,0.11500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,3.14,,,,,,,0.07000,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,3.14,,,,,,,0.13500,3.23,fee schedule,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,3.14,,,,,,,0.29500,3.23,fee schedule,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,outpatient,1,EA,9.47000,8.99000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,outpatient,1,EA,22.15000,21.04000,The Alliance,Premier SAS,,15.24,,,,,,,11.07,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,outpatient,1,EA,20.38000,19.36000,The Alliance,Premier SAS,,14.02,,,,,,,10.19,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,outpatient,1,EA,57.42000,54.55000,The Alliance,Premier SAS,,39.50,,,,,,,28.71,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Premier SAS,,5.46,,,,,,,3.97,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Premier SAS,,6.20,,,,,,,4.50,8.74,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,outpatient,10,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,outpatient,1,EA,4.48000,4.25000,The Alliance,Premier SAS,,3.08,,,,,,,2.24,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,The Alliance,Premier SAS,,3.59,,,,,,,2.61,5.06,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,outpatient,1,EA,1.73000,1.65000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier SAS,,67.00,,,,,,,10.50,492.33,fee schedule,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,outpatient,1,EA,3945.28000,3748.02000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,3826.92,fee schedule,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,outpatient,,,1981.00000,1881.95000,The Alliance,Premier SAS,TC,1362.93,,,,,,,931.15,2210.07,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,,57.75,,,,,,,8.19,424.40,fee schedule,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,outpatient,1,mL,997.15000,947.29000,The Alliance,Premier SAS,,686.04,,,,,,,498.57,967.24,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,outpatient,1,EA,3.91000,3.72000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,TC,151.36,,,,,,,110.00,213.40,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,48.52,,,,,,,6.89,356.54,fee schedule,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,92.41,,,,,,,14.32,679.08,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,outpatient,300,EA,4.99000,4.74000,The Alliance,Premier SAS,,5.56,,,,,,,2.50,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,outpatient,300,EA,0.84000,0.80000,The Alliance,Premier SAS,,5.56,,,,,,,0.42000,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,outpatient,300,EA,0.63000,0.60000,The Alliance,Premier SAS,,5.56,,,,,,,0.31500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,outpatient,300,EA,0.19000,0.18000,The Alliance,Premier SAS,,5.56,,,,,,,0.09500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,outpatient,300,EA,0.65000,0.62000,The Alliance,Premier SAS,,5.56,,,,,,,0.32500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,outpatient,300,EA,0.29000,0.27000,The Alliance,Premier SAS,,5.56,,,,,,,0.14500,5.76,fee schedule,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,outpatient,300,EA,0.11000,0.10000,The Alliance,Premier SAS,,5.56,,,,,,,0.05500,5.76,fee schedule,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,outpatient,,,366.00000,347.70000,The Alliance,Premier SAS,90,224.09,,,,,,,35.33,1646.71,fee schedule,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,113.49,,,,,,,13.39,833.98,fee schedule,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,outpatient,1,EA,4.98000,4.74000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,outpatient,1,mL,12.70000,12.07000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,12.32,fee schedule,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,outpatient,1,EA,0.22000,0.20000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,outpatient,,,273.00000,259.35000,The Alliance,Premier SAS,TC,204.09,,,,,,,136.50,1499.73,fee schedule,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,outpatient,1,EA,440.47000,418.45000,The Alliance,Premier SAS,,303.04,,,,,,,220.24,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,outpatient,1,EA,19.56000,18.58000,The Alliance,Premier SAS,,13.46,,,,,,,9.78,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Premier SAS,,12.78,,,,,,,9.29,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,outpatient,1,EA,30.43000,28.91000,The Alliance,Premier SAS,,20.94,,,,,,,15.21,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Premier SAS,,5.98,,,,,,,4.34,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,outpatient,50,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,outpatient,50,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier SAS,,120.13,,,,,,,17.03,882.80,fee schedule,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,outpatient,,,1625.00000,1543.75000,The Alliance,Premier SAS,TC,1242.95,,,,,,,812.50,9133.75,fee schedule,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,outpatient,1,EA,11.72000,11.14000,The Alliance,Premier SAS,,8.06,,,,,,,5.86,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier SAS,,131.69,,,,,,,18.52,967.70,fee schedule,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier SAS,,30.03,,,,,,,4.27,220.68,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Premier SAS,,2.11,,,,,,,2.11,8.19,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Premier SAS,,2.11,,,,,,,2.11,5.23,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,outpatient,1,EA,6.01000,5.71000,The Alliance,Premier SAS,,2.11,,,,,,,2.11,5.83,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,2.11,,,,,,,0.93000,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier SAS,,2.11,,,,,,,2.04,3.97,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,2.11,,,,,,,1.19,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier SAS,,2.11,,,,,,,2.11,9.96,fee schedule,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,TC,153.26,,,,,,,88.31,1126.22,fee schedule,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier SAS,TC,70.09,,,,,,,41.00,515.07,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier SAS,,2.18,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,2.18,,,,,,,0.01000,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,2.18,,,,,,,0.01000,2.24,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,190.23,,,,,,,133.50,1397.87,fee schedule,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,outpatient,,,306.10000,290.80000,The Alliance,Premier SAS,90,175.58,,,,,,,27.54,1290.24,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,TC,429.00,,,,,,,18.50,442.00,per diem,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier SAS,TC,1755.82,,,,,,,1295.50,12902.54,fee schedule,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,30.03,,,,,,,4.31,220.68,fee schedule,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,outpatient,300,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,outpatient,300,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,outpatient,100,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,outpatient,100,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,outpatient,100,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,outpatient,100,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,outpatient,100,EA,3.10000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Premier SAS,TC,2383.23,,,,,,,1611.84,3360.08,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,outpatient,1,EA,2.24000,2.12000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,outpatient,1,mL,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier SAS,,55.73,,,,,,,40.50,134.64,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,TC,354.94,,,,,,,161.50,2815.39,fee schedule,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,3.94,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,3.94,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,3.94,,,,,,,0.01500,4.06,fee schedule,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,3.94,,,,,,,0.01500,4.06,fee schedule,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Premier SAS,,16.11,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,46.20,,,,,,,6.61,339.51,fee schedule,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,48.52,,,,,,,6.70,356.54,fee schedule,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,outpatient,,,2973.00000,2824.35000,The Alliance,Premier SAS,,5089.43,,,,,,,636.00,37399.48,fee schedule,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,outpatient,30,EA,3.32000,3.16000,The Alliance,Premier SAS,,2.11,,,,,,,1.66,3.22,fee schedule,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier SAS,,2.11,,,,,,,0.79000,2.61,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,outpatient,1,mL,166.31000,158.00000,The Alliance,Premier SAS,,114.42,,,,,,,0.94620,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,outpatient,1,mL,173.64000,164.96000,The Alliance,Premier SAS,,119.46,,,,,,,0.94620,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier SAS,,97.83,,,,,,,0.94620,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Premier SAS,,119.57,,,,,,,0.94620,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,outpatient,1,mL,257.67000,244.78000,The Alliance,Premier SAS,,177.28,,,,,,,0.94620,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,outpatient,1,mL,257.40000,244.53000,The Alliance,Premier SAS,,177.09,,,,,,,0.94620,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,outpatient,1,mL,193.96000,184.26000,The Alliance,Premier SAS,,133.44,,,,,,,0.94620,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,outpatient,1,mL,115.78000,109.99000,The Alliance,Premier SAS,,79.66,,,,,,,0.94620,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,outpatient,1,mL,221.20000,210.14000,The Alliance,Premier SAS,,152.19,,,,,,,0.94620,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,outpatient,1,mL,193.05000,183.40000,The Alliance,Premier SAS,,132.82,,,,,,,0.94620,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,outpatient,1,mL,108.69000,103.25000,The Alliance,Premier SAS,,74.78,,,,,,,0.94620,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,outpatient,1,mL,108.67000,103.24000,The Alliance,Premier SAS,,74.76,,,,,,,0.94620,105.41,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,outpatient,500,EA,0.40000,0.38000,The Alliance,Premier SAS,,3.59,,,,,,,0.20000,3.75,fee schedule,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,outpatient,500,EA,0.12000,0.11000,The Alliance,Premier SAS,,3.59,,,,,,,0.06000,3.75,fee schedule,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,outpatient,1,EA,23.42000,22.24000,The Alliance,Premier SAS,,16.11,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,The Alliance,Premier SAS,,16.11,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,outpatient,1,EA,0.87000,0.82000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,outpatient,50,EA,0.19000,0.18000,The Alliance,Premier SAS,,3.59,,,,,,,0.09500,3.75,fee schedule,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,outpatient,50,EA,0.34000,0.32000,The Alliance,Premier SAS,,3.59,,,,,,,0.17000,3.75,fee schedule,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,The Alliance,Premier SAS,,256.62,,,,,,,186.50,361.81,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,TC,429.00,,,,,,,18.50,442.00,per diem,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,outpatient,1,mL,19.43000,18.46000,The Alliance,Premier SAS,,25.12,,,,,,,9.71,25.89,fee schedule,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,outpatient,1,mL,11.57000,10.99000,The Alliance,Premier SAS,,25.12,,,,,,,5.79,25.89,fee schedule,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,outpatient,1,mL,8.35000,7.93000,The Alliance,Premier SAS,,25.12,,,,,,,4.17,25.89,fee schedule,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier SAS,,110.89,,,,,,,15.49,814.87,fee schedule,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,outpatient,1,EA,45.82000,43.53000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,44.45,fee schedule,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,9.20,fee schedule,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,18.39,fee schedule,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,2.13,,,,,,,2.11,7.66,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,2.13,,,,,,,2.11,6.13,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Premier SAS,,2.13,,,,,,,1.99,3.86,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier SAS,,2.13,,,,,,,1.74,3.38,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,outpatient,1,mL,20.95000,19.90000,The Alliance,Premier SAS,,2.13,,,,,,,2.11,20.32,fee schedule,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,outpatient,1,mL,6.48000,6.15000,The Alliance,Premier SAS,,2.13,,,,,,,2.11,6.29,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,outpatient,1,mL,2.85000,2.71000,The Alliance,Premier SAS,,3.62,,,,,,,1.43,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier SAS,,3.62,,,,,,,1.47,4.28,fee schedule,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Premier SAS,,25.12,,,,,,,9.10,25.89,fee schedule,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,outpatient,1,mL,12.20000,11.59000,The Alliance,Premier SAS,,25.12,,,,,,,6.10,25.89,fee schedule,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,outpatient,1,mL,8.33000,7.91000,The Alliance,Premier SAS,,25.12,,,,,,,4.17,25.89,fee schedule,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,outpatient,,,286.43000,272.11000,The Alliance,Premier SAS,,197.06,,,,,,,143.22,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,outpatient,1,mL,572.85000,544.21000,The Alliance,Premier SAS,,394.12,,,,,,,187.18,555.66,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,outpatient,1,EA,24.86000,23.62000,The Alliance,Premier SAS,,35.32,,,,,,,12.43,36.40,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,outpatient,1,EA,370.86000,352.32000,The Alliance,Premier SAS,,35.32,,,,,,,32.99,359.73,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,outpatient,1,EA,95.97000,91.17000,The Alliance,Premier SAS,,35.32,,,,,,,32.99,93.09,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,outpatient,1,EA,21.68000,20.60000,The Alliance,Premier SAS,,35.32,,,,,,,10.84,36.40,fee schedule,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,outpatient,1,EA,62.44000,59.32000,The Alliance,Premier SAS,,35.32,,,,,,,31.22,60.57,fee schedule,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,outpatient,30,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier SAS,,6.89,,,,,,,5.01,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,outpatient,1,EA,4.68000,4.44000,The Alliance,Premier SAS,,3.22,,,,,,,2.34,4.54,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,outpatient,1,EA,92.08000,87.48000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,89.32,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,18.39,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,outpatient,1,EA,212.08000,201.47000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,205.72,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,outpatient,1,EA,86.25000,81.93000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,83.66,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,outpatient,1,EA,32.77000,31.13000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,31.79,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,outpatient,1,EA,177.91000,169.01000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,172.57,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,outpatient,1,EA,87.82000,83.43000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,85.19,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,outpatient,1,EA,91.64000,87.06000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,88.89,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,outpatient,1,EA,37.92000,36.02000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,36.78,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,18.08,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,33.72,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,61.30,fee schedule,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,outpatient,1,EA,18.17000,17.26000,The Alliance,Premier SAS,,0.70444,,,,,,,0.66805,17.62,fee schedule,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,outpatient,,,188.80000,179.36000,The Alliance,Premier SAS,90,115.51,,,,,,,16.80,848.80,fee schedule,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,outpatient,1,EA,5.74000,5.45000,The Alliance,Premier SAS,,3.95,,,,,,,2.87,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Premier SAS,,4.57,,,,,,,3.32,6.44,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,outpatient,1,EA,9.63000,9.15000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,9.34,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,8.54,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,9.14,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,0.62080,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,3.52,fee schedule,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,outpatient,1,EA,8.75000,8.32000,The Alliance,Premier SAS,,0.32020,,,,,,,0.31155,8.49,fee schedule,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,outpatient,1,EA,2.04000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,outpatient,1,EA,133.19000,126.53000,The Alliance,Premier SAS,,2.77,,,,,,,2.53,129.19,fee schedule,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,outpatient,1,EA,262.28000,249.17000,The Alliance,Premier SAS,,2.77,,,,,,,2.53,254.41,fee schedule,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,outpatient,1,EA,5.38000,5.11000,The Alliance,Premier SAS,,3.70,,,,,,,2.69,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,outpatient,1,EA,9.83000,9.34000,The Alliance,Premier SAS,,6.76,,,,,,,4.92,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier SAS,TC,270.15,,,,,,,119.50,2142.86,fee schedule,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,outpatient,1,EA,19.37000,18.40000,The Alliance,Premier SAS,,13.33,,,,,,,9.69,18.79,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,outpatient,1,EA,224.08000,212.87000,The Alliance,Premier SAS,,154.17,,,,,,,112.04,217.36,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,53.14,,,,,,,4.12,390.47,fee schedule,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,outpatient,1,EA,149.72000,142.23000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,145.23,fee schedule,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,outpatient,1,EA,62.79000,59.65000,The Alliance,Premier SAS,,43.20,,,,,,,31.39,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,outpatient,1,EA,196.71000,186.87000,The Alliance,Premier SAS,,135.34,,,,,,,98.36,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Premier SAS,,46.20,,,,,,,33.58,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,outpatient,1,EA,169.96000,161.46000,The Alliance,Premier SAS,,116.93,,,,,,,84.98,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,outpatient,1,EA,169.86000,161.37000,The Alliance,Premier SAS,,116.86,,,,,,,84.93,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Premier SAS,,119.57,,,,,,,86.90,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,outpatient,1,EA,52.14000,49.53000,The Alliance,Premier SAS,,35.87,,,,,,,26.07,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,outpatient,1,EA,44.32000,42.10000,The Alliance,Premier SAS,,30.49,,,,,,,22.16,42.99,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,outpatient,1,GM,3.90000,3.70000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,outpatient,1,GM,1.36000,1.30000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,outpatient,45,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,outpatient,45,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,outpatient,45,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,outpatient,45,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,outpatient,1,EA,5.68000,5.39000,The Alliance,Premier SAS,,3.91,,,,,,,2.84,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,The Alliance,Premier SAS,,3.18,,,,,,,2.31,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,outpatient,1,EA,3.85000,3.65000,The Alliance,Premier SAS,,2.65,,,,,,,1.93,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier SAS,,2.16,,,,,,,1.57,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Premier SAS,,2.67,,,,,,,1.94,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier SAS,,3.46,,,,,,,2.52,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,outpatient,1,mL,82.30000,78.18000,The Alliance,Premier SAS,,56.62,,,,,,,7.86,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,outpatient,1,mL,74.07000,70.36000,The Alliance,Premier SAS,,50.96,,,,,,,7.86,71.85,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,outpatient,1,mL,10.61000,10.08000,The Alliance,Premier SAS,,3.62,,,,,,,3.62,10.29,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,outpatient,1,EA,32.92000,31.27000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,31.93,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,outpatient,1,EA,20.41000,19.39000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,19.80,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,23.30,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,outpatient,1,EA,36.81000,34.97000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,35.71,fee schedule,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,34.66,,,,,,,4.75,254.68,fee schedule,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,outpatient,1,EA,262.63000,249.50000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,254.75,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,outpatient,1,EA,138.98000,132.03000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,134.81,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,outpatient,1,EA,132.37000,125.75000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,128.40,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,outpatient,1,EA,102.70000,97.56000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,99.62,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,outpatient,1,EA,108.14000,102.73000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,104.90,fee schedule,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,outpatient,5,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,outpatient,1,EA,20.44000,19.42000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,19.83,fee schedule,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,41.58,,,,,,,5.78,305.58,fee schedule,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier SAS,,103.96,,,,,,,14.55,763.98,fee schedule,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,outpatient,1,EA,1.37000,1.31000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,outpatient,1,EA,31.54000,29.96000,The Alliance,Premier SAS,,21.70,,,,,,,15.77,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.49,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,outpatient,1,EA,62.32000,59.20000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,60.45,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,outpatient,1,EA,62.33000,59.21000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,60.46,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,outpatient,1,EA,45.19000,42.93000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,43.83,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,outpatient,1,EA,51.57000,48.99000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,50.02,fee schedule,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,120.13,,,,,,,16.94,882.80,fee schedule,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.60,,,,,,,0.98000,1.90,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,outpatient,2,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.60,,,,,,,0.98000,1.90,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,outpatient,2,EA,5.30000,5.03000,The Alliance,Premier SAS,,1.60,,,,,,,1.60,5.14,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,outpatient,2,EA,4.31000,4.09000,The Alliance,Premier SAS,,1.60,,,,,,,1.60,4.18,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,outpatient,2,EA,5.29000,5.03000,The Alliance,Premier SAS,,1.60,,,,,,,1.60,5.13,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,outpatient,2,EA,0.71000,0.68000,The Alliance,Premier SAS,,1.60,,,,,,,0.35500,1.88,fee schedule,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,outpatient,2,EA,3.48000,3.30000,The Alliance,Premier SAS,,1.60,,,,,,,1.60,3.38,fee schedule,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,outpatient,1,mL,56.56000,53.73000,The Alliance,Premier SAS,,38.91,,,,,,,7.86,54.86,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,,62.38,,,,,,,8.65,458.40,fee schedule,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier SAS,,2.60,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier SAS,,1.43,,,,,,,1.04,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,outpatient,1,EA,1.43000,1.35000,The Alliance,Premier SAS,,0.98384,,,,,,,0.71500,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.12,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,outpatient,5,EA,1.70000,1.62000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,outpatient,5,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,outpatient,5,EA,3.65000,3.47000,The Alliance,Premier SAS,,2.51,,,,,,,1.82,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,outpatient,5,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,outpatient,5,EA,2.04000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,outpatient,5,EA,2.03000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.01,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,outpatient,5,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,outpatient,5,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,outpatient,5,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,outpatient,5,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,outpatient,5,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,9.38,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,0.92150,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,3.49,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,3.50,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,outpatient,1,EA,3.61000,3.43000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,3.50,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,outpatient,1,EA,5.88000,5.58000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,5.70,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.36823,,,,,,,0.35000,0.67900,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.36823,,,,,,,0.24000,0.46560,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,0.95060,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,0.97970,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,2.63,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.36823,,,,,,,0.32500,0.63050,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.36823,,,,,,,0.35000,0.67900,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,outpatient,1,EA,5.28000,5.02000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,5.12,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,1.26,fee schedule,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.36823,,,,,,,0.34000,0.65960,fee schedule,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier SAS,,2.60,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,outpatient,5,EA,3.48000,3.31000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,outpatient,5,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,outpatient,5,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Premier SAS,,11.98,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,The Alliance,Premier SAS,,11.98,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,outpatient,1,EA,7.18000,6.82000,The Alliance,Premier SAS,,4.94,,,,,,,3.59,6.96,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,outpatient,1,EA,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,outpatient,,,25.30000,24.04000,The Alliance,Premier SAS,,17.41,,,,,,,12.65,24.54,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,72.93,,,,,,,53.00,788.42,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,outpatient,1,EA,9.04000,8.59000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,8.77,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,outpatient,1,EA,35.92000,34.13000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,34.84,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,outpatient,1,EA,35.90000,34.10000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,34.82,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,outpatient,1,EA,27.49000,26.12000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,26.67,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,outpatient,1,EA,27.99000,26.59000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,27.15,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,outpatient,1,EA,30.46000,28.94000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,29.55,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,outpatient,1,EA,30.45000,28.92000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,29.54,fee schedule,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,outpatient,1,EA,569.80000,541.31000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,552.71,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,outpatient,1,EA,2907.20000,2761.84000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,2819.98,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,outpatient,1,EA,2907.11000,2761.75000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,2819.90,fee schedule,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,628.08,fee schedule,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier SAS,,46.20,,,,,,,4.05,339.51,fee schedule,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier SAS,,48.52,,,,,,,7.48,356.54,fee schedule,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,The Alliance,Premier SAS,,2.66,,,,,,,1.94,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Premier SAS,,3.55,,,,,,,2.58,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier SAS,,2.38,,,,,,,1.73,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,outpatient,1,EA,3.72000,3.53000,The Alliance,Premier SAS,,2.56,,,,,,,1.86,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,outpatient,,,161.35000,153.28000,The Alliance,Premier SAS,,111.01,,,,,,,80.67,185.08,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,outpatient,1,EA,161.35000,153.28000,The Alliance,Premier SAS,,111.01,,,,,,,80.67,185.08,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier SAS,,7.28,,,,,,,2.58,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,outpatient,1,EA,6.15000,5.84000,The Alliance,Premier SAS,,7.28,,,,,,,3.08,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,outpatient,1,EA,7.89000,7.50000,The Alliance,Premier SAS,,7.28,,,,,,,3.94,7.69,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier SAS,,7.28,,,,,,,4.54,8.80,fee schedule,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,outpatient,1,EA,10.88000,10.34000,The Alliance,Premier SAS,,7.28,,,,,,,5.44,10.55,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,outpatient,1,EA,7.30000,6.93000,The Alliance,Premier SAS,,7.28,,,,,,,3.65,7.69,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,outpatient,1,EA,17.65000,16.77000,The Alliance,Premier SAS,,7.28,,,,,,,7.18,17.12,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,outpatient,1,EA,8.05000,7.65000,The Alliance,Premier SAS,,7.28,,,,,,,4.03,7.81,fee schedule,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,outpatient,1,EA,8.41000,7.99000,The Alliance,Premier SAS,,7.28,,,,,,,4.21,8.16,fee schedule,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier SAS,,135.54,,,,,,,98.50,212.44,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,outpatient,1,EA,12.55000,11.92000,The Alliance,Premier SAS,,8.63,,,,,,,6.28,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.35,,,,,,,0.98000,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Premier SAS,,4.49,,,,,,,3.27,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,The Alliance,Premier SAS,,4.49,,,,,,,3.27,6.33,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,outpatient,1,EA,217.79000,206.90000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,211.26,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04803,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,outpatient,100,EA,0.04000,0.03000,The Alliance,Premier SAS,,0.04803,,,,,,,0.02000,0.04980,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,outpatient,100,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04803,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04803,,,,,,,0.03000,0.05820,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,outpatient,100,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04803,,,,,,,0.03000,0.05820,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,outpatient,100,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.04803,,,,,,,0.02500,0.04980,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,outpatient,100,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04803,,,,,,,0.03500,0.06790,fee schedule,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,outpatient,100,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04000,0.07760,fee schedule,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier SAS,,165.57,,,,,,,5.99,1216.68,fee schedule,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,outpatient,1,EA,15.06000,14.31000,The Alliance,Premier SAS,,10.36,,,,,,,7.53,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,outpatient,1,EA,4.07000,3.86000,The Alliance,Premier SAS,,2.80,,,,,,,2.04,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier SAS,,46.20,,,,,,,6.64,339.51,fee schedule,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,outpatient,30,mL,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,outpatient,30,mL,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,outpatient,30,mL,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,outpatient,,,656.00000,623.20000,The Alliance,Premier SAS,,451.33,,,,,,,360.80,5271.00,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,outpatient,1,EA,630.07000,598.57000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,611.17,fee schedule,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,376.85,fee schedule,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,24.77,,,,,,,18.00,34.92,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,,34.66,,,,,,,4.75,254.68,fee schedule,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Premier SAS,,5.40,,,,,,,3.92,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier SAS,,6.74,,,,,,,4.90,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,outpatient,1,EA,9.82000,9.33000,The Alliance,Premier SAS,,6.76,,,,,,,4.91,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,outpatient,1,mL,2.02000,1.92000,The Alliance,Premier SAS,,7.28,,,,,,,1.01,7.69,fee schedule,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,outpatient,1,EA,5.70000,5.42000,The Alliance,Premier SAS,,3.92,,,,,,,2.85,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Premier SAS,,3.24,,,,,,,2.35,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,outpatient,1,EA,9.88000,9.39000,The Alliance,Premier SAS,,6.80,,,,,,,4.94,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Premier SAS,,4.11,,,,,,,2.98,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Premier SAS,,5.95,,,,,,,4.33,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,outpatient,,,760.00000,722.00000,The Alliance,Premier SAS,TC,1000.37,,,,,,,380.00,7351.18,fee schedule,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,outpatient,1,EA,11.63000,11.05000,The Alliance,Premier SAS,,8.00,,,,,,,5.82,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,outpatient,1,EA,14.54000,13.81000,The Alliance,Premier SAS,,10.00,,,,,,,7.27,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier SAS,,3.84,,,,,,,2.79,5.41,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,outpatient,1,mL,3.90000,3.70000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,outpatient,1,mL,2.57000,2.45000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,outpatient,1,mL,3.86000,3.67000,The Alliance,Premier SAS,,2.66,,,,,,,1.93,3.74,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1269.50,2462.83,per diem,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,outpatient,1,EA,2.52000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.26,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1371.65,3353.29,per diem,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1130.78,2914.85,per diem,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,outpatient,,,3007.00000,2856.65000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2916.79,per diem,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Premier SAS,,7.28,,,,,,,2.73,7.69,fee schedule,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4835.45,per diem,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,outpatient,1,EA,3.62000,3.43000,The Alliance,Premier SAS,,2.49,,,,,,,1.81,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,outpatient,1,EA,2.55000,2.43000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,outpatient,1,EA,1636.88000,1555.04000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,1587.77,fee schedule,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,outpatient,1,EA,1636.83000,1554.99000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,1587.73,fee schedule,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,outpatient,1,EA,471.38000,447.81000,The Alliance,Premier SAS,,45.26,,,,,,,28.27,457.24,fee schedule,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4867.46,per diem,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,outpatient,3,EA,183.41000,174.24000,The Alliance,Premier SAS,,126.19,,,,,,,91.70,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,outpatient,3,EA,35.81000,34.02000,The Alliance,Premier SAS,,24.64,,,,,,,17.91,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,outpatient,3,EA,36.87000,35.02000,The Alliance,Premier SAS,,25.37,,,,,,,18.43,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,outpatient,3,EA,26.64000,25.31000,The Alliance,Premier SAS,,18.33,,,,,,,13.32,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,outpatient,3,EA,53.75000,51.06000,The Alliance,Premier SAS,,36.98,,,,,,,26.88,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,outpatient,3,EA,41.08000,39.03000,The Alliance,Premier SAS,,28.26,,,,,,,20.54,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,outpatient,3,EA,70.51000,66.98000,The Alliance,Premier SAS,,48.51,,,,,,,35.26,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,outpatient,3,EA,21.07000,20.01000,The Alliance,Premier SAS,,14.50,,,,,,,10.54,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,outpatient,3,EA,35.26000,33.49000,The Alliance,Premier SAS,,24.26,,,,,,,17.63,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,outpatient,3,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,outpatient,3,EA,12.22000,11.61000,The Alliance,Premier SAS,,8.41,,,,,,,6.11,11.85,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier SAS,,1.64,,,,,,,1.20,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3934.32,per diem,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier SAS,,2.24,,,,,,,0.99000,2.61,fee schedule,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Premier SAS,,2.24,,,,,,,1.05,2.61,fee schedule,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,12.26,fee schedule,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,outpatient,,,4381.00000,4161.95000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4249.57,per diem,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,864.00,2032.87,per diem,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,924.00,2032.87,per diem,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1129.95,2920.67,per diem,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1353.88,3316.43,per diem,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4221.44,per diem,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1339.64,3425.07,per diem,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,outpatient,,,1560.00000,1482.00000,The Alliance,Premier SAS,TC,1810.00,,,,,,,608.47,2032.87,per diem,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,164.87,,,,,,,16.91,1211.55,fee schedule,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1214.33,3520.13,per diem,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2941.04,per diem,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Premier SAS,,2.77,,,,,,,2.01,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier SAS,,3.46,,,,,,,2.52,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,outpatient,1,EA,3.95000,3.76000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,outpatient,,,2867.00000,2723.65000,The Alliance,Premier SAS,TC,1810.00,,,,,,,902.40,2780.99,per diem,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier SAS,,7.28,,,,,,,2.58,7.69,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Premier SAS,,7.28,,,,,,,3.37,7.69,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,outpatient,1,EA,10.35000,9.83000,The Alliance,Premier SAS,,7.28,,,,,,,5.17,10.04,fee schedule,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,outpatient,1,EA,9.07000,8.62000,The Alliance,Premier SAS,,7.28,,,,,,,4.54,8.80,fee schedule,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1375.22,3364.93,per diem,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,outpatient,,,2725.00000,2588.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2643.25,per diem,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1272.04,4844.18,per diem,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3863.51,per diem,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,outpatient,,,4145.00000,3937.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4345.33,per diem,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1318.80,3125.34,per diem,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1328.10,3480.36,per diem,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Premier SAS,,182.51,,,,,,,28.00,1341.13,fee schedule,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1125.50,2183.47,per diem,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,outpatient,,,3500.00000,3325.00000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3395.00,per diem,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,828.00,2032.87,per diem,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,outpatient,,,5051.00000,4798.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4899.47,per diem,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1127.62,2942.98,per diem,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3584.15,per diem,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,outpatient,,,2339.00000,2222.05000,The Alliance,Premier SAS,TC,1810.00,,,,,,,989.10,2268.83,per diem,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,outpatient,1,EA,2.03000,1.92000,The Alliance,Premier SAS,,1.40,,,,,,,1.01,1.97,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,outpatient,,,4202.00000,3991.90000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4345.33,per diem,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1353.60,3441.56,per diem,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1308.50,2538.49,per diem,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4345.33,per diem,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,outpatient,1,EA,44.30000,42.09000,The Alliance,Premier SAS,,30.48,,,,,,,22.15,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,outpatient,1,EA,48.68000,46.25000,The Alliance,Premier SAS,,33.49,,,,,,,24.34,47.22,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,outpatient,2,EA,4.60000,4.37000,The Alliance,Premier SAS,,3.16,,,,,,,2.30,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,outpatient,2,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,outpatient,2,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3462.90,per diem,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4235.00000,4023.25000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,4107.95,per diem,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Premier SAS,,2561.00,,,,,,,537.90,3163.00,case rate,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,outpatient,30,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,828.00,2032.87,per diem,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier SAS,TC,1810.00,,,,,,,179.69,2032.87,per diem,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,outpatient,,,2936.00000,2789.20000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1468.00,2847.92,per diem,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,outpatient,20,EA,1.83000,1.74000,The Alliance,Premier SAS,,7.28,,,,,,,0.91500,7.69,fee schedule,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,outpatient,,,2082.00000,1977.90000,The Alliance,Premier SAS,TC,1810.00,,,,,,,862.95,2032.87,per diem,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4224.35,per diem,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1128.45,2914.85,per diem,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,outpatient,1,EA,85.92000,81.62000,The Alliance,Premier SAS,,59.11,,,,,,,42.96,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,outpatient,1,EA,94.42000,89.70000,The Alliance,Premier SAS,,64.96,,,,,,,47.21,91.59,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,outpatient,,,4289.00000,4074.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4160.33,per diem,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5104.10000,4848.90000,The Alliance,Premier SAS,,2342.78,,,,,,,2342.78,5104.10,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,outpatient,,,343.00000,325.85000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,2198.99,per diem,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,outpatient,,,12277.00000,11663.15000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,11908.69,per diem,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,,265.67,,,,,,,41.68,1952.29,fee schedule,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1382.32,3348.44,per diem,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,outpatient,,,1408.00000,1337.60000,The Alliance,Premier SAS,,2561.00,,,,,,,750.19,3163.00,case rate,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2942.98,per diem,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1246.80,3800.46,per diem,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Premier SAS,,4.28,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,outpatient,,,3032.00000,2880.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1153.12,2941.04,per diem,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,outpatient,,,2960.00000,2812.00000,The Alliance,Premier SAS,TC,2036.48,,,,,,,1360.59,7180.14,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,outpatient,5,EA,20.10000,19.09000,The Alliance,Premier SAS,,3.49,,,,,,,3.00,19.50,fee schedule,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,outpatient,5,EA,5.18000,4.92000,The Alliance,Premier SAS,,3.49,,,,,,,2.59,5.02,fee schedule,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,outpatient,5,EA,24.12000,22.91000,The Alliance,Premier SAS,,3.49,,,,,,,3.00,23.40,fee schedule,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Premier SAS,TC,345.01,,,,,,,288.68,2535.29,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,27.58,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.68,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.97,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.22,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,0.55290,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.40,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.50,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,0.50440,fee schedule,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.84,fee schedule,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,outpatient,1,EA,71.61000,68.03000,The Alliance,Premier SAS,,49.27,,,,,,,35.80,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,outpatient,1,EA,71.60000,68.02000,The Alliance,Premier SAS,,49.26,,,,,,,35.80,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,outpatient,1,EA,71.10000,67.54000,The Alliance,Premier SAS,,48.92,,,,,,,35.55,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Premier SAS,,47.83,,,,,,,34.76,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,27.18,,,,,,,19.75,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,outpatient,1,EA,71.73000,68.15000,The Alliance,Premier SAS,,49.35,,,,,,,35.87,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,outpatient,1,EA,91.29000,86.73000,The Alliance,Premier SAS,,62.81,,,,,,,45.65,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,outpatient,1,EA,68.57000,65.14000,The Alliance,Premier SAS,,47.18,,,,,,,34.28,66.51,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,4230.17,per diem,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,outpatient,1,mL,270.61000,257.08000,The Alliance,Premier SAS,,186.18,,,,,,,135.31,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,outpatient,1,mL,270.60000,257.07000,The Alliance,Premier SAS,,186.17,,,,,,,135.30,262.48,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Premier SAS,,2.95,,,,,,,2.15,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,outpatient,,,4739.00000,4502.05000,The Alliance,Premier SAS,TC,6990.00,,,,,,,2369.50,8022.25,per diem,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier SAS,,196.08,,,,,,,142.50,417.31,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,outpatient,,,3038.00000,2886.10000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,2946.86,per diem,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,90,134.00,,,,,,,19.37,984.66,fee schedule,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,outpatient,,,2932.00000,2785.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1466.00,2844.04,per diem,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier SAS,TC,2178.90,,,,,,,1488.32,7180.14,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier SAS,TC,3130.40,,,,,,,2150.56,7180.14,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1288.05,4844.18,per diem,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,outpatient,1,EA,3.24000,3.08000,The Alliance,Premier SAS,,2.23,,,,,,,1.62,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,outpatient,1,EA,2.08000,1.98000,The Alliance,Premier SAS,,1.43,,,,,,,1.04,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,outpatient,10,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,outpatient,10,EA,15.98000,15.18000,The Alliance,Premier SAS,,10.99,,,,,,,7.99,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,outpatient,10,EA,3.61000,3.43000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.50,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Premier SAS,90,120.13,,,,,,,17.47,882.80,fee schedule,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1295.50,2513.27,per diem,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier SAS,,273.14,,,,,,,198.50,385.09,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1321.12,3459.02,per diem,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,3.38,fee schedule,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,1.23,fee schedule,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,outpatient,1,EA,5.07000,4.81000,The Alliance,Premier SAS,,3.49,,,,,,,2.54,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier SAS,,3.72,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,outpatient,4,EA,11.39000,10.82000,The Alliance,Premier SAS,,7.84,,,,,,,5.70,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,outpatient,4,EA,17.76000,16.87000,The Alliance,Premier SAS,,12.22,,,,,,,8.88,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,outpatient,4,EA,14.24000,13.52000,The Alliance,Premier SAS,,9.80,,,,,,,7.12,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,outpatient,4,EA,6.90000,6.56000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,outpatient,4,EA,6.57000,6.24000,The Alliance,Premier SAS,,4.52,,,,,,,3.29,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,outpatient,4,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,outpatient,4,EA,8.30000,7.88000,The Alliance,Premier SAS,,5.71,,,,,,,4.15,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,outpatient,4,EA,13.79000,13.10000,The Alliance,Premier SAS,,9.49,,,,,,,6.89,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,outpatient,4,EA,10.10000,9.59000,The Alliance,Premier SAS,,6.95,,,,,,,5.05,9.80,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier SAS,,307.54,,,,,,,223.50,433.59,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier SAS,,92.41,,,,,,,12.92,679.08,fee schedule,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,,251.81,,,,,,,39.26,1850.43,fee schedule,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,outpatient,,,67.00000,63.65000,The Alliance,Premier SAS,,36.97,,,,,,,5.79,271.65,fee schedule,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier SAS,,909.00,,,,,,,124.85,3163.00,case rate,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,outpatient,,,192.80000,183.16000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,outpatient,,,416.00000,395.20000,The Alliance,Premier SAS,,267.98,,,,,,,37.73,1969.25,fee schedule,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.08,fee schedule,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.16,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Premier SAS,,4579.33,,,,,,,2074.81,6456.32,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,outpatient,1,GM,3.59000,3.41000,The Alliance,Premier SAS,,2.47,,,,,,,1.79,3.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,outpatient,1,mL,291.38000,276.81000,The Alliance,Premier SAS,,200.47,,,,,,,145.69,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier SAS,,54.35,,,,,,,39.50,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,outpatient,1,mL,23.61000,22.42000,The Alliance,Premier SAS,,16.24,,,,,,,11.80,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,outpatient,1,mL,37.76000,35.87000,The Alliance,Premier SAS,,25.98,,,,,,,18.88,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,outpatient,1,mL,22.14000,21.03000,The Alliance,Premier SAS,,15.23,,,,,,,11.07,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,outpatient,1,mL,25.68000,24.39000,The Alliance,Premier SAS,,17.67,,,,,,,12.84,24.91,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,outpatient,1,GM,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,outpatient,1,EA,10.42000,9.90000,The Alliance,Premier SAS,,7.17,,,,,,,5.21,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,outpatient,1,EA,8.10000,7.70000,The Alliance,Premier SAS,,5.57,,,,,,,4.05,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,outpatient,1,EA,7.29000,6.93000,The Alliance,Premier SAS,,5.02,,,,,,,3.65,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier SAS,,3.42,,,,,,,2.48,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,outpatient,1,EA,11.28000,10.72000,The Alliance,Premier SAS,,7.76,,,,,,,5.64,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,outpatient,1,EA,12.18000,11.58000,The Alliance,Premier SAS,,8.38,,,,,,,6.09,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier SAS,,1.43,,,,,,,1.04,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Premier SAS,,3.06,,,,,,,2.23,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,outpatient,,,978.00000,929.10000,The Alliance,Premier SAS,,2561.00,,,,,,,537.90,3163.00,case rate,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,outpatient,1,EA,6.96000,6.62000,The Alliance,Premier SAS,,4.79,,,,,,,3.48,6.75,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,outpatient,1,EA,35.25000,33.49000,The Alliance,Premier SAS,,24.25,,,,,,,17.62,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,outpatient,1,EA,39.17000,37.21000,The Alliance,Premier SAS,,26.95,,,,,,,19.59,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,outpatient,1,EA,25.65000,24.36000,The Alliance,Premier SAS,,17.65,,,,,,,12.82,24.88,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier SAS,,4.56,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Premier SAS,,2.84,,,,,,,2.06,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier SAS,,3.72,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier SAS,,3.72,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,outpatient,1,mL,6.36000,6.05000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,6.17,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,7.82,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,outpatient,1,mL,7.68000,7.29000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,7.45,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,8.58,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,outpatient,1,mL,6.71000,6.38000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,6.51,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,outpatient,1,mL,6.04000,5.74000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,5.86,fee schedule,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,6.44,fee schedule,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,outpatient,15,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,outpatient,1,mL,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier SAS,,3.91,,,,,,,2.85,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier SAS,,3.99,,,,,,,2.90,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Premier SAS,,4.00,,,,,,,2.90,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,outpatient,1,mL,1.27000,1.20000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier SAS,90,94.72,,,,,,,13.68,696.05,fee schedule,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,39.22,,,,,,,28.50,70.98,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,outpatient,,,988.00000,938.60000,The Alliance,Premier SAS,90,679.74,,,,,,,14.72,958.36,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier SAS,,201.58,,,,,,,146.50,284.21,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,75.00,155.84,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,outpatient,,,1190.00000,1130.50000,The Alliance,Premier SAS,,818.72,,,,,,,595.00,1154.30,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,outpatient,1,EA,287.54000,273.16000,The Alliance,Premier SAS,,197.83,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,outpatient,1,EA,287.54000,273.17000,The Alliance,Premier SAS,,197.83,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Premier SAS,,196.01,,,,,,,142.45,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,outpatient,1,EA,288.79000,274.35000,The Alliance,Premier SAS,,198.69,,,,,,,144.40,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,outpatient,1,EA,366.61000,348.28000,The Alliance,Premier SAS,,252.23,,,,,,,183.31,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,outpatient,1,EA,121.38000,115.31000,The Alliance,Premier SAS,,83.51,,,,,,,60.69,117.74,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Premier SAS,,1.88,,,,,,,1.36,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier SAS,,3.24,,,,,,,2.35,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,outpatient,1,EA,2.14000,2.04000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,outpatient,1,EA,7.17000,6.81000,The Alliance,Premier SAS,,4.93,,,,,,,3.58,6.95,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,outpatient,1,EA,1787.36000,1697.99000,The Alliance,Premier SAS,,655.64,,,,,,,409.52,1733.74,fee schedule,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier SAS,TC,924.67,,,,,,,672.00,1303.68,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,outpatient,10,EA,5.90000,5.60000,The Alliance,Premier SAS,,2.27,,,,,,,2.08,5.72,fee schedule,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,2.27,,,,,,,0.11000,2.34,fee schedule,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,2.27,,,,,,,0.14000,2.34,fee schedule,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,outpatient,1,EA,6.60000,6.27000,The Alliance,Premier SAS,,4.54,,,,,,,3.30,6.40,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,outpatient,15,EA,2.36000,2.24000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,outpatient,15,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,outpatient,15,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,outpatient,15,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,outpatient,1,EA,11.41000,10.84000,The Alliance,Premier SAS,,7.85,,,,,,,5.71,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,outpatient,1,EA,19.03000,18.08000,The Alliance,Premier SAS,,13.09,,,,,,,9.52,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,outpatient,1,EA,11.30000,10.74000,The Alliance,Premier SAS,,7.77,,,,,,,5.65,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,outpatient,1,EA,10.04000,9.54000,The Alliance,Premier SAS,,6.91,,,,,,,5.02,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,,251.12,,,,,,,182.50,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,90,251.12,,,,,,,182.50,354.05,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,outpatient,5,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,outpatient,5,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,outpatient,5,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,outpatient,5,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,outpatient,5,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Premier SAS,,4401.82,,,,,,,1914.61,6206.06,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,outpatient,1,EA,86.53000,82.20000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,83.93,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,outpatient,1,EA,84.85000,80.60000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,82.30,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,19.92,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,outpatient,1,EA,39.10000,37.15000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,37.93,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,outpatient,1,EA,31.41000,29.84000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,30.47,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,10.42,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,outpatient,1,EA,21.19000,20.13000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,20.55,fee schedule,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,9.96,fee schedule,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,72.93,,,,,,,58.30,5271.00,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,outpatient,2,EA,1.52000,1.44000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.47,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,outpatient,2,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.92150,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,outpatient,2,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.48500,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,outpatient,2,EA,2.03000,1.93000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.97,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,outpatient,2,EA,1.50000,1.43000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.46,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,outpatient,2,EA,3.16000,3.00000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,3.07,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,outpatient,2,EA,2.05000,1.95000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.99,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,outpatient,2,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.56260,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,outpatient,2,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.41,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,outpatient,2,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.70810,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,outpatient,2,EA,1.74000,1.65000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.69,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,outpatient,2,EA,2.77000,2.63000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,2.69,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,outpatient,2,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.53,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,outpatient,2,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.15,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,outpatient,2,EA,3.56000,3.38000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,3.45,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,outpatient,2,EA,3.79000,3.60000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,3.68,fee schedule,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,outpatient,2,EA,3.10000,2.94000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,3.01,fee schedule,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,outpatient,60,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,outpatient,60,EA,27.49000,26.12000,The Alliance,Premier SAS,,18.91,,,,,,,13.74,26.67,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,outpatient,1,EA,5474.37000,5200.65000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,5310.14,fee schedule,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,outpatient,1,EA,7150.48000,6792.96000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,6935.97,fee schedule,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,outpatient,1,EA,0.62000,0.58000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,outpatient,1,mL,461.19000,438.14000,The Alliance,Premier SAS,,125.61,,,,,,,78.46,447.35,fee schedule,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,outpatient,60,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,outpatient,60,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,outpatient,60,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,outpatient,60,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,outpatient,60,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,outpatient,60,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,outpatient,1,EA,5.11000,4.85000,The Alliance,Premier SAS,,3.52,,,,,,,2.56,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier SAS,,1.79,,,,,,,1.30,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,outpatient,1,EA,6455.15000,6132.39000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,6261.50,fee schedule,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,outpatient,1,EA,9368.36000,8899.95000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,9087.31,fee schedule,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,outpatient,1,EA,5.45000,5.17000,The Alliance,Premier SAS,,3.75,,,,,,,2.73,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Premier SAS,,3.01,,,,,,,2.19,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,The Alliance,Premier SAS,,3.90,,,,,,,2.83,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,outpatient,1,EA,7.28000,6.91000,The Alliance,Premier SAS,,5.01,,,,,,,3.64,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier SAS,,3.86,,,,,,,2.81,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,outpatient,1,EA,33.81000,32.12000,The Alliance,Premier SAS,,23.26,,,,,,,16.91,32.80,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,outpatient,15,EA,14.15000,13.44000,The Alliance,Premier SAS,,9.74,,,,,,,7.08,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.20,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.19,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,outpatient,1,mL,0.87000,0.83000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.84390,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,0.76630,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.34,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,2.30,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,outpatient,1,mL,3.20000,3.04000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,3.10,fee schedule,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13330,1.53,fee schedule,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,,175.58,,,,,,,27.39,1290.24,fee schedule,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,27.72,,,,,,,3.66,203.72,fee schedule,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,outpatient,,,22948.00000,21800.60000,The Alliance,Premier SAS,,15788.22,,,,,,,4607.00,22259.56,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,27.72,,,,,,,4.23,203.72,fee schedule,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,113.20,,,,,,,15.92,831.84,fee schedule,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,outpatient,5,EA,81.26000,77.19000,The Alliance,Premier SAS,,55.91,,,,,,,40.63,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,outpatient,5,EA,41.08000,39.03000,The Alliance,Premier SAS,,28.26,,,,,,,20.54,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,outpatient,5,EA,40.75000,38.71000,The Alliance,Premier SAS,,28.04,,,,,,,20.38,39.53,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier SAS,,1502.52,,,,,,,523.04,11041.20,fee schedule,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier SAS,TC,608.88,,,,,,,442.50,858.45,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,34.66,,,,,,,4.26,254.68,fee schedule,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier SAS,,249.74,,,,,,,41.63,352.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier SAS,,4.56,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,The Alliance,Premier SAS,,3.72,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,outpatient,1,EA,5.62000,5.33000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,outpatient,1,EA,9666.09000,9182.79000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,9376.11,fee schedule,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,outpatient,1,EA,12876.34000,12232.52000,The Alliance,Premier SAS,,339.73,,,,,,,212.20,12490.05,fee schedule,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,outpatient,1,EA,45.60000,43.32000,The Alliance,Premier SAS,,31.37,,,,,,,22.80,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Premier SAS,,5.33,,,,,,,3.87,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,outpatient,1,EA,5.50000,5.22000,The Alliance,Premier SAS,,3.78,,,,,,,2.75,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,outpatient,1,EA,5.46000,5.19000,The Alliance,Premier SAS,,3.76,,,,,,,2.73,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,outpatient,1,EA,3.40000,3.23000,The Alliance,Premier SAS,,2.34,,,,,,,1.70,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,outpatient,1,EA,2.27000,2.15000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.35,,,,,,,0.98000,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier SAS,,1.92,,,,,,,1.40,2.71,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier SAS,,154.78,,,,,,,67.50,1137.41,fee schedule,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,outpatient,,,36445.00000,34622.75000,The Alliance,Premier SAS,,25074.16,,,,,,,4607.00,35351.65,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,outpatient,5,EA,183.67000,174.48000,The Alliance,Premier SAS,,126.36,,,,,,,91.83,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,outpatient,5,EA,9.61000,9.13000,The Alliance,Premier SAS,,6.61,,,,,,,4.80,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,outpatient,5,EA,24.99000,23.74000,The Alliance,Premier SAS,,17.19,,,,,,,12.49,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,outpatient,5,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,outpatient,5,EA,4.80000,4.56000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,outpatient,5,EA,26.86000,25.52000,The Alliance,Premier SAS,,18.48,,,,,,,13.43,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,outpatient,5,EA,4.77000,4.53000,The Alliance,Premier SAS,,3.28,,,,,,,2.38,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,outpatient,5,EA,4.46000,4.23000,The Alliance,Premier SAS,,3.07,,,,,,,2.23,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,outpatient,5,EA,4.39000,4.17000,The Alliance,Premier SAS,,3.02,,,,,,,2.19,4.26,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,outpatient,1,EA,15.87000,15.08000,The Alliance,Premier SAS,,10.92,,,,,,,7.93,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,outpatient,1,EA,15.33000,14.56000,The Alliance,Premier SAS,,10.55,,,,,,,7.67,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,outpatient,1,EA,24.33000,23.12000,The Alliance,Premier SAS,,16.74,,,,,,,12.16,23.60,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,outpatient,1,EA,38.67000,36.74000,The Alliance,Premier SAS,,26.60,,,,,,,19.34,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Premier SAS,,7.23,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,outpatient,15,EA,3.29000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,The Alliance,Premier SAS,,7.23,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,outpatient,15,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,2.21,4.28,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,outpatient,1,EA,659.69000,626.71000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,639.90,fee schedule,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,outpatient,1,EA,659.70000,626.71000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,639.91,fee schedule,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,2322.00,,,,,,,1856.25,5271.00,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier SAS,,1.51,,,,,,,1.10,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,outpatient,15,EA,4.09000,3.88000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,outpatient,15,EA,4.59000,4.36000,The Alliance,Premier SAS,,3.16,,,,,,,2.29,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,outpatient,15,EA,3.66000,3.47000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,outpatient,15,EA,3.15000,2.99000,The Alliance,Premier SAS,,2.17,,,,,,,1.57,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,outpatient,1,EA,285.49000,271.21000,The Alliance,Premier SAS,,196.42,,,,,,,142.75,276.93,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier SAS,,55.73,,,,,,,44.55,5271.00,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,outpatient,1,EA,2.41000,2.29000,The Alliance,Premier SAS,,1.66,,,,,,,1.21,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier SAS,,3.98,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier SAS,,3.98,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,outpatient,,,13836.00000,13144.20000,The Alliance,Premier SAS,,9519.17,,,,,,,4607.00,13420.92,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,outpatient,5,EA,10.59000,10.06000,The Alliance,Premier SAS,,7.29,,,,,,,5.29,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,outpatient,5,EA,12.92000,12.27000,The Alliance,Premier SAS,,8.89,,,,,,,6.46,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,outpatient,5,EA,12.27000,11.66000,The Alliance,Premier SAS,,8.44,,,,,,,6.13,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,outpatient,5,EA,14.21000,13.50000,The Alliance,Premier SAS,,9.78,,,,,,,7.11,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,The Alliance,Premier SAS,,4.03,,,,,,,2.93,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier SAS,,37147.18,,,,,,,4607.00,52373.21,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Premier SAS,,122.06,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,outpatient,1,EA,120.63000,114.60000,The Alliance,Premier SAS,,82.99,,,,,,,60.31,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,The Alliance,Premier SAS,,122.06,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,outpatient,1,EA,122.44000,116.32000,The Alliance,Premier SAS,,84.24,,,,,,,61.22,118.77,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,outpatient,,,21293.00000,20228.35000,The Alliance,Premier SAS,,14649.58,,,,,,,4607.00,20654.21,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,outpatient,1,EA,422.19000,401.08000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,409.52,fee schedule,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,46.20,,,,,,,6.61,339.51,fee schedule,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier SAS,,4806.37,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier SAS,,5572.80,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,outpatient,,,10089.00000,9584.55000,The Alliance,Premier SAS,,6941.23,,,,,,,4607.00,9786.33,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,outpatient,1,EA,47.99000,45.59000,The Alliance,Premier SAS,,33.02,,,,,,,24.00,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,outpatient,1,EA,30.22000,28.71000,The Alliance,Premier SAS,,20.79,,,,,,,15.11,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier SAS,,5.66,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,outpatient,1,EA,25.22000,23.96000,The Alliance,Premier SAS,,17.35,,,,,,,12.61,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,outpatient,1,EA,32.24000,30.62000,The Alliance,Premier SAS,,22.18,,,,,,,16.12,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,outpatient,1,EA,25.28000,24.01000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,outpatient,1,EA,35.97000,34.17000,The Alliance,Premier SAS,,24.75,,,,,,,17.98,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,outpatient,1,EA,5.85000,5.55000,The Alliance,Premier SAS,,4.02,,,,,,,2.92,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,outpatient,1,EA,27.40000,26.03000,The Alliance,Premier SAS,,18.85,,,,,,,13.70,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,outpatient,1,EA,5.43000,5.15000,The Alliance,Premier SAS,,3.74,,,,,,,2.71,5.27,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,48.52,,,,,,,6.82,356.54,fee schedule,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,outpatient,1,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier SAS,GO,180.00,,,,,,,70.50,264.00,per diem,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,outpatient,1,EA,2595.50000,2465.73000,The Alliance,Premier SAS,,64.94,,,,,,,40.56,2517.64,fee schedule,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier SAS,GO,180.00,,,,,,,49.00,264.00,per diem,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,outpatient,60,mL,6.35000,6.03000,The Alliance,Premier SAS,,4.37,,,,,,,3.17,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,outpatient,60,mL,8.00000,7.60000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,outpatient,60,mL,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,outpatient,60,mL,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,outpatient,60,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,outpatient,60,mL,5.28000,5.01000,The Alliance,Premier SAS,,3.63,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,outpatient,60,mL,5.28000,5.02000,The Alliance,Premier SAS,,3.63,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,outpatient,60,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,outpatient,60,mL,0.93000,0.89000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,GO,180.00,,,,,,,43.00,264.00,per diem,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Premier SAS,,1702.32,,,,,,,1702.32,3708.75,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,264.00,per diem,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,outpatient,,,213.20000,202.54000,The Alliance,Premier SAS,GO,180.00,,,,,,,106.60,264.00,per diem,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,57.50,264.00,per diem,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,264.00,per diem,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,GO,180.00,,,,,,,62.00,264.00,per diem,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,GO,180.00,,,,,,,76.00,264.00,per diem,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,The Alliance,Premier SAS,,626.77,,,,,,,501.05,5271.00,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,outpatient,,,255.00000,242.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,264.00,per diem,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier SAS,GO,180.00,,,,,,,55.50,264.00,per diem,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,57.50,264.00,per diem,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,GO,180.00,,,,,,,28.50,264.00,per diem,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,90,117.83,,,,,,,17.00,865.84,fee schedule,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,outpatient,1,EA,11.38000,10.81000,The Alliance,Premier SAS,,7.83,,,,,,,5.69,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,outpatient,1,EA,10.90000,10.36000,The Alliance,Premier SAS,,7.50,,,,,,,5.45,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier SAS,,62.38,,,,,,,8.90,458.40,fee schedule,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,GO,180.00,,,,,,,53.00,264.00,per diem,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,outpatient,1,EA,686.35000,652.03000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,665.76,fee schedule,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,97.03,,,,,,,14.86,713.01,fee schedule,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,GO,180.00,,,,,,,43.00,264.00,per diem,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,outpatient,1,EA,24.43000,23.21000,The Alliance,Premier SAS,,16.81,,,,,,,12.21,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,outpatient,1,EA,40.62000,38.59000,The Alliance,Premier SAS,,27.95,,,,,,,20.31,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,outpatient,1,EA,55.18000,52.42000,The Alliance,Premier SAS,,37.96,,,,,,,27.59,53.52,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Premier SAS,90,154.78,,,,,,,92.05,1137.41,fee schedule,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Premier SAS,,276.25,,,,,,,172.55,828.02,fee schedule,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier SAS,GO,180.00,,,,,,,50.50,264.00,per diem,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,outpatient,1,mL,303.44000,288.27000,The Alliance,Premier SAS,,208.77,,,,,,,62.23,294.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,outpatient,1,EA,7.65000,7.26000,The Alliance,Premier SAS,,5.26,,,,,,,3.83,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Premier SAS,,3.89,,,,,,,2.83,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,outpatient,1,EA,16.85000,16.01000,The Alliance,Premier SAS,,11.59,,,,,,,8.43,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Premier SAS,,11.90,,,,,,,8.65,16.78,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,outpatient,1,EA,66.39000,63.07000,The Alliance,Premier SAS,,45.68,,,,,,,33.20,64.40,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,outpatient,,,3486.00000,3311.70000,The Alliance,Premier SAS,TC,2398.37,,,,,,,1598.89,3381.42,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,outpatient,1,EA,31.42000,29.85000,The Alliance,Premier SAS,,21.62,,,,,,,15.71,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,outpatient,1,EA,32.23000,30.62000,The Alliance,Premier SAS,,22.17,,,,,,,16.11,31.26,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,outpatient,1,EA,1372.70000,1304.06000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,1331.52,fee schedule,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,outpatient,,,143.70000,136.51000,The Alliance,Premier SAS,90,92.41,,,,,,,14.93,679.08,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,333.55,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,15.33,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,3.07,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,7.66,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,outpatient,1,mL,10.81000,10.27000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,10.49,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,11.04,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,6.13,fee schedule,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,outpatient,1,mL,17.38000,16.51000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,16.86,fee schedule,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,GO,180.00,,,,,,,55.00,264.00,per diem,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier SAS,,94.72,,,,,,,13.36,696.05,fee schedule,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier SAS,,136.30,,,,,,,21.21,1001.63,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,45.98,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,30.65,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,9.20,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,outpatient,1,mL,178.67000,169.73000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,173.31,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,outpatient,1,mL,154.58000,146.85000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,149.94,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,3.68,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,11.04,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,outpatient,1,mL,286.30000,271.98000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,277.71,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,79.70,fee schedule,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier SAS,,0.72045,,,,,,,0.72045,5.52,fee schedule,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,outpatient,1,EA,1.44000,1.36000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,outpatient,1,EA,1.04000,0.98000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,outpatient,1,EA,1.36000,1.30000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,138.98,,,,,,,101.00,195.94,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,outpatient,500,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.01,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,outpatient,1,EA,5.73000,5.44000,The Alliance,Premier SAS,,3.94,,,,,,,2.87,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Premier SAS,90,147.96,,,,,,,22.97,1087.31,fee schedule,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,The Alliance,Premier SAS,,147.96,,,,,,,22.97,1087.31,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,6.13,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,outpatient,1,mL,5.46000,5.19000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,5.30,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,6.07,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,4.37,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,7.92,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,7.24,fee schedule,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,2.33,fee schedule,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Premier SAS,,31.19,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,outpatient,,,1058.00000,1005.10000,The Alliance,Premier SAS,,5740.92,,,,,,,529.00,42186.85,fee schedule,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,outpatient,1,mL,295.86000,281.06000,The Alliance,Premier SAS,,203.55,,,,,,,62.23,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,outpatient,1,mL,261.75000,248.66000,The Alliance,Premier SAS,,180.08,,,,,,,62.23,253.90,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Premier SAS,,1947.77,,,,,,,1947.77,4116.19,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier SAS,GO,180.00,,,,,,,84.50,264.00,per diem,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,outpatient,1,mL,5334.01000,5067.31000,The Alliance,Premier SAS,,24.14,,,,,,,15.08,5173.99,fee schedule,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,outpatient,1,mL,65.43000,62.16000,The Alliance,Premier SAS,,45.02,,,,,,,32.72,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,outpatient,1,mL,59.25000,56.29000,The Alliance,Premier SAS,,40.76,,,,,,,29.62,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Premier SAS,,35.33,,,,,,,25.68,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,outpatient,1,mL,61.40000,58.33000,The Alliance,Premier SAS,,42.24,,,,,,,30.70,59.56,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,106.27,,,,,,,15.05,780.94,fee schedule,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Premier SAS,,127.06,,,,,,,17.98,933.70,fee schedule,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Premier SAS,,9.03,,,,,,,6.56,12.73,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,outpatient,,,264.90000,251.65000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,outpatient,120,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,outpatient,120,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,outpatient,120,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier SAS,,163.74,,,,,,,20.26,230.86,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,outpatient,1,EA,1.84000,1.74000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Premier SAS,,3.40,,,,,,,2.47,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,The Alliance,Premier SAS,,2.38,,,,,,,1.73,3.36,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Premier SAS,,30.29,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,outpatient,1,EA,28.43000,27.01000,The Alliance,Premier SAS,,19.56,,,,,,,14.21,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,The Alliance,Premier SAS,,5.66,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Premier SAS,,4.19,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,outpatient,1,EA,29.57000,28.10000,The Alliance,Premier SAS,,20.34,,,,,,,14.79,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,outpatient,1,EA,23.38000,22.21000,The Alliance,Premier SAS,,16.09,,,,,,,11.69,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,outpatient,1,EA,32.62000,30.99000,The Alliance,Premier SAS,,22.44,,,,,,,16.31,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,outpatient,1,EA,25.14000,23.88000,The Alliance,Premier SAS,,17.30,,,,,,,12.57,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,outpatient,1,mL,10069.36000,9565.89000,The Alliance,Premier SAS,,45506.92,,,,,,,5034.68,46899.70,fee schedule,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,outpatient,15,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,outpatient,15,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,outpatient,15,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,outpatient,15,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,outpatient,15,EA,1.21000,1.14000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,TC,2705.90,,,,,,,1966.50,3815.01,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,outpatient,30,EA,18.43000,17.51000,The Alliance,Premier SAS,,12.68,,,,,,,9.21,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,outpatient,30,EA,7.12000,6.76000,The Alliance,Premier SAS,,4.90,,,,,,,3.56,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,outpatient,30,EA,11.59000,11.01000,The Alliance,Premier SAS,,7.97,,,,,,,5.79,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,outpatient,30,EA,17.80000,16.91000,The Alliance,Premier SAS,,12.25,,,,,,,8.90,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,outpatient,30,EA,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,outpatient,30,EA,14.75000,14.01000,The Alliance,Premier SAS,,10.15,,,,,,,7.38,14.31,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,outpatient,1,mL,3.33000,3.17000,The Alliance,Premier SAS,,2.29,,,,,,,1.67,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,outpatient,1,mL,2.83000,2.69000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Premier SAS,,73.92,,,,,,,11.54,543.22,fee schedule,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier SAS,,293.40,,,,,,,41.28,2156.01,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,outpatient,1,mL,343.87000,326.68000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,333.55,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,15.33,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,9.20,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,3.07,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,7.66,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,26.05,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,11.04,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,6.13,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,outpatient,1,mL,15.17000,14.41000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,14.71,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,3.83,fee schedule,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,outpatient,1,mL,15.58000,14.80000,The Alliance,Premier SAS,,0.14409,,,,,,,0.07595,15.11,fee schedule,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,outpatient,,,3021.00000,2869.95000,The Alliance,Premier SAS,TC,2078.45,,,,,,,1390.09,2930.37,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,outpatient,1,EA,6.08000,5.77000,The Alliance,Premier SAS,,1.07,,,,,,,1.07,5.90,fee schedule,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,1.07,,,,,,,1.07,30.65,fee schedule,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,outpatient,1,EA,3.68000,3.49000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,outpatient,1,EA,14.71000,13.97000,The Alliance,Premier SAS,,10.12,,,,,,,7.36,14.27,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Premier SAS,,25.41,,,,,,,3.58,186.75,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,outpatient,1,EA,2094.27000,1989.56000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,2031.44,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,91.96,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,outpatient,1,EA,261.69000,248.61000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,253.84,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,outpatient,1,EA,411.81000,391.22000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,399.46,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,376.85,fee schedule,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,outpatient,1,EA,38.55000,36.62000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,37.39,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,outpatient,1,mL,29.56000,28.09000,The Alliance,Premier SAS,,17.87,,,,,,,14.78,28.67,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,outpatient,1,mL,11.33000,10.76000,The Alliance,Premier SAS,,17.87,,,,,,,5.67,23.04,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier SAS,,17.87,,,,,,,4.26,23.04,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,17.87,,,,,,,17.87,122.61,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,outpatient,1,EA,59.38000,56.41000,The Alliance,Premier SAS,,17.87,,,,,,,17.87,57.60,fee schedule,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Premier SAS,,17.87,,,,,,,2.21,23.04,fee schedule,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,outpatient,30,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,outpatient,30,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier SAS,,2.55,,,,,,,1.85,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,outpatient,1,EA,40.20000,38.19000,The Alliance,Premier SAS,,1.41,,,,,,,1.20,38.99,fee schedule,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,outpatient,1,EA,13.78000,13.09000,The Alliance,Premier SAS,,1.41,,,,,,,1.20,13.37,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Premier SAS,,131.87,,,,,,,123.22,363.03,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier SAS,,131.87,,,,,,,123.22,275.87,fee schedule,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Premier SAS,,131.87,,,,,,,123.22,419.28,fee schedule,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Premier SAS,,4.51,,,,,,,3.28,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,The Alliance,Premier SAS,,4.52,,,,,,,3.29,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,outpatient,1,EA,6.25000,5.94000,The Alliance,Premier SAS,,4.30,,,,,,,3.12,6.06,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Premier SAS,,982.75,,,,,,,162.71,7221.66,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,outpatient,2,EA,359.05000,341.10000,The Alliance,Premier SAS,,46.91,,,,,,,29.30,348.28,fee schedule,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14004.86,per diem,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,outpatient,1,EA,8369.01000,7950.56000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,8117.94,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,outpatient,1,EA,1289.41000,1224.94000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,1250.73,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,outpatient,1,EA,1179.64000,1120.66000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,1144.25,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,outpatient,1,EA,2053.87000,1951.18000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,1992.25,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,1256.15,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,376.85,fee schedule,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,outpatient,1,EA,166.28000,157.97000,The Alliance,Premier SAS,,5.97,,,,,,,3.73,161.29,fee schedule,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,outpatient,100,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,outpatient,100,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier SAS,,106.27,,,,,,,15.03,780.94,fee schedule,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,outpatient,2,EA,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,GO,180.00,,,,,,,21.00,264.00,per diem,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,outpatient,1,EA,4.93000,4.68000,The Alliance,Premier SAS,,3.39,,,,,,,2.46,4.78,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,outpatient,1,EA,16.04000,15.24000,The Alliance,Premier SAS,,11.04,,,,,,,8.02,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,outpatient,1,EA,5.16000,4.90000,The Alliance,Premier SAS,,3.55,,,,,,,2.58,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier SAS,,14.13,,,,,,,10.27,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,outpatient,1,EA,15.48000,14.71000,The Alliance,Premier SAS,,10.65,,,,,,,7.74,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier SAS,,10.45,,,,,,,7.59,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,outpatient,1,EA,14.16000,13.45000,The Alliance,Premier SAS,,9.74,,,,,,,7.08,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,outpatient,1,EA,9.39000,8.92000,The Alliance,Premier SAS,,6.46,,,,,,,4.70,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Premier SAS,,9.67,,,,,,,7.03,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier SAS,,9.89,,,,,,,7.18,13.94,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,outpatient,1,EA,1.92000,1.82000,The Alliance,Premier SAS,,1.32,,,,,,,0.96000,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,outpatient,,,14531.00000,13804.45000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14095.07,per diem,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,36.97,,,,,,,5.78,271.65,fee schedule,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14018.44,per diem,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Premier SAS,,97.03,,,,,,,15.30,713.01,fee schedule,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,outpatient,1,EA,4.30000,4.08000,The Alliance,Premier SAS,,43.80,,,,,,,2.15,50.75,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,outpatient,1,EA,83.28000,79.11000,The Alliance,Premier SAS,,43.80,,,,,,,41.64,80.78,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,outpatient,1,EA,55.30000,52.53000,The Alliance,Premier SAS,,43.80,,,,,,,27.65,53.64,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,outpatient,1,EA,68.95000,65.50000,The Alliance,Premier SAS,,43.80,,,,,,,34.48,66.88,fee schedule,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,outpatient,1,EA,67.94000,64.54000,The Alliance,Premier SAS,,43.80,,,,,,,33.97,65.90,fee schedule,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,outpatient,2,EA,18.41000,17.49000,The Alliance,Premier SAS,,12.67,,,,,,,9.21,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,outpatient,2,EA,16.48000,15.66000,The Alliance,Premier SAS,,11.34,,,,,,,8.24,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,outpatient,2,EA,16.99000,16.14000,The Alliance,Premier SAS,,11.69,,,,,,,8.49,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,outpatient,2,EA,13.59000,12.91000,The Alliance,Premier SAS,,9.35,,,,,,,6.79,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,outpatient,2,EA,15.99000,15.19000,The Alliance,Premier SAS,,11.00,,,,,,,8.00,15.51,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,outpatient,30,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,outpatient,30,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,outpatient,30,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,outpatient,1,mL,853.63000,810.95000,The Alliance,Premier SAS,,276.25,,,,,,,172.55,828.02,fee schedule,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,The Alliance,Premier SAS,,3.57,,,,,,,2.60,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,The Alliance,Premier SAS,,2.84,,,,,,,2.06,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,outpatient,2,EA,6.93000,6.58000,The Alliance,Premier SAS,,4.77,,,,,,,3.46,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,outpatient,2,EA,123.69000,117.51000,The Alliance,Premier SAS,,85.10,,,,,,,61.84,119.98,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier SAS,,351.57,,,,,,,122.40,495.67,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier SAS,,283.39,,,,,,,24.91,2082.45,fee schedule,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,outpatient,1,mL,19.60000,18.62000,The Alliance,Premier SAS,,13.48,,,,,,,9.80,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,outpatient,1,mL,16.11000,15.31000,The Alliance,Premier SAS,,11.08,,,,,,,8.05,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,outpatient,1,mL,16.61000,15.78000,The Alliance,Premier SAS,,11.43,,,,,,,8.30,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,outpatient,1,mL,13.28000,12.62000,The Alliance,Premier SAS,,9.14,,,,,,,6.64,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,outpatient,1,mL,15.63000,14.85000,The Alliance,Premier SAS,,10.75,,,,,,,7.82,15.16,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,outpatient,1,mL,151.84000,144.25000,The Alliance,Premier SAS,,43.80,,,,,,,43.80,147.28,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,outpatient,1,mL,167.67000,159.29000,The Alliance,Premier SAS,,43.80,,,,,,,43.80,162.64,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,outpatient,1,mL,106.18000,100.87000,The Alliance,Premier SAS,,43.80,,,,,,,43.80,102.99,fee schedule,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,outpatient,1,mL,173.80000,165.11000,The Alliance,Premier SAS,,43.80,,,,,,,43.80,168.59,fee schedule,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,outpatient,5,EA,1.15000,1.09000,The Alliance,Premier SAS,,1.06,,,,,,,0.57500,1.12,fee schedule,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,outpatient,5,EA,0.86000,0.82000,The Alliance,Premier SAS,,1.06,,,,,,,0.43000,1.09,fee schedule,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,outpatient,,,510.82000,485.28000,The Alliance,Premier SAS,,413.04,,,,,,,255.41,495.50,fee schedule,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,outpatient,1,mL,1021.64000,970.56000,The Alliance,Premier SAS,,413.04,,,,,,,399.88,990.99,fee schedule,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Premier SAS,,3.53,,,,,,,2.56,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Premier SAS,,28.16,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,The Alliance,Premier SAS,,28.16,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,39.28,,,,,,,5.50,288.61,fee schedule,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6366.00000,6047.70000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,6175.02,per diem,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,outpatient,1,EA,41.77000,39.68000,The Alliance,Premier SAS,,28.74,,,,,,,20.89,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,outpatient,1,EA,3.21000,3.05000,The Alliance,Premier SAS,,2.21,,,,,,,1.60,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,outpatient,,,41.50000,39.42000,The Alliance,Premier SAS,90,25.41,,,,,,,3.70,186.75,fee schedule,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,outpatient,1,mL,1207.45000,1147.08000,The Alliance,Premier SAS,,27.04,,,,,,,16.89,1171.23,fee schedule,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,outpatient,2,EA,7.58000,7.20000,The Alliance,Premier SAS,,5.22,,,,,,,3.79,7.35,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,outpatient,,,762.00000,723.90000,The Alliance,Premier SAS,,524.26,,,,,,,419.10,5271.00,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,,619.65,,,,,,,619.65,1350.00,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,outpatient,2,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.06,,,,,,,0.80910,2.09,fee schedule,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,outpatient,2,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.06,,,,,,,0.80910,1.94,fee schedule,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,outpatient,2,EA,1.39000,1.32000,The Alliance,Premier SAS,,1.06,,,,,,,0.69500,1.35,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,outpatient,1,EA,160.78000,152.74000,The Alliance,Premier SAS,,1.41,,,,,,,1.20,155.96,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Premier SAS,,1.41,,,,,,,1.20,155.19,fee schedule,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,outpatient,1,EA,173.80000,165.11000,The Alliance,Premier SAS,,1.41,,,,,,,1.20,168.59,fee schedule,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier SAS,,0.98384,,,,,,,0.71500,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,outpatient,1,EA,26.02000,24.71000,The Alliance,Premier SAS,,17.90,,,,,,,13.01,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,outpatient,1,EA,25.60000,24.32000,The Alliance,Premier SAS,,17.61,,,,,,,12.80,24.83,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,outpatient,1,EA,12.84000,12.19000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,12.45,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,outpatient,1,EA,32.55000,30.92000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,31.57,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,outpatient,1,EA,37.72000,35.83000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,36.59,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,outpatient,1,EA,33.04000,31.39000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,32.05,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,outpatient,1,EA,43.77000,41.58000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,42.46,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,15.78,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,33.72,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,outpatient,1,EA,36.59000,34.76000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,35.49,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,outpatient,1,EA,23.18000,22.02000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,22.48,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,outpatient,1,EA,18.01000,17.11000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,17.47,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,outpatient,1,EA,43.83000,41.64000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,42.52,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,outpatient,1,EA,36.43000,34.61000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,35.34,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,12.26,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,outpatient,1,EA,16.21000,15.40000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,15.72,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,outpatient,1,EA,23.07000,21.91000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,22.38,fee schedule,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,15.64,fee schedule,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,outpatient,237,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,outpatient,237,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,outpatient,237,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,outpatient,237,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,outpatient,,,14477.00000,13753.15000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14042.69,per diem,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,131.69,,,,,,,52.00,967.70,fee schedule,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,32.34,,,,,,,4.76,237.65,fee schedule,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,outpatient,1,EA,10.26000,9.75000,The Alliance,Premier SAS,,7.06,,,,,,,5.13,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Premier SAS,,1.32,,,,,,,0.96000,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,outpatient,1,EA,62.55000,59.42000,The Alliance,Premier SAS,,43.03,,,,,,,31.27,60.67,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,30.03,,,,,,,4.27,220.68,fee schedule,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,outpatient,20,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,outpatient,20,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,outpatient,20,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Premier SAS,,359.14,,,,,,,287.10,5271.00,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,outpatient,17,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,outpatient,17,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,outpatient,17,EA,4.92000,4.67000,The Alliance,Premier SAS,,3.38,,,,,,,2.46,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,outpatient,17,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,outpatient,17,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,outpatient,17,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,outpatient,17,EA,6.49000,6.16000,The Alliance,Premier SAS,,4.47,,,,,,,3.25,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,outpatient,17,EA,4.76000,4.52000,The Alliance,Premier SAS,,3.27,,,,,,,2.38,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,outpatient,17,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,outpatient,17,EA,5.32000,5.06000,The Alliance,Premier SAS,,3.66,,,,,,,2.66,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,outpatient,17,EA,4.22000,4.01000,The Alliance,Premier SAS,,2.90,,,,,,,2.11,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,outpatient,17,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,outpatient,17,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,outpatient,17,EA,3.57000,3.39000,The Alliance,Premier SAS,,2.46,,,,,,,1.78,3.46,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,outpatient,,,130.70000,124.16000,The Alliance,Premier SAS,90,60.06,,,,,,,8.72,441.37,fee schedule,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,outpatient,,,206.80000,196.46000,The Alliance,Premier SAS,90,170.95,,,,,,,25.05,1256.24,fee schedule,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,34.66,,,,,,,4.74,254.68,fee schedule,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,outpatient,1,EA,154.75000,147.01000,The Alliance,Premier SAS,,106.47,,,,,,,77.38,150.11,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier SAS,TC,316.48,,,,,,,230.00,446.20,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,,217.16,,,,,,,91.00,1595.82,fee schedule,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Premier SAS,,24.46,,,,,,,17.77,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier SAS,,11.96,,,,,,,8.69,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,outpatient,1,EA,31.57000,29.99000,The Alliance,Premier SAS,,21.72,,,,,,,15.79,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,14.22,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,outpatient,1,EA,30.21000,28.70000,The Alliance,Premier SAS,,20.78,,,,,,,15.11,29.30,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,outpatient,15,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,30.03,,,,,,,4.73,220.68,fee schedule,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,outpatient,30,EA,2.07000,1.96000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,2.01,fee schedule,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,outpatient,30,EA,2.10000,2.00000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,2.04,fee schedule,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,1132.00000,1075.40000,The Alliance,Premier SAS,,778.82,,,,,,,566.00,1098.04,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,2386.00000,2266.70000,The Alliance,Premier SAS,,1641.57,,,,,,,462.52,2314.42,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,outpatient,1,EA,273.97000,260.27000,The Alliance,Premier SAS,,188.49,,,,,,,136.99,265.75,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Premier SAS,,33.26,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier SAS,,1.80,,,,,,,1.30,2.53,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.06640,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.06640,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.06640,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier SAS,,0.92880,,,,,,,0.06640,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier SAS,,0.43344,,,,,,,0.06640,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.06640,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.06640,0.40740,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,103.96,,,,,,,7.85,763.98,fee schedule,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,outpatient,1,EA,2.26000,2.15000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,outpatient,15,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,outpatient,15,EA,1.70000,1.61000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,outpatient,15,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,outpatient,15,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,outpatient,15,EA,2.93000,2.79000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,outpatient,15,EA,3.56000,3.38000,The Alliance,Premier SAS,,2.45,,,,,,,1.78,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,outpatient,15,EA,2.90000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,outpatient,15,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier SAS,,138.61,,,,,,,19.38,1018.59,fee schedule,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,outpatient,,,6058.00000,5755.10000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,5876.26,per diem,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,outpatient,30,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,outpatient,4000,EA,40.07000,38.07000,The Alliance,Premier SAS,,27.57,,,,,,,20.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,outpatient,4000,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier SAS,90,46.20,,,,,,,6.75,339.51,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,outpatient,1,mL,29.09000,27.64000,The Alliance,Premier SAS,,311.11,,,,,,,14.54,472.00,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier SAS,,311.11,,,,,,,47.40,472.00,fee schedule,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier SAS,,311.11,,,,,,,13.43,472.00,fee schedule,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,32.34,,,,,,,4.48,237.65,fee schedule,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,outpatient,,,1267.00000,1203.65000,The Alliance,Premier SAS,,909.00,,,,,,,668.09,3163.00,case rate,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,,147.86,,,,,,,20.86,1086.52,fee schedule,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier SAS,,85.48,,,,,,,12.01,628.12,fee schedule,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,outpatient,1,EA,1.14000,1.09000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,outpatient,,,264.28000,251.07000,The Alliance,Premier SAS,,213.69,,,,,,,132.14,256.35,fee schedule,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,outpatient,0.5,EA,528.55000,502.12000,The Alliance,Premier SAS,,213.69,,,,,,,206.88,512.69,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,outpatient,30,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.43227,,,,,,,0.34500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,outpatient,30,EA,2.30000,2.19000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,2.23,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.43227,,,,,,,0.26500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,outpatient,30,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.43227,,,,,,,0.17500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,outpatient,30,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.43227,,,,,,,0.28500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,outpatient,30,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.43227,,,,,,,0.13500,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,outpatient,30,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.43227,,,,,,,0.20000,0.79680,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,outpatient,30,EA,3.79000,3.60000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,3.68,fee schedule,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,outpatient,30,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.43227,,,,,,,0.26500,0.79680,fee schedule,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,outpatient,1,EA,48.35000,45.93000,The Alliance,Premier SAS,,33.26,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,outpatient,1,EA,58.39000,55.47000,The Alliance,Premier SAS,,40.17,,,,,,,29.20,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier SAS,,1.80,,,,,,,1.30,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,4.59,,,,,,,1.39,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,4.59,,,,,,,1.36,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Premier SAS,,4.59,,,,,,,2.92,5.66,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,outpatient,1,EA,2.25000,2.13000,The Alliance,Premier SAS,,4.59,,,,,,,1.12,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,outpatient,1,EA,5.52000,5.24000,The Alliance,Premier SAS,,4.59,,,,,,,2.76,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,outpatient,1,EA,6.74000,6.40000,The Alliance,Premier SAS,,4.59,,,,,,,3.37,6.54,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,outpatient,1,EA,10.16000,9.65000,The Alliance,Premier SAS,,4.59,,,,,,,4.59,9.86,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,4.59,,,,,,,1.56,5.49,fee schedule,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.59,,,,,,,3.16,6.13,fee schedule,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Premier SAS,90,103.96,,,,,,,15.20,763.98,fee schedule,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,outpatient,15,EA,3.12000,2.96000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,outpatient,15,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,outpatient,15,EA,7.88000,7.48000,The Alliance,Premier SAS,,5.42,,,,,,,3.94,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,outpatient,15,EA,6.38000,6.06000,The Alliance,Premier SAS,,4.39,,,,,,,3.19,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,outpatient,15,EA,10.10000,9.60000,The Alliance,Premier SAS,,6.95,,,,,,,5.05,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,outpatient,15,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,outpatient,1,EA,1154.70000,1096.96000,The Alliance,Premier SAS,,698.85,,,,,,,436.51,1120.06,fee schedule,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,outpatient,1,EA,1087.28000,1032.92000,The Alliance,Premier SAS,,698.85,,,,,,,436.51,1054.66,fee schedule,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,outpatient,1,EA,388.50000,369.08000,The Alliance,Premier SAS,,698.85,,,,,,,194.25,745.84,fee schedule,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,outpatient,10,EA,16.66000,15.82000,The Alliance,Premier SAS,,11.46,,,,,,,8.33,16.16,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Premier SAS,90,18.48,,,,,,,2.79,142.88,fee schedule,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,outpatient,10,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,outpatient,10,EA,3.40000,3.23000,The Alliance,Premier SAS,,2.34,,,,,,,1.70,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,outpatient,10,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,outpatient,10,EA,3.27000,3.11000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,outpatient,1,EA,27.53000,26.15000,The Alliance,Premier SAS,,18.94,,,,,,,13.77,26.70,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,outpatient,,,785.00000,745.75000,The Alliance,Premier SAS,,540.08,,,,,,,392.50,1692.33,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,,200.22,,,,,,,10.74,1471.29,fee schedule,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,outpatient,118,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.87300,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.68870,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.89240,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.85360,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.36860,fee schedule,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.55290,fee schedule,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,27.72,,,,,,,3.94,203.72,fee schedule,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,outpatient,1,EA,31.98000,30.38000,The Alliance,Premier SAS,,22.00,,,,,,,15.99,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier SAS,,2.87,,,,,,,2.08,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,outpatient,5,EA,59.96000,56.97000,The Alliance,Premier SAS,,41.25,,,,,,,29.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,outpatient,5,EA,27.81000,26.42000,The Alliance,Premier SAS,,19.13,,,,,,,13.90,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,outpatient,5,EA,27.97000,26.57000,The Alliance,Premier SAS,,19.24,,,,,,,13.98,27.13,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Premier SAS,GP,180.00,,,,,,,89.50,264.00,per diem,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Premier SAS,,4.38,,,,,,,3.19,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,outpatient,1,EA,1.88000,1.78000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Premier SAS,,21.19,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,outpatient,1,EA,4.52000,4.30000,The Alliance,Premier SAS,,3.11,,,,,,,2.26,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,The Alliance,Premier SAS,,4.16,,,,,,,3.02,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,outpatient,1,EA,1.69000,1.61000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,,189.44,,,,,,,27.22,1392.10,fee schedule,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier SAS,,2.85,,,,,,,2.07,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,outpatient,1,EA,4.71000,4.48000,The Alliance,Premier SAS,,3.24,,,,,,,2.35,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,outpatient,1,EA,11.34000,10.78000,The Alliance,Premier SAS,,7.80,,,,,,,5.67,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,outpatient,1,EA,10.83000,10.29000,The Alliance,Premier SAS,,7.45,,,,,,,5.42,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,The Alliance,Premier SAS,,1.32,,,,,,,0.96000,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,outpatient,30,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,outpatient,30,EA,45.29000,43.03000,The Alliance,Premier SAS,,31.16,,,,,,,22.64,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,outpatient,30,EA,35.01000,33.26000,The Alliance,Premier SAS,,24.09,,,,,,,17.50,33.96,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,108.58,,,,,,,15.32,797.91,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,outpatient,2,EA,3.95000,3.75000,The Alliance,Premier SAS,,4.03,,,,,,,1.98,4.85,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,outpatient,2,EA,11.46000,10.89000,The Alliance,Premier SAS,,4.03,,,,,,,4.03,11.12,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,outpatient,2,EA,7.31000,6.94000,The Alliance,Premier SAS,,4.03,,,,,,,3.65,7.09,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,outpatient,2,EA,14.22000,13.51000,The Alliance,Premier SAS,,4.03,,,,,,,4.03,13.79,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,outpatient,2,EA,8.37000,7.96000,The Alliance,Premier SAS,,4.03,,,,,,,4.03,8.12,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Premier SAS,,4.03,,,,,,,3.63,7.05,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,outpatient,2,EA,29.23000,27.77000,The Alliance,Premier SAS,,4.03,,,,,,,4.03,28.35,fee schedule,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,outpatient,2,EA,28.44000,27.02000,The Alliance,Premier SAS,,4.03,,,,,,,4.03,27.59,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,outpatient,1,mL,9.78000,9.29000,The Alliance,Premier SAS,,2.63,,,,,,,2.17,9.49,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,outpatient,1,mL,7.05000,6.69000,The Alliance,Premier SAS,,2.63,,,,,,,2.17,6.84,fee schedule,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Premier SAS,,2.63,,,,,,,2.17,6.00,fee schedule,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,outpatient,1,EA,5.66000,5.37000,The Alliance,Premier SAS,,3.89,,,,,,,2.14,5.49,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,outpatient,1,EA,17.88000,16.98000,The Alliance,Premier SAS,,12.30,,,,,,,8.94,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,outpatient,1,EA,2.63000,2.49000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,outpatient,15,EA,8.60000,8.17000,The Alliance,Premier SAS,,5.92,,,,,,,4.30,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Premier SAS,,5.08,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,The Alliance,Premier SAS,,5.08,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,outpatient,15,EA,7.38000,7.01000,The Alliance,Premier SAS,,5.08,,,,,,,3.69,7.16,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,131.69,,,,,,,18.39,967.70,fee schedule,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Premier SAS,,18.66,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,outpatient,1,EA,24.66000,23.42000,The Alliance,Premier SAS,,16.97,,,,,,,12.33,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,GP,180.00,,,,,,,30.50,264.00,per diem,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier SAS,,117.83,,,,,,,16.59,865.84,fee schedule,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier SAS,90,117.83,,,,,,,16.59,865.84,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,outpatient,20,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,outpatient,20,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.87300,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,outpatient,20,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.65960,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,outpatient,20,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.92150,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,outpatient,20,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.79540,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,outpatient,20,EA,0.92000,0.88000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.89240,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,outpatient,20,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.30070,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,outpatient,20,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.36860,fee schedule,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,outpatient,20,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.85360,fee schedule,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,GP,180.00,,,,,,,53.00,264.00,per diem,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier SAS,,4.27,,,,,,,3.10,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier SAS,,4.25,,,,,,,3.09,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier SAS,,2.78,,,,,,,2.02,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Premier SAS,,4.98,,,,,,,3.62,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Premier SAS,,4.99,,,,,,,3.62,7.03,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,,99.34,,,,,,,13.84,729.98,fee schedule,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier SAS,,83.17,,,,,,,11.61,611.15,fee schedule,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,GP,180.00,,,,,,,26.50,264.00,per diem,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier SAS,,3.28,,,,,,,2.38,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,outpatient,1,EA,9.73000,9.25000,The Alliance,Premier SAS,,6.69,,,,,,,4.87,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Premier SAS,,3.65,,,,,,,2.65,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier SAS,GP,180.00,,,,,,,47.00,264.00,per diem,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier SAS,,2561.00,,,,,,,397.10,3163.00,case rate,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,25.41,,,,,,,4.00,186.75,fee schedule,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,27.72,,,,,,,4.29,203.72,fee schedule,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,GP,180.00,,,,,,,31.50,264.00,per diem,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,131.69,,,,,,,18.39,967.70,fee schedule,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,264.00,per diem,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier SAS,GP,180.00,,,,,,,68.50,264.00,per diem,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,GP,180.00,,,,,,,55.00,264.00,per diem,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,264.00,per diem,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,GP,180.00,,,,,,,21.00,264.00,per diem,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier SAS,,699.01,,,,,,,558.80,5271.00,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,outpatient,1,EA,17.19000,16.33000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,16.67,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,outpatient,1,EA,48.57000,46.14000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,47.11,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,42.73,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,outpatient,1,EA,21.69000,20.61000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,21.04,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,outpatient,1,EA,49.30000,46.83000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,47.82,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,outpatient,1,EA,41.08000,39.03000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,39.85,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,20.85,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,outpatient,1,EA,48.24000,45.83000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,46.79,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,19.92,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,23.30,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,outpatient,1,EA,55.49000,52.72000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,53.83,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,outpatient,1,EA,43.39000,41.22000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,42.09,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,outpatient,1,EA,46.14000,43.83000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,44.76,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,outpatient,1,EA,33.43000,31.76000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,32.43,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,outpatient,1,EA,21.33000,20.26000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,20.69,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,outpatient,1,EA,28.91000,27.47000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,28.04,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,18.39,fee schedule,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,GP,180.00,,,,,,,54.00,264.00,per diem,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,GP,180.00,,,,,,,43.00,264.00,per diem,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,outpatient,1,EA,2.11000,2.01000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,outpatient,,,2160.00000,2052.00000,The Alliance,Premier SAS,,1633.33,,,,,,,255.05,12002.48,fee schedule,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,outpatient,,,3096.00000,2941.20000,The Alliance,Premier SAS,TC,2130.05,,,,,,,1428.78,3003.12,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,outpatient,1,EA,3.78000,3.59000,The Alliance,Premier SAS,,2.60,,,,,,,0.73040,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.73040,1.60,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier SAS,GP,180.00,,,,,,,49.00,264.00,per diem,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,outpatient,,,1881.00000,1786.95000,The Alliance,Premier SAS,TC,1294.13,,,,,,,885.12,2210.07,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,outpatient,1,EA,48.03000,45.63000,The Alliance,Premier SAS,,20.49,,,,,,,19.48,46.59,fee schedule,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Premier SAS,90,101.65,,,,,,,14.83,746.94,fee schedule,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,25.41,,,,,,,3.67,186.75,fee schedule,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,outpatient,,,743.00000,705.85000,The Alliance,Premier SAS,,2561.00,,,,,,,408.65,3163.00,case rate,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier SAS,TC,271.07,,,,,,,197.00,382.18,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,GP,180.00,,,,,,,42.00,264.00,per diem,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,5.51,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier SAS,,13.48,,,,,,,5.51,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,outpatient,1,EA,31.82000,30.23000,The Alliance,Premier SAS,,21.89,,,,,,,5.51,30.87,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier SAS,GP,180.00,,,,,,,70.50,264.00,per diem,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,outpatient,0.5,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,outpatient,0.5,EA,6.16000,5.85000,The Alliance,Premier SAS,,4.24,,,,,,,3.08,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,outpatient,0.5,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,The Alliance,Premier SAS,,21.19,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier SAS,TC,376.34,,,,,,,273.50,1232.72,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,GP,180.00,,,,,,,43.00,264.00,per diem,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Premier SAS,TC,2245.63,,,,,,,1527.07,3166.08,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier SAS,,191.26,,,,,,,139.00,269.66,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,outpatient,1,EA,45.52000,43.24000,The Alliance,Premier SAS,,31.32,,,,,,,22.76,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Premier SAS,,2.92,,,,,,,2.12,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,outpatient,1,EA,3.90000,3.71000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,outpatient,1,EA,4.37000,4.16000,The Alliance,Premier SAS,,3.01,,,,,,,2.19,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.12,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,GP,180.00,,,,,,,62.00,264.00,per diem,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,outpatient,1,EA,0.23000,0.21000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,The Alliance,Premier SAS,,39.84,,,,,,,28.95,56.16,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,33.95,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,909.00,,,,,,,127.05,3163.00,case rate,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,86.00,,,,,,,62.50,121.25,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,outpatient,,,2360.00000,2242.00000,The Alliance,Premier SAS,TC,1623.68,,,,,,,1087.81,2289.20,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,264.00,per diem,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier SAS,,233.33,,,,,,,97.50,1714.64,fee schedule,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,outpatient,1,EA,55.27000,52.50000,The Alliance,Premier SAS,,38.03,,,,,,,27.64,53.61,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier SAS,GP,180.00,,,,,,,55.50,264.00,per diem,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,GP,180.00,,,,,,,57.50,264.00,per diem,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,outpatient,,,893.00000,848.35000,The Alliance,Premier SAS,TC,614.38,,,,,,,437.23,1232.72,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier SAS,,62.38,,,,,,,8.68,458.40,fee schedule,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier SAS,GP,180.00,,,,,,,50.50,264.00,per diem,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,outpatient,1,EA,12.28000,11.66000,The Alliance,Premier SAS,,8.45,,,,,,,6.14,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,The Alliance,Premier SAS,,14.35,,,,,,,10.43,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,outpatient,1,EA,12.22000,11.61000,The Alliance,Premier SAS,,8.41,,,,,,,6.11,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,outpatient,1,EA,4.90000,4.65000,The Alliance,Premier SAS,,3.37,,,,,,,2.45,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,outpatient,1,EA,19.31000,18.34000,The Alliance,Premier SAS,,13.29,,,,,,,9.65,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier SAS,,2.51,,,,,,,1.82,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,outpatient,,,1923.00000,1826.85000,The Alliance,Premier SAS,TC,1323.02,,,,,,,905.36,2210.07,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier SAS,TC,372.21,,,,,,,270.50,1232.72,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier SAS,,2.33,,,,,,,1.69,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,outpatient,1,EA,22.91000,21.76000,The Alliance,Premier SAS,,15.76,,,,,,,11.46,22.22,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Premier SAS,,103.96,,,,,,,14.60,763.98,fee schedule,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,The Alliance,Premier SAS,90,103.96,,,,,,,14.60,763.98,fee schedule,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,outpatient,1,EA,38.14000,36.23000,The Alliance,Premier SAS,,26.24,,,,,,,19.07,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,outpatient,2,EA,40.56000,38.53000,The Alliance,Premier SAS,,27.91,,,,,,,20.28,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,outpatient,2,EA,53.34000,50.67000,The Alliance,Premier SAS,,36.70,,,,,,,26.67,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,outpatient,2,EA,31.38000,29.81000,The Alliance,Premier SAS,,21.59,,,,,,,15.69,30.44,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,194.06,,,,,,,56.40,1426.03,fee schedule,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier SAS,,39.28,,,,,,,5.57,288.61,fee schedule,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,outpatient,1,EA,20.17000,19.17000,The Alliance,Premier SAS,,13.88,,,,,,,10.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,outpatient,,,221.00000,209.95000,The Alliance,Premier SAS,,152.05,,,,,,,121.55,5271.00,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,39.22,,,,,,,28.50,55.29,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Premier SAS,,121.56,,,,,,,75.93,287.98,fee schedule,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier SAS,,363.95,,,,,,,173.99,513.13,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,outpatient,1,EA,317.28000,301.41000,The Alliance,Premier SAS,,218.29,,,,,,,158.64,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,outpatient,1,EA,259.49000,246.51000,The Alliance,Premier SAS,,178.53,,,,,,,129.75,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Premier SAS,,218.43,,,,,,,158.74,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,outpatient,1,EA,317.48000,301.61000,The Alliance,Premier SAS,,218.43,,,,,,,158.74,307.96,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,GP,180.00,,,,,,,61.00,264.00,per diem,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,outpatient,1,EA,105.16000,99.91000,The Alliance,Premier SAS,,72.35,,,,,,,52.58,102.01,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,154.78,,,,,,,32.50,1137.41,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,outpatient,5,EA,162.90000,154.76000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,158.01,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,outpatient,5,EA,12.64000,12.01000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,12.26,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,outpatient,5,EA,15.80000,15.01000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,15.33,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,outpatient,5,EA,94.80000,90.06000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,91.96,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,outpatient,5,EA,28.44000,27.02000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,27.59,fee schedule,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,outpatient,5,EA,18.96000,18.01000,The Alliance,Premier SAS,,4.63,,,,,,,4.63,18.39,fee schedule,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,565.00000,536.75000,The Alliance,Premier SAS,,388.72,,,,,,,242.89,548.05,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,330.24,,,,,,,240.00,465.60,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,39.28,,,,,,,5.67,288.61,fee schedule,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,The Alliance,Premier SAS,,12.67,,,,,,,9.21,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,The Alliance,Premier SAS,,2.40,,,,,,,1.75,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,The Alliance,Premier SAS,,11.90,,,,,,,8.65,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Premier SAS,,7.99,,,,,,,5.80,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,The Alliance,Premier SAS,,7.99,,,,,,,5.80,11.26,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,outpatient,1,mL,369.91000,351.42000,The Alliance,Premier SAS,,119.19,,,,,,,74.45,358.81,fee schedule,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,outpatient,1,EA,21.07000,20.01000,The Alliance,Premier SAS,,14.50,,,,,,,10.54,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Premier SAS,,2.12,,,,,,,1.54,2.99,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,,89.44,,,,,,,71.50,5271.00,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,909.00,,,,,,,50.60,3163.00,case rate,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,outpatient,1,EA,193.55000,183.87000,The Alliance,Premier SAS,,133.16,,,,,,,96.78,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,outpatient,1,EA,203.22000,193.06000,The Alliance,Premier SAS,,139.82,,,,,,,101.61,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,outpatient,1,EA,193.68000,184.00000,The Alliance,Premier SAS,,133.25,,,,,,,96.84,187.87,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Premier SAS,,3844.00,,,,,,,365.75,4686.00,case rate,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,outpatient,1,mL,296.89000,282.04000,The Alliance,Premier SAS,,121.56,,,,,,,75.93,287.98,fee schedule,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,outpatient,,,114.40000,108.68000,The Alliance,Premier SAS,90,69.31,,,,,,,10.18,509.30,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,outpatient,1000,EA,0.01000,0.01000,The Alliance,Premier SAS,,3.94,,,,,,,0.00500,4.06,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,3.94,,,,,,,0.01000,4.06,fee schedule,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,outpatient,1000,EA,0.02000,0.02000,The Alliance,Premier SAS,,3.94,,,,,,,0.01000,4.06,fee schedule,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,GP,180.00,,,,,,,57.50,264.00,per diem,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,outpatient,,,234.90000,223.16000,The Alliance,Premier SAS,90,143.23,,,,,,,20.91,1052.52,fee schedule,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,outpatient,1,mL,3.25000,3.08000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,outpatient,1,mL,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,outpatient,1,mL,2.27000,2.15000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,outpatient,1,mL,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,outpatient,1,mL,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,outpatient,1,mL,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.12,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,GP,180.00,,,,,,,28.50,264.00,per diem,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,outpatient,2,EA,919.61000,873.63000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,892.02,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,outpatient,2,EA,965.58000,917.30000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,936.61,fee schedule,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,outpatient,1,mL,335.14000,318.38000,The Alliance,Premier SAS,,119.19,,,,,,,74.45,325.09,fee schedule,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Premier SAS,,13.60,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,outpatient,1,EA,8.42000,8.00000,The Alliance,Premier SAS,,5.79,,,,,,,4.21,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,30.00,58.20,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,30.00,58.20,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,outpatient,1,EA,15.30000,14.54000,The Alliance,Premier SAS,,10.53,,,,,,,7.65,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.66930,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.81480,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.22,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.88,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,outpatient,1,mL,0.67000,0.63000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.64990,fee schedule,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,outpatient,1,mL,0.90000,0.85000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.87300,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,outpatient,30,EA,2.29000,2.17000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.22,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.14,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,outpatient,30,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.53,fee schedule,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,outpatient,30,EA,2.21000,2.10000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.14,fee schedule,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,30.00,58.20,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,,67.00,,,,,,,9.58,492.33,fee schedule,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier SAS,,2.98,,,,,,,2.17,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,outpatient,5,EA,3.25000,3.08000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,outpatient,5,EA,2.33000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,outpatient,5,EA,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,outpatient,5,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,outpatient,5,EA,4.76000,4.52000,The Alliance,Premier SAS,,3.27,,,,,,,2.38,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,outpatient,5,EA,3.07000,2.91000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,outpatient,5,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,outpatient,5,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,outpatient,5,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,outpatient,5,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,outpatient,5,EA,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,outpatient,5,EA,3.03000,2.88000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,outpatient,5,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,outpatient,5,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,outpatient,5,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,outpatient,5,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,outpatient,5,EA,3.71000,3.53000,The Alliance,Premier SAS,,2.55,,,,,,,1.85,3.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,outpatient,1,EA,462.47000,439.35000,The Alliance,Premier SAS,,318.18,,,,,,,231.24,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,outpatient,1,EA,396.27000,376.46000,The Alliance,Premier SAS,,272.63,,,,,,,198.13,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,outpatient,1,EA,399.12000,379.16000,The Alliance,Premier SAS,,274.59,,,,,,,199.56,387.15,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,outpatient,20,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.34,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,outpatient,20,EA,1.16000,1.11000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.13,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,outpatient,20,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.54320,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,outpatient,20,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.38,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,outpatient,20,EA,1.53000,1.45000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.48,fee schedule,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,outpatient,20,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.32,fee schedule,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier SAS,,92.41,,,,,,,14.48,679.08,fee schedule,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier SAS,,620.58,,,,,,,200.06,874.94,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1329.46,fee schedule,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Premier SAS,,18.91,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier SAS,,20.04,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,outpatient,400,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,outpatient,400,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,TC,429.00,,,,,,,37.00,442.00,per diem,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,outpatient,1,EA,172.07000,163.47000,The Alliance,Premier SAS,,118.38,,,,,,,86.03,166.91,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,outpatient,250,EA,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,outpatient,250,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,outpatient,250,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,outpatient,250,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,outpatient,250,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,outpatient,28,EA,25.82000,24.53000,The Alliance,Premier SAS,,17.76,,,,,,,12.91,25.05,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier SAS,,20.04,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,The Alliance,Premier SAS,,2.87,,,,,,,2.08,4.04,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,90.10,,,,,,,13.91,662.12,fee schedule,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,outpatient,1,EA,29.01000,27.56000,The Alliance,Premier SAS,,19.96,,,,,,,14.51,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,The Alliance,Premier SAS,,3.65,,,,,,,2.65,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,5339.00000,5072.05000,The Alliance,Premier SAS,,3673.23,,,,,,,416.78,5178.83,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,499.01,,,,,,,69.33,3666.93,fee schedule,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,outpatient,1,EA,33.84000,32.15000,The Alliance,Premier SAS,,23.28,,,,,,,16.92,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,outpatient,1,EA,31.84000,30.25000,The Alliance,Premier SAS,,21.91,,,,,,,15.92,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,outpatient,1,GM,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,outpatient,1,GM,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,outpatient,1,GM,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,outpatient,1,GM,0.77000,0.74000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,outpatient,1,EA,14.60000,13.87000,The Alliance,Premier SAS,,10.04,,,,,,,7.30,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,outpatient,,,913.00000,867.35000,The Alliance,Premier SAS,TC,628.14,,,,,,,455.68,2210.07,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Premier SAS,,41.53,,,,,,,30.18,58.55,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,outpatient,10,EA,37.19000,35.33000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,36.07,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,outpatient,10,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.08,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.53,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,outpatient,10,EA,3.48000,3.30000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,3.38,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,outpatient,10,EA,1.95000,1.85000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.89,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,outpatient,10,EA,3.59000,3.41000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,3.48,fee schedule,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,outpatient,10,EA,1.17000,1.12000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.13,fee schedule,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,18.48,,,,,,,2.70,135.79,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,outpatient,200,EA,0.63000,0.59000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.61110,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,outpatient,200,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.18,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,outpatient,200,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.92150,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,outpatient,200,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.24,fee schedule,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,outpatient,200,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.11,fee schedule,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,outpatient,1,EA,7.49000,7.11000,The Alliance,Premier SAS,,5.15,,,,,,,3.75,7.27,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Premier SAS,90,182.51,,,,,,,26.38,1341.13,fee schedule,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,outpatient,1,EA,2.17000,2.07000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier SAS,,92.41,,,,,,,12.88,679.08,fee schedule,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,outpatient,50,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,outpatient,1,EA,56.35000,53.53000,The Alliance,Premier SAS,,38.77,,,,,,,28.18,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,outpatient,1,EA,34.93000,33.19000,The Alliance,Premier SAS,,24.03,,,,,,,17.46,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,outpatient,1,EA,58.08000,55.18000,The Alliance,Premier SAS,,39.96,,,,,,,29.04,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,outpatient,1,EA,51.07000,48.51000,The Alliance,Premier SAS,,35.14,,,,,,,25.54,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Premier SAS,,29.03,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,outpatient,1,EA,42.19000,40.08000,The Alliance,Premier SAS,,29.03,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Premier SAS,,46.30,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,outpatient,1,EA,67.30000,63.93000,The Alliance,Premier SAS,,46.30,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,outpatient,1,EA,60.57000,57.54000,The Alliance,Premier SAS,,41.67,,,,,,,30.29,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,outpatient,1,EA,50.72000,48.18000,The Alliance,Premier SAS,,34.90,,,,,,,25.36,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Premier SAS,,20.65,,,,,,,15.01,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,outpatient,1,EA,58.08000,55.17000,The Alliance,Premier SAS,,39.96,,,,,,,29.04,56.34,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,outpatient,1,EA,333.36000,316.69000,The Alliance,Premier SAS,,229.35,,,,,,,166.68,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,The Alliance,Premier SAS,,18.91,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,The Alliance,Premier SAS,,20.04,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Premier SAS,,3.01,,,,,,,2.19,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,outpatient,1,EA,283.39000,269.22000,The Alliance,Premier SAS,,217.69,,,,,,,141.69,274.89,fee schedule,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,outpatient,1,EA,353.87000,336.18000,The Alliance,Premier SAS,,217.69,,,,,,,176.94,343.25,fee schedule,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,outpatient,,,205.00000,194.75000,The Alliance,Premier SAS,,7.96,,,,,,,7.57,198.85,fee schedule,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,39.28,,,,,,,5.51,288.61,fee schedule,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier SAS,,154.78,,,,,,,21.73,1137.41,fee schedule,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,outpatient,,,129.00000,122.55000,The Alliance,Premier SAS,,78.21,,,,,,,11.53,574.73,fee schedule,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,outpatient,50,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,outpatient,50,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,outpatient,50,EA,0.55000,0.53000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,outpatient,50,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,outpatient,50,EA,1.37000,1.31000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,outpatient,50,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,outpatient,1,EA,6621.21000,6290.15000,The Alliance,Premier SAS,,49.76,,,,,,,31.08,6422.57,fee schedule,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,85.48,,,,,,,12.05,628.12,fee schedule,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,62.38,,,,,,,8.61,458.40,fee schedule,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,outpatient,100,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.75660,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.18,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,outpatient,100,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.92150,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,outpatient,100,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.22,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,outpatient,100,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.24,fee schedule,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,outpatient,100,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.18,fee schedule,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,outpatient,,,18565.90000,17637.60000,The Alliance,Premier SAS,,8521.75,,,,,,,8521.75,18565.90,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,outpatient,133,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,outpatient,133,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,outpatient,133,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,outpatient,1,EA,49.86000,47.37000,The Alliance,Premier SAS,,34.30,,,,,,,24.93,48.36,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,34.66,,,,,,,4.81,254.68,fee schedule,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,30.03,,,,,,,4.27,220.68,fee schedule,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,outpatient,120,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,outpatient,120,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,outpatient,50,EA,6.13000,5.82000,The Alliance,Premier SAS,,4.22,,,,,,,3.06,5.95,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,outpatient,10,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,outpatient,10,EA,5.78000,5.49000,The Alliance,Premier SAS,,3.98,,,,,,,2.89,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,outpatient,10,EA,3.42000,3.25000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,outpatient,10,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,outpatient,1,EA,15.92000,15.13000,The Alliance,Premier SAS,,10.95,,,,,,,7.96,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,outpatient,1,EA,22.30000,21.18000,The Alliance,Premier SAS,,15.34,,,,,,,11.15,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,outpatient,1,EA,23.50000,22.33000,The Alliance,Premier SAS,,16.17,,,,,,,11.75,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,outpatient,1,EA,13.15000,12.49000,The Alliance,Premier SAS,,9.05,,,,,,,6.58,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,outpatient,1,EA,20.33000,19.32000,The Alliance,Premier SAS,,13.99,,,,,,,10.16,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,outpatient,1,EA,16.17000,15.36000,The Alliance,Premier SAS,,11.12,,,,,,,8.09,15.68,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,outpatient,30,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,outpatient,30,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,outpatient,30,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,outpatient,1,mL,5.10000,4.84000,The Alliance,Premier SAS,,3.51,,,,,,,2.55,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,outpatient,1,mL,4.44000,4.22000,The Alliance,Premier SAS,,3.05,,,,,,,2.22,4.31,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,85.48,,,,,,,12.31,628.12,fee schedule,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,outpatient,1,GM,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,outpatient,30,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,outpatient,30,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,outpatient,15,EA,10.27000,9.76000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,outpatient,15,EA,9.38000,8.91000,The Alliance,Premier SAS,,6.45,,,,,,,4.69,9.10,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,34.66,,,,,,,5.06,254.68,fee schedule,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,outpatient,500,EA,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.15000,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,outpatient,500,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.15000,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,outpatient,50,EA,1.44000,1.36000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,outpatient,50,EA,0.92000,0.88000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,outpatient,1,mL,987.52000,938.14000,The Alliance,Premier SAS,,679.41,,,,,,,493.76,957.89,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,outpatient,,,359.60000,341.62000,The Alliance,Premier SAS,90,219.47,,,,,,,32.01,1612.78,fee schedule,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,outpatient,1,mL,426.59000,405.26000,The Alliance,Premier SAS,,293.49,,,,,,,213.29,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,outpatient,1,mL,360.24000,342.23000,The Alliance,Premier SAS,,247.85,,,,,,,180.12,349.43,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier SAS,,101.65,,,,,,,14.39,746.94,fee schedule,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,outpatient,45,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,outpatient,45,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,outpatient,45,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,outpatient,45,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17034.50000,16182.77000,The Alliance,Premier SAS,,7818.84,,,,,,,7818.84,17034.50,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,outpatient,60,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,outpatient,60,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,The Alliance,Premier SAS,,135.54,,,,,,,98.50,212.44,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier SAS,,165.57,,,,,,,5.99,1216.68,fee schedule,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,outpatient,10,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,outpatient,10,EA,6.12000,5.82000,The Alliance,Premier SAS,,4.21,,,,,,,3.06,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,outpatient,10,EA,6.06000,5.76000,The Alliance,Premier SAS,,4.17,,,,,,,3.03,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,outpatient,10,EA,0.95000,0.91000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,outpatient,10,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,outpatient,10,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,outpatient,10,EA,6.30000,5.99000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,outpatient,10,EA,10.45000,9.93000,The Alliance,Premier SAS,,7.19,,,,,,,5.22,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,outpatient,10,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,outpatient,1,EA,5.04000,4.79000,The Alliance,Premier SAS,,3.47,,,,,,,2.52,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Premier SAS,,2.94,,,,,,,2.13,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,outpatient,1,EA,53.17000,50.51000,The Alliance,Premier SAS,,36.58,,,,,,,26.59,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,The Alliance,Premier SAS,,2.77,,,,,,,2.01,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,TC,506.73,,,,,,,177.63,3723.67,fee schedule,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,outpatient,,,427.00000,405.65000,The Alliance,Premier SAS,TC,412.01,,,,,,,121.00,3027.62,fee schedule,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2771.00000,2632.45000,The Alliance,Premier SAS,QN,1906.45,,,,,,,1385.50,2687.87,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,outpatient,1,EA,8.95000,8.51000,The Alliance,Premier SAS,,6.16,,,,,,,2.17,8.68,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,103.96,,,,,,,16.07,763.98,fee schedule,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,321.07,per diem,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Premier SAS,,84.93,,,,,,,61.72,119.74,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Premier SAS,,8.26,,,,,,,6.00,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,outpatient,1,EA,16.88000,16.04000,The Alliance,Premier SAS,,11.61,,,,,,,8.44,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,564.54,per diem,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Premier SAS,,15.54,,,,,,,11.29,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,outpatient,1,mL,14.17000,13.46000,The Alliance,Premier SAS,,9.75,,,,,,,7.08,13.74,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,outpatient,,,662.00000,628.90000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,642.14,per diem,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,outpatient,,,192.60000,182.97000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier SAS,GN,180.00,,,,,,,119.00,264.00,per diem,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,264.00,per diem,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,264.00,per diem,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier SAS,,499.01,,,,,,,49.49,3666.93,fee schedule,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,326.89,per diem,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,QW,106.27,,,,,,,16.53,780.94,fee schedule,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,outpatient,1,mL,447.36000,425.00000,The Alliance,Premier SAS,,307.78,,,,,,,223.68,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,outpatient,1,mL,485.51000,461.23000,The Alliance,Premier SAS,,334.03,,,,,,,242.75,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,outpatient,1,mL,669.82000,636.33000,The Alliance,Premier SAS,,460.84,,,,,,,334.91,649.73,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,170.95,,,,,,,71.50,1256.24,fee schedule,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,97.70,,,,,,,71.00,137.74,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,outpatient,1,mL,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,outpatient,,,447.00000,424.65000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,433.59,per diem,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,GN,180.00,,,,,,,91.50,264.00,per diem,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Premier SAS,,662.68,,,,,,,662.68,1443.75,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier SAS,GN,180.00,,,,,,,53.50,264.00,per diem,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,outpatient,,,202.80000,192.66000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,264.00,per diem,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,outpatient,,,683.00000,648.85000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,662.51,per diem,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,985.52,per diem,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,561.63,per diem,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,438.44,per diem,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,34.66,,,,,,,4.86,254.68,fee schedule,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,48.52,,,,,,,5.25,356.54,fee schedule,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,outpatient,,,470.00000,446.50000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,455.90,per diem,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,outpatient,5,EA,3.96000,3.77000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,outpatient,5,EA,3.96000,3.76000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,outpatient,5,EA,3.84000,3.65000,The Alliance,Premier SAS,,2.64,,,,,,,1.92,3.72,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,outpatient,,,1727.00000,1640.65000,The Alliance,Premier SAS,TC,1188.18,,,,,,,863.50,1675.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,outpatient,10,EA,3.21000,3.05000,The Alliance,Premier SAS,,2.21,,,,,,,1.60,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,outpatient,10,EA,2.86000,2.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.43,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,outpatient,10,EA,2.26000,2.15000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,outpatient,10,EA,2.59000,2.46000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier SAS,,1.97,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,outpatient,10,EA,3.28000,3.11000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,The Alliance,Premier SAS,,1.97,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,outpatient,10,EA,2.98000,2.83000,The Alliance,Premier SAS,,2.05,,,,,,,1.49,2.89,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,13.79,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,outpatient,1,EA,18.47000,17.55000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,17.92,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,18.70,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,outpatient,1,EA,35.42000,33.65000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,34.36,fee schedule,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,outpatient,1,EA,17.15000,16.29000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,16.64,fee schedule,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier SAS,,213.28,,,,,,,155.00,1239.81,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,outpatient,1,EA,24.50000,23.28000,The Alliance,Premier SAS,,16.86,,,,,,,12.25,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,outpatient,1,EA,1.25000,1.18000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,outpatient,1,EA,1.82000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,outpatient,1,EA,1.87000,1.77000,The Alliance,Premier SAS,,1.29,,,,,,,0.93500,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,outpatient,5,EA,300.20000,285.19000,The Alliance,Premier SAS,,206.54,,,,,,,150.10,291.19,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Premier SAS,,63.58,,,,,,,38.28,74.27,fee schedule,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,outpatient,0.5,EA,153.14000,145.48000,The Alliance,Premier SAS,,63.58,,,,,,,60.56,148.55,fee schedule,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,outpatient,1,EA,26.23000,24.92000,The Alliance,Premier SAS,,18.05,,,,,,,13.12,25.44,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier SAS,,357.07,,,,,,,48.58,503.43,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,outpatient,30,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,outpatient,,,378.00000,359.10000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,366.66,per diem,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,1.45,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,1.42,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,3.98,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,2.54,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,1.13,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,3.38,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,0.90210,fee schedule,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,outpatient,1,EA,6.26000,5.95000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,6.07,fee schedule,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier SAS,TC,216.03,,,,,,,157.00,304.58,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,outpatient,,,485.00000,460.75000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,470.45,per diem,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,101.65,,,,,,,14.18,746.94,fee schedule,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,,180.20,,,,,,,25.47,1324.17,fee schedule,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,outpatient,,,294.00000,279.30000,The Alliance,Premier SAS,,202.27,,,,,,,161.70,5271.00,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,outpatient,,,5159.00000,4901.05000,The Alliance,Premier SAS,,17011.00,,,,,,,1475.05,17574.00,case rate,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,440.38,per diem,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,outpatient,1,mL,4070.06000,3866.55000,The Alliance,Premier SAS,,51.70,,,,,,,32.29,3947.96,fee schedule,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,outpatient,1,mL,3296.38000,3131.56000,The Alliance,Premier SAS,,51.70,,,,,,,32.29,3197.49,fee schedule,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,outpatient,1,mL,2714.00000,2578.30000,The Alliance,Premier SAS,,51.70,,,,,,,32.29,2632.58,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,2.67,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,outpatient,1,EA,18.87000,17.93000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,18.30,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,outpatient,1,EA,18.58000,17.65000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,18.02,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,2.81,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,4.19,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,outpatient,1,EA,4.81000,4.57000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,4.67,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,outpatient,1,EA,2.28000,2.17000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,2.21,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,3.52,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,0.58200,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,3.40,fee schedule,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,outpatient,1,EA,4.72000,4.49000,The Alliance,Premier SAS,,0.24015,,,,,,,0.24015,4.58,fee schedule,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Premier SAS,,103.27,,,,,,,75.05,145.60,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,,150.17,,,,,,,21.23,1103.49,fee schedule,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,outpatient,0.5,EA,47.34000,44.97000,The Alliance,Premier SAS,,32.57,,,,,,,23.67,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,outpatient,0.5,EA,151.68000,144.10000,The Alliance,Premier SAS,,104.36,,,,,,,75.84,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,outpatient,0.5,EA,352.92000,335.28000,The Alliance,Premier SAS,,242.81,,,,,,,176.46,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,outpatient,0.5,EA,352.91000,335.27000,The Alliance,Premier SAS,,242.80,,,,,,,176.46,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,outpatient,0.5,EA,164.32000,156.10000,The Alliance,Premier SAS,,113.05,,,,,,,82.16,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,outpatient,0.5,EA,69.52000,66.04000,The Alliance,Premier SAS,,47.83,,,,,,,34.76,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,outpatient,0.5,EA,309.68000,294.20000,The Alliance,Premier SAS,,213.06,,,,,,,154.84,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,outpatient,0.5,EA,20.22000,19.21000,The Alliance,Premier SAS,,13.91,,,,,,,10.11,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,outpatient,0.5,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier SAS,,15.14,,,,,,,11.00,21.34,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier SAS,,2.89,,,,,,,2.10,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,outpatient,1,EA,6.02000,5.72000,The Alliance,Premier SAS,,4.14,,,,,,,3.01,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,outpatient,1,EA,5.48000,5.21000,The Alliance,Premier SAS,,3.77,,,,,,,2.74,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,outpatient,1,EA,9.54000,9.06000,The Alliance,Premier SAS,,6.56,,,,,,,4.77,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Premier SAS,,3.94,,,,,,,2.86,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,,251.12,,,,,,,182.50,743.46,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,outpatient,,,422.00000,400.90000,The Alliance,Premier SAS,,290.34,,,,,,,200.06,409.34,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier SAS,,658.42,,,,,,,478.50,1267.58,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,41.58,,,,,,,5.77,305.58,fee schedule,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,32.34,,,,,,,4.40,237.65,fee schedule,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,32.34,,,,,,,4.40,237.65,fee schedule,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,outpatient,1,EA,4.49000,4.26000,The Alliance,Premier SAS,,3.09,,,,,,,2.25,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,outpatient,2,EA,15.72000,14.93000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,15.25,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,outpatient,2,EA,10.11000,9.61000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,9.81,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,outpatient,2,EA,10.39000,9.87000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,10.08,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,outpatient,2,EA,10.93000,10.39000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,10.60,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,outpatient,2,EA,9.65000,9.17000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,9.36,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,outpatient,2,EA,8.90000,8.46000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,8.63,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,outpatient,2,EA,13.49000,12.81000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,13.09,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,outpatient,2,EA,9.80000,9.31000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,9.51,fee schedule,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,outpatient,2,EA,14.83000,14.09000,The Alliance,Premier SAS,,2.87,,,,,,,2.72,14.39,fee schedule,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Premier SAS,,11.56,,,,,,,8.40,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,The Alliance,Premier SAS,,6.63,,,,,,,4.82,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Premier SAS,,3.67,,,,,,,2.67,5.17,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,154.78,,,,,,,24.11,1137.41,fee schedule,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,outpatient,,,173.90000,165.20000,The Alliance,Premier SAS,90,106.27,,,,,,,15.49,780.94,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,outpatient,1,EA,4.11000,3.90000,The Alliance,Premier SAS,,4.39,,,,,,,2.06,4.52,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier SAS,,4.39,,,,,,,1.91,4.52,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,4.39,,,,,,,2.19,12.26,fee schedule,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,outpatient,1,EA,62.25000,59.14000,The Alliance,Premier SAS,,4.39,,,,,,,2.19,60.38,fee schedule,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,113.20,,,,,,,16.06,831.84,fee schedule,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,outpatient,,,819.00000,778.05000,The Alliance,Premier SAS,,909.00,,,,,,,450.45,3163.00,case rate,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,94.72,,,,,,,11.13,696.05,fee schedule,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,outpatient,1,mL,10.44000,9.92000,The Alliance,Premier SAS,,7.18,,,,,,,5.22,10.13,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,41.58,,,,,,,6.01,305.58,fee schedule,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,outpatient,1,EA,226.79000,215.45000,The Alliance,Premier SAS,,156.03,,,,,,,113.39,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,outpatient,1,EA,227.93000,216.53000,The Alliance,Premier SAS,,156.82,,,,,,,113.97,221.09,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,outpatient,,,2006.00000,1905.70000,The Alliance,Premier SAS,TC,1380.13,,,,,,,957.00,2210.07,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,120.13,,,,,,,16.62,882.80,fee schedule,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Premier SAS,,334.98,,,,,,,46.98,2461.58,fee schedule,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,outpatient,,,1987.00000,1887.65000,The Alliance,Premier SAS,TC,1367.06,,,,,,,960.65,2210.07,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier SAS,,39.28,,,,,,,5.50,288.61,fee schedule,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,outpatient,1,EA,27.81000,26.42000,The Alliance,Premier SAS,,19.13,,,,,,,13.90,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,outpatient,1,EA,64.09000,60.89000,The Alliance,Premier SAS,,44.09,,,,,,,32.05,62.17,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,93.57,,,,,,,68.00,187.21,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Premier SAS,TC,551.78,,,,,,,389.35,2210.07,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,outpatient,2,EA,14.52000,13.79000,The Alliance,Premier SAS,,9.99,,,,,,,7.26,14.08,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier SAS,,1.96,,,,,,,1.43,2.76,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,224.09,,,,,,,19.16,1646.71,fee schedule,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,,101.65,,,,,,,14.14,746.94,fee schedule,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,outpatient,1,EA,3.04000,2.89000,The Alliance,Premier SAS,,2.09,,,,,,,1.52,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.35,,,,,,,0.98000,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,64.69,,,,,,,9.02,475.37,fee schedule,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Premier SAS,TC,2169.26,,,,,,,1479.13,3058.41,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,41.58,,,,,,,5.88,305.58,fee schedule,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,,120.13,,,,,,,16.80,882.80,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,outpatient,2,EA,3.84000,3.65000,The Alliance,Premier SAS,,3.94,,,,,,,1.92,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,outpatient,2,EA,17.30000,16.44000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,16.78,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,outpatient,2,EA,3.13000,2.97000,The Alliance,Premier SAS,,3.94,,,,,,,1.56,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,outpatient,2,EA,3.81000,3.62000,The Alliance,Premier SAS,,3.94,,,,,,,1.91,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,outpatient,2,EA,2.84000,2.70000,The Alliance,Premier SAS,,3.94,,,,,,,1.42,4.06,fee schedule,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,outpatient,2,EA,5.36000,5.09000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,5.20,fee schedule,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,outpatient,,,2168.00000,2059.60000,The Alliance,Premier SAS,TC,1491.58,,,,,,,1050.98,2210.07,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Premier SAS,TC,1732.38,,,,,,,1163.40,2442.46,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,The Alliance,Premier SAS,,7.47,,,,,,,5.43,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,outpatient,1,EA,8.91000,8.47000,The Alliance,Premier SAS,,6.13,,,,,,,4.46,8.64,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,outpatient,1,EA,1681.35000,1597.28000,The Alliance,Premier SAS,,923.86,,,,,,,577.05,1630.91,fee schedule,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier SAS,,919.47,,,,,,,70.04,6756.70,fee schedule,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,outpatient,1,EA,23.76000,22.57000,The Alliance,Premier SAS,,16.35,,,,,,,11.88,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Premier SAS,,16.35,,,,,,,11.88,23.05,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,outpatient,5,EA,64.51000,61.28000,The Alliance,Premier SAS,,44.38,,,,,,,32.26,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,outpatient,5,EA,7.34000,6.98000,The Alliance,Premier SAS,,5.05,,,,,,,3.67,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,outpatient,5,EA,7.43000,7.05000,The Alliance,Premier SAS,,5.11,,,,,,,3.71,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,outpatient,5,EA,9.80000,9.31000,The Alliance,Premier SAS,,6.74,,,,,,,4.90,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,outpatient,5,EA,9.79000,9.30000,The Alliance,Premier SAS,,6.74,,,,,,,4.89,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,outpatient,1,EA,2662.25000,2529.14000,The Alliance,Premier SAS,,2.15,,,,,,,1.97,2582.38,fee schedule,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,outpatient,1,EA,362.60000,344.47000,The Alliance,Premier SAS,,2.15,,,,,,,1.97,351.72,fee schedule,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,outpatient,1,EA,608.65000,578.22000,The Alliance,Premier SAS,,2.15,,,,,,,1.97,590.39,fee schedule,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,48.52,,,,,,,6.87,356.54,fee schedule,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,73.98,,,,,,,11.53,543.65,fee schedule,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Premier SAS,,113.20,,,,,,,15.91,831.84,fee schedule,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,outpatient,2,EA,3.67000,3.48000,The Alliance,Premier SAS,,85.49,,,,,,,1.83,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,outpatient,2,EA,3.60000,3.42000,The Alliance,Premier SAS,,85.49,,,,,,,1.80,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,outpatient,2,EA,55.42000,52.65000,The Alliance,Premier SAS,,85.49,,,,,,,27.71,88.11,fee schedule,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,outpatient,2,EA,33.79000,32.10000,The Alliance,Premier SAS,,85.49,,,,,,,16.89,88.11,fee schedule,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier SAS,,182.51,,,,,,,25.81,1341.13,fee schedule,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,outpatient,1,EA,10.52000,10.00000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier SAS,,4.13,,,,,,,3.00,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,outpatient,1,EA,5.26000,5.00000,The Alliance,Premier SAS,,3.62,,,,,,,2.63,5.10,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier SAS,,9.27,,,,,,,5.79,333.61,fee schedule,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier SAS,,9.27,,,,,,,5.79,333.61,fee schedule,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,outpatient,0.5,EA,261.85000,248.76000,The Alliance,Premier SAS,,180.15,,,,,,,130.93,253.99,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,outpatient,5,EA,114.66000,108.93000,The Alliance,Premier SAS,,78.89,,,,,,,57.33,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,outpatient,5,EA,109.85000,104.36000,The Alliance,Premier SAS,,75.58,,,,,,,54.92,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,outpatient,5,EA,134.53000,127.81000,The Alliance,Premier SAS,,92.56,,,,,,,67.27,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,outpatient,5,EA,119.69000,113.71000,The Alliance,Premier SAS,,82.35,,,,,,,59.84,116.10,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,27.18,,,,,,,19.75,38.31,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier SAS,,1048.84,,,,,,,70.04,7707.36,fee schedule,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier SAS,,26.45,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,outpatient,1,EA,20.31000,19.30000,The Alliance,Premier SAS,,13.97,,,,,,,10.15,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,outpatient,1,EA,35.69000,33.91000,The Alliance,Premier SAS,,24.55,,,,,,,17.84,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Premier SAS,,21.98,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,outpatient,1,EA,7.99000,7.59000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,outpatient,1,EA,38.08000,36.17000,The Alliance,Premier SAS,,26.20,,,,,,,19.04,36.94,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,outpatient,,,577.00000,548.15000,The Alliance,Premier SAS,90,1046.53,,,,,,,70.04,7690.40,fee schedule,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,outpatient,,,5977.00000,5678.15000,The Alliance,Premier SAS,TC,4112.18,,,,,,,2988.50,7180.14,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,outpatient,2,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,outpatient,2,EA,6.45000,6.12000,The Alliance,Premier SAS,,4.44,,,,,,,3.23,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,The Alliance,Premier SAS,,1.23,,,,,,,0.89500,1.74,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,outpatient,1,mL,13.87000,13.17000,The Alliance,Premier SAS,,9.54,,,,,,,6.93,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,outpatient,1,mL,6.31000,6.00000,The Alliance,Premier SAS,,4.34,,,,,,,3.15,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,outpatient,1,mL,9.70000,9.22000,The Alliance,Premier SAS,,6.67,,,,,,,4.85,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,outpatient,1,mL,21.93000,20.84000,The Alliance,Premier SAS,,15.09,,,,,,,10.96,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,outpatient,1,mL,9.23000,8.77000,The Alliance,Premier SAS,,6.35,,,,,,,4.62,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,outpatient,1,mL,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,outpatient,1,mL,107.83000,102.44000,The Alliance,Premier SAS,,2.15,,,,,,,1.97,104.60,fee schedule,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,outpatient,1,mL,118.50000,112.57000,The Alliance,Premier SAS,,2.15,,,,,,,1.97,114.94,fee schedule,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,outpatient,1,EA,19.58000,18.60000,The Alliance,Premier SAS,,13.47,,,,,,,9.79,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,outpatient,1,EA,56.44000,53.62000,The Alliance,Premier SAS,,38.83,,,,,,,28.22,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,outpatient,1,EA,0.78000,0.75000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,outpatient,1,EA,1.50000,1.42000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,outpatient,,,185.00000,175.75000,The Alliance,Premier SAS,TC,127.28,,,,,,,92.50,2210.07,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,outpatient,3.5,EA,223.32000,212.15000,The Alliance,Premier SAS,,153.64,,,,,,,111.66,216.62,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,90,27.72,,,,,,,4.08,203.72,fee schedule,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,outpatient,1,mL,4.51000,4.28000,The Alliance,Premier SAS,,3.10,,,,,,,2.25,4.37,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,outpatient,1,EA,7235.17000,6873.41000,The Alliance,Premier SAS,,275.28,,,,,,,171.94,7018.11,fee schedule,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,outpatient,1,EA,11815.83000,11225.04000,The Alliance,Premier SAS,,275.28,,,,,,,171.94,11461.36,fee schedule,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Premier SAS,,275.28,,,,,,,171.94,15291.85,fee schedule,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Premier SAS,90,85.48,,,,,,,12.32,628.12,fee schedule,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,outpatient,5,EA,1.88000,1.79000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,outpatient,5,EA,3.27000,3.10000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,outpatient,5,EA,3.29000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier SAS,,26.45,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,The Alliance,Premier SAS,,26.45,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,outpatient,1,EA,38.84000,36.90000,The Alliance,Premier SAS,,26.72,,,,,,,19.42,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,outpatient,1,EA,37.34000,35.47000,The Alliance,Premier SAS,,25.69,,,,,,,18.67,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,outpatient,1,EA,14.20000,13.49000,The Alliance,Premier SAS,,9.77,,,,,,,7.10,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Premier SAS,,3.35,,,,,,,2.44,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,The Alliance,Premier SAS,,21.98,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,outpatient,1,EA,10.65000,10.12000,The Alliance,Premier SAS,,7.33,,,,,,,5.33,10.33,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,outpatient,1,EA,252.80000,240.16000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,245.22,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,outpatient,1,EA,218.47000,207.54000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,211.92,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,outpatient,1,EA,263.86000,250.67000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,255.94,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,outpatient,1,EA,245.53000,233.26000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,238.16,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,outpatient,1,EA,243.32000,231.15000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,236.02,fee schedule,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,outpatient,1,EA,244.43000,232.20000,The Alliance,Premier SAS,,3.94,,,,,,,2.47,237.10,fee schedule,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier SAS,TC,566.90,,,,,,,360.00,4496.60,fee schedule,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,,73.92,,,,,,,10.63,543.22,fee schedule,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,25.41,,,,,,,3.67,186.75,fee schedule,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,outpatient,2.5,EA,200.57000,190.54000,The Alliance,Premier SAS,,137.99,,,,,,,100.28,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,outpatient,2.5,EA,209.17000,198.71000,The Alliance,Premier SAS,,143.91,,,,,,,104.58,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,outpatient,2.5,EA,158.96000,151.01000,The Alliance,Premier SAS,,109.36,,,,,,,79.48,154.19,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,,90.10,,,,,,,12.76,662.12,fee schedule,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,outpatient,1,EA,6411.37000,6090.80000,The Alliance,Premier SAS,,613.30,,,,,,,383.07,6219.03,fee schedule,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,outpatient,15,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,outpatient,15,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Premier SAS,TC,2255.26,,,,,,,1489.61,7180.14,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,34.66,,,,,,,5.56,254.68,fee schedule,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,80.86,,,,,,,12.47,594.19,fee schedule,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,outpatient,1,EA,6835.14000,6493.38000,The Alliance,Premier SAS,,2.96,,,,,,,1.85,6630.09,fee schedule,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,outpatient,1,EA,906.50000,861.18000,The Alliance,Premier SAS,,2.96,,,,,,,1.85,879.30,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,outpatient,5,EA,7.64000,7.26000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,7.41,fee schedule,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,,80.86,,,,,,,11.53,594.19,fee schedule,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,101.65,,,,,,,14.39,746.94,fee schedule,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,outpatient,1,EA,1924.24000,1828.03000,The Alliance,Premier SAS,,2.96,,,,,,,1.85,1866.51,fee schedule,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,outpatient,1,EA,276.50000,262.68000,The Alliance,Premier SAS,,2.96,,,,,,,1.85,268.20,fee schedule,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier SAS,,1.43,,,,,,,1.04,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,27.72,,,,,,,3.95,203.72,fee schedule,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,,3844.00,,,,,,,658.35,4686.00,case rate,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,outpatient,,,215.00000,204.25000,The Alliance,Premier SAS,,2561.00,,,,,,,118.25,3163.00,case rate,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,23.11,,,,,,,3.48,169.79,fee schedule,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,outpatient,15,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,outpatient,15,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,outpatient,15,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,,829.37,,,,,,,59.00,6094.58,fee schedule,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,outpatient,,,794.00000,754.30000,The Alliance,Premier SAS,TC,546.27,,,,,,,313.12,770.18,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier SAS,,213.28,,,,,,,155.00,1239.81,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,outpatient,,,335.80000,319.01000,The Alliance,Premier SAS,,231.03,,,,,,,23.25,325.73,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,32.34,,,,,,,4.52,237.65,fee schedule,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,outpatient,,,244.00000,231.80000,The Alliance,Premier SAS,,147.86,,,,,,,20.81,1086.52,fee schedule,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,outpatient,1,EA,29.58000,28.10000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,28.69,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,outpatient,1,EA,25.56000,24.29000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,24.79,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,26.05,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,outpatient,1,EA,28.09000,26.69000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,27.25,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,outpatient,1,EA,16.59000,15.76000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,16.09,fee schedule,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,outpatient,1,EA,1.74000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,41.58,,,,,,,5.74,305.58,fee schedule,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Premier SAS,,4.77,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,The Alliance,Premier SAS,,4.77,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Premier SAS,,7.97,,,,,,,5.79,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,outpatient,1,EA,9.27000,8.81000,The Alliance,Premier SAS,,6.38,,,,,,,4.63,8.99,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,361.00,700.34,fee schedule,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,101.65,,,,,,,14.41,746.94,fee schedule,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier SAS,,134.16,,,,,,,56.40,189.15,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,169.00,584.87,fee schedule,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,outpatient,1,mL,1601.79000,1521.70000,The Alliance,Premier SAS,,21.01,,,,,,,13.12,1553.74,fee schedule,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,outpatient,1,EA,30.15000,28.64000,The Alliance,Premier SAS,,20.74,,,,,,,15.07,29.25,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier SAS,,34.66,,,,,,,5.08,254.68,fee schedule,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier SAS,,147.86,,,,,,,20.81,1086.52,fee schedule,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,outpatient,1,mL,389.56000,370.08000,The Alliance,Premier SAS,,39.24,,,,,,,24.51,377.87,fee schedule,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,outpatient,1,mL,2444.96000,2322.71000,The Alliance,Premier SAS,,39.24,,,,,,,24.51,2371.61,fee schedule,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,outpatient,15,EA,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,outpatient,80,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,outpatient,80,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,outpatient,80,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Premier SAS,TC,2306.18,,,,,,,1676.00,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,outpatient,1,mL,343.93000,326.73000,The Alliance,Premier SAS,,9.27,,,,,,,5.79,333.61,fee schedule,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,outpatient,,,270.00000,256.50000,The Alliance,Premier SAS,90,362.70,,,,,,,32.70,2665.30,fee schedule,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Premier SAS,90,90.10,,,,,,,8.17,662.12,fee schedule,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,23.11,,,,,,,3.17,169.79,fee schedule,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,outpatient,,,5196.00000,4936.20000,The Alliance,Premier SAS,90,3781.39,,,,,,,533.12,27787.37,fee schedule,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,806.07,fee schedule,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,outpatient,,,729.00000,692.55000,The Alliance,Premier SAS,TC,532.00,,,,,,,364.50,707.13,fee schedule,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Premier SAS,TC,532.00,,,,,,,208.50,584.87,fee schedule,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,outpatient,60,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,outpatient,60,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,outpatient,60,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,215.27,548.00,fee schedule,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,outpatient,1,mL,246.06000,233.75000,The Alliance,Premier SAS,,21.28,,,,,,,13.29,238.68,fee schedule,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1085.43,fee schedule,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,348.00,675.12,fee schedule,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Premier SAS,,20.80,,,,,,,3.05,152.82,fee schedule,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier SAS,,110.89,,,,,,,15.50,814.87,fee schedule,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Premier SAS,TC,532.00,,,,,,,290.50,584.87,fee schedule,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,532.00,,,,,,,133.50,584.87,fee schedule,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,outpatient,1,EA,25.18000,23.92000,The Alliance,Premier SAS,,17.32,,,,,,,12.59,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,outpatient,1,EA,12.70000,12.07000,The Alliance,Premier SAS,,8.74,,,,,,,6.35,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,outpatient,1,EA,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,The Alliance,Premier SAS,,2.62,,,,,,,1.91,3.70,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,90,34.66,,,,,,,5.67,254.68,fee schedule,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,154.77,548.00,fee schedule,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,97.03,,,,,,,13.54,713.01,fee schedule,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,outpatient,15,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,outpatient,15,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,outpatient,15,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,outpatient,15,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,824.50,fee schedule,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Premier SAS,TC,532.00,,,,,,,320.50,621.77,fee schedule,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1004.92,fee schedule,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,outpatient,,,963.00000,914.85000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,934.11,fee schedule,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,921.50,fee schedule,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,outpatient,15,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,outpatient,15,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,outpatient,15,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,outpatient,15,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,outpatient,15,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,outpatient,15,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1000.07,fee schedule,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,outpatient,5,EA,20.05000,19.04000,The Alliance,Premier SAS,,13.79,,,,,,,10.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,outpatient,5,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,outpatient,5,EA,10.93000,10.38000,The Alliance,Premier SAS,,7.52,,,,,,,5.46,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,outpatient,5,EA,2.28000,2.16000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,outpatient,5,EA,4.23000,4.02000,The Alliance,Premier SAS,,2.91,,,,,,,2.12,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,outpatient,5,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,outpatient,5,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Premier SAS,TC,532.00,,,,,,,353.00,684.82,fee schedule,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,97.03,,,,,,,13.54,713.01,fee schedule,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,outpatient,1,mL,25.54000,24.26000,The Alliance,Premier SAS,,17.57,,,,,,,12.77,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,outpatient,1,mL,11.85000,11.26000,The Alliance,Premier SAS,,8.15,,,,,,,5.92,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,6.32,12.26,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,outpatient,1,EA,16.60000,15.77000,The Alliance,Premier SAS,,11.42,,,,,,,8.30,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Premier SAS,,18.22,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,outpatient,1,EA,9.77000,9.28000,The Alliance,Premier SAS,,6.72,,,,,,,4.88,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Premier SAS,,14.15,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,outpatient,1,EA,15.23000,14.47000,The Alliance,Premier SAS,,10.48,,,,,,,7.62,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,outpatient,1,EA,12.83000,12.19000,The Alliance,Premier SAS,,8.83,,,,,,,6.42,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,outpatient,1,EA,19.91000,18.91000,The Alliance,Premier SAS,,13.70,,,,,,,9.96,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,outpatient,1,EA,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier SAS,,11.19,,,,,,,8.13,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,outpatient,1,EA,16.62000,15.79000,The Alliance,Premier SAS,,11.43,,,,,,,8.31,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier SAS,,18.48,,,,,,,13.43,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,outpatient,1,EA,11.03000,10.48000,The Alliance,Premier SAS,,7.59,,,,,,,5.51,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,outpatient,1,EA,12.51000,11.89000,The Alliance,Premier SAS,,8.61,,,,,,,6.25,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier SAS,,11.30,,,,,,,8.21,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,outpatient,1,EA,6.54000,6.21000,The Alliance,Premier SAS,,4.50,,,,,,,3.27,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,27.18,,,,,,,19.75,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,outpatient,1,EA,15.01000,14.26000,The Alliance,Premier SAS,,10.33,,,,,,,7.50,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,outpatient,1,EA,58.52000,55.59000,The Alliance,Premier SAS,,40.26,,,,,,,29.26,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,outpatient,1,EA,91.70000,87.12000,The Alliance,Premier SAS,,63.09,,,,,,,45.85,88.95,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1356.06,fee schedule,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,867.18,fee schedule,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,46.20,,,,,,,7.20,339.51,fee schedule,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Premier SAS,,31622.24,,,,,,,157.68,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,outpatient,1,mL,52901.43000,50256.36000,The Alliance,Premier SAS,,36396.18,,,,,,,157.68,51314.39,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,TC,532.00,,,,,,,110.28,548.00,fee schedule,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,outpatient,1,mL,16.99000,16.14000,The Alliance,Premier SAS,,8.47,,,,,,,7.96,16.48,fee schedule,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,outpatient,1,EA,19.66000,18.67000,The Alliance,Premier SAS,,13.53,,,,,,,3.02,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,3.02,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,outpatient,1,EA,51.45000,48.88000,The Alliance,Premier SAS,,35.40,,,,,,,3.02,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,outpatient,1,EA,11.80000,11.21000,The Alliance,Premier SAS,,8.12,,,,,,,3.02,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,3.02,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,outpatient,1,EA,50.69000,48.15000,The Alliance,Premier SAS,,34.87,,,,,,,3.02,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,outpatient,1,EA,16.43000,15.61000,The Alliance,Premier SAS,,11.30,,,,,,,3.02,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,3.02,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,outpatient,1,EA,50.24000,47.73000,The Alliance,Premier SAS,,34.57,,,,,,,3.02,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,outpatient,1,EA,13.59000,12.91000,The Alliance,Premier SAS,,9.35,,,,,,,3.02,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,outpatient,1,EA,8.80000,8.36000,The Alliance,Premier SAS,,6.05,,,,,,,3.02,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,outpatient,1,EA,16.42000,15.60000,The Alliance,Premier SAS,,11.30,,,,,,,3.02,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,3.02,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,outpatient,1,EA,18.93000,17.98000,The Alliance,Premier SAS,,13.02,,,,,,,3.02,18.36,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,outpatient,,,1068.00000,1014.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1035.96,fee schedule,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,outpatient,1,EA,23.41000,22.24000,The Alliance,Premier SAS,,16.11,,,,,,,11.71,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier SAS,,8.15,,,,,,,5.92,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,outpatient,1,EA,1.03000,0.97000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,outpatient,1,EA,3.70000,3.51000,The Alliance,Premier SAS,,2.55,,,,,,,1.85,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier SAS,,2.33,,,,,,,1.69,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier SAS,,9.89,,,,,,,7.18,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier SAS,,7.98,,,,,,,5.80,11.25,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,outpatient,,,613.00000,582.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,306.50,594.61,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier SAS,,3.14,,,,,,,3.14,55.17,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,3.14,,,,,,,3.14,61.30,fee schedule,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,outpatient,1,mL,27.71000,26.32000,The Alliance,Premier SAS,,3.14,,,,,,,3.14,26.88,fee schedule,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,outpatient,1,EA,25.79000,24.50000,The Alliance,Premier SAS,,17.74,,,,,,,3.02,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,3.02,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,3.02,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,outpatient,1,EA,7.81000,7.41000,The Alliance,Premier SAS,,5.37,,,,,,,3.02,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,outpatient,1,EA,22.12000,21.01000,The Alliance,Premier SAS,,15.22,,,,,,,3.02,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,outpatient,1,EA,5.28000,5.01000,The Alliance,Premier SAS,,3.63,,,,,,,2.64,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,outpatient,1,EA,25.41000,24.14000,The Alliance,Premier SAS,,17.48,,,,,,,3.02,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,outpatient,1,EA,13.43000,12.76000,The Alliance,Premier SAS,,9.24,,,,,,,3.02,13.03,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Premier SAS,,8.61,,,,,,,6.26,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,outpatient,1,EA,44.47000,42.25000,The Alliance,Premier SAS,,30.60,,,,,,,22.23,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier SAS,TC,1765.41,,,,,,,1283.00,2489.02,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier SAS,,3.14,,,,,,,3.14,76.63,fee schedule,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier SAS,,3.14,,,,,,,3.14,91.96,fee schedule,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,66.50,584.87,fee schedule,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,outpatient,1,EA,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,86.96,,,,,,,3.02,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,outpatient,1,EA,285.22000,270.96000,The Alliance,Premier SAS,,196.23,,,,,,,3.02,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,outpatient,1,EA,63.17000,60.01000,The Alliance,Premier SAS,,43.46,,,,,,,3.02,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,outpatient,1,EA,217.76000,206.87000,The Alliance,Premier SAS,,149.82,,,,,,,3.02,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,outpatient,1,EA,95.12000,90.36000,The Alliance,Premier SAS,,65.44,,,,,,,3.02,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,outpatient,1,EA,157.97000,150.07000,The Alliance,Premier SAS,,108.68,,,,,,,3.02,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,outpatient,1,EA,251.22000,238.66000,The Alliance,Premier SAS,,172.84,,,,,,,3.02,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,outpatient,1,EA,281.02000,266.97000,The Alliance,Premier SAS,,193.34,,,,,,,3.02,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,outpatient,1,EA,94.80000,90.06000,The Alliance,Premier SAS,,65.22,,,,,,,3.02,91.96,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,outpatient,,,372.00000,353.40000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Premier SAS,,529.07,,,,,,,384.50,745.93,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,outpatient,1,EA,37.70000,35.81000,The Alliance,Premier SAS,,25.94,,,,,,,18.85,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Premier SAS,,1.76,,,,,,,1.28,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Premier SAS,,5.68,,,,,,,4.12,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,outpatient,1,EA,12.21000,11.60000,The Alliance,Premier SAS,,8.40,,,,,,,6.11,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1475.05,4686.00,case rate,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,outpatient,,,888.00000,843.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,861.36,fee schedule,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,101.00,548.00,fee schedule,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,outpatient,1,EA,30.62000,29.09000,The Alliance,Premier SAS,,21.07,,,,,,,3.02,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,3.02,27.59,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,outpatient,1,EA,36.27000,34.45000,The Alliance,Premier SAS,,24.95,,,,,,,18.14,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,90,97.03,,,,,,,14.18,713.01,fee schedule,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,,200.99,,,,,,,28.10,1476.99,fee schedule,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,outpatient,1,EA,5.20000,4.94000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,outpatient,1,EA,9.74000,9.26000,The Alliance,Premier SAS,,6.70,,,,,,,4.87,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,36.97,,,,,,,5.82,271.65,fee schedule,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,outpatient,,,892.00000,847.40000,The Alliance,Premier SAS,,613.70,,,,,,,446.00,865.24,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,outpatient,2,EA,46.41000,44.09000,The Alliance,Premier SAS,,31.93,,,,,,,23.20,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,outpatient,2,EA,28.92000,27.47000,The Alliance,Premier SAS,,19.90,,,,,,,14.46,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,outpatient,2,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,outpatient,2,EA,50.80000,48.26000,The Alliance,Premier SAS,,34.95,,,,,,,25.40,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,outpatient,2,EA,7.27000,6.90000,The Alliance,Premier SAS,,5.00,,,,,,,3.63,7.05,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,106.27,,,,,,,15.08,780.94,fee schedule,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,outpatient,1,EA,19.59000,18.61000,The Alliance,Premier SAS,,13.48,,,,,,,9.79,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,outpatient,1,EA,4.56000,4.33000,The Alliance,Premier SAS,,3.14,,,,,,,2.28,4.42,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,outpatient,,,782.00000,742.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,758.54,fee schedule,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,101.00,548.00,fee schedule,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,outpatient,,,296.20000,281.39000,The Alliance,Premier SAS,90,184.81,,,,,,,26.94,1358.10,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,outpatient,0.5,EA,29.99000,28.49000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,29.09,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,outpatient,0.5,EA,26.86000,25.52000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,26.05,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,outpatient,0.5,EA,154.73000,147.00000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,150.09,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,outpatient,0.5,EA,37.92000,36.02000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,36.78,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,outpatient,0.5,EA,11.38000,10.81000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,11.04,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,outpatient,0.5,EA,156.29000,148.48000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,151.60,fee schedule,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,outpatient,0.5,EA,39.50000,37.52000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,38.31,fee schedule,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,outpatient,1,EA,3.75000,3.57000,The Alliance,Premier SAS,,2.58,,,,,,,1.88,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Premier SAS,,4.84,,,,,,,3.52,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,outpatient,1,EA,6.52000,6.19000,The Alliance,Premier SAS,,4.49,,,,,,,3.26,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,876.88,fee schedule,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Premier SAS,90,143.23,,,,,,,19.61,1052.52,fee schedule,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,The Alliance,Premier SAS,,4.51,,,,,,,3.28,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,The Alliance,Premier SAS,,3.28,,,,,,,2.38,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,outpatient,60,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,outpatient,60,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,outpatient,30,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,90,251.81,,,,,,,17.93,1850.43,fee schedule,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,outpatient,1,EA,3.62000,3.44000,The Alliance,Premier SAS,,2.49,,,,,,,1.81,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,The Alliance,Premier SAS,,4.38,,,,,,,3.19,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,outpatient,1,EA,6.80000,6.46000,The Alliance,Premier SAS,,4.68,,,,,,,3.40,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Premier SAS,90,108.58,,,,,,,16.32,797.91,fee schedule,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,TC,180.38,,,,,,,137.50,1430.78,fee schedule,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier SAS,TC,150.47,,,,,,,101.94,1193.49,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,outpatient,1,EA,154.74000,147.00000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,150.10,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,outpatient,1,EA,151.66000,144.08000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,147.11,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,outpatient,1,EA,152.44000,144.82000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,147.87,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,outpatient,1,EA,150.13000,142.63000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,145.63,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,outpatient,1,EA,135.14000,128.39000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,131.09,fee schedule,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,outpatient,1,EA,135.15000,128.40000,The Alliance,Premier SAS,,4.55,,,,,,,3.79,131.10,fee schedule,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,TC,113.06,,,,,,,58.00,896.81,fee schedule,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,outpatient,1,EA,3.76000,3.58000,The Alliance,Premier SAS,,2.59,,,,,,,1.88,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Premier SAS,,4.86,,,,,,,3.53,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,153.26,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,outpatient,1,EA,255.96000,243.16000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,248.28,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,outpatient,1,EA,409.34000,388.88000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,397.06,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,outpatient,1,EA,72.68000,69.05000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,70.50,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,229.89,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,outpatient,1,EA,73.00000,69.35000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,70.81,fee schedule,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,outpatient,1,EA,272.22000,258.61000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,264.05,fee schedule,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,9.09,29.10,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,outpatient,1,EA,21.87000,20.77000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,21.21,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,outpatient,1,EA,22.09000,20.98000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,21.43,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,14.64,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,8.37,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,outpatient,1,EA,10.74000,10.21000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,10.42,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,outpatient,1,EA,21.84000,20.74000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,21.18,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,outpatient,1,EA,14.22000,13.51000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,13.79,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,outpatient,1,EA,11.25000,10.69000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,10.91,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,outpatient,1,EA,8.65000,8.22000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,8.39,fee schedule,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,1.52,,,,,,,1.03,5.45,fee schedule,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,outpatient,,,865.00000,821.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,839.05,fee schedule,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier SAS,TC,230.26,,,,,,,159.50,3015.65,fee schedule,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier SAS,TC,225.27,,,,,,,157.00,1786.85,fee schedule,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,outpatient,1,EA,26.49000,25.17000,The Alliance,Premier SAS,,18.23,,,,,,,3.02,25.70,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,outpatient,1,EA,2.29000,2.18000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Premier SAS,,4.20,,,,,,,3.05,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1082.00000,1027.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1049.54,fee schedule,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,outpatient,,,723.00000,686.85000,The Alliance,Premier SAS,TC,462.17,,,,,,,361.50,3665.88,fee schedule,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier SAS,TC,167.92,,,,,,,118.00,1964.22,fee schedule,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier SAS,TC,225.27,,,,,,,172.00,1786.85,fee schedule,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,311.11,,,,,,,25.31,2286.16,fee schedule,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Premier SAS,,748.74,,,,,,,748.74,1631.25,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,TC,197.84,,,,,,,149.00,1569.27,fee schedule,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,83.17,,,,,,,11.67,611.15,fee schedule,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Premier SAS,90,101.65,,,,,,,14.87,746.94,fee schedule,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,outpatient,,,39.00000,37.05000,The Alliance,Premier SAS,,23.11,,,,,,,3.64,169.79,fee schedule,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,The Alliance,Premier SAS,TC,1110.50,,,,,,,905.50,8808.48,fee schedule,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,outpatient,,,157.10000,149.24000,The Alliance,Premier SAS,90,97.03,,,,,,,13.99,713.01,fee schedule,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,outpatient,,,134.80000,128.06000,The Alliance,Premier SAS,90,83.17,,,,,,,12.00,611.15,fee schedule,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,outpatient,,,314.00000,298.30000,The Alliance,Premier SAS,TC,167.92,,,,,,,136.98,1331.91,fee schedule,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,TC,197.84,,,,,,,140.50,1569.27,fee schedule,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,90,120.13,,,,,,,8.17,882.80,fee schedule,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,outpatient,,,369.00000,350.55000,The Alliance,Premier SAS,TC,235.24,,,,,,,184.50,1865.95,fee schedule,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,outpatient,,,208.30000,197.88000,The Alliance,Premier SAS,90,108.58,,,,,,,16.32,797.91,fee schedule,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.46,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,outpatient,1,EA,5.39000,5.12000,The Alliance,Premier SAS,,3.71,,,,,,,2.69,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,The Alliance,Premier SAS,,6.96,,,,,,,5.05,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.13,1094.55,fee schedule,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,TC,172.90,,,,,,,138.00,1371.46,fee schedule,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.13,1094.55,fee schedule,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,90,274.92,,,,,,,17.50,2020.22,fee schedule,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,The Alliance,Premier SAS,TC,150.47,,,,,,,108.00,1193.49,fee schedule,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,TC,225.27,,,,,,,170.00,1786.85,fee schedule,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,167.92,,,,,,,126.50,1331.91,fee schedule,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,outpatient,,,1120.00000,1064.00000,The Alliance,Premier SAS,TC,714.02,,,,,,,560.00,5663.55,fee schedule,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,outpatient,,,498.00000,473.10000,The Alliance,Premier SAS,TC,300.08,,,,,,,247.55,2380.22,fee schedule,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,TC,137.99,,,,,,,100.00,1094.55,fee schedule,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,The Alliance,Premier SAS,TC,197.84,,,,,,,160.92,1569.27,fee schedule,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,The Alliance,Premier SAS,,2.57,,,,,,,1.87,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Premier SAS,,4.82,,,,,,,3.50,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier SAS,TC,228.66,,,,,,,128.10,1813.71,fee schedule,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,The Alliance,Premier SAS,TC,504.56,,,,,,,372.00,4002.11,fee schedule,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,outpatient,,,755.00000,717.25000,The Alliance,Premier SAS,TC,474.63,,,,,,,377.50,3764.75,fee schedule,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,TC,108.07,,,,,,,83.00,857.19,fee schedule,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier SAS,TC,207.81,,,,,,,165.00,1648.36,fee schedule,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier SAS,TC,205.32,,,,,,,161.00,1628.59,fee schedule,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,TC,195.35,,,,,,,144.00,1549.49,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Premier SAS,,12.58,,,,,,,12.58,46.13,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,outpatient,1,mL,24.33000,23.12000,The Alliance,Premier SAS,,12.58,,,,,,,12.16,23.60,fee schedule,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,outpatient,1,mL,26.86000,25.52000,The Alliance,Premier SAS,,12.58,,,,,,,12.58,26.05,fee schedule,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,TC,137.99,,,,,,,111.00,1094.55,fee schedule,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,outpatient,,,379.00000,360.05000,The Alliance,Premier SAS,TC,242.72,,,,,,,189.50,1925.27,fee schedule,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,The Alliance,Premier SAS,TC,152.96,,,,,,,120.50,1213.27,fee schedule,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier SAS,TC,152.96,,,,,,,122.23,1213.27,fee schedule,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier SAS,TC,180.38,,,,,,,132.50,1430.78,fee schedule,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,TC,225.27,,,,,,,170.00,1786.85,fee schedule,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,The Alliance,Premier SAS,TC,205.32,,,,,,,166.47,1628.59,fee schedule,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,157.95,,,,,,,115.50,1252.81,fee schedule,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier SAS,TC,155.45,,,,,,,107.00,1233.04,fee schedule,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Premier SAS,TC,497.08,,,,,,,417.50,3942.79,fee schedule,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,outpatient,,,1073.00000,1019.35000,The Alliance,Premier SAS,TC,751.42,,,,,,,536.50,5960.23,fee schedule,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,outpatient,,,282.00000,267.90000,The Alliance,Premier SAS,,210.23,,,,,,,29.60,1544.85,fee schedule,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,TC,190.36,,,,,,,137.50,1509.95,fee schedule,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,outpatient,,,462.00000,438.90000,The Alliance,Premier SAS,TC,245.22,,,,,,,203.31,1945.04,fee schedule,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,TC,285.12,,,,,,,234.65,2261.57,fee schedule,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,The Alliance,Premier SAS,TC,197.84,,,,,,,152.00,1569.27,fee schedule,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,TC,155.45,,,,,,,123.50,1233.04,fee schedule,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,outpatient,,,287.00000,272.65000,The Alliance,Premier SAS,TC,185.38,,,,,,,143.50,1470.40,fee schedule,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,outpatient,,,862.00000,818.90000,The Alliance,Premier SAS,TC,556.93,,,,,,,431.00,4417.51,fee schedule,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier SAS,TC,167.92,,,,,,,125.00,1331.91,fee schedule,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,TC,195.35,,,,,,,140.50,1549.49,fee schedule,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier SAS,TC,190.36,,,,,,,144.50,1509.95,fee schedule,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,outpatient,240,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,outpatient,240,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier SAS,TC,147.97,,,,,,,108.50,1173.72,fee schedule,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier SAS,TC,157.95,,,,,,,125.00,1252.81,fee schedule,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,TC,140.49,,,,,,,104.50,1114.32,fee schedule,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,TC,175.40,,,,,,,140.50,1391.23,fee schedule,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier SAS,TC,162.93,,,,,,,122.50,1292.36,fee schedule,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Premier SAS,TC,135.50,,,,,,,101.94,1074.77,fee schedule,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,185.38,,,,,,,133.50,1470.40,fee schedule,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Premier SAS,TC,651.68,,,,,,,513.50,5169.06,fee schedule,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier SAS,TC,175.40,,,,,,,144.32,1391.23,fee schedule,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier SAS,TC,723.99,,,,,,,606.90,5742.65,fee schedule,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,outpatient,,,345.00000,327.75000,The Alliance,Premier SAS,TC,212.80,,,,,,,172.50,1687.91,fee schedule,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,The Alliance,Premier SAS,TC,205.32,,,,,,,152.50,1628.59,fee schedule,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,TC,207.81,,,,,,,161.50,1648.36,fee schedule,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Premier SAS,TC,175.40,,,,,,,142.47,1391.23,fee schedule,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,TC,147.97,,,,,,,120.38,1173.72,fee schedule,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,TC,160.44,,,,,,,129.58,1272.59,fee schedule,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,The Alliance,Premier SAS,TC,733.97,,,,,,,290.00,5821.82,fee schedule,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,TC,93.11,,,,,,,74.29,738.55,fee schedule,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,TC,135.50,,,,,,,93.00,1074.77,fee schedule,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,The Alliance,Premier SAS,TC,337.48,,,,,,,278.89,2676.90,fee schedule,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Premier SAS,TC,195.35,,,,,,,159.07,1549.49,fee schedule,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Premier SAS,TC,559.42,,,,,,,448.00,4437.28,fee schedule,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,80.86,,,,,,,11.39,594.19,fee schedule,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,TC,147.97,,,,,,,120.38,1173.72,fee schedule,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,outpatient,30,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier SAS,TC,649.18,,,,,,,403.50,5149.29,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,outpatient,1,mL,34.25000,32.54000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,33.22,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,8.33,,,,,,,4.74,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Premier SAS,,8.33,,,,,,,5.53,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,outpatient,1,mL,7.43000,7.05000,The Alliance,Premier SAS,,8.33,,,,,,,3.71,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier SAS,,8.33,,,,,,,0.61000,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier SAS,,8.33,,,,,,,0.49500,15.80,fee schedule,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,TC,167.92,,,,,,,132.00,1331.91,fee schedule,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,outpatient,,,411.00000,390.45000,The Alliance,Premier SAS,TC,257.69,,,,,,,205.50,2043.99,fee schedule,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier SAS,TC,419.78,,,,,,,307.50,3329.66,fee schedule,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier SAS,TC,654.17,,,,,,,403.00,5188.83,fee schedule,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier SAS,TC,185.38,,,,,,,153.52,1470.40,fee schedule,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier SAS,TC,155.45,,,,,,,118.50,1233.04,fee schedule,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,TC,210.31,,,,,,,131.50,1668.14,fee schedule,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,TC,152.96,,,,,,,125.88,1213.27,fee schedule,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Premier SAS,,10.49,,,,,,,7.62,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,outpatient,1,EA,9.68000,9.19000,The Alliance,Premier SAS,,6.66,,,,,,,4.84,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,outpatient,1,EA,8.79000,8.35000,The Alliance,Premier SAS,,6.05,,,,,,,4.39,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Premier SAS,,6.02,,,,,,,4.38,8.49,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,The Alliance,Premier SAS,TC,155.45,,,,,,,117.50,1233.04,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,outpatient,20,EA,4.32000,4.11000,The Alliance,Premier SAS,,2.42,,,,,,,2.16,4.19,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,outpatient,20,EA,5.53000,5.25000,The Alliance,Premier SAS,,2.42,,,,,,,2.35,5.36,fee schedule,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,outpatient,20,EA,4.61000,4.38000,The Alliance,Premier SAS,,2.42,,,,,,,2.31,4.47,fee schedule,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,outpatient,,,1106.00000,1050.70000,The Alliance,Premier SAS,TC,719.00,,,,,,,553.00,5703.10,fee schedule,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,outpatient,,,312.00000,296.40000,The Alliance,Premier SAS,TC,195.35,,,,,,,156.00,1549.49,fee schedule,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,outpatient,1,EA,7.31000,6.94000,The Alliance,Premier SAS,,5.03,,,,,,,3.65,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,outpatient,,,564.00000,535.80000,The Alliance,Premier SAS,TC,357.44,,,,,,,282.00,2835.16,fee schedule,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier SAS,TC,182.88,,,,,,,142.50,1450.63,fee schedule,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier SAS,,2.99,,,,,,,2.17,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,outpatient,1,EA,5.99000,5.69000,The Alliance,Premier SAS,,4.12,,,,,,,3.00,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,outpatient,1,EA,5.69000,5.41000,The Alliance,Premier SAS,,3.91,,,,,,,2.85,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Premier SAS,,2.59,,,,,,,1.88,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,outpatient,1,EA,7.62000,7.24000,The Alliance,Premier SAS,,5.24,,,,,,,3.81,7.39,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier SAS,TC,255.20,,,,,,,178.00,2024.21,fee schedule,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,outpatient,,,460.00000,437.00000,The Alliance,Premier SAS,TC,295.09,,,,,,,230.00,2340.67,fee schedule,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Premier SAS,TC,469.64,,,,,,,370.00,3725.20,fee schedule,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier SAS,TC,238.63,,,,,,,238.63,3015.65,fee schedule,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,TC,128.02,,,,,,,77.99,1015.45,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,outpatient,1,mL,477.84000,453.95000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,463.50,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,outpatient,1,mL,63.69000,60.51000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,61.78,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,outpatient,1,mL,21.94000,20.85000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,21.28,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,110.35,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,27.59,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,45.98,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,outpatient,1,mL,37.92000,36.02000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,36.78,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,26.98,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,outpatient,1,mL,42.75000,40.61000,The Alliance,Premier SAS,,8.33,,,,,,,8.33,41.47,fee schedule,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,TC,110.56,,,,,,,87.50,876.96,fee schedule,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier SAS,TC,307.56,,,,,,,234.50,2439.54,fee schedule,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,outpatient,,,217.00000,206.15000,The Alliance,Premier SAS,TC,150.47,,,,,,,108.50,1193.49,fee schedule,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier SAS,,92.19,,,,,,,67.00,129.98,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,outpatient,,,336.00000,319.20000,The Alliance,Premier SAS,TC,192.86,,,,,,,157.22,1529.72,fee schedule,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,The Alliance,Premier SAS,TC,190.36,,,,,,,151.00,1509.95,fee schedule,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,TC,152.96,,,,,,,115.50,1213.27,fee schedule,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,outpatient,,,2119.00000,2013.05000,The Alliance,Premier SAS,TC,2404.69,,,,,,,942.37,19073.89,fee schedule,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,outpatient,,,236.00000,224.20000,The Alliance,Premier SAS,TC,162.93,,,,,,,118.00,1292.36,fee schedule,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,The Alliance,Premier SAS,TC,187.87,,,,,,,46.50,3015.65,fee schedule,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,37.84,,,,,,,27.50,134.64,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,33.71,,,,,,,24.50,47.53,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,outpatient,,,465.80000,442.51000,The Alliance,Premier SAS,TC,1596.00,,,,,,,232.90,1820.00,per diem,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier SAS,,2.75,,,,,,,0.33500,4.20,fee schedule,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,outpatient,1,mL,20.10000,19.10000,The Alliance,Premier SAS,,30.16,,,,,,,10.05,35.77,fee schedule,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,outpatient,1,mL,17.85000,16.96000,The Alliance,Premier SAS,,30.16,,,,,,,8.93,35.77,fee schedule,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Premier SAS,,7569.00,,,,,,,1189.65,7803.00,case rate,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,outpatient,1,mL,165.78000,157.49000,The Alliance,Premier SAS,,114.06,,,,,,,82.89,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,outpatient,1,mL,20.24000,19.22000,The Alliance,Premier SAS,,13.93,,,,,,,10.12,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,outpatient,1,mL,20.26000,19.24000,The Alliance,Premier SAS,,13.94,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,outpatient,1,mL,20.26000,19.25000,The Alliance,Premier SAS,,13.94,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Premier SAS,,12.18,,,,,,,8.85,17.17,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,outpatient,1,EA,4748.76000,4511.33000,The Alliance,Premier SAS,,17.61,,,,,,,11.00,4606.30,fee schedule,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier SAS,,255.25,,,,,,,185.50,359.87,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,outpatient,1,mL,807.75000,767.36000,The Alliance,Premier SAS,,52.83,,,,,,,33.00,783.52,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,outpatient,1,mL,7.05000,6.70000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,6.84,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,outpatient,1,mL,4.50000,4.28000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,4.37,fee schedule,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,outpatient,1,mL,7.74000,7.35000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,7.51,fee schedule,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,outpatient,1,EA,1951.28000,1853.72000,The Alliance,Premier SAS,,40.11,,,,,,,25.05,1892.74,fee schedule,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,outpatient,10,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,outpatient,10,EA,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,outpatient,10,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,outpatient,,,383.00000,363.85000,The Alliance,Premier SAS,,288.78,,,,,,,191.50,2122.08,fee schedule,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,outpatient,1,EA,3584.37000,3405.15000,The Alliance,Premier SAS,,121.96,,,,,,,76.18,3476.84,fee schedule,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,outpatient,1,mL,5.55000,5.27000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,5.38,fee schedule,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,outpatient,1,mL,11.06000,10.51000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,10.73,fee schedule,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,20.80,,,,,,,2.99,152.82,fee schedule,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,25.41,,,,,,,4.00,186.75,fee schedule,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,166.34,,,,,,,26.07,1222.31,fee schedule,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,34.66,,,,,,,4.72,254.68,fee schedule,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Premier SAS,,4.35,,,,,,,1.23,5.23,fee schedule,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,outpatient,,,169.00000,160.55000,The Alliance,Premier SAS,,166.34,,,,,,,26.07,1222.31,fee schedule,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier SAS,,30.03,,,,,,,4.27,220.68,fee schedule,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier SAS,GY,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,outpatient,1,mL,1.06000,1.01000,The Alliance,Premier SAS,GY,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Premier SAS,GY,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier SAS,,2.75,,,,,,,0.41000,4.20,fee schedule,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,outpatient,1,EA,7470.42000,7096.90000,The Alliance,Premier SAS,,17.61,,,,,,,11.00,7246.31,fee schedule,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,outpatient,1,EA,254.92000,242.17000,The Alliance,Premier SAS,,175.38,,,,,,,127.46,247.27,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier SAS,,39.28,,,,,,,5.39,288.61,fee schedule,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,39.28,,,,,,,5.60,288.61,fee schedule,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier SAS,TC,204.09,,,,,,,158.62,1499.73,fee schedule,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,outpatient,,,2478.00000,2354.10000,The Alliance,Premier SAS,,2237.87,,,,,,,162.71,16444.87,fee schedule,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,43.89,,,,,,,6.04,322.54,fee schedule,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Premier SAS,TC,970.77,,,,,,,705.50,1368.67,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier SAS,,138.61,,,,,,,19.63,1018.59,fee schedule,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,GO,180.00,,,,,,,18.50,264.00,per diem,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier SAS,,3640.90,,,,,,,1388.02,5133.24,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,413.53,,,,,,,61.00,3038.81,fee schedule,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,TC,185.38,,,,,,,133.50,1470.40,fee schedule,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,outpatient,,,81.00000,76.95000,The Alliance,Premier SAS,,55.73,,,,,,,40.50,134.64,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier SAS,,133.47,,,,,,,97.00,212.44,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,The Alliance,Premier SAS,TC,794.64,,,,,,,577.50,1120.35,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,outpatient,1,mL,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,outpatient,1,mL,2.67000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,TC,429.00,,,,,,,225.00,492.80,per diem,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,,120.13,,,,,,,16.80,882.80,fee schedule,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,outpatient,1,EA,0.45000,0.42000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.65960,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.92150,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.33950,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,outpatient,1,mL,0.90000,0.86000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.87300,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,outpatient,1,mL,1.07000,1.02000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,1.04,fee schedule,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,0.64990,fee schedule,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,106.27,,,,,,,15.05,780.94,fee schedule,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,41.58,,,,,,,5.37,305.58,fee schedule,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,outpatient,1,mL,1043.05000,990.90000,The Alliance,Premier SAS,,136.49,,,,,,,85.25,1011.76,fee schedule,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,outpatient,1,mL,977.93000,929.03000,The Alliance,Premier SAS,,136.49,,,,,,,85.25,948.59,fee schedule,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,34.66,,,,,,,4.24,254.68,fee schedule,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier SAS,,108.58,,,,,,,15.32,797.91,fee schedule,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,27.72,,,,,,,4.29,203.72,fee schedule,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,,249.50,,,,,,,37.27,1833.46,fee schedule,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,outpatient,,,78.00000,74.10000,The Alliance,Premier SAS,,39.28,,,,,,,5.60,288.61,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,outpatient,1,EA,1320.90000,1254.86000,The Alliance,Premier SAS,,9.14,,,,,,,5.71,1281.27,fee schedule,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier SAS,,143.23,,,,,,,77.53,1052.52,fee schedule,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,84.62,,,,,,,61.50,212.44,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,outpatient,1,mL,2.66000,2.53000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,The Alliance,Premier SAS,,12.18,,,,,,,8.85,17.17,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,62.38,,,,,,,5.38,458.40,fee schedule,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,34.66,,,,,,,5.56,254.68,fee schedule,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,,62.38,,,,,,,8.62,458.40,fee schedule,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Premier SAS,,6.79,,,,,,,4.24,616.02,fee schedule,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier SAS,,909.00,,,,,,,392.70,5858.00,case rate,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,60.54,,,,,,,48.40,5271.00,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,60.54,,,,,,,48.40,5271.00,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,outpatient,1,mL,12.99000,12.34000,The Alliance,Premier SAS,,8.09,,,,,,,6.50,12.60,fee schedule,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,27.13,,,,,,,26.11,147.44,fee schedule,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Premier SAS,,26.03,,,,,,,25.05,74.76,fee schedule,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,86.00,,,,,,,62.50,121.25,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier SAS,,331.90,,,,,,,29.35,2438.99,fee schedule,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2195.00000,2085.25000,The Alliance,Premier SAS,TC,1510.16,,,,,,,1097.50,2210.07,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,The Alliance,Premier SAS,TC,1380.82,,,,,,,940.41,2960.49,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier SAS,TC,6399.09,,,,,,,4467.66,9021.97,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,The Alliance,Premier SAS,TC,2390.11,,,,,,,1364.86,7180.14,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,The Alliance,Premier SAS,TC,1498.46,,,,,,,1036.23,2210.07,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,The Alliance,Premier SAS,TC,847.62,,,,,,,466.73,2210.07,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,outpatient,,,1038.00000,986.10000,The Alliance,Premier SAS,TC,714.14,,,,,,,84.70,1006.86,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,The Alliance,Premier SAS,TC,1512.22,,,,,,,1047.28,2210.07,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,8152.00,,,,,,,2632.30,11015.00,case rate,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier SAS,,7569.00,,,,,,,3612.55,10015.25,case rate,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier SAS,TC,1331.97,,,,,,,918.26,2960.49,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier SAS,TC,513.94,,,,,,,282.87,724.59,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,The Alliance,Premier SAS,TC,829.73,,,,,,,455.68,2210.07,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,2632.30,7803.00,case rate,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier SAS,,8152.00,,,,,,,5343.33,11015.00,case rate,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,outpatient,,,4786.00000,4546.70000,The Alliance,Premier SAS,,7569.00,,,,,,,1801.27,7803.00,case rate,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,outpatient,,,4662.00000,4428.90000,The Alliance,Premier SAS,,7569.00,,,,,,,1801.27,7803.00,case rate,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier SAS,,8152.00,,,,,,,5343.33,11015.00,case rate,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,72.50,1820.00,per diem,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3544.38,per diem,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier SAS,,208.46,,,,,,,78.72,293.91,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier SAS,90,34.66,,,,,,,5.25,254.68,fee schedule,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,outpatient,1,mL,503.59000,478.41000,The Alliance,Premier SAS,,9.38,,,,,,,5.86,488.48,fee schedule,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,The Alliance,Premier SAS,,3.86,,,,,,,2.81,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,outpatient,1,EA,2.35000,2.24000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,103.96,,,,,,,14.55,763.98,fee schedule,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,outpatient,1,mL,10785.83000,10246.53000,The Alliance,Premier SAS,,269.18,,,,,,,168.13,10462.26,fee schedule,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,outpatient,1,mL,4534.31000,4307.59000,The Alliance,Premier SAS,,95.58,,,,,,,59.70,4398.28,fee schedule,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,outpatient,1,mL,2.17000,2.07000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,outpatient,,,740.00000,703.00000,The Alliance,Premier SAS,90,464.36,,,,,,,67.54,3412.32,fee schedule,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,outpatient,,,106.20000,100.89000,The Alliance,Premier SAS,90,73.07,,,,,,,53.10,103.01,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,outpatient,,,1376.00000,1307.20000,The Alliance,Premier SAS,90,1060.39,,,,,,,132.74,7792.26,fee schedule,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,outpatient,,,5754.00000,5466.30000,The Alliance,Premier SAS,TC,3958.75,,,,,,,1631.86,5581.38,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,outpatient,,,4909.00000,4663.55000,The Alliance,Premier SAS,,7569.00,,,,,,,2699.95,7803.00,case rate,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,The Alliance,Premier SAS,TC,1980.06,,,,,,,1114.22,2791.66,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,The Alliance,Premier SAS,TC,3563.84,,,,,,,1273.18,5024.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,The Alliance,Premier SAS,,1293.44,,,,,,,81.69,1823.60,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,outpatient,,,324.00000,307.80000,The Alliance,Premier SAS,,148.72,,,,,,,148.72,324.00,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,outpatient,,,70906.00000,67360.70000,The Alliance,Premier SAS,,8291.74,,,,,,,6083.48,68778.82,fee schedule,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,outpatient,,,1634.00000,1552.30000,The Alliance,Premier SAS,TC,1124.19,,,,,,,671.89,1584.98,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,94.94,,,,,,,69.00,212.44,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,outpatient,,,5032.00000,4780.40000,The Alliance,Premier SAS,,3462.02,,,,,,,2516.00,5156.10,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,outpatient,,,2892.00000,2747.40000,The Alliance,Premier SAS,,2277.05,,,,,,,1446.00,18061.43,fee schedule,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,outpatient,,,589.00000,559.55000,The Alliance,Premier SAS,,405.23,,,,,,,288.84,1203.43,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Premier SAS,,471.85,,,,,,,325.11,1028.00,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier SAS,TC,3199.89,,,,,,,380.83,4511.47,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,outpatient,,,2232.00000,2120.40000,The Alliance,Premier SAS,TC,1535.62,,,,,,,837.18,2210.07,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier SAS,,608.88,,,,,,,122.40,858.45,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,909.00,,,,,,,122.40,5271.00,case rate,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,outpatient,1,mL,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,outpatient,1,mL,55.71000,52.93000,The Alliance,Premier SAS,,38.33,,,,,,,27.86,54.04,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier SAS,,273.14,,,,,,,218.35,5271.00,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,50.91,,,,,,,37.00,71.78,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,outpatient,1,GM,316.85000,301.01000,The Alliance,Premier SAS,,217.99,,,,,,,158.43,307.34,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,outpatient,,,504.00000,478.80000,The Alliance,Premier SAS,,346.75,,,,,,,252.00,488.88,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,outpatient,,,1145.00000,1087.75000,The Alliance,Premier SAS,,787.76,,,,,,,629.75,5271.00,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,outpatient,,,2151.00000,2043.45000,The Alliance,Premier SAS,,1479.89,,,,,,,1183.05,5271.00,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,,25.46,,,,,,,18.50,35.89,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,outpatient,,,1103.00000,1047.85000,The Alliance,Premier SAS,,758.86,,,,,,,606.65,5271.00,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier SAS,,238.74,,,,,,,173.50,336.59,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,outpatient,,,1542.00000,1464.90000,The Alliance,Premier SAS,,1060.90,,,,,,,848.10,5271.00,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,outpatient,,,1023.00000,971.85000,The Alliance,Premier SAS,,703.82,,,,,,,562.65,5271.00,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,140.35,,,,,,,23.25,197.88,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,The Alliance,Premier SAS,,63.58,,,,,,,38.28,74.27,fee schedule,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,outpatient,1,mL,153.14000,145.48000,The Alliance,Premier SAS,,63.58,,,,,,,60.56,148.55,fee schedule,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier SAS,,909.00,,,,,,,179.85,3163.00,case rate,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,outpatient,,,1375.00000,1306.25000,The Alliance,Premier SAS,TC,845.60,,,,,,,384.29,6707.24,fee schedule,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,outpatient,,,2192.00000,2082.40000,The Alliance,Premier SAS,,1508.10,,,,,,,1205.60,5271.00,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,7.69,fee schedule,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,3.19,fee schedule,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,outpatient,1,mL,3.25000,3.09000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,3.15,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,outpatient,1,mL,5.81000,5.52000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.64,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,outpatient,1,mL,6.47000,6.14000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,6.28,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,outpatient,1,mL,12.23000,11.62000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,11.86,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,outpatient,1,mL,6.03000,5.73000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.85,fee schedule,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,outpatient,1,mL,7.93000,7.54000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,7.69,fee schedule,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,3.24,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,outpatient,,,538.00000,511.10000,The Alliance,Premier SAS,,370.14,,,,,,,269.00,521.86,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,outpatient,,,3127.00000,2970.65000,The Alliance,Premier SAS,,2151.38,,,,,,,1563.50,3388.98,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,outpatient,,,2098.00000,1993.10000,The Alliance,Premier SAS,,1443.42,,,,,,,1049.00,2035.06,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,outpatient,1,GM,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier SAS,,273.14,,,,,,,218.35,5271.00,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,outpatient,1,mL,1.38000,1.31000,The Alliance,Premier SAS,,1.34,,,,,,,0.69000,1.39,fee schedule,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier SAS,,1.34,,,,,,,1.07,2.09,fee schedule,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,outpatient,1,EA,126.59000,120.26000,The Alliance,Premier SAS,,87.09,,,,,,,63.30,122.79,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,outpatient,1,EA,0.97000,0.93000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier SAS,,1.79,,,,,,,1.30,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Premier SAS,,4.91,,,,,,,3.57,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,outpatient,1,EA,3.47000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.37,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,outpatient,1,EA,3.34000,3.18000,The Alliance,Premier SAS,,2.30,,,,,,,1.67,3.24,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,The Alliance,Premier SAS,,4.06,,,,,,,2.95,5.72,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,outpatient,1,mL,13.23000,12.57000,The Alliance,Premier SAS,,9.10,,,,,,,6.62,12.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier SAS,,2.50,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier SAS,,2.50,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,outpatient,1,mL,31.25000,29.69000,The Alliance,Premier SAS,,36.21,,,,,,,15.62,39.57,fee schedule,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,outpatient,1,GM,154.10000,146.40000,The Alliance,Premier SAS,,106.02,,,,,,,77.05,149.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,outpatient,1,EA,149.05000,141.60000,The Alliance,Premier SAS,,102.55,,,,,,,74.53,144.58,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,16.46,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,outpatient,1,GM,13.38000,12.71000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,12.98,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,outpatient,1,GM,10.01000,9.51000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,9.71,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,outpatient,1,GM,16.97000,16.12000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,16.46,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,outpatient,1,GM,6.32000,6.00000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,6.13,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,outpatient,1,GM,12.25000,11.64000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,11.88,fee schedule,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,outpatient,1,GM,4.23000,4.02000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,4.10,fee schedule,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,outpatient,1,EA,8081.09000,7677.04000,The Alliance,Premier SAS,,5559.79,,,,,,,4040.55,8747.08,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,outpatient,1,EA,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,27.59,,,,,,,0.47500,31.64,fee schedule,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,The Alliance,Premier SAS,,2.51,,,,,,,1.82,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier SAS,,2.50,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,54.63,,,,,,,0.23500,83.12,fee schedule,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,outpatient,1,mL,2.06000,1.96000,The Alliance,Premier SAS,,84.98,,,,,,,1.03,88.11,fee schedule,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,86.96,,,,,,,63.20,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,outpatient,1,EA,264.15000,250.94000,The Alliance,Premier SAS,,181.74,,,,,,,132.07,256.23,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,outpatient,1,EA,4.43000,4.21000,The Alliance,Premier SAS,,3.05,,,,,,,2.21,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,outpatient,1,EA,6.31000,5.99000,The Alliance,Premier SAS,,4.34,,,,,,,3.15,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,outpatient,1,mL,23.23000,22.07000,The Alliance,Premier SAS,,15.98,,,,,,,11.62,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,outpatient,1,mL,33.95000,32.25000,The Alliance,Premier SAS,,23.36,,,,,,,16.98,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,outpatient,1,mL,9.47000,8.99000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,outpatient,1,mL,26.76000,25.43000,The Alliance,Premier SAS,,18.41,,,,,,,13.38,25.96,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,outpatient,,,3442.00000,3269.90000,The Alliance,Premier SAS,,2368.10,,,,,,,1343.28,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier SAS,,890.96,,,,,,,647.50,1885.25,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,outpatient,1,mL,2.18000,2.08000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,outpatient,1,mL,1.40000,1.33000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,1.36,fee schedule,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11935,0.61110,fee schedule,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier SAS,,4.18,,,,,,,0.36500,4.31,fee schedule,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,outpatient,1,mL,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,outpatient,1,EA,11533.00000,10956.35000,The Alliance,Premier SAS,,368.65,,,,,,,230.26,11187.01,fee schedule,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,outpatient,1,mL,40.61000,38.58000,The Alliance,Premier SAS,,27.94,,,,,,,20.30,39.39,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,outpatient,1,EA,1.86000,1.76000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,8.31,,,,,,,0.79000,8.57,fee schedule,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,outpatient,1,mL,540.41000,513.39000,The Alliance,Premier SAS,,371.80,,,,,,,270.20,524.20,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.99262,,,,,,,0.30000,1.02,fee schedule,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,outpatient,1,mL,42.81000,40.67000,The Alliance,Premier SAS,,29.45,,,,,,,21.41,41.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,outpatient,1,EA,15.50000,14.73000,The Alliance,Premier SAS,,10.66,,,,,,,7.75,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Premier SAS,,8.45,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier SAS,,15.49,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,outpatient,1,EA,8.46000,8.04000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,8.21,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,outpatient,1,EA,10.58000,10.05000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,10.26,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,1.99,fee schedule,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,6.90,fee schedule,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,outpatient,1,EA,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Premier SAS,,6.55,,,,,,,4.09,11.89,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,outpatient,1,mL,16.95000,16.10000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,16.44,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,outpatient,1,mL,13.45000,12.77000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,13.05,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,outpatient,1,mL,16.54000,15.72000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,16.04,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,9.81,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,outpatient,1,mL,20.44000,19.42000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,19.83,fee schedule,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,20.03,fee schedule,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,outpatient,1,EA,19.82000,18.82000,The Alliance,Premier SAS,,13.64,,,,,,,9.91,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,outpatient,1,EA,12.31000,11.69000,The Alliance,Premier SAS,,8.47,,,,,,,6.16,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,outpatient,1,EA,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,outpatient,1,EA,11.08000,10.53000,The Alliance,Premier SAS,,7.62,,,,,,,5.54,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,outpatient,1,EA,4.20000,3.99000,The Alliance,Premier SAS,,2.89,,,,,,,2.10,4.07,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,outpatient,1,EA,4.99000,4.74000,The Alliance,Premier SAS,,2.47,,,,,,,1.54,4.84,fee schedule,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier SAS,,15.49,,,,,,,11.26,21.83,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,outpatient,1,EA,8343.84000,7926.65000,The Alliance,Premier SAS,,5740.56,,,,,,,709.27,8093.52,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,outpatient,1,mL,17.85000,16.95000,The Alliance,Premier SAS,,12.28,,,,,,,8.93,17.31,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,outpatient,1,EA,494.41000,469.68000,The Alliance,Premier SAS,,0.76848,,,,,,,0.73160,479.58,fee schedule,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,outpatient,1,EA,15.58000,14.80000,The Alliance,Premier SAS,,10.72,,,,,,,7.79,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier SAS,,2.50,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,0.31040,fee schedule,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,54.63,,,,,,,0.16000,83.12,fee schedule,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,outpatient,1,EA,4.14000,3.93000,The Alliance,Premier SAS,,2.39,,,,,,,1.49,4.02,fee schedule,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,outpatient,1,EA,4.70000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,outpatient,1,EA,3.64000,3.46000,The Alliance,Premier SAS,,2.50,,,,,,,1.82,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,outpatient,1,EA,93.95000,89.25000,The Alliance,Premier SAS,,64.64,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,outpatient,1,EA,29.95000,28.45000,The Alliance,Premier SAS,,20.61,,,,,,,14.97,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier SAS,,3.17,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,outpatient,1,mL,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,outpatient,1,mL,67.32000,63.95000,The Alliance,Premier SAS,,46.32,,,,,,,33.66,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,outpatient,1,mL,22.00000,20.90000,The Alliance,Premier SAS,,15.14,,,,,,,11.00,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Premier SAS,,4.19,,,,,,,3.04,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,outpatient,1,mL,10.92000,10.38000,The Alliance,Premier SAS,,7.51,,,,,,,5.46,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,outpatient,1,mL,6.02000,5.72000,The Alliance,Premier SAS,,4.14,,,,,,,3.01,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,outpatient,1,mL,16.59000,15.76000,The Alliance,Premier SAS,,11.41,,,,,,,8.29,16.09,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,outpatient,1,EA,1.64000,1.55000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,outpatient,1,EA,1.38000,1.31000,The Alliance,Premier SAS,,0.94944,,,,,,,0.69000,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,outpatient,1,EA,18.36000,17.44000,The Alliance,Premier SAS,,12.63,,,,,,,9.18,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,outpatient,1,EA,25.47000,24.20000,The Alliance,Premier SAS,,17.52,,,,,,,12.73,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,outpatient,1,EA,1.15000,1.09000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier SAS,,31.13,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,outpatient,1,EA,20.34000,19.32000,The Alliance,Premier SAS,,13.99,,,,,,,10.17,19.73,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,outpatient,1,EA,800.41000,760.39000,The Alliance,Premier SAS,,36.21,,,,,,,22.62,776.40,fee schedule,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,outpatient,1,EA,659.80000,626.81000,The Alliance,Premier SAS,,36.21,,,,,,,22.62,640.01,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,outpatient,1,EA,8073.00000,7669.35000,The Alliance,Premier SAS,,7.27,,,,,,,4.54,7830.81,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,outpatient,1,EA,1258.61000,1195.68000,The Alliance,Premier SAS,,7.27,,,,,,,4.54,1220.85,fee schedule,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,outpatient,1,EA,8253.21000,7840.55000,The Alliance,Premier SAS,,7.27,,,,,,,4.54,8005.61,fee schedule,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier SAS,,0.76848,,,,,,,0.73160,275.87,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,outpatient,1,mL,11.66000,11.08000,The Alliance,Premier SAS,,0.99262,,,,,,,0.93155,11.31,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,outpatient,1,mL,19.36000,18.39000,The Alliance,Premier SAS,,0.99262,,,,,,,0.93155,18.78,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,outpatient,1,mL,8.71000,8.28000,The Alliance,Premier SAS,,0.99262,,,,,,,0.93155,8.45,fee schedule,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Premier SAS,,0.99262,,,,,,,0.93155,17.86,fee schedule,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,outpatient,1,EA,1024.57000,973.34000,The Alliance,Premier SAS,,168.02,,,,,,,104.95,993.83,fee schedule,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,outpatient,1,EA,2067.60000,1964.22000,The Alliance,Premier SAS,,1595.22,,,,,,,996.39,2005.57,fee schedule,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,2.39,,,,,,,0.47500,2.61,fee schedule,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,outpatient,1,mL,149.33000,141.87000,The Alliance,Premier SAS,,281.49,,,,,,,74.67,290.17,fee schedule,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,outpatient,1,mL,9.36000,8.90000,The Alliance,Premier SAS,,6.44,,,,,,,4.68,9.08,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.90,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,outpatient,1,GM,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,outpatient,1,mL,177.67000,168.78000,The Alliance,Premier SAS,,9.38,,,,,,,5.86,172.34,fee schedule,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,outpatient,1,mL,187.70000,178.32000,The Alliance,Premier SAS,,9.38,,,,,,,5.86,182.07,fee schedule,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,outpatient,1,mL,119.78000,113.79000,The Alliance,Premier SAS,,9.38,,,,,,,5.86,116.19,fee schedule,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier SAS,,1.96,,,,,,,1.43,2.76,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,outpatient,1,EA,2.71000,2.58000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,outpatient,1,EA,83.83000,79.64000,The Alliance,Premier SAS,,57.68,,,,,,,41.91,81.32,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,The Alliance,Premier SAS,,3.94,,,,,,,2.86,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,The Alliance,Premier SAS,,12.12,,,,,,,8.81,17.09,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,outpatient,1,mL,73.39000,69.72000,The Alliance,Premier SAS,,50.49,,,,,,,36.70,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,outpatient,1,mL,26.33000,25.02000,The Alliance,Premier SAS,,18.12,,,,,,,13.16,25.54,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,outpatient,1,EA,12.28000,11.67000,The Alliance,Premier SAS,,8.45,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,The Alliance,Premier SAS,,15.49,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,outpatient,1,GM,193.93000,184.24000,The Alliance,Premier SAS,,133.42,,,,,,,96.97,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,outpatient,1,GM,247.45000,235.08000,The Alliance,Premier SAS,,170.25,,,,,,,123.72,240.03,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,4.18,,,,,,,0.16000,4.31,fee schedule,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,outpatient,1,EA,41.65000,39.57000,The Alliance,Premier SAS,,28.66,,,,,,,20.82,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier SAS,,2.98,,,,,,,2.17,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,outpatient,1,mL,230.68000,219.15000,The Alliance,Premier SAS,,107.59,,,,,,,83.42,223.76,fee schedule,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,outpatient,1,mL,277.83000,263.94000,The Alliance,Premier SAS,,107.59,,,,,,,83.42,269.50,fee schedule,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,The Alliance,Premier SAS,,31.13,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,The Alliance,Premier SAS,,2.94,,,,,,,2.13,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,outpatient,1,EA,5.49000,5.21000,The Alliance,Premier SAS,,3.78,,,,,,,2.75,5.33,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,outpatient,1,GM,63.71000,60.52000,The Alliance,Premier SAS,,43.83,,,,,,,31.86,61.80,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Premier SAS,,11.03,,,,,,,10.61,22.93,fee schedule,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,outpatient,1,EA,530.95000,504.40000,The Alliance,Premier SAS,,365.29,,,,,,,224.97,515.02,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,11.54,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,outpatient,1,mL,12.49000,11.87000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,12.12,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,outpatient,1,mL,7.51000,7.13000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,7.28,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,outpatient,1,mL,11.90000,11.30000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,11.54,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,outpatient,1,mL,9.59000,9.11000,The Alliance,Premier SAS,,2.05,,,,,,,1.85,9.30,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier SAS,,2.05,,,,,,,1.66,3.22,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Premier SAS,,2.05,,,,,,,1.45,2.81,fee schedule,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,outpatient,1,mL,3.44000,3.27000,The Alliance,Premier SAS,,2.05,,,,,,,1.72,3.34,fee schedule,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,outpatient,1,GM,17.98000,17.08000,The Alliance,Premier SAS,,12.37,,,,,,,8.99,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,outpatient,1,GM,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,outpatient,1,EA,511.78000,486.19000,The Alliance,Premier SAS,,352.10,,,,,,,255.89,496.43,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,outpatient,1,EA,157.08000,149.23000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,152.37,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,outpatient,1,EA,180.75000,171.71000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,175.33,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,outpatient,1,EA,121.63000,115.55000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,117.98,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,outpatient,1,EA,159.45000,151.48000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,154.67,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,outpatient,1,EA,104.66000,99.43000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,101.52,fee schedule,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,outpatient,1,EA,96.95000,92.10000,The Alliance,Premier SAS,,33.46,,,,,,,33.41,94.04,fee schedule,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,outpatient,1,mL,17.10000,16.25000,The Alliance,Premier SAS,,11.76,,,,,,,8.55,16.59,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,outpatient,1,EA,12.01000,11.41000,The Alliance,Premier SAS,,8.26,,,,,,,6.00,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,outpatient,1,GM,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,outpatient,1,GM,1.53000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,outpatient,1,GM,124.12000,117.92000,The Alliance,Premier SAS,,85.39,,,,,,,62.06,120.40,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,outpatient,1,GM,9.43000,8.96000,The Alliance,Premier SAS,,6.49,,,,,,,4.71,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier SAS,,1.92,,,,,,,1.40,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,outpatient,1,mL,21.07000,20.01000,The Alliance,Premier SAS,,14.50,,,,,,,10.54,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,outpatient,1,mL,25.28000,24.02000,The Alliance,Premier SAS,,17.39,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,outpatient,1,mL,40.82000,38.78000,The Alliance,Premier SAS,,28.08,,,,,,,20.41,39.60,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,outpatient,1,EA,2.87000,2.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.44,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier SAS,,4.29,,,,,,,3.12,6.04,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,outpatient,1,EA,4700.21000,4465.20000,The Alliance,Premier SAS,,89.67,,,,,,,56.01,4559.20,fee schedule,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,outpatient,1,EA,3.71000,3.53000,The Alliance,Premier SAS,,2.55,,,,,,,1.85,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier SAS,,3.20,,,,,,,2.33,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,outpatient,1,EA,5.58000,5.31000,The Alliance,Premier SAS,,3.84,,,,,,,2.79,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.12,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.56,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier SAS,,2.74,,,,,,,1.99,3.86,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,outpatient,1,EA,142.79000,135.65000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,138.51,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,outpatient,1,EA,17.12000,16.26000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,16.61,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,outpatient,1,EA,3.60000,3.42000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,3.49,fee schedule,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,3.12,fee schedule,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,outpatient,1,EA,27.33000,25.96000,The Alliance,Premier SAS,,18.80,,,,,,,13.66,26.51,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,outpatient,1,EA,251.66000,239.08000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,244.11,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,outpatient,1,EA,1245.79000,1183.50000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,1208.42,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,outpatient,1,EA,1424.50000,1353.27000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,1381.77,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,229.89,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,outpatient,1,EA,226.21000,214.90000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,219.42,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,outpatient,1,EA,295.71000,280.93000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,286.84,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,outpatient,1,EA,1315.72000,1249.93000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,1276.25,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,outpatient,1,EA,280.13000,266.13000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,271.73,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,outpatient,1,EA,15.19000,14.43000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,14.73,fee schedule,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,outpatient,1,EA,284.40000,270.18000,The Alliance,Premier SAS,,0.27217,,,,,,,0.23715,275.87,fee schedule,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,outpatient,1,mL,259.00000,246.05000,The Alliance,Premier SAS,,2.95,,,,,,,1.84,251.23,fee schedule,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,outpatient,1,mL,265.48000,252.20000,The Alliance,Premier SAS,,2.95,,,,,,,1.84,257.52,fee schedule,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,outpatient,1,mL,3.29000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,outpatient,1,EA,4.32000,4.10000,The Alliance,Premier SAS,,2.97,,,,,,,2.16,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,outpatient,1,EA,6.45000,6.13000,The Alliance,Premier SAS,,4.44,,,,,,,3.23,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,outpatient,1,EA,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,outpatient,1,GM,6.43000,6.11000,The Alliance,Premier SAS,,4.42,,,,,,,3.21,6.24,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,outpatient,1,GM,93.82000,89.13000,The Alliance,Premier SAS,,64.55,,,,,,,46.91,91.01,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,outpatient,1,EA,6.41000,6.09000,The Alliance,Premier SAS,,4.41,,,,,,,3.21,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,The Alliance,Premier SAS,,2.32,,,,,,,1.69,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,The Alliance,Premier SAS,,2.67,,,,,,,1.94,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,outpatient,1,EA,2.70000,2.56000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,outpatient,1,EA,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,outpatient,1,mL,30.17000,28.66000,The Alliance,Premier SAS,,20.76,,,,,,,15.09,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,The Alliance,Premier SAS,,2.20,,,,,,,1.60,3.10,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,3.38,,,,,,,2.21,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Premier SAS,,3.38,,,,,,,2.45,4.86,fee schedule,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,outpatient,1,mL,146.16000,138.85000,The Alliance,Premier SAS,,100.56,,,,,,,73.08,141.78,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,outpatient,1,EA,406.81000,386.47000,The Alliance,Premier SAS,,279.89,,,,,,,203.41,394.61,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,outpatient,1,EA,10.92000,10.38000,The Alliance,Premier SAS,,7.51,,,,,,,5.46,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier SAS,,7.98,,,,,,,5.80,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,outpatient,1,mL,3.22000,3.06000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,3.12,fee schedule,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,outpatient,1,mL,43.04000,40.89000,The Alliance,Premier SAS,,6.61,,,,,,,6.48,41.75,fee schedule,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,outpatient,1,EA,6.33000,6.01000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,6.14,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,outpatient,1,EA,24.61000,23.38000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,23.87,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.29,fee schedule,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,4.91,fee schedule,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,outpatient,1,mL,5.86000,5.57000,The Alliance,Premier SAS,,4.03,,,,,,,2.93,5.68,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,outpatient,1,mL,5.21000,4.95000,The Alliance,Premier SAS,,3.38,,,,,,,2.60,5.05,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,outpatient,1,mL,4.37000,4.15000,The Alliance,Premier SAS,,3.38,,,,,,,2.19,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Premier SAS,,3.38,,,,,,,3.38,8.09,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,outpatient,1,mL,8.47000,8.05000,The Alliance,Premier SAS,,3.38,,,,,,,3.38,8.22,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,outpatient,1,mL,4.56000,4.34000,The Alliance,Premier SAS,,3.38,,,,,,,2.28,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier SAS,,3.38,,,,,,,1.50,4.86,fee schedule,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,outpatient,1,mL,3.31000,3.14000,The Alliance,Premier SAS,,3.38,,,,,,,1.66,4.86,fee schedule,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,outpatient,1,mL,2.45000,2.33000,The Alliance,Premier SAS,,1.34,,,,,,,1.23,2.38,fee schedule,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,outpatient,1,GM,10.36000,9.84000,The Alliance,Premier SAS,,7.13,,,,,,,5.18,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,outpatient,1,GM,8.28000,7.86000,The Alliance,Premier SAS,,5.70,,,,,,,4.14,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,outpatient,1,GM,4.48000,4.25000,The Alliance,Premier SAS,,3.08,,,,,,,2.24,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,outpatient,1,GM,10.34000,9.83000,The Alliance,Premier SAS,,7.11,,,,,,,5.17,10.03,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,The Alliance,Premier SAS,,6.74,,,,,,,4.90,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,The Alliance,Premier SAS,,3.56,,,,,,,2.58,5.01,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,outpatient,1,EA,27.93000,26.54000,The Alliance,Premier SAS,,19.22,,,,,,,13.96,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,outpatient,1,EA,83.20000,79.04000,The Alliance,Premier SAS,,57.24,,,,,,,41.60,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,outpatient,1,EA,27.65000,26.27000,The Alliance,Premier SAS,,19.02,,,,,,,13.82,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,outpatient,1,EA,17.89000,16.99000,The Alliance,Premier SAS,,12.31,,,,,,,8.95,17.35,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,outpatient,1,EA,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,outpatient,1,EA,2.48000,2.35000,The Alliance,Premier SAS,,1.71,,,,,,,1.24,2.41,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,outpatient,1,GM,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,outpatient,1,EA,24.16000,22.96000,The Alliance,Premier SAS,,16.62,,,,,,,12.08,23.44,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,outpatient,1,EA,7.03000,6.68000,The Alliance,Premier SAS,,4.84,,,,,,,3.52,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,outpatient,1,EA,15.83000,15.04000,The Alliance,Premier SAS,,10.89,,,,,,,7.92,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,outpatient,1,EA,8.44000,8.02000,The Alliance,Premier SAS,,5.81,,,,,,,4.22,8.19,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,outpatient,1,EA,18.30000,17.38000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,17.75,fee schedule,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,outpatient,1,EA,59.37000,56.40000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,57.59,fee schedule,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,The Alliance,Premier SAS,,2.95,,,,,,,2.15,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,outpatient,1,EA,2.89000,2.75000,The Alliance,Premier SAS,,1.99,,,,,,,1.45,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,1.33,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,outpatient,1,mL,31.44000,29.87000,The Alliance,Premier SAS,,21.63,,,,,,,1.33,30.50,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,outpatient,1,EA,414.40000,393.68000,The Alliance,Premier SAS,,64.65,,,,,,,50.35,401.97,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier SAS,,64.65,,,,,,,50.35,183.91,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,outpatient,1,EA,100.11000,95.10000,The Alliance,Premier SAS,,64.65,,,,,,,50.05,97.11,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,outpatient,1,EA,153.86000,146.17000,The Alliance,Premier SAS,,64.65,,,,,,,50.35,149.24,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,outpatient,1,EA,515.41000,489.64000,The Alliance,Premier SAS,,64.65,,,,,,,50.35,499.95,fee schedule,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,outpatient,1,EA,751.10000,713.54000,The Alliance,Premier SAS,,64.65,,,,,,,50.35,728.57,fee schedule,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,outpatient,1,mL,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Premier SAS,,11.72,,,,,,,8.52,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,The Alliance,Premier SAS,,9.38,,,,,,,6.82,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,The Alliance,Premier SAS,,4.55,,,,,,,3.31,6.41,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,outpatient,1,EA,30.94000,29.39000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,30.01,fee schedule,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,outpatient,1,EA,67.73000,64.35000,The Alliance,Premier SAS,,1.97,,,,,,,1.86,65.70,fee schedule,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,outpatient,1,EA,7.11000,6.75000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,6.90,fee schedule,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,outpatient,1,EA,9.24000,8.77000,The Alliance,Premier SAS,,3.67,,,,,,,3.12,8.96,fee schedule,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,2.63,,,,,,,0.23500,2.71,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,outpatient,20,EA,1.90000,1.80000,The Alliance,Premier SAS,,3.71,,,,,,,0.95000,3.83,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,outpatient,20,EA,0.39000,0.37000,The Alliance,Premier SAS,,3.71,,,,,,,0.19500,3.83,fee schedule,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,outpatient,1,EA,12.12000,11.51000,The Alliance,Premier SAS,,8.34,,,,,,,6.06,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier SAS,,3.35,,,,,,,2.44,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier SAS,,1.80,,,,,,,1.31,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,outpatient,1,EA,10.66000,10.13000,The Alliance,Premier SAS,,7.33,,,,,,,5.33,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,outpatient,1,EA,443.95000,421.75000,The Alliance,Premier SAS,,278.00,,,,,,,173.64,430.63,fee schedule,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,outpatient,1,EA,8136.71000,7729.88000,The Alliance,Premier SAS,,278.00,,,,,,,173.64,7892.61,fee schedule,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,outpatient,1,EA,6780.60000,6441.57000,The Alliance,Premier SAS,,278.00,,,,,,,173.64,6577.18,fee schedule,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,outpatient,1,mL,91.29000,86.72000,The Alliance,Premier SAS,,43.34,,,,,,,43.34,88.55,fee schedule,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,outpatient,1,mL,78.87000,74.93000,The Alliance,Premier SAS,,43.34,,,,,,,39.44,76.50,fee schedule,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,outpatient,1,mL,9.87000,9.38000,The Alliance,Premier SAS,,6.79,,,,,,,4.93,9.57,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,outpatient,1,EA,8.44000,8.01000,The Alliance,Premier SAS,,5.81,,,,,,,4.22,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,outpatient,1,EA,51.35000,48.78000,The Alliance,Premier SAS,,35.33,,,,,,,25.68,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,outpatient,1,EA,9.88000,9.38000,The Alliance,Premier SAS,,6.80,,,,,,,4.94,9.58,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,6.13,fee schedule,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,outpatient,1,mL,4.12000,3.91000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,4.00,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,outpatient,1,EA,9.49000,9.02000,The Alliance,Premier SAS,,6.53,,,,,,,4.75,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,The Alliance,Premier SAS,,7.20,,,,,,,5.23,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,outpatient,1,EA,9.23000,8.77000,The Alliance,Premier SAS,,6.35,,,,,,,4.62,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,outpatient,1,EA,21.79000,20.70000,The Alliance,Premier SAS,,14.99,,,,,,,10.89,21.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,outpatient,1,EA,76.88000,73.03000,The Alliance,Premier SAS,,52.89,,,,,,,38.44,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,outpatient,1,EA,64.06000,60.86000,The Alliance,Premier SAS,,44.07,,,,,,,32.03,62.14,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Premier SAS,,4.66,,,,,,,3.39,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,outpatient,1,EA,8.17000,7.76000,The Alliance,Premier SAS,,5.62,,,,,,,4.08,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,outpatient,1,EA,22.28000,21.16000,The Alliance,Premier SAS,,15.33,,,,,,,11.14,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,outpatient,1,EA,4.89000,4.65000,The Alliance,Premier SAS,,3.36,,,,,,,2.44,4.74,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,outpatient,1,mL,1.90000,1.81000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06045,1.84,fee schedule,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,outpatient,1,EA,122.99000,116.84000,The Alliance,Premier SAS,,84.62,,,,,,,61.49,119.30,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,outpatient,50,EA,0.29000,0.28000,The Alliance,Premier SAS,,2.67,,,,,,,0.14500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,outpatient,50,EA,1.10000,1.05000,The Alliance,Premier SAS,,2.67,,,,,,,0.55000,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,outpatient,50,EA,0.67000,0.64000,The Alliance,Premier SAS,,2.67,,,,,,,0.33500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,outpatient,50,EA,0.75000,0.71000,The Alliance,Premier SAS,,2.67,,,,,,,0.37500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,outpatient,50,EA,0.43000,0.41000,The Alliance,Premier SAS,,2.67,,,,,,,0.21500,2.76,fee schedule,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,outpatient,50,EA,0.42000,0.40000,The Alliance,Premier SAS,,2.67,,,,,,,0.21000,2.76,fee schedule,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.69,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,0.92150,fee schedule,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,outpatient,1,GM,6.83000,6.49000,The Alliance,Premier SAS,,4.70,,,,,,,3.42,6.63,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,outpatient,1,GM,3.91000,3.71000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,outpatient,1,EA,7.08000,6.72000,The Alliance,Premier SAS,,4.87,,,,,,,3.54,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,outpatient,1,EA,10.38000,9.86000,The Alliance,Premier SAS,,7.14,,,,,,,5.19,10.07,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,outpatient,1,EA,17.09000,16.24000,The Alliance,Premier SAS,,11.76,,,,,,,8.54,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,outpatient,1,EA,10.50000,9.98000,The Alliance,Premier SAS,,7.22,,,,,,,5.25,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Premier SAS,,4.37,,,,,,,3.17,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,outpatient,1,EA,18.34000,17.42000,The Alliance,Premier SAS,,12.62,,,,,,,9.17,17.79,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,outpatient,1,mL,4.31000,4.09000,The Alliance,Premier SAS,,2.97,,,,,,,2.15,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,outpatient,1,mL,1.50000,1.42000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,outpatient,1,mL,0.65000,0.62000,The Alliance,Premier SAS,,1.97,,,,,,,0.32500,2.03,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier SAS,,3.12,,,,,,,0.48500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier SAS,,3.12,,,,,,,0.63500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,outpatient,1,mL,1.77000,1.68000,The Alliance,Premier SAS,,3.12,,,,,,,0.88500,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,3.12,,,,,,,0.95000,4.75,fee schedule,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier SAS,,3.12,,,,,,,0.57000,4.75,fee schedule,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,outpatient,1,GM,7.87000,7.47000,The Alliance,Premier SAS,,5.41,,,,,,,3.94,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,outpatient,1,GM,6.56000,6.23000,The Alliance,Premier SAS,,4.51,,,,,,,3.28,6.36,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,outpatient,1,mL,46.93000,44.58000,The Alliance,Premier SAS,,32.29,,,,,,,23.46,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,outpatient,1,mL,43.17000,41.01000,The Alliance,Premier SAS,,29.70,,,,,,,21.59,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,outpatient,1,mL,42.74000,40.60000,The Alliance,Premier SAS,,29.41,,,,,,,21.37,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,outpatient,1,mL,32.38000,30.76000,The Alliance,Premier SAS,,22.28,,,,,,,16.19,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,outpatient,1,mL,15.72000,14.93000,The Alliance,Premier SAS,,10.82,,,,,,,7.86,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,outpatient,1,GM,19.34000,18.37000,The Alliance,Premier SAS,,13.31,,,,,,,9.67,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,153.26,fee schedule,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,outpatient,1,EA,158.63000,150.70000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,153.87,fee schedule,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,outpatient,1,GM,18.19000,17.28000,The Alliance,Premier SAS,,12.51,,,,,,,9.10,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,outpatient,1,GM,26.20000,24.89000,The Alliance,Premier SAS,,18.03,,,,,,,13.10,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,outpatient,1,GM,13.79000,13.10000,The Alliance,Premier SAS,,9.49,,,,,,,6.89,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,outpatient,1,GM,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,outpatient,1,GM,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,outpatient,1,GM,6.55000,6.22000,The Alliance,Premier SAS,,4.51,,,,,,,3.27,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,outpatient,1,GM,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,outpatient,1,GM,8.15000,7.74000,The Alliance,Premier SAS,,5.61,,,,,,,4.08,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,outpatient,1,GM,0.87000,0.82000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,outpatient,1,GM,7.86000,7.47000,The Alliance,Premier SAS,,5.41,,,,,,,3.93,7.62,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,EA,8.63000,8.20000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,8.37,fee schedule,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,outpatient,1,mL,1.66000,1.58000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,1.61,fee schedule,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,outpatient,1,mL,8.69000,8.26000,The Alliance,Premier SAS,,5.98,,,,,,,4.34,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,outpatient,1,mL,7.34000,6.97000,The Alliance,Premier SAS,,5.05,,,,,,,3.67,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,outpatient,1,mL,7.27000,6.90000,The Alliance,Premier SAS,,5.00,,,,,,,3.63,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,outpatient,1,mL,7.99000,7.60000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,outpatient,1,mL,2.88000,2.74000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,outpatient,1,mL,6.64000,6.30000,The Alliance,Premier SAS,,4.57,,,,,,,3.32,6.44,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier SAS,,6.96,,,,,,,5.05,9.81,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,outpatient,1,mL,5.07000,4.82000,The Alliance,Premier SAS,,3.49,,,,,,,2.54,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,outpatient,1,mL,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,outpatient,1,GM,193.54000,183.86000,The Alliance,Premier SAS,,133.16,,,,,,,96.77,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,outpatient,1,GM,223.33000,212.16000,The Alliance,Premier SAS,,153.65,,,,,,,111.67,216.63,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,outpatient,1,mL,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,outpatient,1,mL,30.48000,28.95000,The Alliance,Premier SAS,,20.97,,,,,,,15.24,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,outpatient,1,mL,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,outpatient,1,mL,3.56000,3.38000,The Alliance,Premier SAS,,2.45,,,,,,,1.78,3.45,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,outpatient,1,EA,195.57000,185.79000,The Alliance,Premier SAS,,134.55,,,,,,,97.78,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,outpatient,1,EA,398.19000,378.28000,The Alliance,Premier SAS,,273.95,,,,,,,199.09,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,outpatient,1,EA,195.79000,186.00000,The Alliance,Premier SAS,,134.70,,,,,,,97.89,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,outpatient,1,EA,97.90000,93.00000,The Alliance,Premier SAS,,67.36,,,,,,,48.95,94.96,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,outpatient,1,mL,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,outpatient,1,GM,21.61000,20.53000,The Alliance,Premier SAS,,14.87,,,,,,,10.80,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,outpatient,1,GM,15.06000,14.31000,The Alliance,Premier SAS,,10.36,,,,,,,7.53,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,outpatient,1,GM,13.12000,12.46000,The Alliance,Premier SAS,,9.03,,,,,,,6.56,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,outpatient,1,GM,11.48000,10.91000,The Alliance,Premier SAS,,7.90,,,,,,,5.74,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,outpatient,1,GM,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,outpatient,1,GM,2.62000,2.49000,The Alliance,Premier SAS,,1.80,,,,,,,1.31,2.54,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,outpatient,1,mL,11.38000,10.81000,The Alliance,Premier SAS,,7.83,,,,,,,5.69,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,outpatient,1,mL,8.15000,7.75000,The Alliance,Premier SAS,,5.61,,,,,,,4.08,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,outpatient,1,mL,13.27000,12.61000,The Alliance,Premier SAS,,9.13,,,,,,,6.63,12.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,outpatient,1,GM,15.20000,14.44000,The Alliance,Premier SAS,,10.46,,,,,,,7.60,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,outpatient,1,GM,21.89000,20.79000,The Alliance,Premier SAS,,15.06,,,,,,,10.95,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,outpatient,1,GM,11.17000,10.61000,The Alliance,Premier SAS,,7.68,,,,,,,5.58,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,outpatient,1,GM,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,outpatient,1,GM,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,outpatient,1,GM,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,outpatient,1,mL,99.81000,94.82000,The Alliance,Premier SAS,,68.67,,,,,,,49.91,96.82,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,outpatient,1,mL,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,outpatient,1,EA,10.87000,10.33000,The Alliance,Premier SAS,,7.48,,,,,,,5.43,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,outpatient,1,EA,8.36000,7.94000,The Alliance,Premier SAS,,5.75,,,,,,,4.18,8.11,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,outpatient,1,mL,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Premier SAS,,14.66,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,outpatient,1,EA,21.57000,20.49000,The Alliance,Premier SAS,,14.84,,,,,,,10.79,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,The Alliance,Premier SAS,,14.66,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,outpatient,1,EA,21.32000,20.25000,The Alliance,Premier SAS,,14.67,,,,,,,10.66,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,outpatient,1,mL,801.86000,761.77000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,777.80,fee schedule,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,outpatient,1,mL,23.90000,22.71000,The Alliance,Premier SAS,,16.44,,,,,,,11.95,23.18,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,The Alliance,Premier SAS,,3.49,,,,,,,2.54,4.92,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,outpatient,1,mL,10.43000,9.91000,The Alliance,Premier SAS,,7.18,,,,,,,5.21,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,outpatient,1,EA,140.98000,133.93000,The Alliance,Premier SAS,,96.99,,,,,,,70.49,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,outpatient,1,EA,141.13000,134.08000,The Alliance,Premier SAS,,97.10,,,,,,,70.56,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,outpatient,1,EA,43.75000,41.56000,The Alliance,Premier SAS,,30.10,,,,,,,21.88,42.44,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,outpatient,1,EA,5.54000,5.26000,The Alliance,Premier SAS,,3.81,,,,,,,2.77,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier SAS,,2.33,,,,,,,1.69,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,outpatient,1,EA,63.57000,60.39000,The Alliance,Premier SAS,,43.74,,,,,,,31.79,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,The Alliance,Premier SAS,,15.01,,,,,,,10.91,21.17,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,outpatient,1,mL,375.55000,356.77000,The Alliance,Premier SAS,,23.57,,,,,,,13.96,364.28,fee schedule,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,outpatient,1,mL,335.74000,318.95000,The Alliance,Premier SAS,,23.57,,,,,,,13.96,325.67,fee schedule,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier SAS,,23.57,,,,,,,13.96,291.19,fee schedule,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Premier SAS,,4.88,,,,,,,3.55,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,outpatient,1,EA,3.26000,3.10000,The Alliance,Premier SAS,,2.24,,,,,,,1.63,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,The Alliance,Premier SAS,,1.56,,,,,,,1.14,2.20,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,outpatient,1,EA,25.93000,24.63000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,25.15,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,outpatient,1,EA,24.65000,23.42000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,23.91,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,outpatient,1,EA,13.89000,13.20000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,13.47,fee schedule,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,outpatient,1,EA,9.72000,9.24000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,9.43,fee schedule,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,outpatient,1,mL,18.82000,17.88000,The Alliance,Premier SAS,,12.95,,,,,,,9.41,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,outpatient,1,mL,22.36000,21.24000,The Alliance,Premier SAS,,15.38,,,,,,,11.18,21.69,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,outpatient,1,GM,31.85000,30.26000,The Alliance,Premier SAS,,21.91,,,,,,,15.93,30.89,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,outpatient,1,GM,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,outpatient,1,EA,11.53000,10.96000,The Alliance,Premier SAS,,7.93,,,,,,,5.76,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,The Alliance,Premier SAS,,1.14,,,,,,,0.83000,1.61,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,outpatient,1,mL,105.97000,100.67000,The Alliance,Premier SAS,,31.64,,,,,,,19.76,102.79,fee schedule,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,outpatient,1,mL,103.60000,98.42000,The Alliance,Premier SAS,,31.64,,,,,,,19.76,100.49,fee schedule,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,outpatient,1,mL,54.12000,51.41000,The Alliance,Premier SAS,,31.64,,,,,,,19.76,52.50,fee schedule,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,outpatient,1,mL,38.34000,36.43000,The Alliance,Premier SAS,,26.38,,,,,,,19.17,37.19,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,1.87,,,,,,,1.36,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,outpatient,1,mL,383.32000,364.15000,The Alliance,Premier SAS,,847.54,,,,,,,191.66,873.48,fee schedule,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,outpatient,1,EA,43.43000,41.26000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,42.13,fee schedule,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,12.26,fee schedule,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,3.12,,,,,,,0.87000,4.75,fee schedule,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,outpatient,1,mL,1.30000,1.24000,The Alliance,Premier SAS,,3.12,,,,,,,0.65000,4.75,fee schedule,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,outpatient,1,EA,26.86000,25.52000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,26.05,fee schedule,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,10.81,fee schedule,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,outpatient,1,EA,9.73000,9.24000,The Alliance,Premier SAS,,1.23,,,,,,,1.15,9.44,fee schedule,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,outpatient,1,mL,36.86000,35.01000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,35.75,fee schedule,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,outpatient,1,mL,14.90000,14.15000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,14.45,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,outpatient,1,mL,36.06000,34.25000,The Alliance,Premier SAS,,116.38,,,,,,,18.03,119.94,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,outpatient,1,mL,16.97000,16.12000,The Alliance,Premier SAS,,116.38,,,,,,,8.48,119.94,fee schedule,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,outpatient,1,mL,13.90000,13.21000,The Alliance,Premier SAS,,116.38,,,,,,,6.95,119.94,fee schedule,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,outpatient,1,mL,16.03000,15.23000,The Alliance,Premier SAS,,11.03,,,,,,,8.02,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,outpatient,1,mL,10.06000,9.56000,The Alliance,Premier SAS,,6.92,,,,,,,5.03,9.76,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,outpatient,1,EA,88.48000,84.06000,The Alliance,Premier SAS,,18.24,,,,,,,18.24,85.83,fee schedule,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Premier SAS,,18.24,,,,,,,16.00,31.05,fee schedule,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,outpatient,1,EA,405.06000,384.81000,The Alliance,Premier SAS,,278.68,,,,,,,202.53,392.91,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,outpatient,1,mL,29.93000,28.43000,The Alliance,Premier SAS,,20.59,,,,,,,14.96,29.03,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,outpatient,1,mL,43.19000,41.03000,The Alliance,Premier SAS,,3.31,,,,,,,3.14,41.89,fee schedule,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,outpatient,1,EA,7.04000,6.69000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,6.83,fee schedule,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,outpatient,1,mL,89.25000,84.79000,The Alliance,Premier SAS,,2896.91,,,,,,,44.62,3007.94,fee schedule,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,outpatient,1,EA,11.50000,10.93000,The Alliance,Premier SAS,,7.91,,,,,,,5.75,11.15,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,outpatient,1,mL,417.74000,396.85000,The Alliance,Premier SAS,,28.88,,,,,,,24.87,405.21,fee schedule,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,outpatient,1,mL,459.10000,436.15000,The Alliance,Premier SAS,,28.88,,,,,,,24.87,445.33,fee schedule,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,2.67,,,,,,,0.16000,2.76,fee schedule,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,outpatient,1,EA,23.67000,22.48000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,22.96,fee schedule,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,outpatient,1,EA,24.02000,22.82000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,23.30,fee schedule,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,outpatient,1,EA,5.32000,5.05000,The Alliance,Premier SAS,,3.17,,,,,,,1.77,5.16,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,outpatient,1,EA,3353.56000,3185.88000,The Alliance,Premier SAS,,484.97,,,,,,,302.92,3252.95,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,outpatient,1,EA,3885.76000,3691.47000,The Alliance,Premier SAS,,484.97,,,,,,,302.92,3769.19,fee schedule,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,outpatient,1,EA,1610.02000,1529.52000,The Alliance,Premier SAS,,484.97,,,,,,,302.92,1561.72,fee schedule,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,The Alliance,Premier SAS,,1.43,,,,,,,1.04,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,outpatient,1,mL,1.71000,1.63000,The Alliance,Premier SAS,,1.30,,,,,,,0.85500,1.66,fee schedule,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,1.30,,,,,,,0.63000,1.34,fee schedule,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,outpatient,1,mL,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,outpatient,1,EA,1973.81000,1875.12000,The Alliance,Premier SAS,,6.98,,,,,,,4.36,1914.60,fee schedule,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,outpatient,1,mL,1535.35000,1458.58000,The Alliance,Premier SAS,,1056.32,,,,,,,767.67,1489.29,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,outpatient,1,EA,12.03000,11.43000,The Alliance,Premier SAS,,8.28,,,,,,,6.01,11.67,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Premier SAS,,7.92,,,,,,,5.75,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,outpatient,1,EA,11.51000,10.94000,The Alliance,Premier SAS,,7.92,,,,,,,5.75,11.16,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,outpatient,1,mL,28.47000,27.05000,The Alliance,Premier SAS,,6.23,,,,,,,3.89,27.62,fee schedule,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier SAS,,4.29,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Premier SAS,,4.96,,,,,,,3.60,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,The Alliance,Premier SAS,,4.29,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,The Alliance,Premier SAS,,11.72,,,,,,,8.52,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,outpatient,1,EA,19.28000,18.31000,The Alliance,Premier SAS,,13.26,,,,,,,9.64,18.70,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,outpatient,1,EA,2.88000,2.74000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,The Alliance,Premier SAS,,4.13,,,,,,,3.00,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Premier SAS,,11.92,,,,,,,8.66,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,outpatient,1,EA,7.44000,7.07000,The Alliance,Premier SAS,,5.12,,,,,,,3.72,7.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier SAS,,1.96,,,,,,,1.43,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,outpatient,1,EA,5.69000,5.40000,The Alliance,Premier SAS,,3.01,,,,,,,1.88,5.52,fee schedule,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,outpatient,1,EA,4.33000,4.11000,The Alliance,Premier SAS,,3.01,,,,,,,1.88,4.20,fee schedule,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Premier SAS,,8.73,,,,,,,6.34,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,The Alliance,Premier SAS,,8.73,,,,,,,6.34,12.31,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,outpatient,1,EA,43.56000,41.39000,The Alliance,Premier SAS,,29.97,,,,,,,21.78,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,outpatient,1,EA,23.96000,22.76000,The Alliance,Premier SAS,,16.48,,,,,,,11.98,23.24,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,outpatient,1,EA,4.61000,4.38000,The Alliance,Premier SAS,,3.17,,,,,,,2.31,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Premier SAS,,6.34,,,,,,,4.61,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,outpatient,1,EA,9.22000,8.75000,The Alliance,Premier SAS,,6.34,,,,,,,4.61,8.94,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,outpatient,1,EA,40.08000,38.08000,The Alliance,Premier SAS,,27.58,,,,,,,20.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,outpatient,1,EA,20.55000,19.52000,The Alliance,Premier SAS,,14.14,,,,,,,10.28,19.93,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,outpatient,1,EA,1420.64000,1349.61000,The Alliance,Premier SAS,,51.38,,,,,,,32.09,1378.02,fee schedule,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,outpatient,1,EA,1187.54000,1128.16000,The Alliance,Premier SAS,,51.38,,,,,,,32.09,1151.91,fee schedule,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,outpatient,1,EA,1033.41000,981.74000,The Alliance,Premier SAS,,51.38,,,,,,,32.09,1002.41,fee schedule,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,outpatient,1,mL,501.16000,476.11000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,486.13,fee schedule,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,outpatient,1,EA,73.47000,69.80000,The Alliance,Premier SAS,,1.30,,,,,,,1.26,71.27,fee schedule,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,outpatient,1,EA,608.34000,577.92000,The Alliance,Premier SAS,,51.38,,,,,,,32.09,590.09,fee schedule,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,outpatient,1,EA,710.33000,674.82000,The Alliance,Premier SAS,,51.38,,,,,,,32.09,689.02,fee schedule,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,The Alliance,Premier SAS,,0.92880,,,,,,,0.67500,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,outpatient,1,GM,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,outpatient,1,GM,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,outpatient,1,GM,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,outpatient,1,mL,1.94000,1.84000,The Alliance,Premier SAS,,1.30,,,,,,,0.97000,1.88,fee schedule,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,4.74,fee schedule,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,1.22,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,outpatient,1,mL,11.35000,10.79000,The Alliance,Premier SAS,,9.88,,,,,,,5.67,11.01,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,outpatient,1,mL,11.53000,10.95000,The Alliance,Premier SAS,,9.88,,,,,,,5.76,11.18,fee schedule,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,outpatient,1,mL,15.13000,14.38000,The Alliance,Premier SAS,,9.88,,,,,,,7.57,14.68,fee schedule,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,outpatient,1,mL,34.06000,32.36000,The Alliance,Premier SAS,,23.43,,,,,,,17.03,33.04,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,outpatient,1,EA,583.45000,554.28000,The Alliance,Premier SAS,,401.41,,,,,,,291.73,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,outpatient,1,EA,375.39000,356.62000,The Alliance,Premier SAS,,258.27,,,,,,,187.69,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,outpatient,1,EA,331.20000,314.64000,The Alliance,Premier SAS,,227.87,,,,,,,165.60,321.26,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,outpatient,1,EA,17147.50000,16290.12000,The Alliance,Premier SAS,,408.40,,,,,,,255.09,16633.08,fee schedule,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,outpatient,1,mL,7.37000,7.00000,The Alliance,Premier SAS,,5.07,,,,,,,3.69,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,outpatient,1,mL,6.27000,5.95000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,outpatient,1,mL,7.48000,7.10000,The Alliance,Premier SAS,,5.15,,,,,,,3.74,7.26,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,outpatient,1,EA,692.13000,657.52000,The Alliance,Premier SAS,,476.19,,,,,,,346.06,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,outpatient,1,EA,445.31000,423.05000,The Alliance,Premier SAS,,306.37,,,,,,,222.66,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,outpatient,1,EA,785.75000,746.47000,The Alliance,Premier SAS,,540.60,,,,,,,392.88,762.18,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,2.18,,,,,,,0.00500,2.24,fee schedule,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,2.18,,,,,,,0.01500,2.24,fee schedule,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Premier SAS,,2.30,,,,,,,1.68,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.27217,,,,,,,0.00500,0.34860,fee schedule,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,outpatient,1,GM,5.19000,4.93000,The Alliance,Premier SAS,,3.57,,,,,,,2.60,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,outpatient,1,GM,0.24000,0.22000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,outpatient,1,GM,1.22000,1.15000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,outpatient,1,GM,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,outpatient,1,GM,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,outpatient,1,GM,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,outpatient,1,GM,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,outpatient,1,GM,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,outpatient,1,GM,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,outpatient,1,mL,4537.21000,4310.35000,The Alliance,Premier SAS,,3121.60,,,,,,,155.39,4401.09,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,outpatient,1,EA,8.94000,8.49000,The Alliance,Premier SAS,,6.15,,,,,,,4.47,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,outpatient,1,EA,23.81000,22.62000,The Alliance,Premier SAS,,16.38,,,,,,,11.90,23.10,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,outpatient,1,mL,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,outpatient,1,mL,0.04000,0.03000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier SAS,,6.40,,,,,,,0.72500,8.10,fee schedule,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,2.18,,,,,,,0.01500,2.24,fee schedule,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,2.18,,,,,,,0.01500,2.24,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,outpatient,1,mL,518.00000,492.10000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,502.46,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,303.45,fee schedule,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,76.63,fee schedule,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,outpatient,1,EA,11.94000,11.35000,The Alliance,Premier SAS,,8.21,,,,,,,5.97,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier SAS,,8.15,,,,,,,5.92,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Premier SAS,,11.81,,,,,,,8.59,16.65,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,outpatient,1,EA,12.67000,12.04000,The Alliance,Premier SAS,,8.72,,,,,,,6.33,12.29,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,outpatient,1,EA,11.14000,10.59000,The Alliance,Premier SAS,,7.66,,,,,,,5.57,10.81,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,outpatient,1,EA,34.50000,32.78000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,33.47,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,outpatient,1,EA,5.33000,5.07000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,5.17,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,outpatient,1,EA,14.93000,14.18000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,14.48,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,outpatient,1,EA,4.37000,4.15000,The Alliance,Premier SAS,,2.69,,,,,,,2.19,4.24,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,15.79,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,outpatient,1,EA,6.24000,5.92000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,6.05,fee schedule,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,outpatient,1,EA,5.33000,5.06000,The Alliance,Premier SAS,,2.69,,,,,,,2.29,5.17,fee schedule,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,outpatient,1,mL,22.88000,21.74000,The Alliance,Premier SAS,,15.74,,,,,,,11.44,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,outpatient,1,mL,23.28000,22.11000,The Alliance,Premier SAS,,16.02,,,,,,,11.64,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,outpatient,1,mL,23.77000,22.58000,The Alliance,Premier SAS,,16.35,,,,,,,11.88,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,outpatient,1,mL,6.66000,6.33000,The Alliance,Premier SAS,,4.58,,,,,,,3.33,6.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,outpatient,1,mL,1490.77000,1416.23000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,1446.05,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,outpatient,1,mL,312.84000,297.20000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,303.45,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,outpatient,1,mL,67.15000,63.79000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,65.14,fee schedule,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,153.26,fee schedule,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,The Alliance,Premier SAS,,4.88,,,,,,,3.55,6.89,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,outpatient,1,EA,4.93000,4.69000,The Alliance,Premier SAS,,3.39,,,,,,,2.46,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,The Alliance,Premier SAS,,1.76,,,,,,,1.28,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier SAS,,1.76,,,,,,,1.28,2.48,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,outpatient,1,mL,29.02000,27.57000,The Alliance,Premier SAS,,19.97,,,,,,,14.51,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,outpatient,1,mL,34.10000,32.39000,The Alliance,Premier SAS,,23.46,,,,,,,17.05,33.08,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,1.06,,,,,,,0.10500,1.18,fee schedule,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier SAS,,1.06,,,,,,,0.12000,1.18,fee schedule,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,outpatient,1,EA,103.29000,98.13000,The Alliance,Premier SAS,,71.06,,,,,,,51.65,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Premier SAS,,5.80,,,,,,,4.21,8.18,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,outpatient,1,EA,256.92000,244.08000,The Alliance,Premier SAS,,176.76,,,,,,,128.46,249.21,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,outpatient,1,mL,563.15000,534.99000,The Alliance,Premier SAS,,387.45,,,,,,,281.57,546.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,outpatient,1,EA,16.22000,15.41000,The Alliance,Premier SAS,,11.16,,,,,,,8.11,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,outpatient,1,EA,2.33000,2.22000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,outpatient,1,mL,692.18000,657.57000,The Alliance,Premier SAS,,12.30,,,,,,,7.68,671.41,fee schedule,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,outpatient,1,EA,36.05000,34.24000,The Alliance,Premier SAS,,24.80,,,,,,,18.02,34.97,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,outpatient,1,EA,175.38000,166.61000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,170.12,fee schedule,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,outpatient,1,EA,681.25000,647.19000,The Alliance,Premier SAS,,4.35,,,,,,,4.35,660.81,fee schedule,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58280,10.66,fee schedule,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,The Alliance,Premier SAS,,2.12,,,,,,,1.54,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,outpatient,1,EA,4.10000,3.89000,The Alliance,Premier SAS,,2.82,,,,,,,2.05,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,outpatient,1,GM,45.93000,43.64000,The Alliance,Premier SAS,,31.60,,,,,,,22.96,44.55,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,outpatient,1,mL,108.82000,103.38000,The Alliance,Premier SAS,,88.31,,,,,,,54.41,105.56,fee schedule,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,outpatient,1,mL,164.17000,155.96000,The Alliance,Premier SAS,,88.31,,,,,,,82.08,159.24,fee schedule,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,outpatient,1,mL,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,outpatient,1,mL,1.14000,1.09000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,outpatient,1,mL,2.42000,2.30000,The Alliance,Premier SAS,,1.66,,,,,,,1.21,2.35,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,outpatient,,,173.44000,164.77000,The Alliance,Premier SAS,,119.33,,,,,,,86.72,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,outpatient,1,mL,346.88000,329.54000,The Alliance,Premier SAS,,238.65,,,,,,,137.83,336.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Premier SAS,,41.47,,,,,,,30.14,58.47,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,outpatient,1,EA,2.68000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,outpatient,1,EA,15.76000,14.98000,The Alliance,Premier SAS,,10.84,,,,,,,7.88,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Premier SAS,,16.00,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,The Alliance,Premier SAS,,16.00,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Premier SAS,,8.79,,,,,,,6.38,12.39,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Premier SAS,,4.49,,,,,,,3.26,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,outpatient,1,mL,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,outpatient,1,GM,25.64000,24.36000,The Alliance,Premier SAS,,17.64,,,,,,,12.82,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,outpatient,1,GM,26.37000,25.05000,The Alliance,Premier SAS,,18.14,,,,,,,13.19,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,outpatient,1,GM,21.11000,20.05000,The Alliance,Premier SAS,,14.52,,,,,,,10.55,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,outpatient,1,GM,18.82000,17.88000,The Alliance,Premier SAS,,12.95,,,,,,,9.41,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,outpatient,1,GM,21.14000,20.08000,The Alliance,Premier SAS,,14.54,,,,,,,10.57,20.51,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,outpatient,1,EA,1675.10000,1591.35000,The Alliance,Premier SAS,,1152.47,,,,,,,837.55,1624.85,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,outpatient,1,EA,729.64000,693.16000,The Alliance,Premier SAS,,501.99,,,,,,,364.82,707.75,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,outpatient,1,mL,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,outpatient,1,EA,24.37000,23.15000,The Alliance,Premier SAS,,16.77,,,,,,,12.19,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,The Alliance,Premier SAS,,6.87,,,,,,,5.00,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,outpatient,1,EA,6.40000,6.08000,The Alliance,Premier SAS,,4.40,,,,,,,3.20,6.21,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,outpatient,1,mL,9.05000,8.60000,The Alliance,Premier SAS,,6.23,,,,,,,4.53,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,outpatient,1,mL,3.18000,3.03000,The Alliance,Premier SAS,,2.19,,,,,,,1.59,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,outpatient,1,mL,16.78000,15.94000,The Alliance,Premier SAS,,11.54,,,,,,,8.39,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Premier SAS,,3.65,,,,,,,2.65,5.15,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,outpatient,1,EA,58.67000,55.73000,The Alliance,Premier SAS,,40.36,,,,,,,29.34,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Premier SAS,,36.04,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,outpatient,1,EA,60.28000,57.26000,The Alliance,Premier SAS,,41.47,,,,,,,30.14,58.47,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,outpatient,1,mL,0.87000,0.82000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43500,0.84390,fee schedule,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,outpatient,1,mL,10.99000,10.44000,The Alliance,Premier SAS,,0.44828,,,,,,,0.43710,10.66,fee schedule,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,outpatient,1,EA,9527.85000,9051.46000,The Alliance,Premier SAS,,6555.16,,,,,,,4763.93,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,outpatient,1,EA,7866.00000,7472.70000,The Alliance,Premier SAS,,5411.81,,,,,,,3933.00,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,outpatient,1,EA,7863.93000,7470.73000,The Alliance,Premier SAS,,5410.38,,,,,,,3931.97,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,outpatient,1,EA,2067.86000,1964.46000,The Alliance,Premier SAS,,1422.69,,,,,,,1033.93,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,outpatient,1,EA,4370.00000,4151.50000,The Alliance,Premier SAS,,3006.56,,,,,,,2185.00,4238.90,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,outpatient,1,EA,53.76000,51.07000,The Alliance,Premier SAS,,36.99,,,,,,,26.88,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,The Alliance,Premier SAS,,36.04,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,outpatient,1,EA,99.17000,94.21000,The Alliance,Premier SAS,,68.23,,,,,,,49.59,96.19,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier SAS,,5.22,,,,,,,3.79,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Premier SAS,,5.87,,,,,,,4.26,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,outpatient,1,mL,15.01000,14.26000,The Alliance,Premier SAS,,10.33,,,,,,,7.50,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Premier SAS,,6.13,,,,,,,4.46,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,outpatient,1,mL,1.87000,1.77000,The Alliance,Premier SAS,,1.29,,,,,,,0.93500,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,outpatient,1,EA,238.04000,226.14000,The Alliance,Premier SAS,,121.29,,,,,,,118.51,230.90,fee schedule,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,outpatient,1,mL,15.31000,14.54000,The Alliance,Premier SAS,,8.58,,,,,,,7.66,14.85,fee schedule,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,outpatient,1,mL,14.71000,13.97000,The Alliance,Premier SAS,,8.58,,,,,,,7.36,14.27,fee schedule,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,The Alliance,Premier SAS,,1.00,,,,,,,0.73000,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Premier SAS,,8.18,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,The Alliance,Premier SAS,,8.18,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,outpatient,1,mL,7.83000,7.44000,The Alliance,Premier SAS,,5.39,,,,,,,3.92,7.60,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,outpatient,1,mL,553.63000,525.95000,The Alliance,Premier SAS,,831.75,,,,,,,276.81,857.21,fee schedule,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,outpatient,1,GM,8.09000,7.69000,The Alliance,Premier SAS,,5.57,,,,,,,4.04,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,outpatient,1,GM,11.75000,11.16000,The Alliance,Premier SAS,,8.08,,,,,,,5.88,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,outpatient,1,GM,25.64000,24.35000,The Alliance,Premier SAS,,17.64,,,,,,,12.82,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,outpatient,1,GM,5.45000,5.18000,The Alliance,Premier SAS,,3.75,,,,,,,2.73,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,outpatient,1,GM,7.44000,7.06000,The Alliance,Premier SAS,,5.12,,,,,,,3.72,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,outpatient,1,GM,12.44000,11.81000,The Alliance,Premier SAS,,8.56,,,,,,,6.22,12.07,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,outpatient,1,EA,5520.00000,5244.00000,The Alliance,Premier SAS,,4.24,,,,,,,2.65,5354.40,fee schedule,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,outpatient,1,mL,104.79000,99.55000,The Alliance,Premier SAS,,12.30,,,,,,,7.68,101.65,fee schedule,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,outpatient,1,mL,168.93000,160.49000,The Alliance,Premier SAS,,12.30,,,,,,,7.68,163.86,fee schedule,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,outpatient,1,EA,116.01000,110.21000,The Alliance,Premier SAS,,79.81,,,,,,,58.01,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,outpatient,1,EA,34.32000,32.60000,The Alliance,Premier SAS,,23.61,,,,,,,17.16,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,outpatient,1,EA,12.10000,11.49000,The Alliance,Premier SAS,,8.32,,,,,,,6.05,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,outpatient,1,mL,801.35000,761.28000,The Alliance,Premier SAS,,551.33,,,,,,,400.68,777.31,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,outpatient,1,EA,34.56000,32.84000,The Alliance,Premier SAS,,23.78,,,,,,,17.28,33.52,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,1.54,,,,,,,0.08000,1.58,fee schedule,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,outpatient,1,mL,7.69000,7.31000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,7.46,fee schedule,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,outpatient,1,EA,77.24000,73.38000,The Alliance,Premier SAS,,53.14,,,,,,,38.62,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,outpatient,1,EA,63.07000,59.91000,The Alliance,Premier SAS,,43.39,,,,,,,31.54,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,11.85,22.99,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,The Alliance,Premier SAS,,2.36,,,,,,,1.72,3.33,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,outpatient,1,EA,37.51000,35.63000,The Alliance,Premier SAS,,25.81,,,,,,,18.75,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,outpatient,1,EA,11.92000,11.33000,The Alliance,Premier SAS,,8.20,,,,,,,5.96,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,outpatient,1,EA,2.98000,2.83000,The Alliance,Premier SAS,,2.05,,,,,,,1.49,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Premier SAS,,9.08,,,,,,,6.60,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,The Alliance,Premier SAS,,3.21,,,,,,,2.33,4.52,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,outpatient,1,mL,118.23000,112.32000,The Alliance,Premier SAS,,12.34,,,,,,,11.32,114.68,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,1.54,,,,,,,0.50000,1.58,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,1.54,,,,,,,0.87000,1.69,fee schedule,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,outpatient,1,mL,0.53000,0.50000,The Alliance,Premier SAS,,1.54,,,,,,,0.26500,1.58,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,outpatient,1,mL,78.39000,74.47000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,76.04,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,outpatient,1,mL,67.57000,64.19000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,65.54,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,outpatient,1,mL,28.06000,26.66000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,27.22,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,outpatient,1,mL,34.60000,32.87000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,33.56,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,outpatient,1,mL,74.18000,70.47000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,71.95,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,outpatient,1,mL,37.46000,35.58000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,36.34,fee schedule,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,outpatient,1,mL,47.40000,45.03000,The Alliance,Premier SAS,,0.91257,,,,,,,0.79980,45.98,fee schedule,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,outpatient,1,mL,19.45000,18.48000,The Alliance,Premier SAS,,13.38,,,,,,,9.72,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,outpatient,1,mL,6.78000,6.44000,The Alliance,Premier SAS,,4.66,,,,,,,3.39,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,outpatient,1,EA,42.99000,40.84000,The Alliance,Premier SAS,,29.58,,,,,,,21.50,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,outpatient,1,EA,13.66000,12.98000,The Alliance,Premier SAS,,9.40,,,,,,,6.83,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.32,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,outpatient,1,EA,286.94000,272.59000,The Alliance,Premier SAS,,197.41,,,,,,,143.47,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,The Alliance,Premier SAS,,5.46,,,,,,,3.97,7.70,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,outpatient,1,EA,38.47000,36.54000,The Alliance,Premier SAS,,26.47,,,,,,,19.23,37.32,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,outpatient,1,EA,198.21000,188.30000,The Alliance,Premier SAS,,136.37,,,,,,,99.11,192.26,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,outpatient,1,EA,8.69000,8.25000,The Alliance,Premier SAS,,5.98,,,,,,,4.34,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,The Alliance,Premier SAS,,3.01,,,,,,,2.19,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Premier SAS,,4.32,,,,,,,3.14,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,The Alliance,Premier SAS,,4.57,,,,,,,3.32,6.44,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.12,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,outpatient,1,EA,4.00000,3.80000,The Alliance,Premier SAS,,2.75,,,,,,,2.00,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,outpatient,1,EA,3.75000,3.56000,The Alliance,Premier SAS,,2.58,,,,,,,1.88,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,outpatient,1,EA,4.89000,4.64000,The Alliance,Premier SAS,,3.36,,,,,,,2.44,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,outpatient,1,mL,6.75000,6.41000,The Alliance,Premier SAS,,4.64,,,,,,,3.38,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,outpatient,1,EA,165.58000,157.30000,The Alliance,Premier SAS,,113.92,,,,,,,82.79,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,outpatient,1,EA,179.07000,170.11000,The Alliance,Premier SAS,,123.20,,,,,,,89.53,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,43.48,,,,,,,31.60,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,outpatient,1,EA,329.03000,312.58000,The Alliance,Premier SAS,,226.37,,,,,,,164.51,319.16,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,outpatient,1,mL,2.14000,2.04000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,outpatient,1,mL,2.35000,2.23000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,outpatient,1,mL,1.84000,1.74000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,outpatient,1,EA,10.41000,9.89000,The Alliance,Premier SAS,,7.16,,,,,,,5.21,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,The Alliance,Premier SAS,,6.20,,,,,,,4.50,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,outpatient,1,mL,49.30000,46.83000,The Alliance,Premier SAS,,12.06,,,,,,,12.06,47.82,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,outpatient,1,mL,75.84000,72.05000,The Alliance,Premier SAS,,12.06,,,,,,,12.06,73.56,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,outpatient,1,mL,97.94000,93.04000,The Alliance,Premier SAS,,12.06,,,,,,,12.06,95.00,fee schedule,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,outpatient,1,mL,76.47000,72.65000,The Alliance,Premier SAS,,12.06,,,,,,,12.06,74.18,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier SAS,,3.62,,,,,,,0.16500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,3.62,,,,,,,0.05500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,3.62,,,,,,,0.11000,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,3.62,,,,,,,0.03500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier SAS,,3.62,,,,,,,0.05500,5.94,fee schedule,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier SAS,,3.62,,,,,,,0.04500,5.94,fee schedule,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,outpatient,1,mL,154.05000,146.35000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,149.43,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,outpatient,1,mL,308.10000,292.70000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,298.86,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,outpatient,1,mL,468.96000,445.51000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,454.89,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,outpatient,1,mL,160.32000,152.30000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,155.51,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,outpatient,1,mL,305.46000,290.19000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,296.30,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,outpatient,1,mL,308.09000,292.68000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,298.85,fee schedule,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,outpatient,1,mL,564.92000,536.68000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,547.97,fee schedule,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,outpatient,1,EA,284.90000,270.65000,The Alliance,Premier SAS,,114.71,,,,,,,71.65,276.35,fee schedule,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,outpatient,1,mL,60.69000,57.66000,The Alliance,Premier SAS,,11.90,,,,,,,7.43,58.87,fee schedule,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,outpatient,1,EA,9.92000,9.42000,The Alliance,Premier SAS,,6.82,,,,,,,4.96,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,outpatient,1,EA,14.06000,13.36000,The Alliance,Premier SAS,,9.67,,,,,,,7.03,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,outpatient,1,EA,6.76000,6.42000,The Alliance,Premier SAS,,4.65,,,,,,,3.38,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier SAS,,5.64,,,,,,,4.10,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier SAS,,3.15,,,,,,,2.29,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,outpatient,1,EA,6.44000,6.12000,The Alliance,Premier SAS,,4.43,,,,,,,3.22,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,outpatient,1,EA,8.51000,8.09000,The Alliance,Premier SAS,,5.85,,,,,,,4.25,8.25,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Premier SAS,,6.94,,,,,,,5.04,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.65,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.08,,,,,,,1.58,3.07,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,outpatient,1,mL,5.92000,5.63000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,5.74,fee schedule,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,7.62,fee schedule,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,outpatient,1,GM,83.93000,79.73000,The Alliance,Premier SAS,,57.74,,,,,,,41.97,81.41,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,outpatient,1,EA,645.01000,612.76000,The Alliance,Premier SAS,,443.77,,,,,,,322.50,625.66,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,outpatient,1,mL,30.84000,29.30000,The Alliance,Premier SAS,,3.15,,,,,,,2.63,29.91,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,outpatient,1,mL,30.84000,29.29000,The Alliance,Premier SAS,,3.15,,,,,,,2.63,29.91,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,outpatient,1,mL,25.38000,24.11000,The Alliance,Premier SAS,,3.15,,,,,,,2.63,24.62,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,outpatient,1,mL,10.00000,9.50000,The Alliance,Premier SAS,,3.15,,,,,,,2.63,9.70,fee schedule,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,outpatient,1,mL,25.37000,24.11000,The Alliance,Premier SAS,,3.15,,,,,,,2.63,24.61,fee schedule,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,outpatient,1,mL,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,outpatient,1,mL,0.95000,0.91000,The Alliance,Premier SAS,,24.94,,,,,,,0.47500,63.16,fee schedule,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,outpatient,1,mL,5.98000,5.68000,The Alliance,Premier SAS,,24.94,,,,,,,2.99,63.16,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier SAS,,4.78,,,,,,,3.48,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,outpatient,1,mL,27.81000,26.42000,The Alliance,Premier SAS,,19.13,,,,,,,13.90,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,outpatient,1,mL,6.52000,6.19000,The Alliance,Premier SAS,,4.49,,,,,,,3.26,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,outpatient,1,mL,5.80000,5.51000,The Alliance,Premier SAS,,3.99,,,,,,,2.90,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,outpatient,1,mL,7.12000,6.76000,The Alliance,Premier SAS,,4.90,,,,,,,3.56,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,outpatient,1,mL,6.93000,6.58000,The Alliance,Premier SAS,,4.77,,,,,,,3.46,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,outpatient,1,mL,19.74000,18.75000,The Alliance,Premier SAS,,13.58,,,,,,,9.87,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,outpatient,1,mL,4.85000,4.61000,The Alliance,Premier SAS,,3.34,,,,,,,2.42,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,outpatient,1,mL,10.11000,9.61000,The Alliance,Premier SAS,,6.96,,,,,,,5.05,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,outpatient,1,EA,1.87000,1.78000,The Alliance,Premier SAS,,1.29,,,,,,,0.93500,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,outpatient,1,EA,7.24000,6.88000,The Alliance,Premier SAS,,4.98,,,,,,,3.62,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,outpatient,1,GM,101.02000,95.97000,The Alliance,Premier SAS,,69.50,,,,,,,50.51,97.99,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,outpatient,1,mL,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,outpatient,1,mL,2.67000,2.53000,The Alliance,Premier SAS,,1.84,,,,,,,1.33,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,outpatient,1,mL,0.63000,0.59000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,outpatient,1,mL,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,outpatient,1,mL,48.94000,46.49000,The Alliance,Premier SAS,,33.67,,,,,,,24.47,47.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,outpatient,1,EA,288.41000,273.99000,The Alliance,Premier SAS,,198.43,,,,,,,144.21,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,outpatient,1,EA,191.20000,181.64000,The Alliance,Premier SAS,,131.55,,,,,,,95.60,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,outpatient,1,EA,220.57000,209.54000,The Alliance,Premier SAS,,151.75,,,,,,,110.28,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier SAS,,130.44,,,,,,,94.80,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,outpatient,1,EA,253.81000,241.12000,The Alliance,Premier SAS,,174.62,,,,,,,126.91,246.20,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,outpatient,1,mL,114.91000,109.16000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,111.46,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,outpatient,1,mL,214.56000,203.84000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,208.12,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,outpatient,1,mL,229.50000,218.02000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,222.62,fee schedule,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,outpatient,1,mL,231.07000,219.51000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,224.14,fee schedule,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,outpatient,1,mL,10.08000,9.58000,The Alliance,Premier SAS,,6.94,,,,,,,5.04,9.78,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,outpatient,1,GM,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Premier SAS,,5.72,,,,,,,4.16,8.07,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,outpatient,1,mL,2.18000,2.07000,The Alliance,Premier SAS,,33.94,,,,,,,1.09,34.98,fee schedule,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,outpatient,,,22.72000,21.58000,The Alliance,Premier SAS,,15.63,,,,,,,11.36,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,outpatient,1,mL,45.44000,43.17000,The Alliance,Premier SAS,,31.26,,,,,,,22.72,44.08,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Premier SAS,,12.18,,,,,,,2.42,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,outpatient,1,EA,3.10000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,outpatient,1,EA,10.81000,10.27000,The Alliance,Premier SAS,,7.44,,,,,,,2.42,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,outpatient,1,mL,22.59000,21.46000,The Alliance,Premier SAS,,15.54,,,,,,,11.29,21.91,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier SAS,,63.43,,,,,,,1.66,65.37,fee schedule,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,The Alliance,Premier SAS,,1.93,,,,,,,1.40,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Premier SAS,,5.35,,,,,,,3.88,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,outpatient,1,mL,3.61000,3.43000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,outpatient,1,mL,5.31000,5.05000,The Alliance,Premier SAS,,3.65,,,,,,,2.65,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,The Alliance,Premier SAS,,1.75,,,,,,,1.27,2.46,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier SAS,,33.94,,,,,,,3.00,34.98,fee schedule,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,outpatient,,,52.92000,50.27000,The Alliance,Premier SAS,,36.41,,,,,,,26.46,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,outpatient,1,mL,105.83000,100.54000,The Alliance,Premier SAS,,72.81,,,,,,,45.95,102.66,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,The Alliance,Premier SAS,,1.97,,,,,,,1.43,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,The Alliance,Premier SAS,,3.35,,,,,,,2.44,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,outpatient,1,EA,5.48000,5.20000,The Alliance,Premier SAS,,3.77,,,,,,,2.74,5.32,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,outpatient,,,11.90000,11.30000,The Alliance,Premier SAS,,8.19,,,,,,,5.95,46.30,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Premier SAS,,16.37,,,,,,,11.89,46.30,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,outpatient,1,mL,351.72000,334.14000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,341.17,fee schedule,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,outpatient,1,mL,666.20000,632.89000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,646.21,fee schedule,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,outpatient,1,mL,354.77000,337.03000,The Alliance,Premier SAS,,1.15,,,,,,,1.15,344.13,fee schedule,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,outpatient,1,GM,68.84000,65.40000,The Alliance,Premier SAS,,47.36,,,,,,,34.42,66.77,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,outpatient,1,GM,17.05000,16.19000,The Alliance,Premier SAS,,11.73,,,,,,,8.53,16.54,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,outpatient,1,mL,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,outpatient,1,EA,2212.30000,2101.69000,The Alliance,Premier SAS,,1522.06,,,,,,,5.18,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,outpatient,1,EA,1874.56000,1780.84000,The Alliance,Premier SAS,,1289.70,,,,,,,5.18,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,outpatient,1,EA,2390.57000,2271.04000,The Alliance,Premier SAS,,1644.71,,,,,,,5.18,2318.85,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,outpatient,1,mL,882.96000,838.81000,The Alliance,Premier SAS,,607.48,,,,,,,441.48,856.47,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,outpatient,1,mL,84.66000,80.42000,The Alliance,Premier SAS,,27.10,,,,,,,27.10,82.12,fee schedule,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,outpatient,1,mL,3.34000,3.17000,The Alliance,Premier SAS,,2.30,,,,,,,1.67,3.24,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,1.87,,,,,,,1.36,2.64,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,outpatient,1,mL,3.89000,3.69000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.77,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,outpatient,1,GM,15.35000,14.58000,The Alliance,Premier SAS,,10.56,,,,,,,7.67,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,outpatient,1,GM,9.54000,9.06000,The Alliance,Premier SAS,,6.56,,,,,,,4.77,9.25,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,The Alliance,Premier SAS,,5.77,,,,,,,4.19,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,outpatient,1,mL,24.27000,23.06000,The Alliance,Premier SAS,,16.70,,,,,,,12.13,23.54,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,outpatient,1,mL,290.44000,275.91000,The Alliance,Premier SAS,,199.82,,,,,,,145.22,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,outpatient,1,mL,590.83000,561.29000,The Alliance,Premier SAS,,406.49,,,,,,,295.42,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,outpatient,1,mL,657.21000,624.35000,The Alliance,Premier SAS,,452.16,,,,,,,328.61,637.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,outpatient,1,mL,52.05000,49.44000,The Alliance,Premier SAS,,59.32,,,,,,,26.02,72.23,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,outpatient,1,EA,216.14000,205.34000,The Alliance,Premier SAS,,63.43,,,,,,,49.73,209.66,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,outpatient,1,EA,18.96000,18.01000,The Alliance,Premier SAS,,63.43,,,,,,,9.48,65.37,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,outpatient,1,EA,154.73000,146.99000,The Alliance,Premier SAS,,63.43,,,,,,,49.73,150.09,fee schedule,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,outpatient,1,EA,139.04000,132.09000,The Alliance,Premier SAS,,63.43,,,,,,,49.73,134.87,fee schedule,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,outpatient,1,mL,3.67000,3.48000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,outpatient,1,EA,295.90000,281.10000,The Alliance,Premier SAS,,203.58,,,,,,,147.95,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,outpatient,1,EA,17.25000,16.39000,The Alliance,Premier SAS,,11.87,,,,,,,8.62,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,outpatient,1,EA,10.77000,10.23000,The Alliance,Premier SAS,,7.41,,,,,,,5.38,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,outpatient,1,EA,138.44000,131.51000,The Alliance,Premier SAS,,95.25,,,,,,,69.22,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,outpatient,1,EA,5.18000,4.92000,The Alliance,Premier SAS,,3.56,,,,,,,2.59,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,outpatient,1,EA,3.86000,3.66000,The Alliance,Premier SAS,,2.66,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,outpatient,1,GM,18.18000,17.27000,The Alliance,Premier SAS,,12.51,,,,,,,9.09,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,outpatient,1,GM,12.78000,12.14000,The Alliance,Premier SAS,,8.79,,,,,,,6.39,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,outpatient,1,GM,24.03000,22.83000,The Alliance,Premier SAS,,16.53,,,,,,,12.02,23.31,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,outpatient,1,EA,873.90000,830.21000,The Alliance,Premier SAS,,601.24,,,,,,,436.95,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,outpatient,1,EA,13.82000,13.12000,The Alliance,Premier SAS,,9.51,,,,,,,6.91,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,outpatient,1,EA,38.82000,36.88000,The Alliance,Premier SAS,,26.71,,,,,,,19.41,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,outpatient,1,EA,248.13000,235.72000,The Alliance,Premier SAS,,170.71,,,,,,,124.06,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,outpatient,1,EA,411.72000,391.14000,The Alliance,Premier SAS,,283.26,,,,,,,205.86,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,outpatient,1,EA,60.61000,57.58000,The Alliance,Premier SAS,,41.70,,,,,,,30.30,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,outpatient,1,EA,12.77000,12.13000,The Alliance,Premier SAS,,8.79,,,,,,,6.38,12.39,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,outpatient,1,mL,669.10000,635.64000,The Alliance,Premier SAS,,49.26,,,,,,,30.77,649.03,fee schedule,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,The Alliance,Premier SAS,,1.87,,,,,,,1.36,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,outpatient,1,GM,18.68000,17.75000,The Alliance,Premier SAS,,12.85,,,,,,,9.34,18.12,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier SAS,,22.61,,,,,,,14.12,105.14,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,outpatient,100,EA,0.09000,0.08000,The Alliance,Premier SAS,,4.19,,,,,,,0.04500,4.32,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,outpatient,100,EA,0.11000,0.10000,The Alliance,Premier SAS,,4.19,,,,,,,0.05500,4.32,fee schedule,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,outpatient,100,EA,0.14000,0.14000,The Alliance,Premier SAS,,4.19,,,,,,,0.07000,4.32,fee schedule,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,outpatient,,,52.65000,50.02000,The Alliance,Premier SAS,,36.22,,,,,,,26.32,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,outpatient,1,mL,105.30000,100.03000,The Alliance,Premier SAS,,72.45,,,,,,,52.65,102.14,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,outpatient,1,EA,1369.95000,1301.46000,The Alliance,Premier SAS,,942.53,,,,,,,684.98,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,outpatient,1,EA,1025.64000,974.36000,The Alliance,Premier SAS,,705.64,,,,,,,512.82,994.87,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,outpatient,1,EA,119.29000,113.33000,The Alliance,Premier SAS,,33.94,,,,,,,31.90,115.71,fee schedule,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,outpatient,1,EA,7.59000,7.21000,The Alliance,Premier SAS,,5.22,,,,,,,3.79,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,The Alliance,Premier SAS,,0.70864,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,outpatient,1,GM,19.63000,18.65000,The Alliance,Premier SAS,,13.51,,,,,,,9.81,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,outpatient,1,GM,13.80000,13.11000,The Alliance,Premier SAS,,9.49,,,,,,,6.90,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,outpatient,1,GM,7.48000,7.10000,The Alliance,Premier SAS,,5.15,,,,,,,3.74,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,outpatient,1,GM,9.66000,9.18000,The Alliance,Premier SAS,,6.65,,,,,,,4.83,9.37,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,outpatient,1,mL,34.08000,32.38000,The Alliance,Premier SAS,,23.45,,,,,,,1.49,33.06,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,outpatient,1,mL,11.95000,11.35000,The Alliance,Premier SAS,,8.22,,,,,,,5.97,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,outpatient,1,mL,10.34000,9.82000,The Alliance,Premier SAS,,7.11,,,,,,,5.17,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,outpatient,1,mL,10.35000,9.83000,The Alliance,Premier SAS,,7.12,,,,,,,5.17,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,outpatient,1,mL,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,outpatient,1,mL,805.95000,765.65000,The Alliance,Premier SAS,,49.26,,,,,,,30.77,781.77,fee schedule,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.21,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,10.70,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,outpatient,1,mL,7.57000,7.19000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,7.34,fee schedule,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,outpatient,1,mL,12.39000,11.77000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,12.02,fee schedule,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,outpatient,1,EA,10088.89000,9584.45000,The Alliance,Premier SAS,,72942.18,,,,,,,5044.44,75174.64,fee schedule,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier SAS,,1.34,,,,,,,0.97500,1.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier SAS,,22.61,,,,,,,14.12,105.14,fee schedule,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,outpatient,1,mL,6.23000,5.91000,The Alliance,Premier SAS,,4.29,,,,,,,3.12,6.04,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,The Alliance,Premier SAS,,2.78,,,,,,,2.02,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier SAS,,2.64,,,,,,,1.92,3.72,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,outpatient,1,mL,11.89000,11.30000,The Alliance,Premier SAS,,8.18,,,,,,,5.95,11.53,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,outpatient,1,mL,170.43000,161.91000,The Alliance,Premier SAS,,117.26,,,,,,,85.22,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,outpatient,1,mL,38.40000,36.48000,The Alliance,Premier SAS,,26.42,,,,,,,19.20,37.25,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,outpatient,1,EA,31.01000,29.46000,The Alliance,Premier SAS,,21.33,,,,,,,15.51,30.08,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,outpatient,1,mL,117.24000,111.37000,The Alliance,Premier SAS,,80.66,,,,,,,58.62,113.72,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,The Alliance,Premier SAS,,1.28,,,,,,,0.93000,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier SAS,,0.46429,,,,,,,0.44330,1.24,fee schedule,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,outpatient,1,mL,3.98000,3.78000,The Alliance,Premier SAS,,2.74,,,,,,,1.99,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,outpatient,1,mL,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,outpatient,1,mL,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,outpatient,1,GM,10.14000,9.63000,The Alliance,Premier SAS,,6.98,,,,,,,5.07,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,outpatient,1,GM,3.46000,3.28000,The Alliance,Premier SAS,,2.38,,,,,,,1.73,3.36,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,outpatient,1,mL,131.99000,125.39000,The Alliance,Premier SAS,,90.81,,,,,,,66.00,128.03,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Premier SAS,,6.61,,,,,,,4.80,9.32,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,outpatient,1,mL,7009.02000,6658.57000,The Alliance,Premier SAS,,4822.21,,,,,,,3504.51,6798.75,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,outpatient,1,EA,39.75000,37.76000,The Alliance,Premier SAS,,27.35,,,,,,,19.88,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Premier SAS,,10.20,,,,,,,7.41,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier SAS,,10.25,,,,,,,7.45,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,outpatient,1,mL,22.54000,21.42000,The Alliance,Premier SAS,,38.89,,,,,,,11.27,40.47,fee schedule,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier SAS,,38.89,,,,,,,3.48,40.47,fee schedule,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,outpatient,1,mL,10.50000,9.98000,The Alliance,Premier SAS,,38.89,,,,,,,5.25,40.47,fee schedule,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,outpatient,1,mL,7.58000,7.20000,The Alliance,Premier SAS,,5.22,,,,,,,3.79,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,outpatient,1,mL,7.62000,7.24000,The Alliance,Premier SAS,,5.24,,,,,,,3.81,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,outpatient,1,mL,7.69000,7.30000,The Alliance,Premier SAS,,5.29,,,,,,,3.85,7.46,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,outpatient,1,EA,45.52000,43.25000,The Alliance,Premier SAS,,31.32,,,,,,,22.76,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,outpatient,1,EA,64.01000,60.81000,The Alliance,Premier SAS,,44.04,,,,,,,32.01,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,outpatient,1,EA,2.73000,2.59000,The Alliance,Premier SAS,,1.88,,,,,,,1.36,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,The Alliance,Premier SAS,,85.02,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,outpatient,1,EA,19.26000,18.30000,The Alliance,Premier SAS,,13.25,,,,,,,9.63,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,outpatient,1,EA,1.78000,1.70000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier SAS,,0.46429,,,,,,,0.44330,0.95060,fee schedule,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,outpatient,1,GM,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,outpatient,1,GM,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,outpatient,1,GM,79.00000,75.05000,The Alliance,Premier SAS,,54.35,,,,,,,39.50,76.63,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,The Alliance,Premier SAS,,4.19,,,,,,,3.04,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,outpatient,1,mL,7.22000,6.86000,The Alliance,Premier SAS,,4.97,,,,,,,3.61,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,outpatient,1,mL,6.19000,5.88000,The Alliance,Premier SAS,,4.26,,,,,,,3.10,6.00,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,1.22,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,5.48,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,2.85,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,outpatient,1,mL,1.69000,1.60000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,1.64,fee schedule,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13485,2.55,fee schedule,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,outpatient,1,mL,274.18000,260.47000,The Alliance,Premier SAS,,188.64,,,,,,,137.09,265.95,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Premier SAS,,1.68,,,,,,,1.22,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,outpatient,1,EA,1.18000,1.12000,The Alliance,Premier SAS,,0.81184,,,,,,,0.59000,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Premier SAS,,3.29,,,,,,,2.39,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,outpatient,1,EA,6.06000,5.76000,The Alliance,Premier SAS,,4.17,,,,,,,3.03,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,outpatient,1,EA,2.66000,2.53000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier SAS,,1.59,,,,,,,1.16,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,outpatient,1,EA,2.12000,2.02000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,outpatient,1,EA,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,outpatient,1,EA,13.08000,12.43000,The Alliance,Premier SAS,,9.00,,,,,,,6.54,12.69,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,outpatient,1,EA,21.51000,20.44000,The Alliance,Premier SAS,,14.80,,,,,,,10.76,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,outpatient,1,EA,37.94000,36.04000,The Alliance,Premier SAS,,26.10,,,,,,,18.97,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,outpatient,1,EA,34.11000,32.40000,The Alliance,Premier SAS,,23.47,,,,,,,17.05,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,outpatient,1,EA,17.55000,16.68000,The Alliance,Premier SAS,,12.07,,,,,,,8.78,17.02,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Premier SAS,,2.43,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,The Alliance,Premier SAS,,2.43,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,outpatient,1,EA,8.28000,7.87000,The Alliance,Premier SAS,,5.70,,,,,,,4.14,8.03,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,outpatient,1,mL,8.12000,7.71000,The Alliance,Premier SAS,,5.59,,,,,,,4.06,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,outpatient,1,mL,4.90000,4.66000,The Alliance,Premier SAS,,3.37,,,,,,,2.45,4.75,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,outpatient,1,EA,26.97000,25.62000,The Alliance,Premier SAS,,18.56,,,,,,,13.48,26.16,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,outpatient,1,mL,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,outpatient,1,mL,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,outpatient,1,mL,5.65000,5.37000,The Alliance,Premier SAS,,3.89,,,,,,,2.83,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,outpatient,1,mL,6.10000,5.79000,The Alliance,Premier SAS,,4.20,,,,,,,3.05,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,outpatient,1,mL,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,outpatient,1,EA,21.90000,20.80000,The Alliance,Premier SAS,,15.07,,,,,,,10.95,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,The Alliance,Premier SAS,,8.15,,,,,,,5.92,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.83,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,outpatient,1,mL,15.07000,14.32000,The Alliance,Premier SAS,,10.37,,,,,,,7.54,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,outpatient,1,mL,20.19000,19.18000,The Alliance,Premier SAS,,13.89,,,,,,,10.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,outpatient,1,mL,15.74000,14.95000,The Alliance,Premier SAS,,10.83,,,,,,,7.87,15.27,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Premier SAS,,24.56,,,,,,,17.85,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,outpatient,1,EA,28.25000,26.84000,The Alliance,Premier SAS,,19.44,,,,,,,14.12,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,outpatient,1,EA,33.83000,32.14000,The Alliance,Premier SAS,,23.28,,,,,,,16.91,32.82,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,outpatient,1,EA,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,outpatient,1,mL,201.05000,191.00000,The Alliance,Premier SAS,,138.32,,,,,,,100.53,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,outpatient,1,mL,135.06000,128.31000,The Alliance,Premier SAS,,92.92,,,,,,,67.53,131.01,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Premier SAS,,1239.29,,,,,,,900.64,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,The Alliance,Premier SAS,,1239.29,,,,,,,900.64,1747.25,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,3.14,,,,,,,1.10,3.23,fee schedule,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,outpatient,1,mL,54.06000,51.36000,The Alliance,Premier SAS,,37.19,,,,,,,27.03,52.44,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,outpatient,1,EA,51.38000,48.81000,The Alliance,Premier SAS,,35.35,,,,,,,25.69,49.84,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,outpatient,1,GM,12.42000,11.80000,The Alliance,Premier SAS,,8.54,,,,,,,6.21,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier SAS,,10.38,,,,,,,7.54,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier SAS,,10.38,,,,,,,7.54,14.64,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,outpatient,1,EA,37.22000,35.36000,The Alliance,Premier SAS,,25.61,,,,,,,18.61,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,outpatient,1,EA,40.94000,38.90000,The Alliance,Premier SAS,,28.17,,,,,,,20.47,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,The Alliance,Premier SAS,,2.68,,,,,,,1.95,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,The Alliance,Premier SAS,,4.27,,,,,,,3.10,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,The Alliance,Premier SAS,,30.08,,,,,,,21.86,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,outpatient,1,EA,28.51000,27.09000,The Alliance,Premier SAS,,19.61,,,,,,,14.26,27.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,outpatient,1,mL,16.68000,15.85000,The Alliance,Premier SAS,,25.12,,,,,,,8.34,25.89,fee schedule,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Premier SAS,,4.52,,,,,,,3.29,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,outpatient,1,mL,6.70000,6.36000,The Alliance,Premier SAS,,4.61,,,,,,,3.35,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier SAS,,3.98,,,,,,,2.89,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,outpatient,1,mL,3.47000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,outpatient,1,mL,5.56000,5.28000,The Alliance,Premier SAS,,3.83,,,,,,,2.78,5.39,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,outpatient,1,mL,1032.80000,981.16000,The Alliance,Premier SAS,,8025.99,,,,,,,516.40,8271.63,fee schedule,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,outpatient,1,mL,1186.38000,1127.06000,The Alliance,Premier SAS,,8025.99,,,,,,,593.19,8271.63,fee schedule,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier SAS,,8.97,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier SAS,,20.26,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier SAS,,28.10,,,,,,,20.43,39.62,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier SAS,,0.48030,,,,,,,0.43865,16.43,fee schedule,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,outpatient,1,EA,16.94000,16.09000,The Alliance,Premier SAS,,0.48030,,,,,,,0.43865,16.43,fee schedule,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,outpatient,1,EA,21.59000,20.51000,The Alliance,Premier SAS,,0.48030,,,,,,,0.43865,20.94,fee schedule,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,outpatient,1,EA,9.59000,9.11000,The Alliance,Premier SAS,,6.60,,,,,,,4.79,9.30,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,outpatient,1,mL,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,outpatient,1,mL,1.17000,1.11000,The Alliance,Premier SAS,,0.80050,,,,,,,0.58500,1.13,fee schedule,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier SAS,,0.80050,,,,,,,0.73500,1.43,fee schedule,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,outpatient,,,386.68000,367.35000,The Alliance,Premier SAS,,266.04,,,,,,,148.70,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,outpatient,1,mL,773.36000,734.69000,The Alliance,Premier SAS,,532.07,,,,,,,148.70,750.16,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,outpatient,1,EA,4.98000,4.73000,The Alliance,Premier SAS,,3.43,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,outpatient,1,EA,2.49000,2.36000,The Alliance,Premier SAS,,1.71,,,,,,,1.25,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,outpatient,1,EA,2.74000,2.61000,The Alliance,Premier SAS,,1.89,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,outpatient,1,EA,1.75000,1.67000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,outpatient,1,EA,140.32000,133.31000,The Alliance,Premier SAS,,96.54,,,,,,,70.16,136.11,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,outpatient,1,EA,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,outpatient,1,EA,4.39000,4.17000,The Alliance,Premier SAS,,3.02,,,,,,,2.19,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,outpatient,1,EA,6.28000,5.96000,The Alliance,Premier SAS,,4.32,,,,,,,3.14,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,outpatient,1,EA,7.96000,7.56000,The Alliance,Premier SAS,,5.48,,,,,,,3.98,7.72,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,outpatient,5,EA,10.04000,9.54000,The Alliance,Premier SAS,,6.91,,,,,,,5.02,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,outpatient,5,EA,11.38000,10.81000,The Alliance,Premier SAS,,7.83,,,,,,,5.69,11.04,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,outpatient,1,EA,45.77000,43.48000,The Alliance,Premier SAS,,31.49,,,,,,,22.89,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,outpatient,1,EA,2.42000,2.30000,The Alliance,Premier SAS,,1.66,,,,,,,1.21,2.35,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,outpatient,1,mL,18.20000,17.29000,The Alliance,Premier SAS,,25.12,,,,,,,9.10,25.89,fee schedule,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,outpatient,1,EA,12.26000,11.65000,The Alliance,Premier SAS,,8.43,,,,,,,6.13,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,outpatient,1,EA,10.59000,10.06000,The Alliance,Premier SAS,,7.29,,,,,,,5.29,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,outpatient,1,EA,7.36000,6.99000,The Alliance,Premier SAS,,5.06,,,,,,,3.68,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,outpatient,1,EA,16.12000,15.31000,The Alliance,Premier SAS,,11.09,,,,,,,8.06,15.64,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,The Alliance,Premier SAS,,1.10,,,,,,,0.80000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,outpatient,1,mL,28.12000,26.72000,The Alliance,Premier SAS,,19.35,,,,,,,14.06,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,outpatient,1,mL,14.15000,13.44000,The Alliance,Premier SAS,,9.74,,,,,,,7.08,13.73,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,outpatient,1,EA,28.94000,27.50000,The Alliance,Premier SAS,,19.91,,,,,,,14.47,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,outpatient,1,EA,35.77000,33.98000,The Alliance,Premier SAS,,24.61,,,,,,,17.89,34.70,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,6.32,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,The Alliance,Premier SAS,,1.62,,,,,,,1.18,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,outpatient,1,EA,41.78000,39.69000,The Alliance,Premier SAS,,28.74,,,,,,,20.89,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,The Alliance,Premier SAS,,11.56,,,,,,,8.40,16.30,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier SAS,,8.97,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,The Alliance,Premier SAS,,20.26,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier SAS,,28.10,,,,,,,20.43,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,The Alliance,Premier SAS,,5.68,,,,,,,4.12,8.00,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,outpatient,1,EA,37.02000,35.17000,The Alliance,Premier SAS,,25.47,,,,,,,18.51,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,outpatient,1,EA,13.95000,13.25000,The Alliance,Premier SAS,,9.60,,,,,,,6.97,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,outpatient,1,EA,122.37000,116.26000,The Alliance,Premier SAS,,84.19,,,,,,,61.19,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,outpatient,1,EA,48.95000,46.50000,The Alliance,Premier SAS,,33.68,,,,,,,24.48,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Premier SAS,,12.72,,,,,,,9.24,17.94,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier SAS,,11.96,,,,,,,8.69,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,outpatient,1,EA,17.70000,16.81000,The Alliance,Premier SAS,,12.18,,,,,,,8.85,17.17,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.56,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,outpatient,1,EA,20.11000,19.11000,The Alliance,Premier SAS,,13.84,,,,,,,10.05,19.51,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,outpatient,1,mL,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,outpatient,1,EA,19.54000,18.57000,The Alliance,Premier SAS,,13.44,,,,,,,9.77,18.95,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,outpatient,1,EA,692.00000,657.40000,The Alliance,Premier SAS,,476.10,,,,,,,346.00,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,outpatient,1,EA,188.18000,178.77000,The Alliance,Premier SAS,,129.47,,,,,,,94.09,182.53,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,outpatient,1,mL,2.36000,2.24000,The Alliance,Premier SAS,,2.11,,,,,,,1.18,2.61,fee schedule,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,outpatient,1,mL,3.36000,3.20000,The Alliance,Premier SAS,,2.11,,,,,,,1.68,3.26,fee schedule,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.11,,,,,,,1.58,3.07,fee schedule,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,outpatient,1,mL,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,outpatient,1,mL,19.18000,18.22000,The Alliance,Premier SAS,,13.20,,,,,,,9.59,18.60,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,outpatient,1,EA,5.51000,5.23000,The Alliance,Premier SAS,,3.79,,,,,,,2.75,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Premier SAS,,6.19,,,,,,,4.50,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,outpatient,1,EA,7.78000,7.39000,The Alliance,Premier SAS,,5.35,,,,,,,3.89,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,outpatient,1,GM,0.22000,0.20000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,outpatient,1,EA,69.52000,66.04000,The Alliance,Premier SAS,,3.33,,,,,,,3.23,67.43,fee schedule,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,outpatient,1,EA,10.54000,10.01000,The Alliance,Premier SAS,,7.25,,,,,,,5.27,10.22,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,The Alliance,Premier SAS,,0.79120,,,,,,,0.57500,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier SAS,,3.62,,,,,,,1.31,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,outpatient,1,mL,2.71000,2.57000,The Alliance,Premier SAS,,3.62,,,,,,,1.35,4.28,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,outpatient,1,mL,2.90000,2.76000,The Alliance,Premier SAS,,3.62,,,,,,,1.45,4.28,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier SAS,,2.24,,,,,,,0.25000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Premier SAS,,2.24,,,,,,,0.47000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier SAS,,2.24,,,,,,,0.25500,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier SAS,,2.24,,,,,,,0.25000,2.61,fee schedule,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Premier SAS,,2.24,,,,,,,0.24000,2.61,fee schedule,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier SAS,,36.68,,,,,,,28.44,55.17,fee schedule,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,outpatient,1,mL,61.46000,58.39000,The Alliance,Premier SAS,,36.68,,,,,,,30.73,59.62,fee schedule,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,outpatient,1,EA,31.45000,29.88000,The Alliance,Premier SAS,,21.64,,,,,,,15.72,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,outpatient,1,EA,14.34000,13.63000,The Alliance,Premier SAS,,9.87,,,,,,,7.17,13.91,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Premier SAS,,166.27,,,,,,,120.83,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Premier SAS,,332.54,,,,,,,187.18,468.84,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,outpatient,1,EA,669.20000,635.74000,The Alliance,Premier SAS,,172.96,,,,,,,108.03,649.12,fee schedule,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,outpatient,1,EA,3779.13000,3590.17000,The Alliance,Premier SAS,,172.96,,,,,,,108.03,3665.76,fee schedule,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,outpatient,1,EA,4600.00000,4370.00000,The Alliance,Premier SAS,,172.96,,,,,,,108.03,4462.00,fee schedule,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier SAS,,6.48,,,,,,,4.71,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,outpatient,1,EA,14.55000,13.82000,The Alliance,Premier SAS,,10.01,,,,,,,7.28,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,outpatient,1,EA,40.76000,38.72000,The Alliance,Premier SAS,,28.04,,,,,,,20.38,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,outpatient,1,EA,16.38000,15.57000,The Alliance,Premier SAS,,11.27,,,,,,,8.19,15.89,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,outpatient,1,EA,20.97000,19.92000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,20.34,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,outpatient,1,EA,7.85000,7.46000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,7.61,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,outpatient,1,EA,8.95000,8.50000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,8.68,fee schedule,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,outpatient,1,EA,7.43000,7.05000,The Alliance,Premier SAS,,0.36823,,,,,,,0.36823,7.21,fee schedule,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,outpatient,1,EA,54.15000,51.44000,The Alliance,Premier SAS,,37.26,,,,,,,27.07,52.53,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,The Alliance,Premier SAS,,2.81,,,,,,,2.04,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,outpatient,1,mL,12.48000,11.86000,The Alliance,Premier SAS,,2.24,,,,,,,2.24,12.11,fee schedule,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,outpatient,1,mL,4.23000,4.02000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,4.10,fee schedule,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,outpatient,1,GM,19.83000,18.84000,The Alliance,Premier SAS,,13.64,,,,,,,9.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier SAS,,5.63,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,outpatient,1,GM,11.68000,11.10000,The Alliance,Premier SAS,,8.04,,,,,,,5.84,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier SAS,,5.63,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,The Alliance,Premier SAS,,5.63,,,,,,,4.09,7.93,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,outpatient,1,GM,5.01000,4.76000,The Alliance,Premier SAS,,3.45,,,,,,,2.50,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,outpatient,1,GM,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,outpatient,1,EA,9.03000,8.58000,The Alliance,Premier SAS,,6.21,,,,,,,4.51,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Premier SAS,,2.19,,,,,,,1.59,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,The Alliance,Premier SAS,,2.53,,,,,,,1.84,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,outpatient,1,GM,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,outpatient,1,GM,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,outpatient,1,EA,8.68000,8.24000,The Alliance,Premier SAS,,5.97,,,,,,,4.34,8.42,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,The Alliance,Premier SAS,,0.72928,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,The Alliance,Premier SAS,,1.64,,,,,,,1.19,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,outpatient,1,mL,1.98000,1.88000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,1.92,fee schedule,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,outpatient,1,mL,8.91000,8.47000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,8.64,fee schedule,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,outpatient,1,mL,6.74000,6.40000,The Alliance,Premier SAS,,4.64,,,,,,,3.37,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,outpatient,1,mL,6.67000,6.33000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,outpatient,1,mL,68.41000,64.98000,The Alliance,Premier SAS,,47.39,,,,,,,29.60,66.36,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Premier SAS,,47.39,,,,,,,26.86,52.11,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,outpatient,1,mL,142.39000,135.27000,The Alliance,Premier SAS,,47.39,,,,,,,29.60,138.12,fee schedule,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Premier SAS,,10.44,,,,,,,7.58,14.71,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,outpatient,1,EA,1.49000,1.42000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,outpatient,1,EA,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,outpatient,1,EA,5.82000,5.53000,The Alliance,Premier SAS,,4.00,,,,,,,2.91,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,outpatient,1,EA,2.76000,2.63000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,The Alliance,Premier SAS,,1.50,,,,,,,1.09,2.11,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,outpatient,1,mL,3.45000,3.28000,The Alliance,Premier SAS,,2.37,,,,,,,1.73,3.35,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,outpatient,1,GM,0.46000,0.43000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,outpatient,1,EA,32.55000,30.93000,The Alliance,Premier SAS,,22.39,,,,,,,16.27,31.57,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,outpatient,1,mL,15.00000,14.25000,The Alliance,Premier SAS,,10.32,,,,,,,7.50,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,outpatient,1,mL,13.24000,12.58000,The Alliance,Premier SAS,,9.11,,,,,,,6.62,12.84,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,The Alliance,Premier SAS,,2.71,,,,,,,1.97,3.82,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,outpatient,1,mL,4.90000,4.65000,The Alliance,Premier SAS,,3.37,,,,,,,2.45,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,outpatient,1,mL,53.72000,51.03000,The Alliance,Premier SAS,,47.39,,,,,,,26.86,52.11,fee schedule,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,outpatient,1,mL,128.82000,122.38000,The Alliance,Premier SAS,,47.39,,,,,,,29.60,124.96,fee schedule,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,outpatient,1,GM,5.52000,5.24000,The Alliance,Premier SAS,,3.80,,,,,,,2.76,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,outpatient,1,GM,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,outpatient,1,GM,5.75000,5.46000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,outpatient,1,GM,4.06000,3.86000,The Alliance,Premier SAS,,2.79,,,,,,,2.03,3.94,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,outpatient,1,mL,1.96000,1.86000,The Alliance,Premier SAS,,1.35,,,,,,,0.98000,1.90,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,outpatient,1,EA,4.97000,4.72000,The Alliance,Premier SAS,,3.42,,,,,,,2.48,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier SAS,,1.64,,,,,,,1.20,2.32,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,outpatient,1,mL,11.03000,10.48000,The Alliance,Premier SAS,,7.59,,,,,,,5.51,10.70,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,outpatient,1,mL,19.99000,18.99000,The Alliance,Premier SAS,,13.75,,,,,,,9.99,19.39,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,outpatient,1,EA,6.34000,6.02000,The Alliance,Premier SAS,,4.36,,,,,,,3.17,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.58,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58000,1.13,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,outpatient,1,EA,13.86000,13.17000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,13.44,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58500,1.13,fee schedule,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,outpatient,1,EA,24.04000,22.84000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,23.32,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,outpatient,1,mL,27.27000,25.91000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,26.45,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,outpatient,1,mL,8.93000,8.49000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,8.66,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,outpatient,1,mL,8.94000,8.49000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,8.67,fee schedule,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,outpatient,1,mL,22.91000,21.77000,The Alliance,Premier SAS,,0.25616,,,,,,,0.23870,22.22,fee schedule,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,outpatient,1,EA,5.79000,5.50000,The Alliance,Premier SAS,,3.98,,,,,,,2.90,5.62,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,outpatient,1,EA,17.10000,16.25000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,16.59,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,outpatient,1,EA,11.55000,10.97000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,11.20,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,outpatient,1,EA,13.12000,12.47000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,12.73,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,outpatient,1,EA,5.31000,5.04000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,5.15,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.59237,,,,,,,0.29500,0.63080,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,outpatient,1,EA,11.77000,11.18000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,11.42,fee schedule,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,outpatient,1,EA,4.58000,4.35000,The Alliance,Premier SAS,,0.59237,,,,,,,0.58745,4.44,fee schedule,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,outpatient,1,EA,16.30000,15.49000,The Alliance,Premier SAS,,11.21,,,,,,,8.15,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,The Alliance,Premier SAS,,1.80,,,,,,,1.31,2.54,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Premier SAS,,2.86,,,,,,,2.08,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,outpatient,1,EA,12.79000,12.15000,The Alliance,Premier SAS,,8.80,,,,,,,6.39,12.41,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,13.94,,,,,,,0.29000,14.37,fee schedule,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Premier SAS,,13.94,,,,,,,0.28000,14.37,fee schedule,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,outpatient,1,EA,1.65000,1.56000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,outpatient,1,EA,39.82000,37.83000,The Alliance,Premier SAS,,27.40,,,,,,,19.91,38.63,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,outpatient,1,mL,11.10000,10.55000,The Alliance,Premier SAS,,5.62,,,,,,,4.77,10.77,fee schedule,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,outpatient,1,EA,16.69000,15.86000,The Alliance,Premier SAS,,11.48,,,,,,,8.35,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,outpatient,1,EA,43.24000,41.07000,The Alliance,Premier SAS,,29.75,,,,,,,21.62,41.94,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,outpatient,1,EA,96.21000,91.40000,The Alliance,Premier SAS,,66.19,,,,,,,48.10,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,outpatient,1,EA,23.30000,22.13000,The Alliance,Premier SAS,,16.03,,,,,,,11.65,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,outpatient,1,EA,31.97000,30.37000,The Alliance,Premier SAS,,22.00,,,,,,,15.98,31.01,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.55,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,The Alliance,Premier SAS,,4.28,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,outpatient,1,mL,69.35000,65.88000,The Alliance,Premier SAS,,47.71,,,,,,,34.67,67.27,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,outpatient,1,EA,15.09000,14.33000,The Alliance,Premier SAS,,10.38,,,,,,,7.54,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,The Alliance,Premier SAS,,3.87,,,,,,,2.81,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,The Alliance,Premier SAS,,1.88,,,,,,,1.36,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,outpatient,1,EA,6.82000,6.48000,The Alliance,Premier SAS,,4.69,,,,,,,3.41,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,outpatient,1,EA,6.64000,6.30000,The Alliance,Premier SAS,,4.57,,,,,,,3.32,6.44,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,outpatient,1,mL,2.44000,2.32000,The Alliance,Premier SAS,,1.68,,,,,,,1.22,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,outpatient,1,EA,11.37000,10.80000,The Alliance,Premier SAS,,7.82,,,,,,,5.68,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,outpatient,1,EA,5.97000,5.67000,The Alliance,Premier SAS,,4.11,,,,,,,2.98,5.79,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,outpatient,1,EA,45.02000,42.77000,The Alliance,Premier SAS,,30.97,,,,,,,22.51,43.67,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,outpatient,1,EA,29.46000,27.99000,The Alliance,Premier SAS,,20.27,,,,,,,14.73,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,outpatient,1,EA,77.26000,73.40000,The Alliance,Premier SAS,,53.15,,,,,,,38.63,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,outpatient,1,mL,37.52000,35.65000,The Alliance,Premier SAS,,25.81,,,,,,,14.28,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,outpatient,1,mL,29.64000,28.16000,The Alliance,Premier SAS,,20.39,,,,,,,14.28,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,outpatient,1,mL,22.12000,21.01000,The Alliance,Premier SAS,,15.22,,,,,,,11.06,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,outpatient,1,mL,11.63000,11.05000,The Alliance,Premier SAS,,8.00,,,,,,,5.82,15.29,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,outpatient,1,mL,29.39000,27.92000,The Alliance,Premier SAS,,20.22,,,,,,,14.28,28.51,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,outpatient,1,EA,36.90000,35.06000,The Alliance,Premier SAS,,25.39,,,,,,,18.45,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,outpatient,1,EA,35.55000,33.77000,The Alliance,Premier SAS,,24.46,,,,,,,17.77,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,outpatient,1,EA,36.97000,35.12000,The Alliance,Premier SAS,,25.44,,,,,,,18.48,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier SAS,,25.00,,,,,,,18.17,35.25,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,outpatient,1,GM,41.32000,39.25000,The Alliance,Premier SAS,,28.43,,,,,,,20.66,40.08,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,outpatient,1,GM,3.69000,3.50000,The Alliance,Premier SAS,,2.54,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,outpatient,1,mL,2.23000,2.12000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.16,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,outpatient,1,EA,11.81000,11.22000,The Alliance,Premier SAS,,8.13,,,,,,,5.91,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,outpatient,1,EA,6.29000,5.97000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.10,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,outpatient,1,mL,5.47000,5.19000,The Alliance,Premier SAS,,3.76,,,,,,,2.73,5.31,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,outpatient,1,EA,158.82000,150.88000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,154.06,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,outpatient,1,EA,124.79000,118.55000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,121.05,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,outpatient,1,EA,80.71000,76.67000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,78.29,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,outpatient,1,EA,104.91000,99.67000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,101.76,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,61.30,fee schedule,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,outpatient,1,EA,111.99000,106.39000,The Alliance,Premier SAS,,1.46,,,,,,,1.44,108.63,fee schedule,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,outpatient,1,EA,5.25000,4.98000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,outpatient,1,EA,6.36000,6.04000,The Alliance,Premier SAS,,4.38,,,,,,,3.18,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,The Alliance,Premier SAS,,4.02,,,,,,,2.92,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,outpatient,1,EA,7.81000,7.42000,The Alliance,Premier SAS,,5.37,,,,,,,3.90,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,3.11,fee schedule,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,outpatient,1,mL,3.00000,2.85000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,2.91,fee schedule,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,outpatient,1,EA,7.11000,6.76000,The Alliance,Premier SAS,,4.89,,,,,,,3.56,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,outpatient,1,EA,7.60000,7.22000,The Alliance,Premier SAS,,5.23,,,,,,,3.80,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,outpatient,1,EA,6.75000,6.41000,The Alliance,Premier SAS,,4.64,,,,,,,3.38,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,The Alliance,Premier SAS,,4.20,,,,,,,3.05,5.92,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,outpatient,1,EA,20.67000,19.64000,The Alliance,Premier SAS,,14.22,,,,,,,10.34,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,outpatient,1,EA,13.02000,12.37000,The Alliance,Premier SAS,,8.96,,,,,,,6.51,12.63,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,outpatient,1,EA,6.07000,5.77000,The Alliance,Premier SAS,,4.18,,,,,,,3.04,5.89,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,outpatient,1,EA,8.07000,7.67000,The Alliance,Premier SAS,,5.55,,,,,,,4.04,7.83,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,outpatient,1,EA,1.57000,1.49000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,outpatient,1,mL,46.48000,44.15000,The Alliance,Premier SAS,,101.47,,,,,,,23.24,123.35,fee schedule,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,outpatient,1,mL,51.07000,48.51000,The Alliance,Premier SAS,,101.47,,,,,,,25.54,123.35,fee schedule,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,outpatient,1,mL,41.78000,39.69000,The Alliance,Premier SAS,,101.47,,,,,,,20.89,123.35,fee schedule,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,outpatient,1,mL,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,outpatient,1,EA,10.68000,10.15000,The Alliance,Premier SAS,,7.35,,,,,,,5.34,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,The Alliance,Premier SAS,,6.61,,,,,,,4.80,9.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,outpatient,1,mL,151.68000,144.10000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,147.13,fee schedule,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,outpatient,1,mL,121.98000,115.88000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,118.32,fee schedule,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,outpatient,1,mL,314.03000,298.33000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,304.61,fee schedule,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,outpatient,1,EA,279.66000,265.68000,The Alliance,Premier SAS,,0.65641,,,,,,,0.47275,271.27,fee schedule,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,outpatient,1,EA,233.84000,222.15000,The Alliance,Premier SAS,,0.65641,,,,,,,0.47275,226.82,fee schedule,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,outpatient,1,EA,229.10000,217.64000,The Alliance,Premier SAS,,0.65641,,,,,,,0.47275,222.23,fee schedule,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,The Alliance,Premier SAS,,6.25,,,,,,,4.54,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,The Alliance,Premier SAS,,5.71,,,,,,,4.15,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,outpatient,1,EA,287.00000,272.65000,The Alliance,Premier SAS,,197.46,,,,,,,143.50,278.39,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,outpatient,1,EA,4.63000,4.40000,The Alliance,Premier SAS,,3.19,,,,,,,2.31,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,outpatient,1,EA,9.26000,8.80000,The Alliance,Premier SAS,,6.37,,,,,,,4.63,8.98,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,The Alliance,Premier SAS,,2.01,,,,,,,1.46,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,outpatient,1,EA,41.11000,39.06000,The Alliance,Premier SAS,,28.28,,,,,,,20.55,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,outpatient,1,EA,4.69000,4.45000,The Alliance,Premier SAS,,3.23,,,,,,,2.35,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.13,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,outpatient,1,mL,13.34000,12.67000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,12.94,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,outpatient,1,mL,7.46000,7.08000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,7.24,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,outpatient,1,mL,31.38000,29.81000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,30.44,fee schedule,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,outpatient,1,mL,12.34000,11.73000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,11.97,fee schedule,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,outpatient,1,EA,7.38000,7.01000,The Alliance,Premier SAS,,5.08,,,,,,,3.69,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,outpatient,1,EA,8.84000,8.40000,The Alliance,Premier SAS,,6.08,,,,,,,4.42,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,The Alliance,Premier SAS,,4.98,,,,,,,3.62,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,The Alliance,Premier SAS,,1.03,,,,,,,0.74500,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,The Alliance,Premier SAS,,6.30,,,,,,,4.58,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,outpatient,1,EA,8.12000,7.72000,The Alliance,Premier SAS,,5.59,,,,,,,4.06,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier SAS,,1.51,,,,,,,1.10,2.13,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,outpatient,1,EA,8.69000,8.26000,The Alliance,Premier SAS,,5.98,,,,,,,4.34,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,outpatient,1,EA,256.00000,243.20000,The Alliance,Premier SAS,,176.13,,,,,,,128.00,248.32,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Premier SAS,,123.01,,,,,,,89.39,173.43,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,outpatient,1,mL,19.62000,18.64000,The Alliance,Premier SAS,,13.50,,,,,,,9.81,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,outpatient,1,mL,8.01000,7.61000,The Alliance,Premier SAS,,5.51,,,,,,,4.00,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,outpatient,1,mL,6.69000,6.36000,The Alliance,Premier SAS,,4.60,,,,,,,3.35,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,outpatient,1,mL,31.50000,29.92000,The Alliance,Premier SAS,,21.67,,,,,,,15.75,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,outpatient,1,mL,19.63000,18.65000,The Alliance,Premier SAS,,13.51,,,,,,,9.81,19.04,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,The Alliance,Premier SAS,,123.01,,,,,,,89.39,173.43,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,outpatient,1,EA,4.90000,4.66000,The Alliance,Premier SAS,,3.37,,,,,,,2.45,4.75,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,outpatient,1,mL,5.08000,4.83000,The Alliance,Premier SAS,,3.50,,,,,,,2.54,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,outpatient,1,mL,2.09000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,6.13,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,outpatient,1,mL,10.62000,10.09000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,10.30,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,outpatient,1,mL,5.32000,5.06000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,5.16,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,outpatient,1,mL,8.53000,8.11000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,8.27,fee schedule,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,4.91,fee schedule,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Premier SAS,,231.81,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,The Alliance,Premier SAS,,231.81,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,outpatient,1,EA,348.70000,331.27000,The Alliance,Premier SAS,,239.91,,,,,,,174.35,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,outpatient,1,EA,316.63000,300.80000,The Alliance,Premier SAS,,217.84,,,,,,,158.31,307.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,outpatient,1,EA,5.91000,5.61000,The Alliance,Premier SAS,,4.07,,,,,,,2.96,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,outpatient,1,EA,3.52000,3.35000,The Alliance,Premier SAS,,2.42,,,,,,,1.76,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,outpatient,1,mL,7116.49000,6760.67000,The Alliance,Premier SAS,,4896.15,,,,,,,719.87,6903.00,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,outpatient,1,mL,3.73000,3.54000,The Alliance,Premier SAS,,2.57,,,,,,,1.86,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,outpatient,1,mL,2.04000,1.93000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,The Alliance,Premier SAS,,3.00,,,,,,,2.18,4.23,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,outpatient,1,EA,9.67000,9.18000,The Alliance,Premier SAS,,6.65,,,,,,,4.83,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,outpatient,1,EA,8.54000,8.12000,The Alliance,Premier SAS,,5.88,,,,,,,4.27,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,outpatient,1,mL,1.28000,1.22000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,1.24,fee schedule,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Premier SAS,,0.14409,,,,,,,0.13795,1.56,fee schedule,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,outpatient,1,mL,8.73000,8.29000,The Alliance,Premier SAS,,6.01,,,,,,,4.37,8.47,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Premier SAS,,15.13,,,,,,,12.32,23.91,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,outpatient,1,mL,25.06000,23.81000,The Alliance,Premier SAS,,15.13,,,,,,,12.53,24.31,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,15.13,,,,,,,9.48,20.47,fee schedule,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,outpatient,1,mL,25.91000,24.62000,The Alliance,Premier SAS,,15.13,,,,,,,12.96,25.13,fee schedule,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,outpatient,1,EA,374.26000,355.54000,The Alliance,Premier SAS,,257.49,,,,,,,187.13,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,outpatient,1,EA,308.73000,293.30000,The Alliance,Premier SAS,,212.41,,,,,,,154.37,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,outpatient,1,EA,432.25000,410.63000,The Alliance,Premier SAS,,297.39,,,,,,,216.12,419.28,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,outpatient,1,EA,20.64000,19.61000,The Alliance,Premier SAS,,14.20,,,,,,,10.32,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,outpatient,1,EA,20.17000,19.16000,The Alliance,Premier SAS,,13.88,,,,,,,10.09,19.56,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,outpatient,1,EA,45.34000,43.07000,The Alliance,Premier SAS,,31.19,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,outpatient,1,EA,0.41000,0.38000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,outpatient,1,EA,0.35000,0.34000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,outpatient,1,EA,20.77000,19.73000,The Alliance,Premier SAS,,14.29,,,,,,,10.38,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,outpatient,1,EA,13.45000,12.78000,The Alliance,Premier SAS,,9.25,,,,,,,6.72,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,outpatient,1,EA,25.32000,24.06000,The Alliance,Premier SAS,,17.42,,,,,,,12.66,24.56,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,outpatient,1,GM,67.76000,64.37000,The Alliance,Premier SAS,,46.62,,,,,,,33.88,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,outpatient,1,GM,51.80000,49.21000,The Alliance,Premier SAS,,35.64,,,,,,,25.90,50.25,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,The Alliance,Premier SAS,,46.20,,,,,,,33.58,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,outpatient,1,EA,5.06000,4.81000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,outpatient,1,EA,22.94000,21.79000,The Alliance,Premier SAS,,15.78,,,,,,,11.47,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,outpatient,1,mL,3.57000,3.39000,The Alliance,Premier SAS,,2.46,,,,,,,1.78,3.46,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,outpatient,1,GM,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,outpatient,1,EA,279.39000,265.42000,The Alliance,Premier SAS,,192.22,,,,,,,139.69,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,outpatient,1,EA,621.55000,590.47000,The Alliance,Premier SAS,,427.63,,,,,,,310.77,602.90,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,outpatient,1,mL,107.32000,101.96000,The Alliance,Premier SAS,,73.84,,,,,,,37.52,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,outpatient,1,mL,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,37.52,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,outpatient,1,EA,7.64000,7.26000,The Alliance,Premier SAS,,5.26,,,,,,,3.82,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Premier SAS,,3.19,,,,,,,2.32,4.50,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,outpatient,1,EA,14.24000,13.53000,The Alliance,Premier SAS,,9.80,,,,,,,7.12,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,The Alliance,Premier SAS,,1.17,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,outpatient,1,EA,4.58000,4.36000,The Alliance,Premier SAS,,3.15,,,,,,,2.29,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,The Alliance,Premier SAS,,3.24,,,,,,,2.35,4.57,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,outpatient,1,mL,4.47000,4.25000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01601,4.34,fee schedule,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,outpatient,1,mL,1.08000,1.02000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01601,1.05,fee schedule,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01601,1.44,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,outpatient,1,mL,4.83000,4.58000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,4.69,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,outpatient,1,mL,8.17000,7.76000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,7.92,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,7.25,fee schedule,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,outpatient,1,mL,3.21000,3.05000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,3.11,fee schedule,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,outpatient,,,482.51000,458.38000,The Alliance,Premier SAS,,331.97,,,,,,,51.13,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,outpatient,1,mL,965.01000,916.76000,The Alliance,Premier SAS,,663.93,,,,,,,51.13,936.06,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,outpatient,1,mL,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,outpatient,1,EA,1.43000,1.36000,The Alliance,Premier SAS,,0.98384,,,,,,,0.53900,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,outpatient,1,EA,4.41000,4.19000,The Alliance,Premier SAS,,3.03,,,,,,,0.53900,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,0.53900,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,outpatient,1,EA,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,outpatient,1,EA,21.70000,20.61000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,21.05,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,outpatient,1,EA,21.71000,20.62000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,21.06,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,outpatient,1,EA,23.29000,22.12000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,22.59,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,outpatient,1,EA,29.23000,27.77000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,28.35,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,9.20,fee schedule,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,outpatient,1,EA,29.22000,27.76000,The Alliance,Premier SAS,,1.78,,,,,,,1.73,28.34,fee schedule,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,outpatient,1,mL,50.03000,47.53000,The Alliance,Premier SAS,,34.42,,,,,,,1.68,48.53,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,The Alliance,Premier SAS,,4.49,,,,,,,3.26,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,outpatient,1,mL,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,outpatient,1,GM,31.50000,29.92000,The Alliance,Premier SAS,,21.67,,,,,,,15.75,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,outpatient,1,GM,25.68000,24.39000,The Alliance,Premier SAS,,17.67,,,,,,,12.84,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,outpatient,1,GM,26.72000,25.38000,The Alliance,Premier SAS,,18.38,,,,,,,13.36,25.92,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,3.05,fee schedule,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,1.77,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.27217,,,,,,,0.10500,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.27217,,,,,,,0.16000,0.34860,fee schedule,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,outpatient,1,mL,14.25000,13.53000,The Alliance,Premier SAS,,9.80,,,,,,,7.12,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,outpatient,1,mL,17.81000,16.92000,The Alliance,Premier SAS,,12.25,,,,,,,8.90,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,outpatient,1,mL,16.76000,15.92000,The Alliance,Premier SAS,,11.53,,,,,,,8.38,16.26,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,outpatient,1,EA,678.29000,644.37000,The Alliance,Premier SAS,,466.66,,,,,,,339.14,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,outpatient,1,EA,34.13000,32.42000,The Alliance,Premier SAS,,23.48,,,,,,,17.07,33.11,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,outpatient,1,mL,972.04000,923.43000,The Alliance,Premier SAS,,668.76,,,,,,,486.02,942.88,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,outpatient,1,mL,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,outpatient,1,EA,4.82000,4.58000,The Alliance,Premier SAS,,3.32,,,,,,,2.41,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,The Alliance,Premier SAS,,2.19,,,,,,,1.59,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,outpatient,1,EA,30.51000,28.98000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,29.59,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,outpatient,1,EA,22.79000,21.65000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,22.11,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,outpatient,1,EA,8.94000,8.50000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,8.67,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,outpatient,1,EA,23.98000,22.79000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,23.26,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,outpatient,1,EA,17.38000,16.51000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,16.86,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,9.75,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,outpatient,1,EA,17.06000,16.21000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,16.55,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,outpatient,1,EA,8.88000,8.44000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,8.61,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,outpatient,1,EA,10.33000,9.82000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,10.02,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,outpatient,1,EA,7.14000,6.78000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,6.93,fee schedule,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,outpatient,1,EA,4.78000,4.54000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,4.64,fee schedule,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,outpatient,1,EA,5.71000,5.42000,The Alliance,Premier SAS,,3.93,,,,,,,2.85,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,The Alliance,Premier SAS,,5.10,,,,,,,3.71,7.20,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,outpatient,1,EA,36.01000,34.21000,The Alliance,Premier SAS,,24.77,,,,,,,18.00,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,outpatient,1,mL,1.24000,1.17000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,outpatient,1,mL,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,outpatient,1,mL,52.14000,49.53000,The Alliance,Premier SAS,,35.87,,,,,,,26.07,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,outpatient,1,mL,35.71000,33.92000,The Alliance,Premier SAS,,24.57,,,,,,,17.86,34.64,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,outpatient,1,mL,43.32000,41.16000,The Alliance,Premier SAS,,29.80,,,,,,,21.66,42.02,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,outpatient,1,mL,114.96000,109.22000,The Alliance,Premier SAS,,311.11,,,,,,,57.48,472.00,fee schedule,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,outpatient,1,mL,777.00000,738.15000,The Alliance,Premier SAS,,311.11,,,,,,,194.32,753.69,fee schedule,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,outpatient,1,EA,5.32000,5.06000,The Alliance,Premier SAS,,3.66,,,,,,,2.66,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,The Alliance,Premier SAS,,2.91,,,,,,,2.12,4.10,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,The Alliance,Premier SAS,,24.56,,,,,,,17.85,34.63,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,outpatient,1,EA,22.83000,21.69000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,22.15,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,outpatient,1,EA,48.81000,46.37000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,47.35,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,outpatient,1,EA,41.00000,38.95000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,39.77,fee schedule,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,outpatient,1,EA,44.24000,42.03000,The Alliance,Premier SAS,,0.43227,,,,,,,0.43227,42.91,fee schedule,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,outpatient,1,mL,7537.53000,7160.66000,The Alliance,Premier SAS,,5185.82,,,,,,,719.87,7311.40,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Premier SAS,,4.95,,,,,,,3.60,6.97,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,The Alliance,Premier SAS,,3.08,,,,,,,2.23,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,The Alliance,Premier SAS,,3.05,,,,,,,2.22,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,outpatient,1,EA,7.62000,7.23000,The Alliance,Premier SAS,,5.24,,,,,,,3.81,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,The Alliance,Premier SAS,,6.94,,,,,,,5.04,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,outpatient,1,mL,7.82000,7.43000,The Alliance,Premier SAS,,5.38,,,,,,,3.91,7.59,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,outpatient,1,EA,6.65000,6.31000,The Alliance,Premier SAS,,4.58,,,,,,,3.33,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,The Alliance,Premier SAS,,0.97008,,,,,,,0.70500,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,The Alliance,Premier SAS,,0.41968,,,,,,,0.30500,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,outpatient,1,mL,12088.99000,11484.54000,The Alliance,Premier SAS,,191.27,,,,,,,38.71,11726.32,fee schedule,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,outpatient,1,mL,2760.00000,2622.00000,The Alliance,Premier SAS,,191.27,,,,,,,38.71,2677.20,fee schedule,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,outpatient,1,mL,1079.15000,1025.19000,The Alliance,Premier SAS,,191.27,,,,,,,38.71,1046.78,fee schedule,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,outpatient,1,mL,15.36000,14.59000,The Alliance,Premier SAS,,10.57,,,,,,,7.68,14.90,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,outpatient,1,EA,3.27000,3.10000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,outpatient,1,mL,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,6.32,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,outpatient,1,mL,14.54000,13.81000,The Alliance,Premier SAS,,10.00,,,,,,,7.27,14.10,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.16,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,The Alliance,Premier SAS,,2.30,,,,,,,1.67,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,The Alliance,Premier SAS,,1.91,,,,,,,1.39,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,outpatient,1,mL,5.68000,5.39000,The Alliance,Premier SAS,,3.91,,,,,,,2.84,5.51,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,outpatient,1,EA,216.55000,205.73000,The Alliance,Premier SAS,,148.99,,,,,,,108.28,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,outpatient,1,EA,95.56000,90.78000,The Alliance,Premier SAS,,65.75,,,,,,,47.78,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,outpatient,1,EA,149.05000,141.59000,The Alliance,Premier SAS,,102.55,,,,,,,74.53,144.58,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,outpatient,1,EA,309.43000,293.96000,The Alliance,Premier SAS,,212.89,,,,,,,154.72,300.15,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,outpatient,1,EA,3.50000,3.32000,The Alliance,Premier SAS,,2.41,,,,,,,0.73040,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,outpatient,1,EA,1.10000,1.05000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,outpatient,1,EA,0.69000,0.65000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.73040,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,outpatient,1,EA,86.34000,82.02000,The Alliance,Premier SAS,,59.40,,,,,,,43.17,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,outpatient,1,EA,50.96000,48.41000,The Alliance,Premier SAS,,35.06,,,,,,,25.48,49.43,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,outpatient,1,EA,10.61000,10.08000,The Alliance,Premier SAS,,7.30,,,,,,,5.30,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,outpatient,1,EA,3.45000,3.28000,The Alliance,Premier SAS,,2.37,,,,,,,1.73,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,The Alliance,Premier SAS,,18.66,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,outpatient,1,GM,0.49000,0.46000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,outpatient,1,EA,23.14000,21.98000,The Alliance,Premier SAS,,15.92,,,,,,,11.57,22.45,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,The Alliance,Premier SAS,,0.99072,,,,,,,0.72000,1.40,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,outpatient,1,EA,20.66000,19.63000,The Alliance,Premier SAS,,14.21,,,,,,,10.33,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,outpatient,1,EA,14.28000,13.57000,The Alliance,Premier SAS,,9.82,,,,,,,7.14,13.85,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,outpatient,1,EA,27.09000,25.73000,The Alliance,Premier SAS,,18.64,,,,,,,13.54,26.28,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,The Alliance,Premier SAS,,1.53,,,,,,,1.11,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,The Alliance,Premier SAS,,5.33,,,,,,,3.87,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,outpatient,1,EA,10.76000,10.23000,The Alliance,Premier SAS,,7.40,,,,,,,5.38,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,outpatient,1,EA,5.84000,5.55000,The Alliance,Premier SAS,,4.02,,,,,,,2.92,5.66,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,outpatient,1,EA,47426.37000,45055.05000,The Alliance,Premier SAS,,32629.34,,,,,,,23713.19,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,outpatient,1,EA,38000.00000,36100.00000,The Alliance,Premier SAS,,26144.00,,,,,,,19000.00,36860.00,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier SAS,,5.64,,,,,,,4.10,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,The Alliance,Premier SAS,,3.45,,,,,,,2.51,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,The Alliance,Premier SAS,,3.46,,,,,,,2.52,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,The Alliance,Premier SAS,,5.64,,,,,,,4.10,7.95,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,outpatient,1,EA,18.52000,17.59000,The Alliance,Premier SAS,,12.74,,,,,,,9.26,17.96,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,The Alliance,Premier SAS,,13.60,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,The Alliance,Premier SAS,,1.18,,,,,,,0.85500,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,outpatient,1,EA,9.35000,8.89000,The Alliance,Premier SAS,,6.43,,,,,,,4.67,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,outpatient,1,EA,18.11000,17.21000,The Alliance,Premier SAS,,12.46,,,,,,,9.05,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,outpatient,1,EA,2062.94000,1959.79000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,2001.05,fee schedule,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,outpatient,1,EA,2387.67000,2268.29000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,2316.04,fee schedule,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,outpatient,1,EA,43.45000,41.27000,The Alliance,Premier SAS,,29.89,,,,,,,21.73,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,outpatient,1,EA,75.34000,71.58000,The Alliance,Premier SAS,,51.83,,,,,,,37.67,73.08,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,outpatient,1,EA,256.79000,243.95000,The Alliance,Premier SAS,,176.67,,,,,,,128.40,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,outpatient,1,EA,35.71000,33.92000,The Alliance,Premier SAS,,24.57,,,,,,,17.86,34.64,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,outpatient,1,EA,10.73000,10.19000,The Alliance,Premier SAS,,7.38,,,,,,,5.37,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier SAS,,24.93,,,,,,,18.12,35.15,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier SAS,,9.89,,,,,,,7.18,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,outpatient,1,EA,4.22000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.11,4.09,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,outpatient,1,EA,3.29000,3.13000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,outpatient,1,EA,12.91000,12.26000,The Alliance,Premier SAS,,8.88,,,,,,,6.46,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,outpatient,1,EA,6.89000,6.54000,The Alliance,Premier SAS,,4.74,,,,,,,3.44,6.68,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,outpatient,1,mL,789.60000,750.12000,The Alliance,Premier SAS,,543.24,,,,,,,394.80,765.91,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,outpatient,1,EA,63.19000,60.03000,The Alliance,Premier SAS,,43.47,,,,,,,31.59,61.29,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,outpatient,1,EA,46.75000,44.41000,The Alliance,Premier SAS,,32.16,,,,,,,23.38,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,outpatient,1,EA,1375.24000,1306.48000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,1333.98,fee schedule,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,outpatient,1,EA,1591.71000,1512.12000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,1543.96,fee schedule,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,outpatient,1,EA,2471.39000,2347.82000,The Alliance,Premier SAS,,602.74,,,,,,,376.48,2397.25,fee schedule,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,outpatient,1,EA,1664.33000,1581.12000,The Alliance,Premier SAS,,1145.06,,,,,,,43.79,1614.40,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,outpatient,1,EA,100.29000,95.28000,The Alliance,Premier SAS,,69.00,,,,,,,50.15,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,outpatient,1,EA,44.23000,42.01000,The Alliance,Premier SAS,,30.43,,,,,,,22.11,42.90,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,outpatient,1,mL,10.78000,10.24000,The Alliance,Premier SAS,,7.42,,,,,,,5.39,10.46,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,outpatient,1,EA,92.40000,87.78000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,89.63,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,outpatient,1,EA,39.50000,37.52000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,38.31,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,outpatient,1,EA,42.55000,40.42000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,41.27,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,outpatient,1,EA,43.10000,40.94000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,41.81,fee schedule,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,outpatient,1,EA,43.87000,41.67000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,42.55,fee schedule,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,outpatient,1,EA,33.47000,31.79000,The Alliance,Premier SAS,,23.03,,,,,,,16.73,32.47,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,outpatient,1,EA,223.47000,212.29000,The Alliance,Premier SAS,,153.75,,,,,,,111.73,216.77,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,outpatient,1,EA,3.02000,2.87000,The Alliance,Premier SAS,,2.08,,,,,,,1.51,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,outpatient,1,EA,8.54000,8.11000,The Alliance,Premier SAS,,5.88,,,,,,,4.27,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,outpatient,1,EA,10.51000,9.98000,The Alliance,Premier SAS,,7.23,,,,,,,5.25,10.19,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier SAS,,24.93,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier SAS,,24.93,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,The Alliance,Premier SAS,,24.93,,,,,,,18.12,35.15,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,The Alliance,Premier SAS,,4.11,,,,,,,2.98,5.79,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,outpatient,1,mL,37.82000,35.92000,The Alliance,Premier SAS,,26.02,,,,,,,18.91,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,outpatient,1,mL,3.18000,3.02000,The Alliance,Premier SAS,,2.19,,,,,,,1.59,3.08,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,outpatient,1,EA,12.36000,11.74000,The Alliance,Premier SAS,,8.50,,,,,,,6.18,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,The Alliance,Premier SAS,,2.46,,,,,,,1.79,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,outpatient,1,EA,40.98000,38.93000,The Alliance,Premier SAS,,28.19,,,,,,,20.49,39.75,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,outpatient,1,EA,641.04000,608.99000,The Alliance,Premier SAS,,89.80,,,,,,,56.09,621.81,fee schedule,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,outpatient,1,EA,565.96000,537.66000,The Alliance,Premier SAS,,89.80,,,,,,,56.09,548.98,fee schedule,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,The Alliance,Premier SAS,,1.11,,,,,,,0.81000,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,outpatient,1,EA,53.51000,50.83000,The Alliance,Premier SAS,,36.81,,,,,,,26.75,51.90,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,The Alliance,Premier SAS,,4.95,,,,,,,3.60,6.97,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,outpatient,1,EA,5.29000,5.03000,The Alliance,Premier SAS,,3.64,,,,,,,2.65,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,outpatient,1,EA,7.70000,7.32000,The Alliance,Premier SAS,,5.30,,,,,,,3.85,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,outpatient,1,EA,5.01000,4.75000,The Alliance,Premier SAS,,3.45,,,,,,,2.50,4.86,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,outpatient,1,mL,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,outpatient,1,EA,11.15000,10.59000,The Alliance,Premier SAS,,7.67,,,,,,,5.58,10.82,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,outpatient,1,mL,839.47000,797.49000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,814.29,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,outpatient,1,mL,881.44000,837.37000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,855.00,fee schedule,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,outpatient,1,EA,40.61000,38.58000,The Alliance,Premier SAS,,27.94,,,,,,,20.30,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,outpatient,1,mL,92.40000,87.78000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,89.63,fee schedule,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,outpatient,1,mL,3.36000,3.19000,The Alliance,Premier SAS,,2.31,,,,,,,1.68,3.26,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,The Alliance,Premier SAS,,3.88,,,,,,,2.82,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,outpatient,1,mL,101.37000,96.30000,The Alliance,Premier SAS,,69.74,,,,,,,50.69,98.33,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,outpatient,1,GM,24.73000,23.49000,The Alliance,Premier SAS,,17.01,,,,,,,12.37,23.99,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,outpatient,1,mL,9.54000,9.06000,The Alliance,Premier SAS,,6.56,,,,,,,4.77,9.25,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,outpatient,1,EA,57.87000,54.97000,The Alliance,Premier SAS,,39.81,,,,,,,28.93,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,outpatient,1,EA,46.74000,44.40000,The Alliance,Premier SAS,,32.16,,,,,,,23.37,45.34,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,outpatient,1,EA,402.97000,382.82000,The Alliance,Premier SAS,,277.24,,,,,,,201.49,390.88,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,The Alliance,Premier SAS,,0.61920,,,,,,,0.45000,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,outpatient,1,EA,89.24000,84.77000,The Alliance,Premier SAS,,61.40,,,,,,,44.62,86.56,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,outpatient,1,mL,1.32000,1.26000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,outpatient,1,mL,2.01000,1.91000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,outpatient,1,mL,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,outpatient,1,mL,1.07000,1.01000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,outpatient,1,EA,250.10000,237.60000,The Alliance,Premier SAS,,172.07,,,,,,,125.05,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,outpatient,1,EA,190.56000,181.03000,The Alliance,Premier SAS,,131.11,,,,,,,95.28,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Premier SAS,,106.97,,,,,,,77.74,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,The Alliance,Premier SAS,,106.97,,,,,,,77.74,150.82,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,outpatient,1,GM,9.26000,8.80000,The Alliance,Premier SAS,,6.37,,,,,,,4.63,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Premier SAS,,9.93,,,,,,,7.21,14.00,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,outpatient,1,mL,1627.34000,1545.97000,The Alliance,Premier SAS,,1119.61,,,,,,,813.67,1578.52,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,outpatient,1,mL,121.66000,115.58000,The Alliance,Premier SAS,,83.70,,,,,,,60.83,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,outpatient,1,mL,123.44000,117.27000,The Alliance,Premier SAS,,84.93,,,,,,,61.72,119.74,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,outpatient,1,mL,1.45000,1.38000,The Alliance,Premier SAS,,0.99760,,,,,,,0.72500,1.41,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,outpatient,1,mL,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,outpatient,1,mL,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,outpatient,1,mL,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,outpatient,1,mL,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,outpatient,1,mL,3.85000,3.66000,The Alliance,Premier SAS,,2.65,,,,,,,1.93,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,outpatient,1,mL,0.41000,0.38000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier SAS,,3.14,,,,,,,2.29,4.43,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,outpatient,1,EA,70.34000,66.82000,The Alliance,Premier SAS,,48.39,,,,,,,35.17,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,outpatient,1,EA,26.05000,24.74000,The Alliance,Premier SAS,,17.92,,,,,,,13.03,25.27,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier SAS,,2.31,,,,,,,1.68,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,outpatient,1,EA,2.43000,2.30000,The Alliance,Premier SAS,,1.67,,,,,,,1.22,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,outpatient,1,EA,2.31000,2.19000,The Alliance,Premier SAS,,1.59,,,,,,,1.16,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,outpatient,1,mL,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier SAS,,0.30960,,,,,,,0.22500,0.43650,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,outpatient,1,mL,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,outpatient,1,mL,10.20000,9.69000,The Alliance,Premier SAS,,7.02,,,,,,,5.10,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,outpatient,1,mL,10.76000,10.22000,The Alliance,Premier SAS,,7.40,,,,,,,5.38,10.44,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,outpatient,1,GM,41.98000,39.88000,The Alliance,Premier SAS,,28.88,,,,,,,20.99,40.72,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,outpatient,1,EA,122.59000,116.46000,The Alliance,Premier SAS,,0.57636,,,,,,,0.57636,118.91,fee schedule,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,outpatient,1,mL,0.92000,0.88000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,outpatient,1,mL,3.53000,3.36000,The Alliance,Premier SAS,,2.43,,,,,,,1.76,3.42,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Premier SAS,,2.77,,,,,,,2.02,3.91,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,outpatient,1,EA,177.91000,169.02000,The Alliance,Premier SAS,,122.40,,,,,,,88.95,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,outpatient,1,mL,6.90000,6.55000,The Alliance,Premier SAS,,4.75,,,,,,,3.45,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,outpatient,1,mL,13.21000,12.55000,The Alliance,Premier SAS,,9.09,,,,,,,6.61,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,outpatient,1,mL,6.29000,5.97000,The Alliance,Premier SAS,,4.33,,,,,,,3.15,6.10,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,outpatient,1,GM,21.95000,20.85000,The Alliance,Premier SAS,,15.10,,,,,,,10.97,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Premier SAS,,18.50,,,,,,,13.45,26.08,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,outpatient,1,EA,24.28000,23.06000,The Alliance,Premier SAS,,16.70,,,,,,,12.14,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,outpatient,1,EA,5.66000,5.38000,The Alliance,Premier SAS,,3.89,,,,,,,2.83,5.49,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,The Alliance,Premier SAS,,3.85,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,The Alliance,Premier SAS,,3.85,,,,,,,2.79,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,The Alliance,Premier SAS,,0.96320,,,,,,,0.70000,1.36,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,outpatient,1,EA,716.81000,680.97000,The Alliance,Premier SAS,,3.06,,,,,,,1.91,695.31,fee schedule,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,outpatient,1,EA,828.93000,787.48000,The Alliance,Premier SAS,,3.06,,,,,,,1.91,804.06,fee schedule,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,outpatient,1,mL,3.96000,3.76000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier SAS,,2.64,,,,,,,1.92,3.72,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,outpatient,1,EA,19.45000,18.47000,The Alliance,Premier SAS,,13.38,,,,,,,9.72,18.87,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,The Alliance,Premier SAS,,5.97,,,,,,,4.34,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,outpatient,1,EA,18.49000,17.57000,The Alliance,Premier SAS,,12.72,,,,,,,9.24,17.94,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,The Alliance,Premier SAS,,18.50,,,,,,,13.45,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,outpatient,1,GM,10.53000,10.01000,The Alliance,Premier SAS,,7.24,,,,,,,5.26,10.21,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,outpatient,1,EA,30.81000,29.27000,The Alliance,Premier SAS,,0.57636,,,,,,,0.57636,29.89,fee schedule,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,64.37,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,61.30,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,outpatient,1,mL,56.88000,54.04000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,55.17,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,outpatient,1,mL,58.43000,55.51000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,56.68,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,outpatient,1,mL,58.59000,55.66000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,56.83,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,outpatient,1,mL,51.29000,48.72000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,49.75,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,outpatient,1,mL,57.67000,54.79000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,55.94,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,outpatient,1,mL,60.83000,57.79000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,59.01,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,outpatient,1,mL,42.66000,40.53000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,41.38,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,39.85,fee schedule,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,outpatient,1,mL,1493.82000,1419.13000,The Alliance,Premier SAS,,1027.75,,,,,,,48.92,1449.01,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,outpatient,1,EA,20.76000,19.72000,The Alliance,Premier SAS,,14.28,,,,,,,10.38,20.14,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,outpatient,1,EA,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,outpatient,1,GM,183.72000,174.54000,The Alliance,Premier SAS,,126.40,,,,,,,91.86,178.21,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,outpatient,1,mL,533.15000,506.50000,The Alliance,Premier SAS,,419.83,,,,,,,262.23,517.16,fee schedule,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,The Alliance,Premier SAS,,10.25,,,,,,,7.45,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,outpatient,1,EA,7.12000,6.76000,The Alliance,Premier SAS,,4.90,,,,,,,3.56,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,The Alliance,Premier SAS,,8.33,,,,,,,6.05,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,outpatient,1,EA,132.04000,125.43000,The Alliance,Premier SAS,,90.84,,,,,,,66.02,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier SAS,,10.10,,,,,,,7.34,14.24,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier SAS,,9.47,,,,,,,6.88,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,outpatient,1,EA,307.01000,291.66000,The Alliance,Premier SAS,,211.22,,,,,,,153.50,297.80,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,outpatient,1,EA,904.51000,859.28000,The Alliance,Premier SAS,,622.30,,,,,,,452.25,877.37,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,outpatient,1,mL,47.20000,44.84000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08060,45.78,fee schedule,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,outpatient,1,mL,42.95000,40.80000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08060,41.66,fee schedule,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,outpatient,1,EA,21.04000,19.99000,The Alliance,Premier SAS,,14.48,,,,,,,10.52,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,The Alliance,Premier SAS,,16.35,,,,,,,11.88,23.05,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,outpatient,1,mL,26.54000,25.22000,The Alliance,Premier SAS,,18.26,,,,,,,13.27,25.74,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier SAS,,50.19,,,,,,,39.66,229.89,fee schedule,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,outpatient,1,EA,904.31000,859.09000,The Alliance,Premier SAS,,622.17,,,,,,,452.15,877.18,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Premier SAS,,58.23,,,,,,,28.36,60.01,fee schedule,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Premier SAS,,58.23,,,,,,,52.64,110.03,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Premier SAS,,3.94,,,,,,,1.13,4.06,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,outpatient,1,mL,2.32000,2.20000,The Alliance,Premier SAS,,3.94,,,,,,,1.16,4.06,fee schedule,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier SAS,,3.94,,,,,,,1.15,4.06,fee schedule,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,The Alliance,Premier SAS,,1.89,,,,,,,1.38,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,outpatient,1,EA,61.04000,57.99000,The Alliance,Premier SAS,,42.00,,,,,,,30.52,59.21,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,The Alliance,Premier SAS,,3.61,,,,,,,2.62,5.09,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,outpatient,1,GM,26.25000,24.94000,The Alliance,Premier SAS,,18.06,,,,,,,13.12,25.46,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,outpatient,1,mL,100.25000,95.24000,The Alliance,Premier SAS,,68.97,,,,,,,50.12,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,outpatient,1,mL,64.08000,60.88000,The Alliance,Premier SAS,,44.09,,,,,,,32.04,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,outpatient,1,mL,73.53000,69.86000,The Alliance,Premier SAS,,50.59,,,,,,,36.77,71.32,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,outpatient,1,EA,4.31000,4.09000,The Alliance,Premier SAS,,2.97,,,,,,,2.15,4.18,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,outpatient,1,EA,20.06000,19.06000,The Alliance,Premier SAS,,13.80,,,,,,,10.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,outpatient,1,EA,27.01000,25.66000,The Alliance,Premier SAS,,18.58,,,,,,,13.51,26.20,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,outpatient,1,mL,12.11000,11.51000,The Alliance,Premier SAS,,8.33,,,,,,,6.05,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Premier SAS,,2.02,,,,,,,1.47,2.85,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,The Alliance,Premier SAS,,2.33,,,,,,,1.69,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,outpatient,1,EA,23.22000,22.06000,The Alliance,Premier SAS,,15.98,,,,,,,11.61,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,outpatient,1,EA,8.59000,8.16000,The Alliance,Premier SAS,,5.91,,,,,,,4.29,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,The Alliance,Premier SAS,,0.90816,,,,,,,0.66000,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,outpatient,1,EA,4.83000,4.59000,The Alliance,Premier SAS,,3.32,,,,,,,2.42,4.69,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,The Alliance,Premier SAS,,2.88,,,,,,,2.10,4.06,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,outpatient,1,mL,3283.73000,3119.54000,The Alliance,Premier SAS,,2259.21,,,,,,,1641.87,3185.22,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,outpatient,1,EA,950.25000,902.73000,The Alliance,Premier SAS,,653.77,,,,,,,365.89,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,outpatient,1,EA,1541.05000,1464.00000,The Alliance,Premier SAS,,1060.24,,,,,,,365.89,1494.82,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,outpatient,1,EA,112.97000,107.32000,The Alliance,Premier SAS,,77.72,,,,,,,56.48,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,outpatient,1,EA,122.45000,116.33000,The Alliance,Premier SAS,,84.25,,,,,,,61.23,118.78,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,The Alliance,Premier SAS,,4.66,,,,,,,3.39,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,outpatient,1,EA,110.60000,105.07000,The Alliance,Premier SAS,,76.09,,,,,,,55.30,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,outpatient,1,mL,30.03000,28.53000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,29.13,fee schedule,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,outpatient,1,mL,27.40000,26.03000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,26.58,fee schedule,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,outpatient,1,mL,22.16000,21.06000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,21.50,fee schedule,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,outpatient,1,EA,72.11000,68.51000,The Alliance,Premier SAS,,49.61,,,,,,,36.05,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,outpatient,1,EA,101.10000,96.04000,The Alliance,Premier SAS,,69.56,,,,,,,50.55,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,outpatient,1,EA,84.98000,80.73000,The Alliance,Premier SAS,,58.47,,,,,,,42.49,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,outpatient,1,EA,86.99000,82.64000,The Alliance,Premier SAS,,59.85,,,,,,,43.49,84.38,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,outpatient,1,GM,2.52000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.26,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,outpatient,1,GM,2.30000,2.18000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.23,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,The Alliance,Premier SAS,,1.96,,,,,,,1.43,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,outpatient,1,EA,690.86000,656.31000,The Alliance,Premier SAS,,0.57636,,,,,,,0.57636,670.13,fee schedule,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,outpatient,1,EA,12.76000,12.12000,The Alliance,Premier SAS,,8.78,,,,,,,6.38,12.38,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,The Alliance,Premier SAS,,4.86,,,,,,,3.53,6.85,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,outpatient,1,EA,486.88000,462.54000,The Alliance,Premier SAS,,334.97,,,,,,,243.44,472.27,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,outpatient,1,GM,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,outpatient,1,GM,5.26000,5.00000,The Alliance,Premier SAS,,3.62,,,,,,,2.63,5.10,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,outpatient,1,mL,11.32000,10.76000,The Alliance,Premier SAS,,7.79,,,,,,,5.66,10.98,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,The Alliance,Premier SAS,,0.66736,,,,,,,0.48500,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,outpatient,1,EA,5.89000,5.59000,The Alliance,Premier SAS,,4.05,,,,,,,2.94,5.71,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,The Alliance,Premier SAS,,1.33,,,,,,,0.97000,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,The Alliance,Premier SAS,,0.74304,,,,,,,0.54000,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,outpatient,1,GM,26.57000,25.24000,The Alliance,Premier SAS,,18.28,,,,,,,13.29,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,outpatient,1,GM,10.25000,9.74000,The Alliance,Premier SAS,,7.05,,,,,,,5.12,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,outpatient,1,GM,9.74000,9.25000,The Alliance,Premier SAS,,6.70,,,,,,,4.87,9.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Premier SAS,,23.15,,,,,,,22.94,80.33,fee schedule,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,outpatient,1,mL,82.81000,78.67000,The Alliance,Premier SAS,,23.15,,,,,,,22.94,80.33,fee schedule,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier SAS,,2.00,,,,,,,1.46,2.82,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,outpatient,1,EA,3.53000,3.36000,The Alliance,Premier SAS,,2.43,,,,,,,1.76,3.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier SAS,,11.19,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,The Alliance,Premier SAS,,11.19,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,outpatient,1,EA,12.80000,12.16000,The Alliance,Premier SAS,,8.81,,,,,,,6.40,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,outpatient,1,EA,23.45000,22.27000,The Alliance,Premier SAS,,16.13,,,,,,,11.72,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,outpatient,1,mL,3.02000,2.87000,The Alliance,Premier SAS,,5.49,,,,,,,1.51,5.89,fee schedule,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,outpatient,1,EA,1283.15000,1219.00000,The Alliance,Premier SAS,,882.81,,,,,,,641.58,1244.66,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,outpatient,1,GM,3.99000,3.79000,The Alliance,Premier SAS,,2.75,,,,,,,2.00,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,outpatient,1,GM,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,outpatient,1,EA,405.34000,385.07000,The Alliance,Premier SAS,,0.81651,,,,,,,0.46810,393.18,fee schedule,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,outpatient,1,EA,404.04000,383.84000,The Alliance,Premier SAS,,0.81651,,,,,,,0.46810,391.92,fee schedule,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,outpatient,1,EA,271.95000,258.35000,The Alliance,Premier SAS,,0.81651,,,,,,,0.46810,263.79,fee schedule,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,outpatient,1,mL,75.14000,71.39000,The Alliance,Premier SAS,,51.70,,,,,,,37.57,72.89,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,outpatient,1,mL,38.43000,36.51000,The Alliance,Premier SAS,,26.44,,,,,,,19.21,37.28,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,outpatient,1,EA,3.59000,3.41000,The Alliance,Premier SAS,,2.47,,,,,,,1.79,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,outpatient,1,EA,4.22000,4.01000,The Alliance,Premier SAS,,2.90,,,,,,,2.11,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,outpatient,1,EA,6.71000,6.37000,The Alliance,Premier SAS,,4.62,,,,,,,3.35,6.51,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,outpatient,1,EA,89.14000,84.68000,The Alliance,Premier SAS,,61.33,,,,,,,44.57,86.47,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,outpatient,1,GM,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,outpatient,1,mL,40.04000,38.04000,The Alliance,Premier SAS,,27.55,,,,,,,20.02,38.84,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,The Alliance,Premier SAS,,18.22,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,The Alliance,Premier SAS,,14.15,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Premier SAS,,3.69,,,,,,,2.68,5.20,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,outpatient,1,mL,16.20000,15.39000,The Alliance,Premier SAS,,11.15,,,,,,,8.10,15.71,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,outpatient,1,EA,43.61000,41.43000,The Alliance,Premier SAS,,8.47,,,,,,,7.96,42.30,fee schedule,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.32,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,outpatient,1,EA,190.55000,181.02000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,184.83,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,outpatient,1,EA,388.34000,368.93000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,376.69,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,outpatient,1,EA,386.40000,367.08000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,374.81,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,122.61,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,outpatient,1,EA,189.60000,180.12000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,183.91,fee schedule,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,outpatient,1,EA,316.16000,300.35000,The Alliance,Premier SAS,,1.25,,,,,,,1.25,306.68,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,outpatient,1,EA,203.60000,193.42000,The Alliance,Premier SAS,,5.03,,,,,,,5.03,197.49,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,outpatient,1,EA,148.52000,141.09000,The Alliance,Premier SAS,,5.03,,,,,,,5.03,144.06,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,outpatient,1,EA,103.62000,98.44000,The Alliance,Premier SAS,,5.03,,,,,,,5.03,100.51,fee schedule,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,outpatient,1,EA,62.92000,59.77000,The Alliance,Premier SAS,,5.03,,,,,,,5.03,61.03,fee schedule,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,outpatient,1,EA,79.88000,75.88000,The Alliance,Premier SAS,,54.96,,,,,,,39.94,77.48,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,outpatient,1,EA,279.35000,265.38000,The Alliance,Premier SAS,,192.19,,,,,,,139.68,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,outpatient,1,EA,65.31000,62.04000,The Alliance,Premier SAS,,44.93,,,,,,,32.66,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,The Alliance,Premier SAS,,7.97,,,,,,,5.79,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,outpatient,1,EA,50.36000,47.85000,The Alliance,Premier SAS,,34.65,,,,,,,25.18,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,outpatient,1,EA,12.54000,11.92000,The Alliance,Premier SAS,,8.63,,,,,,,6.27,12.16,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,outpatient,1,EA,2.44000,2.31000,The Alliance,Premier SAS,,1.68,,,,,,,1.22,2.37,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,outpatient,1,mL,1495.72000,1420.94000,The Alliance,Premier SAS,,1029.06,,,,,,,747.86,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Premier SAS,,130.44,,,,,,,94.80,183.91,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,outpatient,,,150.51000,142.98000,The Alliance,Premier SAS,,103.55,,,,,,,75.25,147.29,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,outpatient,1,EA,301.02000,285.97000,The Alliance,Premier SAS,,207.10,,,,,,,147.29,291.99,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,outpatient,1,mL,2.90000,2.75000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,outpatient,1,mL,8.18000,7.77000,The Alliance,Premier SAS,,5.63,,,,,,,4.09,7.93,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier SAS,,9.72,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier SAS,,9.72,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,The Alliance,Premier SAS,,9.72,,,,,,,7.07,13.71,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,outpatient,1,mL,482.37000,458.26000,The Alliance,Premier SAS,,16.22,,,,,,,10.13,467.90,fee schedule,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,outpatient,1,EA,23.06000,21.91000,The Alliance,Premier SAS,,15.87,,,,,,,11.53,22.37,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,outpatient,1,GM,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,outpatient,1,GM,3.29000,3.13000,The Alliance,Premier SAS,,2.26,,,,,,,1.65,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,outpatient,1,GM,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,outpatient,1,EA,277.41000,263.54000,The Alliance,Premier SAS,,190.86,,,,,,,138.71,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,The Alliance,Premier SAS,,11.92,,,,,,,8.66,16.81,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,outpatient,1,EA,64.78000,61.54000,The Alliance,Premier SAS,,44.57,,,,,,,32.39,62.84,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,outpatient,1,EA,11.16000,10.61000,The Alliance,Premier SAS,,7.68,,,,,,,5.58,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,The Alliance,Premier SAS,,43.48,,,,,,,31.60,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,outpatient,1,EA,30.02000,28.52000,The Alliance,Premier SAS,,20.65,,,,,,,15.01,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,The Alliance,Premier SAS,,6.48,,,,,,,4.71,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,outpatient,1,EA,2.48000,2.36000,The Alliance,Premier SAS,,1.71,,,,,,,1.24,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,outpatient,1,EA,3.72000,3.54000,The Alliance,Premier SAS,,2.56,,,,,,,1.86,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,outpatient,1,EA,140.09000,133.09000,The Alliance,Premier SAS,,96.38,,,,,,,70.05,135.89,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,outpatient,1,EA,53.19000,50.53000,The Alliance,Premier SAS,,36.59,,,,,,,26.59,51.59,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,outpatient,1,mL,8.06000,7.66000,The Alliance,Premier SAS,,5.55,,,,,,,4.03,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,3.04,,,,,,,2.21,4.29,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,outpatient,1,EA,30.27000,28.76000,The Alliance,Premier SAS,,20.83,,,,,,,15.13,29.36,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,outpatient,1,EA,37.52000,35.65000,The Alliance,Premier SAS,,25.81,,,,,,,18.76,36.39,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,outpatient,1,EA,126.72000,120.39000,The Alliance,Premier SAS,,87.18,,,,,,,63.36,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,outpatient,1,EA,13.26000,12.60000,The Alliance,Premier SAS,,9.12,,,,,,,6.63,12.86,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,outpatient,1,EA,4.96000,4.71000,The Alliance,Premier SAS,,3.41,,,,,,,2.48,4.81,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,The Alliance,Premier SAS,,1.03,,,,,,,0.75000,1.46,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,outpatient,1,EA,162.76000,154.62000,The Alliance,Premier SAS,,111.98,,,,,,,81.38,157.88,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,outpatient,1,EA,23.65000,22.47000,The Alliance,Premier SAS,,16.27,,,,,,,11.82,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,outpatient,1,EA,13.88000,13.19000,The Alliance,Premier SAS,,9.55,,,,,,,6.94,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,The Alliance,Premier SAS,,1.72,,,,,,,1.25,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,outpatient,1,EA,2.44000,2.32000,The Alliance,Premier SAS,,1.68,,,,,,,1.22,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,outpatient,1,EA,18.82000,17.88000,The Alliance,Premier SAS,,12.95,,,,,,,9.41,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,outpatient,1,mL,44.32000,42.10000,The Alliance,Premier SAS,,30.49,,,,,,,22.16,42.99,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.65,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,outpatient,1,EA,24.78000,23.54000,The Alliance,Premier SAS,,17.05,,,,,,,12.39,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,outpatient,1,EA,69.38000,65.91000,The Alliance,Premier SAS,,47.73,,,,,,,34.69,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,11.85,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,outpatient,1,EA,18.99000,18.04000,The Alliance,Premier SAS,,13.07,,,,,,,9.49,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,outpatient,1,EA,104.09000,98.88000,The Alliance,Premier SAS,,71.61,,,,,,,52.05,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,outpatient,1,EA,100.16000,95.15000,The Alliance,Premier SAS,,68.91,,,,,,,50.08,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,The Alliance,Premier SAS,,4.82,,,,,,,3.50,6.80,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,outpatient,1,mL,47.56000,45.18000,The Alliance,Premier SAS,,12.58,,,,,,,12.58,46.13,fee schedule,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,outpatient,1,mL,17.89000,16.99000,The Alliance,Premier SAS,,12.58,,,,,,,8.95,17.35,fee schedule,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,The Alliance,Premier SAS,,6.91,,,,,,,5.03,9.75,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,outpatient,1,EA,18.22000,17.31000,The Alliance,Premier SAS,,12.54,,,,,,,9.11,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,outpatient,1,EA,14.92000,14.17000,The Alliance,Premier SAS,,10.26,,,,,,,7.46,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,outpatient,1,EA,26.25000,24.94000,The Alliance,Premier SAS,,18.06,,,,,,,13.12,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,The Alliance,Premier SAS,,2.86,,,,,,,2.08,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,The Alliance,Premier SAS,,4.46,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,outpatient,1,EA,40.35000,38.34000,The Alliance,Premier SAS,,27.76,,,,,,,20.18,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,outpatient,1,EA,2.69000,2.56000,The Alliance,Premier SAS,,1.85,,,,,,,1.34,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,outpatient,1,EA,8.78000,8.35000,The Alliance,Premier SAS,,6.04,,,,,,,4.39,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,The Alliance,Premier SAS,,6.02,,,,,,,4.38,8.49,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,outpatient,1,mL,23.64000,22.45000,The Alliance,Premier SAS,,16.26,,,,,,,11.82,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,outpatient,1,mL,35.57000,33.79000,The Alliance,Premier SAS,,24.47,,,,,,,17.79,34.50,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,outpatient,1,GM,46.14000,43.83000,The Alliance,Premier SAS,,31.74,,,,,,,23.07,44.76,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,outpatient,1,EA,15.86000,15.07000,The Alliance,Premier SAS,,10.91,,,,,,,7.93,15.38,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,The Alliance,Premier SAS,,1.27,,,,,,,0.92000,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,The Alliance,Premier SAS,,2.11,,,,,,,1.53,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,outpatient,1,EA,8.49000,8.06000,The Alliance,Premier SAS,,5.84,,,,,,,4.25,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,outpatient,,,91.00000,86.45000,The Alliance,Premier SAS,,57.75,,,,,,,8.08,424.40,fee schedule,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier SAS,,83.17,,,,,,,11.61,611.15,fee schedule,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,outpatient,,,1089.00000,1034.55000,The Alliance,Premier SAS,,749.23,,,,,,,544.50,1056.33,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier SAS,,507.06,,,,,,,368.50,714.89,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,1.29,fee schedule,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,1.29,fee schedule,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier SAS,,1710.23,,,,,,,1710.23,3726.00,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier SAS,,1084.39,,,,,,,1084.39,2362.50,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier SAS,,1420.03,,,,,,,1420.03,3093.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,40.39,,,,,,,40.39,88.00,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier SAS,,6488.42,,,,,,,6488.42,14136.00,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier SAS,,1084.39,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier SAS,,1290.94,,,,,,,1290.94,2812.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier SAS,,1290.94,,,,,,,1290.94,2812.50,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier SAS,,9988.76,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier SAS,,105.00,,,,,,,105.00,228.75,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier SAS,,9533.43,,,,,,,9533.43,20770.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier SAS,,38.19,,,,,,,38.19,83.20,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier SAS,,9533.43,,,,,,,9533.43,20770.00,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier SAS,,6488.42,,,,,,,6488.42,14136.00,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier SAS,,2209.05,,,,,,,2209.05,4812.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier SAS,,9988.76,,,,,,,9988.76,21762.00,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Premier SAS,,600.72,,,,,,,600.72,1308.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier SAS,,9988.76,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.68000,180.20000,The Alliance,Premier SAS,,87.06,,,,,,,87.06,189.68,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,The Alliance,Premier SAS,,600.72,,,,,,,600.72,1308.75,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier SAS,,387.28,,,,,,,387.28,843.75,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,247.50000,235.12000,The Alliance,Premier SAS,,113.60,,,,,,,113.60,247.50,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier SAS,,9988.76,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier SAS,,114.47,,,,,,,114.47,249.38,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,The Alliance,Premier SAS,,9988.76,,,,,,,9988.76,21762.00,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier SAS,,301.22,,,,,,,301.22,656.25,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,The Alliance,Premier SAS,,6488.42,,,,,,,6488.42,14136.00,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier SAS,,967.59,,,,,,,967.59,2108.03,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,87.21,,,,,,,87.21,190.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Premier SAS,,812.43,,,,,,,812.43,1770.00,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13020.00000,12369.00000,The Alliance,Premier SAS,,5976.18,,,,,,,5976.18,13020.00,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13485.00000,12810.75000,The Alliance,Premier SAS,,6189.61,,,,,,,6189.61,13485.00,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier SAS,,3087.92,,,,,,,3087.92,6727.50,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1266.64000,1203.31000,The Alliance,Premier SAS,,581.39,,,,,,,581.39,1266.64,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,284.01,,,,,,,284.01,618.75,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3476.25000,3302.44000,The Alliance,Premier SAS,,1595.60,,,,,,,1595.60,3476.25,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5126.70000,4870.36000,The Alliance,Premier SAS,,2353.16,,,,,,,2353.16,5126.70,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,45.32000,43.05000,The Alliance,Premier SAS,,20.80,,,,,,,20.80,45.32,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier SAS,,499.16,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier SAS,,370.07,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Premier SAS,,2343.02,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,The Alliance,Premier SAS,,312.92,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,The Alliance,Premier SAS,,2343.02,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier SAS,,370.07,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier SAS,,370.07,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,The Alliance,Premier SAS,,398.52,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Premier SAS,,341.58,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Premier SAS,,857.18,,,,,,,857.18,1867.50,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,702.86000,667.72000,The Alliance,Premier SAS,,322.61,,,,,,,322.61,702.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,The Alliance,Premier SAS,,341.58,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4936.95000,4690.10000,The Alliance,Premier SAS,,2266.06,,,,,,,2266.06,4936.95,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,The Alliance,Premier SAS,,857.18,,,,,,,857.18,1867.50,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Premier SAS,,585.23,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,The Alliance,Premier SAS,,585.23,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier SAS,,17.75,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,90.88000,86.34000,The Alliance,Premier SAS,,41.71,,,,,,,41.71,90.88,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Premier SAS,,4349.70,,,,,,,4349.70,9476.46,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier SAS,,456.13,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,45.90,,,,,,,45.90,100.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier SAS,,86.06,,,,,,,86.06,187.50,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,687.15000,652.79000,The Alliance,Premier SAS,,315.40,,,,,,,315.40,687.15,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier SAS,,2454.50,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,The Alliance,Premier SAS,,161.30,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6520.50000,6194.47000,The Alliance,Premier SAS,,2992.91,,,,,,,2992.91,6520.50,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,485.25000,460.99000,The Alliance,Premier SAS,,222.73,,,,,,,222.73,485.25,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,757.50000,719.62000,The Alliance,Premier SAS,,347.69,,,,,,,347.69,757.50,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier SAS,,8558.74,,,,,,,8558.74,18646.50,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier SAS,,1506.09,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Premier SAS,,197.94,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier SAS,,8558.74,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier SAS,,1506.09,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Premier SAS,,2285.06,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,The Alliance,Premier SAS,,2285.06,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Premier SAS,,2929.57,,,,,,,2929.57,6382.50,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2497.50000,2372.62000,The Alliance,Premier SAS,,1146.35,,,,,,,1146.35,2497.50,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Premier SAS,,207.84,,,,,,,207.84,452.81,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier SAS,,1247.91,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,The Alliance,Premier SAS,,2929.57,,,,,,,2929.57,6382.50,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier SAS,,8558.74,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,The Alliance,Premier SAS,,207.84,,,,,,,207.84,452.81,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier SAS,,298.21,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,,38.56,,,,,,,38.56,84.00,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Premier SAS,,495.72,,,,,,,495.72,1080.00,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier SAS,,298.21,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier SAS,,287.45,,,,,,,287.45,626.25,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,The Alliance,Premier SAS,,298.21,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,91.23,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier SAS,,287.45,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier SAS,,4354.76,,,,,,,4354.76,9487.50,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,666.00000,632.70000,The Alliance,Premier SAS,,305.69,,,,,,,305.69,666.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier SAS,,602.44,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier SAS,,1247.91,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Premier SAS,,35.99,,,,,,,35.99,78.40,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier SAS,,287.45,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,,192.78,,,,,,,192.78,420.00,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,746.29000,708.98000,The Alliance,Premier SAS,,342.55,,,,,,,342.55,746.29,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,,619.65,,,,,,,619.65,1350.00,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier SAS,,602.44,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Premier SAS,,889.89,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,47.68000,45.30000,The Alliance,Premier SAS,,21.89,,,,,,,21.89,47.68,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3479.63000,3305.65000,The Alliance,Premier SAS,,1597.15,,,,,,,1597.15,3479.63,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1162.50000,1104.38000,The Alliance,Premier SAS,,533.59,,,,,,,533.59,1162.50,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9970.50000,9471.98000,The Alliance,Premier SAS,,4576.46,,,,,,,4576.46,9970.50,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Premier SAS,,720.35,,,,,,,720.35,1569.38,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,96.44000,91.62000,The Alliance,Premier SAS,,44.27,,,,,,,44.27,96.44,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier SAS,,3851.19,,,,,,,3851.19,8390.40,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9270.15000,8806.64000,The Alliance,Premier SAS,,4255.00,,,,,,,4255.00,9270.15,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,,38.56,,,,,,,38.56,84.00,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,498.26000,473.35000,The Alliance,Premier SAS,,228.70,,,,,,,228.70,498.26,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,431.25000,409.69000,The Alliance,Premier SAS,,197.94,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,The Alliance,Premier SAS,,889.89,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Premier SAS,,4259.75,,,,,,,4259.75,9280.50,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier SAS,,3851.19,,,,,,,3851.19,8390.40,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,119.76000,113.77000,The Alliance,Premier SAS,,54.97,,,,,,,54.97,119.76,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3660.00000,3477.00000,The Alliance,Premier SAS,,1679.94,,,,,,,1679.94,3660.00,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Premier SAS,,81.72,,,,,,,81.72,178.04,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier SAS,,176.38,,,,,,,176.38,384.26,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,247.43000,235.06000,The Alliance,Premier SAS,,113.57,,,,,,,113.57,247.43,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier SAS,,199.53,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,The Alliance,Premier SAS,,173.19,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,510.00000,484.50000,The Alliance,Premier SAS,,234.09,,,,,,,234.09,510.00,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier SAS,,35.23,,,,,,,35.23,76.76,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2124.00000,2017.80000,The Alliance,Premier SAS,,974.92,,,,,,,974.92,2124.00,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,93.40000,88.73000,The Alliance,Premier SAS,,42.87,,,,,,,42.87,93.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Premier SAS,,937.41,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,320.59000,304.56000,The Alliance,Premier SAS,,147.15,,,,,,,147.15,320.59,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,305.33000,290.06000,The Alliance,Premier SAS,,140.15,,,,,,,140.15,305.33,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,836.25000,794.44000,The Alliance,Premier SAS,,383.84,,,,,,,383.84,836.25,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Premier SAS,,8252.82,,,,,,,8252.82,17980.00,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,The Alliance,Premier SAS,,8252.82,,,,,,,8252.82,17980.00,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Premier SAS,,370.50,,,,,,,370.50,807.19,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,903.75000,858.56000,The Alliance,Premier SAS,,414.82,,,,,,,414.82,903.75,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Premier SAS,,238.36,,,,,,,238.36,519.30,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Premier SAS,,1432.08,,,,,,,1432.08,3120.00,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,416.25000,395.44000,The Alliance,Premier SAS,,191.06,,,,,,,191.06,416.25,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,921.79000,875.70000,The Alliance,Premier SAS,,423.10,,,,,,,423.10,921.79,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,73.44,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier SAS,,1561.17,,,,,,,1561.17,3401.25,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier SAS,,13104.65,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2891.25000,2746.69000,The Alliance,Premier SAS,,1327.08,,,,,,,1327.08,2891.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier SAS,,1561.17,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Premier SAS,,76.27,,,,,,,76.27,166.16,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier SAS,,13104.65,,,,,,,13104.65,28550.44,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,outpatient,,,47250.00000,44887.50000,The Alliance,Premier SAS,,21687.75,,,,,,,21687.75,47250.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,73.44,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Premier SAS,,1002.63,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier SAS,,13104.65,,,,,,,13104.65,28550.44,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,The Alliance,Premier SAS,,13104.65,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,The Alliance,Premier SAS,,1561.17,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,The Alliance,Premier SAS,,937.41,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,91.23,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,5137.91000,4881.01000,The Alliance,Premier SAS,,2358.30,,,,,,,2358.30,5137.91,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,191.25000,181.69000,The Alliance,Premier SAS,,87.78,,,,,,,87.78,191.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier SAS,,2137.79,,,,,,,2137.79,4657.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Premier SAS,,4802.29,,,,,,,4802.29,10148.62,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,,83.54,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11082.50000,10528.38000,The Alliance,Premier SAS,,5086.87,,,,,,,5086.87,10750.02,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,,83.54,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Premier SAS,,9355.71,,,,,,,9355.71,20382.81,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier SAS,,98.97,,,,,,,98.97,215.63,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,24570.00000,23341.50000,The Alliance,Premier SAS,,11277.63,,,,,,,11277.63,24570.00,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier SAS,,92.95,,,,,,,92.95,202.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9842.50000,9350.38000,The Alliance,Premier SAS,,4517.71,,,,,,,4517.71,9547.23,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,637.50000,605.62000,The Alliance,Premier SAS,,292.61,,,,,,,292.61,637.50,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier SAS,,11173.92,,,,,,,11173.92,24344.05,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,46200.00000,43890.00000,The Alliance,Premier SAS,,21205.80,,,,,,,21205.80,46200.00,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier SAS,,11173.92,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,22575.00000,21446.25000,The Alliance,Premier SAS,,10361.92,,,,,,,10361.92,22575.00,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11532.00000,10955.40000,The Alliance,Premier SAS,,5293.19,,,,,,,5293.19,11186.04,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier SAS,,33.89,,,,,,,33.89,73.84,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,431.63000,410.05000,The Alliance,Premier SAS,,198.12,,,,,,,198.12,431.63,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Premier SAS,,4695.57,,,,,,,4695.57,10230.00,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11780.00000,11191.00000,The Alliance,Premier SAS,,5407.02,,,,,,,5407.02,11426.60,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Premier SAS,,339.09,,,,,,,339.09,738.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,29.28000,27.82000,The Alliance,Premier SAS,,13.44,,,,,,,13.44,29.28,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,217.50000,206.62000,The Alliance,Premier SAS,,99.83,,,,,,,99.83,217.50,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,9513.90000,9038.20000,The Alliance,Premier SAS,,4366.88,,,,,,,4366.88,9513.90,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,541.50000,514.42000,The Alliance,Premier SAS,,248.55,,,,,,,248.55,541.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier SAS,,33.89,,,,,,,33.89,73.84,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,881.25000,837.19000,The Alliance,Premier SAS,,404.49,,,,,,,404.49,881.25,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,128.20000,121.79000,The Alliance,Premier SAS,,58.84,,,,,,,58.84,128.20,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.64000,73.76000,The Alliance,Premier SAS,,35.64,,,,,,,35.64,77.64,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Premier SAS,,181.59,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier SAS,,38.19,,,,,,,38.19,83.20,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.85000,253.51000,The Alliance,Premier SAS,,122.48,,,,,,,122.48,266.85,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Premier SAS,,32.00,,,,,,,32.00,69.72,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Premier SAS,,2540.01,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,94.96000,90.21000,The Alliance,Premier SAS,,43.59,,,,,,,43.59,94.96,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier SAS,,301.22,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,46.72000,44.38000,The Alliance,Premier SAS,,21.44,,,,,,,21.44,46.72,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier SAS,,92.95,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,The Alliance,Premier SAS,,2540.01,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,58.84000,55.90000,The Alliance,Premier SAS,,27.01,,,,,,,27.01,58.84,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Premier SAS,,2033.28,,,,,,,2033.28,4429.80,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3397.09000,3227.24000,The Alliance,Premier SAS,,1559.26,,,,,,,1559.26,3397.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Premier SAS,,920.85,,,,,,,920.85,2006.21,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8752.62000,8314.99000,The Alliance,Premier SAS,,4017.45,,,,,,,4017.45,8752.62,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier SAS,,301.22,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.83000,274.39000,The Alliance,Premier SAS,,132.57,,,,,,,132.57,288.83,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,The Alliance,Premier SAS,,2033.28,,,,,,,2033.28,4429.80,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,59.44000,56.47000,The Alliance,Premier SAS,,27.28,,,,,,,27.28,59.44,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Premier SAS,,26025.30,,,,,,,26025.30,56700.00,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier SAS,,183.32,,,,,,,183.32,399.38,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier SAS,,46.60,,,,,,,46.60,101.52,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier SAS,,67.75,,,,,,,67.75,147.60,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,162.40000,154.28000,The Alliance,Premier SAS,,74.54,,,,,,,74.54,162.40,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9953.60000,9455.92000,The Alliance,Premier SAS,,4568.70,,,,,,,4568.70,9953.60,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,606.38000,576.06000,The Alliance,Premier SAS,,278.33,,,,,,,278.33,606.38,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Premier SAS,,101.55,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,177.68000,168.80000,The Alliance,Premier SAS,,81.56,,,,,,,81.56,177.68,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,131.64000,125.06000,The Alliance,Premier SAS,,60.42,,,,,,,60.42,131.64,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier SAS,,67.75,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,16.52,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier SAS,,67.75,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,16.52,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,16.52,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier SAS,,176.38,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,59.56000,56.58000,The Alliance,Premier SAS,,27.34,,,,,,,27.34,59.56,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier SAS,,86.84,,,,,,,86.84,189.20,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,137.96000,131.06000,The Alliance,Premier SAS,,63.32,,,,,,,63.32,137.96,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,440.63000,418.60000,The Alliance,Premier SAS,,202.25,,,,,,,202.25,440.63,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1049.63000,997.15000,The Alliance,Premier SAS,,481.78,,,,,,,481.78,1049.63,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,164.80000,156.56000,The Alliance,Premier SAS,,75.64,,,,,,,75.64,164.80,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.46000,1745.59000,The Alliance,Premier SAS,,843.39,,,,,,,843.39,1837.46,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier SAS,,78.95,,,,,,,78.95,172.00,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier SAS,,2850.39,,,,,,,2850.39,6210.00,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4142.31000,3935.19000,The Alliance,Premier SAS,,1901.32,,,,,,,1901.32,4142.31,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier SAS,,764.24,,,,,,,764.24,1615.05,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3225.00000,3063.75000,The Alliance,Premier SAS,,1480.28,,,,,,,1480.28,3225.00,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Premier SAS,,617.93,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,The Alliance,Premier SAS,,617.93,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Premier SAS,,1204.88,,,,,,,1204.88,2625.00,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4227.56000,4016.18000,The Alliance,Premier SAS,,1940.45,,,,,,,1940.45,4227.56,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7900.50000,7505.47000,The Alliance,Premier SAS,,3626.33,,,,,,,3626.33,7900.50,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier SAS,,1918.31,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier SAS,,1918.31,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier SAS,,1918.31,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2733.75000,2597.06000,The Alliance,Premier SAS,,1254.79,,,,,,,1254.79,2733.75,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2572.50000,2443.88000,The Alliance,Premier SAS,,1180.78,,,,,,,1180.78,2572.50,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.00000,572.85000,The Alliance,Premier SAS,,276.78,,,,,,,276.78,603.00,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Premier SAS,,1617.04,,,,,,,1617.04,3522.97,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Premier SAS,,2106.44,,,,,,,2106.44,4589.19,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,The Alliance,Premier SAS,,2106.44,,,,,,,2106.44,4589.19,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,The Alliance,Premier SAS,,1918.31,,,,,,,1918.31,4179.33,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4305.84000,4090.55000,The Alliance,Premier SAS,,1976.38,,,,,,,1976.38,4305.84,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Premier SAS,,111.50,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier SAS,,144.59,,,,,,,144.59,315.00,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,The Alliance,Premier SAS,,111.50,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Premier SAS,,119.85,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Premier SAS,,2153.63,,,,,,,2153.63,4692.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Premier SAS,,1695.43,,,,,,,1695.43,3693.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.52000,42.29000,The Alliance,Premier SAS,,20.43,,,,,,,20.43,44.52,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier SAS,,426.87,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier SAS,,2644.53,,,,,,,2644.53,5761.50,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier SAS,,843.41,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,2051.96000,1949.36000,The Alliance,Premier SAS,,941.85,,,,,,,941.85,2051.96,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier SAS,,426.87,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,The Alliance,Premier SAS,,1695.43,,,,,,,1695.43,3693.75,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier SAS,,4718.98,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier SAS,,499.16,,,,,,,499.16,1087.50,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier SAS,,4718.98,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Premier SAS,,1841.67,,,,,,,1841.67,4012.35,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier SAS,,426.87,,,,,,,426.87,930.00,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,The Alliance,Premier SAS,,4718.98,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Premier SAS,,3911.37,,,,,,,3911.37,8521.50,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier SAS,,2644.53,,,,,,,2644.53,5761.50,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,187.20000,177.84000,The Alliance,Premier SAS,,85.92,,,,,,,85.92,187.20,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,The Alliance,Premier SAS,,2644.53,,,,,,,2644.53,5761.50,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,The Alliance,Premier SAS,,426.87,,,,,,,426.87,930.00,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Premier SAS,,542.19,,,,,,,542.19,1181.25,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,The Alliance,Premier SAS,,1841.67,,,,,,,1841.67,4012.35,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3904.68000,3709.45000,The Alliance,Premier SAS,,1792.25,,,,,,,1792.25,3904.68,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Premier SAS,,318.43,,,,,,,318.43,693.75,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier SAS,,599.00,,,,,,,599.00,1305.00,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,The Alliance,Premier SAS,,287.45,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1717.50000,1631.62000,The Alliance,Premier SAS,,788.33,,,,,,,788.33,1717.50,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13934.50000,13237.77000,The Alliance,Premier SAS,,6395.94,,,,,,,6395.94,13934.50,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,13.77,,,,,,,13.77,30.00,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1097.25000,1042.39000,The Alliance,Premier SAS,,503.64,,,,,,,503.64,1097.25,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Premier SAS,,253.02,,,,,,,253.02,551.25,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier SAS,,1383.88,,,,,,,1383.88,3015.00,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier SAS,,14.54,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,222.04,,,,,,,222.04,483.75,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,The Alliance,Premier SAS,,253.02,,,,,,,253.02,551.25,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,667.50000,634.12000,The Alliance,Premier SAS,,306.38,,,,,,,306.38,667.50,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5796.00000,5506.20000,The Alliance,Premier SAS,,2660.36,,,,,,,2660.36,5796.00,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier SAS,,14.54,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier SAS,,35.23,,,,,,,35.23,76.76,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier SAS,,14.54,,,,,,,14.54,31.68,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2255.03000,2142.28000,The Alliance,Premier SAS,,1035.06,,,,,,,1035.06,2255.03,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier SAS,,4731.14,,,,,,,4731.14,10307.50,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier SAS,,4731.14,,,,,,,4731.14,10307.50,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,The Alliance,Premier SAS,,765.96,,,,,,,765.96,1668.75,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,The Alliance,Premier SAS,,13040.45,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier SAS,,2454.50,,,,,,,2454.50,5347.50,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Premier SAS,,5379.98,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Premier SAS,,5988.99,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier SAS,,4661.42,,,,,,,4661.42,10155.60,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Premier SAS,,4014.30,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier SAS,,4856.36,,,,,,,4856.36,10580.30,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6244.50000,5932.27000,The Alliance,Premier SAS,,2866.23,,,,,,,2866.23,6244.50,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,The Alliance,Premier SAS,,5988.99,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,The Alliance,Premier SAS,,5379.98,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier SAS,,2367.41,,,,,,,2367.41,5157.75,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6192.75000,5883.11000,The Alliance,Premier SAS,,2842.47,,,,,,,2842.47,6192.75,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6882.75000,6538.61000,The Alliance,Premier SAS,,3159.18,,,,,,,3159.18,6882.75,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Premier SAS,,175.57,,,,,,,175.57,382.50,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier SAS,,843.41,,,,,,,843.41,1837.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,188.68000,179.25000,The Alliance,Premier SAS,,86.60,,,,,,,86.60,188.68,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier SAS,,671.29,,,,,,,671.29,1462.50,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier SAS,,843.41,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1586.25000,1506.94000,The Alliance,Premier SAS,,728.09,,,,,,,728.09,1586.25,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier SAS,,199.53,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier SAS,,1053.40,,,,,,,1053.40,2295.00,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier SAS,,1053.40,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier SAS,,1053.40,,,,,,,1053.40,2295.00,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,The Alliance,Premier SAS,,199.53,,,,,,,199.53,434.70,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier SAS,,1053.40,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2676.38000,2542.56000,The Alliance,Premier SAS,,1228.46,,,,,,,1228.46,2676.38,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier SAS,,78.95,,,,,,,78.95,172.00,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16861.49000,16018.42000,The Alliance,Premier SAS,,7739.42,,,,,,,7739.42,16861.49,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier SAS,,59.56,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier SAS,,589.26,,,,,,,589.26,1283.78,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.69000,839.51000,The Alliance,Premier SAS,,405.61,,,,,,,405.61,883.69,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier SAS,,59.56,,,,,,,59.56,129.76,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,248.15,,,,,,,47.62,349.86,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,926.25000,879.94000,The Alliance,Premier SAS,,425.15,,,,,,,425.15,926.25,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,31.21,,,,,,,31.21,68.00,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,303.75000,288.56000,The Alliance,Premier SAS,,139.42,,,,,,,139.42,303.75,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,The Alliance,Premier SAS,,1702.32,,,,,,,1702.32,3708.75,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier SAS,,3966.79,,,,,,,3966.79,8642.25,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier SAS,,3966.79,,,,,,,3966.79,8642.25,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier SAS,,8040.81,,,,,,,8040.81,17518.10,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,46956.00,,,,,,,34125.00,66202.50,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,297.00000,282.15000,The Alliance,Premier SAS,,136.32,,,,,,,136.32,297.00,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,31326.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1176.15000,1117.34000,The Alliance,Premier SAS,,539.85,,,,,,,539.85,1176.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier SAS,,232.37,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,28.28000,26.87000,The Alliance,Premier SAS,,12.98,,,,,,,12.98,28.28,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,31326.75,,,,,,,31326.75,68250.00,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier SAS,,8040.81,,,,,,,8040.81,17518.10,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,The Alliance,Premier SAS,,1053.40,,,,,,,1053.40,2295.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,41.48000,39.41000,The Alliance,Premier SAS,,19.04,,,,,,,19.04,41.48,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,60.06,,,,,,,9.33,441.37,fee schedule,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,outpatient,,,1234.00000,1172.30000,The Alliance,Premier SAS,,848.99,,,,,,,617.00,1196.98,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier SAS,TC,1028.56,,,,,,,747.50,1450.15,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier SAS,,1126.26,,,,,,,520.63,1587.89,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,The Alliance,Premier SAS,TC,808.40,,,,,,,587.50,1139.75,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,The Alliance,Premier SAS,TC,1756.46,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,The Alliance,Premier SAS,,1849.34,,,,,,,1344.00,2607.36,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,The Alliance,Premier SAS,TC,1656.02,,,,,,,1203.50,2334.79,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,outpatient,1,mL,23.29000,22.12000,The Alliance,Premier SAS,,16.02,,,,,,,11.64,22.59,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier SAS,,180.00,,,,,,,67.00,264.00,per diem,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,outpatient,1,mL,1.47000,1.39000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,909.00,,,,,,,122.40,5271.00,case rate,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Premier SAS,TC,524.51,,,,,,,391.31,29731.35,fee schedule,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier SAS,TC,479.62,,,,,,,356.27,17311.25,fee schedule,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Premier SAS,TC,2357.78,,,,,,,1713.50,3324.19,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,TC,507.05,,,,,,,378.42,17311.25,fee schedule,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier SAS,TC,512.03,,,,,,,361.82,8543.92,fee schedule,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,outpatient,,,17686.00000,16801.70000,The Alliance,Premier SAS,TC,44997.00,,,,,,,8843.00,52322.00,case rate,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Premier SAS,TC,519.51,,,,,,,383.91,8543.92,fee schedule,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier SAS,,17.20,,,,,,,12.50,24.25,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,outpatient,1,mL,42.94000,40.80000,The Alliance,Premier SAS,,76.53,,,,,,,21.47,78.87,fee schedule,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier SAS,TC,532.00,,,,,,,120.00,584.87,fee schedule,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,101.65,,,,,,,14.39,746.94,fee schedule,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,outpatient,,,572.00000,543.40000,The Alliance,Premier SAS,,919.47,,,,,,,70.04,6756.70,fee schedule,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,outpatient,1,mL,1767.80000,1679.41000,The Alliance,Premier SAS,,1216.25,,,,,,,883.90,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,outpatient,1,mL,738.15000,701.24000,The Alliance,Premier SAS,,507.85,,,,,,,369.07,716.01,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,outpatient,,,361.00000,342.95000,The Alliance,Premier SAS,,143.23,,,,,,,77.53,1052.52,fee schedule,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,outpatient,,,1962.00000,1863.90000,The Alliance,Premier SAS,,3844.00,,,,,,,1079.10,4686.00,case rate,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,outpatient,1,mL,204.86000,194.62000,The Alliance,Premier SAS,,140.94,,,,,,,102.43,198.71,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,outpatient,,,4230.00000,4018.50000,The Alliance,Premier SAS,,2910.24,,,,,,,2115.00,4103.10,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,outpatient,1,mL,5.72000,5.43000,The Alliance,Premier SAS,,3.94,,,,,,,2.86,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,,363.26,,,,,,,264.00,689.02,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,outpatient,,,6076.00000,5772.20000,The Alliance,Premier SAS,,3844.00,,,,,,,1801.27,5982.26,case rate,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Premier SAS,TC,541.96,,,,,,,404.21,17311.25,fee schedule,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Premier SAS,,3844.00,,,,,,,815.10,4686.00,case rate,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,outpatient,1,EA,6.73000,6.39000,The Alliance,Premier SAS,,4.63,,,,,,,3.37,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,outpatient,1,EA,6.67000,6.33000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,The Alliance,Premier SAS,,6.19,,,,,,,4.50,8.73,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,484.00000,459.80000,The Alliance,Premier SAS,,332.99,,,,,,,63.95,788.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,outpatient,1,GM,5.94000,5.64000,The Alliance,Premier SAS,,4.09,,,,,,,2.97,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,outpatient,1,GM,5.09000,4.84000,The Alliance,Premier SAS,,3.50,,,,,,,2.54,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,outpatient,1,GM,4.94000,4.70000,The Alliance,Premier SAS,,3.40,,,,,,,2.47,4.79,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,The Alliance,Premier SAS,,73.92,,,,,,,11.54,543.22,fee schedule,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,outpatient,1,mL,3.01000,2.86000,The Alliance,Premier SAS,,2.07,,,,,,,1.50,2.92,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,outpatient,,,303.50000,288.32000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,outpatient,,,1482.00000,1407.90000,The Alliance,Premier SAS,,909.00,,,,,,,483.55,3163.00,case rate,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,outpatient,1,mL,348.87000,331.43000,The Alliance,Premier SAS,,254.43,,,,,,,174.44,338.40,fee schedule,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,46.20,,,,,,,6.48,339.51,fee schedule,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,outpatient,,,164.10000,155.89000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier SAS,,12.82,,,,,,,9.32,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,outpatient,1,EA,13.00000,12.35000,The Alliance,Premier SAS,,8.94,,,,,,,6.50,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,The Alliance,Premier SAS,,3.84,,,,,,,2.79,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,outpatient,1,EA,34.76000,33.03000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,outpatient,,,3378.00000,3209.10000,The Alliance,Premier SAS,,2324.06,,,,,,,1689.00,3276.66,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,outpatient,,,1370.00000,1301.50000,The Alliance,Premier SAS,TC,552.78,,,,,,,413.96,17311.25,fee schedule,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,outpatient,,,243.00000,230.85000,The Alliance,Premier SAS,,167.18,,,,,,,121.50,278.37,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,950.60,fee schedule,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Premier SAS,,2.14,,,,,,,1.55,3.24,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,25159.00000,23901.05000,The Alliance,Premier SAS,,17309.39,,,,,,,772.64,24404.23,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,94.72,,,,,,,8.17,696.05,fee schedule,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier SAS,,3726.21,,,,,,,2708.00,5253.52,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,outpatient,1,EA,41.89000,39.79000,The Alliance,Premier SAS,,28.82,,,,,,,20.95,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,outpatient,1,EA,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,14.22,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,outpatient,1,EA,53.72000,51.03000,The Alliance,Premier SAS,,36.96,,,,,,,26.86,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,outpatient,1,EA,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,17.38,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,outpatient,,,335.00000,318.25000,The Alliance,Premier SAS,,230.48,,,,,,,167.50,324.95,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,outpatient,,,1040.00000,988.00000,The Alliance,Premier SAS,,715.52,,,,,,,520.00,1008.80,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,outpatient,,,6048.00000,5745.60000,The Alliance,Premier SAS,,4161.02,,,,,,,1556.56,5866.56,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,outpatient,,,6019.00000,5718.05000,The Alliance,Premier SAS,,4141.07,,,,,,,1556.56,5838.43,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,outpatient,,,4922.00000,4675.90000,The Alliance,Premier SAS,,3386.34,,,,,,,2461.00,4774.34,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,outpatient,,,7244.00000,6881.80000,The Alliance,Premier SAS,,4983.87,,,,,,,1556.56,7026.68,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier SAS,90,120.13,,,,,,,17.43,882.80,fee schedule,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,70.28000,66.77000,The Alliance,Premier SAS,,32.26,,,,,,,32.26,70.28,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,23.25,63.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,outpatient,1,mL,2.29000,2.17000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.22,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,,280.70,,,,,,,204.00,5271.00,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,outpatient,,,168.70000,160.26000,The Alliance,Premier SAS,90,69.31,,,,,,,10.22,509.30,fee schedule,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,180.00,,,,,,,31.50,264.00,per diem,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,outpatient,1,mL,8.61000,8.18000,The Alliance,Premier SAS,,5.92,,,,,,,4.30,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier SAS,,92.41,,,,,,,12.92,679.08,fee schedule,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier SAS,TC,2178.90,,,,,,,1488.32,7180.14,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,outpatient,,,57.50000,54.62000,The Alliance,Premier SAS,90,154.78,,,,,,,28.75,1137.41,fee schedule,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,36.97,,,,,,,5.12,271.65,fee schedule,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,46.20,,,,,,,6.48,339.51,fee schedule,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,38.16000,36.25000,The Alliance,Premier SAS,,17.52,,,,,,,17.52,38.16,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier SAS,,143.23,,,,,,,77.53,1052.52,fee schedule,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,,75.68,,,,,,,55.00,106.70,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,34.66,,,,,,,4.81,254.68,fee schedule,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,18.48,,,,,,,2.54,135.79,fee schedule,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,34.66,,,,,,,5.06,254.68,fee schedule,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,outpatient,,,1172.00000,1113.40000,The Alliance,Premier SAS,TC,556.26,,,,,,,405.63,4412.20,fee schedule,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier SAS,90,97.03,,,,,,,14.05,713.01,fee schedule,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,outpatient,1,EA,4.50000,4.28000,The Alliance,Premier SAS,,3.10,,,,,,,2.25,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,outpatient,1,GM,10.81000,10.27000,The Alliance,Premier SAS,,7.44,,,,,,,5.41,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,outpatient,1,mL,2.29000,2.18000,The Alliance,Premier SAS,,1.58,,,,,,,1.15,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,The Alliance,Premier SAS,,0.83936,,,,,,,0.61000,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,mL,0.35000,0.33000,The Alliance,Premier SAS,,1.34,,,,,,,0.17500,1.39,fee schedule,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,34.66,,,,,,,4.88,254.68,fee schedule,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,outpatient,1,EA,2578.99000,2450.04000,The Alliance,Premier SAS,,130.80,,,,,,,81.70,2501.62,fee schedule,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.90,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,outpatient,1,mL,7.28000,6.92000,The Alliance,Premier SAS,,5.01,,,,,,,3.64,7.06,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,outpatient,1,EA,2310.25000,2194.74000,The Alliance,Premier SAS,,1589.45,,,,,,,19.81,2240.94,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,The Alliance,Premier SAS,90,164.03,,,,,,,24.43,1205.34,fee schedule,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,3.48,,,,,,,2.53,4.91,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,outpatient,1,mL,6.51000,6.18000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,6.31,fee schedule,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,outpatient,1,mL,7.86000,7.47000,The Alliance,Premier SAS,,2.08,,,,,,,1.65,7.62,fee schedule,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,The Alliance,Premier SAS,,1.54,,,,,,,1.12,2.17,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,The Alliance,Premier SAS,,10.38,,,,,,,7.54,14.64,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,outpatient,1,mL,1.75000,1.66000,The Alliance,Premier SAS,,1.20,,,,,,,0.87500,1.70,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,4.19,,,,,,,0.06000,4.32,fee schedule,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,outpatient,1,mL,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,0.46480,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.46480,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,outpatient,1,mL,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.46480,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,outpatient,1,mL,1.34000,1.28000,The Alliance,Premier SAS,,0.92192,,,,,,,0.46480,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,outpatient,1,EA,237.78000,225.89000,The Alliance,Premier SAS,,163.59,,,,,,,118.89,230.65,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,The Alliance,Premier SAS,,1370.50,,,,,,,100.97,1932.24,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier SAS,TC,3130.40,,,,,,,2150.56,7180.14,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,outpatient,1,EA,483.76000,459.57000,The Alliance,Premier SAS,,332.83,,,,,,,241.88,469.25,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier SAS,,10.10,,,,,,,7.34,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,outpatient,1,EA,14.68000,13.94000,The Alliance,Premier SAS,,10.10,,,,,,,7.34,14.24,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,outpatient,1,EA,40.03000,38.03000,The Alliance,Premier SAS,,27.54,,,,,,,20.02,38.83,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Premier SAS,TC,2919.22,,,,,,,2210.90,23155.09,fee schedule,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier SAS,,335.06,,,,,,,134.64,472.39,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier SAS,,1.47,,,,,,,1.07,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,outpatient,1,mL,0.25000,0.23000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,outpatient,1,mL,54.93000,52.19000,The Alliance,Premier SAS,,37.79,,,,,,,27.46,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,14.22,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,outpatient,1,mL,14.22000,13.51000,The Alliance,Premier SAS,,9.78,,,,,,,7.11,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,outpatient,1,mL,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,outpatient,1,mL,110.60000,105.07000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,107.28,fee schedule,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,outpatient,1,mL,157.02000,149.17000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,152.31,fee schedule,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,outpatient,1,mL,105.95000,100.65000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,102.77,fee schedule,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,,115.51,,,,,,,16.26,848.80,fee schedule,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,The Alliance,Premier SAS,,2.59,,,,,,,1.88,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,The Alliance,Premier SAS,,2.13,,,,,,,1.55,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,outpatient,1,GM,1.72000,1.63000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,outpatient,1,GM,1.72000,1.64000,The Alliance,Premier SAS,,1.18,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,outpatient,1,mL,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,outpatient,1,mL,2.78000,2.64000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,2.70,fee schedule,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,outpatient,1,mL,6.16000,5.85000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,5.98,fee schedule,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,outpatient,1,mL,6.98000,6.63000,The Alliance,Premier SAS,,1.54,,,,,,,1.30,6.77,fee schedule,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,2.67,,,,,,,0.20000,2.76,fee schedule,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier SAS,,2.67,,,,,,,0.41000,2.76,fee schedule,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,2.67,,,,,,,0.46000,2.76,fee schedule,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,The Alliance,Premier SAS,,0.90128,,,,,,,0.65500,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Premier SAS,,0.77056,,,,,,,0.56000,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,outpatient,1,mL,1.11000,1.06000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,outpatient,1,mL,1.89000,1.80000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Premier SAS,,1596.00,,,,,,,434.50,1820.00,per diem,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,outpatient,1,mL,16.53000,15.70000,The Alliance,Premier SAS,,11.37,,,,,,,8.27,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,outpatient,1,mL,12.05000,11.45000,The Alliance,Premier SAS,,8.29,,,,,,,6.03,11.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier SAS,,217.16,,,,,,,67.50,1595.82,fee schedule,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,outpatient,1,EA,34.43000,32.71000,The Alliance,Premier SAS,,23.69,,,,,,,17.21,33.40,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier SAS,TC,412.29,,,,,,,268.62,3270.26,fee schedule,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Premier SAS,,2970.78,,,,,,,1031.39,4188.46,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,outpatient,,,337.00000,320.15000,The Alliance,Premier SAS,TC,231.86,,,,,,,168.50,326.89,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,outpatient,1,GM,1.65000,1.56000,The Alliance,Premier SAS,,1.14,,,,,,,0.82500,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,outpatient,1,GM,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,outpatient,1,GM,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,outpatient,1,mL,4.89000,4.65000,The Alliance,Premier SAS,,3.36,,,,,,,2.44,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,outpatient,1,mL,11.91000,11.32000,The Alliance,Premier SAS,,8.19,,,,,,,5.96,11.55,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,The Alliance,Premier SAS,TC,783.04,,,,,,,595.74,17311.25,fee schedule,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,2.27,,,,,,,0.10500,2.34,fee schedule,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,outpatient,,,1047.00000,994.65000,The Alliance,Premier SAS,TC,601.81,,,,,,,447.16,29731.35,fee schedule,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,The Alliance,Premier SAS,,9.08,,,,,,,6.60,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,outpatient,1,EA,135.69000,128.91000,The Alliance,Premier SAS,,93.35,,,,,,,67.84,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,The Alliance,Premier SAS,,5.80,,,,,,,4.21,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,outpatient,1,EA,13.73000,13.04000,The Alliance,Premier SAS,,9.45,,,,,,,6.87,13.32,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,,78.21,,,,,,,12.05,574.73,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,outpatient,1,EA,387.28000,367.92000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,375.66,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,outpatient,1,EA,546.90000,519.56000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,530.49,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,outpatient,1,EA,140.13000,133.12000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,135.93,fee schedule,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,outpatient,1,EA,493.01000,468.36000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,478.22,fee schedule,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,The Alliance,Premier SAS,,4.96,,,,,,,3.60,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,The Alliance,Premier SAS,,4.56,,,,,,,3.31,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,outpatient,1,EA,5.83000,5.54000,The Alliance,Premier SAS,,4.01,,,,,,,2.92,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,outpatient,1,EA,21.16000,20.10000,The Alliance,Premier SAS,,14.56,,,,,,,10.58,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,The Alliance,Premier SAS,,3.83,,,,,,,2.78,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,outpatient,1,GM,11.94000,11.35000,The Alliance,Premier SAS,,8.21,,,,,,,5.97,11.58,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,592.68,,,,,,,439.81,17311.25,fee schedule,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,outpatient,1,EA,23.40000,22.23000,The Alliance,Premier SAS,,16.10,,,,,,,11.70,22.70,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,outpatient,1,EA,6.19000,5.88000,The Alliance,Premier SAS,,4.26,,,,,,,3.10,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,outpatient,1,EA,60150.20000,57142.69000,The Alliance,Premier SAS,,41383.34,,,,,,,30075.10,58345.69,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Premier SAS,,499.56,,,,,,,312.03,631.01,fee schedule,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,outpatient,1,EA,650.53000,618.00000,The Alliance,Premier SAS,,499.56,,,,,,,312.03,631.01,fee schedule,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,outpatient,1,mL,113.76000,108.07000,The Alliance,Premier SAS,,7.96,,,,,,,7.57,110.35,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,outpatient,1,mL,67.86000,64.47000,The Alliance,Premier SAS,,2.39,,,,,,,1.42,65.82,fee schedule,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,outpatient,1,mL,71.93000,68.34000,The Alliance,Premier SAS,,2.39,,,,,,,1.42,69.77,fee schedule,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,outpatient,1,mL,46.99000,44.64000,The Alliance,Premier SAS,,32.33,,,,,,,23.50,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier SAS,,10.48,,,,,,,7.62,14.77,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,,210.23,,,,,,,91.50,1544.85,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Premier SAS,,4.35,,,,,,,3.21,6.22,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,outpatient,1,mL,5.06000,4.80000,The Alliance,Premier SAS,,4.35,,,,,,,2.53,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,4.35,,,,,,,1.90,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,outpatient,1,mL,3.11000,2.95000,The Alliance,Premier SAS,,4.35,,,,,,,1.55,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,outpatient,1,mL,4.42000,4.20000,The Alliance,Premier SAS,,4.35,,,,,,,2.21,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier SAS,,4.35,,,,,,,0.82000,5.23,fee schedule,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,outpatient,1,mL,3.10000,2.94000,The Alliance,Premier SAS,,4.35,,,,,,,1.55,5.23,fee schedule,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Premier SAS,,551.17,,,,,,,126.07,4371.88,fee schedule,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Premier SAS,TC,464.66,,,,,,,354.42,3685.66,fee schedule,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier SAS,,351.57,,,,,,,122.40,495.67,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Premier SAS,90,829.37,,,,,,,70.04,6094.58,fee schedule,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier SAS,,4863.03,,,,,,,759.53,35735.73,fee schedule,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Premier SAS,90,1235.97,,,,,,,154.60,9082.50,fee schedule,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,outpatient,,,320.70000,304.66000,The Alliance,Premier SAS,90,1894.39,,,,,,,160.35,13920.84,fee schedule,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,outpatient,,,972.00000,923.40000,The Alliance,Premier SAS,90,1171.76,,,,,,,486.00,8610.62,fee schedule,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,outpatient,,,400.00000,380.00000,The Alliance,Premier SAS,TC,481.31,,,,,,,200.00,3536.91,fee schedule,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,TC,169.43,,,,,,,144.00,2342.52,fee schedule,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier SAS,TC,115.51,,,,,,,67.83,848.80,fee schedule,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,outpatient,,,325.00000,308.75000,The Alliance,Premier SAS,TC,407.38,,,,,,,162.50,2993.62,fee schedule,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,outpatient,,,1919.00000,1823.05000,The Alliance,Premier SAS,,1596.00,,,,,,,959.50,1861.43,per diem,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,The Alliance,Premier SAS,TC,337.12,,,,,,,245.00,475.30,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,outpatient,,,1014.00000,963.30000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,983.58,fee schedule,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier SAS,TC,1363.20,,,,,,,833.00,10812.84,fee schedule,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Premier SAS,,143.23,,,,,,,20.05,1052.52,fee schedule,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,outpatient,,,234.00000,222.30000,The Alliance,Premier SAS,,143.23,,,,,,,20.05,1052.52,fee schedule,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,1037.00000,985.15000,The Alliance,Premier SAS,,713.46,,,,,,,213.76,1005.89,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,outpatient,,,3274.00000,3110.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3175.78,per diem,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,outpatient,,,29288.00000,27823.60000,The Alliance,Premier SAS,,13443.19,,,,,,,13443.19,29288.00,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier SAS,,1.76,,,,,,,1.28,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,The Alliance,Premier SAS,,2.13,,,,,,,1.54,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier SAS,,183.32,,,,,,,183.32,399.38,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,The Alliance,Premier SAS,,0.70176,,,,,,,0.51000,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,outpatient,1,mL,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,outpatient,1,mL,1.56000,1.49000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier SAS,,2.50,,,,,,,1.81,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,outpatient,1,mL,2.68000,2.55000,The Alliance,Premier SAS,,1.84,,,,,,,1.34,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,outpatient,1,mL,1.73000,1.64000,The Alliance,Premier SAS,,1.19,,,,,,,0.86500,1.68,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,180.00,,,,,,,15.00,264.00,per diem,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,264.00,per diem,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,GO,180.00,,,,,,,51.50,264.00,per diem,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,GP,180.00,,,,,,,51.50,264.00,per diem,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,264.00,per diem,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,163.52,,,,,,,163.52,356.25,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,outpatient,,,5390.00000,5120.50000,The Alliance,Premier SAS,,3708.32,,,,,,,2964.50,5271.00,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,outpatient,1,mL,10.74000,10.21000,The Alliance,Premier SAS,,7.39,,,,,,,5.37,10.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Premier SAS,TC,1689.02,,,,,,,1293.00,13397.25,fee schedule,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,outpatient,1,mL,34.76000,33.02000,The Alliance,Premier SAS,,23.91,,,,,,,3.49,33.72,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,The Alliance,Premier SAS,TC,304.31,,,,,,,237.91,17311.25,fee schedule,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,outpatient,,,919.00000,873.05000,The Alliance,Premier SAS,TC,524.51,,,,,,,389.46,8543.92,fee schedule,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,1.54,,,,,,,0.47500,1.58,fee schedule,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,outpatient,1,mL,1.68000,1.60000,The Alliance,Premier SAS,,1.54,,,,,,,0.84000,1.63,fee schedule,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,outpatient,1,mL,24.07000,22.86000,The Alliance,Premier SAS,,16.56,,,,,,,12.04,23.35,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,outpatient,1,mL,0.91000,0.86000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,0.88270,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,outpatient,1,mL,14.10000,13.39000,The Alliance,Premier SAS,,9.70,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,outpatient,1,mL,15.23000,14.47000,The Alliance,Premier SAS,,10.48,,,,,,,1.49,14.77,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2084.29000,1980.08000,The Alliance,Premier SAS,,956.69,,,,,,,956.69,2084.29,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,163.52,,,,,,,163.52,356.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,307.13000,291.77000,The Alliance,Premier SAS,,140.97,,,,,,,140.97,307.13,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,The Alliance,Premier SAS,,7083.57,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2500.84000,2375.80000,The Alliance,Premier SAS,,1147.89,,,,,,,1147.89,2500.84,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,The Alliance,Premier SAS,,4581.21,,,,,,,4581.21,9980.85,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,9.88,184.30,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,24.77,,,,,,,18.00,38.16,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,2115.00000,2009.25000,The Alliance,Premier SAS,,1455.12,,,,,,,802.34,2051.55,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,The Alliance,Premier SAS,,7569.00,,,,,,,3612.55,10015.25,case rate,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,The Alliance,Premier SAS,TC,939.29,,,,,,,723.58,29731.35,fee schedule,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,TC,672.47,,,,,,,500.59,29731.35,fee schedule,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Premier SAS,TC,6536.11,,,,,,,5057.86,51844.17,fee schedule,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,outpatient,,,1400.00000,1330.00000,The Alliance,Premier SAS,TC,609.47,,,,,,,450.12,4834.29,fee schedule,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,outpatient,,,1399.00000,1329.05000,The Alliance,Premier SAS,TC,568.72,,,,,,,282.87,4511.07,fee schedule,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier SAS,TC,1260.42,,,,,,,916.00,1777.04,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1329.46,fee schedule,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,,532.00,,,,,,,298.87,674.15,fee schedule,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,The Alliance,Premier SAS,,1596.00,,,,,,,1285.85,4666.67,per diem,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier SAS,,76.24,,,,,,,11.57,560.26,fee schedule,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,,190.58,,,,,,,60.36,268.69,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,outpatient,,,1122.00000,1065.90000,The Alliance,Premier SAS,,771.94,,,,,,,415.12,1088.34,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier SAS,,182.51,,,,,,,25.81,1341.13,fee schedule,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,34.66,,,,,,,5.08,254.68,fee schedule,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Premier SAS,,7569.00,,,,,,,3500.91,8939.52,case rate,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier SAS,,3844.00,,,,,,,1637.45,6189.57,case rate,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,103.96,,,,,,,16.07,763.98,fee schedule,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,,97.03,,,,,,,13.73,713.01,fee schedule,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,outpatient,,,271.10000,257.54000,The Alliance,Premier SAS,90,62.38,,,,,,,8.91,458.40,fee schedule,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier SAS,,471.97,,,,,,,314.95,665.42,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier SAS,,249.43,,,,,,,38.57,1832.89,fee schedule,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,outpatient,,,94.30000,89.58000,The Alliance,Premier SAS,90,639.93,,,,,,,47.15,4702.48,fee schedule,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,GP,180.00,,,,,,,38.00,264.00,per diem,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,The Alliance,Premier SAS,,909.00,,,,,,,38.50,3163.00,case rate,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,909.00,,,,,,,587.06,3163.00,case rate,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Premier SAS,,255.59,,,,,,,185.75,360.36,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,85.48,,,,,,,12.09,628.12,fee schedule,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,327.36,764.36,fee schedule,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,outpatient,1,EA,8.81000,8.37000,The Alliance,Premier SAS,,6.06,,,,,,,4.41,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,outpatient,1,EA,11.12000,10.57000,The Alliance,Premier SAS,,7.65,,,,,,,5.56,10.79,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,outpatient,1,mL,43.92000,41.73000,The Alliance,Premier SAS,,80.74,,,,,,,21.96,83.21,fee schedule,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Premier SAS,,1712.64,,,,,,,1712.64,3731.25,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,outpatient,,,1441.00000,1368.95000,The Alliance,Premier SAS,,3844.00,,,,,,,792.55,4686.00,case rate,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,outpatient,,,1616.00000,1535.20000,The Alliance,Premier SAS,,1111.81,,,,,,,888.80,5271.00,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier SAS,90,145.55,,,,,,,21.00,1069.56,fee schedule,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Premier SAS,,2050.70,,,,,,,2050.70,4467.75,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,,3562.37,,,,,,,204.00,26177.94,fee schedule,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,outpatient,,,484.20000,459.99000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Premier SAS,,20.48,,,,,,,14.88,73.49,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,outpatient,1,mL,29.78000,28.29000,The Alliance,Premier SAS,,20.49,,,,,,,14.89,73.49,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,180.00,,,,,,,52.50,264.00,per diem,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,outpatient,,,351.00000,333.45000,The Alliance,Premier SAS,,820.13,,,,,,,115.36,6026.72,fee schedule,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,34.66,,,,,,,5.06,254.68,fee schedule,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,,180.00,,,,,,,49.50,264.00,per diem,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,564.40,,,,,,,417.10,17311.25,fee schedule,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,The Alliance,Premier SAS,,1.46,,,,,,,1.06,2.06,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,23.53,,,,,,,22.80,54.32,fee schedule,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,outpatient,,,261.00000,247.95000,The Alliance,Premier SAS,,180.20,,,,,,,25.47,1324.17,fee schedule,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,,216.39,,,,,,,6.41,1590.11,fee schedule,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,The Alliance,Premier SAS,TC,3556.27,,,,,,,2584.50,5271.00,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier SAS,,1084.39,,,,,,,1084.39,2362.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,outpatient,1,mL,29.77000,28.29000,The Alliance,Premier SAS,,20.48,,,,,,,14.88,73.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,outpatient,,,130.40000,123.88000,The Alliance,Premier SAS,90,85.48,,,,,,,12.41,628.12,fee schedule,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,outpatient,,,454.10000,431.40000,The Alliance,Premier SAS,90,328.05,,,,,,,52.89,2410.69,fee schedule,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,outpatient,,,192.50000,182.88000,The Alliance,Premier SAS,90,120.13,,,,,,,17.60,882.80,fee schedule,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,The Alliance,Premier SAS,,812.43,,,,,,,812.43,1770.00,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier SAS,,5939.18,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,The Alliance,Premier SAS,,8040.81,,,,,,,8040.81,17518.10,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,14201.10000,13491.04000,The Alliance,Premier SAS,,6518.30,,,,,,,6518.30,14201.10,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier SAS,,180.00,,,,,,,31.00,264.00,per diem,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier SAS,,857.13,,,,,,,126.07,6798.73,fee schedule,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,90,106.27,,,,,,,15.53,780.94,fee schedule,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,outpatient,,,206.00000,195.70000,The Alliance,Premier SAS,,131.69,,,,,,,18.37,967.70,fee schedule,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,140.92,,,,,,,22.91,1035.56,fee schedule,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3505.20000,3329.94000,The Alliance,Premier SAS,,1608.89,,,,,,,1608.89,3505.20,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,outpatient,1,EA,169.94000,161.45000,The Alliance,Premier SAS,,116.92,,,,,,,84.97,164.84,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,outpatient,1,EA,13.76000,13.08000,The Alliance,Premier SAS,,0.76848,,,,,,,0.73160,13.35,fee schedule,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,351.45000,333.88000,The Alliance,Premier SAS,,161.32,,,,,,,161.32,351.45,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,The Alliance,Premier SAS,,0.60544,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,outpatient,,,1354.00000,1286.30000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1313.38,fee schedule,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5168.10000,4909.70000,The Alliance,Premier SAS,,2372.16,,,,,,,2372.16,5168.10,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,outpatient,,,1356.00000,1288.20000,The Alliance,Premier SAS,,909.00,,,,,,,227.78,5858.00,case rate,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,90,129.37,,,,,,,18.65,950.66,fee schedule,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,outpatient,,,158.30000,150.38000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,outpatient,,,228.00000,216.60000,The Alliance,Premier SAS,90,85.48,,,,,,,12.38,628.12,fee schedule,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier SAS,,94.72,,,,,,,13.25,696.05,fee schedule,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,,117.83,,,,,,,16.46,865.84,fee schedule,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier SAS,90,499.01,,,,,,,50.62,3666.93,fee schedule,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier SAS,90,103.96,,,,,,,15.09,763.98,fee schedule,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,outpatient,,,5028.00000,4776.60000,The Alliance,Premier SAS,90,2964.02,,,,,,,430.66,21780.96,fee schedule,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Premier SAS,90,270.30,,,,,,,43.79,1986.29,fee schedule,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,The Alliance,Premier SAS,90,270.30,,,,,,,43.79,1986.29,fee schedule,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier SAS,90,887.12,,,,,,,129.67,6518.98,fee schedule,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,outpatient,,,149.70000,142.21000,The Alliance,Premier SAS,90,92.41,,,,,,,13.33,679.08,fee schedule,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,The Alliance,Premier SAS,,97.70,,,,,,,14.86,137.74,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,outpatient,,,160.20000,152.19000,The Alliance,Premier SAS,90,101.65,,,,,,,14.65,746.94,fee schedule,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,outpatient,,,460.60000,437.57000,The Alliance,Premier SAS,90,288.78,,,,,,,42.11,2122.08,fee schedule,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,outpatient,1,EA,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,outpatient,1,GM,379.18000,360.22000,The Alliance,Premier SAS,,260.88,,,,,,,189.59,367.80,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,outpatient,1,EA,0.36000,0.35000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,The Alliance,Premier SAS,,0.24768,,,,,,,0.18000,0.34920,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,outpatient,1,EA,15.47000,14.69000,The Alliance,Premier SAS,,10.64,,,,,,,7.74,15.01,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier SAS,,1.80,,,,,,,1.30,2.53,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,outpatient,1,EA,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,outpatient,1,mL,3.63000,3.45000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,3.52,fee schedule,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,outpatient,1,EA,10.18000,9.67000,The Alliance,Premier SAS,,7.00,,,,,,,5.09,9.87,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,outpatient,1,EA,3.16000,3.01000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,outpatient,1,mL,1421.20000,1350.14000,The Alliance,Premier SAS,,0.59237,,,,,,,0.37000,1378.56,fee schedule,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,outpatient,1,EA,3.93000,3.74000,The Alliance,Premier SAS,,2.70,,,,,,,1.97,3.81,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,The Alliance,Premier SAS,,0.36464,,,,,,,0.26500,0.51410,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier SAS,,2.16,,,,,,,1.57,3.05,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,The Alliance,Premier SAS,,1.21,,,,,,,0.88000,1.71,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,outpatient,1,EA,2.13000,2.02000,The Alliance,Premier SAS,,1.47,,,,,,,1.06,2.07,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,outpatient,1,EA,40.37000,38.36000,The Alliance,Premier SAS,,27.77,,,,,,,20.18,39.16,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,outpatient,1,mL,301.09000,286.03000,The Alliance,Premier SAS,,207.15,,,,,,,92.50,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,outpatient,1,mL,305.62000,290.34000,The Alliance,Premier SAS,,210.27,,,,,,,92.50,296.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,outpatient,1,mL,14.59000,13.86000,The Alliance,Premier SAS,,10.04,,,,,,,7.29,73.49,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,outpatient,1,EA,5.09000,4.83000,The Alliance,Premier SAS,,3.50,,,,,,,2.54,4.94,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,The Alliance,Premier SAS,,1.36,,,,,,,0.98500,1.91,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,The Alliance,Premier SAS,,2.99,,,,,,,2.17,4.22,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,outpatient,1,EA,8.72000,8.28000,The Alliance,Premier SAS,,6.00,,,,,,,4.36,8.46,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,outpatient,1,mL,5.31000,5.04000,The Alliance,Premier SAS,,3.62,,,,,,,2.65,5.15,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,outpatient,1,mL,16.35000,15.54000,The Alliance,Premier SAS,,3.62,,,,,,,3.62,15.86,fee schedule,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,outpatient,1,mL,6.68000,6.35000,The Alliance,Premier SAS,,3.62,,,,,,,3.34,6.48,fee schedule,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,outpatient,1,EA,890.96000,846.41000,The Alliance,Premier SAS,,612.98,,,,,,,445.48,864.23,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,outpatient,1,mL,1.16000,1.11000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,outpatient,1,GM,11.29000,10.72000,The Alliance,Premier SAS,,7.77,,,,,,,5.64,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,outpatient,1,GM,13.50000,12.82000,The Alliance,Premier SAS,,9.29,,,,,,,6.75,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,outpatient,1,GM,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,outpatient,1,mL,0.10000,0.10000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,The Alliance,Premier SAS,,1.51,,,,,,,1.10,2.13,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,outpatient,,,2143.00000,2035.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1178.65,4686.00,case rate,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,124.80000,118.56000,The Alliance,Premier SAS,,57.28,,,,,,,57.28,124.80,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,90,127.06,,,,,,,18.53,933.70,fee schedule,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier SAS,,174.80,,,,,,,7.33,1284.54,fee schedule,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,outpatient,,,876.00000,832.20000,The Alliance,Premier SAS,,117.83,,,,,,,18.40,865.84,fee schedule,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,556.93,,,,,,,411.55,17311.25,fee schedule,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,outpatient,,,959.00000,911.05000,The Alliance,Premier SAS,90,413.53,,,,,,,59.93,3038.81,fee schedule,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,The Alliance,Premier SAS,TC,566.90,,,,,,,418.96,17311.25,fee schedule,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,outpatient,,,51.00000,48.45000,The Alliance,Premier SAS,,34.66,,,,,,,4.95,254.68,fee schedule,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,92.41,,,,,,,13.38,679.08,fee schedule,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,outpatient,,,129.20000,122.74000,The Alliance,Premier SAS,90,80.86,,,,,,,11.81,594.19,fee schedule,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,outpatient,,,170.50000,161.98000,The Alliance,Premier SAS,90,103.96,,,,,,,15.18,763.98,fee schedule,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,outpatient,,,961.00000,912.95000,The Alliance,Premier SAS,90,605.28,,,,,,,87.93,4447.87,fee schedule,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,outpatient,,,413.30000,392.64000,The Alliance,Premier SAS,90,261.06,,,,,,,37.79,1918.36,fee schedule,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier SAS,90,120.13,,,,,,,17.50,882.80,fee schedule,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier SAS,,322.67,,,,,,,122.40,454.93,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,outpatient,,,1007.00000,956.65000,The Alliance,Premier SAS,,1171.76,,,,,,,503.50,8610.62,fee schedule,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Premier SAS,90,1122.78,,,,,,,143.40,8250.66,fee schedule,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,106.27,,,,,,,15.29,780.94,fee schedule,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Premier SAS,,1049.96,,,,,,,1049.96,2287.50,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,outpatient,,,2733.00000,2596.35000,The Alliance,Premier SAS,90,2076.90,,,,,,,264.01,15261.97,fee schedule,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,outpatient,,,416.90000,396.05000,The Alliance,Premier SAS,90,877.89,,,,,,,137.00,6451.13,fee schedule,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,,286.00,,,,,,,126.50,446.00,case rate,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,outpatient,,,386.00000,366.70000,The Alliance,Premier SAS,,286.00,,,,,,,193.00,446.00,case rate,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1475.00000,1401.25000,The Alliance,Premier SAS,,1183.03,,,,,,,162.71,8693.45,fee schedule,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1422.00000,1350.90000,The Alliance,Premier SAS,90,1183.03,,,,,,,533.12,8693.45,fee schedule,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,outpatient,,,65.80000,62.51000,The Alliance,Premier SAS,90,251.81,,,,,,,32.90,1850.43,fee schedule,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,outpatient,,,227.60000,216.22000,The Alliance,Premier SAS,90,365.02,,,,,,,54.46,2682.34,fee schedule,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,outpatient,,,461.00000,437.95000,The Alliance,Premier SAS,90,288.78,,,,,,,42.11,2122.08,fee schedule,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,outpatient,,,249.00000,236.55000,The Alliance,Premier SAS,90,157.09,,,,,,,22.72,1154.38,fee schedule,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,outpatient,,,630.00000,598.50000,The Alliance,Premier SAS,,131.69,,,,,,,18.37,967.70,fee schedule,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Premier SAS,90,607.24,,,,,,,295.50,4462.27,fee schedule,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,outpatient,,,148.10000,140.70000,The Alliance,Premier SAS,90,103.96,,,,,,,15.06,763.98,fee schedule,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,30.27,,,,,,,22.00,42.68,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,outpatient,,,1743.00000,1655.85000,The Alliance,Premier SAS,,1558.11,,,,,,,50.73,11449.71,fee schedule,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,outpatient,,,299.70000,284.71000,The Alliance,Premier SAS,90,131.69,,,,,,,18.98,967.70,fee schedule,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier SAS,,3483.81,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier SAS,,3483.81,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier SAS,,2137.79,,,,,,,2137.79,4657.50,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier SAS,,130.90,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier SAS,,130.90,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.80000,534.66000,The Alliance,Premier SAS,,258.33,,,,,,,258.33,562.80,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier SAS,,104.14,,,,,,,104.14,226.88,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier SAS,,176.38,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,13.77,,,,,,,13.77,30.00,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,outpatient,,,196.50000,186.67000,The Alliance,Premier SAS,90,1296.04,,,,,,,98.25,9523.86,fee schedule,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,outpatient,,,440.20000,418.19000,The Alliance,Premier SAS,90,134.00,,,,,,,19.60,984.66,fee schedule,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,90,104.58,,,,,,,76.00,241.38,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,92.41,,,,,,,14.61,679.08,fee schedule,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Premier SAS,90,87.78,,,,,,,8.17,645.08,fee schedule,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,outpatient,,,383.80000,364.61000,The Alliance,Premier SAS,,240.26,,,,,,,33.94,1765.53,fee schedule,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,outpatient,,,220.40000,209.38000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Premier SAS,,267.98,,,,,,,37.73,1969.25,fee schedule,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,90,129.37,,,,,,,18.66,950.66,fee schedule,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier SAS,90,1030.36,,,,,,,149.66,7571.58,fee schedule,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1818.00000,1727.10000,The Alliance,Premier SAS,90,1374.59,,,,,,,175.54,10101.09,fee schedule,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,outpatient,,,102.40000,97.28000,The Alliance,Premier SAS,90,67.00,,,,,,,3.40,492.33,fee schedule,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,outpatient,,,156.70000,148.86000,The Alliance,Premier SAS,90,57.75,,,,,,,5.90,424.40,fee schedule,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,The Alliance,Premier SAS,90,103.96,,,,,,,15.09,763.98,fee schedule,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,214.85,,,,,,,33.47,1578.85,fee schedule,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,outpatient,1,mL,2.60000,2.47000,The Alliance,Premier SAS,,1.79,,,,,,,1.30,2.52,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier SAS,,909.00,,,,,,,392.70,5858.00,case rate,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,outpatient,,,2201.00000,2090.95000,The Alliance,Premier SAS,,7569.00,,,,,,,1210.55,7803.00,case rate,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,outpatient,,,248.10000,235.70000,The Alliance,Premier SAS,90,157.09,,,,,,,22.69,1154.38,fee schedule,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,1.54,,,,,,,0.62500,1.58,fee schedule,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,outpatient,1,mL,3285.02000,3120.77000,The Alliance,Premier SAS,,45.95,,,,,,,28.70,3186.47,fee schedule,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Premier SAS,90,207.92,,,,,,,24.65,1527.89,fee schedule,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,87.78,,,,,,,8.17,645.08,fee schedule,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier SAS,,117.83,,,,,,,18.40,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,,110.89,,,,,,,17.27,814.87,fee schedule,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier SAS,,150.17,,,,,,,19.88,1103.49,fee schedule,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.30000,129.49000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,90,106.27,,,,,,,14.99,780.94,fee schedule,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,The Alliance,Premier SAS,,106.27,,,,,,,14.99,780.94,fee schedule,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,outpatient,,,242.00000,229.90000,The Alliance,Premier SAS,,152.47,,,,,,,21.41,1120.45,fee schedule,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier SAS,,117.83,,,,,,,18.40,865.84,fee schedule,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier SAS,,150.17,,,,,,,19.88,1103.49,fee schedule,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,103.96,,,,,,,16.07,763.98,fee schedule,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,outpatient,,,52.40000,49.78000,The Alliance,Premier SAS,90,32.34,,,,,,,4.79,237.65,fee schedule,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier SAS,90,887.12,,,,,,,129.67,6518.98,fee schedule,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,outpatient,,,777.00000,738.15000,The Alliance,Premier SAS,90,487.45,,,,,,,70.88,3582.03,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.67900,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,outpatient,1,mL,1.03000,0.97000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.99910,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,outpatient,1,mL,1.75000,1.67000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,1.70,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,outpatient,1,mL,1.33000,1.27000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,1.29,fee schedule,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,outpatient,1,mL,1.12000,1.06000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,1.09,fee schedule,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,,50.83,,,,,,,7.27,373.51,fee schedule,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,outpatient,,,135.40000,128.63000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,888.52,fee schedule,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier SAS,,532.00,,,,,,,333.50,646.99,fee schedule,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,967.09,fee schedule,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier SAS,,1810.00,,,,,,,333.50,2161.00,per diem,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier SAS,,1810.00,,,,,,,498.50,2161.00,per diem,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,outpatient,,,2025.00000,1923.75000,The Alliance,Premier SAS,,1596.00,,,,,,,1012.50,1964.25,per diem,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,outpatient,,,4212.00000,4001.40000,The Alliance,Premier SAS,,2897.86,,,,,,,542.77,4085.64,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier SAS,,458.90,,,,,,,333.50,646.99,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,outpatient,,,997.00000,947.15000,The Alliance,Premier SAS,,685.94,,,,,,,498.50,967.09,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier SAS,,1290.94,,,,,,,1290.94,2812.50,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,87.78,,,,,,,13.82,645.08,fee schedule,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier SAS,,128.32,,,,,,,128.32,279.56,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,90,94.72,,,,,,,8.17,696.05,fee schedule,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier SAS,,130.90,,,,,,,130.90,285.19,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,outpatient,1,EA,1.54000,1.47000,The Alliance,Premier SAS,,1.06,,,,,,,0.77000,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,90,94.72,,,,,,,8.17,696.05,fee schedule,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,152.47,,,,,,,20.36,1120.45,fee schedule,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,0.24250,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,outpatient,,,640.00000,608.00000,The Alliance,Premier SAS,TC,532.00,,,,,,,320.00,620.80,fee schedule,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,outpatient,1,EA,0.84000,0.80000,The Alliance,Premier SAS,,0.57792,,,,,,,0.42000,0.81480,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,44.12000,41.91000,The Alliance,Premier SAS,,20.25,,,,,,,20.25,44.12,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,outpatient,1,EA,1.77000,1.68000,The Alliance,Premier SAS,,1.22,,,,,,,0.88500,1.72,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,90,120.13,,,,,,,8.17,882.80,fee schedule,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,7.28,,,,,,,0.39500,7.69,fee schedule,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,outpatient,1,mL,1.31000,1.24000,The Alliance,Premier SAS,,7.28,,,,,,,0.65500,7.69,fee schedule,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,outpatient,1,mL,1.12000,1.07000,The Alliance,Premier SAS,,7.28,,,,,,,0.56000,7.69,fee schedule,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,492.09,,,,,,,361.82,17311.25,fee schedule,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier SAS,,532.00,,,,,,,166.00,1692.33,fee schedule,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,90,94.72,,,,,,,8.17,696.05,fee schedule,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2810.00000,2669.50000,The Alliance,Premier SAS,90,7425.07,,,,,,,608.00,54562.77,fee schedule,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2066.00000,1962.70000,The Alliance,Premier SAS,90,7425.07,,,,,,,608.00,54562.77,fee schedule,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,outpatient,,,214.70000,203.96000,The Alliance,Premier SAS,90,173.27,,,,,,,26.72,1273.27,fee schedule,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,The Alliance,Premier SAS,90,887.12,,,,,,,129.67,6518.98,fee schedule,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,outpatient,,,157.60000,149.72000,The Alliance,Premier SAS,90,62.38,,,,,,,9.19,458.40,fee schedule,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,outpatient,,,152.80000,145.16000,The Alliance,Premier SAS,90,97.03,,,,,,,13.97,713.01,fee schedule,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,outpatient,,,208.80000,198.36000,The Alliance,Premier SAS,90,106.27,,,,,,,15.49,780.94,fee schedule,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,outpatient,,,174.00000,165.30000,The Alliance,Premier SAS,90,106.27,,,,,,,15.49,780.94,fee schedule,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,,280.29,,,,,,,203.70,3727.42,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,280.29,,,,,,,203.70,3727.42,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,outpatient,,,153.10000,145.44000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,180.00,,,,,,,26.50,264.00,per diem,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,264.00,per diem,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,264.00,per diem,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,outpatient,,,257.80000,244.91000,The Alliance,Premier SAS,90,161.72,,,,,,,23.57,1188.38,fee schedule,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,outpatient,,,149.40000,141.93000,The Alliance,Premier SAS,,207.92,,,,,,,29.28,1527.89,fee schedule,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Premier SAS,90,64.69,,,,,,,9.32,475.37,fee schedule,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,outpatient,,,131.80000,125.21000,The Alliance,Premier SAS,90,92.41,,,,,,,14.80,679.08,fee schedule,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,90,131.69,,,,,,,20.18,967.70,fee schedule,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier SAS,,1662.73,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,The Alliance,Premier SAS,,820.13,,,,,,,115.36,6026.72,fee schedule,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,The Alliance,Premier SAS,,1049.96,,,,,,,1049.96,2287.50,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,outpatient,,,339.20000,322.24000,The Alliance,Premier SAS,90,120.13,,,,,,,18.72,882.80,fee schedule,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,outpatient,,,3791.00000,3601.45000,The Alliance,Premier SAS,,1740.07,,,,,,,1040.32,3791.00,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.02000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1533.19000,1456.53000,The Alliance,Premier SAS,,703.73,,,,,,,703.73,1533.19,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier SAS,,246.14,,,,,,,246.14,536.25,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier SAS,,246.14,,,,,,,246.14,536.25,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier SAS,,372.21,,,,,,,212.82,1232.72,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier SAS,,14.54,,,,,,,14.54,31.68,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,180.00,,,,,,,54.00,264.00,per diem,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,3015.65,fee schedule,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,90,94.72,,,,,,,13.89,696.05,fee schedule,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4481.55000,4257.47000,The Alliance,Premier SAS,,2057.03,,,,,,,2057.03,4481.55,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,outpatient,1,EA,4.03000,3.83000,The Alliance,Premier SAS,,2.77,,,,,,,2.02,3.91,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,42.23,,,,,,,42.23,92.00,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,outpatient,1,mL,8.95000,8.50000,The Alliance,Premier SAS,,6.16,,,,,,,4.47,8.68,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Premier SAS,,6403.05,,,,,,,6403.05,13950.00,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,967.50000,919.12000,The Alliance,Premier SAS,,444.08,,,,,,,444.08,967.50,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1042.50000,990.38000,The Alliance,Premier SAS,,478.51,,,,,,,478.51,1042.50,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,The Alliance,Premier SAS,,2295.17,,,,,,,295.69,3235.92,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,The Alliance,Premier SAS,,2618.53,,,,,,,295.69,3691.82,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,The Alliance,Premier SAS,,2413.50,,,,,,,295.69,3402.76,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,The Alliance,Premier SAS,TC,2972.16,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3612.00000,3431.40000,The Alliance,Premier SAS,TC,2485.06,,,,,,,1806.00,3503.64,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier SAS,TC,224.98,,,,,,,163.50,317.19,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,The Alliance,Premier SAS,,1234.96,,,,,,,295.69,1741.15,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,The Alliance,Premier SAS,TC,1091.17,,,,,,,793.00,1538.42,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,outpatient,,,417.00000,396.15000,The Alliance,Premier SAS,TC,286.90,,,,,,,208.50,404.49,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier SAS,,2329.57,,,,,,,503.83,3284.42,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier SAS,TC,1026.50,,,,,,,746.00,1447.24,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,The Alliance,Premier SAS,,1139.33,,,,,,,828.00,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,The Alliance,Premier SAS,,1146.21,,,,,,,503.83,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Premier SAS,,3024.45,,,,,,,966.05,4264.12,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,outpatient,1,EA,5074.51000,4820.79000,The Alliance,Premier SAS,,4072.77,,,,,,,2537.26,4922.27,fee schedule,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.10000,227.14000,The Alliance,Premier SAS,,109.75,,,,,,,109.75,239.10,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,outpatient,1,EA,3.52000,3.34000,The Alliance,Premier SAS,,2.42,,,,,,,1.76,3.41,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier SAS,,3.35,,,,,,,2.44,4.72,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,outpatient,1,EA,52.04000,49.44000,The Alliance,Premier SAS,,35.80,,,,,,,26.02,50.48,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,The Alliance,Premier SAS,,1.38,,,,,,,1.00,1.95,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,outpatient,1,EA,0.70000,0.67000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,outpatient,1,EA,2.75000,2.62000,The Alliance,Premier SAS,,1.89,,,,,,,1.38,2.67,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,outpatient,1,EA,8.15000,7.74000,The Alliance,Premier SAS,,5.61,,,,,,,4.08,7.91,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier SAS,,389.87,,,,,,,389.87,849.38,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1853.00000,1760.35000,The Alliance,Premier SAS,90,1166.67,,,,,,,169.42,8573.20,fee schedule,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Premier SAS,90,87.78,,,,,,,12.82,645.08,fee schedule,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Premier SAS,TC,412.01,,,,,,,121.00,3027.62,fee schedule,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,TC,439.72,,,,,,,298.87,3487.84,fee schedule,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,The Alliance,Premier SAS,TC,1420.96,,,,,,,1226.87,11271.02,fee schedule,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,536.97,,,,,,,394.96,17311.25,fee schedule,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,outpatient,,,736.00000,699.20000,The Alliance,Premier SAS,TC,509.54,,,,,,,368.00,11266.81,fee schedule,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,,67.00,,,,,,,9.30,492.33,fee schedule,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.40592,,,,,,,0.29500,0.57230,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier SAS,,1247.91,,,,,,,1247.91,2718.75,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier SAS,,104.14,,,,,,,104.14,226.88,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,,16.96,,,,,,,16.32,80.51,fee schedule,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,92.41,,,,,,,32.85,679.08,fee schedule,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier SAS,90,244.93,,,,,,,178.00,345.32,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1869.00000,1775.55000,The Alliance,Premier SAS,,1285.87,,,,,,,172.18,1812.93,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,outpatient,1,EA,16.52000,15.69000,The Alliance,Premier SAS,,11.37,,,,,,,8.26,16.02,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,The Alliance,Premier SAS,,41.53,,,,,,,30.18,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,outpatient,1,EA,11.31000,10.75000,The Alliance,Premier SAS,,7.78,,,,,,,5.66,10.97,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Premier SAS,90,1171.76,,,,,,,485.50,8610.62,fee schedule,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,outpatient,,,203.50000,193.32000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,The Alliance,Premier SAS,,183.32,,,,,,,183.32,399.38,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,The Alliance,Premier SAS,,1084.39,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,outpatient,1,EA,1113.31000,1057.65000,The Alliance,Premier SAS,,88.20,,,,,,,55.09,1079.91,fee schedule,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,outpatient,1,mL,7201.88000,6841.78000,The Alliance,Premier SAS,,166.04,,,,,,,103.71,6985.82,fee schedule,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,outpatient,1,EA,3.36000,3.20000,The Alliance,Premier SAS,,2.31,,,,,,,1.68,3.26,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,GO,180.00,,,,,,,62.00,264.00,per diem,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,outpatient,,,168.30000,159.88000,The Alliance,Premier SAS,90,110.89,,,,,,,16.02,814.87,fee schedule,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier SAS,90,499.01,,,,,,,50.62,3666.93,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,outpatient,1,EA,153.61000,145.93000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,149.00,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,outpatient,1,EA,207.93000,197.53000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,201.69,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,outpatient,1,EA,227.52000,216.14000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,220.69,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,outpatient,1,EA,75.90000,72.11000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,73.62,fee schedule,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,outpatient,1,EA,90.66000,86.13000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,87.94,fee schedule,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier SAS,,2561.00,,,,,,,160.60,3163.00,case rate,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,outpatient,,,624.00000,592.80000,The Alliance,Premier SAS,,429.31,,,,,,,343.20,5271.00,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,,352.94,,,,,,,256.50,497.61,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,outpatient,,,4933.00000,4686.35000,The Alliance,Premier SAS,,3393.90,,,,,,,2466.50,4785.01,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Premier SAS,TC,464.66,,,,,,,336.50,3685.66,fee schedule,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier SAS,TC,532.00,,,,,,,297.11,692.58,fee schedule,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,outpatient,,,1255.00000,1192.25000,The Alliance,Premier SAS,TC,893.55,,,,,,,627.50,7087.64,fee schedule,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier SAS,TC,5823.00,,,,,,,221.10,6003.00,case rate,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,584.87,fee schedule,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,584.87,fee schedule,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,44.00,548.00,fee schedule,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1396.56,3524.98,per diem,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier SAS,,1810.00,,,,,,,1212.50,2352.25,per diem,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1320.00000,1254.00000,The Alliance,Premier SAS,,1810.00,,,,,,,660.00,2161.00,per diem,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,outpatient,,,869.00000,825.55000,The Alliance,Premier SAS,,2561.00,,,,,,,477.95,3163.00,case rate,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,outpatient,,,1383.00000,1313.85000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,1341.51,fee schedule,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,30.96,,,,,,,22.50,163.43,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier SAS,,2561.00,,,,,,,517.55,3163.00,case rate,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,2561.00,,,,,,,409.75,3163.00,case rate,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier SAS,,2561.00,,,,,,,517.55,3163.00,case rate,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,2561.00,,,,,,,409.75,3163.00,case rate,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,TC,5823.00,,,,,,,658.35,7621.00,case rate,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,TC,909.00,,,,,,,88.00,3163.00,case rate,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,TC,3844.00,,,,,,,177.65,4686.00,case rate,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,The Alliance,Premier SAS,,3844.00,,,,,,,658.35,4686.00,case rate,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,The Alliance,Premier SAS,,791.89,,,,,,,633.05,3163.00,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,5563.92,case rate,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,3844.00,,,,,,,174.90,4686.00,case rate,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1897.32,fee schedule,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,outpatient,,,3829.00000,3637.55000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1329.46,3714.13,per diem,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,The Alliance,Premier SAS,TC,1260.42,,,,,,,916.00,1777.04,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier SAS,TC,514.53,,,,,,,333.50,4081.21,fee schedule,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier SAS,90,413.53,,,,,,,48.55,3038.81,fee schedule,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier SAS,90,4863.03,,,,,,,759.53,35735.73,fee schedule,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Premier SAS,90,106.36,,,,,,,21.69,186.79,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,outpatient,,,158.40000,150.48000,The Alliance,Premier SAS,90,120.48,,,,,,,14.91,885.37,fee schedule,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,outpatient,,,174.60000,165.87000,The Alliance,Premier SAS,90,106.27,,,,,,,15.55,780.94,fee schedule,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,outpatient,,,72.30000,68.68000,The Alliance,Premier SAS,90,49.74,,,,,,,36.15,70.13,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,outpatient,,,97.60000,92.72000,The Alliance,Premier SAS,90,39.28,,,,,,,5.68,288.61,fee schedule,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,outpatient,,,96.00000,91.20000,The Alliance,Premier SAS,,94.72,,,,,,,11.13,696.05,fee schedule,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,outpatient,,,397.00000,377.15000,The Alliance,Premier SAS,90,265.67,,,,,,,43.07,1952.29,fee schedule,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,129.37,,,,,,,10.38,950.66,fee schedule,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Premier SAS,90,120.13,,,,,,,17.43,882.80,fee schedule,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,outpatient,,,276.50000,262.68000,The Alliance,Premier SAS,90,2647.25,,,,,,,138.25,19453.17,fee schedule,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,27.72,,,,,,,3.93,203.72,fee schedule,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier SAS,,1018.98,,,,,,,1018.98,2220.00,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Premier SAS,,3950.96,,,,,,,3950.96,8607.75,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,The Alliance,Premier SAS,,2104.59,,,,,,,1306.65,2967.23,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,The Alliance,Premier SAS,TC,449.69,,,,,,,383.91,10740.24,fee schedule,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier SAS,TC,57.24,,,,,,,41.60,484.28,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,TC,566.90,,,,,,,417.10,17311.25,fee schedule,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,298.87,1820.00,per diem,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,875.89000,832.10000,The Alliance,Premier SAS,,402.03,,,,,,,402.03,875.89,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier SAS,,589.26,,,,,,,589.26,1283.78,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,471.23000,447.67000,The Alliance,Premier SAS,,216.29,,,,,,,216.29,471.23,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,180.00,,,,,,,38.00,264.00,per diem,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,outpatient,,,636.00000,604.20000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,616.92,per diem,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,,180.00,,,,,,,29.50,264.00,per diem,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,491.79,per diem,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,180.00,,,,,,,54.00,264.00,per diem,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,180.00,,,,,,,10.50,264.00,per diem,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,180.00,,,,,,,17.50,264.00,per diem,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,,180.00,,,,,,,21.00,264.00,per diem,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,outpatient,,,69.60000,66.12000,The Alliance,Premier SAS,,180.00,,,,,,,34.80,264.00,per diem,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,GP,180.00,,,,,,,49.50,264.00,per diem,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,GO,180.00,,,,,,,17.50,264.00,per diem,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier SAS,,180.00,,,,,,,119.56,352.11,per diem,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,,176.13,,,,,,,56.40,248.32,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.63,3.16,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,outpatient,,,438.50000,416.58000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,outpatient,,,307.50000,292.12000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,outpatient,,,454.90000,432.15000,The Alliance,Premier SAS,90,131.69,,,,,,,18.98,967.70,fee schedule,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,The Alliance,Premier SAS,,1.37,,,,,,,0.99500,1.93,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,outpatient,1,EA,0.73000,0.70000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,The Alliance,Premier SAS,90,4863.03,,,,,,,759.53,35735.73,fee schedule,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Premier SAS,90,2647.25,,,,,,,135.45,19453.17,fee schedule,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,outpatient,,,110.60000,105.07000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,outpatient,,,286.80000,272.46000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,GO,180.00,,,,,,,21.00,264.00,per diem,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,The Alliance,Premier SAS,GO,180.00,,,,,,,21.00,264.00,per diem,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,outpatient,,,154.60000,146.87000,The Alliance,Premier SAS,90,175.44,,,,,,,27.11,1289.24,fee schedule,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,outpatient,,,668.00000,634.60000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,outpatient,,,305.90000,290.60000,The Alliance,Premier SAS,90,94.72,,,,,,,13.80,696.05,fee schedule,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,outpatient,,,320.40000,304.38000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,outpatient,,,146.60000,139.27000,The Alliance,Premier SAS,90,92.41,,,,,,,14.96,679.08,fee schedule,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,90,85.48,,,,,,,13.69,628.12,fee schedule,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,The Alliance,Premier SAS,90,1030.36,,,,,,,149.66,7571.58,fee schedule,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,90,94.72,,,,,,,13.68,696.05,fee schedule,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.76630,fee schedule,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,outpatient,,,935.00000,888.25000,The Alliance,Premier SAS,,643.28,,,,,,,514.25,5271.00,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,outpatient,1,EA,64.97000,61.72000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,63.02,fee schedule,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,85.48,,,,,,,8.17,628.12,fee schedule,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,outpatient,1,EA,1.89000,1.79000,The Alliance,Premier SAS,,1.30,,,,,,,0.94500,1.83,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,,499.01,,,,,,,50.62,3666.93,fee schedule,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Premier SAS,,12.18,,,,,,,8.86,17.18,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,outpatient,,,284.40000,270.18000,The Alliance,Premier SAS,90,243.08,,,,,,,12.05,1786.28,fee schedule,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,The Alliance,Premier SAS,90,2647.25,,,,,,,135.45,19453.17,fee schedule,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Premier SAS,90,220.71,,,,,,,30.85,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,The Alliance,Premier SAS,,220.71,,,,,,,30.85,311.18,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier SAS,TC,710.90,,,,,,,519.48,5638.86,fee schedule,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,outpatient,,,402.00000,381.90000,The Alliance,Premier SAS,,276.58,,,,,,,201.00,389.94,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,outpatient,1,EA,2.66000,2.52000,The Alliance,Premier SAS,,1.83,,,,,,,1.33,2.58,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,The Alliance,Premier SAS,,12.18,,,,,,,8.86,17.18,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,outpatient,1,EA,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,The Alliance,Premier SAS,,0.80496,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,The Alliance,Premier SAS,,0.37152,,,,,,,0.27000,0.52380,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier SAS,,59.56,,,,,,,59.56,129.76,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier SAS,,4856.36,,,,,,,4856.36,10580.30,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,outpatient,1,GM,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,14.22,27.59,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,outpatient,1,EA,21.96000,20.86000,The Alliance,Premier SAS,,15.11,,,,,,,10.98,21.30,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,outpatient,1,GM,205.53000,195.25000,The Alliance,Premier SAS,,141.40,,,,,,,102.77,199.36,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,outpatient,1,GM,313.19000,297.53000,The Alliance,Premier SAS,,215.47,,,,,,,156.59,303.79,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,outpatient,1,EA,25.01000,23.76000,The Alliance,Premier SAS,,17.21,,,,,,,12.51,24.26,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,outpatient,1,EA,14.17000,13.46000,The Alliance,Premier SAS,,9.75,,,,,,,7.08,13.74,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Premier SAS,,5823.00,,,,,,,1080.75,7304.63,case rate,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Premier SAS,,3844.00,,,,,,,704.00,4686.00,case rate,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,outpatient,,,592.00000,562.40000,The Alliance,Premier SAS,,407.30,,,,,,,296.00,574.24,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,The Alliance,Premier SAS,,1.27,,,,,,,0.92500,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,The Alliance,Premier SAS,,0.94256,,,,,,,0.68500,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,The Alliance,Premier SAS,,1.35,,,,,,,0.98000,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,outpatient,1,EA,1.57000,1.50000,The Alliance,Premier SAS,,1.08,,,,,,,0.78500,1.52,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,outpatient,1,mL,1.93000,1.83000,The Alliance,Premier SAS,,1.33,,,,,,,0.96500,1.87,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,,39.22,,,,,,,28.50,70.98,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,237.49000,225.62000,The Alliance,Premier SAS,,109.01,,,,,,,109.01,237.49,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier SAS,,2315.94,,,,,,,2315.94,5045.63,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier SAS,,2315.94,,,,,,,2315.94,5045.63,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier SAS,,472.00,,,,,,,148.57,1447.00,per diem,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier SAS,90,828.57,,,,,,,380.50,6088.74,fee schedule,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,The Alliance,Premier SAS,,1.11,,,,,,,0.80500,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,outpatient,1,EA,22.00000,20.90000,The Alliance,Premier SAS,,15.14,,,,,,,11.00,21.34,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,outpatient,1,EA,34.14000,32.44000,The Alliance,Premier SAS,,23.49,,,,,,,17.07,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,outpatient,1,EA,32.01000,30.41000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.05,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,outpatient,,,157.00000,149.15000,The Alliance,Premier SAS,,92.41,,,,,,,13.05,679.08,fee schedule,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier SAS,90,115.51,,,,,,,16.80,848.80,fee schedule,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.00000,203.30000,The Alliance,Premier SAS,90,134.00,,,,,,,19.60,984.66,fee schedule,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier SAS,90,164.03,,,,,,,24.43,1205.34,fee schedule,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier SAS,90,85.48,,,,,,,12.51,628.12,fee schedule,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,17.46,fee schedule,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier SAS,,3844.00,,,,,,,125.95,4686.00,case rate,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,outpatient,1,mL,2753.58000,2615.90000,The Alliance,Premier SAS,,64.94,,,,,,,40.56,2670.97,fee schedule,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,The Alliance,Premier SAS,,0.55728,,,,,,,0.40500,0.78570,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,outpatient,,,453.80000,431.11000,The Alliance,Premier SAS,90,120.13,,,,,,,17.43,882.80,fee schedule,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier SAS,,722.40,,,,,,,525.00,1180.23,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Premier SAS,,13982.33,,,,,,,13982.33,30462.60,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1368.75000,1300.31000,The Alliance,Premier SAS,,628.26,,,,,,,628.26,1368.75,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,33159.00000,31501.05000,The Alliance,Premier SAS,,15219.98,,,,,,,15219.98,33159.00,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,The Alliance,Premier SAS,,4856.36,,,,,,,4856.36,10580.30,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,outpatient,,,502.00000,476.90000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,140.92,,,,,,,22.91,1035.56,fee schedule,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,outpatient,,,234.30000,222.58000,The Alliance,Premier SAS,90,154.78,,,,,,,117.15,1137.41,fee schedule,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,The Alliance,Premier SAS,90,87.78,,,,,,,12.82,645.08,fee schedule,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Premier SAS,90,71.62,,,,,,,8.17,526.26,fee schedule,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,outpatient,,,797.00000,757.15000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,773.09,fee schedule,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,outpatient,1,EA,271.76000,258.17000,The Alliance,Premier SAS,,186.97,,,,,,,135.88,263.61,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,outpatient,1,mL,222.19000,211.08000,The Alliance,Premier SAS,,65.96,,,,,,,64.92,215.52,fee schedule,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,outpatient,1,mL,150.10000,142.60000,The Alliance,Premier SAS,,65.96,,,,,,,64.92,145.60,fee schedule,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,The Alliance,Premier SAS,,2.74,,,,,,,1.99,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,outpatient,1,EA,5.81000,5.52000,The Alliance,Premier SAS,,4.00,,,,,,,2.90,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,outpatient,1,EA,9.45000,8.98000,The Alliance,Premier SAS,,6.50,,,,,,,4.72,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,outpatient,1,mL,3726.00000,3539.70000,The Alliance,Premier SAS,,2563.49,,,,,,,1863.00,3614.22,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier SAS,,621.95,,,,,,,268.42,876.88,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,outpatient,,,658.00000,625.10000,The Alliance,Premier SAS,90,120.13,,,,,,,18.72,882.80,fee schedule,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,909.00,,,,,,,82.50,3163.00,case rate,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier SAS,,909.00,,,,,,,257.95,3163.00,case rate,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,outpatient,,,3369.00000,3200.55000,The Alliance,Premier SAS,,2317.87,,,,,,,1852.95,5271.00,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,4.00,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,outpatient,1,GM,0.94000,0.89000,The Alliance,Premier SAS,,0.64672,,,,,,,0.47000,0.91180,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,The Alliance,Premier SAS,TC,571.88,,,,,,,426.30,17311.25,fee schedule,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1475.05,3963.00,case rate,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1475.05,4686.00,case rate,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,outpatient,,,2762.00000,2623.90000,The Alliance,Premier SAS,,5823.00,,,,,,,1519.10,6003.00,case rate,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,The Alliance,Premier SAS,,699.01,,,,,,,558.80,5271.00,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,3.67,,,,,,,1.58,3.78,fee schedule,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier SAS,90,651.48,,,,,,,94.71,4787.38,fee schedule,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,outpatient,,,1965.00000,1866.75000,The Alliance,Premier SAS,TC,3844.00,,,,,,,1080.75,4686.00,case rate,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,73.44,,,,,,,73.44,160.00,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,163.52,,,,,,,163.52,356.25,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Premier SAS,,402.19,,,,,,,402.19,876.23,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1140.19000,1083.18000,The Alliance,Premier SAS,,523.35,,,,,,,523.35,1140.19,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12400.00,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,outpatient,,,457.00000,434.15000,The Alliance,Premier SAS,,314.42,,,,,,,228.50,443.29,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,36.30,145.50,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,The Alliance,Premier SAS,,1.15,,,,,,,0.83500,1.62,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1931.25000,1834.69000,The Alliance,Premier SAS,,886.44,,,,,,,886.44,1931.25,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,49.20000,46.74000,The Alliance,Premier SAS,,22.58,,,,,,,22.58,49.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier SAS,,0.75680,,,,,,,0.55000,1.07,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,90,124.67,,,,,,,21.69,186.79,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,909.00,,,,,,,114.95,3163.00,case rate,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Premier SAS,,2147.01,,,,,,,2147.01,4677.58,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,outpatient,1,GM,0.14000,0.14000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,outpatient,1,EA,11.69000,11.11000,The Alliance,Premier SAS,,8.04,,,,,,,5.84,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Premier SAS,,19.53,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier SAS,,13.77,,,,,,,10.01,19.41,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,TC,272.65,,,,,,,210.00,2162.63,fee schedule,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,TC,190.36,,,,,,,144.00,1509.95,fee schedule,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier SAS,TC,142.98,,,,,,,112.98,1134.10,fee schedule,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Premier SAS,TC,2533.90,,,,,,,1841.50,3572.51,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,,180.00,,,,,,,110.00,264.00,per diem,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,,180.00,,,,,,,110.00,264.00,per diem,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,267.72,per diem,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Premier SAS,,638.46,,,,,,,464.00,900.16,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier SAS,,560.72,,,,,,,448.25,5271.00,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier SAS,,489.86,,,,,,,391.60,5271.00,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier SAS,,1018.98,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,,73.07,,,,,,,73.07,159.20,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1150.20000,1092.69000,The Alliance,Premier SAS,,527.94,,,,,,,527.94,1150.20,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1751.25000,1663.69000,The Alliance,Premier SAS,,803.82,,,,,,,803.82,1751.25,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier SAS,,967.59,,,,,,,967.59,2108.03,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier SAS,TC,142.42,,,,,,,103.50,200.79,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,946.09000,898.79000,The Alliance,Premier SAS,,434.26,,,,,,,434.26,946.09,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,,73.07,,,,,,,73.07,159.20,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,120.13,,,,,,,8.17,882.80,fee schedule,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,outpatient,,,162.60000,154.47000,The Alliance,Premier SAS,90,101.65,,,,,,,14.87,746.94,fee schedule,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,outpatient,,,176.30000,167.49000,The Alliance,Premier SAS,90,110.89,,,,,,,16.11,814.87,fee schedule,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Premier SAS,90,143.23,,,,,,,19.62,1052.52,fee schedule,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,The Alliance,Premier SAS,,2561.00,,,,,,,548.90,3163.00,case rate,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,outpatient,,,1134.00000,1077.30000,The Alliance,Premier SAS,,780.19,,,,,,,567.00,1099.98,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier SAS,,1596.00,,,,,,,672.00,1820.00,per diem,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier SAS,,2.67,,,,,,,0.22500,2.76,fee schedule,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,outpatient,1,mL,0.50000,0.47000,The Alliance,Premier SAS,,2.67,,,,,,,0.25000,2.76,fee schedule,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,14.23,,,,,,,0.52500,14.67,fee schedule,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Premier SAS,,234.95,,,,,,,170.75,331.25,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,outpatient,1,mL,3.17000,3.01000,The Alliance,Premier SAS,,2.18,,,,,,,1.58,3.07,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,outpatient,1,GM,7.76000,7.37000,The Alliance,Premier SAS,,5.34,,,,,,,3.88,7.53,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,The Alliance,Premier SAS,,0.50912,,,,,,,0.37000,0.71780,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,The Alliance,Premier SAS,,0.19952,,,,,,,0.14500,0.28130,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,outpatient,1,mL,51.35000,48.78000,The Alliance,Premier SAS,,35.33,,,,,,,25.68,49.81,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,outpatient,1,mL,492.10000,467.50000,The Alliance,Premier SAS,,338.56,,,,,,,246.05,477.34,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,outpatient,1,mL,705.23000,669.97000,The Alliance,Premier SAS,,485.20,,,,,,,352.62,684.07,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,outpatient,1,mL,117.73000,111.84000,The Alliance,Premier SAS,,81.00,,,,,,,58.87,114.20,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,outpatient,1,mL,42.98000,40.83000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,41.69,fee schedule,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,outpatient,1,mL,24.65000,23.42000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,23.91,fee schedule,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,outpatient,1,mL,62.81000,59.67000,The Alliance,Premier SAS,,0.97661,,,,,,,0.91450,60.93,fee schedule,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Premier SAS,,23.06,,,,,,,1.49,32.51,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,outpatient,1,mL,198.20000,188.29000,The Alliance,Premier SAS,,27.81,,,,,,,17.37,192.25,fee schedule,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier SAS,,59.56,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier SAS,,3483.81,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,outpatient,1,GM,0.04000,0.03000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,outpatient,,,183.00000,173.85000,The Alliance,Premier SAS,90,120.13,,,,,,,18.52,882.80,fee schedule,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,7.28,,,,,,,0.63000,7.69,fee schedule,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier SAS,,7.28,,,,,,,0.73500,7.69,fee schedule,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,12.78,,,,,,,0.14000,13.53,fee schedule,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,12.78,,,,,,,0.06000,13.53,fee schedule,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,outpatient,1,mL,1.10000,1.04000,The Alliance,Premier SAS,,4.18,,,,,,,0.55000,4.31,fee schedule,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier SAS,,862.06,,,,,,,626.50,1215.41,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,outpatient,,,244.20000,231.99000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier SAS,,1740.51,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,303.60000,288.42000,The Alliance,Premier SAS,,139.35,,,,,,,139.35,303.60,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,302.10000,287.00000,The Alliance,Premier SAS,,138.66,,,,,,,138.66,302.10,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,outpatient,1,mL,96.92000,92.07000,The Alliance,Premier SAS,,66.68,,,,,,,48.46,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,outpatient,1,mL,96.91000,92.07000,The Alliance,Premier SAS,,66.67,,,,,,,48.45,94.00,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,180.00,,,,,,,54.00,264.00,per diem,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier SAS,,3851.19,,,,,,,3851.19,8390.40,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier SAS,,4761.02,,,,,,,4761.02,10372.60,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,outpatient,,,3818.00000,3627.10000,The Alliance,Premier SAS,,2626.78,,,,,,,569.17,3703.46,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,outpatient,1,EA,25.76000,24.47000,The Alliance,Premier SAS,,17.72,,,,,,,12.88,24.99,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,29.10,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,189.89,,,,,,,138.00,325.26,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,,232.54,,,,,,,148.57,327.86,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,140.35,,,,,,,23.25,197.88,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,286.00,,,,,,,83.00,446.00,case rate,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,286.00,,,,,,,58.00,446.00,case rate,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,286.00,,,,,,,32.50,446.00,case rate,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier SAS,,286.00,,,,,,,97.00,446.00,case rate,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,outpatient,,,268.00000,254.60000,The Alliance,Premier SAS,,286.00,,,,,,,134.00,446.00,case rate,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier SAS,,286.00,,,,,,,197.00,446.00,case rate,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,outpatient,,,516.00000,490.20000,The Alliance,Premier SAS,,286.00,,,,,,,258.00,500.52,case rate,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,outpatient,,,454.00000,431.30000,The Alliance,Premier SAS,TC,292.60,,,,,,,227.00,2320.90,fee schedule,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,outpatient,,,601.00000,570.95000,The Alliance,Premier SAS,TC,390.78,,,,,,,284.63,3099.68,fee schedule,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,outpatient,,,1218.00000,1157.10000,The Alliance,Premier SAS,,837.98,,,,,,,669.90,5271.00,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,2561.00,,,,,,,409.75,3163.00,case rate,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier SAS,TC,452.18,,,,,,,267.00,3586.71,fee schedule,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,The Alliance,Premier SAS,TC,532.00,,,,,,,47.50,860.53,fee schedule,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier SAS,,298.59,,,,,,,217.00,488.81,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,outpatient,,,1280.00000,1216.00000,The Alliance,Premier SAS,90,835.80,,,,,,,377.60,6141.84,fee schedule,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,outpatient,,,1161.00000,1102.95000,The Alliance,Premier SAS,90,823.01,,,,,,,389.13,6047.82,fee schedule,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,outpatient,1,EA,2.06000,1.95000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,outpatient,1,EA,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Premier SAS,,297.22,,,,,,,98.39,1078.91,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,outpatient,,,299.00000,284.05000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier SAS,90,2647.25,,,,,,,533.12,19453.17,fee schedule,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,outpatient,,,2336.00000,2219.20000,The Alliance,Premier SAS,90,1529.37,,,,,,,234.70,11238.50,fee schedule,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,outpatient,,,2681.00000,2546.95000,The Alliance,Premier SAS,90,1952.14,,,,,,,304.81,14345.24,fee schedule,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,outpatient,1,GM,14.97000,14.22000,The Alliance,Premier SAS,,10.30,,,,,,,7.49,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,outpatient,1,mL,5334.14000,5067.43000,The Alliance,Premier SAS,,24.14,,,,,,,15.08,5174.12,fee schedule,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,outpatient,1,mL,29.43000,27.96000,The Alliance,Premier SAS,,20.25,,,,,,,1.49,28.55,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,outpatient,1,EA,795.93000,756.14000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,772.05,fee schedule,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,outpatient,,,22663.00000,21529.85000,The Alliance,Premier SAS,,15592.14,,,,,,,1519.65,21983.11,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,74.34,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier SAS,,279.33,,,,,,,67.58,393.82,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,The Alliance,Premier SAS,,630.21,,,,,,,314.95,888.52,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,,145.86,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,The Alliance,Premier SAS,,606.13,,,,,,,314.95,854.57,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,The Alliance,Premier SAS,,496.74,,,,,,,314.95,700.34,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,The Alliance,Premier SAS,,127.97,,,,,,,67.58,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,,280.70,,,,,,,67.58,395.76,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier SAS,,334.37,,,,,,,67.58,471.42,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,The Alliance,Premier SAS,,551.17,,,,,,,126.07,4371.88,fee schedule,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,The Alliance,Premier SAS,,13982.33,,,,,,,13982.33,30462.60,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,The Alliance,Premier SAS,,909.00,,,,,,,179.85,3163.00,case rate,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier SAS,,276.18,,,,,,,100.97,2190.64,fee schedule,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,584.87,fee schedule,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,The Alliance,Premier SAS,,352.26,,,,,,,100.97,584.87,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,973.88,fee schedule,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,The Alliance,Premier SAS,,240.11,,,,,,,83.61,484.28,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier SAS,,73.62,,,,,,,35.41,103.79,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier SAS,,306.85,,,,,,,56.40,432.62,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,The Alliance,Premier SAS,,291.68,,,,,,,146.17,2313.59,fee schedule,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,The Alliance,Premier SAS,,21.33,,,,,,,10.00,30.07,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier SAS,,761.20,,,,,,,360.00,6037.79,fee schedule,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,outpatient,,,974.00000,925.30000,The Alliance,Premier SAS,,670.11,,,,,,,122.37,944.78,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,The Alliance,Premier SAS,,143.79,,,,,,,104.50,212.44,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,,85.31,,,,,,,43.81,120.28,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier SAS,,310.98,,,,,,,200.06,438.44,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,43.81,97.00,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,93.57,,,,,,,68.00,131.92,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier SAS,,138.29,,,,,,,67.58,194.97,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,The Alliance,Premier SAS,,101.14,,,,,,,43.81,142.59,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,The Alliance,Premier SAS,,255.25,,,,,,,185.50,359.87,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,,112.14,,,,,,,56.40,158.11,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,545.62,fee schedule,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,outpatient,,,207.20000,196.84000,The Alliance,Premier SAS,,142.55,,,,,,,103.60,212.44,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,The Alliance,Premier SAS,,1810.00,,,,,,,339.11,3584.15,per diem,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,The Alliance,Premier SAS,,238.74,,,,,,,173.50,336.59,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,1076.70,fee schedule,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier SAS,,208.46,,,,,,,35.41,293.91,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier SAS,,351.57,,,,,,,122.40,495.67,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier SAS,,620.58,,,,,,,200.06,874.94,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,909.00,,,,,,,48.40,3163.00,case rate,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,429.00,,,,,,,37.00,442.00,per diem,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,,33.02,,,,,,,24.00,46.56,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,72.24,,,,,,,37.27,101.85,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,The Alliance,Premier SAS,,532.00,,,,,,,100.97,1085.43,fee schedule,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,The Alliance,Premier SAS,,909.00,,,,,,,56.40,5271.00,case rate,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,195.84,,,,,,,83.61,1553.42,fee schedule,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,The Alliance,Premier SAS,,253.33,,,,,,,83.61,2009.44,fee schedule,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,,228.40,,,,,,,83.61,1811.63,fee schedule,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,The Alliance,Premier SAS,,266.47,,,,,,,83.61,2113.62,fee schedule,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,The Alliance,Premier SAS,,354.42,,,,,,,100.97,2811.23,fee schedule,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,The Alliance,Premier SAS,,273.41,,,,,,,83.61,2168.71,fee schedule,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,The Alliance,Premier SAS,,243.35,,,,,,,83.61,1930.27,fee schedule,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,The Alliance,Premier SAS,,195.45,,,,,,,83.61,1550.26,fee schedule,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,The Alliance,Premier SAS,,270.79,,,,,,,83.61,2147.86,fee schedule,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,The Alliance,Premier SAS,,266.47,,,,,,,100.97,2113.62,fee schedule,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,,193.35,,,,,,,83.61,1533.65,fee schedule,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,,247.81,,,,,,,83.61,1965.59,fee schedule,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Premier SAS,,223.41,,,,,,,100.97,1772.08,fee schedule,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,The Alliance,Premier SAS,,233.25,,,,,,,83.61,1850.10,fee schedule,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier SAS,,218.42,,,,,,,83.61,1732.53,fee schedule,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,,221.32,,,,,,,100.97,1755.46,fee schedule,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,The Alliance,Premier SAS,,198.47,,,,,,,100.97,1574.27,fee schedule,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,The Alliance,Premier SAS,,287.09,,,,,,,100.97,2277.19,fee schedule,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,The Alliance,Premier SAS,,276.44,,,,,,,100.97,2192.71,fee schedule,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,The Alliance,Premier SAS,,228.40,,,,,,,83.61,1811.63,fee schedule,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,The Alliance,Premier SAS,TC,2379.10,,,,,,,1609.99,3354.26,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,The Alliance,Premier SAS,TC,1668.40,,,,,,,1212.50,2352.25,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Premier SAS,,174.75,,,,,,,127.00,246.38,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,111.46,,,,,,,81.00,157.14,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2078.89000,1974.95000,The Alliance,Premier SAS,,954.21,,,,,,,954.21,2078.89,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,outpatient,,,11128.16000,10571.75000,The Alliance,Premier SAS,,5107.83,,,,,,,5107.83,11128.16,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,outpatient,1,mL,97.37000,92.50000,The Alliance,Premier SAS,,66.99,,,,,,,1.49,94.45,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,outpatient,1,mL,486.83000,462.49000,The Alliance,Premier SAS,,160.58,,,,,,,100.30,472.23,fee schedule,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,outpatient,1,EA,5750.00000,5462.50000,The Alliance,Premier SAS,,3956.00,,,,,,,131.56,5577.50,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,outpatient,1,mL,1421.18000,1350.13000,The Alliance,Premier SAS,,0.59237,,,,,,,0.37000,1378.54,fee schedule,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,outpatient,1,mL,2524.14000,2397.93000,The Alliance,Premier SAS,,0.59237,,,,,,,0.37000,2448.42,fee schedule,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,41.36000,39.29000,The Alliance,Premier SAS,,18.98,,,,,,,18.98,41.36,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier SAS,,200.49,,,,,,,200.49,436.80,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,,2.35,,,,,,,2.31,12.33,fee schedule,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,The Alliance,Premier SAS,,1.73,,,,,,,1.25,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,The Alliance,Premier SAS,,1.36,,,,,,,0.99000,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,The Alliance,Premier SAS,,0.35088,,,,,,,0.25500,0.49470,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,outpatient,,,229.00000,217.55000,The Alliance,Premier SAS,TC,145.47,,,,,,,114.50,1153.87,fee schedule,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,outpatient,,,218.90000,207.95000,The Alliance,Premier SAS,90,138.61,,,,,,,19.99,1018.59,fee schedule,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Premier SAS,90,92.41,,,,,,,14.96,679.08,fee schedule,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,outpatient,,,240.30000,228.28000,The Alliance,Premier SAS,90,150.17,,,,,,,21.97,1103.49,fee schedule,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,90,94.72,,,,,,,13.89,696.05,fee schedule,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,90,34.66,,,,,,,5.11,254.68,fee schedule,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier SAS,90,50.83,,,,,,,7.27,373.51,fee schedule,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,outpatient,,,295.70000,280.91000,The Alliance,Premier SAS,90,67.00,,,,,,,9.61,492.33,fee schedule,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,outpatient,,,161.60000,153.52000,The Alliance,Premier SAS,90,120.13,,,,,,,17.60,882.80,fee schedule,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,outpatient,,,99.50000,94.52000,The Alliance,Premier SAS,90,154.78,,,,,,,49.75,1137.41,fee schedule,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,outpatient,,,2343.00000,2225.85000,The Alliance,Premier SAS,90,1473.92,,,,,,,214.21,10831.07,fee schedule,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,188.60000,179.17000,The Alliance,Premier SAS,,86.57,,,,,,,86.57,188.60,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1496.25000,1421.44000,The Alliance,Premier SAS,,686.78,,,,,,,686.78,1496.25,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier SAS,TC,167.92,,,,,,,131.00,1331.91,fee schedule,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,outpatient,,,13067.00000,12413.65000,The Alliance,Premier SAS,,8990.10,,,,,,,4314.91,12674.99,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,27.24000,25.88000,The Alliance,Premier SAS,,18.74,,,,,,,13.62,26.42,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,outpatient,,,191.30000,181.74000,The Alliance,Premier SAS,90,120.13,,,,,,,17.47,882.80,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,outpatient,1,mL,0.12000,0.12000,The Alliance,Premier SAS,,0.27217,,,,,,,0.06000,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,outpatient,1,mL,0.15000,0.15000,The Alliance,Premier SAS,,0.27217,,,,,,,0.07500,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.27217,,,,,,,0.08000,0.34860,fee schedule,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27217,1.22,fee schedule,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,The Alliance,Premier SAS,,1.48,,,,,,,1.07,2.09,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,11.85,22.99,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,outpatient,1,EA,2450.87000,2328.32000,The Alliance,Premier SAS,,31.51,,,,,,,19.06,2377.34,fee schedule,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,outpatient,1,EA,5991.52000,5691.95000,The Alliance,Premier SAS,,121.45,,,,,,,75.86,5811.77,fee schedule,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,The Alliance,Premier SAS,,1.51,,,,,,,1.09,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,outpatient,1,EA,149.44000,141.96000,The Alliance,Premier SAS,,102.81,,,,,,,74.72,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,The Alliance,Premier SAS,,1.45,,,,,,,1.05,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,The Alliance,Premier SAS,,0.84624,,,,,,,0.61500,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,outpatient,1,EA,22.44000,21.31000,The Alliance,Premier SAS,,15.44,,,,,,,11.22,21.77,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,outpatient,1,mL,5333.95000,5067.25000,The Alliance,Premier SAS,,24.14,,,,,,,15.08,5173.93,fee schedule,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Premier SAS,TC,569.39,,,,,,,420.81,17311.25,fee schedule,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6744.75000,6407.51000,The Alliance,Premier SAS,,3095.84,,,,,,,3095.84,6744.75,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,79.40,,,,,,,21.50,81.82,fee schedule,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Premier SAS,,15.63,,,,,,,11.36,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,outpatient,1,mL,18.64000,17.71000,The Alliance,Premier SAS,,12.82,,,,,,,9.32,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,outpatient,1,mL,20.05000,19.05000,The Alliance,Premier SAS,,13.79,,,,,,,10.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,outpatient,1,mL,9.60000,9.12000,The Alliance,Premier SAS,,6.60,,,,,,,4.80,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,The Alliance,Premier SAS,,15.63,,,,,,,11.36,22.04,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Premier SAS,,33.35,,,,,,,24.24,47.03,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,outpatient,1,mL,104.41000,99.19000,The Alliance,Premier SAS,,71.83,,,,,,,52.20,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,outpatient,1,mL,95.21000,90.45000,The Alliance,Premier SAS,,65.50,,,,,,,47.60,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,outpatient,1,mL,122.77000,116.63000,The Alliance,Premier SAS,,84.47,,,,,,,61.38,119.09,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,outpatient,,,521.00000,494.95000,The Alliance,Premier SAS,,358.45,,,,,,,286.55,5271.00,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Premier SAS,,73.69,,,,,,,53.55,103.90,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,,928.80,,,,,,,742.50,5271.00,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,The Alliance,Premier SAS,TC,739.80,,,,,,,550.38,17311.25,fee schedule,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,outpatient,,,2929.00000,2782.55000,The Alliance,Premier SAS,,2015.15,,,,,,,1610.95,5271.00,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Premier SAS,TC,909.00,,,,,,,909.00,5271.00,case rate,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier SAS,,4806.37,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,outpatient,,,738.00000,701.10000,The Alliance,Premier SAS,TC,507.74,,,,,,,369.00,715.86,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier SAS,,560.72,,,,,,,448.25,5271.00,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,1549.12,,,,,,,1549.12,3375.00,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,outpatient,1,mL,107.11000,101.75000,The Alliance,Premier SAS,,73.69,,,,,,,1.49,103.90,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,outpatient,1,GM,2.90000,2.75000,The Alliance,Premier SAS,,2.00,,,,,,,1.45,2.81,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,The Alliance,Premier SAS,,473.34,,,,,,,314.95,667.36,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,outpatient,1,EA,24.48000,23.25000,The Alliance,Premier SAS,,16.84,,,,,,,12.24,23.75,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,The Alliance,Premier SAS,,1.13,,,,,,,0.82000,1.59,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Premier SAS,,76.90,,,,,,,14.46,80.87,fee schedule,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,outpatient,1,GM,184.32000,175.11000,The Alliance,Premier SAS,,126.81,,,,,,,92.16,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,outpatient,1,GM,131.67000,125.08000,The Alliance,Premier SAS,,90.59,,,,,,,65.83,127.72,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,outpatient,1,mL,285.68000,271.39000,The Alliance,Premier SAS,,1.22,,,,,,,0.76000,277.11,fee schedule,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,outpatient,1,mL,0.18000,0.17000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01550,0.17460,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,outpatient,1,mL,1762.49000,1674.37000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,1709.62,fee schedule,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Premier SAS,,196.94,,,,,,,143.12,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,The Alliance,Premier SAS,,196.94,,,,,,,143.12,277.66,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,outpatient,1,mL,0.77000,0.73000,The Alliance,Premier SAS,,0.52976,,,,,,,0.38500,0.74690,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,outpatient,1,GM,0.64000,0.61000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Premier SAS,,9974.44,,,,,,,9974.44,21730.80,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,,203.59,,,,,,,83.61,1614.89,fee schedule,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1881.86000,1787.77000,The Alliance,Premier SAS,,863.77,,,,,,,863.77,1881.86,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,14.00000,13.30000,The Alliance,Premier SAS,,12.01,,,,,,,7.00,13.58,fee schedule,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,The Alliance,Premier SAS,TC,197.84,,,,,,,140.50,1569.27,fee schedule,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,7443.72000,7071.53000,The Alliance,Premier SAS,,3416.67,,,,,,,3416.67,7443.72,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.91000,363.76000,The Alliance,Premier SAS,,175.76,,,,,,,175.76,382.91,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,outpatient,1,mL,4.68000,4.44000,The Alliance,Premier SAS,,0.08005,,,,,,,0.08005,4.54,fee schedule,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,outpatient,1,EA,26.01000,24.71000,The Alliance,Premier SAS,,17.89,,,,,,,13.01,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,outpatient,1,EA,17.32000,16.45000,The Alliance,Premier SAS,,11.92,,,,,,,8.66,16.80,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Premier SAS,,4571.71,,,,,,,4571.71,9960.15,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,outpatient,,,274.00000,260.30000,The Alliance,Premier SAS,TC,190.36,,,,,,,137.00,1509.95,fee schedule,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier SAS,,481.95,,,,,,,481.95,1050.00,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,outpatient,,,246.00000,233.70000,The Alliance,Premier SAS,,180.20,,,,,,,25.25,1324.17,fee schedule,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,outpatient,,,238.00000,226.10000,The Alliance,Premier SAS,,163.74,,,,,,,119.00,230.86,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,outpatient,1,mL,8182.76000,7773.62000,The Alliance,Premier SAS,,20.75,,,,,,,12.96,7937.28,fee schedule,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,outpatient,1,EA,254.49000,241.77000,The Alliance,Premier SAS,,175.09,,,,,,,127.25,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,outpatient,1,EA,197.29000,187.43000,The Alliance,Premier SAS,,135.74,,,,,,,98.64,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,outpatient,1,EA,330.51000,313.98000,The Alliance,Premier SAS,,227.39,,,,,,,165.25,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,outpatient,1,EA,251.01000,238.46000,The Alliance,Premier SAS,,172.69,,,,,,,125.50,243.48,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,outpatient,1,EA,167.34000,158.97000,The Alliance,Premier SAS,,115.13,,,,,,,83.67,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,outpatient,1,EA,169.66000,161.18000,The Alliance,Premier SAS,,116.73,,,,,,,84.83,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,outpatient,1,EA,131.53000,124.95000,The Alliance,Premier SAS,,90.49,,,,,,,65.77,127.58,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,outpatient,1,EA,237.52000,225.65000,The Alliance,Premier SAS,,163.41,,,,,,,118.76,230.39,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,outpatient,1,mL,8229.81000,7818.32000,The Alliance,Premier SAS,,20.75,,,,,,,12.96,7982.92,fee schedule,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,outpatient,1,GM,1.13000,1.08000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,The Alliance,Premier SAS,,186.45,,,,,,,135.50,417.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,66.10,,,,,,,66.10,144.00,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,outpatient,1,GM,7.47000,7.10000,The Alliance,Premier SAS,,5.14,,,,,,,3.73,7.25,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,outpatient,1,GM,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,outpatient,1,EA,21.38000,20.31000,The Alliance,Premier SAS,,14.71,,,,,,,10.69,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,outpatient,1,EA,11.79000,11.20000,The Alliance,Premier SAS,,8.11,,,,,,,5.89,11.44,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,outpatient,1,mL,35308.12000,33542.71000,The Alliance,Premier SAS,,5825.81,,,,,,,3638.86,34248.88,fee schedule,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,The Alliance,Premier SAS,,0.59856,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,outpatient,1,EA,2.60000,2.47000,The Alliance,Premier SAS,,1.79,,,,,,,1.30,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,outpatient,,,451.40000,428.83000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,outpatient,,,124.60000,118.37000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,outpatient,,,176.70000,167.86000,The Alliance,Premier SAS,90,134.00,,,,,,,21.79,984.66,fee schedule,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier SAS,90,94.72,,,,,,,13.69,696.05,fee schedule,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,outpatient,,,332.20000,315.59000,The Alliance,Premier SAS,90,228.72,,,,,,,35.97,1680.71,fee schedule,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,The Alliance,Premier SAS,,499.56,,,,,,,312.03,631.01,fee schedule,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,outpatient,1,mL,650.53000,618.00000,The Alliance,Premier SAS,,499.56,,,,,,,312.03,631.01,fee schedule,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier SAS,,69.49,,,,,,,55.55,5271.00,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,20.37,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,48.19,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,outpatient,1,mL,3.13000,2.98000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.04,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,The Alliance,Premier SAS,,2147.01,,,,,,,2147.01,4677.58,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,,73.07,,,,,,,73.07,159.20,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2790.71000,2651.17000,The Alliance,Premier SAS,,1280.94,,,,,,,1280.94,2790.71,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,The Alliance,Premier SAS,,560.72,,,,,,,448.25,5271.00,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,outpatient,,,3561.00000,3382.95000,The Alliance,Premier SAS,,2449.97,,,,,,,1958.55,5271.00,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier SAS,,219.47,,,,,,,175.45,5271.00,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Premier SAS,,664.61,,,,,,,531.30,5271.00,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,The Alliance,Premier SAS,,4.52,,,,,,,3.29,6.37,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,9.32000,8.85000,The Alliance,Premier SAS,,6.41,,,,,,,4.66,9.04,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,The Alliance,Premier SAS,,6.09,,,,,,,4.42,8.58,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,outpatient,1,EA,38.05000,36.14000,The Alliance,Premier SAS,,26.18,,,,,,,19.02,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,outpatient,1,EA,44.05000,41.85000,The Alliance,Premier SAS,,30.31,,,,,,,22.02,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier SAS,,1740.51,,,,,,,1740.51,3791.96,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier SAS,,1740.51,,,,,,,1740.51,3791.96,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier SAS,,1018.98,,,,,,,1018.98,2220.00,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier SAS,TC,1004.16,,,,,,,629.00,7964.98,fee schedule,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,outpatient,1,mL,1.11000,1.05000,The Alliance,Premier SAS,,0.76368,,,,,,,0.55500,1.49,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,The Alliance,Premier SAS,90,2647.25,,,,,,,533.12,19453.17,fee schedule,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,,30.03,,,,,,,4.28,220.68,fee schedule,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier SAS,,0.20640,,,,,,,0.15000,0.29100,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4706.00000,4470.70000,The Alliance,Premier SAS,90,3828.05,,,,,,,597.91,28130.22,fee schedule,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier SAS,90,1171.76,,,,,,,499.50,8610.62,fee schedule,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,outpatient,1,GM,66.56000,63.23000,The Alliance,Premier SAS,,45.79,,,,,,,33.28,64.56,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,outpatient,,,510.69000,485.16000,The Alliance,Premier SAS,,351.35,,,,,,,255.34,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,outpatient,1,mL,1021.38000,970.31000,The Alliance,Premier SAS,,702.71,,,,,,,273.14,990.74,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,outpatient,1,GM,29.41000,27.94000,The Alliance,Premier SAS,,20.23,,,,,,,14.71,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,outpatient,1,GM,46.98000,44.64000,The Alliance,Premier SAS,,32.32,,,,,,,23.49,45.57,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,outpatient,1,mL,108.46000,103.04000,The Alliance,Premier SAS,,74.62,,,,,,,54.23,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,outpatient,1,mL,93.71000,89.02000,The Alliance,Premier SAS,,64.47,,,,,,,46.85,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,outpatient,1,mL,92.53000,87.90000,The Alliance,Premier SAS,,63.66,,,,,,,46.27,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,outpatient,1,mL,97.51000,92.63000,The Alliance,Premier SAS,,67.09,,,,,,,48.76,94.58,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,782.00,1820.00,per diem,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,outpatient,,,352.80000,335.16000,The Alliance,Premier SAS,,242.73,,,,,,,176.40,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,outpatient,1,EA,352.80000,335.16000,The Alliance,Premier SAS,,242.73,,,,,,,176.40,342.22,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,outpatient,1,GM,83.98000,79.78000,The Alliance,Premier SAS,,57.78,,,,,,,41.99,81.46,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,14647.50000,13915.12000,The Alliance,Premier SAS,,6723.20,,,,,,,6723.20,14208.08,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,1046.52,2280.00,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,The Alliance,Premier SAS,TC,752.26,,,,,,,574.33,17311.25,fee schedule,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,The Alliance,Premier SAS,TC,616.76,,,,,,,457.64,29731.35,fee schedule,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,The Alliance,Premier SAS,TC,672.47,,,,,,,498.74,29731.35,fee schedule,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier SAS,TC,1596.00,,,,,,,911.00,1964.22,per diem,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,The Alliance,Premier SAS,,9974.44,,,,,,,9974.44,21730.80,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,outpatient,,,2209.00000,2098.55000,The Alliance,Premier SAS,TC,1787.21,,,,,,,1104.50,14176.04,fee schedule,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,outpatient,,,6409.00000,6088.55000,The Alliance,Premier SAS,,5823.00,,,,,,,2786.18,11015.00,case rate,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,409.75,5271.00,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,outpatient,1,mL,20.54000,19.51000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,19.92,fee schedule,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,outpatient,1,mL,17.30000,16.44000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,16.78,fee schedule,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,0.73646,,,,,,,0.59830,7.66,fee schedule,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,The Alliance,Premier SAS,,0.00688,,,,,,,0.00500,0.00970,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,outpatient,1,mL,38.69000,36.75000,The Alliance,Premier SAS,,0.35222,,,,,,,0.35222,37.53,fee schedule,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,outpatient,1,mL,20.65000,19.61000,The Alliance,Premier SAS,,14.21,,,,,,,10.32,20.03,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,outpatient,1,EA,3.39000,3.22000,The Alliance,Premier SAS,,2.33,,,,,,,1.70,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,outpatient,1,EA,4.45000,4.23000,The Alliance,Premier SAS,,3.06,,,,,,,2.23,4.32,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,outpatient,1,mL,17.68000,16.80000,The Alliance,Premier SAS,,12.16,,,,,,,8.84,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,outpatient,1,mL,11.12000,10.57000,The Alliance,Premier SAS,,7.65,,,,,,,5.56,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,outpatient,1,mL,34.01000,32.31000,The Alliance,Premier SAS,,23.40,,,,,,,17.00,32.99,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,outpatient,1,EA,170.64000,162.11000,The Alliance,Premier SAS,,117.40,,,,,,,85.32,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,outpatient,1,EA,197.50000,187.62000,The Alliance,Premier SAS,,135.88,,,,,,,98.75,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,outpatient,1,EA,71.08000,67.53000,The Alliance,Premier SAS,,48.90,,,,,,,35.54,68.95,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,outpatient,1,EA,6.18000,5.87000,The Alliance,Premier SAS,,4.25,,,,,,,3.09,5.99,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Premier SAS,,0.46429,,,,,,,0.29000,1100.39,fee schedule,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,outpatient,1,EA,68.99000,65.54000,The Alliance,Premier SAS,,47.47,,,,,,,34.49,66.92,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,outpatient,1,mL,27.94000,26.55000,The Alliance,Premier SAS,,19.22,,,,,,,13.97,27.10,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.75,fee schedule,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,outpatient,1,mL,2.99000,2.84000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.90,fee schedule,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,outpatient,1,mL,0.09000,0.09000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,outpatient,1,EA,86.43000,82.10000,The Alliance,Premier SAS,,59.46,,,,,,,43.22,83.84,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier SAS,,117.50,,,,,,,114.64,291.19,fee schedule,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,The Alliance,Premier SAS,,0.33712,,,,,,,0.24500,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,The Alliance,Premier SAS,,0.77744,,,,,,,0.56500,1.10,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,The Alliance,Premier SAS,,176.38,,,,,,,176.38,384.26,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,The Alliance,Premier SAS,,339.09,,,,,,,339.09,738.75,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier SAS,,764.24,,,,,,,764.24,1615.05,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,,73.07,,,,,,,73.07,159.20,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,outpatient,1,mL,28.91000,27.47000,The Alliance,Premier SAS,,76.90,,,,,,,14.46,80.87,fee schedule,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,outpatient,1,GM,8.90000,8.46000,The Alliance,Premier SAS,,6.12,,,,,,,4.45,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,outpatient,1,GM,7.65000,7.27000,The Alliance,Premier SAS,,5.26,,,,,,,3.83,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,outpatient,1,GM,7.42000,7.04000,The Alliance,Premier SAS,,5.10,,,,,,,3.71,7.20,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,outpatient,1,EA,3324.53000,3158.31000,The Alliance,Premier SAS,,222.01,,,,,,,138.67,3224.79,fee schedule,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,outpatient,1,EA,11037.06000,10485.21000,The Alliance,Premier SAS,,222.01,,,,,,,138.67,10705.95,fee schedule,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Premier SAS,,12.78,,,,,,,7.98,1004.92,fee schedule,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,outpatient,1,mL,1036.00000,984.20000,The Alliance,Premier SAS,,12.78,,,,,,,7.98,1004.92,fee schedule,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,outpatient,1,EA,3.96000,3.76000,The Alliance,Premier SAS,,2.72,,,,,,,1.98,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,3.95,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,outpatient,1,EA,7.39000,7.02000,The Alliance,Premier SAS,,5.08,,,,,,,3.69,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,outpatient,1,EA,3.91000,3.71000,The Alliance,Premier SAS,,2.69,,,,,,,1.96,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,The Alliance,Premier SAS,,2.37,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,The Alliance,Premier SAS,,2.24,,,,,,,1.62,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,The Alliance,Premier SAS,,3.35,,,,,,,2.44,4.72,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Premier SAS,,81.56,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,The Alliance,Premier SAS,,81.56,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,outpatient,1,EA,212.90000,202.26000,The Alliance,Premier SAS,,146.48,,,,,,,106.45,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,outpatient,1,EA,169.34000,160.87000,The Alliance,Premier SAS,,116.51,,,,,,,84.67,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,outpatient,1,EA,71.12000,67.57000,The Alliance,Premier SAS,,48.93,,,,,,,35.56,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,outpatient,1,EA,126.40000,120.08000,The Alliance,Premier SAS,,86.96,,,,,,,63.20,122.61,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,27.52,,,,,,,20.00,38.80,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,The Alliance,Premier SAS,,0.87376,,,,,,,0.63500,1.23,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,outpatient,1,mL,4.64000,4.41000,The Alliance,Premier SAS,,3.19,,,,,,,2.32,4.50,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,outpatient,1,mL,0.58000,0.55000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.56260,fee schedule,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.61,fee schedule,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,,32.34,,,,,,,4.40,237.65,fee schedule,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.46000,839.29000,The Alliance,Premier SAS,,405.51,,,,,,,405.51,883.46,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier SAS,,4354.76,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6693.00000,6358.35000,The Alliance,Premier SAS,,3072.09,,,,,,,3072.09,6693.00,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,565.01000,536.76000,The Alliance,Premier SAS,,259.34,,,,,,,259.34,565.01,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,312.86000,297.22000,The Alliance,Premier SAS,,143.60,,,,,,,143.60,312.86,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,The Alliance,Premier SAS,,2315.94,,,,,,,2315.94,5045.63,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,688.69000,654.26000,The Alliance,Premier SAS,,316.11,,,,,,,316.11,688.69,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier SAS,,1740.51,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,outpatient,1,mL,0.49000,0.46000,The Alliance,Premier SAS,,10.15,,,,,,,0.24500,10.52,fee schedule,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,The Alliance,Premier SAS,,1.04,,,,,,,0.75500,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,The Alliance,Premier SAS,,1.86,,,,,,,1.35,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,The Alliance,Premier SAS,,1.98,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,The Alliance,Premier SAS,,0.57104,,,,,,,0.41500,0.80510,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,outpatient,1,mL,19.75000,18.76000,The Alliance,Premier SAS,,13.59,,,,,,,9.88,19.16,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,outpatient,1,mL,1.70000,1.62000,The Alliance,Premier SAS,,7.28,,,,,,,0.85000,7.69,fee schedule,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,The Alliance,Premier SAS,TC,532.00,,,,,,,146.50,584.87,fee schedule,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,TC,1596.00,,,,,,,298.87,1820.00,per diem,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,275.50,584.87,fee schedule,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,outpatient,1,GM,110.60000,105.07000,The Alliance,Premier SAS,,76.09,,,,,,,55.30,107.28,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,outpatient,1,mL,435.00000,413.25000,The Alliance,Premier SAS,,299.28,,,,,,,217.50,421.95,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,outpatient,,,27.90000,26.50000,The Alliance,Premier SAS,,19.20,,,,,,,13.95,27.06,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,outpatient,1,EA,0.89000,0.84000,The Alliance,Premier SAS,,0.61232,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,The Alliance,Premier SAS,,0.13072,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,The Alliance,Premier SAS,,1.07,,,,,,,0.78000,1.51,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier SAS,,128.32,,,,,,,128.32,279.56,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier SAS,,17.75,,,,,,,17.75,38.68,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,outpatient,,,12.60000,11.97000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,2.17,,,,,,,1.58,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,outpatient,1,mL,3.27000,3.11000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,The Alliance,Premier SAS,,1.95,,,,,,,1.42,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,outpatient,1,mL,2.26000,2.15000,The Alliance,Premier SAS,,1.55,,,,,,,1.13,2.19,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,outpatient,1,mL,0.30000,0.29000,The Alliance,Premier SAS,,0.76848,,,,,,,0.15000,0.81340,fee schedule,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,The Alliance,Premier SAS,,116.36,,,,,,,69.38,134.59,fee schedule,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,outpatient,1,mL,138.75000,131.81000,The Alliance,Premier SAS,,116.36,,,,,,,69.38,134.59,fee schedule,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,873.75000,830.06000,The Alliance,Premier SAS,,401.05,,,,,,,401.05,873.75,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,800.63000,760.60000,The Alliance,Premier SAS,,367.49,,,,,,,367.49,800.63,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,54.36000,51.64000,The Alliance,Premier SAS,,24.95,,,,,,,24.95,54.36,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier SAS,,67.75,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,16.52,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,53.24,,,,,,,53.24,116.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Premier SAS,TC,1337.47,,,,,,,797.92,1885.68,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,The Alliance,Premier SAS,,370.50,,,,,,,370.50,807.19,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier SAS,,387.28,,,,,,,387.28,843.75,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,The Alliance,Premier SAS,,720.35,,,,,,,720.35,1569.38,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,20.34,,,,,,,19.58,63.05,fee schedule,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,,176.13,,,,,,,56.40,248.32,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,2.21,fee schedule,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,1596.00,,,,,,,372.50,1820.00,per diem,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,2523.94,fee schedule,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Premier SAS,,2044.05,,,,,,,581.10,2881.87,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,outpatient,,,812.00000,771.40000,The Alliance,Premier SAS,TC,514.53,,,,,,,406.00,4081.21,fee schedule,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier SAS,TC,6399.09,,,,,,,4467.66,9021.97,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1220.26,fee schedule,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,372.50,792.37,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,outpatient,,,7033.00000,6681.35000,The Alliance,Premier SAS,TC,4838.70,,,,,,,3383.38,7180.14,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,TC,6990.00,,,,,,,78.00,8022.25,per diem,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Premier SAS,TC,3248.74,,,,,,,2288.22,7180.14,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,The Alliance,Premier SAS,,1596.00,,,,,,,657.58,2881.87,per diem,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier SAS,TC,331.65,,,,,,,257.95,2630.66,fee schedule,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,outpatient,1,mL,1762.48000,1674.36000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,1709.61,fee schedule,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,outpatient,1,mL,1.33000,1.26000,The Alliance,Premier SAS,,2.63,,,,,,,0.66500,2.71,fee schedule,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,outpatient,1,mL,185.02000,175.77000,The Alliance,Premier SAS,,36.68,,,,,,,32.41,179.47,fee schedule,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,99.07,,,,,,,72.00,260.45,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,outpatient,1,mL,7691.77000,7307.18000,The Alliance,Premier SAS,,5291.94,,,,,,,3845.89,7461.02,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,outpatient,,,94.40000,89.68000,The Alliance,Premier SAS,90,413.53,,,,,,,47.20,3038.81,fee schedule,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,outpatient,,,2215.00000,2104.25000,The Alliance,Premier SAS,,1523.92,,,,,,,1107.50,2148.55,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,114.21,,,,,,,43.81,161.02,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,outpatient,,,882.84000,838.70000,The Alliance,Premier SAS,,630.59,,,,,,,393.87,856.35,fee schedule,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,outpatient,1,EA,998.46000,948.54000,The Alliance,Premier SAS,,630.59,,,,,,,393.87,968.51,fee schedule,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,outpatient,,,430.57000,409.04000,The Alliance,Premier SAS,,296.23,,,,,,,215.28,417.65,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,2328.75000,2212.31000,The Alliance,Premier SAS,,376.51,,,,,,,376.51,2258.89,fee schedule,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,41.00,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,TC,2373.60,,,,,,,1591.55,3346.50,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,,136.22,,,,,,,99.00,192.06,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,,180.00,,,,,,,18.50,264.00,per diem,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,outpatient,,,1236.00000,1174.20000,The Alliance,Premier SAS,,850.37,,,,,,,314.95,1198.92,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,outpatient,,,561.00000,532.95000,The Alliance,Premier SAS,TC,385.97,,,,,,,168.00,544.17,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,outpatient,,,40.55000,38.52000,The Alliance,Premier SAS,,27.90,,,,,,,20.27,39.33,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,The Alliance,Premier SAS,,180.00,,,,,,,70.50,264.00,per diem,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier SAS,,169.62,,,,,,,163.27,323.74,fee schedule,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,outpatient,,,744.63000,707.40000,The Alliance,Premier SAS,,387.23,,,,,,,372.31,722.29,fee schedule,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2714.06,per diem,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,outpatient,,,3.39000,3.22000,The Alliance,Premier SAS,,2.33,,,,,,,1.70,3.29,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,outpatient,,,24.82000,23.58000,The Alliance,Premier SAS,,12.12,,,,,,,7.57,24.08,fee schedule,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,outpatient,,,95.07000,90.32000,The Alliance,Premier SAS,,37.03,,,,,,,35.64,92.22,fee schedule,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Premier SAS,TC,151.22,,,,,,,109.90,213.21,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,,48.51,,,,,,,47.06,111.55,fee schedule,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,outpatient,,,1.25000,1.19000,The Alliance,Premier SAS,,0.86000,,,,,,,0.62500,1.21,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,36.30,145.50,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,outpatient,,,339.00000,322.05000,The Alliance,Premier SAS,,233.23,,,,,,,56.40,328.83,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,The Alliance,Premier SAS,,2970.78,,,,,,,1031.39,4188.46,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,outpatient,,,5.24000,4.98000,The Alliance,Premier SAS,,2.74,,,,,,,2.62,5.08,fee schedule,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,75.00,155.84,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,The Alliance,Premier SAS,,4401.82,,,,,,,1914.61,6206.06,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,outpatient,,,115.43000,109.66000,The Alliance,Premier SAS,,79.42,,,,,,,57.47,111.97,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,29.58,,,,,,,5.83,41.71,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,The Alliance,Premier SAS,TC,2351.58,,,,,,,1578.65,3315.46,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,40.70,,,,,,,39.18,190.12,fee schedule,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Premier SAS,,18.50,,,,,,,17.81,46.17,fee schedule,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,outpatient,,,254.81000,242.07000,The Alliance,Premier SAS,,106.04,,,,,,,102.07,247.17,fee schedule,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier SAS,,53.02,,,,,,,45.34,87.95,fee schedule,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Premier SAS,,23.83,,,,,,,22.93,57.81,fee schedule,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,outpatient,,,28.13000,26.72000,The Alliance,Premier SAS,,13.94,,,,,,,13.42,27.29,fee schedule,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier SAS,,10.16,,,,,,,9.78,40.35,fee schedule,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier SAS,,3640.90,,,,,,,1388.02,5133.24,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,The Alliance,Premier SAS,,4579.33,,,,,,,2074.81,6456.32,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier SAS,,12.69,,,,,,,12.21,37.76,fee schedule,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,outpatient,,,259.13000,246.17000,The Alliance,Premier SAS,,82.28,,,,,,,79.20,251.36,fee schedule,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,outpatient,,,55.73000,52.94000,The Alliance,Premier SAS,,27.88,,,,,,,26.83,54.06,fee schedule,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,outpatient,,,83.07000,78.92000,The Alliance,Premier SAS,,20.22,,,,,,,19.47,80.58,fee schedule,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,outpatient,,,42.67000,40.54000,The Alliance,Premier SAS,,20.12,,,,,,,19.37,41.39,fee schedule,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,outpatient,,,77.07000,73.22000,The Alliance,Premier SAS,,46.75,,,,,,,38.53,74.76,fee schedule,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,outpatient,,,216.94000,206.09000,The Alliance,Premier SAS,,93.43,,,,,,,89.94,210.43,fee schedule,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,outpatient,,,40.28000,38.27000,The Alliance,Premier SAS,,27.71,,,,,,,7.86,39.07,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,outpatient,,,178.00000,169.10000,The Alliance,Premier SAS,,47.59,,,,,,,45.80,172.66,fee schedule,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,outpatient,,,61.47000,58.40000,The Alliance,Premier SAS,,18.07,,,,,,,17.39,59.63,fee schedule,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,outpatient,,,30.67000,29.14000,The Alliance,Premier SAS,,9.03,,,,,,,8.69,29.75,fee schedule,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier SAS,,2547.71,,,,,,,549.28,20208.37,fee schedule,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,outpatient,,,85.33000,81.06000,The Alliance,Premier SAS,,40.29,,,,,,,38.77,82.77,fee schedule,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Premier SAS,,13.95,,,,,,,13.95,30.40,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,outpatient,,,2245.00000,2132.75000,The Alliance,Premier SAS,,1544.56,,,,,,,1122.50,2177.65,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,outpatient,,,4544.00000,4316.80000,The Alliance,Premier SAS,,2085.70,,,,,,,2085.70,4544.00,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,outpatient,,,97.73000,92.84000,The Alliance,Premier SAS,,22.89,,,,,,,22.03,94.80,fee schedule,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,,28.70,,,,,,,27.63,151.32,fee schedule,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,12.06,,,,,,,11.62,45.59,fee schedule,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier SAS,,8.06,,,,,,,7.75,17.46,fee schedule,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier SAS,,8.49,,,,,,,8.17,40.35,fee schedule,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,outpatient,,,38.53000,36.60000,The Alliance,Premier SAS,,13.02,,,,,,,12.54,37.37,fee schedule,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,outpatient,,,50.53000,48.00000,The Alliance,Premier SAS,,13.60,,,,,,,13.09,49.01,fee schedule,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,outpatient,,,23.60000,22.42000,The Alliance,Premier SAS,,6.02,,,,,,,5.79,22.89,fee schedule,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,The Alliance,Premier SAS,,180.00,,,,,,,53.50,264.00,per diem,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,The Alliance,Premier SAS,,15.14,,,,,,,11.00,21.34,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Premier SAS,,4.72,,,,,,,4.54,18.89,fee schedule,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,3853.00000,3660.35000,The Alliance,Premier SAS,,2650.86,,,,,,,1040.32,3737.41,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,outpatient,,,75805.34000,72015.07000,The Alliance,Premier SAS,,89569.50,,,,,,,37902.67,94648.39,fee schedule,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,The Alliance,Premier SAS,TC,1482.64,,,,,,,1006.74,2960.49,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,outpatient,,,19.47000,18.50000,The Alliance,Premier SAS,,6.35,,,,,,,6.12,18.89,fee schedule,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,7.66,156.25,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,outpatient,,,154.00000,146.30000,The Alliance,Premier SAS,,105.95,,,,,,,37.27,149.38,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier SAS,,9.40,,,,,,,9.04,37.76,fee schedule,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,outpatient,,,42.76000,40.62000,The Alliance,Premier SAS,,31.96,,,,,,,21.38,41.48,fee schedule,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,outpatient,,,357.20000,339.34000,The Alliance,Premier SAS,,245.75,,,,,,,178.60,346.48,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,9.88,184.30,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,outpatient,,,370.00000,351.50000,The Alliance,Premier SAS,TC,235.24,,,,,,,181.22,1865.95,fee schedule,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,outpatient,,,2901.00000,2755.95000,The Alliance,Premier SAS,TC,1825.41,,,,,,,1390.65,14479.11,fee schedule,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,outpatient,,,4368.00000,4149.60000,The Alliance,Premier SAS,TC,3005.18,,,,,,,2181.80,4236.96,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,148.57,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Premier SAS,,11076.80,,,,,,,966.05,15617.00,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,The Alliance,Premier SAS,,8.61,,,,,,,6.26,12.14,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,348.00,675.12,fee schedule,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,101.00,548.00,fee schedule,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Premier SAS,,846.93,,,,,,,615.50,1194.07,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,,363.26,,,,,,,264.00,689.02,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,TC,128.66,,,,,,,93.50,181.39,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier SAS,TC,10432.02,,,,,,,7955.77,82746.35,fee schedule,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,The Alliance,Premier SAS,TC,915.73,,,,,,,644.24,2960.49,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,outpatient,,,47.60000,45.22000,The Alliance,Premier SAS,,2.94,,,,,,,2.83,46.17,fee schedule,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,The Alliance,Premier SAS,,846.93,,,,,,,615.50,1194.07,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier SAS,,26.78,,,,,,,19.46,37.76,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,outpatient,,,59.00000,56.05000,The Alliance,Premier SAS,TC,40.59,,,,,,,29.50,57.23,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,496.88000,472.04000,The Alliance,Premier SAS,,848.53,,,,,,,143.61,874.50,fee schedule,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,The Alliance,Premier SAS,TC,2383.23,,,,,,,1611.84,3360.08,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier SAS,TC,541.96,,,,,,,394.00,4298.79,fee schedule,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,15.20000,14.44000,The Alliance,Premier SAS,,10.46,,,,,,,7.60,14.74,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,740.63000,703.60000,The Alliance,Premier SAS,,848.53,,,,,,,143.61,874.50,fee schedule,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,395.31000,375.54000,The Alliance,Premier SAS,,848.53,,,,,,,143.61,874.50,fee schedule,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier SAS,TC,115.58,,,,,,,84.00,162.96,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,238.63000,226.70000,The Alliance,Premier SAS,,848.53,,,,,,,119.31,874.50,fee schedule,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier SAS,TC,305.06,,,,,,,234.00,2419.76,fee schedule,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,307.27000,291.91000,The Alliance,Premier SAS,,848.53,,,,,,,143.61,874.50,fee schedule,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,The Alliance,Premier SAS,TC,1561.07,,,,,,,1134.50,2200.93,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Premier SAS,,12.01,,,,,,,11.56,32.55,fee schedule,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,50.00,97.00,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,42.52000,40.39000,The Alliance,Premier SAS,,12.01,,,,,,,11.56,41.24,fee schedule,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,409.22,fee schedule,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,703.13000,667.97000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,682.04,fee schedule,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,TC,566.90,,,,,,,52.50,4496.60,fee schedule,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,818.44,fee schedule,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,52,429.00,,,,,,,225.00,492.80,per diem,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,outpatient,,,18.48000,17.56000,The Alliance,Premier SAS,,8.48,,,,,,,8.48,17.93,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier SAS,,848.53,,,,,,,134.76,874.50,fee schedule,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,358.80000,340.86000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,348.04,fee schedule,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,48.19,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,TC,111.46,,,,,,,81.00,2210.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,outpatient,,,60.90000,57.85000,The Alliance,Premier SAS,TC,41.90,,,,,,,30.45,59.07,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,TC,418.99,,,,,,,304.50,590.73,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,The Alliance,Premier SAS,,2.28,,,,,,,1.66,3.22,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,outpatient,1,EA,3695.71000,3510.92000,The Alliance,Premier SAS,,19.40,,,,,,,12.12,3584.84,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,outpatient,1,EA,3270.72000,3107.18000,The Alliance,Premier SAS,,19.40,,,,,,,12.12,3172.60,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,outpatient,1,EA,3314.32000,3148.61000,The Alliance,Premier SAS,,19.40,,,,,,,12.12,3214.89,fee schedule,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,outpatient,1,EA,3634.14000,3452.43000,The Alliance,Premier SAS,,19.40,,,,,,,12.12,3525.12,fee schedule,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,269.85000,256.36000,The Alliance,Premier SAS,,123.86,,,,,,,123.86,269.85,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,The Alliance,Premier SAS,,181.59,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30261.00000,28747.95000,The Alliance,Premier SAS,,13889.80,,,,,,,13889.80,30261.00,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier SAS,,57.42,,,,,,,55.26,283.24,fee schedule,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,58.39000,55.47000,The Alliance,Premier SAS,,40.17,,,,,,,29.20,56.64,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Premier SAS,,36.02,,,,,,,26.18,50.79,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,31.65,,,,,,,23.00,44.62,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,23.39,,,,,,,17.00,32.98,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,outpatient,,,209.81000,199.32000,The Alliance,Premier SAS,,151.21,,,,,,,104.91,203.52,fee schedule,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,13.07000,12.42000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,12.68,fee schedule,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,outpatient,,,172.04000,163.44000,The Alliance,Premier SAS,,174.73,,,,,,,86.02,180.06,fee schedule,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,19.26,,,,,,,14.00,27.16,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier SAS,NU,15.58,,,,,,,8.00,16.05,fee schedule,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Premier SAS,,39.47,,,,,,,37.06,71.91,fee schedule,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,17.00000,16.15000,The Alliance,Premier SAS,NU,15.58,,,,,,,8.50,16.49,fee schedule,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier SAS,,216.88,,,,,,,216.88,458.32,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,outpatient,,,65.73000,62.44000,The Alliance,Premier SAS,,45.22,,,,,,,32.87,63.76,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Premier SAS,,22.11,,,,,,,16.07,31.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,15.64000,14.86000,The Alliance,Premier SAS,,10.76,,,,,,,7.82,15.17,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,144.31000,137.09000,The Alliance,Premier SAS,,99.29,,,,,,,72.16,139.98,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,82.93000,78.78000,The Alliance,Premier SAS,,57.06,,,,,,,41.47,80.44,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,outpatient,,,1245.79000,1183.50000,The Alliance,Premier SAS,,697.33,,,,,,,622.89,1208.42,fee schedule,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,167.80000,159.41000,The Alliance,Premier SAS,,115.45,,,,,,,83.90,162.77,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,4.59,,,,,,,3.33,6.47,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,95.46000,90.69000,The Alliance,Premier SAS,,225.64,,,,,,,47.73,232.52,fee schedule,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,outpatient,,,31.33000,29.76000,The Alliance,Premier SAS,,88.19,,,,,,,15.66,90.87,fee schedule,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,outpatient,,,306.76000,291.42000,The Alliance,Premier SAS,,612.00,,,,,,,153.38,630.65,fee schedule,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,The Alliance,Premier SAS,,22.11,,,,,,,16.07,31.17,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,257.76000,244.87000,The Alliance,Premier SAS,,85.32,,,,,,,81.64,250.03,fee schedule,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,50.06000,47.56000,The Alliance,Premier SAS,NU,73.59,,,,,,,25.03,75.83,fee schedule,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,25.77000,24.48000,The Alliance,Premier SAS,,17.73,,,,,,,12.88,25.00,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier SAS,,80.36,,,,,,,45.34,87.95,fee schedule,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,64.53000,61.30000,The Alliance,Premier SAS,,44.40,,,,,,,32.27,62.59,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier SAS,,11.01,,,,,,,8.00,17.60,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,38.27000,36.36000,The Alliance,Premier SAS,,99.18,,,,,,,19.14,102.20,fee schedule,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,127.79000,121.40000,The Alliance,Premier SAS,,87.92,,,,,,,63.90,123.96,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,31.56000,29.98000,The Alliance,Premier SAS,,14.49,,,,,,,14.49,30.61,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,outpatient,,,94.13000,89.42000,The Alliance,Premier SAS,,64.76,,,,,,,47.06,91.31,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,196.16000,186.35000,The Alliance,Premier SAS,NU,56.49,,,,,,,56.49,190.28,fee schedule,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,42.45,,,,,,,20.00,43.75,fee schedule,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,outpatient,,,78.37000,74.45000,The Alliance,Premier SAS,,53.92,,,,,,,39.19,76.02,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,64.42000,61.20000,The Alliance,Premier SAS,,39.47,,,,,,,32.21,62.49,fee schedule,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,outpatient,,,13.82000,13.13000,The Alliance,Premier SAS,,2.18,,,,,,,2.09,13.41,fee schedule,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,,112.83,,,,,,,82.00,159.08,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,NU,15.58,,,,,,,14.99,97.00,fee schedule,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,45.41,,,,,,,33.00,64.02,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,37.08,,,,,,,16.00,38.21,fee schedule,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,53.73000,51.04000,The Alliance,Premier SAS,,36.97,,,,,,,26.86,52.12,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,54.00000,51.30000,The Alliance,Premier SAS,,37.15,,,,,,,27.00,52.38,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,6.47,fee schedule,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,33.92000,32.22000,The Alliance,Premier SAS,,23.34,,,,,,,16.96,32.90,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Premier SAS,,68.08,,,,,,,48.44,93.97,fee schedule,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.94000,188.99000,The Alliance,Premier SAS,,91.31,,,,,,,91.31,192.97,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,11.21000,10.65000,The Alliance,Premier SAS,,10.35,,,,,,,5.61,10.87,fee schedule,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,76.89000,73.05000,The Alliance,Premier SAS,,42.45,,,,,,,38.45,74.58,fee schedule,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,1.80,,,,,,,1.73,6.47,fee schedule,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,45.56000,43.28000,The Alliance,Premier SAS,,118.21,,,,,,,22.78,121.81,fee schedule,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,197.06000,187.21000,The Alliance,Premier SAS,,80.39,,,,,,,77.37,191.15,fee schedule,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,247.54000,235.16000,The Alliance,Premier SAS,,170.31,,,,,,,123.77,240.11,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,16.51,,,,,,,12.00,26.40,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,outpatient,,,96.88000,92.04000,The Alliance,Premier SAS,,59.62,,,,,,,48.44,93.97,fee schedule,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,outpatient,,,1579.84000,1500.85000,The Alliance,Premier SAS,,926.18,,,,,,,789.92,1532.44,fee schedule,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,,57.79,,,,,,,42.00,81.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Premier SAS,,214.79,,,,,,,206.75,590.48,fee schedule,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,outpatient,,,179.66000,170.68000,The Alliance,Premier SAS,,1.77,,,,,,,1.71,174.27,fee schedule,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier SAS,,55.04,,,,,,,40.00,77.60,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier SAS,,7.57,,,,,,,5.50,10.67,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,56.00000,53.20000,The Alliance,Premier SAS,,89.72,,,,,,,28.00,92.45,fee schedule,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,29.10,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,92.48000,87.86000,The Alliance,Premier SAS,,63.63,,,,,,,46.24,89.71,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier SAS,,69.85,,,,,,,50.76,98.47,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,outpatient,,,223.09000,211.94000,The Alliance,Premier SAS,,126.79,,,,,,,111.55,216.40,fee schedule,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,218.81000,207.87000,The Alliance,Premier SAS,,100.43,,,,,,,100.43,212.25,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,outpatient,,,8.67000,8.24000,The Alliance,Premier SAS,,2.82,,,,,,,2.72,8.41,fee schedule,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,83.94,,,,,,,61.00,118.34,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier SAS,,22.70,,,,,,,16.50,36.30,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,outpatient,,,24.93000,23.68000,The Alliance,Premier SAS,,24.95,,,,,,,12.46,25.71,fee schedule,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,44.06000,41.86000,The Alliance,Premier SAS,,30.31,,,,,,,22.03,42.74,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,185.09000,175.84000,The Alliance,Premier SAS,,139.12,,,,,,,92.55,179.54,fee schedule,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier SAS,,229.62,,,,,,,166.88,323.74,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier SAS,,12.38,,,,,,,9.00,17.46,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,outpatient,,,241.12000,229.06000,The Alliance,Premier SAS,,213.20,,,,,,,120.56,233.89,fee schedule,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,41.00000,38.95000,The Alliance,Premier SAS,,28.21,,,,,,,20.50,39.77,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,outpatient,,,19.20000,18.24000,The Alliance,Premier SAS,,19.13,,,,,,,9.60,19.71,fee schedule,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,300.00000,285.00000,The Alliance,Premier SAS,,435.93,,,,,,,150.00,449.21,fee schedule,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,outpatient,,,18.58000,17.65000,The Alliance,Premier SAS,,15.14,,,,,,,9.29,18.02,fee schedule,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier SAS,,13.76,,,,,,,10.00,19.40,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,outpatient,,,208.28000,197.87000,The Alliance,Premier SAS,,106.34,,,,,,,101.76,202.03,fee schedule,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,67.80000,64.41000,The Alliance,Premier SAS,,46.65,,,,,,,33.90,65.77,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,206.25000,195.94000,The Alliance,Premier SAS,,141.90,,,,,,,103.12,200.06,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,outpatient,,,53.07000,50.42000,The Alliance,Premier SAS,,53.02,,,,,,,26.54,54.64,fee schedule,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,79.96000,75.96000,The Alliance,Premier SAS,,55.01,,,,,,,39.98,77.56,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,106.89000,101.55000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,103.68,fee schedule,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,53.14000,50.48000,The Alliance,Premier SAS,,36.56,,,,,,,26.57,51.55,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,196.04000,186.24000,The Alliance,Premier SAS,,134.88,,,,,,,98.02,190.16,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,6.47,fee schedule,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,The Alliance,Premier SAS,TC,57.24,,,,,,,41.60,484.28,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,62.92000,59.77000,The Alliance,Premier SAS,,28.88,,,,,,,28.88,61.03,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,14.40000,13.68000,The Alliance,Premier SAS,,9.91,,,,,,,7.20,13.97,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,14.65000,13.92000,The Alliance,Premier SAS,,6.72,,,,,,,6.72,14.21,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,99.07,,,,,,,72.00,139.68,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier SAS,,128.32,,,,,,,128.32,279.56,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3590.14000,3410.63000,The Alliance,Premier SAS,,1647.87,,,,,,,1647.87,3590.14,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20057.00000,19054.15000,The Alliance,Premier SAS,,9206.16,,,,,,,9206.16,20057.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13068.64000,12415.21000,The Alliance,Premier SAS,,5998.51,,,,,,,5998.51,12676.58,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier SAS,,232.37,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier SAS,,232.37,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,84.62,,,,,,,51.09,119.31,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,The Alliance,Premier SAS,,0.53664,,,,,,,0.39000,0.75660,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier SAS,,2871.77,,,,,,,2871.77,6256.58,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,The Alliance,Premier SAS,,33.89,,,,,,,33.89,73.84,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,The Alliance,Premier SAS,,67.75,,,,,,,67.75,147.60,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier SAS,,3277.95,,,,,,,3277.95,6927.26,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9004.50000,8554.27000,The Alliance,Premier SAS,,4133.07,,,,,,,4133.07,8734.36,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,outpatient,1,mL,971.25000,922.69000,The Alliance,Premier SAS,,846.26,,,,,,,485.62,1101.64,fee schedule,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier SAS,,456.13,,,,,,,456.13,993.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,42.41,,,,,,,42.41,92.40,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,outpatient,,,79.00000,75.05000,The Alliance,Premier SAS,,180.00,,,,,,,39.50,264.00,per diem,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,42.20000,40.09000,The Alliance,Premier SAS,,19.37,,,,,,,19.37,42.20,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier SAS,,231.49,,,,,,,231.49,504.34,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,The Alliance,Premier SAS,,392.85,,,,,,,212.82,1232.72,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,outpatient,,,75.00000,71.25000,The Alliance,Premier SAS,,180.00,,,,,,,37.50,264.00,per diem,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,outpatient,,,155.00000,147.25000,The Alliance,Premier SAS,,106.64,,,,,,,77.50,150.35,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier SAS,,82.56,,,,,,,60.00,116.40,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,outpatient,,,69.00000,65.55000,The Alliance,Premier SAS,,47.47,,,,,,,34.50,134.64,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,,112.83,,,,,,,82.00,159.08,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,outpatient,,,993.00000,943.35000,The Alliance,Premier SAS,,3844.00,,,,,,,546.15,4686.00,case rate,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,9622.40,per diem,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier SAS,,10.32,,,,,,,7.50,25.57,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1487.04,3544.38,per diem,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,outpatient,,,19.00000,18.05000,The Alliance,Premier SAS,,13.07,,,,,,,9.50,18.43,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.04,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,The Alliance,Premier SAS,TC,2533.90,,,,,,,1841.50,3572.51,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,outpatient,1,EA,9729.00000,9242.55000,The Alliance,Premier SAS,,6693.55,,,,,,,365.89,9437.13,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,outpatient,1,mL,0.45000,0.43000,The Alliance,Premier SAS,,1.34,,,,,,,0.22500,1.39,fee schedule,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier SAS,,3562.99,,,,,,,3562.99,7762.50,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier SAS,,2850.39,,,,,,,2850.39,6210.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier SAS,,4354.76,,,,,,,4354.76,9487.50,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier SAS,,2137.79,,,,,,,2137.79,4517.77,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,outpatient,,,182.80000,173.66000,The Alliance,Premier SAS,90,115.51,,,,,,,16.72,848.80,fee schedule,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier SAS,90,820.13,,,,,,,119.20,6026.72,fee schedule,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,233.33,,,,,,,56.40,1714.64,fee schedule,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,,44.72,,,,,,,32.50,63.05,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,outpatient,1,EA,26.02000,24.72000,The Alliance,Premier SAS,,17.90,,,,,,,13.01,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,outpatient,1,EA,6233.30000,5921.63000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,6046.30,fee schedule,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier SAS,,3562.99,,,,,,,3562.99,7762.50,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7.48000,7.11000,The Alliance,Premier SAS,,3.43,,,,,,,3.43,7.48,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier SAS,,4354.76,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Premier SAS,GP,180.00,,,,,,,30.60,264.00,per diem,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Premier SAS,GP,180.00,,,,,,,20.20,264.00,per diem,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,outpatient,1,mL,18.80000,17.86000,The Alliance,Premier SAS,,25.12,,,,,,,9.40,25.89,fee schedule,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,outpatient,1,mL,23.51000,22.33000,The Alliance,Premier SAS,,25.12,,,,,,,11.76,25.89,fee schedule,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,outpatient,1,mL,7.29000,6.93000,The Alliance,Premier SAS,,25.12,,,,,,,3.65,25.89,fee schedule,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Premier SAS,,46.19,,,,,,,28.85,438.23,fee schedule,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier SAS,,3726.21,,,,,,,1256.40,5253.52,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,outpatient,,,8064.00000,7660.80000,The Alliance,Premier SAS,,5548.03,,,,,,,1256.40,7822.08,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2320.24,per diem,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.68000,47.20000,The Alliance,Premier SAS,,22.80,,,,,,,22.80,49.68,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,The Alliance,Premier SAS,,11076.80,,,,,,,966.05,15617.00,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier SAS,,857.13,,,,,,,126.07,6798.73,fee schedule,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,The Alliance,Premier SAS,,3084.99,,,,,,,148.57,4349.48,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,outpatient,,,8601.00000,8170.95000,The Alliance,Premier SAS,,5917.49,,,,,,,503.83,8342.97,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Premier SAS,,49.92,,,,,,,31.18,259.17,fee schedule,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,The Alliance,Premier SAS,,843.41,,,,,,,843.41,1837.50,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,1046.52,2280.00,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier SAS,,130.81,,,,,,,130.81,285.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Premier SAS,TC,625.39,,,,,,,359.37,881.73,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier SAS,,260.25,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier SAS,,260.25,,,,,,,260.25,567.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,outpatient,1,EA,11.13000,10.57000,The Alliance,Premier SAS,,7.66,,,,,,,5.57,10.80,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier SAS,,36.72,,,,,,,36.72,80.00,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,outpatient,,,4020.00000,3819.00000,The Alliance,Premier SAS,TC,2765.76,,,,,,,2010.00,3899.40,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Premier SAS,TC,1817.13,,,,,,,1334.13,14413.40,fee schedule,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier SAS,,114.90,,,,,,,91.85,5271.00,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.23000,103.77000,The Alliance,Premier SAS,,75.15,,,,,,,51.64,105.95,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.92000,100.62000,The Alliance,Premier SAS,,72.87,,,,,,,51.64,102.74,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Premier SAS,,52.45,,,,,,,38.12,73.95,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Premier SAS,,50.93,,,,,,,37.01,71.80,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.22000,103.76000,The Alliance,Premier SAS,,75.14,,,,,,,51.64,105.94,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,The Alliance,Premier SAS,,50.93,,,,,,,37.01,71.80,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,The Alliance,Premier SAS,TC,3130.40,,,,,,,2150.56,7180.14,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,73.93000,70.23000,The Alliance,Premier SAS,,50.86,,,,,,,36.97,71.71,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,85.00000,80.75000,The Alliance,Premier SAS,,58.48,,,,,,,42.50,82.45,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,568.00000,539.60000,The Alliance,Premier SAS,,390.78,,,,,,,9.09,550.96,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,outpatient,,,19.50000,18.52000,The Alliance,Premier SAS,,2.94,,,,,,,2.83,18.91,fee schedule,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier SAS,,13.76,,,,,,,10.00,19.40,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Premier SAS,TC,1912.64,,,,,,,1390.00,2696.60,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,outpatient,,,2.51000,2.38000,The Alliance,Premier SAS,,0.59237,,,,,,,0.37000,2.43,fee schedule,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,532.00,,,,,,,56.50,548.00,fee schedule,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier SAS,TC,130.17,,,,,,,94.60,183.52,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,outpatient,,,557.00000,529.15000,The Alliance,Premier SAS,TC,909.00,,,,,,,278.50,5271.00,case rate,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,4.25000,4.04000,The Alliance,Premier SAS,,2.35,,,,,,,2.12,4.12,fee schedule,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,outpatient,,,1846.00000,1753.70000,The Alliance,Premier SAS,,1270.05,,,,,,,923.00,1790.62,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,250.00000,237.50000,The Alliance,Premier SAS,,172.00,,,,,,,125.00,242.50,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,24.77,,,,,,,18.00,264.00,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,,72.24,,,,,,,52.50,264.00,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1067.00000,1013.65000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,1034.99,fee schedule,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,outpatient,,,1300.00000,1235.00000,The Alliance,Premier SAS,,1016.88,,,,,,,50.73,7472.50,fee schedule,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,outpatient,,,751.00000,713.45000,The Alliance,Premier SAS,TC,516.69,,,,,,,375.50,728.47,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,,105.26,,,,,,,76.50,148.41,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,outpatient,,,38.20000,36.29000,The Alliance,Premier SAS,,26.28,,,,,,,19.10,37.05,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,outpatient,,,157.20000,149.34000,The Alliance,Premier SAS,TC,108.15,,,,,,,78.60,152.48,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,TC,532.00,,,,,,,30.50,548.00,fee schedule,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1129.00000,1072.55000,The Alliance,Premier SAS,,457.84,,,,,,,440.69,1095.13,fee schedule,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier SAS,,1810.00,,,,,,,1272.04,4844.18,per diem,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,928.29,fee schedule,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,111.46,,,,,,,81.00,325.26,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,84.62,,,,,,,61.50,119.31,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,outpatient,,,84.70000,80.47000,The Alliance,Premier SAS,,58.27,,,,,,,42.35,82.16,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier SAS,TC,271.07,,,,,,,197.00,382.18,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier SAS,,2544.33,,,,,,,549.28,20181.52,fee schedule,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,outpatient,,,902.00000,856.90000,The Alliance,Premier SAS,52,429.00,,,,,,,257.00,874.94,per diem,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,The Alliance,Premier SAS,TC,3248.74,,,,,,,2288.22,7180.14,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,The Alliance,Premier SAS,,357.07,,,,,,,48.58,503.43,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier SAS,TC,271.07,,,,,,,197.00,382.18,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,39.90,,,,,,,5.87,113.69,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier SAS,,363.95,,,,,,,173.99,513.13,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier SAS,,284.14,,,,,,,33.63,400.61,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,,251.12,,,,,,,182.50,743.46,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,93.57,,,,,,,68.00,187.21,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier SAS,,213.28,,,,,,,155.00,1239.81,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,,532.00,,,,,,,154.77,548.00,fee schedule,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier SAS,,92.19,,,,,,,67.00,129.98,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,The Alliance,Premier SAS,TC,130.51,,,,,,,101.50,1035.23,fee schedule,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,The Alliance,Premier SAS,TC,532.00,,,,,,,101.00,548.00,fee schedule,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1897.32,fee schedule,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,The Alliance,Premier SAS,TC,651.68,,,,,,,513.50,5169.06,fee schedule,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,The Alliance,Premier SAS,TC,6399.09,,,,,,,4467.66,9021.97,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1076.70,fee schedule,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,90.60000,86.07000,The Alliance,Premier SAS,,41.59,,,,,,,41.59,90.60,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier SAS,,232.37,,,,,,,232.37,506.25,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,22.95,,,,,,,22.95,50.00,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,The Alliance,Premier SAS,TC,2394.24,,,,,,,1609.99,3375.60,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier SAS,,301.22,,,,,,,301.22,656.25,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,23870.00000,22676.50000,The Alliance,Premier SAS,,10956.33,,,,,,,10956.33,23870.00,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,The Alliance,Premier SAS,,3726.21,,,,,,,2708.00,5253.52,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,outpatient,,,326.80000,310.46000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,outpatient,,,331.00000,314.45000,The Alliance,Premier SAS,90,175.58,,,,,,,27.54,1290.24,fee schedule,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,outpatient,,,619.00000,588.05000,The Alliance,Premier SAS,TC,532.00,,,,,,,309.50,600.43,fee schedule,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,outpatient,,,244.40000,232.18000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier SAS,90,48.52,,,,,,,6.92,356.54,fee schedule,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,outpatient,,,126.70000,120.36000,The Alliance,Premier SAS,TC,87.17,,,,,,,63.35,122.90,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,outpatient,1,mL,451.78000,429.19000,The Alliance,Premier SAS,,46.19,,,,,,,28.85,438.23,fee schedule,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,180.00,,,,,,,93.50,264.00,per diem,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1534.00000,1457.30000,The Alliance,Premier SAS,,1810.00,,,,,,,767.00,2161.00,per diem,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,outpatient,,,1077.00000,1023.15000,The Alliance,Premier SAS,,740.98,,,,,,,538.50,1044.69,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1036.00000,984.20000,The Alliance,Premier SAS,,712.77,,,,,,,569.80,5271.00,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,HP,158.93,,,,,,,115.50,224.07,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,outpatient,,,1005.00000,954.75000,The Alliance,Premier SAS,,691.44,,,,,,,502.50,974.85,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier SAS,,532.00,,,,,,,119.50,734.90,fee schedule,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,,79.12,,,,,,,57.50,419.70,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,HP,125.22,,,,,,,91.00,176.54,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,outpatient,,,139.00000,132.05000,The Alliance,Premier SAS,HP,95.63,,,,,,,69.50,134.83,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,HP,98.38,,,,,,,71.50,138.71,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,The Alliance,Premier SAS,HP,125.22,,,,,,,91.00,176.54,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,outpatient,,,968.00000,919.60000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,938.96,fee schedule,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,outpatient,,,849.00000,806.55000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,823.53,fee schedule,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,outpatient,,,451.00000,428.45000,The Alliance,Premier SAS,,310.29,,,,,,,225.50,1692.33,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,outpatient,,,315.00000,299.25000,The Alliance,Premier SAS,,216.72,,,,,,,157.50,305.55,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,HP,44.03,,,,,,,32.00,62.08,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,HP,35.78,,,,,,,26.00,50.44,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,HP,93.57,,,,,,,68.00,131.92,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,outpatient,,,15.17000,14.41000,The Alliance,Premier SAS,,10.44,,,,,,,7.58,25.57,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,HP,41.28,,,,,,,30.00,58.20,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,HP,35.78,,,,,,,26.00,50.44,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,The Alliance,Premier SAS,,0.81872,,,,,,,0.59500,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,outpatient,1,EA,6.69000,6.36000,The Alliance,Premier SAS,,4.60,,,,,,,3.35,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,The Alliance,Premier SAS,,1.44,,,,,,,1.04,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Premier SAS,,554.25,,,,,,,346.19,68191.00,fee schedule,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,251.25000,238.69000,The Alliance,Premier SAS,,115.32,,,,,,,115.32,251.25,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,The Alliance,Premier SAS,,17.75,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier SAS,,6.88,,,,,,,5.00,9.70,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,128.66,,,,,,,102.85,5271.00,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Premier SAS,,146.81,,,,,,,146.81,319.84,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier SAS,,200.49,,,,,,,200.49,436.80,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,outpatient,1,mL,34526.48000,32800.15000,The Alliance,Premier SAS,,225.74,,,,,,,141.00,33490.69,fee schedule,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,The Alliance,Premier SAS,,6.39,,,,,,,4.64,9.01,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,outpatient,1,mL,267.19000,253.83000,The Alliance,Premier SAS,,49.92,,,,,,,31.18,259.17,fee schedule,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Premier SAS,,409.66,,,,,,,409.66,892.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier SAS,,109.47,,,,,,,109.47,238.50,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,TC,2705.90,,,,,,,1966.50,3815.01,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9780.75000,9291.71000,The Alliance,Premier SAS,,4489.36,,,,,,,4489.36,9780.75,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier SAS,,231.49,,,,,,,231.49,504.34,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,outpatient,1,EA,7882.93000,7488.79000,The Alliance,Premier SAS,,69.29,,,,,,,43.25,7646.44,fee schedule,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Premier SAS,,913.38,,,,,,,663.79,1287.75,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier SAS,,152.81,,,,,,,152.81,332.93,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier SAS,,152.81,,,,,,,152.81,332.93,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier SAS,,199.27,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier SAS,,152.81,,,,,,,152.81,332.93,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,TC,36.46,,,,,,,26.50,51.41,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,,331.86,,,,,,,51.31,2438.63,fee schedule,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,outpatient,1,EA,29396.04000,27926.24000,The Alliance,Premier SAS,,574.90,,,,,,,359.09,28514.16,fee schedule,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,outpatient,1,mL,1417.48000,1346.61000,The Alliance,Premier SAS,,38.63,,,,,,,24.13,1374.96,fee schedule,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier SAS,,1383.88,,,,,,,1383.88,3015.00,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1822.00000,1730.90000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,2161.00,per diem,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier SAS,,550.80,,,,,,,550.80,1200.00,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,TC,58.20,,,,,,,42.95,484.28,fee schedule,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier SAS,,78.95,,,,,,,78.95,172.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,The Alliance,Premier SAS,,4354.76,,,,,,,4354.76,9487.50,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,180.00,,,,,,,76.00,264.00,per diem,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,9622.40,per diem,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,outpatient,,,456.00000,433.20000,The Alliance,Premier SAS,,313.73,,,,,,,250.80,5271.00,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,outpatient,1,EA,40006.82000,38006.48000,The Alliance,Premier SAS,,4319.58,,,,,,,2698.05,38806.62,fee schedule,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,outpatient,1,mL,9841.58000,9349.50000,The Alliance,Premier SAS,,117.75,,,,,,,73.55,9546.33,fee schedule,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,outpatient,1,GM,2.34000,2.23000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,outpatient,1,mL,271.28000,257.72000,The Alliance,Premier SAS,,186.64,,,,,,,135.64,263.14,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.38000,179.91000,The Alliance,Premier SAS,,86.93,,,,,,,86.93,189.38,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,outpatient,1,EA,3.41000,3.24000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.31,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14018.44,per diem,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,1.29,fee schedule,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,1.29,fee schedule,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,2.21,fee schedule,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.08,fee schedule,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,,2.35,,,,,,,2.31,12.33,fee schedule,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,0.97000,fee schedule,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,49.00000,46.55000,The Alliance,Premier SAS,,23.53,,,,,,,22.80,47.53,fee schedule,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,2.21,fee schedule,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,0.97000,fee schedule,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,2.21,fee schedule,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,,2.35,,,,,,,2.31,12.33,fee schedule,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.76,fee schedule,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,The Alliance,Premier SAS,,2.79,,,,,,,2.79,7.08,fee schedule,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,2.21,fee schedule,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,The Alliance,Premier SAS,,2137.79,,,,,,,2137.79,4657.50,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,The Alliance,Premier SAS,,3.54,,,,,,,2.58,5.00,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,907.50000,862.12000,The Alliance,Premier SAS,,416.54,,,,,,,416.54,907.50,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,outpatient,1,EA,0.69000,0.66000,The Alliance,Premier SAS,,0.47472,,,,,,,0.34500,0.66930,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,outpatient,,,396.80000,376.96000,The Alliance,Premier SAS,,273.00,,,,,,,23.25,384.90,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2797.00000,2657.15000,The Alliance,Premier SAS,90,1832.01,,,,,,,266.02,13462.44,fee schedule,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,outpatient,,,177.50000,168.62000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier SAS,90,154.78,,,,,,,70.95,1137.41,fee schedule,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,outpatient,,,147.90000,140.50000,The Alliance,Premier SAS,90,154.78,,,,,,,73.95,1137.41,fee schedule,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,outpatient,,,166.60000,158.27000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,outpatient,,,222.00000,210.90000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1070.00,2075.80,per diem,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,90,77.74,,,,,,,56.50,788.42,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Premier SAS,90,50.83,,,,,,,4.57,373.51,fee schedule,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,outpatient,,,130.00000,123.50000,The Alliance,Premier SAS,90,55.45,,,,,,,8.13,407.44,fee schedule,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,The Alliance,Premier SAS,TC,497.08,,,,,,,417.50,3942.79,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,outpatient,1,mL,33.71000,32.03000,The Alliance,Premier SAS,,80.74,,,,,,,16.86,83.21,fee schedule,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,281.28000,267.22000,The Alliance,Premier SAS,,161.25,,,,,,,140.64,272.84,fee schedule,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,137.46000,130.59000,The Alliance,Premier SAS,,161.25,,,,,,,68.73,192.52,fee schedule,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,The Alliance,Premier SAS,,99.07,,,,,,,72.00,260.45,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier SAS,,104.72,,,,,,,101.38,261.44,fee schedule,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Premier SAS,90,34.66,,,,,,,5.17,254.68,fee schedule,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,outpatient,,,62.40000,59.28000,The Alliance,Premier SAS,90,48.52,,,,,,,6.92,356.54,fee schedule,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Premier SAS,90,34.66,,,,,,,5.02,254.68,fee schedule,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,outpatient,,,44.20000,41.99000,The Alliance,Premier SAS,90,34.66,,,,,,,4.90,254.68,fee schedule,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,outpatient,,,2.00000,1.90000,The Alliance,Premier SAS,90,1.38,,,,,,,1.00,1.94,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,outpatient,,,112.20000,106.59000,The Alliance,Premier SAS,90,50.83,,,,,,,4.90,373.51,fee schedule,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,outpatient,,,383.70000,364.52000,The Alliance,Premier SAS,90,880.20,,,,,,,127.80,6468.09,fee schedule,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,outpatient,,,6329.00000,6012.55000,The Alliance,Premier SAS,90,4354.35,,,,,,,2520.00,6139.13,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,936.50,1820.00,per diem,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier SAS,,260.25,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier SAS,,351.57,,,,,,,122.40,495.67,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,outpatient,,,91836.00000,87244.20000,The Alliance,Premier SAS,,63183.17,,,,,,,45918.00,93760.51,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,outpatient,,,969.00000,920.55000,The Alliance,Premier SAS,TC,686.59,,,,,,,484.50,5445.97,fee schedule,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Premier SAS,,4292.50,,,,,,,4292.50,9351.85,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier SAS,,449.25,,,,,,,449.25,978.75,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,43.52000,41.34000,The Alliance,Premier SAS,,19.98,,,,,,,19.98,43.52,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,outpatient,1,GM,9.60000,9.12000,The Alliance,Premier SAS,,6.60,,,,,,,4.80,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,outpatient,1,GM,6.88000,6.54000,The Alliance,Premier SAS,,4.73,,,,,,,3.44,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,outpatient,1,GM,9.67000,9.19000,The Alliance,Premier SAS,,6.65,,,,,,,4.83,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,outpatient,1,GM,9.68000,9.20000,The Alliance,Premier SAS,,6.66,,,,,,,4.84,9.39,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,outpatient,1,mL,63.20000,60.04000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,61.30,fee schedule,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier SAS,,4624.43,,,,,,,4624.43,10075.00,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,outpatient,,,629.80000,598.31000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,outpatient,,,223.90000,212.70000,The Alliance,Premier SAS,90,50.83,,,,,,,8.37,373.51,fee schedule,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,3.24,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,563.00000,534.85000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,546.11,fee schedule,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,The Alliance,Premier SAS,TC,479.62,,,,,,,356.27,17311.25,fee schedule,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,outpatient,,,9708.00000,9222.60000,The Alliance,Premier SAS,TC,17011.00,,,,,,,4854.00,17574.00,case rate,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,outpatient,,,10317.00000,9801.15000,The Alliance,Premier SAS,TC,17011.00,,,,,,,5158.50,17574.00,case rate,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,987.13000,937.77000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,957.52,fee schedule,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,224.25000,213.04000,The Alliance,Premier SAS,,86.07,,,,,,,77.18,217.52,fee schedule,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1186.00000,1126.70000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,1150.42,fee schedule,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Premier SAS,TC,499.49,,,,,,,363.00,704.22,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,outpatient,,,8822.00000,8380.90000,The Alliance,Premier SAS,TC,17011.00,,,,,,,4411.00,17574.00,case rate,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,44.03,,,,,,,32.00,62.08,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Premier SAS,,88.06,,,,,,,64.00,124.16,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,The Alliance,Premier SAS,,658.42,,,,,,,478.50,1267.58,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,The Alliance,Premier SAS,TC,2306.18,,,,,,,1676.00,7180.14,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,The Alliance,Premier SAS,,86.00,,,,,,,62.50,121.25,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,The Alliance,Premier SAS,TC,492.09,,,,,,,361.82,17311.25,fee schedule,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,The Alliance,Premier SAS,TC,519.51,,,,,,,383.91,8543.92,fee schedule,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,The Alliance,Premier SAS,TC,541.96,,,,,,,404.21,17311.25,fee schedule,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,98.24000,93.33000,The Alliance,Premier SAS,,67.59,,,,,,,49.12,95.29,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,509.25,fee schedule,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,112.49000,106.87000,The Alliance,Premier SAS,,77.39,,,,,,,51.64,109.12,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,727.50,fee schedule,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,918.00000,872.10000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,890.46,fee schedule,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,241.88000,229.79000,The Alliance,Premier SAS,,166.41,,,,,,,51.64,234.62,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier SAS,,171.57,,,,,,,51.64,241.90,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,The Alliance,Premier SAS,,52.45,,,,,,,38.12,73.95,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,684.00000,649.80000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,663.48,fee schedule,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,125.49000,119.22000,The Alliance,Premier SAS,,86.34,,,,,,,51.64,121.73,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,591.00000,561.45000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,573.27,fee schedule,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.93000,100.63000,The Alliance,Premier SAS,,72.88,,,,,,,51.64,102.75,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,115.05000,109.30000,The Alliance,Premier SAS,,79.15,,,,,,,51.64,111.60,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,123.23000,117.07000,The Alliance,Premier SAS,,84.78,,,,,,,51.64,119.53,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,The Alliance,Premier SAS,,72.91,,,,,,,51.64,102.80,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,outpatient,,,757.00000,719.15000,The Alliance,Premier SAS,,520.82,,,,,,,416.35,5271.00,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier SAS,TC,331.65,,,,,,,257.95,2630.66,fee schedule,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,outpatient,,,641.00000,608.95000,The Alliance,Premier SAS,,441.01,,,,,,,352.55,5271.00,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1207.50000,1147.12000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,1171.28,fee schedule,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,727.50,fee schedule,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,509.25,fee schedule,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,545.62,fee schedule,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,893.55000,848.87000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,866.74,fee schedule,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,219.94000,208.94000,The Alliance,Premier SAS,,161.25,,,,,,,109.97,213.34,fee schedule,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,158.70000,150.76000,The Alliance,Premier SAS,,161.25,,,,,,,79.35,192.52,fee schedule,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,outpatient,,,706.00000,670.70000,The Alliance,Premier SAS,TC,909.00,,,,,,,353.00,5271.00,case rate,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier SAS,TC,364.64,,,,,,,265.00,514.10,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Premier SAS,TC,909.00,,,,,,,173.00,5271.00,case rate,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,TC,33.02,,,,,,,24.00,46.56,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,outpatient,,,412.00000,391.40000,The Alliance,Premier SAS,TC,169.43,,,,,,,127.30,1245.05,fee schedule,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2294.05,per diem,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,The Alliance,Premier SAS,TC,865.50,,,,,,,629.00,1220.26,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,The Alliance,Premier SAS,TC,844.86,,,,,,,614.00,1191.16,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,outpatient,,,1177.00000,1118.15000,The Alliance,Premier SAS,TC,809.78,,,,,,,588.50,1141.69,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Premier SAS,TC,974.21,,,,,,,708.00,1373.52,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,outpatient,,,2287.00000,2172.65000,The Alliance,Premier SAS,TC,1573.46,,,,,,,1143.50,2218.39,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Premier SAS,TC,1368.43,,,,,,,994.50,1929.33,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,outpatient,,,170.00000,161.50000,The Alliance,Premier SAS,TC,116.96,,,,,,,85.00,164.90,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,TC,145.86,,,,,,,106.00,205.64,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier SAS,,142.78,,,,,,,58.13,1226.08,fee schedule,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier SAS,,142.78,,,,,,,58.13,412.25,fee schedule,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,687.00000,652.65000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,666.39,fee schedule,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,436.50,fee schedule,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,1226.08,fee schedule,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,142.78,,,,,,,58.13,436.50,fee schedule,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,455.21000,432.45000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,441.55,fee schedule,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,424.00000,402.80000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,411.28,fee schedule,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,425.00000,403.75000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,412.25,fee schedule,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,584.87,1820.00,per diem,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,The Alliance,Premier SAS,TC,151.36,,,,,,,110.00,213.40,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,537.00000,510.15000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,520.89,fee schedule,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,667.00000,633.65000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,646.99,fee schedule,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1396.56,3524.98,per diem,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1339.64,3425.07,per diem,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,The Alliance,Premier SAS,52,1810.00,,,,,,,864.00,2032.87,per diem,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,1759.50000,1671.52000,The Alliance,Premier SAS,,104.72,,,,,,,101.38,1706.71,fee schedule,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,149.25000,141.79000,The Alliance,Premier SAS,,104.72,,,,,,,74.62,144.77,fee schedule,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,615.25000,584.49000,The Alliance,Premier SAS,,104.72,,,,,,,101.38,596.79,fee schedule,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,239.49000,227.52000,The Alliance,Premier SAS,,104.72,,,,,,,101.38,232.31,fee schedule,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,518.75000,492.81000,The Alliance,Premier SAS,,104.72,,,,,,,101.38,503.19,fee schedule,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,outpatient,,,1928.00000,1831.60000,The Alliance,Premier SAS,TC,909.00,,,,,,,909.00,5271.00,case rate,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,The Alliance,Premier SAS,TC,142.42,,,,,,,103.50,200.79,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,TC,60.54,,,,,,,44.00,85.36,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,The Alliance,Premier SAS,TC,559.42,,,,,,,448.00,4437.28,fee schedule,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,The Alliance,Premier SAS,,251.12,,,,,,,182.50,743.46,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier SAS,TC,924.67,,,,,,,672.00,1303.68,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,327.36,764.36,fee schedule,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,The Alliance,Premier SAS,TC,566.90,,,,,,,360.00,4496.60,fee schedule,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,154.77,548.00,fee schedule,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,867.18,fee schedule,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,outpatient,,,731.00000,694.45000,The Alliance,Premier SAS,TC,502.93,,,,,,,365.50,709.07,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,The Alliance,Premier SAS,TC,285.12,,,,,,,234.65,2261.57,fee schedule,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier SAS,TC,654.17,,,,,,,403.00,5188.83,fee schedule,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier SAS,,516.38,,,,,,,516.38,1125.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier SAS,,449.25,,,,,,,449.25,978.75,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier SAS,,199.27,,,,,,,199.27,434.14,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,The Alliance,Premier SAS,,1.69,,,,,,,1.23,2.38,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier SAS,,1024.14,,,,,,,1024.14,2231.25,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Premier SAS,90,433.58,,,,,,,26.30,3186.14,fee schedule,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,outpatient,,,52.60000,49.97000,The Alliance,Premier SAS,90,143.23,,,,,,,26.30,1052.52,fee schedule,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,outpatient,,,147.20000,139.84000,The Alliance,Premier SAS,90,117.83,,,,,,,17.27,865.84,fee schedule,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,outpatient,,,367.40000,349.03000,The Alliance,Premier SAS,90,115.51,,,,,,,16.67,848.80,fee schedule,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier SAS,90,115.51,,,,,,,16.67,848.80,fee schedule,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,outpatient,,,257.00000,244.15000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.70000,43.42000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.10,4.08,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,790.00000,750.50000,The Alliance,Premier SAS,,142.78,,,,,,,58.13,766.30,fee schedule,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,30.96,,,,,,,22.50,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,43.13000,40.97000,The Alliance,Premier SAS,,29.67,,,,,,,21.57,41.84,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,,85.31,,,,,,,35.41,120.28,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,outpatient,,,135.00000,128.25000,The Alliance,Premier SAS,,92.88,,,,,,,67.50,130.95,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,110.08,,,,,,,80.00,220.07,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,77.74,,,,,,,56.50,109.61,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,outpatient,,,307.00000,291.65000,The Alliance,Premier SAS,,211.22,,,,,,,23.25,297.79,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,outpatient,,,885.00000,840.75000,The Alliance,Premier SAS,,1596.00,,,,,,,442.50,1820.00,per diem,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,40.93000,38.88000,The Alliance,Premier SAS,,28.16,,,,,,,20.46,39.70,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,190.00000,180.50000,The Alliance,Premier SAS,,130.72,,,,,,,95.00,184.30,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,45.20000,42.94000,The Alliance,Premier SAS,,31.10,,,,,,,22.60,43.84,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,27.52,,,,,,,20.00,264.00,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,outpatient,,,15.00000,14.25000,The Alliance,Premier SAS,,10.32,,,,,,,7.50,264.00,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,outpatient,,,7.00000,6.65000,The Alliance,Premier SAS,,4.82,,,,,,,3.50,264.00,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,28.29,264.00,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier SAS,,284.14,,,,,,,206.50,400.61,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,,77.74,,,,,,,56.50,109.61,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier SAS,,9.17,,,,,,,6.67,12.93,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,The Alliance,Premier SAS,,12.11,,,,,,,8.80,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,outpatient,1,EA,19.94000,18.94000,The Alliance,Premier SAS,,13.72,,,,,,,9.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,outpatient,1,EA,21.49000,20.41000,The Alliance,Premier SAS,,14.79,,,,,,,10.74,20.85,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,31.21,,,,,,,31.21,68.00,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,The Alliance,Premier SAS,,4349.70,,,,,,,4349.70,9476.46,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,41.00,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,1692.33,fee schedule,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Premier SAS,,80.50,,,,,,,58.50,113.49,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,outpatient,,,1238.00000,1176.10000,The Alliance,Premier SAS,,7569.00,,,,,,,680.90,7803.00,case rate,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,outpatient,,,1936.00000,1839.20000,The Alliance,Premier SAS,,1810.00,,,,,,,968.00,2161.00,per diem,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Premier SAS,,895.78,,,,,,,651.00,1692.33,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,,57.79,,,,,,,42.00,81.48,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,32.34,,,,,,,23.50,96.61,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,outpatient,,,167.00000,158.65000,The Alliance,Premier SAS,,114.90,,,,,,,83.50,346.44,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,140.35,,,,,,,37.27,197.88,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,U6,158.93,,,,,,,115.50,224.07,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,123.84,,,,,,,90.00,264.00,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,outpatient,,,966.00000,917.70000,The Alliance,Premier SAS,,3844.00,,,,,,,531.30,4686.00,case rate,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,123.84,,,,,,,90.00,264.00,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,outpatient,,,47.00000,44.65000,The Alliance,Premier SAS,,32.34,,,,,,,23.50,264.00,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,128.66,,,,,,,93.50,264.00,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,123.84,,,,,,,90.00,264.00,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,36.46,,,,,,,26.50,264.00,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.04,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,U6,128.66,,,,,,,93.50,264.00,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,154.11,,,,,,,112.00,264.00,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier SAS,,115.58,,,,,,,84.00,554.21,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,36.46,,,,,,,26.50,264.00,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,264.00,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,128.66,,,,,,,93.50,264.00,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,87.38,,,,,,,63.50,264.00,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14004.86,per diem,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,The Alliance,Premier SAS,,174.75,,,,,,,127.00,246.38,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,The Alliance,Premier SAS,,128.66,,,,,,,93.50,264.00,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,The Alliance,Premier SAS,,19.95,,,,,,,14.50,28.13,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,outpatient,,,11.00000,10.45000,The Alliance,Premier SAS,,7.57,,,,,,,5.50,62.04,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,30.96,,,,,,,22.50,264.00,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,29.58,,,,,,,21.50,41.71,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,,30.96,,,,,,,22.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,100.45,,,,,,,73.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,264.00,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,outpatient,,,103.00000,97.85000,The Alliance,Premier SAS,,243.26,,,,,,,51.50,1787.56,fee schedule,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier SAS,,6.19,,,,,,,4.50,1062.65,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,154.11,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,154.11,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,U6,77.06,,,,,,,56.00,264.00,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,outpatient,,,111.00000,105.45000,The Alliance,Premier SAS,,76.37,,,,,,,55.50,264.00,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,outpatient,,,120.00000,114.00000,The Alliance,Premier SAS,,82.56,,,,,,,60.00,116.40,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier SAS,U6,213.28,,,,,,,155.00,300.70,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,68.80,,,,,,,24.02,97.00,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,outpatient,,,210.00000,199.50000,The Alliance,Premier SAS,,570.20,,,,,,,37.27,4190.05,fee schedule,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,,79.12,,,,,,,57.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,U6,102.51,,,,,,,74.50,264.00,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,43.34,,,,,,,24.02,61.11,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,outpatient,,,251.00000,238.45000,The Alliance,Premier SAS,,172.69,,,,,,,125.50,346.44,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,outpatient,,,82.00000,77.90000,The Alliance,Premier SAS,,56.42,,,,,,,24.02,79.54,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,U6,154.11,,,,,,,112.00,264.00,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,outpatient,,,211.00000,200.45000,The Alliance,Premier SAS,,145.17,,,,,,,23.25,204.67,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,outpatient,,,443.00000,420.85000,The Alliance,Premier SAS,,304.78,,,,,,,221.50,429.71,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,The Alliance,Premier SAS,,213.28,,,,,,,152.56,300.70,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,The Alliance,Premier SAS,TC,2178.90,,,,,,,1488.32,7180.14,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,outpatient,1,mL,87.06000,82.71000,The Alliance,Premier SAS,,59.90,,,,,,,43.53,84.45,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,The Alliance,Premier SAS,,0.14448,,,,,,,0.10500,0.20370,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1579.00000,1500.05000,The Alliance,Premier SAS,90,877.89,,,,,,,109.60,6451.13,fee schedule,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,outpatient,,,361.10000,343.04000,The Alliance,Premier SAS,90,248.44,,,,,,,180.55,350.27,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,outpatient,,,2880.00000,2736.00000,The Alliance,Premier SAS,90,2095.37,,,,,,,304.33,15397.76,fee schedule,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,outpatient,1,EA,1348.98000,1281.53000,The Alliance,Premier SAS,,10.77,,,,,,,6.35,1308.51,fee schedule,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,outpatient,1,EA,1552.65000,1475.02000,The Alliance,Premier SAS,,10.77,,,,,,,6.35,1506.07,fee schedule,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,outpatient,,,168.00000,159.60000,The Alliance,Premier SAS,90,103.96,,,,,,,14.94,763.98,fee schedule,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,outpatient,,,150.30000,142.78000,The Alliance,Premier SAS,90,112.03,,,,,,,17.85,823.21,fee schedule,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier SAS,,456.13,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Premier SAS,90,1485.48,,,,,,,215.88,10915.96,fee schedule,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,90,1432.34,,,,,,,208.21,10525.49,fee schedule,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier SAS,TC,1765.41,,,,,,,1283.00,2489.02,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,outpatient,1,mL,3.16000,3.00000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27125,3.07,fee schedule,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.27217,,,,,,,0.27125,6.13,fee schedule,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,outpatient,1,mL,4.62000,4.39000,The Alliance,Premier SAS,,1.06,,,,,,,1.06,4.48,fee schedule,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,outpatient,1,mL,0.97000,0.92000,The Alliance,Premier SAS,,1.06,,,,,,,0.48500,1.18,fee schedule,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,The Alliance,Premier SAS,TC,230.26,,,,,,,159.50,3015.65,fee schedule,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,outpatient,,,36.27000,34.46000,The Alliance,Premier SAS,,16.18,,,,,,,15.58,35.18,fee schedule,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier SAS,,516.38,,,,,,,516.38,1125.00,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,824.89000,783.65000,The Alliance,Premier SAS,,378.62,,,,,,,378.62,824.89,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,The Alliance,Premier SAS,,14.54,,,,,,,14.54,31.68,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,154.11,,,,,,,112.00,264.00,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,outpatient,,,167.90000,159.50000,The Alliance,Premier SAS,90,122.44,,,,,,,17.73,899.77,fee schedule,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier SAS,90,127.06,,,,,,,17.71,933.70,fee schedule,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,outpatient,,,80.10000,76.09000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,outpatient,,,452.70000,430.06000,The Alliance,Premier SAS,90,311.46,,,,,,,30.85,439.12,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,outpatient,,,308.60000,293.17000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,outpatient,,,400.10000,380.10000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,The Alliance,Premier SAS,,0.37840,,,,,,,0.27500,0.53350,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,The Alliance,Premier SAS,,4.35,,,,,,,3.16,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,The Alliance,Premier SAS,,6.89,,,,,,,5.01,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier SAS,,449.25,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier SAS,,449.25,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,513.38000,487.71000,The Alliance,Premier SAS,,235.64,,,,,,,235.64,513.38,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,209.46,,,,,,,12.05,1539.22,fee schedule,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier SAS,,366.02,,,,,,,63.95,788.42,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,90,180.20,,,,,,,26.32,1324.17,fee schedule,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,outpatient,,,284.90000,270.65000,The Alliance,Premier SAS,90,182.51,,,,,,,26.67,1341.13,fee schedule,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,90,365.02,,,,,,,52.99,2682.34,fee schedule,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,90,120.13,,,,,,,18.72,882.80,fee schedule,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11764.50000,11176.27000,The Alliance,Premier SAS,,5399.91,,,,,,,5399.91,11764.50,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14106.71,per diem,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Premier SAS,,4516.93,,,,,,,4516.93,9840.80,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.84000,47.35000,The Alliance,Premier SAS,,22.88,,,,,,,22.88,49.84,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,The Alliance,Premier SAS,,231.49,,,,,,,231.49,504.34,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,The Alliance,Premier SAS,TC,182.88,,,,,,,142.50,1450.63,fee schedule,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,outpatient,1,mL,541.98000,514.88000,The Alliance,Premier SAS,,89569.50,,,,,,,270.99,94648.39,fee schedule,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,outpatient,1,mL,9.48000,9.01000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,9.20,fee schedule,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,254.36000,241.64000,The Alliance,Premier SAS,,116.75,,,,,,,116.75,254.36,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,outpatient,,,4631.00000,4399.45000,The Alliance,Premier SAS,,3186.13,,,,,,,2315.50,4492.07,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier SAS,,5572.80,,,,,,,4050.00,7857.00,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,outpatient,1,EA,12.60000,11.97000,The Alliance,Premier SAS,,8.67,,,,,,,6.30,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,outpatient,1,EA,28.38000,26.96000,The Alliance,Premier SAS,,19.53,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,outpatient,1,EA,20.01000,19.01000,The Alliance,Premier SAS,,13.77,,,,,,,10.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,outpatient,1,EA,8.90000,8.46000,The Alliance,Premier SAS,,6.12,,,,,,,4.45,8.63,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,The Alliance,Premier SAS,,589.26,,,,,,,589.26,1283.78,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,outpatient,1,mL,1142.71000,1085.57000,The Alliance,Premier SAS,,1.22,,,,,,,0.76000,1108.43,fee schedule,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,The Alliance,Premier SAS,,4731.14,,,,,,,4731.14,10307.50,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,76.00,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier SAS,,1024.14,,,,,,,1024.14,2231.25,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,outpatient,1,mL,11.94000,11.35000,The Alliance,Premier SAS,,8.21,,,,,,,5.97,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,outpatient,1,mL,11.08000,10.53000,The Alliance,Premier SAS,,7.62,,,,,,,5.54,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,outpatient,1,mL,43.42000,41.25000,The Alliance,Premier SAS,,29.87,,,,,,,21.71,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,outpatient,1,mL,13.51000,12.84000,The Alliance,Premier SAS,,9.29,,,,,,,6.75,13.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,The Alliance,Premier SAS,,0.26832,,,,,,,0.19500,0.37830,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,outpatient,1,mL,162.98000,154.83000,The Alliance,Premier SAS,,112.13,,,,,,,81.49,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,outpatient,1,mL,184.83000,175.59000,The Alliance,Premier SAS,,127.16,,,,,,,92.42,179.29,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,outpatient,1,mL,4.39000,4.17000,The Alliance,Premier SAS,,3.02,,,,,,,2.19,4.26,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Premier SAS,,154.91,,,,,,,154.91,337.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,36.30,145.50,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,258.19,,,,,,,258.19,562.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,The Alliance,Premier SAS,,1.01,,,,,,,0.73500,1.43,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,outpatient,1,mL,0.93000,0.88000,The Alliance,Premier SAS,,0.63984,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,outpatient,1,mL,3.08000,2.93000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,2.99,fee schedule,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,The Alliance,Premier SAS,TC,909.00,,,,,,,909.00,5271.00,case rate,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier SAS,TC,751.98,,,,,,,546.50,1060.21,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,outpatient,,,539.00000,512.05000,The Alliance,Premier SAS,TC,370.83,,,,,,,269.50,522.83,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,outpatient,,,210.40000,199.88000,The Alliance,Premier SAS,90,83.17,,,,,,,12.00,611.15,fee schedule,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,outpatient,,,291.00000,276.45000,The Alliance,Premier SAS,90,85.48,,,,,,,12.41,628.12,fee schedule,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,76.76000,72.92000,The Alliance,Premier SAS,,35.23,,,,,,,35.23,76.76,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,outpatient,,,134.90000,128.16000,The Alliance,Premier SAS,90,108.58,,,,,,,15.83,797.91,fee schedule,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,outpatient,1,EA,76.76000,72.92000,The Alliance,Premier SAS,,8.12,,,,,,,7.82,74.46,fee schedule,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,outpatient,,,188.40000,178.98000,The Alliance,Premier SAS,90,152.47,,,,,,,22.12,1120.45,fee schedule,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,outpatient,,,363.00000,344.85000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,outpatient,1,mL,1400.41000,1330.39000,The Alliance,Premier SAS,,963.48,,,,,,,700.21,1358.40,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier SAS,,1383.88,,,,,,,1383.88,3015.00,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.80000,197.41000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,outpatient,,,162.90000,154.76000,The Alliance,Premier SAS,90,131.69,,,,,,,19.14,967.70,fee schedule,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,The Alliance,Premier SAS,TC,2751.30,,,,,,,2751.30,21823.18,fee schedule,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,outpatient,1,mL,1673.67000,1589.99000,The Alliance,Premier SAS,,87.53,,,,,,,54.67,1623.46,fee schedule,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier SAS,90,240.26,,,,,,,35.07,1765.53,fee schedule,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier SAS,,62.38,,,,,,,9.77,458.40,fee schedule,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,The Alliance,Premier SAS,,562.85,,,,,,,562.85,1226.25,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,The Alliance,Premier SAS,TC,1596.00,,,,,,,1136.50,2204.81,per diem,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,outpatient,,,65.70000,62.42000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,317.40000,301.53000,The Alliance,Premier SAS,,172.78,,,,,,,155.27,307.88,fee schedule,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,outpatient,,,151.00000,143.45000,The Alliance,Premier SAS,,103.89,,,,,,,75.50,146.47,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,The Alliance,Premier SAS,,0.44032,,,,,,,0.32000,0.62080,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,180.60,,,,,,,131.25,254.62,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,The Alliance,Premier SAS,,2514.04,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01000,0.34860,fee schedule,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,outpatient,1,mL,0.03000,0.02000,The Alliance,Premier SAS,,0.27217,,,,,,,0.01500,0.34860,fee schedule,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,3.24,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,0.17200,,,,,,,0.12500,10.86,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,491.00000,466.45000,The Alliance,Premier SAS,,337.81,,,,,,,63.95,788.42,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,194.06,,,,,,,56.40,1426.03,fee schedule,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,The Alliance,Premier SAS,,4571.71,,,,,,,4571.71,9960.15,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26931.87000,25585.28000,The Alliance,Premier SAS,,12361.73,,,,,,,12361.73,26931.87,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6722.33000,6386.21000,The Alliance,Premier SAS,,3085.55,,,,,,,3085.55,6722.33,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Premier SAS,,4433.94,,,,,,,4433.94,9660.00,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,outpatient,,,532.00000,505.40000,The Alliance,Premier SAS,,366.02,,,,,,,266.00,516.04,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier SAS,,1420.03,,,,,,,1420.03,3093.75,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier SAS,,3087.92,,,,,,,3087.92,6727.50,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier SAS,,1024.14,,,,,,,1024.14,2231.25,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,The Alliance,Premier SAS,TC,2399.74,,,,,,,1648.68,3383.36,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,The Alliance,Premier SAS,,499.49,,,,,,,100.97,704.22,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,The Alliance,Premier SAS,,234.95,,,,,,,170.75,331.25,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4232.12000,4020.51000,The Alliance,Premier SAS,,1942.54,,,,,,,1942.54,4232.12,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,10.86,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,outpatient,,,42.42000,40.30000,The Alliance,Premier SAS,,29.18,,,,,,,21.21,47.59,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,outpatient,0.5,EA,84.84000,80.60000,The Alliance,Premier SAS,,58.37,,,,,,,42.42,82.29,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,outpatient,,,171.00000,162.45000,The Alliance,Premier SAS,,85.48,,,,,,,12.05,628.12,fee schedule,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,The Alliance,Premier SAS,TC,320.12,,,,,,,280.00,3015.65,fee schedule,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier SAS,,2731.62,,,,,,,2731.62,5951.25,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,310.01000,294.51000,The Alliance,Premier SAS,,142.29,,,,,,,142.29,310.01,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Premier SAS,,172.78,,,,,,,155.27,309.72,fee schedule,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,The Alliance,Premier SAS,,0.26144,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,outpatient,1,GM,0.02000,0.02000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,outpatient,1,EA,3070.66000,2917.13000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,2978.54,fee schedule,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,outpatient,1,EA,3116.66000,2960.83000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,3023.16,fee schedule,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,outpatient,1,EA,33331.78000,31665.19000,The Alliance,Premier SAS,,218.10,,,,,,,136.23,32331.83,fee schedule,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Premier SAS,,9.03,,,,,,,6.57,12.74,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,128.57000,122.14000,The Alliance,Premier SAS,,104.72,,,,,,,64.28,124.71,fee schedule,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,The Alliance,Premier SAS,TC,625.39,,,,,,,359.37,881.73,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,The Alliance,Premier SAS,,128.32,,,,,,,128.32,279.56,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Premier SAS,,11205.34,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,The Alliance,Premier SAS,,11205.34,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Premier SAS,,12101.76,,,,,,,12101.76,26365.50,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,15500.00000,14725.00000,The Alliance,Premier SAS,,7114.50,,,,,,,7114.50,15500.00,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier SAS,,2871.77,,,,,,,2871.77,6256.58,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,The Alliance,Premier SAS,,2871.77,,,,,,,2871.77,6256.58,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,The Alliance,Premier SAS,,12101.76,,,,,,,12101.76,26365.50,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,27825.00000,26433.75000,The Alliance,Premier SAS,,12771.67,,,,,,,12771.67,27825.00,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,The Alliance,Premier SAS,TC,1810.00,,,,,,,1288.05,4844.18,per diem,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,The Alliance,Premier SAS,,1.77,,,,,,,1.28,2.49,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,outpatient,1,EA,2442.69000,2320.56000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,2369.41,fee schedule,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,outpatient,1,EA,2827.18000,2685.82000,The Alliance,Premier SAS,,17.51,,,,,,,10.94,2742.36,fee schedule,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,outpatient,1,EA,21354.33000,20286.61000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,20713.70,fee schedule,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,656.25000,623.44000,The Alliance,Premier SAS,,301.22,,,,,,,301.22,656.25,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier SAS,,92.95,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,The Alliance,Premier SAS,,1712.64,,,,,,,1712.64,3731.25,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,outpatient,1,GM,297.08000,282.23000,The Alliance,Premier SAS,,204.39,,,,,,,148.54,288.17,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,39270.00000,37306.50000,The Alliance,Premier SAS,,18024.93,,,,,,,18024.93,39270.00,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,outpatient,1,EA,3774.55000,3585.83000,The Alliance,Premier SAS,,6.79,,,,,,,4.24,3661.31,fee schedule,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier SAS,,2288.23,,,,,,,2288.23,4985.25,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,outpatient,1,EA,9775.80000,9287.01000,The Alliance,Premier SAS,,261.30,,,,,,,163.21,9482.53,fee schedule,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,outpatient,1,EA,13.13000,12.47000,The Alliance,Premier SAS,,9.03,,,,,,,6.57,12.74,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,outpatient,1,mL,4.58000,4.35000,The Alliance,Premier SAS,,3.15,,,,,,,2.29,4.44,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,outpatient,,,10207.00000,9696.65000,The Alliance,Premier SAS,90,7425.07,,,,,,,608.00,54562.77,fee schedule,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28637.91000,27206.01000,The Alliance,Premier SAS,,13144.80,,,,,,,13144.80,28637.91,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,outpatient,,,1024.00000,972.80000,The Alliance,Premier SAS,TC,584.35,,,,,,,433.70,17311.25,fee schedule,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,The Alliance,Premier SAS,,1860.67,,,,,,,1860.67,4053.75,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier SAS,90,797.03,,,,,,,83.09,5856.94,fee schedule,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,outpatient,,,113.00000,107.35000,The Alliance,Premier SAS,90,1171.76,,,,,,,56.50,8610.62,fee schedule,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,421.88000,400.79000,The Alliance,Premier SAS,,172.78,,,,,,,155.27,409.22,fee schedule,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,The Alliance,Premier SAS,,152.81,,,,,,,152.81,332.93,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,outpatient,,,6126.00000,5819.70000,The Alliance,Premier SAS,TC,4214.69,,,,,,,3063.00,5942.22,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier SAS,,103.28,,,,,,,103.28,225.00,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,The Alliance,Premier SAS,,5.35,,,,,,,3.88,7.54,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier SAS,,298.59,,,,,,,217.00,488.81,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,outpatient,1,mL,2194.08000,2084.37000,The Alliance,Premier SAS,,101.49,,,,,,,63.39,2128.26,fee schedule,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,TC,6990.00,,,,,,,78.00,8022.25,per diem,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,53550.00000,50872.50000,The Alliance,Premier SAS,,24579.45,,,,,,,24579.45,53550.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,outpatient,,,714.00000,678.30000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,outpatient,,,1525.00000,1448.75000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,1479.25,fee schedule,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,The Alliance,Premier SAS,,58.23,,,,,,,28.36,60.01,fee schedule,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,outpatient,1,mL,113.43000,107.76000,The Alliance,Premier SAS,,58.23,,,,,,,52.64,110.03,fee schedule,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,outpatient,1,EA,11.46000,10.88000,The Alliance,Premier SAS,,7.88,,,,,,,5.73,11.12,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,outpatient,1,EA,155.00000,147.25000,The Alliance,Premier SAS,,106.64,,,,,,,77.50,150.35,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,The Alliance,Premier SAS,,0.48848,,,,,,,0.35500,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,The Alliance,Premier SAS,,0.28896,,,,,,,0.21000,0.40740,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier SAS,,4487.78,,,,,,,4487.78,9777.30,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,424.06000,402.86000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,411.34,fee schedule,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,80.12000,76.11000,The Alliance,Premier SAS,,36.78,,,,,,,36.78,80.12,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,31326.75,,,,,,,31326.75,68250.00,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,outpatient,1,EA,7.63000,7.25000,The Alliance,Premier SAS,,5.25,,,,,,,3.81,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,outpatient,1,EA,31.40000,29.83000,The Alliance,Premier SAS,,21.60,,,,,,,15.70,30.46,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier SAS,,142.86,,,,,,,142.86,311.25,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,outpatient,,,984.00000,934.80000,The Alliance,Premier SAS,,676.99,,,,,,,200.06,954.48,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,The Alliance,Premier SAS,,30.03,,,,,,,4.28,220.68,fee schedule,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,657.80000,624.91000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,638.07,fee schedule,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,outpatient,1,GM,10.04000,9.53000,The Alliance,Premier SAS,,6.91,,,,,,,5.02,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Premier SAS,,11201.48,,,,,,,11201.48,24404.10,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Premier SAS,,3642.16,,,,,,,3642.16,7935.00,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,495.00000,470.25000,The Alliance,Premier SAS,,227.21,,,,,,,227.21,495.00,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,267.75000,254.36000,The Alliance,Premier SAS,,122.90,,,,,,,122.90,267.75,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier SAS,,5939.18,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Premier SAS,,12032.04,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier SAS,,4487.78,,,,,,,4487.78,9777.30,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,206.55,,,,,,,206.55,450.00,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,The Alliance,Premier SAS,,228.42,,,,,,,166.00,325.26,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier SAS,,575.86,,,,,,,122.40,811.89,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,outpatient,,,1310.00000,1244.50000,The Alliance,Premier SAS,TC,901.28,,,,,,,655.00,1270.70,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,outpatient,,,1538.00000,1461.10000,The Alliance,Premier SAS,TC,1058.14,,,,,,,769.00,1491.86,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,The Alliance,Premier SAS,,471.97,,,,,,,122.40,665.42,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,outpatient,,,200.00000,190.00000,The Alliance,Premier SAS,TC,137.60,,,,,,,100.00,194.00,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,outpatient,,,1812.00000,1721.40000,The Alliance,Premier SAS,TC,1246.66,,,,,,,906.00,1757.64,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier SAS,TC,1028.56,,,,,,,747.50,1450.15,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,The Alliance,Premier SAS,,751.98,,,,,,,295.69,1060.21,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,The Alliance,Premier SAS,,692.13,,,,,,,503.00,975.82,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,outpatient,1,mL,25.54000,24.27000,The Alliance,Premier SAS,,17.57,,,,,,,12.77,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,outpatient,1,mL,12.79000,12.15000,The Alliance,Premier SAS,,8.80,,,,,,,6.39,12.41,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,outpatient,1,mL,2462.57000,2339.44000,The Alliance,Premier SAS,,1694.25,,,,,,,1231.29,2388.69,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,outpatient,1,EA,1284.64000,1220.41000,The Alliance,Premier SAS,,8.50,,,,,,,5.31,1246.10,fee schedule,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,outpatient,1,mL,2259.81000,2146.82000,The Alliance,Premier SAS,,101.49,,,,,,,63.39,2192.02,fee schedule,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,outpatient,1,EA,1367.29000,1298.92000,The Alliance,Premier SAS,,12.33,,,,,,,11.25,1326.27,fee schedule,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,outpatient,1,mL,7668.27000,7284.86000,The Alliance,Premier SAS,,5275.77,,,,,,,3834.14,7438.22,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier SAS,,10.77,,,,,,,6.35,79.70,fee schedule,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,outpatient,,,59.20000,56.24000,The Alliance,Premier SAS,,40.73,,,,,,,29.60,57.42,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,31326.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1433.85000,1362.16000,The Alliance,Premier SAS,,658.14,,,,,,,658.14,1433.85,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,The Alliance,Premier SAS,,76.27,,,,,,,76.27,166.16,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier SAS,,289.65,,,,,,,231.55,5271.00,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,10.86,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,,141.69,,,,,,,141.69,308.70,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,outpatient,,,8474.00000,8050.30000,The Alliance,Premier SAS,,5830.11,,,,,,,295.69,8219.78,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,The Alliance,Premier SAS,,621.95,,,,,,,268.42,876.88,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,outpatient,,,48.67000,46.24000,The Alliance,Premier SAS,,11.48,,,,,,,11.05,47.21,fee schedule,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,outpatient,,,106.68000,101.35000,The Alliance,Premier SAS,,73.40,,,,,,,53.34,103.48,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,outpatient,1,mL,0.37000,0.35000,The Alliance,Premier SAS,,1.34,,,,,,,0.18500,1.39,fee schedule,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Premier SAS,,23.80,,,,,,,17.30,33.55,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,The Alliance,Premier SAS,,0.21328,,,,,,,0.15500,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,The Alliance,Premier SAS,,0.09632,,,,,,,0.07000,0.13580,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,The Alliance,Premier SAS,,3.54,,,,,,,2.57,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,outpatient,1,EA,15.15000,14.40000,The Alliance,Premier SAS,,10.42,,,,,,,7.58,14.70,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,outpatient,1,mL,3.14000,2.98000,The Alliance,Premier SAS,,2.16,,,,,,,1.57,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,outpatient,1,mL,4.46000,4.24000,The Alliance,Premier SAS,,3.07,,,,,,,2.23,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,outpatient,1,mL,0.80000,0.76000,The Alliance,Premier SAS,,0.55040,,,,,,,0.40000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,outpatient,1,mL,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier SAS,TC,507.06,,,,,,,368.50,714.89,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,outpatient,1,mL,61.62000,58.54000,The Alliance,Premier SAS,,18.70,,,,,,,18.70,59.77,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,outpatient,1,mL,38.30000,36.38000,The Alliance,Premier SAS,,18.70,,,,,,,18.70,37.15,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,outpatient,1,mL,132.81000,126.17000,The Alliance,Premier SAS,,18.70,,,,,,,18.70,128.83,fee schedule,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,outpatient,1,mL,38.87000,36.92000,The Alliance,Premier SAS,,18.70,,,,,,,18.70,37.70,fee schedule,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,The Alliance,Premier SAS,,1.20,,,,,,,0.87000,1.69,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,The Alliance,Premier SAS,,33.35,,,,,,,24.24,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,outpatient,1,EA,41.87000,39.78000,The Alliance,Premier SAS,,28.81,,,,,,,20.93,40.61,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,47.74,,,,,,,47.74,104.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,outpatient,,,1740.00000,1653.00000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,1692.33,fee schedule,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier SAS,,78.95,,,,,,,78.95,172.00,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,542.90000,515.76000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,526.61,fee schedule,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,65.96,,,,,,,44.00,85.36,fee schedule,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier SAS,,289.65,,,,,,,231.55,5271.00,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Premier SAS,,1409.92,,,,,,,595.10,1987.82,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier SAS,,967.59,,,,,,,967.59,2108.03,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier SAS,,199.27,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,The Alliance,Premier SAS,,199.27,,,,,,,199.27,434.14,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,236.44,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,The Alliance,Premier SAS,,2.93,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,The Alliance,Premier SAS,,1.31,,,,,,,0.95500,1.85,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier SAS,,0.50224,,,,,,,0.36500,0.70810,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,outpatient,1,EA,33.88000,32.19000,The Alliance,Premier SAS,,23.31,,,,,,,16.94,32.86,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,outpatient,1,mL,3.74000,3.55000,The Alliance,Premier SAS,,2.57,,,,,,,1.87,3.63,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,outpatient,1,EA,8541.32000,8114.25000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,8285.08,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,outpatient,1,EA,33.71000,32.03000,The Alliance,Premier SAS,,80.74,,,,,,,16.86,83.21,fee schedule,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,2322.00,,,,,,,1856.25,5271.00,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,502.50000,477.38000,The Alliance,Premier SAS,,230.65,,,,,,,230.65,502.50,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,The Alliance,Premier SAS,,78.95,,,,,,,78.95,172.00,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Premier SAS,,16.14,,,,,,,16.14,35.16,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,10.86,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,10.86,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,The Alliance,Premier SAS,,0.89440,,,,,,,0.65000,1.26,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06404,1.21,fee schedule,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,outpatient,1,mL,2421.77000,2300.69000,The Alliance,Premier SAS,,100.81,,,,,,,62.97,2349.12,fee schedule,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,The Alliance,Premier SAS,TC,3199.89,,,,,,,380.83,4511.47,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier SAS,90,97.03,,,,,,,14.00,713.01,fee schedule,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,outpatient,,,117.00000,111.15000,The Alliance,Premier SAS,90,85.48,,,,,,,12.38,628.12,fee schedule,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,outpatient,,,57.00000,54.15000,The Alliance,Premier SAS,90,90.10,,,,,,,8.17,662.12,fee schedule,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,outpatient,,,132.00000,125.40000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,The Alliance,Premier SAS,,2.31,,,,,,,1.68,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier SAS,,2.12,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,The Alliance,Premier SAS,,1.65,,,,,,,1.20,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,The Alliance,Premier SAS,,1.64,,,,,,,1.20,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,outpatient,1,EA,6.77000,6.43000,The Alliance,Premier SAS,,4.66,,,,,,,3.38,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,The Alliance,Premier SAS,,2.22,,,,,,,1.61,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,The Alliance,Premier SAS,,1.05,,,,,,,0.76500,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1012.50000,961.88000,The Alliance,Premier SAS,,464.74,,,,,,,464.74,1012.50,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,91.23,,,,,,,91.23,198.75,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.25000,252.94000,The Alliance,Premier SAS,,122.21,,,,,,,122.21,266.25,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,206.55,,,,,,,206.55,450.00,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,23.87,,,,,,,23.87,52.00,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,16.52,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,42.23,,,,,,,42.23,92.00,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier SAS,,430.31,,,,,,,430.31,937.50,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,outpatient,1,mL,1.25000,1.19000,The Alliance,Premier SAS,,0.12808,,,,,,,0.11780,1.21,fee schedule,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,outpatient,1,mL,0.68000,0.65000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,outpatient,1,mL,0.72000,0.68000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,The Alliance,Premier SAS,,145.72,,,,,,,91.02,1332.27,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,outpatient,1,mL,3.66000,3.47000,The Alliance,Premier SAS,,33.99,,,,,,,1.83,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,outpatient,1,mL,2.91000,2.76000,The Alliance,Premier SAS,,33.99,,,,,,,1.46,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,outpatient,1,mL,2.61000,2.48000,The Alliance,Premier SAS,,33.99,,,,,,,1.30,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,outpatient,1,mL,2.94000,2.80000,The Alliance,Premier SAS,,33.99,,,,,,,1.47,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,outpatient,1,mL,2.94000,2.79000,The Alliance,Premier SAS,,33.99,,,,,,,1.47,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,outpatient,1,mL,2.48000,2.36000,The Alliance,Premier SAS,,33.99,,,,,,,1.24,35.24,fee schedule,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,outpatient,1,mL,2.21000,2.10000,The Alliance,Premier SAS,,33.99,,,,,,,1.10,35.24,fee schedule,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,outpatient,,,49.36000,46.89000,The Alliance,Premier SAS,,33.96,,,,,,,24.68,47.88,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Premier SAS,,242.52,,,,,,,47.62,341.93,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,outpatient,,,261.94000,248.84000,The Alliance,Premier SAS,,135.40,,,,,,,130.34,254.08,fee schedule,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,outpatient,,,245.10000,232.84000,The Alliance,Premier SAS,RR,336.14,,,,,,,122.55,346.38,fee schedule,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Premier SAS,RR,148.52,,,,,,,114.47,242.15,fee schedule,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,outpatient,,,52.36000,49.74000,The Alliance,Premier SAS,,36.02,,,,,,,26.18,50.79,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Premier SAS,UE,2100.80,,,,,,,1526.74,2961.89,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,outpatient,,,6.24000,5.93000,The Alliance,Premier SAS,,0.43524,,,,,,,0.41800,6.05,fee schedule,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier SAS,,855.86,,,,,,,621.99,1206.66,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,outpatient,,,515.78000,489.99000,The Alliance,Premier SAS,RR,373.84,,,,,,,257.89,545.53,fee schedule,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier SAS,NU,855.86,,,,,,,621.99,1206.66,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,71.14,,,,,,,46.20,89.63,fee schedule,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,228.95000,217.50000,The Alliance,Premier SAS,,157.52,,,,,,,114.47,222.08,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,60.76000,57.72000,The Alliance,Premier SAS,,41.80,,,,,,,30.38,58.94,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier SAS,,855.86,,,,,,,621.99,1206.66,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,58.00000,55.10000,The Alliance,Premier SAS,,39.90,,,,,,,29.00,56.26,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,outpatient,,,69.72000,66.23000,The Alliance,Premier SAS,NU,72.16,,,,,,,34.86,74.36,fee schedule,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,outpatient,,,4.36000,4.14000,The Alliance,Premier SAS,,4.96,,,,,,,2.18,5.11,fee schedule,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,outpatient,,,51.33000,48.76000,The Alliance,Premier SAS,,35.32,,,,,,,25.66,49.79,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,outpatient,,,298.00000,283.10000,The Alliance,Premier SAS,,205.02,,,,,,,149.00,289.06,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Premier SAS,UE,4733.57,,,,,,,3440.09,6673.78,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,outpatient,,,97.00000,92.15000,The Alliance,Premier SAS,NU,45.54,,,,,,,43.58,94.09,fee schedule,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,outpatient,,,6.80000,6.46000,The Alliance,Premier SAS,,4.68,,,,,,,3.40,6.60,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,The Alliance,Premier SAS,NU,2100.80,,,,,,,1526.74,2961.89,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,34.88,,,,,,,34.88,73.72,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,outpatient,,,920.00000,874.00000,The Alliance,Premier SAS,,632.96,,,,,,,460.00,892.40,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier SAS,,254.96,,,,,,,185.29,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier SAS,NU,185.10,,,,,,,177.13,359.46,fee schedule,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,121.07000,115.02000,The Alliance,Premier SAS,,83.30,,,,,,,60.53,117.44,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,30.00,58.20,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier SAS,,9.44,,,,,,,6.67,12.93,fee schedule,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,outpatient,,,336.75000,319.91000,The Alliance,Premier SAS,NU,114.55,,,,,,,114.55,326.65,fee schedule,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,outpatient,,,30.40000,28.88000,The Alliance,Premier SAS,,30.32,,,,,,,15.20,31.25,fee schedule,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier SAS,,254.96,,,,,,,185.29,359.46,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,outpatient,,,30380.00000,28861.00000,The Alliance,Premier SAS,NU,12765.57,,,,,,,12765.57,30380.00,fee schedule,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Premier SAS,,64.18,,,,,,,46.65,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,outpatient,,,93.29000,88.63000,The Alliance,Premier SAS,RR,57.21,,,,,,,46.65,98.67,fee schedule,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,The Alliance,Premier SAS,,4733.57,,,,,,,3440.09,6673.78,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,outpatient,,,12.13000,11.52000,The Alliance,Premier SAS,,12.15,,,,,,,6.07,12.52,fee schedule,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,The Alliance,Premier SAS,UE,855.86,,,,,,,621.99,1206.66,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,outpatient,,,33.36000,31.69000,The Alliance,Premier SAS,,49.51,,,,,,,16.68,51.01,fee schedule,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,outpatient,,,217.88000,206.99000,The Alliance,Premier SAS,NU,120.99,,,,,,,108.94,211.34,fee schedule,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier SAS,,12.04,,,,,,,6.00,12.41,fee schedule,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,40.13000,38.12000,The Alliance,Premier SAS,NU,21.38,,,,,,,20.07,38.93,fee schedule,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,outpatient,,,19.77000,18.78000,The Alliance,Premier SAS,,21.85,,,,,,,9.88,22.52,fee schedule,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,outpatient,,,80.09000,76.09000,The Alliance,Premier SAS,NU,29.41,,,,,,,28.30,77.69,fee schedule,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,256.72000,243.88000,The Alliance,Premier SAS,,176.62,,,,,,,128.36,249.02,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,outpatient,,,575.26000,546.50000,The Alliance,Premier SAS,,297.38,,,,,,,286.24,558.00,fee schedule,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Premier SAS,,19.11,,,,,,,13.89,26.95,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,45.73000,43.44000,The Alliance,Premier SAS,,31.46,,,,,,,22.86,44.36,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,85.52000,81.24000,The Alliance,Premier SAS,NU,63.78,,,,,,,42.76,86.57,fee schedule,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,outpatient,,,938.00000,891.10000,The Alliance,Premier SAS,NU,645.34,,,,,,,469.00,909.86,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier SAS,,3.14,,,,,,,3.01,12.93,fee schedule,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,134.85,,,,,,,98.00,190.12,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,outpatient,,,197.20000,187.34000,The Alliance,Premier SAS,,85.09,,,,,,,81.91,191.28,fee schedule,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,outpatient,,,27.78000,26.39000,The Alliance,Premier SAS,RR,18.51,,,,,,,13.89,29.38,fee schedule,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,13.33000,12.66000,The Alliance,Premier SAS,,9.17,,,,,,,6.67,12.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,outpatient,,,352.50000,334.88000,The Alliance,Premier SAS,,242.52,,,,,,,176.25,341.93,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,outpatient,,,40.53000,38.50000,The Alliance,Premier SAS,,40.44,,,,,,,20.27,41.68,fee schedule,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,outpatient,,,3400.00000,3230.00000,The Alliance,Premier SAS,,2339.20,,,,,,,1700.00,3298.00,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,outpatient,,,382.22000,363.11000,The Alliance,Premier SAS,,197.58,,,,,,,190.18,370.75,fee schedule,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,outpatient,,,51.87000,49.28000,The Alliance,Premier SAS,,35.69,,,,,,,25.93,50.31,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.04,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,472.50000,448.88000,The Alliance,Premier SAS,,729.46,,,,,,,236.25,751.69,fee schedule,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,outpatient,,,107.52000,102.14000,The Alliance,Premier SAS,,177.86,,,,,,,53.76,183.28,fee schedule,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,5.33000,5.06000,The Alliance,Premier SAS,,3.67,,,,,,,2.67,5.17,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,outpatient,,,305.06000,289.81000,The Alliance,Premier SAS,,157.71,,,,,,,151.81,295.91,fee schedule,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,95.96000,91.16000,The Alliance,Premier SAS,,66.02,,,,,,,47.98,93.08,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,245.10,,,,,,,178.12,345.56,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,outpatient,,,45.21000,42.95000,The Alliance,Premier SAS,,31.10,,,,,,,22.61,43.85,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,436.07000,414.27000,The Alliance,Premier SAS,NU,67.27,,,,,,,67.27,422.99,fee schedule,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,outpatient,,,12.40000,11.78000,The Alliance,Premier SAS,,12.33,,,,,,,6.20,12.71,fee schedule,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,29.10,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,outpatient,,,245.44000,233.17000,The Alliance,Premier SAS,,150.19,,,,,,,122.72,238.08,fee schedule,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,outpatient,,,2021.78000,1920.69000,The Alliance,Premier SAS,NU,1390.98,,,,,,,1010.89,1961.13,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,66.67000,63.34000,The Alliance,Premier SAS,NU,21.38,,,,,,,21.38,64.67,fee schedule,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,outpatient,,,3430.67000,3259.14000,The Alliance,Premier SAS,,1773.47,,,,,,,1707.07,3327.75,fee schedule,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,outpatient,,,72.00000,68.40000,The Alliance,Premier SAS,,49.54,,,,,,,36.00,69.84,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,outpatient,,,1941.00000,1843.95000,The Alliance,Premier SAS,,730.97,,,,,,,699.50,1882.77,fee schedule,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,292.69000,278.06000,The Alliance,Premier SAS,NU,67.27,,,,,,,67.27,283.91,fee schedule,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,0.98208,,,,,,,0.94600,6.47,fee schedule,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,outpatient,,,7.28000,6.92000,The Alliance,Premier SAS,,1.23,,,,,,,1.18,7.06,fee schedule,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,outpatient,,,69.07000,65.62000,The Alliance,Premier SAS,,78.38,,,,,,,34.53,80.76,fee schedule,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,outpatient,,,976.08000,927.28000,The Alliance,Premier SAS,,504.58,,,,,,,485.68,946.80,fee schedule,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,outpatient,,,14.34000,13.62000,The Alliance,Premier SAS,,5.08,,,,,,,4.88,13.91,fee schedule,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,4.75,,,,,,,3.33,6.47,fee schedule,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,outpatient,,,11.87000,11.28000,The Alliance,Premier SAS,,11.65,,,,,,,5.93,12.01,fee schedule,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,45.41,,,,,,,33.00,72.60,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.01000,0.96000,The Alliance,Premier SAS,,0.69488,,,,,,,0.50500,0.97970,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,outpatient,,,1219.00000,1158.05000,The Alliance,Premier SAS,,559.52,,,,,,,559.52,1182.43,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,outpatient,,,20.24000,19.23000,The Alliance,Premier SAS,,9.20,,,,,,,8.86,19.63,fee schedule,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,outpatient,,,80.00000,76.00000,The Alliance,Premier SAS,,5.17,,,,,,,4.97,77.60,fee schedule,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,NU,54.11,,,,,,,51.00,98.94,fee schedule,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,outpatient,,,916.18000,870.37000,The Alliance,Premier SAS,,473.62,,,,,,,455.88,888.69,fee schedule,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,outpatient,,,1431.00000,1359.45000,The Alliance,Premier SAS,,528.20,,,,,,,508.43,1388.07,fee schedule,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,341.25000,324.19000,The Alliance,Premier SAS,,729.46,,,,,,,170.62,751.69,fee schedule,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,outpatient,,,139.36000,132.39000,The Alliance,Premier SAS,NU,63.78,,,,,,,63.78,135.18,fee schedule,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,outpatient,,,176.52000,167.69000,The Alliance,Premier SAS,NU,57.60,,,,,,,55.44,171.22,fee schedule,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,outpatient,,,49.62000,47.14000,The Alliance,Premier SAS,NU,28.94,,,,,,,24.81,48.13,fee schedule,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,outpatient,,,364.24000,346.03000,The Alliance,Premier SAS,NU,250.60,,,,,,,182.12,353.31,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,45.00000,42.75000,The Alliance,Premier SAS,NU,18.68,,,,,,,17.89,43.65,fee schedule,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,outpatient,,,13.00000,12.35000,The Alliance,Premier SAS,,8.94,,,,,,,6.50,12.61,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,306.75000,291.41000,The Alliance,Premier SAS,NU,63.78,,,,,,,63.78,297.55,fee schedule,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,outpatient,,,7.73000,7.34000,The Alliance,Premier SAS,,7.67,,,,,,,3.87,7.90,fee schedule,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,outpatient,,,9.07000,8.62000,The Alliance,Premier SAS,,3.46,,,,,,,3.33,8.80,fee schedule,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,The Alliance,Premier SAS,UE,138.83,,,,,,,132.85,359.46,fee schedule,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.04,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.78000,1.69000,The Alliance,Premier SAS,,1.22,,,,,,,0.89000,1.73,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,outpatient,,,6478.28000,6154.37000,The Alliance,Premier SAS,,3348.92,,,,,,,3223.54,6283.93,fee schedule,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,outpatient,,,461.88000,438.79000,The Alliance,Premier SAS,NU,120.99,,,,,,,116.46,448.02,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,outpatient,1,mL,0.94000,0.90000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.91180,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.92150,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,outpatient,1,mL,0.86000,0.82000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.83420,fee schedule,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,0.76630,fee schedule,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,outpatient,1,mL,70.06000,66.56000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,67.96,fee schedule,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,outpatient,1,mL,47.36000,44.99000,The Alliance,Premier SAS,,11.37,,,,,,,6.30,45.94,fee schedule,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,3725.18000,3538.92000,The Alliance,Premier SAS,,1709.86,,,,,,,1709.86,3725.18,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,outpatient,,,1687.00000,1602.65000,The Alliance,Premier SAS,90,1106.60,,,,,,,162.98,8131.76,fee schedule,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,outpatient,,,2238.00000,2126.10000,The Alliance,Premier SAS,90,1409.24,,,,,,,204.58,10355.70,fee schedule,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,10.86,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,outpatient,1,mL,0.33000,0.32000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,outpatient,1,mL,1.14000,1.08000,The Alliance,Premier SAS,,0.78432,,,,,,,0.57000,1.11,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,outpatient,1,mL,78.08000,74.18000,The Alliance,Premier SAS,,53.72,,,,,,,39.04,75.74,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier SAS,,2454.50,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,405.56000,385.28000,The Alliance,Premier SAS,,186.15,,,,,,,186.15,405.56,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,83.94,,,,,,,61.00,118.34,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,outpatient,,,779.00000,740.05000,The Alliance,Premier SAS,,933.33,,,,,,,389.50,6858.56,fee schedule,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,The Alliance,Premier SAS,,0.16512,,,,,,,0.12000,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,The Alliance,Premier SAS,,471.85,,,,,,,325.11,1028.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier SAS,TC,620.11,,,,,,,463.75,17311.25,fee schedule,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1755.00000,1667.25000,The Alliance,Premier SAS,,805.54,,,,,,,805.54,1755.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier SAS,,2454.50,,,,,,,2454.50,5347.50,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,The Alliance,Premier SAS,,3.40,,,,,,,2.47,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,outpatient,1,EA,8.22000,7.80000,The Alliance,Premier SAS,,5.66,,,,,,,4.11,7.97,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,outpatient,1,mL,6.00000,5.70000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,5.82,fee schedule,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,outpatient,1,mL,6.86000,6.51000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,6.65,fee schedule,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,905.96000,860.66000,The Alliance,Premier SAS,,415.84,,,,,,,415.84,905.96,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Premier SAS,,418.26,,,,,,,418.26,911.25,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,outpatient,,,4079.00000,3875.05000,The Alliance,Premier SAS,TC,44997.00,,,,,,,2039.50,52322.00,case rate,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Premier SAS,TC,44997.00,,,,,,,976.00,52322.00,case rate,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,The Alliance,Premier SAS,,3.63,,,,,,,2.63,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,outpatient,1,EA,35.83000,34.04000,The Alliance,Premier SAS,,24.65,,,,,,,17.91,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,outpatient,1,EA,13.44000,12.77000,The Alliance,Premier SAS,,9.25,,,,,,,6.72,13.04,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,28350.00000,26932.50000,The Alliance,Premier SAS,,13012.65,,,,,,,13012.65,27499.50,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Premier SAS,,1631.25,,,,,,,1304.05,5271.00,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,outpatient,,,1050.00000,997.50000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,5858.00,case rate,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,3810.53000,3620.00000,The Alliance,Premier SAS,,1749.03,,,,,,,1749.03,3810.53,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11005.00000,10454.75000,The Alliance,Premier SAS,,5051.30,,,,,,,5051.30,11005.00,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,258.19,,,,,,,258.19,562.50,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,The Alliance,Premier SAS,,238.36,,,,,,,238.36,519.30,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,outpatient,1,EA,265.32000,252.05000,The Alliance,Premier SAS,,182.54,,,,,,,132.66,257.36,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,outpatient,1,EA,15105.00000,14349.75000,The Alliance,Premier SAS,,330.01,,,,,,,206.13,14651.85,fee schedule,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,outpatient,,,1046.00000,993.70000,The Alliance,Premier SAS,,650.49,,,,,,,523.00,1014.62,fee schedule,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier SAS,,76.90,,,,,,,19.30,80.87,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier SAS,,76.90,,,,,,,19.30,80.87,fee schedule,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Premier SAS,,25.18,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,outpatient,1,EA,26.11000,24.81000,The Alliance,Premier SAS,,17.96,,,,,,,13.05,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,outpatient,1,EA,9.68000,9.20000,The Alliance,Premier SAS,,6.66,,,,,,,4.84,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,outpatient,1,EA,21.05000,20.00000,The Alliance,Premier SAS,,14.48,,,,,,,10.53,20.42,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,The Alliance,Premier SAS,,8.97,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,The Alliance,Premier SAS,,28.10,,,,,,,20.43,39.62,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier SAS,90,110.89,,,,,,,16.01,814.87,fee schedule,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier SAS,,488.48,,,,,,,390.50,5271.00,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,The Alliance,Premier SAS,,37147.18,,,,,,,4607.00,52373.21,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,189.20000,179.74000,The Alliance,Premier SAS,,86.84,,,,,,,86.84,189.20,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30690.00000,29155.50000,The Alliance,Premier SAS,,14086.71,,,,,,,14086.71,30690.00,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,198.00000,188.10000,The Alliance,Premier SAS,,90.88,,,,,,,90.88,198.00,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,424.88000,403.64000,The Alliance,Premier SAS,,195.02,,,,,,,195.02,424.88,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier SAS,,1328.81,,,,,,,1328.81,2895.00,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1747.46000,1660.09000,The Alliance,Premier SAS,,802.08,,,,,,,802.08,1747.46,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,9642.75000,9160.61000,The Alliance,Premier SAS,,4426.02,,,,,,,4426.02,9642.75,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,The Alliance,Premier SAS,,418.26,,,,,,,418.26,911.25,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,220.32,,,,,,,220.32,480.00,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,The Alliance,Premier SAS,,0.07568,,,,,,,0.05500,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,The Alliance,Premier SAS,,140.35,,,,,,,23.25,197.88,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12220.20000,11609.19000,The Alliance,Premier SAS,,5609.07,,,,,,,5609.07,12220.20,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,The Alliance,Premier SAS,,31326.75,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,The Alliance,Premier SAS,,8558.74,,,,,,,8558.74,18646.50,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.40000,227.43000,The Alliance,Premier SAS,,109.88,,,,,,,109.88,239.40,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,outpatient,,,138.00000,131.10000,The Alliance,Premier SAS,,94.94,,,,,,,69.00,133.86,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,outpatient,1,mL,0.55000,0.53000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,0.53350,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,outpatient,1,mL,1.53000,1.45000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.48,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,outpatient,1,mL,1.55000,1.47000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.50,fee schedule,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,outpatient,1,mL,1.51000,1.44000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.46,fee schedule,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,outpatient,1,mL,119.99000,113.99000,The Alliance,Premier SAS,,82.55,,,,,,,59.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,outpatient,1,mL,134.30000,127.59000,The Alliance,Premier SAS,,92.40,,,,,,,67.15,130.27,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,outpatient,1,mL,2.45000,2.32000,The Alliance,Premier SAS,,1.54,,,,,,,1.23,2.38,fee schedule,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,outpatient,1,mL,108.39000,102.97000,The Alliance,Premier SAS,,74.57,,,,,,,54.20,105.14,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,1.49,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Premier SAS,,12.25,,,,,,,8.90,17.27,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier SAS,,9953.19,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3490.74000,3316.20000,The Alliance,Premier SAS,,1602.25,,,,,,,1602.25,3490.74,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,72.60000,68.97000,The Alliance,Premier SAS,,33.32,,,,,,,33.32,72.60,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,86.00,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,355.69000,337.91000,The Alliance,Premier SAS,,163.26,,,,,,,163.26,355.69,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,25668.00000,24384.60000,The Alliance,Premier SAS,,11781.61,,,,,,,11781.61,25668.00,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,86.00,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier SAS,,277.12,,,,,,,277.12,603.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,1549.12,,,,,,,1549.12,3375.00,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,53.16000,50.50000,The Alliance,Premier SAS,,24.40,,,,,,,24.40,53.16,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier SAS,90,175.44,,,,,,,21.69,1289.24,fee schedule,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,,120.48,,,,,,,14.91,885.37,fee schedule,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,,154.78,,,,,,,144.00,1137.41,fee schedule,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,112.03,,,,,,,13.82,823.21,fee schedule,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier SAS,,120.48,,,,,,,14.91,885.37,fee schedule,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier SAS,,120.48,,,,,,,14.91,885.37,fee schedule,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,outpatient,1,EA,2.95000,2.81000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,The Alliance,Premier SAS,,2.04,,,,,,,1.48,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,The Alliance,Premier SAS,,2.01,,,,,,,1.46,2.83,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,577.50000,548.62000,The Alliance,Premier SAS,,42.83,,,,,,,41.23,560.17,fee schedule,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,126.04000,119.74000,The Alliance,Premier SAS,,86.72,,,,,,,63.02,122.26,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,The Alliance,Premier SAS,,1.39,,,,,,,1.01,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,outpatient,1,EA,2.04000,1.94000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,The Alliance,Premier SAS,,1.80,,,,,,,1.30,2.53,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,The Alliance,Premier SAS,TC,970.77,,,,,,,705.50,1368.67,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,The Alliance,Premier SAS,,25.18,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,outpatient,1,EA,26.10000,24.80000,The Alliance,Premier SAS,,17.96,,,,,,,13.05,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,outpatient,1,EA,3.55000,3.38000,The Alliance,Premier SAS,,2.44,,,,,,,1.77,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,outpatient,1,EA,21.05000,19.99000,The Alliance,Premier SAS,,14.48,,,,,,,10.53,20.42,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,199.44000,189.47000,The Alliance,Premier SAS,,137.21,,,,,,,99.72,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,250.65000,238.12000,The Alliance,Premier SAS,,172.45,,,,,,,125.33,243.13,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,outpatient,,,2750.00000,2612.50000,The Alliance,Premier SAS,,1262.25,,,,,,,1262.25,2667.50,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,114.21,,,,,,,37.27,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,,232.54,,,,,,,122.40,327.86,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,114.21,,,,,,,37.27,161.02,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,693.75000,659.06000,The Alliance,Premier SAS,,318.43,,,,,,,318.43,693.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,outpatient,,,338.00000,321.10000,The Alliance,Premier SAS,,232.54,,,,,,,122.40,327.86,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,TC,24.77,,,,,,,18.00,34.92,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,outpatient,1,EA,106.41000,101.09000,The Alliance,Premier SAS,,73.21,,,,,,,53.20,103.22,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,outpatient,,,713.00000,677.35000,The Alliance,Premier SAS,TC,490.54,,,,,,,356.50,691.61,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,The Alliance,Premier SAS,TC,1135.89,,,,,,,805.84,2210.07,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier SAS,TC,367.39,,,,,,,267.00,517.98,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,The Alliance,Premier SAS,,75.68,,,,,,,55.00,106.70,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,TC,1596.00,,,,,,,979.11,2209.66,per diem,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,The Alliance,Premier SAS,TC,1596.00,,,,,,,924.00,1820.00,per diem,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,284.01,,,,,,,284.01,618.75,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,outpatient,,,781.00000,741.95000,The Alliance,Premier SAS,90,243.08,,,,,,,12.05,1786.28,fee schedule,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,outpatient,,,126.20000,119.89000,The Alliance,Premier SAS,90,78.55,,,,,,,11.52,577.23,fee schedule,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,outpatient,,,971.00000,922.45000,The Alliance,Premier SAS,90,1122.78,,,,,,,143.40,8250.66,fee schedule,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1484.00000,1409.80000,The Alliance,Premier SAS,90,1171.76,,,,,,,664.97,8610.62,fee schedule,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,outpatient,1,EA,4864.22000,4621.01000,The Alliance,Premier SAS,,11.59,,,,,,,7.24,4718.29,fee schedule,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,outpatient,1,EA,4120.10000,3914.10000,The Alliance,Premier SAS,,11.59,,,,,,,7.24,3996.50,fee schedule,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,outpatient,1,mL,3.42000,3.25000,The Alliance,Premier SAS,,2.35,,,,,,,1.71,3.32,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,outpatient,1,mL,2.97000,2.82000,The Alliance,Premier SAS,,2.04,,,,,,,1.49,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier SAS,,4721.18,,,,,,,4721.18,10285.80,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,222.04,,,,,,,222.04,483.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,The Alliance,Premier SAS,,17829.04,,,,,,,17829.04,38843.22,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Premier SAS,,450.97,,,,,,,450.97,982.50,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,The Alliance,Premier SAS,,1409.92,,,,,,,595.10,1987.82,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,outpatient,,,36.64000,34.81000,The Alliance,Premier SAS,,25.21,,,,,,,18.32,35.54,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,outpatient,1,EA,7781.61000,7392.53000,The Alliance,Premier SAS,,218.10,,,,,,,136.23,7548.16,fee schedule,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,outpatient,,,184.60000,175.37000,The Alliance,Premier SAS,90,115.51,,,,,,,16.88,848.80,fee schedule,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,outpatient,1,EA,5033.44000,4781.76000,The Alliance,Premier SAS,,58.05,,,,,,,36.26,4882.44,fee schedule,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,The Alliance,Premier SAS,TC,2255.26,,,,,,,1489.61,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,The Alliance,Premier SAS,,0.73616,,,,,,,0.53500,1.04,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,outpatient,1,EA,42.44000,40.32000,The Alliance,Premier SAS,,29.20,,,,,,,21.22,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,outpatient,1,EA,6.86000,6.51000,The Alliance,Premier SAS,,4.72,,,,,,,3.43,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,outpatient,1,EA,38.63000,36.70000,The Alliance,Premier SAS,,26.58,,,,,,,19.32,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,The Alliance,Premier SAS,,4.71,,,,,,,3.42,6.64,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,The Alliance,Premier SAS,,0.91504,,,,,,,0.66500,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,outpatient,1,EA,28.28000,26.87000,The Alliance,Premier SAS,,19.46,,,,,,,14.14,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,The Alliance,Premier SAS,,1.61,,,,,,,1.17,2.27,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25659.63000,24376.65000,The Alliance,Premier SAS,,11777.77,,,,,,,11777.77,25659.63,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,63.00000,59.85000,The Alliance,Premier SAS,,28.92,,,,,,,28.92,63.00,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,,71.60,,,,,,,71.60,156.00,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,The Alliance,Premier SAS,,2561.00,,,,,,,510.40,3163.00,case rate,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,outpatient,,,303.00000,287.85000,The Alliance,Premier SAS,TC,208.46,,,,,,,151.50,293.91,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier SAS,,1026.50,,,,,,,746.00,2139.65,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,90,60.06,,,,,,,8.72,441.37,fee schedule,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,outpatient,,,286.00000,271.70000,The Alliance,Premier SAS,,660.73,,,,,,,143.00,4855.31,fee schedule,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier SAS,,4661.42,,,,,,,4661.42,10155.60,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2030.96000,1929.41000,The Alliance,Premier SAS,,932.21,,,,,,,932.21,2030.96,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Premier SAS,,1246.18,,,,,,,1246.18,2715.00,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier SAS,,256.47,,,,,,,256.47,558.75,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,64.40000,61.18000,The Alliance,Premier SAS,,29.56,,,,,,,29.56,64.40,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier SAS,,5206.39,,,,,,,5206.39,11342.90,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2906.25000,2760.94000,The Alliance,Premier SAS,,1333.97,,,,,,,1333.97,2906.25,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,163.68000,155.50000,The Alliance,Premier SAS,,161.25,,,,,,,81.84,192.52,fee schedule,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,The Alliance,Premier SAS,,2.26,,,,,,,1.64,3.18,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,outpatient,1,mL,992.83000,943.19000,The Alliance,Premier SAS,,117.50,,,,,,,114.64,963.05,fee schedule,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,727.50000,691.12000,The Alliance,Premier SAS,,333.92,,,,,,,333.92,727.50,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,The Alliance,Premier SAS,,495.72,,,,,,,495.72,1080.00,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier SAS,,626.53,,,,,,,626.53,1365.00,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,outpatient,1,mL,2.33000,2.22000,The Alliance,Premier SAS,,1.60,,,,,,,1.17,2.26,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,The Alliance,Premier SAS,TC,2357.78,,,,,,,1713.50,3324.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Premier SAS,,2323.94,,,,,,,2236.93,7997.10,fee schedule,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1488.71000,1414.27000,The Alliance,Premier SAS,,683.32,,,,,,,683.32,1488.71,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,outpatient,,,805.00000,764.75000,The Alliance,Premier SAS,TC,532.00,,,,,,,318.45,780.85,fee schedule,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,outpatient,,,177.00000,168.15000,The Alliance,Premier SAS,,2561.00,,,,,,,97.35,3163.00,case rate,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,The Alliance,Premier SAS,,24.35,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier SAS,,430.31,,,,,,,430.31,937.50,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2786.25000,2646.94000,The Alliance,Premier SAS,,1278.89,,,,,,,1278.89,2786.25,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,The Alliance,Premier SAS,,9355.71,,,,,,,9355.71,20382.81,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,182.97,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,The Alliance,Premier SAS,,0.67424,,,,,,,0.49000,0.95060,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,outpatient,1,mL,3.82000,3.63000,The Alliance,Premier SAS,,2.63,,,,,,,1.91,3.71,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,The Alliance,Premier SAS,,232.37,,,,,,,232.37,506.25,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier SAS,,16.85,,,,,,,16.85,36.72,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Premier SAS,,32.39,,,,,,,32.39,70.56,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier SAS,,1420.03,,,,,,,1420.03,3093.75,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,30.29,,,,,,,30.29,66.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier SAS,,550.80,,,,,,,550.80,1200.00,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier SAS,,218.60,,,,,,,218.60,476.25,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,372.60000,353.97000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,361.42,fee schedule,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,413.00000,392.35000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,400.61,fee schedule,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,outpatient,,,941.00000,893.95000,The Alliance,Premier SAS,TC,647.41,,,,,,,470.50,912.77,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,The Alliance,Premier SAS,,1002.63,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,outpatient,,,2117.00000,2011.15000,The Alliance,Premier SAS,TC,1449.24,,,,,,,1058.50,11495.30,fee schedule,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,outpatient,,,2717.00000,2581.15000,The Alliance,Premier SAS,TC,1583.93,,,,,,,1358.50,17311.25,fee schedule,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,outpatient,1,EA,6485.63000,6161.35000,The Alliance,Premier SAS,,11.59,,,,,,,7.24,6291.06,fee schedule,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,outpatient,1,mL,1.21000,1.15000,The Alliance,Premier SAS,,0.83248,,,,,,,0.60500,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,0.82560,,,,,,,0.60000,1.16,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,outpatient,1,mL,2392.75000,2273.11000,The Alliance,Premier SAS,,19.21,,,,,,,12.00,2320.97,fee schedule,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,outpatient,1,mL,2460.93000,2337.88000,The Alliance,Premier SAS,,19.21,,,,,,,12.00,2387.10,fee schedule,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9528.90000,9052.46000,The Alliance,Premier SAS,,4373.77,,,,,,,4373.77,9528.90,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Premier SAS,,309.82,,,,,,,309.82,675.00,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,The Alliance,Premier SAS,,1368.43,,,,,,,122.40,1929.33,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,The Alliance,Premier SAS,,4516.93,,,,,,,4516.93,9840.80,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,445.31000,423.04000,The Alliance,Premier SAS,,848.53,,,,,,,143.61,874.50,fee schedule,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,The Alliance,Premier SAS,,3.20,,,,,,,2.33,4.51,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,outpatient,1,GM,77.47000,73.60000,The Alliance,Premier SAS,,53.30,,,,,,,38.73,75.15,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,The Alliance,Premier SAS,TC,1912.64,,,,,,,1390.00,2696.60,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier SAS,,385.56,,,,,,,385.56,840.00,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,The Alliance,Premier SAS,,46.60,,,,,,,46.60,101.52,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,330.24,,,,,,,264.00,5271.00,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,226.88000,215.54000,The Alliance,Premier SAS,,104.14,,,,,,,104.14,226.88,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,outpatient,,,280.00000,266.00000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,271.60,per diem,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier SAS,90,92.41,,,,,,,13.35,679.08,fee schedule,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,outpatient,,,10.00000,9.50000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,outpatient,,,191.00000,181.45000,The Alliance,Premier SAS,90,117.83,,,,,,,17.01,865.84,fee schedule,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,outpatient,,,176.90000,168.06000,The Alliance,Premier SAS,90,106.27,,,,,,,15.27,780.94,fee schedule,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,outpatient,,,98.20000,93.29000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,outpatient,,,178.30000,169.38000,The Alliance,Premier SAS,90,113.20,,,,,,,16.37,831.84,fee schedule,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,outpatient,,,582.00000,552.90000,The Alliance,Premier SAS,90,400.42,,,,,,,291.00,839.96,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,outpatient,,,343.70000,326.52000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,222.04,,,,,,,222.04,483.75,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,18.36,,,,,,,18.36,40.00,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier SAS,,602.44,,,,,,,602.44,1312.50,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,279.53,,,,,,,279.53,609.00,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,2995.31000,2845.54000,The Alliance,Premier SAS,,1374.85,,,,,,,1374.85,2995.31,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,548.10000,520.70000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,531.66,fee schedule,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,The Alliance,Premier SAS,TC,524.51,,,,,,,391.31,29731.35,fee schedule,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,outpatient,1,mL,9.14000,8.69000,The Alliance,Premier SAS,,6.29,,,,,,,1.49,8.87,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Premier SAS,,852.43,,,,,,,498.67,1201.83,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier SAS,,3.14,,,,,,,1.49,4.43,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,331.88000,315.29000,The Alliance,Premier SAS,,152.33,,,,,,,152.33,331.88,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Premier SAS,,954.26,,,,,,,954.26,2079.00,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.75000,359.81000,The Alliance,Premier SAS,,173.85,,,,,,,173.85,378.75,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,900.00000,855.00000,The Alliance,Premier SAS,,413.10,,,,,,,413.10,900.00,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,The Alliance,Premier SAS,,3950.96,,,,,,,3950.96,8607.75,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier SAS,,550.80,,,,,,,550.80,1200.00,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1887.98000,1793.58000,The Alliance,Premier SAS,,866.58,,,,,,,866.58,1887.98,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,The Alliance,Premier SAS,,385.56,,,,,,,385.56,840.00,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,The Alliance,Premier SAS,,389.87,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier SAS,,4661.42,,,,,,,4661.42,10155.60,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,24.77,,,,,,,19.80,5271.00,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier SAS,,64.67,,,,,,,51.70,5271.00,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,The Alliance,Premier SAS,,97.25,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier SAS,,218.60,,,,,,,218.60,476.25,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,outpatient,,,117.80000,111.91000,The Alliance,Premier SAS,90,134.00,,,,,,,14.65,984.66,fee schedule,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,The Alliance,Premier SAS,,852.43,,,,,,,498.67,1201.83,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,outpatient,,,73500.00000,69825.00000,The Alliance,Premier SAS,,33736.50,,,,,,,33736.50,73500.00,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,outpatient,,,5128.00000,4871.60000,The Alliance,Premier SAS,,532.00,,,,,,,384.16,4974.16,fee schedule,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Premier SAS,,3167.10,,,,,,,3167.10,6900.00,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier SAS,,626.53,,,,,,,626.53,1365.00,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,The Alliance,Premier SAS,,3024.45,,,,,,,966.05,4264.12,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,The Alliance,Premier SAS,,2561.00,,,,,,,244.75,3163.00,case rate,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,488.05000,463.65000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,473.41,fee schedule,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,outpatient,,,120.40000,114.38000,The Alliance,Premier SAS,90,154.78,,,,,,,60.20,1137.41,fee schedule,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10064.34000,9561.12000,The Alliance,Premier SAS,,4619.53,,,,,,,4619.53,10064.34,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,47.74,,,,,,,47.74,104.00,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11169.30000,10610.83000,The Alliance,Premier SAS,,5126.71,,,,,,,5126.71,11169.30,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4623.00000,4391.85000,The Alliance,Premier SAS,,2121.96,,,,,,,2121.96,4623.00,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,988.88000,939.44000,The Alliance,Premier SAS,,453.90,,,,,,,453.90,988.88,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier SAS,TC,1596.00,,,,,,,672.00,1820.00,per diem,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,outpatient,,,707.00000,671.65000,The Alliance,Premier SAS,,486.42,,,,,,,353.50,697.17,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,765.00000,726.75000,The Alliance,Premier SAS,,351.13,,,,,,,351.13,765.00,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.64000,99.41000,The Alliance,Premier SAS,,48.03,,,,,,,48.03,104.64,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,381.56000,362.48000,The Alliance,Premier SAS,,175.14,,,,,,,175.14,381.56,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier SAS,,1669.61,,,,,,,1669.61,3637.50,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,outpatient,,,837.00000,795.15000,The Alliance,Premier SAS,TC,575.86,,,,,,,418.50,811.89,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier SAS,,1024.14,,,,,,,1024.14,2231.25,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3912.30000,3716.68000,The Alliance,Premier SAS,,1795.75,,,,,,,1795.75,3912.30,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Premier SAS,,10506.51,,,,,,,10506.51,22890.00,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,509.06000,483.61000,The Alliance,Premier SAS,,350.23,,,,,,,44.30,493.79,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,241.50000,229.42000,The Alliance,Premier SAS,,470.90,,,,,,,120.75,485.24,fee schedule,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,368.12,fee schedule,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Premier SAS,,4678.50,,,,,,,4678.50,10192.80,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier SAS,,12077.43,,,,,,,12077.43,26312.49,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12555.00000,11927.25000,The Alliance,Premier SAS,,5762.74,,,,,,,5762.74,12178.35,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Premier SAS,,205.86,,,,,,,205.86,448.50,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,outpatient,1,GM,4.80000,4.56000,The Alliance,Premier SAS,,3.30,,,,,,,2.40,4.66,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,outpatient,1,GM,59.25000,56.29000,The Alliance,Premier SAS,,40.76,,,,,,,29.62,57.47,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,outpatient,1,EA,12.89000,12.25000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,12.50,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,outpatient,1,EA,15.17000,14.41000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,14.71,fee schedule,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,outpatient,1,EA,19.21000,18.25000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,18.63,fee schedule,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,outpatient,,,471.00000,447.45000,The Alliance,Premier SAS,,267.98,,,,,,,37.73,1969.25,fee schedule,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,The Alliance,Premier SAS,,0.34400,,,,,,,0.25000,0.48500,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1821.18,,,,,,,249.71,14445.56,fee schedule,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,The Alliance,Premier SAS,,2547.71,,,,,,,549.28,20208.37,fee schedule,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Premier SAS,TC,949.31,,,,,,,726.61,7529.89,fee schedule,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Premier SAS,,1062.02,,,,,,,347.60,8423.93,fee schedule,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,The Alliance,Premier SAS,,244.89,,,,,,,34.43,1799.53,fee schedule,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,outpatient,,,1208.00000,1147.60000,The Alliance,Premier SAS,,831.10,,,,,,,604.00,1171.76,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,outpatient,,,1957.00000,1859.15000,The Alliance,Premier SAS,TC,1810.00,,,,,,,978.50,2032.87,per diem,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,outpatient,,,1952.00000,1854.40000,The Alliance,Premier SAS,TC,1810.00,,,,,,,976.00,2032.87,per diem,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier SAS,,0.72045,,,,,,,0.44500,0.86330,fee schedule,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,,124.53,,,,,,,90.50,317.72,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,,78.14,,,,,,,59.00,619.83,fee schedule,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,The Alliance,Premier SAS,,3167.10,,,,,,,3167.10,6900.00,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier SAS,,693.66,,,,,,,693.66,1511.25,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24370.50000,23151.97000,The Alliance,Premier SAS,,11186.06,,,,,,,11186.06,24370.50,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,The Alliance,Premier SAS,,12032.04,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier SAS,,5905.03,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier SAS,,5905.03,,,,,,,5905.03,12865.00,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,,1805.25,,,,,,,1805.25,3933.00,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,The Alliance,Premier SAS,,157.76,,,,,,,157.76,368.12,fee schedule,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,outpatient,,,452.00000,429.40000,The Alliance,Premier SAS,TC,310.98,,,,,,,226.00,438.44,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,outpatient,,,23.07000,21.92000,The Alliance,Premier SAS,,23.10,,,,,,,11.54,23.80,fee schedule,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,The Alliance,Premier SAS,,2.52,,,,,,,1.83,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,outpatient,1,EA,17.16000,16.30000,The Alliance,Premier SAS,,11.81,,,,,,,8.58,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,The Alliance,Premier SAS,,2.39,,,,,,,1.74,3.38,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,10.40000,9.88000,The Alliance,Premier SAS,,10.35,,,,,,,5.20,10.66,fee schedule,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,70.44000,66.92000,The Alliance,Premier SAS,,48.46,,,,,,,35.22,68.33,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,99.47000,94.50000,The Alliance,Premier SAS,,620.14,,,,,,,49.73,639.03,fee schedule,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,87.25000,82.89000,The Alliance,Premier SAS,,60.03,,,,,,,43.62,84.63,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,78.40000,74.48000,The Alliance,Premier SAS,,53.94,,,,,,,39.20,76.05,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,11.78000,11.19000,The Alliance,Premier SAS,,8.10,,,,,,,5.89,11.43,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,69.33000,65.86000,The Alliance,Premier SAS,,47.70,,,,,,,34.66,67.25,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,36.13000,34.32000,The Alliance,Premier SAS,,24.86,,,,,,,18.07,35.05,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,153.40000,145.73000,The Alliance,Premier SAS,,105.54,,,,,,,76.70,148.80,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Premier SAS,,21.00,,,,,,,15.27,29.61,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,148.00000,140.60000,The Alliance,Premier SAS,,101.82,,,,,,,74.00,143.56,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,209.31000,198.84000,The Alliance,Premier SAS,,144.01,,,,,,,104.66,203.03,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,160.90000,152.85000,The Alliance,Premier SAS,,110.70,,,,,,,80.45,156.07,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,40.67000,38.64000,The Alliance,Premier SAS,,27.98,,,,,,,20.34,39.45,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,49.47000,47.00000,The Alliance,Premier SAS,,34.04,,,,,,,24.73,47.99,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,370.50000,351.97000,The Alliance,Premier SAS,,254.90,,,,,,,185.25,359.38,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.20000,41.04000,The Alliance,Premier SAS,,29.72,,,,,,,21.60,41.90,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,59.60000,56.62000,The Alliance,Premier SAS,,41.00,,,,,,,29.80,57.81,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier SAS,,11.01,,,,,,,8.00,15.52,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,182.76000,173.62000,The Alliance,Premier SAS,,125.74,,,,,,,91.38,177.28,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,15.60000,14.82000,The Alliance,Premier SAS,NU,15.58,,,,,,,7.80,16.05,fee schedule,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,80.44000,76.42000,The Alliance,Premier SAS,,338.74,,,,,,,40.22,349.06,fee schedule,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,outpatient,,,20.27000,19.26000,The Alliance,Premier SAS,,13.95,,,,,,,10.13,19.66,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.68000,92.80000,The Alliance,Premier SAS,,67.20,,,,,,,48.84,94.75,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier SAS,,39.47,,,,,,,39.40,76.44,fee schedule,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Premier SAS,,44.36,,,,,,,32.24,62.55,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,89.56000,85.08000,The Alliance,Premier SAS,,61.62,,,,,,,44.78,86.87,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,671.26000,637.70000,The Alliance,Premier SAS,,461.83,,,,,,,335.63,651.12,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,104.10000,98.89000,The Alliance,Premier SAS,,71.62,,,,,,,52.05,100.98,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,outpatient,,,66.50000,63.17000,The Alliance,Premier SAS,NU,56.49,,,,,,,33.25,64.50,fee schedule,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,100.08000,95.08000,The Alliance,Premier SAS,,225.64,,,,,,,50.04,232.52,fee schedule,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,outpatient,,,30.53000,29.00000,The Alliance,Premier SAS,,21.00,,,,,,,15.27,29.61,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,19.97000,18.97000,The Alliance,Premier SAS,,9.17,,,,,,,9.17,19.37,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,20.30000,19.28000,The Alliance,Premier SAS,,13.97,,,,,,,10.15,19.69,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,23.33000,22.16000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,22.63,fee schedule,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,268.98000,255.53000,The Alliance,Premier SAS,,185.06,,,,,,,134.49,260.91,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,21.70000,20.61000,The Alliance,Premier SAS,,14.93,,,,,,,10.85,21.05,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,321.94000,305.84000,The Alliance,Premier SAS,NU,73.59,,,,,,,70.83,312.28,fee schedule,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,79.20000,75.24000,The Alliance,Premier SAS,,54.49,,,,,,,39.60,76.82,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,276.53000,262.70000,The Alliance,Premier SAS,,190.25,,,,,,,138.26,268.23,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,401.25000,381.19000,The Alliance,Premier SAS,,276.06,,,,,,,200.62,389.21,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,79.81,,,,,,,58.00,112.52,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,359.81000,341.82000,The Alliance,Premier SAS,,247.55,,,,,,,179.91,349.02,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,702.00000,666.90000,The Alliance,Premier SAS,,482.98,,,,,,,351.00,680.94,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,outpatient,,,251.80000,239.21000,The Alliance,Premier SAS,,115.58,,,,,,,115.58,244.25,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,89.96,,,,,,,89.96,190.12,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier SAS,,218.60,,,,,,,218.60,461.96,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,68.85,,,,,,,68.85,145.50,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,517.50000,491.62000,The Alliance,Premier SAS,,237.53,,,,,,,237.53,501.98,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,13.80000,13.11000,The Alliance,Premier SAS,,9.49,,,,,,,6.90,13.39,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,351.10000,333.54000,The Alliance,Premier SAS,,241.56,,,,,,,175.55,340.57,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,40.00000,38.00000,The Alliance,Premier SAS,,27.52,,,,,,,20.00,38.80,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,outpatient,,,259.00000,246.05000,The Alliance,Premier SAS,,178.19,,,,,,,129.50,251.23,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,249.38000,236.91000,The Alliance,Premier SAS,,171.57,,,,,,,124.69,241.90,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,181.40000,172.33000,The Alliance,Premier SAS,,83.26,,,,,,,83.26,175.96,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,outpatient,,,18.56000,17.63000,The Alliance,Premier SAS,,8.52,,,,,,,8.52,18.00,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,195.08000,185.33000,The Alliance,Premier SAS,,89.54,,,,,,,89.54,189.23,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,562.50000,534.38000,The Alliance,Premier SAS,,109.47,,,,,,,105.37,545.62,fee schedule,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,59.90000,56.90000,The Alliance,Premier SAS,,63.29,,,,,,,29.95,65.22,fee schedule,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,584.33000,555.11000,The Alliance,Premier SAS,,402.02,,,,,,,292.17,566.80,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,outpatient,,,356.30000,338.48000,The Alliance,Premier SAS,,245.13,,,,,,,178.15,345.61,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,311.25000,295.69000,The Alliance,Premier SAS,,142.86,,,,,,,142.86,301.91,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.75000,188.81000,The Alliance,Premier SAS,,91.23,,,,,,,91.23,192.79,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,55.07000,52.32000,The Alliance,Premier SAS,,37.89,,,,,,,27.54,53.42,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,926.00000,879.70000,The Alliance,Premier SAS,,637.09,,,,,,,463.00,898.22,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,596.00000,566.20000,The Alliance,Premier SAS,,273.56,,,,,,,273.56,578.12,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,228.79000,217.35000,The Alliance,Premier SAS,,157.41,,,,,,,114.39,221.93,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,263.81000,250.62000,The Alliance,Premier SAS,NU,65.48,,,,,,,62.66,255.90,fee schedule,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,87.08000,82.73000,The Alliance,Premier SAS,,131.57,,,,,,,43.54,135.57,fee schedule,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,,71.60,,,,,,,71.60,151.32,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,25.10000,23.84000,The Alliance,Premier SAS,,17.27,,,,,,,12.55,24.35,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,100.44000,95.42000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,97.43,fee schedule,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,98.67000,93.74000,The Alliance,Premier SAS,,67.88,,,,,,,49.34,95.71,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,507.00000,481.65000,The Alliance,Premier SAS,,348.82,,,,,,,253.50,491.79,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Premier SAS,,114.03,,,,,,,85.60,166.06,fee schedule,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,159.90000,151.90000,The Alliance,Premier SAS,,110.01,,,,,,,44.30,155.10,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,231.38000,219.81000,The Alliance,Premier SAS,,106.20,,,,,,,106.20,224.44,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,,143.10,,,,,,,104.00,201.76,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,196.00000,186.20000,The Alliance,Premier SAS,,134.85,,,,,,,98.00,190.12,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,39.80000,37.81000,The Alliance,Premier SAS,,27.38,,,,,,,19.90,38.61,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,193.71000,184.02000,The Alliance,Premier SAS,,88.91,,,,,,,88.91,187.90,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier SAS,,126.59,,,,,,,92.00,178.48,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,The Alliance,Premier SAS,,39.47,,,,,,,37.06,71.91,fee schedule,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,outpatient,,,333.00000,316.35000,The Alliance,Premier SAS,,229.10,,,,,,,166.50,323.01,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.76,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,6.47,fee schedule,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,38.93000,36.98000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,37.76,fee schedule,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,41.33000,39.26000,The Alliance,Premier SAS,,28.44,,,,,,,20.66,40.09,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,21.47000,20.40000,The Alliance,Premier SAS,,9.85,,,,,,,9.85,20.83,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,197.33000,187.46000,The Alliance,Premier SAS,,135.76,,,,,,,98.67,191.41,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,267.68000,254.30000,The Alliance,Premier SAS,,122.87,,,,,,,122.87,259.65,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.44000,28.92000,The Alliance,Premier SAS,,20.94,,,,,,,15.22,29.53,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,63.29,,,,,,,3.33,65.22,fee schedule,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,333.75000,317.06000,The Alliance,Premier SAS,,153.19,,,,,,,153.19,323.74,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,51.63000,49.05000,The Alliance,Premier SAS,,23.70,,,,,,,23.70,50.08,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,25.60000,24.32000,The Alliance,Premier SAS,,17.61,,,,,,,12.80,24.83,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,175.76,fee schedule,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,254.66000,241.93000,The Alliance,Premier SAS,,175.21,,,,,,,127.33,247.02,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.33000,92.46000,The Alliance,Premier SAS,,66.96,,,,,,,48.66,94.41,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.40000,15.58000,The Alliance,Premier SAS,,35.57,,,,,,,8.20,36.65,fee schedule,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Premier SAS,,225.64,,,,,,,217.19,625.76,fee schedule,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,694.00000,659.30000,The Alliance,Premier SAS,,477.47,,,,,,,347.00,673.18,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,67.73000,64.34000,The Alliance,Premier SAS,,46.60,,,,,,,33.87,65.70,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,80.75,,,,,,,58.00,112.52,fee schedule,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,15.70000,14.91000,The Alliance,Premier SAS,,10.80,,,,,,,7.85,15.23,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,363.75,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,184.19000,174.98000,The Alliance,Premier SAS,,80.75,,,,,,,77.73,178.66,fee schedule,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,399.94000,379.94000,The Alliance,Premier SAS,,225.64,,,,,,,199.97,387.94,fee schedule,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,131.96000,125.36000,The Alliance,Premier SAS,,90.79,,,,,,,65.98,128.00,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,,478.16,,,,,,,347.50,674.15,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,381.20000,362.14000,The Alliance,Premier SAS,,262.27,,,,,,,190.60,369.76,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,outpatient,,,2903.00000,2757.85000,The Alliance,Premier SAS,,1332.48,,,,,,,1332.48,2815.91,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,The Alliance,Premier SAS,,44.36,,,,,,,32.24,62.55,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,62.72000,59.58000,The Alliance,Premier SAS,,43.15,,,,,,,31.36,60.84,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,108.80000,103.36000,The Alliance,Premier SAS,,74.85,,,,,,,54.40,105.54,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,179.28000,170.32000,The Alliance,Premier SAS,,123.34,,,,,,,89.64,173.90,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,88.50000,84.08000,The Alliance,Premier SAS,,60.89,,,,,,,44.25,85.84,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,74.00000,70.30000,The Alliance,Premier SAS,,50.91,,,,,,,37.00,71.78,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.36000,41.19000,The Alliance,Premier SAS,,29.83,,,,,,,21.68,42.06,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,49.88000,47.39000,The Alliance,Premier SAS,,34.32,,,,,,,24.94,48.38,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,386.21000,366.90000,The Alliance,Premier SAS,,265.71,,,,,,,193.10,374.62,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,96.32,,,,,,,70.00,135.80,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,3.62000,3.44000,The Alliance,Premier SAS,,2.49,,,,,,,1.81,3.51,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,326.25000,309.94000,The Alliance,Premier SAS,,224.46,,,,,,,163.12,316.46,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,356.81000,338.97000,The Alliance,Premier SAS,NU,65.48,,,,,,,62.66,346.11,fee schedule,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,104.83000,99.59000,The Alliance,Premier SAS,,72.12,,,,,,,52.41,101.69,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,The Alliance,Premier SAS,,397.66,,,,,,,289.00,560.66,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier SAS,,70.56,,,,,,,67.53,218.25,fee schedule,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,314.21000,298.50000,The Alliance,Premier SAS,,118.21,,,,,,,113.78,304.78,fee schedule,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,29.47000,28.00000,The Alliance,Premier SAS,,12.01,,,,,,,11.56,28.59,fee schedule,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,1683.30000,1599.13000,The Alliance,Premier SAS,,1158.11,,,,,,,841.65,1632.80,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,92.30000,87.68000,The Alliance,Premier SAS,,63.50,,,,,,,46.15,89.53,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,58.68000,55.75000,The Alliance,Premier SAS,,40.37,,,,,,,29.34,56.92,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,,41.28,,,,,,,30.00,58.20,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,14.13000,13.42000,The Alliance,Premier SAS,,6.49,,,,,,,6.49,13.71,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,16.00000,15.20000,The Alliance,Premier SAS,,11.01,,,,,,,8.00,15.52,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,608.74000,578.30000,The Alliance,Premier SAS,,418.81,,,,,,,304.37,590.48,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,51.20000,48.64000,The Alliance,Premier SAS,,35.23,,,,,,,25.60,49.66,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,outpatient,,,90.67000,86.14000,The Alliance,Premier SAS,,95.27,,,,,,,45.34,98.18,fee schedule,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Premier SAS,,63.29,,,,,,,19.76,65.22,fee schedule,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,192.18000,182.57000,The Alliance,Premier SAS,NU,65.48,,,,,,,62.66,186.41,fee schedule,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,The Alliance,Premier SAS,,114.03,,,,,,,85.60,166.06,fee schedule,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,57.96000,55.06000,The Alliance,Premier SAS,,39.88,,,,,,,28.98,56.22,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,95.32000,90.55000,The Alliance,Premier SAS,,100.36,,,,,,,47.66,103.42,fee schedule,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier SAS,,6.19,,,,,,,4.50,8.73,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,335.63000,318.85000,The Alliance,Premier SAS,,230.91,,,,,,,167.81,325.56,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier SAS,,22.70,,,,,,,16.50,32.01,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,645.11000,612.85000,The Alliance,Premier SAS,,225.64,,,,,,,217.19,625.76,fee schedule,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,436.46000,414.64000,The Alliance,Premier SAS,,300.28,,,,,,,218.23,423.37,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,outpatient,,,51.48000,48.91000,The Alliance,Premier SAS,,35.42,,,,,,,25.74,49.94,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,,478.16,,,,,,,347.50,674.15,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,outpatient,,,29.04000,27.59000,The Alliance,Premier SAS,,13.33,,,,,,,13.33,28.17,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,145.36000,138.09000,The Alliance,Premier SAS,,114.03,,,,,,,72.68,141.00,fee schedule,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,11.20000,10.64000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,10.86,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,outpatient,1,mL,53.57000,50.89000,The Alliance,Premier SAS,,76.53,,,,,,,26.79,78.87,fee schedule,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Premier SAS,90,245.62,,,,,,,28.07,346.29,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,446.70000,424.36000,The Alliance,Premier SAS,,307.33,,,,,,,63.95,788.42,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,outpatient,1,mL,0.91000,0.87000,The Alliance,Premier SAS,,0.62608,,,,,,,0.45500,1.49,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,outpatient,,,2376.00000,2257.20000,The Alliance,Premier SAS,,7569.00,,,,,,,1306.80,7803.00,case rate,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,455.36000,432.59000,The Alliance,Premier SAS,,41.77,,,,,,,36.03,441.70,fee schedule,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,269.53000,256.05000,The Alliance,Premier SAS,,41.77,,,,,,,36.03,261.44,fee schedule,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,outpatient,,,176.02000,167.22000,The Alliance,Premier SAS,,121.10,,,,,,,88.01,170.74,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,outpatient,,,3030.00000,2878.50000,The Alliance,Premier SAS,TC,2084.64,,,,,,,1515.00,2939.10,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,73.44,,,,,,,73.44,160.00,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,38272.50000,36358.88000,The Alliance,Premier SAS,,17567.08,,,,,,,17567.08,38272.50,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,outpatient,,,981.00000,931.95000,The Alliance,Premier SAS,,674.93,,,,,,,539.55,5271.00,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,The Alliance,Premier SAS,,14.45,,,,,,,10.50,74.34,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,419.33000,398.36000,The Alliance,Premier SAS,NU,65.48,,,,,,,62.66,406.75,fee schedule,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,outpatient,1,EA,34562.60000,32834.47000,The Alliance,Premier SAS,,6040.33,,,,,,,3772.85,33525.72,fee schedule,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,The Alliance,Premier SAS,,4802.29,,,,,,,4802.29,10462.50,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,The Alliance,Premier SAS,,151.22,,,,,,,109.90,213.21,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier SAS,,3562.99,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Premier SAS,,13830.59,,,,,,,13830.59,30132.00,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier SAS,TC,74.99,,,,,,,54.50,105.73,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,outpatient,1,EA,5576.35000,5297.53000,The Alliance,Premier SAS,,48.03,,,,,,,30.00,5409.06,fee schedule,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,outpatient,1,EA,3147.55000,2990.17000,The Alliance,Premier SAS,,22.54,,,,,,,14.08,3053.12,fee schedule,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,outpatient,1,EA,2760.00000,2622.00000,The Alliance,Premier SAS,,22.54,,,,,,,14.08,2677.20,fee schedule,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier SAS,,550.80,,,,,,,550.80,1200.00,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,outpatient,,,11573.00000,10994.35000,The Alliance,Premier SAS,,7962.22,,,,,,,4607.00,11225.81,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier SAS,,2612.86,,,,,,,2612.86,5692.50,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27304.80000,25939.56000,The Alliance,Premier SAS,,12532.90,,,,,,,12532.90,27304.80,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Premier SAS,,335.23,,,,,,,96.44,2659.05,fee schedule,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,outpatient,1,GM,1230.25000,1168.74000,The Alliance,Premier SAS,,846.41,,,,,,,615.12,1193.34,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,outpatient,1,mL,158.00000,150.10000,The Alliance,Premier SAS,,3.62,,,,,,,3.62,153.26,fee schedule,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,outpatient,1,EA,111.42000,105.85000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,108.08,fee schedule,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,outpatient,1,EA,130.19000,123.68000,The Alliance,Premier SAS,,14.44,,,,,,,12.72,126.28,fee schedule,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,The Alliance,Premier SAS,,1.31,,,,,,,0.95000,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,The Alliance,Premier SAS,,1.42,,,,,,,1.03,2.01,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,outpatient,1,mL,1.20000,1.14000,The Alliance,Premier SAS,,8.33,,,,,,,0.60000,15.80,fee schedule,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,outpatient,1,mL,5.69000,5.40000,The Alliance,Premier SAS,,8.33,,,,,,,2.85,15.80,fee schedule,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,outpatient,1,EA,736.75000,699.91000,The Alliance,Premier SAS,,506.88,,,,,,,368.38,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,outpatient,1,EA,769.75000,731.26000,The Alliance,Premier SAS,,529.59,,,,,,,384.88,746.66,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Premier SAS,,783.17,,,,,,,783.17,1706.25,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier SAS,,5939.18,,,,,,,5939.18,12939.40,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,284.01,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,318.75000,302.81000,The Alliance,Premier SAS,,146.31,,,,,,,146.31,318.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier SAS,,18699.66,,,,,,,18699.66,40740.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier SAS,,109.47,,,,,,,109.47,238.50,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,The Alliance,Premier SAS,,101.55,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,230.10000,218.59000,The Alliance,Premier SAS,,105.62,,,,,,,105.62,230.10,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,536.25000,509.44000,The Alliance,Premier SAS,,246.14,,,,,,,246.14,536.25,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,The Alliance,Premier SAS,TC,1596.00,,,,,,,72.50,1820.00,per diem,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,outpatient,,,68.34000,64.92000,The Alliance,Premier SAS,,47.02,,,,,,,34.17,137.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,outpatient,1,EA,136.68000,129.85000,The Alliance,Premier SAS,,94.04,,,,,,,68.34,137.03,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,outpatient,1,EA,269.42000,255.95000,The Alliance,Premier SAS,,185.36,,,,,,,134.71,261.34,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,outpatient,1,EA,1846.15000,1753.84000,The Alliance,Premier SAS,,1270.15,,,,,,,14.79,1790.77,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,outpatient,1,GM,66.04000,62.74000,The Alliance,Premier SAS,,45.44,,,,,,,33.02,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,outpatient,1,GM,115.79000,110.00000,The Alliance,Premier SAS,,79.66,,,,,,,57.90,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,outpatient,1,GM,18.26000,17.35000,The Alliance,Premier SAS,,12.56,,,,,,,9.13,17.71,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,outpatient,1,mL,129.01000,122.56000,The Alliance,Premier SAS,,88.76,,,,,,,64.50,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,outpatient,1,mL,112.05000,106.45000,The Alliance,Premier SAS,,77.09,,,,,,,56.02,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,outpatient,1,mL,80.89000,76.85000,The Alliance,Premier SAS,,55.65,,,,,,,40.45,78.46,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,outpatient,1,mL,12896.29000,12251.47000,The Alliance,Premier SAS,,622.52,,,,,,,388.83,12509.40,fee schedule,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,outpatient,1,mL,11683.35000,11099.18000,The Alliance,Premier SAS,,622.52,,,,,,,388.83,11332.85,fee schedule,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,outpatient,1,mL,728.31000,691.89000,The Alliance,Premier SAS,,2204.24,,,,,,,364.15,2397.95,fee schedule,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,outpatient,1,mL,1149.90000,1092.40000,The Alliance,Premier SAS,,2204.24,,,,,,,574.95,2397.95,fee schedule,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,outpatient,1,mL,81.79000,77.70000,The Alliance,Premier SAS,,56.27,,,,,,,40.90,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,outpatient,1,mL,75.33000,71.57000,The Alliance,Premier SAS,,51.83,,,,,,,37.66,73.07,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,outpatient,1,mL,2474.98000,2351.23000,The Alliance,Premier SAS,,5.33,,,,,,,3.33,2400.73,fee schedule,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,outpatient,1,mL,2500.42000,2375.40000,The Alliance,Premier SAS,,5.33,,,,,,,3.33,2425.41,fee schedule,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,outpatient,1,mL,49140.33000,46683.32000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,47666.12,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,outpatient,1,mL,414.62000,393.89000,The Alliance,Premier SAS,,46.91,,,,,,,29.30,402.18,fee schedule,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,outpatient,1,mL,32751.19000,31113.63000,The Alliance,Premier SAS,,202.11,,,,,,,126.24,31768.65,fee schedule,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,The Alliance,Premier SAS,,1821.08,,,,,,,1821.08,3967.50,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,The Alliance,Premier SAS,,4.31,,,,,,,3.13,6.07,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier SAS,,0.06404,,,,,,,0.06045,1.89,fee schedule,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,outpatient,1,mL,3.72000,3.53000,The Alliance,Premier SAS,,2.63,,,,,,,1.86,3.61,fee schedule,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,outpatient,,,240.00000,228.00000,The Alliance,Premier SAS,TC,160.44,,,,,,,120.00,1272.59,fee schedule,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,outpatient,,,223.00000,211.85000,The Alliance,Premier SAS,,153.42,,,,,,,122.65,5271.00,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier SAS,,3087.92,,,,,,,3087.92,6727.50,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,outpatient,1,EA,6334.20000,6017.49000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,6144.17,fee schedule,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,outpatient,1,EA,8023.11000,7621.96000,The Alliance,Premier SAS,,67.18,,,,,,,41.96,7782.42,fee schedule,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,outpatient,1,EA,22092.57000,20987.94000,The Alliance,Premier SAS,,67.18,,,,,,,41.96,21429.79,fee schedule,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,outpatient,1,EA,3037.03000,2885.18000,The Alliance,Premier SAS,,69.29,,,,,,,43.25,2945.92,fee schedule,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,outpatient,1,mL,2458.76000,2335.82000,The Alliance,Premier SAS,,12.30,,,,,,,7.68,2385.00,fee schedule,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,outpatient,1,mL,3612.56000,3431.94000,The Alliance,Premier SAS,,31.78,,,,,,,19.85,3504.18,fee schedule,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,outpatient,1,mL,6.95000,6.60000,The Alliance,Premier SAS,,6.32,,,,,,,3.48,6.74,fee schedule,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,outpatient,1,mL,2.57000,2.44000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.49,fee schedule,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,outpatient,1,mL,2.93000,2.78000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,2.84,fee schedule,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,outpatient,1,mL,399.99000,379.99000,The Alliance,Premier SAS,,132.66,,,,,,,82.86,387.99,fee schedule,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,outpatient,1,mL,400.00000,380.00000,The Alliance,Premier SAS,,132.66,,,,,,,82.86,388.00,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,outpatient,1,mL,6.41000,6.09000,The Alliance,Premier SAS,,4.35,,,,,,,3.21,6.22,fee schedule,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,outpatient,1,mL,3.48000,3.30000,The Alliance,Premier SAS,,4.35,,,,,,,1.74,5.23,fee schedule,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier SAS,,42.43,,,,,,,26.50,219.71,fee schedule,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,44.86,,,,,,,0.69500,55.44,fee schedule,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Premier SAS,,217.80,,,,,,,136.04,12824.21,fee schedule,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,0.92150,fee schedule,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,outpatient,1,EA,56.21000,53.40000,The Alliance,Premier SAS,,38.67,,,,,,,28.11,54.52,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,473.00000,449.35000,The Alliance,Premier SAS,,325.42,,,,,,,63.95,788.42,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier SAS,,97.83,,,,,,,37.52,137.93,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,The Alliance,Premier SAS,,0.46096,,,,,,,0.33500,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,TC,20.64,,,,,,,15.00,29.10,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,outpatient,,,696.00000,661.20000,The Alliance,Premier SAS,TC,478.85,,,,,,,348.00,675.12,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,outpatient,,,71.65000,68.07000,The Alliance,Premier SAS,,46.75,,,,,,,35.83,69.50,fee schedule,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,The Alliance,Premier SAS,,3844.00,,,,,,,420.20,4686.00,case rate,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier SAS,TC,574.38,,,,,,,422.60,17311.25,fee schedule,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,outpatient,,,43.00000,40.85000,The Alliance,Premier SAS,,29.58,,,,,,,23.65,5271.00,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,2121.10,,,,,,,1695.65,5271.00,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,outpatient,,,94.77000,90.03000,The Alliance,Premier SAS,,909.00,,,,,,,52.12,5858.00,case rate,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,outpatient,1,mL,23.70000,22.52000,The Alliance,Premier SAS,,16.31,,,,,,,11.85,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,outpatient,1,mL,7.81000,7.41000,The Alliance,Premier SAS,,5.37,,,,,,,3.90,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,outpatient,1,mL,14.71000,13.98000,The Alliance,Premier SAS,,10.12,,,,,,,7.36,14.27,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,The Alliance,Premier SAS,TC,1817.13,,,,,,,1334.13,14413.40,fee schedule,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,The Alliance,Premier SAS,,13482.80,,,,,,,1299.22,106944.98,fee schedule,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier SAS,,2257.50,,,,,,,1640.62,3182.81,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,The Alliance,Premier SAS,,3642.16,,,,,,,3642.16,7935.00,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,The Alliance,Premier SAS,,1346.83,,,,,,,1346.83,2934.26,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1845.00000,1752.75000,The Alliance,Premier SAS,,846.86,,,,,,,846.86,1845.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,360.00000,342.00000,The Alliance,Premier SAS,,165.24,,,,,,,165.24,360.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier SAS,,98.97,,,,,,,98.97,215.63,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier SAS,,109.47,,,,,,,109.47,238.50,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier SAS,,2848.81,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1713.75000,1628.06000,The Alliance,Premier SAS,,786.61,,,,,,,786.61,1713.75,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,outpatient,1,mL,0.48000,0.46000,The Alliance,Premier SAS,,0.33024,,,,,,,0.24000,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,The Alliance,Premier SAS,,0.56416,,,,,,,0.41000,0.79540,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,outpatient,1,mL,2.37000,2.25000,The Alliance,Premier SAS,,1.63,,,,,,,1.19,2.30,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,outpatient,1,EA,76.72000,72.89000,The Alliance,Premier SAS,,0.41626,,,,,,,0.26000,74.42,fee schedule,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,outpatient,1,EA,4092.00000,3887.40000,The Alliance,Premier SAS,,24.90,,,,,,,15.55,3969.24,fee schedule,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier SAS,TC,584.35,,,,,,,380.50,4635.02,fee schedule,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,outpatient,1,EA,34.64000,32.91000,The Alliance,Premier SAS,,23.83,,,,,,,17.32,33.60,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,outpatient,1,EA,237.00000,225.15000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,229.89,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,outpatient,1,EA,1548.82000,1471.38000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,1502.36,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,outpatient,1,EA,647.50000,615.12000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,628.08,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,outpatient,1,EA,738.15000,701.24000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,716.01,fee schedule,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,outpatient,1,EA,582.75000,553.61000,The Alliance,Premier SAS,,2.55,,,,,,,2.55,565.27,fee schedule,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,outpatient,,,421.00000,399.95000,The Alliance,Premier SAS,90,182.51,,,,,,,28.00,1341.13,fee schedule,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,outpatient,,,105.00000,99.75000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,outpatient,,,84.60000,80.37000,The Alliance,Premier SAS,90,41.58,,,,,,,20.20,305.58,fee schedule,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,The Alliance,Premier SAS,,335.06,,,,,,,63.95,788.42,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,outpatient,1,EA,6.13000,5.83000,The Alliance,Premier SAS,,4.22,,,,,,,3.06,5.95,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,11473.16,per diem,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,The Alliance,Premier SAS,TC,584.35,,,,,,,380.50,4635.02,fee schedule,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,outpatient,,,2963.00000,2814.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1538.48,4686.00,case rate,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,676.99000,643.14000,The Alliance,Premier SAS,,310.74,,,,,,,310.74,676.99,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier SAS,,0.72045,,,,,,,0.44500,0.86330,fee schedule,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,163.52,,,,,,,163.52,356.25,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,The Alliance,Premier SAS,TC,5823.00,,,,,,,820.60,6003.00,case rate,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,The Alliance,Premier SAS,,954.26,,,,,,,954.26,2079.00,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,990.81,,,,,,,103.97,7859.04,fee schedule,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,The Alliance,Premier SAS,,59.56,,,,,,,59.56,129.76,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Premier SAS,TC,370.83,,,,,,,324.00,2941.42,fee schedule,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier SAS,,2850.39,,,,,,,2850.39,6210.00,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier SAS,,12077.43,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,The Alliance,Premier SAS,,1024.14,,,,,,,1024.14,2231.25,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2388.60000,2269.17000,The Alliance,Premier SAS,,1096.37,,,,,,,1096.37,2388.60,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,The Alliance,Premier SAS,,146.81,,,,,,,146.81,319.84,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,The Alliance,Premier SAS,,3087.92,,,,,,,3087.92,6727.50,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,The Alliance,Premier SAS,,968.77,,,,,,,422.60,17311.25,fee schedule,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Premier SAS,,4150.02,,,,,,,2194.62,5851.04,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Premier SAS,,5964.27,,,,,,,4334.50,8408.93,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,outpatient,,,137.23000,130.37000,The Alliance,Premier SAS,,94.41,,,,,,,68.61,133.11,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,The Alliance,Premier SAS,,4.18,,,,,,,0.36500,4.31,fee schedule,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,outpatient,1,GM,31.19000,29.63000,The Alliance,Premier SAS,,21.46,,,,,,,15.60,30.25,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,outpatient,1,mL,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,The Alliance,Premier SAS,TC,6536.11,,,,,,,5057.86,51844.17,fee schedule,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,outpatient,1,EA,288.61000,274.18000,The Alliance,Premier SAS,,198.56,,,,,,,144.31,279.95,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,The Alliance,Premier SAS,,1289.31,,,,,,,937.00,1817.78,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,The Alliance,Premier SAS,TC,2245.63,,,,,,,1527.07,3166.08,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3487.31000,3312.94000,The Alliance,Premier SAS,,1600.68,,,,,,,1600.68,3487.31,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1342.24,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier SAS,,841.48,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2276.25000,2162.44000,The Alliance,Premier SAS,,1044.80,,,,,,,1044.80,2276.25,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier SAS,,12077.43,,,,,,,12077.43,26312.49,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,The Alliance,Premier SAS,,205.86,,,,,,,205.86,448.50,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,The Alliance,Premier SAS,,4150.02,,,,,,,2194.62,5851.04,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier SAS,,1383.88,,,,,,,1383.88,3015.00,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,outpatient,,,3408.00000,3237.60000,The Alliance,Premier SAS,TC,2344.70,,,,,,,1704.00,3305.76,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,outpatient,1,EA,19551.00000,18573.45000,The Alliance,Premier SAS,,4.24,,,,,,,2.65,18964.47,fee schedule,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10121.50000,9615.42000,The Alliance,Premier SAS,,4645.77,,,,,,,4645.77,10121.50,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,outpatient,,,68.00000,64.60000,The Alliance,Premier SAS,,165.57,,,,,,,5.99,1216.68,fee schedule,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,31.65,,,,,,,5.83,44.62,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,outpatient,1,EA,250.52000,238.00000,The Alliance,Premier SAS,,172.36,,,,,,,125.26,243.00,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,outpatient,1,EA,90046.64000,85544.31000,The Alliance,Premier SAS,,72942.18,,,,,,,45023.32,87345.24,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,outpatient,1,EA,1289.61000,1225.13000,The Alliance,Premier SAS,,8.31,,,,,,,5.19,1250.92,fee schedule,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,outpatient,1,mL,4.70000,4.46000,The Alliance,Premier SAS,,3.23,,,,,,,1.49,4.56,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,The Alliance,Premier SAS,,0.17888,,,,,,,0.13000,0.25220,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,outpatient,,,6.70000,6.36000,The Alliance,Premier SAS,,4.61,,,,,,,3.35,6.50,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,outpatient,,,1803.00000,1712.85000,The Alliance,Premier SAS,,1240.46,,,,,,,283.85,1748.91,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,outpatient,,,843.75000,801.56000,The Alliance,Premier SAS,,606.64,,,,,,,421.88,818.44,fee schedule,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,outpatient,1,EA,51.13000,48.57000,The Alliance,Premier SAS,,35.18,,,,,,,25.57,49.60,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,outpatient,1,mL,2753.56000,2615.88000,The Alliance,Premier SAS,,64.94,,,,,,,40.56,2670.95,fee schedule,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,152.70000,145.06000,The Alliance,Premier SAS,,33.38,,,,,,,33.32,148.12,fee schedule,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,outpatient,,,9.00000,8.55000,The Alliance,Premier SAS,,4.10,,,,,,,3.96,8.73,fee schedule,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,outpatient,1,mL,51.13000,48.57000,The Alliance,Premier SAS,,35.18,,,,,,,25.57,49.60,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Premier SAS,,360.53,,,,,,,225.19,4762.44,fee schedule,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,29.76,,,,,,,23.00,44.62,fee schedule,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,0.68843,,,,,,,0.43000,18.39,fee schedule,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,outpatient,,,92.00000,87.40000,The Alliance,Premier SAS,,233.33,,,,,,,46.00,1714.64,fee schedule,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,outpatient,1,EA,8520.12000,8094.11000,The Alliance,Premier SAS,,4.24,,,,,,,2.65,8264.52,fee schedule,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,outpatient,1,mL,7.49000,7.11000,The Alliance,Premier SAS,,5.15,,,,,,,3.75,7.27,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,outpatient,1,mL,2.72000,2.58000,The Alliance,Premier SAS,,1.44,,,,,,,1.02,2.64,fee schedule,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,outpatient,,,322.90000,306.75000,The Alliance,Premier SAS,,222.16,,,,,,,23.25,313.21,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,153.86,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,outpatient,1,mL,147.89000,140.49000,The Alliance,Premier SAS,,65.96,,,,,,,64.92,143.45,fee schedule,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,453.75000,431.06000,The Alliance,Premier SAS,,208.27,,,,,,,208.27,440.14,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,400.12,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,110.08,,,,,,,80.00,155.20,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,39.52000,37.54000,The Alliance,Premier SAS,,18.14,,,,,,,18.14,39.52,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Premier SAS,,1760.91,,,,,,,1760.91,3836.40,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,The Alliance,Premier SAS,,990.81,,,,,,,103.97,7859.04,fee schedule,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier SAS,,9953.19,,,,,,,9953.19,21684.50,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,The Alliance,Premier SAS,,1760.91,,,,,,,1760.91,3836.40,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,17391.00000,16521.45000,The Alliance,Premier SAS,,7982.47,,,,,,,7982.47,17391.00,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,The Alliance,Premier SAS,,4259.75,,,,,,,4259.75,9280.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,outpatient,1,mL,1032.24000,980.63000,The Alliance,Premier SAS,,710.18,,,,,,,347.32,1001.27,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,outpatient,1,mL,453.41000,430.74000,The Alliance,Premier SAS,,183.28,,,,,,,114.48,439.81,fee schedule,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,outpatient,1,mL,20.79000,19.75000,The Alliance,Premier SAS,,10.77,,,,,,,6.35,20.17,fee schedule,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,7334.70000,6967.96000,The Alliance,Premier SAS,,3366.63,,,,,,,3366.63,7334.70,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,3086.00000,2931.70000,The Alliance,Premier SAS,,2123.17,,,,,,,557.65,2993.42,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,outpatient,1,mL,299.83000,284.84000,The Alliance,Premier SAS,,117.50,,,,,,,114.64,290.84,fee schedule,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,,413.53,,,,,,,62.14,3038.81,fee schedule,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,529.00000,502.55000,The Alliance,Premier SAS,,363.95,,,,,,,63.95,788.42,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,673.00000,639.35000,The Alliance,Premier SAS,,463.02,,,,,,,98.39,1078.91,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,outpatient,,,1508.00000,1432.60000,The Alliance,Premier SAS,,1037.50,,,,,,,132.80,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1840.00000,1748.00000,The Alliance,Premier SAS,,1265.92,,,,,,,172.18,1784.80,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,outpatient,,,350.40000,332.88000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1383.41000,1314.24000,The Alliance,Premier SAS,,634.99,,,,,,,634.99,1383.41,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,81.96000,77.86000,The Alliance,Premier SAS,,37.62,,,,,,,37.62,81.96,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,288.60000,274.17000,The Alliance,Premier SAS,,132.47,,,,,,,132.47,288.60,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Premier SAS,,15821.45,,,,,,,15821.45,33435.32,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Premier SAS,,5418.40,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier SAS,,1927.18,,,,,,,1927.18,4198.65,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,The Alliance,Premier SAS,TC,376.34,,,,,,,273.50,1232.72,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier SAS,,1927.18,,,,,,,1927.18,4198.65,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,The Alliance,Premier SAS,,6403.05,,,,,,,6403.05,13950.00,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier SAS,,5206.39,,,,,,,5206.39,11342.90,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,1549.12,,,,,,,1549.12,3375.00,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10741.50000,10204.42000,The Alliance,Premier SAS,,4930.35,,,,,,,4930.35,10741.50,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,The Alliance,Premier SAS,,12077.43,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Premier SAS,,1075.78,,,,,,,1075.78,2343.75,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,The Alliance,Premier SAS,,1420.03,,,,,,,1420.03,3093.75,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,The Alliance,Premier SAS,,4695.57,,,,,,,4695.57,9923.10,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2568.75000,2440.31000,The Alliance,Premier SAS,,1179.06,,,,,,,1179.06,2568.75,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,286.88000,272.54000,The Alliance,Premier SAS,,131.68,,,,,,,131.68,286.88,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,29826.53000,28335.20000,The Alliance,Premier SAS,,13690.38,,,,,,,13690.38,29826.53,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13814.10000,13123.40000,The Alliance,Premier SAS,,6340.67,,,,,,,6340.67,13814.10,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,The Alliance,Premier SAS,,2140.96,,,,,,,2140.96,4664.40,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,outpatient,,,215.63000,204.85000,The Alliance,Premier SAS,,148.35,,,,,,,107.81,209.16,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,outpatient,1,mL,0.59000,0.56000,The Alliance,Premier SAS,,0.19212,,,,,,,0.14415,0.57230,fee schedule,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,outpatient,1,EA,2879.90000,2735.90000,The Alliance,Premier SAS,,17.61,,,,,,,11.00,2793.50,fee schedule,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,outpatient,1,mL,22.09000,20.98000,The Alliance,Premier SAS,,36.68,,,,,,,11.04,37.80,fee schedule,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,outpatient,1,EA,14.82000,14.07000,The Alliance,Premier SAS,,10.20,,,,,,,7.41,14.38,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,outpatient,1,EA,4547.65000,4320.27000,The Alliance,Premier SAS,,3383.30,,,,,,,2113.24,4411.22,fee schedule,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Premier SAS,,1941.43,,,,,,,1941.43,4229.70,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier SAS,,20528.18,,,,,,,20528.18,43381.99,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,The Alliance,Premier SAS,,5418.40,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,62.42,,,,,,,62.42,136.00,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier SAS,,1328.81,,,,,,,1328.81,2895.00,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Premier SAS,,60.53,,,,,,,60.53,131.88,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,The Alliance,Premier SAS,,60.53,,,,,,,60.53,131.88,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier SAS,,0.27217,,,,,,,0.06500,0.34860,fee schedule,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.27217,,,,,,,0.08000,0.34860,fee schedule,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,The Alliance,Premier SAS,,9953.19,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,outpatient,1,mL,2.65000,2.52000,The Alliance,Premier SAS,,1.82,,,,,,,1.32,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,outpatient,1,mL,3.84000,3.65000,The Alliance,Premier SAS,,2.64,,,,,,,1.92,3.72,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,outpatient,1,mL,436.17000,414.36000,The Alliance,Premier SAS,,300.08,,,,,,,218.09,423.08,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,outpatient,1,mL,1265.76000,1202.47000,The Alliance,Premier SAS,,870.84,,,,,,,632.88,1227.79,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,3.02,15.33,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,806.25000,765.94000,The Alliance,Premier SAS,,370.07,,,,,,,370.07,806.25,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Premier SAS,,14319.70,,,,,,,14319.70,31197.60,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10551.84000,10024.25000,The Alliance,Premier SAS,,4843.29,,,,,,,4843.29,10551.84,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,The Alliance,Premier SAS,,3773.08,,,,,,,3773.08,8220.21,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,outpatient,1,mL,33.52000,31.85000,The Alliance,Premier SAS,,23.06,,,,,,,1.49,32.51,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,outpatient,1,EA,82.92000,78.77000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,80.43,fee schedule,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,outpatient,1,EA,1.13000,1.08000,The Alliance,Premier SAS,,0.76848,,,,,,,0.56500,1.10,fee schedule,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,The Alliance,Premier SAS,,0.39904,,,,,,,0.29000,0.56260,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier SAS,,4721.18,,,,,,,4721.18,10285.80,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,outpatient,1,EA,62.19000,59.08000,The Alliance,Premier SAS,,8.12,,,,,,,7.82,60.32,fee schedule,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,The Alliance,Premier SAS,,4721.18,,,,,,,4721.18,10285.80,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,14312.70000,13597.07000,The Alliance,Premier SAS,,6569.53,,,,,,,6569.53,14312.70,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,outpatient,1,mL,1746.98000,1659.63000,The Alliance,Premier SAS,,1201.92,,,,,,,873.49,1694.57,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,outpatient,1,mL,2.87000,2.73000,The Alliance,Premier SAS,,1.97,,,,,,,1.44,2.78,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,outpatient,1,mL,3.19000,3.03000,The Alliance,Premier SAS,,2.19,,,,,,,1.59,3.09,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,outpatient,1,mL,3836.56000,3644.73000,The Alliance,Premier SAS,,2639.55,,,,,,,1918.28,3721.46,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,3.94,,,,,,,0.01500,4.06,fee schedule,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3360.00000,3192.00000,The Alliance,Premier SAS,,1542.24,,,,,,,1542.24,3360.00,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,712.50000,676.88000,The Alliance,Premier SAS,,327.04,,,,,,,327.04,712.50,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,outpatient,1,mL,69.71000,66.22000,The Alliance,Premier SAS,,12.12,,,,,,,7.57,67.62,fee schedule,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Premier SAS,,1.86,,,,,,,1.16,368.06,fee schedule,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,outpatient,,,155.60000,147.82000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,106.27,,,,,,,15.55,780.94,fee schedule,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,outpatient,,,257.50000,244.62000,The Alliance,Premier SAS,90,207.92,,,,,,,30.26,1527.89,fee schedule,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier SAS,90,210.23,,,,,,,30.59,1544.85,fee schedule,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,outpatient,,,211.80000,201.21000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,outpatient,,,101.60000,96.52000,The Alliance,Premier SAS,90,69.90,,,,,,,9.64,98.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,outpatient,,,511.00000,485.45000,The Alliance,Premier SAS,90,348.84,,,,,,,50.66,2563.44,fee schedule,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,outpatient,,,130.20000,123.69000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier SAS,90,820.13,,,,,,,119.20,6026.72,fee schedule,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,outpatient,,,73.30000,69.63000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,outpatient,,,23.40000,22.23000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,outpatient,,,458.30000,435.38000,The Alliance,Premier SAS,90,348.84,,,,,,,50.66,2563.44,fee schedule,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,outpatient,,,5277.00000,5013.15000,The Alliance,Premier SAS,90,3841.91,,,,,,,480.00,28232.08,fee schedule,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,106.27,,,,,,,15.80,780.94,fee schedule,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,outpatient,,,65.30000,62.03000,The Alliance,Premier SAS,90,120.13,,,,,,,17.33,882.80,fee schedule,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,outpatient,,,118.10000,112.19000,The Alliance,Premier SAS,90,94.72,,,,,,,13.89,696.05,fee schedule,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,outpatient,,,579.00000,550.05000,The Alliance,Premier SAS,TC,412.01,,,,,,,121.00,3027.62,fee schedule,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Premier SAS,,663.03,,,,,,,370.62,4872.27,fee schedule,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier SAS,90,433.58,,,,,,,307.50,3186.14,fee schedule,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier SAS,90,143.23,,,,,,,77.53,1052.52,fee schedule,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Premier SAS,,2076.90,,,,,,,259.66,15261.97,fee schedule,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,outpatient,,,132.40000,125.78000,The Alliance,Premier SAS,90,106.27,,,,,,,8.17,780.94,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,outpatient,,,194.30000,184.58000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,16.51,,,,,,,12.00,23.28,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,outpatient,,,645.00000,612.75000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,outpatient,,,174.70000,165.96000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,90,154.78,,,,,,,50.00,1137.41,fee schedule,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,outpatient,,,116.90000,111.06000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1075.00000,1021.25000,The Alliance,Premier SAS,90,868.64,,,,,,,126.29,6383.20,fee schedule,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,outpatient,,,160.40000,152.38000,The Alliance,Premier SAS,90,85.48,,,,,,,12.29,628.12,fee schedule,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,outpatient,,,101.00000,95.95000,The Alliance,Premier SAS,90,80.86,,,,,,,8.17,594.19,fee schedule,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,outpatient,,,158.00000,150.10000,The Alliance,Premier SAS,90,154.78,,,,,,,79.00,1137.41,fee schedule,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,outpatient,,,38.00000,36.10000,The Alliance,Premier SAS,90,413.53,,,,,,,19.00,3038.81,fee schedule,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3810.00000,3619.50000,The Alliance,Premier SAS,TC,2200.90,,,,,,,533.12,16173.22,fee schedule,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,outpatient,,,396.00000,376.20000,The Alliance,Premier SAS,TC,169.43,,,,,,,127.30,1245.05,fee schedule,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,outpatient,,,432.00000,410.40000,The Alliance,Premier SAS,,921.60,,,,,,,142.63,6772.31,fee schedule,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,outpatient,,,952.00000,904.40000,The Alliance,Premier SAS,,589.11,,,,,,,329.46,4329.05,fee schedule,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,outpatient,,,171.80000,163.21000,The Alliance,Premier SAS,90,145.55,,,,,,,21.00,1069.56,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.40000,303.43000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,outpatient,,,92.40000,87.78000,The Alliance,Premier SAS,,46.20,,,,,,,6.48,339.51,fee schedule,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier SAS,90,820.13,,,,,,,119.20,6026.72,fee schedule,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,outpatient,,,655.00000,622.25000,The Alliance,Premier SAS,,1296.04,,,,,,,161.92,9523.86,fee schedule,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,outpatient,,,2638.00000,2506.10000,The Alliance,Premier SAS,90,1919.79,,,,,,,195.07,14107.52,fee schedule,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,outpatient,,,735.00000,698.25000,The Alliance,Premier SAS,,3841.91,,,,,,,367.50,28232.08,fee schedule,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,outpatient,,,43.30000,41.13000,The Alliance,Premier SAS,90,34.66,,,,,,,4.91,254.68,fee schedule,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,outpatient,,,255.30000,242.54000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,The Alliance,Premier SAS,90,127.06,,,,,,,17.71,933.70,fee schedule,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,outpatient,,,227.90000,216.50000,The Alliance,Premier SAS,90,154.78,,,,,,,113.95,1137.41,fee schedule,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,outpatient,,,105.70000,100.41000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,outpatient,,,119.40000,113.43000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,outpatient,,,855.00000,812.25000,The Alliance,Premier SAS,,921.60,,,,,,,142.63,6772.31,fee schedule,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,outpatient,,,199.20000,189.24000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Premier SAS,90,1235.97,,,,,,,157.98,9082.50,fee schedule,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,outpatient,,,95.20000,90.44000,The Alliance,Premier SAS,90,76.24,,,,,,,11.17,560.26,fee schedule,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,outpatient,,,111.80000,106.21000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,outpatient,,,20708.00000,19672.60000,The Alliance,Premier SAS,90,15674.89,,,,,,,8569.96,115186.20,fee schedule,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,The Alliance,Premier SAS,,663.03,,,,,,,370.62,4872.27,fee schedule,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Premier SAS,TC,2200.90,,,,,,,533.12,16173.22,fee schedule,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,outpatient,,,170.40000,161.88000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,outpatient,,,213.50000,202.82000,The Alliance,Premier SAS,90,180.20,,,,,,,26.09,1324.17,fee schedule,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,outpatient,,,241.80000,229.71000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,outpatient,,,459.10000,436.14000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,outpatient,,,127.20000,120.84000,The Alliance,Premier SAS,90,103.96,,,,,,,14.94,763.98,fee schedule,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,outpatient,,,334.30000,317.58000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,outpatient,,,226.40000,215.08000,The Alliance,Premier SAS,90,189.44,,,,,,,27.67,1392.10,fee schedule,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,outpatient,,,158.90000,150.96000,The Alliance,Premier SAS,90,129.37,,,,,,,10.38,950.66,fee schedule,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier SAS,90,1182.84,,,,,,,179.44,8692.03,fee schedule,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,outpatient,,,623.00000,591.85000,The Alliance,Premier SAS,90,267.98,,,,,,,38.99,1969.25,fee schedule,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,outpatient,,,700.00000,665.00000,The Alliance,Premier SAS,90,457.42,,,,,,,66.55,3361.35,fee schedule,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Premier SAS,TC,1000.37,,,,,,,426.50,7351.18,fee schedule,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Premier SAS,90,1122.78,,,,,,,143.40,8250.66,fee schedule,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,outpatient,,,1635.00000,1553.25000,The Alliance,Premier SAS,90,1235.97,,,,,,,116.74,9082.50,fee schedule,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Premier SAS,TC,2423.84,,,,,,,1836.07,19225.77,fee schedule,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,outpatient,,,85.70000,81.41000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,outpatient,,,10203.00000,9692.85000,The Alliance,Premier SAS,90,7019.66,,,,,,,928.00,9896.91,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,outpatient,,,108.70000,103.26000,The Alliance,Premier SAS,90,71.62,,,,,,,8.17,526.26,fee schedule,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier SAS,,127.06,,,,,,,17.90,933.70,fee schedule,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,outpatient,,,205.30000,195.04000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,outpatient,,,203.40000,193.23000,The Alliance,Premier SAS,90,92.41,,,,,,,15.10,679.08,fee schedule,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,34.66,,,,,,,4.75,254.68,fee schedule,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,outpatient,,,660.00000,627.00000,The Alliance,Premier SAS,,454.08,,,,,,,35.91,891.44,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,outpatient,,,181.00000,171.95000,The Alliance,Premier SAS,TC,407.38,,,,,,,90.50,2993.62,fee schedule,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4707.00000,4471.65000,The Alliance,Premier SAS,90,3562.37,,,,,,,210.00,26177.94,fee schedule,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,outpatient,,,236.40000,224.58000,The Alliance,Premier SAS,90,198.68,,,,,,,28.87,1459.96,fee schedule,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,outpatient,,,212.80000,202.16000,The Alliance,Premier SAS,90,170.95,,,,,,,24.99,1256.24,fee schedule,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,outpatient,,,172.80000,164.16000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4895.00000,4650.25000,The Alliance,Premier SAS,90,3562.37,,,,,,,210.00,26177.94,fee schedule,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,outpatient,,,319.60000,303.62000,The Alliance,Premier SAS,90,83.17,,,,,,,9.83,611.15,fee schedule,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier SAS,90,94.72,,,,,,,8.17,696.05,fee schedule,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier SAS,,23.11,,,,,,,3.48,169.79,fee schedule,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,outpatient,,,256.00000,243.20000,The Alliance,Premier SAS,,249.50,,,,,,,128.00,1833.46,fee schedule,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,outpatient,,,672.00000,638.40000,The Alliance,Premier SAS,TC,580.65,,,,,,,336.00,4266.89,fee schedule,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1355.00000,1287.25000,The Alliance,Premier SAS,TC,1000.37,,,,,,,664.97,7351.18,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.10000,46.64000,The Alliance,Premier SAS,90,30.03,,,,,,,4.49,220.68,fee schedule,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,outpatient,,,1191.00000,1131.45000,The Alliance,Premier SAS,90,1000.33,,,,,,,70.04,7350.89,fee schedule,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,outpatient,,,290.50000,275.97000,The Alliance,Premier SAS,90,198.68,,,,,,,28.73,1459.96,fee schedule,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,outpatient,,,541.00000,513.95000,The Alliance,Premier SAS,,1000.33,,,,,,,70.04,7350.89,fee schedule,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,outpatient,,,80.90000,76.86000,The Alliance,Premier SAS,90,57.75,,,,,,,8.17,424.40,fee schedule,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,outpatient,,,71.00000,67.45000,The Alliance,Premier SAS,,48.85,,,,,,,9.74,68.87,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,outpatient,,,184.30000,175.08000,The Alliance,Premier SAS,,83.17,,,,,,,9.83,611.15,fee schedule,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,outpatient,,,199.30000,189.34000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,outpatient,,,65.00000,61.75000,The Alliance,Premier SAS,90,41.58,,,,,,,5.93,305.58,fee schedule,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,outpatient,,,60.00000,57.00000,The Alliance,Premier SAS,90,36.97,,,,,,,5.48,271.65,fee schedule,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,outpatient,,,81.30000,77.24000,The Alliance,Premier SAS,90,50.83,,,,,,,7.44,373.51,fee schedule,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier SAS,TC,2200.90,,,,,,,533.12,16173.22,fee schedule,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,outpatient,,,44.40000,42.18000,The Alliance,Premier SAS,90,27.72,,,,,,,4.06,203.72,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,outpatient,,,106.50000,101.17000,The Alliance,Premier SAS,90,85.48,,,,,,,12.51,628.12,fee schedule,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,outpatient,,,486.00000,461.70000,The Alliance,Premier SAS,,334.37,,,,,,,35.91,891.44,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,outpatient,,,530.00000,503.50000,The Alliance,Premier SAS,90,965.67,,,,,,,100.54,7096.21,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,outpatient,,,2799.00000,2659.05000,The Alliance,Premier SAS,90,1832.01,,,,,,,266.02,13462.44,fee schedule,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,outpatient,,,73.00000,69.35000,The Alliance,Premier SAS,,46.20,,,,,,,6.47,339.51,fee schedule,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,outpatient,,,379.70000,360.71000,The Alliance,Premier SAS,90,286.47,,,,,,,46.38,2105.11,fee schedule,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,outpatient,,,556.00000,528.20000,The Alliance,Premier SAS,,382.53,,,,,,,278.00,539.32,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,outpatient,,,33.00000,31.35000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,outpatient,,,56.80000,53.96000,The Alliance,Premier SAS,90,34.66,,,,,,,4.24,254.68,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Premier SAS,90,328.05,,,,,,,52.89,2410.69,fee schedule,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,outpatient,,,201.60000,191.52000,The Alliance,Premier SAS,,131.69,,,,,,,18.54,967.70,fee schedule,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,outpatient,,,154.30000,146.58000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier SAS,90,85.48,,,,,,,12.45,628.12,fee schedule,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,outpatient,,,211.70000,201.11000,The Alliance,Premier SAS,90,170.95,,,,,,,24.88,1256.24,fee schedule,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,outpatient,,,49.60000,47.12000,The Alliance,Premier SAS,90,143.23,,,,,,,24.80,1052.52,fee schedule,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,outpatient,,,142.10000,134.99000,The Alliance,Premier SAS,90,90.10,,,,,,,13.00,662.12,fee schedule,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,outpatient,,,164.70000,156.46000,The Alliance,Premier SAS,,103.96,,,,,,,15.78,763.98,fee schedule,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,outpatient,,,175.10000,166.34000,The Alliance,Premier SAS,90,134.00,,,,,,,21.79,984.66,fee schedule,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,The Alliance,Premier SAS,TC,1689.02,,,,,,,1293.00,13397.25,fee schedule,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,outpatient,,,101.90000,96.81000,The Alliance,Premier SAS,90,85.48,,,,,,,12.45,628.12,fee schedule,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,outpatient,,,259.70000,246.71000,The Alliance,Premier SAS,90,210.23,,,,,,,30.51,1544.85,fee schedule,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier SAS,90,46.20,,,,,,,6.85,339.51,fee schedule,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,outpatient,,,153.70000,146.01000,The Alliance,Premier SAS,90,97.03,,,,,,,14.05,713.01,fee schedule,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,outpatient,,,77.70000,73.82000,The Alliance,Premier SAS,,48.52,,,,,,,6.87,356.54,fee schedule,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier SAS,90,1182.84,,,,,,,179.44,8692.03,fee schedule,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,outpatient,,,145.40000,138.13000,The Alliance,Premier SAS,90,154.78,,,,,,,72.70,1137.41,fee schedule,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,outpatient,,,2846.00000,2703.70000,The Alliance,Premier SAS,90,2072.27,,,,,,,139.23,15227.97,fee schedule,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,outpatient,,,455.80000,433.01000,The Alliance,Premier SAS,,877.89,,,,,,,109.60,6451.13,fee schedule,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,outpatient,,,792.00000,752.40000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,outpatient,,,712.00000,676.40000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,outpatient,,,193.40000,183.73000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,outpatient,,,376.80000,357.96000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier SAS,90,2126.42,,,,,,,329.51,15625.93,fee schedule,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,outpatient,,,121.30000,115.23000,The Alliance,Premier SAS,90,87.78,,,,,,,14.25,645.08,fee schedule,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,outpatient,,,85.30000,81.03000,The Alliance,Premier SAS,90,69.31,,,,,,,10.02,509.30,fee schedule,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier SAS,90,97.03,,,,,,,14.05,713.01,fee schedule,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,90,73.92,,,,,,,10.66,543.22,fee schedule,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,outpatient,,,238.60000,226.67000,The Alliance,Premier SAS,,154.78,,,,,,,24.11,1137.41,fee schedule,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,outpatient,,,143.00000,135.85000,The Alliance,Premier SAS,90,115.51,,,,,,,16.80,848.80,fee schedule,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier SAS,,39.28,,,,,,,5.51,288.61,fee schedule,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,outpatient,,,5712.00000,5426.40000,The Alliance,Premier SAS,90,4322.44,,,,,,,270.25,31763.22,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,90,164.03,,,,,,,24.43,1205.34,fee schedule,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,outpatient,,,708.00000,672.60000,The Alliance,Premier SAS,,487.10,,,,,,,354.00,686.76,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2794.00000,2654.30000,The Alliance,Premier SAS,TC,2200.90,,,,,,,533.12,16173.22,fee schedule,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,outpatient,,,103.50000,98.32000,The Alliance,Premier SAS,90,83.17,,,,,,,12.16,611.15,fee schedule,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,outpatient,,,275.40000,261.63000,The Alliance,Premier SAS,90,283.39,,,,,,,23.08,2082.45,fee schedule,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier SAS,90,134.00,,,,,,,19.60,984.66,fee schedule,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier SAS,QW,69.31,,,,,,,9.71,509.30,fee schedule,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2906.00000,2760.70000,The Alliance,Premier SAS,TC,2200.90,,,,,,,533.12,16173.22,fee schedule,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,outpatient,,,5428.00000,5156.60000,The Alliance,Premier SAS,90,4107.58,,,,,,,230.26,30184.37,fee schedule,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier SAS,90,39.28,,,,,,,5.68,372.96,fee schedule,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,outpatient,,,398.80000,378.86000,The Alliance,Premier SAS,90,348.84,,,,,,,50.66,2563.44,fee schedule,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,outpatient,,,162.80000,154.66000,The Alliance,Premier SAS,,67.00,,,,,,,9.30,492.33,fee schedule,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,outpatient,,,282.30000,268.18000,The Alliance,Premier SAS,90,177.89,,,,,,,25.78,1307.20,fee schedule,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2560.00000,2432.00000,The Alliance,Premier SAS,90,1832.01,,,,,,,266.02,13462.44,fee schedule,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,outpatient,,,184.00000,174.80000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Premier SAS,90,5761.70,,,,,,,516.91,42339.61,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,outpatient,,,1098.00000,1043.10000,The Alliance,Premier SAS,90,799.34,,,,,,,73.92,5873.90,fee schedule,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,outpatient,,,1721.00000,1634.95000,The Alliance,Premier SAS,90,1302.97,,,,,,,177.33,9574.83,fee schedule,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,outpatient,,,92.90000,88.25000,The Alliance,Premier SAS,90,63.92,,,,,,,46.45,90.11,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,outpatient,,,283.10000,268.94000,The Alliance,Premier SAS,90,214.85,,,,,,,34.58,1578.85,fee schedule,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,outpatient,,,209.70000,199.21000,The Alliance,Premier SAS,,154.78,,,,,,,24.11,1137.41,fee schedule,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,outpatient,,,5721.00000,5434.95000,The Alliance,Premier SAS,90,4331.68,,,,,,,625.03,31831.15,fee schedule,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,outpatient,,,119.00000,113.05000,The Alliance,Premier SAS,TC,1000.37,,,,,,,59.50,7351.18,fee schedule,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,outpatient,,,134.60000,127.87000,The Alliance,Premier SAS,90,92.41,,,,,,,15.10,679.08,fee schedule,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,The Alliance,Premier SAS,90,85.48,,,,,,,12.40,628.12,fee schedule,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,outpatient,,,983.00000,933.85000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,outpatient,,,654.00000,621.30000,The Alliance,Premier SAS,90,517.50,,,,,,,76.81,3802.79,fee schedule,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,outpatient,,,102.00000,96.90000,The Alliance,Premier SAS,,87.78,,,,,,,11.89,645.08,fee schedule,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,outpatient,,,204.20000,193.99000,The Alliance,Premier SAS,,154.78,,,,,,,24.11,1137.41,fee schedule,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier SAS,90,1231.35,,,,,,,164.96,9048.50,fee schedule,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Premier SAS,90,1171.76,,,,,,,62.60,8610.62,fee schedule,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,outpatient,,,296.80000,281.96000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,outpatient,,,216.20000,205.39000,The Alliance,Premier SAS,90,154.78,,,,,,,108.10,1137.41,fee schedule,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier SAS,90,182.51,,,,,,,28.00,1341.13,fee schedule,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier SAS,90,154.78,,,,,,,24.91,1137.41,fee schedule,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,outpatient,,,384.50000,365.28000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,372.96,fee schedule,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,outpatient,,,84.00000,79.80000,The Alliance,Premier SAS,90,73.92,,,,,,,10.66,543.22,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,outpatient,,,618.00000,587.10000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,outpatient,,,345.50000,328.22000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,outpatient,,,431.20000,409.64000,The Alliance,Premier SAS,90,348.84,,,,,,,50.66,2563.44,fee schedule,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,The Alliance,Premier SAS,90,1171.76,,,,,,,62.60,8610.62,fee schedule,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,The Alliance,Premier SAS,90,1231.35,,,,,,,164.96,9048.50,fee schedule,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,outpatient,,,109.40000,103.93000,The Alliance,Premier SAS,90,76.24,,,,,,,11.16,560.26,fee schedule,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,The Alliance,Premier SAS,TC,177.89,,,,,,,138.83,1411.00,fee schedule,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,outpatient,,,285.50000,271.22000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier SAS,90,154.78,,,,,,,50.60,1137.41,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,outpatient,,,3228.00000,3066.60000,The Alliance,Premier SAS,90,2444.22,,,,,,,103.62,17961.21,fee schedule,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Premier SAS,,243.08,,,,,,,12.05,1786.28,fee schedule,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,The Alliance,Premier SAS,90,243.08,,,,,,,12.05,1786.28,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,outpatient,,,58.30000,55.38000,The Alliance,Premier SAS,90,46.20,,,,,,,6.85,339.51,fee schedule,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,outpatient,,,68.30000,64.88000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,outpatient,,,100.50000,95.47000,The Alliance,Premier SAS,,69.14,,,,,,,50.25,97.48,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4214.00000,4003.30000,The Alliance,Premier SAS,90,1811.22,,,,,,,282.88,13309.69,fee schedule,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Premier SAS,TC,1000.37,,,,,,,427.00,7351.18,fee schedule,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,The Alliance,Premier SAS,90,2126.42,,,,,,,329.51,15625.93,fee schedule,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,outpatient,,,2602.00000,2471.90000,The Alliance,Premier SAS,90,1894.39,,,,,,,236.63,13920.84,fee schedule,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,outpatient,,,5275.00000,5011.25000,The Alliance,Premier SAS,90,3629.20,,,,,,,2637.50,5605.44,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,outpatient,,,1456.00000,1383.20000,The Alliance,Premier SAS,90,1060.39,,,,,,,132.74,7792.26,fee schedule,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,outpatient,,,1483.00000,1408.85000,The Alliance,Premier SAS,90,1122.78,,,,,,,140.32,8250.66,fee schedule,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,,25.46,,,,,,,18.50,35.89,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,outpatient,,,321.00000,304.95000,The Alliance,Premier SAS,90,97.03,,,,,,,14.19,713.01,fee schedule,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,The Alliance,Premier SAS,TC,1000.37,,,,,,,427.00,7351.18,fee schedule,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,The Alliance,Premier SAS,90,820.13,,,,,,,119.20,6026.72,fee schedule,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,outpatient,,,152.40000,144.78000,The Alliance,Premier SAS,,97.03,,,,,,,15.00,713.01,fee schedule,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,outpatient,,,134.50000,127.77000,The Alliance,Premier SAS,90,92.41,,,,,,,14.93,679.08,fee schedule,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,outpatient,,,153.50000,145.82000,The Alliance,Premier SAS,90,154.78,,,,,,,76.75,1137.41,fee schedule,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,outpatient,,,154.10000,146.39000,The Alliance,Premier SAS,,92.41,,,,,,,13.05,679.08,fee schedule,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Premier SAS,,6.12,,,,,,,4.45,8.63,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.20000,53.39000,The Alliance,Premier SAS,,36.97,,,,,,,5.18,271.65,fee schedule,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,outpatient,,,1567.00000,1488.65000,The Alliance,Premier SAS,90,1185.15,,,,,,,185.20,8708.99,fee schedule,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,outpatient,,,357.00000,339.15000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,outpatient,,,217.80000,206.91000,The Alliance,Premier SAS,,106.27,,,,,,,14.28,780.94,fee schedule,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,outpatient,,,179.00000,170.05000,The Alliance,Premier SAS,90,154.78,,,,,,,89.50,1137.41,fee schedule,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,,92.41,,,,,,,8.17,679.08,fee schedule,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,outpatient,,,11319.00000,10753.05000,The Alliance,Premier SAS,90,8238.27,,,,,,,1287.00,60538.53,fee schedule,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier SAS,,209.46,,,,,,,12.05,1539.22,fee schedule,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,outpatient,,,308.70000,293.26000,The Alliance,Premier SAS,90,212.39,,,,,,,28.07,299.44,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,outpatient,,,8234.00000,7822.30000,The Alliance,Premier SAS,90,5992.73,,,,,,,936.00,44037.28,fee schedule,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,outpatient,,,340.70000,323.66000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,outpatient,,,193.00000,183.35000,The Alliance,Premier SAS,,143.23,,,,,,,20.26,1052.52,fee schedule,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,The Alliance,Premier SAS,TC,162.93,,,,,,,96.44,1292.36,fee schedule,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,outpatient,,,170.10000,161.60000,The Alliance,Premier SAS,,101.65,,,,,,,14.39,746.94,fee schedule,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,outpatient,,,63.80000,60.61000,The Alliance,Premier SAS,,39.28,,,,,,,5.50,288.61,fee schedule,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,outpatient,,,382.00000,362.90000,The Alliance,Premier SAS,90,262.82,,,,,,,152.01,370.54,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,outpatient,,,3120.00000,2964.00000,The Alliance,Premier SAS,TC,2003.05,,,,,,,1560.00,14719.32,fee schedule,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,23.11,,,,,,,3.48,169.79,fee schedule,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,outpatient,,,61.50000,58.42000,The Alliance,Premier SAS,,42.31,,,,,,,30.75,59.66,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,outpatient,,,1700.00000,1615.00000,The Alliance,Premier SAS,90,1235.97,,,,,,,154.60,9082.50,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,outpatient,,,846.00000,803.70000,The Alliance,Premier SAS,90,582.05,,,,,,,423.00,820.62,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,outpatient,,,280.70000,266.66000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier SAS,,38.60,,,,,,,28.05,54.42,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,outpatient,,,155.70000,147.92000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,outpatient,,,105.50000,100.22000,The Alliance,Premier SAS,90,50.83,,,,,,,8.37,373.51,fee schedule,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,outpatient,,,2324.00000,2207.80000,The Alliance,Premier SAS,90,1760.39,,,,,,,274.83,12936.18,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,outpatient,,,2548.00000,2420.60000,The Alliance,Premier SAS,90,1929.04,,,,,,,301.35,14175.45,fee schedule,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,outpatient,,,730.00000,693.50000,The Alliance,Premier SAS,90,531.36,,,,,,,85.76,3904.65,fee schedule,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,The Alliance,Premier SAS,90,328.05,,,,,,,52.89,2410.69,fee schedule,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,outpatient,,,665.00000,631.75000,The Alliance,Premier SAS,90,328.05,,,,,,,52.77,2410.69,fee schedule,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,outpatient,,,114.00000,108.30000,The Alliance,Premier SAS,TC,1000.37,,,,,,,57.00,7351.18,fee schedule,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1382.00000,1312.90000,The Alliance,Premier SAS,,868.64,,,,,,,122.22,6383.20,fee schedule,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,outpatient,,,408.00000,387.60000,The Alliance,Premier SAS,90,39.28,,,,,,,5.68,395.76,fee schedule,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,outpatient,,,233.40000,221.73000,The Alliance,Premier SAS,90,160.58,,,,,,,21.69,226.40,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Premier SAS,90,2647.25,,,,,,,166.90,19453.17,fee schedule,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,outpatient,,,120.70000,114.66000,The Alliance,Premier SAS,,73.92,,,,,,,10.63,543.22,fee schedule,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,outpatient,,,806.00000,765.70000,The Alliance,Premier SAS,90,651.48,,,,,,,94.71,4787.38,fee schedule,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,outpatient,,,569.00000,540.55000,The Alliance,Premier SAS,,391.47,,,,,,,284.50,551.93,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2393.00000,2273.35000,The Alliance,Premier SAS,90,1811.22,,,,,,,282.88,13309.69,fee schedule,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,outpatient,,,252.90000,240.26000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,The Alliance,Premier SAS,90,2647.25,,,,,,,166.90,19453.17,fee schedule,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,outpatient,,,590.40000,560.88000,The Alliance,Premier SAS,90,406.20,,,,,,,295.20,572.69,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4864.00000,4620.80000,The Alliance,Premier SAS,90,3828.05,,,,,,,597.91,28130.22,fee schedule,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,outpatient,,,934.00000,887.30000,The Alliance,Premier SAS,,1171.76,,,,,,,467.00,8610.62,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1428.00000,1356.60000,The Alliance,Premier SAS,,1122.78,,,,,,,143.40,8250.66,fee schedule,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,outpatient,,,250.50000,237.98000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,outpatient,,,220.90000,209.85000,The Alliance,Premier SAS,90,57.75,,,,,,,8.35,424.40,fee schedule,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,The Alliance,Premier SAS,90,5761.70,,,,,,,516.91,42339.61,fee schedule,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,outpatient,,,2501.00000,2375.95000,The Alliance,Premier SAS,90,1894.39,,,,,,,175.10,13920.84,fee schedule,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,outpatient,,,27.00000,25.65000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,QW,106.27,,,,,,,16.53,780.94,fee schedule,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,outpatient,,,96.60000,91.77000,The Alliance,Premier SAS,90,154.78,,,,,,,48.30,1137.41,fee schedule,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,outpatient,,,263.80000,250.61000,The Alliance,Premier SAS,90,418.15,,,,,,,131.90,3072.74,fee schedule,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,outpatient,,,37.10000,35.24000,The Alliance,Premier SAS,90,32.34,,,,,,,4.55,237.65,fee schedule,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,outpatient,,,233.70000,222.01000,The Alliance,Premier SAS,,147.86,,,,,,,20.67,1086.52,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1574.00000,1495.30000,The Alliance,Premier SAS,,1235.97,,,,,,,157.98,9082.50,fee schedule,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,136.30,,,,,,,21.21,1001.63,fee schedule,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Premier SAS,,1894.39,,,,,,,145.60,13920.84,fee schedule,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,The Alliance,Premier SAS,TC,1000.37,,,,,,,426.50,7351.18,fee schedule,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,outpatient,,,291.20000,276.64000,The Alliance,Premier SAS,,1185.15,,,,,,,145.60,8708.99,fee schedule,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,outpatient,,,26.00000,24.70000,The Alliance,Premier SAS,,16.17,,,,,,,2.37,118.82,fee schedule,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,3526.00000,3349.70000,The Alliance,Premier SAS,90,2425.89,,,,,,,1458.73,3420.22,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier SAS,90,43.89,,,,,,,6.23,322.54,fee schedule,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,20.80,,,,,,,3.28,152.82,fee schedule,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,outpatient,,,207.30000,196.94000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,outpatient,,,98.10000,93.19000,The Alliance,Premier SAS,90,64.69,,,,,,,9.32,475.37,fee schedule,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,outpatient,,,283.60000,269.42000,The Alliance,Premier SAS,,152.47,,,,,,,20.36,1120.45,fee schedule,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,outpatient,,,438.90000,416.96000,The Alliance,Premier SAS,,301.96,,,,,,,219.45,425.73,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,outpatient,,,123.40000,117.23000,The Alliance,Premier SAS,90,198.68,,,,,,,28.73,1459.96,fee schedule,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,outpatient,,,12.10000,11.49000,The Alliance,Premier SAS,,8.32,,,,,,,6.05,11.74,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier SAS,90,34.66,,,,,,,4.91,254.68,fee schedule,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,outpatient,,,49.30000,46.83000,The Alliance,Premier SAS,90,34.66,,,,,,,5.67,254.68,fee schedule,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,outpatient,,,320.60000,304.57000,The Alliance,Premier SAS,90,113.20,,,,,,,16.59,831.84,fee schedule,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.80000,58.71000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,outpatient,,,116.30000,110.48000,The Alliance,Premier SAS,90,154.78,,,,,,,58.15,1137.41,fee schedule,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,outpatient,,,425.70000,404.41000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,outpatient,,,75.10000,71.34000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,The Alliance,Premier SAS,TC,525.35,,,,,,,401.07,4167.07,fee schedule,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,outpatient,,,153.00000,145.35000,The Alliance,Premier SAS,90,105.26,,,,,,,63.32,148.41,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,outpatient,,,49.70000,47.22000,The Alliance,Premier SAS,90,41.58,,,,,,,6.08,305.58,fee schedule,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,outpatient,,,59.50000,56.52000,The Alliance,Premier SAS,90,92.41,,,,,,,14.93,679.08,fee schedule,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,outpatient,,,271.50000,257.92000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,outpatient,,,292.10000,277.50000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,outpatient,,,903.00000,857.85000,The Alliance,Premier SAS,90,150.17,,,,,,,19.88,1103.49,fee schedule,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,outpatient,,,78.80000,74.86000,The Alliance,Premier SAS,90,120.13,,,,,,,8.17,882.80,fee schedule,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier SAS,90,34.66,,,,,,,5.23,254.68,fee schedule,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,outpatient,,,59.40000,56.43000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,outpatient,,,179.50000,170.52000,The Alliance,Premier SAS,90,150.17,,,,,,,21.94,1103.49,fee schedule,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2812.00000,2671.40000,The Alliance,Premier SAS,,1811.22,,,,,,,282.88,13309.69,fee schedule,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.30000,303.34000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier SAS,90,36.97,,,,,,,5.97,271.65,fee schedule,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,outpatient,,,5074.00000,4820.30000,The Alliance,Premier SAS,90,3841.91,,,,,,,480.56,28232.08,fee schedule,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,outpatient,,,78.90000,74.96000,The Alliance,Premier SAS,90,413.53,,,,,,,39.45,3038.81,fee schedule,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,outpatient,,,57.70000,54.81000,The Alliance,Premier SAS,90,103.96,,,,,,,15.06,763.98,fee schedule,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,outpatient,,,210.20000,199.69000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,53.00000,50.35000,The Alliance,Premier SAS,,36.46,,,,,,,5.87,113.69,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,outpatient,,,227.00000,215.65000,The Alliance,Premier SAS,90,182.51,,,,,,,26.67,1341.13,fee schedule,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,The Alliance,Premier SAS,90,143.23,,,,,,,77.53,1052.52,fee schedule,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,outpatient,,,141.20000,134.14000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,outpatient,,,637.00000,605.15000,The Alliance,Premier SAS,,628.39,,,,,,,90.57,4617.66,fee schedule,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,outpatient,,,31.30000,29.74000,The Alliance,Premier SAS,90,20.80,,,,,,,3.09,152.82,fee schedule,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,outpatient,,,576.00000,547.20000,The Alliance,Premier SAS,90,396.29,,,,,,,288.00,558.72,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,34.66,,,,,,,5.00,254.68,fee schedule,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,outpatient,,,248.90000,236.45000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,outpatient,,,329.50000,313.02000,The Alliance,Premier SAS,90,113.20,,,,,,,16.44,831.84,fee schedule,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,209.46,,,,,,,12.05,1539.22,fee schedule,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,The Alliance,Premier SAS,90,433.58,,,,,,,307.50,3186.14,fee schedule,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,outpatient,,,86.90000,82.56000,The Alliance,Premier SAS,90,113.20,,,,,,,10.82,831.84,fee schedule,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,The Alliance,Premier SAS,,1485.48,,,,,,,208.92,10915.96,fee schedule,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,outpatient,,,238.40000,226.48000,The Alliance,Premier SAS,90,173.27,,,,,,,19.70,1273.27,fee schedule,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,outpatient,,,253.30000,240.64000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,outpatient,,,1837.00000,1745.15000,The Alliance,Premier SAS,90,1185.15,,,,,,,648.20,8708.99,fee schedule,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,outpatient,,,18.00000,17.10000,The Alliance,Premier SAS,90,25.41,,,,,,,3.70,186.75,fee schedule,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier SAS,90,48.52,,,,,,,6.92,356.54,fee schedule,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,outpatient,,,76.00000,72.20000,The Alliance,Premier SAS,,55.45,,,,,,,8.61,407.44,fee schedule,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,outpatient,,,111.90000,106.31000,The Alliance,Premier SAS,90,94.72,,,,,,,11.13,696.05,fee schedule,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,14.65,,,,,,,10.42,177.63,fee schedule,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,outpatient,,,109.70000,104.22000,The Alliance,Premier SAS,90,80.86,,,,,,,12.89,594.19,fee schedule,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,outpatient,,,136.20000,129.39000,The Alliance,Premier SAS,90,351.27,,,,,,,7.27,2581.26,fee schedule,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Premier SAS,90,117.83,,,,,,,17.01,865.84,fee schedule,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,outpatient,,,165.50000,157.22000,The Alliance,Premier SAS,90,138.61,,,,,,,7.06,1018.59,fee schedule,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,outpatient,,,273.70000,260.02000,The Alliance,Premier SAS,90,147.86,,,,,,,21.01,1086.52,fee schedule,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,The Alliance,Premier SAS,90,34.66,,,,,,,5.25,254.68,fee schedule,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier SAS,90,52.08,,,,,,,37.85,73.43,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,outpatient,,,23.30000,22.13000,The Alliance,Premier SAS,90,30.03,,,,,,,4.89,220.68,fee schedule,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,outpatient,,,318.30000,302.38000,The Alliance,Premier SAS,90,113.20,,,,,,,16.59,831.84,fee schedule,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,outpatient,,,128.00000,121.60000,The Alliance,Premier SAS,90,103.96,,,,,,,15.03,763.98,fee schedule,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,The Alliance,Premier SAS,,120.13,,,,,,,18.64,882.80,fee schedule,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,The Alliance,Premier SAS,,1432.34,,,,,,,201.50,10525.49,fee schedule,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,outpatient,,,4578.00000,4349.10000,The Alliance,Premier SAS,TC,3383.74,,,,,,,533.12,24865.24,fee schedule,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,outpatient,,,144.40000,137.18000,The Alliance,Premier SAS,90,108.58,,,,,,,16.32,797.91,fee schedule,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,The Alliance,Premier SAS,90,62.38,,,,,,,8.94,458.40,fee schedule,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,outpatient,,,276.10000,262.30000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,outpatient,,,57.20000,54.34000,The Alliance,Premier SAS,,39.35,,,,,,,28.60,55.48,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier SAS,,54.90,,,,,,,39.90,77.41,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,outpatient,,,398.70000,378.76000,The Alliance,Premier SAS,,302.64,,,,,,,144.13,2223.94,fee schedule,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,outpatient,,,65.50000,62.22000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,The Alliance,Premier SAS,,9.93,,,,,,,7.21,14.00,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,The Alliance,Premier SAS,,3.26,,,,,,,2.37,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,outpatient,1,GM,8.13000,7.73000,The Alliance,Premier SAS,,5.59,,,,,,,4.07,7.89,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,The Alliance,Premier SAS,,1.25,,,,,,,0.90500,1.76,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,outpatient,1,mL,45.79000,43.50000,The Alliance,Premier SAS,,76.53,,,,,,,22.89,78.87,fee schedule,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,outpatient,1,mL,2.05000,1.95000,The Alliance,Premier SAS,,1.41,,,,,,,1.02,1.99,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,The Alliance,Premier SAS,,0.49536,,,,,,,0.36000,0.69840,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,outpatient,1,mL,46.14000,43.83000,The Alliance,Premier SAS,,31.74,,,,,,,23.07,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,outpatient,1,mL,24.67000,23.44000,The Alliance,Premier SAS,,16.97,,,,,,,12.34,23.93,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,outpatient,1,mL,122.89000,116.74000,The Alliance,Premier SAS,,84.55,,,,,,,61.45,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,outpatient,1,mL,112.07000,106.47000,The Alliance,Premier SAS,,77.10,,,,,,,56.03,108.71,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,outpatient,1,mL,3.93000,3.73000,The Alliance,Premier SAS,,2.70,,,,,,,1.97,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,1.74,,,,,,,1.26,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,outpatient,1,mL,4.47000,4.24000,The Alliance,Premier SAS,,3.08,,,,,,,2.23,4.34,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,The Alliance,Premier SAS,,13.04,,,,,,,9.48,18.39,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,The Alliance,Premier SAS,,2.30,,,,,,,1.68,3.25,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,outpatient,1,mL,28.33000,26.92000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,27.48,fee schedule,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,outpatient,1,EA,16163.08000,15354.93000,The Alliance,Premier SAS,,11120.20,,,,,,,8081.54,15678.19,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,outpatient,1,mL,30.39000,28.87000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,29.48,fee schedule,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,outpatient,1,mL,286.22000,271.90000,The Alliance,Premier SAS,,27.81,,,,,,,17.37,277.63,fee schedule,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1821.00000,1729.95000,The Alliance,Premier SAS,TC,1810.00,,,,,,,484.28,2161.00,per diem,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,outpatient,,,77.40000,73.53000,The Alliance,Premier SAS,90,154.78,,,,,,,38.70,1137.41,fee schedule,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,outpatient,1,mL,300.20000,285.19000,The Alliance,Premier SAS,,63.77,,,,,,,39.83,291.19,fee schedule,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,outpatient,1,EA,2.56000,2.43000,The Alliance,Premier SAS,,1.94,,,,,,,1.21,2.48,fee schedule,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,464.18000,440.97000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,450.25,fee schedule,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,The Alliance,Premier SAS,,862.06,,,,,,,626.50,1215.41,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Premier SAS,,6000.37,,,,,,,6000.37,13072.70,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Premier SAS,,4742.73,,,,,,,4742.73,10332.75,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,The Alliance,Premier SAS,,4742.73,,,,,,,4742.73,10332.75,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier SAS,,18511.22,,,,,,,18511.22,40329.45,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,The Alliance,Premier SAS,,4433.94,,,,,,,4433.94,9660.00,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier SAS,,2848.81,,,,,,,2848.81,6206.55,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,0.32980,fee schedule,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,outpatient,,,698.00000,663.10000,The Alliance,Premier SAS,,480.22,,,,,,,50.73,677.06,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,outpatient,1,EA,4155.55000,3947.77000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,4030.88,fee schedule,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,outpatient,,,192.00000,182.40000,The Alliance,Premier SAS,,132.10,,,,,,,19.31,186.24,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,outpatient,,,1804.00000,1713.80000,The Alliance,Premier SAS,,1241.15,,,,,,,902.00,1749.88,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,5592.00,,,,,,,43.00,6456.00,case rate,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,The Alliance,Premier SAS,TC,2928.13,,,,,,,2128.00,4128.32,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Premier SAS,,9.57,,,,,,,5.98,708.47,fee schedule,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,outpatient,,,2454.00000,2331.30000,The Alliance,Premier SAS,TC,1688.35,,,,,,,1227.00,5271.00,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,outpatient,,,7396.00000,7026.20000,The Alliance,Premier SAS,TC,17011.00,,,,,,,3698.00,17574.00,case rate,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,outpatient,1,mL,20.30000,19.29000,The Alliance,Premier SAS,,13.97,,,,,,,0.92000,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,outpatient,1,mL,89.60000,85.12000,The Alliance,Premier SAS,,61.64,,,,,,,0.92000,86.91,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,outpatient,1,EA,2370.47000,2251.95000,The Alliance,Premier SAS,,1630.88,,,,,,,1185.23,2299.36,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,110.08,,,,,,,46.35,319.35,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,outpatient,,,394.00000,374.30000,The Alliance,Premier SAS,,271.07,,,,,,,35.09,382.18,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,outpatient,,,201.00000,190.95000,The Alliance,Premier SAS,,138.29,,,,,,,18.05,194.97,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,,120.40,,,,,,,24.08,169.75,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,outpatient,,,522.00000,495.90000,The Alliance,Premier SAS,,359.14,,,,,,,50.73,506.34,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,The Alliance,Premier SAS,TC,551.78,,,,,,,389.35,2210.07,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Premier SAS,,168.39,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,The Alliance,Premier SAS,,6000.37,,,,,,,6000.37,13072.70,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1342.24,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier SAS,,35.49,,,,,,,25.79,50.03,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,The Alliance,Premier SAS,TC,2919.22,,,,,,,2210.90,23155.09,fee schedule,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier SAS,,8471.90,,,,,,,1667.31,67198.78,fee schedule,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,The Alliance,Premier SAS,,14319.70,,,,,,,14319.70,31197.60,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Premier SAS,,13894.62,,,,,,,13894.62,30271.50,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,outpatient,1,mL,19494.00000,18519.30000,The Alliance,Premier SAS,,88.54,,,,,,,55.30,18909.18,fee schedule,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,mL,3.32000,3.16000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,3.22,fee schedule,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier SAS,,18511.22,,,,,,,18511.22,40329.45,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier SAS,,20528.18,,,,,,,20528.18,44723.70,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,TC,210.31,,,,,,,131.50,1668.14,fee schedule,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,TC,532.00,,,,,,,76.00,548.00,fee schedule,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,19.28000,18.32000,The Alliance,Premier SAS,,13.26,,,,,,,9.64,18.70,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,outpatient,,,571.56000,542.98000,The Alliance,Premier SAS,,500.95,,,,,,,285.78,554.41,fee schedule,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,outpatient,1,mL,1143.11000,1085.95000,The Alliance,Premier SAS,,500.95,,,,,,,485.00,1108.82,fee schedule,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,outpatient,1,EA,205.24000,194.98000,The Alliance,Premier SAS,,141.21,,,,,,,102.62,199.08,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,outpatient,,,346.00000,328.70000,The Alliance,Premier SAS,,238.05,,,,,,,28.27,335.62,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Premier SAS,,12941.28,,,,,,,12941.28,28194.50,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,The Alliance,Premier SAS,,12941.28,,,,,,,12941.28,28194.50,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,The Alliance,Premier SAS,,119.85,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,8814.75000,8374.01000,The Alliance,Premier SAS,,4045.97,,,,,,,4045.97,8814.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,The Alliance,Premier SAS,,1821.18,,,,,,,249.71,14445.56,fee schedule,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,The Alliance,Premier SAS,,532.00,,,,,,,119.50,734.90,fee schedule,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,,143.10,,,,,,,56.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,outpatient,,,308.00000,292.60000,The Alliance,Premier SAS,,211.90,,,,,,,56.40,298.76,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,outpatient,1,EA,3362.49000,3194.36000,The Alliance,Premier SAS,,259.30,,,,,,,161.96,3261.62,fee schedule,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,outpatient,1,mL,22.42000,21.30000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,21.75,fee schedule,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,The Alliance,Premier SAS,,2.06,,,,,,,1.50,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7193.25000,6833.59000,The Alliance,Premier SAS,,3301.70,,,,,,,3301.70,7193.25,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1406.25000,1335.94000,The Alliance,Premier SAS,,645.47,,,,,,,645.47,1406.25,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,The Alliance,Premier SAS,,1220.71,,,,,,,1220.71,2659.50,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,The Alliance,Premier SAS,,5.72,,,,,,,4.16,8.07,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,outpatient,,,1229.00000,1167.55000,The Alliance,Premier SAS,TC,472.00,,,,,,,316.68,1447.00,per diem,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,4652.12,per diem,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6365.00000,6046.75000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,6174.05,per diem,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,The Alliance,Premier SAS,,191.26,,,,,,,139.00,269.66,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,The Alliance,Premier SAS,TC,472.00,,,,,,,316.68,1447.00,per diem,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,outpatient,1,mL,4864.58000,4621.36000,The Alliance,Premier SAS,,29.30,,,,,,,18.30,4718.64,fee schedule,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,950.60,fee schedule,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,outpatient,1,mL,110.58000,105.05000,The Alliance,Premier SAS,,76.08,,,,,,,55.29,107.26,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,The Alliance,Premier SAS,,26025.30,,,,,,,26025.30,56700.00,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,outpatient,,,241.67000,229.59000,The Alliance,Premier SAS,,166.27,,,,,,,120.83,240.53,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,outpatient,1,EA,483.34000,459.17000,The Alliance,Premier SAS,,332.54,,,,,,,240.53,468.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,outpatient,,,113.43000,107.76000,The Alliance,Premier SAS,,78.04,,,,,,,56.72,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,outpatient,1,mL,226.86000,215.52000,The Alliance,Premier SAS,,156.08,,,,,,,113.43,220.05,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,The Alliance,Premier SAS,,1.09,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,outpatient,1,GM,8.39000,7.97000,The Alliance,Premier SAS,,5.77,,,,,,,4.20,8.14,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,The Alliance,Premier SAS,QW,106.27,,,,,,,16.53,780.94,fee schedule,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,outpatient,,,1895.00000,1800.25000,The Alliance,Premier SAS,,1407.75,,,,,,,12.05,10344.80,fee schedule,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,outpatient,,,506.00000,480.70000,The Alliance,Premier SAS,RT,348.13,,,,,,,253.00,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,RT,1696.61,,,,,,,1233.00,2392.02,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,847.16000,804.80000,The Alliance,Premier SAS,,388.85,,,,,,,388.85,847.16,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,The Alliance,Premier SAS,,5964.27,,,,,,,4334.50,8408.93,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4416.00000,4195.20000,The Alliance,Premier SAS,,2026.94,,,,,,,2026.94,4416.00,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,1.34,,,,,,,0.31500,1.39,fee schedule,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Premier SAS,,3008.74,,,,,,,3008.74,6555.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1466.00000,1392.70000,The Alliance,Premier SAS,,912.54,,,,,,,128.29,6705.74,fee schedule,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier SAS,,1290.94,,,,,,,1290.94,2812.50,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,The Alliance,Premier SAS,,0.10320,,,,,,,0.07500,0.14550,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,outpatient,1,EA,14.00000,13.30000,The Alliance,Premier SAS,,9.63,,,,,,,7.00,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,outpatient,1,EA,13.21000,12.55000,The Alliance,Premier SAS,,9.09,,,,,,,6.61,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,The Alliance,Premier SAS,,9.89,,,,,,,7.18,13.94,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,The Alliance,Premier SAS,,0.19264,,,,,,,0.14000,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,outpatient,,,152.78000,145.14000,The Alliance,Premier SAS,,105.11,,,,,,,76.39,195.41,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,outpatient,1,mL,76.39000,72.57000,The Alliance,Premier SAS,,52.56,,,,,,,38.20,195.41,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,The Alliance,Premier SAS,,1290.94,,,,,,,1290.94,2812.50,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Premier SAS,,1780.64,,,,,,,1294.07,2510.50,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,outpatient,1,mL,66.57000,63.24000,The Alliance,Premier SAS,,45.80,,,,,,,0.77000,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,outpatient,1,mL,60.38000,57.36000,The Alliance,Premier SAS,,41.54,,,,,,,0.77000,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,outpatient,1,mL,69.89000,66.40000,The Alliance,Premier SAS,,48.08,,,,,,,0.77000,67.79,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14399.50000,13679.52000,The Alliance,Premier SAS,,6609.37,,,,,,,6609.37,14399.50,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,outpatient,,,606.00000,575.70000,The Alliance,Premier SAS,,416.93,,,,,,,303.00,587.82,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.40000,203.68000,The Alliance,Premier SAS,90,134.00,,,,,,,19.60,984.66,fee schedule,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,outpatient,,,136.80000,129.96000,The Alliance,Premier SAS,90,85.48,,,,,,,12.51,628.12,fee schedule,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1100.00000,1045.00000,The Alliance,Premier SAS,,161.25,,,,,,,158.39,1067.00,fee schedule,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,outpatient,,,117.28000,111.42000,The Alliance,Premier SAS,,74.02,,,,,,,58.64,113.76,fee schedule,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Premier SAS,,49042.02,,,,,,,35641.00,74614.73,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,The Alliance,Premier SAS,TC,1028.56,,,,,,,747.50,1450.15,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,outpatient,,,82.50000,78.38000,The Alliance,Premier SAS,,33.44,,,,,,,20.89,80.03,fee schedule,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier SAS,,965.95,,,,,,,702.00,1361.88,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13175.00000,12516.25000,The Alliance,Premier SAS,,6047.32,,,,,,,6047.32,12779.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,outpatient,,,1069.00000,1015.55000,The Alliance,Premier SAS,,735.47,,,,,,,247.20,1036.93,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,The Alliance,Premier SAS,,81.72,,,,,,,81.72,178.04,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2389.84000,2270.35000,The Alliance,Premier SAS,,1096.94,,,,,,,1096.94,2389.84,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,631.13000,599.57000,The Alliance,Premier SAS,,289.69,,,,,,,289.69,631.13,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier SAS,,9305.77,,,,,,,9305.77,20274.00,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier SAS,,9305.77,,,,,,,9305.77,20274.00,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Premier SAS,,26378.97,,,,,,,10648.19,27182.63,fee schedule,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,outpatient,,,784.00000,744.80000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,760.48,fee schedule,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,outpatient,,,175.00000,166.25000,The Alliance,Premier SAS,QW,143.23,,,,,,,22.48,1052.52,fee schedule,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,The Alliance,Premier SAS,TC,949.31,,,,,,,726.61,7529.89,fee schedule,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier SAS,,9305.77,,,,,,,9305.77,20274.00,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,The Alliance,Premier SAS,,10506.51,,,,,,,10506.51,22890.00,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier SAS,,2612.86,,,,,,,2612.86,5692.50,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,34353.61000,32635.93000,The Alliance,Premier SAS,,26378.97,,,,,,,17176.81,34353.61,fee schedule,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,outpatient,1,mL,619.01000,588.06000,The Alliance,Premier SAS,,156.42,,,,,,,97.70,600.44,fee schedule,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,outpatient,1,mL,0.79000,0.75000,The Alliance,Premier SAS,,0.54352,,,,,,,0.39500,0.76630,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,The Alliance,Premier SAS,,0.46784,,,,,,,0.34000,0.65960,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,279.23000,265.27000,The Alliance,Premier SAS,,128.17,,,,,,,128.17,279.23,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,The Alliance,Premier SAS,TC,1732.38,,,,,,,1163.40,2442.46,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.01000,The Alliance,Premier SAS,,0.01376,,,,,,,0.01000,0.01940,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,outpatient,1,mL,15.80000,15.01000,The Alliance,Premier SAS,,2.02,,,,,,,2.02,15.33,fee schedule,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,outpatient,1,mL,515.41000,489.64000,The Alliance,Premier SAS,,354.60,,,,,,,257.70,499.95,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,The Alliance,Premier SAS,,0.03440,,,,,,,0.02500,0.04850,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,outpatient,1,mL,96.55000,91.72000,The Alliance,Premier SAS,,66.43,,,,,,,48.27,93.65,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,outpatient,,,602.00000,571.90000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,3163.00,case rate,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,40880.70000,38836.66000,The Alliance,Premier SAS,,18764.24,,,,,,,18764.24,40880.70,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier SAS,,109.47,,,,,,,109.47,238.50,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,167.70,,,,,,,121.88,236.44,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,,78.14,,,,,,,59.00,619.83,fee schedule,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18331.42000,17414.85000,The Alliance,Premier SAS,,8414.12,,,,,,,8414.12,18331.42,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,outpatient,,,2290.00000,2175.50000,The Alliance,Premier SAS,,1684.15,,,,,,,232.94,12375.92,fee schedule,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,The Alliance,Premier SAS,,33.44,,,,,,,20.89,1256.15,fee schedule,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,909.00,,,,,,,127.05,3163.00,case rate,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9357.04000,8889.19000,The Alliance,Premier SAS,,4294.88,,,,,,,4294.88,9357.04,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,7036.72000,6684.88000,The Alliance,Premier SAS,,3229.85,,,,,,,3229.85,7036.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,582.19000,553.08000,The Alliance,Premier SAS,,240.68,,,,,,,240.68,564.72,fee schedule,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,outpatient,1,mL,25103.16000,23848.00000,The Alliance,Premier SAS,,119.85,,,,,,,74.86,24350.07,fee schedule,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,outpatient,1,EA,18.49000,17.56000,The Alliance,Premier SAS,,1.34,,,,,,,1.28,17.94,fee schedule,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,outpatient,1,EA,20.54000,19.51000,The Alliance,Premier SAS,,14.13,,,,,,,10.27,19.92,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,outpatient,,,588.75000,559.31000,The Alliance,Premier SAS,,211.40,,,,,,,132.04,571.09,fee schedule,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,The Alliance,Premier SAS,,0.08256,,,,,,,0.06000,0.11640,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,outpatient,1,EA,39.92000,37.92000,The Alliance,Premier SAS,,27.46,,,,,,,19.96,38.72,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,The Alliance,Premier SAS,,12023.50,,,,,,,12023.50,26195.00,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,outpatient,1,EA,51.56000,48.98000,The Alliance,Premier SAS,,8.21,,,,,,,7.77,50.01,fee schedule,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,outpatient,1,EA,29.86000,28.37000,The Alliance,Premier SAS,,6.12,,,,,,,6.12,28.96,fee schedule,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,outpatient,1,EA,158.00000,150.10000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,153.26,fee schedule,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,outpatient,1,EA,717.43000,681.56000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,695.91,fee schedule,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,outpatient,1,EA,169.28000,160.82000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04803,164.20,fee schedule,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,outpatient,1,mL,1202.80000,1142.66000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,1166.72,fee schedule,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,outpatient,1,EA,36.67000,34.84000,The Alliance,Premier SAS,,25.23,,,,,,,18.34,35.57,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,The Alliance,Premier SAS,,30.29,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,The Alliance,Premier SAS,,4.19,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,The Alliance,Premier SAS,,8.70,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,The Alliance,Premier SAS,,0.52288,,,,,,,0.38000,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,The Alliance,Premier SAS,,2.73,,,,,,,1.99,3.85,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,The Alliance,Premier SAS,,542.19,,,,,,,542.19,1181.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier SAS,,154.80,,,,,,,112.50,218.25,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,The Alliance,Premier SAS,,307.75,,,,,,,100.97,2441.08,fee schedule,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,372.50,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,The Alliance,Premier SAS,,512.56,,,,,,,372.50,929.91,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,outpatient,,,2449.00000,2326.55000,The Alliance,Premier SAS,LT,1684.91,,,,,,,1224.50,2375.53,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,outpatient,,,1281.00000,1216.95000,The Alliance,Premier SAS,LT,881.33,,,,,,,640.50,1242.57,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,The Alliance,Premier SAS,,103.20,,,,,,,75.00,308.32,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,The Alliance,Premier SAS,,322.67,,,,,,,234.50,454.93,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,The Alliance,Premier SAS,TC,2169.26,,,,,,,1479.13,3058.41,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,outpatient,1,EA,343.71000,326.53000,The Alliance,Premier SAS,,236.47,,,,,,,171.85,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,outpatient,1,EA,309.79000,294.30000,The Alliance,Premier SAS,,213.14,,,,,,,154.90,300.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,The Alliance,Premier SAS,,0.46429,,,,,,,0.29000,1100.39,fee schedule,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,outpatient,1,mL,12429.17000,11807.71000,The Alliance,Premier SAS,,211.40,,,,,,,132.04,12056.29,fee schedule,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,outpatient,,,169.40000,160.93000,The Alliance,Premier SAS,90,106.27,,,,,,,15.49,780.94,fee schedule,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier SAS,,2612.86,,,,,,,2612.86,5692.50,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,42.01,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,The Alliance,Premier SAS,,2612.86,,,,,,,2612.86,5692.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Premier SAS,,35.03,,,,,,,35.03,76.32,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Premier SAS,,1266.84,,,,,,,1266.84,2760.00,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,The Alliance,Premier SAS,,1266.84,,,,,,,1266.84,2760.00,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,The Alliance,Premier SAS,,2454.50,,,,,,,2454.50,5347.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,outpatient,,,136.51000,129.68000,The Alliance,Premier SAS,,93.92,,,,,,,68.25,144.20,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,outpatient,1,EA,273.02000,259.37000,The Alliance,Premier SAS,,187.84,,,,,,,136.51,264.83,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier SAS,,180.00,,,,,,,68.50,264.00,per diem,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,The Alliance,Premier SAS,,180.00,,,,,,,30.50,264.00,per diem,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,The Alliance,Premier SAS,GO,180.00,,,,,,,20.20,264.00,per diem,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,The Alliance,Premier SAS,GO,180.00,,,,,,,30.60,264.00,per diem,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,The Alliance,Premier SAS,TC,439.72,,,,,,,298.87,3487.84,fee schedule,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,outpatient,,,2470.00000,2346.50000,The Alliance,Premier SAS,TC,1699.36,,,,,,,1235.00,2395.90,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,outpatient,1,mL,5.78000,5.49000,The Alliance,Premier SAS,,0.14409,,,,,,,0.14409,5.61,fee schedule,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,outpatient,,,214.12000,203.41000,The Alliance,Premier SAS,,147.31,,,,,,,107.06,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,outpatient,1,mL,428.24000,406.83000,The Alliance,Premier SAS,,294.63,,,,,,,214.12,415.39,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier SAS,,2.21,,,,,,,0.22000,2.29,fee schedule,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,outpatient,,,113.40000,107.73000,The Alliance,Premier SAS,90,92.41,,,,,,,13.33,679.08,fee schedule,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,outpatient,,,250.40000,237.88000,The Alliance,Premier SAS,90,140.92,,,,,,,22.91,1035.56,fee schedule,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,outpatient,1,mL,11.48000,10.91000,The Alliance,Premier SAS,,3.62,,,,,,,3.62,11.14,fee schedule,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,outpatient,1,EA,156.07000,148.27000,The Alliance,Premier SAS,,107.38,,,,,,,78.03,151.39,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,outpatient,,,123.97000,117.77000,The Alliance,Premier SAS,,85.29,,,,,,,23.25,120.25,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,outpatient,1,mL,3.27000,3.10000,The Alliance,Premier SAS,,2.25,,,,,,,1.64,3.17,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,The Alliance,Premier SAS,,409.66,,,,,,,409.66,892.50,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,outpatient,1,mL,2.63000,2.50000,The Alliance,Premier SAS,,0.01601,,,,,,,0.01000,2.55,fee schedule,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,The Alliance,Premier SAS,,0.22704,,,,,,,0.16500,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,outpatient,1,mL,0.60000,0.57000,The Alliance,Premier SAS,,0.41280,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,outpatient,1,mL,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Premier SAS,,39.32,,,,,,,3.02,55.44,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3198.75000,3038.81000,The Alliance,Premier SAS,,1468.23,,,,,,,1468.23,3198.75,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3168.75000,3010.31000,The Alliance,Premier SAS,,1454.46,,,,,,,1454.46,3168.75,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,506.93000,481.58000,The Alliance,Premier SAS,,232.68,,,,,,,232.68,491.72,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,179.60000,170.62000,The Alliance,Premier SAS,,82.44,,,,,,,82.44,174.21,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,382.50000,363.38000,The Alliance,Premier SAS,,175.57,,,,,,,175.57,382.50,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier SAS,,3277.95,,,,,,,3277.95,7141.50,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier SAS,,2731.62,,,,,,,2731.62,5951.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Premier SAS,,938.08,,,,,,,938.08,2043.75,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,outpatient,1,EA,10207.88000,9697.49000,The Alliance,Premier SAS,,602.74,,,,,,,376.48,9901.64,fee schedule,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,The Alliance,Premier SAS,,1.92,,,,,,,1.40,2.71,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,outpatient,1,EA,53.80000,51.11000,The Alliance,Premier SAS,,0.76848,,,,,,,0.76415,52.19,fee schedule,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,outpatient,1,EA,0.59000,0.56000,The Alliance,Premier SAS,,0.76848,,,,,,,0.29500,0.81340,fee schedule,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier SAS,,35.49,,,,,,,25.79,50.03,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Premier SAS,,44.29,,,,,,,32.19,62.44,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,outpatient,1,EA,61.33000,58.26000,The Alliance,Premier SAS,,42.20,,,,,,,30.66,59.49,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,outpatient,1,EA,1.69000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84500,1.64,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,outpatient,1,mL,1.29000,1.22000,The Alliance,Premier SAS,,0.88752,,,,,,,0.64500,1.25,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,The Alliance,Premier SAS,,0.08944,,,,,,,0.06500,0.12610,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,outpatient,1,mL,1.60000,1.52000,The Alliance,Premier SAS,,13.29,,,,,,,0.80000,18.34,fee schedule,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,outpatient,1,mL,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,outpatient,1,mL,0.65000,0.61000,The Alliance,Premier SAS,,0.44720,,,,,,,0.32500,0.63050,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,outpatient,1,mL,95.59000,90.81000,The Alliance,Premier SAS,,65.77,,,,,,,47.80,92.72,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,outpatient,1,EA,6.35000,6.03000,The Alliance,Premier SAS,,4.37,,,,,,,2.14,6.16,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,outpatient,1,mL,4.34000,4.12000,The Alliance,Premier SAS,,0.35222,,,,,,,0.33945,4.21,fee schedule,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,The Alliance,Premier SAS,,154.11,,,,,,,112.00,264.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,29.92000,28.42000,The Alliance,Premier SAS,,13.73,,,,,,,13.73,29.92,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,821.25000,780.19000,The Alliance,Premier SAS,,376.95,,,,,,,376.95,821.25,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,52.32000,49.70000,The Alliance,Premier SAS,,24.01,,,,,,,24.01,52.32,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,44.64000,42.41000,The Alliance,Premier SAS,,20.49,,,,,,,20.49,44.64,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,46.08000,43.78000,The Alliance,Premier SAS,,21.15,,,,,,,21.15,46.08,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,outpatient,,,308.50000,293.08000,The Alliance,Premier SAS,90,212.25,,,,,,,28.07,299.25,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,outpatient,1,GM,13.05000,12.40000,The Alliance,Premier SAS,,8.98,,,,,,,6.53,12.66,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,outpatient,1,mL,42.10000,40.00000,The Alliance,Premier SAS,,28.96,,,,,,,21.05,40.84,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,outpatient,1,mL,4.11000,3.90000,The Alliance,Premier SAS,,2.83,,,,,,,2.06,3.99,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,outpatient,1,mL,15.52000,14.74000,The Alliance,Premier SAS,,10.68,,,,,,,7.76,15.05,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,outpatient,1,mL,1.15000,1.09000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,1.12,fee schedule,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,outpatient,1,mL,3.59000,3.41000,The Alliance,Premier SAS,,0.09606,,,,,,,0.08525,3.48,fee schedule,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,24.68000,23.45000,The Alliance,Premier SAS,,16.98,,,,,,,12.34,23.94,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,The Alliance,Premier SAS,,1305.76,,,,,,,1305.76,2844.79,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,The Alliance,Premier SAS,,1617.04,,,,,,,1617.04,3522.97,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,The Alliance,Premier SAS,,4487.78,,,,,,,4487.78,9777.30,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.80050,,,,,,,0.01500,0.82500,fee schedule,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,The Alliance,Premier SAS,,31622.24,,,,,,,157.68,44583.68,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6486.00000,6161.70000,The Alliance,Premier SAS,,2977.07,,,,,,,2977.07,6486.00,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Premier SAS,,39.20,,,,,,,28.49,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,The Alliance,Premier SAS,,39.20,,,,,,,28.49,55.27,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,The Alliance,Premier SAS,,3048.33,,,,,,,3048.33,6641.25,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier SAS,,18511.22,,,,,,,18511.22,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier SAS,,20528.18,,,,,,,20528.18,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,The Alliance,Premier SAS,,20528.18,,,,,,,20528.18,43381.99,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier SAS,,19659.70,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,The Alliance,Premier SAS,TC,370.83,,,,,,,324.00,2941.42,fee schedule,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier SAS,,19659.70,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,33730.20000,32043.69000,The Alliance,Premier SAS,,15482.16,,,,,,,15482.16,33730.20,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier SAS,,4761.02,,,,,,,4761.02,10372.60,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier SAS,,12794.81,,,,,,,12794.81,27875.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,The Alliance,Premier SAS,,783.17,,,,,,,783.17,1706.25,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier SAS,,214.81,,,,,,,214.81,468.00,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier SAS,,12130.22,,,,,,,12130.22,26427.50,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,The Alliance,Premier SAS,,1018.98,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier SAS,,1593.85,,,,,,,1593.85,3472.43,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1875.00000,1781.25000,The Alliance,Premier SAS,,860.62,,,,,,,860.62,1875.00,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.75000,274.31000,The Alliance,Premier SAS,,132.54,,,,,,,132.54,288.75,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,The Alliance,Premier SAS,,59.06,,,,,,,59.06,128.68,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.86000,359.92000,The Alliance,Premier SAS,,173.90,,,,,,,173.90,378.86,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,The Alliance,Premier SAS,,4292.50,,,,,,,4292.50,9351.85,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1672.50000,1588.88000,The Alliance,Premier SAS,,767.68,,,,,,,767.68,1672.50,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,The Alliance,Premier SAS,,11566.80,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,28138.24000,26731.33000,The Alliance,Premier SAS,,12915.45,,,,,,,12915.45,28138.24,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,18698.80000,17763.86000,The Alliance,Premier SAS,,8582.75,,,,,,,8582.75,18698.80,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2981.25000,2832.19000,The Alliance,Premier SAS,,1368.39,,,,,,,1368.39,2981.25,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,5789.10000,5499.65000,The Alliance,Premier SAS,,2657.20,,,,,,,2657.20,5789.10,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,The Alliance,Premier SAS,,168.39,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,27830.25000,26438.74000,The Alliance,Premier SAS,,12774.08,,,,,,,12774.08,26995.34,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier SAS,,1927.18,,,,,,,1927.18,4198.65,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier SAS,,1927.18,,,,,,,1927.18,4198.65,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier SAS,,2692.03,,,,,,,2692.03,5865.00,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.00000,41.80000,The Alliance,Premier SAS,,20.20,,,,,,,20.20,44.00,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier SAS,,841.48,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3915.41000,3719.64000,The Alliance,Premier SAS,,1797.17,,,,,,,1797.17,3915.41,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,10260.30000,9747.28000,The Alliance,Premier SAS,,4709.48,,,,,,,4709.48,10260.30,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,30.04000,28.54000,The Alliance,Premier SAS,,13.79,,,,,,,13.79,30.04,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,The Alliance,Premier SAS,TC,2329.57,,,,,,,1693.00,3284.42,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,The Alliance,Premier SAS,,180.00,,,,,,,31.00,264.00,per diem,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,84.28000,80.07000,The Alliance,Premier SAS,,38.68,,,,,,,38.68,84.28,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,The Alliance,Premier SAS,,4565.37,,,,,,,4565.37,9946.35,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,The Alliance,Premier SAS,,8471.90,,,,,,,1667.31,67198.78,fee schedule,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,The Alliance,Premier SAS,,3483.81,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER BALNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,83347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI DIA2.83MM L100MM POLYETH FLP SELF EXP COT-HUIB,83348,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,337.50000,320.62000,The Alliance,Premier SAS,,154.91,,,,,,,154.91,337.50,percent of total billed charges,
IMPLANT BRST 580CC P6.4CM DIA13.5CM X FULL PROJCT SMTH SHELL,83350,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Premier SAS,,1733.99,,,,,,,1733.99,3777.75,percent of total billed charges,
XR ERCP PANC DUCT W IMAGING,83352,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,The Alliance,Premier SAS,TC,453.97,,,,,,,227.70,3600.87,fee schedule,
NM PLUVICTO PER 200MCI,83353,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,The Alliance,Premier SAS,,49042.02,,,,,,,35641.00,74614.73,percent of total billed charges,
C1 INJ PROC CHOLNG EXST ACC,83354,CDM,361,RC,47531,CPT,,,facility,outpatient,,,2612.00000,2481.40000,The Alliance,Premier SAS,,7569.00,,,,,,,1436.60,7803.00,case rate,
XR DRAINAGE CATH EXCHANGE W GUID,83355,CDM,320,RC,49423,CPT,,,facility,outpatient,,,3855.00000,3662.25000,The Alliance,Premier SAS,,2652.24,,,,,,,471.52,3739.35,percent of total billed charges,
CONTRAST ISOVUE 300 30ML,83356,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CONTRAST ISOVUE 300 30ML WASTE,83357,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,1.29,fee schedule,
XR CYSTOGRAPHIN PER ML,83358,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,0.29100,fee schedule,
US OB FETAL CARDIAC F/U,83359,CDM,402,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1885.68,fee schedule,
US MUSCLE/LIG INJECTION,83360,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,909.00,,,,,,,88.00,3163.00,case rate,
DIL BLLN HERCULES 3 STG WRE GD 8FR 15-16.5-18MM 45-49.5-54FR,83361,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,The Alliance,Premier SAS,,450.97,,,,,,,450.97,982.50,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,CPT,,,facility,outpatient,,,194.68000,184.95000,The Alliance,Premier SAS,,133.94,,,,,,,97.34,188.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERT,ACEL-POLIO-HAEM-HEPB VACCINE SUSP (VAXELIS)",83362,CDM,250,RC,90697,HCPCS,63361024315,NDC,facility,outpatient,1,mL,389.35000,369.88000,The Alliance,Premier SAS,,267.87,,,,,,,194.68,377.67,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 5MM X,83363,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X12MM,83364,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
BUTTON GSTRM 18FR SIL RADOPQ LOPRFL PROX ANRFLX,83367,CDM,274,RC,B9998,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,165.55,349.86,percent of total billed charges,
"CATH ON-Q SILVERSOAKER 7.5""",83368,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,473.44000,449.77000,The Alliance,Premier SAS,,217.31,,,,,,,217.31,473.44,percent of total billed charges,
LENS IO +24.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83369,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS IO +18.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83370,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,541.99,fee schedule,
LENS IO +17.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83372,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,65250000301,NDC,facility,outpatient,1,EA,1677.88000,1593.99000,The Alliance,Premier SAS,,29.15,,,,,,,18.21,1627.54,fee schedule,
TRIAMCINOLONE ACETONIDE POWD-INJ 32 MG INTRA-ARTICULAR (ZILRETTA),83373,CDM,636,RC,J3304,HCPCS,70801000301,NDC,facility,outpatient,1,EA,1476.30000,1402.48000,The Alliance,Premier SAS,,29.15,,,,,,,18.21,1432.01,fee schedule,
LEAD PACE L53CM ATRIUM SIL POLYUR INSUL STEROID ELUT IS-1,83375,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
DEVICE CLSR 6/7FR BIOABSRB FULL INTEGR RAP HEMS,83377,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
SHTH GUID 5FR L90CM ID1.9MM 0.018/0.038IN MP,83378,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,The Alliance,Premier SAS,,200.49,,,,,,,200.49,436.80,percent of total billed charges,
CATH EHL PROBE 3.6FR X 65CM,83379,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11492.32000,10917.70000,The Alliance,Premier SAS,,5274.97,,,,,,,5274.97,11492.32,percent of total billed charges,
SHEATH GUIDE INTRO 6FR L45CM DIA0.087IN DIL,83380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 6 ML INTRA-ARTICULAR (SYNVISC-ONE),83381,CDM,636,RC,J7325,HCPCS,58468009003,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Premier SAS,,14.55,,,,,,,9.09,573.48,fee schedule,
STENT COR L16MM DIA2.8MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,83382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,The Alliance,Premier SAS,,3792.60,,,,,,,3792.60,8262.75,percent of total billed charges,
LENS IO +16.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83384,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CATHETER ANGIO AD 6FR L100CM 0.038IN JL4.5.,83385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,34.00000,32.30000,The Alliance,Premier SAS,,15.61,,,,,,,15.61,34.00,percent of total billed charges,
COPPER INTRAUTERINE DEVICE (PARAGARD),83386,CDM,250,RC,J7300,HCPCS,59365512801,NDC,facility,outpatient,1,EA,2061.77000,1958.68000,The Alliance,Premier SAS,,1418.50,,,,,,,1030.88,1999.92,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,CPT,,,facility,outpatient,,,184.10000,174.89000,The Alliance,Premier SAS,,126.66,,,,,,,92.05,205.31,percent of total billed charges,
"TYPHOID VACCINE, INACTIVATED SOLN (TYPHIM VI)",83387,CDM,250,RC,90691,HCPCS,49281079051,NDC,facility,outpatient,1,mL,368.20000,349.79000,The Alliance,Premier SAS,,253.32,,,,,,,184.10,357.15,percent of total billed charges,
HYLAN G-F 20 SOLN 8 MG/ML 2 ML INTRA-ARTICULAR (SYNVISC),83388,CDM,636,RC,J7325,HCPCS,58468009001,NDC,facility,outpatient,1,mL,591.22000,561.66000,The Alliance,Premier SAS,,14.55,,,,,,,9.09,573.48,fee schedule,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 30 MG,83389,CDM,636,RC,J9177,HCPCS,51144003001,NDC,facility,outpatient,1,EA,8551.17000,8123.61000,The Alliance,Premier SAS,,58.69,,,,,,,36.66,8294.63,fee schedule,
TECH TRT AID COMPLEX-TECH,8339,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,The Alliance,Premier SAS,TC,464.66,,,,,,,354.42,3685.66,fee schedule,
LEVONORGESTREL INTRAUTERINE DEVICE 19.5 MG (KYLEENA),83390,CDM,250,RC,J7296,HCPCS,50419042401,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,The Alliance,Premier SAS,,1780.64,,,,,,,1294.07,2510.50,percent of total billed charges,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,00703713103,NDC,facility,outpatient,1,mL,138.09000,131.19000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,133.95,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,10147092205,NDC,facility,outpatient,1,mL,155.95000,148.15000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,151.27,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,25021083301,NDC,facility,outpatient,1,mL,126.40000,120.08000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,122.61,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,63323047101,NDC,facility,outpatient,1,mL,162.68000,154.54000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,157.80,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,67457040913,NDC,facility,outpatient,1,mL,139.04000,132.09000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,134.87,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70710146301,NDC,facility,outpatient,1,mL,132.72000,126.08000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,128.74,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,70756061681,NDC,facility,outpatient,1,mL,85.32000,81.05000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,82.76,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,71288050302,NDC,facility,outpatient,1,mL,94.80000,90.06000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,91.96,fee schedule,
HALOPERIDOL DECANOATE SOLN 100 MG/ML,83391,CDM,250,RC,J1631,HCPCS,72603023001,NDC,facility,outpatient,1,mL,123.46000,117.29000,The Alliance,Premier SAS,,7.49,,,,,,,7.15,119.76,fee schedule,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,CPT,,,facility,outpatient,,,317.36000,301.49000,The Alliance,Premier SAS,,284.27,,,,,,,158.68,307.84,fee schedule,
HEPATITIS B ADULT VACCINE SOLN 20 MCG/0.5 ML (HEPLISAV-B),83392,CDM,250,RC,90739,HCPCS,43528000305,NDC,facility,outpatient,1,mL,634.72000,602.98000,The Alliance,Premier SAS,,284.27,,,,,,,275.21,615.68,fee schedule,
ESTRADIOL CYPIONATE SOLN 5 MG/ML 5 ML (DEPO-ESTRADIOL),83393,CDM,250,RC,J1000,HCPCS,00009027101,NDC,facility,outpatient,1,mL,117.25000,111.39000,The Alliance,Premier SAS,,75.10,,,,,,,58.62,113.73,fee schedule,
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM POWD-INJ 0.9 MG (XIAFLEX),83400,CDM,636,RC,J0775,HCPCS,66887000301,NDC,facility,outpatient,1,EA,12040.81000,11438.77000,The Alliance,Premier SAS,,117.13,,,,,,,73.16,11679.59,fee schedule,
DARBEPOETIN ALFA SOLN 200 MCG/ML,83401,CDM,636,RC,J0882,HCPCS,55513000601,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,The Alliance,Premier SAS,,4.80,,,,,,,3.00,3453.59,fee schedule,
SIZER IMPL 11.25CM NATRELLE INSPIRA P4.5CM FULL,83402,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
RECHARGER NRSTM STRL LF DISP PRGM RTM PAPR LIT,83405,CDM,274,RC,L8689,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Premier SAS,,2323.94,,,,,,,1768.12,3430.16,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00009041702,NDC,facility,outpatient,1,mL,38.54000,36.61000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,37.38,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00143972601,NDC,facility,outpatient,1,mL,24.96000,23.72000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,24.21,fee schedule,
TESTOSTERONE CYPIONATE 200 MG/ML SOLN,83407,CDM,250,RC,J1071,HCPCS,00574082010,NDC,facility,outpatient,1,mL,25.63000,24.35000,The Alliance,Premier SAS,,0.04803,,,,,,,0.04650,24.86,fee schedule,
SODIUM HYALURONATE SOLN 8.4 MG/ML 2 ML INTRA-ARTICULAR (GELSYN-3),83408,CDM,250,RC,J7328,HCPCS,89130311101,NDC,facility,outpatient,1,mL,485.62000,461.34000,The Alliance,Premier SAS,,1.04,,,,,,,0.91760,471.05,fee schedule,
ARIPIPRAZOLE LAUROXIL SUSP INJ 662 MG/2.4 ML (ARISTADA),83409,CDM,636,RC,J1944,HCPCS,65757040203,NDC,facility,outpatient,1,mL,2502.32000,2377.20000,The Alliance,Premier SAS,,5.33,,,,,,,3.33,2427.25,fee schedule,
MICROCATHETER GUID 2.9FR SHFT 2.1FR CROSSING,83411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,The Alliance,Premier SAS,,938.08,,,,,,,938.08,2043.75,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN COIL L8.5CM,83412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F COUDE TIEM 2 W,83413,CDM,274,RC,A4340,HCPCS,,,facility,outpatient,,,19.40000,18.43000,The Alliance,Premier SAS,,49.51,,,,,,,9.70,51.01,fee schedule,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 5 ML,83414,CDM,636,RC,J1010,HCPCS,00009030602,NDC,facility,outpatient,1,mL,62.37000,59.25000,The Alliance,Premier SAS,,0.19212,,,,,,,0.12000,60.50,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,00338006701,NDC,facility,outpatient,1,mL,212.86000,202.21000,The Alliance,Premier SAS,,174.96,,,,,,,106.43,249.68,fee schedule,
DOXORUBICIN LIPOSOMAL 2 MG/ML 25 ML,83415,CDM,636,RC,Q2050,HCPCS,43598068325,NDC,facility,outpatient,1,mL,244.90000,232.66000,The Alliance,Premier SAS,,174.96,,,,,,,109.28,249.68,fee schedule,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 40 GM,83416,CDM,636,RC,J1459,HCPCS,44206043940,NDC,facility,outpatient,1,mL,30.54000,29.02000,The Alliance,Premier SAS,,80.74,,,,,,,15.27,83.21,fee schedule,
"ROTAVIRUS VACCINE, MONOVALENT SUSP (ROTARIX)",83417,CDM,250,RC,90681,HCPCS,58160085452,NDC,facility,outpatient,1,mL,256.88000,244.04000,The Alliance,Premier SAS,,176.73,,,,,,,128.44,249.17,percent of total billed charges,
STENT SURPASS EVOLVE 4.0MM X 17MM,83418,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,CPT,,,facility,outpatient,,,700.93000,665.88000,The Alliance,Premier SAS,,482.24,,,,,,,331.10,679.90,percent of total billed charges,
"JAPANESE ENCEPHALITIS VACCINE SA14-14-2, INACTIVATED SUSP (IXIARO)",83419,CDM,250,RC,90738,HCPCS,42515000201,NDC,facility,outpatient,1,mL,1401.86000,1331.77000,The Alliance,Premier SAS,,964.48,,,,,,,331.10,1359.80,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH L75CM SHTH 9FR,83420,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier SAS,,5983.29,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L75CM SHTH 9FR,83421,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier SAS,,5983.29,,,,,,,5983.29,13035.50,percent of total billed charges,
STENT BILI L80MM DIA8MM CATH L75CM SHTH 9FR,83422,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13035.50000,12383.72000,The Alliance,Premier SAS,,5983.29,,,,,,,5983.29,13035.50,percent of total billed charges,
GORE EXCLUDER CONFORMABLE AAA GRAFT,83423,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier SAS,,12794.81,,,,,,,12794.81,27875.40,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 11 ML (ULTOMIRIS),83424,CDM,636,RC,J1303,HCPCS,25682002801,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,The Alliance,Premier SAS,,360.53,,,,,,,225.19,4762.44,fee schedule,
LEVONORGESTREL INTRAUTERINE DEVICE 13.5 MG (SKYLA),83425,CDM,250,RC,J7301,HCPCS,50419042201,NDC,facility,outpatient,1,EA,2155.06000,2047.31000,The Alliance,Premier SAS,,1482.68,,,,,,,1077.53,2090.41,percent of total billed charges,
CRANBERRY - TAB 450MG,83427,CDM,250,RC,57896-0845-01,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 1,83428,CDM,232,RC,,,,,facility,outpatient,,,87.00000,82.65000,The Alliance,Premier SAS,,59.86,,,,,,,43.50,84.39,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 8 MG-2 MG,83429,CDM,250,RC,J0574,HCPCS,62175045832,NDC,facility,outpatient,1,EA,2.95000,2.80000,The Alliance,Premier SAS,,2.03,,,,,,,1.48,2.86,percent of total billed charges,
OB CHARGE - POSTPARTUM LEVEL 2,83430,CDM,232,RC,,,,,facility,outpatient,,,116.00000,110.20000,The Alliance,Premier SAS,,79.81,,,,,,,58.00,112.52,percent of total billed charges,
SET STNT 4.7FR USABLE L12-18CM GWIRE L145CM DIA0.038IN IORT,83433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.34000,356.57000,The Alliance,Premier SAS,,172.28,,,,,,,172.28,375.34,percent of total billed charges,
CATHETER GUID IMPRESS CS 5FR 75CM,83434,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.00000,444.60000,The Alliance,Premier SAS,,214.81,,,,,,,214.81,468.00,percent of total billed charges,
CATHETER GUID XB 4.5 7FR 100CM,83435,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX3CM,83436,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET 360 NANO 2MMX4CM,83437,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL TARGET XL 360 SFT 2MMX3CM,83438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,The Alliance,Premier SAS,,4762.59,,,,,,,4762.59,10376.01,percent of total billed charges,
XR NEPHROSTOMY CATH REPLC W GUID,83443,CDM,320,RC,50435,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,1696.61,,,,,,,674.25,2392.02,percent of total billed charges,
INTRODUCER SHEATH 10FR L80CM ID3.4MM COMPATIBLE,83444,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Premier SAS,,148.51,,,,,,,148.51,323.55,percent of total billed charges,
SET URET STNT 6FR L28CM CATH 6FR L71.5CM CLR SHTH 8.3FR,83447,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,The Alliance,Premier SAS,,1740.51,,,,,,,1740.51,3791.96,percent of total billed charges,
CATHETER GD EBU4 CRV 7FR 100CM NYL LNCHR LG LUM,83448,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.5 6FR,83450,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
NEPHROSTOMY BALLOON 30FR,83452,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1745.03000,1657.78000,The Alliance,Premier SAS,,800.97,,,,,,,800.97,1745.03,percent of total billed charges,
LENS IO +17.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83454,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
MANTA VASCULAR CLSR DEV 8FR DEPTH LOC,83455,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier SAS,,86.06,,,,,,,86.06,187.50,percent of total billed charges,
KIT HAD 14.5FR L39CM TIP L35CM SYMMETRIC,83456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HD CATH 14.5FR L23CM INSRT L28CM STD PLYR W/ LT STR,83457,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L47CM SYMMTRC STR PRELD,83458,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 50CM,83460,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA12MM IL EXT W/ C3 DEL SYS FOR AAA,83461,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,The Alliance,Premier SAS,,4761.02,,,,,,,4761.02,10372.60,percent of total billed charges,
CATHETER INTVENT 2.9FR L135CM TIP 2.1FR,83462,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3041.25000,2889.19000,The Alliance,Premier SAS,,1395.93,,,,,,,1395.93,3041.25,percent of total billed charges,
INTRO SHTH 7FR L70CM ID2.5MM 0.035IN HYDRPHLC,83463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,The Alliance,Premier SAS,,127.72,,,,,,,127.72,278.25,percent of total billed charges,
SHEATH INTRI24 24FR 33CM,83464,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9300.00000,8835.00000,The Alliance,Premier SAS,,4268.70,,,,,,,4268.70,9300.00,percent of total billed charges,
TUBE GJ 14FR JEJU L45CM STOMA L2CM SIL LP G GRN J POT APPLE,83465,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,47.62,2280.00,percent of total billed charges,
GRAFT EVAR L9.5CM DIA20MM CONTRALATERAL LEG FOR AAA EXCLUDER,83466,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT EVAR L10CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,83467,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,83468,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L10CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,83469,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,The Alliance,Premier SAS,,6973.63,,,,,,,6973.63,15193.10,percent of total billed charges,
US OB NT EACH ADDITIONAL,8347,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier SAS,TC,532.00,,,,,,,144.10,548.00,fee schedule,
CATHETER GUID AD 7FR L100CM COR PERIPH ORNG,83470,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
"ALLERGEN, FEATHER PANEL 2 (FETH2)",83676,CDM,300,RC,86003,CPT,,,facility,outpatient,,,76.60000,72.77000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
BUPIVACAINE 0.25% SOLN,83678,CDM,250,RC,59923-0717-05,NDC,,,facility,outpatient,1,mL,2.80000,2.66000,The Alliance,Premier SAS,,1.93,,,,,,,1.40,2.72,percent of total billed charges,
STENT FRONTIER ONX 2.0X8MM,83681,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONYX 2.25X8MM,83682,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X8MM,83683,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.75X8MM,83684,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.0X8MM,83685,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X8MM,83686,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X8MM,83687,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.0X12MM,83688,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X12MM,83689,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X12MM,83690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X12MM,83691,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X12MM,83692,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X12MM,83693,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X12MM,83694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X12MM,83695,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X12MM,83696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X15MM,83697,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X15MM,83698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 2.5X15MM,83699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X15MM,83700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X15MM,83701,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X15MM,83702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X15MM,83703,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X15MM,83704,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X15MM,83705,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X18MM,83706,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X18MM,83707,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X18MM,83708,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X18MM,83709,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X18MM,83710,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X18MM,83711,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X18MM,83712,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X18MM,83713,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X18MM,83714,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X22MM,83715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X22MM,83716,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X22MM,83717,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X22MM,83718,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X22MM,83719,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X22MM,83720,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 4.0X22MM,83721,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X22MM,83722,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 5.0X22MM,83723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X26MM,83724,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X26MM,83725,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X26MM,83726,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X26MM,83728,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X26MM,83729,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X26MM,83730,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X26MM,83731,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X26MM,83732,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X26MM,83733,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.0X30MM,83734,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,The Alliance,Premier SAS,,774.56,,,,,,,774.56,1687.50,percent of total billed charges,
STENT FRONTIER ONX 2.25X30MM,83735,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X30MM,83736,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X30MM,83737,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X30MM,83738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X30MM,83739,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X30MM,83740,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.5X30MM,83741,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 5.0X30MM,83742,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X34MM,83743,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X34MM,83744,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X34MM,83745,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X34MM,83746,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.5X34MM,83747,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X34MM,83748,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.25X38MM,83749,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.5X38MM,83750,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 2.75X38MM,83751,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 3.0X38MM,83752,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONYX 3.5X38MM,83753,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT FRONTIER ONX 4.0X38MM,83754,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN,83760,CDM,250,RC,J9267,HCPCS,00703321701,NDC,facility,outpatient,1,mL,8.34000,7.93000,The Alliance,Premier SAS,,0.17611,,,,,,,0.17611,8.09,fee schedule,
KIT EXTENSION PERC FOR INTERSTIM,83761,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
PLUG CONN EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83762,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
COIL EMB L1CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,83766,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 10",83767,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
ENVELOPE PLSE GENRTR M 2.7X2.5IN NEURO ANTIBCT ABSRB TYRX.,83768,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,The Alliance,Premier SAS,,2050.70,,,,,,,2050.70,4467.75,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,83770,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 3.75MM COR CROSSFLEX2 TNG TREK,83771,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,68382-0370-03,NDC,,,facility,outpatient,1,GM,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G POWD,83778,CDM,250,RC,69315-0306-60,NDC,,,facility,outpatient,1,GM,3.65000,3.47000,The Alliance,Premier SAS,,2.51,,,,,,,1.82,3.54,percent of total billed charges,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009601,NDC,facility,outpatient,1,EA,5037.00000,4785.15000,The Alliance,Premier SAS,,55.20,,,,,,,34.48,4885.89,fee schedule,
FARICIMA-SVOA SOLN 6 MG/0.05 ML (VABYSMO),83779,CDM,636,RC,J2777,HCPCS,50242009606,NDC,facility,outpatient,1,EA,84884.40000,80640.18000,The Alliance,Premier SAS,,55.20,,,,,,,34.48,82337.87,fee schedule,
WALL MOTION STUDY W/GATE,8378,CDM,340,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,The Alliance,Premier SAS,TC,1444.80,,,,,,,980.94,2210.07,percent of total billed charges,
"HIV 1,2 SCREENING",83782,CDM,300,RC,G0432,HCPCS,,,facility,outpatient,,,194.00000,184.30000,The Alliance,Premier SAS,,133.47,,,,,,,19.57,188.18,percent of total billed charges,
"IRON, LIVER TISSUE (FET) SO",83787,CDM,300,RC,83540,CPT,,,facility,outpatient,,,122.40000,116.28000,The Alliance,Premier SAS,90,46.20,,,,,,,6.69,339.51,fee schedule,
"METHAMPHET MONITOR, U (39413) SO",83788,CDM,300,RC,80374,CPT,,,facility,outpatient,,,186.10000,176.79000,The Alliance,Premier SAS,90,154.78,,,,,,,93.05,1137.41,fee schedule,
"BARBITURATES CONFIRMATION, URINE (BARBU) SO",83789,CDM,300,RC,80345,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier SAS,90,154.78,,,,,,,37.85,1137.41,fee schedule,
MOXIFLOXACIN/NEPAFENAC/PREDNISOLONE OPHTHALMIC 0.5%-0.1%-1% SUSP,83791,CDM,250,RC,J3490,HCPCS,71384032005,NDC,facility,outpatient,1,mL,26.42000,25.10000,The Alliance,Premier SAS,,18.18,,,,,,,13.21,25.63,percent of total billed charges,
VERAPAMIL 120 MG/24 HOURS CAP-,83792,CDM,250,RC,J8499,HCPCS,00591288001,NDC,facility,outpatient,1,EA,4.60000,4.37000,The Alliance,Premier SAS,,3.16,,,,,,,2.30,4.46,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 525 MG/15 ML 240 ML,83793,CDM,250,RC,J8499,HCPCS,00536128736,NDC,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
HYPOCHLORUS ACID 0.033 % SOLN-IRR,83794,CDM,250,RC,85138-3003-13,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE 1 ML UD LIQUID,83795,CDM,250,RC,49348-0740-27-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,The Alliance,Premier SAS,,0.22016,,,,,,,0.16000,0.31040,percent of total billed charges,
EMPAGLIFLOZIN TAB 25 MG,83797,CDM,250,RC,00597-0153-37,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,The Alliance,Premier SAS,,44.29,,,,,,,32.19,62.44,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,CPT,,,facility,outpatient,,,457.32000,434.45000,The Alliance,Premier SAS,,314.64,,,,,,,228.66,443.60,percent of total billed charges,
CHOLERA VACCINE SUSP (VAXCHORA),83802,CDM,250,RC,90625,HCPCS,70460000401,NDC,facility,outpatient,1,mL,4.57000,4.34000,The Alliance,Premier SAS,,3.14,,,,,,,2.29,4.43,percent of total billed charges,
STENT PERIPH L80MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND,83804,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X12MM,83805,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
PET/CT SKULL-THIGH SUBS ENC,83806,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,The Alliance,Premier SAS,TC,6990.00,,,,,,,4549.00,14004.86,per diem,
PET/CT WHOLE BODY SUBS ENC,83807,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,The Alliance,Premier SAS,PS,6990.00,,,,,,,4549.00,14018.44,per diem,
BLLN RX NC TREK NEO 2.5X15MM,83808,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X12MM,83809,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X12MM,83810,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X12MM,83811,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X15MM,83812,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X8MM,83813,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
VALVE HEART EVOLUT FX 29MM,83814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
VALVE HEART EVOLUT FX 34MM,83815,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 23/29MM,83816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Premier SAS,,3341.29,,,,,,,3341.29,7279.50,percent of total billed charges,
SYSTEM CATH DEL W/ INLINE SHTH FOR 34MM VLV,83817,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7279.50000,6915.52000,The Alliance,Premier SAS,,3341.29,,,,,,,3341.29,7279.50,percent of total billed charges,
SYS LOAD EVOLUT FX 23-29MM,83818,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier SAS,,671.29,,,,,,,671.29,1462.50,percent of total billed charges,
CATHETER GD AL.75 CRV 7FR 100CM COR SS NYL PTFE,83819,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X8MM,83822,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X12MM,83823,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE 10.2FR L60CM GWIRE 0.038IN,83824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,530.63000,504.10000,The Alliance,Premier SAS,,243.56,,,,,,,243.56,530.63,percent of total billed charges,
IFOSFAMIDE POWD-INJ 3 GM,83831,CDM,250,RC,J9208,HCPCS,10019092602,NDC,facility,outpatient,1,EA,278.53000,264.60000,The Alliance,Premier SAS,,37.62,,,,,,,37.62,270.17,fee schedule,
CONTRAST RAD INJ BTL 61%,83844,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,50.04000,47.54000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,48.54,fee schedule,
"FOREARM, TURNBUCKL",83845,CDM,274,RC,L3931,HCPCS,,,facility,outpatient,,,828.75000,787.31000,The Alliance,Premier SAS,,255.15,,,,,,,245.60,803.89,fee schedule,
GEMTUZUMAB OZOGAMICIN POWD-INJ 4.5 MG,83846,CDM,636,RC,J9203,HCPCS,00008451001,NDC,facility,outpatient,1,EA,18525.59000,17599.31000,The Alliance,Premier SAS,,378.83,,,,,,,236.62,17969.82,fee schedule,
OCCLUDER CV L10MM DIA16X26MM SHTH 9FR 45 OR 180DEG CRV PI.,83847,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,The Alliance,Premier SAS,,9305.77,,,,,,,9305.77,20274.00,percent of total billed charges,
MOGAMULIZUMAB-KPKC SOLN 4 MG/ML 5 ML (POTELIGEO),83848,CDM,636,RC,J9204,HCPCS,42747076101,NDC,facility,outpatient,1,mL,2334.42000,2217.70000,The Alliance,Premier SAS,,397.85,,,,,,,248.50,2264.39,fee schedule,
CATHETER DIAG 5FR L130CM DIA0.04IN,83849,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
VLV HRT EVOLUT FX 26MM,83853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH7.79CM D0.99CM 2,83854,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,32130.00000,30523.50000,The Alliance,Premier SAS,,14747.67,,,,,,,14747.67,32130.00,percent of total billed charges,
DEFIBRILLATOR CARD 82GM W51XH71IN D13MM DF1 BLUESYNC,83855,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,The Alliance,Premier SAS,,18511.22,,,,,,,18511.22,40329.45,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X15MM,83856,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CLAREON MONOFOCAL  19.5,83863,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  16.0,83864,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  22.0,83865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  22.5,83866,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  21.0 SY60WF.210,83867,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
SYS LOAD EVOLUT FX 34MM,83869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,The Alliance,Premier SAS,,671.29,,,,,,,671.29,1462.50,percent of total billed charges,
CLAREON MONOFOCAL  15.0,83871,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  13.5 LENS SY60WF.135,83872,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
TESTOSTERONE IMPLANT 50 MG (COMPOUNDED),83874,CDM,250,RC,J7999,HCPCS,51552159405,NDC,facility,outpatient,1,EA,48.98000,46.53000,The Alliance,Premier SAS,,33.70,,,,,,,24.49,47.51,percent of total billed charges,
TESTOSTERONE 80 MG IMPLANT,83875,CDM,250,RC,J7999,HCPCS,63275989809,NDC,facility,outpatient,1,EA,74.26000,70.55000,The Alliance,Premier SAS,,51.09,,,,,,,37.13,72.03,percent of total billed charges,
ESTRADIOL IMPLANT 12.5 MG (COMPOUNDED),83876,CDM,250,RC,J7999,HCPCS,51552158705,NDC,facility,outpatient,1,EA,36.34000,34.52000,The Alliance,Premier SAS,,25.00,,,,,,,18.17,35.25,percent of total billed charges,
CLAREON MONOFOCAL  10.5,83877,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  11.0,83878,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  11.5,83879,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  12.0,83880,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  12.5,83881,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,CPT,,,facility,outpatient,,,518.56000,492.63000,The Alliance,Premier SAS,,356.77,,,,,,,0.01000,503.00,percent of total billed charges,
SMALLPOX-MONKEYPOX VACCINE SUSP (JYNNEOS),83882,CDM,250,RC,90611,HCPCS,50632000102,NDC,facility,outpatient,1,mL,1037.12000,985.26000,The Alliance,Premier SAS,,713.54,,,,,,,0.01000,1006.01,percent of total billed charges,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641604710,NDC,facility,outpatient,1,mL,4.57000,4.35000,The Alliance,Premier SAS,,2.11,,,,,,,2.11,4.43,fee schedule,
LORAZEPAM 4 MG/ML SOLN,83883,CDM,250,RC,J2060,HCPCS,00641605110,NDC,facility,outpatient,1,mL,2.91000,2.77000,The Alliance,Premier SAS,,2.11,,,,,,,1.46,2.82,fee schedule,
TISOTUMAB VEDOTIN-TFTV POWD-INJ 40 MG (TIVDAK),83884,CDM,636,RC,J9273,HCPCS,51144000301,NDC,facility,outpatient,1,EA,12538.10000,11911.19000,The Alliance,Premier SAS,,302.03,,,,,,,188.65,12161.96,fee schedule,
CLAREON MONOFOCAL  14.0,83887,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  14.5,83888,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  15.5,83890,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  17.0 LENS  SY60WF.170,83892,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  17.5,83893,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  18.0,83894,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
LENS SY60WF.185  CLAREON MONOFOCAL  18.5,83895,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  19.0,83896,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  20.0  SY60WF.200,83897,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  20.5,83898,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  21.5,83899,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  23.5,83901,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  24.0 LENS SY60WF.240,83902,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  24.5,83903,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
CLAREON MONOFOCAL  25.0,83904,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF1,83905,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,The Alliance,Premier SAS,,13894.62,,,,,,,13894.62,30271.50,percent of total billed charges,
GRAFT EVAR L10CM DIA37X37MM INTENDED AORT DIA29-34MM,83912,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier SAS,,19659.70,,,,,,,19659.70,42831.60,percent of total billed charges,
INCLISIRAN SOLN 284 MG/1.5 ML (LEQVIO),83916,CDM,636,RC,J1306,HCPCS,00078100060,NDC,facility,outpatient,1,mL,5172.56000,4913.93000,The Alliance,Premier SAS,,19.77,,,,,,,12.35,5017.38,fee schedule,
CLAREON MONOFOCAL  26.0,83917,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
SPACER SPNL W18XH6XL60MM 10DEG POR TI LUM IF,83919,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
STENT ES L10CM DIA20MM DEL SYS 10.5FR L180CM PRTLY CVR TTS,83927,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9632.40000,9150.78000,The Alliance,Premier SAS,,4421.27,,,,,,,4421.27,9632.40,percent of total billed charges,
STENT SURPASS EVOLVE L20MM DIA4MM.,83931,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
KIT LD TST CBL EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83933,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,220.32,,,,,,,220.32,480.00,percent of total billed charges,
KIT BUR H DEV EMAN LJ53 FOR DP BRAIN STIM SENSIGHT,83934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.0X60MM,83942,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN TAPR L7CM,83945,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier SAS,,105.00,,,,,,,105.00,228.75,percent of total billed charges,
CATHETER WTCHMAN DLVR SYS SGL FXD,83948,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X15MM,83953,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X18MM,83954,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI,83955,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,The Alliance,Premier SAS,,11173.92,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM FLO DIVERTER 5X17MM PMA SURPS EVOLVE,83956,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
CATH DRNGE MULTI 18FR 25CM,83970,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,363.23000,345.07000,The Alliance,Premier SAS,,166.72,,,,,,,166.72,363.23,percent of total billed charges,
COIL EMB L3CM DIA1MM 360DEG ULT DETACH LSR,83971,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT NEPHSTMY L22CM CATH 10.2FR 0.038IN,83972,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,370.05000,351.55000,The Alliance,Premier SAS,,169.85,,,,,,,169.85,370.05,percent of total billed charges,
STENT ABRE 14MMX60MMX90CM,83973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT PERIPH L79MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,83975,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X28MM,83976,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER INTVN 8FR .088IN .071IN 150CM,83977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
MICROCATHETER NEUROVASC 1.5X3X22MM ST LTX,83981,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,13330.00000,12663.50000,The Alliance,Premier SAS,,6118.47,,,,,,,6118.47,13330.00,percent of total billed charges,
COIL EMB L19CM LOOP DIA10MM 0.029IN DETACH CRSS SECT OCCL 35,83982,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,The Alliance,Premier SAS,,1927.18,,,,,,,1927.18,4198.65,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X33MM,83983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
PALIPERIDONE SUSP 819 MG/2.625 ML (INVEGA TRINZA),83984,CDM,636,RC,J2427,HCPCS,50458060901,NDC,facility,outpatient,1,mL,8213.96000,7803.27000,The Alliance,Premier SAS,,20.75,,,,,,,12.96,7967.54,fee schedule,
GNRTR ICD COBALT XT DR DUAL D1,83985,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,The Alliance,Premier SAS,,15821.45,,,,,,,15821.45,34469.40,percent of total billed charges,
CATH URETH 24FR 30CC BLLN HEMA F 2 W LNG OPN,83986,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,74.80000,71.06000,The Alliance,Premier SAS,,34.33,,,,,,,34.33,74.80,percent of total billed charges,
CATHETER DIAG 6FR L125CM DST L9CM SIM CRV SS,83987,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
COIL EMB L30CM DIA12MM 360DEG STD DETACH TARGET,83988,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
SIZER TRIAL SUT PASS PIN SPEEDSPIRAL CMC,83989,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,The Alliance,Premier SAS,,939.12,,,,,,,682.50,1324.05,percent of total billed charges,
TENECTEPLASE 50 MG POWDER-INJ - STROKE,83993,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,The Alliance,Premier SAS,,275.28,,,,,,,171.94,15291.85,fee schedule,
CALASPARGASE PEGOL-MKNL SOLN 750 UNITS/ML 5 ML,83996,CDM,250,RC,J9118,HCPCS,72694051501,NDC,facility,outpatient,1,mL,9512.59000,9036.96000,The Alliance,Premier SAS,,131.14,,,,,,,118.62,9227.21,fee schedule,
GADOBUTROL 604.72 MG/ML SOLN 2 ML,83997,CDM,250,RC,A9585,HCPCS,50419032537,NDC,facility,outpatient,1,mL,26.23000,24.92000,The Alliance,Premier SAS,,0.41626,,,,,,,0.40920,25.44,fee schedule,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 200 MCG-62.5 MCG-25 MCG/INH POWD,84002,CDM,250,RC,00173-0893-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,The Alliance,Premier SAS,,23.80,,,,,,,17.30,33.55,percent of total billed charges,
GRAFT EVAR L82MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84003,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 6.0X80MM,84004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER ASPIR L115CM ID1.8MM DST OD2.09MM,84005,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,8414.55000,7993.82000,The Alliance,Premier SAS,,3862.28,,,,,,,3862.28,8414.55,percent of total billed charges,
GRAFT EVAR L15CM DIA31X31MM INTENDED AORT DIA24-29MM,84006,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier SAS,,19659.70,,,,,,,19659.70,42831.60,percent of total billed charges,
CATHETER EP QUADRAPOLAR D CRV 6FR L92CM 1MM,84007,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,450.00000,427.50000,The Alliance,Premier SAS,,206.55,,,,,,,206.55,450.00,percent of total billed charges,
CHOLECALCIFEROL 125 MCG TAB,84011,CDM,250,RC,50268-0866-15,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,The Alliance,Premier SAS,,0.59168,,,,,,,0.43000,0.83420,percent of total billed charges,
GRAFT BONE SUB L13MM DIA13MM SPEEDSPIRAL CMC,84012,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
OCCLUDER CV 27MM CATH 10FR L80CM CARDIOFORM ASD,84013,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier SAS,,12130.22,,,,,,,12130.22,26427.50,percent of total billed charges,
KIT GYN IMPL SYN SLNG TRNSVAG MIDURETHRAL BLU,84014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,3489.78000,3315.29000,The Alliance,Premier SAS,,1601.81,,,,,,,1601.81,3489.78,percent of total billed charges,
GRAFT EVAR L10CM DIA28X28MM INTENDED AORT DIA22-26MM,84015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,The Alliance,Premier SAS,,19659.70,,,,,,,19659.70,42831.60,percent of total billed charges,
SURFACE ARTC SZ 00/0 H13MM STD L PROLONG PRI NEUT CONG NTRL,84016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
LENS IO +25.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,84017,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,558.75000,530.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,541.99,fee schedule,
KIT COCHLEAR PROC 2 NAIDA CI M90,84018,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,The Alliance,Premier SAS,,26378.97,,,,,,,10648.19,27182.63,fee schedule,
VLV HRT EVOLUT FX 23MM,84019,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CLAREON MONOFOCAL  27.5,84020,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
STENT BILI 10FR L10CM ACC CHN 3.7MM 0.035IN,84021,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Premier SAS,,382.79,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS PEDIATRIC VACCINE SUSP (TICOVAC),84022,CDM,250,RC,90626,HCPCS,00069029702,NDC,facility,outpatient,1,mL,2225.52000,2114.24000,The Alliance,Premier SAS,,1531.16,,,,,,,1112.76,2158.75,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,CPT,,,facility,outpatient,,,556.38000,528.56000,The Alliance,Premier SAS,,382.79,,,,,,,278.19,539.69,percent of total billed charges,
TICK-BORNE ENCEPHALITIS VACCINE SUSP (TICOVAC),84023,CDM,250,RC,90627,HCPCS,00069041102,NDC,facility,outpatient,1,mL,1112.76000,1057.12000,The Alliance,Premier SAS,,765.58,,,,,,,556.38,1079.38,percent of total billed charges,
BIPAP W/B-UP PURCH-NEW EQUIP,84025,CDM,292,RC,E0471,HCPCS,,,facility,outpatient,,,6705.11000,6369.85000,The Alliance,Premier SAS,NU,4613.12,,,,,,,3352.55,6503.96,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .018IN GW 5FR SHTH PTA,84027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
TUBE GASTROSTMY 18FR 2.0 45 CM,84028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,The Alliance,Premier SAS,,609.36,,,,,,,609.36,1327.58,percent of total billed charges,
DEVICE VASC CLSR 6FR/7FR W/ 10ML LK SYR BLLN.,84029,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2CM 1.5MM 150CM ULTRAVERSE 014,84031,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
BEBTELOVIMAB 175 MG,84039,CDM,636,RC,Q0222,HCPCS,,,facility,outpatient,,,4200.00000,3990.00000,The Alliance,Premier SAS,,2889.60,,,,,,,2100.00,4158.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SFT 300CM,84040,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
GUIDEWIRE VASC 0.035INX145CM STR TIP SS PTFE,84041,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,The Alliance,Premier SAS,,105.00,,,,,,,105.00,228.75,percent of total billed charges,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA21MM LUMN,84043,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Premier SAS,,7802.50,,,,,,,7802.50,16998.91,percent of total billed charges,
TRANYLCYPROMINE 10 MG TAB,84049,CDM,250,RC,J8499,HCPCS,00591559001,NDC,facility,outpatient,1,EA,8.53000,8.11000,The Alliance,Premier SAS,,5.87,,,,,,,4.26,8.27,percent of total billed charges,
ISOCARBOXAZID 10 MG TAB,84050,CDM,250,RC,J8499,HCPCS,30698003201,NDC,facility,outpatient,1,EA,15.67000,14.88000,The Alliance,Premier SAS,,10.78,,,,,,,7.83,15.20,percent of total billed charges,
STENT PANCREAS 3FR L9CM CNTOUR W/ DST PROX FLAP POLYETH N,84052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
DILATOR VESSEL RADPAQ STD 10F 038IN 20CM,84053,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,24.80000,23.56000,The Alliance,Premier SAS,,11.38,,,,,,,11.38,24.80,percent of total billed charges,
BENIK SPLINT W-711,84055,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,412.24000,391.63000,The Alliance,Premier SAS,,306.00,,,,,,,206.12,399.87,fee schedule,
CATHETER EP DECAPOLAR F CRV 7FR L115CM 282MM,84056,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,The Alliance,Premier SAS,,1941.43,,,,,,,1941.43,4229.70,percent of total billed charges,
BENIK SPLINT W-700,84057,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,366.26000,347.95000,The Alliance,Premier SAS,,118.21,,,,,,,113.78,355.27,fee schedule,
"ACE BNDG,STERILE,6""",84062,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,6.47,fee schedule,
"ACE BNDG,STERILE,4""",84065,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,6.47,fee schedule,
JUXTALIT ANK/FT WRP,84066,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,88.00000,83.60000,The Alliance,Premier SAS,,40.39,,,,,,,40.39,85.36,percent of total billed charges,
"ISOBAND BNDG,7.8""",84067,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,52.27000,49.66000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,50.70,fee schedule,
"ROSIDAL STR BNDG 3.14 - 3.93"" W",84071,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,62.67000,59.54000,The Alliance,Premier SAS,,2.73,,,,,,,2.63,60.79,fee schedule,
"RIGID WALKER,WHEELED",84072,CDM,271,RC,E0141,HCPCS,,,facility,outpatient,,,337.88000,320.99000,The Alliance,Premier SAS,NU,65.48,,,,,,,62.66,327.74,fee schedule,
TKO/KNUCKLE ORTHOSIS,84074,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,135.60000,128.82000,The Alliance,Premier SAS,,306.00,,,,,,,67.80,315.32,fee schedule,
THYROID CARCINOMA METAS UPTAKE,84076,CDM,340,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,The Alliance,Premier SAS,TC,513.94,,,,,,,282.87,724.59,percent of total billed charges,
"ROSIDAL STR BNDG 2.36"" W",84078,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,1.80,,,,,,,1.73,23.28,fee schedule,
CATHETER INTVN 5.7FR 150CM HDRPH TRAPLINER 13CM.,84083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2771.25000,2632.69000,The Alliance,Premier SAS,,1272.00,,,,,,,1272.00,2771.25,percent of total billed charges,
IMPLANT SNUS L16MM ETHM MOMETASONE FUROATE CYL,84092,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier SAS,,1593.85,,,,,,,1593.85,3472.43,percent of total billed charges,
C1 ESTERASE INHIB FUNCT(C1INF) SO,84093,CDM,300,RC,83520,CPT,,,facility,outpatient,,,151.70000,144.11000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 150CM,84095,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Premier SAS,,36.54,,,,,,,36.54,79.60,percent of total billed charges,
GWIRE ASTATO XS 20 300CM,84096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
TUBE GJ 14FR STOMA L2CM JEJU L22CM GRN LP,84097,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,The Alliance,Premier SAS,,1046.52,,,,,,,1046.52,2280.00,percent of total billed charges,
PT ULTRAVIOLET UNITS,84099,CDM,420,RC,97028,CPT,,,facility,outpatient,,,24.00000,22.80000,The Alliance,Premier SAS,,180.00,,,,,,,12.00,264.00,per diem,
XRAY/FEMUR 1 VIEW-ASC ONLY,8410,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier SAS,TC,142.98,,,,,,,112.98,1134.10,fee schedule,
BLLN RX NC TREK NEO 4.0X20MM,84102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X20MM,84103,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X6MM,84104,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X25MM,84105,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X25MM,84106,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X15MM,84107,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X15MM,84108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X15MM,84109,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X8MM,84110,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X8MM,84111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 882 MG/3.2 ML (ARISTADA),84121,CDM,636,RC,J1944,HCPCS,65757040303,NDC,facility,outpatient,1,mL,2500.41000,2375.39000,The Alliance,Premier SAS,,5.33,,,,,,,3.33,2425.40,fee schedule,
CATH CAT12 HTORQ 115CM.,84122,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,The Alliance,Premier SAS,,13830.59,,,,,,,13830.59,30132.00,percent of total billed charges,
PROSTHESIS EAR L8MM SHFT DIA0.6MM MALL PIST,84123,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1600.31000,1520.29000,The Alliance,Premier SAS,,457.84,,,,,,,440.69,1600.31,fee schedule,
KIT BUR H DEV LJ53 FOR DP BRAIN STIM SENSIGHT,84124,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,798.75000,758.81000,The Alliance,Premier SAS,,366.63,,,,,,,366.63,798.75,percent of total billed charges,
TUNNELER EXTN EMAN LJ53 FOR DP BRAIN STIM.,84125,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,862.50000,819.38000,The Alliance,Premier SAS,,395.89,,,,,,,395.89,862.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X25MM,84132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X8MM,84133,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X15MM,84135,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BEVACIZUMAB SOLN 1.25 MG/0.05 ML,84137,CDM,636,RC,J9035,HCPCS,71266800605,NDC,facility,outpatient,1,mL,2890.18000,2745.67000,The Alliance,Premier SAS,,116.95,,,,,,,73.05,2803.47,fee schedule,
AFLIBERCEPT SOLN 2 MG/0.05 ML (EYLEA),84138,CDM,636,RC,J0178,HCPCS,61755000502,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,The Alliance,Premier SAS,,1264.85,,,,,,,790.04,68191.00,fee schedule,
INCOBOTULINUMTOXINA POWD-INJ 50 UNITS,84139,CDM,636,RC,J0588,HCPCS,00259160501,NDC,facility,outpatient,1,EA,673.40000,639.73000,The Alliance,Premier SAS,,8.50,,,,,,,5.31,653.20,fee schedule,
BLLN RX NC TREK NEO 4.0X15MM,84145,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,00641606125,NDC,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,3.68,fee schedule,
MIDAZOLAM SOLN 5 MG/ML 1 ML,84146,CDM,250,RC,J2250,HCPCS,63323041225,NDC,facility,outpatient,1,mL,9.04000,8.59000,The Alliance,Premier SAS,,0.25616,,,,,,,0.19995,8.77,fee schedule,
STENT XIENCE SKYPNT 4.5X23MM,84149,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER PTCA 1.5FR USABLE L145CM L38 CM HYDRPHLC GWIRE,84150,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,The Alliance,Premier SAS,,748.74,,,,,,,748.74,1631.25,percent of total billed charges,
GRAFT EVAR L10CM DIA10MM IL BRANCH COMP NIT EPTFE FEP BIFUR,84151,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,The Alliance,Premier SAS,,11201.48,,,,,,,11201.48,24404.10,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 45CM HDRPH GORE DRYSEAL,84153,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3532.50000,3355.88000,The Alliance,Premier SAS,,1621.42,,,,,,,1621.42,3532.50,percent of total billed charges,
NIVOLUMAB-RELATLIMAB-RMBW  SOLN 12 MG-4 MG/ML 20 ML (OPDUALAG),84154,CDM,636,RC,J9298,HCPCS,00003712511,NDC,facility,outpatient,1,mL,1881.95000,1787.86000,The Alliance,Premier SAS,,316.44,,,,,,,197.65,1825.49,fee schedule,
BLLN RX NC TREK NEO 3.75X12MM,84155,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X12MM,84156,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X8MM,84157,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.020IN PERIPH COMPLX L VOL STD FRME,84158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT PANCREAS 5FR L4CM GWIRE 0.035IN POLYETH W/ FLAP CNTOUR,84159,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X20MM,84160,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X20MM,84161,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X20MM,84162,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 6FR L80CM SELF EXP NIT,84163,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI L40MM DIA10MM CATH 6FR L80CM SELF EXP OTW NIT,84164,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 10 ML,84165,CDM,250,RC,J3010,HCPCS,00409909428,NDC,facility,outpatient,1,mL,0.98000,0.93000,The Alliance,Premier SAS,,1.54,,,,,,,0.49000,1.58,fee schedule,
BLLN RX NC TREK NEO 5.0X15MM,84166,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.5X6MM,84167,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X12MM,84168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X20MM,84169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L178MM DIA32MM OD7.7MM ID6.7MM PROX THOR AORT NIT,84175,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,The Alliance,Premier SAS,,17319.36,,,,,,,17319.36,37732.80,percent of total billed charges,
MICROCOIL EMB L3CM DIA3MM 0.018IN NUM OF LOOP 3.2 PLAT FULL,84176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,The Alliance,Premier SAS,,157.44,,,,,,,157.44,343.01,percent of total billed charges,
SUPER SHEATH CBDE 12FR 25CM,84179,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,245.70000,233.42000,The Alliance,Premier SAS,,112.78,,,,,,,112.78,245.70,percent of total billed charges,
"PLUVICTO, 1 MCI",84180,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier SAS,,277.42,,,,,,,201.61,398.00,percent of total billed charges,
GUIDEWIRE ENDOSCP SPYGLS DISCOVER JAGWIRE,84181,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,787.50000,748.12000,The Alliance,Premier SAS,,361.46,,,,,,,361.46,787.50,percent of total billed charges,
BLLN RX NC TREK NEO 3.0X6MM,84182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X8MM,84183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X20MM,84184,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
NM PLUVICTO PER MCI,84185,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier SAS,,277.42,,,,,,,201.61,398.00,percent of total billed charges,
TUBE JJNSTM 16FR 22CM TRNGS SIL MC SLK 7-10MIL,84187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,The Alliance,Premier SAS,,402.19,,,,,,,402.19,876.23,percent of total billed charges,
INTRO SHTH 12FR L80CM ID4.1MM 0.038IN L CK,84188,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,323.55000,307.37000,The Alliance,Premier SAS,,148.51,,,,,,,148.51,323.55,percent of total billed charges,
KIT GJ TB 22FR JEJU L45CM STOMA L3.5CM SIL LP,84189,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,604.23,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN TIP L2CM SS,84190,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
SHEATH PROTRIEVE 20FR 32 CM,84191,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12400.00,percent of total billed charges,
CATHETER BALLOON CONQ 12X4X75 CM,84192,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
PACKING NASAL NOVAPAK STANDARD 2PK,84195,CDM,278,RC,A6407,HCPCS,,,facility,outpatient,,,647.36000,614.99000,The Alliance,Premier SAS,,2.91,,,,,,,2.81,647.36,fee schedule,
BLLN RX NC TREK NEO 2.75X15MM,84204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 4.0X12MM,84205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X8MM,84206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 15CM 3.5MM 150CM ULTRAVERSE 014,84207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ASPIR L125CM OD2.09X2.16MM ID1.8MM L,84208,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9566.51000,9088.18000,The Alliance,Premier SAS,,4391.03,,,,,,,4391.03,9566.51,percent of total billed charges,
CATH SHOCKWAVE M IVL 3.5X60MM,84209,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
DEVICE CPSL DLV 2.5MM 180CM ADV STRL GSEN,84210,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,762.49000,724.37000,The Alliance,Premier SAS,,349.98,,,,,,,349.98,762.49,percent of total billed charges,
TUBE GASTROSTMY 18FR L18IN 3L AUTO XCESS RFLX,84211,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Premier SAS,,709.50,,,,,,,44.30,1000.31,percent of total billed charges,
KIT ACC ANCHR W/ DISPNS TOOL CATH CONN 2.,84212,CDM,278,RC,C1755,HCPCS,,,facility,outpatient,,,750.00000,712.50000,The Alliance,Premier SAS,,344.25,,,,,,,344.25,750.00,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 10 GM,84213,CDM,636,RC,J1566,HCPCS,00944265804,NDC,facility,outpatient,1,EA,5157.98000,4900.08000,The Alliance,Premier SAS,,130.80,,,,,,,81.70,5003.24,fee schedule,
BUPIVACAINE-MELOXICAM SOLN 200 MG-6 MG/7 ML EXTENDED RELEASE,84214,CDM,636,RC,C9088,HCPCS,47426030301,NDC,facility,outpatient,1,mL,8.74000,8.30000,The Alliance,Premier SAS,,6.01,,,,,,,0.77000,8.48,percent of total billed charges,
SLEEP ST/HOME/TYPE 4 PORTA INSTRUCT G0400,84215,CDM,920,RC,G0400,HCPCS,,,facility,outpatient,,,1402.00000,1331.90000,The Alliance,Premier SAS,TC,472.00,,,,,,,316.68,1447.00,per diem,
LENS I0+ 10.5 DIOP  12.5MM OPTIC  5.5MM,84216,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,454.69,fee schedule,
CATHETER DIAG AD 6FR L100CM 0.038IN COR,84219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier SAS,,16.85,,,,,,,16.85,36.72,percent of total billed charges,
BLLN RX NC TREK NEO 2.0X15MM,84220,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 30CM 5MM 130CM ULTRAVERSE 018 CK,84221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
SUTURE CAPIO SZ 0 L36IN NABSRB TC TPRCT L26MM,84223,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,179.80000,170.81000,The Alliance,Premier SAS,,123.70,,,,,,,89.90,174.41,percent of total billed charges,
PEGFILGRASTIM-BMEZ SOLN 6 MG/0.6 ML,84229,CDM,636,RC,Q5120,HCPCS,61314086601,NDC,facility,outpatient,1,mL,12430.84000,11809.30000,The Alliance,Premier SAS,,44.81,,,,,,,27.99,12057.91,fee schedule,
DEVICE CLSR 5FR BIOABSRB FULL INTEGR RAP,84231,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,731.25000,694.69000,The Alliance,Premier SAS,,335.64,,,,,,,335.64,731.25,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA12MM IPSILATERAL LEG,84232,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,The Alliance,Premier SAS,,11193.77,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L156MM DIA16X13MM CATH 16FR POLY NIT STNT,84233,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16817.50000,15976.62000,The Alliance,Premier SAS,,7719.23,,,,,,,7719.23,16817.50,percent of total billed charges,
VEST COMPRESSION MALE SIZE LARGE,84234,CDM,299,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier SAS,,106.83,,,,,,,77.64,150.62,percent of total billed charges,
CATHETER BLNDIL 4.5MM COR CROSSFLEX2 TUNG TREK,84235,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI PLAS CRL 10FR CATH SLF EXP ZMMN,84236,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L5CM WRK CHN,84237,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
SYSTEM ATHRCM HAWKONE H1-S 6FR,84238,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier SAS,,4624.43,,,,,,,4624.43,10075.00,percent of total billed charges,
CATH DIL 24FR L4CM BLLN 8MM HI PRSS UROMX ULT,84240,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,The Alliance,Premier SAS,,841.48,,,,,,,841.48,1833.30,percent of total billed charges,
CATH GUID XB 4 8FR 100CM,84241,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X8MM,84242,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
NM PET PYLARIFY PER MCI,84243,CDM,343,RC,A9595,HCPCS,,,facility,outpatient,,,1089.74000,1035.25000,The Alliance,Premier SAS,,749.74,,,,,,,332.44,1057.05,percent of total billed charges,
SET INTRO 9FR L38.5CM NDL 16GA L50.5CM,84246,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,The Alliance,Premier SAS,,920.85,,,,,,,920.85,2006.21,percent of total billed charges,
XR CEPHALOGRAM ORTHODONTIC-TECH,8425,CDM,402,RC,70350,CPT,,,facility,outpatient,,,118.00000,112.10000,The Alliance,Premier SAS,TC,532.00,,,,,,,59.00,548.00,fee schedule,
BEDSIDE PROCEDURE LEVEL 2,84250,CDM,360,RC,,,,,facility,outpatient,,,3492.00000,3317.40000,The Alliance,Premier SAS,,2402.50,,,,,,,1920.60,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 1,84251,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
BEDSIDE PROCEDURE LEVEL 3,84252,CDM,360,RC,,,,,facility,outpatient,,,6918.00000,6572.10000,The Alliance,Premier SAS,,4759.58,,,,,,,3804.90,6710.46,percent of total billed charges,
VALVE MI 29MM BOV PERICARD LEAFLET COCR STNT,84253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L17MM DIA4.5MM 64,84254,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
SET URET STNT 8FR L26CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84255,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
ORITAVANCIN POWD-INJ 1200 MG (KIMYRSA),84261,CDM,636,RC,J2406,HCPCS,70842022501,NDC,facility,outpatient,1,EA,9557.99000,9080.09000,The Alliance,Premier SAS,,66.28,,,,,,,41.40,9271.25,fee schedule,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00143936201,NDC,facility,outpatient,1,EA,387.46000,368.09000,The Alliance,Premier SAS,,0.49631,,,,,,,0.39525,375.84,fee schedule,
MICAFUNGIN POWD-INJ 100 MG,84262,CDM,250,RC,J2248,HCPCS,00469321110,NDC,facility,outpatient,1,EA,484.33000,460.11000,The Alliance,Premier SAS,,0.49631,,,,,,,0.39525,469.80,fee schedule,
MICAFUNGIN  POWD-INJ 50 MG,84263,CDM,250,RC,J2248,HCPCS,00469325010,NDC,facility,outpatient,1,EA,295.46000,280.69000,The Alliance,Premier SAS,,0.49631,,,,,,,0.39525,286.60,fee schedule,
XR CYSTOGRAPHIN WASTE,84264,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.30000,0.28000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,0.29100,fee schedule,
GRAFIXPLPRM 1.5X2CM,84265,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1202.00000,1141.90000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,1165.94,fee schedule,
GRAFIX PL PRIME 5X5CM,84266,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,385.00000,365.75000,The Alliance,Premier SAS,,218.02,,,,,,,192.50,373.45,fee schedule,
CYTAL 2 LAYER 5X5CM,84267,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,104.55000,99.32000,The Alliance,Premier SAS,,33.38,,,,,,,33.32,101.41,fee schedule,
BLLN RX NC TREK NEO 4.5X15MM,84270,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
LEAD NS 65CM RESPISTIM LQS IV QDPL PROX END IS-1,84271,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER DIAG L90CM TAPR TIP CROSSING CMPTBL,84272,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier SAS,,218.60,,,,,,,218.60,476.25,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM INT IL EXCLUDER,84273,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,The Alliance,Premier SAS,,4678.50,,,,,,,4678.50,10192.80,percent of total billed charges,
PRIM MEMBRANES NEPHROPATHY DIAG (PMND1) SO,84274,CDM,300,RC,83520,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"PLA2R, IMMUNOFLUORESCENSE SO",84275,CDM,300,RC,86255,CPT,,,facility,outpatient,,,350.60000,333.07000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
THROMBOSPONDIN T1 DOMAIN W/7A AB (THSDF7) SO,84276,CDM,300,RC,86255,CPT,,,facility,outpatient,,,581.00000,551.95000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
XR INJ PROC ELBOW ARTHRO,84283,CDM,320,RC,24220,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,RT,1696.61,,,,,,,451.27,2392.02,percent of total billed charges,
TEBENTAFUSP-TEBN 100 MCG/0.5 ML SOLN (KIMMTRACK),84284,CDM,636,RC,J9274,HCPCS,80446040101,NDC,facility,outpatient,1,mL,71288.00000,67723.60000,The Alliance,Premier SAS,,347.56,,,,,,,217.09,69149.36,fee schedule,
CATHETER GUID PTFE SS BRAIDING AMPLATZ L .75,84285,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRODUCER 8F X 45CM X .038 CURVE,84287,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,The Alliance,Premier SAS,,118.77,,,,,,,118.77,258.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X20MM,84288,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X8MM,84289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH HEMO GLDEPATH 14.5FR 27CM,84290,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
INTROD MICRO 5F 10CM NIT WIRE .018 45CM,84291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,222.94000,211.79000,The Alliance,Premier SAS,,102.33,,,,,,,102.33,222.94,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X20MM,84292,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
SHEATH INTRO PINNACLE 10 FRX10 CM 10BX,84293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,46.00000,43.70000,The Alliance,Premier SAS,,21.11,,,,,,,21.11,46.00,percent of total billed charges,
LEAD DEFIB L59CM SIL SGL SHOCK COIL ACT HELIX,84294,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,The Alliance,Premier SAS,,4624.43,,,,,,,4624.43,10075.00,percent of total billed charges,
KIT PNCREAS STENT 5FR L5CM PLS STR NO LEAD,84295,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Premier SAS,,412.93,,,,,,,412.93,899.63,percent of total billed charges,
CATH MICRO LANTERN 45 115CM,84296,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1118.81,,,,,,,1118.81,2437.50,percent of total billed charges,
SET INTRO SHTH 8FR L45CM W/ INTEGR SIDE PRT,84297,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,393.75000,374.06000,The Alliance,Premier SAS,,180.73,,,,,,,180.73,393.75,percent of total billed charges,
BLLN RX NC TREK NEO 3.75X8MM,84298,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
LEUPROLIDE 30 MG/3 MONTHS (LUPRON DEPOT-PED),84299,CDM,250,RC,J1950,HCPCS,00074969403,NDC,facility,outpatient,1,EA,23519.66000,22343.68000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,22814.07,fee schedule,
XR INJ PROC WRIST ARTHRO,84300,CDM,320,RC,25246,CPT,,,facility,outpatient,,,1769.00000,1680.55000,The Alliance,Premier SAS,LT,1217.07,,,,,,,493.80,1715.93,percent of total billed charges,
EFGARTIGIMOD-ALFA-FCAB SOLN 400 MG/20 ML (VYVGART),84301,CDM,636,RC,J9332,HCPCS,73475304105,NDC,facility,outpatient,1,mL,770.52000,732.00000,The Alliance,Premier SAS,,51.87,,,,,,,32.40,747.40,fee schedule,
INTERSTIM RECHARGER KIT,84305,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,2323.94,,,,,,,1218.75,2437.50,fee schedule,
HAIR NAILS EXPOSURE TEST 14 (CHILDGUARD) SO,84308,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
HAIR NAILS EXPOSURE TEST 15 (CHILDGUARD) SO,84309,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
XRAY/FEMUR 1 VIEW,8431,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,The Alliance,Premier SAS,TC,142.98,,,,,,,112.98,1134.10,fee schedule,
GUIDEWIRE VASC ANG TPR .018IN 180CM PLTN NTNL,84311,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,338.78000,321.84000,The Alliance,Premier SAS,,155.50,,,,,,,155.50,338.78,percent of total billed charges,
BUTTON 1.2CM 12FR RADOPQ LOPRFL PROX ANRFLX V,84312,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,248.15,,,,,,,47.62,349.86,percent of total billed charges,
GUIDEWIRE VASCULAR L180CM DIA0.014/0.009IN SPR,84313,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASCLR COR 0.014INX300CM J RADPQ TIP SS,84314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
STENT COR L20MM DIA3.5MM CATH L140CM GWIRE,84315,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier SAS,,5165.13,,,,,,,5165.13,11253.00,percent of total billed charges,
SYSTEM ATHRCTMY L145CM CRWN 2MM INTRO 6FR,84316,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Premier SAS,,4830.75,,,,,,,4830.75,10524.50,percent of total billed charges,
"BILE, URINE - TECH",84317,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,The Alliance,Premier SAS,,16.17,,,,,,,2.25,118.82,fee schedule,
BLLN RX NC TREK NEO 5.0X20MM,84318,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X15MM,84319,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATH ACUNAV VOLUME 4D ICE,84320,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
"DRYSEAL FLEXSHEATH 14FR, 65CM",84321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,,1805.25,,,,,,,1805.25,3933.00,percent of total billed charges,
TUBE JEJU FEED 22FR STOMA L4CM JEJU L45CM,84323,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,The Alliance,Premier SAS,,905.68,,,,,,,47.62,1276.91,percent of total billed charges,
CATHETER BLNDIL 18MM 100CM TSHK II 4CM LOPRFL,84326,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,The Alliance,Premier SAS,,967.59,,,,,,,967.59,2108.03,percent of total billed charges,
AVALUS  AORTIC HEART VALVE  SZ 19MM  40019,84327,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Premier SAS,,8679.69,,,,,,,8679.69,18910.00,percent of total billed charges,
STENT VEN SELF EXPND 16X100MM 80CM OTW DEL,84329,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,The Alliance,Premier SAS,,2848.81,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT ABRE 18MMX80MMX90CM,84330,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE STARTER BENTSON STR 035 150CM,84331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.80000,99.56000,The Alliance,Premier SAS,,48.10,,,,,,,48.10,104.80,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM OD10MM GWIRE,84332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,262.50000,249.38000,The Alliance,Premier SAS,,120.49,,,,,,,120.49,262.50,percent of total billed charges,
ABOBOTULINUMTOXINA POWD-INJ 500 UNITS,84335,CDM,636,RC,J0586,HCPCS,15054050001,NDC,facility,outpatient,1,EA,2224.81000,2113.57000,The Alliance,Premier SAS,,14.68,,,,,,,9.17,2158.07,fee schedule,
PALIPERIDONE SUSP 273 MG/0.875 ML (INVEGA TRINZA),84336,CDM,636,RC,J2427,HCPCS,50458060601,NDC,facility,outpatient,1,mL,8182.59000,7773.46000,The Alliance,Premier SAS,,20.75,,,,,,,12.96,7937.11,fee schedule,
IVERMECTIN LOTION 0.5% 117 GM,84337,CDM,250,RC,51672-4230-08,NDC,,,facility,outpatient,1,GM,4.25000,4.03000,The Alliance,Premier SAS,,2.92,,,,,,,2.12,4.12,percent of total billed charges,
MITOMYCIN SOLN 0.2 MG OPHTH KIT,84338,CDM,636,RC,J7315,HCPCS,49771000203,NDC,facility,outpatient,1,EA,1061.90000,1008.81000,The Alliance,Premier SAS,,730.59,,,,,,,530.95,1030.04,percent of total billed charges,
PANTOPRAZOLE SUSP 40 MG,84339,CDM,250,RC,62756-0071-64,NDC,,,facility,outpatient,1,EA,44.74000,42.50000,The Alliance,Premier SAS,,30.78,,,,,,,22.37,43.40,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 1 GM,84340,CDM,636,RC,J1561,HCPCS,13533080012,NDC,facility,outpatient,1,mL,38.61000,36.68000,The Alliance,Premier SAS,,76.90,,,,,,,19.30,80.87,fee schedule,
BISMUTH SUBSALICYLATE SUSP 525 MG/30 ML,84341,CDM,250,RC,00121-0910-40,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,65162-0049-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
OXYCODONE TAB 15 MG,84342,CDM,250,RC,68094-0005-61,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,The Alliance,Premier SAS,,1.29,,,,,,,0.94000,1.82,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X12MM,84344,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-10,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,The Alliance,Premier SAS,,10.49,,,,,,,7.62,14.79,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50111-0788-55,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,50268-0099-13,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,The Alliance,Premier SAS,,3.69,,,,,,,2.68,5.20,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,60687-0271-21,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,The Alliance,Premier SAS,,7.98,,,,,,,5.80,11.25,percent of total billed charges,
AZITHROMYCIN TAB 500 MG,84345,CDM,250,RC,68180-0862-11,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,The Alliance,Premier SAS,,3.53,,,,,,,2.56,4.98,percent of total billed charges,
DOXAZOSIN TAB 0.5 MG,84346,CDM,250,RC,00904-5522-61-00050,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,The Alliance,Premier SAS,,0.92192,,,,,,,0.67000,1.30,percent of total billed charges,
"ANAPLASMA PHAGOCYTOPHILLUM, INF AGENT DET BY NUCLEIC ACID",84347,CDM,300,RC,87468,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier SAS,,226.17,,,,,,,35.09,1662.04,fee schedule,
"BABESIA MICROTI, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84348,CDM,300,RC,87469,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier SAS,,226.17,,,,,,,35.09,1662.04,fee schedule,
"EHRLICHIA CHAFFEENIS, AMPLIFIED, INF AGENT DET BY NUCLEIC ACID",84349,CDM,300,RC,87484,CPT,,,facility,outpatient,,,398.00000,378.10000,The Alliance,Premier SAS,,226.17,,,,,,,35.09,1662.04,fee schedule,
CLIP APPLIER LIG L235CM OPN 17MM ULT RESOL 360 20/BX,84350,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1071.00000,1017.45000,The Alliance,Premier SAS,,736.85,,,,,,,535.50,1038.87,percent of total billed charges,
RMVL OF SUTURES OR STAPLES NOT REQUIRING ANES 15853,84352,CDM,361,RC,15853,CPT,,,facility,outpatient,,,77.00000,73.15000,The Alliance,Premier SAS,,52.98,,,,,,,42.35,5271.00,percent of total billed charges,
RMVL OF SUTURES & STAPLES NOT REQUIRING ANES 15854,84354,CDM,361,RC,15854,CPT,,,facility,outpatient,,,108.00000,102.60000,The Alliance,Premier SAS,,74.30,,,,,,,59.40,5271.00,percent of total billed charges,
MIRVETUXIMAB SORAVTANSINE-GYNX SOLN 100 MG/20 ML (ELAHERE),84380,CDM,636,RC,J9063,HCPCS,72903085301,NDC,facility,outpatient,1,mL,821.60000,780.52000,The Alliance,Premier SAS,,111.30,,,,,,,69.52,796.95,fee schedule,
TREMELIMUMAB-ACTL SOLN 300 MG/ 15 ML (IMJUDO),84383,CDM,636,RC,J9347,HCPCS,00310453530,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Premier SAS,,226.01,,,,,,,141.17,5800.60,fee schedule,
CARDIAC FOCAL ABLATION RAD TX DVRY 0747T,84389,CDM,333,RC,0747T,HCPCS,,,facility,outpatient,,,19270.00000,18306.50000,The Alliance,Premier SAS,,13257.76,,,,,,,9635.00,18691.90,percent of total billed charges,
TREMELIMUMAB-ACTL SOLN 25 MG/ 1.25 ML (IMJUDO),84390,CDM,636,RC,J9347,HCPCS,00310450525,NDC,facility,outpatient,1,mL,5980.00000,5681.00000,The Alliance,Premier SAS,,226.01,,,,,,,141.17,5800.60,fee schedule,
20X25CM BMW8101,84391,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,57.80000,54.91000,The Alliance,Premier SAS,,86.07,,,,,,,28.90,88.70,fee schedule,
SODIUM HYALURONATE SOLN 20 MG/ML 3ML INTRA-ARTICULAR (DUROLANE),84397,CDM,636,RC,J7318,HCPCS,89130202001,NDC,facility,outpatient,1,mL,928.08000,881.68000,The Alliance,Premier SAS,,10.69,,,,,,,6.68,900.24,fee schedule,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 4 ML",84398,CDM,636,RC,J0561,HCPCS,60793070210,NDC,facility,outpatient,1,mL,367.88000,349.49000,The Alliance,Premier SAS,,46.91,,,,,,,29.30,356.84,fee schedule,
STENT PANCREAS 3FR L7CM CNTOUR W/ DST PROX FLAP POLYETH N,84402,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 500 UNIT,84405,CDM,636,RC,J7209,HCPCS,68982014101,NDC,facility,outpatient,1,EA,1767.52000,1679.14000,The Alliance,Premier SAS,,1.89,,,,,,,1.18,1714.49,fee schedule,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 1000 UNIT,84406,CDM,636,RC,J7209,HCPCS,68982014301,NDC,facility,outpatient,1,EA,3123.40000,2967.23000,The Alliance,Premier SAS,,1.89,,,,,,,1.18,3029.70,fee schedule,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (NUWIQ) 2000 UNIT,84407,CDM,636,RC,J7209,HCPCS,68982014501,NDC,facility,outpatient,1,EA,6578.00000,6249.10000,The Alliance,Premier SAS,,1.89,,,,,,,1.18,6380.66,fee schedule,
RITUXIMAB-ARRX SOLN 10 MG/ML 50 ML (RIABNI),84410,CDM,636,RC,Q5123,HCPCS,55513032601,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier SAS,,47.90,,,,,,,29.92,219.71,fee schedule,
RITUXIMAB-ARRX SOLN 10 MG/ML 10 ML (RIABNI),84411,CDM,636,RC,Q5123,HCPCS,55513022401,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier SAS,,47.90,,,,,,,29.92,219.71,fee schedule,
"GA68 ILLUCX, 1MCI",84429,CDM,343,RC,A9596,HCPCS,,,facility,outpatient,,,1697.40000,1612.53000,The Alliance,Premier SAS,,1167.81,,,,,,,511.55,1711.73,percent of total billed charges,
BLLN RX NC TREK NEO 2.5X6MM,84431,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN RX NC TREK NEO 2.75X6MM,84433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML (ONCE DAILY FORMULATION),84434,CDM,250,RC,60505-1005-01,NDC,,,facility,outpatient,1,mL,162.95000,154.81000,The Alliance,Premier SAS,,112.11,,,,,,,81.47,158.06,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 2 ML,84436,CDM,250,RC,J9171,HCPCS,00409020102,NDC,facility,outpatient,1,mL,110.25000,104.74000,The Alliance,Premier SAS,,0.60838,,,,,,,0.60838,106.94,fee schedule,
RITUXIMAB-PVVR SOLN 10 MG/ML 50 ML (RUXIENCE),84449,CDM,636,RC,Q5119,HCPCS,00069024901,NDC,facility,outpatient,1,mL,226.51000,215.18000,The Alliance,Premier SAS,,42.43,,,,,,,26.50,219.71,fee schedule,
PLUG VASC L18MM DIA13MM VES DIA7-9MM MIC,84451,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier SAS,,2367.41,,,,,,,2367.41,5157.75,percent of total billed charges,
PLUG VASC L16MM DIA9.2MM VES DIA5-7MM MIC,84452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,The Alliance,Premier SAS,,2367.41,,,,,,,2367.41,5157.75,percent of total billed charges,
NEEDLE CRYOABLATION 1.5MM 90DEG ICESPHERE,84453,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT BILI AD L20MM DIA10MM CATH 6FR L80CM LIFESTENT,84454,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X15MM,84456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER CLOTTRIEVER THROMCTMY CLT BOLD,84457,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27900.00,percent of total billed charges,
CT OMNIPAQUE 300 50ML,84466,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.29,fee schedule,
CT OMNIPAQUE 300 50ML WASTE,84467,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,1.29,fee schedule,
NM PLUVICTO WASTE,84471,CDM,344,RC,A9607,HCPCS,,,facility,outpatient,,,403.22000,383.06000,The Alliance,Premier SAS,JW,277.42,,,,,,,201.61,398.00,percent of total billed charges,
LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY 31579,84485,CDM,440,RC,31579,CPT,,,facility,outpatient,,,1467.00000,1393.65000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,1422.99,per diem,
SET ATHRCTMY CATH 6FR L135CM GWIRE 0.018IN,84486,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
GWIRE SYNCHRO SEL 14 STD 300CM,84487,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
CALCIUM URORISK SO,84488,CDM,300,RC,82340,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Premier SAS,90,43.89,,,,,,,6.23,322.54,fee schedule,
SODIUM URORISK SO,84489,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,90,34.66,,,,,,,5.23,254.68,fee schedule,
PHOSPHORUS URORISK SO,84490,CDM,300,RC,84105,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,36.97,,,,,,,5.97,271.65,fee schedule,
MAGNESIUM URORISK SO,84491,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,The Alliance,Premier SAS,90,48.52,,,,,,,6.92,356.54,fee schedule,
CREATININE OTHER SOURCE URORISK SO,84492,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
POTASSIUM URORISK SO,84493,CDM,300,RC,84133,CPT,,,facility,outpatient,,,48.70000,46.26000,The Alliance,Premier SAS,90,30.03,,,,,,,4.89,220.68,fee schedule,
ADUCANUMAB SOLN-AVWA 100 MG/ML 3 ML (ADUHELM),84499,CDM,636,RC,J0172,HCPCS,64406010202,NDC,facility,outpatient,1,mL,730.38000,693.86000,The Alliance,Premier SAS,,9.57,,,,,,,5.98,708.47,fee schedule,
DOXEPIN AND NORDOXEPIN (DXPIN) SO,84500,CDM,300,RC,80335,CPT,,,facility,outpatient,,,152.20000,144.59000,The Alliance,Premier SAS,90,154.78,,,,,,,76.10,1137.41,fee schedule,
RISANKIZUMAB RZAA SOLN 60 MG/ML 10 ML (SKYRIZI),84501,CDM,636,RC,J2327,HCPCS,00074501501,NDC,facility,outpatient,1,mL,2539.73000,2412.75000,The Alliance,Premier SAS,,23.76,,,,,,,14.84,2463.54,fee schedule,
RIMABOTULINUMTOXINB SOLN 5000 UNIT/ML (MYOBLOC),84502,CDM,636,RC,J0587,HCPCS,10454071110,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,The Alliance,Premier SAS,,21.36,,,,,,,13.34,1564.21,fee schedule,
ANAGRELIDE CAP 0.5 MG,84503,CDM,250,RC,00172-5241-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,The Alliance,Premier SAS,,1.81,,,,,,,1.31,2.55,percent of total billed charges,
STENT PERIPH L22MM DIA4.5MM CATH L220CM NO TIP INTCRAN,84504,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17866.91000,16973.56000,The Alliance,Premier SAS,,8200.91,,,,,,,8200.91,17866.91,percent of total billed charges,
REMOTE SLEEP STUDY THER TURN ON/OFF STIM STRENGTH FOR IPG,84506,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
GRAFIX PL PRIME 2X3 CM Q4133,84512,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,691.00000,656.45000,The Alliance,Premier SAS,,218.02,,,,,,,211.37,670.27,fee schedule,
BLLN RX NC TREK NEO 6.0X12MM,84513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM ID0.056IN SS NYL,84514,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,444.19000,421.98000,The Alliance,Premier SAS,,203.88,,,,,,,203.88,444.19,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X12MM,84515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER MAP 3-3-3-3-3 OCTAPOLAR GALAXY D CRV,84516,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER MAP 2-2-2-2-2 OCTAPOLAR PERSEID D,84517,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER BLNDIL 8CM 3.5MM 150CM ULTRAVERSE 014,84518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CAGE INTERBODY CATALYFT PL SHORT 7X22.5,84520,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier SAS,,8523.17,,,,,,,8523.17,18569.00,percent of total billed charges,
MIDAZOLAM 50 MG/NS 50 ML PREMIX,84523,CDM,250,RC,J2251,HCPCS,44567061010,NDC,facility,outpatient,1,mL,1.39000,1.32000,The Alliance,Premier SAS,,0.27217,,,,,,,0.26350,1.35,fee schedule,
EMOLLIENT LIQ SOAP 120 ML (EQV-CETAPHIL),84529,CDM,250,RC,00299-3921-40,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,The Alliance,Premier SAS,,0.06880,,,,,,,0.05000,0.09700,percent of total billed charges,
EMOLLIENT LOTION 354 ML (EQV-AVEENO),84531,CDM,250,RC,38137-0039-16,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LOTION 180 ML (EQV-LUBRIDERM),84532,CDM,250,RC,52800-0488-26,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,The Alliance,Premier SAS,,0.02752,,,,,,,0.02000,0.03880,percent of total billed charges,
STENT CAR L30MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,84533,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,The Alliance,Premier SAS,,3246.28,,,,,,,3246.28,7072.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X6MM,84535,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
CITRIC ACID/GLUCONODELTA-LACTONE/MG CARBONATE SOLN-IRR 30 ML,84537,CDM,250,RC,Q2004,HCPCS,00327001230,NDC,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
BLLN METACROSS RX 3X80X200CM,84538,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X10MM,84539,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,375.00000,356.25000,The Alliance,Premier SAS,,172.12,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER INTVN 5.1FR 150CM HDRPH TRAPLINER 13CM.,84540,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,The Alliance,Premier SAS,,1246.18,,,,,,,1246.18,2715.00,percent of total billed charges,
TUBE GASTRO BLLN 12 FR 1.7CM,84542,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,222.04,,,,,,,47.62,483.75,percent of total billed charges,
SILDENAFIL TAB 10 MG,84545,CDM,250,RC,00093-5517-98-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,The Alliance,Premier SAS,,0.95632,,,,,,,0.69500,1.35,percent of total billed charges,
OPEN END CATH 6X70,84546,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,79.60000,75.62000,The Alliance,Premier SAS,,36.54,,,,,,,36.54,79.60,percent of total billed charges,
CATHETER ELHMST 10FR 300CM HMGLD GLDPRB BP RND,84548,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1135.28000,1078.52000,The Alliance,Premier SAS,,521.09,,,,,,,521.09,1135.28,percent of total billed charges,
MYASTHENIA GRAVIS EVAL MUSK (MGMR) SO,84549,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,The Alliance,Premier SAS,90,117.83,,,,,,,19.00,865.84,fee schedule,
TOBRAMYCIN SOLN-OPHTH 13.6 MG/ML 7 ML,84550,CDM,250,RC,24208-0290-05-01360,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
"BK VIRUS DNA DETECT AND QUANT,U (UBKQN) SO",84551,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.60000,357.77000,The Alliance,Premier SAS,90,304.95,,,,,,,44.27,2240.90,fee schedule,
IMMUNOGLOBULIN GENE REARRANGEMENT IGK (BCGR) SO,84552,CDM,300,RC,81264,CPT,,,facility,outpatient,,,1518.00000,1442.10000,The Alliance,Premier SAS,90,1106.60,,,,,,,162.98,8131.76,fee schedule,
IMMUNOGLOBULIN GENE REARRANGEMENT IGH (BCGR) SO,84553,CDM,310,RC,81261,CPT,,,facility,outpatient,,,1741.00000,1653.95000,The Alliance,Premier SAS,90,1409.24,,,,,,,204.58,10355.70,fee schedule,
"RITUXIMAB-HYALURONIDASE 1400 MG-23,400 UNITS/11.7 ML",84554,CDM,636,RC,J9311,HCPCS,50242010801,NDC,facility,outpatient,1,mL,1455.84000,1383.05000,The Alliance,Premier SAS,,59.17,,,,,,,36.96,1412.16,fee schedule,
LECANEMAB-IRMB SOLN 100 MG/ML 5 ML (LEQEMBI),84555,CDM,636,RC,J0174,HCPCS,62856021501,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Premier SAS,,2.13,,,,,,,1.33,320.08,fee schedule,
LECANEMAB-IRMB SOLN 100 MG/ML 2 ML (LEQEMBI),84556,CDM,636,RC,J0174,HCPCS,62856021201,NDC,facility,outpatient,1,mL,329.98000,313.48000,The Alliance,Premier SAS,,2.13,,,,,,,1.33,320.08,fee schedule,
"HEREDITARY HEMOCHROMATOSIS, HFE VARIANT ANALYSIS, VARIES(HFET) SO",84557,CDM,310,RC,81256,CPT,,,facility,outpatient,,,574.00000,545.30000,The Alliance,Premier SAS,90,464.36,,,,,,,67.54,3412.32,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U CERAMIDE (LSDS) SO",84558,CDM,300,RC,83789,CPT,,,facility,outpatient,,,212.00000,201.40000,The Alliance,Premier SAS,90,154.78,,,,,,,24.91,1137.41,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U MUCO (LSDS) SO",84559,CDM,301,RC,83864,CPT,,,facility,outpatient,,,250.60000,238.07000,The Alliance,Premier SAS,90,182.51,,,,,,,28.00,1341.13,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U CREAT (LSDS) SO",84560,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.60000,43.32000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"LYSOSOMAL STORAGE SCRN, R, U OLIGO (LSDS) SO",84561,CDM,301,RC,84377,CPT,,,facility,outpatient,,,48.40000,45.98000,The Alliance,Premier SAS,90,39.28,,,,,,,5.68,288.61,fee schedule,
CATHETER BLNDIL 9MM 75CM PCLTXL LUTONIX 035 60MM.,84562,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,The Alliance,Premier SAS,,2256.56,,,,,,,2256.56,4916.25,percent of total billed charges,
IOPAMIDOL SOLN 76% 500 ML,84564,CDM,250,RC,Q9967,HCPCS,00270131695,NDC,facility,outpatient,1,mL,1.61000,1.53000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,1.56,fee schedule,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 40 ML,84565,CDM,250,RC,J0744,HCPCS,00409477886,NDC,facility,outpatient,40,EA,0.27000,0.26000,The Alliance,Premier SAS,,3.71,,,,,,,0.13500,3.83,fee schedule,
CATHETER BLNDIL 2CM ACPT .014IN GW 4FR SHTH PTA,84566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.0X12MM,84567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
HYPERS PNEUMONITIS PNL (FHSPP) SO,84569,CDM,300,RC,86001,CPT,,,facility,outpatient,,,68.70000,65.26000,The Alliance,Premier SAS,90,50.83,,,,,,,4.57,373.51,fee schedule,
TUBE VENT DIA1.14MM INTERFLANGE DISTANCE,84570,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,86.68000,82.35000,The Alliance,Premier SAS,,39.79,,,,,,,39.79,86.68,percent of total billed charges,
CATH ANGIO ST JR4 6FR 100CM,84571,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,The Alliance,Premier SAS,,16.85,,,,,,,16.85,36.72,percent of total billed charges,
MICROCATHETER INFUS 2.4FR L150CM 0.021IN,84572,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1310.63000,1245.10000,The Alliance,Premier SAS,,601.58,,,,,,,601.58,1310.63,percent of total billed charges,
GRAFT EVAR L111MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD W5.37XH8.08CM D0.99CM IS-1,84575,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier SAS,,18699.66,,,,,,,18699.66,40740.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X18MM,84576,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X33MM,84577,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATH EP L95CM OD7FR 5MM SPC 2MM TIP STEER DUO,84578,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,The Alliance,Premier SAS,,1506.09,,,,,,,1506.09,3281.25,percent of total billed charges,
CATH IMPRESS STR 5FR 40CM,84579,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,The Alliance,Premier SAS,,22.95,,,,,,,22.95,50.00,percent of total billed charges,
CATH BLLN CONQ 40 7X10X75CM,84581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X12MM,84582,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L20MM DIA6MM CATH L135CM 0.035IN NIT LP,84583,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier SAS,,2692.03,,,,,,,2692.03,5865.00,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 0.4 GM,84585,CDM,250,RC,A9150,HCPCS,0057400693000040,NDC,facility,outpatient,1,EA,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
VALVE AORT 23MM PERICARD BIOPROSTHESIS REDUC,84588,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18910.00000,17964.50000,The Alliance,Premier SAS,,8679.69,,,,,,,8679.69,18910.00,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X15MM,84590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
NM Y-90 PLANNING,84592,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,The Alliance,Premier SAS,,1765.41,,,,,,,381.55,2489.02,percent of total billed charges,
PHENOL INJECTION 5%,84593,CDM,250,RC,38779-1938-08-01000,NDC,,,facility,outpatient,1,mL,8.44000,8.02000,The Alliance,Premier SAS,,5.81,,,,,,,4.22,8.19,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 12 ML,84594,CDM,636,RC,J9299,HCPCS,00003375614,NDC,facility,outpatient,1,mL,776.38000,737.56000,The Alliance,Premier SAS,,52.83,,,,,,,33.00,753.09,fee schedule,
STENT URET 6FR L26CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,84597,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 9X30MM,84598,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
GABAPENTIN LIQ 250 MG/5 ML UD,84599,CDM,250,RC,42192-0608-45,NDC,,,facility,outpatient,1,mL,2.17000,2.06000,The Alliance,Premier SAS,,1.49,,,,,,,1.08,2.10,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 50 LENGTH, 10",84600,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
CATH BLLN CONQ 40 6X4X50CM,84602,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, NUCLEIC ACID AMPLIFICATION, VARIES (CTRNA) SO",84603,CDM,300,RC,87491,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"NEISSERIA GONORRHOEAE, NUCLEIC ACID AMPLIFICATION, VARIES (GCRNA) SO",84604,CDM,300,RC,87591,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"TRICHOMONAS VAGINALIS, NUCLEIC ACID AMPLIFICATION, VARIES (MTRNA) SO",84605,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
BLASTOMYCES AB IMMUNODIFFUSION (SBL) SO,84606,CDM,300,RC,86612,CPT,,,facility,outpatient,,,106.00000,100.70000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,16714018701,NDC,facility,outpatient,1,EA,18.33000,17.41000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,17.78,fee schedule,
SIROLIMUS TAB 0.5 MG,84607,CDM,250,RC,J7520,HCPCS,59762100101,NDC,facility,outpatient,1,EA,13.76000,13.07000,The Alliance,Premier SAS,,1.54,,,,,,,1.54,13.35,fee schedule,
URETEROSCOPE FLEXIBLE GLOBL STD DISP LITHOVUE,84622,CDM,278,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
PRB OPTABLATE DUAL 15MM,84623,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Premier SAS,,7119.39,,,,,,,7119.39,15510.66,percent of total billed charges,
GRAFT HUM TISS W25XL30MM ACELLULR DERM MTRX,84625,CDM,278,RC,Q4125,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,,1805.25,,,,,,,1805.25,3933.00,percent of total billed charges,
"STRIP, GROOVE 2.5 (5/BX)",84626,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,53.56000,50.88000,The Alliance,Premier SAS,,24.58,,,,,,,24.58,53.56,percent of total billed charges,
GRAFT EVAR L96MM DIA30MM SHTH OD7.7MM ID6.7MM AORT VES,84627,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 125CM PERI TRBO ELT,84628,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
NEEDLE KYPHOPLASTY 11GA CRV FOR BNE CEM DEL,84629,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1567.50000,1489.12000,The Alliance,Premier SAS,,1078.44,,,,,,,783.75,1520.47,percent of total billed charges,
"IDENTITI, LIF SPACER, 10 HEIGHT, 18 WIDTH, 60 LENGTH, 0",84630,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
SYSTEM VEIN CLSR VENASEAL,84631,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,6258.30000,5945.38000,The Alliance,Premier SAS,,2872.56,,,,,,,2872.56,6258.30,percent of total billed charges,
CATH WTCHMAN DLVR SYS DBL FXD  M635TU80020,84634,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,The Alliance,Premier SAS,,1583.55,,,,,,,1583.55,3450.00,percent of total billed charges,
"ADENOVIRUS (ADV), MOLECULAR DETECTION, PCR SO",84635,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
VISTASEAL FIBRIN SEALANT 10 ML HUM PLSM,84637,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1938.64000,1841.71000,The Alliance,Premier SAS,,1333.78,,,,,,,142.07,1880.48,percent of total billed charges,
RALTEGRAVIR TAB-CHEW 100 MG,84638,CDM,636,RC,00006-0477-61,NDC,,,facility,outpatient,1,EA,25.15000,23.90000,The Alliance,Premier SAS,,17.30,,,,,,,12.57,24.40,percent of total billed charges,
GRAFT EVAR L82MM DIA24MM SHTH OD7.1MM ID6MM AORT VES,84640,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
INHERITEST CF/SMA PANEL (452172) SO,84643,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Premier SAS,90,3562.37,,,,,,,210.00,26177.94,fee schedule,
INHERITEST CF/SMA PANEL-2 (452172) SO,84644,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier SAS,90,877.89,,,,,,,109.60,6451.13,fee schedule,
"HIV-1 GENOTYPIC DRUG RESISTANCE, P (HIVDR) SO",84645,CDM,310,RC,0219U,HCPCS,,,facility,outpatient,,,5957.00000,5659.15000,The Alliance,Premier SAS,90,4098.42,,,,,,,2537.50,5778.29,percent of total billed charges,
FIBRIN CLOT TECH,84646,CDM,300,RC,83872,CPT,,,facility,outpatient,,,66.00000,62.70000,The Alliance,Premier SAS,,41.58,,,,,,,5.86,305.58,fee schedule,
PEGCETACOPLAN SOLN 15 MG/ 0.1 ML,84648,CDM,636,RC,J2781,HCPCS,73606002001,NDC,facility,outpatient,1,mL,41610.00000,39529.50000,The Alliance,Premier SAS,,227.20,,,,,,,141.91,40361.70,fee schedule,
ORITAVANCIN POWD-INJ 400 MG (ORBACTIV),84651,CDM,636,RC,J2407,HCPCS,70842014003,NDC,facility,outpatient,1,EA,2516.97000,2391.12000,The Alliance,Premier SAS,,45.66,,,,,,,28.52,2441.46,fee schedule,
STENT PERIPH L29MM DIA6-8MM CATH L135CM INTRO 7FR 0.035IN SS,84652,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
VEST COMPRESSION MALE SIZE MEDIUM,84654,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier SAS,,106.83,,,,,,,77.64,150.62,percent of total billed charges,
BIMATOPROST SOLN-OPHTH 0.01% 2.5 ML,84655,CDM,250,RC,00023-3205-03,NDC,,,facility,outpatient,1,mL,260.44000,247.42000,The Alliance,Premier SAS,,179.18,,,,,,,130.22,252.63,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,27241019990,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
DROXIDOPA CAP 100 MG,84656,CDM,250,RC,J8499,HCPCS,31722001490,NDC,facility,outpatient,1,EA,3.51000,3.34000,The Alliance,Premier SAS,,2.41,,,,,,,1.75,3.40,percent of total billed charges,
"HYPERBARIC OXYGEN,CHAMB",84657,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
MOXIFLOXACIN-TRIAMCINOLONE 1 MG-15 MG/ML 0.6 ML INTRAOCULAR,84661,CDM,250,RC,71384-0746-06,NDC,,,facility,outpatient,1,mL,7.11000,6.75000,The Alliance,Premier SAS,,4.89,,,,,,,3.56,6.90,percent of total billed charges,
SLEEVE SILICONE LACE CIRC BAND,84662,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,38.40000,36.48000,The Alliance,Premier SAS,,17.63,,,,,,,17.63,38.40,percent of total billed charges,
BLLN RX NC TREK NEO 1.5X20MM,84664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
IOPAMIDOL SOLN 61% 30 ML,84665,CDM,250,RC,Q9967,HCPCS,00270131525,NDC,facility,outpatient,1,mL,2.32000,2.21000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,2.25,fee schedule,
IOPAMIDOL SOLN 61% 15 ML,84666,CDM,250,RC,Q9967,HCPCS,00270141215,NDC,facility,outpatient,1,mL,18.09000,17.19000,The Alliance,Premier SAS,,0.24015,,,,,,,0.22165,17.55,fee schedule,
METHOTREXATE POWD-INJ 1000 MG,84667,CDM,250,RC,J9260,HCPCS,63323012250,NDC,facility,outpatient,1,EA,200.98000,190.93000,The Alliance,Premier SAS,,3.62,,,,,,,3.62,194.95,fee schedule,
GNRTR VISIONIST X4 CRT-P U228,84669,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier SAS,,9533.43,,,,,,,9533.43,20770.00,percent of total billed charges,
SYS JADA  VACUUM-INDUCED HMRHGE CNTRL SYS  BL SEAL VLV GRN BX INC ACC KT LEG IT JADA-2002,84670,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier SAS,,2209.05,,,,,,,2209.05,4812.75,percent of total billed charges,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES (CFMP) SO",84673,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4573.00000,4344.35000,The Alliance,Premier SAS,90,3562.37,,,,,,,210.00,26177.94,fee schedule,
"CYSTIC FIBROSIS, CFTR GENE, VARIANT PANEL, VARIES DUP/DEL (CFMP) SO",84675,CDM,310,RC,81222,CPT,,,facility,outpatient,,,3575.00000,3396.25000,The Alliance,Premier SAS,90,2786.13,,,,,,,103.64,20473.75,fee schedule,
CAGE SPNL H10MM 32X21MM 7DEG STD LORD ALIF TI NANOLOCK SURF,84677,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Premier SAS,,11548.68,,,,,,,11548.68,25160.53,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,CPT,,,facility,outpatient,,,288.33000,273.91000,The Alliance,Premier SAS,,198.37,,,,,,,144.16,279.68,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (TRUMENBA)",84678,CDM,250,RC,90621,HCPCS,00005010005,NDC,facility,outpatient,1,mL,576.66000,547.83000,The Alliance,Premier SAS,,396.74,,,,,,,145.98,559.36,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 26MM,84679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Premier SAS,,32772.60,,,,,,,32772.60,71400.00,percent of total billed charges,
TESTOSTERONE IMPLANT 75 MG,84680,CDM,250,RC,J3490,HCPCS,66887000420,NDC,facility,outpatient,1,EA,432.53000,410.90000,The Alliance,Premier SAS,,297.58,,,,,,,216.26,419.55,percent of total billed charges,
LIDOCAINE GEL 2% 11 ML,84681,CDM,250,RC,25021-0673-77,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,The Alliance,Premier SAS,,1.25,,,,,,,0.91000,1.77,percent of total billed charges,
"EPSTEIN-BARR VIRUS (EBV), MOL DET, PCR, VARIES (EBVPV) SO",84682,CDM,300,RC,87798,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
CATHETER EP 8FR L120CM 5MM SPC BSKT DIA60MM 64 ELECTRD MAP,84683,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER VASC GUID AMPLATZ L .75 W/ SIDE H,84684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier SAS,,260.25,,,,,,,260.25,567.00,percent of total billed charges,
XR INS CVC WO SUBQ PORT 5YR>,84692,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,The Alliance,Premier SAS,,7569.00,,,,,,,1189.65,7803.00,case rate,
XR INS TUN CATH CVAD W PORT >5Y,84694,CDM,361,RC,36561,CPT,,,facility,outpatient,,,9216.00000,8755.20000,The Alliance,Premier SAS,,7569.00,,,,,,,2988.68,8939.52,case rate,
Q4159 AFFINITY 2.5 X 2.5 CM (6.25 TTL SQ CM),84695,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,1035.00000,983.25000,The Alliance,Premier SAS,,376.51,,,,,,,376.51,1003.95,fee schedule,
Q4197 PURAPLY XT PER SQ CM 4.91 X 4.91,84696,CDM,636,RC,Q4197,HCPCS,,,facility,outpatient,,,421.60000,400.52000,The Alliance,Premier SAS,,113.74,,,,,,,113.74,408.95,fee schedule,
TECLISTAMAB CQYV SOLN 10 MG/ML 3 ML (TECVAYLI),84699,CDM,636,RC,J9380,HCPCS,57894044901,NDC,facility,outpatient,1,mL,1604.51000,1524.28000,The Alliance,Premier SAS,,53.27,,,,,,,33.27,1556.37,fee schedule,
TECLISTAMAB CQYV SOLN 90 MG/ML 1.7 ML,84700,CDM,636,RC,J9380,HCPCS,57894045001,NDC,facility,outpatient,1,mL,10593.45000,10063.78000,The Alliance,Premier SAS,,53.27,,,,,,,33.27,10275.65,fee schedule,
DEVICE EMBOLIC PROTCT FLTR L7MM GWIRE,84701,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,1635.19,,,,,,,1635.19,3562.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 4 HEIGHT, 18 WIDTH, 60 LENGTH, 10",84702,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,The Alliance,Premier SAS,,5335.88,,,,,,,5335.88,11625.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 65CM HDRPH GORE DRYSEAL,84703,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,The Alliance,Premier SAS,,1805.25,,,,,,,1805.25,3933.00,percent of total billed charges,
NM LUTATHERA LU177 WASTE,84704,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,The Alliance,Premier SAS,JW,298.59,,,,,,,217.00,488.81,percent of total billed charges,
HIV-1/HIV-2 RNA DETECT (HIP12) SO,84705,CDM,300,RC,87535,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
HIV-1/HIV-2 RNA DETECT-2 (HIP12) SO,84706,CDM,300,RC,87538,CPT,,,facility,outpatient,,,316.60000,300.77000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
MICROCATHETER VASC L135CM OD2.9X2.1FR,84707,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
KIT FRACTURE 11GA 15MM OMNICURVE,84708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Premier SAS,,3751.43,,,,,,,3751.43,8173.05,percent of total billed charges,
IMMUNE GLOBULIN SOLN (GAMASTAN) 10 ML,84710,CDM,636,RC,J1460,HCPCS,13533033512,NDC,facility,outpatient,1,mL,150.22000,142.71000,The Alliance,Premier SAS,,77.52,,,,,,,48.42,145.71,fee schedule,
"ALDOLASE, SERUM (ALS) SO",84711,CDM,300,RC,82085,CPT,,,facility,outpatient,,,79.80000,75.81000,The Alliance,Premier SAS,90,69.31,,,,,,,10.03,509.30,fee schedule,
RED 43 REPERFUSION CATH,84712,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,The Alliance,Premier SAS,,3911.37,,,,,,,3911.37,8521.50,percent of total billed charges,
CATH REPERFUS RED 72 138CM,84713,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,15391.50000,14621.92000,The Alliance,Premier SAS,,7064.70,,,,,,,7064.70,15391.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 3 ML,84718,CDM,636,RC,90375,HCPCS,13533031803,NDC,facility,outpatient,1,mL,1762.49000,1674.36000,The Alliance,Premier SAS,,426.57,,,,,,,266.44,1709.62,fee schedule,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6350-01,NDC,,,facility,outpatient,1,mL,41.08000,39.03000,The Alliance,Premier SAS,,28.26,,,,,,,20.54,39.85,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71266-6360-01,NDC,,,facility,outpatient,1,mL,46.94000,44.59000,The Alliance,Premier SAS,,32.29,,,,,,,23.47,45.53,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71384-0650-01,NDC,,,facility,outpatient,1,mL,2.92000,2.78000,The Alliance,Premier SAS,,2.01,,,,,,,1.46,2.83,percent of total billed charges,
LIDOCAINE-PHENYLEPHRINE SOLN-OPHTH 1%-1.5% 1ML,84730,CDM,250,RC,71449-0090-42,NDC,,,facility,outpatient,1,mL,66.36000,63.04000,The Alliance,Premier SAS,,45.66,,,,,,,33.18,64.37,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/1 ML,84731,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,The Alliance,Premier SAS,,12.25,,,,,,,8.90,17.27,percent of total billed charges,
UTERINE VACUUM PLACEMENT,84733,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,The Alliance,Premier SAS,,255.59,,,,,,,185.75,360.36,percent of total billed charges,
CATH MAP OPTRELL D-F CRV,84734,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
PROBE ABLAT 17GA L20CM CBL L1.4M PERC ACT,84735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier SAS,,3851.19,,,,,,,3851.19,8390.40,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM,84738,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,The Alliance,Premier SAS,,5206.39,,,,,,,5206.39,11342.90,percent of total billed charges,
"SIROLIMUS, BLOOD",84739,CDM,300,RC,80195,CPT,,,facility,outpatient,,,124.00000,117.80000,The Alliance,Premier SAS,,97.03,,,,,,,13.73,713.01,fee schedule,
"EVEROLIMUS,BLOOD",84740,CDM,300,RC,80169,CPT,,,facility,outpatient,,,123.00000,116.85000,The Alliance,Premier SAS,,97.03,,,,,,,13.73,713.01,fee schedule,
ALBUTEROL NEB 5 MG/ML 5 ML,84741,CDM,250,RC,J7611,HCPCS,69374033005,NDC,facility,outpatient,1,mL,6.32000,6.00000,The Alliance,Premier SAS,,0.25616,,,,,,,0.25616,6.13,fee schedule,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 10 GM,84743,CDM,636,RC,J1561,HCPCS,13533080071,NDC,facility,outpatient,1,mL,44.13000,41.93000,The Alliance,Premier SAS,,76.90,,,,,,,22.07,80.87,fee schedule,
DOSTARLIMAB-GXLY SOLN 50 MG/ML 10 ML (JEMPERLI),84744,CDM,636,RC,J9272,HCPCS,00173089803,NDC,facility,outpatient,1,mL,2518.47000,2392.54000,The Alliance,Premier SAS,,390.36,,,,,,,243.82,2442.92,fee schedule,
PSYLLIUM CAP,84745,CDM,250,RC,37000-0405-14,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,The Alliance,Premier SAS,,0.35776,,,,,,,0.26000,0.50440,percent of total billed charges,
GWIRE PGBCK CONV 0.014 145CM,84758,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,5520.00000,5244.00000,The Alliance,Premier SAS,,2533.68,,,,,,,2533.68,5520.00,percent of total billed charges,
CATH /CANNULA PERF W/ 180DEG DIL CIRC BUB TRAP,84759,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30450.00000,28927.50000,The Alliance,Premier SAS,,13976.55,,,,,,,13976.55,30450.00,percent of total billed charges,
BLLN RX NC TREK NEO 4.5X20MM,84760,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER SHTH 26FR L33CM OD9.5MM ID8.7MM,84761,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,The Alliance,Premier SAS,,1383.88,,,,,,,1383.88,3015.00,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 25 ML,84762,CDM,250,RC,68462-0532-28,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,The Alliance,Premier SAS,,2.61,,,,,,,1.90,3.68,percent of total billed charges,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,72677055101,NDC,facility,outpatient,1,mL,9246.90000,8784.55000,The Alliance,Premier SAS,,791.58,,,,,,,494.43,8969.49,fee schedule,
INEBILIZUMAB-CDON SOLN 10 MG/ML 10 ML (UPLIZNA),84763,CDM,636,RC,J1823,HCPCS,75987015003,NDC,facility,outpatient,1,mL,9459.55000,8986.57000,The Alliance,Premier SAS,,791.58,,,,,,,494.43,9175.76,fee schedule,
PHENOL TOPICAL 89% 100 ML,84764,CDM,250,RC,38779-1938-05,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,The Alliance,Premier SAS,,0.27520,,,,,,,0.20000,0.38800,percent of total billed charges,
INTRO 9FRX25CM SHTH W/ .038IN GWIRE ENGAGE,84782,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,The Alliance,Premier SAS,,39.47,,,,,,,39.47,86.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,CPT,,,facility,outpatient,,,95.22000,90.46000,The Alliance,Premier SAS,,65.51,,,,,,,47.61,92.36,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (QUADRACEL)",84786,CDM,250,RC,90696,HCPCS,49281056415,NDC,facility,outpatient,1,mL,190.45000,180.93000,The Alliance,Premier SAS,,131.03,,,,,,,95.22,184.74,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.75%-1  200,000 30 ML",84787,CDM,250,RC,63323-0460-37,NDC,,,facility,outpatient,1,mL,1.24000,1.18000,The Alliance,Premier SAS,,0.85312,,,,,,,0.62000,1.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,55150047110,NDC,facility,outpatient,1,EA,63.52000,60.34000,The Alliance,Premier SAS,,43.70,,,,,,,9.78,61.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.25 GM,84788,CDM,636,RC,J3371,HCPCS,67457082399,NDC,facility,outpatient,1,EA,57.15000,54.29000,The Alliance,Premier SAS,,39.32,,,,,,,9.78,55.44,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,00143914025,NDC,facility,outpatient,1,EA,27.73000,26.34000,The Alliance,Premier SAS,,1.46,,,,,,,0.91000,26.90,fee schedule,
CEFAZOLIN POWD-INJ 3 GM,84789,CDM,636,RC,J0688,HCPCS,44567084525,NDC,facility,outpatient,1,EA,18.64000,17.71000,The Alliance,Premier SAS,,1.46,,,,,,,0.91000,18.08,fee schedule,
COIL TARGET TETRA 2.0MMX4.5CM.,84790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX6.0CM.,84791,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 2.5MMX6.0CM,84792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.0MMX4.5CM.,84793,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER CATH 5FR L10.5CM PTFE LOK LUER CLLR HUB LONGER T,84794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 8X30MM,84795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
STENT PERIPH 8FR L5CM CATH L120CM VES,84796,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,The Alliance,Premier SAS,,4661.42,,,,,,,4661.42,10155.60,percent of total billed charges,
BALLOON DIL PER DORADO 035IN 5X4 80CM,84797,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
GUIDEWIRE AMPLATZ ULT STF 035INX180CM,84799,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,104.00000,98.80000,The Alliance,Premier SAS,,47.74,,,,,,,47.74,104.00,percent of total billed charges,
UROLIFT 2 IMPL CART,84800,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier SAS,,1662.73,,,,,,,1662.73,3622.50,percent of total billed charges,
KIT CART HNDL FOR UROLIFT 2,84801,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier SAS,,1662.73,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER GUID 0.088IN 2SH AMPLATZ L .75 8FR,84802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,The Alliance,Premier SAS,,260.25,,,,,,,260.25,567.00,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN HYDRPHLC COR,84803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,The Alliance,Premier SAS,,129.09,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X25MM,84804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DOXYCYCLINE LIQ 5 MG/ML,84805,CDM,250,RC,J8499,HCPCS,68180065701,NDC,facility,outpatient,1,mL,0.96000,0.91000,The Alliance,Premier SAS,,0.66048,,,,,,,0.48000,0.93120,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 150 MG/ ML (SKYRIZI),84814,CDM,250,RC,J3490,HCPCS,00074105001,NDC,facility,outpatient,1,mL,39932.98000,37936.33000,The Alliance,Premier SAS,,27473.89,,,,,,,19966.49,38734.99,percent of total billed charges,
BLLN RX NC TREK NEO 3.25X6MM,84815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
FLUORESCEIN-BENOXINATE SOLN-OPHTH  0.4%-0.3% 5 ML,84816,CDM,250,RC,68682-0732-05,NDC,,,facility,outpatient,1,mL,20.22000,19.21000,The Alliance,Premier SAS,,13.91,,,,,,,10.11,19.61,percent of total billed charges,
HYDROGEN PEROXIDE  LIQ 1.5% MOUTHWASH 480 ML,84817,CDM,250,RC,10310-0680-16,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,The Alliance,Premier SAS,,0.32336,,,,,,,0.23500,0.45590,percent of total billed charges,
RALTEGRAVIR PKT PWD 100 MG,84818,CDM,250,RC,J8499,HCPCS,00006360361,NDC,facility,outpatient,1,EA,26.29000,24.98000,The Alliance,Premier SAS,,18.09,,,,,,,13.14,25.50,percent of total billed charges,
ACETIC ACID SOLN-IRR 5% 50 ML,84819,CDM,250,RC,51552-0055-03,NDC,,,facility,outpatient,1,mL,0.62000,0.59000,The Alliance,Premier SAS,,0.42656,,,,,,,0.31000,0.60140,percent of total billed charges,
CATHETER PCNG 5FR 18GA 110 CM CHLRPRP HI LT ORNG.,84820,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1646.25000,1563.94000,The Alliance,Premier SAS,,755.63,,,,,,,755.63,1646.25,percent of total billed charges,
IMMOBILIZER KNEE L16IN FOR 25IN THGH FOAM,84836,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier SAS,,76.88,,,,,,,36.80,93.98,fee schedule,
MECLIZINE TAB-CHEW 25 MG,84849,CDM,250,RC,00536-1018-10,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,The Alliance,Premier SAS,,0.06192,,,,,,,0.04500,0.08730,percent of total billed charges,
SET URET STNT 8FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,84859,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER ASPIR 6FR L19X106CM WRK L125CM,84860,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier SAS,,3555.86,,,,,,,3555.86,7746.98,percent of total billed charges,
SCREWDRIVER SURG DISP N CANN NAVIGUS.,84866,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,480.00000,456.00000,The Alliance,Premier SAS,,330.24,,,,,,,240.00,465.60,percent of total billed charges,
CATH BALLOON OMNICURVE KYPHO 11GAX20MM.,84867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8173.05000,7764.40000,The Alliance,Premier SAS,,3751.43,,,,,,,3751.43,8173.05,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN PERIPH COMPLX L VOL SFT FILL,84868,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L12CM DIA3MM 0.02IN PERIPH COMPLX STD FRME,84869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
"WILSON DISEASE, ATP7B FULL GENE SEQ W/DEL/DUP (WNDZ) SO",84871,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4073.00000,3869.35000,The Alliance,Premier SAS,90,1811.22,,,,,,,282.88,13309.69,fee schedule,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00254301255,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Premier SAS,,279.95,,,,,,,203.46,394.70,percent of total billed charges,
ALVIMOPAN CAP 12 MG,84872,CDM,250,RC,J8499,HCPCS,00591231215,NDC,facility,outpatient,1,EA,406.91000,386.57000,The Alliance,Premier SAS,,279.95,,,,,,,203.46,394.70,percent of total billed charges,
CT OMNIPAQUE 350 500ML,84873,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,,0.72045,,,,,,,0.63085,1.29,fee schedule,
GRAFT EVAR L93MM DIA16X10MM CATH 14FR POLY NIT STNT HYDRPHLC,84874,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,The Alliance,Premier SAS,,5939.18,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA11-16MM CATH L135CM,84876,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L59MM DIA11-16MM CATH L135CM,84877,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR STNT L29MM DIA8-11MM CATH L135CM,84878,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR L39MM DIA24MM INTRO SHTH OD6MM ID5.3MM WVN POLY.,84879,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
WEDGE HEEL 3/4 2.5X9/16 HAPD,84880,CDM,274,RC,L3300,HCPCS,,,facility,outpatient,,,35.16000,33.40000,The Alliance,Premier SAS,,70.13,,,,,,,17.58,72.27,fee schedule,
STENT PERIPH L79MM DIA11X16MM CATH L135CM,84881,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,The Alliance,Premier SAS,,5039.91,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X33MM,84882,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.1% 0.3 ML,84883,CDM,250,RC,71266-8613-01,NDC,,,facility,outpatient,1,mL,309.57000,294.09000,The Alliance,Premier SAS,,212.98,,,,,,,154.78,300.28,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00067-8152-02,NDC,,,facility,outpatient,1,GM,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
DICLOFENAC GEL 1% 50 GM,84884,CDM,250,RC,00536-1294-34,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,The Alliance,Premier SAS,,0.38528,,,,,,,0.28000,0.54320,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y <7HR TECH 95782 52,84886,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,The Alliance,Premier SAS,52,2337.00,,,,,,,1929.64,11473.16,per diem,
PSG SL STG/ATT>=4PM<6Y/PAP<7H TECH 95783 TC,84888,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,10470.18,per diem,
SPCR SPNL SZ B 13MM CERVICOTHORACOLUMBAR SLF EXPND,84895,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Premier SAS,,10757.12,,,,,,,10757.12,23436.00,percent of total billed charges,
GUAIFENESIN-PSEUDOEPHEDRINE TAB-ER 600 MG-60 MG,84896,CDM,250,RC,45802-0230-89,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,The Alliance,Premier SAS,,1.05,,,,,,,0.76000,1.47,percent of total billed charges,
ABDOMINAL BIND 9 IN M/L,84897,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,21.64000,20.56000,The Alliance,Premier SAS,,14.89,,,,,,,10.82,20.99,percent of total billed charges,
BLLN CROSSTELLA RX 2X200X200CM,84898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
IMMOBILIZER KNEE L24IN FOR 25IN THGH FOAM,84900,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier SAS,,76.88,,,,,,,36.80,93.98,fee schedule,
"PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD (PETH) SO",84901,CDM,300,RC,80321,CPT,,,facility,outpatient,,,940.00000,893.00000,The Alliance,Premier SAS,90,646.72,,,,,,,470.00,911.80,percent of total billed charges,
"FECAL MICROBIOTA, LIVE ENEMA 150 ML (REYOTA)",84902,CDM,250,RC,J1440,HCPCS,55566980002,NDC,facility,outpatient,1,mL,189.60000,180.12000,The Alliance,Premier SAS,,102.51,,,,,,,64.03,183.91,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEAS (AMLMRD) SO,84903,CDM,311,RC,88184,CPT,,,facility,outpatient,,,584.00000,554.80000,The Alliance,Premier SAS,90,433.58,,,,,,,292.00,3186.14,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD)SO,84904,CDM,311,RC,88185,CPT,,,facility,outpatient,,,187.80000,178.41000,The Alliance,Premier SAS,90,143.23,,,,,,,77.53,1052.52,fee schedule,
ACUTE MYELOID LEUKEMIA MEAS RESIDUAL DISEASE (AMLMRD) SO,84905,CDM,311,RC,88187,CPT,,,facility,outpatient,,,278.30000,264.38000,The Alliance,Premier SAS,90,253.37,,,,,,,125.97,1861.90,fee schedule,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP) SO",84906,CDM,300,RC,86631,CPT,,,facility,outpatient,,,97.10000,92.24000,The Alliance,Premier SAS,90,83.17,,,,,,,8.17,611.15,fee schedule,
"INTERLEUKIN-6, PLASMA (IL6DX) SO",84907,CDM,300,RC,83529,CPT,,,facility,outpatient,,,141.90000,134.80000,The Alliance,Premier SAS,90,112.03,,,,,,,17.85,823.21,fee schedule,
UMBILICAL CORD DRUG TESTING PANEL 14 SO,84908,CDM,300,RC,80307,CPT,,,facility,outpatient,,,510.50000,484.97000,The Alliance,Premier SAS,90,413.53,,,,,,,63.40,3038.81,fee schedule,
"CHLAMYDIA IGM & IGG PANEL, IMMUNOFLUORESCENCE (CHLAP)SO",84909,CDM,300,RC,86632,CPT,,,facility,outpatient,,,104.20000,98.99000,The Alliance,Premier SAS,90,90.10,,,,,,,8.17,662.12,fee schedule,
"THIOPURINE METHYLTRANSFRASE ACTIVITY PROFILE, ERYTHROCYTES (TPMT3) SO",84910,CDM,300,RC,82657,CPT,,,facility,outpatient,,,524.00000,497.80000,The Alliance,Premier SAS,90,140.92,,,,,,,22.91,1035.56,fee schedule,
"AMIKACIN, PEAK, SERUM (PAMIK) SO",84911,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Premier SAS,90,106.27,,,,,,,15.58,780.94,fee schedule,
OSTEOCALCIN (OSCAL) SO,84912,CDM,300,RC,83937,CPT,,,facility,outpatient,,,245.20000,232.94000,The Alliance,Premier SAS,90,212.54,,,,,,,30.84,1561.82,fee schedule,
MEXILETINE (MEX) SO,84914,CDM,300,RC,80299,CPT,,,facility,outpatient,,,153.20000,145.54000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"SEVERE CONGENITAL AND CYCLIC NEUTROPENIA GENE PANEL, VARIES (SCCNP) SO",84915,CDM,310,RC,81443,CPT,,,facility,outpatient,,,19344.00000,18376.80000,The Alliance,Premier SAS,90,15674.89,,,,,,,8569.96,115186.20,fee schedule,
EXTENDED GASTROINTESTINAL PANEL (EGIPNAT),84916,CDM,300,RC,87507,CPT,,,facility,outpatient,,,3556.00000,3378.20000,The Alliance,Premier SAS,,2964.02,,,,,,,416.78,21780.96,fee schedule,
CELIAC DISEASE COMPREHENSIVE CASCDE (CDCOM),84917,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1004.00000,953.80000,The Alliance,Premier SAS,90,868.64,,,,,,,126.29,6383.20,fee schedule,
USTEKINUMAB QN WITH ANTIBODIES (USTEK),84918,CDM,300,RC,80299,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"SARS-COV-2 SPIKE AB, SEMI-QUANT (COVSQ) SO",84919,CDM,310,RC,86769,CPT,,,facility,outpatient,,,108.40000,102.98000,The Alliance,Premier SAS,90,272.68,,,,,,,42.13,2003.75,fee schedule,
VEDOLIZUMAB QUANT W/ANTIBODIES(VEDOZ) SO,84920,CDM,300,RC,82397,CPT,,,facility,outpatient,,,126.80000,120.46000,The Alliance,Premier SAS,90,99.34,,,,,,,14.59,729.98,fee schedule,
CELIAC DISEASE COMPREHENSIVE CASCADE (CDCOM),84922,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Premier SAS,90,67.00,,,,,,,9.61,492.33,fee schedule,
"USTEKINUMAB QN WITH ANTIBODIES,SERUM (USTEK)",84923,CDM,300,RC,83520,CPT,,,facility,outpatient,,,235.20000,223.44000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
VEDOLIZUMAB QUANT WITH ANTIBODIES (VEDOZ) SO,84924,CDM,300,RC,80280,CPT,,,facility,outpatient,,,380.20000,361.19000,The Alliance,Premier SAS,90,261.58,,,,,,,30.85,368.79,percent of total billed charges,
CELIAC DISEASE SEROLOGY CASCADE (CDSP) SO,84925,CDM,300,RC,82784,CPT,,,facility,outpatient,,,76.40000,72.58000,The Alliance,Premier SAS,90,67.00,,,,,,,9.61,492.33,fee schedule,
"ENDOMYSIAL ABS, IGA (EMA) (EMAT) SO",84926,CDM,300,RC,86231,CPT,,,facility,outpatient,,,99.30000,94.33000,The Alliance,Premier SAS,90,78.21,,,,,,,12.05,574.73,fee schedule,
ENTAMOEBA HISTOLYTICAL ANTIBODY (EHOLG) SO,84927,CDM,300,RC,86753,CPT,,,facility,outpatient,,,97.90000,93.00000,The Alliance,Premier SAS,90,87.78,,,,,,,8.17,645.08,fee schedule,
"MUXF3 (CROSS-REACTIVE CARBOHYDRATE DETERMINANT), IGE (MUXF3) SO",84928,CDM,300,RC,86008,CPT,,,facility,outpatient,,,147.30000,139.94000,The Alliance,Premier SAS,90,127.06,,,,,,,17.71,933.70,fee schedule,
"TISSUE TRANSGLUTAMINASE AB, IGA OR IGG (TTGG)(TTGA) SO",84929,CDM,300,RC,86364,CPT,,,facility,outpatient,,,94.70000,89.97000,The Alliance,Premier SAS,90,73.98,,,,,,,11.53,543.65,fee schedule,
"TPMT & NUDT15 GENOTYPING, VARIES (TPNUQ) SO",84930,CDM,300,RC,0034U,HCPCS,,,facility,outpatient,,,3830.00000,3638.50000,The Alliance,Premier SAS,90,2635.04,,,,,,,1631.60,3715.10,percent of total billed charges,
"THIOPURINE METABOLITES, WHOLE BLOOD (THIO) SO",84931,CDM,300,RC,80299,CPT,,,facility,outpatient,,,461.90000,438.80000,The Alliance,Premier SAS,90,120.13,,,,,,,19.26,882.80,fee schedule,
"GLIADIN (DEAMIDATED) AB, IGA OR IGG (DAGL)(DGGL) SO",84932,CDM,300,RC,86258,CPT,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,90,78.21,,,,,,,11.53,574.73,fee schedule,
STENT PERIPH 5FR L60MM DIA6MM CATH L135CM 0.035IN LP 2 SPD.,84933,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
OXYQUINOLINE-NA LAURYL SULFATE GEL VAG 0.025% 113 GM (TRIMO-SAN),84935,CDM,250,RC,59365-5030-00,NDC,,,facility,outpatient,1,GM,0.75000,0.71000,The Alliance,Premier SAS,,0.51600,,,,,,,0.37500,0.72750,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 1 GM,84936,CDM,250,RC,81033-0025-50,NDC,,,facility,outpatient,1,GM,11.38000,10.81000,The Alliance,Premier SAS,,7.83,,,,,,,5.69,11.04,percent of total billed charges,
COIL EMB L4CM PRI DIA0.02IN 2ND DIA2MM COMPLX SFT FILL L VOL,84941,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,The Alliance,Premier SAS,,1359.79,,,,,,,1359.79,2962.50,percent of total billed charges,
PRB CERTUS PR15 17GA 20CM,84943,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,The Alliance,Premier SAS,,3851.19,,,,,,,3851.19,8390.40,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 141 GM,84944,CDM,250,RC,41167-0057-24,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,The Alliance,Premier SAS,,0.11696,,,,,,,0.08500,0.16490,percent of total billed charges,
STENT PERIPH 5FR L150MM DIA5MM CATH L135CM 0.035IN NIT LP,84946,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Premier SAS,,1265.12,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH PTCA L137CM L6MM DIA3MM 20ATM 0.014IN.,84948,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MRI ENTEROGRAPHY ABD,84950,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,The Alliance,Premier SAS,,1810.00,,,,,,,339.11,4230.17,per diem,
MRI ENTEROGRAPHY PELVIS,84951,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,The Alliance,Premier SAS,,1810.00,,,,,,,339.11,4221.44,per diem,
EMG NEEDLE HEMIDIAPHRAGM 95866 TC,84953,CDM,922,RC,95866,CPT,,,facility,outpatient,,,769.00000,730.55000,The Alliance,Premier SAS,TC,529.07,,,,,,,384.50,745.93,percent of total billed charges,
XR FLUORO DRAINAGE VISCERAL W GUID,84956,CDM,320,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,The Alliance,Premier SAS,,3155.86,,,,,,,1308.97,4449.39,percent of total billed charges,
PACK PROCEDURE CUSTOM BARRIGEL,84957,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10385.00000,9865.75000,The Alliance,Premier SAS,,4766.72,,,,,,,4766.72,10385.00,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X20MM,84958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
LIGHTNING FLSH CATH 115CM HTORQ + LIGHTNING,84960,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Premier SAS,,13901.73,,,,,,,13901.73,30287.00,percent of total billed charges,
LUBIPROSTONE CAP 8 MCG,84961,CDM,250,RC,43598-0163-60,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,The Alliance,Premier SAS,,4.99,,,,,,,3.62,7.03,percent of total billed charges,
NM SMT I-131 THERAPY 1 CAPSULE,84962,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,The Alliance,Premier SAS,,24.77,,,,,,,18.00,38.16,percent of total billed charges,
MOXIFLOXACIN SOLN 5 MG/ML 1 ML INTRAOCULAR,84963,CDM,250,RC,71449-0097-42,NDC,,,facility,outpatient,1,mL,82.16000,78.05000,The Alliance,Premier SAS,,56.53,,,,,,,41.08,79.70,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 750 ML,84964,CDM,250,RC,J3490,HCPCS,14537081775,NDC,facility,outpatient,1,mL,0.08000,0.08000,The Alliance,Premier SAS,,0.05504,,,,,,,0.04000,0.07760,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 2.3 ML,84965,CDM,636,RC,J1305,HCPCS,61755001301,NDC,facility,outpatient,1,mL,9633.00000,9151.35000,The Alliance,Premier SAS,,303.79,,,,,,,189.75,9344.01,fee schedule,
AMPICILLIN-SULBACTAM SOLN SD 45 MG/ML,84966,CDM,250,RC,J0295,HCPCS,6745703481004500,NDC,facility,outpatient,1,mL,5.09000,4.83000,The Alliance,Premier SAS,,2.39,,,,,,,2.39,4.94,fee schedule,
STENT BILI AD L60MM DIA9MM CATH 6FR L80CM LIFESTENT,84969,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
PRB OPTABLATE DUAL 20MM,84970,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,15510.66000,14735.13000,The Alliance,Premier SAS,,7119.39,,,,,,,7119.39,15510.66,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3.5 CRV PTFE LNR,84971,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GUID 6FR ID0.07IN VL3 CRV PTFE LNR,84972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L20CM DIA0.02IN LOOP DIA4MM COMPLX STD FRME RUBY,84975,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
KIT PERI CATH L57CM OD4.9MM ID2.6MM TRNSLUC,84976,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,422.74000,401.60000,The Alliance,Premier SAS,,194.04,,,,,,,194.04,422.74,percent of total billed charges,
CATH INARI TRV16 CRV 16FR 110,84977,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,24800.00000,23560.00000,The Alliance,Premier SAS,,11383.20,,,,,,,11383.20,24800.00,percent of total billed charges,
GWIRE SAFARI XSUP XSM .035 275,84978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2606.25000,2475.94000,The Alliance,Premier SAS,,1196.27,,,,,,,1196.27,2606.25,percent of total billed charges,
STENT PERIPH L38MM DIA10MM CATH L135CM GWIRE 0.035IN CVR,84980,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier SAS,,5905.03,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT XIENCE SKYPNT 4.5X12MM,84981,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X23MM,84983,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERI CATHETER L62CM OD4.9MM ID2.6MM TRNSLUC SIL RUB PTFE 2.,84984,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,418.54000,397.61000,The Alliance,Premier SAS,,192.11,,,,,,,192.11,418.54,percent of total billed charges,
ROD GUIDE W/STP TROCAR TIP 230.,84985,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,145.60000,138.32000,The Alliance,Premier SAS,,66.83,,,,,,,66.83,145.60,percent of total billed charges,
SLING SHOULDER LRG ULT SFT STRP ESSNTL VP20101-040.,84987,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier SAS,,139.12,,,,,,,7.36,143.36,fee schedule,
GRAFT VASC L45CM DIA4-7MM EPTFE GRAD WALL TAPR DBL GDS,84988,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5779.41000,5490.44000,The Alliance,Premier SAS,,2652.75,,,,,,,2652.75,5779.41,percent of total billed charges,
SLING SHLDR SM ULT SOFT STRP ESSENTIAL BREG,84989,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier SAS,,139.12,,,,,,,7.36,143.36,fee schedule,
COLLAR CERV L H3.38XL18.75IN UNIV CNTOUR M,84990,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,34.24000,32.53000,The Alliance,Premier SAS,,35.57,,,,,,,17.12,36.65,fee schedule,
SHOE POSTOP M WMN 6-8 L R FT SFT HK LOOP CLSR,84991,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Premier SAS,,11.81,,,,,,,11.81,24.95,percent of total billed charges,
IMMOBILIZER KNEE L20IN FOR 25IN THGH FOAM,84992,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,73.60000,69.92000,The Alliance,Premier SAS,,76.88,,,,,,,36.80,93.98,fee schedule,
VORTIOXETINE TAB 5 MG,84993,CDM,250,RC,64764-0720-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,The Alliance,Premier SAS,,35.49,,,,,,,25.79,50.03,percent of total billed charges,
NITROGLYCERIN 2 MG/10 ML,84995,CDM,250,RC,J2305,HCPCS,0033810490200200,NDC,facility,outpatient,1,mL,0.25000,0.24000,The Alliance,Premier SAS,,2.27,,,,,,,0.12500,2.34,fee schedule,
VITAMIN B COMPLEX W/ C + FOLIC ACID CAP,85000,CDM,250,RC,63044-0622-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
SILVER GEL 45 GM,85001,CDM,250,RC,08327-0309-09,NDC,,,facility,outpatient,1,mL,1.48000,1.40000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
CLOBETASOL CREAM 0.05% 30 GM,85003,CDM,250,RC,00168-0301-30,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,The Alliance,Premier SAS,,3.58,,,,,,,2.60,5.05,percent of total billed charges,
DABIGATRAN CAP 110 MG,85004,CDM,250,RC,00597-0108-60,NDC,,,facility,outpatient,1,EA,10.45000,9.92000,The Alliance,Premier SAS,,7.19,,,,,,,5.22,10.14,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH 10.2 GM (120 DOSE),85005,CDM,250,RC,00310-7372-20,NDC,,,facility,outpatient,1,GM,67.78000,64.39000,The Alliance,Premier SAS,,46.63,,,,,,,33.89,65.75,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,00121-0942-50,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,The Alliance,Premier SAS,,1.34,,,,,,,0.97500,1.89,percent of total billed charges,
PHENOBARBITAL ELIXIR 20 MG/5 ML,85009,CDM,250,RC,60687-0671-67,NDC,,,facility,outpatient,1,mL,2.81000,2.67000,The Alliance,Premier SAS,,1.93,,,,,,,1.41,2.73,percent of total billed charges,
TRASTUZUMAB-QYYP POWD-INJ 420 MG MDV,85010,CDM,250,RC,Q5116,HCPCS,00069030501,NDC,facility,outpatient,1,EA,7019.54000,6668.56000,The Alliance,Premier SAS,,45.82,,,,,,,28.62,6808.95,fee schedule,
PIPERACILLIN-TAZOBACTAM 2.25 GM/50 ML PREMIX,85011,CDM,250,RC,J2543,HCPCS,00338963224,NDC,facility,outpatient,1,mL,0.48000,0.45000,The Alliance,Premier SAS,,1.78,,,,,,,0.24000,1.86,fee schedule,
NALBUPHINE SOLN 20 MG/ML 10 ML,85012,CDM,250,RC,J2300,HCPCS,00409146701,NDC,facility,outpatient,1,mL,18.41000,17.49000,The Alliance,Premier SAS,,5.62,,,,,,,4.77,17.86,fee schedule,
DEFIBRILLATOR CARD W5.37XH8.18CM D0.99CM IS-1,85013,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier SAS,,18699.66,,,,,,,18699.66,40740.00,percent of total billed charges,
SHEATH LEADLESS 25FR 50CM,85014,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
GENERATOR PACEMKR LEADLESS VR PM.,85015,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,The Alliance,Premier SAS,,12806.10,,,,,,,12806.10,27063.00,percent of total billed charges,
CATHETER LEADLESS VR DELIVERY,85016,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT PERIPH L39MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,85017,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
VALVE AORT 19MM BOV PERICARD COCR ALLY POLY STENTED,85018,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
SNARE ESCP .28IN 79IN COR PERI 1SNR 1 NTNL LOOP,85019,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2325.00000,2208.75000,The Alliance,Premier SAS,,1599.60,,,,,,,1162.50,2255.25,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 10 ML,85030,CDM,250,RC,55150-0440-10,NDC,,,facility,outpatient,1,mL,4.20000,3.99000,The Alliance,Premier SAS,,2.89,,,,,,,2.10,4.07,percent of total billed charges,
SHTH VERS PIG 180CM 55 63CM DO,85032,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier SAS,,1669.61,,,,,,,1669.61,3637.50,percent of total billed charges,
CATHETER EP 6FR L110CM 10 PLAT ELECTRD SPC,85033,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,The Alliance,Premier SAS,,1247.91,,,,,,,1247.91,2718.75,percent of total billed charges,
MICONAZOLE CREAM 2% 57 GM,85035,CDM,250,RC,11701-0045-23,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,31722-0869-03,NDC,,,facility,outpatient,1,EA,310.80000,295.26000,The Alliance,Premier SAS,,213.83,,,,,,,155.40,301.48,percent of total billed charges,
TOLVAPTAN TAB 30 MG,85036,CDM,250,RC,67877-0636-33,NDC,,,facility,outpatient,1,EA,1244.56000,1182.33000,The Alliance,Premier SAS,,856.26,,,,,,,622.28,1207.22,percent of total billed charges,
DEXAMETHASONE TAB 1 MG,85041,CDM,250,RC,J8540,HCPCS,00054817425,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,00641621725,NDC,facility,outpatient,1,mL,2.53000,2.40000,The Alliance,Premier SAS,,7.67,,,,,,,1.26,10.56,fee schedule,
METHOCARBAMOL SOLN100 MG/ML 10 ML,85042,CDM,250,RC,J2800,HCPCS,70069010125,NDC,facility,outpatient,1,mL,1.88000,1.79000,The Alliance,Premier SAS,,7.67,,,,,,,0.94000,10.56,fee schedule,
METHENAMINE MANDELATE TAB 1 GM,85043,CDM,250,RC,62135-0201-60,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,The Alliance,Premier SAS,,6.52,,,,,,,4.74,9.20,percent of total billed charges,
MAGNESIUM OXIDE TAB 250 MG,85044,CDM,250,RC,43292-0557-38,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,The Alliance,Premier SAS,,0.04128,,,,,,,0.03000,0.05820,percent of total billed charges,
LIPID EMULSION 20% 100 ML (SMOFLIPID),85047,CDM,250,RC,63323-0820-00,NDC,,,facility,outpatient,1,mL,0.70000,0.66000,The Alliance,Premier SAS,,0.48160,,,,,,,0.35000,0.67900,percent of total billed charges,
ESCITALOPRAM TAB 20 MG,85048,CDM,250,RC,00904-6427-61,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,The Alliance,Premier SAS,,0.39216,,,,,,,0.28500,0.55290,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 80 MG/ML,85051,CDM,636,RC,J3301,HCPCS,00003031505,NDC,facility,outpatient,1,mL,59.16000,56.20000,The Alliance,Premier SAS,,1.38,,,,,,,1.35,57.39,fee schedule,
CYCLOPHOSPHAMIDE SOLN 200 MG/ML 5 ML,85052,CDM,636,RC,J9073,HCPCS,50742052005,NDC,facility,outpatient,1,mL,379.44000,360.46000,The Alliance,Premier SAS,,1.86,,,,,,,1.16,368.06,fee schedule,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,16714-0401-02,NDC,,,facility,outpatient,1,EA,9.95000,9.46000,The Alliance,Premier SAS,,6.85,,,,,,,4.97,9.65,percent of total billed charges,
CEFUROXIME TAB 500 MG,85053,CDM,250,RC,67877-0216-60,NDC,,,facility,outpatient,1,EA,4.33000,4.12000,The Alliance,Premier SAS,,2.98,,,,,,,2.17,4.20,percent of total billed charges,
AGALSIDASE BETA POWD-INJ 5 MG,85056,CDM,636,RC,J0180,HCPCS,58468004101,NDC,facility,outpatient,1,EA,2377.67000,2258.79000,The Alliance,Premier SAS,,368.65,,,,,,,230.26,2306.34,fee schedule,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (ARALAST NP),85057,CDM,636,RC,J0256,HCPCS,00944281501,NDC,facility,outpatient,1,EA,1087.80000,1033.41000,The Alliance,Premier SAS,,8.31,,,,,,,5.19,1055.17,fee schedule,
AMIODARONE SOLN-INJ 50 MG/ML 18 ML,85059,CDM,250,RC,J0282,HCPCS,67457015318,NDC,facility,outpatient,1,mL,2.62000,2.49000,The Alliance,Premier SAS,,0.81651,,,,,,,0.50685,2.54,fee schedule,
ASENAPINE TAB-DISINTEGRATING 10 MG,85060,CDM,250,RC,42794-0017-10,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,The Alliance,Premier SAS,,7.61,,,,,,,5.53,10.73,percent of total billed charges,
ATOVAQUONE LIQ 1500 MG/10 ML,85061,CDM,250,RC,00121-1796-20,NDC,,,facility,outpatient,1,mL,11.46000,10.88000,The Alliance,Premier SAS,,7.88,,,,,,,5.73,11.12,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,16714-0396-03,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,The Alliance,Premier SAS,,0.65360,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFPROZIL LIQ 25 MG/ML,85066,CDM,250,RC,57237-0034-50,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,The Alliance,Premier SAS,,0.68800,,,,,,,0.50000,0.97000,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 5 ML,85067,CDM,250,RC,00065-0359-05,NDC,,,facility,outpatient,1,mL,39.15000,37.19000,The Alliance,Premier SAS,,26.94,,,,,,,19.57,37.98,percent of total billed charges,
POSACONAZOLE SOLN 18 MG/ML 16.7 ML,85068,CDM,250,RC,J3490,HCPCS,00085433101,NDC,facility,outpatient,1,mL,100.36000,95.34000,The Alliance,Premier SAS,,69.05,,,,,,,50.18,97.35,percent of total billed charges,
DEXTROSE 10%/0.45% NACL 1000 ML,85069,CDM,250,RC,00264-7622-00,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,The Alliance,Premier SAS,,0.02064,,,,,,,0.01500,0.02910,percent of total billed charges,
CEFPROZIL TAB 500 MG,85071,CDM,250,RC,16714-0399-01,NDC,,,facility,outpatient,1,EA,14.92000,14.18000,The Alliance,Premier SAS,,10.26,,,,,,,7.46,14.47,percent of total billed charges,
CITALOPRAM TAB 40 MG,85072,CDM,250,RC,13668-0011-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,The Alliance,Premier SAS,,0.12384,,,,,,,0.09000,0.17460,percent of total billed charges,
SILODOSIN CAP 4 MG,85080,CDM,250,RC,69238-1421-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,The Alliance,Premier SAS,,0.72240,,,,,,,0.52500,1.02,percent of total billed charges,
OLANZAPINE TAB 20 MG,85081,CDM,250,RC,55111-0168-30,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,The Alliance,Premier SAS,,1.52,,,,,,,1.10,2.14,percent of total billed charges,
IMPLANT NSL L23MM 370UG MOMETASONE FUROATE.,85083,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier SAS,,1593.85,,,,,,,1593.85,3472.43,percent of total billed charges,
PROPAFENONE CAP-ER 225 MG,85084,CDM,250,RC,69680-0130-60,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,The Alliance,Premier SAS,,1.78,,,,,,,1.29,2.50,percent of total billed charges,
METHYLPHENIDATE TAB 20 MG (EQV-RITALIN),85085,CDM,250,RC,10702-0102-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPAFENONE TAB 225 MG,85086,CDM,250,RC,62559-0231-01,NDC,,,facility,outpatient,1,EA,1.28000,1.21000,The Alliance,Premier SAS,,0.88064,,,,,,,0.64000,1.24,percent of total billed charges,
EMTRICITABINE CAP 200 MG,85088,CDM,250,RC,61958-0601-01,NDC,,,facility,outpatient,1,EA,56.51000,53.69000,The Alliance,Premier SAS,,38.88,,,,,,,28.25,54.81,percent of total billed charges,
DILTIAZEM TAB-ER 120 MG (24-HOURS),85089,CDM,250,RC,00187-2045-30,NDC,,,facility,outpatient,1,EA,12.02000,11.42000,The Alliance,Premier SAS,,8.27,,,,,,,6.01,11.66,percent of total billed charges,
STENT PERIPH L80MM DIA16MM CATH L80MM SHTH,85090,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X20MM,85091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF,85092,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
SHTH VERS PIG 180CM 90 63CM DO,85093,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier SAS,,1669.61,,,,,,,1669.61,3637.50,percent of total billed charges,
DEXAMETHASONE TAB 6 MG,85095,CDM,250,RC,J8540,HCPCS,00054818325,NDC,facility,outpatient,1,EA,5.00000,4.75000,The Alliance,Premier SAS,,0.03202,,,,,,,0.03202,4.85,fee schedule,
SLING SHLDR XL ULT SFT STRP ESSENTIAL,85098,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier SAS,,139.12,,,,,,,7.36,143.36,fee schedule,
PIN FIX AD SS RADPQ SKULL TRAC RED O RNG FR POS,85099,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,76.32000,72.50000,The Alliance,Premier SAS,,52.51,,,,,,,38.16,74.03,percent of total billed charges,
CATHETER BLNDIL 22CM 3.5MM 150CM ULTRAVERSE 014,85101,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER DIAG 4FR L150CM 30DEG SS HYDRPHLC,85103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 31 MG/ML 10 ML,85106,CDM,250,RC,67457-0339-50-02500,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,CPT,,,facility,outpatient,,,582.12000,553.01000,The Alliance,Premier SAS,,400.50,,,,,,,291.06,564.66,percent of total billed charges,
"RSV VACCINE PREF3, RECOMBINANT PF POWD-INJ (AREXVY)",85107,CDM,250,RC,90679,HCPCS,58160084811,NDC,facility,outpatient,1,EA,582.12000,553.01000,The Alliance,Premier SAS,,400.50,,,,,,,291.06,564.66,percent of total billed charges,
CALMOSEPTINE OINT 3.5 GM,85109,CDM,250,RC,00799-0001-05,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,The Alliance,Premier SAS,,0.24080,,,,,,,0.17500,0.33950,percent of total billed charges,
PENICILLIN G 3 MU/50 ML PREMIX,85110,CDM,250,RC,J2540,HCPCS,00338102541,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,1.41,,,,,,,0.31500,1.45,fee schedule,
TRIPLE ANTIBIOTIC W/ PRAMOXINE (BACIT/NEOMY/POLY/PRAMOXINE) OINT 30 GM,85111,CDM,250,RC,49348-0600-72,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
DRAIN SUR 10FR L1/8IN RND CHN FULL FLUT HEAT,85112,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,87.60000,83.22000,The Alliance,Premier SAS,,40.21,,,,,,,40.21,87.60,percent of total billed charges,
COIL EMB L15CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L,85113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
OXACILLIN POWD-INJ 1 GM/10 ML,85114,CDM,250,RC,J2700,HCPCS,63323081320,NDC,facility,outpatient,1,EA,36.75000,34.91000,The Alliance,Premier SAS,,1.31,,,,,,,0.98580,35.65,fee schedule,
SODIUM CHONDROITIN-HYALURONATE 1.05 ML INTRAOCULAR (DUOVISC),85115,CDM,250,RC,08065-1831-50,NDC,,,facility,outpatient,1,mL,616.69000,585.86000,The Alliance,Premier SAS,,424.28,,,,,,,308.35,598.19,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CREAM 2.5%-1% 30 GM,85116,CDM,250,RC,45802-0124-64,NDC,,,facility,outpatient,1,GM,13.17000,12.51000,The Alliance,Premier SAS,,9.06,,,,,,,6.58,12.77,percent of total billed charges,
LEAD SPC L45CM BPLR AV STR INGEVITY+,85118,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1342.24,percent of total billed charges,
ADAPTER LUER DRAINAGE ASPIRA PLEURAL,85119,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,156.00000,148.20000,The Alliance,Premier SAS,,107.33,,,,,,,78.00,151.32,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX HYDR+ COAT 2,85120,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
PCI CHRG US OB FOLLOW-UP 76816-TC,85121,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,824.50,fee schedule,
STENT BILI L120MM DIA7MM CATH L130CM DIA6FR 0.035IN NIT OTW,85135,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,10939-0887-44,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,The Alliance,Premier SAS,,1.07,,,,,,,0.77500,1.50,percent of total billed charges,
COENZYME Q10 CAP100 MG,85136,CDM,250,RC,57896-0875-03,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,The Alliance,Premier SAS,,0.29584,,,,,,,0.21500,0.41710,percent of total billed charges,
CHOLECALCIFEROL CAP 125 MCG,85138,CDM,250,RC,50268-0868-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,The Alliance,Premier SAS,,0.68112,,,,,,,0.49500,0.96030,percent of total billed charges,
BUPRENORPHINE INJECTION 300 MG/1.5 ML (SUBLOCADE),85139,CDM,636,RC,Q9992,HCPCS,12496030001,NDC,facility,outpatient,1,mL,2944.76000,2797.52000,The Alliance,Premier SAS,,3164.46,,,,,,,1472.38,3261.31,fee schedule,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (HIBERIX)",85140,CDM,250,RC,90648,HCPCS,58160081811,NDC,facility,outpatient,1,EA,23.79000,22.60000,The Alliance,Premier SAS,,16.37,,,,,,,11.89,46.30,percent of total billed charges,
FLUOROMETHOLONE ACETATE SUSP-OPHTH 0.1% 5 ML,85143,CDM,250,RC,71776-0100-05,NDC,,,facility,outpatient,1,mL,79.00000,75.05000,The Alliance,Premier SAS,,54.35,,,,,,,39.50,76.63,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN 20,000 UNITS/ML MDV",85144,CDM,250,RC,Q5106,HCPCS,00069131110,NDC,facility,outpatient,1,mL,571.35000,542.79000,The Alliance,Premier SAS,,12.12,,,,,,,7.57,554.21,fee schedule,
SIMETHICONE LIQ 40 MG/0.6 ML 15 ML,85145,CDM,250,RC,19903-0010-21,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,The Alliance,Premier SAS,,0.63296,,,,,,,0.46000,0.89240,percent of total billed charges,
CATH INTRACARDIAC CIRC ASSIST AXL-PMP GEN 2 IMPELLA 5.5,85146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92400.00000,87780.00000,The Alliance,Premier SAS,,42411.60,,,,,,,42411.60,92400.00,percent of total billed charges,
DEVICE VSC CLSR 5FR W/ 10ML LOK SYR BLLN.,85147,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,885.94000,841.64000,The Alliance,Premier SAS,,406.65,,,,,,,406.65,885.94,percent of total billed charges,
CLAMP EXT FIX 11MM 30DEG ANG UP L 5 H PIN,85153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4151.56000,3943.98000,The Alliance,Premier SAS,,1905.57,,,,,,,1905.57,4151.56,percent of total billed charges,
COUPLER EXT FIX ROD TO ROD DELT FOR HOFFMANN,85154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3649.24000,3466.78000,The Alliance,Premier SAS,,1675.00,,,,,,,1675.00,3649.24,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM 4.5 GM/100 ML PREMIX,85155,CDM,250,RC,J2543,HCPCS,00338963812,NDC,facility,outpatient,1,mL,0.39000,0.37000,The Alliance,Premier SAS,,1.78,,,,,,,0.19500,1.86,fee schedule,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002751001,NDC,facility,outpatient,1,mL,20.98000,19.93000,The Alliance,Premier SAS,,14.43,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 10 ML (EQV-HUMALOG),85156,CDM,250,RC,J1815,HCPCS,00002773701,NDC,facility,outpatient,1,mL,7.90000,7.50000,The Alliance,Premier SAS,,5.44,,,,,,,1.49,7.66,percent of total billed charges,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,CPT,,,facility,outpatient,,,147.06000,139.71000,The Alliance,Premier SAS,,235.44,,,,,,,73.53,244.12,fee schedule,
COVID-19 VACCINE SUSP (MODERNA 6MO - 11 YEARS 2024-2025),85157,CDM,250,RC,91321,HCPCS,80777029180,NDC,facility,outpatient,1,mL,1164.72000,1106.48000,The Alliance,Premier SAS,,235.44,,,,,,,227.94,1129.78,fee schedule,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,CPT,,,facility,outpatient,,,320.07000,304.07000,The Alliance,Premier SAS,,258.80,,,,,,,160.03,310.47,fee schedule,
COVID-19 VACCINE SUSP (SPIKEVAX 12YR+ 2024-2025),85158,CDM,250,RC,91322,HCPCS,80777011093,NDC,facility,outpatient,1,mL,640.14000,608.13000,The Alliance,Premier SAS,,258.80,,,,,,,250.56,620.94,fee schedule,
TROLAMINE SALICYLATE GEL 10% 89 GM,85159,CDM,250,RC,58133-0751-03,NDC,,,facility,outpatient,1,mL,0.66000,0.62000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
AVACINCAPTAD PEGOL SOLN 2 MG/0.1 ML (IZERVAY),85161,CDM,636,RC,J2782,HCPCS,82829000201,NDC,facility,outpatient,1,mL,39900.00000,37905.00000,The Alliance,Premier SAS,,169.55,,,,,,,105.90,38703.00,fee schedule,
STENT PERIPH L120MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF,85162,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,The Alliance,Premier SAS,,1642.07,,,,,,,1642.07,3577.50,percent of total billed charges,
LORAZEPAM SOLN SD 0.2 MG/ML,85163,CDM,250,RC,J2060,HCPCS,0040919853000010,NDC,facility,outpatient,1,mL,1.71000,1.62000,The Alliance,Premier SAS,,2.11,,,,,,,0.85500,2.61,fee schedule,
SEALANT HEMOSTAT 4ML FROZEN PREFIL PRIMA SYR,85164,CDM,636,RC,C9250,HCPCS,,,facility,outpatient,,,1077.53000,1023.65000,The Alliance,Premier SAS,,741.34,,,,,,,142.07,1045.20,percent of total billed charges,
PLASMA FREE HEMOGLOBIN,85165,CDM,300,RC,83051,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,,50.83,,,,,,,4.90,373.51,fee schedule,
STENT BILI L80MM DIA8MM CATH 6FR L80CM GWIRE 0.035IN NIT,85166,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
90480 CORONAVIRUS 2 (COVID-19) ADMIN CHARGE,85169,CDM,771,RC,90480,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,,79.12,,,,,,,39.42,111.55,percent of total billed charges,
CATH MAP OPTRELL F-J CRV,85170,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
GWIRE SYNCHRO SEL 14 SUPRT 300,85171,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,The Alliance,Premier SAS,,1518.14,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL TARGET TETRA 3.0MMX8.0CM COIL,85172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
GENRTR PACEMAKER MICRA AV2 SYSTEM,85173,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,29862.00000,28368.90000,The Alliance,Premier SAS,,13706.66,,,,,,,13706.66,28966.14,percent of total billed charges,
COIL TARGET TETRA 2.5MMX3.5CM,85174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
NIRSEVIMAB SOLN 100 MG/1 ML (BEYFORTUS),85175,CDM,250,RC,90381,HCPCS,49281057415,NDC,facility,outpatient,1,mL,1346.15000,1278.84000,The Alliance,Premier SAS,,926.15,,,,,,,673.08,1305.77,percent of total billed charges,
COIL TARGET TETRA 4.0MMX10.0CM COIL,85176,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 3.5MMX8.0CM COIL,85177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
INTRODUCER TRANSSEPT 8.5FR L63CM DIL 8.5FR,85178,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,675.00000,641.25000,The Alliance,Premier SAS,,309.82,,,,,,,309.82,675.00,percent of total billed charges,
NIRSEVIMAB SOLN 50 MG/0.5 ML (BEYFORTUS),85179,CDM,250,RC,90380,HCPCS,49281057515,NDC,facility,outpatient,1,mL,2390.85000,2271.31000,The Alliance,Premier SAS,,1644.90,,,,,,,1195.42,2319.12,percent of total billed charges,
"LIGAMENT, PIP, REPAIR, SMALL",85181,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,100.20000,95.19000,The Alliance,Premier SAS,,80.39,,,,,,,50.10,97.19,fee schedule,
WRIST WIDGET,85183,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,151.92000,144.32000,The Alliance,Premier SAS,,620.14,,,,,,,75.96,639.03,fee schedule,
SIZE 1 LEFT THUMB OR,85184,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,13.52000,12.84000,The Alliance,Premier SAS,,118.21,,,,,,,6.76,121.81,fee schedule,
CANNABIDIOL LIQ 100 MG/ML,85186,CDM,250,RC,J8499,HCPCS,70127010010,NDC,facility,outpatient,1,mL,49.61000,47.13000,The Alliance,Premier SAS,,34.13,,,,,,,24.80,48.12,percent of total billed charges,
MOXIFLOXACIN SOLN 0.1% 0.8 ML INTRAOCULAR,85187,CDM,250,RC,71384-0509-08,NDC,,,facility,outpatient,1,mL,73.08000,69.42000,The Alliance,Premier SAS,,50.28,,,,,,,36.54,70.89,percent of total billed charges,
SYSTEM FLO DIVERTER EVAR L20MM DIA4.5MM 64,85188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
SYSTEM FLO DIVERTER 5X12MM PMA SURPS EVOLVE,85189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,The Alliance,Premier SAS,,15054.77,,,,,,,15054.77,32799.06,percent of total billed charges,
OMNI SUR SYS: ERGO SER OF REVISIONS,85190,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6551.55000,6223.97000,The Alliance,Premier SAS,,3007.16,,,,,,,3007.16,6551.55,percent of total billed charges,
STENT PERIPH L19MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,85191,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
CATHETER EP DECAPOLAR P CRV 2-8-2MM SPC 5FR,85192,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier SAS,,86.06,,,,,,,86.06,187.50,percent of total billed charges,
INTRO SHEATH 20FR 25CM CKFL 41CM DIL STRL DISP,85194,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier SAS,,1039.74,,,,,,,755.62,1465.91,percent of total billed charges,
CATHETER NEPHSTMY 24FR L35CM INCL C FLX RE,85195,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,555.04000,527.29000,The Alliance,Premier SAS,,381.87,,,,,,,277.52,538.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM SOLN SD 40 MG/ML,85196,CDM,250,RC,J2543,HCPCS,6332309812104000,NDC,facility,outpatient,1,mL,0.63000,0.60000,The Alliance,Premier SAS,,1.78,,,,,,,0.31500,1.86,fee schedule,
PIPERACILLIN-TAZOBACTAM SOLN SD 80 MG/ML,85197,CDM,250,RC,J2543,HCPCS,6332309812108000,NDC,facility,outpatient,1,mL,1.26000,1.20000,The Alliance,Premier SAS,,1.78,,,,,,,0.63000,1.86,fee schedule,
CATHETER EP QPLR CRD-2 CRV 5FR L120CM ELECTRODE.,85198,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,The Alliance,Premier SAS,,73.44,,,,,,,73.44,160.00,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,CPT,,,facility,outpatient,,,584.10000,554.90000,The Alliance,Premier SAS,,401.86,,,,,,,292.05,566.58,percent of total billed charges,
"RSV VACCINE, PREF A-PREF B, RECOMBINANT PF POWD-INJ (ABRYSVO)",85201,CDM,250,RC,90678,HCPCS,00069246510,NDC,facility,outpatient,1,EA,584.10000,554.90000,The Alliance,Premier SAS,,401.86,,,,,,,292.05,566.58,percent of total billed charges,
CT ISOVUE M300 15ML WASTE,85202,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,1.29,fee schedule,
POST-OP SHOE MENS L BREG 100611-040,85204,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,25.72000,24.43000,The Alliance,Premier SAS,,11.81,,,,,,,11.81,24.95,percent of total billed charges,
BLLN RX NC TREK NEO 5.5X15MM,85205,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID 5FR L100CM CLS3.5 CRV UNQ,85206,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
SLING ARM PED XSM W5.5XL10.75IN 2 UNIV COT,85208,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,16.28000,15.47000,The Alliance,Premier SAS,,12.01,,,,,,,8.14,15.79,fee schedule,
STENT VENOVO .035 12X60X120CM STENT,85209,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
"AMIKACIN, TROUGH, SERUM (TAMIK) SO",85210,CDM,300,RC,80150,CPT,,,facility,outpatient,,,123.90000,117.70000,The Alliance,Premier SAS,90,106.27,,,,,,,15.58,780.94,fee schedule,
"MYCOPLASMA PNEUMONIAE MACROLIDE RESISTANCE PREDICTION, MD, PCR, VARIES(RPMPM) SO",85211,CDM,300,RC,87798,CPT,,,facility,outpatient,,,329.20000,312.74000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"SUPERSATURATION PROFILE CALCIUM, 24 HOUR, URINE (SUP24)SO",85212,CDM,300,RC,82340,CPT,,,facility,outpatient,,,49.50000,47.02000,The Alliance,Premier SAS,90,43.89,,,,,,,6.23,322.54,fee schedule,
"SUPERSATURATION PROFILE PHOSPHORUS, 24 HOUR, URINE (SUP24)SO",85213,CDM,300,RC,84105,CPT,,,facility,outpatient,,,47.50000,45.12000,The Alliance,Premier SAS,90,36.97,,,,,,,5.97,271.65,fee schedule,
"SUPERSATURATION PROFILE CHLORIDE, 24 HOUR, URINE (SUP24)SO",85214,CDM,300,RC,82436,CPT,,,facility,outpatient,,,47.20000,44.84000,The Alliance,Premier SAS,90,36.97,,,,,,,5.94,271.65,fee schedule,
"SUPERSATURATION PROFILE URIC ACID, 24 HOUR, URINE (SUP24)SO",85215,CDM,300,RC,84560,CPT,,,facility,outpatient,,,41.70000,39.62000,The Alliance,Premier SAS,90,34.66,,,,,,,5.25,254.68,fee schedule,
"SUPERSATURATION PROFILE AMMONIA, 24 HOUR, URINE (SUP24)SO",85216,CDM,300,RC,82140,CPT,,,facility,outpatient,,,119.70000,113.72000,The Alliance,Premier SAS,90,103.96,,,,,,,15.06,763.98,fee schedule,
"SUPERSATURATION PROFILE CITRATE, 24 HOUR, URINE (SUP24)SO",85217,CDM,300,RC,82507,CPT,,,facility,outpatient,,,228.40000,216.98000,The Alliance,Premier SAS,90,198.68,,,,,,,28.73,1459.96,fee schedule,
"SO-NICOTINE AND METABOLITES, RANDOM, URINE (NICOU) SO",85218,CDM,300,RC,80323,CPT,,,facility,outpatient,,,44.70000,42.47000,The Alliance,Premier SAS,90,154.78,,,,,,,22.35,1137.41,fee schedule,
"SUPERSATURATION PROFILE UREA, 24 HOUR, URINE (SUP24)SO",85219,CDM,300,RC,84540,CPT,,,facility,outpatient,,,45.80000,43.51000,The Alliance,Premier SAS,90,34.66,,,,,,,5.75,254.68,fee schedule,
"SUPERSATURATION PROFILE OSMOLALITY, 24 HOUR, URINE (SUP24)SO",85220,CDM,300,RC,83935,CPT,,,facility,outpatient,,,56.10000,53.30000,The Alliance,Premier SAS,90,48.52,,,,,,,7.05,356.54,fee schedule,
"SUPERSATURATION PROFILE SULFATE, 24 HOUR, URINE (SUP24)SO",85221,CDM,300,RC,84392,CPT,,,facility,outpatient,,,45.10000,42.84000,The Alliance,Premier SAS,90,34.66,,,,,,,5.67,254.68,fee schedule,
"SUPERSATURATION PROFILE SODIUM, 24 HOUR, URINE (SUP24)SO",85222,CDM,300,RC,84300,CPT,,,facility,outpatient,,,41.60000,39.52000,The Alliance,Premier SAS,90,34.66,,,,,,,5.23,254.68,fee schedule,
"SUPERSATURATION PROFILE OXALATE, 24 HOUR, URINE (SUP24)SO",85223,CDM,300,RC,83945,CPT,,,facility,outpatient,,,118.80000,112.86000,The Alliance,Premier SAS,90,92.41,,,,,,,14.93,679.08,fee schedule,
"SUPERSATURATION PROFILE POTASSIUM, 24 HOUR, URINE (SUP24)SO",85224,CDM,300,RC,84133,CPT,,,facility,outpatient,,,38.90000,36.95000,The Alliance,Premier SAS,90,30.03,,,,,,,4.89,220.68,fee schedule,
"SUPERSATURATION PROFILE CREATININE, 24 HOUR, URINE (SUP24)SO",85225,CDM,300,RC,82570,CPT,,,facility,outpatient,,,42.50000,40.38000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"SUPERSATURATION PROFILE PH BF, 24 HOUR, URINE (SUP24)SO",85226,CDM,300,RC,83986,CPT,,,facility,outpatient,,,29.40000,27.93000,The Alliance,Premier SAS,90,25.41,,,,,,,3.70,186.75,fee schedule,
"SUPERSATURATION PROFILE MAGNESIUM, 24 HOUR, URINE (SUP24)SO",85227,CDM,300,RC,83735,CPT,,,facility,outpatient,,,55.00000,52.25000,The Alliance,Premier SAS,90,48.52,,,,,,,6.92,356.54,fee schedule,
"PHOSPHOLIPASE A2 RECEPTOR, MONITORING , SERUM (PLA2M) SO",85228,CDM,300,RC,83520,CPT,,,facility,outpatient,,,327.60000,311.22000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
GENERATOR PACEMKR MICRA VR2 SYSTEM,85229,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,23961.00000,22762.95000,The Alliance,Premier SAS,,10998.10,,,,,,,10998.10,23242.17,percent of total billed charges,
SYSTEM THROMCTMY CATH 130CM INDIGO 7FR 130CM,85230,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,24862.00000,23618.90000,The Alliance,Premier SAS,,17105.06,,,,,,,12431.00,24116.14,percent of total billed charges,
CATHETER BLNDIL 10CM 3.5MM 150CM ULTRAVERSE 014,85231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
US ASP/INJ GANGLION CYST(S),85232,CDM,361,RC,20612,CPT,,,facility,outpatient,,,164.00000,155.80000,The Alliance,Premier SAS,TC,909.00,,,,,,,90.20,3163.00,case rate,
CONTRAST ISOVUE 250 100ML WASTE,85234,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,0.89000,0.85000,The Alliance,Premier SAS,JW,0.24015,,,,,,,0.22165,0.86330,fee schedule,
XR INJ PROC ANKLE ARTHRO,85236,CDM,320,RC,27648,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,1696.61,,,,,,,344.77,2392.02,percent of total billed charges,
XR COLON INTUSS REDUCTION,85237,CDM,320,RC,74283,CPT,,,facility,outpatient,,,1133.00000,1076.35000,The Alliance,Premier SAS,TC,1010.76,,,,,,,566.50,8017.30,fee schedule,
MRI WHOLE BODY WO CONT 76498,85238,CDM,610,RC,76498,CPT,,,facility,outpatient,,,6363.00000,6044.85000,The Alliance,Premier SAS,,1810.00,,,,,,,83.61,6172.11,per diem,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,0090470739300100,NDC,facility,outpatient,1,mL,8.97000,8.52000,The Alliance,Premier SAS,,6.17,,,,,,,4.49,8.70,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6068702528600100,NDC,facility,outpatient,1,mL,8.64000,8.21000,The Alliance,Premier SAS,,5.94,,,,,,,4.32,8.38,percent of total billed charges,
ONDANSETRON LIQ 4 MG/5 ML,85243,CDM,250,RC,J8499,HCPCS,6809407636200500,NDC,facility,outpatient,1,mL,8.07000,7.67000,The Alliance,Premier SAS,,5.55,,,,,,,4.04,7.83,percent of total billed charges,
TALQUETAMAB-TGVS 40 MG/ML (TALVEY),85244,CDM,636,RC,J3055,HCPCS,57894047001,NDC,facility,outpatient,1,mL,19684.00000,18699.80000,The Alliance,Premier SAS,,115.91,,,,,,,72.40,19093.48,fee schedule,
ANIFROLUMAB-FNIA SOLN 150 MG/ML 2 ML (SAPHNELO),85245,CDM,636,RC,J0491,HCPCS,00310304000,NDC,facility,outpatient,1,mL,5752.33000,5464.72000,The Alliance,Premier SAS,,28.98,,,,,,,18.10,5579.76,fee schedule,
OCCLUDER CV 37MM CATH 10FR L80CM CARDIOFORM ASD,85246,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier SAS,,12130.22,,,,,,,12130.22,26427.50,percent of total billed charges,
CATH ANG SV BEREN 5FX40CM .038 NBPG 5BX,85247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,70.56000,67.03000,The Alliance,Premier SAS,,32.39,,,,,,,32.39,70.56,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 15,85248,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12400.00,percent of total billed charges,
IDENTITI ALIF SA SPCR 8 X 34 X 24 MM 10,85249,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12400.00,percent of total billed charges,
BOLT GRFT SPNL ALIF 8.5MM X 25MM IDENTITI,85250,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,The Alliance,Premier SAS,,1204.88,,,,,,,1204.88,2625.00,percent of total billed charges,
CT ASP/INJ JT 20605,85252,CDM,320,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,The Alliance,Premier SAS,,93.57,,,,,,,68.00,308.32,percent of total billed charges,
US OB NUCHAL TRANS EA ADDL 76814,85253,CDM,402,RC,76814,CPT,,,facility,outpatient,,,348.00000,330.60000,The Alliance,Premier SAS,,532.00,,,,,,,144.10,548.00,fee schedule,
NM I 131 DIAG UCI PER DOSE,85258,CDM,343,RC,A9531,HCPCS,,,facility,outpatient,,,233.19000,221.53000,The Alliance,Premier SAS,,160.43,,,,,,,6.95,226.19,percent of total billed charges,
CT BIOPSY RECTAL MASS,85259,CDM,361,RC,45999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,2561.00,,,,,,,865.71,5858.00,case rate,
CT ASP/INJ JT 20610,85260,CDM,320,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,The Alliance,Premier SAS,,111.46,,,,,,,81.00,344.85,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR 3RD LVL 64492,85261,CDM,350,RC,64492,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,1596.00,,,,,,,1285.85,2518.12,per diem,
NM TC99M NEUROLITE TO 25MCI,85262,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,4242.12000,4030.01000,The Alliance,Premier SAS,,2918.58,,,,,,,683.80,4114.86,percent of total billed charges,
IMPLANT BRST 560CC P5.7CM DIA13.5CM COHESIVE SIL GEL SMTH,85264,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,3777.75000,3588.86000,The Alliance,Premier SAS,,1733.99,,,,,,,1733.99,3777.75,percent of total billed charges,
EMG 1 EXT W/WO PARASPINAL 95860,85265,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,The Alliance,Premier SAS,,974.21,,,,,,,122.40,1373.52,percent of total billed charges,
STENT URET 5FR L20CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,85266,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,The Alliance,Premier SAS,,489.64,,,,,,,489.64,1066.76,percent of total billed charges,
STENT ES L8CM BODY DIA20MM FLNG DIA25MM 0.035IN CTRL REL,85267,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,The Alliance,Premier SAS,,3277.95,,,,,,,3277.95,7141.50,percent of total billed charges,
STENT PANCREAS 7FR L7CM PLAS STR LD BARB TRAILING RADPQ MRK,85268,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,514.09000,488.39000,The Alliance,Premier SAS,,235.97,,,,,,,235.97,514.09,percent of total billed charges,
STENT NSL L16MM DIA43.5MM DEL SHTH L110MM,85269,CDM,636,RC,J7402,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,The Alliance,Premier SAS,,18.17,,,,,,,11.35,3368.26,fee schedule,
ROD SPNL L95MM OD4.75MM COCR POST THORACOLUMBOSACRAL CRV,85270,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1476.56000,1402.73000,The Alliance,Premier SAS,,677.74,,,,,,,677.74,1476.56,percent of total billed charges,
PSG SL STG/ATT>=4PM<6Y/PAP7+HR TECH95783,85275,CDM,920,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,The Alliance,Premier SAS,TC,2337.00,,,,,,,1929.64,10470.18,per diem,
BLLN RX NC TREK NEO 1.5X8MM,85282,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
"TICK-BORNE DISEASE AB PANEL,SERUM(TICKS) SO",85283,CDM,300,RC,86753,CPT,,,facility,outpatient,,,101.80000,96.71000,The Alliance,Premier SAS,90,87.78,,,,,,,8.17,645.08,fee schedule,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS)SO",85284,CDM,300,RC,86666,CPT,,,facility,outpatient,,,83.60000,79.42000,The Alliance,Premier SAS,90,71.62,,,,,,,8.17,526.26,fee schedule,
"BONE ALKALINE PHOSPHATASE, SERUM (BAP) SO",85285,CDM,300,RC,84080,CPT,,,facility,outpatient,,,121.50000,115.42000,The Alliance,Premier SAS,90,106.27,,,,,,,15.27,780.94,fee schedule,
"TICK-BORNE DISEASE AB PANEL,SERUM (TICKS) SO",85286,CDM,300,RC,86618,CPT,,,facility,outpatient,,,139.90000,132.90000,The Alliance,Premier SAS,90,120.13,,,,,,,17.60,882.80,fee schedule,
STENT BILI AD L40MM DIA9MM CATH 6FR L80CM LIFESTENT,85287,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,The Alliance,Premier SAS,,1006.93,,,,,,,1006.93,2193.75,percent of total billed charges,
IMPLANTABLE PULSE GENERATOR KIT,85288,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,38850.00000,36907.50000,The Alliance,Premier SAS,,17832.15,,,,,,,17832.15,38850.00,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-02,NDC,,,facility,outpatient,1,mL,0.85000,0.80000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE SPRAY 103.5 ML,85291,CDM,250,RC,00386-0008-03,NDC,,,facility,outpatient,1,mL,0.85000,0.81000,The Alliance,Premier SAS,,0.58480,,,,,,,0.42500,0.82450,percent of total billed charges,
CATHETER GUID OD5FR AL 3 CRV BRT TIP,85293,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X8MM,85294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 11 - LONG,85295,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.28000,2.17000,The Alliance,Premier SAS,,1.57,,,,,,,1.14,2.21,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 12 - LONG,85296,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.04000,1.94000,The Alliance,Premier SAS,,1.40,,,,,,,1.02,1.98,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 2 - LONG,85297,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,12.00000,11.40000,The Alliance,Premier SAS,,8.26,,,,,,,6.00,11.64,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 15 - LONG,85298,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.68000,1.60000,The Alliance,Premier SAS,,1.16,,,,,,,0.84000,1.63,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 6 - LONG,85299,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,4.20000,3.99000,The Alliance,Premier SAS,,2.89,,,,,,,2.10,4.07,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 1 - LONG,85300,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier SAS,,17.20,,,,,,,12.50,24.25,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 7 - LONG,85301,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.60000,3.42000,The Alliance,Premier SAS,,2.48,,,,,,,1.80,3.49,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 8 - LONG,85302,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 9 - LONG,85303,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.76000,2.62000,The Alliance,Premier SAS,,1.90,,,,,,,1.38,2.68,percent of total billed charges,
VENIPUNCTURE CHARGE - OUTREACH,85304,CDM,300,RC,36415,CPT,,,facility,outpatient,,,8.90000,8.46000,The Alliance,Premier SAS,,6.12,,,,,,,4.45,20.67,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 10 - LONG,85305,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,2.52000,2.39000,The Alliance,Premier SAS,,1.73,,,,,,,1.26,2.44,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 13 - LONG,85306,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.92000,1.82000,The Alliance,Premier SAS,,1.32,,,,,,,0.96000,1.86,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 14 - LONG,85307,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,1.80000,1.71000,The Alliance,Premier SAS,,1.24,,,,,,,0.90000,1.75,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 3 - LONG,85308,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,8.00000,7.60000,The Alliance,Premier SAS,,5.50,,,,,,,4.00,7.76,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 5 - LONG,85309,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,3.12000,2.96000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
TRAVEL/SPECIMEN COLLECTION 4 - LONG,85310,CDM,300,RC,P9604,HCPCS,,,facility,outpatient,,,6.00000,5.70000,The Alliance,Premier SAS,,4.13,,,,,,,3.00,5.82,percent of total billed charges,
TUBE G AMT 18FR X 3.4CM,85314,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier SAS,,552.12,,,,,,,47.62,778.42,percent of total billed charges,
LONCASTUXIMAB TESIRINE-LPYL POWD-INJ 10 MG (ZYNLONTA),85315,CDM,636,RC,J9359,HCPCS,79952011001,NDC,facility,outpatient,1,EA,48514.58000,46088.85000,The Alliance,Premier SAS,,347.00,,,,,,,216.74,47059.14,fee schedule,
TPN-ELECTROLYTE ADDITIVE SOLN (LYPHOLYTE II/NUTRILYTE II),85316,CDM,250,RC,J3490,HCPCS,00409577901,NDC,facility,outpatient,1,mL,1.48000,1.41000,The Alliance,Premier SAS,,1.02,,,,,,,0.74000,1.44,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGG (VZPG) SO",85319,CDM,300,RC,86787,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Premier SAS,90,92.41,,,,,,,8.17,679.08,fee schedule,
JAK2 EXON 12 & OTHER NON-V617F MUT DET (JAKXM) SO,85320,CDM,300,RC,0027U,HCPCS,,,facility,outpatient,,,1002.00000,951.90000,The Alliance,Premier SAS,90,689.38,,,,,,,426.69,971.94,percent of total billed charges,
"LEPTOSPIRA, IGM (LEPDT) SO",85321,CDM,300,RC,86720,CPT,,,facility,outpatient,,,163.00000,154.85000,The Alliance,Premier SAS,90,103.96,,,,,,,8.17,763.98,fee schedule,
"STREPTOCOCCUS PNEUMONIAE AG, SPINAL FLUID (SPNC) SO",85322,CDM,300,RC,87899,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,90,103.96,,,,,,,16.61,763.98,fee schedule,
"TOXOPLASMA GONDII, MOL DET, PCR (PTOX) SO",85323,CDM,300,RC,87798,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"MEASLES (RUBEOLA) AB, IGM AND IGG (ROGM) SO",85324,CDM,300,RC,86765,CPT,,,facility,outpatient,,,105.90000,100.61000,The Alliance,Premier SAS,90,92.41,,,,,,,13.31,679.08,fee schedule,
CATH GUIDLNR COAST 6FR 150CM,85325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER THROMCTMY SUCT L115CM OD16MM VAR,85326,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,20150.00000,19142.50000,The Alliance,Premier SAS,,9248.85,,,,,,,9248.85,20150.00,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,51991-0006-33,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,The Alliance,Premier SAS,,2.12,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 25 MG,85331,CDM,250,RC,72888-0175-30,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,The Alliance,Premier SAS,,0.86688,,,,,,,0.63000,1.22,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE LCB,85332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
GUID 6FR ID0.07IN L VASC MACH1 VL4,85333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER IV 14GA L2IN INTROCAN SFTY STR,85335,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,6.32000,6.00000,The Alliance,Premier SAS,,2.90,,,,,,,2.90,6.32,percent of total billed charges,
96381 RSV ADMIN MONOCLONAL ANTIBDY SEASONAL,85336,CDM,771,RC,96381,CPT,,,facility,outpatient,,,166.00000,157.70000,The Alliance,Premier SAS,,114.21,,,,,,,83.00,161.02,percent of total billed charges,
CATHETER NEUROVASC 5FR L115CM INTCRAN SUPP,85341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6070.28000,5766.77000,The Alliance,Premier SAS,,2786.26,,,,,,,2786.26,6070.28,percent of total billed charges,
MICROCATHETER VASC PROX/DST 2.8FRX3 L155CM,85342,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,The Alliance,Premier SAS,,1662.73,,,,,,,1662.73,3622.50,percent of total billed charges,
VALVE MI 31MM BOV PERICARD LEAFLET COCR STNT,85343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
SUTURE 2-0 NABSRB CARTRIDGE POLYOLEFIN,85344,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,1774.50000,1685.77000,The Alliance,Premier SAS,,1220.86,,,,,,,887.25,1721.27,percent of total billed charges,
CATHETER BLNDIL 10CM 6MM 130CM ULTRAVERSE 018 CK,85345,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER PTCA L137CM BLLN L20MM DIA5MM RBP,85347,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,The Alliance,Premier SAS,,2451.00,,,,,,,1781.25,3455.62,percent of total billed charges,
SHEATH INTRO TRNSSEPT GUID 8.5FR L81IN SWARTZ,85348,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,825.00000,783.75000,The Alliance,Premier SAS,,567.60,,,,,,,412.50,800.25,percent of total billed charges,
CATH PTCA L137CM BLLN L6MM DIA3.5MM 20ATM,85349,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,2064.00,,,,,,,1500.00,2910.00,percent of total billed charges,
CATH ANG IMAG II CER BERN 5F 038IN 65CM,85350,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,64.00000,60.80000,The Alliance,Premier SAS,,44.03,,,,,,,32.00,62.08,percent of total billed charges,
SHEATH INTRODUCER 10F X 45CM STRAIGHT,85351,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,The Alliance,Premier SAS,,164.09,,,,,,,119.25,231.34,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID 64493,85352,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,2561.00,,,,,,,845.37,3163.00,case rate,
XR TUBE THORACOSTOMY 32551,85353,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,3844.00,,,,,,,1475.05,4686.00,case rate,
BUTTON GSTRM 20FR 2CM SIL MC SLK 5ML LOPRFL TPR.,85359,CDM,278,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,165.55,,,,,,,47.62,360.68,percent of total billed charges,
LEAD PACE 5.7FR 52CM AV BPLR STR PLAT ALLY,85364,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1548.45,percent of total billed charges,
SHEATH INTRO 8FR L60CM DEFLECTION L17MM 180DEG HYDROPHOBIC,85370,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,The Alliance,Premier SAS,,693.66,,,,,,,693.66,1511.25,percent of total billed charges,
OT ESTIM UNATTENDED WOUND CARE UNITS,85376,CDM,430,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,The Alliance,Premier SAS,,180.00,,,,,,,80.50,264.00,per diem,
DEVICE LIMFLOW TADV,85380,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52500.00000,49875.00000,The Alliance,Premier SAS,,24097.50,,,,,,,24097.50,52500.00,percent of total billed charges,
COIL EMB H2MM DIA4MM CMPTBL CATH VIA17,85381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34639.50000,32907.53000,The Alliance,Premier SAS,,15899.53,,,,,,,15899.53,34639.50,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 0.0175IN X 154CM,85382,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier SAS,,2209.05,,,,,,,2209.05,4812.75,percent of total billed charges,
MICROCATHETER VASC DST 2.2FR PROX 2.5FR X,85383,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,The Alliance,Premier SAS,,2209.05,,,,,,,2209.05,4812.75,percent of total billed charges,
GNRTR REMEDE EL RESPICARDIA,85384,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,57750.00000,54862.50000,The Alliance,Premier SAS,,26507.25,,,,,,,26507.25,57750.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PRPH GRN,85385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
XRAY/MANDIBLE PARTIAL < 4 VWS,8542,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,The Alliance,Premier SAS,TC,190.36,,,,,,,144.00,1509.95,fee schedule,
PROSTHESIS EAR L4.25MM SHFT OD0.6MM.,85440,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Premier SAS,,457.84,,,,,,,440.69,1374.98,fee schedule,
"COR FFR CCTA DATA, NON-INVASIVE, TECH 75580 TC",85442,CDM,480,RC,75580,CPT,,,facility,outpatient,,,8798.00000,8358.10000,The Alliance,Premier SAS,TC,6053.02,,,,,,,4399.00,8534.06,percent of total billed charges,
ICM REMOTE EVAL/30 DAY TECH 93297 TC,85444,CDM,480,RC,93297,CPT,,,facility,outpatient,,,387.00000,367.65000,The Alliance,Premier SAS,TC,266.26,,,,,,,193.50,375.39,percent of total billed charges,
"SLP CAREGIVER TRAINING, FIRST 30 MIN UNIT",85448,CDM,440,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier SAS,,180.00,,,,,,,99.50,264.00,per diem,
ILR REMOTE EVAL/30 DAY TECH 93298 TC,85449,CDM,480,RC,93298,CPT,,,facility,outpatient,,,831.00000,789.45000,The Alliance,Premier SAS,TC,571.73,,,,,,,415.50,806.07,percent of total billed charges,
OT CAREGIVER TRN F2F W/O PT INITAL 30 MINUTES UNITS,85461,CDM,430,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier SAS,,180.00,,,,,,,99.50,264.00,per diem,
PT CAREGIVER TRN F2F W/O PT EA ADDL 15 MINUTES UNITS,85465,CDM,420,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,GP,180.00,,,,,,,50.00,264.00,per diem,
OT CAREGIVER TRN GROUP W/O PT UNITS,85466,CDM,430,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,,180.00,,,,,,,41.50,264.00,per diem,
PT CAREGIVER TRN F2F W/O PT INITAL 30 MIN UNITS,85468,CDM,420,RC,97550,CPT,,,facility,outpatient,,,199.00000,189.05000,The Alliance,Premier SAS,,180.00,,,,,,,99.50,264.00,per diem,
SLP CAREGIVER TRN GROUP W/O PT UNITS,85469,CDM,440,RC,97552,CPT,,,facility,outpatient,,,83.00000,78.85000,The Alliance,Premier SAS,,180.00,,,,,,,41.50,264.00,per diem,
OT CAREGIVER TRN F2F W/O PT EACH ADDL 15 MINUTES UNITS,85470,CDM,430,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,GO,180.00,,,,,,,50.00,264.00,per diem,
"SLP CAREGIVER TRAINING, ADDL 15 MIN UNITS",85471,CDM,440,RC,97551,CPT,,,facility,outpatient,,,100.00000,95.00000,The Alliance,Premier SAS,,180.00,,,,,,,50.00,264.00,per diem,
MORPHINE SOLN SD 0.2 MG/ 0.4 ML,85472,CDM,250,RC,J2270,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,The Alliance,Premier SAS,,7.28,,,,,,,0.96500,7.69,fee schedule,
EPHEDRINE SOLN 5 MG/ML 10 ML,85473,CDM,250,RC,J3490,HCPCS,42023024301,NDC,facility,outpatient,1,mL,9.16000,8.71000,The Alliance,Premier SAS,,6.30,,,,,,,4.58,8.89,percent of total billed charges,
EPIRUBICIN SOLN 2 MG/ML 100 ML,85474,CDM,250,RC,J9178,HCPCS,00009509301,NDC,facility,outpatient,1,mL,7.17000,6.81000,The Alliance,Premier SAS,,2.55,,,,,,,2.50,6.95,fee schedule,
BLLN LUTONIX .018 6X300X130CM,85476,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
CATHETER PTCA L130CM BLLN L200MM DIA5MM GWIRE,85477,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Premier SAS,,3396.71,,,,,,,3396.71,7400.25,percent of total billed charges,
PACEMAKER CARD 30.6GM 15.2ML CONN U225,85478,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,The Alliance,Premier SAS,,9533.43,,,,,,,9533.43,20146.90,percent of total billed charges,
CATH ASPIR 6FR L19X106CM WRK L125CM DA6131ST,85479,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier SAS,,3555.86,,,,,,,3555.86,7746.98,percent of total billed charges,
INTEGRA BMW 5X5CM BMW221 Q4104,85488,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,284.10000,269.90000,The Alliance,Premier SAS,,86.07,,,,,,,77.18,275.58,fee schedule,
STYLET LD L140CM ACT L70CM BEAC TIP LOK,85489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,The Alliance,Premier SAS,,1677.00,,,,,,,1218.75,2364.38,percent of total billed charges,
CATHETER THOR 28FR STR SFT PLEUR-EVAC,85492,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,25.00000,23.75000,The Alliance,Premier SAS,,11.47,,,,,,,11.47,25.00,percent of total billed charges,
VLV HRT SAPIEN 3 RESILIA 20MM,85493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,71400.00000,67830.00000,The Alliance,Premier SAS,,32772.60,,,,,,,32772.60,71400.00,percent of total billed charges,
CT INJ PARAVERT JNT CERV/THOR W GUID,85498,CDM,320,RC,64490,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,1696.61,,,,,,,726.83,2392.02,percent of total billed charges,
TALQUETAMAB-TGVS 3 MG/ 1.5ML (TALVEY),85499,CDM,636,RC,J3055,HCPCS,57894046901,NDC,facility,outpatient,1,mL,1315.72000,1249.93000,The Alliance,Premier SAS,,115.91,,,,,,,72.40,1276.25,fee schedule,
MARKER RADIOLOGICAL 0.40MM X 10MM NDL 20GA PRST GLD ANCHR,85504,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,,240.97,,,,,,,240.97,525.00,percent of total billed charges,
HEPB - OUTREACH ONLY,85505,CDM,300,RC,86704,CPT,,,facility,outpatient,,,142.40000,135.28000,The Alliance,Premier SAS,,85.48,,,,,,,12.05,628.12,fee schedule,
BUTTON GSTRM 18FR 3.5CM ENTRL SIL MC SLK 5ML,85516,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,248.15,,,,,,,47.62,349.86,percent of total billed charges,
KIT PEG 20FR SILICONE PULL FENESTRATE DRAPE CLAMP ENDOVIVE STANDARD UNIVERSAL 5ML STERILE DISPOSABLE,85517,CDM,290,RC,B9998,HCPCS,,,facility,outpatient,,,725.63000,689.35000,The Alliance,Premier SAS,,499.23,,,,,,,362.81,703.86,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL ROSCH INFERIOR,85519,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,62.97,,,,,,,45.76,88.77,percent of total billed charges,
TUBE JEJUSTMY 812FR BENT TIP THRU THE PEG 3 PRT FEED,85522,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,993.75000,944.06000,The Alliance,Premier SAS,,683.70,,,,,,,44.30,963.94,percent of total billed charges,
CLAREON MONOFOCAL  26.5     SY60WF.265,85523,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
TALIMOGENE LAHERPAREPVEC  SUSP-INJ 1 MILLIONPFU/ML (IMLYGIC),85526,CDM,636,RC,J9325,HCPCS,55513007801,NDC,facility,outpatient,1,mL,173.36000,164.69000,The Alliance,Premier SAS,,117.75,,,,,,,73.55,168.16,fee schedule,
TORIPALIMAB-TPZI SOLN 40 MG/ML 6 ML (LOQTORZI),85527,CDM,636,RC,J3263,HCPCS,70114034001,NDC,facility,outpatient,1,mL,3408.61000,3238.18000,The Alliance,Premier SAS,,63.24,,,,,,,39.50,3306.35,fee schedule,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,70092140043,NDC,facility,outpatient,1,mL,21.52000,20.44000,The Alliance,Premier SAS,,14.81,,,,,,,10.76,20.87,percent of total billed charges,
FENTANYL/NS SOLN 10 MCG/ML 1 ML,85528,CDM,250,RC,J3490,HCPCS,71266918001,NDC,facility,outpatient,1,mL,21.27000,20.20000,The Alliance,Premier SAS,,14.63,,,,,,,10.63,20.63,percent of total billed charges,
"MDS PANEL (IN STIU), FISH (MDSDF) SO",85529,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Premier SAS,90,328.05,,,,,,,52.89,2410.69,fee schedule,
"MDS PANEL (INTERP/REPORT), FISH (MDSDF) SO",85530,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Premier SAS,90,223.66,,,,,,,117.50,1643.57,fee schedule,
"MDS PANEL (PROBE), FISH (MDSDF) SO",85531,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
"MDS SYNDROME (IN STIU), FISH (MDSMF) SO",85532,CDM,310,RC,88275,CPT,,,facility,outpatient,,,420.60000,399.57000,The Alliance,Premier SAS,90,328.05,,,,,,,52.89,2410.69,fee schedule,
"MDS SYNDROME (INTERP/REPORT), FISH (MDSMF) SO",85533,CDM,310,RC,88291,CPT,,,facility,outpatient,,,260.10000,247.10000,The Alliance,Premier SAS,90,223.66,,,,,,,117.50,1643.57,fee schedule,
"MDS SYNDROME (PROBE), FISH (MDSMF) SO",85535,CDM,310,RC,88271,CPT,,,facility,outpatient,,,176.00000,167.20000,The Alliance,Premier SAS,90,152.47,,,,,,,20.36,1120.45,fee schedule,
SET DIL SZ A SHTH OTR 13.9X11.6FR L33CM INNR,85536,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,1032.00,,,,,,,750.00,1455.00,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (ELIGARD),85537,CDM,636,RC,J9217,HCPCS,62935075680,NDC,facility,outpatient,1,EA,1169.88000,1111.38000,The Alliance,Premier SAS,,248.83,,,,,,,155.42,1134.78,fee schedule,
HELICOBACTER PYLORI BREATH TEST  (UBT) SO,85538,CDM,300,RC,83013,CPT,,,facility,outpatient,,,532.14000,505.53000,The Alliance,Premier SAS,90,478.22,,,,,,,69.60,3514.18,fee schedule,
US BREAST/AXILLA INFLAMMATORY LESIONS GREATER THAN 7 INJ W/GUIDE,85539,CDM,320,RC,19499,CPT,,,facility,outpatient,,,1050.30000,997.78000,The Alliance,Premier SAS,,722.61,,,,,,,525.15,3999.66,percent of total billed charges,
US BREAST/AXILLA INFLAMMATORY LESIONS UP TO 7 INJ W/GUIDE,85540,CDM,320,RC,19499,CPT,,,facility,outpatient,,,915.50000,869.72000,The Alliance,Premier SAS,,629.86,,,,,,,457.75,3999.66,percent of total billed charges,
US BIOPSY SOFT TISSUE NECK/THORAX,85543,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier SAS,TC,3844.00,,,,,,,2786.18,6189.57,case rate,
BRONCHOSCOPY,85544,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,The Alliance,Premier SAS,,4806.37,,,,,,,3842.30,6776.42,percent of total billed charges,
SCREW BNE L48MM CCK HEX HD STEM FOR LEG NXGN,85545,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,256.50000,243.67000,The Alliance,Premier SAS,,117.73,,,,,,,117.73,256.50,percent of total billed charges,
SKIN BIOPSY,85546,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER,85547,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,The Alliance,Premier SAS,,2322.00,,,,,,,1856.25,5271.00,percent of total billed charges,
LASER EYE TREATMENT,85548,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1857.60,,,,,,,1485.00,5271.00,percent of total billed charges,
AZATHIOPRINE SUSP SD 50 MG/ML,85554,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,mL,2.14000,2.03000,The Alliance,Premier SAS,,3.43,,,,,,,1.07,3.53,fee schedule,
STENT XIENCE SKYPNT 4.5X28MM,85555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
KIT PERICARD ACCS,85556,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,204.75000,194.51000,The Alliance,Premier SAS,,93.98,,,,,,,93.98,204.75,percent of total billed charges,
TRAY BONE MAR ASPIR ANGEL CPRP W/ ADJ CELL LEV,85558,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,3675.00000,3491.25000,The Alliance,Premier SAS,,2528.40,,,,,,,1837.50,3564.75,percent of total billed charges,
CATHETER ANGIO ABP5.5 SIM2 CRV,85559,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,91.52000,86.94000,The Alliance,Premier SAS,,62.97,,,,,,,45.76,88.77,percent of total billed charges,
CATH BLLN SPRINTER OTW 2.0X10,85560,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
KIT GJ TB 14FR STOMA L1CM JEJU L15CM SIL LP,85561,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,1513.80000,1438.11000,The Alliance,Premier SAS,,1041.49,,,,,,,47.62,1468.39,percent of total billed charges,
BLLN METACROSS RX 4X60X200CM.,85562,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
NM BONE MARROW IMAGING LTD-TC,85563,CDM,340,RC,78102,CPT,,,facility,outpatient,,,1494.00000,1419.30000,The Alliance,Premier SAS,TC,1027.87,,,,,,,747.00,2210.07,percent of total billed charges,
MEPERIDINE SOLN 25 MG/0.5 ML,85570,CDM,250,RC,J2175,HCPCS,00409120301,NDC,facility,outpatient,1,mL,12.96000,12.31000,The Alliance,Premier SAS,,25.12,,,,,,,6.48,25.89,fee schedule,
CATH  PTCA PERIPH DRG COAT L130CM BLLN 4X150MM,85571,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
GRAFT EVAR L56MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,85573,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
VALVE ANG R ANTI SIPHON DEV CODMAN CERTAS +.,85574,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Premier SAS,,7841.64,,,,,,,7841.64,17084.19,percent of total billed charges,
COIL EMB L57CM DIA18MM STD COMPLX PERIPH FULL RETRCT SFT,85575,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L60CM DIA0.82MM NIT STR SFT TIP AND J TIP MRK,85576,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.60000,73.72000,The Alliance,Premier SAS,,35.62,,,,,,,35.62,77.60,percent of total billed charges,
PAFOLACIANINE SOLN 2 MG/ML 1.6 ML (CYTALUX),85582,CDM,250,RC,A9603,HCPCS,81052013810,NDC,facility,outpatient,1,mL,6037.50000,5735.62000,The Alliance,Premier SAS,,4153.80,,,,,,,3018.75,5856.38,percent of total billed charges,
Q4114 INTEGRA FLOWABLE 3CC PER CC,85585,CDM,278,RC,Q4114,HCPCS,,,facility,outpatient,,,4690.00000,4455.50000,The Alliance,Premier SAS,,2152.71,,,,,,,2152.71,4690.00,percent of total billed charges,
ECMO/ECLS INITIATION VENOUS,85586,CDM,360,RC,33946,CPT,,,facility,outpatient,,,42710.00000,40574.50000,The Alliance,Premier SAS,,29384.48,,,,,,,4095.00,41428.70,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.5 MG,85587,CDM,250,RC,J8499,HCPCS,49884011174,NDC,facility,outpatient,1,EA,4.25000,4.03000,The Alliance,Premier SAS,,2.92,,,,,,,2.12,4.12,percent of total billed charges,
KT PANCREAS STNT 5 FR L 3CM PLS STR NO LD,85588,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,899.63000,854.65000,The Alliance,Premier SAS,,412.93,,,,,,,412.93,899.63,percent of total billed charges,
CATHETER DRNGE BILI 8.5FR 40CM,85589,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,The Alliance,Premier SAS,,130.90,,,,,,,130.90,285.19,percent of total billed charges,
STENT LACR 40X2MM DIA0.64MM SIL,85590,CDM,278,RC,A4263,HCPCS,,,facility,outpatient,,,325.01000,308.76000,The Alliance,Premier SAS,,149.18,,,,,,,149.18,325.01,percent of total billed charges,
CATHETER PTCA L138CM BLLN L6MM DIA2MM,85591,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L9CM PLAS DUODENAL BEND RX,85592,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
US PELVIS TRANSVAGINAL-TECH,85593,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,The Alliance,Premier SAS,TC,532.00,,,,,,,384.16,1000.07,fee schedule,
CLAREON MONOFOCAL  29.0,85594,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
GRAFT DURA W3XL3IN REGEN MTRX CLLGN BILAYER SUTURABLE DURAGN,85595,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,3698.33000,3513.41000,The Alliance,Premier SAS,,1697.53,,,,,,,1697.53,3698.33,percent of total billed charges,
CATH PA PED L110CM DIA 5FR THRMDIL DL MON SWN,85597,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,417.15000,396.29000,The Alliance,Premier SAS,,191.47,,,,,,,191.47,417.15,percent of total billed charges,
STENT BILI 8.5FR L15CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,85598,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,The Alliance,Premier SAS,,134.26,,,,,,,134.26,292.50,percent of total billed charges,
GRAFT BNE SUB 10CC W1XL4.7CM THK1.1CM MTRX EXTN MASTERGRFT,85599,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3553.98000,3376.28000,The Alliance,Premier SAS,,1631.28,,,,,,,1631.28,3553.98,percent of total billed charges,
KIT BNE GRFT XSM 1.4CC RHBMP-2 ABSRB CLLGN SPNG INFUSE,85600,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6934.50000,6587.77000,The Alliance,Premier SAS,,3182.94,,,,,,,3182.94,6934.50,percent of total billed charges,
CATH BLLN CONQ 40 10X8X75,85608,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,The Alliance,Premier SAS,,285.73,,,,,,,285.73,622.50,percent of total billed charges,
COIL TARGET TETRA 3.5MMX6.0CM TG5413560,85609,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
XRY/TOOTH SINGLE,8561,CDM,320,RC,70300,CPT,,,facility,outpatient,,,109.00000,103.55000,The Alliance,Premier SAS,TC,55.71,,,,,,,41.10,484.28,fee schedule,
XR LYMPHANGIOGRAM  BILAT,85610,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,The Alliance,Premier SAS,TC,1523.24,,,,,,,1523.24,17311.25,fee schedule,
CT ASP/INJ JT 20600,85611,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,,909.00,,,,,,,280.29,3163.00,case rate,
STENT COR L15MM DIA2.5MM CATH L140CM GWIRE,85612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier SAS,,5165.13,,,,,,,5165.13,11253.00,percent of total billed charges,
INTRODUCER SHEATH 12FR L12CM FAST CATH TRIO,85613,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,140.00000,133.00000,The Alliance,Premier SAS,,64.26,,,,,,,64.26,140.00,percent of total billed charges,
STENT XIENCE SKYPNT 5.0X28MM,85614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
GRAFT EVAR L111MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,85615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,The Alliance,Premier SAS,,13190.28,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT EVAR L107MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN.,85616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,The Alliance,Premier SAS,,5465.36,,,,,,,5465.36,11907.10,percent of total billed charges,
CRTS RA SG UTZ BAC CATH ACC 828827PL,85617,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Premier SAS,,9363.12,,,,,,,9363.12,20398.96,percent of total billed charges,
PACEMAKER CARD 2 CHMBR PROMRI EDORA 8 DR T,85618,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,The Alliance,Premier SAS,,5691.60,,,,,,,5691.60,12028.00,percent of total billed charges,
"PHENYTOIN, FREE (PNYF) SO",85619,CDM,300,RC,80186,CPT,,,facility,outpatient,,,138.70000,131.76000,The Alliance,Premier SAS,90,97.03,,,,,,,14.22,713.01,fee schedule,
"ROTAVIRUS ANTIGEN, FECES (ROTA) SO",85620,CDM,300,RC,87425,CPT,,,facility,outpatient,,,94.60000,89.87000,The Alliance,Premier SAS,90,85.48,,,,,,,12.38,628.12,fee schedule,
"CRYOGLOBULIN, SERUM (CRY_S) SO",85621,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Premier SAS,90,46.20,,,,,,,6.69,339.51,fee schedule,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP)SO,85622,CDM,300,RC,82595,CPT,,,facility,outpatient,,,51.10000,48.55000,The Alliance,Premier SAS,90,46.20,,,,,,,6.69,339.51,fee schedule,
CRYOGLOBULIN AND CRYOFIBRINOGEN PANEL (CRGSP) SO,85623,CDM,300,RC,82585,CPT,,,facility,outpatient,,,111.70000,106.11000,The Alliance,Premier SAS,90,90.10,,,,,,,9.02,662.12,fee schedule,
GROUP B STREP SCREEN BY NUCLEIC ACID TEST,85624,CDM,300,RC,87653,CPT,,,facility,outpatient,,,405.00000,384.75000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
QUANTIFERON-TB GOLD,85625,CDM,300,RC,86480,CPT,,,facility,outpatient,,,737.00000,700.15000,The Alliance,Premier SAS,,441.25,,,,,,,61.98,3242.53,fee schedule,
IMMUNOFIXATION CRYOGLOBULIN (IMFXC) SO,85626,CDM,300,RC,86334,CPT,,,facility,outpatient,,,176.50000,167.67000,The Alliance,Premier SAS,90,283.39,,,,,,,23.08,2082.45,fee schedule,
LEAD PACE 45CM R AV STEROID ELUT IS1 CONN ACT,85627,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1545.94,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 40MMX8MMX15CM,85628,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,67200.00000,63840.00000,The Alliance,Premier SAS,,30844.80,,,,,,,30844.80,67200.00,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN 5X100MM,85629,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5658.00000,5375.10000,The Alliance,Premier SAS,,2597.02,,,,,,,2597.02,5658.00,percent of total billed charges,
LEAD PACE 53CM R AV STEROID ELUT IS1 CONN ACT,85630,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1545.94,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L33CM INNR,85631,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1500.00,percent of total billed charges,
LEFLUNOMIDE SUSP SD 2 MG/ML,85635,CDM,250,RC,J8499,HCPCS,2315500430300010,NDC,facility,outpatient,1,mL,0.46000,0.44000,The Alliance,Premier SAS,,0.31648,,,,,,,0.23000,0.44620,percent of total billed charges,
COMPR AUDIOMETRY EVAL-TECH,85637,CDM,471,RC,92557,CPT,,,facility,outpatient,,,52.00000,49.40000,The Alliance,Premier SAS,,35.78,,,,,,,26.00,163.43,percent of total billed charges,
TYMPANOMETRY IMPEDANCE TEST-TECH,85647,CDM,471,RC,92567,CPT,,,facility,outpatient,,,20.00000,19.00000,The Alliance,Premier SAS,,13.76,,,,,,,10.00,41.00,percent of total billed charges,
COIL TARGET TETRA 4.0MMX8.0CM,85656,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
CATH GUID XB 3.0 8FR 100CM,85657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X25MM,85658,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
BLLN ULTRAVER 018 3.5X80X130,85659,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
FINAL DAY,85660,CDM,360,RC,33948,CPT,,,facility,outpatient,,,544.00000,516.80000,The Alliance,Premier SAS,,374.27,,,,,,,299.20,4686.00,percent of total billed charges,
CATH HIPPO 6FR 132CM,85665,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,15174.50000,14415.77000,The Alliance,Premier SAS,,6965.10,,,,,,,6965.10,15174.50,percent of total billed charges,
PROSTHESIS EAR L4.5MM SHFT OD0.6MM,85666,CDM,278,RC,L8613,HCPCS,,,facility,outpatient,,,1374.98000,1306.23000,The Alliance,Premier SAS,,457.84,,,,,,,440.69,1374.98,fee schedule,
COIL TARGET TETRA 4.0MMX6.0CM.,85667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
ISAVUCONAZONIUM CAP 186 MG,85669,CDM,250,RC,00469-0520-02,NDC,,,facility,outpatient,1,EA,291.05000,276.50000,The Alliance,Premier SAS,,200.24,,,,,,,145.53,282.32,percent of total billed charges,
BRONCH THERAPEUTIC INITIAL,85670,CDM,419,RC,31645,CPT,,,facility,outpatient,,,1468.00000,1394.60000,The Alliance,Premier SAS,,1009.98,,,,,,,734.00,1801.19,percent of total billed charges,
BRONCH THERAPEUTIC SUBSEQUENT,85671,CDM,419,RC,31646,CPT,,,facility,outpatient,,,543.00000,515.85000,The Alliance,Premier SAS,,373.58,,,,,,,271.50,526.71,percent of total billed charges,
CONTROLLER PT PROGRAMMER WIRLSS EXT INTELLIS,85673,CDM,274,RC,L8681,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1536.55,,,,,,,1479.03,3681.15,fee schedule,
URTSCP FLXB LITHOVUE GLBL RVRS DISPBL,85675,CDM,272,RC,C1747,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,3560.40,,,,,,,2587.50,5019.75,percent of total billed charges,
SET INTRO 8FR 10FR 70CM DSLT HFMN 30CM CATH,85676,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,202.01000,191.91000,The Alliance,Premier SAS,,92.72,,,,,,,92.72,202.01,percent of total billed charges,
NITROPRUSSIDE 20 MG/NS 100 ML PREMIX,85678,CDM,250,RC,J3490,HCPCS,51754102901,NDC,facility,outpatient,1,mL,1.42000,1.35000,The Alliance,Premier SAS,,0.97696,,,,,,,0.71000,1.38,percent of total billed charges,
DEXTROSE GEL-ORAL 24 GM,85681,CDM,250,RC,00187-0746-33,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,The Alliance,Premier SAS,,0.45408,,,,,,,0.33000,0.64020,percent of total billed charges,
US BOTOX INJ 6 OR MORE MUSCLES 64647 TECH,85685,CDM,330,RC,64647,CPT,,,facility,outpatient,,,2466.00000,2342.70000,The Alliance,Premier SAS,TC,1696.61,,,,,,,1233.00,2392.02,percent of total billed charges,
AMPICILLIN SOLN SD 30 MG/ML,85686,CDM,250,RC,J0290,HCPCS,0078134079503000,NDC,facility,outpatient,1,mL,3.32000,3.15000,The Alliance,Premier SAS,,0.78449,,,,,,,0.78449,3.22,fee schedule,
COIL EMB L15CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,85689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,The Alliance,Premier SAS,,1704.04,,,,,,,1704.04,3712.50,percent of total billed charges,
CERTAS PLUS INLINE WITH SIPHON  828807PL.,85690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20017.48000,19016.61000,The Alliance,Premier SAS,,9188.02,,,,,,,9188.02,20017.48,percent of total billed charges,
DEXAMETHASONE INSERT 0.4 MG INTRAOCULAR,85691,CDM,250,RC,J1096,HCPCS,70382020401,NDC,facility,outpatient,1,EA,1437.45000,1365.58000,The Alliance,Premier SAS,,162.49,,,,,,,96.37,1394.33,fee schedule,
OMADACYCLINE POWD-INJ 100 MG/5 ML,85693,CDM,636,RC,J0121,HCPCS,71715000102,NDC,facility,outpatient,1,EA,1131.92000,1075.32000,The Alliance,Premier SAS,,6.42,,,,,,,4.01,1097.96,fee schedule,
NITRIC OXIDE 94799,85697,CDM,419,RC,94799,CPT,,,facility,outpatient,,,3050.00000,2897.50000,The Alliance,Premier SAS,,2098.40,,,,,,,148.57,2958.50,percent of total billed charges,
DOBUTAMINE 100 MG/D5W 50 ML,85698,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,The Alliance,Premier SAS,,12.78,,,,,,,0.25000,13.53,fee schedule,
STENT BILI 10FR BARB TO BARB L5CM 4.2MM,85699,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
GUIDEWIRE VASC L300CM SPR COIL L12CM RADPQ,85700,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,245.10,,,,,,,178.12,345.56,percent of total billed charges,
TRASTUZUMAB-DKST POWD-INJ 150 MG MDV,85702,CDM,636,RC,Q5114,HCPCS,83257000111,NDC,facility,outpatient,1,EA,2435.92000,2314.12000,The Alliance,Premier SAS,,71.39,,,,,,,44.59,2362.84,fee schedule,
"STAPH. AUREUS DETECTION, PCR",85703,CDM,300,RC,87640,CPT,,,facility,outpatient,,,406.00000,385.70000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
"ENTEROVIRUS, MOLECULAR DETECTION, PCR, VARIES (LENT) SO",85704,CDM,300,RC,87498,CPT,,,facility,outpatient,,,414.00000,393.30000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
"COMPLEMENT, C-3",85708,CDM,300,RC,86160,CPT,,,facility,outpatient,,,137.00000,130.15000,The Alliance,Premier SAS,,85.48,,,,,,,12.00,628.12,fee schedule,
SET SCREW,85709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,The Alliance,Premier SAS,,86.06,,,,,,,86.06,187.50,percent of total billed charges,
FLUOCINONIDE OINT 0.05% 30 GM,85711,CDM,250,RC,70700-0146-16,NDC,,,facility,outpatient,1,GM,2.73000,2.59000,The Alliance,Premier SAS,,1.88,,,,,,,1.36,2.65,percent of total billed charges,
HYDROCORTISONE OINT 2.5% 30 GM,85712,CDM,250,RC,00168-0146-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,The Alliance,Premier SAS,,0.25456,,,,,,,0.18500,0.35890,percent of total billed charges,
MESH BIO BOV CLLGN AND HUM FIBROBLASTS 140 MM,85713,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,4398.75000,4178.81000,The Alliance,Premier SAS,,48.51,,,,,,,47.06,4266.79,fee schedule,
SLING SHLDR UNIV SWTH PLAS BCKL PLUSH FOAM,85714,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,40.16000,38.15000,The Alliance,Premier SAS,,139.12,,,,,,,20.08,143.36,fee schedule,
LEAD PACE 58CM CATH 6FR R ATR/R VENT ULTIPACE,85715,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1455.00,percent of total billed charges,
STENT BILI 10FR BARB TO BARB L7CM 4.2MM,85716,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,848.59000,806.16000,The Alliance,Premier SAS,,389.50,,,,,,,389.50,848.59,percent of total billed charges,
AMINOLEVULINIC ACID LIQ 30 MG/ML 50 ML (GLEOLAN),85718,CDM,250,RC,J8499,HCPCS,59137023101,NDC,facility,outpatient,1,EA,6927.88000,6581.48000,The Alliance,Premier SAS,,4766.38,,,,,,,3463.94,6720.04,percent of total billed charges,
PLEUROLYSIS PROCEDURE INIT DAY,85719,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,The Alliance,Premier SAS,,2121.10,,,,,,,1695.65,5271.00,percent of total billed charges,
"PARANEOPLASTIC VISION LOSS EVALUATION, SERUM (PVLE) SO",85720,CDM,300,RC,86255,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Premier SAS,90,209.46,,,,,,,12.45,1539.22,fee schedule,
"PARANEOPLASTIC VISION LOSS EVAL, SERUM (PVLE) SO",85721,CDM,300,RC,84182,CPT,,,facility,outpatient,,,315.50000,299.72000,The Alliance,Premier SAS,90,311.11,,,,,,,25.31,2286.16,fee schedule,
HEPATITIS A VIRUS TOTAL ANTIBODIES (HAVTA) SO,85722,CDM,300,RC,86708,CPT,,,facility,outpatient,,,146.80000,139.46000,The Alliance,Premier SAS,90,87.78,,,,,,,12.80,645.08,fee schedule,
"PEDIATRIC FEMALE, TRICHOMONAS VAGINALIS AMP RNA (TVRNA) SO",85723,CDM,300,RC,87661,CPT,,,facility,outpatient,,,288.30000,273.88000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
CATHETER GUID 5FR L115CM DST L17CM PROX L98CM,85724,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Premier SAS,,3407.31,,,,,,,2476.24,4803.91,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,17478-0288-10,NDC,,,facility,outpatient,5,EA,3.05000,2.90000,The Alliance,Premier SAS,,2.10,,,,,,,1.52,2.96,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,60758-0801-05,NDC,,,facility,outpatient,5,EA,3.46000,3.28000,The Alliance,Premier SAS,,2.38,,,,,,,1.73,3.36,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,61314-0227-05,NDC,,,facility,outpatient,5,EA,6.10000,5.79000,The Alliance,Premier SAS,,4.20,,,,,,,3.05,5.92,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,64980-0514-05,NDC,,,facility,outpatient,5,EA,6.13000,5.82000,The Alliance,Premier SAS,,4.22,,,,,,,3.06,5.95,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,68682-0813-05,NDC,,,facility,outpatient,5,EA,6.95000,6.60000,The Alliance,Premier SAS,,4.78,,,,,,,3.48,6.74,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 5 ML,85725,CDM,250,RC,72603-0540-01,NDC,,,facility,outpatient,5,EA,6.11000,5.81000,The Alliance,Premier SAS,,4.20,,,,,,,3.06,5.93,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML ON-BODY,85726,CDM,636,RC,Q5111,HCPCS,70114013001,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,The Alliance,Premier SAS,,217.80,,,,,,,136.04,12824.21,fee schedule,
STENT PERIPH L60MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH.,85727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
XRAY/MYELOGRAPHY THORAC,8573,CDM,320,RC,72255,CPT,,,facility,outpatient,,,559.00000,531.05000,The Alliance,Premier SAS,TC,457.18,,,,,,,279.50,4345.33,fee schedule,
HPC AUTOLOGOUS TRANSPLANT 38241,85737,CDM,362,RC,38241,CPT,,,facility,outpatient,,,6381.00000,6061.95000,The Alliance,Premier SAS,,4390.13,,,,,,,1556.56,6189.57,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 4 MCG/ML 5 ML,85738,CDM,250,RC,J3490,HCPCS,71449013111,NDC,facility,outpatient,1,mL,10.27000,9.76000,The Alliance,Premier SAS,,7.07,,,,,,,5.13,9.96,percent of total billed charges,
DEFIBRILLATOR ICD VR VIGILANT EL 5.37CM X D232,85739,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,28140.00000,26733.00000,The Alliance,Premier SAS,,12916.26,,,,,,,12916.26,27295.80,percent of total billed charges,
LEAD PACE 4.1FR X 59CM HELIX 1.8MM RNG SPC 3830-59.,85740,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,The Alliance,Premier SAS,,764.24,,,,,,,764.24,1615.05,percent of total billed charges,
GENERATOR PLSE SMRT MINI W/ TORQ WRNCH AND.,85741,CDM,278,RC,C1824,HCPCS,,,facility,outpatient,,,54600.00000,51870.00000,The Alliance,Premier SAS,,25061.40,,,,,,,25061.40,54600.00,percent of total billed charges,
NEEDLE CRYOABLATION 90 DEG STR GRY HND,85742,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,4153.80,,,,,,,3018.75,5856.38,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 2.5MM X 12MM,85743,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Premier SAS,,11312.06,,,,,,,11312.06,24645.00,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR M6,85744,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Premier SAS,,220.04,,,,,,,220.04,479.40,percent of total billed charges,
SET URET STNT 4.8FR L30CM AXXCESS CATH 6FR PERCFLX HYDR+.,85745,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,The Alliance,Premier SAS,,432.35,,,,,,,432.35,941.93,percent of total billed charges,
LEAD PACE 46CM CATH 6FR R ATR/R VENT ULTIPACE,85746,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1455.00,percent of total billed charges,
LEAD PACE 52CM CATH 6FR R ATR/R VENT ULTIPACE.,85747,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1455.00,percent of total billed charges,
"VAGINITIS PANEL, NAT",85748,CDM,300,RC,81513,CPT,,,facility,outpatient,,,950.00000,902.50000,The Alliance,Premier SAS,,921.60,,,,,,,114.10,6772.31,fee schedule,
IMMUNE GLOBULIN SOLN (GAMASTAN) 2 ML,85749,CDM,636,RC,J1460,HCPCS,13533033504,NDC,facility,outpatient,1,mL,82.19000,78.08000,The Alliance,Premier SAS,,77.52,,,,,,,41.09,81.54,fee schedule,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT-PED),85751,CDM,636,RC,J1950,HCPCS,00074357501,NDC,facility,outpatient,1,EA,44799.32000,42559.35000,The Alliance,Premier SAS,,2781.10,,,,,,,1737.10,43455.34,fee schedule,
SET SCR SPNL DIA4.75MM POST THORLUM SACR TI PERC APPRCH CDH,85752,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Premier SAS,,356.96,,,,,,,356.96,777.68,percent of total billed charges,
CHEMO ADMIN PLEURAL CAV-THROACIC,85754,CDM,331,RC,96440,CPT,,,facility,outpatient,,,3115.00000,2959.25000,The Alliance,Premier SAS,,2143.12,,,,,,,314.95,3021.55,percent of total billed charges,
REMOVAL OF CANNULA AT BEDSIDE,85758,CDM,360,RC,33966,CPT,,,facility,outpatient,,,501.00000,475.95000,The Alliance,Premier SAS,,344.69,,,,,,,275.55,4686.00,percent of total billed charges,
DASATINIB TAB 70 MG,85759,CDM,250,RC,J8999,HCPCS,00003052411,NDC,facility,outpatient,1,EA,874.01000,830.31000,The Alliance,Premier SAS,,601.32,,,,,,,437.00,847.79,percent of total billed charges,
DASATINIB TAB 100 MG,85760,CDM,250,RC,J8999,HCPCS,00003085222,NDC,facility,outpatient,1,EA,1575.00000,1496.25000,The Alliance,Premier SAS,,1083.60,,,,,,,787.50,1527.75,percent of total billed charges,
MIDOSTAURIN CAP 25 MG,85761,CDM,250,RC,J8499,HCPCS,00078069899,NDC,facility,outpatient,1,EA,513.56000,487.88000,The Alliance,Premier SAS,,353.33,,,,,,,256.78,498.15,percent of total billed charges,
ACALABRUTINIB TAB 100 MG,85762,CDM,250,RC,J8999,HCPCS,00310351260,NDC,facility,outpatient,1,EA,663.39000,630.22000,The Alliance,Premier SAS,,456.41,,,,,,,331.69,643.49,percent of total billed charges,
DASATINIB TAB 140 MG,85763,CDM,250,RC,J8999,HCPCS,00003085722,NDC,facility,outpatient,1,EA,1575.27000,1496.50000,The Alliance,Premier SAS,,1083.79,,,,,,,787.63,1528.01,percent of total billed charges,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BONE MARROW (CHRBM) SO",85767,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Premier SAS,90,919.47,,,,,,,70.04,6756.70,fee schedule,
"CHROMOSOME ANALYSIS, HEMAT DISORDERS, BLOOD (CHRHB) SO",85768,CDM,310,RC,88237,CPT,,,facility,outpatient,,,1135.60000,1078.82000,The Alliance,Premier SAS,90,919.47,,,,,,,70.04,6756.70,fee schedule,
US INJ CARPAL TUNNEL,85770,CDM,361,RC,20526,CPT,,,facility,outpatient,,,208.00000,197.60000,The Alliance,Premier SAS,,909.00,,,,,,,114.40,3163.00,case rate,
SEED BRACHYTHERAPY I-125 IOD PROST IMPL PRELD,85772,CDM,278,RC,C2639,HCPCS,,,facility,outpatient,,,152.00000,144.40000,The Alliance,Premier SAS,,69.77,,,,,,,33.34,152.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM DIA0.038X0.029IN,85773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,The Alliance,Premier SAS,,1328.81,,,,,,,1328.81,2895.00,percent of total billed charges,
LEAD PACE 5.7FR L58CM AV POLYUR 55D SIL W/ SILOXANE INSUL,85774,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,The Alliance,Premier SAS,,710.74,,,,,,,710.74,1502.00,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/1 ML,85775,CDM,636,RC,J1447,HCPCS,63459091859,NDC,facility,outpatient,1,mL,647.15000,614.79000,The Alliance,Premier SAS,,0.48030,,,,,,,0.30000,627.74,fee schedule,
TUBE VENT L6MM FLNG L7.6MM LUMN 1.27MM SIL,85776,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87.48000,83.11000,The Alliance,Premier SAS,,40.15,,,,,,,40.15,87.48,percent of total billed charges,
STENT BILI DIA2.0MM L70MM PLAS DUODENAL BEND SELF EXP OTW,85777,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,299.89000,284.90000,The Alliance,Premier SAS,,137.65,,,,,,,137.65,299.89,percent of total billed charges,
COIL TARGET TETRA 2.0MMX2.5CM,85778,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
GRAFT BNE SUB SM CELL ALLGRFT CRYOPRESERVED,85779,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1828.43000,1737.01000,The Alliance,Premier SAS,,839.25,,,,,,,839.25,1828.43,percent of total billed charges,
WASHER EXT FIX 5DEG R SS ANATOMICALLY CNTOUR,85780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4110.81000,3905.27000,The Alliance,Premier SAS,,1886.86,,,,,,,1886.86,4110.81,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION, CSF (ADEVL) SO",85782,CDM,300,RC,82234,CPT,,,facility,outpatient,,,350.00000,332.50000,The Alliance,Premier SAS,90,240.80,,,,,,,175.00,339.50,percent of total billed charges,
CATH GUID AL2 8FR 100CM,85783,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,The Alliance,Premier SAS,,80.16,,,,,,,80.16,174.64,percent of total billed charges,
INTRO CATH .038IN 12FR 75CM ATR CKFL,85784,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,386.10000,366.80000,The Alliance,Premier SAS,,177.22,,,,,,,177.22,386.10,percent of total billed charges,
LOOP FIX ADJ W/O BTTN PROCINCH,85785,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1518.75000,1442.81000,The Alliance,Premier SAS,,697.11,,,,,,,697.11,1518.75,percent of total billed charges,
PHOSPHORUS TAB 62.5 MG (EQV-KPHOS),85786,CDM,250,RC,64980-0104-01-00025,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,The Alliance,Premier SAS,,0.18576,,,,,,,0.13500,0.26190,percent of total billed charges,
GRAFT HUMAN TISSUE 4X7CM THK1.6+/-0.4MM RECT MD,85787,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,3183.75000,3024.56000,The Alliance,Premier SAS,,1461.34,,,,,,,1461.34,3183.75,percent of total billed charges,
BUTTON GSTRM APPLE 12FR 1CM MN 1 BLN LOPRFL STRL,85788,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,47.62,469.24,percent of total billed charges,
RING ANNULPLSTY DIA26MM MI VLV ANG HLDR PHY II,85789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Premier SAS,,3800.52,,,,,,,3800.52,8280.00,percent of total billed charges,
GRAFT HUM TISS 6-10MM 30CC CANC CUBE,85790,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2340.75000,2223.71000,The Alliance,Premier SAS,,1074.40,,,,,,,1074.40,2340.75,percent of total billed charges,
PROCHLORPERAZINE TAB 2.5 MG,85791,CDM,250,RC,Q0164,HCPCS,5026806841500050,NDC,facility,outpatient,1,EA,1.58000,1.50000,The Alliance,Premier SAS,,1.09,,,,,,,0.73040,1.53,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001111,NDC,facility,outpatient,1,mL,83.36000,79.19000,The Alliance,Premier SAS,,57.35,,,,,,,1.49,80.86,percent of total billed charges,
INSULIN GLARGINE-YFGN SOLN 100 UNITS/ML 10 ML (EQV-SEMGLEE),85793,CDM,250,RC,J1815,HCPCS,83257001411,NDC,facility,outpatient,1,mL,19.90000,18.90000,The Alliance,Premier SAS,,13.69,,,,,,,1.49,19.30,percent of total billed charges,
GRAFT CORNEAL W1XL1.5CM THK50-100UM BIO TRANSPLANTATION,85794,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2418.75000,2297.81000,The Alliance,Premier SAS,,1110.21,,,,,,,1110.21,2418.75,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 30 GM,85795,CDM,636,RC,J1568,HCPCS,68982085005,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier SAS,,77.46,,,,,,,15.96,81.35,fee schedule,
TERBINAFINE CREAM 1% 15 GM,85796,CDM,250,RC,51672-2080-01,NDC,,,facility,outpatient,1,GM,1.36000,1.29000,The Alliance,Premier SAS,,0.93568,,,,,,,0.68000,1.32,percent of total billed charges,
DEVICE L ATR APPENDAGE CLSR 12FR 40MM NIT,85797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,The Alliance,Premier SAS,,16386.30,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM EXTRAVASCULAR ICD AURORA EV-ICD MRI,85798,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,45150.00000,42892.50000,The Alliance,Premier SAS,,20723.85,,,,,,,20723.85,45150.00,percent of total billed charges,
SET DIL SHTH 13FR L40.6CM INNR POLYMER SHTH,85799,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
PLI KT SSCL9 SFSHTH II 9FR 19.13CM,85800,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,,275.40,,,,,,,275.40,600.00,percent of total billed charges,
LEAD PACEMAKER ICD EXTRAVASCULAR EPSILA,85801,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,16709.00000,15873.55000,The Alliance,Premier SAS,,7669.43,,,,,,,7669.43,16709.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH L194CM 8FR,85802,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Premier SAS,,3263.08,,,,,,,3263.08,7109.10,percent of total billed charges,
MICROCATHETER VASC 2.4FR X 1.7FR X 150CM TIP,85803,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2632.50000,2500.88000,The Alliance,Premier SAS,,1208.32,,,,,,,1208.32,2632.50,percent of total billed charges,
CATHETER PTCA PACLITAXEL COAT BLLN L300MM,85804,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
XR PLEURAL DRAIN PERC CATH W GUIDE TC,85805,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,The Alliance,Premier SAS,,3844.00,,,,,,,739.20,4686.00,case rate,
CATHETER PTCA L130CM BLLN L300MM DIA5MM GWIRE,85820,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,The Alliance,Premier SAS,,4038.05,,,,,,,4038.05,8797.50,percent of total billed charges,
CATH ATLAS PTA BALLOON DILITATION 16MM.,85821,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,The Alliance,Premier SAS,,449.25,,,,,,,449.25,978.75,percent of total billed charges,
CATH GUIDLNR COAST 5.5FR 150CM,85822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,The Alliance,Premier SAS,,666.12,,,,,,,666.12,1451.25,percent of total billed charges,
ACUPUNC W/ELEC STIM INIT 15MIN-TECH,85823,CDM,940,RC,97813,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,,24.08,,,,,,,17.50,33.95,percent of total billed charges,
CEFTAROLINE POWD-INJ 400 MG,85824,CDM,636,RC,J0712,HCPCS,00456040010,NDC,facility,outpatient,1,EA,635.07000,603.31000,The Alliance,Premier SAS,,6.79,,,,,,,4.24,616.02,fee schedule,
AMINO ACIDS 10% (PREMASOL) 500 ML,85825,CDM,250,RC,J3490,HCPCS,00338113003,NDC,facility,outpatient,1,mL,0.34000,0.32000,The Alliance,Premier SAS,,0.23392,,,,,,,0.17000,0.32980,percent of total billed charges,
VASOPRESSIN 40 UNITS/ NS 100 ML PREMIX,85826,CDM,636,RC,J2601,HCPCS,00338964712,NDC,facility,outpatient,1,mL,4.74000,4.50000,The Alliance,Premier SAS,,4.71,,,,,,,2.37,5.99,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 20 GM,85827,CDM,636,RC,J1568,HCPCS,68982085004,NDC,facility,outpatient,1,mL,31.63000,30.05000,The Alliance,Premier SAS,,77.46,,,,,,,15.81,81.35,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 10 GM,85828,CDM,636,RC,J1568,HCPCS,68982085003,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier SAS,,77.46,,,,,,,15.96,81.35,fee schedule,
IMMUNE GLOBULIN SOLN 10% (OCTAGAM) 5 GM,85829,CDM,636,RC,J1568,HCPCS,68982085002,NDC,facility,outpatient,1,mL,31.92000,30.32000,The Alliance,Premier SAS,,77.46,,,,,,,15.96,81.35,fee schedule,
DUAL PROCESSOR KIT  NUC 7,85830,CDM,274,RC,L8619,HCPCS,,,facility,outpatient,,,29629.15000,28147.69000,The Alliance,Premier SAS,,11324.19,,,,,,,10900.23,28740.28,fee schedule,
AFLIBERCEPT SOLN 8 MG/0.07 ML (EYLEA),85831,CDM,636,RC,J0177,HCPCS,61755005001,NDC,facility,outpatient,1,mL,71250.00000,67687.50000,The Alliance,Premier SAS,,511.90,,,,,,,319.74,69112.50,fee schedule,
SECUKINUMAB SOLN 25 MG/ML 5 ML (COSENTYX),85832,CDM,636,RC,J3247,HCPCS,00078116861,NDC,facility,outpatient,1,mL,1095.57000,1040.79000,The Alliance,Premier SAS,,28.56,,,,,,,17.84,1062.70,fee schedule,
R2P DESTINATION SLENDER GUID SHTH,85836,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,The Alliance,Premier SAS,,550.80,,,,,,,550.80,1200.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X40X200CM,85837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER GUID 5FR L125CM DST L17CM PROX,85838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4952.48000,4704.86000,The Alliance,Premier SAS,,2273.19,,,,,,,2273.19,4952.48,percent of total billed charges,
COIL TARGET TETRA 4.5MMX10.0CM,85839,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
SHEATH GUID 8FR L45CM SS COIL STR CROSSCUT,85840,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,397.50000,377.62000,The Alliance,Premier SAS,,182.45,,,,,,,182.45,397.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X40X130,85841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT OPHTH THK300-400UM W0.75XL1CM COVERING GLAUCOMA DRNGE,85842,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,The Alliance,Premier SAS,,662.68,,,,,,,662.68,1443.75,percent of total billed charges,
PTCH SCLERA TSH 7X7,85843,CDM,278,RC,L8610,HCPCS,,,facility,outpatient,,,1031.25000,979.69000,The Alliance,Premier SAS,,915.80,,,,,,,515.62,1031.25,fee schedule,
GUIDEWIRE ENDOSCP L260CM DIA0.035IN BILI STD,85845,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,897.53000,852.65000,The Alliance,Premier SAS,,411.97,,,,,,,411.97,897.53,percent of total billed charges,
VALVE AORT TRANSCATHETER 29MM EVOLUT FX +.,85846,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CIRCULAR MAP CATH,85847,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4798.95000,4559.00000,The Alliance,Premier SAS,,2202.72,,,,,,,2202.72,4798.95,percent of total billed charges,
STENT URET 4.8FR L22CM FIRM W/O GWIRE TRIA.,85848,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
LEAD PACE 65CM CATH 6FR R ATR/R VNT ULTIPACE,85849,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1455.00,percent of total billed charges,
SYSTEM IMPL INCL 3.9MM BIOCOMPOSITE SWIVELOCK,85850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,The Alliance,Premier SAS,,1377.00,,,,,,,1377.00,3000.00,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 250 MG (MG 12.5 MG),85851,CDM,250,RC,43292-0401-28,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,The Alliance,Premier SAS,,0.04816,,,,,,,0.03500,0.06790,percent of total billed charges,
XR INJ PARAVERT JNT L/S 3RD LVL 64495,85855,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,The Alliance,Premier SAS,,1631.25,,,,,,,1304.05,5271.00,percent of total billed charges,
CATHETER GUID 6FR L115CM DST L19CM PROX L96CM,85857,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7746.98000,7359.63000,The Alliance,Premier SAS,,3555.86,,,,,,,3555.86,7746.98,percent of total billed charges,
CATHETER GUIDE 7FR L95CM SELECTFLEX VAR,85859,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,The Alliance,Premier SAS,,2692.03,,,,,,,2692.03,5865.00,percent of total billed charges,
CATHETER PTCA BALLN L10MM DIA3MM MRAIL,85860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
COLLAR CERVICAL M SERPENTINE STYLE MEDIUM DENSITY,85861,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.32000,15.50000,The Alliance,Premier SAS,,35.57,,,,,,,8.16,36.65,fee schedule,
SET INTRO SHEATH 6FR L90CM W/ INTEGR SIDE PRT.,85865,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1318.46000,1252.54000,The Alliance,Premier SAS,,605.17,,,,,,,605.17,1318.46,percent of total billed charges,
CATHETER IV L150CM 0.014IN CROSSING SUPP SKR,85866,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,The Alliance,Premier SAS,,218.60,,,,,,,218.60,476.25,percent of total billed charges,
SHTH CPS LOCATOR 3D LRG,85867,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,The Alliance,Premier SAS,,602.44,,,,,,,602.44,1312.50,percent of total billed charges,
TADALAFIL TAB 10 MG,85869,CDM,250,RC,31722-0645-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,The Alliance,Premier SAS,,0.71552,,,,,,,0.52000,1.01,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN SD 4 MG/ML,85871,CDM,250,RC,J3490,HCPCS,3982210300200400,NDC,facility,outpatient,1,mL,208.56000,198.13000,The Alliance,Premier SAS,,143.49,,,,,,,104.28,202.30,percent of total billed charges,
IMPLANT SACROILIAC 12X50MM THREADED RIALTO,85875,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Premier SAS,,3958.80,,,,,,,3958.80,8624.83,percent of total billed charges,
IMPLANT SACROILIAC 12X40MM THRD RIALTO,85876,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8624.83000,8193.59000,The Alliance,Premier SAS,,3958.80,,,,,,,3958.80,8624.83,percent of total billed charges,
STENT PERIPH L55MM DIA20MM CATH L75CM SHTH 11FR VEN SELF,85877,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,The Alliance,Premier SAS,,4014.30,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT ABRE 18MMX60MMX90CM,85878,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
MESH SURG W12XL14IN UNCOATED MFIL POLYPR ABSRB HYDRGEL LP.,85880,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,The Alliance,Premier SAS,,2731.62,,,,,,,2731.62,5951.25,percent of total billed charges,
SLING SHLDR XSM ULT SFT STRP ESSENTIAL,85881,CDM,270,RC,A4565,HCPCS,,,facility,outpatient,,,14.72000,13.98000,The Alliance,Premier SAS,,12.01,,,,,,,7.36,14.28,fee schedule,
DEFIBRILLATOR ICD 2 CHMBR RESONATE HF MRI,85882,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,33390.00000,31720.50000,The Alliance,Premier SAS,,15326.01,,,,,,,15326.01,32388.30,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA3.5MM MRAIL,85883,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
MICROCATHETER VASC DST 3.4FR PROX 3.8FR,85884,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,The Alliance,Premier SAS,,1710.23,,,,,,,1710.23,3726.00,percent of total billed charges,
COIL EMB 10MM X 5MM VIA MICROCATHETER 0.033IN INTVASC,85885,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,31395.00000,29825.25000,The Alliance,Premier SAS,,14410.31,,,,,,,14410.31,31395.00,percent of total billed charges,
MICROCATHETER DIAG 3.1FR X 2.6FR X 156CM PTFE,85886,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT FLO DVRTR INTCRAN 4X13X7MM DLIVRD THRU 0.027IN,85887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Premier SAS,,15133.23,,,,,,,15133.23,32970.00,percent of total billed charges,
VALVE AORT TRANSCATHETER 34MM EVOLUT FX +,85888,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
ABDOMINAL BIND 12 IN 2XL,85889,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,39.04000,37.09000,The Alliance,Premier SAS,,26.86,,,,,,,19.52,37.87,percent of total billed charges,
BLLN ARMADA 35 12X40X135CM,85890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,The Alliance,Premier SAS,,215.16,,,,,,,215.16,468.75,percent of total billed charges,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 4 ML,85891,CDM,636,RC,Q5129,HCPCS,72606001101,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Premier SAS,,69.84,,,,,,,43.62,425.46,fee schedule,
BEVACIZUMAB-ADCD SOLN 25 MG/ML 16 ML,85892,CDM,636,RC,Q5129,HCPCS,72606001201,NDC,facility,outpatient,1,mL,438.62000,416.69000,The Alliance,Premier SAS,,69.84,,,,,,,43.62,425.46,fee schedule,
FILGRASTIM-AYOW SOLN 480 MCG/0.8 ML,85893,CDM,636,RC,Q5125,HCPCS,70121157001,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Premier SAS,,0.65641,,,,,,,0.41000,798.91,fee schedule,
FILGRASTIM-AYOW SOLN 300 MCG/0.5 ML,85894,CDM,636,RC,Q5125,HCPCS,70121156801,NDC,facility,outpatient,1,mL,823.62000,782.44000,The Alliance,Premier SAS,,0.65641,,,,,,,0.41000,798.91,fee schedule,
TRASTUZUMAB-DKST POWD-INJ 420 MG MDV,85895,CDM,250,RC,Q5114,HCPCS,83257000412,NDC,facility,outpatient,1,EA,6037.62000,5735.73000,The Alliance,Premier SAS,,71.39,,,,,,,44.59,5856.49,fee schedule,
PALIPERIDONE SUSP 78 MG/0.5 ML (INVEGA SUSTENNA),85897,CDM,636,RC,J2426,HCPCS,50458056101,NDC,facility,outpatient,1,mL,5333.84000,5067.15000,The Alliance,Premier SAS,,24.14,,,,,,,15.08,5173.82,fee schedule,
IMPLANT FIX REV TENS ADJ LOOP PROCINCH,85902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1893.75000,1799.06000,The Alliance,Premier SAS,,869.23,,,,,,,869.23,1893.75,percent of total billed charges,
BUTTON SUT 11MM ID3.5MM THK1.3MM RND CONCAVE,85903,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,937.50000,890.62000,The Alliance,Premier SAS,,430.31,,,,,,,430.31,937.50,percent of total billed charges,
DEV NEUROSTIM 74MM X 79MM NRECHRG WRLSS #9772501,85905,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,The Alliance,Premier SAS,,516.38,,,,,,,516.38,1125.00,percent of total billed charges,
RECHARGE SYS RS6230 PERCEPT RC DBS US,85906,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,The Alliance,Premier SAS,,3670.67,,,,,,,3670.67,7997.10,percent of total billed charges,
COMM HANDSET KT TH91DBS PERCPT PC/RC US,85907,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,The Alliance,Premier SAS,,2288.23,,,,,,,2288.23,4985.25,percent of total billed charges,
INS B35300 DBS PERCEPT RC US EMANUAL,85908,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,51282.00000,48717.90000,The Alliance,Premier SAS,,23538.44,,,,,,,23538.44,51282.00,percent of total billed charges,
CATHETER BLLN RETRV 7-6FR BLLN DIA15-18MM RX.,85909,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,775.39000,736.62000,The Alliance,Premier SAS,,355.90,,,,,,,355.90,775.39,percent of total billed charges,
CYGNUS DUAL 2X3CM Q4282,85911,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1581.25000,1502.19000,The Alliance,Premier SAS,,1087.90,,,,,,,790.62,1533.81,percent of total billed charges,
CYGNUS DUAL 4X6CM Q4282,85913,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,984.38000,935.16000,The Alliance,Premier SAS,,677.25,,,,,,,492.19,954.85,percent of total billed charges,
CYGNUS DUAL 4X4CM Q4282,85914,CDM,623,RC,Q4282,HCPCS,,,facility,outpatient,,,1433.75000,1362.06000,The Alliance,Premier SAS,,986.42,,,,,,,716.88,1390.74,percent of total billed charges,
EPOETIN ALFA-EPBX SOLN PF 4000 UNITS/ML,85918,CDM,636,RC,Q5106,HCPCS,0006913071000030,NDC,facility,outpatient,1,mL,139.42000,132.45000,The Alliance,Premier SAS,,12.12,,,,,,,7.57,135.24,fee schedule,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,55150025410,NDC,facility,outpatient,1,mL,1.16000,1.10000,The Alliance,Premier SAS,,0.79808,,,,,,,0.58000,1.13,percent of total billed charges,
LIDOCAINE SOLN 2% 10 ML,85919,CDM,250,RC,J2003,HCPCS,63323048617,NDC,facility,outpatient,1,mL,1.09000,1.04000,The Alliance,Premier SAS,,0.74992,,,,,,,0.54500,1.06,percent of total billed charges,
XRAY TMJ UNILATERAL-TECH,8592,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,The Alliance,Premier SAS,TC,167.92,,,,,,,131.00,1331.91,fee schedule,
COIL TARGET TETRA 2.0MMX6.0CM,85923,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
CYCLOPENTOLATE/KETOROLAC/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-0.5%-2.5%-1% 1 ML,85925,CDM,250,RC,71266-8240-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Premier SAS,,14.41,,,,,,,10.47,20.32,percent of total billed charges,
GRFT VSC L90CM DIA6MM MINI CUF FLX SM BEAD,85928,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17633.23000,16751.57000,The Alliance,Premier SAS,,8093.65,,,,,,,8093.65,17633.23,percent of total billed charges,
CATHETER PTCA PERIPH DRG COAT L130CM BLLN.,85930,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,The Alliance,Premier SAS,,2834.55,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2.5MM MRAIL,85931,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 10MM,85932,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L15MM,85933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier SAS,,368.35,,,,,,,368.35,802.50,percent of total billed charges,
CATHETER PTCA 2.6X2.3X2.4FR L144CM BLLN L20MM,85934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,802.50000,762.38000,The Alliance,Premier SAS,,368.35,,,,,,,368.35,802.50,percent of total billed charges,
ZALEPLON CAP 10 MG,85935,CDM,250,RC,65862-0215-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,The Alliance,Premier SAS,,0.43344,,,,,,,0.31500,0.61110,percent of total billed charges,
RECELL - AUTOGRAFT SUSPENSION C1832,85936,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Premier SAS,,9782.44,,,,,,,9782.44,21312.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 10 ML,85941,CDM,250,RC,J2003,HCPCS,63323049297,NDC,facility,outpatient,1,mL,1.63000,1.55000,The Alliance,Premier SAS,,1.12,,,,,,,0.81500,1.58,percent of total billed charges,
GORE TAG THOR BRANCH ENDOPROS 17MMX8MMX6CM,85942,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24180.00000,22971.00000,The Alliance,Premier SAS,,11098.62,,,,,,,11098.62,24180.00,percent of total billed charges,
CATH EP DUO DECAPOLAR 7FR L95CM.,85943,CDM,278,RC,C1731,HCPCS,,,facility,outpatient,,,1123.13000,1066.97000,The Alliance,Premier SAS,,515.52,,,,,,,515.52,1123.13,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM GWIRE L145CM,85944,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier SAS,,277.12,,,,,,,277.12,603.75,percent of total billed charges,
PETROLATUM OINT 80 GM (EQV-AQUAPHOR),85945,CDM,250,RC,72140-0037-11,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,The Alliance,Premier SAS,,0.15824,,,,,,,0.11500,0.22310,percent of total billed charges,
EVINACUMAB-DGNB SOLN 150 MG/ML 8 ML (EVKEEZA),85946,CDM,636,RC,J1305,HCPCS,61755001001,NDC,facility,outpatient,1,mL,10018.32000,9517.40000,The Alliance,Premier SAS,,303.79,,,,,,,189.75,9717.77,fee schedule,
LIFESTYLE ENHANCEMENT PROG PER MONTH S9473,85947,CDM,948,RC,S9473,HCPCS,,,facility,outpatient,,,30.00000,28.50000,The Alliance,Premier SAS,,20.64,,,,,,,15.00,29.10,percent of total billed charges,
ALUMINUM FINGER SPLINT A4570,85949,CDM,270,RC,A4570,HCPCS,,,facility,outpatient,,,94.90000,90.16000,The Alliance,Premier SAS,,65.29,,,,,,,47.45,92.05,percent of total billed charges,
VALVE MI 27MM BOV PERICARD LEAFLET COCR STNT,85952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER GUID 5FR L100CM STD COR NYL JL 3 CRV,85953,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
CATH MAP OPTRELL D-F CRV 2.4MM,85954,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,16864-0680-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,The Alliance,Premier SAS,,0.13760,,,,,,,0.10000,0.19400,percent of total billed charges,
BENZOCAINE SPRAY 20% 78 GM (EQV-DERMOPLAST),85955,CDM,250,RC,51409-0007-22,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,The Alliance,Premier SAS,,0.15136,,,,,,,0.11000,0.21340,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,33342-0094-41,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,The Alliance,Premier SAS,,2.16,,,,,,,1.57,3.05,percent of total billed charges,
RIZATRIPTAN TAB-DISINTEGRATING 10 MG,85958,CDM,250,RC,69452-0157-73,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,The Alliance,Premier SAS,,2.15,,,,,,,1.56,3.03,percent of total billed charges,
PHENOBARBITAL SOLN SD 10 MG/ML,85959,CDM,250,RC,J2560,HCPCS,0064104762500010,NDC,facility,outpatient,1,mL,12.80000,12.16000,The Alliance,Premier SAS,,43.80,,,,,,,6.40,48.87,fee schedule,
XRAY/SPEECH EVAL-VID,8596,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,The Alliance,Premier SAS,TC,452.18,,,,,,,267.00,3586.71,fee schedule,
CATHETER PTCA PERIPH DRG COAT L200CM BLLN 6X80MM IN.PACT 018,85961,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,7400.25000,7030.24000,The Alliance,Premier SAS,,3396.71,,,,,,,3396.71,7400.25,percent of total billed charges,
SNARE VASC L180CM DIA0.014IN LOOP DIA4MM HELI,85963,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,8452.50000,8029.88000,The Alliance,Premier SAS,,3879.70,,,,,,,3879.70,8452.50,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.16% 1 ML,85965,CDM,250,RC,71266-8604-01,NDC,,,facility,outpatient,1,mL,27.97000,26.57000,The Alliance,Premier SAS,,19.24,,,,,,,13.98,27.13,percent of total billed charges,
COIL EMB L60CM DIA24MM 0.020IN PERIPH COMPLX L VOL STD FRME,85968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,The Alliance,Premier SAS,,2042.78,,,,,,,2042.78,4450.50,percent of total billed charges,
GUIDEWIRE VASC L180CM DIA0.014IN HYDRPHLC,85969,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,The Alliance,Premier SAS,,163.52,,,,,,,163.52,356.25,percent of total billed charges,
SET DIL SZ AA SHTH OTR 12.3X10FR L41CM INNR,85970,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1500.00,percent of total billed charges,
SET DIL SZ A SHTH OTR 13.9X11.6FR L41CM INNR,85971,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1500.00,percent of total billed charges,
SHEATH DIL SZ B INNR 12.1FR/10FR OTR,85972,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,1500.00000,1425.00000,The Alliance,Premier SAS,,688.50,,,,,,,688.50,1500.00,percent of total billed charges,
EXCLUDER CONFORM AAA PROSTH,85973,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,The Alliance,Premier SAS,,12794.81,,,,,,,12794.81,27875.40,percent of total billed charges,
VALVE AORT TRANSCATHETER 26MM EVOLUT FX +,85974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,The Alliance,Premier SAS,,28917.00,,,,,,,28917.00,63000.00,percent of total billed charges,
CATHETER HAD 14FR L55CM 50CM CUF FR TIP SPL,85977,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,The Alliance,Premier SAS,,490.56,,,,,,,490.56,1068.75,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 5.0X80MM,85978,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
RADIAL TO PERIPH GUID SHTH 6FR 110CM HYDRPHLC,85980,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,748.13000,710.72000,The Alliance,Premier SAS,,343.39,,,,,,,343.39,748.13,percent of total billed charges,
CATH CLOSURE-FAST 6FR 100CM,85981,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3510.00000,3334.50000,The Alliance,Premier SAS,,1611.09,,,,,,,1611.09,3510.00,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS TC, TUMOR SO",85989,CDM,300,RC,88381,CPT,,,facility,outpatient,,,737.50000,700.62000,The Alliance,Premier SAS,TC,1000.37,,,,,,,368.75,7351.18,fee schedule,
ENTERIC VIRAL PANEL BY NUCLEIC ACID TEST,85992,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1535.00000,1458.25000,The Alliance,Premier SAS,,912.54,,,,,,,128.29,6705.74,fee schedule,
CYCLOPENTOLATE/PHENYLEPHRINE/TROPICAMIDE SOLN-OPHTH 1%-2.5%-1% 1 ML,86011,CDM,250,RC,71266-8211-01,NDC,,,facility,outpatient,1,EA,20.95000,19.90000,The Alliance,Premier SAS,,14.41,,,,,,,10.47,20.32,percent of total billed charges,
HISTOPLASMA AB COMP/FIX/IMMDIFF (HISER) SO,86013,CDM,300,RC,86698,CPT,,,facility,outpatient,,,108.90000,103.46000,The Alliance,Premier SAS,90,87.78,,,,,,,14.25,645.08,fee schedule,
ENROUTE ENFLATE TRNSCRTD RX BLLN DIL CATH 4 5X35MM,86017,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1383.75,percent of total billed charges,
INTRODUCER SHTH GUID 8FR L60CM SEPT SER FAST,86021,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,603.75000,573.56000,The Alliance,Premier SAS,,277.12,,,,,,,277.12,603.75,percent of total billed charges,
"CATH ACUNAV LUMOS 4D ICE, 1/1 (510K)",86022,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,CPT,,,facility,outpatient,,,22.49000,21.37000,The Alliance,Premier SAS,,35.78,,,,,,,11.24,37.10,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUZONE 2024-2025),86023,CDM,250,RC,90656,HCPCS,49281042450,NDC,facility,outpatient,1,mL,44.98000,42.73000,The Alliance,Premier SAS,,35.78,,,,,,,22.49,43.63,fee schedule,
GRAFT EVAR L91MM DIA12MM SHTH OD7.7MM ID6.7MM FEN DST BIFR,86024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,12477.50000,11853.62000,The Alliance,Premier SAS,,5727.17,,,,,,,5727.17,12477.50,percent of total billed charges,
BLLN WOLVERINE 3.0MM X 15MM,86025,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
STENT URET 6FR L28CM FIRM TRI LAYR DSGN RAW COLORANT RDPQ,86026,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
BLLN WOLVERINE 3.5MM X 15MM,86027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
ENROUTE ENFLATE TRANSCRTD RX BLLN DIL CATH,86028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1383.75,percent of total billed charges,
RESONATE HF CRT-D X4 CRT-D ENDURALIFE BTTRY,86029,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,41160.00000,39102.00000,The Alliance,Premier SAS,,18892.44,,,,,,,18892.44,39925.20,percent of total billed charges,
"LIVER/KIDNEY MICROSOME TYPE 1 ANTIBODIES, SERUM (LKM) SO",86030,CDM,300,RC,86376,CPT,,,facility,outpatient,,,114.90000,109.16000,The Alliance,Premier SAS,90,103.96,,,,,,,15.03,763.98,fee schedule,
BORRELIA MIYAMOTOI DETECTION PCR (BMIPB) SO,86031,CDM,300,RC,87478,CPT,,,facility,outpatient,,,855.60000,812.82000,The Alliance,Premier SAS,90,226.17,,,,,,,35.09,1662.04,fee schedule,
FILGRASTIM-AYOW/D5W SOLN SD 15 MCG/ML,86032,CDM,636,RC,Q5125,HCPCS,7012115680101500,NDC,facility,outpatient,1,mL,50.24000,47.73000,The Alliance,Premier SAS,,0.65641,,,,,,,0.41000,48.73,fee schedule,
PANCRELIPASE CAP-EC (PERTZYE 4000),86033,CDM,250,RC,59767-0004-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,The Alliance,Premier SAS,,3.96,,,,,,,2.88,5.58,percent of total billed charges,
PANCRELIPASE CAP-EC (PERTZYE 8000),86034,CDM,250,RC,59767-0008-01,NDC,,,facility,outpatient,1,EA,8.58000,8.15000,The Alliance,Premier SAS,,5.90,,,,,,,4.29,8.32,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 16,000)",86035,CDM,250,RC,59767-0016-01,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,The Alliance,Premier SAS,,11.81,,,,,,,8.59,16.65,percent of total billed charges,
"PANCRELIPASE CAP-EC (PERTZYE 24,000)",86036,CDM,250,RC,59767-0024-01,NDC,,,facility,outpatient,1,EA,25.75000,24.47000,The Alliance,Premier SAS,,17.72,,,,,,,12.88,24.98,percent of total billed charges,
STENT BILI L8CM OD10MM INTRO L208CM OD7FR 0.035IN NIT SELF,86037,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5654.55000,5371.82000,The Alliance,Premier SAS,,2595.44,,,,,,,2595.44,5654.55,percent of total billed charges,
THE IVL CATH IS A PROPRIETARY LITHO DEV,86038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.0X80MM,86039,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
SUBSTITUTE BNE 100X10MM DEMIN STRP CORT,86040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4183.13000,3973.97000,The Alliance,Premier SAS,,1920.06,,,,,,,1920.06,4183.13,percent of total billed charges,
SNR VASC 3.2FR L175CM DIA4-8MM CATH L150CM,86041,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2475.00000,2351.25000,The Alliance,Premier SAS,,1136.03,,,,,,,1136.03,2475.00,percent of total billed charges,
CATH PTCA BLLN L12MM DIA1.5MM TRNSTLSS TIP,86042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
DILATOR TRNSSEPT L65CM ELONG SHFT TAPR TIP,86043,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
CATH MAP OPTRELL F-J CRV 2.4MM,86045,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,9273.60000,8809.92000,The Alliance,Premier SAS,,4256.58,,,,,,,4256.58,9273.60,percent of total billed charges,
CATHETER ABLAT PFA LOOP PULSESELECT,86046,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,19957.80000,18959.91000,The Alliance,Premier SAS,,9160.63,,,,,,,9160.63,19957.80,percent of total billed charges,
SHEATH CRYO STEER 10FR X 13MM FLEXCATH CNTOUR,86047,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
ENROUTE ENFLATE TRANS RX BLLN DIL CATH 6 0X25MM,86048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1383.75,percent of total billed charges,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Premier SAS,,133.67,,,,,,,41.74,138.59,fee schedule,
INFLUENZA VACCINE SUSP PF HD TRIVALENT 65 YEARS(+) (FLUZONE HIGH DOSE 2024-2025),86049,CDM,250,RC,90662,HCPCS,49281012465,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Premier SAS,,133.67,,,,,,,83.49,161.97,fee schedule,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,CPT,,,facility,outpatient,,,83.49000,79.32000,The Alliance,Premier SAS,,133.67,,,,,,,41.74,138.59,fee schedule,
INFLUENZA VACCINE SUSP PF RECOMB HEMAGG TRI 18 YEARS(+) (FLUBLOK 2024-2025),86050,CDM,250,RC,90673,HCPCS,49281072410,NDC,facility,outpatient,1,mL,166.98000,158.63000,The Alliance,Premier SAS,,133.67,,,,,,,83.49,161.97,fee schedule,
ETANERCEPT SOLN 25 MG/0.5 ML,86051,CDM,636,RC,J1438,HCPCS,58406005504,NDC,facility,outpatient,1,mL,4383.75000,4164.57000,The Alliance,Premier SAS,,3016.02,,,,,,,1080.88,4252.24,percent of total billed charges,
STENT PERIPH L58MM DIA10MM CATH L135CM 0.035IN VASC SS EPTFE,86052,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,The Alliance,Premier SAS,,5905.03,,,,,,,5905.03,12865.00,percent of total billed charges,
"COPPER, SERUM (CUS1) SO",86053,CDM,300,RC,82525,CPT,,,facility,outpatient,,,98.00000,93.10000,The Alliance,Premier SAS,90,87.78,,,,,,,12.82,645.08,fee schedule,
"ZINC, SERUM (ZN_S) SO",86054,CDM,300,RC,84630,CPT,,,facility,outpatient,,,90.00000,85.50000,The Alliance,Premier SAS,90,80.86,,,,,,,11.77,594.19,fee schedule,
XRAY/TM JOINTS BILATERAL-TC,8606,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,The Alliance,Premier SAS,TC,272.65,,,,,,,210.00,2162.63,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,CPT,,,facility,outpatient,,,36.49000,34.67000,The Alliance,Premier SAS,,59.00,,,,,,,18.25,61.17,fee schedule,
INFLUENZA VACCINE SUSP PF TRIVALENT 6 MO(+) (FLUCELVAX 2024-2025),86076,CDM,250,RC,90661,HCPCS,70461065403,NDC,facility,outpatient,1,mL,72.98000,69.33000,The Alliance,Premier SAS,,59.00,,,,,,,36.49,70.79,fee schedule,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1MM X 2CM,86077,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier SAS,,3562.99,,,,,,,3562.99,7762.50,percent of total billed charges,
COIL NEUROVASCULAR HYDROSOFT 3D ADV 1.5MM X,86078,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,The Alliance,Premier SAS,,3562.99,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT NEUROVASC INTLUMN SUPP 4.0MM X 13MM,86079,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,24645.00000,23412.75000,The Alliance,Premier SAS,,11312.06,,,,,,,11312.06,24645.00,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 2.5X13X8MM,86080,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,36372.00000,34553.40000,The Alliance,Premier SAS,,16694.75,,,,,,,16694.75,36372.00,percent of total billed charges,
MICROCATHETER VASC 2FR X 2.5FR X 156CM STR,86081,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
INTRODUCER SHTH 6FR X 10CM PINN R/O II,86082,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1256.25000,1193.44000,The Alliance,Premier SAS,,576.62,,,,,,,576.62,1256.25,percent of total billed charges,
CATHETER GUID 7FR X 60CM IC90 ACUITY PRO,86083,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,918.75000,872.81000,The Alliance,Premier SAS,,421.71,,,,,,,421.71,918.75,percent of total billed charges,
SHEATH DIL SM 12FR L43CM OD0.215IN ID0.168IN,86084,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier SAS,,499.16,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER PTCA BLLN L10MM DIA2MM MRAIL,86085,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
GENERATOR NEUROSTIM SCS RECHARGABLE CLOSE,86086,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,44688.00000,42453.60000,The Alliance,Premier SAS,,20511.79,,,,,,,20511.79,44688.00,percent of total billed charges,
KIT PRGM HANDSET AND COMMUNICATOR INCEPTIV,86087,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,The Alliance,Premier SAS,,1947.77,,,,,,,1947.77,4243.50,percent of total billed charges,
KIT RECHARGER INCEPTIV,86088,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,3536.25000,3359.44000,The Alliance,Premier SAS,,1623.14,,,,,,,1623.14,3536.25,percent of total billed charges,
CATH SHOCKWAVE L6 IVL 10X30MM,86089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,The Alliance,Premier SAS,,4909.01,,,,,,,4909.01,10695.00,percent of total billed charges,
CATHETER DIAG 1.39MM X 135CM HYDRPHLC 40CM,86090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 2.6FR X 90CM SS HYDRPHLC ANG,86091,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
ENROUTE ENFLATE TRANSCAROTID RX BLLN DIL CATH,86092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1383.75,percent of total billed charges,
VEST COMPRESSION MALE SIZE SM,86093,CDM,290,RC,A4467,HCPCS,,,facility,outpatient,,,155.28000,147.52000,The Alliance,Premier SAS,,106.83,,,,,,,77.64,150.62,percent of total billed charges,
ELECTRD PACE 5FR 110CM R CRV BALLOON CATH,86094,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,915.56000,869.78000,The Alliance,Premier SAS,,420.24,,,,,,,420.24,915.56,percent of total billed charges,
US NONINV LWR EXT /TCOM,86096,CDM,320,RC,93922,CPT,,,facility,outpatient,,,932.00000,885.40000,The Alliance,Premier SAS,TC,641.22,,,,,,,466.00,904.04,percent of total billed charges,
LEUCOVORIN SOLN 10 MG/ML 50 ML,86097,CDM,250,RC,J0640,HCPCS,63323063150,NDC,facility,outpatient,1,mL,7.47000,7.10000,The Alliance,Premier SAS,,6.32,,,,,,,3.73,7.25,fee schedule,
SET INTRO 11FR SHTH L70CM DIL L81CM 0.038IN,86098,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,331.50000,314.92000,The Alliance,Premier SAS,,152.16,,,,,,,152.16,331.50,percent of total billed charges,
GENERATOR BAROSTIM NEO2 IPG,86099,CDM,275,RC,C1767,HCPCS,,,facility,outpatient,,,66150.00000,62842.50000,The Alliance,Premier SAS,,30362.85,,,,,,,30362.85,64165.50,percent of total billed charges,
CATHETER GUID 9FR X 45CM COR SNUS EXT HK OTR.,86100,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1856.25000,1763.44000,The Alliance,Premier SAS,,852.02,,,,,,,852.02,1856.25,percent of total billed charges,
MA CLIP PLCMT LYMPH NODE BX,86101,CDM,360,RC,38999,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,909.00,,,,,,,415.12,5858.00,case rate,
"PRECIVITY AD2, PLASMA (C2AD2) SO",86102,CDM,300,RC,81599,CPT,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,90,928.80,,,,,,,675.00,1309.50,percent of total billed charges,
"FILAMENTOUS-ACTIN AB, IGG (FACT) SO",86103,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
CHEMICAL CAUTERIZE WOUND,86110,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,1786.05,,,,,,,1427.80,5271.00,percent of total billed charges,
DRAIN PERITONSILLAR ABSCESS,86111,CDM,361,RC,42700,CPT,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,909.00,,,,,,,220.50,3163.00,case rate,
ASPIRATION- NON-JOINT,86112,CDM,361,RC,,,,,facility,outpatient,,,2596.00000,2466.20000,The Alliance,Premier SAS,,1786.05,,,,,,,1427.80,5271.00,percent of total billed charges,
CATHETER CARD ABLATION QPLR LG CRV ELECTRD SPC,86114,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,The Alliance,Premier SAS,,2153.63,,,,,,,2153.63,4692.00,percent of total billed charges,
BLLN CROSSTELLA RX 5X200X200CM,86115,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN WOLVERINE 4.0MM X 15MM,86116,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,The Alliance,Premier SAS,,1741.90,,,,,,,1741.90,3795.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 4.0X80MM,86117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER DIAG L90CM HYDRPHLC COAT L40CM SS,86118,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,856.88000,814.04000,The Alliance,Premier SAS,,393.31,,,,,,,393.31,856.88,percent of total billed charges,
CATHETER GUID 6FR L100CM LUMN ID0.071IN,86119,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
FLEXCATH CRSS 65CM 10FR TRNSSEPT ACCS NDL,86123,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
STENT NEPHURET 8FR L26CM NONCOATED INT EXT,86124,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,The Alliance,Premier SAS,,189.34,,,,,,,189.34,412.50,percent of total billed charges,
STRIP BNE GRFT W10XL50MM DEMIN CORT BNE FBR,86126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2484.38000,2360.16000,The Alliance,Premier SAS,,1140.33,,,,,,,1140.33,2484.38,percent of total billed charges,
GRAFT BNE SUB 5CC DBM + PTTY SYR OSTEOSELECT,86127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2925.00000,2778.75000,The Alliance,Premier SAS,,1342.58,,,,,,,1342.58,2925.00,percent of total billed charges,
HAND HELD ECHO LTD 2D 93308 TC,86128,CDM,480,RC,93308,CPT,,,facility,outpatient,,,1477.00000,1403.15000,The Alliance,Premier SAS,TC,1016.18,,,,,,,738.50,1432.69,percent of total billed charges,
93325 HAND HELD ECHO COLOR FLOW TECH,86129,CDM,480,RC,93325,CPT,,,facility,outpatient,,,277.00000,263.15000,The Alliance,Premier SAS,TC,190.58,,,,,,,138.50,268.69,percent of total billed charges,
93321 HAND HELD DOPPLER LTD TECH,86130,CDM,480,RC,93321,CPT,,,facility,outpatient,,,245.00000,232.75000,The Alliance,Premier SAS,TC,168.56,,,,,,,122.50,237.65,percent of total billed charges,
"MITOCHONDRIAL ANTIBODIES, M2 (AMA) SO",86131,CDM,300,RC,86381,CPT,,,facility,outpatient,,,201.10000,191.04000,The Alliance,Premier SAS,90,164.87,,,,,,,16.91,1211.55,fee schedule,
"THIAMIN (VITAMIN B1), WB (TDP) SO",86132,CDM,300,RC,84425,CPT,,,facility,outpatient,,,167.70000,159.31000,The Alliance,Premier SAS,90,150.17,,,,,,,21.94,1103.49,fee schedule,
CARBAPENAMASE DETECTION BY NAT,86133,CDM,300,RC,87150,CPT,,,facility,outpatient,,,277.20000,263.34000,The Alliance,Premier SAS,,249.50,,,,,,,35.09,1833.46,fee schedule,
PRECIVITY AD2 REFLEX TO APOE (AD2AR) SO,86134,CDM,300,RC,0503U,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,The Alliance,Premier SAS,90,928.80,,,,,,,675.00,4687.50,percent of total billed charges,
CATHETER BLLN OCCL 9MM X 165CM SCEPTER MINI,86135,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,10524.50000,9998.27000,The Alliance,Premier SAS,,4830.75,,,,,,,4830.75,10524.50,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,CPT,,,facility,outpatient,,,533.61000,506.93000,The Alliance,Premier SAS,,367.12,,,,,,,266.81,517.60,percent of total billed charges,
CHIKUNGUNYA VACCINE SOLN PF (IXCHIQ),86136,CDM,250,RC,90589,HCPCS,42515000301,NDC,facility,outpatient,1,EA,533.61000,506.93000,The Alliance,Premier SAS,,367.12,,,,,,,266.81,517.60,percent of total billed charges,
BUTTON 4.5CM 16FR RADOPQ LOPRFL PROX ANRFLX V,86139,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,248.15,,,,,,,47.62,349.86,percent of total billed charges,
SET SHTH DIL ROT CTRL RL 11.0FR EVOLUTION,86140,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,The Alliance,Premier SAS,,3325.45,,,,,,,3325.45,7245.00,percent of total billed charges,
VALVE SHUNT 100MM H2O MIC RICKHAM RESVR UNITZ,86141,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,6399.89000,6079.90000,The Alliance,Premier SAS,,2937.55,,,,,,,2937.55,6399.89,percent of total billed charges,
DEV CLOSE VASCADE XL 10-12FR,86142,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,956.25000,908.44000,The Alliance,Premier SAS,,438.92,,,,,,,438.92,956.25,percent of total billed charges,
VANCOMYCIN SOLN SD 10 MG/ML 0.3 ML INTRAOCULAR,86143,CDM,250,RC,J3370,HCPCS,6745703395001000,NDC,facility,outpatient,1,mL,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,3.24,percent of total billed charges,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,00004110020,NDC,facility,outpatient,1,EA,42.84000,40.70000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,41.55,fee schedule,
CAPECITABINE TAB 150 MG,86144,CDM,250,RC,J8522,HCPCS,16714046701,NDC,facility,outpatient,1,EA,19.09000,18.13000,The Alliance,Premier SAS,,0.08005,,,,,,,0.05000,18.52,fee schedule,
PLEUROLYSIS PROCEDURE SUBSQT DAY,86152,CDM,361,RC,,,,,facility,outpatient,,,3245.00000,3082.75000,The Alliance,Premier SAS,,2232.56,,,,,,,1784.75,5271.00,percent of total billed charges,
CATH SHOCKWAVE E8 IVL 3.5X80MM,86154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,The Alliance,Premier SAS,,6687.63,,,,,,,6687.63,14570.00,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 10 ML,86155,CDM,250,RC,J2004,HCPCS,63323049397,NDC,facility,outpatient,1,mL,2.10000,1.99000,The Alliance,Premier SAS,,1.44,,,,,,,1.05,2.04,percent of total billed charges,
ABIRATERONE TAB 250 MG,86157,CDM,250,RC,J8999,HCPCS,60687045521,NDC,facility,outpatient,1,EA,15.80000,15.01000,The Alliance,Premier SAS,,10.87,,,,,,,7.90,15.33,percent of total billed charges,
SYSTEM ACCS SHTH 17FR X 12FR L ATR APPENDAGE,86158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,The Alliance,Premier SAS,,2375.32,,,,,,,2375.32,5175.00,percent of total billed charges,
COIL TARGET 360 NANO 2MMX3CM,86159,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
INTRODUCER SHTH 5FR X 10CM PINN R/O II,86160,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,134.00000,127.30000,The Alliance,Premier SAS,,61.51,,,,,,,61.51,134.00,percent of total billed charges,
STENT BILI 10FR L12CM PLAS DUODENAL BEND RX,86162,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
"PT COMPRESSION BANDAGES UPPER, UNITS",86163,CDM,420,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,782.79,per diem,
"OT COMPRESSION BANDAGES LOWER, UNITS",86164,CDM,430,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,688.70,per diem,
"PT COMPRESSION BANDAGES LOWER, UNITS",86165,CDM,420,RC,29581,CPT,,,facility,outpatient,,,710.00000,674.50000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,688.70,per diem,
"OT COMPRESSION BANDAGES UPPER, UNITS",86166,CDM,430,RC,29584,CPT,,,facility,outpatient,,,807.00000,766.65000,The Alliance,Premier SAS,G0,180.00,,,,,,,126.65,782.79,per diem,
DEV CLOSE PERCLOSE PROSTYL 6FR,86167,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,866.25000,822.94000,The Alliance,Premier SAS,,397.61,,,,,,,397.61,866.25,percent of total billed charges,
CROSSLINK SPNL L 40-56MM OCCIPITOCERVICAL UP THOR MAS TO MAS,86170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3195.98000,3036.18000,The Alliance,Premier SAS,,1466.95,,,,,,,1466.95,3195.98,percent of total billed charges,
SET SCR SPNL OCCIPITOCERVICAL UP THOR FLAT CONN INFIN,86171,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,479.40000,455.43000,The Alliance,Premier SAS,,220.04,,,,,,,220.04,479.40,percent of total billed charges,
MICONAZOLE OINT 2% 71 GM,86173,CDM,250,RC,53329-0172-10,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,The Alliance,Premier SAS,,0.11008,,,,,,,0.08000,0.15520,percent of total billed charges,
NM PET POSLUMA PER MCI,86174,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Premier SAS,,1084.91,,,,,,,671.22,1529.60,percent of total billed charges,
NM PET POSLUMA PER MCI WASTE,86175,CDM,343,RC,A9608,HCPCS,,,facility,outpatient,,,1576.91000,1498.06000,The Alliance,Premier SAS,JW,1084.91,,,,,,,788.46,1529.60,percent of total billed charges,
BUPRENORPHINE PATCH 20 MCG/HR,86176,CDM,250,RC,69238-1205-02,NDC,,,facility,outpatient,1,EA,364.23000,346.02000,The Alliance,Premier SAS,,250.59,,,,,,,182.12,353.30,percent of total billed charges,
MOSUNETUZUMAB-AXGB SOLN 1 MG/ML (LUNSUMIO),86178,CDM,636,RC,J9350,HCPCS,50242015901,NDC,facility,outpatient,1,mL,1585.11000,1505.85000,The Alliance,Premier SAS,,1045.05,,,,,,,652.75,1537.56,fee schedule,
PEGFILGRASTIM-FPGK SOLN 6 MG/0.6 ML,86179,CDM,636,RC,Q5127,HCPCS,65219037110,NDC,facility,outpatient,1,mL,13617.45000,12936.58000,The Alliance,Premier SAS,,366.81,,,,,,,229.11,13208.93,fee schedule,
STENT PERIPH VEN SELF EXPND SYS 12MM X 40MM X.,86188,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM CATH L80CM SHTH 8FR NIT EPTFE SELF,86189,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
LEAD PACE 2.6FR L95CM L VENT,86190,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier SAS,,2850.39,,,,,,,2850.39,6023.70,percent of total billed charges,
"BCR/ABL1 REFLEX (MINOR), QUAL/QUANT (BCRFX) SO",86191,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Premier SAS,90,1030.36,,,,,,,149.66,7571.58,fee schedule,
"GANGLIOSIDE ANTIBODIES EVAL, S (GAES) SO",86192,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
"BCR/ABL1 REFLEX (OTHER), QUAL/QUANT (BCRFX) SO",86193,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1695.50000,1610.72000,The Alliance,Premier SAS,90,1374.59,,,,,,,175.54,10101.09,fee schedule,
"BCR/ABL1, P190, QUANT, REFLEX (CHARGE ONLY) (B190R) SO",86194,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1144.20000,1086.99000,The Alliance,Premier SAS,90,1030.36,,,,,,,149.66,7571.58,fee schedule,
"BCR/ABL1, P210, QUANT, REFLEX (CHARGE ONLY) (B210R) SO",86195,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Premier SAS,90,1166.67,,,,,,,169.42,8573.20,fee schedule,
"BCR/ABL1 REFLEX(MAJOR), QUAL/QUANT (BCRFX) SO",86196,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1295.30000,1230.53000,The Alliance,Premier SAS,90,1166.67,,,,,,,169.42,8573.20,fee schedule,
MEPOLIZUMAB POWD-INJ 100 MG,86198,CDM,636,RC,J2182,HCPCS,00173088101,NDC,facility,outpatient,1,EA,7168.24000,6809.83000,The Alliance,Premier SAS,,50.16,,,,,,,31.33,6953.19,fee schedule,
CLAREON MONOFOCAL  28.5,86199,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
MOSUNETUZUMAB-AXGB SOLN 30 MG/ML 30 ML (LUNSUMIO),86200,CDM,636,RC,J9350,HCPCS,50242014201,NDC,facility,outpatient,1,mL,1585.12000,1505.86000,The Alliance,Premier SAS,,1045.05,,,,,,,652.75,1537.57,fee schedule,
LACTATED RINGERS 50 ML,86201,CDM,250,RC,J7120,HCPCS,0033801170400050,NDC,facility,outpatient,1,mL,0.02000,0.02000,The Alliance,Premier SAS,,3.94,,,,,,,0.01000,4.06,fee schedule,
GUIDEWIRE VASC SFT TIP NIT SS HYDRPHLC,86202,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,The Alliance,Premier SAS,,1612.50,,,,,,,1171.88,2273.44,percent of total billed charges,
CATHETER GUID 8FR 95CM BLLN BOBBY,86203,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,8280.00000,7866.00000,The Alliance,Premier SAS,,5696.64,,,,,,,4140.00,8031.60,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CAR CLLGN ARTEGRAFT,86204,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Premier SAS,,3561.40,,,,,,,3561.40,7759.05,percent of total billed charges,
DEVICE CELL HARV AUTOLGS BTTRY OPRTD,86205,CDM,278,RC,C1832,HCPCS,,,facility,outpatient,,,21312.50000,20246.88000,The Alliance,Premier SAS,,9782.44,,,,,,,9782.44,21312.50,percent of total billed charges,
SHEATH DIL SZ 9F L18.7IN OD9FR ID15.9FR OTR,86206,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,The Alliance,Premier SAS,,5945.87,,,,,,,4321.12,8382.98,percent of total billed charges,
PLATE BNE 51MM X 51MM THCK 0.3MM SM GRID MESH,86207,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5765.30000,5477.04000,The Alliance,Premier SAS,,2646.27,,,,,,,2646.27,5765.30,percent of total billed charges,
BAND SCLER BCKL 2.5MM STYL 240,86208,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,231.75000,220.16000,The Alliance,Premier SAS,,106.37,,,,,,,106.37,231.75,percent of total billed charges,
POLIDOCANOL SOLN 0.5% 2 ML,86212,CDM,250,RC,J3490,HCPCS,67850014005,NDC,facility,outpatient,1,mL,31.13000,29.57000,The Alliance,Premier SAS,,21.42,,,,,,,15.56,30.20,percent of total billed charges,
PALIPERIDONE SUSP 39 MG/0.25 ML (INVEGA SUSTENNA),86213,CDM,636,RC,J2426,HCPCS,50458056001,NDC,facility,outpatient,1,mL,5333.61000,5066.93000,The Alliance,Premier SAS,,24.14,,,,,,,15.08,5173.60,fee schedule,
STENT BILI 7FR L9CM PLAS DUODENAL BEND RX PRELD NAVIFLEX DEL,86214,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
STENT FLO DIVERTER INTCRAN 4.5X25X18MM,86215,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32970.00000,31321.50000,The Alliance,Premier SAS,,15133.23,,,,,,,15133.23,32970.00,percent of total billed charges,
SET SCR SPNL 5.5/6MM CANN FEN MULTIAXIAL CDH,86216,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,777.68000,738.80000,The Alliance,Premier SAS,,356.96,,,,,,,356.96,777.68,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CHRONOFLEX,86217,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier SAS,,599.00,,,,,,,599.00,1305.00,percent of total billed charges,
SPACER SPNL ALIF 32X12X21MM 12DEG LORD STD TI,86218,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25160.53000,23902.50000,The Alliance,Premier SAS,,11548.68,,,,,,,11548.68,25160.53,percent of total billed charges,
GRAFT 5.0ML DEMIN CORT FIBERS 3DEMIN,86219,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1781.25000,1692.19000,The Alliance,Premier SAS,,817.59,,,,,,,817.59,1781.25,percent of total billed charges,
CLAREON MONOFOCAL  25.5,86220,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,159.44,,,,,,,153.47,600.19,fee schedule,
GUSELKUMAB SOLN 10 MG/ML 20 ML (TREMFYA),86223,CDM,636,RC,J1628,HCPCS,57894065002,NDC,facility,outpatient,1,mL,1796.53000,1706.70000,The Alliance,Premier SAS,,119.85,,,,,,,74.86,1742.63,fee schedule,
CRTS SM IL SG UTZ BAC CATH ACC 828817PL.,86224,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20398.96000,19379.01000,The Alliance,Premier SAS,,9363.12,,,,,,,9363.12,20398.96,percent of total billed charges,
PAPAVERINE/PHENTOLAMINE/ALPROSTADIL 30 MG/1 MG/10 MCG/ML 2.5 ML,86225,CDM,250,RC,J7999,HCPCS,73198000503,NDC,facility,outpatient,1,mL,72.68000,69.05000,The Alliance,Premier SAS,,50.00,,,,,,,36.34,70.50,percent of total billed charges,
BUROSUMAB-TWZA SOLN 30 MG/ML (CRYSVITA),86226,CDM,636,RC,J0584,HCPCS,69794030401,NDC,facility,outpatient,1,mL,20263.50000,19250.32000,The Alliance,Premier SAS,,770.99,,,,,,,481.57,19655.60,fee schedule,
LIGHTNING FLSH CATH 100CM XTORQ + LIGHTNING,86227,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30287.00000,28772.65000,The Alliance,Premier SAS,,13901.73,,,,,,,13901.73,30287.00,percent of total billed charges,
SHEATH VERS PIG 230CM 45 81CM DO,86228,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,The Alliance,Premier SAS,,1669.61,,,,,,,1669.61,3637.50,percent of total billed charges,
COIL TARGET TETRA 2.0MMX3.5CM,86229,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
COIL TARGET TETRA 1.5MMX2.0CM,86230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
SILTUXIMAB POWD-INJ 400 MG,86233,CDM,636,RC,J2860,HCPCS,73090042101,NDC,facility,outpatient,1,EA,11110.82000,10555.28000,The Alliance,Premier SAS,,259.30,,,,,,,161.96,10777.50,fee schedule,
KIT CATH 5.8FR 12FR 75CM URMT U QD-FOLD ENCR,86237,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier SAS,,1394.39,,,,,,,1013.37,1965.93,percent of total billed charges,
"TEARS, ARTIFICIAL GEL-OPHTH 15 ML",86239,CDM,250,RC,00023-9205-15,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,The Alliance,Premier SAS,,1.26,,,,,,,0.91500,1.78,percent of total billed charges,
BLLN METACROSS RX 3X60X200CM,86240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,The Alliance,Premier SAS,,547.36,,,,,,,547.36,1192.50,percent of total billed charges,
LEAD PACE L86CM 7.5CM ELECTRD SPC L VENT QPLR TINES 3D SPRL,86241,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,The Alliance,Premier SAS,,2850.39,,,,,,,2850.39,6210.00,percent of total billed charges,
STENT COR L20MM DIA2.5MM CATH L140CM GWIRE 0.014IN COCR,86242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier SAS,,5165.13,,,,,,,5165.13,11253.00,percent of total billed charges,
CRTS SM IL SG VLV ONLY 828814PL,86243,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17084.19000,16229.98000,The Alliance,Premier SAS,,7841.64,,,,,,,7841.64,17084.19,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3MM X,86244,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.5MM X,86245,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIL 7.5FR L180CM BLLN L3CM,86247,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1302.00000,1236.90000,The Alliance,Premier SAS,,597.62,,,,,,,597.62,1302.00,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ PLMR,86248,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier SAS,,930.27,,,,,,,930.27,2026.73,percent of total billed charges,
VENETOCLAX TAB 50 MG,86249,CDM,250,RC,J8499,HCPCS,00074056611,NDC,facility,outpatient,1,EA,161.86000,153.76000,The Alliance,Premier SAS,,111.36,,,,,,,80.93,157.00,percent of total billed charges,
CARDIOPLEGIA DEL NIDO 1000 ML PREMIX,86251,CDM,250,RC,J3490,HCPCS,69374098410,NDC,facility,outpatient,1,mL,0.44000,0.42000,The Alliance,Premier SAS,,0.30272,,,,,,,0.22000,0.42680,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.75MM X 38MM 5FR X 145CM POST DIL,86252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 38MM 5FR X,86253,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
CATH GUID LCB 5FR 100CM,86254,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
SPACER SPNL CERV W/ NANOTECHNOLOGY 10 DEG,86255,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,The Alliance,Premier SAS,,3008.74,,,,,,,3008.74,6555.00,percent of total billed charges,
GRAFT VASC L45CM DIA6MM BOV CAR CLLGN FIBROUS,86256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10036.05000,9534.25000,The Alliance,Premier SAS,,4606.55,,,,,,,4606.55,10036.05,percent of total billed charges,
GRAFT VASC L30CM DIA7MM CLLGN ARTEGRAFT.,86257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,7759.05000,7371.10000,The Alliance,Premier SAS,,3561.40,,,,,,,3561.40,7759.05,percent of total billed charges,
"RAPID PROGRESS DEMENTIA EVAL,CSF (RPDE) SO",86258,CDM,300,RC,83520,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,90,110.89,,,,,,,17.85,814.87,fee schedule,
"GANGLIOSIDE GQ1B ANTIBODY, IGG, ELISA, SERUM (GQ1ES) SO",86259,CDM,300,RC,83516,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
"RAPID PROGRESS DEMENTIA EVAL, CSF (RPDE) SO",86260,CDM,300,RC,84999,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,90,361.20,,,,,,,262.50,509.25,percent of total billed charges,
"PARIETAL CELL ANTIBODIES, IGG (PCAB) SO",86261,CDM,300,RC,83516,CPT,,,facility,outpatient,,,91.10000,86.54000,The Alliance,Premier SAS,90,80.86,,,,,,,11.91,594.19,fee schedule,
HHV-6 A AND B DNA QUANT PCR (QHV6P) SO,86268,CDM,300,RC,87533,CPT,,,facility,outpatient,,,600.00000,570.00000,The Alliance,Premier SAS,90,298.02,,,,,,,43.15,2190.01,fee schedule,
"GLUCOTETRASACCHARIDES, RANDOM,URINE (HEX4) SO",86269,CDM,300,RC,82542,CPT,,,facility,outpatient,,,534.80000,508.06000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
"GLUCOTETRASACCHARIDES, RANDOM, URINE (HEX4) SO",86270,CDM,300,RC,82570,CPT,,,facility,outpatient,,,133.70000,127.01000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"S-SULFOCYSTEINE PANEL, URINE (SSCTU) SO",86271,CDM,300,RC,82542,CPT,,,facility,outpatient,,,225.00000,213.75000,The Alliance,Premier SAS,90,154.78,,,,,,,24.89,1137.41,fee schedule,
INTRODUCER SHTH 8FR X 5.5CM DIL TIP 35MM BRT,86272,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,48.52000,46.09000,The Alliance,Premier SAS,,22.27,,,,,,,22.27,48.52,percent of total billed charges,
SNR VASC 6FR L120CM CATH L100CM DIA12-20MM,86273,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,The Alliance,Premier SAS,,578.34,,,,,,,578.34,1260.00,percent of total billed charges,
GRAFT HUM TISS 2X4CM THK1.6+/-0.4MM RCT MD,86274,CDM,278,RC,Q4116,HCPCS,,,facility,outpatient,,,2246.25000,2133.94000,The Alliance,Premier SAS,,1031.03,,,,,,,1031.03,2246.25,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3MM X 38MM 5FR X,86275,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
OCT POSTERIOR SEGMENT RETINA W/OCT ANGIOGRAPHY 92137 TC,86291,CDM,360,RC,92137,CPT,,,facility,outpatient,,,68.20000,64.79000,The Alliance,Premier SAS,,46.92,,,,,,,37.51,5271.00,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 1000 MG,86299,CDM,250,RC,J8499,HCPCS,68180082147,NDC,facility,outpatient,1,EA,16.28000,15.47000,The Alliance,Premier SAS,,11.20,,,,,,,8.14,15.79,percent of total billed charges,
OT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86326,CDM,430,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier SAS,GO,180.00,,,,,,,72.05,264.00,per diem,
OT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86328,CDM,430,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier SAS,GO,180.00,,,,,,,126.65,283.24,per diem,
OT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86329,CDM,430,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier SAS,GO,180.00,,,,,,,61.30,264.00,per diem,
PT CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86330,CDM,420,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier SAS,GP,180.00,,,,,,,72.05,264.00,per diem,
PT CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86331,CDM,420,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier SAS,GP,180.00,,,,,,,126.65,283.24,per diem,
PT GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86332,CDM,420,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier SAS,GP,180.00,,,,,,,61.30,264.00,per diem,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS EA ADDL 15 MIN G0542,86333,CDM,440,RC,G0542,HCPCS,,,facility,outpatient,,,144.10000,136.89000,The Alliance,Premier SAS,GN,180.00,,,,,,,72.05,264.00,per diem,
SLP CAREGIVER TRAIN REDUCE COMPLICTNS INITL 30 MIN G0541,86334,CDM,440,RC,G0541,HCPCS,,,facility,outpatient,,,292.00000,277.40000,The Alliance,Premier SAS,GN,180.00,,,,,,,126.65,283.24,per diem,
SLP GROUP CAREGIVER TRAIN REDUCE COMPLCTNS G0543,86335,CDM,440,RC,G0543,HCPCS,,,facility,outpatient,,,122.60000,116.47000,The Alliance,Premier SAS,GN,180.00,,,,,,,61.30,264.00,per diem,
STENT COR EVEROLIMUS DRG ELUT SYS RX 2.75MM X,86336,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
SHEATH URETRL ACCS 12/14FR DIL 6-121FR L38CM SS,86338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Premier SAS,,229.84,,,,,,,229.84,500.74,percent of total billed charges,
NM IOFLUPANE CURIUM 5MCI,86340,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,The Alliance,Premier SAS,,3640.90,,,,,,,1388.02,5133.24,percent of total billed charges,
CATHETER GUID 9FR X 7.2FR X 50CM FOR ATTAIN,86341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1041.00000,988.95000,The Alliance,Premier SAS,,477.82,,,,,,,477.82,1041.00,percent of total billed charges,
DEFBRILLTR CRT-D MOMNTM X4 5.37CM X 8.08CM 0.99CM,86342,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,The Alliance,Premier SAS,,18699.66,,,,,,,18699.66,39517.80,percent of total billed charges,
SYSTEM FACET FIX 4MM CERV TI ALLY INCL CAGE.,86343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9455.00000,8982.25000,The Alliance,Premier SAS,,4339.85,,,,,,,4339.85,9455.00,percent of total billed charges,
OPTILUME URETH DRG COAT BLLN LEN 5CM AND INFL,86344,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Premier SAS,,4873.43,,,,,,,4873.43,10617.50,percent of total billed charges,
CATH GUIDE 6FR L90CM IMC CRV PTFE LNR RND.,86345,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,The Alliance,Premier SAS,,106.72,,,,,,,106.72,232.50,percent of total billed charges,
STENT PERPH 5FR L150MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86347,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2756.25000,2618.44000,The Alliance,Premier SAS,,1265.12,,,,,,,1265.12,2756.25,percent of total billed charges,
CATH SWN GZ THRMDIL 7FR DISP/SINGLE USE,86348,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1873.91000,1780.21000,The Alliance,Premier SAS,,860.12,,,,,,,860.12,1873.91,percent of total billed charges,
"BETA GLOBIN GENE CLUSTER, DEL/DUP,B (WBGDR) SO",86349,CDM,300,RC,81363,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier SAS,90,1296.04,,,,,,,161.92,9523.86,fee schedule,
"ALPHA GLOBIN CLUSTER LOCUS DEL/DUP, VARIES (AGDD)(WAGDR) SO",86350,CDM,300,RC,81269,CPT,,,facility,outpatient,,,1599.00000,1519.05000,The Alliance,Premier SAS,90,1296.04,,,,,,,161.92,9523.86,fee schedule,
"VIBRIO CULTURE, STOOL (VIBC) SO",86351,CDM,300,RC,87046,CPT,,,facility,outpatient,,,74.60000,70.87000,The Alliance,Premier SAS,90,67.00,,,,,,,3.40,492.33,fee schedule,
"CALCITRIOL 1,25-DIHYDROXYVITAMIN D (FV125) SO",86352,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,The Alliance,Premier SAS,90,274.92,,,,,,,17.50,2020.22,fee schedule,
"HEPATITIS E, HEV IGG AB (HEVG) SO",86353,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
"HEPATITIS E, HEV IGM AB SCREEN (HEVM) SO",86354,CDM,300,RC,86790,CPT,,,facility,outpatient,,,101.70000,96.61000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
PROSTAGLANDIN D2 (PGD2)(FPDPG) SO,86355,CDM,300,RC,84150,CPT,,,facility,outpatient,,,427.50000,406.12000,The Alliance,Premier SAS,90,267.98,,,,,,,35.09,1969.25,fee schedule,
HEV IGM AB CONFIRMATION (HEVML) SO,86356,CDM,300,RC,86790,CPT,,,facility,outpatient,,,312.60000,296.97000,The Alliance,Premier SAS,90,92.41,,,,,,,45.08,679.08,fee schedule,
CATH PTCA 5FR L130CM BLLN L12MM DIA6MM.,86370,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 2 GM,86372,CDM,250,RC,J3371,HCPCS,72078006699,NDC,facility,outpatient,1,EA,135.25000,128.49000,The Alliance,Premier SAS,,93.05,,,,,,,9.78,131.19,percent of total billed charges,
TARLATAMAB POWD-INJ 1 MG (IMDELLTRA),86373,CDM,636,RC,J9026,HCPCS,55513005901,NDC,facility,outpatient,1,EA,3450.00000,3277.50000,The Alliance,Premier SAS,,2509.55,,,,,,,1567.49,3346.50,fee schedule,
TARLATAMAB POWD-INJ 10 MG (IMDELLTRA),86374,CDM,636,RC,J9026,HCPCS,55513007701,NDC,facility,outpatient,1,EA,28500.00000,27075.00000,The Alliance,Premier SAS,,2509.55,,,,,,,1567.49,27645.00,fee schedule,
FLUCYTOSINE CAP 250 MG,86378,CDM,250,RC,J8499,HCPCS,59651033101,NDC,facility,outpatient,1,EA,31.60000,30.02000,The Alliance,Premier SAS,,21.74,,,,,,,15.80,30.65,percent of total billed charges,
KIT CATH 5.8FR 24FR 75CM URN TRACT HDR+ URMT U,86382,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier SAS,,930.27,,,,,,,930.27,2026.73,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 3.5MM X 18MM 5FR X,86383,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT DURA W5XL7IN ULT PURE CLLGN REGEN MTRX,86384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8350.38000,7932.86000,The Alliance,Premier SAS,,3832.82,,,,,,,3832.82,8350.38,percent of total billed charges,
CATHETER THOR 28FR L23IN CLR PVC HEP STR TAPR,86385,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,26.88000,25.54000,The Alliance,Premier SAS,,12.34,,,,,,,12.34,26.88,percent of total billed charges,
CATHETER VLVULPLSTY L110CM SHFT 9FR BLLN L4CM,86386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3631.24000,3449.68000,The Alliance,Premier SAS,,1666.74,,,,,,,1666.74,3631.24,percent of total billed charges,
CARIPRAZINE CAP 3 MG,86387,CDM,250,RC,J8499,HCPCS,61874013020,NDC,facility,outpatient,1,EA,159.99000,151.99000,The Alliance,Premier SAS,,110.07,,,,,,,80.00,155.19,percent of total billed charges,
ARIA RESPIR MOTION MNGMT SIM 77293 TC,86388,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,The Alliance,Premier SAS,,3191.37,,,,,,,1836.07,25313.80,fee schedule,
GUIDEWIRE VASC PERIPH 0.014INX180CM ANG TIP,86389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1228.13000,1166.72000,The Alliance,Premier SAS,,563.71,,,,,,,563.71,1228.13,percent of total billed charges,
GRAFT VASC L30CM DIA32MM THOR CLLGN PLY WVN STR DBL VEL.,86390,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2311.39000,2195.82000,The Alliance,Premier SAS,,1060.93,,,,,,,1060.93,2311.39,percent of total billed charges,
STENT EVAR CVR 6MM X 60MM 8FR SHTH STR 80CM,86391,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,The Alliance,Premier SAS,,4592.30,,,,,,,4592.30,10005.00,percent of total billed charges,
SHEATH DIL MD 14FR L43CM OD0.253IN ID0.198IN,86392,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,The Alliance,Premier SAS,,499.16,,,,,,,499.16,1087.50,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA5MM CATH L135CM 0.035IN NIT LP,86393,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT PERIPH 5FR L60MM DIA5MM CATH L135CM 0.035IN NIT LP,86394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X6MM,86395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 5.8FR 15FR 75CM URN TRACT HDR+ PLMR,86396,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2026.73000,1925.39000,The Alliance,Premier SAS,,930.27,,,,,,,930.27,2026.73,percent of total billed charges,
METHACHOLINE PULMONARY FUNCTION TEST KIT,86397,CDM,250,RC,J7674,HCPCS,64281011006,NDC,facility,outpatient,1,mL,142.20000,135.09000,The Alliance,Premier SAS,,2.77,,,,,,,2.53,137.93,fee schedule,
ALLODERM 2X4 Q4116,86398,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,280.78000,266.74000,The Alliance,Premier SAS,,193.18,,,,,,,51.64,272.36,percent of total billed charges,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86399,CDM,440,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,180.00,,,,,,,73.00,264.00,per diem,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86401,CDM,430,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,180.00,,,,,,,73.00,264.00,per diem,
SLP CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86402,CDM,440,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,286.15,per diem,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86405,CDM,420,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,286.15,per diem,
PT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN ADD 15 MIN,86407,CDM,420,RC,G0540,HCPCS,,,facility,outpatient,,,146.00000,138.70000,The Alliance,Premier SAS,,180.00,,,,,,,73.00,264.00,per diem,
OT CAREGIVER TRAIN BEHAVIOR MANAGMNT/MODIFICTN INITL 30 MIN,86409,CDM,430,RC,G0539,HCPCS,,,facility,outpatient,,,295.00000,280.25000,The Alliance,Premier SAS,,180.00,,,,,,,126.65,286.15,per diem,
DROPERIDOL SOLN 2.5 MG/ML,86412,CDM,250,RC,J1790,HCPCS,00143951525,NDC,facility,outpatient,1,mL,15.29000,14.53000,The Alliance,Premier SAS,,8.58,,,,,,,7.64,14.83,fee schedule,
ELRANATAMAB-BCMM SOLN 76 MG/1.9 ML (ELREXFIO),86413,CDM,636,RC,J1323,HCPCS,00069449402,NDC,facility,outpatient,1,mL,13763.10000,13074.94000,The Alliance,Premier SAS,,296.68,,,,,,,185.31,13350.21,fee schedule,
ELRANATAMAB-BCMM SOLN 44 MG/1.1 ML (ELREXFIO),86415,CDM,636,RC,J1323,HCPCS,00069252202,NDC,facility,outpatient,1,mL,13762.90000,13074.75000,The Alliance,Premier SAS,,296.68,,,,,,,185.31,13350.01,fee schedule,
BRILLIANT BLUE G SOLN-OPTH 0.025% 0.5 ML,86416,CDM,636,RC,Q9968,HCPCS,68803072225,NDC,facility,outpatient,1,mL,840.20000,798.19000,The Alliance,Premier SAS,,578.06,,,,,,,7.86,814.99,percent of total billed charges,
LEADLESS PACEMKR,86418,CDM,275,RC,C1605,HCPCS,,,facility,outpatient,,,26565.00000,25236.75000,The Alliance,Premier SAS,,12193.33,,,,,,,12193.33,25768.05,percent of total billed charges,
GRAFT EVAR ENDOPROS STNT CVR REDUC PROF 6MM X,86419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,The Alliance,Premier SAS,,4359.51,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERPH 5FR L40MM DIA5MM CATH L135CM 0.035IN NIT LP,86420,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FR BARB TO BARB L7CM WRK CHN,86421,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
CATH DELIVERY LEADLESS AVEIR DELIVERY CATH,86422,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,The Alliance,Premier SAS,,2771.21,,,,,,,2771.21,6037.50,percent of total billed charges,
GRAFT VASC 8MM X 80M RAD SUPP 70CM EPTFE,86423,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5633.85000,5352.16000,The Alliance,Premier SAS,,2585.94,,,,,,,2585.94,5633.85,percent of total billed charges,
ZONISAMIDE SUSP 20 MG/ML 150 ML,86424,CDM,250,RC,J8499,HCPCS,52652800101,NDC,facility,outpatient,1,mL,8.84000,8.40000,The Alliance,Premier SAS,,6.08,,,,,,,4.42,8.57,percent of total billed charges,
SHEATH URET ACCS 12/14FR DIL 6-121FR L46CM SS,86434,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,500.74000,475.70000,The Alliance,Premier SAS,,229.84,,,,,,,229.84,500.74,percent of total billed charges,
BLLN RX NC TREK NEO 2.25X6MM,86435,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
MRI BREAST DEVICE PLCMT W GUID 19287,86436,CDM,610,RC,19287,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1810.00,,,,,,,668.09,2619.00,per diem,
MRI BREAST DEVICE PLCMT W GUID EA ADDL 19288,86437,CDM,610,RC,19288,CPT,,,facility,outpatient,,,2700.00000,2565.00000,The Alliance,Premier SAS,,1810.00,,,,,,,1350.00,2619.00,per diem,
GUIDEWIRE FIRM LT PC HYDRO RR .035X180CM,86438,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,128.96000,122.51000,The Alliance,Premier SAS,,88.72,,,,,,,64.48,125.09,percent of total billed charges,
"FNA W/FLUORO,AD LSN RAD PROF",86439,CDM,960,RC,10008,CPT,,,facility,outpatient,,,1264.00000,1200.80000,The Alliance,Premier SAS,,869.63,,,,,,,632.00,1226.08,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET.,86440,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,The Alliance,Premier SAS,,3873.68,,,,,,,3873.68,8439.39,percent of total billed charges,
STENT BILI 7FR L15CM PLAS DUODENAL BEND RX PRLD,86441,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,732.56000,695.93000,The Alliance,Premier SAS,,336.25,,,,,,,336.25,732.56,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL MD-TECH,86442,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,The Alliance,Premier SAS,,158.93,,,,,,,115.50,224.07,percent of total billed charges,
STENT URET 6FR L22CM SFT W/O GWIRE TRI LYR,86443,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,The Alliance,Premier SAS,,701.37,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER DIL URETH PACLITAXEL COAT BLLN 30FR,86444,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,10617.50000,10086.62000,The Alliance,Premier SAS,,4873.43,,,,,,,4873.43,10617.50,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 10 ML (MDV),86446,CDM,250,RC,J0173,HCPCS,54288012001,NDC,facility,outpatient,1,mL,28.44000,27.02000,The Alliance,Premier SAS,,19.57,,,,,,,3.49,27.59,percent of total billed charges,
GWIRE VASC L125CM DIA0.018IN FLPY TIP L7CM,86447,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,105.60000,100.32000,The Alliance,Premier SAS,,48.47,,,,,,,48.47,105.60,percent of total billed charges,
MRI PROHANCE 1ML 15 ML SDV,86448,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,,2.35,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 10 ML SDV,86449,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,,2.35,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 15 ML SDV WASTE,86450,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,JW,2.35,,,,,,,2.31,12.33,fee schedule,
MRI PROHANCE 1ML 10 ML SDV WASTE,86451,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,The Alliance,Premier SAS,JW,2.35,,,,,,,2.31,12.33,fee schedule,
KIT GRFT PROC 2.5CC ALLOSYNC PURE W/ ANGEL.,86452,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,The Alliance,Premier SAS,,2216.97,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L100MM DIA5MM GWIRE,86453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,The Alliance,Premier SAS,,1900.26,,,,,,,1900.26,4140.00,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 4MM X 48MM,86454,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
BLLN RX NC TREK NEO 6.0X20MM,86455,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,111.88,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH 5FR L40MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 30CM ACPT .018IN GW 5FR SHTH PTA,86457,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,The Alliance,Premier SAS,,261.63,,,,,,,261.63,570.00,percent of total billed charges,
COIL TARGET TETRA 1.5MMX3.0CM,86458,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8560.49000,8132.47000,The Alliance,Premier SAS,,3929.26,,,,,,,3929.26,8560.49,percent of total billed charges,
STENT COR CVR SYS 4.5MM X 26MM PK PAPYRUS,86459,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11253.00000,10690.35000,The Alliance,Premier SAS,,5165.13,,,,,,,5165.13,11253.00,percent of total billed charges,
CATH EVD L35CM LUMN ID1.5MM DPTH MRK 3-15CM FOR EXT,86460,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2171.96000,2063.36000,The Alliance,Premier SAS,,996.93,,,,,,,996.93,2171.96,percent of total billed charges,
SPACER SPNL SZ A 13MM CERVICOTHORACOLUMBAR SELF EXPND,86461,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,23436.00000,22264.20000,The Alliance,Premier SAS,,10757.12,,,,,,,10757.12,23436.00,percent of total billed charges,
BIMATOPROST IMPLANT 10 MCG INTRAOCULAR,86473,CDM,636,RC,J7351,HCPCS,00023965201,NDC,facility,outpatient,1,EA,4657.50000,4424.62000,The Alliance,Premier SAS,,339.99,,,,,,,212.36,4517.77,fee schedule,
SYSTEM SCFLD ESPRIT BTK 3MM X 28MM 5FR X,86474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER PTCA TRANSCAROTID 5.5X25MM RX,86475,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,The Alliance,Premier SAS,,635.14,,,,,,,635.14,1383.75,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8FR L194CM,86476,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7109.10000,6753.65000,The Alliance,Premier SAS,,3263.08,,,,,,,3263.08,7109.10,percent of total billed charges,
CATH GUID EBU4 5FR 100CM,86477,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,The Alliance,Premier SAS,,82.62,,,,,,,82.62,180.00,percent of total billed charges,
BRACE THMB UNIV NEOPRENE SPICA.,86478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,33.56000,31.88000,The Alliance,Premier SAS,,89.72,,,,,,,16.78,92.45,fee schedule,
GLOFITAMAB-GXBM SOLN 1 MG/ML 2.5 ML (COLUMVI),86479,CDM,636,RC,J9286,HCPCS,50242012501,NDC,facility,outpatient,1,mL,2420.87000,2299.83000,The Alliance,Premier SAS,,4435.68,,,,,,,1210.43,4602.85,fee schedule,
GLOFITAMAB-GXBM SOLN 1 MG/ML 10 ML (COLUMVI),86480,CDM,636,RC,J9286,HCPCS,50242012701,NDC,facility,outpatient,1,mL,2420.88000,2299.83000,The Alliance,Premier SAS,,4435.68,,,,,,,1210.44,4602.85,fee schedule,
STENT PERIPH L29MM DIA9-13MM CATH L80CM INTRO 8FR 0.035IN SS,86482,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,The Alliance,Premier SAS,,4571.78,,,,,,,4571.78,9960.30,percent of total billed charges,
COVER BUR H DIA18MM THK0.35MM CP TI 6 H,86483,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1016.03000,965.23000,The Alliance,Premier SAS,,466.36,,,,,,,466.36,1016.03,percent of total billed charges,
STENT COR EVEROLIMUS DRG ELUT SYS RX 3.5MM X,86484,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,The Alliance,Premier SAS,,731.53,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM CRYOTHERAPY CRYOPROBE W/ 2 CANSTR 2,86487,CDM,272,RC,C2618,HCPCS,,,facility,outpatient,,,4764.17000,4525.96000,The Alliance,Premier SAS,,3277.75,,,,,,,2382.09,4621.24,percent of total billed charges,
CATHETER PA 7FR L110CM BLLN DIA10MM 1.25CC,86489,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,543.75000,516.56000,The Alliance,Premier SAS,,249.58,,,,,,,249.58,543.75,percent of total billed charges,
NONINVASIVE AUGMENTATIVE ARRHYTHMIA ANALYSIS 0897T TC,86496,CDM,730,RC,0897T,HCPCS,,,facility,outpatient,,,99.00000,94.05000,The Alliance,Premier SAS,TC,68.11,,,,,,,49.50,96.03,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT EA ADDL 30 MIN,86498,CDM,329,RC,76015,CPT,,,facility,outpatient,,,609.00000,578.55000,The Alliance,Premier SAS,,418.99,,,,,,,282.87,590.73,percent of total billed charges,
MR SAFETY IMPLANT/FOREIGN BODY ASSESSMENT 8-30 MI,86499,CDM,329,RC,76014,CPT,,,facility,outpatient,,,127.00000,120.65000,The Alliance,Premier SAS,,87.38,,,,,,,23.25,134.70,percent of total billed charges,
LADYBEETLE MULTICOLORED ASIAN(HARMONIA AXYRIDIS) IGE(FLBAE)SO,86500,CDM,300,RC,86003,CPT,,,facility,outpatient,,,84.10000,79.89000,The Alliance,Premier SAS,90,36.97,,,,,,,4.57,271.65,fee schedule,
"PANCREATIC ELASTASE, FECAL (PANELA)",86501,CDM,300,RC,82653,CPT,,,facility,outpatient,,,194.10000,184.39000,The Alliance,Premier SAS,,147.96,,,,,,,22.97,1087.31,fee schedule,
CLOSTRIDIUM DIFFICILE TOXIN A/B,86502,CDM,300,RC,87324,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
CLOSTRIDIUM DIFFICILE GLUTAMATE DEHYDROGENASE (GDH),86503,CDM,300,RC,87449,CPT,,,facility,outpatient,,,101.20000,96.14000,The Alliance,Premier SAS,,85.48,,,,,,,11.98,628.12,fee schedule,
CATHETER INTCARD ECHOCARDIOGRAPHY 9FR L90CM,86505,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,10540.00000,10013.00000,The Alliance,Premier SAS,,4837.86,,,,,,,4837.86,10540.00,percent of total billed charges,
GRAFT HUMAN TISS MESH 2:1 464SQCM SKIN,86506,CDM,278,RC,Q4166,HCPCS,,,facility,outpatient,,,26090.40000,24785.88000,The Alliance,Premier SAS,,11975.49,,,,,,,11975.49,26090.40,percent of total billed charges,
ENROUTE TRANSCAROTID NEUROPROTECTION SYS +,86507,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11466.90000,10893.55000,The Alliance,Premier SAS,,5263.31,,,,,,,5263.31,11466.90,percent of total billed charges,
IMMOBILIZER KNEE L27IN FOR 25IN THGH FOAM SGL,86508,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,61.12000,58.06000,The Alliance,Premier SAS,,76.88,,,,,,,30.56,93.98,fee schedule,
STENT GI CATH 10.8FR L138CM TOT L146CM FLNG DIA24MM,86511,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,16998.91000,16148.96000,The Alliance,Premier SAS,,7802.50,,,,,,,7802.50,16998.91,percent of total billed charges,
CYSTOGRAFIN 300ML SDV VIAL PER ML Q9958,86514,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Premier SAS,,0.11207,,,,,,,0.11207,0.32980,fee schedule,
CYSTOGRAFIN 300ML SDV VIAL PER ML WASTE Q9958 JW,86515,CDM,636,RC,Q9958,HCPCS,,,facility,outpatient,,,0.34000,0.32000,The Alliance,Premier SAS,JW,0.11207,,,,,,,0.11207,0.32980,fee schedule,
ROZANOLIXIZUMAB-NOLI SOLN 140 MG/ML 6 ML,86516,CDM,636,RC,J9333,HCPCS,50474098386,NDC,facility,outpatient,1,mL,7608.04000,7227.63000,The Alliance,Premier SAS,,37.08,,,,,,,23.16,7379.80,fee schedule,
THYROID DESICCATED TAB 7.5 MG,86517,CDM,250,RC,J8499,HCPCS,4219203290100025,NDC,facility,outpatient,1,EA,0.41000,0.39000,The Alliance,Premier SAS,,0.28208,,,,,,,0.20500,0.39770,percent of total billed charges,
PSYCHOTHERAPY 45 MIN-APNP-TECH,86518,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,The Alliance,Premier SAS,,102.51,,,,,,,74.50,264.00,percent of total billed charges,
PSYCHOTHERAPY 30 MIN-APNP-TECH,86519,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
"CYTOMEGALOVIRUS(CMV)MOLDET,PCR,LOWER RESP(CMVLR) SO",86520,CDM,300,RC,87496,CPT,,,facility,outpatient,,,296.50000,281.68000,The Alliance,Premier SAS,90,249.50,,,,,,,36.26,1833.46,fee schedule,
VALVE MI 25MM BOV PERICARD LEAFLET COCR STENT,86522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,The Alliance,Premier SAS,,11738.92,,,,,,,11738.92,25575.00,percent of total billed charges,
PORT POWER MRI IMPLANT W/ SUTURE PLUG 8F,86523,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,The Alliance,Premier SAS,,599.00,,,,,,,599.00,1305.00,percent of total billed charges,
SYSTEM SCFLD ESPRIT BTK 2.5MM X 38MM 5FR X,86524,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,The Alliance,Premier SAS,,3958.88,,,,,,,3958.88,8625.00,percent of total billed charges,
INTRODUCER SHTH MIC PUNC 6FR 7CM,86525,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,The Alliance,Premier SAS,,83.94,,,,,,,61.00,118.34,percent of total billed charges,
CATH BLLN SPRINTER OTW 1.5X10,86527,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,The Alliance,Premier SAS,,167.70,,,,,,,121.88,236.44,percent of total billed charges,
CT NEPHROSTOMY CATH INSERT W GUID,86528,CDM,350,RC,50432,CPT,,,facility,outpatient,,,8100.00000,7695.00000,The Alliance,Premier SAS,,1596.00,,,,,,,1285.85,7857.00,per diem,
"ALZHEIMERS DISEASE EVALUATION, CSF(ADEVL) SO",86529,CDM,300,RC,84393,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,90,361.20,,,,,,,262.50,509.25,percent of total billed charges,
"ALZHEIMERS DISEASE EVALUATION,CSF (ADEVL) SO",86530,CDM,300,RC,84394,CPT,,,facility,outpatient,,,525.00000,498.75000,The Alliance,Premier SAS,90,361.20,,,,,,,262.50,509.25,percent of total billed charges,
PILLOW PSTN LARGE ANKLE 2 STRAP BG SVR,86531,CDM,290,RC,E1399,HCPCS,,,facility,outpatient,,,545.93000,518.63000,The Alliance,Premier SAS,,375.60,,,,,,,272.96,529.55,percent of total billed charges,
BUTTON 2.7CM 18FR RADOPQ LOPRFL PROX ANRFLX V,86532,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,The Alliance,Premier SAS,,248.15,,,,,,,47.62,349.86,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM SHT TI,86533,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier SAS,,8523.17,,,,,,,8523.17,18569.00,percent of total billed charges,
MICROSTENT OPHTH HYDRUS,86534,CDM,278,RC,C1783,HCPCS,,,facility,outpatient,,,5985.75000,5686.46000,The Alliance,Premier SAS,,2747.46,,,,,,,2747.46,5985.75,percent of total billed charges,
INTRODUCER SHTH 11FR X 15.5CM ACC 0.038IN,86535,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,The Alliance,Premier SAS,,109.53,,,,,,,79.60,154.42,percent of total billed charges,
GRAFT BNE SUB STRP 50MM X 10MM ALLGRFT DEMIN,86536,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,The Alliance,Premier SAS,,1463.06,,,,,,,1463.06,3187.50,percent of total billed charges,
SYSTEM DIL BLLN L16MM DIA6MM EUSTACHIAN TB,86537,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,5783.37000,5494.20000,The Alliance,Premier SAS,,3978.96,,,,,,,2891.68,5609.87,percent of total billed charges,
AMIVANTAMAB-VMJW SOLN 50 MG/ML 7 ML (RYBREVANT),86539,CDM,636,RC,J9061,HCPCS,57894050101,NDC,facility,outpatient,1,mL,1408.47000,1338.04000,The Alliance,Premier SAS,,35.56,,,,,,,22.21,1366.22,fee schedule,
GRAFT VASC DIA10MM L70CM TAPR TW REM RING GORE TEX,86542,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4602.30000,4372.19000,The Alliance,Premier SAS,,2112.46,,,,,,,2112.46,4602.30,percent of total billed charges,
OCCLUDER CV 48MM TREAT RANG 8-15MM CATH 10FR.,86544,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,The Alliance,Premier SAS,,12130.22,,,,,,,12130.22,26427.50,percent of total billed charges,
CATHETER PA 5FR 8MM 110CM ARW .75CC 1 LUM BLN.,86545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,618.75000,587.81000,The Alliance,Premier SAS,,284.01,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT HUM TISS 2.5CC DBM ALLOSYNC.,86546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,The Alliance,Premier SAS,,1032.75,,,,,,,1032.75,2250.00,percent of total billed charges,
SHEATH GUID L90X15CM DIA7FR SS HYDRPHLC NYL PTFE LAYR MP.,86547,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,The Alliance,Premier SAS,,332.82,,,,,,,241.88,469.24,percent of total billed charges,
90832 PSYCHOTHERAPY 30 MIN-MD-TECH,86548,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,The Alliance,Premier SAS,,77.06,,,,,,,56.00,264.00,percent of total billed charges,
90833 PSYCHOTHERAPY 30 MIN E/M-MD-TECH,86549,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,The Alliance,Premier SAS,,79.12,,,,,,,57.50,264.00,percent of total billed charges,
STENT PERIPH 5FR L100MM DIA6MM CATH L135CM 0.035IN LP 2 SPD,86551,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,The Alliance,Premier SAS,,989.72,,,,,,,989.72,2156.25,percent of total billed charges,
SPACER SPNL TLIF PLIF MIDLF 9MM LNG TI,86552,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18569.00000,17640.55000,The Alliance,Premier SAS,,8523.17,,,,,,,8523.17,18569.00,percent of total billed charges,
"INDIGO CATH 6X 132CM, STR + TRAX + LIGHTNING",86553,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,23932.00000,22735.40000,The Alliance,Premier SAS,,16465.22,,,,,,,11966.00,23214.04,percent of total billed charges,
97810 ACUPUNC WO/ELEC STIM INIT 15MN-TECH,86554,CDM,940,RC,97810,CPT,,,facility,outpatient,,,32.00000,30.40000,The Alliance,Premier SAS,,22.02,,,,,,,16.00,31.04,percent of total billed charges,
OT GAIT TRAINING UNITS,86556,CDM,430,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,The Alliance,Premier SAS,GO,180.00,,,,,,,47.00,264.00,per diem,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR) SO",86566,CDM,300,RC,84150,CPT,,,facility,outpatient,,,353.00000,335.35000,The Alliance,Premier SAS,90,267.98,,,,,,,35.09,1969.25,fee schedule,
"2.3-DINOR-11BETA-PROSTAGLANDIN F2 ALPHA, RANDOM, URINE (23BPR)SO",86567,CDM,300,RC,82570,CPT,,,facility,outpatient,,,43.80000,41.61000,The Alliance,Premier SAS,90,36.97,,,,,,,5.35,271.65,fee schedule,
"KIT P.ASP816VAL VARIANT ANALYSIS, QUANT, VARIES (KITQ) SO",86568,CDM,300,RC,81273,CPT,,,facility,outpatient,,,1055.10000,1002.34000,The Alliance,Premier SAS,90,799.34,,,,,,,73.92,5873.90,fee schedule,
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC,361,RC,29125,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF FINGER SPLINT; STATIC,361,RC,29130,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT),361,RC,29515,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,149.83,3163.00,case rate,
"CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD",361,RC,30901,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND),361,RC,29105,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,149.83,3163.00,case rate,
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES),361,RC,29505,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,149.83,3163.00,case rate,
"INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE",361,RC,10120,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,379.37,3163.00,case rate,
"REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL",361,RC,65205,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
"CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL",361,RC,30905,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
"SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS",361,RC,12011,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,188.67,3163.00,case rate,
APPLICATION OF FINGER SPLINT; DYNAMIC,361,RC,29131,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,56.40,3163.00,case rate,
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC,361,RC,29126,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
"REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE",361,RC,30300,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,122.40,3163.00,case rate,
"CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA",361,RC,26770,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,227.78,3163.00,case rate,
"DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL (LESS THAN 5% TOTAL BODY SURFACE AREA)",361,RC,16020,CPT,,,,,facility,outpatient,,,,,The Alliance,Premier SAS,,909.00,,,,,,,188.67,3163.00,case rate,
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
76376 3D RENDER W/INTRP POSTPROCESS,1234,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,72.50,548.00,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDERING WITH INTERPRETATION AND REPORTING OF CT MRI ULTRASOUND OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION,1244,CDM,402,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,548.00,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1599.00000,1519.05000,Amish/Mennonite,Amish Mennonite,,879.45,,,,,,,783.51,1551.03,percent of total billed charges,
ANGULAR PROSTH PLESTR TITANIUM,1278,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1599.00000,1519.05000,Amish/Mennonite,Amish Mennonite,,879.45,,,,,,,440.69,1551.03,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,661.50,1309.50,percent of total billed charges,
ASTIGMATISM-CORRECT FUNCT-IOL,1294,CDM,276,RC,V2787,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,619.65,1309.50,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,inpatient,,,2901.00000,2755.95000,Amish/Mennonite,Amish Mennonite,,1595.55,,,,,,,1421.49,2813.97,percent of total billed charges,
AQUEOUS SHUNT,1305,CDM,274,RC,L8612,HCPCS,,,facility,outpatient,,,2901.00000,2755.95000,Amish/Mennonite,Amish Mennonite,,1595.55,,,,,,,1026.39,2813.97,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,inpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,,894.85,,,,,,,894.85,1578.19,percent of total billed charges,
COLONOSCOPY DIAGNOSTIC-TECH,1308,CDM,750,RC,45378,CPT,,,facility,outpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,,894.85,,,,,,,813.50,3163.00,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,inpatient,,,1383.00000,1313.85000,Amish/Mennonite,Amish Mennonite,,760.65,,,,,,,760.65,1341.51,percent of total billed charges,
COLONOSC FLEX W/BIOPSY-TECH,1312,CDM,750,RC,45380,CPT,,,facility,outpatient,,,1383.00000,1313.85000,Amish/Mennonite,Amish Mennonite,,760.65,,,,,,,691.50,4686.00,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,1444.85,2548.19,percent of total billed charges,
"CTA-LWR EXTR,INC IMAG PST-PROC-TECH",1410,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,979.11,2548.19,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,Amish/Mennonite,Amish Mennonite,TC,1245.75,,,,,,,1245.75,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY NECK WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1411,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,Amish/Mennonite,Amish Mennonite,TC,1245.75,,,,,,,1132.50,2197.05,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,1444.30,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY UPPER EXTREMITY WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1412,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,979.11,2547.22,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,1273.25,2245.55,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY CHEST (NONCORONARY) WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1419,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,979.11,2245.55,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,545.05,961.27,percent of total billed charges,
CT-ABDOMEN W/O CONTRAST,1424,CDM,350,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,495.50,1820.00,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,TC,78.10,,,,,,,78.10,137.74,percent of total billed charges,
"CT-HEART,W/O CONTR,QUANT EVAL-TECH",1427,CDM,350,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,TC,78.10,,,,,,,71.00,1820.00,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,1029.05,1814.87,percent of total billed charges,
CT-C SPINE W/CONTRAST,1435,CDM,350,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,935.50,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,Amish/Mennonite,Amish Mennonite,TC,1390.40,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR W/WO CONT,1437,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,Amish/Mennonite,Amish Mennonite,TC,1390.40,,,,,,,1264.00,2452.16,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,Amish/Mennonite,Amish Mennonite,TC,1426.15,,,,,,,1426.15,2515.21,percent of total billed charges,
CT-COLONGR DX CNTR NON-CNT IM,1441,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,Amish/Mennonite,Amish Mennonite,TC,1426.15,,,,,,,979.11,2515.21,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,TC,679.25,,,,,,,679.25,1197.95,percent of total billed charges,
"CT-COLONGR,DIAG;W/O CONTR-TECH",1442,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,TC,679.25,,,,,,,584.87,1820.00,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,Amish/Mennonite,Amish Mennonite,TC,805.75,,,,,,,805.75,1421.05,percent of total billed charges,
CT-HEAD;W/CONTRAST-TECH,1444,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,Amish/Mennonite,Amish Mennonite,TC,805.75,,,,,,,732.50,1820.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,Amish/Mennonite,Amish Mennonite,TC,1430.00,,,,,,,1430.00,2522.00,percent of total billed charges,
CT-HEART CONTR EVAL CNG HRT D,1446,CDM,350,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,Amish/Mennonite,Amish Mennonite,TC,1430.00,,,,,,,1285.85,2522.00,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,Amish/Mennonite,Amish Mennonite,TC,986.15,,,,,,,986.15,1739.21,percent of total billed charges,
CT-HEAD W/WO CONTRAST-TECH,1448,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,Amish/Mennonite,Amish Mennonite,TC,986.15,,,,,,,896.50,1820.00,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,Amish/Mennonite,Amish Mennonite,TC,1268.85,,,,,,,1268.85,2237.79,percent of total billed charges,
COMPUTED TOMOGRAPHIC ANGIOGRAPHY HEAD WITH CONTRAST MATERIAL(S) INCLUDING NONCONTRAST IMAGES IF PERFORMED AND IMAGE POSTPROCESSING,1449,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,Amish/Mennonite,Amish Mennonite,TC,1268.85,,,,,,,1153.50,2237.79,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
CT-CHEST W/WO CONTRAST,1451,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,979.11,2209.66,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,TC,1027.95,,,,,,,1027.95,1812.93,percent of total billed charges,
CT-LUMBAR SPINE;W/CNTRAST MATL-TECH,1454,CDM,350,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,TC,1027.95,,,,,,,934.50,1964.22,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,Amish/Mennonite,Amish Mennonite,TC,1267.20,,,,,,,1267.20,2234.88,percent of total billed charges,
CT-C-SPINE W/WO CONTRAST,1455,CDM,350,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,Amish/Mennonite,Amish Mennonite,TC,1267.20,,,,,,,979.11,2234.88,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,684.20,1206.68,percent of total billed charges,
CT-MAXILLOFACIAL W/CONTRAST,1463,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,622.00,1820.00,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,TC,1878.80,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA-PELV INCL IMAGE POST-PROC,1467,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,TC,1878.80,,,,,,,979.11,3313.52,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,680.35,1199.89,percent of total billed charges,
CT-T SPINE W/O CONTRAST,1468,CDM,350,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,584.87,1820.00,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,TC,1299.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST,1471,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,TC,1299.65,,,,,,,979.11,2292.11,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,inpatient,,,7626.00000,7244.70000,Amish/Mennonite,Amish Mennonite,,4194.30,,,,,,,3736.74,7397.22,percent of total billed charges,
DEFLUX 1ML,1488,CDM,274,RC,L8604,HCPCS,,,facility,outpatient,,,7626.00000,7244.70000,Amish/Mennonite,Amish Mennonite,,4194.30,,,,,,,3500.33,7397.22,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,TC,191.95,,,,,,,191.95,338.53,percent of total billed charges,
DEXA BONE DENSITY STUDY APPEND,1489,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,TC,191.95,,,,,,,114.83,1213.27,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
"ECG,TRACING ONLY",1514,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,49.50,96.03,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,TC,522.50,,,,,,,522.50,921.50,percent of total billed charges,
ECHO SPINAL CANAL AND CONTENTS,1515,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,TC,522.50,,,,,,,384.16,921.50,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT,1516,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2015.00,3909.10,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
ECHOGRAPHY PELVIC B-SCAN,1519,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,584.87,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
EKG-SCREENING TRACING ONLY,1525,CDM,730,RC,G0404,HCPCS,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,23.25,96.03,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10 GROUP,15360,CDM,490,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,4607.00,52373.21,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,282.15,497.61,percent of total billed charges,
ECHOGRPHY PREG UTERUS B-SCAN-TECH,1541,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,215.27,548.00,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,inpatient,1,mL,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00143952610,NDC,facility,outpatient,1,mL,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,inpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00409166050,NDC,facility,outpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,00781349495,NDC,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,inpatient,1,mL,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,63323067150,NDC,facility,outpatient,1,mL,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.64,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,inpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,66794023444,NDC,facility,outpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,inpatient,1,mL,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,70121138808,NDC,facility,outpatient,1,mL,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
DEXMEDETOMIDINE 200 MCG/NS 50 ML PREMIX,15499,CDM,250,RC,J3490,HCPCS,71225012605,NDC,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA-PULM INCL IMAGE POST PROCED,15796,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,979.11,2245.55,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,1444.30,2547.22,percent of total billed charges,
CTV-UPR EXTR INCL IMAG POST PR,15798,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,979.11,2547.22,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,1444.85,2548.19,percent of total billed charges,
CTV-LWR EXTR INC IMAG PST-PROCED,15801,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,979.11,2548.19,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,Amish/Mennonite,Amish Mennonite,TC,1246.85,,,,,,,1246.85,2198.99,percent of total billed charges,
MAGNETIC RESONANCE SPECTROSCOPY,15804,CDM,610,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,Amish/Mennonite,Amish Mennonite,TC,1246.85,,,,,,,484.28,2198.99,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W/CONTR,15805,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,Amish/Mennonite,Amish Mennonite,TC,1880.45,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST,15807,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,Amish/Mennonite,Amish Mennonite,TC,1880.45,,,,,,,1353.88,3316.43,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD W/O CONTR,15808,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1128.45,2914.85,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,Amish/Mennonite,Amish Mennonite,TC,1907.95,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA-ABD,15809,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,Amish/Mennonite,Amish Mennonite,TC,1907.95,,,,,,,1375.22,3364.93,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA-HEAD W/CONTR MATERIAL(S),15810,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1214.33,3520.13,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD W-W/O CONTRAST,15811,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,Amish/Mennonite,Amish Mennonite,TC,1439.35,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI-C SPINE W/CONTRAST,15814,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,Amish/Mennonite,Amish Mennonite,TC,1439.35,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,Amish/Mennonite,Amish Mennonite,TC,2190.65,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI-ANY FT UPR EXT W/WO,15815,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,Amish/Mennonite,Amish Mennonite,TC,2190.65,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,Amish/Mennonite,Amish Mennonite,TC,1961.30,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI-LWR EXTR OTHER THAN JOINT,15817,CDM,610,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,Amish/Mennonite,Amish Mennonite,TC,1961.30,,,,,,,1321.12,3459.02,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA-NECK W/O CONTR MATER(S),15821,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,Amish/Mennonite,Amish Mennonite,TC,1396.45,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI-BRAIN W/CONTRAST MATERIALS-TC,15826,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,Amish/Mennonite,Amish Mennonite,TC,1396.45,,,,,,,1269.50,2462.83,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,Amish/Mennonite,Amish Mennonite,TC,1238.05,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI-CARDIAC FUNCTION COMPL STD,15827,CDM,610,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,Amish/Mennonite,Amish Mennonite,TC,1238.05,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,Amish/Mennonite,Amish Mennonite,TC,2395.25,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI-UPR EXTREM OTHER THAN JT,15829,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,Amish/Mennonite,Amish Mennonite,TC,2395.25,,,,,,,1487.04,4224.35,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,Amish/Mennonite,Amish Mennonite,TC,2741.75,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI-CHEST W/O CONTR W/CONT SEQ,15831,CDM,610,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,Amish/Mennonite,Amish Mennonite,TC,2741.75,,,,,,,1487.04,4835.45,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D CT NO IMAGE,15832,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,68.74,718.77,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,Amish/Mennonite,Amish Mennonite,TC,2230.80,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI-ABDOMEN W/CONTR MATRL(S),15833,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,Amish/Mennonite,Amish Mennonite,TC,2230.80,,,,,,,1487.04,3934.32,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-HEAD W/O CONTR W/CONTR MAT,15836,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,Amish/Mennonite,Amish Mennonite,TC,1951.40,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI-ORBIT FACE NECK W/CONTR MAT,15838,CDM,610,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,Amish/Mennonite,Amish Mennonite,TC,1951.40,,,,,,,1353.60,3441.56,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,174.90,308.46,percent of total billed charges,
U.S.GUIDNC FOR NEEDLE PLCMNT,15839,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,154.77,548.00,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D US ON WORK STATION,15841,CDM,333,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,1767.08,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,Amish/Mennonite,Amish Mennonite,TC,1963.50,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI-UPR EXTR OTH THN JT W/CONT,15845,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,Amish/Mennonite,Amish Mennonite,TC,1963.50,,,,,,,1487.04,3462.90,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1668.70,2942.98,percent of total billed charges,
"MRI-UPR EXTR,OTH THN JT,W/O CN-TECH",15847,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1329.46,2942.98,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,Amish/Mennonite,Amish Mennonite,TC,1901.35,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA-LOW EXTREMITY,15850,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,Amish/Mennonite,Amish Mennonite,TC,1901.35,,,,,,,1371.65,3353.29,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,144.65,255.11,percent of total billed charges,
"XRAY/ANKLE,AP AND LATERAL-TECH",15852,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,129.58,1272.59,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,TC,260.15,,,,,,,260.15,458.81,percent of total billed charges,
MRI-VELOCITY FLOW MAPPING,15853,CDM,610,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,TC,260.15,,,,,,,179.69,2032.87,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D US ON SCAN,15854,CDM,333,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,68.74,718.77,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,151.80,267.72,percent of total billed charges,
XRAY/KNEE-AP & LAT,15857,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,138.00,1371.46,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT + CALD,15861,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,125.88,1213.27,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XRAY/P-NAS SINUSES WAT AND LAT,15862,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,125.88,1213.27,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA-NECK W/O CONTR W/CONTR MAT,15864,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,Amish/Mennonite,Amish Mennonite,TC,1656.05,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI-PELVIS W/O CONTR MATERIAL,15867,CDM,610,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,Amish/Mennonite,Amish Mennonite,TC,1656.05,,,,,,,1129.95,2920.67,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/HIP.BILAT LIMITED.1 VIEW,15869,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,160.92,1569.27,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,122.10,215.34,percent of total billed charges,
XRAY/FOOT AP ONLY-TECH COMP,15874,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,111.00,1094.55,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,Amish/Mennonite,Amish Mennonite,TC,1898.60,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA-PELVIS W/WO CONTRAST MATLS,15878,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,Amish/Mennonite,Amish Mennonite,TC,1898.60,,,,,,,1382.32,3348.44,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,inpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,254.10,448.14,percent of total billed charges,
ULTRASONIC GUID-ASPIR OVA,15881,CDM,402,RC,76948,CPT,,,facility,outpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,231.00,548.00,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,Amish/Mennonite,Amish Mennonite,TC,1772.10,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI-L SPINE W/CONTRAST,15885,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,Amish/Mennonite,Amish Mennonite,TC,1772.10,,,,,,,1318.80,3125.34,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,154.55,272.57,percent of total billed charges,
XRAY/FEMUR MIN 2 VWS-ASC ONLY,15886,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,140.50,1391.23,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,Amish/Mennonite,Amish Mennonite,TC,1973.40,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI-PELVIS W/CONTR,15887,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,Amish/Mennonite,Amish Mennonite,TC,1973.40,,,,,,,1328.10,3480.36,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,Amish/Mennonite,Amish Mennonite,TC,2154.90,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA-NECK W/CONTRAST MATERIAL,15889,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,Amish/Mennonite,Amish Mennonite,TC,2154.90,,,,,,,1246.80,3800.46,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI-T-SPINE W/CONTRAST,15890,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1295.50,2513.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,inpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,,169.12,,,,,,,150.68,298.27,percent of total billed charges,
0RSTH ADDN LE PLV,15894,CDM,274,RC,L5695,HCPCS,,,facility,outpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,,169.12,,,,,,,153.75,298.27,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3802.00000,3611.90000,Amish/Mennonite,Amish Mennonite,TC,2091.10,,,,,,,2091.10,3687.94,percent of total billed charges,
EEG COMA/SLEEP ONLY-TECH,16059,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3802.00000,3611.90000,Amish/Mennonite,Amish Mennonite,TC,2091.10,,,,,,,1901.00,3687.94,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,TC,377.30,,,,,,,377.30,665.42,percent of total billed charges,
95865 ELECTROMYOGRAPHY LARYNX TC,16069,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,TC,377.30,,,,,,,343.00,665.42,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,Amish/Mennonite,Amish Mennonite,TC,1834.80,,,,,,,1834.80,3235.92,percent of total billed charges,
95812 EEG 41-60 MINUTES TC,16075,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,Amish/Mennonite,Amish Mennonite,TC,1834.80,,,,,,,1668.00,3235.92,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,inpatient,,,489.00000,464.55000,Amish/Mennonite,Amish Mennonite,TC,268.95,,,,,,,268.95,474.33,percent of total billed charges,
NDL EMG NONEXT W/NRV TST-TECH,16082,CDM,922,RC,95887,CPT,,,facility,outpatient,,,489.00000,464.55000,Amish/Mennonite,Amish Mennonite,TC,268.95,,,,,,,244.50,474.33,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,inpatient,,,455.00000,432.25000,Amish/Mennonite,Amish Mennonite,TC,250.25,,,,,,,250.25,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST LTD-TECH,16099,CDM,922,RC,95885,CPT,,,facility,outpatient,,,455.00000,432.25000,Amish/Mennonite,Amish Mennonite,TC,250.25,,,,,,,227.50,441.35,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,inpatient,,,550.00000,522.50000,Amish/Mennonite,Amish Mennonite,TC,302.50,,,,,,,302.50,533.50,percent of total billed charges,
NDL EMG EXT W/NRV TST COMP-TECH,16117,CDM,922,RC,95886,CPT,,,facility,outpatient,,,550.00000,522.50000,Amish/Mennonite,Amish Mennonite,TC,302.50,,,,,,,275.00,533.50,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,QW,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
84295  LAB/SODIUM QW,16126,CDM,300,RC,84295,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,QW,1252.90,,,,,,,4.81,2209.66,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,Amish/Mennonite,Amish Mennonite,TC,553.30,,,,,,,553.30,975.82,percent of total billed charges,
95962 FUNC CORT MAPPING TC,16135,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,Amish/Mennonite,Amish Mennonite,TC,553.30,,,,,,,503.00,975.82,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHAL OF PENTAMIDINE,16175,CDM,412,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,97.00,212.44,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,584.00000,554.80000,Amish/Mennonite,Amish Mennonite,QW,321.20,,,,,,,321.20,566.48,percent of total billed charges,
RADIESSE 1.5ML,16197,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,584.00000,554.80000,Amish/Mennonite,Amish Mennonite,QW,321.20,,,,,,,292.00,566.48,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,241.18,477.44,percent of total billed charges,
AQUAPLAST RESTING PAN MITT SPL,16213,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,225.92,477.44,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,28.80000,27.36000,Amish/Mennonite,Amish Mennonite,,15.84,,,,,,,14.11,27.94,percent of total billed charges,
AFO SOCK CHILD/INF,16227,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,28.80000,27.36000,Amish/Mennonite,Amish Mennonite,,15.84,,,,,,,13.22,27.94,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,QW,443.85,,,,,,,443.85,782.79,percent of total billed charges,
4428 RESTYLANE 2.0ML,16238,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,QW,443.85,,,,,,,403.50,782.79,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,Amish/Mennonite,Amish Mennonite,TC,2093.30,,,,,,,2093.30,3691.82,percent of total billed charges,
95813 EEG GREATER THAN ONE HOUR TC,16260,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,Amish/Mennonite,Amish Mennonite,TC,2093.30,,,,,,,1903.00,3691.82,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
B2B URINE DIPSTICK,16269,CDM,510,RC,99199,CPT,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.00,7.76,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,Amish/Mennonite,Amish Mennonite,,6820.00,,,,,,,6076.00,12028.00,percent of total billed charges,
BAHA SOFTBAND SYSTEM,16289,CDM,274,RC,L8692,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,Amish/Mennonite,Amish Mennonite,,6820.00,,,,,,,5691.60,12028.00,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,,6.60,,,,,,,6.60,11.64,percent of total billed charges,
BOTOX PER UNIT,16296,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,,6.60,,,,,,,6.00,11.64,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,6.86,13.58,percent of total billed charges,
BUDEN HAMMER TOE SP,16314,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,6.43,13.58,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,17.04000,16.19000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,8.35,16.53,percent of total billed charges,
BUNION SHIELD,16327,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,17.04000,16.19000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,7.82,16.53,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,30.36000,28.84000,Amish/Mennonite,Amish Mennonite,,16.70,,,,,,,14.88,29.45,percent of total billed charges,
BREAST PROSTH COVER,16355,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,30.36000,28.84000,Amish/Mennonite,Amish Mennonite,,16.70,,,,,,,13.94,29.45,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,inpatient,,,1105.00000,1049.75000,Amish/Mennonite,Amish Mennonite,,607.75,,,,,,,607.75,1071.85,percent of total billed charges,
CHEMO ADM INTRA-ART INF TEC 1H,16375,CDM,335,RC,96422,CPT,,,facility,outpatient,,,1105.00000,1049.75000,Amish/Mennonite,Amish Mennonite,,607.75,,,,,,,314.95,1071.85,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT-OTS,16387,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,246.10,477.44,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,20.58,40.74,percent of total billed charges,
CAST BOOT EACH,16388,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,19.28,40.74,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,241.18,477.44,percent of total billed charges,
COMFY HAND SPLINT,16395,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,246.10,477.44,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,inpatient,,,1298.00000,1233.10000,Amish/Mennonite,Amish Mennonite,,713.90,,,,,,,713.90,1259.06,percent of total billed charges,
CHEMOTHER ADM PERITONL CAVITY,16400,CDM,331,RC,96446,CPT,,,facility,outpatient,,,1298.00000,1233.10000,Amish/Mennonite,Amish Mennonite,,713.90,,,,,,,314.95,1259.06,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,10.92000,10.37000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,5.35,10.59,percent of total billed charges,
CERVICAL COLLAR,16405,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,10.92000,10.37000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,5.46,36.65,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,11.15000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,5.46,10.82,percent of total billed charges,
CORK HEEL LIFT,16438,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,11.15000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,5.58,102.20,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,Amish/Mennonite,Amish Mennonite,,378.40,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO INTRA-ARTERIAL PUSH,16443,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,Amish/Mennonite,Amish Mennonite,,378.40,,,,,,,314.95,667.36,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,191.40000,181.83000,Amish/Mennonite,Amish Mennonite,,105.27,,,,,,,93.79,185.66,percent of total billed charges,
DH OFFLOADING SHOE,16445,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,191.40000,181.83000,Amish/Mennonite,Amish Mennonite,,105.27,,,,,,,87.85,185.66,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,42.10000,39.99000,Amish/Mennonite,Amish Mennonite,,23.16,,,,,,,20.63,40.84,percent of total billed charges,
DARCO MED SRG SHOE,16446,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,42.10000,39.99000,Amish/Mennonite,Amish Mennonite,,23.16,,,,,,,19.32,40.84,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,44.80000,42.56000,Amish/Mennonite,Amish Mennonite,,24.64,,,,,,,21.95,43.46,percent of total billed charges,
DARCO ALL PURP BOOT,16447,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,44.80000,42.56000,Amish/Mennonite,Amish Mennonite,,24.64,,,,,,,20.56,43.46,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,264.38000,251.16000,Amish/Mennonite,Amish Mennonite,,145.41,,,,,,,129.55,256.45,percent of total billed charges,
BENIK ELBOW SPLINT,16454,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,264.38000,251.16000,Amish/Mennonite,Amish Mennonite,,145.41,,,,,,,126.64,256.45,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,inpatient,,,386.93000,367.58000,Amish/Mennonite,Amish Mennonite,,212.81,,,,,,,189.60,375.32,percent of total billed charges,
CUSTOM FABRICATED FINGER ORTH,16455,CDM,274,RC,L3935,HCPCS,,,facility,outpatient,,,386.93000,367.58000,Amish/Mennonite,Amish Mennonite,,212.81,,,,,,,193.47,375.32,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,73.15,129.01,percent of total billed charges,
DEFINITY IV PER ML-CATTAILS,16470,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,64.92,129.01,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,17.00000,16.15000,Amish/Mennonite,Amish Mennonite,,9.35,,,,,,,9.35,16.49,percent of total billed charges,
DELTA DRY LINER,16477,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,17.00000,16.15000,Amish/Mennonite,Amish Mennonite,,9.35,,,,,,,8.50,16.49,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,106.56000,101.23000,Amish/Mennonite,Amish Mennonite,,58.61,,,,,,,52.21,103.36,percent of total billed charges,
D-RING WORKHARD WRIST/THMB SUP,16478,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,106.56000,101.23000,Amish/Mennonite,Amish Mennonite,,58.61,,,,,,,53.28,103.36,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,1374.00000,1305.30000,Amish/Mennonite,Amish Mennonite,,755.70,,,,,,,673.26,1332.78,percent of total billed charges,
COAPTITE,16490,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,1374.00000,1305.30000,Amish/Mennonite,Amish Mennonite,,755.70,,,,,,,266.32,1332.78,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,Amish/Mennonite,Amish Mennonite,TC,338.80,,,,,,,338.80,597.52,percent of total billed charges,
FLUOROSC GUID/LOC NDL/CATH TIP-TECH,1650,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,Amish/Mennonite,Amish Mennonite,TC,338.80,,,,,,,308.00,3942.79,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,TC,289.30,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR; PHYS TIME-TECH,1651,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,TC,289.30,,,,,,,146.17,1450.63,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,1172.00000,1113.40000,Amish/Mennonite,Amish Mennonite,,644.60,,,,,,,574.28,1136.84,percent of total billed charges,
DYNAMIC WALK AFO,16515,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,1172.00000,1113.40000,Amish/Mennonite,Amish Mennonite,,644.60,,,,,,,326.06,1136.84,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,26.52000,25.19000,Amish/Mennonite,Amish Mennonite,,14.59,,,,,,,12.99,25.72,percent of total billed charges,
DANCER PADS PAIR,16560,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,26.52000,25.19000,Amish/Mennonite,Amish Mennonite,,14.59,,,,,,,12.17,25.72,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,Amish/Mennonite,Amish Mennonite,TC,1929.40,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE AND DROWSY-TECHNICAL,16568,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,Amish/Mennonite,Amish Mennonite,TC,1929.40,,,,,,,1754.00,3402.76,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,Amish/Mennonite,Amish Mennonite,TC,2376.00,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG INCL AWAKE & ASLEEP-TECH,16575,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,Amish/Mennonite,Amish Mennonite,TC,2376.00,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,TC,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG-NONINTRACRANIAL SRG-TECH,16579,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,TC,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,TC,37.95,,,,,,,37.95,66.93,percent of total billed charges,
ESOPH MOTILITY W/STIM OR PERF,16585,CDM,750,RC,91013,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,TC,37.95,,,,,,,34.50,5271.00,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,134.08000,127.38000,Amish/Mennonite,Amish Mennonite,,73.74,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA-OTS,16610,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,134.08000,127.38000,Amish/Mennonite,Amish Mennonite,,73.74,,,,,,,67.04,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,134.08000,127.38000,Amish/Mennonite,Amish Mennonite,,73.74,,,,,,,65.70,130.06,percent of total billed charges,
EXOS RG THUMB SPICA,16617,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,134.08000,127.38000,Amish/Mennonite,Amish Mennonite,,73.74,,,,,,,67.04,130.06,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,25.48,50.44,percent of total billed charges,
FO PIP DIP WO SP/JT,16647,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,26.00,50.44,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
FECAL-OCCULT BLD TS,16678,CDM,300,RC,82270,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,3.66,203.72,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
GASTROINTES TRANS/PRESS MEASMT,16687,CDM,750,RC,91112,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1857.46,5271.00,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,25.78000,24.49000,Amish/Mennonite,Amish Mennonite,,14.18,,,,,,,12.63,25.01,percent of total billed charges,
FOOT ARCH SUPRT LNG,16700,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,25.78000,24.49000,Amish/Mennonite,Amish Mennonite,,14.18,,,,,,,12.89,65.22,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,inpatient,,,204.99000,194.74000,Amish/Mennonite,Amish Mennonite,,112.74,,,,,,,100.45,198.84,percent of total billed charges,
FOOT INS MLD INL  DME,16706,CDM,274,RC,L3010,HCPCS,,,facility,outpatient,,,204.99000,194.74000,Amish/Mennonite,Amish Mennonite,,112.74,,,,,,,102.50,241.40,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,inpatient,,,309.37000,293.90000,Amish/Mennonite,Amish Mennonite,,170.15,,,,,,,151.59,300.09,percent of total billed charges,
FRAC ORTH WRIST,16716,CDM,274,RC,L3984,HCPCS,,,facility,outpatient,,,309.37000,293.90000,Amish/Mennonite,Amish Mennonite,,170.15,,,,,,,154.69,436.36,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE,16721,CDM,274,RC,L3917,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,99.38,192.79,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,259.91000,246.91000,Amish/Mennonite,Amish Mennonite,,142.95,,,,,,,127.36,252.11,percent of total billed charges,
FOOT DROP SPLINT,16724,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,259.91000,246.91000,Amish/Mennonite,Amish Mennonite,,142.95,,,,,,,99.97,252.11,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,14.48000,13.76000,Amish/Mennonite,Amish Mennonite,,7.96,,,,,,,7.10,14.05,percent of total billed charges,
HEEL ADJUST-A-LIFT,16727,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,14.48000,13.76000,Amish/Mennonite,Amish Mennonite,,7.96,,,,,,,7.24,102.20,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,35.60000,33.82000,Amish/Mennonite,Amish Mennonite,,19.58,,,,,,,17.44,34.53,percent of total billed charges,
FOOT ARCH SUPPORT,16728,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,35.60000,33.82000,Amish/Mennonite,Amish Mennonite,,19.58,,,,,,,17.80,65.22,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,inpatient,,,215.44000,204.67000,Amish/Mennonite,Amish Mennonite,,118.49,,,,,,,105.57,208.98,percent of total billed charges,
HINGED ULNAR DEV,16731,CDM,274,RC,L3930,HCPCS,,,facility,outpatient,,,215.44000,204.67000,Amish/Mennonite,Amish Mennonite,,118.49,,,,,,,107.59,208.98,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,74.05000,70.35000,Amish/Mennonite,Amish Mennonite,,40.73,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS,16746,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,74.05000,70.35000,Amish/Mennonite,Amish Mennonite,,40.73,,,,,,,37.02,121.81,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,39.87000,37.88000,Amish/Mennonite,Amish Mennonite,,21.93,,,,,,,19.54,38.67,percent of total billed charges,
HEEL CUSHION/CUP,16749,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,39.87000,37.88000,Amish/Mennonite,Amish Mennonite,,21.93,,,,,,,19.93,70.48,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,17.24000,16.38000,Amish/Mennonite,Amish Mennonite,,9.48,,,,,,,8.45,16.72,percent of total billed charges,
HEEL CUP,16750,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,17.24000,16.38000,Amish/Mennonite,Amish Mennonite,,9.48,,,,,,,8.62,70.48,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,121.88000,115.79000,Amish/Mennonite,Amish Mennonite,,67.03,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KN SUP PF/CS,16754,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,121.88000,115.79000,Amish/Mennonite,Amish Mennonite,,67.03,,,,,,,60.94,142.65,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,270.94000,257.39000,Amish/Mennonite,Amish Mennonite,,149.02,,,,,,,132.76,262.81,percent of total billed charges,
HIP ABDUCTION LINER,16762,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,270.94000,257.39000,Amish/Mennonite,Amish Mennonite,,149.02,,,,,,,109.77,262.81,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
IMMUN ADM ORAL/INTRANASAL SNGL,16763,CDM,771,RC,90473,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,27.00,74.34,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
GALVESTON BRACE/OTS,16783,CDM,274,RC,L3918,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,99.38,192.79,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
IMM ADM ORL/INTRNAS,16792,CDM,771,RC,90474,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,33.95,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,inpatient,,,233.00000,221.35000,Amish/Mennonite,Amish Mennonite,,128.15,,,,,,,114.17,226.01,percent of total billed charges,
FOOT INSERT CUSTOM,16793,CDM,274,RC,L3020,HCPCS,,,facility,outpatient,,,233.00000,221.35000,Amish/Mennonite,Amish Mennonite,,128.15,,,,,,,116.50,274.91,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,74.05000,70.35000,Amish/Mennonite,Amish Mennonite,,40.73,,,,,,,36.28,71.83,percent of total billed charges,
HFO W/O JOINTS/OTS,16800,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,74.05000,70.35000,Amish/Mennonite,Amish Mennonite,,40.73,,,,,,,37.02,121.81,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
INF ALBUM 25% 50ML,16813,CDM,390,RC,P9047,HCPCS,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,79.00,153.26,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,20.58,40.74,percent of total billed charges,
FOOT H/V NIGHT,16820,CDM,274,RC,L3100,HCPCS,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,21.00,59.94,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,inpatient,,,1751.00000,1663.45000,Amish/Mennonite,Amish Mennonite,,963.05,,,,,,,857.99,1698.47,percent of total billed charges,
INJ BULKING AGENT,16843,CDM,274,RC,L8605,HCPCS,,,facility,outpatient,,,1751.00000,1663.45000,Amish/Mennonite,Amish Mennonite,,963.05,,,,,,,875.50,1698.47,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,844.00000,801.80000,Amish/Mennonite,Amish Mennonite,,464.20,,,,,,,413.56,818.68,percent of total billed charges,
JTO MIAMI THORACIC EXT,16848,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,844.00000,801.80000,Amish/Mennonite,Amish Mennonite,,464.20,,,,,,,360.44,818.68,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,13.46000,12.79000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,6.60,13.06,percent of total billed charges,
HEEL PAD/WEDGE,16851,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,13.46000,12.79000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,6.73,102.20,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
INF ALBUMIN 5% 50ML,16854,CDM,390,RC,P9041,HCPCS,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,9.55,33.95,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,76.13000,72.32000,Amish/Mennonite,Amish Mennonite,,41.87,,,,,,,37.30,73.85,percent of total billed charges,
IMPACTO GLOVES PAIR,16860,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,76.13000,72.32000,Amish/Mennonite,Amish Mennonite,,41.87,,,,,,,34.94,73.85,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,inpatient,,,1117.64000,1061.76000,Amish/Mennonite,Amish Mennonite,,614.70,,,,,,,547.64,1084.11,percent of total billed charges,
KO ADJ JT OTS,16862,CDM,274,RC,L1833,HCPCS,,,facility,outpatient,,,1117.64000,1061.76000,Amish/Mennonite,Amish Mennonite,,614.70,,,,,,,553.79,1084.11,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,199.84000,189.85000,Amish/Mennonite,Amish Mennonite,,109.91,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS/OTS,16866,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,199.84000,189.85000,Amish/Mennonite,Amish Mennonite,,109.91,,,,,,,81.64,193.84,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,91.80000,87.21000,Amish/Mennonite,Amish Mennonite,,50.49,,,,,,,44.98,89.05,percent of total billed charges,
L3807 WRIST HAND FNG ORTH,16868,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,91.80000,87.21000,Amish/Mennonite,Amish Mennonite,,50.49,,,,,,,45.90,315.32,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,121.88000,115.79000,Amish/Mennonite,Amish Mennonite,,67.03,,,,,,,59.72,118.22,percent of total billed charges,
HINGED KNEE SUP/OTS,16881,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,121.88000,115.79000,Amish/Mennonite,Amish Mennonite,,67.03,,,,,,,60.94,118.22,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,260.63000,247.60000,Amish/Mennonite,Amish Mennonite,,143.35,,,,,,,127.71,252.81,percent of total billed charges,
KO HINGED W/CUTOUT,16882,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,260.63000,247.60000,Amish/Mennonite,Amish Mennonite,,143.35,,,,,,,81.64,252.81,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,inpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,47.04,93.12,percent of total billed charges,
INTRAORAL ADAPTOR,16901,CDM,274,RC,L8505,HCPCS,,,facility,outpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,44.06,93.12,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,inpatient,,,441.03000,418.98000,Amish/Mennonite,Amish Mennonite,,242.57,,,,,,,216.10,427.80,percent of total billed charges,
L0642 LMB ORTH SAG CN/OTS,16905,CDM,274,RC,L0642,HCPCS,,,facility,outpatient,,,441.03000,418.98000,Amish/Mennonite,Amish Mennonite,,242.57,,,,,,,220.51,432.02,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,91.80000,87.21000,Amish/Mennonite,Amish Mennonite,,50.49,,,,,,,44.98,89.05,percent of total billed charges,
L3809 WRIST HAND FNG ORTH,16909,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,91.80000,87.21000,Amish/Mennonite,Amish Mennonite,,50.49,,,,,,,45.90,315.32,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,inpatient,,,1333.00000,1266.35000,Amish/Mennonite,Amish Mennonite,,733.15,,,,,,,653.17,1293.01,percent of total billed charges,
KO DOUBLE-UPRIGHT,16924,CDM,274,RC,L1845,HCPCS,,,facility,outpatient,,,1333.00000,1266.35000,Amish/Mennonite,Amish Mennonite,,733.15,,,,,,,666.50,1293.01,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,inpatient,,,160.20000,152.19000,Amish/Mennonite,Amish Mennonite,,88.11,,,,,,,78.50,155.39,percent of total billed charges,
L3215 ORTH FTWEAR LADIES,16935,CDM,274,RC,L3215,HCPCS,,,facility,outpatient,,,160.20000,152.19000,Amish/Mennonite,Amish Mennonite,,88.11,,,,,,,73.53,155.39,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,inpatient,,,199.84000,189.85000,Amish/Mennonite,Amish Mennonite,,109.91,,,,,,,97.92,193.84,percent of total billed charges,
KO ELAS W/JTS,16948,CDM,274,RC,L1810,HCPCS,,,facility,outpatient,,,199.84000,189.85000,Amish/Mennonite,Amish Mennonite,,109.91,,,,,,,99.92,193.84,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
IMMUNIZATION ADMIN SINGLE,16965,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,74.34,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,10.45,18.43,percent of total billed charges,
LAB/BUFFY POOR PLTE,17009,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,9.50,79.34,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN VACC EACH ADDL-TECH,17051,CDM,771,RC,90472,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,33.95,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
LAB/CRYOPRECIPITATE,17082,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,60.36,137.74,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
LAB/DIR DNR PCKD CL,17121,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,74.00,150.74,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP 200 ML,17183,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,38.65,150.35,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,89.24,percent of total billed charges,
LAB/FRESH FROZ PLAS 45ML PEDS,17218,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,38.65,89.24,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
LAB/FFP-CRYOPRECIPITATE REDUC,17255,CDM,390,RC,P9044,HCPCS,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,77.50,153.86,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,488.00000,463.60000,Amish/Mennonite,Amish Mennonite,,268.40,,,,,,,268.40,473.36,percent of total billed charges,
LAB/LEUKORED PACKED CELLS IRR,17357,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,488.00000,463.60000,Amish/Mennonite,Amish Mennonite,,268.40,,,,,,,242.89,473.36,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,664.00000,630.80000,Amish/Mennonite,Amish Mennonite,,365.20,,,,,,,365.20,644.08,percent of total billed charges,
LAB/LD SINGLE DONOR PLATELETS,17364,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,664.00000,630.80000,Amish/Mennonite,Amish Mennonite,,365.20,,,,,,,332.00,644.08,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,760.00000,722.00000,Amish/Mennonite,Amish Mennonite,,418.00,,,,,,,418.00,737.20,percent of total billed charges,
LAB/LEUKORED SNG DONR PLTS IRR,17368,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,760.00000,722.00000,Amish/Mennonite,Amish Mennonite,,418.00,,,,,,,380.00,737.20,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,inpatient,,,336.00000,319.20000,Amish/Mennonite,Amish Mennonite,,184.80,,,,,,,184.80,325.92,percent of total billed charges,
LAB/PCKD CELLS PREP,17438,CDM,390,RC,P9021,HCPCS,,,facility,outpatient,,,336.00000,319.20000,Amish/Mennonite,Amish Mennonite,,184.80,,,,,,,137.04,325.92,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
LAB/PEDIATRIC RED CELL PREP,17440,CDM,390,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,134.64,472.39,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,inpatient,,,458.00000,435.10000,Amish/Mennonite,Amish Mennonite,,251.90,,,,,,,251.90,444.26,percent of total billed charges,
LAB/PACKED CELLS IRRADIATED,17444,CDM,390,RC,P9038,HCPCS,,,facility,outpatient,,,458.00000,435.10000,Amish/Mennonite,Amish Mennonite,,251.90,,,,,,,141.69,444.26,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
LAB/POOLED CRYOPRECIPITATE,17454,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,56.50,109.61,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,inpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,,160.05,,,,,,,160.05,282.27,percent of total billed charges,
LAB/PLATELETS IRRADIATED,17463,CDM,390,RC,P9032,HCPCS,,,facility,outpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,,160.05,,,,,,,128.93,282.27,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,inpatient,,,748.00000,710.60000,Amish/Mennonite,Amish Mennonite,,411.40,,,,,,,411.40,725.56,percent of total billed charges,
LAB/PACKED CELLS DEGLYCEROLIZD,17466,CDM,390,RC,P9039,HCPCS,,,facility,outpatient,,,748.00000,710.60000,Amish/Mennonite,Amish Mennonite,,411.40,,,,,,,374.00,725.56,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
LAB/PAP TBS SCR,17468,CDM,390,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,14.86,137.74,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,inpatient,,,828.00000,786.60000,Amish/Mennonite,Amish Mennonite,,455.40,,,,,,,455.40,803.16,percent of total billed charges,
LAB/PLATELET CONC,17491,CDM,390,RC,P9034,HCPCS,,,facility,outpatient,,,828.00000,786.60000,Amish/Mennonite,Amish Mennonite,,455.40,,,,,,,377.09,803.16,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,inpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,,92.95,,,,,,,92.95,163.93,percent of total billed charges,
LAB/PLATELETS PREP,17505,CDM,390,RC,P9019,HCPCS,,,facility,outpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,,92.95,,,,,,,64.42,163.93,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,inpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,,1582.90,,,,,,,1582.90,2791.66,percent of total billed charges,
LAB/SNG DONOR PLATELETS IRRAD,17514,CDM,390,RC,P9036,HCPCS,,,facility,outpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,,1582.90,,,,,,,558.00,2791.66,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
LAB/SD PLASMA,17532,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,38.65,279.36,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,inpatient,,,637.00000,605.15000,Amish/Mennonite,Amish Mennonite,,350.35,,,,,,,350.35,617.89,percent of total billed charges,
LAB/PACKED CELLS WASHED,17538,CDM,390,RC,P9022,HCPCS,,,facility,outpatient,,,637.00000,605.15000,Amish/Mennonite,Amish Mennonite,,350.35,,,,,,,318.50,617.89,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
LAB/LEUKODEPL CELLS,1808,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,172.82,489.94,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,inpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,TC,255.20,,,,,,,255.20,450.08,percent of total billed charges,
LAB/TISS IMMUNOPER,18440,CDM,310,RC,88342,CPT,,,facility,outpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,TC,255.20,,,,,,,232.00,3299.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,,234.85,,,,,,,234.85,414.19,percent of total billed charges,
LAB/WHOLE BLOOD FOR TRANSFUSN,18480,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,,234.85,,,,,,,213.50,414.19,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,8.53000,8.10000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.18,8.27,percent of total billed charges,
LE INTERFACE SOCK,18488,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,8.53000,8.10000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,3.92,8.27,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,Amish/Mennonite,Amish Mennonite,,1541.65,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SAG-COR RG,18534,CDM,274,RC,L0637,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,Amish/Mennonite,Amish Mennonite,,1541.65,,,,,,,1401.50,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,inpatient,,,2803.00000,2662.85000,Amish/Mennonite,Amish Mennonite,,1541.65,,,,,,,1373.47,2718.91,percent of total billed charges,
L-S ORTH SG-CO/OTS,18552,CDM,274,RC,L0650,HCPCS,,,facility,outpatient,,,2803.00000,2662.85000,Amish/Mennonite,Amish Mennonite,,1541.65,,,,,,,814.56,2718.91,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,188.20000,178.79000,Amish/Mennonite,Amish Mennonite,,103.51,,,,,,,92.22,182.55,percent of total billed charges,
MATERNITY SI LOC,18553,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,188.20000,178.79000,Amish/Mennonite,Amish Mennonite,,103.51,,,,,,,67.53,182.55,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,88.69,175.57,percent of total billed charges,
LIFTS HEEL INCH,18563,CDM,274,RC,L3310,HCPCS,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,90.50,175.57,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,inpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,,655.05,,,,,,,583.59,1155.27,percent of total billed charges,
LITHIUM ION BATTERY RECHRG/RPL,18569,CDM,274,RC,L7367,HCPCS,,,facility,outpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,,655.05,,,,,,,504.90,1155.27,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,inpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,303.31,600.43,percent of total billed charges,
MACROPLASTIQUE,18572,CDM,274,RC,L8606,HCPCS,,,facility,outpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,266.32,600.43,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHEST WALL OSC,18577,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,186.50,361.81,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,,132.55,,,,,,,118.09,233.77,percent of total billed charges,
MITCHELL BAR,18589,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,,132.55,,,,,,,105.37,233.77,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,429.00000,407.55000,Amish/Mennonite,Amish Mennonite,,235.95,,,,,,,210.21,416.13,percent of total billed charges,
MITCHELL AFO EACH,18616,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,429.00000,407.55000,Amish/Mennonite,Amish Mennonite,,235.95,,,,,,,214.50,416.13,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,TC,131.45,,,,,,,131.45,231.83,percent of total billed charges,
MAMMORY DUCTOGR/GALACTOGRM SNG,1863,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,TC,131.45,,,,,,,119.50,2142.86,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,inpatient,,,227.15000,215.79000,Amish/Mennonite,Amish Mennonite,,124.93,,,,,,,111.30,220.34,percent of total billed charges,
NON-PNEUM WK SP-OTS  DME,18636,CDM,274,RC,L4387,HCPCS,,,facility,outpatient,,,227.15000,215.79000,Amish/Mennonite,Amish Mennonite,,124.93,,,,,,,113.58,220.34,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,85.26,168.78,percent of total billed charges,
MINI CRADLE BACK/AB,18644,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,67.53,168.78,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,inpatient,,,170.20000,161.69000,Amish/Mennonite,Amish Mennonite,,93.61,,,,,,,83.40,165.09,percent of total billed charges,
METATARSAL BAR EACH,18646,CDM,274,RC,L3400,HCPCS,,,facility,outpatient,,,170.20000,161.69000,Amish/Mennonite,Amish Mennonite,,93.61,,,,,,,52.68,165.09,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,inpatient,,,200.35000,190.33000,Amish/Mennonite,Amish Mennonite,,110.19,,,,,,,98.17,194.34,percent of total billed charges,
ORTH CERV COLLAR,18663,CDM,274,RC,L0172,HCPCS,,,facility,outpatient,,,200.35000,190.33000,Amish/Mennonite,Amish Mennonite,,110.19,,,,,,,100.17,196.24,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,inpatient,,,441.03000,418.98000,Amish/Mennonite,Amish Mennonite,,242.57,,,,,,,216.10,427.80,percent of total billed charges,
LMB ORTH SAG CN P/C,18664,CDM,274,RC,L0627,HCPCS,,,facility,outpatient,,,441.03000,418.98000,Amish/Mennonite,Amish Mennonite,,242.57,,,,,,,220.51,569.51,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,inpatient,,,1817.00000,1726.15000,Amish/Mennonite,Amish Mennonite,,999.35,,,,,,,890.33,1762.49,percent of total billed charges,
ORTH AFO SPIRAL FITTING/ADJ,18669,CDM,274,RC,L1951,HCPCS,,,facility,outpatient,,,1817.00000,1726.15000,Amish/Mennonite,Amish Mennonite,,999.35,,,,,,,908.50,1762.49,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,56.10,98.94,percent of total billed charges,
NITRIC OXIDE EXP GAS DETERMIN,18670,CDM,924,RC,95012,CPT,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,37.27,98.94,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,inpatient,,,1373.08000,1304.43000,Amish/Mennonite,Amish Mennonite,,755.19,,,,,,,672.81,1331.89,percent of total billed charges,
ORTH EWHFO RIGID W/O JTS,18679,CDM,274,RC,L3765,HCPCS,,,facility,outpatient,,,1373.08000,1304.43000,Amish/Mennonite,Amish Mennonite,,755.19,,,,,,,686.54,1616.93,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,inpatient,,,269.63000,256.15000,Amish/Mennonite,Amish Mennonite,,148.30,,,,,,,132.12,261.54,percent of total billed charges,
ORTH ADDN LE SFT IN,18687,CDM,274,RC,L2820,HCPCS,,,facility,outpatient,,,269.63000,256.15000,Amish/Mennonite,Amish Mennonite,,148.30,,,,,,,105.09,261.54,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,inpatient,,,260.06000,247.06000,Amish/Mennonite,Amish Mennonite,,143.03,,,,,,,127.43,252.26,percent of total billed charges,
ORTH ADDN LE KNEE CNTRL FL CAP,18689,CDM,274,RC,L2795,HCPCS,,,facility,outpatient,,,260.06000,247.06000,Amish/Mennonite,Amish Mennonite,,143.03,,,,,,,106.15,252.26,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,138.45000,131.53000,Amish/Mennonite,Amish Mennonite,,76.15,,,,,,,67.84,134.30,percent of total billed charges,
NEOPRENE KNEE,18690,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,138.45000,131.53000,Amish/Mennonite,Amish Mennonite,,76.15,,,,,,,69.22,196.91,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,,71.50,,,,,,,63.70,126.10,percent of total billed charges,
ORTH EO RIG W/O JTS,18696,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,,71.50,,,,,,,65.00,135.57,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,71.26000,67.70000,Amish/Mennonite,Amish Mennonite,,39.19,,,,,,,34.92,69.12,percent of total billed charges,
"ORTH  AFO,ANK GAUNTL",18698,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,71.26000,67.70000,Amish/Mennonite,Amish Mennonite,,39.19,,,,,,,35.63,103.42,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,13.26000,12.60000,Amish/Mennonite,Amish Mennonite,,7.29,,,,,,,6.50,12.86,percent of total billed charges,
MET ARCH SUPPORT,18716,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,13.26000,12.60000,Amish/Mennonite,Amish Mennonite,,7.29,,,,,,,6.63,65.22,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,,299.75,,,,,,,267.05,528.65,percent of total billed charges,
ORTH AFO PREFABR,18721,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,,299.75,,,,,,,272.50,528.65,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,inpatient,,,71.26000,67.70000,Amish/Mennonite,Amish Mennonite,,39.19,,,,,,,34.92,69.12,percent of total billed charges,
ORTH ADDN UE SOCK,18728,CDM,274,RC,L3995,HCPCS,,,facility,outpatient,,,71.26000,67.70000,Amish/Mennonite,Amish Mennonite,,39.19,,,,,,,35.63,69.12,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,inpatient,,,3043.38000,2891.21000,Amish/Mennonite,Amish Mennonite,,1673.86,,,,,,,1491.26,2952.08,percent of total billed charges,
ORTH KO DOUBLE UPRIGHT ADJ JT,18736,CDM,274,RC,L1846,HCPCS,,,facility,outpatient,,,3043.38000,2891.21000,Amish/Mennonite,Amish Mennonite,,1673.86,,,,,,,1514.36,2952.08,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,inpatient,,,844.00000,801.80000,Amish/Mennonite,Amish Mennonite,,464.20,,,,,,,413.56,818.68,percent of total billed charges,
ORTH ADDN LE PC HIP JT ADJ ABD,18740,CDM,274,RC,L2624,HCPCS,,,facility,outpatient,,,844.00000,801.80000,Amish/Mennonite,Amish Mennonite,,464.20,,,,,,,422.00,818.68,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,inpatient,,,821.00000,779.95000,Amish/Mennonite,Amish Mennonite,,451.55,,,,,,,402.29,796.37,percent of total billed charges,
ORTH KNEE LOCKING KNEE JTS POS,18744,CDM,274,RC,L1831,HCPCS,,,facility,outpatient,,,821.00000,779.95000,Amish/Mennonite,Amish Mennonite,,451.55,,,,,,,380.93,796.37,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,inpatient,,,36.53000,34.70000,Amish/Mennonite,Amish Mennonite,,20.09,,,,,,,17.90,35.43,percent of total billed charges,
ORTH SO FIG 8 CANVAS/WEBBING,18749,CDM,274,RC,L3660,HCPCS,,,facility,outpatient,,,36.53000,34.70000,Amish/Mennonite,Amish Mennonite,,20.09,,,,,,,18.27,130.31,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,inpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,294.98,583.94,percent of total billed charges,
ORTH CERV COLLAR TP 2 PC TH EX,18750,CDM,274,RC,L0174,HCPCS,,,facility,outpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,301.00,583.94,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,111.72,221.16,percent of total billed charges,
ORTH FO W/O JOINTS,18760,CDM,274,RC,L3933,HCPCS,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,114.00,269.05,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,inpatient,,,801.35000,761.28000,Amish/Mennonite,Amish Mennonite,,440.74,,,,,,,392.66,777.31,percent of total billed charges,
ORTH UE FX HUM/RAD/ULNAR WRIST,18767,CDM,274,RC,L3763,HCPCS,,,facility,outpatient,,,801.35000,761.28000,Amish/Mennonite,Amish Mennonite,,440.74,,,,,,,400.68,943.67,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,inpatient,,,773.00000,734.35000,Amish/Mennonite,Amish Mennonite,,425.15,,,,,,,378.77,749.81,percent of total billed charges,
ORTH UE FX RAD/ULN,18771,CDM,274,RC,L3982,HCPCS,,,facility,outpatient,,,773.00000,734.35000,Amish/Mennonite,Amish Mennonite,,425.15,,,,,,,386.50,749.81,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,102.41,202.73,percent of total billed charges,
ORTH HIP FLEX PAVLIK HARNESS,18772,CDM,274,RC,L1620,HCPCS,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,104.50,217.71,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,71.04000,67.49000,Amish/Mennonite,Amish Mennonite,,39.07,,,,,,,34.81,68.91,percent of total billed charges,
ORTHOTIC WEDGE,18774,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,71.04000,67.49000,Amish/Mennonite,Amish Mennonite,,39.07,,,,,,,32.61,68.91,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,inpatient,,,362.51000,344.38000,Amish/Mennonite,Amish Mennonite,,199.38,,,,,,,177.63,351.63,percent of total billed charges,
ORTH ELBOW OTRTH W/O JOINTS,18776,CDM,274,RC,L3702,HCPCS,,,facility,outpatient,,,362.51000,344.38000,Amish/Mennonite,Amish Mennonite,,199.38,,,,,,,181.25,364.14,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,28.42,56.26,percent of total billed charges,
ORTH FO PR INTERPH,18777,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,29.00,82.83,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,inpatient,,,31.14000,29.58000,Amish/Mennonite,Amish Mennonite,,17.13,,,,,,,15.26,30.21,percent of total billed charges,
ORTH CERVICAL PLASTIC COLLAR,18782,CDM,274,RC,L0140,HCPCS,,,facility,outpatient,,,31.14000,29.58000,Amish/Mennonite,Amish Mennonite,,17.13,,,,,,,15.57,82.94,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,inpatient,,,817.43000,776.56000,Amish/Mennonite,Amish Mennonite,,449.59,,,,,,,400.54,792.91,percent of total billed charges,
ORTH WHFO CUST W/TURNBUCKLE,18789,CDM,274,RC,L3806,HCPCS,,,facility,outpatient,,,817.43000,776.56000,Amish/Mennonite,Amish Mennonite,,449.59,,,,,,,408.71,792.91,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,inpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HO WITHOUT JOINTS,18817,CDM,274,RC,L3919,HCPCS,,,facility,outpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,145.00,341.50,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,inpatient,,,2833.00000,2691.35000,Amish/Mennonite,Amish Mennonite,,1558.15,,,,,,,1388.17,2748.01,percent of total billed charges,
ORTH HIP POST-OP HIP ABD,18821,CDM,274,RC,L1686,HCPCS,,,facility,outpatient,,,2833.00000,2691.35000,Amish/Mennonite,Amish Mennonite,,1558.15,,,,,,,1212.77,2748.01,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,inpatient,,,1335.00000,1268.25000,Amish/Mennonite,Amish Mennonite,,734.25,,,,,,,654.15,1294.95,percent of total billed charges,
ORTH MLT PST COLLAR THORAC EXT,18823,CDM,274,RC,L0200,HCPCS,,,facility,outpatient,,,1335.00000,1268.25000,Amish/Mennonite,Amish Mennonite,,734.25,,,,,,,667.50,1294.95,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,51.20000,48.64000,Amish/Mennonite,Amish Mennonite,,28.16,,,,,,,25.09,49.66,percent of total billed charges,
P-CELL INSERT MOD,18827,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,51.20000,48.64000,Amish/Mennonite,Amish Mennonite,,28.16,,,,,,,23.50,49.66,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
PATCH/APPLICATN TST,18833,CDM,924,RC,95044,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,1062.65,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,inpatient,,,760.40000,722.38000,Amish/Mennonite,Amish Mennonite,,418.22,,,,,,,372.60,737.59,percent of total billed charges,
ORTH HAND FINGER ORTHOSIS CUST,18862,CDM,274,RC,L3921,HCPCS,,,facility,outpatient,,,760.40000,722.38000,Amish/Mennonite,Amish Mennonite,,418.22,,,,,,,378.38,737.59,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,inpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,142.10,281.30,percent of total billed charges,
ORTHO HFO WITHOUT JOINTS,18881,CDM,274,RC,L3913,HCPCS,,,facility,outpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,145.00,341.50,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,543.00000,515.85000,Amish/Mennonite,Amish Mennonite,,298.65,,,,,,,266.07,526.71,percent of total billed charges,
ORTH WHO W/O JTS,18888,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,543.00000,515.85000,Amish/Mennonite,Amish Mennonite,,298.65,,,,,,,271.50,639.03,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,inpatient,,,306.76000,291.42000,Amish/Mennonite,Amish Mennonite,,168.72,,,,,,,150.31,297.56,percent of total billed charges,
ORTH ELBW W/ADJ POS,18889,CDM,274,RC,L3760,HCPCS,,,facility,outpatient,,,306.76000,291.42000,Amish/Mennonite,Amish Mennonite,,168.72,,,,,,,153.38,630.65,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
PERM LAC DUCT IMP,18890,CDM,272,RC,A4263,HCPCS,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,inpatient,,,174.49000,165.77000,Amish/Mennonite,Amish Mennonite,,95.97,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALKING SPLNT,18894,CDM,274,RC,L4360,HCPCS,,,facility,outpatient,,,174.49000,165.77000,Amish/Mennonite,Amish Mennonite,,95.97,,,,,,,87.25,358.73,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
PPD SKIN TEST,18898,CDM,300,RC,86580,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,23.25,430.17,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,293.70000,279.02000,Amish/Mennonite,Amish Mennonite,,161.53,,,,,,,143.91,284.89,percent of total billed charges,
ORTH KO ELASTC,18902,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,293.70000,279.02000,Amish/Mennonite,Amish Mennonite,,161.53,,,,,,,146.85,284.89,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,inpatient,,,2541.00000,2413.95000,Amish/Mennonite,Amish Mennonite,,1397.55,,,,,,,1245.09,2464.77,percent of total billed charges,
PROKERA RING,18917,CDM,276,RC,V2790,HCPCS,,,facility,outpatient,,,2541.00000,2413.95000,Amish/Mennonite,Amish Mennonite,,1397.55,,,,,,,1166.32,2464.77,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,inpatient,,,384.09000,364.89000,Amish/Mennonite,Amish Mennonite,,211.25,,,,,,,188.20,372.57,percent of total billed charges,
ORTH UE FX HUMERUS,18931,CDM,274,RC,L3980,HCPCS,,,facility,outpatient,,,384.09000,364.89000,Amish/Mennonite,Amish Mennonite,,211.25,,,,,,,192.04,487.84,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,Amish/Mennonite,Amish Mennonite,,103.75,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN PLUS 0.1ML,18933,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,Amish/Mennonite,Amish Mennonite,,103.75,,,,,,,55.62,188.63,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,inpatient,,,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,12.54,24.83,percent of total billed charges,
P-CELL INS NON-MOD,18942,CDM,274,RC,L9900,HCPCS,,,facility,outpatient,,,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,11.75,24.83,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,31.84,56.16,percent of total billed charges,
NONINVAS EAR/PULSE OXIM OXYGEN,1895,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,28.95,56.16,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,inpatient,,,174.49000,165.77000,Amish/Mennonite,Amish Mennonite,,95.97,,,,,,,85.50,169.26,percent of total billed charges,
PNEUM WALK SPL-OTS,18954,CDM,274,RC,L4361,HCPCS,,,facility,outpatient,,,174.49000,165.77000,Amish/Mennonite,Amish Mennonite,,95.97,,,,,,,87.25,358.73,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,152.90,269.66,percent of total billed charges,
NONINV EAR/PLUSE OX CONT OVRNT,1896,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,139.00,269.66,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,inpatient,,,188.63000,179.20000,Amish/Mennonite,Amish Mennonite,,103.75,,,,,,,92.43,182.97,percent of total billed charges,
PROLARYN VOICE,18991,CDM,278,RC,L8607,HCPCS,,,facility,outpatient,,,188.63000,179.20000,Amish/Mennonite,Amish Mennonite,,103.75,,,,,,,55.62,188.63,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,294.98,583.94,percent of total billed charges,
PRSTH BREAST SIL,19013,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,301.00,583.94,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,inpatient,,,148.65000,141.22000,Amish/Mennonite,Amish Mennonite,,81.76,,,,,,,72.84,144.19,percent of total billed charges,
PRSTH MASTECT SLV,19019,CDM,274,RC,L8010,HCPCS,,,facility,outpatient,,,148.65000,141.22000,Amish/Mennonite,Amish Mennonite,,81.76,,,,,,,68.23,144.19,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,inpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,,36.74,,,,,,,32.73,64.80,percent of total billed charges,
PNEUMATIC ANKL CNTR DME,19025,CDM,274,RC,L4350,HCPCS,,,facility,outpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,,36.74,,,,,,,33.40,134.06,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,inpatient,,,40.48000,38.46000,Amish/Mennonite,Amish Mennonite,,22.26,,,,,,,19.84,39.27,percent of total billed charges,
PRSTH MASTEC FORM,19029,CDM,274,RC,L8020,HCPCS,,,facility,outpatient,,,40.48000,38.46000,Amish/Mennonite,Amish Mennonite,,22.26,,,,,,,20.24,313.88,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,inpatient,,,80.27000,76.26000,Amish/Mennonite,Amish Mennonite,,44.15,,,,,,,39.33,77.86,percent of total billed charges,
PRSTH SHRINKER BK,19030,CDM,274,RC,L8440,HCPCS,,,facility,outpatient,,,80.27000,76.26000,Amish/Mennonite,Amish Mennonite,,44.15,,,,,,,40.13,77.86,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,inpatient,,,14393.00000,13673.35000,Amish/Mennonite,Amish Mennonite,,7916.15,,,,,,,7052.57,13961.21,percent of total billed charges,
PRSTH TRANSCAR/METACARP/PRT HN,19043,CDM,274,RC,L6026,HCPCS,,,facility,outpatient,,,14393.00000,13673.35000,Amish/Mennonite,Amish Mennonite,,7916.15,,,,,,,5640.97,13961.21,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,43.61,86.33,percent of total billed charges,
PRSTH MASTECT BRA,19044,CDM,274,RC,L8000,HCPCS,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,44.50,86.33,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,inpatient,,,42.80000,40.66000,Amish/Mennonite,Amish Mennonite,,23.54,,,,,,,20.97,41.52,percent of total billed charges,
PRSTH SOCKS AK,19069,CDM,274,RC,L8430,HCPCS,,,facility,outpatient,,,42.80000,40.66000,Amish/Mennonite,Amish Mennonite,,23.54,,,,,,,21.40,41.52,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,399.94000,379.94000,Amish/Mennonite,Amish Mennonite,,219.97,,,,,,,195.97,387.94,percent of total billed charges,
PRAFO OTS,19108,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,399.94000,379.94000,Amish/Mennonite,Amish Mennonite,,219.97,,,,,,,199.97,387.94,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,inpatient,,,89.33000,84.86000,Amish/Mennonite,Amish Mennonite,,49.13,,,,,,,43.77,86.65,percent of total billed charges,
PRSTH SHRINKER AK,19117,CDM,274,RC,L8460,HCPCS,,,facility,outpatient,,,89.33000,84.86000,Amish/Mennonite,Amish Mennonite,,49.13,,,,,,,44.66,91.99,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,inpatient,,,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
PROCHLORPERAZINE,19129,CDM,636,RC,Q0164,HCPCS,,,facility,outpatient,,,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.30,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
Q0111 LAB/WET PREP,19134,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,5.87,113.69,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,inpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,257.95,454.93,percent of total billed charges,
PUVA TREATMENT,19148,CDM,940,RC,96912,CPT,,,facility,outpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,56.40,454.93,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,inpatient,,,1327.00000,1260.65000,Amish/Mennonite,Amish Mennonite,,729.85,,,,,,,729.85,1287.19,percent of total billed charges,
REFILL/MAINT IMPL PUMP/RES SPN,19150,CDM,940,RC,95990,CPT,,,facility,outpatient,,,1327.00000,1260.65000,Amish/Mennonite,Amish Mennonite,,729.85,,,,,,,314.95,1287.19,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,inpatient,,,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
FERUMOXYTOL ESRD USE,19153,CDM,636,RC,Q0139,HCPCS,,,facility,outpatient,,,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,0.31000,5.61,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,inpatient,,,77.20000,73.34000,Amish/Mennonite,Amish Mennonite,,42.46,,,,,,,42.46,74.88,percent of total billed charges,
RADIESSEVCGEL 0.1ML,19173,CDM,636,RC,Q2026,HCPCS,,,facility,outpatient,,,77.20000,73.34000,Amish/Mennonite,Amish Mennonite,,42.46,,,,,,,38.60,550.14,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,inpatient,,,56.50000,53.67000,Amish/Mennonite,Amish Mennonite,,31.07,,,,,,,27.68,54.80,percent of total billed charges,
RPR ORTHOTIC DEVICE,19179,CDM,274,RC,L4205,HCPCS,,,facility,outpatient,,,56.50000,53.67000,Amish/Mennonite,Amish Mennonite,,31.07,,,,,,,28.25,54.80,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,114.56000,108.83000,Amish/Mennonite,Amish Mennonite,,63.01,,,,,,,56.13,111.12,percent of total billed charges,
SACROIL ORTH FLEX,19200,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,114.56000,108.83000,Amish/Mennonite,Amish Mennonite,,63.01,,,,,,,57.28,111.12,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,91.53000,86.95000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.85,88.78,percent of total billed charges,
SI BELT NON-RIGID,19204,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,91.53000,86.95000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,45.77,95.58,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,inpatient,,,302.81000,287.67000,Amish/Mennonite,Amish Mennonite,,166.55,,,,,,,148.38,293.73,percent of total billed charges,
PTO KNEE BRACE,19209,CDM,274,RC,L1820,HCPCS,,,facility,outpatient,,,302.81000,287.67000,Amish/Mennonite,Amish Mennonite,,166.55,,,,,,,151.41,293.73,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.27,6.47,percent of total billed charges,
PLASTIC HEEL CUP,19217,CDM,274,RC,L3170,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,70.48,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,inpatient,,,3562.00000,3383.90000,Amish/Mennonite,Amish Mennonite,TC,1959.10,,,,,,,1959.10,3455.14,percent of total billed charges,
SM INTEST IMAGING;INTRALUMINAL-TECH,19226,CDM,750,RC,91110,CPT,,,facility,outpatient,,,3562.00000,3383.90000,Amish/Mennonite,Amish Mennonite,TC,1959.10,,,,,,,1781.00,5271.00,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,inpatient,,,51.73000,49.14000,Amish/Mennonite,Amish Mennonite,,28.45,,,,,,,25.35,50.18,percent of total billed charges,
RE-COVER INLAYS,19291,CDM,274,RC,L4210,HCPCS,,,facility,outpatient,,,51.73000,49.14000,Amish/Mennonite,Amish Mennonite,,28.45,,,,,,,23.74,50.18,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,inpatient,,,812.00000,771.40000,Amish/Mennonite,Amish Mennonite,,446.60,,,,,,,397.88,787.64,percent of total billed charges,
SURGICAL STENT,19299,CDM,278,RC,D5982,HCPCS,,,facility,outpatient,,,812.00000,771.40000,Amish/Mennonite,Amish Mennonite,,446.60,,,,,,,372.71,812.00,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,241.18,477.44,percent of total billed charges,
SPLINT W/DIST,19305,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,492.21000,467.60000,Amish/Mennonite,Amish Mennonite,,270.72,,,,,,,246.10,477.44,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
TEMP LAC DUCT IMP,19331,CDM,272,RC,A4262,HCPCS,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,inpatient,,,3214.00000,3053.30000,Amish/Mennonite,Amish Mennonite,,1767.70,,,,,,,1574.86,3117.58,percent of total billed charges,
TLSO 4 MOD SACRO-SCAP PREFAB,19334,CDM,274,RC,L0464,HCPCS,,,facility,outpatient,,,3214.00000,3053.30000,Amish/Mennonite,Amish Mennonite,,1767.70,,,,,,,1607.00,3117.58,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,inpatient,,,876.00000,832.20000,Amish/Mennonite,Amish Mennonite,,481.80,,,,,,,429.24,849.72,percent of total billed charges,
TLSO RIGID FRAME HYPEREX PREF,19337,CDM,274,RC,L0472,HCPCS,,,facility,outpatient,,,876.00000,832.20000,Amish/Mennonite,Amish Mennonite,,481.80,,,,,,,438.00,849.72,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,inpatient,,,44.77000,42.53000,Amish/Mennonite,Amish Mennonite,,24.62,,,,,,,21.94,43.43,percent of total billed charges,
THUMB STAB SPLINT,19342,CDM,274,RC,L3923,HCPCS,,,facility,outpatient,,,44.77000,42.53000,Amish/Mennonite,Amish Mennonite,,24.62,,,,,,,22.39,121.81,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.48,30.65,percent of total billed charges,
THUMB LOOP,19358,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,14.50,30.65,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,inpatient,,,436.46000,414.64000,Amish/Mennonite,Amish Mennonite,,240.05,,,,,,,213.87,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES,19359,CDM,274,RC,L4398,HCPCS,,,facility,outpatient,,,436.46000,414.64000,Amish/Mennonite,Amish Mennonite,,240.05,,,,,,,99.97,423.37,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,inpatient,,,2171.00000,2062.45000,Amish/Mennonite,Amish Mennonite,,1194.05,,,,,,,1063.79,2105.87,percent of total billed charges,
TLSO 2 MOD SYMPHYSIS-STERN PRE,19371,CDM,274,RC,L0460,HCPCS,,,facility,outpatient,,,2171.00000,2062.45000,Amish/Mennonite,Amish Mennonite,,1194.05,,,,,,,1085.50,2105.87,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC NOT PRESV FREE,19373,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,inpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1053.99,2086.47,percent of total billed charges,
TLSO FLEX PREFAB RG,19389,CDM,274,RC,L0456,HCPCS,,,facility,outpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1075.50,2086.47,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLUMIST QUAD-ADMIN,19391,CDM,636,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-DT(PED) <7 YRS-ADMIN,19404,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,inpatient,,,55.45000,52.68000,Amish/Mennonite,Amish Mennonite,,30.50,,,,,,,27.17,53.79,percent of total billed charges,
VASYLI ORTHOTICS EA,19406,CDM,274,RC,L3060,HCPCS,,,facility,outpatient,,,55.45000,52.68000,Amish/Mennonite,Amish Mennonite,,30.50,,,,,,,27.73,102.20,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,inpatient,,,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
ZINC AIR BATTERY,19408,CDM,299,RC,L8621,HCPCS,,,facility,outpatient,,,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,0.80300,1.94,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,inpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,,169.12,,,,,,,150.68,298.27,percent of total billed charges,
TLSO FLEX PREFAB THORACIC,19409,CDM,274,RC,L0450,HCPCS,,,facility,outpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,,169.12,,,,,,,133.85,298.27,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,inpatient,,,57.29000,54.43000,Amish/Mennonite,Amish Mennonite,,31.51,,,,,,,28.07,55.57,percent of total billed charges,
WHFO W/O JOINTS PREF,19417,CDM,274,RC,L3807,HCPCS,,,facility,outpatient,,,57.29000,54.43000,Amish/Mennonite,Amish Mennonite,,31.51,,,,,,,28.64,315.32,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,inpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,201.85,355.99,percent of total billed charges,
UVB,19419,CDM,940,RC,96910,CPT,,,facility,outpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,56.40,355.99,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,inpatient,,,711.00000,675.45000,Amish/Mennonite,Amish Mennonite,,391.05,,,,,,,391.05,689.67,percent of total billed charges,
THRMBOLYS COR I/V INFUSION,19424,CDM,480,RC,92977,CPT,,,facility,outpatient,,,711.00000,675.45000,Amish/Mennonite,Amish Mennonite,,391.05,,,,,,,314.95,689.67,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-MENINGOCOCCAL REC-IM USE,19434,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-4VHPV-3 DOSE-ADMIN,19435,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,inpatient,,,57.91000,55.01000,Amish/Mennonite,Amish Mennonite,,31.85,,,,,,,28.38,56.17,percent of total billed charges,
ORTH KO IMMOBILIZER DME,1944,CDM,274,RC,L1830,HCPCS,,,facility,outpatient,,,57.91000,55.01000,Amish/Mennonite,Amish Mennonite,,31.85,,,,,,,28.95,93.98,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,inpatient,,,57.80000,54.91000,Amish/Mennonite,Amish Mennonite,,31.79,,,,,,,28.32,56.07,percent of total billed charges,
WRST/THMB SPICA SP,19444,CDM,274,RC,L3809,HCPCS,,,facility,outpatient,,,57.80000,54.91000,Amish/Mennonite,Amish Mennonite,,31.79,,,,,,,28.90,315.32,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-TD PRESERVATIVE FREE-ADMIN,19445,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC-QUADRIV-ADMIN,19462,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PRESRV FREE FLU,19463,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,381.46000,362.39000,Amish/Mennonite,Amish Mennonite,,209.80,,,,,,,186.92,370.02,percent of total billed charges,
WHFO RIGID W/O JTS STRAPS CUST,19464,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,381.46000,362.39000,Amish/Mennonite,Amish Mennonite,,209.80,,,,,,,190.73,449.21,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-IPV-ADMIN,19469,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,152.51,301.91,percent of total billed charges,
WRIST SPLINT W/EXT,19470,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,86.36,301.91,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,29.96000,28.46000,Amish/Mennonite,Amish Mennonite,,16.48,,,,,,,14.68,29.06,percent of total billed charges,
SPLINT-COCK UP WRST,19473,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,29.96000,28.46000,Amish/Mennonite,Amish Mennonite,,16.48,,,,,,,14.98,92.45,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-HIB 3 DOSE SCHED-ADMIN,19477,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,191.95,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG REC,19479,CDM,480,RC,93786,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,122.40,338.53,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,33.55,59.17,percent of total billed charges,
AMB BLD PRESSURE MONITORG SCAN,19480,CDM,480,RC,93788,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,30.50,134.64,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST(PTACT),19484,CDM,471,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOG TSTNG W/SPEECH RECOGN,19485,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,56.40,185.27,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,52,88.00,,,,,,,88.00,155.20,percent of total billed charges,
AUDIOLOGIC TEST-PTACT-UNIL,19487,CDM,470,RC,92552,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,52,88.00,,,,,,,80.00,155.20,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,52,105.05,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-PTA & BCT-UNILA,19488,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,52,105.05,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGIC TEST(PTA & BCT),19491,CDM,471,RC,92553,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,95.50,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,52,105.05,,,,,,,105.05,185.27,percent of total billed charges,
AUDIOLOGY TEST-SRT & SD-UNIL,19492,CDM,471,RC,92556,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,52,105.05,,,,,,,95.50,185.27,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,inpatient,,,348.00000,330.60000,Amish/Mennonite,Amish Mennonite,,191.40,,,,,,,191.40,337.56,percent of total billed charges,
CONDITIONING PLAY AUDIOMETRY,19502,CDM,470,RC,92582,CPT,,,facility,outpatient,,,348.00000,330.60000,Amish/Mennonite,Amish Mennonite,,191.40,,,,,,,148.57,337.56,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,,254.10,,,,,,,254.10,448.14,percent of total billed charges,
"CARDIAC STRESS TEST, TRACING-TECH",19506,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,,254.10,,,,,,,231.00,448.14,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,inpatient,,,2008.00000,1907.60000,Amish/Mennonite,Amish Mennonite,,1104.40,,,,,,,1104.40,1947.76,percent of total billed charges,
CARDIO-MONITOR/SCANNING,19534,CDM,731,RC,93271,CPT,,,facility,outpatient,,,2008.00000,1907.60000,Amish/Mennonite,Amish Mennonite,,1104.40,,,,,,,87.16,1947.76,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,inpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,10.45,18.43,percent of total billed charges,
PROL CLIN STAFF SRV; ADL 30 MIN,19544,CDM,510,RC,99416,CPT,,,facility,outpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,9.50,18.43,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
PROL CLINICAL STAFF SRV;1ST HR,19566,CDM,510,RC,99415,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,34.92,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
OXIMETRY,1957,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,33.95,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
SPEECH AUDIOMET THRESHOLD ONLY,19580,CDM,471,RC,92555,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,56.40,116.40,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,inpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,45.10,79.54,percent of total billed charges,
STENGER TEST PURE TONE,19584,CDM,471,RC,92565,CPT,,,facility,outpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,41.00,79.54,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
VERTICAL ELECTRODE USE,19585,CDM,471,RC,92547,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,15.50,30.07,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,inpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,148.50,261.90,percent of total billed charges,
SELECT PICTURE AUDIOMETRY,19587,CDM,471,RC,92583,CPT,,,facility,outpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,56.40,261.90,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
STENGER TEST SPEECH,19592,CDM,471,RC,92577,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,42.50,554.21,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
KIT CATH 9.6FR 56CM SIL HKMN PEEL-APART PED 1,21453,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
ARTHCS ASP/INJ INT JT WO US-TECH,2163,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,71.50,308.32,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,41.56000,39.48000,Amish/Mennonite,Amish Mennonite,,22.86,,,,,,,20.36,40.31,percent of total billed charges,
CYLINDER MED GAS E CO2 AL,23632,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,41.56000,39.48000,Amish/Mennonite,Amish Mennonite,,22.86,,,,,,,19.08,41.56,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,505.88000,480.59000,Amish/Mennonite,Amish Mennonite,,278.23,,,,,,,247.88,490.70,percent of total billed charges,
PLUG HERN M W1.3XL1.55IN INGUINAL POLYPR REP PRESHAPED ONLAY,23968,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,505.88000,480.59000,Amish/Mennonite,Amish Mennonite,,278.23,,,,,,,232.20,505.88,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,637.50000,605.62000,Amish/Mennonite,Amish Mennonite,,350.62,,,,,,,312.38,618.38,percent of total billed charges,
MESH HERN W10XL14IN INGUINAL POLYPR MFIL RECTANG NABSRB FLAT.,23990,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,637.50000,605.62000,Amish/Mennonite,Amish Mennonite,,350.62,,,,,,,292.61,637.50,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,58.85,103.79,percent of total billed charges,
OFFICE VISIT LEVEL 1-TECH,2976,CDM,510,RC,99211,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,53.50,103.79,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,inpatient,,,1130.00000,1073.50000,Amish/Mennonite,Amish Mennonite,TC,621.50,,,,,,,621.50,1096.10,percent of total billed charges,
ACTIGRAPHY-MIN 3-DAY RECORDING TC,35211,CDM,922,RC,95803,CPT,,,facility,outpatient,,,1130.00000,1073.50000,Amish/Mennonite,Amish Mennonite,TC,621.50,,,,,,,565.00,1096.10,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,inpatient,,,474.00000,450.30000,Amish/Mennonite,Amish Mennonite,TC,260.70,,,,,,,260.70,459.78,percent of total billed charges,
95801 SLEEP STUDY UNATTENDED TC,35212,CDM,922,RC,95801,CPT,,,facility,outpatient,,,474.00000,450.30000,Amish/Mennonite,Amish Mennonite,TC,260.70,,,,,,,237.00,459.78,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,Amish/Mennonite,Amish Mennonite,TC,795.30,,,,,,,795.30,1402.62,percent of total billed charges,
95800 SLEEP STUDY UNATTENDED TC,35213,CDM,922,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,Amish/Mennonite,Amish Mennonite,TC,795.30,,,,,,,723.00,1402.62,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,inpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,TC,173.25,,,,,,,173.25,305.55,percent of total billed charges,
AIRWAY RESIST-IMPULSE OSCILLOM TC,35221,CDM,460,RC,94728,CPT,,,facility,outpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,TC,173.25,,,,,,,157.50,305.55,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,inpatient,,,598.00000,568.10000,Amish/Mennonite,Amish Mennonite,TC,328.90,,,,,,,328.90,580.06,percent of total billed charges,
AUTONOMIC SYMPATHETIC FUNCTION TC,35310,CDM,922,RC,95922,CPT,,,facility,outpatient,,,598.00000,568.10000,Amish/Mennonite,Amish Mennonite,TC,328.90,,,,,,,299.00,580.06,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
BILIRUBIN TRANSCUTANEOUS,35320,CDM,301,RC,88720,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,3.63,254.68,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,TC,40.70,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL TC-52,35328,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,TC,40.70,,,,,,,37.00,442.00,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,TC,29.15,,,,,,,29.15,51.41,percent of total billed charges,
CALORIC VESTIB BIL BITHERMAL TC,35329,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,TC,29.15,,,,,,,26.50,51.41,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,inpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,TC,14.30,,,,,,,14.30,25.22,percent of total billed charges,
CARDIAC EVENT REC TC,35331,CDM,480,RC,93799,CPT,,,facility,outpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,TC,14.30,,,,,,,13.00,25.22,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,TC,71.50,,,,,,,71.50,126.10,percent of total billed charges,
CARDIOMONITOR-TECH ONLY TC,35334,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,TC,71.50,,,,,,,65.00,126.10,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,inpatient,,,4627.00000,4395.65000,Amish/Mennonite,Amish Mennonite,TC,2544.85,,,,,,,2544.85,4488.19,percent of total billed charges,
CENTRAL MOTOR EV PTNL UPR/LWR TC,35335,CDM,929,RC,95939,CPT,,,facility,outpatient,,,4627.00000,4395.65000,Amish/Mennonite,Amish Mennonite,TC,2544.85,,,,,,,2313.50,4488.19,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,TC,16.50,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB BIL MONOTHERMAL TC,35336,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,TC,16.50,,,,,,,15.00,29.10,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,TC,1113.20,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMAGING VASC FLOW ONLY,35341,CDM,340,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,TC,1113.20,,,,,,,864.82,2960.49,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,,1538.90,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR SI JOINTS,35342,CDM,350,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,,1538.90,,,,,,,169.04,2714.06,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,Amish/Mennonite,Amish Mennonite,TC,2110.35,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN SCAN/CEREBRAL B/F SUDY,35347,CDM,340,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,Amish/Mennonite,Amish Mennonite,TC,2110.35,,,,,,,1626.53,3721.89,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,,1299.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT-PELVIS W/CONTRAST SI JOINTS,35350,CDM,350,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,,1299.65,,,,,,,169.04,2292.11,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHOSPASM EVAL-B/A DILATORS TC,35351,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,272.50,528.65,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,52,40.70,,,,,,,40.70,71.78,percent of total billed charges,
BREAST TOMOSYN SCR MOBILE-UNIL 52,35352,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,52,40.70,,,,,,,37.00,442.00,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EV POTTNL URP LM TC,35354,CDM,922,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,828.00,1606.32,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-BIL TC,35355,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,18.50,442.00,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,20.35,35.89,percent of total billed charges,
DIG BRST TOMOSYNTH MOBILE-UNIL TC,35356,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,18.50,442.00,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,TC,916.30,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EV PTNL LWR LMB TC,35358,CDM,922,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,TC,916.30,,,,,,,833.00,1616.02,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,TC,149.05,,,,,,,149.05,262.87,percent of total billed charges,
DOPPLER ECHO F/U OR LMTD STDY TC,35360,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,TC,149.05,,,,,,,135.50,262.87,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,TC,269.50,,,,,,,269.50,475.30,percent of total billed charges,
DOPPLER ECHOCARDIOGRAPHY-TECH TC,35363,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,TC,269.50,,,,,,,245.00,475.30,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,TC,168.85,,,,,,,168.85,297.79,percent of total billed charges,
DOPPLER COLOR FLOW VEL MAP-TC TC,35364,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,TC,168.85,,,,,,,153.50,297.79,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,TC,285.45,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY TC,35365,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,TC,285.45,,,,,,,259.50,503.43,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,inpatient,,,316.00000,300.20000,Amish/Mennonite,Amish Mennonite,TC,173.80,,,,,,,173.80,306.52,percent of total billed charges,
BASIC VEST EVAL MIN 4 POSITION TC,35369,CDM,920,RC,92540,CPT,,,facility,outpatient,,,316.00000,300.20000,Amish/Mennonite,Amish Mennonite,TC,173.80,,,,,,,158.00,306.52,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,inpatient,,,674.00000,640.30000,Amish/Mennonite,Amish Mennonite,TC,370.70,,,,,,,370.70,653.78,percent of total billed charges,
COMB PARASYMPATH/SYMPATH FUNC TC,35372,CDM,922,RC,95924,CPT,,,facility,outpatient,,,674.00000,640.30000,Amish/Mennonite,Amish Mennonite,TC,370.70,,,,,,,337.00,653.78,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,655.05,1155.27,percent of total billed charges,
DUP EXT VNS UNIL/LIMITED STUDY,35373,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,595.50,1155.27,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,TC,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG STORAGE TC,35374,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,TC,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,inpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,TC,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ECG EDITING TC,35376,CDM,480,RC,93799,CPT,,,facility,outpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,TC,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1360.00000,1292.00000,Amish/Mennonite,Amish Mennonite,TC,748.00,,,,,,,748.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D F/U.LMTD,35379,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1360.00000,1292.00000,Amish/Mennonite,Amish Mennonite,TC,748.00,,,,,,,680.00,1319.20,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARDIOGRAPHY 2D  LIMITED,35381,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,614.00,1191.16,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,TC,136.95,,,,,,,136.95,241.53,percent of total billed charges,
ECHO/STR-OFFSITE-M/C NO INTERP TC,35382,CDM,480,RC,93799,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,TC,136.95,,,,,,,124.50,241.53,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,Amish/Mennonite,Amish Mennonite,TC,1833.15,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHOCARDIOGRAPHY 2D W/STRESS TC,35383,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,Amish/Mennonite,Amish Mennonite,TC,1833.15,,,,,,,1666.50,3233.01,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,TC,701.80,,,,,,,701.80,1237.72,percent of total billed charges,
DUPLEX UPR EXTREM ART BIL/LTD TC,35385,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,TC,701.80,,,,,,,638.00,1237.72,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHOCARDIOGRAPHY PROBE PLCMNT TC,35386,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2015.00,3909.10,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,Amish/Mennonite,Amish Mennonite,TC,1404.15,,,,,,,1404.15,2476.41,percent of total billed charges,
"ECHOCARDIOGRAPHY,ELEC MON-TECH",35387,CDM,483,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,Amish/Mennonite,Amish Mennonite,TC,1404.15,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,Amish/Mennonite,Amish Mennonite,TC,646.25,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO 2D COMPLT W/O DPLR-TECH,35392,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,Amish/Mennonite,Amish Mennonite,TC,646.25,,,,,,,587.50,1139.75,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1247.95,2200.93,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSTHOR-TECH",35394,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1134.50,2200.93,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,TC,116.60,,,,,,,116.60,205.64,percent of total billed charges,
ECHO-OFFSITE-M/C NO INTERP TC,35395,CDM,480,RC,93799,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,TC,116.60,,,,,,,106.00,205.64,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,inpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,TC,141.35,,,,,,,141.35,249.29,percent of total billed charges,
ECHOCARDIOGR W/STRESS-OFFSITE TC,35397,CDM,480,RC,93799,CPT,,,facility,outpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,TC,141.35,,,,,,,128.50,249.29,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,Amish/Mennonite,Amish Mennonite,TC,1478.40,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHOCARDIOGRAPHY REAL TM W/IMG TC,35398,CDM,483,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,Amish/Mennonite,Amish Mennonite,TC,1478.40,,,,,,,1344.00,2607.36,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,inpatient,,,564.00000,535.80000,Amish/Mennonite,Amish Mennonite,TC,310.20,,,,,,,310.20,547.08,percent of total billed charges,
ESOPHAG-GASTROES TST W/ELEC PL TC,35399,CDM,750,RC,91037,CPT,,,facility,outpatient,,,564.00000,535.80000,Amish/Mennonite,Amish Mennonite,TC,310.20,,,,,,,282.00,5271.00,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,Amish/Mennonite,Amish Mennonite,TC,1363.45,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W//MUCOSAL TC,35401,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,Amish/Mennonite,Amish Mennonite,TC,1363.45,,,,,,,909.00,5271.00,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,inpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,TC,10.45,,,,,,,10.45,18.43,percent of total billed charges,
ECG-STORAGE/INTRP TC,35406,CDM,480,RC,93799,CPT,,,facility,outpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,TC,10.45,,,,,,,9.50,18.43,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,inpatient,,,2018.00000,1917.10000,Amish/Mennonite,Amish Mennonite,TC,1109.90,,,,,,,1109.90,1957.46,percent of total billed charges,
ESOPH-GASTROESOPH TEST PROL TC,35407,CDM,750,RC,91038,CPT,,,facility,outpatient,,,2018.00000,1917.10000,Amish/Mennonite,Amish Mennonite,TC,1109.90,,,,,,,909.00,5271.00,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,Amish/Mennonite,Amish Mennonite,TC,1323.85,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLT-TECH,35409,CDM,483,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,Amish/Mennonite,Amish Mennonite,TC,1323.85,,,,,,,1203.50,2334.79,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,inpatient,,,219.00000,208.05000,Amish/Mennonite,Amish Mennonite,TC,120.45,,,,,,,120.45,212.43,percent of total billed charges,
ECHO-OFFSITE-TECH TC,35416,CDM,480,RC,93799,CPT,,,facility,outpatient,,,219.00000,208.05000,Amish/Mennonite,Amish Mennonite,TC,120.45,,,,,,,109.50,212.43,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,inpatient,,,2479.00000,2355.05000,Amish/Mennonite,Amish Mennonite,,1363.45,,,,,,,1363.45,2404.63,percent of total billed charges,
ESOPH-GASTROESO TST W/MUSCOSAL,35420,CDM,750,RC,91035,CPT,,,facility,outpatient,,,2479.00000,2355.05000,Amish/Mennonite,Amish Mennonite,,1363.45,,,,,,,503.83,5271.00,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,TC,185.90,,,,,,,185.90,327.86,percent of total billed charges,
GAS DIL/WASHOUT-DTRMN LUNG VOL TC,35421,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,TC,185.90,,,,,,,169.00,327.86,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,TC,42.35,,,,,,,42.35,74.69,percent of total billed charges,
HOLTER REC-RENTAL TC,35425,CDM,480,RC,93799,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,TC,42.35,,,,,,,38.50,74.69,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,1004.85,1772.19,percent of total billed charges,
DUPLX SCN LWR EXTRM ART BYP GR TC,35432,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,913.50,1772.19,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,Amish/Mennonite,Amish Mennonite,TC,1558.70,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY,35439,CDM,340,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,Amish/Mennonite,Amish Mennonite,TC,1558.70,,,,,,,1132.05,2748.98,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,inpatient,,,269.00000,255.55000,Amish/Mennonite,Amish Mennonite,TC,147.95,,,,,,,147.95,260.93,percent of total billed charges,
LAB/FROZEN SECT SGL TC,35442,CDM,310,RC,88331,CPT,,,facility,outpatient,,,269.00000,255.55000,Amish/Mennonite,Amish Mennonite,TC,147.95,,,,,,,134.50,1635.52,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,inpatient,,,2546.00000,2418.70000,Amish/Mennonite,Amish Mennonite,TC,1400.30,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHOCARDIOGRAPHY 2D TRANSESOPH TC,35443,CDM,361,RC,,,,,facility,outpatient,,,2546.00000,2418.70000,Amish/Mennonite,Amish Mennonite,TC,1400.30,,,,,,,1400.30,5271.00,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,TC,900.35,,,,,,,900.35,1587.89,percent of total billed charges,
ECHOCARDIOGRAPHY FOLLOW-UP/LMT TC,35444,CDM,483,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,TC,900.35,,,,,,,818.50,1587.89,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,TC,101.20,,,,,,,101.20,178.48,percent of total billed charges,
INTERR DEV EVAL PACEMAKER SYS TC,35445,CDM,480,RC,93288,CPT,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,TC,101.20,,,,,,,92.00,178.48,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,TC,124.30,,,,,,,124.30,219.22,percent of total billed charges,
INTERR DEV EVAL TRANSV DEFIB TC,35448,CDM,480,RC,93289,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,TC,124.30,,,,,,,113.00,219.22,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,TC,61.05,,,,,,,61.05,107.67,percent of total billed charges,
INTERR DEV EVAL IMPL CARDIO MN TC,35460,CDM,480,RC,93290,CPT,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,TC,61.05,,,,,,,55.50,107.67,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
INHAL BRONCH CHAL TSTG HIS MET PULM,35467,CDM,922,RC,95070,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,81.50,554.21,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,inpatient,,,3396.00000,3226.20000,Amish/Mennonite,Amish Mennonite,TC,1867.80,,,,,,,1867.80,3294.12,percent of total billed charges,
INTRACARD ECHO DURING INTRV-TECH,35469,CDM,480,RC,93662,CPT,,,facility,outpatient,,,3396.00000,3226.20000,Amish/Mennonite,Amish Mennonite,TC,1867.80,,,,,,,1698.00,3294.12,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,TC,71.50,,,,,,,71.50,126.10,percent of total billed charges,
HOLT MON SCAN TC,35491,CDM,480,RC,93799,CPT,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,TC,71.50,,,,,,,65.00,126.10,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,TC,24.75,,,,,,,24.75,43.65,percent of total billed charges,
NEG INSPIRATORY FORCE TC,35498,CDM,460,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,TC,24.75,,,,,,,22.50,43.65,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,inpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,TC,517.00,,,,,,,517.00,911.80,percent of total billed charges,
NRV CONDCT STDY 5-6 STDYS-TECH,35503,CDM,922,RC,95909,CPT,,,facility,outpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,TC,517.00,,,,,,,470.00,911.80,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,inpatient,,,785.00000,745.75000,Amish/Mennonite,Amish Mennonite,TC,431.75,,,,,,,431.75,761.45,percent of total billed charges,
NRV COND STUDIES 3-4 STUDIES TC,35510,CDM,922,RC,95908,CPT,,,facility,outpatient,,,785.00000,745.75000,Amish/Mennonite,Amish Mennonite,TC,431.75,,,,,,,392.50,761.45,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1652.75,2914.85,percent of total billed charges,
MRV-HEAD W/O CONTRAST TC,35511,CDM,614,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1128.45,2914.85,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,inpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,TC,528.55,,,,,,,528.55,932.17,percent of total billed charges,
NRV COND STUDIES 7-8 STUDIES TC,35513,CDM,922,RC,95910,CPT,,,facility,outpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,TC,528.55,,,,,,,480.50,932.17,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,inpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,TC,261.80,,,,,,,261.80,461.72,percent of total billed charges,
NRV COND STUDIES 1-2 STUDIES TC,35514,CDM,922,RC,95907,CPT,,,facility,outpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,TC,261.80,,,,,,,238.00,461.72,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE TC,35516,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,47.50,860.53,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRV-HEAD W-W/O CONTRAST TC,35518,CDM,614,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,TC,92.40,,,,,,,92.40,162.96,percent of total billed charges,
OPHTH BIOMETRY PRT COHERENCE TC,35520,CDM,510,RC,92136,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,TC,92.40,,,,,,,84.00,162.96,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,inpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,TC,6.60,,,,,,,6.60,11.64,percent of total billed charges,
OPTOKIINETIC NYSTAGMUS TEST TC,35525,CDM,471,RC,92544,CPT,,,facility,outpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,TC,6.60,,,,,,,6.00,11.64,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,inpatient,,,1134.00000,1077.30000,Amish/Mennonite,Amish Mennonite,TC,623.70,,,,,,,623.70,1099.98,percent of total billed charges,
NRV COND STUDIES 9-10 STUDIES TC,35527,CDM,922,RC,95911,CPT,,,facility,outpatient,,,1134.00000,1077.30000,Amish/Mennonite,Amish Mennonite,TC,623.70,,,,,,,567.00,1099.98,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,inpatient,,,285.90000,271.60000,Amish/Mennonite,Amish Mennonite,TC,157.25,,,,,,,157.25,277.32,percent of total billed charges,
OUTREACH NONINV STUDY LWR EXT TC,35530,CDM,920,RC,93924,CPT,,,facility,outpatient,,,285.90000,271.60000,Amish/Mennonite,Amish Mennonite,TC,157.25,,,,,,,142.95,277.32,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,inpatient,,,152.50000,144.88000,Amish/Mennonite,Amish Mennonite,TC,83.88,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH DUP LWR EXT STUDY TC,35531,CDM,920,RC,93926,CPT,,,facility,outpatient,,,152.50000,144.88000,Amish/Mennonite,Amish Mennonite,TC,83.88,,,,,,,76.25,147.93,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,TC,313.50,,,,,,,313.50,552.90,percent of total billed charges,
OPHTHALMIC U.S. DX QUANT A-SCN TC,35532,CDM,320,RC,76511,CPT,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,TC,313.50,,,,,,,118.53,1430.78,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,inpatient,,,2216.00000,2105.20000,Amish/Mennonite,Amish Mennonite,TC,1218.80,,,,,,,1218.80,2149.52,percent of total billed charges,
NRV COND STUDIES 13/MR STUDIES TC,35535,CDM,922,RC,95913,CPT,,,facility,outpatient,,,2216.00000,2105.20000,Amish/Mennonite,Amish Mennonite,TC,1218.80,,,,,,,1108.00,2149.52,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,inpatient,,,80.70000,76.66000,Amish/Mennonite,Amish Mennonite,,44.38,,,,,,,44.38,78.28,percent of total billed charges,
ORAL/FACIAL PHOTOGRAPHS,35537,CDM,272,RC,D0350,HCPCS,,,facility,outpatient,,,80.70000,76.66000,Amish/Mennonite,Amish Mennonite,,44.38,,,,,,,40.35,91.97,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,288.20,508.28,percent of total billed charges,
OXYGEN UPTAKE EXP GAS REST IND TC,35538,CDM,460,RC,94690,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,262.00,508.28,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,TC,85.25,,,,,,,85.25,150.35,percent of total billed charges,
PERI-PROC DEV EVAL IMPL DEFIB TC,35542,CDM,480,RC,93287,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,TC,85.25,,,,,,,77.50,150.35,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,inpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,TC,76.45,,,,,,,76.45,134.83,percent of total billed charges,
PERI-PROC DEV EV-LEAD/LEADLESS-TECH,35543,CDM,480,RC,93286,CPT,,,facility,outpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,TC,76.45,,,,,,,69.50,134.83,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,,1878.80,,,,,,,1878.80,3313.52,percent of total billed charges,
PELVIS CTV,35544,CDM,350,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,,1878.80,,,,,,,169.04,3313.52,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,inpatient,,,375.50000,356.72000,Amish/Mennonite,Amish Mennonite,TC,206.53,,,,,,,206.53,364.24,percent of total billed charges,
OUTREACH ARTERIAL SCAN-TECH TC,35549,CDM,920,RC,93925,CPT,,,facility,outpatient,,,375.50000,356.72000,Amish/Mennonite,Amish Mennonite,TC,206.53,,,,,,,187.75,364.24,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY-DTRMN LUNG VOL-TECH,35550,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,230.00,446.20,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,inpatient,,,6252.00000,5939.40000,Amish/Mennonite,Amish Mennonite,TC,3438.60,,,,,,,3438.60,6064.44,percent of total billed charges,
POLYSOMNOGRAPHY SLEEP STG 1-3 TC,35553,CDM,922,RC,95808,CPT,,,facility,outpatient,,,6252.00000,5939.40000,Amish/Mennonite,Amish Mennonite,TC,3438.60,,,,,,,3126.00,6064.44,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,inpatient,,,152.50000,144.88000,Amish/Mennonite,Amish Mennonite,TC,83.88,,,,,,,83.88,147.93,percent of total billed charges,
OUTREACH EXTREMITY STUDY-TECH TC,35554,CDM,920,RC,93922,CPT,,,facility,outpatient,,,152.50000,144.88000,Amish/Mennonite,Amish Mennonite,TC,83.88,,,,,,,76.25,147.93,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,inpatient,,,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,TC,7.15,,,,,,,7.15,12.61,percent of total billed charges,
POSITIONAL NYSTAGMUS/MIN OF 4 TC,35555,CDM,471,RC,92542,CPT,,,facility,outpatient,,,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,TC,7.15,,,,,,,6.50,12.61,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,inpatient,,,1150.00000,1092.50000,Amish/Mennonite,Amish Mennonite,TC,632.50,,,,,,,632.50,1115.50,percent of total billed charges,
NRV COND STUDIES 11-12 STUDIES TC,35557,CDM,922,RC,95912,CPT,,,facility,outpatient,,,1150.00000,1092.50000,Amish/Mennonite,Amish Mennonite,TC,632.50,,,,,,,575.00,1115.50,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,inpatient,,,10794.00000,10254.30000,Amish/Mennonite,Amish Mennonite,TC,5936.70,,,,,,,5936.70,10470.18,percent of total billed charges,
POLYSOM  <6YRS 4+PA W/CPAP-TECH,35562,CDM,922,RC,95783,CPT,,,facility,outpatient,,,10794.00000,10254.30000,Amish/Mennonite,Amish Mennonite,TC,5936.70,,,,,,,5397.00,10470.18,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,inpatient,,,489.00000,464.55000,Amish/Mennonite,Amish Mennonite,TC,268.95,,,,,,,268.95,474.33,percent of total billed charges,
OXYGEN UPTAKE EXPIRED GAS ANAL TC,35565,CDM,460,RC,94681,CPT,,,facility,outpatient,,,489.00000,464.55000,Amish/Mennonite,Amish Mennonite,TC,268.95,,,,,,,244.50,474.33,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,inpatient,,,5814.00000,5523.30000,Amish/Mennonite,Amish Mennonite,TC,3197.70,,,,,,,3197.70,5639.58,percent of total billed charges,
PET IMAG FULL/PRTL-RING PET SC,35571,CDM,404,RC,G0252,HCPCS,,,facility,outpatient,,,5814.00000,5523.30000,Amish/Mennonite,Amish Mennonite,TC,3197.70,,,,,,,377.14,7206.00,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,TC,125.95,,,,,,,125.95,222.13,percent of total billed charges,
PROG DEV EVAL DUAL LEAD PACEMK TC,35603,CDM,480,RC,93280,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,TC,125.95,,,,,,,114.50,222.13,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,102.30,180.42,percent of total billed charges,
PROG DEV EVAL IMPL LOOP RECORD TC,35609,CDM,480,RC,93285,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,93.00,180.42,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,inpatient,,,312.00000,296.40000,Amish/Mennonite,Amish Mennonite,TC,171.60,,,,,,,171.60,302.64,percent of total billed charges,
PROG DEV EVAL MLT TRANSV DEFIB TC,35610,CDM,480,RC,93284,CPT,,,facility,outpatient,,,312.00000,296.40000,Amish/Mennonite,Amish Mennonite,TC,171.60,,,,,,,156.00,302.64,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,inpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,TC,110.55,,,,,,,110.55,194.97,percent of total billed charges,
PROG DEV EVAL PACER SNGL LD-TECH,35611,CDM,480,RC,93279,CPT,,,facility,outpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,TC,110.55,,,,,,,100.50,194.97,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,inpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,299.75,528.65,percent of total billed charges,
PROG DEV EVAL MULT LEAD PACEMK TC,35612,CDM,480,RC,93281,CPT,,,facility,outpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,272.50,528.65,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD DEL TRT CUST BL UP TO 5MEV TECH,35614,CDM,333,RC,G6011,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1404.95,2770.32,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,inpatient,,,1073.00000,1019.35000,Amish/Mennonite,Amish Mennonite,TC,590.15,,,,,,,590.15,1040.81,percent of total billed charges,
PULMONARY STRESS TEST COMPLEX TC,35620,CDM,460,RC,94621,CPT,,,facility,outpatient,,,1073.00000,1019.35000,Amish/Mennonite,Amish Mennonite,TC,590.15,,,,,,,536.50,1040.81,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 11-19MEV,35621,CDM,333,RC,G6013,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1399.96,2770.32,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 20MEV/GRTR,35623,CDM,333,RC,G6010,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1047.39,2099.08,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 6-10MEV,35625,CDM,333,RC,G6012,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT >20MEV,35626,CDM,333,RC,G6006,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,761.71,1516.11,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL CUST BL 20MEV/GRTR,35627,CDM,333,RC,G6014,HCPCS,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1396.31,2770.32,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 11-19MEV,35628,CDM,333,RC,G6005,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,765.41,1516.11,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,inpatient,,,284.00000,269.80000,Amish/Mennonite,Amish Mennonite,TC,156.20,,,,,,,156.20,275.48,percent of total billed charges,
PROG DEV EVAL DUAL TRANSV DEF TC,35629,CDM,480,RC,93283,CPT,,,facility,outpatient,,,284.00000,269.80000,Amish/Mennonite,Amish Mennonite,TC,156.20,,,,,,,142.00,275.48,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL SNG TRT 6-10MEV,35630,CDM,333,RC,G6004,HCPCS,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,763.56,1516.11,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,140.80,248.32,percent of total billed charges,
PROG DEV EVAL IMPL SUBCUT DEF TC,35633,CDM,480,RC,93260,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,128.00,248.32,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,132.00,232.80,percent of total billed charges,
PROG DEV EVAL SNG TRANSV DEFIB TC,35635,CDM,480,RC,93282,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,120.00,232.80,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,TC,193.60,,,,,,,193.60,341.44,percent of total billed charges,
PROLONGED EVAL BROCHOSPASM TC,35636,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,TC,193.60,,,,,,,176.00,341.44,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 6-10MEV,35639,CDM,333,RC,G6008,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1056.58,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,inpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1190.20,2099.08,percent of total billed charges,
RAD TRT DEL MULT BL 11-19MEV,35640,CDM,333,RC,G6009,HCPCS,,,facility,outpatient,,,2164.00000,2055.80000,Amish/Mennonite,Amish Mennonite,,1190.20,,,,,,,1049.24,2099.08,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST,35641,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,172.50,4020.73,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP TC,35645,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,138.00,267.72,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,TC,23.65,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST RET TC,35650,CDM,920,RC,92134,CPT,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,TC,23.65,,,,,,,21.50,41.71,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,TC,314.05,,,,,,,314.05,553.87,percent of total billed charges,
"RADIOPHARM THER,BY INTRA-ARTER-TECH",35653,CDM,342,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,TC,314.05,,,,,,,285.50,1232.72,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY UNATTENDED TC,35656,CDM,922,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,614.50,1192.13,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,TC,297.55,,,,,,,297.55,524.77,percent of total billed charges,
"RADIOPHARM THER,INTRAV ADMIN-TECH",35658,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,TC,297.55,,,,,,,270.50,1232.72,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
RENDERING-3D ANGIO-INDEPEN ST TC,35659,CDM,320,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,1767.08,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,inpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,TC,49.50,,,,,,,49.50,87.30,percent of total billed charges,
SENSORIMOTOR EXAM W/MEAS OCC D TC,35661,CDM,510,RC,92060,CPT,,,facility,outpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,TC,49.50,,,,,,,45.00,87.30,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,TC,987.25,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSEN EVOK POT UPR EXT-TECH,35662,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,TC,987.25,,,,,,,897.50,1741.15,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,Amish/Mennonite,Amish Mennonite,TC,2637.80,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP STUDY ATTENDED-TECH,35663,CDM,922,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,Amish/Mennonite,Amish Mennonite,TC,2637.80,,,,,,,2398.00,4652.12,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,TC,23.10,,,,,,,23.10,40.74,percent of total billed charges,
SCANNING CMP OPH DX IM ANT SEG TC,35665,CDM,510,RC,92132,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,TC,23.10,,,,,,,21.00,40.74,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,TC,987.25,,,,,,,987.25,1741.15,percent of total billed charges,
SOMATOSENS EVOKED POTEN-UPR LM TC,35666,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,TC,987.25,,,,,,,897.50,1741.15,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH COMPONENT TC,35667,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,157.00,304.58,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
RENDERING-3D ANGIO-SAME STATN TC,35669,CDM,320,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,68.74,718.77,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,inpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,TC,8.25,,,,,,,8.25,14.55,percent of total billed charges,
SPONTANEOUS NYSTAGMUS TEST TC,35670,CDM,471,RC,92541,CPT,,,facility,outpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,TC,8.25,,,,,,,7.50,14.55,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,TC,23.65,,,,,,,23.65,41.71,percent of total billed charges,
SCANNING CMP OPH DX IM PST OP TC,35672,CDM,761,RC,92133,CPT,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,TC,23.65,,,,,,,21.50,41.71,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,TC,1095.60,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD TC,35674,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,TC,1095.60,,,,,,,996.00,1932.24,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,TC,15.40,,,,,,,15.40,27.16,percent of total billed charges,
OH SPIRO-PFT - TECH-CLINIC,35675,CDM,460,RC,99199,CPT,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,TC,15.40,,,,,,,14.00,27.16,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,TC,1862.30,,,,,,,1862.30,3284.42,percent of total billed charges,
SOMATOSENS EVOKED POTEN UPR/LW TC,35680,CDM,922,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,TC,1862.30,,,,,,,1693.00,3284.42,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,,1095.60,,,,,,,1095.60,1932.24,percent of total billed charges,
TRANSCRANIAL DOPPLER STUDY LTD US,35681,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,,1095.60,,,,,,,100.97,1932.24,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,TC,142.45,,,,,,,142.45,251.23,percent of total billed charges,
U.S.GUID PLC RAD THER FIELDS TC,35682,CDM,333,RC,G6001,HCPCS,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,TC,142.45,,,,,,,129.50,1145.46,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,122.10,215.34,percent of total billed charges,
TEE-OUTREACH-TECH TC,35683,CDM,480,RC,93799,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,111.00,215.34,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,Amish/Mennonite,Amish Mennonite,TC,872.30,,,,,,,872.30,1538.42,percent of total billed charges,
SOMATOSEN EVOK POT LWR EXT-TECH,35686,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,Amish/Mennonite,Amish Mennonite,TC,872.30,,,,,,,793.00,1538.42,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,820.60,1447.24,percent of total billed charges,
VISUAL EVOKED POTENTIAL-TECH,35689,CDM,922,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,746.00,1447.24,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,inpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,TC,511.50,,,,,,,511.50,902.10,percent of total billed charges,
TILT TABLE TESTING-EEG TC,35690,CDM,480,RC,93660,CPT,,,facility,outpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,TC,511.50,,,,,,,465.00,902.10,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,TC,68.20,,,,,,,68.20,120.28,percent of total billed charges,
VISUAL FIELD EXAM EXTENDED TC,35691,CDM,920,RC,92083,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,TC,68.20,,,,,,,62.00,120.28,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,TC,195.80,,,,,,,195.80,345.32,percent of total billed charges,
XRAY/C-SPINE AP/LAT/FLEX/EXT TC,35696,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,TC,195.80,,,,,,,178.00,2024.21,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,TC,48.95,,,,,,,48.95,86.33,percent of total billed charges,
VISUAL FIELD EXAM INTERMEDIATE TC,35697,CDM,920,RC,92082,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,TC,48.95,,,,,,,44.50,86.33,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,inpatient,,,617.00000,586.15000,Amish/Mennonite,Amish Mennonite,TC,339.35,,,,,,,339.35,598.49,percent of total billed charges,
STEREOSC GUID LOC DEL RAD THER TC,35705,CDM,333,RC,G6002,HCPCS,,,facility,outpatient,,,617.00000,586.15000,Amish/Mennonite,Amish Mennonite,TC,339.35,,,,,,,297.28,598.49,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,675.95,1192.13,percent of total billed charges,
UROGRAPHY IV,35707,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,606.90,5742.65,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,TC,32.45,,,,,,,32.45,57.23,percent of total billed charges,
VISUAL FIELDS LIMITED TECH TC,35708,CDM,510,RC,92081,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,TC,32.45,,,,,,,29.50,57.23,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,inpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,TC,235.40,,,,,,,235.40,415.16,percent of total billed charges,
77065 TC TECH DIAG MAMMOGR CAD UNIL-MOBILE,35768,CDM,401,RC,77065,CPT,,,facility,outpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,TC,235.40,,,,,,,214.00,467.89,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,inpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,300.85,530.59,percent of total billed charges,
77066 TC DIAG MAMMOGR CAD BIL-MOBILE,35806,CDM,401,RC,77066,CPT,,,facility,outpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,257.00,595.98,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,inpatient,,,465.00000,441.75000,Amish/Mennonite,Amish Mennonite,TC,255.75,,,,,,,255.75,451.05,percent of total billed charges,
92242 TC TECH FLUORESC/INDOCYN-GRN ANGIOGR,35939,CDM,320,RC,92242,CPT,,,facility,outpatient,,,465.00000,441.75000,Amish/Mennonite,Amish Mennonite,TC,255.75,,,,,,,232.50,2134.86,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,inpatient,,,1556.00000,1478.20000,Amish/Mennonite,Amish Mennonite,,855.80,,,,,,,762.44,1509.32,percent of total billed charges,
CORNEA PATCH GRAFT #C0301AL,36064,CDM,278,RC,V2785,HCPCS,,,facility,outpatient,,,1556.00000,1478.20000,Amish/Mennonite,Amish Mennonite,,855.80,,,,,,,714.20,1556.00,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,inpatient,,,12133.00000,11526.35000,Amish/Mennonite,Amish Mennonite,,6673.15,,,,,,,6673.15,11769.01,percent of total billed charges,
DSEK CORNEAL TRANSPLANT,36066,CDM,810,RC,V2785,HCPCS,,,facility,outpatient,,,12133.00000,11526.35000,Amish/Mennonite,Amish Mennonite,,6673.15,,,,,,,6066.50,11769.01,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE,36067,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,9.09,29.10,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION CALCANEUS MINIMUM OF 2 VIEWS,3624,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,144.65,255.11,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,3627,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,129.58,1272.59,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,TC,149.60,,,,,,,149.60,263.84,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW COMPLETE MINIMUM OF 3 VIEWS,3628,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,TC,149.60,,,,,,,125.88,1213.27,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
76775 US RETROPERIT LTD SICU TC,36299,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,584.87,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,73.15,129.01,percent of total billed charges,
76857 US PELVIC LTD SICU TC,36305,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,66.50,584.87,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,Amish/Mennonite,Amish Mennonite,TC,635.25,,,,,,,635.25,1120.35,percent of total billed charges,
93971 DUPLEX EXTR VEINS LTD SICU TC,36314,CDM,921,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,Amish/Mennonite,Amish Mennonite,TC,635.25,,,,,,,577.50,1120.35,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,inpatient,,,4144.00000,3936.80000,Amish/Mennonite,Amish Mennonite,,2279.20,,,,,,,2279.20,4019.68,percent of total billed charges,
SOMATOSEN EVOK POT UPR/LWR EXT-TECH,36316,CDM,922,RC,64999,CPT,,,facility,outpatient,,,4144.00000,3936.80000,Amish/Mennonite,Amish Mennonite,,2279.20,,,,,,,280.29,4019.68,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
US PERICARDIOCENTESIS-TECH,36321,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,548.00,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,655.05,1155.27,percent of total billed charges,
76937 US GUID VASC ACCESS SICU TC,36322,CDM,402,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,384.16,1155.27,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,163.90,289.06,percent of total billed charges,
XRAY/FINGER 2 VW-ASC ONLY TC,3634,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,149.00,1569.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,TC,114.95,,,,,,,114.95,202.73,percent of total billed charges,
RADIOLOGIC EXAMINATION FOREARM 2 VIEWS,3635,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,TC,114.95,,,,,,,104.50,1114.32,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,TC,118.80,,,,,,,118.80,209.52,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND 2 VIEWS,3636,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,TC,118.80,,,,,,,108.00,1193.49,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,TC,145.75,,,,,,,145.75,257.05,percent of total billed charges,
RADIOLOGIC EXAMINATION HAND MINIMUM OF 3 VIEWS,3637,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,TC,145.75,,,,,,,132.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,151.80,267.72,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 1 OR 2 VIEWS,3638,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,138.00,1371.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE TC-ANES,36393,CDM,401,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,154.77,308.46,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,Amish/Mennonite,Amish Mennonite,TC,2646.05,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUID VISC TISS ABLAT,36395,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,Amish/Mennonite,Amish Mennonite,TC,2646.05,,,,,,,1285.85,4666.67,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION SINUSES PARANASAL LESS THAN 3 VIEWS,3640,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,125.88,1213.27,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,122.10,215.34,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT 2 VIEWS,3641,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,111.00,1094.55,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,inpatient,1,EA,10866.46000,10323.14000,Amish/Mennonite,Amish Mennonite,,5976.55,,,,,,,5976.55,10540.47,percent of total billed charges,
CERTOLIZUMAB INJECTION 200 MG/ML (CIMZIA),36422,CDM,636,RC,J0717,HCPCS,50474071079,NDC,facility,outpatient,1,EA,10866.46000,10323.14000,Amish/Mennonite,Amish Mennonite,,5976.55,,,,,,,4.49,10540.47,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,inpatient,1,mL,1294.48000,1229.75000,Amish/Mennonite,Amish Mennonite,,711.96,,,,,,,711.96,1255.65,percent of total billed charges,
GOLIMUMAB SOLN 12.5 MG/ML 4 ML (SIMPONI ARIA),36423,CDM,636,RC,J1602,HCPCS,57894035001,NDC,facility,outpatient,1,mL,1294.48000,1229.75000,Amish/Mennonite,Amish Mennonite,,711.96,,,,,,,11.03,1255.65,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,inpatient,1,mL,781.97000,742.88000,Amish/Mennonite,Amish Mennonite,,430.08,,,,,,,430.08,758.51,percent of total billed charges,
"DALTEPARIN 18,000 INTL UNITS/0.72 ML SYRINGE",36427,CDM,250,RC,J1645,HCPCS,00069022802,NDC,facility,outpatient,1,mL,781.97000,742.88000,Amish/Mennonite,Amish Mennonite,,430.08,,,,,,,24.87,758.51,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
RADIOLOGIC EXAMINATION FOOT COMPLETE MINIMUM OF 3 VIEWS,3643,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,126.50,1331.91,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,42.40000,40.28000,Amish/Mennonite,Amish Mennonite,,23.32,,,,,,,20.78,41.13,percent of total billed charges,
RPL HIP STRAP/NEWPT L4002,36430,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,42.40000,40.28000,Amish/Mennonite,Amish Mennonite,,23.32,,,,,,,21.20,41.13,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,Amish/Mennonite,Amish Mennonite,TC,526.90,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INFUS SONOHYSTEROGRAPHY-TECH,36439,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,Amish/Mennonite,Amish Mennonite,TC,526.90,,,,,,,384.16,1329.46,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,TC,177.10,,,,,,,177.10,312.34,percent of total billed charges,
RADIOLOGIC EXAMINATION KNEE 3 VIEWS,3644,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,TC,177.10,,,,,,,161.00,1628.59,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,inpatient,1,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,7.39,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,00052-0106-30,NDC,,,facility,outpatient,1,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,6.71,13.03,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,57237-0011-06,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.41,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
MIRTAZAPINE TAB,36441,CDM,250,RC,65862-0021-06,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-0744-04,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,inpatient,120,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1488-00,NDC,,,facility,outpatient,120,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,inpatient,120,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00121-1744-10,NDC,,,facility,outpatient,120,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00603-0857-94,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,inpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,00904-0061-00,NDC,,,facility,outpatient,120,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,49348-0135-34,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,inpatient,120,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,50383-0063-11,NDC,,,facility,outpatient,120,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,inpatient,120,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
GUAIFENESIN LIQUID,36444,CDM,250,RC,81033-0102-52,NDC,,,facility,outpatient,120,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,inpatient,1,mL,17.06000,16.21000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,9.38,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409128305,NDC,facility,outpatient,1,mL,17.06000,16.21000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,0.14409,16.55,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,inpatient,1,mL,20.10000,19.09000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,11.05,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,00409426401,NDC,facility,outpatient,1,mL,20.10000,19.09000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,0.14409,19.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,inpatient,1,mL,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,12.51,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000905,NDC,facility,outpatient,1,mL,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,0.14409,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,inpatient,1,mL,26.23000,24.92000,Amish/Mennonite,Amish Mennonite,,14.43,,,,,,,14.43,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,76045000906,NDC,facility,outpatient,1,mL,26.23000,24.92000,Amish/Mennonite,Amish Mennonite,,14.43,,,,,,,0.14409,25.44,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,inpatient,1,mL,14.49000,13.77000,Amish/Mennonite,Amish Mennonite,,7.97,,,,,,,7.97,14.06,percent of total billed charges,
HYDROMORPHONE SOLN 0.5 MG/0.5ML,36445,CDM,250,RC,J1171,HCPCS,79045000905,NDC,facility,outpatient,1,mL,14.49000,13.77000,Amish/Mennonite,Amish Mennonite,,7.97,,,,,,,0.14409,14.06,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,00172-2083-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,43547-0397-10,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,29300-0128-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216799,36446,CDM,250,RC,60687-0593-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,00093-2210-98,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,29033-0003-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0753-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,51079-0871-20,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,59762-0401-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,60687-0695-01,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0261-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
SUCRALFATE TAB,36447,CDM,250,RC,63739-0943-10,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,00904-5988-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,16714-0101-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,50268-0350-15,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-00,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60505-0034-02,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,inpatient,1,EA,0.83000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,60687-0224-01,NDC,,,facility,outpatient,1,EA,0.83000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
GEMFIBROZIL TAB,36451,CDM,250,RC,68084-0473-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,137.50,242.50,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST 2 VIEWS,3647,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,125.00,1331.91,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,151.25,266.75,percent of total billed charges,
RADIOLOGIC EXAMINATION ANKLE COMPLETE MINIMUM OF 3 VIEWS-TECH,3648,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,137.50,1430.78,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,119.35,210.49,percent of total billed charges,
RADIOLOGIC EXAMINATION NECK SOFT TISSUE,3650,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,108.50,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,145.20,256.08,percent of total billed charges,
RADIOLOGIC EXAMINATION TOE(S) MINIMUM OF 2 VIEWS,3654,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,120.38,1173.72,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,177.65,313.31,percent of total billed charges,
RADIOLOGIC EXAMINATION WRIST COMPLETE MINIMUM OF 3 VIEWS,3660,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,161.50,1648.36,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
RADIOLOGIC EXAMINATION ELBOW 2 VIEWS,3671,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,111.13,1094.55,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,TC,135.85,,,,,,,135.85,239.59,percent of total billed charges,
RADIOLOGIC EXAMINATION TIBIA AND FIBULA 2 VIEWS,3676,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,TC,135.85,,,,,,,123.50,1233.04,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,TC,460.35,,,,,,,460.35,811.89,percent of total billed charges,
TECH NEEDLE ELECTROMYOGRAPHY LMTD,3915,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,TC,460.35,,,,,,,418.50,811.89,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,73.15,129.01,percent of total billed charges,
"U.S.EXTREMITY,NONVASC,R-T;LMTD-TECH",3950,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,66.50,584.87,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,Amish/Mennonite,Amish Mennonite,TC,768.90,,,,,,,768.90,1356.06,percent of total billed charges,
U.S. TRANSPLANTED KIDNEY-TECH,3965,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,Amish/Mennonite,Amish Mennonite,TC,768.90,,,,,,,384.16,1356.06,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,Amish/Mennonite,Amish Mennonite,TC,322.30,,,,,,,322.30,568.42,percent of total billed charges,
US MONITOR DELIVERY-TECH,3966,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,Amish/Mennonite,Amish Mennonite,TC,322.30,,,,,,,247.28,568.42,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,Amish/Mennonite,Amish Mennonite,TC,567.05,,,,,,,567.05,1000.07,percent of total billed charges,
ULTRASOUND TRANSVAGINAL,3968,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,Amish/Mennonite,Amish Mennonite,TC,567.05,,,,,,,384.16,1000.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,Amish/Mennonite,Amish Mennonite,TC,457.05,,,,,,,457.05,806.07,percent of total billed charges,
"U.S.BREAST,UNILATERAL;COMPLETE-TECH",3984,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,Amish/Mennonite,Amish Mennonite,TC,457.05,,,,,,,384.16,806.07,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/ACROMIOCLAVICULAR JTS-TEC,3987,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,101.94,1193.49,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,163.90,289.06,percent of total billed charges,
VERTEB ASSESSMENT DUAL-ENER,3988,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,135.13,1430.78,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,Amish/Mennonite,Amish Mennonite,TC,996.05,,,,,,,996.05,1756.67,percent of total billed charges,
XRAY/COLON-AIR CONTRAST,3999,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,Amish/Mennonite,Amish Mennonite,TC,996.05,,,,,,,905.50,8808.48,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,TC,281.60,,,,,,,281.60,496.64,percent of total billed charges,
XRAY/DEXA BONE DENSITY STUDY-CATTAILS,4010,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,TC,281.60,,,,,,,151.73,1628.59,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,189.20,333.68,percent of total billed charges,
XRAY/FACIAL BONES-4 VIEWS-TECH,4015,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,172.00,1786.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,TC,167.75,,,,,,,167.75,295.85,percent of total billed charges,
XRAY/MANDIBLE COMPLETE TECH,4025,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,TC,167.75,,,,,,,152.50,1628.59,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,102.30,180.42,percent of total billed charges,
XRAY/NOSE TO RECTUM FOR FB CHL,4027,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,93.00,1074.77,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/ORBITS,AT LEAST 3 VIEW-TECH",4029,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,170.00,1786.85,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,158.40,279.36,percent of total billed charges,
XRAY/RIBS BILATERAL-TECH,4034,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,144.00,1549.49,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,140.80,248.32,percent of total billed charges,
XRAY/SCAPULA COMPLETE-TECH,4037,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,77.99,1015.45,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,TC,443.85,,,,,,,443.85,782.79,percent of total billed charges,
XRAY/SHOULDER ARTHROGRAPHY,4038,CDM,320,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,TC,443.85,,,,,,,403.50,5149.29,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,TC,158.95,,,,,,,158.95,280.33,percent of total billed charges,
XRAY/NASAL BONES-TECH,4039,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,TC,158.95,,,,,,,144.50,1509.95,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,187.00,329.80,percent of total billed charges,
"XRAY/SKULL,COMPLETE,MIN 4 VWS",4040,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,166.47,1628.59,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,TC,96.25,,,,,,,96.25,169.75,percent of total billed charges,
XRAY/SPINE SINGLE VIEW-TECH,4043,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,TC,96.25,,,,,,,87.50,876.96,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,TC,132.55,,,,,,,132.55,233.77,percent of total billed charges,
XRAY/LOWER EXT INFANT-2 VWS,4044,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,TC,132.55,,,,,,,120.50,1213.27,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,166.10,292.94,percent of total billed charges,
XRAY/MASTOIDS-LESS THAN 3 VWS,4046,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,151.00,1509.95,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,409.20,721.68,percent of total billed charges,
XRAY/SPINE THOR/LMB MIN 6 VWS,4048,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,372.00,4002.11,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,TC,167.20,,,,,,,167.20,294.88,percent of total billed charges,
XRAY/STERNOCLAV JTS 3 VWS-TECH,4051,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,TC,167.20,,,,,,,152.00,1569.27,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,181.50,320.10,percent of total billed charges,
"XRAY/KNEE-BOTH,AP-STANDNG-TECH",4057,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,165.00,1648.36,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,TC,338.25,,,,,,,338.25,596.55,percent of total billed charges,
XRAY/SPINE THOR/LMB 4 OR 5 VWS,4059,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,TC,338.25,,,,,,,307.50,3329.66,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XRAY/UPR EXT INFANT MINIM 2VWS,4060,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,115.50,1213.27,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,TC,51.15,,,,,,,51.15,90.21,percent of total billed charges,
XRAY/SURGICAL SPECIMEN,4061,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,TC,51.15,,,,,,,46.50,3015.65,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,TC,319.00,,,,,,,319.00,562.60,percent of total billed charges,
XRAY/UROGRAPHY ANTEGRADE,4062,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,TC,319.00,,,,,,,290.00,5821.82,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,134.75,237.65,percent of total billed charges,
XRAY/SKULL LAT SELLA TURC-TECH,4063,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,122.50,1292.36,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,Amish/Mennonite,Amish Mennonite,TC,642.40,,,,,,,642.40,1132.96,percent of total billed charges,
XRAY/UROGRAPHY RETROGRADE,4066,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,Amish/Mennonite,Amish Mennonite,TC,642.40,,,,,,,278.89,2676.90,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,TC,129.25,,,,,,,129.25,227.95,percent of total billed charges,
XRAY/STERNUM-TECH,4068,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,TC,129.25,,,,,,,117.50,1233.04,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,inpatient,,,1544.00000,1466.80000,Amish/Mennonite,Amish Mennonite,,849.20,,,,,,,849.20,1497.68,percent of total billed charges,
ADRENAL IMAGING-MIBG-TECH,42261,CDM,341,RC,78075,CPT,,,facility,outpatient,,,1544.00000,1466.80000,Amish/Mennonite,Amish Mennonite,,849.20,,,,,,,772.00,7180.14,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,inpatient,1,mL,8.71000,8.28000,Amish/Mennonite,Amish Mennonite,,4.79,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 4 ML,42350,CDM,250,RC,J0278,HCPCS,23155078641,NDC,facility,outpatient,1,mL,8.71000,8.28000,Amish/Mennonite,Amish Mennonite,,4.79,,,,,,,0.93155,8.45,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,,1582.90,,,,,,,1582.90,2791.66,percent of total billed charges,
APP INTERCAV RAD SOURCE SMPL-TECH,42379,CDM,333,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,,1582.90,,,,,,,549.28,22788.40,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,Amish/Mennonite,Amish Mennonite,,2849.00,,,,,,,2849.00,5024.60,percent of total billed charges,
APP INTERCAV RAD SOURCE INTERMED-TECH,42395,CDM,333,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,Amish/Mennonite,Amish Mennonite,,2849.00,,,,,,,549.28,30205.49,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,,398.75,,,,,,,398.75,703.25,percent of total billed charges,
ANGIO THRU EXISTING CATH F/U-TECH,42406,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,,398.75,,,,,,,237.91,17311.25,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,,2558.05,,,,,,,2558.05,4511.47,percent of total billed charges,
APP SURF LOW DOSE RATE RADION-TECH,42413,CDM,333,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,,2558.05,,,,,,,103.97,7209.59,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM INFRAPOPLITEAL VSL,42888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,Amish/Mennonite,Amish Mennonite,,1197.90,,,,,,,1197.90,2112.66,percent of total billed charges,
BRAIN IMG <4 VWS W VASC FLOW-TECH,43015,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,Amish/Mennonite,Amish Mennonite,,1197.90,,,,,,,381.55,2210.07,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,Amish/Mennonite,Amish Mennonite,,1103.85,,,,,,,1103.85,1946.79,percent of total billed charges,
BRAIN IMAGING MIN 4 STATIC VWS-TECH,43020,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,Amish/Mennonite,Amish Mennonite,,1103.85,,,,,,,511.11,2960.49,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,Amish/Mennonite,Amish Mennonite,,2842.95,,,,,,,2842.95,5013.93,percent of total billed charges,
BX TRANSCATHETER-TECH,43143,CDM,761,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,Amish/Mennonite,Amish Mennonite,,2842.95,,,,,,,2584.50,5013.93,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,Amish/Mennonite,Amish Mennonite,,674.44,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 8MM 190CM FSN TTN 4CM BIL.,43275,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,Amish/Mennonite,Amish Mennonite,,674.44,,,,,,,562.85,1226.25,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,427.50000,406.12000,Amish/Mennonite,Amish Mennonite,,235.12,,,,,,,209.47,414.68,percent of total billed charges,
CATHETER CVC 0.7ML 6.6FR L90CM SIL SL ATRAUM,43391,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,427.50000,406.12000,Amish/Mennonite,Amish Mennonite,,235.12,,,,,,,196.22,427.50,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM THRMB 60ML/MIN LNG TPR 5FR 3MM 135CM COR,43860,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3087.92,6727.50,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION 36430,4418,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,182.00,456.63,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,Amish/Mennonite,Amish Mennonite,,1918.40,,,,,,,1918.40,3383.36,percent of total billed charges,
CISTERNOGRAM-TECH,44243,CDM,341,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,Amish/Mennonite,Amish Mennonite,,1918.40,,,,,,,511.11,3383.36,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,Amish/Mennonite,Amish Mennonite,,1910.70,,,,,,,1910.70,3369.78,percent of total billed charges,
CSF LEAKAGE DETECT/LOCALIZATION-TECH,44528,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,Amish/Mennonite,Amish Mennonite,,1910.70,,,,,,,1239.61,7180.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,inpatient,,,3562.00000,3383.90000,Amish/Mennonite,Amish Mennonite,,1959.10,,,,,,,1959.10,3455.14,percent of total billed charges,
DISCOGRAPHY CERV/THORACIC-TECH,44829,CDM,320,RC,72285,CPT,,,facility,outpatient,,,3562.00000,3383.90000,Amish/Mennonite,Amish Mennonite,,1959.10,,,,,,,371.02,10740.24,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL SOLN 10 MG/ML 8 ML,44849,CDM,250,RC,J9171,HCPCS,67457053208,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,0.60838,61.30,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,Amish/Mennonite,Amish Mennonite,,1827.65,,,,,,,1827.65,3223.31,percent of total billed charges,
DISCOGRAPHY LUMBAR-TECH,44896,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,Amish/Mennonite,Amish Mennonite,,1827.65,,,,,,,383.91,10740.24,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,Amish/Mennonite,Amish Mennonite,,1733.05,,,,,,,1733.05,3056.47,percent of total billed charges,
EVASC RPR DESC THOR AORTA SUBCLAV-TECH,45222,CDM,360,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,Amish/Mennonite,Amish Mennonite,,1733.05,,,,,,,1733.05,5271.00,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,inpatient,,,2262.00000,2148.90000,Amish/Mennonite,Amish Mennonite,,1244.10,,,,,,,1244.10,2194.14,percent of total billed charges,
EVASC RPR DESC THOR AORTA CELIAC-TECH,45244,CDM,320,RC,75957,CPT,,,facility,outpatient,,,2262.00000,2148.90000,Amish/Mennonite,Amish Mennonite,,1244.10,,,,,,,1131.00,15808.09,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR FEM DEL ADV TECH DENALI,45564,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2137.79,4657.50,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,Amish/Mennonite,Amish Mennonite,,1564.63,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA18MM BRANCH DIA9MM UNIV CLLGN DBL VEL,45933,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,Amish/Mennonite,Amish Mennonite,,1564.63,,,,,,,1305.76,2844.79,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,Amish/Mennonite,Amish Mennonite,,8487.94,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PERIPH W/ SM CUF DISTAFLO,45990,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,Amish/Mennonite,Amish Mennonite,,8487.94,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,46106,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,Amish/Mennonite,Amish Mennonite,,5489.47,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA7MM RNG L60CM EPTFE TW CBAS HEP SURF REM,46115,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,Amish/Mennonite,Amish Mennonite,,5489.47,,,,,,,4581.21,9980.85,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4205.10000,3994.85000,Amish/Mennonite,Amish Mennonite,,2312.80,,,,,,,2060.50,4078.95,percent of total billed charges,
GRAFT VASC W6MMXL40CM PTFE GRAD WALL W/ SLDE GDS FLIXENE,46124,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4205.10000,3994.85000,Amish/Mennonite,Amish Mennonite,,2312.80,,,,,,,1930.14,4205.10,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC STRG FLT .014IN 185CM VERRATA,46328,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,inpatient,1,mL,78.92000,74.98000,Amish/Mennonite,Amish Mennonite,,43.41,,,,,,,43.41,76.55,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 4 GM,46713,CDM,636,RC,J1559,HCPCS,44206045824,NDC,facility,outpatient,1,mL,78.92000,74.98000,Amish/Mennonite,Amish Mennonite,,43.41,,,,,,,14.12,76.55,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY COMPLEX-TECH,46857,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,549.28,20208.37,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY SIMPLE-TECH,46896,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,549.28,20181.52,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,,9127.25,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS-TECH,46916,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,,9127.25,,,,,,,1299.22,106944.98,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,2049.30,3614.22,percent of total billed charges,
INTENS MOD TRT DEL PER TRT SES-TECH,47187,CDM,333,RC,G6015,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,1863.00,3614.22,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,inpatient,,,497.00000,472.15000,Amish/Mennonite,Amish Mennonite,,273.35,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL XR SNGL SESS-TECH,47284,CDM,333,RC,77424,CPT,,,facility,outpatient,,,497.00000,472.15000,Amish/Mennonite,Amish Mennonite,,273.35,,,,,,,248.50,7984.62,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,inpatient,,,497.00000,472.15000,Amish/Mennonite,Amish Mennonite,,273.35,,,,,,,273.35,482.09,percent of total billed charges,
IO RADTX DEL ELECTRON SNGL SESS-TECH,47366,CDM,333,RC,77425,CPT,,,facility,outpatient,,,497.00000,472.15000,Amish/Mennonite,Amish Mennonite,,273.35,,,,,,,248.50,7984.62,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,,677.60,,,,,,,677.60,1195.04,percent of total billed charges,
LABELED RED CELL SEQUESTRATION-TECH,47484,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,,677.60,,,,,,,381.55,2210.07,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,inpatient,,,2100.00000,1995.00000,Amish/Mennonite,Amish Mennonite,TC,1155.00,,,,,,,1155.00,2037.00,percent of total billed charges,
51727 COMPLEX CYSTOMETROG URETH TC,4753,CDM,320,RC,51727,CPT,,,facility,outpatient,,,2100.00000,1995.00000,Amish/Mennonite,Amish Mennonite,TC,1155.00,,,,,,,1050.00,2037.00,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,inpatient,,,2184.00000,2074.80000,Amish/Mennonite,Amish Mennonite,TC,1201.20,,,,,,,1201.20,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROG VOIDING/UR 51729 TC,4756,CDM,320,RC,51729,CPT,,,facility,outpatient,,,2184.00000,2074.80000,Amish/Mennonite,Amish Mennonite,TC,1201.20,,,,,,,1092.00,2118.48,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,inpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,1004.85,1772.19,percent of total billed charges,
COMPLEX CYSTOMETROGRAM 51726 TC,4757,CDM,320,RC,51726,CPT,,,facility,outpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,913.50,1772.19,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,TC,41.80,,,,,,,41.80,73.72,percent of total billed charges,
COMPLEX UROFLOWMETRY 51741 TC,4763,CDM,320,RC,51741,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,TC,41.80,,,,,,,38.00,73.72,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,inpatient,,,2153.00000,2045.35000,Amish/Mennonite,Amish Mennonite,TC,1184.15,,,,,,,1184.15,2088.41,percent of total billed charges,
51728 COMPLEX CYSTOMETROG VOIDING TC,4781,CDM,320,RC,51728,CPT,,,facility,outpatient,,,2153.00000,2045.35000,Amish/Mennonite,Amish Mennonite,TC,1184.15,,,,,,,1076.50,2088.41,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,,1064.80,,,,,,,1064.80,1877.92,percent of total billed charges,
LIVER IMAGING STATIC-TECH,47978,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,,1064.80,,,,,,,511.11,2960.49,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,inpatient,,,4471.00000,4247.45000,Amish/Mennonite,Amish Mennonite,,2459.05,,,,,,,2459.05,4336.87,percent of total billed charges,
LYMPHANGIOGRAPHY PELV/ABD BIL-TECH,48027,CDM,320,RC,75807,CPT,,,facility,outpatient,,,4471.00000,4247.45000,Amish/Mennonite,Amish Mennonite,,2459.05,,,,,,,1923.03,17311.25,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,Amish/Mennonite,Amish Mennonite,,1387.65,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAPHY EXT ONLY BIL-TECH,48041,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,Amish/Mennonite,Amish Mennonite,,1387.65,,,,,,,1226.87,14613.37,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,inpatient,,,1046.00000,993.70000,Amish/Mennonite,Amish Mennonite,,575.30,,,,,,,575.30,1014.62,percent of total billed charges,
MECH RMVL INTRACATH OBST MAT-CVD-TECH,48118,CDM,320,RC,75902,CPT,,,facility,outpatient,,,1046.00000,993.70000,Amish/Mennonite,Amish Mennonite,,575.30,,,,,,,359.37,4736.20,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,,916.30,,,,,,,916.30,1616.02,percent of total billed charges,
MECH RMVL PERICATH OBST MAT-CVD-TECH,48144,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,,916.30,,,,,,,833.00,12150.98,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,inpatient,,,1702.00000,1616.90000,Amish/Mennonite,Amish Mennonite,,936.10,,,,,,,936.10,1650.94,percent of total billed charges,
NM UNLISTED GASTROINTESTINAL-TECH,48525,CDM,341,RC,78299,CPT,,,facility,outpatient,,,1702.00000,1616.90000,Amish/Mennonite,Amish Mennonite,,936.10,,,,,,,381.55,2210.07,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,inpatient,,,1129.00000,1072.55000,Amish/Mennonite,Amish Mennonite,TC,620.95,,,,,,,620.95,1095.13,percent of total billed charges,
CYSTOMETROGRAM 51725 TC,4889,CDM,320,RC,51725,CPT,,,facility,outpatient,,,1129.00000,1072.55000,Amish/Mennonite,Amish Mennonite,TC,620.95,,,,,,,564.50,1095.13,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
PERQ TRANSHEP PORTOGR W HEMODYN-TECH,49202,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,417.10,17311.25,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,inpatient,,,9110.00000,8654.50000,Amish/Mennonite,Amish Mennonite,,5010.50,,,,,,,5010.50,8836.70,percent of total billed charges,
PET/CT RAD ONC PLAN-TECH,49204,CDM,404,RC,78999,CPT,,,facility,outpatient,,,9110.00000,8654.50000,Amish/Mennonite,Amish Mennonite,,5010.50,,,,,,,381.55,8836.70,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,,647.35,,,,,,,647.35,1141.69,percent of total billed charges,
PERQ PLC ENTEROCLYSIS TUBE-TECH,49300,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,,647.35,,,,,,,519.48,7810.26,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,Amish/Mennonite,Amish Mennonite,,1243.55,,,,,,,1243.55,2193.17,percent of total billed charges,
PLC DSTL EXT PROSTH RPR AORTA-TECH,49573,CDM,360,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,Amish/Mennonite,Amish Mennonite,,1243.55,,,,,,,1243.55,5271.00,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,,1394.80,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX PROSTH EVASC DESC THOR AORTA-TECH,49626,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,,1394.80,,,,,,,990.94,10533.78,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,inpatient,,,45977.00000,43678.15000,Amish/Mennonite,Amish Mennonite,,25287.35,,,,,,,25287.35,44597.69,percent of total billed charges,
RAD DEL STEREOTACTIC CRANL LINEAR-TECH,50112,CDM,333,RC,77372,CPT,,,facility,outpatient,,,45977.00000,43678.15000,Amish/Mennonite,Amish Mennonite,,25287.35,,,,,,,5651.91,58409.77,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,inpatient,,,962.00000,913.90000,Amish/Mennonite,Amish Mennonite,,529.10,,,,,,,529.10,933.14,percent of total billed charges,
RADTX DELIVERY >1 MEV INTERMED-TECH,50171,CDM,333,RC,77407,CPT,,,facility,outpatient,,,962.00000,913.90000,Amish/Mennonite,Amish Mennonite,,529.10,,,,,,,249.71,10786.37,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RADTX DELIVERY >1 MEV SIMPLE-TECH,50178,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,103.97,7859.04,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RADTX DELIVERY >1 MEV COMPLEX-TECH,50231,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,249.71,14445.56,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,inpatient,,,3724.00000,3537.80000,Amish/Mennonite,Amish Mennonite,,2048.20,,,,,,,2048.20,3612.28,percent of total billed charges,
REMOVAL SAVI CATHETER-TECH,50247,CDM,333,RC,77799,CPT,,,facility,outpatient,,,3724.00000,3537.80000,Amish/Mennonite,Amish Mennonite,,2048.20,,,,,,,103.97,3612.28,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,297.55,524.77,percent of total billed charges,
RONC UNLIST PROC IMAGE FUSION-TECH,50443,CDM,333,RC,77399,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,126.07,524.77,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,Amish/Mennonite,Amish Mennonite,,663.30,,,,,,,663.30,1169.82,percent of total billed charges,
SALIVARY GLAND IM W SERIAL IMG-TECH,50579,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,Amish/Mennonite,Amish Mennonite,,663.30,,,,,,,381.55,2210.07,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,187.50000,178.12000,Amish/Mennonite,Amish Mennonite,,103.12,,,,,,,91.88,181.88,percent of total billed charges,
SET SCR SPNL DIA6MM STD VRTX,51281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,187.50000,178.12000,Amish/Mennonite,Amish Mennonite,,103.12,,,,,,,86.06,187.50,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,Amish/Mennonite,Amish Mennonite,,274.21,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL DIA4.75MM TI BRK OFF CDH SOLERA,51341,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,Amish/Mennonite,Amish Mennonite,,274.21,,,,,,,228.84,498.56,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
SET SCR SPNL 6 35MM THRD 1/4-32IN TI BRK OFF CDH SLR,51863,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,498.56000,473.63000,Amish/Mennonite,Amish Mennonite,,274.21,,,,,,,244.29,483.60,percent of total billed charges,
SET SCR SPNL L6MM DIA5.5MM TI BRK OFF LOK W/ DTACH CDH,51865,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,498.56000,473.63000,Amish/Mennonite,Amish Mennonite,,274.21,,,,,,,228.84,498.56,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,inpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,216.31,percent of total billed charges,
SHUNTOGRAM FOR INVESTIGATION-TECH,52008,CDM,320,RC,75809,CPT,,,facility,outpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,100.97,5080.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN-TECH,52350,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,234.00,5323.40,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,283.25,499.55,percent of total billed charges,
SPECL TX PROC BRACHTHERAPY-TECH,52352,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC SAME SITE-TECH,52354,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC MULT SITE-TECH,52356,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC TBI-TECH,52365,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCURRENT CHEMO-TECH,52369,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,inpatient,,,5332.00000,5065.40000,Amish/Mennonite,Amish Mennonite,,2932.60,,,,,,,2932.60,5172.04,percent of total billed charges,
SPECL TX PROC GAMA-TECH,52385,CDM,333,RC,77470,CPT,,,facility,outpatient,,,5332.00000,5065.40000,Amish/Mennonite,Amish Mennonite,,2932.60,,,,,,,138.83,7581.44,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECIAL TX PROC PEDIATRIC-TECH,52396,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,Amish/Mennonite,Amish Mennonite,,3080.00,,,,,,,3080.00,5432.00,percent of total billed charges,
SPLENOPORTOGRAPHY-TECH,52403,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,Amish/Mennonite,Amish Mennonite,,3080.00,,,,,,,2800.00,24628.72,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC ANATOMIC ANOMALY-TECH,52405,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC INTRACAVIT CONE-TECH,52407,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PROFRACTIONATION-TECH,52410,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC PACER/OTHER IMPL-TECH,52414,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,inpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,1307.90,2306.66,percent of total billed charges,
SPECL TX PROC CONCUR HYPERTHRM-TECH,52426,CDM,333,RC,77470,CPT,,,facility,outpatient,,,2378.00000,2259.10000,Amish/Mennonite,Amish Mennonite,,1307.90,,,,,,,138.83,7581.44,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L5CM GWIRE 0.035IN MIN ACC CHN 3.7MM POLY,52814,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L15CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,52853,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L28CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,53055,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,389.87,849.38,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX FIRM DRMTR THRD DBL PGTL,53088,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR ID8-10MM LN L7CM UNLINED L2CM SHTH 10FR BLLN,53094,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8040.81,17518.10,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RADTX <=5FXS-TECH,53162,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,1667.31,67198.78,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,Amish/Mennonite,Amish Mennonite,,1034.00,,,,,,,1034.00,1823.60,percent of total billed charges,
SUPERVISN HNDLG LOAD RADIATION-TECH,53194,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,Amish/Mennonite,Amish Mennonite,,1034.00,,,,,,,81.69,1823.60,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,,410.85,,,,,,,410.85,724.59,percent of total billed charges,
THYROID CARCINOMA METAS UPTAKE-TECH,53347,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,,410.85,,,,,,,282.87,724.59,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,TC,48.95,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON-STRESS TEST-TECH,5343,CDM,720,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,TC,48.95,,,,,,,44.50,86.33,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERMED-TECH,53453,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,52.50,6772.18,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,inpatient,1,mL,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 10 ML,53494,CDM,250,RC,64980-0513-01,NDC,,,facility,outpatient,1,mL,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,111.65,196.91,percent of total billed charges,
TLD/IN VIVO DOSIMETRY SIMPLE-TECH,53593,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,101.50,3679.58,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,433.40,764.36,percent of total billed charges,
US GUID PARENCHYMAL TISS ABLT-TECH,53833,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,327.36,764.36,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST C-14 ACQUISIT-TECH,53843,CDM,300,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,9.88,184.30,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,182.05,321.07,percent of total billed charges,
US GUIDE INTERSTITIAL RADIOEL-TECH,53855,CDM,402,RC,76965,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,149.44,548.00,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,Amish/Mennonite,Amish Mennonite,,1208.90,,,,,,,1208.90,2132.06,percent of total billed charges,
URETERAL REFLUX STUDY-TECH,53875,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,Amish/Mennonite,Amish Mennonite,,1208.90,,,,,,,381.55,2210.07,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,,1075.80,,,,,,,1075.80,1897.32,percent of total billed charges,
US GUIDED COMPRESSION RPR-TECH,53892,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,,1075.80,,,,,,,295.69,1897.32,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,Amish/Mennonite,Amish Mennonite,,1584.55,,,,,,,1584.55,2794.57,percent of total billed charges,
VENOUS SAMPLING THRU CATH-TECH,53930,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,Amish/Mennonite,Amish Mennonite,,1584.55,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY CAVAL INFERIOR-TECH,54428,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,361.82,17311.25,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,inpatient,,,4753.00000,4515.35000,Amish/Mennonite,Amish Mennonite,,2614.15,,,,,,,2614.15,4610.41,percent of total billed charges,
XR VENOGRAPHY ORBITAL-TECH,54446,CDM,320,RC,75880,CPT,,,facility,outpatient,,,4753.00000,4515.35000,Amish/Mennonite,Amish Mennonite,,2614.15,,,,,,,431.85,6628.38,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,,308.00,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY TRANSLUMAR-TECH,54451,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,,308.00,,,,,,,280.00,4040.81,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO PELVIC SEL/SUPRASELEC-TECH,54463,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,500.59,29731.35,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL BIL SEL-TECH,54464,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,439.81,17311.25,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,Amish/Mennonite,Amish Mennonite,,2427.15,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL SEL-TECH,54478,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,Amish/Mennonite,Amish Mennonite,,2427.15,,,,,,,498.74,29731.35,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM UNI SELECTIVE-TECH,54479,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,411.55,17311.25,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAPHY RENAL UNI SEL-TECH,54482,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,394.96,17311.25,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,Amish/Mennonite,Amish Mennonite,,905.85,,,,,,,905.85,1597.59,percent of total billed charges,
XR ANGIOGRAPHY INTRNL MAMMARY-TECH,54483,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,Amish/Mennonite,Amish Mennonite,,905.85,,,,,,,574.33,17311.25,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,Amish/Mennonite,Amish Mennonite,,2582.80,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIO ADRENAL BIL SELECTIVE-TECH,54485,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,Amish/Mennonite,Amish Mennonite,,2582.80,,,,,,,595.74,17311.25,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
XR AORTOGRAM & AORTOFEMORAL-TECH,54486,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,378.42,17311.25,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,,2168.10,,,,,,,2168.10,3823.74,percent of total billed charges,
XR AORTOGRAPHY ABDOMINAL-TECH,54489,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,,2168.10,,,,,,,356.27,17311.25,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,Amish/Mennonite,Amish Mennonite,,1741.30,,,,,,,1741.30,3071.02,percent of total billed charges,
XR HEPATIC VENOGRAPHY W HEMODYN-TECH,54491,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,Amish/Mennonite,Amish Mennonite,,1741.30,,,,,,,418.96,17311.25,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,inpatient,,,1404.00000,1333.80000,Amish/Mennonite,Amish Mennonite,,772.20,,,,,,,772.20,1361.88,percent of total billed charges,
XR ENDO CATH PANCREATIC DUCT SYS-TECH,54502,CDM,320,RC,74329,CPT,,,facility,outpatient,,,1404.00000,1333.80000,Amish/Mennonite,Amish Mennonite,,772.20,,,,,,,227.70,5633.78,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,Amish/Mennonite,Amish Mennonite,,797.50,,,,,,,797.50,1406.50,percent of total billed charges,
XR ANGIOGRAPHY SPINAL SLECTIVE-TECH,54504,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,Amish/Mennonite,Amish Mennonite,,797.50,,,,,,,723.58,29731.35,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,inpatient,,,4226.00000,4014.70000,Amish/Mennonite,Amish Mennonite,,2324.30,,,,,,,2324.30,4099.22,percent of total billed charges,
XR AORTOGRAPHY THOR WO SERIAL-TECH,54508,CDM,320,RC,75600,CPT,,,facility,outpatient,,,4226.00000,4014.70000,Amish/Mennonite,Amish Mennonite,,2324.30,,,,,,,960.76,17311.25,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIO ADRENAL UNI SELECTIVE-TECH,54513,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,,1985.50,,,,,,,550.38,17311.25,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,,785.40,,,,,,,785.40,1385.16,percent of total billed charges,
XR ANGIO PULM NONSELECTIVE-TECH,54514,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,,785.40,,,,,,,463.75,17311.25,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,Amish/Mennonite,Amish Mennonite,,913.00,,,,,,,913.00,1610.20,percent of total billed charges,
XR VENOGRAPHY SINUS/JUG CATH-TECH,54553,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,Amish/Mennonite,Amish Mennonite,,913.00,,,,,,,426.30,17311.25,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIO PULM BIL SELECTIVE-TECH,54568,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,,2302.85,,,,,,,417.10,17311.25,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER MRI INTERP WO WRKSTATN-TECH,55070,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,72.50,548.00,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,inpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00264761000,NDC,facility,outpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00338979901,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 1000 ML,55071,CDM,250,RC,J7042,HCPCS,00990794109,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,2.24,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER CT INTERP IND WRKSTATN-TECH,55072,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER MRI INTER IND WRKSTATN-TECH,55075,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,2032.87,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
3D RENDER US INTERP IND WRKSTATN-TECH,55076,CDM,614,RC,76377,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,2032.87,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00338007704,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00409792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 1000 ML,55077,CDM,250,RC,J3490,HCPCS,00990792409,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,96.25,169.75,percent of total billed charges,
AB ELUTION RBC EA-TECH,55079,CDM,300,RC,86860,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,87.50,1544.85,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
5 HIAA ASSAY-TECH,55080,CDM,300,RC,83497,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,12.90,679.08,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
3D RENDER US INTERP WO WRKSTATN-TECH,55082,CDM,402,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,72.50,548.00,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
AB SCREEN RBC EA SERUM-TECH,55083,CDM,300,RC,86850,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.38,458.40,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,inpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00264775100,NDC,facility,outpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,inpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00338012504,NDC,facility,outpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,9.98,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 1000 ML,55084,CDM,636,RC,J7121,HCPCS,00990792909,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,9.98,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,inpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,90,13.75,,,,,,,13.75,24.25,percent of total billed charges,
17 HYDROXYPROGESTERONE-TECH,55085,CDM,300,RC,83498,CPT,,,facility,outpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,90,13.75,,,,,,,12.50,1426.03,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETIC ACID TOPICAL SOL,55089,CDM,250,RC,51552-0051-06,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,inpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,55150015521,NDC,facility,outpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,0.04803,3.22,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,inpatient,1,mL,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
ACYCLOVIR INJECTION,55090,CDM,250,RC,J0133,HCPCS,63323032520,NDC,facility,outpatient,1,mL,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,0.04803,5.36,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,inpatient,,,3479.00000,3305.05000,Amish/Mennonite,Amish Mennonite,TC,1913.45,,,,,,,1913.45,3374.63,percent of total billed charges,
ACUTE GI BLOOD LOSS IMAGING-TECH,55091,CDM,341,RC,78278,CPT,,,facility,outpatient,,,3479.00000,3305.05000,Amish/Mennonite,Amish Mennonite,TC,1913.45,,,,,,,1628.38,3374.63,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,inpatient,10,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,55150015410,NDC,facility,outpatient,10,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,0.04803,3.45,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,inpatient,10,EA,5.94000,5.64000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,3.27,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032510,NDC,facility,outpatient,10,EA,5.94000,5.64000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,0.04803,5.76,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,inpatient,10,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
ACYCLOVIR INJECTION 7834245,55092,CDM,250,RC,J0133,HCPCS,63323032514,NDC,facility,outpatient,10,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.04803,1.32,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,00093894719,NDC,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,61442011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,inpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,50268006215,NDC,facility,outpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.80,3.49,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
ACYCLOVIR TAB 800 MG,55093,CDM,250,RC,J8499,HCPCS,68084010901,NDC,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-TECH,55095,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,74.34,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN PNEUMOCOCCAL VACC-TECH,55096,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,67457094010,NDC,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.08000,0.36860,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,inpatient,1,mL,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00264410090,NDC,facility,outpatient,1,mL,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.08000,0.25220,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,inpatient,1,mL,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,00781315695,NDC,facility,outpatient,1,mL,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.08000,0.87300,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,inpatient,1,mL,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,24201010024,NDC,facility,outpatient,1,mL,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.08000,1.09,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,inpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
ACETAMINOPHEN SOLN-INJ 1000MG/100 ML,55097,CDM,636,RC,J0131,HCPCS,36000030660,NDC,facility,outpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.08000,0.29100,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,inpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,190.85,336.59,percent of total billed charges,
ACTH ASSAY-TECH,55098,CDM,300,RC,82024,CPT,,,facility,outpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,38.62,2020.22,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012301,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012305,NDC,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012323,NDC,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406012362,NDC,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036523,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00406036562,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00591320201,NDC,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00603389021,NDC,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,00904682461,NDC,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,27808003501,NDC,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,inpatient,1,EA,1.39000,1.33000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,50268040115,NDC,facility,outpatient,1,EA,1.39000,1.33000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51079077721,NDC,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,51862022701,NDC,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,68084089509,NDC,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739032610,NDC,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739053210,NDC,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,inpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55100,CDM,250,RC,J8499,HCPCS,63739070410,NDC,facility,outpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,inpatient,1,mL,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 12 MG-120 MG/5 ML,55101,CDM,250,RC,J8499,HCPCS,50383033706,NDC,facility,outpatient,1,mL,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048401,NDC,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048423,NDC,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,inpatient,1,EA,1.28000,1.21000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,00406048462,NDC,facility,outpatient,1,EA,1.28000,1.21000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,51079016120,NDC,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,inpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,63739000410,NDC,facility,outpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 30 MG -300 MG,55102,CDM,250,RC,J8499,HCPCS,68084037201,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,633.75000,602.06000,Amish/Mennonite,Amish Mennonite,,348.56,,,,,,,310.54,614.74,percent of total billed charges,
BARRIER ADHESION UTER/PELV ABSORB GYNECARE INTCEED.,55103,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,633.75000,602.06000,Amish/Mennonite,Amish Mennonite,,348.56,,,,,,,290.89,633.75,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,inpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00093894019,NDC,facility,outpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,inpatient,1,EA,0.43000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,00904578961,NDC,facility,outpatient,1,EA,0.43000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,51079044701,NDC,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
ACYCLOVIR CAP 200 MG,55104,CDM,250,RC,J8499,HCPCS,72578000201,NDC,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,inpatient,1,mL,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7910405,55105,CDM,250,RC,J7608,HCPCS,63323069210,NDC,facility,outpatient,1,mL,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.10,14.67,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-62,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00406-0512-23,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,00904-6437-61,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,31722-0949-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,42858-0102-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,50268-0644-15,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,inpatient,1,EA,45.56000,43.28000,Amish/Mennonite,Amish Mennonite,,25.06,,,,,,,25.06,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63481-0623-70,NDC,,,facility,outpatient,1,EA,45.56000,43.28000,Amish/Mennonite,Amish Mennonite,,25.06,,,,,,,22.78,44.19,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,63739-0709-10,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68084-0355-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
OXYCODONE-ACETAMINOPHEN TAB 5 MG-325 MG,55106,CDM,250,RC,68308-0405-47,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,inpatient,1,mL,7855.65000,7462.87000,Amish/Mennonite,Amish Mennonite,,4320.61,,,,,,,4320.61,7619.98,percent of total billed charges,
ALEMTUZUMAB INJECTION,55107,CDM,636,RC,J0202,HCPCS,58468035703,NDC,facility,outpatient,1,mL,7855.65000,7462.87000,Amish/Mennonite,Amish Mennonite,,4320.61,,,,,,,2440.70,7619.98,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,inpatient,1,EA,47.27000,44.91000,Amish/Mennonite,Amish Mennonite,,26.00,,,,,,,26.00,45.85,percent of total billed charges,
ADRENALIN EPINEPHRINE INJ 7002306,55108,CDM,250,RC,J0171,HCPCS,42023015925,NDC,facility,outpatient,1,EA,47.27000,44.91000,Amish/Mennonite,Amish Mennonite,,26.00,,,,,,,1.13,45.85,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
ALBUMIN URINE/OTHER SOURCE-TECH,55109,CDM,300,RC,82042,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,7.27,373.51,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,inpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,968.06,percent of total billed charges,
ABD PARACENTESIS W/IMAG GUID-TECH,55110,CDM,361,RC,49083,CPT,,,facility,outpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,3163.00,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,inpatient,1,EA,333.18000,316.52000,Amish/Mennonite,Amish Mennonite,,183.25,,,,,,,183.25,323.18,percent of total billed charges,
ACETYLCHOLINE POWD-INJ 1% 2 ML INTRAOCULAR,55112,CDM,250,RC,24208-0539-20,NDC,,,facility,outpatient,1,EA,333.18000,316.52000,Amish/Mennonite,Amish Mennonite,,183.25,,,,,,,166.59,323.18,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,inpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,223.30,393.82,percent of total billed charges,
ACTH STIMULATION PANEL-TECH,55113,CDM,300,RC,80400,CPT,,,facility,outpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,32.62,1697.68,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,inpatient,15,EA,38.63000,36.70000,Amish/Mennonite,Amish Mennonite,,21.25,,,,,,,21.25,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,16714-0885-01,NDC,,,facility,outpatient,15,EA,38.63000,36.70000,Amish/Mennonite,Amish Mennonite,,21.25,,,,,,,19.32,37.47,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ACYCLOVIR TOPICAL OINTMENT,55116,CDM,250,RC,65162-0835-94,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,inpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,90,87.78,,,,,,,87.78,154.81,percent of total billed charges,
ACHR GANGLIONIC NEURONAL AB (84321)-TECH,55117,CDM,300,RC,83519,CPT,,,facility,outpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,90,87.78,,,,,,,19.00,865.84,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,inpatient,1,EA,3284.86000,3120.62000,Amish/Mennonite,Amish Mennonite,,1806.67,,,,,,,1806.67,3186.31,percent of total billed charges,
ABATACEPT POWD-INJ 250 MG,55118,CDM,636,RC,J0129,HCPCS,00003218713,NDC,facility,outpatient,1,EA,3284.86000,3120.62000,Amish/Mennonite,Amish Mennonite,,1806.67,,,,,,,44.49,3186.31,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,50742023301,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,23155078701,NDC,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,inpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,29033003001,NDC,facility,outpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,inpatient,1,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,8.26,14.56,percent of total billed charges,
ACETAZOLAMIDE CAP-ER 500 MG,55119,CDM,250,RC,J8499,HCPCS,60687057821,NDC,facility,outpatient,1,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,7.50,14.56,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,inpatient,8,EA,8.97000,8.53000,Amish/Mennonite,Amish Mennonite,,4.93,,,,,,,4.93,8.70,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH 8 GM (60 DOSE),55120,CDM,250,RC,J3535,HCPCS,00173068224,NDC,facility,outpatient,8,EA,8.97000,8.53000,Amish/Mennonite,Amish Mennonite,,4.93,,,,,,,4.49,8.70,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,inpatient,30,EA,1.48000,1.40000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00409330803,NDC,facility,outpatient,30,EA,1.48000,1.40000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,inpatient,30,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,00517763003,NDC,facility,outpatient,30,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,inpatient,30,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426315,55121,CDM,250,RC,J7608,HCPCS,63323069030,NDC,facility,outpatient,30,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,14.67,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,inpatient,30,EA,19.80000,18.81000,Amish/Mennonite,Amish Mennonite,,10.89,,,,,,,10.89,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,63323096330,NDC,facility,outpatient,30,EA,19.80000,18.81000,Amish/Mennonite,Amish Mennonite,,10.89,,,,,,,0.59237,19.21,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,inpatient,30,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081230,NDC,facility,outpatient,30,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.59237,15.33,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,inpatient,30,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,25021081266,NDC,facility,outpatient,30,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,0.59237,4.24,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,inpatient,30,EA,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,10.86,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,55150025930,NDC,facility,outpatient,30,EA,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,0.59237,19.16,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,inpatient,30,EA,21.80000,20.71000,Amish/Mennonite,Amish Mennonite,,11.99,,,,,,,11.99,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,66220020730,NDC,facility,outpatient,30,EA,21.80000,20.71000,Amish/Mennonite,Amish Mennonite,,11.99,,,,,,,0.59237,21.15,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,inpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70069078804,NDC,facility,outpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,0.59237,5.44,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,inpatient,30,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,70594011102,NDC,facility,outpatient,30,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.59237,6.13,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,inpatient,30,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,2.14,3.77,percent of total billed charges,
ACETYLCYSTEINE INJECTION,55122,CDM,250,RC,J0132,HCPCS,72611086004,NDC,facility,outpatient,30,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,0.59237,3.77,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,inpatient,5,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 24 MG-240 MG/10ML,55123,CDM,250,RC,J8499,HCPCS,00121050404,NDC,facility,outpatient,5,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,16714063101,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094101,NDC,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,51079094105,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
ALENDRONATE TAB 10 MG,55124,CDM,250,RC,J8499,HCPCS,64980034001,NDC,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
ACETYLCHOLINE RECEPTR MODULATING AB-TECH,55125,CDM,300,RC,83519,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,18.40,865.84,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,inpatient,1,EA,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.57,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,50268005015,NDC,facility,outpatient,1,EA,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.34,4.54,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
ACEBUTOLOL CAP 200 MG,55127,CDM,250,RC,J8499,HCPCS,53746066901,NDC,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,inpatient,,,214.70000,203.96000,Amish/Mennonite,Amish Mennonite,90,118.08,,,,,,,118.08,208.26,percent of total billed charges,
ACETYLCHOLINESTERASE ASSAY-TECH,55129,CDM,300,RC,82013,CPT,,,facility,outpatient,,,214.70000,203.96000,Amish/Mennonite,Amish Mennonite,90,118.08,,,,,,,12.70,577.23,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,inpatient,1,mL,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,00944049301,NDC,facility,outpatient,1,mL,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,inpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,44206025105,NDC,facility,outpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,inpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68982064301,NDC,facility,outpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,inpatient,1,mL,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,68516521607,NDC,facility,outpatient,1,mL,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 50 ML,55130,CDM,250,RC,P9047,HCPCS,76125079225,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,88.11,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN HEP B VAC-TECH,55131,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,247.50,436.50,percent of total billed charges,
ABD PARACENTESIS W/O IMAG GUID-TECH,55133,CDM,361,RC,,,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,247.50,5271.00,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,inpatient,3,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378698831,NDC,facility,outpatient,3,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,inpatient,3,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00378967193,NDC,facility,outpatient,3,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,inpatient,3,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,00487020101,NDC,facility,outpatient,3,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,inpatient,3,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,69097017364,NDC,facility,outpatient,3,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.33000,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,inpatient,3,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,47335075652,NDC,facility,outpatient,3,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,inpatient,3,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,60687040583,NDC,facility,outpatient,3,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,inpatient,3,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060001,NDC,facility,outpatient,3,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.30070,0.65960,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,inpatient,3,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUTEROL-IPRATROPIUM NEB 3 MG(2.5 MG BASE)-0.5 MG/3 ML,55135,CDM,250,RC,J7620,HCPCS,76204060060,NDC,facility,outpatient,3,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,02743-4002-11,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,16963-0020-97,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,27434-0002-11,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
ACETYLCYSTEINE CAP,55136,CDM,250,RC,54629-4097-60,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,inpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,,266.75,,,,,,,266.75,470.45,percent of total billed charges,
ACUTE HEPATITIS PANEL-TECH,55137,CDM,300,RC,80074,CPT,,,facility,outpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,,266.75,,,,,,,47.63,2495.58,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,inpatient,30,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,00472-0825-16,NDC,,,facility,outpatient,30,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ALBUTEROL SYRUP 0.4 MG/ML,55138,CDM,250,RC,70752-0102-12,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,inpatient,1,EA,14.85000,14.11000,Amish/Mennonite,Amish Mennonite,,8.17,,,,,,,8.17,14.40,percent of total billed charges,
ALBUTEROL TAB 2 MG,55139,CDM,250,RC,J8499,HCPCS,53489017601,NDC,facility,outpatient,1,EA,14.85000,14.11000,Amish/Mennonite,Amish Mennonite,,8.17,,,,,,,7.42,14.40,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,inpatient,,,167.30000,158.94000,Amish/Mennonite,Amish Mennonite,90,92.02,,,,,,,92.02,162.28,percent of total billed charges,
ACYLCARNITINES QUANT EA (ACRN) SO,55141,CDM,300,RC,82017,CPT,,,facility,outpatient,,,167.30000,158.94000,Amish/Mennonite,Amish Mennonite,90,92.02,,,,,,,17.43,882.80,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,inpatient,1,EA,5.93000,5.63000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,3.26,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,00093517119,NDC,facility,outpatient,1,EA,5.93000,5.63000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,2.96,5.75,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,inpatient,1,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,16714063301,NDC,facility,outpatient,1,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.45,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,inpatient,1,EA,4.29000,4.08000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.36,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,51079094201,NDC,facility,outpatient,1,EA,4.29000,4.08000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.15,4.16,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,inpatient,1,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.87,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69097022416,NDC,facility,outpatient,1,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.70,3.30,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,inpatient,1,EA,1.48000,1.40000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
ALENDRONATE TAB 70 MG,55142,CDM,250,RC,J8499,HCPCS,69543013120,NDC,facility,outpatient,1,EA,1.48000,1.40000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,inpatient,30,EA,26.39000,25.07000,Amish/Mennonite,Amish Mennonite,,14.51,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,42023016899,NDC,facility,outpatient,30,EA,26.39000,25.07000,Amish/Mennonite,Amish Mennonite,,14.51,,,,,,,1.13,25.60,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,inpatient,30,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
EPINEPHRINE SOLN 1 MG/ML 30 ML (MDV),55143,CDM,250,RC,J0171,HCPCS,76329906000,NDC,facility,outpatient,30,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,1.13,22.99,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,inpatient,1,mL,10.42000,9.90000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.73,10.11,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,00517760425,NDC,facility,outpatient,1,mL,10.42000,9.90000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.21,14.67,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,inpatient,1,mL,11.07000,10.51000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,6.09,10.74,percent of total billed charges,
ACETYLCYSTEINE NON-COMP UNIT 7426316,55144,CDM,250,RC,J7608,HCPCS,63323069404,NDC,facility,outpatient,1,mL,11.07000,10.51000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,5.54,14.67,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,inpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,00944049505,NDC,facility,outpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,inpatient,1,mL,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,44206031025,NDC,facility,outpatient,1,mL,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,inpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,64208251001,NDC,facility,outpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521401,NDC,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521409,NDC,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68516521804,NDC,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,inpatient,1,mL,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,68982062302,NDC,facility,outpatient,1,mL,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,88.11,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 250 ML,55148,CDM,636,RC,P9045,HCPCS,76125079025,NDC,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,88.11,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,inpatient,0.5,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ALBUTEROL SOL 7428584,55149,CDM,250,RC,j7611,HCPCS,00487990130,NDC,facility,outpatient,0.5,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,inpatient,,,3438.00000,3266.10000,Amish/Mennonite,Amish Mennonite,TC,1890.90,,,,,,,1890.90,3334.86,percent of total billed charges,
ACUTE VENOUS THROMB IMG PEPTIDE-TECH,55151,CDM,340,RC,78456,CPT,,,facility,outpatient,,,3438.00000,3266.10000,Amish/Mennonite,Amish Mennonite,TC,1890.90,,,,,,,1436.74,7180.14,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00527105001,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,inpatient,1,EA,11.41000,10.84000,Amish/Mennonite,Amish Mennonite,,6.28,,,,,,,6.28,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,00904666361,NDC,facility,outpatient,1,EA,11.41000,10.84000,Amish/Mennonite,Amish Mennonite,,6.28,,,,,,,5.71,11.07,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,70756072111,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,inpatient,1,EA,8.49000,8.06000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.67,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,50268005415,NDC,facility,outpatient,1,EA,8.49000,8.06000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.25,8.24,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,inpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,6.07,10.70,percent of total billed charges,
ACETAZOLAMIDE TAB 250 MG,55152,CDM,250,RC,J8499,HCPCS,68084054101,NDC,facility,outpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,5.51,10.70,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,inpatient,3,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827052,NDC,facility,outpatient,3,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,inpatient,3,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00378827093,NDC,facility,outpatient,3,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,inpatient,3,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950101,NDC,facility,outpatient,3,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.11935,0.31040,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,inpatient,3,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,00487950160,NDC,facility,outpatient,3,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.11935,0.25220,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,inpatient,3,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,47335070352,NDC,facility,outpatient,3,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,inpatient,3,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,60687039583,NDC,facility,outpatient,3,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.11935,0.29100,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,inpatient,3,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020001,NDC,facility,outpatient,3,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.11935,0.38800,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,inpatient,3,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
ALBUTEROL NEB 2.5 MG/3 ML,55153,CDM,250,RC,J7613,HCPCS,76204020060,NDC,facility,outpatient,3,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.11935,0.30070,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
AFB SMEAR-TECH,55154,CDM,300,RC,87206,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BERMUDA GRASS IGE-TECH,55155,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
ALDOLASE ASSAY-TECH,55157,CDM,300,RC,82085,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,9.71,509.30,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,inpatient,,,266.10000,252.80000,Amish/Mennonite,Amish Mennonite,90,146.35,,,,,,,146.35,258.12,percent of total billed charges,
ADAMTS13 ACTIVITY SO-TECH,55158,CDM,305,RC,85397,CPT,,,facility,outpatient,,,266.10000,252.80000,Amish/Mennonite,Amish Mennonite,90,146.35,,,,,,,31.89,1459.96,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,inpatient,2,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,3.15,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,00409226602,NDC,facility,outpatient,2,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,2.86,5.55,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,inpatient,2,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
ALFENTANIL SOLN 500 MCG/ML 2 ML,55159,CDM,250,RC,J0216,HCPCS,17478006702,NDC,facility,outpatient,2,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,4.27,10.73,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,54505010202,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,inpatient,1,EA,260.67000,247.63000,Amish/Mennonite,Amish Mennonite,,143.37,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050001,NDC,facility,outpatient,1,EA,260.67000,247.63000,Amish/Mennonite,Amish Mennonite,,143.37,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,inpatient,1,EA,788.15000,748.74000,Amish/Mennonite,Amish Mennonite,,433.48,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SYRINGE 0.3 MG INJ KIT,55161,CDM,250,RC,J0171,HCPCS,49502050002,NDC,facility,outpatient,1,EA,788.15000,748.74000,Amish/Mennonite,Amish Mennonite,,433.48,,,,,,,1.13,764.51,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,inpatient,1,EA,104.28000,99.07000,Amish/Mennonite,Amish Mennonite,,57.35,,,,,,,57.35,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143900601,NDC,facility,outpatient,1,EA,104.28000,99.07000,Amish/Mennonite,Amish Mennonite,,57.35,,,,,,,27.59,101.15,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,inpatient,1,EA,138.91000,131.97000,Amish/Mennonite,Amish Mennonite,,76.40,,,,,,,76.40,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,00143950301,NDC,facility,outpatient,1,EA,138.91000,131.97000,Amish/Mennonite,Amish Mennonite,,76.40,,,,,,,27.59,134.74,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,inpatient,1,EA,125.45000,119.18000,Amish/Mennonite,Amish Mennonite,,69.00,,,,,,,69.00,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,23155031331,NDC,facility,outpatient,1,EA,125.45000,119.18000,Amish/Mennonite,Amish Mennonite,,69.00,,,,,,,27.59,121.69,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,inpatient,1,EA,99.54000,94.56000,Amish/Mennonite,Amish Mennonite,,54.75,,,,,,,54.75,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,39822019001,NDC,facility,outpatient,1,EA,99.54000,94.56000,Amish/Mennonite,Amish Mennonite,,54.75,,,,,,,27.59,96.55,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
ACETAZOLAMID SODIUM INJ,55162,CDM,250,RC,J1120,HCPCS,67457085350,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,27.59,122.61,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
ALGINIC ACID/AL HYDROXIDE/MG TRISILICATE TAB,55163,CDM,250,RC,00135-0096-26,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,inpatient,,,210.90000,200.35000,Amish/Mennonite,Amish Mennonite,90,116.00,,,,,,,116.00,204.57,percent of total billed charges,
ACETYLCHOLINE RECEPTR BINDING AB (8338) SO-TECH,55164,CDM,300,RC,86041,CPT,,,facility,outpatient,,,210.90000,200.35000,Amish/Mennonite,Amish Mennonite,90,116.00,,,,,,,14.72,204.57,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CASHEW IGE-TECH,55165,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,30.80,54.32,percent of total billed charges,
ALBUMIN SERUM/PLASMA/WHOLE BLD-TECH,55166,CDM,300,RC,82040,CPT,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,4.95,254.68,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,inpatient,,,496.00000,471.20000,Amish/Mennonite,Amish Mennonite,,272.80,,,,,,,272.80,481.12,percent of total billed charges,
ADMIN CONTRAST DURING STRESS-TECH,55167,CDM,483,RC,93352,CPT,,,facility,outpatient,,,496.00000,471.20000,Amish/Mennonite,Amish Mennonite,,272.80,,,,,,,248.00,481.12,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
ADMIN INFLUENZA VIRUS VACC-LIVE-TECH,55168,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,48.19,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
AFB STAIN-TECH,55171,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.39,288.61,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLADOSPORIUM IGE-TECH,55172,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,inpatient,20,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,4.20,7.40,percent of total billed charges,
ALBUTEROL NEB 5 MG/ML 20 ML,55173,CDM,250,RC,J7611,HCPCS,50383074120,NDC,facility,outpatient,20,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,0.25616,7.40,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
ALCOHOL BREATH TEST-TECH,55174,CDM,300,RC,82075,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.95,1409.06,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,inpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,,235.40,,,,,,,235.40,415.16,percent of total billed charges,
ALDOSTERONE SERUM-TECH,55175,CDM,300,RC,82088,CPT,,,facility,outpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,,235.40,,,,,,,40.75,2122.08,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,inpatient,2,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,25021030167,NDC,facility,outpatient,2,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,0.59830,24.52,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,inpatient,2,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,67457085502,NDC,facility,outpatient,2,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.59830,9.20,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,inpatient,2,EA,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065102,NDC,facility,outpatient,2,EA,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,inpatient,2,EA,25.12000,23.87000,Amish/Mennonite,Amish Mennonite,,13.82,,,,,,,13.82,24.37,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 2 ML,55176,CDM,250,RC,J0153,HCPCS,63323065189,NDC,facility,outpatient,2,EA,25.12000,23.87000,Amish/Mennonite,Amish Mennonite,,13.82,,,,,,,0.59830,24.37,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,inpatient,,,420.10000,399.10000,Amish/Mennonite,Amish Mennonite,,231.06,,,,,,,231.06,407.50,percent of total billed charges,
ACGH WHOLE GENOME (MICROARRAY)-TECH,55177,CDM,310,RC,88399,CPT,,,facility,outpatient,,,420.10000,399.10000,Amish/Mennonite,Amish Mennonite,,231.06,,,,,,,50.73,407.50,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALTERNARIA TENUSIS IGE-TECH,55179,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-04,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,inpatient,1,mL,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-0772-16,NDC,,,facility,outpatient,1,mL,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,inpatient,1,mL,1.74000,1.66000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-40,NDC,,,facility,outpatient,1,mL,1.74000,1.66000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,00121-2316-50,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,60687-0417-71,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-01,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE SOL 7629546,55180,CDM,250,RC,66689-0023-50,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CACAO/COCOA IGE-TECH,55181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,90,61.60,,,,,,,61.60,108.64,percent of total billed charges,
ACID PHOSPHATASE PROSTATIC SO-TECH,55182,CDM,300,RC,84066,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,90,61.60,,,,,,,9.98,509.30,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAT EPITHELIUM IGE-TECH,55183,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BANANA IGE-TECH,55184,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHICKEN IGE-TECH,55185,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN BASS BLACK IGE SO,55186,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,4.57,271.65,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
ALKALIOIDS NOS-TECH,55187,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,63.95,788.42,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CLAM IGE-TECH,55188,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BOX ELDER/MAPLE IGE-TECH,55189,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ALMOND IGE-TECH,55190,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE MOLD IGE-TECH,55191,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BRAZIL NUT IGE-TECH,55192,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CODFISH IGE-TECH,55193,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BREWERS YEAST IGE-TECH,55194,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BEEF IGE-TECH,55195,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CANDIDA ALBICANS IGE-TECH,55196,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CARROT IGE-TECH,55197,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN APPLE IGE-TECH,55198,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HAZELNUT-FOOD IGE-TECH,55199,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRANBERRY IGE-TECH,55200,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CORN-FOOD IGE-TECH,55201,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN CEDAR IGE-TECH,55202,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG WHITE IGE-TECH,55203,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CHEESE CHEDDAR IGE-TECH,55204,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN FIREBUSH IGE-TECH,55205,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN EGG YOLK IGE-TECH,55206,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ASPERGILLUS FUMIGATUS IGE-TECH,55207,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ELM IGE-TECH,55208,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN COCKROACH-TECH,55209,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCKLEBUR IGE-TECH,55210,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
ALLERGEN GLUTEN IGE-TECH,55211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN COCONUT IGE-TECH,55212,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,inpatient,,,87.00000,82.65000,Amish/Mennonite,Amish Mennonite,,47.85,,,,,,,47.85,84.39,percent of total billed charges,
ALLERGEN LATEX-TECH,55213,CDM,300,RC,86003,CPT,,,facility,outpatient,,,87.00000,82.65000,Amish/Mennonite,Amish Mennonite,,47.85,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CRAB IGE-TECH,55216,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MEADOW FESCUE IGE-TECH,55217,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CUMIN IGE-TECH,55218,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN HADDOCK IGE SO-TECH,55219,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,4.57,271.65,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,inpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,00591346753,NDC,facility,outpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 0.63 MG/3 ML,55220,CDM,250,RC,J7613,HCPCS,76204001055,NDC,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.11935,0.61110,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HONEYBEE VENOM IGE-TECH,55221,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ENGLISH PLANTAIN IGE-TECH,55222,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GARLIC IGE-TECH,55223,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MUSTARD IGE-TECH,55224,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN JUNE GRASS IGE-TECH,55225,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN HOUSE DUST PANEL SO-TECH,55227,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN EPICOCCUM PURP. IGE-TECH,55228,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN BLUEBERRY IGE-TECH,55230,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 1 SO,55231,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAT IGE-TECH,55232,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN GRASS PNL 2 SO,55233,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MILK LGE-TECH,55234,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
ALK PHOSPHATASE ISOENZYMES-TECH,55235,CDM,300,RC,84080,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,14.78,780.94,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN MACADAMIA NUT IGE-TECH,55236,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN KIWI IGE-TECH,55237,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN BAKERS YEAST IGE-TECH,55238,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN DOG DANDER IGE-TECH,55239,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUCOR IGE-TECH,55240,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,inpatient,10,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00409493301,NDC,facility,outpatient,10,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.13,2.59,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,inpatient,10,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,00548331600,NDC,facility,outpatient,10,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,inpatient,10,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331601,NDC,facility,outpatient,10,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,inpatient,10,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331614,NDC,facility,outpatient,10,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.21,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,inpatient,10,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
EPINEPHRINE SYRINGE 1 MG/10 ML,55241,CDM,250,RC,J0171,HCPCS,76329331801,NDC,facility,outpatient,10,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.13,3.83,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,inpatient,,,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,90,9.68,,,,,,,9.68,17.07,percent of total billed charges,
"ALLERGEN, PANEL STINGING INSECTS-5 (INSEC) SO",55242,CDM,300,RC,86003,CPT,,,facility,outpatient,,,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,90,9.68,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PEACH IGE-TECH,55243,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GOOSE FEATHERS IGE-TECH,55244,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,inpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,45.10,79.54,percent of total billed charges,
ALLERGEN NECTARINE IGE-TECH,55245,CDM,300,RC,86003,CPT,,,facility,outpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LIME IGE-TECH,55247,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN LAMBS QUARTER IGE-TECH,55248,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN ONION IGE-TECH,55249,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN BEAN BLACK IGE SO-TECH,55250,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN LOBSTER IGE-TECH,55251,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL FOOD #6-TECH,55252,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OYSTER IGE-TECH,55253,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN CATFISH IGE SO-TECH,55254,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CAULIFLOWER IGE-TECH,55255,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED <3 YEAR-TECH,55256,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN CINNAMON IGE-TECH,55259,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PEANUT IGE-TECH,55260,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SCALLOP IGE-TECH,55261,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN NETTLE IGE-TECH,55262,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PENICILLUM IGE-TECH,55263,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN OAK IGE-TECH,55264,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RASPBERRY IGE-TECH,55266,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ORCHARD GRASS IGE-TECH,55267,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,inpatient,,,59.80000,56.81000,Amish/Mennonite,Amish Mennonite,90,32.89,,,,,,,32.89,58.01,percent of total billed charges,
"ALLERGEN SINGLE, QUANT SO -TECH",55268,CDM,300,RC,86008,CPT,,,facility,outpatient,,,59.80000,56.81000,Amish/Mennonite,Amish Mennonite,90,32.89,,,,,,,17.71,933.70,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PISTACHIO IGE-TECH,55269,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH PIGWEED IGE-TECH,55270,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN ROUGH MARSH ELDER IGE-TECH,55271,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN MALT IGE-TECH,55273,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RUSSIAN THISTLE IGE-TECH,55274,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DP IGE-TECH,55275,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,53.35,94.09,percent of total billed charges,
ALLERGEN PANEL PED >8 YEARS-TECH,55276,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SESAME SEED-TECH,55277,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PECAN-FOOD IGE-TECH,55278,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TUNA IGE-TECH,55279,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GIANT RAGWEED IGE-TECH,55280,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,inpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,90,6.05,,,,,,,6.05,10.67,percent of total billed charges,
ALLERGEN SINGLE SO-TECH,55281,CDM,300,RC,86003,CPT,,,facility,outpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,90,6.05,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHRIMP IGE-TECH,55282,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN GELATIN IGE-TECH,55283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN RED DYE IGE-TECH,55285,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN RICE IGE-TECH,55286,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SUNFLOWER SD-TECH,55288,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN GREEN PEA IGE-TECH,55289,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN RYE GRASS IGE-TECH,55290,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HOUSE DUST MITE/DF IGE-TECH,55291,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN MUGWORT IGE-TECH,55292,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TOMATO IGE-TECH,55293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SHORT RAGWEED IGE-TECH,55294,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN SHEEP WOOL IGE-TECH,55295,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,inpatient,,,174.80000,166.06000,Amish/Mennonite,Amish Mennonite,90,96.14,,,,,,,96.14,169.56,percent of total billed charges,
AMIKACIN ASSAY SO-TECH,55296,CDM,300,RC,80150,CPT,,,facility,outpatient,,,174.80000,166.06000,Amish/Mennonite,Amish Mennonite,90,96.14,,,,,,,15.58,780.94,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,90,36.85,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN WALL-EYED PIKE IGE SO -TECH,55297,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,90,36.85,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SALMON IGE-TECH,55298,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,inpatient,,,179.20000,170.24000,Amish/Mennonite,Amish Mennonite,90,98.56,,,,,,,98.56,173.82,percent of total billed charges,
ALPHA-2 PLASMIN INHIBITOR PLASMA-TECH,55299,CDM,300,RC,85410,CPT,,,facility,outpatient,,,179.20000,170.24000,Amish/Mennonite,Amish Mennonite,90,98.56,,,,,,,7.97,407.44,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN POTATO IGE-TECH,55300,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN SILVER BIRCH IGE-TECH,55301,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,inpatient,,,59.80000,56.81000,Amish/Mennonite,Amish Mennonite,90,32.89,,,,,,,32.89,58.01,percent of total billed charges,
ALLERGEN SPECIFIC IGE EA SO-TECH,55302,CDM,300,RC,86003,CPT,,,facility,outpatient,,,59.80000,56.81000,Amish/Mennonite,Amish Mennonite,90,32.89,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHEAT IGE-TECH,55303,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,inpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,36.74,64.80,percent of total billed charges,
ALLERGEN WHITE POPLAR IGE SO,55304,CDM,300,RC,86003,CPT,,,facility,outpatient,,,66.80000,63.46000,Amish/Mennonite,Amish Mennonite,90,36.74,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 1 SO-TECH,55305,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN WHITE HICKORY IGE-TECH,55306,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW FACED HORNET IGE-TECH,55307,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN STRAWBERRY IGE-TECH,55308,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,inpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,36.85,64.99,percent of total billed charges,
ALLERGEN ZUCCHINI SQUASH IGE-TECH,55309,CDM,300,RC,86003,CPT,,,facility,outpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN SEAFOOD PANEL SO-TECH,55310,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TIMOTHY GRASS IGE-TECH,55311,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WATERMELON IGE-TECH,55312,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WALNUT-FOOD IGE-TECH,55313,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,inpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,80.30,141.62,percent of total billed charges,
AMMONIA ASSAY-TECH,55314,CDM,300,RC,82140,CPT,,,facility,outpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,14.57,763.98,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,inpatient,,,194.80000,185.06000,Amish/Mennonite,Amish Mennonite,90,107.14,,,,,,,107.14,188.96,percent of total billed charges,
ALPHA FETOPROTEIN AMNIOTIC-TECH,55315,CDM,300,RC,82106,CPT,,,facility,outpatient,,,194.80000,185.06000,Amish/Mennonite,Amish Mennonite,90,107.14,,,,,,,17.57,882.80,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 3 (WEED3) SO,55316,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN TROUT IGE-TECH,55317,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 4-TECH,55318,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN NUT PANEL 2 SO -TECH,55319,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN PANEL MOLD IGE SO -TECH,55320,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,inpatient,1,EA,378.88000,359.94000,Amish/Mennonite,Amish Mennonite,,208.38,,,,,,,208.38,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00009316906,NDC,facility,outpatient,1,EA,378.88000,359.94000,Amish/Mennonite,Amish Mennonite,,208.38,,,,,,,189.44,367.51,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,inpatient,1,EA,280.60000,266.57000,Amish/Mennonite,Amish Mennonite,,154.33,,,,,,,154.33,272.18,percent of total billed charges,
ALPROSTADIL INJECTION,55321,CDM,250,RC,J0270,HCPCS,00703150102,NDC,facility,outpatient,1,EA,280.60000,266.57000,Amish/Mennonite,Amish Mennonite,,154.33,,,,,,,140.30,272.18,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN TREE PANEL 1 IGE SO,55322,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,90,67.65,,,,,,,67.65,119.31,percent of total billed charges,
AMIODARONE ASSAY-TECH,55323,CDM,301,RC,80151,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,90,67.65,,,,,,,14.91,885.37,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,52.25,92.15,percent of total billed charges,
ANALGESICS NON-OPIOID 1-2-TECH,55324,CDM,300,RC,80329,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,47.50,1137.41,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE PINE IGE-TECH,55325,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,inpatient,1,EA,13388.43000,12719.00000,Amish/Mennonite,Amish Mennonite,,7363.64,,,,,,,7363.64,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008525,NDC,facility,outpatient,1,EA,13388.43000,12719.00000,Amish/Mennonite,Amish Mennonite,,7363.64,,,,,,,94.15,12986.78,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,inpatient,1,EA,16720.68000,15884.65000,Amish/Mennonite,Amish Mennonite,,9196.37,,,,,,,9196.37,16219.06,percent of total billed charges,
ALTEPLASE RECOMBINANT 100 MG,55327,CDM,636,RC,J2997,HCPCS,50242008527,NDC,facility,outpatient,1,EA,16720.68000,15884.65000,Amish/Mennonite,Amish Mennonite,,9196.37,,,,,,,94.15,16219.06,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00378013701,NDC,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020520,NDC,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,00904704161,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16714004110,NDC,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,16729013401,NDC,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,inpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,51079020501,NDC,facility,outpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,60687067701,NDC,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,62584098801,NDC,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
ALLOPURINOL TAB 100 MG,55328,CDM,250,RC,J8499,HCPCS,63739041010,NDC,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,inpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,80.85,142.59,percent of total billed charges,
ALPHA FETOPROTEIN SERUM-TECH,55329,CDM,300,RC,82105,CPT,,,facility,outpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,16.77,882.80,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
ALT SGPT-TECH,55330,CDM,301,RC,84460,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,5.30,271.65,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
ALPHA 1 ANTITRYPSIN TOTAL-TECH,55331,CDM,300,RC,82103,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,13.44,696.05,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN PERCH IGE-TECH,55333,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00228202710,NDC,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,00781106101,NDC,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,51991070405,NDC,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,59762371901,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,60687037701,NDC,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,65862067601,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084001811,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.25 MG,55334,CDM,250,RC,J8499,HCPCS,68084064711,NDC,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,inpatient,1,EA,28.62000,27.19000,Amish/Mennonite,Amish Mennonite,,15.74,,,,,,,15.74,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00009009001,NDC,facility,outpatient,1,EA,28.62000,27.19000,Amish/Mennonite,Amish Mennonite,,15.74,,,,,,,14.31,27.76,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203110,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00228203196,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,00781107901,NDC,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372101,NDC,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,59762372103,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
ALPRAZOLAM TAB 1 MG,55335,CDM,250,RC,J8499,HCPCS,65862067801,NDC,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,inpatient,355,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
ALUMINUM HYDROXIDE SUSP,55336,CDM,250,RC,00536-0091-85,NDC,,,facility,outpatient,355,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,inpatient,,,399.70000,379.71000,Amish/Mennonite,Amish Mennonite,90,219.84,,,,,,,219.84,387.71,percent of total billed charges,
AMINO ACIDS 2 TO 5 QUANT EA-TECH,55337,CDM,300,RC,82136,CPT,,,facility,outpatient,,,399.70000,379.71000,Amish/Mennonite,Amish Mennonite,90,219.84,,,,,,,20.26,916.73,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,inpatient,1,EA,7.52000,7.15000,Amish/Mennonite,Amish Mennonite,,4.14,,,,,,,4.14,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,24658079830,NDC,facility,outpatient,1,EA,7.52000,7.15000,Amish/Mennonite,Amish Mennonite,,4.14,,,,,,,3.76,7.29,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,inpatient,1,EA,67.88000,64.48000,Amish/Mennonite,Amish Mennonite,,37.33,,,,,,,37.33,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,49411005030,NDC,facility,outpatient,1,EA,67.88000,64.48000,Amish/Mennonite,Amish Mennonite,,37.33,,,,,,,33.94,65.84,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,62559022530,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,inpatient,1,EA,18.85000,17.91000,Amish/Mennonite,Amish Mennonite,,10.37,,,,,,,10.37,18.28,percent of total billed charges,
AMINOCAPROIC ACID TAB 500 MG,55338,CDM,250,RC,J8499,HCPCS,69680011530,NDC,facility,outpatient,1,EA,18.85000,17.91000,Amish/Mennonite,Amish Mennonite,,10.37,,,,,,,9.43,18.28,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,inpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,44.88,79.15,percent of total billed charges,
ALLERGEN WHITEFISH IGE SO-TECH,55339,CDM,300,RC,86003,CPT,,,facility,outpatient,,,81.60000,77.52000,Amish/Mennonite,Amish Mennonite,90,44.88,,,,,,,4.57,271.65,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,inpatient,1,EA,456.75000,433.91000,Amish/Mennonite,Amish Mennonite,,251.21,,,,,,,251.21,443.05,percent of total billed charges,
ALTEPLASE RECOMBINANT 2 MG,55340,CDM,636,RC,J2997,HCPCS,50242004164,NDC,facility,outpatient,1,EA,456.75000,433.91000,Amish/Mennonite,Amish Mennonite,,251.21,,,,,,,94.15,443.05,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,inpatient,,,327.70000,311.32000,Amish/Mennonite,Amish Mennonite,90,180.24,,,,,,,180.24,317.87,percent of total billed charges,
ALUMINUM ASSAY-TECH,55342,CDM,300,RC,82108,CPT,,,facility,outpatient,,,327.70000,311.32000,Amish/Mennonite,Amish Mennonite,90,180.24,,,,,,,26.33,1324.17,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,inpatient,9,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,63323061609,NDC,facility,outpatient,9,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.50685,1.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,inpatient,9,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,72078004609,NDC,facility,outpatient,9,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,0.50685,2.64,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,inpatient,9,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
AMIODARONE HCL 7001218,55343,CDM,250,RC,J0282,HCPCS,67457015399,NDC,facility,outpatient,9,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.50685,1.43,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN PORK IGE-TECH,55344,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,inpatient,80,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00143988880,NDC,facility,outpatient,80,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,inpatient,80,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 25 MG/ML,55345,CDM,250,RC,J8499,HCPCS,00781603958,NDC,facility,outpatient,80,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,inpatient,1,EA,9108.37000,8652.95000,Amish/Mennonite,Amish Mennonite,,5009.60,,,,,,,5009.60,8835.12,percent of total billed charges,
ALTEPLASE REC INJECTION,55346,CDM,636,RC,J2997,HCPCS,50242004413,NDC,facility,outpatient,1,EA,9108.37000,8652.95000,Amish/Mennonite,Amish Mennonite,,5009.60,,,,,,,94.15,8835.12,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,51079013101,NDC,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,inpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16714044601,NDC,facility,outpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,16729017101,NDC,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,29300041901,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,50268003715,NDC,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,inpatient,1,EA,0.21000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,69367038801,NDC,facility,outpatient,1,EA,0.21000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70710122501,NDC,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
AMITRIPTYLINE TAB 10 MG,55347,CDM,250,RC,J8499,HCPCS,70756020111,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,171.05,301.67,percent of total billed charges,
ALLERGEN UPPER RESP PANEL (83279)-TECH,55348,CDM,300,RC,86003,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,4.57,301.67,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,inpatient,1,EA,5.05000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,00832011100,NDC,facility,outpatient,1,EA,5.05000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.52,4.90,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,10135069201,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
AMANTADINE TAB 100 MG,55349,CDM,250,RC,J8499,HCPCS,42543049701,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
AMNIOCENTESIS GUIDE-TECH,55350,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,76.00,548.00,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,inpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,50.93,89.82,percent of total billed charges,
ALLERGEN WEED PANEL 1SO - TECH,55351,CDM,300,RC,86003,CPT,,,facility,outpatient,,,92.60000,87.97000,Amish/Mennonite,Amish Mennonite,90,50.93,,,,,,,4.57,271.65,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00228202910,NDC,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00781107701,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,00904585961,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,51079078901,NDC,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,59762372001,NDC,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,60687038801,NDC,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,65862067701,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ALPRAZOLAM TAB 0.5 MG,55352,CDM,250,RC,J8499,HCPCS,68084001911,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,inpatient,20,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00409434673,NDC,facility,outpatient,20,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,inpatient,20,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517912025,NDC,facility,outpatient,20,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,inpatient,20,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
AMINOCAPROIC ACID SOLN-INJ 250 MG/ML 20 ML,55353,CDM,250,RC,J3490,HCPCS,00517919125,NDC,facility,outpatient,20,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,inpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00069152068,NDC,facility,outpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,00904636961,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,0090463706100050,NDC,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 2.5 MG,55354,CDM,250,RC,J8499,HCPCS,51079045001,NDC,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029902,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,00781261301,NDC,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,16714029903,NDC,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
AMOXICILLIN CAP 500 MG,55355,CDM,250,RC,J8499,HCPCS,65862001701,NDC,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,inpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.73,4.82,percent of total billed charges,
AMINOPHYLLINE SOLN 25 MG/ML 10 ML,55356,CDM,250,RC,J0280,HCPCS,00409592101,NDC,facility,outpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.48,18.34,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,inpatient,3,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987501,NDC,facility,outpatient,3,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.84150,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,inpatient,3,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,00143987510,NDC,facility,outpatient,3,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,inpatient,3,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,55150018003,NDC,facility,outpatient,3,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,0.50685,2.05,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,inpatient,3,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,63323061603,NDC,facility,outpatient,3,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.50685,1.78,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,inpatient,3,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015300,NDC,facility,outpatient,3,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.50685,1.37,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,inpatient,3,EA,4.04000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.92,percent of total billed charges,
AMIODARONE HCL 7034804,55357,CDM,250,RC,J0282,HCPCS,67457015303,NDC,facility,outpatient,3,EA,4.04000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,0.50685,3.92,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,51079010701,NDC,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,00904718461,NDC,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,inpatient,1,EA,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,50268003815,NDC,facility,outpatient,1,EA,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,60687043301,NDC,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
AMITRIPTYLINE 25 MG TAB,55358,CDM,250,RC,J8499,HCPCS,70756020211,NDC,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00603221421,NDC,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,inpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,00904718561,NDC,facility,outpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,inpatient,1,EA,1.43000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,16714025901,NDC,facility,outpatient,1,EA,1.43000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.71500,1.39,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,50268003915,NDC,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
AMITRIPTYLINE TAB 50 MG,55359,CDM,250,RC,J8499,HCPCS,60687044401,NDC,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,inpatient,50,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416173,NDC,facility,outpatient,50,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,inpatient,50,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00093416176,NDC,facility,outpatient,50,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,inpatient,50,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988750,NDC,facility,outpatient,50,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,inpatient,50,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00143988775,NDC,facility,outpatient,50,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,inpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615752,NDC,facility,outpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,inpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,00781615757,NDC,facility,outpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,inpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
AMOXICILLIN LIQ 80 MG/ML,55360,CDM,250,RC,J8499,HCPCS,65862007175,NDC,facility,outpatient,50,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,Amish/Mennonite,Amish Mennonite,QN,875.05,,,,,,,875.05,1543.27,percent of total billed charges,
ALS1-EMERGENCY-TECH,55361,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,Amish/Mennonite,Amish Mennonite,QN,875.05,,,,,,,795.50,1543.27,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014701,NDC,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,inpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00245014789,NDC,facility,outpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.85,3.59,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,inpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,00904655661,NDC,facility,outpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,68382022714,NDC,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,16714084401,NDC,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,51862024190,NDC,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,60687043701,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
AMIODARONE TAB 200 MG,55362,CDM,250,RC,J8499,HCPCS,63739005110,NDC,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,inpatient,1,EA,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,00904657261,NDC,facility,outpatient,1,EA,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,16714004210,NDC,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,51079020620,NDC,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,53489015701,NDC,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,inpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071301,NDC,facility,outpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,62584071311,NDC,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
ALLOPURINOL TAB 300 MG,55363,CDM,250,RC,J8499,HCPCS,63739079610,NDC,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,inpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00069153041,NDC,facility,outpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,9.83,19.07,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,00904637061,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039705,NDC,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,29300039719,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,51079045101,NDC,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
AMLODIPINE TAB 5 MG,55364,CDM,250,RC,J8499,HCPCS,60687048801,NDC,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,inpatient,30,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,50383080716,NDC,facility,outpatient,30,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,inpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
AMANTADINE SYRUP 10 MG/ML,55365,CDM,250,RC,J8499,HCPCS,60432009316,NDC,facility,outpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,inpatient,1,EA,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,16714047601,NDC,facility,outpatient,1,EA,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,7.50,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,42571016030,NDC,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,inpatient,1,EA,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,8.25,14.55,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 250 -125 MG,55366,CDM,250,RC,J8499,HCPCS,43598021830,NDC,facility,outpatient,1,EA,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,7.50,14.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,16729-0035-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,50268-0075-15,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,60687-0112-21,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.77,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
ANASTROZOLE TAB 1 MG,55367,CDM,250,RC,68382-0209-06,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,243.00000,230.85000,Amish/Mennonite,Amish Mennonite,HI,133.65,,,,,,,133.65,235.71,percent of total billed charges,
AMBULANCE HOSPITAL TO HELIPAD - TECH,55368,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,243.00000,230.85000,Amish/Mennonite,Amish Mennonite,HI,133.65,,,,,,,121.50,235.71,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,inpatient,,,536.00000,509.20000,Amish/Mennonite,Amish Mennonite,,294.80,,,,,,,294.80,519.92,percent of total billed charges,
AMNISURE ROM-TECH,55369,CDM,300,RC,84112,CPT,,,facility,outpatient,,,536.00000,509.20000,Amish/Mennonite,Amish Mennonite,,294.80,,,,,,,90.57,4617.66,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,inpatient,1,EA,24.37000,23.15000,Amish/Mennonite,Amish Mennonite,,13.40,,,,,,,13.40,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00049001383,NDC,facility,outpatient,1,EA,24.37000,23.15000,Amish/Mennonite,Amish Mennonite,,13.40,,,,,,,2.39,23.64,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,inpatient,1,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,7.30,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,00641611610,NDC,facility,outpatient,1,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,2.39,12.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,inpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,9.56,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,25021014220,NDC,facility,outpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,2.39,16.86,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,inpatient,1,EA,25.12000,23.87000,Amish/Mennonite,Amish Mennonite,,13.82,,,,,,,13.82,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,44567021010,NDC,facility,outpatient,1,EA,25.12000,23.87000,Amish/Mennonite,Amish Mennonite,,13.82,,,,,,,2.39,24.37,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,inpatient,1,EA,8.61000,8.18000,Amish/Mennonite,Amish Mennonite,,4.74,,,,,,,4.74,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,55150011620,NDC,facility,outpatient,1,EA,8.61000,8.18000,Amish/Mennonite,Amish Mennonite,,4.74,,,,,,,2.39,8.35,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,inpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,8.43,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,66794020641,NDC,facility,outpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,2.39,14.87,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,67457034810,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,2.39,9.20,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,inpatient,1,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.92,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,71288003121,NDC,facility,outpatient,1,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,2.39,15.72,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,inpatient,1,EA,9.95000,9.46000,Amish/Mennonite,Amish Mennonite,,5.47,,,,,,,5.47,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72485041610,NDC,facility,outpatient,1,EA,9.95000,9.46000,Amish/Mennonite,Amish Mennonite,,5.47,,,,,,,2.39,9.65,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,inpatient,1,EA,12.72000,12.08000,Amish/Mennonite,Amish Mennonite,,7.00,,,,,,,7.00,12.34,percent of total billed charges,
AMPICILLIN SODIUM 1 G-0.5 G,55370,CDM,250,RC,J0295,HCPCS,72603022010,NDC,facility,outpatient,1,EA,12.72000,12.08000,Amish/Mennonite,Amish Mennonite,,7.00,,,,,,,2.39,12.34,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,inpatient,1,EA,46.02000,43.72000,Amish/Mennonite,Amish Mennonite,,25.31,,,,,,,25.31,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00049001483,NDC,facility,outpatient,1,EA,46.02000,43.72000,Amish/Mennonite,Amish Mennonite,,25.31,,,,,,,2.39,44.64,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,inpatient,1,EA,24.08000,22.88000,Amish/Mennonite,Amish Mennonite,,13.24,,,,,,,13.24,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,00641611710,NDC,facility,outpatient,1,EA,24.08000,22.88000,Amish/Mennonite,Amish Mennonite,,13.24,,,,,,,2.39,23.36,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,inpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,25021014330,NDC,facility,outpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,2.39,27.59,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,inpatient,1,EA,50.40000,47.88000,Amish/Mennonite,Amish Mennonite,,27.72,,,,,,,27.72,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,44567021110,NDC,facility,outpatient,1,EA,50.40000,47.88000,Amish/Mennonite,Amish Mennonite,,27.72,,,,,,,2.39,48.89,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,inpatient,1,EA,16.92000,16.08000,Amish/Mennonite,Amish Mennonite,,9.31,,,,,,,9.31,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,55150011720,NDC,facility,outpatient,1,EA,16.92000,16.08000,Amish/Mennonite,Amish Mennonite,,9.31,,,,,,,2.39,16.41,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,inpatient,1,EA,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,10.86,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794020741,NDC,facility,outpatient,1,EA,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,2.39,19.16,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,inpatient,1,EA,17.85000,16.96000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,9.82,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,66794024241,NDC,facility,outpatient,1,EA,17.85000,16.96000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,2.39,17.31,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,inpatient,1,EA,12.50000,11.88000,Amish/Mennonite,Amish Mennonite,,6.88,,,,,,,6.88,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,67457034910,NDC,facility,outpatient,1,EA,12.50000,11.88000,Amish/Mennonite,Amish Mennonite,,6.88,,,,,,,2.39,12.12,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,inpatient,1,EA,25.82000,24.53000,Amish/Mennonite,Amish Mennonite,,14.20,,,,,,,14.20,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,71288003221,NDC,facility,outpatient,1,EA,25.82000,24.53000,Amish/Mennonite,Amish Mennonite,,14.20,,,,,,,2.39,25.05,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,inpatient,1,EA,16.75000,15.91000,Amish/Mennonite,Amish Mennonite,,9.21,,,,,,,9.21,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72485041710,NDC,facility,outpatient,1,EA,16.75000,15.91000,Amish/Mennonite,Amish Mennonite,,9.21,,,,,,,2.39,16.25,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,inpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,9.15,16.14,percent of total billed charges,
AMPICILLIN-SULBACTAM POWD-INJ 3 GM,55371,CDM,250,RC,J0295,HCPCS,72603033510,NDC,facility,outpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,2.39,16.14,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00093310719,NDC,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,00781202001,NDC,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
AMOXICILLIN CAP 250 MG,55372,CDM,250,RC,J8499,HCPCS,65862001601,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
AMYLASE ASSAY-TECH,55373,CDM,300,RC,82150,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,6.48,339.51,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,inpatient,80,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415573,NDC,facility,outpatient,80,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,inpatient,80,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415579,NDC,facility,outpatient,80,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,inpatient,80,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00093415580,NDC,facility,outpatient,80,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.12,4.10,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,inpatient,80,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988901,NDC,facility,outpatient,80,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,inpatient,80,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988915,NDC,facility,outpatient,80,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,inpatient,80,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00143988980,NDC,facility,outpatient,80,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,inpatient,80,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604146,NDC,facility,outpatient,80,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,inpatient,80,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604155,NDC,facility,outpatient,80,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,inpatient,80,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,00781604158,NDC,facility,outpatient,80,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,inpatient,80,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070701,NDC,facility,outpatient,80,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,inpatient,80,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
AMOXICILLIN LIQ 50 MG/ML,55374,CDM,250,RC,J8499,HCPCS,65862070780,NDC,facility,outpatient,80,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,1591.00000,1511.45000,Amish/Mennonite,Amish Mennonite,QN,875.05,,,,,,,875.05,1543.27,percent of total billed charges,
ALS 1-TECH,55375,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,1591.00000,1511.45000,Amish/Mennonite,Amish Mennonite,QN,875.05,,,,,,,795.50,1543.27,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
AMYLASE PANCREATIC-TECH,55376,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.48,339.51,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,215.05,379.27,percent of total billed charges,
AMPHETAMINES 5 OR >-TECH,55377,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,63.95,788.42,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,inpatient,75,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00093-8675-78,NDC,,,facility,outpatient,75,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,inpatient,75,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,65862-0535-75,NDC,,,facility,outpatient,75,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,inpatient,75,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,00781-6139-57,NDC,,,facility,outpatient,75,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,inpatient,75,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,16714-0294-01,NDC,,,facility,outpatient,75,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,inpatient,75,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN-CLAVULANATE POWDER 600 MG-42.9 MG/5 ML,55378,CDM,250,RC,63304-0768-01,NDC,,,facility,outpatient,75,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN WHITE ASH IGE-TECH,55379,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,51224-0162-12,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
ALUMINUM SULFATE-CALCIUM ACETATE TOPICAL POWD,55380,CDM,250,RC,57074-0001-77,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
ALLERGEN YELLOW JACKET IGE-TECH,55381,CDM,300,RC,86003,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.57,271.65,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,inpatient,1,EA,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,4.05,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00409371801,NDC,facility,outpatient,1,EA,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,0.78449,7.15,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,inpatient,1,EA,8.91000,8.46000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.90,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781340795,NDC,facility,outpatient,1,EA,8.91000,8.46000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,0.78449,8.64,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,inpatient,1,EA,11.14000,10.58000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,6.13,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,00781940795,NDC,facility,outpatient,1,EA,11.14000,10.58000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,0.78449,10.81,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,inpatient,1,EA,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,4.12,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,55150011210,NDC,facility,outpatient,1,EA,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,0.78449,7.27,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,inpatient,1,EA,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,4.27,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,65219001610,NDC,facility,outpatient,1,EA,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,0.78449,7.54,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,inpatient,1,EA,5.37000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,67850002410,NDC,facility,outpatient,1,EA,5.37000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,0.78449,5.21,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
AMPICILLIN INJECTION 7834252,55382,CDM,250,RC,J0290,HCPCS,70860011315,NDC,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,0.78449,3.68,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,inpatient,1,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
AMPHOTERICIN B,55383,CDM,250,RC,J0285,HCPCS,39822105505,NDC,facility,outpatient,1,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,54.63,147.13,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
ANCA ADDED CHARGE-TECH,55384,CDM,300,RC,83520,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,17.27,814.87,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1653.75,3273.75,percent of total billed charges,
2.9 BC LOOP N TACK TENDONDESIS IMPLANT SYSTEM,55385,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1549.12,3375.00,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,inpatient,1,EA,20.82000,19.78000,Amish/Mennonite,Amish Mennonite,,11.45,,,,,,,11.45,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00409372001,NDC,facility,outpatient,1,EA,20.82000,19.78000,Amish/Mennonite,Amish Mennonite,,11.45,,,,,,,0.78449,20.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,inpatient,1,EA,22.45000,21.32000,Amish/Mennonite,Amish Mennonite,,12.35,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781340895,NDC,facility,outpatient,1,EA,22.45000,21.32000,Amish/Mennonite,Amish Mennonite,,12.35,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,inpatient,1,EA,347.11000,329.76000,Amish/Mennonite,Amish Mennonite,,190.91,,,,,,,190.91,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781927395,NDC,facility,outpatient,1,EA,347.11000,329.76000,Amish/Mennonite,Amish Mennonite,,190.91,,,,,,,0.78449,336.70,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,inpatient,1,EA,42.35000,40.23000,Amish/Mennonite,Amish Mennonite,,23.29,,,,,,,23.29,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781940895,NDC,facility,outpatient,1,EA,42.35000,40.23000,Amish/Mennonite,Amish Mennonite,,23.29,,,,,,,0.78449,41.08,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,inpatient,1,EA,87.84000,83.45000,Amish/Mennonite,Amish Mennonite,,48.31,,,,,,,48.31,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,00781941392,NDC,facility,outpatient,1,EA,87.84000,83.45000,Amish/Mennonite,Amish Mennonite,,48.31,,,,,,,0.78449,85.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,25021013720,NDC,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,0.78449,22.99,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,44567010310,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,0.78449,33.72,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,inpatient,1,EA,22.45000,21.33000,Amish/Mennonite,Amish Mennonite,,12.35,,,,,,,12.35,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,55150011420,NDC,facility,outpatient,1,EA,22.45000,21.33000,Amish/Mennonite,Amish Mennonite,,12.35,,,,,,,0.78449,21.78,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,67850002210,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,70860011526,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,inpatient,1,EA,22.47000,21.34000,Amish/Mennonite,Amish Mennonite,,12.36,,,,,,,12.36,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72485042210,NDC,facility,outpatient,1,EA,22.47000,21.34000,Amish/Mennonite,Amish Mennonite,,12.36,,,,,,,0.78449,21.80,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,inpatient,1,EA,24.98000,23.73000,Amish/Mennonite,Amish Mennonite,,13.74,,,,,,,13.74,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834261,55386,CDM,250,RC,J0290,HCPCS,72603045410,NDC,facility,outpatient,1,EA,24.98000,23.73000,Amish/Mennonite,Amish Mennonite,,13.74,,,,,,,0.78449,24.23,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,inpatient,1,EA,11.23000,10.67000,Amish/Mennonite,Amish Mennonite,,6.18,,,,,,,6.18,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00409372601,NDC,facility,outpatient,1,EA,11.23000,10.67000,Amish/Mennonite,Amish Mennonite,,6.18,,,,,,,0.78449,10.89,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,inpatient,1,EA,21.83000,20.74000,Amish/Mennonite,Amish Mennonite,,12.01,,,,,,,12.01,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781940495,NDC,facility,outpatient,1,EA,21.83000,20.74000,Amish/Mennonite,Amish Mennonite,,12.01,,,,,,,0.78449,21.18,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,inpatient,1,EA,17.46000,16.59000,Amish/Mennonite,Amish Mennonite,,9.60,,,,,,,9.60,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781340495,NDC,facility,outpatient,1,EA,17.46000,16.59000,Amish/Mennonite,Amish Mennonite,,9.60,,,,,,,0.78449,16.94,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,inpatient,1,EA,45.28000,43.02000,Amish/Mennonite,Amish Mennonite,,24.90,,,,,,,24.90,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781341292,NDC,facility,outpatient,1,EA,45.28000,43.02000,Amish/Mennonite,Amish Mennonite,,24.90,,,,,,,0.78449,43.92,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,inpatient,1,EA,218.29000,207.38000,Amish/Mennonite,Amish Mennonite,,120.06,,,,,,,120.06,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,00781926195,NDC,facility,outpatient,1,EA,218.29000,207.38000,Amish/Mennonite,Amish Mennonite,,120.06,,,,,,,0.78449,211.74,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,25021013610,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.78449,15.33,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,44567010210,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,0.78449,18.39,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,inpatient,1,EA,15.31000,14.54000,Amish/Mennonite,Amish Mennonite,,8.42,,,,,,,8.42,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,55150011310,NDC,facility,outpatient,1,EA,15.31000,14.54000,Amish/Mennonite,Amish Mennonite,,8.42,,,,,,,0.78449,14.85,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,67850002110,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.78449,9.20,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
AMPICILLIN INJECTION 7834260,55387,CDM,250,RC,J0290,HCPCS,70594008602,NDC,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,0.78449,10.73,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,107.80,190.12,percent of total billed charges,
ANTIDEPRESSANTS NOS-TECH,55388,CDM,300,RC,80338,CPT,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,98.00,190.12,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
ALLERGEN WEED PANEL 2-TECH,55389,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,4.57,271.65,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
ANTINUCLEAR ANTIBODIES TITER-TECH,55390,CDM,300,RC,86039,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,11.16,577.23,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ANA ANTINUCLEAR ANTIBODIES-TECH,55391,CDM,300,RC,86235,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,17.93,933.70,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,90,56.65,,,,,,,56.65,99.91,percent of total billed charges,
METHSUXIMIDE (CELONTIN) (78) SO,55392,CDM,300,RC,80339,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,90,56.65,,,,,,,51.50,1137.41,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,inpatient,1,EA,87.62000,83.24000,Amish/Mennonite,Amish Mennonite,,48.19,,,,,,,48.19,84.99,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 1% UD,55393,CDM,250,RC,82667-0200-01,NDC,,,facility,outpatient,1,EA,87.62000,83.24000,Amish/Mennonite,Amish Mennonite,,48.19,,,,,,,43.81,84.99,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,inpatient,50,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,00143998250,NDC,facility,outpatient,50,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,inpatient,50,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101200,NDC,facility,outpatient,50,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,inpatient,50,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,16714029302,NDC,facility,outpatient,50,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,inpatient,50,EA,57.64000,54.76000,Amish/Mennonite,Amish Mennonite,,31.70,,,,,,,31.70,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,63304097904,NDC,facility,outpatient,50,EA,57.64000,54.76000,Amish/Mennonite,Amish Mennonite,,31.70,,,,,,,28.82,55.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,inpatient,50,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 400 MG-57 MG/5 ML,55394,CDM,250,RC,J8499,HCPCS,66685101202,NDC,facility,outpatient,50,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,inpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,62.70,110.58,percent of total billed charges,
ANTIPSYCHOTICS NOS 1-2-TECH,55395,CDM,300,RC,80342,CPT,,,facility,outpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,57.00,1137.41,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,inpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,00904637161,NDC,facility,outpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,31722023990,NDC,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
AMLODIPINE TAB 10 MG,55396,CDM,250,RC,J8499,HCPCS,69097012805,NDC,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
ANGIOTENSIN I CONVERT ENZYME-TECH,55398,CDM,300,RC,82164,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,14.60,763.98,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,231.00,407.40,percent of total billed charges,
ANAPLASMA EHRLICHIA NUCLEIC ACID TEST-TECH,55399,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,35.09,1833.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,inpatient,1,mL,302.21000,287.10000,Amish/Mennonite,Amish Mennonite,,166.22,,,,,,,166.22,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00143928801,NDC,facility,outpatient,1,mL,302.21000,287.10000,Amish/Mennonite,Amish Mennonite,,166.22,,,,,,,0.74000,293.14,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,inpatient,1,mL,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,284.90,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,63323052603,NDC,facility,outpatient,1,mL,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,0.74000,502.46,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,inpatient,1,mL,281.47000,267.40000,Amish/Mennonite,Amish Mennonite,,154.81,,,,,,,154.81,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,00409114001,NDC,facility,outpatient,1,mL,281.47000,267.40000,Amish/Mennonite,Amish Mennonite,,154.81,,,,,,,0.74000,273.03,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,inpatient,1,mL,528.36000,501.94000,Amish/Mennonite,Amish Mennonite,,290.60,,,,,,,290.60,512.51,percent of total billed charges,
ARGATROBAN SOLN 100 MG/ML 2.5 ML,55400,CDM,636,RC,J0883,HCPCS,67457021202,NDC,facility,outpatient,1,mL,528.36000,501.94000,Amish/Mennonite,Amish Mennonite,,290.60,,,,,,,0.74000,512.51,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,inpatient,1,EA,5.33000,5.07000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,43598022114,NDC,facility,outpatient,1,EA,5.33000,5.07000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.67,5.17,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,inpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,00143924920,NDC,facility,outpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,inpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714001401,NDC,facility,outpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.77,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,inpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047802,NDC,facility,outpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.62,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,16714047801,NDC,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.78,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,65862050320,NDC,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,inpatient,1,EA,5.12000,4.86000,Amish/Mennonite,Amish Mennonite,,2.82,,,,,,,2.82,4.97,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 875 -125 MG,55401,CDM,250,RC,J8499,HCPCS,66685100101,NDC,facility,outpatient,1,EA,5.12000,4.86000,Amish/Mennonite,Amish Mennonite,,2.82,,,,,,,2.56,4.97,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,inpatient,,,172.20000,163.59000,Amish/Mennonite,Amish Mennonite,90,94.71,,,,,,,94.71,167.03,percent of total billed charges,
ANTIDEPRES CYCLICALS 1 OR 2-TECH,55403,CDM,300,RC,80335,CPT,,,facility,outpatient,,,172.20000,163.59000,Amish/Mennonite,Amish Mennonite,90,94.71,,,,,,,86.10,1137.41,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
ANTIBODY ID RBC EACH PANEL-TECH,55405,CDM,300,RC,86870,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,2122.08,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,inpatient,1,EA,132.86000,126.22000,Amish/Mennonite,Amish Mennonite,,73.07,,,,,,,73.07,128.87,percent of total billed charges,
ARIPIPRAZOLE TAB 20 MG,55406,CDM,250,RC,J8499,HCPCS,59148001013,NDC,facility,outpatient,1,EA,132.86000,126.22000,Amish/Mennonite,Amish Mennonite,,73.07,,,,,,,66.43,128.87,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,86.35,152.29,percent of total billed charges,
AMINO ACIDS >=6 QUANT EA-TECH,55407,CDM,300,RC,82139,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,16.87,882.80,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,inpatient,,,224.30000,213.08000,Amish/Mennonite,Amish Mennonite,90,123.36,,,,,,,123.36,217.57,percent of total billed charges,
ARSENIC ASSAY-TECH,55409,CDM,300,RC,82175,CPT,,,facility,outpatient,,,224.30000,213.08000,Amish/Mennonite,Amish Mennonite,90,123.36,,,,,,,19.60,984.66,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,inpatient,,,1022.00000,970.90000,Amish/Mennonite,Amish Mennonite,,562.10,,,,,,,562.10,991.34,percent of total billed charges,
ARTHCS ASP/INJ SM JT W US-TECH,55410,CDM,361,RC,20604,CPT,,,facility,outpatient,,,1022.00000,970.90000,Amish/Mennonite,Amish Mennonite,,562.10,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1117.00000,1061.15000,Amish/Mennonite,Amish Mennonite,,614.35,,,,,,,614.35,1083.49,percent of total billed charges,
ARTHCS ASP/INJ MJR JT W US-TECH-MIL,55412,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1117.00000,1061.15000,Amish/Mennonite,Amish Mennonite,,614.35,,,,,,,280.29,3163.00,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP INJ INT JT WO US-TECH,55413,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,3163.00,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,inpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,,1356.30,,,,,,,1356.30,2392.02,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US 4093727-TECH,55414,CDM,361,RC,20600,CPT,,,facility,outpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,,1356.30,,,,,,,280.29,3163.00,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.36,percent of total billed charges,
ASPIRIN-BUTALBITAL-CAFFEINE CAP 325-50-40 MG,55415,CDM,250,RC,00591-3219-01,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.36,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,inpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089421,NDC,facility,outpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,inpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 5 MG,55416,CDM,250,RC,J8499,HCPCS,00003089431,NDC,facility,outpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,15.65,30.37,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,inpatient,,,339.80000,322.81000,Amish/Mennonite,Amish Mennonite,90,186.89,,,,,,,186.89,329.61,percent of total billed charges,
ANDROSTENEDIONE ASSAY SO-TECH,55417,CDM,300,RC,82157,CPT,,,facility,outpatient,,,339.80000,322.81000,Amish/Mennonite,Amish Mennonite,90,186.89,,,,,,,30.26,1527.89,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-21,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,inpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,17.22,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0893-31,NDC,,,facility,outpatient,1,EA,31.31000,29.74000,Amish/Mennonite,Amish Mennonite,,17.22,,,,,,,15.65,30.37,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,inpatient,1,EA,19.43000,18.46000,Amish/Mennonite,Amish Mennonite,,10.69,,,,,,,10.69,18.85,percent of total billed charges,
APIXABAN TAB 2.5 MG,55419,CDM,250,RC,00003-0894-31-00050,NDC,,,facility,outpatient,1,EA,19.43000,18.46000,Amish/Mennonite,Amish Mennonite,,10.69,,,,,,,9.71,18.85,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,inpatient,1,EA,277.92000,264.03000,Amish/Mennonite,Amish Mennonite,,152.86,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058340,NDC,facility,outpatient,1,EA,277.92000,264.03000,Amish/Mennonite,Amish Mennonite,,152.86,,,,,,,4.35,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,inpatient,1,EA,277.92000,264.02000,Amish/Mennonite,Amish Mennonite,,152.86,,,,,,,152.86,269.58,percent of total billed charges,
APREPITANT CAP,55420,CDM,250,RC,J8501,HCPCS,68462058385,NDC,facility,outpatient,1,EA,277.92000,264.02000,Amish/Mennonite,Amish Mennonite,,152.86,,,,,,,4.35,269.58,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,968.06,percent of total billed charges,
ASP INTERDISCAL DX PERQ-TECH,55421,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,3163.00,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,inpatient,1,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,16714078501,NDC,facility,outpatient,1,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.61,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,27241005303,NDC,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,33342012407,NDC,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,inpatient,1,EA,31.53000,29.95000,Amish/Mennonite,Amish Mennonite,,17.34,,,,,,,17.34,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,50268008915,NDC,facility,outpatient,1,EA,31.53000,29.95000,Amish/Mennonite,Amish Mennonite,,17.34,,,,,,,15.77,30.58,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,inpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,59148000813,NDC,facility,outpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,inpatient,1,EA,25.96000,24.66000,Amish/Mennonite,Amish Mennonite,,14.28,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,60687017901,NDC,facility,outpatient,1,EA,25.96000,24.66000,Amish/Mennonite,Amish Mennonite,,14.28,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 10 MG,55422,CDM,250,RC,J8499,HCPCS,65862066330,NDC,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,inpatient,1,EA,76.37000,72.55000,Amish/Mennonite,Amish Mennonite,,42.00,,,,,,,42.00,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,00904650904,NDC,facility,outpatient,1,EA,76.37000,72.55000,Amish/Mennonite,Amish Mennonite,,42.00,,,,,,,38.19,74.08,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,13668021630,NDC,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,16714078301,NDC,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,inpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,43598055430,NDC,facility,outpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,inpatient,1,EA,35.86000,34.06000,Amish/Mennonite,Amish Mennonite,,19.72,,,,,,,19.72,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,50268008712,NDC,facility,outpatient,1,EA,35.86000,34.06000,Amish/Mennonite,Amish Mennonite,,19.72,,,,,,,17.93,34.78,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,inpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,59148000613,NDC,facility,outpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,inpatient,1,EA,29.53000,28.05000,Amish/Mennonite,Amish Mennonite,,16.24,,,,,,,16.24,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,60687015721,NDC,facility,outpatient,1,EA,29.53000,28.05000,Amish/Mennonite,Amish Mennonite,,16.24,,,,,,,14.77,28.64,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,inpatient,1,EA,26.67000,25.34000,Amish/Mennonite,Amish Mennonite,,14.67,,,,,,,14.67,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,63739006933,NDC,facility,outpatient,1,EA,26.67000,25.34000,Amish/Mennonite,Amish Mennonite,,14.67,,,,,,,13.34,25.87,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,inpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,65162089603,NDC,facility,outpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,inpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,67877043003,NDC,facility,outpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 2 MG,55423,CDM,250,RC,J8499,HCPCS,72865018030,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,inpatient,1,EA,26.45000,25.13000,Amish/Mennonite,Amish Mennonite,,14.55,,,,,,,14.55,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651006,NDC,facility,outpatient,1,EA,26.45000,25.13000,Amish/Mennonite,Amish Mennonite,,14.55,,,,,,,13.22,25.66,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,inpatient,1,EA,70.70000,67.17000,Amish/Mennonite,Amish Mennonite,,38.88,,,,,,,38.88,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,00904651061,NDC,facility,outpatient,1,EA,70.70000,67.17000,Amish/Mennonite,Amish Mennonite,,38.88,,,,,,,35.35,68.58,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,inpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43598055530,NDC,facility,outpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,inpatient,1,EA,3.78000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16714078401,NDC,facility,outpatient,1,EA,3.78000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.89,3.67,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,16729027901,NDC,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,31722082030,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,inpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,43547030303,NDC,facility,outpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,50268008815,NDC,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,inpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,59148000713,NDC,facility,outpatient,1,EA,93.95000,89.26000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,inpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60505267303,NDC,facility,outpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,inpatient,1,EA,25.96000,24.66000,Amish/Mennonite,Amish Mennonite,,14.28,,,,,,,14.28,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,60687016801,NDC,facility,outpatient,1,EA,25.96000,24.66000,Amish/Mennonite,Amish Mennonite,,14.28,,,,,,,12.98,25.18,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,inpatient,1,EA,17.97000,17.07000,Amish/Mennonite,Amish Mennonite,,9.88,,,,,,,9.88,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,63739007010,NDC,facility,outpatient,1,EA,17.97000,17.07000,Amish/Mennonite,Amish Mennonite,,9.88,,,,,,,8.98,17.43,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
ARIPIPRAZOLE TAB 5 MG,55424,CDM,250,RC,J8499,HCPCS,67877043103,NDC,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ASPIRATION/INJ JOINT - ORTHO TX DONE-TECH,55425,CDM,361,RC,20605,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,3163.00,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,inpatient,1,EA,4.46000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,43598020614,NDC,facility,outpatient,1,EA,4.46000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.33,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,inpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00378083094,NDC,facility,outpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,00781183120,NDC,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,inpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.23,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714049401,NDC,facility,outpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.03,3.94,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,16714047701,NDC,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016101,NDC,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,42571016142,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,inpatient,1,EA,4.94000,4.70000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.72,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,49884029812,NDC,facility,outpatient,1,EA,4.94000,4.70000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.47,4.79,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
AMOXICILLIN-CLAVULANATE TAB 500 -125 MG,55428,CDM,250,RC,J8499,HCPCS,65862050220,NDC,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,inpatient,1,EA,53.59000,50.91000,Amish/Mennonite,Amish Mennonite,,29.47,,,,,,,29.47,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517100125,NDC,facility,outpatient,1,EA,53.59000,50.91000,Amish/Mennonite,Amish Mennonite,,29.47,,,,,,,0.11207,51.98,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,inpatient,1,EA,39.69000,37.71000,Amish/Mennonite,Amish Mennonite,,21.83,,,,,,,21.83,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,00517101025,NDC,facility,outpatient,1,EA,39.69000,37.71000,Amish/Mennonite,Amish Mennonite,,21.83,,,,,,,0.11207,38.50,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,inpatient,1,EA,18.36000,17.44000,Amish/Mennonite,Amish Mennonite,,10.10,,,,,,,10.10,17.81,percent of total billed charges,
ATROPINE SOLN 1 MG/ML,55431,CDM,250,RC,J0461,HCPCS,16729052608,NDC,facility,outpatient,1,EA,18.36000,17.44000,Amish/Mennonite,Amish Mennonite,,10.10,,,,,,,0.11207,17.81,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,inpatient,1,EA,15.63000,14.85000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,8.60,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,16714-0964-01,NDC,,,facility,outpatient,1,EA,15.63000,14.85000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,7.82,15.16,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,inpatient,1,EA,15.88000,15.09000,Amish/Mennonite,Amish Mennonite,,8.73,,,,,,,8.73,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,42291-0116-60,NDC,,,facility,outpatient,1,EA,15.88000,15.09000,Amish/Mennonite,Amish Mennonite,,8.73,,,,,,,7.94,15.40,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,inpatient,1,EA,15.76000,14.97000,Amish/Mennonite,Amish Mennonite,,8.67,,,,,,,8.67,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,65162-0596-06,NDC,,,facility,outpatient,1,EA,15.76000,14.97000,Amish/Mennonite,Amish Mennonite,,8.67,,,,,,,7.88,15.29,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.46,percent of total billed charges,
ASPIRIN-DIPYRIDAMOLE CAP-ER 25 MG -200 MG,55432,CDM,250,RC,68462-0405-60,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.46,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
IMMUNOFIXATION ELECTROPHORESIS-TECH,55433,CDM,300,RC,86334,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,22.34,2082.45,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-60,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
ASCORBIC ACID TAB,55435,CDM,250,RC,00904-0523-72,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TECH,55437,CDM,361,RC,20610,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,3163.00,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
AST SGOT-TECH,55438,CDM,300,RC,84450,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,5.18,271.65,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,inpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,115.50,203.70,percent of total billed charges,
ASP BRST CYST -TECH,55439,CDM,361,RC,19001,CPT,,,facility,outpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,115.50,5271.00,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
ASPERGILLUS AB-TECH,55440,CDM,300,RC,86606,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,780.94,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,90,77.00,,,,,,,77.00,135.80,percent of total billed charges,
ASPERGILLUS AG SERUM SO-TECH,55441,CDM,300,RC,87305,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,90,77.00,,,,,,,12.38,628.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,00904-6291-61,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,50268-0094-15,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0209-20,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,51079-0410-01,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,63739-0020-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 20 MG,55442,CDM,250,RC,68084-0098-11,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
ALLERGEN HALIBUT IGE-TECH,55443,CDM,300,RC,86003,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,4.57,271.65,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,inpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,,601.15,,,,,,,601.15,1060.21,percent of total billed charges,
ARTHCS ASP/INJ INT JT W US-TECH,55444,CDM,402,RC,20606,CPT,,,facility,outpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,,601.15,,,,,,,384.16,1060.21,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR-TECH,55445,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,43.81,161.02,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,inpatient,1,EA,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,,32.12,,,,,,,32.12,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-23,NDC,,,facility,outpatient,1,EA,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,,32.12,,,,,,,29.20,56.65,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,inpatient,1,EA,47.24000,44.88000,Amish/Mennonite,Amish Mennonite,,25.98,,,,,,,25.98,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00071-0158-92,NDC,,,facility,outpatient,1,EA,47.24000,44.88000,Amish/Mennonite,Amish Mennonite,,25.98,,,,,,,23.62,45.82,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,00904-6293-04,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0211-03,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,51079-0412-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,60505-2671-09,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-25,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
ATORVASTATIN TAB 80 MG,55447,CDM,250,RC,68084-0590-95,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,inpatient,1,GM,15.81000,15.02000,Amish/Mennonite,Amish Mennonite,,8.70,,,,,,,8.70,15.34,percent of total billed charges,
ATROPINE OPHTH OINT,55448,CDM,250,RC,24208-0825-55,NDC,,,facility,outpatient,1,GM,15.81000,15.02000,Amish/Mennonite,Amish Mennonite,,8.70,,,,,,,7.91,15.34,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,inpatient,60,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
ATROPINE-DIPHENOXYLATE LIQUID,55449,CDM,250,RC,00054-3194-46,NDC,,,facility,outpatient,60,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,inpatient,1,EA,35.04000,33.29000,Amish/Mennonite,Amish Mennonite,,19.27,,,,,,,19.27,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,00009024101,NDC,facility,outpatient,1,EA,35.04000,33.29000,Amish/Mennonite,Amish Mennonite,,19.27,,,,,,,17.52,33.99,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,inpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027702,NDC,facility,outpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,10.27,19.92,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,inpatient,1,EA,21.24000,20.17000,Amish/Mennonite,Amish Mennonite,,11.68,,,,,,,11.68,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,39822027705,NDC,facility,outpatient,1,EA,21.24000,20.17000,Amish/Mennonite,Amish Mennonite,,11.68,,,,,,,10.62,20.60,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002602,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,inpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
"BACITRACIN POWD-INJ 50,000 UNITS",55450,CDM,250,RC,J3490,HCPCS,70594002604,NDC,facility,outpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.37,10.42,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,inpatient,10,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409163010,NDC,facility,outpatient,10,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,0.11207,2.86,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,inpatient,10,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491111,NDC,facility,outpatient,10,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,0.11207,2.83,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,inpatient,10,EA,5.30000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,00409491134,NDC,facility,outpatient,10,EA,5.30000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,0.11207,5.14,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,inpatient,10,EA,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329334001,NDC,facility,outpatient,10,EA,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,0.11207,3.19,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,inpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,64253040091,NDC,facility,outpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.11207,3.07,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,inpatient,10,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
ATROPINE SYRINGE 1 MG/10 ML,55451,CDM,250,RC,J0461,HCPCS,76329333901,NDC,facility,outpatient,10,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,0.11207,2.75,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,51079-0684-20,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ATENOLOL TAB 50 MG,55452,CDM,250,RC,63304-0622-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,inpatient,1,mL,28.25000,26.84000,Amish/Mennonite,Amish Mennonite,,15.54,,,,,,,15.54,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,63402091130,NDC,facility,outpatient,1,mL,28.25000,26.84000,Amish/Mennonite,Amish Mennonite,,15.54,,,,,,,1.06,27.40,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,inpatient,1,mL,10.13000,9.63000,Amish/Mennonite,Amish Mennonite,,5.57,,,,,,,5.57,9.83,percent of total billed charges,
ARFORMOTEROL NON-COMP UNIT,55453,CDM,250,RC,J7605,HCPCS,69097016887,NDC,facility,outpatient,1,mL,10.13000,9.63000,Amish/Mennonite,Amish Mennonite,,5.57,,,,,,,1.06,9.83,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,inpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,TC,308.00,,,,,,,308.00,543.20,percent of total billed charges,
AUD EVOKED POTENTIAL COMPR-TECH,55455,CDM,471,RC,92650,CPT,,,facility,outpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,TC,308.00,,,,,,,280.00,543.20,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,37.78,66.64,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGM-TECH,55456,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,34.35,66.64,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,00904-6290-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,16714-0874-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,50268-0093-15,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,51079-0208-20,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,60505-2578-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,63739-0018-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,68084-0097-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
ATORVASTATIN TAB 10 MG,55457,CDM,250,RC,72205-0022-90,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,inpatient,1,EA,1587.93000,1508.53000,Amish/Mennonite,Amish Mennonite,,873.36,,,,,,,873.36,1540.29,percent of total billed charges,
BELIMUMAB INJECTION,55458,CDM,636,RC,J0490,HCPCS,49401010101,NDC,facility,outpatient,1,EA,1587.93000,1508.53000,Amish/Mennonite,Amish Mennonite,,873.36,,,,,,,56.01,1540.29,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00536-1263-28,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,inpatient,30,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,00713-0280-31,NDC,,,facility,outpatient,30,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,45802-0060-03,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,49348-0154-72,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,inpatient,30,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,58980-0011-10,NDC,,,facility,outpatient,30,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,inpatient,30,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 30 GM,55459,CDM,250,RC,61269-0105-56,NDC,,,facility,outpatient,30,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
ANTIGLOMERULAR BASEMNT MEMBR AB-TECH,55460,CDM,300,RC,83516,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,11.53,594.19,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
ARTERIAL PUNC WITHDRAW BLD-TECH,55461,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,3163.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039814,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,3.44,9.20,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,00069315083,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,3.44,18.39,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,inpatient,1,EA,9.25000,8.79000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,5.09,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,25021018066,NDC,facility,outpatient,1,EA,9.25000,8.79000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,3.44,8.97,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,inpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,10.77,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,55150017410,NDC,facility,outpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,3.44,19.00,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70095002502,NDC,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,3.44,10.73,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,inpatient,1,EA,23.48000,22.30000,Amish/Mennonite,Amish Mennonite,,12.91,,,,,,,12.91,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039810,NDC,facility,outpatient,1,EA,23.48000,22.30000,Amish/Mennonite,Amish Mennonite,,12.91,,,,,,,3.44,22.78,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,inpatient,1,EA,217.44000,206.57000,Amish/Mennonite,Amish Mennonite,,119.59,,,,,,,119.59,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,63323039812,NDC,facility,outpatient,1,EA,217.44000,206.57000,Amish/Mennonite,Amish Mennonite,,119.59,,,,,,,3.44,210.92,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,inpatient,1,EA,14.85000,14.11000,Amish/Mennonite,Amish Mennonite,,8.17,,,,,,,8.17,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70436001982,NDC,facility,outpatient,1,EA,14.85000,14.11000,Amish/Mennonite,Amish Mennonite,,8.17,,,,,,,3.44,14.40,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860010010,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,3.44,15.33,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,inpatient,1,EA,10.98000,10.43000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,6.04,10.65,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG,55462,CDM,250,RC,J0456,HCPCS,70860012566,NDC,facility,outpatient,1,EA,10.98000,10.43000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,3.44,10.65,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,inpatient,15,EA,5.51000,5.24000,Amish/Mennonite,Amish Mennonite,,3.03,,,,,,,3.03,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,00093202723,NDC,facility,outpatient,15,EA,5.51000,5.24000,Amish/Mennonite,Amish Mennonite,,3.03,,,,,,,2.75,5.34,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,inpatient,15,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,42806014731,NDC,facility,outpatient,15,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,inpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59651000715,NDC,facility,outpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,inpatient,15,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,59762311001,NDC,facility,outpatient,15,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,inpatient,15,EA,4.44000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.31,percent of total billed charges,
AZITHROMYCIN LIQ 20 MG/ML,55463,CDM,250,RC,Q0144,HCPCS,70710145701,NDC,facility,outpatient,15,EA,4.44000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.22,4.31,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,inpatient,,,180.30000,171.28000,Amish/Mennonite,Amish Mennonite,90,99.17,,,,,,,99.17,174.89,percent of total billed charges,
BENZODIAZEPINES 1-12-TECH,55464,CDM,300,RC,80346,CPT,,,facility,outpatient,,,180.30000,171.28000,Amish/Mennonite,Amish Mennonite,90,99.17,,,,,,,90.15,1137.41,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00378-0415-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00406-1236-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,00832-0590-11,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,59762-1061-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,60687-0569-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,62559-0490-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,69315-0910-01,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
ATROPINE-DIPHENOXYLATE TAB,55466,CDM,250,RC,71205-0909-90,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,inpatient,,,1903.00000,1807.85000,Amish/Mennonite,Amish Mennonite,90,1046.65,,,,,,,1046.65,1845.91,percent of total billed charges,
BCR/ABL1 MJR BKPT QUAL/QUANT-TECH,55467,CDM,310,RC,81206,CPT,,,facility,outpatient,,,1903.00000,1807.85000,Amish/Mennonite,Amish Mennonite,90,1046.65,,,,,,,169.42,8573.20,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
BARBITURATES-TECH,55468,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,63.95,788.42,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,inpatient,1,EA,10.91000,10.36000,Amish/Mennonite,Amish Mennonite,,6.00,,,,,,,6.00,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00069406189,NDC,facility,outpatient,1,EA,10.91000,10.36000,Amish/Mennonite,Amish Mennonite,,6.00,,,,,,,5.46,10.58,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,inpatient,1,EA,3.90000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,00904735006,NDC,facility,outpatient,1,EA,3.90000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,42291008230,NDC,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,inpatient,1,EA,6.72000,6.38000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.70,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68180016006,NDC,facility,outpatient,1,EA,6.72000,6.38000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.36,6.52,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,inpatient,1,EA,4.45000,4.22000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,65862064163,NDC,facility,outpatient,1,EA,4.45000,4.22000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.32,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007413,NDC,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,inpatient,1,EA,2.75000,2.62000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268007415,NDC,facility,outpatient,1,EA,2.75000,2.62000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.38,2.67,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,50268009815,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,inpatient,1,EA,5.37000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,59762219807,NDC,facility,outpatient,1,EA,5.37000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.69,5.21,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,inpatient,1,EA,5.49000,5.21000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,68084027811,NDC,facility,outpatient,1,EA,5.49000,5.21000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,2.75,5.33,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,60687074265,NDC,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.78,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,inpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,64679096105,NDC,facility,outpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,inpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.71,percent of total billed charges,
AZITHROMYCIN TAB 250 MG,55469,CDM,250,RC,Q0144,HCPCS,69452017113,NDC,facility,outpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.40,2.71,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,113.85,200.79,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLETE SMPL-TECH,55470,CDM,361,RC,11730,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,113.85,3163.00,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,inpatient,,,63.50000,60.32000,Amish/Mennonite,Amish Mennonite,,34.92,,,,,,,34.92,61.59,percent of total billed charges,
BEHAV CHNG SMOKING >10 MIN-TECH,55472,CDM,960,RC,99407,CPT,,,facility,outpatient,,,63.50000,60.32000,Amish/Mennonite,Amish Mennonite,,34.92,,,,,,,28.29,61.59,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,00904-7187-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
ATENOLOL TAB 25 MG,55473,CDM,250,RC,51079-0759-20,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,inpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,00378100501,NDC,facility,outpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,60219107601,NDC,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68084022901,NDC,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,3.53,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
AZATHIOPRINE TAB,55474,CDM,250,RC,J7500,HCPCS,68382000301,NDC,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,3.53,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,inpatient,1,EA,56.72000,53.89000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,31.20,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60219-1748-02,NDC,,,facility,outpatient,1,EA,56.72000,53.89000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,28.36,55.02,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,inpatient,5,EA,57.46000,54.59000,Amish/Mennonite,Amish Mennonite,,31.60,,,,,,,31.60,55.74,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 2 ML,55475,CDM,250,RC,60505-6226-00,NDC,,,facility,outpatient,5,EA,57.46000,54.59000,Amish/Mennonite,Amish Mennonite,,31.60,,,,,,,28.73,55.74,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,inpatient,1,EA,31.16000,29.60000,Amish/Mennonite,Amish Mennonite,,17.14,,,,,,,17.14,30.23,percent of total billed charges,
AZITHROMYCIN POWD-INJ 500 MG A/V,55476,CDM,250,RC,J0456,HCPCS,00409014411,NDC,facility,outpatient,1,EA,31.16000,29.60000,Amish/Mennonite,Amish Mennonite,,17.14,,,,,,,3.44,30.23,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,2234.00000,2122.30000,Amish/Mennonite,Amish Mennonite,QN,1228.70,,,,,,,1228.70,2166.98,percent of total billed charges,
ALS 2-TECH,55477,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,2234.00000,2122.30000,Amish/Mennonite,Amish Mennonite,QN,1228.70,,,,,,,1117.00,2166.98,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,inpatient,3.5,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,00574-4021-35,NDC,,,facility,outpatient,3.5,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,9.83,19.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,inpatient,3.5,EA,12.55000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.90,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,17478-0238-35,NDC,,,facility,outpatient,3.5,EA,12.55000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.28,12.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,inpatient,3.5,EA,20.69000,19.66000,Amish/Mennonite,Amish Mennonite,,11.38,,,,,,,11.38,20.07,percent of total billed charges,
BACITRACIN-POLYMYXIN B OPHTH OINT,55478,CDM,250,RC,24208-0555-55,NDC,,,facility,outpatient,3.5,EA,20.69000,19.66000,Amish/Mennonite,Amish Mennonite,,11.38,,,,,,,10.35,20.07,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,Amish/Mennonite,Amish Mennonite,,755.41,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB SOLN,55479,CDM,636,RC,J9022,HCPCS,50242091701,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,Amish/Mennonite,Amish Mennonite,,755.41,,,,,,,91.02,1332.27,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00378-3952-77,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-06,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,00904-6292-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,16714-0175-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50228-0453-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,50268-0095-15,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,51079-0210-20,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,63739-0036-10,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0099-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
ATORVASTATIN TAB 40 MG,55480,CDM,250,RC,68084-0589-11,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,inpatient,1,GM,89.11000,84.66000,Amish/Mennonite,Amish Mennonite,,49.01,,,,,,,49.01,86.44,percent of total billed charges,
BACITRACIN OPHTH OINT,55482,CDM,250,RC,00574-4022-35,NDC,,,facility,outpatient,1,GM,89.11000,84.66000,Amish/Mennonite,Amish Mennonite,,49.01,,,,,,,44.55,86.44,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-6564-60,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,00904-7153-61,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,42806-0714-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68382-0247-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,68084-0214-11,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,63739-0029-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69452-0143-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
BENZONATATE CAP 100 MG,55483,CDM,250,RC,69387-0119-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,69367020301,NDC,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,inpatient,1,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00603254421,NDC,facility,outpatient,1,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.77,3.44,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,inpatient,1,EA,5.71000,5.42000,Amish/Mennonite,Amish Mennonite,,3.14,,,,,,,3.14,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,00904693806,NDC,facility,outpatient,1,EA,5.71000,5.42000,Amish/Mennonite,Amish Mennonite,,3.14,,,,,,,2.85,5.54,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,10702025301,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,inpatient,1,EA,4.69000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,50268055313,NDC,facility,outpatient,1,EA,4.69000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.55,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,inpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,68084039665,NDC,facility,outpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098130,NDC,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB 325-50-40 MG,55484,CDM,250,RC,J8499,HCPCS,71205098160,NDC,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
BETA HCG QUANT-TECH,55485,CDM,300,RC,84702,CPT,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,15.05,780.94,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
BETA 2 MICROGLOBULIN-TECH,55486,CDM,300,RC,82232,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,16.18,848.80,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,inpatient,45,EA,3.77000,3.58000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,2.07,3.66,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE CREAM,55487,CDM,250,RC,51672-1269-01,NDC,,,facility,outpatient,45,EA,3.77000,3.58000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,1.89,3.66,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,inpatient,3.5,EA,7.75000,7.36000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,4.26,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0240-04,NDC,,,facility,outpatient,3.5,EA,7.75000,7.36000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,3.88,7.52,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,inpatient,3.5,EA,8.82000,8.38000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.85,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0312-04,NDC,,,facility,outpatient,3.5,EA,8.82000,8.38000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.41,8.56,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,inpatient,3.5,EA,6.08000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,3.34,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00023-0667-04,NDC,,,facility,outpatient,3.5,EA,6.08000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,3.04,5.90,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,inpatient,3.5,EA,7.36000,6.99000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,4.05,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0509-39,NDC,,,facility,outpatient,3.5,EA,7.36000,6.99000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,3.68,7.14,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,inpatient,3.5,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.55,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00065-0518-01,NDC,,,facility,outpatient,3.5,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.23,6.26,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,inpatient,3.5,EA,5.87000,5.57000,Amish/Mennonite,Amish Mennonite,,3.23,,,,,,,3.23,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00078-0473-97,NDC,,,facility,outpatient,3.5,EA,5.87000,5.57000,Amish/Mennonite,Amish Mennonite,,3.23,,,,,,,2.94,5.69,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,inpatient,3.5,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00536-6550-91,NDC,,,facility,outpatient,3.5,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,2.41,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,inpatient,3.5,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,00574-4025-35,NDC,,,facility,outpatient,3.5,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,inpatient,3.5,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,10119-0022-39,NDC,,,facility,outpatient,3.5,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,inpatient,3.5,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.54,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,17478-0062-35,NDC,,,facility,outpatient,3.5,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.40,2.72,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,inpatient,3.5,EA,4.72000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.60,4.58,percent of total billed charges,
ARTIFICIAL TEARS OINT,55488,CDM,250,RC,63736-0238-24,NDC,,,facility,outpatient,3.5,EA,4.72000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.36,4.58,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517040125,NDC,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,0.11207,24.52,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,inpatient,1,mL,35.49000,33.71000,Amish/Mennonite,Amish Mennonite,,19.52,,,,,,,19.52,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,00517100425,NDC,facility,outpatient,1,mL,35.49000,33.71000,Amish/Mennonite,Amish Mennonite,,19.52,,,,,,,0.11207,34.43,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,inpatient,1,mL,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML,55489,CDM,250,RC,J0461,HCPCS,16729052508,NDC,facility,outpatient,1,mL,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,0.11207,36.78,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,inpatient,3.5,EA,39.53000,37.55000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,21.74,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,00574-4250-35,NDC,,,facility,outpatient,3.5,EA,39.53000,37.55000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,19.77,38.34,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,inpatient,3.5,EA,36.07000,34.26000,Amish/Mennonite,Amish Mennonite,,19.84,,,,,,,19.84,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,16571-0754-53,NDC,,,facility,outpatient,3.5,EA,36.07000,34.26000,Amish/Mennonite,Amish Mennonite,,19.84,,,,,,,18.04,34.99,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,inpatient,3.5,EA,39.91000,37.91000,Amish/Mennonite,Amish Mennonite,,21.95,,,,,,,21.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,17478-0235-35,NDC,,,facility,outpatient,3.5,EA,39.91000,37.91000,Amish/Mennonite,Amish Mennonite,,21.95,,,,,,,19.95,38.71,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,inpatient,3.5,EA,41.14000,39.09000,Amish/Mennonite,Amish Mennonite,,22.63,,,,,,,22.63,39.91,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OPHTH OINT,55490,CDM,250,RC,24208-0780-55,NDC,,,facility,outpatient,3.5,EA,41.14000,39.09000,Amish/Mennonite,Amish Mennonite,,22.63,,,,,,,20.57,39.91,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,inpatient,1,mL,146.15000,138.84000,Amish/Mennonite,Amish Mennonite,,80.38,,,,,,,80.38,141.77,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015701,NDC,facility,outpatient,1,mL,146.15000,138.84000,Amish/Mennonite,Amish Mennonite,,80.38,,,,,,,73.08,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,inpatient,1,mL,135.88000,129.09000,Amish/Mennonite,Amish Mennonite,,74.73,,,,,,,74.73,131.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,45945015702,NDC,facility,outpatient,1,mL,135.88000,129.09000,Amish/Mennonite,Amish Mennonite,,74.73,,,,,,,67.94,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,inpatient,1,mL,149.33000,141.87000,Amish/Mennonite,Amish Mennonite,,82.13,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015702,NDC,facility,outpatient,1,mL,149.33000,141.87000,Amish/Mennonite,Amish Mennonite,,82.13,,,,,,,74.67,290.17,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,inpatient,1,mL,160.62000,152.59000,Amish/Mennonite,Amish Mennonite,,88.34,,,,,,,88.34,155.80,percent of total billed charges,
BACLOFEN SOLN PF 2000 MCG/ML 20 ML,55491,CDM,636,RC,J0475,HCPCS,66794015701,NDC,facility,outpatient,1,mL,160.62000,152.59000,Amish/Mennonite,Amish Mennonite,,88.34,,,,,,,80.31,290.17,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,inpatient,15,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00081-0798-88,NDC,,,facility,outpatient,15,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,inpatient,15,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00168-0021-35,NDC,,,facility,outpatient,15,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,inpatient,15,EA,13.41000,12.74000,Amish/Mennonite,Amish Mennonite,,7.38,,,,,,,7.38,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00501-3798-05,NDC,,,facility,outpatient,15,EA,13.41000,12.74000,Amish/Mennonite,Amish Mennonite,,7.38,,,,,,,6.71,13.01,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
BACITRACIN-POLYMYXIN B OINT,55493,CDM,250,RC,00536-1174-20,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,inpatient,1,EA,295.97000,281.17000,Amish/Mennonite,Amish Mennonite,,162.78,,,,,,,162.78,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,00143960601,NDC,facility,outpatient,1,EA,295.97000,281.17000,Amish/Mennonite,Amish Mennonite,,162.78,,,,,,,0.33621,287.09,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,inpatient,1,EA,806.22000,765.90000,Amish/Mennonite,Amish Mennonite,,443.42,,,,,,,443.42,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,64679009601,NDC,facility,outpatient,1,EA,806.22000,765.90000,Amish/Mennonite,Amish Mennonite,,443.42,,,,,,,0.33621,782.03,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,inpatient,1,EA,700.52000,665.49000,Amish/Mennonite,Amish Mennonite,,385.29,,,,,,,385.29,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16714092701,NDC,facility,outpatient,1,EA,700.52000,665.49000,Amish/Mennonite,Amish Mennonite,,385.29,,,,,,,0.33621,679.50,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,inpatient,1,EA,310.80000,295.26000,Amish/Mennonite,Amish Mennonite,,170.94,,,,,,,170.94,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,16729030610,NDC,facility,outpatient,1,EA,310.80000,295.26000,Amish/Mennonite,Amish Mennonite,,170.94,,,,,,,0.33621,301.48,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,inpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,284.90,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598030562,NDC,facility,outpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,0.33621,502.46,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,inpatient,1,EA,453.25000,430.59000,Amish/Mennonite,Amish Mennonite,,249.29,,,,,,,249.29,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598046562,NDC,facility,outpatient,1,EA,453.25000,430.59000,Amish/Mennonite,Amish Mennonite,,249.29,,,,,,,0.33621,439.65,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,inpatient,1,EA,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,43598067811,NDC,facility,outpatient,1,EA,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,0.33621,1004.92,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,inpatient,1,EA,1515.77000,1439.98000,Amish/Mennonite,Amish Mennonite,,833.67,,,,,,,833.67,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,59572010201,NDC,facility,outpatient,1,EA,1515.77000,1439.98000,Amish/Mennonite,Amish Mennonite,,833.67,,,,,,,0.33621,1470.30,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,inpatient,1,EA,543.90000,516.70000,Amish/Mennonite,Amish Mennonite,,299.14,,,,,,,299.14,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,69097080540,NDC,facility,outpatient,1,EA,543.90000,516.70000,Amish/Mennonite,Amish Mennonite,,299.14,,,,,,,0.33621,527.58,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,inpatient,1,EA,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288011530,NDC,facility,outpatient,1,EA,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,0.33621,251.23,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,inpatient,1,EA,123.24000,117.08000,Amish/Mennonite,Amish Mennonite,,67.78,,,,,,,67.78,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,71288015395,NDC,facility,outpatient,1,EA,123.24000,117.08000,Amish/Mennonite,Amish Mennonite,,67.78,,,,,,,0.33621,119.54,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,inpatient,1,EA,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,78.21,137.93,percent of total billed charges,
AZACITIDINE INJECTION,55494,CDM,636,RC,J9025,HCPCS,72485020101,NDC,facility,outpatient,1,EA,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,0.33621,137.93,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,inpatient,1,mL,36.50000,34.67000,Amish/Mennonite,Amish Mennonite,,20.07,,,,,,,20.07,35.41,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015501,NDC,facility,outpatient,1,mL,36.50000,34.67000,Amish/Mennonite,Amish Mennonite,,20.07,,,,,,,18.25,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,inpatient,1,mL,33.97000,32.27000,Amish/Mennonite,Amish Mennonite,,18.68,,,,,,,18.68,32.95,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,45945015502,NDC,facility,outpatient,1,mL,33.97000,32.27000,Amish/Mennonite,Amish Mennonite,,18.68,,,,,,,16.98,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,inpatient,1,mL,37.33000,35.47000,Amish/Mennonite,Amish Mennonite,,20.53,,,,,,,20.53,36.21,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,70257056001,NDC,facility,outpatient,1,mL,37.33000,35.47000,Amish/Mennonite,Amish Mennonite,,20.53,,,,,,,18.66,290.17,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,inpatient,1,mL,40.11000,38.11000,Amish/Mennonite,Amish Mennonite,,22.06,,,,,,,22.06,38.91,percent of total billed charges,
BACLOFEN SOLN PF 500 MCG/ML 20 ML,55495,CDM,636,RC,J0475,HCPCS,66794015501,NDC,facility,outpatient,1,mL,40.11000,38.11000,Amish/Mennonite,Amish Mennonite,,22.06,,,,,,,20.05,290.17,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,inpatient,59.2,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
BENZOCAINE TOPICAL SPRAY,55496,CDM,250,RC,00283-0679-02,NDC,,,facility,outpatient,59.2,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,inpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,231.00,407.40,percent of total billed charges,
BABESIA MICROTI NAT-TECH,55497,CDM,300,RC,87798,CPT,,,facility,outpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,35.09,1833.46,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,inpatient,1,mL,34.32000,32.61000,Amish/Mennonite,Amish Mennonite,,18.88,,,,,,,18.88,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,00065-0303-55,NDC,,,facility,outpatient,1,mL,34.32000,32.61000,Amish/Mennonite,Amish Mennonite,,18.88,,,,,,,17.16,33.29,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,inpatient,1,mL,27.68000,26.29000,Amish/Mennonite,Amish Mennonite,,15.22,,,,,,,15.22,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,70756-0652-25,NDC,,,facility,outpatient,1,mL,27.68000,26.29000,Amish/Mennonite,Amish Mennonite,,15.22,,,,,,,13.84,26.85,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,inpatient,1,mL,28.04000,26.64000,Amish/Mennonite,Amish Mennonite,,15.42,,,,,,,15.42,27.20,percent of total billed charges,
ATROPINE SOLN-OPHTH 1% 5 ML,55498,CDM,250,RC,60505-6226-01,NDC,,,facility,outpatient,1,mL,28.04000,26.64000,Amish/Mennonite,Amish Mennonite,,15.42,,,,,,,14.02,27.20,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
ANTISTREPTOLYSIN O TITER-TECH,55500,CDM,300,RC,86060,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,7.30,373.51,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00603-2438-21,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-1056-61,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,00904-7289-61,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,50228-0226-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,60687-0368-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-01,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,68084-0388-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,69315-0137-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 1 MG,55501,CDM,250,RC,76385-0104-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
BIOTINIDASE ASSAY EA-TECH,55503,CDM,300,RC,82261,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,16.87,882.80,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00168-0111-09,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7023-67,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,00904-7402-67,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,45802-0060-70,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM UD,55504,CDM,250,RC,57896-0145-14,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,inpatient,,,340.70000,323.66000,Amish/Mennonite,Amish Mennonite,90,187.38,,,,,,,187.38,330.48,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 AB PANEL SO-TECH,55505,CDM,300,RC,86355,CPT,,,facility,outpatient,,,340.70000,323.66000,Amish/Mennonite,Amish Mennonite,90,187.38,,,,,,,38.99,1969.25,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
BABESIA SMEAR-TECH,55506,CDM,300,RC,87207,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,5.99,1216.68,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,inpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,180.95,319.13,percent of total billed charges,
BIOPSY OF LIVER PERC NEEDLE-TECH,55507,CDM,361,RC,47000,CPT,,,facility,outpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,180.95,4686.00,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,inpatient,8,EA,302.57000,287.44000,Amish/Mennonite,Amish Mennonite,,166.41,,,,,,,166.41,293.49,percent of total billed charges,
BERACTANT SUSP,55509,CDM,250,RC,00074-1040-04,NDC,,,facility,outpatient,8,EA,302.57000,287.44000,Amish/Mennonite,Amish Mennonite,,166.41,,,,,,,151.28,293.49,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,inpatient,5,EA,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,17478-0640-10,NDC,,,facility,outpatient,5,EA,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.89,5.61,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,inpatient,5,EA,27.09000,25.73000,Amish/Mennonite,Amish Mennonite,,14.90,,,,,,,14.90,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,24208-0732-05,NDC,,,facility,outpatient,5,EA,27.09000,25.73000,Amish/Mennonite,Amish Mennonite,,14.90,,,,,,,13.54,26.28,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,inpatient,5,EA,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,12.81,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,54799-0508-05,NDC,,,facility,outpatient,5,EA,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,11.64,22.59,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,inpatient,5,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.87,percent of total billed charges,
BENOXINATEFLUORESCEIN OPHTHALMIC SOLN,55511,CDM,250,RC,59390-0218-05,NDC,,,facility,outpatient,5,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,9.21,17.87,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00168-0012-09,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,00904-8805-67,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,54162-0080-09,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0113-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910586,55512,CDM,250,RC,57896-0143-14,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,inpatient,56,EA,225.62000,214.34000,Amish/Mennonite,Amish Mennonite,,124.09,,,,,,,124.09,218.85,percent of total billed charges,
BENZOCAINE/BUTAMBEN/TETRACAINE TOPICAL SOL,55513,CDM,250,RC,10223-0201-03,NDC,,,facility,outpatient,56,EA,225.62000,214.34000,Amish/Mennonite,Amish Mennonite,,124.09,,,,,,,112.81,218.85,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,inpatient,10,EA,98.13000,93.22000,Amish/Mennonite,Amish Mennonite,,53.97,,,,,,,53.97,95.19,percent of total billed charges,
BETAXOLOL OPHTH SUSP,55514,CDM,250,RC,00065-0246-10,NDC,,,facility,outpatient,10,EA,98.13000,93.22000,Amish/Mennonite,Amish Mennonite,,53.97,,,,,,,49.06,95.19,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
BLD COUNT MANUAL DIFF WBC-TECH,55515,CDM,300,RC,85007,CPT,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,3.80,186.75,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,inpatient,1,EA,2511.99000,2386.39000,Amish/Mennonite,Amish Mennonite,,1381.59,,,,,,,1381.59,2436.63,percent of total billed charges,
BELATACEPT POWD-INJ 250 MG,55516,CDM,636,RC,J0485,HCPCS,00003037113,NDC,facility,outpatient,1,EA,2511.99000,2386.39000,Amish/Mennonite,Amish Mennonite,,1381.59,,,,,,,3.89,2436.63,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,inpatient,30,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202631,NDC,facility,outpatient,30,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,inpatient,30,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,00093202694,NDC,facility,outpatient,30,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,inpatient,30,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806014932,NDC,facility,outpatient,30,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,inpatient,30,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015033,NDC,facility,outpatient,30,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,inpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,42806015134,NDC,facility,outpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,inpatient,30,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762312001,NDC,facility,outpatient,30,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,inpatient,30,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762313001,NDC,facility,outpatient,30,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.73,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,inpatient,30,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,59762314001,NDC,facility,outpatient,30,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,inpatient,30,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
AZITHROMYCIN LIQ 40 MG/ML,55517,CDM,250,RC,Q0144,HCPCS,70710145902,NDC,facility,outpatient,30,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00172-4096-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00603-2406-21,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-3365-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,00904-6475-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,16714-0071-04,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,50268-0106-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,68084-0855-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
BACLOFEN TAB 10 MG,55518,CDM,250,RC,63739-0479-10,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0000-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
BIFIDOBACTERIUM-LACTOBACILLUS CAP,55519,CDM,250,RC,39423-0440-48,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,inpatient,,,2632.00000,2500.40000,Amish/Mennonite,Amish Mennonite,,1447.60,,,,,,,1447.60,2553.04,percent of total billed charges,
BIOPSY OF PANCREAS PERC NEEDLE-TECH,55522,CDM,361,RC,48102,CPT,,,facility,outpatient,,,2632.00000,2500.40000,Amish/Mennonite,Amish Mennonite,,1447.60,,,,,,,1447.60,4686.00,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,inpatient,,,67.40000,64.03000,Amish/Mennonite,Amish Mennonite,90,37.07,,,,,,,37.07,65.38,percent of total billed charges,
BARTONELLA AB-TECH,55523,CDM,300,RC,86611,CPT,,,facility,outpatient,,,67.40000,64.03000,Amish/Mennonite,Amish Mennonite,90,37.07,,,,,,,8.17,526.26,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
BIOPSY-SALIVARY GLAND NEEDLE-TECH,55524,CDM,361,RC,42400,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,3163.00,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGG-TECH,55525,CDM,300,RC,86146,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,1324.17,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
BILIRUBIN DIRECT-TECH,55526,CDM,300,RC,82248,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,4.70,254.68,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,inpatient,1,EA,93.93000,89.23000,Amish/Mennonite,Amish Mennonite,,51.66,,,,,,,51.66,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00003256016,NDC,facility,outpatient,1,EA,93.93000,89.23000,Amish/Mennonite,Amish Mennonite,,51.66,,,,,,,3.84,91.11,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,inpatient,1,EA,104.28000,99.07000,Amish/Mennonite,Amish Mennonite,,57.35,,,,,,,57.35,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,00409082901,NDC,facility,outpatient,1,EA,104.28000,99.07000,Amish/Mennonite,Amish Mennonite,,57.35,,,,,,,3.84,101.15,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,inpatient,1,EA,114.01000,108.31000,Amish/Mennonite,Amish Mennonite,,62.71,,,,,,,62.71,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040120,NDC,facility,outpatient,1,EA,114.01000,108.31000,Amish/Mennonite,Amish Mennonite,,62.71,,,,,,,3.84,110.59,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,inpatient,1,EA,86.30000,81.98000,Amish/Mennonite,Amish Mennonite,,47.47,,,,,,,47.47,83.71,percent of total billed charges,
AZTREONAM POWD-INJ 1 GM,55527,CDM,250,RC,J0457,HCPCS,63323040126,NDC,facility,outpatient,1,EA,86.30000,81.98000,Amish/Mennonite,Amish Mennonite,,47.47,,,,,,,3.84,83.71,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,37.78,66.64,percent of total billed charges,
BETA-2 TRANSFERRIN BF-TECH,55528,CDM,300,RC,84999,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,34.35,66.64,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,inpatient,1,mL,516.02000,490.22000,Amish/Mennonite,Amish Mennonite,,283.81,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB SOLN 25 MG/ML 16 ML,55530,CDM,636,RC,J9035,HCPCS,50242006101,NDC,facility,outpatient,1,mL,516.02000,490.22000,Amish/Mennonite,Amish Mennonite,,283.81,,,,,,,73.05,500.54,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,273.46,482.28,percent of total billed charges,
BK VIRUS PCR QUANT-TECH,55532,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,44.27,2240.90,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,inpatient,1,EA,187.86000,178.47000,Amish/Mennonite,Amish Mennonite,,103.32,,,,,,,103.32,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,00003257016,NDC,facility,outpatient,1,EA,187.86000,178.47000,Amish/Mennonite,Amish Mennonite,,103.32,,,,,,,3.84,182.22,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,inpatient,1,EA,231.66000,220.08000,Amish/Mennonite,Amish Mennonite,,127.41,,,,,,,127.41,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040220,NDC,facility,outpatient,1,EA,231.66000,220.08000,Amish/Mennonite,Amish Mennonite,,127.41,,,,,,,3.84,224.71,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,inpatient,1,EA,172.60000,163.97000,Amish/Mennonite,Amish Mennonite,,94.93,,,,,,,94.93,167.42,percent of total billed charges,
AZTREONAM POWD-INJ 2 GM,55533,CDM,250,RC,J0457,HCPCS,63323040230,NDC,facility,outpatient,1,EA,172.60000,163.97000,Amish/Mennonite,Amish Mennonite,,94.93,,,,,,,3.84,167.42,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,00185-0053-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,43547-0336-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,50268-0110-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,51079-0145-20,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
BENAZEPRIL TAB 10 MG,55534,CDM,250,RC,65862-0116-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,462.00,814.80,percent of total billed charges,
"BALN, DILAT 8/9/10 NO WR",55535,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,420.00,814.80,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
BLD GASES PH ONLY-TECH,55536,CDM,300,RC,82800,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,11.00,509.30,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,90,90.20,,,,,,,90.20,159.08,percent of total billed charges,
"BILE ACIDS, TOTAL (BILEA) SO",55537,CDM,300,RC,82239,CPT,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,90,90.20,,,,,,,17.69,899.77,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,18.70,32.98,percent of total billed charges,
BLD COUNT RBC AUTOMATED-TECH,55538,CDM,300,RC,85041,CPT,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,3.02,152.82,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
BLOOD PRODUCT IRRADIATION-TECH,55539,CDM,300,RC,86945,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,37.27,1426.03,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,inpatient,1,EA,295.84000,281.05000,Amish/Mennonite,Amish Mennonite,,162.71,,,,,,,162.71,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,61703032322,NDC,facility,outpatient,1,EA,295.84000,281.05000,Amish/Mennonite,Amish Mennonite,,162.71,,,,,,,33.41,286.96,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,inpatient,1,EA,274.80000,261.06000,Amish/Mennonite,Amish Mennonite,,151.14,,,,,,,151.14,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,00703315501,NDC,facility,outpatient,1,EA,274.80000,261.06000,Amish/Mennonite,Amish Mennonite,,151.14,,,,,,,33.41,266.56,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,inpatient,1,EA,231.41000,219.84000,Amish/Mennonite,Amish Mennonite,,127.28,,,,,,,127.28,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,63323013720,NDC,facility,outpatient,1,EA,231.41000,219.84000,Amish/Mennonite,Amish Mennonite,,127.28,,,,,,,33.41,224.47,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,inpatient,1,EA,210.74000,200.20000,Amish/Mennonite,Amish Mennonite,,115.91,,,,,,,115.91,204.42,percent of total billed charges,
BLEOMYCIN SULFATE INJECTION,55540,CDM,250,RC,J9040,HCPCS,71288010720,NDC,facility,outpatient,1,EA,210.74000,200.20000,Amish/Mennonite,Amish Mennonite,,115.91,,,,,,,33.41,204.42,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,inpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,741.08,percent of total billed charges,
BIOPSY THYROID PERQ CORE NDL-TECH,55541,CDM,361,RC,60100,CPT,,,facility,outpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,3163.00,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,inpatient,2.5,EA,122.58000,116.45000,Amish/Mennonite,Amish Mennonite,,67.42,,,,,,,67.42,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,00023-9187-03,NDC,,,facility,outpatient,2.5,EA,122.58000,116.45000,Amish/Mennonite,Amish Mennonite,,67.42,,,,,,,61.29,118.90,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,inpatient,2.5,EA,136.13000,129.33000,Amish/Mennonite,Amish Mennonite,,74.87,,,,,,,74.87,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,60505-0583-04,NDC,,,facility,outpatient,2.5,EA,136.13000,129.33000,Amish/Mennonite,Amish Mennonite,,74.87,,,,,,,68.06,132.05,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,inpatient,2.5,EA,132.04000,125.44000,Amish/Mennonite,Amish Mennonite,,72.62,,,,,,,72.62,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,62332-0507-25,NDC,,,facility,outpatient,2.5,EA,132.04000,125.44000,Amish/Mennonite,Amish Mennonite,,72.62,,,,,,,66.02,128.08,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,inpatient,2.5,EA,66.74000,63.40000,Amish/Mennonite,Amish Mennonite,,36.71,,,,,,,36.71,64.74,percent of total billed charges,
BIMATOPROST OPHTHALMIC 0.03% SOLN 2.5 ML,55543,CDM,250,RC,70069-0401-01,NDC,,,facility,outpatient,2.5,EA,66.74000,63.40000,Amish/Mennonite,Amish Mennonite,,36.71,,,,,,,33.37,64.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,inpatient,5,EA,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00085432001,NDC,facility,outpatient,5,EA,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,10.61,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,inpatient,5,EA,34.78000,33.04000,Amish/Mennonite,Amish Mennonite,,19.13,,,,,,,19.13,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517072001,NDC,facility,outpatient,5,EA,34.78000,33.04000,Amish/Mennonite,Amish Mennonite,,19.13,,,,,,,10.61,33.74,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,inpatient,5,EA,25.44000,24.17000,Amish/Mennonite,Amish Mennonite,,13.99,,,,,,,13.99,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,00517079101,NDC,facility,outpatient,5,EA,25.44000,24.17000,Amish/Mennonite,Amish Mennonite,,13.99,,,,,,,10.61,24.68,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,inpatient,5,EA,18.05000,17.15000,Amish/Mennonite,Amish Mennonite,,9.93,,,,,,,9.93,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,40042004805,NDC,facility,outpatient,5,EA,18.05000,17.15000,Amish/Mennonite,Amish Mennonite,,9.93,,,,,,,9.03,17.51,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,inpatient,5,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,51754506001,NDC,facility,outpatient,5,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,10.61,24.52,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,inpatient,5,EA,24.79000,23.55000,Amish/Mennonite,Amish Mennonite,,13.63,,,,,,,13.63,24.05,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 5 ML,55544,CDM,250,RC,J0702,HCPCS,78206011801,NDC,facility,outpatient,5,EA,24.79000,23.55000,Amish/Mennonite,Amish Mennonite,,13.63,,,,,,,10.61,24.05,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,inpatient,1,EA,84.57000,80.34000,Amish/Mennonite,Amish Mennonite,,46.51,,,,,,,46.51,82.03,percent of total billed charges,
BELLADONNA-OPIUM SUPP,55545,CDM,250,RC,00574-7040-12,NDC,,,facility,outpatient,1,EA,84.57000,80.34000,Amish/Mennonite,Amish Mennonite,,46.51,,,,,,,42.28,82.03,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,inpatient,15,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,51672-4048-01,NDC,,,facility,outpatient,15,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.77,3.44,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,00472-0379-15,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,inpatient,15,EA,4.62000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,16714-0496-01,NDC,,,facility,outpatient,15,EA,4.62000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.48,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,inpatient,15,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,66993-0898-15,NDC,,,facility,outpatient,15,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,inpatient,15,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
BETAMETHASONE-CLOTRIMAZOLE TOPICAL CREAM,55546,CDM,250,RC,68462-0298-17,NDC,,,facility,outpatient,15,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,inpatient,,,48.40000,45.98000,Amish/Mennonite,Amish Mennonite,,26.62,,,,,,,26.62,46.95,percent of total billed charges,
BEHAV CHNG SMOKING 3-10 MIN-TECH,55547,CDM,960,RC,99406,CPT,,,facility,outpatient,,,48.40000,45.98000,Amish/Mennonite,Amish Mennonite,,26.62,,,,,,,24.20,46.95,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
BLOOD TYPING RH-TECH,55548,CDM,300,RC,86901,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,2.99,152.82,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
BK VIRUS DETECTION BY PCR-TECH,55549,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,36.26,1833.46,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,90,73.15,,,,,,,73.15,129.01,percent of total billed charges,
BLASTOMYCES AG IA SO-TECH,55550,CDM,300,RC,87449,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,90,73.15,,,,,,,12.38,628.12,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,inpatient,237,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00182-1811-44,NDC,,,facility,outpatient,237,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,inpatient,237,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,00536-1286-36,NDC,,,facility,outpatient,237,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,37000-0032-02,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,inpatient,237,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 240 ML,55551,CDM,250,RC,41167-0333-03,NDC,,,facility,outpatient,237,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,inpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,TC,1113.20,,,,,,,1113.20,1963.28,percent of total billed charges,
BRAIN IMG VASCULAR FLOW ONLY-TECH,55552,CDM,341,RC,78610,CPT,,,facility,outpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,TC,1113.20,,,,,,,864.82,2960.49,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
BLASTOMYCES ANTIBODY-TECH,55553,CDM,300,RC,86612,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,679.08,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,inpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,110.55,194.97,percent of total billed charges,
BLD GASES ANY COMBINATION-TECH,55554,CDM,300,RC,82803,CPT,,,facility,outpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,26.07,1222.31,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1737.00000,1650.15000,Amish/Mennonite,Amish Mennonite,TC,955.35,,,,,,,955.35,1684.89,percent of total billed charges,
BONE &/OR JT IMAGING LTD AREA-TECH,55556,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1737.00000,1650.15000,Amish/Mennonite,Amish Mennonite,TC,955.35,,,,,,,868.50,2210.07,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,inpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,200.20,353.08,percent of total billed charges,
BLOOD TRANSFUSION-TECH,55557,CDM,391,RC,36430,CPT,,,facility,outpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,182.00,456.63,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
BLOOD TYPING OTHER ANTIGENS-TECH,55558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,20.35,35.89,percent of total billed charges,
BLOOD TYPING ABO-TECH,55560,CDM,300,RC,86900,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,2.99,152.82,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,TC,1333.75,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE &/OR JT IMAGING WHOLE BODY-TECH,55562,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,TC,1333.75,,,,,,,1212.50,2352.25,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
BLOOD TYPING RBC AG-TECH,55564,CDM,300,RC,86905,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,3.83,203.72,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,52.25,92.15,percent of total billed charges,
BLOOD TYPING PATIENT SERUM-TECH,55565,CDM,300,RC,86904,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,13.37,763.98,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,inpatient,,,1888.00000,1793.60000,Amish/Mennonite,Amish Mennonite,TC,1038.40,,,,,,,1038.40,1831.36,percent of total billed charges,
BRAIN IMAGING <4 STATIC VIEWS-TECH,55566,CDM,340,RC,78600,CPT,,,facility,outpatient,,,1888.00000,1793.60000,Amish/Mennonite,Amish Mennonite,TC,1038.40,,,,,,,875.87,2210.07,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,inpatient,5,EA,32.06000,30.46000,Amish/Mennonite,Amish Mennonite,,17.63,,,,,,,17.63,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,17478-0705-10,NDC,,,facility,outpatient,5,EA,32.06000,30.46000,Amish/Mennonite,Amish Mennonite,,17.63,,,,,,,16.03,31.10,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,inpatient,5,EA,32.22000,30.61000,Amish/Mennonite,Amish Mennonite,,17.72,,,,,,,17.72,31.25,percent of total billed charges,
BETAXOLOL OPHTH SOL,55567,CDM,250,RC,61314-0245-01,NDC,,,facility,outpatient,5,EA,32.22000,30.61000,Amish/Mennonite,Amish Mennonite,,17.72,,,,,,,16.11,31.25,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1444.00000,1371.80000,Amish/Mennonite,Amish Mennonite,,794.20,,,,,,,794.20,1400.68,percent of total billed charges,
BRAF GENE V600 VARIANT-TECH,55568,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1444.00000,1371.80000,Amish/Mennonite,Amish Mennonite,,794.20,,,,,,,143.40,8250.66,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,inpatient,1,mL,516.02000,490.22000,Amish/Mennonite,Amish Mennonite,,283.81,,,,,,,283.81,500.54,percent of total billed charges,
BEVACIZUMAB  INJECTION,55569,CDM,636,RC,J9035,HCPCS,50242006001,NDC,facility,outpatient,1,mL,516.02000,490.22000,Amish/Mennonite,Amish Mennonite,,283.81,,,,,,,73.05,500.54,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
BASIC METABOLIC PANEL W TOTAL CA-TECH,55570,CDM,300,RC,80048,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,8.46,441.37,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,inpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,,129.25,,,,,,,129.25,227.95,percent of total billed charges,
BREAST CA ANTIGEN CA 15-3/27.29-TECH,55571,CDM,300,RC,86300,CPT,,,facility,outpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,,129.25,,,,,,,20.81,1086.52,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,inpatient,1,GM,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00713-0268-31,NDC,,,facility,outpatient,1,GM,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,00904-0734-31,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,inpatient,1,GM,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,45802-0143-03,NDC,,,facility,outpatient,1,GM,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,inpatient,1,GM,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
BACITRACIN/NEOMYCIN/POLYMYXIN B OINT 7910558,55572,CDM,250,RC,70677-0013-01,NDC,,,facility,outpatient,1,GM,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,Amish/Mennonite,Amish Mennonite,TC,7998.65,,,,,,,7998.65,14106.71,percent of total billed charges,
BRAIN IMG PET METABOLIC EVAL-TECH,55573,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,Amish/Mennonite,Amish Mennonite,TC,7998.65,,,,,,,4549.00,14106.71,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,inpatient,,,733.00000,696.35000,Amish/Mennonite,Amish Mennonite,,403.15,,,,,,,403.15,711.01,percent of total billed charges,
BONE MARROW SMEAR INTERP-TECH,55574,CDM,300,RC,85097,CPT,,,facility,outpatient,,,733.00000,696.35000,Amish/Mennonite,Amish Mennonite,,403.15,,,,,,,236.07,2440.34,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,Amish/Mennonite,Amish Mennonite,TC,1901.90,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMG 3 PHASE STUDY-TECH,55575,CDM,341,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,Amish/Mennonite,Amish Mennonite,TC,1901.90,,,,,,,1609.99,3354.26,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,Amish/Mennonite,Amish Mennonite,,2565.42,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDER TISS 500CC W13XH12CM P6.7CM MOD HT X PROJCT SMTH,55576,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,Amish/Mennonite,Amish Mennonite,,2565.42,,,,,,,2140.96,4664.40,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,inpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,00904-6255-49,NDC,,,facility,outpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.54,8.80,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,48433-0111-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,inpatient,1,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0713-16,NDC,,,facility,outpatient,1,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,3.79,7.35,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0722-83,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0732-16,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,inpatient,1,EA,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,4.10,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,63824-0768-16,NDC,,,facility,outpatient,1,EA,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,3.73,7.24,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,70312-0461-29,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,inpatient,1,EA,7.92000,7.53000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,4.36,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0011-06,NDC,,,facility,outpatient,1,EA,7.92000,7.53000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,3.96,7.68,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BENZOCAINE-MENTHOL LOZENGE,55578,CDM,250,RC,78112-0017-46,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
BETA2 GLYCOPROTEIN 1 IGA-TECH,55579,CDM,300,RC,86146,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,8.17,1324.17,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,inpatient,2,EA,9.20000,8.74000,Amish/Mennonite,Amish Mennonite,,5.06,,,,,,,5.06,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00093681645,NDC,facility,outpatient,2,EA,9.20000,8.74000,Amish/Mennonite,Amish Mennonite,,5.06,,,,,,,1.85,8.92,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,inpatient,2,EA,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.70,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00781751687,NDC,facility,outpatient,2,EA,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,1.85,13.58,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,inpatient,2,EA,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00115168974,NDC,facility,outpatient,2,EA,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,inpatient,2,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.92,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00186198904,NDC,facility,outpatient,2,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,1.85,15.72,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,inpatient,2,EA,14.70000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,8.09,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031953,NDC,facility,outpatient,2,EA,14.70000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,1.85,14.26,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,inpatient,2,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,00487970130,NDC,facility,outpatient,2,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,1.85,7.66,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,inpatient,2,EA,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,16714001930,NDC,facility,outpatient,2,EA,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,1.85,9.76,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,inpatient,2,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,47335063249,NDC,facility,outpatient,2,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,1.85,4.57,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,inpatient,2,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,8.11,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,60687052483,NDC,facility,outpatient,2,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,1.85,14.31,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,inpatient,2,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,68180098430,NDC,facility,outpatient,2,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,2.11,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,inpatient,2,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
BUDESONIDE NEB 500 MCG/2 ML,55582,CDM,250,RC,J7626,HCPCS,69097031987,NDC,facility,outpatient,2,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
BLOOD TYPING RH PHENOTYPE-TECH,55583,CDM,300,RC,86906,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,7.75,407.44,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,inpatient,10,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00409141210,NDC,facility,outpatient,10,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,inpatient,10,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600701,NDC,facility,outpatient,10,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,inpatient,10,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,00641600710,NDC,facility,outpatient,10,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,inpatient,10,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,10019050636,NDC,facility,outpatient,10,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,55390050110,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.61000,1.53,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,inpatient,10,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,65219057210,NDC,facility,outpatient,10,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,inpatient,10,EA,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,68462047054,NDC,facility,outpatient,10,EA,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,1.01,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,inpatient,10,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,70860040610,NDC,facility,outpatient,10,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 10 ML,55584,CDM,250,RC,J1939,HCPCS,72205010207,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,inpatient,30,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409116210,NDC,facility,outpatient,30,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,inpatient,30,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,00409156029,NDC,facility,outpatient,30,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.01550,0.50440,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,inpatient,30,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,55150017030,NDC,facility,outpatient,30,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.01550,0.26190,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,inpatient,30,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046630,NDC,facility,outpatient,30,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.01550,0.53350,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,inpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046631,NDC,facility,outpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.01550,0.75660,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,inpatient,30,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 30 ML,55585,CDM,250,RC,J0665,HCPCS,63323046637,NDC,facility,outpatient,30,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.01550,0.73720,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,inpatient,30,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00143933310,NDC,facility,outpatient,30,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.01550,0.31040,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,inpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115902,NDC,facility,outpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.01550,0.20370,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,inpatient,30,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409115910,NDC,facility,outpatient,30,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.01550,0.17460,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,inpatient,30,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,00409155930,NDC,facility,outpatient,30,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.01550,0.47530,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,inpatient,30,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,55150016830,NDC,facility,outpatient,30,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.01550,0.24250,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,inpatient,30,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046430,NDC,facility,outpatient,30,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.01550,0.49470,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,inpatient,30,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046431,NDC,facility,outpatient,30,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,inpatient,30,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 30 ML,55586,CDM,250,RC,J0665,HCPCS,63323046437,NDC,facility,outpatient,30,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.01550,0.66930,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,Amish/Mennonite,Amish Mennonite,QN,597.30,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-EMERGENCY-TECH,55587,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,Amish/Mennonite,Amish Mennonite,QN,597.30,,,,,,,543.00,1053.42,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,37.78,66.64,percent of total billed charges,
BRUCELLA AB SO-TECH,55588,CDM,300,RC,86622,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,8.17,458.40,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
BREATH RECORDING INFANT 12-24H-TECH,55590,CDM,460,RC,94774,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,80.00,155.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00143986710,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,7.27,18.39,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,inpatient,1,EA,26.07000,24.76000,Amish/Mennonite,Amish Mennonite,,14.34,,,,,,,14.34,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,00409162601,NDC,facility,outpatient,1,EA,26.07000,24.76000,Amish/Mennonite,Amish Mennonite,,14.34,,,,,,,7.27,25.29,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
BUTORPHANOL TARTRATE,55591,CDM,250,RC,J0595,HCPCS,55390018401,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,00591-0718-60,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,16729-0203-12,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,64380-0743-03,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,50268-0135-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,inpatient,1,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
BUSPIRONE TAB 15 MG,55592,CDM,250,RC,51079-0960-20,NDC,,,facility,outpatient,1,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,inpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,205.15,361.81,percent of total billed charges,
BORRELIA PCR AMP PROBE-TECH,55593,CDM,300,RC,87478,CPT,,,facility,outpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,35.09,1662.04,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,inpatient,5,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,17478-0715-10,NDC,,,facility,outpatient,5,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,inpatient,5,EA,9.16000,8.71000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,5.04,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,24208-0411-05,NDC,,,facility,outpatient,5,EA,9.16000,8.71000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,4.58,8.89,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,inpatient,5,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,61314-0143-05,NDC,,,facility,outpatient,5,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,inpatient,5,EA,3.86000,3.67000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.74,percent of total billed charges,
BRIMONIDINE OPHTH SOL,55594,CDM,250,RC,70069-0231-01,NDC,,,facility,outpatient,5,EA,3.86000,3.67000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.74,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409116301,NDC,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.01550,0.18430,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,inpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,00409161050,NDC,facility,outpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.01550,0.34920,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,55150025050,NDC,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.01550,0.19400,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,inpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,63323046757,NDC,facility,outpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.01550,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,inpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BUPIVACAINE SOLN 0.5% 50 ML (MDV),55595,CDM,250,RC,J0665,HCPCS,71288072652,NDC,facility,outpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.01550,0.49470,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,inpatient,4,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00409141204,NDC,facility,outpatient,4,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.61000,1.61,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,inpatient,4,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,00641600801,NDC,facility,outpatient,4,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.61000,1.29,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,inpatient,4,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70748032310,NDC,facility,outpatient,4,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,0.61000,2.32,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,inpatient,4,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,68462046954,NDC,facility,outpatient,4,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.61000,1.75,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,inpatient,4,EA,2.46000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,65219057004,NDC,facility,outpatient,4,EA,2.46000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,0.61000,2.39,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,inpatient,4,EA,2.16000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,70860040504,NDC,facility,outpatient,4,EA,2.16000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,0.61000,2.10,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,inpatient,4,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
BUMETANIDE SOLN-INJ 0.25 MG/ML 4 ML,55596,CDM,250,RC,J1939,HCPCS,72205010107,NDC,facility,outpatient,4,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,0.61000,1.99,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,1237.50000,1175.62000,Amish/Mennonite,Amish Mennonite,,680.62,,,,,,,606.38,1200.38,percent of total billed charges,
BIOMAX BONE PUTTY 2.5CC,55597,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,1237.50000,1175.62000,Amish/Mennonite,Amish Mennonite,,680.62,,,,,,,568.01,1237.50,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1086.00000,1031.70000,Amish/Mennonite,Amish Mennonite,QN,597.30,,,,,,,597.30,1053.42,percent of total billed charges,
BLS-TECH,55598,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1086.00000,1031.70000,Amish/Mennonite,Amish Mennonite,QN,597.30,,,,,,,543.00,1053.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,inpatient,1,mL,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409420810,NDC,facility,outpatient,1,mL,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,00409904517,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 30 ML",55600,CDM,250,RC,J3490,HCPCS,63323046237,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00185-0410-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.23,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-0858-60,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.03,3.94,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,00591-3540-60,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,42806-0410-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43547-0288-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,43598-0751-60,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,50228-0174-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0391-20,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,51079-0939-10,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
BUPROPION TAB-ER 100 MG (12-HOUR SR),55601,CDM,250,RC,68084-0697-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,inpatient,1,EA,12.10000,11.50000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00093-5350-56,NDC,,,facility,outpatient,1,EA,12.10000,11.50000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.74,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.27,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,67767-0141-30,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.06,4.00,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,43598-0655-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7084-61,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.93,5.68,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,00904-7505-61,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,10370-0101-03,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,16729-0443-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68180-0319-06,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,inpatient,1,EA,8.33000,7.92000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.58,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,50268-0140-13,NDC,,,facility,outpatient,1,EA,8.33000,7.92000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.17,8.08,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,inpatient,1,EA,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,51079-0047-20,NDC,,,facility,outpatient,1,EA,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.00,9.70,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,60687-0312-01,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.92,5.67,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.97,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68084-0251-11,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.43,10.53,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
BUPROPION TAB-ER 150 MG (24-HOUR XL),55602,CDM,250,RC,68382-0353-16,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,inpatient,30,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409154110,NDC,facility,outpatient,30,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,inpatient,30,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409174630,NDC,facility,outpatient,30,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,inpatient,30,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,00409904217,NDC,facility,outpatient,30,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,inpatient,30,EA,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 30 ML",55604,CDM,250,RC,J3490,HCPCS,63323046837,NDC,facility,outpatient,30,EA,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,inpatient,10,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00143933110,NDC,facility,outpatient,10,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,inpatient,10,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00186103312,NDC,facility,outpatient,10,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.01550,0.36860,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,inpatient,10,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409116201,NDC,facility,outpatient,10,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.01550,0.70810,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,inpatient,10,EA,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,00409156010,NDC,facility,outpatient,10,EA,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.01550,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,inpatient,10,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,55150016910,NDC,facility,outpatient,10,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,inpatient,10,EA,1.66000,1.57000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
BUPIVACAINE SOLN PF 0.5% 10 ML,55605,CDM,250,RC,J0665,HCPCS,70594011702,NDC,facility,outpatient,10,EA,1.66000,1.57000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.01550,1.61,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,90,147.73,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM-TECH,55606,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,90,147.73,,,,,,,24.43,1205.34,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,90,86.90,,,,,,,86.90,153.26,percent of total billed charges,
C1 ESTERASE INHIB ANTIGEN (8198) SO-TECH,55607,CDM,300,RC,83883,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,90,86.90,,,,,,,14.05,713.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,inpatient,10,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00143933210,NDC,facility,outpatient,10,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,inpatient,10,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00186103712,NDC,facility,outpatient,10,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.01550,1.21,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,inpatient,10,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409116501,NDC,facility,outpatient,10,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,inpatient,10,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,00409158210,NDC,facility,outpatient,10,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.01550,1.06,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,inpatient,10,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,55150017110,NDC,facility,outpatient,10,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.01550,0.80510,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,inpatient,10,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 10 ML,55608,CDM,250,RC,J0665,HCPCS,63323047217,NDC,facility,outpatient,10,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.01550,1.46,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,inpatient,,,409.00000,388.55000,Amish/Mennonite,Amish Mennonite,,224.95,,,,,,,224.95,396.73,percent of total billed charges,
C DIFFICILE TOXIN AMP PROBE-TECH,55610,CDM,300,RC,87493,CPT,,,facility,outpatient,,,409.00000,388.55000,Amish/Mennonite,Amish Mennonite,,224.95,,,,,,,37.27,1833.46,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00143933510,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.01550,0.45590,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,inpatient,1,mL,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,00409116502,NDC,facility,outpatient,1,mL,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.01550,0.29100,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,inpatient,1,mL,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,55150017230,NDC,facility,outpatient,1,mL,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.01550,0.43650,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPIVACAINE SOLN PF 0.75% 30 ML,55611,CDM,250,RC,J0665,HCPCS,63323047237,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.01550,0.76630,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,inpatient,1,EA,11.31000,10.74000,Amish/Mennonite,Amish Mennonite,,6.22,,,,,,,6.22,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00093-5351-56,NDC,,,facility,outpatient,1,EA,11.31000,10.74000,Amish/Mennonite,Amish Mennonite,,6.22,,,,,,,5.66,10.97,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,inpatient,1,EA,4.73000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.60,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,00591-3332-30,NDC,,,facility,outpatient,1,EA,4.73000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.37,4.59,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,inpatient,1,EA,7.99000,7.60000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.39,7.75,percent of total billed charges,
BUPROPION TAB-ER 300 MG (24-HOUR XL),55612,CDM,250,RC,68084-0252-21,NDC,,,facility,outpatient,1,EA,7.99000,7.60000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.00,7.75,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,inpatient,1,mL,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409175550,NDC,facility,outpatient,1,mL,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,inpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409658101,NDC,facility,outpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,00409904601,NDC,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,inpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 50 ML",55613,CDM,250,RC,J3490,HCPCS,63323046357,NDC,facility,outpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,inpatient,1,mL,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362055705,NDC,facility,outpatient,1,mL,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,inpatient,1,mL,5.43000,5.16000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.99,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00362901150,NDC,facility,outpatient,1,mL,5.43000,5.16000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.71,5.27,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,inpatient,1,mL,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1  200,000 1.8 ML",55614,CDM,250,RC,J3490,HCPCS,00409760001,NDC,facility,outpatient,1,mL,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409573810,NDC,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,00409904201,NDC,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046810,NDC,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,inpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.25%-1  200,000 10 ML",55615,CDM,250,RC,J3490,HCPCS,63323046817,NDC,facility,outpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97500,1.89,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,inpatient,1,EA,4.35000,4.14000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-0839-60,NDC,,,facility,outpatient,1,EA,4.35000,4.14000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.22,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-60,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00591-3541-69,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,00904-7214-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,43547-0289-10,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,50228-0175-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,51079-0392-20,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
BUPROPION TAB-ER 150 MG (12-HOUR SR),55616,CDM,250,RC,68084-0708-25,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,741.08,percent of total billed charges,
BX NDL LYMPH NODE SUPRFC-TECH,55617,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,4686.00,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00143932810,NDC,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.01550,0.61110,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,00409116001,NDC,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.01550,0.21340,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,inpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,55150024950,NDC,facility,outpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.01550,0.23280,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,inpatient,1,mL,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,63323046557,NDC,facility,outpatient,1,mL,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.01550,0.62080,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,inpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 50 ML (MDV),55618,CDM,250,RC,J0665,HCPCS,70069075225,NDC,facility,outpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.01550,0.68870,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,inpatient,1,EA,5.95000,5.66000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,3.27,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00378-3017-01,NDC,,,facility,outpatient,1,EA,5.95000,5.66000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,2.98,5.77,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,27241-0162-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.94,5.19,percent of total billed charges,
CAPTOPRIL TAB 50 MG,55619,CDM,250,RC,00904-5047-61,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.67,5.19,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
C DIFFICILE TOXIN AG IA-TECH,55620,CDM,300,RC,87324,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,11.98,628.12,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,inpatient,50,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,63323036059,NDC,facility,outpatient,50,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.06404,1.66,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,inpatient,50,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 50 ML,55621,CDM,250,RC,J0612,HCPCS,70069072725,NDC,facility,outpatient,50,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.06404,6.13,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,inpatient,,,4181.00000,3971.95000,Amish/Mennonite,Amish Mennonite,,2299.55,,,,,,,2299.55,4055.57,percent of total billed charges,
BX BRST 1ST LESN STRTCTC-TECH,55622,CDM,361,RC,19081,CPT,,,facility,outpatient,,,4181.00000,3971.95000,Amish/Mennonite,Amish Mennonite,,2299.55,,,,,,,1538.48,4686.00,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,inpatient,2,EA,50.16000,47.66000,Amish/Mennonite,Amish Mennonite,,27.59,,,,,,,27.59,48.66,percent of total billed charges,
CAFFEINE-SOD BENZOATE SOLN 250 MG/ML 2 ML,55624,CDM,250,RC,J3490,HCPCS,00517250210,NDC,facility,outpatient,2,EA,50.16000,47.66000,Amish/Mennonite,Amish Mennonite,,27.59,,,,,,,25.08,48.66,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,00904-1883-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
CALCIUM CARBONATE TAB 1250 MG,55625,CDM,250,RC,54629-0683-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,90,171.05,,,,,,,171.05,301.67,percent of total billed charges,
CALCITONIN (CATN) SO,55626,CDM,300,RC,82308,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,90,171.05,,,,,,,27.68,1392.10,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409175250,NDC,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,inpatient,1,mL,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,00409381201,NDC,facility,outpatient,1,mL,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,inpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1  200,000 50 ML",55627,CDM,250,RC,J3490,HCPCS,63323046157,NDC,facility,outpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
BX MUSC PERQ NDL-TECH,55628,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,4686.00,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,inpatient,,,3837.00000,3645.15000,Amish/Mennonite,Amish Mennonite,TC,2110.35,,,,,,,2110.35,3721.89,percent of total billed charges,
BRAIN IMG MIN 4 VWS W VASC FLOW-TECH,55629,CDM,341,RC,78606,CPT,,,facility,outpatient,,,3837.00000,3645.15000,Amish/Mennonite,Amish Mennonite,TC,2110.35,,,,,,,1626.53,3721.89,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,inpatient,1,EA,21473.80000,20400.11000,Amish/Mennonite,Amish Mennonite,,11810.59,,,,,,,11810.59,20829.59,percent of total billed charges,
BRENTUXIMAB VEDOTIN INJ,55630,CDM,636,RC,J9042,HCPCS,51144005001,NDC,facility,outpatient,1,EA,21473.80000,20400.11000,Amish/Mennonite,Amish Mennonite,,11810.59,,,,,,,258.52,20829.59,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,Amish/Mennonite,Amish Mennonite,,3154.80,,,,,,,3154.80,5563.92,percent of total billed charges,
BX BONE TROCAR/NDL DEEP-TECH,55631,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,Amish/Mennonite,Amish Mennonite,,3154.80,,,,,,,1538.48,5563.92,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,inpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.78,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000713,NDC,facility,outpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.61,3.13,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,inpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00054000725,NDC,facility,outpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.50,2.90,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,inpatient,1,EA,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,00093735201,NDC,facility,outpatient,1,EA,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.51,2.93,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,inpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,23155011801,NDC,facility,outpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.53,2.97,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,inpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,69452020720,NDC,facility,outpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,inpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,60687034501,NDC,facility,outpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,63629874101,NDC,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,inpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
CALCITRIOL CAP 0.25 MCG,55633,CDM,250,RC,J8499,HCPCS,64380072304,NDC,facility,outpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,Amish/Mennonite,Amish Mennonite,,1876.05,,,,,,,1876.05,3308.67,percent of total billed charges,
BX PLEURA PERCUTANEOUS NEEDLE-TECH,55634,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,Amish/Mennonite,Amish Mennonite,,1876.05,,,,,,,1538.48,4686.00,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,inpatient,1.5,EA,94.13000,89.42000,Amish/Mennonite,Amish Mennonite,,51.77,,,,,,,51.77,91.31,percent of total billed charges,
CARBACHOL OPHTH SOL,55635,CDM,250,RC,00065-0023-15,NDC,,,facility,outpatient,1.5,EA,94.13000,89.42000,Amish/Mennonite,Amish Mennonite,,51.77,,,,,,,47.06,91.31,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,82.67,145.79,percent of total billed charges,
C1 ESTERASE INHIB FUNC (81493)-TECH,55636,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,17.85,814.87,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,inpatient,,,6381.00000,6061.95000,Amish/Mennonite,Amish Mennonite,,3509.55,,,,,,,3509.55,6189.57,percent of total billed charges,
BX SOFT TISS NK/THORAX-TECH,55637,CDM,361,RC,21550,CPT,,,facility,outpatient,,,6381.00000,6061.95000,Amish/Mennonite,Amish Mennonite,,3509.55,,,,,,,1538.48,6189.57,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM TOTAL-TECH,55638,CDM,300,RC,82310,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,5.16,271.65,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,inpatient,10,EA,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,75834017119,NDC,facility,outpatient,10,EA,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.06404,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,inpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM GLUCONATE SOLN-INJ 100 MG/ML 10 ML,55640,CDM,250,RC,J0612,HCPCS,80830167202,NDC,facility,outpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.06404,3.07,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,Amish/Mennonite,Amish Mennonite,TC,908.05,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT DETECTION-TECH,55641,CDM,341,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,Amish/Mennonite,Amish Mennonite,TC,908.05,,,,,,,805.84,2210.07,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,inpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,147.40,259.96,percent of total billed charges,
CALPROTECTIN FECAL ASSAY-TECH,55642,CDM,300,RC,83993,CPT,,,facility,outpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,19.63,1018.59,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,inpatient,1,EA,8.55000,8.13000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00078-0511-05,NDC,,,facility,outpatient,1,EA,8.55000,8.13000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.28,8.29,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5087-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,00781-5987-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16571-0681-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,inpatient,1,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,16714-0064-01,NDC,,,facility,outpatient,1,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,51672-4124-01,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,inpatient,1,EA,10.63000,10.10000,Amish/Mennonite,Amish Mennonite,,5.85,,,,,,,5.85,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-21,NDC,,,facility,outpatient,1,EA,10.63000,10.10000,Amish/Mennonite,Amish Mennonite,,5.85,,,,,,,5.32,10.31,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,inpatient,1,EA,5.44000,5.17000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.99,5.28,percent of total billed charges,
CARBAMAZEPINE TAB 7224074,55643,CDM,250,RC,68084-0561-11,NDC,,,facility,outpatient,1,EA,5.44000,5.17000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.72,5.28,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,inpatient,10,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409163110,NDC,facility,outpatient,10,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,inpatient,10,EA,2.70000,2.56000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00409492834,NDC,facility,outpatient,10,EA,2.70000,2.56000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.62,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,inpatient,10,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,00548330400,NDC,facility,outpatient,10,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,inpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,64253090091,NDC,facility,outpatient,10,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,inpatient,10,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
CALCIUM CHLORIDE SYRINGE 1 GM/ 10 ML,55644,CDM,250,RC,J3490,HCPCS,76329330401,NDC,facility,outpatient,10,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-10,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00228-2540-50,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,50228-0459-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,51079-0783-20,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,59651-0458-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,60687-0836-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,63739-0048-10,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-250 MG,55646,CDM,250,RC,68084-0094-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1320.00000,1254.00000,Amish/Mennonite,Amish Mennonite,,726.00,,,,,,,726.00,1280.40,percent of total billed charges,
BX BRST ADDL LESN US IMG-TECH,55647,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1320.00000,1254.00000,Amish/Mennonite,Amish Mennonite,,726.00,,,,,,,726.00,5271.00,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00093-4234-01,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00185-0130-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,00832-0542-11,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,16714-0833-01,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,69238-1491-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,inpatient,1,EA,5.42000,5.15000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.98,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,50268-0132-15,NDC,,,facility,outpatient,1,EA,5.42000,5.15000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.71,5.26,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51079-0893-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,51672-4225-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.56,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,60687-0535-01,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.33,4.52,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
BUMETANIDE TAB 2 MG,55649,CDM,250,RC,68382-0527-01,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.46,2.83,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,inpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,299.75,528.65,percent of total billed charges,
BRONCHODILATON RESPONSE-TECH,55650,CDM,460,RC,94060,CPT,,,facility,outpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,TC,299.75,,,,,,,272.50,528.65,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,inpatient,,,8368.00000,7949.60000,Amish/Mennonite,Amish Mennonite,90,4602.40,,,,,,,4602.40,8116.96,percent of total billed charges,
CARBAMAZ 10 11 EPOX ASSAY-TECH,55651,CDM,301,RC,80161,CPT,,,facility,outpatient,,,8368.00000,7949.60000,Amish/Mennonite,Amish Mennonite,90,4602.40,,,,,,,14.91,8116.96,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,inpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008813,NDC,facility,outpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.51,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00054008826,NDC,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00781208102,NDC,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,inpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654606,NDC,facility,outpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,inpatient,1,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.53,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904654661,NDC,facility,outpatient,1,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.30,4.46,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,inpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,00904711906,NDC,facility,outpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,23155053102,NDC,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,24689079302,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,62135019122,NDC,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,50268014815,NDC,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68084047901,NDC,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CALCIUM ACETATE CAP 667 MG,55652,CDM,250,RC,J8499,HCPCS,68094000261,NDC,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,inpatient,1,EA,308.21000,292.80000,Amish/Mennonite,Amish Mennonite,,169.52,,,,,,,169.52,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,49643013801,NDC,facility,outpatient,1,EA,308.21000,292.80000,Amish/Mennonite,Amish Mennonite,,169.52,,,,,,,154.10,298.96,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,inpatient,1,EA,766.64000,728.31000,Amish/Mennonite,Amish Mennonite,,421.65,,,,,,,421.65,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59584013801,NDC,facility,outpatient,1,EA,766.64000,728.31000,Amish/Mennonite,Amish Mennonite,,421.65,,,,,,,383.32,743.64,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,inpatient,1,EA,357.42000,339.55000,Amish/Mennonite,Amish Mennonite,,196.58,,,,,,,196.58,346.70,percent of total billed charges,
CANDIDA ALBICANS SKIN TEST SOLN 1 ML,55653,CDM,250,RC,J3490,HCPCS,59684013801,NDC,facility,outpatient,1,EA,357.42000,339.55000,Amish/Mennonite,Amish Mennonite,,196.58,,,,,,,178.71,346.70,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,inpatient,30,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00054-3117-63,NDC,,,facility,outpatient,30,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,inpatient,30,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CALCIUM CARBONATE SUSP,55654,CDM,250,RC,00121-0766-16,NDC,,,facility,outpatient,30,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
CAROTENE ASSAY-TECH,55656,CDM,300,RC,82380,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,9.22,475.37,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,inpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,254.10,448.14,percent of total billed charges,
CARDIAC STRESS TEST TRACING-TECH,55657,CDM,482,RC,93017,CPT,,,facility,outpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,231.00,448.14,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00093-0054-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00172-5664-10,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,00591-0658-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,16729-0202-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,51079-0986-20,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,60687-0812-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BUSPIRONE TAB 10 MG,55658,CDM,250,RC,64380-0742-06,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00093-0280-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,00904-6635-61,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,24689-0119-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.30,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,50268-0142-15,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.10,4.06,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.76,percent of total billed charges,
BUPROPION TAB 75 MG,55660,CDM,250,RC,51079-0943-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.76,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,inpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,49.50,87.30,percent of total billed charges,
C PEPTIDE ASSAY-TECH,55661,CDM,300,RC,84681,CPT,,,facility,outpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,7.34,1086.52,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,00378-0094-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.22,4.31,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,16729-0079-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,51079-0923-20,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.74,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,62756-0457-88,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 50 MG-200 MG,55662,CDM,250,RC,68084-0282-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.23,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,inpatient,10,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00143933010,NDC,facility,outpatient,10,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.01550,0.64020,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,inpatient,10,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409115901,NDC,facility,outpatient,10,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.01550,0.60140,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,inpatient,10,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,00409155910,NDC,facility,outpatient,10,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.01550,1.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,inpatient,10,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,55150016710,NDC,facility,outpatient,10,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.01550,0.69840,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,inpatient,10,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,63323046417,NDC,facility,outpatient,10,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.01550,1.75,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,inpatient,10,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
BUPIVACAINE SOLN PF 0.25% 10 ML,55663,CDM,250,RC,J0665,HCPCS,70594011402,NDC,facility,outpatient,10,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,0.01550,2.01,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
BX BONE TROC/NDL SUPFCL-TECH,55664,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,4686.00,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,inpatient,1,EA,9.52000,9.04000,Amish/Mennonite,Amish Mennonite,,5.24,,,,,,,5.24,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00078-0509-05,NDC,,,facility,outpatient,1,EA,9.52000,9.04000,Amish/Mennonite,Amish Mennonite,,5.24,,,,,,,4.76,9.23,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00093-1233-19,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00182-1233-89,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,00904-3855-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-20,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51079-0385-19,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,51672-4005-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,60505-0183-00,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.92,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,68084-0444-01,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBAMAZEPINE TAB 7221260,55665,CDM,250,RC,75834-0221-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,inpatient,3.7,EA,256.63000,243.79000,Amish/Mennonite,Amish Mennonite,,141.15,,,,,,,141.15,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00078-0311-54,NDC,,,facility,outpatient,3.7,EA,256.63000,243.79000,Amish/Mennonite,Amish Mennonite,,141.15,,,,,,,128.31,248.93,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,inpatient,3.7,EA,50.82000,48.28000,Amish/Mennonite,Amish Mennonite,,27.95,,,,,,,27.95,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,00245-0008-35,NDC,,,facility,outpatient,3.7,EA,50.82000,48.28000,Amish/Mennonite,Amish Mennonite,,27.95,,,,,,,25.41,49.30,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,inpatient,3.7,EA,63.94000,60.75000,Amish/Mennonite,Amish Mennonite,,35.17,,,,,,,35.17,62.02,percent of total billed charges,
CALCITONIN SPRAY,55666,CDM,250,RC,60505-0823-06,NDC,,,facility,outpatient,3.7,EA,63.94000,60.75000,Amish/Mennonite,Amish Mennonite,,35.17,,,,,,,31.97,62.02,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,inpatient,222,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00145-0628-05,NDC,,,facility,outpatient,222,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,inpatient,222,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00316-0229-75,NDC,,,facility,outpatient,222,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,inpatient,222,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,00536-1268-12,NDC,,,facility,outpatient,222,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,inpatient,222,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-07,NDC,,,facility,outpatient,222,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,inpatient,222,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CAMPHOR-MENTHOL LOTION,55667,CDM,250,RC,54162-0550-09,NDC,,,facility,outpatient,222,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,inpatient,1,EA,244.62000,232.38000,Amish/Mennonite,Amish Mennonite,,134.54,,,,,,,134.54,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085605,NDC,facility,outpatient,1,EA,244.62000,232.38000,Amish/Mennonite,Amish Mennonite,,134.54,,,,,,,122.31,237.28,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,inpatient,1,EA,917.98000,872.08000,Amish/Mennonite,Amish Mennonite,,504.89,,,,,,,504.89,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,00009085608,NDC,facility,outpatient,1,EA,917.98000,872.08000,Amish/Mennonite,Amish Mennonite,,504.89,,,,,,,458.99,890.44,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,inpatient,1,EA,826.18000,784.87000,Amish/Mennonite,Amish Mennonite,,454.40,,,,,,,454.40,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,43598091758,NDC,facility,outpatient,1,EA,826.18000,784.87000,Amish/Mennonite,Amish Mennonite,,454.40,,,,,,,413.09,801.39,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
CARBOPROST SOLN 250 MCG/ML,55668,CDM,250,RC,J3490,HCPCS,70594011202,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,63.20,122.61,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,inpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001628,NDC,facility,outpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,inpatient,1,EA,11.22000,10.66000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,00186001631,NDC,facility,outpatient,1,EA,11.22000,10.66000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,inpatient,1,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
CANDESARTAN TAB 16 MG,55669,CDM,250,RC,J8499,HCPCS,33342011607,NDC,facility,outpatient,1,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,inpatient,1,EA,4.83000,4.59000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.66,4.69,percent of total billed charges,
CALCITRIOL CAP 0.5 MCG,55670,CDM,250,RC,J8499,HCPCS,63304024001,NDC,facility,outpatient,1,EA,4.83000,4.59000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.42,4.69,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,inpatient,1,mL,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,00703423981,NDC,facility,outpatient,1,mL,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,inpatient,1,mL,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,16729029512,NDC,facility,outpatient,1,mL,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,inpatient,1,mL,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,50742044860,NDC,facility,outpatient,1,mL,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.63,5.10,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,inpatient,1,mL,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,55150038601,NDC,facility,outpatient,1,mL,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,inpatient,1,mL,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,61703060005,NDC,facility,outpatient,1,mL,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,4.86,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,inpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
CARBOPLATIN 600 MG/60ML SOLN (MDV),55671,CDM,250,RC,J9045,HCPCS,63323017260,NDC,facility,outpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,5.52,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-03,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,inpatient,12,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0070-27,NDC,,,facility,outpatient,12,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,inpatient,12,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00135-0071-48,NDC,,,facility,outpatient,12,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,inpatient,12,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00536-1007-15,NDC,,,facility,outpatient,12,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,inpatient,12,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,00904-6412-92,NDC,,,facility,outpatient,12,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,inpatient,12,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,48433-0106-01,NDC,,,facility,outpatient,12,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,inpatient,12,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,66553-0004-01,NDC,,,facility,outpatient,12,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,inpatient,12,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,68084-0988-32,NDC,,,facility,outpatient,12,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,inpatient,12,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CALCIUM CARBONATE TAB-CHEW 500 MG (CA 200 MG),55673,CDM,250,RC,69618-0020-15,NDC,,,facility,outpatient,12,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,inpatient,,,298.50000,283.58000,Amish/Mennonite,Amish Mennonite,90,164.18,,,,,,,164.18,289.55,percent of total billed charges,
"CATECHOLAMINE, FRACTIONATION, FREE PLASMA SO-TECH",55674,CDM,300,RC,82384,CPT,,,facility,outpatient,,,298.50000,283.58000,Amish/Mennonite,Amish Mennonite,90,164.18,,,,,,,26.09,1324.17,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
CALCIUM URINE QUANT TIMED SPEC-TECH,55675,CDM,300,RC,82340,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,6.03,322.54,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
CALCIUM IONIZED-TECH,55676,CDM,300,RC,82330,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,13.68,713.01,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,inpatient,15,EA,11.52000,10.94000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,6.34,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-01,NDC,,,facility,outpatient,15,EA,11.52000,10.94000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,5.76,11.17,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,inpatient,15,EA,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00074-7362-03,NDC,,,facility,outpatient,15,EA,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.03,9.76,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,inpatient,15,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-3220-35,NDC,,,facility,outpatient,15,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,inpatient,15,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,00904-6627-35,NDC,,,facility,outpatient,15,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,inpatient,15,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,37205-0457-05,NDC,,,facility,outpatient,15,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,inpatient,15,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,57896-0339-05,NDC,,,facility,outpatient,15,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,inpatient,15,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,67172-0361-02,NDC,,,facility,outpatient,15,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,inpatient,15,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1153-01,NDC,,,facility,outpatient,15,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,inpatient,15,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
CARBAMIDE PEROXIDE SOL,55677,CDM,250,RC,70677-1154-01,NDC,,,facility,outpatient,15,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00093-7295-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-6302-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,00904-7307-61,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,51079-0931-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,68084-0263-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CARVEDILOL TAB 12.5 MG,55678,CDM,250,RC,72888-0036-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,inpatient,1,EA,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,8.36,14.74,percent of total billed charges,
CANDESARTAN TAB 32 MG,55679,CDM,250,RC,J8499,HCPCS,00186003231,NDC,facility,outpatient,1,EA,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,7.60,14.74,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00093-0053-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-16,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,00172-5663-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,16729-0200-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,51079-0985-20,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
BUSPIRONE TAB 5 MG,55680,CDM,250,RC,64380-0741-06,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00517002010,NDC,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,inpatient,1,mL,10.52000,10.00000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,00641626710,NDC,facility,outpatient,1,mL,10.52000,10.00000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.20,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,inpatient,1,mL,19.74000,18.75000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,10.86,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,25021060103,NDC,facility,outpatient,1,mL,19.74000,18.75000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,9.87,19.15,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,inpatient,1,mL,17.91000,17.01000,Amish/Mennonite,Amish Mennonite,,9.85,,,,,,,9.85,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,42571024469,NDC,facility,outpatient,1,mL,17.91000,17.01000,Amish/Mennonite,Amish Mennonite,,9.85,,,,,,,8.96,17.37,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,51754050201,NDC,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,inpatient,1,mL,5.67000,5.38000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,55150018703,NDC,facility,outpatient,1,mL,5.67000,5.38000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.83,5.50,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,inpatient,1,mL,32.79000,31.15000,Amish/Mennonite,Amish Mennonite,,18.03,,,,,,,18.03,31.81,percent of total billed charges,
CAFFEINE CITRATE INJECTION,55681,CDM,250,RC,J0706,HCPCS,63323040703,NDC,facility,outpatient,1,mL,32.79000,31.15000,Amish/Mennonite,Amish Mennonite,,18.03,,,,,,,16.39,31.81,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,177.51,percent of total billed charges,
CARBAMAZEPINE/TEGRETOL ASSAY-TECH,55682,CDM,300,RC,80156,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,14.57,763.98,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,inpatient,1,EA,874.67000,830.94000,Amish/Mennonite,Amish Mennonite,,481.07,,,,,,,481.07,848.43,percent of total billed charges,
CASPOFUNGIN ACETATE,55683,CDM,250,RC,J0637,HCPCS,00006382210,NDC,facility,outpatient,1,EA,874.67000,830.94000,Amish/Mennonite,Amish Mennonite,,481.07,,,,,,,3.63,848.43,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,inpatient,1,mL,17567.59000,16689.21000,Amish/Mennonite,Amish Mennonite,,9662.17,,,,,,,9662.17,17040.56,percent of total billed charges,
CABAZITAXEL INJ,55684,CDM,636,RC,J9043,HCPCS,00024582411,NDC,facility,outpatient,1,mL,17567.59000,16689.21000,Amish/Mennonite,Amish Mennonite,,9662.17,,,,,,,227.10,17040.56,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,inpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,TC,193.60,,,,,,,193.60,341.44,percent of total billed charges,
BRONCHOSPASM PROVOC EVAL-TECH,55685,CDM,460,RC,94070,CPT,,,facility,outpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,TC,193.60,,,,,,,176.00,341.44,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00228-2538-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00378-0078-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,00904-7718-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,42291-0465-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,59651-0456-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0046-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 10 MG-100 MG,55686,CDM,250,RC,63739-0107-10,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,inpatient,,,153.80000,146.11000,Amish/Mennonite,Amish Mennonite,90,84.59,,,,,,,84.59,149.19,percent of total billed charges,
"CARBAMAZEPINE, FREE, SERUM (CARF) SO",55687,CDM,300,RC,80157,CPT,,,facility,outpatient,,,153.80000,146.11000,Amish/Mennonite,Amish Mennonite,90,84.59,,,,,,,13.69,696.05,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,inpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,109.45,193.03,percent of total billed charges,
CEA CARCINOEMBRYONIC ANTIGEN-TECH,55688,CDM,300,RC,82378,CPT,,,facility,outpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,18.96,984.66,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,16714-0510-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,50742-0656-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,51079-0055-20,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,58657-0645-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CARISOPRODOL TAB,55689,CDM,250,RC,69584-0111-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,inpatient,1,EA,11.22000,10.66000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,6.17,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,00186000831,NDC,facility,outpatient,1,EA,11.22000,10.66000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,5.61,10.88,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,inpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
CANDESARTAN TAB 8 MG,55690,CDM,250,RC,J8499,HCPCS,33342011507,NDC,facility,outpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,inpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,00338350841,NDC,facility,outpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,inpatient,1,mL,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092101915,NDC,facility,outpatient,1,mL,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,2.19,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,inpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 100 ML PREMIX,55691,CDM,636,RC,J0689,HCPCS,70092162115,NDC,facility,outpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,2.19,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,182.60,322.04,percent of total billed charges,
BX RENAL NEEDLE/TROC PERQ-TECH,55692,CDM,350,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,166.00,1820.00,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM LACTATE TAB,55693,CDM,250,RC,00536-3422-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,inpatient,1,EA,3597.38000,3417.51000,Amish/Mennonite,Amish Mennonite,,1978.56,,,,,,,1978.56,3489.46,percent of total billed charges,
CARFILZOMIB POWD-INJ 30 MG,55694,CDM,636,RC,J9047,HCPCS,76075010201,NDC,facility,outpatient,1,EA,3597.38000,3417.51000,Amish/Mennonite,Amish Mennonite,,1978.56,,,,,,,55.09,3489.46,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2100.00000,1995.00000,Amish/Mennonite,Amish Mennonite,TC,1155.00,,,,,,,1155.00,2037.00,percent of total billed charges,
CARD BLD POOL GATED PLANAR SNGL-TECH,55695,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2100.00000,1995.00000,Amish/Mennonite,Amish Mennonite,TC,1155.00,,,,,,,980.94,2210.07,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,inpatient,1,EA,24.39000,23.17000,Amish/Mennonite,Amish Mennonite,,13.41,,,,,,,13.41,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-31,NDC,,,facility,outpatient,1,EA,24.39000,23.17000,Amish/Mennonite,Amish Mennonite,,13.41,,,,,,,12.20,23.66,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,inpatient,1,EA,23.23000,22.07000,Amish/Mennonite,Amish Mennonite,,12.78,,,,,,,12.78,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00025-1520-34,NDC,,,facility,outpatient,1,EA,23.23000,22.07000,Amish/Mennonite,Amish Mennonite,,12.78,,,,,,,11.62,22.53,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,00904-6502-61,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.70,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.03,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,16714-0732-02,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,inpatient,1,EA,3.47000,3.29000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,50268-0168-15,NDC,,,facility,outpatient,1,EA,3.47000,3.29000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.37,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,4.08,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,68084-0969-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,3.71,7.20,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,60687-0436-01,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.38,2.67,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CELECOXIB CAP 100 MG,55696,CDM,250,RC,69097-0422-07,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,47.30,83.42,percent of total billed charges,
CARDIOLIPIN AB EA IG CLASS-TECH,55697,CDM,300,RC,86147,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,8.17,1324.17,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,inpatient,,,67.40000,64.03000,Amish/Mennonite,Amish Mennonite,90,37.07,,,,,,,37.07,65.38,percent of total billed charges,
CANDIDA AB SO -TECH,55698,CDM,300,RC,86628,CPT,,,facility,outpatient,,,67.40000,64.03000,Amish/Mennonite,Amish Mennonite,90,37.07,,,,,,,8.17,628.12,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,inpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,00093413764,NDC,facility,outpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,1.97,3.81,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,inpatient,1,mL,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,16714039301,NDC,facility,outpatient,1,mL,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,68180072304,NDC,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,inpatient,1,mL,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CEFDINIR LIQ 50 MG/ML,55699,CDM,250,RC,J8499,HCPCS,67877054898,NDC,facility,outpatient,1,mL,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,inpatient,,,1010.55000,960.02000,Amish/Mennonite,Amish Mennonite,,555.80,,,,,,,495.17,980.23,percent of total billed charges,
BLN DSCT LAPSCP LG KNDY PRPERITN PVC PDB SM EXVW,55700,CDM,278,RC,C1727,HCPCS,,,facility,outpatient,,,1010.55000,960.02000,Amish/Mennonite,Amish Mennonite,,555.80,,,,,,,463.84,1010.55,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,inpatient,1,EA,5931.95000,5635.36000,Amish/Mennonite,Amish Mennonite,,3262.57,,,,,,,3262.57,5753.99,percent of total billed charges,
CARFILZOMIB POWD-INJ 60 MG,55701,CDM,636,RC,J9047,HCPCS,76075010101,NDC,facility,outpatient,1,EA,5931.95000,5635.36000,Amish/Mennonite,Amish Mennonite,,3262.57,,,,,,,55.09,5753.99,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1419.00000,1348.05000,Amish/Mennonite,Amish Mennonite,,780.45,,,,,,,780.45,1376.43,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTRNL-TECH,55702,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1419.00000,1348.05000,Amish/Mennonite,Amish Mennonite,,780.45,,,,,,,621.36,1376.43,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,inpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,,1333.75,,,,,,,1333.75,2352.25,percent of total billed charges,
BX BRST 1ST LESN US IMG-TECH,55703,CDM,361,RC,19083,CPT,,,facility,outpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,,1333.75,,,,,,,1333.75,4686.00,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,inpatient,1,EA,62.57000,59.44000,Amish/Mennonite,Amish Mennonite,,34.41,,,,,,,34.41,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,00143987725,NDC,facility,outpatient,1,EA,62.57000,59.44000,Amish/Mennonite,Amish Mennonite,,34.41,,,,,,,7.77,60.69,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,25021011020,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,7.77,30.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,inpatient,1,EA,63.04000,59.89000,Amish/Mennonite,Amish Mennonite,,34.67,,,,,,,34.67,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024625,NDC,facility,outpatient,1,EA,63.04000,59.89000,Amish/Mennonite,Amish Mennonite,,34.67,,,,,,,7.77,61.15,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,44567024685,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,inpatient,1,EA,44.11000,41.91000,Amish/Mennonite,Amish Mennonite,,24.26,,,,,,,24.26,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034225,NDC,facility,outpatient,1,EA,44.11000,41.91000,Amish/Mennonite,Amish Mennonite,,24.26,,,,,,,7.77,42.79,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,inpatient,1,EA,20.26000,19.24000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,11.14,19.65,percent of total billed charges,
CEFOXITIN POWD-INJ 2 GM/20 ML,55705,CDM,250,RC,J0694,HCPCS,63323034229,NDC,facility,outpatient,1,EA,20.26000,19.24000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,7.77,19.65,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,00143-9985-01,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.61,5.06,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,inpatient,1,EA,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,3.19,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,47781-0266-03,NDC,,,facility,outpatient,1,EA,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,2.90,5.63,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,3.16,5.58,percent of total billed charges,
CEFACLOR CAP,55706,CDM,250,RC,61442-0171-30,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,2.88,5.58,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,inpatient,,,1182.00000,1122.90000,Amish/Mennonite,Amish Mennonite,,650.10,,,,,,,650.10,1146.54,percent of total billed charges,
CATH W INJ CNTRST HSG-TECH,55707,CDM,361,RC,58340,CPT,,,facility,outpatient,,,1182.00000,1122.90000,Amish/Mennonite,Amish Mennonite,,650.10,,,,,,,650.10,5271.00,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,inpatient,1,EA,46.64000,44.31000,Amish/Mennonite,Amish Mennonite,,25.65,,,,,,,25.65,45.24,percent of total billed charges,
CEFAZOLIN 2 GM/D5W 50 ML PREMIX,55708,CDM,250,RC,J0690,HCPCS,00264310511,NDC,facility,outpatient,1,EA,46.64000,44.31000,Amish/Mennonite,Amish Mennonite,,25.65,,,,,,,1.28,45.24,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,inpatient,60,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00536-2525-25,NDC,,,facility,outpatient,60,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,00603-0648-88,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,inpatient,60,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
CAPSAICIN TOPICAL CREAM,55709,CDM,250,RC,50268-0195-60,NDC,,,facility,outpatient,60,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,inpatient,,,2596.00000,2466.20000,Amish/Mennonite,Amish Mennonite,TC,1427.80,,,,,,,1427.80,2518.12,percent of total billed charges,
CARD BLD POOL GATED MULT-TECH,55710,CDM,340,RC,78473,CPT,,,facility,outpatient,,,2596.00000,2466.20000,Amish/Mennonite,Amish Mennonite,TC,1427.80,,,,,,,1189.19,2518.12,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
CBC W AUTO DIFF-TECH,55711,CDM,300,RC,85025,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,7.77,407.44,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,inpatient,,,273.00000,259.35000,Amish/Mennonite,Amish Mennonite,,150.15,,,,,,,150.15,264.81,percent of total billed charges,
CARD REHAB W ECG MONITORING-TECH,55712,CDM,943,RC,93798,CPT,,,facility,outpatient,,,273.00000,259.35000,Amish/Mennonite,Amish Mennonite,,150.15,,,,,,,119.56,264.81,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,inpatient,1,EA,15.16000,14.40000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00007-4142-20,NDC,,,facility,outpatient,1,EA,15.16000,14.40000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,14.71,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-6303-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,00904-7308-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,51079-0932-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,68084-0876-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 25 MG,55713,CDM,250,RC,72888-0037-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
CELL COUNT W DIFF BODY FLUID-TECH,55715,CDM,300,RC,89051,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,5.60,288.61,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,inpatient,1,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00143992490,NDC,facility,outpatient,1,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,1.28,4.19,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345170,NDC,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.28,3.22,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,00781345196,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,1.28,4.60,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010110,NDC,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,1.28,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,inpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,25021010167,NDC,facility,outpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.28,2.82,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,44567070725,NDC,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,1.28,5.05,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,inpatient,1,EA,4.52000,4.29000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,2.49,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,60505614205,NDC,facility,outpatient,1,EA,4.52000,4.29000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,1.28,4.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,inpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.63,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML,55716,CDM,250,RC,J0690,HCPCS,63323023710,NDC,facility,outpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,1.28,4.63,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00093-0051-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-6300-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,00904-7305-61,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,51079-0771-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68382-0092-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,68084-0261-11,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
CARVEDILOL TAB 3.125 MG,55717,CDM,250,RC,72888-0034-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,inpatient,,,54.50000,51.77000,Amish/Mennonite,Amish Mennonite,90,29.98,,,,,,,29.98,52.87,percent of total billed charges,
CALCULUS QUANT CHEMICAL- SO TECH,55719,CDM,300,RC,82360,CPT,,,facility,outpatient,,,54.50000,51.77000,Amish/Mennonite,Amish Mennonite,90,29.98,,,,,,,13.30,679.08,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,inpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143926110,NDC,facility,outpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,1.28,26.05,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,inpatient,1,EA,34.92000,33.17000,Amish/Mennonite,Amish Mennonite,,19.21,,,,,,,19.21,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998303,NDC,facility,outpatient,1,EA,34.92000,33.17000,Amish/Mennonite,Amish Mennonite,,19.21,,,,,,,1.28,33.87,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,inpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00143998391,NDC,facility,outpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,1.28,45.98,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,inpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,60505614304,NDC,facility,outpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,1.28,36.78,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,inpatient,1,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,00781345295,NDC,facility,outpatient,1,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,1.28,147.13,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,inpatient,1,EA,39.63000,37.65000,Amish/Mennonite,Amish Mennonite,,21.80,,,,,,,21.80,38.44,percent of total billed charges,
CEFAZOLIN SODIUM INJECTION 7855890,55721,CDM,250,RC,J0690,HCPCS,63323023861,NDC,facility,outpatient,1,EA,39.63000,37.65000,Amish/Mennonite,Amish Mennonite,,21.80,,,,,,,1.28,38.44,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,inpatient,1,EA,3686.90000,3502.55000,Amish/Mennonite,Amish Mennonite,,2027.80,,,,,,,2027.80,3576.29,percent of total billed charges,
BORTEZOMIB INJECTION,55722,CDM,250,RC,J9041,HCPCS,63020004901,NDC,facility,outpatient,1,EA,3686.90000,3502.55000,Amish/Mennonite,Amish Mennonite,,2027.80,,,,,,,2.55,3576.29,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
CARBOXYHEMOGLOBIN QUANT-TECH,55724,CDM,300,RC,82375,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,12.32,645.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00143985725,NDC,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,0.76415,7.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,inpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.65,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733220,NDC,facility,outpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,0.76415,4.67,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,inpatient,1,EA,12.32000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,6.78,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00409733349,NDC,facility,outpatient,1,EA,12.32000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,0.76415,11.95,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,inpatient,1,EA,14.73000,13.99000,Amish/Mennonite,Amish Mennonite,,8.10,,,,,,,8.10,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320885,NDC,facility,outpatient,1,EA,14.73000,13.99000,Amish/Mennonite,Amish Mennonite,,8.10,,,,,,,0.76415,14.29,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,inpatient,1,EA,11.06000,10.50000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,00781320895,NDC,facility,outpatient,1,EA,11.06000,10.50000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,0.76415,10.73,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,inpatient,1,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,25021010610,NDC,facility,outpatient,1,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,0.76415,7.35,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,44567070125,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,inpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,60505614804,NDC,facility,outpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,0.76415,4.66,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,inpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
CEFTRIAXONE POWD-INJ 1 GM/10 ML,55725,CDM,250,RC,J0696,HCPCS,64679098302,NDC,facility,outpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,0.76415,21.46,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,inpatient,1,EA,19.34000,18.37000,Amish/Mennonite,Amish Mennonite,,10.64,,,,,,,10.64,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00264310311,NDC,facility,outpatient,1,EA,19.34000,18.37000,Amish/Mennonite,Amish Mennonite,,10.64,,,,,,,9.67,18.76,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CEFAZOLIN 1 GM/50 ML PREMIX,55726,CDM,636,RC,j0690,HCPCS,00338350341,NDC,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.60,3.10,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,27241-0160-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,inpatient,1,EA,4.46000,4.24000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,00904-7105-61,NDC,,,facility,outpatient,1,EA,4.46000,4.24000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.33,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.34,percent of total billed charges,
CAPTOPRIL TAB 12.5 MG,55727,CDM,250,RC,60687-0304-21,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.23,4.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00143985625,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.76415,9.20,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,inpatient,1,EA,9.14000,8.68000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,5.03,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733520,NDC,facility,outpatient,1,EA,9.14000,8.68000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,0.76415,8.87,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,inpatient,1,EA,24.82000,23.58000,Amish/Mennonite,Amish Mennonite,,13.65,,,,,,,13.65,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00409733604,NDC,facility,outpatient,1,EA,24.82000,23.58000,Amish/Mennonite,Amish Mennonite,,13.65,,,,,,,0.76415,24.08,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,inpatient,1,EA,28.19000,26.78000,Amish/Mennonite,Amish Mennonite,,15.50,,,,,,,15.50,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,00781320995,NDC,facility,outpatient,1,EA,28.19000,26.78000,Amish/Mennonite,Amish Mennonite,,15.50,,,,,,,0.76415,27.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,inpatient,1,EA,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,7.64,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010720,NDC,facility,outpatient,1,EA,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,0.76415,13.48,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,inpatient,1,EA,6.97000,6.62000,Amish/Mennonite,Amish Mennonite,,3.83,,,,,,,3.83,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,25021010768,NDC,facility,outpatient,1,EA,6.97000,6.62000,Amish/Mennonite,Amish Mennonite,,3.83,,,,,,,0.76415,6.76,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,inpatient,1,EA,7.41000,7.04000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,4.08,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,44567070225,NDC,facility,outpatient,1,EA,7.41000,7.04000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,0.76415,7.19,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,inpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,60505614904,NDC,facility,outpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,0.76415,13.79,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
CEFTRIAXONE POWD-INJ 2 GM/20 ML,55728,CDM,250,RC,J0696,HCPCS,64679070301,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,0.76415,33.72,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,,503.80,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP-TECH,55729,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,,503.80,,,,,,,314.95,888.52,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,25021010910,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,7.77,18.39,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,inpatient,1,EA,31.44000,29.87000,Amish/Mennonite,Amish Mennonite,,17.29,,,,,,,17.29,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024525,NDC,facility,outpatient,1,EA,31.44000,29.87000,Amish/Mennonite,Amish Mennonite,,17.29,,,,,,,7.77,30.50,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,44567024585,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,inpatient,1,EA,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,12.15,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034125,NDC,facility,outpatient,1,EA,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,7.77,21.43,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,inpatient,1,EA,10.14000,9.64000,Amish/Mennonite,Amish Mennonite,,5.58,,,,,,,5.58,9.84,percent of total billed charges,
CEFOXITIN POWD-INJ 1 GM/10 ML,55732,CDM,250,RC,J0694,HCPCS,63323034129,NDC,facility,outpatient,1,EA,10.14000,9.64000,Amish/Mennonite,Amish Mennonite,,5.58,,,,,,,5.07,9.84,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00143985825,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,0.76415,4.60,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00409733820,NDC,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,0.76415,2.96,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,inpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
CEFTRIAXONE POWD-INJ 500 MG,55733,CDM,250,RC,J0696,HCPCS,00781320795,NDC,facility,outpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,0.76415,2.59,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,inpatient,1,EA,31.76000,30.17000,Amish/Mennonite,Amish Mennonite,,17.47,,,,,,,17.47,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,00409973510,NDC,facility,outpatient,1,EA,31.76000,30.17000,Amish/Mennonite,Amish Mennonite,,17.47,,,,,,,1.86,30.81,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,25021012267,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,1.86,30.65,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,inpatient,1,EA,30.97000,29.42000,Amish/Mennonite,Amish Mennonite,,17.03,,,,,,,17.03,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,70594009002,NDC,facility,outpatient,1,EA,30.97000,29.42000,Amish/Mennonite,Amish Mennonite,,17.03,,,,,,,1.86,30.04,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,inpatient,1,EA,16.61000,15.78000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,9.14,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614504,NDC,facility,outpatient,1,EA,16.61000,15.78000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,1.86,16.11,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,inpatient,1,EA,44.65000,42.42000,Amish/Mennonite,Amish Mennonite,,24.56,,,,,,,24.56,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,60505614704,NDC,facility,outpatient,1,EA,44.65000,42.42000,Amish/Mennonite,Amish Mennonite,,24.56,,,,,,,1.86,43.31,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,inpatient,1,EA,31.28000,29.72000,Amish/Mennonite,Amish Mennonite,,17.20,,,,,,,17.20,30.34,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 2 GM,55734,CDM,250,RC,J0692,HCPCS,66794021041,NDC,facility,outpatient,1,EA,31.28000,29.72000,Amish/Mennonite,Amish Mennonite,,17.20,,,,,,,1.86,30.34,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00093-0135-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00378-3632-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00781-5222-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-6301-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,00904-7306-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,51079-0930-19,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,68084-0854-01,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CARVEDILOL TAB 6.25 MG,55735,CDM,250,RC,72888-0035-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00093-3145-01,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,00143-9898-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,inpatient,1,EA,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,50268-0151-15,NDC,,,facility,outpatient,1,EA,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,60687-0152-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,62756-0293-88,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,65862-0018-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,67877-0220-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CEPHALEXIN CAP 250 MG,55736,CDM,250,RC,68180-0121-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00378-3012-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00781-8061-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,inpatient,1,EA,4.73000,4.50000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.60,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,00904-5046-61,NDC,,,facility,outpatient,1,EA,4.73000,4.50000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.37,4.59,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,inpatient,1,EA,4.91000,4.66000,Amish/Mennonite,Amish Mennonite,,2.70,,,,,,,2.70,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,51079-0864-20,NDC,,,facility,outpatient,1,EA,4.91000,4.66000,Amish/Mennonite,Amish Mennonite,,2.70,,,,,,,2.46,4.76,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,inpatient,1,EA,4.86000,4.62000,Amish/Mennonite,Amish Mennonite,,2.67,,,,,,,2.67,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,60687-0315-21,NDC,,,facility,outpatient,1,EA,4.86000,4.62000,Amish/Mennonite,Amish Mennonite,,2.67,,,,,,,2.43,4.71,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
CAPTOPRIL TAB 25 MG,55737,CDM,250,RC,64679-0903-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
CELL COUNT BODY FLUID-TECH,55738,CDM,300,RC,89050,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,4.72,254.68,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,00574-9855-10,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.03,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,inpatient,1,EA,9.90000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,5.45,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,16714-0829-01,NDC,,,facility,outpatient,1,EA,9.90000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,4.95,9.60,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,23.46,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,60687-0596-32,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,21.33,41.38,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,Amish/Mennonite,Amish Mennonite,,11.47,,,,,,,11.47,20.23,percent of total billed charges,
BUDESONIDE CAP-EC 3 MG,55739,CDM,250,RC,65162-0778-10,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,Amish/Mennonite,Amish Mennonite,,11.47,,,,,,,10.43,20.23,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,inpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,211.46,percent of total billed charges,
CAST APPLIED-TX DONE-TECH,55740,CDM,361,RC,,,,,facility,outpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,5271.00,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,inpatient,1,EA,2.41000,2.29000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.33,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00409733720,NDC,facility,outpatient,1,EA,2.41000,2.29000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,0.76415,2.34,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,inpatient,1,EA,5.62000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
CEFTRIAXONE POWD-INJ 250 MG,55744,CDM,250,RC,J0696,HCPCS,00781320695,NDC,facility,outpatient,1,EA,5.62000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,0.76415,5.45,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0121-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,inpatient,120,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-04,NDC,,,facility,outpatient,120,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,inpatient,120,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,00574-0521-74,NDC,,,facility,outpatient,120,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,inpatient,120,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
CHARCOAL SUSP,55745,CDM,250,RC,66689-0202-04,NDC,,,facility,outpatient,120,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,inpatient,1,mL,49.82000,47.33000,Amish/Mennonite,Amish Mennonite,,27.40,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION 7910204,55746,CDM,636,RC,J9055,HCPCS,66733094823,NDC,facility,outpatient,1,mL,49.82000,47.33000,Amish/Mennonite,Amish Mennonite,,27.40,,,,,,,24.91,129.48,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,inpatient,1,EA,38.10000,36.19000,Amish/Mennonite,Amish Mennonite,,20.95,,,,,,,20.95,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00025-1525-34,NDC,,,facility,outpatient,1,EA,38.10000,36.19000,Amish/Mennonite,Amish Mennonite,,20.95,,,,,,,19.05,36.96,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00378-7150-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,1.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,00904-6503-61,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,16714-0733-01,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,69097-0421-07,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,50268-0169-15,NDC,,,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.78,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60505-3849-01,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,inpatient,1,EA,6.39000,6.07000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.51,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,60687-0447-01,NDC,,,facility,outpatient,1,EA,6.39000,6.07000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.19,6.20,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,63739-0298-10,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.97,3.82,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,65862-0909-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CELECOXIB CAP 200 MG,55747,CDM,250,RC,72241-0024-05,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,110.00,194.00,percent of total billed charges,
CELIAC PANEL AGE OVER 2 YEARS-TECH,55749,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,11.53,594.19,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,00904-3854-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,13668-0271-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51079-0870-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,51672-4041-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
CARBAMAZEPINE TAB 7221328,55750,CDM,250,RC,60687-0479-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,inpatient,100,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-01,NDC,,,facility,outpatient,100,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,inpatient,100,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,68180-0441-02,NDC,,,facility,outpatient,100,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,inpatient,100,EA,25.98000,24.68000,Amish/Mennonite,Amish Mennonite,,14.29,,,,,,,14.29,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,63304-0959-02,NDC,,,facility,outpatient,100,EA,25.98000,24.68000,Amish/Mennonite,Amish Mennonite,,14.29,,,,,,,12.99,25.20,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-68,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,inpatient,100,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CEPHALEXIN POWDER,55752,CDM,250,RC,67877-0545-88,NDC,,,facility,outpatient,100,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,inpatient,,,2419.00000,2298.05000,Amish/Mennonite,Amish Mennonite,,1330.45,,,,,,,1330.45,2346.43,percent of total billed charges,
BX BRST ADDL LESN STRTCTC-TECH,55754,CDM,361,RC,19082,CPT,,,facility,outpatient,,,2419.00000,2298.05000,Amish/Mennonite,Amish Mennonite,,1330.45,,,,,,,1330.45,5271.00,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00116-2001-15,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00121-0893-40,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,00904-7035-87,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,50383-0720-17,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,53462-0003-15,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,63739-0052-69,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-17,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,inpatient,1,mL,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID 7910589,55755,CDM,250,RC,69339-0138-19,NDC,,,facility,outpatient,1,mL,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,00555-0158-02,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 5 MG,55756,CDM,250,RC,51079-0374-20,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.01,1.97,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,inpatient,1,EA,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714023201,NDC,facility,outpatient,1,EA,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,inpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.94,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040001,NDC,facility,outpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.67,5.19,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,inpatient,1,EA,5.09000,4.83000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.80,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,16714040002,NDC,facility,outpatient,1,EA,5.09000,4.83000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.54,4.94,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,inpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,3.06,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,51079001620,NDC,facility,outpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,2.78,5.39,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005820,NDC,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,57237005860,NDC,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,inpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.97,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,60687027294,NDC,facility,outpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.43,10.53,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,inpatient,1,EA,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,3.20,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,65862069920,NDC,facility,outpatient,1,EA,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,2.90,5.64,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,inpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021520,NDC,facility,outpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
CEFUROXIME TAB 250 MG,55757,CDM,250,RC,J8499,HCPCS,67877021560,NDC,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
CHLAMYDIA AB IGM-TECH,55759,CDM,300,RC,86632,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,8.17,662.12,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,inpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,138.60,244.44,percent of total billed charges,
CHROM ANAL ADDL CELL COUNTS-TECH,55760,CDM,310,RC,88285,CPT,,,facility,outpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,26.72,1273.27,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,inpatient,,,35.20000,33.44000,Amish/Mennonite,Amish Mennonite,90,19.36,,,,,,,19.36,34.14,percent of total billed charges,
CHEMILUMINESCENT ASSAY-TECH,55761,CDM,300,RC,82397,CPT,,,facility,outpatient,,,35.20000,33.44000,Amish/Mennonite,Amish Mennonite,90,19.36,,,,,,,14.59,729.98,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
CBC AUTO WO DIFF-TECH,55762,CDM,300,RC,85027,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.47,339.51,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,inpatient,2,EA,47.59000,45.21000,Amish/Mennonite,Amish Mennonite,,26.17,,,,,,,26.17,46.16,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,00641139835,NDC,facility,outpatient,2,EA,47.59000,45.21000,Amish/Mennonite,Amish Mennonite,,26.17,,,,,,,23.80,48.21,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,inpatient,2,EA,52.30000,49.68000,Amish/Mennonite,Amish Mennonite,,28.77,,,,,,,28.77,50.73,percent of total billed charges,
CHLORPROMAZINE HCL INJ,55763,CDM,250,RC,J3230,HCPCS,55150031925,NDC,facility,outpatient,2,EA,52.30000,49.68000,Amish/Mennonite,Amish Mennonite,,28.77,,,,,,,26.15,50.73,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,inpatient,,,167.30000,158.94000,Amish/Mennonite,Amish Mennonite,90,92.02,,,,,,,92.02,162.28,percent of total billed charges,
CARNITINE QUANT EA SPECIMEN (CARN) SO,55764,CDM,300,RC,82379,CPT,,,facility,outpatient,,,167.30000,158.94000,Amish/Mennonite,Amish Mennonite,90,92.02,,,,,,,17.43,882.80,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,Amish/Mennonite,Amish Mennonite,,484.55,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR-TECH,55765,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,Amish/Mennonite,Amish Mennonite,,484.55,,,,,,,314.95,854.57,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,inpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,TC,434.50,,,,,,,434.50,766.30,percent of total billed charges,
CHG PERQ DRNG TBE/CATH W CNTRST-TECH,55767,CDM,320,RC,75984,CPT,,,facility,outpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,TC,434.50,,,,,,,304.21,3547.16,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM-TECH,55768,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,67.58,471.42,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
CERULOPLASMIN ASSAY-TECH,55769,CDM,300,RC,82390,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,10.74,560.26,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM-TECH,55770,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG-TECH,55771,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,314.95,700.34,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,inpatient,2,EA,2573.64000,2444.96000,Amish/Mennonite,Amish Mennonite,,1415.50,,,,,,,1415.50,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,00078014923,NDC,facility,outpatient,2,EA,2573.64000,2444.96000,Amish/Mennonite,Amish Mennonite,,1415.50,,,,,,,835.80,2496.43,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,inpatient,2,EA,3600.65000,3420.62000,Amish/Mennonite,Amish Mennonite,,1980.36,,,,,,,1980.36,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,42023020501,NDC,facility,outpatient,2,EA,3600.65000,3420.62000,Amish/Mennonite,Amish Mennonite,,1980.36,,,,,,,835.80,3492.63,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,inpatient,2,EA,2626.01000,2494.71000,Amish/Mennonite,Amish Mennonite,,1444.31,,,,,,,1444.31,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,54766014923,NDC,facility,outpatient,2,EA,2626.01000,2494.71000,Amish/Mennonite,Amish Mennonite,,1444.31,,,,,,,835.80,2547.23,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,inpatient,2,EA,3601.91000,3421.82000,Amish/Mennonite,Amish Mennonite,,1981.05,,,,,,,1981.05,3493.85,percent of total billed charges,
CALCITONIN SOLN 200 UNIT/ML 2 ML MDV,55772,CDM,636,RC,J0630,HCPCS,72078003802,NDC,facility,outpatient,2,EA,3601.91000,3421.82000,Amish/Mennonite,Amish Mennonite,,1981.05,,,,,,,835.80,3493.85,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR-TECH,55773,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,67.58,180.42,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
CHLORIDE OTHER SOURCE-TECH,55775,CDM,300,RC,82438,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,5.00,254.68,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,37.78,66.64,percent of total billed charges,
CHLAMYDIA AB-TECH,55777,CDM,300,RC,86631,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,8.17,611.15,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00143992801,NDC,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00172531210,NDC,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904708361,NDC,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,00904724361,NDC,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,16714065202,NDC,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,43063054701,NDC,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,inpatient,1,EA,18.13000,17.22000,Amish/Mennonite,Amish Mennonite,,9.97,,,,,,,9.97,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,50419075401,NDC,facility,outpatient,1,EA,18.13000,17.22000,Amish/Mennonite,Amish Mennonite,,9.97,,,,,,,9.06,17.59,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,51079018220,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,58657067601,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,63739055910,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,65862007701,NDC,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
CIPROFLOXACIN TAB 500 MG,55778,CDM,250,RC,J8499,HCPCS,68084007011,NDC,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,inpatient,1,EA,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,6.57,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,69238105601,NDC,facility,outpatient,1,EA,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,5.97,11.58,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,inpatient,1,EA,17.32000,16.45000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,9.53,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832030101,NDC,facility,outpatient,1,EA,17.32000,16.45000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,8.66,16.80,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,inpatient,1,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00832601800,NDC,facility,outpatient,1,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,inpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904689361,NDC,facility,outpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.27,8.28,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,inpatient,1,EA,17.40000,16.53000,Amish/Mennonite,Amish Mennonite,,9.57,,,,,,,9.57,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,00904713061,NDC,facility,outpatient,1,EA,17.40000,16.53000,Amish/Mennonite,Amish Mennonite,,9.57,,,,,,,8.70,16.88,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,inpatient,1,EA,12.33000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,6.78,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,16714004801,NDC,facility,outpatient,1,EA,12.33000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,6.17,11.96,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,50268016315,NDC,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,inpatient,1,EA,20.14000,19.13000,Amish/Mennonite,Amish Mennonite,,11.08,,,,,,,11.08,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,51079051920,NDC,facility,outpatient,1,EA,20.14000,19.13000,Amish/Mennonite,Amish Mennonite,,11.08,,,,,,,10.07,19.54,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,62332073631,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,inpatient,1,EA,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CHLORPROMAZINE TAB,55779,CDM,250,RC,Q0161,HCPCS,70710113001,NDC,facility,outpatient,1,EA,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00143-9947-50,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,1.82,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,inpatient,1,EA,6.62000,6.29000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.64,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,00172-4058-43,NDC,,,facility,outpatient,1,EA,6.62000,6.29000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.31,6.42,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,inpatient,1,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0204-02,NDC,,,facility,outpatient,1,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.45,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
CEFADROXIL CAP,55780,CDM,250,RC,16714-0388-02,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,inpatient,1,EA,16.31000,15.49000,Amish/Mennonite,Amish Mennonite,,8.97,,,,,,,8.97,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409021901,NDC,facility,outpatient,1,EA,16.31000,15.49000,Amish/Mennonite,Amish Mennonite,,8.97,,,,,,,1.86,15.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,inpatient,1,EA,19.05000,18.10000,Amish/Mennonite,Amish Mennonite,,10.48,,,,,,,10.48,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,00409956610,NDC,facility,outpatient,1,EA,19.05000,18.10000,Amish/Mennonite,Amish Mennonite,,10.48,,,,,,,1.86,18.48,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,25021012166,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,1.86,18.39,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,inpatient,1,EA,18.01000,17.11000,Amish/Mennonite,Amish Mennonite,,9.91,,,,,,,9.91,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,44567024010,NDC,facility,outpatient,1,EA,18.01000,17.11000,Amish/Mennonite,Amish Mennonite,,9.91,,,,,,,1.86,17.47,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,inpatient,1,EA,22.50000,21.37000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,12.38,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614604,NDC,facility,outpatient,1,EA,22.50000,21.37000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,1.86,21.82,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,60505614404,NDC,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,1.86,8.58,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,inpatient,1,EA,18.33000,17.41000,Amish/Mennonite,Amish Mennonite,,10.08,,,,,,,10.08,17.78,percent of total billed charges,
CEFEPIME HCL FOR INJECTION 1 GM,55781,CDM,250,RC,J0692,HCPCS,63323032620,NDC,facility,outpatient,1,EA,18.33000,17.41000,Amish/Mennonite,Amish Mennonite,,10.08,,,,,,,1.86,17.78,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,00603-2714-21,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,42582-0300-10,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.57,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,51293-0607-01,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.15,8.05,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,64125-0132-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,inpatient,1,EA,13.54000,12.87000,Amish/Mennonite,Amish Mennonite,,7.45,,,,,,,7.45,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,68682-0409-10,NDC,,,facility,outpatient,1,EA,13.54000,12.87000,Amish/Mennonite,Amish Mennonite,,7.45,,,,,,,6.77,13.13,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.58,6.31,percent of total billed charges,
CHLORDIAZEPOXIDE-CLIDINIUM CAP,55782,CDM,250,RC,76439-0302-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.25,6.31,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,inpatient,50,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0216-01,NDC,,,facility,outpatient,50,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,inpatient,50,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0387-01,NDC,,,facility,outpatient,50,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,inpatient,50,EA,1.85000,1.75000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-01,NDC,,,facility,outpatient,50,EA,1.85000,1.75000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,inpatient,50,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,16714-0397-03,NDC,,,facility,outpatient,50,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,inpatient,50,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,63304-0961-03,NDC,,,facility,outpatient,50,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,inpatient,50,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-01,NDC,,,facility,outpatient,50,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,inpatient,50,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
CEFPROZIL POWDER 7936546,55783,CDM,250,RC,68180-0402-03,NDC,,,facility,outpatient,50,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00536-3334-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,20555-0033-00,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-89,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,inpatient,1,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,00904-5824-93,NDC,,,facility,outpatient,1,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,48433-0104-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,54629-0502-33,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 1000 INTL UNITS,55784,CDM,250,RC,80681-0169-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00228-2539-10,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7257-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,00904-7501-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,42291-0472-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,50228-0458-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,62756-0518-88,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,inpatient,1,EA,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,59651-0457-01,NDC,,,facility,outpatient,1,EA,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,68084-0093-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0047-10,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB 25 MG-100 MG,55785,CDM,250,RC,63739-0108-10,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,inpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,45.65,80.51,percent of total billed charges,
CHOLINESTERASE RBC-TECH,55786,CDM,300,RC,82482,CPT,,,facility,outpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,9.81,458.40,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
CHLORIDE URINE ASSAY-TECH,55787,CDM,300,RC,82436,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.75,271.65,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
CHOLINESTERASE SERUM-TECH,55790,CDM,300,RC,82480,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,7.87,407.44,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
CHLORIDE BLOOD ASSAY-TECH,55791,CDM,300,RC,82435,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,4.60,237.65,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00093314701,NDC,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,00904733761,NDC,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,50268015215,NDC,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,60687016301,NDC,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,inpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,62584023601,NDC,facility,outpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CEPHALEXIN CAP 500 MG,55792,CDM,250,RC,J8499,HCPCS,68180012201,NDC,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR-TECH,55794,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,67.58,395.76,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,inpatient,1,mL,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.43,percent of total billed charges,
CHLOROPROCAINE SOLN PF 3% 20 ML,55795,CDM,250,RC,J2401,HCPCS,63323047827,NDC,facility,outpatient,1,mL,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,0.06045,3.43,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,inpatient,1,mL,104.95000,99.70000,Amish/Mennonite,Amish Mennonite,,57.72,,,,,,,57.72,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00078-0799-75,NDC,,,facility,outpatient,1,mL,104.95000,99.70000,Amish/Mennonite,Amish Mennonite,,57.72,,,,,,,52.48,101.80,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,inpatient,1,mL,94.45000,89.73000,Amish/Mennonite,Amish Mennonite,,51.95,,,,,,,51.95,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,00781-6186-67,NDC,,,facility,outpatient,1,mL,94.45000,89.73000,Amish/Mennonite,Amish Mennonite,,51.95,,,,,,,47.23,91.62,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,inpatient,1,mL,86.63000,82.30000,Amish/Mennonite,Amish Mennonite,,47.65,,,,,,,47.65,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,16714-0628-01,NDC,,,facility,outpatient,1,mL,86.63000,82.30000,Amish/Mennonite,Amish Mennonite,,47.65,,,,,,,43.31,84.03,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,inpatient,1,mL,73.73000,70.05000,Amish/Mennonite,Amish Mennonite,,40.55,,,,,,,40.55,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,43598-0326-75,NDC,,,facility,outpatient,1,mL,73.73000,70.05000,Amish/Mennonite,Amish Mennonite,,40.55,,,,,,,36.87,71.52,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,inpatient,1,mL,48.60000,46.17000,Amish/Mennonite,Amish Mennonite,,26.73,,,,,,,26.73,47.14,percent of total billed charges,
CIPROFLOXACIN-DEXAMETHASONE SUSP,55796,CDM,250,RC,72485-0625-13,NDC,,,facility,outpatient,1,mL,48.60000,46.17000,Amish/Mennonite,Amish Mennonite,,26.73,,,,,,,24.30,47.14,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,inpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,178.20,314.28,percent of total billed charges,
CHLAMYDIA TRACHOMATIS PCR-TECH,55797,CDM,300,RC,87491,CPT,,,facility,outpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,35.09,1833.46,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00116-2001-16,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,00121-0893-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
CHLORHEXIDINE TOPICAL LIQUID,55798,CDM,250,RC,50383-0720-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00378-0222-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,00904-6900-61,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0128-01,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,16714-0800-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0170-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,43598-0719-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.37,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,51079-0058-20,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.02,5.86,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,inpatient,1,EA,6.05000,5.75000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.33,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,60687-0317-25,NDC,,,facility,outpatient,1,EA,6.05000,5.75000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.02,5.87,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,65162-0247-09,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
CHLORTHALIDONE TAB,55799,CDM,250,RC,72789-0358-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
CHROMATGRPHY/MASS SPECT QUANT-TECH,55800,CDM,300,RC,82542,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,24.09,1137.41,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,inpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,76.45,134.83,percent of total billed charges,
CHLAMYDIA IGG ANTIBODY-TECH,55801,CDM,300,RC,86331,CPT,,,facility,outpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,11.98,628.12,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00172-4741-10,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,00904-6085-61,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,13668-0010-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,55111-0343-30,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,57664-0508-88,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,59762-4801-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,60505-2519-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CITALOPRAM TAB,55803,CDM,250,RC,68084-0744-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,00904-5823-60,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,43292-0558-81,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,48433-0109-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,50268-0863-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,74312-0011-40,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
CHOLECALCIFEROL TAB 400 INTL UNITS,55804,CDM,250,RC,77333-0948-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,inpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00409477723,NDC,facility,outpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,00781323946,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,36000029724,NDC,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,3.83,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 200 MG/100 ML PREMIX,55805,CDM,250,RC,J0744,HCPCS,25021019282,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,3.83,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,inpatient,,,1316.00000,1250.20000,Amish/Mennonite,Amish Mennonite,,723.80,,,,,,,723.80,1276.52,percent of total billed charges,
CHROM ANAL 20-25 CELLS-TECH,55806,CDM,310,RC,88264,CPT,,,facility,outpatient,,,1316.00000,1250.20000,Amish/Mennonite,Amish Mennonite,,723.80,,,,,,,144.61,6807.60,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-2064-06,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,inpatient,1,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,00093-7231-06,NDC,,,facility,outpatient,1,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.16,4.19,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,50268-0177-15,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,59148-0002-16,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
CILOSTAZOL TAB,55807,CDM,250,RC,60505-2522-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,inpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,169.40,298.76,percent of total billed charges,
CHROM ANAL ADDL KARYOTYPE EA-TECH,55808,CDM,310,RC,88280,CPT,,,facility,outpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,33.47,1578.85,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,inpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,,893.75,,,,,,,893.75,1576.25,percent of total billed charges,
CHROM ANAL 15-20 CELLS 2 KARYO-TECH,55809,CDM,310,RC,88262,CPT,,,facility,outpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,,893.75,,,,,,,125.49,6518.98,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,inpatient,1,EA,6.49000,6.17000,Amish/Mennonite,Amish Mennonite,,3.57,,,,,,,3.57,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-42,NDC,,,facility,outpatient,1,EA,6.49000,6.17000,Amish/Mennonite,Amish Mennonite,,3.57,,,,,,,3.25,6.30,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,00245-0036-60,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,68382-0529-60,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,42806-0270-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.71,percent of total billed charges,
CHOLESTYRAMINE POWDER,55810,CDM,250,RC,67877-0422-60,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.40,2.71,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,inpatient,,,2292.00000,2177.40000,Amish/Mennonite,Amish Mennonite,,1260.60,,,,,,,1260.60,2223.24,percent of total billed charges,
CHROM ANAL 5 CELLS 1 KARYOTYPE-TECH,55811,CDM,310,RC,88261,CPT,,,facility,outpatient,,,2292.00000,2177.40000,Amish/Mennonite,Amish Mennonite,,1260.60,,,,,,,248.52,12426.88,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,inpatient,10,EA,9.91000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,5.45,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00074437805,NDC,facility,outpatient,10,EA,9.91000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,4.96,9.61,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,inpatient,10,EA,10.62000,10.09000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.84,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,00409109802,NDC,facility,outpatient,10,EA,10.62000,10.09000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.31,10.30,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,inpatient,10,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,63323041605,NDC,facility,outpatient,10,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,inpatient,10,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,70069014110,NDC,facility,outpatient,10,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,inpatient,10,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288071206,NDC,facility,outpatient,10,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,inpatient,10,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
CISATRACURIUM SOLN-INJ 2 MG/ML 5 ML,55812,CDM,250,RC,J3490,HCPCS,71288072096,NDC,facility,outpatient,10,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,inpatient,,,890.00000,845.50000,Amish/Mennonite,Amish Mennonite,,489.50,,,,,,,489.50,863.30,percent of total billed charges,
CHROM ANAL ADDL SPECL BANDING-TECH,55814,CDM,310,RC,88283,CPT,,,facility,outpatient,,,890.00000,845.50000,Amish/Mennonite,Amish Mennonite,,489.50,,,,,,,68.60,3582.03,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,inpatient,,,84.40000,80.18000,Amish/Mennonite,Amish Mennonite,90,46.42,,,,,,,46.42,81.87,percent of total billed charges,
CHROMIUM ASSAY (CRS) SO,55815,CDM,300,RC,82495,CPT,,,facility,outpatient,,,84.40000,80.18000,Amish/Mennonite,Amish Mennonite,90,46.42,,,,,,,10.23,1052.52,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
CHROMOGENIC SUBSTRATE ASSAY-TECH,55816,CDM,300,RC,85130,CPT,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,11.89,628.12,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
CHOLESTEROL TOTAL-TECH,55817,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,4.35,220.68,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 66.8 MG-100 MG/ML,55818,CDM,250,RC,J8499,HCPCS,00121059516,NDC,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,90,18.70,,,,,,,18.70,32.98,percent of total billed charges,
CHROMOGRANIN A (CGAK) SO,55819,CDM,300,RC,86316,CPT,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,90,18.70,,,,,,,17.00,1086.52,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00093-3212-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00228-3004-11,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,00904-7728-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,16729-0137-00,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,43547-0407-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,51079-0882-20,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,60687-0555-01,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 1 MG,55820,CDM,250,RC,63739-0264-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,inpatient,1,mL,22.31000,21.19000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,12.27,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,17478-0714-10,NDC,,,facility,outpatient,1,mL,22.31000,21.19000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,11.15,21.64,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
CIPROFLOXACIN OPHTH SOL,55821,CDM,250,RC,69315-0308-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,63304-0693-01,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.92,3.39,percent of total billed charges,
CLINDAMYCIN CAP 300 MG,55822,CDM,250,RC,68084-0244-01,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.75,3.39,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG-TECH,55823,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,67.58,393.82,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00054-0037-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,00781-1962-60,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,50268-0179-13,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,9.21,17.87,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,,9.68,,,,,,,9.68,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,51079-0673-06,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,,9.68,,,,,,,8.80,17.07,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,57237-0045-60,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.60,5.03,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,65862-0226-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,inpatient,1,EA,15.74000,14.95000,Amish/Mennonite,Amish Mennonite,,8.66,,,,,,,8.66,15.27,percent of total billed charges,
CLARITHROMYCIN TAB,55824,CDM,250,RC,68084-0651-25,NDC,,,facility,outpatient,1,EA,15.74000,14.95000,Amish/Mennonite,Amish Mennonite,,8.66,,,,,,,7.87,15.27,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,00143-9927-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16571-0411-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,16714-0651-02,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,43547-0688-10,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,inpatient,1,EA,15.49000,14.71000,Amish/Mennonite,Amish Mennonite,,8.52,,,,,,,8.52,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,50419-0758-01,NDC,,,facility,outpatient,1,EA,15.49000,14.71000,Amish/Mennonite,Amish Mennonite,,8.52,,,,,,,7.75,15.03,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,58657-0675-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,inpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,68084-0069-11,NDC,,,facility,outpatient,1,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,63739-0700-10,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
CIPROFLOXACIN TAB 250 MG,55826,CDM,250,RC,65862-0076-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-02,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,00555-0159-04,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,inpatient,1,EA,52.90000,50.26000,Amish/Mennonite,Amish Mennonite,,29.09,,,,,,,29.09,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,42806-0563-01,NDC,,,facility,outpatient,1,EA,52.90000,50.26000,Amish/Mennonite,Amish Mennonite,,29.09,,,,,,,26.45,51.31,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,51079-0141-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
CHLORDIAZEPOXIDE CAP 25 MG,55827,CDM,250,RC,60687-0807-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,inpatient,1,EA,36.26000,34.45000,Amish/Mennonite,Amish Mennonite,,19.94,,,,,,,19.94,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,16714007801,NDC,facility,outpatient,1,EA,36.26000,34.45000,Amish/Mennonite,Amish Mennonite,,19.94,,,,,,,1.63,35.17,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,64380088304,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,inpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.27,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,31722010330,NDC,facility,outpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.16,2.24,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,47335037983,NDC,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,inpatient,1,EA,84.97000,80.72000,Amish/Mennonite,Amish Mennonite,,46.73,,,,,,,46.73,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,55513007330,NDC,facility,outpatient,1,EA,84.97000,80.72000,Amish/Mennonite,Amish Mennonite,,46.73,,,,,,,1.63,82.42,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,inpatient,1,EA,81.63000,77.55000,Amish/Mennonite,Amish Mennonite,,44.90,,,,,,,44.90,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,60687052521,NDC,facility,outpatient,1,EA,81.63000,77.55000,Amish/Mennonite,Amish Mennonite,,44.90,,,,,,,1.63,79.18,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,67877050330,NDC,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.63,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,inpatient,1,EA,17.91000,17.01000,Amish/Mennonite,Amish Mennonite,,9.85,,,,,,,9.85,17.37,percent of total billed charges,
CINACALCET TAB,55828,CDM,636,RC,J0604,HCPCS,70436000704,NDC,facility,outpatient,1,EA,17.91000,17.01000,Amish/Mennonite,Amish Mennonite,,9.85,,,,,,,1.63,17.37,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,inpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409174910,NDC,facility,outpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409812610,NDC,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,inpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,00409904501,NDC,facility,outpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,inpatient,1,mL,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
"BUPIVACAINE-EPINEPHRINE SOLN PF 0.5%-1  200,000 10 ML",55829,CDM,250,RC,J3490,HCPCS,63323046217,NDC,facility,outpatient,1,mL,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,245.30,432.62,percent of total billed charges,
CHROM ANAL ADDL HIGH RESOLUTION-TECH,55830,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,34.43,1799.53,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013505,NDC,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904565661,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,00904744261,NDC,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,29300013501,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,50268019215,NDC,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,inpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029920,NDC,facility,outpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,51079029919,NDC,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,58657064701,NDC,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB 0.1 MG,55831,CDM,250,RC,J8499,HCPCS,60687011301,NDC,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,177.51,percent of total billed charges,
CIRCUMCISION WITH CLAMP/BLOCK,55832,CDM,361,RC,54150,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,6003.00,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,inpatient,,,151.40000,143.83000,Amish/Mennonite,Amish Mennonite,90,83.27,,,,,,,83.27,146.86,percent of total billed charges,
CITRATE ASSAY URORISK SO-TECH,55833,CDM,300,RC,82507,CPT,,,facility,outpatient,,,151.40000,143.83000,Amish/Mennonite,Amish Mennonite,90,83.27,,,,,,,28.73,1459.96,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,inpatient,1,mL,49.82000,47.33000,Amish/Mennonite,Amish Mennonite,,27.40,,,,,,,27.40,48.33,percent of total billed charges,
CETUXIMAB INJECTION,55834,CDM,636,RC,J9055,HCPCS,66733095823,NDC,facility,outpatient,1,mL,49.82000,47.33000,Amish/Mennonite,Amish Mennonite,,27.40,,,,,,,24.91,129.48,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,inpatient,1,mL,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
CHLOROPROCAINE SOLN PF 2% 20 ML,55835,CDM,250,RC,J2401,HCPCS,63323047727,NDC,facility,outpatient,1,mL,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,0.06045,3.27,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .3 MG,55836,CDM,250,RC,00046-1100-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,10.91,21.17,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
COOMBS TEST DIRECT EACH-TECH,55837,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.39,288.61,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,inpatient,6,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009060204,NDC,facility,outpatient,6,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,inpatient,6,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077526,NDC,facility,outpatient,6,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,inpatient,6,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009077520,NDC,facility,outpatient,6,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,inpatient,6,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,00009407304,NDC,facility,outpatient,6,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,inpatient,6,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,25021011504,NDC,facility,outpatient,6,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,inpatient,6,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 4 ML,55838,CDM,250,RC,J0736,HCPCS,63323028204,NDC,facility,outpatient,6,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.46,2.83,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,inpatient,1,EA,41.98000,39.89000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-07,NDC,,,facility,outpatient,1,EA,41.98000,39.89000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,inpatient,1,EA,25.85000,24.56000,Amish/Mennonite,Amish Mennonite,,14.22,,,,,,,14.22,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,00904-6467-10,NDC,,,facility,outpatient,1,EA,25.85000,24.56000,Amish/Mennonite,Amish Mennonite,,14.22,,,,,,,12.93,25.07,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,inpatient,1,EA,30.74000,29.20000,Amish/Mennonite,Amish Mennonite,,16.91,,,,,,,16.91,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,50268-0184-12,NDC,,,facility,outpatient,1,EA,30.74000,29.20000,Amish/Mennonite,Amish Mennonite,,16.91,,,,,,,15.37,29.82,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,inpatient,1,EA,65.64000,62.35000,Amish/Mennonite,Amish Mennonite,,36.10,,,,,,,36.10,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,55111-0671-31,NDC,,,facility,outpatient,1,EA,65.64000,62.35000,Amish/Mennonite,Amish Mennonite,,36.10,,,,,,,32.82,63.67,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,inpatient,1,EA,41.98000,39.88000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,23.09,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,63739-0178-30,NDC,,,facility,outpatient,1,EA,41.98000,39.88000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,20.99,40.72,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,inpatient,1,EA,45.08000,42.83000,Amish/Mennonite,Amish Mennonite,,24.79,,,,,,,24.79,43.73,percent of total billed charges,
CLOPIDOGREL TAB 300 MG,55839,CDM,250,RC,68084-0752-25,NDC,,,facility,outpatient,1,EA,45.08000,42.83000,Amish/Mennonite,Amish Mennonite,,24.79,,,,,,,22.54,43.73,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,inpatient,1,EA,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.98,12.31,percent of total billed charges,
CLORAZEPATE TAB,55840,CDM,250,RC,51672-4043-01,NDC,,,facility,outpatient,1,EA,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.34,12.31,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,inpatient,15,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00536-1272-11,NDC,,,facility,outpatient,15,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,inpatient,15,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,00904-7822-36,NDC,,,facility,outpatient,15,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,inpatient,15,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-1275-01,NDC,,,facility,outpatient,15,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,inpatient,15,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,51672-2002-01,NDC,,,facility,outpatient,15,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,inpatient,15,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
CLOTRIMAZOLE CRM 7323108,55841,CDM,250,RC,68462-0181-17,NDC,,,facility,outpatient,15,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,220.19,percent of total billed charges,
CLSD REDUCTION FX-TX DONE-TECH,55842,CDM,450,RC,,,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,113.50,220.19,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,inpatient,10,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,7.30,12.87,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,00517073001,NDC,facility,outpatient,10,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,6.63,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,inpatient,10,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,39822200001,NDC,facility,outpatient,10,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,29.16,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,inpatient,10,EA,9.90000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,5.45,9.60,percent of total billed charges,
CLONIDINE HYDROCHLORIDE,55843,CDM,250,RC,J0735,HCPCS,67457021810,NDC,facility,outpatient,10,EA,9.90000,9.41000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,4.95,29.16,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,inpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,73.70,129.98,percent of total billed charges,
COMPLEMENT ANTIGEN EACH-TECH,55844,CDM,300,RC,86160,CPT,,,facility,outpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,12.00,628.12,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,inpatient,40,EA,6.86000,6.52000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00009-3448-01,NDC,,,facility,outpatient,40,EA,6.86000,6.52000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.43,6.65,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,inpatient,40,EA,8.24000,7.82000,Amish/Mennonite,Amish Mennonite,,4.53,,,,,,,4.53,7.99,percent of total billed charges,
CLINDAMYCIN CREAM,55845,CDM,250,RC,00168-0277-40,NDC,,,facility,outpatient,40,EA,8.24000,7.82000,Amish/Mennonite,Amish Mennonite,,4.53,,,,,,,4.12,7.99,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,inpatient,1,EA,83.73000,79.55000,Amish/Mennonite,Amish Mennonite,,46.05,,,,,,,46.05,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00591-3508-04,NDC,,,facility,outpatient,1,EA,83.73000,79.55000,Amish/Mennonite,Amish Mennonite,,46.05,,,,,,,41.87,81.22,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,inpatient,1,EA,52.59000,49.96000,Amish/Mennonite,Amish Mennonite,,28.92,,,,,,,28.92,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-01,NDC,,,facility,outpatient,1,EA,52.59000,49.96000,Amish/Mennonite,Amish Mennonite,,28.92,,,,,,,26.30,51.01,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,inpatient,1,EA,83.82000,79.63000,Amish/Mennonite,Amish Mennonite,,46.10,,,,,,,46.10,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00555-1009-16,NDC,,,facility,outpatient,1,EA,83.82000,79.63000,Amish/Mennonite,Amish Mennonite,,46.10,,,,,,,41.91,81.31,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,inpatient,1,EA,207.99000,197.59000,Amish/Mennonite,Amish Mennonite,,114.39,,,,,,,114.39,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,00597-0031-34,NDC,,,facility,outpatient,1,EA,207.99000,197.59000,Amish/Mennonite,Amish Mennonite,,114.39,,,,,,,104.00,201.75,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,inpatient,1,EA,60.92000,57.87000,Amish/Mennonite,Amish Mennonite,,33.51,,,,,,,33.51,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,49884-0774-86,NDC,,,facility,outpatient,1,EA,60.92000,57.87000,Amish/Mennonite,Amish Mennonite,,33.51,,,,,,,30.46,59.09,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,inpatient,1,EA,41.91000,39.81000,Amish/Mennonite,Amish Mennonite,,23.05,,,,,,,23.05,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,75907-0023-48,NDC,,,facility,outpatient,1,EA,41.91000,39.81000,Amish/Mennonite,Amish Mennonite,,23.05,,,,,,,20.95,40.65,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,inpatient,1,EA,25.98000,24.68000,Amish/Mennonite,Amish Mennonite,,14.29,,,,,,,14.29,25.20,percent of total billed charges,
CLONIDINE PATCH,55846,CDM,250,RC,52817-0610-04,NDC,,,facility,outpatient,1,EA,25.98000,24.68000,Amish/Mennonite,Amish Mennonite,,14.29,,,,,,,12.99,25.20,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,inpatient,6,EA,2.25000,2.13000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009090218,NDC,facility,outpatient,6,EA,2.25000,2.13000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,inpatient,6,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,00009509506,NDC,facility,outpatient,6,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,inpatient,6,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,25021011506,NDC,facility,outpatient,6,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.76,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,inpatient,6,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 6 ML,55847,CDM,250,RC,J0736,HCPCS,72611064225,NDC,facility,outpatient,6,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,2.76,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN-TECH,55848,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,122.40,5271.00,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,59651-0722-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-6101-61,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,00904-7227-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,43547-0406-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,51079-0881-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,60687-0544-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,63629-1202-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CLONAZEPAM TAB .5 MG,55849,CDM,250,RC,72888-0152-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00591570801,NDC,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,00904595961,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,inpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,51079059820,NDC,facility,outpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,inpatient,1,EA,1.78000,1.70000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
CLINDAMYCIN CAP 150 MG,55851,CDM,250,RC,J8499,HCPCS,68084024301,NDC,facility,outpatient,1,EA,1.78000,1.70000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,inpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121059530,NDC,facility,outpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,inpatient,30,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,00121119000,NDC,facility,outpatient,30,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,inpatient,30,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 2000 MG-3000 MG/30 ML,55852,CDM,250,RC,J8499,HCPCS,50268018330,NDC,facility,outpatient,30,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,29300-0136-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,51079-0300-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,60687-0124-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,62332-0055-31,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
CLONIDINE TAB .2 MG,55853,CDM,250,RC,63739-0061-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS TAB .625 MG,55854,CDM,250,RC,00046-1102-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,10.91,21.17,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00378-3627-77,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,00904-6294-61,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,16714-0052-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,51079-0557-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,65862-0357-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,inpatient,1,EA,20.37000,19.35000,Amish/Mennonite,Amish Mennonite,,11.20,,,,,,,11.20,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,63653-1171-03,NDC,,,facility,outpatient,1,EA,20.37000,19.35000,Amish/Mennonite,Amish Mennonite,,11.20,,,,,,,10.19,19.76,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
CLOPIDOGREL TAB 75 MG,55855,CDM,250,RC,68084-0536-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,33.55,59.17,percent of total billed charges,
CREATININE OTHER SOURCE-TECH,55856,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,5.18,271.65,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
C-REACTIVE PROTEIN-TECH,55857,CDM,300,RC,86140,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.18,271.65,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,inpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,94.05,165.87,percent of total billed charges,
CMV AB-TECH,55858,CDM,300,RC,86644,CPT,,,facility,outpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,14.39,746.94,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,inpatient,,,1930.00000,1833.50000,Amish/Mennonite,Amish Mennonite,90,1061.50,,,,,,,1061.50,1872.10,percent of total billed charges,
CHROM ANAL IN SITU AMNIO FLUID SO-TECH,55859,CDM,300,RC,88235,CPT,,,facility,outpatient,,,1930.00000,1833.50000,Amish/Mennonite,Amish Mennonite,90,1061.50,,,,,,,70.04,7690.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,inpatient,1,EA,1.63000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00143120101,NDC,facility,outpatient,1,EA,1.63000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,inpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,66993016502,NDC,facility,outpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.18,2.29,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,inpatient,1,EA,17.74000,16.85000,Amish/Mennonite,Amish Mennonite,,9.76,,,,,,,9.76,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00254200811,NDC,facility,outpatient,1,EA,17.74000,16.85000,Amish/Mennonite,Amish Mennonite,,9.76,,,,,,,8.87,17.21,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00591256230,NDC,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,inpatient,1,EA,15.16000,14.40000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,00904712004,NDC,facility,outpatient,1,EA,15.16000,14.40000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,14.71,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,inpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,8.43,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,13310011907,NDC,facility,outpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,7.67,14.87,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,inpatient,1,EA,14.19000,13.48000,Amish/Mennonite,Amish Mennonite,,7.80,,,,,,,7.80,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003901,NDC,facility,outpatient,1,EA,14.19000,13.48000,Amish/Mennonite,Amish Mennonite,,7.80,,,,,,,7.09,13.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,inpatient,1,EA,16.25000,15.43000,Amish/Mennonite,Amish Mennonite,,8.94,,,,,,,8.94,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,16714003902,NDC,facility,outpatient,1,EA,16.25000,15.43000,Amish/Mennonite,Amish Mennonite,,8.94,,,,,,,8.12,15.76,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,inpatient,1,EA,8.81000,8.37000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.85,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,42292005403,NDC,facility,outpatient,1,EA,8.81000,8.37000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.41,8.55,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,inpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,43598037230,NDC,facility,outpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.07,4.02,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,inpatient,1,EA,11.76000,11.17000,Amish/Mennonite,Amish Mennonite,,6.47,,,,,,,6.47,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,50268018715,NDC,facility,outpatient,1,EA,11.76000,11.17000,Amish/Mennonite,Amish Mennonite,,6.47,,,,,,,5.88,11.41,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,inpatient,1,EA,29.36000,27.89000,Amish/Mennonite,Amish Mennonite,,16.15,,,,,,,16.15,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,60687072721,NDC,facility,outpatient,1,EA,29.36000,27.89000,Amish/Mennonite,Amish Mennonite,,16.15,,,,,,,14.68,28.48,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,63629876601,NDC,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,inpatient,1,EA,22.06000,20.96000,Amish/Mennonite,Amish Mennonite,,12.13,,,,,,,12.13,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,64764011907,NDC,facility,outpatient,1,EA,22.06000,20.96000,Amish/Mennonite,Amish Mennonite,,12.13,,,,,,,11.03,21.40,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,inpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071003,NDC,facility,outpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,inpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,65162071009,NDC,facility,outpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,67877058901,NDC,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,inpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70010000201,NDC,facility,outpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.61,3.12,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,inpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
COLCHICINE TAB 0.6 MG,55860,CDM,250,RC,J8499,HCPCS,70710135103,NDC,facility,outpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,inpatient,1,EA,5.49000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-4146-23,NDC,,,facility,outpatient,1,EA,5.49000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,2.75,5.33,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.77,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00054-8146-22,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.34,8.42,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-14,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,inpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.23,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-70,NDC,,,facility,outpatient,1,EA,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.03,3.94,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,inpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.50,percent of total billed charges,
CLOTRIMAZOLE LOZENGE,55861,CDM,250,RC,00574-0107-77,NDC,,,facility,outpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.80,3.50,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,inpatient,1,mL,141.01000,133.96000,Amish/Mennonite,Amish Mennonite,,77.56,,,,,,,77.56,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527172874,NDC,facility,outpatient,1,mL,141.01000,133.96000,Amish/Mennonite,Amish Mennonite,,77.56,,,,,,,70.50,136.78,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,inpatient,1,mL,174.20000,165.49000,Amish/Mennonite,Amish Mennonite,,95.81,,,,,,,95.81,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,00527197174,NDC,facility,outpatient,1,mL,174.20000,165.49000,Amish/Mennonite,Amish Mennonite,,95.81,,,,,,,87.10,168.97,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,inpatient,1,mL,193.55000,183.87000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,106.45,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,64950036204,NDC,facility,outpatient,1,mL,193.55000,183.87000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,96.78,187.74,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,inpatient,1,mL,232.26000,220.65000,Amish/Mennonite,Amish Mennonite,,127.74,,,,,,,127.74,225.29,percent of total billed charges,
COCAINE LIQ-TOP 4% 4 ML,55862,CDM,636,RC,C9046,HCPCS,70839036204,NDC,facility,outpatient,1,mL,232.26000,220.65000,Amish/Mennonite,Amish Mennonite,,127.74,,,,,,,116.13,225.29,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
COPPER ASSAY-TECH,55863,CDM,300,RC,82525,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,12.41,645.08,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,inpatient,42.5,EA,47.41000,45.04000,Amish/Mennonite,Amish Mennonite,,26.08,,,,,,,26.08,45.99,percent of total billed charges,
CONJUGATED ESTROGEN CRM-VAG 0.625 MG/GM W/APPL 30 GM,55864,CDM,250,RC,00046-0872-21,NDC,,,facility,outpatient,42.5,EA,47.41000,45.04000,Amish/Mennonite,Amish Mennonite,,26.08,,,,,,,23.70,45.99,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
CORTISOL TOTAL-TECH,55865,CDM,300,RC,82533,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,16.30,848.80,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,inpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,,160.05,,,,,,,160.05,282.27,percent of total billed charges,
COMPATIBILITY TEST IMM SPIN EA-TECH,55866,CDM,300,RC,86920,CPT,,,facility,outpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,,160.05,,,,,,,145.50,1714.64,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,inpatient,,,6254.85000,5942.11000,Amish/Mennonite,Amish Mennonite,,3440.17,,,,,,,3064.88,6067.20,percent of total billed charges,
GRAFT NRV L2CM ID7MM CLLGN PERIPH NEURAWRAP,55868,CDM,278,RC,C9353,HCPCS,,,facility,outpatient,,,6254.85000,5942.11000,Amish/Mennonite,Amish Mennonite,,3440.17,,,,,,,2870.98,6254.85,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
CRYOFIBRINOGEN ASSAY-TECH,55869,CDM,300,RC,82585,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,9.02,662.12,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,inpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00143950501,NDC,facility,outpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,inpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,00703574811,NDC,facility,outpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,44567051001,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,inpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,63323010365,NDC,facility,outpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,4.75,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CISPLATIN INJECTION,55870,CDM,250,RC,J9060,HCPCS,72266025301,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,4.75,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
CPAP/BIPAP SUBSEQ-TECH,55871,CDM,410,RC,94660,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,212.44,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,inpatient,,,1859.00000,1766.05000,Amish/Mennonite,Amish Mennonite,TC,1022.45,,,,,,,1022.45,1803.23,percent of total billed charges,
CT ABDOMEN W CNTRST-TECH,55872,CDM,352,RC,74160,CPT,,,facility,outpatient,,,1859.00000,1766.05000,Amish/Mennonite,Amish Mennonite,TC,1022.45,,,,,,,929.50,1820.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,inpatient,,,3545.00000,3367.75000,Amish/Mennonite,Amish Mennonite,TC,1949.75,,,,,,,1949.75,3438.65,percent of total billed charges,
CT ABDOMEN/PELVIS WO/W CNTRST-TECH,55873,CDM,352,RC,74178,CPT,,,facility,outpatient,,,3545.00000,3367.75000,Amish/Mennonite,Amish Mennonite,TC,1949.75,,,,,,,1285.85,3438.65,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,inpatient,1,EA,103.18000,98.02000,Amish/Mennonite,Amish Mennonite,,56.75,,,,,,,56.75,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,00006351659,NDC,facility,outpatient,1,EA,103.18000,98.02000,Amish/Mennonite,Amish Mennonite,,56.75,,,,,,,11.16,100.08,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,inpatient,1,EA,94.74000,90.00000,Amish/Mennonite,Amish Mennonite,,52.11,,,,,,,52.11,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032225,NDC,facility,outpatient,1,EA,94.74000,90.00000,Amish/Mennonite,Amish Mennonite,,52.11,,,,,,,11.16,91.90,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
CILASTATIN SODIUM INJECTION,55874,CDM,250,RC,J0743,HCPCS,63323032294,NDC,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,11.16,38.31,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,64.90,114.46,percent of total billed charges,
COMPR METABOLIC PANEL-TECH,55875,CDM,300,RC,80053,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,10.56,441.94,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
COMPATIBILITY TEST ANTIGLOB EA-TECH,55876,CDM,300,RC,86922,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,37.50,1833.46,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,7417.50000,7046.62000,Amish/Mennonite,Amish Mennonite,,4079.62,,,,,,,3634.57,7194.98,percent of total billed charges,
ALLOGRAFT VNEW DERMAL POSTERIOR,55877,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,7417.50000,7046.62000,Amish/Mennonite,Amish Mennonite,,4079.62,,,,,,,3404.63,7417.50,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,inpatient,,,974.00000,925.30000,Amish/Mennonite,Amish Mennonite,,535.70,,,,,,,535.70,944.78,percent of total billed charges,
CRITICAL CARE EA ADDTL 30 MIN-TECH,55878,CDM,450,RC,99292,CPT,,,facility,outpatient,,,974.00000,925.30000,Amish/Mennonite,Amish Mennonite,,535.70,,,,,,,487.00,944.78,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
COOMBS TEST INDIRECT AB TITER-TECH,55879,CDM,300,RC,86886,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,5.18,271.65,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409330024,NDC,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477702,NDC,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00409477750,NDC,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,inpatient,1,mL,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,00781324009,NDC,facility,outpatient,1,mL,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,25021019287,NDC,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,inpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000000924,NDC,facility,outpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,inpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,36000029824,NDC,facility,outpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,3.83,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CIPROFLOXACIN 400 MG/200 ML PREMIX,55880,CDM,250,RC,J0744,HCPCS,50419075901,NDC,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,3.83,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
CREATININE BLOOD-TECH,55881,CDM,300,RC,82565,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,5.12,271.65,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
CORTISOL URINE-TECH,55882,CDM,300,RC,82530,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,16.71,865.84,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
COXIELLA BRUNETII Q FEVER AB-TECH,55883,CDM,300,RC,86638,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,8.17,628.12,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
COMPATIBILITY TEST INCUBATE-TECH,55884,CDM,300,RC,86921,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,36.50,1544.85,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,inpatient,1,EA,276.04000,262.24000,Amish/Mennonite,Amish Mennonite,,151.82,,,,,,,151.82,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00548590000,NDC,facility,outpatient,1,EA,276.04000,262.24000,Amish/Mennonite,Amish Mennonite,,151.82,,,,,,,44.86,267.76,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,inpatient,1,EA,253.43000,240.76000,Amish/Mennonite,Amish Mennonite,,139.39,,,,,,,139.39,245.83,percent of total billed charges,
COSYNTROPIN POWD-INJ 0.25 MG,55885,CDM,250,RC,J0834,HCPCS,00781344095,NDC,facility,outpatient,1,EA,253.43000,240.76000,Amish/Mennonite,Amish Mennonite,,139.39,,,,,,,44.86,245.83,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,inpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,TC,679.25,,,,,,,679.25,1197.95,percent of total billed charges,
CT COLONOGRAPHY DX WO CNTRST-TECH,55886,CDM,350,RC,74261,CPT,,,facility,outpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,TC,679.25,,,,,,,584.87,1820.00,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE A AB PANEL (80248)-TECH,55887,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,8.17,679.08,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,inpatient,118,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,00603-1585-54,NDC,,,facility,outpatient,118,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,inpatient,118,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,27808-0065-02,NDC,,,facility,outpatient,118,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,inpatient,118,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,50383-0804-16,NDC,,,facility,outpatient,118,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,inpatient,118,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
CODEINE-PROMETHAZINE SYRUP,55888,CDM,250,RC,60432-0606-16,NDC,,,facility,outpatient,118,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM AG IA-TECH,55889,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,13.82,645.08,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,inpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,545.05,961.27,percent of total billed charges,
CT ABDOMEN WO CNRST-TECH,55890,CDM,352,RC,74150,CPT,,,facility,outpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,495.50,1820.00,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,inpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,685.30,1208.62,percent of total billed charges,
CT SPINE CERVICAL WO CNTRST-TECH,55891,CDM,352,RC,72125,CPT,,,facility,outpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,584.87,1820.00,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2823.14,5588.65,percent of total billed charges,
CLAMP SPNL W12MM DIA5.8MM ROD SLOT INLINE SILC,55892,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2644.53,5761.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,inpatient,,,2650.00000,2517.50000,Amish/Mennonite,Amish Mennonite,TC,1457.50,,,,,,,1457.50,2570.50,percent of total billed charges,
CT ABDOMEN/PELVIS W CNTRST-TECH,55893,CDM,352,RC,74177,CPT,,,facility,outpatient,,,2650.00000,2517.50000,Amish/Mennonite,Amish Mennonite,TC,1457.50,,,,,,,1285.85,2570.50,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,00472-0220-63,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,inpatient,45,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CLOTRIMAZOLE CRM 7108194,55894,CDM,250,RC,51672-2003-06,NDC,,,facility,outpatient,45,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,Amish/Mennonite,Amish Mennonite,TC,1177.00,,,,,,,1177.00,2075.80,percent of total billed charges,
CT COLONOGR SCRN W IMG POST-PROC-TECH,55895,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,Amish/Mennonite,Amish Mennonite,TC,1177.00,,,,,,,1070.00,2075.80,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,inpatient,,,3245.00000,3082.75000,Amish/Mennonite,Amish Mennonite,,1784.75,,,,,,,1784.75,3147.65,percent of total billed charges,
CRITICAL CARE 1ST 30-74MIN-TECH,55896,CDM,450,RC,99291,CPT,,,facility,outpatient,,,3245.00000,3082.75000,Amish/Mennonite,Amish Mennonite,,1784.75,,,,,,,800.09,4686.00,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,inpatient,,,1950.00000,1852.50000,Amish/Mennonite,Amish Mennonite,TC,1072.50,,,,,,,1072.50,1891.50,percent of total billed charges,
CT ABDOMEN/PELVIS WO CNTRST-TECH,55897,CDM,352,RC,74176,CPT,,,facility,outpatient,,,1950.00000,1852.50000,Amish/Mennonite,Amish Mennonite,TC,1072.50,,,,,,,975.00,1891.50,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
COXSACKIE B VIRUS AB (80247)-TECH,55898,CDM,300,RC,86658,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,8.17,679.08,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,inpatient,,,29.20000,27.74000,Amish/Mennonite,Amish Mennonite,90,16.06,,,,,,,16.06,28.32,percent of total billed charges,
CRYOPRESERVATION SO -TECH,55899,CDM,310,RC,88240,CPT,,,facility,outpatient,,,29.20000,27.74000,Amish/Mennonite,Amish Mennonite,90,16.06,,,,,,,9.83,611.15,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,inpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,62.70,110.58,percent of total billed charges,
CREATININE CLEARANCE-TECH,55900,CDM,300,RC,82575,CPT,,,facility,outpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,9.46,492.33,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,inpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087026,NDC,facility,outpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,1.97,3.81,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,inpatient,1,mL,9.57000,9.10000,Amish/Mennonite,Amish Mennonite,,5.26,,,,,,,5.26,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009087021,NDC,facility,outpatient,1,mL,9.57000,9.10000,Amish/Mennonite,Amish Mennonite,,5.26,,,,,,,2.50,9.28,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,inpatient,1,mL,96.78000,91.94000,Amish/Mennonite,Amish Mennonite,,53.23,,,,,,,53.23,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,00009305102,NDC,facility,outpatient,1,mL,96.78000,91.94000,Amish/Mennonite,Amish Mennonite,,53.23,,,,,,,2.50,93.88,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,inpatient,1,mL,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,47781061969,NDC,facility,outpatient,1,mL,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,2.50,9.51,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,inpatient,1,mL,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.24,percent of total billed charges,
CLINDAMYCIN SOLN-INJ 150 MG/ML 2 ML,55901,CDM,250,RC,J0736,HCPCS,67457081402,NDC,facility,outpatient,1,mL,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.67,3.24,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
CRP HIGH SENSITIVITY-TECH,55902,CDM,300,RC,86141,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,12.95,679.08,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
CRYOGLOBULIN ASSAY-TECH,55903,CDM,300,RC,82595,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,6.47,339.51,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,Amish/Mennonite,Amish Mennonite,,2522.85,,,,,,,2522.85,4449.39,percent of total billed charges,
CT GUID FL COL DRN CATH VISC-TECH,55904,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,Amish/Mennonite,Amish Mennonite,,2522.85,,,,,,,1538.48,4686.00,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1020.00000,969.00000,Amish/Mennonite,Amish Mennonite,TC,561.00,,,,,,,561.00,989.40,percent of total billed charges,
CT HEAD OR BRAIN WO CNTRST-TECH,55905,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1020.00000,969.00000,Amish/Mennonite,Amish Mennonite,TC,561.00,,,,,,,510.00,1820.00,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
CRYSTAL EXAM TISS/FLUID-TECH,55906,CDM,300,RC,89060,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,7.33,1284.54,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,inpatient,1,mL,9.11000,8.65000,Amish/Mennonite,Amish Mennonite,,5.01,,,,,,,5.01,8.84,percent of total billed charges,
COPPER CHLORIDE SOL,55907,CDM,250,RC,00409-4092-01,NDC,,,facility,outpatient,1,mL,9.11000,8.65000,Amish/Mennonite,Amish Mennonite,,5.01,,,,,,,4.55,8.84,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,inpatient,,,2304.00000,2188.80000,Amish/Mennonite,Amish Mennonite,TC,1267.20,,,,,,,1267.20,2234.88,percent of total billed charges,
CT SPINE CERVICAL WO/W CNTRST-TECH,55908,CDM,352,RC,72127,CPT,,,facility,outpatient,,,2304.00000,2188.80000,Amish/Mennonite,Amish Mennonite,TC,1267.20,,,,,,,979.11,2234.88,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,inpatient,,,2144.00000,2036.80000,Amish/Mennonite,Amish Mennonite,TC,1179.20,,,,,,,1179.20,2079.68,percent of total billed charges,
CT ABDOMEN WO/W CNTRST-TECH,55909,CDM,352,RC,74170,CPT,,,facility,outpatient,,,2144.00000,2036.80000,Amish/Mennonite,Amish Mennonite,TC,1179.20,,,,,,,979.11,2079.68,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,Amish/Mennonite,Amish Mennonite,TC,1300.75,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LWR EXT WO/W CNTRST-TECH,55910,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,Amish/Mennonite,Amish Mennonite,TC,1300.75,,,,,,,979.11,2294.05,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
COLD AGGLUTININ TITER-TECH,55911,CDM,300,RC,86157,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.06,424.40,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
CREATINE KINASE TOTAL-TECH,55913,CDM,300,RC,82550,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.51,339.51,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1081.00000,1026.95000,Amish/Mennonite,Amish Mennonite,TC,594.55,,,,,,,594.55,1048.57,percent of total billed charges,
CT MAXILLOFACIAL WO CNTRST-TECH,55914,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1081.00000,1026.95000,Amish/Mennonite,Amish Mennonite,TC,594.55,,,,,,,540.50,1820.00,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,TC,108.90,,,,,,,108.90,192.06,percent of total billed charges,
CT LOW DOSE LUNG CANCER SCRN,55915,CDM,352,RC,71271,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,TC,108.90,,,,,,,99.00,1820.00,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
CMV AB IGM-TECH,55916,CDM,300,RC,86645,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,8.17,882.80,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,inpatient,,,49.50000,47.02000,Amish/Mennonite,Amish Mennonite,TC,27.23,,,,,,,27.23,48.02,percent of total billed charges,
CT CALCIUM SCORE SCREEN-TECH,55917,CDM,320,RC,76499,CPT,,,facility,outpatient,,,49.50000,47.02000,Amish/Mennonite,Amish Mennonite,TC,27.23,,,,,,,24.75,484.28,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,inpatient,,,1793.00000,1703.35000,Amish/Mennonite,Amish Mennonite,TC,986.15,,,,,,,986.15,1739.21,percent of total billed charges,
CT HEAD OR BRAIN WO/W CNTRST-TECH,55918,CDM,351,RC,70470,CPT,,,facility,outpatient,,,1793.00000,1703.35000,Amish/Mennonite,Amish Mennonite,TC,986.15,,,,,,,896.50,1820.00,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1465.00000,1391.75000,Amish/Mennonite,Amish Mennonite,TC,805.75,,,,,,,805.75,1421.05,percent of total billed charges,
CT HEAD OR BRAIN W CNTRST-TECH,55919,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1465.00000,1391.75000,Amish/Mennonite,Amish Mennonite,TC,805.75,,,,,,,732.50,1820.00,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,TC,1538.90,,,,,,,1538.90,2714.06,percent of total billed charges,
CT PELVIS WO/W CNTRST-TECH,55920,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,TC,1538.90,,,,,,,979.11,2714.06,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,inpatient,120,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
CODEINE-GUAIFENESIN SYRUP,55921,CDM,250,RC,50383-0087-07,NDC,,,facility,outpatient,120,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,inpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,409.20,721.68,percent of total billed charges,
CT GUIDE NEEDLE PLC-TECH,55922,CDM,352,RC,77012,CPT,,,facility,outpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,306.02,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,inpatient,,,2600.00000,2470.00000,Amish/Mennonite,Amish Mennonite,TC,1430.00,,,,,,,1430.00,2522.00,percent of total billed charges,
CT HRT W CNTRST EVAL CONG HRT D-TECH,55923,CDM,352,RC,75573,CPT,,,facility,outpatient,,,2600.00000,2470.00000,Amish/Mennonite,Amish Mennonite,TC,1430.00,,,,,,,1285.85,2522.00,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,inpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,TC,1299.65,,,,,,,1299.65,2292.11,percent of total billed charges,
CT PELVIS W CNTRST-TECH,55924,CDM,352,RC,72193,CPT,,,facility,outpatient,,,2363.00000,2244.85000,Amish/Mennonite,Amish Mennonite,TC,1299.65,,,,,,,979.11,2292.11,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV-TECH,55925,CDM,300,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,122.40,238.62,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,inpatient,,,2299.00000,2184.05000,Amish/Mennonite,Amish Mennonite,TC,1264.45,,,,,,,1264.45,2230.03,percent of total billed charges,
CT SPINE LUMBAR WO/W CNTRST-TECH,55926,CDM,352,RC,72133,CPT,,,facility,outpatient,,,2299.00000,2184.05000,Amish/Mennonite,Amish Mennonite,TC,1264.45,,,,,,,979.11,2230.03,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,inpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,,306.35,,,,,,,306.35,540.29,percent of total billed charges,
CPR-TECH,55927,CDM,480,RC,92950,CPT,,,facility,outpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,,306.35,,,,,,,278.50,540.29,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,inpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,1273.25,2245.55,percent of total billed charges,
CTA CHST WO/W CNTRST POST PROC-TECH,55928,CDM,352,RC,71275,CPT,,,facility,outpatient,,,2315.00000,2199.25000,Amish/Mennonite,Amish Mennonite,TC,1273.25,,,,,,,979.11,2245.55,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,65.45,115.43,percent of total billed charges,
CULT FUNGI DEFIN ID YEAST EACH-TECH,55929,CDM,300,RC,87106,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,10.32,543.22,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,inpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,TC,1027.95,,,,,,,1027.95,1812.93,percent of total billed charges,
CT SPINE LUMBAR W CNTRST-TECH,55930,CDM,352,RC,72132,CPT,,,facility,outpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,TC,1027.95,,,,,,,934.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,inpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE THORACIC WO CNTRST-TECH,55931,CDM,352,RC,72128,CPT,,,facility,outpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,584.87,1820.00,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,inpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,1029.05,1814.87,percent of total billed charges,
CT LWR EXT W CNTRST-TECH,55932,CDM,352,RC,73701,CPT,,,facility,outpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,935.50,1820.00,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
COCCIDIOIDES AB-TECH,55933,CDM,300,RC,86635,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,594.19,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,TC,78.10,,,,,,,78.10,137.74,percent of total billed charges,
CT HRT WO CNTRST W QUANT EVAL-TECH,55934,CDM,352,RC,75571,CPT,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,TC,78.10,,,,,,,71.00,1820.00,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,1002.10,1767.34,percent of total billed charges,
CT UPPER EXT W CNTRST-TECH,55935,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,911.00,1964.22,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2528.00000,2401.60000,Amish/Mennonite,Amish Mennonite,TC,1390.40,,,,,,,1390.40,2452.16,percent of total billed charges,
CT ORB SEL P FOS EAR WO/W CNTRST-TECH,55936,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2528.00000,2401.60000,Amish/Mennonite,Amish Mennonite,TC,1390.40,,,,,,,1264.00,2452.16,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
CULT BORDETELLA SCRN-TECH,55937,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,6.63,339.51,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,177.65,313.31,percent of total billed charges,
CPAP/BIPAP INITIAL-TECH,55938,CDM,410,RC,94660,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,161.50,313.31,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,55939,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,60.36,222.13,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,685.30,1208.62,percent of total billed charges,
CT ORB SEL P FOS EAR WO CNTRST-TECH,55940,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,623.00,1820.00,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,680.35,1199.89,percent of total billed charges,
CT LWR EXT WO CNTRST-TECH,55941,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,584.87,1820.00,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,inpatient,,,2196.00000,2086.20000,Amish/Mennonite,Amish Mennonite,TC,1207.80,,,,,,,1207.80,2130.12,percent of total billed charges,
CT HRT W CNTRST EVAL STRUC/MOR-TECH,55942,CDM,352,RC,75572,CPT,,,facility,outpatient,,,2196.00000,2086.20000,Amish/Mennonite,Amish Mennonite,TC,1207.80,,,,,,,1098.00,2130.12,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,Amish/Mennonite,Amish Mennonite,,758.45,,,,,,,758.45,1337.63,percent of total billed charges,
CULT TYPE NUC ACID SEQ EA ISOL-TECH,55943,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,Amish/Mennonite,Amish Mennonite,,758.45,,,,,,,115.36,6026.72,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,inpatient,,,2621.00000,2489.95000,Amish/Mennonite,Amish Mennonite,TC,1441.55,,,,,,,1441.55,2542.37,percent of total billed charges,
CTA HRT ART/GRFT W CNTRST 3D IMG-TECH,55944,CDM,352,RC,75574,CPT,,,facility,outpatient,,,2621.00000,2489.95000,Amish/Mennonite,Amish Mennonite,TC,1441.55,,,,,,,1285.85,2542.37,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,inpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV ABD AOR BILRUNOFF W IMG-TECH,55945,CDM,352,RC,75635,CPT,,,facility,outpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,979.11,2548.19,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
CULT GROUP B STREP SCRN-TECH,55946,CDM,300,RC,87081,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,6.63,339.51,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
CULT MYCOBACT DEFIN ID EA ISO-TECH,55947,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,14.61,679.08,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,Amish/Mennonite,Amish Mennonite,TC,1030.15,,,,,,,1030.15,1816.81,percent of total billed charges,
CT SPINE THORACIC W CNTRST-TECH,55948,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,Amish/Mennonite,Amish Mennonite,TC,1030.15,,,,,,,936.50,1820.00,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
CULT CHLAMYDIA ANY SOURCE-TECH,55949,CDM,300,RC,87110,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,19.60,1018.59,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
CT BIOPSY NDL ABD/RETROPER MASS PERC-TECH,55950,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,4686.00,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
CT THORAX WO/W CNTRST + SECTNS-TECH,55951,CDM,352,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,979.11,2209.66,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,1016.40,1792.56,percent of total billed charges,
CT THORAX W CNTRST-TECH,55952,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,924.00,1820.00,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,inpatient,,,1776.00000,1687.20000,Amish/Mennonite,Amish Mennonite,TC,976.80,,,,,,,976.80,1722.72,percent of total billed charges,
CT STEREOTACTIC LOCALIZATION-TECH,55953,CDM,352,RC,77011,CPT,,,facility,outpatient,,,1776.00000,1687.20000,Amish/Mennonite,Amish Mennonite,TC,976.80,,,,,,,837.93,1820.00,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,Amish/Mennonite,Amish Mennonite,TC,1315.60,,,,,,,1315.60,2320.24,percent of total billed charges,
CT UPPER EXT WO/W CNTRST-TECH,55954,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,Amish/Mennonite,Amish Mennonite,TC,1315.60,,,,,,,979.11,2320.24,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,inpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,680.35,1199.89,percent of total billed charges,
CT SPINE LUMBAR WO CNTRST-TECH,55955,CDM,352,RC,72131,CPT,,,facility,outpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,584.87,1820.00,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,684.20,1206.68,percent of total billed charges,
CT THORAX WO CNTRST-TECH,55956,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,584.87,1820.00,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,inpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,1029.05,1814.87,percent of total billed charges,
CT SPINE CERVICAL W CNTRST-TECH,55957,CDM,352,RC,72126,CPT,,,facility,outpatient,,,1871.00000,1777.45000,Amish/Mennonite,Amish Mennonite,TC,1029.05,,,,,,,935.50,1964.22,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,inpatient,,,2319.00000,2203.05000,Amish/Mennonite,Amish Mennonite,TC,1275.45,,,,,,,1275.45,2249.43,percent of total billed charges,
CT SPINE THORACIC WO/W CNTRST-TECH,55958,CDM,352,RC,72130,CPT,,,facility,outpatient,,,2319.00000,2203.05000,Amish/Mennonite,Amish Mennonite,TC,1275.45,,,,,,,979.11,2249.43,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,685.30,1208.62,percent of total billed charges,
CT SOFT TISSUE NECK WO CNTRST-TECH,55959,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1246.00000,1183.70000,Amish/Mennonite,Amish Mennonite,TC,685.30,,,,,,,623.00,1820.00,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,,132.00,,,,,,,132.00,232.80,percent of total billed charges,
CULT TYPE DNA/RNA DIR PROBE EA-TECH,55960,CDM,300,RC,87149,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,,132.00,,,,,,,20.05,1052.52,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE COLONY COUNT-TECH,55961,CDM,300,RC,87086,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,8.07,424.40,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
CULT GONORRHEA SCRN-TECH,55962,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,6.63,339.51,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,inpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,,93.50,,,,,,,93.50,164.90,percent of total billed charges,
CULTURE TYPE PULSE FIELD GEL-TECH,55963,CDM,300,RC,87152,CPT,,,facility,outpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,,93.50,,,,,,,7.36,356.54,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
CULT FREE LIVING AMOEBA SCRN-TECH,55964,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,6.63,339.51,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,TC,1878.80,,,,,,,1878.80,3313.52,percent of total billed charges,
CTA PELV INCL IMG POST PROC-TECH,55965,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3416.00000,3245.20000,Amish/Mennonite,Amish Mennonite,TC,1878.80,,,,,,,979.11,3313.52,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00093-3422-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00591-5658-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,00904-7809-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,50268-0191-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,51079-0644-19,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,52817-0332-10,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,inpatient,1,EA,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,60687-0558-01,NDC,,,facility,outpatient,1,EA,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0066-10,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,63739-0531-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB,55966,CDM,250,RC,69097-0846-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
CULT ANAEROBE W ISOL PRES ID-TECH,55967,CDM,300,RC,87075,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,9.47,492.33,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,Amish/Mennonite,Amish Mennonite,TC,860.20,,,,,,,860.20,1517.08,percent of total billed charges,
CT MAXILLOFACIAL WO/W CNTRST-TECH,55968,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,Amish/Mennonite,Amish Mennonite,TC,860.20,,,,,,,782.00,1820.00,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,inpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,52.80,93.12,percent of total billed charges,
CULT AEROBIC OTH W ISOL PRES ID-TECH,55969,CDM,300,RC,87070,CPT,,,facility,outpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,8.62,458.40,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,inpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,684.20,1206.68,percent of total billed charges,
CT MAXILLOFACIAL W CNTRST-TECH,55970,CDM,351,RC,70487,CPT,,,facility,outpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,622.00,1820.00,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
CULT GROUP A STREP ONLY SCRN-TECH,55971,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,6.63,339.51,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
COMPLEMENT TOTAL HEMOLYTIC-TECH,55972,CDM,300,RC,86162,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,20.32,1069.56,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,Amish/Mennonite,Amish Mennonite,TC,705.65,,,,,,,705.65,1244.51,percent of total billed charges,
CT PELVIS WO CNTRST-TECH,55973,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,Amish/Mennonite,Amish Mennonite,TC,705.65,,,,,,,584.87,1820.00,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,53.35,94.09,percent of total billed charges,
CULT AEROBIC DEFIN ID EA ISO-TECH,55974,CDM,300,RC,87077,CPT,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,8.08,424.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,inpatient,1,EA,1451.33000,1378.77000,Amish/Mennonite,Amish Mennonite,,798.23,,,,,,,798.23,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,00781324494,NDC,facility,outpatient,1,EA,1451.33000,1378.77000,Amish/Mennonite,Amish Mennonite,,798.23,,,,,,,0.62000,1407.79,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,inpatient,1,EA,958.30000,910.38000,Amish/Mennonite,Amish Mennonite,,527.07,,,,,,,527.07,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019094401,NDC,facility,outpatient,1,EA,958.30000,910.38000,Amish/Mennonite,Amish Mennonite,,527.07,,,,,,,0.62000,929.55,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,inpatient,1,EA,1897.17000,1802.32000,Amish/Mennonite,Amish Mennonite,,1043.44,,,,,,,1043.44,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,10019095601,NDC,facility,outpatient,1,EA,1897.17000,1802.32000,Amish/Mennonite,Amish Mennonite,,1043.44,,,,,,,0.62000,1840.25,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,inpatient,1,EA,1750.45000,1662.93000,Amish/Mennonite,Amish Mennonite,,962.75,,,,,,,962.75,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,16714085701,NDC,facility,outpatient,1,EA,1750.45000,1662.93000,Amish/Mennonite,Amish Mennonite,,962.75,,,,,,,0.62000,1697.94,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,inpatient,1,EA,655.27000,622.51000,Amish/Mennonite,Amish Mennonite,,360.40,,,,,,,360.40,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,25021024851,NDC,facility,outpatient,1,EA,655.27000,622.51000,Amish/Mennonite,Amish Mennonite,,360.40,,,,,,,0.62000,635.61,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,inpatient,1,EA,932.40000,885.78000,Amish/Mennonite,Amish Mennonite,,512.82,,,,,,,512.82,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,65219013120,NDC,facility,outpatient,1,EA,932.40000,885.78000,Amish/Mennonite,Amish Mennonite,,512.82,,,,,,,0.62000,904.43,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,inpatient,1,EA,1707.46000,1622.08000,Amish/Mennonite,Amish Mennonite,,939.10,,,,,,,939.10,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,70121123901,NDC,facility,outpatient,1,EA,1707.46000,1622.08000,Amish/Mennonite,Amish Mennonite,,939.10,,,,,,,0.62000,1656.24,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,inpatient,1,EA,1750.53000,1663.00000,Amish/Mennonite,Amish Mennonite,,962.79,,,,,,,962.79,1698.01,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 1000 MG,55975,CDM,636,RC,J9075,HCPCS,72603032601,NDC,facility,outpatient,1,EA,1750.53000,1663.00000,Amish/Mennonite,Amish Mennonite,,962.79,,,,,,,0.62000,1698.01,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
CULT URINE PRESUMPT ID EA ISOL-TECH,55976,CDM,300,RC,87088,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,8.09,424.40,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE BLOOD AEROBIC-TECH,55977,CDM,300,RC,87040,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,10.32,543.22,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00182-0037-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,80681-0072-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,00904-3207-13,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,10006-0701-64,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,20555-0032-00,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,50268-0854-15,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,51645-0913-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CYANOCOBALAMIN TAB 500 MCG,55978,CDM,250,RC,77333-0937-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
CULT ACID FAST BACILLI-TECH,55979,CDM,300,RC,87116,CPT,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,10.80,560.26,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,inpatient,,,2404.00000,2283.80000,Amish/Mennonite,Amish Mennonite,TC,1322.20,,,,,,,1322.20,2331.88,percent of total billed charges,
CTA ABDOMEN INCL IMG POST-PROC-TECH,55980,CDM,352,RC,74175,CPT,,,facility,outpatient,,,2404.00000,2283.80000,Amish/Mennonite,Amish Mennonite,TC,1322.20,,,,,,,979.11,2331.88,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
CULT TYPE GLC/HPLC METHOD-TECH,55981,CDM,300,RC,87143,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,12.52,662.12,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,inpatient,,,634.00000,602.30000,Amish/Mennonite,Amish Mennonite,TC,348.70,,,,,,,348.70,614.98,percent of total billed charges,
CYTO FNA INTERP & REPORT-TECH,55982,CDM,311,RC,88173,CPT,,,facility,outpatient,,,634.00000,602.30000,Amish/Mennonite,Amish Mennonite,TC,348.70,,,,,,,177.63,3899.16,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,inpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,216.31,percent of total billed charges,
CYCLOSPORINE ASSAY-TECH,55984,CDM,300,RC,80158,CPT,,,facility,outpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,18.05,950.66,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,inpatient,1,mL,5.89000,5.60000,Amish/Mennonite,Amish Mennonite,,3.24,,,,,,,3.24,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,17478-0100-12,NDC,,,facility,outpatient,1,mL,5.89000,5.60000,Amish/Mennonite,Amish Mennonite,,3.24,,,,,,,2.94,5.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,3.28,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,24208-0735-06,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,2.98,5.79,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.72,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 15 ML,55985,CDM,250,RC,61314-0396-03,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,2.95,5.72,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,inpatient,,,2265.00000,2151.75000,Amish/Mennonite,Amish Mennonite,TC,1245.75,,,,,,,1245.75,2197.05,percent of total billed charges,
CTA/CTV NECK INCL IMG POST-PROC-TECH,55986,CDM,351,RC,70498,CPT,,,facility,outpatient,,,2265.00000,2151.75000,Amish/Mennonite,Amish Mennonite,TC,1245.75,,,,,,,1132.50,2197.05,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,inpatient,,,2593.00000,2463.35000,Amish/Mennonite,Amish Mennonite,TC,1426.15,,,,,,,1426.15,2515.21,percent of total billed charges,
CT COLONOGR DX W IMG POST-PROC-TECH,55987,CDM,350,RC,74262,CPT,,,facility,outpatient,,,2593.00000,2463.35000,Amish/Mennonite,Amish Mennonite,TC,1426.15,,,,,,,979.11,2515.21,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,65.45,115.43,percent of total billed charges,
CULT MYCOPLASMA ANY SOURCE-TECH,55988,CDM,300,RC,87109,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,14.01,797.91,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,inpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,1016.40,1792.56,percent of total billed charges,
CT SOFT TISSUE NECK W CNTRST-TECH,55989,CDM,350,RC,70491,CPT,,,facility,outpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,924.00,1820.00,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
CULT MRSA SCRN-TECH,55990,CDM,300,RC,87081,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,6.63,339.51,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,inpatient,1,EA,725.69000,689.41000,Amish/Mennonite,Amish Mennonite,,399.13,,,,,,,399.13,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,00781323394,NDC,facility,outpatient,1,EA,725.69000,689.41000,Amish/Mennonite,Amish Mennonite,,399.13,,,,,,,0.62000,703.92,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,inpatient,1,EA,479.15000,455.19000,Amish/Mennonite,Amish Mennonite,,263.53,,,,,,,263.53,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019094301,NDC,facility,outpatient,1,EA,479.15000,455.19000,Amish/Mennonite,Amish Mennonite,,263.53,,,,,,,0.62000,464.78,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,inpatient,1,EA,948.59000,901.16000,Amish/Mennonite,Amish Mennonite,,521.72,,,,,,,521.72,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,10019095501,NDC,facility,outpatient,1,EA,948.59000,901.16000,Amish/Mennonite,Amish Mennonite,,521.72,,,,,,,0.62000,920.13,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,inpatient,1,EA,877.73000,833.84000,Amish/Mennonite,Amish Mennonite,,482.75,,,,,,,482.75,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,16714085901,NDC,facility,outpatient,1,EA,877.73000,833.84000,Amish/Mennonite,Amish Mennonite,,482.75,,,,,,,0.62000,851.40,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,inpatient,1,EA,466.20000,442.89000,Amish/Mennonite,Amish Mennonite,,256.41,,,,,,,256.41,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,65219013520,NDC,facility,outpatient,1,EA,466.20000,442.89000,Amish/Mennonite,Amish Mennonite,,256.41,,,,,,,0.62000,452.21,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,inpatient,1,EA,311.63000,296.05000,Amish/Mennonite,Amish Mennonite,,171.40,,,,,,,171.40,302.28,percent of total billed charges,
CYCLOPHOSPHAMIDE POWD-INJ 500 MG,55991,CDM,636,RC,J9075,HCPCS,72603010401,NDC,facility,outpatient,1,EA,311.63000,296.05000,Amish/Mennonite,Amish Mennonite,,171.40,,,,,,,0.62000,302.28,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,680.35,1199.89,percent of total billed charges,
CT UPPER EXT WO CNTRST-TECH,55993,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1237.00000,1175.15000,Amish/Mennonite,Amish Mennonite,TC,680.35,,,,,,,584.87,1820.00,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
CULT VANCO RESIST ENTEROCOC SCRN-TECH,55994,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,6.63,339.51,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
CYSTATIN C-TECH,55995,CDM,300,RC,82610,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,18.52,865.84,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,inpatient,1,mL,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,71288010920,NDC,facility,outpatient,1,mL,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.26,2.81,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,inpatient,1,mL,3.30000,3.14000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,63323012020,NDC,facility,outpatient,1,mL,3.30000,3.14000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.26,3.20,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CYTARABINE HCL INJ 100 MG/ML,55996,CDM,250,RC,J9100,HCPCS,67457045220,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.26,3.07,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,inpatient,2,EA,69.77000,66.28000,Amish/Mennonite,Amish Mennonite,,38.37,,,,,,,38.37,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,00065-0397-02,NDC,,,facility,outpatient,2,EA,69.77000,66.28000,Amish/Mennonite,Amish Mennonite,,38.37,,,,,,,34.88,67.68,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,inpatient,2,EA,37.30000,35.44000,Amish/Mennonite,Amish Mennonite,,20.52,,,,,,,20.52,36.18,percent of total billed charges,
CYCLOPENTOLATE OPHTH SOL 7733611,55997,CDM,250,RC,17478-0097-02,NDC,,,facility,outpatient,2,EA,37.30000,35.44000,Amish/Mennonite,Amish Mennonite,,20.52,,,,,,,18.65,36.18,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
CULT FUNGI DEFIN ID MOLD EACH-TECH,55998,CDM,300,RC,87107,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,10.32,543.22,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,Amish/Mennonite,Amish Mennonite,TC,1250.15,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK WO/W CNTRST-TECH,55999,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,Amish/Mennonite,Amish Mennonite,TC,1250.15,,,,,,,1136.50,2204.81,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,171.05,301.67,percent of total billed charges,
CYTO SMEAR CELL ENHANCE NONGYN-TECH,56000,CDM,310,RC,88112,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,50.73,3254.22,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,TC,84.15,,,,,,,84.15,148.41,percent of total billed charges,
CYTO FNA IMMED ADEQUACY EVAL-TECH,56001,CDM,311,RC,88172,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,TC,84.15,,,,,,,76.50,905.54,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,inpatient,1,EA,15.71000,14.92000,Amish/Mennonite,Amish Mennonite,,8.64,,,,,,,8.64,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00078-0419-15,NDC,,,facility,outpatient,1,EA,15.71000,14.92000,Amish/Mennonite,Amish Mennonite,,8.64,,,,,,,7.86,15.24,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,inpatient,1,EA,27.95000,26.56000,Amish/Mennonite,Amish Mennonite,,15.37,,,,,,,15.37,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,00591-4375-30,NDC,,,facility,outpatient,1,EA,27.95000,26.56000,Amish/Mennonite,Amish Mennonite,,15.37,,,,,,,13.97,27.11,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,inpatient,1,EA,10.35000,9.84000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,13668-0202-30,NDC,,,facility,outpatient,1,EA,10.35000,9.84000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,33342-0276-07,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,inpatient,1,EA,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,69097-0431-02,NDC,,,facility,outpatient,1,EA,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.04,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,inpatient,1,EA,6.83000,6.48000,Amish/Mennonite,Amish Mennonite,,3.76,,,,,,,3.76,6.63,percent of total billed charges,
DARIFENACIN TAB 7.5 MG,56002,CDM,250,RC,70700-0182-30,NDC,,,facility,outpatient,1,EA,6.83000,6.48000,Amish/Mennonite,Amish Mennonite,,3.76,,,,,,,3.42,6.63,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,inpatient,1,EA,5.53000,5.26000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00074310832,NDC,facility,outpatient,1,EA,5.53000,5.26000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,1.15,5.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,inpatient,1,EA,8.46000,8.04000,Amish/Mennonite,Amish Mennonite,,4.65,,,,,,,4.65,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00078024615,NDC,facility,outpatient,1,EA,8.46000,8.04000,Amish/Mennonite,Amish Mennonite,,4.65,,,,,,,1.15,8.21,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,inpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00093574065,NDC,facility,outpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,inpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,00591222215,NDC,facility,outpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.15,3.37,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
CYCLOSPORINE MICROEMULSION CAP,56003,CDM,250,RC,J7515,HCPCS,51862045847,NDC,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.15,2.36,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,inpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,49.50,87.30,percent of total billed charges,
CULT FUNGI PRES ID SKIN/HAIR/NL-TECH,56004,CDM,300,RC,87101,CPT,,,facility,outpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,7.71,407.44,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,60.50,106.70,percent of total billed charges,
CULT STOOL AEROBIC SALM SHIG-TECH,56005,CDM,300,RC,87045,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,9.44,492.33,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,104.76,percent of total billed charges,
CULT FUNGI PRES ID BLOOD-TECH,56006,CDM,300,RC,87103,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,12.68,967.70,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,inpatient,1,EA,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,18.70,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00023-9163-30,NDC,,,facility,outpatient,1,EA,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,17.00,32.98,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,00378-8760-58,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.75,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,inpatient,1,EA,14.74000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,8.11,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,10702-0808-03,NDC,,,facility,outpatient,1,EA,14.74000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,7.37,14.30,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,inpatient,1,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,8.11,14.31,percent of total billed charges,
CYCLOSPORINE OPH EMULSION,56007,CDM,250,RC,60505-6202-01,NDC,,,facility,outpatient,1,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,7.38,14.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,inpatient,2,EA,53.31000,50.64000,Amish/Mennonite,Amish Mennonite,,29.32,,,,,,,29.32,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,00065-0396-02,NDC,,,facility,outpatient,2,EA,53.31000,50.64000,Amish/Mennonite,Amish Mennonite,,29.32,,,,,,,26.66,51.71,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,inpatient,2,EA,18.68000,17.74000,Amish/Mennonite,Amish Mennonite,,10.27,,,,,,,10.27,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,17478-0100-02,NDC,,,facility,outpatient,2,EA,18.68000,17.74000,Amish/Mennonite,Amish Mennonite,,10.27,,,,,,,9.34,18.12,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,inpatient,2,EA,229.42000,217.95000,Amish/Mennonite,Amish Mennonite,,126.18,,,,,,,126.18,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,24208-0735-01,NDC,,,facility,outpatient,2,EA,229.42000,217.95000,Amish/Mennonite,Amish Mennonite,,126.18,,,,,,,114.71,222.54,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,inpatient,2,EA,18.88000,17.94000,Amish/Mennonite,Amish Mennonite,,10.38,,,,,,,10.38,18.31,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 2 ML,56008,CDM,250,RC,61314-0396-01,NDC,,,facility,outpatient,2,EA,18.88000,17.94000,Amish/Mennonite,Amish Mennonite,,10.38,,,,,,,9.44,18.31,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,1444.85,2548.19,percent of total billed charges,
CTA/CTV LWR EXT INCL IMG POST PROC-TECH,56009,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2627.00000,2495.65000,Amish/Mennonite,Amish Mennonite,TC,1444.85,,,,,,,979.11,2548.19,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,inpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,90,105.60,,,,,,,105.60,186.24,percent of total billed charges,
CYTOGENETICS DNA PROBE EA SO -TECH,56010,CDM,310,RC,88271,CPT,,,facility,outpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,90,105.60,,,,,,,20.36,1120.45,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00115-4411-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.48,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00149-0030-05,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,inpatient,1,EA,4.99000,4.75000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,00904-7211-04,NDC,,,facility,outpatient,1,EA,4.99000,4.75000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,4.84,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,42023-0124-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.69,3.28,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,50268-0217-15,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.13,6.07,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-11,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.60,3.10,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
DANTROLENE CAP,56011,CDM,250,RC,68084-0300-21,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0149-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,inpatient,1,EA,10.45000,9.93000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.75,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,00597-0355-56,NDC,,,facility,outpatient,1,EA,10.45000,9.93000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.22,10.14,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,inpatient,1,EA,9.53000,9.05000,Amish/Mennonite,Amish Mennonite,,5.24,,,,,,,5.24,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,31722-0621-60,NDC,,,facility,outpatient,1,EA,9.53000,9.05000,Amish/Mennonite,Amish Mennonite,,5.24,,,,,,,4.76,9.24,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,inpatient,1,EA,37.86000,35.96000,Amish/Mennonite,Amish Mennonite,,20.82,,,,,,,20.82,36.72,percent of total billed charges,
DABIGATRAN CAP 75 MG,56012,CDM,250,RC,60687-0744-21,NDC,,,facility,outpatient,1,EA,37.86000,35.96000,Amish/Mennonite,Amish Mennonite,,20.82,,,,,,,18.93,36.72,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,inpatient,1,mL,4.01000,3.81000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.21,3.89,percent of total billed charges,
CYTARABINE SOLN PF 20 MG/ML 5 ML,56013,CDM,250,RC,J9100,HCPCS,61703030538,NDC,facility,outpatient,1,mL,4.01000,3.81000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,1.26,3.89,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,1444.30,2547.22,percent of total billed charges,
CTA/CTV UPR EXT INCL IMG POST PROC-TECH,56014,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2626.00000,2494.70000,Amish/Mennonite,Amish Mennonite,TC,1444.30,,,,,,,979.11,2547.22,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,inpatient,,,2887.00000,2742.65000,Amish/Mennonite,Amish Mennonite,90,1587.85,,,,,,,1587.85,2800.39,percent of total billed charges,
CYTOGEN MICROARRAY COPY NO&SNP (CMAP) SO,56015,CDM,310,RC,81229,CPT,,,facility,outpatient,,,2887.00000,2742.65000,Amish/Mennonite,Amish Mennonite,90,1587.85,,,,,,,608.00,54562.77,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2287.00000,2172.65000,Amish/Mennonite,Amish Mennonite,TC,1257.85,,,,,,,1257.85,2218.39,percent of total billed charges,
CT ORB SEL P FOS EAR W CNTRST-TECH,56016,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2287.00000,2172.65000,Amish/Mennonite,Amish Mennonite,TC,1257.85,,,,,,,1143.50,2218.39,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,52.25,92.15,percent of total billed charges,
CULT ANAEROBE DEFIN ID EA ISO-TECH,56017,CDM,300,RC,87076,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,8.08,424.40,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,inpatient,,,3088.00000,2933.60000,Amish/Mennonite,Amish Mennonite,TC,1698.40,,,,,,,1698.40,2995.36,percent of total billed charges,
CTA/CTV ABD/PELV W IMG POST PROC-TECH,56018,CDM,352,RC,74174,CPT,,,facility,outpatient,,,3088.00000,2933.60000,Amish/Mennonite,Amish Mennonite,TC,1698.40,,,,,,,1285.85,2995.36,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,TC,41.80,,,,,,,41.80,73.72,percent of total billed charges,
DECALCIFICATION PROC-TECH,56019,CDM,310,RC,88311,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,TC,41.80,,,,,,,30.28,413.21,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2307.00000,2191.65000,Amish/Mennonite,Amish Mennonite,TC,1268.85,,,,,,,1268.85,2237.79,percent of total billed charges,
CTA/CTV HEAD INCL IMG POST-PROC-TECH,56020,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2307.00000,2191.65000,Amish/Mennonite,Amish Mennonite,TC,1268.85,,,,,,,1153.50,2237.79,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
CYTOPATH C/V MATURATION INDEX-TECH,56021,CDM,311,RC,88155,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,8.42,696.05,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,0.3,EA,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,0.3,EA,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,3.00,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA 150 MCG/0.3 ML SOLN,56022,CDM,636,RC,J0882,HCPCS,55513002704,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,3.00,7770.57,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
CYTOMEGALOVIRUS CULTURE-TECH,56023,CDM,300,RC,87254,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,7.06,1018.59,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
CULT TYPE IMMUNOFL EA ANTISERUM-TECH,56024,CDM,300,RC,87140,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.57,288.61,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,inpatient,1,EA,6472.37000,6148.75000,Amish/Mennonite,Amish Mennonite,,3559.80,,,,,,,3559.80,6278.20,percent of total billed charges,
DANTROLENE POWDER 250 MG,56025,CDM,250,RC,42367-0540-32,NDC,,,facility,outpatient,1,EA,6472.37000,6148.75000,Amish/Mennonite,Amish Mennonite,,3559.80,,,,,,,3236.18,6278.20,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,inpatient,1,mL,301.66000,286.57000,Amish/Mennonite,Amish Mennonite,,165.91,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050205,NDC,facility,outpatient,1,mL,301.66000,286.57000,Amish/Mennonite,Amish Mennonite,,165.91,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,inpatient,1,mL,346.54000,329.21000,Amish/Mennonite,Amish Mennonite,,190.60,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910289,56026,CDM,636,RC,J9145,HCPCS,57894050505,NDC,facility,outpatient,1,mL,346.54000,329.21000,Amish/Mennonite,Amish Mennonite,,190.60,,,,,,,69.84,336.14,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,inpatient,1,EA,44.48000,42.25000,Amish/Mennonite,Amish Mennonite,,24.46,,,,,,,24.46,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,00078024115,NDC,facility,outpatient,1,EA,44.48000,42.25000,Amish/Mennonite,Amish Mennonite,,24.46,,,,,,,3.14,43.15,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,inpatient,1,EA,38.82000,36.88000,Amish/Mennonite,Amish Mennonite,,21.35,,,,,,,21.35,37.66,percent of total billed charges,
CYCLOSPORINE ORAL 100 MG,56027,CDM,250,RC,J7502,HCPCS,60505013400,NDC,facility,outpatient,1,EA,38.82000,36.88000,Amish/Mennonite,Amish Mennonite,,21.35,,,,,,,3.14,37.66,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
CULT FUNGI PRES ID OTHR SOURCE-TECH,56028,CDM,300,RC,87102,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,8.41,441.37,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,inpatient,1,mL,3994.25000,3794.54000,Amish/Mennonite,Amish Mennonite,,2196.84,,,,,,,2196.84,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071001,NDC,facility,outpatient,1,mL,3994.25000,3794.54000,Amish/Mennonite,Amish Mennonite,,2196.84,,,,,,,29.24,3874.42,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,inpatient,1,mL,4108.08000,3902.67000,Amish/Mennonite,Amish Mennonite,,2259.44,,,,,,,2259.44,3984.84,percent of total billed charges,
DENOSUMAB SOLN 60 MG/ML (PROLIA),56029,CDM,636,RC,J0897,HCPCS,55513071021,NDC,facility,outpatient,1,mL,4108.08000,3902.67000,Amish/Mennonite,Amish Mennonite,,2259.44,,,,,,,29.24,3984.84,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 200 MCG/0.4 ML,56030,CDM,636,RC,J0882,HCPCS,55513002801,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,3.00,7770.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,inpatient,1,mL,501.16000,476.11000,Amish/Mennonite,Amish Mennonite,,275.64,,,,,,,275.64,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910393",56031,CDM,636,RC,J0882,HCPCS,55513000204,NDC,facility,outpatient,1,mL,501.16000,476.11000,Amish/Mennonite,Amish Mennonite,,275.64,,,,,,,3.00,486.13,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,0.4,EA,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,0.4,EA,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,3.00,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7530215",56032,CDM,636,RC,J0882,HCPCS,5551300210400100,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,3.00,1944.52,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,inpatient,1,EA,21.10000,20.04000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,11.61,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,00597-0135-54,NDC,,,facility,outpatient,1,EA,21.10000,20.04000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,10.55,20.47,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,31722-0622-60,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
DABIGATRAN CAP 150 MG,56033,CDM,250,RC,62332-0636-06,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
CYTO FNA IMMED EA ADDL EPISODE-TECH,56034,CDM,310,RC,88177,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,25.45,1453.11,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
CULT STOOL ADDL PATHOGENS EA-TECH,56035,CDM,300,RC,87046,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,3.40,492.33,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,inpatient,1,EA,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,71288011920,NDC,facility,outpatient,1,EA,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,2.55,251.23,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,inpatient,1,EA,2460.50000,2337.48000,Amish/Mennonite,Amish Mennonite,,1353.28,,,,,,,1353.28,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,43598034837,NDC,facility,outpatient,1,EA,2460.50000,2337.48000,Amish/Mennonite,Amish Mennonite,,1353.28,,,,,,,2.55,2386.68,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,inpatient,1,EA,1554.00000,1476.30000,Amish/Mennonite,Amish Mennonite,,854.70,,,,,,,854.70,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55111055610,NDC,facility,outpatient,1,EA,1554.00000,1476.30000,Amish/Mennonite,Amish Mennonite,,854.70,,,,,,,2.55,1507.38,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,inpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,356.12,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,47335036141,NDC,facility,outpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,2.55,628.08,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,inpatient,1,EA,971.25000,922.69000,Amish/Mennonite,Amish Mennonite,,534.19,,,,,,,534.19,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,55150037601,NDC,facility,outpatient,1,EA,971.25000,922.69000,Amish/Mennonite,Amish Mennonite,,534.19,,,,,,,2.55,942.11,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,inpatient,1,EA,3935.30000,3738.53000,Amish/Mennonite,Amish Mennonite,,2164.41,,,,,,,2164.41,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,62856060001,NDC,facility,outpatient,1,EA,3935.30000,3738.53000,Amish/Mennonite,Amish Mennonite,,2164.41,,,,,,,2.55,3817.24,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,inpatient,1,EA,1023.05000,971.90000,Amish/Mennonite,Amish Mennonite,,562.68,,,,,,,562.68,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,67457031625,NDC,facility,outpatient,1,EA,1023.05000,971.90000,Amish/Mennonite,Amish Mennonite,,562.68,,,,,,,2.55,992.36,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,inpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,284.90,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,70860021920,NDC,facility,outpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,2.55,502.46,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,inpatient,1,EA,512.82000,487.18000,Amish/Mennonite,Amish Mennonite,,282.05,,,,,,,282.05,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72205003601,NDC,facility,outpatient,1,EA,512.82000,487.18000,Amish/Mennonite,Amish Mennonite,,282.05,,,,,,,2.55,497.44,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,inpatient,1,EA,2432.29000,2310.68000,Amish/Mennonite,Amish Mennonite,,1337.76,,,,,,,1337.76,2359.32,percent of total billed charges,
DECITABINE INJECTION,56036,CDM,636,RC,J0894,HCPCS,72603010701,NDC,facility,outpatient,1,EA,2432.29000,2310.68000,Amish/Mennonite,Amish Mennonite,,1337.76,,,,,,,2.55,2359.32,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,inpatient,0.5,EA,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,5551300250100100,NDC,facility,outpatient,0.5,EA,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 100 MCG/0.5 ML - ESRD,56037,CDM,636,RC,J0882,HCPCS,55513002504,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,inpatient,0.42,EA,1193.25000,1133.59000,Amish/Mennonite,Amish Mennonite,,656.29,,,,,,,656.29,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,55513005704,NDC,facility,outpatient,0.42,EA,1193.25000,1133.59000,Amish/Mennonite,Amish Mennonite,,656.29,,,,,,,3.00,1157.45,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,inpatient,1,mL,1193.24000,1133.58000,Amish/Mennonite,Amish Mennonite,,656.28,,,,,,,656.28,1157.44,percent of total billed charges,
DARBEPOETIN ALFA 25 MCG / 0.42 ML SOLN,56038,CDM,636,RC,J0882,HCPCS,5551300570400100,NDC,facility,outpatient,1,mL,1193.24000,1133.58000,Amish/Mennonite,Amish Mennonite,,656.28,,,,,,,3.00,1157.44,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,inpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,23155-0579-01,NDC,,,facility,outpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,inpatient,1,EA,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,45963-0342-02,NDC,,,facility,outpatient,1,EA,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.77,3.43,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
DESIPRAMINE TAB,56039,CDM,250,RC,50742-0113-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
CULT STAPHLOCOCCUS SCRN-TECH,56040,CDM,300,RC,87081,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,6.63,339.51,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 500 MCG/ML,56042,CDM,636,RC,J0882,HCPCS,5551300320100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,3.00,7770.57,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,inpatient,1,EA,12.93000,12.28000,Amish/Mennonite,Amish Mennonite,,7.11,,,,,,,7.11,12.54,percent of total billed charges,
CYCLOPHOSPHAMIDE ORAL,56043,CDM,250,RC,J8530,HCPCS,00054413025,NDC,facility,outpatient,1,EA,12.93000,12.28000,Amish/Mennonite,Amish Mennonite,,7.11,,,,,,,1.77,12.54,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,Amish/Mennonite,Amish Mennonite,,2741.89,,,,,,,2442.77,4835.69,percent of total billed charges,
ACTIVA DBS PATIENT PROGRAMMER,56044,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,Amish/Mennonite,Amish Mennonite,,2741.89,,,,,,,2288.23,4985.25,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
CULT STREP THROAT ONLY SCRN-TECH,56045,CDM,300,RC,87081,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,6.63,339.51,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,inpatient,500,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00074-5645-25,NDC,,,facility,outpatient,500,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,inpatient,500,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROSE WATER SOL,56046,CDM,250,RC,00409-7936-19,NDC,,,facility,outpatient,500,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
CYCLIC CITRULLINATED PEPTD AB-TECH,56047,CDM,300,RC,86200,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,12.95,679.08,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,inpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,00641614525,NDC,facility,outpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,0.14415,2.97,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,55150023701,NDC,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,0.14415,2.39,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,inpatient,1,EA,8.31000,7.90000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.57,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016501,NDC,facility,outpatient,1,EA,8.31000,7.90000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,0.14415,8.06,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,63323016516,NDC,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,0.14415,2.64,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML,56048,CDM,636,RC,J1100,HCPCS,67457042312,NDC,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,0.14415,2.38,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,inpatient,3.5,EA,206.04000,195.74000,Amish/Mennonite,Amish Mennonite,,113.32,,,,,,,113.32,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00065-0648-35,NDC,,,facility,outpatient,3.5,EA,206.04000,195.74000,Amish/Mennonite,Amish Mennonite,,113.32,,,,,,,103.02,199.86,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,inpatient,3.5,EA,244.89000,232.65000,Amish/Mennonite,Amish Mennonite,,134.69,,,,,,,134.69,237.54,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE OINT-OPHTH 0.3%-0.1% 3.5 GM,56049,CDM,250,RC,00078-0876-01,NDC,,,facility,outpatient,3.5,EA,244.89000,232.65000,Amish/Mennonite,Amish Mennonite,,134.69,,,,,,,122.44,237.54,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,00781-6172-86,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0641-34,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,inpatient,1,mL,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
DESFLURANE LIQUID,56050,CDM,250,RC,10019-0644-34,NDC,,,facility,outpatient,1,mL,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,inpatient,1,mL,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.36,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,63323016530,NDC,facility,outpatient,1,mL,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,0.14415,4.16,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,inpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
DEXAMETHASONE SODIUM PHOS 7910199,56051,CDM,250,RC,J1100,HCPCS,67457042130,NDC,facility,outpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.14415,0.98940,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,inpatient,1,EA,79.95000,75.95000,Amish/Mennonite,Amish Mennonite,,43.97,,,,,,,43.97,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,00409275701,NDC,facility,outpatient,1,EA,79.95000,75.95000,Amish/Mennonite,Amish Mennonite,,43.97,,,,,,,0.04803,77.55,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,inpatient,1,EA,1061.15000,1008.09000,Amish/Mennonite,Amish Mennonite,,583.63,,,,,,,583.63,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16714089201,NDC,facility,outpatient,1,EA,1061.15000,1008.09000,Amish/Mennonite,Amish Mennonite,,583.63,,,,,,,0.04803,1029.32,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,inpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,16729043505,NDC,facility,outpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,0.04803,229.89,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,inpatient,1,EA,252.14000,239.53000,Amish/Mennonite,Amish Mennonite,,138.68,,,,,,,138.68,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,43598041311,NDC,facility,outpatient,1,EA,252.14000,239.53000,Amish/Mennonite,Amish Mennonite,,138.68,,,,,,,0.04803,244.58,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,inpatient,1,EA,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323037119,NDC,facility,outpatient,1,EA,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,0.04803,76.63,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,inpatient,1,EA,1153.79000,1096.10000,Amish/Mennonite,Amish Mennonite,,634.58,,,,,,,634.58,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,63323087115,NDC,facility,outpatient,1,EA,1153.79000,1096.10000,Amish/Mennonite,Amish Mennonite,,634.58,,,,,,,0.04803,1119.18,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,inpatient,1,EA,323.78000,307.59000,Amish/Mennonite,Amish Mennonite,,178.08,,,,,,,178.08,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67457081350,NDC,facility,outpatient,1,EA,323.78000,307.59000,Amish/Mennonite,Amish Mennonite,,178.08,,,,,,,0.04803,314.07,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,inpatient,1,EA,1153.82000,1096.13000,Amish/Mennonite,Amish Mennonite,,634.60,,,,,,,634.60,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,67919001202,NDC,facility,outpatient,1,EA,1153.82000,1096.13000,Amish/Mennonite,Amish Mennonite,,634.60,,,,,,,0.04803,1119.21,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,inpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001615,NDC,facility,outpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,0.04803,91.96,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,inpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,70594003401,NDC,facility,outpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,0.04803,183.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,inpatient,1,EA,58.74000,55.81000,Amish/Mennonite,Amish Mennonite,,32.31,,,,,,,32.31,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,71288001695,NDC,facility,outpatient,1,EA,58.74000,55.81000,Amish/Mennonite,Amish Mennonite,,32.31,,,,,,,0.04803,56.98,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,inpatient,1,EA,1061.41000,1008.34000,Amish/Mennonite,Amish Mennonite,,583.78,,,,,,,583.78,1029.57,percent of total billed charges,
DAPTOMYCIN POWD-INJ 500 MG,56052,CDM,250,RC,J0878,HCPCS,72603015201,NDC,facility,outpatient,1,EA,1061.41000,1008.34000,Amish/Mennonite,Amish Mennonite,,583.78,,,,,,,0.04803,1029.57,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,inpatient,1,mL,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,1102.56,1944.52,percent of total billed charges,
"DARBEPOETIN ALFA, ESRD USE 7910392",56053,CDM,636,RC,J0882,HCPCS,55513000504,NDC,facility,outpatient,1,mL,2004.66000,1904.43000,Amish/Mennonite,Amish Mennonite,,1102.56,,,,,,,3.00,1944.52,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,inpatient,1,EA,40.14000,38.13000,Amish/Mennonite,Amish Mennonite,,22.08,,,,,,,22.08,38.94,percent of total billed charges,
DARIFENACIN TAB 15 MG,56054,CDM,250,RC,00430-0171-15,NDC,,,facility,outpatient,1,EA,40.14000,38.13000,Amish/Mennonite,Amish Mennonite,,22.08,,,,,,,20.07,38.94,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,inpatient,,,2468.00000,2344.60000,Amish/Mennonite,Amish Mennonite,,1357.40,,,,,,,1357.40,2393.96,percent of total billed charges,
DELIVERY CHARGE LEVEL 2,56055,CDM,722,RC,,,,,facility,outpatient,,,2468.00000,2344.60000,Amish/Mennonite,Amish Mennonite,,1357.40,,,,,,,1234.00,2393.96,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,inpatient,5,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,00641614625,NDC,facility,outpatient,5,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.14415,0.57230,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,inpatient,5,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,55150023805,NDC,facility,outpatient,5,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.14415,0.64020,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,inpatient,5,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,63323016505,NDC,facility,outpatient,5,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.14415,0.69840,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,inpatient,5,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457041805,NDC,facility,outpatient,5,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14415,0.28130,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,inpatient,5,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DEXAMETHASONE SOLN 4 MG/ML 5 ML,56056,CDM,250,RC,J1100,HCPCS,67457042254,NDC,facility,outpatient,5,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.14415,1.19,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,0.3,EA,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,0.3,EA,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,3.00,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,inpatient,1,mL,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,1958.22,3453.59,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 60 MCG/0.3 ML,56058,CDM,636,RC,J0882,HCPCS,55513002304,NDC,facility,outpatient,1,mL,3560.40000,3382.38000,Amish/Mennonite,Amish Mennonite,,1958.22,,,,,,,3.00,3453.59,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,inpatient,1,mL,4321.88000,4105.78000,Amish/Mennonite,Amish Mennonite,,2377.03,,,,,,,2377.03,4192.22,percent of total billed charges,
DENOSUMAB SOLN 120 MG/1.7 ML (XGEVA),56059,CDM,636,RC,J0897,HCPCS,55513073001,NDC,facility,outpatient,1,mL,4321.88000,4105.78000,Amish/Mennonite,Amish Mennonite,,2377.03,,,,,,,29.24,4192.22,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,inpatient,,,325.00000,308.75000,Amish/Mennonite,Amish Mennonite,,178.75,,,,,,,178.75,315.25,percent of total billed charges,
CYTO SMEARS W INTERP NONGYN-TECH,56060,CDM,310,RC,88104,CPT,,,facility,outpatient,,,325.00000,308.75000,Amish/Mennonite,Amish Mennonite,,178.75,,,,,,,37.27,3305.11,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
DHEA SULFATE-TECH,56061,CDM,300,RC,82627,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,22.23,1154.38,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,inpatient,1,EA,1265.09000,1201.83000,Amish/Mennonite,Amish Mennonite,,695.80,,,,,,,695.80,1227.14,percent of total billed charges,
DEGARELIX INJECTION,56063,CDM,636,RC,J9155,HCPCS,55566830301,NDC,facility,outpatient,1,EA,1265.09000,1201.83000,Amish/Mennonite,Amish Mennonite,,695.80,,,,,,,4.36,1227.14,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00093-3123-01,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,00781-2248-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
DICLOXACILLIN CAP,56064,CDM,250,RC,59651-0565-01,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,inpatient,1,EA,224.08000,212.87000,Amish/Mennonite,Amish Mennonite,,123.24,,,,,,,123.24,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00143929701,NDC,facility,outpatient,1,EA,224.08000,212.87000,Amish/Mennonite,Amish Mennonite,,123.24,,,,,,,112.04,217.36,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,inpatient,1,EA,196.46000,186.63000,Amish/Mennonite,Amish Mennonite,,108.05,,,,,,,108.05,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,00149073402,NDC,facility,outpatient,1,EA,196.46000,186.63000,Amish/Mennonite,Amish Mennonite,,108.05,,,,,,,98.23,190.57,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,inpatient,1,EA,255.96000,243.16000,Amish/Mennonite,Amish Mennonite,,140.78,,,,,,,140.78,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,27505000165,NDC,facility,outpatient,1,EA,255.96000,243.16000,Amish/Mennonite,Amish Mennonite,,140.78,,,,,,,127.98,248.28,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,inpatient,1,EA,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,121.66,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,78670000367,NDC,facility,outpatient,1,EA,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,110.60,214.56,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,inpatient,1,EA,280.10000,266.10000,Amish/Mennonite,Amish Mennonite,,154.06,,,,,,,154.06,271.70,percent of total billed charges,
DANTROLENE POWD-INJ 20 MG,56065,CDM,250,RC,J3490,HCPCS,42023012306,NDC,facility,outpatient,1,EA,280.10000,266.10000,Amish/Mennonite,Amish Mennonite,,154.06,,,,,,,140.05,271.70,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00378-1620-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00591-0795-01,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,00904-6988-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
DICYCLOMINE CAP 20 MG,56066,CDM,250,RC,51079-0119-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,inpatient,2,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00143953225,NDC,facility,outpatient,2,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,10.27,19.92,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,inpatient,2,EA,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,36.50,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,00409163802,NDC,facility,outpatient,2,EA,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,33.18,64.37,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,inpatient,2,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,16729043293,NDC,facility,outpatient,2,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,5.69,11.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,inpatient,2,EA,56.25000,53.44000,Amish/Mennonite,Amish Mennonite,,30.94,,,,,,,30.94,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,17478005502,NDC,facility,outpatient,2,EA,56.25000,53.44000,Amish/Mennonite,Amish Mennonite,,30.94,,,,,,,28.12,54.56,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,inpatient,2,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,12.86,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,42023014625,NDC,facility,outpatient,2,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,11.69,22.68,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,inpatient,2,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,27.81,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,55150020902,NDC,facility,outpatient,2,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,25.28,49.04,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,inpatient,2,EA,30.16000,28.65000,Amish/Mennonite,Amish Mennonite,,16.59,,,,,,,16.59,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,63323042116,NDC,facility,outpatient,2,EA,30.16000,28.65000,Amish/Mennonite,Amish Mennonite,,16.59,,,,,,,15.08,29.26,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,inpatient,2,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.57,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023042,NDC,facility,outpatient,2,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.15,8.05,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,inpatient,2,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,66794023342,NDC,facility,outpatient,2,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,2.77,5.36,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,inpatient,2,EA,26.61000,25.28000,Amish/Mennonite,Amish Mennonite,,14.64,,,,,,,14.64,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,67457025102,NDC,facility,outpatient,2,EA,26.61000,25.28000,Amish/Mennonite,Amish Mennonite,,14.64,,,,,,,13.30,25.81,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,inpatient,2,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,70860060503,NDC,facility,outpatient,2,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.22,27.59,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,inpatient,2,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.69,8.27,percent of total billed charges,
DEXMEDETOMIDINE SOLN-INJ 100 MCG/ML 2 ML,56067,CDM,250,RC,J3490,HCPCS,71288050503,NDC,facility,outpatient,2,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.26,8.27,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 0.5 MG,56068,CDM,250,RC,J8540,HCPCS,72603021201,NDC,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,inpatient,,,293.20000,278.54000,Amish/Mennonite,Amish Mennonite,90,161.26,,,,,,,161.26,284.40,percent of total billed charges,
DHEA - SO TECH,56069,CDM,300,RC,82626,CPT,,,facility,outpatient,,,293.20000,278.54000,Amish/Mennonite,Amish Mennonite,90,161.26,,,,,,,26.11,1324.17,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,inpatient,3.5,EA,15.03000,14.28000,Amish/Mennonite,Amish Mennonite,,8.27,,,,,,,8.27,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,00574-4160-35,NDC,,,facility,outpatient,3.5,EA,15.03000,14.28000,Amish/Mennonite,Amish Mennonite,,8.27,,,,,,,7.51,14.58,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,inpatient,3.5,EA,14.35000,13.63000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,7.89,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,24208-0795-35,NDC,,,facility,outpatient,3.5,EA,14.35000,13.63000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,7.17,13.92,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,inpatient,3.5,EA,16.25000,15.44000,Amish/Mennonite,Amish Mennonite,,8.94,,,,,,,8.94,15.76,percent of total billed charges,
DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH OINT,56070,CDM,250,RC,61314-0631-36,NDC,,,facility,outpatient,3.5,EA,16.25000,15.44000,Amish/Mennonite,Amish Mennonite,,8.94,,,,,,,8.12,15.76,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,inpatient,1,mL,4.52000,4.29000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,2.49,4.38,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML,56071,CDM,250,RC,J1100,HCPCS,0064103672500010,NDC,facility,outpatient,1,mL,4.52000,4.29000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,0.14415,4.38,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,inpatient,1,EA,4.51000,4.29000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.48,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,25021005301,NDC,facility,outpatient,1,EA,4.51000,4.29000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,0.14415,4.37,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,inpatient,1,EA,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,7.64,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,55150030425,NDC,facility,outpatient,1,EA,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,0.14415,13.48,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050601,NDC,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,0.14415,22.99,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,inpatient,1,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,63323050616,NDC,facility,outpatient,1,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,0.14415,5.36,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,inpatient,1,EA,16.56000,15.73000,Amish/Mennonite,Amish Mennonite,,9.11,,,,,,,9.11,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,70069002125,NDC,facility,outpatient,1,EA,16.56000,15.73000,Amish/Mennonite,Amish Mennonite,,9.11,,,,,,,0.14415,16.06,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,inpatient,1,EA,18.26000,17.35000,Amish/Mennonite,Amish Mennonite,,10.04,,,,,,,10.04,17.71,percent of total billed charges,
DEXAMETHASONE SOLN PF 10 MG/ML,56072,CDM,250,RC,J1100,HCPCS,76045010910,NDC,facility,outpatient,1,EA,18.26000,17.35000,Amish/Mennonite,Amish Mennonite,,10.04,,,,,,,0.14415,17.71,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,inpatient,1,EA,3.30000,3.14000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,00378-2474-01,NDC,,,facility,outpatient,1,EA,3.30000,3.14000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.20,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC POTASSIUM TAB,56073,CDM,250,RC,72888-0073-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,inpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,,291.50,,,,,,,291.50,514.10,percent of total billed charges,
CYTO SMEARS EXTNDED STDY/>5 SL-TECH,56074,CDM,311,RC,88162,CPT,,,facility,outpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,,291.50,,,,,,,50.73,4789.16,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,inpatient,,,503.00000,477.85000,Amish/Mennonite,Amish Mennonite,,276.65,,,,,,,276.65,487.91,percent of total billed charges,
DIALYSIS SNGL EVAL-TECH,56075,CDM,841,RC,90945,CPT,,,facility,outpatient,,,503.00000,477.85000,Amish/Mennonite,Amish Mennonite,,276.65,,,,,,,251.50,487.91,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQUID,56076,CDM,250,RC,00641-0367-25-00010,NDC,,,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.50,4.85,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00527-0586-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,00904-6987-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,51079-0118-01,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
DICYCLOMINE CAP 10 MG,56079,CDM,250,RC,60687-0369-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,inpatient,1,EA,1328.67000,1262.24000,Amish/Mennonite,Amish Mennonite,,730.77,,,,,,,730.77,1288.81,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,00281036510,NDC,facility,outpatient,1,EA,1328.67000,1262.24000,Amish/Mennonite,Amish Mennonite,,730.77,,,,,,,664.34,8365.47,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,inpatient,1,EA,9519.93000,9043.93000,Amish/Mennonite,Amish Mennonite,,5235.96,,,,,,,5235.96,9234.33,percent of total billed charges,
DIGOXIN IMMUNE FAB (OVINE),56080,CDM,636,RC,J1162,HCPCS,50633012011,NDC,facility,outpatient,1,EA,9519.93000,9043.93000,Amish/Mennonite,Amish Mennonite,,5235.96,,,,,,,4759.97,9234.33,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
CULT TYPE IMMUNO EA ANTISERUM-TECH,56081,CDM,300,RC,87147,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.18,271.65,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,inpatient,2.5,EA,48.01000,45.61000,Amish/Mennonite,Amish Mennonite,,26.41,,,,,,,26.41,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,16571-0101-25,NDC,,,facility,outpatient,2.5,EA,48.01000,45.61000,Amish/Mennonite,Amish Mennonite,,26.41,,,,,,,24.00,46.57,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,inpatient,2.5,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,7.30,12.87,percent of total billed charges,
DICLOFENAC OPHTH SOL,56082,CDM,250,RC,61314-0014-25,NDC,,,facility,outpatient,2.5,EA,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,6.63,12.87,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,inpatient,1,mL,105.09000,99.83000,Amish/Mennonite,Amish Mennonite,,57.80,,,,,,,57.80,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,00065-0647-25,NDC,,,facility,outpatient,1,mL,105.09000,99.83000,Amish/Mennonite,Amish Mennonite,,57.80,,,,,,,52.55,101.94,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,inpatient,1,mL,47.94000,45.55000,Amish/Mennonite,Amish Mennonite,,26.37,,,,,,,26.37,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,69238-1373-02,NDC,,,facility,outpatient,1,mL,47.94000,45.55000,Amish/Mennonite,Amish Mennonite,,26.37,,,,,,,23.97,46.50,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,inpatient,1,mL,63.92000,60.72000,Amish/Mennonite,Amish Mennonite,,35.16,,,,,,,35.16,62.00,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH 0.3%-0.1% 2.5 ML,56083,CDM,250,RC,24208-0295-25,NDC,,,facility,outpatient,1,mL,63.92000,60.72000,Amish/Mennonite,Amish Mennonite,,35.16,,,,,,,31.96,62.00,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,inpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,TC,285.45,,,,,,,285.45,503.43,percent of total billed charges,
DIFFUSING CAPACITY-TECH,56084,CDM,460,RC,94729,CPT,,,facility,outpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,TC,285.45,,,,,,,259.50,503.43,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,inpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,4405.99,7770.57,percent of total billed charges,
DARBEPOETIN ALFA SYRINGE 300 MCG/0.6 ML,56085,CDM,636,RC,J0881,HCPCS,5551301110100100,NDC,facility,outpatient,1,mL,8010.90000,7610.35000,Amish/Mennonite,Amish Mennonite,,4405.99,,,,,,,3.00,7770.57,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00143952510,NDC,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,63323067100,NDC,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,00409159610,NDC,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,inpatient,1,mL,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,42023018710,NDC,facility,outpatient,1,mL,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,inpatient,1,mL,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,43066055712,NDC,facility,outpatient,1,mL,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,inpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,66794023541,NDC,facility,outpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,inpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,67457092510,NDC,facility,outpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,inpatient,1,mL,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121138907,NDC,facility,outpatient,1,mL,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.51,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,inpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXMEDETOMIDINE 400 MCG/NS 100ML PREMIX,56086,CDM,250,RC,J3490,HCPCS,70121171203,NDC,facility,outpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00172-3925-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,00378-0271-01,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
DIAZEPAM TAB 2MG,56087,CDM,250,RC,51079-0284-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,inpatient,,,293.80000,279.11000,Amish/Mennonite,Amish Mennonite,,161.59,,,,,,,161.59,284.99,percent of total billed charges,
DIALYSIS OUTPATIENT-TECH,56088,CDM,821,RC,90999,CPT,,,facility,outpatient,,,293.80000,279.11000,Amish/Mennonite,Amish Mennonite,,161.59,,,,,,,146.90,284.99,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,inpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00406895801,NDC,facility,outpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,00555095202,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,10702006501,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,11534018801,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,13107003501,NDC,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,inpatient,1,EA,7.66000,7.28000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,4.21,7.43,percent of total billed charges,
DEXTROAMPHETAMINE TAB 5 MG,56089,CDM,250,RC,J8499,HCPCS,52536050001,NDC,facility,outpatient,1,EA,7.66000,7.28000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,3.83,7.43,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68001-0281-06,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00228-2551-11,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,00781-1789-60,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,16571-0201-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,51079-0224-20,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,68084-0333-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
DICLOFENAC SODIUM TAB,56090,CDM,250,RC,61442-0103-60,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00172-3926-60,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00378-0345-05,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,inpatient,1,EA,0.18000,0.18000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,00904-5880-61,NDC,,,facility,outpatient,1,EA,0.18000,0.18000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,51079-0285-20,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
DIAZEPAM TAB 5 MG,56091,CDM,250,RC,63739-0073-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60505-0014-06,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,00904-7217-61,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,10370-0829-11,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,42291-0184-90,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,50742-0248-30,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,51079-0947-08,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,60687-0195-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
DILTIAZEM CAP 120 MG,56092,CDM,250,RC,68084-0052-11,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,inpatient,2,EA,53.18000,50.53000,Amish/Mennonite,Amish Mennonite,,29.25,,,,,,,29.25,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00409127332,NDC,facility,outpatient,2,EA,53.18000,50.53000,Amish/Mennonite,Amish Mennonite,,29.25,,,,,,,8.97,51.58,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,inpatient,2,EA,38.88000,36.94000,Amish/Mennonite,Amish Mennonite,,21.38,,,,,,,21.38,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,00641624410,NDC,facility,outpatient,2,EA,38.88000,36.94000,Amish/Mennonite,Amish Mennonite,,21.38,,,,,,,8.97,37.71,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,inpatient,2,EA,38.89000,36.95000,Amish/Mennonite,Amish Mennonite,,21.39,,,,,,,21.39,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,69339013634,NDC,facility,outpatient,2,EA,38.89000,36.95000,Amish/Mennonite,Amish Mennonite,,21.39,,,,,,,8.97,37.72,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,inpatient,2,EA,38.55000,36.62000,Amish/Mennonite,Amish Mennonite,,21.20,,,,,,,21.20,37.39,percent of total billed charges,
DIAZEPAM INJECTION,56093,CDM,250,RC,J3360,HCPCS,76045020420,NDC,facility,outpatient,2,EA,38.55000,36.62000,Amish/Mennonite,Amish Mennonite,,21.20,,,,,,,8.97,37.39,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,inpatient,1,mL,124.51000,118.28000,Amish/Mennonite,Amish Mennonite,,68.48,,,,,,,68.48,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,24208-0342-05,NDC,,,facility,outpatient,1,mL,124.51000,118.28000,Amish/Mennonite,Amish Mennonite,,68.48,,,,,,,62.26,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,inpatient,1,mL,77.82000,73.93000,Amish/Mennonite,Amish Mennonite,,42.80,,,,,,,42.80,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,60505-0815-00,NDC,,,facility,outpatient,1,mL,77.82000,73.93000,Amish/Mennonite,Amish Mennonite,,42.80,,,,,,,38.91,75.49,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,inpatient,1,mL,124.50000,118.28000,Amish/Mennonite,Amish Mennonite,,68.47,,,,,,,68.47,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,69918-0501-05,NDC,,,facility,outpatient,1,mL,124.50000,118.28000,Amish/Mennonite,Amish Mennonite,,68.47,,,,,,,62.25,120.77,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,inpatient,1,mL,113.46000,107.79000,Amish/Mennonite,Amish Mennonite,,62.40,,,,,,,62.40,110.06,percent of total billed charges,
DESMOPRESSIN SPRAY,56094,CDM,250,RC,68382-0384-01,NDC,,,facility,outpatient,1,mL,113.46000,107.79000,Amish/Mennonite,Amish Mennonite,,62.40,,,,,,,56.73,110.06,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,inpatient,1,EA,8.02000,7.62000,Amish/Mennonite,Amish Mennonite,,4.41,,,,,,,4.41,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,00378-6060-01,NDC,,,facility,outpatient,1,EA,8.02000,7.62000,Amish/Mennonite,Amish Mennonite,,4.41,,,,,,,4.01,7.78,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,inpatient,1,EA,8.74000,8.30000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.81,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,68462-0850-01,NDC,,,facility,outpatient,1,EA,8.74000,8.30000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.37,8.48,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,inpatient,1,EA,7.94000,7.55000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,4.37,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-01,NDC,,,facility,outpatient,1,EA,7.94000,7.55000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,3.97,7.70,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.75,10.15,percent of total billed charges,
DILTIAZEM CAP 60 MG 12 HR,56095,CDM,250,RC,51079-0924-20,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.23,10.15,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,inpatient,2,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00641618425,NDC,facility,outpatient,2,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.34,8.43,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,inpatient,2,EA,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,5.20,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,00781305995,NDC,facility,outpatient,2,EA,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,4.72,9.17,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,inpatient,2,EA,133.60000,126.92000,Amish/Mennonite,Amish Mennonite,,73.48,,,,,,,73.48,129.59,percent of total billed charges,
DIGOXIN INJECTION,56097,CDM,250,RC,J1160,HCPCS,24987026010,NDC,facility,outpatient,2,EA,133.60000,126.92000,Amish/Mennonite,Amish Mennonite,,73.48,,,,,,,6.40,129.59,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,inpatient,1,EA,5.43000,5.16000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.99,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,10370-0832-09,NDC,,,facility,outpatient,1,EA,5.43000,5.16000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.71,5.27,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,49884-0832-11,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,42291-0187-90,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,50742-0251-90,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,60687-0228-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,62584-0977-11,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,inpatient,1,EA,6.56000,6.23000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,63739-0286-10,NDC,,,facility,outpatient,1,EA,6.56000,6.23000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.28,6.36,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68084-0055-01,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.48,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
DILTIAZEM CAP 300 MG,56098,CDM,250,RC,68682-0370-90,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,inpatient,1,GM,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00168-0046-31,NDC,,,facility,outpatient,1,GM,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,inpatient,1,GM,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,00536-1211-95,NDC,,,facility,outpatient,1,GM,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,inpatient,1,GM,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,45802-0050-03,NDC,,,facility,outpatient,1,GM,0.56000,0.54000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,54162-0011-01,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,inpatient,1,GM,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
DIBUCAINE OINT 1% 28 GM,56099,CDM,250,RC,71399-2829-01,NDC,,,facility,outpatient,1,GM,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,inpatient,1,EA,36.06000,34.26000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,19.83,34.98,percent of total billed charges,
DILTIAZEM POWD-INJ 100 MG A/V,56100,CDM,250,RC,J3490,HCPCS,00409435003,NDC,facility,outpatient,1,EA,36.06000,34.26000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,18.03,34.98,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,inpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,,207.90,,,,,,,207.90,366.66,percent of total billed charges,
CYTO SMEARS OTHER SOURCE-TECH,56101,CDM,311,RC,88160,CPT,,,facility,outpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,,207.90,,,,,,,23.25,3435.48,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,90.20,159.08,percent of total billed charges,
DIGOXIN TOTAL ASSAY-TECH,56102,CDM,300,RC,80162,CPT,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,13.28,696.05,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,inpatient,,,2211.00000,2100.45000,Amish/Mennonite,Amish Mennonite,,1216.05,,,,,,,1216.05,2144.67,percent of total billed charges,
DELIVERY CHARGE LEVEL 1,56103,CDM,722,RC,,,,,facility,outpatient,,,2211.00000,2100.45000,Amish/Mennonite,Amish Mennonite,,1216.05,,,,,,,1105.50,2144.67,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-12,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,00904-2051-59,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
DIMENHYDRINATE TAB,56104,CDM,250,RC,49348-0070-02,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,00093-0319-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,50228-0482-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,51079-0746-20,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0573-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 60 MG,56106,CDM,250,RC,60687-0728-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,16714-0590-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00173-0242-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,00904-5921-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,57664-0437-88,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,60687-0540-01,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,3.55,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,68084-0366-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.44,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
DIGOXIN TAB 125 MCG,56107,CDM,250,RC,82685-0201-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,inpatient,1,mL,137.78000,130.89000,Amish/Mennonite,Amish Mennonite,,75.78,,,,,,,75.78,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,00065-9240-07,NDC,,,facility,outpatient,1,mL,137.78000,130.89000,Amish/Mennonite,Amish Mennonite,,75.78,,,,,,,68.89,133.65,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,inpatient,1,mL,113.36000,107.69000,Amish/Mennonite,Amish Mennonite,,62.35,,,,,,,62.35,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69097-0341-35,NDC,,,facility,outpatient,1,mL,113.36000,107.69000,Amish/Mennonite,Amish Mennonite,,62.35,,,,,,,56.68,109.96,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,inpatient,1,mL,110.52000,105.00000,Amish/Mennonite,Amish Mennonite,,60.79,,,,,,,60.79,107.20,percent of total billed charges,
DIFLUPREDNATE OPHTH 0.05% EMULSION,56108,CDM,250,RC,69238-1380-03,NDC,,,facility,outpatient,1,mL,110.52000,105.00000,Amish/Mennonite,Amish Mennonite,,60.79,,,,,,,55.26,107.20,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,inpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,49884-0831-11,NDC,,,facility,outpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.16,4.19,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,00904-7219-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,42291-0186-90,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,50742-0250-90,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,60505-0016-06,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.46,2.83,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,62584-0976-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0016-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,inpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,63739-0285-10,NDC,,,facility,outpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.62,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.30,4.06,percent of total billed charges,
DILTIAZEM CAP 240 MG,56109,CDM,250,RC,68682-0997-98,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.10,4.06,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,inpatient,1,EA,2.47000,2.35000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60505-0015-06,NDC,,,facility,outpatient,1,EA,2.47000,2.35000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,2.40,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,00904-7218-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,42291-0185-90,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,47335-0670-81,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-30,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,50742-0249-90,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,60687-0206-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68084-0053-11,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
DILTIAZEM CAP 180 MG,56110,CDM,250,RC,68682-0368-90,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00054-0434-25,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00115-1070-01,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.18,2.29,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00555-0252-02,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,00904-1086-61,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,50268-0263-15,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.63,percent of total billed charges,
DIPYRIDAMOLE TAB 25 MG,56111,CDM,250,RC,64980-0133-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.87,3.63,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,5.04,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,00378-6090-01,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,4.58,8.89,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-01,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.54,8.81,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,inpatient,1,EA,12.30000,11.69000,Amish/Mennonite,Amish Mennonite,,6.76,,,,,,,6.76,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,51079-0925-20,NDC,,,facility,outpatient,1,EA,12.30000,11.69000,Amish/Mennonite,Amish Mennonite,,6.76,,,,,,,6.15,11.93,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,Amish/Mennonite,Amish Mennonite,,5.49,,,,,,,5.49,9.69,percent of total billed charges,
DILTIAZEM CAP-ER 90 MG (12-HOUR),56112,CDM,250,RC,68462-0851-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,Amish/Mennonite,Amish Mennonite,,5.49,,,,,,,5.00,9.69,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,inpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,63323012820,NDC,facility,outpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,6.12,36.78,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,inpatient,1,EA,51.86000,49.26000,Amish/Mennonite,Amish Mennonite,,28.52,,,,,,,28.52,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,00703507501,NDC,facility,outpatient,1,EA,51.86000,49.26000,Amish/Mennonite,Amish Mennonite,,28.52,,,,,,,6.12,50.30,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
DACARBAZINE POWD-INJ 200 MG,56113,CDM,250,RC,J9130,HCPCS,71288017421,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,6.12,30.65,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00245-0181-89,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00832-7123-11,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,00904-6860-61,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,62756-0797-88,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0314-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG EC,56114,CDM,250,RC,68084-0776-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,inpatient,50,EA,43.92000,41.73000,Amish/Mennonite,Amish Mennonite,,24.16,,,,,,,24.16,42.60,percent of total billed charges,
DIMETHYL SULFOXIDE 50% SOLN-IRR 50 ML (EQV-RIMSO),56115,CDM,636,RC,J1212,HCPCS,67457017750,NDC,facility,outpatient,50,EA,43.92000,41.73000,Amish/Mennonite,Amish Mennonite,,24.16,,,,,,,21.96,1225.79,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00143-9748-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,00904-6478-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,13668-0103-30,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 10 MG,56116,CDM,250,RC,60687-0303-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,inpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004534,NDC,facility,outpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,inpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,49348004537,NDC,facility,outpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,inpatient,120,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,50580053404,NDC,facility,outpatient,120,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,inpatient,120,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54838013570,NDC,facility,outpatient,120,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,inpatient,120,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,54859081116,NDC,facility,outpatient,120,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,inpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DIPHENHYDRAMINE HCL 300MG,56117,CDM,250,RC,Q0163,HCPCS,70677014401,NDC,facility,outpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.46480,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,inpatient,25,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641601510,NDC,facility,outpatient,25,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,inpatient,25,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,00641921910,NDC,facility,outpatient,25,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,inpatient,25,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051004,NDC,facility,outpatient,25,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,inpatient,25,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019051035,NDC,facility,outpatient,25,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,inpatient,25,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057004,NDC,facility,outpatient,25,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,inpatient,25,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,10019057035,NDC,facility,outpatient,25,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,inpatient,25,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,17478093725,NDC,facility,outpatient,25,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,inpatient,25,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,55390056630,NDC,facility,outpatient,25,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,inpatient,25,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 25 ML,56118,CDM,250,RC,J3490,HCPCS,70860030125,NDC,facility,outpatient,25,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,inpatient,,,4574.00000,4345.30000,Amish/Mennonite,Amish Mennonite,,2515.70,,,,,,,2515.70,4436.78,percent of total billed charges,
DMSA TO 10 MCI,56119,CDM,343,RC,A9551,HCPCS,,,facility,outpatient,,,4574.00000,4345.30000,Amish/Mennonite,Amish Mennonite,,2515.70,,,,,,,970.83,4436.78,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,inpatient,10,EA,23.95000,22.76000,Amish/Mennonite,Amish Mennonite,,13.17,,,,,,,13.17,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,00006-3519-36,NDC,,,facility,outpatient,10,EA,23.95000,22.76000,Amish/Mennonite,Amish Mennonite,,13.17,,,,,,,11.97,23.23,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,inpatient,10,EA,10.74000,10.20000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,69315-0304-10,NDC,,,facility,outpatient,10,EA,10.74000,10.20000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.37,10.42,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,50383-0232-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,inpatient,10,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,70377-0081-11,NDC,,,facility,outpatient,10,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,inpatient,10,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
DORZOLAMIDE OPHTH SOL,56121,CDM,250,RC,72266-0197-01,NDC,,,facility,outpatient,10,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,inpatient,1,EA,1357.11000,1289.25000,Amish/Mennonite,Amish Mennonite,,746.41,,,,,,,746.41,1316.40,percent of total billed charges,
DINOPROSTONE SUPP 10 MG,56122,CDM,250,RC,55566-2800-01,NDC,,,facility,outpatient,1,EA,1357.11000,1289.25000,Amish/Mennonite,Amish Mennonite,,746.41,,,,,,,678.55,1316.40,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,inpatient,10,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097800,NDC,facility,outpatient,10,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.46480,1.15,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,inpatient,10,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00121097810,NDC,facility,outpatient,10,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,inpatient,10,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,69339015217,NDC,facility,outpatient,10,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,inpatient,10,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
DIPHENHYDRAMINE HCL 25MG,56123,CDM,250,RC,Q0163,HCPCS,00904674172,NDC,facility,outpatient,10,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,inpatient,5,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00409117101,NDC,facility,outpatient,5,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,inpatient,5,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641921710,NDC,facility,outpatient,5,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,inpatient,5,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,00641601310,NDC,facility,outpatient,5,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,inpatient,5,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,10019051079,NDC,facility,outpatient,5,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,inpatient,5,EA,1.77000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,17478093705,NDC,facility,outpatient,5,EA,1.77000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,inpatient,5,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,70860030105,NDC,facility,outpatient,5,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,inpatient,5,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 5 ML,56125,CDM,250,RC,J3590,HCPCS,55390056605,NDC,facility,outpatient,5,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,inpatient,1,EA,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00409229031,NDC,facility,outpatient,1,EA,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,1.02,5.33,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,inpatient,1,EA,3.70000,3.52000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641037625,NDC,facility,outpatient,1,EA,3.70000,3.52000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.02,3.59,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,inpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,00641628225,NDC,facility,outpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,inpatient,1,EA,9.51000,9.04000,Amish/Mennonite,Amish Mennonite,,5.23,,,,,,,5.23,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066401,NDC,facility,outpatient,1,EA,9.51000,9.04000,Amish/Mennonite,Amish Mennonite,,5.23,,,,,,,1.02,9.22,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,inpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,63323066416,NDC,facility,outpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.02,2.51,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,72485010125,NDC,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,1.02,4.91,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,inpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
DIPHENHYDRAMINE SOLN 50 MG/ML,56126,CDM,250,RC,J1200,HCPCS,76045010210,NDC,facility,outpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,1.02,7.97,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00378-3125-01,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97500,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,00904-7053-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,inpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,16714-0133-01,NDC,,,facility,outpatient,1,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,1.82,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,51079-0437-20,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,inpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
DOXEPIN CAP 25 MG,56127,CDM,250,RC,69238-1170-09,NDC,,,facility,outpatient,1,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97500,1.89,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,00904-6477-61,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,43547-0275-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,59762-0245-03,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,60687-0292-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62756-0440-83,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,inpatient,1,EA,48.51000,46.08000,Amish/Mennonite,Amish Mennonite,,26.68,,,,,,,26.68,47.05,percent of total billed charges,
DONEPEZIL TAB 5 MG,56128,CDM,250,RC,62856-0245-41,NDC,,,facility,outpatient,1,EA,48.51000,46.08000,Amish/Mennonite,Amish Mennonite,,26.68,,,,,,,24.25,47.05,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00338100702,NDC,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,1.18,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,inpatient,1,mL,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
DOPAMINE INJECTION,56129,CDM,250,RC,J1265,HCPCS,00409780922,NDC,facility,outpatient,1,mL,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,1.18,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,00904-1088-61,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
DIPYRIDAMOLE TAB 75 MG,56130,CDM,250,RC,51079-0070-20,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,inpatient,1,EA,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,11.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,00555-0701-02,NDC,,,facility,outpatient,1,EA,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,10.00,19.40,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,inpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,11.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,65162-0554-10,NDC,,,facility,outpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,10.01,19.41,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,inpatient,1,EA,19.92000,18.93000,Amish/Mennonite,Amish Mennonite,,10.96,,,,,,,10.96,19.32,percent of total billed charges,
DEMECLOCYCLINE TAB,56131,CDM,250,RC,62584-0159-01,NDC,,,facility,outpatient,1,EA,19.92000,18.93000,Amish/Mennonite,Amish Mennonite,,10.96,,,,,,,9.96,19.32,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,inpatient,,,173.44000,164.77000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,95.39,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,CPT,,,facility,outpatient,,,173.44000,164.77000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,47.59,168.24,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,inpatient,1,mL,346.88000,329.54000,Amish/Mennonite,Amish Mennonite,,190.78,,,,,,,190.78,336.47,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (INFANRIX),56132,CDM,250,RC,90700,HCPCS,58160081052,NDC,facility,outpatient,1,mL,346.88000,329.54000,Amish/Mennonite,Amish Mennonite,,190.78,,,,,,,47.59,336.47,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,00591-0411-50,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.29,6.37,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68382-0707-18,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,inpatient,1,EA,2.98000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,50268-0281-15,NDC,,,facility,outpatient,1,EA,2.98000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.49,2.89,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,60687-0716-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,63304-0616-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-21,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE CAP,56133,CDM,250,RC,68084-0743-32,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.35,4.57,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,inpatient,1,mL,301.66000,286.57000,Amish/Mennonite,Amish Mennonite,,165.91,,,,,,,165.91,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050220,NDC,facility,outpatient,1,mL,301.66000,286.57000,Amish/Mennonite,Amish Mennonite,,165.91,,,,,,,69.84,292.61,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,inpatient,1,mL,346.54000,329.21000,Amish/Mennonite,Amish Mennonite,,190.60,,,,,,,190.60,336.14,percent of total billed charges,
DARATUMUMAB INJECTION 7910290,56135,CDM,636,RC,J9145,HCPCS,57894050520,NDC,facility,outpatient,1,mL,346.54000,329.21000,Amish/Mennonite,Amish Mennonite,,190.60,,,,,,,69.84,336.14,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,132.00,232.80,percent of total billed charges,
MIL-DOPPLR VEL FETAL UMBIL ARTERY-TECH,56136,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,120.00,584.87,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,inpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,655.05,1155.27,percent of total billed charges,
DUP SCAN EXT VEIN UNI/LTD-TECH,56137,CDM,929,RC,93971,CPT,,,facility,outpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,TC,655.05,,,,,,,595.50,1155.27,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,inpatient,1,EA,9.92000,9.43000,Amish/Mennonite,Amish Mennonite,,5.46,,,,,,,5.46,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,00069-5810-61,NDC,,,facility,outpatient,1,EA,9.92000,9.43000,Amish/Mennonite,Amish Mennonite,,5.46,,,,,,,4.96,9.62,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,inpatient,1,EA,17.26000,16.40000,Amish/Mennonite,Amish Mennonite,,9.49,,,,,,,9.49,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,16714-0841-01,NDC,,,facility,outpatient,1,EA,17.26000,16.40000,Amish/Mennonite,Amish Mennonite,,9.49,,,,,,,8.63,16.74,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42291-0412-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,inpatient,1,EA,9.88000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,5.43,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,42794-0045-10,NDC,,,facility,outpatient,1,EA,9.88000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,4.94,9.58,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,51862-0025-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,59762-0038-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,69452-0132-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
DONEPEZIL TAB 250 MCG,56138,CDM,250,RC,72205-0040-60,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,24208-0486-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,inpatient,10,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,69315-0305-10,NDC,,,facility,outpatient,10,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,inpatient,10,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,70069-0051-01,NDC,,,facility,outpatient,10,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,inpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
DORZOLAMIDE-TIMOLOL SOLN-OPHTH 2%-0.5% 10 ML,56139,CDM,250,RC,71921-0226-10,NDC,,,facility,outpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,inpatient,1,EA,13.23000,12.57000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,7.28,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00074-6215-11,NDC,,,facility,outpatient,1,EA,13.23000,12.57000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,6.62,12.83,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00245-0182-89,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,68084-0782-01,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,00904-6861-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,51079-0475-08,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG EC,56140,CDM,250,RC,62756-0798-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,inpatient,,,1828.00000,1736.60000,Amish/Mennonite,Amish Mennonite,TC,1005.40,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN ABD PELV COMPLT-TECH,56141,CDM,920,RC,93975,CPT,,,facility,outpatient,,,1828.00000,1736.60000,Amish/Mennonite,Amish Mennonite,TC,1005.40,,,,,,,914.00,1773.16,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,18.06,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,16.42,31.85,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00069-5820-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,9.15,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,00904-6683-08,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,8.32,16.14,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,16714-0842-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,8.81,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,42291-0413-60,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,11.89,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,51862-0005-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,10.81,20.97,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,7.24,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,59762-0039-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,6.58,12.77,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72205-0041-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,9.69,17.09,percent of total billed charges,
DONEPEZIL TAB 500 MCG,56142,CDM,250,RC,72603-0132-01,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,8.81,17.09,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,79.75,140.65,percent of total billed charges,
DNA AB NATIVE/DOUBLE STRANDED-TECH,56143,CDM,300,RC,86225,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,13.74,713.01,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,inpatient,1,mL,118.72000,112.79000,Amish/Mennonite,Amish Mennonite,,65.30,,,,,,,65.30,115.16,percent of total billed charges,
DOLASETRON MESYLATE,56144,CDM,250,RC,J1260,HCPCS,00088120806,NDC,facility,outpatient,1,mL,118.72000,112.79000,Amish/Mennonite,Amish Mennonite,,65.30,,,,,,,59.36,115.16,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00378-1049-01,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,00904-7052-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,16714-0132-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,51079-0436-20,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,64980-0594-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
DOXEPIN CAP 10 MG,56145,CDM,250,RC,70756-0424-11,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,inpatient,3,EA,92.78000,88.14000,Amish/Mennonite,Amish Mennonite,,51.03,,,,,,,51.03,90.00,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,11098052603,NDC,facility,outpatient,3,EA,92.78000,88.14000,Amish/Mennonite,Amish Mennonite,,51.03,,,,,,,46.39,99.28,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,inpatient,3,EA,178.30000,169.38000,Amish/Mennonite,Amish Mennonite,,98.06,,,,,,,98.06,172.95,percent of total billed charges,
DIMERCAPROL SOLN 100 MG/ML 3 ML,56147,CDM,250,RC,J0470,HCPCS,17478052603,NDC,facility,outpatient,3,EA,178.30000,169.38000,Amish/Mennonite,Amish Mennonite,,98.06,,,,,,,89.15,172.95,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,478.13000,454.22000,Amish/Mennonite,Amish Mennonite,,262.97,,,,,,,262.97,463.79,percent of total billed charges,
BIT DRL L125MM DIA2.7MM QC NS FOR UNIV SM FRAG SYS,56148,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,478.13000,454.22000,Amish/Mennonite,Amish Mennonite,,262.97,,,,,,,239.06,463.79,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
DRUG TESTS PRSMTV INSTRMNT-TECH,56151,CDM,300,RC,80306,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,17.14,797.91,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
EAR - REMOVAL LOCATION-TECH,56152,CDM,361,RC,69200,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,3163.00,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
DIPHTHERIA AB-TECH,56153,CDM,300,RC,86648,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,8.17,797.91,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00182-1113-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1247-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-1248-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00536-4086-01,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5512-61,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-5643-61,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,00904-7440-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,10135-0669-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,49348-0156-19,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,51645-0850-99,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0304-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0455-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-06,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,57896-0555-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,60687-0622-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-02,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,63739-0432-10,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,67618-0310-60,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,69618-0049-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70000-0526-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0042-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
DOCUSATE-SENNA TAB,56154,CDM,250,RC,70677-0083-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,inpatient,1,EA,18.61000,17.68000,Amish/Mennonite,Amish Mennonite,,10.24,,,,,,,10.24,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00074-7126-11,NDC,,,facility,outpatient,1,EA,18.61000,17.68000,Amish/Mennonite,Amish Mennonite,,10.24,,,,,,,9.30,18.05,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,inpatient,1,EA,7.97000,7.57000,Amish/Mennonite,Amish Mennonite,,4.38,,,,,,,4.38,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-45,NDC,,,facility,outpatient,1,EA,7.97000,7.57000,Amish/Mennonite,Amish Mennonite,,4.38,,,,,,,3.98,7.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.58,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-6364-61,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.25,6.31,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,00904-7182-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,16714-0485-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,50268-0260-13,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,inpatient,1,EA,10.30000,9.79000,Amish/Mennonite,Amish Mennonite,,5.67,,,,,,,5.67,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,51079-0767-08,NDC,,,facility,outpatient,1,EA,10.30000,9.79000,Amish/Mennonite,Amish Mennonite,,5.67,,,,,,,5.15,9.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65162-0757-10,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,65862-0595-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,inpatient,1,EA,6.91000,6.57000,Amish/Mennonite,Amish Mennonite,,3.80,,,,,,,3.80,6.70,percent of total billed charges,
DIVALPROEX SODIUM TAB 500 MG ER,56155,CDM,250,RC,68084-0415-01,NDC,,,facility,outpatient,1,EA,6.91000,6.57000,Amish/Mennonite,Amish Mennonite,,3.80,,,,,,,3.46,6.70,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,inpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,TC,149.05,,,,,,,149.05,262.87,percent of total billed charges,
DPLR ECHO PULSE LTD/FU-TECH,56156,CDM,483,RC,93321,CPT,,,facility,outpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,TC,149.05,,,,,,,135.50,262.87,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,inpatient,1,EA,34.68000,32.94000,Amish/Mennonite,Amish Mennonite,,19.07,,,,,,,19.07,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-10,NDC,,,facility,outpatient,1,EA,34.68000,32.94000,Amish/Mennonite,Amish Mennonite,,19.07,,,,,,,17.34,33.64,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,inpatient,1,EA,42.03000,39.93000,Amish/Mennonite,Amish Mennonite,,23.12,,,,,,,23.12,40.77,percent of total billed charges,
DRONEDARONE TAB,56158,CDM,250,RC,00024-4142-60,NDC,,,facility,outpatient,1,EA,42.03000,39.93000,Amish/Mennonite,Amish Mennonite,,23.12,,,,,,,21.02,40.77,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,00904-5523-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,50268-0223-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,inpatient,1,EA,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-01,NDC,,,facility,outpatient,1,EA,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,inpatient,1,EA,9.90000,9.40000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,5.45,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,51079-0958-20,NDC,,,facility,outpatient,1,EA,9.90000,9.40000,Amish/Mennonite,Amish Mennonite,,5.45,,,,,,,4.95,9.60,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68084-0851-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
DOXAZOSIN TAB 2 MG,56159,CDM,250,RC,68382-0784-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,inpatient,1,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00143211250,NDC,facility,outpatient,1,EA,3.55000,3.37000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.77,3.44,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,inpatient,1,EA,6.90000,6.56000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,00904043006,NDC,facility,outpatient,1,EA,6.90000,6.56000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,27808023401,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,42806031250,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069301,NDC,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,inpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,62584069321,NDC,facility,outpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.75,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,inpatient,1,EA,7.51000,7.13000,Amish/Mennonite,Amish Mennonite,,4.13,,,,,,,4.13,7.28,percent of total billed charges,
DOXYCYCLINE HYCLATE TAB 100 MG,56160,CDM,250,RC,J8499,HCPCS,63739016833,NDC,facility,outpatient,1,EA,7.51000,7.13000,Amish/Mennonite,Amish Mennonite,,4.13,,,,,,,3.75,7.28,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,inpatient,,,1034.00000,982.30000,Amish/Mennonite,Amish Mennonite,TC,568.70,,,,,,,568.70,1002.98,percent of total billed charges,
DUP SCAN HEMO ACCESS-TECH,56161,CDM,920,RC,93990,CPT,,,facility,outpatient,,,1034.00000,982.30000,Amish/Mennonite,Amish Mennonite,TC,568.70,,,,,,,517.00,1002.98,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,inpatient,1,EA,22.50000,21.37000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,12.38,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00002-3235-60,NDC,,,facility,outpatient,1,EA,22.50000,21.37000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,11.25,21.82,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.79,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-6452-61,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.54,4.92,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,inpatient,1,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.53,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,00904-7043-04,NDC,,,facility,outpatient,1,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.30,4.46,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,47335-0381-86,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0269-15,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,inpatient,1,EA,4.15000,3.95000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,50268-0286-15,NDC,,,facility,outpatient,1,EA,4.15000,3.95000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.08,4.03,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,57237-0017-60,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.41,percent of total billed charges,
DULOXETINE CAP 20 MG,56162,CDM,250,RC,68084-0675-21,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.41,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,inpatient,,,2031.00000,1929.45000,Amish/Mennonite,Amish Mennonite,TC,1117.05,,,,,,,1117.05,1970.07,percent of total billed charges,
DUP SCAN EXTCR ART COMPL BI-TECH,56163,CDM,920,RC,93880,CPT,,,facility,outpatient,,,2031.00000,1929.45000,Amish/Mennonite,Amish Mennonite,TC,1117.05,,,,,,,1015.50,1970.07,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,inpatient,1,EA,107.57000,102.19000,Amish/Mennonite,Amish Mennonite,,59.16,,,,,,,59.16,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00078046791,NDC,facility,outpatient,1,EA,107.57000,102.19000,Amish/Mennonite,Amish Mennonite,,59.16,,,,,,,12.72,104.34,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,inpatient,1,EA,29.74000,28.25000,Amish/Mennonite,Amish Mennonite,,16.36,,,,,,,16.36,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,00409233610,NDC,facility,outpatient,1,EA,29.74000,28.25000,Amish/Mennonite,Amish Mennonite,,16.36,,,,,,,12.72,28.85,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,47781062307,NDC,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,12.72,38.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,inpatient,1,EA,70.42000,66.90000,Amish/Mennonite,Amish Mennonite,,38.73,,,,,,,38.73,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,60505623606,NDC,facility,outpatient,1,EA,70.42000,66.90000,Amish/Mennonite,Amish Mennonite,,38.73,,,,,,,12.72,68.31,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,inpatient,1,EA,40.92000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,22.51,39.69,percent of total billed charges,
DEFEROXAMINE MESYLATE INJ,56164,CDM,250,RC,J0895,HCPCS,63323059710,NDC,facility,outpatient,1,EA,40.92000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,12.72,39.69,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,Amish/Mennonite,Amish Mennonite,TC,2340.80,,,,,,,2340.80,4128.32,percent of total billed charges,
ECHO TEE FOR MONITORING-TECH,56165,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,Amish/Mennonite,Amish Mennonite,TC,2340.80,,,,,,,2128.00,4128.32,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,inpatient,1,EA,20.26000,19.25000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,11.14,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,00173-0712-15,NDC,,,facility,outpatient,1,EA,20.26000,19.25000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,10.13,19.65,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,31722-0131-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-09,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,42806-0549-30,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,50268-0282-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.50,2.92,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,63629-1223-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
DUTASTERIDE CAP,56166,CDM,250,RC,65162-0750-09,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,inpatient,,,1568.00000,1489.60000,Amish/Mennonite,Amish Mennonite,TC,862.40,,,,,,,862.40,1520.96,percent of total billed charges,
DUP SCAN LWR EXT ART UNI/LTD-TECH,56167,CDM,920,RC,93926,CPT,,,facility,outpatient,,,1568.00000,1489.60000,Amish/Mennonite,Amish Mennonite,TC,862.40,,,,,,,784.00,1520.96,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,TC,191.95,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY APPENDICULAR-TECH,56168,CDM,320,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,TC,191.95,,,,,,,114.83,1213.27,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
EAR LAVAGE REQ INSTRUMENTATION-TECH,56170,CDM,361,RC,,,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,5271.00,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,inpatient,1,EA,5.68000,5.40000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-11,NDC,,,facility,outpatient,1,EA,5.68000,5.40000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.84,5.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,inpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.94,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00074-6114-13,NDC,,,facility,outpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.67,5.19,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,inpatient,1,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,00904-6615-61,NDC,,,facility,outpatient,1,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.74,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,27241-0115-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,50268-0258-13,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.67,3.24,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,55111-0532-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,inpatient,1,EA,2.65000,2.51000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68084-0313-01,NDC,,,facility,outpatient,1,EA,2.65000,2.51000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
DIVALPROEX SODIUM TAB 125 MG EC,56171,CDM,250,RC,68382-0106-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,Amish/Mennonite,Amish Mennonite,,7.50,,,,,,,7.50,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3237-33,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,Amish/Mennonite,Amish Mennonite,,7.50,,,,,,,6.82,13.22,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00002-3270-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-6368-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,inpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,00904-7045-61,NDC,,,facility,outpatient,1,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.51,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,57237-0019-30,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 60 MG,56172,CDM,250,RC,68084-0692-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,00093-0318-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,50228-0481-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,51079-0745-20,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0562-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
DILTIAZEM CAP 30 MG,56173,CDM,250,RC,60687-0717-01,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,inpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,18.06,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-43,NDC,,,facility,outpatient,1,EA,32.84000,31.20000,Amish/Mennonite,Amish Mennonite,,18.06,,,,,,,16.42,31.85,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00069-5800-61,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,inpatient,1,EA,16.31000,15.50000,Amish/Mennonite,Amish Mennonite,,8.97,,,,,,,8.97,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-6681-08,NDC,,,facility,outpatient,1,EA,16.31000,15.50000,Amish/Mennonite,Amish Mennonite,,8.97,,,,,,,8.15,15.82,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,inpatient,1,EA,14.62000,13.88000,Amish/Mennonite,Amish Mennonite,,8.04,,,,,,,8.04,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,00904-7522-08,NDC,,,facility,outpatient,1,EA,14.62000,13.88000,Amish/Mennonite,Amish Mennonite,,8.04,,,,,,,7.31,14.18,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,16714-0840-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,8.48,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,42291-0411-60,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59651-0118-60,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,inpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,11.89,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,51862-0125-60,NDC,,,facility,outpatient,1,EA,21.62000,20.54000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,10.81,20.97,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,inpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,7.24,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,59762-0037-02,NDC,,,facility,outpatient,1,EA,13.17000,12.51000,Amish/Mennonite,Amish Mennonite,,7.24,,,,,,,6.58,12.77,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,69452-0131-17,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72205-0039-60,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,inpatient,1,EA,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,9.33,16.46,percent of total billed charges,
DOFETILIDE CAP 125 MCG,56174,CDM,250,RC,72603-0130-01,NDC,,,facility,outpatient,1,EA,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,8.48,16.46,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,inpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,TC,701.80,,,,,,,701.80,1237.72,percent of total billed charges,
DUP SCAN UPR EXT ART UNI/LTD-TECH,56175,CDM,920,RC,93931,CPT,,,facility,outpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,TC,701.80,,,,,,,638.00,1237.72,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1828.00000,1736.60000,Amish/Mennonite,Amish Mennonite,TC,1005.40,,,,,,,1005.40,1773.16,percent of total billed charges,
DUP SCAN EXT VEIN BIL-TECH,56176,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1828.00000,1736.60000,Amish/Mennonite,Amish Mennonite,TC,1005.40,,,,,,,914.00,1773.16,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,227.15,400.61,percent of total billed charges,
DTPA-AEROSOL,56177,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,33.63,400.61,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,inpatient,1,EA,10.60000,10.07000,Amish/Mennonite,Amish Mennonite,,5.83,,,,,,,5.83,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-11,NDC,,,facility,outpatient,1,EA,10.60000,10.07000,Amish/Mennonite,Amish Mennonite,,5.83,,,,,,,5.30,10.28,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.51,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00074-3826-13,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.01,9.72,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,inpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.65,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-45,NDC,,,facility,outpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.40,4.67,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,inpatient,1,EA,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,00904-6363-61,NDC,,,facility,outpatient,1,EA,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.04,3.96,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,50268-0259-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,51079-0766-08,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.10,6.02,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,65862-0594-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.56,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0310-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.33,4.51,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-01,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.09,5.99,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
DIVALPROEX SODIUM TAB 250 MG ER,56178,CDM,250,RC,68084-0316-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,inpatient,,,484.00000,459.80000,Amish/Mennonite,Amish Mennonite,,266.20,,,,,,,266.20,469.48,percent of total billed charges,
ECHO TEE PROBE PLACE ONLY-TECH,56179,CDM,483,RC,93313,CPT,,,facility,outpatient,,,484.00000,459.80000,Amish/Mennonite,Amish Mennonite,,266.20,,,,,,,242.00,572.69,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,inpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,216.31,percent of total billed charges,
EBV VIRAL CAPSID-TECH,56180,CDM,300,RC,86665,CPT,,,facility,outpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,18.14,950.66,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,inpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,1004.85,1772.19,percent of total billed charges,
DUP SCAN LWR EXT ART BIL-TECH,56181,CDM,920,RC,93925,CPT,,,facility,outpatient,,,1827.00000,1735.65000,Amish/Mennonite,Amish Mennonite,TC,1004.85,,,,,,,913.50,1772.19,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,inpatient,,,455.00000,432.25000,Amish/Mennonite,Amish Mennonite,TC,250.25,,,,,,,250.25,441.35,percent of total billed charges,
DXA BN DENSITY AXIAL & VERT FX-TECH,56182,CDM,320,RC,77085,CPT,,,facility,outpatient,,,455.00000,432.25000,Amish/Mennonite,Amish Mennonite,TC,250.25,,,,,,,201.46,2123.08,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,inpatient,,,586.00000,556.70000,Amish/Mennonite,Amish Mennonite,TC,322.30,,,,,,,322.30,568.42,percent of total billed charges,
ECHOGRAPHY INTRAOPERATIVE-TECH,56183,CDM,402,RC,76998,CPT,,,facility,outpatient,,,586.00000,556.70000,Amish/Mennonite,Amish Mennonite,TC,322.30,,,,,,,247.28,568.42,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,inpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,94.05,165.87,percent of total billed charges,
ELECTRONIC CROSSMATCH CHG ONLY-TECH,56184,CDM,300,RC,86923,CPT,,,facility,outpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,85.50,1375.13,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,inpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,1007.60,1777.04,percent of total billed charges,
DUP SCAN UPR EXT ART BILAT-TECH,56185,CDM,920,RC,93930,CPT,,,facility,outpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,916.00,1777.04,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,inpatient,1,mL,209.51000,199.03000,Amish/Mennonite,Amish Mennonite,,115.23,,,,,,,115.23,203.22,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00338008001,NDC,facility,outpatient,1,mL,209.51000,199.03000,Amish/Mennonite,Amish Mennonite,,115.23,,,,,,,104.75,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,inpatient,1,mL,188.56000,179.13000,Amish/Mennonite,Amish Mennonite,,103.71,,,,,,,103.71,182.90,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,00574093010,NDC,facility,outpatient,1,mL,188.56000,179.13000,Amish/Mennonite,Amish Mennonite,,103.71,,,,,,,94.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,inpatient,1,mL,244.90000,232.66000,Amish/Mennonite,Amish Mennonite,,134.69,,,,,,,134.69,237.55,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598028335,NDC,facility,outpatient,1,mL,244.90000,232.66000,Amish/Mennonite,Amish Mennonite,,134.69,,,,,,,109.28,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,inpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,78.21,137.93,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,43598068235,NDC,facility,outpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,71.10,249.68,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,inpatient,1,mL,306.20000,290.89000,Amish/Mennonite,Amish Mennonite,,168.41,,,,,,,168.41,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,72603010301,NDC,facility,outpatient,1,mL,306.20000,290.89000,Amish/Mennonite,Amish Mennonite,,168.41,,,,,,,109.28,297.01,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,inpatient,1,mL,323.48000,307.31000,Amish/Mennonite,Amish Mennonite,,177.91,,,,,,,177.91,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,59676096001,NDC,facility,outpatient,1,mL,323.48000,307.31000,Amish/Mennonite,Amish Mennonite,,177.91,,,,,,,109.28,313.78,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,inpatient,1,mL,214.34000,203.63000,Amish/Mennonite,Amish Mennonite,,117.89,,,,,,,117.89,207.91,percent of total billed charges,
DOXORUBICIN LIPOSOMAL 2 MG/ML 10 ML,56186,CDM,636,RC,Q2050,HCPCS,70710153001,NDC,facility,outpatient,1,mL,214.34000,203.63000,Amish/Mennonite,Amish Mennonite,,117.89,,,,,,,107.17,249.68,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
EBV EARLY ANTIGEN-TECH,56187,CDM,300,RC,86663,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,13.12,679.08,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,inpatient,,,742.00000,704.90000,Amish/Mennonite,Amish Mennonite,,408.10,,,,,,,408.10,719.74,percent of total billed charges,
ED VISIT LEVEL 3-TECH,56188,CDM,450,RC,99283,CPT,,,facility,outpatient,,,742.00000,704.90000,Amish/Mennonite,Amish Mennonite,,408.10,,,,,,,262.92,1172.00,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,inpatient,,,1496.00000,1421.20000,Amish/Mennonite,Amish Mennonite,TC,822.80,,,,,,,822.80,1451.12,percent of total billed charges,
DUP SCAN ABD PELV LTD-TECH,56190,CDM,920,RC,93976,CPT,,,facility,outpatient,,,1496.00000,1421.20000,Amish/Mennonite,Amish Mennonite,TC,822.80,,,,,,,748.00,1451.12,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,inpatient,,,3333.00000,3166.35000,Amish/Mennonite,Amish Mennonite,TC,1833.15,,,,,,,1833.15,3233.01,percent of total billed charges,
ECHO 2D W/STRESS-TECH,56191,CDM,483,RC,93350,CPT,,,facility,outpatient,,,3333.00000,3166.35000,Amish/Mennonite,Amish Mennonite,TC,1833.15,,,,,,,1666.50,3233.01,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,99.00,174.60,percent of total billed charges,
EBV NUCLEAR ANTIGEN-TECH,56192,CDM,300,RC,86664,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,15.29,797.91,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,163.90,289.06,percent of total billed charges,
DXA VERTEBRAL FX ASSESSMENT-TECH,56194,CDM,320,RC,77086,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,135.13,1430.78,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,inpatient,,,2546.00000,2418.70000,Amish/Mennonite,Amish Mennonite,TC,1400.30,,,,,,,1400.30,2469.62,percent of total billed charges,
ECHO TRANSESOPHAGEAL-TECH,56195,CDM,483,RC,93312,CPT,,,facility,outpatient,,,2546.00000,2418.70000,Amish/Mennonite,Amish Mennonite,TC,1400.30,,,,,,,1273.00,2469.62,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,inpatient,,,2109.00000,2003.55000,Amish/Mennonite,Amish Mennonite,,1159.95,,,,,,,1159.95,2045.73,percent of total billed charges,
ED VISIT LEVEL 5-TECH,56196,CDM,450,RC,99285,CPT,,,facility,outpatient,,,2109.00000,2003.55000,Amish/Mennonite,Amish Mennonite,,1159.95,,,,,,,582.16,3515.00,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
ENCEPHALITIS WESTERN EQUINE AB-TECH,56197,CDM,300,RC,86654,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,8.17,696.05,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,inpatient,,,2224.00000,2112.80000,Amish/Mennonite,Amish Mennonite,TC,1223.20,,,,,,,1223.20,2157.28,percent of total billed charges,
ELECTRON MICROSCOPY DIAGNOSTIC-TECH,56198,CDM,310,RC,88348,CPT,,,facility,outpatient,,,2224.00000,2112.80000,Amish/Mennonite,Amish Mennonite,TC,1223.20,,,,,,,1112.00,14719.32,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,TC,281.60,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL-TECH,56199,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,TC,281.60,,,,,,,151.73,1628.59,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,675.40,1191.16,percent of total billed charges,
ECHO 2D FOLLOW-UP/LIMITED-TECH,56200,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,614.00,1191.16,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,inpatient,1,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,24200009650,NDC,facility,outpatient,1,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.26,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,inpatient,1,EA,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,6.03,10.64,percent of total billed charges,
EPHEDRINE SYRINGE 5 MG/ML 10 ML,56201,CDM,250,RC,J3490,HCPCS,70092145546,NDC,facility,outpatient,1,EA,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,5.49,10.64,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,inpatient,1,EA,5030.77000,4779.23000,Amish/Mennonite,Amish Mennonite,,2766.92,,,,,,,2766.92,4879.85,percent of total billed charges,
ELOTUZUMAB INJ 300 MG,56202,CDM,636,RC,J9176,HCPCS,00003229111,NDC,facility,outpatient,1,EA,5030.77000,4779.23000,Amish/Mennonite,Amish Mennonite,,2766.92,,,,,,,7.88,4879.85,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS EASTERN EQUINE AB-TECH,56205,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,8.17,696.05,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,inpatient,,,544.00000,516.80000,Amish/Mennonite,Amish Mennonite,,299.20,,,,,,,299.20,527.68,percent of total billed charges,
ECHO TEE CONG PROBE PLACE-TECH,56206,CDM,483,RC,93316,CPT,,,facility,outpatient,,,544.00000,516.80000,Amish/Mennonite,Amish Mennonite,,299.20,,,,,,,272.00,572.69,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1160.00000,1102.00000,Amish/Mennonite,Amish Mennonite,,638.00,,,,,,,638.00,1125.20,percent of total billed charges,
ED VISIT LEVEL 4-TECH,56207,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1160.00000,1102.00000,Amish/Mennonite,Amish Mennonite,,638.00,,,,,,,404.33,3515.00,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,inpatient,,,2660.00000,2527.00000,Amish/Mennonite,Amish Mennonite,,1463.00,,,,,,,1463.00,2580.20,percent of total billed charges,
EGFR GENE COMMON VARIANTS-TECH,56208,CDM,310,RC,81235,CPT,,,facility,outpatient,,,2660.00000,2527.00000,Amish/Mennonite,Amish Mennonite,,1463.00,,,,,,,264.01,15261.97,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,16714-0534-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.68,3.25,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,inpatient,1,EA,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,3.39,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,60687-0719-25,NDC,,,facility,outpatient,1,EA,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,3.08,5.98,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,inpatient,1,EA,150.45000,142.92000,Amish/Mennonite,Amish Mennonite,,82.75,,,,,,,82.75,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,61958-0701-01,NDC,,,facility,outpatient,1,EA,150.45000,142.92000,Amish/Mennonite,Amish Mennonite,,82.75,,,,,,,75.22,145.94,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
EMTRICITABINE-TENOFOVIR TAB,56209,CDM,250,RC,65862-0354-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,inpatient,1,EA,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,12.63,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-33,NDC,,,facility,outpatient,1,EA,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,11.48,22.28,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,inpatient,1,EA,25.25000,23.99000,Amish/Mennonite,Amish Mennonite,,13.89,,,,,,,13.89,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00002-3240-30,NDC,,,facility,outpatient,1,EA,25.25000,23.99000,Amish/Mennonite,Amish Mennonite,,13.89,,,,,,,12.62,24.49,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,inpatient,1,EA,4.30000,4.08000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00228-2891-03,NDC,,,facility,outpatient,1,EA,4.30000,4.08000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.15,4.17,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,inpatient,1,EA,4.54000,4.31000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.50,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-6367-61,NDC,,,facility,outpatient,1,EA,4.54000,4.31000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.27,4.40,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,00904-7044-61,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.12,4.10,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,51991-0747-90,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,47335-0382-83,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,inpatient,1,EA,3.30000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0270-13,NDC,,,facility,outpatient,1,EA,3.30000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.20,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,50268-0287-13,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.75,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,8.20,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,55111-0609-30,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,7.45,14.45,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,57237-0018-90,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
DULOXETINE CAP 30 MG,56210,CDM,250,RC,68084-0683-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
ELEC STIM OTHR THAN WOUND-TECH,56211,CDM,420,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,inpatient,1,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048731,NDC,facility,outpatient,1,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,inpatient,1,mL,1.25000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 30 ML",56212,CDM,250,RC,J2004,HCPCS,63323048737,NDC,facility,outpatient,1,mL,1.25000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,00904-5610-61,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,16714-0444-02,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,51672-4245-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ENALAPRIL TAB 10 MG,56213,CDM,250,RC,68084-0391-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,,87.06,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY FECES-TECH,56215,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,,87.06,,,,,,,79.15,153.55,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,inpatient,1,EA,79.03000,75.08000,Amish/Mennonite,Amish Mennonite,,43.47,,,,,,,43.47,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00641623825,NDC,facility,outpatient,1,EA,79.03000,75.08000,Amish/Mennonite,Amish Mennonite,,43.47,,,,,,,39.52,76.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,inpatient,1,EA,89.66000,85.18000,Amish/Mennonite,Amish Mennonite,,49.31,,,,,,,49.31,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,00781326995,NDC,facility,outpatient,1,EA,89.66000,85.18000,Amish/Mennonite,Amish Mennonite,,49.31,,,,,,,44.83,86.97,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,inpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,14789001401,NDC,facility,outpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,23.70,45.98,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,inpatient,1,EA,115.04000,109.28000,Amish/Mennonite,Amish Mennonite,,63.27,,,,,,,63.27,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,16714003710,NDC,facility,outpatient,1,EA,115.04000,109.28000,Amish/Mennonite,Amish Mennonite,,63.27,,,,,,,57.52,111.59,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,inpatient,1,EA,62.15000,59.05000,Amish/Mennonite,Amish Mennonite,,34.18,,,,,,,34.18,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478041510,NDC,facility,outpatient,1,EA,62.15000,59.05000,Amish/Mennonite,Amish Mennonite,,34.18,,,,,,,31.07,60.29,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,inpatient,1,EA,138.98000,132.03000,Amish/Mennonite,Amish Mennonite,,76.44,,,,,,,76.44,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478051500,NDC,facility,outpatient,1,EA,138.98000,132.03000,Amish/Mennonite,Amish Mennonite,,76.44,,,,,,,69.49,134.81,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,inpatient,1,EA,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,60.83,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,17478095510,NDC,facility,outpatient,1,EA,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,55.30,107.28,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,inpatient,1,EA,91.77000,87.18000,Amish/Mennonite,Amish Mennonite,,50.47,,,,,,,50.47,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,42023021625,NDC,facility,outpatient,1,EA,91.77000,87.18000,Amish/Mennonite,Amish Mennonite,,50.47,,,,,,,45.88,89.02,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,inpatient,1,EA,48.66000,46.23000,Amish/Mennonite,Amish Mennonite,,26.76,,,,,,,26.76,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,43598072525,NDC,facility,outpatient,1,EA,48.66000,46.23000,Amish/Mennonite,Amish Mennonite,,26.76,,,,,,,24.33,47.20,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,inpatient,1,EA,32.58000,30.95000,Amish/Mennonite,Amish Mennonite,,17.92,,,,,,,17.92,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,51754420004,NDC,facility,outpatient,1,EA,32.58000,30.95000,Amish/Mennonite,Amish Mennonite,,17.92,,,,,,,16.29,31.60,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,inpatient,1,EA,24.62000,23.39000,Amish/Mennonite,Amish Mennonite,,13.54,,,,,,,13.54,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,65219025701,NDC,facility,outpatient,1,EA,24.62000,23.39000,Amish/Mennonite,Amish Mennonite,,13.54,,,,,,,12.31,23.88,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000801,NDC,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,inpatient,1,EA,32.90000,31.26000,Amish/Mennonite,Amish Mennonite,,18.09,,,,,,,18.09,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,66758000802,NDC,facility,outpatient,1,EA,32.90000,31.26000,Amish/Mennonite,Amish Mennonite,,18.09,,,,,,,16.45,31.91,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,inpatient,1,EA,35.20000,33.44000,Amish/Mennonite,Amish Mennonite,,19.36,,,,,,,19.36,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,70756061125,NDC,facility,outpatient,1,EA,35.20000,33.44000,Amish/Mennonite,Amish Mennonite,,19.36,,,,,,,17.60,34.14,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,inpatient,1,EA,59.44000,56.47000,Amish/Mennonite,Amish Mennonite,,32.69,,,,,,,32.69,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,72603020325,NDC,facility,outpatient,1,EA,59.44000,56.47000,Amish/Mennonite,Amish Mennonite,,32.69,,,,,,,29.72,57.66,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,inpatient,1,EA,87.82000,83.43000,Amish/Mennonite,Amish Mennonite,,48.30,,,,,,,48.30,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000525,NDC,facility,outpatient,1,EA,87.82000,83.43000,Amish/Mennonite,Amish Mennonite,,48.30,,,,,,,43.91,85.19,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
EPHEDRINE SOLN 50 MG/ML,56216,CDM,250,RC,J3490,HCPCS,76014000530,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,inpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,TC,168.85,,,,,,,168.85,297.79,percent of total billed charges,
DPLR ECHO COLOR FLOW-TECH,56217,CDM,483,RC,93325,CPT,,,facility,outpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,TC,168.85,,,,,,,153.50,297.79,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,inpatient,1,EA,6707.63000,6372.25000,Amish/Mennonite,Amish Mennonite,,3689.20,,,,,,,3689.20,6506.40,percent of total billed charges,
ELOTUZUMAB INJ 400 MG,56218,CDM,636,RC,J9176,HCPCS,00003452211,NDC,facility,outpatient,1,EA,6707.63000,6372.25000,Amish/Mennonite,Amish Mennonite,,3689.20,,,,,,,7.88,6506.40,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,inpatient,,,188.00000,178.60000,Amish/Mennonite,Amish Mennonite,,103.40,,,,,,,103.40,182.36,percent of total billed charges,
EHRLICHIOSIS ANTIBODY-TECH,56219,CDM,300,RC,87798,CPT,,,facility,outpatient,,,188.00000,178.60000,Amish/Mennonite,Amish Mennonite,,103.40,,,,,,,35.09,1833.46,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
ENCEPHALITIS ST LOUIS AB-TECH,56220,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,8.17,696.05,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,inpatient,2,EA,11.29000,10.72000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,6.21,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00143978610,NDC,facility,outpatient,2,EA,11.29000,10.72000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,5.64,10.95,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,inpatient,2,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.53,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,00409212202,NDC,facility,outpatient,2,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.30,4.46,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,inpatient,2,EA,14.98000,14.23000,Amish/Mennonite,Amish Mennonite,,8.24,,,,,,,8.24,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,43598016958,NDC,facility,outpatient,2,EA,14.98000,14.23000,Amish/Mennonite,Amish Mennonite,,8.24,,,,,,,7.49,14.53,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,inpatient,2,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML 2 ML,56221,CDM,250,RC,J3490,HCPCS,55390001110,NDC,facility,outpatient,2,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,4.90,9.51,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHO 2D COMPLT W DPLR-TECH,56222,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1134.50,2200.93,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
DRUG TESTS PRSMTV CHEM ANLYZR-TECH,56224,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,62.14,3038.81,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,inpatient,20,mL,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,00409318301,NDC,facility,outpatient,20,mL,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,inpatient,20,mL,2.86000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  200,000 20 ML",56226,CDM,250,RC,J2004,HCPCS,63323048927,NDC,facility,outpatient,20,mL,2.86000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.77,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,inpatient,5,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048889,NDC,facility,outpatient,5,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,inpatient,5,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 10 ML",56227,CDM,250,RC,J2004,HCPCS,63323048817,NDC,facility,outpatient,5,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,inpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,212.85,375.39,percent of total billed charges,
ED VISIT LEVEL 2-TECH,56228,CDM,450,RC,99282,CPT,,,facility,outpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,150.37,585.00,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,inpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL-LABOR AND DELIVERY-TECH,56229,CDM,720,RC,,,,,facility,outpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,407.50,790.55,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,inpatient,1,EA,26.39000,25.07000,Amish/Mennonite,Amish Mennonite,,14.51,,,,,,,14.51,25.60,percent of total billed charges,
EPINEPHRINE SOL 1  1000,56230,CDM,250,RC,42023-0103-01,NDC,,,facility,outpatient,1,EA,26.39000,25.07000,Amish/Mennonite,Amish Mennonite,,14.51,,,,,,,13.20,25.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,inpatient,1,mL,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,00409318203,NDC,facility,outpatient,1,mL,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,inpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 50 ML",56231,CDM,250,RC,J2004,HCPCS,63323048357,NDC,facility,outpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
ED VISIT LEVEL 1-TECH,56234,CDM,450,RC,99281,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,83.61,585.00,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502010102,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,1.13,376.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,inpatient,1,EA,511.80000,486.21000,Amish/Mennonite,Amish Mennonite,,281.49,,,,,,,281.49,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,00115169549,NDC,facility,outpatient,1,EA,511.80000,486.21000,Amish/Mennonite,Amish Mennonite,,281.49,,,,,,,1.13,496.45,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,inpatient,1,EA,260.67000,247.63000,Amish/Mennonite,Amish Mennonite,,143.37,,,,,,,143.37,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050101,NDC,facility,outpatient,1,EA,260.67000,247.63000,Amish/Mennonite,Amish Mennonite,,143.37,,,,,,,1.13,252.85,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,inpatient,1,EA,788.15000,748.74000,Amish/Mennonite,Amish Mennonite,,433.48,,,,,,,433.48,764.51,percent of total billed charges,
EPINEPHRINE SOLN 0.15 MG INJ KIT,56236,CDM,250,RC,J0171,HCPCS,49502050102,NDC,facility,outpatient,1,EA,788.15000,748.74000,Amish/Mennonite,Amish Mennonite,,433.48,,,,,,,1.13,764.51,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,inpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2216.50,3909.10,percent of total billed charges,
ECHO TEE CONGENITAL-TECH,56237,CDM,483,RC,93315,CPT,,,facility,outpatient,,,4030.00000,3828.50000,Amish/Mennonite,Amish Mennonite,TC,2216.50,,,,,,,2015.00,3909.10,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,inpatient,1,EA,59.06000,56.11000,Amish/Mennonite,Amish Mennonite,,32.48,,,,,,,32.48,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00173051700,NDC,facility,outpatient,1,EA,59.06000,56.11000,Amish/Mennonite,Amish Mennonite,,32.48,,,,,,,24.92,57.29,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,inpatient,1,EA,51.19000,48.63000,Amish/Mennonite,Amish Mennonite,,28.15,,,,,,,28.15,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,00703198501,NDC,facility,outpatient,1,EA,51.19000,48.63000,Amish/Mennonite,Amish Mennonite,,28.15,,,,,,,24.92,49.65,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,inpatient,1,EA,74.01000,70.31000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,40.71,71.79,percent of total billed charges,
EPOPROSTENOL POWD 0.5 MG,56239,CDM,250,RC,J1325,HCPCS,66215040301,NDC,facility,outpatient,1,EA,74.01000,70.31000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,24.92,71.79,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,inpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,25021020325,NDC,facility,outpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,2.50,7.35,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,inpatient,1,mL,12.05000,11.44000,Amish/Mennonite,Amish Mennonite,,6.63,,,,,,,6.63,11.69,percent of total billed charges,
EPIRUBICIN HCL INJECTION 2MG,56240,CDM,250,RC,J9178,HCPCS,63323015125,NDC,facility,outpatient,1,mL,12.05000,11.44000,Amish/Mennonite,Amish Mennonite,,6.63,,,,,,,2.50,11.69,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,inpatient,1,EA,8.14000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.48,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,00024-0392-02,NDC,,,facility,outpatient,1,EA,8.14000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.07,7.90,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,inpatient,1,EA,3.84000,3.64000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50111-0990-01,NDC,,,facility,outpatient,1,EA,3.84000,3.64000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,3.72,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,inpatient,1,EA,4.08000,3.87000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,42291-0266-01,NDC,,,facility,outpatient,1,EA,4.08000,3.87000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.04,3.96,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,50268-0297-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64380-0737-06,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,64980-0157-01,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
ERGOCALCIFEROL CAP,56243,CDM,250,RC,69452-0151-20,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,58.85,103.79,percent of total billed charges,
ELECTROLYTE PANEL-TECH,56244,CDM,300,RC,80051,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,7.01,373.51,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,inpatient,1,EA,142.64000,135.51000,Amish/Mennonite,Amish Mennonite,,78.45,,,,,,,78.45,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,00173051900,NDC,facility,outpatient,1,EA,142.64000,135.51000,Amish/Mennonite,Amish Mennonite,,78.45,,,,,,,24.92,138.36,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,inpatient,1,EA,146.56000,139.23000,Amish/Mennonite,Amish Mennonite,,80.61,,,,,,,80.61,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,62756006040,NDC,facility,outpatient,1,EA,146.56000,139.23000,Amish/Mennonite,Amish Mennonite,,80.61,,,,,,,24.92,142.16,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,inpatient,1,EA,148.01000,140.61000,Amish/Mennonite,Amish Mennonite,,81.41,,,,,,,81.41,143.57,percent of total billed charges,
EPOPROSTENOL POWD 1.5 MG,56245,CDM,250,RC,J1325,HCPCS,66215040201,NDC,facility,outpatient,1,EA,148.01000,140.61000,Amish/Mennonite,Amish Mennonite,,81.41,,,,,,,24.92,143.57,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,inpatient,1,mL,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.8 ML",56246,CDM,250,RC,J2004,HCPCS,58472003250,NDC,facility,outpatient,1,mL,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,00074-6320-13,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.61,5.06,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-03,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,inpatient,1,EA,29.28000,27.81000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,16.10,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,24338-0124-13,NDC,,,facility,outpatient,1,EA,29.28000,27.81000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,14.64,28.40,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,inpatient,1,EA,19.85000,18.86000,Amish/Mennonite,Amish Mennonite,,10.92,,,,,,,10.92,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,52536-0183-03,NDC,,,facility,outpatient,1,EA,19.85000,18.86000,Amish/Mennonite,Amish Mennonite,,10.92,,,,,,,9.93,19.25,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,inpatient,1,EA,26.70000,25.37000,Amish/Mennonite,Amish Mennonite,,14.69,,,,,,,14.69,25.90,percent of total billed charges,
ERYTHROMYCIN TAB,56247,CDM,250,RC,69238-1472-03,NDC,,,facility,outpatient,1,EA,26.70000,25.37000,Amish/Mennonite,Amish Mennonite,,14.69,,,,,,,13.35,25.90,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,inpatient,1,mL,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069303420,NDC,facility,outpatient,1,mL,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,45963073360,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,inpatient,1,mL,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.47,4.36,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00069403701,NDC,facility,outpatient,1,mL,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.25,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,00143937201,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,inpatient,1,mL,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,16714000101,NDC,facility,outpatient,1,mL,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,5.23,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,inpatient,1,mL,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 100 ML (MDV),56249,CDM,250,RC,J9000,HCPCS,25021020751,NDC,facility,outpatient,1,mL,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.10,5.23,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,inpatient,10,EA,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 2% -1  200,000 10 ML",56250,CDM,250,RC,J2004,HCPCS,63323048917,NDC,facility,outpatient,10,EA,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,inpatient,1,EA,121.79000,115.70000,Amish/Mennonite,Amish Mennonite,,66.98,,,,,,,66.98,118.14,percent of total billed charges,
EPIRUBICIN HCL INJECTION 50MG,56251,CDM,250,RC,J9178,HCPCS,61703034735,NDC,facility,outpatient,1,EA,121.79000,115.70000,Amish/Mennonite,Amish Mennonite,,66.98,,,,,,,2.50,118.14,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,inpatient,1,EA,36.03000,34.23000,Amish/Mennonite,Amish Mennonite,,19.82,,,,,,,19.82,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-01,NDC,,,facility,outpatient,1,EA,36.03000,34.23000,Amish/Mennonite,Amish Mennonite,,19.82,,,,,,,18.02,34.95,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,inpatient,1,EA,27.49000,26.11000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,15.12,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00025-1710-03,NDC,,,facility,outpatient,1,EA,27.49000,26.11000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,13.74,26.67,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,inpatient,1,EA,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,6.03,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,00185-5368-30,NDC,,,facility,outpatient,1,EA,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,5.49,10.64,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-02,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,16729-0293-15,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,31722-0049-30,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
EPLERENONE TAB,56252,CDM,250,RC,59762-1710-01,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,4.90,9.51,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
EKG 12 LEAD TRACING ONLY-TECH,56254,CDM,730,RC,93005,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,49.50,96.03,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
EHRLICHIA ANTIBODY-TECH,56255,CDM,300,RC,86666,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,526.26,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,inpatient,10,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,00641296545,NDC,facility,outpatient,10,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,0.43710,3.22,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,inpatient,10,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,10019012039,NDC,facility,outpatient,10,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,0.43710,3.72,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,25021031410,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.43710,1.53,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,inpatient,10,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,55150019410,NDC,facility,outpatient,10,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.43710,1.35,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,inpatient,10,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,63323065210,NDC,facility,outpatient,10,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,0.43710,4.83,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,inpatient,10,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018200,NDC,facility,outpatient,10,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,inpatient,10,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ESMOLOL SOLN-INJ 10 MG/ML 10 ML,56256,CDM,250,RC,J1805,HCPCS,67457018210,NDC,facility,outpatient,10,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.43710,2.14,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,inpatient,1,mL,1825.95000,1734.65000,Amish/Mennonite,Amish Mennonite,,1004.27,,,,,,,1004.27,1771.17,percent of total billed charges,
ERIBULIN MESYLATE INJECTION,56257,CDM,636,RC,J9179,HCPCS,62856038901,NDC,facility,outpatient,1,mL,1825.95000,1734.65000,Amish/Mennonite,Amish Mennonite,,1004.27,,,,,,,104.58,1771.17,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5040-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 40 MG,56258,CDM,250,RC,00186-5042-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,12.46,24.18,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
ERYTHROPOIETIN ASSAY-TECH,56259,CDM,300,RC,82668,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,18.79,984.66,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,00904-5502-61,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,16714-0443-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,23155-0705-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,51079-0951-20,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,inpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRIL TAB 5 MG,56260,CDM,250,RC,64679-0924-02,NDC,,,facility,outpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
ESTRADIOL ASSAY-TECH,56261,CDM,300,RC,82670,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,27.94,1459.96,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,inpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409000710,NDC,facility,outpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,inpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,00409317801,NDC,facility,outpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,inpatient,20,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048226,NDC,facility,outpatient,20,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,inpatient,20,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 20 ML",56262,CDM,250,RC,J2004,HCPCS,63323048227,NDC,facility,outpatient,20,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,inpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,,,facility,outpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.00,15.24,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,inpatient,1,EA,333.23000,316.57000,Amish/Mennonite,Amish Mennonite,,183.28,,,,,,,183.28,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384371,NDC,facility,outpatient,1,EA,333.23000,316.57000,Amish/Mennonite,Amish Mennonite,,183.28,,,,,,,14.23,323.23,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,inpatient,1,EA,349.86000,332.36000,Amish/Mennonite,Amish Mennonite,,192.42,,,,,,,192.42,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,00006384571,NDC,facility,outpatient,1,EA,349.86000,332.36000,Amish/Mennonite,Amish Mennonite,,192.42,,,,,,,14.23,339.36,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028209,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,14.23,122.61,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,inpatient,1,EA,274.88000,261.14000,Amish/Mennonite,Amish Mennonite,,151.18,,,,,,,151.18,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,16714088910,NDC,facility,outpatient,1,EA,274.88000,261.14000,Amish/Mennonite,Amish Mennonite,,151.18,,,,,,,14.23,266.63,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,inpatient,1,EA,303.21000,288.05000,Amish/Mennonite,Amish Mennonite,,166.77,,,,,,,166.77,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,60505619604,NDC,facility,outpatient,1,EA,303.21000,288.05000,Amish/Mennonite,Amish Mennonite,,166.77,,,,,,,14.23,294.11,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,inpatient,1,EA,359.49000,341.52000,Amish/Mennonite,Amish Mennonite,,197.72,,,,,,,197.72,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,44567082010,NDC,facility,outpatient,1,EA,359.49000,341.52000,Amish/Mennonite,Amish Mennonite,,197.72,,,,,,,14.23,348.71,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,inpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
ERTAPENEM POWD-INJ 1 GM,56263,CDM,250,RC,J1335,HCPCS,55150028220,NDC,facility,outpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,14.23,183.91,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,inpatient,1,EA,22.90000,21.75000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,12.60,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,00574-4024-50,NDC,,,facility,outpatient,1,EA,22.90000,21.75000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,11.45,22.21,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,inpatient,1,EA,25.83000,24.54000,Amish/Mennonite,Amish Mennonite,,14.21,,,,,,,14.21,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,17478-0070-31,NDC,,,facility,outpatient,1,EA,25.83000,24.54000,Amish/Mennonite,Amish Mennonite,,14.21,,,,,,,12.91,25.06,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,inpatient,1,EA,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,17.26,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,24208-0910-19,NDC,,,facility,outpatient,1,EA,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,15.69,30.44,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,inpatient,1,EA,47.49000,45.11000,Amish/Mennonite,Amish Mennonite,,26.12,,,,,,,26.12,46.07,percent of total billed charges,
ERYTHROMYCIN OINT-OPHTH 0.5% 1 GM UD,56264,CDM,250,RC,72485-0670-31,NDC,,,facility,outpatient,1,EA,47.49000,45.11000,Amish/Mennonite,Amish Mennonite,,26.12,,,,,,,23.75,46.07,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,inpatient,1,EA,33.11000,31.46000,Amish/Mennonite,Amish Mennonite,,18.21,,,,,,,18.21,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-01,NDC,,,facility,outpatient,1,EA,33.11000,31.46000,Amish/Mennonite,Amish Mennonite,,18.21,,,,,,,16.55,32.12,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,inpatient,1,EA,24.04000,22.84000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,13.22,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00456-2010-63,NDC,,,facility,outpatient,1,EA,24.04000,22.84000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,12.02,23.32,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,00904-6426-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,inpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,51079-0543-20,NDC,,,facility,outpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
ESCITALOPRAM TAB,56266,CDM,250,RC,68084-0617-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,inpatient,57,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,70501-0013-00,NDC,,,facility,outpatient,57,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,inpatient,57,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
EMOLLIENT CREAM 60 GM (EQV-EUCERIN),56267,CDM,250,RC,72140-0038-68,NDC,,,facility,outpatient,57,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,inpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,,87.06,,,,,,,87.06,153.55,percent of total billed charges,
ELECTRON MICROSCOPY BODY FLUID-TECH,56268,CDM,300,RC,87999,CPT,,,facility,outpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,,87.06,,,,,,,79.15,153.55,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,inpatient,50,EA,7.45000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,4.10,7.23,percent of total billed charges,
PETROLATUM OINT 50 GM (EQV-AQUAPHOR),56269,CDM,250,RC,72140-0452-31,NDC,,,facility,outpatient,50,EA,7.45000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,3.73,7.23,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,inpatient,1,GM,13.52000,12.84000,Amish/Mennonite,Amish Mennonite,,7.44,,,,,,,7.44,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,00574-4024-35,NDC,,,facility,outpatient,1,GM,13.52000,12.84000,Amish/Mennonite,Amish Mennonite,,7.44,,,,,,,6.76,13.11,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,inpatient,1,GM,13.47000,12.80000,Amish/Mennonite,Amish Mennonite,,7.41,,,,,,,7.41,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,17478-0070-35,NDC,,,facility,outpatient,1,GM,13.47000,12.80000,Amish/Mennonite,Amish Mennonite,,7.41,,,,,,,6.74,13.07,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,inpatient,1,GM,13.72000,13.04000,Amish/Mennonite,Amish Mennonite,,7.55,,,,,,,7.55,13.31,percent of total billed charges,
ERYTHROMYCIN OPHTH OINT 7735152,56270,CDM,250,RC,24208-0910-55,NDC,,,facility,outpatient,1,GM,13.72000,13.04000,Amish/Mennonite,Amish Mennonite,,7.55,,,,,,,6.86,13.31,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,inpatient,,,189.00000,179.55000,Amish/Mennonite,Amish Mennonite,,103.95,,,,,,,103.95,183.33,percent of total billed charges,
EXTRACT NUC AG EA AB-TECH,56271,CDM,300,RC,86235,CPT,,,facility,outpatient,,,189.00000,179.55000,Amish/Mennonite,Amish Mennonite,,103.95,,,,,,,17.93,933.70,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,inpatient,1,mL,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019005561,NDC,facility,outpatient,1,mL,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,0.43710,5.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,inpatient,1,mL,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067010,NDC,facility,outpatient,1,mL,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.43710,1.73,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,10019067210,NDC,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.43710,1.84,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,inpatient,1,mL,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,25021030884,NDC,facility,outpatient,1,mL,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,0.43710,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,inpatient,1,mL,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,44567045010,NDC,facility,outpatient,1,mL,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.43710,1.13,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,inpatient,1,mL,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.96,percent of total billed charges,
ESMOLOL 2500 MG/NS 250 ML PREMIX,56272,CDM,250,RC,J1805,HCPCS,67457065725,NDC,facility,outpatient,1,mL,4.08000,3.88000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,0.43710,3.96,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR XII ASSAY-TECH,56273,CDM,300,RC,85280,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,19.35,1018.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,inpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409014710,NDC,facility,outpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,inpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,00409318201,NDC,facility,outpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,inpatient,20,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 20 ML",56274,CDM,250,RC,J2004,HCPCS,63323048327,NDC,facility,outpatient,20,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,63.80,112.52,percent of total billed charges,
ESTRIOL ASSAY-TECH,56275,CDM,300,RC,82677,CPT,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,24.18,1256.24,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,00378-1454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,51862-0333-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
ESTRADIOL TAB,56276,CDM,250,RC,42806-0088-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,inpatient,20,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143931110,NDC,facility,outpatient,20,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,inpatient,20,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00143950710,NDC,facility,outpatient,20,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,inpatient,20,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409669502,NDC,facility,outpatient,20,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,inpatient,20,EA,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.47,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,00409806029,NDC,facility,outpatient,20,EA,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.25,4.36,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,inpatient,20,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,65219044720,NDC,facility,outpatient,20,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,inpatient,20,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,67457090320,NDC,facility,outpatient,20,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,inpatient,20,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 20 ML,56277,CDM,250,RC,J3490,HCPCS,72266014710,NDC,facility,outpatient,20,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
FACTOR INHIBITOR TEST-TECH,56278,CDM,300,RC,85335,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,12.87,679.08,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,inpatient,,,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,90,104.28,,,,,,,104.28,183.91,percent of total billed charges,
ETHOSUXIMIDE ASSAY SO -TECH,56279,CDM,300,RC,80168,CPT,,,facility,outpatient,,,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,90,104.28,,,,,,,16.88,848.80,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,inpatient,1,EA,240.56000,228.53000,Amish/Mennonite,Amish Mennonite,,132.31,,,,,,,132.31,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409647644,NDC,facility,outpatient,1,EA,240.56000,228.53000,Amish/Mennonite,Amish Mennonite,,132.31,,,,,,,102.24,233.34,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,inpatient,1,EA,287.19000,272.83000,Amish/Mennonite,Amish Mennonite,,157.95,,,,,,,157.95,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,00409648201,NDC,facility,outpatient,1,EA,287.19000,272.83000,Amish/Mennonite,Amish Mennonite,,157.95,,,,,,,102.24,278.57,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,inpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,284.90,502.46,percent of total billed charges,
ERYTHROMYCIN POWD-INJ 500 MG,56280,CDM,250,RC,J1364,HCPCS,14789011605,NDC,facility,outpatient,1,EA,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,102.24,502.46,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-02,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,inpatient,1,mL,10.74000,10.20000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-03,NDC,,,facility,outpatient,1,mL,10.74000,10.20000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.37,10.42,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,inpatient,1,mL,11.65000,11.07000,Amish/Mennonite,Amish Mennonite,,6.41,,,,,,,6.41,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-04,NDC,,,facility,outpatient,1,mL,11.65000,11.07000,Amish/Mennonite,Amish Mennonite,,6.41,,,,,,,5.83,11.30,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
ETHYL CHLORIDE SPRAY,56281,CDM,250,RC,00386-0001-11,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,inpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,50.05,88.27,percent of total billed charges,
EVACUATION SUBUNGUAL HEMA-TECH,56282,CDM,361,RC,11740,CPT,,,facility,outpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,50.05,3163.00,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,inpatient,10,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00143931010,NDC,facility,outpatient,10,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,inpatient,10,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,00409669501,NDC,facility,outpatient,10,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,inpatient,10,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,25021067410,NDC,facility,outpatient,10,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,inpatient,10,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,65219044510,NDC,facility,outpatient,10,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,inpatient,10,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.92,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,55390076210,NDC,facility,outpatient,10,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.75,3.39,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,inpatient,10,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,72266014610,NDC,facility,outpatient,10,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,inpatient,10,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
ETOMIDATE SOLN 2 MG/ML 10 ML,56283,CDM,250,RC,J3490,HCPCS,68382054507,NDC,facility,outpatient,10,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,inpatient,1,EA,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5020-31,NDC,,,facility,outpatient,1,EA,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,inpatient,1,EA,24.93000,23.69000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,13.71,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,00186-5022-28,NDC,,,facility,outpatient,1,EA,24.93000,23.69000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,12.46,24.18,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
ESOMEPRAZOLE CAP 20 MG,56285,CDM,250,RC,70069-0814-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,16714-0244-01,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.13,6.07,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,31722-0063-31,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,inpatient,1,mL,12.40000,11.78000,Amish/Mennonite,Amish Mennonite,,6.82,,,,,,,6.82,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,65649-0211-24,NDC,,,facility,outpatient,1,mL,12.40000,11.78000,Amish/Mennonite,Amish Mennonite,,6.82,,,,,,,6.20,12.03,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68180-0150-01,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.61,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,68382-0444-05,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.19,8.13,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70377-0113-11,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,inpatient,1,mL,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
FAMOTIDINE POWDER,56286,CDM,250,RC,70954-0316-10,NDC,,,facility,outpatient,1,mL,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,inpatient,1,mL,1384.36000,1315.14000,Amish/Mennonite,Amish Mennonite,,761.40,,,,,,,761.40,1342.83,percent of total billed charges,
"EPOETIN ALFA SOLN 20,000 UNITS/ML MDV",56287,CDM,636,RC,J0885,HCPCS,59676032004,NDC,facility,outpatient,1,mL,1384.36000,1315.14000,Amish/Mennonite,Amish Mennonite,,761.40,,,,,,,7.68,1342.83,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,inpatient,100,EA,89.81000,85.32000,Amish/Mennonite,Amish Mennonite,,49.40,,,,,,,49.40,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0148-48,NDC,,,facility,outpatient,100,EA,89.81000,85.32000,Amish/Mennonite,Amish Mennonite,,49.40,,,,,,,44.91,87.12,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,inpatient,100,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,61553-0844-48,NDC,,,facility,outpatient,100,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,inpatient,100,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-1259-75,NDC,,,facility,outpatient,100,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,inpatient,100,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.21,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-7259-75,NDC,,,facility,outpatient,100,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.10,2.13,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,inpatient,100,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML CADD,56288,CDM,250,RC,70092-9259-75,NDC,,,facility,outpatient,100,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.23,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,inpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,147.40,259.96,percent of total billed charges,
FACTOR X ASSAY-TECH,56289,CDM,300,RC,85260,CPT,,,facility,outpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,17.90,933.70,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,inpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,180.95,319.13,percent of total billed charges,
EXTRNL CEPHALIC VER W/WO TOC-TECH,56290,CDM,720,RC,59412,CPT,,,facility,outpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,164.50,3321.00,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,inpatient,,,475.00000,451.25000,Amish/Mennonite,Amish Mennonite,,261.25,,,,,,,261.25,460.75,percent of total billed charges,
F2 GENE 20210G>A VARIANT-TECH,56291,CDM,310,RC,81240,CPT,,,facility,outpatient,,,475.00000,451.25000,Amish/Mennonite,Amish Mennonite,,261.25,,,,,,,53.70,3089.77,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,inpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.25,percent of total billed charges,
ETODOLAC CAP 400 MG,56292,CDM,250,RC,51672-4018-01,NDC,,,facility,outpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.68,3.25,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,inpatient,,,598.00000,568.10000,Amish/Mennonite,Amish Mennonite,,328.90,,,,,,,328.90,580.06,percent of total billed charges,
F5 GENE LEIDEN VARIANT-TECH,56293,CDM,310,RC,81241,CPT,,,facility,outpatient,,,598.00000,568.10000,Amish/Mennonite,Amish Mennonite,,328.90,,,,,,,66.70,3446.25,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,inpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,00409318101,NDC,facility,outpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,inpatient,1,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048831,NDC,facility,outpatient,1,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,inpatient,1,mL,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 30 ML",56294,CDM,250,RC,J2004,HCPCS,63323048837,NDC,facility,outpatient,1,mL,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,inpatient,250,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LIPID EMULSION 20% 250 ML (NUTRILIPID),56295,CDM,250,RC,J3490,HCPCS,00264446030,NDC,facility,outpatient,250,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,inpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,211.46,percent of total billed charges,
FACTOR VII ASSAY-TECH,56296,CDM,300,RC,85230,CPT,,,facility,outpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,17.90,933.70,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,inpatient,,,233.00000,221.35000,Amish/Mennonite,Amish Mennonite,,128.15,,,,,,,128.15,226.01,percent of total billed charges,
FACTOR V ASSAY-TECH,56298,CDM,300,RC,85220,CPT,,,facility,outpatient,,,233.00000,221.35000,Amish/Mennonite,Amish Mennonite,,128.15,,,,,,,17.65,916.73,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,inpatient,2,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00069012101,NDC,facility,outpatient,2,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,inpatient,2,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,67457045720,NDC,facility,outpatient,2,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,inpatient,2,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602201,NDC,facility,outpatient,2,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,inpatient,2,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,00641602225,NDC,facility,outpatient,2,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,inpatient,2,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004502,NDC,facility,outpatient,2,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,inpatient,2,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,10019004517,NDC,facility,outpatient,2,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,inpatient,2,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073912,NDC,facility,outpatient,2,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,inpatient,2,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,63323073916,NDC,facility,outpatient,2,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,inpatient,2,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 2 ML,56299,CDM,250,RC,J3490,HCPCS,70860075102,NDC,facility,outpatient,2,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
FACTOR VIII VWF ANTIGEN-TECH,56300,CDM,300,RC,85246,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,22.94,1205.34,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,inpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,90,115.33,,,,,,,115.33,203.41,percent of total billed charges,
FATTY ACID VERY LONG CHAIN-TECH,56301,CDM,300,RC,82726,CPT,,,facility,outpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,90,115.33,,,,,,,20.41,950.66,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,56.65,99.91,percent of total billed charges,
FACTOR VIII 1 STAGE ASSAY-TECH,56302,CDM,300,RC,85240,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,9.84,933.70,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,inpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,133.10,234.74,percent of total billed charges,
FACTOR VIII VWF RISTO COFACT-TECH,56303,CDM,300,RC,85245,CPT,,,facility,outpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,22.94,1205.34,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,inpatient,1,EA,48.88000,46.43000,Amish/Mennonite,Amish Mennonite,,26.88,,,,,,,26.88,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9119-16,NDC,,,facility,outpatient,1,EA,48.88000,46.43000,Amish/Mennonite,Amish Mennonite,,26.88,,,,,,,24.44,47.41,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,inpatient,1,EA,51.32000,48.76000,Amish/Mennonite,Amish Mennonite,,28.23,,,,,,,28.23,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,60505-7080-02,NDC,,,facility,outpatient,1,EA,51.32000,48.76000,Amish/Mennonite,Amish Mennonite,,28.23,,,,,,,25.66,49.78,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,inpatient,1,EA,30.07000,28.57000,Amish/Mennonite,Amish Mennonite,,16.54,,,,,,,16.54,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00378-9199-16,NDC,,,facility,outpatient,1,EA,30.07000,28.57000,Amish/Mennonite,Amish Mennonite,,16.54,,,,,,,15.04,29.17,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,inpatient,1,EA,34.89000,33.14000,Amish/Mennonite,Amish Mennonite,,19.19,,,,,,,19.19,33.84,percent of total billed charges,
FENTANYL PATCH 12 MCG/HR,56304,CDM,250,RC,00781-7109-55,NDC,,,facility,outpatient,1,EA,34.89000,33.14000,Amish/Mennonite,Amish Mennonite,,19.19,,,,,,,17.45,33.84,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00115-5522-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,inpatient,1,EA,8.50000,8.08000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.67,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,00904-7128-04,NDC,,,facility,outpatient,1,EA,8.50000,8.08000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.25,8.24,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,27241-0117-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,42858-0660-45,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,50268-0313-15,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.05,9.81,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,60219-5522-09,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,inpatient,1,EA,9.24000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,5.08,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,68084-0328-21,NDC,,,facility,outpatient,1,EA,9.24000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,4.62,8.96,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
FENOFIBRATE TAB 160 MG,56305,CDM,250,RC,71205-0949-30,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,inpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,,119.35,,,,,,,119.35,210.49,percent of total billed charges,
FACTOR XI ASSAY-TECH,56306,CDM,300,RC,85270,CPT,,,facility,outpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,,119.35,,,,,,,17.90,933.70,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,inpatient,8,EA,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.51,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,48783-0112-08,NDC,,,facility,outpatient,8,EA,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.19,6.19,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,inpatient,8,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,5.99,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP  8 ML (EQV-MONSEL'S),56307,CDM,250,RC,59365-6065-01,NDC,,,facility,outpatient,8,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.09,5.99,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,inpatient,,,315.40000,299.63000,Amish/Mennonite,Amish Mennonite,90,173.47,,,,,,,173.47,305.94,percent of total billed charges,
FACTOR VIII VWF MULTIMETRIC SO-TECH,56308,CDM,300,RC,85247,CPT,,,facility,outpatient,,,315.40000,299.63000,Amish/Mennonite,Amish Mennonite,90,173.47,,,,,,,23.70,1205.34,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,inpatient,50,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
FAMOTIDINE 20 MG/50 ML PREMIX,56309,CDM,636,RC,J3490,HCPCS,00338519741,NDC,facility,outpatient,50,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,inpatient,,,154.40000,146.68000,Amish/Mennonite,Amish Mennonite,90,84.92,,,,,,,84.92,149.77,percent of total billed charges,
FATTY ACID NONESTERIFIED-TECH,56310,CDM,300,RC,82725,CPT,,,facility,outpatient,,,154.40000,146.68000,Amish/Mennonite,Amish Mennonite,90,84.92,,,,,,,18.72,882.80,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,inpatient,1,EA,141.09000,134.04000,Amish/Mennonite,Amish Mennonite,,77.60,,,,,,,77.60,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,00186604001,NDC,facility,outpatient,1,EA,141.09000,134.04000,Amish/Mennonite,Amish Mennonite,,77.60,,,,,,,70.55,136.86,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,inpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,17478085010,NDC,facility,outpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,inpatient,1,EA,132.34000,125.72000,Amish/Mennonite,Amish Mennonite,,72.79,,,,,,,72.79,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050940,NDC,facility,outpatient,1,EA,132.34000,125.72000,Amish/Mennonite,Amish Mennonite,,72.79,,,,,,,66.17,128.37,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,inpatient,1,EA,110.28000,104.77000,Amish/Mennonite,Amish Mennonite,,60.65,,,,,,,60.65,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,47335050944,NDC,facility,outpatient,1,EA,110.28000,104.77000,Amish/Mennonite,Amish Mennonite,,60.65,,,,,,,55.14,106.97,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,inpatient,1,EA,109.02000,103.57000,Amish/Mennonite,Amish Mennonite,,59.96,,,,,,,59.96,105.75,percent of total billed charges,
ESOMEPRAZOLE POWD-INJ 40 MG,56311,CDM,250,RC,J3490,HCPCS,55150018505,NDC,facility,outpatient,1,EA,109.02000,103.57000,Amish/Mennonite,Amish Mennonite,,59.96,,,,,,,54.51,105.75,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,inpatient,1,EA,101.66000,96.57000,Amish/Mennonite,Amish Mennonite,,55.91,,,,,,,55.91,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,00378-9123-16,NDC,,,facility,outpatient,1,EA,101.66000,96.57000,Amish/Mennonite,Amish Mennonite,,55.91,,,,,,,50.83,98.61,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,inpatient,1,EA,63.26000,60.10000,Amish/Mennonite,Amish Mennonite,,34.79,,,,,,,34.79,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-18,NDC,,,facility,outpatient,1,EA,63.26000,60.10000,Amish/Mennonite,Amish Mennonite,,34.79,,,,,,,31.63,61.36,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,inpatient,1,EA,39.09000,37.13000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,21.50,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-00,NDC,,,facility,outpatient,1,EA,39.09000,37.13000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,19.55,37.92,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,inpatient,1,EA,39.10000,37.14000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,21.50,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7083-02,NDC,,,facility,outpatient,1,EA,39.10000,37.14000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,19.55,37.93,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,inpatient,1,EA,19.48000,18.51000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,10.71,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,60505-7008-80,NDC,,,facility,outpatient,1,EA,19.48000,18.51000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,9.74,18.90,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,inpatient,1,EA,40.92000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,22.51,39.69,percent of total billed charges,
FENTANYL PATCH 7111941,56312,CDM,250,RC,67767-0122-08,NDC,,,facility,outpatient,1,EA,40.92000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,20.46,39.69,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,inpatient,1,EA,321.99000,305.89000,Amish/Mennonite,Amish Mennonite,,177.09,,,,,,,177.09,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,00186-0451-28,NDC,,,facility,outpatient,1,EA,321.99000,305.89000,Amish/Mennonite,Amish Mennonite,,177.09,,,,,,,161.00,312.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,53489-0369-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,68462-0234-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
FELODIPINE TAB,56313,CDM,250,RC,51079-0467-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,inpatient,1,EA,3.74000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,16714-0591-01,NDC,,,facility,outpatient,1,EA,3.74000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.87,3.63,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00173-0249-56,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,00904-5922-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,59651-0438-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
DIGOXIN TAB 250 MCG,56314,CDM,250,RC,62584-0990-11,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,inpatient,50,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909441,NDC,facility,outpatient,50,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,inpatient,50,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00409909461,NDC,facility,outpatient,50,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,inpatient,50,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,00641603001,NDC,facility,outpatient,50,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,inpatient,50,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,10019003783,NDC,facility,outpatient,50,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,1.58,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,inpatient,50,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL CITRATE INJ 7633143,56318,CDM,250,RC,J3010,HCPCS,63323080650,NDC,facility,outpatient,50,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.58,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,inpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,221.10,389.94,percent of total billed charges,
EBV PCR QUAL BLOOD (EBVB)-TECH,56319,CDM,300,RC,87798,CPT,,,facility,outpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,35.09,1833.46,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60219-5511-09,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,42858-0454-45,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,inpatient,1,EA,4.16000,3.95000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,50268-0312-15,NDC,,,facility,outpatient,1,EA,4.16000,3.95000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,60687-0655-21,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,63304-0900-90,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68084-0827-25,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
FENOFIBRATE TAB 54 MG,56320,CDM,250,RC,68180-0231-09,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
FETAL LUNG LAMELLAR BODY COUNT-TECH,56321,CDM,300,RC,83664,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,6.82,984.66,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,inpatient,1,EA,22.53000,21.40000,Amish/Mennonite,Amish Mennonite,,12.39,,,,,,,12.39,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-18,NDC,,,facility,outpatient,1,EA,22.53000,21.40000,Amish/Mennonite,Amish Mennonite,,12.39,,,,,,,11.27,21.85,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,7.57,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,49884-0761-52,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,6.88,13.35,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,inpatient,1,EA,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.94,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7081-02,NDC,,,facility,outpatient,1,EA,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.21,14.00,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,60505-7011-02,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.03,9.75,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,inpatient,1,EA,14.84000,14.10000,Amish/Mennonite,Amish Mennonite,,8.16,,,,,,,8.16,14.39,percent of total billed charges,
FENTANYL PATCH 7110554,56322,CDM,250,RC,67767-0120-08,NDC,,,facility,outpatient,1,EA,14.84000,14.10000,Amish/Mennonite,Amish Mennonite,,8.16,,,,,,,7.42,14.39,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-29,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00603-0179-55,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7590-60,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,inpatient,1,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-60,NDC,,,facility,outpatient,1,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,00904-7591-61,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
FERROUS SULFATE TAB,56323,CDM,250,RC,57664-0070-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,inpatient,5,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909335,NDC,facility,outpatient,5,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,inpatient,5,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00409909425,NDC,facility,outpatient,5,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,inpatient,5,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602501,NDC,facility,outpatient,5,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,inpatient,5,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602510,NDC,facility,outpatient,5,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,inpatient,5,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602801,NDC,facility,outpatient,5,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,inpatient,5,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,00641602825,NDC,facility,outpatient,5,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,inpatient,5,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003372,NDC,facility,outpatient,5,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,inpatient,5,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003705,NDC,facility,outpatient,5,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,inpatient,5,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,10019003730,NDC,facility,outpatient,5,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,inpatient,5,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,17478003005,NDC,facility,outpatient,5,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,inpatient,5,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 5 ML,56324,CDM,250,RC,J3010,HCPCS,63323080605,NDC,facility,outpatient,5,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.58,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,inpatient,1,EA,87.08000,82.73000,Amish/Mennonite,Amish Mennonite,,47.89,,,,,,,47.89,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,47781-0428-47,NDC,,,facility,outpatient,1,EA,87.08000,82.73000,Amish/Mennonite,Amish Mennonite,,47.89,,,,,,,43.54,84.47,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,inpatient,1,EA,87.09000,82.74000,Amish/Mennonite,Amish Mennonite,,47.90,,,,,,,47.90,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00245-0423-89,NDC,,,facility,outpatient,1,EA,87.09000,82.74000,Amish/Mennonite,Amish Mennonite,,47.90,,,,,,,43.55,84.48,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,inpatient,1,EA,134.90000,128.16000,Amish/Mennonite,Amish Mennonite,,74.19,,,,,,,74.19,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00378-9124-16,NDC,,,facility,outpatient,1,EA,134.90000,128.16000,Amish/Mennonite,Amish Mennonite,,74.19,,,,,,,67.45,130.85,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,inpatient,1,EA,43.32000,41.16000,Amish/Mennonite,Amish Mennonite,,23.83,,,,,,,23.83,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,00406-9100-76,NDC,,,facility,outpatient,1,EA,43.32000,41.16000,Amish/Mennonite,Amish Mennonite,,23.83,,,,,,,21.66,42.02,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,inpatient,1,EA,61.30000,58.24000,Amish/Mennonite,Amish Mennonite,,33.72,,,,,,,33.72,59.46,percent of total billed charges,
FENTANYL PATCH 7110570,56325,CDM,250,RC,60505-7084-02,NDC,,,facility,outpatient,1,EA,61.30000,58.24000,Amish/Mennonite,Amish Mennonite,,33.72,,,,,,,30.65,59.46,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
EYE - REMOVAL LOCATION-TECH,56327,CDM,361,RC,,,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,5271.00,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
FERRITIN ASSAY-TECH,56329,CDM,300,RC,82728,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,13.63,713.01,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
FAT STAIN FECES/URINE/RESP-TECH,56330,CDM,300,RC,89125,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,5.88,271.65,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,inpatient,1,mL,99.43000,94.46000,Amish/Mennonite,Amish Mennonite,,54.69,,,,,,,54.69,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,00409020120,NDC,facility,outpatient,1,mL,99.43000,94.46000,Amish/Mennonite,Amish Mennonite,,54.69,,,,,,,0.60838,96.45,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,inpatient,1,mL,97.76000,92.87000,Amish/Mennonite,Amish Mennonite,,53.77,,,,,,,53.77,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,43066001001,NDC,facility,outpatient,1,mL,97.76000,92.87000,Amish/Mennonite,Amish Mennonite,,53.77,,,,,,,0.60838,94.83,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,67457053316,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,0.60838,61.30,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,inpatient,1,mL,113.48000,107.80000,Amish/Mennonite,Amish Mennonite,,62.41,,,,,,,62.41,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758005003,NDC,facility,outpatient,1,mL,113.48000,107.80000,Amish/Mennonite,Amish Mennonite,,62.41,,,,,,,0.60838,110.08,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,inpatient,1,mL,189.13000,179.67000,Amish/Mennonite,Amish Mennonite,,104.02,,,,,,,104.02,183.46,percent of total billed charges,
DOCETAXEL 160 MG/16 ML SOLN (MDV),56332,CDM,250,RC,J9171,HCPCS,66758095004,NDC,facility,outpatient,1,mL,189.13000,179.67000,Amish/Mennonite,Amish Mennonite,,104.02,,,,,,,0.60838,183.46,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
FIBRIN DEGRADATION AGLUTINATION-TECH,56333,CDM,300,RC,85362,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,6.89,356.54,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC-TECH,56335,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,360.00,4457.06,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,inpatient,,,256.60000,243.77000,Amish/Mennonite,Amish Mennonite,90,141.13,,,,,,,141.13,248.90,percent of total billed charges,
FIBROBLAST GROWTH FACTOR 23 (88662)-TECH,56336,CDM,300,RC,83520,CPT,,,facility,outpatient,,,256.60000,243.77000,Amish/Mennonite,Amish Mennonite,90,141.13,,,,,,,17.85,814.87,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,171.05,301.67,percent of total billed charges,
ENZYME ACTIVITY NON-RADIO EA-TECH,56337,CDM,300,RC,82657,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,22.17,1035.56,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,inpatient,1,mL,14.59000,13.86000,Amish/Mennonite,Amish Mennonite,,8.02,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 20 GM,56338,CDM,636,RC,J1572,HCPCS,61953000405,NDC,facility,outpatient,1,mL,14.59000,13.86000,Amish/Mennonite,Amish Mennonite,,8.02,,,,,,,7.29,73.49,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,inpatient,30,EA,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,00536-0650-85,NDC,,,facility,outpatient,30,EA,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,inpatient,30,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,50383-0778-16,NDC,,,facility,outpatient,30,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
FERROUS SULFATE ELIX,56339,CDM,250,RC,54838-0001-80,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,inpatient,1,mL,221.87000,210.78000,Amish/Mennonite,Amish Mennonite,,122.03,,,,,,,122.03,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,59338077501,NDC,facility,outpatient,1,mL,221.87000,210.78000,Amish/Mennonite,Amish Mennonite,,122.03,,,,,,,0.31000,215.21,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,inpatient,1,mL,221.86000,210.77000,Amish/Mennonite,Amish Mennonite,,122.02,,,,,,,122.02,215.20,percent of total billed charges,
FERUMOXYTOL SOLN 30 MG/ML 17 ML,56340,CDM,636,RC,Q0138,HCPCS,5933807750100100,NDC,facility,outpatient,1,mL,221.86000,210.77000,Amish/Mennonite,Amish Mennonite,,122.02,,,,,,,0.31000,215.20,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,60.50,106.70,percent of total billed charges,
"D-DIMER, QUANTITATIVE-TECH",56341,CDM,300,RC,85379,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,10.18,526.26,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,inpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,,312.40,,,,,,,312.40,550.96,percent of total billed charges,
FETAL FIBRONECTIN ASSAY-TECH,56342,CDM,300,RC,82731,CPT,,,facility,outpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,,312.40,,,,,,,64.41,3361.35,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,inpatient,1,EA,40.02000,38.02000,Amish/Mennonite,Amish Mennonite,,22.01,,,,,,,22.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,47781-0426-47,NDC,,,facility,outpatient,1,EA,40.02000,38.02000,Amish/Mennonite,Amish Mennonite,,22.01,,,,,,,20.01,38.82,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,inpatient,1,EA,30.97000,29.42000,Amish/Mennonite,Amish Mennonite,,17.03,,,,,,,17.03,30.04,percent of total billed charges,
FENTANYL PATCH 7110562,56343,CDM,250,RC,60505-7082-02,NDC,,,facility,outpatient,1,EA,30.97000,29.42000,Amish/Mennonite,Amish Mennonite,,17.03,,,,,,,15.48,30.04,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,187.00,329.80,percent of total billed charges,
FFP SNGL DONOR FRZN 8 HRS EA UNIT,56345,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,38.65,329.80,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,inpatient,2,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909332,NDC,facility,outpatient,2,EA,2.82000,2.68000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.30,2.74,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,inpatient,2,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00409909422,NDC,facility,outpatient,2,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,inpatient,2,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602410,NDC,facility,outpatient,2,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,inpatient,2,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,00641602725,NDC,facility,outpatient,2,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.30,3.26,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,inpatient,2,EA,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.51,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 2 ML,56346,CDM,250,RC,J3010,HCPCS,63323080602,NDC,facility,outpatient,2,EA,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.30,3.51,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,inpatient,,,964.00000,915.80000,Amish/Mennonite,Amish Mennonite,,530.20,,,,,,,530.20,935.08,percent of total billed charges,
FLOW CYTO INTERP 16+ MARKERS-TECH,56348,CDM,311,RC,88189,CPT,,,facility,outpatient,,,964.00000,915.80000,Amish/Mennonite,Amish Mennonite,,530.20,,,,,,,295.54,4230.40,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,00703301912,NDC,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,inpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,70700018922,NDC,facility,outpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,25021021599,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,inpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,62332077931,NDC,facility,outpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,inpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011761,NDC,facility,outpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,inpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 100 ML,56349,CDM,250,RC,J9190,HCPCS,63323011769,NDC,facility,outpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,3.67,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,inpatient,1,EA,66.55000,63.22000,Amish/Mennonite,Amish Mennonite,,36.60,,,,,,,36.60,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,00143938110,NDC,facility,outpatient,1,EA,66.55000,63.22000,Amish/Mennonite,Amish Mennonite,,36.60,,,,,,,33.27,64.55,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,inpatient,1,EA,73.10000,69.44000,Amish/Mennonite,Amish Mennonite,,40.20,,,,,,,40.20,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,16714064410,NDC,facility,outpatient,1,EA,73.10000,69.44000,Amish/Mennonite,Amish Mennonite,,40.20,,,,,,,36.55,70.91,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,inpatient,1,EA,38.24000,36.32000,Amish/Mennonite,Amish Mennonite,,21.03,,,,,,,21.03,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,55390011010,NDC,facility,outpatient,1,EA,38.24000,36.32000,Amish/Mennonite,Amish Mennonite,,21.03,,,,,,,19.12,37.09,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,inpatient,1,EA,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,45.76,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013011,NDC,facility,outpatient,1,EA,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,41.60,80.70,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,inpatient,1,EA,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,36.50,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,63323013017,NDC,facility,outpatient,1,EA,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,33.18,64.37,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,inpatient,1,EA,52.68000,50.05000,Amish/Mennonite,Amish Mennonite,,28.97,,,,,,,28.97,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,67457043710,NDC,facility,outpatient,1,EA,52.68000,50.05000,Amish/Mennonite,Amish Mennonite,,28.97,,,,,,,26.34,51.10,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,inpatient,1,EA,76.35000,72.53000,Amish/Mennonite,Amish Mennonite,,41.99,,,,,,,41.99,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,68382091010,NDC,facility,outpatient,1,EA,76.35000,72.53000,Amish/Mennonite,Amish Mennonite,,41.99,,,,,,,38.17,74.06,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,inpatient,1,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,27.81,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,71288003021,NDC,facility,outpatient,1,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,25.28,49.04,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,inpatient,1,EA,46.36000,44.04000,Amish/Mennonite,Amish Mennonite,,25.50,,,,,,,25.50,44.97,percent of total billed charges,
DOXYCYCLINE POWD-INJ 100 MG/10 ML,56350,CDM,250,RC,J3490,HCPCS,72266023705,NDC,facility,outpatient,1,EA,46.36000,44.04000,Amish/Mennonite,Amish Mennonite,,25.50,,,,,,,23.18,44.97,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00074-3189-90,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,inpatient,1,EA,2.06000,1.96000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,00378-3066-77,NDC,,,facility,outpatient,1,EA,2.06000,1.96000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.03,2.00,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,inpatient,1,EA,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,4.05,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,60687-0629-21,NDC,,,facility,outpatient,1,EA,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,3.69,7.15,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,inpatient,1,EA,10.43000,9.90000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.74,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,68084-0636-25,NDC,,,facility,outpatient,1,EA,10.43000,9.90000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.21,10.12,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
FENOFIBRATE TAB 145 MG,56352,CDM,250,RC,69097-0458-05,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,inpatient,30,EA,7.68000,7.29000,Amish/Mennonite,Amish Mennonite,,4.22,,,,,,,4.22,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1253-02,NDC,,,facility,outpatient,30,EA,7.68000,7.29000,Amish/Mennonite,Amish Mennonite,,4.22,,,,,,,3.84,7.45,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,inpatient,30,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
FLUOCINONIDE TOPICAL CREAM,56353,CDM,250,RC,51672-1386-02,NDC,,,facility,outpatient,30,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,inpatient,1,mL,281.66000,267.58000,Amish/Mennonite,Amish Mennonite,,154.91,,,,,,,154.91,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,25021024202,NDC,facility,outpatient,1,mL,281.66000,267.58000,Amish/Mennonite,Amish Mennonite,,154.91,,,,,,,71.65,273.21,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,inpatient,1,mL,171.83000,163.23000,Amish/Mennonite,Amish Mennonite,,94.51,,,,,,,94.51,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,45963062151,NDC,facility,outpatient,1,mL,171.83000,163.23000,Amish/Mennonite,Amish Mennonite,,94.51,,,,,,,71.65,166.68,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,inpatient,1,mL,352.08000,334.48000,Amish/Mennonite,Amish Mennonite,,193.64,,,,,,,193.64,341.52,percent of total billed charges,
FLUDARABINE PHOSPHATE INJ,56354,CDM,250,RC,J9185,HCPCS,63323019202,NDC,facility,outpatient,1,mL,352.08000,334.48000,Amish/Mennonite,Amish Mennonite,,193.64,,,,,,,71.65,341.52,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
FOLIC ACID SERUM ASSAY-TECH,56355,CDM,300,RC,82746,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,14.70,763.98,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-19,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00093-4356-93,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,00904-7346-61,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,16714-0721-02,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,50111-0648-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,51079-0971-20,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,68084-0605-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUOXETINE CAP 7216088,56356,CDM,250,RC,71205-0975-72,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,108.90,192.06,percent of total billed charges,
FETAL LUNG MATURITY TDX-TECH,56357,CDM,300,RC,83663,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,13.65,984.66,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,inpatient,1,mL,12.47000,11.85000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 5 GM,56358,CDM,636,RC,J1572,HCPCS,61953000408,NDC,facility,outpatient,1,mL,12.47000,11.85000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,6.24,73.49,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,inpatient,1,mL,12.47000,11.85000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,6.86,12.10,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 10 GM,56359,CDM,636,RC,J1572,HCPCS,61953000409,NDC,facility,outpatient,1,mL,12.47000,11.85000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,6.24,73.49,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,inpatient,100,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00338604648,NDC,facility,outpatient,100,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,inpatient,100,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468818,NDC,facility,outpatient,100,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,inpatient,100,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00409468823,NDC,facility,outpatient,100,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,00703101909,NDC,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,inpatient,100,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018466,NDC,facility,outpatient,100,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,inpatient,100,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,25021018482,NDC,facility,outpatient,100,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,70655000206,NDC,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,inpatient,100,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,36000000210,NDC,facility,outpatient,100,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,5.94,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,inpatient,100,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
FLUCONAZOLE,56360,CDM,250,RC,J1450,HCPCS,55390001201,NDC,facility,outpatient,100,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,5.94,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,65162-0641-10,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
FLECAINIDE TAB 7910575,56361,CDM,250,RC,62559-0380-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00591-3713-30,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.71500,1.39,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.64,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00781-5690-31,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.31,6.41,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,inpatient,1,EA,34.79000,33.05000,Amish/Mennonite,Amish Mennonite,,19.13,,,,,,,19.13,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-6664-04,NDC,,,facility,outpatient,1,EA,34.79000,33.05000,Amish/Mennonite,Amish Mennonite,,19.13,,,,,,,17.39,33.75,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,inpatient,1,EA,28.96000,27.52000,Amish/Mennonite,Amish Mennonite,,15.93,,,,,,,15.93,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,00904-7103-04,NDC,,,facility,outpatient,1,EA,28.96000,27.52000,Amish/Mennonite,Amish Mennonite,,15.93,,,,,,,14.48,28.09,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,10135-0787-90,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16714-0813-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.73,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,16729-0433-10,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,inpatient,1,EA,15.79000,15.00000,Amish/Mennonite,Amish Mennonite,,8.68,,,,,,,8.68,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,50268-0298-12,NDC,,,facility,outpatient,1,EA,15.79000,15.00000,Amish/Mennonite,Amish Mennonite,,8.68,,,,,,,7.89,15.32,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,51660-0200-90,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,59651-0052-90,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,Amish/Mennonite,Amish Mennonite,,17.95,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0284-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,Amish/Mennonite,Amish Mennonite,,17.95,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,inpatient,1,EA,32.64000,31.01000,Amish/Mennonite,Amish Mennonite,,17.95,,,,,,,17.95,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,60687-0373-21,NDC,,,facility,outpatient,1,EA,32.64000,31.01000,Amish/Mennonite,Amish Mennonite,,17.95,,,,,,,16.32,31.66,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,19.99,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-54,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,18.17,35.25,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,inpatient,1,EA,12.84000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,7.06,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,66582-0414-29,NDC,,,facility,outpatient,1,EA,12.84000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,6.42,12.45,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,67877-0490-90,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,68382-0773-16,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
EZETIMIBE TAB,56362,CDM,250,RC,69238-1154-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,25021021598,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,inpatient,1,mL,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,62332075150,NDC,facility,outpatient,1,mL,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,inpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011751,NDC,facility,outpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,inpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,63323011759,NDC,facility,outpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,inpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 50 ML,56363,CDM,250,RC,J9190,HCPCS,70700018822,NDC,facility,outpatient,1,mL,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,3.67,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,inpatient,,,195.10000,185.34000,Amish/Mennonite,Amish Mennonite,90,107.31,,,,,,,107.31,189.25,percent of total billed charges,
FAT/LIPIDS FECES QUANT SO-TECH,56364,CDM,300,RC,82710,CPT,,,facility,outpatient,,,195.10000,185.34000,Amish/Mennonite,Amish Mennonite,90,107.31,,,,,,,17.36,882.80,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,inpatient,1,mL,30.39000,28.87000,Amish/Mennonite,Amish Mennonite,,16.71,,,,,,,16.71,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,43598060710,NDC,facility,outpatient,1,mL,30.39000,28.87000,Amish/Mennonite,Amish Mennonite,,16.71,,,,,,,1.15,29.48,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,inpatient,1,mL,291.73000,277.14000,Amish/Mennonite,Amish Mennonite,,160.45,,,,,,,160.45,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067802,NDC,facility,outpatient,1,mL,291.73000,277.14000,Amish/Mennonite,Amish Mennonite,,160.45,,,,,,,1.15,282.98,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,inpatient,1,mL,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,81.69,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55111067810,NDC,facility,outpatient,1,mL,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,1.15,144.06,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,inpatient,1,mL,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,55150023010,NDC,facility,outpatient,1,mL,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,1.15,147.13,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,inpatient,1,mL,157.10000,149.25000,Amish/Mennonite,Amish Mennonite,,86.41,,,,,,,86.41,152.39,percent of total billed charges,
FONDAPARINUX SOL,56365,CDM,250,RC,J1652,HCPCS,67457058210,NDC,facility,outpatient,1,mL,157.10000,149.25000,Amish/Mennonite,Amish Mennonite,,86.41,,,,,,,1.15,152.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-10,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,inpatient,1,EA,5.56000,5.29000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00172-5411-46,NDC,,,facility,outpatient,1,EA,5.56000,5.29000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-06,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.10,4.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,00904-6500-61,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.23,4.34,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,16714-0691-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,inpatient,1,EA,5.37000,5.11000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,50268-0337-15,NDC,,,facility,outpatient,1,EA,5.37000,5.11000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.69,5.21,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,3.06,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,55111-0144-30,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,2.78,5.39,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,57237-0004-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,inpatient,1,EA,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68084-0728-01,NDC,,,facility,outpatient,1,EA,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,2.96,5.73,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
FLUCONAZOLE TAB,56366,CDM,250,RC,68462-0102-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,00574-0508-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE TAB,56367,CDM,250,RC,20555-0019-00,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,inpatient,1,EA,55.82000,53.03000,Amish/Mennonite,Amish Mennonite,,30.70,,,,,,,30.70,54.15,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737563,56368,CDM,250,RC,00173-0697-04,NDC,,,facility,outpatient,1,EA,55.82000,53.03000,Amish/Mennonite,Amish Mennonite,,30.70,,,,,,,27.91,54.15,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00093735556,NDC,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683006,NDC,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,inpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,00904683061,NDC,facility,outpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.63,3.16,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009010,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,16729009015,NDC,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,31722052530,NDC,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268031415,NDC,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,inpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.78,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,50268032315,NDC,facility,outpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.61,3.13,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,inpatient,1,EA,3.99000,3.79000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,51079052020,NDC,facility,outpatient,1,EA,3.99000,3.79000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.00,3.87,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,60687042865,NDC,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014930,NDC,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,65862014990,NDC,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,67877028890,NDC,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,inpatient,1,EA,4.08000,3.87000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.96,percent of total billed charges,
FINASTERIDE TAB 5 MG,56369,CDM,250,RC,J8499,HCPCS,68084039901,NDC,facility,outpatient,1,EA,4.08000,3.87000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.04,3.96,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,inpatient,1,EA,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-20,NDC,,,facility,outpatient,1,EA,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.49,2.88,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,inpatient,1,EA,2.96000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
FLECAINIDE TAB 7910574,56370,CDM,250,RC,00054-0011-21,NDC,,,facility,outpatient,1,EA,2.96000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,52.25,92.15,percent of total billed charges,
FROZEN SECTION EA ADDL-TECH,56371,CDM,310,RC,88332,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,47.50,1075.26,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,inpatient,4,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00143915610,NDC,facility,outpatient,4,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,inpatient,4,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00409610226,NDC,facility,outpatient,4,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,0.64740,2.25,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,inpatient,4,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,00517570425,NDC,facility,outpatient,4,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.64740,1.34,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,inpatient,4,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,64679075902,NDC,facility,outpatient,4,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,0.64740,2.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,inpatient,4,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,36000028325,NDC,facility,outpatient,4,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,inpatient,4,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028004,NDC,facility,outpatient,4,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.64740,2.14,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,inpatient,4,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,63323028026,NDC,facility,outpatient,4,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,inpatient,4,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,70860030204,NDC,facility,outpatient,4,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,inpatient,4,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 4 ML,56372,CDM,250,RC,J1940,HCPCS,72603025125,NDC,facility,outpatient,4,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,inpatient,1,mL,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,16729027668,NDC,facility,outpatient,1,mL,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.91,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,inpatient,1,mL,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011710,NDC,facility,outpatient,1,mL,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,inpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 10 ML,56373,CDM,250,RC,J9190,HCPCS,63323011719,NDC,facility,outpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,3.67,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,inpatient,1,mL,2655.14000,2522.38000,Amish/Mennonite,Amish Mennonite,,1460.33,,,,,,,1460.33,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00517071001,NDC,facility,outpatient,1,mL,2655.14000,2522.38000,Amish/Mennonite,Amish Mennonite,,1460.33,,,,,,,6.03,2575.49,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,inpatient,1,mL,1849.97000,1757.47000,Amish/Mennonite,Amish Mennonite,,1017.48,,,,,,,1017.48,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,00781318273,NDC,facility,outpatient,1,mL,1849.97000,1757.47000,Amish/Mennonite,Amish Mennonite,,1017.48,,,,,,,6.03,1794.47,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,inpatient,1,mL,1856.17000,1763.36000,Amish/Mennonite,Amish Mennonite,,1020.89,,,,,,,1020.89,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,39822071001,NDC,facility,outpatient,1,mL,1856.17000,1763.36000,Amish/Mennonite,Amish Mennonite,,1020.89,,,,,,,6.03,1800.48,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,inpatient,1,mL,1702.49000,1617.37000,Amish/Mennonite,Amish Mennonite,,936.37,,,,,,,936.37,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,67457021102,NDC,facility,outpatient,1,mL,1702.49000,1617.37000,Amish/Mennonite,Amish Mennonite,,936.37,,,,,,,6.03,1651.42,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,inpatient,1,mL,2300.00000,2185.00000,Amish/Mennonite,Amish Mennonite,,1265.00,,,,,,,1265.00,2231.00,percent of total billed charges,
FOMEPIZOLE,56374,CDM,636,RC,J1451,HCPCS,70710147801,NDC,facility,outpatient,1,mL,2300.00000,2185.00000,Amish/Mennonite,Amish Mennonite,,1265.00,,,,,,,6.03,2231.00,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,inpatient,5,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,36000014810,NDC,facility,outpatient,5,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,inpatient,5,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,63323042405,NDC,facility,outpatient,5,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.55,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,inpatient,5,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
FLUMAZENIL SOLN-INJ 0.1 MG/ML 5 ML,56375,CDM,250,RC,J3490,HCPCS,67457044700,NDC,facility,outpatient,5,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,inpatient,16,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,00054-3270-99,NDC,,,facility,outpatient,16,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,inpatient,16,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,50383-0700-16,NDC,,,facility,outpatient,16,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,inpatient,16,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60432-0264-15,NDC,,,facility,outpatient,16,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,inpatient,16,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
FLUTICASONE AERO 7737554,56377,CDM,250,RC,60505-0829-01,NDC,,,facility,outpatient,16,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.45,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,inpatient,100,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUCONAZOLE 7034853,56378,CDM,250,RC,J1450,HCPCS,55390019401,NDC,facility,outpatient,100,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,5.94,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-TECH,56379,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,10.00,30.07,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,313.50,552.90,percent of total billed charges,
FLOW CYTOMETRY 1ST MARKER-TECH,56380,CDM,311,RC,88184,CPT,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,285.00,3186.14,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,inpatient,1,EA,866.69000,823.36000,Amish/Mennonite,Amish Mennonite,,476.68,,,,,,,476.68,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006306104,NDC,facility,outpatient,1,EA,866.69000,823.36000,Amish/Mennonite,Amish Mennonite,,476.68,,,,,,,0.17611,840.69,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,inpatient,1,EA,829.37000,787.90000,Amish/Mennonite,Amish Mennonite,,456.15,,,,,,,456.15,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00006394132,NDC,facility,outpatient,1,EA,829.37000,787.90000,Amish/Mennonite,Amish Mennonite,,456.15,,,,,,,0.17611,804.49,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,inpatient,1,EA,205.40000,195.13000,Amish/Mennonite,Amish Mennonite,,112.97,,,,,,,112.97,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00143938401,NDC,facility,outpatient,1,EA,205.40000,195.13000,Amish/Mennonite,Amish Mennonite,,112.97,,,,,,,0.17611,199.24,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,inpatient,1,EA,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72205005401,NDC,facility,outpatient,1,EA,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,0.17611,76.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,inpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00338000801,NDC,facility,outpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,0.17611,91.96,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,inpatient,1,EA,748.82000,711.38000,Amish/Mennonite,Amish Mennonite,,411.85,,,,,,,411.85,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,00591438579,NDC,facility,outpatient,1,EA,748.82000,711.38000,Amish/Mennonite,Amish Mennonite,,411.85,,,,,,,0.17611,726.36,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,inpatient,1,EA,259.69000,246.70000,Amish/Mennonite,Amish Mennonite,,142.83,,,,,,,142.83,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,43598094811,NDC,facility,outpatient,1,EA,259.69000,246.70000,Amish/Mennonite,Amish Mennonite,,142.83,,,,,,,0.17611,251.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,inpatient,1,EA,780.03000,741.03000,Amish/Mennonite,Amish Mennonite,,429.02,,,,,,,429.02,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,60505610501,NDC,facility,outpatient,1,EA,780.03000,741.03000,Amish/Mennonite,Amish Mennonite,,429.02,,,,,,,0.17611,756.63,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,inpatient,1,EA,256.53000,243.70000,Amish/Mennonite,Amish Mennonite,,141.09,,,,,,,141.09,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,67457088910,NDC,facility,outpatient,1,EA,256.53000,243.70000,Amish/Mennonite,Amish Mennonite,,141.09,,,,,,,0.17611,248.83,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,inpatient,1,EA,530.95000,504.40000,Amish/Mennonite,Amish Mennonite,,292.02,,,,,,,292.02,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,69097083037,NDC,facility,outpatient,1,EA,530.95000,504.40000,Amish/Mennonite,Amish Mennonite,,292.02,,,,,,,0.17611,515.02,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,inpatient,1,EA,454.54000,431.82000,Amish/Mennonite,Amish Mennonite,,250.00,,,,,,,250.00,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,70860078010,NDC,facility,outpatient,1,EA,454.54000,431.82000,Amish/Mennonite,Amish Mennonite,,250.00,,,,,,,0.17611,440.90,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,inpatient,1,EA,271.95000,258.35000,Amish/Mennonite,Amish Mennonite,,149.57,,,,,,,149.57,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,71839010401,NDC,facility,outpatient,1,EA,271.95000,258.35000,Amish/Mennonite,Amish Mennonite,,149.57,,,,,,,0.17611,263.79,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,inpatient,1,EA,714.37000,678.66000,Amish/Mennonite,Amish Mennonite,,392.90,,,,,,,392.90,692.94,percent of total billed charges,
FOSAPREPITANT POWD-INJ 150 MG,56381,CDM,250,RC,J1453,HCPCS,72603010601,NDC,facility,outpatient,1,EA,714.37000,678.66000,Amish/Mennonite,Amish Mennonite,,392.90,,,,,,,0.17611,692.94,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,inpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,TC,95.15,,,,,,,95.15,167.81,percent of total billed charges,
FETAL STRESS TEST-TECH,56382,CDM,920,RC,59020,CPT,,,facility,outpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,TC,95.15,,,,,,,86.50,167.81,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,89.24,percent of total billed charges,
FIBRINOGEN ACTIVTY-TECH,56383,CDM,300,RC,85384,CPT,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,9.72,458.40,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
GAMMA GLUTAMYL TRANSFERASE-TECH,56384,CDM,300,RC,82977,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,7.20,373.51,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,TC,289.30,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME-TECH,56385,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,TC,289.30,,,,,,,146.17,1450.63,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00115-7033-01,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,inpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,00555-0997-02,NDC,,,facility,outpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,50268-0330-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-01,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
FLUDROCORTISONE TAB,56386,CDM,250,RC,68084-0288-11,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,inpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,129.80,228.92,percent of total billed charges,
FROZEN SECTION SINGLE/1ST-TECH,56389,CDM,310,RC,88331,CPT,,,facility,outpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,118.00,1635.52,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
FETAL NON STRESS TEST-TECH,56390,CDM,920,RC,59025,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,44.50,210.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,107.80,190.12,percent of total billed charges,
FLUORIDE ASSAY-TECH,56391,CDM,300,RC,82735,CPT,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,18.54,967.70,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,inpatient,2.5,EA,45.50000,43.23000,Amish/Mennonite,Amish Mennonite,,25.02,,,,,,,25.02,44.13,percent of total billed charges,
FLURBIPROFEN OPHTH SOL,56392,CDM,250,RC,69292-0722-25,NDC,,,facility,outpatient,2.5,EA,45.50000,43.23000,Amish/Mennonite,Amish Mennonite,,25.02,,,,,,,22.75,44.13,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,inpatient,1,mL,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.64,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610202,NDC,facility,outpatient,1,mL,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,0.64740,6.41,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,inpatient,1,mL,5.40000,5.13000,Amish/Mennonite,Amish Mennonite,,2.97,,,,,,,2.97,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00409610225,NDC,facility,outpatient,1,mL,5.40000,5.13000,Amish/Mennonite,Amish Mennonite,,2.97,,,,,,,0.64740,5.24,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,inpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,00517570225,NDC,facility,outpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,0.64740,2.30,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,inpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,36000028225,NDC,facility,outpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,0.64740,3.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,inpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028002,NDC,facility,outpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,0.64740,3.22,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,inpatient,1,mL,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,63323028016,NDC,facility,outpatient,1,mL,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.64740,1.38,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,70860030202,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.64740,3.07,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,71288020303,NDC,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,inpatient,1,mL,4.29000,4.08000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.36,4.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 2 ML,56393,CDM,250,RC,J1940,HCPCS,72603013325,NDC,facility,outpatient,1,mL,4.29000,4.08000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,0.64740,4.16,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,inpatient,12,EA,72.11000,68.50000,Amish/Mennonite,Amish Mennonite,,39.66,,,,,,,39.66,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,00173-0719-20,NDC,,,facility,outpatient,12,EA,72.11000,68.50000,Amish/Mennonite,Amish Mennonite,,39.66,,,,,,,36.05,69.95,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,inpatient,12,EA,46.87000,44.53000,Amish/Mennonite,Amish Mennonite,,25.78,,,,,,,25.78,45.46,percent of total billed charges,
FLUTICASONE AERO 7733587,56394,CDM,250,RC,66993-0079-96,NDC,,,facility,outpatient,12,EA,46.87000,44.53000,Amish/Mennonite,Amish Mennonite,,25.78,,,,,,,23.43,45.46,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,inpatient,2,EA,43.15000,40.99000,Amish/Mennonite,Amish Mennonite,,23.73,,,,,,,23.73,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069547102,NDC,facility,outpatient,2,EA,43.15000,40.99000,Amish/Mennonite,Amish Mennonite,,23.73,,,,,,,21.57,41.86,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,inpatient,2,EA,63.88000,60.69000,Amish/Mennonite,Amish Mennonite,,35.13,,,,,,,35.13,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00069600125,NDC,facility,outpatient,2,EA,63.88000,60.69000,Amish/Mennonite,Amish Mennonite,,35.13,,,,,,,31.94,61.96,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,inpatient,2,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.27,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00143978825,NDC,facility,outpatient,2,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.16,2.24,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,inpatient,2,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00409485702,NDC,facility,outpatient,2,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,inpatient,2,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613601,NDC,facility,outpatient,2,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,inpatient,2,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,12.86,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,00641613625,NDC,facility,outpatient,2,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,11.69,22.68,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,inpatient,2,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323040302,NDC,facility,outpatient,2,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,inpatient,2,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,63323403002,NDC,facility,outpatient,2,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,2.85,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,inpatient,2,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,67457051625,NDC,facility,outpatient,2,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,11.85,22.99,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,inpatient,2,EA,7.78000,7.39000,Amish/Mennonite,Amish Mennonite,,4.28,,,,,,,4.28,7.55,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529555,56395,CDM,250,RC,Q2009,HCPCS,68462062154,NDC,facility,outpatient,2,EA,7.78000,7.39000,Amish/Mennonite,Amish Mennonite,,4.28,,,,,,,3.89,7.55,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-19,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00093-1042-93,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,00904-5784-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,16714-0720-02,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50111-0647-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,50228-0113-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,51079-0997-20,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,62332-0022-31,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
FLUOXETINE CAP 10 MG,56396,CDM,250,RC,65862-0192-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054429925,NDC,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00054829925,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290700,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00172290710,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,00904717861,NDC,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,43547040211,NDC,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007320,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,51079007356,NDC,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63304062501,NDC,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
FUROSEMIDE TAB 40 MG,56399,CDM,250,RC,J8499,HCPCS,63739011201,NDC,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
FREE LIGHT CHAINS EACH-TECH,56400,CDM,300,RC,83521,CPT,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,17.27,823.21,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737540,56401,CDM,250,RC,00173-0695-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,17.12,33.22,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,49158-0506-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
ETODOLAC CAP 300 MG,56402,CDM,250,RC,60505-0040-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,inpatient,1,mL,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018201,NDC,facility,outpatient,1,mL,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,inpatient,1,mL,5.38000,5.11000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.96,5.22,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910208,56403,CDM,250,RC,J9201,HCPCS,00409018225,NDC,facility,outpatient,1,mL,5.38000,5.11000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.69,5.22,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,82.67,145.79,percent of total billed charges,
GANGLIOSIDE ANTIBODY PNL (83189) SO-TECH,56404,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,17.85,814.87,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00093-0507-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00182-0507-89,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,00904-7224-61,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,11534-0165-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,51079-0105-20,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,65162-0361-10,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,60687-0681-01,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,62584-0897-11,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
FOLIC ACID TAB,56405,CDM,250,RC,63739-0537-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,191.95,338.53,percent of total billed charges,
FLOW CYTOMETRY EA ADDL MARKER-TECH,56406,CDM,311,RC,88185,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,77.53,1052.52,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
G6PD QUANT-TECH,56407,CDM,300,RC,82955,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,9.70,509.30,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00093722398,NDC,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,00185004209,NDC,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,31722020190,NDC,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 20 MG,56408,CDM,250,RC,J8499,HCPCS,69097085705,NDC,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,inpatient,,,137.20000,130.34000,Amish/Mennonite,Amish Mennonite,90,75.46,,,,,,,75.46,133.08,percent of total billed charges,
FRUCTOSAMINE ASSAY (FRUCT) SO,56409,CDM,300,RC,82985,CPT,,,facility,outpatient,,,137.20000,130.34000,Amish/Mennonite,Amish Mennonite,90,75.46,,,,,,,16.62,780.94,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,433.40,764.36,percent of total billed charges,
FLUOROS GUID CVAD PLC REPL RM-TECH,56410,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,394.00,4298.79,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,inpatient,10.6,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-00,NDC,,,facility,outpatient,10.6,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.51,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,inpatient,10.6,EA,60.98000,57.93000,Amish/Mennonite,Amish Mennonite,,33.54,,,,,,,33.54,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,00173-0718-20,NDC,,,facility,outpatient,10.6,EA,60.98000,57.93000,Amish/Mennonite,Amish Mennonite,,33.54,,,,,,,30.49,59.15,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,inpatient,10.6,EA,39.63000,37.65000,Amish/Mennonite,Amish Mennonite,,21.80,,,,,,,21.80,38.44,percent of total billed charges,
FLUTICASONE AERO 7737653,56412,CDM,250,RC,66993-0078-96,NDC,,,facility,outpatient,10.6,EA,39.63000,37.65000,Amish/Mennonite,Amish Mennonite,,21.80,,,,,,,19.82,38.44,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,00093-7222-98,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FOSINOPRIL TAB 7222614,56413,CDM,250,RC,69097-0856-05,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,inpatient,1,mL,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00143951101,NDC,facility,outpatient,1,mL,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,inpatient,1,mL,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,00703565601,NDC,facility,outpatient,1,mL,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,1.65,4.66,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,inpatient,1,mL,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,16729011408,NDC,facility,outpatient,1,mL,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,inpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 25 ML (MDV),56414,CDM,250,RC,J9181,HCPCS,63323010425,NDC,facility,outpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,1.65,7.62,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,inpatient,1,GM,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
DEXTROSE GEL-ORAL 40% 15 GM,56415,CDM,250,RC,A9150,HCPCS,00574007030,NDC,facility,outpatient,1,GM,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
FUNGI SPECIAL STAIN-TECH,56416,CDM,300,RC,87206,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,5.39,288.61,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,inpatient,100,EA,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 10 GM,56417,CDM,636,RC,J1569,HCPCS,00944270005,NDC,facility,outpatient,100,EA,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,26.79,78.87,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,inpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,69.30,122.22,percent of total billed charges,
FOLIC ACID RBC ASSAY-TECH,56418,CDM,300,RC,82747,CPT,,,facility,outpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,16.37,899.77,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-5032-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,16714-0895-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59651-0269-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,59762-0541-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,64980-0280-01,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
GLIPIZIDE TAB 7216559,56419,CDM,250,RC,68084-0111-11,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,inpatient,2,EA,8.55000,8.12000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017302,NDC,facility,outpatient,2,EA,8.55000,8.12000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,3.82,8.29,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,inpatient,2,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017394,NDC,facility,outpatient,2,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,inpatient,2,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323017395,NDC,facility,outpatient,2,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,4.32,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,inpatient,2,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
GARAMYCIN GENTAMICIN INJ 7834542,56420,CDM,250,RC,J1580,HCPCS,63323051302,NDC,facility,outpatient,2,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,inpatient,1,EA,1919.06000,1823.11000,Amish/Mennonite,Amish Mennonite,,1055.48,,,,,,,1055.48,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,00002750201,NDC,facility,outpatient,1,EA,1919.06000,1823.11000,Amish/Mennonite,Amish Mennonite,,1055.48,,,,,,,4.61,1861.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,inpatient,1,EA,145.14000,137.88000,Amish/Mennonite,Amish Mennonite,,79.83,,,,,,,79.83,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,71288011450,NDC,facility,outpatient,1,EA,145.14000,137.88000,Amish/Mennonite,Amish Mennonite,,79.83,,,,,,,4.61,140.79,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,inpatient,1,EA,157.65000,149.77000,Amish/Mennonite,Amish Mennonite,,86.71,,,,,,,86.71,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16714093001,NDC,facility,outpatient,1,EA,157.65000,149.77000,Amish/Mennonite,Amish Mennonite,,86.71,,,,,,,4.61,152.92,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,inpatient,1,EA,156.74000,148.90000,Amish/Mennonite,Amish Mennonite,,86.21,,,,,,,86.21,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,16729011711,NDC,facility,outpatient,1,EA,156.74000,148.90000,Amish/Mennonite,Amish Mennonite,,86.21,,,,,,,4.61,152.04,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,inpatient,1,EA,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,199.43,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,45963061959,NDC,facility,outpatient,1,EA,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,4.61,351.72,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,inpatient,1,EA,154.84000,147.10000,Amish/Mennonite,Amish Mennonite,,85.16,,,,,,,85.16,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,63323012553,NDC,facility,outpatient,1,EA,154.84000,147.10000,Amish/Mennonite,Amish Mennonite,,85.16,,,,,,,4.61,150.19,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,inpatient,1,EA,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,81.69,144.06,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910214,56421,CDM,250,RC,J9201,HCPCS,70860020550,NDC,facility,outpatient,1,EA,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,4.61,144.06,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-19,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00093-1039-93,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00228-2666-11,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-5632-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,00904-6666-61,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,16714-0662-02,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,53746-0102-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0375-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,68084-0762-11,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0903-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN CAP 300 MG,56422,CDM,250,RC,63739-0689-10,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,inpatient,1,mL,3.92000,3.72000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,16729027667,NDC,facility,outpatient,1,mL,3.92000,3.72000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,1.96,3.80,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,inpatient,1,mL,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011720,NDC,facility,outpatient,1,mL,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,inpatient,1,mL,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,63323011728,NDC,facility,outpatient,1,mL,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,3.67,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,inpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
FLUOROURACIL SOLN 50 MG/ML 20ML,56423,CDM,250,RC,J9190,HCPCS,70700018723,NDC,facility,outpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,3.67,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,inpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001020,NDC,facility,outpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.48,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,inpatient,1,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 20 ML,56424,CDM,250,RC,J1580,HCPCS,63323001095,NDC,facility,outpatient,1,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,4.32,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,inpatient,,,616.00000,585.20000,Amish/Mennonite,Amish Mennonite,TC,338.80,,,,,,,338.80,597.52,percent of total billed charges,
FLUORO GUID LOC NDL/CATH TIP-TECH,56425,CDM,320,RC,77003,CPT,,,facility,outpatient,,,616.00000,585.20000,Amish/Mennonite,Amish Mennonite,TC,338.80,,,,,,,308.00,3942.79,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,inpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,69.30,122.22,percent of total billed charges,
FLUORESCENT NONINF AB SCRN EA-TECH,56426,CDM,300,RC,86036,CPT,,,facility,outpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,12.05,574.73,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,inpatient,50,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409490234,NDC,facility,outpatient,50,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,inpatient,50,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409664802,NDC,facility,outpatient,50,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,inpatient,50,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,00409751716,NDC,facility,outpatient,50,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,inpatient,50,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,70092147550,NDC,facility,outpatient,50,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,inpatient,50,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330101,NDC,facility,outpatient,50,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,inpatient,50,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
DEXTROSE 50% SOLN 25 GM/50 ML,56427,CDM,250,RC,J3490,HCPCS,76329330201,NDC,facility,outpatient,50,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,inpatient,,,614.00000,583.30000,Amish/Mennonite,Amish Mennonite,,337.70,,,,,,,337.70,595.58,percent of total billed charges,
FLOW CYTO INTERP 2-8 MARKERS-TECH,56428,CDM,311,RC,88187,CPT,,,facility,outpatient,,,614.00000,583.30000,Amish/Mennonite,Amish Mennonite,,337.70,,,,,,,125.97,1861.90,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-5631-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6078-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,00904-6665-61,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,16714-0661-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,50228-0179-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,59762-5026-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,60687-0580-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0079-11,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,63739-0675-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,65862-0198-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,67877-0222-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
GABAPENTIN CAP 100 MG,56429,CDM,250,RC,68084-0783-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
FACTOR IX ASSAY-TECH,56430,CDM,300,RC,85250,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,19.04,1001.63,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,inpatient,,,189.00000,179.55000,Amish/Mennonite,Amish Mennonite,,103.95,,,,,,,103.95,183.33,percent of total billed charges,
GASTRIN ASSAY-TECH,56431,CDM,300,RC,82941,CPT,,,facility,outpatient,,,189.00000,179.55000,Amish/Mennonite,Amish Mennonite,,103.95,,,,,,,17.63,916.73,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE BLD QUANT-TECH,56432,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.93,203.72,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,inpatient,,,153.80000,146.11000,Amish/Mennonite,Amish Mennonite,90,84.59,,,,,,,84.59,149.19,percent of total billed charges,
GABAPENTIN ASSAY SO-TECH,56433,CDM,300,RC,80171,CPT,,,facility,outpatient,,,153.80000,146.11000,Amish/Mennonite,Amish Mennonite,90,84.59,,,,,,,14.48,1018.59,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,60505-2551-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,00904-6823-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,16714-0330-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0325-15,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,50268-0351-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,59762-5023-01,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.02,5.86,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68084-0797-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,2.01,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,63739-0560-10,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN TAB,56434,CDM,250,RC,68462-0126-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,inpatient,1,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 30 GM,56435,CDM,636,RC,J1569,HCPCS,00944270007,NDC,facility,outpatient,1,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,26.79,78.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,00591-0900-30,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,16714-0894-01,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,64980-0279-03,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,59762-0540-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-21,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.79,3.47,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,60687-0768-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
GLIPIZIDE TAB 7223696,56436,CDM,250,RC,68084-0295-11,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
GALACTOSE ASSAY-TECH,56437,CDM,300,RC,82760,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,577.23,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,TC,1897.50,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY-TECH,56439,CDM,341,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,TC,1897.50,,,,,,,1591.55,3346.50,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
FINGER SPLINT FOUR-PRONG APPLIED - ORTHO TX DONE-TECH,56440,CDM,450,RC,,,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,35.50,68.87,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,inpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-00,NDC,,,facility,outpatient,1,EA,19.66000,18.68000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,9.83,19.07,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,inpatient,1,EA,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,18.84,33.22,percent of total billed charges,
FLUTICASONE-SALMETEROL POWD 7737522,56441,CDM,250,RC,00173-0696-04,NDC,,,facility,outpatient,1,EA,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,17.12,33.22,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
FUNGUS AB NON SPECIFIED-TECH,56442,CDM,300,RC,86671,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,7.15,645.08,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,inpatient,30,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
GENTIAN VIOLET SOL,56443,CDM,250,RC,00395-1003-92,NDC,,,facility,outpatient,30,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,inpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
FLUZONE VACC 3 YRS & > IM 8610010,56444,CDM,636,RC,Q2038,HCPCS,,,facility,outpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,81.87,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-4301-25,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,00054-8301-25,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,43547-0403-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,51079-0527-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,63304-0626-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,64980-0564-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
FUROSEMIDE TAB 7217672,56445,CDM,250,RC,68084-0017-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,00093-8343-98,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,23155-0057-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,51079-0872-20,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216534,56446,CDM,250,RC,65862-0029-01,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-19,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,00093-8344-93,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,23155-0058-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-19,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
GLYBURIDE TAB 7216526,56447,CDM,250,RC,51079-0873-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,inpatient,5,EA,9.70000,9.22000,Amish/Mennonite,Amish Mennonite,,5.33,,,,,,,5.33,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,17478-0283-10,NDC,,,facility,outpatient,5,EA,9.70000,9.22000,Amish/Mennonite,Amish Mennonite,,5.33,,,,,,,4.85,9.41,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,inpatient,5,EA,22.57000,21.44000,Amish/Mennonite,Amish Mennonite,,12.41,,,,,,,12.41,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,24208-0580-60,NDC,,,facility,outpatient,5,EA,22.57000,21.44000,Amish/Mennonite,Amish Mennonite,,12.41,,,,,,,11.29,21.89,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,inpatient,5,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,60758-0188-05,NDC,,,facility,outpatient,5,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
GENTAMICIN OPHTH SOL,56449,CDM,250,RC,61314-0633-05,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,inpatient,,,2834.00000,2692.30000,Amish/Mennonite,Amish Mennonite,TC,1558.70,,,,,,,1558.70,2748.98,percent of total billed charges,
GASTROESOPHAGEAL REFLUX STUDY-TECH,56450,CDM,341,RC,78262,CPT,,,facility,outpatient,,,2834.00000,2692.30000,Amish/Mennonite,Amish Mennonite,TC,1558.70,,,,,,,1132.05,2748.98,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,inpatient,1,mL,5.36000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018301,NDC,facility,outpatient,1,mL,5.36000,5.10000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.68,5.20,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,inpatient,1,mL,5.61000,5.32000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,00409018325,NDC,facility,outpatient,1,mL,5.61000,5.32000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.44,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,inpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,67457061610,NDC,facility,outpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,inpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
GEMCITABINE HCL INJECTION,56451,CDM,250,RC,J9201,HCPCS,72485022102,NDC,facility,outpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,4.95,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,inpatient,,,90.60000,86.07000,Amish/Mennonite,Amish Mennonite,90,49.83,,,,,,,49.83,87.88,percent of total billed charges,
GLUCAGON ASSAY SO-TECH,56452,CDM,300,RC,82943,CPT,,,facility,outpatient,,,90.60000,86.07000,Amish/Mennonite,Amish Mennonite,90,49.83,,,,,,,13.88,746.94,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
FLUORESCENT NONINF AB TITER EA-TECH,56453,CDM,300,RC,86256,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,12.05,1539.22,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,inpatient,10,EA,16.13000,15.33000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,8.87,15.65,percent of total billed charges,
GRAMICIDIN/NEOMYCIN/POLYMYXIN B OPHTH SOL,56454,CDM,250,RC,24208-0790-62,NDC,,,facility,outpatient,10,EA,16.13000,15.33000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,8.06,15.65,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,inpatient,1,EA,383.81000,364.62000,Amish/Mennonite,Amish Mennonite,,211.10,,,,,,,211.10,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,00002750101,NDC,facility,outpatient,1,EA,383.81000,364.62000,Amish/Mennonite,Amish Mennonite,,211.10,,,,,,,4.61,372.30,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,inpatient,1,EA,31.35000,29.78000,Amish/Mennonite,Amish Mennonite,,17.24,,,,,,,17.24,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,16729009203,NDC,facility,outpatient,1,EA,31.35000,29.78000,Amish/Mennonite,Amish Mennonite,,17.24,,,,,,,4.61,30.41,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,45963061257,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,4.61,122.61,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,inpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,63323010213,NDC,facility,outpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,4.61,36.78,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,inpatient,1,EA,29.01000,27.56000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,15.96,28.14,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910064,56455,CDM,250,RC,J9201,HCPCS,71288011310,NDC,facility,outpatient,1,EA,29.01000,27.56000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,4.61,28.14,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,inpatient,1,EA,3.14000,2.99000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.05,percent of total billed charges,
GLYCERIN WITCH HAZEL TOPICAL PAD,56456,CDM,250,RC,50289-3250-01,NDC,,,facility,outpatient,1,EA,3.14000,2.99000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.57,3.05,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,inpatient,15,EA,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,45802-0046-35,NDC,,,facility,outpatient,15,EA,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.16,8.07,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,inpatient,15,EA,6.87000,6.52000,Amish/Mennonite,Amish Mennonite,,3.78,,,,,,,3.78,6.66,percent of total billed charges,
GENTAMICIN OINT,56457,CDM,250,RC,52565-0090-15,NDC,,,facility,outpatient,15,EA,6.87000,6.52000,Amish/Mennonite,Amish Mennonite,,3.78,,,,,,,3.44,6.66,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,122.10,215.34,percent of total billed charges,
GENTAMYCIN ASSAY-TECH,56459,CDM,300,RC,80170,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,16.38,848.80,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,inpatient,10,EA,25.01000,23.76000,Amish/Mennonite,Amish Mennonite,,13.76,,,,,,,13.76,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069547402,NDC,facility,outpatient,10,EA,25.01000,23.76000,Amish/Mennonite,Amish Mennonite,,13.76,,,,,,,12.51,24.26,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,inpatient,10,EA,38.33000,36.41000,Amish/Mennonite,Amish Mennonite,,21.08,,,,,,,21.08,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00069600121,NDC,facility,outpatient,10,EA,38.33000,36.41000,Amish/Mennonite,Amish Mennonite,,21.08,,,,,,,19.16,37.18,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,inpatient,10,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00143978210,NDC,facility,outpatient,10,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,inpatient,10,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00409485710,NDC,facility,outpatient,10,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,inpatient,10,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613701,NDC,facility,outpatient,10,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,inpatient,10,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,8.26,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,00641613710,NDC,facility,outpatient,10,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,7.50,14.56,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,inpatient,10,EA,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.47,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,63323040310,NDC,facility,outpatient,10,EA,4.49000,4.27000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.25,4.36,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,inpatient,10,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
FOSPHENYTOIN INJ PE 7529571,56460,CDM,250,RC,Q2009,HCPCS,67457051701,NDC,facility,outpatient,10,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,14.71,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00054829725,NDC,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00172290810,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,63739054110,NDC,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00781181801,NDC,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,00904717761,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,43547040110,NDC,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,51079007220,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056201,NDC,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
FUROSEMIDE TAB 20 MG,56461,CDM,250,RC,J8499,HCPCS,64980056210,NDC,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,inpatient,1,EA,1566.95000,1488.60000,Amish/Mennonite,Amish Mennonite,,861.82,,,,,,,861.82,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,00310095036,NDC,facility,outpatient,1,EA,1566.95000,1488.60000,Amish/Mennonite,Amish Mennonite,,861.82,,,,,,,734.15,1519.94,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,inpatient,1,EA,2451.28000,2328.72000,Amish/Mennonite,Amish Mennonite,,1348.20,,,,,,,1348.20,2377.74,percent of total billed charges,
GOSERELIN IMPLANT 3.6 MG,56462,CDM,636,RC,J9202,HCPCS,70720095036,NDC,facility,outpatient,1,EA,2451.28000,2328.72000,Amish/Mennonite,Amish Mennonite,,1348.20,,,,,,,734.15,2377.74,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,inpatient,200,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 20 GM,56463,CDM,636,RC,J1569,HCPCS,00944270006,NDC,facility,outpatient,200,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,26.79,78.87,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
GLUCOSE POSTDOSE-TECH,56464,CDM,300,RC,82950,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,4.75,254.68,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
GTT EA ADDL SPECIMEN-TECH,56466,CDM,300,RC,82952,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.92,203.72,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
GLIADIN AB EACH-TECH,56467,CDM,300,RC,86258,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,11.53,574.73,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,inpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,115.50,203.70,percent of total billed charges,
FSH/FOLLICLE STIM HORMONE-TECH,56468,CDM,300,RC,83001,CPT,,,facility,outpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,18.58,967.70,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,inpatient,1,EA,727.27000,690.91000,Amish/Mennonite,Amish Mennonite,,400.00,,,,,,,400.00,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00002803101,NDC,facility,outpatient,1,EA,727.27000,690.91000,Amish/Mennonite,Amish Mennonite,,400.00,,,,,,,195.79,705.45,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,inpatient,1,EA,730.51000,693.98000,Amish/Mennonite,Amish Mennonite,,401.78,,,,,,,401.78,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00169706515,NDC,facility,outpatient,1,EA,730.51000,693.98000,Amish/Mennonite,Amish Mennonite,,401.78,,,,,,,195.79,708.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,inpatient,1,EA,725.20000,688.94000,Amish/Mennonite,Amish Mennonite,,398.86,,,,,,,398.86,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00548585000,NDC,facility,outpatient,1,EA,725.20000,688.94000,Amish/Mennonite,Amish Mennonite,,398.86,,,,,,,195.79,703.44,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,inpatient,1,EA,410.23000,389.72000,Amish/Mennonite,Amish Mennonite,,225.63,,,,,,,225.63,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,00597005345,NDC,facility,outpatient,1,EA,410.23000,389.72000,Amish/Mennonite,Amish Mennonite,,225.63,,,,,,,195.79,397.92,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,inpatient,1,EA,444.44000,422.22000,Amish/Mennonite,Amish Mennonite,,244.44,,,,,,,244.44,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,55390000410,NDC,facility,outpatient,1,EA,444.44000,422.22000,Amish/Mennonite,Amish Mennonite,,244.44,,,,,,,195.79,431.11,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,inpatient,1,EA,724.68000,688.45000,Amish/Mennonite,Amish Mennonite,,398.57,,,,,,,398.57,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323058282,NDC,facility,outpatient,1,EA,724.68000,688.45000,Amish/Mennonite,Amish Mennonite,,398.57,,,,,,,195.79,702.94,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,inpatient,1,EA,441.85000,419.76000,Amish/Mennonite,Amish Mennonite,,243.02,,,,,,,243.02,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059303,NDC,facility,outpatient,1,EA,441.85000,419.76000,Amish/Mennonite,Amish Mennonite,,243.02,,,,,,,195.79,428.59,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,inpatient,1,EA,273.01000,259.36000,Amish/Mennonite,Amish Mennonite,,150.16,,,,,,,150.16,264.82,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059403,NDC,facility,outpatient,1,EA,273.01000,259.36000,Amish/Mennonite,Amish Mennonite,,150.16,,,,,,,136.50,323.05,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,inpatient,1,EA,441.60000,419.52000,Amish/Mennonite,Amish Mennonite,,242.88,,,,,,,242.88,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059613,NDC,facility,outpatient,1,EA,441.60000,419.52000,Amish/Mennonite,Amish Mennonite,,242.88,,,,,,,195.79,428.35,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,inpatient,1,EA,419.58000,398.60000,Amish/Mennonite,Amish Mennonite,,230.77,,,,,,,230.77,406.99,percent of total billed charges,
GLUCAGON POWD-INJ 1 MG,56469,CDM,636,RC,J1610,HCPCS,63323059616,NDC,facility,outpatient,1,EA,419.58000,398.60000,Amish/Mennonite,Amish Mennonite,,230.77,,,,,,,195.79,406.99,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,inpatient,1,mL,57.32000,54.46000,Amish/Mennonite,Amish Mennonite,,31.53,,,,,,,31.53,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,00143974410,NDC,facility,outpatient,1,mL,57.32000,54.46000,Amish/Mennonite,Amish Mennonite,,31.53,,,,,,,0.36823,55.60,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,inpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,25021077901,NDC,facility,outpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,0.36823,30.65,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,63323031801,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,0.36823,61.30,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,inpatient,1,mL,29.61000,28.13000,Amish/Mennonite,Amish Mennonite,,16.29,,,,,,,16.29,28.72,percent of total billed charges,
GRANISETRON HCL INJECTION,56471,CDM,250,RC,J1626,HCPCS,67457086301,NDC,facility,outpatient,1,mL,29.61000,28.13000,Amish/Mennonite,Amish Mennonite,,16.29,,,,,,,0.36823,28.72,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,00143950125,NDC,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,1.20,4.91,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,inpatient,1,EA,65.21000,61.95000,Amish/Mennonite,Amish Mennonite,,35.87,,,,,,,35.87,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,50458025501,NDC,facility,outpatient,1,EA,65.21000,61.95000,Amish/Mennonite,Amish Mennonite,,35.87,,,,,,,1.20,63.25,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,inpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.91,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390014710,NDC,facility,outpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,1.20,6.90,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,55390044710,NDC,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.20,3.38,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,inpatient,1,EA,18.93000,17.98000,Amish/Mennonite,Amish Mennonite,,10.41,,,,,,,10.41,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,63323047401,NDC,facility,outpatient,1,EA,18.93000,17.98000,Amish/Mennonite,Amish Mennonite,,10.41,,,,,,,1.20,18.36,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
HALOPERIDOL INJECTION,56472,CDM,250,RC,J1630,HCPCS,67457042612,NDC,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.20,2.70,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00591-0461-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,00904-6123-61,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,50268-0362-15,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,51079-0811-20,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE TAB 7216518,56473,CDM,250,RC,60505-0142-00,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,00904-5293-52,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,43292-0558-57,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,50268-0375-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
GLUCOSAMINE CAP,56475,CDM,250,RC,54629-0078-70,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00172-4383-10,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.82,3.54,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-5633-61,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6105-61,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,00904-6667-61,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,16714-0663-02,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,50228-0181-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,58657-0622-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,59762-4240-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60505-0114-00,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,60687-0602-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0376-10,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0693-10,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,63739-0984-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
GABAPENTIN CAP 400 MG,56478,CDM,250,RC,67877-0224-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,inpatient,,,147.70000,140.31000,Amish/Mennonite,Amish Mennonite,,81.23,,,,,,,81.23,143.27,percent of total billed charges,
GA67 GALLIUM,56479,CDM,636,RC,A9556,HCPCS,,,facility,outpatient,,,147.70000,140.31000,Amish/Mennonite,Amish Mennonite,,81.23,,,,,,,36.30,143.27,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,inpatient,2,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120703,NDC,facility,outpatient,2,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,inpatient,2,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,00409120725,NDC,facility,outpatient,2,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,inpatient,2,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,55150040225,NDC,facility,outpatient,2,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.32,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,inpatient,2,EA,6.43000,6.11000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.54,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001002,NDC,facility,outpatient,2,EA,6.43000,6.11000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.21,6.24,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,inpatient,2,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
GENTAMICIN SOLN-INJ 40 MG/ML 2 ML,56480,CDM,250,RC,J1580,HCPCS,63323001094,NDC,facility,outpatient,2,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,4.32,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
TURNKEY FCS SRG,56481,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
HCG SERUM-TECH,56482,CDM,300,RC,84703,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,7.52,390.47,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,inpatient,10,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610210,NDC,facility,outpatient,10,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.64740,1.78,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00409610227,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.64740,1.53,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,inpatient,10,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,00517571025,NDC,facility,outpatient,10,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,inpatient,10,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,23155047344,NDC,facility,outpatient,10,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,inpatient,10,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,25021031110,NDC,facility,outpatient,10,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,inpatient,10,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,36000028425,NDC,facility,outpatient,10,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,inpatient,10,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,63323028010,NDC,facility,outpatient,10,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,0.64740,7.16,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,inpatient,10,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,71288020311,NDC,facility,outpatient,10,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.64740,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,inpatient,10,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
FUROSEMIDE SOLN-INJ 10 MG/ML 10 ML,56483,CDM,250,RC,J1940,HCPCS,72603047425,NDC,facility,outpatient,10,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.64740,1.29,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00093-8035-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,00378-1125-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
GLYBURIDE TAB 7216575,56484,CDM,250,RC,67253-0461-10,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,inpatient,12,EA,40.91000,38.87000,Amish/Mennonite,Amish Mennonite,,22.50,,,,,,,22.50,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072000,NDC,facility,outpatient,12,EA,40.91000,38.87000,Amish/Mennonite,Amish Mennonite,,22.50,,,,,,,20.45,39.68,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,inpatient,12,EA,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,00173072020,NDC,facility,outpatient,12,EA,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,56.00,108.64,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,inpatient,12,EA,72.80000,69.16000,Amish/Mennonite,Amish Mennonite,,40.04,,,,,,,40.04,70.62,percent of total billed charges,
FLUTICASONE INHALER 220 MCG/INH 12 GM (120 DOSE),56485,CDM,250,RC,J3535,HCPCS,66993008096,NDC,facility,outpatient,12,EA,72.80000,69.16000,Amish/Mennonite,Amish Mennonite,,40.04,,,,,,,36.40,70.62,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
GLYCERIN LIQUID,56486,CDM,250,RC,00395-1031-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,56.10,98.94,percent of total billed charges,
HEMOGLOBIN PLASMA ASSAY-TECH,56487,CDM,300,RC,83051,CPT,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,4.90,373.51,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
HEMATOCRIT-TECH,56488,CDM,300,RC,85014,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,2.37,118.82,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
GTT 3 SPECIMENS-TECH,56490,CDM,300,RC,82951,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,12.87,679.08,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00378-0257-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,00781-1392-13,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,51079-0734-20,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,58657-0701-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.64,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,69292-0582-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
HALOPERIDOL TAB 7216716,56491,CDM,250,RC,70756-0002-11,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,inpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,16714053625,NDC,facility,outpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,inpatient,1,mL,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00143968225,NDC,facility,outpatient,1,mL,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,0.43000,7.97,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,inpatient,1,mL,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,22.59,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,00517460125,NDC,facility,outpatient,1,mL,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,0.43000,39.85,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,inpatient,1,mL,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,43547063925,NDC,facility,outpatient,1,mL,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,inpatient,1,mL,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.91,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,66794020242,NDC,facility,outpatient,1,mL,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,0.43000,6.90,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,inpatient,1,mL,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70069001125,NDC,facility,outpatient,1,mL,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,0.43000,2.06,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,inpatient,1,mL,22.27000,21.15000,Amish/Mennonite,Amish Mennonite,,12.25,,,,,,,12.25,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,70121139405,NDC,facility,outpatient,1,mL,22.27000,21.15000,Amish/Mennonite,Amish Mennonite,,12.25,,,,,,,0.43000,21.60,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,inpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 1 ML,56492,CDM,250,RC,J1596,HCPCS,71288041403,NDC,facility,outpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,0.43000,7.66,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,177.65,313.31,percent of total billed charges,
GONORRHOEAE AMPL PROBE-TECH,56493,CDM,300,RC,87591,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,35.09,1833.46,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,73.15,129.01,percent of total billed charges,
HEPARIN NEUTRALIZATION-TECH,56495,CDM,300,RC,85525,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,11.84,611.15,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,inpatient,1,EA,6103.28000,5798.12000,Amish/Mennonite,Amish Mennonite,,3356.80,,,,,,,3356.80,5920.18,percent of total billed charges,
GOSERELIN IMPLANT 10.8 MG,56496,CDM,636,RC,J9202,HCPCS,70720095130,NDC,facility,outpatient,1,EA,6103.28000,5798.12000,Amish/Mennonite,Amish Mennonite,,3356.80,,,,,,,734.15,5920.18,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1278.00000,1214.10000,Amish/Mennonite,Amish Mennonite,,702.90,,,,,,,702.90,1239.66,percent of total billed charges,
GI PATHOGENS AMP PROBE-TECH,56497,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1278.00000,1214.10000,Amish/Mennonite,Amish Mennonite,,702.90,,,,,,,128.29,6705.74,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,inpatient,1,mL,5.44000,5.17000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.99,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,00409018125,NDC,facility,outpatient,1,mL,5.44000,5.17000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.72,5.28,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,inpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.49,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,67457061730,NDC,facility,outpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.31,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,inpatient,1,mL,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,71288011728,NDC,facility,outpatient,1,mL,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,4.95,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,inpatient,1,mL,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
GEMCITABINE HCL INJECTION 7910065,56498,CDM,250,RC,J9201,HCPCS,72485022210,NDC,facility,outpatient,1,mL,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,4.95,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,Amish/Mennonite,Amish Mennonite,,32.55,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,Amish/Mennonite,Amish Mennonite,,32.55,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,Amish/Mennonite,Amish Mennonite,,65.11,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 5 MCG/0.5 ML (RECOMBIVAX-HB),56500,CDM,250,RC,90744,HCPCS,00006498100,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,Amish/Mennonite,Amish Mennonite,,65.11,,,,,,,49.09,114.83,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,inpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,39822110001,NDC,facility,outpatient,10,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,inpatient,10,EA,15.54000,14.76000,Amish/Mennonite,Amish Mennonite,,8.55,,,,,,,8.55,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018410,NDC,facility,outpatient,10,EA,15.54000,14.76000,Amish/Mennonite,Amish Mennonite,,8.55,,,,,,,7.77,15.07,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,inpatient,10,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.19,percent of total billed charges,
FOLIC ACID SOLN-INJ 5 MG/ML 10 ML,56501,CDM,250,RC,J3490,HCPCS,63323018411,NDC,facility,outpatient,10,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.22,8.19,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,inpatient,4,EA,1.28000,1.21000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,00212-2823-74,NDC,,,facility,outpatient,4,EA,1.28000,1.21000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,inpatient,4,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
GUAR GUM PACKET,56502,CDM,250,RC,43900-0976-47,NDC,,,facility,outpatient,4,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,inpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,391.60,690.64,percent of total billed charges,
H PYLORI BREATH TEST-TECH,56503,CDM,300,RC,83013,CPT,,,facility,outpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,67.36,3514.18,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,inpatient,,,4882.00000,4637.90000,Amish/Mennonite,Amish Mennonite,TC,2685.10,,,,,,,2685.10,4735.54,percent of total billed charges,
GASTRIC EMP IMG SM BOWEL/COLON-TECH,56504,CDM,340,RC,78266,CPT,,,facility,outpatient,,,4882.00000,4637.90000,Amish/Mennonite,Amish Mennonite,TC,2685.10,,,,,,,2091.58,4735.54,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
HEMOGLOBIN-TECH,56505,CDM,300,RC,85018,CPT,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,2.37,118.82,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,733.05000,696.40000,Amish/Mennonite,Amish Mennonite,,403.18,,,,,,,359.19,711.06,percent of total billed charges,
CLIP XTRNFX 1.5-1.8MM ILZ WRE DISC STRL GRY,56506,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,733.05000,696.40000,Amish/Mennonite,Amish Mennonite,,403.18,,,,,,,336.47,733.05,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,inpatient,,,22.90000,21.75000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,12.60,22.21,percent of total billed charges,
HEPARSORB CORRECTION TEST-TECH,56507,CDM,300,RC,85999,CPT,,,facility,outpatient,,,22.90000,21.75000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,11.45,22.21,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-00,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00172-3649-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00173-3649-00,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00182-1994-89,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,00904-6637-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,50268-0361-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,51079-0810-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
GLIPIZIDE TAB 7216492,56508,CDM,250,RC,60505-0141-00,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-01,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,00781-1393-13,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,inpatient,1,EA,1.77000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
HALOPERIDOL TAB 7216724,56509,CDM,250,RC,51079-0735-20,NDC,,,facility,outpatient,1,EA,1.77000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,inpatient,1,mL,414.52000,393.79000,Amish/Mennonite,Amish Mennonite,,227.99,,,,,,,227.99,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,13533-0636-05,NDC,,,facility,outpatient,1,mL,414.52000,393.79000,Amish/Mennonite,Amish Mennonite,,227.99,,,,,,,207.26,402.08,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,inpatient,1,mL,378.56000,359.63000,Amish/Mennonite,Amish Mennonite,,208.21,,,,,,,208.21,367.20,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7528797,56510,CDM,250,RC,69800-4203-01,NDC,,,facility,outpatient,1,mL,378.56000,359.63000,Amish/Mennonite,Amish Mennonite,,208.21,,,,,,,189.28,367.20,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143958625,NDC,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,0.43000,8.58,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,inpatient,1,EA,24.19000,22.98000,Amish/Mennonite,Amish Mennonite,,13.30,,,,,,,13.30,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968101,NDC,facility,outpatient,1,EA,24.19000,22.98000,Amish/Mennonite,Amish Mennonite,,13.30,,,,,,,0.43000,23.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,inpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00143968125,NDC,facility,outpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,0.43000,21.46,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,inpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,19.99,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00517460225,NDC,facility,outpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,0.43000,35.25,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603401,NDC,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.43000,1.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,inpatient,1,EA,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,00641603425,NDC,facility,outpatient,1,EA,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,0.43000,2.99,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,inpatient,1,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.69,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714062025,NDC,facility,outpatient,1,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,0.43000,8.27,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,inpatient,1,EA,23.47000,22.30000,Amish/Mennonite,Amish Mennonite,,12.91,,,,,,,12.91,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,16714099825,NDC,facility,outpatient,1,EA,23.47000,22.30000,Amish/Mennonite,Amish Mennonite,,12.91,,,,,,,0.43000,22.77,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,inpatient,1,EA,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,4.73,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,43547064025,NDC,facility,outpatient,1,EA,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,0.43000,8.34,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,inpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70069001225,NDC,facility,outpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,0.43000,8.28,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,inpatient,1,EA,22.91000,21.76000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,12.60,22.22,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 2 ML,56511,CDM,250,RC,J1596,HCPCS,70121139505,NDC,facility,outpatient,1,EA,22.91000,21.76000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,0.43000,22.22,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,inpatient,1,mL,458.17000,435.26000,Amish/Mennonite,Amish Mennonite,,251.99,,,,,,,251.99,444.42,percent of total billed charges,
HEPATITIS B IMMUNE GLOBULIN SOL 7531999,56512,CDM,250,RC,13533-0636-03,NDC,,,facility,outpatient,1,mL,458.17000,435.26000,Amish/Mennonite,Amish Mennonite,,251.99,,,,,,,229.09,444.42,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
HEPATITIS A AB-TECH,56514,CDM,300,RC,86708,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,12.39,645.08,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
HEPATITIS B SURFACE AB-TECH,56515,CDM,300,RC,86706,CPT,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,10.74,560.26,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,13.20,23.28,percent of total billed charges,
GLUCOSE BLD BY REAGENT STRIP-TECH,56516,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,3.28,152.82,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,inpatient,10,EA,4.89000,4.64000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.74,percent of total billed charges,
DEXTROSE 25% SOLN 10 ML,56517,CDM,250,RC,J3490,HCPCS,00409177510,NDC,facility,outpatient,10,EA,4.89000,4.64000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.44,4.74,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,inpatient,1,mL,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP 50 UNITS/ML (VAQTA),56518,CDM,250,RC,90632,HCPCS,00006484141,NDC,facility,outpatient,1,mL,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,69.38,134.59,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,00093-7255-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,16729-0002-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,50268-0359-15,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,51079-0425-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,55111-0321-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE TAB,56519,CDM,250,RC,68084-0326-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
HEPARIN ASSAY-TECH,56520,CDM,300,RC,85520,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,13.09,679.08,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,inpatient,,,383.00000,363.85000,Amish/Mennonite,Amish Mennonite,,210.65,,,,,,,210.65,371.51,percent of total billed charges,
HPV HIGH RISK TYPES-TECH,56521,CDM,300,RC,87624,CPT,,,facility,outpatient,,,383.00000,363.85000,Amish/Mennonite,Amish Mennonite,,210.65,,,,,,,35.09,1833.46,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,inpatient,1,mL,75.21000,71.45000,Amish/Mennonite,Amish Mennonite,,41.37,,,,,,,41.37,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,00703712103,NDC,facility,outpatient,1,mL,75.21000,71.45000,Amish/Mennonite,Amish Mennonite,,41.37,,,,,,,7.15,72.95,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,inpatient,1,mL,88.73000,84.30000,Amish/Mennonite,Amish Mennonite,,48.80,,,,,,,48.80,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,63323046901,NDC,facility,outpatient,1,mL,88.73000,84.30000,Amish/Mennonite,Amish Mennonite,,48.80,,,,,,,7.15,86.07,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,inpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069003003,NDC,facility,outpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,7.15,76.63,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,inpatient,1,mL,67.43000,64.06000,Amish/Mennonite,Amish Mennonite,,37.09,,,,,,,37.09,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70069038101,NDC,facility,outpatient,1,mL,67.43000,64.06000,Amish/Mennonite,Amish Mennonite,,37.09,,,,,,,7.15,65.41,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,inpatient,1,mL,67.31000,63.94000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,37.02,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,70756061510,NDC,facility,outpatient,1,mL,67.31000,63.94000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,7.15,65.29,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
HALOPERIDOL DECANOATE INJ,56523,CDM,250,RC,J1631,HCPCS,71288050202,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,7.15,61.30,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,inpatient,,,231.53000,219.95000,Amish/Mennonite,Amish Mennonite,,127.34,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,CPT,,,facility,outpatient,,,231.53000,219.95000,Amish/Mennonite,Amish Mennonite,,127.34,,,,,,,115.77,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,inpatient,1,mL,231.53000,219.95000,Amish/Mennonite,Amish Mennonite,,127.34,,,,,,,127.34,224.58,percent of total billed charges,
HEPATITIS A-HEPATITIS B VACCINE SUSP PF (TWINRIX),56524,CDM,250,RC,90636,HCPCS,58160081552,NDC,facility,outpatient,1,mL,231.53000,219.95000,Amish/Mennonite,Amish Mennonite,,127.34,,,,,,,115.77,224.58,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 1-TECH,56525,CDM,300,RC,87274,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,11.98,628.12,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
HEPATIC FUNCTION PANEL-TECH,56526,CDM,300,RC,80076,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,8.17,424.40,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,inpatient,,,146.22000,138.91000,Amish/Mennonite,Amish Mennonite,,80.42,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,CPT,,,facility,outpatient,,,146.22000,138.91000,Amish/Mennonite,Amish Mennonite,,80.42,,,,,,,73.11,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,inpatient,1,mL,146.22000,138.91000,Amish/Mennonite,Amish Mennonite,,80.42,,,,,,,80.42,141.83,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 10 MCG/ML (RECOMBIVAX-HB),56527,CDM,250,RC,90746,HCPCS,00006499500,NDC,facility,outpatient,1,mL,146.22000,138.91000,Amish/Mennonite,Amish Mennonite,,80.42,,,,,,,73.11,141.83,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
HERPES SIMPLEX VIRUS TYPE 2-TECH,56530,CDM,300,RC,87273,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,11.98,628.12,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00378-1160-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00591-0444-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,00904-5579-60,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,24979-0198-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
GUANFACINE TAB,56531,CDM,250,RC,65162-0711-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
HELICOBACTER PYLORI AB-TECH,56532,CDM,300,RC,86677,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,8.17,797.91,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
GLUCOSE BODY FLUID-TECH,56533,CDM,300,RC,82945,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,3.93,203.72,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,inpatient,1,mL,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,00409272302,NDC,facility,outpatient,1,mL,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,0.33945,3.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,inpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,25021040210,NDC,facility,outpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,0.33945,2.57,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,inpatient,1,mL,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63323004710,NDC,facility,outpatient,1,mL,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,0.33945,5.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,inpatient,1,mL,4.00000,3.80000,Amish/Mennonite,Amish Mennonite,,2.20,,,,,,,2.20,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,63739090128,NDC,facility,outpatient,1,mL,4.00000,3.80000,Amish/Mennonite,Amish Mennonite,,2.20,,,,,,,0.33945,3.88,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,inpatient,1,mL,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML 10 ML,56534,CDM,250,RC,J1644,HCPCS,67457038399,NDC,facility,outpatient,1,mL,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,0.33945,2.96,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
HEPATITIS B SURFACE AG IA-TECH,56535,CDM,300,RC,87340,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,10.33,543.22,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,00904-6782-61,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,60687-0161-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,58657-0703-01,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,68382-0079-01,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
HALOPERIDOL TAB 7216732,56536,CDM,250,RC,70756-0004-11,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,90,71.50,,,,,,,71.50,126.10,percent of total billed charges,
HEPATITIS BE AG IA SO-TECH,56537,CDM,300,RC,87350,CPT,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,90,71.50,,,,,,,11.91,594.19,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,QN,14.30,,,,,,,14.30,25.22,percent of total billed charges,
GROUND MILEAGE-TECH,56538,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,QN,14.30,,,,,,,13.00,25.22,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,275.62,545.62,percent of total billed charges,
GUIDEWIRE ORTH 3.2MM 230MM VFX2 CLBRT FEM FX SYS,56539,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,258.19,562.50,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,inpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,,226.60,,,,,,,226.60,399.64,percent of total billed charges,
HPV TYPES 16 & 18/45 PCR-TECH,56540,CDM,300,RC,87625,CPT,,,facility,outpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,,226.60,,,,,,,38.30,1901.39,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
HEMOGLOBIN GLYCOSYLATED A1C-TECH,56541,CDM,300,RC,83036,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,9.71,509.30,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,inpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,69.30,122.22,percent of total billed charges,
HEPATITIS B CORE AB TOTAL-TECH,56542,CDM,300,RC,86704,CPT,,,facility,outpatient,,,126.00000,119.70000,Amish/Mennonite,Amish Mennonite,,69.30,,,,,,,12.05,628.12,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,inpatient,,,254.90000,242.16000,Amish/Mennonite,Amish Mennonite,90,140.19,,,,,,,140.19,247.25,percent of total billed charges,
HEAVY METAL QUANT EA-TECH,56543,CDM,300,RC,83018,CPT,,,facility,outpatient,,,254.90000,242.16000,Amish/Mennonite,Amish Mennonite,90,140.19,,,,,,,22.69,1154.38,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
HIV-2 ANTIBODY-TECH,56544,CDM,300,RC,86702,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,13.52,713.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,00904-6718-39,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.73,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-58,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,45802-0498-78,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-10,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,inpatient,1,EA,1.21000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-15,NDC,,,facility,outpatient,1,EA,1.21000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-32,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,inpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-34,NDC,,,facility,outpatient,1,EA,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-69,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,63824-0008-86,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,68084-0572-01,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,2.56,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
GUAIFENESIN TAB,56545,CDM,250,RC,70677-0055-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
HEPATITIS C ANTIBODY-TECH,56546,CDM,300,RC,86803,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,14.27,746.94,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
HEPATITIS B CORE AB IGM-TECH,56547,CDM,300,RC,86705,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,11.77,611.15,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,inpatient,,,139.34000,132.37000,Amish/Mennonite,Amish Mennonite,,76.64,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,CPT,,,facility,outpatient,,,139.34000,132.37000,Amish/Mennonite,Amish Mennonite,,76.64,,,,,,,69.67,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,inpatient,1,EA,139.34000,132.37000,Amish/Mennonite,Amish Mennonite,,76.64,,,,,,,76.64,135.16,percent of total billed charges,
HEPATITIS B ADULT VACCINE SUSP 20 MCG/ML (ENGERIX-B),56548,CDM,250,RC,90746,HCPCS,58160082152,NDC,facility,outpatient,1,EA,139.34000,132.37000,Amish/Mennonite,Amish Mennonite,,76.64,,,,,,,69.67,135.16,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,inpatient,1,mL,10.40000,9.88000,Amish/Mennonite,Amish Mennonite,,5.72,,,,,,,5.72,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,00409272101,NDC,facility,outpatient,1,mL,10.40000,9.88000,Amish/Mennonite,Amish Mennonite,,5.72,,,,,,,0.33945,10.09,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,inpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,25021040366,NDC,facility,outpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,0.33945,5.61,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,inpatient,1,mL,24.11000,22.91000,Amish/Mennonite,Amish Mennonite,,13.26,,,,,,,13.26,23.39,percent of total billed charges,
HEPARIN SOL 7910611,56549,CDM,250,RC,J1644,HCPCS,63323054213,NDC,facility,outpatient,1,mL,24.11000,22.91000,Amish/Mennonite,Amish Mennonite,,13.26,,,,,,,0.33945,23.39,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
HAPTOGLOBIN ASSAY QUANT-TECH,56550,CDM,300,RC,83010,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,12.58,662.12,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,inpatient,,,276.60000,262.77000,Amish/Mennonite,Amish Mennonite,90,152.13,,,,,,,152.13,268.30,percent of total billed charges,
"ECHINOCOCCUS AB, IGG (ECHNG) SO",56551,CDM,300,RC,86682,CPT,,,facility,outpatient,,,276.60000,262.77000,Amish/Mennonite,Amish Mennonite,90,152.13,,,,,,,8.17,679.08,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
HCG QUAL URINE-TECH,56552,CDM,300,RC,81025,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,8.61,407.44,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,60505-2657-01,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7218043,56553,CDM,250,RC,51079-0433-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,73.15,129.01,percent of total billed charges,
HISTOPLASMA AB-TECH,56555,CDM,300,RC,86698,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,,73.15,,,,,,,13.79,645.08,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
HGB FETAL QUAL-TECH,56556,CDM,300,RC,83033,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,8.00,373.51,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,inpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,00641623125,NDC,facility,outpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,6.82,45.98,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,inpatient,1,EA,134.16000,127.46000,Amish/Mennonite,Amish Mennonite,,73.79,,,,,,,73.79,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,17478093401,NDC,facility,outpatient,1,EA,134.16000,127.46000,Amish/Mennonite,Amish Mennonite,,73.79,,,,,,,6.82,130.14,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,inpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,39822050004,NDC,facility,outpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,6.82,27.59,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,55150040025,NDC,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,inpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,24.89,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061401,NDC,facility,outpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,6.82,43.89,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,inpatient,1,EA,7.65000,7.26000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,4.21,7.42,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061416,NDC,facility,outpatient,1,EA,7.65000,7.26000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,3.83,8.56,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,63323061455,NDC,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,inpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
HYDRALAZINE SOLN 20 MG/ML,56557,CDM,250,RC,J0360,HCPCS,67457029101,NDC,facility,outpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,6.82,36.78,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,171.05,301.67,percent of total billed charges,
HLA TYPING A/B/C MULT AG-TECH,56558,CDM,300,RC,86813,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,58.00,3038.81,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,inpatient,,,392.00000,372.40000,Amish/Mennonite,Amish Mennonite,,215.60,,,,,,,215.60,380.24,percent of total billed charges,
HEPATITIS E-TECH,56559,CDM,300,RC,86849,CPT,,,facility,outpatient,,,392.00000,372.40000,Amish/Mennonite,Amish Mennonite,,215.60,,,,,,,196.00,380.24,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,90,29.15,,,,,,,29.15,51.41,percent of total billed charges,
HEMOGLOBIN ELECTROPHORESIS CASCADE (HBEL1) SO,56560,CDM,300,RC,83020,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,90,29.15,,,,,,,6.41,1590.11,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,Amish/Mennonite,Amish Mennonite,TC,1879.90,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAGING-TECH,56561,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,Amish/Mennonite,Amish Mennonite,TC,1879.90,,,,,,,1578.65,3315.46,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
H PYLORI STOOL AG IA-TECH,56562,CDM,300,RC,87338,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,14.38,746.94,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,inpatient,,,301.21000,286.15000,Amish/Mennonite,Amish Mennonite,,165.67,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,CPT,,,facility,outpatient,,,301.21000,286.15000,Amish/Mennonite,Amish Mennonite,,165.67,,,,,,,150.60,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,inpatient,1,mL,301.21000,286.15000,Amish/Mennonite,Amish Mennonite,,165.67,,,,,,,165.67,292.17,percent of total billed charges,
HEPATITIS B ADULT VACCINE DIALYSIS SUSP 40 MCG/ML (RECOMBIVAX-HB DIALYSIS),56563,CDM,250,RC,90740,HCPCS,00006499200,NDC,facility,outpatient,1,mL,301.21000,286.15000,Amish/Mennonite,Amish Mennonite,,165.67,,,,,,,150.60,292.17,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,inpatient,1,EA,36.47000,34.64000,Amish/Mennonite,Amish Mennonite,,20.06,,,,,,,20.06,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00574-7090-12,NDC,,,facility,outpatient,1,EA,36.47000,34.64000,Amish/Mennonite,Amish Mennonite,,20.06,,,,,,,18.23,35.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-06,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,19.99,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00713-0503-12,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,18.17,35.25,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,inpatient,1,EA,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,00904-7340-12,NDC,,,facility,outpatient,1,EA,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,inpatient,1,EA,34.63000,32.90000,Amish/Mennonite,Amish Mennonite,,19.05,,,,,,,19.05,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0301-24,NDC,,,facility,outpatient,1,EA,34.63000,32.90000,Amish/Mennonite,Amish Mennonite,,19.05,,,,,,,17.32,33.59,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,42494-0341-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,inpatient,1,EA,9.39000,8.92000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,5.16,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,50268-0411-12,NDC,,,facility,outpatient,1,EA,9.39000,8.92000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,4.70,9.11,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,inpatient,1,EA,151.75000,144.17000,Amish/Mennonite,Amish Mennonite,,83.46,,,,,,,83.46,147.20,percent of total billed charges,
HYDROCORTISONE SUPP,56564,CDM,250,RC,65649-0411-12,NDC,,,facility,outpatient,1,EA,151.75000,144.17000,Amish/Mennonite,Amish Mennonite,,83.46,,,,,,,75.88,147.20,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,inpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,,217.80,,,,,,,217.80,384.12,percent of total billed charges,
HIV-1 AG IA-TECH,56565,CDM,300,RC,87390,CPT,,,facility,outpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,,217.80,,,,,,,24.06,1137.41,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,inpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,TC,256.30,,,,,,,256.30,452.02,percent of total billed charges,
HISTOCHEMISTRY ENZYME-TECH,56566,CDM,310,RC,88319,CPT,,,facility,outpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,TC,256.30,,,,,,,233.00,4012.21,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
HERPES SIMPLEX AB TYPE 2-TECH,56567,CDM,300,RC,86696,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,19.35,1018.59,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
HTLV I AB-TECH,56568,CDM,300,RC,86687,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,9.09,441.37,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,inpatient,28.35,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0020-31,NDC,,,facility,outpatient,28.35,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00168-0181-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,inpatient,28.35,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,00472-0345-56,NDC,,,facility,outpatient,28.35,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,45802-0276-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,inpatient,28.35,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,49348-0522-72,NDC,,,facility,outpatient,28.35,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,inpatient,28.35,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE OINT,56569,CDM,250,RC,51672-2018-02,NDC,,,facility,outpatient,28.35,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,inpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,,269.50,,,,,,,269.50,475.30,percent of total billed charges,
HEPATITIS C PCR QUANT-TECH,56570,CDM,300,RC,87522,CPT,,,facility,outpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,,269.50,,,,,,,42.84,2240.90,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,inpatient,,,59.19000,56.23000,Amish/Mennonite,Amish Mennonite,,32.55,,,,,,,32.55,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,CPT,,,facility,outpatient,,,59.19000,56.23000,Amish/Mennonite,Amish Mennonite,,32.55,,,,,,,29.59,57.41,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,inpatient,0.5,EA,118.38000,112.46000,Amish/Mennonite,Amish Mennonite,,65.11,,,,,,,65.11,114.83,percent of total billed charges,
HEPATITIS B PEDIATRIC VACCINE SUSP 10 MCG/0.5 ML (ENGERIX-B),56571,CDM,250,RC,90744,HCPCS,58160082052,NDC,facility,outpatient,0.5,EA,118.38000,112.46000,Amish/Mennonite,Amish Mennonite,,65.11,,,,,,,49.09,114.83,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00182-0554-89,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,00904-6441-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,23155-0833-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,31722-0520-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,49884-0027-01,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,50228-0183-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,51079-0075-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,62584-0733-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0126-10,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213523,56572,CDM,250,RC,63739-0327-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,inpatient,30,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,00168-0080-31,NDC,,,facility,outpatient,30,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,inpatient,30,EA,7.80000,7.41000,Amish/Mennonite,Amish Mennonite,,4.29,,,,,,,4.29,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,10631-0407-01,NDC,,,facility,outpatient,30,EA,7.80000,7.41000,Amish/Mennonite,Amish Mennonite,,4.29,,,,,,,3.90,7.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,inpatient,30,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,45802-0004-03,NDC,,,facility,outpatient,30,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,inpatient,30,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,51672-3003-02,NDC,,,facility,outpatient,30,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,inpatient,30,EA,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,62559-0431-30,NDC,,,facility,outpatient,30,EA,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,3.65,7.08,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,inpatient,30,EA,1.59000,1.52000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,63629-8847-01,NDC,,,facility,outpatient,30,EA,1.59000,1.52000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,inpatient,30,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0301-30,NDC,,,facility,outpatient,30,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.32,6.44,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,inpatient,30,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,64980-0324-30,NDC,,,facility,outpatient,30,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,inpatient,30,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0302-30,NDC,,,facility,outpatient,30,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,inpatient,30,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 2.5%,56573,CDM,250,RC,69315-0312-28,NDC,,,facility,outpatient,30,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
HUMERAL SPLINT APPLIED - ORTHO TX DONE-TECH,56574,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,71.00,137.74,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-00,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00182-0905-89,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,00904-6440-61,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,23155-0832-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,31722-0519-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,49884-0029-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,50111-0398-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,51079-0074-20,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
HYDRALAZINE TAB 7213515,56575,CDM,250,RC,68084-0447-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,inpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,497.20,876.88,percent of total billed charges,
HIV-1 QUANT-TECH,56576,CDM,300,RC,87536,CPT,,,facility,outpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,85.10,4447.87,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-10,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,00172-5032-60,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212018,56577,CDM,250,RC,68180-0520-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,00591-0861-01,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,50268-0480-15,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE-LISINOPRIL TAB 7212109,56578,CDM,250,RC,68180-0519-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,inpatient,,,217.70000,206.81000,Amish/Mennonite,Amish Mennonite,90,119.73,,,,,,,119.73,211.17,percent of total billed charges,
HLA TYPING A/B/C SNGL AG-TECH,56579,CDM,300,RC,86812,CPT,,,facility,outpatient,,,217.70000,206.81000,Amish/Mennonite,Amish Mennonite,90,119.73,,,,,,,26.67,1341.13,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
GIARDIA AG IA-TECH,56580,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,11.98,628.12,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-0264-24,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00054-8394-24,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,00406-3244-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,42858-0302-25,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,inpatient,1,EA,10.30000,9.78000,Amish/Mennonite,Amish Mennonite,,5.67,,,,,,,5.67,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,59011-0454-10,NDC,,,facility,outpatient,1,EA,10.30000,9.78000,Amish/Mennonite,Amish Mennonite,,5.67,,,,,,,5.15,9.99,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,inpatient,1,EA,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,60687-0590-01,NDC,,,facility,outpatient,1,EA,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
HYDROMORPHONE TAB 7633126,56581,CDM,250,RC,68084-0472-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,inpatient,1,mL,5.92000,5.62000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,3.26,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128310,NDC,facility,outpatient,1,mL,5.92000,5.62000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,0.14409,5.74,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,inpatient,1,mL,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.45,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128331,NDC,facility,outpatient,1,mL,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,0.14409,7.85,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,inpatient,1,mL,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,6.03,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409128337,NDC,facility,outpatient,1,mL,10.97000,10.42000,Amish/Mennonite,Amish Mennonite,,6.03,,,,,,,0.14409,10.64,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,inpatient,1,mL,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,3.21,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,00409255201,NDC,facility,outpatient,1,mL,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,0.14409,5.66,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,inpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000910,NDC,facility,outpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,0.14409,11.04,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,inpatient,1,mL,13.11000,12.46000,Amish/Mennonite,Amish Mennonite,,7.21,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 1 MG/ML,56582,CDM,250,RC,J1171,HCPCS,76045000911,NDC,facility,outpatient,1,mL,13.11000,12.46000,Amish/Mennonite,Amish Mennonite,,7.21,,,,,,,0.14409,12.72,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,inpatient,1,mL,133.27000,126.60000,Amish/Mennonite,Amish Mennonite,,73.30,,,,,,,73.30,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657010202,NDC,facility,outpatient,1,mL,133.27000,126.60000,Amish/Mennonite,Amish Mennonite,,73.30,,,,,,,0.56420,129.27,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,inpatient,1,mL,176.33000,167.51000,Amish/Mennonite,Amish Mennonite,,96.98,,,,,,,96.98,171.04,percent of total billed charges,
HYALURONIDASE SOLN 150 UNITS/ML HUMAN RECOMBINANT (HYLENEX),56583,CDM,250,RC,J3473,HCPCS,18657011704,NDC,facility,outpatient,1,mL,176.33000,167.51000,Amish/Mennonite,Amish Mennonite,,96.98,,,,,,,0.56420,171.04,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
HERPES SIMPLEX AB TYPE 1-TECH,56584,CDM,300,RC,86695,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,13.19,696.05,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,inpatient,1,mL,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,17238-0610-15,NDC,,,facility,outpatient,1,mL,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,54799-0503-15,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,inpatient,1,mL,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.02,percent of total billed charges,
HYDROXYPROPYL METHYLCELLULOSE OPHTH SOL,56585,CDM,250,RC,77790-0022-15,NDC,,,facility,outpatient,1,mL,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.10,6.02,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,00378-0351-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
HALOPERIDOL TAB 7215627,56586,CDM,250,RC,51079-0733-20,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
HIV 1 AB-TECH,56587,CDM,300,RC,86701,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,8.89,458.40,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,inpatient,,,459.00000,436.05000,Amish/Mennonite,Amish Mennonite,,252.45,,,,,,,252.45,445.23,percent of total billed charges,
HEPATITIS B PCR QUANT-TECH,56588,CDM,300,RC,87517,CPT,,,facility,outpatient,,,459.00000,436.05000,Amish/Mennonite,Amish Mennonite,,252.45,,,,,,,42.84,2240.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,inpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,203.50,358.90,percent of total billed charges,
HERPES SIMPLEX VIRUS BY PCR-TECH,56589,CDM,300,RC,87529,CPT,,,facility,outpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,35.09,1833.46,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00527-1632-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,00781-2074-01,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,51079-0935-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE TAB 7215536,56590,CDM,250,RC,72578-0090-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,inpatient,1,EA,3.88000,3.69000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,00378-0403-01,NDC,,,facility,outpatient,1,EA,3.88000,3.69000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.76,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,inpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,51079-0104-20,NDC,,,facility,outpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,5.52,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,inpatient,1,EA,3.86000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,53489-0144-01,NDC,,,facility,outpatient,1,EA,3.86000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROCHLORO-SPIRONOLACT TAB,56592,CDM,250,RC,63629-1071-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,inpatient,60,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-01,NDC,,,facility,outpatient,60,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,inpatient,60,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,00574-2020-07,NDC,,,facility,outpatient,60,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,inpatient,60,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-11,NDC,,,facility,outpatient,60,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,inpatient,60,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0111-11,NDC,,,facility,outpatient,60,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,inpatient,60,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
HYDROCORTISONE SUSP,56593,CDM,250,RC,62559-0138-07,NDC,,,facility,outpatient,60,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,inpatient,,,1293.00000,1228.35000,Amish/Mennonite,Amish Mennonite,90,711.15,,,,,,,711.15,1254.21,percent of total billed charges,
HLA I TYPING LOCUS LR SO-TECH,56594,CDM,310,RC,81373,CPT,,,facility,outpatient,,,1293.00000,1228.35000,Amish/Mennonite,Amish Mennonite,90,711.15,,,,,,,121.54,5992.72,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,inpatient,50,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,4.20,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00409263450,NDC,facility,outpatient,50,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,0.14409,7.40,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,inpatient,50,EA,6.54000,6.21000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,3.60,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,00703001801,NDC,facility,outpatient,50,EA,6.54000,6.21000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,0.14409,6.34,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,inpatient,50,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.55,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,17478054050,NDC,facility,outpatient,50,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,0.14409,6.26,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,inpatient,50,EA,8.96000,8.51000,Amish/Mennonite,Amish Mennonite,,4.93,,,,,,,4.93,8.69,percent of total billed charges,
HYDROMORPHONE SOLN-IV 10 MG/ML 50 ML,56595,CDM,250,RC,J1171,HCPCS,63323085150,NDC,facility,outpatient,50,EA,8.96000,8.51000,Amish/Mennonite,Amish Mennonite,,4.93,,,,,,,0.14409,8.69,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,inpatient,500,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00264196510,NDC,facility,outpatient,500,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,inpatient,500,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
HETASTARCH 6% IN 0.9% NACL 500 ML,56597,CDM,250,RC,J3490,HCPCS,00409724803,NDC,facility,outpatient,500,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
CLOTTING INHIPITORS ANTITHROMBIN-TECH,56598,CDM,300,RC,85300,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,11.85,611.15,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,inpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
HETASTARCH 6% IN LACTATED RINGERS 500 ML,56599,CDM,250,RC,J3490,HCPCS,00409155554,NDC,facility,outpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,inpatient,1,EA,4.31000,4.10000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00003083050,NDC,facility,outpatient,1,EA,4.31000,4.10000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.15,4.18,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,inpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00555088202,NDC,facility,outpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,00904693961,NDC,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,49884072401,NDC,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,inpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
HYDROXYUREA CAP 500 MG,56600,CDM,250,RC,J8499,HCPCS,68084028401,NDC,facility,outpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,90,72.05,,,,,,,72.05,127.07,percent of total billed charges,
HEPATITIS BE AB SO-TECH,56602,CDM,300,RC,86707,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,90,72.05,,,,,,,11.96,611.15,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,inpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,3.19,5.63,percent of total billed charges,
IFOSFAMIDE INJECTION 7910243,56604,CDM,250,RC,J9208,HCPCS,00703342711,NDC,facility,outpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,2.90,40.87,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
IMMUNOGLOBULIN IGE ASSAY-TECH,56605,CDM,300,RC,82785,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,16.46,865.84,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,inpatient,1,EA,64.46000,61.24000,Amish/Mennonite,Amish Mennonite,,35.45,,,,,,,35.45,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001103,NDC,facility,outpatient,1,EA,64.46000,61.24000,Amish/Mennonite,Amish Mennonite,,35.45,,,,,,,31.90,62.53,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,inpatient,1,EA,64.49000,61.26000,Amish/Mennonite,Amish Mennonite,,35.47,,,,,,,35.47,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009001104,NDC,facility,outpatient,1,EA,64.49000,61.26000,Amish/Mennonite,Amish Mennonite,,35.47,,,,,,,31.90,62.56,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,inpatient,1,EA,47.72000,45.33000,Amish/Mennonite,Amish Mennonite,,26.25,,,,,,,26.25,46.29,percent of total billed charges,
HYDROCORTISONE POWD-INJ 100 MG/2 ML,56606,CDM,250,RC,J1720,HCPCS,00009082501,NDC,facility,outpatient,1,EA,47.72000,45.33000,Amish/Mennonite,Amish Mennonite,,26.25,,,,,,,23.86,46.29,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,00781176201,NDC,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,42291034501,NDC,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69315013301,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,53489033001,NDC,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
IMIPRAMINE TAB 10 MG,56609,CDM,250,RC,J8499,HCPCS,69584042510,NDC,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,inpatient,1,EA,5.29000,5.02000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,2.91,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00009-0031-01,NDC,,,facility,outpatient,1,EA,5.29000,5.02000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,2.65,5.13,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,00904-7188-61,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.83,5.50,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59651-0414-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,59762-0074-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,inpatient,1,EA,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,60687-0582-01,NDC,,,facility,outpatient,1,EA,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.64,5.12,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,64380-0971-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.63,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
HYDROCORTISONE TAB,56610,CDM,250,RC,68084-0469-01,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.44,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,inpatient,,,32.40000,30.78000,Amish/Mennonite,Amish Mennonite,90,17.82,,,,,,,17.82,31.43,percent of total billed charges,
IBD QUANT EACH-TECH,56611,CDM,300,RC,83520,CPT,,,facility,outpatient,,,32.40000,30.78000,Amish/Mennonite,Amish Mennonite,90,17.82,,,,,,,16.20,814.87,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,inpatient,1,mL,263.33000,250.17000,Amish/Mennonite,Amish Mennonite,,144.83,,,,,,,144.83,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,25021082761,NDC,facility,outpatient,1,mL,263.33000,250.17000,Amish/Mennonite,Amish Mennonite,,144.83,,,,,,,34.44,255.43,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,inpatient,1,mL,363.46000,345.29000,Amish/Mennonite,Amish Mennonite,,199.90,,,,,,,199.90,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,62756021840,NDC,facility,outpatient,1,mL,363.46000,345.29000,Amish/Mennonite,Amish Mennonite,,199.90,,,,,,,34.44,352.56,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,inpatient,1,mL,258.07000,245.16000,Amish/Mennonite,Amish Mennonite,,141.94,,,,,,,141.94,250.33,percent of total billed charges,
IBANDRONATE SODIUM INJECTION,56612,CDM,250,RC,J1740,HCPCS,67457052433,NDC,facility,outpatient,1,mL,258.07000,245.16000,Amish/Mennonite,Amish Mennonite,,141.94,,,,,,,34.44,250.33,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
HTLV/HIV AB CONFIRMATORY TEST-TECH,56613,CDM,300,RC,86689,CPT,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.35,1018.59,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-HEPATITIS B,56615,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00406-3243-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,00527-1353-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,42858-0301-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,60687-0579-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,63739-0275-10,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROMORPHONE TAB 7632169,56616,CDM,250,RC,68084-0423-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,inpatient,1,EA,238.67000,226.74000,Amish/Mennonite,Amish Mennonite,,131.27,,,,,,,131.27,231.51,percent of total billed charges,
HYDROCORTISONE SODIUM SUCC I 7910237,56617,CDM,250,RC,J1720,HCPCS,00009001612,NDC,facility,outpatient,1,EA,238.67000,226.74000,Amish/Mennonite,Amish Mennonite,,131.27,,,,,,,31.90,231.51,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,inpatient,1,EA,93.35000,88.68000,Amish/Mennonite,Amish Mennonite,,51.34,,,,,,,51.34,90.55,percent of total billed charges,
HYDROXYZINE HCL INJ,56618,CDM,250,RC,J3410,HCPCS,00517560125,NDC,facility,outpatient,1,EA,93.35000,88.68000,Amish/Mennonite,Amish Mennonite,,51.34,,,,,,,27.10,90.55,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,inpatient,,,842.00000,799.90000,Amish/Mennonite,Amish Mennonite,,463.10,,,,,,,463.10,816.74,percent of total billed charges,
ID BY SEQUENCING 1-TECH,56619,CDM,300,RC,87801,CPT,,,facility,outpatient,,,842.00000,799.90000,Amish/Mennonite,Amish Mennonite,,463.10,,,,,,,50.62,3666.93,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,inpatient,1,mL,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00409381412,NDC,facility,outpatient,1,mL,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,17.80,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,inpatient,1,mL,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,4.37,7.70,percent of total billed charges,
IN MORPHINE PRESERVATIV FREE 7632228,56620,CDM,250,RC,J2274,HCPCS,00641602010,NDC,facility,outpatient,1,mL,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,3.97,17.80,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
HIV 1 AND HIV 2 SNGL RESULT AB-TECH,56621,CDM,300,RC,87389,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,24.08,1256.24,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,inpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,233.75,412.25,percent of total billed charges,
IN SITU HYBRID 10-30 CELLS-TECH,56625,CDM,310,RC,88273,CPT,,,facility,outpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,34.81,1680.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,inpatient,1,EA,26.51000,25.19000,Amish/Mennonite,Amish Mennonite,,14.58,,,,,,,14.58,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-11,NDC,,,facility,outpatient,1,EA,26.51000,25.19000,Amish/Mennonite,Amish Mennonite,,14.58,,,,,,,13.26,25.71,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,inpatient,1,EA,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,12.51,22.07,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/ HC SUSP-OTIC 10 ML,56626,CDM,250,RC,61314-0645-10,NDC,,,facility,outpatient,1,EA,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,11.38,22.07,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,inpatient,1,EA,8.66000,8.23000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,4.76,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131210,NDC,facility,outpatient,1,EA,8.66000,8.23000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,0.14409,8.40,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,inpatient,1,EA,10.64000,10.10000,Amish/Mennonite,Amish Mennonite,,5.85,,,,,,,5.85,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409131230,NDC,facility,outpatient,1,EA,10.64000,10.10000,Amish/Mennonite,Amish Mennonite,,5.85,,,,,,,0.14409,10.32,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409335601,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,0.14409,4.60,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336501,NDC,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,0.14409,4.78,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,inpatient,1,EA,6.05000,5.75000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.33,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00409336510,NDC,facility,outpatient,1,EA,6.05000,5.75000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,0.14409,5.87,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,inpatient,1,EA,4.55000,4.32000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.50,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641012125,NDC,facility,outpatient,1,EA,4.55000,4.32000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,0.14409,4.41,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,00641615125,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.14409,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,24200030045,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.14409,15.33,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,inpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,59011044210,NDC,facility,outpatient,1,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,0.14409,4.62,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,inpatient,1,EA,13.65000,12.97000,Amish/Mennonite,Amish Mennonite,,7.51,,,,,,,7.51,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,63323085325,NDC,facility,outpatient,1,EA,13.65000,12.97000,Amish/Mennonite,Amish Mennonite,,7.51,,,,,,,0.14409,13.24,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,inpatient,1,EA,13.11000,12.46000,Amish/Mennonite,Amish Mennonite,,7.21,,,,,,,7.21,12.72,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML,56627,CDM,250,RC,J1171,HCPCS,76045001011,NDC,facility,outpatient,1,EA,13.11000,12.46000,Amish/Mennonite,Amish Mennonite,,7.21,,,,,,,0.14409,12.72,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
HOMOVANILLIC ACID ASSAY-TECH,56628,CDM,300,RC,83150,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,19.62,1052.52,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,inpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,49.50,87.30,percent of total billed charges,
HGB/RBC FETAL DIFF LYSIS-TECH,56630,CDM,300,RC,85460,CPT,,,facility,outpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,,49.50,,,,,,,7.73,407.44,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,inpatient,5,EA,119.08000,113.13000,Amish/Mennonite,Amish Mennonite,,65.49,,,,,,,65.49,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037505,NDC,facility,outpatient,5,EA,119.08000,113.13000,Amish/Mennonite,Amish Mennonite,,65.49,,,,,,,59.54,115.51,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,inpatient,5,EA,4.55000,4.32000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.50,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,00517037510,NDC,facility,outpatient,5,EA,4.55000,4.32000,Amish/Mennonite,Amish Mennonite,,2.50,,,,,,,2.27,4.41,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,inpatient,5,EA,4.84000,4.60000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.66,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,17478050801,NDC,facility,outpatient,5,EA,4.84000,4.60000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.42,4.69,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,inpatient,5,EA,252.80000,240.16000,Amish/Mennonite,Amish Mennonite,,139.04,,,,,,,139.04,245.22,percent of total billed charges,
INDIGO CARMINE SOLN-INJ 8 MG/ML 5 ML,56632,CDM,250,RC,J3490,HCPCS,81284031505,NDC,facility,outpatient,5,EA,252.80000,240.16000,Amish/Mennonite,Amish Mennonite,,139.04,,,,,,,126.40,245.22,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,99.55,175.57,percent of total billed charges,
HUMAN GROWTH HORMONE ASSAY-TECH,56633,CDM,300,RC,83003,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,16.67,865.84,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,Amish/Mennonite,Amish Mennonite,,1682.45,,,,,,,1682.45,2967.23,percent of total billed charges,
IMAGE GUID FL COL PERI/RETRO-TECH,56634,CDM,361,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,Amish/Mennonite,Amish Mennonite,,1682.45,,,,,,,1538.48,4686.00,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,inpatient,1,EA,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,,63.85,,,,,,,63.85,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,10019092501,NDC,facility,outpatient,1,EA,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,,63.85,,,,,,,37.62,112.62,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,inpatient,1,EA,183.44000,174.27000,Amish/Mennonite,Amish Mennonite,,100.89,,,,,,,100.89,177.94,percent of total billed charges,
IFOSFAMIDE INJECTION,56635,CDM,250,RC,J9208,HCPCS,63323014210,NDC,facility,outpatient,1,EA,183.44000,174.27000,Amish/Mennonite,Amish Mennonite,,100.89,,,,,,,37.62,177.94,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7212017,56636,CDM,250,RC,68180-0518-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,inpatient,10,EA,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,,91.80,,,,,,,91.80,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,00703505103,NDC,facility,outpatient,10,EA,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,,91.80,,,,,,,3.89,161.89,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,inpatient,10,EA,94.35000,89.64000,Amish/Mennonite,Amish Mennonite,,51.89,,,,,,,51.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,43598093109,NDC,facility,outpatient,10,EA,94.35000,89.64000,Amish/Mennonite,Amish Mennonite,,51.89,,,,,,,3.89,91.52,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,inpatient,10,EA,256.40000,243.58000,Amish/Mennonite,Amish Mennonite,,141.02,,,,,,,141.02,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,55566220000,NDC,facility,outpatient,10,EA,256.40000,243.58000,Amish/Mennonite,Amish Mennonite,,141.02,,,,,,,3.89,248.71,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,inpatient,10,EA,185.79000,176.50000,Amish/Mennonite,Amish Mennonite,,102.18,,,,,,,102.18,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089910,NDC,facility,outpatient,10,EA,185.79000,176.50000,Amish/Mennonite,Amish Mennonite,,102.18,,,,,,,3.89,180.22,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,inpatient,10,EA,100.32000,95.31000,Amish/Mennonite,Amish Mennonite,,55.18,,,,,,,55.18,97.31,percent of total billed charges,
INJ DESMOPRESSIN ACETATE 7529465,56637,CDM,636,RC,J2597,HCPCS,69918089911,NDC,facility,outpatient,10,EA,100.32000,95.31000,Amish/Mennonite,Amish Mennonite,,55.18,,,,,,,3.89,97.31,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,90,60.50,,,,,,,60.50,106.70,percent of total billed charges,
IMMUNOGLOBGULINS EA-TECH,56638,CDM,300,RC,82784,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,90,60.50,,,,,,,9.61,492.33,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,inpatient,1,GM,11.69000,11.11000,Amish/Mennonite,Amish Mennonite,,6.43,,,,,,,6.43,11.34,percent of total billed charges,
HYDROCORTISONE POWDER,56639,CDM,250,RC,00574-0420-10,NDC,,,facility,outpatient,1,GM,11.69000,11.11000,Amish/Mennonite,Amish Mennonite,,6.43,,,,,,,5.84,11.34,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,inpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176401,NDC,facility,outpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,00781176413,NDC,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,42291034601,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69315013401,NDC,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,49884005510,NDC,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
IMIPRAMINE TAB 25 MG,56640,CDM,250,RC,J8499,HCPCS,69584042610,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,inpatient,,,475.00000,451.25000,Amish/Mennonite,Amish Mennonite,TC,261.25,,,,,,,261.25,460.75,percent of total billed charges,
IHC AB STAIN INITIAL PER SPEC-TECH,56641,CDM,310,RC,88342,CPT,,,facility,outpatient,,,475.00000,451.25000,Amish/Mennonite,Amish Mennonite,TC,261.25,,,,,,,237.50,3299.19,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
INHIBIN B TUMOR MARKER-TECH,56642,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,17.85,814.87,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,inpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,,145.75,,,,,,,145.75,257.05,percent of total billed charges,
IMMUNO TYPING-TECH,56643,CDM,300,RC,86334,CPT,,,facility,outpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,,145.75,,,,,,,22.34,2082.45,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,inpatient,1,EA,3703.00000,3517.85000,Amish/Mennonite,Amish Mennonite,,2036.65,,,,,,,2036.65,3591.91,percent of total billed charges,
IMUGLUCERASE INJECTION,56644,CDM,636,RC,J1786,HCPCS,58468466301,NDC,facility,outpatient,1,EA,3703.00000,3517.85000,Amish/Mennonite,Amish Mennonite,,2036.65,,,,,,,43.29,3591.91,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,29300-0130-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,50228-0146-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,51079-0776-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,57237-0002-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,59746-0382-06,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 7216800,56645,CDM,250,RC,60687-0683-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,inpatient,1,EA,10.33000,9.82000,Amish/Mennonite,Amish Mennonite,,5.68,,,,,,,5.68,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00378-0373-01,NDC,,,facility,outpatient,1,EA,10.33000,9.82000,Amish/Mennonite,Amish Mennonite,,5.68,,,,,,,5.17,10.02,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-1407-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00781-5994-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,inpatient,1,EA,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,4.11,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-6508-06,NDC,,,facility,outpatient,1,EA,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.73,7.25,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,00904-7046-06,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0110-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,inpatient,1,EA,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.82,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0474-01,NDC,,,facility,outpatient,1,EA,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.48,6.74,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,16714-0753-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,inpatient,1,EA,9.19000,8.73000,Amish/Mennonite,Amish Mennonite,,5.05,,,,,,,5.05,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,42292-0011-06,NDC,,,facility,outpatient,1,EA,9.19000,8.73000,Amish/Mennonite,Amish Mennonite,,5.05,,,,,,,4.59,8.91,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,inpatient,1,EA,4.67000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.57,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,50268-0412-15,NDC,,,facility,outpatient,1,EA,4.67000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.33,4.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,57664-0761-88,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63304-0296-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,inpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.58,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,63739-0777-10,NDC,,,facility,outpatient,1,EA,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.25,6.31,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,66993-0057-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,5.30,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,4.82,9.35,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68084-0269-11,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,68382-0096-05,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
HYDROXYCHLOROQUINE TAB,56646,CDM,250,RC,69238-1544-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,inpatient,,,1160.00000,1102.00000,Amish/Mennonite,Amish Mennonite,TC,638.00,,,,,,,638.00,1125.20,percent of total billed charges,
IN SITU HYBRID MULTIPLEX EACH-TECH,56647,CDM,310,RC,88366,CPT,,,facility,outpatient,,,1160.00000,1102.00000,Amish/Mennonite,Amish Mennonite,TC,638.00,,,,,,,580.00,10163.53,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,inpatient,,,603.00000,572.85000,Amish/Mennonite,Amish Mennonite,,331.65,,,,,,,331.65,584.91,percent of total billed charges,
IN SITU HYBRID 100-300 CELLS-TECH,56648,CDM,310,RC,88275,CPT,,,facility,outpatient,,,603.00000,572.85000,Amish/Mennonite,Amish Mennonite,,331.65,,,,,,,51.19,2410.69,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,inpatient,1,EA,28.05000,26.64000,Amish/Mennonite,Amish Mennonite,,15.43,,,,,,,15.43,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00069001102,NDC,facility,outpatient,1,EA,28.05000,26.64000,Amish/Mennonite,Amish Mennonite,,15.43,,,,,,,2.48,27.21,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,inpatient,1,EA,13.47000,12.80000,Amish/Mennonite,Amish Mennonite,,7.41,,,,,,,7.41,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00409508216,NDC,facility,outpatient,1,EA,13.47000,12.80000,Amish/Mennonite,Amish Mennonite,,7.41,,,,,,,2.48,13.07,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,inpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,00781317780,NDC,facility,outpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,2.48,17.87,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,inpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,9.04,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,25021012720,NDC,facility,outpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,2.48,15.94,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,inpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
CEFTAZIDIME POWD-INJ 1 GM/10 ML,56649,CDM,250,RC,J0713,HCPCS,44567023525,NDC,facility,outpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,2.48,13.79,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,00904661761,NDC,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,10702001101,NDC,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008204,NDC,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,16714008210,NDC,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,23155050101,NDC,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079053120,NDC,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,51079080620,NDC,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025401,NDC,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,63739048610,NDC,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
HYDROXYZINE HCL TAB 25 MG,56650,CDM,250,RC,J8499,HCPCS,68084025411,NDC,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,inpatient,0.5,mL,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,7.64,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00264570510,NDC,facility,outpatient,0.5,mL,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,0.33945,13.48,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,inpatient,0.5,mL,18.14000,17.23000,Amish/Mennonite,Amish Mennonite,,9.98,,,,,,,9.98,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,00409131632,NDC,facility,outpatient,0.5,mL,18.14000,17.23000,Amish/Mennonite,Amish Mennonite,,9.98,,,,,,,0.33945,17.60,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,inpatient,0.5,mL,9.67000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323011805,NDC,facility,outpatient,0.5,mL,9.67000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,0.33945,9.38,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,inpatient,0.5,mL,35.83000,34.04000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,19.71,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,63323054313,NDC,facility,outpatient,0.5,mL,35.83000,34.04000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,0.33945,34.76,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,inpatient,0.5,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71288040581,NDC,facility,outpatient,0.5,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,0.33945,26.05,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,inpatient,0.5,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
"HEPARIN SOLN 5,000 UNITS/0.5 ML",56651,CDM,250,RC,J1644,HCPCS,71839011825,NDC,facility,outpatient,0.5,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,0.33945,24.52,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,Amish/Mennonite,Amish Mennonite,90,126.78,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGG SO-TECH,56652,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,Amish/Mennonite,Amish Mennonite,90,126.78,,,,,,,45.08,679.08,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
HEPATITIS A AB IGM-TECH,56653,CDM,300,RC,86709,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,11.26,594.19,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,inpatient,10,EA,173.44000,164.76000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,95.39,168.24,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379401,NDC,facility,outpatient,10,EA,173.44000,164.76000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,86.72,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,inpatient,10,EA,142.92000,135.77000,Amish/Mennonite,Amish Mennonite,,78.61,,,,,,,78.61,138.63,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,00009379422,NDC,facility,outpatient,10,EA,142.92000,135.77000,Amish/Mennonite,Amish Mennonite,,78.61,,,,,,,71.46,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,inpatient,10,EA,94.26000,89.55000,Amish/Mennonite,Amish Mennonite,,51.84,,,,,,,51.84,91.43,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,23155032631,NDC,facility,outpatient,10,EA,94.26000,89.55000,Amish/Mennonite,Amish Mennonite,,51.84,,,,,,,47.13,340.40,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,inpatient,10,EA,71.43000,67.85000,Amish/Mennonite,Amish Mennonite,,39.29,,,,,,,39.29,69.29,percent of total billed charges,
IBUTILIDE FUMARATE INJECTION,56654,CDM,636,RC,J1742,HCPCS,67457036610,NDC,facility,outpatient,10,EA,71.43000,67.85000,Amish/Mennonite,Amish Mennonite,,39.29,,,,,,,35.72,340.40,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,inpatient,1,mL,211.33000,200.76000,Amish/Mennonite,Amish Mennonite,,116.23,,,,,,,116.23,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,00075245153,NDC,facility,outpatient,1,mL,211.33000,200.76000,Amish/Mennonite,Amish Mennonite,,116.23,,,,,,,3.89,204.99,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,39822625001,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,3.89,61.30,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,inpatient,1,mL,165.90000,157.60000,Amish/Mennonite,Amish Mennonite,,91.25,,,,,,,91.25,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,70860045410,NDC,facility,outpatient,1,mL,165.90000,157.60000,Amish/Mennonite,Amish Mennonite,,91.25,,,,,,,3.89,160.92,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,inpatient,1,mL,259.60000,246.62000,Amish/Mennonite,Amish Mennonite,,142.78,,,,,,,142.78,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,55566230000,NDC,facility,outpatient,1,mL,259.60000,246.62000,Amish/Mennonite,Amish Mennonite,,142.78,,,,,,,3.89,251.81,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,inpatient,1,mL,187.77000,178.38000,Amish/Mennonite,Amish Mennonite,,103.27,,,,,,,103.27,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,62756052940,NDC,facility,outpatient,1,mL,187.77000,178.38000,Amish/Mennonite,Amish Mennonite,,103.27,,,,,,,3.89,182.14,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,inpatient,1,mL,188.08000,178.68000,Amish/Mennonite,Amish Mennonite,,103.44,,,,,,,103.44,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090110,NDC,facility,outpatient,1,mL,188.08000,178.68000,Amish/Mennonite,Amish Mennonite,,103.44,,,,,,,3.89,182.44,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,inpatient,1,mL,101.57000,96.49000,Amish/Mennonite,Amish Mennonite,,55.86,,,,,,,55.86,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,69918090111,NDC,facility,outpatient,1,mL,101.57000,96.49000,Amish/Mennonite,Amish Mennonite,,55.86,,,,,,,3.89,98.52,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,inpatient,1,mL,124.82000,118.58000,Amish/Mennonite,Amish Mennonite,,68.65,,,,,,,68.65,121.08,percent of total billed charges,
DESMOPRESSIN SOLN 4 MCG/ML 10 ML MDV,56655,CDM,636,RC,J2597,HCPCS,83634045110,NDC,facility,outpatient,1,mL,124.82000,118.58000,Amish/Mennonite,Amish Mennonite,,68.65,,,,,,,3.89,121.08,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,inpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,264.00,465.60,percent of total billed charges,
INFECT DETECT DNA MULTIPLE-TECH,56656,CDM,300,RC,87800,CPT,,,facility,outpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,28.92,2088.15,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,inpatient,1,EA,801.42000,761.35000,Amish/Mennonite,Amish Mennonite,,440.78,,,,,,,440.78,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,00054-1950-30,NDC,,,facility,outpatient,1,EA,801.42000,761.35000,Amish/Mennonite,Amish Mennonite,,440.78,,,,,,,400.71,777.38,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,inpatient,1,EA,483.89000,459.70000,Amish/Mennonite,Amish Mennonite,,266.14,,,,,,,266.14,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,42211-0102-43,NDC,,,facility,outpatient,1,EA,483.89000,459.70000,Amish/Mennonite,Amish Mennonite,,266.14,,,,,,,241.94,469.37,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,inpatient,1,EA,937.33000,890.47000,Amish/Mennonite,Amish Mennonite,,515.53,,,,,,,515.53,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,69344-0102-33,NDC,,,facility,outpatient,1,EA,937.33000,890.47000,Amish/Mennonite,Amish Mennonite,,515.53,,,,,,,468.67,909.21,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,inpatient,1,EA,890.47000,845.94000,Amish/Mennonite,Amish Mennonite,,489.76,,,,,,,489.76,863.76,percent of total billed charges,
INDOMETHACIN SUPP 50 MG,56657,CDM,250,RC,70710-1852-07,NDC,,,facility,outpatient,1,EA,890.47000,845.94000,Amish/Mennonite,Amish Mennonite,,489.76,,,,,,,445.24,863.76,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,Amish/Mennonite,Amish Mennonite,,633.05,,,,,,,633.05,1116.47,percent of total billed charges,
INJ ANES/STRD SI JT W IMG GUID-TECH,56658,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,Amish/Mennonite,Amish Mennonite,,633.05,,,,,,,633.05,3163.00,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,inpatient,,,3081.00000,2926.95000,Amish/Mennonite,Amish Mennonite,,1694.55,,,,,,,1694.55,2988.57,percent of total billed charges,
HEPATITIS C GENOTYPING-TECH,56659,CDM,300,RC,87902,CPT,,,facility,outpatient,,,3081.00000,2926.95000,Amish/Mennonite,Amish Mennonite,,1694.55,,,,,,,257.45,13462.44,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,inpatient,1,EA,8055.92000,7653.13000,Amish/Mennonite,Amish Mennonite,,4430.76,,,,,,,4430.76,7814.24,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910073,56660,CDM,636,RC,J9354,HCPCS,50242008801,NDC,facility,outpatient,1,EA,8055.92000,7653.13000,Amish/Mennonite,Amish Mennonite,,4430.76,,,,,,,41.85,7814.24,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,inpatient,,,333.00000,316.35000,Amish/Mennonite,Amish Mennonite,,183.15,,,,,,,183.15,323.01,percent of total billed charges,
IMMUNOFIXATION URINE-TECH,56661,CDM,300,RC,86335,CPT,,,facility,outpatient,,,333.00000,316.35000,Amish/Mennonite,Amish Mennonite,,183.15,,,,,,,29.35,2438.99,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,79.75,140.65,percent of total billed charges,
IMMOBILIZER/SPLINT APPLIED-TX DONE-TECH,56662,CDM,361,RC,,,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,79.75,5271.00,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,inpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00409381512,NDC,facility,outpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,inpatient,10,EA,9.15000,8.69000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,5.03,8.88,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,00641601910,NDC,facility,outpatient,10,EA,9.15000,8.69000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,4.58,17.80,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,inpatient,10,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
MORPHINE SOLN PF 1 MG/ML 10 ML,56663,CDM,250,RC,J2274,HCPCS,60977001701,NDC,facility,outpatient,10,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,17.80,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,inpatient,1,EA,11830.90000,11239.36000,Amish/Mennonite,Amish Mennonite,,6506.99,,,,,,,6506.99,11475.97,percent of total billed charges,
INJ ADO-TRASTUZUMAB EMT 7910074,56664,CDM,636,RC,J9354,HCPCS,50242008701,NDC,facility,outpatient,1,EA,11830.90000,11239.36000,Amish/Mennonite,Amish Mennonite,,6506.99,,,,,,,41.85,11475.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,inpatient,1,mL,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00069005903,NDC,facility,outpatient,1,mL,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,0.33945,3.70,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,inpatient,1,mL,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,4.96,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409140212,NDC,facility,outpatient,1,mL,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,0.33945,8.74,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,inpatient,1,mL,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.51,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00409272301,NDC,facility,outpatient,1,mL,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,0.33945,6.19,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,inpatient,1,mL,8.10000,7.70000,Amish/Mennonite,Amish Mennonite,,4.46,,,,,,,4.46,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,00641040012,NDC,facility,outpatient,1,mL,8.10000,7.70000,Amish/Mennonite,Amish Mennonite,,4.46,,,,,,,0.33945,7.86,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,inpatient,1,mL,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,25021040201,NDC,facility,outpatient,1,mL,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,0.33945,7.97,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,inpatient,1,mL,13.15000,12.49000,Amish/Mennonite,Amish Mennonite,,7.23,,,,,,,7.23,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026206,NDC,facility,outpatient,1,mL,13.15000,12.49000,Amish/Mennonite,Amish Mennonite,,7.23,,,,,,,0.33945,12.76,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,inpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026226,NDC,facility,outpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,0.33945,3.71,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,inpatient,1,mL,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63323026255,NDC,facility,outpatient,1,mL,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,0.33945,4.14,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,inpatient,1,mL,10.65000,10.12000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,5.86,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,63739095325,NDC,facility,outpatient,1,mL,10.65000,10.12000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,0.33945,10.33,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,inpatient,1,mL,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,5.20,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,67457037499,NDC,facility,outpatient,1,mL,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,0.33945,9.17,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,inpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,71288040302,NDC,facility,outpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,0.33945,5.82,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,inpatient,1,mL,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,72603041225,NDC,facility,outpatient,1,mL,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,0.33945,4.83,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,inpatient,1,mL,12.17000,11.56000,Amish/Mennonite,Amish Mennonite,,6.69,,,,,,,6.69,11.80,percent of total billed charges,
HEPARIN SOLN 5000 UNITS/ML,56665,CDM,250,RC,J1644,HCPCS,76045010810,NDC,facility,outpatient,1,mL,12.17000,11.56000,Amish/Mennonite,Amish Mennonite,,6.69,,,,,,,0.33945,11.80,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,inpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,52.80,93.12,percent of total billed charges,
INHIBIN A-TECH,56666,CDM,300,RC,86336,CPT,,,facility,outpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,15.59,814.87,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,inpatient,0.4,EA,241.18000,229.12000,Amish/Mennonite,Amish Mennonite,,132.65,,,,,,,132.65,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075062040,NDC,facility,outpatient,0.4,EA,241.18000,229.12000,Amish/Mennonite,Amish Mennonite,,132.65,,,,,,,0.79980,233.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,inpatient,0.4,EA,113.78000,108.09000,Amish/Mennonite,Amish Mennonite,,62.58,,,,,,,62.58,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801401,NDC,facility,outpatient,0.4,EA,113.78000,108.09000,Amish/Mennonite,Amish Mennonite,,62.58,,,,,,,0.79980,110.37,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,inpatient,0.4,EA,261.30000,248.24000,Amish/Mennonite,Amish Mennonite,,143.72,,,,,,,143.72,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00075801410,NDC,facility,outpatient,0.4,EA,261.30000,248.24000,Amish/Mennonite,Amish Mennonite,,143.72,,,,,,,0.79980,253.46,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,inpatient,0.4,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288041083,NDC,facility,outpatient,0.4,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,inpatient,0.4,EA,26.46000,25.14000,Amish/Mennonite,Amish Mennonite,,14.55,,,,,,,14.55,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00548563200,NDC,facility,outpatient,0.4,EA,26.46000,25.14000,Amish/Mennonite,Amish Mennonite,,14.55,,,,,,,0.79980,25.67,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,inpatient,0.4,EA,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,31.84,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00703854023,NDC,facility,outpatient,0.4,EA,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,0.79980,56.16,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,inpatient,0.4,EA,70.55000,67.03000,Amish/Mennonite,Amish Mennonite,,38.80,,,,,,,38.80,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00781324664,NDC,facility,outpatient,0.4,EA,70.55000,67.03000,Amish/Mennonite,Amish Mennonite,,38.80,,,,,,,0.79980,68.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,inpatient,0.4,EA,86.73000,82.39000,Amish/Mennonite,Amish Mennonite,,47.70,,,,,,,47.70,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,00955100410,NDC,facility,outpatient,0.4,EA,86.73000,82.39000,Amish/Mennonite,Amish Mennonite,,47.70,,,,,,,0.79980,84.13,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,inpatient,0.4,EA,61.62000,58.54000,Amish/Mennonite,Amish Mennonite,,33.89,,,,,,,33.89,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,16714001610,NDC,facility,outpatient,0.4,EA,61.62000,58.54000,Amish/Mennonite,Amish Mennonite,,33.89,,,,,,,0.79980,59.77,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,inpatient,0.4,EA,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,,24.42,,,,,,,24.42,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,60505079204,NDC,facility,outpatient,0.4,EA,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,,24.42,,,,,,,0.79980,43.07,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,inpatient,0.4,EA,62.73000,59.59000,Amish/Mennonite,Amish Mennonite,,34.50,,,,,,,34.50,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323053587,NDC,facility,outpatient,0.4,EA,62.73000,59.59000,Amish/Mennonite,Amish Mennonite,,34.50,,,,,,,0.79980,60.85,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,inpatient,0.4,EA,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,17.42,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056896,NDC,facility,outpatient,0.4,EA,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,0.79980,30.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,inpatient,0.4,EA,29.07000,27.62000,Amish/Mennonite,Amish Mennonite,,15.99,,,,,,,15.99,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71288043383,NDC,facility,outpatient,0.4,EA,29.07000,27.62000,Amish/Mennonite,Amish Mennonite,,15.99,,,,,,,0.79980,28.20,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,inpatient,0.4,EA,25.09000,23.84000,Amish/Mennonite,Amish Mennonite,,13.80,,,,,,,13.80,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,63323056887,NDC,facility,outpatient,0.4,EA,25.09000,23.84000,Amish/Mennonite,Amish Mennonite,,13.80,,,,,,,0.79980,24.34,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,inpatient,0.4,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,19.99,35.25,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7034275,56667,CDM,250,RC,J1650,HCPCS,71839011010,NDC,facility,outpatient,0.4,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,0.79980,35.25,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,inpatient,1,EA,78.48000,74.56000,Amish/Mennonite,Amish Mennonite,,43.16,,,,,,,43.16,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075062300,NDC,facility,outpatient,1,EA,78.48000,74.56000,Amish/Mennonite,Amish Mennonite,,43.16,,,,,,,0.79980,76.13,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,inpatient,1,EA,67.53000,64.15000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,37.14,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00075802010,NDC,facility,outpatient,1,EA,67.53000,64.15000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,0.79980,65.50,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,inpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288041089,NDC,facility,outpatient,1,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.79980,45.98,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,inpatient,1,EA,31.73000,30.14000,Amish/Mennonite,Amish Mennonite,,17.45,,,,,,,17.45,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060594,NDC,facility,outpatient,1,EA,31.73000,30.14000,Amish/Mennonite,Amish Mennonite,,17.45,,,,,,,0.79980,30.78,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,inpatient,1,EA,62.82000,59.68000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,34.55,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,63323060584,NDC,facility,outpatient,1,EA,62.82000,59.68000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,0.79980,60.94,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,inpatient,1,EA,70.63000,67.10000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00781326869,NDC,facility,outpatient,1,EA,70.63000,67.10000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,inpatient,1,EA,21.05000,20.00000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,11.58,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,00955101010,NDC,facility,outpatient,1,EA,21.05000,20.00000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,0.79980,20.42,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,inpatient,1,EA,60.99000,57.94000,Amish/Mennonite,Amish Mennonite,,33.54,,,,,,,33.54,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,16714004610,NDC,facility,outpatient,1,EA,60.99000,57.94000,Amish/Mennonite,Amish Mennonite,,33.54,,,,,,,0.79980,59.16,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,inpatient,1,EA,27.71000,26.33000,Amish/Mennonite,Amish Mennonite,,15.24,,,,,,,15.24,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,25021041071,NDC,facility,outpatient,1,EA,27.71000,26.33000,Amish/Mennonite,Amish Mennonite,,15.24,,,,,,,0.79980,26.88,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,inpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,16.20,28.57,percent of total billed charges,
ENOXAPARIN SOLN 100 MG/ML,56668,CDM,250,RC,J1650,HCPCS,71288043689,NDC,facility,outpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,0.79980,28.57,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,inpatient,28.35,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00168-0154-31,NDC,,,facility,outpatient,28.35,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,inpatient,28.35,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00472-0321-26,NDC,,,facility,outpatient,28.35,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,inpatient,28.35,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,00603-0535-50,NDC,,,facility,outpatient,28.35,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,inpatient,28.35,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,45802-0438-03,NDC,,,facility,outpatient,28.35,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,inpatient,28.35,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,51672-3004-02,NDC,,,facility,outpatient,28.35,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,inpatient,28.35,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
HYDROCORTISONE TOPICAL CREAM 1%,56669,CDM,250,RC,64980-0302-30,NDC,,,facility,outpatient,28.35,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,108.35,191.09,percent of total billed charges,
INHALATION THERAPY DEMO-TECH,56670,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,98.50,212.44,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,inpatient,1,EA,30.18000,28.68000,Amish/Mennonite,Amish Mennonite,,16.60,,,,,,,16.60,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00409508411,NDC,facility,outpatient,1,EA,30.18000,28.68000,Amish/Mennonite,Amish Mennonite,,16.60,,,,,,,2.48,29.27,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,inpatient,1,EA,50.50000,47.97000,Amish/Mennonite,Amish Mennonite,,27.77,,,,,,,27.77,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,00781317891,NDC,facility,outpatient,1,EA,50.50000,47.97000,Amish/Mennonite,Amish Mennonite,,27.77,,,,,,,2.48,48.98,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,25021012850,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,2.48,33.72,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
CEFTAZIDIME POWD-INJ 2 GM/11.5 ML,56671,CDM,250,RC,J0713,HCPCS,44567023610,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,2.48,30.65,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,inpatient,,,160.90000,152.85000,Amish/Mennonite,Amish Mennonite,90,88.50,,,,,,,88.50,156.07,percent of total billed charges,
IMMUNOGLOBIN SUBCLASSES EA-TECH,56672,CDM,300,RC,82787,CPT,,,facility,outpatient,,,160.90000,152.85000,Amish/Mennonite,Amish Mennonite,90,88.50,,,,,,,5.90,424.40,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,inpatient,5,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.73,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00409263405,NDC,facility,outpatient,5,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,0.14409,6.58,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,inpatient,5,EA,5.95000,5.66000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,3.27,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,00703011303,NDC,facility,outpatient,5,EA,5.95000,5.66000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,0.14409,5.77,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,inpatient,5,EA,4.35000,4.14000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,17478054005,NDC,facility,outpatient,5,EA,4.35000,4.14000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,0.14409,4.22,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,inpatient,5,EA,8.78000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,4.83,8.52,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML 5 ML,56673,CDM,250,RC,J1171,HCPCS,63323085115,NDC,facility,outpatient,5,EA,8.78000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,0.14409,8.52,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,31722-0542-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,50268-0430-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,51079-0190-20,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
INDOMETHACIN CAP,56674,CDM,250,RC,68462-0406-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP-TECH,56675,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,104.50,212.44,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,inpatient,1,mL,1728.59000,1642.16000,Amish/Mennonite,Amish Mennonite,,950.72,,,,,,,950.72,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092410,NDC,facility,outpatient,1,mL,1728.59000,1642.16000,Amish/Mennonite,Amish Mennonite,,950.72,,,,,,,0.99000,1676.73,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,inpatient,1,mL,1728.57000,1642.14000,Amish/Mennonite,Amish Mennonite,,950.71,,,,,,,950.71,1676.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 300 MCG,56676,CDM,636,RC,J1442,HCPCS,55513092491,NDC,facility,outpatient,1,mL,1728.57000,1642.14000,Amish/Mennonite,Amish Mennonite,,950.71,,,,,,,0.99000,1676.71,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,inpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,TC,258.50,,,,,,,258.50,455.90,percent of total billed charges,
IHC AB STAIN EA ADDL PER SPEC-TECH,56677,CDM,310,RC,88341,CPT,,,facility,outpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,TC,258.50,,,,,,,215.60,3038.81,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,00904-6618-61,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,10702-0012-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,16714-0083-04,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0532-20,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,51079-0816-20,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROXYZINE HCL TAB 7214216,56678,CDM,250,RC,68084-0255-11,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,inpatient,1,mL,5.66000,5.38000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.49,percent of total billed charges,
IFOSFAMIDE INJECTION 7910293,56679,CDM,250,RC,J9208,HCPCS,00703342911,NDC,facility,outpatient,1,mL,5.66000,5.38000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,2.83,40.87,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,inpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,TC,261.80,,,,,,,261.80,461.72,percent of total billed charges,
IHC MORPHMETRIC ANAL EA AB-TECH,56680,CDM,310,RC,88360,CPT,,,facility,outpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,TC,261.80,,,,,,,238.00,3910.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,inpatient,1,mL,52.80000,50.16000,Amish/Mennonite,Amish Mennonite,,29.04,,,,,,,29.04,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026609,NDC,facility,outpatient,1,mL,52.80000,50.16000,Amish/Mennonite,Amish Mennonite,,29.04,,,,,,,1.42,51.22,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,inpatient,1,mL,49.77000,47.28000,Amish/Mennonite,Amish Mennonite,,27.37,,,,,,,27.37,48.28,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 20 ML,56681,CDM,636,RC,J0666,HCPCS,65250026620,NDC,facility,outpatient,1,mL,49.77000,47.28000,Amish/Mennonite,Amish Mennonite,,27.37,,,,,,,1.42,48.28,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,inpatient,20,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234401,NDC,facility,outpatient,20,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,inpatient,20,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234402,NDC,facility,outpatient,20,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,inpatient,20,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,00409234488,NDC,facility,outpatient,20,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,13.53,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,inpatient,20,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
INJ DOBUTAMINE HCL/250 MG 7002066,56682,CDM,250,RC,J1250,HCPCS,70436020382,NDC,facility,outpatient,20,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,13.53,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,inpatient,,,351.00000,333.45000,Amish/Mennonite,Amish Mennonite,,193.05,,,,,,,193.05,340.47,percent of total billed charges,
ED I&D WOUND -TECH,56683,CDM,450,RC,,,,,facility,outpatient,,,351.00000,333.45000,Amish/Mennonite,Amish Mennonite,,193.05,,,,,,,175.50,340.47,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,inpatient,,,839.00000,797.05000,Amish/Mennonite,Amish Mennonite,TC,461.45,,,,,,,461.45,813.83,percent of total billed charges,
IN SITU HYBRID INITIAL PROBE-TECH,56684,CDM,310,RC,88365,CPT,,,facility,outpatient,,,839.00000,797.05000,Amish/Mennonite,Amish Mennonite,TC,461.45,,,,,,,419.50,6479.64,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,inpatient,1,EA,16.22000,15.41000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.92,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054207,NDC,facility,outpatient,1,EA,16.22000,15.41000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,0.33945,15.73,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,inpatient,1,EA,6.66000,6.33000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,3.66,6.46,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7003015,56685,CDM,250,RC,J1644,HCPCS,63323054214,NDC,facility,outpatient,1,EA,6.66000,6.33000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,0.33945,6.46,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,inpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,,549.45,,,,,,,549.45,969.03,percent of total billed charges,
INJ HIP XR-TECH,56686,CDM,361,RC,27093,CPT,,,facility,outpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,,549.45,,,,,,,549.45,5271.00,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,inpatient,1,mL,292.42000,277.80000,Amish/Mennonite,Amish Mennonite,,160.83,,,,,,,160.83,283.65,percent of total billed charges,
INJ FERRIC CARBOXYMALTOS,56688,CDM,636,RC,J1439,HCPCS,00517065001,NDC,facility,outpatient,1,mL,292.42000,277.80000,Amish/Mennonite,Amish Mennonite,,160.83,,,,,,,1.14,283.65,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,inpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,162.25,286.15,percent of total billed charges,
INF AGENT DETECT PCR AMPL PROBE-TECH,56689,CDM,300,RC,87801,CPT,,,facility,outpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,50.62,3666.93,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,90,155.65,,,,,,,155.65,274.51,percent of total billed charges,
IMMUNE COMPLEX PROFILE-TECH,56690,CDM,300,RC,86332,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,90,155.65,,,,,,,25.18,1273.27,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,inpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,,299.75,,,,,,,299.75,528.65,percent of total billed charges,
INJ CONTRAST KNEE ARTHOGRAPHY-TECH,56691,CDM,361,RC,27369,CPT,,,facility,outpatient,,,545.00000,517.75000,Amish/Mennonite,Amish Mennonite,,299.75,,,,,,,299.75,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,inpatient,0.8,EA,261.61000,248.53000,Amish/Mennonite,Amish Mennonite,,143.89,,,,,,,143.89,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075062280,NDC,facility,outpatient,0.8,EA,261.61000,248.53000,Amish/Mennonite,Amish Mennonite,,143.89,,,,,,,0.79980,253.76,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,inpatient,0.8,EA,67.52000,64.14000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,37.14,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00075801810,NDC,facility,outpatient,0.8,EA,67.52000,64.14000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,0.79980,65.49,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,inpatient,0.8,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00548560400,NDC,facility,outpatient,0.8,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,0.79980,36.78,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,inpatient,0.8,EA,31.72000,30.13000,Amish/Mennonite,Amish Mennonite,,17.45,,,,,,,17.45,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056899,NDC,facility,outpatient,0.8,EA,31.72000,30.13000,Amish/Mennonite,Amish Mennonite,,17.45,,,,,,,0.79980,30.77,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,inpatient,0.8,EA,62.80000,59.66000,Amish/Mennonite,Amish Mennonite,,34.54,,,,,,,34.54,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323056890,NDC,facility,outpatient,0.8,EA,62.80000,59.66000,Amish/Mennonite,Amish Mennonite,,34.54,,,,,,,0.79980,60.92,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,inpatient,0.8,EA,70.63000,67.09000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,38.85,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00781326268,NDC,facility,outpatient,0.8,EA,70.63000,67.09000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,0.79980,68.51,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,inpatient,0.8,EA,235.19000,223.43000,Amish/Mennonite,Amish Mennonite,,129.35,,,,,,,129.35,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,00955100810,NDC,facility,outpatient,0.8,EA,235.19000,223.43000,Amish/Mennonite,Amish Mennonite,,129.35,,,,,,,0.79980,228.13,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,inpatient,0.8,EA,62.41000,59.29000,Amish/Mennonite,Amish Mennonite,,34.33,,,,,,,34.33,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,16714003610,NDC,facility,outpatient,0.8,EA,62.41000,59.29000,Amish/Mennonite,Amish Mennonite,,34.33,,,,,,,0.79980,60.54,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,inpatient,0.8,EA,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,,24.42,,,,,,,24.42,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,60505079404,NDC,facility,outpatient,0.8,EA,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,,24.42,,,,,,,0.79980,43.07,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,inpatient,0.8,EA,20.30000,19.28000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,11.16,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,63323058465,NDC,facility,outpatient,0.8,EA,20.30000,19.28000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,0.79980,19.69,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,inpatient,0.8,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,16.08,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288043587,NDC,facility,outpatient,0.8,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,0.79980,28.35,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,inpatient,0.8,EA,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,31.28,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71288041087,NDC,facility,outpatient,0.8,EA,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,0.79980,55.17,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,inpatient,0.8,EA,32.39000,30.77000,Amish/Mennonite,Amish Mennonite,,17.81,,,,,,,17.81,31.42,percent of total billed charges,
ENOXAPARIN SOLN 80 MG/0.8 ML,56692,CDM,250,RC,J1650,HCPCS,71839011210,NDC,facility,outpatient,0.8,EA,32.39000,30.77000,Amish/Mennonite,Amish Mennonite,,17.81,,,,,,,0.79980,31.42,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,inpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,9.32,16.43,percent of total billed charges,
INJ CEFTAZIDIME PER 500 MG 7856073,56693,CDM,250,RC,J0713,HCPCS,00409509216,NDC,facility,outpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,2.48,16.43,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,inpatient,1,mL,1720.49000,1634.47000,Amish/Mennonite,Amish Mennonite,,946.27,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020910,NDC,facility,outpatient,1,mL,1720.49000,1634.47000,Amish/Mennonite,Amish Mennonite,,946.27,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,inpatient,1,mL,1720.50000,1634.48000,Amish/Mennonite,Amish Mennonite,,946.27,,,,,,,946.27,1668.88,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 480 MCG,56694,CDM,636,RC,J1442,HCPCS,55513020991,NDC,facility,outpatient,1,mL,1720.50000,1634.48000,Amish/Mennonite,Amish Mennonite,,946.27,,,,,,,0.99000,1668.88,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,inpatient,100,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00264440054,NDC,facility,outpatient,100,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,inpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00338170940,NDC,facility,outpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,inpatient,100,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,00409672723,NDC,facility,outpatient,100,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,inpatient,100,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,44567041024,NDC,facility,outpatient,100,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,inpatient,100,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,63323010801,NDC,facility,outpatient,100,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,inpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003792,56695,CDM,250,RC,J3475,HCPCS,67457056700,NDC,facility,outpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.82500,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,282.15,497.61,percent of total billed charges,
IMMUNOFL INITIAL AB STAIN-TECH,56696,CDM,312,RC,88346,CPT,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,256.50,4266.89,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,inpatient,1,EA,953.25000,905.59000,Amish/Mennonite,Amish Mennonite,,524.29,,,,,,,524.29,924.65,percent of total billed charges,
INJ ESTROGEN CONJUGATE,56698,CDM,636,RC,J1410,HCPCS,00046074905,NDC,facility,outpatient,1,EA,953.25000,905.59000,Amish/Mennonite,Amish Mennonite,,524.29,,,,,,,390.74,924.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,inpatient,0.6,EA,261.61000,248.53000,Amish/Mennonite,Amish Mennonite,,143.89,,,,,,,143.89,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075062160,NDC,facility,outpatient,0.6,EA,261.61000,248.53000,Amish/Mennonite,Amish Mennonite,,143.89,,,,,,,0.79980,253.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,inpatient,0.6,EA,67.53000,64.16000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,37.14,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00075801610,NDC,facility,outpatient,0.6,EA,67.53000,64.16000,Amish/Mennonite,Amish Mennonite,,37.14,,,,,,,0.79980,65.50,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,inpatient,0.6,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00548560300,NDC,facility,outpatient,0.6,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,inpatient,0.6,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,25021041077,NDC,facility,outpatient,0.6,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,0.79980,30.65,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,inpatient,0.6,EA,62.83000,59.69000,Amish/Mennonite,Amish Mennonite,,34.56,,,,,,,34.56,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056888,NDC,facility,outpatient,0.6,EA,62.83000,59.69000,Amish/Mennonite,Amish Mennonite,,34.56,,,,,,,0.79980,60.95,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,inpatient,0.6,EA,70.64000,67.10000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,38.85,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,00781325666,NDC,facility,outpatient,0.6,EA,70.64000,67.10000,Amish/Mennonite,Amish Mennonite,,38.85,,,,,,,0.79980,68.52,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,inpatient,0.6,EA,62.15000,59.04000,Amish/Mennonite,Amish Mennonite,,34.18,,,,,,,34.18,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,16714002610,NDC,facility,outpatient,0.6,EA,62.15000,59.04000,Amish/Mennonite,Amish Mennonite,,34.18,,,,,,,0.79980,60.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,inpatient,0.6,EA,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,15.55,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,71288043485,NDC,facility,outpatient,0.6,EA,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,0.79980,27.43,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,inpatient,0.6,EA,30.65000,29.12000,Amish/Mennonite,Amish Mennonite,,16.86,,,,,,,16.86,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056698,NDC,facility,outpatient,0.6,EA,30.65000,29.12000,Amish/Mennonite,Amish Mennonite,,16.86,,,,,,,0.79980,29.73,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,inpatient,0.6,EA,31.71000,30.12000,Amish/Mennonite,Amish Mennonite,,17.44,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323056898,NDC,facility,outpatient,0.6,EA,31.71000,30.12000,Amish/Mennonite,Amish Mennonite,,17.44,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,inpatient,0.6,EA,62.82000,59.68000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,34.55,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060788,NDC,facility,outpatient,0.6,EA,62.82000,59.68000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,0.79980,60.94,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,inpatient,0.6,EA,30.55000,29.02000,Amish/Mennonite,Amish Mennonite,,16.80,,,,,,,16.80,29.63,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003676,56700,CDM,250,RC,J1650,HCPCS,63323060798,NDC,facility,outpatient,0.6,EA,30.55000,29.02000,Amish/Mennonite,Amish Mennonite,,16.80,,,,,,,0.79980,29.63,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,inpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,545.05,961.27,percent of total billed charges,
IHC MULTIPLEX AB STAIN EACH-TECH,56701,CDM,310,RC,88344,CPT,,,facility,outpatient,,,991.00000,941.45000,Amish/Mennonite,Amish Mennonite,TC,545.05,,,,,,,495.50,6355.04,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,inpatient,0.3,EA,261.31000,248.25000,Amish/Mennonite,Amish Mennonite,,143.72,,,,,,,143.72,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075062430,NDC,facility,outpatient,0.3,EA,261.31000,248.25000,Amish/Mennonite,Amish Mennonite,,143.72,,,,,,,0.79980,253.47,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,inpatient,0.3,EA,67.57000,64.19000,Amish/Mennonite,Amish Mennonite,,37.16,,,,,,,37.16,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00075801310,NDC,facility,outpatient,0.3,EA,67.57000,64.19000,Amish/Mennonite,Amish Mennonite,,37.16,,,,,,,0.79980,65.54,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,inpatient,0.3,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548560100,NDC,facility,outpatient,0.3,EA,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.79980,45.98,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,inpatient,0.3,EA,21.55000,20.47000,Amish/Mennonite,Amish Mennonite,,11.85,,,,,,,11.85,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00548563100,NDC,facility,outpatient,0.3,EA,21.55000,20.47000,Amish/Mennonite,Amish Mennonite,,11.85,,,,,,,0.79980,20.90,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,inpatient,0.3,EA,62.88000,59.74000,Amish/Mennonite,Amish Mennonite,,34.58,,,,,,,34.58,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055993,NDC,facility,outpatient,0.3,EA,62.88000,59.74000,Amish/Mennonite,Amish Mennonite,,34.58,,,,,,,0.79980,60.99,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,inpatient,0.3,EA,21.57000,20.49000,Amish/Mennonite,Amish Mennonite,,11.86,,,,,,,11.86,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,00955100310,NDC,facility,outpatient,0.3,EA,21.57000,20.49000,Amish/Mennonite,Amish Mennonite,,11.86,,,,,,,0.79980,20.92,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,inpatient,0.3,EA,102.07000,96.96000,Amish/Mennonite,Amish Mennonite,,56.14,,,,,,,56.14,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,16714000610,NDC,facility,outpatient,0.3,EA,102.07000,96.96000,Amish/Mennonite,Amish Mennonite,,56.14,,,,,,,0.79980,99.01,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,inpatient,0.3,EA,31.71000,30.12000,Amish/Mennonite,Amish Mennonite,,17.44,,,,,,,17.44,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323056894,NDC,facility,outpatient,0.3,EA,31.71000,30.12000,Amish/Mennonite,Amish Mennonite,,17.44,,,,,,,0.79980,30.76,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,inpatient,0.3,EA,29.18000,27.72000,Amish/Mennonite,Amish Mennonite,,16.05,,,,,,,16.05,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,63323055965,NDC,facility,outpatient,0.3,EA,29.18000,27.72000,Amish/Mennonite,Amish Mennonite,,16.05,,,,,,,0.79980,28.30,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,inpatient,0.3,EA,29.17000,27.71000,Amish/Mennonite,Amish Mennonite,,16.04,,,,,,,16.04,28.29,percent of total billed charges,
INJ ENOXAPARIN SODIUM 7003619,56702,CDM,250,RC,J1650,HCPCS,71288043281,NDC,facility,outpatient,0.3,EA,29.17000,27.71000,Amish/Mennonite,Amish Mennonite,,16.04,,,,,,,0.79980,28.29,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,inpatient,10,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00409272002,NDC,facility,outpatient,10,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.33945,0.88270,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,00781354025,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.33945,1.08,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,inpatient,10,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040010,NDC,facility,outpatient,10,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.33945,1.11,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,inpatient,10,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,25021040067,NDC,facility,outpatient,10,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,inpatient,10,EA,2.30000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054015,NDC,facility,outpatient,10,EA,2.30000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,0.33945,2.23,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,inpatient,10,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054057,NDC,facility,outpatient,10,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.33945,0.82450,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,inpatient,10,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63323054067,NDC,facility,outpatient,10,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.33945,0.65960,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,inpatient,10,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,63739093128,NDC,facility,outpatient,10,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.33945,1.14,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,inpatient,10,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,67457038599,NDC,facility,outpatient,10,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.33945,1.27,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,inpatient,10,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,71288040211,NDC,facility,outpatient,10,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.33945,1.21,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,inpatient,10,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
HEPARIN SOLN 1000 UNITS/ML 10 ML,56703,CDM,250,RC,J1644,HCPCS,72603017925,NDC,facility,outpatient,10,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.33945,1.51,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
INJ IM/SUBQ-TECH,56704,CDM,260,RC,96372,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,67.58,157.14,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,Amish/Mennonite,Amish Mennonite,,446.34,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054601,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,Amish/Mennonite,Amish Mennonite,,446.34,,,,,,,0.99000,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,inpatient,1.6,EA,811.53000,770.95000,Amish/Mennonite,Amish Mennonite,,446.34,,,,,,,446.34,787.18,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL,56705,CDM,636,RC,J1442,HCPCS,55513054610,NDC,facility,outpatient,1.6,EA,811.53000,770.95000,Amish/Mennonite,Amish Mennonite,,446.34,,,,,,,0.99000,787.18,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,inpatient,2,EA,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,,30.86,,,,,,,30.86,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,00023608210,NDC,facility,outpatient,2,EA,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,,30.86,,,,,,,18.03,54.42,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,inpatient,2,EA,41.90000,39.81000,Amish/Mennonite,Amish Mennonite,,23.05,,,,,,,23.05,40.64,percent of total billed charges,
IRON (AS DEXTRAN) SOLN 50 MG/ML 2 ML,56706,CDM,636,RC,J1750,HCPCS,52544093107,NDC,facility,outpatient,2,EA,41.90000,39.81000,Amish/Mennonite,Amish Mennonite,,23.05,,,,,,,18.03,40.64,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,inpatient,1,EA,387.20000,367.84000,Amish/Mennonite,Amish Mennonite,,212.96,,,,,,,212.96,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00143927310,NDC,facility,outpatient,1,EA,387.20000,367.84000,Amish/Mennonite,Amish Mennonite,,212.96,,,,,,,132.91,375.58,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,inpatient,1,EA,340.20000,323.19000,Amish/Mennonite,Amish Mennonite,,187.11,,,,,,,187.11,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085005,NDC,facility,outpatient,1,EA,340.20000,323.19000,Amish/Mennonite,Amish Mennonite,,187.11,,,,,,,132.91,329.99,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,inpatient,1,EA,323.19000,307.03000,Amish/Mennonite,Amish Mennonite,,177.75,,,,,,,177.75,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085010,NDC,facility,outpatient,1,EA,323.19000,307.03000,Amish/Mennonite,Amish Mennonite,,177.75,,,,,,,132.91,313.49,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,inpatient,1,EA,323.18000,307.02000,Amish/Mennonite,Amish Mennonite,,177.75,,,,,,,177.75,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,00574085050,NDC,facility,outpatient,1,EA,323.18000,307.02000,Amish/Mennonite,Amish Mennonite,,177.75,,,,,,,132.91,313.48,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,inpatient,1,EA,266.10000,252.80000,Amish/Mennonite,Amish Mennonite,,146.35,,,,,,,146.35,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041101,NDC,facility,outpatient,1,EA,266.10000,252.80000,Amish/Mennonite,Amish Mennonite,,146.35,,,,,,,132.91,258.12,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,inpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,8.35,14.73,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,61990041102,NDC,facility,outpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,7.59,160.17,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,inpatient,1,EA,209.51000,199.03000,Amish/Mennonite,Amish Mennonite,,115.23,,,,,,,115.23,203.22,percent of total billed charges,
INJ DIHYDROERGOTAMINE MESYLT,56707,CDM,250,RC,J1110,HCPCS,81284041110,NDC,facility,outpatient,1,EA,209.51000,199.03000,Amish/Mennonite,Amish Mennonite,,115.23,,,,,,,104.75,203.22,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,inpatient,1,mL,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.27,2.24,percent of total billed charges,
MIDAZOLAM SYRINGE PF 1 MG/ML 2 ML,56708,CDM,250,RC,J2250,HCPCS,00409230662,NDC,facility,outpatient,1,mL,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,0.19995,2.24,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,inpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00264420654,NDC,facility,outpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00338171540,NDC,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,00409672923,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,44567042124,NDC,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,63323010601,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,67457055400,NDC,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,70121172009,NDC,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM SULFATE 4 GM/ 100 ML PREMIX,56709,CDM,250,RC,J3475,HCPCS,83634050082,NDC,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.82500,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,inpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00143902202,NDC,facility,outpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,6.98,45.98,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,inpatient,1,mL,502.21000,477.10000,Amish/Mennonite,Amish Mennonite,,276.22,,,,,,,276.22,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,25021046274,NDC,facility,outpatient,1,mL,502.21000,477.10000,Amish/Mennonite,Amish Mennonite,,276.22,,,,,,,6.98,487.14,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,inpatient,1,mL,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,60.83,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00310772010,NDC,facility,outpatient,1,mL,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,6.98,107.28,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,inpatient,1,mL,433.92000,412.22000,Amish/Mennonite,Amish Mennonite,,238.66,,,,,,,238.66,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,00591501902,NDC,facility,outpatient,1,mL,433.92000,412.22000,Amish/Mennonite,Amish Mennonite,,238.66,,,,,,,6.98,420.90,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,inpatient,1,mL,205.40000,195.13000,Amish/Mennonite,Amish Mennonite,,112.97,,,,,,,112.97,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70700028498,NDC,facility,outpatient,1,mL,205.40000,195.13000,Amish/Mennonite,Amish Mennonite,,112.97,,,,,,,6.98,199.24,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,43598026202,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,6.98,61.30,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,inpatient,1,mL,420.23000,399.22000,Amish/Mennonite,Amish Mennonite,,231.13,,,,,,,231.13,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,16714007002,NDC,facility,outpatient,1,mL,420.23000,399.22000,Amish/Mennonite,Amish Mennonite,,231.13,,,,,,,6.98,407.62,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,inpatient,1,mL,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,63323071505,NDC,facility,outpatient,1,mL,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,6.98,251.23,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,inpatient,1,mL,451.99000,429.39000,Amish/Mennonite,Amish Mennonite,,248.59,,,,,,,248.59,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,67457031105,NDC,facility,outpatient,1,mL,451.99000,429.39000,Amish/Mennonite,Amish Mennonite,,248.59,,,,,,,6.98,438.43,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,inpatient,1,mL,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,,147.73,,,,,,,147.73,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,70860021174,NDC,facility,outpatient,1,mL,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,,147.73,,,,,,,6.98,260.54,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,inpatient,1,mL,58.46000,55.54000,Amish/Mennonite,Amish Mennonite,,32.15,,,,,,,32.15,56.71,percent of total billed charges,
INJ FULVESTRANT,56710,CDM,636,RC,J9395,HCPCS,71288055586,NDC,facility,outpatient,1,mL,58.46000,55.54000,Amish/Mennonite,Amish Mennonite,,32.15,,,,,,,6.98,56.71,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,inpatient,1,EA,815.41000,774.64000,Amish/Mennonite,Amish Mennonite,,448.48,,,,,,,448.48,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053001,NDC,facility,outpatient,1,EA,815.41000,774.64000,Amish/Mennonite,Amish Mennonite,,448.48,,,,,,,0.99000,790.95,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,inpatient,1,EA,815.42000,774.65000,Amish/Mennonite,Amish Mennonite,,448.48,,,,,,,448.48,790.96,percent of total billed charges,
INJ FILGRASTIM EXCL BIOSIMIL 7529548,56711,CDM,636,RC,J1442,HCPCS,55513053010,NDC,facility,outpatient,1,EA,815.42000,774.65000,Amish/Mennonite,Amish Mennonite,,448.48,,,,,,,0.99000,790.96,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
INFLUENZA VIRUS AB-TECH,56712,CDM,300,RC,86710,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,13.55,713.01,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,inpatient,1,mL,2952.26000,2804.64000,Amish/Mennonite,Amish Mennonite,,1623.74,,,,,,,1623.74,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302602,NDC,facility,outpatient,1,mL,2952.26000,2804.64000,Amish/Mennonite,Amish Mennonite,,1623.74,,,,,,,58.56,2863.69,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,inpatient,1,mL,3195.57000,3035.80000,Amish/Mennonite,Amish Mennonite,,1757.56,,,,,,,1757.56,3099.70,percent of total billed charges,
PEMBROLIZUMAB SOLN 25 MG/ML 4 ML,56713,CDM,636,RC,J9271,HCPCS,00006302604,NDC,facility,outpatient,1,mL,3195.57000,3035.80000,Amish/Mennonite,Amish Mennonite,,1757.56,,,,,,,58.56,3099.70,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,inpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 10 ML,56714,CDM,636,RC,J9299,HCPCS,00003377412,NDC,facility,outpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,33.00,783.52,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
I-123--200UCI,56715,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,inpatient,,,830.00000,788.50000,Amish/Mennonite,Amish Mennonite,TC,456.50,,,,,,,456.50,805.10,percent of total billed charges,
IN SITU HYBRID EA ADDL PROBE-TECH,56717,CDM,310,RC,88364,CPT,,,facility,outpatient,,,830.00000,788.50000,Amish/Mennonite,Amish Mennonite,TC,456.50,,,,,,,370.62,4895.01,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,inpatient,1,EA,250.17000,237.66000,Amish/Mennonite,Amish Mennonite,,137.59,,,,,,,137.59,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17238042406,NDC,facility,outpatient,1,EA,250.17000,237.66000,Amish/Mennonite,Amish Mennonite,,137.59,,,,,,,7.86,242.66,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,inpatient,1,EA,295.08000,280.33000,Amish/Mennonite,Amish Mennonite,,162.29,,,,,,,162.29,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,17478070102,NDC,facility,outpatient,1,EA,295.08000,280.33000,Amish/Mennonite,Amish Mennonite,,162.29,,,,,,,7.86,286.23,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,inpatient,1,EA,351.81000,334.22000,Amish/Mennonite,Amish Mennonite,,193.50,,,,,,,193.50,341.26,percent of total billed charges,
INDOCYANINE GREEN POWD-INJ 25 MG,56719,CDM,636,RC,Q9968,HCPCS,70100042402,NDC,facility,outpatient,1,EA,351.81000,334.22000,Amish/Mennonite,Amish Mennonite,,193.50,,,,,,,7.86,341.26,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,inpatient,1,EA,321.74000,305.65000,Amish/Mennonite,Amish Mennonite,,176.96,,,,,,,176.96,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075291501,NDC,facility,outpatient,1,EA,321.74000,305.65000,Amish/Mennonite,Amish Mennonite,,176.96,,,,,,,0.79980,312.09,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,inpatient,1,EA,101.28000,96.21000,Amish/Mennonite,Amish Mennonite,,55.70,,,,,,,55.70,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,00075802510,NDC,facility,outpatient,1,EA,101.28000,96.21000,Amish/Mennonite,Amish Mennonite,,55.70,,,,,,,0.79980,98.24,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,inpatient,1,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71288041183,NDC,facility,outpatient,1,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,inpatient,1,EA,94.20000,89.49000,Amish/Mennonite,Amish Mennonite,,51.81,,,,,,,51.81,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056984,NDC,facility,outpatient,1,EA,94.20000,89.49000,Amish/Mennonite,Amish Mennonite,,51.81,,,,,,,0.79980,91.37,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,inpatient,1,EA,92.59000,87.96000,Amish/Mennonite,Amish Mennonite,,50.92,,,,,,,50.92,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,16714006610,NDC,facility,outpatient,1,EA,92.59000,87.96000,Amish/Mennonite,Amish Mennonite,,50.92,,,,,,,0.79980,89.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,inpatient,1,EA,47.59000,45.21000,Amish/Mennonite,Amish Mennonite,,26.17,,,,,,,26.17,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323056995,NDC,facility,outpatient,1,EA,47.59000,45.21000,Amish/Mennonite,Amish Mennonite,,26.17,,,,,,,0.79980,46.16,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,inpatient,1,EA,44.11000,41.91000,Amish/Mennonite,Amish Mennonite,,24.26,,,,,,,24.26,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,63323058994,NDC,facility,outpatient,1,EA,44.11000,41.91000,Amish/Mennonite,Amish Mennonite,,24.26,,,,,,,0.79980,42.79,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,inpatient,1,EA,105.99000,100.69000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,70710176306,NDC,facility,outpatient,1,EA,105.99000,100.69000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,0.79980,102.81,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,inpatient,1,EA,55.30000,52.53000,Amish/Mennonite,Amish Mennonite,,30.41,,,,,,,30.41,53.64,percent of total billed charges,
ENOXAPARIN SOLN 150 MG/ML,56721,CDM,250,RC,J1650,HCPCS,71839011610,NDC,facility,outpatient,1,EA,55.30000,52.53000,Amish/Mennonite,Amish Mennonite,,30.41,,,,,,,0.79980,53.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,inpatient,10,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,00409258705,NDC,facility,outpatient,10,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.19995,0.57230,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,inpatient,10,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10019002839,NDC,facility,outpatient,10,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.19995,0.67900,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,inpatient,10,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,10015002839,NDC,facility,outpatient,10,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.26400,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,inpatient,10,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 10 ML,56722,CDM,250,RC,J2250,HCPCS,63323041110,NDC,facility,outpatient,10,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.19995,1.75,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,inpatient,1,mL,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,367.95,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,15054004301,NDC,facility,outpatient,1,mL,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,65.26,648.93,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,inpatient,1,mL,507.12000,481.77000,Amish/Mennonite,Amish Mennonite,,278.92,,,,,,,278.92,491.91,percent of total billed charges,
INJ IRINOTECAN LIPOSOME 1 MG,56723,CDM,636,RC,J9205,HCPCS,69171039801,NDC,facility,outpatient,1,mL,507.12000,481.77000,Amish/Mennonite,Amish Mennonite,,278.92,,,,,,,65.26,491.91,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
INJ MYELOGRAPHY CT LUMBAR-TECH,56724,CDM,361,RC,62284,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,5271.00,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,inpatient,2,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,00517260225,NDC,facility,outpatient,2,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.76570,1.77,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,inpatient,2,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006403,NDC,facility,outpatient,2,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,0.76570,2.42,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,inpatient,2,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006409,NDC,facility,outpatient,2,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.76570,1.72,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,inpatient,2,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 2 ML,56725,CDM,250,RC,J3475,HCPCS,63323006423,NDC,facility,outpatient,2,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.76570,1.84,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,inpatient,2,EA,26.78000,25.44000,Amish/Mennonite,Amish Mennonite,,14.73,,,,,,,14.73,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,00548336900,NDC,facility,outpatient,2,EA,26.78000,25.44000,Amish/Mennonite,Amish Mennonite,,14.73,,,,,,,13.39,25.98,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,inpatient,2,EA,49.77000,47.28000,Amish/Mennonite,Amish Mennonite,,27.37,,,,,,,27.37,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,55150034510,NDC,facility,outpatient,2,EA,49.77000,47.28000,Amish/Mennonite,Amish Mennonite,,27.37,,,,,,,14.28,48.28,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,inpatient,2,EA,49.53000,47.06000,Amish/Mennonite,Amish Mennonite,,27.24,,,,,,,27.24,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,43598075058,NDC,facility,outpatient,2,EA,49.53000,47.06000,Amish/Mennonite,Amish Mennonite,,27.24,,,,,,,14.28,48.04,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,inpatient,2,EA,24.89000,23.64000,Amish/Mennonite,Amish Mennonite,,13.69,,,,,,,13.69,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76045011220,NDC,facility,outpatient,2,EA,24.89000,23.64000,Amish/Mennonite,Amish Mennonite,,13.69,,,,,,,12.45,24.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,inpatient,2,EA,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,28.68,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336901,NDC,facility,outpatient,2,EA,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,14.28,50.58,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,inpatient,2,EA,20.48000,19.45000,Amish/Mennonite,Amish Mennonite,,11.26,,,,,,,11.26,19.87,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004062,56726,CDM,250,RC,J2310,HCPCS,76329336916,NDC,facility,outpatient,2,EA,20.48000,19.45000,Amish/Mennonite,Amish Mennonite,,11.26,,,,,,,10.24,19.87,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,inpatient,5,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230505,NDC,facility,outpatient,5,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.19995,0.62080,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,inpatient,5,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00409230550,NDC,facility,outpatient,5,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.19995,0.59170,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,inpatient,5,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,00641605910,NDC,facility,outpatient,5,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.19995,0.85360,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,inpatient,5,EA,1.79000,1.71000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 1 MG/ML 5 ML,56727,CDM,250,RC,J2250,HCPCS,63323041125,NDC,facility,outpatient,5,EA,1.79000,1.71000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.19995,1.74,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,101.20,178.48,percent of total billed charges,
INJ PERFLUTREN LIP MICROS ML,56728,CDM,636,RC,Q9957,HCPCS,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,64.92,178.48,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,inpatient,1,mL,137.46000,130.59000,Amish/Mennonite,Amish Mennonite,,75.60,,,,,,,75.60,133.34,percent of total billed charges,
INJ CLADRIBINE,56729,CDM,636,RC,J9065,HCPCS,63323014010,NDC,facility,outpatient,1,mL,137.46000,130.59000,Amish/Mennonite,Amish Mennonite,,75.60,,,,,,,9.73,133.34,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,00409216877,NDC,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,inpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003772,56730,CDM,250,RC,J3475,HCPCS,63323064220,NDC,facility,outpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,inpatient,1,EA,2685.99000,2551.69000,Amish/Mennonite,Amish Mennonite,,1477.29,,,,,,,1477.29,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894003001,NDC,facility,outpatient,1,EA,2685.99000,2551.69000,Amish/Mennonite,Amish Mennonite,,1477.29,,,,,,,31.18,2605.41,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,inpatient,1,EA,1230.25000,1168.74000,Amish/Mennonite,Amish Mennonite,,676.64,,,,,,,676.64,1193.34,percent of total billed charges,
INFLIXIMAB POWD-INJ 100 MG (EQV-REMICADE),56731,CDM,636,RC,J1745,HCPCS,57894016001,NDC,facility,outpatient,1,EA,1230.25000,1168.74000,Amish/Mennonite,Amish Mennonite,,676.64,,,,,,,31.18,1193.34,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,inpatient,100,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00338070548,NDC,facility,outpatient,100,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,inpatient,100,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00409707526,NDC,facility,outpatient,100,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,inpatient,100,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
INJ POTASSIUM CHLORIDE,56733,CDM,250,RC,J3480,HCPCS,00990707526,NDC,facility,outpatient,100,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,inpatient,10,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,00409665106,NDC,facility,outpatient,10,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.27217,0.91180,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,inpatient,10,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005580,56734,CDM,250,RC,J3480,HCPCS,63323096510,NDC,facility,outpatient,10,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27217,0.53350,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,inpatient,1,mL,22.86000,21.72000,Amish/Mennonite,Amish Mennonite,,12.57,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART SOLN 100 UNITS/ML 10 ML (EQV-NOVOLOG),56735,CDM,250,RC,J1815,HCPCS,00169750111,NDC,facility,outpatient,1,mL,22.86000,21.72000,Amish/Mennonite,Amish Mennonite,,12.57,,,,,,,1.49,22.17,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00264786500,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00338069104,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,00990711509,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,inpatient,1,mL,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099401,56736,CDM,250,RC,J3480,HCPCS,63323068610,NDC,facility,outpatient,1,mL,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,inpatient,,,403.00000,382.85000,Amish/Mennonite,Amish Mennonite,,221.65,,,,,,,221.65,390.91,percent of total billed charges,
INJ SHLDR XR-TECH,56737,CDM,361,RC,23350,CPT,,,facility,outpatient,,,403.00000,382.85000,Amish/Mennonite,Amish Mennonite,,221.65,,,,,,,221.65,5271.00,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,inpatient,0.8,EA,117.76000,111.87000,Amish/Mennonite,Amish Mennonite,,64.77,,,,,,,64.77,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075291201,NDC,facility,outpatient,0.8,EA,117.76000,111.87000,Amish/Mennonite,Amish Mennonite,,64.77,,,,,,,0.79980,114.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,inpatient,0.8,EA,101.27000,96.21000,Amish/Mennonite,Amish Mennonite,,55.70,,,,,,,55.70,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00075802210,NDC,facility,outpatient,0.8,EA,101.27000,96.21000,Amish/Mennonite,Amish Mennonite,,55.70,,,,,,,0.79980,98.23,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,inpatient,0.8,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,39.10,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,71288041181,NDC,facility,outpatient,0.8,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,0.79980,68.97,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,inpatient,0.8,EA,94.21000,89.50000,Amish/Mennonite,Amish Mennonite,,51.82,,,,,,,51.82,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323060990,NDC,facility,outpatient,0.8,EA,94.21000,89.50000,Amish/Mennonite,Amish Mennonite,,51.82,,,,,,,0.79980,91.38,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,inpatient,0.8,EA,289.24000,274.78000,Amish/Mennonite,Amish Mennonite,,159.08,,,,,,,159.08,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,00955101210,NDC,facility,outpatient,0.8,EA,289.24000,274.78000,Amish/Mennonite,Amish Mennonite,,159.08,,,,,,,0.79980,280.56,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,inpatient,0.8,EA,93.61000,88.93000,Amish/Mennonite,Amish Mennonite,,51.49,,,,,,,51.49,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,16714005610,NDC,facility,outpatient,0.8,EA,93.61000,88.93000,Amish/Mennonite,Amish Mennonite,,51.49,,,,,,,0.79980,90.80,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,inpatient,0.8,EA,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,26.18,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323056999,NDC,facility,outpatient,0.8,EA,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,0.79980,46.17,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,inpatient,0.8,EA,43.81000,41.62000,Amish/Mennonite,Amish Mennonite,,24.10,,,,,,,24.10,42.50,percent of total billed charges,
ENOXAPARIN SOLN 120 MG/0.8 ML,56738,CDM,250,RC,J1650,HCPCS,63323065599,NDC,facility,outpatient,0.8,EA,43.81000,41.62000,Amish/Mennonite,Amish Mennonite,,24.10,,,,,,,0.79980,42.50,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,inpatient,20,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,00409665305,NDC,facility,outpatient,20,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.27217,0.77600,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,inpatient,20,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7005598,56739,CDM,250,RC,J3480,HCPCS,63323096520,NDC,facility,outpatient,20,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,inpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00409230517,NDC,facility,outpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.19995,1.41,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,inpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,00641605725,NDC,facility,outpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.19995,0.99910,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,inpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,23155060041,NDC,facility,outpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.19995,0.84390,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,inpatient,1,mL,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,63323041112,NDC,facility,outpatient,1,mL,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.19995,1.75,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,inpatient,1,mL,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,70860060002,NDC,facility,outpatient,1,mL,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.19995,0.71780,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 1 MG/ML 2 ML,56740,CDM,250,RC,J2250,HCPCS,72611074125,NDC,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,0.19995,24.52,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,inpatient,10,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00409259605,NDC,facility,outpatient,10,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,inpatient,10,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,00641619010,NDC,facility,outpatient,10,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,0.19995,2.11,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,inpatient,10,EA,3.65000,3.46000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,17478052410,NDC,facility,outpatient,10,EA,3.65000,3.46000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,0.19995,3.54,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,inpatient,10,EA,1.69000,1.61000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,23155060142,NDC,facility,outpatient,10,EA,1.69000,1.61000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.19995,1.64,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,inpatient,10,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,47781058991,NDC,facility,outpatient,10,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.19995,1.80,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,inpatient,10,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,57664063445,NDC,facility,outpatient,10,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,0.19995,2.82,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,inpatient,10,EA,8.76000,8.32000,Amish/Mennonite,Amish Mennonite,,4.82,,,,,,,4.82,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,63323041210,NDC,facility,outpatient,10,EA,8.76000,8.32000,Amish/Mennonite,Amish Mennonite,,4.82,,,,,,,0.19995,8.50,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,inpatient,10,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
MIDAZOLAM SOLN-INJ 5 MG/ML 10 ML,56741,CDM,250,RC,J2250,HCPCS,70860060110,NDC,facility,outpatient,10,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.19995,0.52380,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,inpatient,1,EA,11.45000,10.87000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,6.30,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146301,NDC,facility,outpatient,1,EA,11.45000,10.87000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,4.77,11.11,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,inpatient,1,EA,11.34000,10.78000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,6.24,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,00409146349,NDC,facility,outpatient,1,EA,11.34000,10.78000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,4.77,11.00,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,inpatient,1,EA,19.55000,18.57000,Amish/Mennonite,Amish Mennonite,,10.75,,,,,,,10.75,18.96,percent of total billed charges,
INJ NALBUPHINE HYDROCHLORIDE 7034523,56742,CDM,250,RC,J2300,HCPCS,70069067110,NDC,facility,outpatient,1,EA,19.55000,18.57000,Amish/Mennonite,Amish Mennonite,,10.75,,,,,,,4.77,18.96,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,inpatient,1,EA,50.02000,47.52000,Amish/Mennonite,Amish Mennonite,,27.51,,,,,,,27.51,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121501,NDC,facility,outpatient,1,EA,50.02000,47.52000,Amish/Mennonite,Amish Mennonite,,27.51,,,,,,,14.28,48.52,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,inpatient,1,EA,49.26000,46.80000,Amish/Mennonite,Amish Mennonite,,27.09,,,,,,,27.09,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409121525,NDC,facility,outpatient,1,EA,49.26000,46.80000,Amish/Mennonite,Amish Mennonite,,27.09,,,,,,,14.28,47.78,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,inpatient,1,EA,48.79000,46.35000,Amish/Mennonite,Amish Mennonite,,26.83,,,,,,,26.83,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,00409178269,NDC,facility,outpatient,1,EA,48.79000,46.35000,Amish/Mennonite,Amish Mennonite,,26.83,,,,,,,14.28,47.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,70069007110,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,14.28,30.65,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,inpatient,1,EA,41.38000,39.31000,Amish/Mennonite,Amish Mennonite,,22.76,,,,,,,22.76,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,17478004101,NDC,facility,outpatient,1,EA,41.38000,39.31000,Amish/Mennonite,Amish Mennonite,,22.76,,,,,,,14.28,40.14,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,36000030810,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,inpatient,1,EA,47.98000,45.58000,Amish/Mennonite,Amish Mennonite,,26.39,,,,,,,26.39,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,67457059902,NDC,facility,outpatient,1,EA,47.98000,45.58000,Amish/Mennonite,Amish Mennonite,,26.39,,,,,,,14.28,46.54,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,inpatient,1,EA,34.71000,32.97000,Amish/Mennonite,Amish Mennonite,,19.09,,,,,,,19.09,33.67,percent of total billed charges,
INJ NALOXONE HYDROCHLORIDE 7004567,56744,CDM,250,RC,J2310,HCPCS,72603059010,NDC,facility,outpatient,1,EA,34.71000,32.97000,Amish/Mennonite,Amish Mennonite,,19.09,,,,,,,14.28,33.67,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,inpatient,2,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230802,NDC,facility,outpatient,2,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,0.19995,2.08,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,inpatient,2,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00409230850,NDC,facility,outpatient,2,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.19995,1.43,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,inpatient,2,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606303,NDC,facility,outpatient,2,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.19995,1.39,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,inpatient,2,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN-INJ PF 5 MG/ML 2 ML,56745,CDM,250,RC,J2250,HCPCS,00641606310,NDC,facility,outpatient,2,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.19995,1.92,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,inpatient,2,EA,61.91000,58.82000,Amish/Mennonite,Amish Mennonite,,34.05,,,,,,,34.05,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972901,NDC,facility,outpatient,2,EA,61.91000,58.82000,Amish/Mennonite,Amish Mennonite,,34.05,,,,,,,25.99,60.05,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,inpatient,2,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,00143972905,NDC,facility,outpatient,2,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,25.99,91.96,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,inpatient,2,EA,74.26000,70.55000,Amish/Mennonite,Amish Mennonite,,40.84,,,,,,,40.84,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,68382086010,NDC,facility,outpatient,2,EA,74.26000,70.55000,Amish/Mennonite,Amish Mennonite,,40.84,,,,,,,25.99,72.03,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,inpatient,2,EA,86.90000,82.56000,Amish/Mennonite,Amish Mennonite,,47.80,,,,,,,47.80,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,63323097002,NDC,facility,outpatient,2,EA,86.90000,82.56000,Amish/Mennonite,Amish Mennonite,,47.80,,,,,,,25.99,84.29,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,inpatient,2,EA,184.58000,175.35000,Amish/Mennonite,Amish Mennonite,,101.52,,,,,,,101.52,179.04,percent of total billed charges,
INJ BENZTROPINE MESYLATE,56746,CDM,250,RC,J0515,HCPCS,67386061152,NDC,facility,outpatient,2,EA,184.58000,175.35000,Amish/Mennonite,Amish Mennonite,,101.52,,,,,,,25.99,179.04,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,inpatient,1,EA,1642.06000,1559.96000,Amish/Mennonite,Amish Mennonite,,903.13,,,,,,,903.13,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023114501,NDC,facility,outpatient,1,EA,1642.06000,1559.96000,Amish/Mennonite,Amish Mennonite,,903.13,,,,,,,6.50,1592.80,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,inpatient,1,EA,1556.59000,1478.76000,Amish/Mennonite,Amish Mennonite,,856.12,,,,,,,856.12,1509.89,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 100 UNIT (BOTOX),56747,CDM,636,RC,J0585,HCPCS,00023923201,NDC,facility,outpatient,1,EA,1556.59000,1478.76000,Amish/Mennonite,Amish Mennonite,,856.12,,,,,,,6.50,1509.89,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,00228-2571-11,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,62559-0511-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
INDAPAMIDE TAB,56748,CDM,250,RC,51079-0868-01,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,inpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00338107502,NDC,facility,outpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,13.53,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
DOBUTAMINE 500 MG/D5W 250 ML PREMIX,56749,CDM,250,RC,J1250,HCPCS,00409234732,NDC,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,13.53,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,182.05,321.07,percent of total billed charges,
INFLUENZA 1ST 2 TYPES AMP PROBE-TECH,56750,CDM,300,RC,87502,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,95.80,4498.77,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,inpatient,30,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00069013703,NDC,facility,outpatient,30,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,inpatient,30,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,00409272003,NDC,facility,outpatient,30,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,inpatient,30,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,25021040030,NDC,facility,outpatient,30,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.33945,0.69840,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,inpatient,30,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,63323054036,NDC,facility,outpatient,30,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.33945,0.72750,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,inpatient,30,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,67457038499,NDC,facility,outpatient,30,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.33945,0.74690,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,inpatient,30,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7002991,56751,CDM,250,RC,J1644,HCPCS,71288040231,NDC,facility,outpatient,30,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,inpatient,1,mL,14.09000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 3 ML,56752,CDM,250,RC,J1815,HCPCS,00002871517,NDC,facility,outpatient,1,mL,14.09000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,1.49,13.67,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,inpatient,1,EA,2916.40000,2770.58000,Amish/Mennonite,Amish Mennonite,,1604.02,,,,,,,1604.02,2828.91,percent of total billed charges,
ONABOTULINUM TOXIN A POWD-INJ 200 UNIT (BOTOX),56753,CDM,636,RC,J0585,HCPCS,00023392102,NDC,facility,outpatient,1,EA,2916.40000,2770.58000,Amish/Mennonite,Amish Mennonite,,1604.02,,,,,,,6.50,2828.91,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,inpatient,,,938.00000,891.10000,Amish/Mennonite,Amish Mennonite,,515.90,,,,,,,515.90,909.86,percent of total billed charges,
INS VEN CATH W/O PORT/PMP >5YR-TECH,56754,CDM,361,RC,36573,CPT,,,facility,outpatient,,,938.00000,891.10000,Amish/Mennonite,Amish Mennonite,,515.90,,,,,,,515.90,4686.00,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,inpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,138.05,243.47,percent of total billed charges,
INJ PROC RAD TRCR ID SENTIN ND-TECH,56755,CDM,340,RC,38792,CPT,,,facility,outpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,125.50,419.70,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,inpatient,,,1949.00000,1851.55000,Amish/Mennonite,Amish Mennonite,,1071.95,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/REPL TEMP TRNSVEN ELEC/CTH-TECH,56756,CDM,361,RC,33210,CPT,,,facility,outpatient,,,1949.00000,1851.55000,Amish/Mennonite,Amish Mennonite,,1071.95,,,,,,,1071.95,16988.00,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,inpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,00409469924,NDC,facility,outpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,inpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,16714069010,NDC,facility,outpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,inpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,23155034543,NDC,facility,outpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.14409,0.50440,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,inpatient,1,mL,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,43598054910,NDC,facility,outpatient,1,mL,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026965,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 1000 MG/100 ML,56757,CDM,250,RC,J2704,HCPCS,63323026969,NDC,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.14409,0.36860,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,inpatient,3,EA,46.99000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN INJECTION 7324200,56758,CDM,250,RC,J1815,HCPCS,00002831517,NDC,facility,outpatient,3,EA,46.99000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,1.49,45.58,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,Amish/Mennonite,Amish Mennonite,TC,1914.00,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING-MECKELS SPECT-TECH,56759,CDM,341,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,Amish/Mennonite,Amish Mennonite,TC,1914.00,,,,,,,1609.99,3375.60,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,inpatient,1,mL,1612.59000,1531.96000,Amish/Mennonite,Amish Mennonite,,886.92,,,,,,,886.92,1564.21,percent of total billed charges,
RIMABOTULINUMTOXINB SOLN 2500 UNITS/0.5 ML (MYOBLOC),56760,CDM,636,RC,J0587,HCPCS,10454071010,NDC,facility,outpatient,1,mL,1612.59000,1531.96000,Amish/Mennonite,Amish Mennonite,,886.92,,,,,,,13.34,1564.21,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
INS NON-INDWELLING BLAD CATH-TECH,56761,CDM,761,RC,51701,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,32.00,134.64,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,inpatient,1,mL,1294.64000,1229.91000,Amish/Mennonite,Amish Mennonite,,712.05,,,,,,,712.05,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091211,NDC,facility,outpatient,1,mL,1294.64000,1229.91000,Amish/Mennonite,Amish Mennonite,,712.05,,,,,,,0.30000,1255.80,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,inpatient,1,mL,1215.93000,1155.13000,Amish/Mennonite,Amish Mennonite,,668.76,,,,,,,668.76,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091212,NDC,facility,outpatient,1,mL,1215.93000,1155.13000,Amish/Mennonite,Amish Mennonite,,668.76,,,,,,,0.30000,1179.45,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,inpatient,1,mL,1294.63000,1229.90000,Amish/Mennonite,Amish Mennonite,,712.05,,,,,,,712.05,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091215,NDC,facility,outpatient,1,mL,1294.63000,1229.90000,Amish/Mennonite,Amish Mennonite,,712.05,,,,,,,0.30000,1255.79,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,inpatient,1,mL,1544.61000,1467.38000,Amish/Mennonite,Amish Mennonite,,849.54,,,,,,,849.54,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091217,NDC,facility,outpatient,1,mL,1544.61000,1467.38000,Amish/Mennonite,Amish Mennonite,,849.54,,,,,,,0.30000,1498.27,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,inpatient,1,mL,1544.29000,1467.07000,Amish/Mennonite,Amish Mennonite,,849.36,,,,,,,849.36,1497.96,percent of total billed charges,
TBO-FILGRASTIM SOLN 480 MCG/0.8 ML,56762,CDM,636,RC,J1447,HCPCS,63459091236,NDC,facility,outpatient,1,mL,1544.29000,1467.07000,Amish/Mennonite,Amish Mennonite,,849.36,,,,,,,0.30000,1497.96,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,inpatient,5,EA,6.69000,6.35000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,3.68,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022930,NDC,facility,outpatient,5,EA,6.69000,6.35000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,2.17,6.49,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,inpatient,5,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022935,NDC,facility,outpatient,5,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,inpatient,5,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
INJ PROTAMINE SULFATE,56763,CDM,250,RC,J2720,HCPCS,63323022995,NDC,facility,outpatient,5,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,inpatient,10,EA,26.99000,25.64000,Amish/Mennonite,Amish Mennonite,,14.84,,,,,,,14.84,26.18,percent of total billed charges,
INSULIN INJECTION 7530108,56764,CDM,250,RC,J1815,HCPCS,00002751101,NDC,facility,outpatient,10,EA,26.99000,25.64000,Amish/Mennonite,Amish Mennonite,,14.84,,,,,,,1.49,26.18,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,inpatient,1,EA,8.99000,8.54000,Amish/Mennonite,Amish Mennonite,,4.94,,,,,,,4.94,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00087-2772-35,NDC,,,facility,outpatient,1,EA,8.99000,8.54000,Amish/Mennonite,Amish Mennonite,,4.94,,,,,,,4.50,8.72,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,00093-7465-56,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-30,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,31722-0730-90,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
IRBESARTAN TAB 7216054,56765,CDM,250,RC,62332-0042-90,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,inpatient,1,mL,1294.27000,1229.56000,Amish/Mennonite,Amish Mennonite,,711.85,,,,,,,711.85,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091011,NDC,facility,outpatient,1,mL,1294.27000,1229.56000,Amish/Mennonite,Amish Mennonite,,711.85,,,,,,,0.30000,1255.44,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,inpatient,1,mL,1275.16000,1211.40000,Amish/Mennonite,Amish Mennonite,,701.34,,,,,,,701.34,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091012,NDC,facility,outpatient,1,mL,1275.16000,1211.40000,Amish/Mennonite,Amish Mennonite,,701.34,,,,,,,0.30000,1236.91,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,inpatient,1,mL,1294.29000,1229.58000,Amish/Mennonite,Amish Mennonite,,711.86,,,,,,,711.86,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091015,NDC,facility,outpatient,1,mL,1294.29000,1229.58000,Amish/Mennonite,Amish Mennonite,,711.86,,,,,,,0.30000,1255.46,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,inpatient,1,mL,1551.93000,1474.33000,Amish/Mennonite,Amish Mennonite,,853.56,,,,,,,853.56,1505.37,percent of total billed charges,
TBO-FILGRASTIM SOLN 300 MCG/0.5 ML,56766,CDM,636,RC,J1447,HCPCS,63459091036,NDC,facility,outpatient,1,mL,1551.93000,1474.33000,Amish/Mennonite,Amish Mennonite,,853.56,,,,,,,0.30000,1505.37,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,inpatient,50,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00264420452,NDC,facility,outpatient,50,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,inpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,47335099201,NDC,facility,outpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,inpatient,50,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,00409672924,NDC,facility,outpatient,50,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,inpatient,50,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,25021061281,NDC,facility,outpatient,50,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,inpatient,50,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,44567042024,NDC,facility,outpatient,50,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,inpatient,50,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010605,NDC,facility,outpatient,50,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,inpatient,50,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,63323010626,NDC,facility,outpatient,50,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,inpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,67457055300,NDC,facility,outpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,inpatient,50,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,70121171902,NDC,facility,outpatient,50,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.82500,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,inpatient,50,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM SULFATE 2 GM/ 50 ML PREMIX,56767,CDM,250,RC,J3475,HCPCS,83634050081,NDC,facility,outpatient,50,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,inpatient,1,mL,5.23000,4.97000,Amish/Mennonite,Amish Mennonite,,2.88,,,,,,,2.88,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,00409175410,NDC,facility,outpatient,1,mL,5.23000,4.97000,Amish/Mennonite,Amish Mennonite,,2.88,,,,,,,0.76570,5.07,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,inpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,51754100004,NDC,facility,outpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,inpatient,1,mL,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003771,56768,CDM,250,RC,J3475,HCPCS,63323006411,NDC,facility,outpatient,1,mL,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.82500,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00264765200,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00338080304,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ POTASSIUM CHLORIDE 7099005,56770,CDM,250,RC,J3480,HCPCS,00990710709,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,inpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,90,111.65,,,,,,,111.65,196.91,percent of total billed charges,
INSULIN-LIKE GROWTH FACTOR BP3 (83300) SO-TECH,56772,CDM,300,RC,83520,CPT,,,facility,outpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,90,111.65,,,,,,,17.85,814.87,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,558.11000,530.20000,Amish/Mennonite,Amish Mennonite,,306.96,,,,,,,273.47,541.37,percent of total billed charges,
ACCESS SHEATH 10.7 FR. 28CM,56773,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,558.11000,530.20000,Amish/Mennonite,Amish Mennonite,,306.96,,,,,,,256.17,558.11,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,104.76,percent of total billed charges,
INS TEMPORARY FOLEY CATH SMPL-TECH,56774,CDM,361,RC,51702,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,3163.00,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,inpatient,,,635.00000,603.25000,Amish/Mennonite,Amish Mennonite,,349.25,,,,,,,349.25,615.95,percent of total billed charges,
INSERT CERVICAL DILATOR-TECH,56775,CDM,720,RC,59200,CPT,,,facility,outpatient,,,635.00000,603.25000,Amish/Mennonite,Amish Mennonite,,349.25,,,,,,,288.84,615.95,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,inpatient,1,mL,1885.86000,1791.57000,Amish/Mennonite,Amish Mennonite,,1037.22,,,,,,,1037.22,1829.28,percent of total billed charges,
IPILIMUMAB SOLN 5 MG/ML 10 ML,56776,CDM,636,RC,J9228,HCPCS,00003232711,NDC,facility,outpatient,1,mL,1885.86000,1791.57000,Amish/Mennonite,Amish Mennonite,,1037.22,,,,,,,183.41,1829.28,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,inpatient,3,EA,14.09000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,7.75,13.67,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 3 ML,56777,CDM,250,RC,J1815,HCPCS,00002821517,NDC,facility,outpatient,3,EA,14.09000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,1.49,13.67,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,inpatient,,,164.10000,155.89000,Amish/Mennonite,Amish Mennonite,90,90.25,,,,,,,90.25,159.18,percent of total billed charges,
ISLET CELL AB SO - TECH,56778,CDM,300,RC,83519,CPT,,,facility,outpatient,,,164.10000,155.89000,Amish/Mennonite,Amish Mennonite,90,90.25,,,,,,,19.00,865.84,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,inpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,,134.75,,,,,,,134.75,237.65,percent of total billed charges,
INSULIN LIKE GROWTH FACT I-TECH,56779,CDM,300,RC,84305,CPT,,,facility,outpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,,134.75,,,,,,,21.26,1103.49,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,inpatient,10,EA,22.86000,21.72000,Amish/Mennonite,Amish Mennonite,,12.57,,,,,,,12.57,22.17,percent of total billed charges,
INSULIN ASPART PROTAMINE SUSP,56780,CDM,250,RC,J1815,HCPCS,73070020011,NDC,facility,outpatient,10,EA,22.86000,21.72000,Amish/Mennonite,Amish Mennonite,,12.57,,,,,,,1.49,22.17,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,inpatient,1,mL,14.10000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00002821501,NDC,facility,outpatient,1,mL,14.10000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,inpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN REGULAR SOLN 100 UNITS/ML 10 ML,56781,CDM,250,RC,J1815,HCPCS,00169183311,NDC,facility,outpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,1.49,14.77,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,inpatient,,,248.60000,236.17000,Amish/Mennonite,Amish Mennonite,90,136.73,,,,,,,136.73,241.14,percent of total billed charges,
INSULIN ANTIBODY SO,56782,CDM,300,RC,86337,CPT,,,facility,outpatient,,,248.60000,236.17000,Amish/Mennonite,Amish Mennonite,90,136.73,,,,,,,22.12,1120.45,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00143-1772-01,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.00,1.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,inpatient,1,EA,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00781-1695-13,NDC,,,facility,outpatient,1,EA,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.50,2.92,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-2154-61,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.38,2.67,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,00904-6620-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,2.18,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,50268-0449-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,63739-0367-10,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217243,56783,CDM,250,RC,68084-0083-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.60,3.10,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,inpatient,1,mL,23.59000,22.41000,Amish/Mennonite,Amish Mennonite,,12.97,,,,,,,12.97,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00009752903,NDC,facility,outpatient,1,mL,23.59000,22.41000,Amish/Mennonite,Amish Mennonite,,12.97,,,,,,,2.24,22.88,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,inpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143958301,NDC,facility,outpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,2.24,12.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,inpatient,1,mL,19.38000,18.41000,Amish/Mennonite,Amish Mennonite,,10.66,,,,,,,10.66,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00143970101,NDC,facility,outpatient,1,mL,19.38000,18.41000,Amish/Mennonite,Amish Mennonite,,10.66,,,,,,,2.24,18.80,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,inpatient,1,mL,22.31000,21.19000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,12.27,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,00703443481,NDC,facility,outpatient,1,mL,22.31000,21.19000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,2.24,21.64,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,inpatient,1,mL,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,9.04,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,59923070205,NDC,facility,outpatient,1,mL,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,2.24,15.94,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,inpatient,1,mL,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,10.45,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,70700017022,NDC,facility,outpatient,1,mL,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,2.24,18.43,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,60505627201,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,inpatient,1,mL,12.56000,11.93000,Amish/Mennonite,Amish Mennonite,,6.91,,,,,,,6.91,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,61703034909,NDC,facility,outpatient,1,mL,12.56000,11.93000,Amish/Mennonite,Amish Mennonite,,6.91,,,,,,,2.24,12.18,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,inpatient,1,mL,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,11.82,20.85,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 5 ML,56784,CDM,250,RC,J9206,HCPCS,63323019355,NDC,facility,outpatient,1,mL,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,2.24,20.85,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,inpatient,2,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797055,NDC,facility,outpatient,2,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,inpatient,2,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00378797093,NDC,facility,outpatient,2,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,inpatient,2,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,00487980130,NDC,facility,outpatient,2,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,inpatient,2,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,60687039483,NDC,facility,outpatient,2,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,inpatient,2,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010001,NDC,facility,outpatient,2,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.64350,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,inpatient,2,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
IPRATROPIUM NEB 0.5 MG/2.5 ML,56785,CDM,250,RC,J7644,HCPCS,76204010060,NDC,facility,outpatient,2,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.64350,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
IRON ASSAY-TECH,56786,CDM,300,RC,83540,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,6.47,339.51,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,inpatient,1,mL,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,199.43,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,55150024005,NDC,facility,outpatient,1,mL,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,7.86,351.72,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,inpatient,1,mL,325.82000,309.53000,Amish/Mennonite,Amish Mennonite,,179.20,,,,,,,179.20,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,63261025021,NDC,facility,outpatient,1,mL,325.82000,309.53000,Amish/Mennonite,Amish Mennonite,,179.20,,,,,,,7.86,316.05,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,inpatient,1,mL,577.02000,548.17000,Amish/Mennonite,Amish Mennonite,,317.36,,,,,,,317.36,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457022005,NDC,facility,outpatient,1,mL,577.02000,548.17000,Amish/Mennonite,Amish Mennonite,,317.36,,,,,,,7.86,559.71,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,inpatient,1,mL,458.13000,435.23000,Amish/Mennonite,Amish Mennonite,,251.97,,,,,,,251.97,444.39,percent of total billed charges,
ISOSULFAN BLUE SOLN 10 MG/ML 5 ML,56787,CDM,636,RC,Q9968,HCPCS,67457058605,NDC,facility,outpatient,1,mL,458.13000,435.23000,Amish/Mennonite,Amish Mennonite,,251.97,,,,,,,7.86,444.39,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,inpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 4 ML,56788,CDM,636,RC,J9299,HCPCS,00003377211,NDC,facility,outpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,33.00,783.52,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,inpatient,1,EA,6883.45000,6539.28000,Amish/Mennonite,Amish Mennonite,,3785.90,,,,,,,3785.90,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089201,NDC,facility,outpatient,1,EA,6883.45000,6539.28000,Amish/Mennonite,Amish Mennonite,,3785.90,,,,,,,31.33,6676.95,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,inpatient,1,EA,7635.88000,7254.08000,Amish/Mennonite,Amish Mennonite,,4199.73,,,,,,,4199.73,7406.80,percent of total billed charges,
INJ MEPOLIZUMAB,56789,CDM,636,RC,J2182,HCPCS,00173089242,NDC,facility,outpatient,1,EA,7635.88000,7254.08000,Amish/Mennonite,Amish Mennonite,,4199.73,,,,,,,31.33,7406.80,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD-TECH,56790,CDM,335,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,56.40,158.11,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,inpatient,,,552.00000,524.40000,Amish/Mennonite,Amish Mennonite,,303.60,,,,,,,303.60,535.44,percent of total billed charges,
INTUBATION ENDOTRACH EMER PROC-TECH,56792,CDM,361,RC,,,,,facility,outpatient,,,552.00000,524.40000,Amish/Mennonite,Amish Mennonite,,303.60,,,,,,,303.60,5271.00,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,inpatient,10,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,00781355525,NDC,facility,outpatient,10,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,0.33945,4.14,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,inpatient,10,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,9.04,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,25021040102,NDC,facility,outpatient,10,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,0.33945,15.94,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,inpatient,10,EA,20.84000,19.80000,Amish/Mennonite,Amish Mennonite,,11.46,,,,,,,11.46,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63323027602,NDC,facility,outpatient,10,EA,20.84000,19.80000,Amish/Mennonite,Amish Mennonite,,11.46,,,,,,,0.33945,20.21,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,inpatient,10,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,10.25,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,63739090026,NDC,facility,outpatient,10,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,0.33945,18.08,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,inpatient,10,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,8.26,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71288040003,NDC,facility,outpatient,10,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,0.33945,14.56,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,inpatient,10,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,7.39,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,71839011725,NDC,facility,outpatient,10,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,0.33945,13.03,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,inpatient,10,EA,19.09000,18.14000,Amish/Mennonite,Amish Mennonite,,10.50,,,,,,,10.50,18.52,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7004503,56793,CDM,250,RC,J1644,HCPCS,72603033625,NDC,facility,outpatient,10,EA,19.09000,18.14000,Amish/Mennonite,Amish Mennonite,,10.50,,,,,,,0.33945,18.52,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,00904-5395-61,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-11,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,51991-0203-99,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
IRON POLYSACCHARIDE CAP,56794,CDM,250,RC,63044-0203-61,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,inpatient,5,EA,927.28000,880.91000,Amish/Mennonite,Amish Mennonite,,510.00,,,,,,,510.00,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,42998040205,NDC,facility,outpatient,5,EA,927.28000,880.91000,Amish/Mennonite,Amish Mennonite,,510.00,,,,,,,463.64,899.46,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,inpatient,5,EA,30.66000,29.13000,Amish/Mennonite,Amish Mennonite,,16.86,,,,,,,16.86,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00409141005,NDC,facility,outpatient,5,EA,30.66000,29.13000,Amish/Mennonite,Amish Mennonite,,16.86,,,,,,,15.33,29.74,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,inpatient,5,EA,118.23000,112.32000,Amish/Mennonite,Amish Mennonite,,65.03,,,,,,,65.03,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,00548950200,NDC,facility,outpatient,5,EA,118.23000,112.32000,Amish/Mennonite,Amish Mennonite,,65.03,,,,,,,59.12,114.68,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,inpatient,5,EA,310.80000,295.26000,Amish/Mennonite,Amish Mennonite,,170.94,,,,,,,170.94,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,14789001505,NDC,facility,outpatient,5,EA,310.80000,295.26000,Amish/Mennonite,Amish Mennonite,,170.94,,,,,,,155.40,301.48,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,inpatient,5,EA,88.48000,84.06000,Amish/Mennonite,Amish Mennonite,,48.66,,,,,,,48.66,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,23155066142,NDC,facility,outpatient,5,EA,88.48000,84.06000,Amish/Mennonite,Amish Mennonite,,48.66,,,,,,,44.24,85.83,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,inpatient,5,EA,673.40000,639.73000,Amish/Mennonite,Amish Mennonite,,370.37,,,,,,,370.37,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69097052235,NDC,facility,outpatient,5,EA,673.40000,639.73000,Amish/Mennonite,Amish Mennonite,,370.37,,,,,,,336.70,653.20,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,inpatient,5,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,69918073510,NDC,facility,outpatient,5,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,75.84,147.13,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,inpatient,5,EA,569.80000,541.31000,Amish/Mennonite,Amish Mennonite,,313.39,,,,,,,313.39,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,70121160507,NDC,facility,outpatient,5,EA,569.80000,541.31000,Amish/Mennonite,Amish Mennonite,,313.39,,,,,,,284.90,552.71,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,inpatient,5,EA,44.24000,42.03000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,24.33,42.91,percent of total billed charges,
ISOPROTERENOL SOLN 0.2 MG/ML 5 ML,56795,CDM,636,RC,J3490,HCPCS,72485011310,NDC,facility,outpatient,5,EA,44.24000,42.03000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,22.12,42.91,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT-TECH,56796,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,131.92,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00264987210,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00338043103,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409100520,NDC,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.36520,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
INJ HEPARIN SODIUM PER 1000U 7910441,56797,CDM,250,RC,J1644,HCPCS,00409762003,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.36520,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409205020,NDC,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,inpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,00409672903,NDC,facility,outpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.82500,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
INJ MAGNESIUM SULFATE 7003791,56798,CDM,250,RC,J3475,HCPCS,63323010615,NDC,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.82500,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,00904-6450-61,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,23155-0178-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,50268-0452-15,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.20,2.32,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,62175-0119-37,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0436-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.21,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-01,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.10,2.13,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7217284,56799,CDM,250,RC,68084-0592-11,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,inpatient,,,163.90000,155.70000,Amish/Mennonite,Amish Mennonite,90,90.14,,,,,,,90.14,158.98,percent of total billed charges,
LAB/SO PTH-RELATED PEPTIDE (81774)-TECH,56800,CDM,300,RC,82397,CPT,,,facility,outpatient,,,163.90000,155.70000,Amish/Mennonite,Amish Mennonite,90,90.14,,,,,,,14.59,729.98,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,inpatient,1,mL,23.97000,22.77000,Amish/Mennonite,Amish Mennonite,,13.18,,,,,,,13.18,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00143970201,NDC,facility,outpatient,1,mL,23.97000,22.77000,Amish/Mennonite,Amish Mennonite,,13.18,,,,,,,2.24,23.25,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,inpatient,1,mL,23.98000,22.79000,Amish/Mennonite,Amish Mennonite,,13.19,,,,,,,13.19,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,00703443281,NDC,facility,outpatient,1,mL,23.98000,22.79000,Amish/Mennonite,Amish Mennonite,,13.19,,,,,,,2.24,23.26,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,inpatient,1,mL,23.26000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,12.79,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,16714002701,NDC,facility,outpatient,1,mL,23.26000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,2.24,22.56,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,inpatient,1,mL,27.13000,25.77000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,14.92,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,25021023002,NDC,facility,outpatient,1,mL,27.13000,25.77000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,2.24,26.32,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,inpatient,1,mL,34.13000,32.42000,Amish/Mennonite,Amish Mennonite,,18.77,,,,,,,18.77,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,45963061451,NDC,facility,outpatient,1,mL,34.13000,32.42000,Amish/Mennonite,Amish Mennonite,,18.77,,,,,,,2.24,33.11,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,inpatient,1,mL,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,12.63,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,60505612800,NDC,facility,outpatient,1,mL,22.97000,21.82000,Amish/Mennonite,Amish Mennonite,,12.63,,,,,,,2.24,22.28,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,inpatient,1,mL,19.50000,18.52000,Amish/Mennonite,Amish Mennonite,,10.72,,,,,,,10.72,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,61703034916,NDC,facility,outpatient,1,mL,19.50000,18.52000,Amish/Mennonite,Amish Mennonite,,10.72,,,,,,,2.24,18.91,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
IRINOTECAN SOLN 20 MG/ML 2 ML,56801,CDM,250,RC,J9206,HCPCS,63323019352,NDC,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,2.24,24.52,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,inpatient,1,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217219,56802,CDM,250,RC,57664-0600-88,NDC,,,facility,outpatient,1,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.13,6.07,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,inpatient,1,mL,2209.91000,2099.41000,Amish/Mennonite,Amish Mennonite,,1215.45,,,,,,,1215.45,2143.61,percent of total billed charges,
IPILIMUMAB INJ 7910022,56803,CDM,636,RC,J9228,HCPCS,00003232822,NDC,facility,outpatient,1,mL,2209.91000,2099.41000,Amish/Mennonite,Amish Mennonite,,1215.45,,,,,,,183.41,2143.61,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,inpatient,1,EA,3.06000,2.91000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,16252-0539-01,NDC,,,facility,outpatient,1,EA,3.06000,2.91000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.53,2.97,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,inpatient,1,EA,3.05000,2.89000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,42806-0263-01,NDC,,,facility,outpatient,1,EA,3.05000,2.89000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,inpatient,1,EA,3.04000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.95,percent of total billed charges,
ISRADIPINE CAP,56804,CDM,250,RC,52152-0263-01,NDC,,,facility,outpatient,1,EA,3.04000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.52,2.95,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,inpatient,10,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00143950810,NDC,facility,outpatient,10,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,inpatient,10,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,00409205310,NDC,facility,outpatient,10,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,inpatient,10,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,25021068310,NDC,facility,outpatient,10,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,inpatient,10,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023011410,NDC,facility,outpatient,10,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,inpatient,10,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,42023013810,NDC,facility,outpatient,10,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,inpatient,10,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55150043910,NDC,facility,outpatient,10,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,inpatient,10,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,55390047510,NDC,facility,outpatient,10,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,inpatient,10,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
KETAMINE SOLN 50 MG/ML 10 ML,56805,CDM,250,RC,J3490,HCPCS,67457000100,NDC,facility,outpatient,10,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-01,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,00555-0071-02,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,51079-0083-20,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.63,3.16,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
ISONIAZID TAB,56807,CDM,250,RC,61748-0013-30,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,inpatient,0.6,EA,20323.63000,19307.45000,Amish/Mennonite,Amish Mennonite,,11178.00,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML,56808,CDM,636,RC,J2506,HCPCS,55513019001,NDC,facility,outpatient,0.6,EA,20323.63000,19307.45000,Amish/Mennonite,Amish Mennonite,,11178.00,,,,,,,30.97,19713.92,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,10019-0360-40,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ISOFLURANE LIQUID,56809,CDM,250,RC,66794-0019-10,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,inpatient,1,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00338006910,NDC,facility,outpatient,1,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,0.33000,3.84,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,inpatient,1,EA,6.04000,5.73000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409228831,NDC,facility,outpatient,1,EA,6.04000,5.73000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,0.33000,5.86,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,inpatient,1,EA,9.51000,9.03000,Amish/Mennonite,Amish Mennonite,,5.23,,,,,,,5.23,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00409379301,NDC,facility,outpatient,1,EA,9.51000,9.03000,Amish/Mennonite,Amish Mennonite,,5.23,,,,,,,0.33000,9.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,inpatient,1,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,00641604125,NDC,facility,outpatient,1,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,0.33000,4.55,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,inpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002902,NDC,facility,outpatient,1,EA,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,0.33000,3.25,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,10019002912,NDC,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.33000,1.66,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,inpatient,1,EA,10.68000,10.15000,Amish/Mennonite,Amish Mennonite,,5.87,,,,,,,5.87,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,25021070001,NDC,facility,outpatient,1,EA,10.68000,10.15000,Amish/Mennonite,Amish Mennonite,,5.87,,,,,,,0.33000,10.36,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,47781058368,NDC,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,0.33000,3.22,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,inpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,70860070002,NDC,facility,outpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,0.33000,5.52,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,inpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,6.52,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016101,NDC,facility,outpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,0.33000,11.49,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,63323016116,NDC,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,0.33000,2.42,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,64679075702,NDC,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,0.33000,4.29,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,inpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72266023425,NDC,facility,outpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,0.33000,3.71,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,inpatient,1,EA,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72603015325,NDC,facility,outpatient,1,EA,5.91000,5.62000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,0.33000,5.73,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,inpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
KETOROLAC SOLN 15 MG/ML,56810,CDM,250,RC,J1885,HCPCS,72611071925,NDC,facility,outpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,0.33000,3.01,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,inpatient,5,EA,38.69000,36.76000,Amish/Mennonite,Amish Mennonite,,21.28,,,,,,,21.28,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234010,NDC,facility,outpatient,5,EA,38.69000,36.76000,Amish/Mennonite,Amish Mennonite,,21.28,,,,,,,0.35222,37.53,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,inpatient,5,EA,23.26000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,12.79,22.56,percent of total billed charges,
IRON (AS SUCROSE) SOLN 20 MG/ML 5 ML,56811,CDM,250,RC,J1756,HCPCS,00517234099,NDC,facility,outpatient,5,EA,23.26000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,0.35222,22.56,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR-TECH,56812,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,43.81,120.28,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG-TECH,56813,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,43.81,142.59,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,inpatient,1,EA,115.64000,109.85000,Amish/Mennonite,Amish Mennonite,,63.60,,,,,,,63.60,112.17,percent of total billed charges,
IPRATROPIUM AERO,56814,CDM,250,RC,00597-0087-17,NDC,,,facility,outpatient,1,EA,115.64000,109.85000,Amish/Mennonite,Amish Mennonite,,63.60,,,,,,,57.82,112.17,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,inpatient,3,EA,20.98000,19.93000,Amish/Mennonite,Amish Mennonite,,11.54,,,,,,,11.54,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00002753301,NDC,facility,outpatient,3,EA,20.98000,19.93000,Amish/Mennonite,Amish Mennonite,,11.54,,,,,,,1.49,20.35,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,inpatient,3,EA,41.32000,39.26000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,22.73,40.08,percent of total billed charges,
INSULIN LISPRO SOLN 100 UNITS/ML 3 ML (EQV-HUMALOG),56816,CDM,250,RC,J1815,HCPCS,00024592605,NDC,facility,outpatient,3,EA,41.32000,39.26000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,1.49,40.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,inpatient,20,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00143962201,NDC,facility,outpatient,20,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,inpatient,20,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226720,NDC,facility,outpatient,20,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,inpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,00409226725,NDC,facility,outpatient,20,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,inpatient,20,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,17478042020,NDC,facility,outpatient,20,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,0.62439,3.83,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,inpatient,20,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,25021030020,NDC,facility,outpatient,20,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,inpatient,20,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,36000032202,NDC,facility,outpatient,20,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,inpatient,20,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72611073401,NDC,facility,outpatient,20,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.62439,1.69,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,inpatient,20,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,55390013020,NDC,facility,outpatient,20,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,inpatient,20,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72266010201,NDC,facility,outpatient,20,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.62439,1.22,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,inpatient,20,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 20 ML,56817,CDM,250,RC,J1920,HCPCS,72603014601,NDC,facility,outpatient,20,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,inpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,211.46,percent of total billed charges,
IVP EA ADDL SEQ SAME DRUG-TECH,56818,CDM,260,RC,96376,CPT,,,facility,outpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,109.00,211.46,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,inpatient,10,EA,20.31000,19.29000,Amish/Mennonite,Amish Mennonite,,11.17,,,,,,,11.17,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088222033,NDC,facility,outpatient,10,EA,20.31000,19.29000,Amish/Mennonite,Amish Mennonite,,11.17,,,,,,,1.49,19.70,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,inpatient,10,EA,89.60000,85.12000,Amish/Mennonite,Amish Mennonite,,49.28,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00088502101,NDC,facility,outpatient,10,EA,89.60000,85.12000,Amish/Mennonite,Amish Mennonite,,49.28,,,,,,,1.49,86.91,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,inpatient,10,EA,35.84000,34.05000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,19.71,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,00955172901,NDC,facility,outpatient,10,EA,35.84000,34.05000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,1.49,34.76,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,inpatient,10,EA,31.17000,29.61000,Amish/Mennonite,Amish Mennonite,,17.14,,,,,,,17.14,30.23,percent of total billed charges,
INSULIN INJECTION 7530033,56819,CDM,250,RC,J1815,HCPCS,49502019580,NDC,facility,outpatient,10,EA,31.17000,29.61000,Amish/Mennonite,Amish Mennonite,,17.14,,,,,,,1.49,30.23,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,inpatient,1,EA,2.49000,2.37000,Amish/Mennonite,Amish Mennonite,,1.37,,,,,,,1.37,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,68084-0894-25,NDC,,,facility,outpatient,1,EA,2.49000,2.37000,Amish/Mennonite,Amish Mennonite,,1.37,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,00904-2150-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.54,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,50268-0447-15,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.40,2.72,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217193,56820,CDM,250,RC,72888-0081-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71247-0126-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-5928-61,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,inpatient,1,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,00904-7109-61,NDC,,,facility,outpatient,1,EA,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,23155-0723-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,51079-0928-20,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.71500,1.39,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0114-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,60687-0439-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,68382-0798-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
LABETALOL TAB 100 MG,56821,CDM,250,RC,71930-0035-12,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
LABOR LEVEL 1,56822,CDM,721,RC,,,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,42.50,82.45,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,inpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,,,facility,outpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.00,36.40,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,inpatient,1,EA,16466.50000,15643.18000,Amish/Mennonite,Amish Mennonite,,9056.58,,,,,,,9056.58,15972.50,percent of total billed charges,
VEDOLIZUMAB POWD-INJ 300 MG (ENTYVIO),56823,CDM,636,RC,J3380,HCPCS,64764030020,NDC,facility,outpatient,1,EA,16466.50000,15643.18000,Amish/Mennonite,Amish Mennonite,,9056.58,,,,,,,22.06,15972.50,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,inpatient,,,467.00000,443.65000,Amish/Mennonite,Amish Mennonite,,256.85,,,,,,,256.85,452.99,percent of total billed charges,
IRREGATION BLADDER SIMPLE 402271-TECH,56824,CDM,361,RC,51700,CPT,,,facility,outpatient,,,467.00000,443.65000,Amish/Mennonite,Amish Mennonite,,256.85,,,,,,,230.94,3163.00,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR-TECH,56825,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,67.58,194.97,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
LEAD ASSAY-TECH,56826,CDM,300,RC,83655,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,12.11,628.12,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,65.45,115.43,percent of total billed charges,
INSULIN TOTAL ASSAY-TECH,56827,CDM,300,RC,83525,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,11.43,594.19,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR-TECH,56828,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,43.81,97.00,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,inpatient,1,mL,20323.63000,19307.45000,Amish/Mennonite,Amish Mennonite,,11178.00,,,,,,,11178.00,19713.92,percent of total billed charges,
PEGFILGRASTIM SOLN 6 MG/0.6 ML ON-BODY,56829,CDM,636,RC,J2506,HCPCS,55513019201,NDC,facility,outpatient,1,mL,20323.63000,19307.45000,Amish/Mennonite,Amish Mennonite,,11178.00,,,,,,,30.97,19713.92,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,inpatient,,,658.00000,625.10000,Amish/Mennonite,Amish Mennonite,,361.90,,,,,,,361.90,638.26,percent of total billed charges,
INSITU HYBRID AUTO MULTIPLEX EA-TECH,56830,CDM,310,RC,88374,CPT,,,facility,outpatient,,,658.00000,625.10000,Amish/Mennonite,Amish Mennonite,,361.90,,,,,,,162.71,16444.87,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,TC,732.05,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMG FLOW/FUNCT SNGL W RX-TECH,56832,CDM,341,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,TC,732.05,,,,,,,644.24,2960.49,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,00904-6449-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50268-0451-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,50742-0175-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,62175-0128-37,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB-ER 30 MG,56834,CDM,250,RC,68084-0591-11,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,47.30,83.42,percent of total billed charges,
IRON BINDING CAPACITY-TECH,56835,CDM,300,RC,83550,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,8.74,458.40,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
IRBESARTAN TAB 7212031,56836,CDM,250,RC,00093-7466-56,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,inpatient,,,317.00000,301.15000,Amish/Mennonite,Amish Mennonite,,174.35,,,,,,,174.35,307.49,percent of total billed charges,
IV DAILY ADMIN CHARGE,56838,CDM,260,RC,,,,,facility,outpatient,,,317.00000,301.15000,Amish/Mennonite,Amish Mennonite,,174.35,,,,,,,158.50,307.49,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,inpatient,,,754.00000,716.30000,Amish/Mennonite,Amish Mennonite,,414.70,,,,,,,414.70,731.38,percent of total billed charges,
INJECTION CYSTOGRAPHY/VUCG-TECH,56839,CDM,361,RC,51600,CPT,,,facility,outpatient,,,754.00000,716.30000,Amish/Mennonite,Amish Mennonite,,414.70,,,,,,,414.70,5271.00,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,inpatient,2.5,EA,179.56000,170.58000,Amish/Mennonite,Amish Mennonite,,98.76,,,,,,,98.76,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-01,NDC,,,facility,outpatient,2.5,EA,179.56000,170.58000,Amish/Mennonite,Amish Mennonite,,98.76,,,,,,,89.78,174.17,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,inpatient,2.5,EA,273.80000,260.11000,Amish/Mennonite,Amish Mennonite,,150.59,,,,,,,150.59,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00013-8303-04,NDC,,,facility,outpatient,2.5,EA,273.80000,260.11000,Amish/Mennonite,Amish Mennonite,,150.59,,,,,,,136.90,265.59,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,inpatient,2.5,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,00517-0830-01,NDC,,,facility,outpatient,2.5,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,14.71,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,inpatient,2.5,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,17478-0625-12,NDC,,,facility,outpatient,2.5,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,9.83,19.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,inpatient,2.5,EA,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,12.51,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,24208-0463-25,NDC,,,facility,outpatient,2.5,EA,22.75000,21.61000,Amish/Mennonite,Amish Mennonite,,12.51,,,,,,,11.38,22.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,inpatient,2.5,EA,13.13000,12.48000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,59762-0333-02,NDC,,,facility,outpatient,2.5,EA,13.13000,12.48000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,6.57,12.74,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,inpatient,2.5,EA,13.52000,12.85000,Amish/Mennonite,Amish Mennonite,,7.44,,,,,,,7.44,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-01,NDC,,,facility,outpatient,2.5,EA,13.52000,12.85000,Amish/Mennonite,Amish Mennonite,,7.44,,,,,,,6.76,13.11,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,inpatient,2.5,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,9.32,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,61314-0547-03,NDC,,,facility,outpatient,2.5,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,8.47,16.43,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,inpatient,2.5,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
LATANOPROST OPHTH SOL,56840,CDM,250,RC,70069-0421-01,NDC,,,facility,outpatient,2.5,EA,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.13,6.07,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
KOH FUNGAL DIRECT EXAM-TECH,56841,CDM,300,RC,87220,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,4.27,220.68,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
KETONE BODY QUANTITATIVE-TECH,56842,CDM,300,RC,82010,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,8.17,424.40,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR-TECH,56843,CDM,260,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,187.00,362.78,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,inpatient,2,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,00409379601,NDC,facility,outpatient,2,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,0.33000,5.01,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,inpatient,2,EA,8.90000,8.45000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.89,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,25021070102,NDC,facility,outpatient,2,EA,8.90000,8.45000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,0.33000,8.63,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,inpatient,2,EA,11.36000,10.79000,Amish/Mennonite,Amish Mennonite,,6.25,,,,,,,6.25,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016202,NDC,facility,outpatient,2,EA,11.36000,10.79000,Amish/Mennonite,Amish Mennonite,,6.25,,,,,,,0.33000,11.02,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,inpatient,2,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,63323016226,NDC,facility,outpatient,2,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.33000,1.58,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,inpatient,2,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72266011925,NDC,facility,outpatient,2,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.33000,3.07,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,inpatient,2,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,70860070104,NDC,facility,outpatient,2,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,0.33000,2.17,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,inpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
KETOROLAC SOLN 60 MG/2 ML,56844,CDM,250,RC,J1885,HCPCS,72611072525,NDC,facility,outpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.33000,1.90,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,inpatient,,,1064.00000,1010.80000,Amish/Mennonite,Amish Mennonite,90,585.20,,,,,,,585.20,1032.08,percent of total billed charges,
JAK2 V617F GENE ANALYSIS-TECH,56845,CDM,310,RC,81270,CPT,,,facility,outpatient,,,1064.00000,1010.80000,Amish/Mennonite,Amish Mennonite,90,585.20,,,,,,,94.71,4787.38,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,Amish/Mennonite,Amish Mennonite,,67.96,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00088-2161-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,Amish/Mennonite,Amish Mennonite,,67.96,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,00781-5057-31,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,10702-0278-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,23155-0044-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,inpatient,1,EA,6.12000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.37,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,50268-0478-15,NDC,,,facility,outpatient,1,EA,6.12000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.06,5.94,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,59651-0349-30,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,inpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,9.15,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,60505-2503-01,NDC,,,facility,outpatient,1,EA,16.64000,15.81000,Amish/Mennonite,Amish Mennonite,,9.15,,,,,,,8.32,16.14,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,62332-0062-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,inpatient,1,EA,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.45,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70710-1158-03,NDC,,,facility,outpatient,1,EA,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.04,7.85,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB,56846,CDM,250,RC,70748-0130-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,inpatient,,,1733.00000,1646.35000,Amish/Mennonite,Amish Mennonite,TC,953.15,,,,,,,953.15,1681.01,percent of total billed charges,
KIDNEY IMAGE MORPHOLOGY-TECH,56847,CDM,341,RC,78700,CPT,,,facility,outpatient,,,1733.00000,1646.35000,Amish/Mennonite,Amish Mennonite,TC,953.15,,,,,,,811.39,2210.07,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,,248.60,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION INIT 1ST HR-TECH,56848,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,,248.60,,,,,,,200.06,438.44,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,inpatient,1,EA,73.95000,70.25000,Amish/Mennonite,Amish Mennonite,,40.67,,,,,,,40.67,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00078-0249-15,NDC,,,facility,outpatient,1,EA,73.95000,70.25000,Amish/Mennonite,Amish Mennonite,,40.67,,,,,,,36.98,71.73,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,59651-0180-30,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,00378-2071-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,inpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,50268-0476-15,NDC,,,facility,outpatient,1,EA,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,51991-0759-90,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,60505-3255-03,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,inpatient,1,EA,1114.87000,1059.12000,Amish/Mennonite,Amish Mennonite,,613.18,,,,,,,613.18,1081.42,percent of total billed charges,
LETROZOLE TAB,56849,CDM,250,RC,78024-4915-15,NDC,,,facility,outpatient,1,EA,1114.87000,1059.12000,Amish/Mennonite,Amish Mennonite,,613.18,,,,,,,557.43,1081.42,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,Amish/Mennonite,Amish Mennonite,TC,1185.25,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMG W FLOW/FUNCT SNGL-TECH,56851,CDM,341,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,Amish/Mennonite,Amish Mennonite,TC,1185.25,,,,,,,1006.74,2960.49,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,inpatient,4,EA,7.18000,6.82000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.95,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,00409233934,NDC,facility,outpatient,4,EA,7.18000,6.82000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,0.62439,6.96,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,inpatient,4,EA,3.33000,3.17000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,36000032010,NDC,facility,outpatient,4,EA,3.33000,3.17000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,0.62439,3.23,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,inpatient,4,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 4 ML,56852,CDM,250,RC,J1920,HCPCS,60505071700,NDC,facility,outpatient,4,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,0.62439,2.09,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
LABOR LEVEL 2,56854,CDM,721,RC,,,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,53.00,102.82,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,826.88,1636.88,percent of total billed charges,
1-PEG PATELLA 26MM EXP,56856,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,774.56,1687.50,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,inpatient,1,EA,9777.53000,9288.66000,Amish/Mennonite,Amish Mennonite,,5377.64,,,,,,,5377.64,9484.20,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT),56857,CDM,636,RC,J1950,HCPCS,00074366303,NDC,facility,outpatient,1,EA,9777.53000,9288.66000,Amish/Mennonite,Amish Mennonite,,5377.64,,,,,,,1737.10,9484.20,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,00228-2620-11,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,62175-0107-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,inpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,6.07,10.70,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB 7213093,56859,CDM,250,RC,81665-0103-10,NDC,,,facility,outpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,5.51,10.70,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,inpatient,,,181.10000,172.04000,Amish/Mennonite,Amish Mennonite,90,99.61,,,,,,,99.61,175.67,percent of total billed charges,
LEGIONELLA AB-TECH,56860,CDM,300,RC,86713,CPT,,,facility,outpatient,,,181.10000,172.04000,Amish/Mennonite,Amish Mennonite,90,99.61,,,,,,,15.81,797.91,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,inpatient,,,1949.00000,1851.55000,Amish/Mennonite,Amish Mennonite,,1071.95,,,,,,,1071.95,1890.53,percent of total billed charges,
INS/RPLC DUAL CHMBR TEMP PCMKR-TECH,56861,CDM,361,RC,33211,CPT,,,facility,outpatient,,,1949.00000,1851.55000,Amish/Mennonite,Amish Mennonite,,1071.95,,,,,,,1071.95,16988.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00143950910,NDC,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,inpatient,1,mL,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409004010,NDC,facility,outpatient,1,mL,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,inpatient,1,mL,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,00409205105,NDC,facility,outpatient,1,mL,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.59,5.02,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,inpatient,1,mL,6.24000,5.93000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023011510,NDC,facility,outpatient,1,mL,6.24000,5.93000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.12,6.05,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,inpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
KETAMINE SOLN 100 MG/ML 5 ML,56862,CDM,250,RC,J3490,HCPCS,42023013910,NDC,facility,outpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,inpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,90,112.75,,,,,,,112.75,198.85,percent of total billed charges,
LACTOFERRIN FECAL QUAL SO-TECH,56863,CDM,300,RC,83630,CPT,,,facility,outpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,90,112.75,,,,,,,16.82,1018.59,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
0.035INX5IN K-WIRE DBLE ENDED,56864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00116-4005-40,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,00121-4577-15,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
LACTULOSE SYRUP 7424048,56865,CDM,250,RC,66689-0039-50,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,inpatient,1,EA,43.58000,41.40000,Amish/Mennonite,Amish Mennonite,,23.97,,,,,,,23.97,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,00173-0595-00,NDC,,,facility,outpatient,1,EA,43.58000,41.40000,Amish/Mennonite,Amish Mennonite,,23.97,,,,,,,21.79,42.27,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,inpatient,1,EA,47.47000,45.10000,Amish/Mennonite,Amish Mennonite,,26.11,,,,,,,26.11,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,49702-0202-18,NDC,,,facility,outpatient,1,EA,47.47000,45.10000,Amish/Mennonite,Amish Mennonite,,26.11,,,,,,,23.73,46.05,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,inpatient,1,EA,19.63000,18.64000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,10.80,19.04,percent of total billed charges,
LAMIVUDINE-ZIDOVUDINE TAB,56866,CDM,250,RC,65862-0597-60,NDC,,,facility,outpatient,1,EA,19.63000,18.64000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,9.81,19.04,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,inpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,90.75,160.05,percent of total billed charges,
LAMOTRIGINE ASSAY-TECH,56867,CDM,300,RC,80175,CPT,,,facility,outpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,13.25,696.05,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,inpatient,1,EA,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,45.19,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,00143955201,NDC,facility,outpatient,1,EA,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,5.45,79.70,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,inpatient,1,EA,59.88000,56.89000,Amish/Mennonite,Amish Mennonite,,32.93,,,,,,,32.93,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,67457053035,NDC,facility,outpatient,1,EA,59.88000,56.89000,Amish/Mennonite,Amish Mennonite,,32.93,,,,,,,5.45,58.08,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,inpatient,1,EA,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,121.66,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081630,NDC,facility,outpatient,1,EA,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,5.45,214.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,inpatient,1,EA,55.62000,52.84000,Amish/Mennonite,Amish Mennonite,,30.59,,,,,,,30.59,53.95,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION,56868,CDM,250,RC,J0640,HCPCS,25021081667,NDC,facility,outpatient,1,EA,55.62000,52.84000,Amish/Mennonite,Amish Mennonite,,30.59,,,,,,,5.45,53.95,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,inpatient,1,EA,1.83000,1.73000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00143-1771-01,NDC,,,facility,outpatient,1,EA,1.83000,1.73000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00781-1556-13,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-2151-61,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,00904-6619-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,50268-0448-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,63739-0569-10,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,inpatient,1,EA,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,68084-0082-01,NDC,,,facility,outpatient,1,EA,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,2.85,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 7217201,56869,CDM,250,RC,72888-0082-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,243.10,428.74,percent of total billed charges,
LEUKODEPLETED CELLS EA UNIT,56870,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,172.82,489.94,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,inpatient,1,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72266011825,NDC,facility,outpatient,1,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,0.33000,5.36,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,inpatient,1,EA,11.50000,10.93000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,6.33,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409228731,NDC,facility,outpatient,1,EA,11.50000,10.93000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,0.33000,11.15,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,inpatient,1,EA,20.63000,19.60000,Amish/Mennonite,Amish Mennonite,,11.35,,,,,,,11.35,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00409379501,NDC,facility,outpatient,1,EA,20.63000,19.60000,Amish/Mennonite,Amish Mennonite,,11.35,,,,,,,0.33000,20.01,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,00641604225,NDC,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.33000,4.85,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,inpatient,1,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,10019003012,NDC,facility,outpatient,1,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,0.33000,3.46,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,inpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,25021070101,NDC,facility,outpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,0.33000,13.79,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,inpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,62332060025,NDC,facility,outpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,0.33000,5.82,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016201,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.33000,15.33,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,inpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,63323016216,NDC,facility,outpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,0.33000,2.67,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,68462075625,NDC,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,0.33000,4.78,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,inpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,70860070103,NDC,facility,outpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,0.33000,4.07,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,inpatient,1,EA,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,72611072225,NDC,facility,outpatient,1,EA,3.54000,3.36000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,0.33000,3.43,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,inpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
KETOROLAC SOLN 30 MG/ML,56871,CDM,250,RC,J1885,HCPCS,76045010410,NDC,facility,outpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,0.33000,10.42,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143936801,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,5.45,30.65,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,inpatient,1,EA,75.84000,72.05000,Amish/Mennonite,Amish Mennonite,,41.71,,,,,,,41.71,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,00143955301,NDC,facility,outpatient,1,EA,75.84000,72.05000,Amish/Mennonite,Amish Mennonite,,41.71,,,,,,,5.45,73.56,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,67457052920,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,5.45,122.61,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,inpatient,1,EA,48.66000,46.23000,Amish/Mennonite,Amish Mennonite,,26.76,,,,,,,26.76,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,25021081567,NDC,facility,outpatient,1,EA,48.66000,46.23000,Amish/Mennonite,Amish Mennonite,,26.76,,,,,,,5.45,47.20,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,inpatient,1,EA,72.87000,69.23000,Amish/Mennonite,Amish Mennonite,,40.08,,,,,,,40.08,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071050,NDC,facility,outpatient,1,EA,72.87000,69.23000,Amish/Mennonite,Amish Mennonite,,40.08,,,,,,,5.45,70.68,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,inpatient,1,EA,66.55000,63.22000,Amish/Mennonite,Amish Mennonite,,36.60,,,,,,,36.60,64.55,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910058,56872,CDM,250,RC,J0640,HCPCS,63323071059,NDC,facility,outpatient,1,EA,66.55000,63.22000,Amish/Mennonite,Amish Mennonite,,36.60,,,,,,,5.45,64.55,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,inpatient,1,mL,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
LEVOFLOXACIN OPHTH SOL,56875,CDM,250,RC,17478-0106-10,NDC,,,facility,outpatient,1,mL,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,19.75,38.31,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,inpatient,1,EA,11651.31000,11068.75000,Amish/Mennonite,Amish Mennonite,,6408.22,,,,,,,6408.22,11301.77,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (LUPRON DEPOT),56876,CDM,636,RC,J9217,HCPCS,00074334603,NDC,facility,outpatient,1,EA,11651.31000,11068.75000,Amish/Mennonite,Amish Mennonite,,6408.22,,,,,,,155.42,11301.77,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
LACTIC ACID ASSAY-TECH,56877,CDM,300,RC,83605,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,11.57,560.26,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,inpatient,100,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143931624,NDC,facility,outpatient,100,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,inpatient,100,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334209,NDC,facility,outpatient,100,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00143972124,NDC,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,inpatient,100,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00409333024,NDC,facility,outpatient,100,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,inpatient,100,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,00781334246,NDC,facility,outpatient,100,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021082582,NDC,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,inpatient,100,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,25021013282,NDC,facility,outpatient,100,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,inpatient,100,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,36000004724,NDC,facility,outpatient,100,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,inpatient,100,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,44567043624,NDC,facility,outpatient,100,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,inpatient,100,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,50458016801,NDC,facility,outpatient,100,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,3.23,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,inpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
LEVOFLOXACIN 500 MG/100 ML PREMIX,56878,CDM,250,RC,J1956,HCPCS,55150024447,NDC,facility,outpatient,100,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,3.23,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,inpatient,1,EA,298.62000,283.69000,Amish/Mennonite,Amish Mennonite,,164.24,,,,,,,164.24,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,70860045110,NDC,facility,outpatient,1,EA,298.62000,283.69000,Amish/Mennonite,Amish Mennonite,,164.24,,,,,,,11.25,289.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,inpatient,1,EA,273.45000,259.78000,Amish/Mennonite,Amish Mennonite,,150.40,,,,,,,150.40,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064916,NDC,facility,outpatient,1,EA,273.45000,259.78000,Amish/Mennonite,Amish Mennonite,,150.40,,,,,,,11.25,265.25,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,inpatient,1,EA,290.12000,275.61000,Amish/Mennonite,Amish Mennonite,,159.57,,,,,,,159.57,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,63323064994,NDC,facility,outpatient,1,EA,290.12000,275.61000,Amish/Mennonite,Amish Mennonite,,159.57,,,,,,,11.25,281.42,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,inpatient,1,EA,322.97000,306.82000,Amish/Mennonite,Amish Mennonite,,177.63,,,,,,,177.63,313.28,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 100 MCG,56879,CDM,250,RC,J0650,HCPCS,66794064902,NDC,facility,outpatient,1,EA,322.97000,306.82000,Amish/Mennonite,Amish Mennonite,,177.63,,,,,,,11.25,313.28,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,inpatient,1,EA,23303.03000,22137.87000,Amish/Mennonite,Amish Mennonite,,12816.67,,,,,,,12816.67,22603.94,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (LUPRON DEPOT),56880,CDM,636,RC,J9217,HCPCS,00074347303,NDC,facility,outpatient,1,EA,23303.03000,22137.87000,Amish/Mennonite,Amish Mennonite,,12816.67,,,,,,,155.42,22603.94,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,inpatient,30,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00054022463,NDC,facility,outpatient,30,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,inpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,00121079916,NDC,facility,outpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,inpatient,30,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,16714035801,NDC,facility,outpatient,30,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,inpatient,30,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50383024106,NDC,facility,outpatient,30,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,inpatient,30,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.65,percent of total billed charges,
LEVETIRACETAM LIQ 100 MG/ML,56881,CDM,250,RC,J8499,HCPCS,50474000148,NDC,facility,outpatient,30,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.40,4.65,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,90,108.90,,,,,,,108.90,192.06,percent of total billed charges,
"CORTISOL, SALIVA (CTSAL) SO",56883,CDM,300,RC,82533,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,90,108.90,,,,,,,16.84,848.80,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,inpatient,1,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,27.81,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,71288016120,NDC,facility,outpatient,1,EA,50.56000,48.03000,Amish/Mennonite,Amish Mennonite,,27.81,,,,,,,5.45,49.04,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,67457052810,NDC,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,5.45,61.30,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,inpatient,1,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,15.30,26.98,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910057,56884,CDM,250,RC,J0640,HCPCS,25021081467,NDC,facility,outpatient,1,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,5.45,26.98,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL-TECH,56885,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,185.50,359.87,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,inpatient,1,EA,46.10000,43.80000,Amish/Mennonite,Amish Mennonite,,25.36,,,,,,,25.36,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00173-0642-55,NDC,,,facility,outpatient,1,EA,46.10000,43.80000,Amish/Mennonite,Amish Mennonite,,25.36,,,,,,,23.05,44.72,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,00904-7008-61,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,16714-0701-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51079-0499-20,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,51672-4131-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,59746-0246-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,inpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0179-10,NDC,,,facility,outpatient,1,EA,0.37000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,63739-0516-10,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,65862-0228-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
LAMOTRIGINE TAB,56887,CDM,250,RC,68084-0319-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
LACTATE DEHYDROGENASE LDH-TECH,56889,CDM,300,RC,83615,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,6.04,322.54,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,inpatient,40,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00143962301,NDC,facility,outpatient,40,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,inpatient,40,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226726,NDC,facility,outpatient,40,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,inpatient,40,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,00409226754,NDC,facility,outpatient,40,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,inpatient,40,EA,3.75000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,17478042040,NDC,facility,outpatient,40,EA,3.75000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,0.62439,3.64,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,inpatient,40,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,47781058656,NDC,facility,outpatient,40,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.69720,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,inpatient,40,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,51991093598,NDC,facility,outpatient,40,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.62439,1.92,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,inpatient,40,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LABETALOL SOLN-INJ 5 MG/ML 40 ML,56890,CDM,250,RC,J1920,HCPCS,72266010341,NDC,facility,outpatient,40,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.69720,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,inpatient,1,EA,248.72000,236.29000,Amish/Mennonite,Amish Mennonite,,136.80,,,,,,,136.80,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,63323071100,NDC,facility,outpatient,1,EA,248.72000,236.29000,Amish/Mennonite,Amish Mennonite,,136.80,,,,,,,5.45,241.26,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,inpatient,1,EA,272.36000,258.74000,Amish/Mennonite,Amish Mennonite,,149.80,,,,,,,149.80,264.19,percent of total billed charges,
LEUCOVORIN CALCIUM INJECTION 7910060,56891,CDM,250,RC,J0640,HCPCS,71288016450,NDC,facility,outpatient,1,EA,272.36000,258.74000,Amish/Mennonite,Amish Mennonite,,149.80,,,,,,,5.45,264.19,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00143957710,NDC,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,00409427602,NDC,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,55150025350,NDC,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,inpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
LIDOCAINE SOLN 1% 50 ML,56892,CDM,250,RC,J2003,HCPCS,63323048557,NDC,facility,outpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
LEUKOCYTE WBC COUNT AUTO-TECH,56893,CDM,300,RC,85048,CPT,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,2.54,135.79,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,inpatient,1,EA,62.02000,58.92000,Amish/Mennonite,Amish Mennonite,,34.11,,,,,,,34.11,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00045-1525-10,NDC,,,facility,outpatient,1,EA,62.02000,58.92000,Amish/Mennonite,Amish Mennonite,,34.11,,,,,,,31.01,60.16,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,00904-6352-61,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,inpatient,1,EA,94.91000,90.17000,Amish/Mennonite,Amish Mennonite,,52.20,,,,,,,52.20,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,50458-0925-10,NDC,,,facility,outpatient,1,EA,94.91000,90.17000,Amish/Mennonite,Amish Mennonite,,52.20,,,,,,,47.45,92.06,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,51079-0035-20,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
LEVOFLOXACIN TAB,56894,CDM,250,RC,68084-0482-11,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,17478010720,NDC,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,inpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,36000004501,NDC,facility,outpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,inpatient,1,mL,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
LEVOFLOXACIN INJECTION 7910449,56895,CDM,250,RC,J1956,HCPCS,55150015620,NDC,facility,outpatient,1,mL,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,3.23,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,inpatient,3,EA,5.65000,5.36000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00093414656,NDC,facility,outpatient,3,EA,5.65000,5.36000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,inpatient,3,EA,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,00378968144,NDC,facility,outpatient,3,EA,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,inpatient,3,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051200,NDC,facility,outpatient,3,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,0.13485,4.14,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,inpatient,3,EA,8.27000,7.86000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,4.55,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,63402051224,NDC,facility,outpatient,3,EA,8.27000,7.86000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,0.13485,8.02,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,inpatient,3,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002227,NDC,facility,outpatient,3,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,inpatient,3,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,66993002235,NDC,facility,outpatient,3,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,0.13485,3.92,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,inpatient,3,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NON-COMP UNIT,56896,CDM,250,RC,J7614,HCPCS,76204080001,NDC,facility,outpatient,3,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.13485,1.64,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
LEGIONELLA AG URINE IA-TECH,56897,CDM,300,RC,87899,CPT,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,16.07,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,inpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00143959525,NDC,facility,outpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471302,NDC,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,inpatient,1,EA,6.81000,6.47000,Amish/Mennonite,Amish Mennonite,,3.75,,,,,,,3.75,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409471375,NDC,facility,outpatient,1,EA,6.81000,6.47000,Amish/Mennonite,Amish Mennonite,,3.75,,,,,,,3.40,6.61,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,inpatient,1,EA,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409490434,NDC,facility,outpatient,1,EA,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.84,5.51,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,inpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.94,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,00409913705,NDC,facility,outpatient,1,EA,5.35000,5.08000,Amish/Mennonite,Amish Mennonite,,2.94,,,,,,,2.67,5.19,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150015974,NDC,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,inpatient,1,EA,1.87000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,55150016205,NDC,facility,outpatient,1,EA,1.87000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.93500,1.81,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,inpatient,1,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63323049257,NDC,facility,outpatient,1,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,2.41,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017024,NDC,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,63739017027,NDC,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
LIDOCAINE SOLN PF 1% 5 ML,56898,CDM,250,RC,J2003,HCPCS,73293000102,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372713,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,inpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00074372790,NDC,facility,outpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,inpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00378182301,NDC,facility,outpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,inpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,00781519192,NDC,facility,outpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,42292004120,NDC,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,47781065990,NDC,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,inpatient,1,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60687056301,NDC,facility,outpatient,1,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,inpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
LEVOTHYROXINE TAB 137 MCG (0.137 MG),56899,CDM,250,RC,J8499,HCPCS,60793085701,NDC,facility,outpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,00904-7123-61,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,16714-0354-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,50268-0467-15,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,51079-0820-20,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,63739-0411-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
LEVETIRACETAM TAB 7224222,56900,CDM,250,RC,68084-0859-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,inpatient,5,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143957425,NDC,facility,outpatient,5,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,0.08005,2.38,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,inpatient,5,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967301,NDC,facility,outpatient,5,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,0.08005,2.26,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,inpatient,5,EA,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,67457079005,NDC,facility,outpatient,5,EA,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,0.08005,6.44,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,inpatient,5,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00143967325,NDC,facility,outpatient,5,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,0.08005,2.45,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,inpatient,5,EA,2.46000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,00409201125,NDC,facility,outpatient,5,EA,2.46000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,0.08005,2.39,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,inpatient,5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,14789040005,NDC,facility,outpatient,5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,0.08005,11.04,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,inpatient,5,EA,3.92000,3.72000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,39822400001,NDC,facility,outpatient,5,EA,3.92000,3.72000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,0.08005,3.80,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,inpatient,5,EA,21.12000,20.06000,Amish/Mennonite,Amish Mennonite,,11.62,,,,,,,11.62,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,50474000263,NDC,facility,outpatient,5,EA,21.12000,20.06000,Amish/Mennonite,Amish Mennonite,,11.62,,,,,,,0.08005,20.49,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,inpatient,5,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72205012007,NDC,facility,outpatient,5,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.08005,1.83,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,inpatient,5,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,51224001325,NDC,facility,outpatient,5,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,0.08005,1.96,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,inpatient,5,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,55150017705,NDC,facility,outpatient,5,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,0.08005,4.91,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,inpatient,5,EA,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,62756051344,NDC,facility,outpatient,5,EA,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,0.08005,20.37,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,inpatient,5,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,63323040005,NDC,facility,outpatient,5,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,0.08005,4.84,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,inpatient,5,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010610,NDC,facility,outpatient,5,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.08005,0.73720,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,inpatient,5,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LEVETIRACETAM INJECTION,56901,CDM,250,RC,J1953,HCPCS,72485010625,NDC,facility,outpatient,5,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.08005,1.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,inpatient,1,mL,33272.80000,31609.16000,Amish/Mennonite,Amish Mennonite,,18300.04,,,,,,,18300.04,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112003,NDC,facility,outpatient,1,mL,33272.80000,31609.16000,Amish/Mennonite,Amish Mennonite,,18300.04,,,,,,,36.66,32274.62,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,inpatient,1,mL,36335.60000,34518.82000,Amish/Mennonite,Amish Mennonite,,19984.58,,,,,,,19984.58,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,15054112004,NDC,facility,outpatient,1,mL,36335.60000,34518.82000,Amish/Mennonite,Amish Mennonite,,19984.58,,,,,,,36.66,35245.53,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,inpatient,1,mL,33792.11000,32102.50000,Amish/Mennonite,Amish Mennonite,,18585.66,,,,,,,18585.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,69097087067,NDC,facility,outpatient,1,mL,33792.11000,32102.50000,Amish/Mennonite,Amish Mennonite,,18585.66,,,,,,,36.66,32778.35,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,inpatient,1,mL,11961.94000,11363.85000,Amish/Mennonite,Amish Mennonite,,6579.07,,,,,,,6579.07,11603.08,percent of total billed charges,
LANREOTIDE SOLN 120 MG/0.5 ML (SOMATULINE DEPOT),56903,CDM,636,RC,J1930,HCPCS,76282072067,NDC,facility,outpatient,1,mL,11961.94000,11363.85000,Amish/Mennonite,Amish Mennonite,,6579.07,,,,,,,36.66,11603.08,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00378-5615-78,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,00904-7124-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,16714-0355-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,inpatient,1,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50268-0468-15,NDC,,,facility,outpatient,1,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,inpatient,1,EA,9.41000,8.94000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,5.18,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0592-40,NDC,,,facility,outpatient,1,EA,9.41000,8.94000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,4.71,9.13,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,inpatient,1,EA,31.20000,29.64000,Amish/Mennonite,Amish Mennonite,,17.16,,,,,,,17.16,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,50474-0595-40,NDC,,,facility,outpatient,1,EA,31.20000,29.64000,Amish/Mennonite,Amish Mennonite,,17.16,,,,,,,15.60,30.26,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,51079-0821-20,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,60687-0657-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,63739-0411-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,65862-0246-08,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
LEVETIRACETAM TAB 7224223,56904,CDM,250,RC,68084-0870-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,50383-0172-90,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.69,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,54482-0144-07,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.60,3.10,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
LEVOCARNITINE TAB,56906,CDM,250,RC,64980-0130-09,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,inpatient,1,EA,15535.12000,14758.37000,Amish/Mennonite,Amish Mennonite,,8544.32,,,,,,,8544.32,15069.07,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (LUPRON DEPOT),56907,CDM,636,RC,J9217,HCPCS,00074368303,NDC,facility,outpatient,1,EA,15535.12000,14758.37000,Amish/Mennonite,Amish Mennonite,,8544.32,,,,,,,155.42,15069.07,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,inpatient,1,mL,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,55150024647,NDC,facility,outpatient,1,mL,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.08005,0.56260,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,inpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025500,NDC,facility,outpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.08005,0.53350,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,inpatient,1,mL,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,67457025510,NDC,facility,outpatient,1,mL,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.08005,0.63050,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,inpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
LEVETIRACETAM INJECTION 7002044,56908,CDM,250,RC,J1953,HCPCS,70860060282,NDC,facility,outpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.08005,0.39770,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,inpatient,5,EA,11.32000,10.75000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,6.23,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,24208-0505-05,NDC,,,facility,outpatient,5,EA,11.32000,10.75000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,5.66,10.98,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
LEVOBUNOLOL OPHTH SOL,56909,CDM,250,RC,60758-0060-05,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,inpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929613,NDC,facility,outpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00074929690,NDC,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,inpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527134601,NDC,facility,outpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,inpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00781518592,NDC,facility,outpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00527328546,NDC,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,00904695461,NDC,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,42292003920,NDC,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,60687050801,NDC,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,inpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
LEVOTHYROXINE TAB 112 MCG (0.112 MG),56910,CDM,250,RC,J8499,HCPCS,68180097003,NDC,facility,outpatient,1,EA,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,inpatient,1,mL,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML,56911,CDM,250,RC,J2003,HCPCS,00409428202,NDC,facility,outpatient,1,mL,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,inpatient,30,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00093-0840-30,NDC,,,facility,outpatient,30,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.26,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,inpatient,30,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,00168-0099-30,NDC,,,facility,outpatient,30,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,inpatient,30,EA,4.27000,4.06000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,16714-0955-02,NDC,,,facility,outpatient,30,EA,4.27000,4.06000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.13,4.14,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,inpatient,30,EA,4.01000,3.81000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.21,3.89,percent of total billed charges,
KETOCONAZOLE CRM,56912,CDM,250,RC,51672-1298-02,NDC,,,facility,outpatient,30,EA,4.01000,3.81000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.00,3.89,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,00904-6353-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,inpatient,1,EA,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,31722-0723-20,NDC,,,facility,outpatient,1,EA,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7910235,56913,CDM,250,RC,68084-0483-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6249-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,00904-6351-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,55111-0279-50,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,65862-0536-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
LEVOFLOXACIN TAB 7936099,56914,CDM,250,RC,68084-0481-11,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,inpatient,1,EA,23.83000,22.64000,Amish/Mennonite,Amish Mennonite,,13.11,,,,,,,13.11,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,00536-1142-63,NDC,,,facility,outpatient,1,EA,23.83000,22.64000,Amish/Mennonite,Amish Mennonite,,13.11,,,,,,,11.91,23.12,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,inpatient,1,EA,85.13000,80.87000,Amish/Mennonite,Amish Mennonite,,46.82,,,,,,,46.82,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,16714-0809-01,NDC,,,facility,outpatient,1,EA,85.13000,80.87000,Amish/Mennonite,Amish Mennonite,,46.82,,,,,,,42.56,82.58,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,inpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,50742-0352-01,NDC,,,facility,outpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,11.06,21.46,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,inpatient,1,EA,102.70000,97.56000,Amish/Mennonite,Amish Mennonite,,56.48,,,,,,,56.48,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,69536-0162-88,NDC,,,facility,outpatient,1,EA,102.70000,97.56000,Amish/Mennonite,Amish Mennonite,,56.48,,,,,,,51.35,99.62,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,62756-0718-60,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,31.60,61.30,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,inpatient,1,EA,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,23.46,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0852-11,NDC,,,facility,outpatient,1,EA,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,21.33,41.38,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,inpatient,1,EA,92.43000,87.81000,Amish/Mennonite,Amish Mennonite,,50.84,,,,,,,50.84,89.66,percent of total billed charges,
LEVONORGESTREL TAB,56915,CDM,250,RC,68180-0853-13,NDC,,,facility,outpatient,1,EA,92.43000,87.81000,Amish/Mennonite,Amish Mennonite,,50.84,,,,,,,46.22,89.66,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,inpatient,5,EA,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409132305,NDC,facility,outpatient,5,EA,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.35,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,inpatient,5,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,00409490334,NDC,facility,outpatient,5,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.80,3.49,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,inpatient,5,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.55,percent of total billed charges,
LIDOCAINE SYRINGE PF 2% 5 ML,56917,CDM,250,RC,J2003,HCPCS,76329339001,NDC,facility,outpatient,5,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.55,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434113,NDC,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,inpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00074434190,NDC,facility,outpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00378180001,NDC,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00781518092,NDC,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,00904694961,NDC,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,51079044420,NDC,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,inpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,60687045301,NDC,facility,outpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 25 MCG (0.025 MG),56918,CDM,250,RC,J8499,HCPCS,68180096501,NDC,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,inpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662411,NDC,facility,outpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00074662490,NDC,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00378180977,NDC,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,68180096901,NDC,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,inpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00527328446,NDC,facility,outpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,inpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,00904695361,NDC,facility,outpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,51079044220,NDC,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,inpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
LEVOTHYROXINE TAB 100 MCG (0.1 MG),56920,CDM,250,RC,J8499,HCPCS,60687049701,NDC,facility,outpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,Amish/Mennonite,Amish Mennonite,,24.05,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB,56922,CDM,250,RC,64764-0544-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,Amish/Mennonite,Amish Mennonite,,24.05,,,,,,,21.86,42.41,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,Amish/Mennonite,Amish Mennonite,,40.60,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,82584-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,Amish/Mennonite,Amish Mennonite,,40.60,,,,,,,36.91,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,inpatient,1,mL,73.82000,70.13000,Amish/Mennonite,Amish Mennonite,,40.60,,,,,,,40.60,71.61,percent of total billed charges,
LIDOCAIN OPHTH GEL,56924,CDM,250,RC,17478-0792-25,NDC,,,facility,outpatient,1,mL,73.82000,70.13000,Amish/Mennonite,Amish Mennonite,,40.60,,,,,,,36.91,71.61,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00074455211,NDC,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00527134201,NDC,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00781518192,NDC,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,00904695061,NDC,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,16729044815,NDC,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,51079044020,NDC,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,60687046401,NDC,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 50 MCG (0.05 MG),56925,CDM,250,RC,J8499,HCPCS,69238183101,NDC,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659413,NDC,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,inpatient,1,EA,4.98000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00074659490,NDC,facility,outpatient,1,EA,4.98000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,inpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180701,NDC,facility,outpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,inpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00378180777,NDC,facility,outpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00527328346,NDC,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,inpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00781518392,NDC,facility,outpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,00904695261,NDC,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,16729045015,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,42292003820,NDC,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LEVOTHYROXINE TAB 88 MCG (0.088 MG),56926,CDM,250,RC,J8499,HCPCS,60687048601,NDC,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,inpatient,,,193.00000,183.35000,Amish/Mennonite,Amish Mennonite,,106.15,,,,,,,106.15,187.21,percent of total billed charges,
LIDOCAINE ASSAY-TECH,56927,CDM,300,RC,80176,CPT,,,facility,outpatient,,,193.00000,183.35000,Amish/Mennonite,Amish Mennonite,,106.15,,,,,,,14.69,763.98,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,inpatient,5,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428301,NDC,facility,outpatient,5,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.53,2.97,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,inpatient,5,EA,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,00409428325,NDC,facility,outpatient,5,EA,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,inpatient,5,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,63323049089,NDC,facility,outpatient,5,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,inpatient,5,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 4% 5 ML,56928,CDM,250,RC,J2003,HCPCS,83090000710,NDC,facility,outpatient,5,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.44,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,inpatient,1,mL,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,00409428201,NDC,facility,outpatient,1,mL,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,inpatient,1,mL,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,55150016402,NDC,facility,outpatient,1,mL,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,inpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,63323049527,NDC,facility,outpatient,1,mL,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.31,4.49,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,inpatient,1,mL,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
LIDOCAINE SOLN PF 2% 2 ML,56929,CDM,250,RC,J2003,HCPCS,70756064225,NDC,facility,outpatient,1,mL,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,inpatient,1,GM,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,00536-1357-95,NDC,,,facility,outpatient,1,GM,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,inpatient,1,GM,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,24357-0701-30,NDC,,,facility,outpatient,1,GM,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,inpatient,1,GM,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,39328-0024-30,NDC,,,facility,outpatient,1,GM,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,inpatient,1,GM,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,42291-0399-30,NDC,,,facility,outpatient,1,GM,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
LIDOCAINE CREAM 4% 30 GM,56930,CDM,250,RC,58980-0824-30,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,inpatient,1,EA,4701.43000,4466.36000,Amish/Mennonite,Amish Mennonite,,2585.79,,,,,,,2585.79,4560.39,percent of total billed charges,
LEUPROLIDE 7.5 MG/MONTH (LUPRON DEPOT),56931,CDM,636,RC,J9217,HCPCS,00074364203,NDC,facility,outpatient,1,EA,4701.43000,4466.36000,Amish/Mennonite,Amish Mennonite,,2585.79,,,,,,,155.42,4560.39,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,inpatient,50,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143931524,NDC,facility,outpatient,50,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,inpatient,50,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00143972201,NDC,facility,outpatient,50,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,inpatient,50,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409052813,NDC,facility,outpatient,50,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,inpatient,50,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00409222024,NDC,facility,outpatient,50,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,inpatient,50,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334109,NDC,facility,outpatient,50,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,inpatient,50,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,00781334152,NDC,facility,outpatient,50,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,inpatient,50,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021082581,NDC,facility,outpatient,50,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,inpatient,50,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,25021013281,NDC,facility,outpatient,50,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,inpatient,50,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,50458016701,NDC,facility,outpatient,50,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,inpatient,50,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
LEVOFLOXACIN INJECTION 7834187,56932,CDM,250,RC,J1956,HCPCS,63323035550,NDC,facility,outpatient,50,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,3.23,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,61.05,107.67,percent of total billed charges,
LABOR LEVEL 3,56933,CDM,721,RC,,,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,55.50,107.67,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,inpatient,1,mL,21.71000,20.62000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,11.94,21.06,percent of total billed charges,
LIDOCAINE SOL 7910451,56934,CDM,250,RC,76329-6300-05,NDC,,,facility,outpatient,1,mL,21.71000,20.62000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,10.86,21.06,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,inpatient,1,EA,21.40000,20.33000,Amish/Mennonite,Amish Mennonite,,11.77,,,,,,,11.77,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,00168-0204-37,NDC,,,facility,outpatient,1,EA,21.40000,20.33000,Amish/Mennonite,Amish Mennonite,,11.77,,,,,,,10.70,20.76,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,inpatient,1,EA,5.76000,5.47000,Amish/Mennonite,Amish Mennonite,,3.17,,,,,,,3.17,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,16714-0878-01,NDC,,,facility,outpatient,1,EA,5.76000,5.47000,Amish/Mennonite,Amish Mennonite,,3.17,,,,,,,2.88,5.59,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,inpatient,1,EA,9.33000,8.86000,Amish/Mennonite,Amish Mennonite,,5.13,,,,,,,5.13,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,33342-0405-35,NDC,,,facility,outpatient,1,EA,9.33000,8.86000,Amish/Mennonite,Amish Mennonite,,5.13,,,,,,,4.67,9.05,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,inpatient,1,EA,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,4.27,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,51672-3020-09,NDC,,,facility,outpatient,1,EA,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,3.88,7.54,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,52565-0008-14,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,64380-0789-32,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,65162-0918-38,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-79,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,67877-0473-80,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,68462-0418-20,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,inpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,69680-0120-35,NDC,,,facility,outpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE OINT 5% 35 GM,56935,CDM,250,RC,70752-0113-03,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,inpatient,50,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00054-3505-47,NDC,,,facility,outpatient,50,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,inpatient,50,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00121-0972-51,NDC,,,facility,outpatient,50,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,inpatient,50,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00527-6004-80,NDC,,,facility,outpatient,50,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,inpatient,50,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,00603-1394-47,NDC,,,facility,outpatient,50,EA,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,inpatient,50,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.87,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,52565-0009-50,NDC,,,facility,outpatient,50,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.70,3.30,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,inpatient,50,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,60432-0465-50,NDC,,,facility,outpatient,50,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,inpatient,50,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,64679-0465-51,NDC,,,facility,outpatient,50,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,inpatient,50,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,63739-0997-64,NDC,,,facility,outpatient,50,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,inpatient,50,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN 4% 50 ML TOPICAL,56937,CDM,250,RC,70954-0518-10,NDC,,,facility,outpatient,50,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,inpatient,30,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427001,NDC,facility,outpatient,30,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,inpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427901,NDC,facility,outpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,inpatient,30,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,00409427902,NDC,facility,outpatient,30,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,inpatient,30,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,55150016330,NDC,facility,outpatient,30,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,inpatient,30,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049226,NDC,facility,outpatient,30,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,inpatient,30,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
LIDOCAINE SOLN PF 1% 30 ML,56938,CDM,250,RC,J2003,HCPCS,63323049237,NDC,facility,outpatient,30,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,inpatient,20,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00054850016,NDC,facility,outpatient,20,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,inpatient,20,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121090340,NDC,facility,outpatient,20,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,inpatient,20,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,00121495040,NDC,facility,outpatient,20,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,inpatient,20,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,50383077517,NDC,facility,outpatient,20,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,inpatient,20,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 15 ML,56939,CDM,250,RC,J8499,HCPCS,63739069457,NDC,facility,outpatient,20,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,inpatient,20,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,00409427601,NDC,facility,outpatient,20,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,inpatient,20,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,55150025220,NDC,facility,outpatient,20,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,inpatient,20,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
LIDOCAINE SOLN 1% 20 ML,56940,CDM,250,RC,J2003,HCPCS,63323048527,NDC,facility,outpatient,20,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 1 GM/D5W 250 ML PREMIX,56941,CDM,250,RC,J2002,HCPCS,00264959420,NDC,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,inpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
LIDOCAINE TOPICAL GEL 7910602,56942,CDM,250,RC,17478-0840-30,NDC,,,facility,outpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,inpatient,5,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3012-05,NDC,,,facility,outpatient,5,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,inpatient,5,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 5 ML,56943,CDM,250,RC,76329-3011-05,NDC,,,facility,outpatient,5,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,inpatient,5,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00143959425,NDC,facility,outpatient,5,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,inpatient,5,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,00409206605,NDC,facility,outpatient,5,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,inpatient,5,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,55150016505,NDC,facility,outpatient,5,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,inpatient,5,EA,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323020805,NDC,facility,outpatient,5,EA,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,inpatient,5,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049505,NDC,facility,outpatient,5,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,inpatient,5,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049507,NDC,facility,outpatient,5,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,inpatient,5,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,63323049526,NDC,facility,outpatient,5,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,inpatient,5,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,70756064325,NDC,facility,outpatient,5,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,inpatient,5,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
LIDOCAINE SOLN PF 2% 5 ML,56944,CDM,250,RC,J2003,HCPCS,72603050510,NDC,facility,outpatient,5,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,inpatient,1,EA,7754.97000,7367.22000,Amish/Mennonite,Amish Mennonite,,4265.23,,,,,,,4265.23,7522.32,percent of total billed charges,
LEUPROLIDE 11.25 MG/MONTH (LUPRON DEPOT-PEDS),56945,CDM,636,RC,J1950,HCPCS,00074228203,NDC,facility,outpatient,1,EA,7754.97000,7367.22000,Amish/Mennonite,Amish Mennonite,,4265.23,,,,,,,1737.10,7522.32,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,inpatient,50,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00186013501,NDC,facility,outpatient,50,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,inpatient,50,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,00409427501,NDC,facility,outpatient,50,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,inpatient,50,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE SOLN 0.5% 50 ML,56946,CDM,250,RC,J2003,HCPCS,63323048457,NDC,facility,outpatient,50,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,inpatient,2,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,00409471332,NDC,facility,outpatient,2,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,inpatient,2,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150015872,NDC,facility,outpatient,2,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,inpatient,2,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,55150016102,NDC,facility,outpatient,2,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,inpatient,2,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049202,NDC,facility,outpatient,2,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,inpatient,2,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,63323049227,NDC,facility,outpatient,2,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,inpatient,2,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LIDOCAINE SOLN PF 1% 2 ML,56947,CDM,250,RC,J2003,HCPCS,70756064025,NDC,facility,outpatient,2,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,inpatient,1,mL,2.03000,1.92000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
LIDOCAINE GEL 2%  W/APPL (UROJET) 10 ML,56948,CDM,250,RC,76329-3013-05,NDC,,,facility,outpatient,1,mL,2.03000,1.92000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.01,1.97,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,inpatient,1,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00143931724,NDC,facility,outpatient,1,EA,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334309,NDC,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409052831,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00409444424,NDC,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,inpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,00781334355,NDC,facility,outpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,1.59,21.46,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021082583,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,25021013283,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,36000004824,NDC,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,44567043724,NDC,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,3.23,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
LEVOFLOXACIN INJECTION,56949,CDM,250,RC,J1956,HCPCS,50458016601,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,3.23,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,inpatient,1,EA,9.47000,8.99000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00603-1880-16,NDC,,,facility,outpatient,1,EA,9.47000,8.99000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.19,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,inpatient,1,EA,22.15000,21.04000,Amish/Mennonite,Amish Mennonite,,12.18,,,,,,,12.18,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,00591-3525-11,NDC,,,facility,outpatient,1,EA,22.15000,21.04000,Amish/Mennonite,Amish Mennonite,,12.18,,,,,,,11.07,21.49,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,42858-0118-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,inpatient,1,EA,20.38000,19.36000,Amish/Mennonite,Amish Mennonite,,11.21,,,,,,,11.21,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-01,NDC,,,facility,outpatient,1,EA,20.38000,19.36000,Amish/Mennonite,Amish Mennonite,,11.21,,,,,,,10.19,19.77,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,inpatient,1,EA,57.42000,54.55000,Amish/Mennonite,Amish Mennonite,,31.58,,,,,,,31.58,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,63481-0687-06,NDC,,,facility,outpatient,1,EA,57.42000,54.55000,Amish/Mennonite,Amish Mennonite,,31.58,,,,,,,28.71,55.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,4.37,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,65162-0791-08,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,3.97,7.70,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,4.96,8.74,percent of total billed charges,
LIDOCAINE PATCH,56950,CDM,250,RC,82347-0505-05,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,4.50,8.74,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,inpatient,10,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
LIDOCAINE SOLN PF 2% 10 ML STERIPAK,56951,CDM,250,RC,J2003,HCPCS,63323049697,NDC,facility,outpatient,10,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,inpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00143957510,NDC,facility,outpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,inpatient,1,mL,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,00409427702,NDC,facility,outpatient,1,mL,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,inpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
LIDOCAINE SOLN 2% 50 ML,56952,CDM,250,RC,J2003,HCPCS,63323048657,NDC,facility,outpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,inpatient,1,EA,4.48000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,00591-2070-72,NDC,,,facility,outpatient,1,EA,4.48000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.24,4.35,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,52565-0007-07,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,inpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.06,percent of total billed charges,
LIDOCAINE-PRILOCAINE CREAM 2.5%-2.5% 5 GM,56953,CDM,250,RC,62332-0582-04,NDC,,,facility,outpatient,1,EA,5.22000,4.96000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.61,5.06,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,inpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706811,NDC,facility,outpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,inpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00074706890,NDC,facility,outpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,inpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00527134701,NDC,facility,outpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,inpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00781518692,NDC,facility,outpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,00904695561,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,51079044320,NDC,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,inpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,60687051901,NDC,facility,outpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,68180097101,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,69238183601,NDC,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,inpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LEVOTHYROXINE TAB 125 MCG (0.125 MG),56954,CDM,250,RC,J8499,HCPCS,72305012530,NDC,facility,outpatient,1,EA,1.73000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,55.55,97.97,percent of total billed charges,
LIPOPROTEIN LDL CHOLESTEROL-TECH,56955,CDM,300,RC,83721,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,10.50,492.33,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,inpatient,1,EA,3945.28000,3748.02000,Amish/Mennonite,Amish Mennonite,,2169.90,,,,,,,2169.90,3826.92,percent of total billed charges,
LEUPROLIDE 3.75 MG/MONTH (LUPRON DEPOT),56956,CDM,636,RC,J1950,HCPCS,00074364103,NDC,facility,outpatient,1,EA,3945.28000,3748.02000,Amish/Mennonite,Amish Mennonite,,2169.90,,,,,,,1737.10,3826.92,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,00904720061,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,43547035610,NDC,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,60687067801,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
LISINOPRIL TAB 40 MG,56957,CDM,250,RC,J8499,HCPCS,68084019901,NDC,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,inpatient,,,1981.00000,1881.95000,Amish/Mennonite,Amish Mennonite,TC,1089.55,,,,,,,1089.55,1921.57,percent of total billed charges,
LIVER & SPLEEN IMG STATIC ONLY-TECH,56958,CDM,341,RC,78215,CPT,,,facility,outpatient,,,1981.00000,1881.95000,Amish/Mennonite,Amish Mennonite,TC,1089.55,,,,,,,931.15,2210.07,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,inpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,45.65,80.51,percent of total billed charges,
LIPOPROTEIN HDL CHOLESTEROL-TECH,56960,CDM,300,RC,83718,CPT,,,facility,outpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,8.19,424.40,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00172375910,NDC,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904580861,NDC,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,00904679861,NDC,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,43547035311,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,inpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098219,NDC,facility,outpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,51079098220,NDC,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,60687032501,NDC,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,63739034943,NDC,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,68180098001,NDC,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,inpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 10 MG,56961,CDM,250,RC,J8499,HCPCS,76282073001,NDC,facility,outpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,inpatient,1,mL,997.15000,947.29000,Amish/Mennonite,Amish Mennonite,,548.43,,,,,,,548.43,967.24,percent of total billed charges,
LIOTHYRONINE SOLN 10 MCG/ML,56962,CDM,250,RC,J3490,HCPCS,39822015101,NDC,facility,outpatient,1,mL,997.15000,947.29000,Amish/Mennonite,Amish Mennonite,,548.43,,,,,,,498.57,967.24,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,inpatient,5,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
LIDOCAINE GEL 2% 5 ML,56963,CDM,250,RC,17478-0711-10,NDC,,,facility,outpatient,5,EA,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,2.85,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,inpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706911,NDC,facility,outpatient,1,EA,3.91000,3.72000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,inpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00074706990,NDC,facility,outpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,4.84,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,inpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00781518792,NDC,facility,outpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,inpatient,1,EA,2.24000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,00904695661,NDC,facility,outpatient,1,EA,2.24000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,51079044520,NDC,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,inpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,60687053001,NDC,facility,outpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.23,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,inpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
LEVOTHYROXINE TAB 150 MCG (0.15 MG),56964,CDM,250,RC,J8499,HCPCS,69238183801,NDC,facility,outpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,TC,121.00,,,,,,,121.00,213.40,percent of total billed charges,
LUNG FUNCTION TEST (MBC/MVV)-TECH,56965,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,TC,121.00,,,,,,,110.00,213.40,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
LIPASE ASSAY-TECH,56966,CDM,300,RC,83690,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,6.89,356.54,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
LIPOPROTEIN A-TECH,56967,CDM,300,RC,83695,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,14.32,679.08,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,inpatient,300,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009499202,NDC,facility,outpatient,300,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.50,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,inpatient,300,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009514001,NDC,facility,outpatient,300,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,inpatient,300,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00009780702,NDC,facility,outpatient,300,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,inpatient,300,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,00781343395,NDC,facility,outpatient,300,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,inpatient,300,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,55150024251,NDC,facility,outpatient,300,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,inpatient,300,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,57664068331,NDC,facility,outpatient,300,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,5.76,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,inpatient,300,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
LINEZOLID INJ,56968,CDM,250,RC,J2020,HCPCS,66794021943,NDC,facility,outpatient,300,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,5.76,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00172375800,NDC,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,00904679761,NDC,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,43547041510,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,51079098101,NDC,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
LISINOPRIL TAB 5 MG,56969,CDM,250,RC,J8499,HCPCS,68180051301,NDC,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,90,201.30,,,,,,,201.30,355.02,percent of total billed charges,
LIPOPROTEIN BLD BY NMR SO-TECH,56970,CDM,300,RC,83704,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,90,201.30,,,,,,,35.33,1646.71,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
LIPID PANEL-TECH,56971,CDM,300,RC,80061,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,13.39,833.98,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,inpatient,1,EA,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518211,NDC,facility,outpatient,1,EA,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,inpatient,1,EA,4.98000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00074518290,NDC,facility,outpatient,1,EA,4.98000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180501,NDC,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00378180577,NDC,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00527328246,NDC,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,00904695161,NDC,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,inpatient,1,EA,1.86000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
LEVOTHYROXINE TAB 75 MCG (0.075 MG),56973,CDM,250,RC,J8499,HCPCS,60687047501,NDC,facility,outpatient,1,EA,1.86000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,13107008301,NDC,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,inpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00182823789,NDC,facility,outpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024005,NDC,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00591024010,NDC,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904598061,NDC,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600760,NDC,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,00904600761,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,51079041720,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,60687062701,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,inpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739015410,NDC,facility,outpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,63739049910,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,68084073601,NDC,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 7629975,56974,CDM,250,RC,J8499,HCPCS,69315090401,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00172-3757-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,00378-2072-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68180-0512-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,43547-0414-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
LISINOPRIL TAB 7222847,56975,CDM,250,RC,68084-0765-25,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
LOSARTAN TAB 100 MG,56976,CDM,250,RC,J8499,HCPCS,00093736698,NDC,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,inpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00264959820,NDC,facility,outpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.00465,0.05820,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00338041102,NDC,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.00465,0.08730,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
LIDOCAINE 2 GM /D5W 250 ML PREMIX,56977,CDM,250,RC,J2002,HCPCS,00409793932,NDC,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.00465,0.07760,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-2526-25,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,00054-8526-25,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
LITHIUM CAP,56980,CDM,250,RC,68462-0220-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,inpatient,1,mL,12.70000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.99,12.32,percent of total billed charges,
LOCM 300-399 MG/ML IODINE 1ML,56983,CDM,250,RC,Q9967,HCPCS,00407141310,NDC,facility,outpatient,1,mL,12.70000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,0.22165,12.32,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,inpatient,1,EA,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,00904679961,NDC,facility,outpatient,1,EA,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,43547041711,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098320,NDC,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,51079098319,NDC,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,60687033301,NDC,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,inpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,63739035010,NDC,facility,outpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,68180098101,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
LISINOPRIL TAB 20 MG,56984,CDM,250,RC,J8499,HCPCS,76282073101,NDC,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,00185-0070-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
LOVASTATIN TAB 7212045,56986,CDM,250,RC,68180-0467-07,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,inpatient,,,273.00000,259.35000,Amish/Mennonite,Amish Mennonite,TC,150.15,,,,,,,150.15,264.81,percent of total billed charges,
LVL 4 SURG PATH GROSS & MICRO-TECH,56989,CDM,310,RC,88305,CPT,,,facility,outpatient,,,273.00000,259.35000,Amish/Mennonite,Amish Mennonite,TC,150.15,,,,,,,136.50,1499.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,inpatient,1,EA,440.47000,418.45000,Amish/Mennonite,Amish Mennonite,,242.26,,,,,,,242.26,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00009-5135-03,NDC,,,facility,outpatient,1,EA,440.47000,418.45000,Amish/Mennonite,Amish Mennonite,,242.26,,,,,,,220.24,427.26,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,inpatient,1,EA,19.56000,18.58000,Amish/Mennonite,Amish Mennonite,,10.76,,,,,,,10.76,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,00904-6553-04,NDC,,,facility,outpatient,1,EA,19.56000,18.58000,Amish/Mennonite,Amish Mennonite,,10.76,,,,,,,9.78,18.97,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,inpatient,1,EA,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,10.22,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,31722-0749-20,NDC,,,facility,outpatient,1,EA,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,9.29,18.02,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,inpatient,1,EA,30.43000,28.91000,Amish/Mennonite,Amish Mennonite,,16.74,,,,,,,16.74,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,59762-1307-02,NDC,,,facility,outpatient,1,EA,30.43000,28.91000,Amish/Mennonite,Amish Mennonite,,16.74,,,,,,,15.21,29.52,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,inpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-20,NDC,,,facility,outpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.34,8.43,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
LINEZOLID TAB,56990,CDM,250,RC,67877-0419-84,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,inpatient,50,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,00409427801,NDC,facility,outpatient,50,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,inpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
LIDOCAINE SOLN PF 0.5% 50 ML,56991,CDM,250,RC,J2003,HCPCS,63323049157,NDC,facility,outpatient,50,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00093736498,NDC,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,00904704761,NDC,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,31722070010,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268050415,NDC,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,50268051611,NDC,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,63739067310,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,65862020190,NDC,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68084034601,NDC,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68180037609,NDC,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN TAB 25 MG,56993,CDM,250,RC,J8499,HCPCS,68382013516,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,inpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,107.25,189.15,percent of total billed charges,
LYME DISEASE AB-TECH,56994,CDM,300,RC,86618,CPT,,,facility,outpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,17.03,882.80,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,inpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,TC,893.75,,,,,,,893.75,1576.25,percent of total billed charges,
LVL 5 SURG PATH GROSS & MICRO-TECH,56995,CDM,310,RC,88307,CPT,,,facility,outpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,TC,893.75,,,,,,,812.50,9133.75,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,inpatient,1,EA,11.72000,11.14000,Amish/Mennonite,Amish Mennonite,,6.45,,,,,,,6.45,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00006095254,NDC,facility,outpatient,1,EA,11.72000,11.14000,Amish/Mennonite,Amish Mennonite,,6.45,,,,,,,5.86,11.37,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00093736598,NDC,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,inpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,00904704861,NDC,facility,outpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070190,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,31722070130,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268050515,NDC,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,50268051711,NDC,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,63739068610,NDC,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020230,NDC,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020290,NDC,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,inpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,65862020299,NDC,facility,outpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68084034701,NDC,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LOSARTAN TAB 50 MG,56996,CDM,250,RC,J8499,HCPCS,68180037709,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,inpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,,112.75,,,,,,,112.75,198.85,percent of total billed charges,
LUTEINIZING HORMONE-TECH,56997,CDM,300,RC,83002,CPT,,,facility,outpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,,112.75,,,,,,,18.52,967.70,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
MACROSCOPIC EXAM ARTHROPOD-TECH,56999,CDM,300,RC,87168,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,4.27,220.68,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,inpatient,1,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409198530,NDC,facility,outpatient,1,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,2.11,8.19,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,inpatient,1,EA,5.39000,5.12000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.96,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00409677802,NDC,facility,outpatient,1,EA,5.39000,5.12000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.11,5.23,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,inpatient,1,EA,6.01000,5.71000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,3.31,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641600125,NDC,facility,outpatient,1,EA,6.01000,5.71000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,2.11,5.83,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604401,NDC,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,inpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,00641604825,NDC,facility,outpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,10019010239,NDC,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,inpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML,57000,CDM,250,RC,J2060,HCPCS,17478004001,NDC,facility,outpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,2.11,9.96,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,TC,108.90,,,,,,,108.90,192.06,percent of total billed charges,
LVL 2 SURG PATH GROSS & MICRO-TECH,57001,CDM,310,RC,88302,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,TC,108.90,,,,,,,88.31,1126.22,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,00409317701,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LIDOCAINE-EPI SOLN  0.5%-1  200000 50 ML,57004,CDM,250,RC,J2004,HCPCS,63323048157,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,inpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,TC,45.10,,,,,,,45.10,79.54,percent of total billed charges,
LVL 1 SURG PATH GROSS ONLY-TECH,57005,CDM,310,RC,88300,CPT,,,facility,outpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,TC,45.10,,,,,,,41.00,515.07,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,inpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00264761200,NDC,facility,outpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00338008504,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 1000 ML,57006,CDM,250,RC,J7042,HCPCS,00990792609,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,2.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00338066304,NDC,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098288,57007,CDM,250,RC,J3480,HCPCS,00990790109,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
LVL 3 SURG PATH GROSS & MICRO-TECH,57010,CDM,310,RC,88304,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,1397.87,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,inpatient,,,306.10000,290.80000,Amish/Mennonite,Amish Mennonite,90,168.35,,,,,,,168.35,296.92,percent of total billed charges,
"MANGANESE, SERUM (MNS) SO",57011,CDM,300,RC,83785,CPT,,,facility,outpatient,,,306.10000,290.80000,Amish/Mennonite,Amish Mennonite,90,168.35,,,,,,,27.54,1290.24,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098684,57013,CDM,250,RC,J3480,HCPCS,00338067504,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS BIL-TECH,57014,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,18.50,442.00,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,inpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1425.05,2513.27,percent of total billed charges,
LVL 6 SURG PATH GROSS & MICRO-TECH,57015,CDM,310,RC,88309,CPT,,,facility,outpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1295.50,12902.54,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
MACROSCOPIC EXAM PARASITE-TECH,57016,CDM,300,RC,87169,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,4.31,220.68,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,00093-0928-06,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
LOVASTATIN TAB 7212046,57019,CDM,250,RC,68180-0469-01,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0166-38,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0667-38,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,inpatient,300,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0686-38,NDC,,,facility,outpatient,300,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,inpatient,300,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-0693-38,NDC,,,facility,outpatient,300,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00869-2635-08,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-6787-44,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,00904-7418-44,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,inpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,49348-0696-49,NDC,,,facility,outpatient,300,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,24385-0910-10,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0389-98,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,inpatient,300,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,69452-0390-98,NDC,,,facility,outpatient,300,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-0053-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1111-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,inpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,70677-1112-01,NDC,,,facility,outpatient,300,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,inpatient,300,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM CITRATE LIQUID,57021,CDM,250,RC,71399-7889-01,NDC,,,facility,outpatient,300,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,inpatient,100,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,72888012526,NDC,facility,outpatient,100,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,inpatient,100,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,00603139364,NDC,facility,outpatient,100,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,inpatient,100,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,16714009701,NDC,facility,outpatient,100,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,inpatient,100,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,60432046400,NDC,facility,outpatient,100,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,inpatient,100,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,62135071242,NDC,facility,outpatient,100,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LIDOCAINE VISCOUS LIQ 2% 100 ML,57023,CDM,250,RC,J8499,HCPCS,63629209501,NDC,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,00338066904,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7098528,57024,CDM,250,RC,J3480,HCPCS,65219014210,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,Amish/Mennonite,Amish Mennonite,TC,1905.20,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHATICS & LYMPH NODES IMG-TECH,57025,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,Amish/Mennonite,Amish Mennonite,TC,1905.20,,,,,,,1611.84,3360.08,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,00603-0209-22,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,10006-0700-28,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,57896-0634-12,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,60258-0171-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0058-02,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,63739-0354-10,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-98,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MAGNESIUM OXIDE TAB,57026,CDM,250,RC,68585-0006-12,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LVP POTASSIUM DEXTROSE W NACL AND KCL SOL 7099484,57027,CDM,250,RC,00338-0695-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00536-1178-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,00904-7375-61,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,50268-0522-15,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,51079-0423-20,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,68084-0490-01,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
MECLIZINE TAB 12.5 MG,57028,CDM,250,RC,69618-0027-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046807,NDC,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,inpatient,1,EA,2.24000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,63739028110,NDC,facility,outpatient,1,EA,2.24000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
LOVASTATIN TAB 20 MG,57029,CDM,250,RC,J8499,HCPCS,68180046801,NDC,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,inpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00264757820,NDC,facility,outpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,inpatient,1,mL,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00338035702,NDC,facility,outpatient,1,mL,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00409771502,NDC,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,inpatient,1,mL,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MANNITOL 20% 250 ML,57030,CDM,250,RC,J7799,HCPCS,00990771502,NDC,facility,outpatient,1,mL,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,inpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,44.55,78.57,percent of total billed charges,
MANIP CHST WALL INIT-TECH,57031,CDM,410,RC,94667,CPT,,,facility,outpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,40.50,134.64,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,177.65,313.31,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM MULT-TECH,57032,CDM,320,RC,77054,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,161.50,2815.39,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,00904-7911-52,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
MAGNESIUM CHLORIDE TAB,57033,CDM,250,RC,68585-0005-75,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00264775010,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00338011703,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,00990795303,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,4.06,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 500 ML,57034,CDM,250,RC,J7120,HCPCS,63323016475,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,4.06,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00456-3205-60,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-06,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,00904-6505-61,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,29300-0171-16,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
MEMANTINE TAB 7910302,57035,CDM,250,RC,60687-0173-57,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
LITHIUM ASSAY-TECH,57036,CDM,300,RC,80178,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,6.61,339.51,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
MAGNESIUM ASSAY-TECH,57037,CDM,300,RC,83735,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,6.70,356.54,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,inpatient,,,2973.00000,2824.35000,Amish/Mennonite,Amish Mennonite,,1635.15,,,,,,,1635.15,2883.81,percent of total billed charges,
MATERNI I21 PLUS-TECH,57038,CDM,310,RC,81507,CPT,,,facility,outpatient,,,2973.00000,2824.35000,Amish/Mennonite,Amish Mennonite,,1635.15,,,,,,,636.00,37399.48,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,inpatient,30,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,65162068784,NDC,facility,outpatient,30,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,inpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LORAZEPAM INJECTION 7632631,57040,CDM,250,RC,J2060,HCPCS,00121077001,NDC,facility,outpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,2.61,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00338067104,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00409790209,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 20 MEQ/L 1000 ML,57041,CDM,250,RC,J3480,HCPCS,00990790209,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,inpatient,1,mL,166.31000,158.00000,Amish/Mennonite,Amish Mennonite,,91.47,,,,,,,91.47,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009074630,NDC,facility,outpatient,1,mL,166.31000,158.00000,Amish/Mennonite,Amish Mennonite,,91.47,,,,,,,0.94620,161.32,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,inpatient,1,mL,173.64000,164.96000,Amish/Mennonite,Amish Mennonite,,95.50,,,,,,,95.50,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00009737611,NDC,facility,outpatient,1,mL,173.64000,164.96000,Amish/Mennonite,Amish Mennonite,,95.50,,,,,,,0.94620,168.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,inpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,78.21,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548541025,NDC,facility,outpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,0.94620,137.93,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,inpatient,1,mL,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,95.59,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00548570100,NDC,facility,outpatient,1,mL,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,0.94620,168.59,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,inpatient,1,mL,257.67000,244.78000,Amish/Mennonite,Amish Mennonite,,141.72,,,,,,,141.72,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680101,NDC,facility,outpatient,1,mL,257.67000,244.78000,Amish/Mennonite,Amish Mennonite,,141.72,,,,,,,0.94620,249.94,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,inpatient,1,mL,257.40000,244.53000,Amish/Mennonite,Amish Mennonite,,141.57,,,,,,,141.57,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,00703680104,NDC,facility,outpatient,1,mL,257.40000,244.53000,Amish/Mennonite,Amish Mennonite,,141.57,,,,,,,0.94620,249.68,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,inpatient,1,mL,193.96000,184.26000,Amish/Mennonite,Amish Mennonite,,106.68,,,,,,,106.68,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,16714098101,NDC,facility,outpatient,1,mL,193.96000,184.26000,Amish/Mennonite,Amish Mennonite,,106.68,,,,,,,0.94620,188.14,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,inpatient,1,mL,115.78000,109.99000,Amish/Mennonite,Amish Mennonite,,63.68,,,,,,,63.68,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150032901,NDC,facility,outpatient,1,mL,115.78000,109.99000,Amish/Mennonite,Amish Mennonite,,63.68,,,,,,,0.94620,112.31,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,inpatient,1,mL,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,121.66,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,55150033001,NDC,facility,outpatient,1,mL,221.20000,210.14000,Amish/Mennonite,Amish Mennonite,,121.66,,,,,,,0.94620,214.56,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,inpatient,1,mL,193.05000,183.40000,Amish/Mennonite,Amish Mennonite,,106.18,,,,,,,106.18,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,59762453702,NDC,facility,outpatient,1,mL,193.05000,183.40000,Amish/Mennonite,Amish Mennonite,,106.18,,,,,,,0.94620,187.26,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,inpatient,1,mL,108.69000,103.25000,Amish/Mennonite,Amish Mennonite,,59.78,,,,,,,59.78,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088701,NDC,facility,outpatient,1,mL,108.69000,103.25000,Amish/Mennonite,Amish Mennonite,,59.78,,,,,,,0.94620,105.43,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,inpatient,1,mL,108.67000,103.24000,Amish/Mennonite,Amish Mennonite,,59.77,,,,,,,59.77,105.41,percent of total billed charges,
MEDROXYPROGESTERONE SUSP 150 MG/ML,57042,CDM,250,RC,J1050,HCPCS,67457088799,NDC,facility,outpatient,1,mL,108.67000,103.24000,Amish/Mennonite,Amish Mennonite,,59.77,,,,,,,0.94620,105.41,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,inpatient,500,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00338035703,NDC,facility,outpatient,500,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,3.75,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,inpatient,500,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
MANNITOL 20% 500 ML,57044,CDM,250,RC,J2150,HCPCS,00990771503,NDC,facility,outpatient,500,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,3.75,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00182-1864-89,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,00904-7236-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,63739-0165-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
MEGESTROL TAB,57049,CDM,250,RC,64380-0159-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216915,57050,CDM,250,RC,00555-0873-02,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,inpatient,1,EA,23.42000,22.24000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-11,NDC,,,facility,outpatient,1,EA,23.42000,22.24000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,inpatient,1,EA,23.42000,22.25000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,12.88,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,00456-3210-63,NDC,,,facility,outpatient,1,EA,23.42000,22.25000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,11.71,22.72,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
MEMANTINE TAB 7224231,57053,CDM,250,RC,60687-0184-57,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,13107008401,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00182823889,NDC,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00591024105,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600860,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,00904600861,NDC,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,60687063801,NDC,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,inpatient,1,EA,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,68084074201,NDC,facility,outpatient,1,EA,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,63739050010,NDC,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090501,NDC,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LORAZEPAM TAB 1 MG,57054,CDM,250,RC,J8499,HCPCS,69315090510,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,inpatient,50,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,00409403101,NDC,facility,outpatient,50,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,3.75,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,inpatient,50,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
MANNITOL 25% SOLN-INJ 12.5GM/50 ML,57055,CDM,250,RC,J2150,HCPCS,63323002425,NDC,facility,outpatient,50,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,3.75,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,inpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,205.15,361.81,percent of total billed charges,
MECH CHST WALL OSC LUNG FUNC-TECH,57057,CDM,410,RC,94669,CPT,,,facility,outpatient,,,373.00000,354.35000,Amish/Mennonite,Amish Mennonite,,205.15,,,,,,,186.50,361.81,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,20.35,35.89,percent of total billed charges,
MA MAMMO DIAG TOMOSYNTHESIS UNI-TECH,57058,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,TC,20.35,,,,,,,18.50,442.00,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,inpatient,1,mL,19.43000,18.46000,Amish/Mennonite,Amish Mennonite,,10.69,,,,,,,10.69,18.85,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409117830,NDC,facility,outpatient,1,mL,19.43000,18.46000,Amish/Mennonite,Amish Mennonite,,10.69,,,,,,,9.71,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,inpatient,1,mL,11.57000,10.99000,Amish/Mennonite,Amish Mennonite,,6.36,,,,,,,6.36,11.22,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00409125301,NDC,facility,outpatient,1,mL,11.57000,10.99000,Amish/Mennonite,Amish Mennonite,,6.36,,,,,,,5.79,25.89,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,inpatient,1,mL,8.35000,7.93000,Amish/Mennonite,Amish Mennonite,,4.59,,,,,,,4.59,8.10,percent of total billed charges,
MEPERIDINE SOLN 50 MG/ML,57060,CDM,250,RC,J2175,HCPCS,00641605325,NDC,facility,outpatient,1,mL,8.35000,7.93000,Amish/Mennonite,Amish Mennonite,,4.59,,,,,,,4.17,25.89,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7216914,57062,CDM,250,RC,59762-3740-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,inpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,95.70,168.78,percent of total billed charges,
LYME DISEASE CONFIRMATORY TEST-TECH,57063,CDM,300,RC,86617,CPT,,,facility,outpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,15.49,814.87,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.3% NACL 1000 ML,57064,CDM,250,RC,J3490,HCPCS,00409792509,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,00093-7299-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,50268-0526-15,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,61442-0127-01,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MELOXICAM TAB 7212051,57065,CDM,250,RC,65862-0098-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,inpatient,1,EA,45.82000,43.53000,Amish/Mennonite,Amish Mennonite,,25.20,,,,,,,25.20,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,55150020720,NDC,facility,outpatient,1,EA,45.82000,43.53000,Amish/Mennonite,Amish Mennonite,,25.20,,,,,,,0.66805,44.45,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050721,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.66805,9.20,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 500 MG,57067,CDM,250,RC,J2185,HCPCS,63323050725,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,0.66805,18.39,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,59762-3742-02,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
MEDROXYPROGESTERONE TAB 7219660,57068,CDM,250,RC,60687-0105-21,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
METAPROTERENOL SYRUP,57070,CDM,250,RC,00603-1422-58,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,inpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,10019095301,NDC,facility,outpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,2.11,7.66,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020111,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,2.11,6.13,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,inpatient,1,mL,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,25021020168,NDC,facility,outpatient,1,mL,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,inpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,47781062222,NDC,facility,outpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,inpatient,1,mL,20.95000,19.90000,Amish/Mennonite,Amish Mennonite,,11.52,,,,,,,11.52,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,63323073310,NDC,facility,outpatient,1,mL,20.95000,19.90000,Amish/Mennonite,Amish Mennonite,,11.52,,,,,,,2.11,20.32,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,inpatient,1,mL,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
MESNA INJ,57071,CDM,250,RC,J9209,HCPCS,70860020910,NDC,facility,outpatient,1,mL,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,2.11,6.29,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,inpatient,1,mL,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.76,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,00703367501,NDC,facility,outpatient,1,mL,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,inpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 10 ML,57072,CDM,250,RC,J9260,HCPCS,16729027703,NDC,facility,outpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,4.28,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,00093-2204-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-14,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0629-20,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
METOCLOPRAMIDE TAB 7220536,57073,CDM,250,RC,51079-0886-20,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,66689-0053-99,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,inpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,63739-0196-10,NDC,,,facility,outpatient,30,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
MAGNESIUM HYDROXIDE SUSP,57074,CDM,250,RC,69339-0153-17,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,inpatient,1,mL,18.20000,17.29000,Amish/Mennonite,Amish Mennonite,,10.01,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409118069,NDC,facility,outpatient,1,mL,18.20000,17.29000,Amish/Mennonite,Amish Mennonite,,10.01,,,,,,,9.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,inpatient,1,mL,12.20000,11.59000,Amish/Mennonite,Amish Mennonite,,6.71,,,,,,,6.71,11.83,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00409125601,NDC,facility,outpatient,1,mL,12.20000,11.59000,Amish/Mennonite,Amish Mennonite,,6.71,,,,,,,6.10,25.89,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,inpatient,1,mL,8.33000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.58,8.08,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML,57075,CDM,250,RC,J2175,HCPCS,00641605425,NDC,facility,outpatient,1,mL,8.33000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.17,25.89,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,inpatient,,,286.43000,272.11000,Amish/Mennonite,Amish Mennonite,,157.54,,,,,,,157.54,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,CPT,,,facility,outpatient,,,286.43000,272.11000,Amish/Mennonite,Amish Mennonite,,157.54,,,,,,,143.22,277.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,inpatient,1,mL,572.85000,544.21000,Amish/Mennonite,Amish Mennonite,,315.07,,,,,,,315.07,555.66,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENACTRA)",57076,CDM,250,RC,90734,HCPCS,49281058905,NDC,facility,outpatient,1,mL,572.85000,544.21000,Amish/Mennonite,Amish Mennonite,,315.07,,,,,,,187.18,555.66,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42291-0497-90,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,42385-0977-90,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0531-15,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,50268-0550-15,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,60687-0640-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,62756-0142-02,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,67877-0413-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
METFORMIN TAB 7222987,57077,CDM,250,RC,70010-0491-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,inpatient,1,EA,24.86000,23.62000,Amish/Mennonite,Amish Mennonite,,13.67,,,,,,,13.67,24.11,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005303,NDC,facility,outpatient,1,EA,24.86000,23.62000,Amish/Mennonite,Amish Mennonite,,13.67,,,,,,,12.43,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,inpatient,1,EA,370.86000,352.32000,Amish/Mennonite,Amish Mennonite,,203.97,,,,,,,203.97,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00078005361,NDC,facility,outpatient,1,EA,370.86000,352.32000,Amish/Mennonite,Amish Mennonite,,203.97,,,,,,,32.99,359.73,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,inpatient,1,EA,95.97000,91.17000,Amish/Mennonite,Amish Mennonite,,52.78,,,,,,,52.78,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,00517074020,NDC,facility,outpatient,1,EA,95.97000,91.17000,Amish/Mennonite,Amish Mennonite,,52.78,,,,,,,32.99,93.09,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,inpatient,1,EA,21.68000,20.60000,Amish/Mennonite,Amish Mennonite,,11.92,,,,,,,11.92,21.03,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,17478050101,NDC,facility,outpatient,1,EA,21.68000,20.60000,Amish/Mennonite,Amish Mennonite,,11.92,,,,,,,10.84,36.40,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,inpatient,1,EA,62.44000,59.32000,Amish/Mennonite,Amish Mennonite,,34.34,,,,,,,34.34,60.57,percent of total billed charges,
METHYLERGONOVINE SOLN 0.2 MG/ML,57078,CDM,250,RC,J2210,HCPCS,51991014417,NDC,facility,outpatient,1,EA,62.44000,59.32000,Amish/Mennonite,Amish Mennonite,,34.34,,,,,,,31.22,60.57,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,64380-0160-01,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,inpatient,30,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-38,NDC,,,facility,outpatient,30,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,inpatient,30,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,49884-0907-88,NDC,,,facility,outpatient,30,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,inpatient,30,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
MEGESTROL SUSP 40 MG/ML,57079,CDM,250,RC,60432-0126-08,NDC,,,facility,outpatient,30,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.51,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,00378-3547-52,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.01,9.72,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,inpatient,1,EA,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.57,4.54,percent of total billed charges,
MERCAPTOPURINE TAB,57081,CDM,250,RC,69076-0913-02,NDC,,,facility,outpatient,1,EA,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.34,4.54,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,inpatient,1,EA,92.08000,87.48000,Amish/Mennonite,Amish Mennonite,,50.64,,,,,,,50.64,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409350601,NDC,facility,outpatient,1,EA,92.08000,87.48000,Amish/Mennonite,Amish Mennonite,,50.64,,,,,,,0.66805,89.32,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00143943110,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,0.66805,18.39,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,inpatient,1,EA,212.08000,201.47000,Amish/Mennonite,Amish Mennonite,,116.64,,,,,,,116.64,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00310032130,NDC,facility,outpatient,1,EA,212.08000,201.47000,Amish/Mennonite,Amish Mennonite,,116.64,,,,,,,0.66805,205.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,inpatient,1,EA,86.25000,81.93000,Amish/Mennonite,Amish Mennonite,,47.44,,,,,,,47.44,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00409139122,NDC,facility,outpatient,1,EA,86.25000,81.93000,Amish/Mennonite,Amish Mennonite,,47.44,,,,,,,0.66805,83.66,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,inpatient,1,EA,32.77000,31.13000,Amish/Mennonite,Amish Mennonite,,18.02,,,,,,,18.02,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781309895,NDC,facility,outpatient,1,EA,32.77000,31.13000,Amish/Mennonite,Amish Mennonite,,18.02,,,,,,,0.66805,31.79,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,inpatient,1,EA,177.91000,169.01000,Amish/Mennonite,Amish Mennonite,,97.85,,,,,,,97.85,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326790,NDC,facility,outpatient,1,EA,177.91000,169.01000,Amish/Mennonite,Amish Mennonite,,97.85,,,,,,,0.66805,172.57,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,inpatient,1,EA,87.82000,83.43000,Amish/Mennonite,Amish Mennonite,,48.30,,,,,,,48.30,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,00781326795,NDC,facility,outpatient,1,EA,87.82000,83.43000,Amish/Mennonite,Amish Mennonite,,48.30,,,,,,,0.66805,85.19,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,inpatient,1,EA,91.64000,87.06000,Amish/Mennonite,Amish Mennonite,,50.40,,,,,,,50.40,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,55150020830,NDC,facility,outpatient,1,EA,91.64000,87.06000,Amish/Mennonite,Amish Mennonite,,50.40,,,,,,,0.66805,88.89,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,inpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050831,NDC,facility,outpatient,1,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,0.66805,36.78,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,inpatient,1,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,10.25,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,63323050830,NDC,facility,outpatient,1,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,0.66805,18.08,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70121145307,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,0.66805,33.72,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,70594007602,NDC,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,0.66805,61.30,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,inpatient,1,EA,18.17000,17.26000,Amish/Mennonite,Amish Mennonite,,9.99,,,,,,,9.99,17.62,percent of total billed charges,
MEROPENEM POWD-INJ 1000 MG,57083,CDM,250,RC,J2185,HCPCS,72485041210,NDC,facility,outpatient,1,EA,18.17000,17.26000,Amish/Mennonite,Amish Mennonite,,9.99,,,,,,,0.66805,17.62,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
"METHADONE 40 MG ORAL TAB, DISPERSIBLE",57084,CDM,250,RC,J8499,HCPCS,64019053825,NDC,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,inpatient,,,188.80000,179.36000,Amish/Mennonite,Amish Mennonite,90,103.84,,,,,,,103.84,183.14,percent of total billed charges,
MERCURY QUANTITATIVE-TECH,57085,CDM,300,RC,83825,CPT,,,facility,outpatient,,,188.80000,179.36000,Amish/Mennonite,Amish Mennonite,90,103.84,,,,,,,16.80,848.80,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,inpatient,1,EA,5.74000,5.45000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,3.16,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00149-0752-15,NDC,,,facility,outpatient,1,EA,5.74000,5.45000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,2.87,5.57,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
MESALAMINE TAB,57086,CDM,250,RC,00430-0752-27,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.32,6.44,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-6691-61,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,00904-7164-61,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,60687-0162-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216568,57088,CDM,250,RC,65862-0010-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-6568-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,00904-7126-61,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,16571-0664-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,29300-0227-46,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50111-0334-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,50268-0535-15,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,51079-0217-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,60687-0424-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,68084-0966-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
METRONIDAZOLE TAB 7935795,57089,CDM,250,RC,62332-0017-31,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,inpatient,1,EA,9.63000,9.15000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,5.30,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00054855025,NDC,facility,outpatient,1,EA,9.63000,9.15000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,0.31155,9.34,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,inpatient,1,EA,8.80000,8.36000,Amish/Mennonite,Amish Mennonite,,4.84,,,,,,,4.84,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00555057235,NDC,facility,outpatient,1,EA,8.80000,8.36000,Amish/Mennonite,Amish Mennonite,,4.84,,,,,,,0.31155,8.54,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,inpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,5.18,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,00904714110,NDC,facility,outpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,0.31155,9.14,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,16729048601,NDC,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.31155,0.62080,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,50268052715,NDC,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,0.31155,3.52,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,inpatient,1,EA,8.75000,8.32000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.81,8.49,percent of total billed charges,
METHOTREXATE TAB,57090,CDM,250,RC,J8610,HCPCS,51079067005,NDC,facility,outpatient,1,EA,8.75000,8.32000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,0.31155,8.49,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,23155-0071-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,49884-0641-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,51293-0821-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,inpatient,1,EA,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0370-01,NDC,,,facility,outpatient,1,EA,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.02,1.98,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
METHIMAZOLE TAB,57092,CDM,250,RC,60687-0680-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,inpatient,1,EA,133.19000,126.53000,Amish/Mennonite,Amish Mennonite,,73.25,,,,,,,73.25,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010000,NDC,facility,outpatient,1,EA,133.19000,126.53000,Amish/Mennonite,Amish Mennonite,,73.25,,,,,,,2.53,129.19,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,inpatient,1,EA,262.28000,249.17000,Amish/Mennonite,Amish Mennonite,,144.25,,,,,,,144.25,254.41,percent of total billed charges,
METHACHOLINE SOLN 100 MG,57093,CDM,250,RC,J7674,HCPCS,64281010006,NDC,facility,outpatient,1,EA,262.28000,249.17000,Amish/Mennonite,Amish Mennonite,,144.25,,,,,,,2.53,254.41,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-19,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00093-1049-93,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-6327-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,00904-7163-61,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,23155-0103-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,70010-0064-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,51991-0806-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,60687-0143-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
METFORMIN TAB 7222508,57094,CDM,250,RC,65862-0009-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,00378-0611-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,16729-0030-16,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
METHYLDOPA TAB,57095,CDM,250,RC,51079-0200-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
METHYL SALICYLATE TOPICAL OINT,57096,CDM,250,RC,54162-0555-01,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,69292-0564-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00378-6173-01,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,inpatient,1,EA,5.38000,5.11000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.96,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,00527-2216-37,NDC,,,facility,outpatient,1,EA,5.38000,5.11000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.69,5.22,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,inpatient,1,EA,9.83000,9.34000,Amish/Mennonite,Amish Mennonite,,5.41,,,,,,,5.41,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,51079-0024-20,NDC,,,facility,outpatient,1,EA,9.83000,9.34000,Amish/Mennonite,Amish Mennonite,,5.41,,,,,,,4.92,9.54,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,63739-0404-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
METOLAZONE TAB 7216989,57097,CDM,250,RC,72888-0053-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,TC,131.45,,,,,,,131.45,231.83,percent of total billed charges,
MAMMARY DUCTOGR/GALACTOGRM SNGL-TECH,57098,CDM,320,RC,77053,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,TC,131.45,,,,,,,119.50,2142.86,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,inpatient,1,EA,19.37000,18.40000,Amish/Mennonite,Amish Mennonite,,10.65,,,,,,,10.65,18.79,percent of total billed charges,
METHAZOLAMIDE TAB,57099,CDM,250,RC,00781-1071-01,NDC,,,facility,outpatient,1,EA,19.37000,18.40000,Amish/Mennonite,Amish Mennonite,,10.65,,,,,,,9.69,18.79,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,inpatient,1,EA,224.08000,212.87000,Amish/Mennonite,Amish Mennonite,,123.24,,,,,,,123.24,217.36,percent of total billed charges,
METHOHEXITAL POWD-INJ 500 MG,57100,CDM,250,RC,J3490,HCPCS,42023010501,NDC,facility,outpatient,1,EA,224.08000,212.87000,Amish/Mennonite,Amish Mennonite,,123.24,,,,,,,112.04,217.36,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,17.60,31.04,percent of total billed charges,
METHEMOGLOBIN QUANT-TECH,57101,CDM,300,RC,83050,CPT,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,4.12,390.47,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,00904-7057-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,31722-0533-01,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,43547-0405-10,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,inpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,50268-0520-15,NDC,,,facility,outpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,60687-0559-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,63739-0991-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,69584-0611-50,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,70010-0754-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
METHOCARBAMOL TAB,57102,CDM,250,RC,76385-0123-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,inpatient,1,EA,149.72000,142.23000,Amish/Mennonite,Amish Mennonite,,82.35,,,,,,,82.35,145.23,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 500 MG,57103,CDM,250,RC,J2919,HCPCS,00009000302,NDC,facility,outpatient,1,EA,149.72000,142.23000,Amish/Mennonite,Amish Mennonite,,82.35,,,,,,,0.26000,145.23,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,inpatient,1,EA,62.79000,59.65000,Amish/Mennonite,Amish Mennonite,,34.53,,,,,,,34.53,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,00093-3655-22,NDC,,,facility,outpatient,1,EA,62.79000,59.65000,Amish/Mennonite,Amish Mennonite,,34.53,,,,,,,31.39,60.91,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,inpatient,1,EA,196.71000,186.87000,Amish/Mennonite,Amish Mennonite,,108.19,,,,,,,108.19,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,27437-0050-57,NDC,,,facility,outpatient,1,EA,196.71000,186.87000,Amish/Mennonite,Amish Mennonite,,108.19,,,,,,,98.36,190.81,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,36.93,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-07,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,33.58,65.14,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,inpatient,1,EA,169.96000,161.46000,Amish/Mennonite,Amish Mennonite,,93.48,,,,,,,93.48,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-02,NDC,,,facility,outpatient,1,EA,169.96000,161.46000,Amish/Mennonite,Amish Mennonite,,93.48,,,,,,,84.98,164.86,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,inpatient,1,EA,169.86000,161.37000,Amish/Mennonite,Amish Mennonite,,93.42,,,,,,,93.42,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,43386-0140-28,NDC,,,facility,outpatient,1,EA,169.86000,161.37000,Amish/Mennonite,Amish Mennonite,,93.42,,,,,,,84.93,164.76,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,inpatient,1,EA,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,95.59,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,60687-0410-94,NDC,,,facility,outpatient,1,EA,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,86.90,168.59,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,inpatient,1,EA,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,28.68,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,69238-1605-08,NDC,,,facility,outpatient,1,EA,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,26.07,50.58,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,inpatient,1,EA,44.32000,42.10000,Amish/Mennonite,Amish Mennonite,,24.38,,,,,,,24.38,42.99,percent of total billed charges,
METHYLERGONOVINE TAB,57104,CDM,250,RC,70010-0786-12,NDC,,,facility,outpatient,1,EA,44.32000,42.10000,Amish/Mennonite,Amish Mennonite,,24.38,,,,,,,22.16,42.99,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,00496-0892-30,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,inpatient,1,GM,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,24357-0702-30,NDC,,,facility,outpatient,1,GM,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,inpatient,1,GM,1.36000,1.30000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
LIDOCAINE CREAM 5% 30 GM,57105,CDM,250,RC,75834-0141-30,NDC,,,facility,outpatient,1,GM,1.36000,1.30000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,inpatient,45,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00713-0252-37,NDC,,,facility,outpatient,45,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,inpatient,45,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,00904-7734-45,NDC,,,facility,outpatient,45,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,inpatient,45,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,51672-2035-06,NDC,,,facility,outpatient,45,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,inpatient,45,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
MICONAZOLE CRM,57106,CDM,250,RC,61269-0730-41,NDC,,,facility,outpatient,45,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,inpatient,1,EA,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00186-1092-39,NDC,,,facility,outpatient,1,EA,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.84,5.51,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,inpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6171-61,NDC,,,facility,outpatient,1,EA,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.48,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,inpatient,1,EA,3.85000,3.65000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,00904-6324-61,NDC,,,facility,outpatient,1,EA,3.85000,3.65000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.73,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,16714-0854-01,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.57,3.05,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50268-0542-15,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,50742-0617-01,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,51079-0171-03,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.76,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,60687-0413-01,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.77,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,63739-0454-10,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.52,4.88,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
METOPROLOL TAB 7214489,57107,CDM,250,RC,68084-0673-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,50268-0525-15,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,51079-0457-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
MELOXICAM TAB 7221592,57110,CDM,250,RC,69097-0158-07,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,inpatient,1,mL,82.30000,78.18000,Amish/Mennonite,Amish Mennonite,,45.27,,,,,,,45.27,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517037405,NDC,facility,outpatient,1,mL,82.30000,78.18000,Amish/Mennonite,Amish Mennonite,,45.27,,,,,,,7.86,79.83,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,inpatient,1,mL,74.07000,70.36000,Amish/Mennonite,Amish Mennonite,,40.74,,,,,,,40.74,71.85,percent of total billed charges,
METHYLENE BLUE SOLN 5 MG/ML (0.5%) 10 ML,57111,CDM,636,RC,Q9968,HCPCS,00517038105,NDC,facility,outpatient,1,mL,74.07000,70.36000,Amish/Mennonite,Amish Mennonite,,40.74,,,,,,,7.86,71.85,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,inpatient,1,mL,10.61000,10.08000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.84,10.29,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 10 ML,57112,CDM,250,RC,J9260,HCPCS,63323012310,NDC,facility,outpatient,1,mL,10.61000,10.08000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,3.62,10.29,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,inpatient,1,EA,32.92000,31.27000,Amish/Mennonite,Amish Mennonite,,18.11,,,,,,,18.11,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00009004726,NDC,facility,outpatient,1,EA,32.92000,31.27000,Amish/Mennonite,Amish Mennonite,,18.11,,,,,,,0.26000,31.93,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,inpatient,1,EA,20.41000,19.39000,Amish/Mennonite,Amish Mennonite,,11.23,,,,,,,11.23,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,00143975425,NDC,facility,outpatient,1,EA,20.41000,19.39000,Amish/Mennonite,Amish Mennonite,,11.23,,,,,,,0.26000,19.80,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,inpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,13.21,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,43598012925,NDC,facility,outpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,0.26000,23.30,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,inpatient,1,EA,36.81000,34.97000,Amish/Mennonite,Amish Mennonite,,20.25,,,,,,,20.25,35.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 125 MG/2 ML,57113,CDM,636,RC,J2919,HCPCS,63323025803,NDC,facility,outpatient,1,EA,36.81000,34.97000,Amish/Mennonite,Amish Mennonite,,20.25,,,,,,,0.26000,35.71,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
MICROBE SUSCEP ENZYME EA-TECH,57115,CDM,300,RC,87185,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,4.75,254.68,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577162,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,inpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577101,NDC,facility,outpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00406577123,NDC,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,00904653061,NDC,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,63739000610,NDC,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,66689082010,NDC,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,inpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
METHADONE TAB 10 MG,57116,CDM,250,RC,J8499,HCPCS,67877011601,NDC,facility,outpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,inpatient,1,EA,262.63000,249.50000,Amish/Mennonite,Amish Mennonite,,144.45,,,,,,,144.45,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 2 GM,57117,CDM,636,RC,J2919,HCPCS,00009085001,NDC,facility,outpatient,1,EA,262.63000,249.50000,Amish/Mennonite,Amish Mennonite,,144.45,,,,,,,0.26000,254.75,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,inpatient,1,EA,138.98000,132.03000,Amish/Mennonite,Amish Mennonite,,76.44,,,,,,,76.44,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00009069801,NDC,facility,outpatient,1,EA,138.98000,132.03000,Amish/Mennonite,Amish Mennonite,,76.44,,,,,,,0.26000,134.81,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,inpatient,1,EA,132.37000,125.75000,Amish/Mennonite,Amish Mennonite,,72.80,,,,,,,72.80,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,00143985101,NDC,facility,outpatient,1,EA,132.37000,125.75000,Amish/Mennonite,Amish Mennonite,,72.80,,,,,,,0.26000,128.40,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,inpatient,1,EA,102.70000,97.56000,Amish/Mennonite,Amish Mennonite,,56.48,,,,,,,56.48,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,43598013074,NDC,facility,outpatient,1,EA,102.70000,97.56000,Amish/Mennonite,Amish Mennonite,,56.48,,,,,,,0.26000,99.62,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,inpatient,1,EA,108.14000,102.73000,Amish/Mennonite,Amish Mennonite,,59.48,,,,,,,59.48,104.90,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 1 GM,57118,CDM,636,RC,J2919,HCPCS,63323026530,NDC,facility,outpatient,1,EA,108.14000,102.73000,Amish/Mennonite,Amish Mennonite,,59.48,,,,,,,0.26000,104.90,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,inpatient,5,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
METHYLDOPA SOL,57119,CDM,250,RC,J0210,HCPCS,00517890510,NDC,facility,outpatient,5,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,inpatient,1,EA,20.44000,19.42000,Amish/Mennonite,Amish Mennonite,,11.24,,,,,,,11.24,19.83,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 40 MG,57120,CDM,636,RC,J2919,HCPCS,00009003932,NDC,facility,outpatient,1,EA,20.44000,19.42000,Amish/Mennonite,Amish Mennonite,,11.24,,,,,,,0.26000,19.83,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,00904-7156-61,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,50268-0534-15,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
METRONIDAZOLE TAB 7935794,57121,CDM,250,RC,51079-0216-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,62584026601,NDC,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080120,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,51079080119,NDC,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 50 MG,57122,CDM,250,RC,J8499,HCPCS,65862006301,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
MICROALBUMIN QUANT URINE-TECH,57123,CDM,300,RC,82043,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,5.78,305.58,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,inpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,95.70,168.78,percent of total billed charges,
MICROSOMAL AB EA-TECH,57124,CDM,300,RC,86376,CPT,,,facility,outpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,14.55,763.98,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00115-1801-01,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00406-1122-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,31722-0174-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,00591-5883-01,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,inpatient,1,EA,1.37000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16714-0822-01,NDC,,,facility,outpatient,1,EA,1.37000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,16729-0479-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,inpatient,1,EA,31.54000,29.96000,Amish/Mennonite,Amish Mennonite,,17.35,,,,,,,17.35,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,53265-0254-10,NDC,,,facility,outpatient,1,EA,31.54000,29.96000,Amish/Mennonite,Amish Mennonite,,17.35,,,,,,,15.77,30.59,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPHENIDATE TAB,57125,CDM,250,RC,68084-0823-21,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.80,3.49,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,inpatient,1,EA,62.32000,59.20000,Amish/Mennonite,Amish Mennonite,,34.28,,,,,,,34.28,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347522,NDC,facility,outpatient,1,EA,62.32000,59.20000,Amish/Mennonite,Amish Mennonite,,34.28,,,,,,,0.12000,60.45,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,inpatient,1,EA,62.33000,59.21000,Amish/Mennonite,Amish Mennonite,,34.28,,,,,,,34.28,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00009347523,NDC,facility,outpatient,1,EA,62.33000,59.21000,Amish/Mennonite,Amish Mennonite,,34.28,,,,,,,0.12000,60.46,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,inpatient,1,EA,45.19000,42.93000,Amish/Mennonite,Amish Mennonite,,24.85,,,,,,,24.85,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,00703005104,NDC,facility,outpatient,1,EA,45.19000,42.93000,Amish/Mennonite,Amish Mennonite,,24.85,,,,,,,0.12000,43.83,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,inpatient,1,EA,51.57000,48.99000,Amish/Mennonite,Amish Mennonite,,28.36,,,,,,,28.36,50.02,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 80 MG/ML 1 ML,57126,CDM,636,RC,J1010,HCPCS,70121157405,NDC,facility,outpatient,1,EA,51.57000,48.99000,Amish/Mennonite,Amish Mennonite,,28.36,,,,,,,0.12000,50.02,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
METANEPHRINES ASSAY-TECH,57127,CDM,300,RC,83835,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,16.94,882.80,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,00121-0576-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE SYRUP,57128,CDM,250,RC,62559-0190-16,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,inpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341401,NDC,facility,outpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,inpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00409341411,NDC,facility,outpatient,2,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,inpatient,2,EA,5.30000,5.03000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450204,NDC,facility,outpatient,2,EA,5.30000,5.03000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,1.60,5.14,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,inpatient,2,EA,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450284,NDC,facility,outpatient,2,EA,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,1.60,4.18,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,inpatient,2,EA,5.29000,5.03000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,2.91,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,00703450293,NDC,facility,outpatient,2,EA,5.29000,5.03000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,1.60,5.13,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,inpatient,2,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,10019045039,NDC,facility,outpatient,2,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,1.88,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,inpatient,2,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
METOCLOPRAMIDE SOLN 5 MG/ML 2 ML,57129,CDM,250,RC,J2765,HCPCS,23155024041,NDC,facility,outpatient,2,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.60,3.38,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,inpatient,1,mL,56.56000,53.73000,Amish/Mennonite,Amish Mennonite,,31.11,,,,,,,31.11,54.86,percent of total billed charges,
METHYLENE BLUE SOL 7910563,57130,CDM,636,RC,Q9968,HCPCS,17478050401,NDC,facility,outpatient,1,mL,56.56000,53.73000,Amish/Mennonite,Amish Mennonite,,31.11,,,,,,,7.86,54.86,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
MICROBE SUSCEP MICRO/AGAR-TECH,57132,CDM,300,RC,87186,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,8.65,458.40,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00378001801,NDC,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,00904634061,NDC,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025520,NDC,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,51079025517,NDC,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,65862006201,NDC,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,57664050652,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
METOPROLOL TARTRATE TAB 25 MG,57133,CDM,250,RC,J8499,HCPCS,62584026501,NDC,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00186-1090-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00378-4596-77,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.82,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,00904-6323-61,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.66,3.21,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.04,2.02,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,16714-0853-02,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,45963-0676-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,inpatient,1,EA,1.43000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50268-0541-15,NDC,,,facility,outpatient,1,EA,1.43000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.71500,1.39,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,50742-0616-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,51079-0170-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,60687-0402-65,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,2.18,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222565,57134,CDM,250,RC,68084-0666-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,inpatient,5,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00143987310,NDC,facility,outpatient,5,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,inpatient,5,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177805,NDC,facility,outpatient,5,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,inpatient,5,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409177835,NDC,facility,outpatient,5,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.82,3.54,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,inpatient,5,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00409201610,NDC,facility,outpatient,5,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,inpatient,5,EA,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307175,NDC,facility,outpatient,5,EA,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.02,1.98,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,inpatient,5,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,00781307195,NDC,facility,outpatient,5,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.01,1.97,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,inpatient,5,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72266012225,NDC,facility,outpatient,5,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,inpatient,5,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,72611074010,NDC,facility,outpatient,5,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,inpatient,5,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,55390007310,NDC,facility,outpatient,5,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,inpatient,5,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,63323066005,NDC,facility,outpatient,5,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,inpatient,5,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
METOPROLOL TARTRATE SOLN-INJ 1 MG/ML 5 ML,57135,CDM,250,RC,J3490,HCPCS,70860030005,NDC,facility,outpatient,5,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,51079-0802-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,65862-0064-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,57664-0167-52,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7217773,57136,CDM,250,RC,62584-0267-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,inpatient,1,EA,9.67000,9.18000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005602,NDC,facility,outpatient,1,EA,9.67000,9.18000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,0.36823,9.38,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00009005604,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.36823,0.92150,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,inpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00603459315,NDC,facility,outpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,0.36823,3.49,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,inpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502201,NDC,facility,outpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,inpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00781502207,NDC,facility,outpatient,1,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,0.36823,3.50,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,inpatient,1,EA,5.88000,5.58000,Amish/Mennonite,Amish Mennonite,,3.23,,,,,,,3.23,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,00904691461,NDC,facility,outpatient,1,EA,5.88000,5.58000,Amish/Mennonite,Amish Mennonite,,3.23,,,,,,,0.36823,5.70,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040001,NDC,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,42806040021,NDC,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59746000103,NDC,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.36823,0.95060,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762332702,NDC,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.36823,0.97970,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,inpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,59762444002,NDC,facility,outpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,0.36823,2.63,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63629222601,NDC,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,63739016110,NDC,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,inpatient,1,EA,5.28000,5.02000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68084014901,NDC,facility,outpatient,1,EA,5.28000,5.02000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,0.36823,5.12,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,68382091601,NDC,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.36823,1.26,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,inpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
METHYLPREDNISOLONE ORAL,57137,CDM,250,RC,J7509,HCPCS,72647033104,NDC,facility,outpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,inpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00186-1088-39,NDC,,,facility,outpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.89,3.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00527-2600-37,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,00904-6322-06,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,inpatient,1,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-20,NDC,,,facility,outpatient,1,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.69,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,16714-0852-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50268-0540-15,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,50742-0615-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,51079-0169-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,55111-0466-01,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,68084-0659-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
METOPROLOL TAB 7222839,57138,CDM,250,RC,62037-0830-01,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,inpatient,5,EA,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00054-3566-99,NDC,,,facility,outpatient,5,EA,3.48000,3.31000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,inpatient,5,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,00574-0150-04,NDC,,,facility,outpatient,5,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,inpatient,5,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
MIDAZOLAM SYRUP 2 MG/ML,57139,CDM,250,RC,63304-0205-18,NDC,,,facility,outpatient,5,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,Amish/Mennonite,Amish Mennonite,,9.58,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-31,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,Amish/Mennonite,Amish Mennonite,,9.58,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,inpatient,1,EA,17.42000,16.55000,Amish/Mennonite,Amish Mennonite,,9.58,,,,,,,9.58,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,00025-1461-60,NDC,,,facility,outpatient,1,EA,17.42000,16.55000,Amish/Mennonite,Amish Mennonite,,9.58,,,,,,,8.71,16.90,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,10135-0746-60,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,70954-0444-20,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-01,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,59762-5008-02,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,inpatient,1,EA,7.18000,6.82000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.95,6.96,percent of total billed charges,
MISOPROSTOL TAB 200 MCG,57142,CDM,250,RC,68084-0041-01,NDC,,,facility,outpatient,1,EA,7.18000,6.82000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.59,6.96,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575562,NDC,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00054070925,NDC,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,00406575501,NDC,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,inpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
METHADONE TAB 5 MG,57143,CDM,250,RC,J8499,HCPCS,60687021401,NDC,facility,outpatient,1,EA,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,inpatient,,,25.30000,24.04000,Amish/Mennonite,Amish Mennonite,,13.91,,,,,,,13.91,24.54,percent of total billed charges,
MNT INDV REASSESS EA 15MIN-TECH,57144,CDM,960,RC,97803,CPT,,,facility,outpatient,,,25.30000,24.04000,Amish/Mennonite,Amish Mennonite,,13.91,,,,,,,12.65,24.54,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00093-1048-19,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,00904-7162-61,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,23155-0102-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,60687-0155-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,67877-0561-05,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,68382-0758-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
METFORMIN TAB 7216567,57145,CDM,250,RC,70010-0063-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
METHADONE QUANT ASSAY URINE-TECH,57146,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,53.00,788.42,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,inpatient,1,EA,9.04000,8.59000,Amish/Mennonite,Amish Mennonite,,4.97,,,,,,,4.97,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307301,NDC,facility,outpatient,1,EA,9.04000,8.59000,Amish/Mennonite,Amish Mennonite,,4.97,,,,,,,0.12000,8.77,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,inpatient,1,EA,35.92000,34.13000,Amish/Mennonite,Amish Mennonite,,19.76,,,,,,,19.76,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307323,NDC,facility,outpatient,1,EA,35.92000,34.13000,Amish/Mennonite,Amish Mennonite,,19.76,,,,,,,0.12000,34.84,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,inpatient,1,EA,35.90000,34.10000,Amish/Mennonite,Amish Mennonite,,19.75,,,,,,,19.75,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00009307322,NDC,facility,outpatient,1,EA,35.90000,34.10000,Amish/Mennonite,Amish Mennonite,,19.75,,,,,,,0.12000,34.82,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,inpatient,1,EA,27.49000,26.12000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,15.12,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,00703003104,NDC,facility,outpatient,1,EA,27.49000,26.12000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,0.12000,26.67,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,inpatient,1,EA,27.99000,26.59000,Amish/Mennonite,Amish Mennonite,,15.39,,,,,,,15.39,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,16714008825,NDC,facility,outpatient,1,EA,27.99000,26.59000,Amish/Mennonite,Amish Mennonite,,15.39,,,,,,,0.12000,27.15,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,inpatient,1,EA,30.46000,28.94000,Amish/Mennonite,Amish Mennonite,,16.75,,,,,,,16.75,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157301,NDC,facility,outpatient,1,EA,30.46000,28.94000,Amish/Mennonite,Amish Mennonite,,16.75,,,,,,,0.12000,29.55,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,inpatient,1,EA,30.45000,28.92000,Amish/Mennonite,Amish Mennonite,,16.75,,,,,,,16.75,29.54,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 1 ML,57148,CDM,636,RC,J1010,HCPCS,70121157305,NDC,facility,outpatient,1,EA,30.45000,28.92000,Amish/Mennonite,Amish Mennonite,,16.75,,,,,,,0.12000,29.54,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
MODIFIED KINYION STAIN-TECH,57150,CDM,300,RC,87206,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.39,288.61,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,inpatient,1,EA,569.80000,541.31000,Amish/Mennonite,Amish Mennonite,,313.39,,,,,,,313.39,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143913601,NDC,facility,outpatient,1,EA,569.80000,541.31000,Amish/Mennonite,Amish Mennonite,,313.39,,,,,,,28.27,552.71,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,inpatient,1,EA,2907.20000,2761.84000,Amish/Mennonite,Amish Mennonite,,1598.96,,,,,,,1598.96,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,00143928001,NDC,facility,outpatient,1,EA,2907.20000,2761.84000,Amish/Mennonite,Amish Mennonite,,1598.96,,,,,,,28.27,2819.98,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,inpatient,1,EA,2907.11000,2761.75000,Amish/Mennonite,Amish Mennonite,,1598.91,,,,,,,1598.91,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,67457052040,NDC,facility,outpatient,1,EA,2907.11000,2761.75000,Amish/Mennonite,Amish Mennonite,,1598.91,,,,,,,28.27,2819.90,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,inpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,356.12,628.08,percent of total billed charges,
MITOMYCIN POWD-INJ 40 MG,57151,CDM,636,RC,J9280,HCPCS,55390025301,NDC,facility,outpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,28.27,628.08,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,inpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,45.10,79.54,percent of total billed charges,
MICROBE SUSCEP MYCOBACTERIA EA-TECH,57152,CDM,300,RC,87190,CPT,,,facility,outpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,4.05,339.51,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
MICROBE SUSCEP DISK METHOD EA-TECH,57155,CDM,300,RC,87184,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,7.48,356.54,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,inpatient,1,EA,3.87000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60505-1321-01,NDC,,,facility,outpatient,1,EA,3.87000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.75,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-61,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00245-0212-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,inpatient,1,EA,5.16000,4.90000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00378-1902-01,NDC,,,facility,outpatient,1,EA,5.16000,4.90000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,inpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,00904-6818-06,NDC,,,facility,outpatient,1,EA,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,42291-0561-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,inpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,51079-0453-20,NDC,,,facility,outpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.80,3.49,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,60687-0398-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0145-10,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,63739-0556-10,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.36,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,inpatient,1,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,68084-0241-01,NDC,,,facility,outpatient,1,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.61,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB,57156,CDM,250,RC,72888-0113-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,inpatient,,,161.35000,153.28000,Amish/Mennonite,Amish Mennonite,,88.74,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,CPT,,,facility,outpatient,,,161.35000,153.28000,Amish/Mennonite,Amish Mennonite,,88.74,,,,,,,80.67,185.08,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,inpatient,1,EA,161.35000,153.28000,Amish/Mennonite,Amish Mennonite,,88.74,,,,,,,88.74,156.51,percent of total billed charges,
MEASLES-MUMPS-RUBELLA VACCINE POWD-INJ (M-M-R II),57157,CDM,636,RC,90707,HCPCS,58160082415,NDC,facility,outpatient,1,EA,161.35000,153.28000,Amish/Mennonite,Amish Mennonite,,88.74,,,,,,,80.67,185.08,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,inpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409125830,NDC,facility,outpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,inpatient,1,EA,6.15000,5.84000,Amish/Mennonite,Amish Mennonite,,3.38,,,,,,,3.38,5.97,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00409189101,NDC,facility,outpatient,1,EA,6.15000,5.84000,Amish/Mennonite,Amish Mennonite,,3.38,,,,,,,3.08,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,inpatient,1,EA,7.89000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.65,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,00641612525,NDC,facility,outpatient,1,EA,7.89000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.94,7.69,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,inpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000510,NDC,facility,outpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.54,8.80,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,inpatient,1,EA,10.88000,10.34000,Amish/Mennonite,Amish Mennonite,,5.98,,,,,,,5.98,10.55,percent of total billed charges,
MORPHINE SOLN 4 MG/ML,57158,CDM,250,RC,J2270,HCPCS,76045000511,NDC,facility,outpatient,1,EA,10.88000,10.34000,Amish/Mennonite,Amish Mennonite,,5.98,,,,,,,5.44,10.55,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,inpatient,1,EA,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.08,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189301,NDC,facility,outpatient,1,EA,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,3.65,7.69,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,inpatient,1,EA,17.65000,16.77000,Amish/Mennonite,Amish Mennonite,,9.71,,,,,,,9.71,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00409189323,NDC,facility,outpatient,1,EA,17.65000,16.77000,Amish/Mennonite,Amish Mennonite,,9.71,,,,,,,7.18,17.12,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,inpatient,1,EA,8.05000,7.65000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,4.43,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,00641612725,NDC,facility,outpatient,1,EA,8.05000,7.65000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,4.03,7.81,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,inpatient,1,EA,8.41000,7.99000,Amish/Mennonite,Amish Mennonite,,4.63,,,,,,,4.63,8.16,percent of total billed charges,
MORPHINE SULFATE INJECTION 7632755,57160,CDM,250,RC,J2270,HCPCS,63323045100,NDC,facility,outpatient,1,EA,8.41000,7.99000,Amish/Mennonite,Amish Mennonite,,4.63,,,,,,,4.21,8.16,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,inpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,65862-0211-50,NDC,,,facility,outpatient,1,EA,1.76000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,00904-6888-06,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,60687-0336-65,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
MINOCYCLINE CAP,57161,CDM,250,RC,63304-0696-50,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,108.35,191.09,percent of total billed charges,
MDI DEMONSTRATION-TECH,57162,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,98.50,212.44,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,inpatient,1,EA,12.55000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.90,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00025-1451-34,NDC,,,facility,outpatient,1,EA,12.55000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.28,12.17,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-20,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,00172-4430-59,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,70954-0443-10,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,59762-5007-02,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,60687-0735-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.27,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,inpatient,1,EA,6.53000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.33,percent of total billed charges,
MISOPROSTOL TAB 100 MCG,57163,CDM,250,RC,68084-0040-01,NDC,,,facility,outpatient,1,EA,6.53000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.27,6.33,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,inpatient,1,EA,217.79000,206.90000,Amish/Mennonite,Amish Mennonite,,119.78,,,,,,,119.78,211.26,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ PF 1 GM,57164,CDM,636,RC,J2919,HCPCS,00009001820,NDC,facility,outpatient,1,EA,217.79000,206.90000,Amish/Mennonite,Amish Mennonite,,119.78,,,,,,,0.26000,211.26,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,inpatient,100,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338105548,NDC,facility,outpatient,100,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,inpatient,100,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00338954124,NDC,facility,outpatient,100,EA,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,inpatient,100,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409015224,NDC,facility,outpatient,100,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,inpatient,100,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781110,NDC,facility,outpatient,100,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,inpatient,100,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781124,NDC,facility,outpatient,100,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,inpatient,100,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,00409781137,NDC,facility,outpatient,100,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04980,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,inpatient,100,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,25021013182,NDC,facility,outpatient,100,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,inpatient,100,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
METRONIDAZOLE 500 MG/100 ML PREMIX,57165,CDM,250,RC,J1836,HCPCS,47335099301,NDC,facility,outpatient,100,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,39.60,69.84,percent of total billed charges,
MODIFIED TRICHROME STAIN-TECH,57166,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,5.99,1216.68,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,inpatient,1,EA,15.06000,14.31000,Amish/Mennonite,Amish Mennonite,,8.28,,,,,,,8.28,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00006011701,NDC,facility,outpatient,1,EA,15.06000,14.31000,Amish/Mennonite,Amish Mennonite,,8.28,,,,,,,7.53,14.61,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680806,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,00904680861,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072630,NDC,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,31722072690,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,33342010207,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,65862057490,NDC,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
MONTELUKAST TAB 10 MG,57167,CDM,250,RC,J8499,HCPCS,68084087501,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,inpatient,1,EA,4.07000,3.86000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.24,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-24,NDC,,,facility,outpatient,1,EA,4.07000,3.86000,Amish/Mennonite,Amish Mennonite,,2.24,,,,,,,2.04,3.95,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
MORPHINE TAB 7631930,57168,CDM,250,RC,00054-0236-25,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
MICROBE SUSCEP MACROBROTH EA-TECH,57169,CDM,300,RC,87188,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,6.64,339.51,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0404-50,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00054-0517-41,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,inpatient,30,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00406-8003-30,NDC,,,facility,outpatient,30,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,inpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,00527-1425-36,NDC,,,facility,outpatient,30,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,inpatient,30,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,27808-0082-01,NDC,,,facility,outpatient,30,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,inpatient,30,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/ML,57170,CDM,250,RC,50383-0965-30,NDC,,,facility,outpatient,30,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,inpatient,,,656.00000,623.20000,Amish/Mennonite,Amish Mennonite,,360.80,,,,,,,360.80,636.32,percent of total billed charges,
MAM DUCTOGRAM INJ-TECH,57172,CDM,361,RC,19030,CPT,,,facility,outpatient,,,656.00000,623.20000,Amish/Mennonite,Amish Mennonite,,360.80,,,,,,,360.80,5271.00,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,inpatient,1,EA,630.07000,598.57000,Amish/Mennonite,Amish Mennonite,,346.54,,,,,,,346.54,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,67457051805,NDC,facility,outpatient,1,EA,630.07000,598.57000,Amish/Mennonite,Amish Mennonite,,346.54,,,,,,,28.27,611.17,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
MITOMYCIN POWD-INJ 5 MG,57173,CDM,636,RC,J9280,HCPCS,71288013720,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,28.27,376.85,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
MNT GROUP INIT EA 30MIN-TECH,57175,CDM,942,RC,97804,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,34.92,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,33.55,59.17,percent of total billed charges,
MICROBE SUSCEP AGAR DILUT EA-TECH,57177,CDM,300,RC,87181,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,4.75,254.68,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00378-0018-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
METOPROLOL TAB 7214209,57178,CDM,250,RC,00904-6340-61-00050,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,inpatient,1,EA,7.85000,7.46000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-01,NDC,,,facility,outpatient,1,EA,7.85000,7.46000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,3.92,7.61,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-23,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,4.90,9.51,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,inpatient,1,EA,9.82000,9.33000,Amish/Mennonite,Amish Mennonite,,5.40,,,,,,,5.40,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,00406-8380-62,NDC,,,facility,outpatient,1,EA,9.82000,9.33000,Amish/Mennonite,Amish Mennonite,,5.40,,,,,,,4.91,9.53,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,inpatient,1,EA,3.69000,3.51000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
MORPHINE TAB 7630692,57180,CDM,250,RC,42858-0803-01,NDC,,,facility,outpatient,1,EA,3.69000,3.51000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,inpatient,1,mL,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
MORPHINE SULFATE INJECTION 7910566,57181,CDM,250,RC,J2270,HCPCS,00641606801,NDC,facility,outpatient,1,mL,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,7.69,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,inpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,69292056201,NDC,facility,outpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,inpatient,1,EA,5.70000,5.42000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00378617201,NDC,facility,outpatient,1,EA,5.70000,5.42000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,5.53,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,inpatient,1,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00527221537,NDC,facility,outpatient,1,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.35,4.57,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,inpatient,1,EA,9.88000,9.39000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,5.43,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,00904691661,NDC,facility,outpatient,1,EA,9.88000,9.39000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,4.94,9.58,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,inpatient,1,EA,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,3.28,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002301,NDC,facility,outpatient,1,EA,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,2.98,5.79,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,inpatient,1,EA,8.65000,8.22000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,4.76,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,51079002320,NDC,facility,outpatient,1,EA,8.65000,8.22000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,4.33,8.39,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,inpatient,1,EA,3.50000,3.32000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,65580064371,NDC,facility,outpatient,1,EA,3.50000,3.32000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
METOLAZONE TAB 2.5 MG,57182,CDM,250,RC,J8499,HCPCS,72888005201,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,inpatient,,,760.00000,722.00000,Amish/Mennonite,Amish Mennonite,TC,418.00,,,,,,,418.00,737.20,percent of total billed charges,
MICRODISSECTION MANUAL-TECH,57183,CDM,310,RC,88381,CPT,,,facility,outpatient,,,760.00000,722.00000,Amish/Mennonite,Amish Mennonite,TC,418.00,,,,,,,380.00,7351.18,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA/MRV HEAD WO/W CNTRST +SEQ-TECH,57184,CDM,615,RC,70546,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,inpatient,1,EA,11.63000,11.05000,Amish/Mennonite,Amish Mennonite,,6.40,,,,,,,6.40,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-01,NDC,,,facility,outpatient,1,EA,11.63000,11.05000,Amish/Mennonite,Amish Mennonite,,6.40,,,,,,,5.82,11.28,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,inpatient,1,EA,14.54000,13.81000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,8.00,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,00406-8390-62,NDC,,,facility,outpatient,1,EA,14.54000,13.81000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,7.27,14.10,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.41,percent of total billed charges,
MORPHINE TAB 7630999,57185,CDM,250,RC,42858-0804-01,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.41,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00054-0237-55,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,00121-0904-94,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,inpatient,1,mL,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,60687-0760-86,NDC,,,facility,outpatient,1,mL,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
MORPHINE SOL,57186,CDM,250,RC,68094-0001-62,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,inpatient,1,mL,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,60687057686,NDC,facility,outpatient,1,mL,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,inpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071659,NDC,facility,outpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,inpatient,1,mL,2.57000,2.45000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094071662,NDC,facility,outpatient,1,mL,2.57000,2.45000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,inpatient,1,mL,3.86000,3.67000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.74,percent of total billed charges,
MIDAZOLAM SYRUP 10MG/5ML,57187,CDM,250,RC,J8499,HCPCS,68094076462,NDC,facility,outpatient,1,mL,3.86000,3.67000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.74,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
MORPHINE SOL 7630776,57190,CDM,250,RC,00054-0238-63,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,inpatient,,,2539.00000,2412.05000,Amish/Mennonite,Amish Mennonite,TC,1396.45,,,,,,,1396.45,2462.83,percent of total billed charges,
MRI BRAIN W CNTRST-TECH,57193,CDM,611,RC,70552,CPT,,,facility,outpatient,,,2539.00000,2412.05000,Amish/Mennonite,Amish Mennonite,TC,1396.45,,,,,,,1269.50,2462.83,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220301,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,00093220305,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,42291059690,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,inpatient,1,EA,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,51079088820,NDC,facility,outpatient,1,EA,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.44,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084067601,NDC,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63304084601,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739017210,NDC,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739029310,NDC,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,63739048210,NDC,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
METOCLOPRAMIDE TAB 10 MG,57197,CDM,250,RC,J8499,HCPCS,68084009111,NDC,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3457.00000,3284.15000,Amish/Mennonite,Amish Mennonite,TC,1901.35,,,,,,,1901.35,3353.29,percent of total billed charges,
MRA LWR EXT W/WO CNTRST-TECH,57198,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3457.00000,3284.15000,Amish/Mennonite,Amish Mennonite,TC,1901.35,,,,,,,1371.65,3353.29,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,inpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA NECK WO CNTRST-TECH,57199,CDM,615,RC,70547,CPT,,,facility,outpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1130.78,2914.85,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,inpatient,,,3007.00000,2856.65000,Amish/Mennonite,Amish Mennonite,TC,1653.85,,,,,,,1653.85,2916.79,percent of total billed charges,
MRI CHEST WO CNTRST-TECH,57200,CDM,614,RC,71550,CPT,,,facility,outpatient,,,3007.00000,2856.65000,Amish/Mennonite,Amish Mennonite,TC,1653.85,,,,,,,1329.46,2916.79,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,inpatient,1,mL,5.47000,5.19000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,3.01,5.31,percent of total billed charges,
MORPHINE SULFATE INJECTION 7855763,57201,CDM,250,RC,J2270,HCPCS,61553035379,NDC,facility,outpatient,1,mL,5.47000,5.19000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,2.73,7.69,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,inpatient,,,4985.00000,4735.75000,Amish/Mennonite,Amish Mennonite,TC,2741.75,,,,,,,2741.75,4835.45,percent of total billed charges,
MRI CHEST WO/W CNTRST + SEQ-TECH,57202,CDM,614,RC,71552,CPT,,,facility,outpatient,,,4985.00000,4735.75000,Amish/Mennonite,Amish Mennonite,TC,2741.75,,,,,,,1487.04,4835.45,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00046-8315-62,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-23,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00406-8315-62,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,inpatient,1,EA,3.62000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,00904-6557-61,NDC,,,facility,outpatient,1,EA,3.62000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.81,3.51,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,inpatient,1,EA,2.55000,2.43000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
MORPHINE TAB 7631732,57203,CDM,250,RC,68084-0157-01,NDC,,,facility,outpatient,1,EA,2.55000,2.43000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,inpatient,1,EA,1636.88000,1555.04000,Amish/Mennonite,Amish Mennonite,,900.28,,,,,,,900.28,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,00143927901,NDC,facility,outpatient,1,EA,1636.88000,1555.04000,Amish/Mennonite,Amish Mennonite,,900.28,,,,,,,28.27,1587.77,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,inpatient,1,EA,1636.83000,1554.99000,Amish/Mennonite,Amish Mennonite,,900.26,,,,,,,900.26,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,67457051920,NDC,facility,outpatient,1,EA,1636.83000,1554.99000,Amish/Mennonite,Amish Mennonite,,900.26,,,,,,,28.27,1587.73,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,inpatient,1,EA,471.38000,447.81000,Amish/Mennonite,Amish Mennonite,,259.26,,,,,,,259.26,457.24,percent of total billed charges,
MITOMYCIN POWD-INJ 20 MG,57204,CDM,636,RC,J9280,HCPCS,55390045201,NDC,facility,outpatient,1,EA,471.38000,447.81000,Amish/Mennonite,Amish Mennonite,,259.26,,,,,,,28.27,457.24,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,inpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,2759.90,4867.46,percent of total billed charges,
MRA NECK WO/W CNTRST + SEQ-TECH,57205,CDM,615,RC,70549,CPT,,,facility,outpatient,,,5018.00000,4767.10000,Amish/Mennonite,Amish Mennonite,TC,2759.90,,,,,,,1487.04,4867.46,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,inpatient,3,EA,183.41000,174.24000,Amish/Mennonite,Amish Mennonite,,100.88,,,,,,,100.88,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00078-0939-26,NDC,,,facility,outpatient,3,EA,183.41000,174.24000,Amish/Mennonite,Amish Mennonite,,100.88,,,,,,,91.70,177.91,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,inpatient,3,EA,35.81000,34.02000,Amish/Mennonite,Amish Mennonite,,19.70,,,,,,,19.70,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00378-5430-35,NDC,,,facility,outpatient,3,EA,35.81000,34.02000,Amish/Mennonite,Amish Mennonite,,19.70,,,,,,,17.91,34.74,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,inpatient,3,EA,36.87000,35.02000,Amish/Mennonite,Amish Mennonite,,20.28,,,,,,,20.28,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00781-7135-93,NDC,,,facility,outpatient,3,EA,36.87000,35.02000,Amish/Mennonite,Amish Mennonite,,20.28,,,,,,,18.43,35.76,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,inpatient,3,EA,26.64000,25.31000,Amish/Mennonite,Amish Mennonite,,14.65,,,,,,,14.65,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,00832-1410-03,NDC,,,facility,outpatient,3,EA,26.64000,25.31000,Amish/Mennonite,Amish Mennonite,,14.65,,,,,,,13.32,25.84,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,inpatient,3,EA,53.75000,51.06000,Amish/Mennonite,Amish Mennonite,,29.56,,,,,,,29.56,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,16714-0643-01,NDC,,,facility,outpatient,3,EA,53.75000,51.06000,Amish/Mennonite,Amish Mennonite,,29.56,,,,,,,26.88,52.14,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,inpatient,3,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,22.59,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,17478-0519-19,NDC,,,facility,outpatient,3,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,20.54,39.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,inpatient,3,EA,70.51000,66.98000,Amish/Mennonite,Amish Mennonite,,38.78,,,,,,,38.78,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,60505-0582-04,NDC,,,facility,outpatient,3,EA,70.51000,66.98000,Amish/Mennonite,Amish Mennonite,,38.78,,,,,,,35.26,68.39,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,inpatient,3,EA,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,11.59,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,62332-0505-03,NDC,,,facility,outpatient,3,EA,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,10.54,20.44,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,inpatient,3,EA,35.26000,33.49000,Amish/Mennonite,Amish Mennonite,,19.39,,,,,,,19.39,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,65862-0840-03,NDC,,,facility,outpatient,3,EA,35.26000,33.49000,Amish/Mennonite,Amish Mennonite,,19.39,,,,,,,17.63,34.20,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,inpatient,3,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,68180-0422-01,NDC,,,facility,outpatient,3,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,inpatient,3,EA,12.22000,11.61000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.72,11.85,percent of total billed charges,
MOXIFLOXACIN SOLN-OPHTH 0.5% 3 ML,57206,CDM,250,RC,72266-0158-01,NDC,,,facility,outpatient,3,EA,12.22000,11.61000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.11,11.85,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-24,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.20,2.32,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,00054-0235-25,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MORPHINE TAB 7632326,57207,CDM,250,RC,58177-0313-04,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,inpatient,,,4056.00000,3853.20000,Amish/Mennonite,Amish Mennonite,TC,2230.80,,,,,,,2230.80,3934.32,percent of total billed charges,
MRI ABDOMEN W CNTRST-TECH,57209,CDM,614,RC,74182,CPT,,,facility,outpatient,,,4056.00000,3853.20000,Amish/Mennonite,Amish Mennonite,TC,2230.80,,,,,,,1487.04,3934.32,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,inpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00143971010,NDC,facility,outpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,inpatient,1,mL,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,00409021201,NDC,facility,outpatient,1,mL,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.61,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,inpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 10 ML,57210,CDM,250,RC,J2260,HCPCS,63323061710,NDC,facility,outpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,2.24,12.26,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,inpatient,,,4381.00000,4161.95000,Amish/Mennonite,Amish Mennonite,TC,2409.55,,,,,,,2409.55,4249.57,percent of total billed charges,
MRI LWR EXT OTH THN JT WO/W CNTRST-TECH,57211,CDM,614,RC,73720,CPT,,,facility,outpatient,,,4381.00000,4161.95000,Amish/Mennonite,Amish Mennonite,TC,2409.55,,,,,,,1487.04,4249.57,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,Amish/Mennonite,Amish Mennonite,TC,950.40,,,,,,,950.40,1676.16,percent of total billed charges,
MRI BRAIN WO CNTRST-TECH,57212,CDM,611,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,Amish/Mennonite,Amish Mennonite,TC,950.40,,,,,,,864.00,2032.87,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,inpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,1016.40,1792.56,percent of total billed charges,
MRI UPR EXT ANY JT WO CNTRST-TECH,57213,CDM,614,RC,73221,CPT,,,facility,outpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,924.00,2032.87,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,inpatient,,,3011.00000,2860.45000,Amish/Mennonite,Amish Mennonite,TC,1656.05,,,,,,,1656.05,2920.67,percent of total billed charges,
MRI PELVIS WO CNTRST-TECH,57214,CDM,614,RC,72195,CPT,,,facility,outpatient,,,3011.00000,2860.45000,Amish/Mennonite,Amish Mennonite,TC,1656.05,,,,,,,1129.95,2920.67,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
MONOTEST TEST SCREEN-TECH,57215,CDM,300,RC,86308,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.18,271.65,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3419.00000,3248.05000,Amish/Mennonite,Amish Mennonite,TC,1880.45,,,,,,,1880.45,3316.43,percent of total billed charges,
MRA CHEST W/WO CNTRST-TECH,57216,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3419.00000,3248.05000,Amish/Mennonite,Amish Mennonite,TC,1880.45,,,,,,,1353.88,3316.43,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,inpatient,,,4352.00000,4134.40000,Amish/Mennonite,Amish Mennonite,TC,2393.60,,,,,,,2393.60,4221.44,percent of total billed charges,
MRI PELVIS WO/W CNTRST +SEQ-TECH,57218,CDM,614,RC,72197,CPT,,,facility,outpatient,,,4352.00000,4134.40000,Amish/Mennonite,Amish Mennonite,TC,2393.60,,,,,,,1487.04,4221.44,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,Amish/Mennonite,Amish Mennonite,TC,1942.05,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPR EXT W/WO CNTRST-TECH,57220,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,Amish/Mennonite,Amish Mennonite,TC,1942.05,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,inpatient,,,1560.00000,1482.00000,Amish/Mennonite,Amish Mennonite,TC,858.00,,,,,,,858.00,1513.20,percent of total billed charges,
MRI FETAL EA ADDL GESTATION-TECH,57221,CDM,614,RC,74713,CPT,,,facility,outpatient,,,1560.00000,1482.00000,Amish/Mennonite,Amish Mennonite,TC,858.00,,,,,,,608.47,2032.87,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
MITOCHONDRIAL AB (M2) IGG-TECH,57224,CDM,300,RC,86381,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,16.91,1211.55,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1995.95,3520.13,percent of total billed charges,
MRA/MRV HEAD W CNTRST-TECH,57225,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3629.00000,3447.55000,Amish/Mennonite,Amish Mennonite,TC,1995.95,,,,,,,1214.33,3520.13,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,inpatient,,,3032.00000,2880.40000,Amish/Mennonite,Amish Mennonite,TC,1667.60,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI BONE MARROW BLOOD SUPPLY-TECH,57226,CDM,614,RC,77084,CPT,,,facility,outpatient,,,3032.00000,2880.40000,Amish/Mennonite,Amish Mennonite,TC,1667.60,,,,,,,1329.46,2941.04,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.21,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.01,3.90,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-23,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.77,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00406-8330-62,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.52,4.88,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,inpatient,1,EA,3.95000,3.76000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,00904-6558-61,NDC,,,facility,outpatient,1,EA,3.95000,3.76000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,42858-0802-01,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
MORPHINE TAB 7632672,57227,CDM,250,RC,72162-1790-03,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,inpatient,,,2867.00000,2723.65000,Amish/Mennonite,Amish Mennonite,TC,1576.85,,,,,,,1576.85,2780.99,percent of total billed charges,
MRI ABDOMEN WO CNTRST-TECH,57228,CDM,614,RC,74181,CPT,,,facility,outpatient,,,2867.00000,2723.65000,Amish/Mennonite,Amish Mennonite,TC,1576.85,,,,,,,902.40,2780.99,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,inpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409176230,NDC,facility,outpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,inpatient,1,EA,6.73000,6.39000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.70,6.53,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189001,NDC,facility,outpatient,1,EA,6.73000,6.39000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.37,7.69,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,inpatient,1,EA,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,00409189023,NDC,facility,outpatient,1,EA,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.04,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,inpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.80,percent of total billed charges,
MORPHINE SOLN 2 MG/ML,57229,CDM,250,RC,J2270,HCPCS,76045000411,NDC,facility,outpatient,1,EA,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.54,8.80,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3469.00000,3295.55000,Amish/Mennonite,Amish Mennonite,TC,1907.95,,,,,,,1907.95,3364.93,percent of total billed charges,
MRA ABDOMEN W/WO CNTRST-TECH,57230,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3469.00000,3295.55000,Amish/Mennonite,Amish Mennonite,TC,1907.95,,,,,,,1375.22,3364.93,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,inpatient,,,2725.00000,2588.75000,Amish/Mennonite,Amish Mennonite,TC,1498.75,,,,,,,1498.75,2643.25,percent of total billed charges,
MRI TMJ-TECH,57231,CDM,614,RC,70336,CPT,,,facility,outpatient,,,2725.00000,2588.75000,Amish/Mennonite,Amish Mennonite,TC,1498.75,,,,,,,1329.46,2643.25,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST BIL-TECH,57232,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,1272.04,4844.18,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,inpatient,,,3983.00000,3783.85000,Amish/Mennonite,Amish Mennonite,TC,2190.65,,,,,,,2190.65,3863.51,percent of total billed charges,
MRI UPR EXT ANY JT WO/W CNTRST-TECH,57233,CDM,614,RC,73223,CPT,,,facility,outpatient,,,3983.00000,3783.85000,Amish/Mennonite,Amish Mennonite,TC,2190.65,,,,,,,1487.04,3863.51,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,inpatient,,,4145.00000,3937.75000,Amish/Mennonite,Amish Mennonite,TC,2279.75,,,,,,,2279.75,4020.65,percent of total billed charges,
MRI CHEST W CNTRST-TECH,57234,CDM,614,RC,71551,CPT,,,facility,outpatient,,,4145.00000,3937.75000,Amish/Mennonite,Amish Mennonite,TC,2279.75,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,inpatient,,,3222.00000,3060.90000,Amish/Mennonite,Amish Mennonite,TC,1772.10,,,,,,,1772.10,3125.34,percent of total billed charges,
MRI SPINE LUMBAR W CNTRST-TECH,57235,CDM,612,RC,72149,CPT,,,facility,outpatient,,,3222.00000,3060.90000,Amish/Mennonite,Amish Mennonite,TC,1772.10,,,,,,,1318.80,3125.34,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,inpatient,,,3588.00000,3408.60000,Amish/Mennonite,Amish Mennonite,TC,1973.40,,,,,,,1973.40,3480.36,percent of total billed charges,
MRI PELVIS W CNTRST-TECH,57236,CDM,614,RC,72196,CPT,,,facility,outpatient,,,3588.00000,3408.60000,Amish/Mennonite,Amish Mennonite,TC,1973.40,,,,,,,1328.10,3480.36,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,inpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,116.05,204.67,percent of total billed charges,
MUCOPOLYSACCHARIDES-TECH,57237,CDM,300,RC,83864,CPT,,,facility,outpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,28.00,1341.13,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,inpatient,,,2251.00000,2138.45000,Amish/Mennonite,Amish Mennonite,TC,1238.05,,,,,,,1238.05,2183.47,percent of total billed charges,
MRI CARD MORPH&FUNC WO CNTRST-TECH,57238,CDM,614,RC,75557,CPT,,,facility,outpatient,,,2251.00000,2138.45000,Amish/Mennonite,Amish Mennonite,TC,1238.05,,,,,,,1125.50,2183.47,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,inpatient,,,3500.00000,3325.00000,Amish/Mennonite,Amish Mennonite,TC,1925.00,,,,,,,1925.00,3395.00,percent of total billed charges,
MRI BRAIN WO/W CNTRST + SEQ-TECH,57239,CDM,611,RC,70553,CPT,,,facility,outpatient,,,3500.00000,3325.00000,Amish/Mennonite,Amish Mennonite,TC,1925.00,,,,,,,1487.04,3395.00,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,inpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE CERVICAL WO CNTRST-TECH,57240,CDM,612,RC,72141,CPT,,,facility,outpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,828.00,2032.87,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,inpatient,,,5051.00000,4798.45000,Amish/Mennonite,Amish Mennonite,TC,2778.05,,,,,,,2778.05,4899.47,percent of total billed charges,
MRI LWR EXT ANY JT WO/W CNTRST-TECH,57241,CDM,614,RC,73723,CPT,,,facility,outpatient,,,5051.00000,4798.45000,Amish/Mennonite,Amish Mennonite,TC,2778.05,,,,,,,1487.04,4899.47,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
MORPHINE SUPP 7632375,57242,CDM,250,RC,00574-7114-12,NDC,,,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,inpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI LWR EXT OTH THN JT WO CNTRST-TECH,57243,CDM,614,RC,73718,CPT,,,facility,outpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1127.62,2942.98,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,Amish/Mennonite,Amish Mennonite,TC,2032.25,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-TECH,57244,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,Amish/Mennonite,Amish Mennonite,TC,2032.25,,,,,,,1487.04,3584.15,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,inpatient,,,2339.00000,2222.05000,Amish/Mennonite,Amish Mennonite,TC,1286.45,,,,,,,1286.45,2268.83,percent of total billed charges,
MRI LWR EXT ANY JT WO CNTRST-TECH,57245,CDM,614,RC,73721,CPT,,,facility,outpatient,,,2339.00000,2222.05000,Amish/Mennonite,Amish Mennonite,TC,1286.45,,,,,,,989.10,2268.83,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,inpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,00591-5643-01,NDC,,,facility,outpatient,1,EA,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,49884-0257-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,inpatient,1,EA,2.03000,1.92000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
MINOXIDIL TAB,57246,CDM,250,RC,68084-0205-01,NDC,,,facility,outpatient,1,EA,2.03000,1.92000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.01,1.97,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,inpatient,,,4202.00000,3991.90000,Amish/Mennonite,Amish Mennonite,TC,2311.10,,,,,,,2311.10,4075.94,percent of total billed charges,
MRI LWR EXT ANY JT W CNTRST-TECH,57247,CDM,614,RC,73722,CPT,,,facility,outpatient,,,4202.00000,3991.90000,Amish/Mennonite,Amish Mennonite,TC,2311.10,,,,,,,1487.04,4345.33,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,inpatient,,,3548.00000,3370.60000,Amish/Mennonite,Amish Mennonite,TC,1951.40,,,,,,,1951.40,3441.56,percent of total billed charges,
MRI ORBT/FACE/NECK W CNTRST-TECH,57248,CDM,614,RC,70542,CPT,,,facility,outpatient,,,3548.00000,3370.60000,Amish/Mennonite,Amish Mennonite,TC,1951.40,,,,,,,1353.60,3441.56,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,inpatient,,,2617.00000,2486.15000,Amish/Mennonite,Amish Mennonite,TC,1439.35,,,,,,,1439.35,2538.49,percent of total billed charges,
MRI SPINE CERVICAL W CNTRST-TECH,57249,CDM,612,RC,72142,CPT,,,facility,outpatient,,,2617.00000,2486.15000,Amish/Mennonite,Amish Mennonite,TC,1439.35,,,,,,,1308.50,2538.49,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,inpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,TC,1812.80,,,,,,,1812.80,3197.12,percent of total billed charges,
MRI UPR EXT ANY JT W CNTRST-TECH,57251,CDM,614,RC,73222,CPT,,,facility,outpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,TC,1812.80,,,,,,,1487.04,4345.33,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,inpatient,1,EA,44.30000,42.09000,Amish/Mennonite,Amish Mennonite,,24.36,,,,,,,24.36,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781312815,NDC,facility,outpatient,1,EA,44.30000,42.09000,Amish/Mennonite,Amish Mennonite,,24.36,,,,,,,22.15,42.97,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,inpatient,1,EA,48.68000,46.25000,Amish/Mennonite,Amish Mennonite,,26.77,,,,,,,26.77,47.22,percent of total billed charges,
NAFCILLIN POWD-INJ 1 GM A/V,57252,CDM,250,RC,J3490,HCPCS,00781922492,NDC,facility,outpatient,1,EA,48.68000,46.25000,Amish/Mennonite,Amish Mennonite,,26.77,,,,,,,24.34,47.22,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,inpatient,2,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.53,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00093-1010-42,NDC,,,facility,outpatient,2,EA,4.60000,4.37000,Amish/Mennonite,Amish Mennonite,,2.53,,,,,,,2.30,4.46,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,inpatient,2,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,00168-0352-22,NDC,,,facility,outpatient,2,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,inpatient,2,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
MUPIROCIN OINTMENT,57253,CDM,250,RC,68462-0180-22,NDC,,,facility,outpatient,2,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
MORPHINE SUPP 7632342,57254,CDM,250,RC,00574-7112-12,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,inpatient,,,3570.00000,3391.50000,Amish/Mennonite,Amish Mennonite,TC,1963.50,,,,,,,1963.50,3462.90,percent of total billed charges,
MRI UPR EXT OTH THN JT W CNTRST-TECH,57255,CDM,614,RC,73219,CPT,,,facility,outpatient,,,3570.00000,3391.50000,Amish/Mennonite,Amish Mennonite,TC,1963.50,,,,,,,1487.04,3462.90,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4235.00000,4023.25000,Amish/Mennonite,Amish Mennonite,TC,2329.25,,,,,,,2329.25,4107.95,percent of total billed charges,
MULT SLEEP LATENCY TEST-TECH,57256,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4235.00000,4023.25000,Amish/Mennonite,Amish Mennonite,TC,2329.25,,,,,,,1929.64,4107.95,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,inpatient,,,978.00000,929.10000,Amish/Mennonite,Amish Mennonite,,537.90,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I CERV-TECH,57257,CDM,361,RC,62302,CPT,,,facility,outpatient,,,978.00000,929.10000,Amish/Mennonite,Amish Mennonite,,537.90,,,,,,,537.90,3163.00,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,00904533960,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,39328010610,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
"MULTIVITAMIN W/ FOLIC ACID 1 MG, PRENATAL TAB",57258,CDM,250,RC,J8499,HCPCS,69367026701,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00005-4344-62,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,inpatient,30,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00536-2790-59,NDC,,,facility,outpatient,30,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,00573-0513-30,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,inpatient,30,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323181,57259,CDM,250,RC,54629-0800-98,NDC,,,facility,outpatient,30,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,inpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,910.80,1606.32,percent of total billed charges,
MRI SPINE THORACIC WO CNTRST-TECH,57260,CDM,612,RC,72146,CPT,,,facility,outpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,TC,910.80,,,,,,,828.00,2032.87,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,inpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,TC,260.15,,,,,,,260.15,458.81,percent of total billed charges,
MRI CARD VELOC FLOW MAPPING-TECH,57261,CDM,614,RC,75565,CPT,,,facility,outpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,TC,260.15,,,,,,,179.69,2032.87,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,inpatient,,,2936.00000,2789.20000,Amish/Mennonite,Amish Mennonite,TC,1614.80,,,,,,,1614.80,2847.92,percent of total billed charges,
MRI SPINE THOR WO/W CNTRST +SEQ-TECH,57262,CDM,612,RC,72157,CPT,,,facility,outpatient,,,2936.00000,2789.20000,Amish/Mennonite,Amish Mennonite,TC,1614.80,,,,,,,1468.00,2847.92,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,inpatient,20,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
MORPHINE SULFATE INJECTION 7633191,57264,CDM,250,RC,J2270,HCPCS,00409113403,NDC,facility,outpatient,20,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,7.69,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,inpatient,,,2082.00000,1977.90000,Amish/Mennonite,Amish Mennonite,TC,1145.10,,,,,,,1145.10,2019.54,percent of total billed charges,
MRI SPINE LUMBAR WO CNTRST-TECH,57265,CDM,612,RC,72148,CPT,,,facility,outpatient,,,2082.00000,1977.90000,Amish/Mennonite,Amish Mennonite,TC,1145.10,,,,,,,862.95,2032.87,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-4178-41,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00536-5090-08,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,00904-7735-52,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,10939-0953-65,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-60,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7328223,57266,CDM,250,RC,24208-0387-62,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,Amish/Mennonite,Amish Mennonite,90,120.56,,,,,,,120.56,212.62,percent of total billed charges,
MYOMARKER PANEL 2-TECH,57267,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,Amish/Mennonite,Amish Mennonite,90,120.56,,,,,,,11.91,594.19,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,inpatient,,,4355.00000,4137.25000,Amish/Mennonite,Amish Mennonite,TC,2395.25,,,,,,,2395.25,4224.35,percent of total billed charges,
MRI UPR EXT OTH THN JT WO/W CNTRST-TECH,57268,CDM,614,RC,73220,CPT,,,facility,outpatient,,,4355.00000,4137.25000,Amish/Mennonite,Amish Mennonite,TC,2395.25,,,,,,,1487.04,4224.35,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,inpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1652.75,2914.85,percent of total billed charges,
MRA/MRV HEAD WO CNTRST-TECH,57269,CDM,615,RC,70544,CPT,,,facility,outpatient,,,3005.00000,2854.75000,Amish/Mennonite,Amish Mennonite,TC,1652.75,,,,,,,1128.45,2914.85,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,inpatient,1,EA,85.92000,81.62000,Amish/Mennonite,Amish Mennonite,,47.26,,,,,,,47.26,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-15,NDC,,,facility,outpatient,1,EA,85.92000,81.62000,Amish/Mennonite,Amish Mennonite,,47.26,,,,,,,42.96,83.34,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,inpatient,1,EA,94.42000,89.70000,Amish/Mennonite,Amish Mennonite,,51.93,,,,,,,51.93,91.59,percent of total billed charges,
NAFCILLIN INJ 7856008,57270,CDM,250,RC,00781-3129-92,NDC,,,facility,outpatient,1,EA,94.42000,89.70000,Amish/Mennonite,Amish Mennonite,,51.93,,,,,,,47.21,91.59,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,inpatient,,,4289.00000,4074.55000,Amish/Mennonite,Amish Mennonite,TC,2358.95,,,,,,,2358.95,4160.33,percent of total billed charges,
MRI ORBT/FACE/NK WO/W +SEQ-TECH,57271,CDM,614,RC,70543,CPT,,,facility,outpatient,,,4289.00000,4074.55000,Amish/Mennonite,Amish Mennonite,TC,2358.95,,,,,,,1487.04,4160.33,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5104.10000,4848.90000,Amish/Mennonite,Amish Mennonite,,2807.26,,,,,,,2501.01,4950.98,percent of total billed charges,
04.015.550 5.0MM TI DUAL CORE LCK SYNTHE,57272,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5104.10000,4848.90000,Amish/Mennonite,Amish Mennonite,,2807.26,,,,,,,2342.78,5104.10,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,inpatient,,,343.00000,325.85000,Amish/Mennonite,Amish Mennonite,,188.65,,,,,,,188.65,332.71,percent of total billed charges,
MRSA AMPL PROBE-TECH,57273,CDM,300,RC,87641,CPT,,,facility,outpatient,,,343.00000,325.85000,Amish/Mennonite,Amish Mennonite,,188.65,,,,,,,35.09,1833.46,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,inpatient,,,2267.00000,2153.65000,Amish/Mennonite,Amish Mennonite,TC,1246.85,,,,,,,1246.85,2198.99,percent of total billed charges,
MRI SPECTROSCOPY-TECH,57274,CDM,614,RC,76390,CPT,,,facility,outpatient,,,2267.00000,2153.65000,Amish/Mennonite,Amish Mennonite,TC,1246.85,,,,,,,484.28,2198.99,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,inpatient,,,12277.00000,11663.15000,Amish/Mennonite,Amish Mennonite,TC,6752.35,,,,,,,6752.35,11908.69,percent of total billed charges,
MYOCARD IMG PET PERF MULT STDY-TECH,57275,CDM,404,RC,78492,CPT,,,facility,outpatient,,,12277.00000,11663.15000,Amish/Mennonite,Amish Mennonite,TC,6752.35,,,,,,,4549.00,11908.69,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,inpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,231.00,407.40,percent of total billed charges,
MYCOBACTERIA TB PCR-TECH,57276,CDM,300,RC,87556,CPT,,,facility,outpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,41.68,1952.29,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3452.00000,3279.40000,Amish/Mennonite,Amish Mennonite,TC,1898.60,,,,,,,1898.60,3348.44,percent of total billed charges,
MRA PELVIS W/WO CNTRST-TECH,57277,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3452.00000,3279.40000,Amish/Mennonite,Amish Mennonite,TC,1898.60,,,,,,,1382.32,3348.44,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,inpatient,,,1408.00000,1337.60000,Amish/Mennonite,Amish Mennonite,,774.40,,,,,,,774.40,1365.76,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I LUMB-TECH,57278,CDM,361,RC,62304,CPT,,,facility,outpatient,,,1408.00000,1337.60000,Amish/Mennonite,Amish Mennonite,,774.40,,,,,,,750.19,3163.00,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,inpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1668.70,2942.98,percent of total billed charges,
MRI UPR EXT OTH THN JT WO CNTRST-TECH,57279,CDM,614,RC,73218,CPT,,,facility,outpatient,,,3034.00000,2882.30000,Amish/Mennonite,Amish Mennonite,TC,1668.70,,,,,,,1329.46,2942.98,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,00536-7300-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,10542-0010-10,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0160-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
MULTIVITAMIN TAB 7222227,57280,CDM,250,RC,60258-0161-01,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,inpatient,,,3918.00000,3722.10000,Amish/Mennonite,Amish Mennonite,TC,2154.90,,,,,,,2154.90,3800.46,percent of total billed charges,
MRA NECK W CNTRST-TECH,57281,CDM,615,RC,70548,CPT,,,facility,outpatient,,,3918.00000,3722.10000,Amish/Mennonite,Amish Mennonite,TC,2154.90,,,,,,,1246.80,3800.46,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00087-0402-03,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,00536-8450-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN PEDS LIQUID,57282,CDM,250,RC,69618-0062-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,inpatient,,,3032.00000,2880.40000,Amish/Mennonite,Amish Mennonite,TC,1667.60,,,,,,,1667.60,2941.04,percent of total billed charges,
MRI ORBIT/FACE/NECK WO CNTRST-TECH,57283,CDM,614,RC,70540,CPT,,,facility,outpatient,,,3032.00000,2880.40000,Amish/Mennonite,Amish Mennonite,TC,1667.60,,,,,,,1153.12,2941.04,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,inpatient,,,2960.00000,2812.00000,Amish/Mennonite,Amish Mennonite,TC,1628.00,,,,,,,1628.00,2871.20,percent of total billed charges,
MYOCARD PERF PLANAR SNGL STDY-TECH,57284,CDM,341,RC,78453,CPT,,,facility,outpatient,,,2960.00000,2812.00000,Amish/Mennonite,Amish Mennonite,TC,1628.00,,,,,,,1360.59,7180.14,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,inpatient,5,EA,20.10000,19.09000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,11.05,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,52544092226,NDC,facility,outpatient,5,EA,20.10000,19.09000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,3.00,19.50,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,inpatient,5,EA,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143929810,NDC,facility,outpatient,5,EA,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.59,5.02,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,inpatient,5,EA,24.12000,22.91000,Amish/Mennonite,Amish Mennonite,,13.27,,,,,,,13.27,23.40,percent of total billed charges,
NA FERRIC GLUCONATE COMPLEX,57285,CDM,250,RC,J2916,HCPCS,00143957001,NDC,facility,outpatient,5,EA,24.12000,22.91000,Amish/Mennonite,Amish Mennonite,,13.27,,,,,,,3.00,23.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,inpatient,,,920.00000,874.00000,Amish/Mennonite,Amish Mennonite,TC,506.00,,,,,,,506.00,892.40,percent of total billed charges,
MUSCLE BIOPSY COMPLEX-TECH,57286,CDM,310,RC,88355,CPT,,,facility,outpatient,,,920.00000,874.00000,Amish/Mennonite,Amish Mennonite,TC,506.00,,,,,,,288.68,2535.29,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,inpatient,1,EA,28.43000,27.01000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00004025901,NDC,facility,outpatient,1,EA,28.43000,27.01000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,0.23870,27.58,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,inpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00054016325,NDC,facility,outpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.23870,1.68,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,inpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,00093733401,NDC,facility,outpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,0.23870,1.97,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,inpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,16729009401,NDC,facility,outpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.23870,1.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,31722087801,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.23870,0.55290,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,51079072120,NDC,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.23870,1.40,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,60687049401,NDC,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.23870,1.50,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,64380072606,NDC,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.23870,0.50440,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL,57287,CDM,250,RC,J7517,HCPCS,68084079501,NDC,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.23870,1.84,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,inpatient,1,EA,71.61000,68.03000,Amish/Mennonite,Amish Mennonite,,39.39,,,,,,,39.39,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312585,NDC,facility,outpatient,1,EA,71.61000,68.03000,Amish/Mennonite,Amish Mennonite,,39.39,,,,,,,35.80,69.46,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,inpatient,1,EA,71.60000,68.02000,Amish/Mennonite,Amish Mennonite,,39.38,,,,,,,39.38,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,00781312595,NDC,facility,outpatient,1,EA,71.60000,68.02000,Amish/Mennonite,Amish Mennonite,,39.38,,,,,,,35.80,69.45,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,inpatient,1,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,39.10,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,25021014010,NDC,facility,outpatient,1,EA,71.10000,67.54000,Amish/Mennonite,Amish Mennonite,,39.10,,,,,,,35.55,68.97,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,inpatient,1,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,38.24,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,44567022210,NDC,facility,outpatient,1,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,34.76,67.43,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012315,NDC,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,19.75,38.31,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,inpatient,1,EA,71.73000,68.15000,Amish/Mennonite,Amish Mennonite,,39.45,,,,,,,39.45,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,55150012316,NDC,facility,outpatient,1,EA,71.73000,68.15000,Amish/Mennonite,Amish Mennonite,,39.45,,,,,,,35.87,69.58,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,inpatient,1,EA,91.29000,86.73000,Amish/Mennonite,Amish Mennonite,,50.21,,,,,,,50.21,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,63323032820,NDC,facility,outpatient,1,EA,91.29000,86.73000,Amish/Mennonite,Amish Mennonite,,50.21,,,,,,,45.65,88.55,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,inpatient,1,EA,68.57000,65.14000,Amish/Mennonite,Amish Mennonite,,37.71,,,,,,,37.71,66.51,percent of total billed charges,
NAFCILLIN POWD-INJ 2 GM,57288,CDM,250,RC,J3490,HCPCS,70860011726,NDC,facility,outpatient,1,EA,68.57000,65.14000,Amish/Mennonite,Amish Mennonite,,37.71,,,,,,,34.28,66.51,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,inpatient,,,4361.00000,4142.95000,Amish/Mennonite,Amish Mennonite,TC,2398.55,,,,,,,2398.55,4230.17,percent of total billed charges,
MRI ABDOMEN WO/W CNTRST+SEQ-TECH,57289,CDM,614,RC,74183,CPT,,,facility,outpatient,,,4361.00000,4142.95000,Amish/Mennonite,Amish Mennonite,TC,2398.55,,,,,,,1487.04,4230.17,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,inpatient,1,mL,270.61000,257.08000,Amish/Mennonite,Amish Mennonite,,148.84,,,,,,,148.84,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00065-0002-03,NDC,,,facility,outpatient,1,mL,270.61000,257.08000,Amish/Mennonite,Amish Mennonite,,148.84,,,,,,,135.31,262.49,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,inpatient,1,mL,270.60000,257.07000,Amish/Mennonite,Amish Mennonite,,148.83,,,,,,,148.83,262.48,percent of total billed charges,
NEPAFENAC OPHTH SUSP,57290,CDM,250,RC,00078-0778-03,NDC,,,facility,outpatient,1,mL,270.60000,257.07000,Amish/Mennonite,Amish Mennonite,,148.83,,,,,,,135.30,262.48,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,00093-1177-01,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.36,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.15,4.16,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,39822-0310-07,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,50383-0565-10,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
NEOMYCIN TAB,57291,CDM,250,RC,51079-0015-20,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,inpatient,,,4739.00000,4502.05000,Amish/Mennonite,Amish Mennonite,TC,2606.45,,,,,,,2606.45,4596.83,percent of total billed charges,
MYOCARD IMG PET PERF SNGL STDY-TECH,57292,CDM,404,RC,78491,CPT,,,facility,outpatient,,,4739.00000,4502.05000,Amish/Mennonite,Amish Mennonite,TC,2606.45,,,,,,,2369.50,8022.25,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,inpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,156.75,276.45,percent of total billed charges,
NEG PRES DME WND TX >50SCM-TECH,57293,CDM,940,RC,97608,CPT,,,facility,outpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,142.50,417.31,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,inpatient,,,3038.00000,2886.10000,Amish/Mennonite,Amish Mennonite,TC,1670.90,,,,,,,1670.90,2946.86,percent of total billed charges,
MRI FETAL SINGLE 1ST GESTATION-TECH,57294,CDM,614,RC,74712,CPT,,,facility,outpatient,,,3038.00000,2886.10000,Amish/Mennonite,Amish Mennonite,TC,1670.90,,,,,,,1329.46,2946.86,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,90,144.38,,,,,,,144.38,254.62,percent of total billed charges,
MURAMIDASE-TECH,57296,CDM,300,RC,85549,CPT,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,90,144.38,,,,,,,19.37,984.66,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,inpatient,,,2932.00000,2785.40000,Amish/Mennonite,Amish Mennonite,TC,1612.60,,,,,,,1612.60,2844.04,percent of total billed charges,
MRI SPINE CERV WO/W CNTRST +SEQ-TECH,57297,CDM,612,RC,72156,CPT,,,facility,outpatient,,,2932.00000,2785.40000,Amish/Mennonite,Amish Mennonite,TC,1612.60,,,,,,,1466.00,2844.04,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00245-0091-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-3445-08,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-4661-38,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00536-5589-08,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00573-4463-91,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-13,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-61,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,00904-5492-80,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,57896-0531-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,77333-0861-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0141-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN W MINERALS TAB 7323579,57299,CDM,250,RC,80681-0160-00,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNGL STDY-TECH,57300,CDM,341,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1488.32,7180.14,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STDY-TECH,57301,CDM,341,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2150.56,7180.14,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI BREAST W/WO CNTRST UNI-TECH,57302,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,1288.05,4844.18,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00115-1657-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,00591-3670-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,50228-0465-01,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,inpatient,1,EA,3.24000,3.08000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.78,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,51079-0989-20,NDC,,,facility,outpatient,1,EA,3.24000,3.08000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.62,3.14,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,60687-0630-21,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,inpatient,1,EA,2.08000,1.98000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,68084-0246-11,NDC,,,facility,outpatient,1,EA,2.08000,1.98000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.04,2.02,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,69097-0965-07,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
NABUMETONE TAB,57304,CDM,250,RC,76282-0257-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,inpatient,10,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643564901,NDC,facility,outpatient,10,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,inpatient,10,EA,15.98000,15.18000,Amish/Mennonite,Amish Mennonite,,8.79,,,,,,,8.79,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,54643900701,NDC,facility,outpatient,10,EA,15.98000,15.18000,Amish/Mennonite,Amish Mennonite,,8.79,,,,,,,7.99,15.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,inpatient,10,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.50,percent of total billed charges,
MULTIVITAMIN W/ VIT K (ADULT) SOLN-INJ 10 ML,57305,CDM,250,RC,J3490,HCPCS,61703043482,NDC,facility,outpatient,10,EA,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.80,3.50,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,inpatient,,,196.50000,186.67000,Amish/Mennonite,Amish Mennonite,90,108.08,,,,,,,108.08,190.60,percent of total billed charges,
NEUTRALIZATION TEST VIRAL SO-TECH,57306,CDM,300,RC,86382,CPT,,,facility,outpatient,,,196.50000,186.67000,Amish/Mennonite,Amish Mennonite,90,108.08,,,,,,,17.47,882.80,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,inpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1425.05,2513.27,percent of total billed charges,
MRI SPINE THORACIC W CNTRST-TECH,57307,CDM,612,RC,72147,CPT,,,facility,outpatient,,,2591.00000,2461.45000,Amish/Mennonite,Amish Mennonite,TC,1425.05,,,,,,,1295.50,2513.27,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,inpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,218.35,385.09,percent of total billed charges,
NM I 123 PER MCI,57308,CDM,343,RC,A9509,HCPCS,,,facility,outpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,198.50,385.09,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,inpatient,,,3566.00000,3387.70000,Amish/Mennonite,Amish Mennonite,TC,1961.30,,,,,,,1961.30,3459.02,percent of total billed charges,
MRI LWR EXT OTH THN JT W CNTRST-TECH,57309,CDM,614,RC,73719,CPT,,,facility,outpatient,,,3566.00000,3387.70000,Amish/Mennonite,Amish Mennonite,TC,1961.30,,,,,,,1321.12,3459.02,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,00054016625,NDC,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,0.23870,3.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL ORAL TAB,57310,CDM,250,RC,J7517,HCPCS,64380072506,NDC,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.23870,1.23,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,inpatient,1,EA,5.07000,4.81000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.79,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-28,NDC,,,facility,outpatient,1,EA,5.07000,4.81000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.54,4.92,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00067-5126-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,00536-5896-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,43598-0448-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 21 MG/24 HR,57311,CDM,250,RC,70677-0032-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,inpatient,4,EA,11.39000,10.82000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00143931810,NDC,facility,outpatient,4,EA,11.39000,10.82000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,5.70,11.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,inpatient,4,EA,17.76000,16.87000,Amish/Mennonite,Amish Mennonite,,9.77,,,,,,,9.77,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,00409337504,NDC,facility,outpatient,4,EA,17.76000,16.87000,Amish/Mennonite,Amish Mennonite,,9.77,,,,,,,8.88,17.23,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,inpatient,4,EA,14.24000,13.52000,Amish/Mennonite,Amish Mennonite,,7.83,,,,,,,7.83,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,70121157607,NDC,facility,outpatient,4,EA,14.24000,13.52000,Amish/Mennonite,Amish Mennonite,,7.83,,,,,,,7.12,13.81,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,inpatient,4,EA,6.90000,6.56000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,47335061544,NDC,facility,outpatient,4,EA,6.90000,6.56000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,inpatient,4,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,36000016210,NDC,facility,outpatient,4,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.29,6.37,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,inpatient,4,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,43066099710,NDC,facility,outpatient,4,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,inpatient,4,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.57,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,63323094004,NDC,facility,outpatient,4,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.15,8.05,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,inpatient,4,EA,13.79000,13.10000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,7.58,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72078000204,NDC,facility,outpatient,4,EA,13.79000,13.10000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,6.89,13.38,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,inpatient,4,EA,10.10000,9.59000,Amish/Mennonite,Amish Mennonite,,5.55,,,,,,,5.55,9.80,percent of total billed charges,
NOREPINEPHRINE SOLN-INJ 1 MG/ML 4 ML,57313,CDM,250,RC,J3490,HCPCS,72603018010,NDC,facility,outpatient,4,EA,10.10000,9.59000,Amish/Mennonite,Amish Mennonite,,5.55,,,,,,,5.05,9.80,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,inpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,,245.85,,,,,,,245.85,433.59,percent of total billed charges,
NEG PRES DISP WND TX <=50SCM-TECH,57314,CDM,940,RC,97607,CPT,,,facility,outpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,,245.85,,,,,,,223.50,433.59,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,76.45,134.83,percent of total billed charges,
MYOGLOBIN ASSAY-TECH,57315,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,12.92,679.08,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,185.90,327.86,percent of total billed charges,
NATRIURETIC PEPTIDE-TECH,57316,CDM,300,RC,83880,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,39.26,1850.43,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-46,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0530-61,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
MULTIVITAMIN TAB 7323595,57317,CDM,250,RC,00904-0539-61,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,inpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,36.85,64.99,percent of total billed charges,
NASAL SMEAR FOR EOSINOPHILS-TECH,57318,CDM,300,RC,89190,CPT,,,facility,outpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,5.79,271.65,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,220.19,percent of total billed charges,
NASO- OR ORO-GASTRIC TUBE PLC-TECH,57319,CDM,361,RC,43752,CPT,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,3163.00,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,inpatient,,,192.80000,183.16000,Amish/Mennonite,Amish Mennonite,90,106.04,,,,,,,106.04,187.02,percent of total billed charges,
MYASTHENIA GRAVIS EVAL PED (83371)-TECH,57320,CDM,300,RC,83519,CPT,,,facility,outpatient,,,192.80000,183.16000,Amish/Mennonite,Amish Mennonite,90,106.04,,,,,,,19.00,865.84,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00135-0474-08,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00536-1362-23,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,00904-5734-51,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0573-08,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,49348-0691-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
NICOTINE GUM 7910544,57321,CDM,250,RC,70677-1166-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,inpatient,,,416.00000,395.20000,Amish/Mennonite,Amish Mennonite,,228.80,,,,,,,228.80,403.52,percent of total billed charges,
NATURAL KILLER CELLS COUNT-TECH,57322,CDM,300,RC,86357,CPT,,,facility,outpatient,,,416.00000,395.20000,Amish/Mennonite,Amish Mennonite,,228.80,,,,,,,37.73,1969.25,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.08,percent of total billed charges,
MULTIHANCE INJ,57323,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,2.79,7.08,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.16,percent of total billed charges,
NITROGLYCERIN FILM 7108244,57324,CDM,250,RC,68382-0309-30,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.11,2.16,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,Amish/Mennonite,Amish Mennonite,,3660.80,,,,,,,3660.80,6456.32,percent of total billed charges,
NM I-123 MIBG,57325,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,Amish/Mennonite,Amish Mennonite,,3660.80,,,,,,,2074.81,6456.32,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,inpatient,1,GM,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.48,percent of total billed charges,
NITROGLYCERIN OINTMENT,57326,CDM,250,RC,00281-0326-30,NDC,,,facility,outpatient,1,GM,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.79,3.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,inpatient,1,mL,291.38000,276.81000,Amish/Mennonite,Amish Mennonite,,160.26,,,,,,,160.26,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,14789001202,NDC,facility,outpatient,1,mL,291.38000,276.81000,Amish/Mennonite,Amish Mennonite,,160.26,,,,,,,145.69,282.64,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,inpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,25208000305,NDC,facility,outpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,39.50,76.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,inpatient,1,mL,23.61000,22.42000,Amish/Mennonite,Amish Mennonite,,12.99,,,,,,,12.99,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,43598058723,NDC,facility,outpatient,1,mL,23.61000,22.42000,Amish/Mennonite,Amish Mennonite,,12.99,,,,,,,11.80,22.90,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,inpatient,1,mL,37.76000,35.87000,Amish/Mennonite,Amish Mennonite,,20.77,,,,,,,20.77,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,67457083902,NDC,facility,outpatient,1,mL,37.76000,35.87000,Amish/Mennonite,Amish Mennonite,,20.77,,,,,,,18.88,36.63,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,inpatient,1,mL,22.14000,21.03000,Amish/Mennonite,Amish Mennonite,,12.18,,,,,,,12.18,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,70069026101,NDC,facility,outpatient,1,mL,22.14000,21.03000,Amish/Mennonite,Amish Mennonite,,12.18,,,,,,,11.07,21.48,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,inpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485010501,NDC,facility,outpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,inpatient,1,mL,25.68000,24.39000,Amish/Mennonite,Amish Mennonite,,14.12,,,,,,,14.12,24.91,percent of total billed charges,
NITROPRUSSIDE SOLN 25 MG/ML 2 ML,57327,CDM,250,RC,J3490,HCPCS,72485030501,NDC,facility,outpatient,1,mL,25.68000,24.39000,Amish/Mennonite,Amish Mennonite,,14.12,,,,,,,12.84,24.91,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
MYELOPEROXIDASE AB-TECH,57328,CDM,300,RC,83516,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,11.53,594.19,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,00081-0737-94,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,inpatient,1,GM,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
NEOMYCIN/POLYMYXIN B/PRAMOXINE TOPICAL CRM,57329,CDM,250,RC,49348-0690-69,NDC,,,facility,outpatient,1,GM,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
MYOMARKER PANEL 1 (FMYO)-TECH,57330,CDM,300,RC,83516,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,11.53,594.19,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,79854-0100-78,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,47335-0539-81,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0583-15,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,inpatient,1,EA,10.42000,9.90000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.73,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,50268-0584-13,NDC,,,facility,outpatient,1,EA,10.42000,9.90000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.21,10.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,59651-0018-90,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
NIACIN TAB 7223035,57331,CDM,250,RC,62175-0320-46,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00185012201,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,inpatient,1,EA,8.10000,7.70000,Amish/Mennonite,Amish Mennonite,,4.46,,,,,,,4.46,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00378342201,NDC,facility,outpatient,1,EA,8.10000,7.70000,Amish/Mennonite,Amish Mennonite,,4.46,,,,,,,4.05,7.86,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,inpatient,1,EA,7.29000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,00904713761,NDC,facility,outpatient,1,EA,7.29000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,3.65,7.07,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,inpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.73,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,16714043901,NDC,facility,outpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.48,4.82,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,inpatient,1,EA,11.28000,10.72000,Amish/Mennonite,Amish Mennonite,,6.20,,,,,,,6.20,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,50268062515,NDC,facility,outpatient,1,EA,11.28000,10.72000,Amish/Mennonite,Amish Mennonite,,6.20,,,,,,,5.64,10.94,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,inpatient,1,EA,12.18000,11.58000,Amish/Mennonite,Amish Mennonite,,6.70,,,,,,,6.70,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,51079034820,NDC,facility,outpatient,1,EA,12.18000,11.58000,Amish/Mennonite,Amish Mennonite,,6.70,,,,,,,6.09,11.81,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,inpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,60687063301,NDC,facility,outpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,inpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,63629246401,NDC,facility,outpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.04,2.02,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,inpatient,1,EA,4.45000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,65162047810,NDC,facility,outpatient,1,EA,4.45000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.32,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,inpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,68084044601,NDC,facility,outpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
NITROFURANTOIN MONO/MACROCRYSTALS 100 MG CAP (EQV-MACROBID),57333,CDM,250,RC,J8499,HCPCS,70756040411,NDC,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,inpatient,,,978.00000,929.10000,Amish/Mennonite,Amish Mennonite,,537.90,,,,,,,537.90,948.66,percent of total billed charges,
MYELOGRAPHY LUMB INJ S&I THOR-TECH,57334,CDM,361,RC,62303,CPT,,,facility,outpatient,,,978.00000,929.10000,Amish/Mennonite,Amish Mennonite,,537.90,,,,,,,537.90,3163.00,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,inpatient,1,EA,6.96000,6.62000,Amish/Mennonite,Amish Mennonite,,3.83,,,,,,,3.83,6.75,percent of total billed charges,
NITROGLYCERIN OINT 2% 1 GM,57335,CDM,250,RC,00281-0326-08,NDC,,,facility,outpatient,1,EA,6.96000,6.62000,Amish/Mennonite,Amish Mennonite,,3.83,,,,,,,3.48,6.75,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,inpatient,1,EA,35.25000,33.49000,Amish/Mennonite,Amish Mennonite,,19.39,,,,,,,19.39,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,42806-0501-09,NDC,,,facility,outpatient,1,EA,35.25000,33.49000,Amish/Mennonite,Amish Mennonite,,19.39,,,,,,,17.62,34.19,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,inpatient,1,EA,39.17000,37.21000,Amish/Mennonite,Amish Mennonite,,21.54,,,,,,,21.54,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,62559-0205-90,NDC,,,facility,outpatient,1,EA,39.17000,37.21000,Amish/Mennonite,Amish Mennonite,,21.54,,,,,,,19.59,37.99,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,inpatient,1,EA,25.65000,24.36000,Amish/Mennonite,Amish Mennonite,,14.11,,,,,,,14.11,24.88,percent of total billed charges,
NICARDIPINE CAP,57336,CDM,250,RC,68462-0120-90,NDC,,,facility,outpatient,1,EA,25.65000,24.36000,Amish/Mennonite,Amish Mennonite,,14.11,,,,,,,12.82,24.88,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00067-5125-14,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.27,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00135-0195-05,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.06,4.01,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-1107-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,00536-5895-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,43598-0447-74,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7110646,57337,CDM,250,RC,70677-0031-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,inpatient,1,mL,6.36000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.50,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143959310,NDC,facility,outpatient,1,mL,6.36000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,0.13795,6.17,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,inpatient,1,mL,8.06000,7.66000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,4.43,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,00143968910,NDC,facility,outpatient,1,mL,8.06000,7.66000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,0.13795,7.82,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,inpatient,1,mL,7.68000,7.29000,Amish/Mennonite,Amish Mennonite,,4.22,,,,,,,4.22,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088240,NDC,facility,outpatient,1,mL,7.68000,7.29000,Amish/Mennonite,Amish Mennonite,,4.22,,,,,,,0.13795,7.45,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,inpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,41616088244,NDC,facility,outpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,0.13795,8.58,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,inpatient,1,mL,6.71000,6.38000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.69,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018310,NDC,facility,outpatient,1,mL,6.71000,6.38000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,0.13795,6.51,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,inpatient,1,mL,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,55150018311,NDC,facility,outpatient,1,mL,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,0.13795,5.86,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,inpatient,1,mL,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
NICARDIPINE SOLN-INJ 2.5 MG/ML 10 ML,57338,CDM,250,RC,J2404,HCPCS,72485011610,NDC,facility,outpatient,1,mL,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,0.13795,6.44,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,45802-0059-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,inpatient,15,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107360,57339,CDM,250,RC,51672-1289-01,NDC,,,facility,outpatient,15,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,inpatient,1,mL,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00548960200,NDC,facility,outpatient,1,mL,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,inpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641614910,NDC,facility,outpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,inpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,00641626510,NDC,facility,outpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,inpatient,1,mL,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,42023018910,NDC,facility,outpatient,1,mL,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,inpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,43598052936,NDC,facility,outpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,5.52,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,inpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,3.19,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,76014090310,NDC,facility,outpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,2.90,5.63,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,inpatient,1,mL,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,3.20,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,51754124003,NDC,facility,outpatient,1,mL,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,2.90,5.64,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,inpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041510,NDC,facility,outpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,63323041536,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,inpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70069080610,NDC,facility,outpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,inpatient,1,mL,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,70700017223,NDC,facility,outpatient,1,mL,1.27000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
NEOSTIGMINE SOLN 1 MG/ML 10 ML,57340,CDM,250,RC,J2710,HCPCS,71839010601,NDC,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,90,86.35,,,,,,,86.35,152.29,percent of total billed charges,
MYCOPLASMA AB-TECH,57341,CDM,300,RC,86738,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,90,86.35,,,,,,,13.68,696.05,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
NM THALLIUM T1-201 PER MCI,57342,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,28.50,70.98,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,inpatient,,,988.00000,938.60000,Amish/Mennonite,Amish Mennonite,90,543.40,,,,,,,543.40,958.36,percent of total billed charges,
MUSK AUTOANTIBODY (MUSK) SO,57343,CDM,300,RC,86366,CPT,,,facility,outpatient,,,988.00000,938.60000,Amish/Mennonite,Amish Mennonite,90,543.40,,,,,,,14.72,958.36,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,inpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,,161.15,,,,,,,161.15,284.21,percent of total billed charges,
NURSERY CHARGE LEVEL 2,57344,CDM,231,RC,,,,,facility,outpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,,161.15,,,,,,,146.50,284.21,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
NM I131 PER MCI,57345,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,75.00,155.84,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,inpatient,,,1190.00000,1130.50000,Amish/Mennonite,Amish Mennonite,,654.50,,,,,,,654.50,1154.30,percent of total billed charges,
NURSERY CHARGE LEVEL 3,57347,CDM,231,RC,,,,,facility,outpatient,,,1190.00000,1130.50000,Amish/Mennonite,Amish Mennonite,,654.50,,,,,,,595.00,1154.30,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,inpatient,1,EA,287.54000,273.16000,Amish/Mennonite,Amish Mennonite,,158.15,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312646,NDC,facility,outpatient,1,EA,287.54000,273.16000,Amish/Mennonite,Amish Mennonite,,158.15,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,inpatient,1,EA,287.54000,273.17000,Amish/Mennonite,Amish Mennonite,,158.15,,,,,,,158.15,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,00781312695,NDC,facility,outpatient,1,EA,287.54000,273.17000,Amish/Mennonite,Amish Mennonite,,158.15,,,,,,,143.77,278.91,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,inpatient,1,EA,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,,156.69,,,,,,,156.69,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,25021014199,NDC,facility,outpatient,1,EA,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,,156.69,,,,,,,142.45,276.35,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,inpatient,1,EA,288.79000,274.35000,Amish/Mennonite,Amish Mennonite,,158.83,,,,,,,158.83,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,55150012499,NDC,facility,outpatient,1,EA,288.79000,274.35000,Amish/Mennonite,Amish Mennonite,,158.83,,,,,,,144.40,280.13,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,inpatient,1,EA,366.61000,348.28000,Amish/Mennonite,Amish Mennonite,,201.64,,,,,,,201.64,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,63323033060,NDC,facility,outpatient,1,EA,366.61000,348.28000,Amish/Mennonite,Amish Mennonite,,201.64,,,,,,,183.31,355.61,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,inpatient,1,EA,121.38000,115.31000,Amish/Mennonite,Amish Mennonite,,66.76,,,,,,,66.76,117.74,percent of total billed charges,
NAFCILLIN POWD-INJ 10 GM,57348,CDM,250,RC,J3490,HCPCS,70860011999,NDC,facility,outpatient,1,EA,121.38000,115.31000,Amish/Mennonite,Amish Mennonite,,66.76,,,,,,,60.69,117.74,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00093-2057-01,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.65,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,inpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,00904-7208-06,NDC,,,facility,outpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-11,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50268-0597-15,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0260-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,50742-0620-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,inpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,51079-0940-20,NDC,,,facility,outpatient,1,EA,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68084-0597-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.35,4.57,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
NIFEDIPINE TAB,57349,CDM,250,RC,68682-0105-10,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-16,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00378-9116-93,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,inpatient,1,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,00904-5497-46,NDC,,,facility,outpatient,1,EA,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,inpatient,1,EA,7.17000,6.81000,Amish/Mennonite,Amish Mennonite,,3.94,,,,,,,3.94,6.95,percent of total billed charges,
NITROGLYCERIN PATCH,57350,CDM,250,RC,43598-0893-30,NDC,,,facility,outpatient,1,EA,7.17000,6.81000,Amish/Mennonite,Amish Mennonite,,3.94,,,,,,,3.58,6.95,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,inpatient,1,EA,1787.36000,1697.99000,Amish/Mennonite,Amish Mennonite,,983.05,,,,,,,983.05,1733.74,percent of total billed charges,
NETUPITANT-PALONOSETRON CAP 300 MG-0.5 MG,57351,CDM,250,RC,J8655,HCPCS,69639010101,NDC,facility,outpatient,1,EA,1787.36000,1697.99000,Amish/Mennonite,Amish Mennonite,,983.05,,,,,,,409.52,1733.74,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,739.20,1303.68,percent of total billed charges,
NONINV STDY ART BI COMPL-TECH,57353,CDM,920,RC,93923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,672.00,1303.68,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,inpatient,10,EA,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.72,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 5 MG/ML 10 ML,57354,CDM,250,RC,J2305,HCPCS,00517481025,NDC,facility,outpatient,10,EA,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,2.08,5.72,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
NITROGLYCERIN 25 MG/D5W 250 ML PREMIX,57355,CDM,250,RC,J2305,HCPCS,00338104702,NDC,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,2.34,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
NITROGLYCERIN 50 MG/D5W 250 ML PREMIX,57356,CDM,250,RC,J2305,HCPCS,00338104902,NDC,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,2.34,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,00378-9112-93,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,inpatient,1,EA,6.60000,6.27000,Amish/Mennonite,Amish Mennonite,,3.63,,,,,,,3.63,6.40,percent of total billed charges,
NITROGLYCERIN FILM 7108269,57357,CDM,250,RC,43598-0894-30,NDC,,,facility,outpatient,1,EA,6.60000,6.27000,Amish/Mennonite,Amish Mennonite,,3.63,,,,,,,3.30,6.40,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,inpatient,15,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-35,NDC,,,facility,outpatient,15,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,inpatient,15,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,13668-0534-01,NDC,,,facility,outpatient,15,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.18,2.29,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,inpatient,15,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,33342-0481-15,NDC,,,facility,outpatient,15,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,inpatient,15,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,45802-0048-11,NDC,,,facility,outpatient,15,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,inpatient,15,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107931,57358,CDM,250,RC,72578-0089-01,NDC,,,facility,outpatient,15,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,inpatient,1,EA,11.41000,10.84000,Amish/Mennonite,Amish Mennonite,,6.28,,,,,,,6.28,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,00904-7071-07,NDC,,,facility,outpatient,1,EA,11.41000,10.84000,Amish/Mennonite,Amish Mennonite,,6.28,,,,,,,5.71,11.07,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,62332-0403-31,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,inpatient,1,EA,19.03000,18.08000,Amish/Mennonite,Amish Mennonite,,10.47,,,,,,,10.47,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,51079-0813-01,NDC,,,facility,outpatient,1,EA,19.03000,18.08000,Amish/Mennonite,Amish Mennonite,,10.47,,,,,,,9.52,18.46,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,inpatient,1,EA,11.30000,10.74000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,6.21,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,60687-0313-25,NDC,,,facility,outpatient,1,EA,11.30000,10.74000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,5.65,10.96,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,inpatient,1,EA,10.04000,9.54000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.52,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,69097-0868-07,NDC,,,facility,outpatient,1,EA,10.04000,9.54000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.02,9.74,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76282-0348-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,inpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
NADOLOL TAB,57359,CDM,250,RC,76385-0134-01,NDC,,,facility,outpatient,1,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,182.50,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,90,200.75,,,,,,,200.75,354.05,percent of total billed charges,
NEONATAL SCREEN (281) SO,57360,CDM,300,RC,84999,CPT,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,90,200.75,,,,,,,182.50,354.05,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00121-4810-40,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,inpatient,5,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00472-5003-60,NDC,,,facility,outpatient,5,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,inpatient,5,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,00904-7276-70,NDC,,,facility,outpatient,5,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0160-10,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,inpatient,5,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,63739-0634-56,NDC,,,facility,outpatient,5,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,inpatient,5,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-99,NDC,,,facility,outpatient,5,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,inpatient,5,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,66689-0037-50,NDC,,,facility,outpatient,5,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,inpatient,5,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-59,NDC,,,facility,outpatient,5,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,inpatient,5,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
NYSTATIN SUSP 7935923,57361,CDM,250,RC,68094-0599-62,NDC,,,facility,outpatient,5,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,Amish/Mennonite,Amish Mennonite,,3518.90,,,,,,,3518.90,6206.06,percent of total billed charges,
NM INDIUM IN-111PENTETREOTIDE TO 6MCI,57362,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,Amish/Mennonite,Amish Mennonite,,3518.90,,,,,,,1914.61,6206.06,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,inpatient,1,EA,86.53000,82.20000,Amish/Mennonite,Amish Mennonite,,47.59,,,,,,,47.59,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018101,NDC,facility,outpatient,1,EA,86.53000,82.20000,Amish/Mennonite,Amish Mennonite,,47.59,,,,,,,0.91450,83.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,inpatient,1,EA,84.85000,80.60000,Amish/Mennonite,Amish Mennonite,,46.67,,,,,,,46.67,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,00078018161,NDC,facility,outpatient,1,EA,84.85000,80.60000,Amish/Mennonite,Amish Mennonite,,46.67,,,,,,,0.91450,82.30,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,inpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,25021045201,NDC,facility,outpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,0.91450,19.92,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,inpatient,1,EA,39.10000,37.15000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,21.50,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,62756034944,NDC,facility,outpatient,1,EA,39.10000,37.15000,Amish/Mennonite,Amish Mennonite,,21.50,,,,,,,0.91450,37.93,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,inpatient,1,EA,31.41000,29.84000,Amish/Mennonite,Amish Mennonite,,17.28,,,,,,,17.28,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037601,NDC,facility,outpatient,1,EA,31.41000,29.84000,Amish/Mennonite,Amish Mennonite,,17.28,,,,,,,0.91450,30.47,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,inpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,63323037604,NDC,facility,outpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,0.91450,10.42,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,inpatient,1,EA,21.19000,20.13000,Amish/Mennonite,Amish Mennonite,,11.65,,,,,,,11.65,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,67457024501,NDC,facility,outpatient,1,EA,21.19000,20.13000,Amish/Mennonite,Amish Mennonite,,11.65,,,,,,,0.91450,20.55,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,inpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
OCTREOTIDE INJECTION NON-DEPOT,57363,CDM,250,RC,J2354,HCPCS,68462089610,NDC,facility,outpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,0.91450,9.96,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
NASAL PACKING/CAUTERY-TECH,57365,CDM,361,RC,,,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,5271.00,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,inpatient,2,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00069134005,NDC,facility,outpatient,2,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.13330,1.47,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,inpatient,2,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00641608025,NDC,facility,outpatient,2,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.13330,0.92150,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,inpatient,2,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00143989105,NDC,facility,outpatient,2,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.13330,0.48500,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,inpatient,2,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00409475503,NDC,facility,outpatient,2,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,0.13330,1.97,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,inpatient,2,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,10019090517,NDC,facility,outpatient,2,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.13330,1.46,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,inpatient,2,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00703722102,NDC,facility,outpatient,2,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.13330,3.07,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,inpatient,2,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,00781301095,NDC,facility,outpatient,2,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,0.13330,1.99,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,inpatient,2,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019631,NDC,facility,outpatient,2,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.13330,0.56260,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,inpatient,2,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155019642,NDC,facility,outpatient,2,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.13330,1.41,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,inpatient,2,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,60505613005,NDC,facility,outpatient,2,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.13330,0.70810,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,inpatient,2,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,23155054831,NDC,facility,outpatient,2,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.13330,1.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,inpatient,2,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,25021077702,NDC,facility,outpatient,2,EA,2.77000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,0.13330,2.69,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,inpatient,2,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,36000001225,NDC,facility,outpatient,2,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.13330,1.53,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,inpatient,2,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,55150012502,NDC,facility,outpatient,2,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.13330,1.15,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,inpatient,2,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,63323037302,NDC,facility,outpatient,2,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,0.13330,3.45,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,inpatient,2,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,64679072601,NDC,facility,outpatient,2,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,0.13330,3.68,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,inpatient,2,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
ONDANSETRON SOLN-INJ 2 MG/ML 2 ML,57366,CDM,250,RC,J2405,HCPCS,70860077602,NDC,facility,outpatient,2,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,0.13330,3.01,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,inpatient,60,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,27437-0106-01,NDC,,,facility,outpatient,60,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,inpatient,60,EA,27.49000,26.12000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,15.12,26.67,percent of total billed charges,
NITAZOXANIDE POWDER,57367,CDM,250,RC,67546-0212-21,NDC,,,facility,outpatient,60,EA,27.49000,26.12000,Amish/Mennonite,Amish Mennonite,,15.12,,,,,,,13.74,26.67,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,inpatient,1,EA,5474.37000,5200.65000,Amish/Mennonite,Amish Mennonite,,3010.90,,,,,,,3010.90,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078034061,NDC,facility,outpatient,1,EA,5474.37000,5200.65000,Amish/Mennonite,Amish Mennonite,,3010.90,,,,,,,212.20,5310.14,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,inpatient,1,EA,7150.48000,6792.96000,Amish/Mennonite,Amish Mennonite,,3932.76,,,,,,,3932.76,6935.97,percent of total billed charges,
OCTREOTIDE INJECTION DEPOT 7910215,57368,CDM,636,RC,J2353,HCPCS,00078081181,NDC,facility,outpatient,1,EA,7150.48000,6792.96000,Amish/Mennonite,Amish Mennonite,,3932.76,,,,,,,212.20,6935.97,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,inpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,133.10,234.74,percent of total billed charges,
NORWALK-LIKE VIRUS AG FECES IA-TECH,57369,CDM,300,RC,87449,CPT,,,facility,outpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,11.98,628.12,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,inpatient,1,EA,0.62000,0.58000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,75907-0069-01,NDC,,,facility,outpatient,1,EA,0.62000,0.58000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,50268-0603-15,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,51672-4001-05,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-01,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
NORTRIPTYLINE CAP 7218365,57370,CDM,250,RC,68084-0031-11,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,inpatient,1,mL,461.19000,438.14000,Amish/Mennonite,Amish Mennonite,,253.65,,,,,,,253.65,447.35,percent of total billed charges,
OBINUTUZUMAB SOLN 25 MG/ML 40 ML,57371,CDM,636,RC,J9301,HCPCS,50242007001,NDC,facility,outpatient,1,mL,461.19000,438.14000,Amish/Mennonite,Amish Mennonite,,253.65,,,,,,,78.46,447.35,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 7 EA ADDL 15 MINS,57372,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,00093-0811-05,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,50268-0604-15,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,51672-4002-05,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-01,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
NORTRIPTYLINE CAP 7219207,57373,CDM,250,RC,68084-0032-11,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00182-4405-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACIN TAB 7223027,57375,CDM,250,RC,00904-2272-60,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,inpatient,60,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00121-0868-02,NDC,,,facility,outpatient,60,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,inpatient,60,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00472-1320-02,NDC,,,facility,outpatient,60,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,inpatient,60,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00527-5121-62,NDC,,,facility,outpatient,60,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,inpatient,60,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,00603-1481-49,NDC,,,facility,outpatient,60,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,inpatient,60,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,60432-0537-60,NDC,,,facility,outpatient,60,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,inpatient,60,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
NYSTATIN SUSP 7935927,57376,CDM,250,RC,51672-4117-04,NDC,,,facility,outpatient,60,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,inpatient,1,EA,5.11000,4.85000,Amish/Mennonite,Amish Mennonite,,2.81,,,,,,,2.81,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,00071041813,NDC,facility,outpatient,1,EA,5.11000,4.85000,Amish/Mennonite,Amish Mennonite,,2.81,,,,,,,2.56,4.96,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,inpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,43598043611,NDC,facility,outpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330401,NDC,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,59762330403,NDC,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,inpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.43,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,68462063945,NDC,facility,outpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.30,2.52,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,69339017441,NDC,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,70756001402,NDC,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB 0.4 MG SUBLINGUAL,57377,CDM,250,RC,J8499,HCPCS,72888013933,NDC,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,inpatient,1,EA,6455.15000,6132.39000,Amish/Mennonite,Amish Mennonite,,3550.33,,,,,,,3550.33,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078034161,NDC,facility,outpatient,1,EA,6455.15000,6132.39000,Amish/Mennonite,Amish Mennonite,,3550.33,,,,,,,212.20,6261.50,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,inpatient,1,EA,9368.36000,8899.95000,Amish/Mennonite,Amish Mennonite,,5152.60,,,,,,,5152.60,9087.31,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 20 MG,57378,CDM,636,RC,J2353,HCPCS,00078081881,NDC,facility,outpatient,1,EA,9368.36000,8899.95000,Amish/Mennonite,Amish Mennonite,,5152.60,,,,,,,212.20,9087.31,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-19,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,inpatient,1,EA,5.45000,5.17000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,3.00,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,00093-2130-93,NDC,,,facility,outpatient,1,EA,5.45000,5.17000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,2.73,5.29,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,inpatient,1,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,47781-0307-01,NDC,,,facility,outpatient,1,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.19,4.24,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,inpatient,1,EA,5.67000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,50268-0623-15,NDC,,,facility,outpatient,1,EA,5.67000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.83,5.50,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,inpatient,1,EA,7.28000,6.91000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,51079-0584-20,NDC,,,facility,outpatient,1,EA,7.28000,6.91000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,3.64,7.06,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68084-0077-01,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.44,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,62332-0390-31,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,68382-0559-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
NITROFURANTOIN CAP 7936586,57379,CDM,250,RC,70756-0411-11,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,inpatient,1,EA,33.81000,32.12000,Amish/Mennonite,Amish Mennonite,,18.60,,,,,,,18.60,32.80,percent of total billed charges,
OLMESARTAN TAB 7212049,57380,CDM,250,RC,65597-0104-30,NDC,,,facility,outpatient,1,EA,33.81000,32.12000,Amish/Mennonite,Amish Mennonite,,18.60,,,,,,,16.91,32.80,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,inpatient,15,EA,14.15000,13.44000,Amish/Mennonite,Amish Mennonite,,7.78,,,,,,,7.78,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,00168-0081-15,NDC,,,facility,outpatient,15,EA,14.15000,13.44000,Amish/Mennonite,Amish Mennonite,,7.78,,,,,,,7.08,13.73,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL CREAM 7107345,57381,CDM,250,RC,68462-0314-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,inpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00143989010,NDC,facility,outpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.13330,1.20,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,inpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,00641607901,NDC,facility,outpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.13330,1.19,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,inpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,16729029805,NDC,facility,outpatient,1,mL,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.13330,0.84390,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,72266012401,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.13330,0.76630,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,inpatient,1,mL,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,23155054931,NDC,facility,outpatient,1,mL,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.13330,1.34,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,inpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,25021078220,NDC,facility,outpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,0.13330,2.30,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,inpatient,1,mL,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,63323037420,NDC,facility,outpatient,1,mL,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,0.13330,3.10,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ONDANSETRON SOLN 2 MG/ML 20 ML,57383,CDM,250,RC,J2405,HCPCS,70860077720,NDC,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.13330,1.53,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
OLIGOCLONAL BANDS-TECH,57385,CDM,300,RC,83916,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,27.39,1290.24,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,18.70,32.98,percent of total billed charges,
OCCULT BLOOD FECES CA SCREEN-TECH,57388,CDM,300,RC,82270,CPT,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,3.66,203.72,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,inpatient,,,22948.00000,21800.60000,Amish/Mennonite,Amish Mennonite,,12621.40,,,,,,,12621.40,22259.56,percent of total billed charges,
OR LEVEL 8,57389,CDM,360,RC,,,,,facility,outpatient,,,22948.00000,21800.60000,Amish/Mennonite,Amish Mennonite,,12621.40,,,,,,,4607.00,22259.56,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD FECES NON-CA SCRN-TECH,57390,CDM,300,RC,82272,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,4.23,203.72,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,inpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,80.30,141.62,percent of total billed charges,
OCCULT BLD FECES IMMUNOASSAY-TECH,57391,CDM,300,RC,82274,CPT,,,facility,outpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,15.92,831.84,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,inpatient,5,EA,81.26000,77.19000,Amish/Mennonite,Amish Mennonite,,44.69,,,,,,,44.69,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,24208-0410-05,NDC,,,facility,outpatient,5,EA,81.26000,77.19000,Amish/Mennonite,Amish Mennonite,,44.69,,,,,,,40.63,78.82,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,inpatient,5,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,22.59,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,60505-0363-01,NDC,,,facility,outpatient,5,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,20.54,39.85,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN OPHTHALMIC SOL 7736044,57392,CDM,250,RC,72603-0186-01,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,inpatient,5,EA,40.75000,38.71000,Amish/Mennonite,Amish Mennonite,,22.41,,,,,,,22.41,39.53,percent of total billed charges,
NYSTATIN TOPICAL PASTE,57393,CDM,250,RC,64980-0320-05,NDC,,,facility,outpatient,5,EA,40.75000,38.71000,Amish/Mennonite,Amish Mennonite,,22.41,,,,,,,20.38,39.53,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,inpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,,675.40,,,,,,,675.40,1191.16,percent of total billed charges,
NERVE TEASING PREP-TECH,57394,CDM,310,RC,88362,CPT,,,facility,outpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,,675.40,,,,,,,523.04,11041.20,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,TC,486.75,,,,,,,486.75,858.45,percent of total billed charges,
NONINV STDY EXT ART LTD BI-TECH,57395,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,TC,486.75,,,,,,,442.50,858.45,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
OCCULT BLOOD OTHER SOURCE-TECH,57396,CDM,300,RC,82271,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,4.26,254.68,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,199.65,352.11,percent of total billed charges,
NM DTPA PENETETATE TO 25MCI,57397,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,41.63,352.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-70,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.31,6.43,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,inpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.98,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-88,NDC,,,facility,outpatient,1,EA,5.41000,5.14000,Amish/Mennonite,Amish Mennonite,,2.98,,,,,,,2.71,5.25,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,00536-5894-53,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,inpatient,1,EA,5.62000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,43598-0446-74,NDC,,,facility,outpatient,1,EA,5.62000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,inpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
NICOTINE PATCH 7116031,57398,CDM,250,RC,70677-0030-01,NDC,,,facility,outpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,inpatient,1,EA,9666.09000,9182.79000,Amish/Mennonite,Amish Mennonite,,5316.35,,,,,,,5316.35,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078034261,NDC,facility,outpatient,1,EA,9666.09000,9182.79000,Amish/Mennonite,Amish Mennonite,,5316.35,,,,,,,212.20,9376.11,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,inpatient,1,EA,12876.34000,12232.52000,Amish/Mennonite,Amish Mennonite,,7081.99,,,,,,,7081.99,12490.05,percent of total billed charges,
OCTREOTIDE DEPOT POWD-INJ 30 MG,57399,CDM,636,RC,J2353,HCPCS,00078082581,NDC,facility,outpatient,1,EA,12876.34000,12232.52000,Amish/Mennonite,Amish Mennonite,,7081.99,,,,,,,212.20,12490.05,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,inpatient,1,EA,45.60000,43.32000,Amish/Mennonite,Amish Mennonite,,25.08,,,,,,,25.08,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00002-4453-85,NDC,,,facility,outpatient,1,EA,45.60000,43.32000,Amish/Mennonite,Amish Mennonite,,25.08,,,,,,,22.80,44.23,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,00093-5245-65,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,4.26,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,13668-0086-30,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,3.87,7.51,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,64380-0172-02,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.62,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,inpatient,1,EA,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,50268-0615-13,NDC,,,facility,outpatient,1,EA,5.50000,5.22000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,2.75,5.33,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,inpatient,1,EA,5.46000,5.19000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,3.00,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,55111-0262-81,NDC,,,facility,outpatient,1,EA,5.46000,5.19000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,2.73,5.30,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
OLANZAPINE TAB 7910542,57400,CDM,250,RC,60505-3275-00,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,69315-0211-01,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.62,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,inpatient,1,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.87,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,00904-7229-61,NDC,,,facility,outpatient,1,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.70,3.30,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,23155-0194-01,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,42192-0615-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,inpatient,1,EA,2.27000,2.15000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,43386-0440-24,NDC,,,facility,outpatient,1,EA,2.27000,2.15000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
NIFEDIPINE CAP,57401,CDM,250,RC,60687-0425-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 5 EA ADDL 15 MINS,57402,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-16,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,00378-9102-93,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.71,percent of total billed charges,
NITROGLYCERIN FILM 7108277,57403,CDM,250,RC,47781-0296-03,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.40,2.71,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
OPIATE >1 QUANT ASSAY-TECH,57404,CDM,300,RC,80361,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,67.50,1137.41,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,inpatient,,,36445.00000,34622.75000,Amish/Mennonite,Amish Mennonite,,20044.75,,,,,,,20044.75,35351.65,percent of total billed charges,
OR LEVEL 9,57405,CDM,360,RC,,,,,facility,outpatient,,,36445.00000,34622.75000,Amish/Mennonite,Amish Mennonite,,20044.75,,,,,,,4607.00,35351.65,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,inpatient,5,EA,183.67000,174.48000,Amish/Mennonite,Amish Mennonite,,101.02,,,,,,,101.02,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00065-0271-05,NDC,,,facility,outpatient,5,EA,183.67000,174.48000,Amish/Mennonite,Amish Mennonite,,101.02,,,,,,,91.83,178.16,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,inpatient,5,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,5.29,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,00536-1308-40,NDC,,,facility,outpatient,5,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,4.80,9.32,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,inpatient,5,EA,24.99000,23.74000,Amish/Mennonite,Amish Mennonite,,13.74,,,,,,,13.74,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,60505-0575-01,NDC,,,facility,outpatient,5,EA,24.99000,23.74000,Amish/Mennonite,Amish Mennonite,,13.74,,,,,,,12.49,24.24,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,inpatient,5,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,51407-0499-05,NDC,,,facility,outpatient,5,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,inpatient,5,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,58602-0006-40,NDC,,,facility,outpatient,5,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.40,4.66,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,inpatient,5,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,65862-0757-05,NDC,,,facility,outpatient,5,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,13.43,26.05,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,inpatient,5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0007-01,NDC,,,facility,outpatient,5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,inpatient,5,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70069-0017-01,NDC,,,facility,outpatient,5,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.63,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,inpatient,5,EA,4.46000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70512-0520-05,NDC,,,facility,outpatient,5,EA,4.46000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.33,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,inpatient,5,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.26,percent of total billed charges,
OLOPATADINE OPHTH SOL,57406,CDM,250,RC,70677-1156-01,NDC,,,facility,outpatient,5,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.26,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,10939-8824-04,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,47469-0009-28,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
OMEGA-3 POLYUNSATURATED FATTY ACIDS CAP,57407,CDM,250,RC,77333-0308-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,68462-0437-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,inpatient,1,EA,15.87000,15.08000,Amish/Mennonite,Amish Mennonite,,8.73,,,,,,,8.73,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,42292-0036-03,NDC,,,facility,outpatient,1,EA,15.87000,15.08000,Amish/Mennonite,Amish Mennonite,,8.73,,,,,,,7.93,15.39,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,inpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,8.43,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-10,NDC,,,facility,outpatient,1,EA,15.33000,14.56000,Amish/Mennonite,Amish Mennonite,,8.43,,,,,,,7.67,14.87,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,inpatient,1,EA,24.33000,23.12000,Amish/Mennonite,Amish Mennonite,,13.38,,,,,,,13.38,23.60,percent of total billed charges,
OLMESARTAN TAB 7224272,57408,CDM,250,RC,65597-0103-30,NDC,,,facility,outpatient,1,EA,24.33000,23.12000,Amish/Mennonite,Amish Mennonite,,13.38,,,,,,,12.16,23.60,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,inpatient,1,EA,38.67000,36.74000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,21.27,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00002-4115-33,NDC,,,facility,outpatient,1,EA,38.67000,36.74000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,19.34,37.51,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,00904-6377-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,43598-0164-30,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,60505-3111-00,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
OLANZAPINE TAB,57409,CDM,250,RC,69543-0381-90,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,00168-0089-15,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,inpatient,15,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,45802-0244-14,NDC,,,facility,outpatient,15,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,inpatient,15,EA,10.51000,9.99000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.78,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,51672-1272-01,NDC,,,facility,outpatient,15,EA,10.51000,9.99000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.25,10.19,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,inpatient,15,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,52565-0042-15,NDC,,,facility,outpatient,15,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,inpatient,15,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
NYSTATIN TOPICAL OINTMENT 7107352,57410,CDM,250,RC,68462-0799-17,NDC,,,facility,outpatient,15,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.28,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,inpatient,1,EA,659.69000,626.71000,Amish/Mennonite,Amish Mennonite,,362.83,,,,,,,362.83,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,68462058576,NDC,facility,outpatient,1,EA,659.69000,626.71000,Amish/Mennonite,Amish Mennonite,,362.83,,,,,,,4.35,639.90,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,inpatient,1,EA,659.70000,626.71000,Amish/Mennonite,Amish Mennonite,,362.83,,,,,,,362.83,639.91,percent of total billed charges,
ORAL APREPITANT 7910070,57411,CDM,250,RC,J8501,HCPCS,13668059386,NDC,facility,outpatient,1,EA,659.70000,626.71000,Amish/Mennonite,Amish Mennonite,,362.83,,,,,,,4.35,639.91,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1856.25,3273.75,percent of total billed charges,
OR LEVEL 2,57412,CDM,360,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1856.25,5271.00,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,00904-6917-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0634-03,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,16714-0747-02,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,50268-0619-15,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,51079-0007-01,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,59651-0002-90,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-02,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.21,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,60505-0065-07,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.10,2.13,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68084-0128-11,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
OMEPRAZOLE CAP,57413,CDM,250,RC,68462-0396-90,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,inpatient,15,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,69315-0306-15,NDC,,,facility,outpatient,15,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,inpatient,15,EA,4.59000,4.36000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,00832-0465-15,NDC,,,facility,outpatient,15,EA,4.59000,4.36000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.45,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,inpatient,15,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,16714-0769-01,NDC,,,facility,outpatient,15,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,3.55,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,inpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,39822-3015-01,NDC,,,facility,outpatient,15,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,inpatient,15,EA,3.15000,2.99000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,43386-0530-01,NDC,,,facility,outpatient,15,EA,3.15000,2.99000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.57,3.06,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68308-0152-15,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,inpatient,15,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
NYSTATIN TOPICAL POWDER,57414,CDM,250,RC,68382-0370-01,NDC,,,facility,outpatient,15,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,inpatient,1,EA,285.49000,271.21000,Amish/Mennonite,Amish Mennonite,,157.02,,,,,,,157.02,276.93,percent of total billed charges,
OMEPRAZOLE-SODIUM BICARBONATE POWDER,57416,CDM,250,RC,68012-0052-30,NDC,,,facility,outpatient,1,EA,285.49000,271.21000,Amish/Mennonite,Amish Mennonite,,157.02,,,,,,,142.75,276.93,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0403-30,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-0506-50,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00023-5487-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0416-25,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-8063-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0419-28,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,00065-0431-33,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
OCULAR LUBRICANT SOL,57417,CDM,250,RC,58790-0000-30,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,inpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,44.55,78.57,percent of total billed charges,
NOSE-REMOVAL LOCATION-TECH,57418,CDM,361,RC,,,,,facility,outpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,44.55,5271.00,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,inpatient,1,EA,2.41000,2.29000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.33,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,16714020130,NDC,facility,outpatient,1,EA,2.41000,2.29000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.21,2.34,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,1671402013000100,NDC,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,57237007810,NDC,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,inpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,5723700781000100,NDC,facility,outpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,inpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,62756035664,NDC,facility,outpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,inpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6275603566400100,NDC,facility,outpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.90,5.62,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,inpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6586203911000100,NDC,facility,outpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581100100,NDC,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
ONDANSETRON TAB-DIS 8 MG,57419,CDM,250,RC,J8499,HCPCS,6846201581300100,NDC,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,inpatient,,,13836.00000,13144.20000,Amish/Mennonite,Amish Mennonite,,7609.80,,,,,,,7609.80,13420.92,percent of total billed charges,
OR LEVEL 6,57420,CDM,360,RC,,,,,facility,outpatient,,,13836.00000,13144.20000,Amish/Mennonite,Amish Mennonite,,7609.80,,,,,,,4607.00,13420.92,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,inpatient,5,EA,10.59000,10.06000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,5.82,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,60505-0560-00,NDC,,,facility,outpatient,5,EA,10.59000,10.06000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,5.29,10.27,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,inpatient,5,EA,12.92000,12.27000,Amish/Mennonite,Amish Mennonite,,7.11,,,,,,,7.11,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-05,NDC,,,facility,outpatient,5,EA,12.92000,12.27000,Amish/Mennonite,Amish Mennonite,,7.11,,,,,,,6.46,12.53,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,inpatient,5,EA,12.27000,11.66000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.75,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,24208-0434-10,NDC,,,facility,outpatient,5,EA,12.27000,11.66000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.13,11.90,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,inpatient,5,EA,14.21000,13.50000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,61314-0012-05,NDC,,,facility,outpatient,5,EA,14.21000,13.50000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.11,13.78,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,inpatient,5,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
OFLOXACIN SOLN-OPHTH 0.3% 5 ML,57421,CDM,250,RC,70756-0607-30,NDC,,,facility,outpatient,5,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 9 EA ADDL 15 MINS,57422,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,inpatient,1,EA,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,00555-0211-10,NDC,,,facility,outpatient,1,EA,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.93,5.68,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,50742-0267-50,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
NORETHINDRONE TAB,57423,CDM,250,RC,68462-0304-50,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,29696.15,52373.21,percent of total billed charges,
OR LEVEL 10,57424,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,4607.00,52373.21,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 1 EA ADDL 15 MINS,57425,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,Amish/Mennonite,Amish Mennonite,,97.58,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,70007-0300-65,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,Amish/Mennonite,Amish Mennonite,,97.58,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,inpatient,1,EA,120.63000,114.60000,Amish/Mennonite,Amish Mennonite,,66.35,,,,,,,66.35,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,45802-0210-01,NDC,,,facility,outpatient,1,EA,120.63000,114.60000,Amish/Mennonite,Amish Mennonite,,66.35,,,,,,,60.31,117.01,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,inpatient,1,EA,177.41000,168.54000,Amish/Mennonite,Amish Mennonite,,97.58,,,,,,,97.58,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,28595-0550-49,NDC,,,facility,outpatient,1,EA,177.41000,168.54000,Amish/Mennonite,Amish Mennonite,,97.58,,,,,,,88.70,172.09,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,inpatient,1,EA,122.44000,116.32000,Amish/Mennonite,Amish Mennonite,,67.34,,,,,,,67.34,118.77,percent of total billed charges,
NITROGLYCERIN SPRAY,57426,CDM,250,RC,59630-0300-65,NDC,,,facility,outpatient,1,EA,122.44000,116.32000,Amish/Mennonite,Amish Mennonite,,67.34,,,,,,,61.22,118.77,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 4 MG,57427,CDM,250,RC,J8540,HCPCS,60219204301,NDC,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,inpatient,,,21293.00000,20228.35000,Amish/Mennonite,Amish Mennonite,,11711.15,,,,,,,11711.15,20654.21,percent of total billed charges,
OR LEVEL 7,57428,CDM,360,RC,,,,,facility,outpatient,,,21293.00000,20228.35000,Amish/Mennonite,Amish Mennonite,,11711.15,,,,,,,4607.00,20654.21,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,inpatient,1,EA,422.19000,401.08000,Amish/Mennonite,Amish Mennonite,,232.20,,,,,,,232.20,409.52,percent of total billed charges,
ORAL APREPITANT 7910210,57429,CDM,250,RC,J8501,HCPCS,68462058476,NDC,facility,outpatient,1,EA,422.19000,401.08000,Amish/Mennonite,Amish Mennonite,,232.20,,,,,,,4.35,409.52,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
OSMOLALITY ASSAY BLOOD-TECH,57430,CDM,300,RC,83930,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,6.61,339.51,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,Amish/Mennonite,Amish Mennonite,,3842.30,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 3,57431,CDM,360,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,Amish/Mennonite,Amish Mennonite,,3842.30,,,,,,,3842.30,6776.42,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,Amish/Mennonite,Amish Mennonite,,4455.00,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4,57432,CDM,360,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,Amish/Mennonite,Amish Mennonite,,4455.00,,,,,,,4455.00,7857.00,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 4 EA ADDL 15 MINS,57433,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,inpatient,,,10089.00000,9584.55000,Amish/Mennonite,Amish Mennonite,,5548.95,,,,,,,5548.95,9786.33,percent of total billed charges,
OR LEVEL 5,57434,CDM,360,RC,,,,,facility,outpatient,,,10089.00000,9584.55000,Amish/Mennonite,Amish Mennonite,,5548.95,,,,,,,4607.00,9786.33,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,inpatient,1,EA,47.99000,45.59000,Amish/Mennonite,Amish Mennonite,,26.39,,,,,,,26.39,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00004-0800-85,NDC,,,facility,outpatient,1,EA,47.99000,45.59000,Amish/Mennonite,Amish Mennonite,,26.39,,,,,,,24.00,46.55,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,inpatient,1,EA,4.09000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,00527-4593-13,NDC,,,facility,outpatient,1,EA,4.09000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,inpatient,1,EA,30.22000,28.71000,Amish/Mennonite,Amish Mennonite,,16.62,,,,,,,16.62,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,16714-0819-01,NDC,,,facility,outpatient,1,EA,30.22000,28.71000,Amish/Mennonite,Amish Mennonite,,16.62,,,,,,,15.11,29.31,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,68180-0677-11,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,33342-0258-66,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,inpatient,1,EA,25.22000,23.96000,Amish/Mennonite,Amish Mennonite,,13.87,,,,,,,13.87,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,42291-0664-10,NDC,,,facility,outpatient,1,EA,25.22000,23.96000,Amish/Mennonite,Amish Mennonite,,13.87,,,,,,,12.61,24.46,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,inpatient,1,EA,32.24000,30.62000,Amish/Mennonite,Amish Mennonite,,17.73,,,,,,,17.73,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,47781-0470-13,NDC,,,facility,outpatient,1,EA,32.24000,30.62000,Amish/Mennonite,Amish Mennonite,,17.73,,,,,,,16.12,31.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,inpatient,1,EA,25.28000,24.01000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,62332-0415-10,NDC,,,facility,outpatient,1,EA,25.28000,24.01000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,inpatient,1,EA,35.97000,34.17000,Amish/Mennonite,Amish Mennonite,,19.78,,,,,,,19.78,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,63739-0050-07,NDC,,,facility,outpatient,1,EA,35.97000,34.17000,Amish/Mennonite,Amish Mennonite,,19.78,,,,,,,17.98,34.89,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,inpatient,1,EA,5.85000,5.55000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,72205-0044-11,NDC,,,facility,outpatient,1,EA,5.85000,5.55000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.92,5.67,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,inpatient,1,EA,27.40000,26.03000,Amish/Mennonite,Amish Mennonite,,15.07,,,,,,,15.07,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,69238-1266-01,NDC,,,facility,outpatient,1,EA,27.40000,26.03000,Amish/Mennonite,Amish Mennonite,,15.07,,,,,,,13.70,26.58,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,inpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,70710-1010-02,NDC,,,facility,outpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,inpatient,1,EA,5.43000,5.15000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.99,5.27,percent of total billed charges,
OSELTAMIVIR CAP 7223738,57435,CDM,250,RC,76282-0704-45,NDC,,,facility,outpatient,1,EA,5.43000,5.15000,Amish/Mennonite,Amish Mennonite,,2.99,,,,,,,2.71,5.27,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 2 EA ADDL 15 MINS,57436,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 3 EA ADDL 15 MINS,57437,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
OSMOLALITY ASSAY URINE-TECH,57438,CDM,300,RC,83935,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,6.82,356.54,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,inpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,0090465526100100,NDC,facility,outpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,1671401600100100,NDC,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5026806221500010,NDC,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,inpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,5511101543000100,NDC,facility,outpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6373903331000100,NDC,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6586201883000100,NDC,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,inpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
ONDANSETRON TAB 8 MG,57439,CDM,250,RC,J8499,HCPCS,6808402210100100,NDC,facility,outpatient,1,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 6 EA ADDL 15 MINS,57441,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,GO,77.55,,,,,,,77.55,136.77,percent of total billed charges,
OT AQUATIC THERAPY EA 15MIN-TECH,57443,CDM,430,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,GO,77.55,,,,,,,70.50,264.00,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 10 EA ADDL 15 MINS,57444,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,inpatient,1,EA,2595.50000,2465.73000,Amish/Mennonite,Amish Mennonite,,1427.53,,,,,,,1427.53,2517.64,percent of total billed charges,
OMALIZUMAB INJECTION,57445,CDM,636,RC,J2357,HCPCS,50242004062,NDC,facility,outpatient,1,EA,2595.50000,2465.73000,Amish/Mennonite,Amish Mennonite,,1427.53,,,,,,,40.56,2517.64,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,GO,53.90,,,,,,,53.90,95.06,percent of total billed charges,
OT MANUAL THERAPY EA 15MIN-TECH,57447,CDM,430,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,GO,53.90,,,,,,,49.00,264.00,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,inpatient,60,mL,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.49,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0820-09,NDC,,,facility,outpatient,60,mL,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.17,6.16,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,inpatient,60,mL,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00004-0822-05,NDC,,,facility,outpatient,60,mL,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.00,7.76,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,inpatient,60,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00093-8180-64,NDC,,,facility,outpatient,60,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,inpatient,60,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,00527-5137-62,NDC,,,facility,outpatient,60,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,inpatient,60,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,27241-0139-09,NDC,,,facility,outpatient,60,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,inpatient,60,mL,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,42291-0567-60,NDC,,,facility,outpatient,60,mL,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,inpatient,60,mL,5.28000,5.02000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,70710-1165-06,NDC,,,facility,outpatient,60,mL,5.28000,5.02000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.64,5.12,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,inpatient,60,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,68180-0678-01,NDC,,,facility,outpatient,60,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,inpatient,60,mL,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
OSELTAMIVIR,57448,CDM,250,RC,76282-0739-52,NDC,,,facility,outpatient,60,mL,0.93000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GO,47.30,,,,,,,47.30,83.42,percent of total billed charges,
OT IONTOPHORESIS EA 15MIN-TECH,57450,CDM,430,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GO,47.30,,,,,,,43.00,264.00,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,Amish/Mennonite,Amish Mennonite,,2039.81,,,,,,,1817.29,3597.49,percent of total billed charges,
KIT ASCP FX CLGN INTERNALBRACE FIBERTAPE LGMNT,57451,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,Amish/Mennonite,Amish Mennonite,,2039.81,,,,,,,1702.32,3708.75,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,1671402003000100,NDC,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,inpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,5723700771000100,NDC,facility,outpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,inpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,57237007730,NDC,facility,outpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,inpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6586203901000100,NDC,facility,outpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,inpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6275602406400100,NDC,facility,outpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
ONDANSETRON TAB-DIS 4 MG,57452,CDM,250,RC,J8499,HCPCS,6846201571300100,NDC,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,inpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL LOW COMPLEX 30 MIN-TECH,57453,CDM,430,RC,97165,CPT,,,facility,outpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,126.65,264.00,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,inpatient,,,213.20000,202.54000,Amish/Mennonite,Amish Mennonite,GO,117.26,,,,,,,117.26,206.80,percent of total billed charges,
OT ONSITE DRIVER SAFETY EVAL-TECH,57454,CDM,430,RC,97799,CPT,,,facility,outpatient,,,213.20000,202.54000,Amish/Mennonite,Amish Mennonite,GO,117.26,,,,,,,106.60,264.00,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GO,63.25,,,,,,,63.25,111.55,percent of total billed charges,
OT THER ACTVTY DIRECT EA 15MIN-TECH,57456,CDM,430,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GO,63.25,,,,,,,57.50,264.00,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,inpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL MOD COMPLEX 45 MIN-TECH,57457,CDM,430,RC,97166,CPT,,,facility,outpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,126.65,264.00,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GO,68.20,,,,,,,68.20,120.28,percent of total billed charges,
OT ORTHOTIC FIT & TRAIN EA 15M-TECH,57458,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GO,68.20,,,,,,,62.00,264.00,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,GO,83.60,,,,,,,83.60,147.44,percent of total billed charges,
OT SENSORY INTEGRATION EA 15M-TECH,57460,CDM,430,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,GO,83.60,,,,,,,76.00,264.00,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,inpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,883.67,percent of total billed charges,
OR LEVEL 8 EA ADDL 15 MINS,57461,CDM,360,RC,,,,,facility,outpatient,,,911.00000,865.45000,Amish/Mennonite,Amish Mennonite,,501.05,,,,,,,501.05,5271.00,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00603-4975-21,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00832-0038-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,00904-7027-61,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,10702-0201-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
OXYBUTYNIN TAB,57463,CDM,250,RC,68084-0400-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,inpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,140.25,247.35,percent of total billed charges,
OT EVAL HIGH COMPLEX 60 MIN-TECH,57464,CDM,430,RC,97167,CPT,,,facility,outpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,GO,140.25,,,,,,,126.65,264.00,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,GO,61.05,,,,,,,61.05,107.67,percent of total billed charges,
OT NEUROMUSC RE-ED EA 15MIN-TECH,57466,CDM,430,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,GO,61.05,,,,,,,55.50,264.00,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GO,63.25,,,,,,,63.25,111.55,percent of total billed charges,
OT HOME MGMT TRAIN EA 15MIN-TECH,57468,CDM,430,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GO,63.25,,,,,,,57.50,264.00,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,GO,31.35,,,,,,,31.35,55.29,percent of total billed charges,
OT THER PROC GROUP-TECH,57469,CDM,430,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,GO,31.35,,,,,,,28.50,264.00,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,90,105.05,,,,,,,105.05,185.27,percent of total billed charges,
"ORGANIC ACIDS SCREEN, URINE (OAU) SO",57470,CDM,300,RC,83919,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,90,105.05,,,,,,,17.00,865.84,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,inpatient,1,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,42023011625,NDC,facility,outpatient,1,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,5.69,11.04,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001207,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,inpatient,1,EA,10.90000,10.36000,Amish/Mennonite,Amish Mennonite,,6.00,,,,,,,6.00,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001211,NDC,facility,outpatient,1,EA,10.90000,10.36000,Amish/Mennonite,Amish Mennonite,,6.00,,,,,,,5.45,10.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 1 ML,57471,CDM,250,RC,J2590,HCPCS,63323001212,NDC,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,58.85,103.79,percent of total billed charges,
OVA & PARASITES SMEARS-TECH,57472,CDM,300,RC,87177,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,8.90,458.40,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,GO,58.30,,,,,,,58.30,102.82,percent of total billed charges,
OT THER EXERCISE EA 15MIN-TECH,57474,CDM,430,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,GO,58.30,,,,,,,53.00,264.00,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,inpatient,1,EA,686.35000,652.03000,Amish/Mennonite,Amish Mennonite,,377.49,,,,,,,377.49,665.76,percent of total billed charges,
OXALIPLATIN 7910032,57475,CDM,250,RC,J9263,HCPCS,47335017640,NDC,facility,outpatient,1,EA,686.35000,652.03000,Amish/Mennonite,Amish Mennonite,,377.49,,,,,,,0.07595,665.76,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
PAP MANUAL UNDER PHYS SUPERVSN-TECH,57477,CDM,311,RC,88164,CPT,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,14.86,713.01,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GO,47.30,,,,,,,47.30,83.42,percent of total billed charges,
OT THER MASSAGE EA 15MIN-TECH,57478,CDM,430,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GO,47.30,,,,,,,43.00,264.00,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,inpatient,1,EA,24.43000,23.21000,Amish/Mennonite,Amish Mennonite,,13.44,,,,,,,13.44,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,00093-5733-01,NDC,,,facility,outpatient,1,EA,24.43000,23.21000,Amish/Mennonite,Amish Mennonite,,13.44,,,,,,,12.21,23.70,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,inpatient,1,EA,40.62000,38.59000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,22.34,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-10,NDC,,,facility,outpatient,1,EA,40.62000,38.59000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,20.31,39.40,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,inpatient,1,EA,55.18000,52.42000,Amish/Mennonite,Amish Mennonite,,30.35,,,,,,,30.35,53.52,percent of total billed charges,
OXYCODONE TAB-ER 40 MG,57479,CDM,250,RC,59011-0440-20,NDC,,,facility,outpatient,1,EA,55.18000,52.42000,Amish/Mennonite,Amish Mennonite,,30.35,,,,,,,27.59,53.52,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,inpatient,,,184.10000,174.89000,Amish/Mennonite,Amish Mennonite,90,101.25,,,,,,,101.25,178.58,percent of total billed charges,
OXYCODONE SCREENING SO-TECH,57480,CDM,300,RC,80365,CPT,,,facility,outpatient,,,184.10000,174.89000,Amish/Mennonite,Amish Mennonite,90,101.25,,,,,,,92.05,1137.41,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,inpatient,1,mL,853.63000,810.95000,Amish/Mennonite,Amish Mennonite,,469.50,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 20 ML,57481,CDM,636,RC,J9303,HCPCS,55513095601,NDC,facility,outpatient,1,mL,853.63000,810.95000,Amish/Mennonite,Amish Mennonite,,469.50,,,,,,,172.55,828.02,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,GO,55.55,,,,,,,55.55,97.97,percent of total billed charges,
OT WHEELCHAIR MGMT EA 15MIN-TECH,57482,CDM,430,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,GO,55.55,,,,,,,50.50,264.00,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,inpatient,1,mL,303.44000,288.27000,Amish/Mennonite,Amish Mennonite,,166.89,,,,,,,166.89,294.34,percent of total billed charges,
OFATUMUMAB INJ,57483,CDM,636,RC,J9302,HCPCS,00078069061,NDC,facility,outpatient,1,mL,303.44000,288.27000,Amish/Mennonite,Amish Mennonite,,166.89,,,,,,,62.23,294.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,inpatient,1,EA,7.65000,7.26000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,4.21,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,00093-5731-01,NDC,,,facility,outpatient,1,EA,7.65000,7.26000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,3.83,7.42,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,inpatient,1,EA,5.66000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0100-10,NDC,,,facility,outpatient,1,EA,5.66000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,2.83,5.49,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,inpatient,1,EA,16.85000,16.01000,Amish/Mennonite,Amish Mennonite,,9.27,,,,,,,9.27,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-10,NDC,,,facility,outpatient,1,EA,16.85000,16.01000,Amish/Mennonite,Amish Mennonite,,9.27,,,,,,,8.43,16.34,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,9.52,16.78,percent of total billed charges,
OXYCODONE TAB-ER 10 MG,57484,CDM,250,RC,59011-0410-20,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,8.65,16.78,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,inpatient,1,EA,66.39000,63.07000,Amish/Mennonite,Amish Mennonite,,36.51,,,,,,,36.51,64.40,percent of total billed charges,
OXYCODONE TAB-ER 80 MG,57485,CDM,250,RC,59011-0480-20,NDC,,,facility,outpatient,1,EA,66.39000,63.07000,Amish/Mennonite,Amish Mennonite,,36.51,,,,,,,33.20,64.40,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,inpatient,,,3486.00000,3311.70000,Amish/Mennonite,Amish Mennonite,TC,1917.30,,,,,,,1917.30,3381.42,percent of total billed charges,
PARATHYROID PLANAR SPECT-TECH,57486,CDM,340,RC,78071,CPT,,,facility,outpatient,,,3486.00000,3311.70000,Amish/Mennonite,Amish Mennonite,TC,1917.30,,,,,,,1598.89,3381.42,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
OR LEVEL 1,57487,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
BSS SOLN 15 ML IRRIGATION,57488,CDM,250,RC,00065-0795-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,inpatient,1,EA,31.42000,29.85000,Amish/Mennonite,Amish Mennonite,,17.28,,,,,,,17.28,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-10,NDC,,,facility,outpatient,1,EA,31.42000,29.85000,Amish/Mennonite,Amish Mennonite,,17.28,,,,,,,15.71,30.48,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,inpatient,1,EA,32.23000,30.62000,Amish/Mennonite,Amish Mennonite,,17.73,,,,,,,17.73,31.26,percent of total billed charges,
OXYCODONE TAB-ER 20 MG,57489,CDM,250,RC,59011-0420-20,NDC,,,facility,outpatient,1,EA,32.23000,30.62000,Amish/Mennonite,Amish Mennonite,,17.73,,,,,,,16.11,31.26,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,inpatient,1,EA,1372.70000,1304.06000,Amish/Mennonite,Amish Mennonite,,754.99,,,,,,,754.99,1331.52,percent of total billed charges,
OXALIPLATIN 7910033,57490,CDM,250,RC,J9263,HCPCS,47335017840,NDC,facility,outpatient,1,EA,1372.70000,1304.06000,Amish/Mennonite,Amish Mennonite,,754.99,,,,,,,0.07595,1331.52,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,inpatient,,,143.70000,136.51000,Amish/Mennonite,Amish Mennonite,90,79.03,,,,,,,79.03,139.39,percent of total billed charges,
OXYLATE ASSAY URORISK SO-TECH,57492,CDM,300,RC,83945,CPT,,,facility,outpatient,,,143.70000,136.51000,Amish/Mennonite,Amish Mennonite,90,79.03,,,,,,,14.93,679.08,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,inpatient,1,mL,343.87000,326.68000,Amish/Mennonite,Amish Mennonite,,189.13,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00024059010,NDC,facility,outpatient,1,mL,343.87000,326.68000,Amish/Mennonite,Amish Mennonite,,189.13,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,inpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00955173110,NDC,facility,outpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,00781931570,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,inpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,16729033203,NDC,facility,outpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,inpatient,1,mL,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,5.95,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47335004640,NDC,facility,outpatient,1,mL,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,0.07595,10.49,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,inpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,47781059122,NDC,facility,outpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,60505613206,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,inpatient,1,mL,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,9.56,16.86,percent of total billed charges,
OXALIPLATIN 7910400,57493,CDM,250,RC,J9263,HCPCS,61703036318,NDC,facility,outpatient,1,mL,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,0.07595,16.86,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,GO,60.50,,,,,,,60.50,106.70,percent of total billed charges,
OT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57494,CDM,430,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,GO,60.50,,,,,,,55.00,264.00,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,00904-5677-61,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,16714-0182-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,51079-0774-20,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,60505-0083-02,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,63739-0963-10,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
PAROXETINE TAB 7213325,57495,CDM,250,RC,68084-0045-11,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,inpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,162.25,286.15,percent of total billed charges,
OSMOTIC FRAGILITY INCUBATED-TECH,57496,CDM,300,RC,85557,CPT,,,facility,outpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,13.36,696.05,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00395-0094-16,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0302-16,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ORAL SUSPENDING COMPOUND SUSP,57497,CDM,250,RC,00574-0303-16,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,86.35,152.29,percent of total billed charges,
ORGANIC ACID SNGL QUANT-TECH,57499,CDM,300,RC,83921,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,21.21,1001.63,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,inpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00703409401,NDC,facility,outpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.72045,45.98,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,inpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,63323067389,NDC,facility,outpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,0.72045,30.65,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,00781341575,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.72045,9.20,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,inpatient,1,mL,178.67000,169.73000,Amish/Mennonite,Amish Mennonite,,98.27,,,,,,,98.27,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16714083401,NDC,facility,outpatient,1,mL,178.67000,169.73000,Amish/Mennonite,Amish Mennonite,,98.27,,,,,,,0.72045,173.31,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,inpatient,1,mL,154.58000,146.85000,Amish/Mennonite,Amish Mennonite,,85.02,,,,,,,85.02,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,16729036566,NDC,facility,outpatient,1,mL,154.58000,146.85000,Amish/Mennonite,Amish Mennonite,,85.02,,,,,,,0.72045,149.94,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,36000032602,NDC,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,0.72045,3.68,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,inpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,60505619301,NDC,facility,outpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,0.72045,11.04,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,inpatient,1,mL,286.30000,271.98000,Amish/Mennonite,Amish Mennonite,,157.47,,,,,,,157.47,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,62856079701,NDC,facility,outpatient,1,mL,286.30000,271.98000,Amish/Mennonite,Amish Mennonite,,157.47,,,,,,,0.72045,277.71,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,inpatient,1,mL,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,45.19,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,69097043935,NDC,facility,outpatient,1,mL,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,0.72045,79.70,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,inpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
PALONOSETRON SOLN 0.25 MG/5 ML,57500,CDM,250,RC,J2469,HCPCS,71288040905,NDC,facility,outpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,0.72045,5.52,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055201,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000110,NDC,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,inpatient,1,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00406055262,NDC,facility,outpatient,1,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904644461,NDC,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,inpatient,1,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,00904696661,NDC,facility,outpatient,1,EA,1.04000,0.98000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,10702001850,NDC,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,42858000101,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,57664022388,NDC,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,63739036510,NDC,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035401,NDC,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68084035411,NDC,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,inpatient,1,EA,1.36000,1.30000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
OXYCODONE TAB 5 MG,57501,CDM,250,RC,J8499,HCPCS,68308050547,NDC,facility,outpatient,1,EA,1.36000,1.30000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
OXYGEN UPTAKE W EX SIMPLE-TECH,57502,CDM,460,RC,94680,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,195.94,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,inpatient,500,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PARENTERAL NUTRITION SOL 7034770,57503,CDM,250,RC,00409-4164-03,NDC,,,facility,outpatient,500,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,inpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00172-4805-60,NDC,,,facility,outpatient,1,EA,2.03000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.01,1.97,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,00781-2810-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,inpatient,1,EA,5.73000,5.44000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,3.15,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-01,NDC,,,facility,outpatient,1,EA,5.73000,5.44000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,2.87,5.56,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
OXAZEPAM CAP 7631252,57504,CDM,250,RC,62584-0813-11,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,Amish/Mennonite,Amish Mennonite,90,262.35,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,Amish/Mennonite,Amish Mennonite,90,262.35,,,,,,,22.97,1087.31,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,inpatient,,,477.00000,453.15000,Amish/Mennonite,Amish Mennonite,,262.35,,,,,,,262.35,462.69,percent of total billed charges,
PANCREATIC ELASTASE FECAL SO-TECH,57505,CDM,300,RC,82653,CPT,,,facility,outpatient,,,477.00000,453.15000,Amish/Mennonite,Amish Mennonite,,262.35,,,,,,,22.97,1087.31,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,00703476881,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,inpatient,1,mL,5.46000,5.19000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,3.00,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,16714013701,NDC,facility,outpatient,1,mL,5.46000,5.19000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,0.17611,5.30,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,inpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,44567050601,NDC,facility,outpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,0.17611,6.07,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,inpatient,1,mL,4.51000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.48,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,61703034250,NDC,facility,outpatient,1,mL,4.51000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,0.17611,4.37,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,inpatient,1,mL,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,63323076350,NDC,facility,outpatient,1,mL,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,inpatient,1,mL,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,4.10,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860020050,NDC,facility,outpatient,1,mL,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,0.17611,7.24,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,inpatient,1,mL,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
PACLITAXEL INJECTION,57509,CDM,250,RC,J9267,HCPCS,70860021568,NDC,facility,outpatient,1,mL,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,0.17611,2.33,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,66993-0068-80,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,inpatient,1,EA,45.34000,43.07000,Amish/Mennonite,Amish Mennonite,,24.94,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00008-0841-81,NDC,,,facility,outpatient,1,EA,45.34000,43.07000,Amish/Mennonite,Amish Mennonite,,24.94,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00093-0012-98,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6474-61,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,00904-6870-45,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,50268-0639-15,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,51079-0051-20,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0813-09,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,63739-0564-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,65862-0560-99,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,inpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
PANTOPRAZOLE TAB-EC 40 MG,57510,CDM,250,RC,68084-0283-11,NDC,,,facility,outpatient,1,EA,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,inpatient,,,1058.00000,1005.10000,Amish/Mennonite,Amish Mennonite,,581.90,,,,,,,581.90,1026.26,percent of total billed charges,
OVA1-TECH,57512,CDM,300,RC,81503,CPT,,,facility,outpatient,,,1058.00000,1005.10000,Amish/Mennonite,Amish Mennonite,,581.90,,,,,,,529.00,42186.85,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,inpatient,1,mL,295.86000,281.06000,Amish/Mennonite,Amish Mennonite,,162.72,,,,,,,162.72,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00078066913,NDC,facility,outpatient,1,mL,295.86000,281.06000,Amish/Mennonite,Amish Mennonite,,162.72,,,,,,,62.23,286.98,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,inpatient,1,mL,261.75000,248.66000,Amish/Mennonite,Amish Mennonite,,143.96,,,,,,,143.96,253.90,percent of total billed charges,
OFATUMUMAB INJ 7910319,57513,CDM,636,RC,J9302,HCPCS,00173082133,NDC,facility,outpatient,1,mL,261.75000,248.66000,Amish/Mennonite,Amish Mennonite,,143.96,,,,,,,62.23,253.90,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,inpatient,,,4243.50000,4031.32000,Amish/Mennonite,Amish Mennonite,,2333.93,,,,,,,2079.32,4116.19,percent of total billed charges,
CONTROLLER NEUROSTIM HND HELD PRGMR WIRLSS PTM FOR PAIN.,57514,CDM,274,RC,C1787,HCPCS,,,facility,outpatient,,,4243.50000,4031.32000,Amish/Mennonite,Amish Mennonite,,2333.93,,,,,,,1947.77,4116.19,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,inpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,GO,92.95,,,,,,,92.95,163.93,percent of total billed charges,
OT RE-EVAL EST PLAN OF CARE-TECH,57515,CDM,430,RC,97168,CPT,,,facility,outpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,GO,92.95,,,,,,,84.50,264.00,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,inpatient,1,mL,5334.01000,5067.31000,Amish/Mennonite,Amish Mennonite,,2933.71,,,,,,,2933.71,5173.99,percent of total billed charges,
PALIPERIDONE SUSP 234 MG/1.5 ML (INVEGA SUSTENNA),57516,CDM,636,RC,J2426,HCPCS,50458056401,NDC,facility,outpatient,1,mL,5334.01000,5067.31000,Amish/Mennonite,Amish Mennonite,,2933.71,,,,,,,15.08,5173.99,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,inpatient,1,mL,65.43000,62.16000,Amish/Mennonite,Amish Mennonite,,35.99,,,,,,,35.99,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,00517400225,NDC,facility,outpatient,1,mL,65.43000,62.16000,Amish/Mennonite,Amish Mennonite,,35.99,,,,,,,32.72,63.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,inpatient,1,mL,59.25000,56.29000,Amish/Mennonite,Amish Mennonite,,32.59,,,,,,,32.59,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,14789012105,NDC,facility,outpatient,1,mL,59.25000,56.29000,Amish/Mennonite,Amish Mennonite,,32.59,,,,,,,29.62,57.47,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,inpatient,1,mL,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,28.24,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,54288014210,NDC,facility,outpatient,1,mL,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,25.68,49.81,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,inpatient,1,mL,61.40000,58.33000,Amish/Mennonite,Amish Mennonite,,33.77,,,,,,,33.77,59.56,percent of total billed charges,
PAPAVERINE SOL,57517,CDM,250,RC,J2440,HCPCS,72516002425,NDC,facility,outpatient,1,mL,61.40000,58.33000,Amish/Mennonite,Amish Mennonite,,33.77,,,,,,,30.70,59.56,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
PAPP-A-TECH,57518,CDM,300,RC,84163,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,15.05,780.94,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,inpatient,,,215.00000,204.25000,Amish/Mennonite,Amish Mennonite,,118.25,,,,,,,118.25,208.55,percent of total billed charges,
OVA AND PARA SPECIAL STAIN-TECH,57519,CDM,300,RC,87209,CPT,,,facility,outpatient,,,215.00000,204.25000,Amish/Mennonite,Amish Mennonite,,118.25,,,,,,,17.98,933.70,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00338002304,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 10% 1000 ML,57520,CDM,250,RC,J3490,HCPCS,00990793009,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,inpatient,1,EA,13.12000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.73,percent of total billed charges,
PANCRELIPASE CAP 7212038,57521,CDM,250,RC,00032-1212-01,NDC,,,facility,outpatient,1,EA,13.12000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,6.56,12.73,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,inpatient,,,264.90000,251.65000,Amish/Mennonite,Amish Mennonite,90,145.69,,,,,,,145.69,256.95,percent of total billed charges,
"PANCREATIC POLYPEPTIDE, PLASMA (HPP) SO",57522,CDM,300,RC,83519,CPT,,,facility,outpatient,,,264.90000,251.65000,Amish/Mennonite,Amish Mennonite,90,145.69,,,,,,,19.00,865.84,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,inpatient,120,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00065-0530-04,NDC,,,facility,outpatient,120,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,inpatient,120,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00536-1224-97,NDC,,,facility,outpatient,120,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,inpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,00904-6491-20,NDC,,,facility,outpatient,120,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,inpatient,120,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
OPHTH IRR EXTRAOCULAR SOL,57523,CDM,250,RC,10119-0002-52,NDC,,,facility,outpatient,120,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,inpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,130.90,230.86,percent of total billed charges,
PAP THIN PREP MANUAL-TECH,57524,CDM,311,RC,G0123,HCPCS,,,facility,outpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,20.26,230.86,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910513,57525,CDM,250,RC,00338-1123-04,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00172-4804-60,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,inpatient,1,EA,1.84000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,00781-2809-01,NDC,,,facility,outpatient,1,EA,1.84000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.72,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-01,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.47,4.79,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,inpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.36,percent of total billed charges,
OXAZEPAM CAP 7631302,57526,CDM,250,RC,62584-0812-11,NDC,,,facility,outpatient,1,EA,3.46000,3.29000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.36,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,Amish/Mennonite,Amish Mennonite,,24.22,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00004-0802-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,Amish/Mennonite,Amish Mennonite,,24.22,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,00527-4591-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,inpatient,1,EA,28.43000,27.01000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,16714-0817-01,NDC,,,facility,outpatient,1,EA,28.43000,27.01000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.21,27.58,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,inpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,31722-0630-31,NDC,,,facility,outpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.11,7.97,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,33342-0256-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,inpatient,1,EA,29.57000,28.10000,Amish/Mennonite,Amish Mennonite,,16.26,,,,,,,16.26,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,47781-0468-13,NDC,,,facility,outpatient,1,EA,29.57000,28.10000,Amish/Mennonite,Amish Mennonite,,16.26,,,,,,,14.79,28.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,inpatient,1,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,12.86,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,62332-0413-10,NDC,,,facility,outpatient,1,EA,23.38000,22.21000,Amish/Mennonite,Amish Mennonite,,12.86,,,,,,,11.69,22.68,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,inpatient,1,EA,32.62000,30.99000,Amish/Mennonite,Amish Mennonite,,17.94,,,,,,,17.94,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,63739-0038-07,NDC,,,facility,outpatient,1,EA,32.62000,30.99000,Amish/Mennonite,Amish Mennonite,,17.94,,,,,,,16.31,31.64,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,inpatient,1,EA,25.14000,23.88000,Amish/Mennonite,Amish Mennonite,,13.83,,,,,,,13.83,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,64380-0797-01,NDC,,,facility,outpatient,1,EA,25.14000,23.88000,Amish/Mennonite,Amish Mennonite,,13.83,,,,,,,12.57,24.39,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,68180-0675-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR CAP 7223739,57527,CDM,250,RC,72205-0042-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,inpatient,1,mL,10069.36000,9565.89000,Amish/Mennonite,Amish Mennonite,,5538.15,,,,,,,5538.15,9767.28,percent of total billed charges,
PEGASPARGASE INJECTION,57528,CDM,636,RC,J9266,HCPCS,72694095401,NDC,facility,outpatient,1,mL,10069.36000,9565.89000,Amish/Mennonite,Amish Mennonite,,5538.15,,,,,,,5034.68,46899.70,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,inpatient,15,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7006-35,NDC,,,facility,outpatient,15,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,inpatient,15,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,00904-7435-35,NDC,,,facility,outpatient,15,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,inpatient,15,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1159-01,NDC,,,facility,outpatient,15,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,inpatient,15,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,11523-1167-06,NDC,,,facility,outpatient,15,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,inpatient,15,EA,1.21000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 15 ML NASAL,57529,CDM,250,RC,41100-0811-27,NDC,,,facility,outpatient,15,EA,1.21000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,TC,2163.15,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLANAR SPECT&CT-TECH,57530,CDM,341,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,TC,2163.15,,,,,,,1966.50,3815.01,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,inpatient,30,EA,18.43000,17.51000,Amish/Mennonite,Amish Mennonite,,10.14,,,,,,,10.14,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00054-0522-44,NDC,,,facility,outpatient,30,EA,18.43000,17.51000,Amish/Mennonite,Amish Mennonite,,10.14,,,,,,,9.21,17.88,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,inpatient,30,EA,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.92,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00121-0826-01,NDC,,,facility,outpatient,30,EA,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.56,6.91,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,inpatient,30,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,6.37,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,00406-8557-30,NDC,,,facility,outpatient,30,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,5.79,11.24,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,inpatient,30,EA,17.80000,16.91000,Amish/Mennonite,Amish Mennonite,,9.79,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,68462-0347-37,NDC,,,facility,outpatient,30,EA,17.80000,16.91000,Amish/Mennonite,Amish Mennonite,,9.79,,,,,,,8.90,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,inpatient,30,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,66689-0025-30,NDC,,,facility,outpatient,30,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,inpatient,30,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,8.11,14.31,percent of total billed charges,
OXYCODONE CONC LIQ 20 MG/ML,57531,CDM,250,RC,71930-0023-30,NDC,,,facility,outpatient,30,EA,14.75000,14.01000,Amish/Mennonite,Amish Mennonite,,8.11,,,,,,,7.38,14.31,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,inpatient,1,mL,3.33000,3.17000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011601,NDC,facility,outpatient,1,mL,3.33000,3.17000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.67,3.23,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023011602,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,inpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,42023014101,NDC,facility,outpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,inpatient,1,mL,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
OXYTOCIN SOL,57532,CDM,250,RC,J2590,HCPCS,63323001210,NDC,facility,outpatient,1,mL,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,Amish/Mennonite,Amish Mennonite,,66.55,,,,,,,66.55,117.37,percent of total billed charges,
PARTICLE AGGLUT EA AB SCREEN-TECH,57533,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,Amish/Mennonite,Amish Mennonite,,66.55,,,,,,,11.54,543.22,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00093-1174-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,57237-0041-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,00781-1655-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,16714-0235-01,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 500 MG,57534,CDM,250,RC,67253-0201-10,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,inpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,203.50,358.90,percent of total billed charges,
PARATHORMONE ASSAY-TECH,57535,CDM,300,RC,83970,CPT,,,facility,outpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,41.28,2156.01,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,inpatient,1,mL,343.87000,326.68000,Amish/Mennonite,Amish Mennonite,,189.13,,,,,,,189.13,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00024059120,NDC,facility,outpatient,1,mL,343.87000,326.68000,Amish/Mennonite,Amish Mennonite,,189.13,,,,,,,0.07595,333.55,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,inpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47335004740,NDC,facility,outpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,0.07595,15.33,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,00781331780,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.07595,9.20,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,71288010120,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.07595,3.07,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,inpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,55150033201,NDC,facility,outpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,0.07595,7.66,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,inpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,25021023320,NDC,facility,outpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,0.07595,26.05,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,inpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,47781059229,NDC,facility,outpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,0.07595,11.04,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,60505613207,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.07595,6.13,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,inpatient,1,mL,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,61703036322,NDC,facility,outpatient,1,mL,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,0.07595,14.71,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,inpatient,1,mL,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72266016201,NDC,facility,outpatient,1,mL,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,0.07595,3.83,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,inpatient,1,mL,15.58000,14.80000,Amish/Mennonite,Amish Mennonite,,8.57,,,,,,,8.57,15.11,percent of total billed charges,
OXALIPLATIN,57537,CDM,250,RC,J9263,HCPCS,72603010101,NDC,facility,outpatient,1,mL,15.58000,14.80000,Amish/Mennonite,Amish Mennonite,,8.57,,,,,,,0.07595,15.11,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00264752020,NDC,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00338002302,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 10% 250 ML,57538,CDM,250,RC,J3490,HCPCS,00990793002,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,inpatient,,,3021.00000,2869.95000,Amish/Mennonite,Amish Mennonite,TC,1661.55,,,,,,,1661.55,2930.37,percent of total billed charges,
PARATHYROID PLANAR IMAGING-TECH,57539,CDM,340,RC,78070,CPT,,,facility,outpatient,,,3021.00000,2869.95000,Amish/Mennonite,Amish Mennonite,TC,1661.55,,,,,,,1390.09,2930.37,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,inpatient,1,EA,6.08000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,3.34,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,00074165801,NDC,facility,outpatient,1,EA,6.08000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,1.07,5.90,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
PARICALCITOL,57540,CDM,250,RC,J2501,HCPCS,16729031108,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,1.07,30.65,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,60505-1317-03,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,inpatient,1,EA,3.68000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,62175-0471-32,NDC,,,facility,outpatient,1,EA,3.68000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,inpatient,1,EA,14.71000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,8.09,14.27,percent of total billed charges,
PAROXETINE TAB 7224306,57541,CDM,250,RC,68180-0646-06,NDC,,,facility,outpatient,1,EA,14.71000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,7.36,14.27,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910510,57542,CDM,250,RC,00338-1137-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,inpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,21.45,37.83,percent of total billed charges,
PH BODY FLUID OTHER-TECH,57543,CDM,300,RC,83986,CPT,,,facility,outpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,3.58,186.75,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,inpatient,1,EA,2094.27000,1989.56000,Amish/Mennonite,Amish Mennonite,,1151.85,,,,,,,1151.85,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,00002764001,NDC,facility,outpatient,1,EA,2094.27000,1989.56000,Amish/Mennonite,Amish Mennonite,,1151.85,,,,,,,3.73,2031.44,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,inpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016610,NDC,facility,outpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,3.73,91.96,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,inpatient,1,EA,261.69000,248.61000,Amish/Mennonite,Amish Mennonite,,143.93,,,,,,,143.93,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,16729022903,NDC,facility,outpatient,1,EA,261.69000,248.61000,Amish/Mennonite,Amish Mennonite,,143.93,,,,,,,3.73,253.84,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,inpatient,1,EA,411.81000,391.22000,Amish/Mennonite,Amish Mennonite,,226.50,,,,,,,226.50,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,43598038662,NDC,facility,outpatient,1,EA,411.81000,391.22000,Amish/Mennonite,Amish Mennonite,,226.50,,,,,,,3.73,399.46,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,55150038101,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,inpatient,1,EA,38.55000,36.62000,Amish/Mennonite,Amish Mennonite,,21.20,,,,,,,21.20,37.39,percent of total billed charges,
PEMETREXED POWD-INJ 100 MG,57544,CDM,636,RC,J9305,HCPCS,71288016691,NDC,facility,outpatient,1,EA,38.55000,36.62000,Amish/Mennonite,Amish Mennonite,,21.20,,,,,,,3.73,37.39,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,inpatient,1,mL,29.56000,28.09000,Amish/Mennonite,Amish Mennonite,,16.26,,,,,,,16.26,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,67457044610,NDC,facility,outpatient,1,mL,29.56000,28.09000,Amish/Mennonite,Amish Mennonite,,16.26,,,,,,,14.78,28.67,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,inpatient,1,mL,11.33000,10.76000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,6.23,10.99,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7910211,57545,CDM,250,RC,J2430,HCPCS,61703032618,NDC,facility,outpatient,1,mL,11.33000,10.76000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,5.67,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,inpatient,1,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.69,8.27,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,67457043010,NDC,facility,outpatient,1,EA,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.26,23.04,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,55390012701,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,17.87,122.61,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,inpatient,1,EA,59.38000,56.41000,Amish/Mennonite,Amish Mennonite,,32.66,,,,,,,32.66,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,59923060110,NDC,facility,outpatient,1,EA,59.38000,56.41000,Amish/Mennonite,Amish Mennonite,,32.66,,,,,,,17.87,57.60,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,inpatient,1,EA,4.43000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.30,percent of total billed charges,
PAMIDRONATE DISODIUM /30 MG 7034762,57549,CDM,250,RC,J2430,HCPCS,61703032418,NDC,facility,outpatient,1,EA,4.43000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.21,23.04,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,inpatient,30,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00054-3682-63,NDC,,,facility,outpatient,30,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,inpatient,30,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,00406-8555-50,NDC,,,facility,outpatient,30,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0024-16,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,inpatient,30,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYCODONE LIQ 1 MG/ML,57550,CDM,250,RC,66689-0403-16,NDC,,,facility,outpatient,30,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,inpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,10135062001,NDC,facility,outpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.00,1.95,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42192080101,NDC,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,42937070110,NDC,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,75826011410,NDC,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,65162068110,NDC,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,inpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029201,NDC,facility,outpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.85,3.59,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
PHENAZOPYRIDINE TAB 100 MG,57551,CDM,250,RC,J8499,HCPCS,68084029211,NDC,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,inpatient,1,EA,40.20000,38.19000,Amish/Mennonite,Amish Mennonite,,22.11,,,,,,,22.11,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,00049052083,NDC,facility,outpatient,1,EA,40.20000,38.19000,Amish/Mennonite,Amish Mennonite,,22.11,,,,,,,1.20,38.99,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,inpatient,1,EA,13.78000,13.09000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,7.58,13.37,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834815,57552,CDM,250,RC,J2540,HCPCS,44567031110,NDC,facility,outpatient,1,EA,13.78000,13.09000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,1.20,13.37,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,inpatient,1,EA,374.26000,355.54000,Amish/Mennonite,Amish Mennonite,,205.84,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,13925052201,NDC,facility,outpatient,1,EA,374.26000,355.54000,Amish/Mennonite,Amish Mennonite,,205.84,,,,,,,123.22,363.03,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,inpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,156.42,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,39822303002,NDC,facility,outpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,123.22,275.87,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,inpatient,1,EA,432.25000,410.63000,Amish/Mennonite,Amish Mennonite,,237.74,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD INH 300 MG,57554,CDM,250,RC,J2545,HCPCS,63323087715,NDC,facility,outpatient,1,EA,432.25000,410.63000,Amish/Mennonite,Amish Mennonite,,237.74,,,,,,,123.22,419.28,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-0046-70,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.28,6.36,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,inpatient,1,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-01,NDC,,,facility,outpatient,1,EA,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.29,6.37,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,inpatient,1,EA,6.25000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.06,percent of total billed charges,
PANCRELIPASE CAP 7212037,57555,CDM,250,RC,00032-1206-07,NDC,,,facility,outpatient,1,EA,6.25000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.12,6.06,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,inpatient,,,1466.00000,1392.70000,Amish/Mennonite,Amish Mennonite,,806.30,,,,,,,806.30,1422.02,percent of total billed charges,
PATH CONS&REPRT COMPREHENSIVE-TECH,57559,CDM,310,RC,88325,CPT,,,facility,outpatient,,,1466.00000,1392.70000,Amish/Mennonite,Amish Mennonite,,806.30,,,,,,,162.71,7221.66,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,inpatient,1,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641608801,NDC,facility,outpatient,1,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,0.00310,3.46,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,inpatient,1,EA,16.68000,15.85000,Amish/Mennonite,Amish Mennonite,,9.17,,,,,,,9.17,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614201,NDC,facility,outpatient,1,EA,16.68000,15.85000,Amish/Mennonite,Amish Mennonite,,9.17,,,,,,,0.00310,16.18,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00641614225,NDC,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,0.00310,12.26,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,00703163101,NDC,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.00310,1.23,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,25021031501,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.00310,9.20,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,inpatient,1,EA,7.84000,7.44000,Amish/Mennonite,Amish Mennonite,,4.31,,,,,,,4.31,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,10019016339,NDC,facility,outpatient,1,EA,7.84000,7.44000,Amish/Mennonite,Amish Mennonite,,4.31,,,,,,,0.00310,7.60,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,71288080702,NDC,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.00310,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,inpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,55150030025,NDC,facility,outpatient,1,EA,8.22000,7.81000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,0.00310,7.97,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,inpatient,1,EA,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.45,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,61990021103,NDC,facility,outpatient,1,EA,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,0.00310,7.85,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,inpatient,1,EA,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,63323075113,NDC,facility,outpatient,1,EA,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,0.00310,9.81,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,inpatient,1,EA,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.82,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70069080125,NDC,facility,outpatient,1,EA,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,0.00310,6.74,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,inpatient,1,EA,12.33000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,6.78,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70121157705,NDC,facility,outpatient,1,EA,12.33000,11.71000,Amish/Mennonite,Amish Mennonite,,6.78,,,,,,,0.00310,11.96,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,inpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70594006302,NDC,facility,outpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,0.00310,8.43,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,inpatient,1,EA,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,70756062125,NDC,facility,outpatient,1,EA,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,0.00310,5.15,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,inpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,72485050425,NDC,facility,outpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,0.00310,5.82,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
PHENYLEPHRINE SOLN 10 MG/ML,57560,CDM,250,RC,J2371,HCPCS,81284021125,NDC,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,0.00310,4.91,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,inpatient,2,EA,359.05000,341.10000,Amish/Mennonite,Amish Mennonite,,197.48,,,,,,,197.48,348.28,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 2 ML",57561,CDM,636,RC,J0561,HCPCS,60793070110,NDC,facility,outpatient,2,EA,359.05000,341.10000,Amish/Mennonite,Amish Mennonite,,197.48,,,,,,,29.30,348.28,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,Amish/Mennonite,Amish Mennonite,TC,7940.90,,,,,,,7940.90,14004.86,percent of total billed charges,
PET W CT SKULL BASE-MID-THIGH-TECH,57562,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,Amish/Mennonite,Amish Mennonite,TC,7940.90,,,,,,,4549.00,14004.86,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,inpatient,1,EA,8369.01000,7950.56000,Amish/Mennonite,Amish Mennonite,,4602.96,,,,,,,4602.96,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00002762301,NDC,facility,outpatient,1,EA,8369.01000,7950.56000,Amish/Mennonite,Amish Mennonite,,4602.96,,,,,,,3.73,8117.94,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,inpatient,1,EA,1289.41000,1224.94000,Amish/Mennonite,Amish Mennonite,,709.18,,,,,,,709.18,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,00409106101,NDC,facility,outpatient,1,EA,1289.41000,1224.94000,Amish/Mennonite,Amish Mennonite,,709.18,,,,,,,3.73,1250.73,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,inpatient,1,EA,1179.64000,1120.66000,Amish/Mennonite,Amish Mennonite,,648.80,,,,,,,648.80,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,16729023011,NDC,facility,outpatient,1,EA,1179.64000,1120.66000,Amish/Mennonite,Amish Mennonite,,648.80,,,,,,,3.73,1144.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,inpatient,1,EA,2053.87000,1951.18000,Amish/Mennonite,Amish Mennonite,,1129.63,,,,,,,1129.63,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,43598038711,NDC,facility,outpatient,1,EA,2053.87000,1951.18000,Amish/Mennonite,Amish Mennonite,,1129.63,,,,,,,3.73,1992.25,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,712.25,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,55150038201,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,3.73,1256.15,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016750,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,3.73,376.85,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,inpatient,1,EA,166.28000,157.97000,Amish/Mennonite,Amish Mennonite,,91.45,,,,,,,91.45,161.29,percent of total billed charges,
PEMETREXED POWD-INJ 500 MG,57563,CDM,636,RC,J9305,HCPCS,71288016795,NDC,facility,outpatient,1,EA,166.28000,157.97000,Amish/Mennonite,Amish Mennonite,,91.45,,,,,,,3.73,161.29,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,inpatient,100,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-73,NDC,,,facility,outpatient,100,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,inpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
PENICILLIN V POTASSIUM LIQ 50 MG/ML,57565,CDM,250,RC,00093-4127-74,NDC,,,facility,outpatient,100,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
PARVOVIRUS AB-TECH,57566,CDM,300,RC,86747,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,15.03,780.94,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
PERMETHRIN TOPICAL CREAM,57567,CDM,250,RC,45802-0269-37,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,inpatient,2,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 15 ML,57569,CDM,250,RC,70756-0649-35,NDC,,,facility,outpatient,2,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND EA 15MIN-TECH,57571,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,21.00,264.00,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,inpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,10135062101,NDC,facility,outpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,42937070210,NDC,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,51293081101,NDC,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,65162068210,NDC,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,inpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
PHENAZOPYRIDINE TAB 200 MG,57572,CDM,250,RC,J8499,HCPCS,75826011510,NDC,facility,outpatient,1,EA,4.93000,4.68000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.78,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,00904-5448-61,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,51079-0889-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,60505-0033-06,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
PENTOXIFYLLINE TAB,57573,CDM,250,RC,68682-0101-10,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,inpatient,1,EA,16.04000,15.24000,Amish/Mennonite,Amish Mennonite,,8.82,,,,,,,8.82,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008400110,NDC,facility,outpatient,1,EA,16.04000,15.24000,Amish/Mennonite,Amish Mennonite,,8.82,,,,,,,8.02,15.56,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,70095002402,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,inpatient,1,EA,5.16000,4.90000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00008200125,NDC,facility,outpatient,1,EA,5.16000,4.90000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,inpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143928410,NDC,facility,outpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,10.27,19.92,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00143930010,NDC,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,inpatient,1,EA,15.48000,14.71000,Amish/Mennonite,Amish Mennonite,,8.51,,,,,,,8.51,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,00781323295,NDC,facility,outpatient,1,EA,15.48000,14.71000,Amish/Mennonite,Amish Mennonite,,8.51,,,,,,,7.74,15.02,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,25021075110,NDC,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,inpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,8.35,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,62756012944,NDC,facility,outpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,7.59,14.73,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,inpatient,1,EA,14.16000,13.45000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.79,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,65219043315,NDC,facility,outpatient,1,EA,14.16000,13.45000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.08,13.74,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,inpatient,1,EA,9.39000,8.92000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,5.16,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71288060011,NDC,facility,outpatient,1,EA,9.39000,8.92000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,4.70,9.11,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,inpatient,1,EA,14.06000,13.36000,Amish/Mennonite,Amish Mennonite,,7.73,,,,,,,7.73,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,71839012210,NDC,facility,outpatient,1,EA,14.06000,13.36000,Amish/Mennonite,Amish Mennonite,,7.73,,,,,,,7.03,13.64,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,inpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.90,13.94,percent of total billed charges,
PANTOPRAZOLE POWD-INJ 40 MG,57574,CDM,250,RC,J2470,HCPCS,72603012810,NDC,facility,outpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.18,13.94,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,13107-0154-30,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,00904-6109-61,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,50268-0640-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,inpatient,1,EA,1.92000,1.82000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,63739-0888-10,NDC,,,facility,outpatient,1,EA,1.92000,1.82000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96000,1.86,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
PAROXETINE TAB 7213326,57575,CDM,250,RC,68084-0044-11,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,inpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910511,57576,CDM,250,RC,00338-1147-03,NDC,,,facility,outpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,inpatient,10,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,05446154410,NDC,facility,outpatient,10,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,0.00310,2.30,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,inpatient,10,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,24200009150,NDC,facility,outpatient,10,EA,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,0.00310,3.61,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,69374095710,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.00310,1.53,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,inpatient,10,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,70092104646,NDC,facility,outpatient,10,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.00310,1.50,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,inpatient,10,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 10 ML,57577,CDM,250,RC,J2371,HCPCS,71266901101,NDC,facility,outpatient,10,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.00310,1.64,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,inpatient,,,14531.00000,13804.45000,Amish/Mennonite,Amish Mennonite,TC,7992.05,,,,,,,7992.05,14095.07,percent of total billed charges,
PET IMG METAB EVAL MYOCARD-TECH,57578,CDM,404,RC,78459,CPT,,,facility,outpatient,,,14531.00000,13804.45000,Amish/Mennonite,Amish Mennonite,TC,7992.05,,,,,,,4549.00,14095.07,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
PARENTERAL NUTRITION SOL 7910512,57579,CDM,250,RC,00338-1099-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
PHOSPHORUS URINE ASSAY-TECH,57580,CDM,300,RC,84105,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,5.78,271.65,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,Amish/Mennonite,Amish Mennonite,TC,7948.60,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W CT WHOLE BODY-TECH,57581,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,Amish/Mennonite,Amish Mennonite,TC,7948.60,,,,,,,4549.00,14018.44,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-67,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,00472-5242-69,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,49348-0150-78,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
PERMETHRIN TOPICAL LOTION,57583,CDM,250,RC,63736-0120-02,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,00093-1172-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,16714-0234-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,57237-0040-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PENICILLIN V POTASSIUM TAB 250 MG,57584,CDM,250,RC,65862-0175-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
PHENOBARBITAL ASSAY-TECH,57586,CDM,300,RC,80184,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,15.30,713.01,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
PHENYLEPHRINE OPHTHALMIC SOL 7910464,57587,CDM,250,RC,70756-0614-30,NDC,,,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,inpatient,1,EA,4.30000,4.08000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.17,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047621,NDC,facility,outpatient,1,EA,4.30000,4.08000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.15,50.75,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,inpatient,1,EA,83.28000,79.11000,Amish/Mennonite,Amish Mennonite,,45.80,,,,,,,45.80,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,00641047625,NDC,facility,outpatient,1,EA,83.28000,79.11000,Amish/Mennonite,Amish Mennonite,,45.80,,,,,,,41.64,80.78,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,inpatient,1,EA,55.30000,52.53000,Amish/Mennonite,Amish Mennonite,,30.41,,,,,,,30.41,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,14789012705,NDC,facility,outpatient,1,EA,55.30000,52.53000,Amish/Mennonite,Amish Mennonite,,30.41,,,,,,,27.65,53.64,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,inpatient,1,EA,68.95000,65.50000,Amish/Mennonite,Amish Mennonite,,37.92,,,,,,,37.92,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,42494041525,NDC,facility,outpatient,1,EA,68.95000,65.50000,Amish/Mennonite,Amish Mennonite,,37.92,,,,,,,34.48,66.88,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,inpatient,1,EA,67.94000,64.54000,Amish/Mennonite,Amish Mennonite,,37.37,,,,,,,37.37,65.90,percent of total billed charges,
PHENOBARBITAL SOL,57588,CDM,636,RC,J2560,HCPCS,54288013610,NDC,facility,outpatient,1,EA,67.94000,64.54000,Amish/Mennonite,Amish Mennonite,,37.37,,,,,,,33.97,65.90,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,inpatient,2,EA,18.41000,17.49000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,00998-0204-15,NDC,,,facility,outpatient,2,EA,18.41000,17.49000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,9.21,17.86,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,inpatient,2,EA,16.48000,15.66000,Amish/Mennonite,Amish Mennonite,,9.06,,,,,,,9.06,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,17478-0224-12,NDC,,,facility,outpatient,2,EA,16.48000,15.66000,Amish/Mennonite,Amish Mennonite,,9.06,,,,,,,8.24,15.99,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,inpatient,2,EA,16.99000,16.14000,Amish/Mennonite,Amish Mennonite,,9.34,,,,,,,9.34,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,61314-0204-15,NDC,,,facility,outpatient,2,EA,16.99000,16.14000,Amish/Mennonite,Amish Mennonite,,9.34,,,,,,,8.49,16.48,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,inpatient,2,EA,13.59000,12.91000,Amish/Mennonite,Amish Mennonite,,7.47,,,,,,,7.47,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,69238-1746-08,NDC,,,facility,outpatient,2,EA,13.59000,12.91000,Amish/Mennonite,Amish Mennonite,,7.47,,,,,,,6.79,13.18,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,inpatient,2,EA,15.99000,15.19000,Amish/Mennonite,Amish Mennonite,,8.79,,,,,,,8.79,15.51,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 2% 15 ML,57589,CDM,250,RC,70069-0191-01,NDC,,,facility,outpatient,2,EA,15.99000,15.19000,Amish/Mennonite,Amish Mennonite,,8.79,,,,,,,8.00,15.51,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00121-0942-16,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,inpatient,30,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,00603-1508-58,NDC,,,facility,outpatient,30,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,inpatient,30,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,13517-0107-16,NDC,,,facility,outpatient,30,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,inpatient,30,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,16571-0675-16,NDC,,,facility,outpatient,30,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
PHENOBARBITAL ELIXIR,57591,CDM,250,RC,54932-0501-81,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,inpatient,1,mL,853.63000,810.95000,Amish/Mennonite,Amish Mennonite,,469.50,,,,,,,469.50,828.02,percent of total billed charges,
PANITUMUMAB SOLN 20 MG/ML 5 ML,57592,CDM,636,RC,J9303,HCPCS,55513095401,NDC,facility,outpatient,1,mL,853.63000,810.95000,Amish/Mennonite,Amish Mennonite,,469.50,,,,,,,172.55,828.02,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00603-5166-21,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,00904-6575-61,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,13517-0111-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PHENOBARBITAL TAB,57595,CDM,250,RC,16571-0673-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,inpatient,1,EA,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00071-0007-40,NDC,,,facility,outpatient,1,EA,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.60,5.03,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,inpatient,1,EA,4.13000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.27,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,00904-7199-07,NDC,,,facility,outpatient,1,EA,4.13000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.06,4.01,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51079-0129-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,51672-4146-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
PHENYTOIN TAB,57596,CDM,250,RC,60687-0156-25,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,inpatient,2,EA,6.93000,6.58000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.81,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,11098051002,NDC,facility,outpatient,2,EA,6.93000,6.58000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.46,6.72,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,inpatient,2,EA,123.69000,117.51000,Amish/Mennonite,Amish Mennonite,,68.03,,,,,,,68.03,119.98,percent of total billed charges,
PHYSOSTIGMINE SOLN-INJ 1 MG/ML 2 ML,57598,CDM,250,RC,J3490,HCPCS,17478051002,NDC,facility,outpatient,2,EA,123.69000,117.51000,Amish/Mennonite,Amish Mennonite,,68.03,,,,,,,61.84,119.98,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,inpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,,93.50,,,,,,,93.50,164.90,percent of total billed charges,
PHENYTOIN TOTAL ASSAY-TECH,57599,CDM,300,RC,80185,CPT,,,facility,outpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,,93.50,,,,,,,13.25,696.05,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC-TECH,57600,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,122.40,495.67,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,inpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,,132.55,,,,,,,132.55,233.77,percent of total billed charges,
PLATELET AGGREGATION EA AGENT-TECH,57603,CDM,300,RC,85576,CPT,,,facility,outpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,,132.55,,,,,,,24.91,2082.45,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-10,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00573-2871-93,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
PHENYLEPHRINE TOPICAL OINT,57604,CDM,250,RC,00713-0298-31,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,inpatient,1,mL,19.60000,18.62000,Amish/Mennonite,Amish Mennonite,,10.78,,,,,,,10.78,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,00998-0203-15,NDC,,,facility,outpatient,1,mL,19.60000,18.62000,Amish/Mennonite,Amish Mennonite,,10.78,,,,,,,9.80,19.01,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,inpatient,1,mL,16.11000,15.31000,Amish/Mennonite,Amish Mennonite,,8.86,,,,,,,8.86,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,17478-0223-12,NDC,,,facility,outpatient,1,mL,16.11000,15.31000,Amish/Mennonite,Amish Mennonite,,8.86,,,,,,,8.05,15.63,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,inpatient,1,mL,16.61000,15.78000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,9.14,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,61314-0203-15,NDC,,,facility,outpatient,1,mL,16.61000,15.78000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,8.30,16.11,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,inpatient,1,mL,13.28000,12.62000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,7.30,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,69238-1745-08,NDC,,,facility,outpatient,1,mL,13.28000,12.62000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,6.64,12.88,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,inpatient,1,mL,15.63000,14.85000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,8.60,15.16,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 15 ML,57605,CDM,250,RC,70069-0181-01,NDC,,,facility,outpatient,1,mL,15.63000,14.85000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,7.82,15.16,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,inpatient,1,mL,151.84000,144.25000,Amish/Mennonite,Amish Mennonite,,83.51,,,,,,,83.51,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,00641047725,NDC,facility,outpatient,1,mL,151.84000,144.25000,Amish/Mennonite,Amish Mennonite,,83.51,,,,,,,43.80,147.28,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,inpatient,1,mL,167.67000,159.29000,Amish/Mennonite,Amish Mennonite,,92.22,,,,,,,92.22,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494041625,NDC,facility,outpatient,1,mL,167.67000,159.29000,Amish/Mennonite,Amish Mennonite,,92.22,,,,,,,43.80,162.64,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,inpatient,1,mL,106.18000,100.87000,Amish/Mennonite,Amish Mennonite,,58.40,,,,,,,58.40,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,42494044225,NDC,facility,outpatient,1,mL,106.18000,100.87000,Amish/Mennonite,Amish Mennonite,,58.40,,,,,,,43.80,102.99,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,inpatient,1,mL,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,95.59,168.59,percent of total billed charges,
PHENOBARBITAL SOL 7910239,57606,CDM,636,RC,J2560,HCPCS,54288013710,NDC,facility,outpatient,1,mL,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,43.80,168.59,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,inpatient,5,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641255545,NDC,facility,outpatient,5,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,inpatient,5,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
PHENYTOIN SODIUM INJ,57607,CDM,250,RC,J1165,HCPCS,00641613925,NDC,facility,outpatient,5,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,1.09,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,inpatient,,,510.82000,485.28000,Amish/Mennonite,Amish Mennonite,,280.95,,,,,,,280.95,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,CPT,,,facility,outpatient,,,510.82000,485.28000,Amish/Mennonite,Amish Mennonite,,280.95,,,,,,,255.41,495.50,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,inpatient,1,mL,1021.64000,970.56000,Amish/Mennonite,Amish Mennonite,,561.90,,,,,,,561.90,990.99,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 13-VALENT SUSP-INJ (PREVNAR 13)",57608,CDM,250,RC,90670,HCPCS,00005197105,NDC,facility,outpatient,1,mL,1021.64000,970.56000,Amish/Mennonite,Amish Mennonite,,561.90,,,,,,,399.88,990.99,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00093-2048-56,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,00781-5420-92,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,65862-0512-30,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,16729-0020-15,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,inpatient,1,EA,5.13000,4.87000,Amish/Mennonite,Amish Mennonite,,2.82,,,,,,,2.82,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,51079-0513-20,NDC,,,facility,outpatient,1,EA,5.13000,4.87000,Amish/Mennonite,Amish Mennonite,,2.82,,,,,,,2.56,4.98,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,57237-0219-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,60687-0391-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-04,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,inpatient,1,EA,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,22.51,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,64764-0151-05,NDC,,,facility,outpatient,1,EA,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,20.46,39.70,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
PIOGLITAZONE TAB 7213119,57609,CDM,250,RC,68084-0878-01,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,54162-0597-05,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM OINT 100% 5 GM,57610,CDM,250,RC,57896-0164-14,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
PHENYLALANINE PKU BLOOD-TECH,57611,CDM,300,RC,84030,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.50,288.61,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6366.00000,6047.70000,Amish/Mennonite,Amish Mennonite,TC,3501.30,,,,,,,3501.30,6175.02,percent of total billed charges,
POLYSOM 6+YRS 4+PA W/CPAP-TECH,57612,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6366.00000,6047.70000,Amish/Mennonite,Amish Mennonite,TC,3501.30,,,,,,,1929.64,6175.02,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,inpatient,1,EA,41.77000,39.68000,Amish/Mennonite,Amish Mennonite,,22.97,,,,,,,22.97,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,00069-3230-66,NDC,,,facility,outpatient,1,EA,41.77000,39.68000,Amish/Mennonite,Amish Mennonite,,22.97,,,,,,,20.89,40.52,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,inpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,29033-0013-01,NDC,,,facility,outpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,inpatient,1,EA,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,42543-0115-01,NDC,,,facility,outpatient,1,EA,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.60,3.11,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
PIROXICAM CAP,57613,CDM,250,RC,51079-0743-20,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,inpatient,,,41.50000,39.42000,Amish/Mennonite,Amish Mennonite,90,22.82,,,,,,,22.82,40.26,percent of total billed charges,
PH FOR URORISK PANEL SO-TECH,57614,CDM,300,RC,83986,CPT,,,facility,outpatient,,,41.50000,39.42000,Amish/Mennonite,Amish Mennonite,90,22.82,,,,,,,3.70,186.75,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,inpatient,1,mL,1207.45000,1147.08000,Amish/Mennonite,Amish Mennonite,,664.10,,,,,,,664.10,1171.23,percent of total billed charges,
PERTUZUMAB SOLN  30 MG/ML 14 ML,57617,CDM,636,RC,J9306,HCPCS,50242014501,NDC,facility,outpatient,1,mL,1207.45000,1147.08000,Amish/Mennonite,Amish Mennonite,,664.10,,,,,,,16.89,1171.23,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,inpatient,2,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 1% 2 ML,57619,CDM,250,RC,00065-0728-12,NDC,,,facility,outpatient,2,EA,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,3.79,7.35,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,inpatient,,,762.00000,723.90000,Amish/Mennonite,Amish Mennonite,,419.10,,,,,,,419.10,739.14,percent of total billed charges,
PLC PERQ DEV BRST ADDL US IMG-TECH,57621,CDM,361,RC,19286,CPT,,,facility,outpatient,,,762.00000,723.90000,Amish/Mennonite,Amish Mennonite,,419.10,,,,,,,419.10,5271.00,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,661.50,1309.50,percent of total billed charges,
ANCHOR SUT L19.5MM DIA3.5MM BIO PSHLCK,57622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,619.65,1350.00,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,inpatient,2,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00143988225,NDC,facility,outpatient,2,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,0.80910,2.09,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,inpatient,2,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641049325,NDC,facility,outpatient,2,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,0.80910,1.94,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,inpatient,2,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
PHENYTOIN SODIUM INJ 7002033,57623,CDM,250,RC,J1165,HCPCS,00641613825,NDC,facility,outpatient,2,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,inpatient,1,EA,160.78000,152.74000,Amish/Mennonite,Amish Mennonite,,88.43,,,,,,,88.43,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053022,NDC,facility,outpatient,1,EA,160.78000,152.74000,Amish/Mennonite,Amish Mennonite,,88.43,,,,,,,1.20,155.96,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,inpatient,1,EA,159.99000,151.99000,Amish/Mennonite,Amish Mennonite,,87.99,,,,,,,87.99,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,00049053028,NDC,facility,outpatient,1,EA,159.99000,151.99000,Amish/Mennonite,Amish Mennonite,,87.99,,,,,,,1.20,155.19,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,inpatient,1,EA,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,95.59,168.59,percent of total billed charges,
PENICILLIN G POTASSIUM INJ 7834831,57624,CDM,250,RC,J2540,HCPCS,70860012751,NDC,facility,outpatient,1,EA,173.80000,165.11000,Amish/Mennonite,Amish Mennonite,,95.59,,,,,,,1.20,168.59,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00074-7804-13,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,66758-0170-13,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00245-0057-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0524-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,inpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00378-4561-77,NDC,,,facility,outpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.71500,1.39,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00574-0275-11,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00832-5324-11,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7085-61,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,00904-7292-61,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,60687-0466-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,63739-0972-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 10 MEQ,57625,CDM,250,RC,68084-0632-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,inpatient,1,EA,26.02000,24.71000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,14.31,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-2636-01,NDC,,,facility,outpatient,1,EA,26.02000,24.71000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,13.01,25.24,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,inpatient,1,EA,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,14.08,24.83,percent of total billed charges,
PANCRELIPASE CAP 7212039,57626,CDM,250,RC,00032-1224-07,NDC,,,facility,outpatient,1,EA,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,12.80,24.83,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,inpatient,1,EA,12.84000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,7.06,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206350101,NDC,facility,outpatient,1,EA,12.84000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,1.73,12.45,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,inpatient,1,EA,32.55000,30.92000,Amish/Mennonite,Amish Mennonite,,17.90,,,,,,,17.90,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00206885408,NDC,facility,outpatient,1,EA,32.55000,30.92000,Amish/Mennonite,Amish Mennonite,,17.90,,,,,,,1.73,31.57,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,inpatient,1,EA,37.72000,35.83000,Amish/Mennonite,Amish Mennonite,,20.75,,,,,,,20.75,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409337813,NDC,facility,outpatient,1,EA,37.72000,35.83000,Amish/Mennonite,Amish Mennonite,,20.75,,,,,,,1.73,36.59,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,inpatient,1,EA,33.04000,31.39000,Amish/Mennonite,Amish Mennonite,,18.17,,,,,,,18.17,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00409338513,NDC,facility,outpatient,1,EA,33.04000,31.39000,Amish/Mennonite,Amish Mennonite,,18.17,,,,,,,1.73,32.05,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,inpatient,1,EA,43.77000,41.58000,Amish/Mennonite,Amish Mennonite,,24.07,,,,,,,24.07,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781311390,NDC,facility,outpatient,1,EA,43.77000,41.58000,Amish/Mennonite,Amish Mennonite,,24.07,,,,,,,1.73,42.46,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,inpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.95,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,00781921395,NDC,facility,outpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,1.73,15.78,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,44567080210,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,1.73,33.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,inpatient,1,EA,36.59000,34.76000,Amish/Mennonite,Amish Mennonite,,20.12,,,,,,,20.12,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,55150012030,NDC,facility,outpatient,1,EA,36.59000,34.76000,Amish/Mennonite,Amish Mennonite,,20.12,,,,,,,1.73,35.49,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,inpatient,1,EA,23.18000,22.02000,Amish/Mennonite,Amish Mennonite,,12.75,,,,,,,12.75,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,60505615704,NDC,facility,outpatient,1,EA,23.18000,22.02000,Amish/Mennonite,Amish Mennonite,,12.75,,,,,,,1.73,22.48,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,inpatient,1,EA,18.01000,17.11000,Amish/Mennonite,Amish Mennonite,,9.91,,,,,,,9.91,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323030036,NDC,facility,outpatient,1,EA,18.01000,17.11000,Amish/Mennonite,Amish Mennonite,,9.91,,,,,,,1.73,17.47,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,inpatient,1,EA,43.83000,41.64000,Amish/Mennonite,Amish Mennonite,,24.11,,,,,,,24.11,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,63323098321,NDC,facility,outpatient,1,EA,43.83000,41.64000,Amish/Mennonite,Amish Mennonite,,24.11,,,,,,,1.73,42.52,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,inpatient,1,EA,36.43000,34.61000,Amish/Mennonite,Amish Mennonite,,20.04,,,,,,,20.04,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,64679005601,NDC,facility,outpatient,1,EA,36.43000,34.61000,Amish/Mennonite,Amish Mennonite,,20.04,,,,,,,1.73,35.34,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,65219043620,NDC,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,1.73,12.26,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,inpatient,1,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.92,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,71288000331,NDC,facility,outpatient,1,EA,16.21000,15.40000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,1.73,15.72,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,inpatient,1,EA,23.07000,21.91000,Amish/Mennonite,Amish Mennonite,,12.69,,,,,,,12.69,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,72485040310,NDC,facility,outpatient,1,EA,23.07000,21.91000,Amish/Mennonite,Amish Mennonite,,12.69,,,,,,,1.73,22.38,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,inpatient,1,EA,16.12000,15.31000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,8.87,15.64,percent of total billed charges,
PIPERACILLIN/TAZOBACTAM 7855794,57627,CDM,250,RC,J2543,HCPCS,81284015210,NDC,facility,outpatient,1,EA,16.12000,15.31000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,1.73,15.64,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,inpatient,237,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00071-2214-20,NDC,,,facility,outpatient,237,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,inpatient,237,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,00472-0067-08,NDC,,,facility,outpatient,237,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,inpatient,237,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,66689-0775-08,NDC,,,facility,outpatient,237,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,inpatient,237,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
PHENYTOIN SUSP,57629,CDM,250,RC,60432-0131-08,NDC,,,facility,outpatient,237,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,inpatient,,,14477.00000,13753.15000,Amish/Mennonite,Amish Mennonite,TC,7962.35,,,,,,,7962.35,14042.69,percent of total billed charges,
PET W CT LIMITED AREA-TECH,57630,CDM,404,RC,78814,CPT,,,facility,outpatient,,,14477.00000,13753.15000,Amish/Mennonite,Amish Mennonite,TC,7962.35,,,,,,,4549.00,14042.69,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,57.20,100.88,percent of total billed charges,
PLASMA FRESH FROZEN-TECH,57631,CDM,300,RC,86927,CPT,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,52.00,967.70,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,69536-0025-15,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324239,57633,CDM,250,RC,00225-0800-47,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
POTASSIUM SERUM ASSAY-TECH,57634,CDM,300,RC,84132,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,4.76,237.65,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,00093-2047-56,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,33342-0055-07,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,inpatient,1,EA,10.26000,9.75000,Amish/Mennonite,Amish Mennonite,,5.64,,,,,,,5.64,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,51079-0514-20,NDC,,,facility,outpatient,1,EA,10.26000,9.75000,Amish/Mennonite,Amish Mennonite,,5.64,,,,,,,5.13,9.95,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-14,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96000,1.86,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,inpatient,1,EA,62.55000,59.42000,Amish/Mennonite,Amish Mennonite,,34.40,,,,,,,34.40,60.67,percent of total billed charges,
PIOGLITAZONE TAB 7214232,57635,CDM,250,RC,64764-0301-15,NDC,,,facility,outpatient,1,EA,62.55000,59.42000,Amish/Mennonite,Amish Mennonite,,34.40,,,,,,,31.27,60.67,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,30.80,54.32,percent of total billed charges,
PINWORM EXAM-TECH,57636,CDM,300,RC,87172,CPT,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,4.27,220.68,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,inpatient,20,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818301,NDC,facility,outpatient,20,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,inpatient,20,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,00409818325,NDC,facility,outpatient,20,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,inpatient,20,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
POTASSIUM ACETATE SOLN-INJ 2 MEQ/ML 20 ML,57637,CDM,250,RC,J3490,HCPCS,51754200104,NDC,facility,outpatient,20,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,inpatient,,,522.00000,495.90000,Amish/Mennonite,Amish Mennonite,,287.10,,,,,,,287.10,506.34,percent of total billed charges,
PLC PERQ DEV BRST ADDL W IMG-TECH,57638,CDM,361,RC,19282,CPT,,,facility,outpatient,,,522.00000,495.90000,Amish/Mennonite,Amish Mennonite,,287.10,,,,,,,287.10,5271.00,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,inpatient,17,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00574-0412-07,NDC,,,facility,outpatient,17,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-13,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,inpatient,17,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6422-81,NDC,,,facility,outpatient,17,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,inpatient,17,EA,4.92000,4.67000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-26,NDC,,,facility,outpatient,17,EA,4.92000,4.67000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.77,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,inpatient,17,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,00904-6931-76,NDC,,,facility,outpatient,17,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,inpatient,17,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7234-05,NDC,,,facility,outpatient,17,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,inpatient,17,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-03,NDC,,,facility,outpatient,17,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,inpatient,17,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,11523-7268-08,NDC,,,facility,outpatient,17,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,inpatient,17,EA,6.49000,6.16000,Amish/Mennonite,Amish Mennonite,,3.57,,,,,,,3.57,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,45802-0868-66,NDC,,,facility,outpatient,17,EA,6.49000,6.16000,Amish/Mennonite,Amish Mennonite,,3.57,,,,,,,3.25,6.30,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,inpatient,17,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,51079-0306-30,NDC,,,facility,outpatient,17,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.62,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,inpatient,17,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,57896-0490-03,NDC,,,facility,outpatient,17,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,inpatient,17,EA,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,60687-0431-98,NDC,,,facility,outpatient,17,EA,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.66,5.16,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,inpatient,17,EA,4.22000,4.01000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,62559-0157-10,NDC,,,facility,outpatient,17,EA,4.22000,4.01000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.11,4.09,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,inpatient,17,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,63739-0198-61,NDC,,,facility,outpatient,17,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,inpatient,17,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,68084-0430-98,NDC,,,facility,outpatient,17,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,inpatient,17,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.46,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER,57639,CDM,250,RC,69784-0180-30,NDC,,,facility,outpatient,17,EA,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.46,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,inpatient,,,130.70000,124.16000,Amish/Mennonite,Amish Mennonite,90,71.89,,,,,,,71.89,126.78,percent of total billed charges,
PORPHOBILINOGEN URINE QUANT SO,57640,CDM,300,RC,84110,CPT,,,facility,outpatient,,,130.70000,124.16000,Amish/Mennonite,Amish Mennonite,90,71.89,,,,,,,8.72,441.37,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,inpatient,30,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372250,NDC,facility,outpatient,30,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,0.00620,2.05,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,inpatient,30,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7426406,57641,CDM,250,RC,J7512,HCPCS,00054372263,NDC,facility,outpatient,30,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.00620,1.90,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,inpatient,,,206.80000,196.46000,Amish/Mennonite,Amish Mennonite,90,113.74,,,,,,,113.74,200.60,percent of total billed charges,
PROINSULIN ASSAY (PINS) SO,57642,CDM,300,RC,84206,CPT,,,facility,outpatient,,,206.80000,196.46000,Amish/Mennonite,Amish Mennonite,90,113.74,,,,,,,25.05,1256.24,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
PHOSPHORUS ASSAY-TECH,57643,CDM,300,RC,84100,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,4.74,254.68,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,inpatient,1,EA,154.75000,147.01000,Amish/Mennonite,Amish Mennonite,,85.11,,,,,,,85.11,150.11,percent of total billed charges,
PHYTONADIONE SOL,57644,CDM,250,RC,00409-9158-01-01000,NDC,,,facility,outpatient,1,EA,154.75000,147.01000,Amish/Mennonite,Amish Mennonite,,85.11,,,,,,,77.38,150.11,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,inpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,253.00,446.20,percent of total billed charges,
PLETHYSMOGRAPHY LUNG VOLS-TECH,57645,CDM,460,RC,94726,CPT,,,facility,outpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,230.00,446.20,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,100.10,176.54,percent of total billed charges,
POOLING PLT/OTHR BLD PRODUCTS-TECH,57646,CDM,300,RC,86965,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,91.00,1595.82,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,inpatient,1,EA,35.55000,33.77000,Amish/Mennonite,Amish Mennonite,,19.55,,,,,,,19.55,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70594004901,NDC,facility,outpatient,1,EA,35.55000,33.77000,Amish/Mennonite,Amish Mennonite,,19.55,,,,,,,17.77,34.48,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,inpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,9.56,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,47781059691,NDC,facility,outpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,8.69,16.86,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,55150023410,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,inpatient,1,EA,31.57000,29.99000,Amish/Mennonite,Amish Mennonite,,17.36,,,,,,,17.36,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323032110,NDC,facility,outpatient,1,EA,31.57000,29.99000,Amish/Mennonite,Amish Mennonite,,17.36,,,,,,,15.79,30.62,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,63323036711,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,inpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,70860010310,NDC,facility,outpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.22,27.59,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,inpatient,1,EA,30.21000,28.70000,Amish/Mennonite,Amish Mennonite,,16.62,,,,,,,16.62,29.30,percent of total billed charges,
"POLYMYXIN B SULFATE POWD-INJ 500,000 UNITS",57648,CDM,250,RC,J3490,HCPCS,72266024910,NDC,facility,outpatient,1,EA,30.21000,28.70000,Amish/Mennonite,Amish Mennonite,,16.62,,,,,,,15.11,29.30,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00536-1271-80,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,inpatient,30,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00603-0599-50,NDC,,,facility,outpatient,30,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,inpatient,30,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
POVIDONE IODINE OPHTH SOL 7107048,57649,CDM,250,RC,00904-1102-31,NDC,,,facility,outpatient,30,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,inpatient,15,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00024-1353-01,NDC,,,facility,outpatient,15,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,inpatient,15,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
PHENYLEPHRINE NASAL SOL 7324247,57650,CDM,250,RC,00225-0805-47,NDC,,,facility,outpatient,15,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
POTASSIUM URINE ASSAY-TECH,57651,CDM,300,RC,84133,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,4.73,220.68,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,inpatient,30,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,13925016604,NDC,facility,outpatient,30,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,0.43227,2.01,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,inpatient,30,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
PREDNISOLONE ORAL,57652,CDM,250,RC,J7510,HCPCS,5038300400403000,NDC,facility,outpatient,30,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,0.43227,2.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,1132.00000,1075.40000,Amish/Mennonite,Amish Mennonite,,622.60,,,,,,,622.60,1098.04,percent of total billed charges,
PLT PHERESIS LR IRRAD EA UNIT,57653,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,1132.00000,1075.40000,Amish/Mennonite,Amish Mennonite,,622.60,,,,,,,566.00,1098.04,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,2386.00000,2266.70000,Amish/Mennonite,Amish Mennonite,,1312.30,,,,,,,1312.30,2314.42,percent of total billed charges,
PLT PHERESIS LR EA UNIT,57654,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,2386.00000,2266.70000,Amish/Mennonite,Amish Mennonite,,1312.30,,,,,,,462.52,2314.42,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001820,NDC,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.00620,0.69840,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00054001825,NDC,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.00620,0.45590,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00143147701,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.00620,0.20370,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59746017506,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.00620,0.57230,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00603533928,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.00620,0.58200,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,00904712761,NDC,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,59651048801,NDC,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,60687014501,NDC,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.00620,0.60140,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,63739020910,NDC,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.00620,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,inpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISONE TAB 20 MG,57655,CDM,250,RC,J7512,HCPCS,70954006020,NDC,facility,outpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.00620,0.26190,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,inpatient,1,EA,273.97000,260.27000,Amish/Mennonite,Amish Mennonite,,150.68,,,,,,,150.68,265.75,percent of total billed charges,
PRALIDOXIME CHLORIDE INJ,57656,CDM,250,RC,J2730,HCPCS,60977014127,NDC,facility,outpatient,1,EA,273.97000,260.27000,Amish/Mennonite,Amish Mennonite,,150.68,,,,,,,136.99,265.75,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,inpatient,1,EA,48.35000,45.93000,Amish/Mennonite,Amish Mennonite,,26.59,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,00002-5121-30,NDC,,,facility,outpatient,1,EA,48.35000,45.93000,Amish/Mennonite,Amish Mennonite,,26.59,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 7212062,57658,CDM,250,RC,60505-4642-03,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.30,2.53,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00781183001,NDC,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.06640,1.16,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904646161,NDC,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.06640,0.35890,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,00904730461,NDC,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.06640,0.46560,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,inpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,63739021310,NDC,facility,outpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.06640,1.31,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,inpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,65162052110,NDC,facility,outpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.06640,0.61110,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68084015501,NDC,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.06640,1.26,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
PROMETHAZINE TAB 7219736,57660,CDM,250,RC,Q0169,HCPCS,68382004101,NDC,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.06640,0.40740,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
PREALBUMIN ASSAY-TECH,57661,CDM,300,RC,84134,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,7.85,763.98,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00245531901,NDC,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532511,NDC,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00832532515,NDC,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904708661,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,00904729361,NDC,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,60687075609,NDC,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63304098701,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,inpatient,1,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044701,NDC,facility,outpatient,1,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,inpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739044710,NDC,facility,outpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,inpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,63739097310,NDC,facility,outpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,68084036009,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,69238106901,NDC,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
POTASSIUM CHLORIDE TAB-ER 20 MEQ,57662,CDM,250,RC,J8499,HCPCS,70010013505,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,inpatient,15,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00121-1680-40,NDC,,,facility,outpatient,15,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,inpatient,15,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,00904-7061-87,NDC,,,facility,outpatient,15,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,inpatient,15,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,43598-0891-52,NDC,,,facility,outpatient,15,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,inpatient,15,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,50268-0674-15,NDC,,,facility,outpatient,15,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,inpatient,15,EA,2.93000,2.79000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,60687-0628-71,NDC,,,facility,outpatient,15,EA,2.93000,2.79000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.47,2.84,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,inpatient,15,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-30,NDC,,,facility,outpatient,15,EA,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.45,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,inpatient,15,EA,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,66689-0047-50,NDC,,,facility,outpatient,15,EA,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,inpatient,15,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0220-52,NDC,,,facility,outpatient,15,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
POTASSIUM CHLORIDE LIQUID,57663,CDM,250,RC,81033-0412-50,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,00486-1125-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,64980-0104-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,68084-0764-25,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
POTASSIUM PHOSPHATE TAB,57664,CDM,250,RC,69543-0268-10,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,inpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,96.80,170.72,percent of total billed charges,
PROLACTIN ASSAY-TECH,57665,CDM,300,RC,84146,CPT,,,facility,outpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,19.38,1018.59,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,inpatient,,,6058.00000,5755.10000,Amish/Mennonite,Amish Mennonite,TC,3331.90,,,,,,,3331.90,5876.26,percent of total billed charges,
POLYSOM 6+YRS 4+ PA-TECH,57666,CDM,920,RC,95810,CPT,,,facility,outpatient,,,6058.00000,5755.10000,Amish/Mennonite,Amish Mennonite,TC,3331.90,,,,,,,1929.64,5876.26,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,inpatient,30,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 30 ML,57667,CDM,250,RC,00065-0411-30,NDC,,,facility,outpatient,30,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,10572-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0050-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,inpatient,4000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,43386-0060-19,NDC,,,facility,outpatient,4000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0100-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0302-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0400-01,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,inpatient,4000,EA,40.07000,38.07000,Amish/Mennonite,Amish Mennonite,,22.04,,,,,,,22.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,52268-0700-01,NDC,,,facility,outpatient,4000,EA,40.07000,38.07000,Amish/Mennonite,Amish Mennonite,,22.04,,,,,,,20.04,38.87,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,inpatient,4000,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,64380-0769-21,NDC,,,facility,outpatient,4000,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,inpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL POWDER 7425101,57668,CDM,250,RC,68220-0131-04,NDC,,,facility,outpatient,4000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,inpatient,,,101.70000,96.61000,Amish/Mennonite,Amish Mennonite,90,55.94,,,,,,,55.94,98.65,percent of total billed charges,
PLASMINOGEN ACTIVITY PLASMA-TECH,57669,CDM,300,RC,85420,CPT,,,facility,outpatient,,,101.70000,96.61000,Amish/Mennonite,Amish Mennonite,90,55.94,,,,,,,6.75,339.51,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,inpatient,1,mL,29.09000,27.64000,Amish/Mennonite,Amish Mennonite,,16.00,,,,,,,16.00,28.22,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,00409190201,NDC,facility,outpatient,1,mL,29.09000,27.64000,Amish/Mennonite,Amish Mennonite,,16.00,,,,,,,14.54,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,inpatient,1,mL,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,14789090110,NDC,facility,outpatient,1,mL,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,47.40,472.00,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,inpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
PROCAINAMIDE HCL INJ,57670,CDM,250,RC,J2690,HCPCS,76329339905,NDC,facility,outpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,13.43,472.00,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
PLATELET COUNT AUTO-TECH,57671,CDM,300,RC,85049,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,4.48,237.65,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-01,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00832-5322-11,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CHLORIDE TAB 7220718,57672,CDM,250,RC,00245-0040-89,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,inpatient,,,1267.00000,1203.65000,Amish/Mennonite,Amish Mennonite,,696.85,,,,,,,696.85,1228.99,percent of total billed charges,
PLC PERQ DEV BRST 1ST US IMG-TECH,57673,CDM,361,RC,19285,CPT,,,facility,outpatient,,,1267.00000,1203.65000,Amish/Mennonite,Amish Mennonite,,696.85,,,,,,,668.09,3163.00,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00054001720,NDC,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.00620,0.64990,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00143147301,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.00620,0.12610,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00603533831,NDC,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,0.00620,2.11,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,inpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,00904692361,NDC,facility,outpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,60687013401,NDC,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.00620,0.54320,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,inpatient,1,EA,0.61000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,63739051910,NDC,facility,outpatient,1,EA,0.61000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.00620,0.59170,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
PREDNISONE TAB 10 MG,57674,CDM,250,RC,J7512,HCPCS,70954005910,NDC,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.00620,0.24250,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,00904-6704-61,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,13668-0092-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,51079-0577-01,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,57237-0181-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,60687-0570-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB,57675,CDM,250,RC,68462-0331-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,110.00,194.00,percent of total billed charges,
PROGESTERONE ASSAY-TECH,57676,CDM,300,RC,84144,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,20.86,1086.52,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,inpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,75.35,132.89,percent of total billed charges,
PROTEIN C ANTIGEN-TECH,57677,CDM,300,RC,85302,CPT,,,facility,outpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,12.01,628.12,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00143-1484-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,00527-1231-01,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,inpatient,1,EA,1.14000,1.09000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,65162-0545-10,NDC,,,facility,outpatient,1,EA,1.14000,1.09000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,inpatient,1,EA,2.06000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,50268-0687-15,NDC,,,facility,outpatient,1,EA,2.06000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.03,2.00,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,68084-0203-11,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
PRIMIDONE TAB 7218282,57678,CDM,250,RC,72888-0046-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,inpatient,,,264.28000,251.07000,Amish/Mennonite,Amish Mennonite,,145.35,,,,,,,145.35,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,CPT,,,facility,outpatient,,,264.28000,251.07000,Amish/Mennonite,Amish Mennonite,,145.35,,,,,,,132.14,256.35,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,inpatient,0.5,EA,528.55000,502.12000,Amish/Mennonite,Amish Mennonite,,290.70,,,,,,,290.70,512.69,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 23-VALENT SOLN (PNEUMOVAX 23)",57679,CDM,250,RC,90732,HCPCS,00006494301,NDC,facility,outpatient,0.5,EA,528.55000,502.12000,Amish/Mennonite,Amish Mennonite,,290.70,,,,,,,206.88,512.69,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,inpatient,30,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121075908,NDC,facility,outpatient,30,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,inpatient,30,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,00121088508,NDC,facility,outpatient,30,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,0.43227,2.23,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,inpatient,30,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,42799081501,NDC,facility,outpatient,30,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,inpatient,30,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004224,NDC,facility,outpatient,30,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,inpatient,30,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,50383004248,NDC,facility,outpatient,30,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,inpatient,30,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,58177093205,NDC,facility,outpatient,30,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,inpatient,30,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,60432021208,NDC,facility,outpatient,30,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.79680,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,inpatient,30,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,62135025047,NDC,facility,outpatient,30,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,0.43227,3.68,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,inpatient,30,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISOLONE LIQUID,57680,CDM,250,RC,J7510,HCPCS,69238212209,NDC,facility,outpatient,30,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.79680,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,inpatient,1,EA,48.35000,45.93000,Amish/Mennonite,Amish Mennonite,,26.59,,,,,,,26.59,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00002512377,NDC,facility,outpatient,1,EA,48.35000,45.93000,Amish/Mennonite,Amish Mennonite,,26.59,,,,,,,24.18,46.90,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00378518693,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,inpatient,1,EA,58.39000,55.47000,Amish/Mennonite,Amish Mennonite,,32.11,,,,,,,32.11,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,00713088230,NDC,facility,outpatient,1,EA,58.39000,55.47000,Amish/Mennonite,Amish Mennonite,,32.11,,,,,,,29.20,56.64,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,inpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,65862083030,NDC,facility,outpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.30,2.53,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
PRASUGREL TAB 10 MG,57681,CDM,250,RC,J8499,HCPCS,67877060530,NDC,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00143986922,NDC,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641092821,NDC,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,inpatient,1,EA,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,3.21,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641149535,NDC,facility,outpatient,1,EA,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,2.92,5.66,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,inpatient,1,EA,2.25000,2.13000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095521,NDC,facility,outpatient,1,EA,2.25000,2.13000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,inpatient,1,EA,5.52000,5.24000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.35,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641095525,NDC,facility,outpatient,1,EA,5.52000,5.24000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,2.76,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,inpatient,1,EA,6.74000,6.40000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.71,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608403,NDC,facility,outpatient,1,EA,6.74000,6.40000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.37,6.54,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,inpatient,1,EA,10.16000,9.65000,Amish/Mennonite,Amish Mennonite,,5.59,,,,,,,5.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,00641608425,NDC,facility,outpatient,1,EA,10.16000,9.65000,Amish/Mennonite,Amish Mennonite,,5.59,,,,,,,4.59,9.86,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550002,NDC,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,5.49,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PROMETHAZINE SOLN 25 MG/ML,57683,CDM,250,RC,J2550,HCPCS,39822550003,NDC,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,inpatient,,,173.90000,165.20000,Amish/Mennonite,Amish Mennonite,90,95.64,,,,,,,95.64,168.68,percent of total billed charges,
PORPHYRINS URINE QUANT FRACT (8562) SO,57684,CDM,300,RC,84120,CPT,,,facility,outpatient,,,173.90000,165.20000,Amish/Mennonite,Amish Mennonite,90,95.64,,,,,,,15.20,763.98,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,inpatient,15,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00409729501,NDC,facility,outpatient,15,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.03,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,inpatient,15,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,00517231525,NDC,facility,outpatient,15,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,inpatient,15,EA,7.88000,7.48000,Amish/Mennonite,Amish Mennonite,,4.33,,,,,,,4.33,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,46287002410,NDC,facility,outpatient,15,EA,7.88000,7.48000,Amish/Mennonite,Amish Mennonite,,4.33,,,,,,,3.94,7.64,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,inpatient,15,EA,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.51,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,63323008615,NDC,facility,outpatient,15,EA,6.38000,6.06000,Amish/Mennonite,Amish Mennonite,,3.51,,,,,,,3.19,6.19,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,inpatient,15,EA,10.10000,9.60000,Amish/Mennonite,Amish Mennonite,,5.55,,,,,,,5.55,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,65219005429,NDC,facility,outpatient,15,EA,10.10000,9.60000,Amish/Mennonite,Amish Mennonite,,5.55,,,,,,,5.05,9.80,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,inpatient,15,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN-INJ 3 MMOL/ML 15 ML,57685,CDM,250,RC,J3490,HCPCS,80830169102,NDC,facility,outpatient,15,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,inpatient,1,EA,1154.70000,1096.96000,Amish/Mennonite,Amish Mennonite,,635.09,,,,,,,635.09,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,00143956401,NDC,facility,outpatient,1,EA,1154.70000,1096.96000,Amish/Mennonite,Amish Mennonite,,635.09,,,,,,,436.51,1120.06,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,inpatient,1,EA,1087.28000,1032.92000,Amish/Mennonite,Amish Mennonite,,598.00,,,,,,,598.00,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,68094010120,NDC,facility,outpatient,1,EA,1087.28000,1032.92000,Amish/Mennonite,Amish Mennonite,,598.00,,,,,,,436.51,1054.66,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,inpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,213.68,376.85,percent of total billed charges,
PHENTOLAINE MESYLATE INJ,57686,CDM,636,RC,J2760,HCPCS,55390011301,NDC,facility,outpatient,1,EA,388.50000,369.08000,Amish/Mennonite,Amish Mennonite,,213.68,,,,,,,194.25,745.84,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,inpatient,10,EA,16.66000,15.82000,Amish/Mennonite,Amish Mennonite,,9.16,,,,,,,9.16,16.16,percent of total billed charges,
PREDNISOLONE OPHTH SODIUM PHOSPHATE SOL,57687,CDM,250,RC,24208-0715-10,NDC,,,facility,outpatient,10,EA,16.66000,15.82000,Amish/Mennonite,Amish Mennonite,,9.16,,,,,,,8.33,16.16,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,inpatient,,,147.30000,139.94000,Amish/Mennonite,Amish Mennonite,90,81.02,,,,,,,81.02,142.88,percent of total billed charges,
PROCAINAMIDE W NAPA ASSAY SO-TECH,57688,CDM,300,RC,85652,CPT,,,facility,outpatient,,,147.30000,139.94000,Amish/Mennonite,Amish Mennonite,90,81.02,,,,,,,2.79,142.88,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00245-5326-30,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,00603-4170-16,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0001-40,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
POTASSIUM BICARBONATE TAB,57689,CDM,250,RC,51801-0007-30,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,inpatient,10,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,17478-0703-11,NDC,,,facility,outpatient,10,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,inpatient,10,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.87,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,24208-0315-10,NDC,,,facility,outpatient,10,EA,3.40000,3.23000,Amish/Mennonite,Amish Mennonite,,1.87,,,,,,,1.70,3.30,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,inpatient,10,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,60758-0908-10,NDC,,,facility,outpatient,10,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,inpatient,10,EA,3.27000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
POLYMYXIN B-TRIMETHOPRIM SOLN-OPHTH 10 ML,57690,CDM,250,RC,61314-0628-10,NDC,,,facility,outpatient,10,EA,3.27000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,inpatient,1,EA,27.53000,26.15000,Amish/Mennonite,Amish Mennonite,,15.14,,,,,,,15.14,26.70,percent of total billed charges,
PROCHLORPERAZINE SUPP,57691,CDM,250,RC,00713-0135-12,NDC,,,facility,outpatient,1,EA,27.53000,26.15000,Amish/Mennonite,Amish Mennonite,,15.14,,,,,,,13.77,26.70,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00093720198,NDC,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,00904589261,NDC,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,inpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,50268066615,NDC,facility,outpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,51079045820,NDC,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,60687017801,NDC,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63629916301,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
PRAVASTATIN TAB 20 MG,57692,CDM,250,RC,J8499,HCPCS,63739064910,NDC,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,inpatient,,,785.00000,745.75000,Amish/Mennonite,Amish Mennonite,,431.75,,,,,,,431.75,761.45,percent of total billed charges,
PLC PERQ DEV BRST 1ST W IMG-TECH,57693,CDM,401,RC,19281,CPT,,,facility,outpatient,,,785.00000,745.75000,Amish/Mennonite,Amish Mennonite,,431.75,,,,,,,392.50,1692.33,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00182-1814-89,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,00378-0184-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,69238-2079-01,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0664-15,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,50268-0702-15,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,51079-0279-20,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
PROPRANOLOL TAB 7217102,57694,CDM,250,RC,60687-0609-01,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,56.10,98.94,percent of total billed charges,
PROTEIN ELECTROPHORESIS SERUM-TECH,57695,CDM,300,RC,84165,CPT,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,10.74,1471.29,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
PREDNISOLONE-SULFACE SOD OPHTH SOD PHOSPHATE SOL,57696,CDM,250,RC,24208-0317-05,NDC,,,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,inpatient,118,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 7423593,57697,CDM,250,RC,Q0169,HCPCS,00603158454,NDC,facility,outpatient,118,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,inpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,16714097720,NDC,facility,outpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,inpatient,1,mL,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,00591213651,NDC,facility,outpatient,1,mL,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,inpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,23155034542,NDC,facility,outpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.14409,0.68870,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,inpatient,1,mL,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,25021060850,NDC,facility,outpatient,1,mL,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,inpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,43598054821,NDC,facility,outpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.14409,0.85360,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026950,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,63323026959,NDC,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,inpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
PROPOFOL 500 MG/50 ML,57698,CDM,250,RC,J2704,HCPCS,80830236408,NDC,facility,outpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.14409,0.55290,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,24.20,42.68,percent of total billed charges,
PRO TIME SUBSTITUTION-TECH,57699,CDM,300,RC,85611,CPT,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,3.94,203.72,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,inpatient,1,EA,31.98000,30.38000,Amish/Mennonite,Amish Mennonite,,17.59,,,,,,,17.59,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00071-1012-68,NDC,,,facility,outpatient,1,EA,31.98000,30.38000,Amish/Mennonite,Amish Mennonite,,17.59,,,,,,,15.99,31.02,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-04,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,00904-6991-61,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,60687-0473-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,62332-0119-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,64980-0410-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,69238-1310-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,72205-0011-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
PREGABALIN 25 MG CAP,57701,CDM,250,RC,76282-0568-90,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,inpatient,5,EA,59.96000,56.97000,Amish/Mennonite,Amish Mennonite,,32.98,,,,,,,32.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,00065-0638-27,NDC,,,facility,outpatient,5,EA,59.96000,56.97000,Amish/Mennonite,Amish Mennonite,,32.98,,,,,,,29.98,58.16,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,inpatient,5,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,15.30,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,70748-0332-02,NDC,,,facility,outpatient,5,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,13.90,26.98,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,inpatient,5,EA,27.97000,26.57000,Amish/Mennonite,Amish Mennonite,,15.38,,,,,,,15.38,27.13,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 5 ML,57702,CDM,250,RC,61314-0637-05,NDC,,,facility,outpatient,5,EA,27.97000,26.57000,Amish/Mennonite,Amish Mennonite,,15.38,,,,,,,13.98,27.13,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,inpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,GP,98.45,,,,,,,98.45,173.63,percent of total billed charges,
PT RE-EVAL EST PLAN OF CARE-TECH,57703,CDM,420,RC,97164,CPT,,,facility,outpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,GP,98.45,,,,,,,89.50,264.00,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00378-0156-01,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.50,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00527-1367-01,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.19,6.18,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,inpatient,1,EA,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,00591-5347-01,NDC,,,facility,outpatient,1,EA,1.88000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,1.82,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
PROBENECID TAB,57704,CDM,250,RC,10135-0541-01,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,Amish/Mennonite,Amish Mennonite,,16.94,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,51672-5297-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,Amish/Mennonite,Amish Mennonite,,16.94,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
PROMETHAZINE SUPP 7528847,57705,CDM,250,RC,45802-0759-00,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,inpatient,1,EA,4.52000,4.30000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,2.49,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00071-0369-40,NDC,,,facility,outpatient,1,EA,4.52000,4.30000,Amish/Mennonite,Amish Mennonite,,2.49,,,,,,,2.26,4.38,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,inpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,00904-6187-61,NDC,,,facility,outpatient,1,EA,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51079-0905-01,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,51672-4111-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,inpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,58151-0110-88,NDC,,,facility,outpatient,1,EA,6.04000,5.74000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.02,5.86,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,inpatient,1,EA,1.69000,1.61000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
PHENYTOIN CAP,57706,CDM,250,RC,68084-0376-01,NDC,,,facility,outpatient,1,EA,1.69000,1.61000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,140.80,248.32,percent of total billed charges,
PROCALCITONIN-TECH,57707,CDM,300,RC,84145,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,27.22,1392.10,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,inpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,00378-3205-01,NDC,,,facility,outpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.07,4.02,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,inpatient,1,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-01,NDC,,,facility,outpatient,1,EA,4.71000,4.48000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.35,4.57,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,inpatient,1,EA,11.34000,10.78000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,6.24,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,51079-0632-20,NDC,,,facility,outpatient,1,EA,11.34000,10.78000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,5.67,11.00,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,59762-5350-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,inpatient,1,EA,10.83000,10.29000,Amish/Mennonite,Amish Mennonite,,5.96,,,,,,,5.96,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,60687-0572-32,NDC,,,facility,outpatient,1,EA,10.83000,10.29000,Amish/Mennonite,Amish Mennonite,,5.96,,,,,,,5.42,10.51,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,66993-0433-85,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,inpatient,1,EA,1.92000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,70954-0021-10,NDC,,,facility,outpatient,1,EA,1.92000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96000,1.86,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
PRAZOSIN CAP 7218290,57708,CDM,250,RC,76282-0723-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,00054001920,NDC,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.00620,1.03,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,59651048901,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.00620,0.92150,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,inpatient,1,EA,1.42000,1.34000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219512,57709,CDM,250,RC,J7512,HCPCS,60687085401,NDC,facility,outpatient,1,EA,1.42000,1.34000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.00620,1.38,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,inpatient,30,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,00245000331,NDC,facility,outpatient,30,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,inpatient,30,EA,45.29000,43.03000,Amish/Mennonite,Amish Mennonite,,24.91,,,,,,,24.91,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,71740011230,NDC,facility,outpatient,30,EA,45.29000,43.03000,Amish/Mennonite,Amish Mennonite,,24.91,,,,,,,22.64,43.93,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,inpatient,30,EA,35.01000,33.26000,Amish/Mennonite,Amish Mennonite,,19.26,,,,,,,19.26,33.96,percent of total billed charges,
POTASSIUM IODIDE CONC LIQ 1000 MG/ML (SSKI) 30 ML,57710,CDM,250,RC,J8499,HCPCS,75834028030,NDC,facility,outpatient,30,EA,35.01000,33.26000,Amish/Mennonite,Amish Mennonite,,19.26,,,,,,,17.50,33.96,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
PROTEIN S FREE-TECH,57712,CDM,300,RC,85306,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,15.32,797.91,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,inpatient,2,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641049125,NDC,facility,outpatient,2,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,4.85,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,inpatient,2,EA,11.46000,10.89000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,6.30,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,00641613525,NDC,facility,outpatient,2,EA,11.46000,10.89000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,4.03,11.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,inpatient,2,EA,7.31000,6.94000,Amish/Mennonite,Amish Mennonite,,4.02,,,,,,,4.02,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155052341,NDC,facility,outpatient,2,EA,7.31000,6.94000,Amish/Mennonite,Amish Mennonite,,4.02,,,,,,,3.65,7.09,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,inpatient,2,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,23155029442,NDC,facility,outpatient,2,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,4.03,13.79,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,inpatient,2,EA,8.37000,7.96000,Amish/Mennonite,Amish Mennonite,,4.60,,,,,,,4.60,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,43066009025,NDC,facility,outpatient,2,EA,8.37000,7.96000,Amish/Mennonite,Amish Mennonite,,4.60,,,,,,,4.03,8.12,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,inpatient,2,EA,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,55390007710,NDC,facility,outpatient,2,EA,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,3.63,7.05,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,inpatient,2,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,16.08,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,67457064099,NDC,facility,outpatient,2,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,4.03,28.35,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,inpatient,2,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
PROCHLORPERAZINE SOLN 5 MG/ML 2 ML,57714,CDM,250,RC,J0780,HCPCS,70860077802,NDC,facility,outpatient,2,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,4.03,27.59,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,inpatient,1,mL,9.78000,9.29000,Amish/Mennonite,Amish Mennonite,,5.38,,,,,,,5.38,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022905,NDC,facility,outpatient,1,mL,9.78000,9.29000,Amish/Mennonite,Amish Mennonite,,5.38,,,,,,,2.17,9.49,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,inpatient,1,mL,7.05000,6.69000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.88,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022915,NDC,facility,outpatient,1,mL,7.05000,6.69000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,2.17,6.84,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,inpatient,1,mL,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,6.00,percent of total billed charges,
PROTAMINE SOL,57715,CDM,250,RC,J2720,HCPCS,63323022994,NDC,facility,outpatient,1,mL,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,2.17,6.00,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,inpatient,1,EA,5.66000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.49,percent of total billed charges,
PROTHROMBIN COMPLEX POWDER,57716,CDM,636,RC,J7168,HCPCS,63833038602,NDC,facility,outpatient,1,EA,5.66000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,2.14,5.49,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,inpatient,1,EA,17.88000,16.98000,Amish/Mennonite,Amish Mennonite,,9.83,,,,,,,9.83,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00003-5194-10,NDC,,,facility,outpatient,1,EA,17.88000,16.98000,Amish/Mennonite,Amish Mennonite,,9.83,,,,,,,8.94,17.34,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,00904-5893-61,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60505-0170-09,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,inpatient,1,EA,2.63000,2.49000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
PRAVASTATIN TAB 7224322,57717,CDM,250,RC,60687-0190-01,NDC,,,facility,outpatient,1,EA,2.63000,2.49000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,inpatient,15,EA,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,4.73,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,00998-0016-15,NDC,,,facility,outpatient,15,EA,8.60000,8.17000,Amish/Mennonite,Amish Mennonite,,4.73,,,,,,,4.30,8.34,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,24208-0730-06,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,inpatient,15,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,61314-0016-01,NDC,,,facility,outpatient,15,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,3.69,7.17,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,inpatient,15,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.16,percent of total billed charges,
PROPARACAINE OPHTH SOL,57718,CDM,250,RC,70069-0601-01,NDC,,,facility,outpatient,15,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,3.69,7.16,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
PSA FREE-TECH,57719,CDM,300,RC,84154,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,18.39,967.70,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,inpatient,1,EA,24.66000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,13.56,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00071-1013-68,NDC,,,facility,outpatient,1,EA,24.66000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,12.33,23.92,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,00904-6992-61,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,50228-0351-90,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,60687-0484-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,62332-0120-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,64980-0411-09,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,69238-1311-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,72205-0012-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PREGABALIN 50 MG CAP,57720,CDM,250,RC,76282-0569-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,GP,33.55,,,,,,,33.55,59.17,percent of total billed charges,
PT WND DEBRID 1ST 20 SQ CM-TECH,57721,CDM,420,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,GP,33.55,,,,,,,30.50,264.00,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,,105.93,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,,105.93,,,,,,,16.59,865.84,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,inpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,90,105.93,,,,,,,105.93,186.82,percent of total billed charges,
PRIMIDONE ASSAY SO -TECH,57722,CDM,300,RC,80188,CPT,,,facility,outpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,90,105.93,,,,,,,16.59,865.84,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,inpatient,20,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00069020910,NDC,facility,outpatient,20,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,inpatient,20,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00591213695,NDC,facility,outpatient,20,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.14409,0.87300,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,inpatient,20,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,00409601025,NDC,facility,outpatient,20,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.14409,0.65960,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,inpatient,20,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026929,NDC,facility,outpatient,20,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.14409,0.92150,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,inpatient,20,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,16714052810,NDC,facility,outpatient,20,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.14409,0.79540,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,inpatient,20,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,25021060820,NDC,facility,outpatient,20,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.14409,0.89240,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,inpatient,20,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,43598026558,NDC,facility,outpatient,20,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.14409,0.30070,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,inpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323026994,NDC,facility,outpatient,20,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.14409,0.36860,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,inpatient,20,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
PROPOFOL SOLN-INJ 10 MG/ML 20 ML,57723,CDM,250,RC,J2704,HCPCS,63323027025,NDC,facility,outpatient,20,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.14409,0.85360,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,GP,58.30,,,,,,,58.30,102.82,percent of total billed charges,
PT THER EXERCISE EA 15MIN-TECH,57724,CDM,420,RC,97110,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,GP,58.30,,,,,,,53.00,264.00,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00228-2779-11,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.10,6.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,00527-4117-37,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,42291-0523-01,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,inpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,43478-0901-88,NDC,,,facility,outpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.09,5.99,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,49884-0328-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,51991-0818-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.92,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.98,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,60687-0226-01,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.62,7.02,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0210-11,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.40,4.65,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,inpatient,1,EA,7.25000,6.89000,Amish/Mennonite,Amish Mennonite,,3.99,,,,,,,3.99,7.03,percent of total billed charges,
PROPRANOLOL CAP 7217276,57725,CDM,250,RC,68084-0504-01,NDC,,,facility,outpatient,1,EA,7.25000,6.89000,Amish/Mennonite,Amish Mennonite,,3.99,,,,,,,3.62,7.03,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
PROTEIN C ACTIVTY-TECH,57726,CDM,300,RC,85303,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,13.84,729.98,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,69238-2077-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-0411-61,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,00904-6550-61,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,50268-0662-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-20,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,51079-0277-19,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
PROPRANOLOL TAB 7217086,57727,CDM,250,RC,60687-0587-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,72.60,128.04,percent of total billed charges,
PROTEIN S TOTAL-TECH,57728,CDM,300,RC,85305,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,11.61,611.15,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,GP,29.15,,,,,,,29.15,51.41,percent of total billed charges,
PT MECH TRACTION-TECH,57730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,GP,29.15,,,,,,,26.50,264.00,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50111-0468-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00378-0183-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,inpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00591-5555-01,NDC,,,facility,outpatient,1,EA,1.09000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00603-5483-21,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,00904-6705-06,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0663-15,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,50268-0701-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,51079-0278-20,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0306-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.53,2.97,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,60687-0598-01,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
PROPRANOLOL TAB 7217094,57731,CDM,250,RC,71335-0082-05,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054472825,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.00620,0.55290,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,00054872425,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.00620,0.61110,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,59746017206,NDC,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.00620,0.47530,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,60687012201,NDC,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.00620,0.51410,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,63739051810,NDC,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.00620,0.53350,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219462,57734,CDM,250,RC,J7512,HCPCS,70954005810,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.00620,0.22310,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00378-1101-01,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,00904-7020-61,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-01,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,51079-0630-20,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.63,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,59762-5310-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,68084-0996-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70756-0429-11,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,70954-0019-10,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
PRAZOSIN CAP 7218183,57735,CDM,250,RC,76282-0721-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,inpatient,1,EA,9.73000,9.25000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,5.35,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00046-0470-81,NDC,,,facility,outpatient,1,EA,9.73000,9.25000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,4.87,9.44,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00228-2778-11,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.65,5.15,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,00527-4116-37,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0503-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,62559-0530-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
PROPRANOLOL CAP 7214927,57736,CDM,250,RC,68084-0209-11,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,inpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,GP,51.70,,,,,,,51.70,91.18,percent of total billed charges,
PT GAIT TRAINING EA 15MIN-TECH,57737,CDM,420,RC,97116,CPT,,,facility,outpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,GP,51.70,,,,,,,47.00,264.00,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,inpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,397.10,700.34,percent of total billed charges,
PUNC ASP CYST BRST-TECH,57738,CDM,361,RC,19000,CPT,,,facility,outpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,397.10,3163.00,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
PROTEIN TOTAL BODY FLUID-TECH,57739,CDM,300,RC,84157,CPT,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,4.00,186.75,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
PROTHROMBIN TIME-TECH,57740,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,4.29,203.72,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,GP,34.65,,,,,,,34.65,61.11,percent of total billed charges,
PT E-STIM MAN EA 15MIN-TECH,57741,CDM,420,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,GP,34.65,,,,,,,31.50,264.00,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
PSA TOTAL-TECH,57742,CDM,300,RC,84153,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,18.39,967.70,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,GP,149.05,,,,,,,149.05,262.87,percent of total billed charges,
PT NEG PRES DME WND TX <=50SCM-TECH,57745,CDM,420,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,GP,149.05,,,,,,,126.65,264.00,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,GP,75.35,,,,,,,75.35,132.89,percent of total billed charges,
PT WND DEBRIDE NON SELECTIVE-TECH,57749,CDM,420,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,GP,75.35,,,,,,,68.50,264.00,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,GP,60.50,,,,,,,60.50,106.70,percent of total billed charges,
PT ORTHO/PROSTH CKOUT EA 15MIN-TECH,57750,CDM,420,RC,97763,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,GP,60.50,,,,,,,55.00,264.00,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,GP,144.65,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL HIGH COMPLEX 45 MIN-TECH,57751,CDM,420,RC,97163,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,GP,144.65,,,,,,,126.65,264.00,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00527-1301-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,00904-5559-60,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,50268-0686-15,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,53746-0544-01,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,68084-0202-11,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,inpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
PRIMIDONE TAB 7222771,57754,CDM,250,RC,69584-0684-10,NDC,,,facility,outpatient,1,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GP,23.10,,,,,,,23.10,40.74,percent of total billed charges,
PT ULTRASOUND EA 15MIN-TECH,57755,CDM,420,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GP,23.10,,,,,,,21.00,264.00,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,,558.80,,,,,,,558.80,985.52,percent of total billed charges,
PUNCTURE SPINAL LUMB DX-TECH,57756,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,,558.80,,,,,,,558.80,5271.00,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,inpatient,1,EA,17.19000,16.33000,Amish/Mennonite,Amish Mennonite,,9.45,,,,,,,9.45,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00206450101,NDC,facility,outpatient,1,EA,17.19000,16.33000,Amish/Mennonite,Amish Mennonite,,9.45,,,,,,,1.73,16.67,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,inpatient,1,EA,48.57000,46.14000,Amish/Mennonite,Amish Mennonite,,26.71,,,,,,,26.71,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409337904,NDC,facility,outpatient,1,EA,48.57000,46.14000,Amish/Mennonite,Amish Mennonite,,26.71,,,,,,,1.73,47.11,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,inpatient,1,EA,44.05000,41.85000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,24.23,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00409339004,NDC,facility,outpatient,1,EA,44.05000,41.85000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,1.73,42.73,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,inpatient,1,EA,21.69000,20.61000,Amish/Mennonite,Amish Mennonite,,11.93,,,,,,,11.93,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,00781921495,NDC,facility,outpatient,1,EA,21.69000,20.61000,Amish/Mennonite,Amish Mennonite,,11.93,,,,,,,1.73,21.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,inpatient,1,EA,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,,27.11,,,,,,,27.11,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,25021017750,NDC,facility,outpatient,1,EA,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,,27.11,,,,,,,1.73,47.82,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,inpatient,1,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,22.59,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,39822012706,NDC,facility,outpatient,1,EA,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,1.73,39.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,inpatient,1,EA,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,11.82,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,44567080310,NDC,facility,outpatient,1,EA,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,1.73,20.85,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,inpatient,1,EA,48.24000,45.83000,Amish/Mennonite,Amish Mennonite,,26.53,,,,,,,26.53,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,55150012150,NDC,facility,outpatient,1,EA,48.24000,45.83000,Amish/Mennonite,Amish Mennonite,,26.53,,,,,,,1.73,46.79,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,inpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,60505615904,NDC,facility,outpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,1.73,19.92,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,inpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,13.21,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,61990013002,NDC,facility,outpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,1.73,23.30,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,inpatient,1,EA,55.49000,52.72000,Amish/Mennonite,Amish Mennonite,,30.52,,,,,,,30.52,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323098252,NDC,facility,outpatient,1,EA,55.49000,52.72000,Amish/Mennonite,Amish Mennonite,,30.52,,,,,,,1.73,53.83,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,inpatient,1,EA,43.39000,41.22000,Amish/Mennonite,Amish Mennonite,,23.86,,,,,,,23.86,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,63323032056,NDC,facility,outpatient,1,EA,43.39000,41.22000,Amish/Mennonite,Amish Mennonite,,23.86,,,,,,,1.73,42.09,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,inpatient,1,EA,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,25.38,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,64679001201,NDC,facility,outpatient,1,EA,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,1.73,44.76,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,inpatient,1,EA,33.43000,31.76000,Amish/Mennonite,Amish Mennonite,,18.39,,,,,,,18.39,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,65219025945,NDC,facility,outpatient,1,EA,33.43000,31.76000,Amish/Mennonite,Amish Mennonite,,18.39,,,,,,,1.73,32.43,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,inpatient,1,EA,21.33000,20.26000,Amish/Mennonite,Amish Mennonite,,11.73,,,,,,,11.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,71288000451,NDC,facility,outpatient,1,EA,21.33000,20.26000,Amish/Mennonite,Amish Mennonite,,11.73,,,,,,,1.73,20.69,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,inpatient,1,EA,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,15.90,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,72485040410,NDC,facility,outpatient,1,EA,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,1.73,28.04,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 4.5 GM,57757,CDM,250,RC,J2543,HCPCS,81284015310,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,1.73,18.39,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,GP,59.40,,,,,,,59.40,104.76,percent of total billed charges,
PT PROSTHETIC TRAIN EA 15MIN-TECH,57759,CDM,420,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,GP,59.40,,,,,,,54.00,264.00,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GP,47.30,,,,,,,47.30,83.42,percent of total billed charges,
PT IONTOPHORESIS EA 15MIN-TECH,57760,CDM,420,RC,97033,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GP,47.30,,,,,,,43.00,264.00,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,00904589161,NDC,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,55111022990,NDC,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60505016809,NDC,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,inpatient,1,EA,2.11000,2.01000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
PRAVASTATIN TAB 10 MG,57761,CDM,250,RC,J8499,HCPCS,60687016901,NDC,facility,outpatient,1,EA,2.11000,2.01000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,inpatient,,,2160.00000,2052.00000,Amish/Mennonite,Amish Mennonite,,1188.00,,,,,,,1188.00,2095.20,percent of total billed charges,
PROSTATE CANCER GENE 3-TECH,57762,CDM,300,RC,81313,CPT,,,facility,outpatient,,,2160.00000,2052.00000,Amish/Mennonite,Amish Mennonite,,1188.00,,,,,,,255.05,12002.48,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,inpatient,,,3096.00000,2941.20000,Amish/Mennonite,Amish Mennonite,TC,1702.80,,,,,,,1702.80,3003.12,percent of total billed charges,
QUANT DIFF PULM PERF & VENT-TECH,57763,CDM,341,RC,78598,CPT,,,facility,outpatient,,,3096.00000,2941.20000,Amish/Mennonite,Amish Mennonite,TC,1702.80,,,,,,,1428.78,3003.12,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,inpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,50268068515,NDC,facility,outpatient,1,EA,3.78000,3.59000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,0.73040,3.67,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,inpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
PROCHLORPERAZINE TAB 10 MG,57764,CDM,250,RC,Q0164,HCPCS,59746011506,NDC,facility,outpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.73040,1.60,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,inpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,GP,53.90,,,,,,,53.90,95.06,percent of total billed charges,
PT MANUAL THERAPY EA 15MIN-TECH,57765,CDM,420,RC,97140,CPT,,,facility,outpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,GP,53.90,,,,,,,49.00,264.00,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,inpatient,,,1881.00000,1786.95000,Amish/Mennonite,Amish Mennonite,TC,1034.55,,,,,,,1034.55,1824.57,percent of total billed charges,
PULMONARY VENTILATION IMAGING-TECH,57766,CDM,341,RC,78579,CPT,,,facility,outpatient,,,1881.00000,1786.95000,Amish/Mennonite,Amish Mennonite,TC,1034.55,,,,,,,885.12,2210.07,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,72.60,128.04,percent of total billed charges,
PROTEINASE 3 AB-TECH,57767,CDM,300,RC,83516,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,11.53,594.19,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,inpatient,1,EA,48.03000,45.63000,Amish/Mennonite,Amish Mennonite,,26.42,,,,,,,26.42,46.59,percent of total billed charges,
PYRIDOXINE HCL,57768,CDM,250,RC,J3415,HCPCS,63323018001,NDC,facility,outpatient,1,EA,48.03000,45.63000,Amish/Mennonite,Amish Mennonite,,26.42,,,,,,,19.48,46.59,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054474125,NDC,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00054873925,NDC,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.00620,0.67900,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,00603533521,NDC,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.00620,0.62080,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,59651048401,NDC,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.00620,0.31040,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
PREDNISONE IR OR DR ORAL 7219447,57769,CDM,250,RC,J7512,HCPCS,64380078206,NDC,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.00620,0.22310,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,inpatient,,,166.60000,158.27000,Amish/Mennonite,Amish Mennonite,90,91.63,,,,,,,91.63,161.60,percent of total billed charges,
PROTOPORPHYRINS RBC QUANT-TECH,57770,CDM,300,RC,84202,CPT,,,facility,outpatient,,,166.60000,158.27000,Amish/Mennonite,Amish Mennonite,90,91.63,,,,,,,14.83,746.94,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
PROTEIN TOTAL URINE-TECH,57772,CDM,300,RC,84156,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.67,186.75,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,inpatient,,,743.00000,705.85000,Amish/Mennonite,Amish Mennonite,,408.65,,,,,,,408.65,720.71,percent of total billed charges,
PUNCTURE SPINAL THER DRAIN CSF-TECH,57773,CDM,361,RC,62272,CPT,,,facility,outpatient,,,743.00000,705.85000,Amish/Mennonite,Amish Mennonite,,408.65,,,,,,,408.65,3163.00,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,216.70,382.18,percent of total billed charges,
PULM STRESS TEST SMPL-TECH,57774,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,197.00,382.18,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,GP,46.20,,,,,,,46.20,81.48,percent of total billed charges,
PT STRAPPING ANKLE/FOOT-TECH,57775,CDM,420,RC,29540,CPT,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,GP,46.20,,,,,,,42.00,264.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,inpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,00143987210,NDC,facility,outpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,5.51,24.52,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,inpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,10.77,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,55390000310,NDC,facility,outpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,5.51,19.00,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,inpatient,1,EA,31.82000,30.23000,Amish/Mennonite,Amish Mennonite,,17.50,,,,,,,17.50,30.87,percent of total billed charges,
PROPRANOLOL INJECTION,57776,CDM,250,RC,J1800,HCPCS,63323060401,NDC,facility,outpatient,1,EA,31.82000,30.23000,Amish/Mennonite,Amish Mennonite,,17.50,,,,,,,5.51,30.87,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,GP,77.55,,,,,,,77.55,136.77,percent of total billed charges,
PT AQUATIC THERAPY EA 15MIN-TECH,57777,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,GP,77.55,,,,,,,70.50,264.00,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,inpatient,0.5,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-2784-01,NDC,,,facility,outpatient,0.5,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,inpatient,0.5,EA,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,3.39,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-10,NDC,,,facility,outpatient,0.5,EA,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,3.08,5.98,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,inpatient,0.5,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
RACEPINEPHRINE SOL,57778,CDM,250,RC,00487-5901-99,NDC,,,facility,outpatient,0.5,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,inpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00574-7236-12,NDC,,,facility,outpatient,1,EA,10.27000,9.75000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,inpatient,1,EA,30.80000,29.26000,Amish/Mennonite,Amish Mennonite,,16.94,,,,,,,16.94,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,51672-5296-01,NDC,,,facility,outpatient,1,EA,30.80000,29.26000,Amish/Mennonite,Amish Mennonite,,16.94,,,,,,,15.40,29.88,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
PROMETHAZINE SUPP 7528870,57779,CDM,250,RC,00713-0536-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00182-1605-16,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-0250-59,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
PSEUDOEPHEDRINE-TRIPROLIDINE TAB,57780,CDM,250,RC,00904-7302-24,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM TX BY ORAL ADMIN-TECH,57781,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,273.50,1232.72,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GP,47.30,,,,,,,47.30,83.42,percent of total billed charges,
PT THER MASSAGE EA 15MIN-TECH,57782,CDM,420,RC,97124,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,GP,47.30,,,,,,,43.00,264.00,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,Amish/Mennonite,Amish Mennonite,TC,1795.20,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION PERF IMG-TECH,57783,CDM,341,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,Amish/Mennonite,Amish Mennonite,TC,1795.20,,,,,,,1527.07,3166.08,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,152.90,269.66,percent of total billed charges,
PULSE OX CONT OVERNIGHT-TECH,57784,CDM,460,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,139.00,269.66,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00115-3511-01,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,inpatient,1,EA,45.52000,43.24000,Amish/Mennonite,Amish Mennonite,,25.04,,,,,,,25.04,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00187-3010-30,NDC,,,facility,outpatient,1,EA,45.52000,43.24000,Amish/Mennonite,Amish Mennonite,,25.04,,,,,,,22.76,44.15,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,inpatient,1,EA,4.25000,4.03000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,00904-6622-61,NDC,,,facility,outpatient,1,EA,4.25000,4.03000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.12,4.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,inpatient,1,EA,3.90000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,60687-0502-01,NDC,,,facility,outpatient,1,EA,3.90000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,63739-0969-40,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,64720-0128-10,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,inpatient,1,EA,4.37000,4.16000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68084-0494-01,NDC,,,facility,outpatient,1,EA,4.37000,4.16000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.19,4.24,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
PYRIDOSTIGMINE TAB,57785,CDM,250,RC,68682-0302-10,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.61,3.12,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GP,68.20,,,,,,,68.20,120.28,percent of total billed charges,
PT ORTHOTIC FIT & TRAIN EA 15M-TECH,57786,CDM,420,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GP,68.20,,,,,,,62.00,264.00,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0700-12,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,10006-0730-17,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,50268-0858-15,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,inpatient,1,EA,0.23000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,61748-0095-01,NDC,,,facility,outpatient,1,EA,0.23000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
PYRIDOXINE TAB,57787,CDM,250,RC,77333-0940-10,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,inpatient,,,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,31.84,56.16,percent of total billed charges,
PULSE OX O2 SAT MULT-TECH,57788,CDM,460,RC,94761,CPT,,,facility,outpatient,,,57.90000,55.00000,Amish/Mennonite,Amish Mennonite,,31.84,,,,,,,28.95,56.16,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
PULSE OX O2 SAT SNGL-TECH,57789,CDM,460,RC,94760,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,33.95,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
PUNC ASP ABSC HEMA CYST-TECH,57790,CDM,361,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,3163.00,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
PYP TO 30 MCI,57791,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,62.50,121.25,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,inpatient,,,2360.00000,2242.00000,Amish/Mennonite,Amish Mennonite,TC,1298.00,,,,,,,1298.00,2289.20,percent of total billed charges,
PULMONARY PERF IMG PARTICULATE-TECH,57792,CDM,341,RC,78580,CPT,,,facility,outpatient,,,2360.00000,2242.00000,Amish/Mennonite,Amish Mennonite,TC,1298.00,,,,,,,1087.81,2289.20,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,GP,144.65,,,,,,,144.65,255.11,percent of total billed charges,
PT EVAL MOD COMPLEX 30 MIN-TECH,57793,CDM,420,RC,97162,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,GP,144.65,,,,,,,126.65,264.00,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,inpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,107.25,189.15,percent of total billed charges,
RBC NEUT/INHIB FOR AB ID-TECH,57794,CDM,300,RC,86977,CPT,,,facility,outpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,97.50,1714.64,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,inpatient,1,EA,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,00904637561,NDC,facility,outpatient,1,EA,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62175030232,NDC,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,inpatient,1,EA,55.27000,52.50000,Amish/Mennonite,Amish Mennonite,,30.40,,,,,,,30.40,53.61,percent of total billed charges,
RABEPRAZOLE TAB-EC 20 MG,57795,CDM,250,RC,J8499,HCPCS,62856024330,NDC,facility,outpatient,1,EA,55.27000,52.50000,Amish/Mennonite,Amish Mennonite,,30.40,,,,,,,27.64,53.61,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,GP,61.05,,,,,,,61.05,107.67,percent of total billed charges,
PT NEUROMUSC RE-ED EA 15MIN-TECH,57796,CDM,420,RC,97112,CPT,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,GP,61.05,,,,,,,55.50,264.00,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GP,63.25,,,,,,,63.25,111.55,percent of total billed charges,
PT HOME MGMT TRAIN EA 15MIN-TECH,57797,CDM,420,RC,97535,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GP,63.25,,,,,,,57.50,264.00,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,inpatient,,,893.00000,848.35000,Amish/Mennonite,Amish Mennonite,TC,491.15,,,,,,,491.15,866.21,percent of total billed charges,
RADIOPHARM TX RADIOLAB AB IV-TECH,57798,CDM,341,RC,79403,CPT,,,facility,outpatient,,,893.00000,848.35000,Amish/Mennonite,Amish Mennonite,TC,491.15,,,,,,,437.23,1232.72,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,inpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,,53.90,,,,,,,53.90,95.06,percent of total billed charges,
RENAL FUNCTION PANEL-TECH,57800,CDM,300,RC,80069,CPT,,,facility,outpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,,53.90,,,,,,,8.68,458.40,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,GP,55.55,,,,,,,55.55,97.97,percent of total billed charges,
PT WHEELCHAIR MGMT EA 15MIN-TECH,57801,CDM,420,RC,97542,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,GP,55.55,,,,,,,50.50,264.00,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
QUINAPRIL TAB 7224348,57802,CDM,250,RC,59762-5022-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,inpatient,1,EA,12.28000,11.66000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.75,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00310-0275-39,NDC,,,facility,outpatient,1,EA,12.28000,11.66000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.14,11.91,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,00904-6638-61,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,16714-0452-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,50268-0630-15,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,60687-0327-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
QUETIAPINE TAB 7222888,57803,CDM,250,RC,67877-0242-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,inpatient,1,EA,20.86000,19.81000,Amish/Mennonite,Amish Mennonite,,11.47,,,,,,,11.47,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00002-4165-30,NDC,,,facility,outpatient,1,EA,20.86000,19.81000,Amish/Mennonite,Amish Mennonite,,11.47,,,,,,,10.43,20.23,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,inpatient,1,EA,12.22000,11.61000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.72,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,00093-7290-56,NDC,,,facility,outpatient,1,EA,12.22000,11.61000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.11,11.85,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,inpatient,1,EA,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,16714-0213-01,NDC,,,facility,outpatient,1,EA,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.45,4.75,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,inpatient,1,EA,19.31000,18.34000,Amish/Mennonite,Amish Mennonite,,10.62,,,,,,,10.62,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,50268-0694-15,NDC,,,facility,outpatient,1,EA,19.31000,18.34000,Amish/Mennonite,Amish Mennonite,,10.62,,,,,,,9.65,18.73,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,52343-0137-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,65162-0057-03,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,69097-0825-02,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.82,3.54,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
RALOXIFENE TAB,57804,CDM,250,RC,72241-0010-22,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,inpatient,,,1923.00000,1826.85000,Amish/Mennonite,Amish Mennonite,TC,1057.65,,,,,,,1057.65,1865.31,percent of total billed charges,
QUANT DIFF PULM PERFUSION-TECH,57805,CDM,341,RC,78597,CPT,,,facility,outpatient,,,1923.00000,1826.85000,Amish/Mennonite,Amish Mennonite,TC,1057.65,,,,,,,905.36,2210.07,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,TC,297.55,,,,,,,297.55,524.77,percent of total billed charges,
RADIOPHARM TX BY IV ADMIN-TECH,57807,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,TC,297.55,,,,,,,270.50,1232.72,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,51079-0027-20,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.69,3.28,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,inpatient,1,EA,22.91000,21.76000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,12.60,22.22,percent of total billed charges,
QUINIDINE TAB 7219942,57808,CDM,250,RC,53489-0141-01,NDC,,,facility,outpatient,1,EA,22.91000,21.76000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,11.46,22.22,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,Amish/Mennonite,Amish Mennonite,,70.56,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,Amish/Mennonite,Amish Mennonite,,70.56,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,inpatient,,,128.30000,121.89000,Amish/Mennonite,Amish Mennonite,90,70.56,,,,,,,70.56,124.45,percent of total billed charges,
QUINIDINE ASSAY SO-TECH,57809,CDM,300,RC,80194,CPT,,,facility,outpatient,,,128.30000,121.89000,Amish/Mennonite,Amish Mennonite,90,70.56,,,,,,,14.60,763.98,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00185-4346-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,00591-5438-01,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,inpatient,1,EA,38.14000,36.23000,Amish/Mennonite,Amish Mennonite,,20.98,,,,,,,20.98,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,42806-0513-30,NDC,,,facility,outpatient,1,EA,38.14000,36.23000,Amish/Mennonite,Amish Mennonite,,20.98,,,,,,,19.07,37.00,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
QUINIDINE TAB,57810,CDM,250,RC,53489-0461-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,inpatient,2,EA,40.56000,38.53000,Amish/Mennonite,Amish Mennonite,,22.31,,,,,,,22.31,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304072,NDC,facility,outpatient,2,EA,40.56000,38.53000,Amish/Mennonite,Amish Mennonite,,22.31,,,,,,,20.28,39.34,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,inpatient,2,EA,53.34000,50.67000,Amish/Mennonite,Amish Mennonite,,29.34,,,,,,,29.34,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,00781304095,NDC,facility,outpatient,2,EA,53.34000,50.67000,Amish/Mennonite,Amish Mennonite,,29.34,,,,,,,26.67,51.74,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,inpatient,2,EA,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,17.26,30.44,percent of total billed charges,
PYRIDOSTIGMINE SOLN-INJ 5 MG/ML 2 ML,57812,CDM,250,RC,J3490,HCPCS,54643582000,NDC,facility,outpatient,2,EA,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,15.69,30.44,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
RBC PRETX FOR RBC AB DETECTION-TECH,57813,CDM,300,RC,86970,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,56.40,1426.03,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,inpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,34.10,60.14,percent of total billed charges,
RETICULOCYTE COUNT AUTO-TECH,57814,CDM,300,RC,85046,CPT,,,facility,outpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,5.57,288.61,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,inpatient,1,EA,20.17000,19.17000,Amish/Mennonite,Amish Mennonite,,11.09,,,,,,,11.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00310-0278-39,NDC,,,facility,outpatient,1,EA,20.17000,19.17000,Amish/Mennonite,Amish Mennonite,,11.09,,,,,,,10.09,19.56,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,00904-6639-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,50268-0631-15,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
QUETIAPINE TAB 7223540,57815,CDM,250,RC,60687-0338-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,inpatient,,,221.00000,209.95000,Amish/Mennonite,Amish Mennonite,,121.55,,,,,,,121.55,214.37,percent of total billed charges,
REDUCTION/MANIP OF DISLOC-ORTHO TX DONE-TECH,57816,CDM,361,RC,,,,,facility,outpatient,,,221.00000,209.95000,Amish/Mennonite,Amish Mennonite,,121.55,,,,,,,121.55,5271.00,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
PULMONARY REHAB GROUP SESSION-TECH,57817,CDM,410,RC,G0239,HCPCS,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,28.50,55.29,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,inpatient,1,mL,296.89000,282.04000,Amish/Mennonite,Amish Mennonite,,163.29,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 10 ML,57818,CDM,636,RC,J9312,HCPCS,50242005121,NDC,facility,outpatient,1,mL,296.89000,282.04000,Amish/Mennonite,Amish Mennonite,,163.29,,,,,,,75.93,287.98,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,290.95,513.13,percent of total billed charges,
RBC TAG TO 30 MCI,57819,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,173.99,513.13,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,inpatient,1,EA,317.28000,301.41000,Amish/Mennonite,Amish Mennonite,,174.50,,,,,,,174.50,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,00143939210,NDC,facility,outpatient,1,EA,317.28000,301.41000,Amish/Mennonite,Amish Mennonite,,174.50,,,,,,,158.64,307.76,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,inpatient,1,EA,259.49000,246.51000,Amish/Mennonite,Amish Mennonite,,142.72,,,,,,,142.72,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,63323072405,NDC,facility,outpatient,1,EA,259.49000,246.51000,Amish/Mennonite,Amish Mennonite,,142.72,,,,,,,129.75,251.71,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,inpatient,1,EA,317.48000,301.61000,Amish/Mennonite,Amish Mennonite,,174.61,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,67457019805,NDC,facility,outpatient,1,EA,317.48000,301.61000,Amish/Mennonite,Amish Mennonite,,174.61,,,,,,,158.74,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,inpatient,1,EA,317.48000,301.61000,Amish/Mennonite,Amish Mennonite,,174.61,,,,,,,174.61,307.96,percent of total billed charges,
REMIFENTANIL POWDER 7910496,57820,CDM,250,RC,J3490,HCPCS,72078003502,NDC,facility,outpatient,1,EA,317.48000,301.61000,Amish/Mennonite,Amish Mennonite,,174.61,,,,,,,158.74,307.96,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,GP,67.10,,,,,,,67.10,118.34,percent of total billed charges,
PT WND DEBRID EA ADDL 20 SQCM-TECH,57822,CDM,420,RC,97598,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,GP,67.10,,,,,,,61.00,264.00,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,inpatient,1,EA,105.16000,99.91000,Amish/Mennonite,Amish Mennonite,,57.84,,,,,,,57.84,102.01,percent of total billed charges,
RALTEGRAVIR TAB 400 MG,57823,CDM,250,RC,00006-0227-61,NDC,,,facility,outpatient,1,EA,105.16000,99.91000,Amish/Mennonite,Amish Mennonite,,57.84,,,,,,,52.58,102.01,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
RBC INCUBATION W ENZYMES-TECH,57826,CDM,300,RC,86971,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,1137.41,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,inpatient,5,EA,162.90000,154.76000,Amish/Mennonite,Amish Mennonite,,89.59,,,,,,,89.59,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,00469650189,NDC,facility,outpatient,5,EA,162.90000,154.76000,Amish/Mennonite,Amish Mennonite,,89.59,,,,,,,4.63,158.01,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,inpatient,5,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,16729047731,NDC,facility,outpatient,5,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,4.63,12.26,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,inpatient,5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,36000036401,NDC,facility,outpatient,5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,4.63,15.33,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,inpatient,5,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,55150044301,NDC,facility,outpatient,5,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,4.63,91.96,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,inpatient,5,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,60505611600,NDC,facility,outpatient,5,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,4.63,27.59,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,inpatient,5,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
REGADENOSON SOLN 0.4 MG/5 ML,57827,CDM,250,RC,J2785,HCPCS,76329332100,NDC,facility,outpatient,5,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,4.63,18.39,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,565.00000,536.75000,Amish/Mennonite,Amish Mennonite,,310.75,,,,,,,310.75,548.05,percent of total billed charges,
RBC LR IRRAD EA UNIT,57829,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,565.00000,536.75000,Amish/Mennonite,Amish Mennonite,,310.75,,,,,,,242.89,548.05,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,62332-0030-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,inpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,00904-6373-61,NDC,,,facility,outpatient,1,EA,1.55000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,43547-0268-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,50268-0741-15,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,60687-0577-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212020,57830,CDM,250,RC,68462-0253-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,inpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,264.00,465.60,percent of total billed charges,
REDUCTION OF DISLOC - REASON FOR SEDATION-TECH,57831,CDM,450,RC,,,,,facility,outpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,240.00,465.60,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
PTT SUBSTITUTION PLASMA-TECH,57833,CDM,300,RC,85732,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,6.47,339.51,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
RHEUMATOID FACTOR QUANT-TECH,57834,CDM,300,RC,86431,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,5.67,288.61,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,inpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00007-4894-20,NDC,,,facility,outpatient,1,EA,18.42000,17.50000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,9.21,17.87,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212025,57835,CDM,250,RC,00054-0122-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,inpatient,1,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.92,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,00904-5282-61,NDC,,,facility,outpatient,1,EA,3.49000,3.32000,Amish/Mennonite,Amish Mennonite,,1.92,,,,,,,1.75,3.39,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,inpatient,1,EA,17.30000,16.43000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,9.52,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,51079-0890-17,NDC,,,facility,outpatient,1,EA,17.30000,16.43000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,8.65,16.78,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,60687-0586-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,63739-0415-10,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,Amish/Mennonite,Amish Mennonite,,6.39,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-06,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,Amish/Mennonite,Amish Mennonite,,6.39,,,,,,,5.80,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,inpatient,1,EA,11.61000,11.03000,Amish/Mennonite,Amish Mennonite,,6.39,,,,,,,6.39,11.26,percent of total billed charges,
RIFAMPIN CAP,57836,CDM,250,RC,68180-0659-07,NDC,,,facility,outpatient,1,EA,11.61000,11.03000,Amish/Mennonite,Amish Mennonite,,6.39,,,,,,,5.80,11.26,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,inpatient,1,mL,369.91000,351.42000,Amish/Mennonite,Amish Mennonite,,203.45,,,,,,,203.45,358.81,percent of total billed charges,
RAMUCIRUMAB INJ,57837,CDM,636,RC,J9308,HCPCS,00002766901,NDC,facility,outpatient,1,mL,369.91000,351.42000,Amish/Mennonite,Amish Mennonite,,203.45,,,,,,,74.45,358.81,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,inpatient,1,EA,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,11.59,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00310-0271-39,NDC,,,facility,outpatient,1,EA,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,10.54,20.44,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,00904-6640-61,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,16714-0454-01,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,50268-0632-15,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,60687-0349-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,63739-0665-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.99,percent of total billed charges,
QUETIAPINE TAB 7223548,57838,CDM,250,RC,68084-0532-01,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.54,2.99,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,,71.50,,,,,,,71.50,126.10,percent of total billed charges,
REPAIR WOUND -TECH,57839,CDM,361,RC,,,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,,71.50,,,,,,,71.50,5271.00,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,89.24,percent of total billed charges,
REMOVAL FB CORNEA W SLIT-TECH,57840,CDM,361,RC,65222,CPT,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,3163.00,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,inpatient,1,EA,193.55000,183.87000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,106.45,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,00143939110,NDC,facility,outpatient,1,EA,193.55000,183.87000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,96.78,187.74,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,inpatient,1,EA,203.22000,193.06000,Amish/Mennonite,Amish Mennonite,,111.77,,,,,,,111.77,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,63323072303,NDC,facility,outpatient,1,EA,203.22000,193.06000,Amish/Mennonite,Amish Mennonite,,111.77,,,,,,,101.61,197.12,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,inpatient,1,EA,193.68000,184.00000,Amish/Mennonite,Amish Mennonite,,106.52,,,,,,,106.52,187.87,percent of total billed charges,
REMIFENTANIL POWDER 7910383,57841,CDM,250,RC,J3490,HCPCS,72078003401,NDC,facility,outpatient,1,EA,193.68000,184.00000,Amish/Mennonite,Amish Mennonite,,106.52,,,,,,,96.84,187.87,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,inpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,,365.75,,,,,,,365.75,645.05,percent of total billed charges,
REPLC COMPL NON-TUN CATH SAME ACCESS-TECH,57842,CDM,361,RC,36584,CPT,,,facility,outpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,,365.75,,,,,,,365.75,4686.00,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,inpatient,1,mL,296.89000,282.04000,Amish/Mennonite,Amish Mennonite,,163.29,,,,,,,163.29,287.98,percent of total billed charges,
RITUXIMAB SOLN 10 MG/ML 50 ML,57843,CDM,636,RC,J9312,HCPCS,50242005306,NDC,facility,outpatient,1,mL,296.89000,282.04000,Amish/Mennonite,Amish Mennonite,,163.29,,,,,,,75.93,287.98,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,inpatient,,,114.40000,108.68000,Amish/Mennonite,Amish Mennonite,90,62.92,,,,,,,62.92,110.97,percent of total billed charges,
REPTILASE TEST SO-TECH,57844,CDM,300,RC,85635,CPT,,,facility,outpatient,,,114.40000,108.68000,Amish/Mennonite,Amish Mennonite,90,62.92,,,,,,,10.18,509.30,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,inpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00338011704,NDC,facility,outpatient,1000,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,00990795309,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,4.06,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,inpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
LACTATED RINGERS 1000 ML,57845,CDM,250,RC,J7120,HCPCS,17271071007,NDC,facility,outpatient,1000,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,4.06,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GP,63.25,,,,,,,63.25,111.55,percent of total billed charges,
PT THER ACTVTY DIRECT EA 15MIN-TECH,57846,CDM,420,RC,97530,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,GP,63.25,,,,,,,57.50,264.00,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,inpatient,,,234.90000,223.16000,Amish/Mennonite,Amish Mennonite,90,129.19,,,,,,,129.19,227.85,percent of total billed charges,
RIBOFLAVIN (VITAMIN B2) ASSAY (VITB2) SO,57849,CDM,300,RC,84252,CPT,,,facility,outpatient,,,234.90000,223.16000,Amish/Mennonite,Amish Mennonite,90,129.19,,,,,,,20.91,1052.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,inpatient,1,mL,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00143925110,NDC,facility,outpatient,1,mL,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,inpatient,1,mL,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409516010,NDC,facility,outpatient,1,mL,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,inpatient,1,mL,2.27000,2.15000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409703710,NDC,facility,outpatient,1,mL,2.27000,2.15000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,inpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955810,NDC,facility,outpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,inpatient,1,mL,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,00409955850,NDC,facility,outpatient,1,mL,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,25021066210,NDC,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,inpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,39822420006,NDC,facility,outpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,inpatient,1,mL,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,43066001310,NDC,facility,outpatient,1,mL,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,inpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,55150022610,NDC,facility,outpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,inpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,63323042610,NDC,facility,outpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,inpatient,1,mL,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,66794022941,NDC,facility,outpatient,1,mL,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,67457057410,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,inpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,70860065110,NDC,facility,outpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,71288071811,NDC,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,inpatient,1,mL,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 10 ML,57850,CDM,250,RC,J3490,HCPCS,72611075710,NDC,facility,outpatient,1,mL,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.61,3.12,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,GP,31.35,,,,,,,31.35,55.29,percent of total billed charges,
PT THER PROC GROUP-TECH,57851,CDM,420,RC,97150,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,GP,31.35,,,,,,,28.50,264.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,inpatient,2,EA,919.61000,873.63000,Amish/Mennonite,Amish Mennonite,,505.79,,,,,,,505.79,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,13533061802,NDC,facility,outpatient,2,EA,919.61000,873.63000,Amish/Mennonite,Amish Mennonite,,505.79,,,,,,,266.44,892.02,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,inpatient,2,EA,965.58000,917.30000,Amish/Mennonite,Amish Mennonite,,531.07,,,,,,,531.07,936.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML,57852,CDM,636,RC,90375,HCPCS,76125015002,NDC,facility,outpatient,2,EA,965.58000,917.30000,Amish/Mennonite,Amish Mennonite,,531.07,,,,,,,266.44,936.61,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
ROPINIROLE TAB 7212026,57853,CDM,250,RC,00378-5503-01,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212023,57854,CDM,250,RC,68462-0256-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,inpatient,1,mL,335.14000,318.38000,Amish/Mennonite,Amish Mennonite,,184.33,,,,,,,184.33,325.09,percent of total billed charges,
RAMUCIRUMAB INJ 7910285,57855,CDM,636,RC,J9308,HCPCS,00002767801,NDC,facility,outpatient,1,mL,335.14000,318.38000,Amish/Mennonite,Amish Mennonite,,184.33,,,,,,,74.45,325.09,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00169-0084-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,inpatient,1,EA,8.42000,8.00000,Amish/Mennonite,Amish Mennonite,,4.63,,,,,,,4.63,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00378-3123-01,NDC,,,facility,outpatient,1,EA,8.42000,8.00000,Amish/Mennonite,Amish Mennonite,,4.63,,,,,,,4.21,8.17,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE TAB,57856,CDM,250,RC,00574-0242-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7530274,57857,CDM,250,RC,50458-0578-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,30.00,58.20,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,00054-0121-25,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212024,57858,CDM,250,RC,43547-0273-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7283364,57859,CDM,250,RC,50458-0579-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,30.00,58.20,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,inpatient,1,EA,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,8.41,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,00071-0530-40,NDC,,,facility,outpatient,1,EA,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,7.65,14.84,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,65862-0618-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
QUINAPRIL TAB 7219892,57860,CDM,250,RC,68180-0557-09,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,inpatient,1,mL,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,00409930130,NDC,facility,outpatient,1,mL,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.08525,0.66930,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,inpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,43066002310,NDC,facility,outpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.08525,0.81480,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,55150019830,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,inpatient,1,mL,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028631,NDC,facility,outpatient,1,mL,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,inpatient,1,mL,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028635,NDC,facility,outpatient,1,mL,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,0.08525,2.88,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,inpatient,1,mL,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,63323028695,NDC,facility,outpatient,1,mL,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.08525,0.64990,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,inpatient,1,mL,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 30 ML,57862,CDM,250,RC,J2795,HCPCS,70069006425,NDC,facility,outpatient,1,mL,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.08525,0.87300,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,inpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,55150019720,NDC,facility,outpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,inpatient,30,EA,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,63323028623,NDC,facility,outpatient,30,EA,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,0.08525,2.22,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,inpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,70069006325,NDC,facility,outpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.08525,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,inpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,71288073421,NDC,facility,outpatient,30,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,inpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROPIVACAINE SOLN 0.5% 20 ML,57864,CDM,250,RC,J2795,HCPCS,72603021725,NDC,facility,outpatient,30,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,0.08525,2.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,00904-6924-61,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-04,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,16714-0611-05,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0149-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,51079-0762-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,60687-0231-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214456,57865,CDM,250,RC,68084-0180-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,inpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
RIVAROXABAN TAB 7910247,57866,CDM,250,RC,50458-0580-30,NDC,,,facility,outpatient,1,EA,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,30.00,58.20,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
RUSSELL VIPER VENOM DILUTED-TECH,57867,CDM,300,RC,85613,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,9.58,492.33,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,00904-6779-61,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.17,4.20,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,16714-0989-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,inpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,50268-0709-15,NDC,,,facility,outpatient,1,EA,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,60687-0245-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,68462-0262-90,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7224273,57869,CDM,250,RC,72205-0003-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,43547-0269-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,50268-0742-15,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68084-0306-21,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212021,57870,CDM,250,RC,68462-0254-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,inpatient,5,EA,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00143925010,NDC,facility,outpatient,5,EA,3.25000,3.08000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,inpatient,5,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409140310,NDC,facility,outpatient,5,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,inpatient,5,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955805,NDC,facility,outpatient,5,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,inpatient,5,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00409955849,NDC,facility,outpatient,5,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,inpatient,5,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,00781322095,NDC,facility,outpatient,5,EA,4.76000,4.52000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.62,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,inpatient,5,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057305,NDC,facility,outpatient,5,EA,3.07000,2.91000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,inpatient,5,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,55150022505,NDC,facility,outpatient,5,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,inpatient,5,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,39822420002,NDC,facility,outpatient,5,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,inpatient,5,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,43066000710,NDC,facility,outpatient,5,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,inpatient,5,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,47781061617,NDC,facility,outpatient,5,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,inpatient,5,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,63323042605,NDC,facility,outpatient,5,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,inpatient,5,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,66794022841,NDC,facility,outpatient,5,EA,3.03000,2.88000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.51,2.94,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,inpatient,5,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457022800,NDC,facility,outpatient,5,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,inpatient,5,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,67457057300,NDC,facility,outpatient,5,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,inpatient,5,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,70860065105,NDC,facility,outpatient,5,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,inpatient,5,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,71839014110,NDC,facility,outpatient,5,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,inpatient,5,EA,3.71000,3.53000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.60,percent of total billed charges,
ROCURONIUM SOLN 10 MG/ML 5 ML,57871,CDM,250,RC,J3490,HCPCS,72611075610,NDC,facility,outpatient,5,EA,3.71000,3.53000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.85,3.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,inpatient,1,EA,462.47000,439.35000,Amish/Mennonite,Amish Mennonite,,254.36,,,,,,,254.36,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,00068059901,NDC,facility,outpatient,1,EA,462.47000,439.35000,Amish/Mennonite,Amish Mennonite,,254.36,,,,,,,231.24,448.60,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,inpatient,1,EA,396.27000,376.46000,Amish/Mennonite,Amish Mennonite,,217.95,,,,,,,217.95,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,63323035120,NDC,facility,outpatient,1,EA,396.27000,376.46000,Amish/Mennonite,Amish Mennonite,,217.95,,,,,,,198.13,384.38,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,inpatient,1,EA,399.12000,379.16000,Amish/Mennonite,Amish Mennonite,,219.52,,,,,,,219.52,387.15,percent of total billed charges,
RIFAMPIN POWD-INJ 600 MG,57872,CDM,250,RC,J3490,HCPCS,67457044560,NDC,facility,outpatient,1,EA,399.12000,379.16000,Amish/Mennonite,Amish Mennonite,,219.52,,,,,,,199.56,387.15,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-5068-60,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,00904-7206-60,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0147-07,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0188-10,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,49348-0509-07,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,57896-0791-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,63739-0225-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,69618-0033-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SIMETHICONE TAB,57875,CDM,250,RC,77333-0812-10,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
ROTAVIRUS ANTIGEN IA-TECH,57876,CDM,300,RC,87425,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,11.98,628.12,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,inpatient,20,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00143926310,NDC,facility,outpatient,20,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.08525,1.34,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,inpatient,20,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00186085954,NDC,facility,outpatient,20,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.08525,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,inpatient,20,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,00409930020,NDC,facility,outpatient,20,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.08525,0.54320,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,inpatient,20,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,55150019520,NDC,facility,outpatient,20,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.08525,1.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,inpatient,20,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,63323028528,NDC,facility,outpatient,20,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,inpatient,20,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008477,57878,CDM,250,RC,J2795,HCPCS,70069006210,NDC,facility,outpatient,20,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.08525,1.32,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,inpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,62.70,110.58,percent of total billed charges,
PYRUVATE ASSAY-TECH,57880,CDM,300,RC,84210,CPT,,,facility,outpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,,62.70,,,,,,,14.48,679.08,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,,496.10,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP-TECH,57881,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,,496.10,,,,,,,200.06,874.94,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,inpatient,,,958.00000,910.10000,Amish/Mennonite,Amish Mennonite,TC,526.90,,,,,,,526.90,929.26,percent of total billed charges,
SALINE INF SONOHYSTEROGRAPHY-TECH,57882,CDM,402,RC,76831,CPT,,,facility,outpatient,,,958.00000,910.10000,Amish/Mennonite,Amish Mennonite,TC,526.90,,,,,,,384.16,1329.46,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,Amish/Mennonite,Amish Mennonite,,15.11,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-0755-90,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,Amish/Mennonite,Amish Mennonite,,15.11,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00310-7560-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,00904-6778-61,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,72205-0027-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,16714-0988-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212029,57883,CDM,250,RC,60687-0234-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,00591-0810-46,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,43598-0210-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,inpatient,400,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,49884-0600-40,NDC,,,facility,outpatient,400,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,inpatient,400,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,61570-0131-40,NDC,,,facility,outpatient,400,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,inpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7107444,57884,CDM,250,RC,67877-0124-40,NDC,,,facility,outpatient,400,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,TC,40.70,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL-TECH,57885,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,TC,40.70,,,,,,,37.00,442.00,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,inpatient,1,EA,172.07000,163.47000,Amish/Mennonite,Amish Mennonite,,94.64,,,,,,,94.64,166.91,percent of total billed charges,
RIFAXIMIN TAB,57886,CDM,250,RC,65649-0303-03,NDC,,,facility,outpatient,1,EA,172.07000,163.47000,Amish/Mennonite,Amish Mennonite,,94.64,,,,,,,86.03,166.91,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,inpatient,250,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00074-4456-51,NDC,,,facility,outpatient,250,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,inpatient,250,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,00781-6160-86,NDC,,,facility,outpatient,250,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,inpatient,250,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,10019-0653-64,NDC,,,facility,outpatient,250,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,inpatient,250,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0015-25,NDC,,,facility,outpatient,250,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,inpatient,250,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
SEVOFLURANE LIQUID,57887,CDM,250,RC,66794-0022-25,NDC,,,facility,outpatient,250,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,inpatient,28,EA,25.82000,24.53000,Amish/Mennonite,Amish Mennonite,,14.20,,,,,,,14.20,25.05,percent of total billed charges,
SALMETEROL POWDER,57890,CDM,250,RC,00173-0520-00,NDC,,,facility,outpatient,28,EA,25.82000,24.53000,Amish/Mennonite,Amish Mennonite,,14.20,,,,,,,12.91,25.05,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,00310-0754-30,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,inpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.29,4.04,percent of total billed charges,
ROSUVASTATIN TAB 7224274,57891,CDM,250,RC,50268-0711-15,NDC,,,facility,outpatient,1,EA,4.17000,3.96000,Amish/Mennonite,Amish Mennonite,,2.29,,,,,,,2.08,4.04,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,00395-2661-16,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SIMPLE SYRUP LIQUID,57893,CDM,250,RC,31722-0937-47,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
RSV ANTIGEN IMMUNOASSAY-TECH,57894,CDM,300,RC,87420,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,13.91,662.12,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-5973-61,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,00904-6357-61,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,43547-0339-06,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,inpatient,1,EA,29.01000,27.56000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,15.96,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0301-01,NDC,,,facility,outpatient,1,EA,29.01000,27.56000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,14.51,28.14,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,inpatient,1,EA,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-10,NDC,,,facility,outpatient,1,EA,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.65,5.15,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,50458-0590-60,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68084-0270-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
RISPERIDONE TAB 7220314,57895,CDM,250,RC,68382-0112-14,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,5339.00000,5072.05000,Amish/Mennonite,Amish Mennonite,,2936.45,,,,,,,2936.45,5178.83,percent of total billed charges,
RSV PANEL 12-25 TARGETS-TECH,57896,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,5339.00000,5072.05000,Amish/Mennonite,Amish Mennonite,,2936.45,,,,,,,416.78,5178.83,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
RSV NAT PCR-TECH,57897,CDM,300,RC,87634,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,69.33,3666.93,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-6359-61,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,00904-7362-61,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,13668-0037-60,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,27241-0001-06,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,43547-0341-06,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,inpatient,1,EA,33.84000,32.15000,Amish/Mennonite,Amish Mennonite,,18.61,,,,,,,18.61,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,50458-0300-01,NDC,,,facility,outpatient,1,EA,33.84000,32.15000,Amish/Mennonite,Amish Mennonite,,18.61,,,,,,,16.92,32.82,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68084-0272-01,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220312,57898,CDM,250,RC,68382-0114-14,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-6358-61,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,00904-7361-61,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50268-0695-15,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,inpatient,1,EA,31.84000,30.25000,Amish/Mennonite,Amish Mennonite,,17.51,,,,,,,17.51,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,50458-0302-06,NDC,,,facility,outpatient,1,EA,31.84000,30.25000,Amish/Mennonite,Amish Mennonite,,17.51,,,,,,,15.92,30.88,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-0461-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,51079-9461-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68084-0271-01,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
RISPERIDONE TAB 7220313,57900,CDM,250,RC,68382-0113-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,inpatient,1,GM,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,43598-0210-55,NDC,,,facility,outpatient,1,GM,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,inpatient,1,GM,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-50,NDC,,,facility,outpatient,1,GM,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,inpatient,1,GM,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,61570-0131-55,NDC,,,facility,outpatient,1,GM,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,inpatient,1,GM,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL CREAM 7910556,57902,CDM,250,RC,67877-0124-05,NDC,,,facility,outpatient,1,GM,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,inpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,00904-6374-61,NDC,,,facility,outpatient,1,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,43547-0270-10,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,60687-0588-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,62332-0032-31,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68084-0307-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
ROPINIROLE TAB 7212022,57903,CDM,250,RC,68462-0255-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,inpatient,1,EA,14.60000,13.87000,Amish/Mennonite,Amish Mennonite,,8.03,,,,,,,8.03,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,00006-0735-54,NDC,,,facility,outpatient,1,EA,14.60000,13.87000,Amish/Mennonite,Amish Mennonite,,8.03,,,,,,,7.30,14.16,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,16714-0682-02,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,51079-0454-20,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0436-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,63739-0571-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68084-0511-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMVASTATIN TAB 7223613,57904,CDM,250,RC,68180-0478-02,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,inpatient,,,913.00000,867.35000,Amish/Mennonite,Amish Mennonite,TC,502.15,,,,,,,502.15,885.61,percent of total billed charges,
SALIVARY GLAND FUNCTION STUDY-TECH,57905,CDM,341,RC,78232,CPT,,,facility,outpatient,,,913.00000,867.35000,Amish/Mennonite,Amish Mennonite,TC,502.15,,,,,,,455.68,2210.07,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,Amish/Mennonite,Amish Mennonite,,33.20,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN TAB 7212044,57906,CDM,250,RC,00006-0277-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,Amish/Mennonite,Amish Mennonite,,33.20,,,,,,,30.18,58.55,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,inpatient,10,EA,37.19000,35.33000,Amish/Mennonite,Amish Mennonite,,20.45,,,,,,,20.45,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00186086854,NDC,facility,outpatient,10,EA,37.19000,35.33000,Amish/Mennonite,Amish Mennonite,,20.45,,,,,,,0.08525,36.07,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,inpatient,10,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,00409930320,NDC,facility,outpatient,10,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.08525,1.08,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,43066002710,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.08525,1.53,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,inpatient,10,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,55150020120,NDC,facility,outpatient,10,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,0.08525,3.38,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,inpatient,10,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028810,NDC,facility,outpatient,10,EA,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.08525,1.89,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,inpatient,10,EA,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028821,NDC,facility,outpatient,10,EA,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,0.08525,3.48,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,inpatient,10,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008478,57907,CDM,250,RC,J2795,HCPCS,63323028829,NDC,facility,outpatient,10,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.08525,1.13,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
SEDIMENTATION RATE AUTOMATED-TECH,57908,CDM,300,RC,85652,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,2.70,135.79,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,inpatient,200,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,25021067167,NDC,facility,outpatient,200,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.08525,0.61110,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,inpatient,200,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028563,NDC,facility,outpatient,200,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,inpatient,200,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,43066015410,NDC,facility,outpatient,200,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,inpatient,200,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028564,NDC,facility,outpatient,200,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,inpatient,200,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008760,57909,CDM,250,RC,J2795,HCPCS,63323028573,NDC,facility,outpatient,200,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.08525,1.11,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,16714-0684-02,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,51079-0456-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,60687-0210-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMVASTATIN TAB 7223597,57911,CDM,250,RC,63739-0573-10,NDC,,,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,inpatient,1,EA,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,4.12,7.27,percent of total billed charges,
SELEGILINE TAB,57912,CDM,250,RC,00378-9290-91,NDC,,,facility,outpatient,1,EA,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,3.75,7.27,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,inpatient,,,296.20000,281.39000,Amish/Mennonite,Amish Mennonite,90,162.91,,,,,,,162.91,287.31,percent of total billed charges,
SELENIUM ASSAY-TECH,57913,CDM,300,RC,84255,CPT,,,facility,outpatient,,,296.20000,281.39000,Amish/Mennonite,Amish Mennonite,90,162.91,,,,,,,26.38,1341.13,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12165-0100-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,inpatient,1,EA,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-01,NDC,,,facility,outpatient,1,EA,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
SILVER NITRATE STICK,57914,CDM,250,RC,12870-0001-02,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,inpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,90.75,160.05,percent of total billed charges,
RUBEOLA AB-TECH,57915,CDM,300,RC,86765,CPT,,,facility,outpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,12.88,679.08,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,inpatient,50,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,00409663714,NDC,facility,outpatient,50,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,inpatient,50,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
SODIUM BICARBONATE SYRINGE 1 MEQ/ML 50 ML (8.4%),57916,CDM,250,RC,J3490,HCPCS,76329335201,NDC,facility,outpatient,50,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00182-8215-89,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00603-0282-21,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-6522-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,00904-7252-61,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,57896-0454-01,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-10,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,67618-0300-50,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,69618-0064-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0058-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-0164-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SENNA TAB,57917,CDM,250,RC,70677-1097-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,inpatient,1,EA,56.35000,53.53000,Amish/Mennonite,Amish Mennonite,,30.99,,,,,,,30.99,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434504,NDC,facility,outpatient,1,EA,56.35000,53.53000,Amish/Mennonite,Amish Mennonite,,30.99,,,,,,,28.18,54.66,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,inpatient,1,EA,34.93000,33.19000,Amish/Mennonite,Amish Mennonite,,19.21,,,,,,,19.21,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00067434509,NDC,facility,outpatient,1,EA,34.93000,33.19000,Amish/Mennonite,Amish Mennonite,,19.21,,,,,,,17.46,33.88,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,inpatient,1,EA,58.08000,55.18000,Amish/Mennonite,Amish Mennonite,,31.94,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647044,NDC,facility,outpatient,1,EA,58.08000,55.18000,Amish/Mennonite,Amish Mennonite,,31.94,,,,,,,29.04,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,inpatient,1,EA,51.07000,48.51000,Amish/Mennonite,Amish Mennonite,,28.09,,,,,,,28.09,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00378647099,NDC,facility,outpatient,1,EA,51.07000,48.51000,Amish/Mennonite,Amish Mennonite,,28.09,,,,,,,25.54,49.54,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,inpatient,1,EA,42.19000,40.08000,Amish/Mennonite,Amish Mennonite,,23.20,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225804,NDC,facility,outpatient,1,EA,42.19000,40.08000,Amish/Mennonite,Amish Mennonite,,23.20,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,inpatient,1,EA,42.19000,40.08000,Amish/Mennonite,Amish Mennonite,,23.20,,,,,,,23.20,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,00591225823,NDC,facility,outpatient,1,EA,42.19000,40.08000,Amish/Mennonite,Amish Mennonite,,23.20,,,,,,,21.09,40.92,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,inpatient,1,EA,67.30000,63.93000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055388,NDC,facility,outpatient,1,EA,67.30000,63.93000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,inpatient,1,EA,67.30000,63.93000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,37.02,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,10019055304,NDC,facility,outpatient,1,EA,67.30000,63.93000,Amish/Mennonite,Amish Mennonite,,37.02,,,,,,,33.65,65.28,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,inpatient,1,EA,60.57000,57.54000,Amish/Mennonite,Amish Mennonite,,33.31,,,,,,,33.31,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058062,NDC,facility,outpatient,1,EA,60.57000,57.54000,Amish/Mennonite,Amish Mennonite,,33.31,,,,,,,30.29,58.75,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,inpatient,1,EA,50.72000,48.18000,Amish/Mennonite,Amish Mennonite,,27.90,,,,,,,27.90,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,45802058084,NDC,facility,outpatient,1,EA,50.72000,48.18000,Amish/Mennonite,Amish Mennonite,,27.90,,,,,,,25.36,49.20,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,inpatient,1,EA,30.02000,28.52000,Amish/Mennonite,Amish Mennonite,,16.51,,,,,,,16.51,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050510,NDC,facility,outpatient,1,EA,30.02000,28.52000,Amish/Mennonite,Amish Mennonite,,16.51,,,,,,,15.01,29.12,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,inpatient,1,EA,58.08000,55.17000,Amish/Mennonite,Amish Mennonite,,31.94,,,,,,,31.94,56.34,percent of total billed charges,
SCOPOLAMINE PATCH 1 MG/72 HR,57918,CDM,636,RC,J3490,HCPCS,50742050524,NDC,facility,outpatient,1,EA,58.08000,55.17000,Amish/Mennonite,Amish Mennonite,,31.94,,,,,,,29.04,56.34,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-20,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,00054-0107-25,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,31722-0272-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,57237-0223-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,inpatient,1,EA,333.36000,316.69000,Amish/Mennonite,Amish Mennonite,,183.35,,,,,,,183.35,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,61570-0111-56,NDC,,,facility,outpatient,1,EA,333.36000,316.69000,Amish/Mennonite,Amish Mennonite,,183.35,,,,,,,166.68,323.36,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68084-0266-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
RAMIPRIL CAP,57919,CDM,250,RC,68180-0589-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,inpatient,1,EA,27.48000,26.11000,Amish/Mennonite,Amish Mennonite,,15.11,,,,,,,15.11,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-39,NDC,,,facility,outpatient,1,EA,27.48000,26.11000,Amish/Mennonite,Amish Mennonite,,15.11,,,,,,,13.74,26.66,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,inpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,16.02,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,00310-0752-90,NDC,,,facility,outpatient,1,EA,29.13000,27.67000,Amish/Mennonite,Amish Mennonite,,16.02,,,,,,,14.56,28.26,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,16714-0990-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,27808-0157-01,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,42292-0031-20,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.25,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,50268-0710-15,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
ROSUVASTATIN TAB 7212030,57921,CDM,250,RC,60687-0256-01,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,inpatient,1,EA,283.39000,269.22000,Amish/Mennonite,Amish Mennonite,,155.86,,,,,,,155.86,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,00270055615,NDC,facility,outpatient,1,EA,283.39000,269.22000,Amish/Mennonite,Amish Mennonite,,155.86,,,,,,,141.69,274.89,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,inpatient,1,EA,353.87000,336.18000,Amish/Mennonite,Amish Mennonite,,194.63,,,,,,,194.63,343.25,percent of total billed charges,
SINCALIDE INJECTION,57922,CDM,250,RC,J2805,HCPCS,72266024805,NDC,facility,outpatient,1,EA,353.87000,336.18000,Amish/Mennonite,Amish Mennonite,,194.63,,,,,,,176.94,343.25,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,inpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,,112.75,,,,,,,112.75,198.85,percent of total billed charges,
RHO D IMMUNE GLOBULIN INJ,57924,CDM,250,RC,J2791,HCPCS,,,facility,outpatient,,,205.00000,194.75000,Amish/Mennonite,Amish Mennonite,,112.75,,,,,,,7.57,198.85,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE ENEM,57925,CDM,250,RC,00132-0202-20,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
SICKLE CELL TEST-TECH,57926,CDM,300,RC,85660,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.51,288.61,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,00904-6925-61,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16714-0612-04,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,16729-0216-15,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,51079-0763-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,59762-4900-03,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,60687-0242-01,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,65862-0012-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68084-0181-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,68180-0352-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
SERTRALINE TAB 7214455,57928,CDM,250,RC,76282-0213-90,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,inpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,,141.35,,,,,,,141.35,249.29,percent of total billed charges,
SEX HORMONE BINDING GLOBULIN-TECH,57929,CDM,300,RC,84270,CPT,,,facility,outpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,,141.35,,,,,,,21.73,1137.41,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,16714-0683-02,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,51079-0455-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,63739-0572-10,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
SIMVASTATIN TAB 7223605,57930,CDM,250,RC,68084-0512-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
SMOOTH MUSCLE AB ACTIN IGG-TECH,57931,CDM,300,RC,86015,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,11.53,574.73,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,inpatient,50,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662514,NDC,facility,outpatient,50,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,inpatient,50,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,00409662535,NDC,facility,outpatient,50,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,inpatient,50,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,51754500105,NDC,facility,outpatient,50,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,inpatient,50,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,63323008950,NDC,facility,outpatient,50,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,inpatient,50,EA,1.37000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,70095005003,NDC,facility,outpatient,50,EA,1.37000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,inpatient,50,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
SODIUM BICARBONATE SOLN-INJ 1 MEQ/ML 50 ML (8.4%),57932,CDM,250,RC,J3490,HCPCS,81298762003,NDC,facility,outpatient,50,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,inpatient,1,EA,6621.21000,6290.15000,Amish/Mennonite,Amish Mennonite,,3641.67,,,,,,,3641.67,6422.57,percent of total billed charges,
ROMIDEPSIN INJ,57934,CDM,636,RC,J9319,HCPCS,59572098401,NDC,facility,outpatient,1,EA,6621.21000,6290.15000,Amish/Mennonite,Amish Mennonite,,3641.67,,,,,,,31.08,6422.57,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
SEMEN ANAL PRESENCE MOTILITY-TECH,57935,CDM,300,RC,89321,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,12.05,628.12,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,63.80,112.52,percent of total billed charges,
SEMEN ANAL COUNT & MOTILITY-TECH,57937,CDM,300,RC,89310,CPT,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,8.61,458.40,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,inpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,00904-1250-61,NDC,,,facility,outpatient,1,EA,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,42192-0365-10,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,51293-0803-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SALSALATE TAB,57939,CDM,250,RC,65162-0512-10,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,inpatient,100,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,25021067166,NDC,facility,outpatient,100,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.08525,0.75660,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,inpatient,100,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028561,NDC,facility,outpatient,100,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.08525,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,inpatient,100,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,43066015210,NDC,facility,outpatient,100,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.08525,0.92150,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,inpatient,100,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,55150019699,NDC,facility,outpatient,100,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.08525,1.22,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,inpatient,100,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028565,NDC,facility,outpatient,100,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.08525,1.24,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,inpatient,100,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
ROPIVACAINE HCL INJECTION 7008758,57940,CDM,250,RC,J2795,HCPCS,63323028568,NDC,facility,outpatient,100,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.08525,1.18,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,inpatient,,,18565.90000,17637.60000,Amish/Mennonite,Amish Mennonite,,10211.25,,,,,,,9097.29,18008.92,percent of total billed charges,
ALLOGRAFT MEM AMNIO 5.0CM X 8.0CM AMNIOEXCEL +,57942,CDM,278,RC,Q4137,HCPCS,,,facility,outpatient,,,18565.90000,17637.60000,Amish/Mennonite,Amish Mennonite,,10211.25,,,,,,,8521.75,18565.90,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,inpatient,133,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00132-0201-40,NDC,,,facility,outpatient,133,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,inpatient,133,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00536-7415-51,NDC,,,facility,outpatient,133,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,inpatient,133,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BIPHOSPHATE-SODIUM PHOSPHATE 7 G-19 G ENEMA,57943,CDM,250,RC,00904-6320-78,NDC,,,facility,outpatient,133,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,inpatient,1,EA,49.86000,47.37000,Amish/Mennonite,Amish Mennonite,,27.42,,,,,,,27.42,48.36,percent of total billed charges,
SITAGLIPTIN TAB 7212048,57944,CDM,250,RC,00006-0112-31,NDC,,,facility,outpatient,1,EA,49.86000,47.37000,Amish/Mennonite,Amish Mennonite,,27.42,,,,,,,24.93,48.36,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
SODIUM SERUM/PLASMA/WHOLE BLD-TECH,57946,CDM,300,RC,84295,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,4.81,254.68,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
SMEAR GRAM STAIN-TECH,57947,CDM,300,RC,87205,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,4.27,220.68,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,00904-6926-61,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,16714-0613-04,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,31722-0214-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,51079-0151-20,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,60687-0253-01,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68084-0182-11,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,68180-0353-09,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SERTRALINE TAB 7214458,57949,CDM,250,RC,76282-0214-90,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,inpatient,120,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,45802-0040-64,NDC,,,facility,outpatient,120,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,inpatient,120,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
SELENIUM SULFIDE TOPICAL LOTION,57951,CDM,250,RC,60432-0528-04,NDC,,,facility,outpatient,120,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,inpatient,50,EA,6.13000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.37,5.95,percent of total billed charges,
SODIUM THIOSULFATE SOLN 25% 50 ML,57952,CDM,250,RC,J0209,HCPCS,60267070550,NDC,facility,outpatient,50,EA,6.13000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.06,5.95,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,inpatient,10,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00074553418,NDC,facility,outpatient,10,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,inpatient,10,EA,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553414,NDC,facility,outpatient,10,EA,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.89,5.61,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,inpatient,10,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,00409553434,NDC,facility,outpatient,10,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.32,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,inpatient,10,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
SODIUM BICARBONATE  SOLN 0.5 MEQ/ML 10 ML (4.2% ),57953,CDM,250,RC,J3490,HCPCS,51754501204,NDC,facility,outpatient,10,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,inpatient,1,EA,15.92000,15.13000,Amish/Mennonite,Amish Mennonite,,8.76,,,,,,,8.76,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,00955-1048-18,NDC,,,facility,outpatient,1,EA,15.92000,15.13000,Amish/Mennonite,Amish Mennonite,,8.76,,,,,,,7.96,15.44,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,inpatient,1,EA,22.30000,21.18000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,12.27,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,58468-0021-01,NDC,,,facility,outpatient,1,EA,22.30000,21.18000,Amish/Mennonite,Amish Mennonite,,12.27,,,,,,,11.15,21.63,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,inpatient,1,EA,23.50000,22.33000,Amish/Mennonite,Amish Mennonite,,12.93,,,,,,,12.93,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,60687-0449-01,NDC,,,facility,outpatient,1,EA,23.50000,22.33000,Amish/Mennonite,Amish Mennonite,,12.93,,,,,,,11.75,22.80,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,inpatient,1,EA,13.15000,12.49000,Amish/Mennonite,Amish Mennonite,,7.23,,,,,,,7.23,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,68462-0447-18,NDC,,,facility,outpatient,1,EA,13.15000,12.49000,Amish/Mennonite,Amish Mennonite,,7.23,,,,,,,6.58,12.76,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,inpatient,1,EA,20.33000,19.32000,Amish/Mennonite,Amish Mennonite,,11.18,,,,,,,11.18,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,70748-0173-26,NDC,,,facility,outpatient,1,EA,20.33000,19.32000,Amish/Mennonite,Amish Mennonite,,11.18,,,,,,,10.16,19.72,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,inpatient,1,EA,16.17000,15.36000,Amish/Mennonite,Amish Mennonite,,8.89,,,,,,,8.89,15.68,percent of total billed charges,
SEVELAMER TAB,57955,CDM,250,RC,72603-0148-01,NDC,,,facility,outpatient,1,EA,16.17000,15.36000,Amish/Mennonite,Amish Mennonite,,8.89,,,,,,,8.09,15.68,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-1303-75,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,inpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00536-2220-75,NDC,,,facility,outpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,inpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,50383-0785-30,NDC,,,facility,outpatient,30,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,inpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,00904-5894-30,NDC,,,facility,outpatient,30,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,49348-0740-27,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,inpatient,30,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,56184-1204-01,NDC,,,facility,outpatient,30,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,inpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,57896-0798-01,NDC,,,facility,outpatient,30,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,inpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,62372-0630-30,NDC,,,facility,outpatient,30,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,inpatient,30,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,69618-0059-51,NDC,,,facility,outpatient,30,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,inpatient,30,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70000-0051-01,NDC,,,facility,outpatient,30,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,inpatient,30,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,70677-1078-01,NDC,,,facility,outpatient,30,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,inpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
SIMETHICONE LIQ 40 MG/0.6 ML 30 ML,57956,CDM,250,RC,71399-0041-01,NDC,,,facility,outpatient,30,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,inpatient,1,mL,5.10000,4.84000,Amish/Mennonite,Amish Mennonite,,2.81,,,,,,,2.81,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490014,NDC,facility,outpatient,1,mL,5.10000,4.84000,Amish/Mennonite,Amish Mennonite,,2.81,,,,,,,2.55,4.95,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,inpatient,1,mL,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.31,percent of total billed charges,
SODIUM BICARBONATE SOLN 1 MEQ/ML 10 ML (8.4%),57958,CDM,250,RC,J3490,HCPCS,00409490034,NDC,facility,outpatient,1,mL,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.22,4.31,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
SEMEN ANAL VOL CNT MOTIL DIFF-TECH,57959,CDM,300,RC,89320,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,12.31,628.12,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950410,NDC,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,inpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CITRATE 4% 500 ML,57960,CDM,250,RC,J3490,HCPCS,00942950510,NDC,facility,outpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,inpatient,1,GM,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SODIUM CHLORIDE NASAL GEL,57966,CDM,250,RC,00225-0525-47,NDC,,,facility,outpatient,1,GM,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,inpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,00517293025,NDC,facility,outpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,inpatient,30,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323009330,NDC,facility,outpatient,30,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,inpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM CHLORIDE SOL 7010101,57967,CDM,250,RC,J7131,HCPCS,63323018730,NDC,facility,outpatient,30,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,inpatient,15,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,24208-0670-04,NDC,,,facility,outpatient,15,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,inpatient,15,EA,9.38000,8.91000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,5.16,9.10,percent of total billed charges,
SODIUM SULFACETAMIDE OPHTHALMIC SOL,57968,CDM,250,RC,61314-0701-01,NDC,,,facility,outpatient,15,EA,9.38000,8.91000,Amish/Mennonite,Amish Mennonite,,5.16,,,,,,,4.69,9.10,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM URINE-TECH,57970,CDM,300,RC,84300,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,5.06,254.68,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,inpatient,500,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00264780510,NDC,facility,outpatient,500,EA,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.15000,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,inpatient,500,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
SODIUM CHLORIDE SOL 7034325,57971,CDM,636,RC,J7131,HCPCS,00338005403,NDC,facility,outpatient,500,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.15000,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,inpatient,50,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,61570-0131-20,NDC,,,facility,outpatient,50,EA,1.44000,1.36000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,inpatient,50,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
SILVER SULFADIAZINE CREAM 1% 20 GM,57974,CDM,250,RC,67877-0124-20,NDC,,,facility,outpatient,50,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,inpatient,1,mL,987.52000,938.14000,Amish/Mennonite,Amish Mennonite,,543.14,,,,,,,543.14,957.89,percent of total billed charges,
SODIUM CHONDROITIN-HYALURONATE OPHTH SOL,57976,CDM,250,RC,08065-1839-05,NDC,,,facility,outpatient,1,mL,987.52000,938.14000,Amish/Mennonite,Amish Mennonite,,543.14,,,,,,,493.76,957.89,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,inpatient,,,359.60000,341.62000,Amish/Mennonite,Amish Mennonite,90,197.78,,,,,,,197.78,348.81,percent of total billed charges,
SEROTONIN ASSAY (SER) SO,57977,CDM,300,RC,84260,CPT,,,facility,outpatient,,,359.60000,341.62000,Amish/Mennonite,Amish Mennonite,90,197.78,,,,,,,32.01,1612.78,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,inpatient,1,mL,426.59000,405.26000,Amish/Mennonite,Amish Mennonite,,234.62,,,,,,,234.62,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,00016-0319-85,NDC,,,facility,outpatient,1,mL,426.59000,405.26000,Amish/Mennonite,Amish Mennonite,,234.62,,,,,,,213.29,413.79,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,inpatient,1,mL,360.24000,342.23000,Amish/Mennonite,Amish Mennonite,,198.13,,,,,,,198.13,349.43,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7529530,57978,CDM,250,RC,05047-4508-54,NDC,,,facility,outpatient,1,mL,360.24000,342.23000,Amish/Mennonite,Amish Mennonite,,198.13,,,,,,,180.12,349.43,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
RUBELLA AB-TECH,57979,CDM,300,RC,86762,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,14.39,746.94,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,inpatient,45,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00187-5260-03,NDC,,,facility,outpatient,45,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,inpatient,45,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00225-0380-80,NDC,,,facility,outpatient,45,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,inpatient,45,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,00904-3865-75,NDC,,,facility,outpatient,45,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,45802-0357-58,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,inpatient,45,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM CHLORIDE NASAL SPRAY,57980,CDM,250,RC,49348-0356-25,NDC,,,facility,outpatient,45,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17034.50000,16182.77000,Amish/Mennonite,Amish Mennonite,,9368.98,,,,,,,8346.91,16523.47,percent of total billed charges,
SERAFUSE IMP FASTENER KIT,57981,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17034.50000,16182.77000,Amish/Mennonite,Amish Mennonite,,9368.98,,,,,,,7818.84,17034.50,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,inpatient,60,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,00574200202,NDC,facility,outpatient,60,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,inpatient,60,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,46287000660,NDC,facility,outpatient,60,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,inpatient,60,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE SUSP,57983,CDM,250,RC,J8499,HCPCS,62559035601,NDC,facility,outpatient,60,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00223-1721-01,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00536-1047-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,64980-0528-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,00904-7261-61,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,66553-0008-01,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,69618-0034-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM BICARBONATE TAB,57985,CDM,250,RC,77333-0831-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,inpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,108.35,191.09,percent of total billed charges,
SPUTUM INDUCTION-TECH,57986,CDM,410,RC,94664,CPT,,,facility,outpatient,,,197.00000,187.15000,Amish/Mennonite,Amish Mennonite,,108.35,,,,,,,98.50,212.44,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,inpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,39.60,69.84,percent of total billed charges,
SILVER STAIN-TECH,57987,CDM,300,RC,87207,CPT,,,facility,outpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,5.99,1216.68,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00378-2146-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,00904-6927-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,inpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-01,NDC,,,facility,outpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-19,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,51079-0103-20,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,53489-0143-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,59651-0426-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,60687-0465-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1061-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63629-1064-03,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,63739-0544-10,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,65162-0511-10,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,68382-0660-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
SPIRONOLACTONE TAB 7213192,57988,CDM,250,RC,69584-0852-10,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,inpatient,10,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00074662902,NDC,facility,outpatient,10,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,inpatient,10,EA,6.12000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.37,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00409662902,NDC,facility,outpatient,10,EA,6.12000,5.82000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.06,5.94,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,inpatient,10,EA,6.06000,5.76000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.33,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70710137702,NDC,facility,outpatient,10,EA,6.06000,5.76000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.03,5.88,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,inpatient,10,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300970,NDC,facility,outpatient,10,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,inpatient,10,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,00781300995,NDC,facility,outpatient,10,EA,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,inpatient,10,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,16729049345,NDC,facility,outpatient,10,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,inpatient,10,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70069030125,NDC,facility,outpatient,10,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,inpatient,10,EA,6.30000,5.99000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,63323094310,NDC,facility,outpatient,10,EA,6.30000,5.99000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,inpatient,10,EA,10.45000,9.93000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.75,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,70092108746,NDC,facility,outpatient,10,EA,10.45000,9.93000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.22,10.14,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,inpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
SUCCINYLCHOLINE SOLN-INJ 20 MG/ML 10 ML,57989,CDM,250,RC,J0330,HCPCS,71288071911,NDC,facility,outpatient,10,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00093-1061-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,inpatient,1,EA,5.04000,4.79000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.77,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,00245-0012-01,NDC,,,facility,outpatient,1,EA,5.04000,4.79000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.52,4.89,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-4387-11,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50268-0724-15,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.13,4.14,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,inpatient,1,EA,53.17000,50.51000,Amish/Mennonite,Amish Mennonite,,29.24,,,,,,,29.24,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,50419-0105-10,NDC,,,facility,outpatient,1,EA,53.17000,50.51000,Amish/Mennonite,Amish Mennonite,,29.24,,,,,,,26.59,51.57,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,60505-0080-00,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0387-11,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,inpatient,1,EA,4.02000,3.82000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.21,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,68084-0654-01,NDC,,,facility,outpatient,1,EA,4.02000,3.82000,Amish/Mennonite,Amish Mennonite,,2.21,,,,,,,2.01,3.90,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,69584-0841-10,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
SOTALOL TAB,57990,CDM,250,RC,76385-0114-01,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,TC,290.40,,,,,,,290.40,512.16,percent of total billed charges,
SPECIAL STAIN GROUP 1-TECH,57993,CDM,310,RC,88312,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,TC,290.40,,,,,,,177.63,3723.67,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,inpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,TC,234.85,,,,,,,234.85,414.19,percent of total billed charges,
SPECIAL STAIN GROUP 2-TECH,57995,CDM,310,RC,88313,CPT,,,facility,outpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,TC,234.85,,,,,,,121.00,3027.62,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2771.00000,2632.45000,Amish/Mennonite,Amish Mennonite,QN,1524.05,,,,,,,1524.05,2687.87,percent of total billed charges,
SPECIALTY CARE TRANSPORT-TECH,57996,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2771.00000,2632.45000,Amish/Mennonite,Amish Mennonite,QN,1524.05,,,,,,,1385.50,2687.87,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,inpatient,1,EA,8.95000,8.51000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.68,percent of total billed charges,
NITHIODOTE KIT,57997,CDM,636,RC,J0211,HCPCS,60267081200,NDC,facility,outpatient,1,EA,8.95000,8.51000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,2.17,8.68,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
STREP PNEUMONIAE AG-TECH,57999,CDM,300,RC,87899,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,16.07,763.98,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,GN,182.05,,,,,,,182.05,321.07,percent of total billed charges,
ST EVAL AUD REHAB STATUS 1ST H-TECH,58001,CDM,440,RC,92626,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,GN,182.05,,,,,,,126.65,321.07,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,inpatient,1,mL,123.44000,117.27000,Amish/Mennonite,Amish Mennonite,,67.89,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE SOL,58003,CDM,250,RC,67457-0162-02,NDC,,,facility,outpatient,1,mL,123.44000,117.27000,Amish/Mennonite,Amish Mennonite,,67.89,,,,,,,61.72,119.74,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,inpatient,1,EA,12.01000,11.41000,Amish/Mennonite,Amish Mennonite,,6.61,,,,,,,6.61,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00093022219,NDC,facility,outpatient,1,EA,12.01000,11.41000,Amish/Mennonite,Amish Mennonite,,6.61,,,,,,,6.00,11.65,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,inpatient,1,EA,16.88000,16.04000,Amish/Mennonite,Amish Mennonite,,9.28,,,,,,,9.28,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00173073500,NDC,facility,outpatient,1,EA,16.88000,16.04000,Amish/Mennonite,Amish Mennonite,,9.28,,,,,,,8.44,16.37,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,inpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,00378563059,NDC,facility,outpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,inpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,65862014636,NDC,facility,outpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,42043022009,NDC,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
SUMATRIPTAN TAB 25 MG,58004,CDM,250,RC,J8499,HCPCS,69452034472,NDC,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,inpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,GN,320.10,,,,,,,320.10,564.54,percent of total billed charges,
ST EVAL SPEECH FLUENCY-TECH,58005,CDM,440,RC,92521,CPT,,,facility,outpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,GN,320.10,,,,,,,126.65,564.54,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,inpatient,1,mL,22.59000,21.46000,Amish/Mennonite,Amish Mennonite,,12.42,,,,,,,12.42,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,00409338221,NDC,facility,outpatient,1,mL,22.59000,21.46000,Amish/Mennonite,Amish Mennonite,,12.42,,,,,,,11.29,21.91,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,inpatient,1,mL,14.17000,13.46000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.79,13.74,percent of total billed charges,
SUFENTANIL SOLN 50 MCG/ML,58006,CDM,250,RC,J3490,HCPCS,17478005001,NDC,facility,outpatient,1,mL,14.17000,13.46000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.08,13.74,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,00228-2672-11,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-01,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,51079-0979-20,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,53489-0328-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0416-10,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,63739-0545-10,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SPIRONOLACTONE TAB 7213200,58007,CDM,250,RC,68382-0661-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,inpatient,,,662.00000,628.90000,Amish/Mennonite,Amish Mennonite,GN,364.10,,,,,,,364.10,642.14,percent of total billed charges,
ST EVAL SPEECH-GEN DEV 1ST HR-TECH,58008,CDM,440,RC,92607,CPT,,,facility,outpatient,,,662.00000,628.90000,Amish/Mennonite,Amish Mennonite,GN,364.10,,,,,,,126.65,642.14,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,inpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,90,105.93,,,,,,,105.93,186.82,percent of total billed charges,
SUGARS SINGLE QUANT EA SPEC SO-TECH,58011,CDM,300,RC,84378,CPT,,,facility,outpatient,,,192.60000,182.97000,Amish/Mennonite,Amish Mennonite,90,105.93,,,,,,,11.91,594.19,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,inpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,GN,130.90,,,,,,,130.90,230.86,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD INDV-TECH,58012,CDM,440,RC,92507,CPT,,,facility,outpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,GN,130.90,,,,,,,119.00,264.00,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,GN,145.20,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB PRELING HEAR LOSS-TECH,58013,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,GN,145.20,,,,,,,126.65,264.00,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,GN,145.20,,,,,,,145.20,256.08,percent of total billed charges,
ST AUD REHAB POSTLING HEAR LOS-TECH,58014,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,GN,145.20,,,,,,,126.65,264.00,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,inpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,,245.85,,,,,,,245.85,433.59,percent of total billed charges,
STEM CELLS CD24 TOTAL COUNT-TECH,58015,CDM,300,RC,86367,CPT,,,facility,outpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,,245.85,,,,,,,49.49,3666.93,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,inpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,GN,185.35,,,,,,,185.35,326.89,percent of total billed charges,
ST EVAL NONSPCH-GEN DEV 1ST HR-TECH,58016,CDM,440,RC,92605,CPT,,,facility,outpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,GN,185.35,,,,,,,126.65,326.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,QW,20.35,,,,,,,20.35,35.89,percent of total billed charges,
STREP SCREEN RAPID-TECH,58017,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,QW,20.35,,,,,,,16.53,780.94,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
STENT BILI AD L30MM DIA1.67MM CATH 10FR L210CM 0.035IN PUR,58018,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,inpatient,1,mL,447.36000,425.00000,Amish/Mennonite,Amish Mennonite,,246.05,,,,,,,246.05,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,00016-0310-55,NDC,,,facility,outpatient,1,mL,447.36000,425.00000,Amish/Mennonite,Amish Mennonite,,246.05,,,,,,,223.68,433.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,inpatient,1,mL,485.51000,461.23000,Amish/Mennonite,Amish Mennonite,,267.03,,,,,,,267.03,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,05047-4636-97,NDC,,,facility,outpatient,1,mL,485.51000,461.23000,Amish/Mennonite,Amish Mennonite,,267.03,,,,,,,242.75,470.94,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,inpatient,1,mL,669.82000,636.33000,Amish/Mennonite,Amish Mennonite,,368.40,,,,,,,368.40,649.73,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC LIQUID 7910440,58020,CDM,250,RC,08065-1830-55,NDC,,,facility,outpatient,1,mL,669.82000,636.33000,Amish/Mennonite,Amish Mennonite,,368.40,,,,,,,334.91,649.73,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
SPLIT BLD/BLD PRODUCTS EA UNIT-TECH,58023,CDM,300,RC,86985,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,71.50,1256.24,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
SPORT SPLINT APPLIED - ORTHO TX DONE-TECH,58024,CDM,450,RC,,,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,71.00,137.74,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,inpatient,1,mL,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
SODIUM BICARBONATE 7.5% SOLN,58026,CDM,250,RC,J3490,HCPCS,00409491634,NDC,facility,outpatient,1,mL,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,inpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,GN,245.85,,,,,,,245.85,433.59,percent of total billed charges,
ST EVAL SWALLOWING FUNCTION-TECH,58027,CDM,440,RC,92610,CPT,,,facility,outpatient,,,447.00000,424.65000,Amish/Mennonite,Amish Mennonite,GN,245.85,,,,,,,126.65,433.59,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,00436-0672-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE TOPICAL SOL,58028,CDM,250,RC,39328-0064-12,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,GN,100.65,,,,,,,100.65,177.51,percent of total billed charges,
ST ASSESS APHASIA PER HR-TECH,58029,CDM,440,RC,96105,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,GN,100.65,,,,,,,91.50,264.00,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1443.75000,1371.56000,Amish/Mennonite,Amish Mennonite,,794.06,,,,,,,707.44,1400.44,percent of total billed charges,
ANCHOR SUT XL DIA1.7MM CRV W/ SZ 2-0 ULTRABRAID BLU SUT,58031,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1443.75000,1371.56000,Amish/Mennonite,Amish Mennonite,,794.06,,,,,,,662.68,1443.75,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,GN,58.85,,,,,,,58.85,103.79,percent of total billed charges,
ST SPCH/LANG/VCE/COMM/APD GRP-TECH,58032,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,GN,58.85,,,,,,,53.50,264.00,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,inpatient,,,202.80000,192.66000,Amish/Mennonite,Amish Mennonite,90,111.54,,,,,,,111.54,196.72,percent of total billed charges,
STRIATED MUSCLE AB IGG (8746)-TECH,58035,CDM,300,RC,83520,CPT,,,facility,outpatient,,,202.80000,192.66000,Amish/Mennonite,Amish Mennonite,90,111.54,,,,,,,17.85,814.87,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,inpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,00121-0659-30,NDC,,,facility,outpatient,30,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,inpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
SORBITOL LIQUID,58036,CDM,250,RC,46287-0500-30,NDC,,,facility,outpatient,30,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GN,142.45,,,,,,,142.45,251.23,percent of total billed charges,
ST THER SRVC NONSPEECH-GEN DEV-TECH,58037,CDM,440,RC,92606,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GN,142.45,,,,,,,126.65,264.00,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,inpatient,,,683.00000,648.85000,Amish/Mennonite,Amish Mennonite,GN,375.65,,,,,,,375.65,662.51,percent of total billed charges,
ST COGNITIVE PERF TEST PER HR-TECH,58038,CDM,440,RC,96125,CPT,,,facility,outpatient,,,683.00000,648.85000,Amish/Mennonite,Amish Mennonite,GN,375.65,,,,,,,126.65,662.51,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,inpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,GN,558.80,,,,,,,558.80,985.52,percent of total billed charges,
ST EVAL SPEECH SOUND W LANG-TECH,58042,CDM,440,RC,92523,CPT,,,facility,outpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,GN,558.80,,,,,,,126.65,985.52,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,inpatient,,,579.00000,550.05000,Amish/Mennonite,Amish Mennonite,GN,318.45,,,,,,,318.45,561.63,percent of total billed charges,
ST THER SERVICE SPEECH-GEN DEV-TECH,58044,CDM,440,RC,92609,CPT,,,facility,outpatient,,,579.00000,550.05000,Amish/Mennonite,Amish Mennonite,GN,318.45,,,,,,,126.65,561.63,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,00904272561,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) TAB 800 MG -160 MG,58045,CDM,250,RC,J8499,HCPCS,65862042001,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,inpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,GN,248.60,,,,,,,248.60,438.44,percent of total billed charges,
ST ORAL/SWALLOWING DYSFUNCTION-TECH,58046,CDM,440,RC,92526,CPT,,,facility,outpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,GN,248.60,,,,,,,126.65,438.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
SODIUM OTHER SOURCE-TECH,58047,CDM,300,RC,84302,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,4.86,254.68,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00228-2076-10,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,00406-9961-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,inpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,50268-0779-15,NDC,,,facility,outpatient,1,EA,2.58000,2.45000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.50,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,63739-0877-10,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
TEMAZEPAM CAP,58048,CDM,250,RC,67877-0146-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
SPECIMEN CONCENTRATION INF AGENT-TECH,58050,CDM,300,RC,87015,CPT,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,5.25,356.54,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,inpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,GN,258.50,,,,,,,258.50,455.90,percent of total billed charges,
ST ANALYSIS BEHAV/QUAL VOICE-TECH,58051,CDM,440,RC,92524,CPT,,,facility,outpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,GN,258.50,,,,,,,126.65,455.90,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,inpatient,5,EA,3.96000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457077805,NDC,facility,outpatient,5,EA,3.96000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,inpatient,5,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,67457092105,NDC,facility,outpatient,5,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,inpatient,5,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 -16 MG/ML 5 ML,58052,CDM,250,RC,J3490,HCPCS,70069036110,NDC,facility,outpatient,5,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,3.72,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,inpatient,,,1727.00000,1640.65000,Amish/Mennonite,Amish Mennonite,TC,949.85,,,,,,,949.85,1675.19,percent of total billed charges,
STUDY EXT ART W EXER-TECH,58053,CDM,920,RC,93924,CPT,,,facility,outpatient,,,1727.00000,1640.65000,Amish/Mennonite,Amish Mennonite,TC,949.85,,,,,,,863.50,1675.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,inpatient,10,EA,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0747-40,NDC,,,facility,outpatient,10,EA,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.60,3.11,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,inpatient,10,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00121-0974-94,NDC,,,facility,outpatient,10,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.77,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,inpatient,10,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7269-18,NDC,,,facility,outpatient,10,EA,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,inpatient,1,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,00904-7470-95,NDC,,,facility,outpatient,1,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,inpatient,10,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.42,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,63739-0193-51,NDC,,,facility,outpatient,10,EA,2.59000,2.46000,Amish/Mennonite,Amish Mennonite,,1.42,,,,,,,1.29,2.51,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,60687-0738-56,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,inpatient,10,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,66689-0790-01,NDC,,,facility,outpatient,10,EA,3.28000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,inpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0043-62,NDC,,,facility,outpatient,10,EA,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.78,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,inpatient,10,EA,2.98000,2.83000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.89,percent of total billed charges,
SUCRALFATE SUSP,58054,CDM,250,RC,68094-0171-62,NDC,,,facility,outpatient,10,EA,2.98000,2.83000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.49,2.89,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,inpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143956725,NDC,facility,outpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,3.12,13.79,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,inpatient,1,EA,18.47000,17.55000,Amish/Mennonite,Amish Mennonite,,10.16,,,,,,,10.16,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997722,NDC,facility,outpatient,1,EA,18.47000,17.55000,Amish/Mennonite,Amish Mennonite,,10.16,,,,,,,3.12,17.92,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,inpatient,1,EA,19.28000,18.31000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,10.60,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,00143997790,NDC,facility,outpatient,1,EA,19.28000,18.31000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,3.12,18.70,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,inpatient,1,EA,35.42000,33.65000,Amish/Mennonite,Amish Mennonite,,19.48,,,,,,,19.48,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,24987035410,NDC,facility,outpatient,1,EA,35.42000,33.65000,Amish/Mennonite,Amish Mennonite,,19.48,,,,,,,3.12,34.36,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,inpatient,1,EA,17.15000,16.29000,Amish/Mennonite,Amish Mennonite,,9.43,,,,,,,9.43,16.64,percent of total billed charges,
STERILE CEFUROXIME INJECTION,58056,CDM,250,RC,J0697,HCPCS,25021011920,NDC,facility,outpatient,1,EA,17.15000,16.29000,Amish/Mennonite,Amish Mennonite,,9.43,,,,,,,3.12,16.64,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,170.50,300.70,percent of total billed charges,
SULFUR COLLOID TO 20MCI,58057,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,155.00,1239.81,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,00093-7156-98,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
SIMVASTATIN TAB 7223598,58058,CDM,250,RC,68084-0514-11,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,inpatient,1,EA,24.50000,23.28000,Amish/Mennonite,Amish Mennonite,,13.47,,,,,,,13.47,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00597005801,NDC,facility,outpatient,1,EA,24.50000,23.28000,Amish/Mennonite,Amish Mennonite,,13.47,,,,,,,12.25,23.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,inpatient,1,EA,1.25000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904615661,NDC,facility,outpatient,1,EA,1.25000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,00904640161,NDC,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,16714071301,NDC,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,50268074015,NDC,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,inpatient,1,EA,1.82000,1.72000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,51079029420,NDC,facility,outpatient,1,EA,1.82000,1.72000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,inpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,63739056710,NDC,facility,outpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,65862059801,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,inpatient,1,EA,1.87000,1.77000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,68084029901,NDC,facility,outpatient,1,EA,1.87000,1.77000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.93500,1.81,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
TAMSULOSIN CAP 0.4 MG,58059,CDM,250,RC,J8499,HCPCS,72603011501,NDC,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,inpatient,5,EA,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,165.11,291.19,percent of total billed charges,
STERILE TALC,58061,CDM,250,RC,63256-0200-05,NDC,,,facility,outpatient,5,EA,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,150.10,291.19,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,Amish/Mennonite,Amish Mennonite,,42.11,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,Amish/Mennonite,Amish Mennonite,,42.11,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,inpatient,0.5,EA,153.14000,145.48000,Amish/Mennonite,Amish Mennonite,,84.23,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (ADACEL),58062,CDM,636,RC,90715,HCPCS,49281040020,NDC,facility,outpatient,0.5,EA,153.14000,145.48000,Amish/Mennonite,Amish Mennonite,,84.23,,,,,,,60.56,148.55,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,inpatient,1,EA,26.23000,24.92000,Amish/Mennonite,Amish Mennonite,,14.43,,,,,,,14.43,25.44,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 0.6 ML,58064,CDM,250,RC,54799-0504-01,NDC,,,facility,outpatient,1,EA,26.23000,24.92000,Amish/Mennonite,Amish Mennonite,,14.43,,,,,,,13.12,25.44,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,,285.45,,,,,,,285.45,503.43,percent of total billed charges,
TC99 MAA 1 VIAL,58065,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,,285.45,,,,,,,48.58,503.43,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,50268-0728-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,53489-0145-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,65862-0419-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,57237-0232-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 7936131,58067,CDM,250,RC,60687-0603-65,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,inpatient,30,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,00121-0854-16,NDC,,,facility,outpatient,30,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,inpatient,30,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,50383-0824-16,NDC,,,facility,outpatient,30,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,inpatient,30,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,54879-0007-16,NDC,,,facility,outpatient,30,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP,58068,CDM,250,RC,65862-0496-47,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,inpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,GN,207.90,,,,,,,207.90,366.66,percent of total billed charges,
ST EVAL USE/FIT VOICE PROSTH-TECH,58070,CDM,440,RC,92597,CPT,,,facility,outpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,GN,207.90,,,,,,,126.65,366.66,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00378204501,NDC,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.24015,1.45,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00781210201,NDC,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.24015,1.42,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,inpatient,1,EA,4.10000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,00904662361,NDC,facility,outpatient,1,EA,4.10000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,0.24015,3.98,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,inpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16714009801,NDC,facility,outpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,0.24015,2.54,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,16729004101,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.24015,1.13,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,51079081720,NDC,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,0.24015,3.38,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,64380072006,NDC,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.24015,0.90210,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,inpatient,1,EA,6.26000,5.95000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
TACROLIMUS CAP 7212028,58071,CDM,250,RC,J7507,HCPCS,68084044901,NDC,facility,outpatient,1,EA,6.26000,5.95000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,0.24015,6.07,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,inpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,172.70,304.58,percent of total billed charges,
SPIROMETRY-TECH,58072,CDM,460,RC,94010,CPT,,,facility,outpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,157.00,304.58,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,inpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,GN,266.75,,,,,,,266.75,470.45,percent of total billed charges,
ST EVAL SPEECH SOUND PRODUCT-TECH,58074,CDM,440,RC,92522,CPT,,,facility,outpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,GN,266.75,,,,,,,126.65,470.45,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
T3 TOTAL-TECH,58075,CDM,300,RC,84480,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,14.18,746.94,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,151.25,266.75,percent of total billed charges,
TESTOSTERONE FREE-TECH,58076,CDM,300,RC,84402,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,25.47,1324.17,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,inpatient,,,294.00000,279.30000,Amish/Mennonite,Amish Mennonite,,161.70,,,,,,,161.70,285.18,percent of total billed charges,
THOR NDL/CATH ASP W/O IMG-TECH,58082,CDM,361,RC,,,,,facility,outpatient,,,294.00000,279.30000,Amish/Mennonite,Amish Mennonite,,161.70,,,,,,,161.70,5271.00,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,inpatient,,,5159.00000,4901.05000,Amish/Mennonite,Amish Mennonite,,2837.45,,,,,,,2837.45,5004.23,percent of total billed charges,
SWAN GANZ CATH PLACEMENT-TECH,58084,CDM,481,RC,93503,CPT,,,facility,outpatient,,,5159.00000,4901.05000,Amish/Mennonite,Amish Mennonite,,2837.45,,,,,,,1475.05,17574.00,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,inpatient,,,454.00000,431.30000,Amish/Mennonite,Amish Mennonite,GN,249.70,,,,,,,249.70,440.38,percent of total billed charges,
ST MOTION FLUORO SWALLOW STUDY-TECH,58085,CDM,440,RC,92611,CPT,,,facility,outpatient,,,454.00000,431.30000,Amish/Mennonite,Amish Mennonite,GN,249.70,,,,,,,126.65,440.38,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00054-8831-25,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,68382-0826-14,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,00591-2472-60,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,51407-0439-60,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,59651-0299-60,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
TAMOXIFEN TAB,58086,CDM,250,RC,63739-0269-10,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,inpatient,1,mL,4070.06000,3866.55000,Amish/Mennonite,Amish Mennonite,,2238.53,,,,,,,2238.53,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,00008117901,NDC,facility,outpatient,1,mL,4070.06000,3866.55000,Amish/Mennonite,Amish Mennonite,,2238.53,,,,,,,32.29,3947.96,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,inpatient,1,mL,3296.38000,3131.56000,Amish/Mennonite,Amish Mennonite,,1813.01,,,,,,,1813.01,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,16729022361,NDC,facility,outpatient,1,mL,3296.38000,3131.56000,Amish/Mennonite,Amish Mennonite,,1813.01,,,,,,,32.29,3197.49,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,inpatient,1,mL,2714.00000,2578.30000,Amish/Mennonite,Amish Mennonite,,1492.70,,,,,,,1492.70,2632.58,percent of total billed charges,
TEMSIROLIMUS SOLN 25 MG/ML,58087,CDM,636,RC,J9330,HCPCS,65219020005,NDC,facility,outpatient,1,mL,2714.00000,2578.30000,Amish/Mennonite,Amish Mennonite,,1492.70,,,,,,,32.29,2632.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,inpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00378204601,NDC,facility,outpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,0.24015,2.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,inpatient,1,EA,18.87000,17.93000,Amish/Mennonite,Amish Mennonite,,10.38,,,,,,,10.38,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061711,NDC,facility,outpatient,1,EA,18.87000,17.93000,Amish/Mennonite,Amish Mennonite,,10.38,,,,,,,0.24015,18.30,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,inpatient,1,EA,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,10.22,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00469061773,NDC,facility,outpatient,1,EA,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,0.24015,18.02,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,inpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00781210301,NDC,facility,outpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,0.24015,2.81,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,inpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,00904709761,NDC,facility,outpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,0.24015,4.19,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,inpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.65,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,16714009901,NDC,facility,outpatient,1,EA,4.81000,4.57000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,0.24015,4.67,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,inpatient,1,EA,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,55111052601,NDC,facility,outpatient,1,EA,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.24015,2.21,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,51079081820,NDC,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,0.24015,3.52,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,54288013501,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.24015,0.58200,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,inpatient,1,EA,3.51000,3.34000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,64380072106,NDC,facility,outpatient,1,EA,3.51000,3.34000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,0.24015,3.40,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,inpatient,1,EA,4.72000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,2.60,4.58,percent of total billed charges,
TACROLIMUS CAP 7212027,58090,CDM,250,RC,J7507,HCPCS,68084045001,NDC,facility,outpatient,1,EA,4.72000,4.49000,Amish/Mennonite,Amish Mennonite,,2.60,,,,,,,0.24015,4.58,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,inpatient,1,mL,150.10000,142.60000,Amish/Mennonite,Amish Mennonite,,82.56,,,,,,,82.56,145.60,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 5 ML,58091,CDM,250,RC,J3490,HCPCS,00006542515,NDC,facility,outpatient,1,mL,150.10000,142.60000,Amish/Mennonite,Amish Mennonite,,82.56,,,,,,,75.05,145.60,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,50268-0764-15,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,51079-0936-01,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7214661,58092,CDM,250,RC,59746-0383-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
THIAMINE VITAMIN B1 ASSAY-TECH,58093,CDM,300,RC,84425,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,21.23,1103.49,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,inpatient,0.5,EA,47.34000,44.97000,Amish/Mennonite,Amish Mennonite,,26.04,,,,,,,26.04,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00143963801,NDC,facility,outpatient,0.5,EA,47.34000,44.97000,Amish/Mennonite,Amish Mennonite,,26.04,,,,,,,23.67,45.92,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,inpatient,0.5,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,64679072801,NDC,facility,outpatient,0.5,EA,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,75.84,147.13,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,inpatient,0.5,EA,352.92000,335.28000,Amish/Mennonite,Amish Mennonite,,194.11,,,,,,,194.11,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317414,NDC,facility,outpatient,0.5,EA,352.92000,335.28000,Amish/Mennonite,Amish Mennonite,,194.11,,,,,,,176.46,342.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,inpatient,0.5,EA,352.91000,335.27000,Amish/Mennonite,Amish Mennonite,,194.10,,,,,,,194.10,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,00781317471,NDC,facility,outpatient,0.5,EA,352.91000,335.27000,Amish/Mennonite,Amish Mennonite,,194.10,,,,,,,176.46,342.32,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,inpatient,0.5,EA,164.32000,156.10000,Amish/Mennonite,Amish Mennonite,,90.38,,,,,,,90.38,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,25021070360,NDC,facility,outpatient,0.5,EA,164.32000,156.10000,Amish/Mennonite,Amish Mennonite,,90.38,,,,,,,82.16,159.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,inpatient,0.5,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,38.24,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,55150017305,NDC,facility,outpatient,0.5,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,34.76,67.43,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,inpatient,0.5,EA,309.68000,294.20000,Amish/Mennonite,Amish Mennonite,,170.32,,,,,,,170.32,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,63323027301,NDC,facility,outpatient,0.5,EA,309.68000,294.20000,Amish/Mennonite,Amish Mennonite,,170.32,,,,,,,154.84,300.39,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,inpatient,0.5,EA,20.22000,19.21000,Amish/Mennonite,Amish Mennonite,,11.12,,,,,,,11.12,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,67457088005,NDC,facility,outpatient,0.5,EA,20.22000,19.21000,Amish/Mennonite,Amish Mennonite,,11.12,,,,,,,10.11,19.61,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,inpatient,0.5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
SUMATRIPTAN SOLN 6 MG/0.5 ML,58094,CDM,250,RC,J3030,HCPCS,70069080405,NDC,facility,outpatient,0.5,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
TC99M PERTECHNETATE,58095,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,21.34,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,inpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00049-5730-66,NDC,,,facility,outpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.10,4.07,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,inpatient,1,EA,6.02000,5.72000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,3.31,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00378-3005-01,NDC,,,facility,outpatient,1,EA,6.02000,5.72000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,3.01,5.84,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,00781-2228-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,inpatient,1,EA,5.48000,5.21000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,3.01,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-01,NDC,,,facility,outpatient,1,EA,5.48000,5.21000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,2.74,5.32,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,inpatient,1,EA,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,5.25,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,51079-0588-20,NDC,,,facility,outpatient,1,EA,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,4.77,9.25,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,3.15,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,60219-1675-01,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,2.86,5.55,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7224363,58096,CDM,250,RC,70954-0016-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,200.75,354.05,percent of total billed charges,
TC99 SESTAMIBI PER DOSE,58098,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,182.50,743.46,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,inpatient,,,422.00000,400.90000,Amish/Mennonite,Amish Mennonite,,232.10,,,,,,,232.10,409.34,percent of total billed charges,
SUBCUT INFUSION UP TO 1 HR-TECH,58099,CDM,260,RC,96369,CPT,,,facility,outpatient,,,422.00000,400.90000,Amish/Mennonite,Amish Mennonite,,232.10,,,,,,,200.06,409.34,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,,526.35,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MERTIATIDE,58100,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,,526.35,,,,,,,478.50,1267.58,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
THROMBIN TIME PLASMA-TECH,58101,CDM,300,RC,85670,CPT,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,5.77,305.58,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUAN-TECH,58102,CDM,300,RC,86593,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,4.40,237.65,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
SYPHILIS TEST NON TREP AB QUANT-TECH,58103,CDM,300,RC,86593,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,4.40,237.65,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,inpatient,1,EA,4.49000,4.26000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.47,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00013-0101-10,NDC,,,facility,outpatient,1,EA,4.49000,4.26000,Amish/Mennonite,Amish Mennonite,,2.47,,,,,,,2.25,4.36,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,00591-0796-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
SULFASALAZINE TAB,58104,CDM,250,RC,59762-5000-05,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,inpatient,2,EA,15.72000,14.93000,Amish/Mennonite,Amish Mennonite,,8.65,,,,,,,8.65,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001302,NDC,facility,outpatient,2,EA,15.72000,14.93000,Amish/Mennonite,Amish Mennonite,,8.65,,,,,,,2.72,15.25,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,inpatient,2,EA,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,43598005025,NDC,facility,outpatient,2,EA,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,2.72,9.81,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,inpatient,2,EA,10.39000,9.87000,Amish/Mennonite,Amish Mennonite,,5.71,,,,,,,5.71,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,55150027325,NDC,facility,outpatient,2,EA,10.39000,9.87000,Amish/Mennonite,Amish Mennonite,,5.71,,,,,,,2.72,10.08,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,inpatient,2,EA,10.93000,10.39000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,6.01,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,63323001326,NDC,facility,outpatient,2,EA,10.93000,10.39000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,2.72,10.60,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,inpatient,2,EA,9.65000,9.17000,Amish/Mennonite,Amish Mennonite,,5.31,,,,,,,5.31,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,65145012925,NDC,facility,outpatient,2,EA,9.65000,9.17000,Amish/Mennonite,Amish Mennonite,,5.31,,,,,,,2.72,9.36,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,inpatient,2,EA,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.89,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019600,NDC,facility,outpatient,2,EA,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,2.72,8.63,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,inpatient,2,EA,13.49000,12.81000,Amish/Mennonite,Amish Mennonite,,7.42,,,,,,,7.42,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,67457019602,NDC,facility,outpatient,2,EA,13.49000,12.81000,Amish/Mennonite,Amish Mennonite,,7.42,,,,,,,2.72,13.09,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,inpatient,2,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72485050725,NDC,facility,outpatient,2,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,2.72,9.51,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,inpatient,2,EA,14.83000,14.09000,Amish/Mennonite,Amish Mennonite,,8.16,,,,,,,8.16,14.39,percent of total billed charges,
THIAMINE SOLN 100 MG/ML 2 ML,58105,CDM,250,RC,J3411,HCPCS,72603013925,NDC,facility,outpatient,2,EA,14.83000,14.09000,Amish/Mennonite,Amish Mennonite,,8.16,,,,,,,2.72,14.39,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,Amish/Mennonite,Amish Mennonite,,9.24,,,,,,,9.24,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,00527-1311-01,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,Amish/Mennonite,Amish Mennonite,,9.24,,,,,,,8.40,16.30,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,inpatient,1,EA,9.64000,9.16000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,5.30,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,62559-0722-01,NDC,,,facility,outpatient,1,EA,9.64000,9.16000,Amish/Mennonite,Amish Mennonite,,5.30,,,,,,,4.82,9.35,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-11,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,inpatient,1,EA,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.17,percent of total billed charges,
TERBUTALINE TAB,58106,CDM,250,RC,68084-0257-21,NDC,,,facility,outpatient,1,EA,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.67,5.17,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,inpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,50268-0766-15,NDC,,,facility,outpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,51079-0938-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 7222631,58107,CDM,250,RC,59746-0385-06,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,00904612761,NDC,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,inpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,50268076515,NDC,facility,outpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,2.56,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,51079093720,NDC,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
TERAZOSIN CAP 2 MG,58108,CDM,250,RC,J8499,HCPCS,59746038406,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-1611-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
THEOPHYLLINE TAB 7221278,58109,CDM,250,RC,00904-5888-61,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
THIOPURINE METHYLTRANSFERASE RBC-TECH,58110,CDM,300,RC,83789,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,24.11,1137.41,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,inpatient,,,173.90000,165.20000,Amish/Mennonite,Amish Mennonite,90,95.64,,,,,,,95.64,168.68,percent of total billed charges,
TETANUS ANTIBODY (TTIGS) SO,58111,CDM,300,RC,86317,CPT,,,facility,outpatient,,,173.90000,165.20000,Amish/Mennonite,Amish Mennonite,90,95.64,,,,,,,15.49,780.94,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,inpatient,1,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143937510,NDC,facility,outpatient,1,EA,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,inpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974601,NDC,facility,outpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,4.52,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,00143974610,NDC,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,2.19,12.26,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,inpatient,1,EA,62.25000,59.14000,Amish/Mennonite,Amish Mennonite,,34.24,,,,,,,34.24,60.38,percent of total billed charges,
TERBUTALINE SULFATE INJ,58112,CDM,250,RC,J3105,HCPCS,63323066501,NDC,facility,outpatient,1,EA,62.25000,59.14000,Amish/Mennonite,Amish Mennonite,,34.24,,,,,,,2.19,60.38,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
THYROGLOBULIN ASSAY-TECH,58113,CDM,300,RC,84432,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,16.06,831.84,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,inpatient,,,819.00000,778.05000,Amish/Mennonite,Amish Mennonite,,450.45,,,,,,,450.45,794.43,percent of total billed charges,
THOR NDL/CATH ASP PLEU W/IMG-TECH,58114,CDM,361,RC,32555,CPT,,,facility,outpatient,,,819.00000,778.05000,Amish/Mennonite,Amish Mennonite,,450.45,,,,,,,450.45,3163.00,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,47.30,83.42,percent of total billed charges,
SYPHILLIS FTA-ABS-TECH,58115,CDM,300,RC,86780,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,11.13,696.05,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,inpatient,1,mL,10.44000,9.92000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.74,10.13,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 4 ML,58117,CDM,636,RC,J3490,HCPCS,00065074114,NDC,facility,outpatient,1,mL,10.44000,9.92000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.22,10.13,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
THROMBOPLASTIN TIME PARTIAL-TECH,58118,CDM,300,RC,85730,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,6.01,305.58,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,inpatient,1,EA,226.79000,215.45000,Amish/Mennonite,Amish Mennonite,,124.73,,,,,,,124.73,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,52604-7102-01,NDC,,,facility,outpatient,1,EA,226.79000,215.45000,Amish/Mennonite,Amish Mennonite,,124.73,,,,,,,113.39,219.99,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,inpatient,1,EA,227.93000,216.53000,Amish/Mennonite,Amish Mennonite,,125.36,,,,,,,125.36,221.09,percent of total billed charges,
"THROMBIN BOVINE TOPICAL POWD 5,000 UNIT",58119,CDM,250,RC,60793-0215-05,NDC,,,facility,outpatient,1,EA,227.93000,216.53000,Amish/Mennonite,Amish Mennonite,,125.36,,,,,,,113.97,221.09,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00182-0047-89,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-0544-60,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,00904-7191-06,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10006-0730-20,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,10135-0132-01,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,48433-0108-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,79854-0200-10,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,51645-0905-99,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE TAB,58122,CDM,250,RC,77333-0934-10,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,inpatient,,,2006.00000,1905.70000,Amish/Mennonite,Amish Mennonite,TC,1103.30,,,,,,,1103.30,1945.82,percent of total billed charges,
TESTICULAR IMG W VASC FLOW-TECH,58123,CDM,341,RC,78761,CPT,,,facility,outpatient,,,2006.00000,1905.70000,Amish/Mennonite,Amish Mennonite,TC,1103.30,,,,,,,957.00,2210.07,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
T3 FREE-TECH,58124,CDM,300,RC,84481,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,16.62,882.80,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,inpatient,,,495.00000,470.25000,Amish/Mennonite,Amish Mennonite,,272.25,,,,,,,272.25,480.15,percent of total billed charges,
T CELL ABSOLUTE CD4 CD8 RATIO-TECH,58125,CDM,300,RC,86360,CPT,,,facility,outpatient,,,495.00000,470.25000,Amish/Mennonite,Amish Mennonite,,272.25,,,,,,,46.98,2461.58,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,inpatient,1,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
THIORIDAZINE TAB 7218092,58126,CDM,250,RC,51079-0566-20,NDC,,,facility,outpatient,1,EA,1.68000,1.59000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,00378-0612-01,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,51079-0565-20,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
THIORIDAZINE TAB 7221336,58128,CDM,250,RC,53489-0148-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,inpatient,,,1987.00000,1887.65000,Amish/Mennonite,Amish Mennonite,TC,1092.85,,,,,,,1092.85,1927.39,percent of total billed charges,
THYROID IMAGING-TECH,58129,CDM,341,RC,78013,CPT,,,facility,outpatient,,,1987.00000,1887.65000,Amish/Mennonite,Amish Mennonite,TC,1092.85,,,,,,,960.65,2210.07,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,inpatient,,,87.00000,82.65000,Amish/Mennonite,Amish Mennonite,,47.85,,,,,,,47.85,84.39,percent of total billed charges,
SUGARS SINGLE QUAL EA SPECIMEN-TECH,58130,CDM,300,RC,84376,CPT,,,facility,outpatient,,,87.00000,82.65000,Amish/Mennonite,Amish Mennonite,,47.85,,,,,,,5.50,288.61,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,inpatient,1,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,15.30,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-41,NDC,,,facility,outpatient,1,EA,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,13.90,26.98,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,inpatient,1,EA,64.09000,60.89000,Amish/Mennonite,Amish Mennonite,,35.25,,,,,,,35.25,62.17,percent of total billed charges,
TIOTROPIUM CAP,58131,CDM,250,RC,00597-0075-75,NDC,,,facility,outpatient,1,EA,64.09000,60.89000,Amish/Mennonite,Amish Mennonite,,35.25,,,,,,,32.05,62.17,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
TC99M CHOLETEC 1 VIAL,58132,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,187.21,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,TC,441.10,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE MEAS SNGL/MULT-TECH,58133,CDM,341,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,TC,441.10,,,,,,,389.35,2210.07,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,inpatient,2,EA,14.52000,13.79000,Amish/Mennonite,Amish Mennonite,,7.99,,,,,,,7.99,14.08,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 2ML,58134,CDM,250,RC,00065-0741-12,NDC,,,facility,outpatient,2,EA,14.52000,13.79000,Amish/Mennonite,Amish Mennonite,,7.99,,,,,,,7.26,14.08,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,70954-0014-10,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.76,percent of total billed charges,
THIOTHIXENE CAP 7218464,58135,CDM,250,RC,60219-1673-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.76,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
THROMBOXANE URINE-TECH,58136,CDM,300,RC,84431,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,19.16,1646.71,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
THEOPHYLLINE ASSAY-TECH,58137,CDM,300,RC,80198,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,14.14,746.94,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,inpatient,1,EA,3.04000,2.89000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.67,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-01,NDC,,,facility,outpatient,1,EA,3.04000,2.89000,Amish/Mennonite,Amish Mennonite,,1.67,,,,,,,1.52,2.95,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,00456-0458-63,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,42192-0329-01,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,49483-0021-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,62559-0741-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
THYROID DESICCATED TAB 30 MG,58138,CDM,250,RC,75834-0311-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,inpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,227.15,400.61,percent of total billed charges,
TICK BORNE PANEL-TECH,58139,CDM,300,RC,87798,CPT,,,facility,outpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,35.09,1833.46,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
THYROXINE FREE ASSAY-TECH,58140,CDM,300,RC,84439,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,9.02,475.37,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,Amish/Mennonite,Amish Mennonite,TC,1734.15,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA MET WHOLE BD-TECH,58141,CDM,341,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,Amish/Mennonite,Amish Mennonite,TC,1734.15,,,,,,,1479.13,3058.41,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
TISSUE HOMOGENIZATION CULT-TECH,58143,CDM,300,RC,87176,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,5.88,305.58,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,100.10,176.54,percent of total billed charges,
THYROID STIMULATING HORMONE-TECH,58144,CDM,300,RC,84443,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,16.80,882.80,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,inpatient,2,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00409357801,NDC,facility,outpatient,2,EA,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,inpatient,2,EA,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,9.52,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,00703940201,NDC,facility,outpatient,2,EA,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,2.47,16.78,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,inpatient,2,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,67457047322,NDC,facility,outpatient,2,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,inpatient,2,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.70,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,17478011402,NDC,facility,outpatient,2,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,inpatient,2,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,36000024425,NDC,facility,outpatient,2,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,4.06,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,inpatient,2,EA,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.20,percent of total billed charges,
TOBRAMYCIN SOLN-INJ 40 MG/ML 2 ML,58145,CDM,250,RC,J3260,HCPCS,63323030602,NDC,facility,outpatient,2,EA,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.47,5.20,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,inpatient,,,2168.00000,2059.60000,Amish/Mennonite,Amish Mennonite,TC,1192.40,,,,,,,1192.40,2102.96,percent of total billed charges,
THYROID CARCINOMA MET IMG LTD-TECH,58146,CDM,341,RC,78015,CPT,,,facility,outpatient,,,2168.00000,2059.60000,Amish/Mennonite,Amish Mennonite,TC,1192.40,,,,,,,1050.98,2210.07,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,Amish/Mennonite,Amish Mennonite,TC,1384.90,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMG SNGL/MULT UPT QUAN-TECH,58147,CDM,341,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,Amish/Mennonite,Amish Mennonite,TC,1384.90,,,,,,,1163.40,2442.46,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-1612-61,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,00904-5889-61,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,50111-0459-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,inpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.97,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,62332-0025-31,NDC,,,facility,outpatient,1,EA,10.86000,10.32000,Amish/Mennonite,Amish Mennonite,,5.97,,,,,,,5.43,10.53,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,inpatient,1,EA,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.90,8.64,percent of total billed charges,
THEOPHYLLINE TAB 7221286,58148,CDM,250,RC,68462-0721-01,NDC,,,facility,outpatient,1,EA,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.46,8.64,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,inpatient,1,EA,1681.35000,1597.28000,Amish/Mennonite,Amish Mennonite,,924.74,,,,,,,924.74,1630.91,percent of total billed charges,
TETANUS IMMUNE GLOBULIN SOLN 250 UNITS,58149,CDM,636,RC,J1670,HCPCS,13533063402,NDC,facility,outpatient,1,EA,1681.35000,1597.28000,Amish/Mennonite,Amish Mennonite,,924.74,,,,,,,577.05,1630.91,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,inpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,,314.05,,,,,,,314.05,553.87,percent of total billed charges,
TISS CULT NEOP BONE MARR0W/BLD-TECH,58150,CDM,310,RC,88237,CPT,,,facility,outpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,,314.05,,,,,,,70.04,6756.70,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,90,86.35,,,,,,,86.35,152.29,percent of total billed charges,
THYROTROPIN RECEPTOR AB (81797) SO -TECH,58151,CDM,300,RC,83520,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,90,86.35,,,,,,,17.85,814.87,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,inpatient,1,EA,23.76000,22.57000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-39,NDC,,,facility,outpatient,1,EA,23.76000,22.57000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,11.88,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB,58152,CDM,250,RC,00186-0777-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,11.88,23.05,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,inpatient,5,EA,64.51000,61.28000,Amish/Mennonite,Amish Mennonite,,35.48,,,,,,,35.48,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,00065-0643-05,NDC,,,facility,outpatient,5,EA,64.51000,61.28000,Amish/Mennonite,Amish Mennonite,,35.48,,,,,,,32.26,62.57,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,inpatient,5,EA,7.34000,6.98000,Amish/Mennonite,Amish Mennonite,,4.04,,,,,,,4.04,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,17478-0290-10,NDC,,,facility,outpatient,5,EA,7.34000,6.98000,Amish/Mennonite,Amish Mennonite,,4.04,,,,,,,3.67,7.12,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,inpatient,5,EA,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,4.09,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,24208-0290-05,NDC,,,facility,outpatient,5,EA,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,3.71,7.21,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,inpatient,5,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,61314-0643-05,NDC,,,facility,outpatient,5,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,4.90,9.51,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,inpatient,5,EA,9.79000,9.30000,Amish/Mennonite,Amish Mennonite,,5.38,,,,,,,5.38,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,62332-0518-05,NDC,,,facility,outpatient,5,EA,9.79000,9.30000,Amish/Mennonite,Amish Mennonite,,5.38,,,,,,,4.89,9.50,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,inpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH 0.3% 5 ML,58153,CDM,250,RC,70069-0131-01,NDC,,,facility,outpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,inpatient,1,EA,2662.25000,2529.14000,Amish/Mennonite,Amish Mennonite,,1464.24,,,,,,,1464.24,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,00007420101,NDC,facility,outpatient,1,EA,2662.25000,2529.14000,Amish/Mennonite,Amish Mennonite,,1464.24,,,,,,,1.97,2582.38,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,inpatient,1,EA,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,199.43,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076294,NDC,facility,outpatient,1,EA,362.60000,344.47000,Amish/Mennonite,Amish Mennonite,,199.43,,,,,,,1.97,351.72,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,inpatient,1,EA,608.65000,578.22000,Amish/Mennonite,Amish Mennonite,,334.76,,,,,,,334.76,590.39,percent of total billed charges,
TOPOTECAN INJECTION,58154,CDM,250,RC,J9351,HCPCS,63323076210,NDC,facility,outpatient,1,EA,608.65000,578.22000,Amish/Mennonite,Amish Mennonite,,334.76,,,,,,,1.97,590.39,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
THYROXINE TOTAL ASSAY-TECH,58155,CDM,300,RC,84436,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.87,356.54,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
TISSUE TRANSGLUT AB EACH-TECH,58156,CDM,300,RC,86364,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,11.53,543.65,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,101.75,179.45,percent of total billed charges,
THYROGLOBULIN AB-TECH,58157,CDM,300,RC,86800,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,15.91,831.84,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,16252-0542-90,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
TRANDOLAPRIL TAB 7222623,58158,CDM,250,RC,57237-0090-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,inpatient,2,EA,3.67000,3.48000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00074195232,NDC,facility,outpatient,2,EA,3.67000,3.48000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,inpatient,2,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,00409195232,NDC,facility,outpatient,2,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.80,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,inpatient,2,EA,55.42000,52.65000,Amish/Mennonite,Amish Mennonite,,30.48,,,,,,,30.48,53.76,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023011925,NDC,facility,outpatient,2,EA,55.42000,52.65000,Amish/Mennonite,Amish Mennonite,,30.48,,,,,,,27.71,88.11,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,inpatient,2,EA,33.79000,32.10000,Amish/Mennonite,Amish Mennonite,,18.58,,,,,,,18.58,32.78,percent of total billed charges,
TRIMETHOBENZAMIDE HCL INJ,58159,CDM,250,RC,J3250,HCPCS,42023014325,NDC,facility,outpatient,2,EA,33.79000,32.10000,Amish/Mennonite,Amish Mennonite,,18.58,,,,,,,16.89,88.11,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,136.95,241.53,percent of total billed charges,
TESTOSTERONE TOTAL-TECH,58160,CDM,300,RC,84403,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,25.81,1341.13,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-00,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,00172-2416-10,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,inpatient,1,EA,10.52000,10.00000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0017-01,NDC,,,facility,outpatient,1,EA,10.52000,10.00000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.20,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,23155-0766-01,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.00,5.82,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,inpatient,1,EA,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.10,percent of total billed charges,
TETRACYCLINE CAP,58161,CDM,250,RC,51991-0906-01,NDC,,,facility,outpatient,1,EA,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.63,5.10,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,inpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910042,58162,CDM,636,RC,J3262,HCPCS,50242013501,NDC,facility,outpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,5.79,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,inpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB SOLN 20 MG/ML 10 ML (ACTEMRA),58163,CDM,636,RC,J3262,HCPCS,50242013601,NDC,facility,outpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,5.79,333.61,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,inpatient,0.5,EA,261.85000,248.76000,Amish/Mennonite,Amish Mennonite,,144.02,,,,,,,144.02,253.99,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7741432,58165,CDM,250,RC,68803-0612-10,NDC,,,facility,outpatient,0.5,EA,261.85000,248.76000,Amish/Mennonite,Amish Mennonite,,144.02,,,,,,,130.93,253.99,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,inpatient,5,EA,114.66000,108.93000,Amish/Mennonite,Amish Mennonite,,63.06,,,,,,,63.06,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,24208-0819-05,NDC,,,facility,outpatient,5,EA,114.66000,108.93000,Amish/Mennonite,Amish Mennonite,,63.06,,,,,,,57.33,111.22,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,inpatient,5,EA,109.85000,104.36000,Amish/Mennonite,Amish Mennonite,,60.42,,,,,,,60.42,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,61314-0225-05,NDC,,,facility,outpatient,5,EA,109.85000,104.36000,Amish/Mennonite,Amish Mennonite,,60.42,,,,,,,54.92,106.55,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,inpatient,5,EA,134.53000,127.81000,Amish/Mennonite,Amish Mennonite,,73.99,,,,,,,73.99,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,62332-0546-05,NDC,,,facility,outpatient,5,EA,134.53000,127.81000,Amish/Mennonite,Amish Mennonite,,73.99,,,,,,,67.27,130.49,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,inpatient,5,EA,119.69000,113.71000,Amish/Mennonite,Amish Mennonite,,65.83,,,,,,,65.83,116.10,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.5% 5 ML,58166,CDM,250,RC,72603-0163-01,NDC,,,facility,outpatient,5,EA,119.69000,113.71000,Amish/Mennonite,Amish Mennonite,,65.83,,,,,,,59.84,116.10,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
TRACE ELEMENTS SOLN-INJ 1 ML,58167,CDM,250,RC,J3490,HCPCS,00517820125,NDC,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,19.75,38.31,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,inpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,267.30,471.42,percent of total billed charges,
TISS CULT NEOP SOLID TUMOR-TECH,58169,CDM,310,RC,88239,CPT,,,facility,outpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,70.04,7707.36,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00009-5190-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,inpatient,1,EA,20.31000,19.30000,Amish/Mennonite,Amish Mennonite,,11.17,,,,,,,11.17,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00093-7163-56,NDC,,,facility,outpatient,1,EA,20.31000,19.30000,Amish/Mennonite,Amish Mennonite,,11.17,,,,,,,10.15,19.70,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,inpatient,1,EA,35.69000,33.91000,Amish/Mennonite,Amish Mennonite,,19.63,,,,,,,19.63,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,00904-6592-04,NDC,,,facility,outpatient,1,EA,35.69000,33.91000,Amish/Mennonite,Amish Mennonite,,19.63,,,,,,,17.84,34.62,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,13668-0189-30,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,43975-0322-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,Amish/Mennonite,Amish Mennonite,,17.57,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,51079-0197-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,Amish/Mennonite,Amish Mennonite,,17.57,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,inpatient,1,EA,7.99000,7.59000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.39,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,59762-0047-01,NDC,,,facility,outpatient,1,EA,7.99000,7.59000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.00,7.75,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,inpatient,1,EA,38.08000,36.17000,Amish/Mennonite,Amish Mennonite,,20.94,,,,,,,20.94,36.94,percent of total billed charges,
TOLTERODINE CAP 7224371,58170,CDM,250,RC,60687-0319-21,NDC,,,facility,outpatient,1,EA,38.08000,36.17000,Amish/Mennonite,Amish Mennonite,,20.94,,,,,,,19.04,36.94,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,inpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,90,317.35,,,,,,,317.35,559.69,percent of total billed charges,
TISS CULT NONNEOP AMNIO/CHRVS-TECH,58172,CDM,310,RC,88235,CPT,,,facility,outpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,90,317.35,,,,,,,70.04,7690.40,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,inpatient,,,5977.00000,5678.15000,Amish/Mennonite,Amish Mennonite,TC,3287.35,,,,,,,3287.35,5797.69,percent of total billed charges,
TMR IMG WHOLE BODY >=2 DAYS-TECH,58173,CDM,341,RC,78804,CPT,,,facility,outpatient,,,5977.00000,5678.15000,Amish/Mennonite,Amish Mennonite,TC,3287.35,,,,,,,2988.50,7180.14,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,17478-0102-12,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,inpatient,2,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,24208-0585-64,NDC,,,facility,outpatient,2,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,inpatient,2,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.55,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,61314-0355-02,NDC,,,facility,outpatient,2,EA,6.45000,6.12000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.23,6.26,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,inpatient,2,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.98450,1.74,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 15 ML,58174,CDM,250,RC,70069-0121-01,NDC,,,facility,outpatient,2,EA,1.79000,1.70000,Amish/Mennonite,Amish Mennonite,,0.98450,,,,,,,0.89500,1.74,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,58175,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00013111421,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,inpatient,1,mL,13.87000,13.17000,Amish/Mennonite,Amish Mennonite,,7.63,,,,,,,7.63,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,00517096001,NDC,facility,outpatient,1,mL,13.87000,13.17000,Amish/Mennonite,Amish Mennonite,,7.63,,,,,,,6.93,13.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,inpatient,1,mL,6.31000,6.00000,Amish/Mennonite,Amish Mennonite,,3.47,,,,,,,3.47,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,23155016641,NDC,facility,outpatient,1,mL,6.31000,6.00000,Amish/Mennonite,Amish Mennonite,,3.47,,,,,,,3.15,6.12,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,inpatient,1,mL,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,25021041510,NDC,facility,outpatient,1,mL,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,inpatient,1,mL,9.70000,9.22000,Amish/Mennonite,Amish Mennonite,,5.33,,,,,,,5.33,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,39822100001,NDC,facility,outpatient,1,mL,9.70000,9.22000,Amish/Mennonite,Amish Mennonite,,5.33,,,,,,,4.85,9.41,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,43066000810,NDC,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,55150018810,NDC,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,61990061102,NDC,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,63323056310,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,inpatient,1,mL,21.93000,20.84000,Amish/Mennonite,Amish Mennonite,,12.06,,,,,,,12.06,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019700,NDC,facility,outpatient,1,mL,21.93000,20.84000,Amish/Mennonite,Amish Mennonite,,12.06,,,,,,,10.96,21.27,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,inpatient,1,mL,9.23000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,5.08,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,67457019710,NDC,facility,outpatient,1,mL,9.23000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,4.62,8.95,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,inpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,70860040010,NDC,facility,outpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.22,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,inpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72485051010,NDC,facility,outpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,inpatient,1,mL,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,72603038710,NDC,facility,outpatient,1,mL,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061110,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
TRANEXAMIC ACID SOLN 100 MG/ML 10 ML,58176,CDM,250,RC,J3490,HCPCS,81284061210,NDC,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,inpatient,1,mL,107.83000,102.44000,Amish/Mennonite,Amish Mennonite,,59.31,,,,,,,59.31,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,00409030201,NDC,facility,outpatient,1,mL,107.83000,102.44000,Amish/Mennonite,Amish Mennonite,,59.31,,,,,,,1.97,104.60,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,inpatient,1,mL,118.50000,112.57000,Amish/Mennonite,Amish Mennonite,,65.17,,,,,,,65.17,114.94,percent of total billed charges,
TOPOTECAN SOLN 1 MG/ML 4 ML,58177,CDM,250,RC,J9351,HCPCS,25021023604,NDC,facility,outpatient,1,mL,118.50000,112.57000,Amish/Mennonite,Amish Mennonite,,65.17,,,,,,,1.97,114.94,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,29300-0116-16,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,68084-0343-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,inpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7910507,58178,CDM,250,RC,69097-0817-03,NDC,,,facility,outpatient,1,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,inpatient,1,EA,19.58000,18.60000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,10.77,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,00045-0641-65,NDC,,,facility,outpatient,1,EA,19.58000,18.60000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,9.79,18.99,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,inpatient,1,EA,56.44000,53.62000,Amish/Mennonite,Amish Mennonite,,31.04,,,,,,,31.04,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,50458-0641-65,NDC,,,facility,outpatient,1,EA,56.44000,53.62000,Amish/Mennonite,Amish Mennonite,,31.04,,,,,,,28.22,54.75,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,inpatient,1,EA,0.78000,0.75000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,51079-0728-20,NDC,,,facility,outpatient,1,EA,0.78000,0.75000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,inpatient,1,EA,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68084-0344-01,NDC,,,facility,outpatient,1,EA,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,68382-0140-14,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-03,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
TOPIRAMATE TAB 7224389,58179,CDM,250,RC,69097-0124-12,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,TC,101.75,,,,,,,101.75,179.45,percent of total billed charges,
TUMOR LOCALIZATION LTD AREA-TECH,58180,CDM,341,RC,78800,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,TC,101.75,,,,,,,92.50,2210.07,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,inpatient,3.5,EA,223.32000,212.15000,Amish/Mennonite,Amish Mennonite,,122.83,,,,,,,122.83,216.62,percent of total billed charges,
TOBRAMYCIN OINT-OPHTH 0.3% 3.5 GM,58181,CDM,250,RC,00078-0813-01,NDC,,,facility,outpatient,3.5,EA,223.32000,212.15000,Amish/Mennonite,Amish Mennonite,,122.83,,,,,,,111.66,216.62,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,90,25.85,,,,,,,25.85,45.59,percent of total billed charges,
UREA NITROGEN QUANT-TECH,58182,CDM,300,RC,84520,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,90,25.85,,,,,,,4.08,203.72,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,inpatient,1,mL,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,17478-0101-12,NDC,,,facility,outpatient,1,mL,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,24208-0590-64,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,inpatient,1,mL,4.51000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.48,4.37,percent of total billed charges,
TROPICAMIDE OPHTH SOL 7910472,58183,CDM,250,RC,61314-0354-01,NDC,,,facility,outpatient,1,mL,4.51000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.25,4.37,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,inpatient,1,EA,7235.17000,6873.41000,Amish/Mennonite,Amish Mennonite,,3979.34,,,,,,,3979.34,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242003861,NDC,facility,outpatient,1,EA,7235.17000,6873.41000,Amish/Mennonite,Amish Mennonite,,3979.34,,,,,,,171.94,7018.11,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,inpatient,1,EA,11815.83000,11225.04000,Amish/Mennonite,Amish Mennonite,,6498.71,,,,,,,6498.71,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012001,NDC,facility,outpatient,1,EA,11815.83000,11225.04000,Amish/Mennonite,Amish Mennonite,,6498.71,,,,,,,171.94,11461.36,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,inpatient,1,EA,15764.79000,14976.55000,Amish/Mennonite,Amish Mennonite,,8670.63,,,,,,,8670.63,15291.85,percent of total billed charges,
TENECTEPLASE POWD-INJ 50 MG (MI KIT),58184,CDM,636,RC,J3101,HCPCS,50242012047,NDC,facility,outpatient,1,EA,15764.79000,14976.55000,Amish/Mennonite,Amish Mennonite,,8670.63,,,,,,,171.94,15291.85,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,inpatient,,,142.40000,135.28000,Amish/Mennonite,Amish Mennonite,90,78.32,,,,,,,78.32,138.13,percent of total billed charges,
TOPIRAMATE ASSAY SO-TECH,58185,CDM,300,RC,80201,CPT,,,facility,outpatient,,,142.40000,135.28000,Amish/Mennonite,Amish Mennonite,90,78.32,,,,,,,12.32,628.12,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,inpatient,5,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,60758-0802-05,NDC,,,facility,outpatient,5,EA,1.88000,1.79000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.94000,1.82,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,inpatient,5,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,61314-0226-05,NDC,,,facility,outpatient,5,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,inpatient,5,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.25% 5 ML,58186,CDM,250,RC,64980-0513-05,NDC,,,facility,outpatient,5,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-01,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,inpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,21.15,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-02,NDC,,,facility,outpatient,1,EA,38.45000,36.52000,Amish/Mennonite,Amish Mennonite,,21.15,,,,,,,19.23,37.30,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,inpatient,1,EA,38.84000,36.90000,Amish/Mennonite,Amish Mennonite,,21.36,,,,,,,21.36,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00009-5191-04,NDC,,,facility,outpatient,1,EA,38.84000,36.90000,Amish/Mennonite,Amish Mennonite,,21.36,,,,,,,19.42,37.67,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,inpatient,1,EA,37.34000,35.47000,Amish/Mennonite,Amish Mennonite,,20.54,,,,,,,20.54,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,00904-6593-04,NDC,,,facility,outpatient,1,EA,37.34000,35.47000,Amish/Mennonite,Amish Mennonite,,20.54,,,,,,,18.67,36.22,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,inpatient,1,EA,14.20000,13.49000,Amish/Mennonite,Amish Mennonite,,7.81,,,,,,,7.81,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,13668-0190-30,NDC,,,facility,outpatient,1,EA,14.20000,13.49000,Amish/Mennonite,Amish Mennonite,,7.81,,,,,,,7.10,13.77,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,31722-0608-30,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.68,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,43975-0323-03,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.44,4.72,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,inpatient,1,EA,31.95000,30.35000,Amish/Mennonite,Amish Mennonite,,17.57,,,,,,,17.57,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,51079-0198-03,NDC,,,facility,outpatient,1,EA,31.95000,30.35000,Amish/Mennonite,Amish Mennonite,,17.57,,,,,,,15.97,30.99,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,inpatient,1,EA,10.65000,10.12000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,5.86,10.33,percent of total billed charges,
TOLTERODINE CAP 7222961,58188,CDM,250,RC,59762-0048-02,NDC,,,facility,outpatient,1,EA,10.65000,10.12000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,5.33,10.33,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,inpatient,1,EA,252.80000,240.16000,Amish/Mennonite,Amish Mennonite,,139.04,,,,,,,139.04,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041201,NDC,facility,outpatient,1,EA,252.80000,240.16000,Amish/Mennonite,Amish Mennonite,,139.04,,,,,,,2.47,245.22,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,inpatient,1,EA,218.47000,207.54000,Amish/Mennonite,Amish Mennonite,,120.16,,,,,,,120.16,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,39822041206,NDC,facility,outpatient,1,EA,218.47000,207.54000,Amish/Mennonite,Amish Mennonite,,120.16,,,,,,,2.47,211.92,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,inpatient,1,EA,263.86000,250.67000,Amish/Mennonite,Amish Mennonite,,145.12,,,,,,,145.12,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,70700017322,NDC,facility,outpatient,1,EA,263.86000,250.67000,Amish/Mennonite,Amish Mennonite,,145.12,,,,,,,2.47,255.94,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,inpatient,1,EA,245.53000,233.26000,Amish/Mennonite,Amish Mennonite,,135.04,,,,,,,135.04,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,63323030355,NDC,facility,outpatient,1,EA,245.53000,233.26000,Amish/Mennonite,Amish Mennonite,,135.04,,,,,,,2.47,238.16,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,inpatient,1,EA,243.32000,231.15000,Amish/Mennonite,Amish Mennonite,,133.83,,,,,,,133.83,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72266016306,NDC,facility,outpatient,1,EA,243.32000,231.15000,Amish/Mennonite,Amish Mennonite,,133.83,,,,,,,2.47,236.02,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,inpatient,1,EA,244.43000,232.20000,Amish/Mennonite,Amish Mennonite,,134.44,,,,,,,134.44,237.10,percent of total billed charges,
TOBRAMYCIN POWD-INJ 1.2 GM,58189,CDM,250,RC,J3260,HCPCS,72603016006,NDC,facility,outpatient,1,EA,244.43000,232.20000,Amish/Mennonite,Amish Mennonite,,134.44,,,,,,,2.47,237.10,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,396.00,698.40,percent of total billed charges,
"URETHROCYSTOGRAPHY, VOIDING-TECH",58190,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,360.00,4496.60,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,60.50,106.70,percent of total billed charges,
TYROSINE ASSAY-TECH,58191,CDM,300,RC,84510,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,10.63,543.22,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
TOTAL PROTEIN-TECH,58192,CDM,300,RC,84155,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.67,186.75,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,inpatient,2.5,EA,200.57000,190.54000,Amish/Mennonite,Amish Mennonite,,110.31,,,,,,,110.31,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00378-9651-32,NDC,,,facility,outpatient,2.5,EA,200.57000,190.54000,Amish/Mennonite,Amish Mennonite,,110.31,,,,,,,100.28,194.55,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,inpatient,2.5,EA,209.17000,198.71000,Amish/Mennonite,Amish Mennonite,,115.04,,,,,,,115.04,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,00781-6185-56,NDC,,,facility,outpatient,2.5,EA,209.17000,198.71000,Amish/Mennonite,Amish Mennonite,,115.04,,,,,,,104.58,202.89,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,inpatient,2.5,EA,158.96000,151.01000,Amish/Mennonite,Amish Mennonite,,87.43,,,,,,,87.43,154.19,percent of total billed charges,
TRAVOPROST SOL,58193,CDM,250,RC,60505-0593-04,NDC,,,facility,outpatient,2.5,EA,158.96000,151.01000,Amish/Mennonite,Amish Mennonite,,87.43,,,,,,,79.48,154.19,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-08,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,00904-7496-61,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,51079-0991-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,57664-0377-13,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,60687-0795-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-11,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,65162-0627-50,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,68084-0808-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
TRAMADOL TAB,58195,CDM,250,RC,72888-0080-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,79.75,140.65,percent of total billed charges,
TRANSFERRIN ASSAY-TECH,58196,CDM,300,RC,84466,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,12.76,662.12,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,inpatient,1,EA,6411.37000,6090.80000,Amish/Mennonite,Amish Mennonite,,3526.25,,,,,,,3526.25,6219.03,percent of total billed charges,
TRABECTEDIN INJ,58197,CDM,636,RC,J9352,HCPCS,59676061001,NDC,facility,outpatient,1,EA,6411.37000,6090.80000,Amish/Mennonite,Amish Mennonite,,3526.25,,,,,,,383.07,6219.03,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,inpatient,15,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,45802-0143-01,NDC,,,facility,outpatient,15,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,inpatient,15,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2016-01,NDC,,,facility,outpatient,15,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,inpatient,15,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
TRIPLE ANTIBIOTIC (BACIT/NEOMY/POLY) TOP OINT,58198,CDM,250,RC,51672-2120-01,NDC,,,facility,outpatient,15,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,Amish/Mennonite,Amish Mennonite,TC,1802.90,,,,,,,1802.90,3179.66,percent of total billed charges,
TMR IMG WHOLE BODY SNGL DAY-TECH,58199,CDM,340,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,Amish/Mennonite,Amish Mennonite,TC,1802.90,,,,,,,1489.61,7180.14,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
UREA NITROGEN URINE,58200,CDM,300,RC,84540,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,5.56,254.68,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
TROPONIN QUANT-TECH,58201,CDM,300,RC,84484,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,12.47,594.19,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,inpatient,1,EA,6835.14000,6493.38000,Amish/Mennonite,Amish Mennonite,,3759.33,,,,,,,3759.33,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,63459039120,NDC,facility,outpatient,1,EA,6835.14000,6493.38000,Amish/Mennonite,Amish Mennonite,,3759.33,,,,,,,1.85,6630.09,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,inpatient,1,EA,906.50000,861.18000,Amish/Mennonite,Amish Mennonite,,498.57,,,,,,,498.57,879.30,percent of total billed charges,
TREANDA INJECTION,58204,CDM,636,RC,J9033,HCPCS,71288010320,NDC,facility,outpatient,1,EA,906.50000,861.18000,Amish/Mennonite,Amish Mennonite,,498.57,,,,,,,1.85,879.30,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,inpatient,5,EA,7.64000,7.26000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,4.20,7.41,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 10 MG/ML 5 ML,58205,CDM,250,RC,J3301,HCPCS,00003049420,NDC,facility,outpatient,5,EA,7.64000,7.26000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,1.35,7.41,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,110.00,194.00,percent of total billed charges,
TISSUE TRANSGLUTAMINASE AB IGG-TECH,58206,CDM,300,RC,83516,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,11.53,594.19,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
TOXOPLASMA AB-TECH,58207,CDM,300,RC,86777,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,14.39,746.94,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,inpatient,1,EA,1924.24000,1828.03000,Amish/Mennonite,Amish Mennonite,,1058.33,,,,,,,1058.33,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,63459039008,NDC,facility,outpatient,1,EA,1924.24000,1828.03000,Amish/Mennonite,Amish Mennonite,,1058.33,,,,,,,1.85,1866.51,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,inpatient,1,EA,276.50000,262.68000,Amish/Mennonite,Amish Mennonite,,152.07,,,,,,,152.07,268.20,percent of total billed charges,
TREANDA INJECTION 7910016,58210,CDM,636,RC,J9033,HCPCS,71288010210,NDC,facility,outpatient,1,EA,276.50000,262.68000,Amish/Mennonite,Amish Mennonite,,152.07,,,,,,,1.85,268.20,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6193-61,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,00904-6418-61,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,16714-0172-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,42291-0809-15,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,50268-0760-15,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.04,2.02,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,inpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,51079-0998-20,NDC,,,facility,outpatient,1,EA,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,inpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,55111-0180-15,NDC,,,facility,outpatient,1,EA,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,68084-0645-11,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
TIZANIDINE TAB,58211,CDM,250,RC,72789-0325-77,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-00,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00182-1259-89,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,00904-6868-61,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,53489-0510-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60505-2653-05,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,60687-0443-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE TAB 7221658,58213,CDM,250,RC,68382-0805-10,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00182-1260-89,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,00904-6869-61,NDC,,,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,68382-0806-01,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
TRAZODONE TAB 7223019,58214,CDM,250,RC,60687-0454-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
UREA NITROGEN-TECH,58215,CDM,300,RC,84520,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,3.95,203.72,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY NDL ABD/RETROPER MASS PERC-TECH,58217,CDM,361,RC,49180,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,4686.00,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,inpatient,,,215.00000,204.25000,Amish/Mennonite,Amish Mennonite,,118.25,,,,,,,118.25,208.55,percent of total billed charges,
US FLUID DRG SFT TISS-TECH,58219,CDM,361,RC,10030,CPT,,,facility,outpatient,,,215.00000,204.25000,Amish/Mennonite,Amish Mennonite,,118.25,,,,,,,118.25,3163.00,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
URINALYSIS NON AUTO WO MICRO-TECH,58220,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,3.48,169.79,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,inpatient,15,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,52565-0056-15,NDC,,,facility,outpatient,15,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,inpatient,15,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,16714-0986-01,NDC,,,facility,outpatient,15,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,inpatient,15,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,33342-0329-15,NDC,,,facility,outpatient,15,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,inpatient,15,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,45802-0064-35,NDC,,,facility,outpatient,15,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,inpatient,15,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107212,58221,CDM,250,RC,67877-0251-15,NDC,,,facility,outpatient,15,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,64.90,114.46,percent of total billed charges,
TISS CULT NONNEOP LYMPHOCYTE-TECH,58223,CDM,310,RC,88230,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,59.00,6094.58,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,inpatient,,,794.00000,754.30000,Amish/Mennonite,Amish Mennonite,TC,436.70,,,,,,,436.70,770.18,percent of total billed charges,
URINARY BLADDER RESIDUAL STUDY-TECH,58224,CDM,340,RC,78730,CPT,,,facility,outpatient,,,794.00000,754.30000,Amish/Mennonite,Amish Mennonite,TC,436.70,,,,,,,313.12,770.18,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,170.50,300.70,percent of total billed charges,
TC99M SULFUR COLLOID,58225,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,155.00,1239.81,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,inpatient,,,335.80000,319.01000,Amish/Mennonite,Amish Mennonite,,184.69,,,,,,,184.69,325.73,percent of total billed charges,
UNLISTED TRANSFUSION PROCEDURE-TECH,58226,CDM,300,RC,86999,CPT,,,facility,outpatient,,,335.80000,319.01000,Amish/Mennonite,Amish Mennonite,,184.69,,,,,,,23.25,325.73,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
URIC ACID BLOOD-TECH,58227,CDM,300,RC,84550,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,4.52,237.65,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,inpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,134.20,236.68,percent of total billed charges,
TUMOR ANTIGEN CA 125-TECH,58228,CDM,300,RC,86304,CPT,,,facility,outpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,20.81,1086.52,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,200.75,354.05,percent of total billed charges,
TRICHOMONAS VAGINALIS AMPL PROBE-TECH,58229,CDM,300,RC,87661,CPT,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,35.09,1833.46,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,inpatient,1,EA,29.58000,28.10000,Amish/Mennonite,Amish Mennonite,,16.27,,,,,,,16.27,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00003029305,NDC,facility,outpatient,1,EA,29.58000,28.10000,Amish/Mennonite,Amish Mennonite,,16.27,,,,,,,1.35,28.69,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,inpatient,1,EA,25.56000,24.29000,Amish/Mennonite,Amish Mennonite,,14.06,,,,,,,14.06,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,00703024101,NDC,facility,outpatient,1,EA,25.56000,24.29000,Amish/Mennonite,Amish Mennonite,,14.06,,,,,,,1.35,24.79,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,inpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,70121165105,NDC,facility,outpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,1.35,26.05,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,inpatient,1,EA,28.09000,26.69000,Amish/Mennonite,Amish Mennonite,,15.45,,,,,,,15.45,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,67457062102,NDC,facility,outpatient,1,EA,28.09000,26.69000,Amish/Mennonite,Amish Mennonite,,15.45,,,,,,,1.35,27.25,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,inpatient,1,EA,16.59000,15.76000,Amish/Mennonite,Amish Mennonite,,9.12,,,,,,,9.12,16.09,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML,58230,CDM,250,RC,J3301,HCPCS,81298578105,NDC,facility,outpatient,1,EA,16.59000,15.76000,Amish/Mennonite,Amish Mennonite,,9.12,,,,,,,1.35,16.09,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,57237-0089-01,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,inpatient,1,EA,1.74000,1.66000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
TRANDOLAPRIL TAB 7213838,58231,CDM,250,RC,68180-0566-01,NDC,,,facility,outpatient,1,EA,1.74000,1.66000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
TRIGLYCERIDES ASSAY-TECH,58232,CDM,301,RC,84478,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.74,305.58,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-4858-51,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,inpatient,1,EA,6.93000,6.59000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.81,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,00054-8858-25,NDC,,,facility,outpatient,1,EA,6.93000,6.59000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.46,6.72,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,15330-0249-01,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,6.37,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-04,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,5.79,11.24,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,inpatient,1,EA,9.27000,8.81000,Amish/Mennonite,Amish Mennonite,,5.10,,,,,,,5.10,8.99,percent of total billed charges,
TRIAZOLAM TAB,58234,CDM,250,RC,59762-3717-09,NDC,,,facility,outpatient,1,EA,9.27000,8.81000,Amish/Mennonite,Amish Mennonite,,5.10,,,,,,,4.63,8.99,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,inpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,TC,397.10,,,,,,,397.10,700.34,percent of total billed charges,
US CHEST-TECH,58235,CDM,402,RC,76604,CPT,,,facility,outpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,TC,397.10,,,,,,,361.00,700.34,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
TOXOPLASMA AB IGM-TECH,58236,CDM,300,RC,86778,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,14.41,746.94,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,107.25,189.15,percent of total billed charges,
US BLADDER POST VOIDING URINE-TECH,58237,CDM,761,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,56.40,189.15,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,90,82.50,,,,,,,82.50,145.50,percent of total billed charges,
TRYPTASE (81608)-TECH,58238,CDM,300,RC,83520,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,90,82.50,,,,,,,17.85,814.87,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,TC,185.90,,,,,,,185.90,327.86,percent of total billed charges,
US RETROPERITONEAL LTD-TECH,58239,CDM,402,RC,76775,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,TC,185.90,,,,,,,169.00,584.87,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,inpatient,1,mL,1601.79000,1521.70000,Amish/Mennonite,Amish Mennonite,,880.98,,,,,,,880.98,1553.74,percent of total billed charges,
BENDAMUSTINE 25 MG/ML SOLN,58240,CDM,636,RC,J9034,HCPCS,63459034804,NDC,facility,outpatient,1,mL,1601.79000,1521.70000,Amish/Mennonite,Amish Mennonite,,880.98,,,,,,,13.12,1553.74,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,inpatient,1,EA,30.15000,28.64000,Amish/Mennonite,Amish Mennonite,,16.58,,,,,,,16.58,29.25,percent of total billed charges,
TRIAMTERENE CAP,58241,CDM,250,RC,66993-0831-02,NDC,,,facility,outpatient,1,EA,30.15000,28.64000,Amish/Mennonite,Amish Mennonite,,16.58,,,,,,,15.07,29.25,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
URIC ACID OTHER SOURCE-TECH,58242,CDM,300,RC,84560,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,5.08,254.68,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,inpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,,118.80,,,,,,,118.80,209.52,percent of total billed charges,
TUMOR ANTIGEN CA 19-9-TECH,58243,CDM,300,RC,86301,CPT,,,facility,outpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,,118.80,,,,,,,20.81,1086.52,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,inpatient,1,mL,389.56000,370.08000,Amish/Mennonite,Amish Mennonite,,214.26,,,,,,,214.26,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00065054301,NDC,facility,outpatient,1,mL,389.56000,370.08000,Amish/Mennonite,Amish Mennonite,,214.26,,,,,,,24.51,377.87,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,inpatient,1,mL,2444.96000,2322.71000,Amish/Mennonite,Amish Mennonite,,1344.73,,,,,,,1344.73,2371.61,percent of total billed charges,
TRIAMCINOLONE A INJ PRS-FREE,58245,CDM,250,RC,J3300,HCPCS,00078089778,NDC,facility,outpatient,1,mL,2444.96000,2322.71000,Amish/Mennonite,Amish Mennonite,,1344.73,,,,,,,24.51,2371.61,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,inpatient,15,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,00713-0229-15,NDC,,,facility,outpatient,15,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,16714-0267-01,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,inpatient,15,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107220,58247,CDM,250,RC,45802-0054-35,NDC,,,facility,outpatient,15,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,inpatient,80,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,00168-0004-80,NDC,,,facility,outpatient,80,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,inpatient,80,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,40085-0029-80,NDC,,,facility,outpatient,80,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,inpatient,80,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107980,58248,CDM,250,RC,45802-0064-36,NDC,,,facility,outpatient,80,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,Amish/Mennonite,Amish Mennonite,TC,1843.60,,,,,,,1843.60,3251.44,percent of total billed charges,
TUMOR LOCALIZATION SPECT-TECH,58249,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,Amish/Mennonite,Amish Mennonite,TC,1843.60,,,,,,,1676.00,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,00143-1764-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-10,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,62584-0886-11,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL TAB 2 MG,58250,CDM,250,RC,70954-0212-20,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,31722-0530-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50111-0916-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
TORSEMIDE TAB,58251,CDM,250,RC,50268-0755-15,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,inpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,189.16,333.61,percent of total billed charges,
TOCILIZUMAB INJECTION 7910212,58252,CDM,636,RC,J3262,HCPCS,50242013701,NDC,facility,outpatient,1,mL,343.93000,326.73000,Amish/Mennonite,Amish Mennonite,,189.16,,,,,,,5.79,333.61,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,inpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,90,148.50,,,,,,,148.50,261.90,percent of total billed charges,
THYROID STIM IMMUNOGLOBIN SO -TECH,58253,CDM,300,RC,84445,CPT,,,facility,outpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,90,148.50,,,,,,,32.70,2665.30,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,inpatient,,,83.60000,79.42000,Amish/Mennonite,Amish Mennonite,90,45.98,,,,,,,45.98,81.09,percent of total billed charges,
"TRICHINELLA ANTIBODY, IGG, SERUM (TRCNG) SO",58254,CDM,300,RC,86784,CPT,,,facility,outpatient,,,83.60000,79.42000,Amish/Mennonite,Amish Mennonite,90,45.98,,,,,,,8.17,662.12,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
URINALYSIS AUTO W MICRO-TECH,58255,CDM,300,RC,81001,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,3.17,169.79,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,inpatient,,,5196.00000,4936.20000,Amish/Mennonite,Amish Mennonite,90,2857.80,,,,,,,2857.80,5040.12,percent of total billed charges,
UROVYSION BLADDER CA DETECTION-TECH,58256,CDM,310,RC,88120,CPT,,,facility,outpatient,,,5196.00000,4936.20000,Amish/Mennonite,Amish Mennonite,90,2857.80,,,,,,,533.12,27787.37,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,inpatient,,,831.00000,789.45000,Amish/Mennonite,Amish Mennonite,TC,457.05,,,,,,,457.05,806.07,percent of total billed charges,
US BREAST UNILATERAL COMPLT-TECH,58257,CDM,402,RC,76641,CPT,,,facility,outpatient,,,831.00000,789.45000,Amish/Mennonite,Amish Mennonite,TC,457.05,,,,,,,384.16,806.07,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,inpatient,,,729.00000,692.55000,Amish/Mennonite,Amish Mennonite,TC,400.95,,,,,,,400.95,707.13,percent of total billed charges,
US ABDOMINAL LIMITED-TECH,58258,CDM,402,RC,76705,CPT,,,facility,outpatient,,,729.00000,692.55000,Amish/Mennonite,Amish Mennonite,TC,400.95,,,,,,,364.50,707.13,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,inpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,TC,229.35,,,,,,,229.35,404.49,percent of total billed charges,
US SCROTUM & CONTENTS-TECH,58259,CDM,402,RC,76870,CPT,,,facility,outpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,TC,229.35,,,,,,,208.50,584.87,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,inpatient,60,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00168-0337-60,NDC,,,facility,outpatient,60,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,inpatient,60,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,00603-7864-49,NDC,,,facility,outpatient,60,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,inpatient,60,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL LOTION,58260,CDM,250,RC,60432-0561-61,NDC,,,facility,outpatient,60,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,282.15,497.61,percent of total billed charges,
US OB TRANSABD >=14 WKS EA ADDL-TECH,58261,CDM,402,RC,76810,CPT,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,215.27,548.00,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,inpatient,1,mL,246.06000,233.75000,Amish/Mennonite,Amish Mennonite,,135.33,,,,,,,135.33,238.68,percent of total billed charges,
USTEKINUMAB SOLN 5 MG/ML 26 ML (STELARA),58262,CDM,636,RC,J3358,HCPCS,57894005427,NDC,facility,outpatient,1,mL,246.06000,233.75000,Amish/Mennonite,Amish Mennonite,,135.33,,,,,,,13.29,238.68,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,Amish/Mennonite,Amish Mennonite,TC,615.45,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL-TECH,58263,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,Amish/Mennonite,Amish Mennonite,TC,615.45,,,,,,,384.16,1085.43,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,382.80,675.12,percent of total billed charges,
US OB TRANSVAGINAL-TECH,58264,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,348.00,675.12,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,inpatient,,,38.00000,36.10000,Amish/Mennonite,Amish Mennonite,,20.90,,,,,,,20.90,36.86,percent of total billed charges,
URINE MICROSCOPIC EXAM-TECH,58265,CDM,300,RC,81015,CPT,,,facility,outpatient,,,38.00000,36.10000,Amish/Mennonite,Amish Mennonite,,20.90,,,,,,,3.05,152.82,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
VANILLYLMANDELIC ACID URINE-TECH,58266,CDM,300,RC,84585,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,15.50,814.87,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,inpatient,,,581.00000,551.95000,Amish/Mennonite,Amish Mennonite,TC,319.55,,,,,,,319.55,563.57,percent of total billed charges,
US FETAL BIOPHYS PROF WO NON-STR-TECH,58267,CDM,402,RC,76819,CPT,,,facility,outpatient,,,581.00000,551.95000,Amish/Mennonite,Amish Mennonite,TC,319.55,,,,,,,290.50,584.87,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
US PELVIC NON OB LTD F/U-TECH,58268,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,584.87,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,inpatient,1,EA,25.18000,23.92000,Amish/Mennonite,Amish Mennonite,,13.85,,,,,,,13.85,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-34,NDC,,,facility,outpatient,1,EA,25.18000,23.92000,Amish/Mennonite,Amish Mennonite,,13.85,,,,,,,12.59,24.42,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,inpatient,1,EA,12.70000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.99,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00078-0359-61,NDC,,,facility,outpatient,1,EA,12.70000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.35,12.32,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,00378-5814-77,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,inpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,31722-0153-90,NDC,,,facility,outpatient,1,EA,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,33342-0064-10,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,inpatient,1,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.70,percent of total billed charges,
VALSARTAN TAB 7222526,58269,CDM,250,RC,60687-0634-01,NDC,,,facility,outpatient,1,EA,3.81000,3.62000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.70,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,90,30.25,,,,,,,30.25,53.35,percent of total billed charges,
URINE SULFATE ASSAY URORISK SO-TECH,58270,CDM,300,RC,84392,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,90,30.25,,,,,,,5.67,254.68,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT-TECH,58271,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,154.77,548.00,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
VANCOMYCIN ASSAY-TECH,58272,CDM,300,RC,80202,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,13.54,713.01,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,inpatient,15,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,00168-0003-15,NDC,,,facility,outpatient,15,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,inpatient,15,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,16714-0985-01,NDC,,,facility,outpatient,15,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,inpatient,15,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,33342-0327-15,NDC,,,facility,outpatient,15,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,inpatient,15,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
TRIAMCINOLONE TOPICAL CREAM 7107204,58274,CDM,250,RC,45802-0063-35,NDC,,,facility,outpatient,15,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,inpatient,,,850.00000,807.50000,Amish/Mennonite,Amish Mennonite,TC,467.50,,,,,,,467.50,824.50,percent of total billed charges,
US OB F/U PER FETUS-TECH,58275,CDM,402,RC,76816,CPT,,,facility,outpatient,,,850.00000,807.50000,Amish/Mennonite,Amish Mennonite,TC,467.50,,,,,,,384.16,824.50,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,inpatient,,,641.00000,608.95000,Amish/Mennonite,Amish Mennonite,TC,352.55,,,,,,,352.55,621.77,percent of total billed charges,
US BREAST UNILATERAL LIMITED-TECH,58276,CDM,402,RC,76642,CPT,,,facility,outpatient,,,641.00000,608.95000,Amish/Mennonite,Amish Mennonite,TC,352.55,,,,,,,320.50,621.77,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,inpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,TC,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
US SFT TISS HEAD & NECK-TECH,58277,CDM,402,RC,76536,CPT,,,facility,outpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,TC,569.80,,,,,,,384.16,1004.92,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,inpatient,,,963.00000,914.85000,Amish/Mennonite,Amish Mennonite,TC,529.65,,,,,,,529.65,934.11,percent of total billed charges,
US ABDOMINAL COMPLT-TECH,58278,CDM,402,RC,76700,CPT,,,facility,outpatient,,,963.00000,914.85000,Amish/Mennonite,Amish Mennonite,TC,529.65,,,,,,,384.16,934.11,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,inpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,TC,522.50,,,,,,,522.50,921.50,percent of total billed charges,
US SPINAL CANAL AND CONTENTS-TECH,58279,CDM,402,RC,76800,CPT,,,facility,outpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,TC,522.50,,,,,,,384.16,921.50,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00591-4012-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,00832-0310-11,NDC,,,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,51079-0298-20,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,inpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0251-10,NDC,,,facility,outpatient,1,EA,1.35000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,63739-0253-40,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
VALPROIC ACID CAP,58280,CDM,250,RC,69452-0150-20,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,inpatient,15,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,00168-0006-15,NDC,,,facility,outpatient,15,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,inpatient,15,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,21922-0063-04,NDC,,,facility,outpatient,15,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,inpatient,15,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,33342-0333-15,NDC,,,facility,outpatient,15,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,inpatient,15,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,45802-0055-35,NDC,,,facility,outpatient,15,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,inpatient,15,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,51672-1284-01,NDC,,,facility,outpatient,15,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,inpatient,15,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
TRIAMCINOLONE TOPICAL OINT 7107238,58281,CDM,250,RC,52565-0014-15,NDC,,,facility,outpatient,15,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,inpatient,,,1031.00000,979.45000,Amish/Mennonite,Amish Mennonite,TC,567.05,,,,,,,567.05,1000.07,percent of total billed charges,
US FOLLICLE STUDY IVT INFERTILITY-TECH,58282,CDM,402,RC,76830,CPT,,,facility,outpatient,,,1031.00000,979.45000,Amish/Mennonite,Amish Mennonite,TC,567.05,,,,,,,384.16,1000.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,inpatient,5,EA,20.05000,19.04000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,11.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00074156410,NDC,facility,outpatient,5,EA,20.05000,19.04000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,10.03,19.45,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,inpatient,5,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143963710,NDC,facility,outpatient,5,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,inpatient,5,EA,10.93000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,6.01,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,00143978510,NDC,facility,outpatient,5,EA,10.93000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,5.46,10.60,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,inpatient,5,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,55390000710,NDC,facility,outpatient,5,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,inpatient,5,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049405,NDC,facility,outpatient,5,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.12,4.10,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,inpatient,5,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,63323049416,NDC,facility,outpatient,5,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,inpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
VALPROATE SODIUM SOLN-INJ 100 MG/ML 5 ML,58283,CDM,250,RC,J3490,HCPCS,70860078405,NDC,facility,outpatient,5,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,inpatient,,,706.00000,670.70000,Amish/Mennonite,Amish Mennonite,TC,388.30,,,,,,,388.30,684.82,percent of total billed charges,
US OB 1ST TRI FETAL NT SNGL-TECH,58284,CDM,402,RC,76813,CPT,,,facility,outpatient,,,706.00000,670.70000,Amish/Mennonite,Amish Mennonite,TC,388.30,,,,,,,353.00,684.82,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
VALPROIC ACID TOTAL ASSAY-TECH,58285,CDM,300,RC,80164,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,13.54,713.01,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,inpatient,1,mL,25.54000,24.26000,Amish/Mennonite,Amish Mennonite,,14.05,,,,,,,14.05,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,00409114402,NDC,facility,outpatient,1,mL,25.54000,24.26000,Amish/Mennonite,Amish Mennonite,,14.05,,,,,,,12.77,24.77,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,inpatient,1,mL,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,6.52,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,43066003505,NDC,facility,outpatient,1,mL,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,5.92,11.49,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,inpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
VERAPAMIL SOLN-INJ 2.5 MG/ML 4 ML,58286,CDM,250,RC,J3490,HCPCS,55150034305,NDC,facility,outpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.32,12.26,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,inpatient,1,EA,16.60000,15.77000,Amish/Mennonite,Amish Mennonite,,9.13,,,,,,,9.13,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-12,NDC,,,facility,outpatient,1,EA,16.60000,15.77000,Amish/Mennonite,Amish Mennonite,,9.13,,,,,,,8.30,16.10,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,Amish/Mennonite,Amish Mennonite,,14.56,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,Amish/Mennonite,Amish Mennonite,,14.56,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,inpatient,1,EA,9.77000,9.28000,Amish/Mennonite,Amish Mennonite,,5.37,,,,,,,5.37,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,00069-0469-97,NDC,,,facility,outpatient,1,EA,9.77000,9.28000,Amish/Mennonite,Amish Mennonite,,5.37,,,,,,,4.88,9.48,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,Amish/Mennonite,Amish Mennonite,,11.31,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,49884-0156-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,Amish/Mennonite,Amish Mennonite,,11.31,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
VARENICLINE TAB,58287,CDM,250,RC,68462-0894-56,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,inpatient,1,EA,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,8.38,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00143923410,NDC,facility,outpatient,1,EA,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,7.62,14.77,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,inpatient,1,EA,12.83000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,7.06,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00409163201,NDC,facility,outpatient,1,EA,12.83000,12.19000,Amish/Mennonite,Amish Mennonite,,7.06,,,,,,,6.42,12.45,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,inpatient,1,EA,19.91000,18.91000,Amish/Mennonite,Amish Mennonite,,10.95,,,,,,,10.95,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,00703291403,NDC,facility,outpatient,1,EA,19.91000,18.91000,Amish/Mennonite,Amish Mennonite,,10.95,,,,,,,9.96,19.31,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,inpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021065710,NDC,facility,outpatient,1,EA,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,inpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.95,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,25021068510,NDC,facility,outpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.13,15.78,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,inpatient,1,EA,16.62000,15.79000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,9.14,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,41616093140,NDC,facility,outpatient,1,EA,16.62000,15.79000,Amish/Mennonite,Amish Mennonite,,9.14,,,,,,,8.31,16.12,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,inpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,47335093144,NDC,facility,outpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,13.43,26.05,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,inpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,6.07,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023510,NDC,facility,outpatient,1,EA,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,5.51,10.70,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,inpatient,1,EA,12.51000,11.89000,Amish/Mennonite,Amish Mennonite,,6.88,,,,,,,6.88,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55150023511,NDC,facility,outpatient,1,EA,12.51000,11.89000,Amish/Mennonite,Amish Mennonite,,6.88,,,,,,,6.25,12.13,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,55390003710,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,inpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,9.04,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,63323078110,NDC,facility,outpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,8.21,15.94,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VECURONIUM POWD-INJ 10 MG,58288,CDM,250,RC,J3490,HCPCS,67457043810,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-20,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,inpatient,1,EA,6.54000,6.21000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,3.60,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,00121-0867-50,NDC,,,facility,outpatient,1,EA,6.54000,6.21000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,3.27,6.34,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,17478-0741-02,NDC,,,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,19.75,38.31,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,inpatient,1,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,8.26,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,23155-0858-78,NDC,,,facility,outpatient,1,EA,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,7.50,14.56,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,68180-0166-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,62559-0390-50,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,inpatient,1,EA,58.52000,55.59000,Amish/Mennonite,Amish Mennonite,,32.19,,,,,,,32.19,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-01,NDC,,,facility,outpatient,1,EA,58.52000,55.59000,Amish/Mennonite,Amish Mennonite,,32.19,,,,,,,29.26,56.76,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,inpatient,1,EA,91.70000,87.12000,Amish/Mennonite,Amish Mennonite,,50.44,,,,,,,50.44,88.95,percent of total billed charges,
VANCOMYCIN CAP 125 MG,58289,CDM,250,RC,66593-3125-02,NDC,,,facility,outpatient,1,EA,91.70000,87.12000,Amish/Mennonite,Amish Mennonite,,50.44,,,,,,,45.85,88.95,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,inpatient,,,1398.00000,1328.10000,Amish/Mennonite,Amish Mennonite,TC,768.90,,,,,,,768.90,1356.06,percent of total billed charges,
US TRANSPLANTED KIDNEY-TECH,58290,CDM,402,RC,76776,CPT,,,facility,outpatient,,,1398.00000,1328.10000,Amish/Mennonite,Amish Mennonite,TC,768.90,,,,,,,384.16,1356.06,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS LTD STATIC-TECH,58291,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,384.16,867.18,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
UREA-N CLEARANCE-TECH,58292,CDM,300,RC,84545,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,7.20,339.51,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,Amish/Mennonite,Amish Mennonite,,25279.41,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006002,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,Amish/Mennonite,Amish Mennonite,,25279.41,,,,,,,157.68,44583.68,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,inpatient,1,mL,52901.43000,50256.36000,Amish/Mennonite,Amish Mennonite,,29095.79,,,,,,,29095.79,51314.39,percent of total billed charges,
USTEKINUMAB SUB CU INJ,58293,CDM,636,RC,J3357,HCPCS,57894006003,NDC,facility,outpatient,1,mL,52901.43000,50256.36000,Amish/Mennonite,Amish Mennonite,,29095.79,,,,,,,157.68,51314.39,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
TROPHEYMA WHIPPLEI PCR-TECH,58294,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,36.26,1833.46,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,145.20,256.08,percent of total billed charges,
US OB TRANSABD  < 14 WKS EA ADDL-TECH,58295,CDM,402,RC,76802,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,110.28,548.00,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,inpatient,1,mL,16.99000,16.14000,Amish/Mennonite,Amish Mennonite,,9.34,,,,,,,9.34,16.48,percent of total billed charges,
VINBLASTINE SOLN 1 MG/ML 10 ML,58296,CDM,250,RC,J9360,HCPCS,63323027810,NDC,facility,outpatient,1,mL,16.99000,16.14000,Amish/Mennonite,Amish Mennonite,,9.34,,,,,,,7.96,16.48,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,inpatient,1,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,10.81,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00069258903,NDC,facility,outpatient,1,EA,19.66000,18.67000,Amish/Mennonite,Amish Mennonite,,10.81,,,,,,,3.02,19.07,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,71288002321,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,3.02,18.39,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,inpatient,1,EA,51.45000,48.88000,Amish/Mennonite,Amish Mennonite,,28.30,,,,,,,28.30,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653321,NDC,facility,outpatient,1,EA,51.45000,48.88000,Amish/Mennonite,Amish Mennonite,,28.30,,,,,,,3.02,49.91,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,inpatient,1,EA,11.80000,11.21000,Amish/Mennonite,Amish Mennonite,,6.49,,,,,,,6.49,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00409653331,NDC,facility,outpatient,1,EA,11.80000,11.21000,Amish/Mennonite,Amish Mennonite,,6.49,,,,,,,3.02,11.45,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,00781318880,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,3.02,30.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,inpatient,1,EA,50.69000,48.15000,Amish/Mennonite,Amish Mennonite,,27.88,,,,,,,27.88,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034001,NDC,facility,outpatient,1,EA,50.69000,48.15000,Amish/Mennonite,Amish Mennonite,,27.88,,,,,,,3.02,49.17,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,inpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,9.04,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,25021015120,NDC,facility,outpatient,1,EA,16.43000,15.61000,Amish/Mennonite,Amish Mennonite,,9.04,,,,,,,3.02,15.94,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,55150020420,NDC,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,3.02,12.26,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,inpatient,1,EA,50.24000,47.73000,Amish/Mennonite,Amish Mennonite,,27.63,,,,,,,27.63,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028420,NDC,facility,outpatient,1,EA,50.24000,47.73000,Amish/Mennonite,Amish Mennonite,,27.63,,,,,,,3.02,48.73,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,inpatient,1,EA,13.59000,12.91000,Amish/Mennonite,Amish Mennonite,,7.47,,,,,,,7.47,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,63323028426,NDC,facility,outpatient,1,EA,13.59000,12.91000,Amish/Mennonite,Amish Mennonite,,7.47,,,,,,,3.02,13.18,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,inpatient,1,EA,8.80000,8.36000,Amish/Mennonite,Amish Mennonite,,4.84,,,,,,,4.84,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,67457034000,NDC,facility,outpatient,1,EA,8.80000,8.36000,Amish/Mennonite,Amish Mennonite,,4.84,,,,,,,3.02,8.54,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,inpatient,1,EA,16.42000,15.60000,Amish/Mennonite,Amish Mennonite,,9.03,,,,,,,9.03,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70436002182,NDC,facility,outpatient,1,EA,16.42000,15.60000,Amish/Mennonite,Amish Mennonite,,9.03,,,,,,,3.02,15.93,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,70860010520,NDC,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,3.02,22.99,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,inpatient,1,EA,18.93000,17.98000,Amish/Mennonite,Amish Mennonite,,10.41,,,,,,,10.41,18.36,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM,58297,CDM,250,RC,J3370,HCPCS,72611076510,NDC,facility,outpatient,1,EA,18.93000,17.98000,Amish/Mennonite,Amish Mennonite,,10.41,,,,,,,3.02,18.36,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,inpatient,,,4587.00000,4357.65000,Amish/Mennonite,Amish Mennonite,,2522.85,,,,,,,2522.85,4449.39,percent of total billed charges,
US GUID FL COL DRN CATH VISC-TECH,58298,CDM,361,RC,49405,CPT,,,facility,outpatient,,,4587.00000,4357.65000,Amish/Mennonite,Amish Mennonite,,2522.85,,,,,,,1538.48,4686.00,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,inpatient,,,1068.00000,1014.60000,Amish/Mennonite,Amish Mennonite,TC,587.40,,,,,,,587.40,1035.96,percent of total billed charges,
US INFANT HIPS DYNAMIC-TECH,58299,CDM,402,RC,76885,CPT,,,facility,outpatient,,,1068.00000,1014.60000,Amish/Mennonite,Amish Mennonite,TC,587.40,,,,,,,384.16,1035.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-06,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,inpatient,1,EA,23.41000,22.24000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,12.88,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-34,NDC,,,facility,outpatient,1,EA,23.41000,22.24000,Amish/Mennonite,Amish Mennonite,,12.88,,,,,,,11.71,22.71,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,6.52,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00078-0358-61,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,5.92,11.49,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00378-5813-77,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00781-5608-92,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,inpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,00904-6594-61,NDC,,,facility,outpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,inpatient,1,EA,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,31722-0152-90,NDC,,,facility,outpatient,1,EA,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,inpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,65862-0571-90,NDC,,,facility,outpatient,1,EA,1.08000,1.03000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,43547-0368-09,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,inpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,50268-0747-15,NDC,,,facility,outpatient,1,EA,3.70000,3.51000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.85,3.59,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,59746-0361-90,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,60687-0623-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.69,3.28,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.90,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-01,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.18,13.94,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,Amish/Mennonite,Amish Mennonite,,6.38,,,,,,,6.38,11.25,percent of total billed charges,
VALSARTAN TAB 7222524,58300,CDM,250,RC,68084-0804-11,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,Amish/Mennonite,Amish Mennonite,,6.38,,,,,,,5.80,11.25,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,inpatient,,,613.00000,582.35000,Amish/Mennonite,Amish Mennonite,TC,337.15,,,,,,,337.15,594.61,percent of total billed charges,
US OB LIMITED >=1 FETUS-TECH,58301,CDM,402,RC,76815,CPT,,,facility,outpatient,,,613.00000,582.35000,Amish/Mennonite,Amish Mennonite,TC,337.15,,,,,,,306.50,594.61,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,inpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,31.28,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,25021020405,NDC,facility,outpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,3.14,55.17,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,00703418301,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,3.14,61.30,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,inpatient,1,mL,27.71000,26.32000,Amish/Mennonite,Amish Mennonite,,15.24,,,,,,,15.24,26.88,percent of total billed charges,
VINORELBINE TARTRATE INJ,58302,CDM,250,RC,J9390,HCPCS,61703034109,NDC,facility,outpatient,1,mL,27.71000,26.32000,Amish/Mennonite,Amish Mennonite,,15.24,,,,,,,3.14,26.88,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,inpatient,1,EA,25.79000,24.50000,Amish/Mennonite,Amish Mennonite,,14.18,,,,,,,14.18,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00409433201,NDC,facility,outpatient,1,EA,25.79000,24.50000,Amish/Mennonite,Amish Mennonite,,14.18,,,,,,,3.02,25.02,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,00781318795,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,3.02,15.33,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,72611076110,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,3.02,9.20,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,inpatient,1,EA,7.81000,7.41000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,4.30,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022116,NDC,facility,outpatient,1,EA,7.81000,7.41000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,3.02,7.58,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,inpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,63323022138,NDC,facility,outpatient,1,EA,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,3.02,21.46,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,inpatient,1,EA,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033900,NDC,facility,outpatient,1,EA,5.28000,5.01000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.64,5.12,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,inpatient,1,EA,25.41000,24.14000,Amish/Mennonite,Amish Mennonite,,13.98,,,,,,,13.98,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,67457033950,NDC,facility,outpatient,1,EA,25.41000,24.14000,Amish/Mennonite,Amish Mennonite,,13.98,,,,,,,3.02,24.65,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,inpatient,1,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,7.39,13.03,percent of total billed charges,
VANCOMYCIN POWD-INJ 500 MG,58303,CDM,250,RC,J3370,HCPCS,70436002082,NDC,facility,outpatient,1,EA,13.43000,12.76000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,3.02,13.03,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,Amish/Mennonite,Amish Mennonite,,6.89,,,,,,,6.89,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-02,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,Amish/Mennonite,Amish Mennonite,,6.89,,,,,,,6.26,12.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,inpatient,1,EA,44.47000,42.25000,Amish/Mennonite,Amish Mennonite,,24.46,,,,,,,24.46,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00008-0833-03,NDC,,,facility,outpatient,1,EA,44.47000,42.25000,Amish/Mennonite,Amish Mennonite,,24.46,,,,,,,22.23,43.14,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-56,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00093-7385-98,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-6247-61,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,inpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,00904-7077-61,NDC,,,facility,outpatient,1,EA,1.65000,1.57000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,42291-0898-90,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,inpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,51079-0135-20,NDC,,,facility,outpatient,1,EA,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-03,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,59762-0181-34,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-30,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,65862-0528-90,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68084-0709-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,inpatient,1,EA,1.45000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
VENLAFAXINE CAP-ER 75 MG,58304,CDM,250,RC,68382-0035-16,NDC,,,facility,outpatient,1,EA,1.45000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
VARICELLA ZOSTER AB-TECH,58305,CDM,300,RC,86787,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,8.17,679.08,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,Amish/Mennonite,Amish Mennonite,TC,1411.30,,,,,,,1411.30,2489.02,percent of total billed charges,
TUMOR LOCALIZATION MULT AREAS-TECH,58306,CDM,341,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,Amish/Mennonite,Amish Mennonite,TC,1411.30,,,,,,,1283.00,2489.02,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,inpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,25021020401,NDC,facility,outpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,3.14,76.63,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,inpatient,1,mL,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
VINORELBINE TARTRATE INJ 7910104,58307,CDM,250,RC,J9390,HCPCS,64370053201,NDC,facility,outpatient,1,mL,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,3.14,91.96,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,inpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,73.15,129.01,percent of total billed charges,
US EXTREMITY NONVASC LTD-TECH,58308,CDM,402,RC,76882,CPT,,,facility,outpatient,,,133.00000,126.35000,Amish/Mennonite,Amish Mennonite,TC,73.15,,,,,,,66.50,584.87,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,57664011888,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,inpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,51079086920,NDC,facility,outpatient,1,EA,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,68462026001,NDC,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,inpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
VERAPAMIL TAB-ER 240 MG (12-HOUR),58309,CDM,250,RC,J8499,HCPCS,75834015901,NDC,facility,outpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00143916301,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,3.02,122.61,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,inpatient,1,EA,285.22000,270.96000,Amish/Mennonite,Amish Mennonite,,156.87,,,,,,,156.87,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650901,NDC,facility,outpatient,1,EA,285.22000,270.96000,Amish/Mennonite,Amish Mennonite,,156.87,,,,,,,3.02,276.66,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,inpatient,1,EA,63.17000,60.01000,Amish/Mennonite,Amish Mennonite,,34.74,,,,,,,34.74,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,00409650949,NDC,facility,outpatient,1,EA,63.17000,60.01000,Amish/Mennonite,Amish Mennonite,,34.74,,,,,,,3.02,61.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,inpatient,1,EA,217.76000,206.87000,Amish/Mennonite,Amish Mennonite,,119.77,,,,,,,119.77,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,16714051701,NDC,facility,outpatient,1,EA,217.76000,206.87000,Amish/Mennonite,Amish Mennonite,,119.77,,,,,,,3.02,211.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,inpatient,1,EA,95.12000,90.36000,Amish/Mennonite,Amish Mennonite,,52.32,,,,,,,52.32,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,23360015365,NDC,facility,outpatient,1,EA,95.12000,90.36000,Amish/Mennonite,Amish Mennonite,,52.32,,,,,,,3.02,92.27,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,inpatient,1,EA,157.97000,150.07000,Amish/Mennonite,Amish Mennonite,,86.88,,,,,,,86.88,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,25021015799,NDC,facility,outpatient,1,EA,157.97000,150.07000,Amish/Mennonite,Amish Mennonite,,86.88,,,,,,,3.02,153.23,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,inpatient,1,EA,251.22000,238.66000,Amish/Mennonite,Amish Mennonite,,138.17,,,,,,,138.17,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,63323029561,NDC,facility,outpatient,1,EA,251.22000,238.66000,Amish/Mennonite,Amish Mennonite,,138.17,,,,,,,3.02,243.68,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,inpatient,1,EA,281.02000,266.97000,Amish/Mennonite,Amish Mennonite,,154.56,,,,,,,154.56,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70436002282,NDC,facility,outpatient,1,EA,281.02000,266.97000,Amish/Mennonite,Amish Mennonite,,154.56,,,,,,,3.02,272.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,inpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,52.14,91.96,percent of total billed charges,
VANCOMYCIN POWD-INJ 5 GM,58310,CDM,250,RC,J3370,HCPCS,70594004701,NDC,facility,outpatient,1,EA,94.80000,90.06000,Amish/Mennonite,Amish Mennonite,,52.14,,,,,,,3.02,91.96,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,inpatient,,,372.00000,353.40000,Amish/Mennonite,Amish Mennonite,,204.60,,,,,,,204.60,360.84,percent of total billed charges,
VARICELLA ZOSTER BY RAPID PCR-TECH,58312,CDM,300,RC,87798,CPT,,,facility,outpatient,,,372.00000,353.40000,Amish/Mennonite,Amish Mennonite,,204.60,,,,,,,35.09,1833.46,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,inpatient,,,769.00000,730.55000,Amish/Mennonite,Amish Mennonite,,422.95,,,,,,,422.95,745.93,percent of total billed charges,
VENTIL MGMT IP/OBS SUBSQ DAY-TECH,58313,CDM,410,RC,94003,CPT,,,facility,outpatient,,,769.00000,730.55000,Amish/Mennonite,Amish Mennonite,,422.95,,,,,,,384.50,745.93,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,inpatient,1,EA,37.70000,35.81000,Amish/Mennonite,Amish Mennonite,,20.73,,,,,,,20.73,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,00173-0933-08,NDC,,,facility,outpatient,1,EA,37.70000,35.81000,Amish/Mennonite,Amish Mennonite,,20.73,,,,,,,18.85,36.57,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,16714-0698-01,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.48,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,31722-0704-30,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,Amish/Mennonite,Amish Mennonite,,4.54,,,,,,,4.54,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,50268-0788-15,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,Amish/Mennonite,Amish Mennonite,,4.54,,,,,,,4.12,8.00,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,57237-0042-30,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,inpatient,1,EA,12.21000,11.60000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.72,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,63739-0525-10,NDC,,,facility,outpatient,1,EA,12.21000,11.60000,Amish/Mennonite,Amish Mennonite,,6.72,,,,,,,6.11,11.84,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
VALACYCLOVIR TAB,58314,CDM,250,RC,68084-0215-21,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,inpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,2990.51,percent of total billed charges,
TUBE THORACOSTOMY W/WO SEAL-TECH,58315,CDM,361,RC,32551,CPT,,,facility,outpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1475.05,4686.00,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,inpatient,,,888.00000,843.60000,Amish/Mennonite,Amish Mennonite,TC,488.40,,,,,,,488.40,861.36,percent of total billed charges,
US PELVIC NON OB COMPLT-TECH,58316,CDM,402,RC,76856,CPT,,,facility,outpatient,,,888.00000,843.60000,Amish/Mennonite,Amish Mennonite,TC,488.40,,,,,,,384.16,861.36,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
US SONOSITE GUIDE VASC ACCESS-TECH,58317,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,548.00,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,inpatient,1,EA,30.62000,29.09000,Amish/Mennonite,Amish Mennonite,,16.84,,,,,,,16.84,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,00409653102,NDC,facility,outpatient,1,EA,30.62000,29.09000,Amish/Mennonite,Amish Mennonite,,16.84,,,,,,,3.02,29.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,inpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
VANCOMYCIN POWD-INJ 750 MG,58318,CDM,250,RC,J3370,HCPCS,71288002421,NDC,facility,outpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,3.02,27.59,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,inpatient,1,EA,36.27000,34.45000,Amish/Mennonite,Amish Mennonite,,19.95,,,,,,,19.95,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00008-0837-03,NDC,,,facility,outpatient,1,EA,36.27000,34.45000,Amish/Mennonite,Amish Mennonite,,19.95,,,,,,,18.14,35.18,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-6246-61,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,00904-7075-61,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,50268-0817-15,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-20,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,51079-0134-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,59762-0180-03,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-30,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,inpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,65862-0527-90,NDC,,,facility,outpatient,1,EA,0.86000,0.81000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,inpatient,1,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68084-0698-01,NDC,,,facility,outpatient,1,EA,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
VENLAFAXINE CAP 7223530,58319,CDM,250,RC,68382-0034-16,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,inpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,90,87.56,,,,,,,87.56,154.42,percent of total billed charges,
VITAMIN K ASSAY SO,58321,CDM,300,RC,84597,CPT,,,facility,outpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,90,87.56,,,,,,,14.18,713.01,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
VITAMIN B6 ASSAY-TECH,58322,CDM,300,RC,84207,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,28.10,1476.99,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,inpatient,1,EA,5.20000,4.94000,Amish/Mennonite,Amish Mennonite,,2.86,,,,,,,2.86,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-01,NDC,,,facility,outpatient,1,EA,5.20000,4.94000,Amish/Mennonite,Amish Mennonite,,2.86,,,,,,,2.60,5.04,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,inpatient,1,EA,9.74000,9.26000,Amish/Mennonite,Amish Mennonite,,5.36,,,,,,,5.36,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00056-0173-75,NDC,,,facility,outpatient,1,EA,9.74000,9.26000,Amish/Mennonite,Amish Mennonite,,5.36,,,,,,,4.87,9.45,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00093-1719-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,51672-4034-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
WARFARIN TAB 7214778,58323,CDM,250,RC,00832-1218-01,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00591-0343-01,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,00904-2920-61,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,23155-0026-01,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
VERAPAMIL TAB 7222144,58325,CDM,250,RC,51079-0682-20,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
WET PREP-TECH,58326,CDM,300,RC,87210,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,5.82,271.65,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,inpatient,,,892.00000,847.40000,Amish/Mennonite,Amish Mennonite,,490.60,,,,,,,490.60,865.24,percent of total billed charges,
VENTIL MGMT IP/OBS INIT DAY-TECH,58327,CDM,410,RC,94002,CPT,,,facility,outpatient,,,892.00000,847.40000,Amish/Mennonite,Amish Mennonite,,490.60,,,,,,,446.00,865.24,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,inpatient,2,EA,46.41000,44.09000,Amish/Mennonite,Amish Mennonite,,25.53,,,,,,,25.53,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409114410,NDC,facility,outpatient,2,EA,46.41000,44.09000,Amish/Mennonite,Amish Mennonite,,25.53,,,,,,,23.20,45.02,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,inpatient,2,EA,28.92000,27.47000,Amish/Mennonite,Amish Mennonite,,15.91,,,,,,,15.91,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,00409401101,NDC,facility,outpatient,2,EA,28.92000,27.47000,Amish/Mennonite,Amish Mennonite,,15.91,,,,,,,14.46,28.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,inpatient,2,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,70710164307,NDC,facility,outpatient,2,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,inpatient,2,EA,50.80000,48.26000,Amish/Mennonite,Amish Mennonite,,27.94,,,,,,,27.94,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,51754020304,NDC,facility,outpatient,2,EA,50.80000,48.26000,Amish/Mennonite,Amish Mennonite,,27.94,,,,,,,25.40,49.28,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,inpatient,2,EA,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.05,percent of total billed charges,
VERAPAMIL SOL 7008204,58328,CDM,636,RC,J3490,HCPCS,72485010805,NDC,facility,outpatient,2,EA,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,3.63,7.05,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
VITAMIN B12 ASSAY-TECH,58330,CDM,300,RC,82607,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,15.08,780.94,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,inpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,10.77,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00078-0423-15,NDC,,,facility,outpatient,1,EA,19.59000,18.61000,Amish/Mennonite,Amish Mennonite,,10.77,,,,,,,9.79,19.00,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00093-7431-56,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,00378-5807-93,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,31722-0745-30,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,65862-0570-30,NDC,,,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,43547-0367-03,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,55111-0731-30,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,60687-0612-21,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,inpatient,1,EA,4.56000,4.33000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.51,4.42,percent of total billed charges,
VALSARTAN TAB 7910238,58333,CDM,250,RC,62332-0044-30,NDC,,,facility,outpatient,1,EA,4.56000,4.33000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.28,4.42,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,inpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,TC,430.10,,,,,,,430.10,758.54,percent of total billed charges,
US ABDOMINAL AORTA SCRN AAA-TECH,58334,CDM,402,RC,76706,CPT,,,facility,outpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,TC,430.10,,,,,,,384.16,758.54,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC-EVAL DOC VIS-TECH,58335,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,548.00,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,inpatient,,,296.20000,281.39000,Amish/Mennonite,Amish Mennonite,90,162.91,,,,,,,162.91,287.31,percent of total billed charges,
VIRUS CULTURE-TECH,58336,CDM,300,RC,87252,CPT,,,facility,outpatient,,,296.20000,281.39000,Amish/Mennonite,Amish Mennonite,90,162.91,,,,,,,26.94,1358.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,inpatient,0.5,EA,29.99000,28.49000,Amish/Mennonite,Amish Mennonite,,16.49,,,,,,,16.49,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00409915701,NDC,facility,outpatient,0.5,EA,29.99000,28.49000,Amish/Mennonite,Amish Mennonite,,16.49,,,,,,,3.79,29.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,inpatient,0.5,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,00548124000,NDC,facility,outpatient,0.5,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,3.79,26.05,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,inpatient,0.5,EA,154.73000,147.00000,Amish/Mennonite,Amish Mennonite,,85.10,,,,,,,85.10,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097000396,NDC,facility,outpatient,0.5,EA,154.73000,147.00000,Amish/Mennonite,Amish Mennonite,,85.10,,,,,,,3.79,150.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,inpatient,0.5,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,69097070996,NDC,facility,outpatient,0.5,EA,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,3.79,36.78,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,inpatient,0.5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,73629124001,NDC,facility,outpatient,0.5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,3.79,11.04,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,inpatient,0.5,EA,156.29000,148.48000,Amish/Mennonite,Amish Mennonite,,85.96,,,,,,,85.96,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124001,NDC,facility,outpatient,0.5,EA,156.29000,148.48000,Amish/Mennonite,Amish Mennonite,,85.96,,,,,,,3.79,151.60,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,inpatient,0.5,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ,58337,CDM,250,RC,J3430,HCPCS,76329124005,NDC,facility,outpatient,0.5,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,3.79,38.31,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,inpatient,1,EA,3.75000,3.57000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-01,NDC,,,facility,outpatient,1,EA,3.75000,3.57000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.88,3.64,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,inpatient,1,EA,7.04000,6.69000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,3.87,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00056-0188-75,NDC,,,facility,outpatient,1,EA,7.04000,6.69000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,3.52,6.83,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00555-0925-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222532,58339,CDM,250,RC,00832-1214-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,inpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-01,NDC,,,facility,outpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.37,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,inpatient,1,EA,6.52000,6.19000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00056-0169-75,NDC,,,facility,outpatient,1,EA,6.52000,6.19000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.26,6.32,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00093-1712-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00555-0831-02,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,00832-1211-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
WARFARIN TAB 7215221,58340,CDM,250,RC,57237-0119-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,inpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,TC,497.20,,,,,,,497.20,876.88,percent of total billed charges,
US URINARY TRACT-TECH,58341,CDM,402,RC,76770,CPT,,,facility,outpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,TC,497.20,,,,,,,384.16,876.88,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,inpatient,,,164.80000,156.56000,Amish/Mennonite,Amish Mennonite,90,90.64,,,,,,,90.64,159.86,percent of total billed charges,
VIRUS CULTURE ID-TECH,58342,CDM,300,RC,87253,CPT,,,facility,outpatient,,,164.80000,156.56000,Amish/Mennonite,Amish Mennonite,90,90.64,,,,,,,19.61,1052.52,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-01,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,inpatient,1,EA,6.56000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,51079-0899-20,NDC,,,facility,outpatient,1,EA,6.56000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.28,6.36,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,inpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.62,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,60687-0504-01,NDC,,,facility,outpatient,1,EA,4.77000,4.53000,Amish/Mennonite,Amish Mennonite,,2.62,,,,,,,2.38,4.63,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68084-0674-11,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,68462-0293-01,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
VERAPAMIL TAB 7222326,58343,CDM,250,RC,75834-0158-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,inpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,13.75,24.25,percent of total billed charges,
VISIT EST PAT LEVEL 1-TECH,58344,CDM,510,RC,99211,CPT,,,facility,outpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,12.50,24.25,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,inpatient,60,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,00168-0035-01,NDC,,,facility,outpatient,60,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,inpatient,60,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,54162-0000-02,NDC,,,facility,outpatient,60,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,inpatient,60,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINTMENT,58346,CDM,250,RC,71399-0122-02,NDC,,,facility,outpatient,60,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,inpatient,30,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-16,NDC,,,facility,outpatient,30,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,00121-0675-85,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,inpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,50383-0792-16,NDC,,,facility,outpatient,30,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,inpatient,30,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
VALPROIC ACID SYRUP,58347,CDM,250,RC,60432-0621-16,NDC,,,facility,outpatient,30,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,40985-0212-45,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,54629-0400-01,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,57896-0752-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
VITAMIN E CAP,58348,CDM,250,RC,77333-0951-10,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,90,81.40,,,,,,,81.40,143.56,percent of total billed charges,
VASOACTIVE INTESTINAL PEPTIDE SO-TECH,58349,CDM,300,RC,84586,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,90,81.40,,,,,,,17.93,1850.43,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,inpatient,1,EA,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-01,NDC,,,facility,outpatient,1,EA,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.81,3.51,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,inpatient,1,EA,6.37000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.50,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-70,NDC,,,facility,outpatient,1,EA,6.37000,6.05000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.19,6.18,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,inpatient,1,EA,6.80000,6.46000,Amish/Mennonite,Amish Mennonite,,3.74,,,,,,,3.74,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00056-0170-75,NDC,,,facility,outpatient,1,EA,6.80000,6.46000,Amish/Mennonite,Amish Mennonite,,3.74,,,,,,,3.40,6.60,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00093-1713-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00555-0869-02,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,00832-1212-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
WARFARIN TAB 7214745,58350,CDM,250,RC,62584-0984-01,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,inpatient,,,162.60000,154.47000,Amish/Mennonite,Amish Mennonite,90,89.43,,,,,,,89.43,157.72,percent of total billed charges,
VITAMIN B5 ASSAY (FPAB) SO,58351,CDM,300,RC,84591,CPT,,,facility,outpatient,,,162.60000,154.47000,Amish/Mennonite,Amish Mennonite,90,89.43,,,,,,,16.32,797.91,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,151.25,266.75,percent of total billed charges,
XR ANKLE COMPLT MIN 3 VWS-TECH,58353,CDM,320,RC,73610,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,137.50,1430.78,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,166.10,292.94,percent of total billed charges,
XR ACROMIOCLAVICULAR JOINTS-TECH,58354,CDM,320,RC,73050,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,101.94,1193.49,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,inpatient,1,EA,154.74000,147.00000,Amish/Mennonite,Amish Mennonite,,85.11,,,,,,,85.11,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915801,NDC,facility,outpatient,1,EA,154.74000,147.00000,Amish/Mennonite,Amish Mennonite,,85.11,,,,,,,3.79,150.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,inpatient,1,EA,151.66000,144.08000,Amish/Mennonite,Amish Mennonite,,83.41,,,,,,,83.41,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915825,NDC,facility,outpatient,1,EA,151.66000,144.08000,Amish/Mennonite,Amish Mennonite,,83.41,,,,,,,3.79,147.11,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,inpatient,1,EA,152.44000,144.82000,Amish/Mennonite,Amish Mennonite,,83.84,,,,,,,83.84,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915850,NDC,facility,outpatient,1,EA,152.44000,144.82000,Amish/Mennonite,Amish Mennonite,,83.84,,,,,,,3.79,147.87,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,inpatient,1,EA,150.13000,142.63000,Amish/Mennonite,Amish Mennonite,,82.57,,,,,,,82.57,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,00409915855,NDC,facility,outpatient,1,EA,150.13000,142.63000,Amish/Mennonite,Amish Mennonite,,82.57,,,,,,,3.79,145.63,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,inpatient,1,EA,135.14000,128.39000,Amish/Mennonite,Amish Mennonite,,74.33,,,,,,,74.33,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,68462075825,NDC,facility,outpatient,1,EA,135.14000,128.39000,Amish/Mennonite,Amish Mennonite,,74.33,,,,,,,3.79,131.09,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,inpatient,1,EA,135.15000,128.40000,Amish/Mennonite,Amish Mennonite,,74.33,,,,,,,74.33,131.10,percent of total billed charges,
VITAMIN K PHYTONADIONE INJ 7001118,58355,CDM,250,RC,J3430,HCPCS,69097070896,NDC,facility,outpatient,1,EA,135.15000,128.40000,Amish/Mennonite,Amish Mennonite,,74.33,,,,,,,3.79,131.10,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,TC,63.80,,,,,,,63.80,112.52,percent of total billed charges,
XR CHEST 1 VW FRONTAL-TECH,58356,CDM,324,RC,71045,CPT,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,TC,63.80,,,,,,,58.00,896.81,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,inpatient,1,EA,3.76000,3.58000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,2.07,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-01,NDC,,,facility,outpatient,1,EA,3.76000,3.58000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,1.88,3.65,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.88,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00056-0168-75,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.53,6.85,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00555-0874-02,NDC,,,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,inpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
WARFARIN TAB 7222540,58357,CDM,250,RC,00832-1215-01,NDC,,,facility,outpatient,1,EA,1.26000,1.19000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,inpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,00548970100,NDC,facility,outpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,2.02,153.26,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,inpatient,1,EA,255.96000,243.16000,Amish/Mennonite,Amish Mennonite,,140.78,,,,,,,140.78,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42023016425,NDC,facility,outpatient,1,EA,255.96000,243.16000,Amish/Mennonite,Amish Mennonite,,140.78,,,,,,,2.02,248.28,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,inpatient,1,EA,409.34000,388.88000,Amish/Mennonite,Amish Mennonite,,225.14,,,,,,,225.14,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,42367057087,NDC,facility,outpatient,1,EA,409.34000,388.88000,Amish/Mennonite,Amish Mennonite,,225.14,,,,,,,2.02,397.06,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,inpatient,1,EA,72.68000,69.05000,Amish/Mennonite,Amish Mennonite,,39.97,,,,,,,39.97,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,63323093001,NDC,facility,outpatient,1,EA,72.68000,69.05000,Amish/Mennonite,Amish Mennonite,,39.97,,,,,,,2.02,70.50,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,inpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,55150037025,NDC,facility,outpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,2.02,229.89,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,inpatient,1,EA,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,65219003901,NDC,facility,outpatient,1,EA,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,2.02,70.81,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,inpatient,1,EA,272.22000,258.61000,Amish/Mennonite,Amish Mennonite,,149.72,,,,,,,149.72,264.05,percent of total billed charges,
VASOPRESSIN SOLN 20 UNITS/ML,58358,CDM,250,RC,J2598,HCPCS,70121164207,NDC,facility,outpatient,1,EA,272.22000,258.61000,Amish/Mennonite,Amish Mennonite,,149.72,,,,,,,2.02,264.05,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
VENIPUNCTURE-TECH,58359,CDM,300,RC,36415,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,9.09,29.10,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,inpatient,1,EA,21.87000,20.77000,Amish/Mennonite,Amish Mennonite,,12.03,,,,,,,12.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00143962125,NDC,facility,outpatient,1,EA,21.87000,20.77000,Amish/Mennonite,Amish Mennonite,,12.03,,,,,,,1.03,21.21,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,inpatient,1,EA,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,12.15,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,00517003125,NDC,facility,outpatient,1,EA,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,1.03,21.43,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,inpatient,1,EA,15.09000,14.33000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,8.30,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,16714016525,NDC,facility,outpatient,1,EA,15.09000,14.33000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,1.03,14.64,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,inpatient,1,EA,8.63000,8.20000,Amish/Mennonite,Amish Mennonite,,4.75,,,,,,,4.75,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,25021050201,NDC,facility,outpatient,1,EA,8.63000,8.20000,Amish/Mennonite,Amish Mennonite,,4.75,,,,,,,1.03,8.37,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,inpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,55150036425,NDC,facility,outpatient,1,EA,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,1.03,10.42,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,inpatient,1,EA,21.84000,20.74000,Amish/Mennonite,Amish Mennonite,,12.01,,,,,,,12.01,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,63323004401,NDC,facility,outpatient,1,EA,21.84000,20.74000,Amish/Mennonite,Amish Mennonite,,12.01,,,,,,,1.03,21.18,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,inpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,69680011210,NDC,facility,outpatient,1,EA,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,1.03,13.79,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,inpatient,1,EA,11.25000,10.69000,Amish/Mennonite,Amish Mennonite,,6.19,,,,,,,6.19,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70069000510,NDC,facility,outpatient,1,EA,11.25000,10.69000,Amish/Mennonite,Amish Mennonite,,6.19,,,,,,,1.03,10.91,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,inpatient,1,EA,8.65000,8.22000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,4.76,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,70710166307,NDC,facility,outpatient,1,EA,8.65000,8.22000,Amish/Mennonite,Amish Mennonite,,4.76,,,,,,,1.03,8.39,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
CYANOCOBALAMIN SOLN 1000 MCG/ML 1 ML,58360,CDM,250,RC,J3420,HCPCS,71288030302,NDC,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,1.03,5.45,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,inpatient,,,865.00000,821.75000,Amish/Mennonite,Amish Mennonite,TC,475.75,,,,,,,475.75,839.05,percent of total billed charges,
US OB TRANSABD  < 14 WKS SNGL-TECH,58361,CDM,402,RC,76801,CPT,,,facility,outpatient,,,865.00000,821.75000,Amish/Mennonite,Amish Mennonite,TC,475.75,,,,,,,384.16,839.05,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,TC,175.45,,,,,,,175.45,309.43,percent of total billed charges,
XR ABSCESS FISTULA/SINUS TRACT-TECH,58362,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,TC,175.45,,,,,,,159.50,3015.65,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
URINALYSIS AUTO WO MICROSCOPY-TECH,58365,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,2.25,118.82,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,inpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN COMPLT W DECUB/ERECT-TECH,58366,CDM,320,RC,74022,CPT,,,facility,outpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,157.00,1786.85,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,inpatient,1,EA,26.49000,25.17000,Amish/Mennonite,Amish Mennonite,,14.57,,,,,,,14.57,25.70,percent of total billed charges,
VANCOMYCIN POWD-INJ 1 GM A/V,58367,CDM,250,RC,J3370,HCPCS,00409653501,NDC,facility,outpatient,1,EA,26.49000,25.17000,Amish/Mennonite,Amish Mennonite,,14.57,,,,,,,3.02,25.70,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,inpatient,1,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,00172-4285-60,NDC,,,facility,outpatient,1,EA,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.22,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,51079-0894-20,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.05,5.92,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,60687-0493-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,68462-0292-01,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
VERAPAMIL TAB 7223217,58368,CDM,250,RC,75834-0320-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1082.00000,1027.90000,Amish/Mennonite,Amish Mennonite,TC,595.10,,,,,,,595.10,1049.54,percent of total billed charges,
US OB TRANSABD >=14 WKS SNGL-TECH,58369,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1082.00000,1027.90000,Amish/Mennonite,Amish Mennonite,TC,595.10,,,,,,,384.16,1049.54,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,inpatient,,,723.00000,686.85000,Amish/Mennonite,Amish Mennonite,TC,397.65,,,,,,,397.65,701.31,percent of total billed charges,
XR ESOPHAGRAM-TECH,58370,CDM,320,RC,74220,CPT,,,facility,outpatient,,,723.00000,686.85000,Amish/Mennonite,Amish Mennonite,TC,397.65,,,,,,,361.50,3665.88,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,inpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,129.80,228.92,percent of total billed charges,
XR CYSTOGRAPHY MIN 3 VWS-TECH,58371,CDM,320,RC,74430,CPT,,,facility,outpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,118.00,1964.22,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,inpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,189.20,333.68,percent of total billed charges,
XR FACIAL BNS MIN 3 VWS-TECH,58372,CDM,320,RC,70150,CPT,,,facility,outpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,172.00,1786.85,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
WESTERN BLOT TEST IMM PROBE-TECH,58373,CDM,300,RC,84182,CPT,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,25.31,2286.16,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1631.25000,1549.69000,Amish/Mennonite,Amish Mennonite,,897.19,,,,,,,799.31,1582.31,percent of total billed charges,
BUTTON SUT L PEC FOR FIX OF SFT TISS TO BNE,58374,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1631.25000,1549.69000,Amish/Mennonite,Amish Mennonite,,897.19,,,,,,,748.74,1631.25,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS-TECH,58375,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,TC,163.90,,,,,,,149.00,1569.27,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
VISCOSITY-TECH,58376,CDM,300,RC,85810,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,11.67,611.15,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,inpatient,,,170.10000,161.60000,Amish/Mennonite,Amish Mennonite,90,93.56,,,,,,,93.56,165.00,percent of total billed charges,
WEST NILE VIRUS AB (WNC) SO,58377,CDM,300,RC,86789,CPT,,,facility,outpatient,,,170.10000,161.60000,Amish/Mennonite,Amish Mennonite,90,93.56,,,,,,,14.87,746.94,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,inpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,21.45,37.83,percent of total billed charges,
VOLUME MEASURE TIMED COLLECT-TECH,58378,CDM,300,RC,81050,CPT,,,facility,outpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,3.64,169.79,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,inpatient,,,1811.00000,1720.45000,Amish/Mennonite,Amish Mennonite,TC,996.05,,,,,,,996.05,1756.67,percent of total billed charges,
XR COLON AIR CNTRST W BARIUM-TECH,58379,CDM,320,RC,74280,CPT,,,facility,outpatient,,,1811.00000,1720.45000,Amish/Mennonite,Amish Mennonite,TC,996.05,,,,,,,905.50,8808.48,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,inpatient,,,157.10000,149.24000,Amish/Mennonite,Amish Mennonite,90,86.41,,,,,,,86.41,152.39,percent of total billed charges,
VALPROIC ACID FREE ASSAY SO-TECH,58380,CDM,300,RC,80165,CPT,,,facility,outpatient,,,157.10000,149.24000,Amish/Mennonite,Amish Mennonite,90,86.41,,,,,,,13.99,713.01,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,inpatient,,,134.80000,128.06000,Amish/Mennonite,Amish Mennonite,90,74.14,,,,,,,74.14,130.76,percent of total billed charges,
VITAMIN A ASSAY-TECH,58381,CDM,300,RC,84590,CPT,,,facility,outpatient,,,134.80000,128.06000,Amish/Mennonite,Amish Mennonite,90,74.14,,,,,,,12.00,611.15,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,inpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,172.70,304.58,percent of total billed charges,
XR ABDOMEN 2 VIEWS-TECH,58382,CDM,320,RC,74019,CPT,,,facility,outpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,TC,172.70,,,,,,,136.98,1331.91,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,154.55,272.57,percent of total billed charges,
XR CHST 4 OR MORE VWS-TECH,58384,CDM,320,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,140.50,1569.27,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,37.78,66.64,percent of total billed charges,
WEST NILE VIRUS AB IGM (WNV) SO,58385,CDM,300,RC,86788,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,90,37.78,,,,,,,8.17,882.80,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,inpatient,,,369.00000,350.55000,Amish/Mennonite,Amish Mennonite,TC,202.95,,,,,,,202.95,357.93,percent of total billed charges,
XR HIP W PELVIS UNI 2-3 VWS-TECH,58386,CDM,320,RC,73502,CPT,,,facility,outpatient,,,369.00000,350.55000,Amish/Mennonite,Amish Mennonite,TC,202.95,,,,,,,184.50,1865.95,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,inpatient,,,208.30000,197.88000,Amish/Mennonite,Amish Mennonite,90,114.56,,,,,,,114.56,202.05,percent of total billed charges,
VITAMIN B7 ASSAY SO-TECH,58387,CDM,300,RC,84591,CPT,,,facility,outpatient,,,208.30000,197.88000,Amish/Mennonite,Amish Mennonite,90,114.56,,,,,,,16.32,797.91,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,00093-0199-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,16714-0655-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,23155-0246-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,50268-0798-15,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,55111-0545-90,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,57237-0172-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68382-0018-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,62332-0008-31,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,inpatient,1,EA,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.46,percent of total billed charges,
VENLAFAXINE TAB,58388,CDM,250,RC,68084-0896-25,NDC,,,facility,outpatient,1,EA,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.46,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,inpatient,1,EA,5.39000,5.12000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.96,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-01,NDC,,,facility,outpatient,1,EA,5.39000,5.12000,Amish/Mennonite,Amish Mennonite,,2.96,,,,,,,2.69,5.23,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,inpatient,1,EA,10.11000,9.60000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00056-0174-75,NDC,,,facility,outpatient,1,EA,10.11000,9.60000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.05,9.81,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,00832-1219-89,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
WARFARIN TAB 7214786,58389,CDM,250,RC,51672-4035-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XR ELBOW 2 VWS-TECH,58390,CDM,320,RC,73070,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,111.13,1094.55,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -TECH,58391,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,TC,151.80,,,,,,,138.00,1371.46,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS -TECH,58392,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,111.13,1094.55,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,90,19.25,,,,,,,19.25,33.95,percent of total billed charges,
VITAMIN D 1 25 DIHYDROXY (DHVD) SO,58393,CDM,300,RC,82652,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,90,19.25,,,,,,,17.50,2020.22,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,inpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,TC,118.80,,,,,,,118.80,209.52,percent of total billed charges,
XR HAND 2 VWS-TECH,58394,CDM,320,RC,73120,CPT,,,facility,outpatient,,,216.00000,205.20000,Amish/Mennonite,Amish Mennonite,TC,118.80,,,,,,,108.00,1193.49,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,187.00,329.80,percent of total billed charges,
XR KNEE COMPLT >=4 VWS-TECH,58395,CDM,320,RC,73564,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,170.00,1786.85,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS-TECH,58396,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,126.50,1331.91,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,inpatient,,,1120.00000,1064.00000,Amish/Mennonite,Amish Mennonite,TC,616.00,,,,,,,616.00,1086.40,percent of total billed charges,
XR COLON BARIUM ENEMA W/WO KUB-TECH,58397,CDM,320,RC,74270,CPT,,,facility,outpatient,,,1120.00000,1064.00000,Amish/Mennonite,Amish Mennonite,TC,616.00,,,,,,,560.00,5663.55,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,inpatient,,,498.00000,473.10000,Amish/Mennonite,Amish Mennonite,TC,273.90,,,,,,,273.90,483.06,percent of total billed charges,
XR HIP W PELVIS BIL MIN 5 VWS-TECH,58398,CDM,320,RC,73523,CPT,,,facility,outpatient,,,498.00000,473.10000,Amish/Mennonite,Amish Mennonite,TC,273.90,,,,,,,247.55,2380.22,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,TC,110.00,,,,,,,110.00,194.00,percent of total billed charges,
XR ABDOMEN SNGL AP VW-TECH,58400,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,TC,110.00,,,,,,,100.00,1094.55,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,inpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,189.20,333.68,percent of total billed charges,
XR HIP W PELVIS BIL 2 VWS-TECH,58401,CDM,320,RC,73521,CPT,,,facility,outpatient,,,344.00000,326.80000,Amish/Mennonite,Amish Mennonite,TC,189.20,,,,,,,160.92,1569.27,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,inpatient,1,EA,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-01,NDC,,,facility,outpatient,1,EA,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.87,3.63,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,Amish/Mennonite,Amish Mennonite,,3.86,,,,,,,3.86,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00056-0176-75,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,Amish/Mennonite,Amish Mennonite,,3.86,,,,,,,3.50,6.80,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00555-0832-02,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,00832-1213-01,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,51672-4029-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
WARFARIN TAB 7214752,58402,CDM,250,RC,68084-0027-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
0.054INX6IN K-WIRE DOUBLE ENDE,58403,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,inpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,TC,292.60,,,,,,,292.60,516.04,percent of total billed charges,
XR CHOLANG/PANCR INTRAOP-TECH,58404,CDM,320,RC,74300,CPT,,,facility,outpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,TC,292.60,,,,,,,128.10,1813.71,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,inpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,409.20,721.68,percent of total billed charges,
XR SPINE THORACOLUMB MIN 6VW-TECH,58405,CDM,320,RC,72084,CPT,,,facility,outpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,TC,409.20,,,,,,,372.00,4002.11,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,inpatient,,,755.00000,717.25000,Amish/Mennonite,Amish Mennonite,TC,415.25,,,,,,,415.25,732.35,percent of total billed charges,
XR OSSEOUS SURVEY INFANT-TECH,58406,CDM,320,RC,77076,CPT,,,facility,outpatient,,,755.00000,717.25000,Amish/Mennonite,Amish Mennonite,TC,415.25,,,,,,,377.50,3764.75,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,TC,91.30,,,,,,,91.30,161.02,percent of total billed charges,
XR BONE AGE STUDIES-TECH,58407,CDM,320,RC,77072,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,TC,91.30,,,,,,,83.00,857.19,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,inpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,181.50,320.10,percent of total billed charges,
XR KNEE BOTH STANDING AP-TECH,58408,CDM,320,RC,73565,CPT,,,facility,outpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,165.00,1648.36,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,TC,177.10,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -TECH,58409,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,TC,177.10,,,,,,,161.00,1628.59,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,158.40,279.36,percent of total billed charges,
XR RIBS BILATERAL 3 VWS-TECH,58410,CDM,320,RC,71110,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,144.00,1549.49,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,inpatient,1,mL,47.56000,45.18000,Amish/Mennonite,Amish Mennonite,,26.16,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,00703441211,NDC,facility,outpatient,1,mL,47.56000,45.18000,Amish/Mennonite,Amish Mennonite,,26.16,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,inpatient,1,mL,24.33000,23.12000,Amish/Mennonite,Amish Mennonite,,13.38,,,,,,,13.38,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030916,NDC,facility,outpatient,1,mL,24.33000,23.12000,Amish/Mennonite,Amish Mennonite,,13.38,,,,,,,12.16,23.60,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,inpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML 2 ML,58411,CDM,250,RC,J9370,HCPCS,61703030925,NDC,facility,outpatient,1,mL,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,12.58,26.05,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS -TECH,58412,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,TC,122.10,,,,,,,111.00,1094.55,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,inpatient,,,379.00000,360.05000,Amish/Mennonite,Amish Mennonite,TC,208.45,,,,,,,208.45,367.63,percent of total billed charges,
XR RIBS BIL W PA CHEST MIN 4VWS-TECH,58413,CDM,320,RC,71111,CPT,,,facility,outpatient,,,379.00000,360.05000,Amish/Mennonite,Amish Mennonite,TC,208.45,,,,,,,189.50,1925.27,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,inpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,TC,132.55,,,,,,,132.55,233.77,percent of total billed charges,
XR LWR EXT INFANT MIN 2 VWS-TECH,58414,CDM,320,RC,73592,CPT,,,facility,outpatient,,,241.00000,228.95000,Amish/Mennonite,Amish Mennonite,TC,132.55,,,,,,,120.50,1213.27,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,inpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,134.75,237.65,percent of total billed charges,
XR HIP W PELVIS UNI 1 VW-TECH,58415,CDM,320,RC,73501,CPT,,,facility,outpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,122.23,1213.27,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,TC,145.75,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-TECH,58416,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,TC,145.75,,,,,,,132.50,1430.78,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,187.00,329.80,percent of total billed charges,
XR ORBITS COMPLT MIN 4 VWS-TECH,58417,CDM,320,RC,70200,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,170.00,1786.85,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,inpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,TC,149.60,,,,,,,149.60,263.84,percent of total billed charges,
XR ELBOW COMPLT MIN 3 VWS-TECH,58418,CDM,320,RC,73080,CPT,,,facility,outpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,TC,149.60,,,,,,,125.88,1213.27,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,187.00,329.80,percent of total billed charges,
XR SKULL COMPLT MIN 4 VWS-70260 TC,58419,CDM,320,RC,70260,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,TC,187.00,,,,,,,166.47,1628.59,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XR CLAVICAL COMPLT-TECH,58420,CDM,320,RC,73000,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,115.50,1252.81,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,inpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,TC,117.70,,,,,,,117.70,207.58,percent of total billed charges,
XR EYE DETECT FB-TECH,58421,CDM,320,RC,70030,CPT,,,facility,outpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,TC,117.70,,,,,,,107.00,1233.04,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,TC,459.25,,,,,,,459.25,809.95,percent of total billed charges,
XR HYSTEROSALPINGOGRAPHY-TECH,58422,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,TC,459.25,,,,,,,417.50,3942.79,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,inpatient,,,1073.00000,1019.35000,Amish/Mennonite,Amish Mennonite,TC,590.15,,,,,,,590.15,1040.81,percent of total billed charges,
XR KNEE ARTHROGRAPHY-TECH,58424,CDM,322,RC,73580,CPT,,,facility,outpatient,,,1073.00000,1019.35000,Amish/Mennonite,Amish Mennonite,TC,590.15,,,,,,,536.50,5960.23,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,inpatient,,,282.00000,267.90000,Amish/Mennonite,Amish Mennonite,,155.10,,,,,,,155.10,273.54,percent of total billed charges,
VITAMIN D 25 HYDROXY-TECH,58425,CDM,300,RC,82306,CPT,,,facility,outpatient,,,282.00000,267.90000,Amish/Mennonite,Amish Mennonite,,155.10,,,,,,,29.60,1544.85,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-TECH,58426,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,TC,151.25,,,,,,,137.50,1509.95,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,inpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,254.10,448.14,percent of total billed charges,
XR SPINE LUMBOSACRAL MIN 4VWS-TECH,58427,CDM,320,RC,72110,CPT,,,facility,outpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,TC,254.10,,,,,,,203.31,1945.04,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,282.15,497.61,percent of total billed charges,
XR OSSEOUS SURVEY LIMITED-TECH,58428,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,234.65,2261.57,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,inpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,TC,167.20,,,,,,,167.20,294.88,percent of total billed charges,
XR STRENOCLAVIC JT MIN 3 VWS-TECH,58430,CDM,320,RC,71130,CPT,,,facility,outpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,TC,167.20,,,,,,,152.00,1569.27,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,TC,135.85,,,,,,,135.85,239.59,percent of total billed charges,
XR TIBIA/FIBULA 2 VWS -TECH,58431,CDM,320,RC,73590,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,TC,135.85,,,,,,,123.50,1233.04,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,inpatient,,,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,TC,157.85,,,,,,,157.85,278.39,percent of total billed charges,
XR SPINE THORACIC 3 VWS-TECH,58432,CDM,320,RC,72072,CPT,,,facility,outpatient,,,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,TC,157.85,,,,,,,143.50,1470.40,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,inpatient,,,862.00000,818.90000,Amish/Mennonite,Amish Mennonite,TC,474.10,,,,,,,474.10,836.14,percent of total billed charges,
XR UPPER GI TRACT WO KUB-TECH,58433,CDM,320,RC,74240,CPT,,,facility,outpatient,,,862.00000,818.90000,Amish/Mennonite,Amish Mennonite,TC,474.10,,,,,,,431.00,4417.51,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,inpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,137.50,242.50,percent of total billed charges,
XR WRIST 2 VWS-TECH,58434,CDM,320,RC,73100,CPT,,,facility,outpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,125.00,1331.91,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,154.55,272.57,percent of total billed charges,
XR ABDOMEN AP OBLIQUES CONE VW-TECH,58435,CDM,320,RC,74021,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,140.50,1549.49,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,TC,158.95,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-TECH,58436,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,TC,158.95,,,,,,,144.50,1509.95,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,inpatient,240,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,00173-0113-18,NDC,,,facility,outpatient,240,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,inpatient,240,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
ZIDOVUDINE SYRUP,58437,CDM,250,RC,65862-0048-24,NDC,,,facility,outpatient,240,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,inpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,119.35,210.49,percent of total billed charges,
XR NECK SOFT TISSUE-TECH,58438,CDM,320,RC,70360,CPT,,,facility,outpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,108.50,1173.72,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,inpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,137.50,242.50,percent of total billed charges,
XR HUMERUS MIN 2 VWS-TECH,58439,CDM,320,RC,73060,CPT,,,facility,outpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,TC,137.50,,,,,,,125.00,1252.81,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,TC,114.95,,,,,,,114.95,202.73,percent of total billed charges,
XR FOREARM 2 VWS -TECH,58441,CDM,320,RC,73090,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,TC,114.95,,,,,,,104.50,1114.32,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,154.55,272.57,percent of total billed charges,
XR FEMUR MIN 2 VWS -TECH,58442,CDM,320,RC,73552,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,140.50,1391.23,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,inpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,134.75,237.65,percent of total billed charges,
XR SKULL SELLA TURCICA-TECH,58443,CDM,320,RC,70240,CPT,,,facility,outpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,TC,134.75,,,,,,,122.50,1292.36,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,TC,153.45,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-TECH,58444,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,TC,153.45,,,,,,,101.94,1074.77,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS-TECH,58445,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,1470.40,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,Amish/Mennonite,Amish Mennonite,TC,564.85,,,,,,,564.85,996.19,percent of total billed charges,
XR UPR GI AIR CNTRST WO KUB-TECH,58446,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,Amish/Mennonite,Amish Mennonite,TC,564.85,,,,,,,513.50,5169.06,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,166.10,292.94,percent of total billed charges,
XR SINUSES/PNSL CMPLT MIN 3 VWS-TECH,58447,CDM,320,RC,70220,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,144.32,1391.23,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,inpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,675.95,1192.13,percent of total billed charges,
XR UROGRAPHY IV-TECH,58448,CDM,320,RC,74400,CPT,,,facility,outpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,606.90,5742.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,189.75,334.65,percent of total billed charges,
XR SPINE THORACIC MIN 4 VWS-TECH,58449,CDM,320,RC,72074,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,TC,189.75,,,,,,,172.50,1687.91,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,inpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,TC,167.75,,,,,,,167.75,295.85,percent of total billed charges,
XR MANDIBLE COMPLT MIN 4 VWS-TECH,58450,CDM,320,RC,70110,CPT,,,facility,outpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,TC,167.75,,,,,,,152.50,1628.59,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS -TECH,58451,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,161.50,1648.36,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00677-0622-01,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,00904-5332-60,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,20555-0040-00,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,51645-0991-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,68585-0008-01,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,77333-0983-10,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
ZINC SULFATE CAP,58452,CDM,250,RC,80681-0135-00,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,inpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,TC,157.30,,,,,,,157.30,277.42,percent of total billed charges,
XR SKULL <4 VWS-TECH,58453,CDM,320,RC,70250,CPT,,,facility,outpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,TC,157.30,,,,,,,142.47,1391.23,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,TC,152.35,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-TECH,58454,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,TC,152.35,,,,,,,120.38,1173.72,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,144.65,255.11,percent of total billed charges,
XR ANKLE 2 VWS-TECH,58455,CDM,320,RC,73600,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,129.58,1272.59,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,inpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,TC,319.00,,,,,,,319.00,562.60,percent of total billed charges,
XR UROGRAPHY ANTEGRADE-TECH,58456,CDM,320,RC,74425,CPT,,,facility,outpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,TC,319.00,,,,,,,290.00,5821.82,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,TC,100.65,,,,,,,100.65,177.51,percent of total billed charges,
XR SHOULDER 1 VW-TECH,58457,CDM,320,RC,73020,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,TC,100.65,,,,,,,74.29,738.55,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,102.30,180.42,percent of total billed charges,
XR NOSE TO RECTM FOR FB CHLD-TECH,58458,CDM,320,RC,76010,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,TC,102.30,,,,,,,93.00,1074.77,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,inpatient,,,1168.00000,1109.60000,Amish/Mennonite,Amish Mennonite,TC,642.40,,,,,,,642.40,1132.96,percent of total billed charges,
XR UROGRAPHY RETROGRADE-TECH,58459,CDM,320,RC,74420,CPT,,,facility,outpatient,,,1168.00000,1109.60000,Amish/Mennonite,Amish Mennonite,TC,642.40,,,,,,,278.89,2676.90,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,TC,195.25,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-72120 TC,58460,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,TC,195.25,,,,,,,159.07,1549.49,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,Amish/Mennonite,Amish Mennonite,TC,492.80,,,,,,,492.80,869.12,percent of total billed charges,
XR SM BOWEL SERIES-TECH,58461,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,Amish/Mennonite,Amish Mennonite,TC,492.80,,,,,,,448.00,4437.28,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,57.20,100.88,percent of total billed charges,
ZINC ASSAY-TECH,58463,CDM,300,RC,84630,CPT,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,11.39,594.19,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00093-0073-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,00904-6082-61,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,13668-0007-74,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,16714-0621-01,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,51079-0724-20,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
ZOLPIDEM TAB 7629520,58464,CDM,250,RC,68084-0189-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS-TECH,58465,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,120.38,1173.72,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,inpatient,30,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00168-0062-31,NDC,,,facility,outpatient,30,EA,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,inpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,00536-5700-28,NDC,,,facility,outpatient,30,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,inpatient,30,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ZINC OXIDE OINT 20% 30 GM,58466,CDM,250,RC,75834-0170-01,NDC,,,facility,outpatient,30,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,inpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,TC,443.85,,,,,,,443.85,782.79,percent of total billed charges,
XR SHOULDER ARTHROGRAPHY-TECH,58467,CDM,322,RC,73040,CPT,,,facility,outpatient,,,807.00000,766.65000,Amish/Mennonite,Amish Mennonite,TC,443.85,,,,,,,403.50,5149.29,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,inpatient,1,mL,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,18.84,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,00078043561,NDC,facility,outpatient,1,mL,34.25000,32.54000,Amish/Mennonite,Amish Mennonite,,18.84,,,,,,,8.33,33.22,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,63323096600,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,inpatient,1,mL,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457079410,NDC,facility,outpatient,1,mL,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,inpatient,1,mL,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,4.09,7.21,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,67457061910,NDC,facility,outpatient,1,mL,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,3.71,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,inpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,70860080282,NDC,facility,outpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,inpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
ZOLEDRONIC ACID SOLN 5 MG/100 ML PREMIX,58468,CDM,250,RC,J3489,HCPCS,72266015201,NDC,facility,outpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,15.80,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,145.20,256.08,percent of total billed charges,
XR RIBS UNILATERAL 2 VWS -TECH,58469,CDM,320,RC,71100,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,TC,145.20,,,,,,,132.00,1331.91,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,inpatient,,,411.00000,390.45000,Amish/Mennonite,Amish Mennonite,TC,226.05,,,,,,,226.05,398.67,percent of total billed charges,
XR HIP W PELVIS BIL 3-4 VWS-TECH,58470,CDM,320,RC,73522,CPT,,,facility,outpatient,,,411.00000,390.45000,Amish/Mennonite,Amish Mennonite,TC,226.05,,,,,,,205.50,2043.99,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,inpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,TC,338.25,,,,,,,338.25,596.55,percent of total billed charges,
XR SPINE THORACOLUMB 4-5VW-TECH,58471,CDM,320,RC,72083,CPT,,,facility,outpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,TC,338.25,,,,,,,307.50,3329.66,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,TC,443.30,,,,,,,443.30,781.82,percent of total billed charges,
XR HIP ARTHROGRAPHY-TECH,58472,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,TC,443.30,,,,,,,403.00,5188.83,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-TECH,58473,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,TC,181.50,,,,,,,153.52,1470.40,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,TC,130.35,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-TECH,58474,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,TC,130.35,,,,,,,118.50,1233.04,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,144.65,255.11,percent of total billed charges,
XR BONE LENGTH STUDIES-TECH,58475,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,131.50,1668.14,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XR SINUSES/PARANASAL <3 VWS-TECH,58476,CDM,320,RC,70210,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,TC,139.15,,,,,,,125.88,1213.27,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00781-2164-60,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,inpatient,1,EA,15.25000,14.48000,Amish/Mennonite,Amish Mennonite,,8.39,,,,,,,8.39,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-08,NDC,,,facility,outpatient,1,EA,15.25000,14.48000,Amish/Mennonite,Amish Mennonite,,8.39,,,,,,,7.62,14.79,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,00904-6269-45,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,inpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,16714-0835-01,NDC,,,facility,outpatient,1,EA,4.26000,4.05000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,33342-0144-09,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,inpatient,1,EA,9.68000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,50268-0811-12,NDC,,,facility,outpatient,1,EA,9.68000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,4.84,9.39,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,inpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,60505-2528-06,NDC,,,facility,outpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,inpatient,1,EA,8.79000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,4.83,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,63739-0988-32,NDC,,,facility,outpatient,1,EA,8.79000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,4.39,8.53,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,65862-0702-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP,58477,CDM,250,RC,68084-0103-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.38,8.49,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,inpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,TC,129.25,,,,,,,129.25,227.95,percent of total billed charges,
XR STERNUM MIN 2 VWS-TECH,58478,CDM,320,RC,71120,CPT,,,facility,outpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,TC,129.25,,,,,,,117.50,1233.04,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,inpatient,20,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,00173010793,NDC,facility,outpatient,20,EA,4.32000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.16,4.19,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,inpatient,20,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021301,NDC,facility,outpatient,20,EA,5.53000,5.25000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,2.35,5.36,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,inpatient,20,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
ZIDOVUDINE,58479,CDM,250,RC,J3485,HCPCS,49702021305,NDC,facility,outpatient,20,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,inpatient,,,1106.00000,1050.70000,Amish/Mennonite,Amish Mennonite,TC,608.30,,,,,,,608.30,1072.82,percent of total billed charges,
XR SWALLOWING FUNC W VIDEO-TECH,58480,CDM,320,RC,74230,CPT,,,facility,outpatient,,,1106.00000,1050.70000,Amish/Mennonite,Amish Mennonite,TC,608.30,,,,,,,553.00,5703.10,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,inpatient,,,312.00000,296.40000,Amish/Mennonite,Amish Mennonite,TC,171.60,,,,,,,171.60,302.64,percent of total billed charges,
XR SPINE THORACOLUMBAR 1VW-TECH,58481,CDM,320,RC,72081,CPT,,,facility,outpatient,,,312.00000,296.40000,Amish/Mennonite,Amish Mennonite,TC,171.60,,,,,,,156.00,1549.49,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,inpatient,1,EA,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-01,NDC,,,facility,outpatient,1,EA,3.90000,3.70000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.95,3.78,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,inpatient,1,EA,7.31000,6.94000,Amish/Mennonite,Amish Mennonite,,4.02,,,,,,,4.02,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00056-0172-75,NDC,,,facility,outpatient,1,EA,7.31000,6.94000,Amish/Mennonite,Amish Mennonite,,4.02,,,,,,,3.65,7.09,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,51672-4032-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,00832-1216-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
WARFARIN TAB 7214760,58482,CDM,250,RC,62584-0994-01,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,inpatient,,,564.00000,535.80000,Amish/Mennonite,Amish Mennonite,TC,310.20,,,,,,,310.20,547.08,percent of total billed charges,
XR SPINE THORACOLUMB 2-3VW-TECH,58483,CDM,320,RC,72082,CPT,,,facility,outpatient,,,564.00000,535.80000,Amish/Mennonite,Amish Mennonite,TC,310.20,,,,,,,282.00,2835.16,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,TC,156.75,,,,,,,156.75,276.45,percent of total billed charges,
XR SACROILIAC JT >=3 VWS-TECH,58484,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,TC,156.75,,,,,,,142.50,1450.63,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-39,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.22,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,inpatient,1,EA,5.99000,5.69000,Amish/Mennonite,Amish Mennonite,,3.29,,,,,,,3.29,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,00310-0402-60,NDC,,,facility,outpatient,1,EA,5.99000,5.69000,Amish/Mennonite,Amish Mennonite,,3.29,,,,,,,3.00,5.81,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,2.14,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,31722-0008-60,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,1.95,3.77,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,49884-0304-02,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.40,4.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,inpatient,1,EA,5.69000,5.41000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,55111-0626-60,NDC,,,facility,outpatient,1,EA,5.69000,5.41000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,5.52,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,2.07,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-11,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,1.88,3.65,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,inpatient,1,EA,7.62000,7.24000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,4.19,7.39,percent of total billed charges,
ZAFIRLUKAST TAB,58485,CDM,250,RC,68084-0059-21,NDC,,,facility,outpatient,1,EA,7.62000,7.24000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,3.81,7.39,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,TC,195.80,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-TECH,58486,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,TC,195.80,,,,,,,178.00,2024.21,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,inpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,253.00,446.20,percent of total billed charges,
XR MASTOIDS COMPLT-TECH,58487,CDM,320,RC,70130,CPT,,,facility,outpatient,,,460.00000,437.00000,Amish/Mennonite,Amish Mennonite,TC,253.00,,,,,,,230.00,2340.67,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,inpatient,,,740.00000,703.00000,Amish/Mennonite,Amish Mennonite,TC,407.00,,,,,,,407.00,717.80,percent of total billed charges,
XR OSSEOUS SURVEY COMPLT-TECH,58488,CDM,320,RC,77075,CPT,,,facility,outpatient,,,740.00000,703.00000,Amish/Mennonite,Amish Mennonite,TC,407.00,,,,,,,370.00,3725.20,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,inpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,TC,320.10,,,,,,,320.10,564.54,percent of total billed charges,
XR PERITONEOGRAM-TECH,58489,CDM,320,RC,74190,CPT,,,facility,outpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,TC,320.10,,,,,,,238.63,3015.65,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,140.80,248.32,percent of total billed charges,
XR SCAPULA COMPLT-TECH,58490,CDM,320,RC,73010,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,TC,140.80,,,,,,,77.99,1015.45,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,inpatient,1,mL,477.84000,453.95000,Amish/Mennonite,Amish Mennonite,,262.81,,,,,,,262.81,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,00078038725,NDC,facility,outpatient,1,mL,477.84000,453.95000,Amish/Mennonite,Amish Mennonite,,262.81,,,,,,,8.33,463.50,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,inpatient,1,mL,63.69000,60.51000,Amish/Mennonite,Amish Mennonite,,35.03,,,,,,,35.03,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16714081501,NDC,facility,outpatient,1,mL,63.69000,60.51000,Amish/Mennonite,Amish Mennonite,,35.03,,,,,,,8.33,61.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,inpatient,1,mL,21.94000,20.85000,Amish/Mennonite,Amish Mennonite,,12.07,,,,,,,12.07,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,16729024231,NDC,facility,outpatient,1,mL,21.94000,20.85000,Amish/Mennonite,Amish Mennonite,,12.07,,,,,,,8.33,21.28,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,inpatient,1,mL,113.76000,108.07000,Amish/Mennonite,Amish Mennonite,,62.57,,,,,,,62.57,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,25021080166,NDC,facility,outpatient,1,mL,113.76000,108.07000,Amish/Mennonite,Amish Mennonite,,62.57,,,,,,,8.33,110.35,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,inpatient,1,mL,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,43598033011,NDC,facility,outpatient,1,mL,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,8.33,27.59,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,inpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,55111068507,NDC,facility,outpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,8.33,45.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,inpatient,1,mL,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,20.86,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,60505611000,NDC,facility,outpatient,1,mL,37.92000,36.02000,Amish/Mennonite,Amish Mennonite,,20.86,,,,,,,8.33,36.78,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,inpatient,1,mL,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,15.30,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,67457092005,NDC,facility,outpatient,1,mL,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,8.33,26.98,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,inpatient,1,mL,42.75000,40.61000,Amish/Mennonite,Amish Mennonite,,23.51,,,,,,,23.51,41.47,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/5 ML,58491,CDM,250,RC,J3489,HCPCS,72603019801,NDC,facility,outpatient,1,mL,42.75000,40.61000,Amish/Mennonite,Amish Mennonite,,23.51,,,,,,,8.33,41.47,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,TC,96.25,,,,,,,96.25,169.75,percent of total billed charges,
XR SPINE 1 VW-TECH,58492,CDM,320,RC,72020,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,TC,96.25,,,,,,,87.50,876.96,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,inpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,TC,257.95,,,,,,,257.95,454.93,percent of total billed charges,
XR SPINE CERVICAL >= 6 VWS-TECH,58493,CDM,320,RC,72052,CPT,,,facility,outpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,TC,257.95,,,,,,,234.50,2439.54,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,inpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,119.35,210.49,percent of total billed charges,
XR CHEST 2 VWS FRONTAL&LATL-TECH,58494,CDM,324,RC,71046,CPT,,,facility,outpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,TC,119.35,,,,,,,108.50,1193.49,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,73.70,129.98,percent of total billed charges,
XTC99M MDP 30 MCI,58495,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,67.00,129.98,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,inpatient,,,336.00000,319.20000,Amish/Mennonite,Amish Mennonite,TC,184.80,,,,,,,184.80,325.92,percent of total billed charges,
XR PELVIS COMPLT MIN 3 VWS-TECH,58496,CDM,320,RC,72190,CPT,,,facility,outpatient,,,336.00000,319.20000,Amish/Mennonite,Amish Mennonite,TC,184.80,,,,,,,157.22,1529.72,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,166.10,292.94,percent of total billed charges,
XR MASTOIDS <3 VWS-TECH,58497,CDM,320,RC,70120,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,TC,166.10,,,,,,,151.00,1509.95,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XR UPR EXT INFANT MIN 2 VW-TECH,58498,CDM,320,RC,73092,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,TC,127.05,,,,,,,115.50,1213.27,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,inpatient,,,2119.00000,2013.05000,Amish/Mennonite,Amish Mennonite,TC,1165.45,,,,,,,1165.45,2055.43,percent of total billed charges,
XR SM BOWEL VIA ENTEROCLYSIS-TECH,58499,CDM,320,RC,74251,CPT,,,facility,outpatient,,,2119.00000,2013.05000,Amish/Mennonite,Amish Mennonite,TC,1165.45,,,,,,,942.37,19073.89,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,inpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,129.80,228.92,percent of total billed charges,
XR SHLDR COMPLT MIN 2 VWS-TECH,58501,CDM,320,RC,73030,CPT,,,facility,outpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,TC,129.80,,,,,,,118.00,1292.36,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,TC,51.15,,,,,,,51.15,90.21,percent of total billed charges,
XR SURGICAL SPECIMEN-TECH,58502,CDM,320,RC,76098,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,TC,51.15,,,,,,,46.50,3015.65,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
CONTINUOUS INITIAL SETUP RT AEROSOL TREATMENT - TECH,58520,CDM,460,RC,94644,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,27.50,134.64,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
RT NEBULIZER ADDL HOURS - TECH,58521,CDM,460,RC,94645,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,24.50,47.53,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,inpatient,,,465.80000,442.51000,Amish/Mennonite,Amish Mennonite,TC,256.19,,,,,,,256.19,451.83,percent of total billed charges,
NM CT ATTENUATION SINGLE/MULTI - TECH,58525,CDM,350,RC,76497,CPT,,,facility,outpatient,,,465.80000,442.51000,Amish/Mennonite,Amish Mennonite,TC,256.19,,,,,,,232.90,1820.00,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,inpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/NS 50 ML PREMIX,58526,CDM,250,RC,J0737,HCPCS,00338954924,NDC,facility,outpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,4.20,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,inpatient,1,mL,20.10000,19.10000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,11.05,19.50,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,66794025964,NDC,facility,outpatient,1,mL,20.10000,19.10000,Amish/Mennonite,Amish Mennonite,,11.05,,,,,,,10.05,35.77,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,inpatient,1,mL,17.85000,16.96000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,9.82,17.31,percent of total billed charges,
EDARAVONE 30 MG/100 ML SOLN,58527,CDM,636,RC,J1301,HCPCS,70510217102,NDC,facility,outpatient,1,mL,17.85000,16.96000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,8.93,35.77,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,inpatient,,,2163.00000,2054.85000,Amish/Mennonite,Amish Mennonite,,1189.65,,,,,,,1189.65,2098.11,percent of total billed charges,
CENTRAL VENOUS LINE INSERTION,58530,CDM,361,RC,36556,CPT,,,facility,outpatient,,,2163.00000,2054.85000,Amish/Mennonite,Amish Mennonite,,1189.65,,,,,,,1189.65,7803.00,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,inpatient,1,mL,165.78000,157.49000,Amish/Mennonite,Amish Mennonite,,91.18,,,,,,,91.18,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,00023-2181-05,NDC,,,facility,outpatient,1,mL,165.78000,157.49000,Amish/Mennonite,Amish Mennonite,,91.18,,,,,,,82.89,160.81,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,inpatient,1,mL,20.24000,19.22000,Amish/Mennonite,Amish Mennonite,,11.13,,,,,,,11.13,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,17478-0209-10,NDC,,,facility,outpatient,1,mL,20.24000,19.22000,Amish/Mennonite,Amish Mennonite,,11.13,,,,,,,10.12,19.63,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,42571-0137-25,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,inpatient,1,mL,20.26000,19.24000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,47335-0220-90,NDC,,,facility,outpatient,1,mL,20.26000,19.24000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,inpatient,1,mL,20.26000,19.25000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,11.14,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,60505-1003-01,NDC,,,facility,outpatient,1,mL,20.26000,19.25000,Amish/Mennonite,Amish Mennonite,,11.14,,,,,,,10.13,19.65,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 5 ML,58533,CDM,250,RC,61314-0126-05,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,8.85,17.17,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,inpatient,1,EA,4748.76000,4511.33000,Amish/Mennonite,Amish Mennonite,,2611.82,,,,,,,2611.82,4606.30,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 250 MCG,58534,CDM,636,RC,J2802,HCPCS,55513022101,NDC,facility,outpatient,1,EA,4748.76000,4511.33000,Amish/Mennonite,Amish Mennonite,,2611.82,,,,,,,11.00,4606.30,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,inpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,204.05,359.87,percent of total billed charges,
DIALYSIS INPATIENT,58536,CDM,801,RC,,,,,facility,outpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,185.50,359.87,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
ACETAMINOPHEN LEVEL,58537,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,62.14,3038.81,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
SALICYLATE LEVEL,58538,CDM,300,RC,80307,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,62.14,3038.81,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,inpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,444.26,783.52,percent of total billed charges,
NIVOLUMAB SOLN 10 MG/ML 24 ML,58539,CDM,636,RC,J9299,HCPCS,00003373413,NDC,facility,outpatient,1,mL,807.75000,767.36000,Amish/Mennonite,Amish Mennonite,,444.26,,,,,,,33.00,783.52,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,inpatient,1,mL,7.05000,6.70000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.88,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409176102,NDC,facility,outpatient,1,mL,7.05000,6.70000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,0.01550,6.84,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,inpatient,1,mL,4.50000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.48,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,00409361301,NDC,facility,outpatient,1,mL,4.50000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,0.01550,4.37,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,inpatient,1,mL,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,4.26,7.51,percent of total billed charges,
BUPIVACAINE-DEXTROSE SOLN PF 0.75%-D8.25% 2 ML SPINAL,58540,CDM,250,RC,J0665,HCPCS,36000009210,NDC,facility,outpatient,1,mL,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,0.01550,7.51,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,inpatient,1,EA,1951.28000,1853.72000,Amish/Mennonite,Amish Mennonite,,1073.20,,,,,,,1073.20,1892.74,percent of total billed charges,
INFLIXIMAB-ABDA POWD-INJ 100 MG (RENFLEXIS),58541,CDM,636,RC,Q5104,HCPCS,78206016201,NDC,facility,outpatient,1,EA,1951.28000,1853.72000,Amish/Mennonite,Amish Mennonite,,1073.20,,,,,,,25.05,1892.74,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,inpatient,10,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,55150025110,NDC,facility,outpatient,10,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,inpatient,10,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,63323020110,NDC,facility,outpatient,10,EA,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,inpatient,10,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
LIDOCAINE SOLN 1% 10 ML,58542,CDM,250,RC,J2003,HCPCS,70756064525,NDC,facility,outpatient,10,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
DIRECT ANTIGLOBULIN TEST,58549,CDM,300,RC,86880,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,5.39,288.61,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,inpatient,,,383.00000,363.85000,Amish/Mennonite,Amish Mennonite,,210.65,,,,,,,210.65,371.51,percent of total billed charges,
ANTIBODY IDENTIFICATION,58550,CDM,300,RC,86870,CPT,,,facility,outpatient,,,383.00000,363.85000,Amish/Mennonite,Amish Mennonite,,210.65,,,,,,,191.50,2122.08,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
BUN POST HEMODIALYSIS - TECH,58551,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.93,203.72,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,inpatient,1,EA,3584.37000,3405.15000,Amish/Mennonite,Amish Mennonite,,1971.40,,,,,,,1971.40,3476.84,percent of total billed charges,
TRASTUZUMAB POWD-INJ 150 MG,58553,CDM,636,RC,J9355,HCPCS,50242013201,NDC,facility,outpatient,1,EA,3584.37000,3405.15000,Amish/Mennonite,Amish Mennonite,,1971.40,,,,,,,76.18,3476.84,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,inpatient,1,mL,5.55000,5.27000,Amish/Mennonite,Amish Mennonite,,3.05,,,,,,,3.05,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,16729051243,NDC,facility,outpatient,1,mL,5.55000,5.27000,Amish/Mennonite,Amish Mennonite,,3.05,,,,,,,0.11207,5.38,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,inpatient,1,mL,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
ATROPINE SOLN 0.4 MG/ML 20 ML (MDV),58555,CDM,250,RC,J0461,HCPCS,63323058020,NDC,facility,outpatient,1,mL,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,0.11207,10.73,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
DAT (ARC) CHARGE ONLY,58556,CDM,300,RC,86880,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.39,288.61,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
RH TYPE (ARC) CHARGE ONLY,58557,CDM,300,RC,86901,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,2.99,152.82,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,24.20,42.68,percent of total billed charges,
PROTEIN,58559,CDM,300,RC,84157,CPT,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,4.00,186.75,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
"GLUCOSE, CSF",58560,CDM,300,RC,82945,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,3.93,203.72,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
BLOOD GAS CAPILLARY,58561,CDM,300,RC,82803,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,26.07,1222.31,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT,58562,CDM,300,RC,89050,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,4.72,254.68,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,inpatient,1,mL,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
DOXORUBICIN 150 MG/75 ML SOLN (MDV),58563,CDM,250,RC,J9000,HCPCS,00069303320,NDC,facility,outpatient,1,mL,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,5.23,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,inpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,,92.95,,,,,,,92.95,163.93,percent of total billed charges,
ART.BLOOD GAS-UMBILICAL,58564,CDM,300,RC,82803,CPT,,,facility,outpatient,,,169.00000,160.55000,Amish/Mennonite,Amish Mennonite,,92.95,,,,,,,26.07,1222.31,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
WHITE BLOOD CELL STOOL,58568,CDM,300,RC,87205,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,4.27,220.68,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,inpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,GY,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,63739050510,NDC,facility,outpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,GY,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,inpatient,1,mL,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,GY,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904684470,NDC,facility,outpatient,1,mL,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,GY,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,inpatient,1,mL,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,GY,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU,58569,CDM,250,RC,A9270,HCPCS,00904713470,NDC,facility,outpatient,1,mL,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,GY,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,inpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/NS 50 ML PREMIX,58570,CDM,250,RC,J0737,HCPCS,00338955324,NDC,facility,outpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,4.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 30 ML",58571,CDM,250,RC,J2004,HCPCS,00409317802,NDC,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,inpatient,1,EA,7470.42000,7096.90000,Amish/Mennonite,Amish Mennonite,,4108.73,,,,,,,4108.73,7246.31,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 500 MCG,58572,CDM,636,RC,J2802,HCPCS,55513022201,NDC,facility,outpatient,1,EA,7470.42000,7096.90000,Amish/Mennonite,Amish Mennonite,,4108.73,,,,,,,11.00,7246.31,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,inpatient,1,EA,254.92000,242.17000,Amish/Mennonite,Amish Mennonite,,140.21,,,,,,,140.21,247.27,percent of total billed charges,
CINACALCET 90 MG TAB,58579,CDM,250,RC,J0604,HCPCS,55513007530,NDC,facility,outpatient,1,EA,254.92000,242.17000,Amish/Mennonite,Amish Mennonite,,140.21,,,,,,,127.46,247.27,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
"CREATININE, OTHER SOURCE",58596,CDM,300,RC,82570,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,5.18,271.65,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,inpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,34.10,60.14,percent of total billed charges,
MBAFB,58597,CDM,300,RC,87206,CPT,,,facility,outpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,5.39,288.61,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
BODY FLUID DIFF (MARSH),58598,CDM,300,RC,89051,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,5.60,288.61,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,inpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,TC,312.40,,,,,,,312.40,550.96,percent of total billed charges,
CYTO CELL BLOCKS,58600,CDM,310,RC,88305,CPT,,,facility,outpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,TC,312.40,,,,,,,158.62,1499.73,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,inpatient,,,2478.00000,2354.10000,Amish/Mennonite,Amish Mennonite,,1362.90,,,,,,,1362.90,2403.66,percent of total billed charges,
FISH HER-2/NEU AMPLIFICATION,58601,CDM,300,RC,88374,CPT,,,facility,outpatient,,,2478.00000,2354.10000,Amish/Mennonite,Amish Mennonite,,1362.90,,,,,,,162.71,16444.87,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
"LACTATE DEHYDROGENASE, OTHER BODY FLUIDS",58603,CDM,300,RC,83615,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,6.04,322.54,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,Amish/Mennonite,Amish Mennonite,TC,776.05,,,,,,,776.05,1368.67,percent of total billed charges,
US CAROTID DUPLEX UNI LEFT,58604,CDM,921,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,Amish/Mennonite,Amish Mennonite,TC,776.05,,,,,,,705.50,1368.67,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,inpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,107.25,189.15,percent of total billed charges,
"CALPROTECTIN, STOOL",58605,CDM,300,RC,83993,CPT,,,facility,outpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,19.63,1018.59,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,GO,20.35,,,,,,,20.35,35.89,percent of total billed charges,
OT HOT/COLD PACK-TECH,58621,CDM,430,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,GO,20.35,,,,,,,18.50,264.00,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,Amish/Mennonite,Amish Mennonite,,2910.60,,,,,,,2910.60,5133.24,percent of total billed charges,
I-123 IOFLUPANE-5MCI-TECH,58626,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,Amish/Mennonite,Amish Mennonite,,2910.60,,,,,,,1388.02,5133.24,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
MECONIUM DRUG SREEN-TECH,58628,CDM,300,RC,80307,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,3038.81,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,146.85,258.99,percent of total billed charges,
"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS-TECH",58630,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,TC,146.85,,,,,,,133.50,1470.40,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,inpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,44.55,78.57,percent of total billed charges,
"MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING-TECH",58631,CDM,410,RC,94668,CPT,,,facility,outpatient,,,81.00000,76.95000,Amish/Mennonite,Amish Mennonite,,44.55,,,,,,,40.50,134.64,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,inpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,106.70,188.18,percent of total billed charges,
AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS-TECH,58632,CDM,410,RC,94642,CPT,,,facility,outpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,97.00,212.44,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,inpatient,,,1155.00000,1097.25000,Amish/Mennonite,Amish Mennonite,TC,635.25,,,,,,,635.25,1120.35,percent of total billed charges,
"DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE-TECH",58633,CDM,920,RC,93979,CPT,,,facility,outpatient,,,1155.00000,1097.25000,Amish/Mennonite,Amish Mennonite,TC,635.25,,,,,,,577.50,1120.35,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00378-0860-01,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,00904-7087-61,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,51079-0922-20,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,inpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,57664-0347-88,NDC,,,facility,outpatient,1,EA,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,60429-0990-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
CLOZAPINE 100MG TAB,58634,CDM,250,RC,65862-0846-01,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,inpatient,1,mL,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120901,NDC,facility,outpatient,1,mL,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,inpatient,1,mL,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1.5% -1  200,000 5 ML",58635,CDM,250,RC,J2004,HCPCS,00409120965,NDC,facility,outpatient,1,mL,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,TC,247.50,,,,,,,247.50,436.50,percent of total billed charges,
"SCREENING MAMMOGRAPHY, UNILATERAL-TECH",58639,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,TC,247.50,,,,,,,225.00,492.80,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,177.51,percent of total billed charges,
THYROID DIAGNOSTIC CASCADE-TECH,58645,CDM,300,RC,84443,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,16.80,882.80,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-52,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,00904-5182-61,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-00,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,inpatient,1,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,20555-0036-01,NDC,,,facility,outpatient,1,EA,0.45000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,50268-0524-15,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,54458-0213-60,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,57896-0864-06,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,68094-0110-61,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
MELATONIN 3MG TAB,58647,CDM,250,RC,77333-0516-10,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,inpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,14789022010,NDC,facility,outpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.08005,0.65960,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,55150024747,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.08005,0.92150,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,44567050210,NDC,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.08005,0.33950,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,inpatient,1,mL,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026500,NDC,facility,outpatient,1,mL,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.08005,0.87300,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,inpatient,1,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,67457026510,NDC,facility,outpatient,1,mL,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.08005,1.04,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,inpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
LEVETIRACETAM 1000 MG/100 ML PREMIX,58661,CDM,250,RC,J1953,HCPCS,70860060382,NDC,facility,outpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.08005,0.64990,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,30.80,54.32,percent of total billed charges,
CREATININE; OTHER SOURCE DIALYSIS-TECH,58662,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,5.18,271.65,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE-TECH",58663,CDM,300,RC,84702,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,15.05,780.94,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
"BLOOD TYPING, SEROLOGIC; ANTIGEN TESTING OF DONOR-TECH",58664,CDM,300,RC,86902,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,5.37,305.58,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,inpatient,1,mL,1043.05000,990.90000,Amish/Mennonite,Amish Mennonite,,573.68,,,,,,,573.68,1011.76,percent of total billed charges,
DURVALUMAB SOLN 500 MG/10 ML,58682,CDM,636,RC,J9173,HCPCS,00310461150,NDC,facility,outpatient,1,mL,1043.05000,990.90000,Amish/Mennonite,Amish Mennonite,,573.68,,,,,,,85.25,1011.76,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,inpatient,1,mL,977.93000,929.03000,Amish/Mennonite,Amish Mennonite,,537.86,,,,,,,537.86,948.59,percent of total billed charges,
DURVALUMAB 120 MG/2.4 ML SOLN,58683,CDM,636,RC,J9173,HCPCS,00310450012,NDC,facility,outpatient,1,mL,977.93000,929.03000,Amish/Mennonite,Amish Mennonite,,537.86,,,,,,,85.25,948.59,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,60687-0568-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,70010-0770-01,NDC,,,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0167-10,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,inpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,63739-0992-10,NDC,,,facility,outpatient,1,EA,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,68084-0057-01,NDC,,,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
METHOCARBAMOL 750MG TAB UD,58732,CDM,250,RC,76385-0124-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,151.25,266.75,percent of total billed charges,
"URINE DRUG SCREEN, EACH DRUG-TECH",58734,CDM,300,RC,80307,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,62.14,3038.81,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,30.80,54.32,percent of total billed charges,
"ALKALINE PHOSPHATASE, TOTAL-TECH",58739,CDM,300,RC,84075,CPT,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,5.18,271.65,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
BILIRUBIN-TECH,58740,CDM,300,RC,82247,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,4.24,254.68,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
PROTEIN S TOTAL-NO COUMADIN-TECH,58741,CDM,300,RC,85306,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,15.32,797.91,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
COMPREHENSIVE ANTIPHOSPHOLIPID SYNDROME-TECH,58742,CDM,300,RC,85610,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,4.29,203.72,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,224.40,395.76,percent of total billed charges,
"CLOSTRIDIUM DIFFICILE TOXIN, NAT-TECH",58746,CDM,300,RC,87493,CPT,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,37.27,1833.46,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
"THROMBOPLASTIN TIME, PARTIAL (PTT);-TECH",58747,CDM,300,RC,85732,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,6.47,339.51,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
CEREBROSPINAL FLUID CELL COUNT AND MANUAL-TECH,58755,CDM,300,RC,89051,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,5.60,288.61,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,inpatient,1,EA,1320.90000,1254.86000,Amish/Mennonite,Amish Mennonite,,726.50,,,,,,,726.50,1281.27,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/50ML (GLASSIA),58758,CDM,636,RC,J0257,HCPCS,00944288401,NDC,facility,outpatient,1,EA,1320.90000,1254.86000,Amish/Mennonite,Amish Mennonite,,726.50,,,,,,,5.71,1281.27,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-8-TECH,58763,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,77.53,1052.52,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00264-2304-00,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00338-0656-04,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN,58769,CDM,250,RC,00409-6143-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
ASPIRATION CATH NASOTRACHEAL-TECH,58770,CDM,410,RC,31720,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,212.44,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,inpatient,1,mL,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,60505-1003-02,NDC,,,facility,outpatient,1,mL,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,inpatient,1,mL,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,9.73,17.17,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.5% 10 ML,58771,CDM,250,RC,61314-0126-10,NDC,,,facility,outpatient,1,mL,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,8.85,17.17,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
ANITBODY SCREEN (ARC)-TECH,58772,CDM,300,RC,86850,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,5.38,458.40,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
"UREA NITROGEN, URINE 24 HOUR-TECH",58773,CDM,300,RC,84540,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,5.56,254.68,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
"CREATININE, URINE 24 HOUR-TECH",58774,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.18,271.65,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
ALBUMIN LEVEL URINE-TECH,58775,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,2.25,118.82,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,56.65,99.91,percent of total billed charges,
LEGIONELLA CULTURE-TECH,58790,CDM,300,RC,87070,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,8.62,458.40,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,inpatient,1,EA,635.07000,603.31000,Amish/Mennonite,Amish Mennonite,,349.29,,,,,,,349.29,616.02,percent of total billed charges,
CEFTAROLINE 600 MG POWD,58791,CDM,636,RC,J0712,HCPCS,00456060010,NDC,facility,outpatient,1,EA,635.07000,603.31000,Amish/Mennonite,Amish Mennonite,,349.29,,,,,,,4.24,616.02,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX-TECH,58792,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,392.70,5858.00,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-UNILATERAL-TECH,58844,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,5271.00,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
EAR LAVAGE-BILATERAL-TECH,58845,CDM,361,RC,,,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,5271.00,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,inpatient,1,mL,12.99000,12.34000,Amish/Mennonite,Amish Mennonite,,7.14,,,,,,,7.14,12.60,percent of total billed charges,
BUTORPHANOL 1 MG/ML INJ SOL 1 ML,58846,CDM,250,RC,J0595,HCPCS,00409162301,NDC,facility,outpatient,1,mL,12.99000,12.34000,Amish/Mennonite,Amish Mennonite,,7.14,,,,,,,6.50,12.60,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
CAST SUP SHT ARM ADULT FBRGL,58868,CDM,270,RC,Q4010,HCPCS,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,26.11,147.44,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,inpatient,,,77.07000,73.22000,Amish/Mennonite,Amish Mennonite,,42.39,,,,,,,42.39,74.76,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,FIBERGL",58896,CDM,270,RC,Q4046,HCPCS,,,facility,outpatient,,,77.07000,73.22000,Amish/Mennonite,Amish Mennonite,,42.39,,,,,,,25.05,74.76,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
OH HAZMAT EXAM,59087,CDM,960,RC,99199,CPT,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,62.50,121.25,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,182.05,321.07,percent of total billed charges,
"IMMUNOFIXATION, URINE 24HR-TECH",59493,CDM,300,RC,86335,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,29.35,2438.99,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2195.00000,2085.25000,Amish/Mennonite,Amish Mennonite,TC,1207.25,,,,,,,1207.25,2129.15,percent of total billed charges,
NM BONE SCAN MULTIPLE AREAS,59495,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2195.00000,2085.25000,Amish/Mennonite,Amish Mennonite,TC,1207.25,,,,,,,1097.50,2210.07,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,inpatient,,,2007.00000,1906.65000,Amish/Mennonite,Amish Mennonite,TC,1103.85,,,,,,,1103.85,1946.79,percent of total billed charges,
NM BRAIN SCAN STATIC MIN 4 VIEWS,59496,CDM,341,RC,78605,CPT,,,facility,outpatient,,,2007.00000,1906.65000,Amish/Mennonite,Amish Mennonite,TC,1103.85,,,,,,,940.41,2960.49,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,5115.55,9021.97,percent of total billed charges,
NM ADRENAL SCAN MIBG,59497,CDM,341,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,4467.66,9021.97,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,inpatient,,,3474.00000,3300.30000,Amish/Mennonite,Amish Mennonite,TC,1910.70,,,,,,,1910.70,3369.78,percent of total billed charges,
NM CSF LEAKAGE,59498,CDM,341,RC,78650,CPT,,,facility,outpatient,,,3474.00000,3300.30000,Amish/Mennonite,Amish Mennonite,TC,1910.70,,,,,,,1364.86,7180.14,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,inpatient,,,2178.00000,2069.10000,Amish/Mennonite,Amish Mennonite,TC,1197.90,,,,,,,1197.90,2112.66,percent of total billed charges,
NM BRAIN SCAN W FLOW 1-3 VIEWS,59499,CDM,341,RC,78601,CPT,,,facility,outpatient,,,2178.00000,2069.10000,Amish/Mennonite,Amish Mennonite,TC,1197.90,,,,,,,1036.23,2210.07,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,inpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,TC,677.60,,,,,,,677.60,1195.04,percent of total billed charges,
NM LIVER RBC SCAN,59501,CDM,341,RC,78140,CPT,,,facility,outpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,TC,677.60,,,,,,,466.73,2210.07,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,inpatient,,,1038.00000,986.10000,Amish/Mennonite,Amish Mennonite,TC,570.90,,,,,,,570.90,1006.86,percent of total billed charges,
NM UREA BREATH TEST C14 ANLYS,59503,CDM,341,RC,78268,CPT,,,facility,outpatient,,,1038.00000,986.10000,Amish/Mennonite,Amish Mennonite,TC,570.90,,,,,,,84.70,1006.86,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,inpatient,,,2198.00000,2088.10000,Amish/Mennonite,Amish Mennonite,TC,1208.90,,,,,,,1208.90,2132.06,percent of total billed charges,
NM URETERAL REFLUX SCAN,59504,CDM,341,RC,78740,CPT,,,facility,outpatient,,,2198.00000,2088.10000,Amish/Mennonite,Amish Mennonite,TC,1208.90,,,,,,,1047.28,2210.07,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP DIAG ONLY,59505,CDM,361,RC,43260,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W LITHO OF STONES,59506,CDM,361,RC,43265,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,11015.00,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION,59507,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,3612.55,10015.25,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,inpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,TC,1064.80,,,,,,,1064.80,1877.92,percent of total billed charges,
NM LIVER SCAN STATIC ONLY,59508,CDM,341,RC,78201,CPT,,,facility,outpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,TC,1064.80,,,,,,,918.26,2960.49,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,inpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,TC,410.85,,,,,,,410.85,724.59,percent of total billed charges,
NM THYROID CARCINOMA MET UPTAKE,59509,CDM,341,RC,78020,CPT,,,facility,outpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,TC,410.85,,,,,,,282.87,724.59,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,inpatient,,,1206.00000,1145.70000,Amish/Mennonite,Amish Mennonite,TC,663.30,,,,,,,663.30,1169.82,percent of total billed charges,
NM SALIVARY GLAND IMAGING,59510,CDM,341,RC,78231,CPT,,,facility,outpatient,,,1206.00000,1145.70000,Amish/Mennonite,Amish Mennonite,TC,663.30,,,,,,,455.68,2210.07,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W BIOPSY SGL OR MULTI,59511,CDM,361,RC,43261,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W ABLATION,59512,CDM,361,RC,43278,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W SPHINCTEROTOMY,59513,CDM,361,RC,43262,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STONE REMOVAL,59514,CDM,361,RC,43264,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,7803.00,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,inpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT CHANGE,59515,CDM,361,RC,43276,CPT,,,facility,outpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5343.33,11015.00,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,inpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,2632.30,4642.42,percent of total billed charges,
XR ERCP W STENT REMOVAL,59516,CDM,361,RC,43275,CPT,,,facility,outpatient,,,4786.00000,4546.70000,Amish/Mennonite,Amish Mennonite,,2632.30,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,inpatient,,,4662.00000,4428.90000,Amish/Mennonite,Amish Mennonite,,2564.10,,,,,,,2564.10,4522.14,percent of total billed charges,
XR ERCP W SPHINCTER PRESSURE,59517,CDM,361,RC,43263,CPT,,,facility,outpatient,,,4662.00000,4428.90000,Amish/Mennonite,Amish Mennonite,,2564.10,,,,,,,1801.27,7803.00,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,inpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W STENT INSERTION,59518,CDM,361,RC,43274,CPT,,,facility,outpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5343.33,11015.00,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
CT 3D RENDERING CT CONSOLE-TECH,59519,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,72.50,1820.00,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,Amish/Mennonite,Amish Mennonite,TC,2009.70,,,,,,,2009.70,3544.38,percent of total billed charges,
MRI GUIDANCE NEEDLE PLCMT-TECH,59520,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,Amish/Mennonite,Amish Mennonite,TC,2009.70,,,,,,,1487.04,3544.38,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,inpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,166.65,293.91,percent of total billed charges,
"PAP, THIN PREP-TECH",59536,CDM,300,RC,G0124,HCPCS,,,facility,outpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,78.72,293.91,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,14.69,25.90,percent of total billed charges,
URIC ACID FOR URORISK SO-TECH,59537,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,5.25,254.68,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,inpatient,1,mL,503.59000,478.41000,Amish/Mennonite,Amish Mennonite,,276.97,,,,,,,276.97,488.48,percent of total billed charges,
ARSENIC TRIOXIDE 2 MG/ML SOLN,59538,CDM,636,RC,J9017,HCPCS,63459060106,NDC,facility,outpatient,1,mL,503.59000,478.41000,Amish/Mennonite,Amish Mennonite,,276.97,,,,,,,5.86,488.48,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-11,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,inpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00074-6212-13,NDC,,,facility,outpatient,1,EA,5.61000,5.33000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.44,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,16714-0511-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,00245-0180-89,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,29300-0138-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,57237-0106-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,inpatient,1,EA,2.35000,2.24000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,60687-0211-21,NDC,,,facility,outpatient,1,EA,2.35000,2.24000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,62756-0796-88,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
DIVALPROEX SODIUM 125 MG TAB,59539,CDM,250,RC,68382-0031-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,152.35,268.69,percent of total billed charges,
CANNABINOID SCREEN URINE-TECH,59550,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,62.14,3038.81,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
LIVER-KIDNEY MICROSOMAL-1 AB-TECH,59551,CDM,300,RC,86376,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,14.55,763.98,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,inpatient,1,mL,10785.83000,10246.53000,Amish/Mennonite,Amish Mennonite,,5932.21,,,,,,,5932.21,10462.26,percent of total billed charges,
BENRALIZUMAB SOLN 30 MG/ML (FASENRA),59564,CDM,636,RC,J0517,HCPCS,00310183030,NDC,facility,outpatient,1,mL,10785.83000,10246.53000,Amish/Mennonite,Amish Mennonite,,5932.21,,,,,,,168.13,10462.26,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,inpatient,1,mL,4534.31000,4307.59000,Amish/Mennonite,Amish Mennonite,,2493.87,,,,,,,2493.87,4398.28,percent of total billed charges,
OCRELIZUMAB 300MG/10 ML SOLN,59578,CDM,636,RC,J2350,HCPCS,50242015001,NDC,facility,outpatient,1,mL,4534.31000,4307.59000,Amish/Mennonite,Amish Mennonite,,2493.87,,,,,,,59.70,4398.28,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,inpatient,1,mL,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641601410,NDC,facility,outpatient,1,mL,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,00641921810,NDC,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,inpatient,1,mL,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55150042610,NDC,facility,outpatient,1,mL,2.17000,2.07000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,55390056510,NDC,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,inpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
DILTIAZEM SOLN-INJ 5 MG/ML 10 ML,59584,CDM,250,RC,J3490,HCPCS,70860030110,NDC,facility,outpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,inpatient,,,740.00000,703.00000,Amish/Mennonite,Amish Mennonite,90,407.00,,,,,,,407.00,717.80,percent of total billed charges,
HEREDITARY HEMO SO-TECH,59598,CDM,310,RC,81256,CPT,,,facility,outpatient,,,740.00000,703.00000,Amish/Mennonite,Amish Mennonite,90,407.00,,,,,,,67.54,3412.32,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,inpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,90,448.25,,,,,,,448.25,790.55,percent of total billed charges,
NUCLEIC ACID AMPLIFICATION SO-TECH,59599,CDM,300,RC,86255,CPT,,,facility,outpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,90,448.25,,,,,,,12.45,1539.22,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,inpatient,,,106.20000,100.89000,Amish/Mennonite,Amish Mennonite,90,58.41,,,,,,,58.41,103.01,percent of total billed charges,
IBD NUCLEIC ACID PROBE SO-TECH,59600,CDM,310,RC,81479,CPT,,,facility,outpatient,,,106.20000,100.89000,Amish/Mennonite,Amish Mennonite,90,58.41,,,,,,,53.10,103.01,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,inpatient,,,1376.00000,1307.20000,Amish/Mennonite,Amish Mennonite,90,756.80,,,,,,,756.80,1334.72,percent of total billed charges,
FLT3SO-TECH,59602,CDM,300,RC,81245,CPT,,,facility,outpatient,,,1376.00000,1307.20000,Amish/Mennonite,Amish Mennonite,90,756.80,,,,,,,132.74,7792.26,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,inpatient,,,5754.00000,5466.30000,Amish/Mennonite,Amish Mennonite,TC,3164.70,,,,,,,3164.70,5581.38,percent of total billed charges,
BRACHY INCAV CMP LDR,59603,CDM,342,RC,77763,CPT,,,facility,outpatient,,,5754.00000,5466.30000,Amish/Mennonite,Amish Mennonite,TC,3164.70,,,,,,,1631.86,5581.38,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,inpatient,,,4909.00000,4663.55000,Amish/Mennonite,Amish Mennonite,,2699.95,,,,,,,2699.95,4761.73,percent of total billed charges,
BRACHY EYE APP,59604,CDM,360,RC,67218,CPT,,,facility,outpatient,,,4909.00000,4663.55000,Amish/Mennonite,Amish Mennonite,,2699.95,,,,,,,2699.95,7803.00,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,inpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,TC,1582.90,,,,,,,1582.90,2791.66,percent of total billed charges,
BRACHY INCAV SMP LDR,59605,CDM,342,RC,77761,CPT,,,facility,outpatient,,,2878.00000,2734.10000,Amish/Mennonite,Amish Mennonite,TC,1582.90,,,,,,,1114.22,2791.66,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,inpatient,,,5180.00000,4921.00000,Amish/Mennonite,Amish Mennonite,TC,2849.00,,,,,,,2849.00,5024.60,percent of total billed charges,
BRACHY INCAV INT LDR,59606,CDM,342,RC,77762,CPT,,,facility,outpatient,,,5180.00000,4921.00000,Amish/Mennonite,Amish Mennonite,TC,2849.00,,,,,,,1273.18,5024.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,inpatient,,,1880.00000,1786.00000,Amish/Mennonite,Amish Mennonite,,1034.00,,,,,,,1034.00,1823.60,percent of total billed charges,
"BRACHY S, H, L",59607,CDM,342,RC,77790,CPT,,,facility,outpatient,,,1880.00000,1786.00000,Amish/Mennonite,Amish Mennonite,,1034.00,,,,,,,81.69,1823.60,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,inpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,158.76,314.28,percent of total billed charges,
I-125 SOURCES-NON-STRANDED>1.01 MCI/SOURCE,59609,CDM,278,RC,C2634,HCPCS,,,facility,outpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,148.72,324.00,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
HBO UND PRESS FULL CHAM/30,59610,CDM,413,RC,G0277,HCPCS,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,inpatient,,,70906.00000,67360.70000,Amish/Mennonite,Amish Mennonite,,38998.30,,,,,,,38998.30,68778.82,percent of total billed charges,
GAMMA KNIFE,59612,CDM,333,RC,77371,CPT,,,facility,outpatient,,,70906.00000,67360.70000,Amish/Mennonite,Amish Mennonite,,38998.30,,,,,,,6083.48,68778.82,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,inpatient,,,1634.00000,1552.30000,Amish/Mennonite,Amish Mennonite,TC,898.70,,,,,,,898.70,1584.98,percent of total billed charges,
INFUSION RADIOEL,59613,CDM,342,RC,77750,CPT,,,facility,outpatient,,,1634.00000,1552.30000,Amish/Mennonite,Amish Mennonite,TC,898.70,,,,,,,671.89,1584.98,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
RT PULM SURFACTANT ADMIN ET TUBE,59614,CDM,410,RC,94610,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,69.00,212.44,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,inpatient,,,5032.00000,4780.40000,Amish/Mennonite,Amish Mennonite,,2767.60,,,,,,,2767.60,4881.04,percent of total billed charges,
INTERSITIAL NEEDLE PLACEMENT,59615,CDM,333,RC,55920,CPT,,,facility,outpatient,,,5032.00000,4780.40000,Amish/Mennonite,Amish Mennonite,,2767.60,,,,,,,2516.00,5156.10,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,inpatient,,,2892.00000,2747.40000,Amish/Mennonite,Amish Mennonite,,1590.60,,,,,,,1590.60,2805.24,percent of total billed charges,
INTRAOP RAD MGMT,59616,CDM,333,RC,77469,CPT,,,facility,outpatient,,,2892.00000,2747.40000,Amish/Mennonite,Amish Mennonite,,1590.60,,,,,,,1446.00,18061.43,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,inpatient,,,589.00000,559.55000,Amish/Mennonite,Amish Mennonite,,323.95,,,,,,,323.95,571.33,percent of total billed charges,
INSERTION OF VAGINAL CYLINDER,59618,CDM,333,RC,57156,CPT,,,facility,outpatient,,,589.00000,559.55000,Amish/Mennonite,Amish Mennonite,,323.95,,,,,,,288.84,1203.43,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,Amish/Mennonite,Amish Mennonite,,565.40,,,,,,,503.72,997.16,percent of total billed charges,
IR-192 SOURCE HOSPITAL,59619,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,Amish/Mennonite,Amish Mennonite,,565.40,,,,,,,325.11,1028.00,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,TC,2558.05,,,,,,,2558.05,4511.47,percent of total billed charges,
BRACHY SURF APP,59620,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,TC,2558.05,,,,,,,380.83,4511.47,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,inpatient,,,2232.00000,2120.40000,Amish/Mennonite,Amish Mennonite,TC,1227.60,,,,,,,1227.60,2165.04,percent of total billed charges,
SPLEEN IMAGING-TECH,59621,CDM,341,RC,78185,CPT,,,facility,outpatient,,,2232.00000,2120.40000,Amish/Mennonite,Amish Mennonite,TC,1227.60,,,,,,,837.18,2210.07,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,inpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,,486.75,,,,,,,486.75,858.45,percent of total billed charges,
TRANSCUTANEOUS 02 MONITOR,59623,CDM,920,RC,93922,CPT,,,facility,outpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,,486.75,,,,,,,122.40,858.45,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
COLLECT BLOOD FROM PICC,59628,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,122.40,5271.00,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,inpatient,1,mL,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
BUPIVACAINE 0.1%-FENTANYL 2 MCG/ML-NACL 0.9% SOLN,59629,CDM,250,RC,61553-0869-50,NDC,,,facility,outpatient,1,mL,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,inpatient,1,mL,55.71000,52.93000,Amish/Mennonite,Amish Mennonite,,30.64,,,,,,,30.64,54.04,percent of total billed charges,
CYCLOPENTOLATE-PHENYLEPHRINE SOLN-OPHTH 0.2%-1% 2 ML,59632,CDM,250,RC,00065-0359-02,NDC,,,facility,outpatient,1,mL,55.71000,52.93000,Amish/Mennonite,Amish Mennonite,,30.64,,,,,,,27.86,54.04,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,218.35,385.09,percent of total billed charges,
CHANGE TUBE TRACHEOSTOMY,59633,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,218.35,5271.00,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
CARSEAT CHALLENGE 1ST 60 MIN,59634,CDM,460,RC,94780,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,37.00,71.78,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
COLONOSCOPY,59635,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,inpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,00591-3256-01,NDC,,,facility,outpatient,1,EA,0.53000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-01,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,10702-0006-50,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,52817-0330-10,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,43547-0399-10,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,inpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,50268-0190-15,NDC,,,facility,outpatient,1,EA,2.16000,2.05000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,59746-0211-06,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
CYCLOBENZAPRINE TAB 5MG,59636,CDM,250,RC,68084-0753-25,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,inpatient,1,GM,316.85000,301.01000,Amish/Mennonite,Amish Mennonite,,174.27,,,,,,,174.27,307.34,percent of total billed charges,
ALBUTEROL-IPRATROPIUM INHALER 100 MCG-20 MCG/INH 4 GM (120 DOSE),59637,CDM,250,RC,J3535,HCPCS,00597002402,NDC,facility,outpatient,1,GM,316.85000,301.01000,Amish/Mennonite,Amish Mennonite,,174.27,,,,,,,158.43,307.34,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,inpatient,,,504.00000,478.80000,Amish/Mennonite,Amish Mennonite,,277.20,,,,,,,277.20,488.88,percent of total billed charges,
CONS SEDAT UNDER 5YRS TO 30 MIN,59638,CDM,370,RC,99151,CPT,,,facility,outpatient,,,504.00000,478.80000,Amish/Mennonite,Amish Mennonite,,277.20,,,,,,,252.00,488.88,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,inpatient,,,1145.00000,1087.75000,Amish/Mennonite,Amish Mennonite,,629.75,,,,,,,629.75,1110.65,percent of total billed charges,
CHG G-TUBE PERC W/O IMGNG/ENDO,59640,CDM,361,RC,,,,,facility,outpatient,,,1145.00000,1087.75000,Amish/Mennonite,Amish Mennonite,,629.75,,,,,,,629.75,5271.00,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,inpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1183.05,2086.47,percent of total billed charges,
BONE MARROW BX,59641,CDM,361,RC,,,,,facility,outpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1183.05,5271.00,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,20.35,35.89,percent of total billed charges,
CARSEAT CHALLENGE EACH ADD 30 MIN,59642,CDM,460,RC,94781,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,18.50,35.89,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,inpatient,,,1103.00000,1047.85000,Amish/Mennonite,Amish Mennonite,,606.65,,,,,,,606.65,1069.91,percent of total billed charges,
ARTERIAL LINE INSERT,59643,CDM,361,RC,36140,CPT,,,facility,outpatient,,,1103.00000,1047.85000,Amish/Mennonite,Amish Mennonite,,606.65,,,,,,,606.65,5271.00,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,190.85,336.59,percent of total billed charges,
CONS SEDAT EA ADD 15 MIN,59644,CDM,370,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,173.50,336.59,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,inpatient,,,1542.00000,1464.90000,Amish/Mennonite,Amish Mennonite,,848.10,,,,,,,848.10,1495.74,percent of total billed charges,
EMERGENT TRACH-TECH,59645,CDM,361,RC,,,,,facility,outpatient,,,1542.00000,1464.90000,Amish/Mennonite,Amish Mennonite,,848.10,,,,,,,848.10,5271.00,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,inpatient,,,1023.00000,971.85000,Amish/Mennonite,Amish Mennonite,,562.65,,,,,,,562.65,992.31,percent of total billed charges,
VENTRICULAR DRAIN INSERTION,59651,CDM,361,RC,,,,,facility,outpatient,,,1023.00000,971.85000,Amish/Mennonite,Amish Mennonite,,562.65,,,,,,,562.65,5271.00,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
RT EXERCISE 1  1 15 MINUTES,59652,CDM,410,RC,G0238,HCPCS,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,23.25,197.88,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,inpatient,,,76.57000,72.74000,Amish/Mennonite,Amish Mennonite,,42.11,,,,,,,42.11,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,CPT,,,facility,outpatient,,,76.57000,72.74000,Amish/Mennonite,Amish Mennonite,,42.11,,,,,,,38.28,74.27,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,inpatient,1,mL,153.14000,145.48000,Amish/Mennonite,Amish Mennonite,,84.23,,,,,,,84.23,148.55,percent of total billed charges,
TETANUS-DIPHTHERIA-PERTUSSIS (TDAP) VACCINE SUSP (BOOSTRIX),59654,CDM,636,RC,90715,HCPCS,58160084252,NDC,facility,outpatient,1,mL,153.14000,145.48000,Amish/Mennonite,Amish Mennonite,,84.23,,,,,,,60.56,148.55,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71019025301,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,inpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092106807,NDC,facility,outpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,inpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,70092155207,NDC,facility,outpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510001,NDC,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,inpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71266510301,NDC,facility,outpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,inpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
OXYTOCIN 30 UNITS/500ML NACL 30 UNITS,59659,CDM,250,RC,J2590,HCPCS,71506002859,NDC,facility,outpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,,179.85,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT VAD OR CATH W/AGENT,59660,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,,179.85,,,,,,,179.85,3163.00,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,inpatient,,,1375.00000,1306.25000,Amish/Mennonite,Amish Mennonite,TC,756.25,,,,,,,756.25,1333.75,percent of total billed charges,
XR ERCP BILIARY/PANCREAT DCT-TECH,59662,CDM,320,RC,74330,CPT,,,facility,outpatient,,,1375.00000,1306.25000,Amish/Mennonite,Amish Mennonite,TC,756.25,,,,,,,384.29,6707.24,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
SIGMOIDOSCOPY,59663,CDM,360,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,inpatient,,,2192.00000,2082.40000,Amish/Mennonite,Amish Mennonite,,1205.60,,,,,,,1205.60,2126.24,percent of total billed charges,
ESOPHOGASTRODUODENOSCOPY,59666,CDM,360,RC,,,,,facility,outpatient,,,2192.00000,2082.40000,Amish/Mennonite,Amish Mennonite,,1205.60,,,,,,,1205.60,5271.00,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,inpatient,1,mL,7.93000,7.54000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,4.36,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230760,NDC,facility,outpatient,1,mL,7.93000,7.54000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,0.19995,7.69,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,inpatient,1,mL,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230801,NDC,facility,outpatient,1,mL,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,0.19995,3.19,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,inpatient,1,mL,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
MIDAZOLAM SOLN PF 5 MG/ML,59667,CDM,250,RC,J2250,HCPCS,00409230849,NDC,facility,outpatient,1,mL,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,0.19995,3.15,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,inpatient,1,mL,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,3.20,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00409272001,NDC,facility,outpatient,1,mL,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,0.33945,5.64,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,inpatient,1,mL,6.47000,6.14000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,00641039112,NDC,facility,outpatient,1,mL,6.47000,6.14000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,0.33945,6.28,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,inpatient,1,mL,12.23000,11.62000,Amish/Mennonite,Amish Mennonite,,6.73,,,,,,,6.73,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63323054013,NDC,facility,outpatient,1,mL,12.23000,11.62000,Amish/Mennonite,Amish Mennonite,,6.73,,,,,,,0.33945,11.86,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,inpatient,1,mL,6.03000,5.73000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,3.32,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092011,NDC,facility,outpatient,1,mL,6.03000,5.73000,Amish/Mennonite,Amish Mennonite,,3.32,,,,,,,0.33945,5.85,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,inpatient,1,mL,7.93000,7.54000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,4.36,7.69,percent of total billed charges,
HEPARIN 1000 UNITS/ML SOLN,59669,CDM,250,RC,J1644,HCPCS,63739092025,NDC,facility,outpatient,1,mL,7.93000,7.54000,Amish/Mennonite,Amish Mennonite,,4.36,,,,,,,0.33945,7.69,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
VANCOMYCIN/NS SOLN SD 5 MG/ML,59670,CDM,250,RC,J3370,HCPCS,6745703395000500,NDC,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,3.24,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,inpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,295.90,521.86,percent of total billed charges,
DRESS/DEBRIDEMENT LG,59676,CDM,450,RC,16030,CPT,,,facility,outpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,269.00,521.86,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,inpatient,,,3127.00000,2970.65000,Amish/Mennonite,Amish Mennonite,,1719.85,,,,,,,1719.85,3033.19,percent of total billed charges,
AMPUTATION W/CLOSURE FINGER/THUMB,59677,CDM,450,RC,26951,CPT,,,facility,outpatient,,,3127.00000,2970.65000,Amish/Mennonite,Amish Mennonite,,1719.85,,,,,,,1563.50,3388.98,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,inpatient,,,2098.00000,1993.10000,Amish/Mennonite,Amish Mennonite,,1153.90,,,,,,,1153.90,2035.06,percent of total billed charges,
NURSERY CHARGE LEVEL 4,59678,CDM,231,RC,,,,,facility,outpatient,,,2098.00000,1993.10000,Amish/Mennonite,Amish Mennonite,,1153.90,,,,,,,1049.00,2035.06,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
MISOPROSTOL TAB 50MCG,59679,CDM,250,RC,J8499,HCPCS,5976250070100050,NDC,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,inpatient,1,GM,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (EQV-DERMOPLAST),59680,CDM,250,RC,63029-8504-01,NDC,,,facility,outpatient,1,GM,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,inpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,218.35,385.09,percent of total billed charges,
"INCISION AND REMOVAL OF FOREIGN BODY, SKIN-TECH",59695,CDM,361,RC,,,,,facility,outpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,,218.35,,,,,,,218.35,5271.00,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,inpatient,1,mL,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092123847,NDC,facility,outpatient,1,mL,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.39,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,inpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML SYRINGE,59696,CDM,250,RC,J0690,HCPCS,70092160447,NDC,facility,outpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,23155-0532-01,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,50111-0901-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,61748-0025-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ETHOSUXIMIDE 250 MG CAP,59697,CDM,250,RC,69452-0152-20,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,80681-0057-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
NIACIN 100. MG TAB,59698,CDM,250,RC,50268-0582-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,inpatient,1,EA,126.59000,120.26000,Amish/Mennonite,Amish Mennonite,,69.62,,,,,,,69.62,122.79,percent of total billed charges,
LIDOCAINE CREAM 4% KIT,59699,CDM,250,RC,00496-0882-07,NDC,,,facility,outpatient,1,EA,126.59000,120.26000,Amish/Mennonite,Amish Mennonite,,69.62,,,,,,,63.30,122.79,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00223-1760-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,00904-7239-61,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,69367-0220-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
SODIUM CHLORIDE 1. GM TAB,59701,CDM,250,RC,77333-0844-10,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,00904-6442-61,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,23155-0834-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,31722-0521-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,50111-0328-01,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,51079-0076-20,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,inpatient,1,EA,0.97000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,62584-0734-01,NDC,,,facility,outpatient,1,EA,0.97000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0127-10,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,63739-0328-10,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
HYDRALAZINE 50 MG TAB,59702,CDM,250,RC,76282-0311-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,inpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.43,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,00378633380,NDC,facility,outpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.30,2.52,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,inpatient,1,EA,7.14000,6.78000,Amish/Mennonite,Amish Mennonite,,3.93,,,,,,,3.93,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,60687012125,NDC,facility,outpatient,1,EA,7.14000,6.78000,Amish/Mennonite,Amish Mennonite,,3.93,,,,,,,3.57,6.93,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,inpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
ACAMPROSATE TAB-EC 333 MG,59718,CDM,250,RC,J8499,HCPCS,68462043518,NDC,facility,outpatient,1,EA,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.37,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,inpatient,1,EA,3.34000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.24,percent of total billed charges,
ACARBOSE TAB 50 MG,59720,CDM,250,RC,J8499,HCPCS,50419086148,NDC,facility,outpatient,1,EA,3.34000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.67,3.24,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,31722055760,NDC,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,inpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
ABACAVIR TAB 300 MG,59723,CDM,250,RC,J8499,HCPCS,69097051403,NDC,facility,outpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,inpatient,1,mL,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.72,percent of total billed charges,
ACETIC ACID OTIC 2% SOL 15 ML,59724,CDM,250,RC,60432-0741-16,NDC,,,facility,outpatient,1,mL,5.90000,5.60000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,2.95,5.72,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,inpatient,1,mL,13.23000,12.57000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,7.28,12.83,percent of total billed charges,
CODEINE-ACETAMINOPHEN LIQ 2.4 MG-24 MG/ML,59727,CDM,250,RC,J8499,HCPCS,00187000301,NDC,facility,outpatient,1,mL,13.23000,12.57000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,6.62,12.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,47781-0176-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-0762-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,00527-1502-37,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,11534-0192-01,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,13107-0070-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0804-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,16714-0950-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,42806-0341-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,57664-0643-08,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64720-0132-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 10 MG,59728,CDM,250,RC,64850-0502-01,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
ACETIC ACID SOLN-IRR 0.25% 250 ML,59729,CDM,250,RC,00990-6143-22,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-20,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00067-2000-24,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
ACETAMINOPHEN-ASPIRIN-CAFFEINE TAB 250 MG-250 MG-65 MG,59730,CDM,250,RC,00536-1326-01,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,inpatient,1,mL,31.25000,29.69000,Amish/Mennonite,Amish Mennonite,,17.19,,,,,,,17.19,30.31,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL/D5W SD 2 MG/ML,59731,CDM,636,RC,J0289,HCPCS,0046930513000200,NDC,facility,outpatient,1,mL,31.25000,29.69000,Amish/Mennonite,Amish Mennonite,,17.19,,,,,,,15.62,39.57,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,inpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00093226401,NDC,facility,outpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,2.01,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928501,NDC,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,00143928520,NDC,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,65862001501,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
AMOXICILLIN TAB 875 MG,59734,CDM,250,RC,J8499,HCPCS,57237002920,NDC,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,inpatient,1,GM,154.10000,146.40000,Amish/Mennonite,Amish Mennonite,,84.75,,,,,,,84.75,149.48,percent of total billed charges,
ACYCLOVIR OINT 5% 30 GM,59735,CDM,250,RC,00187-0993-95,NDC,,,facility,outpatient,1,GM,154.10000,146.40000,Amish/Mennonite,Amish Mennonite,,84.75,,,,,,,77.05,149.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00406-0124-62,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,00904-6420-61,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,13107-0020-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,50268-0400-15,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,inpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-7.5 MG,59736,CDM,250,RC,57664-0170-88,NDC,,,facility,outpatient,1,EA,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,inpatient,1,EA,149.05000,141.60000,Amish/Mennonite,Amish Mennonite,,81.98,,,,,,,81.98,144.58,percent of total billed charges,
ADEFOVIR TAB 10 MG,59737,CDM,250,RC,J8499,HCPCS,61958050101,NDC,facility,outpatient,1,EA,149.05000,141.60000,Amish/Mennonite,Amish Mennonite,,81.98,,,,,,,74.53,144.58,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00406-0125-62,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,00904-6825-61,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,27808-0037-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,50268-0402-15,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,inpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,51079-0779-21,NDC,,,facility,outpatient,1,EA,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,53746-0110-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE TAB 325 MG-10 MG,59738,CDM,250,RC,60687-0418-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,13107005801,NDC,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 15 MG-300 MG,59739,CDM,250,RC,J8499,HCPCS,00406048301,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,inpatient,1,GM,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,45802008801,NDC,facility,outpatient,1,GM,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,inpatient,1,GM,13.38000,12.71000,Amish/Mennonite,Amish Mennonite,,7.36,,,,,,,7.36,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,68180096301,NDC,facility,outpatient,1,GM,13.38000,12.71000,Amish/Mennonite,Amish Mennonite,,7.36,,,,,,,0.11935,12.98,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,inpatient,1,GM,10.01000,9.51000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.51,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00173068220,NDC,facility,outpatient,1,GM,10.01000,9.51000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,0.11935,9.71,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,inpatient,1,GM,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,9.33,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,00781729685,NDC,facility,outpatient,1,GM,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,0.11935,16.46,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,inpatient,1,GM,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,66993001968,NDC,facility,outpatient,1,GM,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.11935,6.13,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,inpatient,1,GM,12.25000,11.64000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,6.74,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,69097014260,NDC,facility,outpatient,1,GM,12.25000,11.64000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,0.11935,11.88,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,inpatient,1,GM,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
ALBUTEROL INHALER 90 MCG/INH (200 DOSE),59741,CDM,250,RC,J7613,HCPCS,76282067942,NDC,facility,outpatient,1,GM,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,0.11935,4.10,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,inpatient,1,EA,8081.09000,7677.04000,Amish/Mennonite,Amish Mennonite,,4444.60,,,,,,,4444.60,7838.66,percent of total billed charges,
"ALDESLEUKIN POWD-INJ 22,000,000 UNIT",59742,CDM,636,RC,J9015,HCPCS,65483011607,NDC,facility,outpatient,1,EA,8081.09000,7677.04000,Amish/Mennonite,Amish Mennonite,,4444.60,,,,,,,4040.55,8747.08,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,inpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,31722077701,NDC,facility,outpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,3172207780100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,50268006115,NDC,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,inpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,61442011201,NDC,facility,outpatient,1,EA,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
ACYCLOVIR TAB 400 MG,59743,CDM,250,RC,J8499,HCPCS,68084010801,NDC,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ACETAZOLAMIDE SUSP SD 25 MG/ML,59744,CDM,250,RC,J1120,HCPCS,5167240220102500,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,31.64,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,51672402201,NDC,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
ACETAZOLAMIDE TAB 125 MG,59745,CDM,250,RC,J8499,HCPCS,64380083306,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,00904673151,NDC,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,49348014010,NDC,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE TAB 500 MG-25 MG,59746,CDM,250,RC,J8499,HCPCS,57896022405,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,inpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00406-8893-01,NDC,,,facility,outpatient,1,EA,3.65000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.82,3.54,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00527-1505-37,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,00555-0973-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,13107-0073-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,16714-0953-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,42806-0344-01,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,47781-0179-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64720-0135-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 20 MG,59747,CDM,250,RC,64850-0505-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
AMPICILLIN CAP 250 MG,59749,CDM,250,RC,67253-0180-10,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE SUSP SD 0.2 MG/ML,59750,CDM,250,RC,J0285,HCPCS,3982210550500020,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,83.12,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,29300015519,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,47335095688,NDC,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
ALFUZOSIN TAB-ER 10 MG,59751,CDM,250,RC,J8499,HCPCS,57237011490,NDC,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
ALLOPURINOL TAB 150 MG,59753,CDM,250,RC,J8499,HCPCS,5107902060100050,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,inpatient,1,mL,2.06000,1.96000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,2.00,percent of total billed charges,
ALBUMIN HUMAN SOLN 5% 50 ML,59754,CDM,250,RC,P9045,HCPCS,68516521405,NDC,facility,outpatient,1,mL,2.06000,1.96000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.03,88.11,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,43598045202,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,63.20,122.61,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,inpatient,1,EA,264.15000,250.94000,Amish/Mennonite,Amish Mennonite,,145.28,,,,,,,145.28,256.23,percent of total billed charges,
ALBENDAZOLE TAB 200 MG,59755,CDM,250,RC,J8499,HCPCS,52054055028,NDC,facility,outpatient,1,EA,264.15000,250.94000,Amish/Mennonite,Amish Mennonite,,145.28,,,,,,,132.07,256.23,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,inpatient,1,EA,4.43000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,00904704206,NDC,facility,outpatient,1,EA,4.43000,4.21000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.21,4.30,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,16571083401,NDC,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,inpatient,1,EA,6.31000,5.99000,Amish/Mennonite,Amish Mennonite,,3.47,,,,,,,3.47,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,50268006915,NDC,facility,outpatient,1,EA,6.31000,5.99000,Amish/Mennonite,Amish Mennonite,,3.47,,,,,,,3.15,6.12,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,inpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
AMANTADINE CAP 100 MG,59756,CDM,250,RC,J8499,HCPCS,62332024631,NDC,facility,outpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,inpatient,1,mL,23.23000,22.07000,Amish/Mennonite,Amish Mennonite,,12.78,,,,,,,12.78,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,17478044708,NDC,facility,outpatient,1,mL,23.23000,22.07000,Amish/Mennonite,Amish Mennonite,,12.78,,,,,,,11.62,22.53,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,inpatient,1,mL,33.95000,32.25000,Amish/Mennonite,Amish Mennonite,,18.67,,,,,,,18.67,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,49411005208,NDC,facility,outpatient,1,mL,33.95000,32.25000,Amish/Mennonite,Amish Mennonite,,18.67,,,,,,,16.98,32.93,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,inpatient,1,mL,9.47000,8.99000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,52817081508,NDC,facility,outpatient,1,mL,9.47000,8.99000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.19,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,inpatient,1,mL,26.76000,25.43000,Amish/Mennonite,Amish Mennonite,,14.72,,,,,,,14.72,25.96,percent of total billed charges,
AMINOCAPROIC ACID  LIQ 0.25 GM/ML,59758,CDM,250,RC,J8499,HCPCS,69238159608,NDC,facility,outpatient,1,mL,26.76000,25.43000,Amish/Mennonite,Amish Mennonite,,14.72,,,,,,,13.38,25.96,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,inpatient,,,3442.00000,3269.90000,Amish/Mennonite,Amish Mennonite,,1893.10,,,,,,,1893.10,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,,,facility,outpatient,,,3442.00000,3269.90000,Amish/Mennonite,Amish Mennonite,,1893.10,,,,,,,1343.28,3338.74,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,712.25,1256.15,percent of total billed charges,
AMIFOSTINE 500 MG IV INJ,59759,CDM,636,RC,J0207,HCPCS,55390030803,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,647.50,1885.25,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,inpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
ACETAMINOPHEN-HYDROCODONE LIQ 21.7 MG-0.5 MG/ML 118 ML,59760,CDM,250,RC,64376-0640-40,NDC,,,facility,outpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,inpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,43598020451,NDC,facility,outpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,inpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020410,NDC,facility,outpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,inpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002601,NDC,facility,outpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,inpatient,1,mL,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,59651002675,NDC,facility,outpatient,1,mL,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.02,1.98,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,inpatient,1,mL,2.18000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006500,NDC,facility,outpatient,1,mL,2.18000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,inpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,60432006575,NDC,facility,outpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,inpatient,1,mL,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,72508020407,NDC,facility,outpatient,1,mL,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,inpatient,1,mL,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
AMOXICILLIN-CLAVULANATE LIQ 250 MG-62.5 MG/5 ML,59762,CDM,250,RC,J8499,HCPCS,81964020410,NDC,facility,outpatient,1,mL,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ALLOPURINOL SUSP SD 20 MG/ML,59763,CDM,250,RC,J8499,HCPCS,5107902051902000,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,inpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00378699252,NDC,facility,outpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,inpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,00487990425,NDC,facility,outpatient,1,mL,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.11935,1.36,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
ALBUTEROL NEB 1.25 MG/3 ML,59764,CDM,250,RC,J7613,HCPCS,76204001155,NDC,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.11935,0.61110,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
AMPICILLIN LIQ 50 MG/ML,59765,CDM,250,RC,67253-0183-20,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 360 MG/D5W 200 ML PREMIX,59767,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,4.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,inpatient,1,mL,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,00472008216,NDC,facility,outpatient,1,mL,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ACYCLOVIR LIQ 40 MG/ML,59768,CDM,250,RC,J8499,HCPCS,70954018810,NDC,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,inpatient,1,EA,11533.00000,10956.35000,Amish/Mennonite,Amish Mennonite,,6343.15,,,,,,,6343.15,11187.01,percent of total billed charges,
AGALSIDASE BETA 35 MG IV INJ,59769,CDM,636,RC,J0180,HCPCS,58468004001,NDC,facility,outpatient,1,EA,11533.00000,10956.35000,Amish/Mennonite,Amish Mennonite,,6343.15,,,,,,,230.26,11187.01,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,inpatient,1,mL,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
AMINO ACIDS 15% (AMINOSYN II SULFITE-FREE) SOLN,59770,CDM,250,RC,00409-7171-17,NDC,,,facility,outpatient,1,mL,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,inpatient,1,mL,40.61000,38.58000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,22.34,39.39,percent of total billed charges,
APRACLONIDINE SOLN-OPHTH 0.5% 5 ML,59773,CDM,250,RC,61314-0665-05,NDC,,,facility,outpatient,1,mL,40.61000,38.58000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,20.30,39.39,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,13107006001,NDC,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,00406048501,NDC,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,inpatient,1,EA,1.86000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
CODEINE-ACETAMINOPHEN TAB 60 MG-300 MG,59774,CDM,250,RC,J8499,HCPCS,68084037301,NDC,facility,outpatient,1,EA,1.86000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN POWD-INJ (PROLASTIN-C),59775,CDM,636,RC,J0256,HCPCS,13533070310,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,8.57,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
AMINO ACIDS 15% 1000 ML,59776,CDM,250,RC,00264-3200-55,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,inpatient,1,mL,540.41000,513.39000,Amish/Mennonite,Amish Mennonite,,297.23,,,,,,,297.23,524.20,percent of total billed charges,
ANAKINRA SOLN 100 MG/0.67 ML,59777,CDM,250,RC,66658-0234-07,NDC,,,facility,outpatient,1,mL,540.41000,513.39000,Amish/Mennonite,Amish Mennonite,,297.23,,,,,,,270.20,524.20,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
AMIKACIN/NS SOLN SD 5 MG/ML,59778,CDM,250,RC,J0278,HCPCS,0070390320300500,NDC,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,1.02,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,inpatient,1,mL,42.81000,40.67000,Amish/Mennonite,Amish Mennonite,,23.55,,,,,,,23.55,41.53,percent of total billed charges,
ACETIC ACID-HC SOLN-OTIC 2%-1% 10 ML,59780,CDM,250,RC,51672-3007-01,NDC,,,facility,outpatient,1,mL,42.81000,40.67000,Amish/Mennonite,Amish Mennonite,,23.55,,,,,,,21.41,41.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,inpatient,1,EA,15.50000,14.73000,Amish/Mennonite,Amish Mennonite,,8.53,,,,,,,8.53,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00115148701,NDC,facility,outpatient,1,EA,15.50000,14.73000,Amish/Mennonite,Amish Mennonite,,8.53,,,,,,,7.75,15.04,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,inpatient,1,EA,12.28000,11.67000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00228305911,NDC,facility,outpatient,1,EA,12.28000,11.67000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,00527551137,NDC,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,66993059502,NDC,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,31722018601,NDC,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,42858061001,NDC,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,inpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,54092038301,NDC,facility,outpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 10 MG,59781,CDM,250,RC,J8499,HCPCS,64850051101,NDC,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,inpatient,1,EA,8.46000,8.04000,Amish/Mennonite,Amish Mennonite,,4.65,,,,,,,4.65,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781340295,NDC,facility,outpatient,1,EA,8.46000,8.04000,Amish/Mennonite,Amish Mennonite,,4.65,,,,,,,0.78449,8.21,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,inpatient,1,EA,10.58000,10.05000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,5.82,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,00781940295,NDC,facility,outpatient,1,EA,10.58000,10.05000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,0.78449,10.26,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,55150011110,NDC,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,0.78449,1.99,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,inpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.91,6.90,percent of total billed charges,
AMPICILLIN POWD-INJ 250 MG,59782,CDM,250,RC,J0290,HCPCS,65219001410,NDC,facility,outpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,0.78449,6.90,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,inpatient,1,mL,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
AMILORIDE SUSP SD 0.5 MG/ML,59783,CDM,250,RC,J8499,HCPCS,4988401170100050,NDC,facility,outpatient,1,mL,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,inpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
AMILORIDE-HYDROCHLOROTHIAZIDE TAB 5 MG-50 MG,59784,CDM,250,RC,J8499,HCPCS,00378057701,NDC,facility,outpatient,1,EA,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,inpatient,1,EA,12.26000,11.65000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,6.74,11.89,percent of total billed charges,
ANTITHROMBIN III  POWD-INJ 500 UNIT(S),59785,CDM,636,RC,J7197,HCPCS,13533060320,NDC,facility,outpatient,1,EA,12.26000,11.65000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,4.09,11.89,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,inpatient,1,mL,16.95000,16.10000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,9.32,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00409193202,NDC,facility,outpatient,1,mL,16.95000,16.10000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,0.59830,16.44,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,inpatient,1,mL,13.45000,12.77000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,7.40,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,00703877701,NDC,facility,outpatient,1,mL,13.45000,12.77000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,0.59830,13.05,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,inpatient,1,mL,16.54000,15.72000,Amish/Mennonite,Amish Mennonite,,9.10,,,,,,,9.10,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,16714099701,NDC,facility,outpatient,1,mL,16.54000,15.72000,Amish/Mennonite,Amish Mennonite,,9.10,,,,,,,0.59830,16.04,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,inpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,23155025832,NDC,facility,outpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,0.59830,9.81,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,inpatient,1,mL,20.44000,19.42000,Amish/Mennonite,Amish Mennonite,,11.24,,,,,,,11.24,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,63323065130,NDC,facility,outpatient,1,mL,20.44000,19.42000,Amish/Mennonite,Amish Mennonite,,11.24,,,,,,,0.59830,19.83,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,inpatient,1,mL,20.65000,19.61000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,11.36,20.03,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 30 ML,59786,CDM,250,RC,J0153,HCPCS,67457085930,NDC,facility,outpatient,1,mL,20.65000,19.61000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,0.59830,20.03,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,inpatient,1,EA,19.82000,18.82000,Amish/Mennonite,Amish Mennonite,,10.90,,,,,,,10.90,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245014530,NDC,facility,outpatient,1,EA,19.82000,18.82000,Amish/Mennonite,Amish Mennonite,,10.90,,,,,,,9.91,19.23,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,inpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,00245164530,NDC,facility,outpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,inpatient,1,EA,12.31000,11.69000,Amish/Mennonite,Amish Mennonite,,6.77,,,,,,,6.77,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,16714084501,NDC,facility,outpatient,1,EA,12.31000,11.69000,Amish/Mennonite,Amish Mennonite,,6.77,,,,,,,6.16,11.94,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,inpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51672405706,NDC,facility,outpatient,1,EA,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,inpatient,1,EA,11.08000,10.53000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,6.09,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,51862024230,NDC,facility,outpatient,1,EA,11.08000,10.53000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,5.54,10.75,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,inpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.31,4.07,percent of total billed charges,
AMIODARONE TAB 400 MG,59789,CDM,250,RC,J8499,HCPCS,72888006130,NDC,facility,outpatient,1,EA,4.20000,3.99000,Amish/Mennonite,Amish Mennonite,,2.31,,,,,,,2.10,4.07,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,53746-0617-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ACETAMINOPHEN-TRAMADOL TAB 325 MG-37.5 MG,59790,CDM,250,RC,68084-0825-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,inpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.84,percent of total billed charges,
ANTIHEMOPHILIC FACTOR RECOMBINANT-FACTOR VIII POWD-INJ (KOGENATE FS),59791,CDM,636,RC,J7192,HCPCS,00026378665,NDC,facility,outpatient,1,EA,4.99000,4.74000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,1.54,4.84,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,00536-1143-97,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
AQUAPHOR OINT 105 GM,59792,CDM,250,RC,72140-0032-63,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00245-0023-22,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,00904-5984-26,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,45802-0419-54,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,51672-1300-05,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
AMMONIUM LACTATE LOT 12%,59793,CDM,250,RC,92771-0612-08,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
AMLODIPINE SUSP SD 1 MG/ML,59794,CDM,250,RC,51079-0450-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,31722-0195-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 30 MG,59795,CDM,250,RC,54092-0391-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,11.26,21.83,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,inpatient,1,EA,8343.84000,7926.65000,Amish/Mennonite,Amish Mennonite,,4589.11,,,,,,,4589.11,8093.52,percent of total billed charges,
"ASPARAGINASE ERWINIA CHRYSANTHEMI POWD-INJ 10,000 UNIT",59796,CDM,250,RC,J9019,HCPCS,57902024905,NDC,facility,outpatient,1,EA,8343.84000,7926.65000,Amish/Mennonite,Amish Mennonite,,4589.11,,,,,,,709.27,8093.52,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,inpatient,1,mL,17.85000,16.95000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,9.82,17.31,percent of total billed charges,
ARIPIPRAZOLE LIQ 1 MG/ML,59797,CDM,250,RC,J8499,HCPCS,65162089374,NDC,facility,outpatient,1,mL,17.85000,16.95000,Amish/Mennonite,Amish Mennonite,,9.82,,,,,,,8.93,17.31,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
AMIODARONE SUSP SD 5 MG/ML,59798,CDM,250,RC,63739-0387-10-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,inpatient,1,EA,494.41000,469.68000,Amish/Mennonite,Amish Mennonite,,271.93,,,,,,,271.93,479.58,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 100 MG,59799,CDM,250,RC,J0348,HCPCS,00049011628,NDC,facility,outpatient,1,EA,494.41000,469.68000,Amish/Mennonite,Amish Mennonite,,271.93,,,,,,,0.73160,479.58,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
ACETAMINOPHEN-CAFFEINE TAB 500 MG-65 MG,59802,CDM,250,RC,00067-8139-01,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,inpatient,1,EA,15.58000,14.80000,Amish/Mennonite,Amish Mennonite,,8.57,,,,,,,8.57,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0762-02,NDC,,,facility,outpatient,1,EA,15.58000,14.80000,Amish/Mennonite,Amish Mennonite,,8.57,,,,,,,7.79,15.11,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,inpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,00555-0971-02,NDC,,,facility,outpatient,1,EA,2.74000,2.60000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,13107-0068-01,NDC,,,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,inpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,16714-0948-01,NDC,,,facility,outpatient,1,EA,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,42806-0339-01,NDC,,,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,inpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64720-0130-10,NDC,,,facility,outpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.82,3.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,64850-0500-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE TAB 5 MG,59803,CDM,250,RC,72516-0016-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ACYCLOVIR/D5W SOLN SD 7 MG/ML,59804,CDM,250,RC,J0133,HCPCS,6332303251000700,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.04803,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
AMPHOTERICIN B DEOXYCHOLATE/D5W SOLN SD 0.1 MG/ML,59805,CDM,250,RC,J0285,HCPCS,3982210550500010,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,83.12,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
AMPICILLIN SOLN SD 100 MG/ML,59806,CDM,250,RC,00781-3407-95-10000,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,inpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.02,percent of total billed charges,
ANTIHEMOPHILIC FACTOR-VON WILLEBRAND FACTOR POWD-INJ (HUMATE-P),59808,CDM,636,RC,J7187,HCPCS,63833061702,NDC,facility,outpatient,1,EA,4.14000,3.93000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,1.49,4.02,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,inpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,43598055730,NDC,facility,outpatient,1,EA,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,inpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,16714078601,NDC,facility,outpatient,1,EA,3.64000,3.46000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.82,3.53,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,inpatient,1,EA,93.95000,89.25000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,51.67,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,59148000935,NDC,facility,outpatient,1,EA,93.95000,89.25000,Amish/Mennonite,Amish Mennonite,,51.67,,,,,,,46.98,91.13,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,inpatient,1,EA,29.95000,28.45000,Amish/Mennonite,Amish Mennonite,,16.47,,,,,,,16.47,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,60687019121,NDC,facility,outpatient,1,EA,29.95000,28.45000,Amish/Mennonite,Amish Mennonite,,16.47,,,,,,,14.97,29.05,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,inpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65162089903,NDC,facility,outpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,65862066430,NDC,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
ARIPIPRAZOLE TAB 15 MG,59809,CDM,250,RC,J8499,HCPCS,72865018330,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,inpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-01,NDC,,,facility,outpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,inpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00023-0798-15,NDC,,,facility,outpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,inpatient,1,mL,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-36,NDC,,,facility,outpatient,1,mL,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,inpatient,1,mL,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00065-0426-37,NDC,,,facility,outpatient,1,mL,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,inpatient,1,mL,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00536-1325-94,NDC,,,facility,outpatient,1,mL,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,inpatient,1,mL,67.32000,63.95000,Amish/Mennonite,Amish Mennonite,,37.03,,,,,,,37.03,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,00998-0408-15,NDC,,,facility,outpatient,1,mL,67.32000,63.95000,Amish/Mennonite,Amish Mennonite,,37.03,,,,,,,33.66,65.30,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,49348-0095-29,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,50268-0043-15,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,inpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,57896-0181-05,NDC,,,facility,outpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,inpatient,1,mL,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,58790-0001-15,NDC,,,facility,outpatient,1,mL,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,70677-1157-01,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
ARTIFICIAL TEARS SOLN-OPHTH 15 ML,59810,CDM,250,RC,74300-0010-67,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,inpatient,1,mL,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,00173-0665-18,NDC,,,facility,outpatient,1,mL,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,21.34,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,10702-0223-21,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.04,5.91,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,inpatient,1,mL,10.92000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,6.01,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,16714-0900-01,NDC,,,facility,outpatient,1,mL,10.92000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,5.46,10.59,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,inpatient,1,mL,6.02000,5.72000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,3.31,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,31722-0629-21,NDC,,,facility,outpatient,1,mL,6.02000,5.72000,Amish/Mennonite,Amish Mennonite,,3.31,,,,,,,3.01,5.84,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,inpatient,1,mL,16.59000,15.76000,Amish/Mennonite,Amish Mennonite,,9.12,,,,,,,9.12,16.09,percent of total billed charges,
ATOVAQUONE LIQ 150 MG/ML,59811,CDM,250,RC,65162-0693-88,NDC,,,facility,outpatient,1,mL,16.59000,15.76000,Amish/Mennonite,Amish Mennonite,,9.12,,,,,,,8.29,16.09,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,inpatient,1,EA,1.64000,1.55000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
AMPICILLIN CAP 500 MG,59812,CDM,250,RC,00781-2145-01,NDC,,,facility,outpatient,1,EA,1.64000,1.55000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,inpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.75900,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00093309056,NDC,facility,outpatient,1,EA,1.38000,1.31000,Amish/Mennonite,Amish Mennonite,,0.75900,,,,,,,0.69000,1.34,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,inpatient,1,EA,18.36000,17.44000,Amish/Mennonite,Amish Mennonite,,10.10,,,,,,,10.10,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,00378343193,NDC,facility,outpatient,1,EA,18.36000,17.44000,Amish/Mennonite,Amish Mennonite,,10.10,,,,,,,9.18,17.81,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,inpatient,1,EA,25.47000,24.20000,Amish/Mennonite,Amish Mennonite,,14.01,,,,,,,14.01,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,63459020530,NDC,facility,outpatient,1,EA,25.47000,24.20000,Amish/Mennonite,Amish Mennonite,,14.01,,,,,,,12.73,24.71,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,inpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
ARMODAFINIL TAB 50 MG,59813,CDM,250,RC,J8499,HCPCS,65862080530,NDC,facility,outpatient,1,EA,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,00002-3239-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,inpatient,1,EA,20.34000,19.32000,Amish/Mennonite,Amish Mennonite,,11.19,,,,,,,11.19,19.73,percent of total billed charges,
ATOMOXETINE CAP 60 MG,59814,CDM,250,RC,68462-0269-30,NDC,,,facility,outpatient,1,EA,20.34000,19.32000,Amish/Mennonite,Amish Mennonite,,11.19,,,,,,,10.17,19.73,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,inpatient,1,EA,800.41000,760.39000,Amish/Mennonite,Amish Mennonite,,440.23,,,,,,,440.23,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,00469305130,NDC,facility,outpatient,1,EA,800.41000,760.39000,Amish/Mennonite,Amish Mennonite,,440.23,,,,,,,22.62,776.40,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,inpatient,1,EA,659.80000,626.81000,Amish/Mennonite,Amish Mennonite,,362.89,,,,,,,362.89,640.01,percent of total billed charges,
AMPHOTERICIN B LIPOSOMAL POWD-INJ 50 MG,59816,CDM,636,RC,J0289,HCPCS,62756023301,NDC,facility,outpatient,1,EA,659.80000,626.81000,Amish/Mennonite,Amish Mennonite,,362.89,,,,,,,22.62,640.01,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,inpatient,1,EA,8073.00000,7669.35000,Amish/Mennonite,Amish Mennonite,,4440.15,,,,,,,4440.15,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,00143953301,NDC,facility,outpatient,1,EA,8073.00000,7669.35000,Amish/Mennonite,Amish Mennonite,,4440.15,,,,,,,4.54,7830.81,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,inpatient,1,EA,1258.61000,1195.68000,Amish/Mennonite,Amish Mennonite,,692.24,,,,,,,692.24,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,55390010601,NDC,facility,outpatient,1,EA,1258.61000,1195.68000,Amish/Mennonite,Amish Mennonite,,692.24,,,,,,,4.54,1220.85,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,inpatient,1,EA,8253.21000,7840.55000,Amish/Mennonite,Amish Mennonite,,4539.27,,,,,,,4539.27,8005.61,percent of total billed charges,
ALLOPURINOL POWD-INJ 500 MG,59818,CDM,636,RC,J0206,HCPCS,67457018750,NDC,facility,outpatient,1,EA,8253.21000,7840.55000,Amish/Mennonite,Amish Mennonite,,4539.27,,,,,,,4.54,8005.61,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,inpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,156.42,275.87,percent of total billed charges,
ANIDULAFUNGIN POWD-INJ 50 MG,59819,CDM,250,RC,J0348,HCPCS,00049011428,NDC,facility,outpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,0.73160,275.87,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,inpatient,1,mL,11.66000,11.08000,Amish/Mennonite,Amish Mennonite,,6.41,,,,,,,6.41,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00641616710,NDC,facility,outpatient,1,mL,11.66000,11.08000,Amish/Mennonite,Amish Mennonite,,6.41,,,,,,,0.93155,11.31,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,inpatient,1,mL,19.36000,18.39000,Amish/Mennonite,Amish Mennonite,,10.65,,,,,,,10.65,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,00703903203,NDC,facility,outpatient,1,mL,19.36000,18.39000,Amish/Mennonite,Amish Mennonite,,10.65,,,,,,,0.93155,18.78,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,inpatient,1,mL,8.71000,8.28000,Amish/Mennonite,Amish Mennonite,,4.79,,,,,,,4.79,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,23155078541,NDC,facility,outpatient,1,mL,8.71000,8.28000,Amish/Mennonite,Amish Mennonite,,4.79,,,,,,,0.93155,8.45,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,inpatient,1,mL,18.41000,17.49000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,10.13,17.86,percent of total billed charges,
AMIKACIN SOLN 250 MG/ML 2 ML,59821,CDM,250,RC,J0278,HCPCS,63323081502,NDC,facility,outpatient,1,mL,18.41000,17.49000,Amish/Mennonite,Amish Mennonite,,10.13,,,,,,,0.93155,17.86,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,inpatient,1,EA,1024.57000,973.34000,Amish/Mennonite,Amish Mennonite,,563.51,,,,,,,563.51,993.83,percent of total billed charges,
CEFTAZIDIME-AVIBACTAM POWD-INJ 2.5 GM,59822,CDM,636,RC,J0714,HCPCS,00456270010,NDC,facility,outpatient,1,EA,1024.57000,973.34000,Amish/Mennonite,Amish Mennonite,,563.51,,,,,,,104.95,993.83,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,inpatient,1,EA,2067.60000,1964.22000,Amish/Mennonite,Amish Mennonite,,1137.18,,,,,,,1137.18,2005.57,percent of total billed charges,
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG,59823,CDM,636,RC,J7511,HCPCS,58468008001,NDC,facility,outpatient,1,EA,2067.60000,1964.22000,Amish/Mennonite,Amish Mennonite,,1137.18,,,,,,,996.39,2005.57,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
AMPICILLIN SOLN SD 250 MG/ML (IM DILUTION),59826,CDM,250,RC,J0295,HCPCS,6332303871025000,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,2.61,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,inpatient,1,mL,149.33000,141.87000,Amish/Mennonite,Amish Mennonite,,82.13,,,,,,,82.13,144.85,percent of total billed charges,
BACLOFEN 2000 MCG/ML SOLN PF 5 ML,59828,CDM,636,RC,J0475,HCPCS,58281056102,NDC,facility,outpatient,1,mL,149.33000,141.87000,Amish/Mennonite,Amish Mennonite,,82.13,,,,,,,74.67,290.17,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,inpatient,1,mL,9.36000,8.90000,Amish/Mennonite,Amish Mennonite,,5.15,,,,,,,5.15,9.08,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE LIQUID (EQV-DONNATAL),59829,CDM,250,RC,59212-0423-16,NDC,,,facility,outpatient,1,mL,9.36000,8.90000,Amish/Mennonite,Amish Mennonite,,5.15,,,,,,,4.68,9.08,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,inpatient,1,mL,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.90,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 10 ML,59830,CDM,250,RC,J3490,HCPCS,71288070210,NDC,facility,outpatient,1,mL,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.50,2.90,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,45802-0060-01,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,51672-2075-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,54162-0017-15,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,inpatient,1,GM,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
BACITRACIN OINT 500 UNITS/GM 15 GM,59831,CDM,250,RC,61269-0105-34,NDC,,,facility,outpatient,1,GM,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,inpatient,1,mL,177.67000,168.78000,Amish/Mennonite,Amish Mennonite,,97.72,,,,,,,97.72,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,14789060010,NDC,facility,outpatient,1,mL,177.67000,168.78000,Amish/Mennonite,Amish Mennonite,,97.72,,,,,,,5.86,172.34,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,inpatient,1,mL,187.70000,178.32000,Amish/Mennonite,Amish Mennonite,,103.23,,,,,,,103.23,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,63323063710,NDC,facility,outpatient,1,mL,187.70000,178.32000,Amish/Mennonite,Amish Mennonite,,103.23,,,,,,,5.86,182.07,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,inpatient,1,mL,119.78000,113.79000,Amish/Mennonite,Amish Mennonite,,65.88,,,,,,,65.88,116.19,percent of total billed charges,
ARSENIC TRIOXIDE SOLN 1 MG/ML 10 ML,59832,CDM,636,RC,J9017,HCPCS,68382099710,NDC,facility,outpatient,1,mL,119.78000,113.79000,Amish/Mennonite,Amish Mennonite,,65.88,,,,,,,5.86,116.19,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,00574029201,NDC,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,inpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.76,percent of total billed charges,
AMILORIDE TAB 5 MG,59833,CDM,250,RC,J8499,HCPCS,49884011701,NDC,facility,outpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.76,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
AMYL NITRITE 0.3 ML INH SOL,59835,CDM,250,RC,46414-2222-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
AMOXICILLIN TAB-CHEW 250 MG,59836,CDM,250,RC,00093-2268-01,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,inpatient,1,EA,2.71000,2.58000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,00603221521,NDC,facility,outpatient,1,EA,2.71000,2.58000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.63,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,70756020411,NDC,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,16714044901,NDC,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
AMITRIPTYLINE TAB 75 MG,59837,CDM,250,RC,J8499,HCPCS,50268004015,NDC,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
ATORVASTATIN TAB 5 MG,59838,CDM,250,RC,68084-0097-11-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,20555-0001-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
ASCORBIC ACID 250 MG TAB,59839,CDM,250,RC,50268-0860-15,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,inpatient,1,EA,83.83000,79.64000,Amish/Mennonite,Amish Mennonite,,46.11,,,,,,,46.11,81.32,percent of total billed charges,
ARMODAFINIL TAB 150 MG,59840,CDM,250,RC,J8499,HCPCS,63459021530,NDC,facility,outpatient,1,EA,83.83000,79.64000,Amish/Mennonite,Amish Mennonite,,46.11,,,,,,,41.91,81.32,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,inpatient,1,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,3.15,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,50268-0102-13,NDC,,,facility,outpatient,1,EA,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,2.86,5.55,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,inpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,9.69,17.09,percent of total billed charges,
BALSALAZIDE CAP 750 MG,59841,CDM,250,RC,65649-0101-02,NDC,,,facility,outpatient,1,EA,17.62000,16.74000,Amish/Mennonite,Amish Mennonite,,9.69,,,,,,,8.81,17.09,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,inpatient,1,mL,73.39000,69.72000,Amish/Mennonite,Amish Mennonite,,40.36,,,,,,,40.36,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,00037-7025-60,NDC,,,facility,outpatient,1,mL,73.39000,69.72000,Amish/Mennonite,Amish Mennonite,,40.36,,,,,,,36.70,71.19,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,inpatient,1,mL,26.33000,25.02000,Amish/Mennonite,Amish Mennonite,,14.48,,,,,,,14.48,25.54,percent of total billed charges,
AZELASTINE SOLN-OPHTH 0.05% 6 ML,59842,CDM,250,RC,60505-0578-04,NDC,,,facility,outpatient,1,mL,26.33000,25.02000,Amish/Mennonite,Amish Mennonite,,14.48,,,,,,,13.16,25.54,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,43547-0337-10,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,50268-0111-15,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 20 MG,59843,CDM,250,RC,65862-0117-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,inpatient,1,EA,12.28000,11.67000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.75,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00228-3062-11,NDC,,,facility,outpatient,1,EA,12.28000,11.67000,Amish/Mennonite,Amish Mennonite,,6.75,,,,,,,6.14,11.91,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,00527-5510-37,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,66993-0594-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,31722-0185-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,42858-0055-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,inpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,12.38,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,54092-0381-01,NDC,,,facility,outpatient,1,EA,22.51000,21.38000,Amish/Mennonite,Amish Mennonite,,12.38,,,,,,,11.26,21.83,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,64850-0510-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE CAP-ER 5 MG,59848,CDM,250,RC,70010-0029-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,inpatient,1,mL,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
ATRACURIUM SOLN 10 MG/ML 5 ML,59849,CDM,250,RC,J3490,HCPCS,55390010205,NDC,facility,outpatient,1,mL,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,inpatient,1,GM,193.93000,184.24000,Amish/Mennonite,Amish Mennonite,,106.66,,,,,,,106.66,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,00064-0810-15,NDC,,,facility,outpatient,1,GM,193.93000,184.24000,Amish/Mennonite,Amish Mennonite,,106.66,,,,,,,96.97,188.11,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,inpatient,1,GM,247.45000,235.08000,Amish/Mennonite,Amish Mennonite,,136.10,,,,,,,136.10,240.03,percent of total billed charges,
BECAPLERMIN GEL 0.01% 15 GM,59850,CDM,250,RC,50484-0810-15,NDC,,,facility,outpatient,1,GM,247.45000,235.08000,Amish/Mennonite,Amish Mennonite,,136.10,,,,,,,123.72,240.03,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
BENZOYL PEROXIDE GEL 2.5% 60 GM,59851,CDM,250,RC,45802-0101-96,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN SUSP SD 5 MG/ML,59852,CDM,250,RC,68084-0855-01-00500,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
AZITHROMYCIN/NS SOLN SD 2 MG/ML,59853,CDM,250,RC,J0456,HCPCS,6332303981000200,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,4.31,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,inpatient,1,EA,41.65000,39.57000,Amish/Mennonite,Amish Mennonite,,22.91,,,,,,,22.91,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,00002-3228-30,NDC,,,facility,outpatient,1,EA,41.65000,39.57000,Amish/Mennonite,Amish Mennonite,,22.91,,,,,,,20.82,40.40,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,inpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,42291-0066-30,NDC,,,facility,outpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.17,4.20,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,55111-0528-30,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,inpatient,1,EA,5.14000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
ATOMOXETINE CAP 25 MG,59854,CDM,250,RC,64980-0375-03,NDC,,,facility,outpatient,1,EA,5.14000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,inpatient,1,mL,230.68000,219.15000,Amish/Mennonite,Amish Mennonite,,126.87,,,,,,,126.87,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,58281056201,NDC,facility,outpatient,1,mL,230.68000,219.15000,Amish/Mennonite,Amish Mennonite,,126.87,,,,,,,83.42,223.76,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,inpatient,1,mL,277.83000,263.94000,Amish/Mennonite,Amish Mennonite,,152.81,,,,,,,152.81,269.50,percent of total billed charges,
BACLOFEN SOLN PF 50 MCG/ML,59855,CDM,250,RC,J0476,HCPCS,66794015101,NDC,facility,outpatient,1,mL,277.83000,263.94000,Amish/Mennonite,Amish Mennonite,,152.81,,,,,,,83.42,269.50,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,inpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,24.89,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,00002-3229-30,NDC,,,facility,outpatient,1,EA,45.25000,42.99000,Amish/Mennonite,Amish Mennonite,,24.89,,,,,,,22.62,43.89,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,inpatient,1,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.35,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,42291-0067-30,NDC,,,facility,outpatient,1,EA,4.27000,4.05000,Amish/Mennonite,Amish Mennonite,,2.35,,,,,,,2.13,4.14,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,inpatient,1,EA,5.49000,5.21000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,3.02,5.33,percent of total billed charges,
ATOMOXETINE CAP 40 MG,59856,CDM,250,RC,68462-0268-30,NDC,,,facility,outpatient,1,EA,5.49000,5.21000,Amish/Mennonite,Amish Mennonite,,3.02,,,,,,,2.75,5.33,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,inpatient,1,GM,63.71000,60.52000,Amish/Mennonite,Amish Mennonite,,35.04,,,,,,,35.04,61.80,percent of total billed charges,
BECLOMETHASONE 40 MCG/INH INH AER W/ADAPT,59857,CDM,250,RC,59310-0302-40,NDC,,,facility,outpatient,1,GM,63.71000,60.52000,Amish/Mennonite,Amish Mennonite,,35.04,,,,,,,31.86,61.80,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,inpatient,1,mL,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,13.00,22.93,percent of total billed charges,
BETAMETHASONE SUSP INJ 6 MG/ML 2 ML,59863,CDM,250,RC,J0702,HCPCS,00085056605,NDC,facility,outpatient,1,mL,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,10.61,22.93,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,inpatient,1,EA,530.95000,504.40000,Amish/Mennonite,Amish Mennonite,,292.02,,,,,,,292.02,515.02,percent of total billed charges,
AZATHIOPRINE POWD-INJ 100 MG,59865,CDM,636,RC,J7501,HCPCS,55390060020,NDC,facility,outpatient,1,EA,530.95000,504.40000,Amish/Mennonite,Amish Mennonite,,292.02,,,,,,,224.97,515.02,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,inpatient,1,mL,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00093681573,NDC,facility,outpatient,1,mL,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,inpatient,1,mL,12.49000,11.87000,Amish/Mennonite,Amish Mennonite,,6.87,,,,,,,6.87,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031853,NDC,facility,outpatient,1,mL,12.49000,11.87000,Amish/Mennonite,Amish Mennonite,,6.87,,,,,,,1.85,12.12,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,inpatient,1,mL,7.51000,7.13000,Amish/Mennonite,Amish Mennonite,,4.13,,,,,,,4.13,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00487960130,NDC,facility,outpatient,1,mL,7.51000,7.13000,Amish/Mennonite,Amish Mennonite,,4.13,,,,,,,1.85,7.28,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,inpatient,1,mL,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,00781751587,NDC,facility,outpatient,1,mL,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,1.85,11.54,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,inpatient,1,mL,9.59000,9.11000,Amish/Mennonite,Amish Mennonite,,5.27,,,,,,,5.27,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,16714001830,NDC,facility,outpatient,1,mL,9.59000,9.11000,Amish/Mennonite,Amish Mennonite,,5.27,,,,,,,1.85,9.30,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,inpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,47335063149,NDC,facility,outpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,inpatient,1,mL,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,69097031887,NDC,facility,outpatient,1,mL,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,inpatient,1,mL,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
BUDESONIDE NEB 250 MCG/2 ML,59867,CDM,250,RC,J7626,HCPCS,76282064038,NDC,facility,outpatient,1,mL,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,00904-5983-48,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
AMMONIUM LACTATE CRM 12%,59869,CDM,250,RC,63044-0404-20,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,inpatient,1,GM,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZOYL PEROXIDE GEL 5% 42.5 GM,59870,CDM,250,RC,00536-4089-56,NDC,,,facility,outpatient,1,GM,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,inpatient,1,GM,17.98000,17.08000,Amish/Mennonite,Amish Mennonite,,9.89,,,,,,,9.89,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,00085-0517-01,NDC,,,facility,outpatient,1,GM,17.98000,17.08000,Amish/Mennonite,Amish Mennonite,,9.89,,,,,,,8.99,17.44,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,inpatient,1,GM,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 15 GM",59871,CDM,250,RC,45802-0376-35,NDC,,,facility,outpatient,1,GM,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,inpatient,1,EA,511.78000,486.19000,Amish/Mennonite,Amish Mennonite,,281.48,,,,,,,281.48,496.43,percent of total billed charges,
BUDESONIDE INHALER 90 MCG/INH,59875,CDM,250,RC,00186-0917-06,NDC,,,facility,outpatient,1,EA,511.78000,486.19000,Amish/Mennonite,Amish Mennonite,,281.48,,,,,,,255.89,496.43,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
BENZOYL PEROXIDE LIQ-TOP 5% 240 ML,59876,CDM,250,RC,67405-0825-08,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
"BETAMETHASONE DIPROP, AUGMENTED CRM 0.05% 50 GM",59877,CDM,250,RC,45802-0376-32,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,inpatient,1,EA,157.08000,149.23000,Amish/Mennonite,Amish Mennonite,,86.39,,,,,,,86.39,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00409033220,NDC,facility,outpatient,1,EA,157.08000,149.23000,Amish/Mennonite,Amish Mennonite,,86.39,,,,,,,33.41,152.37,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,inpatient,1,EA,180.75000,171.71000,Amish/Mennonite,Amish Mennonite,,99.41,,,,,,,99.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,00703315401,NDC,facility,outpatient,1,EA,180.75000,171.71000,Amish/Mennonite,Amish Mennonite,,99.41,,,,,,,33.41,175.33,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,inpatient,1,EA,121.63000,115.55000,Amish/Mennonite,Amish Mennonite,,66.90,,,,,,,66.90,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,16714088601,NDC,facility,outpatient,1,EA,121.63000,115.55000,Amish/Mennonite,Amish Mennonite,,66.90,,,,,,,33.41,117.98,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,inpatient,1,EA,159.45000,151.48000,Amish/Mennonite,Amish Mennonite,,87.70,,,,,,,87.70,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,61703033218,NDC,facility,outpatient,1,EA,159.45000,151.48000,Amish/Mennonite,Amish Mennonite,,87.70,,,,,,,33.41,154.67,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,inpatient,1,EA,104.66000,99.43000,Amish/Mennonite,Amish Mennonite,,57.56,,,,,,,57.56,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,63323013610,NDC,facility,outpatient,1,EA,104.66000,99.43000,Amish/Mennonite,Amish Mennonite,,57.56,,,,,,,33.41,101.52,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,inpatient,1,EA,96.95000,92.10000,Amish/Mennonite,Amish Mennonite,,53.32,,,,,,,53.32,94.04,percent of total billed charges,
BLEOMYCIN POWD-INJ 15 UNITS,59878,CDM,250,RC,J9040,HCPCS,71288010610,NDC,facility,outpatient,1,EA,96.95000,92.10000,Amish/Mennonite,Amish Mennonite,,53.32,,,,,,,33.41,94.04,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,inpatient,1,mL,17.10000,16.25000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,9.40,16.59,percent of total billed charges,
ASCORBIC ACID SOLN 500 MG/ML,59879,CDM,250,RC,J3490,HCPCS,67157010150,NDC,facility,outpatient,1,mL,17.10000,16.25000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,8.55,16.59,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,inpatient,1,EA,12.01000,11.41000,Amish/Mennonite,Amish Mennonite,,6.61,,,,,,,6.61,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,50383029493,NDC,facility,outpatient,1,EA,12.01000,11.41000,Amish/Mennonite,Amish Mennonite,,6.61,,,,,,,6.00,11.65,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
BUPRENORPHINE-NALOXONE TAB-DISINTEGRATING 2 MG-0.5 MG,59880,CDM,250,RC,J0572,HCPCS,63629948201,NDC,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,00168-0057-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,inpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
BETAMETHASONE DIPROPIONATE LOT 0.05%,59881,CDM,250,RC,45802-0021-46,NDC,,,facility,outpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,00168-0258-46,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,inpatient,1,GM,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,16714-0496-02,NDC,,,facility,outpatient,1,GM,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,inpatient,1,GM,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,51672-4048-06,NDC,,,facility,outpatient,1,GM,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,inpatient,1,GM,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
BETAMETHASONE-CLOTRIM CRM 0.05-1% 45 GM,59882,CDM,250,RC,68462-0298-55,NDC,,,facility,outpatient,1,GM,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,inpatient,1,GM,124.12000,117.92000,Amish/Mennonite,Amish Mennonite,,68.27,,,,,,,68.27,120.40,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 160 MCG-4.5 MCG/INH,59883,CDM,250,RC,00186-0370-28,NDC,,,facility,outpatient,1,GM,124.12000,117.92000,Amish/Mennonite,Amish Mennonite,,68.27,,,,,,,62.06,120.40,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,inpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
ARGININE 10% IV SOL 300 ML,59884,CDM,250,RC,J3490,HCPCS,00009043601,NDC,facility,outpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,inpatient,1,GM,9.43000,8.96000,Amish/Mennonite,Amish Mennonite,,5.19,,,,,,,5.19,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,00283-0871-31,NDC,,,facility,outpatient,1,GM,9.43000,8.96000,Amish/Mennonite,Amish Mennonite,,5.19,,,,,,,4.71,9.15,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
BENZOCAINE GEL 20% 30 GM,59885,CDM,250,RC,54162-0926-29,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-1315-46,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,00904-7205-46,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,49348-0953-44,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,69618-0029-03,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
BISMUTH SUBSALICYLATE TAB-CHEW 262 MG,59888,CDM,250,RC,70677-1080-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,00904-6019-46,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16714-0816-01,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.11,2.16,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,16729-0023-10,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
BICALUTAMIDE TAB 50 MG,59890,CDM,250,RC,47335-0485-83,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,00185-0774-30,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.40,2.71,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,29300-0127-13,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,inpatient,1,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
BISOPROLOL TAB 10 MG,59891,CDM,250,RC,59762-1261-01,NDC,,,facility,outpatient,1,EA,2.50000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,inpatient,1,mL,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,11.59,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,25021060203,NDC,facility,outpatient,1,mL,21.07000,20.01000,Amish/Mennonite,Amish Mennonite,,11.59,,,,,,,10.54,20.44,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,inpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,13.90,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,51754050303,NDC,facility,outpatient,1,mL,25.28000,24.02000,Amish/Mennonite,Amish Mennonite,,13.90,,,,,,,12.64,24.52,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,inpatient,1,mL,40.82000,38.78000,Amish/Mennonite,Amish Mennonite,,22.45,,,,,,,22.45,39.60,percent of total billed charges,
CAFFEINE CITRATE LIQ 20 MG/ML,59893,CDM,250,RC,J8499,HCPCS,63323040603,NDC,facility,outpatient,1,mL,40.82000,38.78000,Amish/Mennonite,Amish Mennonite,,22.45,,,,,,,20.41,39.60,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,inpatient,1,EA,2.87000,2.72000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,00378-0523-93,NDC,,,facility,outpatient,1,EA,2.87000,2.72000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.78,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,52817-0270-30,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
BISOPROLOL TAB 5 MG,59896,CDM,250,RC,50268-0127-15,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.04,percent of total billed charges,
BUDESONIDE INHALER 180 MCG/INH,59897,CDM,250,RC,00186-0916-12,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.12,6.04,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,inpatient,1,EA,4700.21000,4465.20000,Amish/Mennonite,Amish Mennonite,,2585.12,,,,,,,2585.12,4559.20,percent of total billed charges,
BELIMUMAB 400 MG POWD,59898,CDM,636,RC,J0490,HCPCS,49401010201,NDC,facility,outpatient,1,EA,4700.21000,4465.20000,Amish/Mennonite,Amish Mennonite,,2585.12,,,,,,,56.01,4559.20,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,inpatient,1,EA,3.71000,3.53000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,2.04,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00781-1064-01,NDC,,,facility,outpatient,1,EA,3.71000,3.53000,Amish/Mennonite,Amish Mennonite,,2.04,,,,,,,1.85,3.60,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.56,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,00904-6636-61,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.33,4.51,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,23155-0192-01,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,inpatient,1,EA,5.58000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,50268-0143-15,NDC,,,facility,outpatient,1,EA,5.58000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.41,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,51079-0944-20,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60505-0157-01,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,2.18,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,inpatient,1,EA,4.70000,4.47000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
BUPROPION TAB 100 MG,59899,CDM,250,RC,60687-0351-01,NDC,,,facility,outpatient,1,EA,4.70000,4.47000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.56,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 1000 ML,59900,CDM,250,RC,00942-0641-04,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00185-0128-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,00832-0540-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,16714-0831-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,42799-0119-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
BUMETANIDE TAB 0.5 MG,59901,CDM,250,RC,50268-0130-15,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,inpatient,1,EA,142.79000,135.65000,Amish/Mennonite,Amish Mennonite,,78.53,,,,,,,78.53,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00004110150,NDC,facility,outpatient,1,EA,142.79000,135.65000,Amish/Mennonite,Amish Mennonite,,78.53,,,,,,,0.05000,138.51,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,inpatient,1,EA,17.12000,16.26000,Amish/Mennonite,Amish Mennonite,,9.42,,,,,,,9.42,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,00054027223,NDC,facility,outpatient,1,EA,17.12000,16.26000,Amish/Mennonite,Amish Mennonite,,9.42,,,,,,,0.05000,16.61,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,inpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,1.98,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16714046801,NDC,facility,outpatient,1,EA,3.60000,3.42000,Amish/Mennonite,Amish Mennonite,,1.98,,,,,,,0.05000,3.49,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,inpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
CAPECITABINE TAB 500 MG,59902,CDM,250,RC,J8522,HCPCS,16729007329,NDC,facility,outpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,0.05000,3.12,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-1056-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,inpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BENZOYL PEROXIDE GEL 10% 42.5 GM,59904,CDM,250,RC,00536-4092-56,NDC,,,facility,outpatient,1,GM,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,00603-2439-21,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,68084-0389-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,69315-0138-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
BENZTROPINE TAB 2 MG,59905,CDM,250,RC,76385-0105-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,inpatient,1,EA,27.33000,25.96000,Amish/Mennonite,Amish Mennonite,,15.03,,,,,,,15.03,26.51,percent of total billed charges,
ATROPINE/HYOSCYAMINE/PB/SCOPOLAMINE TAB (EQV-DONNATAL),59906,CDM,250,RC,66213-0425-10,NDC,,,facility,outpatient,1,EA,27.33000,25.96000,Amish/Mennonite,Amish Mennonite,,15.03,,,,,,,13.66,26.51,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,00904-2533-21,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
CALAMINE-ZINC OXIDE LOT 8%-8% 180 ML,59907,CDM,250,RC,49348-0011-34,NDC,,,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,inpatient,1,EA,251.66000,239.08000,Amish/Mennonite,Amish Mennonite,,138.41,,,,,,,138.41,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00409830010,NDC,facility,outpatient,1,EA,251.66000,239.08000,Amish/Mennonite,Amish Mennonite,,138.41,,,,,,,0.23715,244.11,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,inpatient,1,EA,1245.79000,1183.50000,Amish/Mennonite,Amish Mennonite,,685.18,,,,,,,685.18,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781315894,NDC,facility,outpatient,1,EA,1245.79000,1183.50000,Amish/Mennonite,Amish Mennonite,,685.18,,,,,,,0.23715,1208.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,inpatient,1,EA,1424.50000,1353.27000,Amish/Mennonite,Amish Mennonite,,783.48,,,,,,,783.48,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,67457025610,NDC,facility,outpatient,1,EA,1424.50000,1353.27000,Amish/Mennonite,Amish Mennonite,,783.48,,,,,,,0.23715,1381.77,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,inpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,00781915895,NDC,facility,outpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,0.23715,229.89,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,inpatient,1,EA,226.21000,214.90000,Amish/Mennonite,Amish Mennonite,,124.42,,,,,,,124.42,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,16729027567,NDC,facility,outpatient,1,EA,226.21000,214.90000,Amish/Mennonite,Amish Mennonite,,124.42,,,,,,,0.23715,219.42,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,inpatient,1,EA,295.71000,280.93000,Amish/Mennonite,Amish Mennonite,,162.64,,,,,,,162.64,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,55111065237,NDC,facility,outpatient,1,EA,295.71000,280.93000,Amish/Mennonite,Amish Mennonite,,162.64,,,,,,,0.23715,286.84,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,inpatient,1,EA,1315.72000,1249.93000,Amish/Mennonite,Amish Mennonite,,723.65,,,,,,,723.65,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,63323056210,NDC,facility,outpatient,1,EA,1315.72000,1249.93000,Amish/Mennonite,Amish Mennonite,,723.65,,,,,,,0.23715,1276.25,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,inpatient,1,EA,280.13000,266.13000,Amish/Mennonite,Amish Mennonite,,154.07,,,,,,,154.07,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,70860040210,NDC,facility,outpatient,1,EA,280.13000,266.13000,Amish/Mennonite,Amish Mennonite,,154.07,,,,,,,0.23715,271.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,inpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,8.35,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,71288042711,NDC,facility,outpatient,1,EA,15.19000,14.43000,Amish/Mennonite,Amish Mennonite,,8.35,,,,,,,0.23715,14.73,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,inpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,156.42,275.87,percent of total billed charges,
BIVALIRUDIN POWD-INJ 250 MG,59909,CDM,250,RC,J0583,HCPCS,83634040010,NDC,facility,outpatient,1,EA,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,,156.42,,,,,,,0.23715,275.87,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,inpatient,1,mL,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,59148007091,NDC,facility,outpatient,1,mL,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,1.84,251.23,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,inpatient,1,mL,265.48000,252.20000,Amish/Mennonite,Amish Mennonite,,146.01,,,,,,,146.01,257.52,percent of total billed charges,
BUSULFAN SOLN 6 MG/ML 10 ML,59911,CDM,636,RC,J0594,HCPCS,70121124407,NDC,facility,outpatient,1,mL,265.48000,252.20000,Amish/Mennonite,Amish Mennonite,,146.01,,,,,,,1.84,257.52,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,inpatient,1,mL,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
CAFFEINE CITRATE SOLN SD 10 MG/ML,59912,CDM,250,RC,J0706,HCPCS,6332304070301000,NDC,facility,outpatient,1,mL,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00054017613,NDC,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,inpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00228315603,NDC,facility,outpatient,1,EA,4.32000,4.10000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.16,4.19,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,inpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,00378092393,NDC,facility,outpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,42858050103,NDC,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,inpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,50383092493,NDC,facility,outpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,inpatient,1,EA,6.45000,6.13000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.55,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,60687048121,NDC,facility,outpatient,1,EA,6.45000,6.13000,Amish/Mennonite,Amish Mennonite,,3.55,,,,,,,3.23,6.26,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,inpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,62756045983,NDC,facility,outpatient,1,EA,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
BUPRENORPHINE TAB-DISINTEGRATING 2 MG,59913,CDM,250,RC,J0571,HCPCS,72888018230,NDC,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,inpatient,1,GM,6.43000,6.11000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.54,6.24,percent of total billed charges,
CADEXOMER IODINE GEL 0.9% 40 GM,59915,CDM,250,RC,40565-0122-49,NDC,,,facility,outpatient,1,GM,6.43000,6.11000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.21,6.24,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,inpatient,1,GM,93.82000,89.13000,Amish/Mennonite,Amish Mennonite,,51.60,,,,,,,51.60,91.01,percent of total billed charges,
BUDESONIDE-FORMOTEROL INHALER 80 MCG-4.5 MCG/INH,59916,CDM,250,RC,00186-0372-28,NDC,,,facility,outpatient,1,GM,93.82000,89.13000,Amish/Mennonite,Amish Mennonite,,51.60,,,,,,,46.91,91.01,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
CALCIUM CARBONATE COMPOUNDING PWDR,59917,CDM,250,RC,00395-0431-01,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,inpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,42799-0120-01,NDC,,,facility,outpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,inpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00832-0541-11,NDC,,,facility,outpatient,1,EA,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,inpatient,1,EA,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.53,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-04,NDC,,,facility,outpatient,1,EA,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.21,6.22,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,inpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-06,NDC,,,facility,outpatient,1,EA,3.37000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.69,3.27,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,inpatient,1,EA,3.88000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,2.13,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,00904-7016-61,NDC,,,facility,outpatient,1,EA,3.88000,3.68000,Amish/Mennonite,Amish Mennonite,,2.13,,,,,,,1.94,3.76,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,inpatient,1,EA,2.70000,2.56000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,16714-0832-01,NDC,,,facility,outpatient,1,EA,2.70000,2.56000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.62,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,50268-0131-15,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,51079-0892-20,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.32,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,inpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,60687-0384-25,NDC,,,facility,outpatient,1,EA,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,68382-0526-01,NDC,,,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
BUMETANIDE TAB 1 MG,59918,CDM,250,RC,69238-1490-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,inpatient,1,mL,30.17000,28.66000,Amish/Mennonite,Amish Mennonite,,16.59,,,,,,,16.59,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,00054312041,NDC,facility,outpatient,1,mL,30.17000,28.66000,Amish/Mennonite,Amish Mennonite,,16.59,,,,,,,15.09,29.26,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,inpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
CALCITRIOL LIQ 1 MCG/ML,59919,CDM,250,RC,J8499,HCPCS,64980044715,NDC,facility,outpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,00904-5272-60,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CALCIUM (AS CITRATE)-VITAMIN D TAB 315 MG-250 UNIT,59920,CDM,250,RC,77333-0113-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,inpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.76,3.10,percent of total billed charges,
CAPTOPRIL 6.25 MG TAB,59921,CDM,250,RC,00143-1171-01,NDC,,,facility,outpatient,1,EA,3.20000,3.04000,Amish/Mennonite,Amish Mennonite,,1.76,,,,,,,1.60,3.10,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,00703424601,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,inpatient,1,mL,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.75,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 15 ML,59922,CDM,250,RC,J9045,HCPCS,61703033922,NDC,facility,outpatient,1,mL,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.45,4.86,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,inpatient,1,mL,146.16000,138.85000,Amish/Mennonite,Amish Mennonite,,80.39,,,,,,,80.39,141.78,percent of total billed charges,
BROMFENAC 0.09% OPHTH SOL,59923,CDM,250,RC,00378-7110-35,NDC,,,facility,outpatient,1,mL,146.16000,138.85000,Amish/Mennonite,Amish Mennonite,,80.39,,,,,,,73.08,141.78,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,inpatient,1,EA,406.81000,386.47000,Amish/Mennonite,Amish Mennonite,,223.75,,,,,,,223.75,394.61,percent of total billed charges,
BCG 50 MG INTRAVESICAL INJ,59925,CDM,250,RC,J9031,HCPCS,00052060202,NDC,facility,outpatient,1,EA,406.81000,386.47000,Amish/Mennonite,Amish Mennonite,,223.75,,,,,,,203.41,394.61,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,66993-0409-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,inpatient,1,EA,10.92000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,6.01,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,50268-0172-13,NDC,,,facility,outpatient,1,EA,10.92000,10.38000,Amish/Mennonite,Amish Mennonite,,6.01,,,,,,,5.46,10.59,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,54092-0173-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 300 MG ER CAP,59926,CDM,250,RC,60505-2807-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,inpatient,1,EA,11.60000,11.02000,Amish/Mennonite,Amish Mennonite,,6.38,,,,,,,6.38,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,00904-6885-04,NDC,,,facility,outpatient,1,EA,11.60000,11.02000,Amish/Mennonite,Amish Mennonite,,6.38,,,,,,,5.80,11.25,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,29033-0020-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,54092-0172-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 200 MG ER CAP,59927,CDM,250,RC,66993-0408-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,inpatient,1,mL,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
CALCIUM GLUCONATE/NS SOLN SD 50 MG/ML,59928,CDM,250,RC,J0612,HCPCS,6332303111905000,NDC,facility,outpatient,1,mL,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,0.06404,3.12,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,inpatient,1,mL,43.04000,40.89000,Amish/Mennonite,Amish Mennonite,,23.67,,,,,,,23.67,41.75,percent of total billed charges,
BUPRENORPHINE SOLN 0.3 MG/ML,59930,CDM,250,RC,J0592,HCPCS,42023017905,NDC,facility,outpatient,1,mL,43.04000,40.89000,Amish/Mennonite,Amish Mennonite,,23.67,,,,,,,6.48,41.75,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00536-1118-25,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
CAPSAICIN CRM 0.075% 60 GM,59931,CDM,250,RC,00603-0649-88,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
CALMOSEPTINE OINT,59932,CDM,250,RC,00799-0001-04,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,inpatient,1,EA,6.33000,6.01000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00143992390,NDC,facility,outpatient,1,EA,6.33000,6.01000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,1.28,6.14,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,inpatient,1,EA,24.61000,23.38000,Amish/Mennonite,Amish Mennonite,,13.54,,,,,,,13.54,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,00781345095,NDC,facility,outpatient,1,EA,24.61000,23.38000,Amish/Mennonite,Amish Mennonite,,13.54,,,,,,,1.28,23.87,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,25021010010,NDC,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,1.28,4.29,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
CEFAZOLIN POWD-INJ 500 MG,59933,CDM,250,RC,J0690,HCPCS,44567070625,NDC,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,1.28,4.91,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,inpatient,1,mL,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.68,percent of total billed charges,
CALCIUM CHLORIDE SOLN 1 GM/10 ML,59936,CDM,250,RC,J3490,HCPCS,00517671010,NDC,facility,outpatient,1,mL,5.86000,5.57000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.93,5.68,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,20555-0017-00,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-92,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,00904-3233-93,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,77333-0115-10,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM (AS CO3)-VITAMIN D TAB 600 MG-400 UNIT,59938,CDM,250,RC,80681-0029-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CAPTOPRIL SUSP SD 1 MG/ML,59939,CDM,250,RC,00143-1171-01-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,inpatient,1,mL,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,00703424401,NDC,facility,outpatient,1,mL,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,inpatient,1,mL,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.24,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,16729029531,NDC,facility,outpatient,1,mL,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.19,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,inpatient,1,mL,8.34000,7.93000,Amish/Mennonite,Amish Mennonite,,4.59,,,,,,,4.59,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703033918,NDC,facility,outpatient,1,mL,8.34000,7.93000,Amish/Mennonite,Amish Mennonite,,4.59,,,,,,,3.38,8.09,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,inpatient,1,mL,8.47000,8.05000,Amish/Mennonite,Amish Mennonite,,4.66,,,,,,,4.66,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 5 ML,59940,CDM,250,RC,J9045,HCPCS,61703036018,NDC,facility,outpatient,1,mL,8.47000,8.05000,Amish/Mennonite,Amish Mennonite,,4.66,,,,,,,3.38,8.22,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,inpatient,1,mL,4.56000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.51,4.42,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,00703424891,NDC,facility,outpatient,1,mL,4.56000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.28,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,inpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,55150033501,NDC,facility,outpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,4.86,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,inpatient,1,mL,3.31000,3.14000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.82,3.21,percent of total billed charges,
CARBOPLATIN SOLN 10 MG/ML 45 ML,59942,CDM,250,RC,J9045,HCPCS,61703033950,NDC,facility,outpatient,1,mL,3.31000,3.14000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.66,4.86,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,inpatient,1,mL,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM/10 ML SYRINGE,59943,CDM,250,RC,J0690,HCPCS,61553001272,NDC,facility,outpatient,1,mL,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0008-59,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-59,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
CARBAMAZEPINE LIQ 200 MG/10 ML,59945,CDM,250,RC,68094-0214-62,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,inpatient,1,GM,10.36000,9.84000,Amish/Mennonite,Amish Mennonite,,5.70,,,,,,,5.70,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00168-0056-15,NDC,,,facility,outpatient,1,GM,10.36000,9.84000,Amish/Mennonite,Amish Mennonite,,5.70,,,,,,,5.18,10.05,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,inpatient,1,GM,8.28000,7.86000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,4.55,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,00472-0381-15,NDC,,,facility,outpatient,1,GM,8.28000,7.86000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,4.14,8.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,inpatient,1,GM,4.48000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,52817-0824-15,NDC,,,facility,outpatient,1,GM,4.48000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.24,4.35,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,inpatient,1,GM,10.34000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.03,percent of total billed charges,
BETAMETHASONE DIPROPIONATE ONT 0.05% 15 GM,59946,CDM,250,RC,72578-0093-01,NDC,,,facility,outpatient,1,GM,10.34000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.03,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,inpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,29033-0019-12,NDC,,,facility,outpatient,1,EA,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.40,4.66,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,inpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,5.39,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,50268-0170-13,NDC,,,facility,outpatient,1,EA,9.80000,9.31000,Amish/Mennonite,Amish Mennonite,,5.39,,,,,,,4.90,9.51,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,54092-0171-12,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,60505-2805-07,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,inpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.84,5.01,percent of total billed charges,
CARBAMAZEPINE 100 MG ER CAP,59947,CDM,250,RC,66993-0407-32,NDC,,,facility,outpatient,1,EA,5.17000,4.91000,Amish/Mennonite,Amish Mennonite,,2.84,,,,,,,2.58,5.01,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,inpatient,1,EA,27.93000,26.54000,Amish/Mennonite,Amish Mennonite,,15.36,,,,,,,15.36,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,16714-0067-01,NDC,,,facility,outpatient,1,EA,27.93000,26.54000,Amish/Mennonite,Amish Mennonite,,15.36,,,,,,,13.96,27.09,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,inpatient,1,EA,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,45.76,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,25010-0711-15,NDC,,,facility,outpatient,1,EA,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,41.60,80.70,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,inpatient,1,EA,27.65000,26.27000,Amish/Mennonite,Amish Mennonite,,15.21,,,,,,,15.21,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,43975-0220-10,NDC,,,facility,outpatient,1,EA,27.65000,26.27000,Amish/Mennonite,Amish Mennonite,,15.21,,,,,,,13.82,26.82,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,inpatient,1,EA,17.89000,16.99000,Amish/Mennonite,Amish Mennonite,,9.84,,,,,,,9.84,17.35,percent of total billed charges,
CARBIDOPA TAB 25 MG,59948,CDM,250,RC,47781-0332-01,NDC,,,facility,outpatient,1,EA,17.89000,16.99000,Amish/Mennonite,Amish Mennonite,,9.84,,,,,,,8.95,17.35,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,inpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,16729007801,NDC,facility,outpatient,1,EA,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,51079097820,NDC,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,62756046188,NDC,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,inpatient,1,EA,2.48000,2.35000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.41,percent of total billed charges,
CARBIDOPA-LEVODOPA TAB-ER 25 MG-100 MG,59949,CDM,250,RC,J8499,HCPCS,68084028101,NDC,facility,outpatient,1,EA,2.48000,2.35000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,2.41,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,37000-0671-01,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,inpatient,1,GM,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CAMPHOR-MENTHOL OINT (VAPORUB EQUIV),59952,CDM,250,RC,70000-0480-01,NDC,,,facility,outpatient,1,GM,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,inpatient,1,EA,24.16000,22.96000,Amish/Mennonite,Amish Mennonite,,13.29,,,,,,,13.29,23.44,percent of total billed charges,
CARBIDOPA/ENTACAPONE/LEVODOPA TAB 25 MG-200 MG-100 MG,59953,CDM,250,RC,00078-0408-05,NDC,,,facility,outpatient,1,EA,24.16000,22.96000,Amish/Mennonite,Amish Mennonite,,13.29,,,,,,,12.08,23.44,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,inpatient,1,EA,7.03000,6.68000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,3.87,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,00378876593,NDC,facility,outpatient,1,EA,7.03000,6.68000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,3.52,6.82,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,inpatient,1,EA,15.83000,15.04000,Amish/Mennonite,Amish Mennonite,,8.71,,,,,,,8.71,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,12496120203,NDC,facility,outpatient,1,EA,15.83000,15.04000,Amish/Mennonite,Amish Mennonite,,8.71,,,,,,,7.92,15.36,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,inpatient,1,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.19,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 2 MG-0.5 MG,59954,CDM,250,RC,J0572,HCPCS,47781035503,NDC,facility,outpatient,1,EA,8.44000,8.02000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.22,8.19,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,inpatient,1,EA,18.30000,17.38000,Amish/Mennonite,Amish Mennonite,,10.06,,,,,,,10.06,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,00409021701,NDC,facility,outpatient,1,EA,18.30000,17.38000,Amish/Mennonite,Amish Mennonite,,10.06,,,,,,,1.86,17.75,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,inpatient,1,EA,59.37000,56.40000,Amish/Mennonite,Amish Mennonite,,32.65,,,,,,,32.65,57.59,percent of total billed charges,
CEFEPIME 1 GM A/V,59955,CDM,250,RC,J0692,HCPCS,51479005420,NDC,facility,outpatient,1,EA,59.37000,56.40000,Amish/Mennonite,Amish Mennonite,,32.65,,,,,,,1.86,57.59,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,inpatient,1,EA,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.36,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,00078-0510-05,NDC,,,facility,outpatient,1,EA,4.29000,4.07000,Amish/Mennonite,Amish Mennonite,,2.36,,,,,,,2.15,4.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,inpatient,1,EA,2.89000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,16714-0063-01,NDC,,,facility,outpatient,1,EA,2.89000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.80,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
CARBAMAZEPINE TAB-ER 100 MG,59956,CDM,250,RC,51672-4123-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,inpatient,1,mL,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,17478093101,NDC,facility,outpatient,1,mL,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,1.33,22.99,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,inpatient,1,mL,31.44000,29.87000,Amish/Mennonite,Amish Mennonite,,17.29,,,,,,,17.29,30.50,percent of total billed charges,
CALCITRIOL SOLN 1 MCG/ML,59957,CDM,250,RC,J0636,HCPCS,72266025110,NDC,facility,outpatient,1,mL,31.44000,29.87000,Amish/Mennonite,Amish Mennonite,,17.29,,,,,,,1.33,30.50,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,inpatient,1,EA,414.40000,393.68000,Amish/Mennonite,Amish Mennonite,,227.92,,,,,,,227.92,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,00517182001,NDC,facility,outpatient,1,EA,414.40000,393.68000,Amish/Mennonite,Amish Mennonite,,227.92,,,,,,,50.35,401.97,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,inpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030520,NDC,facility,outpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,50.35,183.91,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,inpatient,1,EA,100.11000,95.10000,Amish/Mennonite,Amish Mennonite,,55.06,,,,,,,55.06,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,25021030566,NDC,facility,outpatient,1,EA,100.11000,95.10000,Amish/Mennonite,Amish Mennonite,,55.06,,,,,,,50.05,97.11,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,inpatient,1,EA,153.86000,146.17000,Amish/Mennonite,Amish Mennonite,,84.62,,,,,,,84.62,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065827,NDC,facility,outpatient,1,EA,153.86000,146.17000,Amish/Mennonite,Amish Mennonite,,84.62,,,,,,,50.35,149.24,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,inpatient,1,EA,515.41000,489.64000,Amish/Mennonite,Amish Mennonite,,283.48,,,,,,,283.48,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,63323065894,NDC,facility,outpatient,1,EA,515.41000,489.64000,Amish/Mennonite,Amish Mennonite,,283.48,,,,,,,50.35,499.95,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,inpatient,1,EA,751.10000,713.54000,Amish/Mennonite,Amish Mennonite,,413.11,,,,,,,413.11,728.57,percent of total billed charges,
CHLOROTHIAZIDE POWD-INJ 0.5 GM,59958,CDM,250,RC,J1205,HCPCS,67457026330,NDC,facility,outpatient,1,EA,751.10000,713.54000,Amish/Mennonite,Amish Mennonite,,413.11,,,,,,,50.35,728.57,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,inpatient,1,mL,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE SUSP 8 MG-10 MG/5 ML 473 ML,59960,CDM,250,RC,27808-0086-02,NDC,,,facility,outpatient,1,mL,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,9.37,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,16714-0394-01,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,8.52,16.52,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,inpatient,1,EA,13.63000,12.95000,Amish/Mennonite,Amish Mennonite,,7.50,,,,,,,7.50,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,42043-0120-20,NDC,,,facility,outpatient,1,EA,13.63000,12.95000,Amish/Mennonite,Amish Mennonite,,7.50,,,,,,,6.82,13.22,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,65862-0095-20,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,inpatient,1,EA,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.64,6.41,percent of total billed charges,
CEFPODOXIME TAB 100 MG,59961,CDM,250,RC,67877-0878-20,NDC,,,facility,outpatient,1,EA,6.61000,6.28000,Amish/Mennonite,Amish Mennonite,,3.64,,,,,,,3.31,6.41,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,inpatient,1,EA,30.94000,29.39000,Amish/Mennonite,Amish Mennonite,,17.02,,,,,,,17.02,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,00409021801,NDC,facility,outpatient,1,EA,30.94000,29.39000,Amish/Mennonite,Amish Mennonite,,17.02,,,,,,,1.86,30.01,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,inpatient,1,EA,67.73000,64.35000,Amish/Mennonite,Amish Mennonite,,37.25,,,,,,,37.25,65.70,percent of total billed charges,
CEFEPIME 2 GM A/V,59962,CDM,250,RC,J0692,HCPCS,51479005510,NDC,facility,outpatient,1,EA,67.73000,64.35000,Amish/Mennonite,Amish Mennonite,,37.25,,,,,,,1.86,65.70,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,inpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.91,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143956825,NDC,facility,outpatient,1,EA,7.11000,6.75000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.12,6.90,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,inpatient,1,EA,9.24000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,5.08,8.96,percent of total billed charges,
CEFUROXIME POWD-INJ 750 MG,59963,CDM,250,RC,J0697,HCPCS,00143997922,NDC,facility,outpatient,1,EA,9.24000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,3.12,8.96,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CARVEDILOL SUSP SD 1 MG/ML,59964,CDM,250,RC,00904-6300-61-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CEFTAZIDIME SOLN SD 22.5 MG/ML INTRAVITREAL,59965,CDM,250,RC,J0713,HCPCS,0040950821602250,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,2.71,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,inpatient,20,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00026856220,NDC,facility,outpatient,20,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,3.83,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,inpatient,20,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
CIPROFLOXACIN SOLN-INJ 10 MG/ML 20 ML,59966,CDM,250,RC,J0744,HCPCS,00409476586,NDC,facility,outpatient,20,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,3.83,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,inpatient,1,EA,12.12000,11.51000,Amish/Mennonite,Amish Mennonite,,6.67,,,,,,,6.67,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,00093-3160-06,NDC,,,facility,outpatient,1,EA,12.12000,11.51000,Amish/Mennonite,Amish Mennonite,,6.67,,,,,,,6.06,11.76,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.68,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,16714-0391-02,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.44,4.72,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,57237-0099-60,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.31,2.54,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,inpatient,1,EA,10.66000,10.13000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,5.86,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,60687-0699-21,NDC,,,facility,outpatient,1,EA,10.66000,10.13000,Amish/Mennonite,Amish Mennonite,,5.86,,,,,,,5.33,10.34,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,67877-0543-60,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
CEFDINIR CAP 300 MG,59968,CDM,250,RC,68180-0711-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,inpatient,1,EA,443.95000,421.75000,Amish/Mennonite,Amish Mennonite,,244.17,,,,,,,244.17,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,00015301260,NDC,facility,outpatient,1,EA,443.95000,421.75000,Amish/Mennonite,Amish Mennonite,,244.17,,,,,,,173.64,430.63,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,inpatient,1,EA,8136.71000,7729.88000,Amish/Mennonite,Amish Mennonite,,4475.19,,,,,,,4475.19,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,23155026141,NDC,facility,outpatient,1,EA,8136.71000,7729.88000,Amish/Mennonite,Amish Mennonite,,4475.19,,,,,,,173.64,7892.61,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,inpatient,1,EA,6780.60000,6441.57000,Amish/Mennonite,Amish Mennonite,,3729.33,,,,,,,3729.33,6577.18,percent of total billed charges,
CARMUSTINE POWD-INJ 100 MG,59969,CDM,636,RC,J9050,HCPCS,70710152509,NDC,facility,outpatient,1,EA,6780.60000,6441.57000,Amish/Mennonite,Amish Mennonite,,3729.33,,,,,,,173.64,6577.18,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,inpatient,1,mL,91.29000,86.72000,Amish/Mennonite,Amish Mennonite,,50.21,,,,,,,50.21,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,00641139735,NDC,facility,outpatient,1,mL,91.29000,86.72000,Amish/Mennonite,Amish Mennonite,,50.21,,,,,,,43.34,88.55,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,inpatient,1,mL,78.87000,74.93000,Amish/Mennonite,Amish Mennonite,,43.38,,,,,,,43.38,76.50,percent of total billed charges,
CHLORPROMAZINE SOLN 25 MG/ML,59970,CDM,250,RC,J3230,HCPCS,70710184907,NDC,facility,outpatient,1,mL,78.87000,74.93000,Amish/Mennonite,Amish Mennonite,,43.38,,,,,,,39.44,76.50,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0121-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,00574-0521-76,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0201-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,inpatient,1,mL,9.87000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,5.43,9.57,percent of total billed charges,
CHARCOAL 50 GM SUSP 240 ML,59971,CDM,250,RC,66689-0202-08,NDC,,,facility,outpatient,1,mL,9.87000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,4.93,9.57,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,inpatient,1,EA,8.44000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,00832-0512-01,NDC,,,facility,outpatient,1,EA,8.44000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.22,8.19,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
BETHANECHOL TAB 25 MG,59972,CDM,250,RC,65162-0573-10,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
CEFPODOXIME SUSP 20 MG/ML,59973,CDM,250,RC,64980-0403-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,inpatient,1,EA,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,28.24,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,00093542088,NDC,facility,outpatient,1,EA,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,25.68,49.81,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,inpatient,1,EA,9.88000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,5.43,9.58,percent of total billed charges,
CABERGOLINE TAB 0.5 MG,59975,CDM,250,RC,J8515,HCPCS,50742011808,NDC,facility,outpatient,1,EA,9.88000,9.38000,Amish/Mennonite,Amish Mennonite,,5.43,,,,,,,4.94,9.58,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 50 MG/ML,59978,CDM,250,RC,J0690,HCPCS,2502101001005000,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,1.28,6.13,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,inpatient,1,mL,4.12000,3.91000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.27,4.00,percent of total billed charges,
CIPROFLOXACIN LIQ 50 MG/ML,59979,CDM,250,RC,50419-0777-01,NDC,,,facility,outpatient,1,mL,4.12000,3.91000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.06,4.00,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,inpatient,1,EA,9.49000,9.02000,Amish/Mennonite,Amish Mennonite,,5.22,,,,,,,5.22,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00574-0106-01,NDC,,,facility,outpatient,1,EA,9.49000,9.02000,Amish/Mennonite,Amish Mennonite,,5.22,,,,,,,4.75,9.21,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,inpatient,1,EA,10.46000,9.94000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.75,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,63304-0962-30,NDC,,,facility,outpatient,1,EA,10.46000,9.94000,Amish/Mennonite,Amish Mennonite,,5.75,,,,,,,5.23,10.15,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,inpatient,1,EA,9.23000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,5.08,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,00781-5325-31,NDC,,,facility,outpatient,1,EA,9.23000,8.77000,Amish/Mennonite,Amish Mennonite,,5.08,,,,,,,4.62,8.95,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,inpatient,1,EA,21.79000,20.70000,Amish/Mennonite,Amish Mennonite,,11.98,,,,,,,11.98,21.14,percent of total billed charges,
BROMOCRIPTINE TAB 2.5 MG,59980,CDM,250,RC,60687-0286-21,NDC,,,facility,outpatient,1,EA,21.79000,20.70000,Amish/Mennonite,Amish Mennonite,,11.98,,,,,,,10.89,21.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,inpatient,1,EA,76.88000,73.03000,Amish/Mennonite,Amish Mennonite,,42.28,,,,,,,42.28,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063525,NDC,facility,outpatient,1,EA,76.88000,73.03000,Amish/Mennonite,Amish Mennonite,,42.28,,,,,,,38.44,74.57,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,inpatient,1,EA,64.06000,60.86000,Amish/Mennonite,Amish Mennonite,,35.23,,,,,,,35.23,62.14,percent of total billed charges,
CHLORAMBUCIL TAB 2 MG,59982,CDM,250,RC,S0172,HCPCS,76388063550,NDC,facility,outpatient,1,EA,64.06000,60.86000,Amish/Mennonite,Amish Mennonite,,35.23,,,,,,,32.03,62.14,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.73,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,16571-0657-10,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.39,6.58,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,inpatient,1,EA,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,4.49,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63304-0479-01,NDC,,,facility,outpatient,1,EA,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,4.08,7.92,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,inpatient,1,EA,22.28000,21.16000,Amish/Mennonite,Amish Mennonite,,12.25,,,,,,,12.25,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,63395-0201-13,NDC,,,facility,outpatient,1,EA,22.28000,21.16000,Amish/Mennonite,Amish Mennonite,,12.25,,,,,,,11.14,21.61,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,inpatient,1,EA,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.74,percent of total billed charges,
CEVIMELINE 30 MG CAP,59983,CDM,250,RC,72888-0118-30,NDC,,,facility,outpatient,1,EA,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.44,4.74,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,51672-4047-09,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,inpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
CARBAMAZEPINE LIQ 20 MG/ML,59984,CDM,250,RC,60432-0129-16,NDC,,,facility,outpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,inpatient,1,mL,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
CHLOROPROCAINE SOLN 1% 30 ML,59985,CDM,250,RC,J2401,HCPCS,63323047537,NDC,facility,outpatient,1,mL,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.06045,1.84,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,inpatient,1,EA,122.99000,116.84000,Amish/Mennonite,Amish Mennonite,,67.64,,,,,,,67.64,119.30,percent of total billed charges,
CHLORAMPHENICOL POWD-INJ 1 GM,59986,CDM,250,RC,J0720,HCPCS,63323001115,NDC,facility,outpatient,1,EA,122.99000,116.84000,Amish/Mennonite,Amish Mennonite,,67.64,,,,,,,61.49,119.30,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,inpatient,50,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337501,NDC,facility,outpatient,50,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,inpatient,50,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00009337502,NDC,facility,outpatient,50,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,inpatient,50,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,43066099324,NDC,facility,outpatient,50,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,inpatient,50,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328909,NDC,facility,outpatient,50,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,inpatient,50,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,00781328991,NDC,facility,outpatient,50,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,2.76,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,inpatient,50,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
CLINDAMYCIN 600 MG/D5W 50 ML PREMIX,59987,CDM,250,RC,J0736,HCPCS,17478012150,NDC,facility,outpatient,50,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,2.76,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,49884-0465-65,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,42806-0266-95,NDC,,,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,inpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
CHOLESTYRAMINE/SUCROSE PWD PKT 4 GM,59988,CDM,250,RC,67877-0298-60,NDC,,,facility,outpatient,1,EA,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
CHLORPHENIRAMINE TAB 4 MG,59991,CDM,250,RC,00904-0012-59,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,00378-5052-01,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,inpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.69,percent of total billed charges,
CARBIDOPA-LEVODOPA 25 MG-100 MG TAB DIS,59992,CDM,250,RC,62756-0187-88,NDC,,,facility,outpatient,1,EA,2.77000,2.64000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.39,2.69,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00527-1931-06,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.63,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,00781-1961-60,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
CLARITHROMYCIN TAB 250 MG,59994,CDM,250,RC,65862-0225-60,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
CALCIUM GLUCONATE SOLN 100 MG/ML 100 ML,59995,CDM,250,RC,J0612,HCPCS,63323036061,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.06404,0.92150,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,53191-0362-01,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,75834-0020-12,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,inpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
"CHOLECALCIFEROL 50,000 INTL UNITS CAP",59996,CDM,250,RC,80681-0174-01,NDC,,,facility,outpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,inpatient,1,GM,6.83000,6.49000,Amish/Mennonite,Amish Mennonite,,3.76,,,,,,,3.76,6.63,percent of total billed charges,
CICLOPIROX GEL 0.77%,59997,CDM,250,RC,00168-0407-30,NDC,,,facility,outpatient,1,GM,6.83000,6.49000,Amish/Mennonite,Amish Mennonite,,3.76,,,,,,,3.42,6.63,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,inpatient,1,GM,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
CICLOPIROX CREAM 0.77%,59998,CDM,250,RC,00713-0638-15,NDC,,,facility,outpatient,1,GM,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,00087-0866-44,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CHOLECALCIFEROL LIQ 400 INTL UNITS/ML,60000,CDM,250,RC,54838-0006-50,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,inpatient,1,EA,7.08000,6.72000,Amish/Mennonite,Amish Mennonite,,3.89,,,,,,,3.89,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,16714-0398-01,NDC,,,facility,outpatient,1,EA,7.08000,6.72000,Amish/Mennonite,Amish Mennonite,,3.89,,,,,,,3.54,6.87,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,inpatient,1,EA,10.38000,9.86000,Amish/Mennonite,Amish Mennonite,,5.71,,,,,,,5.71,10.07,percent of total billed charges,
CEFPROZIL TAB 250 MG,60002,CDM,250,RC,68180-0403-01,NDC,,,facility,outpatient,1,EA,10.38000,9.86000,Amish/Mennonite,Amish Mennonite,,5.71,,,,,,,5.19,10.07,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,inpatient,1,EA,17.09000,16.24000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,9.40,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00078-0512-05,NDC,,,facility,outpatient,1,EA,17.09000,16.24000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,8.54,16.58,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,inpatient,1,EA,10.50000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.78,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,00781-5988-01,NDC,,,facility,outpatient,1,EA,10.50000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.25,10.19,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,inpatient,1,EA,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.49,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,16714-0065-01,NDC,,,facility,outpatient,1,EA,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.17,6.16,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,51672-4125-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,inpatient,1,EA,18.34000,17.42000,Amish/Mennonite,Amish Mennonite,,10.09,,,,,,,10.09,17.79,percent of total billed charges,
CARBAMAZEPINE TAB-ER 400 MG,60003,CDM,250,RC,68084-0562-21,NDC,,,facility,outpatient,1,EA,18.34000,17.42000,Amish/Mennonite,Amish Mennonite,,10.09,,,,,,,9.17,17.79,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
CHLOROTHIAZIDE LIQ 50 MG/ML,60004,CDM,250,RC,65649-0311-12,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
CITALOPRAM TAB 10 MG,60005,CDM,250,RC,00904-6084-61,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,inpatient,1,mL,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,00009-0760-04,NDC,,,facility,outpatient,1,mL,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.15,4.18,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,inpatient,1,mL,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,16714-0483-01,NDC,,,facility,outpatient,1,mL,1.50000,1.42000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,inpatient,1,mL,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,59762-0016-01,NDC,,,facility,outpatient,1,mL,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,64980-0511-10,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,inpatient,1,mL,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
CLINDAMYCIN 75 MG/5 ML ORAL LIQ,60006,CDM,250,RC,65862-0596-01,NDC,,,facility,outpatient,1,mL,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,00121-0677-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CITRIC ACID-K CITRATE-NA CITRATE LIQ  66.7 MG-110MG-100MG/ML,60007,CDM,250,RC,58657-0311-16,NDC,,,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,inpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,00591-2520-01,NDC,,,facility,outpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,59651-0306-01,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
CHLORZOXAZONE TAB 500 MG,60008,CDM,250,RC,70954-0085-10,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,inpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
CIMETIDINE TAB 300 MG,60009,CDM,250,RC,60505-0019-06,NDC,,,facility,outpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,inpatient,1,mL,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
CEFEPIME/NS SOLN SD 40 MG/ML,60010,CDM,250,RC,J0692,HCPCS,2502101212004000,NDC,facility,outpatient,1,mL,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,2.03,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,inpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00143950401,NDC,facility,outpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,inpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,00703574711,NDC,facility,outpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,inpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,25021025350,NDC,facility,outpatient,1,mL,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,60505627700,NDC,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,4.75,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,inpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
CISPLATIN 1 MG/ML SOLN 50ML,60014,CDM,250,RC,J9060,HCPCS,63323010351,NDC,facility,outpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,4.75,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,inpatient,1,GM,7.87000,7.47000,Amish/Mennonite,Amish Mennonite,,4.33,,,,,,,4.33,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,00168-0202-60,NDC,,,facility,outpatient,1,GM,7.87000,7.47000,Amish/Mennonite,Amish Mennonite,,4.33,,,,,,,3.94,7.63,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,inpatient,1,GM,6.56000,6.23000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.36,percent of total billed charges,
CLINDAMYCIN GEL 1% 60 GM,60015,CDM,250,RC,59762-3743-02,NDC,,,facility,outpatient,1,GM,6.56000,6.23000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.28,6.36,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,inpatient,1,mL,46.93000,44.58000,Amish/Mennonite,Amish Mennonite,,25.81,,,,,,,25.81,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00074438291,NDC,facility,outpatient,1,mL,46.93000,44.58000,Amish/Mennonite,Amish Mennonite,,25.81,,,,,,,23.46,45.52,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,inpatient,1,mL,43.17000,41.01000,Amish/Mennonite,Amish Mennonite,,23.74,,,,,,,23.74,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00409110301,NDC,facility,outpatient,1,mL,43.17000,41.01000,Amish/Mennonite,Amish Mennonite,,23.74,,,,,,,21.59,41.87,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,inpatient,1,mL,42.74000,40.60000,Amish/Mennonite,Amish Mennonite,,23.51,,,,,,,23.51,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,63323041820,NDC,facility,outpatient,1,mL,42.74000,40.60000,Amish/Mennonite,Amish Mennonite,,23.51,,,,,,,21.37,41.46,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,inpatient,1,mL,32.38000,30.76000,Amish/Mennonite,Amish Mennonite,,17.81,,,,,,,17.81,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,00781315395,NDC,facility,outpatient,1,mL,32.38000,30.76000,Amish/Mennonite,Amish Mennonite,,17.81,,,,,,,16.19,31.41,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,inpatient,1,mL,15.72000,14.93000,Amish/Mennonite,Amish Mennonite,,8.65,,,,,,,8.65,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,70069015110,NDC,facility,outpatient,1,mL,15.72000,14.93000,Amish/Mennonite,Amish Mennonite,,8.65,,,,,,,7.86,15.25,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,inpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,71288071321,NDC,facility,outpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
CISATRACURIUM SOLN 10 MG/ML 20 ML,60019,CDM,250,RC,J3490,HCPCS,72485051310,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,inpatient,1,GM,19.34000,18.37000,Amish/Mennonite,Amish Mennonite,,10.64,,,,,,,10.64,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,00472-0400-60,NDC,,,facility,outpatient,1,GM,19.34000,18.37000,Amish/Mennonite,Amish Mennonite,,10.64,,,,,,,9.67,18.76,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,42291-0076-60,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
CLOBETASOL CRM 0.05% 60 GM,60020,CDM,250,RC,69238-1532-06,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,inpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,44567024710,NDC,facility,outpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,7.77,153.26,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,inpatient,1,EA,158.63000,150.70000,Amish/Mennonite,Amish Mennonite,,87.25,,,,,,,87.25,153.87,percent of total billed charges,
CEFOXITIN POWD-INJ 10 GM,60021,CDM,250,RC,J0694,HCPCS,60505076101,NDC,facility,outpatient,1,EA,158.63000,150.70000,Amish/Mennonite,Amish Mennonite,,87.25,,,,,,,7.77,153.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,inpatient,1,GM,18.19000,17.28000,Amish/Mennonite,Amish Mennonite,,10.00,,,,,,,10.00,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00168-0162-15,NDC,,,facility,outpatient,1,GM,18.19000,17.28000,Amish/Mennonite,Amish Mennonite,,10.00,,,,,,,9.10,17.64,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,inpatient,1,GM,26.20000,24.89000,Amish/Mennonite,Amish Mennonite,,14.41,,,,,,,14.41,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,00378-8190-15,NDC,,,facility,outpatient,1,GM,26.20000,24.89000,Amish/Mennonite,Amish Mennonite,,14.41,,,,,,,13.10,25.41,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,inpatient,1,GM,13.79000,13.10000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,7.58,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,16714-0782-01,NDC,,,facility,outpatient,1,GM,13.79000,13.10000,Amish/Mennonite,Amish Mennonite,,7.58,,,,,,,6.89,13.38,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,inpatient,1,GM,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,21922-0017-04,NDC,,,facility,outpatient,1,GM,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,inpatient,1,GM,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,42291-0077-15,NDC,,,facility,outpatient,1,GM,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,inpatient,1,GM,6.55000,6.22000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,3.60,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,43386-0096-60,NDC,,,facility,outpatient,1,GM,6.55000,6.22000,Amish/Mennonite,Amish Mennonite,,3.60,,,,,,,3.27,6.35,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,inpatient,1,GM,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,50383-0268-15,NDC,,,facility,outpatient,1,GM,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,inpatient,1,GM,8.15000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.48,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,51672-1259-01,NDC,,,facility,outpatient,1,GM,8.15000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.08,7.91,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,52565-0039-15,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,inpatient,1,GM,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,63629-2458-01,NDC,,,facility,outpatient,1,GM,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,inpatient,1,GM,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.62,percent of total billed charges,
CLOBETASOL OINT 0.05% 15 GM,60022,CDM,250,RC,68462-0530-17,NDC,,,facility,outpatient,1,GM,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,3.93,7.62,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,EA,8.63000,8.20000,Amish/Mennonite,Amish Mennonite,,4.75,,,,,,,4.75,8.37,percent of total billed charges,
CEFAZOLIN POWD-INJ 1 GM A/V,60023,CDM,250,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,EA,8.63000,8.20000,Amish/Mennonite,Amish Mennonite,,4.75,,,,,,,1.28,8.37,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,inpatient,1,mL,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
CEFTRIAXONE SOLN SD 350 MG/ML (IM DILUTION),60024,CDM,250,RC,J0696,HCPCS,0040973380135000,NDC,facility,outpatient,1,mL,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.76415,1.61,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,inpatient,1,mL,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00074-4380-10,NDC,,,facility,outpatient,1,mL,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.34,8.43,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,inpatient,1,mL,7.34000,6.97000,Amish/Mennonite,Amish Mennonite,,4.04,,,,,,,4.04,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00409-1208-01,NDC,,,facility,outpatient,1,mL,7.34000,6.97000,Amish/Mennonite,Amish Mennonite,,4.04,,,,,,,3.67,7.12,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,inpatient,1,mL,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,63323-0417-10,NDC,,,facility,outpatient,1,mL,7.27000,6.90000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,3.63,7.05,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,inpatient,1,mL,7.99000,7.60000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.39,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,00781-3152-95,NDC,,,facility,outpatient,1,mL,7.99000,7.60000,Amish/Mennonite,Amish Mennonite,,4.39,,,,,,,4.00,7.75,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,inpatient,1,mL,2.88000,2.74000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,70069-0161-10,NDC,,,facility,outpatient,1,mL,2.88000,2.74000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,inpatient,1,mL,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
CISATRACURIUM SOLN 2 MG/ML 10 ML,60026,CDM,250,RC,71288-0714-11,NDC,,,facility,outpatient,1,mL,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.32,6.44,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,inpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
CLINDAMYCIN SOLN-OPHTH SD 50 MG/ML,60027,CDM,250,RC,00009-0775-26-05000,NDC,,,facility,outpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.05,9.81,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,inpatient,1,mL,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.79,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00074-3188-13,NDC,,,facility,outpatient,1,mL,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.54,4.92,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,inpatient,1,mL,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
CLARITHROMYCIN LIQ 50 MG/ML 100 ML,60028,CDM,250,RC,00781-6023-46,NDC,,,facility,outpatient,1,mL,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,inpatient,1,GM,193.54000,183.86000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,106.45,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00065-0654-35,NDC,,,facility,outpatient,1,GM,193.54000,183.86000,Amish/Mennonite,Amish Mennonite,,106.45,,,,,,,96.77,187.73,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,inpatient,1,GM,223.33000,212.16000,Amish/Mennonite,Amish Mennonite,,122.83,,,,,,,122.83,216.63,percent of total billed charges,
CIPROFLOXACIN OINT-OPHTH 0.3% 3.5 GM,60029,CDM,250,RC,00078-0841-01,NDC,,,facility,outpatient,1,GM,223.33000,212.16000,Amish/Mennonite,Amish Mennonite,,122.83,,,,,,,111.67,216.63,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,inpatient,1,mL,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,16714-0087-01,NDC,,,facility,outpatient,1,mL,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,inpatient,1,mL,30.48000,28.95000,Amish/Mennonite,Amish Mennonite,,16.76,,,,,,,16.76,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,67386-0313-21,NDC,,,facility,outpatient,1,mL,30.48000,28.95000,Amish/Mennonite,Amish Mennonite,,16.76,,,,,,,15.24,29.57,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,inpatient,1,mL,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69238-1535-02,NDC,,,facility,outpatient,1,mL,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,inpatient,1,mL,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.45,percent of total billed charges,
CLOBAZAM LIQ 2.5 MG/ML,60031,CDM,250,RC,69452-0116-45,NDC,,,facility,outpatient,1,mL,3.56000,3.38000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.45,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,inpatient,1,EA,195.57000,185.79000,Amish/Mennonite,Amish Mennonite,,107.56,,,,,,,107.56,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00591-3510-04,NDC,,,facility,outpatient,1,EA,195.57000,185.79000,Amish/Mennonite,Amish Mennonite,,107.56,,,,,,,97.78,189.70,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,inpatient,1,EA,398.19000,378.28000,Amish/Mennonite,Amish Mennonite,,219.00,,,,,,,219.00,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,00597-0033-34,NDC,,,facility,outpatient,1,EA,398.19000,378.28000,Amish/Mennonite,Amish Mennonite,,219.00,,,,,,,199.09,386.24,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,inpatient,1,EA,195.79000,186.00000,Amish/Mennonite,Amish Mennonite,,107.68,,,,,,,107.68,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,51862-0455-04,NDC,,,facility,outpatient,1,EA,195.79000,186.00000,Amish/Mennonite,Amish Mennonite,,107.68,,,,,,,97.89,189.92,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,inpatient,1,EA,97.90000,93.00000,Amish/Mennonite,Amish Mennonite,,53.84,,,,,,,53.84,94.96,percent of total billed charges,
CLONIDINE PATCH 0.3 MG/24 HR,60032,CDM,250,RC,75907-0025-48,NDC,,,facility,outpatient,1,EA,97.90000,93.00000,Amish/Mennonite,Amish Mennonite,,53.84,,,,,,,48.95,94.96,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,inpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,00121067616,NDC,facility,outpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,inpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
CITRIC ACID-POTASSIUM CITRATE LIQ 66.8MG-220 MG/ML,60033,CDM,250,RC,J8499,HCPCS,58657031216,NDC,facility,outpatient,1,mL,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00168-0301-15,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,inpatient,1,GM,21.61000,20.53000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,11.89,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,00472-0400-15,NDC,,,facility,outpatient,1,GM,21.61000,20.53000,Amish/Mennonite,Amish Mennonite,,11.89,,,,,,,10.80,20.96,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,69238-1532-05,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,inpatient,1,GM,15.06000,14.31000,Amish/Mennonite,Amish Mennonite,,8.28,,,,,,,8.28,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,16714-0992-01,NDC,,,facility,outpatient,1,GM,15.06000,14.31000,Amish/Mennonite,Amish Mennonite,,8.28,,,,,,,7.53,14.61,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,42291-0076-15,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,inpatient,1,GM,13.12000,12.46000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1258-01,NDC,,,facility,outpatient,1,GM,13.12000,12.46000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,6.56,12.73,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,inpatient,1,GM,11.48000,10.91000,Amish/Mennonite,Amish Mennonite,,6.31,,,,,,,6.31,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,51672-1297-01,NDC,,,facility,outpatient,1,GM,11.48000,10.91000,Amish/Mennonite,Amish Mennonite,,6.31,,,,,,,5.74,11.14,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,inpatient,1,GM,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,52565-0051-15,NDC,,,facility,outpatient,1,GM,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,inpatient,1,GM,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.54,percent of total billed charges,
CLOBETASOL CRM 0.05% 15 GM,60034,CDM,250,RC,68462-0529-17,NDC,,,facility,outpatient,1,GM,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.31,2.54,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,inpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,16571-0120-25,NDC,,,facility,outpatient,1,mL,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,5.69,11.04,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,inpatient,1,mL,8.15000,7.75000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.48,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,17478-0714-25,NDC,,,facility,outpatient,1,mL,8.15000,7.75000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.08,7.91,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,inpatient,1,mL,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,7.30,12.87,percent of total billed charges,
CIPROFLOXACIN SOLN-OPHTH 0.3% 2.5 ML,60035,CDM,250,RC,69315-0308-02,NDC,,,facility,outpatient,1,mL,13.27000,12.61000,Amish/Mennonite,Amish Mennonite,,7.30,,,,,,,6.63,12.87,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,inpatient,1,GM,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,8.36,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00168-0162-30,NDC,,,facility,outpatient,1,GM,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,7.60,14.74,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,inpatient,1,GM,21.89000,20.79000,Amish/Mennonite,Amish Mennonite,,12.04,,,,,,,12.04,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,00378-8190-30,NDC,,,facility,outpatient,1,GM,21.89000,20.79000,Amish/Mennonite,Amish Mennonite,,12.04,,,,,,,10.95,21.23,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,inpatient,1,GM,11.17000,10.61000,Amish/Mennonite,Amish Mennonite,,6.14,,,,,,,6.14,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,16714-0782-02,NDC,,,facility,outpatient,1,GM,11.17000,10.61000,Amish/Mennonite,Amish Mennonite,,6.14,,,,,,,5.58,10.83,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,inpatient,1,GM,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,42291-0077-30,NDC,,,facility,outpatient,1,GM,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,inpatient,1,GM,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,52565-0039-30,NDC,,,facility,outpatient,1,GM,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,inpatient,1,GM,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,63629-2457-01,NDC,,,facility,outpatient,1,GM,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,inpatient,1,GM,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
CLOBETASOL OINT 0.05% 30 GM,60036,CDM,250,RC,70700-0106-16,NDC,,,facility,outpatient,1,GM,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,inpatient,1,mL,99.81000,94.82000,Amish/Mennonite,Amish Mennonite,,54.90,,,,,,,54.90,96.82,percent of total billed charges,
CIPROFLOXACIN-HYDROCORTISONE SUSP-OTIC 0.2%-1% 10 ML,60037,CDM,250,RC,00078-0855-26,NDC,,,facility,outpatient,1,mL,99.81000,94.82000,Amish/Mennonite,Amish Mennonite,,54.90,,,,,,,49.91,96.82,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,inpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CLORAZEPATE TAB 3.75 MG,60038,CDM,250,RC,63304-0552-01,NDC,,,facility,outpatient,1,EA,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,inpatient,1,mL,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,51672-1260-03,NDC,,,facility,outpatient,1,mL,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,52817-0800-30,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CLOTRIMAZOLE LIQ-TOP 1%,60039,CDM,250,RC,70954-0036-20,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,inpatient,1,EA,10.87000,10.33000,Amish/Mennonite,Amish Mennonite,,5.98,,,,,,,5.98,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,00781591301,NDC,facility,outpatient,1,EA,10.87000,10.33000,Amish/Mennonite,Amish Mennonite,,5.98,,,,,,,5.43,10.54,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,inpatient,1,EA,8.36000,7.94000,Amish/Mennonite,Amish Mennonite,,4.60,,,,,,,4.60,8.11,percent of total billed charges,
CHLORPROMAZINE 10 MG TAB,60040,CDM,250,RC,Q0161,HCPCS,69238105401,NDC,facility,outpatient,1,EA,8.36000,7.94000,Amish/Mennonite,Amish Mennonite,,4.60,,,,,,,4.18,8.11,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CLONIDINE SUSP SD 100 MCG/ML,60041,CDM,250,RC,J8499,HCPCS,6373900601010000,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,00054-0062-58,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,inpatient,1,mL,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
CITALOPRAM LIQ 2 MG/ML,60042,CDM,250,RC,54838-0540-70,NDC,,,facility,outpatient,1,mL,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM SUSP SD 0.1 MG/1 ML,60043,CDM,250,RC,00904-6101-61-00250,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,Amish/Mennonite,Amish Mennonite,,11.72,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,00781-2027-01,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,Amish/Mennonite,Amish Mennonite,,11.72,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16571-0683-03,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,inpatient,1,EA,21.57000,20.49000,Amish/Mennonite,Amish Mennonite,,11.86,,,,,,,11.86,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-01,NDC,,,facility,outpatient,1,EA,21.57000,20.49000,Amish/Mennonite,Amish Mennonite,,11.86,,,,,,,10.79,20.92,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,inpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,6.08,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,16714-0849-03,NDC,,,facility,outpatient,1,EA,11.06000,10.51000,Amish/Mennonite,Amish Mennonite,,6.08,,,,,,,5.53,10.73,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,inpatient,1,EA,21.31000,20.25000,Amish/Mennonite,Amish Mennonite,,11.72,,,,,,,11.72,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-05,NDC,,,facility,outpatient,1,EA,21.31000,20.25000,Amish/Mennonite,Amish Mennonite,,11.72,,,,,,,10.65,20.67,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,inpatient,1,EA,21.32000,20.25000,Amish/Mennonite,Amish Mennonite,,11.73,,,,,,,11.73,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,51672-4011-06,NDC,,,facility,outpatient,1,EA,21.32000,20.25000,Amish/Mennonite,Amish Mennonite,,11.73,,,,,,,10.66,20.68,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
CLOMIPRAMINE CAP 25 MG,60044,CDM,250,RC,52817-0280-10,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,00904-5658-61,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,inpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CLONIDINE TAB 0.3 MG,60045,CDM,250,RC,29300-0137-01,NDC,,,facility,outpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,inpatient,1,mL,801.86000,761.77000,Amish/Mennonite,Amish Mennonite,,441.02,,,,,,,441.02,777.80,percent of total billed charges,
DARBEPOETIN ALFA SOLN 40 MCG/ML,60047,CDM,636,RC,J0881,HCPCS,55513000304,NDC,facility,outpatient,1,mL,801.86000,761.77000,Amish/Mennonite,Amish Mennonite,,441.02,,,,,,,3.00,777.80,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,inpatient,1,mL,23.90000,22.71000,Amish/Mennonite,Amish Mennonite,,13.14,,,,,,,13.14,23.18,percent of total billed charges,
COLISTIN/HC/NEOMYCIN/THONZONIUM SUSP-OTIC (COLY-MYCIN S EQUIV),60048,CDM,250,RC,42023-0108-01,NDC,,,facility,outpatient,1,mL,23.90000,22.71000,Amish/Mennonite,Amish Mennonite,,13.14,,,,,,,11.95,23.18,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,inpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,64980-0149-01,NDC,,,facility,outpatient,1,EA,2.55000,2.42000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.47,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,16571-0832-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,inpatient,1,EA,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.79,4.92,percent of total billed charges,
COLCHICINE-PROBENECID TAB 0.5 MG-500 MG,60050,CDM,250,RC,50742-0263-01,NDC,,,facility,outpatient,1,EA,5.07000,4.82000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.54,4.92,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00168-0269-50,NDC,,,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,inpatient,1,mL,10.43000,9.91000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.74,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,00472-0402-50,NDC,,,facility,outpatient,1,mL,10.43000,9.91000,Amish/Mennonite,Amish Mennonite,,5.74,,,,,,,5.21,10.12,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,33342-0321-86,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
CLOBETASOL LIQ-TOP 0.05% 50 ML,60051,CDM,250,RC,68462-0532-53,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,inpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
CODEINE/GUAIFENESIN/PSE 10 MG-100 MG-30 MG/5 ML ORAL LIQ 480 ML,60052,CDM,250,RC,00603-1078-58,NDC,,,facility,outpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,inpatient,1,EA,140.98000,133.93000,Amish/Mennonite,Amish Mennonite,,77.54,,,,,,,77.54,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,00378-0872-99,NDC,,,facility,outpatient,1,EA,140.98000,133.93000,Amish/Mennonite,Amish Mennonite,,77.54,,,,,,,70.49,136.75,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,inpatient,1,EA,141.13000,134.08000,Amish/Mennonite,Amish Mennonite,,77.62,,,,,,,77.62,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,51862-0454-04,NDC,,,facility,outpatient,1,EA,141.13000,134.08000,Amish/Mennonite,Amish Mennonite,,77.62,,,,,,,70.56,136.90,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,inpatient,1,EA,43.75000,41.56000,Amish/Mennonite,Amish Mennonite,,24.06,,,,,,,24.06,42.44,percent of total billed charges,
CLONIDINE PATCH 0.2 MG/24 HR,60053,CDM,250,RC,52817-0611-04,NDC,,,facility,outpatient,1,EA,43.75000,41.56000,Amish/Mennonite,Amish Mennonite,,24.06,,,,,,,21.88,42.44,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
COAL TAR SHAMPOO 1%,60054,CDM,250,RC,54162-0200-06,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,inpatient,1,EA,5.54000,5.26000,Amish/Mennonite,Amish Mennonite,,3.05,,,,,,,3.05,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,16714-0887-01,NDC,,,facility,outpatient,1,EA,5.54000,5.26000,Amish/Mennonite,Amish Mennonite,,3.05,,,,,,,2.77,5.37,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,31722-0639-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.69,3.28,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,51991-0900-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,60687-0423-21,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,inpatient,1,EA,63.57000,60.39000,Amish/Mennonite,Amish Mennonite,,34.96,,,,,,,34.96,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,67386-0314-01,NDC,,,facility,outpatient,1,EA,63.57000,60.39000,Amish/Mennonite,Amish Mennonite,,34.96,,,,,,,31.79,61.66,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,68180-0157-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69238-1305-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
CLOBAZAM TAB 10 MG,60055,CDM,250,RC,69452-0114-20,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,inpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,12.00,21.17,percent of total billed charges,
CONJUGATED ESTROGENS 1.25 MG TAB,60056,CDM,250,RC,00046-1104-81,NDC,,,facility,outpatient,1,EA,21.82000,20.73000,Amish/Mennonite,Amish Mennonite,,12.00,,,,,,,10.91,21.17,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CHLORAL HYDRATE SYRUP 500 MG/5 ML,60057,CDM,250,RC,51552-0528-09-00500,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,inpatient,1,mL,375.55000,356.77000,Amish/Mennonite,Amish Mennonite,,206.55,,,,,,,206.55,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,00955174601,NDC,facility,outpatient,1,mL,375.55000,356.77000,Amish/Mennonite,Amish Mennonite,,206.55,,,,,,,13.96,364.28,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,inpatient,1,mL,335.74000,318.95000,Amish/Mennonite,Amish Mennonite,,184.66,,,,,,,184.66,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,58468010001,NDC,facility,outpatient,1,mL,335.74000,318.95000,Amish/Mennonite,Amish Mennonite,,184.66,,,,,,,13.96,325.67,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,inpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,165.11,291.19,percent of total billed charges,
CLOFARABINE SOLN 1 MG/ML 20 ML,60058,CDM,636,RC,J9027,HCPCS,60505616600,NDC,facility,outpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,13.96,291.19,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,Amish/Mennonite,Amish Mennonite,,3.90,,,,,,,3.90,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00009-0450-03,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,Amish/Mennonite,Amish Mennonite,,3.90,,,,,,,3.55,6.89,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,inpatient,1,EA,3.26000,3.10000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,00115-5211-16,NDC,,,facility,outpatient,1,EA,3.26000,3.10000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.63,3.16,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
COLESTIPOL TAB 1 GM,60059,CDM,250,RC,59762-0450-01,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,inpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.20,percent of total billed charges,
CODEINE SULFATE TAB 15 MG,60060,CDM,250,RC,00054-0243-24,NDC,,,facility,outpatient,1,EA,2.27000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.20,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
CODEINE-GUAIFENESIN LIQ 2 MG-20 MG/ML 10 ML,60061,CDM,250,RC,50383-0087-12,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,inpatient,1,EA,25.93000,24.63000,Amish/Mennonite,Amish Mennonite,,14.26,,,,,,,14.26,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00078024815,NDC,facility,outpatient,1,EA,25.93000,24.63000,Amish/Mennonite,Amish Mennonite,,14.26,,,,,,,3.14,25.15,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,inpatient,1,EA,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,13.56,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,00093574219,NDC,facility,outpatient,1,EA,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,3.14,23.91,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,inpatient,1,EA,13.89000,13.20000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,7.64,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,60505463203,NDC,facility,outpatient,1,EA,13.89000,13.20000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,3.14,13.47,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,inpatient,1,EA,9.72000,9.24000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,5.35,9.43,percent of total billed charges,
CYCLOSPORINE CAP 100 MG (EQV-NEORAL),60062,CDM,250,RC,J7502,HCPCS,51862046047,NDC,facility,outpatient,1,EA,9.72000,9.24000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,3.14,9.43,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,inpatient,1,mL,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,10.35,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,00469160210,NDC,facility,outpatient,1,mL,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,9.41,18.26,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,inpatient,1,mL,22.36000,21.24000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,12.30,21.69,percent of total billed charges,
CONIVAPTAN 20 MG/D5W 100 ML PREMIX,60063,CDM,250,RC,C9488,HCPCS,66220016010,NDC,facility,outpatient,1,mL,22.36000,21.24000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,11.18,21.69,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,inpatient,1,GM,31.85000,30.26000,Amish/Mennonite,Amish Mennonite,,17.52,,,,,,,17.52,30.89,percent of total billed charges,
COLLAGENASE TOP 250 UNITS/G OINT,60064,CDM,250,RC,50484-0010-30,NDC,,,facility,outpatient,1,GM,31.85000,30.26000,Amish/Mennonite,Amish Mennonite,,17.52,,,,,,,15.93,30.89,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,00536-1265-26,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,inpatient,1,GM,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,51672-1275-06,NDC,,,facility,outpatient,1,GM,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,inpatient,1,GM,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
CLOTRIMAZOLE CRM 1% 45 GM,60065,CDM,250,RC,68462-0181-47,NDC,,,facility,outpatient,1,GM,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,51660-0996-28,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,inpatient,1,EA,11.53000,10.96000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,6.34,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,65597-0701-18,NDC,,,facility,outpatient,1,EA,11.53000,10.96000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,5.76,11.18,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,inpatient,1,EA,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
COLESEVELAM TAB 625 MG,60066,CDM,250,RC,67877-0506-51,NDC,,,facility,outpatient,1,EA,2.83000,2.69000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,00143-9929-50,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,16714-0653-01,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,inpatient,1,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,59651-0873-50,NDC,,,facility,outpatient,1,EA,1.70000,1.61000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,inpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.91300,1.61,percent of total billed charges,
CIPROFLOXACIN TAB 750 MG,60067,CDM,250,RC,68084-0071-01,NDC,,,facility,outpatient,1,EA,1.66000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91300,,,,,,,0.83000,1.61,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,inpatient,1,mL,105.97000,100.67000,Amish/Mennonite,Amish Mennonite,,58.28,,,,,,,58.28,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,00703523313,NDC,facility,outpatient,1,mL,105.97000,100.67000,Amish/Mennonite,Amish Mennonite,,58.28,,,,,,,19.76,102.79,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,inpatient,1,mL,103.60000,98.42000,Amish/Mennonite,Amish Mennonite,,56.98,,,,,,,56.98,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,42658002102,NDC,facility,outpatient,1,mL,103.60000,98.42000,Amish/Mennonite,Amish Mennonite,,56.98,,,,,,,19.76,100.49,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,inpatient,1,mL,54.12000,51.41000,Amish/Mennonite,Amish Mennonite,,29.77,,,,,,,29.77,52.50,percent of total billed charges,
DAUNORUBICIN 5 MG/ML IV LIQ,60068,CDM,636,RC,J9150,HCPCS,55390010810,NDC,facility,outpatient,1,mL,54.12000,51.41000,Amish/Mennonite,Amish Mennonite,,29.77,,,,,,,19.76,52.50,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,00904-4218-13,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,50268-0853-15,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,79854-0200-55,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
CYANOCOBALAMIN TAB 250 MCG,60070,CDM,250,RC,80681-0165-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,inpatient,1,mL,38.34000,36.43000,Amish/Mennonite,Amish Mennonite,,21.09,,,,,,,21.09,37.19,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 1% 5 ML,60072,CDM,250,RC,00065-0396-05,NDC,,,facility,outpatient,1,mL,38.34000,36.43000,Amish/Mennonite,Amish Mennonite,,21.09,,,,,,,19.17,37.19,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-24,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.64,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
CODEINE SULFATE TAB 30 MG,60073,CDM,250,RC,00054-0244-25,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00093-3213-01,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,00904-6103-61,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,16729-0138-00,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,51079-0883-20,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
CLONAZEPAM TAB 2 MG,60074,CDM,250,RC,72888-0154-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,inpatient,1,mL,383.32000,364.15000,Amish/Mennonite,Amish Mennonite,,210.83,,,,,,,210.83,371.82,percent of total billed charges,
CIDOFOVIR 75 MG/ML IV SOL,60075,CDM,636,RC,J0740,HCPCS,23155021631,NDC,facility,outpatient,1,mL,383.32000,364.15000,Amish/Mennonite,Amish Mennonite,,210.83,,,,,,,191.66,873.48,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,inpatient,1,EA,43.43000,41.26000,Amish/Mennonite,Amish Mennonite,,23.89,,,,,,,23.89,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,00054038325,NDC,facility,outpatient,1,EA,43.43000,41.26000,Amish/Mennonite,Amish Mennonite,,23.89,,,,,,,1.77,42.13,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 50 MG,60076,CDM,250,RC,J8530,HCPCS,54879002201,NDC,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,1.77,12.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,44567051101,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,4.75,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,inpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
CISPLATIN SOLN 1 MG/ML 200 ML (MDV),60077,CDM,250,RC,J9060,HCPCS,63323010364,NDC,facility,outpatient,1,mL,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,4.75,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,80681-0071-00,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,50268-0852-15,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CYANOCOBALAMIN TAB 100 MCG,60078,CDM,250,RC,54629-0058-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,inpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,14.77,26.05,percent of total billed charges,
CYTARABINE POWD-INJ 500 MG,60079,CDM,250,RC,J9100,HCPCS,55390013210,NDC,facility,outpatient,1,EA,26.86000,25.52000,Amish/Mennonite,Amish Mennonite,,14.77,,,,,,,1.26,26.05,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,inpatient,1,EA,11.14000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,6.13,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,00078024015,NDC,facility,outpatient,1,EA,11.14000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,1.15,10.81,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,inpatient,1,EA,9.73000,9.24000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,5.35,9.44,percent of total billed charges,
CYCLOSPORINE CAP 25 MG (EQV-SANDIMMUNE),60080,CDM,250,RC,J7515,HCPCS,60505013300,NDC,facility,outpatient,1,EA,9.73000,9.24000,Amish/Mennonite,Amish Mennonite,,5.35,,,,,,,1.15,9.44,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,inpatient,1,mL,36.86000,35.01000,Amish/Mennonite,Amish Mennonite,,20.27,,,,,,,20.27,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00078027422,NDC,facility,outpatient,1,mL,36.86000,35.01000,Amish/Mennonite,Amish Mennonite,,20.27,,,,,,,3.14,35.75,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,inpatient,1,mL,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,8.20,14.45,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-NEORAL),60081,CDM,250,RC,J7502,HCPCS,00172731320,NDC,facility,outpatient,1,mL,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,3.14,14.45,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,inpatient,1,mL,36.06000,34.25000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,19.83,34.98,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00078010901,NDC,facility,outpatient,1,mL,36.06000,34.25000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,18.03,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,inpatient,1,mL,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,9.33,16.46,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,00517086610,NDC,facility,outpatient,1,mL,16.97000,16.12000,Amish/Mennonite,Amish Mennonite,,9.33,,,,,,,8.48,119.94,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,inpatient,1,mL,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,7.64,13.48,percent of total billed charges,
CYCLOSPORINE SOLN 50 MG/ML 5 ML,60082,CDM,250,RC,J7516,HCPCS,55390012210,NDC,facility,outpatient,1,mL,13.90000,13.21000,Amish/Mennonite,Amish Mennonite,,7.64,,,,,,,6.95,119.94,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,inpatient,1,mL,16.03000,15.23000,Amish/Mennonite,Amish Mennonite,,8.82,,,,,,,8.82,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,00065-0395-15,NDC,,,facility,outpatient,1,mL,16.03000,15.23000,Amish/Mennonite,Amish Mennonite,,8.82,,,,,,,8.02,15.55,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,inpatient,1,mL,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.76,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 0.5% 15 ML,60084,CDM,250,RC,17478-0096-15,NDC,,,facility,outpatient,1,mL,10.06000,9.56000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.03,9.76,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,inpatient,1,EA,88.48000,84.06000,Amish/Mennonite,Amish Mennonite,,48.66,,,,,,,48.66,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,70594002301,NDC,facility,outpatient,1,EA,88.48000,84.06000,Amish/Mennonite,Amish Mennonite,,48.66,,,,,,,18.24,85.83,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,inpatient,1,EA,32.01000,30.41000,Amish/Mennonite,Amish Mennonite,,17.61,,,,,,,17.61,31.05,percent of total billed charges,
COLISTIMETHATE POWD-INJ 150 MG,60085,CDM,250,RC,J0770,HCPCS,63323039306,NDC,facility,outpatient,1,EA,32.01000,30.41000,Amish/Mennonite,Amish Mennonite,,17.61,,,,,,,16.00,31.05,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,inpatient,1,EA,405.06000,384.81000,Amish/Mennonite,Amish Mennonite,,222.78,,,,,,,222.78,392.91,percent of total billed charges,
DEFERASIROX TAB-EFF 500 MG,60086,CDM,250,RC,00078-0470-15,NDC,,,facility,outpatient,1,EA,405.06000,384.81000,Amish/Mennonite,Amish Mennonite,,222.78,,,,,,,202.53,392.91,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,inpatient,1,mL,29.93000,28.43000,Amish/Mennonite,Amish Mennonite,,16.46,,,,,,,16.46,29.03,percent of total billed charges,
CYSTEINE 50 MG/ML SOLN,60087,CDM,250,RC,J3490,HCPCS,51754100703,NDC,facility,outpatient,1,mL,29.93000,28.43000,Amish/Mennonite,Amish Mennonite,,16.46,,,,,,,14.96,29.03,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,inpatient,1,mL,43.19000,41.03000,Amish/Mennonite,Amish Mennonite,,23.75,,,,,,,23.75,41.89,percent of total billed charges,
CYCLOSPORINE LIQ 100 MG/ML (EQV-SANDIMMUNE),60089,CDM,250,RC,J7502,HCPCS,00078011022,NDC,facility,outpatient,1,mL,43.19000,41.03000,Amish/Mennonite,Amish Mennonite,,23.75,,,,,,,3.14,41.89,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,inpatient,1,EA,7.04000,6.69000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,3.87,6.83,percent of total billed charges,
CYCLOPHOSPHAMIDE TAB 25 MG,60090,CDM,250,RC,J8530,HCPCS,00054412925,NDC,facility,outpatient,1,EA,7.04000,6.69000,Amish/Mennonite,Amish Mennonite,,3.87,,,,,,,1.77,6.83,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,inpatient,1,mL,89.25000,84.79000,Amish/Mennonite,Amish Mennonite,,49.09,,,,,,,49.09,86.57,percent of total billed charges,
CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML IV SOL,60091,CDM,636,RC,J0850,HCPCS,44206053211,NDC,facility,outpatient,1,mL,89.25000,84.79000,Amish/Mennonite,Amish Mennonite,,49.09,,,,,,,44.62,3007.94,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,inpatient,1,EA,11.50000,10.93000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,6.33,11.15,percent of total billed charges,
CONJUGATED ESTROGENS SYNTHETIC 0.625 MG TAB,60092,CDM,250,RC,51285-0442-02,NDC,,,facility,outpatient,1,EA,11.50000,10.93000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,5.75,11.15,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,inpatient,1,mL,417.74000,396.85000,Amish/Mennonite,Amish Mennonite,,229.76,,,,,,,229.76,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050001,NDC,facility,outpatient,1,mL,417.74000,396.85000,Amish/Mennonite,Amish Mennonite,,229.76,,,,,,,24.87,405.21,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,inpatient,1,mL,459.10000,436.15000,Amish/Mennonite,Amish Mennonite,,252.50,,,,,,,252.50,445.33,percent of total billed charges,
DALTEPARIN 5000 INTL UNITS/0.2 ML SUBQ SOL,60093,CDM,250,RC,J1645,HCPCS,62856050010,NDC,facility,outpatient,1,mL,459.10000,436.15000,Amish/Mennonite,Amish Mennonite,,252.50,,,,,,,24.87,445.33,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CLINDAMYCIN/NS SOLN SD 15 MG/ML,60094,CDM,250,RC,J0736,HCPCS,0000907752601500,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,2.76,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,45802-0562-01,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.46,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,inpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,52565-0018-29,NDC,,,facility,outpatient,1,mL,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
CLINDAMYCIN LIQ-TOP 1% 30 ML,60095,CDM,250,RC,63629-8633-01,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,inpatient,1,EA,23.67000,22.48000,Amish/Mennonite,Amish Mennonite,,13.02,,,,,,,13.02,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,00054038225,NDC,facility,outpatient,1,EA,23.67000,22.48000,Amish/Mennonite,Amish Mennonite,,13.02,,,,,,,1.77,22.96,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,inpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,13.21,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,54879002101,NDC,facility,outpatient,1,EA,24.02000,22.82000,Amish/Mennonite,Amish Mennonite,,13.21,,,,,,,1.77,23.30,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,inpatient,1,EA,5.32000,5.05000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.16,percent of total billed charges,
CYCLOPHOSPHAMIDE CAP 25 MG,60096,CDM,250,RC,J8530,HCPCS,62332061831,NDC,facility,outpatient,1,EA,5.32000,5.05000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,1.77,5.16,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,inpatient,1,EA,3353.56000,3185.88000,Amish/Mennonite,Amish Mennonite,,1844.46,,,,,,,1844.46,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67457092802,NDC,facility,outpatient,1,EA,3353.56000,3185.88000,Amish/Mennonite,Amish Mennonite,,1844.46,,,,,,,302.92,3252.95,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,inpatient,1,EA,3885.76000,3691.47000,Amish/Mennonite,Amish Mennonite,,2137.17,,,,,,,2137.17,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,55292081155,NDC,facility,outpatient,1,EA,3885.76000,3691.47000,Amish/Mennonite,Amish Mennonite,,2137.17,,,,,,,302.92,3769.19,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,inpatient,1,EA,1610.02000,1529.52000,Amish/Mennonite,Amish Mennonite,,885.51,,,,,,,885.51,1561.72,percent of total billed charges,
DACTINOMYCIN 0.5 MG IV SOL,60097,CDM,636,RC,J9120,HCPCS,67386081155,NDC,facility,outpatient,1,EA,1610.02000,1529.52000,Amish/Mennonite,Amish Mennonite,,885.51,,,,,,,302.92,1561.72,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,inpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
DESIPRAMINE 10 MG TAB,60098,CDM,250,RC,45963-0341-02,NDC,,,facility,outpatient,1,EA,2.95000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50742-0190-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,50268-0189-15,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,inpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,51991-0838-01,NDC,,,facility,outpatient,1,EA,2.08000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.04,2.02,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,52817-0210-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
CYPROHEPTADINE TAB 4 MG,60100,CDM,250,RC,70710-1110-01,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,inpatient,1,mL,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,61703030346,NDC,facility,outpatient,1,mL,1.71000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 50 ML,60101,CDM,250,RC,J9100,HCPCS,67457045450,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.34,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,inpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
CYPROHEPTADINE LIQ 0.4 MG/ML,60102,CDM,250,RC,J8499,HCPCS,64980050448,NDC,facility,outpatient,1,mL,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,49938-0101-30,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,inpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-10,NDC,,,facility,outpatient,1,EA,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
DAPSONE TAB 100 MG,60103,CDM,250,RC,70954-0136-20,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,inpatient,1,EA,1973.81000,1875.12000,Amish/Mennonite,Amish Mennonite,,1085.60,,,,,,,1085.60,1914.60,percent of total billed charges,
DEGARELIX 120 MG POWD,60104,CDM,636,RC,J9155,HCPCS,55566840301,NDC,facility,outpatient,1,EA,1973.81000,1875.12000,Amish/Mennonite,Amish Mennonite,,1085.60,,,,,,,4.36,1914.60,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,inpatient,1,mL,1535.35000,1458.58000,Amish/Mennonite,Amish Mennonite,,844.44,,,,,,,844.44,1489.29,percent of total billed charges,
CYTARABINE LIPOSOMAL 10 MG/ML INTRATHECAL SUSP,60106,CDM,250,RC,J9098,HCPCS,57665033101,NDC,facility,outpatient,1,mL,1535.35000,1458.58000,Amish/Mennonite,Amish Mennonite,,844.44,,,,,,,767.67,1489.29,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,inpatient,1,EA,12.03000,11.43000,Amish/Mennonite,Amish Mennonite,,6.62,,,,,,,6.62,11.67,percent of total billed charges,
DANAZOL 100 MG CAP,60108,CDM,250,RC,00555-0634-02,NDC,,,facility,outpatient,1,EA,12.03000,11.43000,Amish/Mennonite,Amish Mennonite,,6.62,,,,,,,6.01,11.67,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,inpatient,1,EA,11.51000,10.94000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,00406896101,NDC,facility,outpatient,1,EA,11.51000,10.94000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,5.75,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,inpatient,1,EA,11.51000,10.94000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,6.33,11.16,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 10 MG,60109,CDM,250,RC,S0160,HCPCS,51862034590,NDC,facility,outpatient,1,EA,11.51000,10.94000,Amish/Mennonite,Amish Mennonite,,6.33,,,,,,,5.75,11.16,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,inpatient,1,mL,28.47000,27.05000,Amish/Mennonite,Amish Mennonite,,15.66,,,,,,,15.66,27.62,percent of total billed charges,
DESMOPRESSIN/NS SOLN SD 0.5 MCG/ML,60110,CDM,636,RC,J2597,HCPCS,5556623000000050,NDC,facility,outpatient,1,mL,28.47000,27.05000,Amish/Mennonite,Amish Mennonite,,15.66,,,,,,,3.89,27.62,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,13925-0504-30,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.97,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,49938-0102-30,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.60,6.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,64980-0567-03,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,inpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,69543-0150-30,NDC,,,facility,outpatient,1,EA,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,inpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-10,NDC,,,facility,outpatient,1,EA,6.23000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.12,6.04,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
DAPSONE TAB 25 MG,60111,CDM,250,RC,70954-0135-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
CORTISONE TAB 25 MG,60112,CDM,250,RC,00143-1202-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,inpatient,1,EA,17.03000,16.18000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,9.37,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00078-0126-05,NDC,,,facility,outpatient,1,EA,17.03000,16.18000,Amish/Mennonite,Amish Mennonite,,9.37,,,,,,,8.52,16.52,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00093-4359-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.73,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,00904-7089-61,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,51079-0921-20,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,inpatient,1,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,60687-0404-01,NDC,,,facility,outpatient,1,EA,2.07000,1.97000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,2.01,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,65862-0844-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,inpatient,1,EA,19.28000,18.31000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,10.60,18.70,percent of total billed charges,
CLOZAPINE TAB 25 MG,60114,CDM,250,RC,69809-0126-05,NDC,,,facility,outpatient,1,EA,19.28000,18.31000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,9.64,18.70,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,inpatient,1,EA,2.88000,2.74000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,16714-0883-01,NDC,,,facility,outpatient,1,EA,2.88000,2.74000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,23155-0489-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,60505-0257-01,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,inpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,68084-0606-21,NDC,,,facility,outpatient,1,EA,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.00,5.82,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.82,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.1 MG,60115,CDM,250,RC,69918-0101-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.66,3.21,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,9.53,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,00591-2465-01,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,8.66,16.81,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,inpatient,1,EA,7.44000,7.07000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,4.09,7.22,percent of total billed charges,
DESMOPRESSIN TAB 0.2 MG,60116,CDM,250,RC,68084-0604-21,NDC,,,facility,outpatient,1,EA,7.44000,7.07000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,3.72,7.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00078-0381-05,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.76,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,00781-5689-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,10702-0107-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 5 MG,60119,CDM,250,RC,57664-0378-88,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,inpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,00944303202,NDC,facility,outpatient,1,EA,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,1.88,5.52,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,inpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,2.38,4.20,percent of total billed charges,
COAGULATION FACTOR IX RECOMBINANT INJ,60120,CDM,636,RC,J7195,HCPCS,58394063503,NDC,facility,outpatient,1,EA,4.33000,4.11000,Amish/Mennonite,Amish Mennonite,,2.38,,,,,,,1.88,4.20,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
DEXAMETHASONE SOLN SD 1 MG/ML,60122,CDM,250,RC,63323-0165-01-00100,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 2 MG,60124,CDM,250,RC,J8540,HCPCS,00054817625,NDC,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,00168-0310-02,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.34,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,inpatient,1,mL,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.98,12.31,percent of total billed charges,
DESONIDE LOT 0.05% 59 ML,60125,CDM,250,RC,68462-0513-39,NDC,,,facility,outpatient,1,mL,12.69000,12.05000,Amish/Mennonite,Amish Mennonite,,6.98,,,,,,,6.34,12.31,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 1 MG/ML,60126,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE SOLN SD 0.5 MG/ML,60127,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,inpatient,1,EA,43.56000,41.39000,Amish/Mennonite,Amish Mennonite,,23.96,,,,,,,23.96,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00078-0431-05,NDC,,,facility,outpatient,1,EA,43.56000,41.39000,Amish/Mennonite,Amish Mennonite,,23.96,,,,,,,21.78,42.25,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,inpatient,1,EA,23.96000,22.76000,Amish/Mennonite,Amish Mennonite,,13.18,,,,,,,13.18,23.24,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 10 MG,60128,CDM,250,RC,00781-2683-01,NDC,,,facility,outpatient,1,EA,23.96000,22.76000,Amish/Mennonite,Amish Mennonite,,13.18,,,,,,,11.98,23.24,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,00904-0053-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-34,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0017-37,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,49348-0861-34,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54838-0139-40,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,54859-0505-04,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,57896-0736-04,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML LIQU 473 ML,60129,CDM,250,RC,58657-0504-08,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,inpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00378107001,NDC,facility,outpatient,1,EA,4.61000,4.38000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.31,4.47,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,inpatient,1,EA,9.22000,8.75000,Amish/Mennonite,Amish Mennonite,,5.07,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,00406896001,NDC,facility,outpatient,1,EA,9.22000,8.75000,Amish/Mennonite,Amish Mennonite,,5.07,,,,,,,4.61,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,inpatient,1,EA,9.22000,8.75000,Amish/Mennonite,Amish Mennonite,,5.07,,,,,,,5.07,8.94,percent of total billed charges,
DEXTROAMPHETAMINE CAP-ER 5 MG,60130,CDM,250,RC,S0160,HCPCS,45963030309,NDC,facility,outpatient,1,EA,9.22000,8.75000,Amish/Mennonite,Amish Mennonite,,5.07,,,,,,,4.61,8.94,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,inpatient,1,EA,40.08000,38.08000,Amish/Mennonite,Amish Mennonite,,22.04,,,,,,,22.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00078-0430-05,NDC,,,facility,outpatient,1,EA,40.08000,38.08000,Amish/Mennonite,Amish Mennonite,,22.04,,,,,,,20.04,38.88,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,inpatient,1,EA,20.55000,19.52000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.93,percent of total billed charges,
DEXMETHYLPHENIDATE CAP-ER 5 MG,60131,CDM,250,RC,00781-2682-01,NDC,,,facility,outpatient,1,EA,20.55000,19.52000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,10.28,19.93,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,inpatient,1,EA,1420.64000,1349.61000,Amish/Mennonite,Amish Mennonite,,781.35,,,,,,,781.35,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,55150043701,NDC,facility,outpatient,1,EA,1420.64000,1349.61000,Amish/Mennonite,Amish Mennonite,,781.35,,,,,,,32.09,1378.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,inpatient,1,EA,1187.54000,1128.16000,Amish/Mennonite,Amish Mennonite,,653.15,,,,,,,653.15,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72266010101,NDC,facility,outpatient,1,EA,1187.54000,1128.16000,Amish/Mennonite,Amish Mennonite,,653.15,,,,,,,32.09,1151.91,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,inpatient,1,EA,1033.41000,981.74000,Amish/Mennonite,Amish Mennonite,,568.38,,,,,,,568.38,1002.41,percent of total billed charges,
DEXRAZOXANE POWD-INJ 500 MG,60133,CDM,636,RC,J1190,HCPCS,72611071601,NDC,facility,outpatient,1,EA,1033.41000,981.74000,Amish/Mennonite,Amish Mennonite,,568.38,,,,,,,32.09,1002.41,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,inpatient,1,mL,501.16000,476.11000,Amish/Mennonite,Amish Mennonite,,275.64,,,,,,,275.64,486.13,percent of total billed charges,
DARBEPOETIN ALFA SOLN 10 MCG/0.4 ML,60134,CDM,636,RC,J0881,HCPCS,55513009804,NDC,facility,outpatient,1,mL,501.16000,476.11000,Amish/Mennonite,Amish Mennonite,,275.64,,,,,,,3.00,486.13,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,45802-0433-21,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0171-63,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-63,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
DEXTROMETHORPHAN LIQ-ER 6 MG/ML,60137,CDM,250,RC,63824-0175-65,NDC,,,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0433-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 4.25% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911034,60138,CDM,250,RC,00941-0459-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,inpatient,1,EA,73.47000,69.80000,Amish/Mennonite,Amish Mennonite,,40.41,,,,,,,40.41,71.27,percent of total billed charges,
CYTARABINE POWD-INJ 1 GM,60139,CDM,250,RC,J9100,HCPCS,55390013301,NDC,facility,outpatient,1,EA,73.47000,69.80000,Amish/Mennonite,Amish Mennonite,,40.41,,,,,,,1.26,71.27,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,inpatient,1,EA,608.34000,577.92000,Amish/Mennonite,Amish Mennonite,,334.59,,,,,,,334.59,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,00013871762,NDC,facility,outpatient,1,EA,608.34000,577.92000,Amish/Mennonite,Amish Mennonite,,334.59,,,,,,,32.09,590.09,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,inpatient,1,EA,710.33000,674.82000,Amish/Mennonite,Amish Mennonite,,390.68,,,,,,,390.68,689.02,percent of total billed charges,
DEXRAZOXANE POWD-INJ 250 MG,60142,CDM,636,RC,J1190,HCPCS,67457020725,NDC,facility,outpatient,1,EA,710.33000,674.82000,Amish/Mennonite,Amish Mennonite,,390.68,,,,,,,32.09,689.02,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-34,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,00536-1161-37,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,inpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.74250,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-01,NDC,,,facility,outpatient,1,EA,1.35000,1.28000,Amish/Mennonite,Amish Mennonite,,0.74250,,,,,,,0.67500,1.31,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-20,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,inpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-32,NDC,,,facility,outpatient,1,EA,1.90000,1.81000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,inpatient,1,EA,1.46000,1.38000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN TAB-ER 30 MG-600 MG,60144,CDM,250,RC,63824-0056-34,NDC,,,facility,outpatient,1,EA,1.46000,1.38000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,inpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
DEXTRAN 40 10%/NS 500 ML,60145,CDM,250,RC,J7100,HCPCS,00409741903,NDC,facility,outpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,inpatient,1,GM,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,49348-0379-54,NDC,,,facility,outpatient,1,GM,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,inpatient,1,GM,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-2062-00,NDC,,,facility,outpatient,1,GM,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,inpatient,1,GM,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,51672-6708-00,NDC,,,facility,outpatient,1,GM,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,inpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
CLOTRIMAZOLE CRM-VAG 2% W/APPL 21 GM,60146,CDM,250,RC,70677-1231-01,NDC,,,facility,outpatient,1,GM,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,inpatient,1,mL,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
CYTARABINE SOLN 20 MG/ML 25ML,60149,CDM,250,RC,J9100,HCPCS,61703030436,NDC,facility,outpatient,1,mL,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,inpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE LIQ 0.1 MG/ML,60152,CDM,250,RC,J8540,HCPCS,54879000308,NDC,facility,outpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,inpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE TAB 1.5 MG,60153,CDM,250,RC,J8540,HCPCS,00054818125,NDC,facility,outpatient,1,EA,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00338067304,NDC,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.45% NACL W/ KCL 30 MEQ/L 1000 ML,60154,CDM,250,RC,J3480,HCPCS,00409790309,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,inpatient,1,mL,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,63323051610,NDC,facility,outpatient,1,mL,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,0.14415,4.74,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
DEXAMETHASONE SOLN 10 MG/ML 10ML,60156,CDM,250,RC,J1100,HCPCS,67457042010,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.14415,1.22,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,inpatient,1,mL,11.35000,10.79000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,6.24,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321310,NDC,facility,outpatient,1,mL,11.35000,10.79000,Amish/Mennonite,Amish Mennonite,,6.24,,,,,,,5.67,11.01,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,inpatient,1,mL,11.53000,10.95000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,6.34,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,00409321312,NDC,facility,outpatient,1,mL,11.53000,10.95000,Amish/Mennonite,Amish Mennonite,,6.34,,,,,,,5.76,11.18,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,inpatient,1,mL,15.13000,14.38000,Amish/Mennonite,Amish Mennonite,,8.32,,,,,,,8.32,14.68,percent of total billed charges,
DIAZEPAM SOLN 5 MG/ML 10 ML,60157,CDM,250,RC,J3360,HCPCS,69339013705,NDC,facility,outpatient,1,mL,15.13000,14.38000,Amish/Mennonite,Amish Mennonite,,8.32,,,,,,,7.57,14.68,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
DEXTROSE 20% 500 ML,60158,CDM,250,RC,J3490,HCPCS,00409793519,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,inpatient,1,mL,34.06000,32.36000,Amish/Mennonite,Amish Mennonite,,18.73,,,,,,,18.73,33.04,percent of total billed charges,
DEXAMETHASONE SOLN-OPHTH 0.1%,60160,CDM,250,RC,24208-0720-02,NDC,,,facility,outpatient,1,mL,34.06000,32.36000,Amish/Mennonite,Amish Mennonite,,18.73,,,,,,,17.03,33.04,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00338007703,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.2% NACL 500 ML,60163,CDM,250,RC,J3490,HCPCS,00409792403,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,inpatient,1,EA,583.45000,554.28000,Amish/Mennonite,Amish Mennonite,,320.90,,,,,,,320.90,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,00093-6137-32,NDC,,,facility,outpatient,1,EA,583.45000,554.28000,Amish/Mennonite,Amish Mennonite,,320.90,,,,,,,291.73,565.95,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,inpatient,1,EA,375.39000,356.62000,Amish/Mennonite,Amish Mennonite,,206.46,,,,,,,206.46,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,66490-0650-20,NDC,,,facility,outpatient,1,EA,375.39000,356.62000,Amish/Mennonite,Amish Mennonite,,206.46,,,,,,,187.69,364.13,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,inpatient,1,EA,331.20000,314.64000,Amish/Mennonite,Amish Mennonite,,182.16,,,,,,,182.16,321.26,percent of total billed charges,
DIAZEPAM GEL 2.5 MG RECTAL,60165,CDM,250,RC,68682-0650-20,NDC,,,facility,outpatient,1,EA,331.20000,314.64000,Amish/Mennonite,Amish Mennonite,,182.16,,,,,,,165.60,321.26,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00338012503,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS 500 ML,60167,CDM,250,RC,J7121,HCPCS,00409792903,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,inpatient,1,EA,17147.50000,16290.12000,Amish/Mennonite,Amish Mennonite,,9431.12,,,,,,,9431.12,16633.08,percent of total billed charges,
DAUNORUBICIN 2.2 MG/ML (W/CYTARABINE 5 MG/ML) LIPOSOMAL POWD-INJ 20 ML,60169,CDM,636,RC,J9153,HCPCS,68727074502,NDC,facility,outpatient,1,EA,17147.50000,16290.12000,Amish/Mennonite,Amish Mennonite,,9431.12,,,,,,,255.09,16633.08,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00264752010,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,00338002303,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 10% 500 ML,60171,CDM,250,RC,J3490,HCPCS,63323082475,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,inpatient,1,mL,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,4.05,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,00054-0057-46,NDC,,,facility,outpatient,1,mL,7.37000,7.00000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,3.69,7.15,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,inpatient,1,mL,6.27000,5.95000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.45,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,66689-0327-02,NDC,,,facility,outpatient,1,mL,6.27000,5.95000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.13,6.08,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,inpatient,1,mL,7.48000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,4.11,7.26,percent of total billed charges,
DIGOXIN ELIXIR 50 MCG/ML,60172,CDM,250,RC,69292-0605-60,NDC,,,facility,outpatient,1,mL,7.48000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.74,7.26,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,inpatient,1,EA,692.13000,657.52000,Amish/Mennonite,Amish Mennonite,,380.67,,,,,,,380.67,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00093-6138-32,NDC,,,facility,outpatient,1,EA,692.13000,657.52000,Amish/Mennonite,Amish Mennonite,,380.67,,,,,,,346.06,671.37,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,inpatient,1,EA,445.31000,423.05000,Amish/Mennonite,Amish Mennonite,,244.92,,,,,,,244.92,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,00187-0658-20,NDC,,,facility,outpatient,1,EA,445.31000,423.05000,Amish/Mennonite,Amish Mennonite,,244.92,,,,,,,222.66,431.95,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,inpatient,1,EA,785.75000,746.47000,Amish/Mennonite,Amish Mennonite,,432.16,,,,,,,432.16,762.18,percent of total billed charges,
DIAZEPAM GEL 10 MG RECTAL,60173,CDM,250,RC,68682-0652-20,NDC,,,facility,outpatient,1,EA,785.75000,746.47000,Amish/Mennonite,Amish Mennonite,,432.16,,,,,,,392.88,762.18,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
DIAZEPAM LIQ 1 MG/1 ML,60174,CDM,250,RC,00054-3188-63-00100,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00264761010,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,2.24,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL 500 ML,60175,CDM,250,RC,J7042,HCPCS,00409794103,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,2.24,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00054-3185-44,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.68,3.25,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,inpatient,1,mL,2.91000,2.77000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
DIAZEPAM 5 MG/ML ORAL CONC,60176,CDM,250,RC,00527-1768-36,NDC,,,facility,outpatient,1,mL,2.91000,2.77000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00264762500,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00338068304,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00409790509,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.34860,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5% W/ KCL 20 MEQ/L 1000 ML,60177,CDM,250,RC,J3480,HCPCS,00990790509,NDC,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,inpatient,1,GM,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00501-3201-01,NDC,,,facility,outpatient,1,GM,5.19000,4.93000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.60,5.03,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,00904-5354-31,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,45802-0358-03,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,inpatient,1,GM,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
DIPHENHYDRAMINE CRM 2% 28 GM,60178,CDM,250,RC,49348-0854-72,NDC,,,facility,outpatient,1,GM,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,inpatient,1,GM,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00067-8152-03,NDC,,,facility,outpatient,1,GM,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,inpatient,1,GM,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,50383-0272-01,NDC,,,facility,outpatient,1,GM,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,00536-1294-97,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,inpatient,1,GM,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,16714-0976-01,NDC,,,facility,outpatient,1,GM,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,inpatient,1,GM,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,21922-0009-09,NDC,,,facility,outpatient,1,GM,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,43598-0977-10,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,inpatient,1,GM,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0160-00,NDC,,,facility,outpatient,1,GM,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,45802-0953-01,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,inpatient,1,GM,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,57896-0140-01,NDC,,,facility,outpatient,1,GM,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,inpatient,1,GM,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,58602-0604-07,NDC,,,facility,outpatient,1,GM,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,inpatient,1,GM,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,63481-0684-47,NDC,,,facility,outpatient,1,GM,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,inpatient,1,GM,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,69097-0524-44,NDC,,,facility,outpatient,1,GM,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
DICLOFENAC GEL 1% 100 GM,60179,CDM,250,RC,76282-0663-39,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,00228-2550-11,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,inpatient,1,EA,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,16571-0202-10,NDC,,,facility,outpatient,1,EA,0.77000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,51079-0466-20,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,60687-0606-01,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,61442-0102-60,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
DICLOFENAC SODIUM TAB-EC 50 MG,60180,CDM,250,RC,71205-0995-30,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,inpatient,1,mL,4537.21000,4310.35000,Amish/Mennonite,Amish Mennonite,,2495.47,,,,,,,2495.47,4401.09,percent of total billed charges,
DINUTUXIMAB 17.5 MG/5 ML SOLN,60181,CDM,636,RC,J1246,HCPCS,66302001401,NDC,facility,outpatient,1,mL,4537.21000,4310.35000,Amish/Mennonite,Amish Mennonite,,2495.47,,,,,,,155.39,4401.09,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,00378-4140-01,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,inpatient,1,EA,8.94000,8.49000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,47781-0607-30,NDC,,,facility,outpatient,1,EA,8.94000,8.49000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.47,8.67,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,inpatient,1,EA,23.81000,22.62000,Amish/Mennonite,Amish Mennonite,,13.10,,,,,,,13.10,23.10,percent of total billed charges,
DISULFIRAM TAB 250 MG,60183,CDM,250,RC,51285-0523-02,NDC,,,facility,outpatient,1,EA,23.81000,22.62000,Amish/Mennonite,Amish Mennonite,,13.10,,,,,,,11.90,23.10,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00264-7387-50,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 70% 2000 ML,60184,CDM,250,RC,00409-7120-07,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,inpatient,1,mL,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
DIAZEPAM LIQ 1 MG/ML,60186,CDM,250,RC,00054-3188-63,NDC,,,facility,outpatient,1,mL,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,inpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0409-06,NDC,,,facility,outpatient,1,mL,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 1.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML,60187,CDM,250,RC,00941-0424-52,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,inpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
DIGOXIN/NS SOLN SD 10 MCG/ML,60188,CDM,250,RC,J1160,HCPCS,2498702621001000,NDC,facility,outpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,8.10,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00338008503,NDC,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,2.24,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.45% NACL 500 ML,60189,CDM,250,RC,J7042,HCPCS,00409792603,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,2.24,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,inpatient,1,mL,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,284.90,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,00703572001,NDC,facility,outpatient,1,mL,518.00000,492.10000,Amish/Mennonite,Amish Mennonite,,284.90,,,,,,,0.60838,502.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,inpatient,1,mL,312.84000,297.20000,Amish/Mennonite,Amish Mennonite,,172.06,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,16729026763,NDC,facility,outpatient,1,mL,312.84000,297.20000,Amish/Mennonite,Amish Mennonite,,172.06,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,inpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML,60192,CDM,250,RC,J9171,HCPCS,25021024501,NDC,facility,outpatient,1,mL,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,0.60838,76.63,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,00093-0320-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,50228-0483-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
DILTIAZEM TAB 90 MG,60193,CDM,250,RC,51079-0747-20,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,inpatient,1,EA,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,6.57,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,68462-0562-01,NDC,,,facility,outpatient,1,EA,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,5.97,11.58,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,6.52,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,24979-0183-01,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,5.92,11.49,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,inpatient,1,EA,17.17000,16.31000,Amish/Mennonite,Amish Mennonite,,9.44,,,,,,,9.44,16.65,percent of total billed charges,
DILTIAZEM CAP-ER 120 MG/12 HOURS,60194,CDM,250,RC,51079-0926-20,NDC,,,facility,outpatient,1,EA,17.17000,16.31000,Amish/Mennonite,Amish Mennonite,,9.44,,,,,,,8.59,16.65,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00338-0221-04,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ELECTROLYTE SOLN (PLASMA-LYTE/NORMOSOL) 1000 ML,60196,CDM,250,RC,00409-7670-09,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,inpatient,1,EA,12.67000,12.04000,Amish/Mennonite,Amish Mennonite,,6.97,,,,,,,6.97,12.29,percent of total billed charges,
DISOPYRAMIDE 100 MG ER CAP,60197,CDM,250,RC,00025-2732-31,NDC,,,facility,outpatient,1,EA,12.67000,12.04000,Amish/Mennonite,Amish Mennonite,,6.97,,,,,,,6.33,12.29,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT LOTION 473 ML (EQV-LUBRIDERM),60198,CDM,250,RC,52800-0488-56,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,inpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,00591-5560-01,NDC,,,facility,outpatient,1,EA,6.30000,5.98000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.11,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,inpatient,1,EA,11.14000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,6.13,10.81,percent of total billed charges,
DISOPYRAMIDE CAP 100 MG,60199,CDM,250,RC,51862-0093-01,NDC,,,facility,outpatient,1,EA,11.14000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,5.57,10.81,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,inpatient,1,EA,34.50000,32.78000,Amish/Mennonite,Amish Mennonite,,18.98,,,,,,,18.98,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00051002121,NDC,facility,outpatient,1,EA,34.50000,32.78000,Amish/Mennonite,Amish Mennonite,,18.98,,,,,,,2.29,33.47,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,inpatient,1,EA,5.33000,5.07000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,17478076106,NDC,facility,outpatient,1,EA,5.33000,5.07000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.29,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,inpatient,1,EA,14.93000,14.18000,Amish/Mennonite,Amish Mennonite,,8.21,,,,,,,8.21,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,00904714461,NDC,facility,outpatient,1,EA,14.93000,14.18000,Amish/Mennonite,Amish Mennonite,,8.21,,,,,,,2.29,14.48,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,inpatient,1,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,42858086706,NDC,facility,outpatient,1,EA,4.37000,4.15000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.19,4.24,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,inpatient,1,EA,16.28000,15.47000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.95,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,60687037501,NDC,facility,outpatient,1,EA,16.28000,15.47000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,2.29,15.79,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,inpatient,1,EA,6.24000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877056860,NDC,facility,outpatient,1,EA,6.24000,5.92000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,2.29,6.05,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,inpatient,1,EA,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.17,percent of total billed charges,
DRONABINOL CAP 2.5 MG,60200,CDM,250,RC,Q0167,HCPCS,67877075360,NDC,facility,outpatient,1,EA,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.29,5.17,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0430-52,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
DEXTROSE 2.5% WITH ELECTROLYTES (DIANEAL LOW CALCIUM) INTRAPERITONEAL SOL 2000 ML 7911029,60201,CDM,250,RC,00941-0457-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,inpatient,1,mL,22.88000,21.74000,Amish/Mennonite,Amish Mennonite,,12.58,,,,,,,12.58,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,61553030833,NDC,facility,outpatient,1,mL,22.88000,21.74000,Amish/Mennonite,Amish Mennonite,,12.58,,,,,,,11.44,22.19,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,inpatient,1,mL,23.28000,22.11000,Amish/Mennonite,Amish Mennonite,,12.80,,,,,,,12.80,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092147744,NDC,facility,outpatient,1,mL,23.28000,22.11000,Amish/Mennonite,Amish Mennonite,,12.80,,,,,,,11.64,22.58,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,inpatient,1,mL,23.77000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,13.07,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,70092247744,NDC,facility,outpatient,1,mL,23.77000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,11.88,23.06,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,inpatient,1,mL,6.66000,6.33000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,3.66,6.46,percent of total billed charges,
EPHEDRINE/NS SOLN 10 MG/ML 5 ML,60202,CDM,250,RC,J3490,HCPCS,71030000109,NDC,facility,outpatient,1,mL,6.66000,6.33000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,3.33,6.46,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,inpatient,1,mL,1490.77000,1416.23000,Amish/Mennonite,Amish Mennonite,,819.92,,,,,,,819.92,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,00075800404,NDC,facility,outpatient,1,mL,1490.77000,1416.23000,Amish/Mennonite,Amish Mennonite,,819.92,,,,,,,0.60838,1446.05,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,inpatient,1,mL,312.84000,297.20000,Amish/Mennonite,Amish Mennonite,,172.06,,,,,,,172.06,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,16729026764,NDC,facility,outpatient,1,mL,312.84000,297.20000,Amish/Mennonite,Amish Mennonite,,172.06,,,,,,,0.60838,303.45,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,inpatient,1,mL,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,36.93,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,25021024504,NDC,facility,outpatient,1,mL,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,0.60838,65.14,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,inpatient,1,mL,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
DOCETAXEL SOLN 20 MG/ML 4 ML,60205,CDM,250,RC,J9171,HCPCS,43598061040,NDC,facility,outpatient,1,mL,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,0.60838,153.26,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,inpatient,1,EA,7.10000,6.75000,Amish/Mennonite,Amish Mennonite,,3.90,,,,,,,3.90,6.89,percent of total billed charges,
DISOPYRAMIDE 150 MG CAP,60206,CDM,250,RC,00591-5561-01,NDC,,,facility,outpatient,1,EA,7.10000,6.75000,Amish/Mennonite,Amish Mennonite,,3.90,,,,,,,3.55,6.89,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,inpatient,1,EA,4.93000,4.69000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.71,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,50268-0277-15,NDC,,,facility,outpatient,1,EA,4.93000,4.69000,Amish/Mennonite,Amish Mennonite,,2.71,,,,,,,2.46,4.78,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,inpatient,1,EA,2.56000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,53489-0118-02,NDC,,,facility,outpatient,1,EA,2.56000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
DOXYCYCLINE HYCLATE CAP 50 MG,60208,CDM,250,RC,67405-0650-55,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.48,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,inpatient,1,mL,29.02000,27.57000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,15.96,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00254-1010-19,NDC,,,facility,outpatient,1,mL,29.02000,27.57000,Amish/Mennonite,Amish Mennonite,,15.96,,,,,,,14.51,28.15,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,inpatient,1,mL,34.10000,32.39000,Amish/Mennonite,Amish Mennonite,,18.75,,,,,,,18.75,33.08,percent of total billed charges,
DIAZOXIDE SUSP 50 MG/ML,60210,CDM,250,RC,00575-6200-30,NDC,,,facility,outpatient,1,mL,34.10000,32.39000,Amish/Mennonite,Amish Mennonite,,18.75,,,,,,,17.05,33.08,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00338100902,NDC,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,1.18,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,inpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
DOPAMINE 800 MG/250 ML D5W PREMIX,60211,CDM,250,RC,J1265,HCPCS,00409781022,NDC,facility,outpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,1.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,inpatient,1,EA,103.29000,98.13000,Amish/Mennonite,Amish Mennonite,,56.81,,,,,,,56.81,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,00056-0510-30,NDC,,,facility,outpatient,1,EA,103.29000,98.13000,Amish/Mennonite,Amish Mennonite,,56.81,,,,,,,51.65,100.19,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.18,percent of total billed charges,
EFAVIRENZ TAB 600 MG,60212,CDM,250,RC,31722-0504-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.21,8.18,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,inpatient,1,EA,256.92000,244.08000,Amish/Mennonite,Amish Mennonite,,141.31,,,,,,,141.31,249.21,percent of total billed charges,
DILTIAZEM CAP-ER 360 MG/24 HOURS,60214,CDM,250,RC,00187-0799-42,NDC,,,facility,outpatient,1,EA,256.92000,244.08000,Amish/Mennonite,Amish Mennonite,,141.31,,,,,,,128.46,249.21,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,inpatient,1,mL,563.15000,534.99000,Amish/Mennonite,Amish Mennonite,,309.73,,,,,,,309.73,546.26,percent of total billed charges,
ECULIZUMAB 10 MG/ML IV SOL,60216,CDM,636,RC,J1300,HCPCS,25682000101,NDC,facility,outpatient,1,mL,563.15000,534.99000,Amish/Mennonite,Amish Mennonite,,309.73,,,,,,,281.57,546.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,inpatient,1,EA,16.22000,15.41000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.92,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,00049-2780-66,NDC,,,facility,outpatient,1,EA,16.22000,15.41000,Amish/Mennonite,Amish Mennonite,,8.92,,,,,,,8.11,15.73,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,16729-0415-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,inpatient,1,EA,2.33000,2.22000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,67253-0383-10,NDC,,,facility,outpatient,1,EA,2.33000,2.22000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 8 MG,60218,CDM,250,RC,68382-0786-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,inpatient,1,mL,692.18000,657.57000,Amish/Mennonite,Amish Mennonite,,380.70,,,,,,,380.70,671.41,percent of total billed charges,
"EPOETIN ALFA SOLN PF 10,000 UNITS/ML",60219,CDM,636,RC,J0885,HCPCS,5967603100100100,NDC,facility,outpatient,1,mL,692.18000,657.57000,Amish/Mennonite,Amish Mennonite,,380.70,,,,,,,7.68,671.41,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,inpatient,1,EA,36.05000,34.24000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,19.83,34.97,percent of total billed charges,
ERYTHROMYCIN TAB-EC 500 MG,60220,CDM,250,RC,24338-0126-13,NDC,,,facility,outpatient,1,EA,36.05000,34.24000,Amish/Mennonite,Amish Mennonite,,19.83,,,,,,,18.02,34.97,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,inpatient,1,EA,175.38000,166.61000,Amish/Mennonite,Amish Mennonite,,96.46,,,,,,,96.46,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,55390023301,NDC,facility,outpatient,1,EA,175.38000,166.61000,Amish/Mennonite,Amish Mennonite,,96.46,,,,,,,4.35,170.12,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,inpatient,1,EA,681.25000,647.19000,Amish/Mennonite,Amish Mennonite,,374.69,,,,,,,374.69,660.81,percent of total billed charges,
DOXORUBICIN POWD-INJ 50 MG,60222,CDM,250,RC,J9000,HCPCS,67457043650,NDC,facility,outpatient,1,EA,681.25000,647.19000,Amish/Mennonite,Amish Mennonite,,374.69,,,,,,,4.35,660.81,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,inpatient,1,mL,10.99000,10.44000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,6.04,10.66,percent of total billed charges,
DOXERCALCIFEROL SOLN 2 MCG/ML 2 ML,60224,CDM,250,RC,J1270,HCPCS,58468012301,NDC,facility,outpatient,1,mL,10.99000,10.44000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,0.58280,10.66,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,inpatient,1,EA,3.08000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,51079-0438-20,NDC,,,facility,outpatient,1,EA,3.08000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.54,2.99,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,inpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
DOXEPIN 50 MG CAP,60225,CDM,250,RC,69238-1171-09,NDC,,,facility,outpatient,1,EA,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
ERYTHROMYCIN LIQ-TOP 2% 60 ML,60226,CDM,250,RC,60432-0671-60,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ENALAPRIL SUSP SD 1 MG/ML,60227,CDM,250,RC,51079-0950-20-00100,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,inpatient,1,EA,4.10000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,00078-0382-05,NDC,,,facility,outpatient,1,EA,4.10000,3.89000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.05,3.98,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
DEXMETHYLPHENIDATE TAB 10 MG,60229,CDM,250,RC,10702-0108-01,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,inpatient,1,GM,45.93000,43.64000,Amish/Mennonite,Amish Mennonite,,25.26,,,,,,,25.26,44.55,percent of total billed charges,
DILTIAZEM COMPOUNDING PWDR,60230,CDM,250,RC,J3490,HCPCS,38779022703,NDC,facility,outpatient,1,GM,45.93000,43.64000,Amish/Mennonite,Amish Mennonite,,25.26,,,,,,,22.96,44.55,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,inpatient,1,mL,108.82000,103.38000,Amish/Mennonite,Amish Mennonite,,59.85,,,,,,,59.85,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010039,NDC,facility,outpatient,1,mL,108.82000,103.38000,Amish/Mennonite,Amish Mennonite,,59.85,,,,,,,54.41,105.56,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,inpatient,1,mL,164.17000,155.96000,Amish/Mennonite,Amish Mennonite,,90.29,,,,,,,90.29,159.24,percent of total billed charges,
DORNASE ALFA SOLN 2.5 MG/2.5 ML,60231,CDM,250,RC,J7639,HCPCS,50242010040,NDC,facility,outpatient,1,mL,164.17000,155.96000,Amish/Mennonite,Amish Mennonite,,90.29,,,,,,,82.08,159.24,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,00093-9612-12,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,54838-0512-40,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,inpatient,1,mL,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
DOXEPIN CONCENTRATE 10 MG/ML,60234,CDM,250,RC,60432-0651-04,NDC,,,facility,outpatient,1,mL,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,inpatient,1,mL,1.14000,1.09000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,00054-8207-16,NDC,,,facility,outpatient,1,mL,1.14000,1.09000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,inpatient,1,mL,2.42000,2.30000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.33,2.35,percent of total billed charges,
DIAZEPAM LIQ 5 MG/5 ML,60235,CDM,250,RC,68094-0750-62,NDC,,,facility,outpatient,1,mL,2.42000,2.30000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.21,2.35,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT LOTION 226 GM  (EQV-MOISTUREL),60236,CDM,250,RC,00430-3100-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,inpatient,,,173.44000,164.77000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,95.39,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,CPT,,,facility,outpatient,,,173.44000,164.77000,Amish/Mennonite,Amish Mennonite,,95.39,,,,,,,86.72,168.24,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,inpatient,1,mL,346.88000,329.54000,Amish/Mennonite,Amish Mennonite,,190.78,,,,,,,190.78,336.47,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-HEPB-POLIO VACCINE SUSP (PEDIARIX)",60237,CDM,250,RC,90723,HCPCS,58160081152,NDC,facility,outpatient,1,mL,346.88000,329.54000,Amish/Mennonite,Amish Mennonite,,190.78,,,,,,,137.83,336.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,inpatient,1,EA,60.28000,57.26000,Amish/Mennonite,Amish Mennonite,,33.15,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.025 MG/24 HR WEEKLY,60238,CDM,250,RC,J3490,HCPCS,50419045404,NDC,facility,outpatient,1,EA,60.28000,57.26000,Amish/Mennonite,Amish Mennonite,,33.15,,,,,,,30.14,58.47,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,inpatient,1,EA,2.68000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,00904-5522-61,NDC,,,facility,outpatient,1,EA,2.68000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-00,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,inpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,60505-0093-01,NDC,,,facility,outpatient,1,EA,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,inpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
DOXAZOSIN TAB 1 MG,60239,CDM,250,RC,68084-0836-25,NDC,,,facility,outpatient,1,EA,2.67000,2.54000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,inpatient,1,EA,15.76000,14.98000,Amish/Mennonite,Amish Mennonite,,8.67,,,,,,,8.67,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,52536-0180-03,NDC,,,facility,outpatient,1,EA,15.76000,14.98000,Amish/Mennonite,Amish Mennonite,,8.67,,,,,,,7.88,15.29,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-03,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,inpatient,1,EA,23.25000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,12.79,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,24338-0122-13,NDC,,,facility,outpatient,1,EA,23.25000,22.09000,Amish/Mennonite,Amish Mennonite,,12.79,,,,,,,11.62,22.55,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,inpatient,1,EA,12.77000,12.13000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,7.02,12.39,percent of total billed charges,
ERYTHROMYCIN TAB-EC 250 MG,60240,CDM,250,RC,69238-1471-01,NDC,,,facility,outpatient,1,EA,12.77000,12.13000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,6.38,12.39,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,00299-3918-08,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,54162-0620-08,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LOTION 240 ML,60241,CDM,250,RC,72140-0110-19,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,00456-2101-08,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.26,6.32,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,inpatient,1,mL,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,31722-0569-24,NDC,,,facility,outpatient,1,mL,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,54838-0551-70,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
ESCITALOPRAM LIQ 1 MG/ML,60242,CDM,250,RC,65162-0705-88,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,inpatient,1,GM,25.64000,24.36000,Amish/Mennonite,Amish Mennonite,,14.10,,,,,,,14.10,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00135-0200-03,NDC,,,facility,outpatient,1,GM,25.64000,24.36000,Amish/Mennonite,Amish Mennonite,,14.10,,,,,,,12.82,24.87,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,inpatient,1,GM,26.37000,25.05000,Amish/Mennonite,Amish Mennonite,,14.50,,,,,,,14.50,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00536-1379-04,NDC,,,facility,outpatient,1,GM,26.37000,25.05000,Amish/Mennonite,Amish Mennonite,,14.50,,,,,,,13.19,25.58,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,inpatient,1,GM,21.11000,20.05000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,11.61,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,61269-0981-35,NDC,,,facility,outpatient,1,GM,21.11000,20.05000,Amish/Mennonite,Amish Mennonite,,11.61,,,,,,,10.55,20.48,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,inpatient,1,GM,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,10.35,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,00766-0801-35,NDC,,,facility,outpatient,1,GM,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,9.41,18.26,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,inpatient,1,GM,21.14000,20.08000,Amish/Mennonite,Amish Mennonite,,11.63,,,,,,,11.63,20.51,percent of total billed charges,
DOCOSANOL TOP 10% CRM,60243,CDM,250,RC,70677-1046-01,NDC,,,facility,outpatient,1,GM,21.14000,20.08000,Amish/Mennonite,Amish Mennonite,,11.63,,,,,,,10.57,20.51,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,inpatient,1,EA,1675.10000,1591.35000,Amish/Mennonite,Amish Mennonite,,921.30,,,,,,,921.30,1624.85,percent of total billed charges,
ETANERCEPT SOLN-INJ 25 MG,60244,CDM,636,RC,J1438,HCPCS,58406042534,NDC,facility,outpatient,1,EA,1675.10000,1591.35000,Amish/Mennonite,Amish Mennonite,,921.30,,,,,,,837.55,1624.85,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,00299-3917-16,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,inpatient,1,GM,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,72140-0000-21,NDC,,,facility,outpatient,1,GM,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
EMOLLIENT CREAM 453 GM (EQV-VANICREAM),60245,CDM,250,RC,45334-0300-01,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT LIQ SOAP 240 ML (EQV-CETAPHIL),60246,CDM,250,RC,00299-3921-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,inpatient,1,EA,729.64000,693.16000,Amish/Mennonite,Amish Mennonite,,401.30,,,,,,,401.30,707.75,percent of total billed charges,
ERLOTINIB TAB 150 MG,60247,CDM,250,RC,50242-0064-01,NDC,,,facility,outpatient,1,EA,729.64000,693.16000,Amish/Mennonite,Amish Mennonite,,401.30,,,,,,,364.82,707.75,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,inpatient,1,mL,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
ENALAPRILAT/NS SOLN SD 20 MCG/ML,60248,CDM,250,RC,J3490,HCPCS,0014397871002000,NDC,facility,outpatient,1,mL,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,inpatient,1,EA,24.37000,23.15000,Amish/Mennonite,Amish Mennonite,,13.40,,,,,,,13.40,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00078-0327-05,NDC,,,facility,outpatient,1,EA,24.37000,23.15000,Amish/Mennonite,Amish Mennonite,,13.40,,,,,,,12.19,23.64,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,inpatient,1,EA,9.99000,9.49000,Amish/Mennonite,Amish Mennonite,,5.49,,,,,,,5.49,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,00781-5578-01,NDC,,,facility,outpatient,1,EA,9.99000,9.49000,Amish/Mennonite,Amish Mennonite,,5.49,,,,,,,5.00,9.69,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,27241-0049-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,33342-0260-11,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,inpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
ENTACAPONE TAB 200 MG,60251,CDM,250,RC,60687-0188-11,NDC,,,facility,outpatient,1,EA,1.30000,1.24000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,inpatient,1,EA,6.40000,6.08000,Amish/Mennonite,Amish Mennonite,,3.52,,,,,,,3.52,6.21,percent of total billed charges,
EMOLLIENT BAR (BASIS SOAP),60252,CDM,250,RC,72140-0857-29,NDC,,,facility,outpatient,1,EA,6.40000,6.08000,Amish/Mennonite,Amish Mennonite,,3.52,,,,,,,3.20,6.21,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,inpatient,1,mL,9.05000,8.60000,Amish/Mennonite,Amish Mennonite,,4.98,,,,,,,4.98,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,00091-4150-60,NDC,,,facility,outpatient,1,mL,9.05000,8.60000,Amish/Mennonite,Amish Mennonite,,4.98,,,,,,,4.53,8.78,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,inpatient,1,mL,3.18000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.75,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,69543-0234-60,NDC,,,facility,outpatient,1,mL,3.18000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.59,3.08,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,inpatient,1,mL,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
ERGOCALCIFEROL LIQ 8000 UNIT/ML,60253,CDM,250,RC,75834-0010-60,NDC,,,facility,outpatient,1,mL,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,inpatient,1,mL,16.78000,15.94000,Amish/Mennonite,Amish Mennonite,,9.23,,,,,,,9.23,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,43598007858,NDC,facility,outpatient,1,mL,16.78000,15.94000,Amish/Mennonite,Amish Mennonite,,9.23,,,,,,,8.39,16.28,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,inpatient,1,mL,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
ENALAPRILAT SOLN 1.25 MG/ML,60254,CDM,250,RC,J3490,HCPCS,00409212201,NDC,facility,outpatient,1,mL,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.65,5.15,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,inpatient,1,EA,58.67000,55.73000,Amish/Mennonite,Amish Mennonite,,32.27,,,,,,,32.27,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,00781-7133-54,NDC,,,facility,outpatient,1,EA,58.67000,55.73000,Amish/Mennonite,Amish Mennonite,,32.27,,,,,,,29.34,56.91,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,Amish/Mennonite,Amish Mennonite,,28.81,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,47781-0206-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,Amish/Mennonite,Amish Mennonite,,28.81,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,inpatient,1,EA,60.28000,57.26000,Amish/Mennonite,Amish Mennonite,,33.15,,,,,,,33.15,58.47,percent of total billed charges,
ESTRADIOL PATCH 0.05 MG/24 HR WEEKLY,60258,CDM,250,RC,50419-0451-04,NDC,,,facility,outpatient,1,EA,60.28000,57.26000,Amish/Mennonite,Amish Mennonite,,33.15,,,,,,,30.14,58.47,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,inpatient,1,mL,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,10019007587,NDC,facility,outpatient,1,mL,0.87000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,inpatient,1,mL,10.99000,10.44000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,6.04,10.66,percent of total billed charges,
ESMOLOL 2000 MG/NS 100 ML PREMIX,60259,CDM,250,RC,J1805,HCPCS,67457065810,NDC,facility,outpatient,1,mL,10.99000,10.44000,Amish/Mennonite,Amish Mennonite,,6.04,,,,,,,0.43710,10.66,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,inpatient,1,EA,9527.85000,9051.46000,Amish/Mennonite,Amish Mennonite,,5240.32,,,,,,,5240.32,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,25010021027,NDC,facility,outpatient,1,EA,9527.85000,9051.46000,Amish/Mennonite,Amish Mennonite,,5240.32,,,,,,,4763.93,9242.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,inpatient,1,EA,7866.00000,7472.70000,Amish/Mennonite,Amish Mennonite,,4326.30,,,,,,,4326.30,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,42023015701,NDC,facility,outpatient,1,EA,7866.00000,7472.70000,Amish/Mennonite,Amish Mennonite,,4326.30,,,,,,,3933.00,7630.02,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,inpatient,1,EA,7863.93000,7470.73000,Amish/Mennonite,Amish Mennonite,,4325.16,,,,,,,4325.16,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001227,NDC,facility,outpatient,1,EA,7863.93000,7470.73000,Amish/Mennonite,Amish Mennonite,,4325.16,,,,,,,3931.97,7628.01,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,inpatient,1,EA,2067.86000,1964.46000,Amish/Mennonite,Amish Mennonite,,1137.32,,,,,,,1137.32,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,68682001250,NDC,facility,outpatient,1,EA,2067.86000,1964.46000,Amish/Mennonite,Amish Mennonite,,1137.32,,,,,,,1033.93,2005.82,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,inpatient,1,EA,4370.00000,4151.50000,Amish/Mennonite,Amish Mennonite,,2403.50,,,,,,,2403.50,4238.90,percent of total billed charges,
ETHACRYNIC ACID POWD-INJ 50 MG,60261,CDM,250,RC,J3490,HCPCS,69315070150,NDC,facility,outpatient,1,EA,4370.00000,4151.50000,Amish/Mennonite,Amish Mennonite,,2403.50,,,,,,,2185.00,4238.90,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,inpatient,1,EA,53.76000,51.07000,Amish/Mennonite,Amish Mennonite,,29.57,,,,,,,29.57,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,00378-3352-99,NDC,,,facility,outpatient,1,EA,53.76000,51.07000,Amish/Mennonite,Amish Mennonite,,29.57,,,,,,,26.88,52.15,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,inpatient,1,EA,52.38000,49.77000,Amish/Mennonite,Amish Mennonite,,28.81,,,,,,,28.81,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,47781-0209-04,NDC,,,facility,outpatient,1,EA,52.38000,49.77000,Amish/Mennonite,Amish Mennonite,,28.81,,,,,,,26.19,50.81,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,inpatient,1,EA,99.17000,94.21000,Amish/Mennonite,Amish Mennonite,,54.54,,,,,,,54.54,96.19,percent of total billed charges,
ESTRADIOL PATCH 0.1 MG/24 HR WEEKLY,60262,CDM,250,RC,50419-0452-04,NDC,,,facility,outpatient,1,EA,99.17000,94.21000,Amish/Mennonite,Amish Mennonite,,54.54,,,,,,,49.59,96.19,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,inpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,00338955810,NDC,facility,outpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,3.79,7.35,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,inpatient,1,mL,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.69,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,17478090390,NDC,facility,outpatient,1,mL,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.26,8.27,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,inpatient,1,mL,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,8.26,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,55150021899,NDC,facility,outpatient,1,mL,15.01000,14.26000,Amish/Mennonite,Amish Mennonite,,8.26,,,,,,,7.50,14.56,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,67457063110,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70121100301,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,inpatient,1,mL,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.90,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,70436002780,NDC,facility,outpatient,1,mL,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.46,8.64,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,inpatient,1,mL,1.87000,1.77000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,72078002610,NDC,facility,outpatient,1,mL,1.87000,1.77000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.93500,1.81,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,inpatient,1,mL,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
EPTIFIBATIDE SOLN 75 MG/100 ML,60263,CDM,250,RC,J1327,HCPCS,83634030151,NDC,facility,outpatient,1,mL,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,inpatient,1,EA,238.04000,226.14000,Amish/Mennonite,Amish Mennonite,,130.92,,,,,,,130.92,230.90,percent of total billed charges,
ETOPOSIDE CAP 50 MG,60264,CDM,250,RC,J8560,HCPCS,00378326694,NDC,facility,outpatient,1,EA,238.04000,226.14000,Amish/Mennonite,Amish Mennonite,,130.92,,,,,,,118.51,230.90,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,inpatient,1,mL,15.31000,14.54000,Amish/Mennonite,Amish Mennonite,,8.42,,,,,,,8.42,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00143951425,NDC,facility,outpatient,1,mL,15.31000,14.54000,Amish/Mennonite,Amish Mennonite,,8.42,,,,,,,7.66,14.85,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,inpatient,1,mL,14.71000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,8.09,14.27,percent of total billed charges,
DROPERIDOL SOLN 2.5 MG/ML 2 ML,60265,CDM,250,RC,J1790,HCPCS,00517970225,NDC,facility,outpatient,1,mL,14.71000,13.97000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,7.36,14.27,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,inpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.80300,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,00904-5609-61,NDC,,,facility,outpatient,1,EA,1.46000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80300,,,,,,,0.73000,1.42,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,inpatient,1,EA,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,16714-0442-01,NDC,,,facility,outpatient,1,EA,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ENALAPRIL TAB 2.5 MG,60266,CDM,250,RC,51672-4037-01,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0132-13,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,inpatient,1,mL,11.89000,11.29000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,24338-0134-02,NDC,,,facility,outpatient,1,mL,11.89000,11.29000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,5.95,11.53,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,inpatient,1,mL,7.83000,7.44000,Amish/Mennonite,Amish Mennonite,,4.31,,,,,,,4.31,7.60,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE LIQ 40 MG/ML,60267,CDM,250,RC,69238-1503-01,NDC,,,facility,outpatient,1,mL,7.83000,7.44000,Amish/Mennonite,Amish Mennonite,,4.31,,,,,,,3.92,7.60,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,inpatient,1,mL,553.63000,525.95000,Amish/Mennonite,Amish Mennonite,,304.50,,,,,,,304.50,537.02,percent of total billed charges,
ETHANOLAMINE OLEATE SOLN 5% 2 ML,60268,CDM,636,RC,J1430,HCPCS,67871479006,NDC,facility,outpatient,1,mL,553.63000,525.95000,Amish/Mennonite,Amish Mennonite,,304.50,,,,,,,276.81,857.21,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,inpatient,1,mL,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
FAMOTIDINE SOLN 10 MG/ML 20 ML,60269,CDM,250,RC,J3490,HCPCS,63323073820,NDC,facility,outpatient,1,mL,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,inpatient,1,GM,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.45,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00093-3541-43,NDC,,,facility,outpatient,1,GM,8.09000,7.69000,Amish/Mennonite,Amish Mennonite,,4.45,,,,,,,4.04,7.85,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,inpatient,1,GM,11.75000,11.16000,Amish/Mennonite,Amish Mennonite,,6.46,,,,,,,6.46,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00378-8770-35,NDC,,,facility,outpatient,1,GM,11.75000,11.16000,Amish/Mennonite,Amish Mennonite,,6.46,,,,,,,5.88,11.40,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,inpatient,1,GM,25.64000,24.35000,Amish/Mennonite,Amish Mennonite,,14.10,,,,,,,14.10,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,00430-3754-14,NDC,,,facility,outpatient,1,GM,25.64000,24.35000,Amish/Mennonite,Amish Mennonite,,14.10,,,,,,,12.82,24.87,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,inpatient,1,GM,5.45000,5.18000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,3.00,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,42291-0426-42,NDC,,,facility,outpatient,1,GM,5.45000,5.18000,Amish/Mennonite,Amish Mennonite,,3.00,,,,,,,2.73,5.29,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,inpatient,1,GM,7.44000,7.06000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,4.09,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,66993-0002-10,NDC,,,facility,outpatient,1,GM,7.44000,7.06000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,3.72,7.22,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,inpatient,1,GM,12.44000,11.81000,Amish/Mennonite,Amish Mennonite,,6.84,,,,,,,6.84,12.07,percent of total billed charges,
ESTRADIOL CREAM-VAG 0.01% 42.5 GM,60270,CDM,250,RC,47781-0104-44,NDC,,,facility,outpatient,1,GM,12.44000,11.81000,Amish/Mennonite,Amish Mennonite,,6.84,,,,,,,6.22,12.07,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,inpatient,1,EA,5520.00000,5244.00000,Amish/Mennonite,Amish Mennonite,,3036.00,,,,,,,3036.00,5354.40,percent of total billed charges,
FACTOR VIIA 1000 MCG (NOVOSEVEN),60272,CDM,636,RC,J7189,HCPCS,00169720101,NDC,facility,outpatient,1,EA,5520.00000,5244.00000,Amish/Mennonite,Amish Mennonite,,3036.00,,,,,,,2.65,5354.40,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,inpatient,1,mL,104.79000,99.55000,Amish/Mennonite,Amish Mennonite,,57.63,,,,,,,57.63,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5551301261000100,NDC,facility,outpatient,1,mL,104.79000,99.55000,Amish/Mennonite,Amish Mennonite,,57.63,,,,,,,7.68,101.65,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,inpatient,1,mL,168.93000,160.49000,Amish/Mennonite,Amish Mennonite,,92.91,,,,,,,92.91,163.86,percent of total billed charges,
EPOETIN ALFA SOLN PF 2000 UNITS/ML,60273,CDM,636,RC,J0885,HCPCS,5967603020100100,NDC,facility,outpatient,1,mL,168.93000,160.49000,Amish/Mennonite,Amish Mennonite,,92.91,,,,,,,7.68,163.86,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
EMOLLIENT OINT 396 GM (AQUAPHOR),60275,CDM,250,RC,72140-0031-47,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,inpatient,1,EA,116.01000,110.21000,Amish/Mennonite,Amish Mennonite,,63.81,,,,,,,63.81,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00009766304,NDC,facility,outpatient,1,EA,116.01000,110.21000,Amish/Mennonite,Amish Mennonite,,63.81,,,,,,,58.01,112.53,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,inpatient,1,EA,34.32000,32.60000,Amish/Mennonite,Amish Mennonite,,18.88,,,,,,,18.88,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00054008013,NDC,facility,outpatient,1,EA,34.32000,32.60000,Amish/Mennonite,Amish Mennonite,,18.88,,,,,,,17.16,33.29,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,inpatient,1,EA,12.10000,11.49000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,00378500193,NDC,facility,outpatient,1,EA,12.10000,11.49000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.74,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,inpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,47781010830,NDC,facility,outpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,69097031602,NDC,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,inpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
EXEMESTANE TAB 25 MG,60276,CDM,250,RC,S0156,HCPCS,68382038306,NDC,facility,outpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,54879-0001-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,61748-0011-01,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
ETHAMBUTOL TAB 100 MG,60277,CDM,250,RC,68180-0280-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,inpatient,1,mL,801.35000,761.28000,Amish/Mennonite,Amish Mennonite,,440.74,,,,,,,440.74,777.31,percent of total billed charges,
FENOLDOPAM SOLN 10 MG/ML,60278,CDM,250,RC,J3490,HCPCS,00409230401,NDC,facility,outpatient,1,mL,801.35000,761.28000,Amish/Mennonite,Amish Mennonite,,440.74,,,,,,,400.68,777.31,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,inpatient,1,EA,34.56000,32.84000,Amish/Mennonite,Amish Mennonite,,19.01,,,,,,,19.01,33.52,percent of total billed charges,
ERYTHROMYCIN STEARATE TAB 250 MG,60283,CDM,250,RC,24338-0106-20,NDC,,,facility,outpatient,1,EA,34.56000,32.84000,Amish/Mennonite,Amish Mennonite,,19.01,,,,,,,17.28,33.52,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
ETHOSUXIMIDE LIQ 50 MG/ML,60284,CDM,250,RC,61748-0024-16,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/1 ML,60288,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,0064160272500500,NDC,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,1.58,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,inpatient,1,mL,7.69000,7.31000,Amish/Mennonite,Amish Mennonite,,4.23,,,,,,,4.23,7.46,percent of total billed charges,
FENTANYL 5 MCG/ML-0.9% SOLN,60290,CDM,250,RC,J3010,HCPCS,61553010779,NDC,facility,outpatient,1,mL,7.69000,7.31000,Amish/Mennonite,Amish Mennonite,,4.23,,,,,,,1.30,7.46,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,inpatient,1,EA,77.24000,73.38000,Amish/Mennonite,Amish Mennonite,,42.48,,,,,,,42.48,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,25010-0215-15,NDC,,,facility,outpatient,1,EA,77.24000,73.38000,Amish/Mennonite,Amish Mennonite,,42.48,,,,,,,38.62,74.92,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,inpatient,1,EA,63.07000,59.91000,Amish/Mennonite,Amish Mennonite,,34.69,,,,,,,34.69,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,42799-0405-01,NDC,,,facility,outpatient,1,EA,63.07000,59.91000,Amish/Mennonite,Amish Mennonite,,34.69,,,,,,,31.54,61.18,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
ETHACRYNIC ACID TAB 25 MG,60291,CDM,250,RC,69238-1126-01,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,11.85,22.99,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,80681-0155-00,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 120 GM (EQV-EUCERIN),60292,CDM,250,RC,92771-0600-02,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,68462-0233-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,inpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.33,percent of total billed charges,
FELODIPINE TAB-ER 2.5 MG,60294,CDM,250,RC,63304-0435-01,NDC,,,facility,outpatient,1,EA,3.43000,3.26000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.33,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,inpatient,1,EA,37.51000,35.63000,Amish/Mennonite,Amish Mennonite,,20.63,,,,,,,20.63,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,00037-0430-01,NDC,,,facility,outpatient,1,EA,37.51000,35.63000,Amish/Mennonite,Amish Mennonite,,20.63,,,,,,,18.75,36.38,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,inpatient,1,EA,11.92000,11.33000,Amish/Mennonite,Amish Mennonite,,6.56,,,,,,,6.56,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,51525-0430-01,NDC,,,facility,outpatient,1,EA,11.92000,11.33000,Amish/Mennonite,Amish Mennonite,,6.56,,,,,,,5.96,11.56,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,inpatient,1,EA,2.98000,2.83000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,62559-0730-01,NDC,,,facility,outpatient,1,EA,2.98000,2.83000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.49,2.89,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,Amish/Mennonite,Amish Mennonite,,7.26,,,,,,,7.26,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,65162-0734-09,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,Amish/Mennonite,Amish Mennonite,,7.26,,,,,,,6.60,12.80,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,inpatient,1,EA,4.66000,4.43000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.56,4.52,percent of total billed charges,
FELBAMATE TAB 400 MG,60295,CDM,250,RC,72578-0056-16,NDC,,,facility,outpatient,1,EA,4.66000,4.43000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.33,4.52,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,inpatient,1,mL,118.23000,112.32000,Amish/Mennonite,Amish Mennonite,,65.03,,,,,,,65.03,114.68,percent of total billed charges,
ESTRADIOL VALERATE SOLN 20 MG/ML 5 ML,60296,CDM,250,RC,J1380,HCPCS,42023011101,NDC,facility,outpatient,1,mL,118.23000,112.32000,Amish/Mennonite,Amish Mennonite,,65.03,,,,,,,11.32,114.68,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,inpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00409909431,NDC,facility,outpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,1.58,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,00641602925,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,inpatient,1,mL,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 20 ML,60297,CDM,250,RC,J3010,HCPCS,63323080620,NDC,facility,outpatient,1,mL,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,1.58,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,inpatient,1,mL,78.39000,74.47000,Amish/Mennonite,Amish Mennonite,,43.11,,,,,,,43.11,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00075062603,NDC,facility,outpatient,1,mL,78.39000,74.47000,Amish/Mennonite,Amish Mennonite,,43.11,,,,,,,0.79980,76.04,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,inpatient,1,mL,67.57000,64.19000,Amish/Mennonite,Amish Mennonite,,37.16,,,,,,,37.16,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00955101601,NDC,facility,outpatient,1,mL,67.57000,64.19000,Amish/Mennonite,Amish Mennonite,,37.16,,,,,,,0.79980,65.54,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,inpatient,1,mL,28.06000,26.66000,Amish/Mennonite,Amish Mennonite,,15.43,,,,,,,15.43,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,00548560800,NDC,facility,outpatient,1,mL,28.06000,26.66000,Amish/Mennonite,Amish Mennonite,,15.43,,,,,,,0.79980,27.22,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,inpatient,1,mL,34.60000,32.87000,Amish/Mennonite,Amish Mennonite,,19.03,,,,,,,19.03,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323053903,NDC,facility,outpatient,1,mL,34.60000,32.87000,Amish/Mennonite,Amish Mennonite,,19.03,,,,,,,0.79980,33.56,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,inpatient,1,mL,74.18000,70.47000,Amish/Mennonite,Amish Mennonite,,40.80,,,,,,,40.80,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056586,NDC,facility,outpatient,1,mL,74.18000,70.47000,Amish/Mennonite,Amish Mennonite,,40.80,,,,,,,0.79980,71.95,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,inpatient,1,mL,37.46000,35.58000,Amish/Mennonite,Amish Mennonite,,20.60,,,,,,,20.60,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,63323056593,NDC,facility,outpatient,1,mL,37.46000,35.58000,Amish/Mennonite,Amish Mennonite,,20.60,,,,,,,0.79980,36.34,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,inpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,26.07,45.98,percent of total billed charges,
ENOXAPARIN 300 MG/3 ML SC SOL SYRINGE,60298,CDM,250,RC,J1650,HCPCS,71288042603,NDC,facility,outpatient,1,mL,47.40000,45.03000,Amish/Mennonite,Amish Mennonite,,26.07,,,,,,,0.79980,45.98,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,inpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,00574-0115-01,NDC,,,facility,outpatient,1,EA,3.50000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,inpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
FLAVOXATE TAB 100 MG,60299,CDM,250,RC,42806-0058-01,NDC,,,facility,outpatient,1,EA,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,inpatient,1,mL,19.45000,18.48000,Amish/Mennonite,Amish Mennonite,,10.70,,,,,,,10.70,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,00037-0442-67,NDC,,,facility,outpatient,1,mL,19.45000,18.48000,Amish/Mennonite,Amish Mennonite,,10.70,,,,,,,9.72,18.87,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,inpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,16714-0775-01,NDC,,,facility,outpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,inpatient,1,mL,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.73,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,51525-0442-08,NDC,,,facility,outpatient,1,mL,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.39,6.58,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
FELBAMATE LIQ 120 MG/ML,60300,CDM,250,RC,70954-0051-10,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
FAMOTIDINE/0.9% NACL SOLN INJ 2 MG/ML 10 ML,60301,CDM,250,RC,J3490,HCPCS,61553076272,NDC,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,inpatient,1,EA,42.99000,40.84000,Amish/Mennonite,Amish Mennonite,,23.64,,,,,,,23.64,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,00037-0431-01,NDC,,,facility,outpatient,1,EA,42.99000,40.84000,Amish/Mennonite,Amish Mennonite,,23.64,,,,,,,21.50,41.70,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,inpatient,1,EA,13.66000,12.98000,Amish/Mennonite,Amish Mennonite,,7.51,,,,,,,7.51,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,51525-0431-01,NDC,,,facility,outpatient,1,EA,13.66000,12.98000,Amish/Mennonite,Amish Mennonite,,7.51,,,,,,,6.83,13.25,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.32,percent of total billed charges,
FELBAMATE TAB 600 MG,60302,CDM,250,RC,62559-0731-01,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.32,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,inpatient,1,EA,286.94000,272.59000,Amish/Mennonite,Amish Mennonite,,157.82,,,,,,,157.82,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,15584-0101-01,NDC,,,facility,outpatient,1,EA,286.94000,272.59000,Amish/Mennonite,Amish Mennonite,,157.82,,,,,,,143.47,278.33,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,inpatient,1,EA,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,4.37,7.70,percent of total billed charges,
EFAVIRENZ/EMTRICITABINE/TENOFOVIR TAB 600 MG-200 MG-300 MG,60303,CDM,250,RC,65862-0497-30,NDC,,,facility,outpatient,1,EA,7.94000,7.54000,Amish/Mennonite,Amish Mennonite,,4.37,,,,,,,3.97,7.70,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,inpatient,1,EA,38.47000,36.54000,Amish/Mennonite,Amish Mennonite,,21.16,,,,,,,21.16,37.32,percent of total billed charges,
ERYTHROMYCIN ETHYLSUCCINATE TAB 400 MG,60304,CDM,250,RC,24338-0110-13,NDC,,,facility,outpatient,1,EA,38.47000,36.54000,Amish/Mennonite,Amish Mennonite,,21.16,,,,,,,19.23,37.32,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,inpatient,1,EA,198.21000,188.30000,Amish/Mennonite,Amish Mennonite,,109.02,,,,,,,109.02,192.26,percent of total billed charges,
FENTANYL LOZ 200 MCG,60306,CDM,250,RC,63459-0502-30,NDC,,,facility,outpatient,1,EA,198.21000,188.30000,Amish/Mennonite,Amish Mennonite,,109.02,,,,,,,99.11,192.26,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
FERRIC SUBSULFATE LIQ-TOP 60 ML (MONSEL'S),60307,CDM,250,RC,10481-0112-02,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,inpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,00338051913,NDC,facility,outpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,inpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LIPID EMULSION 20% 500 ML (INTRALIPID),60308,CDM,250,RC,J3490,HCPCS,65219053550,NDC,facility,outpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,inpatient,1,EA,8.69000,8.25000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,16714-0692-11,NDC,,,facility,outpatient,1,EA,8.69000,8.25000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.34,8.43,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,55111-0145-71,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,57237-0005-11,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,inpatient,1,EA,4.38000,4.16000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,62559-0992-12,NDC,,,facility,outpatient,1,EA,4.38000,4.16000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.25,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,inpatient,1,EA,6.28000,5.96000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.45,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,67405-0603-01,NDC,,,facility,outpatient,1,EA,6.28000,5.96000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.14,6.09,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,inpatient,1,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
FLUCONAZOLE 150 MG TAB,60309,CDM,250,RC,68462-0103-40,NDC,,,facility,outpatient,1,EA,6.64000,6.31000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.32,6.44,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,inpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,00904-5611-61,NDC,,,facility,outpatient,1,EA,2.25000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.12,2.18,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,inpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,16714-0445-01,NDC,,,facility,outpatient,1,EA,2.30000,2.19000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.23,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
ENALAPRIL TAB 20 MG,60310,CDM,250,RC,51672-4040-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 7.5 MG/0.5 ML,60311,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
FLECAINIDE SUSP SD 10 MG/ML,60314,CDM,250,RC,00054-0010-21-01000,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,inpatient,1,EA,4.00000,3.80000,Amish/Mennonite,Amish Mennonite,,2.20,,,,,,,2.20,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,42806-0102-01,NDC,,,facility,outpatient,1,EA,4.00000,3.80000,Amish/Mennonite,Amish Mennonite,,2.20,,,,,,,2.00,3.88,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,54879-0002-01,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,inpatient,1,EA,3.75000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,61748-0014-01,NDC,,,facility,outpatient,1,EA,3.75000,3.56000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.88,3.64,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,inpatient,1,EA,4.89000,4.64000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68084-0280-01,NDC,,,facility,outpatient,1,EA,4.89000,4.64000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.44,4.74,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
ETHAMBUTOL TAB 400 MG,60315,CDM,250,RC,68850-0012-02,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,inpatient,1,mL,6.75000,6.41000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.71,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00087-0740-02,NDC,,,facility,outpatient,1,mL,6.75000,6.41000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.38,6.55,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,00536-0710-80,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,50383-0627-50,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,54838-0011-50,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,69618-0070-59,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 15 MG/ML,60317,CDM,250,RC,71399-7480-05,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,inpatient,1,EA,165.58000,157.30000,Amish/Mennonite,Amish Mennonite,,91.07,,,,,,,91.07,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42494-0340-03,NDC,,,facility,outpatient,1,EA,165.58000,157.30000,Amish/Mennonite,Amish Mennonite,,91.07,,,,,,,82.79,160.61,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,inpatient,1,EA,179.07000,170.11000,Amish/Mennonite,Amish Mennonite,,98.49,,,,,,,98.49,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,42794-0010-08,NDC,,,facility,outpatient,1,EA,179.07000,170.11000,Amish/Mennonite,Amish Mennonite,,98.49,,,,,,,89.53,173.70,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,59651-0332-01,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,31.60,61.30,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,inpatient,1,EA,329.03000,312.58000,Amish/Mennonite,Amish Mennonite,,180.97,,,,,,,180.97,319.16,percent of total billed charges,
FLUCYTOSINE CAP 500 MG,60320,CDM,250,RC,60687-0363-25,NDC,,,facility,outpatient,1,EA,329.03000,312.58000,Amish/Mennonite,Amish Mennonite,,180.97,,,,,,,164.51,319.16,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,inpatient,1,mL,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,00121-0530-05,NDC,,,facility,outpatient,1,mL,2.14000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,inpatient,1,mL,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,50268-0336-24,NDC,,,facility,outpatient,1,mL,2.35000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.18,2.28,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,inpatient,1,mL,1.84000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FERROUS SULFATE LIQ 300 MG/5 ML,60321,CDM,250,RC,63739-0157-10,NDC,,,facility,outpatient,1,mL,1.84000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3.6 MG/0.24 ML,60322,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
FENTANYL 2 MCG/ML-BUPIVACAINE 0.125% NS 250 ML CADD,60323,CDM,250,RC,61553-0205-02,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 9 MG/0.6 ML,60326,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00378-6004-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,inpatient,1,EA,10.41000,9.89000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.73,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,00527-1788-01,NDC,,,facility,outpatient,1,EA,10.41000,9.89000,Amish/Mennonite,Amish Mennonite,,5.73,,,,,,,5.21,10.10,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,inpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,16714-0672-01,NDC,,,facility,outpatient,1,EA,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,inpatient,1,EA,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,4.96,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,50268-0366-15,NDC,,,facility,outpatient,1,EA,9.01000,8.56000,Amish/Mennonite,Amish Mennonite,,4.96,,,,,,,4.50,8.74,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
FLUPHENAZINE TAB 1 MG,60327,CDM,250,RC,51079-0485-20,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 10.5 MG/0.7 ML,60328,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,inpatient,1,mL,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,,27.11,,,,,,,27.11,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,72205010001,NDC,facility,outpatient,1,mL,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,,27.11,,,,,,,12.06,47.82,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,inpatient,1,mL,75.84000,72.05000,Amish/Mennonite,Amish Mennonite,,41.71,,,,,,,41.71,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,55150026705,NDC,facility,outpatient,1,mL,75.84000,72.05000,Amish/Mennonite,Amish Mennonite,,41.71,,,,,,,12.06,73.56,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,inpatient,1,mL,97.94000,93.04000,Amish/Mennonite,Amish Mennonite,,53.87,,,,,,,53.87,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,63323027205,NDC,facility,outpatient,1,mL,97.94000,93.04000,Amish/Mennonite,Amish Mennonite,,53.87,,,,,,,12.06,95.00,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,inpatient,1,mL,76.47000,72.65000,Amish/Mennonite,Amish Mennonite,,42.06,,,,,,,42.06,74.18,percent of total billed charges,
FLUPHENAZINE DECANOATE INJECTION 25 MG/ML 5 ML,60330,CDM,250,RC,J2680,HCPCS,67457035959,NDC,facility,outpatient,1,mL,76.47000,72.65000,Amish/Mennonite,Amish Mennonite,,42.06,,,,,,,12.06,74.18,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,inpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00338604537,NDC,facility,outpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,00409468812,NDC,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018487,NDC,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,25021018467,NDC,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,inpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008806,NDC,facility,outpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,5.94,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,inpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
FLUCONAZOLE 400 MG/NS 200 ML PREMIX,60331,CDM,250,RC,J1450,HCPCS,70655008810,NDC,facility,outpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,5.94,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,60505-0165-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE TAB 50 MG,60332,CDM,250,RC,62559-0159-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,inpatient,1,mL,154.05000,146.35000,Amish/Mennonite,Amish Mennonite,,84.73,,,,,,,84.73,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060902,NDC,facility,outpatient,1,mL,154.05000,146.35000,Amish/Mennonite,Amish Mennonite,,84.73,,,,,,,1.15,149.43,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,inpatient,1,mL,308.10000,292.70000,Amish/Mennonite,Amish Mennonite,,169.46,,,,,,,169.46,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,43598060910,NDC,facility,outpatient,1,mL,308.10000,292.70000,Amish/Mennonite,Amish Mennonite,,169.46,,,,,,,1.15,298.86,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,inpatient,1,mL,468.96000,445.51000,Amish/Mennonite,Amish Mennonite,,257.93,,,,,,,257.93,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068002,NDC,facility,outpatient,1,mL,468.96000,445.51000,Amish/Mennonite,Amish Mennonite,,257.93,,,,,,,1.15,454.89,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,inpatient,1,mL,160.32000,152.30000,Amish/Mennonite,Amish Mennonite,,88.18,,,,,,,88.18,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55111068010,NDC,facility,outpatient,1,mL,160.32000,152.30000,Amish/Mennonite,Amish Mennonite,,88.18,,,,,,,1.15,155.51,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,inpatient,1,mL,305.46000,290.19000,Amish/Mennonite,Amish Mennonite,,168.00,,,,,,,168.00,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,55150023210,NDC,facility,outpatient,1,mL,305.46000,290.19000,Amish/Mennonite,Amish Mennonite,,168.00,,,,,,,1.15,296.30,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,inpatient,1,mL,308.09000,292.68000,Amish/Mennonite,Amish Mennonite,,169.45,,,,,,,169.45,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457058406,NDC,facility,outpatient,1,mL,308.09000,292.68000,Amish/Mennonite,Amish Mennonite,,169.45,,,,,,,1.15,298.85,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,inpatient,1,mL,564.92000,536.68000,Amish/Mennonite,Amish Mennonite,,310.71,,,,,,,310.71,547.97,percent of total billed charges,
FONDAPARINUX SOLN 7.5 MG/0.6 ML,60333,CDM,250,RC,J1652,HCPCS,67457059406,NDC,facility,outpatient,1,mL,564.92000,536.68000,Amish/Mennonite,Amish Mennonite,,310.71,,,,,,,1.15,547.97,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 6 MG/0.4 ML,60334,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,44946-1032-08,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,58657-0322-50,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,inpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
FLUORIDE (AS SODIUM) LIQ 0.5 MG/ML,60335,CDM,250,RC,61269-0165-50,NDC,,,facility,outpatient,1,mL,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,inpatient,1,EA,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,,156.69,,,,,,,156.69,276.35,percent of total billed charges,
FLUDARABINE POWD-INJ 50 MG,60336,CDM,250,RC,J9185,HCPCS,25021023706,NDC,facility,outpatient,1,EA,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,,156.69,,,,,,,71.65,276.35,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,inpatient,1,mL,60.69000,57.66000,Amish/Mennonite,Amish Mennonite,,33.38,,,,,,,33.38,58.87,percent of total billed charges,
FLUPHENAZINE SOLN 2.5 MG/ML 10 ML,60337,CDM,250,RC,J2679,HCPCS,63323028110,NDC,facility,outpatient,1,mL,60.69000,57.66000,Amish/Mennonite,Amish Mennonite,,33.38,,,,,,,7.43,58.87,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,inpatient,1,EA,9.92000,9.42000,Amish/Mennonite,Amish Mennonite,,5.46,,,,,,,5.46,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,00527-1790-01,NDC,,,facility,outpatient,1,EA,9.92000,9.42000,Amish/Mennonite,Amish Mennonite,,5.46,,,,,,,4.96,9.62,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
FLUPHENAZINE TAB 5 MG,60339,CDM,250,RC,51079-0487-20,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,inpatient,1,EA,14.06000,13.36000,Amish/Mennonite,Amish Mennonite,,7.73,,,,,,,7.73,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00527-1789-01,NDC,,,facility,outpatient,1,EA,14.06000,13.36000,Amish/Mennonite,Amish Mennonite,,7.73,,,,,,,7.03,13.64,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,inpatient,1,EA,6.76000,6.42000,Amish/Mennonite,Amish Mennonite,,3.72,,,,,,,3.72,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,00832-6004-11,NDC,,,facility,outpatient,1,EA,6.76000,6.42000,Amish/Mennonite,Amish Mennonite,,3.72,,,,,,,3.38,6.56,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0003-01,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.51,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,16714-0673-01,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.10,7.95,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,24979-0137-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FLUPHENAZINE TAB 2.5 MG,60341,CDM,250,RC,70954-0274-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,inpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-06,NDC,,,facility,outpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.44,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,inpatient,1,EA,6.44000,6.12000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.54,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,00904-6501-61,NDC,,,facility,outpatient,1,EA,6.44000,6.12000,Amish/Mennonite,Amish Mennonite,,3.54,,,,,,,3.22,6.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,inpatient,1,EA,8.51000,8.09000,Amish/Mennonite,Amish Mennonite,,4.68,,,,,,,4.68,8.25,percent of total billed charges,
FLUCONAZOLE 200 MG TAB,60343,CDM,250,RC,68084-0735-01,NDC,,,facility,outpatient,1,EA,8.51000,8.09000,Amish/Mennonite,Amish Mennonite,,4.68,,,,,,,4.25,8.25,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.54,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,51079-0852-03,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.04,9.78,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,70436-0004-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,2.01,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.65,percent of total billed charges,
GALANTAMINE TAB 4 MG,60344,CDM,250,RC,63739-0999-33,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.40,4.65,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,00143937601,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,inpatient,1,mL,5.92000,5.63000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,3.26,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,16729011431,NDC,facility,outpatient,1,mL,5.92000,5.63000,Amish/Mennonite,Amish Mennonite,,3.26,,,,,,,1.65,5.74,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,inpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE SOLN 20 MG/ML 5 ML,60345,CDM,250,RC,J9181,HCPCS,63323010406,NDC,facility,outpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,1.65,7.62,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,inpatient,1,GM,83.93000,79.73000,Amish/Mennonite,Amish Mennonite,,46.16,,,,,,,46.16,81.41,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 115 - 21 MCG 8 GM,60346,CDM,250,RC,00173-0716-22,NDC,,,facility,outpatient,1,GM,83.93000,79.73000,Amish/Mennonite,Amish Mennonite,,46.16,,,,,,,41.97,81.41,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,inpatient,1,EA,645.01000,612.76000,Amish/Mennonite,Amish Mennonite,,354.76,,,,,,,354.76,625.66,percent of total billed charges,
FIDAXOMICIN TAB 200 MG,60347,CDM,250,RC,52015-0080-01,NDC,,,facility,outpatient,1,EA,645.01000,612.76000,Amish/Mennonite,Amish Mennonite,,354.76,,,,,,,322.50,625.66,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,inpatient,1,mL,30.84000,29.30000,Amish/Mennonite,Amish Mennonite,,16.96,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060530,NDC,facility,outpatient,1,mL,30.84000,29.30000,Amish/Mennonite,Amish Mennonite,,16.96,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,inpatient,1,mL,30.84000,29.29000,Amish/Mennonite,Amish Mennonite,,16.96,,,,,,,16.96,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,49502060561,NDC,facility,outpatient,1,mL,30.84000,29.29000,Amish/Mennonite,Amish Mennonite,,16.96,,,,,,,2.63,29.91,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,inpatient,1,mL,25.38000,24.11000,Amish/Mennonite,Amish Mennonite,,13.96,,,,,,,13.96,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70748026130,NDC,facility,outpatient,1,mL,25.38000,24.11000,Amish/Mennonite,Amish Mennonite,,13.96,,,,,,,2.63,24.62,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,inpatient,1,mL,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,70756060870,NDC,facility,outpatient,1,mL,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,2.63,9.70,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,inpatient,1,mL,25.37000,24.11000,Amish/Mennonite,Amish Mennonite,,13.95,,,,,,,13.95,24.61,percent of total billed charges,
FORMOTEROL NEB 20 MCG/2 ML,60349,CDM,250,RC,J7606,HCPCS,72603062030,NDC,facility,outpatient,1,mL,25.37000,24.11000,Amish/Mennonite,Amish Mennonite,,13.95,,,,,,,2.63,24.61,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,inpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.1% NS,60352,CDM,250,RC,61553-0240-37,NDC,,,facility,outpatient,1,mL,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,inpatient,1,mL,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,00409386305,NDC,facility,outpatient,1,mL,0.95000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,63.16,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,inpatient,1,mL,5.98000,5.68000,Amish/Mennonite,Amish Mennonite,,3.29,,,,,,,3.29,5.80,percent of total billed charges,
FOSCARNET 24 MG/ML IV SOL,60353,CDM,636,RC,J1455,HCPCS,76310002425,NDC,facility,outpatient,1,mL,5.98000,5.68000,Amish/Mennonite,Amish Mennonite,,3.29,,,,,,,2.99,63.16,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,inpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.82,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143958525,NDC,facility,outpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.48,6.74,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00143968025,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,inpatient,1,mL,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,15.30,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00517460525,NDC,facility,outpatient,1,mL,27.81000,26.42000,Amish/Mennonite,Amish Mennonite,,15.30,,,,,,,13.90,26.98,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,inpatient,1,mL,6.52000,6.19000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,00781382996,NDC,facility,outpatient,1,mL,6.52000,6.19000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.26,6.32,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,inpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,3.19,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,55150029405,NDC,facility,outpatient,1,mL,5.80000,5.51000,Amish/Mennonite,Amish Mennonite,,3.19,,,,,,,2.90,5.63,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,inpatient,1,mL,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.92,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,63323057805,NDC,facility,outpatient,1,mL,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.56,6.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,inpatient,1,mL,6.93000,6.58000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.81,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700016725,NDC,facility,outpatient,1,mL,6.93000,6.58000,Amish/Mennonite,Amish Mennonite,,3.81,,,,,,,3.46,6.72,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,inpatient,1,mL,19.74000,18.75000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,10.86,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70121139605,NDC,facility,outpatient,1,mL,19.74000,18.75000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,9.87,19.15,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,inpatient,1,mL,4.85000,4.61000,Amish/Mennonite,Amish Mennonite,,2.67,,,,,,,2.67,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,70700090225,NDC,facility,outpatient,1,mL,4.85000,4.61000,Amish/Mennonite,Amish Mennonite,,2.67,,,,,,,2.42,4.70,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,inpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.56,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71288040806,NDC,facility,outpatient,1,mL,10.11000,9.61000,Amish/Mennonite,Amish Mennonite,,5.56,,,,,,,5.05,9.81,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 5 ML,60355,CDM,250,RC,J3490,HCPCS,71839012525,NDC,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,inpatient,1,EA,1.87000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,1.03,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-6586-61,NDC,,,facility,outpatient,1,EA,1.87000,1.78000,Amish/Mennonite,Amish Mennonite,,1.03,,,,,,,0.93500,1.81,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,00904-7108-61,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,inpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,16714-0332-02,NDC,,,facility,outpatient,1,EA,0.96000,0.92000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,inpatient,1,EA,7.24000,6.88000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.98,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,59762-5024-01,NDC,,,facility,outpatient,1,EA,7.24000,6.88000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.62,7.02,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
GABAPENTIN 800 MG TAB,60356,CDM,250,RC,60687-0518-01,NDC,,,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,inpatient,1,GM,101.02000,95.97000,Amish/Mennonite,Amish Mennonite,,55.56,,,,,,,55.56,97.99,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 8 GM,60358,CDM,250,RC,00173-0717-22,NDC,,,facility,outpatient,1,GM,101.02000,95.97000,Amish/Mennonite,Amish Mennonite,,55.56,,,,,,,50.51,97.99,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,inpatient,1,mL,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,00121-0721-04,NDC,,,facility,outpatient,1,mL,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,29033-0503-31,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,65862-0306-12,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,inpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
FLUOXETINE LIQ 4 MG/ML,60359,CDM,250,RC,70954-0600-10,NDC,,,facility,outpatient,1,mL,1.06000,1.00000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,inpatient,1,mL,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
FENTANYL 3 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60360,CDM,250,RC,61553-0239-02,NDC,,,facility,outpatient,1,mL,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,inpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML,60361,CDM,250,RC,54838-0501-40,NDC,,,facility,outpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,inpatient,1,mL,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,00071201223,NDC,facility,outpatient,1,mL,2.67000,2.53000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.33,2.59,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,inpatient,1,mL,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,42192060816,NDC,facility,outpatient,1,mL,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,inpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,50383031147,NDC,facility,outpatient,1,mL,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762502501,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,59762505007,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,inpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
GABAPENTIN LIQ 50 MG/ML,60362,CDM,250,RC,J8499,HCPCS,72888010425,NDC,facility,outpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,inpatient,1,mL,48.94000,46.49000,Amish/Mennonite,Amish Mennonite,,26.92,,,,,,,26.92,47.47,percent of total billed charges,
FLUOROMETHOLONE SUSP-OPHTH 0.1% 5 ML,60363,CDM,250,RC,60758-0880-05,NDC,,,facility,outpatient,1,mL,48.94000,46.49000,Amish/Mennonite,Amish Mennonite,,26.92,,,,,,,24.47,47.47,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 3 MG/0.2 ML,60364,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,00121-1744-05,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-06,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,50383-0063-07,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
GUAIFENESIN LIQ 100 MG/5 ML,60365,CDM,250,RC,81033-0102-51,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
GLYCOPYRROLATE SUSP SD 1 MG/ML,60367,CDM,250,RC,00603-3180-21-00100,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,inpatient,1,EA,288.41000,273.99000,Amish/Mennonite,Amish Mennonite,,158.63,,,,,,,158.63,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-01,NDC,,,facility,outpatient,1,EA,288.41000,273.99000,Amish/Mennonite,Amish Mennonite,,158.63,,,,,,,144.21,279.76,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,inpatient,1,EA,191.20000,181.64000,Amish/Mennonite,Amish Mennonite,,105.16,,,,,,,105.16,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,00456-4300-08,NDC,,,facility,outpatient,1,EA,191.20000,181.64000,Amish/Mennonite,Amish Mennonite,,105.16,,,,,,,95.60,185.46,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,inpatient,1,EA,220.57000,209.54000,Amish/Mennonite,Amish Mennonite,,121.31,,,,,,,121.31,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,67877-0749-57,NDC,,,facility,outpatient,1,EA,220.57000,209.54000,Amish/Mennonite,Amish Mennonite,,121.31,,,,,,,110.28,213.95,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,inpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,69097-0579-67,NDC,,,facility,outpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,94.80,183.91,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,inpatient,1,EA,253.81000,241.12000,Amish/Mennonite,Amish Mennonite,,139.60,,,,,,,139.60,246.20,percent of total billed charges,
FOSFOMYCIN 3 G ORAL PWDR,60368,CDM,250,RC,70700-0268-94,NDC,,,facility,outpatient,1,EA,253.81000,241.12000,Amish/Mennonite,Amish Mennonite,,139.60,,,,,,,126.91,246.20,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,inpatient,1,mL,114.91000,109.16000,Amish/Mennonite,Amish Mennonite,,63.20,,,,,,,63.20,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,43598060610,NDC,facility,outpatient,1,mL,114.91000,109.16000,Amish/Mennonite,Amish Mennonite,,63.20,,,,,,,1.15,111.46,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,inpatient,1,mL,214.56000,203.84000,Amish/Mennonite,Amish Mennonite,,118.01,,,,,,,118.01,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55111068102,NDC,facility,outpatient,1,mL,214.56000,203.84000,Amish/Mennonite,Amish Mennonite,,118.01,,,,,,,1.15,208.12,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,inpatient,1,mL,229.50000,218.02000,Amish/Mennonite,Amish Mennonite,,126.22,,,,,,,126.22,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,55150023310,NDC,facility,outpatient,1,mL,229.50000,218.02000,Amish/Mennonite,Amish Mennonite,,126.22,,,,,,,1.15,222.62,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,inpatient,1,mL,231.07000,219.51000,Amish/Mennonite,Amish Mennonite,,127.09,,,,,,,127.09,224.14,percent of total billed charges,
FONDAPARINUX SOLN 10 MG/0.8 ML,60369,CDM,250,RC,J1652,HCPCS,67457058508,NDC,facility,outpatient,1,mL,231.07000,219.51000,Amish/Mennonite,Amish Mennonite,,127.09,,,,,,,1.15,224.14,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
FERROUS SULFATE (AS ELEMENTAL IRON) DROPS 5.1 MG/0.34 ML,60370,CDM,250,RC,00536-0710-80-00020,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,inpatient,1,mL,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.54,9.78,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 10 MG/ML,60371,CDM,250,RC,Q2009,HCPCS,0064161362501000,NDC,facility,outpatient,1,mL,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.04,9.78,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,00536-3844-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,50268-0346-15,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,54738-0140-01,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
FOLIC ACID TAB 0.4 MG,60372,CDM,250,RC,80681-0099-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
GLYCERIN LIQ 177 ML,60375,CDM,250,RC,00395-1031-96,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,inpatient,1,GM,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
FLUTICASONE OINT 0.005% 60 GM,60376,CDM,250,RC,45802-0221-37,NDC,,,facility,outpatient,1,GM,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00172-2089-60,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,00603-3857-21,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,16729-0184-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 50 MG,60377,CDM,250,RC,29300-0129-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN CRM 0.1% 15 GM,60378,CDM,250,RC,52565-0085-15,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.16,8.07,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,inpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
HYDROCORTISONE SOLN SD 1 MG/ML,60380,CDM,250,RC,J1720,HCPCS,0000900110400100,NDC,facility,outpatient,1,mL,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,34.98,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,16729-0001-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,50268-0358-15,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,55111-0320-01,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,61442-0115-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIMEPIRIDE 1 MG TAB,60381,CDM,250,RC,69543-0123-10,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE SUSP SD 5 MG/ML,60382,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,inpatient,,,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,12.50,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,CPT,,,facility,outpatient,,,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,11.36,22.04,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,inpatient,1,mL,45.44000,43.17000,Amish/Mennonite,Amish Mennonite,,24.99,,,,,,,24.99,44.08,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP PF 720 UNITS/0.5 ML (HAVRIX),60384,CDM,250,RC,90633,HCPCS,58160082552,NDC,facility,outpatient,1,mL,45.44000,43.17000,Amish/Mennonite,Amish Mennonite,,24.99,,,,,,,22.72,44.08,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,inpatient,1,EA,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,9.73,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,00054014308,NDC,facility,outpatient,1,EA,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,2.42,17.17,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,inpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,42043039020,NDC,facility,outpatient,1,EA,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,inpatient,1,EA,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,5.95,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,51991073520,NDC,facility,outpatient,1,EA,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,2.42,10.49,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
GRANISETRON TAB 1 MG,60385,CDM,250,RC,Q0166,HCPCS,69452035092,NDC,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
GLIPIZIDE TAB 2.5 MG,60386,CDM,250,RC,51079-0810-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,inpatient,1,mL,22.59000,21.46000,Amish/Mennonite,Amish Mennonite,,12.42,,,,,,,12.42,21.91,percent of total billed charges,
FOSPHENYTOIN (AS PE) SOLN SD 25 MG/ML,60387,CDM,636,RC,Q2009,HCPCS,0064161362502500,NDC,facility,outpatient,1,mL,22.59000,21.46000,Amish/Mennonite,Amish Mennonite,,12.42,,,,,,,11.29,21.91,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,inpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
GANCICLOVIR/NS SOLN SD 5 MG/ML,60388,CDM,250,RC,J1570,HCPCS,0000469400300500,NDC,facility,outpatient,1,mL,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,65.37,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,00904-6709-61,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,64980-0272-01,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,16571-0743-09,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,23155-0606-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,inpatient,1,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.54,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,49884-0065-01,NDC,,,facility,outpatient,1,EA,2.80000,2.66000,Amish/Mennonite,Amish Mennonite,,1.54,,,,,,,1.40,2.72,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
GLYCOPYRROLATE TAB 1 MG,60390,CDM,250,RC,60687-0458-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00049-3450-19,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,4.27,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,00093-5415-95,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,3.88,7.54,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,inpatient,1,mL,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,57237-0150-35,NDC,,,facility,outpatient,1,mL,3.61000,3.43000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.80,3.50,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,inpatient,1,mL,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,59762-5030-01,NDC,,,facility,outpatient,1,mL,5.31000,5.05000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.65,5.15,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,inpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.40,2.46,percent of total billed charges,
FLUCONAZOLE 40 MG/ML ORAL LIQ,60391,CDM,250,RC,70436-0227-48,NDC,,,facility,outpatient,1,mL,2.54000,2.41000,Amish/Mennonite,Amish Mennonite,,1.40,,,,,,,1.27,2.46,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,inpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
HYDROCORTISONE SOLN SD 10 MG/ML,60392,CDM,250,RC,J1720,HCPCS,0000900110401000,NDC,facility,outpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.00,34.98,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
HYDROCORTISONE SUSP SD 2 MG/ML,60393,CDM,250,RC,00009-0012-01-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,inpatient,,,52.92000,50.27000,Amish/Mennonite,Amish Mennonite,,29.11,,,,,,,29.11,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,CPT,,,facility,outpatient,,,52.92000,50.27000,Amish/Mennonite,Amish Mennonite,,29.11,,,,,,,26.46,51.33,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,inpatient,1,mL,105.83000,100.54000,Amish/Mennonite,Amish Mennonite,,58.21,,,,,,,58.21,102.66,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-OMP) SUSP (PEDVAXHIB)",60395,CDM,250,RC,90647,HCPCS,00006489700,NDC,facility,outpatient,1,mL,105.83000,100.54000,Amish/Mennonite,Amish Mennonite,,58.21,,,,,,,45.95,102.66,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
GLUCOSAMINE-CHONDROITIN CAP 500 MG-400 MG,60396,CDM,250,RC,00904-5481-52,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,inpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,00143-1254-01,NDC,,,facility,outpatient,1,EA,2.86000,2.72000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.77,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,59762-0075-01,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,inpatient,1,EA,4.87000,4.62000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.68,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,64380-0972-06,NDC,,,facility,outpatient,1,EA,4.87000,4.62000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.44,4.72,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,inpatient,1,EA,5.48000,5.20000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,3.01,5.32,percent of total billed charges,
HYDROCORTISONE TAB 20 MG,60397,CDM,250,RC,68084-0930-25,NDC,,,facility,outpatient,1,EA,5.48000,5.20000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,2.74,5.32,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00009-0012-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,00603-3899-19,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,59762-0073-01,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,64380-0970-25,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
HYDROCORTISONE TAB 5 MG,60398,CDM,250,RC,72789-0095-50,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,00121-2232-00,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN LIQ 300 MG/15 ML,60399,CDM,250,RC,50383-0063-18,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,inpatient,,,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.54,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,CPT,,,facility,outpatient,,,11.90000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,5.95,46.30,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,inpatient,1,EA,23.79000,22.60000,Amish/Mennonite,Amish Mennonite,,13.08,,,,,,,13.08,23.08,percent of total billed charges,
"HAEMOPHILUS B VACCINE, CONJUGATE (PRP-T) POWD-INJ (ACTHIB)",60400,CDM,250,RC,90648,HCPCS,49281054505,NDC,facility,outpatient,1,EA,23.79000,22.60000,Amish/Mennonite,Amish Mennonite,,13.08,,,,,,,11.89,46.30,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-02,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
FEXOFENADINE-PSEUDOEPHEDRINE TAB-ER 60 MG-120 MG,60401,CDM,250,RC,41167-4310-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,inpatient,1,mL,351.72000,334.14000,Amish/Mennonite,Amish Mennonite,,193.45,,,,,,,193.45,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,55111067902,NDC,facility,outpatient,1,mL,351.72000,334.14000,Amish/Mennonite,Amish Mennonite,,193.45,,,,,,,1.15,341.17,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,inpatient,1,mL,666.20000,632.89000,Amish/Mennonite,Amish Mennonite,,366.41,,,,,,,366.41,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,60505607904,NDC,facility,outpatient,1,mL,666.20000,632.89000,Amish/Mennonite,Amish Mennonite,,366.41,,,,,,,1.15,646.21,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,inpatient,1,mL,354.77000,337.03000,Amish/Mennonite,Amish Mennonite,,195.12,,,,,,,195.12,344.13,percent of total billed charges,
FONDAPARINUX SOLN 5 MG/0.4 ML,60404,CDM,250,RC,J1652,HCPCS,67457058304,NDC,facility,outpatient,1,mL,354.77000,337.03000,Amish/Mennonite,Amish Mennonite,,195.12,,,,,,,1.15,344.13,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,inpatient,1,GM,68.84000,65.40000,Amish/Mennonite,Amish Mennonite,,37.86,,,,,,,37.86,66.77,percent of total billed charges,
HYDROCORTISONE FOAM-RECTAL 10%,60405,CDM,250,RC,68220-0140-15,NDC,,,facility,outpatient,1,GM,68.84000,65.40000,Amish/Mennonite,Amish Mennonite,,37.86,,,,,,,34.42,66.77,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,00054-0386-63,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,inpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
HYDROMORPHONE LIQ 1 MG/ML,60407,CDM,250,RC,42858-0304-16,NDC,,,facility,outpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,inpatient,1,GM,17.05000,16.19000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,9.38,16.54,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE OINT 2.5%-1%,60409,CDM,250,RC,00496-0777-04,NDC,,,facility,outpatient,1,GM,17.05000,16.19000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,8.53,16.54,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,16714-0081-10,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,63739-0483-10,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE TAB 10 MG,60410,CDM,250,RC,68084-0253-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,inpatient,1,mL,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-46,NDC,,,facility,outpatient,1,mL,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
FUROSEMIDE LIQ 10 MG/ML,60413,CDM,250,RC,00054-3294-50,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,inpatient,1,EA,2212.30000,2101.69000,Amish/Mennonite,Amish Mennonite,,1216.77,,,,,,,1216.77,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,11704037001,NDC,facility,outpatient,1,EA,2212.30000,2101.69000,Amish/Mennonite,Amish Mennonite,,1216.77,,,,,,,5.18,2145.93,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,inpatient,1,EA,1874.56000,1780.84000,Amish/Mennonite,Amish Mennonite,,1031.01,,,,,,,1031.01,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,38779253303,NDC,facility,outpatient,1,EA,1874.56000,1780.84000,Amish/Mennonite,Amish Mennonite,,1031.01,,,,,,,5.18,1818.32,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,inpatient,1,EA,2390.57000,2271.04000,Amish/Mennonite,Amish Mennonite,,1314.81,,,,,,,1314.81,2318.85,percent of total billed charges,
HYDROXOCOBALAMIN POWD-INJ 5 GM,60414,CDM,636,RC,J3424,HCPCS,50633031011,NDC,facility,outpatient,1,EA,2390.57000,2271.04000,Amish/Mennonite,Amish Mennonite,,1314.81,,,,,,,5.18,2318.85,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,inpatient,1,mL,882.96000,838.81000,Amish/Mennonite,Amish Mennonite,,485.63,,,,,,,485.63,856.47,percent of total billed charges,
HYDROXYPROGESTERONE SOLN 250 MG/ML 5 ML,60415,CDM,250,RC,J1725,HCPCS,67457088605,NDC,facility,outpatient,1,mL,882.96000,838.81000,Amish/Mennonite,Amish Mennonite,,485.63,,,,,,,441.48,856.47,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,inpatient,1,mL,84.66000,80.42000,Amish/Mennonite,Amish Mennonite,,46.56,,,,,,,46.56,82.12,percent of total billed charges,
HYDROXYZINE HCL SOLN 25 MG/ML,60420,CDM,250,RC,J3410,HCPCS,00517420125,NDC,facility,outpatient,1,mL,84.66000,80.42000,Amish/Mennonite,Amish Mennonite,,46.56,,,,,,,27.10,82.12,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,inpatient,1,mL,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,54838-0502-80,NDC,,,facility,outpatient,1,mL,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,inpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-04,NDC,,,facility,outpatient,1,mL,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,60432-0150-16,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,inpatient,1,mL,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.24,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 10 MG/5 ML SYRU 473 ML,60421,CDM,250,RC,62135-0502-47,NDC,,,facility,outpatient,1,mL,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.67,3.24,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
HYDROCODONE-IBUPROFEN TAB 7.5 MG-200 MG,60422,CDM,250,RC,00093-5161-01,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.64,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,inpatient,1,mL,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,2.14,3.77,percent of total billed charges,
HYDROCORTISONE SOLN SD 5 MG/ML,60423,CDM,250,RC,00009-0011-04-00500,NDC,,,facility,outpatient,1,mL,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,1.95,3.77,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,inpatient,1,GM,15.35000,14.58000,Amish/Mennonite,Amish Mennonite,,8.44,,,,,,,8.44,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,52187-0532-01,NDC,,,facility,outpatient,1,GM,15.35000,14.58000,Amish/Mennonite,Amish Mennonite,,8.44,,,,,,,7.67,14.89,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,inpatient,1,GM,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,5.25,9.25,percent of total billed charges,
HYDROCORTISONE-IODOQUINOL TOP CRM,60424,CDM,250,RC,58980-0811-10,NDC,,,facility,outpatient,1,GM,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,4.77,9.25,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,inpatient,1,mL,8.38000,7.96000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.61,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,39328-0047-15,NDC,,,facility,outpatient,1,mL,8.38000,7.96000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.19,8.13,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,inpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
HYOSCYAMINE DROPS 0.125 MG/ML,60425,CDM,250,RC,54838-0506-15,NDC,,,facility,outpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,00536-1182-97,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
GUAIFENESIN LIQ 20 MG/ML 120 ML,60426,CDM,250,RC,54859-0507-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
HYDROMORPHONE LIQ 2 MG/2 ML,60427,CDM,250,RC,42858-0304-16-00200,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,inpatient,1,mL,24.27000,23.06000,Amish/Mennonite,Amish Mennonite,,13.35,,,,,,,13.35,23.54,percent of total billed charges,
HOMATROPINE OPHTH 5% SOL,60428,CDM,250,RC,00998-0315-05,NDC,,,facility,outpatient,1,mL,24.27000,23.06000,Amish/Mennonite,Amish Mennonite,,13.35,,,,,,,12.13,23.54,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,inpatient,1,mL,290.44000,275.91000,Amish/Mennonite,Amish Mennonite,,159.74,,,,,,,159.74,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,39822103002,NDC,facility,outpatient,1,mL,290.44000,275.91000,Amish/Mennonite,Amish Mennonite,,159.74,,,,,,,145.22,281.73,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,inpatient,1,mL,590.83000,561.29000,Amish/Mennonite,Amish Mennonite,,324.96,,,,,,,324.96,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,66993049036,NDC,facility,outpatient,1,mL,590.83000,561.29000,Amish/Mennonite,Amish Mennonite,,324.96,,,,,,,295.42,573.11,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,inpatient,1,mL,657.21000,624.35000,Amish/Mennonite,Amish Mennonite,,361.47,,,,,,,361.47,637.49,percent of total billed charges,
IBUPROFEN (AS LYSINE) SOLN 10 MG/ML 2 ML,60433,CDM,250,RC,J3490,HCPCS,67386012252,NDC,facility,outpatient,1,mL,657.21000,624.35000,Amish/Mennonite,Amish Mennonite,,361.47,,,,,,,328.61,637.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,inpatient,1,mL,52.05000,49.44000,Amish/Mennonite,Amish Mennonite,,28.63,,,,,,,28.63,50.49,percent of total billed charges,
IDARUBICIN SOLN 1 MG/ML,60434,CDM,250,RC,J9211,HCPCS,00703415411,NDC,facility,outpatient,1,mL,52.05000,49.44000,Amish/Mennonite,Amish Mennonite,,28.63,,,,,,,26.02,72.23,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,inpatient,1,EA,216.14000,205.34000,Amish/Mennonite,Amish Mennonite,,118.88,,,,,,,118.88,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,00143929910,NDC,facility,outpatient,1,EA,216.14000,205.34000,Amish/Mennonite,Amish Mennonite,,118.88,,,,,,,49.73,209.66,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,inpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,25021018510,NDC,facility,outpatient,1,EA,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,65.37,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,inpatient,1,EA,154.73000,146.99000,Amish/Mennonite,Amish Mennonite,,85.10,,,,,,,85.10,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,63323031510,NDC,facility,outpatient,1,EA,154.73000,146.99000,Amish/Mennonite,Amish Mennonite,,85.10,,,,,,,49.73,150.09,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,inpatient,1,EA,139.04000,132.09000,Amish/Mennonite,Amish Mennonite,,76.47,,,,,,,76.47,134.87,percent of total billed charges,
GANCICLOVIR SOLN 50 MG/ML 10 ML,60435,CDM,250,RC,J1570,HCPCS,70436023155,NDC,facility,outpatient,1,EA,139.04000,132.09000,Amish/Mennonite,Amish Mennonite,,76.47,,,,,,,49.73,134.87,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
ICODEXTRIN 7.5% WITH ELECTROLYTES (EXTRANEAL) INTRAPERITONEAL SOL 2000 ML,60436,CDM,250,RC,00941-0679-52,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,inpatient,1,mL,3.67000,3.48000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
HYDRALAZINE SOLN SD 1 MG/ML,60437,CDM,250,RC,63323-0614-01-00100,NDC,,,facility,outpatient,1,mL,3.67000,3.48000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,inpatient,1,EA,295.90000,281.10000,Amish/Mennonite,Amish Mennonite,,162.75,,,,,,,162.75,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00078040134,NDC,facility,outpatient,1,EA,295.90000,281.10000,Amish/Mennonite,Amish Mennonite,,162.75,,,,,,,147.95,287.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,inpatient,1,EA,17.25000,16.39000,Amish/Mennonite,Amish Mennonite,,9.49,,,,,,,9.49,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00093762998,NDC,facility,outpatient,1,EA,17.25000,16.39000,Amish/Mennonite,Amish Mennonite,,9.49,,,,,,,8.62,16.73,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,inpatient,1,EA,10.77000,10.23000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.92,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,00378224577,NDC,facility,outpatient,1,EA,10.77000,10.23000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.38,10.45,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,inpatient,1,EA,138.44000,131.51000,Amish/Mennonite,Amish Mennonite,,76.14,,,,,,,76.14,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,16714070401,NDC,facility,outpatient,1,EA,138.44000,131.51000,Amish/Mennonite,Amish Mennonite,,76.14,,,,,,,69.22,134.29,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,inpatient,1,EA,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.85,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,47335047281,NDC,facility,outpatient,1,EA,5.18000,4.92000,Amish/Mennonite,Amish Mennonite,,2.85,,,,,,,2.59,5.02,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,inpatient,1,EA,3.86000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.74,percent of total billed charges,
IMATINIB TAB 100 MG,60438,CDM,250,RC,J8999,HCPCS,59651024090,NDC,facility,outpatient,1,EA,3.86000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.74,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,inpatient,1,GM,18.18000,17.27000,Amish/Mennonite,Amish Mennonite,,10.00,,,,,,,10.00,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,00496-0778-04,NDC,,,facility,outpatient,1,GM,18.18000,17.27000,Amish/Mennonite,Amish Mennonite,,10.00,,,,,,,9.09,17.63,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,inpatient,1,GM,12.78000,12.14000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,7.03,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,45802-0144-64,NDC,,,facility,outpatient,1,GM,12.78000,12.14000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,6.39,12.40,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,inpatient,1,GM,24.03000,22.83000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,13.22,23.31,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE CRM-RECTAL 1%-1%,60439,CDM,250,RC,54766-0778-04,NDC,,,facility,outpatient,1,GM,24.03000,22.83000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,12.02,23.31,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,inpatient,1,EA,873.90000,830.21000,Amish/Mennonite,Amish Mennonite,,480.64,,,,,,,480.64,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00078064930,NDC,facility,outpatient,1,EA,873.90000,830.21000,Amish/Mennonite,Amish Mennonite,,480.64,,,,,,,436.95,847.68,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,inpatient,1,EA,13.82000,13.12000,Amish/Mennonite,Amish Mennonite,,7.60,,,,,,,7.60,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00093763056,NDC,facility,outpatient,1,EA,13.82000,13.12000,Amish/Mennonite,Amish Mennonite,,7.60,,,,,,,6.91,13.41,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,inpatient,1,EA,38.82000,36.88000,Amish/Mennonite,Amish Mennonite,,21.35,,,,,,,21.35,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,00378224693,NDC,facility,outpatient,1,EA,38.82000,36.88000,Amish/Mennonite,Amish Mennonite,,21.35,,,,,,,19.41,37.66,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,inpatient,1,EA,248.13000,235.72000,Amish/Mennonite,Amish Mennonite,,136.47,,,,,,,136.47,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,16714070501,NDC,facility,outpatient,1,EA,248.13000,235.72000,Amish/Mennonite,Amish Mennonite,,136.47,,,,,,,124.06,240.69,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,inpatient,1,EA,411.72000,391.14000,Amish/Mennonite,Amish Mennonite,,226.45,,,,,,,226.45,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,54868542700,NDC,facility,outpatient,1,EA,411.72000,391.14000,Amish/Mennonite,Amish Mennonite,,226.45,,,,,,,205.86,399.37,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,inpatient,1,EA,60.61000,57.58000,Amish/Mennonite,Amish Mennonite,,33.34,,,,,,,33.34,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,60505290103,NDC,facility,outpatient,1,EA,60.61000,57.58000,Amish/Mennonite,Amish Mennonite,,33.34,,,,,,,30.30,58.79,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,inpatient,1,EA,12.77000,12.13000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,7.02,12.39,percent of total billed charges,
IMATINIB TAB 400 MG,60440,CDM,250,RC,J8999,HCPCS,72485020330,NDC,facility,outpatient,1,EA,12.77000,12.13000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,6.38,12.39,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,inpatient,1,mL,669.10000,635.64000,Amish/Mennonite,Amish Mennonite,,368.00,,,,,,,368.00,649.03,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/1.3 ML (WINRHO SDF),60442,CDM,636,RC,J2792,HCPCS,00944296703,NDC,facility,outpatient,1,mL,669.10000,635.64000,Amish/Mennonite,Amish Mennonite,,368.00,,,,,,,30.77,649.03,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,00225-0295-15,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,inpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,24486-0601-10,NDC,,,facility,outpatient,1,EA,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.64,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0338-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,42192-0339-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,43199-0011-01,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,inpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,63629-1031-01,NDC,,,facility,outpatient,1,EA,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
HYOSCYAMINE TAB-SL 0.125 MG,60443,CDM,250,RC,68047-0253-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,inpatient,1,GM,18.68000,17.75000,Amish/Mennonite,Amish Mennonite,,10.27,,,,,,,10.27,18.12,percent of total billed charges,
HALOBETASOL OINT 0.05% 15 GM,60444,CDM,250,RC,00713-0639-15,NDC,,,facility,outpatient,1,GM,18.68000,17.75000,Amish/Mennonite,Amish Mennonite,,10.27,,,,,,,9.34,18.12,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00603-0857-58,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-0061-16,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,00904-6763-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
GUAIFENESIN 100 MG/5 ML LIQU 480 ML,60446,CDM,250,RC,58657-0509-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,inpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 1 GM,60447,CDM,636,RC,J1559,HCPCS,44206045101,NDC,facility,outpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,inpatient,100,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00264580832,NDC,facility,outpatient,100,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,inpatient,100,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00338050348,NDC,facility,outpatient,100,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,4.32,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,inpatient,100,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
GENTAMICIN 80 MG/NS 100 ML PREMIX,60448,CDM,250,RC,J1580,HCPCS,00409788423,NDC,facility,outpatient,100,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,4.32,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
HYDROMORPHONE 10 MCG/ML-BUPIVACAINE 0.1% NS 250 ML CADD,60450,CDM,250,RC,61553-0911-48,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,inpatient,,,52.65000,50.02000,Amish/Mennonite,Amish Mennonite,,28.96,,,,,,,28.96,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,CPT,,,facility,outpatient,,,52.65000,50.02000,Amish/Mennonite,Amish Mennonite,,28.96,,,,,,,26.32,51.07,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,inpatient,1,mL,105.30000,100.03000,Amish/Mennonite,Amish Mennonite,,57.91,,,,,,,57.91,102.14,percent of total billed charges,
HEPATITIS A PEDIATRIC VACCINE SUSP 25 UNITS/0.5 ML (VAQTA),60451,CDM,250,RC,90633,HCPCS,00006483141,NDC,facility,outpatient,1,mL,105.30000,100.03000,Amish/Mennonite,Amish Mennonite,,57.91,,,,,,,52.65,102.14,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,inpatient,1,EA,1369.95000,1301.46000,Amish/Mennonite,Amish Mennonite,,753.47,,,,,,,753.47,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065903,NDC,facility,outpatient,1,EA,1369.95000,1301.46000,Amish/Mennonite,Amish Mennonite,,753.47,,,,,,,684.98,1328.85,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,inpatient,1,EA,1025.64000,974.36000,Amish/Mennonite,Amish Mennonite,,564.10,,,,,,,564.10,994.87,percent of total billed charges,
INDOMETHACIN POWD-INJ 1 MG,60452,CDM,250,RC,J3490,HCPCS,63323065909,NDC,facility,outpatient,1,EA,1025.64000,974.36000,Amish/Mennonite,Amish Mennonite,,564.10,,,,,,,512.82,994.87,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,inpatient,1,EA,119.29000,113.33000,Amish/Mennonite,Amish Mennonite,,65.61,,,,,,,65.61,115.71,percent of total billed charges,
HYDROCORTISONE POWD-INJ PF 250 MG,60457,CDM,250,RC,J1720,HCPCS,00009001305,NDC,facility,outpatient,1,EA,119.29000,113.33000,Amish/Mennonite,Amish Mennonite,,65.61,,,,,,,31.90,115.71,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,inpatient,1,EA,7.59000,7.21000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,00185-0720-60,NDC,,,facility,outpatient,1,EA,7.59000,7.21000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,3.79,7.36,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,inpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
INDOMETHACIN 75 MG ER CAP,60458,CDM,250,RC,65162-0506-06,NDC,,,facility,outpatient,1,EA,1.03000,0.98000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.51500,0.99910,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,inpatient,1,GM,19.63000,18.65000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,10.80,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,00496-0799-04,NDC,,,facility,outpatient,1,GM,19.63000,18.65000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,9.81,19.04,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,inpatient,1,GM,13.80000,13.11000,Amish/Mennonite,Amish Mennonite,,7.59,,,,,,,7.59,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,45802-0472-64,NDC,,,facility,outpatient,1,GM,13.80000,13.11000,Amish/Mennonite,Amish Mennonite,,7.59,,,,,,,6.90,13.39,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,inpatient,1,GM,7.48000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,4.11,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,52817-0817-01,NDC,,,facility,outpatient,1,GM,7.48000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.74,7.26,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,inpatient,1,GM,9.66000,9.18000,Amish/Mennonite,Amish Mennonite,,5.31,,,,,,,5.31,9.37,percent of total billed charges,
HYDROCORTISONE-PRAMOXINE TOP 2.5%-1% CRM W/APPL,60459,CDM,250,RC,75834-0197-01,NDC,,,facility,outpatient,1,GM,9.66000,9.18000,Amish/Mennonite,Amish Mennonite,,5.31,,,,,,,4.83,9.37,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
GLYCOPYRROLATE/NS SOLN SD 50 MCG/ML,60460,CDM,250,RC,00517-4601-25-05000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
HYDRALAZINE SUSP SD 1 MG/ML,60463,CDM,250,RC,51079-0074-20-00100,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,inpatient,1,mL,34.08000,32.38000,Amish/Mennonite,Amish Mennonite,,18.74,,,,,,,18.74,33.06,percent of total billed charges,
INSULIN DETEMIR SOLN 100 UNITS/ML 10 ML (EQV-LEVEMIR),60464,CDM,250,RC,J1815,HCPCS,00169368712,NDC,facility,outpatient,1,mL,34.08000,32.38000,Amish/Mennonite,Amish Mennonite,,18.74,,,,,,,1.49,33.06,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,inpatient,1,mL,11.95000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,6.57,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,00131181067,NDC,facility,outpatient,1,mL,11.95000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,5.97,11.59,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,inpatient,1,mL,10.34000,9.82000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,25021079120,NDC,facility,outpatient,1,mL,10.34000,9.82000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.03,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,inpatient,1,mL,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.69,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,70710188606,NDC,facility,outpatient,1,mL,10.35000,9.83000,Amish/Mennonite,Amish Mennonite,,5.69,,,,,,,5.17,10.04,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
LACOSAMIDE SOLN 10 MG/ML 20 ML,60468,CDM,250,RC,C9254,HCPCS,83090001210,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,inpatient,1,mL,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
INSULIN REGULAR HUMAN SOLN SD 2 UNITS/ML,60469,CDM,250,RC,00002-8215-17-00200,NDC,,,facility,outpatient,1,mL,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,inpatient,1,mL,805.95000,765.65000,Amish/Mennonite,Amish Mennonite,,443.27,,,,,,,443.27,781.77,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 1000 MCG/4.4 ML  (WINRHO SDF),60473,CDM,636,RC,J2792,HCPCS,53270310001,NDC,facility,outpatient,1,mL,805.95000,765.65000,Amish/Mennonite,Amish Mennonite,,443.27,,,,,,,30.77,781.77,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,inpatient,1,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,16714-0010-01,NDC,,,facility,outpatient,1,EA,3.29000,3.12000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,inpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.82,3.21,percent of total billed charges,
ISOSORBIDE DINITRATE TAB 30 MG,60474,CDM,250,RC,49884-0009-01,NDC,,,facility,outpatient,1,EA,3.31000,3.15000,Amish/Mennonite,Amish Mennonite,,1.82,,,,,,,1.66,3.21,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,inpatient,1,mL,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,6.07,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,00703011003,NDC,facility,outpatient,1,mL,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,0.14409,10.70,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,inpatient,1,mL,7.57000,7.19000,Amish/Mennonite,Amish Mennonite,,4.16,,,,,,,4.16,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,17478054001,NDC,facility,outpatient,1,mL,7.57000,7.19000,Amish/Mennonite,Amish Mennonite,,4.16,,,,,,,0.14409,7.34,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,inpatient,1,mL,12.39000,11.77000,Amish/Mennonite,Amish Mennonite,,6.81,,,,,,,6.81,12.02,percent of total billed charges,
HYDROMORPHONE SOLN PF 10 MG/ML,60476,CDM,250,RC,J1171,HCPCS,63323085110,NDC,facility,outpatient,1,mL,12.39000,11.77000,Amish/Mennonite,Amish Mennonite,,6.81,,,,,,,0.14409,12.02,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,inpatient,1,mL,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% ORAL SOL 473 ML,60477,CDM,250,RC,00395-2775-16,NDC,,,facility,outpatient,1,mL,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,inpatient,1,EA,10088.89000,9584.45000,Amish/Mennonite,Amish Mennonite,,5548.89,,,,,,,5548.89,9786.22,percent of total billed charges,
HISTRELIN 50 MG/12 MONTHS,60478,CDM,636,RC,J9226,HCPCS,67979050001,NDC,facility,outpatient,1,EA,10088.89000,9584.45000,Amish/Mennonite,Amish Mennonite,,5548.89,,,,,,,5044.44,75174.64,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,inpatient,1,mL,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
ISONIAZID LIQ 10 MG/ML,60480,CDM,250,RC,46287-0009-01,NDC,,,facility,outpatient,1,mL,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97500,1.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,inpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,59.61,105.14,percent of total billed charges,
IMMUNE GLOBULIN SOLN 20% (HIZENTRA) 10 GM,60481,CDM,636,RC,J1559,HCPCS,44206045510,NDC,facility,outpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,14.12,105.14,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,inpatient,1,mL,6.23000,5.91000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.04,percent of total billed charges,
GENTAMICIN SOLN SD 4 MG/ML,60482,CDM,250,RC,63323-0173-02-00400,NDC,,,facility,outpatient,1,mL,6.23000,5.91000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.12,6.04,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,54162-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LANOLIN OINT 454 GM,60483,CDM,250,RC,92771-0596-14,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,16477-0738-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,inpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,47781-0014-01,NDC,,,facility,outpatient,1,EA,4.04000,3.84000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.92,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,51525-0115-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
HYOSCYAMINE TAB-ER 0.375 MG,60484,CDM,250,RC,68047-0255-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,60505-0826-01,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,inpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.03%,60485,CDM,250,RC,24208-0398-30,NDC,,,facility,outpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,3.72,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,64980-0146-12,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
LACTOBACILLUS ACIDOPHILUS 1 GM PACKET,60487,CDM,250,RC,71351-0013-12,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,inpatient,1,mL,11.89000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,6.54,11.53,percent of total billed charges,
INDOMETHACIN 25 MG/5 ML ORAL SUSP,60488,CDM,250,RC,42211-0101-11,NDC,,,facility,outpatient,1,mL,11.89000,11.30000,Amish/Mennonite,Amish Mennonite,,6.54,,,,,,,5.95,11.53,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,inpatient,1,mL,170.43000,161.91000,Amish/Mennonite,Amish Mennonite,,93.74,,,,,,,93.74,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,00023-9277-05,NDC,,,facility,outpatient,1,mL,170.43000,161.91000,Amish/Mennonite,Amish Mennonite,,93.74,,,,,,,85.22,165.32,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,inpatient,1,mL,38.40000,36.48000,Amish/Mennonite,Amish Mennonite,,21.12,,,,,,,21.12,37.25,percent of total billed charges,
KETOROLAC SOLN-OPHTH 0.4% 5 ML,60489,CDM,250,RC,60758-0773-05,NDC,,,facility,outpatient,1,mL,38.40000,36.48000,Amish/Mennonite,Amish Mennonite,,21.12,,,,,,,19.20,37.25,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,inpatient,1,EA,31.01000,29.46000,Amish/Mennonite,Amish Mennonite,,17.06,,,,,,,17.06,30.08,percent of total billed charges,
HYDROMORPHONE SUPP 3 MG,60490,CDM,250,RC,00574-7224-06,NDC,,,facility,outpatient,1,EA,31.01000,29.46000,Amish/Mennonite,Amish Mennonite,,17.06,,,,,,,15.51,30.08,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,inpatient,1,mL,117.24000,111.37000,Amish/Mennonite,Amish Mennonite,,64.48,,,,,,,64.48,113.72,percent of total billed charges,
IDARUCIZUMAB SOLN 2.5 GM/50 ML,60492,CDM,250,RC,J3590,HCPCS,00597019705,NDC,facility,outpatient,1,mL,117.24000,111.37000,Amish/Mennonite,Amish Mennonite,,64.48,,,,,,,58.62,113.72,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,10147-0750-05,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,45802-0465-64,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,inpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
KETOCONAZOLE SHAMPOO 2% 120 ML,60493,CDM,250,RC,63646-0010-04,NDC,,,facility,outpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-5929-61,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,00904-7110-61,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,23155-0724-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0125-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,60687-0450-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,inpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,63739-0366-10,NDC,,,facility,outpatient,1,EA,1.86000,1.77000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.93000,1.80,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,68382-0799-01,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
LABETALOL 200 MG TAB,60494,CDM,250,RC,71247-0127-01,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,inpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
IOTHALAMATE SOLN 60% 30 ML,60495,CDM,250,RC,Q9961,HCPCS,00019095313,NDC,facility,outpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.44330,1.24,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,inpatient,1,mL,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,25021068220,NDC,facility,outpatient,1,mL,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,inpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,42023011310,NDC,facility,outpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,inpatient,1,mL,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,67457018120,NDC,facility,outpatient,1,mL,3.05000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.52,2.96,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,inpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 20 ML,60497,CDM,250,RC,J3490,HCPCS,65219018420,NDC,facility,outpatient,1,mL,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,inpatient,1,GM,10.14000,9.63000,Amish/Mennonite,Amish Mennonite,,5.58,,,,,,,5.58,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,45802-0455-42,NDC,,,facility,outpatient,1,GM,10.14000,9.63000,Amish/Mennonite,Amish Mennonite,,5.58,,,,,,,5.07,9.84,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,inpatient,1,GM,3.46000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.36,percent of total billed charges,
HYDROCORTISONE VALERATE CREAM 0.2% 45 GM,60498,CDM,250,RC,51672-1290-06,NDC,,,facility,outpatient,1,GM,3.46000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.36,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,inpatient,1,mL,131.99000,125.39000,Amish/Mennonite,Amish Mennonite,,72.59,,,,,,,72.59,128.03,percent of total billed charges,
LACOSAMIDE LIQ 250 MG/25 ML,60499,CDM,250,RC,00131-5410-71-02500,NDC,,,facility,outpatient,1,mL,131.99000,125.39000,Amish/Mennonite,Amish Mennonite,,72.59,,,,,,,66.00,128.03,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,55111-0398-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,5.29,9.32,percent of total billed charges,
LANSOPRAZOLE CAP-EC 15 MG,60500,CDM,250,RC,60687-0111-21,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,4.80,9.32,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,inpatient,1,mL,7009.02000,6658.57000,Amish/Mennonite,Amish Mennonite,,3854.96,,,,,,,3854.96,6798.75,percent of total billed charges,
"INTERFERON GAMMA-1B 2,000,000 INTL UNITS/0.5 ML INJ SOL",60503,CDM,250,RC,J9216,HCPCS,64116001101,NDC,facility,outpatient,1,mL,7009.02000,6658.57000,Amish/Mennonite,Amish Mennonite,,3854.96,,,,,,,3504.51,6798.75,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,inpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,00406-3249-01,NDC,,,facility,outpatient,1,EA,3.07000,2.92000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.53,2.98,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
HYDROMORPHONE TAB 8 MG,60504,CDM,250,RC,42858-0303-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,inpatient,1,EA,39.75000,37.76000,Amish/Mennonite,Amish Mennonite,,21.86,,,,,,,21.86,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,00378-5100-93,NDC,,,facility,outpatient,1,EA,39.75000,37.76000,Amish/Mennonite,Amish Mennonite,,21.86,,,,,,,19.88,38.56,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,67877-0454-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,inpatient,1,EA,14.82000,14.07000,Amish/Mennonite,Amish Mennonite,,8.15,,,,,,,8.15,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,16714-0743-02,NDC,,,facility,outpatient,1,EA,14.82000,14.07000,Amish/Mennonite,Amish Mennonite,,8.15,,,,,,,7.41,14.38,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,8.20,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,50268-0450-12,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,7.45,14.45,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,inpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
ITRACONAZOLE CAP 100 MG,60505,CDM,250,RC,60687-0299-25,NDC,,,facility,outpatient,1,EA,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE LIQ 10 MG/0.2 ML,60506,CDM,250,RC,00409-2053-10-00100,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,inpatient,1,mL,22.54000,21.42000,Amish/Mennonite,Amish Mennonite,,12.40,,,,,,,12.40,21.86,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00143985210,NDC,facility,outpatient,1,mL,22.54000,21.42000,Amish/Mennonite,Amish Mennonite,,12.40,,,,,,,11.27,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,inpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.82,6.74,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,00517104525,NDC,facility,outpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.48,40.47,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,inpatient,1,mL,10.50000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.78,10.19,percent of total billed charges,
LEVOCARNITINE SOLN 200 MG/ML 5 ML,60508,CDM,250,RC,J1955,HCPCS,54482014701,NDC,facility,outpatient,1,mL,10.50000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.25,40.47,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,inpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,4.17,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,60505-0827-01,NDC,,,facility,outpatient,1,mL,7.58000,7.20000,Amish/Mennonite,Amish Mennonite,,4.17,,,,,,,3.79,7.35,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,inpatient,1,mL,7.62000,7.24000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,4.19,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,16714-0527-01,NDC,,,facility,outpatient,1,mL,7.62000,7.24000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,3.81,7.39,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,inpatient,1,mL,7.69000,7.30000,Amish/Mennonite,Amish Mennonite,,4.23,,,,,,,4.23,7.46,percent of total billed charges,
IPRATROPIUM NASAL SPRAY 0.06%,60509,CDM,250,RC,24208-0399-15,NDC,,,facility,outpatient,1,mL,7.69000,7.30000,Amish/Mennonite,Amish Mennonite,,4.23,,,,,,,3.85,7.46,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,inpatient,1,EA,45.52000,43.25000,Amish/Mennonite,Amish Mennonite,,25.04,,,,,,,25.04,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-35,NDC,,,facility,outpatient,1,EA,45.52000,43.25000,Amish/Mennonite,Amish Mennonite,,25.04,,,,,,,22.76,44.15,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,inpatient,1,EA,64.01000,60.81000,Amish/Mennonite,Amish Mennonite,,35.21,,,,,,,35.21,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00131-2478-60,NDC,,,facility,outpatient,1,EA,64.01000,60.81000,Amish/Mennonite,Amish Mennonite,,35.21,,,,,,,32.01,62.09,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,inpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,00904-7245-68,NDC,,,facility,outpatient,1,EA,6.48000,6.16000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,inpatient,1,EA,2.73000,2.59000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,16714-0549-01,NDC,,,facility,outpatient,1,EA,2.73000,2.59000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.65,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,inpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,50228-0193-60,NDC,,,facility,outpatient,1,EA,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,inpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
LACOSAMIDE TAB 100 MG,60511,CDM,250,RC,51991-0349-06,NDC,,,facility,outpatient,1,EA,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
ISONIAZID TAB 100 MG,60512,CDM,250,RC,00555-0066-02,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,inpatient,1,EA,123.57000,117.39000,Amish/Mennonite,Amish Mennonite,,67.96,,,,,,,67.96,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00088-2160-30,NDC,,,facility,outpatient,1,EA,123.57000,117.39000,Amish/Mennonite,Amish Mennonite,,67.96,,,,,,,61.78,119.86,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,00955-1735-30,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,10702-0277-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,inpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,23155-0043-03,NDC,,,facility,outpatient,1,EA,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LEFLUNOMIDE TAB 10 MG,60513,CDM,250,RC,70748-0129-06,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00264959410,NDC,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.00465,0.04850,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
LIDOCAINE 2 GM/D5W 500 ML PREMIX,60515,CDM,250,RC,J2002,HCPCS,00338040903,NDC,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.00465,0.03880,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,inpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,35573-0433-30,NDC,,,facility,outpatient,1,EA,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
KETOCONAZOLE TAB 200 MG,60517,CDM,250,RC,64380-0827-06,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69543-0388-10,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,inpatient,1,EA,19.26000,18.30000,Amish/Mennonite,Amish Mennonite,,10.59,,,,,,,10.59,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,60687-0104-21,NDC,,,facility,outpatient,1,EA,19.26000,18.30000,Amish/Mennonite,Amish Mennonite,,10.59,,,,,,,9.63,18.68,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,inpatient,1,EA,1.78000,1.70000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,69452-0275-20,NDC,,,facility,outpatient,1,EA,1.78000,1.70000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,inpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
KETOROLAC TAB 10 MG,60519,CDM,250,RC,70710-1710-01,NDC,,,facility,outpatient,1,EA,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,13668-0106-01,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
ISOSORBIDE MONONITRATE TAB ER 120 MG,60520,CDM,250,RC,62175-0129-37,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,inpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
IOTHALAMATE SOLN 60% 50 ML,60522,CDM,250,RC,Q9961,HCPCS,00019095305,NDC,facility,outpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.44330,0.95060,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,inpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
LABETALOL SUSP SD 40 MG/ML,60525,CDM,250,RC,00904-5928-61-04000,NDC,,,facility,outpatient,1,mL,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,inpatient,1,GM,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,39328-0024-55,NDC,,,facility,outpatient,1,GM,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,24357-0701-06,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,inpatient,1,GM,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-47,NDC,,,facility,outpatient,1,GM,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,inpatient,1,GM,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
LIDOCAINE CREAM 4% 5 GM,60526,CDM,250,RC,47781-0570-89,NDC,,,facility,outpatient,1,GM,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,39.50,76.63,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,inpatient,1,mL,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,10147-0150-01,NDC,,,facility,outpatient,1,mL,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.04,5.91,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,inpatient,1,mL,7.22000,6.86000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.97,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,50458-0295-15,NDC,,,facility,outpatient,1,mL,7.22000,6.86000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.61,7.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,inpatient,1,mL,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,6.00,percent of total billed charges,
ITRACONAZOLE LIQ 10 MG/ML,60527,CDM,250,RC,65162-0087-74,NDC,,,facility,outpatient,1,mL,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.10,6.00,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,35573044525,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.13485,1.22,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,inpatient,1,mL,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,00378968244,NDC,facility,outpatient,1,mL,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,0.13485,5.48,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,inpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,66993002327,NDC,facility,outpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,0.13485,2.85,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,inpatient,1,mL,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090001,NDC,facility,outpatient,1,mL,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.13485,1.64,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,inpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/3 ML,60529,CDM,250,RC,J7614,HCPCS,76204090024,NDC,facility,outpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,0.13485,2.55,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,inpatient,1,mL,274.18000,260.47000,Amish/Mennonite,Amish Mennonite,,150.80,,,,,,,150.80,265.95,percent of total billed charges,
INDOMETHACIN/NS SOLN SD 0.2 MG/ML,60531,CDM,250,RC,63323-0659-03-00020,NDC,,,facility,outpatient,1,mL,274.18000,260.47000,Amish/Mennonite,Amish Mennonite,,150.80,,,,,,,137.09,265.95,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,inpatient,1,EA,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,16714016601,NDC,facility,outpatient,1,EA,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.37,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,inpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.64900,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,42794001802,NDC,facility,outpatient,1,EA,1.18000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64900,,,,,,,0.59000,1.14,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,59762120601,NDC,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,inpatient,1,EA,4.78000,4.54000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,51862032001,NDC,facility,outpatient,1,EA,4.78000,4.54000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.39,4.64,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,inpatient,1,EA,6.06000,5.76000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.33,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,60793011501,NDC,facility,outpatient,1,EA,6.06000,5.76000,Amish/Mennonite,Amish Mennonite,,3.33,,,,,,,3.03,5.88,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
LIOTHYRONINE TAB 5 MCG,60532,CDM,250,RC,J8499,HCPCS,62756058988,NDC,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00045-0080-02,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00536-4087-06,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,00904-5224-52,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
LACTASE TAB,60533,CDM,250,RC,77333-0430-50,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00527135001,NDC,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,inpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,00904695761,NDC,facility,outpatient,1,EA,2.66000,2.53000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,inpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.27,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,42292004020,NDC,facility,outpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.16,2.24,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,inpatient,1,EA,2.12000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,47781066590,NDC,facility,outpatient,1,EA,2.12000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,inpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,60687054101,NDC,facility,outpatient,1,EA,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
LEVOTHYROXINE TAB 175 MCG (0.175 MG),60534,CDM,250,RC,J8499,HCPCS,68180097401,NDC,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,inpatient,1,EA,13.08000,12.43000,Amish/Mennonite,Amish Mennonite,,7.19,,,,,,,7.19,12.69,percent of total billed charges,
IVERMECTIN TAB 3 MG,60535,CDM,250,RC,42799-0806-01,NDC,,,facility,outpatient,1,EA,13.08000,12.43000,Amish/Mennonite,Amish Mennonite,,7.19,,,,,,,6.54,12.69,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,inpatient,1,EA,21.51000,20.44000,Amish/Mennonite,Amish Mennonite,,11.83,,,,,,,11.83,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025245,NDC,facility,outpatient,1,EA,21.51000,20.44000,Amish/Mennonite,Amish Mennonite,,11.83,,,,,,,10.76,20.86,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,inpatient,1,EA,37.94000,36.04000,Amish/Mennonite,Amish Mennonite,,20.87,,,,,,,20.87,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,54092025290,NDC,facility,outpatient,1,EA,37.94000,36.04000,Amish/Mennonite,Amish Mennonite,,20.87,,,,,,,18.97,36.80,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,inpatient,1,EA,34.11000,32.40000,Amish/Mennonite,Amish Mennonite,,18.76,,,,,,,18.76,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,66993042285,NDC,facility,outpatient,1,EA,34.11000,32.40000,Amish/Mennonite,Amish Mennonite,,18.76,,,,,,,17.05,33.09,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,inpatient,1,EA,17.55000,16.68000,Amish/Mennonite,Amish Mennonite,,9.65,,,,,,,9.65,17.02,percent of total billed charges,
LANTHANUM CARBONATE TAB-CHEW 500 MG,60536,CDM,250,RC,J8499,HCPCS,68180081942,NDC,facility,outpatient,1,EA,17.55000,16.68000,Amish/Mennonite,Amish Mennonite,,9.65,,,,,,,8.78,17.02,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,inpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-1154-40,NDC,,,facility,outpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,00121-4577-30,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
LACTULOSE SYRUP 20 GM/30 ML,60539,CDM,250,RC,66689-0038-50,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-4496-13,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00054-8496-19,NDC,,,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,inpatient,1,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,00555-0484-01,NDC,,,facility,outpatient,1,EA,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,inpatient,1,EA,3.53000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,50742-0181-30,NDC,,,facility,outpatient,1,EA,3.53000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.42,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,inpatient,1,EA,8.28000,7.87000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,4.55,8.03,percent of total billed charges,
LEUCOVORIN TAB 5 MG,60540,CDM,250,RC,51079-0581-06,NDC,,,facility,outpatient,1,EA,8.28000,7.87000,Amish/Mennonite,Amish Mennonite,,4.55,,,,,,,4.14,8.03,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE SUSP SD 25 MG/ML,60541,CDM,250,RC,63739-0670-10-02500,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,inpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 1% 2 ML,60543,CDM,250,RC,J2003,HCPCS,63323020102,NDC,facility,outpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,00409317803,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 50 ML",60544,CDM,250,RC,J2004,HCPCS,63323048257,NDC,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,inpatient,1,mL,8.12000,7.71000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.47,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,00527-1948-66,NDC,,,facility,outpatient,1,mL,8.12000,7.71000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.06,7.88,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,inpatient,1,mL,4.90000,4.66000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.75,percent of total billed charges,
LEVOFLOXACIN LIQ 25 MG/ML,60546,CDM,250,RC,50458-0170-01,NDC,,,facility,outpatient,1,mL,4.90000,4.66000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.45,4.75,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
LEVOTHYROXINE SUSP SD 25 MCG/ML,60547,CDM,250,RC,51079-0444-20-02500,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,inpatient,1,EA,26.97000,25.62000,Amish/Mennonite,Amish Mennonite,,14.83,,,,,,,14.83,26.16,percent of total billed charges,
LOPINAVIR-RITONAVIR TAB 200 MG-50 MG,60548,CDM,250,RC,00074-6799-22,NDC,,,facility,outpatient,1,EA,26.97000,25.62000,Amish/Mennonite,Amish Mennonite,,14.83,,,,,,,13.48,26.16,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,00409427701,NDC,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,inpatient,1,mL,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,55150025520,NDC,facility,outpatient,1,mL,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,inpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048626,NDC,facility,outpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,inpatient,1,mL,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,63323048627,NDC,facility,outpatient,1,mL,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,inpatient,1,mL,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
LIDOCAINE SOLN 2% 20 ML,60549,CDM,250,RC,J2003,HCPCS,70756064825,NDC,facility,outpatient,1,mL,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00121-0873-16,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,00527-5125-70,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0038-16,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0438-64,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,45963-0439-63,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,50383-0795-16,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-08,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
LACTULOSE 10 GM/15 ML LIQU 473 ML,60550,CDM,250,RC,60432-0037-32,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,inpatient,1,mL,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-71,NDC,,,facility,outpatient,1,mL,5.65000,5.37000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,2.83,5.48,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,inpatient,1,mL,6.10000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,00131-5410-72,NDC,,,facility,outpatient,1,mL,6.10000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.05,5.92,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,inpatient,1,mL,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
LACOSAMIDE LIQ 10 MG/ML,60552,CDM,250,RC,67877-0732-95,NDC,,,facility,outpatient,1,mL,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,inpatient,1,EA,21.90000,20.80000,Amish/Mennonite,Amish Mennonite,,12.04,,,,,,,12.04,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,49702-0203-18,NDC,,,facility,outpatient,1,EA,21.90000,20.80000,Amish/Mennonite,Amish Mennonite,,12.04,,,,,,,10.95,21.24,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,inpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,6.52,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,60505-3251-06,NDC,,,facility,outpatient,1,EA,11.85000,11.26000,Amish/Mennonite,Amish Mennonite,,6.52,,,,,,,5.92,11.49,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,inpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.83,percent of total billed charges,
LAMIVUDINE TAB 150 MG,60553,CDM,250,RC,64380-0710-03,NDC,,,facility,outpatient,1,EA,3.95000,3.75000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.98,3.83,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,inpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,0040920531000100,NDC,facility,outpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,inpatient,1,mL,15.07000,14.32000,Amish/Mennonite,Amish Mennonite,,8.29,,,,,,,8.29,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092112043,NDC,facility,outpatient,1,mL,15.07000,14.32000,Amish/Mennonite,Amish Mennonite,,8.29,,,,,,,7.54,14.62,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,inpatient,1,mL,20.19000,19.18000,Amish/Mennonite,Amish Mennonite,,11.10,,,,,,,11.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,70092912043,NDC,facility,outpatient,1,mL,20.19000,19.18000,Amish/Mennonite,Amish Mennonite,,11.10,,,,,,,10.10,19.58,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,inpatient,1,mL,15.74000,14.95000,Amish/Mennonite,Amish Mennonite,,8.66,,,,,,,8.66,15.27,percent of total billed charges,
KETAMINE SOLN 50 MG/1 ML,60554,CDM,250,RC,J3490,HCPCS,71266907002,NDC,facility,outpatient,1,mL,15.74000,14.95000,Amish/Mennonite,Amish Mennonite,,8.66,,,,,,,7.87,15.27,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,19.64,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,00054-4499-11,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,17.85,34.63,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,inpatient,1,EA,28.25000,26.84000,Amish/Mennonite,Amish Mennonite,,15.54,,,,,,,15.54,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,42806-0359-25,NDC,,,facility,outpatient,1,EA,28.25000,26.84000,Amish/Mennonite,Amish Mennonite,,15.54,,,,,,,14.12,27.40,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,51079-0582-05,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,inpatient,1,EA,33.83000,32.14000,Amish/Mennonite,Amish Mennonite,,18.61,,,,,,,18.61,32.82,percent of total billed charges,
LEUCOVORIN TAB 25 MG,60555,CDM,250,RC,60687-0227-94,NDC,,,facility,outpatient,1,EA,33.83000,32.14000,Amish/Mennonite,Amish Mennonite,,18.61,,,,,,,16.91,32.82,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,00904-5930-61,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,23155-0725-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,60687-0136-01,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
LABETALOL 300 MG TAB,60556,CDM,250,RC,71247-0130-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00074714811,NDC,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,inpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,00527329046,NDC,facility,outpatient,1,EA,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,60687055201,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097501,NDC,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
LEVOTHYROXINE TAB 200 MCG (0.2 MG),60557,CDM,250,RC,J8499,HCPCS,68180097509,NDC,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,inpatient,1,mL,201.05000,191.00000,Amish/Mennonite,Amish Mennonite,,110.58,,,,,,,110.58,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,24208-0299-05,NDC,,,facility,outpatient,1,mL,201.05000,191.00000,Amish/Mennonite,Amish Mennonite,,110.58,,,,,,,100.53,195.02,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,inpatient,1,mL,135.06000,128.31000,Amish/Mennonite,Amish Mennonite,,74.28,,,,,,,74.28,131.01,percent of total billed charges,
LOTEPREDNOL SUSP OPHTH 0.5%,60559,CDM,250,RC,68682-0299-05,NDC,,,facility,outpatient,1,mL,135.06000,128.31000,Amish/Mennonite,Amish Mennonite,,74.28,,,,,,,67.53,131.01,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,Amish/Mennonite,Amish Mennonite,,990.71,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-00,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,Amish/Mennonite,Amish Mennonite,,990.71,,,,,,,900.64,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,inpatient,1,EA,1801.29000,1711.22000,Amish/Mennonite,Amish Mennonite,,990.71,,,,,,,990.71,1747.25,percent of total billed charges,
LENALIDOMIDE CAP 5 MG,60562,CDM,250,RC,59572-0405-28,NDC,,,facility,outpatient,1,EA,1801.29000,1711.22000,Amish/Mennonite,Amish Mennonite,,990.71,,,,,,,900.64,1747.25,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,00904-7007-61,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,16714-0700-01,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51079-0498-20,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,51672-4130-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,59746-0245-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,65862-0227-01,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
LAMOTRIGINE TAB 25 MG,60563,CDM,250,RC,68084-0318-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
LEVOFLOXACIN SOLN 25 MG/ML 30 ML,60564,CDM,250,RC,J1956,HCPCS,25021013030,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,3.23,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,inpatient,1,mL,54.06000,51.36000,Amish/Mennonite,Amish Mennonite,,29.73,,,,,,,29.73,52.44,percent of total billed charges,
LODOXAMIDE OPHTH 0.1% SOL,60567,CDM,250,RC,00065-0345-10,NDC,,,facility,outpatient,1,mL,54.06000,51.36000,Amish/Mennonite,Amish Mennonite,,29.73,,,,,,,27.03,52.44,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,inpatient,1,EA,51.38000,48.81000,Amish/Mennonite,Amish Mennonite,,28.26,,,,,,,28.26,49.84,percent of total billed charges,
LAMIVUDINE TAB 100 MG,60568,CDM,250,RC,00173-0662-00,NDC,,,facility,outpatient,1,EA,51.38000,48.81000,Amish/Mennonite,Amish Mennonite,,28.26,,,,,,,25.69,49.84,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,inpatient,1,GM,12.42000,11.80000,Amish/Mennonite,Amish Mennonite,,6.83,,,,,,,6.83,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,00591-2927-54,NDC,,,facility,outpatient,1,GM,12.42000,11.80000,Amish/Mennonite,Amish Mennonite,,6.83,,,,,,,6.21,12.05,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,27437-0056-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,7.54,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,8.30,14.64,percent of total billed charges,
LEVALBUTEROL INHALER 45 MCG/INH 15 GM,60570,CDM,250,RC,63402-0510-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,7.54,14.64,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,inpatient,1,EA,37.22000,35.36000,Amish/Mennonite,Amish Mennonite,,20.47,,,,,,,20.47,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-35,NDC,,,facility,outpatient,1,EA,37.22000,35.36000,Amish/Mennonite,Amish Mennonite,,20.47,,,,,,,18.61,36.10,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,inpatient,1,EA,40.94000,38.90000,Amish/Mennonite,Amish Mennonite,,22.52,,,,,,,22.52,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00131-2477-60,NDC,,,facility,outpatient,1,EA,40.94000,38.90000,Amish/Mennonite,Amish Mennonite,,22.52,,,,,,,20.47,39.71,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,inpatient,1,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,2.14,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,00904-7244-68,NDC,,,facility,outpatient,1,EA,3.89000,3.69000,Amish/Mennonite,Amish Mennonite,,2.14,,,,,,,1.95,3.77,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,16714-0548-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,50228-0192-60,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,51991-0348-06,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,inpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,60687-0676-57,NDC,,,facility,outpatient,1,EA,6.21000,5.90000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.10,6.02,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LACOSAMIDE TAB 50 MG,60571,CDM,250,RC,67877-0733-60,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,inpatient,1,EA,43.72000,41.54000,Amish/Mennonite,Amish Mennonite,,24.05,,,,,,,24.05,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,64764-0543-11,NDC,,,facility,outpatient,1,EA,43.72000,41.54000,Amish/Mennonite,Amish Mennonite,,24.05,,,,,,,21.86,42.41,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,inpatient,1,EA,28.51000,27.09000,Amish/Mennonite,Amish Mennonite,,15.68,,,,,,,15.68,27.65,percent of total billed charges,
LANSOPRAZOLE TAB-DISINTEGRATING 15 MG,60572,CDM,250,RC,68382-0771-77,NDC,,,facility,outpatient,1,EA,28.51000,27.09000,Amish/Mennonite,Amish Mennonite,,15.68,,,,,,,14.26,27.65,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,inpatient,1,mL,16.68000,15.85000,Amish/Mennonite,Amish Mennonite,,9.17,,,,,,,9.17,16.18,percent of total billed charges,
MEPERIDINE SOLN 100 MG/ML 20 ML,60573,CDM,250,RC,J2175,HCPCS,00409120120,NDC,facility,outpatient,1,mL,16.68000,15.85000,Amish/Mennonite,Amish Mennonite,,9.17,,,,,,,8.34,25.89,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,00054-0020-25,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68084-0655-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,inpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,64980-0278-01,NDC,,,facility,outpatient,1,EA,0.71000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 450 MG,60574,CDM,250,RC,68462-0224-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00065-4011-05,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.29,6.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,inpatient,1,mL,6.70000,6.36000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.69,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,00536-1252-40,NDC,,,facility,outpatient,1,mL,6.70000,6.36000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.35,6.50,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,inpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,17478-0717-10,NDC,,,facility,outpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.89,5.61,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,inpatient,1,mL,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,49348-0107-17,NDC,,,facility,outpatient,1,mL,3.47000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.37,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,inpatient,1,mL,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,3.06,5.39,percent of total billed charges,
KETOTIFEN SOLN-OPHTH 0.025% 5 ML,60575,CDM,250,RC,76385-0106-17,NDC,,,facility,outpatient,1,mL,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,2.78,5.39,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
MAGNESIUM CARBONATE LIQ 54 MG/5 ML,60576,CDM,250,RC,00187-5267-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,inpatient,1,mL,1032.80000,981.16000,Amish/Mennonite,Amish Mennonite,,568.04,,,,,,,568.04,1001.82,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722401,NDC,facility,outpatient,1,mL,1032.80000,981.16000,Amish/Mennonite,Amish Mennonite,,568.04,,,,,,,516.40,8271.63,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,inpatient,1,mL,1186.38000,1127.06000,Amish/Mennonite,Amish Mennonite,,652.51,,,,,,,652.51,1150.79,percent of total billed charges,
"LYMPHOCYTE IMMUNE GLOBULIN, ANTI-THY (EQUINE) SOLN 50 MG/ML 5 ML",60578,CDM,636,RC,J7504,HCPCS,00009722402,NDC,facility,outpatient,1,mL,1186.38000,1127.06000,Amish/Mennonite,Amish Mennonite,,652.51,,,,,,,593.19,8271.63,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
LISINOPRIL SUSP SD 2 MG/ML,60579,CDM,250,RC,00603-4209-21-00200,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,00480-3566-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,47781-0563-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 20 MG CAP,60580,CDM,250,RC,59417-0102-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,20.43,39.62,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,inpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00093414719,NDC,facility,outpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,inpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,9.32,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,00378699393,NDC,facility,outpatient,1,EA,16.94000,16.09000,Amish/Mennonite,Amish Mennonite,,9.32,,,,,,,0.43865,16.43,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,inpatient,1,EA,21.59000,20.51000,Amish/Mennonite,Amish Mennonite,,11.87,,,,,,,11.87,20.94,percent of total billed charges,
LEVALBUTEROL NEB 1.25 MG/0.5 ML,60581,CDM,250,RC,J7612,HCPCS,17478017130,NDC,facility,outpatient,1,EA,21.59000,20.51000,Amish/Mennonite,Amish Mennonite,,11.87,,,,,,,0.43865,20.94,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,inpatient,1,EA,9.59000,9.11000,Amish/Mennonite,Amish Mennonite,,5.27,,,,,,,5.27,9.30,percent of total billed charges,
MESALAMINE 250 MG ER CAP,60582,CDM,250,RC,54092-0189-81,NDC,,,facility,outpatient,1,EA,9.59000,9.11000,Amish/Mennonite,Amish Mennonite,,5.27,,,,,,,4.79,9.30,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,inpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 30 ML",60585,CDM,250,RC,J2004,HCPCS,00409318202,NDC,facility,outpatient,1,mL,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,inpatient,1,mL,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323006450,NDC,facility,outpatient,1,mL,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,inpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
MAGNESIUM SULFATE SOLN 0.5 GM/ML 50 ML,60586,CDM,250,RC,J3475,HCPCS,63323064250,NDC,facility,outpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,inpatient,,,386.68000,367.35000,Amish/Mennonite,Amish Mennonite,,212.67,,,,,,,212.67,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,CPT,,,facility,outpatient,,,386.68000,367.35000,Amish/Mennonite,Amish Mennonite,,212.67,,,,,,,148.70,375.08,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,inpatient,1,mL,773.36000,734.69000,Amish/Mennonite,Amish Mennonite,,425.35,,,,,,,425.35,750.16,percent of total billed charges,
"MENINGOCOCCAL VACCINE, RECOMBINANT SUSP (BEXSERO)",60587,CDM,250,RC,90620,HCPCS,58160097620,NDC,facility,outpatient,1,mL,773.36000,734.69000,Amish/Mennonite,Amish Mennonite,,425.35,,,,,,,148.70,750.16,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00591-0242-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,00904-6009-61,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LORAZEPAM TAB 2 MG,60588,CDM,250,RC,69315-0906-01,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,inpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.74,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00074714990,NDC,facility,outpatient,1,EA,4.98000,4.73000,Amish/Mennonite,Amish Mennonite,,2.74,,,,,,,2.49,4.83,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,inpatient,1,EA,2.74000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182101,NDC,facility,outpatient,1,EA,2.74000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,inpatient,1,EA,2.49000,2.36000,Amish/Mennonite,Amish Mennonite,,1.37,,,,,,,1.37,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00378182177,NDC,facility,outpatient,1,EA,2.49000,2.36000,Amish/Mennonite,Amish Mennonite,,1.37,,,,,,,1.25,2.42,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,inpatient,1,EA,2.74000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,00781519092,NDC,facility,outpatient,1,EA,2.74000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.37,2.66,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,16729045815,NDC,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,47781067190,NDC,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097601,NDC,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,68180097609,NDC,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,inpatient,1,EA,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
LEVOTHYROXINE TAB 300 MCG (0.3 MG),60589,CDM,250,RC,J8499,HCPCS,69238184101,NDC,facility,outpatient,1,EA,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
MAGNESIUM GLUCONATE TAB 500 MG,60590,CDM,250,RC,60258-0172-01,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,inpatient,1,EA,140.32000,133.31000,Amish/Mennonite,Amish Mennonite,,77.18,,,,,,,77.18,136.11,percent of total billed charges,
LOMUSTINE CAP 40 MG,60591,CDM,250,RC,58181-3031-05,NDC,,,facility,outpatient,1,EA,140.32000,133.31000,Amish/Mennonite,Amish Mennonite,,77.18,,,,,,,70.16,136.11,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,inpatient,1,EA,2.66000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,00574022201,NDC,facility,outpatient,1,EA,2.66000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,inpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,16714016701,NDC,facility,outpatient,1,EA,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,inpatient,1,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51407038501,NDC,facility,outpatient,1,EA,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.26,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,inpatient,1,EA,6.28000,5.96000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.45,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,51862032101,NDC,facility,outpatient,1,EA,6.28000,5.96000,Amish/Mennonite,Amish Mennonite,,3.45,,,,,,,3.14,6.09,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,59762120701,NDC,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,inpatient,1,EA,7.96000,7.56000,Amish/Mennonite,Amish Mennonite,,4.38,,,,,,,4.38,7.72,percent of total billed charges,
LIOTHYRONINE TAB 25 MCG,60592,CDM,250,RC,J8499,HCPCS,60793011601,NDC,facility,outpatient,1,EA,7.96000,7.56000,Amish/Mennonite,Amish Mennonite,,4.38,,,,,,,3.98,7.72,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,inpatient,5,EA,10.04000,9.54000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.52,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,24208-0830-60,NDC,,,facility,outpatient,5,EA,10.04000,9.54000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.02,9.74,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,inpatient,5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,6.26,11.04,percent of total billed charges,
MAXITROL (NEOMYCIN/POLY B/DEX) OPHTH SUSP 5 ML,60593,CDM,250,RC,61314-0630-06,NDC,,,facility,outpatient,5,EA,11.38000,10.81000,Amish/Mennonite,Amish Mennonite,,6.26,,,,,,,5.69,11.04,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,inpatient,1,EA,1.67000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00113-2013-60,NDC,,,facility,outpatient,1,EA,1.67000,1.58000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,00573-2660-24,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,inpatient,1,EA,45.77000,43.48000,Amish/Mennonite,Amish Mennonite,,25.17,,,,,,,25.17,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,11523-7162-01,NDC,,,facility,outpatient,1,EA,45.77000,43.48000,Amish/Mennonite,Amish Mennonite,,25.17,,,,,,,22.89,44.40,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.78,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-46,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.61,3.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,inpatient,1,EA,2.42000,2.30000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.33,2.35,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 5 MG-120 MG,60594,CDM,250,RC,45802-0122-65,NDC,,,facility,outpatient,1,EA,2.42000,2.30000,Amish/Mennonite,Amish Mennonite,,1.33,,,,,,,1.21,2.35,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,inpatient,1,mL,18.20000,17.29000,Amish/Mennonite,Amish Mennonite,,10.01,,,,,,,10.01,17.65,percent of total billed charges,
MEPERIDINE SOLN 75 MG/ML,60595,CDM,250,RC,J2175,HCPCS,00409117930,NDC,facility,outpatient,1,mL,18.20000,17.29000,Amish/Mennonite,Amish Mennonite,,10.01,,,,,,,9.10,25.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,inpatient,1,EA,12.26000,11.65000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,6.74,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00023-5853-18,NDC,,,facility,outpatient,1,EA,12.26000,11.65000,Amish/Mennonite,Amish Mennonite,,6.74,,,,,,,6.13,11.89,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,inpatient,1,EA,10.59000,10.06000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,5.82,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00093-5907-86,NDC,,,facility,outpatient,1,EA,10.59000,10.06000,Amish/Mennonite,Amish Mennonite,,5.82,,,,,,,5.29,10.27,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,inpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.65,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,00430-0753-27,NDC,,,facility,outpatient,1,EA,10.27000,9.76000,Amish/Mennonite,Amish Mennonite,,5.65,,,,,,,5.13,9.96,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,inpatient,1,EA,7.36000,6.99000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,4.05,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,59762-0117-01,NDC,,,facility,outpatient,1,EA,7.36000,6.99000,Amish/Mennonite,Amish Mennonite,,4.05,,,,,,,3.68,7.14,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,inpatient,1,EA,16.12000,15.31000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,8.87,15.64,percent of total billed charges,
MESALAMINE EC CAP 400 MG,60597,CDM,250,RC,60687-0556-32,NDC,,,facility,outpatient,1,EA,16.12000,15.31000,Amish/Mennonite,Amish Mennonite,,8.87,,,,,,,8.06,15.64,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-2527-25,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,00054-8527-25,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,inpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
LITHIUM CARBONATE CAP 300 MG,60598,CDM,250,RC,68462-0221-01,NDC,,,facility,outpatient,1,EA,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,inpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0363-74,NDC,,,facility,outpatient,1,EA,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,1.55,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
LACTOBACILLUS GG (CULTURELLE) CAP,60600,CDM,250,RC,49100-0400-09,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,inpatient,1,mL,28.12000,26.72000,Amish/Mennonite,Amish Mennonite,,15.47,,,,,,,15.47,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00009-5136-01,NDC,,,facility,outpatient,1,mL,28.12000,26.72000,Amish/Mennonite,Amish Mennonite,,15.47,,,,,,,14.06,27.28,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,inpatient,1,mL,14.15000,13.44000,Amish/Mennonite,Amish Mennonite,,7.78,,,,,,,7.78,13.73,percent of total billed charges,
LINEZOLID SUSP 20 MG/ML,60602,CDM,250,RC,00054-0319-50,NDC,,,facility,outpatient,1,mL,14.15000,13.44000,Amish/Mennonite,Amish Mennonite,,7.78,,,,,,,7.08,13.73,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,inpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,00409477601,NDC,facility,outpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,inpatient,1,mL,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
LIDOCAINE SOLN PF 1.5% 20 ML,60603,CDM,250,RC,J2003,HCPCS,63323049391,NDC,facility,outpatient,1,mL,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,inpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LOXAPINE CAP 5 MG,60604,CDM,250,RC,00591-0369-01,NDC,,,facility,outpatient,1,EA,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,10006-0730-51,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,47469-0004-65,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,74312-0028-32,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
MELATONIN TAB 1 MG,60605,CDM,250,RC,80681-0041-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,inpatient,1,EA,28.94000,27.50000,Amish/Mennonite,Amish Mennonite,,15.92,,,,,,,15.92,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,47781020050,NDC,facility,outpatient,1,EA,28.94000,27.50000,Amish/Mennonite,Amish Mennonite,,15.92,,,,,,,14.47,28.07,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,inpatient,1,EA,35.77000,33.98000,Amish/Mennonite,Amish Mennonite,,19.67,,,,,,,19.67,34.70,percent of total billed charges,
MELPHALAN TAB 2 MG,60606,CDM,250,RC,J8600,HCPCS,52609000105,NDC,facility,outpatient,1,EA,35.77000,33.98000,Amish/Mennonite,Amish Mennonite,,19.67,,,,,,,17.89,34.70,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,00406-0127-01,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.32,12.26,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,inpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,13811-0707-10,NDC,,,facility,outpatient,1,EA,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.18,2.29,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,inpatient,1,EA,41.78000,39.69000,Amish/Mennonite,Amish Mennonite,,22.98,,,,,,,22.98,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,50458-0588-01,NDC,,,facility,outpatient,1,EA,41.78000,39.69000,Amish/Mennonite,Amish Mennonite,,22.98,,,,,,,20.89,40.53,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,inpatient,1,EA,16.80000,15.96000,Amish/Mennonite,Amish Mennonite,,9.24,,,,,,,9.24,16.30,percent of total billed charges,
METHYLPHENIDATE TAB-24 27 MG,60607,CDM,250,RC,62175-0311-37,NDC,,,facility,outpatient,1,EA,16.80000,15.96000,Amish/Mennonite,Amish Mennonite,,9.24,,,,,,,8.40,16.30,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,00480-3567-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,inpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,16.20,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,47781-0564-01,NDC,,,facility,outpatient,1,EA,29.45000,27.98000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,14.72,28.57,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,59417-0103-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,20.43,39.62,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,inpatient,1,EA,8.25000,7.84000,Amish/Mennonite,Amish Mennonite,,4.54,,,,,,,4.54,8.00,percent of total billed charges,
LISDEXAMFETAMINE 30 MG CAP,60608,CDM,250,RC,65162-0024-09,NDC,,,facility,outpatient,1,EA,8.25000,7.84000,Amish/Mennonite,Amish Mennonite,,4.54,,,,,,,4.12,8.00,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,inpatient,1,EA,37.02000,35.17000,Amish/Mennonite,Amish Mennonite,,20.36,,,,,,,20.36,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,16714-0245-30,NDC,,,facility,outpatient,1,EA,37.02000,35.17000,Amish/Mennonite,Amish Mennonite,,20.36,,,,,,,18.51,35.91,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,inpatient,1,EA,13.95000,13.25000,Amish/Mennonite,Amish Mennonite,,7.67,,,,,,,7.67,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,31722-0005-30,NDC,,,facility,outpatient,1,EA,13.95000,13.25000,Amish/Mennonite,Amish Mennonite,,7.67,,,,,,,6.97,13.53,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,inpatient,1,EA,122.37000,116.26000,Amish/Mennonite,Amish Mennonite,,67.30,,,,,,,67.30,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,58914-0501-56,NDC,,,facility,outpatient,1,EA,122.37000,116.26000,Amish/Mennonite,Amish Mennonite,,67.30,,,,,,,61.19,118.70,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,inpatient,1,EA,48.95000,46.50000,Amish/Mennonite,Amish Mennonite,,26.92,,,,,,,26.92,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,69918-0560-30,NDC,,,facility,outpatient,1,EA,48.95000,46.50000,Amish/Mennonite,Amish Mennonite,,26.92,,,,,,,24.48,47.48,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,inpatient,1,EA,18.49000,17.56000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,10.17,17.94,percent of total billed charges,
MESALAMINE 1000 MG SUPP,60611,CDM,250,RC,70710-1302-07,NDC,,,facility,outpatient,1,EA,18.49000,17.56000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,9.24,17.94,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00527-1435-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,inpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,9.56,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,00904-6831-04,NDC,,,facility,outpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,8.69,16.86,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,55111-0650-01,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,inpatient,1,EA,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,9.73,17.17,percent of total billed charges,
METAXALONE TAB 800 MG,60612,CDM,250,RC,68084-0135-21,NDC,,,facility,outpatient,1,EA,17.70000,16.81000,Amish/Mennonite,Amish Mennonite,,9.73,,,,,,,8.85,17.17,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,00555-0606-02,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
MEGESTROL TAB 20 MG,60613,CDM,250,RC,64380-0158-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
MEPERIDINE TAB 50 MG,60614,CDM,250,RC,00054-8595-11,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,2.56,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,inpatient,1,EA,20.11000,19.11000,Amish/Mennonite,Amish Mennonite,,11.06,,,,,,,11.06,19.51,percent of total billed charges,
MILNACIPRAN TAB 50 MG,60615,CDM,250,RC,00456-1550-60,NDC,,,facility,outpatient,1,EA,20.11000,19.11000,Amish/Mennonite,Amish Mennonite,,11.06,,,,,,,10.05,19.51,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,43386-0510-87,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,inpatient,1,mL,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,45802-0098-51,NDC,,,facility,outpatient,1,mL,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,inpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
MESALAMINE ENEMA 4 G/60 ML,60616,CDM,250,RC,62559-0420-07,NDC,,,facility,outpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,inpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
LEVOCARNITINE LIQ 100 MG/ML,60617,CDM,250,RC,J8499,HCPCS,64980050312,NDC,facility,outpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00093-7367-98,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,00603-4228-02,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,inpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,16714-0226-01,NDC,,,facility,outpatient,1,EA,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,inpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
LOSARTAN-HYDROCHLOROTHIAZIDE TAB 50 MG-12.5 MG,60618,CDM,250,RC,62332-0048-30,NDC,,,facility,outpatient,1,EA,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,inpatient,1,EA,19.54000,18.57000,Amish/Mennonite,Amish Mennonite,,10.75,,,,,,,10.75,18.95,percent of total billed charges,
LUBIPROSTONE 24 MCG CAP,60619,CDM,250,RC,64764-0240-60,NDC,,,facility,outpatient,1,EA,19.54000,18.57000,Amish/Mennonite,Amish Mennonite,,10.75,,,,,,,9.77,18.95,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,inpatient,1,EA,692.00000,657.40000,Amish/Mennonite,Amish Mennonite,,380.60,,,,,,,380.60,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055107,NDC,facility,outpatient,1,EA,692.00000,657.40000,Amish/Mennonite,Amish Mennonite,,380.60,,,,,,,346.00,671.24,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,inpatient,1,EA,188.18000,178.77000,Amish/Mennonite,Amish Mennonite,,103.50,,,,,,,103.50,182.53,percent of total billed charges,
METHYLNALTREXONE SOLN 12 MG/0.6 ML,60620,CDM,250,RC,J2212,HCPCS,65649055305,NDC,facility,outpatient,1,EA,188.18000,178.77000,Amish/Mennonite,Amish Mennonite,,103.50,,,,,,,94.09,182.53,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,inpatient,1,mL,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.29,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00409678002,NDC,facility,outpatient,1,mL,2.36000,2.24000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.18,2.61,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,inpatient,1,mL,3.36000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,00641605010,NDC,facility,outpatient,1,mL,3.36000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
LORAZEPAM SOLN 2 MG/ML 10 ML,60622,CDM,250,RC,J2060,HCPCS,76329826101,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,inpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
METHADONE LIQ 1 MG/1 ML,60623,CDM,250,RC,S0109,HCPCS,0005435556300100,NDC,facility,outpatient,1,mL,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,inpatient,1,mL,19.18000,18.22000,Amish/Mennonite,Amish Mennonite,,10.55,,,,,,,10.55,18.60,percent of total billed charges,
METHOHEXITAL SOLN 10 MG/ML 10 ML,60624,CDM,250,RC,61553-0397-65,NDC,,,facility,outpatient,1,mL,19.18000,18.22000,Amish/Mennonite,Amish Mennonite,,10.55,,,,,,,9.59,18.60,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,inpatient,1,EA,5.51000,5.23000,Amish/Mennonite,Amish Mennonite,,3.03,,,,,,,3.03,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,43199-0020-01,NDC,,,facility,outpatient,1,EA,5.51000,5.23000,Amish/Mennonite,Amish Mennonite,,3.03,,,,,,,2.75,5.34,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.95,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,50268-0549-15,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.50,8.73,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,inpatient,1,EA,7.78000,7.39000,Amish/Mennonite,Amish Mennonite,,4.28,,,,,,,4.28,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,60687-0694-21,NDC,,,facility,outpatient,1,EA,7.78000,7.39000,Amish/Mennonite,Amish Mennonite,,4.28,,,,,,,3.89,7.55,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
METHENAMINE HIPPURATE TAB 1 GM,60625,CDM,250,RC,65862-0782-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,58232-4021-01,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,inpatient,1,GM,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 10%-15% CREA,60626,CDM,250,RC,74300-0081-86,NDC,,,facility,outpatient,1,GM,0.22000,0.20000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,inpatient,1,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,38.24,67.43,percent of total billed charges,
MEROPENEM SOLN 1000 MG/NS 50 ML PREMIX,60627,CDM,250,RC,J2184,HCPCS,00264318511,NDC,facility,outpatient,1,EA,69.52000,66.04000,Amish/Mennonite,Amish Mennonite,,38.24,,,,,,,3.23,67.43,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,inpatient,1,EA,10.54000,10.01000,Amish/Mennonite,Amish Mennonite,,5.80,,,,,,,5.80,10.22,percent of total billed charges,
MECLOFENAMATE 50 MG CAP,60629,CDM,250,RC,00378-2150-01,NDC,,,facility,outpatient,1,EA,10.54000,10.01000,Amish/Mennonite,Amish Mennonite,,5.80,,,,,,,5.27,10.22,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,inpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,00406-1473-01,NDC,,,facility,outpatient,1,EA,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,10702-0076-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
METHYLPHENIDATE TAB-ER 20 MG/8 HR,60630,CDM,250,RC,70010-0043-01,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,00054-0021-25,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,inpatient,1,EA,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,51079-0180-20,NDC,,,facility,outpatient,1,EA,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,inpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68084-0640-01,NDC,,,facility,outpatient,1,EA,1.15000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.57500,1.12,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
LITHIUM CARBONATE TAB-ER 300 MG,60631,CDM,250,RC,68462-0223-01,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,inpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
METHYL SALICYLATE CRM 57 GM,60632,CDM,250,RC,74300-0005-30,NDC,,,facility,outpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,inpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,00703367801,NDC,facility,outpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,inpatient,1,mL,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,16729027735,NDC,facility,outpatient,1,mL,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,4.28,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,inpatient,1,mL,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 40 ML,60633,CDM,250,RC,J9260,HCPCS,61703040841,NDC,facility,outpatient,1,mL,2.90000,2.76000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,4.28,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,inpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00143971810,NDC,facility,outpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,inpatient,1,mL,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00338601137,NDC,facility,outpatient,1,mL,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,inpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409198310,NDC,facility,outpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,inpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,00409277602,NDC,facility,outpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,2.61,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,inpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
MILRINONE 40 MG/D5W 200 ML PREMIX,60634,CDM,250,RC,J2260,HCPCS,55150028810,NDC,facility,outpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,2.61,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,inpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,31.28,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,17478038020,NDC,facility,outpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,28.44,55.17,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,inpatient,1,mL,61.46000,58.39000,Amish/Mennonite,Amish Mennonite,,33.80,,,,,,,33.80,59.62,percent of total billed charges,
METHADONE SOLN 10 MG/ML 20 ML,60635,CDM,250,RC,J1230,HCPCS,67457021720,NDC,facility,outpatient,1,mL,61.46000,58.39000,Amish/Mennonite,Amish Mennonite,,33.80,,,,,,,30.73,59.62,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,inpatient,1,EA,31.45000,29.88000,Amish/Mennonite,Amish Mennonite,,17.30,,,,,,,17.30,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,00078-0370-05,NDC,,,facility,outpatient,1,EA,31.45000,29.88000,Amish/Mennonite,Amish Mennonite,,17.30,,,,,,,15.72,30.51,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,inpatient,1,EA,14.34000,13.63000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,7.89,13.91,percent of total billed charges,
METHYLPHENIDATE CAP-ER 20 MG/24 HR,60637,CDM,250,RC,51862-0263-01,NDC,,,facility,outpatient,1,EA,14.34000,13.63000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,7.17,13.91,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,inpatient,,,241.67000,229.59000,Amish/Mennonite,Amish Mennonite,,132.92,,,,,,,132.92,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,CPT,,,facility,outpatient,,,241.67000,229.59000,Amish/Mennonite,Amish Mennonite,,132.92,,,,,,,120.83,234.42,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,inpatient,1,EA,483.34000,459.17000,Amish/Mennonite,Amish Mennonite,,265.84,,,,,,,265.84,468.84,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE POWD-INJ (MENVEO)",60638,CDM,250,RC,90734,HCPCS,58160095509,NDC,facility,outpatient,1,EA,483.34000,459.17000,Amish/Mennonite,Amish Mennonite,,265.84,,,,,,,187.18,468.84,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,inpatient,1,EA,669.20000,635.74000,Amish/Mennonite,Amish Mennonite,,368.06,,,,,,,368.06,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,63323076020,NDC,facility,outpatient,1,EA,669.20000,635.74000,Amish/Mennonite,Amish Mennonite,,368.06,,,,,,,108.03,649.12,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,inpatient,1,EA,3779.13000,3590.17000,Amish/Mennonite,Amish Mennonite,,2078.52,,,,,,,2078.52,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,67457057901,NDC,facility,outpatient,1,EA,3779.13000,3590.17000,Amish/Mennonite,Amish Mennonite,,2078.52,,,,,,,108.03,3665.76,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,inpatient,1,EA,4600.00000,4370.00000,Amish/Mennonite,Amish Mennonite,,2530.00,,,,,,,2530.00,4462.00,percent of total billed charges,
MELPHALAN POWD-INJ 50 MG,60639,CDM,636,RC,J9245,HCPCS,68152010900,NDC,facility,outpatient,1,EA,4600.00000,4370.00000,Amish/Mennonite,Amish Mennonite,,2530.00,,,,,,,108.03,4462.00,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,5.18,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,00527-3310-37,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,4.71,9.14,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,13811-0706-10,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,inpatient,1,EA,14.55000,13.82000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,8.00,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,16714-0124-01,NDC,,,facility,outpatient,1,EA,14.55000,13.82000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,7.28,14.11,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,inpatient,1,EA,40.76000,38.72000,Amish/Mennonite,Amish Mennonite,,22.42,,,,,,,22.42,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,50458-0585-01,NDC,,,facility,outpatient,1,EA,40.76000,38.72000,Amish/Mennonite,Amish Mennonite,,22.42,,,,,,,20.38,39.54,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,inpatient,1,EA,16.38000,15.57000,Amish/Mennonite,Amish Mennonite,,9.01,,,,,,,9.01,15.89,percent of total billed charges,
METHYLPHENIDATE TAB-24 18 MG,60640,CDM,250,RC,62175-0310-37,NDC,,,facility,outpatient,1,EA,16.38000,15.57000,Amish/Mennonite,Amish Mennonite,,9.01,,,,,,,8.19,15.89,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,inpatient,1,EA,20.97000,19.92000,Amish/Mennonite,Amish Mennonite,,11.53,,,,,,,11.53,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,00009007301,NDC,facility,outpatient,1,EA,20.97000,19.92000,Amish/Mennonite,Amish Mennonite,,11.53,,,,,,,0.36823,20.34,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,inpatient,1,EA,7.85000,7.46000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59746000314,NDC,facility,outpatient,1,EA,7.85000,7.46000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,0.36823,7.61,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,inpatient,1,EA,8.95000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,59762005001,NDC,facility,outpatient,1,EA,8.95000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,0.36823,8.68,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,inpatient,1,EA,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,4.09,7.21,percent of total billed charges,
METHYLPREDNISOLONE TAB 16 MG,60641,CDM,250,RC,J7509,HCPCS,68382091818,NDC,facility,outpatient,1,EA,7.43000,7.05000,Amish/Mennonite,Amish Mennonite,,4.09,,,,,,,0.36823,7.21,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
METOPROLOL TAB-ER 12.5 MG,60642,CDM,250,RC,00904-6322-61-00050,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,inpatient,1,EA,54.15000,51.44000,Amish/Mennonite,Amish Mennonite,,29.78,,,,,,,29.78,52.53,percent of total billed charges,
LOMUSTINE CAP 10 MG,60643,CDM,250,RC,58181-3030-05,NDC,,,facility,outpatient,1,EA,54.15000,51.44000,Amish/Mennonite,Amish Mennonite,,29.78,,,,,,,27.07,52.53,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
METRONIDAZOLE SUSP SD 50 MG/ML,60644,CDM,250,RC,51079-0216-20-05000,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
METOPROLOL TAB 6.25 MG,60645,CDM,250,RC,00904-6340-61-00025,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,inpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.25,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,00093-8739-01,NDC,,,facility,outpatient,1,EA,4.09000,3.88000,Amish/Mennonite,Amish Mennonite,,2.25,,,,,,,2.04,3.97,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,50742-0239-01,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
MEXILETINE 150 MG CAP,60647,CDM,250,RC,62559-0820-01,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
METOPROLOL SUSP SD 10 MG/ML,60648,CDM,250,RC,00904-6340-61-01000,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,inpatient,1,mL,12.48000,11.86000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,6.86,12.11,percent of total billed charges,
MILRINONE SOLN 1 MG/ML 20 ML,60649,CDM,250,RC,J2260,HCPCS,63323061720,NDC,facility,outpatient,1,mL,12.48000,11.86000,Amish/Mennonite,Amish Mennonite,,6.86,,,,,,,2.24,12.11,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,inpatient,1,mL,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
METHYLPREDNISOLONE  NA SUCC SOLN SD 10 MG/ML,60650,CDM,636,RC,J2919,HCPCS,0000900392801000,NDC,facility,outpatient,1,mL,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,0.26000,4.10,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,23155-0070-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,49884-0640-01,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,51293-0820-01,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
METHIMAZOLE TAB 5 MG,60651,CDM,250,RC,60687-0669-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,inpatient,1,GM,19.83000,18.84000,Amish/Mennonite,Amish Mennonite,,10.91,,,,,,,10.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00299-3820-60,NDC,,,facility,outpatient,1,GM,19.83000,18.84000,Amish/Mennonite,Amish Mennonite,,10.91,,,,,,,9.91,19.24,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,00781-7080-35,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,inpatient,1,GM,11.68000,11.10000,Amish/Mennonite,Amish Mennonite,,6.42,,,,,,,6.42,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,66993-0936-61,NDC,,,facility,outpatient,1,GM,11.68000,11.10000,Amish/Mennonite,Amish Mennonite,,6.42,,,,,,,5.84,11.33,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,51672-4215-03,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.09,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,inpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.50,7.93,percent of total billed charges,
METRONIDAZOLE GEL 1% 60 GM,60652,CDM,250,RC,62332-0630-60,NDC,,,facility,outpatient,1,GM,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.09,7.93,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,65862-0209-01,NDC,,,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,63304-0694-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,inpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
MINOCYCLINE CAP 50 MG,60653,CDM,250,RC,47781-0544-01,NDC,,,facility,outpatient,1,EA,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,inpatient,1,GM,5.01000,4.76000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,66993-0960-45,NDC,,,facility,outpatient,1,GM,5.01000,4.76000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.50,4.86,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,inpatient,1,GM,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
METRONIDAZOLE CRM 0.75% 45 GM,60654,CDM,250,RC,72578-0129-08,NDC,,,facility,outpatient,1,GM,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,inpatient,1,EA,9.03000,8.58000,Amish/Mennonite,Amish Mennonite,,4.97,,,,,,,4.97,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,00186-1094-05,NDC,,,facility,outpatient,1,EA,9.03000,8.58000,Amish/Mennonite,Amish Mennonite,,4.97,,,,,,,4.51,8.76,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.75,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,16714-0855-01,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.59,3.09,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,24979-0040-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,50742-0618-01,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,inpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,55111-0469-01,NDC,,,facility,outpatient,1,EA,3.68000,3.50000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.84,3.57,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
METOPROLOL TAB-ER 200 MG,60655,CDM,250,RC,72516-0033-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,inpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,00316022530,NDC,facility,outpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,inpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,10135072085,NDC,facility,outpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,inpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11017025030,NDC,facility,outpatient,1,GM,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,inpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,11701003816,NDC,facility,outpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MICONAZOLE TOP 2% PWDR,60656,CDM,250,RC,J3490,HCPCS,53329016979,NDC,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,inpatient,1,GM,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,11701-0067-23,NDC,,,facility,outpatient,1,GM,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,inpatient,1,GM,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MICONAZOLE OINT 2% 60 GM,60657,CDM,250,RC,16864-0400-02,NDC,,,facility,outpatient,1,GM,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
METRONIDAZOLE SUSP SD 125 MG/ML,60658,CDM,250,RC,51079-0216-20-12500,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL GEL 4% 120 ML,60659,CDM,250,RC,59316-0102-20,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,inpatient,1,EA,8.68000,8.24000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.77,8.42,percent of total billed charges,
MIGLITOL TAB 25 MG,60660,CDM,250,RC,00009-5012-01,NDC,,,facility,outpatient,1,EA,8.68000,8.24000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.34,8.42,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,inpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
MAGNESIUM SULFATE/D5W SOLN SD 50 MG/ML,60661,CDM,250,RC,00517-2602-25,NDC,,,facility,outpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,inpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,00121-1576-10,NDC,,,facility,outpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.64000,1.24,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,inpatient,1,mL,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
METOCLOPRAMIDE LIQ 10 MG/10 ML,60662,CDM,250,RC,66689-0031-50,NDC,,,facility,outpatient,1,mL,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,inpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,51079-0087-20,NDC,,,facility,outpatient,1,EA,0.75000,0.71000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,inpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,63739-0099-10,NDC,,,facility,outpatient,1,EA,0.54000,0.52000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,inpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.58300,1.03,percent of total billed charges,
MIRTAZAPINE TAB 30 MG,60663,CDM,250,RC,68084-0120-01,NDC,,,facility,outpatient,1,EA,1.06000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58300,,,,,,,0.53000,1.03,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,00869-0602-43,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,49348-0018-75,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,inpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
MAGNESIUM SULFATE COMPOUNDING PWDR,60664,CDM,250,RC,70677-0038-01,NDC,,,facility,outpatient,1,GM,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,inpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-15,NDC,,,facility,outpatient,1,EA,2.38000,2.26000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.19,2.31,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,00904-5833-48,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,49348-0543-57,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,inpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-15,NDC,,,facility,outpatient,1,EA,1.51000,1.43000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
LORATADINE-PSEUDOEPHEDRINE TAB-ER 10 MG-240 MG,60665,CDM,250,RC,51660-0724-56,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00378-3515-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,00904-6519-61,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,57237-0008-30,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,51079-0086-20,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,63739-0098-10,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
MIRTAZAPINE TAB 15 MG,60666,CDM,250,RC,68084-0119-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,inpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,00641606325,NDC,facility,outpatient,1,mL,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.19995,1.92,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,inpatient,1,mL,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,4.90,8.64,percent of total billed charges,
MIDAZOLAM SOLN 5 MG/ML 2 ML,60668,CDM,250,RC,J2250,HCPCS,63323041202,NDC,facility,outpatient,1,mL,8.91000,8.47000,Amish/Mennonite,Amish Mennonite,,4.90,,,,,,,0.19995,8.64,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,inpatient,1,mL,6.74000,6.40000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.71,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,60687-0576-10,NDC,,,facility,outpatient,1,mL,6.74000,6.40000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.37,6.54,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,inpatient,1,mL,6.67000,6.33000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
MIDAZOLAM SYRUP 5 MG/2.5 ML,60669,CDM,250,RC,68094-0762-62,NDC,,,facility,outpatient,1,mL,6.67000,6.33000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,inpatient,1,mL,68.41000,64.98000,Amish/Mennonite,Amish Mennonite,,37.63,,,,,,,37.63,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,00703468001,NDC,facility,outpatient,1,mL,68.41000,64.98000,Amish/Mennonite,Amish Mennonite,,37.63,,,,,,,29.60,66.36,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,inpatient,1,mL,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,61703034365,NDC,facility,outpatient,1,mL,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,inpatient,1,mL,142.39000,135.27000,Amish/Mennonite,Amish Mennonite,,78.31,,,,,,,78.31,138.12,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 12.5 ML MDV,60674,CDM,250,RC,J9293,HCPCS,63323013212,NDC,facility,outpatient,1,mL,142.39000,135.27000,Amish/Mennonite,Amish Mennonite,,78.31,,,,,,,29.60,138.12,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,inpatient,1,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
MITOTANE TAB 500 MG,60676,CDM,250,RC,J8999,HCPCS,00015308060,NDC,facility,outpatient,1,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,14.71,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,inpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00536408501,NDC,facility,outpatient,1,EA,1.49000,1.42000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,00904531360,NDC,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,48433011201,NDC,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,inpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
"MULTIVITAMIN, PRENATAL TAB",60677,CDM,250,RC,S0197,HCPCS,77333071510,NDC,facility,outpatient,1,EA,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,00406-1445-01,NDC,,,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,inpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
METHYLPHENIDATE TAB-ER 10 MG/8 HR,60678,CDM,250,RC,70010-0042-01,NDC,,,facility,outpatient,1,EA,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,inpatient,1,EA,5.82000,5.53000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,3.20,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,00093-8741-01,NDC,,,facility,outpatient,1,EA,5.82000,5.53000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,2.91,5.65,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,inpatient,1,EA,2.76000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62559-0822-01,NDC,,,facility,outpatient,1,EA,2.76000,2.63000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,inpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.11,percent of total billed charges,
MEXILETINE 250 MG CAP,60679,CDM,250,RC,62756-0957-01,NDC,,,facility,outpatient,1,EA,2.18000,2.07000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.11,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,inpatient,1,mL,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.35,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC DROPS",60680,CDM,250,RC,58204-0004-04,NDC,,,facility,outpatient,1,mL,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.35,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,61269-0735-56,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1134-28,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,inpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,00536-1375-75,NDC,,,facility,outpatient,1,GM,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,49348-0689-72,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,inpatient,1,GM,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,51672-2001-02,NDC,,,facility,outpatient,1,GM,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,inpatient,1,GM,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MICONAZOLE TOP 2% CRM,60681,CDM,250,RC,70677-1000-01,NDC,,,facility,outpatient,1,GM,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00135-0089-69,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
METHYLCELLULOSE POWD 2 GM/SCOOP,60682,CDM,250,RC,00904-5675-16,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,inpatient,1,EA,32.55000,30.93000,Amish/Mennonite,Amish Mennonite,,17.90,,,,,,,17.90,31.57,percent of total billed charges,
MORPHINE CAP-ER 60 MG (24-HOUR),60684,CDM,250,RC,60793-0606-01,NDC,,,facility,outpatient,1,EA,32.55000,30.93000,Amish/Mennonite,Amish Mennonite,,17.90,,,,,,,16.27,31.57,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,inpatient,1,mL,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,8.25,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0045-58,NDC,,,facility,outpatient,1,mL,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,7.50,14.55,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,inpatient,1,mL,13.24000,12.58000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,7.28,12.84,percent of total billed charges,
MORPHINE CONC LIQ 10 MG/0.5 ML,60686,CDM,250,RC,68094-0754-58,NDC,,,facility,outpatient,1,mL,13.24000,12.58000,Amish/Mennonite,Amish Mennonite,,7.28,,,,,,,6.62,12.84,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC CAP",60687,CDM,250,RC,68212-0500-60,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,inpatient,1,EA,3.94000,3.74000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,2.17,3.82,percent of total billed charges,
NEFAZODONE TAB 100 MG,60688,CDM,250,RC,00093-1024-06,NDC,,,facility,outpatient,1,EA,3.94000,3.74000,Amish/Mennonite,Amish Mennonite,,2.17,,,,,,,1.97,3.82,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,51224-0107-50,NDC,,,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,inpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,53746-0179-01,NDC,,,facility,outpatient,1,EA,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,62756-0143-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,67877-0414-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
METFORMIN TAB-ER 750 MG,60689,CDM,250,RC,70010-0492-01,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,inpatient,1,mL,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00087-0403-03,NDC,,,facility,outpatient,1,mL,4.90000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.45,4.75,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,inpatient,1,mL,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
"MULTIVITAMIN (A, D, C) DROPS-ORAL 50 ML (TRI-VI-SOL EQUIV)",60690,CDM,250,RC,00536-8501-80,NDC,,,facility,outpatient,1,mL,0.32000,0.31000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,inpatient,1,mL,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,29.55,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,61703034318,NDC,facility,outpatient,1,mL,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,26.86,52.11,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,inpatient,1,mL,128.82000,122.38000,Amish/Mennonite,Amish Mennonite,,70.85,,,,,,,70.85,124.96,percent of total billed charges,
MITOXANTRONE SOLN-INJ 2 MG/ML 10 ML MDV,60691,CDM,250,RC,J9293,HCPCS,63323013210,NDC,facility,outpatient,1,mL,128.82000,122.38000,Amish/Mennonite,Amish Mennonite,,70.85,,,,,,,29.60,124.96,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,inpatient,1,GM,5.52000,5.24000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,3.04,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,00781-7077-87,NDC,,,facility,outpatient,1,GM,5.52000,5.24000,Amish/Mennonite,Amish Mennonite,,3.04,,,,,,,2.76,5.35,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,inpatient,1,GM,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,16714-0557-01,NDC,,,facility,outpatient,1,GM,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,inpatient,1,GM,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,21922-0039-23,NDC,,,facility,outpatient,1,GM,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,inpatient,1,GM,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,3.16,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,45802-0139-70,NDC,,,facility,outpatient,1,GM,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,2.88,5.58,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,inpatient,1,GM,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.23,3.94,percent of total billed charges,
METRONIDAZOLE GEL 0.75% VAG 70 GM,60692,CDM,250,RC,73473-0303-70,NDC,,,facility,outpatient,1,GM,4.06000,3.86000,Amish/Mennonite,Amish Mennonite,,2.23,,,,,,,2.03,3.94,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,inpatient,1,mL,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
METOLAZONE SUSP SD 1 MG/ML,60694,CDM,250,RC,00378-6172-01-00100,NDC,,,facility,outpatient,1,mL,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,inpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.73,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,00093-8740-01,NDC,,,facility,outpatient,1,EA,4.97000,4.72000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.48,4.82,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,50742-0240-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.32,percent of total billed charges,
MEXILETINE 200 MG CAP,60696,CDM,250,RC,62559-0821-01,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.20,2.32,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,inpatient,1,mL,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,6.07,10.70,percent of total billed charges,
METRONIDAZOLE LOT 0.75% 59 ML,60697,CDM,250,RC,00168-0383-60,NDC,,,facility,outpatient,1,mL,11.03000,10.48000,Amish/Mennonite,Amish Mennonite,,6.07,,,,,,,5.51,10.70,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,inpatient,1,mL,19.99000,18.99000,Amish/Mennonite,Amish Mennonite,,10.99,,,,,,,10.99,19.39,percent of total billed charges,
MULTIVITAMIN SOLN (PED),60698,CDM,250,RC,J3490,HCPCS,54643564601,NDC,facility,outpatient,1,mL,19.99000,18.99000,Amish/Mennonite,Amish Mennonite,,10.99,,,,,,,9.99,19.39,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,inpatient,1,EA,6.34000,6.02000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.49,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,00093-7304-65,NDC,,,facility,outpatient,1,EA,6.34000,6.02000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.17,6.15,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,inpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,57237-0012-06,NDC,,,facility,outpatient,1,EA,2.28000,2.16000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.14,2.21,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,3.16,5.58,percent of total billed charges,
MIRTAZAPINE TAB-DISINTEGRATING 30 MG,60699,CDM,250,RC,65862-0022-06,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,2.88,5.58,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,72888020012,NDC,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,inpatient,1,EA,13.86000,13.17000,Amish/Mennonite,Amish Mennonite,,7.62,,,,,,,7.62,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,60505296607,NDC,facility,outpatient,1,EA,13.86000,13.17000,Amish/Mennonite,Amish Mennonite,,7.62,,,,,,,0.58745,13.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,67877042712,NDC,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,inpatient,1,EA,24.04000,22.84000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,13.22,23.32,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 360 MG,60700,CDM,250,RC,J7518,HCPCS,68084091825,NDC,facility,outpatient,1,EA,24.04000,22.84000,Amish/Mennonite,Amish Mennonite,,13.22,,,,,,,0.58745,23.32,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,inpatient,1,mL,27.27000,25.91000,Amish/Mennonite,Amish Mennonite,,15.00,,,,,,,15.00,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,00004026129,NDC,facility,outpatient,1,mL,27.27000,25.91000,Amish/Mennonite,Amish Mennonite,,15.00,,,,,,,0.23870,26.45,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,inpatient,1,mL,8.93000,8.49000,Amish/Mennonite,Amish Mennonite,,4.91,,,,,,,4.91,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,23155084851,NDC,facility,outpatient,1,mL,8.93000,8.49000,Amish/Mennonite,Amish Mennonite,,4.91,,,,,,,0.23870,8.66,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,inpatient,1,mL,8.94000,8.49000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,66689030708,NDC,facility,outpatient,1,mL,8.94000,8.49000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,0.23870,8.67,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,inpatient,1,mL,22.91000,21.77000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,12.60,22.22,percent of total billed charges,
MYCOPHENOLATE MOFETIL SUSP 200 MG/ML,60701,CDM,250,RC,J7517,HCPCS,67877023022,NDC,facility,outpatient,1,mL,22.91000,21.77000,Amish/Mennonite,Amish Mennonite,,12.60,,,,,,,0.23870,22.22,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16729-0478-01,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,10702-0100-01,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,inpatient,1,EA,1.02000,0.96000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,16714-0821-01,NDC,,,facility,outpatient,1,EA,1.02000,0.96000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,31722-0173-01,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,67877-0616-01,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,inpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.62,percent of total billed charges,
METHYLPHENIDATE TAB 5 MG,60702,CDM,250,RC,68084-0805-21,NDC,,,facility,outpatient,1,EA,5.79000,5.50000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,2.90,5.62,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,inpatient,1,EA,17.10000,16.25000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,9.40,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00078038566,NDC,facility,outpatient,1,EA,17.10000,16.25000,Amish/Mennonite,Amish Mennonite,,9.40,,,,,,,0.58745,16.59,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,inpatient,1,EA,11.55000,10.97000,Amish/Mennonite,Amish Mennonite,,6.35,,,,,,,6.35,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00378420178,NDC,facility,outpatient,1,EA,11.55000,10.97000,Amish/Mennonite,Amish Mennonite,,6.35,,,,,,,0.58745,11.20,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,inpatient,1,EA,13.12000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,00904678504,NDC,facility,outpatient,1,EA,13.12000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,0.58745,12.73,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,inpatient,1,EA,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,60505296507,NDC,facility,outpatient,1,EA,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,0.58745,5.15,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,67877042612,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.63080,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,inpatient,1,EA,11.77000,11.18000,Amish/Mennonite,Amish Mennonite,,6.47,,,,,,,6.47,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,68084090721,NDC,facility,outpatient,1,EA,11.77000,11.18000,Amish/Mennonite,Amish Mennonite,,6.47,,,,,,,0.58745,11.42,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,inpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
MYCOPHENOLIC ACID TAB-EC 180 MG,60703,CDM,250,RC,J7518,HCPCS,70748021716,NDC,facility,outpatient,1,EA,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,0.58745,4.44,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69097-0867-07,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,inpatient,1,EA,16.30000,15.49000,Amish/Mennonite,Amish Mennonite,,8.96,,,,,,,8.96,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,51079-0812-20,NDC,,,facility,outpatient,1,EA,16.30000,15.49000,Amish/Mennonite,Amish Mennonite,,8.96,,,,,,,8.15,15.81,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,inpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,69238-1123-09,NDC,,,facility,outpatient,1,EA,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76282-0347-01,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,inpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.54,percent of total billed charges,
NADOLOL TAB 20 MG,60704,CDM,250,RC,76385-0133-01,NDC,,,facility,outpatient,1,EA,2.62000,2.49000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.31,2.54,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0088-06,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.08,4.03,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
MULTIVITAMIN W/ MINERALS/IRON TAB-CHEW,60705,CDM,250,RC,16500-0599-18,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,inpatient,1,EA,12.79000,12.15000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,7.03,12.41,percent of total billed charges,
NELFINAVIR TAB 250 MG,60706,CDM,250,RC,63010-0010-30,NDC,,,facility,outpatient,1,EA,12.79000,12.15000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,6.39,12.41,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,63323085074,NDC,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,14.37,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,inpatient,1,mL,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
MOXIFLOXACIN SOLN 400 MG/250 ML,60707,CDM,636,RC,J2280,HCPCS,67457032325,NDC,facility,outpatient,1,mL,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,14.37,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,00591-5642-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,49884-0256-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,53489-0386-01,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,inpatient,1,EA,1.65000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
MINOXIDIL TAB 2.5 MG,60708,CDM,250,RC,68084-0204-01,NDC,,,facility,outpatient,1,EA,1.65000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0363-05,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MILK OF MAGNESIA SUSP 360 ML,60709,CDM,250,RC,12843-0393-24,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,inpatient,1,EA,39.82000,37.83000,Amish/Mennonite,Amish Mennonite,,21.90,,,,,,,21.90,38.63,percent of total billed charges,
MULTIVITAMIN W/ VIT K (PED) POWD-INJ,60711,CDM,250,RC,61703-0421-53,NDC,,,facility,outpatient,1,EA,39.82000,37.83000,Amish/Mennonite,Amish Mennonite,,21.90,,,,,,,19.91,38.63,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,inpatient,1,mL,11.10000,10.55000,Amish/Mennonite,Amish Mennonite,,6.11,,,,,,,6.11,10.77,percent of total billed charges,
NALBUPHINE SOLN 10 MG/ML 10 ML,60712,CDM,250,RC,J2300,HCPCS,00409146401,NDC,facility,outpatient,1,mL,11.10000,10.55000,Amish/Mennonite,Amish Mennonite,,6.11,,,,,,,4.77,10.77,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,inpatient,1,EA,16.69000,15.86000,Amish/Mennonite,Amish Mennonite,,9.18,,,,,,,9.18,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-06,NDC,,,facility,outpatient,1,EA,16.69000,15.86000,Amish/Mennonite,Amish Mennonite,,9.18,,,,,,,8.35,16.19,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,inpatient,1,EA,43.24000,41.07000,Amish/Mennonite,Amish Mennonite,,23.78,,,,,,,23.78,41.94,percent of total billed charges,
MOMETASONE INHALER 220 MCG/INH,60714,CDM,250,RC,00085-1341-07,NDC,,,facility,outpatient,1,EA,43.24000,41.07000,Amish/Mennonite,Amish Mennonite,,23.78,,,,,,,21.62,41.94,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
NAPHAZOLINE SOLN-OPHTH 0.012% 15 ML,60715,CDM,250,RC,78112-0254-15,NDC,,,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,inpatient,1,EA,96.21000,91.40000,Amish/Mennonite,Amish Mennonite,,52.92,,,,,,,52.92,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,00085-1733-01,NDC,,,facility,outpatient,1,EA,96.21000,91.40000,Amish/Mennonite,Amish Mennonite,,52.92,,,,,,,48.10,93.32,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
MOXIFLOXACIN TAB 400 MG,60716,CDM,250,RC,65862-0603-30,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,inpatient,1,EA,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,12.81,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00074-3079-90,NDC,,,facility,outpatient,1,EA,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,11.65,22.60,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
NIACIN 750 MG ER TAB,60717,CDM,250,RC,00536-7033-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-49,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,00054-0237-63,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
MORPHINE LIQ 2 MG.ML,60719,CDM,250,RC,66689-0032-16,NDC,,,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,inpatient,1,EA,31.97000,30.37000,Amish/Mennonite,Amish Mennonite,,17.58,,,,,,,17.58,31.01,percent of total billed charges,
NELFINAVIR TAB 625 MG,60721,CDM,250,RC,63010-0027-70,NDC,,,facility,outpatient,1,EA,31.97000,30.37000,Amish/Mennonite,Amish Mennonite,,17.58,,,,,,,15.98,31.01,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,00713-0197-57,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
MICONAZOLE SUPP-VAG 100 MG,60722,CDM,250,RC,49348-0833-61,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,3.55,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,inpatient,1,mL,6.22000,5.91000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.42,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,00087-0405-01,NDC,,,facility,outpatient,1,mL,6.22000,5.91000,Amish/Mennonite,Amish Mennonite,,3.42,,,,,,,3.11,6.03,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MULTIVITAMIN (POLY-VI-SOL W/ IRON) DROPS 50 ML,60724,CDM,250,RC,69618-0063-59,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,inpatient,1,mL,69.35000,65.88000,Amish/Mennonite,Amish Mennonite,,38.14,,,,,,,38.14,67.27,percent of total billed charges,
NATAMYCIN SUSP-OPHTH 5%,60725,CDM,250,RC,00065-0645-15,NDC,,,facility,outpatient,1,mL,69.35000,65.88000,Amish/Mennonite,Amish Mennonite,,38.14,,,,,,,34.67,67.27,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,inpatient,1,EA,15.09000,14.33000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,8.30,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,00456-1410-30,NDC,,,facility,outpatient,1,EA,15.09000,14.33000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,7.54,14.64,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
NEBIVOLOL TAB 10 MG,60726,CDM,250,RC,31722-0587-30,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,00781-5554-31,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,31722-0727-30,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,42291-0622-30,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,inpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,57237-0212-30,NDC,,,facility,outpatient,1,EA,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
MONTELUKAST TAB-CHEW 4 MG,60727,CDM,250,RC,68084-0638-21,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00406-1170-03,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,inpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,3.09,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,00904-7036-04,NDC,,,facility,outpatient,1,EA,5.62000,5.34000,Amish/Mennonite,Amish Mennonite,,3.09,,,,,,,2.81,5.45,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,inpatient,1,EA,2.73000,2.60000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,51224-0206-30,NDC,,,facility,outpatient,1,EA,2.73000,2.60000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.36,2.65,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,inpatient,1,EA,6.82000,6.48000,Amish/Mennonite,Amish Mennonite,,3.75,,,,,,,3.75,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68084-0291-21,NDC,,,facility,outpatient,1,EA,6.82000,6.48000,Amish/Mennonite,Amish Mennonite,,3.75,,,,,,,3.41,6.62,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,inpatient,1,EA,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.44,percent of total billed charges,
NALTREXONE TAB 50 MG,60729,CDM,250,RC,68094-0853-62,NDC,,,facility,outpatient,1,EA,6.64000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.32,6.44,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,inpatient,1,mL,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,00597-0047-24,NDC,,,facility,outpatient,1,mL,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.37,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
NEVIRAPINE LIQ 10 MG/ML,60731,CDM,250,RC,65862-0057-24,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,inpatient,1,EA,11.37000,10.80000,Amish/Mennonite,Amish Mennonite,,6.25,,,,,,,6.25,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,00078-0351-05,NDC,,,facility,outpatient,1,EA,11.37000,10.80000,Amish/Mennonite,Amish Mennonite,,6.25,,,,,,,5.68,11.03,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,inpatient,1,EA,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,3.28,5.79,percent of total billed charges,
NATEGLINIDE TAB 60 MG,60732,CDM,250,RC,68084-0458-21,NDC,,,facility,outpatient,1,EA,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,2.98,5.79,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,inpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,58204-0004-01,NDC,,,facility,outpatient,1,EA,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
"MULTIVITAMIN (A,B,D,E,K) W/ ZINC TAB-CHEW",60733,CDM,250,RC,68212-0600-90,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,inpatient,1,mL,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
NAFCILLIN SOLN SD 20 MG/ML,60734,CDM,250,RC,55150-0122-15-02000,NDC,,,facility,outpatient,1,mL,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
NEOSTIGMINE 1 MG/ML INJ SOL,60735,CDM,250,RC,J2710,HCPCS,00517003325,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,inpatient,1,EA,45.02000,42.77000,Amish/Mennonite,Amish Mennonite,,24.76,,,,,,,24.76,43.67,percent of total billed charges,
NEVIRAPINE TAB 200 MG,60736,CDM,250,RC,00597-0046-60,NDC,,,facility,outpatient,1,EA,45.02000,42.77000,Amish/Mennonite,Amish Mennonite,,24.76,,,,,,,22.51,43.67,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-06,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,inpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
NITROGLYCERIN CAP-ER 6.5 MG,60737,CDM,250,RC,49483-0222-10,NDC,,,facility,outpatient,1,EA,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,inpatient,1,EA,29.46000,27.99000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,16.20,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,00904-6423-04,NDC,,,facility,outpatient,1,EA,29.46000,27.99000,Amish/Mennonite,Amish Mennonite,,16.20,,,,,,,14.73,28.58,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,60505-2526-03,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,inpatient,1,EA,77.26000,73.40000,Amish/Mennonite,Amish Mennonite,,42.49,,,,,,,42.49,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,63459-0101-01,NDC,,,facility,outpatient,1,EA,77.26000,73.40000,Amish/Mennonite,Amish Mennonite,,42.49,,,,,,,38.63,74.94,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
MODAFINIL TAB 100 MG,60738,CDM,250,RC,65862-0601-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,inpatient,1,mL,37.52000,35.65000,Amish/Mennonite,Amish Mennonite,,20.64,,,,,,,20.64,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,00409121901,NDC,facility,outpatient,1,mL,37.52000,35.65000,Amish/Mennonite,Amish Mennonite,,20.64,,,,,,,14.28,36.39,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,inpatient,1,mL,29.64000,28.16000,Amish/Mennonite,Amish Mennonite,,16.30,,,,,,,16.30,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,17478004210,NDC,facility,outpatient,1,mL,29.64000,28.16000,Amish/Mennonite,Amish Mennonite,,16.30,,,,,,,14.28,28.75,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,inpatient,1,mL,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,12.17,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,36000031002,NDC,facility,outpatient,1,mL,22.12000,21.01000,Amish/Mennonite,Amish Mennonite,,12.17,,,,,,,11.06,21.46,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,inpatient,1,mL,11.63000,11.05000,Amish/Mennonite,Amish Mennonite,,6.40,,,,,,,6.40,11.28,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457029910,NDC,facility,outpatient,1,mL,11.63000,11.05000,Amish/Mennonite,Amish Mennonite,,6.40,,,,,,,5.82,15.29,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,inpatient,1,mL,29.39000,27.92000,Amish/Mennonite,Amish Mennonite,,16.16,,,,,,,16.16,28.51,percent of total billed charges,
NALOXONE SOLN 0.4 MG/ML 10 ML,60739,CDM,250,RC,J2310,HCPCS,67457098710,NDC,facility,outpatient,1,mL,29.39000,27.92000,Amish/Mennonite,Amish Mennonite,,16.16,,,,,,,14.28,28.51,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,inpatient,1,EA,36.90000,35.06000,Amish/Mennonite,Amish Mennonite,,20.30,,,,,,,20.30,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,00781-9124-95,NDC,,,facility,outpatient,1,EA,36.90000,35.06000,Amish/Mennonite,Amish Mennonite,,20.30,,,,,,,18.45,35.79,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,inpatient,1,EA,35.55000,33.77000,Amish/Mennonite,Amish Mennonite,,19.55,,,,,,,19.55,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,25021-0139-10,NDC,,,facility,outpatient,1,EA,35.55000,33.77000,Amish/Mennonite,Amish Mennonite,,19.55,,,,,,,17.77,34.48,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,44567-0221-10,NDC,,,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,inpatient,1,EA,36.97000,35.12000,Amish/Mennonite,Amish Mennonite,,20.33,,,,,,,20.33,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,55150-0122-15,NDC,,,facility,outpatient,1,EA,36.97000,35.12000,Amish/Mennonite,Amish Mennonite,,20.33,,,,,,,18.48,35.86,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,inpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,19.99,35.25,percent of total billed charges,
NAFCILLIN 1 G POWD,60741,CDM,250,RC,70860-0116-26,NDC,,,facility,outpatient,1,EA,36.34000,34.52000,Amish/Mennonite,Amish Mennonite,,19.99,,,,,,,18.17,35.25,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
NIACINAMIDE TAB 100 MG,60744,CDM,250,RC,00536-4068-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,inpatient,1,GM,41.32000,39.25000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,22.73,40.08,percent of total billed charges,
MUPIROCIN CRM 2% 15 GM,60745,CDM,250,RC,68462-0564-17,NDC,,,facility,outpatient,1,GM,41.32000,39.25000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,20.66,40.08,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,00338011220,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,inpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/D5W 250 ML PREMIX,60746,CDM,250,RC,J3490,HCPCS,70092103417,NDC,facility,outpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,inpatient,1,GM,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,2.03,3.58,percent of total billed charges,
MOMETASONE CRM 0.1% 15 GM,60747,CDM,250,RC,68462-0192-17,NDC,,,facility,outpatient,1,GM,3.69000,3.50000,Amish/Mennonite,Amish Mennonite,,2.03,,,,,,,1.84,3.58,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,inpatient,1,mL,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.16,percent of total billed charges,
MORPHINE SOLN 25 MG/ML PF,60748,CDM,250,RC,J2275,HCPCS,00409113502,NDC,facility,outpatient,1,mL,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.11,2.16,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,inpatient,1,EA,11.81000,11.22000,Amish/Mennonite,Amish Mennonite,,6.50,,,,,,,6.50,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,00078-0352-05,NDC,,,facility,outpatient,1,EA,11.81000,11.22000,Amish/Mennonite,Amish Mennonite,,6.50,,,,,,,5.91,11.46,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,inpatient,1,EA,6.29000,5.97000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.10,percent of total billed charges,
NATEGLINIDE TAB 120 MG,60749,CDM,250,RC,68084-0459-21,NDC,,,facility,outpatient,1,EA,6.29000,5.97000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.10,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,10006-0700-20,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,inpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
NIACIN CAP-ER 250 MG,60750,CDM,250,RC,74312-0058-00,NDC,,,facility,outpatient,1,EA,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
NIACINAMIDE TAB 500 MG,60751,CDM,250,RC,00536-4069-01,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,inpatient,1,mL,5.47000,5.19000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,3.01,5.31,percent of total billed charges,
NAFCILLIN SOLN SD 100 MG/ML,60754,CDM,250,RC,55150-0122-15-10000,NDC,,,facility,outpatient,1,mL,5.47000,5.19000,Amish/Mennonite,Amish Mennonite,,3.01,,,,,,,2.73,5.31,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,inpatient,1,EA,158.82000,150.88000,Amish/Mennonite,Amish Mennonite,,87.35,,,,,,,87.35,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00002759701,NDC,facility,outpatient,1,EA,158.82000,150.88000,Amish/Mennonite,Amish Mennonite,,87.35,,,,,,,1.44,154.06,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,inpatient,1,EA,124.79000,118.55000,Amish/Mennonite,Amish Mennonite,,68.63,,,,,,,68.63,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00517095501,NDC,facility,outpatient,1,EA,124.79000,118.55000,Amish/Mennonite,Amish Mennonite,,68.63,,,,,,,1.44,121.05,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,inpatient,1,EA,80.71000,76.67000,Amish/Mennonite,Amish Mennonite,,44.39,,,,,,,44.39,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781315972,NDC,facility,outpatient,1,EA,80.71000,76.67000,Amish/Mennonite,Amish Mennonite,,44.39,,,,,,,1.44,78.29,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,inpatient,1,EA,104.91000,99.67000,Amish/Mennonite,Amish Mennonite,,57.70,,,,,,,57.70,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,00781910572,NDC,facility,outpatient,1,EA,104.91000,99.67000,Amish/Mennonite,Amish Mennonite,,57.70,,,,,,,1.44,101.76,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,31722030801,NDC,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,1.44,61.30,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,inpatient,1,EA,111.99000,106.39000,Amish/Mennonite,Amish Mennonite,,61.59,,,,,,,61.59,108.63,percent of total billed charges,
OLANZAPINE POWD-INJ 10 MG,60755,CDM,250,RC,J2359,HCPCS,55150030801,NDC,facility,outpatient,1,EA,111.99000,106.39000,Amish/Mennonite,Amish Mennonite,,61.59,,,,,,,1.44,108.63,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,inpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00536-3030-23,NDC,,,facility,outpatient,1,EA,0.90000,0.86000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,00904-5735-51,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0572-08,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
NICOTINE GUM 4 MG,60756,CDM,250,RC,49348-0692-36,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,inpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50268-0598-15,NDC,,,facility,outpatient,1,EA,5.25000,4.98000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,50742-0261-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,inpatient,1,EA,6.36000,6.04000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.50,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,51079-0896-20,NDC,,,facility,outpatient,1,EA,6.36000,6.04000,Amish/Mennonite,Amish Mennonite,,3.50,,,,,,,3.18,6.17,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,inpatient,1,EA,5.85000,5.56000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,3.22,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,62175-0261-37,NDC,,,facility,outpatient,1,EA,5.85000,5.56000,Amish/Mennonite,Amish Mennonite,,3.22,,,,,,,2.92,5.67,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,inpatient,1,EA,7.81000,7.42000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,4.30,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68084-0598-01,NDC,,,facility,outpatient,1,EA,7.81000,7.42000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,3.90,7.58,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,68682-0106-10,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
NIFEDIPINE TAB-ER 60 MG,60757,CDM,250,RC,71205-0964-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,inpatient,1,mL,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,43066001610,NDC,facility,outpatient,1,mL,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,0.13795,3.11,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,inpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
NICARDIPINE 40 MG/200 ML-NACL 0.83%,60758,CDM,250,RC,J2404,HCPCS,24477032302,NDC,facility,outpatient,1,mL,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,0.13795,2.91,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,24979-0009-01,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,inpatient,1,EA,7.11000,6.76000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.91,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50268-0599-15,NDC,,,facility,outpatient,1,EA,7.11000,6.76000,Amish/Mennonite,Amish Mennonite,,3.91,,,,,,,3.56,6.90,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,50742-0262-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,inpatient,1,EA,7.60000,7.22000,Amish/Mennonite,Amish Mennonite,,4.18,,,,,,,4.18,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,51079-0897-08,NDC,,,facility,outpatient,1,EA,7.60000,7.22000,Amish/Mennonite,Amish Mennonite,,4.18,,,,,,,3.80,7.37,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,inpatient,1,EA,6.75000,6.41000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.71,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,62175-0262-37,NDC,,,facility,outpatient,1,EA,6.75000,6.41000,Amish/Mennonite,Amish Mennonite,,3.71,,,,,,,3.38,6.55,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,inpatient,1,EA,6.10000,5.80000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.92,percent of total billed charges,
NIFEDIPINE TAB-ER 90 MG,60759,CDM,250,RC,68084-0603-21,NDC,,,facility,outpatient,1,EA,6.10000,5.80000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.05,5.92,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,inpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,68094-0120-61,NDC,,,facility,outpatient,1,mL,0.50000,0.48000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
MULTIVITAMIN W/ IRON LIQ 15 ML,60760,CDM,250,RC,81033-0501-50,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,inpatient,1,EA,20.67000,19.64000,Amish/Mennonite,Amish Mennonite,,11.37,,,,,,,11.37,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,54396-0111-11,NDC,,,facility,outpatient,1,EA,20.67000,19.64000,Amish/Mennonite,Amish Mennonite,,11.37,,,,,,,10.34,20.05,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,inpatient,1,EA,13.02000,12.37000,Amish/Mennonite,Amish Mennonite,,7.16,,,,,,,7.16,12.63,percent of total billed charges,
OXANDROLONE TAB 2.5 MG,60761,CDM,250,RC,68084-0424-21,NDC,,,facility,outpatient,1,EA,13.02000,12.37000,Amish/Mennonite,Amish Mennonite,,7.16,,,,,,,6.51,12.63,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,00071-0417-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.3 MG,60762,CDM,250,RC,68462-0638-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,inpatient,1,EA,6.07000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,3.34,5.89,percent of total billed charges,
NEOSTIGMINE TAB 15 MG,60763,CDM,250,RC,00187-3100-10,NDC,,,facility,outpatient,1,EA,6.07000,5.77000,Amish/Mennonite,Amish Mennonite,,3.34,,,,,,,3.04,5.89,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,inpatient,1,EA,8.07000,7.67000,Amish/Mennonite,Amish Mennonite,,4.44,,,,,,,4.44,7.83,percent of total billed charges,
NICARDIPINE CAP 30 MG,60764,CDM,250,RC,00378-1430-77,NDC,,,facility,outpatient,1,EA,8.07000,7.67000,Amish/Mennonite,Amish Mennonite,,4.44,,,,,,,4.04,7.83,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,inpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,0090465516100100,NDC,facility,outpatient,1,EA,1.57000,1.49000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,5026806211500100,NDC,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6586201873000100,NDC,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
ONDANSETRON TAB 4 MG,60765,CDM,250,RC,J8499,HCPCS,6808402200100100,NDC,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,inpatient,1,mL,46.48000,44.15000,Amish/Mennonite,Amish Mennonite,,25.56,,,,,,,25.56,45.09,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00007440101,NDC,facility,outpatient,1,mL,46.48000,44.15000,Amish/Mennonite,Amish Mennonite,,25.56,,,,,,,23.24,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,inpatient,1,mL,51.07000,48.51000,Amish/Mennonite,Amish Mennonite,,28.09,,,,,,,28.09,49.54,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,00078068361,NDC,facility,outpatient,1,mL,51.07000,48.51000,Amish/Mennonite,Amish Mennonite,,28.09,,,,,,,25.54,123.35,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,inpatient,1,mL,41.78000,39.69000,Amish/Mennonite,Amish Mennonite,,22.98,,,,,,,22.98,40.53,percent of total billed charges,
NELARABINE 5 MG/ML IV SOL,60767,CDM,636,RC,J9261,HCPCS,70710172601,NDC,facility,outpatient,1,mL,41.78000,39.69000,Amish/Mennonite,Amish Mennonite,,22.98,,,,,,,20.89,123.35,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0810-16,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,inpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-0868-16,NDC,,,facility,outpatient,1,mL,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,00121-1045-16,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,60432-0537-16,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
NYSTATIN SUSP 100000 UNITS/ML 473 ML,60768,CDM,250,RC,66689-0008-16,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,inpatient,1,EA,10.68000,10.15000,Amish/Mennonite,Amish Mennonite,,5.87,,,,,,,5.87,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,00904-6706-06,NDC,,,facility,outpatient,1,EA,10.68000,10.15000,Amish/Mennonite,Amish Mennonite,,5.87,,,,,,,5.34,10.36,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42291-0657-12,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,42806-0552-12,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,inpatient,1,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,5.29,9.32,percent of total billed charges,
OMEGA-3 FATTY ACIDS ETHYL ESTERS CAP 1000 MG,60769,CDM,250,RC,60687-0127-65,NDC,,,facility,outpatient,1,EA,9.61000,9.13000,Amish/Mennonite,Amish Mennonite,,5.29,,,,,,,4.80,9.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,inpatient,1,mL,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,83.42,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,55390016401,NDC,facility,outpatient,1,mL,151.68000,144.10000,Amish/Mennonite,Amish Mennonite,,83.42,,,,,,,0.91450,147.13,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,inpatient,1,mL,121.98000,115.88000,Amish/Mennonite,Amish Mennonite,,67.09,,,,,,,67.09,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,23155068631,NDC,facility,outpatient,1,mL,121.98000,115.88000,Amish/Mennonite,Amish Mennonite,,67.09,,,,,,,0.91450,118.32,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,inpatient,1,mL,314.03000,298.33000,Amish/Mennonite,Amish Mennonite,,172.72,,,,,,,172.72,304.61,percent of total billed charges,
OCTREOTIDE SOLN 1000 MCG/ML 5 ML,60770,CDM,250,RC,J2354,HCPCS,63323037905,NDC,facility,outpatient,1,mL,314.03000,298.33000,Amish/Mennonite,Amish Mennonite,,172.72,,,,,,,0.91450,304.61,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,00904-6376-61,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,69543-0383-30,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,43598-0166-30,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,60505-3113-00,NDC,,,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
OLANZAPINE TAB 10 MG,60771,CDM,250,RC,68084-0740-01,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,inpatient,1,EA,279.66000,265.68000,Amish/Mennonite,Amish Mennonite,,153.81,,,,,,,153.81,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,00004029809,NDC,facility,outpatient,1,EA,279.66000,265.68000,Amish/Mennonite,Amish Mennonite,,153.81,,,,,,,0.47275,271.27,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,inpatient,1,EA,233.84000,222.15000,Amish/Mennonite,Amish Mennonite,,128.61,,,,,,,128.61,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,17478042240,NDC,facility,outpatient,1,EA,233.84000,222.15000,Amish/Mennonite,Amish Mennonite,,128.61,,,,,,,0.47275,226.82,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,inpatient,1,EA,229.10000,217.64000,Amish/Mennonite,Amish Mennonite,,126.00,,,,,,,126.00,222.23,percent of total billed charges,
MYCOPHENOLATE MOFETIL POWD-INJ 500 MG,60772,CDM,250,RC,J7519,HCPCS,71288080321,NDC,facility,outpatient,1,EA,229.10000,217.64000,Amish/Mennonite,Amish Mennonite,,126.00,,,,,,,0.47275,222.23,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,inpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.99000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,00071-0419-24,NDC,,,facility,outpatient,1,EA,1.80000,1.71000,Amish/Mennonite,Amish Mennonite,,0.99000,,,,,,,0.90000,1.75,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
NITROGLYCERIN TAB-SL 0.6 MG,60774,CDM,250,RC,68462-0640-01,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MORPHINE LIQ 1 MG/0.5 ML,60775,CDM,250,RC,66689-0032-16-00050,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,23155-0512-30,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,inpatient,1,EA,9.08000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,63739-0797-33,NDC,,,facility,outpatient,1,EA,9.08000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.54,8.81,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,inpatient,1,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.57,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,68084-0912-32,NDC,,,facility,outpatient,1,EA,8.30000,7.88000,Amish/Mennonite,Amish Mennonite,,4.57,,,,,,,4.15,8.05,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,inpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
NIMODIPINE CAP 30 MG,60776,CDM,250,RC,69452-0209-20,NDC,,,facility,outpatient,1,EA,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,inpatient,1,EA,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,,157.85,,,,,,,157.85,278.39,percent of total billed charges,
NITISINONE 2 MG CAP,60777,CDM,250,RC,66658-0102-60,NDC,,,facility,outpatient,1,EA,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,,157.85,,,,,,,143.50,278.39,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,inpatient,1,EA,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,00185-0141-01,NDC,,,facility,outpatient,1,EA,4.63000,4.40000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.31,4.49,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,inpatient,1,EA,9.26000,8.80000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,5.09,8.98,percent of total billed charges,
OXAPROZIN TAB 600 MG,60778,CDM,250,RC,55111-0170-01,NDC,,,facility,outpatient,1,EA,9.26000,8.80000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,4.63,8.98,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,inpatient,1,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,00781-2785-31,NDC,,,facility,outpatient,1,EA,2.92000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.46,2.83,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,16714-0746-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,55111-0157-30,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE CAP EC 10 MG,60779,CDM,250,RC,68462-0395-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,inpatient,1,EA,41.11000,39.06000,Amish/Mennonite,Amish Mennonite,,22.61,,,,,,,22.61,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,00074-4317-30,NDC,,,facility,outpatient,1,EA,41.11000,39.06000,Amish/Mennonite,Amish Mennonite,,22.61,,,,,,,20.55,39.88,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,inpatient,1,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,65862-0936-30,NDC,,,facility,outpatient,1,EA,4.69000,4.45000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.35,4.55,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,inpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.78,3.13,percent of total billed charges,
PARICALCITOL 1 MCG CAP,60780,CDM,250,RC,68382-0330-06,NDC,,,facility,outpatient,1,EA,3.23000,3.07000,Amish/Mennonite,Amish Mennonite,,1.78,,,,,,,1.61,3.13,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,inpatient,1,mL,13.34000,12.67000,Amish/Mennonite,Amish Mennonite,,7.34,,,,,,,7.34,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00641617410,NDC,facility,outpatient,1,mL,13.34000,12.67000,Amish/Mennonite,Amish Mennonite,,7.34,,,,,,,0.91450,12.94,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,inpatient,1,mL,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,4.10,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,00703330104,NDC,facility,outpatient,1,mL,7.46000,7.08000,Amish/Mennonite,Amish Mennonite,,4.10,,,,,,,0.91450,7.24,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,inpatient,1,mL,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,17.26,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,55390016010,NDC,facility,outpatient,1,mL,31.38000,29.81000,Amish/Mennonite,Amish Mennonite,,17.26,,,,,,,0.91450,30.44,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,inpatient,1,mL,12.34000,11.73000,Amish/Mennonite,Amish Mennonite,,6.79,,,,,,,6.79,11.97,percent of total billed charges,
OCTREOTIDE SOLN 50 MCG/ML,60782,CDM,250,RC,J2354,HCPCS,67457023901,NDC,facility,outpatient,1,mL,12.34000,11.73000,Amish/Mennonite,Amish Mennonite,,6.79,,,,,,,0.91450,11.97,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,inpatient,1,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-41,NDC,,,facility,outpatient,1,EA,7.38000,7.01000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,3.69,7.16,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,inpatient,1,EA,8.84000,8.40000,Amish/Mennonite,Amish Mennonite,,4.86,,,,,,,4.86,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-06,NDC,,,facility,outpatient,1,EA,8.84000,8.40000,Amish/Mennonite,Amish Mennonite,,4.86,,,,,,,4.42,8.57,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,inpatient,1,EA,7.24000,6.87000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.98,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,00904-6570-61,NDC,,,facility,outpatient,1,EA,7.24000,6.87000,Amish/Mennonite,Amish Mennonite,,3.98,,,,,,,3.62,7.02,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,inpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.81950,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,16729-0317-01,NDC,,,facility,outpatient,1,EA,1.49000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81950,,,,,,,0.74500,1.45,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,27241-0155-04,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,62175-0270-37,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,inpatient,1,EA,9.16000,8.70000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,5.04,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,63739-0548-33,NDC,,,facility,outpatient,1,EA,9.16000,8.70000,Amish/Mennonite,Amish Mennonite,,5.04,,,,,,,4.58,8.89,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,64980-0209-01,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,inpatient,1,EA,8.12000,7.72000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.47,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68084-0480-01,NDC,,,facility,outpatient,1,EA,8.12000,7.72000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.06,7.88,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
OXYBUTYNIN TAB-ER 5 MG,60783,CDM,250,RC,68382-0255-01,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,10119-0020-90,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,42002-0200-05,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
NAPHAZOLINE-PHENIRAMINE OPHTH 0.025%-0.3% SOL,60785,CDM,250,RC,69968-0063-01,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,inpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,43598-0486-72,NDC,,,facility,outpatient,1,EA,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 2 MG,60786,CDM,250,RC,45802-0344-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.21,2.13,percent of total billed charges,
ORPHENADRINE 100 MG ER TAB,60787,CDM,250,RC,43386-0480-24,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.10,2.13,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,inpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.78,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,00023963704,NDC,facility,outpatient,1,EA,8.69000,8.26000,Amish/Mennonite,Amish Mennonite,,4.78,,,,,,,4.34,8.43,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,inpatient,1,EA,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,140.80,248.32,percent of total billed charges,
OXYBUTYNIN PATCH 3.9 MG/24 HR,60788,CDM,250,RC,J3490,HCPCS,52544092008,NDC,facility,outpatient,1,EA,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,128.00,248.32,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,Amish/Mennonite,Amish Mennonite,,98.33,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 2.5 MG,60789,CDM,250,RC,00173-0562-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,Amish/Mennonite,Amish Mennonite,,98.33,,,,,,,89.39,173.43,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,inpatient,1,mL,19.62000,18.64000,Amish/Mennonite,Amish Mennonite,,10.79,,,,,,,10.79,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,72603-0176-01,NDC,,,facility,outpatient,1,mL,19.62000,18.64000,Amish/Mennonite,Amish Mennonite,,10.79,,,,,,,9.81,19.03,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,inpatient,1,mL,8.01000,7.61000,Amish/Mennonite,Amish Mennonite,,4.41,,,,,,,4.41,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,57664-0239-32,NDC,,,facility,outpatient,1,mL,8.01000,7.61000,Amish/Mennonite,Amish Mennonite,,4.41,,,,,,,4.00,7.77,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,inpatient,1,mL,6.69000,6.36000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,3.68,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,65162-0689-88,NDC,,,facility,outpatient,1,mL,6.69000,6.36000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,3.35,6.49,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,inpatient,1,mL,31.50000,29.92000,Amish/Mennonite,Amish Mennonite,,17.32,,,,,,,17.32,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70408-0239-32,NDC,,,facility,outpatient,1,mL,31.50000,29.92000,Amish/Mennonite,Amish Mennonite,,17.32,,,,,,,15.75,30.55,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,inpatient,1,mL,19.63000,18.65000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,10.80,19.04,percent of total billed charges,
NITROFURANTOIN SUSP 5 MG/ML,60790,CDM,250,RC,70954-0496-10,NDC,,,facility,outpatient,1,mL,19.63000,18.65000,Amish/Mennonite,Amish Mennonite,,10.80,,,,,,,9.81,19.04,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,inpatient,1,EA,178.79000,169.85000,Amish/Mennonite,Amish Mennonite,,98.33,,,,,,,98.33,173.43,percent of total billed charges,
NARATRIPTAN TAB 1 MG,60791,CDM,250,RC,00173-0561-00,NDC,,,facility,outpatient,1,EA,178.79000,169.85000,Amish/Mennonite,Amish Mennonite,,98.33,,,,,,,89.39,173.43,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68462-0139-01,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,inpatient,1,EA,4.90000,4.66000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.75,percent of total billed charges,
OXCARBAZEPINE TAB 600 MG,60792,CDM,250,RC,68084-0867-01,NDC,,,facility,outpatient,1,EA,4.90000,4.66000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.45,4.75,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00054-0199-59,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,inpatient,1,mL,5.08000,4.83000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.79,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,00078-0357-52,NDC,,,facility,outpatient,1,mL,5.08000,4.83000,Amish/Mennonite,Amish Mennonite,,2.79,,,,,,,2.54,4.93,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,inpatient,1,mL,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,65162-0649-78,NDC,,,facility,outpatient,1,mL,2.09000,1.99000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,50383-0312-84,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,69452-0125-50,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,inpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
OXCARBAZEPINE LIQ 60 MG/ML,60793,CDM,250,RC,72888-0074-14,NDC,,,facility,outpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,00703476481,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.17611,6.13,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,inpatient,1,mL,10.62000,10.09000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.84,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,25021021305,NDC,facility,outpatient,1,mL,10.62000,10.09000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,0.17611,10.30,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,inpatient,1,mL,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,61703034209,NDC,facility,outpatient,1,mL,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,0.17611,5.16,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,inpatient,1,mL,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,4.69,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860020005,NDC,facility,outpatient,1,mL,8.53000,8.11000,Amish/Mennonite,Amish Mennonite,,4.69,,,,,,,0.17611,8.27,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
PACLITAXEL 6 MG/ML SOLN 5 ML,60794,CDM,250,RC,J9267,HCPCS,70860021566,NDC,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,0.17611,4.91,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,Amish/Mennonite,Amish Mennonite,,185.32,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,43386-0405-12,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,Amish/Mennonite,Amish Mennonite,,185.32,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,inpatient,1,EA,336.94000,320.09000,Amish/Mennonite,Amish Mennonite,,185.32,,,,,,,185.32,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,64980-0526-60,NDC,,,facility,outpatient,1,EA,336.94000,320.09000,Amish/Mennonite,Amish Mennonite,,185.32,,,,,,,168.47,326.83,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,inpatient,1,EA,348.70000,331.27000,Amish/Mennonite,Amish Mennonite,,191.78,,,,,,,191.78,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-12,NDC,,,facility,outpatient,1,EA,348.70000,331.27000,Amish/Mennonite,Amish Mennonite,,191.78,,,,,,,174.35,338.24,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,inpatient,1,EA,316.63000,300.80000,Amish/Mennonite,Amish Mennonite,,174.15,,,,,,,174.15,307.13,percent of total billed charges,
NITAZOXANIDE TAB 500 MG,60795,CDM,250,RC,67546-0111-14,NDC,,,facility,outpatient,1,EA,316.63000,300.80000,Amish/Mennonite,Amish Mennonite,,174.15,,,,,,,158.31,307.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,inpatient,1,EA,5.91000,5.61000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,3.25,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-1316-03,NDC,,,facility,outpatient,1,EA,5.91000,5.61000,Amish/Mennonite,Amish Mennonite,,3.25,,,,,,,2.96,5.73,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,60505-3673-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,inpatient,1,EA,3.52000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,62175-0470-32,NDC,,,facility,outpatient,1,EA,3.52000,3.35000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.41,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
PAROXETINE 12.5 MG ER TAB,60796,CDM,250,RC,72241-0029-22,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,inpatient,1,mL,7116.49000,6760.67000,Amish/Mennonite,Amish Mennonite,,3914.07,,,,,,,3914.07,6903.00,percent of total billed charges,
PALIVIZUMAB SOLN 100 MG/ML (SYNAGIS),60797,CDM,636,RC,90378,HCPCS,66658023101,NDC,facility,outpatient,1,mL,7116.49000,6760.67000,Amish/Mennonite,Amish Mennonite,,3914.07,,,,,,,719.87,6903.00,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,inpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00121-4827-40,NDC,,,facility,outpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,inpatient,1,mL,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,64950-0354-55,NDC,,,facility,outpatient,1,mL,3.73000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.62,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,inpatient,1,mL,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,00904-6828-94,NDC,,,facility,outpatient,1,mL,2.04000,1.93000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.02,1.98,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,inpatient,1,mL,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
OXYCODONE LIQ 5 MG/5 ML,60798,CDM,250,RC,66689-0401-50,NDC,,,facility,outpatient,1,mL,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,4.23,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,inpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,64980-0210-01,NDC,,,facility,outpatient,1,EA,2.51000,2.39000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,inpatient,1,EA,9.67000,9.18000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,50268-0628-15,NDC,,,facility,outpatient,1,EA,9.67000,9.18000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,4.83,9.38,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,65162-0372-10,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,inpatient,1,EA,8.54000,8.12000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68084-0610-21,NDC,,,facility,outpatient,1,EA,8.54000,8.12000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.27,8.28,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
OXYBUTYNIN TAB-ER 10 MG,60799,CDM,250,RC,68382-0256-01,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,inpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.70400,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,00143963410,NDC,facility,outpatient,1,mL,1.28000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70400,,,,,,,0.13795,1.24,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,inpatient,1,mL,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
NICARDIPINE 20 MG/NS 200 ML PREMIX,60800,CDM,250,RC,J2404,HCPCS,43066000910,NDC,facility,outpatient,1,mL,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.13795,1.56,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,inpatient,1,mL,8.73000,8.29000,Amish/Mennonite,Amish Mennonite,,4.80,,,,,,,4.80,8.47,percent of total billed charges,
OXYCODONE CONC LIQ 10 MG/0.5 ML,60801,CDM,250,RC,68094-0801-58,NDC,,,facility,outpatient,1,mL,8.73000,8.29000,Amish/Mennonite,Amish Mennonite,,4.80,,,,,,,4.37,8.47,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,inpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
"PENICILLIN G POTASSIUM SOLN SD 50,000 UNITS/ML",60802,CDM,250,RC,00049-0520-83-05000,NDC,,,facility,outpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,inpatient,1,mL,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,13.56,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,00641618225,NDC,facility,outpatient,1,mL,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,12.32,23.91,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,inpatient,1,mL,25.06000,23.81000,Amish/Mennonite,Amish Mennonite,,13.78,,,,,,,13.78,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,17478053802,NDC,facility,outpatient,1,mL,25.06000,23.81000,Amish/Mennonite,Amish Mennonite,,13.78,,,,,,,12.53,24.31,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,25021065102,NDC,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,20.47,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,inpatient,1,mL,25.91000,24.62000,Amish/Mennonite,Amish Mennonite,,14.25,,,,,,,14.25,25.13,percent of total billed charges,
ORPHENADRINE 30 MG/ML INJ SOL,60803,CDM,250,RC,J2360,HCPCS,55390005910,NDC,facility,outpatient,1,mL,25.91000,24.62000,Amish/Mennonite,Amish Mennonite,,14.25,,,,,,,12.96,25.13,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,inpatient,1,EA,374.26000,355.54000,Amish/Mennonite,Amish Mennonite,,205.84,,,,,,,205.84,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,13925051510,NDC,facility,outpatient,1,EA,374.26000,355.54000,Amish/Mennonite,Amish Mennonite,,205.84,,,,,,,187.13,363.03,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,inpatient,1,EA,308.73000,293.30000,Amish/Mennonite,Amish Mennonite,,169.80,,,,,,,169.80,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,23155074841,NDC,facility,outpatient,1,EA,308.73000,293.30000,Amish/Mennonite,Amish Mennonite,,169.80,,,,,,,154.37,299.47,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,inpatient,1,EA,432.25000,410.63000,Amish/Mennonite,Amish Mennonite,,237.74,,,,,,,237.74,419.28,percent of total billed charges,
PENTAMIDINE POWD-INJ 300 MG,60804,CDM,250,RC,J3490,HCPCS,63323011310,NDC,facility,outpatient,1,EA,432.25000,410.63000,Amish/Mennonite,Amish Mennonite,,237.74,,,,,,,216.12,419.28,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,inpatient,1,EA,20.64000,19.61000,Amish/Mennonite,Amish Mennonite,,11.35,,,,,,,11.35,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-10,NDC,,,facility,outpatient,1,EA,20.64000,19.61000,Amish/Mennonite,Amish Mennonite,,11.35,,,,,,,10.32,20.02,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,inpatient,1,EA,20.17000,19.16000,Amish/Mennonite,Amish Mennonite,,11.09,,,,,,,11.09,19.56,percent of total billed charges,
OXYCODONE TAB-ER 15 MG,60806,CDM,250,RC,59011-0415-20,NDC,,,facility,outpatient,1,EA,20.17000,19.16000,Amish/Mennonite,Amish Mennonite,,11.09,,,,,,,10.09,19.56,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,inpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
OMEPRAZOLE SUSP SD 5 MG/ML,60807,CDM,250,RC,00378-5211-93-00500,NDC,,,facility,outpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,inpatient,1,EA,45.34000,43.07000,Amish/Mennonite,Amish Mennonite,,24.94,,,,,,,24.94,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00008084381,NDC,facility,outpatient,1,EA,45.34000,43.07000,Amish/Mennonite,Amish Mennonite,,24.94,,,,,,,22.67,43.98,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,inpatient,1,EA,0.41000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,00093001198,NDC,facility,outpatient,1,EA,0.41000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,inpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65162063609,NDC,facility,outpatient,1,EA,0.35000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,inpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,50268063615,NDC,facility,outpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,68084064301,NDC,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,60687072501,NDC,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
PANTOPRAZOLE TAB-EC 20 MG,60808,CDM,250,RC,J8499,HCPCS,65862055990,NDC,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,inpatient,1,EA,20.77000,19.73000,Amish/Mennonite,Amish Mennonite,,11.42,,,,,,,11.42,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,00023-6112-01,NDC,,,facility,outpatient,1,EA,20.77000,19.73000,Amish/Mennonite,Amish Mennonite,,11.42,,,,,,,10.38,20.15,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,inpatient,1,EA,13.45000,12.78000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,7.40,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,42865-0103-02,NDC,,,facility,outpatient,1,EA,13.45000,12.78000,Amish/Mennonite,Amish Mennonite,,7.40,,,,,,,6.72,13.05,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,inpatient,1,EA,25.32000,24.06000,Amish/Mennonite,Amish Mennonite,,13.93,,,,,,,13.93,24.56,percent of total billed charges,
PANCREALIPASE CAP-EC (ZENPEP 20),60809,CDM,250,RC,73562-0112-01,NDC,,,facility,outpatient,1,EA,25.32000,24.06000,Amish/Mennonite,Amish Mennonite,,13.93,,,,,,,12.66,24.56,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,inpatient,1,GM,67.76000,64.37000,Amish/Mennonite,Amish Mennonite,,37.27,,,,,,,37.27,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,10337-0358-30,NDC,,,facility,outpatient,1,GM,67.76000,64.37000,Amish/Mennonite,Amish Mennonite,,37.27,,,,,,,33.88,65.73,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,inpatient,1,GM,51.80000,49.21000,Amish/Mennonite,Amish Mennonite,,28.49,,,,,,,28.49,50.25,percent of total billed charges,
OXICONAZOLE TOP 1% CRM,60810,CDM,250,RC,51672-1359-02,NDC,,,facility,outpatient,1,GM,51.80000,49.21000,Amish/Mennonite,Amish Mennonite,,28.49,,,,,,,25.90,50.25,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,00113-0873-03,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,inpatient,1,EA,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,43598-0487-72,NDC,,,facility,outpatient,1,EA,1.22000,1.15000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,inpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
NICOTINE LOZ 4 MG,60811,CDM,250,RC,45802-0873-05,NDC,,,facility,outpatient,1,EA,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,inpatient,1,EA,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,36.93,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,00002-4454-85,NDC,,,facility,outpatient,1,EA,67.15000,63.79000,Amish/Mennonite,Amish Mennonite,,36.93,,,,,,,33.58,65.14,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,inpatient,1,EA,5.06000,4.81000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,49884-0321-55,NDC,,,facility,outpatient,1,EA,5.06000,4.81000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,inpatient,1,EA,22.94000,21.79000,Amish/Mennonite,Amish Mennonite,,12.62,,,,,,,12.62,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,55111-0263-81,NDC,,,facility,outpatient,1,EA,22.94000,21.79000,Amish/Mennonite,Amish Mennonite,,12.62,,,,,,,11.47,22.25,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
OLANZAPINE TAB-DISINTEGRATING 10 MG,60812,CDM,250,RC,60505-3276-03,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,inpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,00121-0671-16,NDC,,,facility,outpatient,1,mL,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,54838-0510-80,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
OXYBUTYNIN 5 MG/5 ML ORAL SYRUP,60813,CDM,250,RC,60432-0092-16,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,inpatient,1,mL,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.96,3.46,percent of total billed charges,
PHENOBARBITAL ELIXIR 30 MG/7.5 ML,60815,CDM,250,RC,16571-0330-16-00750,NDC,,,facility,outpatient,1,mL,3.57000,3.39000,Amish/Mennonite,Amish Mennonite,,1.96,,,,,,,1.78,3.46,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,inpatient,1,GM,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
OXYCHLOROSENE SODIUM POWD 2 GM,60817,CDM,250,RC,00327-0001-10,NDC,,,facility,outpatient,1,GM,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,inpatient,1,EA,279.39000,265.42000,Amish/Mennonite,Amish Mennonite,,153.66,,,,,,,153.66,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,49884-0038-01,NDC,,,facility,outpatient,1,EA,279.39000,265.42000,Amish/Mennonite,Amish Mennonite,,153.66,,,,,,,139.69,271.01,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,inpatient,1,EA,621.55000,590.47000,Amish/Mennonite,Amish Mennonite,,341.85,,,,,,,341.85,602.90,percent of total billed charges,
PHENOXYBENZAMINE 10 MG CAP,60818,CDM,250,RC,65197-0001-01,NDC,,,facility,outpatient,1,EA,621.55000,590.47000,Amish/Mennonite,Amish Mennonite,,341.85,,,,,,,310.77,602.90,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,00143-1455-05,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0693-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,13517-0757-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
PHENOBARBITAL TAB 60 MG,60819,CDM,250,RC,16571-0674-01,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,inpatient,1,EA,1.97000,1.88000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,00054-0110-25,NDC,,,facility,outpatient,1,EA,1.97000,1.88000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
PERINDOPRIL TAB 2 MG,60820,CDM,250,RC,65862-0286-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,inpatient,1,mL,107.32000,101.96000,Amish/Mennonite,Amish Mennonite,,59.03,,,,,,,59.03,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,24201001020,NDC,facility,outpatient,1,mL,107.32000,101.96000,Amish/Mennonite,Amish Mennonite,,59.03,,,,,,,37.52,104.10,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,inpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 20ML MDV,60821,CDM,250,RC,J2515,HCPCS,76478050120,NDC,facility,outpatient,1,mL,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,37.52,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,inpatient,1,EA,7.64000,7.26000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,4.20,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,00071-0350-60,NDC,,,facility,outpatient,1,EA,7.64000,7.26000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,3.82,7.41,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
PHENELZINE TAB 15 MG,60823,CDM,250,RC,59762-0119-01,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,51293-0627-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0112-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,13517-0627-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,16571-0667-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
PHENOBARBITAL TAB 64.8 MG,60824,CDM,250,RC,75826-0141-10,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,inpatient,1,mL,4.64000,4.41000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.50,percent of total billed charges,
PAROXETINE LIQ 2 MG/ML,60825,CDM,250,RC,60505-0402-05,NDC,,,facility,outpatient,1,mL,4.64000,4.41000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.32,4.50,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,inpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00054-0097-20,NDC,,,facility,outpatient,1,EA,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,inpatient,1,EA,14.24000,13.53000,Amish/Mennonite,Amish Mennonite,,7.83,,,,,,,7.83,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,00078-0456-05,NDC,,,facility,outpatient,1,EA,14.24000,13.53000,Amish/Mennonite,Amish Mennonite,,7.83,,,,,,,7.12,13.81,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,50268-0679-15,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,inpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68084-0845-01,NDC,,,facility,outpatient,1,EA,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,1.65,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
OXCARBAZEPINE TAB 150 MG,60826,CDM,250,RC,68462-0137-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
NIFEDIPINE SUSP SD 4 MG/ML,60827,CDM,250,RC,68084-0022-01-00400,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,inpatient,1,EA,4.58000,4.36000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,00071-3740-66,NDC,,,facility,outpatient,1,EA,4.58000,4.36000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.44,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,inpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.59,4.57,percent of total billed charges,
PHENYTOIN CAP-ER 30 MG,60828,CDM,250,RC,58151-0118-01,NDC,,,facility,outpatient,1,EA,4.71000,4.47000,Amish/Mennonite,Amish Mennonite,,2.59,,,,,,,2.35,4.57,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,inpatient,1,mL,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,1671406710200100,NDC,facility,outpatient,1,mL,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,0.01601,4.34,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,inpatient,1,mL,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5167240910300100,NDC,facility,outpatient,1,mL,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.01601,1.05,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,inpatient,1,mL,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
ONDANSETRON LIQ 0.8 MG/ML,60829,CDM,250,RC,Q0162,HCPCS,5483805555000100,NDC,facility,outpatient,1,mL,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.01601,1.44,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,inpatient,1,mL,4.83000,4.58000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.66,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,61703034222,NDC,facility,outpatient,1,mL,4.83000,4.58000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,0.17611,4.69,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,inpatient,1,mL,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,4.49,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,63323076316,NDC,facility,outpatient,1,mL,8.17000,7.76000,Amish/Mennonite,Amish Mennonite,,4.49,,,,,,,0.17611,7.92,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,inpatient,1,mL,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,4.11,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860020017,NDC,facility,outpatient,1,mL,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,0.17611,7.25,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,inpatient,1,mL,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.11,percent of total billed charges,
PACLITAXEL 100 MG/16.7 ML SOLN (MDV),60830,CDM,250,RC,J9267,HCPCS,70860021567,NDC,facility,outpatient,1,mL,3.21000,3.05000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,0.17611,3.11,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,inpatient,,,482.51000,458.38000,Amish/Mennonite,Amish Mennonite,,265.38,,,,,,,265.38,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,CPT,,,facility,outpatient,,,482.51000,458.38000,Amish/Mennonite,Amish Mennonite,,265.38,,,,,,,51.13,468.03,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,inpatient,1,mL,965.01000,916.76000,Amish/Mennonite,Amish Mennonite,,530.76,,,,,,,530.76,936.06,percent of total billed charges,
"POLIOVIRUS VACCINE, INACTIVATED SUSP (IPOL)",60831,CDM,250,RC,90713,HCPCS,49281086010,NDC,facility,outpatient,1,mL,965.01000,916.76000,Amish/Mennonite,Amish Mennonite,,530.76,,,,,,,51.13,936.06,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-1228-58,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00536-2425-58,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,00904-6305-21,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,49348-0991-36,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,inpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-03,NDC,,,facility,outpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,inpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
PHENOL SPRAY 1.4% (CHLORASEPTIC EQUIV) 180 ML,60832,CDM,250,RC,78112-0011-04,NDC,,,facility,outpatient,1,mL,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,inpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.78650,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00591410101,NDC,facility,outpatient,1,EA,1.43000,1.36000,Amish/Mennonite,Amish Mennonite,,0.78650,,,,,,,0.53900,1.39,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,inpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00781104601,NDC,facility,outpatient,1,EA,4.41000,4.19000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,0.53900,4.28,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,00904659961,NDC,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,0.53900,3.04,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,inpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,23155079901,NDC,facility,outpatient,1,EA,0.85000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
PERPHENAZINE TAB 2 MG,60833,CDM,250,RC,Q0175,HCPCS,68382059101,NDC,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,inpatient,1,EA,21.70000,20.61000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,11.94,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00409338302,NDC,facility,outpatient,1,EA,21.70000,20.61000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,1.73,21.05,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,inpatient,1,EA,21.71000,20.62000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,11.94,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,00781921095,NDC,facility,outpatient,1,EA,21.71000,20.62000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,1.73,21.06,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,inpatient,1,EA,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,12.81,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,55150011930,NDC,facility,outpatient,1,EA,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,1.73,22.59,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,inpatient,1,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,16.08,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,63323098121,NDC,facility,outpatient,1,EA,29.23000,27.77000,Amish/Mennonite,Amish Mennonite,,16.08,,,,,,,1.73,28.35,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,inpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,65219043420,NDC,facility,outpatient,1,EA,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,1.73,9.20,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,inpatient,1,EA,29.22000,27.76000,Amish/Mennonite,Amish Mennonite,,16.07,,,,,,,16.07,28.34,percent of total billed charges,
PIPERACILLIN-TAZOBACTAM POWD-INJ 2.25 GM,60834,CDM,250,RC,J2543,HCPCS,67457052122,NDC,facility,outpatient,1,EA,29.22000,27.76000,Amish/Mennonite,Amish Mennonite,,16.07,,,,,,,1.73,28.34,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,inpatient,1,mL,50.03000,47.53000,Amish/Mennonite,Amish Mennonite,,27.52,,,,,,,27.52,48.53,percent of total billed charges,
PERAMIVIR SOLN 10 MG/ML,60835,CDM,636,RC,J2547,HCPCS,61364018103,NDC,facility,outpatient,1,mL,50.03000,47.53000,Amish/Mennonite,Amish Mennonite,,27.52,,,,,,,1.68,48.53,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,inpatient,1,mL,6.52000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.59,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,61553-0156-61,NDC,,,facility,outpatient,1,mL,6.52000,6.20000,Amish/Mennonite,Amish Mennonite,,3.59,,,,,,,3.26,6.32,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,inpatient,1,mL,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,70092-9042-05,NDC,,,facility,outpatient,1,mL,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71019-0270-09,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
PHENYLEPHRINE 20 MG/NS 250 ML,60836,CDM,250,RC,71506-0002-58,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
PHENYTOIN SUSP 100 MG/4 ML,60837,CDM,250,RC,66689-0036-50,NDC,,,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,inpatient,1,GM,31.50000,29.92000,Amish/Mennonite,Amish Mennonite,,17.32,,,,,,,17.32,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00187-5100-01,NDC,,,facility,outpatient,1,GM,31.50000,29.92000,Amish/Mennonite,Amish Mennonite,,17.32,,,,,,,15.75,30.55,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,inpatient,1,GM,25.68000,24.39000,Amish/Mennonite,Amish Mennonite,,14.12,,,,,,,14.12,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,00591-2944-30,NDC,,,facility,outpatient,1,GM,25.68000,24.39000,Amish/Mennonite,Amish Mennonite,,14.12,,,,,,,12.84,24.91,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,inpatient,1,GM,26.72000,25.38000,Amish/Mennonite,Amish Mennonite,,14.70,,,,,,,14.70,25.92,percent of total billed charges,
PIMECROLIMUS CREAM 1%,60839,CDM,250,RC,68462-0609-35,NDC,,,facility,outpatient,1,GM,26.72000,25.38000,Amish/Mennonite,Amish Mennonite,,14.70,,,,,,,13.36,25.92,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,inpatient,1,mL,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,00409663501,NDC,facility,outpatient,1,mL,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,0.27217,3.05,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,inpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
POTASSIUM CHLORIDE SOLN 2 MEQ/ML 5 ML,60841,CDM,250,RC,J3480,HCPCS,63323096505,NDC,facility,outpatient,1,mL,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.27217,1.77,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00338070541,NDC,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/50 ML PREMIX,60843,CDM,250,RC,J3480,HCPCS,00990707514,NDC,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.34860,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,inpatient,1,mL,14.25000,13.53000,Amish/Mennonite,Amish Mennonite,,7.84,,,,,,,7.84,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,69238-1747-08,NDC,,,facility,outpatient,1,mL,14.25000,13.53000,Amish/Mennonite,Amish Mennonite,,7.84,,,,,,,7.12,13.82,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,inpatient,1,mL,17.81000,16.92000,Amish/Mennonite,Amish Mennonite,,9.80,,,,,,,9.80,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,61314-0206-15,NDC,,,facility,outpatient,1,mL,17.81000,16.92000,Amish/Mennonite,Amish Mennonite,,9.80,,,,,,,8.90,17.28,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,inpatient,1,mL,16.76000,15.92000,Amish/Mennonite,Amish Mennonite,,9.22,,,,,,,9.22,16.26,percent of total billed charges,
PILOCARPINE SOLN-OPHTH 4% 15 ML,60844,CDM,250,RC,70069-0201-01,NDC,,,facility,outpatient,1,mL,16.76000,15.92000,Amish/Mennonite,Amish Mennonite,,9.22,,,,,,,8.38,16.26,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,inpatient,1,EA,678.29000,644.37000,Amish/Mennonite,Amish Mennonite,,373.06,,,,,,,373.06,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,25010-0705-15,NDC,,,facility,outpatient,1,EA,678.29000,644.37000,Amish/Mennonite,Amish Mennonite,,373.06,,,,,,,339.14,657.94,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,inpatient,1,EA,34.13000,32.42000,Amish/Mennonite,Amish Mennonite,,18.77,,,,,,,18.77,33.11,percent of total billed charges,
PENICILLAMINE 250 MG CAP,60845,CDM,250,RC,51991-0974-01,NDC,,,facility,outpatient,1,EA,34.13000,32.42000,Amish/Mennonite,Amish Mennonite,,18.77,,,,,,,17.07,33.11,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,inpatient,1,mL,972.04000,923.43000,Amish/Mennonite,Amish Mennonite,,534.62,,,,,,,534.62,942.88,percent of total billed charges,
PORACTANT SUSP 80 MG/ML INTRATRACHEAL 3 ML,60846,CDM,250,RC,10122-0510-03,NDC,,,facility,outpatient,1,mL,972.04000,923.43000,Amish/Mennonite,Amish Mennonite,,534.62,,,,,,,486.02,942.88,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,inpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
NORTRIPTYLINE LIQ 2 MG/ML,60847,CDM,250,RC,00121-0678-16,NDC,,,facility,outpatient,1,mL,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,inpatient,1,EA,4.82000,4.58000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.65,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00178-0600-01,NDC,,,facility,outpatient,1,EA,4.82000,4.58000,Amish/Mennonite,Amish Mennonite,,2.65,,,,,,,2.41,4.68,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,inpatient,1,EA,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.75,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,00245-0070-11,NDC,,,facility,outpatient,1,EA,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.59,3.09,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,31722-0129-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,42543-0406-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 5 MEQ,60848,CDM,250,RC,68382-0536-01,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,inpatient,1,EA,30.51000,28.98000,Amish/Mennonite,Amish Mennonite,,16.78,,,,,,,16.78,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245003501,NDC,facility,outpatient,1,EA,30.51000,28.98000,Amish/Mennonite,Amish Mennonite,,16.78,,,,,,,0.27217,29.59,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,inpatient,1,EA,22.79000,21.65000,Amish/Mennonite,Amish Mennonite,,12.53,,,,,,,12.53,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00603155404,NDC,facility,outpatient,1,EA,22.79000,21.65000,Amish/Mennonite,Amish Mennonite,,12.53,,,,,,,0.27217,22.11,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,inpatient,1,EA,8.94000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,00245036030,NDC,facility,outpatient,1,EA,8.94000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,0.27217,8.67,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,inpatient,1,EA,23.98000,22.79000,Amish/Mennonite,Amish Mennonite,,13.19,,,,,,,13.19,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543037930,NDC,facility,outpatient,1,EA,23.98000,22.79000,Amish/Mennonite,Amish Mennonite,,13.19,,,,,,,0.27217,23.26,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,inpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,9.56,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,42806009430,NDC,facility,outpatient,1,EA,17.38000,16.51000,Amish/Mennonite,Amish Mennonite,,9.56,,,,,,,0.27217,16.86,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,inpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019430,NDC,facility,outpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,0.27217,9.75,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,inpatient,1,EA,17.06000,16.21000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,9.38,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,43386019431,NDC,facility,outpatient,1,EA,17.06000,16.21000,Amish/Mennonite,Amish Mennonite,,9.38,,,,,,,0.27217,16.55,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,inpatient,1,EA,8.88000,8.44000,Amish/Mennonite,Amish Mennonite,,4.88,,,,,,,4.88,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,64380087569,NDC,facility,outpatient,1,EA,8.88000,8.44000,Amish/Mennonite,Amish Mennonite,,4.88,,,,,,,0.27217,8.61,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,inpatient,1,EA,10.33000,9.82000,Amish/Mennonite,Amish Mennonite,,5.68,,,,,,,5.68,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69238161703,NDC,facility,outpatient,1,EA,10.33000,9.82000,Amish/Mennonite,Amish Mennonite,,5.68,,,,,,,0.27217,10.02,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,inpatient,1,EA,7.14000,6.78000,Amish/Mennonite,Amish Mennonite,,3.93,,,,,,,3.93,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,69543045110,NDC,facility,outpatient,1,EA,7.14000,6.78000,Amish/Mennonite,Amish Mennonite,,3.93,,,,,,,0.27217,6.93,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,inpatient,1,EA,4.78000,4.54000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.64,percent of total billed charges,
POTASSIUM CHLORIDE POWD 20 MEQ,60849,CDM,250,RC,J3480,HCPCS,72888002407,NDC,facility,outpatient,1,EA,4.78000,4.54000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,0.27217,4.64,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
PHENYLEPHRINE DROPS-NASAL 0.125% 15 ML,60851,CDM,250,RC,56184-0121-05,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,inpatient,1,EA,5.71000,5.42000,Amish/Mennonite,Amish Mennonite,,3.14,,,,,,,3.14,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,49884-0348-01,NDC,,,facility,outpatient,1,EA,5.71000,5.42000,Amish/Mennonite,Amish Mennonite,,3.14,,,,,,,2.85,5.54,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,inpatient,1,EA,7.42000,7.05000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,4.08,7.20,percent of total billed charges,
PIMOZIDE TAB 2 MG,60853,CDM,250,RC,57844-0187-01,NDC,,,facility,outpatient,1,EA,7.42000,7.05000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,3.71,7.20,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,inpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,60854,CDM,250,RC,63323-0086-05-00010,NDC,,,facility,outpatient,1,mL,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,inpatient,1,EA,36.01000,34.21000,Amish/Mennonite,Amish Mennonite,,19.81,,,,,,,19.81,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00002-4112-30,NDC,,,facility,outpatient,1,EA,36.01000,34.21000,Amish/Mennonite,Amish Mennonite,,19.81,,,,,,,18.00,34.93,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,00904-6283-61,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,50268-0609-15,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,55111-0163-30,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,60505-3110-00,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,68084-0525-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
OLANZAPINE TAB 2.5 MG,60855,CDM,250,RC,69543-0380-30,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,72888-0041-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,00121-1680-16,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,inpatient,1,mL,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,43386-0168-01,NDC,,,facility,outpatient,1,mL,1.24000,1.17000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,inpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
POTASSIUM CHLORIDE LIQ 1.3 MEQ/ML,60857,CDM,250,RC,42571-0357-07,NDC,,,facility,outpatient,1,mL,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,inpatient,1,mL,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,28.68,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,46783022152,NDC,facility,outpatient,1,mL,52.14000,49.53000,Amish/Mennonite,Amish Mennonite,,28.68,,,,,,,26.07,50.58,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,inpatient,1,mL,35.71000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,19.64,34.64,percent of total billed charges,
POLIDOCANOL SOLN 1% 2 ML,60858,CDM,250,RC,J3490,HCPCS,67850014105,NDC,facility,outpatient,1,mL,35.71000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,17.86,34.64,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,inpatient,1,mL,43.32000,41.16000,Amish/Mennonite,Amish Mennonite,,23.83,,,,,,,23.83,42.02,percent of total billed charges,
POSACONAZOLE SUSP 40 MG/ML,60860,CDM,250,RC,J8499,HCPCS,00085132801,NDC,facility,outpatient,1,mL,43.32000,41.16000,Amish/Mennonite,Amish Mennonite,,23.83,,,,,,,21.66,42.02,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,00904-5678-61,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,13107-0156-30,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,inpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,50268-0642-15,NDC,,,facility,outpatient,1,EA,2.64000,2.51000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.32,2.56,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,60505-0084-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
PAROXETINE 30 MG TAB,60861,CDM,250,RC,68084-0046-01,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,inpatient,1,mL,114.96000,109.22000,Amish/Mennonite,Amish Mennonite,,63.23,,,,,,,63.23,111.51,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,00409190301,NDC,facility,outpatient,1,mL,114.96000,109.22000,Amish/Mennonite,Amish Mennonite,,63.23,,,,,,,57.48,472.00,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,inpatient,1,mL,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,,427.35,,,,,,,427.35,753.69,percent of total billed charges,
PROCAINAMIDE SOLN 500 MG/ML 2 ML,60862,CDM,636,RC,J2690,HCPCS,14789090002,NDC,facility,outpatient,1,mL,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,,427.35,,,,,,,194.32,753.69,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,inpatient,1,EA,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,00024-1596-01,NDC,,,facility,outpatient,1,EA,5.32000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.66,5.16,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,inpatient,1,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.33,4.10,percent of total billed charges,
PRIMAQUINE PHOSPHATE 26.3 MG (15 MG BASE) TAB,60863,CDM,250,RC,76385-0102-01,NDC,,,facility,outpatient,1,EA,4.23000,4.02000,Amish/Mennonite,Amish Mennonite,,2.33,,,,,,,2.12,4.10,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,inpatient,1,EA,35.70000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,19.64,34.63,percent of total billed charges,
PENTOSAN POLYSULFATE SODIUM 100 MG CAP,60864,CDM,250,RC,50458-0098-01,NDC,,,facility,outpatient,1,EA,35.70000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,17.85,34.63,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00005-2500-33,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-08,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00536-4306-11,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,00904-2500-91,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,49348-0190-13,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0118-10,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
POLYCARBOPHIL TAB 625 MG,60865,CDM,250,RC,77333-0120-50,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,inpatient,1,EA,22.83000,21.69000,Amish/Mennonite,Amish Mennonite,,12.56,,,,,,,12.56,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,16477050501,NDC,facility,outpatient,1,EA,22.83000,21.69000,Amish/Mennonite,Amish Mennonite,,12.56,,,,,,,0.43227,22.15,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,inpatient,1,EA,48.81000,46.37000,Amish/Mennonite,Amish Mennonite,,26.85,,,,,,,26.85,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050501,NDC,facility,outpatient,1,EA,48.81000,46.37000,Amish/Mennonite,Amish Mennonite,,26.85,,,,,,,0.43227,47.35,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,inpatient,1,EA,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,23594050550,NDC,facility,outpatient,1,EA,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,0.43227,39.77,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,inpatient,1,EA,44.24000,42.03000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,24.33,42.91,percent of total billed charges,
PREDNISOLONE TAB 5 MG,60867,CDM,250,RC,J7510,HCPCS,62135043730,NDC,facility,outpatient,1,EA,44.24000,42.03000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,0.43227,42.91,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,inpatient,1,mL,7537.53000,7160.66000,Amish/Mennonite,Amish Mennonite,,4145.64,,,,,,,4145.64,7311.40,percent of total billed charges,
PALIVIZUMAB SOLN 50 MG/0.5 ML (SYNAGIS),60869,CDM,636,RC,90378,HCPCS,66658023001,NDC,facility,outpatient,1,mL,7537.53000,7160.66000,Amish/Mennonite,Amish Mennonite,,4145.64,,,,,,,719.87,7311.40,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
POTASSIUM CHLORIDE SOLN SD 1 MEQ/ML,60870,CDM,250,RC,00409-6635-01-00100,NDC,,,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00115-5922-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,00527-1313-01,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,inpatient,1,EA,3.12000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,16714-0121-01,NDC,,,facility,outpatient,1,EA,3.12000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.03,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.95,6.97,percent of total billed charges,
PILOCARPINE TAB 5 MG,60871,CDM,250,RC,68084-0928-25,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.60,6.97,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,00603-5165-32,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,inpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,75826-0137-10,NDC,,,facility,outpatient,1,EA,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,inpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,13517-0625-01,NDC,,,facility,outpatient,1,EA,0.63000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,51293-0625-01,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,inpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,1.00,1.77,percent of total billed charges,
PHENOBARBITAL TAB 16.2 MG,60872,CDM,250,RC,63739-0192-10,NDC,,,facility,outpatient,1,EA,1.82000,1.73000,Amish/Mennonite,Amish Mennonite,,1.00,,,,,,,0.91000,1.77,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 453.6 GM,60873,CDM,250,RC,00168-0053-16,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,inpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,00245-0071-11,NDC,,,facility,outpatient,1,EA,4.47000,4.25000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.23,4.34,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,31722-0130-01,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,inpatient,1,EA,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.44,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,42543-0407-01,NDC,,,facility,outpatient,1,EA,4.44000,4.22000,Amish/Mennonite,Amish Mennonite,,2.44,,,,,,,2.22,4.31,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,62559-0291-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,inpatient,1,EA,7.62000,7.23000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,4.19,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68084-0850-32,NDC,,,facility,outpatient,1,EA,7.62000,7.23000,Amish/Mennonite,Amish Mennonite,,4.19,,,,,,,3.81,7.39,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
POTASSIUM CITRATE TAB-ER 10 MEQ,60874,CDM,250,RC,68382-0537-01,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,inpatient,1,EA,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.54,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00228-2781-11,NDC,,,facility,outpatient,1,EA,10.08000,9.58000,Amish/Mennonite,Amish Mennonite,,5.54,,,,,,,5.04,9.78,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,00527-4119-37,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
PROPRANOLOL CAP-ER 160 MG,60875,CDM,250,RC,62559-0533-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,38779-0623-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
POTASSIUM CITRATE GRANULES,60876,CDM,250,RC,51552-0342-06,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 960 ML,60878,CDM,250,RC,52380-1905-07,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
POVIDONE IODINE TOP 5% SPRY,60880,CDM,250,RC,67618-0148-03,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
POTASSIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,60881,CDM,250,RC,63323-0086-05-00005,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,inpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
PETROLATUM TOPICAL 100% OINT 30 GM,60882,CDM,250,RC,00168-0053-21,NDC,,,facility,outpatient,1,GM,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,inpatient,1,mL,7.82000,7.43000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,4.30,7.59,percent of total billed charges,
PYRIDOSTIGMINE LIQ 60 MG/5 ML,60883,CDM,250,RC,00187-3012-20,NDC,,,facility,outpatient,1,mL,7.82000,7.43000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,3.91,7.59,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,00093-4068-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,inpatient,1,EA,6.65000,6.31000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,3.66,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,51079-0631-20,NDC,,,facility,outpatient,1,EA,6.65000,6.31000,Amish/Mennonite,Amish Mennonite,,3.66,,,,,,,3.33,6.45,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,59762-5320-01,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,inpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.77550,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,66993-0432-85,NDC,,,facility,outpatient,1,EA,1.41000,1.34000,Amish/Mennonite,Amish Mennonite,,0.77550,,,,,,,0.70500,1.37,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,inpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.33550,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,70954-0020-10,NDC,,,facility,outpatient,1,EA,0.61000,0.58000,Amish/Mennonite,Amish Mennonite,,0.33550,,,,,,,0.30500,0.59170,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
PRAZOSIN CAP 2 MG,60884,CDM,250,RC,76282-0722-01,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,inpatient,1,mL,12088.99000,11484.54000,Amish/Mennonite,Amish Mennonite,,6648.94,,,,,,,6648.94,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,00024586201,NDC,facility,outpatient,1,mL,12088.99000,11484.54000,Amish/Mennonite,Amish Mennonite,,6648.94,,,,,,,38.71,11726.32,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,inpatient,1,mL,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1518.00,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,70710120801,NDC,facility,outpatient,1,mL,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,38.71,2677.20,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,inpatient,1,mL,1079.15000,1025.19000,Amish/Mennonite,Amish Mennonite,,593.53,,,,,,,593.53,1046.78,percent of total billed charges,
PLERIXAFOR 20 MG/ML SOLN,60886,CDM,636,RC,J2562,HCPCS,71288015501,NDC,facility,outpatient,1,mL,1079.15000,1025.19000,Amish/Mennonite,Amish Mennonite,,593.53,,,,,,,38.71,1046.78,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,13668-0093-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68462-0332-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,60687-0581-21,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
PRAMIPEXOLE TAB 0.5 MG,60888,CDM,250,RC,68084-0974-25,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,inpatient,1,mL,15.36000,14.59000,Amish/Mennonite,Amish Mennonite,,8.45,,,,,,,8.45,14.90,percent of total billed charges,
PHYTONADIONE LIQ SD 1 MG/ML,60889,CDM,250,RC,00409-9158-01-00100,NDC,,,facility,outpatient,1,mL,15.36000,14.59000,Amish/Mennonite,Amish Mennonite,,8.45,,,,,,,7.68,14.90,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,inpatient,1,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
PHENTERMINE 30 MG CAP,60890,CDM,250,RC,00185-0647-01,NDC,,,facility,outpatient,1,EA,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054474225,NDC,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.00620,0.40740,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,00054874025,NDC,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.00620,0.44620,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
PREDNISONE TAB 2.5 MG,60891,CDM,250,RC,J7512,HCPCS,59651048501,NDC,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.00620,0.37830,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,inpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,65219-0052-29,NDC,,,facility,outpatient,1,mL,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.32,12.26,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,inpatient,1,mL,14.54000,13.81000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,8.00,14.10,percent of total billed charges,
POTASSIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,60892,CDM,250,RC,80830-1693-03,NDC,,,facility,outpatient,1,mL,14.54000,13.81000,Amish/Mennonite,Amish Mennonite,,8.00,,,,,,,7.27,14.10,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,67253-0651-10,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,inpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,68084-0964-25,NDC,,,facility,outpatient,1,EA,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,inpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,70752-0171-10,NDC,,,facility,outpatient,1,EA,2.32000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,2.25,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,inpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
PROPYLTHIOURACIL TAB 50 MG,60893,CDM,250,RC,72162-2072-01,NDC,,,facility,outpatient,1,EA,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,inpatient,1,EA,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,00378-0052-01,NDC,,,facility,outpatient,1,EA,3.34000,3.17000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.67,3.24,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,inpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,57664-0655-88,NDC,,,facility,outpatient,1,EA,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.39,2.70,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
PINDOLOL TAB 5 MG,60895,CDM,250,RC,62559-0560-01,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,inpatient,1,mL,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,3.12,5.51,percent of total billed charges,
QUINIDINE SOLN-INJ 80 MG/ML,60897,CDM,250,RC,J3490,HCPCS,00002140701,NDC,facility,outpatient,1,mL,5.68000,5.39000,Amish/Mennonite,Amish Mennonite,,3.12,,,,,,,2.84,5.51,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,inpatient,1,EA,216.55000,205.73000,Amish/Mennonite,Amish Mennonite,,119.10,,,,,,,119.10,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00085-4324-02,NDC,,,facility,outpatient,1,EA,216.55000,205.73000,Amish/Mennonite,Amish Mennonite,,119.10,,,,,,,108.28,210.05,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,inpatient,1,EA,95.56000,90.78000,Amish/Mennonite,Amish Mennonite,,52.56,,,,,,,52.56,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,00527-2133-35,NDC,,,facility,outpatient,1,EA,95.56000,90.78000,Amish/Mennonite,Amish Mennonite,,52.56,,,,,,,47.78,92.69,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,inpatient,1,EA,149.05000,141.59000,Amish/Mennonite,Amish Mennonite,,81.98,,,,,,,81.98,144.58,percent of total billed charges,
POSACONAZOLE 100 MG EC TAB,60899,CDM,250,RC,60687-0523-21,NDC,,,facility,outpatient,1,EA,149.05000,141.59000,Amish/Mennonite,Amish Mennonite,,81.98,,,,,,,74.53,144.58,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,inpatient,1,EA,309.43000,293.96000,Amish/Mennonite,Amish Mennonite,,170.19,,,,,,,170.19,300.15,percent of total billed charges,
PROCARBAZINE 50 MG CAP,60900,CDM,250,RC,54482-0053-01,NDC,,,facility,outpatient,1,EA,309.43000,293.96000,Amish/Mennonite,Amish Mennonite,,170.19,,,,,,,154.72,300.15,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,00378510501,NDC,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,inpatient,1,EA,3.50000,3.32000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,50268068415,NDC,facility,outpatient,1,EA,3.50000,3.32000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,0.73040,3.40,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,inpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,59746011306,NDC,facility,outpatient,1,EA,1.10000,1.05000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,inpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
PROCHLORPERAZINE TAB 5 MG,60901,CDM,250,RC,Q0164,HCPCS,68462088901,NDC,facility,outpatient,1,EA,0.69000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.73040,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,inpatient,1,EA,86.34000,82.02000,Amish/Mennonite,Amish Mennonite,,47.49,,,,,,,47.49,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,00187-3013-30,NDC,,,facility,outpatient,1,EA,86.34000,82.02000,Amish/Mennonite,Amish Mennonite,,47.49,,,,,,,43.17,83.75,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,inpatient,1,EA,50.96000,48.41000,Amish/Mennonite,Amish Mennonite,,28.03,,,,,,,28.03,49.43,percent of total billed charges,
PYRIDOSTIGMINE TAB-ER 180 MG,60902,CDM,250,RC,64980-0220-03,NDC,,,facility,outpatient,1,EA,50.96000,48.41000,Amish/Mennonite,Amish Mennonite,,28.03,,,,,,,25.48,49.43,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,inpatient,1,EA,10.61000,10.08000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.84,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,00032-1708-01,NDC,,,facility,outpatient,1,EA,10.61000,10.08000,Amish/Mennonite,Amish Mennonite,,5.84,,,,,,,5.30,10.29,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,inpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,16714-0157-01,NDC,,,facility,outpatient,1,EA,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,17478-0766-10,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,inpatient,1,EA,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.90,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,43598-0349-01,NDC,,,facility,outpatient,1,EA,3.45000,3.28000,Amish/Mennonite,Amish Mennonite,,1.90,,,,,,,1.73,3.35,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
PROGESTERONE 100 MG CAP,60903,CDM,250,RC,65162-0807-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
PROPANTHELINE TAB 15 MG,60905,CDM,250,RC,00054-4721-25,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0755-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,13517-0691-01,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
PHENOBARBITAL TAB 15 MG,60906,CDM,250,RC,75826-0136-10,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
PROMETHAZINE TAB 12.5 MG,60908,CDM,250,RC,00781-1830-01,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,inpatient,1,EA,27.12000,25.76000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,14.92,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00071-1014-41,NDC,,,facility,outpatient,1,EA,27.12000,25.76000,Amish/Mennonite,Amish Mennonite,,14.92,,,,,,,13.56,26.31,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,00904-7000-61,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,60687-0495-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,62332-0121-90,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,69238-1312-09,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72205-0013-90,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,inpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,72606-0006-01,NDC,,,facility,outpatient,1,EA,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
PREGABALIN CAP 75 MG,60909,CDM,250,RC,76282-0570-90,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,inpatient,1,GM,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
PRAMOXINE-ZINC OXIDE CRM 1%-5%,60911,CDM,250,RC,11868-0814-01,NDC,,,facility,outpatient,1,GM,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,inpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,60258-0006-01,NDC,,,facility,outpatient,1,EA,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
PHOSPHORUS (NA/K) POWD 250 MG,60913,CDM,250,RC,71351-0010-01,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,inpatient,1,EA,23.14000,21.98000,Amish/Mennonite,Amish Mennonite,,12.73,,,,,,,12.73,22.45,percent of total billed charges,
RAMIPRIL CAP 10 MG,60914,CDM,250,RC,61570-0120-01,NDC,,,facility,outpatient,1,EA,23.14000,21.98000,Amish/Mennonite,Amish Mennonite,,12.73,,,,,,,11.57,22.45,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,13668-0091-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,57237-0180-90,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 0.125 MG,60915,CDM,250,RC,68462-0330-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,inpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.41250,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,50268-0859-15,NDC,,,facility,outpatient,1,EA,0.75000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41250,,,,,,,0.37500,0.72750,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,inpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
PYRIDOXINE TAB 100 MG,60916,CDM,250,RC,74312-0006-50,NDC,,,facility,outpatient,1,EA,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
QUETIAPINE TAB 12.5 MG,60917,CDM,250,RC,00904-6638-61-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,inpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.79200,1.40,percent of total billed charges,
QUINIDINE TAB 300 MG,60918,CDM,250,RC,00185-1047-01,NDC,,,facility,outpatient,1,EA,1.44000,1.37000,Amish/Mennonite,Amish Mennonite,,0.79200,,,,,,,0.72000,1.40,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,00536-4406-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
PYRIDOXINE TAB 25 MG,60919,CDM,250,RC,61748-0092-30,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
QUINIDINE 300 MG ER TAB,60920,CDM,250,RC,00093-9175-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,50228-0423-60,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,inpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,60687-0549-21,NDC,,,facility,outpatient,1,EA,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,inpatient,1,EA,20.66000,19.63000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,11.36,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,61958-1003-01,NDC,,,facility,outpatient,1,EA,20.66000,19.63000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,10.33,20.04,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,63304-0017-60,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,inpatient,1,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,70756-0703-60,NDC,,,facility,outpatient,1,EA,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,inpatient,1,EA,14.28000,13.57000,Amish/Mennonite,Amish Mennonite,,7.85,,,,,,,7.85,13.85,percent of total billed charges,
RANOLAZINE 500 MG ER TAB,60921,CDM,250,RC,68180-0354-07,NDC,,,facility,outpatient,1,EA,14.28000,13.57000,Amish/Mennonite,Amish Mennonite,,7.85,,,,,,,7.14,13.85,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,inpatient,1,EA,27.09000,25.73000,Amish/Mennonite,Amish Mennonite,,14.90,,,,,,,14.90,26.28,percent of total billed charges,
RITONAVIR CAP 100 MG,60923,CDM,250,RC,00074-6633-30,NDC,,,facility,outpatient,1,EA,27.09000,25.73000,Amish/Mennonite,Amish Mennonite,,14.90,,,,,,,13.54,26.28,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
RIFAMPIN SUSP SD 10 MG/ML,60924,CDM,250,RC,00185-0801-30-01000,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,inpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,00603-5485-21,NDC,,,facility,outpatient,1,EA,2.23000,2.12000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.11,2.16,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,inpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69238-2080-01,NDC,,,facility,outpatient,1,EA,2.22000,2.11000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.11,2.15,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,inpatient,1,EA,2.26000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
PROPRANOLOL 60 MG TAB,60925,CDM,250,RC,69292-0536-01,NDC,,,facility,outpatient,1,EA,2.26000,2.14000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,inpatient,1,EA,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,4.26,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,00054-0210-25,NDC,,,facility,outpatient,1,EA,7.74000,7.35000,Amish/Mennonite,Amish Mennonite,,4.26,,,,,,,3.87,7.51,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,inpatient,1,EA,10.76000,10.23000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.92,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,51285-0595-02,NDC,,,facility,outpatient,1,EA,10.76000,10.23000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.38,10.44,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,inpatient,1,EA,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,3.21,5.66,percent of total billed charges,
PROTRIPTYLINE TAB 5 MG,60927,CDM,250,RC,64980-0158-01,NDC,,,facility,outpatient,1,EA,5.84000,5.55000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,2.92,5.66,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
PROPRANOLOL LIQ 4 MG/ML,60929,CDM,250,RC,00054-3727-63,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,inpatient,1,EA,47426.37000,45055.05000,Amish/Mennonite,Amish Mennonite,,26084.50,,,,,,,26084.50,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,00187-0007-14,NDC,,,facility,outpatient,1,EA,47426.37000,45055.05000,Amish/Mennonite,Amish Mennonite,,26084.50,,,,,,,23713.19,46003.58,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,inpatient,1,EA,38000.00000,36100.00000,Amish/Mennonite,Amish Mennonite,,20900.00,,,,,,,20900.00,36860.00,percent of total billed charges,
RIBAVIRIN 6 G INH PWDR FOR RECON,60930,CDM,250,RC,68382-0395-04,NDC,,,facility,outpatient,1,EA,38000.00000,36100.00000,Amish/Mennonite,Amish Mennonite,,20900.00,,,,,,,19000.00,36860.00,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00185-0801-30,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.10,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,inpatient,1,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,00527-1393-30,NDC,,,facility,outpatient,1,EA,3.12000,2.96000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.03,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,inpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,60687-0575-21,NDC,,,facility,outpatient,1,EA,5.02000,4.77000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.51,4.87,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,inpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,61748-0015-30,NDC,,,facility,outpatient,1,EA,3.11000,2.96000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.02,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,inpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.77,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68084-0357-21,NDC,,,facility,outpatient,1,EA,5.03000,4.78000,Amish/Mennonite,Amish Mennonite,,2.77,,,,,,,2.52,4.88,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,inpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.51,7.95,percent of total billed charges,
RIFAMPIN CAP 150 MG,60931,CDM,250,RC,68180-0658-06,NDC,,,facility,outpatient,1,EA,8.20000,7.79000,Amish/Mennonite,Amish Mennonite,,4.51,,,,,,,4.10,7.95,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0023-04,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,inpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,37000-0024-04,NDC,,,facility,outpatient,1,EA,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,inpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
PSYLLIUM PWDR,60932,CDM,250,RC,38485-0808-57,NDC,,,facility,outpatient,1,EA,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,00093-7437-01,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,65862-0476-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
RAMIPRIL CAP 5 MG,60933,CDM,250,RC,68382-0146-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,50742-0238-30,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,inpatient,1,EA,18.52000,17.59000,Amish/Mennonite,Amish Mennonite,,10.19,,,,,,,10.19,17.96,percent of total billed charges,
QUININE 324 MG CAP,60936,CDM,250,RC,53489-0700-07,NDC,,,facility,outpatient,1,EA,18.52000,17.59000,Amish/Mennonite,Amish Mennonite,,10.19,,,,,,,9.26,17.96,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,inpatient,1,EA,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,10.87,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00169-0082-81,NDC,,,facility,outpatient,1,EA,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,9.88,19.18,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,inpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.94050,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,00574-0241-01,NDC,,,facility,outpatient,1,EA,1.71000,1.62000,Amish/Mennonite,Amish Mennonite,,0.94050,,,,,,,0.85500,1.66,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,inpatient,1,EA,9.35000,8.89000,Amish/Mennonite,Amish Mennonite,,5.14,,,,,,,5.14,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,60687-0560-21,NDC,,,facility,outpatient,1,EA,9.35000,8.89000,Amish/Mennonite,Amish Mennonite,,5.14,,,,,,,4.67,9.07,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE TAB 1 MG,60937,CDM,250,RC,65862-0671-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,inpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
RIBAVIRIN TAB 200 MG,60938,CDM,250,RC,65862-0207-68,NDC,,,facility,outpatient,1,EA,1.94000,1.84000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,inpatient,1,EA,18.11000,17.21000,Amish/Mennonite,Amish Mennonite,,9.96,,,,,,,9.96,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,00078-0325-44,NDC,,,facility,outpatient,1,EA,18.11000,17.21000,Amish/Mennonite,Amish Mennonite,,9.96,,,,,,,9.05,17.57,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE 4.5 MG CAP,60939,CDM,250,RC,55111-0354-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,inpatient,1,EA,2062.94000,1959.79000,Amish/Mennonite,Amish Mennonite,,1134.62,,,,,,,1134.62,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,00480134208,NDC,facility,outpatient,1,EA,2062.94000,1959.79000,Amish/Mennonite,Amish Mennonite,,1134.62,,,,,,,10.94,2001.05,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,inpatient,1,EA,2387.67000,2268.29000,Amish/Mennonite,Amish Mennonite,,1313.22,,,,,,,1313.22,2316.04,percent of total billed charges,
"RISPERIDONE 37.5 MG/2 WEEKS IM INJ, ER",60940,CDM,636,RC,J2794,HCPCS,50458030711,NDC,facility,outpatient,1,EA,2387.67000,2268.29000,Amish/Mennonite,Amish Mennonite,,1313.22,,,,,,,10.94,2316.04,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,inpatient,1,EA,43.45000,41.27000,Amish/Mennonite,Amish Mennonite,,23.90,,,,,,,23.90,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,00378-1271-93,NDC,,,facility,outpatient,1,EA,43.45000,41.27000,Amish/Mennonite,Amish Mennonite,,23.90,,,,,,,21.73,42.15,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,inpatient,1,EA,75.34000,71.58000,Amish/Mennonite,Amish Mennonite,,41.44,,,,,,,41.44,73.08,percent of total billed charges,
RASAGILINE TAB 1 MG,60941,CDM,250,RC,68546-0229-56,NDC,,,facility,outpatient,1,EA,75.34000,71.58000,Amish/Mennonite,Amish Mennonite,,41.44,,,,,,,37.67,73.08,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
SALICYLIC ACID TOP COMPOUNDING PWDR,60942,CDM,250,RC,00395-2625-01,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,inpatient,1,EA,256.79000,243.95000,Amish/Mennonite,Amish Mennonite,,141.23,,,,,,,141.23,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,00430-0472-03,NDC,,,facility,outpatient,1,EA,256.79000,243.95000,Amish/Mennonite,Amish Mennonite,,141.23,,,,,,,128.40,249.09,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,inpatient,1,EA,35.71000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,19.64,34.64,percent of total billed charges,
RISEDRONATE TAB 35 MG,60943,CDM,250,RC,60505-3165-00,NDC,,,facility,outpatient,1,EA,35.71000,33.92000,Amish/Mennonite,Amish Mennonite,,19.64,,,,,,,17.86,34.64,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,inpatient,1,EA,10.73000,10.19000,Amish/Mennonite,Amish Mennonite,,5.90,,,,,,,5.90,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,00591-3209-60,NDC,,,facility,outpatient,1,EA,10.73000,10.19000,Amish/Mennonite,Amish Mennonite,,5.90,,,,,,,5.37,10.41,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE 3 MG CAP,60944,CDM,250,RC,33342-0090-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 97 MG-103 MG,60945,CDM,250,RC,00078-0696-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,18.12,35.15,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.90,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,00884-6297-30,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.18,13.94,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,inpatient,1,mL,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
PHENOL TOPICAL 89% SWAB,60946,CDM,250,RC,51552-0118-03,NDC,,,facility,outpatient,1,mL,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,inpatient,1,EA,4.22000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.09,percent of total billed charges,
RIBAVIRIN CAP 200 MG,60947,CDM,250,RC,68382-0260-12,NDC,,,facility,outpatient,1,EA,4.22000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.11,4.09,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,33342-0089-09,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,inpatient,1,EA,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,51991-0793-06,NDC,,,facility,outpatient,1,EA,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
RIVASTIGMINE CAP 1.5 MG,60948,CDM,250,RC,55111-0352-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,inpatient,1,EA,12.91000,12.26000,Amish/Mennonite,Amish Mennonite,,7.10,,,,,,,7.10,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,49884-0315-55,NDC,,,facility,outpatient,1,EA,12.91000,12.26000,Amish/Mennonite,Amish Mennonite,,7.10,,,,,,,6.46,12.52,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,inpatient,1,EA,6.89000,6.54000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.68,percent of total billed charges,
RISPERIDONE 1 MG DIS TAB,60949,CDM,250,RC,59746-0020-22,NDC,,,facility,outpatient,1,EA,6.89000,6.54000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.44,6.68,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,inpatient,1,mL,789.60000,750.12000,Amish/Mennonite,Amish Mennonite,,434.28,,,,,,,434.28,765.91,percent of total billed charges,
PORACTANT 80 MG/ML INTRATRACHEAL SUSP,60950,CDM,250,RC,10122-0510-01,NDC,,,facility,outpatient,1,mL,789.60000,750.12000,Amish/Mennonite,Amish Mennonite,,434.28,,,,,,,394.80,765.91,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,inpatient,1,EA,63.19000,60.03000,Amish/Mennonite,Amish Mennonite,,34.75,,,,,,,34.75,61.29,percent of total billed charges,
RISPERIDONE 2 MG DIS TAB,60951,CDM,250,RC,50458-0325-28,NDC,,,facility,outpatient,1,EA,63.19000,60.03000,Amish/Mennonite,Amish Mennonite,,34.75,,,,,,,31.59,61.29,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,inpatient,1,EA,46.75000,44.41000,Amish/Mennonite,Amish Mennonite,,25.71,,,,,,,25.71,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,00310-0095-30,NDC,,,facility,outpatient,1,EA,46.75000,44.41000,Amish/Mennonite,Amish Mennonite,,25.71,,,,,,,23.38,45.35,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
ROFLUMILAST TAB 500 MCG,60952,CDM,250,RC,31722-0623-30,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,inpatient,1,EA,1375.24000,1306.48000,Amish/Mennonite,Amish Mennonite,,756.38,,,,,,,756.38,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,00480123208,NDC,facility,outpatient,1,EA,1375.24000,1306.48000,Amish/Mennonite,Amish Mennonite,,756.38,,,,,,,10.94,1333.98,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,inpatient,1,EA,1591.71000,1512.12000,Amish/Mennonite,Amish Mennonite,,875.44,,,,,,,875.44,1543.96,percent of total billed charges,
RISPERIDONE POWD-INJ 25 MG/2 WEEKS (RISPERDAL CONSTA),60953,CDM,636,RC,J2794,HCPCS,50458030611,NDC,facility,outpatient,1,EA,1591.71000,1512.12000,Amish/Mennonite,Amish Mennonite,,875.44,,,,,,,10.94,1543.96,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,inpatient,1,EA,2471.39000,2347.82000,Amish/Mennonite,Amish Mennonite,,1359.26,,,,,,,1359.26,2397.25,percent of total billed charges,
RASBURICASE POWD-INJ 1.5 MG,60954,CDM,636,RC,J2783,HCPCS,00024515010,NDC,facility,outpatient,1,EA,2471.39000,2347.82000,Amish/Mennonite,Amish Mennonite,,1359.26,,,,,,,376.48,2397.25,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,inpatient,1,EA,1664.33000,1581.12000,Amish/Mennonite,Amish Mennonite,,915.38,,,,,,,915.38,1614.40,percent of total billed charges,
SECRETIN SYNTHETIC HUMAN 16 MCG IV INJ,60955,CDM,636,RC,J2850,HCPCS,67066000501,NDC,facility,outpatient,1,EA,1664.33000,1581.12000,Amish/Mennonite,Amish Mennonite,,915.38,,,,,,,43.79,1614.40,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,inpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,13668-0094-90,NDC,,,facility,outpatient,1,EA,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,33342-0034-10,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,57237-0184-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,inpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,60687-0592-21,NDC,,,facility,outpatient,1,EA,3.09000,2.93000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
PRAMIPEXOLE TAB 1 MG,60956,CDM,250,RC,68462-0333-90,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
ROPIVACAINE 250 MG/250 ML CADD,60957,CDM,250,RC,61553-0134-09,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
SALICYLIC ACID-SULFUR TOP 2%-2% SHAMPOO,60958,CDM,250,RC,10631-0108-07,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,inpatient,1,EA,100.29000,95.28000,Amish/Mennonite,Amish Mennonite,,55.16,,,,,,,55.16,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,00013530117,NDC,facility,outpatient,1,EA,100.29000,95.28000,Amish/Mennonite,Amish Mennonite,,55.16,,,,,,,50.15,97.28,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,inpatient,1,EA,44.23000,42.01000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,24.33,42.90,percent of total billed charges,
RIFABUTIN 150 MG CAP,60959,CDM,250,RC,J3490,HCPCS,68180028501,NDC,facility,outpatient,1,EA,44.23000,42.01000,Amish/Mennonite,Amish Mennonite,,24.33,,,,,,,22.11,42.90,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,inpatient,1,mL,10.78000,10.24000,Amish/Mennonite,Amish Mennonite,,5.93,,,,,,,5.93,10.46,percent of total billed charges,
SILDENAFIL SUSP SD 2.5 MG/ML,60960,CDM,250,RC,00069-4210-30-00250,NDC,,,facility,outpatient,1,mL,10.78000,10.24000,Amish/Mennonite,Amish Mennonite,,5.93,,,,,,,5.39,10.46,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,inpatient,1,EA,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,00008104105,NDC,facility,outpatient,1,EA,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,1.54,89.63,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,inpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,21.73,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,16714018801,NDC,facility,outpatient,1,EA,39.50000,37.52000,Amish/Mennonite,Amish Mennonite,,21.73,,,,,,,1.54,38.31,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,inpatient,1,EA,42.55000,40.42000,Amish/Mennonite,Amish Mennonite,,23.40,,,,,,,23.40,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,50268071813,NDC,facility,outpatient,1,EA,42.55000,40.42000,Amish/Mennonite,Amish Mennonite,,23.40,,,,,,,1.54,41.27,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,inpatient,1,EA,43.10000,40.94000,Amish/Mennonite,Amish Mennonite,,23.70,,,,,,,23.70,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,55111065301,NDC,facility,outpatient,1,EA,43.10000,40.94000,Amish/Mennonite,Amish Mennonite,,23.70,,,,,,,1.54,41.81,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,inpatient,1,EA,43.87000,41.67000,Amish/Mennonite,Amish Mennonite,,24.13,,,,,,,24.13,42.55,percent of total billed charges,
SIROLIMUS TAB 1 MG,60961,CDM,250,RC,J7520,HCPCS,68084091525,NDC,facility,outpatient,1,EA,43.87000,41.67000,Amish/Mennonite,Amish Mennonite,,24.13,,,,,,,1.54,42.55,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,inpatient,1,EA,33.47000,31.79000,Amish/Mennonite,Amish Mennonite,,18.41,,,,,,,18.41,32.47,percent of total billed charges,
RIFAXIMIN 200 MG TAB,60963,CDM,250,RC,65649-0301-03,NDC,,,facility,outpatient,1,EA,33.47000,31.79000,Amish/Mennonite,Amish Mennonite,,18.41,,,,,,,16.73,32.47,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
RITONAVIR LIQ 80 MG/ML,60964,CDM,250,RC,00074-1940-63,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,inpatient,1,EA,223.47000,212.29000,Amish/Mennonite,Amish Mennonite,,122.91,,,,,,,122.91,216.77,percent of total billed charges,
SILDENAFIL TAB 50 MG,60965,CDM,250,RC,00069-4210-30,NDC,,,facility,outpatient,1,EA,223.47000,212.29000,Amish/Mennonite,Amish Mennonite,,122.91,,,,,,,111.73,216.77,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,inpatient,1,EA,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,69452-0156-73,NDC,,,facility,outpatient,1,EA,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.51,2.93,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,inpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.70,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,33342-0093-72,NDC,,,facility,outpatient,1,EA,8.54000,8.11000,Amish/Mennonite,Amish Mennonite,,4.70,,,,,,,4.27,8.28,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,inpatient,1,EA,10.51000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.78,10.19,percent of total billed charges,
RIZATRIPTAN 5 MG DIS TAB,60966,CDM,250,RC,60505-3723-01,NDC,,,facility,outpatient,1,EA,10.51000,9.98000,Amish/Mennonite,Amish Mennonite,,5.78,,,,,,,5.25,10.19,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 24 MG-26 MG,60967,CDM,250,RC,00078-0659-67,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,18.12,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,inpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,19.93,35.15,percent of total billed charges,
SACUBITRIL-VALSARTAN TAB 49 MG-51 MG,60968,CDM,250,RC,00078-0777-20,NDC,,,facility,outpatient,1,EA,36.24000,34.42000,Amish/Mennonite,Amish Mennonite,,19.93,,,,,,,18.12,35.15,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,inpatient,1,mL,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,3.28,5.79,percent of total billed charges,
RIFAMPIN/D5W SOLN SD 6 MG/ML,60970,CDM,250,RC,55390-0123-01-00600,NDC,,,facility,outpatient,1,mL,5.97000,5.67000,Amish/Mennonite,Amish Mennonite,,3.28,,,,,,,2.98,5.79,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,inpatient,1,mL,37.82000,35.92000,Amish/Mennonite,Amish Mennonite,,20.80,,,,,,,20.80,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0305-03,NDC,,,facility,outpatient,1,mL,37.82000,35.92000,Amish/Mennonite,Amish Mennonite,,20.80,,,,,,,18.91,36.69,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,inpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,50458-0596-01,NDC,,,facility,outpatient,1,mL,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,inpatient,1,mL,3.18000,3.02000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.75,3.08,percent of total billed charges,
RISPERIDONE LIQ 1 MG/ML,60971,CDM,250,RC,65162-0673-84,NDC,,,facility,outpatient,1,mL,3.18000,3.02000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.59,3.08,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,inpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00591-0582-01,NDC,,,facility,outpatient,1,EA,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,00603-5448-21,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,53489-0551-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,inpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,59651-0256-01,NDC,,,facility,outpatient,1,EA,0.74000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,inpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
PROPAFENONE TAB 150 MG,60972,CDM,250,RC,60687-0537-01,NDC,,,facility,outpatient,1,EA,2.43000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,inpatient,1,EA,12.36000,11.74000,Amish/Mennonite,Amish Mennonite,,6.80,,,,,,,6.80,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,50268-0708-15,NDC,,,facility,outpatient,1,EA,12.36000,11.74000,Amish/Mennonite,Amish Mennonite,,6.80,,,,,,,6.18,11.99,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,inpatient,1,EA,3.58000,3.40000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,52817-0235-30,NDC,,,facility,outpatient,1,EA,3.58000,3.40000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.79,3.47,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,inpatient,1,EA,40.98000,38.93000,Amish/Mennonite,Amish Mennonite,,22.54,,,,,,,22.54,39.75,percent of total billed charges,
RAMELTEON TAB 8 MG,60973,CDM,250,RC,64764-0805-30,NDC,,,facility,outpatient,1,EA,40.98000,38.93000,Amish/Mennonite,Amish Mennonite,,22.54,,,,,,,20.49,39.75,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,inpatient,1,EA,641.04000,608.99000,Amish/Mennonite,Amish Mennonite,,352.57,,,,,,,352.57,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,00024584305,NDC,facility,outpatient,1,EA,641.04000,608.99000,Amish/Mennonite,Amish Mennonite,,352.57,,,,,,,56.09,621.81,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,inpatient,1,EA,565.96000,537.66000,Amish/Mennonite,Amish Mennonite,,311.28,,,,,,,311.28,548.98,percent of total billed charges,
SARGRAMOSTIM 250 MCG IV INJ,60974,CDM,636,RC,J2820,HCPCS,58468018002,NDC,facility,outpatient,1,EA,565.96000,537.66000,Amish/Mennonite,Amish Mennonite,,311.28,,,,,,,56.09,548.98,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,inpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.89100,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,00115-1365-29,NDC,,,facility,outpatient,1,EA,1.62000,1.54000,Amish/Mennonite,Amish Mennonite,,0.89100,,,,,,,0.81000,1.57,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,inpatient,1,EA,53.51000,50.83000,Amish/Mennonite,Amish Mennonite,,29.43,,,,,,,29.43,51.90,percent of total billed charges,
SEVELAMER CARBONATE PWD 0.8 GM PKT,60975,CDM,250,RC,58468-0132-01,NDC,,,facility,outpatient,1,EA,53.51000,50.83000,Amish/Mennonite,Amish Mennonite,,29.43,,,,,,,26.75,51.90,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,inpatient,1,EA,7.19000,6.83000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.95,6.97,percent of total billed charges,
RIMANTADINE TAB 100 MG,60976,CDM,250,RC,00115-1911-01,NDC,,,facility,outpatient,1,EA,7.19000,6.83000,Amish/Mennonite,Amish Mennonite,,3.95,,,,,,,3.60,6.97,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,inpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,00409666075,NDC,facility,outpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323009040,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,inpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
SODIUM CHLORIDE SOLN 2.5 MEQ/ML 40 ML,60977,CDM,250,RC,J7131,HCPCS,63323013940,NDC,facility,outpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,inpatient,1,EA,5.29000,5.03000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,2.91,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,60505-0055-01,NDC,,,facility,outpatient,1,EA,5.29000,5.03000,Amish/Mennonite,Amish Mennonite,,2.91,,,,,,,2.65,5.13,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
SELEGILINE 5 MG CAP,60978,CDM,250,RC,70954-0504-10,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,inpatient,1,EA,7.70000,7.32000,Amish/Mennonite,Amish Mennonite,,4.24,,,,,,,4.24,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00228-2780-11,NDC,,,facility,outpatient,1,EA,7.70000,7.32000,Amish/Mennonite,Amish Mennonite,,4.24,,,,,,,3.85,7.47,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,00527-4118-37,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,42291-0524-01,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,inpatient,1,EA,5.01000,4.75000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.76,4.86,percent of total billed charges,
PROPRANOLOL CAP-ER 120 MG,60980,CDM,250,RC,51991-0819-01,NDC,,,facility,outpatient,1,EA,5.01000,4.75000,Amish/Mennonite,Amish Mennonite,,2.76,,,,,,,2.50,4.86,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,inpatient,1,mL,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
SELENIUM SOLN-INJ 40 MCG/ML,60981,CDM,250,RC,J3490,HCPCS,00517651025,NDC,facility,outpatient,1,mL,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ROPIVACAINE 500 MG/250 ML CADD,60982,CDM,250,RC,45183-0902-02,NDC,,,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,inpatient,1,EA,11.15000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,6.13,10.82,percent of total billed charges,
SEVELAMER TAB 400 MG,60983,CDM,250,RC,58468-0020-01,NDC,,,facility,outpatient,1,EA,11.15000,10.59000,Amish/Mennonite,Amish Mennonite,,6.13,,,,,,,5.58,10.82,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,inpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
SELENIUM TAB 200 MCG,60984,CDM,250,RC,74312-0032-01,NDC,,,facility,outpatient,1,EA,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,16714-0681-01,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
SIMVASTATIN 5 MG TAB,60985,CDM,250,RC,63739-0570-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SELENIUM TAB 50 MCG,60986,CDM,250,RC,00904-3162-60,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
RISEDRONATE TAB 5 MG,60990,CDM,250,RC,33342-0107-07,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-06,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 100 ML,60991,CDM,250,RC,00409-3299-25,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM ACETATE SOLN 4 MEQ/ML,60992,CDM,250,RC,J3490,HCPCS,00517502325,NDC,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,inpatient,1,mL,839.47000,797.49000,Amish/Mennonite,Amish Mennonite,,461.71,,,,,,,461.71,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,13533061810,NDC,facility,outpatient,1,mL,839.47000,797.49000,Amish/Mennonite,Amish Mennonite,,461.71,,,,,,,266.44,814.29,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,inpatient,1,mL,881.44000,837.37000,Amish/Mennonite,Amish Mennonite,,484.79,,,,,,,484.79,855.00,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 10 ML,60994,CDM,636,RC,90375,HCPCS,76125015010,NDC,facility,outpatient,1,mL,881.44000,837.37000,Amish/Mennonite,Amish Mennonite,,484.79,,,,,,,266.44,855.00,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,27241-0037-03,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,42291-0739-90,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,50228-0427-90,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,inpatient,1,EA,40.61000,38.58000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,22.34,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,51248-0150-01,NDC,,,facility,outpatient,1,EA,40.61000,38.58000,Amish/Mennonite,Amish Mennonite,,22.34,,,,,,,20.30,39.39,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,inpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
SOLIFENACIN TAB 5 MG,60995,CDM,250,RC,68462-0386-30,NDC,,,facility,outpatient,1,EA,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,inpatient,1,mL,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,50.82,89.63,percent of total billed charges,
SIROLIMUS LIQ 1 MG/ML,60997,CDM,250,RC,J7520,HCPCS,00008103006,NDC,facility,outpatient,1,mL,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,1.54,89.63,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,inpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
SALICYLIC ACID LIQ-TOP 3%,60999,CDM,250,RC,11509-0003-25,NDC,,,facility,outpatient,1,mL,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,inpatient,1,mL,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 2% SOL",61000,CDM,250,RC,24208-0276-15,NDC,,,facility,outpatient,1,mL,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.05 MMOL/ML,61002,CDM,250,RC,00517-3405-25-00005,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,00536-4540-10,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
SODIUM BICARBONATE TAB 325 MG,61003,CDM,250,RC,69618-0035-10,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,inpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,3.10,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,51293-0804-01,NDC,,,facility,outpatient,1,EA,5.64000,5.36000,Amish/Mennonite,Amish Mennonite,,3.10,,,,,,,2.82,5.47,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,65162-0513-10,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
SALSALATE TAB 750 MG,61004,CDM,250,RC,71205-0983-30,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,inpatient,1,mL,101.37000,96.30000,Amish/Mennonite,Amish Mennonite,,55.75,,,,,,,55.75,98.33,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 0.12% 5 ML,61006,CDM,250,RC,11980-0174-05,NDC,,,facility,outpatient,1,mL,101.37000,96.30000,Amish/Mennonite,Amish Mennonite,,55.75,,,,,,,50.69,98.33,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,inpatient,1,GM,24.73000,23.49000,Amish/Mennonite,Amish Mennonite,,13.60,,,,,,,13.60,23.99,percent of total billed charges,
SODIUM SULFACETAMIDE-SULFUR TOP 10%-5% LOTION,61007,CDM,250,RC,44523-0607-01,NDC,,,facility,outpatient,1,GM,24.73000,23.49000,Amish/Mennonite,Amish Mennonite,,13.60,,,,,,,12.37,23.99,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,inpatient,1,mL,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,5.25,9.25,percent of total billed charges,
SODIUM HYALURONATE GEL TOP,61009,CDM,250,RC,89141-0456-02,NDC,,,facility,outpatient,1,mL,9.54000,9.06000,Amish/Mennonite,Amish Mennonite,,5.25,,,,,,,4.77,9.25,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,inpatient,1,EA,57.87000,54.97000,Amish/Mennonite,Amish Mennonite,,31.83,,,,,,,31.83,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,49884-0170-04,NDC,,,facility,outpatient,1,EA,57.87000,54.97000,Amish/Mennonite,Amish Mennonite,,31.83,,,,,,,28.93,56.13,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,inpatient,1,EA,46.74000,44.40000,Amish/Mennonite,Amish Mennonite,,25.71,,,,,,,25.71,45.34,percent of total billed charges,
SODIUM PHENYLBUTYRATE TAB 500 MG,61010,CDM,250,RC,62592-0496-03,NDC,,,facility,outpatient,1,EA,46.74000,44.40000,Amish/Mennonite,Amish Mennonite,,25.71,,,,,,,23.37,45.34,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00338070434,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
SODIUM CHLORIDE 0.45% W/ KCL 20 MEQ/L 1000 ML,61011,CDM,250,RC,J3480,HCPCS,00990925739,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,inpatient,1,EA,402.97000,382.82000,Amish/Mennonite,Amish Mennonite,,221.63,,,,,,,221.63,390.88,percent of total billed charges,
SORAFENIB TAB 200 MG,61012,CDM,250,RC,J8999,HCPCS,50419048858,NDC,facility,outpatient,1,EA,402.97000,382.82000,Amish/Mennonite,Amish Mennonite,,221.63,,,,,,,201.49,390.88,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,00904-6362-61,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,inpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.49500,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,27241-0006-06,NDC,,,facility,outpatient,1,EA,0.90000,0.85000,Amish/Mennonite,Amish Mennonite,,0.49500,,,,,,,0.45000,0.87300,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,43547-0344-06,NDC,,,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,inpatient,1,EA,89.24000,84.77000,Amish/Mennonite,Amish Mennonite,,49.08,,,,,,,49.08,86.56,percent of total billed charges,
RISPERIDONE 4 MG TAB,61015,CDM,250,RC,50458-0350-06,NDC,,,facility,outpatient,1,EA,89.24000,84.77000,Amish/Mennonite,Amish Mennonite,,49.08,,,,,,,44.62,86.56,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,inpatient,1,mL,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,00254-1011-96,NDC,,,facility,outpatient,1,mL,1.32000,1.26000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,inpatient,1,mL,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,58914-0170-14,NDC,,,facility,outpatient,1,mL,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.00,1.95,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,inpatient,1,mL,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
SUCRALFATE 1 G/10 ML SUSP 420 ML,61016,CDM,250,RC,66689-0305-16,NDC,,,facility,outpatient,1,mL,1.34000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.67000,1.30,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,inpatient,1,mL,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 120 ML,61017,CDM,250,RC,46287-0006-04,NDC,,,facility,outpatient,1,mL,1.07000,1.01000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,inpatient,1,EA,250.10000,237.60000,Amish/Mennonite,Amish Mennonite,,137.56,,,,,,,137.56,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00173-0523-00,NDC,,,facility,outpatient,1,EA,250.10000,237.60000,Amish/Mennonite,Amish Mennonite,,137.56,,,,,,,125.05,242.60,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,inpatient,1,EA,190.56000,181.03000,Amish/Mennonite,Amish Mennonite,,104.81,,,,,,,104.81,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00527-1859-43,NDC,,,facility,outpatient,1,EA,190.56000,181.03000,Amish/Mennonite,Amish Mennonite,,104.81,,,,,,,95.28,184.84,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,Amish/Mennonite,Amish Mennonite,,85.51,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,00781-6523-86,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,Amish/Mennonite,Amish Mennonite,,85.51,,,,,,,77.74,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,inpatient,1,EA,155.48000,147.70000,Amish/Mennonite,Amish Mennonite,,85.51,,,,,,,85.51,150.82,percent of total billed charges,
SUMATRIPTAN SPRAY NASAL 20 MG/INH,61018,CDM,250,RC,66993-0082-69,NDC,,,facility,outpatient,1,EA,155.48000,147.70000,Amish/Mennonite,Amish Mennonite,,85.51,,,,,,,77.74,150.82,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,inpatient,1,GM,9.26000,8.80000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,5.09,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,00536-1253-91,NDC,,,facility,outpatient,1,GM,9.26000,8.80000,Amish/Mennonite,Amish Mennonite,,5.09,,,,,,,4.63,8.98,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.94,14.00,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% OINT",61019,CDM,250,RC,24208-0385-55,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.21,14.00,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,00536-1995-53,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SELENIUM SULFIDE SHAMPOO 1% 207 ML,61020,CDM,250,RC,41167-0606-16,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,inpatient,1,mL,1627.34000,1545.97000,Amish/Mennonite,Amish Mennonite,,895.04,,,,,,,895.04,1578.52,percent of total billed charges,
SODIUM BENZOATE-SODIUM PHENYLACETATE 10%-10% 50 ML,61021,CDM,250,RC,62592-0720-50,NDC,,,facility,outpatient,1,mL,1627.34000,1545.97000,Amish/Mennonite,Amish Mennonite,,895.04,,,,,,,813.67,1578.52,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,inpatient,1,mL,121.66000,115.58000,Amish/Mennonite,Amish Mennonite,,66.91,,,,,,,66.91,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,24201020105,NDC,facility,outpatient,1,mL,121.66000,115.58000,Amish/Mennonite,Amish Mennonite,,66.91,,,,,,,60.83,118.01,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,inpatient,1,mL,123.44000,117.27000,Amish/Mennonite,Amish Mennonite,,67.89,,,,,,,67.89,119.74,percent of total billed charges,
SODIUM TETRADECYL SULFATE 3% SOLN,61022,CDM,250,RC,J3490,HCPCS,67457016302,NDC,facility,outpatient,1,mL,123.44000,117.27000,Amish/Mennonite,Amish Mennonite,,67.89,,,,,,,61.72,119.74,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,00436-0936-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.25% (DAKINS HALF STRENGTH)  473 ML,61023,CDM,250,RC,39328-0063-25,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,inpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.79750,1.41,percent of total billed charges,
TACROLIMUS SUSP SD 0.5 MG/ML,61024,CDM,250,RC,16729-0041-01-00050,NDC,,,facility,outpatient,1,mL,1.45000,1.38000,Amish/Mennonite,Amish Mennonite,,0.79750,,,,,,,0.72500,1.41,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,inpatient,1,mL,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729925,NDC,facility,outpatient,1,mL,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,inpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00409729973,NDC,facility,outpatient,1,mL,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,inpatient,1,mL,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00517209625,NDC,facility,outpatient,1,mL,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,inpatient,1,mL,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
SODIUM ACETATE SOLN 2 MEQ/ML 20 ML,61025,CDM,250,RC,J3490,HCPCS,00641626101,NDC,facility,outpatient,1,mL,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
SPIRONOLACTONE SUSP SD 5 MG/ML,61026,CDM,250,RC,51079-0103-20-00500,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,inpatient,1,mL,3.85000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,2.12,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,00409-7391-72,NDC,,,facility,outpatient,1,mL,3.85000,3.66000,Amish/Mennonite,Amish Mennonite,,2.12,,,,,,,1.93,3.73,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,inpatient,1,mL,0.41000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0170-15,NDC,,,facility,outpatient,1,mL,0.41000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,inpatient,1,mL,4.57000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.51,4.43,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 15 ML,61027,CDM,250,RC,63323-0881-16,NDC,,,facility,outpatient,1,mL,4.57000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.29,4.43,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,inpatient,1,EA,70.34000,66.82000,Amish/Mennonite,Amish Mennonite,,38.69,,,,,,,38.69,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,55292-0201-11,NDC,,,facility,outpatient,1,EA,70.34000,66.82000,Amish/Mennonite,Amish Mennonite,,38.69,,,,,,,35.17,68.23,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,inpatient,1,EA,26.05000,24.74000,Amish/Mennonite,Amish Mennonite,,14.33,,,,,,,14.33,25.27,percent of total billed charges,
SUCCIMER 100 MG CAP,61029,CDM,250,RC,67386-0201-11,NDC,,,facility,outpatient,1,EA,26.05000,24.74000,Amish/Mennonite,Amish Mennonite,,14.33,,,,,,,13.03,25.27,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,16714-0086-03,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,51079-0980-20,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,inpatient,1,EA,2.43000,2.30000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,53746-0515-01,NDC,,,facility,outpatient,1,EA,2.43000,2.30000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.36,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,inpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.27,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,60687-0487-01,NDC,,,facility,outpatient,1,EA,2.31000,2.19000,Amish/Mennonite,Amish Mennonite,,1.27,,,,,,,1.16,2.24,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,63629-1095-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
SPIRONOLACTONE TAB 100 MG,61030,CDM,250,RC,68382-0662-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,inpatient,1,mL,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,00054-0379-63,NDC,,,facility,outpatient,1,mL,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,inpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE 15 G/60 ML SUSP 473 ML,61031,CDM,250,RC,46287-0006-01,NDC,,,facility,outpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,0.43650,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,inpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,00517340525,NDC,facility,outpatient,1,mL,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,inpatient,1,mL,10.20000,9.69000,Amish/Mennonite,Amish Mennonite,,5.61,,,,,,,5.61,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323017005,NDC,facility,outpatient,1,mL,10.20000,9.69000,Amish/Mennonite,Amish Mennonite,,5.61,,,,,,,5.10,9.89,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,inpatient,1,mL,10.76000,10.22000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.92,10.44,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 5 ML,61032,CDM,250,RC,J3490,HCPCS,63323088406,NDC,facility,outpatient,1,mL,10.76000,10.22000,Amish/Mennonite,Amish Mennonite,,5.92,,,,,,,5.38,10.44,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,inpatient,1,GM,41.98000,39.88000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,23.09,40.72,percent of total billed charges,
TAZAROTENE TOP 0.05% CRM,61034,CDM,250,RC,00023-9155-30,NDC,,,facility,outpatient,1,GM,41.98000,39.88000,Amish/Mennonite,Amish Mennonite,,23.09,,,,,,,20.99,40.72,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,inpatient,1,EA,122.59000,116.46000,Amish/Mennonite,Amish Mennonite,,67.42,,,,,,,67.42,118.91,percent of total billed charges,
TEMOZOLOMIDE 20 MG CAP,61035,CDM,250,RC,J8700,HCPCS,00093760041,NDC,facility,outpatient,1,EA,122.59000,116.46000,Amish/Mennonite,Amish Mennonite,,67.42,,,,,,,0.57636,118.91,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
SODIUM CHLORIDE DROPS-NASAL 0.65% 30 ML,61036,CDM,250,RC,00225-0550-50,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,inpatient,1,mL,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,00536-1254-94,NDC,,,facility,outpatient,1,mL,0.92000,0.88000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,inpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,17478-0623-12,NDC,,,facility,outpatient,1,mL,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,inpatient,1,mL,3.53000,3.36000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.42,percent of total billed charges,
"SODIUM CHLORIDE, HYPERTONIC, OPHTH 5% SOL",61037,CDM,250,RC,24208-0277-15,NDC,,,facility,outpatient,1,mL,3.53000,3.36000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.42,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,inpatient,1,EA,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.91,percent of total billed charges,
SULINDAC TAB 200 MG,61038,CDM,250,RC,51079-0667-20,NDC,,,facility,outpatient,1,EA,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.91,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
SPIRONOLACTONE 12.5 MG TAB,61039,CDM,250,RC,51079-0103-20-00050,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,inpatient,1,EA,177.91000,169.02000,Amish/Mennonite,Amish Mennonite,,97.85,,,,,,,97.85,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,00002-4464-30,NDC,,,facility,outpatient,1,EA,177.91000,169.02000,Amish/Mennonite,Amish Mennonite,,97.85,,,,,,,88.95,172.57,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,inpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
TADALAFIL TAB 20 MG,61040,CDM,250,RC,29300-0289-13,NDC,,,facility,outpatient,1,EA,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
SOTALOL SUSP SD 5 MG/ML,61041,CDM,250,RC,68084-0654-01-00500,NDC,,,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,inpatient,1,mL,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.79,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71019034104,NDC,facility,outpatient,1,mL,6.90000,6.55000,Amish/Mennonite,Amish Mennonite,,3.79,,,,,,,3.45,6.69,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,inpatient,1,mL,13.21000,12.55000,Amish/Mennonite,Amish Mennonite,,7.27,,,,,,,7.27,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,70092108644,NDC,facility,outpatient,1,mL,13.21000,12.55000,Amish/Mennonite,Amish Mennonite,,7.27,,,,,,,6.61,12.81,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,inpatient,1,mL,6.29000,5.97000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.46,6.10,percent of total billed charges,
SUCCINYLCHOLINE SOLN 20 MG/ML 5 ML,61042,CDM,250,RC,J0330,HCPCS,71266200101,NDC,facility,outpatient,1,mL,6.29000,5.97000,Amish/Mennonite,Amish Mennonite,,3.46,,,,,,,3.15,6.10,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,inpatient,1,GM,21.95000,20.85000,Amish/Mennonite,Amish Mennonite,,12.07,,,,,,,12.07,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00168-0417-30,NDC,,,facility,outpatient,1,GM,21.95000,20.85000,Amish/Mennonite,Amish Mennonite,,12.07,,,,,,,10.97,21.29,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,Amish/Mennonite,Amish Mennonite,,14.79,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.03% 30 GM,61045,CDM,250,RC,00469-5201-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,Amish/Mennonite,Amish Mennonite,,14.79,,,,,,,13.45,26.08,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,inpatient,1,EA,24.28000,23.06000,Amish/Mennonite,Amish Mennonite,,13.35,,,,,,,13.35,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,00003-1967-01,NDC,,,facility,outpatient,1,EA,24.28000,23.06000,Amish/Mennonite,Amish Mennonite,,13.35,,,,,,,12.14,23.55,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,inpatient,1,EA,5.66000,5.38000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,3.11,5.49,percent of total billed charges,
STAVUDINE 40 MG CAP,61046,CDM,250,RC,31722-0518-60,NDC,,,facility,outpatient,1,EA,5.66000,5.38000,Amish/Mennonite,Amish Mennonite,,3.11,,,,,,,2.83,5.49,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,00378-5631-59,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,inpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,3.08,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,62756-0521-69,NDC,,,facility,outpatient,1,EA,5.60000,5.32000,Amish/Mennonite,Amish Mennonite,,3.08,,,,,,,2.80,5.43,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,inpatient,1,EA,5.59000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,42043-0221-09,NDC,,,facility,outpatient,1,EA,5.59000,5.31000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.42,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,inpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.77000,1.36,percent of total billed charges,
SUMATRIPTAN TAB 50 MG,61048,CDM,250,RC,65862-0147-36,NDC,,,facility,outpatient,1,EA,1.40000,1.33000,Amish/Mennonite,Amish Mennonite,,0.77000,,,,,,,0.70000,1.36,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,inpatient,1,EA,716.81000,680.97000,Amish/Mennonite,Amish Mennonite,,394.25,,,,,,,394.25,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,67919004001,NDC,facility,outpatient,1,EA,716.81000,680.97000,Amish/Mennonite,Amish Mennonite,,394.25,,,,,,,1.91,695.31,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,inpatient,1,EA,828.93000,787.48000,Amish/Mennonite,Amish Mennonite,,455.91,,,,,,,455.91,804.06,percent of total billed charges,
TEDIZOLID POWD-INJ 200 MG,61049,CDM,636,RC,J3090,HCPCS,72000032010,NDC,facility,outpatient,1,EA,828.93000,787.48000,Amish/Mennonite,Amish Mennonite,,455.91,,,,,,,1.91,804.06,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,inpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,3.16,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,00013-0102-01,NDC,,,facility,outpatient,1,EA,5.75000,5.46000,Amish/Mennonite,Amish Mennonite,,3.16,,,,,,,2.88,5.58,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-05,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
SULFASALAZINE TAB-EC 500 MG,61050,CDM,250,RC,59762-0104-06,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,inpatient,1,mL,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,00703951493,NDC,facility,outpatient,1,mL,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.98,3.84,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,inpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 80 MG-16 MG/ML SOLN 10ML,61051,CDM,250,RC,J3490,HCPCS,70069036210,NDC,facility,outpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,3.72,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 15ML,61053,CDM,250,RC,68682-0920-64,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,inpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,46287-0500-01,NDC,,,facility,outpatient,1,mL,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
SORBITOL 70% LIQ 480 ML,61054,CDM,250,RC,54162-0700-16,NDC,,,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,inpatient,1,EA,19.45000,18.47000,Amish/Mennonite,Amish Mennonite,,10.70,,,,,,,10.70,18.87,percent of total billed charges,
TAPENTADOL TAB 75 MG,61057,CDM,250,RC,50458-0830-04,NDC,,,facility,outpatient,1,EA,19.45000,18.47000,Amish/Mennonite,Amish Mennonite,,10.70,,,,,,,9.72,18.87,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,inpatient,1,EA,8.68000,8.25000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.77,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,50474-0300-01,NDC,,,facility,outpatient,1,EA,8.68000,8.25000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.34,8.42,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,inpatient,1,EA,18.49000,17.57000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,10.17,17.94,percent of total billed charges,
THEOPHYLLINE CAP-24 300 MG/24 HOURS,61058,CDM,250,RC,52244-0300-10,NDC,,,facility,outpatient,1,EA,18.49000,17.57000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,9.24,17.94,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
SODIUM PHOSPHATE SOLN 3 MMOL/ML 50 ML,61060,CDM,250,RC,00517-3450-25,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,inpatient,1,GM,26.89000,25.54000,Amish/Mennonite,Amish Mennonite,,14.79,,,,,,,14.79,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,00469-5202-30,NDC,,,facility,outpatient,1,GM,26.89000,25.54000,Amish/Mennonite,Amish Mennonite,,14.79,,,,,,,13.45,26.08,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,inpatient,1,GM,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.79,10.21,percent of total billed charges,
TACROLIMUS OINT 0.1% 30 GM,61061,CDM,250,RC,68462-0534-35,NDC,,,facility,outpatient,1,GM,10.53000,10.01000,Amish/Mennonite,Amish Mennonite,,5.79,,,,,,,5.26,10.21,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,inpatient,1,EA,30.81000,29.27000,Amish/Mennonite,Amish Mennonite,,16.95,,,,,,,16.95,29.89,percent of total billed charges,
TEMOZOLOMIDE 5 MG CAP,61062,CDM,250,RC,J8700,HCPCS,00093759941,NDC,facility,outpatient,1,EA,30.81000,29.27000,Amish/Mennonite,Amish Mennonite,,16.95,,,,,,,0.57636,29.89,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM PHOSPHATE/D5W SOLN SD 0.1 MMOL/ML,61064,CDM,250,RC,00517-3405-25-00010,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,inpatient,1,mL,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,36.50,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009008601,NDC,facility,outpatient,1,mL,66.36000,63.04000,Amish/Mennonite,Amish Mennonite,,36.50,,,,,,,0.04650,64.37,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00009041701,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,0.04650,61.30,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,inpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,31.28,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00143965901,NDC,facility,outpatient,1,mL,56.88000,54.04000,Amish/Mennonite,Amish Mennonite,,31.28,,,,,,,0.04650,55.17,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,inpatient,1,mL,58.43000,55.51000,Amish/Mennonite,Amish Mennonite,,32.14,,,,,,,32.14,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00409656201,NDC,facility,outpatient,1,mL,58.43000,55.51000,Amish/Mennonite,Amish Mennonite,,32.14,,,,,,,0.04650,56.68,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,inpatient,1,mL,58.59000,55.66000,Amish/Mennonite,Amish Mennonite,,32.22,,,,,,,32.22,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00574082701,NDC,facility,outpatient,1,mL,58.59000,55.66000,Amish/Mennonite,Amish Mennonite,,32.22,,,,,,,0.04650,56.83,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,inpatient,1,mL,51.29000,48.72000,Amish/Mennonite,Amish Mennonite,,28.21,,,,,,,28.21,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,00781307471,NDC,facility,outpatient,1,mL,51.29000,48.72000,Amish/Mennonite,Amish Mennonite,,28.21,,,,,,,0.04650,49.75,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,inpatient,1,mL,57.67000,54.79000,Amish/Mennonite,Amish Mennonite,,31.72,,,,,,,31.72,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,52536062501,NDC,facility,outpatient,1,mL,57.67000,54.79000,Amish/Mennonite,Amish Mennonite,,31.72,,,,,,,0.04650,55.94,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,inpatient,1,mL,60.83000,57.79000,Amish/Mennonite,Amish Mennonite,,33.46,,,,,,,33.46,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,62756001540,NDC,facility,outpatient,1,mL,60.83000,57.79000,Amish/Mennonite,Amish Mennonite,,33.46,,,,,,,0.04650,59.01,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,inpatient,1,mL,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,23.46,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,69097080232,NDC,facility,outpatient,1,mL,42.66000,40.53000,Amish/Mennonite,Amish Mennonite,,23.46,,,,,,,0.04650,41.38,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,inpatient,1,mL,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,22.59,39.85,percent of total billed charges,
TESTOSTERONE CYPIONATE 200 MG/ML IM SOL,61066,CDM,250,RC,J1071,HCPCS,70700028922,NDC,facility,outpatient,1,mL,41.08000,39.03000,Amish/Mennonite,Amish Mennonite,,22.59,,,,,,,0.04650,39.85,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,inpatient,1,mL,1493.82000,1419.13000,Amish/Mennonite,Amish Mennonite,,821.60,,,,,,,821.60,1449.01,percent of total billed charges,
SOMATROPIN SOLN 5 MG/ML 2 ML,61067,CDM,250,RC,J2941,HCPCS,50242004314,NDC,facility,outpatient,1,mL,1493.82000,1419.13000,Amish/Mennonite,Amish Mennonite,,821.60,,,,,,,48.92,1449.01,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,inpatient,1,EA,20.76000,19.72000,Amish/Mennonite,Amish Mennonite,,11.42,,,,,,,11.42,20.14,percent of total billed charges,
TETRACYCLINE 500 MG CAP,61069,CDM,250,RC,23155-0018-01,NDC,,,facility,outpatient,1,EA,20.76000,19.72000,Amish/Mennonite,Amish Mennonite,,11.42,,,,,,,10.38,20.14,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,00591-5661-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,42806-0018-01,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SULINDAC TAB 150 MG,61070,CDM,250,RC,53489-0478-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714050102,NDC,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,16714079501,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,inpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,55111025030,NDC,facility,outpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,inpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,65862007930,NDC,facility,outpatient,1,EA,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
TERBINAFINE TAB 250 MG,61071,CDM,250,RC,J8499,HCPCS,67405050003,NDC,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
THIOTHIXENE 2 MG CAP,61072,CDM,250,RC,00378-2002-01,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,inpatient,1,GM,183.72000,174.54000,Amish/Mennonite,Amish Mennonite,,101.05,,,,,,,101.05,178.21,percent of total billed charges,
TESTOSTERONE PROPIONATE MICRONIZED COMPOUNDING PWDR,61074,CDM,250,RC,38779-0165-03,NDC,,,facility,outpatient,1,GM,183.72000,174.54000,Amish/Mennonite,Amish Mennonite,,101.05,,,,,,,91.86,178.21,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,inpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
THEOPHYLLINE TAB-ER 100 MG/12 HOURS,61075,CDM,250,RC,00904-5887-61,NDC,,,facility,outpatient,1,EA,1.54000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,inpatient,1,mL,533.15000,506.50000,Amish/Mennonite,Amish Mennonite,,293.23,,,,,,,293.23,517.16,percent of total billed charges,
TACROLIMUS SOLN 5 MG/ML,61076,CDM,636,RC,J7525,HCPCS,00469301601,NDC,facility,outpatient,1,mL,533.15000,506.50000,Amish/Mennonite,Amish Mennonite,,293.23,,,,,,,262.23,517.16,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,inpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,8.20,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,00904-6821-04,NDC,,,facility,outpatient,1,EA,14.90000,14.15000,Amish/Mennonite,Amish Mennonite,,8.20,,,,,,,7.45,14.45,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,inpatient,1,EA,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.92,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,16714-0820-01,NDC,,,facility,outpatient,1,EA,7.12000,6.76000,Amish/Mennonite,Amish Mennonite,,3.92,,,,,,,3.56,6.91,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,inpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,31722-0535-30,NDC,,,facility,outpatient,1,EA,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.75,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,inpatient,1,EA,132.04000,125.43000,Amish/Mennonite,Amish Mennonite,,72.62,,,,,,,72.62,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,61958-0401-01,NDC,,,facility,outpatient,1,EA,132.04000,125.43000,Amish/Mennonite,Amish Mennonite,,72.62,,,,,,,66.02,128.08,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,inpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,8.07,14.24,percent of total billed charges,
TENOFOVIR TAB 300 MG,61077,CDM,250,RC,69097-0533-02,NDC,,,facility,outpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,7.34,14.24,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,inpatient,1,EA,13.76000,13.07000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,7.57,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,00527-1318-01,NDC,,,facility,outpatient,1,EA,13.76000,13.07000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,6.88,13.35,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
TERBUTALINE TAB 2.5 MG,61079,CDM,250,RC,62559-0721-01,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,inpatient,1,EA,307.01000,291.66000,Amish/Mennonite,Amish Mennonite,,168.86,,,,,,,168.86,297.80,percent of total billed charges,
TOLCAPONE TAB 100 MG,61080,CDM,250,RC,00187-0938-01,NDC,,,facility,outpatient,1,EA,307.01000,291.66000,Amish/Mennonite,Amish Mennonite,,168.86,,,,,,,153.50,297.80,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,inpatient,1,EA,904.51000,859.28000,Amish/Mennonite,Amish Mennonite,,497.48,,,,,,,497.48,877.37,percent of total billed charges,
STREPTOZOCIN 1 G IV INJ,61082,CDM,250,RC,J9320,HCPCS,00703463601,NDC,facility,outpatient,1,EA,904.51000,859.28000,Amish/Mennonite,Amish Mennonite,,497.48,,,,,,,452.25,877.37,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,inpatient,1,mL,47.20000,44.84000,Amish/Mennonite,Amish Mennonite,,25.96,,,,,,,25.96,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00143975001,NDC,facility,outpatient,1,mL,47.20000,44.84000,Amish/Mennonite,Amish Mennonite,,25.96,,,,,,,0.08060,45.78,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,inpatient,1,mL,42.95000,40.80000,Amish/Mennonite,Amish Mennonite,,23.62,,,,,,,23.62,41.66,percent of total billed charges,
TESTOSTERONE ENANTHATE SOLN 200 MG/ML 5 ML,61083,CDM,250,RC,J3121,HCPCS,00591322126,NDC,facility,outpatient,1,mL,42.95000,40.80000,Amish/Mennonite,Amish Mennonite,,23.62,,,,,,,0.08060,41.66,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,inpatient,1,EA,21.04000,19.99000,Amish/Mennonite,Amish Mennonite,,11.57,,,,,,,11.57,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,00597-0040-37,NDC,,,facility,outpatient,1,EA,21.04000,19.99000,Amish/Mennonite,Amish Mennonite,,11.57,,,,,,,10.52,20.41,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
TELMISARTAN TAB 40 MG,61084,CDM,250,RC,68382-0472-78,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,inpatient,1,EA,23.76000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,13.07,23.05,percent of total billed charges,
TICAGRELOR TAB 60 MG,61085,CDM,250,RC,00186-0776-60,NDC,,,facility,outpatient,1,EA,23.76000,22.58000,Amish/Mennonite,Amish Mennonite,,13.07,,,,,,,11.88,23.05,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1002-94,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,00536-1217-94,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,inpatient,1,mL,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,49348-0037-29,NDC,,,facility,outpatient,1,mL,0.34000,0.33000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,inpatient,1,mL,26.54000,25.22000,Amish/Mennonite,Amish Mennonite,,14.60,,,,,,,14.60,25.74,percent of total billed charges,
TETRAHYDROZOLINE SOLN-OPHTH 0.05% 15 ML,61086,CDM,250,RC,69968-0355-01,NDC,,,facility,outpatient,1,mL,26.54000,25.22000,Amish/Mennonite,Amish Mennonite,,14.60,,,,,,,13.27,25.74,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,inpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
STREPTOMYCIN POWD-INJ 1 GM,61087,CDM,250,RC,J3000,HCPCS,39822070602,NDC,facility,outpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,39.66,229.89,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,inpatient,1,EA,904.31000,859.09000,Amish/Mennonite,Amish Mennonite,,497.37,,,,,,,497.37,877.18,percent of total billed charges,
SUNITINIB 25 MG CAP,61089,CDM,250,RC,J8999,HCPCS,00069077038,NDC,facility,outpatient,1,EA,904.31000,859.09000,Amish/Mennonite,Amish Mennonite,,497.37,,,,,,,452.15,877.18,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,00378-0616-01,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
THIORIDAZINE 50 MG TAB,61091,CDM,250,RC,51079-0567-20,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,inpatient,1,mL,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP (TDVAX),61092,CDM,250,RC,90714,HCPCS,13533013101,NDC,facility,outpatient,1,mL,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,52.64,110.03,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,inpatient,1,mL,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,36000024201,NDC,facility,outpatient,1,mL,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,inpatient,1,mL,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.25,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,63323030630,NDC,facility,outpatient,1,mL,2.32000,2.20000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.16,4.06,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,inpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
TOBRAMYCIN SOLN 40 MG/ML 30 ML,61093,CDM,250,RC,J3260,HCPCS,67457042830,NDC,facility,outpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,4.06,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,inpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.23650,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,16714-0171-01,NDC,,,facility,outpatient,1,EA,0.43000,0.41000,Amish/Mennonite,Amish Mennonite,,0.23650,,,,,,,0.21500,0.41710,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,29300-0168-15,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,42291-0808-15,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,inpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,50268-0759-15,NDC,,,facility,outpatient,1,EA,2.75000,2.61000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.38,2.67,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,55111-0179-15,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,57664-0502-89,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,60505-0251-03,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
TIZANIDINE TAB 2 MG,61094,CDM,250,RC,68084-0775-25,NDC,,,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,inpatient,1,EA,61.04000,57.99000,Amish/Mennonite,Amish Mennonite,,33.57,,,,,,,33.57,59.21,percent of total billed charges,
TOPIRAMATE TAB 200 MG,61096,CDM,250,RC,50458-0642-65,NDC,,,facility,outpatient,1,EA,61.04000,57.99000,Amish/Mennonite,Amish Mennonite,,33.57,,,,,,,30.52,59.21,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,inpatient,1,EA,5.25000,4.99000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.09,percent of total billed charges,
TRIAMTERENE-HCTZ CAP 50 MG-25 MG,61097,CDM,250,RC,00781-2715-01,NDC,,,facility,outpatient,1,EA,5.25000,4.99000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.62,5.09,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,inpatient,1,GM,26.25000,24.94000,Amish/Mennonite,Amish Mennonite,,14.44,,,,,,,14.44,25.46,percent of total billed charges,
TESTOSTERONE 25 MG/2.5 G (1%) GEL,61098,CDM,250,RC,00051-8425-30,NDC,,,facility,outpatient,1,GM,26.25000,24.94000,Amish/Mennonite,Amish Mennonite,,14.44,,,,,,,13.12,25.46,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,inpatient,1,mL,100.25000,95.24000,Amish/Mennonite,Amish Mennonite,,55.14,,,,,,,55.14,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,00065-0647-05,NDC,,,facility,outpatient,1,mL,100.25000,95.24000,Amish/Mennonite,Amish Mennonite,,55.14,,,,,,,50.12,97.24,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,inpatient,1,mL,64.08000,60.88000,Amish/Mennonite,Amish Mennonite,,35.24,,,,,,,35.24,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,24208-0295-05,NDC,,,facility,outpatient,1,mL,64.08000,60.88000,Amish/Mennonite,Amish Mennonite,,35.24,,,,,,,32.04,62.16,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,inpatient,1,mL,73.53000,69.86000,Amish/Mennonite,Amish Mennonite,,40.44,,,,,,,40.44,71.32,percent of total billed charges,
TOBRAMYCIN-DEXAMETHASONE SUSP-OPHTH  0.3%-0.1% 5 ML,61099,CDM,250,RC,61314-0647-05,NDC,,,facility,outpatient,1,mL,73.53000,69.86000,Amish/Mennonite,Amish Mennonite,,40.44,,,,,,,36.77,71.32,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,inpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
SPIRONOLACTONE-HCTZ SUSP SD 5 MG-5 MG/ML,61100,CDM,250,RC,59762-5014-01-00500,NDC,,,facility,outpatient,1,mL,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,inpatient,1,EA,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.37,4.18,percent of total billed charges,
TIMOLOL TAB 10 MG,61102,CDM,250,RC,00378-0221-01,NDC,,,facility,outpatient,1,EA,4.31000,4.09000,Amish/Mennonite,Amish Mennonite,,2.37,,,,,,,2.15,4.18,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,inpatient,1,EA,20.06000,19.06000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,11.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,72205-0085-30,NDC,,,facility,outpatient,1,EA,20.06000,19.06000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,10.03,19.46,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,inpatient,1,EA,27.01000,25.66000,Amish/Mennonite,Amish Mennonite,,14.86,,,,,,,14.86,26.20,percent of total billed charges,
TIAGABINE TAB 4 MG,61103,CDM,250,RC,63459-0404-30,NDC,,,facility,outpatient,1,EA,27.01000,25.66000,Amish/Mennonite,Amish Mennonite,,14.86,,,,,,,13.51,26.20,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,inpatient,1,mL,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,00049-4940-23,NDC,,,facility,outpatient,1,mL,12.11000,11.51000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.75,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,inpatient,1,mL,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
SERTRALINE CONC 20 MG/ML,61104,CDM,250,RC,59762-0067-01,NDC,,,facility,outpatient,1,mL,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,2.85,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,inpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,00456-0459-01,NDC,,,facility,outpatient,1,EA,3.38000,3.21000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.69,3.28,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
THYROID DESICCATED TAB 60 MG,61105,CDM,250,RC,52959-0149-00,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,inpatient,1,EA,23.22000,22.06000,Amish/Mennonite,Amish Mennonite,,12.77,,,,,,,12.77,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00009-4544-02,NDC,,,facility,outpatient,1,EA,23.22000,22.06000,Amish/Mennonite,Amish Mennonite,,12.77,,,,,,,11.61,22.52,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,inpatient,1,EA,8.59000,8.16000,Amish/Mennonite,Amish Mennonite,,4.72,,,,,,,4.72,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,00093-0018-06,NDC,,,facility,outpatient,1,EA,8.59000,8.16000,Amish/Mennonite,Amish Mennonite,,4.72,,,,,,,4.29,8.33,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,inpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.72600,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,33342-0098-09,NDC,,,facility,outpatient,1,EA,1.32000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72600,,,,,,,0.66000,1.28,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,inpatient,1,EA,4.83000,4.59000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.66,4.69,percent of total billed charges,
TOLTERODINE TAB 2 MG,61106,CDM,250,RC,59762-0800-02,NDC,,,facility,outpatient,1,EA,4.83000,4.59000,Amish/Mennonite,Amish Mennonite,,2.66,,,,,,,2.42,4.69,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,inpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.30,4.06,percent of total billed charges,
TOPIRAMATE CAP 25 MG,61107,CDM,250,RC,68382-0005-14,NDC,,,facility,outpatient,1,EA,4.19000,3.98000,Amish/Mennonite,Amish Mennonite,,2.30,,,,,,,2.10,4.06,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,inpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
TOBRAMYCIN SOLN SD 4 MG/ML,61108,CDM,250,RC,63323-0306-02-00400,NDC,,,facility,outpatient,1,mL,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,inpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
THEOPHYLLINE LIQ 5.3 MG/ML,61111,CDM,250,RC,27808-0033-01,NDC,,,facility,outpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,inpatient,1,mL,3283.73000,3119.54000,Amish/Mennonite,Amish Mennonite,,1806.05,,,,,,,1806.05,3185.22,percent of total billed charges,
TERIPARATIDE SOLN 250 MCG/ML 2.4 ML,61112,CDM,250,RC,J3110,HCPCS,00002840001,NDC,facility,outpatient,1,mL,3283.73000,3119.54000,Amish/Mennonite,Amish Mennonite,,1806.05,,,,,,,1641.87,3185.22,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,inpatient,1,EA,950.25000,902.73000,Amish/Mennonite,Amish Mennonite,,522.64,,,,,,,522.64,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,00143956501,NDC,facility,outpatient,1,EA,950.25000,902.73000,Amish/Mennonite,Amish Mennonite,,522.64,,,,,,,365.89,921.74,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,inpatient,1,EA,1541.05000,1464.00000,Amish/Mennonite,Amish Mennonite,,847.58,,,,,,,847.58,1494.82,percent of total billed charges,
THIOTEPA POWD-INJ 15 MG,61113,CDM,636,RC,J9340,HCPCS,55390003010,NDC,facility,outpatient,1,EA,1541.05000,1464.00000,Amish/Mennonite,Amish Mennonite,,847.58,,,,,,,365.89,1494.82,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,inpatient,1,EA,112.97000,107.32000,Amish/Mennonite,Amish Mennonite,,62.13,,,,,,,62.13,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,50102-0911-01,NDC,,,facility,outpatient,1,EA,112.97000,107.32000,Amish/Mennonite,Amish Mennonite,,62.13,,,,,,,56.48,109.58,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,inpatient,1,EA,122.45000,116.33000,Amish/Mennonite,Amish Mennonite,,67.35,,,,,,,67.35,118.78,percent of total billed charges,
ULIPRISTAL TAB 30 MG,61114,CDM,250,RC,73302-0456-01,NDC,,,facility,outpatient,1,EA,122.45000,116.33000,Amish/Mennonite,Amish Mennonite,,67.35,,,,,,,61.23,118.78,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,inpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,00536-4678-01,NDC,,,facility,outpatient,1,EA,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
THIAMINE 50 MG TAB,61116,CDM,250,RC,80681-0097-00,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,inpatient,1,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.73,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,49884-0412-01,NDC,,,facility,outpatient,1,EA,6.78000,6.44000,Amish/Mennonite,Amish Mennonite,,3.73,,,,,,,3.39,6.58,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,inpatient,1,EA,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,60.83,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,60687-0527-21,NDC,,,facility,outpatient,1,EA,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,55.30,107.28,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
URSODIOL TAB 250 MG,61117,CDM,250,RC,64380-0918-06,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,inpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
TOBRAMYCIN SOLN-OPHTH SD 13 MG/ML,61118,CDM,250,RC,63323-0306-02-01300,NDC,,,facility,outpatient,1,mL,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,inpatient,1,GM,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
TOLNAFTATE TOP 1% CRM,61120,CDM,250,RC,51672-2020-02,NDC,,,facility,outpatient,1,GM,0.55000,0.52000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,inpatient,1,mL,30.03000,28.53000,Amish/Mennonite,Amish Mennonite,,16.52,,,,,,,16.52,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,00003029320,NDC,facility,outpatient,1,mL,30.03000,28.53000,Amish/Mennonite,Amish Mennonite,,16.52,,,,,,,1.35,29.13,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,inpatient,1,mL,27.40000,26.03000,Amish/Mennonite,Amish Mennonite,,15.07,,,,,,,15.07,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121116801,NDC,facility,outpatient,1,mL,27.40000,26.03000,Amish/Mennonite,Amish Mennonite,,15.07,,,,,,,1.35,26.58,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,inpatient,1,mL,22.16000,21.06000,Amish/Mennonite,Amish Mennonite,,12.19,,,,,,,12.19,21.50,percent of total billed charges,
TRIAMCINOLONE ACETONIDE INJ 40 MG/ML 5 ML,61121,CDM,250,RC,J3301,HCPCS,70121165201,NDC,facility,outpatient,1,mL,22.16000,21.06000,Amish/Mennonite,Amish Mennonite,,12.19,,,,,,,1.35,21.50,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,00168-0006-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 454 GM,61122,CDM,250,RC,45802-0055-05,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,inpatient,1,EA,72.11000,68.51000,Amish/Mennonite,Amish Mennonite,,39.66,,,,,,,39.66,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00555-0808-02,NDC,,,facility,outpatient,1,EA,72.11000,68.51000,Amish/Mennonite,Amish Mennonite,,39.66,,,,,,,36.05,69.95,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,inpatient,1,EA,101.10000,96.04000,Amish/Mennonite,Amish Mennonite,,55.60,,,,,,,55.60,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,00904-6867-04,NDC,,,facility,outpatient,1,EA,101.10000,96.04000,Amish/Mennonite,Amish Mennonite,,55.60,,,,,,,50.55,98.07,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,inpatient,1,EA,84.98000,80.73000,Amish/Mennonite,Amish Mennonite,,46.74,,,,,,,46.74,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,10370-0268-01,NDC,,,facility,outpatient,1,EA,84.98000,80.73000,Amish/Mennonite,Amish Mennonite,,46.74,,,,,,,42.49,82.43,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,inpatient,1,EA,86.99000,82.64000,Amish/Mennonite,Amish Mennonite,,47.84,,,,,,,47.84,84.38,percent of total billed charges,
TRETINOIN CAP 10 MG,61123,CDM,250,RC,68084-0075-21,NDC,,,facility,outpatient,1,EA,86.99000,82.64000,Amish/Mennonite,Amish Mennonite,,47.84,,,,,,,43.49,84.38,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
TOPIRAMATE SUSP SD 25 MG/ML,61124,CDM,250,RC,J8499,HCPCS,0009373360602500,NDC,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,inpatient,1,GM,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00168-0346-46,NDC,,,facility,outpatient,1,GM,2.52000,2.39000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.44,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,inpatient,1,GM,2.30000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.23,percent of total billed charges,
TERCONAZOLE 0.4% VAG CRM,61126,CDM,250,RC,00591-3196-89,NDC,,,facility,outpatient,1,GM,2.30000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.23,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,inpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.57,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00781-1032-01,NDC,,,facility,outpatient,1,EA,2.85000,2.71000,Amish/Mennonite,Amish Mennonite,,1.57,,,,,,,1.43,2.76,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,inpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,00832-0495-11,NDC,,,facility,outpatient,1,EA,2.46000,2.34000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.39,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
TRIFLUOPERAZINE 2 MG TAB,61127,CDM,250,RC,51079-0573-20,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,inpatient,1,EA,690.86000,656.31000,Amish/Mennonite,Amish Mennonite,,379.97,,,,,,,379.97,670.13,percent of total billed charges,
TEMOZOLOMIDE 100 MG CAP,61128,CDM,250,RC,J8700,HCPCS,00085136602,NDC,facility,outpatient,1,EA,690.86000,656.31000,Amish/Mennonite,Amish Mennonite,,379.97,,,,,,,0.57636,670.13,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,inpatient,1,EA,12.76000,12.12000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,7.02,12.38,percent of total billed charges,
SULFADIAZINE TAB 500 MG,61129,CDM,250,RC,00185-0757-01,NDC,,,facility,outpatient,1,EA,12.76000,12.12000,Amish/Mennonite,Amish Mennonite,,7.02,,,,,,,6.38,12.38,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,inpatient,1,EA,7.06000,6.71000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.88,6.85,percent of total billed charges,
THEOPHYLLINE CAP-24 200 MG/24 HOURS,61130,CDM,250,RC,50474-0200-01,NDC,,,facility,outpatient,1,EA,7.06000,6.71000,Amish/Mennonite,Amish Mennonite,,3.88,,,,,,,3.53,6.85,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,inpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,00143-1763-01,NDC,,,facility,outpatient,1,EA,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,inpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.52800,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,16571-0161-10,NDC,,,facility,outpatient,1,EA,0.96000,0.91000,Amish/Mennonite,Amish Mennonite,,0.52800,,,,,,,0.48000,0.93120,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,69452-0242-20,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
TRIHEXYPHENIDYL TAB 5 MG,61131,CDM,250,RC,70954-0211-10,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,inpatient,1,EA,486.88000,462.54000,Amish/Mennonite,Amish Mennonite,,267.78,,,,,,,267.78,472.27,percent of total billed charges,
THALIDOMIDE 50 MG CAP,61132,CDM,250,RC,59572-0205-97,NDC,,,facility,outpatient,1,EA,486.88000,462.54000,Amish/Mennonite,Amish Mennonite,,267.78,,,,,,,243.44,472.27,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
UREA TOP 20% CRM,61133,CDM,250,RC,00884-0449-04,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,inpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
VALACYCLOVIR SUSP SD 50 MG/ML,61134,CDM,250,RC,63739-0525-10-05000,NDC,,,facility,outpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,inpatient,1,GM,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,49348-0790-72,NDC,,,facility,outpatient,1,GM,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,inpatient,1,GM,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,51672-2080-02,NDC,,,facility,outpatient,1,GM,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,inpatient,1,GM,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.89,5.10,percent of total billed charges,
TERBINAFINE CREAM 1% 30 GM,61135,CDM,250,RC,70677-1003-01,NDC,,,facility,outpatient,1,GM,5.26000,5.00000,Amish/Mennonite,Amish Mennonite,,2.89,,,,,,,2.63,5.10,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,inpatient,1,mL,11.32000,10.76000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,6.23,10.98,percent of total billed charges,
TRACE ELEMENTS - PEDS,61136,CDM,250,RC,J3490,HCPCS,00517920325,NDC,facility,outpatient,1,mL,11.32000,10.76000,Amish/Mennonite,Amish Mennonite,,6.23,,,,,,,5.66,10.98,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,inpatient,1,GM,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,00168-0004-16,NDC,,,facility,outpatient,1,GM,0.17000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,16714-0986-04,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,21922-0062-30,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,45802-0064-05,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,52565-0056-26,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 454 GM,61137,CDM,250,RC,67877-0251-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,00093-2158-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,inpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,43386-0330-01,NDC,,,facility,outpatient,1,EA,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,0.94090,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,inpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,50268-0775-15,NDC,,,facility,outpatient,1,EA,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,inpatient,1,EA,5.89000,5.59000,Amish/Mennonite,Amish Mennonite,,3.24,,,,,,,3.24,5.71,percent of total billed charges,
TRIMETHOPRIM TAB 100 MG,61138,CDM,250,RC,51862-0486-01,NDC,,,facility,outpatient,1,EA,5.89000,5.59000,Amish/Mennonite,Amish Mennonite,,3.24,,,,,,,2.94,5.71,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,inpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00054-0077-25,NDC,,,facility,outpatient,1,EA,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,00904-7283-61,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,31722-0531-01,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,inpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50111-0917-01,NDC,,,facility,outpatient,1,EA,1.94000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.97000,1.88,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,inpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.59400,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,50268-0756-15,NDC,,,facility,outpatient,1,EA,1.08000,1.02000,Amish/Mennonite,Amish Mennonite,,0.59400,,,,,,,0.54000,1.05,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,inpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
TORSEMIDE 20 MG TAB,61139,CDM,250,RC,68084-0539-01,NDC,,,facility,outpatient,1,EA,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,inpatient,1,GM,26.57000,25.24000,Amish/Mennonite,Amish Mennonite,,14.61,,,,,,,14.61,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,10631-0093-62,NDC,,,facility,outpatient,1,GM,26.57000,25.24000,Amish/Mennonite,Amish Mennonite,,14.61,,,,,,,13.29,25.77,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,inpatient,1,GM,10.25000,9.74000,Amish/Mennonite,Amish Mennonite,,5.64,,,,,,,5.64,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,45802-0045-01,NDC,,,facility,outpatient,1,GM,10.25000,9.74000,Amish/Mennonite,Amish Mennonite,,5.64,,,,,,,5.12,9.94,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,inpatient,1,GM,9.74000,9.25000,Amish/Mennonite,Amish Mennonite,,5.36,,,,,,,5.36,9.45,percent of total billed charges,
TRIAMCINOLONE SPRAY 0.147 MG/G 63 GM,61140,CDM,250,RC,64980-0429-63,NDC,,,facility,outpatient,1,GM,9.74000,9.25000,Amish/Mennonite,Amish Mennonite,,5.36,,,,,,,4.87,9.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,inpatient,1,mL,82.81000,78.67000,Amish/Mennonite,Amish Mennonite,,45.55,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049461,NDC,facility,outpatient,1,mL,82.81000,78.67000,Amish/Mennonite,Amish Mennonite,,45.55,,,,,,,22.94,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,inpatient,1,mL,82.81000,78.67000,Amish/Mennonite,Amish Mennonite,,45.55,,,,,,,45.55,80.33,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/5 ML (EQV-TOBI),61142,CDM,250,RC,J7682,HCPCS,00078049471,NDC,facility,outpatient,1,mL,82.81000,78.67000,Amish/Mennonite,Amish Mennonite,,45.55,,,,,,,22.94,80.33,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,inpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
URSODIOL SUSP SD 60 MG/ML,61143,CDM,250,RC,66993-0405-02-06000,NDC,,,facility,outpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,2.82,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,inpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,00832-0494-11,NDC,,,facility,outpatient,1,EA,1.93000,1.84000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,inpatient,1,EA,3.53000,3.36000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.42,percent of total billed charges,
TRIFLUOPERAZINE TAB 1 MG,61144,CDM,250,RC,51079-0572-20,NDC,,,facility,outpatient,1,EA,3.53000,3.36000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-30,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,inpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.95,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,13811-0712-90,NDC,,,facility,outpatient,1,EA,16.27000,15.46000,Amish/Mennonite,Amish Mennonite,,8.95,,,,,,,8.13,15.78,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,inpatient,1,EA,12.80000,12.16000,Amish/Mennonite,Amish Mennonite,,7.04,,,,,,,7.04,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,16714-0903-01,NDC,,,facility,outpatient,1,EA,12.80000,12.16000,Amish/Mennonite,Amish Mennonite,,7.04,,,,,,,6.40,12.42,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,inpatient,1,EA,23.45000,22.27000,Amish/Mennonite,Amish Mennonite,,12.90,,,,,,,12.90,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,65580-0301-09,NDC,,,facility,outpatient,1,EA,23.45000,22.27000,Amish/Mennonite,Amish Mennonite,,12.90,,,,,,,11.72,22.75,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,inpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
VENLAFAXINE TAB-ER 37.5 MG,61145,CDM,250,RC,70710-1348-03,NDC,,,facility,outpatient,1,EA,2.69000,2.55000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,inpatient,1,mL,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.93,percent of total billed charges,
TIROFIBAN 12500 MG/250 ML PREMIX,61146,CDM,250,RC,J3246,HCPCS,25208000202,NDC,facility,outpatient,1,mL,3.02000,2.87000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.51,5.89,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,inpatient,1,EA,1283.15000,1219.00000,Amish/Mennonite,Amish Mennonite,,705.73,,,,,,,705.73,1244.66,percent of total billed charges,
TOLVAPTAN TAB 15 MG,61147,CDM,250,RC,59148-0020-50,NDC,,,facility,outpatient,1,EA,1283.15000,1219.00000,Amish/Mennonite,Amish Mennonite,,705.73,,,,,,,641.58,1244.66,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,inpatient,1,GM,3.99000,3.79000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,00904-7167-23,NDC,,,facility,outpatient,1,GM,3.99000,3.79000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.00,3.87,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,inpatient,1,GM,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
UREA TOP 40% CRM,61149,CDM,250,RC,67877-0272-21,NDC,,,facility,outpatient,1,GM,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
TOLNAFTATE TOP 1% PWDR,61150,CDM,250,RC,00536-5150-26,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,inpatient,1,EA,405.34000,385.07000,Amish/Mennonite,Amish Mennonite,,222.94,,,,,,,222.94,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,00008499420,NDC,facility,outpatient,1,EA,405.34000,385.07000,Amish/Mennonite,Amish Mennonite,,222.94,,,,,,,0.46810,393.18,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,inpatient,1,EA,404.04000,383.84000,Amish/Mennonite,Amish Mennonite,,222.22,,,,,,,222.22,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,63323096010,NDC,facility,outpatient,1,EA,404.04000,383.84000,Amish/Mennonite,Amish Mennonite,,222.22,,,,,,,0.46810,391.92,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,inpatient,1,EA,271.95000,258.35000,Amish/Mennonite,Amish Mennonite,,149.57,,,,,,,149.57,263.79,percent of total billed charges,
TIGECYCLINE POWD-INJ 50 MG,61151,CDM,250,RC,J3243,HCPCS,71288001911,NDC,facility,outpatient,1,EA,271.95000,258.35000,Amish/Mennonite,Amish Mennonite,,149.57,,,,,,,0.46810,263.79,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,inpatient,1,mL,75.14000,71.39000,Amish/Mennonite,Amish Mennonite,,41.33,,,,,,,41.33,72.89,percent of total billed charges,
TRIFLURIDINE OPHTH 1% SOL,61152,CDM,250,RC,61314-0044-75,NDC,,,facility,outpatient,1,mL,75.14000,71.39000,Amish/Mennonite,Amish Mennonite,,41.33,,,,,,,37.57,72.89,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 57 GM,61153,CDM,250,RC,00235-1170-02,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,inpatient,1,mL,38.43000,36.51000,Amish/Mennonite,Amish Mennonite,,21.14,,,,,,,21.14,37.28,percent of total billed charges,
VALGANCICLOVIR LIQ 50 MG/ML,61154,CDM,250,RC,00004-0039-09,NDC,,,facility,outpatient,1,mL,38.43000,36.51000,Amish/Mennonite,Amish Mennonite,,21.14,,,,,,,19.21,37.28,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,inpatient,1,EA,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,00378-2405-01,NDC,,,facility,outpatient,1,EA,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.79,3.48,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,inpatient,1,EA,4.22000,4.01000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-01,NDC,,,facility,outpatient,1,EA,4.22000,4.01000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.11,4.09,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,inpatient,1,EA,6.71000,6.37000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.69,6.51,percent of total billed charges,
TRIFLUOPERAZINE TAB 5 MG,61155,CDM,250,RC,51079-0574-20,NDC,,,facility,outpatient,1,EA,6.71000,6.37000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.35,6.51,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,inpatient,1,EA,89.14000,84.68000,Amish/Mennonite,Amish Mennonite,,49.03,,,,,,,49.03,86.47,percent of total billed charges,
TIOPRONIN TAB 100 MG,61156,CDM,250,RC,00178-0900-01,NDC,,,facility,outpatient,1,EA,89.14000,84.68000,Amish/Mennonite,Amish Mennonite,,49.03,,,,,,,44.57,86.47,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,inpatient,1,GM,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,41167-0730-03,NDC,,,facility,outpatient,1,GM,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,45802-0356-53,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,49348-0883-84,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
TROLAMINE SALICYLATE CREAM 10% 85 GM,61157,CDM,250,RC,70000-0169-01,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,inpatient,1,mL,40.04000,38.04000,Amish/Mennonite,Amish Mennonite,,22.02,,,,,,,22.02,38.84,percent of total billed charges,
THIOGUANINE SUSP SD 20 MG/ML,61159,CDM,250,RC,76388-0880-25-02000,NDC,,,facility,outpatient,1,mL,40.04000,38.04000,Amish/Mennonite,Amish Mennonite,,22.02,,,,,,,20.02,38.84,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,inpatient,1,EA,26.48000,25.16000,Amish/Mennonite,Amish Mennonite,,14.56,,,,,,,14.56,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,00069-0468-56,NDC,,,facility,outpatient,1,EA,26.48000,25.16000,Amish/Mennonite,Amish Mennonite,,14.56,,,,,,,13.24,25.69,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,inpatient,1,EA,20.57000,19.54000,Amish/Mennonite,Amish Mennonite,,11.31,,,,,,,11.31,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,49884-0155-76,NDC,,,facility,outpatient,1,EA,20.57000,19.54000,Amish/Mennonite,Amish Mennonite,,11.31,,,,,,,10.29,19.95,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,inpatient,1,EA,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.95,5.20,percent of total billed charges,
VARENICLINE TAB 0.5 MG,61160,CDM,250,RC,70748-0127-49,NDC,,,facility,outpatient,1,EA,5.36000,5.09000,Amish/Mennonite,Amish Mennonite,,2.95,,,,,,,2.68,5.20,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
ZINC OXIDE TOP COMPOUNDING PWDR,61161,CDM,250,RC,00395-3501-01,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,inpatient,1,mL,16.20000,15.39000,Amish/Mennonite,Amish Mennonite,,8.91,,,,,,,8.91,15.71,percent of total billed charges,
TRACE ELEMENTS - NEONATAL,61162,CDM,250,RC,J3490,HCPCS,00517620225,NDC,facility,outpatient,1,mL,16.20000,15.39000,Amish/Mennonite,Amish Mennonite,,8.91,,,,,,,8.10,15.71,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,inpatient,1,EA,43.61000,41.43000,Amish/Mennonite,Amish Mennonite,,23.99,,,,,,,23.99,42.30,percent of total billed charges,
VINBLASTINE POWD-INJ 10 MG,61163,CDM,250,RC,J9360,HCPCS,55390009110,NDC,facility,outpatient,1,EA,43.61000,41.43000,Amish/Mennonite,Amish Mennonite,,23.99,,,,,,,7.96,42.30,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,inpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.10,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,50268-0799-15,NDC,,,facility,outpatient,1,EA,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,,1.10,,,,,,,1.00,1.94,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,57664-0393-88,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,inpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
VENLAFAXINE TAB 37.5 MG,61164,CDM,250,RC,68084-0844-01,NDC,,,facility,outpatient,1,EA,2.13000,2.03000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,inpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.32,percent of total billed charges,
TOPIRAMATE CAP 15 MG,61165,CDM,250,RC,68382-0004-14,NDC,,,facility,outpatient,1,EA,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.32,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,inpatient,1,EA,190.55000,181.02000,Amish/Mennonite,Amish Mennonite,,104.80,,,,,,,104.80,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319001,NDC,facility,outpatient,1,EA,190.55000,181.02000,Amish/Mennonite,Amish Mennonite,,104.80,,,,,,,1.25,184.83,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,inpatient,1,EA,388.34000,368.93000,Amish/Mennonite,Amish Mennonite,,213.59,,,,,,,213.59,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049319028,NDC,facility,outpatient,1,EA,388.34000,368.93000,Amish/Mennonite,Amish Mennonite,,213.59,,,,,,,1.25,376.69,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,inpatient,1,EA,386.40000,367.08000,Amish/Mennonite,Amish Mennonite,,212.52,,,,,,,212.52,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,00049419001,NDC,facility,outpatient,1,EA,386.40000,367.08000,Amish/Mennonite,Amish Mennonite,,212.52,,,,,,,1.25,374.81,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,39822107701,NDC,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,1.25,122.61,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,inpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,65219019030,NDC,facility,outpatient,1,EA,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,1.25,183.91,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,inpatient,1,EA,316.16000,300.35000,Amish/Mennonite,Amish Mennonite,,173.89,,,,,,,173.89,306.68,percent of total billed charges,
VORICONAZOLE POWD-INJ 200 MG,61166,CDM,250,RC,J3465,HCPCS,70436002980,NDC,facility,outpatient,1,EA,316.16000,300.35000,Amish/Mennonite,Amish Mennonite,,173.89,,,,,,,1.25,306.68,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,inpatient,1,EA,203.60000,193.42000,Amish/Mennonite,Amish Mennonite,,111.98,,,,,,,111.98,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,00049392083,NDC,facility,outpatient,1,EA,203.60000,193.42000,Amish/Mennonite,Amish Mennonite,,111.98,,,,,,,5.03,197.49,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,inpatient,1,EA,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,81.69,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,43598084858,NDC,facility,outpatient,1,EA,148.52000,141.09000,Amish/Mennonite,Amish Mennonite,,81.69,,,,,,,5.03,144.06,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,inpatient,1,EA,103.62000,98.44000,Amish/Mennonite,Amish Mennonite,,56.99,,,,,,,56.99,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016010,NDC,facility,outpatient,1,EA,103.62000,98.44000,Amish/Mennonite,Amish Mennonite,,56.99,,,,,,,5.03,100.51,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,inpatient,1,EA,62.92000,59.77000,Amish/Mennonite,Amish Mennonite,,34.61,,,,,,,34.61,61.03,percent of total billed charges,
ZIPRASIDONE POWD-INJ 20 MG,61167,CDM,250,RC,J3486,HCPCS,72266016042,NDC,facility,outpatient,1,EA,62.92000,59.77000,Amish/Mennonite,Amish Mennonite,,34.61,,,,,,,5.03,61.03,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,inpatient,1,EA,79.88000,75.88000,Amish/Mennonite,Amish Mennonite,,43.93,,,,,,,43.93,77.48,percent of total billed charges,
THIOGUANINE TAB 40 MG,61169,CDM,250,RC,76388-0880-25,NDC,,,facility,outpatient,1,EA,79.88000,75.88000,Amish/Mennonite,Amish Mennonite,,43.93,,,,,,,39.94,77.48,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,inpatient,1,EA,279.35000,265.38000,Amish/Mennonite,Amish Mennonite,,153.64,,,,,,,153.64,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,00004-0038-22,NDC,,,facility,outpatient,1,EA,279.35000,265.38000,Amish/Mennonite,Amish Mennonite,,153.64,,,,,,,139.68,270.97,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,inpatient,1,EA,65.31000,62.04000,Amish/Mennonite,Amish Mennonite,,35.92,,,,,,,35.92,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,16714-0765-01,NDC,,,facility,outpatient,1,EA,65.31000,62.04000,Amish/Mennonite,Amish Mennonite,,35.92,,,,,,,32.66,63.35,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,inpatient,1,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,6.37,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,42291-0973-60,NDC,,,facility,outpatient,1,EA,11.59000,11.01000,Amish/Mennonite,Amish Mennonite,,6.37,,,,,,,5.79,11.24,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,inpatient,1,EA,50.36000,47.85000,Amish/Mennonite,Amish Mennonite,,27.70,,,,,,,27.70,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,50268-0787-12,NDC,,,facility,outpatient,1,EA,50.36000,47.85000,Amish/Mennonite,Amish Mennonite,,27.70,,,,,,,25.18,48.85,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,inpatient,1,EA,12.54000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.90,12.16,percent of total billed charges,
VALGANCICLOVIR TAB 450 MG,61170,CDM,250,RC,65862-0753-60,NDC,,,facility,outpatient,1,EA,12.54000,11.92000,Amish/Mennonite,Amish Mennonite,,6.90,,,,,,,6.27,12.16,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-00,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,00121-4675-05,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
VALPROIC ACID LIQ 250 MG/5 ML,61171,CDM,250,RC,68094-0193-61,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,inpatient,1,EA,2.44000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.37,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE EQUIV),61172,CDM,250,RC,51991-0384-90,NDC,,,facility,outpatient,1,EA,2.44000,2.31000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.37,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,inpatient,1,mL,1495.72000,1420.94000,Amish/Mennonite,Amish Mennonite,,822.65,,,,,,,822.65,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041807,NDC,facility,outpatient,1,mL,1495.72000,1420.94000,Amish/Mennonite,Amish Mennonite,,822.65,,,,,,,747.86,1450.85,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,inpatient,1,mL,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,104.28,183.91,percent of total billed charges,
"VITAMIN A SOLN 50,000 UNITS/ML 2 ML",61173,CDM,250,RC,J3490,HCPCS,61703041818,NDC,facility,outpatient,1,mL,189.60000,180.12000,Amish/Mennonite,Amish Mennonite,,104.28,,,,,,,94.80,183.91,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,inpatient,,,150.51000,142.98000,Amish/Mennonite,Amish Mennonite,,82.78,,,,,,,82.78,145.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,CPT,,,facility,outpatient,,,150.51000,142.98000,Amish/Mennonite,Amish Mennonite,,82.78,,,,,,,75.25,147.29,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,inpatient,1,EA,301.02000,285.97000,Amish/Mennonite,Amish Mennonite,,165.56,,,,,,,165.56,291.99,percent of total billed charges,
VARICELLA VACCINE POWD-INJ (VARIVAX),61174,CDM,250,RC,90716,HCPCS,00006482700,NDC,facility,outpatient,1,EA,301.02000,285.97000,Amish/Mennonite,Amish Mennonite,,165.56,,,,,,,147.29,291.99,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,inpatient,1,mL,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,54838-0005-30,NDC,,,facility,outpatient,1,mL,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,inpatient,1,mL,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.50,7.93,percent of total billed charges,
VITAMIN E LIQ 50 UNIT/ML,61175,CDM,250,RC,61703-0419-77,NDC,,,facility,outpatient,1,mL,8.18000,7.77000,Amish/Mennonite,Amish Mennonite,,4.50,,,,,,,4.09,7.93,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,00574-2325-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,43478-0244-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.07,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,inpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.77,13.71,percent of total billed charges,
TRETINOIN GEL 0.025%,61177,CDM,250,RC,66530-0257-15,NDC,,,facility,outpatient,1,GM,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,7.07,13.71,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,inpatient,1,mL,482.37000,458.26000,Amish/Mennonite,Amish Mennonite,,265.30,,,,,,,265.30,467.90,percent of total billed charges,
ZICONOTIDE 25 MCG/ML INTRATHECAL SOL,61178,CDM,636,RC,J2278,HCPCS,18860072310,NDC,facility,outpatient,1,mL,482.37000,458.26000,Amish/Mennonite,Amish Mennonite,,265.30,,,,,,,10.13,467.90,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,inpatient,1,EA,23.06000,21.91000,Amish/Mennonite,Amish Mennonite,,12.68,,,,,,,12.68,22.37,percent of total billed charges,
VERAPAMIL CAP-24 300 MG,61179,CDM,250,RC,00091-4087-01,NDC,,,facility,outpatient,1,EA,23.06000,21.91000,Amish/Mennonite,Amish Mennonite,,12.68,,,,,,,11.53,22.37,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,inpatient,1,GM,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,00904-7167-83,NDC,,,facility,outpatient,1,GM,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,inpatient,1,GM,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.81,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,44523-0617-03,NDC,,,facility,outpatient,1,GM,3.29000,3.13000,Amish/Mennonite,Amish Mennonite,,1.81,,,,,,,1.65,3.19,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,inpatient,1,GM,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
UREA TOP 40% CRM 7911877,61181,CDM,250,RC,50268-0872-85,NDC,,,facility,outpatient,1,GM,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,inpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
"VITAMIN A CAP 10,000 UNIT",61182,CDM,250,RC,00904-2085-60,NDC,,,facility,outpatient,1,EA,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
VITAMIN E CAP 200 INTUNIT,61183,CDM,250,RC,80681-0159-00,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,inpatient,1,EA,277.41000,263.54000,Amish/Mennonite,Amish Mennonite,,152.58,,,,,,,152.58,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,64896-0691-51,NDC,,,facility,outpatient,1,EA,277.41000,263.54000,Amish/Mennonite,Amish Mennonite,,152.58,,,,,,,138.71,269.09,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,inpatient,1,EA,17.33000,16.46000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,9.53,16.81,percent of total billed charges,
ZOLMITRIPTAN TAB-DIS 2.5 MG,61184,CDM,250,RC,68462-0499-76,NDC,,,facility,outpatient,1,EA,17.33000,16.46000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,8.66,16.81,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,00904-6928-61,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,51079-0726-20,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,inpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,68084-0342-01,NDC,,,facility,outpatient,1,EA,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
TOPIRAMATE TAB 25 MG,61185,CDM,250,RC,69097-0122-03,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,inpatient,1,EA,64.78000,61.54000,Amish/Mennonite,Amish Mennonite,,35.63,,,,,,,35.63,62.84,percent of total billed charges,
ZOLMITRIPTAN TAB 5 MG,61186,CDM,250,RC,47335-0979-67,NDC,,,facility,outpatient,1,EA,64.78000,61.54000,Amish/Mennonite,Amish Mennonite,,35.63,,,,,,,32.39,62.84,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00168-0062-16,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC OXIDE OINT 20% 454 GM,61187,CDM,250,RC,00536-5700-98,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,inpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,00168-0006-80,NDC,,,facility,outpatient,1,GM,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,inpatient,1,GM,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,45802-0055-36,NDC,,,facility,outpatient,1,GM,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
TRIAMCINOLONE OINT 0.1% 80 GM,61188,CDM,250,RC,52565-0014-80,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,inpatient,1,EA,11.16000,10.61000,Amish/Mennonite,Amish Mennonite,,6.14,,,,,,,6.14,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,00023-3513-60,NDC,,,facility,outpatient,1,EA,11.16000,10.61000,Amish/Mennonite,Amish Mennonite,,6.14,,,,,,,5.58,10.83,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,68462-0461-60,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
TROSPIUM CHLORIDE TAB 20 MG,61189,CDM,250,RC,23155-0530-06,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,47781-0730-02,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,inpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,17478-0742-02,NDC,,,facility,outpatient,1,EA,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,31.60,61.30,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,inpatient,1,EA,30.02000,28.52000,Amish/Mennonite,Amish Mennonite,,16.51,,,,,,,16.51,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,23155-0859-78,NDC,,,facility,outpatient,1,EA,30.02000,28.52000,Amish/Mennonite,Amish Mennonite,,16.51,,,,,,,15.01,29.12,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN CAP 250 MG,61190,CDM,250,RC,68180-0167-13,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,inpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,5.18,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00056-0189-75,NDC,,,facility,outpatient,1,EA,9.42000,8.95000,Amish/Mennonite,Amish Mennonite,,5.18,,,,,,,4.71,9.14,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,00832-1217-01,NDC,,,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,inpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
WARFARIN 6 MG TAB,61191,CDM,250,RC,51672-4033-01,NDC,,,facility,outpatient,1,EA,1.52000,1.45000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,16714-0658-01,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,23155-0249-01,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,inpatient,1,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,50268-0801-15,NDC,,,facility,outpatient,1,EA,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,2.41,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,57237-0175-01,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,inpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
VENLAFAXINE TAB 75 MG,61192,CDM,250,RC,68084-0856-01,NDC,,,facility,outpatient,1,EA,2.33000,2.21000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00591-0345-01,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,00904-2924-61,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
VERAPAMIL TAB 120 MG,61193,CDM,250,RC,23155-0486-01,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,inpatient,1,EA,3.72000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,55111-0288-01,NDC,,,facility,outpatient,1,EA,3.72000,3.54000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.61,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,62756-0260-02,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
ZONISAMIDE CAP 100 MG,61194,CDM,250,RC,69097-0861-07,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,inpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,00904-0277-60,NDC,,,facility,outpatient,1,EA,0.31000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,inpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
VITAMIN E CAP 1000 INTL UNITS,61195,CDM,250,RC,54629-0105-05,NDC,,,facility,outpatient,1,EA,0.46000,0.43000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,10135-0120-01,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,30768-0006-01,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,50268-0857-15,NDC,,,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,inpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
VITAMIN B COMPLEX TAB,61196,CDM,250,RC,54629-0130-01,NDC,,,facility,outpatient,1,EA,0.26000,0.24000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,inpatient,1,EA,140.09000,133.09000,Amish/Mennonite,Amish Mennonite,,77.05,,,,,,,77.05,135.89,percent of total billed charges,
ZOLMITRIPTAN TAB DIS 5 MG,61197,CDM,250,RC,00115-0692-50,NDC,,,facility,outpatient,1,EA,140.09000,133.09000,Amish/Mennonite,Amish Mennonite,,77.05,,,,,,,70.05,135.89,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,inpatient,1,EA,53.19000,50.53000,Amish/Mennonite,Amish Mennonite,,29.25,,,,,,,29.25,51.59,percent of total billed charges,
ZOLPIDEM 12.5 MG ER TAB,61198,CDM,250,RC,00024-5521-31,NDC,,,facility,outpatient,1,EA,53.19000,50.53000,Amish/Mennonite,Amish Mennonite,,29.25,,,,,,,26.59,51.59,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,inpatient,1,mL,8.06000,7.66000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,4.43,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,00517611025,NDC,facility,outpatient,1,mL,8.06000,7.66000,Amish/Mennonite,Amish Mennonite,,4.43,,,,,,,4.03,7.82,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
ZINC SULFATE SOLN 1 MG/ML,61199,CDM,250,RC,J3490,HCPCS,70710187607,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,4.29,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,inpatient,1,EA,30.27000,28.76000,Amish/Mennonite,Amish Mennonite,,16.65,,,,,,,16.65,29.36,percent of total billed charges,
TRIAMTERENE 100 MG CAP,61200,CDM,250,RC,65197-0003-01,NDC,,,facility,outpatient,1,EA,30.27000,28.76000,Amish/Mennonite,Amish Mennonite,,16.65,,,,,,,15.13,29.36,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,inpatient,1,EA,37.52000,35.65000,Amish/Mennonite,Amish Mennonite,,20.64,,,,,,,20.64,36.39,percent of total billed charges,
ZOLPIDEM 10 MG TAB,61201,CDM,250,RC,00037-6010-30,NDC,,,facility,outpatient,1,EA,37.52000,35.65000,Amish/Mennonite,Amish Mennonite,,20.64,,,,,,,18.76,36.39,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,inpatient,1,EA,126.72000,120.39000,Amish/Mennonite,Amish Mennonite,,69.70,,,,,,,69.70,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,00115-0671-51,NDC,,,facility,outpatient,1,EA,126.72000,120.39000,Amish/Mennonite,Amish Mennonite,,69.70,,,,,,,63.36,122.92,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,inpatient,1,EA,13.26000,12.60000,Amish/Mennonite,Amish Mennonite,,7.29,,,,,,,7.29,12.86,percent of total billed charges,
ZOLMITRIPTAN TAB 2.5 MG,61202,CDM,250,RC,68462-0497-76,NDC,,,facility,outpatient,1,EA,13.26000,12.60000,Amish/Mennonite,Amish Mennonite,,7.29,,,,,,,6.63,12.86,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,23155-0059-01,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
VERAPAMIL TAB 40 MG,61207,CDM,250,RC,42291-0853-01,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,inpatient,1,EA,4.96000,4.71000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.73,4.81,percent of total billed charges,
VERAPAMIL CAP-24 100 MG,61208,CDM,250,RC,00378-6201-01,NDC,,,facility,outpatient,1,EA,4.96000,4.71000,Amish/Mennonite,Amish Mennonite,,2.73,,,,,,,2.48,4.81,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,00054-0084-25,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,inpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.82500,1.46,percent of total billed charges,
ZALEPLON 5 MG CAP,61209,CDM,250,RC,29300-0131-01,NDC,,,facility,outpatient,1,EA,1.50000,1.43000,Amish/Mennonite,Amish Mennonite,,0.82500,,,,,,,0.75000,1.46,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,62756-0258-02,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,68462-0128-01,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,inpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
ZONISAMIDE CAP 25 MG,61210,CDM,250,RC,76282-0226-01,NDC,,,facility,outpatient,1,EA,0.44000,0.41000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
VITAMIN B+C W/ FOLIC ACID TAB (DIALYVITE 3000 EQUIV),61211,CDM,250,RC,10542-0014-09,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,inpatient,1,EA,162.76000,154.62000,Amish/Mennonite,Amish Mennonite,,89.52,,,,,,,89.52,157.88,percent of total billed charges,
VARDENAFIL TAB 10 MG,61212,CDM,250,RC,00173-0830-13,NDC,,,facility,outpatient,1,EA,162.76000,154.62000,Amish/Mennonite,Amish Mennonite,,89.52,,,,,,,81.38,157.88,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,inpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
WARFARIN SUSP SD 1 MG/ML,61213,CDM,250,RC,00832-1211-01-00100,NDC,,,facility,outpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,inpatient,1,EA,23.65000,22.47000,Amish/Mennonite,Amish Mennonite,,13.01,,,,,,,13.01,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-06,NDC,,,facility,outpatient,1,EA,23.65000,22.47000,Amish/Mennonite,Amish Mennonite,,13.01,,,,,,,11.82,22.94,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,inpatient,1,EA,13.88000,13.19000,Amish/Mennonite,Amish Mennonite,,7.63,,,,,,,7.63,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,00904-7168-61,NDC,,,facility,outpatient,1,EA,13.88000,13.19000,Amish/Mennonite,Amish Mennonite,,7.63,,,,,,,6.94,13.46,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,inpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,10702-0237-01,NDC,,,facility,outpatient,1,EA,2.50000,2.37000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.42,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,inpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.83600,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,42291-0923-01,NDC,,,facility,outpatient,1,EA,1.52000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83600,,,,,,,0.76000,1.47,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,inpatient,1,EA,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.34,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,43063-0871-60,NDC,,,facility,outpatient,1,EA,2.44000,2.32000,Amish/Mennonite,Amish Mennonite,,1.34,,,,,,,1.22,2.37,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,inpatient,1,EA,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,10.35,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,60687-0100-01,NDC,,,facility,outpatient,1,EA,18.82000,17.88000,Amish/Mennonite,Amish Mennonite,,10.35,,,,,,,9.41,18.26,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
URSODIOL CAP 300 MG,61215,CDM,250,RC,69238-1540-01,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,inpatient,1,mL,44.32000,42.10000,Amish/Mennonite,Amish Mennonite,,24.38,,,,,,,24.38,42.99,percent of total billed charges,
ZINC SULFATE SOLN 5 MG/ML,61216,CDM,250,RC,J3490,HCPCS,00517800525,NDC,facility,outpatient,1,mL,44.32000,42.10000,Amish/Mennonite,Amish Mennonite,,24.38,,,,,,,22.16,42.99,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,inpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.63,4.65,percent of total billed charges,
ZIDOVUDINE CAP 100 MG,61217,CDM,250,RC,65862-0107-01,NDC,,,facility,outpatient,1,EA,4.79000,4.55000,Amish/Mennonite,Amish Mennonite,,2.63,,,,,,,2.40,4.65,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,inpatient,1,GM,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ZEASORB POWD 71 GM,61218,CDM,250,RC,00145-1504-05,NDC,,,facility,outpatient,1,GM,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,inpatient,1,EA,24.78000,23.54000,Amish/Mennonite,Amish Mennonite,,13.63,,,,,,,13.63,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0199-01,NDC,,,facility,outpatient,1,EA,24.78000,23.54000,Amish/Mennonite,Amish Mennonite,,13.63,,,,,,,12.39,24.04,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,inpatient,1,EA,69.38000,65.91000,Amish/Mennonite,Amish Mennonite,,38.16,,,,,,,38.16,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,16714-0515-01,NDC,,,facility,outpatient,1,EA,69.38000,65.91000,Amish/Mennonite,Amish Mennonite,,38.16,,,,,,,34.69,67.30,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,68462-0573-30,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,11.85,22.99,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,inpatient,1,EA,18.99000,18.04000,Amish/Mennonite,Amish Mennonite,,10.44,,,,,,,10.44,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,43547-0378-03,NDC,,,facility,outpatient,1,EA,18.99000,18.04000,Amish/Mennonite,Amish Mennonite,,10.44,,,,,,,9.49,18.42,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,inpatient,1,EA,104.09000,98.88000,Amish/Mennonite,Amish Mennonite,,57.25,,,,,,,57.25,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,51079-0165-03,NDC,,,facility,outpatient,1,EA,104.09000,98.88000,Amish/Mennonite,Amish Mennonite,,57.25,,,,,,,52.05,100.97,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,inpatient,1,EA,100.16000,95.15000,Amish/Mennonite,Amish Mennonite,,55.09,,,,,,,55.09,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,60687-0273-21,NDC,,,facility,outpatient,1,EA,100.16000,95.15000,Amish/Mennonite,Amish Mennonite,,55.09,,,,,,,50.08,97.16,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,inpatient,1,EA,7.01000,6.66000,Amish/Mennonite,Amish Mennonite,,3.86,,,,,,,3.86,6.80,percent of total billed charges,
VORICONAZOLE TAB 200 MG,61220,CDM,250,RC,63629-8734-01,NDC,,,facility,outpatient,1,EA,7.01000,6.66000,Amish/Mennonite,Amish Mennonite,,3.86,,,,,,,3.50,6.80,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,inpatient,1,mL,47.56000,45.18000,Amish/Mennonite,Amish Mennonite,,26.16,,,,,,,26.16,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,00703440211,NDC,facility,outpatient,1,mL,47.56000,45.18000,Amish/Mennonite,Amish Mennonite,,26.16,,,,,,,12.58,46.13,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,inpatient,1,mL,17.89000,16.99000,Amish/Mennonite,Amish Mennonite,,9.84,,,,,,,9.84,17.35,percent of total billed charges,
VINCRISTINE SOLN 1 MG/ML,61221,CDM,250,RC,J9370,HCPCS,61703030926,NDC,facility,outpatient,1,mL,17.89000,16.99000,Amish/Mennonite,Amish Mennonite,,9.84,,,,,,,8.95,17.35,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,inpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.53,9.75,percent of total billed charges,
TOLMETIN TAB 600 MG,61222,CDM,250,RC,00378-0313-01,NDC,,,facility,outpatient,1,EA,10.05000,9.55000,Amish/Mennonite,Amish Mennonite,,5.53,,,,,,,5.03,9.75,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,inpatient,1,EA,18.22000,17.31000,Amish/Mennonite,Amish Mennonite,,10.02,,,,,,,10.02,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,13811-0713-30,NDC,,,facility,outpatient,1,EA,18.22000,17.31000,Amish/Mennonite,Amish Mennonite,,10.02,,,,,,,9.11,17.67,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,inpatient,1,EA,14.92000,14.17000,Amish/Mennonite,Amish Mennonite,,8.21,,,,,,,8.21,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,16714-0904-01,NDC,,,facility,outpatient,1,EA,14.92000,14.17000,Amish/Mennonite,Amish Mennonite,,8.21,,,,,,,7.46,14.47,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,inpatient,1,EA,26.25000,24.94000,Amish/Mennonite,Amish Mennonite,,14.44,,,,,,,14.44,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,65580-0302-09,NDC,,,facility,outpatient,1,EA,26.25000,24.94000,Amish/Mennonite,Amish Mennonite,,14.44,,,,,,,13.12,25.46,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,inpatient,1,EA,4.15000,3.94000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.28,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,70710-1349-03,NDC,,,facility,outpatient,1,EA,4.15000,3.94000,Amish/Mennonite,Amish Mennonite,,2.28,,,,,,,2.08,4.03,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,inpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.56,6.29,percent of total billed charges,
VENLAFAXINE TAB-ER 75 MG,61224,CDM,250,RC,75834-0217-30,NDC,,,facility,outpatient,1,EA,6.48000,6.15000,Amish/Mennonite,Amish Mennonite,,3.56,,,,,,,3.24,6.29,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,inpatient,1,EA,40.35000,38.34000,Amish/Mennonite,Amish Mennonite,,22.19,,,,,,,22.19,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00049-3970-41,NDC,,,facility,outpatient,1,EA,40.35000,38.34000,Amish/Mennonite,Amish Mennonite,,22.19,,,,,,,20.18,39.14,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,00904-6270-45,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,inpatient,1,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.48,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,16714-0836-01,NDC,,,facility,outpatient,1,EA,2.69000,2.56000,Amish/Mennonite,Amish Mennonite,,1.48,,,,,,,1.34,2.61,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,inpatient,1,EA,8.78000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,4.83,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,63739-0005-32,NDC,,,facility,outpatient,1,EA,8.78000,8.35000,Amish/Mennonite,Amish Mennonite,,4.83,,,,,,,4.39,8.52,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,inpatient,1,EA,8.75000,8.31000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.81,8.49,percent of total billed charges,
ZIPRASIDONE CAP 40 MG,61225,CDM,250,RC,68084-0104-09,NDC,,,facility,outpatient,1,EA,8.75000,8.31000,Amish/Mennonite,Amish Mennonite,,4.81,,,,,,,4.38,8.49,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,inpatient,1,mL,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,13.00,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,00049316044,NDC,facility,outpatient,1,mL,23.64000,22.45000,Amish/Mennonite,Amish Mennonite,,13.00,,,,,,,11.82,22.93,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,inpatient,1,mL,35.57000,33.79000,Amish/Mennonite,Amish Mennonite,,19.56,,,,,,,19.56,34.50,percent of total billed charges,
VORICONAZOLE LIQ 40 MG/ML,61226,CDM,250,RC,J8499,HCPCS,59762093503,NDC,facility,outpatient,1,mL,35.57000,33.79000,Amish/Mennonite,Amish Mennonite,,19.56,,,,,,,17.79,34.50,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,54629-0100-01,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
VITAMIN E CAP 100 INTUNIT,61227,CDM,250,RC,80681-0134-00,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,inpatient,1,GM,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,25.38,44.76,percent of total billed charges,
TRETINOIN GEL 0.1%,61228,CDM,250,RC,00378-8093-45,NDC,,,facility,outpatient,1,GM,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,23.07,44.76,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,inpatient,1,EA,15.86000,15.07000,Amish/Mennonite,Amish Mennonite,,8.72,,,,,,,8.72,15.38,percent of total billed charges,
VERAPAMIL CAP-24 200 MG,61229,CDM,250,RC,00091-4086-01,NDC,,,facility,outpatient,1,EA,15.86000,15.07000,Amish/Mennonite,Amish Mennonite,,8.72,,,,,,,7.93,15.38,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,00536-6671-01,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,74312-0020-60,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
ZINC GLUCONATE TAB 50 MG,61230,CDM,250,RC,80681-0002-00,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,inpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,00781-2168-60,NDC,,,facility,outpatient,1,EA,1.84000,1.75000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.92000,1.78,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,inpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.68,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,16714-0838-01,NDC,,,facility,outpatient,1,EA,3.06000,2.90000,Amish/Mennonite,Amish Mennonite,,1.68,,,,,,,1.53,2.97,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,inpatient,1,EA,8.49000,8.06000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.67,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,50268-0814-12,NDC,,,facility,outpatient,1,EA,8.49000,8.06000,Amish/Mennonite,Amish Mennonite,,4.67,,,,,,,4.25,8.24,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,inpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
ZIPRASIDONE 80 MG CAP,61277,CDM,250,RC,60505-2531-06,NDC,,,facility,outpatient,1,EA,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,inpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,50.05,88.27,percent of total billed charges,
"CULTURE, BACTERIAL; AEROBIC ISOLATE-TECH",61278,CDM,300,RC,87077,CPT,,,facility,outpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,8.08,424.40,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,inpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,111.65,196.91,percent of total billed charges,
CLOTTING INHIBITORS OR ANTICOAG-TECH,61279,CDM,300,RC,85305,CPT,,,facility,outpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,11.61,611.15,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,inpatient,,,1089.00000,1034.55000,Amish/Mennonite,Amish Mennonite,,598.95,,,,,,,598.95,1056.33,percent of total billed charges,
CRRT,61288,CDM,841,RC,90947,CPT,,,facility,outpatient,,,1089.00000,1034.55000,Amish/Mennonite,Amish Mennonite,,598.95,,,,,,,544.50,1056.33,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,inpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,,405.35,,,,,,,405.35,714.89,percent of total billed charges,
TRANSCUTANEOUS PACING - TECH,61290,CDM,480,RC,92953,CPT,,,facility,outpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,,405.35,,,,,,,368.50,714.89,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE 370 50ML,61291,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
ISOVUE CONTRAST,61292,CDM,250,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 300, 50ML",61293,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 200ML",61294,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 150ML,61295,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.63085,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CONTRAST ISOVUE 370, 125ML",61296,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST VISI 250 50ML,61297,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.63085,1.29,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,1825.74,3614.22,percent of total billed charges,
SYSTEM THROMCTMY CATH 6FR L175CM CONT ASPIR,61317,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,1710.23,3726.00,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR 90D MIC 2.3-3FR 2MM 175CM NTNL TUNG AU.,61332,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1084.39,2362.50,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO SHEATH 16.8MM 8.5FR CV AGILIS NXT STRBL CATH,61354,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1420.03,3093.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,43.12,85.36,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .038IN 80CM SS PTFE,61367,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,40.39,88.00,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA7MM CATH L132CM 0.014IN NIT RX LP,61373,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3246.28,7072.50,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA6-8MM CATH L132CM 0.014IN NIT RX LP,61374,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3246.28,7072.50,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L5MM DIA5X4MM RETEN SKRT DIA9MM SHTH 5FR.,61380,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6488.42,14136.00,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1157.62,2291.62,percent of total billed charges,
KIT SNAR MIC 4MM 2.3-3FR 175CM AGN 150CM,61384,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 20MM 165CM ACHV 146CM,61386,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1290.94,2812.50,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 4MM 1MM 3.3FR 15MM 165CM ACHV 146CM,61387,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1290.94,2812.50,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SPT 12FR WAIST L4MM DIA38MM ATR DISC DIA48X54MM,61402,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,228.75000,217.31000,Amish/Mennonite,Amish Mennonite,,125.81,,,,,,,112.09,221.89,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .035IN 260CM AMP,61406,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,228.75000,217.31000,Amish/Mennonite,Amish Mennonite,,125.81,,,,,,,105.00,228.75,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,Amish/Mennonite,Amish Mennonite,,11423.50,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 7FR WAIST L4MM DIA16MM ATR DISC DIA26X30MM.,61409,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,Amish/Mennonite,Amish Mennonite,,11423.50,,,,,,,9533.43,20770.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM AMPTZ SS,61411,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,38.19,83.20,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20770.00000,19731.50000,Amish/Mennonite,Amish Mennonite,,11423.50,,,,,,,10177.30,20146.90,percent of total billed charges,
OCCLUDER SEPT 8FR DISC DIA18MM NIT POLY MULTIFENESTRATED.,61414,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20770.00000,19731.50000,Amish/Mennonite,Amish Mennonite,,11423.50,,,,,,,9533.43,20770.00,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER DUCT L7MM DIA6X4MM RETEN SKRT DIA10MM SHTH 6FR.,61415,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6488.42,14136.00,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4812.75000,4572.11000,Amish/Mennonite,Amish Mennonite,,2647.01,,,,,,,2358.25,4668.37,percent of total billed charges,
FILTER EMB 7.5MM CATH 8FR SHTH 6FR GWIRE L190MM NIT RX RADPQ,61426,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4812.75000,4572.11000,Amish/Mennonite,Amish Mennonite,,2647.01,,,,,,,2209.05,4812.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA24MM ATR DISC DIA34X38MM.,61432,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,9988.76,21762.00,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,Amish/Mennonite,Amish Mennonite,,719.81,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 27MM 70CM AMPLZR 4.5CM 3 LUM SFT DIST.,61446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,Amish/Mennonite,Amish Mennonite,,719.81,,,,,,,600.72,1308.75,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 9FR WAIST L4MM DIA22MM ATR DISC DIA32X36MM.,61449,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.68000,180.20000,Amish/Mennonite,Amish Mennonite,,104.32,,,,,,,92.94,183.99,percent of total billed charges,
GUIDEWIRE VASCU MOD J CRV .035IN 260CM SS PTFE.,61461,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.68000,180.20000,Amish/Mennonite,Amish Mennonite,,104.32,,,,,,,87.06,189.68,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1308.75000,1243.31000,Amish/Mennonite,Amish Mennonite,,719.81,,,,,,,641.29,1269.49,percent of total billed charges,
BALLOON SZ 20MM 70CM AMPLZR 3.5CM 3 LUM SFT DIST.,61465,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1308.75000,1243.31000,Amish/Mennonite,Amish Mennonite,,719.81,,,,,,,600.72,1308.75,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE VASC CLSR 8FR GWIRE 0.035IN ANGIOSEAL VIP,61471,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,387.28,843.75,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,247.50000,235.12000,Amish/Mennonite,Amish Mennonite,,136.12,,,,,,,121.28,240.07,percent of total billed charges,
GUIDEWIRE VASC MOD J CRV .035IN 260CM SS PTFE.,61478,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,247.50000,235.12000,Amish/Mennonite,Amish Mennonite,,136.12,,,,,,,113.60,247.50,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA8MM ATR DISC DIA16X20MM.,61480,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,9988.76,21762.00,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,122.20,241.90,percent of total billed charges,
GUIDEWIRE VASC ANG .025IN 260CM PERI NTN PU,61481,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,114.47,249.38,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,10663.38,21109.14,percent of total billed charges,
OCCLUDER SEPT 6FR WAIST L3MM DIA9MM ATR DISC DIA17X21MM.,61485,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21762.00000,20673.90000,Amish/Mennonite,Amish Mennonite,,11969.10,,,,,,,9988.76,21762.00,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 10FR 25CM FLXM PU APD REG,61488,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,321.56,636.56,percent of total billed charges,
SET INTRO 7FR 8FR 100CM PERC S ARWFLX ADLT 3W.,61513,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,301.22,656.25,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6926.64,13711.92,percent of total billed charges,
OCCLUDER CV 6FR L7MM DIA8X6MM RETEN SKRT DIA12MM 180DEG TIP.,61522,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,14136.00000,13429.20000,Amish/Mennonite,Amish Mennonite,,7774.80,,,,,,,6488.42,14136.00,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 22MM 100CM TSHK II 4CM LOPRFL,61529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,967.59,2108.03,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,93.10,184.30,percent of total billed charges,
GUIDEWIRE VASC ANG .025INX150CM GLDWR NTNL PU,61532,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,87.21,190.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,Amish/Mennonite,Amish Mennonite,,973.50,,,,,,,867.30,1716.90,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 205CM AVIGO SS HDRPH,61545,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,Amish/Mennonite,Amish Mennonite,,973.50,,,,,,,812.43,1770.00,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13020.00000,12369.00000,Amish/Mennonite,Amish Mennonite,,7161.00,,,,,,,6379.80,12629.40,percent of total billed charges,
CATHETER CRYABL 10.5FR 23MM 95CM ARCTIC FRN ADV,61546,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13020.00000,12369.00000,Amish/Mennonite,Amish Mennonite,,7161.00,,,,,,,5976.18,13020.00,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,13485.00000,12810.75000,Amish/Mennonite,Amish Mennonite,,7416.75,,,,,,,6607.65,13080.45,percent of total billed charges,
CATHETER CARD ABLAT 10.5FR L95CM TIP W28MM,61562,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,13485.00000,12810.75000,Amish/Mennonite,Amish Mennonite,,7416.75,,,,,,,6189.61,13485.00,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 2CM RADOPQ RPD,61565,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3296.47,6525.68,percent of total billed charges,
CATHETER SPIROFLX ULTRA 4FRX135CM,61575,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3087.92,6727.50,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 11FR 28MM 100CM ZMED II 4CM COAX,61580,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 4CM RADOPQ RPD.,61581,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 4CM RADOPQ RPD,61585,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1266.64000,1203.31000,Amish/Mennonite,Amish Mennonite,,696.65,,,,,,,620.65,1228.64,percent of total billed charges,
CATHETER PA 6FR 9MM 110CM ARW 1CC 1 LUM BLN WDG,61586,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1266.64000,1203.31000,Amish/Mennonite,Amish Mennonite,,696.65,,,,,,,581.39,1266.64,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 75CM ATLS 4CM RPD,61587,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 2CM RADOPQ RPD,61590,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 2CM RPD INFL,61596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
CATHETER PA 5FR 8MM 60CM ARW .75CC 1 LM BLN WDG,61601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,284.01,618.75,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM CONQ 4CM RADOPQ RPD,61607,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3476.25000,3302.44000,Amish/Mennonite,Amish Mennonite,,1911.94,,,,,,,1703.36,3371.96,percent of total billed charges,
CATHETER ABLT 4MM 2.5MM SPC LG CRV STRG 7FR 110,61609,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3476.25000,3302.44000,Amish/Mennonite,Amish Mennonite,,1911.94,,,,,,,1595.60,3476.25,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRAPOPLITEL,61614,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRPOPLITEAL,61619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM CONQ 2CM RADOPQ RPD,61620,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5126.70000,4870.36000,Amish/Mennonite,Amish Mennonite,,2819.68,,,,,,,2512.08,4972.90,percent of total billed charges,
CATHETER ABLT 8MM 2.5MM SPC LG CRV STRG 7FR 8FR,61622,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5126.70000,4870.36000,Amish/Mennonite,Amish Mennonite,,2819.68,,,,,,,2353.16,5126.70,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,45.32000,43.05000,Amish/Mennonite,Amish Mennonite,,24.93,,,,,,,22.21,43.96,percent of total billed charges,
CATHETER PRSS MNTR 7FR 110CM PULM WDG STRL LF.,61625,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,45.32000,43.05000,Amish/Mennonite,Amish Mennonite,,24.93,,,,,,,20.80,45.32,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM ILC INFRAPOPLITEAL,61631,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L4 ILC INFRAPOPLITEAL,61632,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,Amish/Mennonite,Amish Mennonite,,598.12,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 6FR 90CM IPSL PVC ARW-BRMN FLT.,61633,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,Amish/Mennonite,Amish Mennonite,,598.12,,,,,,,499.16,1087.50,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM L4 ILC INFRAPOPLITEAL,61635,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L8 INFRAPOPLITEAL,61637,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM CONQ 4CM RADOPQ RPD,61642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM L15 INFRAPOPLITEAL,61643,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L15 INFRAPOPLITEAL,61644,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEL,61652,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM L15 INFRAPOPLITEAL,61653,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 7MM 170CM ILC INFRAPOPLITEAL,61655,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 4MM 170CM ILC INFRAPOPLITEAL,61657,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1745.62,3455.62,percent of total billed charges,
CATHETER BLNDIL 5MM 137CM L40 FMPLT ART NTNL,61663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1635.19,3562.50,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM L142CM CRTD PERI RNL,61665,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DORADO CK 20CM 3,61677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 137CM NTNL ANGIOSCULPT 10,61687,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 6MM 170CM L8 ILC INFRAPOPLITEAL,61691,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 5MM 170CM ILC INFRAPOPLITEAL,61693,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 10CM 3,61695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 10CM 3,61697,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,Amish/Mennonite,Amish Mennonite,,2807.54,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 95CM NRVSC SS FLOWGATE2 LG LUM 2,61698,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,Amish/Mennonite,Amish Mennonite,,2807.54,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 6MM 142CM CRTD PERI RNL,61700,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM L142CM CRTD PERI RNL,61706,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM L142CM CRTD PERI RNL,61709,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,334.06,661.30,percent of total billed charges,
CATHETER BLNDIL 3MM 170CM ILC INFRPOPLITEAL,61711,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,681.75000,647.66000,Amish/Mennonite,Amish Mennonite,,374.96,,,,,,,312.92,681.75,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5104.62000,4849.39000,Amish/Mennonite,Amish Mennonite,,2807.54,,,,,,,2501.26,4951.48,percent of total billed charges,
CATHETER GD 8FR 85CM NRVSC SS FLOWGATE2 LG LUM 2,61712,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5104.62000,4849.39000,Amish/Mennonite,Amish Mennonite,,2807.54,,,,,,,2343.02,5104.62,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 5MM 142CM CRTD PERI RNL,61713,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 20CM 3,61714,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM L142CM CRTD PERI RNL,61715,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 4MM 142CM CRTD PERI RNL,61718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3MM 137CM NTNL ANGIOSCULPT 10MM,61721,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,395.06,782.06,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 20CM 3,61725,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,370.07,806.25,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 10CM 3,61727,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 10MM 135CM PERI DORADO CK 4CM 3,61741,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 8MM 135CM PERI DORADO CK 4CM 3,61753,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,425.44,842.19,percent of total billed charges,
CATHETER BLNDIL .014IN 7MM 142CM CRTD PERI RNL,61758,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,868.24000,824.83000,Amish/Mennonite,Amish Mennonite,,477.53,,,,,,,398.52,868.24,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 7MM 135CM PERI DORADO CK 4CM 3,61762,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 6MM 135CM PERI DORADO CK 6CM 3,61768,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM PCLTXL LUTONIX 035 40MM.,61770,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONX 035 80,61780,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTXL LUTONX 035 150,61783,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,Amish/Mennonite,Amish Mennonite,,409.30,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM FEM/ILC DRLN HDRPH,61785,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,Amish/Mennonite,Amish Mennonite,,409.30,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035 40,61791,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEL VSL,61792,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,Amish/Mennonite,Amish Mennonite,,1027.12,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 10FR 46MM 140CM PU CODA 60CC 2,61802,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,Amish/Mennonite,Amish Mennonite,,1027.12,,,,,,,857.18,1867.50,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,702.86000,667.72000,Amish/Mennonite,Amish Mennonite,,386.57,,,,,,,344.40,681.77,percent of total billed charges,
CATHETER BLNDIL 6MM 150CM L40 FEM/ILC DRLN HDRPH,61804,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,702.86000,667.72000,Amish/Mennonite,Amish Mennonite,,386.57,,,,,,,322.61,702.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,744.19000,706.98000,Amish/Mennonite,Amish Mennonite,,409.30,,,,,,,364.65,721.86,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM DRLN HDRPH CRDS SBR,61807,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,744.19000,706.98000,Amish/Mennonite,Amish Mennonite,,409.30,,,,,,,341.58,744.19,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.25MM 150CM INFRAPOPLITEAL VSL,61814,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VS,61815,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM L150CM INFRAPOPLITEAL VSL,61818,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 4MM 130CM PCLTXL LUTONX 035 80,61819,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 18MM 110CM TRUE DIL 4.5CM OTW 2,61822,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61827,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLLNDIL 3MM 150CM ULT-CX ULTRAVERSE 014,61830,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61834,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 200CM ULT-CX ULTRAVERSE,61836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 25MM 110CM TRUE DIL 4.5CM,61840,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 23MM 110CM TRUE DIL 4.5CM OTW 2,61841,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 22MM 110CM TRUE DIL 4.5CM OTW 2,61843,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM ULT-CX ULTRAVERSE,61844,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 13FR 26MM 110CM AORTA TRUE 4.5CM,61845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 24MM 110CM AORTA TRUE 4.5CM,61846,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
BLLN TRUE 28MMX4.5CMX110CM,61847,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERSE 014,61848,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X120X150CM,61849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4936.95000,4690.10000,Amish/Mennonite,Amish Mennonite,,2715.32,,,,,,,2419.11,4788.84,percent of total billed charges,
TRAY BN CMNT 13GA 10MM AVAMAX BLN,61850,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4936.95000,4690.10000,Amish/Mennonite,Amish Mennonite,,2715.32,,,,,,,2266.06,4936.95,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATH  BLNDIL 20MM 110CM AORTA TRUE 4.5CM.,61851,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
CATHETER BLNDIL 12FR 21MM 110CM TRUE DIL 4.5CM 2,61854,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1867.50000,1774.12000,Amish/Mennonite,Amish Mennonite,,1027.12,,,,,,,915.08,1811.47,percent of total billed charges,
CATHETER BLNDIL 32MM 120CM PU CODA ACPT .035IN,61855,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1867.50000,1774.12000,Amish/Mennonite,Amish Mennonite,,1027.12,,,,,,,857.18,1867.50,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 3X100X150CM,61858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 4MM 75CM ULTRAVERS 035 GEOALIGN.,61860,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM ULT-CX ULTRAVERSE,61863,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM ULTRAVERSE 035 GEOALIGN,61865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BALNDIL 5MM 130CM ULTRAVERSE 035,61866,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,61870,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM ULT-CX ULTRAVERS 014,61871,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,Amish/Mennonite,Amish Mennonite,,701.25,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 16MM L120CM PERI LV XXL 20MM,61876,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,Amish/Mennonite,Amish Mennonite,,701.25,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL2 CRV 5FR 100CM COR FEM VESTAN.,61885,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHL,61886,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVERSE 2.5X100X150CM,61890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2MM 200CM ULT-CX ULTRAVERSE 014,61891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1275.00000,1211.25000,Amish/Mennonite,Amish Mennonite,,701.25,,,,,,,624.75,1236.75,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM PERI LV XXL 20MM,61895,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1275.00000,1211.25000,Amish/Mennonite,Amish Mennonite,,701.25,,,,,,,585.23,1275.00,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL5 CRV 5FR 100CM COR FEM VESTAN.,61901,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATH  DIAG AD 6FR L100CM COR GRN HYDRPHLC NYL RT,61905,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FL4 CRV 5FR 125CM FEM TRILON EXPO,61908,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO FR4 CRV 5FR 125CM VNTRC IMPLS 2,61910,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL JUDKINS R.,61911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL AR I MOD.,61912,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD  5FR L100CM COR  GRY HYDRO  NY  IM W/O SIDE,61913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 125CM PERI TRILON,61914,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JIM CRV 5FR 100CM COR SS NYL TRNB,61918,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL3.5 3,61920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 5FR 100CM COR FEM.,61925,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM COR NYL AMPLATZ L.,61926,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL4.5 CRV 6FR 100CM COR FEM,61927,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATH ANGIO CORO DIAG 6 FR 100 CM LGTH AMPLATZ LEFT,61930,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS L.,61932,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 130CM 7MMULTRAVERSE 035,61933,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR 100CML 0.038IN VASC DIAG 3,61934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,18.95,37.52,percent of total billed charges,
CATHETER ANGIO JL4 CRV 4FR 100CM COR FEM VESTAN,61936,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 5FR 110CM VNTRC,61937,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO MPA2 CRV 6FR 100CM FEM VESTAN SS,61944,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO RCB CRV 6FR 100CM COR FEM VESTAN,61946,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,90.88000,86.34000,Amish/Mennonite,Amish Mennonite,,49.98,,,,,,,44.53,88.15,percent of total billed charges,
CATHETER ANGIO C2 CRV 4FR 65CM VSCR SFVU RADOPQ,61949,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,90.88000,86.34000,Amish/Mennonite,Amish Mennonite,,49.98,,,,,,,41.71,90.88,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L110CM 155DEG GRY SS NYL.,61957,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 4CM OTW,61958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO AL3 CRV 5FR 100CM COR FEM VESTAN.,61960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR 100CM 0.038IN VASC JUDKINS,61964,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER ANGIO 5FR L100CM GRY SS NYL JL4 3,61968,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,Amish/Mennonite,Amish Mennonite,,5212.05,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER GD 6FR 132CM AXS CTLST 6 DIST ACC STRL,61970,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,Amish/Mennonite,Amish Mennonite,,5212.05,,,,,,,4349.70,9476.46,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER BLNDIL 10MM 120CM PERI CONQ 4CM RPD,61971,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG AD 6FR L100CM COR GRN HYDRPHLC.,61972,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,49.00,97.00,percent of total billed charges,
CATHETER ANGIO IM BC MOD CRV 5.2FR 100CM PU CRDS,61977,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,45.90,100.00,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM GWIRE 0.038IN NYL,61982,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR 110CM 155DEG VASC 3 STG BRD,61983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL .035IN 10MM 135CM PFLX 40MM 2,61984,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PERI CONQ 40 4CM OTW,61985,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 2CM OTW,61992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 2CM OTW,61994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,187.50000,178.12000,Amish/Mennonite,Amish Mennonite,,103.12,,,,,,,91.88,181.88,percent of total billed charges,
CATHETER BLNOCC 6FR 90CM COR VNS EZTRK GW PRSS,61995,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,187.50000,178.12000,Amish/Mennonite,Amish Mennonite,,103.12,,,,,,,86.06,187.50,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL6 CRV 6FR 100CM COR FEM VESTAN,61996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PERI CONQ 40 2CM OTW,62008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,687.15000,652.79000,Amish/Mennonite,Amish Mennonite,,377.93,,,,,,,336.70,666.54,percent of total billed charges,
CATHETER PCNG 1CM PROX 5FR 110CM NTR RBR BARD,62018,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,687.15000,652.79000,Amish/Mennonite,Amish Mennonite,,377.93,,,,,,,315.40,687.15,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG 12MM 80CM ATLS AU 4CM,62019,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRDS,62021,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PERI CONQ 40 4CM OTW,62026,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 10MM 80CM PERI DRLN MDX CRDS,62033,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JL5 CRV 6FR 100CM COR FEM VESTAN,62034,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 135CM PERI DRLN MDX CRDS,62040,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BALLNDIL 5FR 5MM 80CM PERI DRLN MDX CRD,62042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PERI CONQ 40 4CM OTW,62045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO LCB CRV 6FR 100CM COR FEM VESTAN,62052,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 10MM 80CM PERI DRLN MDX CRDS,62063,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLLNDIL 5FR 6MM 80CM PERI DRLN MDX CRD,62067,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5MM 135CM PERI DRLN MDX CORDS,62069,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 4MM 5FR 135CM PERI DRLN MDX CRDS,62071,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 7MM 135CM PERI DRLN MDX CRDS,62078,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2620.28,5187.07,percent of total billed charges,
CATHETER BLNDIL 5MM 130CM PCLTX UREA INPACT,62080,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 4MM 80CM PERI DRLN MDX CRD,62081,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 6MM 135CM PERI DRLN MDX CRDS,62082,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62086,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDL 5FR 8MM 135CM PERI DRLN MDX CRD,62089,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 5FR 135CM PERI DRLN MDX CRDS,62091,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 5FR 8MM 135CM PERI DRLN MDX CRD,62092,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 8MM 80CM PERI DRLN MDX CRDS PFLX,62093,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 8MM RX,62098,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 6MM RX,62102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 12MM 80CM PERI DRLN MDX CRDS,62108,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 20,62112,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 15,62117,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 21CM .02IN 1.25MM 142CM FULCRUM.,62121,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 15MM RX,62126,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,62129,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 7MM 80CM PERI DRLN MDX CRDS PFLX,62131,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,172.19,340.87,percent of total billed charges,
CATHETER BLNDIL 9MM 80CM PERI DRLN MDX CRD PFLX,62132,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,351.41000,333.84000,Amish/Mennonite,Amish Mennonite,,193.28,,,,,,,161.30,351.41,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6520.50000,6194.47000,Amish/Mennonite,Amish Mennonite,,3586.28,,,,,,,3195.05,6324.89,percent of total billed charges,
CATHETER THRMB 6FR 135CM PERI INDG LG LUM ASP.,62135,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6520.50000,6194.47000,Amish/Mennonite,Amish Mennonite,,3586.28,,,,,,,2992.91,6520.50,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.2MM COR TUNG MN TREK 12MM RX,62137,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM COR TUNG MN TREK 20MM RX,62139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,62142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,485.25000,460.99000,Amish/Mennonite,Amish Mennonite,,266.89,,,,,,,237.77,470.69,percent of total billed charges,
CATHETER ART LN .025IN 6FR 110CM HEP 4 LM TD    TD2604NDXF(SUB),62143,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,485.25000,460.99000,Amish/Mennonite,Amish Mennonite,,266.89,,,,,,,222.73,485.25,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 90CM PLTN IR CXI ANG TIP,62146,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.75MM COR CROSSFLEX2 TUNG TRK,62154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 5FR 100CM PERI SS HDRPH,62159,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,62163,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 150CM ASAHI CORSAIR PRO SPRL,62170,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM PERI SS HDRPH,62171,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT DAVIS CRV 4FR 150CM SS HDRPH CXI,62174,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 8FR 25CM FLXM PU APD REG DRMTR,62175,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.25MM SPNTR LGND 6MM OTW LF.,62176,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,826.88,1636.88,percent of total billed charges,
CATHETER THRMB 6FR .07IN 140CM XPRT AP ASP FULL,62178,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,774.56,1687.50,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN LOOP 14FR 25CM FLXM PU APD REG,62182,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL TRNB,62183,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM PERI SS HDRPH,62186,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,757.50000,719.62000,Amish/Mennonite,Amish Mennonite,,416.62,,,,,,,371.18,734.77,percent of total billed charges,
CATHETER CCSTM 10.2FR 24CM PERC PU CHAIT 3-9CM.,62191,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,757.50000,719.62000,Amish/Mennonite,Amish Mennonite,,416.62,,,,,,,347.69,757.50,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATHETER SPRT 2.3FR 150CM SS HDRPH CXI ANG TIP,62192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONC MACH 4,62193,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,8558.74,18646.50,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
MCTH INFS 2.6-2.8FR 135CM ASAHI CORSAIR PRO SPRL,62196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER CLOSUREFAST RFA 7FRX7X60C,62200,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TNG TREK,62202,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LCB CRV 6FR 100CM COR SS NYL PTFE,62203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO C2 CRV 5FR 65CM VSCR SS NYL,62208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,431.25000,409.69000,Amish/Mennonite,Amish Mennonite,,237.19,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER DRN .038IN 8.5FR 50CM BIL HDRPH ULTHNE.,62209,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,431.25000,409.69000,Amish/Mennonite,Amish Mennonite,,237.19,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM COR TUNG MN TREK SLIM SL 20,62211,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE DRG DLV 5.4FR 106CM EVAS EKOSONIC MACH 4,62213,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 120CM PERI SS HDRPH,62221,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM PERI SS NYL PTFE,62222,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 100CM PERI SS HDRPH,62224,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1607.81,3182.81,percent of total billed charges,
CATHETER INTVN 7FR 60CM ENDOVENOUS CLOSUREFAST 3,62226,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1506.09,3281.25,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL2 CRV 6FR 100CM PERI SS NYL PTFE,62227,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 6FR 90CM COR SS NYL PTFE CRDS,62228,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL4 CRV 6FR 100CM COR PERI NYL.,62234,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,Amish/Mennonite,Amish Mennonite,,2738.09,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CURV CIRC 7.5FR,62236,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,Amish/Mennonite,Amish Mennonite,,2738.09,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD RCB CRV 6FR 100CM COR SS NYL PTFE,62237,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,4978.35000,4729.43000,Amish/Mennonite,Amish Mennonite,,2738.09,,,,,,,2439.39,4829.00,percent of total billed charges,
CATHETER MP 2MM 3-3-3MM SPC D-F CRV CIRC 7.5FR,62240,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,4978.35000,4729.43000,Amish/Mennonite,Amish Mennonite,,2738.09,,,,,,,2285.06,4978.35,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD STD JCL3.5 CRV 6FR 100CM COR NYL.,62250,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM CR PRIPH GRN NYL PTFE MPA1,62252,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR SS NYL PTFE,62258,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SET CATH STRG 14FR 18GA 28CM TRINIFLEX SPLT3 BSC,62261,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM COR PERIPH GRN,62266,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 6FR 100CM COR SS NYL PTFE,62267,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 85CM FEM PTFE RWY LG,62268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,Amish/Mennonite,Amish Mennonite,,3510.38,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC D-F CRV 8FR 115CM,62269,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,Amish/Mennonite,Amish Mennonite,,3510.38,,,,,,,2929.57,6382.50,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2497.50000,2372.62000,Amish/Mennonite,Amish Mennonite,,1373.62,,,,,,,1223.78,2422.57,percent of total billed charges,
CATHETER EP 2-8-2MM SPC XL SWP 6FR 115CM LVWR 2.,62271,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2497.50000,2372.62000,Amish/Mennonite,Amish Mennonite,,1373.62,,,,,,,1146.35,2497.50,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTRVN 5FR .056IN .046IN 150CM SS PLMR,62273,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 7FR 100CM COR SS NYL PTFE.,62277,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,Amish/Mennonite,Amish Mennonite,,249.05,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER DLYS KT 13FR L20CM SHT TERM 2 LUMN,62279,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,Amish/Mennonite,Amish Mennonite,,249.05,,,,,,,207.84,452.81,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 6FR 110CM FEM PTFE RWY LG,62281,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XBLAD3.5 CRV 6FR 100CM COR SS NYL,62284,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 6FR 100CM COR,62290,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US .014P INTVASC VSN PV DGT ACPT 5FR GW,62295,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG MPA1 CRV 5FR 100CM COR SS NYL,62298,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,6382.50000,6063.38000,Amish/Mennonite,Amish Mennonite,,3510.38,,,,,,,3127.43,6191.02,percent of total billed charges,
CATHETER ABLT 1-4-1MM SPC F-J CRV 8FR 115CM,62299,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,6382.50000,6063.38000,Amish/Mennonite,Amish Mennonite,,3510.38,,,,,,,2929.57,6382.50,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,9136.78,18087.10,percent of total billed charges,
DEVICE THRMB 5.4FR 135CM EVAS EKOSONIC MACH 4 40,62302,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,8558.74,18646.50,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO JB1 CRV 5FR 100CM CRBRL SS NYL,62307,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN .012IN 6FR 5.1FR .056IN 150CM,62309,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,452.81000,430.17000,Amish/Mennonite,Amish Mennonite,,249.05,,,,,,,221.88,439.23,percent of total billed charges,
CATHETER HAD 13FR L24CM KT SHT TERM 2 LUMN,62311,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,452.81000,430.17000,Amish/Mennonite,Amish Mennonite,,249.05,,,,,,,207.84,452.81,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 24CM PU PWR-TRIALYSIS 3 LUM,62313,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XB3.5 CRV 5FR 100CM COR SS NYL,62314,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JR4 CRV 6FR 100CM COR SS NYL PTFE,62320,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 5FR 65CM SFVU RADOPQ HTORQ,62322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,38.56,84.00,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 6FR 100CM COR SS NYL PTF,62323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG XBLAD3.5 CRV 5FR 100CM COR SS,62324,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG KMP CRV 5FR 40CM VSCR SS NYL,62325,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG 5FR L125CM GWIRE 0.038IN NYL MP.,62326,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,711.11,1407.71,percent of total billed charges,
CATHETER INTVN 7FR 150CM GUIDELINER V3 25CM RX,62327,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,666.12,1451.25,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP 5MM SPC MED CRV 6FR 110CM INQ 2MM MP,62330,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,495.72,1080.00,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,318.35,630.20,percent of total billed charges,
KIT HAD INSERT L30CM SHT TERM STR DLYS CATH,62331,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.5FR 150CM HDRPH QKCRS,62332,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,287.45,626.25,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,318.35,630.20,percent of total billed charges,
KIT CATH STRG 13FR 20CM PU POWER-TRIALYSIS 3 LUM,62338,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,649.69000,617.21000,Amish/Mennonite,Amish Mennonite,,357.33,,,,,,,298.21,649.69,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 5FR 110CM VNTRC RT SS,62339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB 4 CRV 6FR .07IN 100CM SS PTFE NYL,62340,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR .05-.063IN 90CM SS,62341,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4648.88,9202.88,percent of total billed charges,
CATHETER US .014IN CRV 6FR 120CM PNR + REENTRY,62343,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4354.76,9487.50,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,666.00000,632.70000,Amish/Mennonite,Amish Mennonite,,366.30,,,,,,,326.34,646.02,percent of total billed charges,
CAPE EXM 30X21IN TPT ENCR FRN/BK OPN DISP BLU,62344,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,666.00000,632.70000,Amish/Mennonite,Amish Mennonite,,366.30,,,,,,,305.69,666.00,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO 1 CRV 5FR 100CM CRBRL SS NYL TRNB,62346,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,643.12,1273.12,percent of total billed charges,
CATHETER INTVN 2.7-2.9FR .025IN 130CM HDRPH,62348,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3 CRV 6FR 100CM COR NYL PTFE SS,62352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1332.19,2637.19,percent of total billed charges,
CATHETER US 20MHZ 3.3-2.9FR 20MM 150CM GLYDX,62355,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1247.91,2718.75,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,78.40000,74.48000,Amish/Mennonite,Amish Mennonite,,43.12,,,,,,,38.42,76.05,percent of total billed charges,
CATHETER ANGIO PGTL 5FR 70CM 10,62357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,78.40000,74.48000,Amish/Mennonite,Amish Mennonite,,43.12,,,,,,,35.99,78.40,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO MIK CRV 80CM 5FR VSCR SS NYL TRNB,62367,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATH DIAG AD 5FR L100CM COR GRY HYDR NY MPA 2 WITH 2 SIDEHOLE BRD,62370,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 50MM SPC 3.1FR 65CM QKCRS RADOPQ,62375,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,205.80,407.40,percent of total billed charges,
CATHETER ART LN STD 7FR 110CM SG 4 LUM TD VOL,62379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,,231.00,,,,,,,192.78,420.00,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD CATH 14FR L32CM DL CUF KINK RESIST STR W/ DIL INJ,62382,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SET HAD 14FR L25CM STR W/ DIL INJ CAP INTRO NDL SPL CATH,62385,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 6FR 100CM COR SS,62389,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 150CM .047IN .9MM .038IN PERI,62391,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,746.29000,708.98000,Amish/Mennonite,Amish Mennonite,,410.46,,,,,,,365.68,723.90,percent of total billed charges,
KIT DRN 8FR 22GA 6.44IN PNMTHRX 10ML CATH RADOPQ,62392,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,746.29000,708.98000,Amish/Mennonite,Amish Mennonite,,410.46,,,,,,,342.55,746.29,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB LAD 3.5 CRV 6FR 100CM PERI LUB,62396,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,661.50,1309.50,percent of total billed charges,
CATHETER HAD L18CM 10FR SIL NONCOATED STR DL CUF TIP STD FLO,62397,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,619.65,1350.00,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL  NYL,62398,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,643.12,1273.12,percent of total billed charges,
MCTH INFS 900 PSI 2.8FR 130CM TRMO GLD TCH TUNG,62400,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,602.44,1312.50,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,Amish/Mennonite,Amish Mennonite,,1066.31,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 120D MIC 2.4-3.2FR .017-.018IN,62402,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,Amish/Mennonite,Amish Mennonite,,1066.31,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,47.68000,45.30000,Amish/Mennonite,Amish Mennonite,,26.22,,,,,,,23.36,46.25,percent of total billed charges,
CATHETER ANGIO SOS O2 CRV 5FR 80CM VSCR SFVU,62410,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,47.68000,45.30000,Amish/Mennonite,Amish Mennonite,,26.22,,,,,,,21.89,47.68,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3479.63000,3305.65000,Amish/Mennonite,Amish Mennonite,,1913.80,,,,,,,1705.02,3375.24,percent of total billed charges,
CATHETER GD RNGD 18 MIC NEURO,62411,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3479.63000,3305.65000,Amish/Mennonite,Amish Mennonite,,1913.80,,,,,,,1597.15,3479.63,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1162.50000,1104.38000,Amish/Mennonite,Amish Mennonite,,639.38,,,,,,,569.62,1127.62,percent of total billed charges,
KIT HAD CATH L47CM CUF L42CM DIA16FR POLYUR STR STD LT,62412,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1162.50000,1104.38000,Amish/Mennonite,Amish Mennonite,,639.38,,,,,,,533.59,1162.50,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 6FR 100CM COR SS,62413,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9970.50000,9471.98000,Amish/Mennonite,Amish Mennonite,,5483.77,,,,,,,4885.55,9671.39,percent of total billed charges,
CATHETER THRMB 8FR 115CM INDG CNT LG LUM ASP X,62414,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9970.50000,9471.98000,Amish/Mennonite,Amish Mennonite,,5483.77,,,,,,,4576.46,9970.50,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,inpatient,,,3795.00000,3605.25000,Amish/Mennonite,Amish Mennonite,,2087.25,,,,,,,1859.55,3681.15,percent of total billed charges,
CATHETER US VIEWFLEXXICE VIEWMAT.,62416,CDM,278,RC,C1753,HCPCS,,,facility,outpatient,,,3795.00000,3605.25000,Amish/Mennonite,Amish Mennonite,,2087.25,,,,,,,1741.90,3795.00,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,Amish/Mennonite,Amish Mennonite,,863.16,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA10MM 0.035IN HYDRGEL PUSHABLE 35,62418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,Amish/Mennonite,Amish Mennonite,,863.16,,,,,,,720.35,1569.38,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,96.44000,91.62000,Amish/Mennonite,Amish Mennonite,,53.04,,,,,,,47.26,93.55,percent of total billed charges,
CATHETER ANGIO RCQT CRV 5FR 100CM ANGPTC RADOPQ,62420,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,96.44000,91.62000,Amish/Mennonite,Amish Mennonite,,53.04,,,,,,,44.27,96.44,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 6FR .9MM 135CM COR SS ELCA PTCA,62423,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 2.45GHZ 15CM CERTUS 140 1.4MR 3 INDPD,62425,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,3851.19,8390.40,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 12FR 35CM BIL FLXM REG DRMTR FLXB,62426,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9270.15000,8806.64000,Amish/Mennonite,Amish Mennonite,,5098.58,,,,,,,4542.37,8992.05,percent of total billed charges,
CATHETER ABLT 75MM CRV 2-5-2MM SPC 7FR 115CM,62428,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9270.15000,8806.64000,Amish/Mennonite,Amish Mennonite,,5098.58,,,,,,,4255.00,9270.15,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,41.16,81.48,percent of total billed charges,
CATHETER ANGIO OM CRV 4FR 90CM SFVU RADOPQ FLSH,62432,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,38.56,84.00,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2CM DIA3-2MM 0.018IN PLAT SPC SYN FBR TORN,62435,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,498.26000,473.35000,Amish/Mennonite,Amish Mennonite,,274.04,,,,,,,244.15,483.31,percent of total billed charges,
KIT CATH 5FR 18GA 70CM NTNL P PICC SOLO RDSTC 2,62437,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,498.26000,473.35000,Amish/Mennonite,Amish Mennonite,,274.04,,,,,,,228.70,498.26,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,431.25000,409.69000,Amish/Mennonite,Amish Mennonite,,237.19,,,,,,,211.31,418.31,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 100CM CAVA.,62440,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,431.25000,409.69000,Amish/Mennonite,Amish Mennonite,,237.19,,,,,,,197.94,431.25,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1938.75000,1841.81000,Amish/Mennonite,Amish Mennonite,,1066.31,,,,,,,949.99,1880.59,percent of total billed charges,
CATHETER INTVN 90D .014IN MIC 2.1-2.5FR .017IN.,62442,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1938.75000,1841.81000,Amish/Mennonite,Amish Mennonite,,1066.31,,,,,,,889.89,1938.75,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,Amish/Mennonite,Amish Mennonite,,5104.27,,,,,,,4547.44,9002.08,percent of total billed charges,
CATHETER THRMB 8FR 50CM INDG STRL LF,62443,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,Amish/Mennonite,Amish Mennonite,,5104.27,,,,,,,4259.75,9280.50,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA3MM CATH ID0.018IN LOOP 14.9 PERIPH,62450,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE CERTUS PR15 17GA 20 CM,62453,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,3851.19,8390.40,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L5CM DIA12MM 0.038IN FOR ART AND VEN VES MREYE.,62456,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4CM DIA4-2MM 0.018IN PLAT SPC SYN FBR TORN,62466,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 100CM CRBRL SS NYL,62469,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5.8CM DIA6-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62470,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
CATHETER DRN 8FR 35CM BIL FLXM REG DRMTR FLXB,62476,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB .035IN DIA EXT EMBOLUS 10CM COILED EMBOLUS 10MM DIA,62477,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB L10MM UNRESTRAINED L5CM DIA2MM GWIRE 0.018IN FBR,62482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L3.7MM DIA4MM INTRO L41MM GWIRE,62483,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.018IN LOOP 11.1 PERIPH,62485,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,119.76000,113.77000,Amish/Mennonite,Amish Mennonite,,65.87,,,,,,,58.68,116.17,percent of total billed charges,
CATHETER ANGIO ANG VANSCHIE 5 CRV 5FR 65CM SS,62488,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,119.76000,113.77000,Amish/Mennonite,Amish Mennonite,,65.87,,,,,,,54.97,119.76,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L1CM 0.018IN PLAT SPC SYN FBR STR HILAL,62489,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L6MM DIA6MM INTRO L30MM GWIRE 0.018IN,62490,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L4.1CM DIA5-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L2.6CM DIA4-3MM CATH ID0.035IN PLAT SPC SYN FBR LD,62496,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO JB1 CRV 4FR 100CM CRBRL SS HDRPH,62497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3660.00000,3477.00000,Amish/Mennonite,Amish Mennonite,,2013.00,,,,,,,1793.40,3550.20,percent of total billed charges,
CATHETER INFS MIC 2.8-3.2FR .027IN 150CM PERI,62498,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3660.00000,3477.00000,Amish/Mennonite,Amish Mennonite,,2013.00,,,,,,,1679.94,3660.00,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L8CM DIA10MM 0.038IN FOR ART AND VEN VES MREYE,62500,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L7CM DIA6-2MM PLAT SPC SYN FBR TORN,62506,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.018IN LOOP 5.6 PERIPH,62513,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L8CM DIA8-4MM 0.035IN PLAT SPC SYN FBR TORN,62514,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.018IN LOOP 4.5 PERIPH,62520,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO .038IN SIM2 CRV 5FR 100CM CRBRL,62521,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,Amish/Mennonite,Amish Mennonite,,97.92,,,,,,,87.24,172.70,percent of total billed charges,
SET INTRO .038IN 14FR 13CM CKFL PRFRMR 24CM JTP,62523,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,Amish/Mennonite,Amish Mennonite,,97.92,,,,,,,81.72,178.04,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.018IN LOOP 7.4 PERIPH,62525,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 14FR 85CM FEP PLMR CKFL PRFRMR MLN,62526,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,176.38,384.26,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L12.5CM DIA10-5MM CATH ID0.035IN PLAT SPC SYN FBR,62527,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,247.43000,235.06000,Amish/Mennonite,Amish Mennonite,,136.09,,,,,,,121.24,240.01,percent of total billed charges,
INTRO SHTH 12FR 4.1MM 40CM FLXR CHFL LG VLV ACP,62530,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,247.43000,235.06000,Amish/Mennonite,Amish Mennonite,,136.09,,,,,,,113.57,247.43,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 7FR 2.5IN 80CM AQ FLXR SH RADOPQ,62533,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,184.89,366.01,percent of total billed charges,
COIL EMB L5CM DIA5-2MM 0.018IN PLAT SPC SYN FBR TORN,62540,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,377.33000,358.46000,Amish/Mennonite,Amish Mennonite,,207.53,,,,,,,173.19,377.33,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,510.00000,484.50000,Amish/Mennonite,Amish Mennonite,,280.50,,,,,,,249.90,494.70,percent of total billed charges,
CATHETER PA .032IN STD 7.5FR 110CM SG VIP 5 LUM,62545,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,510.00000,484.50000,Amish/Mennonite,Amish Mennonite,,280.50,,,,,,,234.09,510.00,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GD 8FR L100CM TP L0.1IN PTFE INR LNR TOP AR,62563,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD HS CRV 8FR 100CM PERI SS NYL PTFE.,62568,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1.5 CRV 7FR 100CM COR PERI SS NYL.,62575,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AR1 CRV 8FR 100CM COR SS NYL PTFE.,62583,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD 8FR L100CM TIP L0.1IN PTFE INNR,62603,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,37.61,74.46,percent of total billed charges,
SHTH INTRO AVANTI+ 5FR 7.5CM,62604,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,35.23,76.76,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2124.00000,2017.80000,Amish/Mennonite,Amish Mennonite,,1168.20,,,,,,,1040.76,2060.28,percent of total billed charges,
CATH GUID ENVOY XB ST 6FR 90CM,62609,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2124.00000,2017.80000,Amish/Mennonite,Amish Mennonite,,1168.20,,,,,,,974.92,2124.00,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
COIL EMB UNRESTRAINED L5.5MM DIA5MM INTRO L58MM GWIRE,62619,CDM,278,RC,A4649,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR 100CM.,62620,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD JL4 CRV 8FR 100CM COR SS NYL PTFE,62621,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD MPA1 CRV 8FR 100CM COR SS NYL PTFE.,62625,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,93.40000,88.73000,Amish/Mennonite,Amish Mennonite,,51.37,,,,,,,45.77,90.60,percent of total billed charges,
SET INTRO 4FR 40CM NTNL MPNCH PED 10CM SH TRNLS,62628,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,93.40000,88.73000,Amish/Mennonite,Amish Mennonite,,51.37,,,,,,,42.87,93.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 7FR 100CM,62633,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID 8FR L100CM TIP L0.1IN PTFE INNR,62637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,Amish/Mennonite,Amish Mennonite,,1123.26,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GUID ENVOY STR 5FR 90CM,62639,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,Amish/Mennonite,Amish Mennonite,,1123.26,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,320.59000,304.56000,Amish/Mennonite,Amish Mennonite,,176.32,,,,,,,157.09,310.97,percent of total billed charges,
CATHETER GD RDC1 CRV SM 7FR 55CM PERI SS NYL,62643,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,320.59000,304.56000,Amish/Mennonite,Amish Mennonite,,176.32,,,,,,,147.15,320.59,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE BRITE XB3.5 CRV 8FR 100CM COR NYL PTFE SS,62649,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 8FR L100CM TIP L0.1IN PTFE INNR,62656,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD IM CRV 7FR 100CM COR SS NYL PTFE,62657,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,305.33000,290.06000,Amish/Mennonite,Amish Mennonite,,167.93,,,,,,,149.61,296.17,percent of total billed charges,
CATHETER GD RDC1 CRV SM 8FR 55CM PERI SS NYL,62660,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,305.33000,290.06000,Amish/Mennonite,Amish Mennonite,,167.93,,,,,,,140.15,305.33,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .035IN 260CM CONFIDA STRL LF DISP,62669,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,335.64,731.25,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD AL1 CRV 7FR 100CM COR PERI SS NYL.,62676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .032IN 3MM SL1 CRV 8.5FR 63CM TRNSPT,62683,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR2 CRV 8.5FR 63CM TRNSPT.,62691,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,249.58,543.75,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,836.25000,794.44000,Amish/Mennonite,Amish Mennonite,,459.94,,,,,,,409.76,811.16,percent of total billed charges,
PLATE BNE L28MM THK0.3MM 6 H CMF TI STR FOR 1.5MM SCR,62692,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,836.25000,794.44000,Amish/Mennonite,Amish Mennonite,,459.94,,,,,,,383.84,836.25,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB3.5 CRV 8FR 100CM COR SS NYL PTFE,62709,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,Amish/Mennonite,Amish Mennonite,,9889.00,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD 17.6CUCM W4.45XH6.17CM D0.75CM RA/RV IS1-LV,62710,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,Amish/Mennonite,Amish Mennonite,,9889.00,,,,,,,8252.82,17980.00,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1745.62,3455.62,percent of total billed charges,
PLATE BNE W53XL85MM THK0.3MM CMF TI PNL GRID MESH THINFLAP,62712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1635.19,3562.50,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,17980.00000,17081.00000,Amish/Mennonite,Amish Mennonite,,9889.00,,,,,,,8810.20,17440.60,percent of total billed charges,
PACEMAKER CARD W1.8XH2.4IN THK0.3IN 30.6GM RA/RV IS-1 CONN,62713,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,17980.00000,17081.00000,Amish/Mennonite,Amish Mennonite,,9889.00,,,,,,,8252.82,17980.00,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,Amish/Mennonite,Amish Mennonite,,443.95,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 6-7FR VASC CRDS MYNXGRIP 10ML BLN,62716,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,Amish/Mennonite,Amish Mennonite,,443.95,,,,,,,370.50,807.19,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR3 CRV 8.5FR 63CM TRNSPT.,62717,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,249.58,543.75,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR1 CRV 8.5FR 63CM FSTCTH.,62720,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,249.58,543.75,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUIDE 8FR L100CM TIP L0.1IN PTFE INNR,62721,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BUR H L DIA18.5MM 5 H TI BENT W/O TAB NONCOMPRESSION,62723,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,903.75000,858.56000,Amish/Mennonite,Amish Mennonite,,497.06,,,,,,,442.84,876.64,percent of total billed charges,
PLATE BNE L65MM THK0.3MM 16 H CMF TI STR FOR 1.5MM SCR,62725,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,903.75000,858.56000,Amish/Mennonite,Amish Mennonite,,497.06,,,,,,,414.82,903.75,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,Amish/Mennonite,Amish Mennonite,,285.62,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP 2-8-2MM SPC D CRV 5FR 110CM REDEL 1,62735,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,Amish/Mennonite,Amish Mennonite,,285.62,,,,,,,238.36,519.30,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3120.00000,2964.00000,Amish/Mennonite,Amish Mennonite,,1716.00,,,,,,,1528.80,3026.40,percent of total billed charges,
PLUG VASC 5FR L7MM DIA10MM CATH 6FR L100CM NIT MULT LAYR,62747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3120.00000,2964.00000,Amish/Mennonite,Amish Mennonite,,1716.00,,,,,,,1432.08,3120.00,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,266.44,527.44,percent of total billed charges,
INTRO SHTH .038IN SR0 CRV J 8.5FR 63CM.,62758,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,543.75000,516.56000,Amish/Mennonite,Amish Mennonite,,299.06,,,,,,,249.58,543.75,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
DEVICE CLSR 6FR VASC NTNL STRCLS SE CLIP STRL LF,62775,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,2028.60,4015.80,percent of total billed charges,
CATHETER EP 5-5-5MM SPC SUP LG CRV 7FR 100CM,62782,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,1900.26,4140.00,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,inpatient,,,416.25000,395.44000,Amish/Mennonite,Amish Mennonite,,228.94,,,,,,,203.96,403.76,percent of total billed charges,
PLATE BNE L22MM THK0.3MM 4 H CRANIOMAXILLOFACIAL TI STR,62785,CDM,278,RC,C1734,HCPCS,,,facility,outpatient,,,416.25000,395.44000,Amish/Mennonite,Amish Mennonite,,228.94,,,,,,,191.06,416.25,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,921.79000,875.70000,Amish/Mennonite,Amish Mennonite,,506.98,,,,,,,451.68,894.14,percent of total billed charges,
SET DIL 84CM 6-30FR 8FR 30CM RNL PTFE AMPTZ 16CM,62788,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,921.79000,875.70000,Amish/Mennonite,Amish Mennonite,,506.98,,,,,,,423.10,921.79,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
PLATE BNE L25MM THK0.3MM 6 H CRANIOMAXILLOFACIAL TI CRV,62790,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 6FR 120CM SPRM,62802,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER EP 1MM 2MM 5-5-5 SPC MD SWP CRV 6FR,62804,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC B CRV 7FR 115CM C,62814,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1561.17,3401.25,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L23MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62819,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2891.25000,2746.69000,Amish/Mennonite,Amish Mennonite,,1590.19,,,,,,,1416.71,2804.51,percent of total billed charges,
CATHETER EP BLZR II LG CRV 7 FR 4M,62823,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2891.25000,2746.69000,Amish/Mennonite,Amish Mennonite,,1590.19,,,,,,,1327.08,2891.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC D CRV 7FR 115CM C 4MM,62828,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,Amish/Mennonite,Amish Mennonite,,91.39,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC COURNAND1 CRV 6FR 120CM SPRM,62830,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,Amish/Mennonite,Amish Mennonite,,91.39,,,,,,,76.27,166.16,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L30MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62839,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13104.65,28550.44,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,inpatient,,,47250.00000,44887.50000,Amish/Mennonite,Amish Mennonite,,25987.50,,,,,,,23152.50,45832.50,percent of total billed charges,
SYSTEM CRD CARDIOMEMS PA SNSR DLV,62843,CDM,278,RC,C2624,HCPCS,,,facility,outpatient,,,47250.00000,44887.50000,Amish/Mennonite,Amish Mennonite,,25987.50,,,,,,,21687.75,47250.00,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,78.40,155.20,percent of total billed charges,
CATHETER EP 5MM SPC CRNND CRV 5FR 120 CM SPRM.,62845,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,73.44,160.00,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,Amish/Mennonite,Amish Mennonite,,1201.41,,,,,,,1070.35,2118.85,percent of total billed charges,
CATHETER GD 1.8-2.6FR 150CM COR SS HDRPH,62848,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,Amish/Mennonite,Amish Mennonite,,1201.41,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L16MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62851,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13104.65,28550.44,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13989.72,27693.93,percent of total billed charges,
STENT NEUROVASC L39MM DIA2.5X4MM W/ DST TIP VASC RECON DEV.,62856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28550.44000,27122.92000,Amish/Mennonite,Amish Mennonite,,15702.74,,,,,,,13104.65,28550.44,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1666.61,3299.21,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC F CRV 7FR 115CM C,62875,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3401.25000,3231.19000,Amish/Mennonite,Amish Mennonite,,1870.69,,,,,,,1561.17,3401.25,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2042.29000,1940.18000,Amish/Mennonite,Amish Mennonite,,1123.26,,,,,,,1000.72,1981.02,percent of total billed charges,
CATHETER GD MPD CRV 6FR 90CM NRVSC SS NYL PU,62877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2042.29000,1940.18000,Amish/Mennonite,Amish Mennonite,,1123.26,,,,,,,937.41,2042.29,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PCNG 1CM SPC CRV 6FR 110CM VNTRC RT SS,62881,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,91.23,198.75,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 49MM REACH SHRT 7FR,62899,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRMY 14FR 4CM ENTRL SIL MC SLK 5ML,62916,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER CRYABL 60MM LNG 7FR 108CM FRZRX5 6MM,62921,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,5137.91000,4881.01000,Amish/Mennonite,Amish Mennonite,,2825.85,,,,,,,2517.58,4983.77,percent of total billed charges,
FILTER VENA CAVA CATH 11FR L75CM MAX DIA40MM INTRO SHTH 20FR,62923,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,5137.91000,4881.01000,Amish/Mennonite,Amish Mennonite,,2825.85,,,,,,,2358.30,5137.91,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,191.25000,181.69000,Amish/Mennonite,Amish Mennonite,,105.19,,,,,,,93.71,185.51,percent of total billed charges,
GUIDEWIRE VASC STD SHFT FLXB COR TO TIP RADOPQ,62938,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,191.25000,181.69000,Amish/Mennonite,Amish Mennonite,,105.19,,,,,,,87.78,191.25,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 55MM REACH MED 7FR 108,62946,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2282.18,4517.77,percent of total billed charges,
KIT EMB VENA CAVA FLTR JUG SUBCLAV DEL ADV TECH DENALI,62950,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2137.79,4657.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,Amish/Mennonite,Amish Mennonite,,5754.38,,,,,,,5126.62,10148.62,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.8GM 2 CHMBR,62952,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,Amish/Mennonite,Amish Mennonite,,5754.38,,,,,,,4802.29,10148.62,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC ANG .035IN 180CM PERI NTNL PU,62955,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11082.50000,10528.38000,Amish/Mennonite,Amish Mennonite,,6095.38,,,,,,,5430.43,10750.02,percent of total billed charges,
PACEMAKER CARD 15.8CC W4.45XH5.88CM D0.75CM 29.1GM 2 CHMBR,62957,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11082.50000,10528.38000,Amish/Mennonite,Amish Mennonite,,6095.38,,,,,,,5086.87,10750.02,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SHEATH FLEXCATHETER 12 FR 81CM,62958,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,89.18,176.54,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 180CM PERI NTNL PU,62963,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,83.54,182.00,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,Amish/Mennonite,Amish Mennonite,,11210.55,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM MRI W/ SURESCAN TECH,62965,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,Amish/Mennonite,Amish Mennonite,,11210.55,,,,,,,9355.71,20382.81,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 14FR 3CM ENTRL SIL MC SLK LOPRFL FD,62974,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOPQ,62975,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,98.97,215.63,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,24570.00000,23341.50000,Amish/Mennonite,Amish Mennonite,,13513.50,,,,,,,12039.30,23832.90,percent of total billed charges,
DEFIBRILLATOR CRD 36ML DF-4 IS-1 SNSE PACE CONN RF TELMTRY,62978,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,24570.00000,23341.50000,Amish/Mennonite,Amish Mennonite,,13513.50,,,,,,,11277.63,24570.00,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC STF SHFT FLXB COR TO TIP RADOP,62979,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,92.95,202.50,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9842.50000,9350.38000,Amish/Mennonite,Amish Mennonite,,5413.38,,,,,,,4822.82,9547.23,percent of total billed charges,
PACEMAKER CARD 13.7CC W4.45XH5.02CM D0.75CM 24.4GM 2 CHMBR,62995,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9842.50000,9350.38000,Amish/Mennonite,Amish Mennonite,,5413.38,,,,,,,4517.71,9547.23,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH74MM D13MM 81GM TI POLYUR SIL,62997,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,637.50000,605.62000,Amish/Mennonite,Amish Mennonite,,350.62,,,,,,,312.38,618.38,percent of total billed charges,
GUIDEWIRE VASC .025IN 175CM TORAYGUIDE SS 140MM,63001,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,637.50000,605.62000,Amish/Mennonite,Amish Mennonite,,350.62,,,,,,,292.61,637.50,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,Amish/Mennonite,Amish Mennonite,,13389.23,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 30GM W46.5XH59MM D11MM MRI W/ SURESCAN,63004,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,Amish/Mennonite,Amish Mennonite,,13389.23,,,,,,,11173.92,24344.05,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,46200.00000,43890.00000,Amish/Mennonite,Amish Mennonite,,25410.00,,,,,,,22638.00,44814.00,percent of total billed charges,
DEFIBRILLATOR CARD W83.1XH69.1MM D12.7MM S-ICD TYP CONN INT,63011,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,46200.00000,43890.00000,Amish/Mennonite,Amish Mennonite,,25410.00,,,,,,,21205.80,46200.00,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,24344.05000,23126.85000,Amish/Mennonite,Amish Mennonite,,13389.23,,,,,,,11928.58,23613.73,percent of total billed charges,
PACEMAKER CARD 19.5CC W46.5XH59MM D11MM 30GM TI POLYUR SIL,63019,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,24344.05000,23126.85000,Amish/Mennonite,Amish Mennonite,,13389.23,,,,,,,11173.92,24344.05,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,22575.00000,21446.25000,Amish/Mennonite,Amish Mennonite,,12416.25,,,,,,,11061.75,21897.75,percent of total billed charges,
SYSTEM PACEMKR 0.8ML L25.9MM DIA6.7MM TRANSCATHETER INTRO,63026,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,22575.00000,21446.25000,Amish/Mennonite,Amish Mennonite,,12416.25,,,,,,,10361.92,22575.00,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11532.00000,10955.40000,Amish/Mennonite,Amish Mennonite,,6342.60,,,,,,,5650.68,11186.04,percent of total billed charges,
PACEMAKER CARD W50.8XH46.6MM D7.4MM 12.75CUCM TI PLYR SIL.,63055,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11532.00000,10955.40000,Amish/Mennonite,Amish Mennonite,,6342.60,,,,,,,5293.19,11186.04,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ BL MWT,63070,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .032IN 180CM,63071,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,33.89,73.84,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,431.63000,410.05000,Amish/Mennonite,Amish Mennonite,,237.40,,,,,,,211.50,418.68,percent of total billed charges,
GUIDEWIRE IABP J .025IN 145CM SS PTFE SNS + LNR,63096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,431.63000,410.05000,Amish/Mennonite,Amish Mennonite,,237.40,,,,,,,198.12,431.63,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,Amish/Mennonite,Amish Mennonite,,5626.50,,,,,,,5012.70,9923.10,percent of total billed charges,
PACEMAKER CARD 21.5GM W42.9XH40.2MM D7.5MM IS-1 UPLR,63098,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,Amish/Mennonite,Amish Mennonite,,5626.50,,,,,,,4695.57,10230.00,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,11780.00000,11191.00000,Amish/Mennonite,Amish Mennonite,,6479.00,,,,,,,5772.20,11426.60,percent of total billed charges,
PACEMAKER CARD W47.9XH46.7MM D7.5MM GENRTR PERM 2 CHMBR BPLR,63103,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,11780.00000,11191.00000,Amish/Mennonite,Amish Mennonite,,6479.00,,,,,,,5407.02,11426.60,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,Amish/Mennonite,Amish Mennonite,,406.31,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 90D 60D .018IN 180CM NTNL PU,63104,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,Amish/Mennonite,Amish Mennonite,,406.31,,,,,,,339.09,738.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM HTRQ BL MWT,63105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,29.28000,27.82000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,14.35,28.40,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 150CM INQWR,63107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,29.28000,27.82000,Amish/Mennonite,Amish Mennonite,,16.10,,,,,,,13.44,29.28,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,217.50000,206.62000,Amish/Mennonite,Amish Mennonite,,119.62,,,,,,,106.58,210.97,percent of total billed charges,
GUIDEWIRE VASC 5IN STF STRBL TRQ DEV ANG SHRT.,63111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,217.50000,206.62000,Amish/Mennonite,Amish Mennonite,,119.62,,,,,,,99.83,217.50,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,9513.90000,9038.20000,Amish/Mennonite,Amish Mennonite,,5232.65,,,,,,,4661.81,9228.48,percent of total billed charges,
PACEMAKER CARD 22.5GM W50.8XH42.6MM D7.4MM TI POLYUR SIL RUB,63114,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,9513.90000,9038.20000,Amish/Mennonite,Amish Mennonite,,5232.65,,,,,,,4366.88,9513.90,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,541.50000,514.42000,Amish/Mennonite,Amish Mennonite,,297.82,,,,,,,265.33,525.25,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM SS PTFE LNDRQS,63117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,541.50000,514.42000,Amish/Mennonite,Amish Mennonite,,297.82,,,,,,,248.55,541.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .035IN 260CM SS,63120,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,33.89,73.84,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,881.25000,837.19000,Amish/Mennonite,Amish Mennonite,,484.69,,,,,,,431.81,854.81,percent of total billed charges,
PUSHER SRG .016FR .018IN 177CM EMBL COIL,63122,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,881.25000,837.19000,Amish/Mennonite,Amish Mennonite,,484.69,,,,,,,404.49,881.25,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,128.20000,121.79000,Amish/Mennonite,Amish Mennonite,,70.51,,,,,,,62.82,124.35,percent of total billed charges,
GUIDEWIRE VASC ANG STD TPR .018IN 60CM CP MDRL,63125,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,128.20000,121.79000,Amish/Mennonite,Amish Mennonite,,70.51,,,,,,,58.84,128.20,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,77.64000,73.76000,Amish/Mennonite,Amish Mennonite,,42.70,,,,,,,38.04,75.31,percent of total billed charges,
GW VASC 260CM .035IN FX COR,63126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,77.64000,73.76000,Amish/Mennonite,Amish Mennonite,,42.70,,,,,,,35.64,77.64,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,Amish/Mennonite,Amish Mennonite,,217.60,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM COR NTNL HDRPH,63132,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,Amish/Mennonite,Amish Mennonite,,217.60,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,40.77,80.70,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM AMPTZ SS,63133,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,,45.76,,,,,,,38.19,83.20,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEEL PLMR,63142,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
EXTENSION GW .014-.018IN 145CM DOC.,63143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.85000,253.51000,Amish/Mennonite,Amish Mennonite,,146.77,,,,,,,130.76,258.84,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 180CM SS PTFE,63144,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.85000,253.51000,Amish/Mennonite,Amish Mennonite,,146.77,,,,,,,122.48,266.85,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,69.72000,66.23000,Amish/Mennonite,Amish Mennonite,,38.35,,,,,,,34.16,67.63,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM CRBRL,63145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,69.72000,66.23000,Amish/Mennonite,Amish Mennonite,,38.35,,,,,,,32.00,69.72,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,Amish/Mennonite,Amish Mennonite,,3043.59,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM,63154,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,Amish/Mennonite,Amish Mennonite,,3043.59,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,94.96000,90.21000,Amish/Mennonite,Amish Mennonite,,52.23,,,,,,,46.53,92.11,percent of total billed charges,
GUIDEWIRE VASC 1.5MM RDS J CRV RSN TPR .035IN,63161,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,94.96000,90.21000,Amish/Mennonite,Amish Mennonite,,52.23,,,,,,,43.59,94.96,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASC STRG SHRT TPR .018IN 200CM V-18,63165,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,46.72000,44.38000,Amish/Mennonite,Amish Mennonite,,25.70,,,,,,,22.89,45.32,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 260CM PERI SS,63166,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,46.72000,44.38000,Amish/Mennonite,Amish Mennonite,,25.70,,,,,,,21.44,46.72,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,99.22,196.43,percent of total billed charges,
GUIDEWIRE VASC 0D STRG .018IN 60CM PERI COR NTN,63168,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5533.80000,5257.11000,Amish/Mennonite,Amish Mennonite,,3043.59,,,,,,,2711.56,5367.79,percent of total billed charges,
CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM,63171,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5533.80000,5257.11000,Amish/Mennonite,Amish Mennonite,,3043.59,,,,,,,2540.01,5533.80,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,58.84000,55.90000,Amish/Mennonite,Amish Mennonite,,32.36,,,,,,,28.83,57.07,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 260CM,63173,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,58.84000,55.90000,Amish/Mennonite,Amish Mennonite,,32.36,,,,,,,27.01,58.84,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,Amish/Mennonite,Amish Mennonite,,2436.39,,,,,,,2170.60,4296.91,percent of total billed charges,
BALLOON OCCL HYPR GLDE 4X20X150MM,63177,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,Amish/Mennonite,Amish Mennonite,,2436.39,,,,,,,2033.28,4429.80,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3397.09000,3227.24000,Amish/Mennonite,Amish Mennonite,,1868.40,,,,,,,1664.57,3295.18,percent of total billed charges,
CATHETER IAB 7.5FR LNR 25CC STRL LF DISP,63178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3397.09000,3227.24000,Amish/Mennonite,Amish Mennonite,,1868.40,,,,,,,1559.26,3397.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SION ASAHI BLU PTCA,63185,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2006.21000,1905.90000,Amish/Mennonite,Amish Mennonite,,1103.42,,,,,,,983.04,1946.02,percent of total billed charges,
SET ACC 10FR 16GA 50.5CM TRNJUG INTRHEP 38.5CM,63190,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2006.21000,1905.90000,Amish/Mennonite,Amish Mennonite,,1103.42,,,,,,,920.85,2006.21,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SLIP-COAT SS,63193,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8752.62000,8314.99000,Amish/Mennonite,Amish Mennonite,,4813.94,,,,,,,4288.78,8490.04,percent of total billed charges,
STENT TRACHBRONCH L16MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,63194,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8752.62000,8314.99000,Amish/Mennonite,Amish Mennonite,,4813.94,,,,,,,4017.45,8752.62,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM DURASTEEL PLMR,63201,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,321.56,636.56,percent of total billed charges,
GUIDEWIRE VASCULAR STRG SHRT TPR .018IN 300CM V-18,63204,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,301.22,656.25,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.83000,274.39000,Amish/Mennonite,Amish Mennonite,,158.86,,,,,,,141.53,280.17,percent of total billed charges,
GUIDEWIRE VASC J CRV TPR .035IN 180CM AMPTZ SS,63206,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.83000,274.39000,Amish/Mennonite,Amish Mennonite,,158.86,,,,,,,132.57,288.83,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4429.80000,4208.31000,Amish/Mennonite,Amish Mennonite,,2436.39,,,,,,,2170.60,4296.91,percent of total billed charges,
CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM,63207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4429.80000,4208.31000,Amish/Mennonite,Amish Mennonite,,2436.39,,,,,,,2033.28,4429.80,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,59.44000,56.47000,Amish/Mennonite,Amish Mennonite,,32.69,,,,,,,29.13,57.66,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 180CM CRBRL,63213,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,59.44000,56.47000,Amish/Mennonite,Amish Mennonite,,32.69,,,,,,,27.28,59.44,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,Amish/Mennonite,Amish Mennonite,,31185.00,,,,,,,27783.00,54999.00,percent of total billed charges,
CATHETER AST 9.3IN 10-40C 17.4X13.8IN IMPELLA.,63237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,Amish/Mennonite,Amish Mennonite,,31185.00,,,,,,,26025.30,56700.00,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO 10CM 6FR 22GA .021IN 45CM GLIDESHEATH,63266,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,183.32,399.38,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
SYSTEM INTRO .018IN .038IN J 6FR 4FR 60CM SS,63267,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM NTNL MPNCH 40CM,63275,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,46.60,101.52,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 8FR .038IN 13CM PRELUDE SNP 50CM RBST,63276,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,67.75,147.60,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD ANSEL 2 CRV 7FR 2.5MM 45CM HDRPH CKFL,63279,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD 6FR 2.2MM 45CM FLXR ANSEL MODIFICATION,63283,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,162.40000,154.28000,Amish/Mennonite,Amish Mennonite,,89.32,,,,,,,79.58,157.53,percent of total billed charges,
SET INTRO .018IN 5FR 21GA 10CM PLTN NTNL MPNCH,63291,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,162.40000,154.28000,Amish/Mennonite,Amish Mennonite,,89.32,,,,,,,74.54,162.40,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9953.60000,9455.92000,Amish/Mennonite,Amish Mennonite,,5474.48,,,,,,,4877.26,9654.99,percent of total billed charges,
STNT TRACHBRONCH L16MM DIA6MM CATH 7FR L120CM SS PTFE CVR.,63295,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9953.60000,9455.92000,Amish/Mennonite,Amish Mennonite,,5474.48,,,,,,,4568.70,9953.60,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,606.38000,576.06000,Amish/Mennonite,Amish Mennonite,,333.51,,,,,,,297.13,588.19,percent of total billed charges,
KIT CATHR RVRS TPR 4FR 6FR 17GA 70CM NTNL XCELA,63296,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,606.38000,576.06000,Amish/Mennonite,Amish Mennonite,,333.51,,,,,,,278.33,606.38,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,Amish/Mennonite,Amish Mennonite,,121.69,,,,,,,108.41,214.61,percent of total billed charges,
SHEATH GD RAABE CRV 8FR 2.9MM 55CM FLXR CHFL,63305,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,Amish/Mennonite,Amish Mennonite,,121.69,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,177.68000,168.80000,Amish/Mennonite,Amish Mennonite,,97.72,,,,,,,87.06,172.35,percent of total billed charges,
INTRO SHTH 6.5FR 37CM DSLT HFMN RB LIEBERMAN,63311,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,177.68000,168.80000,Amish/Mennonite,Amish Mennonite,,97.72,,,,,,,81.56,177.68,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,131.64000,125.06000,Amish/Mennonite,Amish Mennonite,,72.40,,,,,,,64.50,127.69,percent of total billed charges,
KIT INTRO .038IN 7FR 14CM PTFE INDN SPNLK 19CM,63313,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,131.64000,125.06000,Amish/Mennonite,Amish Mennonite,,72.40,,,,,,,60.42,131.64,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 10FR .131IN 13CM PRELUDE SNP RBST VLV,63317,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 6FR 12CM,63318,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 7FR 10CM COR HDRPH PTFE PNCL 2.5CM,63320,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 9FR .118IN 13CM PRELUDE SNP RBST VLV,63321,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 5FR 12CM,63322,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.52,36.00,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 7FR 12CM,63326,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 6FR 45CM SS NYL HDRPH PTFE PN,63329,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 6FR 10CM COR HDRPH PTFE PNCL 2.5CM,63334,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH 18FR 5.9MM 30CM PRFRMR RADOPQ STRL,63338,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,59.56000,56.58000,Amish/Mennonite,Amish Mennonite,,32.76,,,,,,,29.18,57.77,percent of total billed charges,
INTRO SHTH .038IN 12FR 12CM FSTCTH 50CM LG LUM,63339,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,59.56000,56.58000,Amish/Mennonite,Amish Mennonite,,32.76,,,,,,,27.34,59.56,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,,104.06,,,,,,,92.71,183.52,percent of total billed charges,
INTRO SHTH 9FR .118IN 25CM PRELUDE SNP RBST VLV,63348,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,,104.06,,,,,,,86.84,189.20,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GD STRG 7FR 45CM SS NYL HDRPH PTFE PN,63353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
INTRO SHTH 8FR 10CM COR HDRPH PTFE PNCL 2.5CM,63357,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,137.96000,131.06000,Amish/Mennonite,Amish Mennonite,,75.88,,,,,,,67.60,133.82,percent of total billed charges,
KIT SHTH .038IN 50CM 3MM 12FR 18GA 14CM SS PTFE,63359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,137.96000,131.06000,Amish/Mennonite,Amish Mennonite,,75.88,,,,,,,63.32,137.96,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHEATH INTRO 5FR 10CM COR SS HDRPH PTFE PNCL 2.5,63363,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,440.63000,418.60000,Amish/Mennonite,Amish Mennonite,,242.35,,,,,,,215.91,427.41,percent of total billed charges,
SHEATH GD STRG 6FR 65CM SS NYL HDRPH PTFE PN,63366,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,440.63000,418.60000,Amish/Mennonite,Amish Mennonite,,242.35,,,,,,,202.25,440.63,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1049.63000,997.15000,Amish/Mennonite,Amish Mennonite,,577.30,,,,,,,514.32,1018.14,percent of total billed charges,
SYSTEM DTCH INZONE STRL LF DISP,63370,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1049.63000,997.15000,Amish/Mennonite,Amish Mennonite,,577.30,,,,,,,481.78,1049.63,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,164.80000,156.56000,Amish/Mennonite,Amish Mennonite,,90.64,,,,,,,80.75,159.86,percent of total billed charges,
SET INTRO 21GA 4CM 4FR .018IN 2.9FR 7CM NTNL PL,63382,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,164.80000,156.56000,Amish/Mennonite,Amish Mennonite,,90.64,,,,,,,75.64,164.80,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.46000,1745.59000,Amish/Mennonite,Amish Mennonite,,1010.60,,,,,,,900.36,1782.34,percent of total billed charges,
SET INTVN 10FR LVR TRNJUG RU ACC STRL DISP.,63385,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.46000,1745.59000,Amish/Mennonite,Amish Mennonite,,1010.60,,,,,,,843.39,1837.46,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 10CM HDRPH GLIDESHEATH 45CM,63397,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,78.95,172.00,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VNT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,63410,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,2850.39,6210.00,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4142.31000,3935.19000,Amish/Mennonite,Amish Mennonite,,2278.27,,,,,,,2029.73,4018.04,percent of total billed charges,
SYSTEM DX CATH 11GA 10MM IVAS INFL STRL LF DISP,63416,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4142.31000,3935.19000,Amish/Mennonite,Amish Mennonite,,2278.27,,,,,,,1901.32,4142.31,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,Amish/Mennonite,Amish Mennonite,,915.75,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 4.1FR L69CM AV TRNSVEN SIL POLYUR INSULATOR,63423,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,Amish/Mennonite,Amish Mennonite,,915.75,,,,,,,764.24,1615.05,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,Amish/Mennonite,Amish Mennonite,,1237.50,,,,,,,1102.50,2182.50,percent of total billed charges,
CATHETER ABLT 2-5-2MM SPC 2MM LG CRV 7FR 110CM,63426,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,Amish/Mennonite,Amish Mennonite,,1237.50,,,,,,,1032.75,2250.00,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,3225.00000,3063.75000,Amish/Mennonite,Amish Mennonite,,1773.75,,,,,,,1580.25,3128.25,percent of total billed charges,
CATHETER ABL 2MM 2-5-2MM SPC LG CRV 7FR 110CM,63427,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,3225.00000,3063.75000,Amish/Mennonite,Amish Mennonite,,1773.75,,,,,,,1480.28,3225.00,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
KIT LD LCK LLD XTRT ACC DISP,63428,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE AD L65CM DIA6FR SIL PLAT BPLR VENT INSUL,63529,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L45CM SIL INSUL BPLR PLATINIZED STEROID DXAC,63540,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L58CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63546,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,710.74,1502.00,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,Amish/Mennonite,Amish Mennonite,,740.44,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L52CM AV POLYUR MNTOL PLAT IRIDIM IS 1 BPLR,63555,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,Amish/Mennonite,Amish Mennonite,,740.44,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1346.25000,1278.94000,Amish/Mennonite,Amish Mennonite,,740.44,,,,,,,659.66,1305.86,percent of total billed charges,
LEAD PACE 5.1FR L45CM AV POLYUR MNTOL PLAT IRIDIUM IS 1 BPLR,63562,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1346.25000,1278.94000,Amish/Mennonite,Amish Mennonite,,740.44,,,,,,,617.93,1305.86,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 6FR L52CM SIL INSUL BPLR PLATINIZED STEROID DXAC.,63608,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,710.74,1502.00,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2625.00000,2493.75000,Amish/Mennonite,Amish Mennonite,,1443.75,,,,,,,1286.25,2546.25,percent of total billed charges,
CATHETER INFS MIC 2.7-1.5FR .015-.013FRX165CM,63610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2625.00000,2493.75000,Amish/Mennonite,Amish Mennonite,,1443.75,,,,,,,1204.88,2625.00,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GASTROSTMY 18FRCH 2.3 45 CM,63632,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4227.56000,4016.18000,Amish/Mennonite,Amish Mennonite,,2325.16,,,,,,,2071.50,4100.73,percent of total billed charges,
MICROCATH CRBRVASC  1.7-2.3FR .015IN 150CM COR.,63658,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4227.56000,4016.18000,Amish/Mennonite,Amish Mennonite,,2325.16,,,,,,,1940.45,4227.56,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,7900.50000,7505.47000,Amish/Mennonite,Amish Mennonite,,4345.27,,,,,,,3871.24,7663.48,percent of total billed charges,
SNARE VASC .014IN 2MM 180CM MIC ELT RADOPQ,63662,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,7900.50000,7505.47000,Amish/Mennonite,Amish Mennonite,,4345.27,,,,,,,3626.33,7900.50,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 45D MIC 2.4-1.7FR .0165IN 150CM,63672,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D MIC 2.4-1.7FR .0165IN 150CM,63675,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC STRG 2.4-1.7FR .0165IN 150CM HDRLN,63676,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,1918.31,4179.33,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2733.75000,2597.06000,Amish/Mennonite,Amish Mennonite,,1503.56,,,,,,,1339.54,2651.74,percent of total billed charges,
MCTH CRBRVASC 45D 10 1.7-2.1FR .017IN 150CM,63679,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2733.75000,2597.06000,Amish/Mennonite,Amish Mennonite,,1503.56,,,,,,,1254.79,2733.75,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2572.50000,2443.88000,Amish/Mennonite,Amish Mennonite,,1414.88,,,,,,,1260.53,2495.32,percent of total billed charges,
CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM,63687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2572.50000,2443.88000,Amish/Mennonite,Amish Mennonite,,1414.88,,,,,,,1180.78,2572.50,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.00000,572.85000,Amish/Mennonite,Amish Mennonite,,331.65,,,,,,,295.47,584.91,percent of total billed charges,
GUIDEWIRE VASC BNTSN STRG TPR .035IN 260CM,63693,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.00000,572.85000,Amish/Mennonite,Amish Mennonite,,331.65,,,,,,,276.78,603.00,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,Amish/Mennonite,Amish Mennonite,,1937.63,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CRBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,63700,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,Amish/Mennonite,Amish Mennonite,,1937.63,,,,,,,1617.04,3522.97,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,Amish/Mennonite,Amish Mennonite,,2524.05,,,,,,,2248.70,4451.51,percent of total billed charges,
MCTH CRBRVASC 150CM EXCLS XT-27 6CM 1 TIP MRKR,63701,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,Amish/Mennonite,Amish Mennonite,,2524.05,,,,,,,2106.44,4589.19,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4589.19000,4359.73000,Amish/Mennonite,Amish Mennonite,,2524.05,,,,,,,2248.70,4451.51,percent of total billed charges,
CATH CRBRVASC 2.9-2.7FR .027IN 150CM SS EXCLS,63703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4589.19000,4359.73000,Amish/Mennonite,Amish Mennonite,,2524.05,,,,,,,2106.44,4589.19,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,2047.87,4053.95,percent of total billed charges,
MCTH CRBRVASC 90D .014-.016IN MIC 2.6-2FR .019IN,63713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4179.33000,3970.36000,Amish/Mennonite,Amish Mennonite,,2298.63,,,,,,,1918.31,4179.33,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO MIK CRV 5FR 80CM VSCR SS NYL TRNB,63728,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4305.84000,4090.55000,Amish/Mennonite,Amish Mennonite,,2368.21,,,,,,,2109.86,4176.66,percent of total billed charges,
MCTH CRBRVASC STRG 1.9-2.3FR .015IN 150CM COR,63745,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4305.84000,4090.55000,Amish/Mennonite,Amish Mennonite,,2368.21,,,,,,,1976.38,4305.84,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,Amish/Mennonite,Amish Mennonite,,133.61,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 5FR 100CM MLTRCK RADOPQ OFST DIST,63770,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,Amish/Mennonite,Amish Mennonite,,133.61,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,,173.25,,,,,,,154.35,305.55,percent of total billed charges,
CATHETER ANGIO MPB 5FR 100CM,63773,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,,173.25,,,,,,,144.59,315.00,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,242.93000,230.78000,Amish/Mennonite,Amish Mennonite,,133.61,,,,,,,119.04,235.64,percent of total billed charges,
CATHETER ANGIO 100CM 6FR MLTRCK RADOPQ OFST DIST,63777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,242.93000,230.78000,Amish/Mennonite,Amish Mennonite,,133.61,,,,,,,111.50,242.93,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,Amish/Mennonite,Amish Mennonite,,143.61,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRN 8.5FR 25CM BD ULTHNE HDRPH,63779,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,Amish/Mennonite,Amish Mennonite,,143.61,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4692.00000,4457.40000,Amish/Mennonite,Amish Mennonite,,2580.60,,,,,,,2299.08,4551.24,percent of total billed charges,
CATHETER NAVIEN STR 5FR 115 CM,63785,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4692.00000,4457.40000,Amish/Mennonite,Amish Mennonite,,2580.60,,,,,,,2153.63,4692.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,Amish/Mennonite,Amish Mennonite,,2031.56,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX95CM,63822,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,Amish/Mennonite,Amish Mennonite,,2031.56,,,,,,,1695.43,3693.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.52000,42.29000,Amish/Mennonite,Amish Mennonite,,24.49,,,,,,,21.81,43.18,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV NWTN LT TPR .035IN,63836,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.52000,42.29000,Amish/Mennonite,Amish Mennonite,,24.49,,,,,,,20.43,44.52,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 100-300UM 2ML YEL PREFIL SYR NONRADIOACTIVE,63837,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER MIDWAY 43 6FRX115CM,63838,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2644.53,5761.50,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,900.38,1782.38,percent of total billed charges,
SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM,63845,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,2051.96000,1949.36000,Amish/Mennonite,Amish Mennonite,,1128.58,,,,,,,1005.46,1990.40,percent of total billed charges,
CATHETER PA 7FR 110CM ATR VNTRC SG 4 LUM TD PACE,63849,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,2051.96000,1949.36000,Amish/Mennonite,Amish Mennonite,,1128.58,,,,,,,941.85,2051.96,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 300-500UM 2ML BLU NACL SYR DEL SYS,63852,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,426.87,930.00,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3693.75000,3509.06000,Amish/Mennonite,Amish Mennonite,,2031.56,,,,,,,1809.94,3582.94,percent of total billed charges,
CATHETER BENCHMARK 6FRX105CM,63856,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3693.75000,3509.06000,Amish/Mennonite,Amish Mennonite,,2031.56,,,,,,,1695.43,3693.75,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .045INX134CM PENUMBRA SYS SEPRTR,63858,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1087.50000,1033.12000,Amish/Mennonite,Amish Mennonite,,598.12,,,,,,,532.88,1054.88,percent of total billed charges,
CATHETER ANGIO 5FR 80CM IPSL PVC ARW-BRMN FLT.,63859,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1087.50000,1033.12000,Amish/Mennonite,Amish Mennonite,,598.12,,,,,,,499.16,1087.50,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB .035IN 142CM PENUMBRA SYS SEPRT,63868,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,Amish/Mennonite,Amish Mennonite,,2206.79,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 3.4-4.1FR .041IN .032IN 150CM.,63871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,Amish/Mennonite,Amish Mennonite,,2206.79,,,,,,,1841.67,4012.35,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,455.70,902.10,percent of total billed charges,
SPHERE EMB 700-900UM 2ML NACL GRN PREFIL 20ML SYR ACRYL GEL,63875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,426.87,930.00,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,5037.69,9972.57,percent of total billed charges,
SEPARATOR THRMB PENUMBRA SYST SEPRTR 3MAX LF,63880,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,10281.00000,9766.95000,Amish/Mennonite,Amish Mennonite,,5654.55,,,,,,,4718.98,10281.00,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8521.50000,8095.42000,Amish/Mennonite,Amish Mennonite,,4686.82,,,,,,,4175.53,8265.85,percent of total billed charges,
CATHETER THRMB 132CM PENUMBRA SYS 5MAX ACE,63893,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8521.50000,8095.42000,Amish/Mennonite,Amish Mennonite,,4686.82,,,,,,,3911.37,8521.50,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB 4.7-3.8FR .035IN 153CM PENUMBRA,63900,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2644.53,5761.50,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,187.20000,177.84000,Amish/Mennonite,Amish Mennonite,,102.96,,,,,,,91.73,181.58,percent of total billed charges,
INTRO SHTH .038IN LNG 7FR 18GA 25CM CLS SHTH,63902,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,187.20000,177.84000,Amish/Mennonite,Amish Mennonite,,102.96,,,,,,,85.92,187.20,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2823.14,5588.65,percent of total billed charges,
CATHETER THRMB .014IN 6-4.3FR .041IN 139CM NTNL,63915,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5761.50000,5473.42000,Amish/Mennonite,Amish Mennonite,,3168.82,,,,,,,2644.53,5761.50,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,455.70,902.10,percent of total billed charges,
MICROSPHERE EMB 500-700UM 2ML RED PREFIL SYR EMBOSPHERE,63919,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,930.00000,883.50000,Amish/Mennonite,Amish Mennonite,,511.50,,,,,,,426.87,930.00,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,Amish/Mennonite,Amish Mennonite,,649.69,,,,,,,578.81,1145.81,percent of total billed charges,
KIT PWR INJ PRT TI SL 8FR CATH VLV N FILL W/O INFUS SET,63933,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,Amish/Mennonite,Amish Mennonite,,649.69,,,,,,,542.19,1181.25,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4012.35000,3811.73000,Amish/Mennonite,Amish Mennonite,,2206.79,,,,,,,1966.05,3891.98,percent of total billed charges,
CATHETER THRMB 6-5FR .064IN .054IN 132CM PER,63935,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4012.35000,3811.73000,Amish/Mennonite,Amish Mennonite,,2206.79,,,,,,,1841.67,4012.35,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3904.68000,3709.45000,Amish/Mennonite,Amish Mennonite,,2147.57,,,,,,,1913.29,3787.54,percent of total billed charges,
KIT DRN,63950,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3904.68000,3709.45000,Amish/Mennonite,Amish Mennonite,,2147.57,,,,,,,1792.25,3904.68,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,693.75000,659.06000,Amish/Mennonite,Amish Mennonite,,381.56,,,,,,,339.94,672.94,percent of total billed charges,
PORT INFUS 6FR L60CM TI SIL FLL CT LP PWR INJ SUT H INTMED,63953,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,693.75000,659.06000,Amish/Mennonite,Amish Mennonite,,381.56,,,,,,,318.43,693.75,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,639.45,1265.85,percent of total billed charges,
PORT INFUS 8FR L45CM POLYUR ATTCH CATH PLAS STD,63976,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,599.00,1305.00,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,306.86,607.46,percent of total billed charges,
CATHETER SPRT 15MM SPC 1.8FR .03-.044IN 150CM,63996,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,626.25000,594.94000,Amish/Mennonite,Amish Mennonite,,344.44,,,,,,,287.45,626.25,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1717.50000,1631.62000,Amish/Mennonite,Amish Mennonite,,944.62,,,,,,,841.58,1665.97,percent of total billed charges,
CATHETER INFS MIC 2.3-2.8FR .021IN 153CM SS,64012,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1717.50000,1631.62000,Amish/Mennonite,Amish Mennonite,,944.62,,,,,,,788.33,1717.50,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13934.50000,13237.77000,Amish/Mennonite,Amish Mennonite,,7663.98,,,,,,,6827.90,13516.47,percent of total billed charges,
SYSTEM CARD MON LINQ REVEAL,64043,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13934.50000,13237.77000,Amish/Mennonite,Amish Mennonite,,7663.98,,,,,,,6395.94,13934.50,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS3.5 CRV 7FR 100CM FEM PERI PTFE,64067,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 9-15MM 6FR .062IN 47IN NTNL ENSNR,64069,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,578.34,1260.00,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,617.40,1222.20,percent of total billed charges,
SNARE VASC STD 18-30MM 7FR 120CM PLTN NTNL ENSNR,64077,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,578.34,1260.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER BLNDIL 3.25MM 142CM NYL F CBLN 15MM,64111,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 35CM EVAS SIL CRDS BRTP 35MM KINK,64129,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 6FR 23CM TRNSPT FSTCTH HMSTS,64135,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,13.77,30.00,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1097.25000,1042.39000,Amish/Mennonite,Amish Mennonite,,603.49,,,,,,,537.65,1064.33,percent of total billed charges,
SET RTRVL 6.3FR 11FR 80CM VC GNTH TLP 60CM 3W,64138,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1097.25000,1042.39000,Amish/Mennonite,Amish Mennonite,,603.49,,,,,,,503.64,1097.25,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD AR1 CRV 6FR 100CM FEM PERI PTFE MACH,64140,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 6FR 100CM FEM PERI PTFE,64141,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,Amish/Mennonite,Amish Mennonite,,303.19,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 16FR 28CM HDRPH SENTRANT.,64146,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,Amish/Mennonite,Amish Mennonite,,303.19,,,,,,,253.02,551.25,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 6FR 90CM EVAS SIL CRDS BRTP 35MM KINK.,64162,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4 CRV 7FR 100CM FEM PERI PTFE,64169,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 6.7MM 18FR 33CM HDRPH GORE DRYSEAL,64170,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1383.88,3015.00,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 6FR 11CM FEP SIL AVNT+ 17CM MN,64176,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 35CM EVAS SIL BRTP SLIX 35MM KINK,64184,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH GD STRG 8FR 90CM SS PTFE NYL HDRPH PN,64186,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,222.04,483.75,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,551.25000,523.69000,Amish/Mennonite,Amish Mennonite,,303.19,,,,,,,270.11,534.71,percent of total billed charges,
SHEATH INTRO .035IN 20FR 28CM HDRPH SENTRANT.,64189,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,551.25000,523.69000,Amish/Mennonite,Amish Mennonite,,303.19,,,,,,,253.02,551.25,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,667.50000,634.12000,Amish/Mennonite,Amish Mennonite,,367.12,,,,,,,327.07,647.48,percent of total billed charges,
SHEATH INTRO .035IN 14FR 28CM HDRPH SENTRANT,64192,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,667.50000,634.12000,Amish/Mennonite,Amish Mennonite,,367.12,,,,,,,306.38,667.50,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 35MM 6FR 120CM NTNL AGN 102CM CATH INTR.,64196,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,5796.00000,5506.20000,Amish/Mennonite,Amish Mennonite,,3187.80,,,,,,,2840.04,5622.12,percent of total billed charges,
SEPARATOR THRMB 8FR.,64197,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,5796.00000,5506.20000,Amish/Mennonite,Amish Mennonite,,3187.80,,,,,,,2660.36,5796.00,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM3 CRV 5FR 100CM CRBRL SS NYL,64203,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH,64207,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,14.54,31.68,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 8FR 55CM EVAS SIL CRDS BRTP 35MM KINK.,64209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GD CLS4.5 CRV 7FR 100CM FEM PERI PTFE,64213,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHTH .038IN 6FR 5.5CM BRCHL ART AVNT+ PED.,64218,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,35.23,76.76,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH .038IN 9FR 11CM SS AVNT+ MN GW KINK,64220,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,14.54,31.68,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2255.03000,2142.28000,Amish/Mennonite,Amish Mennonite,,1240.27,,,,,,,1104.96,2187.38,percent of total billed charges,
GUIDEWIRE ESCP 2CM 10CM .01IN 195CM NRVSC PERI.,64230,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2255.03000,2142.28000,Amish/Mennonite,Amish Mennonite,,1240.27,,,,,,,1035.06,2255.03,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L19MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS EPTFE,64252,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,3792.60,8262.75,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR 25-80HZ 12FR 7.5FR 8.3FR 12.5FR 50CM,64253,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,4731.14,10307.50,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH LSR .192IN 25-80HZ 14FR .124IN .134IN 50,64271,CDM,278,RC,C2629,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,4731.14,10307.50,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA4MM THK0.52MM CATH 6FR 0.014IN SS 316L,64276,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA2.8MM SS PTFE RX GRFT SYS GRAFTMASTER,64277,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,4048.75,8014.87,percent of total billed charges,
STENT COR L26MM DIA3.5MM THK0.52MM CATH 6FR 0.014IN SS 316L,64279,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,3792.60,8262.75,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA7MM CATH L135CM IL LIFESTAR,64284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L40MM DIA10MM CATH L80CM IL LIFESTAR,64288,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L80MM DIA8MM CATH L80CM IL LIFESTAR,64306,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI L60MM DIA10MM 6FR L80CM 0.035IN SELF EXPND FLX,64317,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT BILI DIA12MM L60MM CATH L80CM LIFESTAR,64325,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L60MM DIA8MM CATH L80CM IL LIFESTAR,64343,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,817.69,1618.69,percent of total billed charges,
STENT PERIPH L20MM DIA8MM CATH L80CM IL LIFESTAR,64359,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1668.75000,1585.31000,Amish/Mennonite,Amish Mennonite,,917.81,,,,,,,765.96,1668.75,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
SYSTEM STNT L21MM DIA3MM MICRODELIVERY NEUROFORM ATLS.,64371,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4.5MM NIT SELF EXPND OPN CELL,64372,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L21MM DIA4MM NIT SELF EXPND OPN CELL,64381,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA3MM NIT SELF EXPND OPN CELL,64383,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L130CM LIFESTENT,64384,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L24MM DIA4MM NIT SELF EXPND OPN CELL,64402,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L15MM DIA3MM NIT SELF EXPND OPN CELL,64410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13921.18,27558.25,percent of total billed charges,
STENT NEUROVASC L30MM DIA4.5MM NIT SELF EXPND OPN CELL,64444,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28410.57000,26990.04000,Amish/Mennonite,Amish Mennonite,,15625.81,,,,,,,13040.45,28410.57,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64448,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA6.5MM CATH 6FR L120CM NIT OTW SELF,64456,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2454.50,5347.50,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,Amish/Mennonite,Amish Mennonite,,6446.60,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA5MM CATH L120CM DIA6FR 0.035IN HEP,64481,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,Amish/Mennonite,Amish Mennonite,,6446.60,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 8FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,64508,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,Amish/Mennonite,Amish Mennonite,,7176.35,,,,,,,6393.47,12656.46,percent of total billed charges,
STENT PERIPH L150MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64515,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,Amish/Mennonite,Amish Mennonite,,7176.35,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT EPRSTH 13MM 12FR 5CM VBHN HEP NTNL EPTFE,64538,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4661.42,10155.60,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8745.75000,8308.46000,Amish/Mennonite,Amish Mennonite,,4810.16,,,,,,,4285.42,8483.38,percent of total billed charges,
STENT PERIPH L90MM DIA18MM CATH L75CM SHTH 11FR VEN SELF,64546,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8745.75000,8308.46000,Amish/Mennonite,Amish Mennonite,,4810.16,,,,,,,4014.30,8745.75,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.018IN FEM IL ART,64550,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,4856.36,10580.30,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6244.50000,5932.27000,Amish/Mennonite,Amish Mennonite,,3434.47,,,,,,,3059.80,6057.16,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L75CM SHTH 10FR VEN SELF,64559,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6244.50000,5932.27000,Amish/Mennonite,Amish Mennonite,,3434.47,,,,,,,2866.23,6244.50,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13047.90000,12395.50000,Amish/Mennonite,Amish Mennonite,,7176.35,,,,,,,6393.47,12656.46,percent of total billed charges,
GRAFT EVAR L150MM DIA6MM CATH 6FR L120CM GWIRE 0.035IN HEP,64561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13047.90000,12395.50000,Amish/Mennonite,Amish Mennonite,,7176.35,,,,,,,5988.99,13047.90,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11721.10000,11135.04000,Amish/Mennonite,Amish Mennonite,,6446.60,,,,,,,5743.34,11369.47,percent of total billed charges,
STENT PERIPH L100MM DIA8MM CATH L120CM DIA7FR 0.035IN HEP,64593,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11721.10000,11135.04000,Amish/Mennonite,Amish Mennonite,,6446.60,,,,,,,5379.98,11721.10,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5157.75000,4899.86000,Amish/Mennonite,Amish Mennonite,,2836.76,,,,,,,2527.30,5003.02,percent of total billed charges,
STENT PERIPH L60MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64597,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5157.75000,4899.86000,Amish/Mennonite,Amish Mennonite,,2836.76,,,,,,,2367.41,5157.75,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6192.75000,5883.11000,Amish/Mennonite,Amish Mennonite,,3406.01,,,,,,,3034.45,6006.97,percent of total billed charges,
STENT PERIPH L100MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6192.75000,5883.11000,Amish/Mennonite,Amish Mennonite,,3406.01,,,,,,,2842.47,6192.75,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC STD TIP RADOPQ MICROFABRICATE ACC,64617,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6882.75000,6538.61000,Amish/Mennonite,Amish Mennonite,,3785.51,,,,,,,3372.55,6676.27,percent of total billed charges,
STENT PERIPH L120MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6882.75000,6538.61000,Amish/Mennonite,Amish Mennonite,,3785.51,,,,,,,3159.18,6882.75,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.50000,363.38000,Amish/Mennonite,Amish Mennonite,,210.38,,,,,,,187.43,371.02,percent of total billed charges,
SUT ANCHR GI ENTUIT 17GX12CM,64623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.50000,363.38000,Amish/Mennonite,Amish Mennonite,,210.38,,,,,,,175.57,382.50,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER DLV SYS STRG .088IN 80CM NEURON MAX DIL,64628,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,843.41,1837.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS ACUITY BRKWY DELIVERY,64637,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
STENT PERIPH L40MM DIA6MM DEL SYS L125CM SHTH 6FR 0.035IN,64642,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,188.68000,179.25000,Amish/Mennonite,Amish Mennonite,,103.77,,,,,,,92.45,183.02,percent of total billed charges,
GUIDEWIRE VASC .032IN 260CM SFTJ SS PTFE HEP 3MM,64651,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,188.68000,179.25000,Amish/Mennonite,Amish Mennonite,,103.77,,,,,,,86.60,188.68,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1462.50000,1389.38000,Amish/Mennonite,Amish Mennonite,,804.38,,,,,,,716.62,1418.62,percent of total billed charges,
SYSTEM LD W/ CATH TIP GUID BACKPLATE OUTFLO CONE CAP GUID TB,64653,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1462.50000,1389.38000,Amish/Mennonite,Amish Mennonite,,804.38,,,,,,,671.29,1462.50,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC RADOPQ SFT MICROFABRICATE ACC,64654,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
SYSTEM VERTPLSTY MIX W/ VERTAPLEX HV BNE CEM AUTOPLEX,64662,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA10MM 360DEG STD DETACH TARGET,64663,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG SFT DETACH TARGET,64666,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .014IN 300CM SNCHR14 NTNL,64668,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1518.14,3307.50,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA4MM 360DEG SFT DETACH TARGET,64669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG STD DETACH TARGET,64672,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG SFT DETACH TARGET,64676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L3CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64680,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA8MM 360DEG STD DETACH TARGET,64681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON STR 6 FR 90CM,64683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,843.41,1837.50,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,inpatient,,,1586.25000,1506.94000,Amish/Mennonite,Amish Mennonite,,872.44,,,,,,,777.26,1538.66,percent of total billed charges,
CATHETER PA STD 8FR 110CM SG C VIP SVO2 TD CO,64693,CDM,278,RC,C1756,HCPCS,,,facility,outpatient,,,1586.25000,1506.94000,Amish/Mennonite,Amish Mennonite,,872.44,,,,,,,728.09,1586.25,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH TARGET,64703,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L4CM DIA2MM 360DEG ULT DETACH HELI TARGET,64707,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM 360DEG STD DETACH TARGET,64708,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG LSR ABLATED DARKER RADPQ MRK,64709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA4MM 360DEG ULT DETACH LSR ABLATED DARKER,64711,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L15CM DIA6MM DETACH TARGET 3D,64713,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L1CM DIA1.5MM HELI DETACH TARGET NANO,64714,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA5MM 360DEG STD DETACH TARGET,64716,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG ULT DETACH TARGET,64717,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG SFT DETACH TARGET XL,64719,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM OD8MM 360DEG SFT DETACH TARGET,64720,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA4MM 360DEG SFT DETACH TARGET,64722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC FLT RBN .012-.01IN 200CM SNCHR-10,64726,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA4MM DETACH TARGET 3D,64727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA2MM 360DEG ULT DETACH HELI TARGET,64729,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA1.5MM HELI DETACH TARGET NANO,64732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L40CM DIA10MM 360DEG SFT DETACH TARGET XL,64733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L2CM DIA2MM DETACH HELI ULT TARGET,64737,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA14MM 360DEG STD DETACH TARGET XL,64745,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA8MM 360DEG SFT DETACH TARGET XL,64747,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L45CM DIA12MM 360DEG SFT DETACH TARGET XL,64749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA18MM 360DEG SFT DETACH TARGET XL,64750,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA6MM 360DEG STD DETACH LSR ABLATED DARKER,64751,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L50CM DIA20MM 360DEG SFT DETACH TARGET XL,64753,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,213.00,421.66,percent of total billed charges,
SHEATH GD 6FR 2.2MM 80CM AQ FLXR SH SFTP RADOPQ,64763,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,199.53,434.70,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L30CM DIA9MM 360DEG SFT DETACH TARGET XL,64765,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG STD DETACH TARGET XL,64767,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM DIA5MM DETACH TARGET 3D,64769,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC 3CM .014IN 205CM TRNSD EX,64772,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1053.40,2295.00,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2MM 360DEG ULT DETACH LSR ABLATED DARKER,64774,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET XL,64775,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM DETACH 360 ULT TARGET,64782,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC SFTP RADOPQ .014IN 205CM TRNSD EX,64786,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VAS .01IN 200CM TRNSD SCITANIUM ICE 2,64790,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1053.40,2295.00,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,213.00,421.66,percent of total billed charges,
INTRO CATH 7FR 2.5MM 90CM AQ FLXR SH T-B SDARM,64801,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,434.70000,412.96000,Amish/Mennonite,Amish Mennonite,,239.09,,,,,,,199.53,434.70,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC FLPY TIP RADOPQ .014IN 205CM,64803,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1053.40,2295.00,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2676.38000,2542.56000,Amish/Mennonite,Amish Mennonite,,1472.01,,,,,,,1311.43,2596.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM SCITANIUM ICE TRNSD,64807,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2676.38000,2542.56000,Amish/Mennonite,Amish Mennonite,,1472.01,,,,,,,1228.46,2676.38,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .035IN 6FR 10CM HDRPH GLIDESHEATH 45CM,64809,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,78.95,172.00,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.75MM COR CROSSFLEX2 TUNG TREK,64824,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.25MM COR CROSSFLEX2 TUNG TREK,64829,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM LOPRFL TPR 14FR 4.5CM ENTRL SL MC,64853,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,16861.49000,16018.42000,Amish/Mennonite,Amish Mennonite,,9273.82,,,,,,,8262.13,16355.65,percent of total billed charges,
SYSTEM EMB LIQ 1GM N BCA TANT PWD 10CC ETHIODIZED OIL VI.,64869,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,16861.49000,16018.42000,Amish/Mennonite,Amish Mennonite,,9273.82,,,,,,,7739.42,16861.49,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 22FR SIL MC SLK 7-10ML MED PRT,64875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLLNDIL 2.5MM COR CROSSFLEX2 TUNG TREK,64877,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 2CM 16FR 30CM TRNGS TUNG SIL MC SLK,64881,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,629.05,1245.27,percent of total billed charges,
KIT JJNSTM 45CM 18FR SIL MC SLK 7-10ML RADOPQ,64884,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,589.26,1283.78,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.69000,839.51000,Amish/Mennonite,Amish Mennonite,,486.03,,,,,,,433.01,857.18,percent of total billed charges,
KIT JJNSTM 16FR 30CM SIL MC SLK 7-10ML UNV FD,64893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.69000,839.51000,Amish/Mennonite,Amish Mennonite,,486.03,,,,,,,405.61,883.69,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 14FR 2CM ENTRL SIL MC SLK 5ML,64896,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
TUBE GSTRM 3CM ENTRL SIL MC SLK 5ML RADIOP 20FR,64897,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GSTRM 16FR SIL MC SLK 3-5ML MED PORT RADOPQ,64908,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,59.56,129.76,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GSTRM 20FR SIL MC SLK 7-10ML MED PORT,64911,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,198.37,349.86,percent of total billed charges,
TUBE GASTROSTMY 16FR L5CM SIL LP W/ SECUR LOK.,64918,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,47.62,349.86,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,926.25000,879.94000,Amish/Mennonite,Amish Mennonite,,509.44,,,,,,,453.86,898.46,percent of total billed charges,
BUTTON GSTRM 24FR 2.4CM EVV REPL LOPRFL DISP,64919,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,926.25000,879.94000,Amish/Mennonite,Amish Mennonite,,509.44,,,,,,,425.15,926.25,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 40CM,64930,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVLPLSTY 8FR L100CM BLLN L5CM,64934,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLLN VLVPLSTY 23MMX5CM,64937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VLVULPLSTY 8FR L100CM BLLN L5CM,64939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 50CM,64945,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 40CM,64952,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 10CM,64959,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO VERT CRV 5FR 100CM CRBRL SLX NYL,64960,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,31.21,68.00,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 20CM,64963,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 20CM,64966,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 5CM,64967,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 135CM UNFS FLW-THRU HUB 30CM,64981,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,450.19,891.19,percent of total billed charges,
CATHETER THRMB 5FR 90CM UNFS FLW-THRU HUB 10CM,64982,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,918.75000,872.81000,Amish/Mennonite,Amish Mennonite,,505.31,,,,,,,421.71,918.75,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,303.75000,288.56000,Amish/Mennonite,Amish Mennonite,,167.06,,,,,,,148.84,294.64,percent of total billed charges,
CATHETER INFS 5FR 100CM CRGG-MCNAM,64983,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,303.75000,288.56000,Amish/Mennonite,Amish Mennonite,,167.06,,,,,,,139.42,303.75,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3708.75000,3523.31000,Amish/Mennonite,Amish Mennonite,,2039.81,,,,,,,1817.29,3597.49,percent of total billed charges,
CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM,64984,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3708.75000,3523.31000,Amish/Mennonite,Amish Mennonite,,2039.81,,,,,,,1702.32,3708.75,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,Amish/Mennonite,Amish Mennonite,,4753.24,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 20FR 13FR 25FR 13.2FR 18.7IN,64992,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,Amish/Mennonite,Amish Mennonite,,4753.24,,,,,,,3966.79,8642.25,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,8642.25000,8210.14000,Amish/Mennonite,Amish Mennonite,,4753.24,,,,,,,4234.70,8382.98,percent of total billed charges,
SHEATH DIL 18FR 11FR 23FR 11.2FR 18.7IN,65004,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,8642.25000,8210.14000,Amish/Mennonite,Amish Mennonite,,4753.24,,,,,,,3966.79,8642.25,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR DIA8-10MM LN L8CM SHTH 10FR ENDOPROS TIP W/ CTRL,65015,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8040.81,17518.10,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,37537.50,66202.50,percent of total billed charges,
VALVE HRT H15.5MM MT DIA20MM BOV PERICARD TISS FRME COCR,65047,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,34125.00,66202.50,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,297.00000,282.15000,Amish/Mennonite,Amish Mennonite,,163.35,,,,,,,145.53,288.09,percent of total billed charges,
GUIDEWIRE VASC .014IN 145CM ADDWIRE EXCH XTN,65049,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,297.00000,282.15000,Amish/Mennonite,Amish Mennonite,,163.35,,,,,,,136.32,297.00,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM CARD 29MM BOV INCLUDE COMMND DEL ESHEATH INTRO SET,65050,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1176.15000,1117.34000,Amish/Mennonite,Amish Mennonite,,646.88,,,,,,,576.31,1140.87,percent of total billed charges,
CATHETER BLN DILATION STRG 10MM 15CM PTFE X-FRC,65051,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1176.15000,1117.34000,Amish/Mennonite,Amish Mennonite,,646.88,,,,,,,539.85,1176.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM HTORQ CMND ES NTNL.,65056,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,13.86,27.43,percent of total billed charges,
GUIDEWIRE VAS 15MM RDS J CRV .035IN 150CM INQWR,65057,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,12.98,28.28,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 20MM TRANSCATHETER W/ CERTITUDE SAPIEN 3,65060,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,31326.75,68250.00,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L6CM DIA8-10MM INTRO 10FR BLLN DIA10MM GWIRE,65066,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8040.81,17518.10,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1124.55,2226.15,percent of total billed charges,
GUIDEWIRE VASC .014IN 182CM TRNSD EX SCITANIUM,65105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2295.00000,2180.25000,Amish/Mennonite,Amish Mennonite,,1262.25,,,,,,,1053.40,2295.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 5MM 320CM CRTD LWR,65125,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,41.48000,39.41000,Amish/Mennonite,Amish Mennonite,,22.81,,,,,,,20.33,40.24,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV .035IN 50CM SS SFTJ,65126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,41.48000,39.41000,Amish/Mennonite,Amish Mennonite,,22.81,,,,,,,19.04,41.48,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
HEMOGLOBIN OR RBC'S FETAL-TECH,65152,CDM,300,RC,85461,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,9.33,441.37,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,inpatient,,,1234.00000,1172.30000,Amish/Mennonite,Amish Mennonite,,678.70,,,,,,,678.70,1196.98,percent of total billed charges,
ECHO 2D/TEE FOR TAVR/LAA/MITRA CLIP,65158,CDM,480,RC,93355,CPT,,,facility,outpatient,,,1234.00000,1172.30000,Amish/Mennonite,Amish Mennonite,,678.70,,,,,,,617.00,1196.98,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,inpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,822.25,1450.15,percent of total billed charges,
ECHO TEE CONGEN IMAGE/INTERP ONLY,65159,CDM,480,RC,93317,CPT,,,facility,outpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,747.50,1450.15,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,inpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,,900.35,,,,,,,900.35,1587.89,percent of total billed charges,
ECHO CONGENITAL LTD OR F/U,65160,CDM,480,RC,93304,CPT,,,facility,outpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,,900.35,,,,,,,520.63,1587.89,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,inpatient,,,1175.00000,1116.25000,Amish/Mennonite,Amish Mennonite,TC,646.25,,,,,,,646.25,1139.75,percent of total billed charges,
ECHO COMPLETE 2D ONLY,65161,CDM,480,RC,93307,CPT,,,facility,outpatient,,,1175.00000,1116.25000,Amish/Mennonite,Amish Mennonite,TC,646.25,,,,,,,587.50,1139.75,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,inpatient,,,2553.00000,2425.35000,Amish/Mennonite,Amish Mennonite,TC,1404.15,,,,,,,1404.15,2476.41,percent of total billed charges,
ECHO STRESS W ECG MONITOR,65162,CDM,480,RC,93351,CPT,,,facility,outpatient,,,2553.00000,2425.35000,Amish/Mennonite,Amish Mennonite,TC,1404.15,,,,,,,1276.50,2476.41,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,inpatient,,,2688.00000,2553.60000,Amish/Mennonite,Amish Mennonite,,1478.40,,,,,,,1478.40,2607.36,percent of total billed charges,
ECHO TEE IMAGE/INTERP ONLY,65163,CDM,480,RC,93314,CPT,,,facility,outpatient,,,2688.00000,2553.60000,Amish/Mennonite,Amish Mennonite,,1478.40,,,,,,,1344.00,2607.36,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,inpatient,,,2407.00000,2286.65000,Amish/Mennonite,Amish Mennonite,TC,1323.85,,,,,,,1323.85,2334.79,percent of total billed charges,
ECHO CONGENITAL COMPLETE,65164,CDM,480,RC,93303,CPT,,,facility,outpatient,,,2407.00000,2286.65000,Amish/Mennonite,Amish Mennonite,TC,1323.85,,,,,,,1203.50,2334.79,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,inpatient,1,mL,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,12.81,22.59,percent of total billed charges,
FLUORESCEIN-PROPARACAINE OPHTHALMIC 0.25%-0.5% SOLN,65165,CDM,250,RC,54799-0507-21,NDC,,,facility,outpatient,1,mL,23.29000,22.12000,Amish/Mennonite,Amish Mennonite,,12.81,,,,,,,11.64,22.59,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,inpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,73.70,129.98,percent of total billed charges,
CARD REHAB WO ECG MONITORING-TECH,65168,CDM,943,RC,93797,CPT,,,facility,outpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,67.00,264.00,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,inpatient,1,mL,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,39328-0020-08,NDC,,,facility,outpatient,1,mL,1.47000,1.39000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,inpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54162-0007-08,NDC,,,facility,outpatient,1,mL,0.13000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,54859-0808-08,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0452-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,inpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
SENNA 8.8 MG/5 ML SYRU,65169,CDM,250,RC,57896-0462-08,NDC,,,facility,outpatient,1,mL,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
CENTRAL LINE BLOOD DRAW,65171,CDM,361,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,122.40,5271.00,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,TC,507.10,,,,,,,507.10,894.34,percent of total billed charges,
THORACIC AORTOGRAM,65175,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,TC,507.10,,,,,,,391.31,29731.35,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,TC,2168.10,,,,,,,2168.10,3823.74,percent of total billed charges,
ABDOMINAL AORTOGRAM,65176,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,TC,2168.10,,,,,,,356.27,17311.25,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,Amish/Mennonite,Amish Mennonite,TC,1884.85,,,,,,,1884.85,3324.19,percent of total billed charges,
ICD AND GENERATOR TESTING,65177,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,Amish/Mennonite,Amish Mennonite,TC,1884.85,,,,,,,1713.50,3324.19,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
ABDOMINAL AORTOGRAM W/RUNOFF,65178,CDM,320,RC,75630,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,378.42,17311.25,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,inpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,491.70,867.18,percent of total billed charges,
"VENOGRAM, EXTREMITY/UNILATERAL",65179,CDM,320,RC,75820,CPT,,,facility,outpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,361.82,8543.92,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,inpatient,,,17686.00000,16801.70000,Amish/Mennonite,Amish Mennonite,TC,9727.30,,,,,,,9727.30,17155.42,percent of total billed charges,
INTRA-OP CARDIAC PACING/MAPPING,65180,CDM,480,RC,93631,CPT,,,facility,outpatient,,,17686.00000,16801.70000,Amish/Mennonite,Amish Mennonite,TC,9727.30,,,,,,,8843.00,52322.00,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,Amish/Mennonite,Amish Mennonite,TC,519.75,,,,,,,519.75,916.65,percent of total billed charges,
"VENOGRAM, EXTREMITY/BILATERAL",65181,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,Amish/Mennonite,Amish Mennonite,TC,519.75,,,,,,,383.91,8543.92,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,inpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,13.75,24.25,percent of total billed charges,
1ST CORE SESSION ATTND,65194,CDM,510,RC,G9873,HCPCS,,,facility,outpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,12.50,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,inpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,13.75,24.25,percent of total billed charges,
BRIDGE PAYMENT,65196,CDM,969,RC,G9890,HCPCS,,,facility,outpatient,,,25.00000,23.75000,Amish/Mennonite,Amish Mennonite,,13.75,,,,,,,12.50,24.25,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,inpatient,1,mL,42.94000,40.80000,Amish/Mennonite,Amish Mennonite,,23.62,,,,,,,23.62,41.65,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 2.5 GM,65207,CDM,636,RC,J1569,HCPCS,00944270003,NDC,facility,outpatient,1,mL,42.94000,40.80000,Amish/Mennonite,Amish Mennonite,,23.62,,,,,,,21.47,78.87,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,132.00,232.80,percent of total billed charges,
US OB FETAL UMB ARTERY DOPPLER,65208,CDM,402,RC,76820,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,120.00,584.87,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
CMV IGG,65210,CDM,300,RC,86644,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,14.39,746.94,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,inpatient,,,572.00000,543.40000,Amish/Mennonite,Amish Mennonite,,314.60,,,,,,,314.60,554.84,percent of total billed charges,
TISS CULT NEO BM/BLD ADD,65211,CDM,300,RC,88237,CPT,,,facility,outpatient,,,572.00000,543.40000,Amish/Mennonite,Amish Mennonite,,314.60,,,,,,,70.04,6756.70,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,inpatient,1,mL,1767.80000,1679.41000,Amish/Mennonite,Amish Mennonite,,972.29,,,,,,,972.29,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,55150030901,NDC,facility,outpatient,1,mL,1767.80000,1679.41000,Amish/Mennonite,Amish Mennonite,,972.29,,,,,,,883.90,1714.77,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,inpatient,1,mL,738.15000,701.24000,Amish/Mennonite,Amish Mennonite,,405.98,,,,,,,405.98,716.01,percent of total billed charges,
HYDROXYPROGESTERONE 250 MG/ML SOLN,65212,CDM,250,RC,J1729,HCPCS,67457096701,NDC,facility,outpatient,1,mL,738.15000,701.24000,Amish/Mennonite,Amish Mennonite,,405.98,,,,,,,369.07,716.01,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,inpatient,,,361.00000,342.95000,Amish/Mennonite,Amish Mennonite,,198.55,,,,,,,198.55,350.17,percent of total billed charges,
CHG-CELL MARKER-3,65213,CDM,300,RC,88185,CPT,,,facility,outpatient,,,361.00000,342.95000,Amish/Mennonite,Amish Mennonite,,198.55,,,,,,,77.53,1052.52,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,inpatient,,,1962.00000,1863.90000,Amish/Mennonite,Amish Mennonite,,1079.10,,,,,,,1079.10,1903.14,percent of total billed charges,
BRONCH W/ BAL - RT CHARGE BRONCHOSCOPY,65214,CDM,360,RC,31624,CPT,,,facility,outpatient,,,1962.00000,1863.90000,Amish/Mennonite,Amish Mennonite,,1079.10,,,,,,,1079.10,4686.00,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,inpatient,1,mL,204.86000,194.62000,Amish/Mennonite,Amish Mennonite,,112.67,,,,,,,112.67,198.71,percent of total billed charges,
SUGAMMADEX SOLN 100 MG/ML 2 ML,65215,CDM,250,RC,J3490,HCPCS,00006542312,NDC,facility,outpatient,1,mL,204.86000,194.62000,Amish/Mennonite,Amish Mennonite,,112.67,,,,,,,102.43,198.71,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,inpatient,,,4230.00000,4018.50000,Amish/Mennonite,Amish Mennonite,,2326.50,,,,,,,2326.50,4103.10,percent of total billed charges,
TRAUMA LEVEL I W/O CC,65217,CDM,681,RC,,,,,facility,outpatient,,,4230.00000,4018.50000,Amish/Mennonite,Amish Mennonite,,2326.50,,,,,,,2115.00,4103.10,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,inpatient,1,mL,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,3.15,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,3982204120104000,NDC,facility,outpatient,1,mL,5.72000,5.43000,Amish/Mennonite,Amish Mennonite,,3.15,,,,,,,2.86,5.55,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
TOBRAMYCIN NEB 300 MG/7.5 ML,65218,CDM,250,RC,J7685,HCPCS,6332303060204000,NDC,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,290.40,512.16,percent of total billed charges,
NM PET F-18 FDG TO 45MCI,65219,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,264.00,689.02,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,inpatient,,,6076.00000,5772.20000,Amish/Mennonite,Amish Mennonite,,3341.80,,,,,,,3341.80,5893.72,percent of total billed charges,
XR GASTROSTOMY TUBE INSERT,65221,CDM,361,RC,49440,CPT,,,facility,outpatient,,,6076.00000,5772.20000,Amish/Mennonite,Amish Mennonite,,3341.80,,,,,,,1801.27,5982.26,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,TC,656.15,,,,,,,656.15,1157.21,percent of total billed charges,
XR ANGIOGRAM EXTREMITY-TECH,65225,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,TC,656.15,,,,,,,404.21,17311.25,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,inpatient,,,1482.00000,1407.90000,Amish/Mennonite,Amish Mennonite,,815.10,,,,,,,815.10,1437.54,percent of total billed charges,
DIAG BRONCH W/ CELL WASH - RT CHARGE BRONCHOSCOPY,65226,CDM,360,RC,31622,CPT,,,facility,outpatient,,,1482.00000,1407.90000,Amish/Mennonite,Amish Mennonite,,815.10,,,,,,,815.10,4686.00,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,inpatient,1,EA,6.73000,6.39000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.70,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,13107-0001-30,NDC,,,facility,outpatient,1,EA,6.73000,6.39000,Amish/Mennonite,Amish Mennonite,,3.70,,,,,,,3.37,6.53,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,inpatient,1,EA,6.67000,6.33000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,57664-0510-83,NDC,,,facility,outpatient,1,EA,6.67000,6.33000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,inpatient,1,EA,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.95,8.73,percent of total billed charges,
MIRTAZAPINE 7.5 MG TAB,65227,CDM,250,RC,60687-0584-21,NDC,,,facility,outpatient,1,EA,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.50,8.73,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
ISOSORBIDE MONONITRATE 15 MG TAB-ER,65228,CDM,250,RC,00904-6449-61-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,484.00000,459.80000,Amish/Mennonite,Amish Mennonite,,266.20,,,,,,,266.20,469.48,percent of total billed charges,
"AMPHETAMINE, URINE, CONFIRM ONLY BY LCMS/MS",65229,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,484.00000,459.80000,Amish/Mennonite,Amish Mennonite,,266.20,,,,,,,63.95,788.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,inpatient,1,GM,5.94000,5.64000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,3.27,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,00168-0055-46,NDC,,,facility,outpatient,1,GM,5.94000,5.64000,Amish/Mennonite,Amish Mennonite,,3.27,,,,,,,2.97,5.76,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,inpatient,1,GM,5.09000,4.84000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.80,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,16714-0996-02,NDC,,,facility,outpatient,1,GM,5.09000,4.84000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.54,4.94,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,inpatient,1,GM,4.94000,4.70000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.72,4.79,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM 45GRM,65231,CDM,250,RC,70710-1233-04,NDC,,,facility,outpatient,1,GM,4.94000,4.70000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.47,4.79,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,inpatient,,,121.00000,114.95000,Amish/Mennonite,Amish Mennonite,,66.55,,,,,,,66.55,117.37,percent of total billed charges,
CMV TEST,65232,CDM,300,RC,86403,CPT,,,facility,outpatient,,,121.00000,114.95000,Amish/Mennonite,Amish Mennonite,,66.55,,,,,,,11.54,543.22,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,inpatient,1,mL,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.66,2.92,percent of total billed charges,
LORAZEPAM CONC LIQ 1 MG/0.5 ML,65233,CDM,250,RC,J8499,HCPCS,0012107700100050,NDC,facility,outpatient,1,mL,3.01000,2.86000,Amish/Mennonite,Amish Mennonite,,1.66,,,,,,,1.50,2.92,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,inpatient,,,303.50000,288.32000,Amish/Mennonite,Amish Mennonite,90,166.93,,,,,,,166.93,294.39,percent of total billed charges,
C3A RUO SO,65234,CDM,300,RC,86160,CPT,,,facility,outpatient,,,303.50000,288.32000,Amish/Mennonite,Amish Mennonite,90,166.93,,,,,,,12.40,628.12,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,inpatient,,,1482.00000,1407.90000,Amish/Mennonite,Amish Mennonite,,815.10,,,,,,,815.10,1437.54,percent of total billed charges,
BRONCH THRU ESTAB TRACH - RT CHARGE BRONCHOSCOPY,65235,CDM,360,RC,31615,CPT,,,facility,outpatient,,,1482.00000,1407.90000,Amish/Mennonite,Amish Mennonite,,815.10,,,,,,,483.55,3163.00,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,inpatient,1,mL,348.87000,331.43000,Amish/Mennonite,Amish Mennonite,,191.88,,,,,,,191.88,338.40,percent of total billed charges,
ILOPROST NEB 10 MCG/ML,65236,CDM,250,RC,Q4074,HCPCS,66215030230,NDC,facility,outpatient,1,mL,348.87000,331.43000,Amish/Mennonite,Amish Mennonite,,191.88,,,,,,,174.44,338.40,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, NON-BLOOD SOURCE",65237,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.48,339.51,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,inpatient,,,164.10000,155.89000,Amish/Mennonite,Amish Mennonite,90,90.25,,,,,,,90.25,159.18,percent of total billed charges,
ISLET AG 2 (IA-2) ANTIBODY (IA2) SO,65238,CDM,300,RC,86341,CPT,,,facility,outpatient,,,164.10000,155.89000,Amish/Mennonite,Amish Mennonite,90,90.25,,,,,,,19.88,1103.49,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,inpatient,1,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,10.25,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00378-3925-93,NDC,,,facility,outpatient,1,EA,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,9.32,18.08,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,00527-2244-32,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,inpatient,1,EA,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,,7.15,,,,,,,7.15,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,16714-0059-01,NDC,,,facility,outpatient,1,EA,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,,7.15,,,,,,,6.50,12.61,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,55111-0796-30,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,inpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,3.07,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,62332-0190-30,NDC,,,facility,outpatient,1,EA,5.58000,5.30000,Amish/Mennonite,Amish Mennonite,,3.07,,,,,,,2.79,5.41,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,inpatient,1,EA,34.76000,33.03000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,64764-0918-30,NDC,,,facility,outpatient,1,EA,34.76000,33.03000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,inpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.86900,1.53,percent of total billed charges,
FEBUXOSTAT 40 MG TAB,65240,CDM,250,RC,72205-0028-30,NDC,,,facility,outpatient,1,EA,1.58000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86900,,,,,,,0.79000,1.53,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,inpatient,,,3378.00000,3209.10000,Amish/Mennonite,Amish Mennonite,,1857.90,,,,,,,1857.90,3276.66,percent of total billed charges,
CONSULT - ED TRAUMA ACTIVATION CHARGE,65241,CDM,682,RC,,,,,facility,outpatient,,,3378.00000,3209.10000,Amish/Mennonite,Amish Mennonite,,1857.90,,,,,,,1689.00,3276.66,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
SALIVA SUBSTITUTE LIQ (BIOTENE) 240 ML,65243,CDM,250,RC,04858-2802-20,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,inpatient,,,1370.00000,1301.50000,Amish/Mennonite,Amish Mennonite,TC,753.50,,,,,,,753.50,1328.90,percent of total billed charges,
XR ANGIOGRAM EXTREMITY BILAT,65244,CDM,320,RC,75716,CPT,,,facility,outpatient,,,1370.00000,1301.50000,Amish/Mennonite,Amish Mennonite,TC,753.50,,,,,,,413.96,17311.25,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,inpatient,,,243.00000,230.85000,Amish/Mennonite,Amish Mennonite,,133.65,,,,,,,133.65,235.71,percent of total billed charges,
NM XOFIGO RA-223 PER UCI,65245,CDM,344,RC,A9606,HCPCS,,,facility,outpatient,,,243.00000,230.85000,Amish/Mennonite,Amish Mennonite,,133.65,,,,,,,121.50,278.37,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,TC,539.00,,,,,,,539.00,950.60,percent of total billed charges,
US EXTREM NON-VASC COMP JOINT,65247,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,TC,539.00,,,,,,,384.16,950.60,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,inpatient,1,mL,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/1 ML,65249,CDM,250,RC,J3370,HCPCS,6787707518100030,NDC,facility,outpatient,1,mL,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.24,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,25159.00000,23901.05000,Amish/Mennonite,Amish Mennonite,,13837.45,,,,,,,13837.45,24404.23,percent of total billed charges,
NM INDIUM IN-111 OXINE PER 0.5MCI,65250,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,25159.00000,23901.05000,Amish/Mennonite,Amish Mennonite,,13837.45,,,,,,,772.64,24404.23,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
"WESTERN EQUINE ENCEPHALITIS ANTIBODY, IGG AND IGM CSF",65251,CDM,300,RC,86654,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,8.17,696.05,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/O CC,65252,CDM,682,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,2708.00,5253.52,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,inpatient,1,EA,41.89000,39.79000,Amish/Mennonite,Amish Mennonite,,23.04,,,,,,,23.04,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,00409163401,NDC,facility,outpatient,1,EA,41.89000,39.79000,Amish/Mennonite,Amish Mennonite,,23.04,,,,,,,20.95,40.63,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,inpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,55150023620,NDC,facility,outpatient,1,EA,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.22,27.59,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,inpatient,1,EA,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,29.55,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,47335093244,NDC,facility,outpatient,1,EA,53.72000,51.03000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,26.86,52.11,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,inpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,63323078220,NDC,facility,outpatient,1,EA,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,17.38,33.72,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
VECURONIUM POWD-INJ 20 MG,65253,CDM,250,RC,J3490,HCPCS,67457047520,NDC,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,inpatient,,,335.00000,318.25000,Amish/Mennonite,Amish Mennonite,,184.25,,,,,,,184.25,324.95,percent of total billed charges,
MOD SED SAME PHYS  OVER 5 YRS INITIAL15M,65262,CDM,370,RC,99152,CPT,,,facility,outpatient,,,335.00000,318.25000,Amish/Mennonite,Amish Mennonite,,184.25,,,,,,,167.50,324.95,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CONTRAST ISOVUE,65263,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,inpatient,,,1040.00000,988.00000,Amish/Mennonite,Amish Mennonite,,572.00,,,,,,,572.00,1008.80,percent of total billed charges,
DIALYSIS OP EMERGENT/UNSCHEDULED TX-TECH,65264,CDM,829,RC,G0257,HCPCS,,,facility,outpatient,,,1040.00000,988.00000,Amish/Mennonite,Amish Mennonite,,572.00,,,,,,,520.00,1008.80,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,inpatient,,,6048.00000,5745.60000,Amish/Mennonite,Amish Mennonite,,3326.40,,,,,,,3326.40,5866.56,percent of total billed charges,
THERAPEUTIC PLASMA EXCHANGE-TECH,65265,CDM,940,RC,36514,CPT,,,facility,outpatient,,,6048.00000,5745.60000,Amish/Mennonite,Amish Mennonite,,3326.40,,,,,,,1556.56,5866.56,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,inpatient,,,6019.00000,5718.05000,Amish/Mennonite,Amish Mennonite,,3310.45,,,,,,,3310.45,5838.43,percent of total billed charges,
THERAPEUTIC LEUKOPHERISIS-TECH,65266,CDM,940,RC,36511,CPT,,,facility,outpatient,,,6019.00000,5718.05000,Amish/Mennonite,Amish Mennonite,,3310.45,,,,,,,1556.56,5838.43,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,inpatient,,,4922.00000,4675.90000,Amish/Mennonite,Amish Mennonite,,2707.10,,,,,,,2707.10,4774.34,percent of total billed charges,
THERAPEUTIC APHERISIS PLATELETS-TECH,65267,CDM,399,RC,,,,,facility,outpatient,,,4922.00000,4675.90000,Amish/Mennonite,Amish Mennonite,,2707.10,,,,,,,2461.00,4774.34,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,inpatient,,,7244.00000,6881.80000,Amish/Mennonite,Amish Mennonite,,3984.20,,,,,,,3984.20,7026.68,percent of total billed charges,
HARVEST PROGEN CELL/COLLECTION AUTO-TECH,65268,CDM,399,RC,38206,CPT,,,facility,outpatient,,,7244.00000,6881.80000,Amish/Mennonite,Amish Mennonite,,3984.20,,,,,,,1556.56,7026.68,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,inpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,90,97.35,,,,,,,97.35,171.69,percent of total billed charges,
"AMINO ACID PANEL, URINE (AAPD) SO",65286,CDM,300,RC,82139,CPT,,,facility,outpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,90,97.35,,,,,,,17.43,882.80,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,70.28000,66.77000,Amish/Mennonite,Amish Mennonite,,38.65,,,,,,,34.44,68.17,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM TEFCOR SS,65287,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,70.28000,66.77000,Amish/Mennonite,Amish Mennonite,,38.65,,,,,,,32.26,70.28,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,inpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
DEXAMETHASONE 0.2 MG/ML SOLN,65288,CDM,250,RC,63323-0165-01-00020,NDC,,,facility,outpatient,1,mL,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
PV TRANSCUTANEOUS PO2 MEASURE,65289,CDM,920,RC,93998,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,23.25,63.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,inpatient,1,mL,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 ML POWD,65290,CDM,250,RC,51552-1345-01,NDC,,,facility,outpatient,1,mL,2.29000,2.17000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.22,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, URINE",65291,CDM,300,RC,82570,CPT,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,5.18,271.65,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,224.40,395.76,percent of total billed charges,
IR OCCLUSIVE DEVICE IN VEIN ART,65292,CDM,481,RC,G0269,HCPCS,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,204.00,5271.00,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,inpatient,,,168.70000,160.26000,Amish/Mennonite,Amish Mennonite,90,92.78,,,,,,,92.78,163.64,percent of total billed charges,
ASCORBIC ACID (VITC) SO,65293,CDM,300,RC,82180,CPT,,,facility,outpatient,,,168.70000,160.26000,Amish/Mennonite,Amish Mennonite,90,92.78,,,,,,,10.22,509.30,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
OT ATTENDED E-STIM UNITS,65294,CDM,430,RC,97032,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,31.50,264.00,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,inpatient,1,mL,8.61000,8.18000,Amish/Mennonite,Amish Mennonite,,4.74,,,,,,,4.74,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,24208-0411-10,NDC,,,facility,outpatient,1,mL,8.61000,8.18000,Amish/Mennonite,Amish Mennonite,,4.74,,,,,,,4.30,8.35,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
BRIMONIDINE SOLN-OPHTH 0.2% 10 ML,65295,CDM,250,RC,61314-0143-10,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,inpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,76.45,134.83,percent of total billed charges,
"MYOGLOBIN, URINE QUANTITATIVE",65296,CDM,300,RC,83874,CPT,,,facility,outpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,,76.45,,,,,,,12.92,679.08,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1741.85,3071.99,percent of total billed charges,
NM MYOCARD PERF SCAN SGL,65297,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1488.32,7180.14,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,inpatient,,,57.50000,54.62000,Amish/Mennonite,Amish Mennonite,90,31.62,,,,,,,31.62,55.77,percent of total billed charges,
"NORTRIPTYLINE, S (NORTP) SO",65298,CDM,300,RC,80335,CPT,,,facility,outpatient,,,57.50000,54.62000,Amish/Mennonite,Amish Mennonite,90,31.62,,,,,,,28.75,1137.41,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
"RENAL FAILURE INDICIES-CREATININE, SERUM",65299,CDM,300,RC,82565,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.12,271.65,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
"AMYLASE, PANCREATIC-OTHER",65300,CDM,300,RC,82150,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,6.48,339.51,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,38.16000,36.25000,Amish/Mennonite,Amish Mennonite,,20.99,,,,,,,18.70,37.02,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .035IN 145CM SS PTFE 6CM,65301,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,38.16000,36.25000,Amish/Mennonite,Amish Mennonite,,20.99,,,,,,,17.52,38.16,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,inpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,211.75,373.45,percent of total billed charges,
CHG-CELL MARKER-7,65302,CDM,300,RC,88185,CPT,,,facility,outpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,77.53,1052.52,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,60.50,106.70,percent of total billed charges,
RHYTHM STRIP,65303,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,55.00,106.70,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, SERUM",65304,CDM,300,RC,84295,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,4.81,254.68,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
WHITE BLOOD COUNT (WBC),65305,CDM,300,RC,85048,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,2.54,135.79,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
"RENAL FAILURE INDICIES-SODIUM, URINE",65307,CDM,300,RC,84300,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,5.06,254.68,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,inpatient,,,1172.00000,1113.40000,Amish/Mennonite,Amish Mennonite,TC,644.60,,,,,,,644.60,1136.84,percent of total billed charges,
XR INTRO LOGN GI TUBE,65308,CDM,320,RC,74340,CPT,,,facility,outpatient,,,1172.00000,1113.40000,Amish/Mennonite,Amish Mennonite,TC,644.60,,,,,,,405.63,4412.20,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,inpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,86.79,153.07,percent of total billed charges,
"TOTAL LIGHT CHAINS, URINE (TLCU)",65309,CDM,300,RC,83883,CPT,,,facility,outpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,14.05,713.01,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
TPN-CLINIMIX N14G30E W/ ELECTROLYTES 2L . SOLN-IV,65310,CDM,250,RC,00338-9587-04,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE 370 TO 75ML,65311,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,00904-6475-61-00050,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,inpatient,1,EA,4.50000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.48,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,50268-0105-15,NDC,,,facility,outpatient,1,EA,4.50000,4.28000,Amish/Mennonite,Amish Mennonite,,2.48,,,,,,,2.25,4.37,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,inpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
BACLOFEN TAB 5 MG,65314,CDM,250,RC,72888-0009-01,NDC,,,facility,outpatient,1,EA,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,inpatient,1,GM,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,5.95,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,00501-3798-01,NDC,,,facility,outpatient,1,GM,10.81000,10.27000,Amish/Mennonite,Amish Mennonite,,5.95,,,,,,,5.41,10.49,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,inpatient,1,GM,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,49348-0274-72,NDC,,,facility,outpatient,1,GM,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
BACITRACIN-POLYMYXIN B TOPICAL 500 UNITS-10000 UNITS/G OINT,65316,CDM,250,RC,70677-1212-01,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,42291-0094-30,NDC,,,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,inpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.26,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,60505-0833-05,NDC,,,facility,outpatient,1,mL,2.29000,2.18000,Amish/Mennonite,Amish Mennonite,,1.26,,,,,,,1.15,2.22,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,59651-0214-30,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,inpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.67100,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,63629-2057-01,NDC,,,facility,outpatient,1,mL,1.22000,1.16000,Amish/Mennonite,Amish Mennonite,,0.67100,,,,,,,0.61000,1.18,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
AZELASTINE NASAL 137 MCG/INH SPRA,65317,CDM,250,RC,65162-0676-84,NDC,,,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG -50 MG TAB,65319,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,inpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CEFAZOLIN POWD-INJ 3 GM/30 ML SYRINGE,65320,CDM,636,RC,J0690,HCPCS,00409258501,NDC,facility,outpatient,1,mL,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,1.39,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
BICARBONATE LEVEL,65325,CDM,300,RC,82374,CPT,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,4.88,254.68,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,inpatient,1,EA,2578.99000,2450.04000,Amish/Mennonite,Amish Mennonite,,1418.44,,,,,,,1418.44,2501.62,percent of total billed charges,
IMMUNE GLOBULIN POWD-INJ (GAMMAGARD S/D) 5 GM,65327,CDM,636,RC,J1566,HCPCS,00944265603,NDC,facility,outpatient,1,EA,2578.99000,2450.04000,Amish/Mennonite,Amish Mennonite,,1418.44,,,,,,,81.70,2501.62,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00054-0028-21,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,00093-2065-06,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.90,percent of total billed charges,
CILOSTAZOL 50 MG TAB,65328,CDM,250,RC,50268-0176-15,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.50,2.90,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,inpatient,1,mL,7.28000,6.92000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.06,percent of total billed charges,
IODINE-POTASSIUM IODIDE 5%-10% SOLN,65329,CDM,250,RC,48433-0230-15,NDC,,,facility,outpatient,1,mL,7.28000,6.92000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,3.64,7.06,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,inpatient,1,EA,2310.25000,2194.74000,Amish/Mennonite,Amish Mennonite,,1270.64,,,,,,,1270.64,2240.94,percent of total billed charges,
CANGRELOR POWD-INJ 50 MG,65332,CDM,636,RC,C9460,HCPCS,10122062010,NDC,facility,outpatient,1,EA,2310.25000,2194.74000,Amish/Mennonite,Amish Mennonite,,1270.64,,,,,,,19.81,2240.94,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,inpatient,,,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,90,147.73,,,,,,,147.73,260.54,percent of total billed charges,
CADMIUM SO,65333,CDM,300,RC,82300,CPT,,,facility,outpatient,,,268.60000,255.17000,Amish/Mennonite,Amish Mennonite,90,147.73,,,,,,,24.43,1205.34,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,00093-0688-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,inpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,68462-0228-01,NDC,,,facility,outpatient,1,EA,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
LAMOTRIGINE 5. MG,65334,CDM,250,RC,65862-0361-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MEDIUM CHAIN TRIGLYCERIDES 100% OIL,65336,CDM,250,RC,41679-0365-13,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,inpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,00143978310,NDC,facility,outpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
FLUMAZENIL SOLN 0.1 MG/ML 10 ML,65337,CDM,250,RC,J3490,HCPCS,36000014910,NDC,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,4.91,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,inpatient,1,mL,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,3.58,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,16729011411,NDC,facility,outpatient,1,mL,6.51000,6.18000,Amish/Mennonite,Amish Mennonite,,3.58,,,,,,,1.65,6.31,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,inpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,4.32,7.62,percent of total billed charges,
ETOPOSIDE 20 MG/ML SOLN,65339,CDM,250,RC,J9181,HCPCS,63323010450,NDC,facility,outpatient,1,mL,7.86000,7.47000,Amish/Mennonite,Amish Mennonite,,4.32,,,,,,,1.65,7.62,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
CHONDROITIN-GLUCOSAMINE 400 MG-500 MG TAB,65340,CDM,250,RC,43292-0560-03,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,00603-7521-49,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,inpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.23,2.17,percent of total billed charges,
ETHINYL ESTRADIOL-NORETHINDRONE 35 MCG-1 MG TAB,65342,CDM,250,RC,16714-0348-04,NDC,,,facility,outpatient,1,EA,2.24000,2.13000,Amish/Mennonite,Amish Mennonite,,1.23,,,,,,,1.12,2.17,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,inpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,8.30,14.64,percent of total billed charges,
HYDROCORTISONE TOPICAL VALERATE 0.2% CREA,65343,CDM,250,RC,51672-1290-01,NDC,,,facility,outpatient,1,GM,15.09000,14.34000,Amish/Mennonite,Amish Mennonite,,8.30,,,,,,,7.54,14.64,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,inpatient,1,mL,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
LIDOCAINE-SODIUM BICARBONATE 1%-8.4% SOLN,65346,CDM,250,RC,70092-1175-46,NDC,,,facility,outpatient,1,mL,1.75000,1.66000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.87500,1.70,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
GENTAMICIN 100 MG/NS 100 ML PREMIX,65348,CDM,250,RC,J1580,HCPCS,00338050548,NDC,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,4.32,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,inpatient,1,mL,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00121048900,NDC,facility,outpatient,1,mL,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,0.46480,2.33,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,inpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,00904674070,NDC,facility,outpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.46480,1.26,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,0090451741600500,NDC,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.46480,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,inpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,68094002262,NDC,facility,outpatient,1,mL,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.46480,0.97970,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,inpatient,1,mL,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.73700,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,69339015119,NDC,facility,outpatient,1,mL,1.34000,1.28000,Amish/Mennonite,Amish Mennonite,,0.73700,,,,,,,0.46480,1.30,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
DIPHENHYDRAMINE LIQ 12.5 MG/5 ML,65351,CDM,250,RC,Q0163,HCPCS,81033000350,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,inpatient,1,GM,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,10702-0036-45,NDC,,,facility,outpatient,1,GM,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE - POWD,65352,CDM,250,RC,46287-0012-16,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,inpatient,1,EA,237.78000,225.89000,Amish/Mennonite,Amish Mennonite,,130.78,,,,,,,130.78,230.65,percent of total billed charges,
DOLUTEGRAVIR 50 MG TAB,65353,CDM,250,RC,49702-0228-13,NDC,,,facility,outpatient,1,EA,237.78000,225.89000,Amish/Mennonite,Amish Mennonite,,130.78,,,,,,,118.89,230.65,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,inpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
METHADONE 5 MG/5 ML SOLN,65354,CDM,250,RC,00054-3555-63,NDC,,,facility,outpatient,1,mL,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,inpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
OXYTOCIN SOLN 10 UNITS/ML 30 ML,65356,CDM,250,RC,J2590,HCPCS,63323001230,NDC,facility,outpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,inpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,,1095.60,,,,,,,1095.60,1932.24,percent of total billed charges,
TCD LTD,65359,CDM,920,RC,93888,CPT,,,facility,outpatient,,,1992.00000,1892.40000,Amish/Mennonite,Amish Mennonite,,1095.60,,,,,,,100.97,1932.24,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2502.50,4413.50,percent of total billed charges,
NM MYOCARD PERF SCAN MULTI,65360,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2150.56,7180.14,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,inpatient,1,EA,483.76000,459.57000,Amish/Mennonite,Amish Mennonite,,266.07,,,,,,,266.07,469.25,percent of total billed charges,
IVACAFTOR-LUMACAFTOR 125 MG-200 MG TAB,65361,CDM,250,RC,51167-0809-01,NDC,,,facility,outpatient,1,EA,483.76000,459.57000,Amish/Mennonite,Amish Mennonite,,266.07,,,,,,,241.88,469.25,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,inpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,00406896201,NDC,facility,outpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,7.34,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,inpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,8.07,14.24,percent of total billed charges,
DEXTROAMPHETAMINE 15 MG CAP-,65362,CDM,250,RC,S0160,HCPCS,45963030509,NDC,facility,outpatient,1,EA,14.68000,13.94000,Amish/Mennonite,Amish Mennonite,,8.07,,,,,,,7.34,14.24,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,inpatient,1,EA,40.03000,38.03000,Amish/Mennonite,Amish Mennonite,,22.02,,,,,,,22.02,38.83,percent of total billed charges,
RUFINAMIDE 200 MG TAB,65364,CDM,250,RC,62856-0582-52,NDC,,,facility,outpatient,1,EA,40.03000,38.03000,Amish/Mennonite,Amish Mennonite,,22.02,,,,,,,20.02,38.83,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,Amish/Mennonite,Amish Mennonite,TC,2591.60,,,,,,,2591.60,4570.64,percent of total billed charges,
SIMULATION COMPLEX,65365,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,Amish/Mennonite,Amish Mennonite,TC,2591.60,,,,,,,2210.90,23155.09,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
SYR-CHG ONLY,65368,CDM,300,RC,P9011,HCPCS,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,134.64,472.39,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,inpatient,1,mL,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00054-3553-44,NDC,,,facility,outpatient,1,mL,2.14000,2.03000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.08,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,inpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
METHADONE 10 MG/ML CONC,65369,CDM,250,RC,00406-0527-10,NDC,,,facility,outpatient,1,mL,0.25000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
MAGNESIUM OXIDE 200 MG TAB,65370,CDM,250,RC,63739-0354-10-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,inpatient,1,mL,54.93000,52.19000,Amish/Mennonite,Amish Mennonite,,30.21,,,,,,,30.21,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,00085117705,NDC,facility,outpatient,1,mL,54.93000,52.19000,Amish/Mennonite,Amish Mennonite,,30.21,,,,,,,27.46,53.28,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,inpatient,1,mL,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,17478090210,NDC,facility,outpatient,1,mL,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.22,27.59,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,inpatient,1,mL,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.82,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,55150021910,NDC,facility,outpatient,1,mL,14.22000,13.51000,Amish/Mennonite,Amish Mennonite,,7.82,,,,,,,7.11,13.79,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,72078002510,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,4.74,9.20,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,inpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
EPTIFIBATIDE SOLN 20 MG/10 ML,65371,CDM,250,RC,J1327,HCPCS,70121100201,NDC,facility,outpatient,1,mL,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,inpatient,1,mL,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,60.83,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,23155068941,NDC,facility,outpatient,1,mL,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,0.91450,107.28,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,inpatient,1,mL,157.02000,149.17000,Amish/Mennonite,Amish Mennonite,,86.36,,,,,,,86.36,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,63323037701,NDC,facility,outpatient,1,mL,157.02000,149.17000,Amish/Mennonite,Amish Mennonite,,86.36,,,,,,,0.91450,152.31,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,inpatient,1,mL,105.95000,100.65000,Amish/Mennonite,Amish Mennonite,,58.27,,,,,,,58.27,102.77,percent of total billed charges,
OCTREOTIDE 500 MCG/ML SOLN,65372,CDM,250,RC,J2354,HCPCS,67457024601,NDC,facility,outpatient,1,mL,105.95000,100.65000,Amish/Mennonite,Amish Mennonite,,58.27,,,,,,,0.91450,102.77,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,99.55,175.57,percent of total billed charges,
"MERCURY, BLOOD (HG)",65373,CDM,300,RC,83825,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,16.26,848.80,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
QUETIAPINE 6.25 MG TAB,65375,CDM,250,RC,00904-6638-61-00025,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00093-5517-98,NDC,,,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-04,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,00904-6671-06,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,inpatient,1,EA,3.76000,3.57000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,2.07,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,50268-0717-15,NDC,,,facility,outpatient,1,EA,3.76000,3.57000,Amish/Mennonite,Amish Mennonite,,2.07,,,,,,,1.88,3.65,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,inpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,52817-0295-90,NDC,,,facility,outpatient,1,EA,0.30000,0.28000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,inpatient,1,EA,3.10000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,60687-0416-21,NDC,,,facility,outpatient,1,EA,3.10000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,3.01,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
SILDENAFIL 20 MG TAB,65377,CDM,250,RC,65162-0351-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,inpatient,1,GM,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,16714-0268-01,NDC,,,facility,outpatient,1,GM,1.72000,1.63000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,inpatient,1,GM,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.94600,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,45802-0049-35,NDC,,,facility,outpatient,1,GM,1.72000,1.64000,Amish/Mennonite,Amish Mennonite,,0.94600,,,,,,,0.86000,1.67,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,inpatient,1,GM,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% OINT,65378,CDM,250,RC,52565-0048-15,NDC,,,facility,outpatient,1,GM,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,inpatient,1,mL,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
NIMODIPINE 30 MG LIQUID,65379,CDM,250,RC,23155-0108-30-00100,NDC,,,facility,outpatient,1,mL,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,inpatient,1,mL,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,0064160272500100,NDC,facility,outpatient,1,mL,2.78000,2.64000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.30,2.70,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,inpatient,1,mL,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,3.39,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,00641624725,NDC,facility,outpatient,1,mL,6.16000,5.85000,Amish/Mennonite,Amish Mennonite,,3.39,,,,,,,1.30,5.98,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,inpatient,1,mL,6.98000,6.63000,Amish/Mennonite,Amish Mennonite,,3.84,,,,,,,3.84,6.77,percent of total billed charges,
FENTANYL SOLN 50 MCG/ML 1 ML,65380,CDM,250,RC,J3010,HCPCS,63323080811,NDC,facility,outpatient,1,mL,6.98000,6.63000,Amish/Mennonite,Amish Mennonite,,3.84,,,,,,,1.30,6.77,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
FLUVOXAMINE 100 MG TAB,65381,CDM,250,RC,60505-0166-01,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,inpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00009989001,NDC,facility,outpatient,1,mL,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,inpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,43066099524,NDC,facility,outpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,2.76,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,inpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
CLINDAMYCIN 900 MG/D5W 50 ML PREMIX,65382,CDM,250,RC,J0736,HCPCS,00781922209,NDC,facility,outpatient,1,mL,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,2.76,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,inpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-0945-40,NDC,,,facility,outpatient,1,mL,1.31000,1.25000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,1.27,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,00121-4776-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,inpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0063-62,NDC,,,facility,outpatient,1,mL,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,inpatient,1,mL,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,66689-0020-01,NDC,,,facility,outpatient,1,mL,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,1.09,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,inpatient,1,mL,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,68094-0250-62,NDC,,,facility,outpatient,1,mL,1.11000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.08,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,inpatient,1,mL,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
MEGESTROL 40 MG/ML SUSP,65383,CDM,250,RC,69339-0160-19,NDC,,,facility,outpatient,1,mL,1.89000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,inpatient,,,869.00000,825.55000,Amish/Mennonite,Amish Mennonite,,477.95,,,,,,,477.95,842.93,percent of total billed charges,
CT ASPIRATION FNA,65384,CDM,350,RC,10009,CPT,,,facility,outpatient,,,869.00000,825.55000,Amish/Mennonite,Amish Mennonite,,477.95,,,,,,,434.50,1820.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,49348-0622-38,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SOLN,65387,CDM,250,RC,67618-0150-17,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,inpatient,1,mL,16.53000,15.70000,Amish/Mennonite,Amish Mennonite,,9.09,,,,,,,9.09,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,42799-0217-01,NDC,,,facility,outpatient,1,mL,16.53000,15.70000,Amish/Mennonite,Amish Mennonite,,9.09,,,,,,,8.27,16.03,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,inpatient,1,mL,12.05000,11.45000,Amish/Mennonite,Amish Mennonite,,6.63,,,,,,,6.63,11.69,percent of total billed charges,
OPIUM 10% LIQ (EQV TO MORPHINE 10 MG/ML) TINTURE,65388,CDM,250,RC,62559-0153-04,NDC,,,facility,outpatient,1,mL,12.05000,11.45000,Amish/Mennonite,Amish Mennonite,,6.63,,,,,,,6.03,11.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
FLUVOXAMINE 25 MG TAB,65389,CDM,250,RC,62559-0158-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
CHG-VOLUME REDUCTION,65391,CDM,300,RC,86960,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,67.50,1595.82,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,inpatient,1,EA,34.43000,32.71000,Amish/Mennonite,Amish Mennonite,,18.94,,,,,,,18.94,33.40,percent of total billed charges,
EFAVIRENZ 200 MG CAP,65392,CDM,250,RC,00056-0474-92,NDC,,,facility,outpatient,1,EA,34.43000,32.71000,Amish/Mennonite,Amish Mennonite,,18.94,,,,,,,17.21,33.40,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
THEOPHYLLINE 400 MG/24 HOURS TAB-,65393,CDM,250,RC,42858-0701-01,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,inpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,TC,434.50,,,,,,,434.50,766.30,percent of total billed charges,
XR ANGIOGRAM SELECTIVE EA. ADDL',65394,CDM,320,RC,75774,CPT,,,facility,outpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,TC,434.50,,,,,,,268.62,3270.26,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,Amish/Mennonite,Amish Mennonite,,2374.90,,,,,,,2374.90,4188.46,percent of total billed charges,
NM INDIUM IN-111 AUTOLOG WBC 1MCI,65395,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,Amish/Mennonite,Amish Mennonite,,2374.90,,,,,,,1031.39,4188.46,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,inpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,TC,185.35,,,,,,,185.35,326.89,percent of total billed charges,
PV TCD COMPLETE,65396,CDM,920,RC,93886,CPT,,,facility,outpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,TC,185.35,,,,,,,168.50,326.89,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,inpatient,1,GM,1.65000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.90750,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,16714-0987-01,NDC,,,facility,outpatient,1,GM,1.65000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90750,,,,,,,0.82500,1.60,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,inpatient,1,GM,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,33342-0328-15,NDC,,,facility,outpatient,1,GM,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,inpatient,1,GM,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
TRIAMCINOLONE TOPICAL 0.5% CREA,65397,CDM,250,RC,45802-0065-35,NDC,,,facility,outpatient,1,GM,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,inpatient,1,mL,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.69,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,00409-5555-02,NDC,,,facility,outpatient,1,mL,4.89000,4.65000,Amish/Mennonite,Amish Mennonite,,2.69,,,,,,,2.44,4.74,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,inpatient,1,mL,11.91000,11.32000,Amish/Mennonite,Amish Mennonite,,6.55,,,,,,,6.55,11.55,percent of total billed charges,
SODIUM BICARBONATE 4.2% SOLN,65399,CDM,250,RC,63323-0083-05,NDC,,,facility,outpatient,1,mL,11.91000,11.32000,Amish/Mennonite,Amish Mennonite,,6.55,,,,,,,5.96,11.55,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH 5% 1 ML,65400,CDM,250,RC,00065-0411-30-00100,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
SODIUM CHLORIDE 5% 500 ML,65402,CDM,250,RC,J7131,HCPCS,00338005603,NDC,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,inpatient,,,4696.00000,4461.20000,Amish/Mennonite,Amish Mennonite,TC,2582.80,,,,,,,2582.80,4555.12,percent of total billed charges,
XR ANGIOGRAM ADRENAL BILATERAL,65404,CDM,320,RC,75733,CPT,,,facility,outpatient,,,4696.00000,4461.20000,Amish/Mennonite,Amish Mennonite,TC,2582.80,,,,,,,595.74,17311.25,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
NITROGLYCERIN SOLN-INJ 1000 MCG/ 10 ML,65405,CDM,250,RC,J2305,HCPCS,0033810470201000,NDC,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,2.34,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CITRIC ACID-SODIUM CITRATE LIQ 334 MG-500 MG/5 ML,65406,CDM,250,RC,00121-0595-16-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,inpatient,,,1047.00000,994.65000,Amish/Mennonite,Amish Mennonite,TC,575.85,,,,,,,575.85,1015.59,percent of total billed charges,
XR ANGIOGRAM VISCERAL +/- FLUSH,65407,CDM,320,RC,75726,CPT,,,facility,outpatient,,,1047.00000,994.65000,Amish/Mennonite,Amish Mennonite,TC,575.85,,,,,,,447.16,29731.35,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,inpatient,1,EA,13.20000,12.54000,Amish/Mennonite,Amish Mennonite,,7.26,,,,,,,7.26,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60505-3638-03,NDC,,,facility,outpatient,1,EA,13.20000,12.54000,Amish/Mennonite,Amish Mennonite,,7.26,,,,,,,6.60,12.80,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,inpatient,1,EA,135.69000,128.91000,Amish/Mennonite,Amish Mennonite,,74.63,,,,,,,74.63,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,60687-0750-21,NDC,,,facility,outpatient,1,EA,135.69000,128.91000,Amish/Mennonite,Amish Mennonite,,74.63,,,,,,,67.84,131.62,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,inpatient,1,EA,8.43000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.64,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,62559-0265-30,NDC,,,facility,outpatient,1,EA,8.43000,8.01000,Amish/Mennonite,Amish Mennonite,,4.64,,,,,,,4.21,8.18,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,inpatient,1,EA,13.73000,13.04000,Amish/Mennonite,Amish Mennonite,,7.55,,,,,,,7.55,13.32,percent of total billed charges,
TRANEXAMIC ACID 650 MG TAB,65408,CDM,250,RC,69918-0301-30,NDC,,,facility,outpatient,1,EA,13.73000,13.04000,Amish/Mennonite,Amish Mennonite,,7.55,,,,,,,6.87,13.32,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,79.75,140.65,percent of total billed charges,
ENDOMYSIAL IGA AB,65409,CDM,300,RC,86231,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,,79.75,,,,,,,12.05,574.73,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,inpatient,1,EA,387.28000,367.92000,Amish/Mennonite,Amish Mennonite,,213.00,,,,,,,213.00,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,42023020201,NDC,facility,outpatient,1,EA,387.28000,367.92000,Amish/Mennonite,Amish Mennonite,,213.00,,,,,,,6.30,375.66,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,inpatient,1,EA,546.90000,519.56000,Amish/Mennonite,Amish Mennonite,,300.80,,,,,,,300.80,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323064710,NDC,facility,outpatient,1,EA,546.90000,519.56000,Amish/Mennonite,Amish Mennonite,,300.80,,,,,,,6.30,530.49,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,inpatient,1,EA,140.13000,133.12000,Amish/Mennonite,Amish Mennonite,,77.07,,,,,,,77.07,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,63323089010,NDC,facility,outpatient,1,EA,140.13000,133.12000,Amish/Mennonite,Amish Mennonite,,77.07,,,,,,,6.30,135.93,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,inpatient,1,EA,493.01000,468.36000,Amish/Mennonite,Amish Mennonite,,271.16,,,,,,,271.16,478.22,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 200 MCG,65410,CDM,636,RC,J0651,HCPCS,70860045210,NDC,facility,outpatient,1,EA,493.01000,468.36000,Amish/Mennonite,Amish Mennonite,,271.16,,,,,,,6.30,478.22,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 180 MG CAP,65411,CDM,250,RC,00536-3604-08,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,inpatient,1,EA,7.21000,6.85000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.97,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,00904-6707-06,NDC,,,facility,outpatient,1,EA,7.21000,6.85000,Amish/Mennonite,Amish Mennonite,,3.97,,,,,,,3.60,6.99,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,inpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.65,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,16714-0814-01,NDC,,,facility,outpatient,1,EA,6.63000,6.30000,Amish/Mennonite,Amish Mennonite,,3.65,,,,,,,3.31,6.43,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,inpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,50268-0720-15,NDC,,,facility,outpatient,1,EA,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,3.55,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,inpatient,1,EA,5.83000,5.54000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,3.21,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65162-0058-27,NDC,,,facility,outpatient,1,EA,5.83000,5.54000,Amish/Mennonite,Amish Mennonite,,3.21,,,,,,,2.92,5.66,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,inpatient,1,EA,21.16000,20.10000,Amish/Mennonite,Amish Mennonite,,11.64,,,,,,,11.64,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,60687-0328-65,NDC,,,facility,outpatient,1,EA,21.16000,20.10000,Amish/Mennonite,Amish Mennonite,,11.64,,,,,,,10.58,20.53,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,inpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,65862-0921-27,NDC,,,facility,outpatient,1,EA,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,inpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,3.06,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,68094-0034-64,NDC,,,facility,outpatient,1,EA,5.56000,5.28000,Amish/Mennonite,Amish Mennonite,,3.06,,,,,,,2.78,5.39,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,inpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
SEVELAMER CARBONATE 800 MG TAB,65413,CDM,250,RC,71205-0966-67,NDC,,,facility,outpatient,1,EA,0.88000,0.83000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,inpatient,1,GM,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,6.57,11.58,percent of total billed charges,
EMOLLIENT CREAM 90 GM (EQV-SWEEN),65414,CDM,250,RC,10181-0400-08,NDC,,,facility,outpatient,1,GM,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,5.97,11.58,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM RENAL  BILATERAL,65415,CDM,320,RC,75833,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,439.81,17311.25,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,inpatient,1,EA,23.40000,22.23000,Amish/Mennonite,Amish Mennonite,,12.87,,,,,,,12.87,22.70,percent of total billed charges,
RITONAVIR 100 MG TAB,65417,CDM,250,RC,68382-0696-06,NDC,,,facility,outpatient,1,EA,23.40000,22.23000,Amish/Mennonite,Amish Mennonite,,12.87,,,,,,,11.70,22.70,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,inpatient,1,EA,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,52380-4101-01,NDC,,,facility,outpatient,1,EA,6.19000,5.88000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.10,6.00,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
POVIDONE IODINE TOPICAL 10% SWAB,65418,CDM,250,RC,67618-0153-01,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,inpatient,1,EA,60150.20000,57142.69000,Amish/Mennonite,Amish Mennonite,,33082.61,,,,,,,33082.61,58345.69,percent of total billed charges,
GLUCARPIDASE POWD-INJ 1000 UNITS,65420,CDM,250,RC,C9293,HCPCS,50633021011,NDC,facility,outpatient,1,EA,60150.20000,57142.69000,Amish/Mennonite,Amish Mennonite,,33082.61,,,,,,,30075.10,58345.69,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,inpatient,1,EA,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, HUMAN DIPLOID POWD-INJ (IMOVAX RABIES)",65421,CDM,636,RC,90675,HCPCS,49281025251,NDC,facility,outpatient,1,EA,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,312.03,631.01,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,inpatient,1,mL,113.76000,108.07000,Amish/Mennonite,Amish Mennonite,,62.57,,,,,,,62.57,110.35,percent of total billed charges,
IMMUNE GLOBULIN RHO (D) SOLN 300 MCG/2 ML (RHOPHYLAC),65422,CDM,250,RC,J2791,HCPCS,44206030010,NDC,facility,outpatient,1,mL,113.76000,108.07000,Amish/Mennonite,Amish Mennonite,,62.57,,,,,,,7.57,110.35,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,inpatient,1,mL,67.86000,64.47000,Amish/Mennonite,Amish Mennonite,,37.32,,,,,,,37.32,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013304,NDC,facility,outpatient,1,mL,67.86000,64.47000,Amish/Mennonite,Amish Mennonite,,37.32,,,,,,,1.42,65.82,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,inpatient,1,mL,71.93000,68.34000,Amish/Mennonite,Amish Mennonite,,39.56,,,,,,,39.56,69.77,percent of total billed charges,
BUPIVACAINE LIPOSOME SUSP INJ 13.3 MG/ML 10 ML,65425,CDM,636,RC,J0666,HCPCS,65250013309,NDC,facility,outpatient,1,mL,71.93000,68.34000,Amish/Mennonite,Amish Mennonite,,39.56,,,,,,,1.42,69.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,inpatient,1,mL,46.99000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,25.84,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00002-8315-01,NDC,,,facility,outpatient,1,mL,46.99000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,23.50,45.58,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,inpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN ISOPHANE (NPH) HUMAN RECOMBINANT 100 UNITS/ML SUSP,65426,CDM,250,RC,00169-1834-11,NDC,,,facility,outpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,7.62,14.77,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,177.51,percent of total billed charges,
ELUTION STUDY,65427,CDM,300,RC,86860,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,91.50,1544.85,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,inpatient,1,mL,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00069303020,NDC,facility,outpatient,1,mL,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,inpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.78,4.91,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143908401,NDC,facility,outpatient,1,mL,5.06000,4.80000,Amish/Mennonite,Amish Mennonite,,2.78,,,,,,,2.53,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,00143936901,NDC,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912243,65428,CDM,250,RC,J9000,HCPCS,45963073355,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,inpatient,1,mL,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.02,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00069303220,NDC,facility,outpatient,1,mL,3.11000,2.95000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,inpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.43,4.29,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,45963073368,NDC,facility,outpatient,1,mL,4.42000,4.20000,Amish/Mennonite,Amish Mennonite,,2.43,,,,,,,2.21,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,inpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,00143937101,NDC,facility,outpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,5.23,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,inpatient,1,mL,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.71,3.01,percent of total billed charges,
DOXORUBICIN 2 MG/ML SOLN 7912242,65429,CDM,250,RC,J9000,HCPCS,25021020725,NDC,facility,outpatient,1,mL,3.10000,2.94000,Amish/Mennonite,Amish Mennonite,,1.71,,,,,,,1.55,5.23,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,inpatient,1,mL,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,00121-0775-16,NDC,,,facility,outpatient,1,mL,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,58657-0500-04,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,inpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-04,NDC,,,facility,outpatient,1,mL,0.29000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
CODEINE-GUAIFENESIN 10 MG-100 MG/5 ML SYRU 7912238,65430,CDM,250,RC,69543-0252-16,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MEDICAL PHYSICS CONSULTATION-TECH,65433,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,126.07,4371.88,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,inpatient,,,953.00000,905.35000,Amish/Mennonite,Amish Mennonite,TC,524.15,,,,,,,524.15,924.41,percent of total billed charges,
TREATMENT DEVICE-TECH,65434,CDM,333,RC,77334,CPT,,,facility,outpatient,,,953.00000,905.35000,Amish/Mennonite,Amish Mennonite,TC,524.15,,,,,,,354.42,3685.66,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,281.05,495.67,percent of total billed charges,
DIALYSIS RBC DEPLETION,65438,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,122.40,495.67,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,inpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,90,309.65,,,,,,,309.65,546.11,percent of total billed charges,
CHROM CULTURE/SO-TECH,65457,CDM,300,RC,88230,CPT,,,facility,outpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,90,309.65,,,,,,,70.04,6094.58,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,154.55,272.57,percent of total billed charges,
DRUG TEST PRSMV INSTRUMENT CHEM ANALYZES PR DATE-TECH,65459,CDM,300,RC,80307,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,62.14,3038.81,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,,2959.00,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACCUTE MYELOID LEUK/SO-TECH,65460,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,,2959.00,,,,,,,759.53,35735.73,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,inpatient,,,320.70000,304.66000,Amish/Mennonite,Amish Mennonite,90,176.38,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 1MT/SO-TECH,65461,CDM,300,RC,81120,CPT,,,facility,outpatient,,,320.70000,304.66000,Amish/Mennonite,Amish Mennonite,90,176.38,,,,,,,154.60,9082.50,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,inpatient,,,320.70000,304.66000,Amish/Mennonite,Amish Mennonite,90,176.38,,,,,,,176.38,311.08,percent of total billed charges,
ISOCITRATE DEHYDROG 2MT/SO-TECH,65462,CDM,300,RC,81121,CPT,,,facility,outpatient,,,320.70000,304.66000,Amish/Mennonite,Amish Mennonite,90,176.38,,,,,,,160.35,13920.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,inpatient,,,972.00000,923.40000,Amish/Mennonite,Amish Mennonite,90,534.60,,,,,,,534.60,942.84,percent of total billed charges,
ISOCITRATE DEYDROG 12 MICRODISSECT MANUAL/SO-TECH,65463,CDM,300,RC,88381,CPT,,,facility,outpatient,,,972.00000,923.40000,Amish/Mennonite,Amish Mennonite,90,534.60,,,,,,,486.00,8610.62,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,inpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,TC,220.00,,,,,,,220.00,388.00,percent of total billed charges,
HISTOCHEMICAL STAIN-TECH,65464,CDM,300,RC,88314,CPT,,,facility,outpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,TC,220.00,,,,,,,200.00,3536.91,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,158.40,279.36,percent of total billed charges,
TOUCH PREP-TECH,65465,CDM,300,RC,88333,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,144.00,2342.52,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,TC,97.90,,,,,,,97.90,172.66,percent of total billed charges,
TOUCH PREP ADD'L-TECH,65466,CDM,300,RC,88334,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,TC,97.90,,,,,,,67.83,848.80,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,inpatient,,,325.00000,308.75000,Amish/Mennonite,Amish Mennonite,TC,178.75,,,,,,,178.75,315.25,percent of total billed charges,
"IF, EA ADD'L ANTIBOCY-TECH",65467,CDM,300,RC,88350,CPT,,,facility,outpatient,,,325.00000,308.75000,Amish/Mennonite,Amish Mennonite,TC,178.75,,,,,,,162.50,2993.62,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,inpatient,,,1919.00000,1823.05000,Amish/Mennonite,Amish Mennonite,,1055.45,,,,,,,1055.45,1861.43,percent of total billed charges,
CT CEREBRAL PERFUSION,65471,CDM,351,RC,0042T,HCPCS,,,facility,outpatient,,,1919.00000,1823.05000,Amish/Mennonite,Amish Mennonite,,1055.45,,,,,,,959.50,1861.43,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,inpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,TC,269.50,,,,,,,269.50,475.30,percent of total billed charges,
ECHO DOPPLER COMP,65472,CDM,483,RC,93320,CPT,,,facility,outpatient,,,490.00000,465.50000,Amish/Mennonite,Amish Mennonite,TC,269.50,,,,,,,245.00,475.30,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,inpatient,,,1014.00000,963.30000,Amish/Mennonite,Amish Mennonite,TC,557.70,,,,,,,557.70,983.58,percent of total billed charges,
US CRANIUM,65473,CDM,402,RC,76506,CPT,,,facility,outpatient,,,1014.00000,963.30000,Amish/Mennonite,Amish Mennonite,TC,557.70,,,,,,,384.16,983.58,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT VISIPAQUE 320 TO 100ML,65474,CDM,255,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,inpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,TC,916.30,,,,,,,916.30,1616.02,percent of total billed charges,
XR FIBRIN SHEATH STRIPPING,65475,CDM,320,RC,75901,CPT,,,facility,outpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,TC,916.30,,,,,,,833.00,10812.84,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,inpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,128.70,226.98,percent of total billed charges,
GARDNERELLA VAG DIR PR-TECH,65480,CDM,300,RC,87510,CPT,,,facility,outpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,20.05,1052.52,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,inpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,128.70,226.98,percent of total billed charges,
TRICHOMONA VAG DIR PR-TECH,65481,CDM,300,RC,87660,CPT,,,facility,outpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,20.05,1052.52,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
FACTOR ASSAY-2 (II)-TECH,65482,CDM,300,RC,85210,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,8.17,679.08,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,inpatient,,,1037.00000,985.15000,Amish/Mennonite,Amish Mennonite,,570.35,,,,,,,570.35,1005.89,percent of total billed charges,
LEUKOCYTE DEPLETED WHOLE BLOOD-TECH,65483,CDM,390,RC,P9010,HCPCS,,,facility,outpatient,,,1037.00000,985.15000,Amish/Mennonite,Amish Mennonite,,570.35,,,,,,,213.76,1005.89,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,inpatient,,,3274.00000,3110.30000,Amish/Mennonite,Amish Mennonite,TC,1800.70,,,,,,,1800.70,3175.78,percent of total billed charges,
CARDIAC MRI FOR MORPH-TECH,65484,CDM,614,RC,75561,CPT,,,facility,outpatient,,,3274.00000,3110.30000,Amish/Mennonite,Amish Mennonite,TC,1800.70,,,,,,,1487.04,3175.78,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,inpatient,,,29288.00000,27823.60000,Amish/Mennonite,Amish Mennonite,,16108.40,,,,,,,14351.12,28409.36,percent of total billed charges,
NM YTTRIUM 90-TECH,65486,CDM,278,RC,C2616,HCPCS,,,facility,outpatient,,,29288.00000,27823.60000,Amish/Mennonite,Amish Mennonite,,16108.40,,,,,,,13443.19,29288.00,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA8-16MM CATH L80CM 0.035IN PROX DST IL,65487,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR CRIMPED L39MM DIA8X16MM CATH 7FR L80CM 0.035IN,65488,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,inpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00245-0211-11,NDC,,,facility,outpatient,1,EA,0.76000,0.72000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,inpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00378-1901-01,NDC,,,facility,outpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.48,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-06,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,inpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,00904-6817-61,NDC,,,facility,outpatient,1,EA,2.71000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.63,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,42291-0560-90,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,inpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.19,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,50268-0561-15,NDC,,,facility,outpatient,1,EA,2.17000,2.06000,Amish/Mennonite,Amish Mennonite,,1.19,,,,,,,1.08,2.10,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,51079-0453-20-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.12000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,inpatient,1,EA,3.09000,2.94000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.70,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,60687-0387-01,NDC,,,facility,outpatient,1,EA,3.09000,2.94000,Amish/Mennonite,Amish Mennonite,,1.70,,,,,,,1.54,3.00,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
MIDODRINE TAB 2.5MG,65489,CDM,250,RC,82293-0003-10,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM SHRT ANG 7FR 22GA 10CM PLS,65491,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,183.32,399.38,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,inpatient,1,mL,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,00121-4967-40,NDC,,,facility,outpatient,1,mL,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,inpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.56100,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,39328-0120-50,NDC,,,facility,outpatient,1,mL,1.02000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56100,,,,,,,0.51000,0.98940,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,inpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,48433-0219-40,NDC,,,facility,outpatient,1,mL,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,inpatient,1,mL,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,50268-0731-24,NDC,,,facility,outpatient,1,mL,1.56000,1.49000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,54162-0007-08-00500,NDC,,,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,inpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
SENNA LIQ 5ML,65492,CDM,250,RC,68094-0049-62,NDC,,,facility,outpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,inpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,69339-0157-17,NDC,,,facility,outpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.81,3.52,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,inpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,16714-0358-01-00500,NDC,,,facility,outpatient,1,mL,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,inpatient,1,mL,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.47,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,50268-0470-13,NDC,,,facility,outpatient,1,mL,2.68000,2.55000,Amish/Mennonite,Amish Mennonite,,1.47,,,,,,,1.34,2.60,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,inpatient,1,mL,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.95150,1.68,percent of total billed charges,
LEVETIRACETAM LIQ 500MG,65493,CDM,250,RC,63739-0158-32,NDC,,,facility,outpatient,1,mL,1.73000,1.64000,Amish/Mennonite,Amish Mennonite,,0.95150,,,,,,,0.86500,1.68,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
LIFESTYLE ENHANCE PROG PER MNTH-TECH,65558,CDM,943,RC,S9472,HCPCS,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GO,142.45,,,,,,,142.45,251.23,percent of total billed charges,
OT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65559,CDM,430,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GO,142.45,,,,,,,126.65,264.00,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,GO,56.65,,,,,,,56.65,99.91,percent of total billed charges,
OT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65560,CDM,430,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,GO,56.65,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,GP,56.65,,,,,,,56.65,99.91,percent of total billed charges,
PT WORK HARDENING/CONDITIONING EA ADD'L HR-TECH,65561,CDM,420,RC,97546,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,GP,56.65,,,,,,,51.50,264.00,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GP,142.45,,,,,,,142.45,251.23,percent of total billed charges,
PT WORK HARDENING/CONDITIONING INITIAL 2HRS/DAY-TECH,65562,CDM,420,RC,97545,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,GP,142.45,,,,,,,126.65,264.00,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 180CM TRUTRQ HBRD A,65568,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,163.52,356.25,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,inpatient,,,5390.00000,5120.50000,Amish/Mennonite,Amish Mennonite,,2964.50,,,,,,,2964.50,5228.30,percent of total billed charges,
TRACH PLANNED-TECH,65569,CDM,361,RC,,,,,facility,outpatient,,,5390.00000,5120.50000,Amish/Mennonite,Amish Mennonite,,2964.50,,,,,,,2964.50,5271.00,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,inpatient,1,mL,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.91,10.42,percent of total billed charges,
TROPICAMIDE SOLN-OPHTH 1% 3 ML,65571,CDM,250,RC,61314-0355-01,NDC,,,facility,outpatient,1,mL,10.74000,10.21000,Amish/Mennonite,Amish Mennonite,,5.91,,,,,,,5.37,10.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,Amish/Mennonite,Amish Mennonite,TC,1422.30,,,,,,,1422.30,2508.42,percent of total billed charges,
THERAP RAD SIMULATION SIMPLE-TECH,65572,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,Amish/Mennonite,Amish Mennonite,TC,1422.30,,,,,,,1293.00,13397.25,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,inpatient,1,mL,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,19.12,33.72,percent of total billed charges,
EPINEPHRINE SOLN PF 1 MG/ML,65573,CDM,636,RC,J0173,HCPCS,54288010310,NDC,facility,outpatient,1,mL,34.76000,33.02000,Amish/Mennonite,Amish Mennonite,,19.12,,,,,,,3.49,33.72,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,inpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,TC,398.75,,,,,,,398.75,703.25,percent of total billed charges,
ANGIOGRAPHY THROUGH EXISTING CATH-TECH,65574,CDM,320,RC,75898,CPT,,,facility,outpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,TC,398.75,,,,,,,237.91,17311.25,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,inpatient,,,919.00000,873.05000,Amish/Mennonite,Amish Mennonite,TC,505.45,,,,,,,505.45,891.43,percent of total billed charges,
VENOGRAPHY CAVAL SUPERIOR-TECH,65575,CDM,320,RC,75827,CPT,,,facility,outpatient,,,919.00000,873.05000,Amish/Mennonite,Amish Mennonite,TC,505.45,,,,,,,389.46,8543.92,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,0040990941805500,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,1.58,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,inpatient,1,mL,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.92400,1.63,percent of total billed charges,
FENTANYL PCA 50 MCG/ML 50 ML,65581,CDM,250,RC,J3010,HCPCS,70092150935,NDC,facility,outpatient,1,mL,1.68000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92400,,,,,,,0.84000,1.63,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 12MG,65582,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,inpatient,1,mL,24.07000,22.86000,Amish/Mennonite,Amish Mennonite,,13.24,,,,,,,13.24,23.35,percent of total billed charges,
CLOBAZAM 5 MG,65583,CDM,250,RC,67386-0313-21-00200,NDC,,,facility,outpatient,1,mL,24.07000,22.86000,Amish/Mennonite,Amish Mennonite,,13.24,,,,,,,12.04,23.35,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
HYDROCHLOROTHIAZIDE 6.25 MG TAB,65586,CDM,250,RC,16729-0183-01-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
LOSARTAN 12.5 MG TAB,65587,CDM,250,RC,68084-0346-11-00050,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,inpatient,1,mL,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
SENNA 10 ML LIQUID,65588,CDM,250,RC,54162-0007-08-01000,NDC,,,facility,outpatient,1,mL,0.91000,0.86000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,0.88270,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,inpatient,1,mL,14.10000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,7.75,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00002871501,NDC,facility,outpatient,1,mL,14.10000,13.39000,Amish/Mennonite,Amish Mennonite,,7.75,,,,,,,1.49,13.68,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,inpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,8.38,14.77,percent of total billed charges,
INSULIN NPH-REGULAR SUSP 70-30 UNITS/ML 10 ML,65595,CDM,250,RC,J1815,HCPCS,00169183711,NDC,facility,outpatient,1,mL,15.23000,14.47000,Amish/Mennonite,Amish Mennonite,,8.38,,,,,,,1.49,14.77,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2084.29000,1980.08000,Amish/Mennonite,Amish Mennonite,,1146.36,,,,,,,1021.30,2021.76,percent of total billed charges,
SPHNTM ESCP 5MM .035IN STRG 4.4FR 260CM BIL,65607,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2084.29000,1980.08000,Amish/Mennonite,Amish Mennonite,,1146.36,,,,,,,956.69,2084.29,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65608,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L80CM INTRO SHTH 7FR 0.035IN,65611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM TRUTORQ HBRD A,65612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,163.52,356.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM TRUTORQ HDRPH A,65613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,307.13000,291.77000,Amish/Mennonite,Amish Mennonite,,168.92,,,,,,,150.49,297.92,percent of total billed charges,
GUIDEWIRE ORTH 3MM 100CM BALL TIP STRL LF NTR NL,65616,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,307.13000,291.77000,Amish/Mennonite,Amish Mennonite,,168.92,,,,,,,140.97,307.13,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15432.61000,14660.98000,Amish/Mennonite,Amish Mennonite,,8487.94,,,,,,,7561.98,14969.63,percent of total billed charges,
GRAFT VASC L80CM DIA7MM PTFE PERIPH STR BEAD W/ STD CUF SM,65617,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15432.61000,14660.98000,Amish/Mennonite,Amish Mennonite,,8487.94,,,,,,,7083.57,15432.61,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2500.84000,2375.80000,Amish/Mennonite,Amish Mennonite,,1375.46,,,,,,,1225.41,2425.81,percent of total billed charges,
GRAFT BIFUR KNIT HEMAGRD 12X6,65620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2500.84000,2375.80000,Amish/Mennonite,Amish Mennonite,,1375.46,,,,,,,1147.89,2500.84,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9980.85000,9481.81000,Amish/Mennonite,Amish Mennonite,,5489.47,,,,,,,4890.62,9681.42,percent of total billed charges,
GRAFT VASC L80CM DIA6MM PTFE CBAS HEP SURF THN WALLED REM,65622,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9980.85000,9481.81000,Amish/Mennonite,Amish Mennonite,,5489.47,,,,,,,4581.21,9980.85,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CURI-TECH,65626,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
UREA BREATH TEST-TEST,65627,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,9.88,184.30,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
IODINE I-131 IODIDE CAPSULE,65628,CDM,344,RC,A9517,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,38.16,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,2115.00000,2009.25000,Amish/Mennonite,Amish Mennonite,,1163.25,,,,,,,1163.25,2051.55,percent of total billed charges,
TECHNETIUM TC-99M EXAMETAZIME,65629,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,2115.00000,2009.25000,Amish/Mennonite,Amish Mennonite,,1163.25,,,,,,,802.34,2051.55,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,inpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,5678.75,10015.25,percent of total billed charges,
XR ERCP W DILATION-TECH,65630,CDM,361,RC,43277,CPT,,,facility,outpatient,,,10325.00000,9808.75000,Amish/Mennonite,Amish Mennonite,,5678.75,,,,,,,3612.55,10015.25,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,inpatient,,,1450.00000,1377.50000,Amish/Mennonite,Amish Mennonite,TC,797.50,,,,,,,797.50,1406.50,percent of total billed charges,
ANGIO SPINAL SELECTIVE-TECH,65632,CDM,320,RC,75705,CPT,,,facility,outpatient,,,1450.00000,1377.50000,Amish/Mennonite,Amish Mennonite,TC,797.50,,,,,,,723.58,29731.35,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
ANGIO PELVIC SELECTIVE-TECH,65633,CDM,320,RC,75736,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,500.59,29731.35,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,Amish/Mennonite,Amish Mennonite,TC,5897.65,,,,,,,5897.65,10401.31,percent of total billed charges,
TRANSCATHETER THERAPY-TECH,65634,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,Amish/Mennonite,Amish Mennonite,TC,5897.65,,,,,,,5057.86,51844.17,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,inpatient,,,1400.00000,1330.00000,Amish/Mennonite,Amish Mennonite,TC,770.00,,,,,,,770.00,1358.00,percent of total billed charges,
INTRALUMINAL DILATION OF STRICTURES-TECH,65635,CDM,320,RC,74360,CPT,,,facility,outpatient,,,1400.00000,1330.00000,Amish/Mennonite,Amish Mennonite,TC,770.00,,,,,,,450.12,4834.29,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,inpatient,,,1399.00000,1329.05000,Amish/Mennonite,Amish Mennonite,TC,769.45,,,,,,,769.45,1357.03,percent of total billed charges,
ENDOSCOPIC CATHETERIZATION OF BILIARY DUCT-TECH,65637,CDM,320,RC,74328,CPT,,,facility,outpatient,,,1399.00000,1329.05000,Amish/Mennonite,Amish Mennonite,TC,769.45,,,,,,,282.87,4511.07,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,1007.60,1777.04,percent of total billed charges,
DUPLEX SCAN OF AORTA-TECH,65638,CDM,920,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,916.00,1777.04,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,inpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,TC,548.35,,,,,,,548.35,967.09,percent of total billed charges,
US OB EXTENDED-TECH,65639,CDM,402,RC,76811,CPT,,,facility,outpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,TC,548.35,,,,,,,384.16,1329.46,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,382.25,674.15,percent of total billed charges,
US GUIDANCE FOR PERC DRAINAGE-TECH,65640,CDM,402,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,298.87,674.15,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,inpatient,,,4811.00000,4570.45000,Amish/Mennonite,Amish Mennonite,,2646.05,,,,,,,2646.05,4666.67,percent of total billed charges,
CT GUIDANCE FOR TISSUE ABLATION-TECH,65641,CDM,350,RC,77013,CPT,,,facility,outpatient,,,4811.00000,4570.45000,Amish/Mennonite,Amish Mennonite,,2646.05,,,,,,,1285.85,4666.67,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,inpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,,59.95,,,,,,,59.95,105.73,percent of total billed charges,
LACTATE-TECH,65642,CDM,300,RC,83605,CPT,,,facility,outpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,,59.95,,,,,,,11.57,560.26,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,inpatient,,,484.20000,459.99000,Amish/Mennonite,Amish Mennonite,90,266.31,,,,,,,266.31,469.67,percent of total billed charges,
INFECT AGENT DETECT BY NUCLEIC ACID-TECH,65643,CDM,300,RC,87799,CPT,,,facility,outpatient,,,484.20000,459.99000,Amish/Mennonite,Amish Mennonite,90,266.31,,,,,,,44.27,2240.90,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,152.35,268.69,percent of total billed charges,
CRYOPRECIPITATE-TECH,65644,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,60.36,268.69,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TABLET FOR BILI-TECH,65645,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,2.25,118.82,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
UA BY DIP OR TAB REG FOR BILI-TECH,65646,CDM,300,RC,81003,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,2.25,118.82,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
GLUCOSE QUANT BLOOD-TECH,65647,CDM,300,RC,82947,CPT,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,3.93,203.72,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,inpatient,,,1122.00000,1065.90000,Amish/Mennonite,Amish Mennonite,,617.10,,,,,,,617.10,1088.34,percent of total billed charges,
TRANSPLANT PREP OF HPC-TECH,65648,CDM,319,RC,38207,CPT,,,facility,outpatient,,,1122.00000,1065.90000,Amish/Mennonite,Amish Mennonite,,617.10,,,,,,,415.12,1088.34,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,158.95,280.33,percent of total billed charges,
"HLA TYPING-A,B OR C-TECH",65649,CDM,300,RC,86812,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,25.81,1341.13,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,27.50,48.50,percent of total billed charges,
URIC ACID OTH SOURCE-TECH,65650,CDM,300,RC,84560,CPT,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,5.08,254.68,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,inpatient,,,9216.00000,8755.20000,Amish/Mennonite,Amish Mennonite,,5068.80,,,,,,,5068.80,8939.52,percent of total billed charges,
BRONCHOSCOPY RIGID OR FLEX-TECH,65652,CDM,360,RC,31629,CPT,,,facility,outpatient,,,9216.00000,8755.20000,Amish/Mennonite,Amish Mennonite,,5068.80,,,,,,,3500.91,8939.52,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,inpatient,,,6381.00000,6061.95000,Amish/Mennonite,Amish Mennonite,,3509.55,,,,,,,3509.55,6189.57,percent of total billed charges,
BRONCH RIGID OR FLEX W/FB REMOVAL-TECH,65653,CDM,360,RC,31635,CPT,,,facility,outpatient,,,6381.00000,6061.95000,Amish/Mennonite,Amish Mennonite,,3509.55,,,,,,,1637.45,6189.57,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
INFECT AGENT ANTIGEN DETECT-TECH,65654,CDM,300,RC,87899,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,16.07,763.98,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,99.55,175.57,percent of total billed charges,
TACROLIMUS-TECH,65655,CDM,300,RC,80197,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,13.73,713.01,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,inpatient,,,271.10000,257.54000,Amish/Mennonite,Amish Mennonite,90,149.10,,,,,,,149.10,262.97,percent of total billed charges,
"CULTURE, BACTERIAL; ANY OTHER SOURCE-TECH",65657,CDM,300,RC,87070,CPT,,,facility,outpatient,,,271.10000,257.54000,Amish/Mennonite,Amish Mennonite,90,149.10,,,,,,,8.91,458.40,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM VESTAN,65678,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,inpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,,377.30,,,,,,,377.30,665.42,percent of total billed charges,
CHEMO ADMIN INTRATHECAL-TECH,65683,CDM,331,RC,96450,CPT,,,facility,outpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,,377.30,,,,,,,314.95,665.42,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,inpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,97.35,171.69,percent of total billed charges,
METHOTREXATE LEVEL-TECH,65684,CDM,301,RC,80204,CPT,,,facility,outpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,38.57,1832.89,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,inpatient,,,94.30000,89.58000,Amish/Mennonite,Amish Mennonite,90,51.87,,,,,,,51.87,91.47,percent of total billed charges,
TB TEST SO- TECH,65685,CDM,300,RC,86481,CPT,,,facility,outpatient,,,94.30000,89.58000,Amish/Mennonite,Amish Mennonite,90,51.87,,,,,,,47.15,4702.48,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65696,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,65697,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,65698,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,GP,41.80,,,,,,,41.80,73.72,percent of total billed charges,
"PT WHIRLPOOL, FLUIDOTHERAPY UNITS",65700,CDM,420,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,GP,41.80,,,,,,,38.00,264.00,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM A FLDR,65702,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
ABG PUNCTURE-TECH,65705,CDM,361,RC,36600,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,3163.00,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,inpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,2990.51,percent of total billed charges,
INJECTION PROCEDURE FOR PERC TRMT-TECH,65709,CDM,361,RC,36002,CPT,,,facility,outpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,587.06,3163.00,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,inpatient,,,371.50000,352.92000,Amish/Mennonite,Amish Mennonite,,204.32,,,,,,,204.32,360.36,percent of total billed charges,
INSERT UTERINE BLLN TAMPONADE-TECH,65711,CDM,724,RC,59899,CPT,,,facility,outpatient,,,371.50000,352.92000,Amish/Mennonite,Amish Mennonite,,204.32,,,,,,,185.75,360.36,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,63.80,112.52,percent of total billed charges,
ANTINUCLEAR ANTIBODIES-TECH,65714,CDM,300,RC,86038,CPT,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,12.09,628.12,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
URINALYSIS BY DIP OR REGENT STRIP-TECH,65715,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,2.25,118.82,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,inpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
GONIOSCOPY-TECH,65723,CDM,510,RC,92020,CPT,,,facility,outpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,134.64,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,433.40,764.36,percent of total billed charges,
US GUIDE FOR TISSUE ABALATION-TECH,65734,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,327.36,764.36,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
BACLOFEN TAB 2.5 MG,65735,CDM,250,RC,00904-6475-61-00025,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
ACYCLOVIR TAB 200 MG,65736,CDM,250,RC,J8499,HCPCS,3172207780100025,NDC,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,inpatient,1,EA,8.81000,8.37000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.85,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,00245014401,NDC,facility,outpatient,1,EA,8.81000,8.37000,Amish/Mennonite,Amish Mennonite,,4.85,,,,,,,4.41,8.55,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,0090465566100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,inpatient,1,EA,11.12000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,6.12,10.79,percent of total billed charges,
AMIODARONE TAB 100MG,65737,CDM,250,RC,J8499,HCPCS,50268009715,NDC,facility,outpatient,1,EA,11.12000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,5.56,10.79,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,51079-0960-20-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
BUSPIRONE TAB 7.5 MG,65738,CDM,250,RC,64380-0787-06,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,inpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
BUPROPION TAB 50 MG,65739,CDM,250,RC,51079-0944-20-00050,NDC,,,facility,outpatient,1,EA,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,inpatient,1,mL,43.92000,41.73000,Amish/Mennonite,Amish Mennonite,,24.16,,,,,,,24.16,42.60,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 10 GM,65741,CDM,636,RC,J1459,HCPCS,44206043710,NDC,facility,outpatient,1,mL,43.92000,41.73000,Amish/Mennonite,Amish Mennonite,,24.16,,,,,,,21.96,83.21,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,inpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,143.55,253.17,percent of total billed charges,
ADNB,65749,CDM,300,RC,86215,CPT,,,facility,outpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,13.25,696.05,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM VESTAN SS,65755,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 6FR 100CM PERI TRNRDL NYL,65756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,Amish/Mennonite,Amish Mennonite,,2052.19,,,,,,,1828.31,3619.31,percent of total billed charges,
MCTH CRBRVASC .036-.04IN .027IN 15CM PHENOM RND,65758,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,Amish/Mennonite,Amish Mennonite,,2052.19,,,,,,,1712.64,3731.25,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,inpatient,,,1441.00000,1368.95000,Amish/Mennonite,Amish Mennonite,,792.55,,,,,,,792.55,1397.77,percent of total billed charges,
BRONCH W/ BRUSHING - RT CHARGE BRONCHOSCOPY,65759,CDM,360,RC,31623,CPT,,,facility,outpatient,,,1441.00000,1368.95000,Amish/Mennonite,Amish Mennonite,,792.55,,,,,,,792.55,4686.00,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,inpatient,,,1616.00000,1535.20000,Amish/Mennonite,Amish Mennonite,,888.80,,,,,,,888.80,1567.52,percent of total billed charges,
FB REMOVAL ANAL -TECH,65761,CDM,361,RC,,,,,facility,outpatient,,,1616.00000,1535.20000,Amish/Mennonite,Amish Mennonite,,888.80,,,,,,,888.80,5271.00,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,inpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,90,117.70,,,,,,,117.70,207.58,percent of total billed charges,
"COMPLEMENT, TOTAL, S (COM) SO",65763,CDM,300,RC,86162,CPT,,,facility,outpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,90,117.70,,,,,,,21.00,1069.56,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4467.75000,4244.36000,Amish/Mennonite,Amish Mennonite,,2457.26,,,,,,,2189.20,4333.72,percent of total billed charges,
CATHETER INFS .055-.061IN .0445IN 120CM PHENOM +,65764,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4467.75000,4244.36000,Amish/Mennonite,Amish Mennonite,,2457.26,,,,,,,2050.70,4467.75,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,224.40,395.76,percent of total billed charges,
CYSTIC FIBROSIS CARRIER DETECTION TEST (23 MUTATIONS),65765,CDM,300,RC,81220,CPT,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,204.00,26177.94,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,inpatient,,,484.20000,459.99000,Amish/Mennonite,Amish Mennonite,90,266.31,,,,,,,266.31,469.67,percent of total billed charges,
"CMV DNA DETECTION, PLASMA (CMVQN) SO",65766,CDM,300,RC,87497,CPT,,,facility,outpatient,,,484.20000,459.99000,Amish/Mennonite,Amish Mennonite,90,266.31,,,,,,,44.27,2240.90,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,inpatient,1,mL,29.77000,28.29000,Amish/Mennonite,Amish Mennonite,,16.37,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 5 GM,65767,CDM,636,RC,J1572,HCPCS,61953000501,NDC,facility,outpatient,1,mL,29.77000,28.29000,Amish/Mennonite,Amish Mennonite,,16.37,,,,,,,14.88,73.49,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CURI,65768,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,inpatient,1,mL,29.78000,28.29000,Amish/Mennonite,Amish Mennonite,,16.38,,,,,,,16.38,28.89,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 10 GM,65769,CDM,636,RC,J1572,HCPCS,61953000502,NDC,facility,outpatient,1,mL,29.78000,28.29000,Amish/Mennonite,Amish Mennonite,,16.38,,,,,,,14.89,73.49,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,90.03,158.79,percent of total billed charges,
DNA PROBE,65770,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,20.36,1120.45,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
SLP FIBEROPTIC SWALLOW EVAL UNITS,65771,CDM,440,RC,92612,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,52.50,264.00,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,inpatient,,,351.00000,333.45000,Amish/Mennonite,Amish Mennonite,,193.05,,,,,,,193.05,340.47,percent of total billed charges,
ID BY SEQUENCING2,65772,CDM,300,RC,87153,CPT,,,facility,outpatient,,,351.00000,333.45000,Amish/Mennonite,Amish Mennonite,,193.05,,,,,,,115.36,6026.72,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
"SODIUM, URINE 24 HOUR",65773,CDM,300,RC,84300,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.06,254.68,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
"OT COMMUNITY, WORK REINTEGRATION UNITS",65774,CDM,430,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,49.50,264.00,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY BILATERAL,65775,CDM,320,RC,75743,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,417.10,17311.25,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,inpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.78100,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,51525-0112-01,NDC,,,facility,outpatient,1,EA,1.42000,1.35000,Amish/Mennonite,Amish Mennonite,,0.78100,,,,,,,0.71000,1.38,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,inpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.06,percent of total billed charges,
HYOSCYAMINE 0.125 MG TAB,65776,CDM,250,RC,47781-0013-01,NDC,,,facility,outpatient,1,EA,2.12000,2.01000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.06,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,30.80,54.32,percent of total billed charges,
EOVIST 1 ML,65779,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,22.80,54.32,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,inpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,143.55,253.17,percent of total billed charges,
"TESTOSTERONE, FREE (INCLUDES TOTAL AND SHBG)",65780,CDM,300,RC,84402,CPT,,,facility,outpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,25.47,1324.17,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA20MM FEP NIT CONTRALATERAL LEG IL,65781,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 100 UCI CARD,65782,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
PT UNATTENDED E-STIM UNITS,65784,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,26.40,46.56,percent of total billed charges,
HEMOGLOBIN FRACTIONATION,65785,CDM,300,RC,83020,CPT,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,6.41,1590.11,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,inpatient,,,5169.00000,4910.55000,Amish/Mennonite,Amish Mennonite,TC,2842.95,,,,,,,2842.95,5013.93,percent of total billed charges,
XR BIOPSY TRANSCATHETER,65788,CDM,481,RC,75970,CPT,,,facility,outpatient,,,5169.00000,4910.55000,Amish/Mennonite,Amish Mennonite,TC,2842.95,,,,,,,2584.50,5271.00,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE VASC SM CRV .035IN 275X4.2X4.2CM,65792,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1084.39,2362.50,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,inpatient,1,mL,29.77000,28.29000,Amish/Mennonite,Amish Mennonite,,16.37,,,,,,,16.37,28.88,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (FLEBOGAMMA) 20 GM,65793,CDM,636,RC,J1572,HCPCS,61953000503,NDC,facility,outpatient,1,mL,29.77000,28.29000,Amish/Mennonite,Amish Mennonite,,16.37,,,,,,,14.88,73.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,inpatient,,,130.40000,123.88000,Amish/Mennonite,Amish Mennonite,90,71.72,,,,,,,71.72,126.49,percent of total billed charges,
"CLOTTING INHIBITORS, PROTEIN C SO-TECH",65795,CDM,300,RC,85302,CPT,,,facility,outpatient,,,130.40000,123.88000,Amish/Mennonite,Amish Mennonite,90,71.72,,,,,,,12.41,628.12,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,inpatient,,,454.10000,431.40000,Amish/Mennonite,Amish Mennonite,90,249.75,,,,,,,249.75,440.48,percent of total billed charges,
MOLECULAR CYTOGENICS INTERPHASES-TECH,65796,CDM,300,RC,88275,CPT,,,facility,outpatient,,,454.10000,431.40000,Amish/Mennonite,Amish Mennonite,90,249.75,,,,,,,52.89,2410.69,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,inpatient,,,192.50000,182.88000,Amish/Mennonite,Amish Mennonite,90,105.88,,,,,,,105.88,186.72,percent of total billed charges,
"ANTIBODY, LYME DISEASE SO-TECH",65798,CDM,300,RC,86618,CPT,,,facility,outpatient,,,192.50000,182.88000,Amish/Mennonite,Amish Mennonite,90,105.88,,,,,,,17.60,882.80,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
INFECT AGENT DETECT BY NUC ACID-TECH,65799,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,36.26,1833.46,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 7.5 MG,65802,CDM,250,RC,13668-0219-30-00050,NDC,,,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,00904-6788-61,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,60687-0356-01,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,68084-0381-01,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.5 MG,65803,CDM,250,RC,69315-0136-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 250 MG TAB-CHEW,65804,CDM,250,RC,66553-0004-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1770.00000,1681.50000,Amish/Mennonite,Amish Mennonite,,973.50,,,,,,,867.30,1716.90,percent of total billed charges,
CATHETER OCL 10-46MM 100CM PU RLNT STNT GFT DLV,65805,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1770.00000,1681.50000,Amish/Mennonite,Amish Mennonite,,973.50,,,,,,,812.43,1770.00,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L124MM DIA16X16MM CATH 14FR POLY NIT STNT,65808,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8583.87,16992.56,percent of total billed charges,
GRAFT EVAR L156MM DIA16X16MM CATH 16FR POLY NIT STNT,65810,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,17518.10000,16642.19000,Amish/Mennonite,Amish Mennonite,,9634.95,,,,,,,8040.81,17518.10,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,14201.10000,13491.04000,Amish/Mennonite,Amish Mennonite,,7810.60,,,,,,,6958.54,13775.07,percent of total billed charges,
GRAFT VASC L90X40CM DIA8X8MM AXILLOBIFEMORAL PTFE CBAS HEP,65811,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,14201.10000,13491.04000,Amish/Mennonite,Amish Mennonite,,7810.60,,,,,,,6518.30,14201.10,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,34.10,60.14,percent of total billed charges,
PT VASOPNEUMATIC DEVICES UNITS,65813,CDM,420,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,31.00,264.00,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,717.75,1265.85,percent of total billed charges,
SPECIAL MED RAD PHYSICS CONSULT-TECH,65819,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,126.07,6798.73,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,90,84.15,,,,,,,84.15,148.41,percent of total billed charges,
"PARVOVIRUS B19 ABS, S (PARVS) SO",65820,CDM,300,RC,86747,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,90,84.15,,,,,,,15.53,780.94,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,inpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,90,138.05,,,,,,,138.05,243.47,percent of total billed charges,
C4A LEVEL (FC4AL) SO,65821,CDM,300,RC,86160,CPT,,,facility,outpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,90,138.05,,,,,,,12.40,628.12,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,inpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,218.24,384.90,percent of total billed charges,
INFECT AGENT DETECT HSV SO-TECH,65822,CDM,300,RC,87529,CPT,,,facility,outpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,36.26,1833.46,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,inpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,113.30,199.82,percent of total billed charges,
AB ID PLATELET AB-HEPARIN THROMBOCYTO-TECH,65823,CDM,300,RC,86022,CPT,,,facility,outpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,18.37,967.70,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
ENZYME ACTIVITY SO-TECH,65824,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,22.91,1035.56,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
ASCORBIC ACID 125 MG TAB,65825,CDM,250,RC,00904-0522-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,inpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
CHLORTHALIDONE 12.5 MG TAB,65826,CDM,250,RC,51079-0058-20-00050,NDC,,,facility,outpatient,1,EA,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CLONIDINE 0.15 MG TAB,65828,CDM,250,RC,00904-5658-61-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3505.20000,3329.94000,Amish/Mennonite,Amish Mennonite,,1927.86,,,,,,,1717.55,3400.04,percent of total billed charges,
AUGMENT FEM L65MM THK5MM RL LM POST KNEE TI PRI PRESSFIT BLK,65829,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3505.20000,3329.94000,Amish/Mennonite,Amish Mennonite,,1927.86,,,,,,,1608.89,3505.20,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,inpatient,1,EA,169.94000,161.45000,Amish/Mennonite,Amish Mennonite,,93.47,,,,,,,93.47,164.84,percent of total billed charges,
CINACALCET 60 MG TAB,65830,CDM,250,RC,J0604,HCPCS,55513007430,NDC,facility,outpatient,1,EA,169.94000,161.45000,Amish/Mennonite,Amish Mennonite,,93.47,,,,,,,84.97,164.84,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,inpatient,1,EA,13.76000,13.08000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,7.57,13.35,percent of total billed charges,
ANIDULAFUNGIN SOLN 10 MG/3 ML,65831,CDM,250,RC,J0348,HCPCS,0004901142800100,NDC,facility,outpatient,1,EA,13.76000,13.08000,Amish/Mennonite,Amish Mennonite,,7.57,,,,,,,0.73160,13.35,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,inpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,00904-6426-61-00050,NDC,,,facility,outpatient,1,EA,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,43547-0280-10,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,inpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
ESCITALOPRAM 5 MG TAB,65832,CDM,250,RC,69097-0847-05,NDC,,,facility,outpatient,1,EA,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
ESCITALOPRAM 2.5 MG TAB,65833,CDM,250,RC,00904-6426-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
ARIPIPRAZOLE TAB 2.5 MG,65834,CDM,250,RC,J8499,HCPCS,6586206633000025,NDC,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
AMLODIPINE TAB 1.25 MG,65836,CDM,250,RC,J8499,HCPCS,0090463696100050,NDC,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,351.45000,333.88000,Amish/Mennonite,Amish Mennonite,,193.30,,,,,,,172.21,340.91,percent of total billed charges,
GUIDEWIRE ORTH 2.8MM 300MM SS 150MM CLBRT FLUT,65837,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,351.45000,333.88000,Amish/Mennonite,Amish Mennonite,,193.30,,,,,,,161.32,351.45,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
CYCLOBENZAPRINE 2.5 MG TAB,65838,CDM,250,RC,10702-0006-50-00050,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,inpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
CLOZAPINE 50 MG TAB,65839,CDM,250,RC,51079-0922-20-00050,NDC,,,facility,outpatient,1,EA,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.77500,1.50,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
CARBAMAZEPINE TAB 100 MG,65841,CDM,250,RC,60505-0183-00-00050,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,inpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
DIGOXIN 62.5 MCG (0.0625 MG) TAB,65842,CDM,250,RC,68084-0366-01-00050,NDC,,,facility,outpatient,1,EA,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDRALAZINE 5 MG TAB,65844,CDM,250,RC,00904-6440-61-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L109MM DIA30MM SHTH OD6MM ID5.3MM PROX COMP,65845,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,17319.36,37732.80,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
GLYCOPYRROLATE 0.5 MG TAB,65846,CDM,250,RC,64980-0272-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,inpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.48400,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,00228-2820-11,NDC,,,facility,outpatient,1,EA,0.88000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48400,,,,,,,0.44000,0.85360,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,16729-0182-01,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,63739-0128-10-00500,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
HYDROCHLOROTHIAZIDE TAB 12.5 MG,65847,CDM,250,RC,69315-0155-01,NDC,,,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L9CM 0.035IN ACC CHN 2.8MM PLAS,65848,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,inpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
FERROUS SULFATE 4.2 MG / 0.25 ML DROPS-ORAL,65849,CDM,250,RC,50383-0627-50-00028,NDC,,,facility,outpatient,1,mL,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
GABAPENTIN 300 MG TAB,65850,CDM,250,RC,68084-0797-01-00050,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
HALOPERIDOL 0.25 MG TAB,65851,CDM,250,RC,51079-0733-20-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
GEMFIBROZIL 300 MG TAB,65852,CDM,250,RC,50268-0350-15-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
SERTRALINE 12.5 MG TAB,65856,CDM,250,RC,60687-0231-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,inpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.46750,0.82450,percent of total billed charges,
ESTRADIOL 0.5 MG TAB,65860,CDM,250,RC,00555-0899-02,NDC,,,facility,outpatient,1,EA,0.85000,0.81000,Amish/Mennonite,Amish Mennonite,,0.46750,,,,,,,0.42500,0.82450,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,inpatient,,,1354.00000,1286.30000,Amish/Mennonite,Amish Mennonite,TC,744.70,,,,,,,744.70,1313.38,percent of total billed charges,
US OB EXTENDED EA ADDL,65861,CDM,402,RC,76812,CPT,,,facility,outpatient,,,1354.00000,1286.30000,Amish/Mennonite,Amish Mennonite,TC,744.70,,,,,,,384.16,1313.38,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,5168.10000,4909.70000,Amish/Mennonite,Amish Mennonite,,2842.45,,,,,,,2532.37,5013.06,percent of total billed charges,
GRAFT VASC L40CM DIA8MM PTFE CBAS HEP SURF THN WALLED REM,65862,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,5168.10000,4909.70000,Amish/Mennonite,Amish Mennonite,,2842.45,,,,,,,2372.16,5168.10,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
FUROSEMIDE 10 MG TAB,65865,CDM,250,RC,00054-8297-25-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,inpatient,,,1356.00000,1288.20000,Amish/Mennonite,Amish Mennonite,,745.80,,,,,,,745.80,1315.32,percent of total billed charges,
US TENDON LAVAGE CALCIFIC PERC,65874,CDM,361,RC,20999,CPT,,,facility,outpatient,,,1356.00000,1288.20000,Amish/Mennonite,Amish Mennonite,,745.80,,,,,,,227.78,5858.00,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,90,112.20,,,,,,,112.20,197.88,percent of total billed charges,
MYCOPHENOLIC ACID SO-TECH,65875,CDM,300,RC,80180,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,90,112.20,,,,,,,18.65,950.66,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
OXCARBAZEPINE-TECH,65876,CDM,300,RC,80183,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,13.25,696.05,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
LEVETIRACETAM-TECH,65877,CDM,300,RC,80177,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,13.25,696.05,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,inpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,90,87.06,,,,,,,87.06,153.55,percent of total billed charges,
"FLUOXETINE,, SERUM (FLUOX) SO",65879,CDM,300,RC,80299,CPT,,,facility,outpatient,,,158.30000,150.38000,Amish/Mennonite,Amish Mennonite,90,87.06,,,,,,,19.26,882.80,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
"PARVOVIRUS B19, PCR SO",65880,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,36.26,1833.46,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,90,125.40,,,,,,,125.40,221.16,percent of total billed charges,
FUNGITELL-TECH,65881,CDM,300,RC,87449,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,90,125.40,,,,,,,12.38,628.12,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,inpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,90.75,160.05,percent of total billed charges,
ZONISAMIDE-TECH,65882,CDM,300,RC,80203,CPT,,,facility,outpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,,90.75,,,,,,,13.25,696.05,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
CHROMOTOGRAPHY QLT OR QNT SO-TECH,65883,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,24.89,1137.41,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,85.80,151.32,percent of total billed charges,
IGE LEVEL-TECH,65884,CDM,300,RC,82785,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,16.46,865.84,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,inpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,218.24,384.90,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV), MOL DET, PCR (CMVPV) SO",65885,CDM,300,RC,87496,CPT,,,facility,outpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,36.26,1833.46,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,inpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,218.24,384.90,percent of total billed charges,
LEGIONELLA SP PCR SO-TECH,65886,CDM,300,RC,87801,CPT,,,facility,outpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,90,218.24,,,,,,,50.62,3666.93,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
WBC AUTO DIFF-TECH,65887,CDM,300,RC,85004,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,6.47,339.51,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,90,90.75,,,,,,,90.75,160.05,percent of total billed charges,
ANGIOTENSIN CONV ENZYME-TECH,65888,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,90,90.75,,,,,,,15.09,763.98,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,inpatient,,,5028.00000,4776.60000,Amish/Mennonite,Amish Mennonite,90,2765.40,,,,,,,2765.40,4877.16,percent of total billed charges,
EXTENDED FECAL PATH PCR-TECH,65889,CDM,300,RC,87507,CPT,,,facility,outpatient,,,5028.00000,4776.60000,Amish/Mennonite,Amish Mennonite,90,2765.40,,,,,,,430.66,21780.96,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,Amish/Mennonite,Amish Mennonite,90,216.43,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES 1-99-TECH,65890,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,Amish/Mennonite,Amish Mennonite,90,216.43,,,,,,,43.79,1986.29,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,inpatient,,,393.50000,373.82000,Amish/Mennonite,Amish Mennonite,90,216.43,,,,,,,216.43,381.69,percent of total billed charges,
INTERPHASES-TECH,65891,CDM,300,RC,88274,CPT,,,facility,outpatient,,,393.50000,373.82000,Amish/Mennonite,Amish Mennonite,90,216.43,,,,,,,43.79,1986.29,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, 15-20-TECH",65892,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,129.67,6518.98,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,inpatient,,,149.70000,142.21000,Amish/Mennonite,Amish Mennonite,90,82.33,,,,,,,82.33,145.21,percent of total billed charges,
5-HYDROXYINDOLEACETIC ACID (HIAA) SO,65893,CDM,300,RC,83497,CPT,,,facility,outpatient,,,149.70000,142.21000,Amish/Mennonite,Amish Mennonite,90,82.33,,,,,,,13.33,679.08,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,inpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,78.10,137.74,percent of total billed charges,
PAP-TECH,65894,CDM,300,RC,P3000,HCPCS,,,facility,outpatient,,,142.00000,134.90000,Amish/Mennonite,Amish Mennonite,,78.10,,,,,,,14.86,137.74,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
HYDRALAZINE 25 MG TAB,65895,CDM,250,RC,63739-0126-10-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,273.46,482.28,percent of total billed charges,
EBV DNA DET + QUANT SO-TECH,65942,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,44.27,2240.90,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,inpatient,,,160.20000,152.19000,Amish/Mennonite,Amish Mennonite,90,88.11,,,,,,,88.11,155.39,percent of total billed charges,
VITAMIN E SO-TECH,65943,CDM,300,RC,84446,CPT,,,facility,outpatient,,,160.20000,152.19000,Amish/Mennonite,Amish Mennonite,90,88.11,,,,,,,14.65,746.94,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,inpatient,,,460.60000,437.57000,Amish/Mennonite,Amish Mennonite,90,253.33,,,,,,,253.33,446.78,percent of total billed charges,
ALDOSTERONE 24 HOUR URINE (ALDU) SO,65944,CDM,300,RC,82088,CPT,,,facility,outpatient,,,460.60000,437.57000,Amish/Mennonite,Amish Mennonite,90,253.33,,,,,,,42.11,2122.08,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-10,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
AMANTADINE 100 MG / 10 ML SYRUP,65949,CDM,250,RC,00121-0646-16-01000,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
ALLOPURINOL TAB 75 MG,65950,CDM,250,RC,J8499,HCPCS,0090465726100025,NDC,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ALLOPURINOL TAB 25 MG,65954,CDM,250,RC,J8499,HCPCS,0090465716100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
AMIODARONE TAB 50 MG,65956,CDM,250,RC,J8499,HCPCS,0090465566100025,NDC,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
AMILORIDE TAB 2.5 MG,65957,CDM,250,RC,J8499,HCPCS,5026800711500050,NDC,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
AMITRIPTYLINE TAB 5 MG,65960,CDM,250,RC,J8499,HCPCS,5107901312000050,NDC,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETAMINOPHEN-DIPHENHYDRAMINE 250 MG-12.5 MG TAB,65961,CDM,250,RC,00904-7651-51-00050,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,inpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
ALLOPURINOL TAB 50 MG,65962,CDM,250,RC,J8499,HCPCS,0090465716100050,NDC,facility,outpatient,1,EA,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,0.42680,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
BENZTROPINE TAB 0.25 MG,65963,CDM,250,RC,00603-2438-21-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,inpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.52,2.68,percent of total billed charges,
ACETAZOLAMIDE TAB 62.5 MG,65964,CDM,250,RC,J8499,HCPCS,5167240220100050,NDC,facility,outpatient,1,EA,2.76000,2.62000,Amish/Mennonite,Amish Mennonite,,1.52,,,,,,,1.38,2.68,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,inpatient,1,GM,379.18000,360.22000,Amish/Mennonite,Amish Mennonite,,208.55,,,,,,,208.55,367.80,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 5 GM,65967,CDM,250,RC,10223-0201-04,NDC,,,facility,outpatient,1,GM,379.18000,360.22000,Amish/Mennonite,Amish Mennonite,,208.55,,,,,,,189.59,367.80,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,inpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
AMITRIPTYLINE TAB 12.5 MG,65968,CDM,250,RC,J8499,HCPCS,5107901072000050,NDC,facility,outpatient,1,EA,0.36000,0.35000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
CARBIDOPA-LEVODOPA 12.5 MG-125 MG TAB,65971,CDM,250,RC,00904-6238-61,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
CARBAMAZEPINE 50 MG TAB-CHEW,65974,CDM,250,RC,00904-3854-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
CEFUROXIME 125 MG TAB,65975,CDM,250,RC,16714-0400-01-00050,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
ATORVASTATIN 2.5 MG TAB,65976,CDM,250,RC,00904-6290-61-00025,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
CLOPIDOGREL 37.5 MG TAB,65978,CDM,250,RC,00904-6294-61-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CALCIUM-VITAMIN D 158 MG-125 UNIT TAB,65979,CDM,250,RC,00536-3224-08-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,inpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.19800,0.34920,percent of total billed charges,
BISOPROLOL TAB 2.5 MG,65980,CDM,250,RC,29300-0127-13-00025,NDC,,,facility,outpatient,1,EA,0.36000,0.34000,Amish/Mennonite,Amish Mennonite,,0.19800,,,,,,,0.18000,0.34920,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,inpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
COLESTIPOL 0.5 GM TAB,65982,CDM,250,RC,59762-0450-01-00050,NDC,,,facility,outpatient,1,EA,1.29000,1.23000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
DICYCLOMINE 10 MG TAB,65984,CDM,250,RC,00378-1620-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,inpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.025 MG TAB,65985,CDM,250,RC,68084-0606-21-00025,NDC,,,facility,outpatient,1,EA,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
CYPROHEPTADINE 2 MG TAB,65986,CDM,250,RC,70710-1110-01-00050,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,inpatient,1,EA,15.47000,14.69000,Amish/Mennonite,Amish Mennonite,,8.51,,,,,,,8.51,15.01,percent of total billed charges,
DRONEDARONE 200 MG TAB,65987,CDM,250,RC,00024-4142-10-00050,NDC,,,facility,outpatient,1,EA,15.47000,14.69000,Amish/Mennonite,Amish Mennonite,,8.51,,,,,,,7.74,15.01,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.53,percent of total billed charges,
AZITHROMYCIN TAB 125 MG,65988,CDM,250,RC,60687-0282-01-00050,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.30,2.53,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,inpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
ARIPIPRAZOLE TAB 1 MG,65989,CDM,250,RC,J8499,HCPCS,1366802163000050,NDC,facility,outpatient,1,EA,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,46017-0018-40,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
CAFFEINE 200 MG TAB,65993,CDM,250,RC,70677-0021-01,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,inpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
CIPROFLOXACIN 125 MG TAB,65994,CDM,250,RC,63739-0700-10-00050,NDC,,,facility,outpatient,1,EA,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,inpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,2.00,3.52,percent of total billed charges,
DIPHENHYDRAMINE 50 MG/ML SOLN,65996,CDM,250,RC,J1200,HCPCS,67457012410,NDC,facility,outpatient,1,mL,3.63000,3.45000,Amish/Mennonite,Amish Mennonite,,2.00,,,,,,,1.02,3.52,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,inpatient,1,EA,10.18000,9.67000,Amish/Mennonite,Amish Mennonite,,5.60,,,,,,,5.60,9.87,percent of total billed charges,
COLCHICINE 0.3 MG TAB,65997,CDM,250,RC,64764-0119-07-00050,NDC,,,facility,outpatient,1,EA,10.18000,9.67000,Amish/Mennonite,Amish Mennonite,,5.60,,,,,,,5.09,9.87,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
BUSPIRONE TAB 2.5 MG,65999,CDM,250,RC,00093-0053-01-00050,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
DILTIAZEM 7.5 MG TAB,66000,CDM,250,RC,63739-0079-10-00025,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,inpatient,1,EA,3.16000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
BUMETANIDE TAB 0.25 MG,66001,CDM,250,RC,42799-0119-01-00050,NDC,,,facility,outpatient,1,EA,3.16000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,inpatient,1,mL,1421.20000,1350.14000,Amish/Mennonite,Amish Mennonite,,781.66,,,,,,,781.66,1378.56,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 480 MCG/0.8 ML,66003,CDM,636,RC,Q5101,HCPCS,61314032610,NDC,facility,outpatient,1,mL,1421.20000,1350.14000,Amish/Mennonite,Amish Mennonite,,781.66,,,,,,,0.37000,1378.56,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
DILTIAZEM 15 MG TAB,66004,CDM,250,RC,63739-0079-10-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,inpatient,1,EA,3.93000,3.74000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.81,percent of total billed charges,
BROMOCRIPTINE TAB 1.25 MG,66006,CDM,250,RC,00574-0106-03-00050,NDC,,,facility,outpatient,1,EA,3.93000,3.74000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,1.97,3.81,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,inpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.29150,0.51410,percent of total billed charges,
DILTIAZEM 45 MG TAB,66007,CDM,250,RC,51079-0747-20-00050,NDC,,,facility,outpatient,1,EA,0.53000,0.50000,Amish/Mennonite,Amish Mennonite,,0.29150,,,,,,,0.26500,0.51410,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
GLIPIZIDE 1.25 MG TAB,66009,CDM,250,RC,51079-0810-20-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,inpatient,1,EA,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.05,percent of total billed charges,
EZETIMIBE 5 MG TAB,66011,CDM,250,RC,00781-5690-31-00050,NDC,,,facility,outpatient,1,EA,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.57,3.05,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
HYDROCORTISONE 1.25 MG TAB,66013,CDM,250,RC,59762-0073-01-00025,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
EPLERENONE 12.5 MG TAB,66014,CDM,250,RC,00378-1030-93-00050,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,inpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.96800,1.71,percent of total billed charges,
BUPROPION TAB 37.5 MG,66015,CDM,250,RC,51079-0943-20-00050,NDC,,,facility,outpatient,1,EA,1.76000,1.68000,Amish/Mennonite,Amish Mennonite,,0.96800,,,,,,,0.88000,1.71,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,inpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
CITALOPRAM 2.5 MG TAB,66018,CDM,250,RC,00904-6084-61-00025,NDC,,,facility,outpatient,1,EA,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
FERROUS GLUCONATE 162 MG TAB,66019,CDM,250,RC,00574-0508-11-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,inpatient,1,EA,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.17,2.07,percent of total billed charges,
FLUCONAZOLE 50 MG TAB,66021,CDM,250,RC,00904-6500-61-00050,NDC,,,facility,outpatient,1,EA,2.13000,2.02000,Amish/Mennonite,Amish Mennonite,,1.17,,,,,,,1.06,2.07,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,inpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CARBIDOPA-LEVODOPA 6.25 MG-25 MG TAB,66023,CDM,250,RC,00904-6237-61,NDC,,,facility,outpatient,1,EA,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,inpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
FLUDROCORTISONE 0.05 MG TAB,66024,CDM,250,RC,68084-0288-01-00050,NDC,,,facility,outpatient,1,EA,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 4.25 GM PACKET,66026,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
CARVEDILOL 1.56 MG TAB,66027,CDM,250,RC,51079-0771-20-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
CYANOCOBALAMIN 50 MCG TAB,66028,CDM,250,RC,50268-0852-15-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,inpatient,1,EA,40.37000,38.36000,Amish/Mennonite,Amish Mennonite,,22.20,,,,,,,22.20,39.16,percent of total billed charges,
CINACALCET 15 MG TAB,66029,CDM,250,RC,J0604,HCPCS,5551300733000050,NDC,facility,outpatient,1,EA,40.37000,38.36000,Amish/Mennonite,Amish Mennonite,,22.20,,,,,,,20.18,39.16,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
FLECAINIDE 25 MG TAB,66030,CDM,250,RC,00054-0010-20-00050,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
CALCIUM-VITAMIN D 300 MG-200 INTL UNITS TAB,66031,CDM,250,RC,50268-0150-15,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,inpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
CAPTOPRIL 3.125 MG TAB,66033,CDM,250,RC,00143-1171-01-00025,NDC,,,facility,outpatient,1,EA,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,inpatient,1,mL,301.09000,286.03000,Amish/Mennonite,Amish Mennonite,,165.60,,,,,,,165.60,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,62225060004,NDC,facility,outpatient,1,mL,301.09000,286.03000,Amish/Mennonite,Amish Mennonite,,165.60,,,,,,,92.50,292.06,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,inpatient,1,mL,305.62000,290.34000,Amish/Mennonite,Amish Mennonite,,168.09,,,,,,,168.09,296.45,percent of total billed charges,
KETOROLAC-PHENYLEPHRINE SOLN-IRR 0.3%-1% 4 ML,66035,CDM,250,RC,J1097,HCPCS,82604060004,NDC,facility,outpatient,1,mL,305.62000,290.34000,Amish/Mennonite,Amish Mennonite,,168.09,,,,,,,92.50,296.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,inpatient,1,mL,14.59000,13.86000,Amish/Mennonite,Amish Mennonite,,8.02,,,,,,,8.02,14.15,percent of total billed charges,
IMMUNE GLOBULIN SOLN 5% (FLEBOGAMMA) 2.5 GM,66036,CDM,636,RC,J1572,HCPCS,61953000402,NDC,facility,outpatient,1,mL,14.59000,13.86000,Amish/Mennonite,Amish Mennonite,,8.02,,,,,,,7.29,73.49,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,inpatient,1,EA,5.09000,4.83000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.80,4.94,percent of total billed charges,
COLCHICINE 0.15 MG TAB,66037,CDM,250,RC,64764-0119-07-00025,NDC,,,facility,outpatient,1,EA,5.09000,4.83000,Amish/Mennonite,Amish Mennonite,,2.80,,,,,,,2.54,4.94,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,inpatient,1,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.91,percent of total billed charges,
BROMOCRIPTINE TAB 0.625 MG,66038,CDM,250,RC,00574-0106-03-00025,NDC,,,facility,outpatient,1,EA,1.97000,1.87000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98500,1.91,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CITALOPRAM 5 MG TAB,66039,CDM,250,RC,00904-6084-61-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
FUROSEMIDE 5 MG TAB,66041,CDM,250,RC,00054-8297-25-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,inpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.22,percent of total billed charges,
FENOFIBRATE 80 MG TAB,66042,CDM,250,RC,68084-0328-21-00050,NDC,,,facility,outpatient,1,EA,4.35000,4.13000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.17,4.22,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,inpatient,1,EA,8.72000,8.28000,Amish/Mennonite,Amish Mennonite,,4.80,,,,,,,4.80,8.46,percent of total billed charges,
CHLORPROMAZINE 12.5 MG TAB,66043,CDM,250,RC,51079-0519-20-00050,NDC,,,facility,outpatient,1,EA,8.72000,8.28000,Amish/Mennonite,Amish Mennonite,,4.80,,,,,,,4.36,8.46,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,inpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,68462-0229-01,NDC,,,facility,outpatient,1,EA,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,inpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.50600,0.89240,percent of total billed charges,
LAMOTRIGINE 25 MG DSPT,66047,CDM,250,RC,65862-0362-01,NDC,,,facility,outpatient,1,EA,0.92000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50600,,,,,,,0.46000,0.89240,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,inpatient,1,mL,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.92,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00143951910,NDC,facility,outpatient,1,mL,5.31000,5.04000,Amish/Mennonite,Amish Mennonite,,2.92,,,,,,,2.65,5.15,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,inpatient,1,mL,16.35000,15.54000,Amish/Mennonite,Amish Mennonite,,8.99,,,,,,,8.99,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,00703367101,NDC,facility,outpatient,1,mL,16.35000,15.54000,Amish/Mennonite,Amish Mennonite,,8.99,,,,,,,3.62,15.86,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,inpatient,1,mL,6.68000,6.35000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.48,percent of total billed charges,
METHOTREXATE SOLN PF 25 MG/ML 2 ML,66048,CDM,250,RC,J9260,HCPCS,16729027730,NDC,facility,outpatient,1,mL,6.68000,6.35000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.34,6.48,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
GABAPENTIN 150 MG TAB,66049,CDM,250,RC,68084-0797-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.47000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,inpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
FLUDROCORTISONE 0.025 MG TAB,66050,CDM,250,RC,68084-0288-01-00025,NDC,,,facility,outpatient,1,EA,0.52000,0.50000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
CHOLECALCIFEROL 200 INTL UNITS TAB,66052,CDM,250,RC,00904-5823-60-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,inpatient,1,EA,890.96000,846.41000,Amish/Mennonite,Amish Mennonite,,490.03,,,,,,,490.03,864.23,percent of total billed charges,
"THROMBIN TOPICAL RECOMBINANT 20,000 INTL UNITS POWD",66053,CDM,250,RC,00338-0326-01,NDC,,,facility,outpatient,1,EA,890.96000,846.41000,Amish/Mennonite,Amish Mennonite,,490.03,,,,,,,445.48,864.23,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,inpatient,1,mL,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
CHLORPHENIRAMINE-HYDROCODONE 8 MG-10 MG/5 ML SUSP,66054,CDM,250,RC,27808-0086-02-00500,NDC,,,facility,outpatient,1,mL,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
SPIRONOLACTONE-HCTZ 12.5 MG-12.5 MG TAB,66055,CDM,250,RC,59762-5014-01,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,inpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
PHENOBARBITAL 8 MG / 2 ML ELIXIR,66056,CDM,250,RC,00603-1508-58-00300,NDC,,,facility,outpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,inpatient,1,GM,11.29000,10.72000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,6.21,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0568-15,NDC,,,facility,outpatient,1,GM,11.29000,10.72000,Amish/Mennonite,Amish Mennonite,,6.21,,,,,,,5.64,10.95,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,inpatient,1,GM,13.50000,12.82000,Amish/Mennonite,Amish Mennonite,,7.42,,,,,,,7.42,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,50268-0572-60,NDC,,,facility,outpatient,1,GM,13.50000,12.82000,Amish/Mennonite,Amish Mennonite,,7.42,,,,,,,6.75,13.10,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,inpatient,1,GM,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
MUPIROCIN TOPICAL 2% OINT,66057,CDM,250,RC,81033-0020-50,NDC,,,facility,outpatient,1,GM,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,inpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
CLONIDINE 0.05 MG TAB,66058,CDM,250,RC,63739-0060-10-00050,NDC,,,facility,outpatient,1,EA,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,inpatient,1,mL,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
LIDOCAINE SOLN 1% 0.5 ML,66059,CDM,250,RC,J2003,HCPCS,0040942761700050,NDC,facility,outpatient,1,mL,0.10000,0.10000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,inpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,17.38,30.65,percent of total billed charges,
LEUCOVORIN 50 MG POWD,66060,CDM,250,RC,25021-0813-10,NDC,,,facility,outpatient,1,EA,31.60000,30.02000,Amish/Mennonite,Amish Mennonite,,17.38,,,,,,,15.80,30.65,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,inpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.21,2.13,percent of total billed charges,
DESMOPRESSIN (DDAVP) 0.05 MG TAB,66061,CDM,250,RC,68084-0606-21-00050,NDC,,,facility,outpatient,1,EA,2.20000,2.09000,Amish/Mennonite,Amish Mennonite,,1.21,,,,,,,1.10,2.13,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
HYDROCORTISONE 2.5 MG TAB,66063,CDM,250,RC,59762-0073-01-00050,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
PREDNISONE TAB 0.5 MG,66064,CDM,250,RC,J7512,HCPCS,0005487392500050,NDC,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.00620,0.23280,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
FOLIC ACID 0.2 MG TAB,66065,CDM,250,RC,00536-3844-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,inpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 8.5 GM PACKET,66069,CDM,250,RC,51991-0457-58-00425,NDC,,,facility,outpatient,1,GM,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-0795-50,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
"OPHTHALMIC IRRIGATION, INTRAOCULAR BALANCED SALT SOLUTION SOLN",66070,CDM,250,RC,00065-1795-04,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,inpatient,,,2143.00000,2035.85000,Amish/Mennonite,Amish Mennonite,,1178.65,,,,,,,1178.65,2078.71,percent of total billed charges,
BRONCH W BRONCHIAL BX(S) - RT CHARGE BRONCHOSCOPY,66072,CDM,360,RC,31625,CPT,,,facility,outpatient,,,2143.00000,2035.85000,Amish/Mennonite,Amish Mennonite,,1178.65,,,,,,,1178.65,4686.00,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
INTRO SHTH 7FR 23CM CRDS BRTP SIL 35MM EVAS KINK,66074,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,124.80000,118.56000,Amish/Mennonite,Amish Mennonite,,68.64,,,,,,,61.15,121.06,percent of total billed charges,
GUIDEWIRE ESCP .035IN STRG 145CM PTFE SS AMPTZ 5.,66075,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,124.80000,118.56000,Amish/Mennonite,Amish Mennonite,,68.64,,,,,,,57.28,124.80,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,90,116.60,,,,,,,116.60,205.64,percent of total billed charges,
MYOMARKER PANEL 2 (JO-1),66077,CDM,300,RC,86235,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,90,116.60,,,,,,,18.53,933.70,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
PAIN CLINIC DRUGS W/ CONF URINE,66078,CDM,300,RC,80307,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,62.14,3038.81,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,53.35,94.09,percent of total billed charges,
CRYSTAL ID,66079,CDM,300,RC,89060,CPT,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,7.33,1284.54,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE VASC ANG .018IN 180CM GLDWR NTNL PU,66080,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66081,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5039.91,10980.20,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,inpatient,,,876.00000,832.20000,Amish/Mennonite,Amish Mennonite,,481.80,,,,,,,481.80,849.72,percent of total billed charges,
TSH RECEPTOR AB,66082,CDM,300,RC,83519,CPT,,,facility,outpatient,,,876.00000,832.20000,Amish/Mennonite,Amish Mennonite,,481.80,,,,,,,18.40,865.84,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR ANGIOGRAM PULMONARY,66084,CDM,320,RC,75741,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,411.55,17311.25,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,inpatient,,,959.00000,911.05000,Amish/Mennonite,Amish Mennonite,90,527.45,,,,,,,527.45,930.23,percent of total billed charges,
HLA TRANSPLANT MATCH-CHG ONLY,66086,CDM,300,RC,86813,CPT,,,facility,outpatient,,,959.00000,911.05000,Amish/Mennonite,Amish Mennonite,90,527.45,,,,,,,59.93,3038.81,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,inpatient,,,3166.00000,3007.70000,Amish/Mennonite,Amish Mennonite,TC,1741.30,,,,,,,1741.30,3071.02,percent of total billed charges,
XR VENOGRAM HEPATIC W/HD EVAL,66087,CDM,320,RC,75889,CPT,,,facility,outpatient,,,3166.00000,3007.70000,Amish/Mennonite,Amish Mennonite,TC,1741.30,,,,,,,418.96,17311.25,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
"ALBUMIN, SERUM, PLASMA OR WHOLE-TECH",66088,CDM,300,RC,82040,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,4.95,254.68,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
INSULIN FREE-TECH,66093,CDM,300,RC,83527,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,13.38,679.08,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,inpatient,,,129.20000,122.74000,Amish/Mennonite,Amish Mennonite,90,71.06,,,,,,,71.06,125.32,percent of total billed charges,
INSULIN TOTAL-TECH,66094,CDM,300,RC,83525,CPT,,,facility,outpatient,,,129.20000,122.74000,Amish/Mennonite,Amish Mennonite,90,71.06,,,,,,,11.81,594.19,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,inpatient,,,170.50000,161.98000,Amish/Mennonite,Amish Mennonite,90,93.78,,,,,,,93.78,165.38,percent of total billed charges,
"LIDOCAINE, SERUM-TECH",66095,CDM,300,RC,80176,CPT,,,facility,outpatient,,,170.50000,161.98000,Amish/Mennonite,Amish Mennonite,90,93.78,,,,,,,15.18,763.98,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,90,56.10,,,,,,,56.10,98.94,percent of total billed charges,
NEURON SPECIFIC ENOLASE (NSE) SO,66096,CDM,300,RC,83520,CPT,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,90,56.10,,,,,,,17.85,814.87,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,inpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,90,528.55,,,,,,,528.55,932.17,percent of total billed charges,
"HIV-1 RNA DETECT/QUANT., PLASMA SO-TECH",66097,CDM,300,RC,87536,CPT,,,facility,outpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,90,528.55,,,,,,,87.93,4447.87,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,inpatient,,,413.30000,392.64000,Amish/Mennonite,Amish Mennonite,90,227.31,,,,,,,227.31,400.90,percent of total billed charges,
"TRANSFERRIN RECEPTORS, SOLUBLE-TECH",66098,CDM,300,RC,84238,CPT,,,facility,outpatient,,,413.30000,392.64000,Amish/Mennonite,Amish Mennonite,90,227.31,,,,,,,37.79,1918.36,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,inpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,90,105.60,,,,,,,105.60,186.24,percent of total billed charges,
METANEPHRINE FRAC FR SO -TECH,66099,CDM,300,RC,83835,CPT,,,facility,outpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,90,105.60,,,,,,,17.50,882.80,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,inpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,257.95,454.93,percent of total billed charges,
HOLTER/TO 48 HRS/REC/CONNECT/DISCO/93225,66104,CDM,731,RC,93225,CPT,,,facility,outpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,122.40,454.93,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,inpatient,,,1007.00000,956.65000,Amish/Mennonite,Amish Mennonite,,553.85,,,,,,,553.85,976.79,percent of total billed charges,
MICRODISSECTION-TECH,66105,CDM,300,RC,88381,CPT,,,facility,outpatient,,,1007.00000,956.65000,Amish/Mennonite,Amish Mennonite,,553.85,,,,,,,503.50,8610.62,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,inpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,90,816.20,,,,,,,816.20,1439.48,percent of total billed charges,
BRAFTSO-TECH,66106,CDM,300,RC,81210,CPT,,,facility,outpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,90,816.20,,,,,,,143.40,8250.66,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM HTRQ BL MWT U,66107,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU5 CRV 6FR 100CM COR NYL LNCHR LG,66108,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
FIRST TRIMESTER SCREEN-TECH,66124,CDM,300,RC,84704,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,15.29,780.94,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,711.11,1407.71,percent of total billed charges,
SHEATH CATH 180D 7FR 45CM TOURGUIDE HDRPH 9MM.,66136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1451.25000,1378.69000,Amish/Mennonite,Amish Mennonite,,798.19,,,,,,,666.12,1451.25,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,66137,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,Amish/Mennonite,Amish Mennonite,,1258.12,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 6.5FR 45CM TOURGUIDE HDRPH 9MM.,66138,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,Amish/Mennonite,Amish Mennonite,,1258.12,,,,,,,1049.96,2287.50,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,inpatient,,,2733.00000,2596.35000,Amish/Mennonite,Amish Mennonite,90,1503.15,,,,,,,1503.15,2651.01,percent of total billed charges,
EGFR MUTATION ANALYSIS-TECH,66139,CDM,300,RC,81235,CPT,,,facility,outpatient,,,2733.00000,2596.35000,Amish/Mennonite,Amish Mennonite,90,1503.15,,,,,,,264.01,15261.97,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,74.91,132.11,percent of total billed charges,
FLUORESCENT IDENTIFICATION SO-TECH,66143,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,12.45,1539.22,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY FOR ANALYTE SO-TECH,66144,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,17.85,814.87,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,inpatient,,,416.90000,396.05000,Amish/Mennonite,Amish Mennonite,90,229.29,,,,,,,229.29,404.39,percent of total billed charges,
"CROHN'S PROGNOSTIC, PROMETHEUS SO -TECH",66145,CDM,300,RC,81401,CPT,,,facility,outpatient,,,416.90000,396.05000,Amish/Mennonite,Amish Mennonite,90,229.29,,,,,,,137.00,6451.13,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL4 CRV 6FR 100CM COR FEM PU CRDS,66146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JR4 CRV 6FR 100CM COR FEM PU CRDS,66147,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO JL3.5 CRV 6FR 100CM COR FEM PU,66148,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
"UC VISIT, LEVEL 4 EST TECH",66154,CDM,456,RC,99214,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,inpatient,,,386.00000,366.70000,Amish/Mennonite,Amish Mennonite,,212.30,,,,,,,212.30,374.42,percent of total billed charges,
"UC VISIT EST, LEVEL 5 TECH",66155,CDM,456,RC,99215,CPT,,,facility,outpatient,,,386.00000,366.70000,Amish/Mennonite,Amish Mennonite,,212.30,,,,,,,193.00,446.00,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1475.00000,1401.25000,Amish/Mennonite,Amish Mennonite,,811.25,,,,,,,811.25,1430.75,percent of total billed charges,
"HPV, HIGH RISK ONLY-TECH",66156,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1475.00000,1401.25000,Amish/Mennonite,Amish Mennonite,,811.25,,,,,,,162.71,8693.45,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,inpatient,,,1422.00000,1350.90000,Amish/Mennonite,Amish Mennonite,90,782.10,,,,,,,782.10,1379.34,percent of total billed charges,
HPV HIGH RISK E6/E7 RNA SO-TECH,66157,CDM,300,RC,88365,CPT,,,facility,outpatient,,,1422.00000,1350.90000,Amish/Mennonite,Amish Mennonite,90,782.10,,,,,,,533.12,8693.45,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,inpatient,,,65.80000,62.51000,Amish/Mennonite,Amish Mennonite,90,36.19,,,,,,,36.19,63.83,percent of total billed charges,
BTYPE NATRIURETIC PEPTD-TECH,66158,CDM,300,RC,83880,CPT,,,facility,outpatient,,,65.80000,62.51000,Amish/Mennonite,Amish Mennonite,90,36.19,,,,,,,32.90,1850.43,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,inpatient,,,227.60000,216.22000,Amish/Mennonite,Amish Mennonite,90,125.18,,,,,,,125.18,220.77,percent of total billed charges,
"FRAGILE X SYNDROME, MOL ANALYS (FXS) SO",66159,CDM,300,RC,81243,CPT,,,facility,outpatient,,,227.60000,216.22000,Amish/Mennonite,Amish Mennonite,90,125.18,,,,,,,54.46,2682.34,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,inpatient,,,461.00000,437.95000,Amish/Mennonite,Amish Mennonite,90,253.55,,,,,,,253.55,447.17,percent of total billed charges,
ALDOSTERONE SERUM SO-TECH,66160,CDM,300,RC,82088,CPT,,,facility,outpatient,,,461.00000,437.95000,Amish/Mennonite,Amish Mennonite,90,253.55,,,,,,,42.11,2122.08,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,90,136.95,,,,,,,136.95,241.53,percent of total billed charges,
RENIN ACTIVITY PLASMA-TECH,66161,CDM,300,RC,84244,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,90,136.95,,,,,,,22.72,1154.38,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,inpatient,,,630.00000,598.50000,Amish/Mennonite,Amish Mennonite,,346.50,,,,,,,346.50,611.10,percent of total billed charges,
SEROTONON SO-TECH,66162,CDM,300,RC,86022,CPT,,,facility,outpatient,,,630.00000,598.50000,Amish/Mennonite,Amish Mennonite,,346.50,,,,,,,18.37,967.70,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
"CANDIDA SPP, AMPLIFIED PROBE - TECH",66163,CDM,300,RC,87481,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,35.09,1833.46,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,inpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,90,325.05,,,,,,,325.05,573.27,percent of total billed charges,
"CUTANEOUS IMM, AB ADDL-TECH",66164,CDM,300,RC,88350,CPT,,,facility,outpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,90,325.05,,,,,,,295.50,4462.27,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,inpatient,,,148.10000,140.70000,Amish/Mennonite,Amish Mennonite,90,81.45,,,,,,,81.45,143.66,percent of total billed charges,
"CARBAMAZEPINE, TOTAL SO-TECH",66165,CDM,300,RC,80156,CPT,,,facility,outpatient,,,148.10000,140.70000,Amish/Mennonite,Amish Mennonite,90,81.45,,,,,,,15.06,763.98,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,inpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,13.20,23.28,percent of total billed charges,
ALLERGEN SINGLE 1-TECH,66166,CDM,300,RC,86003,CPT,,,facility,outpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,24.20,42.68,percent of total billed charges,
ALLERGEN SINGLE 2-TECH,66167,CDM,300,RC,,,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,22.00,42.68,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,inpatient,,,1743.00000,1655.85000,Amish/Mennonite,Amish Mennonite,,958.65,,,,,,,958.65,1690.71,percent of total billed charges,
NERVE BIOPSY CMPLX-TECH,66168,CDM,300,RC,88356,CPT,,,facility,outpatient,,,1743.00000,1655.85000,Amish/Mennonite,Amish Mennonite,,958.65,,,,,,,50.73,11449.71,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,inpatient,,,230.50000,218.98000,Amish/Mennonite,Amish Mennonite,90,126.78,,,,,,,126.78,223.59,percent of total billed charges,
HEPATITIS E AB IGM SO-TECH,66169,CDM,300,RC,86790,CPT,,,facility,outpatient,,,230.50000,218.98000,Amish/Mennonite,Amish Mennonite,90,126.78,,,,,,,45.08,679.08,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,inpatient,,,299.70000,284.71000,Amish/Mennonite,Amish Mennonite,90,164.84,,,,,,,164.84,290.71,percent of total billed charges,
PLATELET ANTIBODY SCREEN SO-TECH,66170,CDM,300,RC,86022,CPT,,,facility,outpatient,,,299.70000,284.71000,Amish/Mennonite,Amish Mennonite,90,164.84,,,,,,,18.98,967.70,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 18MM 11FR 110CM TRFLW 3.5CM VLVPL,66172,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 20MM 11FR 110CM TRFLW 3.5CM VLVPL,66173,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2282.18,4517.77,percent of total billed charges,
CATHETER PRFSN 26MM 16FR 110CM TRFLW 3.5CM VLVPL,66174,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2137.79,4657.50,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 3DRC CRV 6FR 100CM COR FEM VESTAN,66177,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO MPA1 CRV 6FR 100CM FEM PU CRDS,66178,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO STRG PGTL CRV 6FR 110CM VNTRC.,66179,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 65CM,66180,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO IM CRV 6FR 100CM FEM PU CRDS ST+,66181,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 8MM,66183,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 2.0X12MM.,66184,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 8MM MN-TREK,66185,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM COR CROSSFLEX2 TNG TREK,66186,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.0X12MM,66187,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 10.2FR 40CM,66189,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 14FR 40CM,66190,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,130.90,285.19,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.75 CRV 6FR 100CM COR NYL LNCHR,66192,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.80000,534.66000,Amish/Mennonite,Amish Mennonite,,309.54,,,,,,,275.77,545.92,percent of total billed charges,
INTRO CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ,66194,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.80000,534.66000,Amish/Mennonite,Amish Mennonite,,309.54,,,,,,,258.33,562.80,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM 6FR 21GA 10CM SS HDRPH,66195,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,104.14,226.88,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,188.29,372.73,percent of total billed charges,
INTRO SHTH .038IN LG 16FR 30CM CKFL PRFRMR 42CM,66196,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,176.38,384.26,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,14.70,29.10,percent of total billed charges,
INTRO SHTH .038IN 5FR 23CM TRNSPT FSTCTH HMSTS,66197,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,13.77,30.00,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA8-16MM CATH L80CM INTRO SHTH 8FR 0.035IN,66204,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5039.91,10980.20,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,inpatient,,,196.50000,186.67000,Amish/Mennonite,Amish Mennonite,90,108.08,,,,,,,108.08,190.60,percent of total billed charges,
ALPHA-GLOBIN GENE ANALYSIS (ATHAL) SO,66207,CDM,300,RC,81269,CPT,,,facility,outpatient,,,196.50000,186.67000,Amish/Mennonite,Amish Mennonite,90,108.08,,,,,,,98.25,9523.86,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,inpatient,,,440.20000,418.19000,Amish/Mennonite,Amish Mennonite,90,242.11,,,,,,,242.11,426.99,percent of total billed charges,
ARSENIC FRACTION SO-TECH,66208,CDM,300,RC,82175,CPT,,,facility,outpatient,,,440.20000,418.19000,Amish/Mennonite,Amish Mennonite,90,242.11,,,,,,,19.60,984.66,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,90,83.60,,,,,,,83.60,147.44,percent of total billed charges,
ANTIMULLERIAN HORMONE SO-TECH,66209,CDM,300,RC,82166,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,90,83.60,,,,,,,76.00,241.38,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,90.03,158.79,percent of total billed charges,
AML FISH PR SO-TECH,66211,CDM,300,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,20.36,1120.45,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
CULTURE MYCOBACTERIAL DEF ID EA  -TECH,66212,CDM,300,RC,87118,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,14.61,679.08,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,inpatient,,,569.00000,540.55000,Amish/Mennonite,Amish Mennonite,,312.95,,,,,,,312.95,551.93,percent of total billed charges,
"MUMPS VIRUS, PCR SO-TECH",66213,CDM,300,RC,87798,CPT,,,facility,outpatient,,,569.00000,540.55000,Amish/Mennonite,Amish Mennonite,,312.95,,,,,,,35.09,1833.46,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,inpatient,,,216.20000,205.39000,Amish/Mennonite,Amish Mennonite,90,118.91,,,,,,,118.91,209.71,percent of total billed charges,
BABESIA MICROTI IGG AB SO-TECH,66221,CDM,300,RC,86753,CPT,,,facility,outpatient,,,216.20000,205.39000,Amish/Mennonite,Amish Mennonite,90,118.91,,,,,,,8.17,645.08,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,inpatient,,,383.80000,364.61000,Amish/Mennonite,Amish Mennonite,,211.09,,,,,,,211.09,372.29,percent of total billed charges,
ARGININE VASSOPRESSIN  SO-TECH,66223,CDM,300,RC,84588,CPT,,,facility,outpatient,,,383.80000,364.61000,Amish/Mennonite,Amish Mennonite,,211.09,,,,,,,33.94,1765.53,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,inpatient,,,220.40000,209.38000,Amish/Mennonite,Amish Mennonite,90,121.22,,,,,,,121.22,213.79,percent of total billed charges,
ALK REAR PRB SO-TECH,66224,CDM,300,RC,88271,CPT,,,facility,outpatient,,,220.40000,209.38000,Amish/Mennonite,Amish Mennonite,90,121.22,,,,,,,20.36,1120.45,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,inpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,248.05,437.47,percent of total billed charges,
T CELLS-TECH,66226,CDM,300,RC,86359,CPT,,,facility,outpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,37.73,1969.25,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,90,112.20,,,,,,,112.20,197.88,percent of total billed charges,
HEMOGLOBIN FRAC/QUANT CHROMATOGRAPHY SO,66227,CDM,300,RC,83021,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,90,112.20,,,,,,,18.66,950.66,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,90,900.35,,,,,,,900.35,1587.89,percent of total billed charges,
RCR/ABL1 GENE MINOR SO,66228,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,90,900.35,,,,,,,149.66,7571.58,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,inpatient,,,1818.00000,1727.10000,Amish/Mennonite,Amish Mennonite,90,999.90,,,,,,,999.90,1763.46,percent of total billed charges,
RCR/ABL1 GENE OTHR SO,66229,CDM,300,RC,81208,CPT,,,facility,outpatient,,,1818.00000,1727.10000,Amish/Mennonite,Amish Mennonite,90,999.90,,,,,,,175.54,10101.09,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,inpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,273.46,482.28,percent of total billed charges,
JC POLYOMA VIRUS DNA-TECH,66230,CDM,300,RC,87799,CPT,,,facility,outpatient,,,497.20000,472.34000,Amish/Mennonite,Amish Mennonite,90,273.46,,,,,,,44.27,2240.90,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,inpatient,,,102.40000,97.28000,Amish/Mennonite,Amish Mennonite,90,56.32,,,,,,,56.32,99.33,percent of total billed charges,
"CULTURE, YERSINIA SO -TECH",66231,CDM,300,RC,87046,CPT,,,facility,outpatient,,,102.40000,97.28000,Amish/Mennonite,Amish Mennonite,90,56.32,,,,,,,3.40,492.33,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,inpatient,,,156.70000,148.86000,Amish/Mennonite,Amish Mennonite,90,86.19,,,,,,,86.19,152.00,percent of total billed charges,
IMMUNOGLOBULIN SUBCLASS IGG4 SO-TECH,66232,CDM,300,RC,82787,CPT,,,facility,outpatient,,,156.70000,148.86000,Amish/Mennonite,Amish Mennonite,90,86.19,,,,,,,5.90,424.40,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,inpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,90,90.75,,,,,,,90.75,160.05,percent of total billed charges,
"ANGIOTENSIN CONVERTING ENZYME, CSF (FACEC) SO",66233,CDM,300,RC,82164,CPT,,,facility,outpatient,,,165.00000,156.75000,Amish/Mennonite,Amish Mennonite,90,90.75,,,,,,,15.09,763.98,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
ADDITIONAL KARYOTYPES,66235,CDM,300,RC,88280,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,33.47,1578.85,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,TC,1394.80,,,,,,,1394.80,2459.92,percent of total billed charges,
XR ENDOVASCULAR TAA PROX EXT,66236,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,TC,1394.80,,,,,,,990.94,2459.92,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,inpatient,1,mL,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.43,2.52,percent of total billed charges,
VANCOMYCIN LIQ 25 MG/ML,66238,CDM,250,RC,65628-0204-05,NDC,,,facility,outpatient,1,mL,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.30,2.52,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,inpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,392.70,692.58,percent of total billed charges,
US CLIP PLACE LYMPH NODE BX LEFT,66239,CDM,360,RC,38999,CPT,,,facility,outpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,392.70,5858.00,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,inpatient,,,2201.00000,2090.95000,Amish/Mennonite,Amish Mennonite,,1210.55,,,,,,,1210.55,2134.97,percent of total billed charges,
BRONCH TRANSBRONCH BX SGL LOBE - RT CHARGE BRONCHOSCOPY,66240,CDM,360,RC,31628,CPT,,,facility,outpatient,,,2201.00000,2090.95000,Amish/Mennonite,Amish Mennonite,,1210.55,,,,,,,1210.55,7803.00,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,inpatient,,,248.10000,235.70000,Amish/Mennonite,Amish Mennonite,90,136.46,,,,,,,136.46,240.66,percent of total billed charges,
"COBALT, SERUM (80084) SO",66241,CDM,300,RC,83018,CPT,,,facility,outpatient,,,248.10000,235.70000,Amish/Mennonite,Amish Mennonite,90,136.46,,,,,,,22.69,1154.38,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
FENTANYL 20 MCG/ML SOLN,66244,CDM,250,RC,J3010,HCPCS,0040990941802000,NDC,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.58,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,inpatient,1,mL,3285.02000,3120.77000,Amish/Mennonite,Amish Mennonite,,1806.76,,,,,,,1806.76,3186.47,percent of total billed charges,
CEMIPLIMAB-RWLC SOLN 50 MG/ML 7 ML,66246,CDM,636,RC,J9119,HCPCS,61755000801,NDC,facility,outpatient,1,mL,3285.02000,3120.77000,Amish/Mennonite,Amish Mennonite,,1806.76,,,,,,,28.70,3186.47,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,inpatient,,,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,90,27.11,,,,,,,27.11,47.82,percent of total billed charges,
DIHYDROTESTOSTERONE (DHTS) SO,66249,CDM,300,RC,82642,CPT,,,facility,outpatient,,,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,90,27.11,,,,,,,24.65,1527.89,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
ENTAMOEBA HISTOL SO-TECH,66250,CDM,300,RC,86753,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,8.17,645.08,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,83.98,148.12,percent of total billed charges,
AUTOIMMUNE DYS SO-TECH,66251,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,18.40,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,,80.52,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT  SO-TECH,66252,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,,80.52,,,,,,,17.27,814.87,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,,87.78,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMMUNE DYST ISLET SO-TECH,66253,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,,87.78,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.30000,129.49000,Amish/Mennonite,Amish Mennonite,90,74.97,,,,,,,74.97,132.21,percent of total billed charges,
AUTOIMMUNE DYST FLURO AB SO-TECH,66254,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.30000,129.49000,Amish/Mennonite,Amish Mennonite,90,74.97,,,,,,,12.45,1539.22,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,90,72.05,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,90,72.05,,,,,,,14.99,780.94,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
DIPH AB SO-TECH,66255,CDM,300,RC,86317,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,14.99,780.94,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,inpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,133.10,234.74,percent of total billed charges,
DIABETES INSUL AB SO-TECH,66256,CDM,300,RC,86337,CPT,,,facility,outpatient,,,242.00000,229.90000,Amish/Mennonite,Amish Mennonite,,133.10,,,,,,,21.41,1120.45,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,83.98,148.12,percent of total billed charges,
DIABET GAD65 AB SO-TECH,66257,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,18.40,865.84,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,,87.78,,,,,,,87.78,154.81,percent of total billed charges,
DIABETES ISLET SO-TECH,66258,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,,87.78,,,,,,,19.88,1103.49,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOCOCCUS ADDL AG-TECH,66259,CDM,300,RC,87899,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,16.07,763.98,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,32.12,56.65,percent of total billed charges,
CREATININE DIS PANEL OTH SO-TECH,66260,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,5.35,271.65,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,inpatient,,,52.40000,49.78000,Amish/Mennonite,Amish Mennonite,90,28.82,,,,,,,28.82,50.83,percent of total billed charges,
ASSAY OF CREATINE SO-TECH,66261,CDM,300,RC,82540,CPT,,,facility,outpatient,,,52.40000,49.78000,Amish/Mennonite,Amish Mennonite,90,28.82,,,,,,,4.79,237.65,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
CREAT DIS PANEL CCQNT SO-TECH,66262,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,24.89,1137.41,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,775.50,1367.70,percent of total billed charges,
METAPHASES 1-20 SO-TECH,66263,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,129.67,6518.98,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,inpatient,,,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,90,427.35,,,,,,,427.35,753.69,percent of total billed charges,
AG-NOR/CBL STAIN SO-TECH,66264,CDM,300,RC,88283,CPT,,,facility,outpatient,,,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,90,427.35,,,,,,,70.88,3582.03,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,inpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092111450,NDC,facility,outpatient,1,mL,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.14409,0.67900,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,inpatient,1,mL,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.56650,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092128735,NDC,facility,outpatient,1,mL,1.03000,0.97000,Amish/Mennonite,Amish Mennonite,,0.56650,,,,,,,0.14409,0.99910,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,inpatient,1,mL,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.96250,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928674,NDC,facility,outpatient,1,mL,1.75000,1.67000,Amish/Mennonite,Amish Mennonite,,0.96250,,,,,,,0.14409,1.70,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,inpatient,1,mL,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,70092928735,NDC,facility,outpatient,1,mL,1.33000,1.27000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.14409,1.29,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,inpatient,1,mL,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
HYDROMORPHONE PCA 0.2 MG/ML 50 ML,66265,CDM,250,RC,J1171,HCPCS,71266911003,NDC,facility,outpatient,1,mL,1.12000,1.06000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.14409,1.09,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,,32.12,,,,,,,32.12,56.65,percent of total billed charges,
ALBUMIN CSF SO-TECH,66267,CDM,300,RC,82042,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,,32.12,,,,,,,7.27,373.51,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,inpatient,,,135.40000,128.63000,Amish/Mennonite,Amish Mennonite,,74.47,,,,,,,74.47,131.34,percent of total billed charges,
IMMUNODIFFUSION EA AG ANTIBODY SO-TECH,66268,CDM,300,RC,86331,CPT,,,facility,outpatient,,,135.40000,128.63000,Amish/Mennonite,Amish Mennonite,,74.47,,,,,,,11.98,628.12,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,inpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,TC,503.80,,,,,,,503.80,888.52,percent of total billed charges,
ELASTOGRAPHY-TECH,66272,CDM,402,RC,76981,CPT,,,facility,outpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,TC,503.80,,,,,,,384.16,888.52,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,inpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,366.85,646.99,percent of total billed charges,
US FINE NEEDLE ASP ADD'L-TECH,66273,CDM,402,RC,10006,CPT,,,facility,outpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,333.50,646.99,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,inpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,548.35,967.09,percent of total billed charges,
US FINE NEEDLE ASP 1ST -TECH,66274,CDM,402,RC,10005,CPT,,,facility,outpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,384.16,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,inpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,366.85,646.99,percent of total billed charges,
MRI FINE NEEDLE ASP ADD'L-TECH,66275,CDM,614,RC,10012,CPT,,,facility,outpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,333.50,2161.00,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,inpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,548.35,967.09,percent of total billed charges,
MRI FINE NEEDLE ASP 1ST-TECH,66276,CDM,614,RC,10011,CPT,,,facility,outpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,498.50,2161.00,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,inpatient,,,2025.00000,1923.75000,Amish/Mennonite,Amish Mennonite,,1113.75,,,,,,,1113.75,1964.25,percent of total billed charges,
CT FINE NEEDLE ASP ADD'L-TECH,66277,CDM,350,RC,10010,CPT,,,facility,outpatient,,,2025.00000,1923.75000,Amish/Mennonite,Amish Mennonite,,1113.75,,,,,,,1012.50,1964.25,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,inpatient,,,4212.00000,4001.40000,Amish/Mennonite,Amish Mennonite,,2316.60,,,,,,,2316.60,4085.64,percent of total billed charges,
PICC LINE UNDER 5YRS-TECH,66278,CDM,320,RC,36572,CPT,,,facility,outpatient,,,4212.00000,4001.40000,Amish/Mennonite,Amish Mennonite,,2316.60,,,,,,,542.77,4085.64,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,inpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,366.85,646.99,percent of total billed charges,
XR FINE NEEDLE ASP ADD'L-TECH,66279,CDM,320,RC,10008,CPT,,,facility,outpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,333.50,646.99,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,inpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,548.35,967.09,percent of total billed charges,
XR FINE NEEDLE ASP -TECH,66280,CDM,320,RC,10007,CPT,,,facility,outpatient,,,997.00000,947.15000,Amish/Mennonite,Amish Mennonite,,548.35,,,,,,,498.50,967.09,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1378.12,2728.12,percent of total billed charges,
CATHETER EP 20MM ACHV ADV MP.,66281,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1290.94,2812.50,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
CRYPTOSPORIDIUM,66283,CDM,300,RC,87328,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,13.82,645.08,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 14FR 18GA 25CM ULTHNE HDRPH MCLC 6,66284,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,128.32,279.56,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.25MM COR CROSSFLX2 TUNG TREK,66289,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,31.90,56.26,percent of total billed charges,
EASTERN EQUINE ENCEPHALITIS ANTIBODY SO,66290,CDM,300,RC,86652,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,8.17,696.05,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
ISOSORBIDE DINITRATE 2.5 MG TAB,66291,CDM,250,RC,00781-1635-01-00050,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,139.74,276.63,percent of total billed charges,
CATHETER DRNGE BILI 12FR 40CM,66292,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,285.19000,270.93000,Amish/Mennonite,Amish Mennonite,,156.85,,,,,,,130.90,285.19,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,inpatient,1,EA,1.54000,1.47000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.84700,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,00228-2631-11,NDC,,,facility,outpatient,1,EA,1.54000,1.47000,Amish/Mennonite,Amish Mennonite,,0.84700,,,,,,,0.77000,1.49,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,inpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
ISOSORBIDE MONONITRATE 10 MG TAB,66293,CDM,250,RC,62175-0106-01,NDC,,,facility,outpatient,1,EA,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,31.90,56.26,percent of total billed charges,
CALIFORNIA VIRUS (LA CROSSE) ENCEPHALITIS ANTIBODY SO,66294,CDM,300,RC,86651,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,8.17,696.05,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP VS1 5FR 80CM,66295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,inpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
INDAPAMIDE 0.625 MG TAB,66296,CDM,250,RC,00228-2571-11-00025,NDC,,,facility,outpatient,1,EA,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
DNA PROBE FOR B-CELL LYMPHOMA,66297,CDM,300,RC,88271,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,20.36,1120.45,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,inpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5 ML SUSP,66298,CDM,250,RC,62175-0107-01-00025,NDC,,,facility,outpatient,1,EA,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,0.24250,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,inpatient,,,640.00000,608.00000,Amish/Mennonite,Amish Mennonite,TC,352.00,,,,,,,352.00,620.80,percent of total billed charges,
US OB FETAL MIDDLE CEREBRAL ARTERY,66300,CDM,402,RC,76821,CPT,,,facility,outpatient,,,640.00000,608.00000,Amish/Mennonite,Amish Mennonite,TC,352.00,,,,,,,320.00,620.80,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,inpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.46200,0.81480,percent of total billed charges,
LEVOTHYROXINE TAB 62.5 MCG (0.0625 MG),66302,CDM,250,RC,J8499,HCPCS,5107904432000050,NDC,facility,outpatient,1,EA,0.84000,0.80000,Amish/Mennonite,Amish Mennonite,,0.46200,,,,,,,0.42000,0.81480,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,44.12000,41.91000,Amish/Mennonite,Amish Mennonite,,24.27,,,,,,,21.62,42.80,percent of total billed charges,
SIZER GFT SM 5-24MM PLS MPK LF DISP  EA= BX10 EA,66304,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,44.12000,41.91000,Amish/Mennonite,Amish Mennonite,,24.27,,,,,,,20.25,44.12,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
LAMOTRIGINE 50 MG TAB,66306,CDM,250,RC,51079-0499-20-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,inpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.97350,1.72,percent of total billed charges,
LEVOTHYROXINE TAB 12.5 MCG (0.0125 MG),66308,CDM,250,RC,J8499,HCPCS,0007443419000050,NDC,facility,outpatient,1,EA,1.77000,1.68000,Amish/Mennonite,Amish Mennonite,,0.97350,,,,,,,0.88500,1.72,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,90,79.20,,,,,,,79.20,139.68,percent of total billed charges,
WEST NILE VIRUS ANTIBODY SO,66309,CDM,300,RC,86788,CPT,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,90,79.20,,,,,,,8.17,882.80,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,inpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
LOSARTAN 6.25 MG TAB,66310,CDM,250,RC,63739-0673-10-00025,NDC,,,facility,outpatient,1,EA,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,0064161270100500,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,inpatient,1,mL,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.72050,1.27,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092112735,NDC,facility,outpatient,1,mL,1.31000,1.24000,Amish/Mennonite,Amish Mennonite,,0.72050,,,,,,,0.65500,7.69,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,inpatient,1,mL,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.61600,1.09,percent of total billed charges,
MORPHINE PCA 1 MG/ML 50 ML,66311,CDM,250,RC,J2270,HCPCS,70092152235,NDC,facility,outpatient,1,mL,1.12000,1.07000,Amish/Mennonite,Amish Mennonite,,0.61600,,,,,,,0.56000,7.69,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
LEVETIRACETAM 125 MG TAB,66312,CDM,250,RC,63739-0411-10-00025,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,00456-1410-30-00025,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,inpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
NEBIVOLOL 2.5 MG TAB,66314,CDM,250,RC,43547-0524-03,NDC,,,facility,outpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XR VENOGRAM IVC,66315,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,361.82,17311.25,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
METFORMIN 250 MG TAB,66316,CDM,250,RC,63739-0640-10-00050,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,inpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,182.60,322.04,percent of total billed charges,
US BIOPSY RENAL,66320,CDM,402,RC,50200,CPT,,,facility,outpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,166.00,1692.33,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT PERIPH L79MM DIA11-16MM CATH L80CM INTRO 8FR 0.035IN,66321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5039.91,10980.20,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
ONDANSETRON TAB 2 MG,66322,CDM,250,RC,J8499,HCPCS,0090465526100025,NDC,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,31.90,56.26,percent of total billed charges,
ST. LOUIS ENCEPHALITIS ANTIBODY SO,66323,CDM,300,RC,86653,CPT,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,90,31.90,,,,,,,8.17,696.05,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
"O AND P,ROUTINE (GIARDIA ONLY)",66329,CDM,300,RC,87329,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,11.98,628.12,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
LABETALOL 25 MG TAB,66331,CDM,250,RC,60687-0114-01-00025,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2810.00000,2669.50000,Amish/Mennonite,Amish Mennonite,90,1545.50,,,,,,,1545.50,2725.70,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, POC SO-TECH",66332,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2810.00000,2669.50000,Amish/Mennonite,Amish Mennonite,90,1545.50,,,,,,,608.00,54562.77,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,inpatient,,,2066.00000,1962.70000,Amish/Mennonite,Amish Mennonite,90,1136.30,,,,,,,1136.30,2004.02,percent of total billed charges,
"CHROMOSOMAL MICROARRAY, CONGENITAL (CMACB) SO",66333,CDM,300,RC,81229,CPT,,,facility,outpatient,,,2066.00000,1962.70000,Amish/Mennonite,Amish Mennonite,90,1136.30,,,,,,,608.00,54562.77,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,inpatient,,,214.70000,203.96000,Amish/Mennonite,Amish Mennonite,90,118.08,,,,,,,118.08,208.26,percent of total billed charges,
CHRMSM ANALY ADDL CELLS COUNTED-TECH,66334,CDM,300,RC,88285,CPT,,,facility,outpatient,,,214.70000,203.96000,Amish/Mennonite,Amish Mennonite,90,118.08,,,,,,,26.72,1273.27,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,inpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,775.50,1367.70,percent of total billed charges,
"METAPHASES, >20 SO -TECH",66335,CDM,300,RC,88262,CPT,,,facility,outpatient,,,1410.00000,1339.50000,Amish/Mennonite,Amish Mennonite,90,775.50,,,,,,,129.67,6518.98,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,inpatient,,,157.60000,149.72000,Amish/Mennonite,Amish Mennonite,90,86.68,,,,,,,86.68,152.87,percent of total billed charges,
HIV-1 CONFIRM DIFF SO-TECH,66338,CDM,300,RC,86701,CPT,,,facility,outpatient,,,157.60000,149.72000,Amish/Mennonite,Amish Mennonite,90,86.68,,,,,,,9.19,458.40,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,inpatient,,,152.80000,145.16000,Amish/Mennonite,Amish Mennonite,90,84.04,,,,,,,84.04,148.22,percent of total billed charges,
HIV-2 CONFIRM DIFF SO-TECH,66339,CDM,300,RC,86702,CPT,,,facility,outpatient,,,152.80000,145.16000,Amish/Mennonite,Amish Mennonite,90,84.04,,,,,,,13.97,713.01,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,inpatient,,,208.80000,198.36000,Amish/Mennonite,Amish Mennonite,90,114.84,,,,,,,114.84,202.54,percent of total billed charges,
PROTEIN WESTERN BLOT BLOOD/OTH SO-TECH,66340,CDM,300,RC,86317,CPT,,,facility,outpatient,,,208.80000,198.36000,Amish/Mennonite,Amish Mennonite,90,114.84,,,,,,,15.49,780.94,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,inpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,90,95.70,,,,,,,95.70,168.78,percent of total billed charges,
IMMUNOASSAY INFECT AGENT PRION SO-TECH,66341,CDM,300,RC,86317,CPT,,,facility,outpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,90,95.70,,,,,,,15.49,780.94,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,,224.07,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,,224.07,,,,,,,203.70,3727.42,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
AMPLIFIED PROBE EA ORGANISM PRION SO-TECH,66342,CDM,300,RC,0035U,HCPCS,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,203.70,3727.42,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,90,83.98,,,,,,,83.98,148.12,percent of total billed charges,
MYASTHENIA GRAVIS ACH R BIND SO-TECH,66343,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,90,83.98,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT SO-TECH,66344,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,17.85,814.87,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,inpatient,,,153.10000,145.44000,Amish/Mennonite,Amish Mennonite,90,84.20,,,,,,,84.20,148.51,percent of total billed charges,
MYASTHENIA GRAVIS CAL CBA SO-TECH,66345,CDM,300,RC,83519,CPT,,,facility,outpatient,,,153.10000,145.44000,Amish/Mennonite,Amish Mennonite,90,84.20,,,,,,,19.00,865.84,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
IMMUNOASSAY ANALYTE QNT MG STRIAT AB SO-TECH,66347,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,17.85,814.87,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
SLP FIBEROPTIC SWALLOW-TECH,66348,CDM,440,RC,92613,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,26.50,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, PRE-LING-TECH",66349,CDM,440,RC,92630,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,126.65,264.00,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,145.20,256.08,percent of total billed charges,
"SLP AUDITORY REHAB, POST-LING-TECH",66350,CDM,440,RC,92633,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,126.65,264.00,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,inpatient,,,257.80000,244.91000,Amish/Mennonite,Amish Mennonite,90,141.79,,,,,,,141.79,250.07,percent of total billed charges,
17 HYDROXYPREGNENOLONE SO-TECH,66351,CDM,300,RC,84143,CPT,,,facility,outpatient,,,257.80000,244.91000,Amish/Mennonite,Amish Mennonite,90,141.79,,,,,,,23.57,1188.38,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,inpatient,,,149.40000,141.93000,Amish/Mennonite,Amish Mennonite,,82.17,,,,,,,82.17,144.92,percent of total billed charges,
DIHYDROTESTOSTERONE DHT SO-TECH,66352,CDM,300,RC,82642,CPT,,,facility,outpatient,,,149.40000,141.93000,Amish/Mennonite,Amish Mennonite,,82.17,,,,,,,29.28,1527.89,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,inpatient,,,101.90000,96.81000,Amish/Mennonite,Amish Mennonite,90,56.05,,,,,,,56.05,98.84,percent of total billed charges,
T4 FREE BY DIALYSIS SO-TECH,66353,CDM,300,RC,84439,CPT,,,facility,outpatient,,,101.90000,96.81000,Amish/Mennonite,Amish Mennonite,90,56.05,,,,,,,9.32,475.37,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,inpatient,,,131.80000,125.21000,Amish/Mennonite,Amish Mennonite,90,72.49,,,,,,,72.49,127.85,percent of total billed charges,
"LIPOPROTEIN (A), SERUM SO-TECH",66354,CDM,300,RC,83695,CPT,,,facility,outpatient,,,131.80000,125.21000,Amish/Mennonite,Amish Mennonite,90,72.49,,,,,,,14.80,679.08,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,90,114.95,,,,,,,114.95,202.73,percent of total billed charges,
CLOZAPINE SO-TECH,66355,CDM,300,RC,80159,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,90,114.95,,,,,,,20.18,967.70,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3622.50000,3441.38000,Amish/Mennonite,Amish Mennonite,,1992.38,,,,,,,1775.03,3513.82,percent of total billed charges,
MCTH INFS .016IN BERN 2.4FR .027IN 130CM NTNL,66357,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3622.50000,3441.38000,Amish/Mennonite,Amish Mennonite,,1992.38,,,,,,,1662.73,3622.50,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER MP 3MM SPC DF CRV 8FR 105CM ADVISOR HD,66358,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,3958.88,8625.00,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DIA18MM CONTRALATERAL LEG FOR AAA,66359,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1379.00000,1310.05000,Amish/Mennonite,Amish Mennonite,,758.45,,,,,,,758.45,1337.63,percent of total billed charges,
CHG-ID BY SEQUENCING MBSEQO,66360,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1379.00000,1310.05000,Amish/Mennonite,Amish Mennonite,,758.45,,,,,,,115.36,6026.72,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE VASC J CRV FLT .014IN 185CM GLYDX PTFE,66362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2287.50000,2173.12000,Amish/Mennonite,Amish Mennonite,,1258.12,,,,,,,1120.88,2218.88,percent of total billed charges,
SHEATH CATH 180D 7FR 55CM HDRPH TOURGUIDE 9MM.,66363,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2287.50000,2173.12000,Amish/Mennonite,Amish Mennonite,,1258.12,,,,,,,1049.96,2287.50,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,inpatient,,,339.20000,322.24000,Amish/Mennonite,Amish Mennonite,90,186.56,,,,,,,186.56,329.02,percent of total billed charges,
"FATTY ACID PROFILE, COMPREHENSIVE (FAPCP) SO",66367,CDM,300,RC,82725,CPT,,,facility,outpatient,,,339.20000,322.24000,Amish/Mennonite,Amish Mennonite,90,186.56,,,,,,,18.72,882.80,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,66368,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,inpatient,,,3791.00000,3601.45000,Amish/Mennonite,Amish Mennonite,,2085.05,,,,,,,1857.59,3677.27,percent of total billed charges,
NM CERETEC WBC 1MCI,66372,CDM,278,RC,A9569,HCPCS,,,facility,outpatient,,,3791.00000,3601.45000,Amish/Mennonite,Amish Mennonite,,2085.05,,,,,,,1040.32,3791.00,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,inpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CLONAZEPAM 0.5 MG TAB,66375,CDM,250,RC,50268-0609-15-00050,NDC,,,facility,outpatient,1,EA,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
OLANZAPINE 1.25 MG TAB,66377,CDM,250,RC,00536-4076-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1533.19000,1456.53000,Amish/Mennonite,Amish Mennonite,,843.25,,,,,,,751.26,1487.19,percent of total billed charges,
ATCH ROD MR CONDITIONAL NS LG MLPN CLP,66381,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1533.19000,1456.53000,Amish/Mennonite,Amish Mennonite,,843.25,,,,,,,703.73,1533.19,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER OMNI FLSH 5FRX70CMX1CM,66398,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,246.14,536.25,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO .035IN OM FLSH CRV 5FR 100CM ACVU,66399,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,246.14,536.25,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,297.55,524.77,percent of total billed charges,
NM IV DRUG INJ,66402,CDM,340,RC,79101,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,212.82,1232.72,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH 7FR 5.5CM EVAS CRDS AVNT+ PED KINK,66403,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,14.54,31.68,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,104.76,percent of total billed charges,
"OT PROSTHETIC MANAGEMENT, TRAIN UNITS",66406,CDM,430,RC,97761,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,54.00,264.00,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SIMETHICONE 40 MG TAB-CHEW,66407,CDM,250,RC,63739-0225-10-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,,1247.95,,,,,,,1247.95,2200.93,percent of total billed charges,
US OB FETAL CARDIAC COMPLETE,66409,CDM,402,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,,1247.95,,,,,,,384.16,3015.65,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,90,85.80,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1-ANTITRYPSIN FECES (A1AF) SO,66414,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,90,85.80,,,,,,,13.89,696.05,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM A FLDR,66417,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4481.55000,4257.47000,Amish/Mennonite,Amish Mennonite,,2464.85,,,,,,,2195.96,4347.10,percent of total billed charges,
SHUNT CV T 2.67MM 31CM PRUITT F3 PLS OUTLYING,66418,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4481.55000,4257.47000,Amish/Mennonite,Amish Mennonite,,2464.85,,,,,,,2057.03,4481.55,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,inpatient,1,EA,0.19000,0.19000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
TRAZODONE 25 MG TAB,66419,CDM,250,RC,00904-6554-61-00050,NDC,,,facility,outpatient,1,EA,0.19000,0.19000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,inpatient,1,EA,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.22,3.91,percent of total billed charges,
PERPHENAZINE TAB 4 MG,66420,CDM,250,RC,J8499,HCPCS,00603506121,NDC,facility,outpatient,1,EA,4.03000,3.83000,Amish/Mennonite,Amish Mennonite,,2.22,,,,,,,2.02,3.91,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO 6FR 25CM COR SS HDRPH PTFE PNCL 2.5,66421,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,42.23,92.00,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,inpatient,1,mL,8.95000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.92,8.68,percent of total billed charges,
FAMOTIDINE POWD SUSP 20 MG/2.5 ML,66425,CDM,250,RC,J3490,HCPCS,6818001500100250,NDC,facility,outpatient,1,mL,8.95000,8.50000,Amish/Mennonite,Amish Mennonite,,4.92,,,,,,,4.47,8.68,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
NYSTATIN 100000 UNITS/ML SUSP,66426,CDM,250,RC,60432-0537-16-00100,NDC,,,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
POTASSIUM CHLORIDE 5 MEQ TAB,66427,CDM,250,RC,66758-0170-13-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,Amish/Mennonite,Amish Mennonite,,7672.50,,,,,,,6835.50,13531.50,percent of total billed charges,
VALVE AORT H17.8MM OD25MM ID23.4MM FLARE DIA26.4MM SEW RNG,66428,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,Amish/Mennonite,Amish Mennonite,,7672.50,,,,,,,6403.05,13950.00,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,826.88,1636.88,percent of total billed charges,
KIT SNR 20MM NTNL BARD 2 SHTH RTRVL KINK RST,66429,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,774.56,1687.50,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,967.50000,919.12000,Amish/Mennonite,Amish Mennonite,,532.12,,,,,,,474.07,938.48,percent of total billed charges,
CATH CV 0.62ML 5FR PLYR SL GRAV FLO RT 1245ML/HR,66430,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,967.50000,919.12000,Amish/Mennonite,Amish Mennonite,,532.12,,,,,,,444.08,967.50,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,1042.50000,990.38000,Amish/Mennonite,Amish Mennonite,,573.38,,,,,,,510.82,1011.23,percent of total billed charges,
TRAY CATH 981ML/HR 6FR PU PWRLN 2 LUM PWR INJ,66431,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,1042.50000,990.38000,Amish/Mennonite,Amish Mennonite,,573.38,,,,,,,478.51,1042.50,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONIX 035,66432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE TORAY 0.025 X 230CM,66433,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,335.64,731.25,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,inpatient,,,3336.00000,3169.20000,Amish/Mennonite,Amish Mennonite,,1834.80,,,,,,,1834.80,3235.92,percent of total billed charges,
EEG 41-60 MIN-TECH,66435,CDM,740,RC,95812,CPT,,,facility,outpatient,,,3336.00000,3169.20000,Amish/Mennonite,Amish Mennonite,,1834.80,,,,,,,295.69,3235.92,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,inpatient,,,3806.00000,3615.70000,Amish/Mennonite,Amish Mennonite,,2093.30,,,,,,,2093.30,3691.82,percent of total billed charges,
EEG OVER 1 HOUR-TECH,66436,CDM,740,RC,95813,CPT,,,facility,outpatient,,,3806.00000,3615.70000,Amish/Mennonite,Amish Mennonite,,2093.30,,,,,,,295.69,3691.82,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,inpatient,,,3508.00000,3332.60000,Amish/Mennonite,Amish Mennonite,,1929.40,,,,,,,1929.40,3402.76,percent of total billed charges,
EEG AWAKE & DROWSY-TECH,66437,CDM,740,RC,95816,CPT,,,facility,outpatient,,,3508.00000,3332.60000,Amish/Mennonite,Amish Mennonite,,1929.40,,,,,,,295.69,3402.76,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,inpatient,,,4320.00000,4104.00000,Amish/Mennonite,Amish Mennonite,TC,2376.00,,,,,,,2376.00,4190.40,percent of total billed charges,
EEG ROUTINE-TECH,66438,CDM,740,RC,95819,CPT,,,facility,outpatient,,,4320.00000,4104.00000,Amish/Mennonite,Amish Mennonite,TC,2376.00,,,,,,,2160.00,4190.40,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,inpatient,,,3612.00000,3431.40000,Amish/Mennonite,Amish Mennonite,TC,1986.60,,,,,,,1986.60,3503.64,percent of total billed charges,
EEG ASLEEP OR COMA-TECH,66439,CDM,740,RC,95822,CPT,,,facility,outpatient,,,3612.00000,3431.40000,Amish/Mennonite,Amish Mennonite,TC,1986.60,,,,,,,1806.00,3503.64,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,inpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,TC,179.85,,,,,,,179.85,317.19,percent of total billed charges,
EEG CEREBRAL DEATH ONLY-TECH,66440,CDM,740,RC,95824,CPT,,,facility,outpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,TC,179.85,,,,,,,163.50,317.19,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,inpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,,987.25,,,,,,,987.25,1741.15,percent of total billed charges,
EVOKED POTENTIAL - UPPER SOMATOSENSORY-TECH,66441,CDM,922,RC,95925,CPT,,,facility,outpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,,987.25,,,,,,,295.69,1741.15,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,inpatient,,,1586.00000,1506.70000,Amish/Mennonite,Amish Mennonite,TC,872.30,,,,,,,872.30,1538.42,percent of total billed charges,
EVOKED POTENTIAL - LOWER SOMATOSENSORY-TECH,66442,CDM,922,RC,95926,CPT,,,facility,outpatient,,,1586.00000,1506.70000,Amish/Mennonite,Amish Mennonite,TC,872.30,,,,,,,793.00,1538.42,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,inpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,TC,229.35,,,,,,,229.35,404.49,percent of total billed charges,
EEG HEMISPHERE FUNCTION (WADA)-TECH,66443,CDM,740,RC,95958,CPT,,,facility,outpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,TC,229.35,,,,,,,208.50,404.49,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,,1862.30,,,,,,,1862.30,3284.42,percent of total billed charges,
EVOKED POTENTIAL - UPPER AND LOWER SOMATOSENSORY-TECH,66444,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,,1862.30,,,,,,,503.83,3284.42,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,inpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,820.60,1447.24,percent of total billed charges,
VEP VISUAL EVOKED POTENTIAL-TECH,66445,CDM,740,RC,95930,CPT,,,facility,outpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,746.00,1447.24,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
EEG DURING NONINTRACRANIAL SURGERY-TECH,66446,CDM,740,RC,95955,CPT,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,inpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,,910.80,,,,,,,910.80,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN UPPER-TECH,66447,CDM,920,RC,95928,CPT,,,facility,outpatient,,,1656.00000,1573.20000,Amish/Mennonite,Amish Mennonite,,910.80,,,,,,,828.00,1606.32,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,inpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,,916.30,,,,,,,916.30,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKE POTEN LOWER-TECH,66448,CDM,740,RC,95929,CPT,,,facility,outpatient,,,1666.00000,1582.70000,Amish/Mennonite,Amish Mennonite,,916.30,,,,,,,503.83,1616.02,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,Amish/Mennonite,Amish Mennonite,,2417.80,,,,,,,2417.80,4264.12,percent of total billed charges,
CENTRAL MOTOR EVOKED POTEN UPPER/LOWER-TECH,66449,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,Amish/Mennonite,Amish Mennonite,,2417.80,,,,,,,966.05,4264.12,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,inpatient,1,EA,5074.51000,4820.79000,Amish/Mennonite,Amish Mennonite,,2790.98,,,,,,,2790.98,4922.27,percent of total billed charges,
PENTOSTATIN 10 MG POWD,66472,CDM,636,RC,J9268,HCPCS,00409080101,NDC,facility,outpatient,1,EA,5074.51000,4820.79000,Amish/Mennonite,Amish Mennonite,,2790.98,,,,,,,2537.26,4922.27,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT EVAR 8FR L40MM DIA9MM CATH L80CM CVR STR COVERA.,66474,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.10000,227.14000,Amish/Mennonite,Amish Mennonite,,131.50,,,,,,,117.16,231.93,percent of total billed charges,
GUIDEWIRE ORTH SPNE TI SXTNT BLNT DISP ROD INS,66475,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.10000,227.14000,Amish/Mennonite,Amish Mennonite,,131.50,,,,,,,109.75,239.10,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,inpatient,1,EA,3.52000,3.34000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.94,3.41,percent of total billed charges,
WARFARIN TAB 1.5 MG,66489,CDM,250,RC,00056-0188-75-00050,NDC,,,facility,outpatient,1,EA,3.52000,3.34000,Amish/Mennonite,Amish Mennonite,,1.94,,,,,,,1.76,3.41,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.68,4.72,percent of total billed charges,
WARFARIN TAB 3.75 MG,66490,CDM,250,RC,00056-0173-75-00050,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.44,4.72,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,inpatient,1,EA,52.04000,49.44000,Amish/Mennonite,Amish Mennonite,,28.62,,,,,,,28.62,50.48,percent of total billed charges,
VARICONAZOLE TAB 100MG,66491,CDM,250,RC,51079-0165-03-00050,NDC,,,facility,outpatient,1,EA,52.04000,49.44000,Amish/Mennonite,Amish Mennonite,,28.62,,,,,,,26.02,50.48,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,inpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.95,percent of total billed charges,
SOTALOL TAB 40MG,66492,CDM,250,RC,68084-0654-01-00050,NDC,,,facility,outpatient,1,EA,2.01000,1.91000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.00,1.95,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SODIUM CHLORIDE TAB 0.25 GM,66493,CDM,250,RC,00223-1760-01-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,inpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
LEVOTHYROXINE TAB 37.5 MCG (0.0375 MG),66497,CDM,250,RC,J8499,HCPCS,5107904412000050,NDC,facility,outpatient,1,EA,0.70000,0.67000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
LISINOPRIL TAB 1.25MG,66498,CDM,250,RC,68084-0765-25-00050,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,inpatient,1,EA,2.75000,2.62000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.51,2.67,percent of total billed charges,
METHENAMINE HIPPURATE TAB 0.5 MG,66499,CDM,250,RC,65862-0782-01-00050,NDC,,,facility,outpatient,1,EA,2.75000,2.62000,Amish/Mennonite,Amish Mennonite,,1.51,,,,,,,1.38,2.67,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
MONTELUKAST 5 MG TAB,66500,CDM,250,RC,50268-0575-15-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,inpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
METHYLPREDNISOLONE TAB 2MG,66501,CDM,250,RC,59746-0001-06-00050,NDC,,,facility,outpatient,1,EA,0.51000,0.48000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,inpatient,1,EA,8.15000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.48,7.91,percent of total billed charges,
NADOLOL TAB 10 MG,66502,CDM,250,RC,51079-0812-20-00050,NDC,,,facility,outpatient,1,EA,8.15000,7.74000,Amish/Mennonite,Amish Mennonite,,4.48,,,,,,,4.08,7.91,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L22CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,66503,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,389.87,849.38,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,inpatient,,,1853.00000,1760.35000,Amish/Mennonite,Amish Mennonite,90,1019.15,,,,,,,1019.15,1797.41,percent of total billed charges,
BCR/ABL-1 RNA-QUAL DIAGNOSTIC (BADX) SO,66506,CDM,300,RC,81206,CPT,,,facility,outpatient,,,1853.00000,1760.35000,Amish/Mennonite,Amish Mennonite,90,1019.15,,,,,,,169.42,8573.20,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,90,63.85,,,,,,,63.85,112.62,percent of total billed charges,
"COPPER, LIVER TISSUE SO-TECH",66507,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,90,63.85,,,,,,,12.82,645.08,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,inpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,TC,286.55,,,,,,,286.55,505.37,percent of total billed charges,
HEMATOLOGY STAIN-TECH,66508,CDM,300,RC,88313,CPT,,,facility,outpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,TC,286.55,,,,,,,121.00,3027.62,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,382.25,674.15,percent of total billed charges,
FLUORO GUIDE FOR PERC DRAINAGE-TECH,66509,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,298.87,3487.84,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,inpatient,,,2523.00000,2396.85000,Amish/Mennonite,Amish Mennonite,TC,1387.65,,,,,,,1387.65,2447.31,percent of total billed charges,
LYMPHANGIOGRAM EXT BILATERAL-TECH,66510,CDM,320,RC,75803,CPT,,,facility,outpatient,,,2523.00000,2396.85000,Amish/Mennonite,Amish Mennonite,TC,1387.65,,,,,,,1226.87,11271.02,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
VENOGRAPHY RENAL UNILATERAL-TECH,66511,CDM,320,RC,75831,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,394.96,17311.25,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,inpatient,,,736.00000,699.20000,Amish/Mennonite,Amish Mennonite,TC,404.80,,,,,,,404.80,713.92,percent of total billed charges,
DILATION NEPH URETERS URETH-TECH,66512,CDM,320,RC,74485,CPT,,,facility,outpatient,,,736.00000,699.20000,Amish/Mennonite,Amish Mennonite,TC,404.80,,,,,,,368.00,11266.81,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
NM I-123 CAP 200 UCI CARD,66513,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,inpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.34100,0.60140,percent of total billed charges,
PREVASTATIN TAB 5MG,66514,CDM,250,RC,00904-5891-61-00050,NDC,,,facility,outpatient,1,EA,0.62000,0.59000,Amish/Mennonite,Amish Mennonite,,0.34100,,,,,,,0.31000,0.60140,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,52.25,92.15,percent of total billed charges,
IMMUNOGLOBULIN G (IGG)-TECH,66518,CDM,300,RC,82784,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,,52.25,,,,,,,9.30,492.33,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 6MM 130CM PCLTXL LUTONIX 035,66523,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT GRFT EVAR L80CM L40MM DIA12MM EXP FLUENCY +.,66552,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT PERIPH L60MM DIA12MM CATH L80CM 10FR 0.035IN NIT EPTFE.,66553,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
GRAFT EVAR WRK L80CM L40MM DIA13.5MM FLUENCY +.,66554,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L60MM DIA13.5MM L117CM VASC.,66555,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66556,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA7MM SHTH 8FR CVR STR STNT COVERA.,66557,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L40MM DIA8MM CATH L80CM SHTH 8FR STR CVR.,66558,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM SHTH 8FR CVR STR STNT COVERA.,66559,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA8MM SHTH 8FR CVR FLR STNT COVERA,66560,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA8MM CATH L80CM SHTH 8FR CVR FLR HELI,66561,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
STENT VASC L60MM DIA9MM CATH L80CM SHTH 8FR CVR STR COVERA.,66562,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66563,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA9MM SHTH 8FR CVR FLR STNT COVERA,66564,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L40MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66565,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L60MM DIA10MM SHTH 8FR CVR STR STNT COVERA.,66566,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L22CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66567,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L24CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66568,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT URET 10FR L26CM PERCFLX GLDEX RADPQ DBL PGTL THRD,66569,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA7-11MM CATH L80CM INTRO SHTH 7FR 0.035IN,66571,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
TZANIDINE TAB 1MG,66575,CDM,250,RC,00904-6418-61-00025,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
SULFAMETHOXAZOLE-TMP 200 MG-40,66576,CDM,250,RC,53746-0271-01,NDC,,,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.57230,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1332.19,2637.19,percent of total billed charges,
KIT CATH 20MM 2.7FR 135CM HDRPH DRAGONFLY OPTIS,66577,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,2718.75000,2582.81000,Amish/Mennonite,Amish Mennonite,,1495.31,,,,,,,1247.91,2718.75,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO .021IN 35MM FLX STRG 5FR 21GA 10CM SS,66579,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,104.14,226.88,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,inpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,45.65,80.51,percent of total billed charges,
CAST SUP SHT ARM SPLINT FBRG,66593,CDM,270,RC,Q4022,HCPCS,,,facility,outpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,16.32,80.51,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
OXYBUTYNIN 2.5 MG TAB,66673,CDM,250,RC,68084-0400-01-00050,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
HTLV I/II SO-TECH,66685,CDM,300,RC,86790,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,32.85,679.08,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,90,195.80,,,,,,,195.80,345.32,percent of total billed charges,
HTLV I/II AB CONFIRMATION (HTLVL) SO,66687,CDM,300,RC,86849,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,90,195.80,,,,,,,178.00,345.32,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,,1027.95,,,,,,,1027.95,1812.93,percent of total billed charges,
DRUG DEFINITIV 22+ CLASS TECH,66694,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1869.00000,1775.55000,Amish/Mennonite,Amish Mennonite,,1027.95,,,,,,,172.18,1812.93,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,inpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
METOCLOPRAMIDE 2.5 MG TAB,66703,CDM,250,RC,63739-0103-10-00050,NDC,,,facility,outpatient,1,EA,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,inpatient,1,EA,16.52000,15.69000,Amish/Mennonite,Amish Mennonite,,9.09,,,,,,,9.09,16.02,percent of total billed charges,
LEUCOVORIN 12.5 MG TAB,66704,CDM,250,RC,51079-0582-05-00050,NDC,,,facility,outpatient,1,EA,16.52000,15.69000,Amish/Mennonite,Amish Mennonite,,9.09,,,,,,,8.26,16.02,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,inpatient,1,EA,60.36000,57.34000,Amish/Mennonite,Amish Mennonite,,33.20,,,,,,,33.20,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0221-31,NDC,,,facility,outpatient,1,EA,60.36000,57.34000,Amish/Mennonite,Amish Mennonite,,33.20,,,,,,,30.18,58.55,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,inpatient,1,EA,11.31000,10.75000,Amish/Mennonite,Amish Mennonite,,6.22,,,,,,,6.22,10.97,percent of total billed charges,
SITAGLIPTIN 25 MG TAB,66705,CDM,250,RC,00006-0277-31-00025,NDC,,,facility,outpatient,1,EA,11.31000,10.75000,Amish/Mennonite,Amish Mennonite,,6.22,,,,,,,5.66,10.97,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MELATONIN 0.5 MG TAB,66706,CDM,250,RC,74312-0028-32-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,inpatient,,,971.00000,922.45000,Amish/Mennonite,Amish Mennonite,90,534.05,,,,,,,534.05,941.87,percent of total billed charges,
EGFR MUT DISEC SO-TECH,66712,CDM,300,RC,88381,CPT,,,facility,outpatient,,,971.00000,922.45000,Amish/Mennonite,Amish Mennonite,90,534.05,,,,,,,485.50,8610.62,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,inpatient,,,203.50000,193.32000,Amish/Mennonite,Amish Mennonite,90,111.92,,,,,,,111.92,197.40,percent of total billed charges,
5-IGG WESTERN BLOT SO-TECH,66713,CDM,300,RC,84182,CPT,,,facility,outpatient,,,203.50000,193.32000,Amish/Mennonite,Amish Mennonite,90,111.92,,,,,,,25.31,2286.16,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L7CM GWIRE 0.035IN MIN ACC CHN 2.8MM POLY,66715,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,195.70,387.40,percent of total billed charges,
KIT INTRO .021IN 25MM 5FR 22GA 10CM PLS,66716,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,399.38000,379.41000,Amish/Mennonite,Amish Mennonite,,219.66,,,,,,,183.32,399.38,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1157.62,2291.62,percent of total billed charges,
GUIDEWIRE SAFARI X-SM CRV .035 275,66717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2362.50000,2244.38000,Amish/Mennonite,Amish Mennonite,,1299.38,,,,,,,1084.39,2362.50,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM COR CROSSFLEX2 TNG TREK,66718,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3.25MM COR CROSSFLX2 TUNG TREK,66719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.25MM COR CROSSFLEX2 TUNG TREK,66720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 23MM BOV PERICARD COCR ALLY POLY STENTED,66723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,11738.92,25575.00,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,inpatient,1,EA,1113.31000,1057.65000,Amish/Mennonite,Amish Mennonite,,612.32,,,,,,,612.32,1079.91,percent of total billed charges,
CARFILZOMIB POWD-INJ 10 MG,66724,CDM,636,RC,J9047,HCPCS,76075010301,NDC,facility,outpatient,1,EA,1113.31000,1057.65000,Amish/Mennonite,Amish Mennonite,,612.32,,,,,,,55.09,1079.91,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,inpatient,1,mL,7201.88000,6841.78000,Amish/Mennonite,Amish Mennonite,,3961.03,,,,,,,3961.03,6985.82,percent of total billed charges,
PEGFILGRASTIM-JMDB SOLN 6 MG/0.6 ML,66726,CDM,250,RC,Q5108,HCPCS,83257000541,NDC,facility,outpatient,1,mL,7201.88000,6841.78000,Amish/Mennonite,Amish Mennonite,,3961.03,,,,,,,103.71,6985.82,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,inpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.93,3.40,percent of total billed charges,
WARFARIN TAB 1.25 MG,66727,CDM,250,RC,00056-0176-75-00050,NDC,,,facility,outpatient,1,EA,3.51000,3.33000,Amish/Mennonite,Amish Mennonite,,1.93,,,,,,,1.75,3.40,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL,66729,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
LEVOTHYROXINE TAB 56 MCG (0.056 MG),66730,CDM,250,RC,J8499,HCPCS,4229200392000050,NDC,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,inpatient,1,EA,3.36000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
MIRTAZAPINE TAB 3.75 MG,66731,CDM,250,RC,13107-0001-30-00050,NDC,,,facility,outpatient,1,EA,3.36000,3.20000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GO,68.20,,,,,,,68.20,120.28,percent of total billed charges,
OT ORHTOTICS FIT/TRAIN -15 MIN;INITIAL E,67152,CDM,430,RC,97760,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,GO,68.20,,,,,,,62.00,264.00,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,inpatient,,,168.30000,159.88000,Amish/Mennonite,Amish Mennonite,90,92.56,,,,,,,92.56,163.25,percent of total billed charges,
VANILLYLMANDELIC ACID SO-TECH,67363,CDM,300,RC,84585,CPT,,,facility,outpatient,,,168.30000,159.88000,Amish/Mennonite,Amish Mennonite,90,92.56,,,,,,,16.02,814.87,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,inpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,90,418.55,,,,,,,418.55,738.17,percent of total billed charges,
BROAD RANGE BACTERIAL PCR & SEQ (BRBPS) SO,67364,CDM,300,RC,87801,CPT,,,facility,outpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,90,418.55,,,,,,,50.62,3666.93,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,inpatient,1,EA,153.61000,145.93000,Amish/Mennonite,Amish Mennonite,,84.49,,,,,,,84.49,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,00049002428,NDC,facility,outpatient,1,EA,153.61000,145.93000,Amish/Mennonite,Amish Mennonite,,84.49,,,,,,,2.39,149.00,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,inpatient,1,EA,207.93000,197.53000,Amish/Mennonite,Amish Mennonite,,114.36,,,,,,,114.36,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,55150011899,NDC,facility,outpatient,1,EA,207.93000,197.53000,Amish/Mennonite,Amish Mennonite,,114.36,,,,,,,2.39,201.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,inpatient,1,EA,227.52000,216.14000,Amish/Mennonite,Amish Mennonite,,125.14,,,,,,,125.14,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,66794020815,NDC,facility,outpatient,1,EA,227.52000,216.14000,Amish/Mennonite,Amish Mennonite,,125.14,,,,,,,2.39,220.69,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,inpatient,1,EA,75.90000,72.11000,Amish/Mennonite,Amish Mennonite,,41.74,,,,,,,41.74,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,67457064910,NDC,facility,outpatient,1,EA,75.90000,72.11000,Amish/Mennonite,Amish Mennonite,,41.74,,,,,,,2.39,73.62,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,inpatient,1,EA,90.66000,86.13000,Amish/Mennonite,Amish Mennonite,,49.86,,,,,,,49.86,87.94,percent of total billed charges,
AMPICILLIN/SULBACTAM,67365,CDM,250,RC,J0295,HCPCS,71288000775,NDC,facility,outpatient,1,EA,90.66000,86.13000,Amish/Mennonite,Amish Mennonite,,49.86,,,,,,,2.39,87.94,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,inpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,160.60,283.24,percent of total billed charges,
DEBRIDEMENT SUBQ 20CM,67366,CDM,361,RC,11402,CPT,,,facility,outpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,160.60,3163.00,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,inpatient,,,624.00000,592.80000,Amish/Mennonite,Amish Mennonite,,343.20,,,,,,,343.20,605.28,percent of total billed charges,
DEBRIDEMENT SUBQ ADD'L 20CM,67367,CDM,361,RC,,,,,facility,outpatient,,,624.00000,592.80000,Amish/Mennonite,Amish Mennonite,,343.20,,,,,,,343.20,5271.00,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,,282.15,,,,,,,282.15,497.61,percent of total billed charges,
INJECTION TRIGGER POINT-TECH,67368,CDM,450,RC,,,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,,282.15,,,,,,,256.50,497.61,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,inpatient,,,4933.00000,4686.35000,Amish/Mennonite,Amish Mennonite,,2713.15,,,,,,,2713.15,4785.01,percent of total billed charges,
FIXATION FRACTURE-TECH,67369,CDM,450,RC,,,,,facility,outpatient,,,4933.00000,4686.35000,Amish/Mennonite,Amish Mennonite,,2713.15,,,,,,,2466.50,4785.01,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,inpatient,,,673.00000,639.35000,Amish/Mennonite,Amish Mennonite,TC,370.15,,,,,,,370.15,652.81,percent of total billed charges,
RADIOLOGIC EXAM SINGLE PLANE-TECH,67370,CDM,320,RC,76100,CPT,,,facility,outpatient,,,673.00000,639.35000,Amish/Mennonite,Amish Mennonite,TC,370.15,,,,,,,336.50,3685.66,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,inpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,TC,392.70,,,,,,,392.70,692.58,percent of total billed charges,
CHORIONIC VILLUS SAMPLING-TECH,67371,CDM,402,RC,76945,CPT,,,facility,outpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,TC,392.70,,,,,,,297.11,692.58,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,inpatient,,,1255.00000,1192.25000,Amish/Mennonite,Amish Mennonite,TC,690.25,,,,,,,690.25,1217.35,percent of total billed charges,
UROGRAPHY INFUSION-TECH,67372,CDM,320,RC,74415,CPT,,,facility,outpatient,,,1255.00000,1192.25000,Amish/Mennonite,Amish Mennonite,TC,690.25,,,,,,,627.50,7087.64,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,inpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,TC,221.10,,,,,,,221.10,389.94,percent of total billed charges,
BIOPSY PROSTATE-TECH,67373,CDM,361,RC,55700,CPT,,,facility,outpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,TC,221.10,,,,,,,221.10,6003.00,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,Amish/Mennonite,Amish Mennonite,,303.05,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMP-TECH,67374,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,Amish/Mennonite,Amish Mennonite,,303.05,,,,,,,100.97,584.87,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,,161.15,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL FOLLOW UP-TECH,67375,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,,161.15,,,,,,,100.97,584.87,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,TC,48.40,,,,,,,48.40,85.36,percent of total billed charges,
AMNIOCENTESIS-TECH,67376,CDM,402,RC,59000,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,TC,48.40,,,,,,,44.00,548.00,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,Amish/Mennonite,Amish Mennonite,TC,1998.70,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL-TECH,67377,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,Amish/Mennonite,Amish Mennonite,TC,1998.70,,,,,,,1396.56,3524.98,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,inpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,,1333.75,,,,,,,1333.75,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT 1ST-TECH,67378,CDM,610,RC,19085,CPT,,,facility,outpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,,1333.75,,,,,,,1212.50,2352.25,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1320.00000,1254.00000,Amish/Mennonite,Amish Mennonite,,726.00,,,,,,,726.00,1280.40,percent of total billed charges,
MRI-BREAST BIOPSY W/LOC PLCMNT EA ADD'L-TECH,67379,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1320.00000,1254.00000,Amish/Mennonite,Amish Mennonite,,726.00,,,,,,,660.00,2161.00,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,inpatient,,,869.00000,825.55000,Amish/Mennonite,Amish Mennonite,,477.95,,,,,,,477.95,842.93,percent of total billed charges,
ASP OR INJ THYROID CYST-TECH,67380,CDM,361,RC,60300,CPT,,,facility,outpatient,,,869.00000,825.55000,Amish/Mennonite,Amish Mennonite,,477.95,,,,,,,477.95,3163.00,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,inpatient,,,1383.00000,1313.85000,Amish/Mennonite,Amish Mennonite,,760.65,,,,,,,760.65,1341.51,percent of total billed charges,
PLCMT LOC DEVICE EA ADD'L-TECH,67381,CDM,402,RC,10036,CPT,,,facility,outpatient,,,1383.00000,1313.85000,Amish/Mennonite,Amish Mennonite,,760.65,,,,,,,384.16,1341.51,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
VAPOTHERM INHALATION-TECH,67382,CDM,410,RC,94799,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,22.50,163.43,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,inpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,,517.55,,,,,,,517.55,912.77,percent of total billed charges,
INJ ANES AGNT W/GUIDE-TECH,67383,CDM,361,RC,64483,CPT,,,facility,outpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,,517.55,,,,,,,517.55,3163.00,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ EPID/SUBARCH CER/THOR W/GUIDE-TECH,67384,CDM,361,RC,62321,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,3163.00,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,inpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,,517.55,,,,,,,517.55,912.77,percent of total billed charges,
INJ EPID/SUBARCH LUM/SAC W/GUIDE-TECH,67385,CDM,361,RC,62323,CPT,,,facility,outpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,,517.55,,,,,,,517.55,3163.00,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
INJ EPID/SUBARCH CONT LUM/SAC W/GUIDE-TECH,67387,CDM,361,RC,62327,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,3163.00,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,TC,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY SOFT TISSUE ELBOW-TECH,67388,CDM,361,RC,24066,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,TC,658.35,,,,,,,658.35,7621.00,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,TC,88.00,,,,,,,88.00,155.20,percent of total billed charges,
CT MUSCLE/LIG INJ-TECH,67389,CDM,361,RC,20550,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,TC,88.00,,,,,,,88.00,3163.00,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,177.65,313.31,percent of total billed charges,
US BIOPSY LUNG/MEDIAS PERC-TECH,67391,CDM,361,RC,32408,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,TC,177.65,,,,,,,177.65,4686.00,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,inpatient,,,3411.00000,3240.45000,Amish/Mennonite,Amish Mennonite,,1876.05,,,,,,,1876.05,3308.67,percent of total billed charges,
US BIOPSY LUNG PLEURA-TECH,67392,CDM,361,RC,32400,CPT,,,facility,outpatient,,,3411.00000,3240.45000,Amish/Mennonite,Amish Mennonite,,1876.05,,,,,,,1538.48,4686.00,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,1161.09,percent of total billed charges,
US BIOPSY MUSCLE PERC-TECH,67393,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1197.00000,1137.15000,Amish/Mennonite,Amish Mennonite,,658.35,,,,,,,658.35,4686.00,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1151.00000,1093.45000,Amish/Mennonite,Amish Mennonite,,633.05,,,,,,,633.05,1116.47,percent of total billed charges,
CT INJ PROC SI JOINTS-TECH,67394,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1151.00000,1093.45000,Amish/Mennonite,Amish Mennonite,,633.05,,,,,,,633.05,3163.00,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,inpatient,,,5736.00000,5449.20000,Amish/Mennonite,Amish Mennonite,,3154.80,,,,,,,3154.80,5563.92,percent of total billed charges,
US BIOPSY BONE DEEP TROCAR NDL-TECH,67395,CDM,361,RC,20225,CPT,,,facility,outpatient,,,5736.00000,5449.20000,Amish/Mennonite,Amish Mennonite,,3154.80,,,,,,,1538.48,5563.92,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US BIOPSY BONE SUPRFIC TROCAR NDL-TECH,67396,CDM,361,RC,20220,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,4686.00,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,TC,1075.80,,,,,,,1075.80,1897.32,percent of total billed charges,
US PSEUDOANTREATMT W COMPRESS-TECH,67397,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,TC,1075.80,,,,,,,384.16,1897.32,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,inpatient,,,3829.00000,3637.55000,Amish/Mennonite,Amish Mennonite,TC,2105.95,,,,,,,2105.95,3714.13,percent of total billed charges,
MRI BRAIN FUNC WO PHYS ADMIN-TECH,67398,CDM,611,RC,70554,CPT,,,facility,outpatient,,,3829.00000,3637.55000,Amish/Mennonite,Amish Mennonite,TC,2105.95,,,,,,,1329.46,3714.13,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,inpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,1007.60,1777.04,percent of total billed charges,
IVC DUPLEX W ILIACS-TECH,67400,CDM,921,RC,93978,CPT,,,facility,outpatient,,,1832.00000,1740.40000,Amish/Mennonite,Amish Mennonite,TC,1007.60,,,,,,,916.00,1777.04,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,inpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,TC,366.85,,,,,,,366.85,646.99,percent of total billed charges,
XR PHARYNX/LARYNX W/FLUORO-TECH,67401,CDM,320,RC,70370,CPT,,,facility,outpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,TC,366.85,,,,,,,333.50,4081.21,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,inpatient,,,97.10000,92.24000,Amish/Mennonite,Amish Mennonite,90,53.41,,,,,,,53.41,94.19,percent of total billed charges,
DRUG SCRN5 MECON (809566) SO,67402,CDM,300,RC,80307,CPT,,,facility,outpatient,,,97.10000,92.24000,Amish/Mennonite,Amish Mennonite,90,53.41,,,,,,,48.55,3038.81,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,90,2959.00,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS HEMATOLOGC NEOPLASM SO TECH,67404,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,90,2959.00,,,,,,,759.53,35735.73,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,inpatient,,,154.60000,146.87000,Amish/Mennonite,Amish Mennonite,90,85.03,,,,,,,85.03,149.96,percent of total billed charges,
"VORICONAZOLE, S (VORI) SO",67405,CDM,300,RC,80285,CPT,,,facility,outpatient,,,154.60000,146.87000,Amish/Mennonite,Amish Mennonite,90,85.03,,,,,,,21.69,186.79,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,inpatient,,,158.40000,150.48000,Amish/Mennonite,Amish Mennonite,90,87.12,,,,,,,87.12,153.65,percent of total billed charges,
FLECAINIDE SO TECH,67406,CDM,301,RC,80181,CPT,,,facility,outpatient,,,158.40000,150.48000,Amish/Mennonite,Amish Mennonite,90,87.12,,,,,,,14.91,885.37,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,inpatient,,,174.60000,165.87000,Amish/Mennonite,Amish Mennonite,90,96.03,,,,,,,96.03,169.36,percent of total billed charges,
"GRANULOCYTE ABS, SERUM (LAGGT) SO",67407,CDM,300,RC,86021,CPT,,,facility,outpatient,,,174.60000,165.87000,Amish/Mennonite,Amish Mennonite,90,96.03,,,,,,,15.55,780.94,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,inpatient,,,72.30000,68.68000,Amish/Mennonite,Amish Mennonite,90,39.77,,,,,,,39.77,70.13,percent of total billed charges,
PNEUMOCOCCAL (PN23M) SO,67408,CDM,300,RC,86581,CPT,,,facility,outpatient,,,72.30000,68.68000,Amish/Mennonite,Amish Mennonite,90,39.77,,,,,,,36.15,70.13,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,inpatient,,,97.60000,92.72000,Amish/Mennonite,Amish Mennonite,90,53.68,,,,,,,53.68,94.67,percent of total billed charges,
"REDUCING SUBST, FECES SO TECH",67409,CDM,300,RC,84376,CPT,,,facility,outpatient,,,97.60000,92.72000,Amish/Mennonite,Amish Mennonite,90,53.68,,,,,,,5.68,288.61,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,inpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,52.80,93.12,percent of total billed charges,
TREPONEMA PALLIDUM AB TECH,67410,CDM,300,RC,86780,CPT,,,facility,outpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,11.13,696.05,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,inpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,90,218.35,,,,,,,218.35,385.09,percent of total billed charges,
MYCO TUBERCULOSIS PCR SO TECH,67411,CDM,300,RC,87556,CPT,,,facility,outpatient,,,397.00000,377.15000,Amish/Mennonite,Amish Mennonite,90,218.35,,,,,,,43.07,1952.29,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
CARB DEF TRANSFERRIN SO TECH,67412,CDM,300,RC,82373,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,10.38,950.66,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,inpatient,,,162.80000,154.66000,Amish/Mennonite,Amish Mennonite,90,89.54,,,,,,,89.54,157.92,percent of total billed charges,
"BIOTINIDASE, SERUM (BIOTS) SO",67413,CDM,300,RC,82261,CPT,,,facility,outpatient,,,162.80000,154.66000,Amish/Mennonite,Amish Mennonite,90,89.54,,,,,,,17.43,882.80,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
"ACYLGLYCINES,QUANT,U SO TECH",67414,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,24.89,1137.41,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,inpatient,,,276.50000,262.68000,Amish/Mennonite,Amish Mennonite,90,152.07,,,,,,,152.07,268.20,percent of total billed charges,
INTERPRETATION AND REPORT FOR B-CELL LYMPHBLAST-TECH,67416,CDM,310,RC,88377,CPT,,,facility,outpatient,,,276.50000,262.68000,Amish/Mennonite,Amish Mennonite,90,152.07,,,,,,,138.25,19453.17,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
GLUCOSE BODY FLUID OTHER THAN BLOOD-TECH,67422,CDM,300,RC,82945,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,3.93,203.72,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,67480,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 4.7MM 12FR 33CM HDRPH GORE DRYSEAL,67481,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1018.98,2220.00,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,Amish/Mennonite,Amish Mennonite,,4734.26,,,,,,,4217.80,8349.52,percent of total billed charges,
PROBE CRYABL 10CM CRYOICE MLBL,67482,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,Amish/Mennonite,Amish Mennonite,,4734.26,,,,,,,3950.96,8607.75,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,inpatient,,,3059.00000,2906.05000,Amish/Mennonite,Amish Mennonite,,1682.45,,,,,,,1682.45,2967.23,percent of total billed charges,
FLUORO GUID DRAIN FL COL PERIT/RETRO-TECH,67484,CDM,320,RC,49406,CPT,,,facility,outpatient,,,3059.00000,2906.05000,Amish/Mennonite,Amish Mennonite,,1682.45,,,,,,,1306.65,2967.23,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,inpatient,,,2261.00000,2147.95000,Amish/Mennonite,Amish Mennonite,TC,1243.55,,,,,,,1243.55,2193.17,percent of total billed charges,
"ENDOVASCULAR TAA DIST EXT, DELAYED-TECH",67485,CDM,320,RC,75959,CPT,,,facility,outpatient,,,2261.00000,2147.95000,Amish/Mennonite,Amish Mennonite,TC,1243.55,,,,,,,866.42,2193.17,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,inpatient,,,3323.00000,3156.85000,Amish/Mennonite,Amish Mennonite,TC,1827.65,,,,,,,1827.65,3223.31,percent of total billed charges,
XR  DISCOGRAPHY LUMBAR-TECH,67487,CDM,320,RC,72295,CPT,,,facility,outpatient,,,3323.00000,3156.85000,Amish/Mennonite,Amish Mennonite,TC,1827.65,,,,,,,383.91,10740.24,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,TC,45.76,,,,,,,45.76,80.70,percent of total billed charges,
XR CATHETER CHECK-TECH,67488,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,TC,45.76,,,,,,,41.60,484.28,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/HD-TECH,67489,CDM,320,RC,75885,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,417.10,17311.25,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,382.25,674.15,percent of total billed charges,
CT GUIDE FOR PERCUT DRAINAGE-TECH,67490,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,298.87,1820.00,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 100CM SS NYL TRNB,67491,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
CATHETER EP 25MM ACHV ADV MP,67492,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,875.89000,832.10000,Amish/Mennonite,Amish Mennonite,,481.74,,,,,,,429.19,849.61,percent of total billed charges,
CATHETER CHAIT CECOSTOMY 28CM,67493,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,875.89000,832.10000,Amish/Mennonite,Amish Mennonite,,481.74,,,,,,,402.03,875.89,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 6FR 100CM COR NYL LNCHR LG,67496,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO KMP ANG 5FR 100CM,67497,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 4.0X12MM,67498,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3 6FR,67501,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE JJNSTM 16FR 45CM SIL MC SLK 7-10ML UNV FD,67502,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,589.26,1283.78,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,471.23000,447.67000,Amish/Mennonite,Amish Mennonite,,259.18,,,,,,,230.90,457.09,percent of total billed charges,
KIT CATH 70CM 4FR 18GA NTNL P PICC SOLO RDSTC 1.,67503,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,471.23000,447.67000,Amish/Mennonite,Amish Mennonite,,259.18,,,,,,,216.29,471.23,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTENDED,67528,CDM,430,RC,G0283,HCPCS,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,41.80,73.72,percent of total billed charges,
OT FLUIDOTHERAPY,67529,CDM,430,RC,97022,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,38.00,264.00,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,inpatient,,,636.00000,604.20000,Amish/Mennonite,Amish Mennonite,,349.80,,,,,,,349.80,616.92,percent of total billed charges,
PT CANALITH REPOSITIONING,67531,CDM,420,RC,95992,CPT,,,facility,outpatient,,,636.00000,604.20000,Amish/Mennonite,Amish Mennonite,,349.80,,,,,,,126.65,616.92,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
PT CONTRAST BATH,67533,CDM,420,RC,97034,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,29.50,264.00,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,inpatient,,,507.00000,481.65000,Amish/Mennonite,Amish Mennonite,,278.85,,,,,,,278.85,491.79,percent of total billed charges,
PT CUSTOM ORTHOTICS-INITIAL,67534,CDM,420,RC,L3000,HCPCS,,,facility,outpatient,,,507.00000,481.65000,Amish/Mennonite,Amish Mennonite,,278.85,,,,,,,126.65,491.79,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,104.76,percent of total billed charges,
PT PHYSICAL PERFORMANCE TEST,67536,CDM,420,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,54.00,264.00,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
PT INFRARED/ANODYNE,67537,CDM,420,RC,97026,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,264.00,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
PT PARAFFIN,67538,CDM,420,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,264.00,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
PT PHONOPHORESIS,67540,CDM,421,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,21.00,264.00,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,inpatient,,,69.60000,66.12000,Amish/Mennonite,Amish Mennonite,,38.28,,,,,,,38.28,67.51,percent of total billed charges,
PT THERAPUTIC DRY NEEDLING,67541,CDM,420,RC,97799,CPT,,,facility,outpatient,,,69.60000,66.12000,Amish/Mennonite,Amish Mennonite,,38.28,,,,,,,34.80,264.00,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,GP,54.45,,,,,,,54.45,96.03,percent of total billed charges,
PT COMMUNITY WORK REINTEGRATION,67542,CDM,420,RC,97537,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,GP,54.45,,,,,,,49.50,264.00,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,GO,19.25,,,,,,,19.25,33.95,percent of total billed charges,
OT PARAFFIN,67543,CDM,430,RC,97018,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,GO,19.25,,,,,,,17.50,264.00,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,inpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,199.65,352.11,percent of total billed charges,
PHASE II DIABETIC,67544,CDM,943,RC,93798,CPT,,,facility,outpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,119.56,352.11,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL VASCULAR REHAB,67562,CDM,940,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,56.40,248.32,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,inpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.16,percent of total billed charges,
WARFARIN 0.5 MG TAB,67569,CDM,250,RC,00056-0169-75-00050,NDC,,,facility,outpatient,1,EA,3.26000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.63,3.16,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,inpatient,,,438.50000,416.58000,Amish/Mennonite,Amish Mennonite,90,241.18,,,,,,,241.18,425.35,percent of total billed charges,
PIPECOLIC ACID SO TECH,67570,CDM,300,RC,82542,CPT,,,facility,outpatient,,,438.50000,416.58000,Amish/Mennonite,Amish Mennonite,90,241.18,,,,,,,24.89,1137.41,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,inpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
PRIMIDONE 25 MG TAB,67572,CDM,250,RC,68084-0202-01-00050,NDC,,,facility,outpatient,1,EA,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.43000,0.83420,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,inpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,90,169.12,,,,,,,169.12,298.27,percent of total billed charges,
STEROLS SO TECH,67573,CDM,300,RC,82542,CPT,,,facility,outpatient,,,307.50000,292.12000,Amish/Mennonite,Amish Mennonite,90,169.12,,,,,,,24.89,1137.41,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,inpatient,,,454.90000,432.15000,Amish/Mennonite,Amish Mennonite,90,250.19,,,,,,,250.19,441.25,percent of total billed charges,
ANTI-PLATE AB W/DRUGS (9000) SO,67582,CDM,300,RC,86022,CPT,,,facility,outpatient,,,454.90000,432.15000,Amish/Mennonite,Amish Mennonite,90,250.19,,,,,,,18.98,967.70,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,inpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.93,percent of total billed charges,
HYDROXYCHLOROQUINE 100 MG,67593,CDM,250,RC,00904-6508-06-00050,NDC,,,facility,outpatient,1,EA,1.99000,1.89000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99500,1.93,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,inpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
THIAMINE 25 MG TAB,67594,CDM,250,RC,00536-4678-01-00050,NDC,,,facility,outpatient,1,EA,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
PROPRANOLOL 5 MG TAB,67595,CDM,250,RC,00904-6550-61-00050,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,inpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
LEVOTHYROXINE TAB 44 MCG (0.044 MG),67596,CDM,250,RC,J8499,HCPCS,4229200382000050,NDC,facility,outpatient,1,EA,0.73000,0.70000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,inpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,90,2959.00,,,,,,,2959.00,5218.60,percent of total billed charges,
NGS ACUTE MYELOID LEUK SO TECH,67600,CDM,300,RC,81450,CPT,,,facility,outpatient,,,5380.00000,5111.00000,Amish/Mennonite,Amish Mennonite,90,2959.00,,,,,,,759.53,35735.73,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,Amish/Mennonite,Amish Mennonite,90,92.51,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,BREAST (H2BR) SO",67601,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,Amish/Mennonite,Amish Mennonite,90,92.51,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,Amish/Mennonite,Amish Mennonite,90,149.00,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,BREAST,FISH SO TECH",67602,CDM,300,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,Amish/Mennonite,Amish Mennonite,90,149.00,,,,,,,135.45,19453.17,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,inpatient,,,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,90,60.83,,,,,,,60.83,107.28,percent of total billed charges,
ARBOVIRUS AB SO TECH,67603,CDM,300,RC,86790,CPT,,,facility,outpatient,,,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,90,60.83,,,,,,,45.08,679.08,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,inpatient,,,286.80000,272.46000,Amish/Mennonite,Amish Mennonite,90,157.74,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB S SO TECH,67604,CDM,300,RC,86255,CPT,,,facility,outpatient,,,286.80000,272.46000,Amish/Mennonite,Amish Mennonite,90,157.74,,,,,,,12.45,1539.22,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,inpatient,,,286.80000,272.46000,Amish/Mennonite,Amish Mennonite,90,157.74,,,,,,,157.74,278.20,percent of total billed charges,
PHOSPHOLIPS A2 RPT AB T SO TECH,67605,CDM,300,RC,83520,CPT,,,facility,outpatient,,,286.80000,272.46000,Amish/Mennonite,Amish Mennonite,90,157.74,,,,,,,17.85,814.87,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,23.10,40.74,percent of total billed charges,
OT PHONOPHORESIS,67606,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,21.00,264.00,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,23.10,40.74,percent of total billed charges,
OT ULTRASOUND,67607,CDM,430,RC,97035,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,GO,23.10,,,,,,,21.00,264.00,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,inpatient,,,154.60000,146.87000,Amish/Mennonite,Amish Mennonite,90,85.03,,,,,,,85.03,149.96,percent of total billed charges,
ITRACONAZOLE (ITCON) SO,67608,CDM,301,RC,80189,CPT,,,facility,outpatient,,,154.60000,146.87000,Amish/Mennonite,Amish Mennonite,90,85.03,,,,,,,27.11,1289.24,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,90,74.80,,,,,,,74.80,131.92,percent of total billed charges,
COMPLEMENT C-1Q (C1Q) SO,67609,CDM,300,RC,86160,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,90,74.80,,,,,,,12.40,628.12,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,inpatient,,,668.00000,634.60000,Amish/Mennonite,Amish Mennonite,90,367.40,,,,,,,367.40,647.96,percent of total billed charges,
"PLASMA CELL PROLIFERATIVE FISH, T (PLASF) SO",67611,CDM,300,RC,88271,CPT,,,facility,outpatient,,,668.00000,634.60000,Amish/Mennonite,Amish Mennonite,90,367.40,,,,,,,20.36,1120.45,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,inpatient,,,305.90000,290.60000,Amish/Mennonite,Amish Mennonite,90,168.25,,,,,,,168.25,296.72,percent of total billed charges,
OSMOTIC FRAGILITY RBC SO TECH,67612,CDM,300,RC,85557,CPT,,,facility,outpatient,,,305.90000,290.60000,Amish/Mennonite,Amish Mennonite,90,168.25,,,,,,,13.80,696.05,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,inpatient,,,320.40000,304.38000,Amish/Mennonite,Amish Mennonite,90,176.22,,,,,,,176.22,310.79,percent of total billed charges,
N-METHYL-D-ASP AB IGG SO TECH,67613,CDM,300,RC,86255,CPT,,,facility,outpatient,,,320.40000,304.38000,Amish/Mennonite,Amish Mennonite,90,176.22,,,,,,,12.45,1539.22,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,inpatient,,,146.60000,139.27000,Amish/Mennonite,Amish Mennonite,90,80.63,,,,,,,80.63,142.20,percent of total billed charges,
"PYRUVIC ACID, BLOOD SO TECH",67620,CDM,300,RC,84210,CPT,,,facility,outpatient,,,146.60000,139.27000,Amish/Mennonite,Amish Mennonite,90,80.63,,,,,,,14.96,679.08,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,90,99.00,,,,,,,99.00,174.60,percent of total billed charges,
HISTOPLASMA ANTIGEN SO TECH,67621,CDM,300,RC,87385,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,90,99.00,,,,,,,13.69,628.12,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,inpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,90,900.35,,,,,,,900.35,1587.89,percent of total billed charges,
BCR/ABL P190 RT-PCR SO TECH,67623,CDM,300,RC,81207,CPT,,,facility,outpatient,,,1637.00000,1555.15000,Amish/Mennonite,Amish Mennonite,90,900.35,,,,,,,149.66,7571.58,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,90,82.50,,,,,,,82.50,145.50,percent of total billed charges,
"M. PNEUMONIAE IGM, IFA (MMYCO) SO",67624,CDM,300,RC,86738,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,90,82.50,,,,,,,13.68,696.05,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
HYDROMORPHONE PCA 1 MG/ML 50 ML,67625,CDM,250,RC,J1171,HCPCS,0070301130100100,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.14409,0.76630,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,inpatient,,,935.00000,888.25000,Amish/Mennonite,Amish Mennonite,,514.25,,,,,,,514.25,906.95,percent of total billed charges,
INJECTION EYE-TECH,67626,CDM,361,RC,,,,,facility,outpatient,,,935.00000,888.25000,Amish/Mennonite,Amish Mennonite,,514.25,,,,,,,514.25,5271.00,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,inpatient,1,EA,64.97000,61.72000,Amish/Mennonite,Amish Mennonite,,35.73,,,,,,,35.73,63.02,percent of total billed charges,
CEFOXITIN 2 G POWD,67627,CDM,250,RC,J0694,HCPCS,00264312511,NDC,facility,outpatient,1,EA,64.97000,61.72000,Amish/Mennonite,Amish Mennonite,,35.73,,,,,,,7.77,63.02,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
Q-FEVER ABS SO TECH,67628,CDM,300,RC,86638,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,8.17,628.12,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,inpatient,1,EA,1.89000,1.79000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.83,percent of total billed charges,
LIOTHYRONINE TAB 2.5 MCG,67630,CDM,250,RC,J8499,HCPCS,5186203200100050,NDC,facility,outpatient,1,EA,1.89000,1.79000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.94500,1.83,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,154.55,272.57,percent of total billed charges,
"BACT VAGINOSIS, AMP PROBE TECH",67631,CDM,300,RC,87801,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,50.62,3666.93,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
"CANDIDA GLABRATA, AMP PROB TECH",67632,CDM,300,RC,87481,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,35.09,1833.46,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,Amish/Mennonite,Amish Mennonite,,9.74,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL 100 MCG-25,67633,CDM,250,RC,00173-0859-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,Amish/Mennonite,Amish Mennonite,,9.74,,,,,,,8.86,17.18,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
"TRICH VAGINALIS, AMP PROBE TECH",67634,CDM,300,RC,87661,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,35.09,1833.46,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MORPHINE PCA 5 MG/ML 50 ML,67635,CDM,250,RC,J2271,HCPCS,0040911350200500,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,inpatient,,,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,90,156.42,,,,,,,156.42,275.87,percent of total billed charges,
NMO/AQP4 FACS SO TECH,67636,CDM,300,RC,86053,CPT,,,facility,outpatient,,,284.40000,270.18000,Amish/Mennonite,Amish Mennonite,90,156.42,,,,,,,12.05,1786.28,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,inpatient,,,168.20000,159.79000,Amish/Mennonite,Amish Mennonite,90,92.51,,,,,,,92.51,163.15,percent of total billed charges,
"HER2 AMP P,GASTROESOPH (H2GE) SO",67637,CDM,300,RC,88271,CPT,,,facility,outpatient,,,168.20000,159.79000,Amish/Mennonite,Amish Mennonite,90,92.51,,,,,,,20.36,1120.45,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,inpatient,,,270.90000,257.35000,Amish/Mennonite,Amish Mennonite,90,149.00,,,,,,,149.00,262.77,percent of total billed charges,
"HER2 AMP R,GASTRO,FISH SO TECH",67638,CDM,310,RC,88377,CPT,,,facility,outpatient,,,270.90000,257.35000,Amish/Mennonite,Amish Mennonite,90,149.00,,,,,,,135.45,19453.17,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,Amish/Mennonite,Amish Mennonite,90,176.44,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,Amish/Mennonite,Amish Mennonite,90,176.44,,,,,,,30.85,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,inpatient,,,320.80000,304.76000,Amish/Mennonite,Amish Mennonite,,176.44,,,,,,,176.44,311.18,percent of total billed charges,
INFLIXIMAB QNT W/RFLX (INFXR) SO,67649,CDM,300,RC,80230,CPT,,,facility,outpatient,,,320.80000,304.76000,Amish/Mennonite,Amish Mennonite,,176.44,,,,,,,30.85,311.18,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,inpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,TC,647.35,,,,,,,647.35,1141.69,percent of total billed charges,
PLACEMENT ENTEROCLYSIS-TECH,67663,CDM,320,RC,74355,CPT,,,facility,outpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,TC,647.35,,,,,,,519.48,5638.86,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,inpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,221.10,389.94,percent of total billed charges,
TUBE EVAL BY CONTRAST INJEC-TECH,67664,CDM,320,RC,49465,CPT,,,facility,outpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,201.00,389.94,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,67665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,inpatient,1,EA,2.66000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.58,percent of total billed charges,
RISPERIDONE TAB 0.125 MG,67667,CDM,250,RC,50458-0590-10-00050,NDC,,,facility,outpatient,1,EA,2.66000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.33,2.58,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,inpatient,1,EA,17.71000,16.82000,Amish/Mennonite,Amish Mennonite,,9.74,,,,,,,9.74,17.18,percent of total billed charges,
FLUTICASONE-VILANTEROL INHALER 200-25MCG,67668,CDM,250,RC,00173-0882-14,NDC,,,facility,outpatient,1,EA,17.71000,16.82000,Amish/Mennonite,Amish Mennonite,,9.74,,,,,,,8.86,17.18,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,inpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
SENNA 4.3 MG TAB,67689,CDM,250,RC,00904-6522-61-00050,NDC,,,facility,outpatient,1,EA,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,inpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE TAB 6.25MG,67691,CDM,250,RC,Q0169,HCPCS,0090464616100025,NDC,facility,outpatient,1,EA,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,00536-1349-57,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,45802-0174-53,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,49348-0426-84,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MENTHOL-METHYL SALICYLATE CREAM 10%-15% 85 GM,67692,CDM,250,RC,57896-0116-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
MAGNESIUM OXIDE 100 MG TAB,67694,CDM,250,RC,63739-0354-10-00025,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,inpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.64350,1.13,percent of total billed charges,
PAROXETINE TAB 15 MG,67696,CDM,250,RC,00904-5678-61-00050,NDC,,,facility,outpatient,1,EA,1.17000,1.11000,Amish/Mennonite,Amish Mennonite,,0.64350,,,,,,,0.58500,1.13,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,inpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.29700,0.52380,percent of total billed charges,
POTASSIUM PHOSPHATE-SODIUM PHOSPHATE 125 MG TAB,67697,CDM,250,RC,64980-0104-01-00050,NDC,,,facility,outpatient,1,EA,0.54000,0.51000,Amish/Mennonite,Amish Mennonite,,0.29700,,,,,,,0.27000,0.52380,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 18FR SIL UNV FD PORT CNCT,67700,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,59.56,129.76,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA14MM 0.020IN PERIPH COMPLX L VOL STD FRME,67701,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA6MM CATH 6FR L120CM 0.018/0.014IN,67702,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,4856.36,10580.30,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,inpatient,1,GM,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,15.64,27.59,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AERO,67705,CDM,250,RC,00597-0100-31,NDC,,,facility,outpatient,1,GM,28.44000,27.02000,Amish/Mennonite,Amish Mennonite,,15.64,,,,,,,14.22,27.59,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,inpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
PROBENECID 250 MG TAB,67706,CDM,250,RC,00591-5347-01-00050,NDC,,,facility,outpatient,1,EA,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,inpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
ANTICOAG CITRATE DEXTROSE 10,67708,CDM,250,RC,00942-0641-03-01000,NDC,,,facility,outpatient,1,mL,0.06000,0.05000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,inpatient,1,EA,21.96000,20.86000,Amish/Mennonite,Amish Mennonite,,12.08,,,,,,,12.08,21.30,percent of total billed charges,
FLUTICASONE FUROATE 100 MCG POWD,67709,CDM,250,RC,00173-0874-14,NDC,,,facility,outpatient,1,EA,21.96000,20.86000,Amish/Mennonite,Amish Mennonite,,12.08,,,,,,,10.98,21.30,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,inpatient,1,GM,205.53000,195.25000,Amish/Mennonite,Amish Mennonite,,113.04,,,,,,,113.04,199.36,percent of total billed charges,
OLODATEROL 2.5 MCG/INH AERO,67710,CDM,250,RC,00597-0192-61,NDC,,,facility,outpatient,1,GM,205.53000,195.25000,Amish/Mennonite,Amish Mennonite,,113.04,,,,,,,102.77,199.36,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,inpatient,1,GM,313.19000,297.53000,Amish/Mennonite,Amish Mennonite,,172.25,,,,,,,172.25,303.79,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5,67711,CDM,250,RC,00597-0155-61,NDC,,,facility,outpatient,1,GM,313.19000,297.53000,Amish/Mennonite,Amish Mennonite,,172.25,,,,,,,156.59,303.79,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,inpatient,1,EA,25.01000,23.76000,Amish/Mennonite,Amish Mennonite,,13.76,,,,,,,13.76,24.26,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25,67712,CDM,250,RC,00173-0869-10,NDC,,,facility,outpatient,1,EA,25.01000,23.76000,Amish/Mennonite,Amish Mennonite,,13.76,,,,,,,12.51,24.26,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,inpatient,1,EA,14.17000,13.46000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.79,13.74,percent of total billed charges,
FLUTICASONE FUROATE 50 MCG POWD,67713,CDM,250,RC,00173-0888-10,NDC,,,facility,outpatient,1,EA,14.17000,13.46000,Amish/Mennonite,Amish Mennonite,,7.79,,,,,,,7.08,13.74,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,inpatient,,,1965.00000,1866.75000,Amish/Mennonite,Amish Mennonite,,1080.75,,,,,,,1080.75,1906.05,percent of total billed charges,
CT BIOPSY BONE MARROW AND ASP-TECH,67719,CDM,361,RC,38222,CPT,,,facility,outpatient,,,1965.00000,1866.75000,Amish/Mennonite,Amish Mennonite,,1080.75,,,,,,,1080.75,7304.63,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,inpatient,,,1280.00000,1216.00000,Amish/Mennonite,Amish Mennonite,,704.00,,,,,,,704.00,1241.60,percent of total billed charges,
BIOPSY PELVIS/HIP SOFT TISS-TECH,67720,CDM,361,RC,27040,CPT,,,facility,outpatient,,,1280.00000,1216.00000,Amish/Mennonite,Amish Mennonite,,704.00,,,,,,,704.00,4686.00,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,inpatient,,,592.00000,562.40000,Amish/Mennonite,Amish Mennonite,,325.60,,,,,,,325.60,574.24,percent of total billed charges,
DEEP SEDATION-TECH,67728,CDM,370,RC,,,,,facility,outpatient,,,592.00000,562.40000,Amish/Mennonite,Amish Mennonite,,325.60,,,,,,,296.00,574.24,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,inpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,1.02,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,00904-7076-61,NDC,,,facility,outpatient,1,EA,1.85000,1.76000,Amish/Mennonite,Amish Mennonite,,1.02,,,,,,,0.92500,1.79,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,50268-0819-15,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,inpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.74800,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-30,NDC,,,facility,outpatient,1,EA,1.36000,1.29000,Amish/Mennonite,Amish Mennonite,,0.74800,,,,,,,0.68000,1.32,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,inpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.75350,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,65862-0697-90,NDC,,,facility,outpatient,1,EA,1.37000,1.30000,Amish/Mennonite,Amish Mennonite,,0.75350,,,,,,,0.68500,1.33,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,inpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,1.08,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68084-0713-01,NDC,,,facility,outpatient,1,EA,1.96000,1.86000,Amish/Mennonite,Amish Mennonite,,1.08,,,,,,,0.98000,1.90,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,inpatient,1,EA,1.57000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.86350,1.52,percent of total billed charges,
VENLAFAXINE 150 MG CAP-,67730,CDM,250,RC,68382-0036-06,NDC,,,facility,outpatient,1,EA,1.57000,1.50000,Amish/Mennonite,Amish Mennonite,,0.86350,,,,,,,0.78500,1.52,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,inpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
NYSTATIN TOPICAL 100000 UNITS/G CREA,67731,CDM,250,RC,45802-0059-11,NDC,,,facility,outpatient,1,GM,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  50,000 1.7 ML",67732,CDM,250,RC,J2004,HCPCS,50227102005,NDC,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-6761-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,inpatient,1,mL,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,00904-7427-30,NDC,,,facility,outpatient,1,mL,0.24000,0.22000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,inpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,45802-0410-59,NDC,,,facility,outpatient,1,mL,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0028-27,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0130-27,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,49348-0231-27,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,inpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,69618-0050-51,NDC,,,facility,outpatient,1,mL,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1037-01,NDC,,,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09000,0.17460,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,inpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
OXYMETAZOLINE SPRAY 0.05% 30 ML NASAL,67733,CDM,250,RC,70677-1039-01,NDC,,,facility,outpatient,1,mL,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,inpatient,1,mL,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,1.06,1.87,percent of total billed charges,
"OPHTHALMIC IRRIGATION, EXTRAOCULAR",67735,CDM,250,RC,00065-0530-01,NDC,,,facility,outpatient,1,mL,1.93000,1.83000,Amish/Mennonite,Amish Mennonite,,1.06,,,,,,,0.96500,1.87,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
THALLIUM TL-201 5.6MCI PER MCI,67737,CDM,343,RC,A9505,HCPCS,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,28.50,70.98,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,237.49000,225.62000,Amish/Mennonite,Amish Mennonite,,130.62,,,,,,,116.37,230.37,percent of total billed charges,
SYSTEM GWIRE L300CM DIA0.035IN STD STEER,67738,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,237.49000,225.62000,Amish/Mennonite,Amish Mennonite,,130.62,,,,,,,109.01,237.49,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X10X150CM,67739,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2315.94,5045.63,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X15X150CM,67740,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2315.94,5045.63,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,inpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,,675.95,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP STUDY; UNATTENDED-TECH,67743,CDM,920,RC,95806,CPT,,,facility,outpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,,675.95,,,,,,,148.57,1447.00,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,inpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,90,418.55,,,,,,,418.55,738.17,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB-TECH",67745,CDM,300,RC,88346,CPT,,,facility,outpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,90,418.55,,,,,,,380.50,6088.74,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,inpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.88550,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,00115-3511-01-00050,NDC,,,facility,outpatient,1,EA,1.61000,1.53000,Amish/Mennonite,Amish Mennonite,,0.88550,,,,,,,0.80500,1.56,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,inpatient,1,EA,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
PYRIDOSTIGMINE 30 MG TAB,67746,CDM,250,RC,58657-0810-21,NDC,,,facility,outpatient,1,EA,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,21.34,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,inpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.89650,1.58,percent of total billed charges,
WARFARIN 0.25 MG TAB,67747,CDM,250,RC,00056-0169-75-00025,NDC,,,facility,outpatient,1,EA,1.63000,1.55000,Amish/Mennonite,Amish Mennonite,,0.89650,,,,,,,0.81500,1.58,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,inpatient,1,EA,34.14000,32.44000,Amish/Mennonite,Amish Mennonite,,18.78,,,,,,,18.78,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-11,NDC,,,facility,outpatient,1,EA,34.14000,32.44000,Amish/Mennonite,Amish Mennonite,,18.78,,,,,,,17.07,33.12,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,inpatient,1,EA,32.01000,30.41000,Amish/Mennonite,Amish Mennonite,,17.61,,,,,,,17.61,31.05,percent of total billed charges,
BENZOCAINE SPRAY 20% UD (EQV-HURRICAINE),67751,CDM,250,RC,00283-0610-26,NDC,,,facility,outpatient,1,EA,32.01000,30.41000,Amish/Mennonite,Amish Mennonite,,17.61,,,,,,,16.00,31.05,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,86.35,152.29,percent of total billed charges,
MUMPS IMMUNE STATUS-TECH,67752,CDM,300,RC,86735,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,13.05,679.08,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,90,101.20,,,,,,,101.20,178.48,percent of total billed charges,
"MERCURY, BLOOD SO TECH",67753,CDM,300,RC,83825,CPT,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,90,101.20,,,,,,,16.80,848.80,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,90,117.70,,,,,,,117.70,207.58,percent of total billed charges,
"ARSENIC, BLOOD SO TECH",67754,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.00000,203.30000,Amish/Mennonite,Amish Mennonite,90,117.70,,,,,,,19.60,984.66,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,inpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,90,144.10,,,,,,,144.10,254.14,percent of total billed charges,
"CADMIUM, BLOOD SO TECH",67755,CDM,300,RC,82300,CPT,,,facility,outpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,90,144.10,,,,,,,24.43,1205.34,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,inpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,90,77.55,,,,,,,77.55,136.77,percent of total billed charges,
"LEAD, BLOOD SO TECH",67756,CDM,300,RC,83655,CPT,,,facility,outpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,90,77.55,,,,,,,12.51,628.12,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
TOPIRAMATE 12.5 MG TAB,67758,CDM,250,RC,68084-0342-01-00050,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.90,17.46,percent of total billed charges,
ISOVUE M200 TO 10ML,67763,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,0.63085,17.46,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
FRENECTOMY-TECH,67764,CDM,361,RC,41010,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,4686.00,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,inpatient,1,mL,2753.58000,2615.90000,Amish/Mennonite,Amish Mennonite,,1514.47,,,,,,,1514.47,2670.97,percent of total billed charges,
OMALIZUMAB 150 MG/ML SOLN,67765,CDM,636,RC,J2357,HCPCS,50242021501,NDC,facility,outpatient,1,mL,2753.58000,2615.90000,Amish/Mennonite,Amish Mennonite,,1514.47,,,,,,,40.56,2670.97,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,inpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.44550,0.78570,percent of total billed charges,
PYRIDOSTIGMINE 15 MG TAB,67766,CDM,250,RC,00115-3511-01-00025,NDC,,,facility,outpatient,1,EA,0.81000,0.77000,Amish/Mennonite,Amish Mennonite,,0.44550,,,,,,,0.40500,0.78570,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,inpatient,,,453.80000,431.11000,Amish/Mennonite,Amish Mennonite,90,249.59,,,,,,,249.59,440.19,percent of total billed charges,
"AMINO ACIDS,QNT,CSF SO TECH",67767,CDM,300,RC,82139,CPT,,,facility,outpatient,,,453.80000,431.11000,Amish/Mennonite,Amish Mennonite,90,249.59,,,,,,,17.43,882.80,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,inpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,90,83.98,,,,,,,83.98,148.12,percent of total billed charges,
PARANEOPLASTIC AUTOAB ACHR SO TECH,67768,CDM,300,RC,83519,CPT,,,facility,outpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,90,83.98,,,,,,,19.00,865.84,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,inpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,80.52,142.01,percent of total billed charges,
STRIATIONAL AB SO TECH,67769,CDM,300,RC,83520,CPT,,,facility,outpatient,,,146.40000,139.08000,Amish/Mennonite,Amish Mennonite,90,80.52,,,,,,,17.85,814.87,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,inpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,74.91,132.11,percent of total billed charges,
PARANEOPLASTIC AB SCREEN  SO TECH,67770,CDM,300,RC,86255,CPT,,,facility,outpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,12.45,1539.22,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,inpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
LAMOTRIGINE 12.5 MG TAB,67776,CDM,250,RC,51079-0498-20-00050,NDC,,,facility,outpatient,1,EA,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
SODIUM CHLORIDE 500 MG TAB,67777,CDM,250,RC,00223-1760-01-00050,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,577.50,1018.50,percent of total billed charges,
INDIUM IN-111 DTPA PER 0.5MCI,67782,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,525.00,1180.23,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,Amish/Mennonite,Amish Mennonite,,16754.43,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L14MM OD3.5MM 55DEG SFT DST TIP BRD 4 FLX TECH,67784,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,Amish/Mennonite,Amish Mennonite,,16754.43,,,,,,,13982.33,30462.60,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67785,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67786,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 1.5MM 145CM PEBAX HDRCT MN TREK,67787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1368.75000,1300.31000,Amish/Mennonite,Amish Mennonite,,752.81,,,,,,,670.69,1327.69,percent of total billed charges,
GUIDEWIRE VASC .016IN 180CM PERI SS NTNL PTFE,67788,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1368.75000,1300.31000,Amish/Mennonite,Amish Mennonite,,752.81,,,,,,,628.26,1368.75,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,33159.00000,31501.05000,Amish/Mennonite,Amish Mennonite,,18237.45,,,,,,,16247.91,32164.23,percent of total billed charges,
DEVICE EMB L25MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,67789,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,33159.00000,31501.05000,Amish/Mennonite,Amish Mennonite,,18237.45,,,,,,,15219.98,33159.00,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,5184.35,10262.89,percent of total billed charges,
STENT ENDOPROS L2.5CM DIA7MM CATH 7FR L120CM 0.018/0.014IN,67790,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10580.30000,10051.28000,Amish/Mennonite,Amish Mennonite,,5819.16,,,,,,,4856.36,10580.30,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,inpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,276.10,486.94,percent of total billed charges,
PAIN CLINIC SCREEN W/CONF-TECH,67792,CDM,300,RC,80307,CPT,,,facility,outpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,62.14,3038.81,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
ALPHA GLACTOSIDASE SO-TECH,67793,CDM,300,RC,82657,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,22.91,1035.56,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,inpatient,,,234.30000,222.58000,Amish/Mennonite,Amish Mennonite,90,128.87,,,,,,,128.87,227.27,percent of total billed charges,
CLONAZEPAN SO-TECH,67794,CDM,300,RC,80346,CPT,,,facility,outpatient,,,234.30000,222.58000,Amish/Mennonite,Amish Mennonite,90,128.87,,,,,,,117.15,1137.41,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,inpatient,,,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,90,63.85,,,,,,,63.85,112.62,percent of total billed charges,
COPPER URINE SO-TECH,67795,CDM,300,RC,82525,CPT,,,facility,outpatient,,,116.10000,110.29000,Amish/Mennonite,Amish Mennonite,90,63.85,,,,,,,12.82,645.08,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,inpatient,,,228.40000,216.98000,Amish/Mennonite,Amish Mennonite,90,125.62,,,,,,,125.62,221.55,percent of total billed charges,
"ANAPLASMA PHAGOCYT AB, IGG (ANAP) SO",67796,CDM,300,RC,86666,CPT,,,facility,outpatient,,,228.40000,216.98000,Amish/Mennonite,Amish Mennonite,90,125.62,,,,,,,8.17,526.26,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,inpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,438.35,773.09,percent of total billed charges,
FETAL BIOPHYSICAL PROFILE W/NON-STRESS TESTING-TECH,67797,CDM,402,RC,76818,CPT,,,facility,outpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,100.97,773.09,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
MULTIVITAMIN VITAMIN B COMPLEX TAB,67799,CDM,250,RC,50268-0857-15-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00168-0062-02,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,00536-5700-25,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,inpatient,1,GM,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
ZINC OXIDE OINT 20% 60 GM,67800,CDM,250,RC,75834-0170-02,NDC,,,facility,outpatient,1,GM,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,inpatient,1,EA,271.76000,258.17000,Amish/Mennonite,Amish Mennonite,,149.47,,,,,,,149.47,263.61,percent of total billed charges,
THROMBIN TOPICAL RECOMBINANT 5000 INTL UNITS POWD,67802,CDM,250,RC,43825-0606-41,NDC,,,facility,outpatient,1,EA,271.76000,258.17000,Amish/Mennonite,Amish Mennonite,,149.47,,,,,,,135.88,263.61,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
PHENAZOPYRIDINE 95 MG TAB,67804,CDM,250,RC,49348-0076-44,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,inpatient,1,mL,222.19000,211.08000,Amish/Mennonite,Amish Mennonite,,122.20,,,,,,,122.20,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001104,NDC,facility,outpatient,1,mL,222.19000,211.08000,Amish/Mennonite,Amish Mennonite,,122.20,,,,,,,64.92,215.52,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,inpatient,1,mL,150.10000,142.60000,Amish/Mennonite,Amish Mennonite,,82.56,,,,,,,82.56,145.60,percent of total billed charges,
PERFLUTREN (LIPID MICROSPHERES) SUSP,67805,CDM,250,RC,Q9957,HCPCS,11994001116,NDC,facility,outpatient,1,mL,150.10000,142.60000,Amish/Mennonite,Amish Mennonite,,82.56,,,,,,,64.92,145.60,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,inpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,2.19,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,11509-0000-03,NDC,,,facility,outpatient,1,EA,3.98000,3.78000,Amish/Mennonite,Amish Mennonite,,2.19,,,,,,,1.99,3.86,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,inpatient,1,EA,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,3.20,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0001-87,NDC,,,facility,outpatient,1,EA,5.81000,5.52000,Amish/Mennonite,Amish Mennonite,,3.20,,,,,,,2.90,5.64,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,inpatient,1,EA,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,5.20,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0625-42,NDC,,,facility,outpatient,1,EA,9.45000,8.98000,Amish/Mennonite,Amish Mennonite,,5.20,,,,,,,4.72,9.17,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0627-49,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,12546-0628-69,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,inpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0986-05,NDC,,,facility,outpatient,1,EA,3.13000,2.97000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
MENTHOL LOZENGE,67806,CDM,250,RC,49348-0990-44,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,inpatient,1,mL,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,2049.30,3614.22,percent of total billed charges,
ANGIOTENSIN II 2.5 MG/ML SOLN,67807,CDM,250,RC,68547-0501-02,NDC,,,facility,outpatient,1,mL,3726.00000,3539.70000,Amish/Mennonite,Amish Mennonite,,2049.30,,,,,,,1863.00,3614.22,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,497.20,876.88,percent of total billed charges,
"FLUCICLOVINE F-18, DIAGNOSTIC, 1 MILLICURIE",67808,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,268.42,876.88,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,inpatient,,,658.00000,625.10000,Amish/Mennonite,Amish Mennonite,90,361.90,,,,,,,361.90,638.26,percent of total billed charges,
FATTY ACID MITOCHON (FAPM) SO,67809,CDM,300,RC,82725,CPT,,,facility,outpatient,,,658.00000,625.10000,Amish/Mennonite,Amish Mennonite,90,361.90,,,,,,,18.72,882.80,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
INJ PARAVERTEBRAL W/GUIDANCE-TECH,67812,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
INJ MUSCLE TRIGGER PTS 1-2-TECH,67813,CDM,361,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,3163.00,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,257.95,454.93,percent of total billed charges,
INJ MUSCLE TRIGGER PT 3 OR MORE-TECH,67814,CDM,361,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,257.95,3163.00,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,inpatient,,,3369.00000,3200.55000,Amish/Mennonite,Amish Mennonite,,1852.95,,,,,,,1852.95,3267.93,percent of total billed charges,
LARYNGOSCOPY-TECH,67815,CDM,361,RC,,,,,facility,outpatient,,,3369.00000,3200.55000,Amish/Mennonite,Amish Mennonite,,1852.95,,,,,,,1852.95,5271.00,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
PRIMIDONE 125 MG TAB,67817,CDM,250,RC,53746-0545-01-00050,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,inpatient,1,EA,4.12000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.27,4.00,percent of total billed charges,
VALACYCLOVIR TAB 250 MG,67818,CDM,250,RC,50268-0788-15-00050,NDC,,,facility,outpatient,1,EA,4.12000,3.92000,Amish/Mennonite,Amish Mennonite,,2.27,,,,,,,2.06,4.00,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
VENLAFAXINE 18.75 MG TAB,67819,CDM,250,RC,68084-0856-01-00025,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,inpatient,1,GM,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,43598-0210-25,NDC,,,facility,outpatient,1,GM,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,inpatient,1,GM,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
SILVER SULFADIAZINE TOPICAL 1% CREA,67821,CDM,250,RC,61570-0131-25,NDC,,,facility,outpatient,1,GM,0.94000,0.89000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.47000,0.91180,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,inpatient,,,1660.00000,1577.00000,Amish/Mennonite,Amish Mennonite,TC,913.00,,,,,,,913.00,1610.20,percent of total billed charges,
"VENOGRAPHY, VENOUS SINUS-TECH",67822,CDM,320,RC,75860,CPT,,,facility,outpatient,,,1660.00000,1577.00000,Amish/Mennonite,Amish Mennonite,TC,913.00,,,,,,,426.30,17311.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRP,67824,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEFORCE CX 90 DEG,67827,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICEROD CX 90 DEG,67828,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,inpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE <5-TECH,67830,CDM,361,RC,36568,CPT,,,facility,outpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1475.05,3963.00,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,inpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,2990.51,percent of total billed charges,
PICC INSERT WO GUIDE 5 OR OLDER-TECH,67831,CDM,361,RC,36569,CPT,,,facility,outpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1475.05,4686.00,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,inpatient,,,2762.00000,2623.90000,Amish/Mennonite,Amish Mennonite,,1519.10,,,,,,,1519.10,2679.14,percent of total billed charges,
CYSTOURETHROSCOPY -TECH,67833,CDM,361,RC,52310,CPT,,,facility,outpatient,,,2762.00000,2623.90000,Amish/Mennonite,Amish Mennonite,,1519.10,,,,,,,1519.10,6003.00,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,inpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,,558.80,,,,,,,558.80,985.52,percent of total billed charges,
BLOOD PATCH-TECH,67834,CDM,361,RC,,,,,facility,outpatient,,,1016.00000,965.20000,Amish/Mennonite,Amish Mennonite,,558.80,,,,,,,558.80,5271.00,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,inpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
VERAPAMIL 60 MG TAB,67841,CDM,250,RC,00904-2924-61-00050,NDC,,,facility,outpatient,1,EA,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
CEFUROXIME 10 MG/ML SOLN-,67842,CDM,250,RC,J0697,HCPCS,0014395682501000,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.78,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,inpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,90,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
JAK2 GENE MBLD BN SO TECH,67844,CDM,300,RC,81270,CPT,,,facility,outpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,90,569.80,,,,,,,94.71,4787.38,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,67851,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,inpatient,,,1965.00000,1866.75000,Amish/Mennonite,Amish Mennonite,TC,1080.75,,,,,,,1080.75,1906.05,percent of total billed charges,
DIAGNOSTIC BONE MARROW; BIOPSY(IES) CT-TECH,67860,CDM,361,RC,38221,CPT,,,facility,outpatient,,,1965.00000,1866.75000,Amish/Mennonite,Amish Mennonite,TC,1080.75,,,,,,,1080.75,4686.00,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,78.40,155.20,percent of total billed charges,
CATH EP SUPREME JSN 5FR X120 CM,67861,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,73.44,160.00,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L24CM AXXCESS CATH 6FR HYDR+ DBL PGTL,67862,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 4.8FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67863,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURSTEEL PLMR,67864,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,174.56,345.56,percent of total billed charges,
GUIDEWIRE FIELDER FC J .014 180CM,67865,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,163.52,356.25,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,876.23000,832.42000,Amish/Mennonite,Amish Mennonite,,481.93,,,,,,,429.35,849.94,percent of total billed charges,
TUBE JJNSTM 18FR 45CM MC SLK SIL 7-10ML RADOPQ,67867,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,876.23000,832.42000,Amish/Mennonite,Amish Mennonite,,481.93,,,,,,,402.19,876.23,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1140.19000,1083.18000,Amish/Mennonite,Amish Mennonite,,627.10,,,,,,,558.69,1105.98,percent of total billed charges,
GUIDEWIRE ORTH 3MM 800MM TI T2 BALL TIP STRL FEM,67868,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1140.19000,1083.18000,Amish/Mennonite,Amish Mennonite,,627.10,,,,,,,523.35,1140.19,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,12400.00000,11780.00000,Amish/Mennonite,Amish Mennonite,,6820.00,,,,,,,6076.00,12028.00,percent of total billed charges,
SYSTEM EMBL PRTC 6FR 10-15MM 95CM SNTNL 4CM 6,67869,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,12400.00000,11780.00000,Amish/Mennonite,Amish Mennonite,,6820.00,,,,,,,5691.60,12400.00,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN PEDIATRIC MULTIPLE,67878,CDM,250,RC,00087-0402-03-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MULTIVITAMIN W/ IRON PEDIATRIC,67879,CDM,250,RC,00087-0405-01-00050,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,inpatient,1,mL,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
FENTANYL-BUPIVACAINE 2 MCG/ML-,67880,CDM,250,RC,70092-1255-75,NDC,,,facility,outpatient,1,mL,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 4MM COR CROSSFLEX2 TUNG TREK,67898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,inpatient,,,457.00000,434.15000,Amish/Mennonite,Amish Mennonite,,251.35,,,,,,,251.35,443.29,percent of total billed charges,
DENTAL BLOCK-TECH,67899,CDM,450,RC,,,,,facility,outpatient,,,457.00000,434.15000,Amish/Mennonite,Amish Mennonite,,251.35,,,,,,,228.50,443.29,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 30MM 120CM ZMED 4CM FLXB DIST,67903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
GALLIUM 67-6MCI PER MCI,67905,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,36.30,145.50,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L40MM PLUNG GRP FLX SHFT FOR GILLINOV,67910,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,1900.26,4140.00,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
MULTIVITAMIN W/ MINERAL 0.5 TAB,67911,CDM,250,RC,16500-0088-06-00050,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
CHOLECALCIFEROL LIQUID,67912,CDM,250,RC,00087-0866-44-00100,NDC,,,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,inpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
PETROLATUM TOPICAL 100% OIN,67921,CDM,250,RC,00521-2311-00,NDC,,,facility,outpatient,1,GM,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,inpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.91850,1.62,percent of total billed charges,
VERAPAMIL 60 MG TAB-ER,67922,CDM,250,RC,51079-0869-20-00025,NDC,,,facility,outpatient,1,EA,1.67000,1.59000,Amish/Mennonite,Amish Mennonite,,0.91850,,,,,,,0.83500,1.62,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1931.25000,1834.69000,Amish/Mennonite,Amish Mennonite,,1062.19,,,,,,,946.31,1873.31,percent of total billed charges,
CATHETER BLNOCC 10-37MM 90CM GORE 4CM MLD STNT,67936,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1931.25000,1834.69000,Amish/Mennonite,Amish Mennonite,,1062.19,,,,,,,886.44,1931.25,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X10MM,67937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,49.20000,46.74000,Amish/Mennonite,Amish Mennonite,,27.06,,,,,,,24.11,47.72,percent of total billed charges,
CATHETER URET 6FR 70CM SFLX OP-EN ACPT .04IN GW,67938,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,49.20000,46.74000,Amish/Mennonite,Amish Mennonite,,27.06,,,,,,,22.58,49.20,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,inpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
"LIDOCAINE-EPI SOLN 1% -1  100,000 10 ML",67939,CDM,250,RC,J2004,HCPCS,63323048217,NDC,facility,outpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,1.07,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,99.66,175.76,percent of total billed charges,
LACTOSAMIDE SO TECH,67944,CDM,300,RC,80235,CPT,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,21.69,186.79,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
I&D WOUND -TECH,67948,CDM,361,RC,10060,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,3163.00,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,Amish/Mennonite,Amish Mennonite,,2572.67,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC 1 BRANCH DBL VEL AORT ARCH POLY WVN IMPL L50CM,67949,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,Amish/Mennonite,Amish Mennonite,,2572.67,,,,,,,2147.01,4677.58,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,inpatient,1,GM,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,11523-7204-01,NDC,,,facility,outpatient,1,GM,0.16000,0.16000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,inpatient,1,GM,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTMENT,67953,CDM,250,RC,41100-8116-03,NDC,,,facility,outpatient,1,GM,0.14000,0.14000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,inpatient,1,EA,11.69000,11.11000,Amish/Mennonite,Amish Mennonite,,6.43,,,,,,,6.43,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,00378876693,NDC,facility,outpatient,1,EA,11.69000,11.11000,Amish/Mennonite,Amish Mennonite,,6.43,,,,,,,5.84,11.34,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,inpatient,1,EA,28.38000,26.96000,Amish/Mennonite,Amish Mennonite,,15.61,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,12496120403,NDC,facility,outpatient,1,EA,28.38000,26.96000,Amish/Mennonite,Amish Mennonite,,15.61,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,inpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 4 MG-1 MG,67954,CDM,250,RC,J0573,HCPCS,47781035603,NDC,facility,outpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,10.01,19.41,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,inpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
OXCARBAZEPINE 75 MG TAB,67958,CDM,250,RC,00054-0097-20-00050,NDC,,,facility,outpatient,1,EA,0.67000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,inpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,TC,231.00,,,,,,,231.00,407.40,percent of total billed charges,
TMJ OPEN/CLOSED MOUTH BILAT-TECH,67959,CDM,320,RC,70330,CPT,,,facility,outpatient,,,420.00000,399.00000,Amish/Mennonite,Amish Mennonite,TC,231.00,,,,,,,210.00,2162.63,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,158.40,279.36,percent of total billed charges,
"RAD EXAM, MANDIBLE; LESS THAN 4 VIEWS-TECH",67961,CDM,320,RC,70100,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,TC,158.40,,,,,,,144.00,1509.95,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,inpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,TC,130.35,,,,,,,130.35,229.89,percent of total billed charges,
"RAD EXAM, FEMUR; 1 VIEW-TECH",67962,CDM,320,RC,73551,CPT,,,facility,outpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,TC,130.35,,,,,,,112.98,1134.10,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,Amish/Mennonite,Amish Mennonite,TC,2025.65,,,,,,,2025.65,3572.51,percent of total billed charges,
BILIARY IMAGING; INCLUDING GALLBLADDER W PHARM-TECH,67963,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,Amish/Mennonite,Amish Mennonite,TC,2025.65,,,,,,,1841.50,3572.51,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
PT BIOFEEDBACK UNITS-TECH,67964,CDM,420,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,264.00,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
OT BIOFEEDBACK UNITS-TECH,67965,CDM,430,RC,90901,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,264.00,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
EVAL FOR SPEECH GENERATING DEVICE-TECH,67966,CDM,440,RC,92608,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,126.65,267.72,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,510.40,900.16,percent of total billed charges,
BLOOD  PATCH-TECH,67970,CDM,450,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,464.00,900.16,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,790.55,percent of total billed charges,
EPIDURAL STEROID INJ-TECH,67976,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,5271.00,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
TRAZODONE 12.5 MG TAB,67977,CDM,250,RC,00904-6554-61-00025,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,inpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,391.60,690.64,percent of total billed charges,
FIBER OPTIC SCOPE-TECH,67982,CDM,361,RC,,,,,facility,outpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,391.60,5271.00,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
LABETALOL 50 MG TAB,67986,CDM,250,RC,60687-0114-01-00050,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L8CM DIA3MM 360DEG ULT DETACH TARGET,67989,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 5.3MM 14FR 33CM HDRPH GORE DRYSEAL,67990,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,67991,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,inpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
PAROXETINE 5 MG TAB,67992,CDM,250,RC,00904-5676-61-00050,NDC,,,facility,outpatient,1,EA,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,1.22,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 22FR 13CM PLWY 20CM STRL DISP ACPT,67993,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,73.07,159.20,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1150.20000,1092.69000,Amish/Mennonite,Amish Mennonite,,632.61,,,,,,,563.60,1115.69,percent of total billed charges,
BLLN PTS 25MMX3.0CMX80CM,67994,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1150.20000,1092.69000,Amish/Mennonite,Amish Mennonite,,632.61,,,,,,,527.94,1150.20,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1751.25000,1663.69000,Amish/Mennonite,Amish Mennonite,,963.19,,,,,,,858.11,1698.71,percent of total billed charges,
CATHETER BLLN DLTN 75CM 2CM 8MM FLXBL TIP LP 6FR,67995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1751.25000,1663.69000,Amish/Mennonite,Amish Mennonite,,963.19,,,,,,,803.82,1751.25,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLLN DLTN  90CM 2CM 9MM LP 5FR,67996,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,967.59,2108.03,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 100 MG / 2.5 ML,67997,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGE ECG-TECH,67998,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,103.50,200.79,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,946.09000,898.79000,Amish/Mennonite,Amish Mennonite,,520.35,,,,,,,463.58,917.71,percent of total billed charges,
SET URET STNT 4.8FR L28CM AXXCESS CATH 6FR PERCFLX HYDR+ FRM,67999,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,946.09000,898.79000,Amish/Mennonite,Amish Mennonite,,520.35,,,,,,,434.26,946.09,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM ELASTINITE,68000,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH 18FR 15.5CM PLWY PERC STRL DISP ACPT,68001,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,73.07,159.20,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
W NILE IGM SO-TECH,68002,CDM,300,RC,86788,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,8.17,882.80,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,inpatient,,,162.60000,154.47000,Amish/Mennonite,Amish Mennonite,90,89.43,,,,,,,89.43,157.72,percent of total billed charges,
WEST NILE IGG SO-TECH,68003,CDM,300,RC,86789,CPT,,,facility,outpatient,,,162.60000,154.47000,Amish/Mennonite,Amish Mennonite,90,89.43,,,,,,,14.87,746.94,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,inpatient,,,176.30000,167.49000,Amish/Mennonite,Amish Mennonite,90,96.97,,,,,,,96.97,171.01,percent of total billed charges,
INHIBIN A SO-TECH,68004,CDM,300,RC,86336,CPT,,,facility,outpatient,,,176.30000,167.49000,Amish/Mennonite,Amish Mennonite,90,96.97,,,,,,,16.11,814.87,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,inpatient,,,210.20000,199.69000,Amish/Mennonite,Amish Mennonite,90,115.61,,,,,,,115.61,203.89,percent of total billed charges,
HOMOVANILLIC ACID SO-TECH,68005,CDM,300,RC,83150,CPT,,,facility,outpatient,,,210.20000,199.69000,Amish/Mennonite,Amish Mennonite,90,115.61,,,,,,,19.62,1052.52,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,inpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,968.06,percent of total billed charges,
PERC ASP INTERVERTEBRAL DISC-TECH,68009,CDM,361,RC,62267,CPT,,,facility,outpatient,,,998.00000,948.10000,Amish/Mennonite,Amish Mennonite,,548.90,,,,,,,548.90,3163.00,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,inpatient,,,1134.00000,1077.30000,Amish/Mennonite,Amish Mennonite,,623.70,,,,,,,623.70,1099.98,percent of total billed charges,
MYELO VIA LUMBAR INJ 2 REGIONS-TECH,68010,CDM,320,RC,62305,CPT,,,facility,outpatient,,,1134.00000,1077.30000,Amish/Mennonite,Amish Mennonite,,623.70,,,,,,,567.00,1099.98,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,inpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,,739.20,,,,,,,739.20,1303.68,percent of total billed charges,
"PLEURAL DRAINAGE, PERC W/CATH INSERT-TECH",68011,CDM,350,RC,32557,CPT,,,facility,outpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,,739.20,,,,,,,672.00,1820.00,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,16714-0190-01,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
GUANFACINE 1 MG TAB-,68014,CDM,250,RC,62332-0745-31,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,inpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00338341024,NDC,facility,outpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,2.76,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,inpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
CLINDAMYCIN 300 MG/D5W 50 ML PREMIX,68019,CDM,250,RC,J0736,HCPCS,00781922009,NDC,facility,outpatient,1,mL,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,2.76,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
ACETYLCYSTEINE SOLN INH 10% 30 ML,68020,CDM,250,RC,J7608,HCPCS,00409330703,NDC,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,14.67,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,Amish/Mennonite,Amish Mennonite,,187.82,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 1.25 MCG/INH AERO,68021,CDM,250,RC,00597-0160-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,Amish/Mennonite,Amish Mennonite,,187.82,,,,,,,170.75,331.25,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
EMOLLIENT CREAM 106 GM (EQV-EUCERIN),68022,CDM,250,RC,61924-0174-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,inpatient,1,mL,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
BETAMETHASONE TOPICAL VALERATE 0.1%,68023,CDM,250,RC,54879-0004-60,NDC,,,facility,outpatient,1,mL,3.17000,3.01000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,inpatient,1,GM,7.76000,7.37000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,4.27,7.53,percent of total billed charges,
CAPSAICIN TOPICAL 0.1% CREA,68024,CDM,250,RC,41167-0751-42,NDC,,,facility,outpatient,1,GM,7.76000,7.37000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,3.88,7.53,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,inpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,00904-6710-15,NDC,,,facility,outpatient,1,EA,0.58000,0.56000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,inpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.25300,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1611-11,NDC,,,facility,outpatient,1,EA,0.46000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25300,,,,,,,0.23000,0.44620,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,inpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,56151-1610-51,NDC,,,facility,outpatient,1,EA,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,inpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.40700,0.71780,percent of total billed charges,
GLUCOSE 4 G TAB-,68025,CDM,250,RC,80681-0100-00,NDC,,,facility,outpatient,1,EA,0.74000,0.71000,Amish/Mennonite,Amish Mennonite,,0.40700,,,,,,,0.37000,0.71780,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,inpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.15950,0.28130,percent of total billed charges,
MENTHOL TOPICAL 4% GEL,68032,CDM,250,RC,59316-0103-12,NDC,,,facility,outpatient,1,mL,0.29000,0.28000,Amish/Mennonite,Amish Mennonite,,0.15950,,,,,,,0.14500,0.28130,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,inpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,00436-0946-16,NDC,,,facility,outpatient,1,mL,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,inpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
SODIUM HYPOCHLORITE IRR 0.5% (DAKINS) 473 ML,68040,CDM,250,RC,39328-0062-50,NDC,,,facility,outpatient,1,mL,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,inpatient,1,mL,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,28.24,49.81,percent of total billed charges,
PHENYLEPHRINE SOLN-OPHTH 2.5% 2 ML,68041,CDM,250,RC,70756-0629-25,NDC,,,facility,outpatient,1,mL,51.35000,48.78000,Amish/Mennonite,Amish Mennonite,,28.24,,,,,,,25.68,49.81,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,inpatient,1,mL,492.10000,467.50000,Amish/Mennonite,Amish Mennonite,,270.65,,,,,,,270.65,477.34,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 16,68042,CDM,250,RC,57770-0495-67,NDC,,,facility,outpatient,1,mL,492.10000,467.50000,Amish/Mennonite,Amish Mennonite,,270.65,,,,,,,246.05,477.34,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,inpatient,1,mL,705.23000,669.97000,Amish/Mennonite,Amish Mennonite,,387.88,,,,,,,387.88,684.07,percent of total billed charges,
OPHTHALMIC 40 MG-30 MG/ML SOLN,68044,CDM,250,RC,08065-1839-75,NDC,,,facility,outpatient,1,mL,705.23000,669.97000,Amish/Mennonite,Amish Mennonite,,387.88,,,,,,,352.62,684.07,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,inpatient,1,mL,117.73000,111.84000,Amish/Mennonite,Amish Mennonite,,64.75,,,,,,,64.75,114.20,percent of total billed charges,
INSULIN ASPART 100 UNITS/ML SOL,68046,CDM,250,RC,00169-6339-10,NDC,,,facility,outpatient,1,mL,117.73000,111.84000,Amish/Mennonite,Amish Mennonite,,64.75,,,,,,,58.87,114.20,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,inpatient,1,mL,42.98000,40.83000,Amish/Mennonite,Amish Mennonite,,23.64,,,,,,,23.64,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,25021045405,NDC,facility,outpatient,1,mL,42.98000,40.83000,Amish/Mennonite,Amish Mennonite,,23.64,,,,,,,0.91450,41.69,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,inpatient,1,mL,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,13.56,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,23155068531,NDC,facility,outpatient,1,mL,24.65000,23.42000,Amish/Mennonite,Amish Mennonite,,13.56,,,,,,,0.91450,23.91,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,inpatient,1,mL,62.81000,59.67000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,34.55,60.93,percent of total billed charges,
OCTREOTIDE 200 MCG/ML SOLN,68047,CDM,250,RC,J2354,HCPCS,63323037805,NDC,facility,outpatient,1,mL,62.81000,59.67000,Amish/Mennonite,Amish Mennonite,,34.55,,,,,,,0.91450,60.93,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
NIACIN 500 MG CAP-,68048,CDM,250,RC,00536-4077-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,inpatient,1,mL,33.52000,31.85000,Amish/Mennonite,Amish Mennonite,,18.44,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO-INSULIN LISPRO PROTAMINE 25,68053,CDM,250,RC,J1815,HCPCS,00002879759,NDC,facility,outpatient,1,mL,33.52000,31.85000,Amish/Mennonite,Amish Mennonite,,18.44,,,,,,,1.49,32.51,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,inpatient,1,mL,198.20000,188.29000,Amish/Mennonite,Amish Mennonite,,109.01,,,,,,,109.01,192.25,percent of total billed charges,
PENICILLIN G BENZ/PROC 900/300 SUSP-INJ 2 ML,68054,CDM,636,RC,J0558,HCPCS,60793060210,NDC,facility,outpatient,1,mL,198.20000,188.29000,Amish/Mennonite,Amish Mennonite,,109.01,,,,,,,17.37,192.25,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,2028.60,4015.80,percent of total billed charges,
DEVICE OCCL CLP L35MM PLUNG GRP FLX SHFT FOR GILLINOV,68055,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,1900.26,4140.00,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,63.58,125.87,percent of total billed charges,
TUBE 14FR SIL UNV FD PORT CNCT,68056,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,59.56,129.76,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 22MM 12FR 110CM TRFLW 3.5CM VLVPL,68058,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3483.81,7590.00,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3.5 CRV 7FR 100CM PERI TRNRDL NYL,68059,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO AL3 CRV 6FR 100CM COR FEM VESTAN,68060,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,inpatient,1,GM,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
PETROLATUM TOPICAL 1 OINTMENT,68061,CDM,250,RC,00521-2345-00,NDC,,,facility,outpatient,1,GM,0.04000,0.03000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,90,100.65,,,,,,,100.65,177.51,percent of total billed charges,
"HOMOCYSTEINE,TOTAL SO TECH",68091,CDM,300,RC,83090,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,90,100.65,,,,,,,18.52,882.80,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191101,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.63000,7.69,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,inpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
MORPHINE 1 MG/ML SOL,68094,CDM,250,RC,J2270,HCPCS,76329191201,NDC,facility,outpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,7.69,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00338107302,NDC,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,13.53,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
DOBUTAMINE 1 MG/ML-D5% SOLN,68095,CDM,250,RC,J1250,HCPCS,00409234632,NDC,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,13.53,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,inpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.60500,1.07,percent of total billed charges,
AMIODARONE 150 MG/D5W 100 ML PREMIX,68096,CDM,250,RC,J0283,HCPCS,43066015010,NDC,facility,outpatient,1,mL,1.10000,1.04000,Amish/Mennonite,Amish Mennonite,,0.60500,,,,,,,0.55000,4.31,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,,689.15,,,,,,,689.15,1215.41,percent of total billed charges,
TECHNETIUM TC-99M TILMANOCEPT,68097,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,,689.15,,,,,,,626.50,1215.41,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,inpatient,,,244.20000,231.99000,Amish/Mennonite,Amish Mennonite,90,134.31,,,,,,,134.31,236.87,percent of total billed charges,
COMPLEMENT ALT PATH FUNC (AH50) SO,68099,CDM,300,RC,86161,CPT,,,facility,outpatient,,,244.20000,231.99000,Amish/Mennonite,Amish Mennonite,90,134.31,,,,,,,12.40,628.12,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 15 MG/0.75 ML,68100,CDM,250,RC,00054-0517-44-00050,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L20CM MET W/ POS SYS RESONANCE,68101,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATH BLLN CONQ 8X6X50CM.,68102,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,303.60000,288.42000,Amish/Mennonite,Amish Mennonite,,166.98,,,,,,,148.76,294.49,percent of total billed charges,
ZIPWIRE .038IN ANGLED TIP BX 5,68103,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,303.60000,288.42000,Amish/Mennonite,Amish Mennonite,,166.98,,,,,,,139.35,303.60,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD LNG JL3.5 CRV 5FR 100CM COR SS NYL.,68103,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,302.10000,287.00000,Amish/Mennonite,Amish Mennonite,,166.16,,,,,,,148.03,293.04,percent of total billed charges,
SET INTRO .035IN 6FR 8FR 11CM PERC S ARWFLX ADLT.,68104,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,302.10000,287.00000,Amish/Mennonite,Amish Mennonite,,166.16,,,,,,,138.66,302.10,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,inpatient,1,mL,96.92000,92.07000,Amish/Mennonite,Amish Mennonite,,53.31,,,,,,,53.31,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,61314-0144-05,NDC,,,facility,outpatient,1,mL,96.92000,92.07000,Amish/Mennonite,Amish Mennonite,,53.31,,,,,,,48.46,94.01,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,inpatient,1,mL,96.91000,92.07000,Amish/Mennonite,Amish Mennonite,,53.30,,,,,,,53.30,94.00,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.15% SOLN,68105,CDM,250,RC,82182-0773-05,NDC,,,facility,outpatient,1,mL,96.91000,92.07000,Amish/Mennonite,Amish Mennonite,,53.30,,,,,,,48.45,94.00,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,inpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,59.40,104.76,percent of total billed charges,
OT PHYSICAL PERFORMANCE TEST,68107,CDM,430,RC,97750,CPT,,,facility,outpatient,,,108.00000,102.60000,Amish/Mennonite,Amish Mennonite,,59.40,,,,,,,54.00,264.00,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASCU 1MM MIC J CRV .014IN 190CM,68111,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,4111.30,8138.69,percent of total billed charges,
PROBE ABLT 15GA 15CM NEUWAVE PR15XT,68112,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8390.40000,7970.88000,Amish/Mennonite,Amish Mennonite,,4614.72,,,,,,,3851.19,8390.40,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,Amish/Mennonite,Amish Mennonite,,5704.93,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT ENDOPROS L7CM DST DIA14.5MM IL EXT W/ C3 DEL SYS,68113,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,Amish/Mennonite,Amish Mennonite,,5704.93,,,,,,,4761.02,10372.60,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,inpatient,,,3818.00000,3627.10000,Amish/Mennonite,Amish Mennonite,,2099.90,,,,,,,2099.90,3703.46,percent of total billed charges,
PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) -TECH,68114,CDM,320,RC,10035,CPT,,,facility,outpatient,,,3818.00000,3627.10000,Amish/Mennonite,Amish Mennonite,,2099.90,,,,,,,569.17,3703.46,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
CARBAMAZEPINE 25 MG/ML LIQUID,68120,CDM,250,RC,60505-0183-00-02500,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,inpatient,1,EA,25.76000,24.47000,Amish/Mennonite,Amish Mennonite,,14.17,,,,,,,14.17,24.99,percent of total billed charges,
UMECLIDINIUM-VILANTEROL 62.5 MCG-25 MCG/INH POWD,68121,CDM,250,RC,00173-0869-06,NDC,,,facility,outpatient,1,EA,25.76000,24.47000,Amish/Mennonite,Amish Mennonite,,14.17,,,,,,,12.88,24.99,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,inpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
VALSARTAN 20 MG TAB,68124,CDM,250,RC,43547-0367-03-00050,NDC,,,facility,outpatient,1,EA,0.42000,0.40000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,inpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
EMOLLIENT LIQ SOAP 473 ML (EQV-CETAPHIL),68126,CDM,250,RC,00299-3921-16,NDC,,,facility,outpatient,1,mL,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-10,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,inpatient,1,EA,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
RIVAROXABAN TAB 2.5 MG,68127,CDM,250,RC,50458-0577-60,NDC,,,facility,outpatient,1,EA,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,29.10,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
RESPIRATORY FLOW VOLUME LOOP-TECH,68128,CDM,460,RC,94375,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,138.00,325.26,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,185.90,327.86,percent of total billed charges,
GAS DILUTION/WASHOUT DETERMINE LUNG VLM-TECH,68129,CDM,460,RC,94727,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,148.57,327.86,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
THERAP PROC INCREASE STRNGTH/ENDURANCE-TECH,68130,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,23.25,197.88,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
"UC VISIT EST, LEVEL 3 TECH",68131,CDM,456,RC,99213,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,83.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,63.80,112.52,percent of total billed charges,
"UC VISIT EST, LEVEL 2 TECH",68132,CDM,456,RC,99212,CPT,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,58.00,446.00,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
"UC VISIT EST, LEVEL 1 TECH",68133,CDM,456,RC,99211,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,inpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,106.70,188.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 2 TECH",68135,CDM,456,RC,99202,CPT,,,facility,outpatient,,,194.00000,184.30000,Amish/Mennonite,Amish Mennonite,,106.70,,,,,,,97.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,inpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,147.40,259.96,percent of total billed charges,
"UC VISIT NEW, LEVEL 3 TECH",68136,CDM,456,RC,99203,CPT,,,facility,outpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,134.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,inpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,,216.70,,,,,,,216.70,382.18,percent of total billed charges,
"UC VISIT NEW, LEVEL 4 TECH",68137,CDM,456,RC,99204,CPT,,,facility,outpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,,216.70,,,,,,,197.00,446.00,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,inpatient,,,516.00000,490.20000,Amish/Mennonite,Amish Mennonite,,283.80,,,,,,,283.80,500.52,percent of total billed charges,
"UC VISIT NEW, LEVEL 5 TECH",68138,CDM,456,RC,99205,CPT,,,facility,outpatient,,,516.00000,490.20000,Amish/Mennonite,Amish Mennonite,,283.80,,,,,,,258.00,500.52,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 300CM,68146,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL CX 90 DEG,68148,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,inpatient,,,454.00000,431.30000,Amish/Mennonite,Amish Mennonite,TC,249.70,,,,,,,249.70,440.38,percent of total billed charges,
XR HIP UNIL W/WO PELV 4/MORE VWS-TECH,68149,CDM,320,RC,73503,CPT,,,facility,outpatient,,,454.00000,431.30000,Amish/Mennonite,Amish Mennonite,TC,249.70,,,,,,,227.00,2320.90,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,inpatient,,,601.00000,570.95000,Amish/Mennonite,Amish Mennonite,TC,330.55,,,,,,,330.55,582.97,percent of total billed charges,
XR TRANSCERVICAL FALLOP TUB CATH-TECH,68150,CDM,320,RC,74742,CPT,,,facility,outpatient,,,601.00000,570.95000,Amish/Mennonite,Amish Mennonite,TC,330.55,,,,,,,284.63,3099.68,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,inpatient,,,1218.00000,1157.10000,Amish/Mennonite,Amish Mennonite,,669.90,,,,,,,669.90,1181.46,percent of total billed charges,
PERICARDIOCENTESIS-TECH,68155,CDM,361,RC,,,,,facility,outpatient,,,1218.00000,1157.10000,Amish/Mennonite,Amish Mennonite,,669.90,,,,,,,669.90,5271.00,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT SGL LVL CER/THOR W GUID-TECH,68156,CDM,361,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,3163.00,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S SGL LVL W GUID-TECH,68157,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ ANES AGNT L/S ADDL W GUID-TECH,68158,CDM,361,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT PARAVERT INJ L/S ADDL LVL-TECH,68159,CDM,361,RC,64494,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,inpatient,,,534.00000,507.30000,Amish/Mennonite,Amish Mennonite,TC,293.70,,,,,,,293.70,517.98,percent of total billed charges,
XR COMPLEX PHARYNGEAL/SPEECH EVAL-TECH,68160,CDM,320,RC,70371,CPT,,,facility,outpatient,,,534.00000,507.30000,Amish/Mennonite,Amish Mennonite,TC,293.70,,,,,,,267.00,3586.71,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,inpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,52.25,92.15,percent of total billed charges,
LIVER ELASTOGRAPHY SHEAR WAVE-TECH,68163,CDM,402,RC,91200,CPT,,,facility,outpatient,,,95.00000,90.25000,Amish/Mennonite,Amish Mennonite,TC,52.25,,,,,,,47.50,860.53,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,238.70,420.98,percent of total billed charges,
NM LUTATHERA LU177 PER MCI,68164,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,217.00,488.81,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,inpatient,,,1280.00000,1216.00000,Amish/Mennonite,Amish Mennonite,90,704.00,,,,,,,704.00,1241.60,percent of total billed charges,
"HER2, BREAST IHC AUTO (HERBN) SO",68165,CDM,300,RC,88361,CPT,,,facility,outpatient,,,1280.00000,1216.00000,Amish/Mennonite,Amish Mennonite,90,704.00,,,,,,,377.60,6141.84,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,inpatient,,,1161.00000,1102.95000,Amish/Mennonite,Amish Mennonite,90,638.55,,,,,,,638.55,1126.17,percent of total billed charges,
"HER2, BREAST SEMI-QNT IHC, MANUAL (HERBM) SO",68166,CDM,300,RC,88360,CPT,,,facility,outpatient,,,1161.00000,1102.95000,Amish/Mennonite,Amish Mennonite,90,638.55,,,,,,,389.13,6047.82,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,inpatient,1,EA,2.06000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,24338000590,NDC,facility,outpatient,1,EA,2.06000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.03,2.00,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,inpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
THYROID DESICCATED 15 MG TAB,68167,CDM,250,RC,J8499,HCPCS,4219203290100050,NDC,facility,outpatient,1,EA,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,432.00000,410.40000,Amish/Mennonite,Amish Mennonite,,237.60,,,,,,,237.60,419.04,percent of total billed charges,
"TARGETED DRUG PANEL,URINE TECH",68168,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,432.00000,410.40000,Amish/Mennonite,Amish Mennonite,,237.60,,,,,,,98.39,1078.91,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,inpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,164.45,290.03,percent of total billed charges,
"PAIN CLINIC SURVEY 4,URINE TECH",68169,CDM,300,RC,80307,CPT,,,facility,outpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,62.14,3038.81,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,90,1812.80,,,,,,,1812.80,3197.12,percent of total billed charges,
"PROBE, EACH ADDTL SO TECH",68177,CDM,300,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,90,1812.80,,,,,,,533.12,19453.17,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,inpatient,,,2336.00000,2219.20000,Amish/Mennonite,Amish Mennonite,90,1284.80,,,,,,,1284.80,2265.92,percent of total billed charges,
COMP ANALY USING STR SO TECH,68178,CDM,300,RC,81265,CPT,,,facility,outpatient,,,2336.00000,2219.20000,Amish/Mennonite,Amish Mennonite,90,1284.80,,,,,,,234.70,11238.50,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,inpatient,,,2681.00000,2546.95000,Amish/Mennonite,Amish Mennonite,90,1474.55,,,,,,,1474.55,2600.57,percent of total billed charges,
ADDL COMP ANALY STR SO TECH,68179,CDM,300,RC,81266,CPT,,,facility,outpatient,,,2681.00000,2546.95000,Amish/Mennonite,Amish Mennonite,90,1474.55,,,,,,,304.81,14345.24,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,inpatient,1,GM,14.97000,14.22000,Amish/Mennonite,Amish Mennonite,,8.23,,,,,,,8.23,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,16714-0992-03,NDC,,,facility,outpatient,1,GM,14.97000,14.22000,Amish/Mennonite,Amish Mennonite,,8.23,,,,,,,7.49,14.52,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,inpatient,1,GM,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.19250,0.33950,percent of total billed charges,
CLOBETASOL TOPICAL 0.05% CREA,68180,CDM,250,RC,42291-0076-45,NDC,,,facility,outpatient,1,GM,0.35000,0.33000,Amish/Mennonite,Amish Mennonite,,0.19250,,,,,,,0.17500,0.33950,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,inpatient,1,mL,5334.14000,5067.43000,Amish/Mennonite,Amish Mennonite,,2933.78,,,,,,,2933.78,5174.12,percent of total billed charges,
PALIPERIDONE SUSP 156 MG/ML (INVEGA SUSTENNA),68181,CDM,636,RC,J2426,HCPCS,50458056301,NDC,facility,outpatient,1,mL,5334.14000,5067.43000,Amish/Mennonite,Amish Mennonite,,2933.78,,,,,,,15.08,5174.12,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,inpatient,1,mL,29.43000,27.96000,Amish/Mennonite,Amish Mennonite,,16.19,,,,,,,16.19,28.55,percent of total billed charges,
INSULIN ASPART-INSULIN ASPART PROTAMINE 30 UNITS-70 UNITS/ML SUSP,68182,CDM,250,RC,J1815,HCPCS,00169369619,NDC,facility,outpatient,1,mL,29.43000,27.96000,Amish/Mennonite,Amish Mennonite,,16.19,,,,,,,1.49,28.55,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,inpatient,1,EA,795.93000,756.14000,Amish/Mennonite,Amish Mennonite,,437.76,,,,,,,437.76,772.05,percent of total billed charges,
RISPERIDONE POWD-INJ 12.5 MG/2 WEEKS (RISPERDAL CONSTA),68183,CDM,636,RC,J2794,HCPCS,50458030911,NDC,facility,outpatient,1,EA,795.93000,756.14000,Amish/Mennonite,Amish Mennonite,,437.76,,,,,,,10.94,772.05,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA12MM 0.02IN PERIPH COMPLX STD FRME,68185,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA10MM 0.020IN PERIPH COMPLX L VOL STD FRME,68186,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,68187,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,inpatient,,,22663.00000,21529.85000,Amish/Mennonite,Amish Mennonite,,12464.65,,,,,,,12464.65,21983.11,percent of total billed charges,
APP MULT EXTRNL FIX EXCH STRUT-TECH,68223,CDM,960,RC,20697,CPT,,,facility,outpatient,,,22663.00000,21529.85000,Amish/Mennonite,Amish Mennonite,,12464.65,,,,,,,1519.65,21983.11,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMIN VACC SNGL-PROF,68229,CDM,771,RC,90471,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,74.34,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 1 INJ-TECH,68331,CDM,510,RC,95115,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,29.50,57.23,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
ALLERGEN IMMUNOTHRPY 2+ INJ,68342,CDM,510,RC,95117,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,34.50,66.93,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,inpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,223.30,393.82,percent of total billed charges,
CHEMO IVP EA ADDL DRUG,68613,CDM,331,RC,96411,CPT,,,facility,outpatient,,,406.00000,385.70000,Amish/Mennonite,Amish Mennonite,,223.30,,,,,,,67.58,393.82,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,inpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,,503.80,,,,,,,503.80,888.52,percent of total billed charges,
CHEMO INITIATE PROL INF W PUMP,68638,CDM,335,RC,96416,CPT,,,facility,outpatient,,,916.00000,870.20000,Amish/Mennonite,Amish Mennonite,,503.80,,,,,,,314.95,888.52,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,116.60,205.64,percent of total billed charges,
CHEMO HORMONAL SUBQ/IM,68639,CDM,331,RC,96402,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,67.58,205.64,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,inpatient,,,881.00000,836.95000,Amish/Mennonite,Amish Mennonite,,484.55,,,,,,,484.55,854.57,percent of total billed charges,
CHEMO IV INF 1ST HR,68654,CDM,335,RC,96413,CPT,,,facility,outpatient,,,881.00000,836.95000,Amish/Mennonite,Amish Mennonite,,484.55,,,,,,,314.95,854.57,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,inpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,397.10,700.34,percent of total billed charges,
CHEMO IVP SNGL/INIT DRUG,68672,CDM,331,RC,96409,CPT,,,facility,outpatient,,,722.00000,685.90000,Amish/Mennonite,Amish Mennonite,,397.10,,,,,,,314.95,700.34,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL HR,68687,CDM,335,RC,96415,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,67.58,180.42,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,224.40,395.76,percent of total billed charges,
CHEMO IV INF EA ADDL SEQ 1 HR,68706,CDM,335,RC,96417,CPT,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,,224.40,,,,,,,67.58,395.76,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,inpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,267.30,471.42,percent of total billed charges,
CHEMO NONHORMONAL SUBQ/IM,68773,CDM,331,RC,96401,CPT,,,facility,outpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,67.58,471.42,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,inpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,135.30,238.62,percent of total billed charges,
COLL BLD SPEC/IMPL VEN ACC DEV,68812,CDM,510,RC,36591,CPT,,,facility,outpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,122.40,238.62,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
COLL BLOOD SPEC USING CATH VEN,68905,CDM,510,RC,36592,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,122.40,267.72,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,inpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,468.60,826.44,percent of total billed charges,
CONTINUING MED PHYSICS CONSULT,68955,CDM,333,RC,77336,CPT,,,facility,outpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,126.07,4371.88,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30462.60000,28939.47000,Amish/Mennonite,Amish Mennonite,,16754.43,,,,,,,14926.67,29548.72,percent of total billed charges,
DEVICE EMB L18MM DIA4.5MM BRD SFT DST TIP PIPELINE FLX,68973,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30462.60000,28939.47000,Amish/Mennonite,Amish Mennonite,,16754.43,,,,,,,13982.33,30462.60,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,inpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,,179.85,,,,,,,179.85,317.19,percent of total billed charges,
DECLOT IMPL VEN ACCESS DEVICE-TECH,69083,CDM,361,RC,36593,CPT,,,facility,outpatient,,,327.00000,310.65000,Amish/Mennonite,Amish Mennonite,,179.85,,,,,,,179.85,3163.00,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,281.60,496.64,percent of total billed charges,
DXA/XR BN DENSITY AXIAL,69225,CDM,320,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,100.97,2190.64,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
ECHO PELVIC NON OB LTD F/U-PROF,69249,CDM,402,RC,76857,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,100.97,584.87,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,inpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,281.60,496.64,percent of total billed charges,
DXA BN DENSITY AXIAL,69284,CDM,341,RC,77080,CPT,,,facility,outpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,100.97,584.87,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,inpatient,,,1004.00000,953.80000,Amish/Mennonite,Amish Mennonite,,552.20,,,,,,,552.20,973.88,percent of total billed charges,
ECHO OB LIMITED >=1 FETUS-PROF,69311,CDM,402,RC,76815,CPT,,,facility,outpatient,,,1004.00000,953.80000,Amish/Mennonite,Amish Mennonite,,552.20,,,,,,,100.97,973.88,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,191.95,338.53,percent of total billed charges,
DXA BN DENSITY FOREARM,69348,CDM,341,RC,77081,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,83.61,484.28,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,58.85,103.79,percent of total billed charges,
EVENT MTR HOOK UP & REC 30 DAY-TECH,69422,CDM,731,RC,93270,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,35.41,103.79,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,inpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,245.30,432.62,percent of total billed charges,
EXT ECG MONIT SCAN ANALYS&RPRT-TECH,69645,CDM,731,RC,93226,CPT,,,facility,outpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,56.40,432.62,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,inpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,,289.30,,,,,,,289.30,510.22,percent of total billed charges,
FLUOROSCOPY TO 1 HR PHYS TIME ORTHO SURG-PROF,69688,CDM,320,RC,76000,CPT,,,facility,outpatient,,,526.00000,499.70000,Amish/Mennonite,Amish Mennonite,,289.30,,,,,,,146.17,2313.59,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
FINGER/HEEL/EAR STICK-PROF,69695,CDM,300,RC,36416,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,10.00,30.07,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,inpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,,396.00,,,,,,,396.00,698.40,percent of total billed charges,
FLUORO GUIDE NEEDLE PLC ORTHO-PROF,69731,CDM,320,RC,77002,CPT,,,facility,outpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,,396.00,,,,,,,360.00,6037.79,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,inpatient,,,974.00000,925.30000,Amish/Mennonite,Amish Mennonite,,535.70,,,,,,,535.70,944.78,percent of total billed charges,
GLUCOSE MONITOR >=72HRS-TECH,69808,CDM,920,RC,95250,CPT,,,facility,outpatient,,,974.00000,925.30000,Amish/Mennonite,Amish Mennonite,,535.70,,,,,,,122.37,944.78,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,inpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,114.95,202.73,percent of total billed charges,
INH TX/SPUT AERO/NEB/IPP,69909,CDM,410,RC,94640,CPT,,,facility,outpatient,,,209.00000,198.55000,Amish/Mennonite,Amish Mennonite,,114.95,,,,,,,104.50,212.44,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,68.20,120.28,percent of total billed charges,
IV INFUSION EA ADDL HR,70106,CDM,260,RC,96366,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,43.81,120.28,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,inpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,,248.60,,,,,,,248.60,438.44,percent of total billed charges,
IV INFUSION THERAPY INIT 1ST HR,70124,CDM,260,RC,96365,CPT,,,facility,outpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,,248.60,,,,,,,200.06,438.44,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
IV HYDRATION EA ADDL HR,70151,CDM,260,RC,96361,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,43.81,97.00,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
IV INFUSION CONCURRENT,70152,CDM,260,RC,96368,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,131.92,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,inpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,110.55,194.97,percent of total billed charges,
IV INFUSION SEQ NEW DRG TO 1HR,70158,CDM,260,RC,96367,CPT,,,facility,outpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,67.58,194.97,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,inpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,80.85,142.59,percent of total billed charges,
IVP EA ADDL SEQ NEW DRUG,70176,CDM,260,RC,96375,CPT,,,facility,outpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,43.81,142.59,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,inpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,204.05,359.87,percent of total billed charges,
IVP SINGLE/INITIAL,70185,CDM,260,RC,96374,CPT,,,facility,outpatient,,,371.00000,352.45000,Amish/Mennonite,Amish Mennonite,,204.05,,,,,,,185.50,359.87,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
IRRIGATE IMPLANTED VAD,70213,CDM,260,RC,96523,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,56.40,158.11,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,inpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,205.70,362.78,percent of total billed charges,
IV HYDRATION INIT 31MIN-1HR,70250,CDM,510,RC,96360,CPT,,,facility,outpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,187.00,362.78,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,275.62,545.62,percent of total billed charges,
B&L ENVITSA ASPIRE DIOPTER RANGE 6.0-34.0,70302,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,153.47,545.62,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,inpatient,,,207.20000,196.84000,Amish/Mennonite,Amish Mennonite,,113.96,,,,,,,113.96,200.98,percent of total billed charges,
MDI DEMONSTRATION,70304,CDM,960,RC,94664,CPT,,,facility,outpatient,,,207.20000,196.84000,Amish/Mennonite,Amish Mennonite,,113.96,,,,,,,103.60,212.44,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,inpatient,,,3695.00000,3510.25000,Amish/Mennonite,Amish Mennonite,,2032.25,,,,,,,2032.25,3584.15,percent of total billed charges,
MRI SPINE LUMB WO/W CNTRST +SEQ-PROF,70392,CDM,612,RC,72158,CPT,,,facility,outpatient,,,3695.00000,3510.25000,Amish/Mennonite,Amish Mennonite,,2032.25,,,,,,,339.11,3584.15,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,inpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,190.85,336.59,percent of total billed charges,
MOD SED SAME MD EA ADDL 15MIN-TECH,70461,CDM,372,RC,99153,CPT,,,facility,outpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,173.50,336.59,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,Amish/Mennonite,Amish Mennonite,,610.50,,,,,,,610.50,1076.70,percent of total billed charges,
OPHTH US DX B-SCAN-PROF,70462,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,Amish/Mennonite,Amish Mennonite,,610.50,,,,,,,100.97,1076.70,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,inpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,166.65,293.91,percent of total billed charges,
INTERROG DEV EVAL TECH SERV 90D-TECH,70495,CDM,480,RC,93296,CPT,,,facility,outpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,35.41,293.91,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,281.05,495.67,percent of total billed charges,
PHLEBOTOMY-THERAPEUTIC,70633,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,122.40,495.67,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,inpatient,,,877.00000,833.15000,Amish/Mennonite,Amish Mennonite,,482.35,,,,,,,482.35,850.69,percent of total billed charges,
PHOTODYNAMIC TX SKIN-TECH,70653,CDM,510,RC,96567,CPT,,,facility,outpatient,,,877.00000,833.15000,Amish/Mennonite,Amish Mennonite,,482.35,,,,,,,188.67,850.69,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,inpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,,496.10,,,,,,,496.10,874.94,percent of total billed charges,
REFILL/MAINT PORTABLE PUMP,70870,CDM,335,RC,96521,CPT,,,facility,outpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,,496.10,,,,,,,200.06,874.94,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
RMV IMPAC CERUMEN IRR/LAV UNI,71059,CDM,361,RC,69209,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,3163.00,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
SCRN BREAST TOMOSYNTHESIS BIL MOBILE-TECH,71345,CDM,403,RC,77063,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,37.00,442.00,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,26.40,46.56,percent of total billed charges,
TELEHEALTH FACILITY FEES-CAT,71489,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,24.00,46.56,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
ULTRAVIOLET LIGHT THERAPY-TECH,71759,CDM,940,RC,96900,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,37.27,101.85,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT RHEUM-PROF,71808,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 89025-PROF,71820,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ENDOCR-PROF,71821,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT MED/REHAB-PROF,71836,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT 36937-PROF,71850,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,inpatient,,,1119.00000,1063.05000,Amish/Mennonite,Amish Mennonite,,615.45,,,,,,,615.45,1085.43,percent of total billed charges,
US TRANSRECTAL 34886-PROF,71852,CDM,402,RC,76872,CPT,,,facility,outpatient,,,1119.00000,1063.05000,Amish/Mennonite,Amish Mennonite,,615.45,,,,,,,100.97,1085.43,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDE NEEDLE PLACEMENT ANESTH,71864,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,inpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,107.25,189.15,percent of total billed charges,
MEAS POST-VOID RESID URINE/BLD,71918,CDM,361,RC,51798,CPT,,,facility,outpatient,,,195.00000,185.25000,Amish/Mennonite,Amish Mennonite,,107.25,,,,,,,56.40,5271.00,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
XR CALCANEUS MIN 2 VWS ASC ONLY -PROF,71924,CDM,320,RC,73650,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,83.61,1553.42,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,158.95,280.33,percent of total billed charges,
XR NASL BNS MIN 3 VWS-PROF,71957,CDM,320,RC,70160,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,83.61,2009.44,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS ASC ONLY-PROF,71974,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,83.61,1811.63,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
XR SPINE CERVICAL 2-3 VWS FLEX/LAT ONLY-PROF,71976,CDM,320,RC,72040,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,83.61,2113.62,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,195.80,345.32,percent of total billed charges,
XR SPINE CERVICAL 4-5 VWS-PROF,71978,CDM,320,RC,72050,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,100.97,2811.23,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,inpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,,177.10,,,,,,,177.10,312.34,percent of total billed charges,
XR KNEE 3 VWS -PROF,71981,CDM,320,RC,73562,CPT,,,facility,outpatient,,,322.00000,305.90000,Amish/Mennonite,Amish Mennonite,,177.10,,,,,,,83.61,2168.71,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,inpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,,145.75,,,,,,,145.75,257.05,percent of total billed charges,
XR HAND MIN 3 VWS-PROF,71982,CDM,320,RC,73130,CPT,,,facility,outpatient,,,265.00000,251.75000,Amish/Mennonite,Amish Mennonite,,145.75,,,,,,,83.61,1930.27,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,145.20,256.08,percent of total billed charges,
XR TOES MIN 2 VWS ASC ONLY-PROF,71987,CDM,320,RC,73660,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,83.61,1550.26,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,inpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,177.65,313.31,percent of total billed charges,
XR WRIST COMPLT MIN 3 VWS NAVICULAR  14438-PROF,71995,CDM,320,RC,73110,CPT,,,facility,outpatient,,,323.00000,306.85000,Amish/Mennonite,Amish Mennonite,,177.65,,,,,,,83.61,2147.86,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,inpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,,181.50,,,,,,,181.50,320.10,percent of total billed charges,
XR SPINE LUMBOSACRAL 2-3VW-PROF,71996,CDM,320,RC,72100,CPT,,,facility,outpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,,181.50,,,,,,,100.97,2113.62,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,122.10,215.34,percent of total billed charges,
XR FOOT 2 VWS ASC ONLY-PROF,72000,CDM,320,RC,73620,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,83.61,1533.65,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,163.90,289.06,percent of total billed charges,
XR FINGERS MIN 2 VWS ORTHO-PROF,72005,CDM,320,RC,73140,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,83.61,1965.59,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,inpatient,,,353.00000,335.35000,Amish/Mennonite,Amish Mennonite,,194.15,,,,,,,194.15,342.41,percent of total billed charges,
XR SACROILIAC JT <3 VWS-PROF,72010,CDM,320,RC,72200,CPT,,,facility,outpatient,,,353.00000,335.35000,Amish/Mennonite,Amish Mennonite,,194.15,,,,,,,100.97,1772.08,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,inpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,151.80,267.72,percent of total billed charges,
XR KNEE 1-2 VWS -PROF,72018,CDM,320,RC,73560,CPT,,,facility,outpatient,,,276.00000,262.20000,Amish/Mennonite,Amish Mennonite,,151.80,,,,,,,83.61,1850.10,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,inpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
XR SACRUM & COCCYX MIN 2 VW-PROF,72021,CDM,320,RC,72220,CPT,,,facility,outpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,83.61,1732.53,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,152.35,268.69,percent of total billed charges,
XR SPINE THORACIC 2 VWS-PROF,72023,CDM,320,RC,72070,CPT,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,100.97,1755.46,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,inpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,153.45,270.63,percent of total billed charges,
XR PELVIS 1-2 VWS-PROF,72025,CDM,320,RC,72170,CPT,,,facility,outpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,100.97,1574.27,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,151.25,266.75,percent of total billed charges,
XR RIBS UNI W PA CHEST MIN 3VWS-PROF,72026,CDM,320,RC,71101,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,100.97,2277.19,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,inpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,,195.25,,,,,,,195.25,344.35,percent of total billed charges,
XR LS BEND VW ONLY 2-3 VWS-PROF,72031,CDM,320,RC,72120,CPT,,,facility,outpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,,195.25,,,,,,,100.97,2192.71,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
XR FOOT COMPLT MIN 3 VWS,72034,CDM,320,RC,73630,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,83.61,1811.63,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L40CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72039,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L20CM DIA6MM 0.020IN COMPLX L VOL DETACH STD FRME,72040,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA20MM SHTH OD6MM ID5.3MM,72042,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
ANOSCOPY DIAG COL SPECIMEN(S)-TECH,72044,CDM,510,RC,46600,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,81.50,158.11,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,inpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,138.60,244.44,percent of total billed charges,
APP LONG ARM SPLINT-TECH,72045,CDM,510,RC,29105,CPT,,,facility,outpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,126.00,244.44,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,inpatient,,,687.00000,652.65000,Amish/Mennonite,Amish Mennonite,,377.85,,,,,,,377.85,666.39,percent of total billed charges,
ANTEPARTUM CARE ONLY 4-6 VISIT-TECH,72046,CDM,510,RC,59425,CPT,,,facility,outpatient,,,687.00000,652.65000,Amish/Mennonite,Amish Mennonite,,377.85,,,,,,,343.50,666.39,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,inpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,95.15,167.81,percent of total billed charges,
ASP/INJ GANGLION CYST-TECH,72047,CDM,510,RC,20612,CPT,,,facility,outpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,86.50,308.32,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,inpatient,,,1230.00000,1168.50000,Amish/Mennonite,Amish Mennonite,,676.50,,,,,,,676.50,1193.10,percent of total billed charges,
ANTEPARTUM CARE ONLY 7+ VISITS-TECH,72048,CDM,510,RC,59426,CPT,,,facility,outpatient,,,1230.00000,1168.50000,Amish/Mennonite,Amish Mennonite,,676.50,,,,,,,615.00,1193.10,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,inpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,,129.25,,,,,,,129.25,227.95,percent of total billed charges,
APPLICATION OF SHORT LEG CAST-TECH,72049,CDM,510,RC,29405,CPT,,,facility,outpatient,,,235.00000,223.25000,Amish/Mennonite,Amish Mennonite,,129.25,,,,,,,117.50,277.40,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,inpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,,342.65,,,,,,,342.65,604.31,percent of total billed charges,
ASP BLADDER/INS SUPUBIC CATH-TECH,72050,CDM,510,RC,51102,CPT,,,facility,outpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,,342.65,,,,,,,311.50,2139.65,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,101.75,179.45,percent of total billed charges,
APP SHORT ARM SPLINT STATIC-TECH,72051,CDM,510,RC,29125,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,92.50,179.45,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,inpatient,,,248.00000,235.60000,Amish/Mennonite,Amish Mennonite,,136.40,,,,,,,136.40,240.56,percent of total billed charges,
APPLICATION OF FOREARM CAST-TECH,72053,CDM,510,RC,29075,CPT,,,facility,outpatient,,,248.00000,235.60000,Amish/Mennonite,Amish Mennonite,,136.40,,,,,,,124.00,277.40,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
APP MULTILYR COMPRSN LWR LEG-TECH,72054,CDM,510,RC,29581,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,89.00,172.66,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,inpatient,,,901.00000,855.95000,Amish/Mennonite,Amish Mennonite,,495.55,,,,,,,495.55,873.97,percent of total billed charges,
CLSD TX DIST FIB WO MANIP-TECH,72056,CDM,510,RC,27786,CPT,,,facility,outpatient,,,901.00000,855.95000,Amish/Mennonite,Amish Mennonite,,495.55,,,,,,,227.78,873.97,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,inpatient,,,309.00000,293.55000,Amish/Mennonite,Amish Mennonite,,169.95,,,,,,,169.95,299.73,percent of total billed charges,
COLPOSCOPY CERVIX W BX&CURETT-TECH,72057,CDM,510,RC,57454,CPT,,,facility,outpatient,,,309.00000,293.55000,Amish/Mennonite,Amish Mennonite,,169.95,,,,,,,154.50,317.72,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,33.55,59.17,percent of total billed charges,
DBRD NAILS ANY METHOD 1-5-TC,72058,CDM,510,RC,11720,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,30.50,62.04,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,inpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,211.46,percent of total billed charges,
DBRD SKIN & SUBQ TISS<=20SCM-TECH,72059,CDM,510,RC,11042,CPT,,,facility,outpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,109.00,417.31,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,inpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
DEST PREMLG LESN 2ND-14TH EACH-TECH,72060,CDM,510,RC,17003,CPT,,,facility,outpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.00,9.70,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,inpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,,235.40,,,,,,,235.40,415.16,percent of total billed charges,
DRN ABSC/HEMA NASL SEPTUM-TECH,72061,CDM,510,RC,30020,CPT,,,facility,outpatient,,,428.00000,406.60000,Amish/Mennonite,Amish Mennonite,,235.40,,,,,,,214.00,531.90,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,inpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,340.45,600.43,percent of total billed charges,
EXN B9+MARG SNHFG >4CM-TECH,72063,CDM,510,RC,11426,CPT,,,facility,outpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,309.50,2989.39,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,inpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,,517.00,,,,,,,517.00,911.80,percent of total billed charges,
BX/EXN LYMPH NDS SUPERVICIAL-TECH,72064,CDM,510,RC,38500,CPT,,,facility,outpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,,517.00,,,,,,,470.00,3999.66,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,288.20,508.28,percent of total billed charges,
EXN B9+MARG FEEYNLMM 3.1-4CM-TECH,72065,CDM,510,RC,11444,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,262.00,1692.33,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,TC,46.75,,,,,,,46.75,82.45,percent of total billed charges,
DBRD NAILS ANY METHOD >=6-TECH,72066,CDM,510,RC,11721,CPT,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,TC,46.75,,,,,,,42.50,82.45,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,inpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,169.40,298.76,percent of total billed charges,
EXN B9+MARG TR/LIMB 1.1-2CM-TECH,72067,CDM,510,RC,11402,CPT,,,facility,outpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,154.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,inpatient,,,596.00000,566.20000,Amish/Mennonite,Amish Mennonite,,327.80,,,,,,,327.80,578.12,percent of total billed charges,
EXN FEEYNL MLG+MARG 2.1-3-TECH,72068,CDM,510,RC,11643,CPT,,,facility,outpatient,,,596.00000,566.20000,Amish/Mennonite,Amish Mennonite,,327.80,,,,,,,298.00,1692.33,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,113.85,200.79,percent of total billed charges,
DEST BENIGN LESN <=14-TECH,72069,CDM,510,RC,17110,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,103.50,200.79,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,inpatient,,,728.00000,691.60000,Amish/Mennonite,Amish Mennonite,,400.40,,,,,,,400.40,706.16,percent of total billed charges,
EXN FACE-MM B9+MARG >4 CM-TECH,72070,CDM,510,RC,11446,CPT,,,facility,outpatient,,,728.00000,691.60000,Amish/Mennonite,Amish Mennonite,,400.40,,,,,,,364.00,2989.39,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,inpatient,,,506.00000,480.70000,Amish/Mennonite,Amish Mennonite,,278.30,,,,,,,278.30,490.82,percent of total billed charges,
EXN FEEYNL MLG+MARG 1.1-2-TECH,72071,CDM,510,RC,11642,CPT,,,facility,outpatient,,,506.00000,480.70000,Amish/Mennonite,Amish Mennonite,,278.30,,,,,,,253.00,734.90,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,inpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,95.70,168.78,percent of total billed charges,
CTRL NASAL HEMORRHAGE ANT SMPL-TECH,72072,CDM,510,RC,30901,CPT,,,facility,outpatient,,,174.00000,165.30000,Amish/Mennonite,Amish Mennonite,,95.70,,,,,,,87.00,168.78,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,inpatient,,,376.00000,357.20000,Amish/Mennonite,Amish Mennonite,,206.80,,,,,,,206.80,364.72,percent of total billed charges,
EXN B9+MARG SNHFG 2.1-3CM-TECH,72073,CDM,510,RC,11423,CPT,,,facility,outpatient,,,376.00000,357.20000,Amish/Mennonite,Amish Mennonite,,206.80,,,,,,,188.00,1692.33,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,inpatient,,,22.37000,21.25000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,12.30,21.70,percent of total billed charges,
BIOMETRIC EXAM ONLY-TECH,72074,CDM,510,RC,99199,CPT,,,facility,outpatient,,,22.37000,21.25000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,inpatient,,,838.00000,796.10000,Amish/Mennonite,Amish Mennonite,,460.90,,,,,,,460.90,812.86,percent of total billed charges,
EXN MLG+MARG TR/LIMB >4CM-TECH,72075,CDM,510,RC,11606,CPT,,,facility,outpatient,,,838.00000,796.10000,Amish/Mennonite,Amish Mennonite,,460.90,,,,,,,419.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,inpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,229.35,404.49,percent of total billed charges,
EXN B9+MARG FEEYNLMM 2.1-3CM-TECH,72076,CDM,510,RC,11443,CPT,,,facility,outpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,208.50,1692.33,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,inpatient,,,1210.00000,1149.50000,Amish/Mennonite,Amish Mennonite,,665.50,,,,,,,665.50,1173.70,percent of total billed charges,
EXN TMR WRST/ARM SUBQ >=3CM-TECH,72077,CDM,510,RC,25071,CPT,,,facility,outpatient,,,1210.00000,1149.50000,Amish/Mennonite,Amish Mennonite,,665.50,,,,,,,605.00,1692.33,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,101.75,179.45,percent of total billed charges,
BIOPSY EXTERNAL EAR-TECH,72078,CDM,510,RC,69100,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,92.50,242.55,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
FITTING & INSERTION PESSARY-TECH,72079,CDM,510,RC,57160,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,77.00,210.12,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
CHEM CAUTERY GRANULATION TISS-TECH,72080,CDM,510,RC,17250,CPT,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,74.00,207.54,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,152.35,268.69,percent of total billed charges,
EXN B9 A/L 0.6-1.0CM-TECH,72082,CDM,510,RC,11401,CPT,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,138.50,417.31,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,inpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,52.80,93.12,percent of total billed charges,
CRYOTHERAPY FOR ACNE-TECH,72083,CDM,510,RC,17340,CPT,,,facility,outpatient,,,96.00000,91.20000,Amish/Mennonite,Amish Mennonite,,52.80,,,,,,,48.00,93.12,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,inpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,,149.60,,,,,,,149.60,263.84,percent of total billed charges,
COLPOSCOPY CX ENDOCX CURETT-TECH,72084,CDM,510,RC,57456,CPT,,,facility,outpatient,,,272.00000,258.40000,Amish/Mennonite,Amish Mennonite,,149.60,,,,,,,136.00,317.72,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,inpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,,234.85,,,,,,,234.85,414.19,percent of total billed charges,
DBRD MUSC FASCIA<=20SCM-TECH,72085,CDM,510,RC,11043,CPT,,,facility,outpatient,,,427.00000,405.65000,Amish/Mennonite,Amish Mennonite,,234.85,,,,,,,213.50,639.36,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,182.05,321.07,percent of total billed charges,
DEST MLG LESN FEEYNLMM 0.6-1CM-TECH,72086,CDM,510,RC,17281,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,,182.05,,,,,,,165.50,321.07,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,inpatient,,,1189.00000,1129.55000,Amish/Mennonite,Amish Mennonite,,653.95,,,,,,,653.95,1153.33,percent of total billed charges,
EXN HAND LES SC 1.5 CM/>-TECH,72087,CDM,510,RC,26111,CPT,,,facility,outpatient,,,1189.00000,1129.55000,Amish/Mennonite,Amish Mennonite,,653.95,,,,,,,594.50,1692.33,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,inpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,283.25,499.55,percent of total billed charges,
EXN PILONIDAL CYST SMPL-TECH,72088,CDM,510,RC,11770,CPT,,,facility,outpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,,283.25,,,,,,,257.50,2989.39,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,inpatient,,,326.00000,309.70000,Amish/Mennonite,Amish Mennonite,,179.30,,,,,,,179.30,316.22,percent of total billed charges,
EXN B9+MARG SNHFG 1.1-2CM-TECH,72089,CDM,510,RC,11422,CPT,,,facility,outpatient,,,326.00000,309.70000,Amish/Mennonite,Amish Mennonite,,179.30,,,,,,,163.00,1692.33,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,inpatient,,,313.00000,297.35000,Amish/Mennonite,Amish Mennonite,,172.15,,,,,,,172.15,303.61,percent of total billed charges,
EXN B9 FEEYNLMM 0.6-1.0CM-TECH,72090,CDM,510,RC,11441,CPT,,,facility,outpatient,,,313.00000,297.35000,Amish/Mennonite,Amish Mennonite,,172.15,,,,,,,156.50,734.90,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,inpatient,,,1879.00000,1785.05000,Amish/Mennonite,Amish Mennonite,,1033.45,,,,,,,1033.45,1822.63,percent of total billed charges,
EXN TMR BACK/FLNK SUBFAS <5CM-TECH,72091,CDM,510,RC,21932,CPT,,,facility,outpatient,,,1879.00000,1785.05000,Amish/Mennonite,Amish Mennonite,,1033.45,,,,,,,939.50,2989.39,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,inpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,319.00,562.60,percent of total billed charges,
EXN B9+MARG TR/LIMB >4CM-TECH,72092,CDM,510,RC,11406,CPT,,,facility,outpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,290.00,1692.33,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
EXN B9 LESN SNHFG <=0.5CM-TECH,72093,CDM,510,RC,11420,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,114.50,1692.33,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,inpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,145.20,256.08,percent of total billed charges,
DESTRUCTION LESION VULVA SMPL-TECH,72094,CDM,510,RC,56501,CPT,,,facility,outpatient,,,264.00000,250.80000,Amish/Mennonite,Amish Mennonite,,145.20,,,,,,,132.00,1910.62,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,inpatient,,,384.00000,364.80000,Amish/Mennonite,Amish Mennonite,,211.20,,,,,,,211.20,372.48,percent of total billed charges,
CLSD TX RADL HD PEDS W MANIP-TECH,72095,CDM,510,RC,24640,CPT,,,facility,outpatient,,,384.00000,364.80000,Amish/Mennonite,Amish Mennonite,,211.20,,,,,,,192.00,372.48,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,inpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,160.60,283.24,percent of total billed charges,
EXN B9 SNHFG 0.6-1.0CM-TECH,72096,CDM,510,RC,11421,CPT,,,facility,outpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,146.00,734.90,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,inpatient,,,258.00000,245.10000,Amish/Mennonite,Amish Mennonite,,141.90,,,,,,,141.90,250.26,percent of total billed charges,
BIOPSY CERVIX-TECH,72097,CDM,510,RC,57500,CPT,,,facility,outpatient,,,258.00000,245.10000,Amish/Mennonite,Amish Mennonite,,141.90,,,,,,,129.00,909.48,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,inpatient,,,429.00000,407.55000,Amish/Mennonite,Amish Mennonite,,235.95,,,,,,,235.95,416.13,percent of total billed charges,
EXN MLG+MARG SNFHG 0.6-1CM-TECH,72098,CDM,510,RC,11621,CPT,,,facility,outpatient,,,429.00000,407.55000,Amish/Mennonite,Amish Mennonite,,235.95,,,,,,,214.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,inpatient,,,404.00000,383.80000,Amish/Mennonite,Amish Mennonite,,222.20,,,,,,,222.20,391.88,percent of total billed charges,
EXN B9+MARG TR/LIMB 3.1-4CM-TECH,72099,CDM,510,RC,11404,CPT,,,facility,outpatient,,,404.00000,383.80000,Amish/Mennonite,Amish Mennonite,,222.20,,,,,,,202.00,1692.33,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,inpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,138.60,244.44,percent of total billed charges,
EXN B9+MARG FEEYNLMM <=0.5CM-TECH,72100,CDM,510,RC,11440,CPT,,,facility,outpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,126.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,inpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,205.70,362.78,percent of total billed charges,
EXN FEEYNL MLG+MARG <=0.5CM-TECH,72101,CDM,510,RC,11640,CPT,,,facility,outpatient,,,374.00000,355.30000,Amish/Mennonite,Amish Mennonite,,205.70,,,,,,,187.00,734.90,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,inpatient,,,471.50000,447.92000,Amish/Mennonite,Amish Mennonite,,259.32,,,,,,,259.32,457.36,percent of total billed charges,
DESTRUC LESION ANUL ELECTRODES-TECH,72102,CDM,510,RC,46910,CPT,,,facility,outpatient,,,471.50000,447.92000,Amish/Mennonite,Amish Mennonite,,259.32,,,,,,,235.75,1910.62,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,290.40,512.16,percent of total billed charges,
EXN MLG+MARG TR/LIMB 2.1-3CM-TECH,72103,CDM,510,RC,11603,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,264.00,734.90,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,inpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,404.25,712.95,percent of total billed charges,
EXN FEEYNL MLG+MARG 3.1-4-TECH,72104,CDM,510,RC,11644,CPT,,,facility,outpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,367.50,1692.33,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,inpatient,,,362.00000,343.90000,Amish/Mennonite,Amish Mennonite,,199.10,,,,,,,199.10,351.14,percent of total billed charges,
EXN MLG+MARG SNFHG <=0.5CM-TECH,72105,CDM,510,RC,11620,CPT,,,facility,outpatient,,,362.00000,343.90000,Amish/Mennonite,Amish Mennonite,,199.10,,,,,,,181.00,1692.33,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,238.70,420.98,percent of total billed charges,
EXN B9+MARG SNHFG 3.1-4CM-TECH,72106,CDM,510,RC,11424,CPT,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,217.00,1692.33,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,inpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,,256.30,,,,,,,256.30,452.02,percent of total billed charges,
EXN OF LINGUAL FRENUM-TECH,72107,CDM,510,RC,41115,CPT,,,facility,outpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,,256.30,,,,,,,233.00,1547.18,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,inpatient,,,1517.00000,1441.15000,Amish/Mennonite,Amish Mennonite,,834.35,,,,,,,834.35,1471.49,percent of total billed charges,
EXN TMR NK/THORAX SUBFAS <5CM-TECH,72108,CDM,510,RC,21556,CPT,,,facility,outpatient,,,1517.00000,1441.15000,Amish/Mennonite,Amish Mennonite,,834.35,,,,,,,758.50,2989.39,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,inpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,38.50,67.90,percent of total billed charges,
EYE EXAM ESTAB PAT INTERMED-TECH,72109,CDM,510,RC,92012,CPT,,,facility,outpatient,,,70.00000,66.50000,Amish/Mennonite,Amish Mennonite,,38.50,,,,,,,35.00,134.61,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,inpatient,,,638.00000,606.10000,Amish/Mennonite,Amish Mennonite,,350.90,,,,,,,350.90,618.86,percent of total billed charges,
DEST CUTANEOUS LESNS <10 SQCM-TECH,72110,CDM,510,RC,17106,CPT,,,facility,outpatient,,,638.00000,606.10000,Amish/Mennonite,Amish Mennonite,,350.90,,,,,,,319.00,618.86,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,inpatient,,,759.00000,721.05000,Amish/Mennonite,Amish Mennonite,,417.45,,,,,,,417.45,736.23,percent of total billed charges,
EXN SNFHG MLG+MARG >4 CM-TECH,72111,CDM,510,RC,11626,CPT,,,facility,outpatient,,,759.00000,721.05000,Amish/Mennonite,Amish Mennonite,,417.45,,,,,,,379.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,inpatient,,,1270.00000,1206.50000,Amish/Mennonite,Amish Mennonite,,698.50,,,,,,,698.50,1231.90,percent of total billed charges,
EXN TMR NK/THORAX SUBQ >=3CM-TECH,72112,CDM,510,RC,21552,CPT,,,facility,outpatient,,,1270.00000,1206.50000,Amish/Mennonite,Amish Mennonite,,698.50,,,,,,,635.00,2989.39,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
EXCISN B9 LESN TR/LIMB <=0.5CM-TECH,72113,CDM,510,RC,11400,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,734.90,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,195.80,345.32,percent of total billed charges,
EXN B9+MARG TR/LIMB 2.1-3CM-TECH,72114,CDM,510,RC,11403,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,178.00,734.90,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
BX ENDOMET W/WO ENDOCERV SAMP-TECH,72116,CDM,510,RC,58100,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,213.40,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,inpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,,308.00,,,,,,,308.00,543.20,percent of total billed charges,
EXN MLG+MARG SNFHG 2.1-3CM-TECH,72118,CDM,510,RC,11623,CPT,,,facility,outpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,,308.00,,,,,,,280.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,inpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,,528.55,,,,,,,528.55,932.17,percent of total billed charges,
EXN FEEYNL MLG+MARG >4 CM-TECH,72119,CDM,510,RC,11646,CPT,,,facility,outpatient,,,961.00000,912.95000,Amish/Mennonite,Amish Mennonite,,528.55,,,,,,,480.50,2989.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,inpatient,,,587.00000,557.65000,Amish/Mennonite,Amish Mennonite,,322.85,,,,,,,322.85,569.39,percent of total billed charges,
EXN MLG+MARG TR/LIMB 3.1-4CM-TECH,72120,CDM,510,RC,11604,CPT,,,facility,outpatient,,,587.00000,557.65000,Amish/Mennonite,Amish Mennonite,,322.85,,,,,,,293.50,734.90,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,inpatient,,,631.00000,599.45000,Amish/Mennonite,Amish Mennonite,,347.05,,,,,,,347.05,612.07,percent of total billed charges,
EXN MLG+MARG SNFHG 3.1-4CM-TECH,72121,CDM,510,RC,11624,CPT,,,facility,outpatient,,,631.00000,599.45000,Amish/Mennonite,Amish Mennonite,,347.05,,,,,,,315.50,1692.33,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,inpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,,149.05,,,,,,,149.05,262.87,percent of total billed charges,
DESTROY PREMAL LESIONS 15/>-TECH,72122,CDM,510,RC,17004,CPT,,,facility,outpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,,149.05,,,,,,,135.50,417.31,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,68.20,120.28,percent of total billed charges,
DEST PREMLG LESN 1ST-TECH,72123,CDM,510,RC,17000,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,62.00,207.54,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,inpatient,,,478.00000,454.10000,Amish/Mennonite,Amish Mennonite,,262.90,,,,,,,262.90,463.66,percent of total billed charges,
EXN MLG+MARG SNFHG 1.1-2CM-TECH,72124,CDM,510,RC,11622,CPT,,,facility,outpatient,,,478.00000,454.10000,Amish/Mennonite,Amish Mennonite,,262.90,,,,,,,239.00,734.90,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,inpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,,185.35,,,,,,,185.35,326.89,percent of total billed charges,
EXN THROMBOSED HEMORR EXTERNAL-TECH,72125,CDM,510,RC,46320,CPT,,,facility,outpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,,185.35,,,,,,,168.50,1231.54,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,inpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,,254.10,,,,,,,254.10,448.14,percent of total billed charges,
EXN MLG+MARG TR/LIMB 1.1-2CM-TECH,72126,CDM,510,RC,11602,CPT,,,facility,outpatient,,,462.00000,438.90000,Amish/Mennonite,Amish Mennonite,,254.10,,,,,,,231.00,448.14,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
EYE EXAM NEW PAT INTERMED-TECH,72127,CDM,510,RC,92002,CPT,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,33.00,134.61,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,55.55,97.97,percent of total billed charges,
EYE EXAM ESTAB PAT COMPR-TECH,72128,CDM,510,RC,92014,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,50.50,134.61,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,inpatient,,,1192.00000,1132.40000,Amish/Mennonite,Amish Mennonite,,655.60,,,,,,,655.60,1156.24,percent of total billed charges,
EXN TMR SHOULDER SUBQ >=3CM-TECH,72129,CDM,510,RC,23071,CPT,,,facility,outpatient,,,1192.00000,1132.40000,Amish/Mennonite,Amish Mennonite,,655.60,,,,,,,596.00,1692.33,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,inpatient,,,1513.00000,1437.35000,Amish/Mennonite,Amish Mennonite,,832.15,,,,,,,832.15,1467.61,percent of total billed charges,
I & D ABSC LEG/ANKLE DEEP-TECH,72131,CDM,510,RC,27603,CPT,,,facility,outpatient,,,1513.00000,1437.35000,Amish/Mennonite,Amish Mennonite,,832.15,,,,,,,756.50,2989.39,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,inpatient,,,584.00000,554.80000,Amish/Mennonite,Amish Mennonite,,321.20,,,,,,,321.20,566.48,percent of total billed charges,
BIOPSY TEMPORAL ARTERY-TECH,72132,CDM,510,RC,37609,CPT,,,facility,outpatient,,,584.00000,554.80000,Amish/Mennonite,Amish Mennonite,,321.20,,,,,,,292.00,1692.33,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,inpatient,,,444.00000,421.80000,Amish/Mennonite,Amish Mennonite,,244.20,,,,,,,244.20,430.68,percent of total billed charges,
EXN FEEYNL MLG+MARG 0.6-1-TECH,72133,CDM,510,RC,11641,CPT,,,facility,outpatient,,,444.00000,421.80000,Amish/Mennonite,Amish Mennonite,,244.20,,,,,,,222.00,734.90,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,inpatient,,,819.00000,778.05000,Amish/Mennonite,Amish Mennonite,,450.45,,,,,,,450.45,794.43,percent of total billed charges,
DRAINAGE OF ARM BURSA-TECH,72135,CDM,510,RC,23931,CPT,,,facility,outpatient,,,819.00000,778.05000,Amish/Mennonite,Amish Mennonite,,450.45,,,,,,,409.50,1692.33,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,inpatient,,,1535.00000,1458.25000,Amish/Mennonite,Amish Mennonite,,844.25,,,,,,,844.25,1488.95,percent of total billed charges,
EXN TMR SHOULDER SUBFAS <5CM-TECH,72136,CDM,510,RC,23076,CPT,,,facility,outpatient,,,1535.00000,1458.25000,Amish/Mennonite,Amish Mennonite,,844.25,,,,,,,767.50,2989.39,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,inpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,191.95,338.53,percent of total billed charges,
EXN B9+MARG FEEYNLMM 1.1-2CM-TECH,72137,CDM,510,RC,11442,CPT,,,facility,outpatient,,,349.00000,331.55000,Amish/Mennonite,Amish Mennonite,,191.95,,,,,,,174.50,734.90,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,inpatient,,,1061.00000,1007.95000,Amish/Mennonite,Amish Mennonite,,583.55,,,,,,,583.55,1029.17,percent of total billed charges,
EXN PILONIDAL CYST EXTENSIVE-TECH,72138,CDM,510,RC,11771,CPT,,,facility,outpatient,,,1061.00000,1007.95000,Amish/Mennonite,Amish Mennonite,,583.55,,,,,,,530.50,2989.39,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,inpatient,,,1183.00000,1123.85000,Amish/Mennonite,Amish Mennonite,,650.65,,,,,,,650.65,1147.51,percent of total billed charges,
EXN TMR NK/THORAX SUBQ <3CM-TECH,72139,CDM,510,RC,21555,CPT,,,facility,outpatient,,,1183.00000,1123.85000,Amish/Mennonite,Amish Mennonite,,650.65,,,,,,,591.50,1692.33,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,inpatient,,,1394.00000,1324.30000,Amish/Mennonite,Amish Mennonite,,766.70,,,,,,,766.70,1352.18,percent of total billed charges,
EXN TMR ARM/ELBOW SUBQ <3CM-TECH,72140,CDM,510,RC,24075,CPT,,,facility,outpatient,,,1394.00000,1324.30000,Amish/Mennonite,Amish Mennonite,,766.70,,,,,,,697.00,1692.33,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,inpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,,701.80,,,,,,,701.80,1237.72,percent of total billed charges,
NEUROPLASTY MEDIAN CARPAL TUNNEL-TECH,72141,CDM,510,RC,64721,CPT,,,facility,outpatient,,,1276.00000,1212.20000,Amish/Mennonite,Amish Mennonite,,701.80,,,,,,,638.00,2039.65,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,inpatient,,,652.00000,619.40000,Amish/Mennonite,Amish Mennonite,,358.60,,,,,,,358.60,632.44,percent of total billed charges,
CLSD TX ARTICULAR FX WO MANIP-TECH,72142,CDM,510,RC,26740,CPT,,,facility,outpatient,,,652.00000,619.40000,Amish/Mennonite,Amish Mennonite,,358.60,,,,,,,227.78,632.44,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
EYE EXAM NEW PATIENT COMPR-TECH,72143,CDM,510,RC,92004,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,134.61,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
I&D ABSCESS SMPL/SNGL-TECH,72144,CDM,510,RC,10060,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,213.40,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIGGER PNT 1 OR 2 MUSC-TECH,72145,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,79.00,308.32,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
FCE BEHAV CNSL OBES 15MIN-TECH,72147,CDM,510,RC,G0447,HCPCS,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,23.50,96.61,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,inpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,,134.75,,,,,,,134.75,237.65,percent of total billed charges,
DEST BENIGN LESN >15-TECH,72148,CDM,510,RC,17111,CPT,,,facility,outpatient,,,245.00000,232.75000,Amish/Mennonite,Amish Mennonite,,134.75,,,,,,,122.50,237.65,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,inpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,276.10,486.94,percent of total billed charges,
I&D PILONIDAL CYST CMPLX-TECH,72149,CDM,510,RC,10081,CPT,,,facility,outpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,251.00,734.90,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,inpatient,,,335.00000,318.25000,Amish/Mennonite,Amish Mennonite,,184.25,,,,,,,184.25,324.95,percent of total billed charges,
I&D PILONIDAL CYST SMPL-TECH,72151,CDM,510,RC,10080,CPT,,,facility,outpatient,,,335.00000,318.25000,Amish/Mennonite,Amish Mennonite,,184.25,,,,,,,167.50,734.90,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,inpatient,,,457.00000,434.15000,Amish/Mennonite,Amish Mennonite,,251.35,,,,,,,251.35,443.29,percent of total billed charges,
I&D WND POSTOP CMPLX-TECH,72152,CDM,510,RC,10180,CPT,,,facility,outpatient,,,457.00000,434.15000,Amish/Mennonite,Amish Mennonite,,251.35,,,,,,,228.50,2989.39,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,inpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,,167.75,,,,,,,167.75,295.85,percent of total billed charges,
I&D HEMA/SEROMA/FLUID COLL-TECH,72153,CDM,510,RC,10140,CPT,,,facility,outpatient,,,305.00000,289.75000,Amish/Mennonite,Amish Mennonite,,167.75,,,,,,,152.50,1692.33,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,inpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,156.75,276.45,percent of total billed charges,
I&R FB SUBQ TISS SMPL-TECH,72154,CDM,510,RC,10120,CPT,,,facility,outpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,142.50,417.31,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TH,85.80,,,,,,,85.80,151.32,percent of total billed charges,
INIT ANTEPARTUM CARE VISIT-TECH,72157,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TH,85.80,,,,,,,78.00,151.32,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,187.00,329.80,percent of total billed charges,
EXN NAIL MATRIX PRTL/COMPLT-TECH,72158,CDM,510,RC,11750,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,170.00,417.31,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,inpatient,,,1490.00000,1415.50000,Amish/Mennonite,Amish Mennonite,,819.50,,,,,,,819.50,1445.30,percent of total billed charges,
EXN TMR FACE/SCLP SUBFAS >=2CM-TECH,72159,CDM,510,RC,21014,CPT,,,facility,outpatient,,,1490.00000,1415.50000,Amish/Mennonite,Amish Mennonite,,819.50,,,,,,,745.00,2989.39,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,inpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,203.50,358.90,percent of total billed charges,
I&D PERIANAL ABSCESS SPRFCL-TECH,72160,CDM,510,RC,46050,CPT,,,facility,outpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,185.00,952.28,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,inpatient,,,1922.00000,1825.90000,Amish/Mennonite,Amish Mennonite,,1057.10,,,,,,,1057.10,1864.34,percent of total billed charges,
INS GASTROSTOMY TUBE FLUOROSC-TECH,72161,CDM,510,RC,49440,CPT,,,facility,outpatient,,,1922.00000,1825.90000,Amish/Mennonite,Amish Mennonite,,1057.10,,,,,,,961.00,1981.40,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,inpatient,,,386.00000,366.70000,Amish/Mennonite,Amish Mennonite,,212.30,,,,,,,212.30,374.42,percent of total billed charges,
I&D ABSCESS CMPLX/MULT-TECH,72163,CDM,510,RC,10061,CPT,,,facility,outpatient,,,386.00000,366.70000,Amish/Mennonite,Amish Mennonite,,212.30,,,,,,,193.00,417.31,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
PREVENT MED COUNSEL 60 MIN-TECH,72165,CDM,510,RC,99404,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,76.50,148.41,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,inpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,154.00,271.60,percent of total billed charges,
POST PARTUM CARE ONLY-TECH,72167,CDM,510,RC,59430,CPT,,,facility,outpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,140.00,271.60,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
DBRD BURN PRTL THCK SM <5%-TECH,72168,CDM,510,RC,16020,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,76.00,207.54,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,inpatient,,,219.00000,208.05000,Amish/Mennonite,Amish Mennonite,,120.45,,,,,,,120.45,212.43,percent of total billed charges,
INJ THERAPEUTIC CARP TUNNEL-TECH,72169,CDM,510,RC,20526,CPT,,,facility,outpatient,,,219.00000,208.05000,Amish/Mennonite,Amish Mennonite,,120.45,,,,,,,109.50,308.32,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN >4-TECH,72171,CDM,510,RC,11057,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,207.54,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,inpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,42.90,75.66,percent of total billed charges,
PREVENT MED COUNSEL 30 MIN-TECH,72172,CDM,510,RC,99402,CPT,,,facility,outpatient,,,78.00000,74.10000,Amish/Mennonite,Amish Mennonite,,42.90,,,,,,,39.00,75.66,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,inpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,,195.25,,,,,,,195.25,344.35,percent of total billed charges,
INS TEMPORARY FOLEY CATH CMPLX-TECH,72173,CDM,510,RC,51703,CPT,,,facility,outpatient,,,355.00000,337.25000,Amish/Mennonite,Amish Mennonite,,195.25,,,,,,,148.57,344.35,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,92.40,162.96,percent of total billed charges,
INJ SNGL TENDON/SHTH/LGMNT-TECH,72176,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,84.00,308.32,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,inpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,143.55,253.17,percent of total billed charges,
INS NON-BIODEG DRUG DEL IMPL-TECH,72178,CDM,510,RC,11981,CPT,,,facility,outpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,122.40,253.17,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,inpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,,539.00,,,,,,,539.00,950.60,percent of total billed charges,
PERIRECTAL ABSCESS I & D-TECH,72179,CDM,510,RC,46040,CPT,,,facility,outpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,,539.00,,,,,,,490.00,1231.54,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,inpatient,,,3458.00000,3285.10000,Amish/Mennonite,Amish Mennonite,TC,1901.90,,,,,,,1901.90,3354.26,percent of total billed charges,
BONE &/OR JT IMAG 3 PHASE STD,7218,CDM,340,RC,78315,CPT,,,facility,outpatient,,,3458.00000,3285.10000,Amish/Mennonite,Amish Mennonite,TC,1901.90,,,,,,,1609.99,3354.26,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
PREVENT MED COUNSEL 15 MIN-TECH,72180,CDM,510,RC,99401,CPT,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,20.00,38.80,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,inpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,,59.95,,,,,,,59.95,105.73,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN 2-4-TECH,72181,CDM,510,RC,11056,CPT,,,facility,outpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,,59.95,,,,,,,54.50,207.54,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,inpatient,,,1375.00000,1306.25000,Amish/Mennonite,Amish Mennonite,,756.25,,,,,,,756.25,1333.75,percent of total billed charges,
RMVL FB FOOT DEEP-TECH,72182,CDM,510,RC,28192,CPT,,,facility,outpatient,,,1375.00000,1306.25000,Amish/Mennonite,Amish Mennonite,,756.25,,,,,,,687.50,1692.33,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,inpatient,,,341.00000,323.95000,Amish/Mennonite,Amish Mennonite,,187.55,,,,,,,187.55,330.77,percent of total billed charges,
RMVE FB INTRANASL OFFICE PROC -TECH,72186,CDM,510,RC,30300,CPT,,,facility,outpatient,,,341.00000,323.95000,Amish/Mennonite,Amish Mennonite,,187.55,,,,,,,122.40,330.77,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,134.20,236.68,percent of total billed charges,
PUNC ASP ABSC HEMATOM CYST-US-TECH,72187,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,122.00,417.31,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,inpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,100.65,177.51,percent of total billed charges,
RMVL FB AUD CANAL EXTRNL WO GEN ANES-TECH,72188,CDM,510,RC,69200,CPT,,,facility,outpatient,,,183.00000,173.85000,Amish/Mennonite,Amish Mennonite,,100.65,,,,,,,91.50,177.51,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,64.90,114.46,percent of total billed charges,
PREVENT MED COUNSEL 45 MIN-TECH,72189,CDM,510,RC,99403,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,59.00,114.46,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
PSYCH DIAGNOSTIC EVAL APNP-TECH,72190,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
PAR/CUT BENIGN SKIN LESN SNGL-TECH,72192,CDM,510,RC,11055,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,44.50,207.54,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,inpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,36.85,64.99,percent of total billed charges,
RMVE NAIL PLATE ADD-ON-TECH,72193,CDM,510,RC,11732,CPT,,,facility,outpatient,,,67.00000,63.65000,Amish/Mennonite,Amish Mennonite,,36.85,,,,,,,33.50,64.99,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,inpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,,166.10,,,,,,,166.10,292.94,percent of total billed charges,
RPR FEEYNLMM 7.6-12.5CM SMPL-TECH,72194,CDM,510,RC,12015,CPT,,,facility,outpatient,,,302.00000,286.90000,Amish/Mennonite,Amish Mennonite,,166.10,,,,,,,151.00,292.94,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,inpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,,410.85,,,,,,,410.85,724.59,percent of total billed charges,
RMVL FB FOOT SUBQ-TECH,72195,CDM,510,RC,28190,CPT,,,facility,outpatient,,,747.00000,709.65000,Amish/Mennonite,Amish Mennonite,,410.85,,,,,,,373.50,734.90,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,90.20,159.08,percent of total billed charges,
RMVE SKIN TAG UP TO 15-TECH,72196,CDM,510,RC,11200,CPT,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,82.00,207.54,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
RMVE SKIN TAGS ADD-ON-TECH,72197,CDM,510,RC,11201,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,34.92,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,inpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,295.90,521.86,percent of total billed charges,
RPR NHFG 2.6-7.5 INT-TECH,72198,CDM,510,RC,12042,CPT,,,facility,outpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,269.00,521.86,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,inpatient,,,248.00000,235.60000,Amish/Mennonite,Amish Mennonite,,136.40,,,,,,,136.40,240.56,percent of total billed charges,
RPR SAL EA ADDL 5CM CMPLX-TECH,72199,CDM,510,RC,13122,CPT,,,facility,outpatient,,,248.00000,235.60000,Amish/Mennonite,Amish Mennonite,,136.40,,,,,,,124.00,240.56,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,inpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,TC,1333.75,,,,,,,1333.75,2352.25,percent of total billed charges,
BONE IMAGING;WHOLE -TECH,7220,CDM,340,RC,78306,CPT,,,facility,outpatient,,,2425.00000,2303.75000,Amish/Mennonite,Amish Mennonite,TC,1333.75,,,,,,,1212.50,2352.25,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,inpatient,,,416.00000,395.20000,Amish/Mennonite,Amish Mennonite,,228.80,,,,,,,228.80,403.52,percent of total billed charges,
RMVE W INS NON-BIODEG RX IMPL-TECH,72200,CDM,510,RC,11983,CPT,,,facility,outpatient,,,416.00000,395.20000,Amish/Mennonite,Amish Mennonite,,228.80,,,,,,,208.00,416.79,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,inpatient,,,549.00000,521.55000,Amish/Mennonite,Amish Mennonite,,301.95,,,,,,,301.95,532.53,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM INT-TECH,72201,CDM,510,RC,12052,CPT,,,facility,outpatient,,,549.00000,521.55000,Amish/Mennonite,Amish Mennonite,,301.95,,,,,,,274.50,532.53,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
I&D VULVA/PERINEAL ABSCESS-TECH,72202,CDM,510,RC,56405,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,317.72,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,inpatient,,,718.00000,682.10000,Amish/Mennonite,Amish Mennonite,,394.90,,,,,,,394.90,696.46,percent of total billed charges,
RPR FCCMNAGHF 1.1-2.5 CMPLX-TECH,72203,CDM,510,RC,13131,CPT,,,facility,outpatient,,,718.00000,682.10000,Amish/Mennonite,Amish Mennonite,,394.90,,,,,,,359.00,696.46,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,inpatient,,,213.00000,202.35000,Amish/Mennonite,Amish Mennonite,,117.15,,,,,,,117.15,206.61,percent of total billed charges,
RPR FEEYNLMM 2.6-5.0CM SMPL-TECH,72204,CDM,510,RC,12013,CPT,,,facility,outpatient,,,213.00000,202.35000,Amish/Mennonite,Amish Mennonite,,117.15,,,,,,,106.50,207.54,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,inpatient,,,565.00000,536.75000,Amish/Mennonite,Amish Mennonite,,310.75,,,,,,,310.75,548.05,percent of total billed charges,
RPR SATE 2.6-7.5CM INT-TECH,72205,CDM,510,RC,12032,CPT,,,facility,outpatient,,,565.00000,536.75000,Amish/Mennonite,Amish Mennonite,,310.75,,,,,,,282.50,548.05,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CATH W/O PUMP/PORT-TECH,72206,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,195.50,645.77,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
SHAVE LSN <=0.5CM SNHFG-TECH,72207,CDM,510,RC,11305,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,93.00,207.54,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
VISIT EST PAT LEVEL 4-TECH,72208,CDM,510,RC,99214,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,inpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,438.35,773.09,percent of total billed charges,
RPR SAL 2.6-7.5CM CMPLX-TECH,72210,CDM,510,RC,13121,CPT,,,facility,outpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,398.50,773.09,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,TC,58.30,,,,,,,58.30,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 3-TECH,72211,CDM,510,RC,99203,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,TC,58.30,,,,,,,53.00,102.82,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,inpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,111.65,196.91,percent of total billed charges,
RPR SNAGTE 2.6-7.5CM SMPL-TECH,72212,CDM,510,RC,12002,CPT,,,facility,outpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,,111.65,,,,,,,101.50,207.54,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,inpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,243.10,428.74,percent of total billed charges,
RPR SATE <=2.5CM INT-TECH,72213,CDM,510,RC,12031,CPT,,,facility,outpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,221.00,428.74,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
VISIT PREV MED EST AGE 18-39-TECH,72214,CDM,510,RC,99395,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,119.31,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,inpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,391.60,690.64,percent of total billed charges,
RPR SATE 12.6-20CM INT-TECH,72215,CDM,510,RC,12035,CPT,,,facility,outpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,,391.60,,,,,,,356.00,690.64,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
VISIT EST PAT LEVEL 3-TECH,72216,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,33.00,64.02,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
RPR FEEYNLMM <=2.5CM SMPL-TECH,72217,CDM,510,RC,12011,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,55.55,97.97,percent of total billed charges,
VISIT PREV MED ESTAB AGE 12-17-TECH,72218,CDM,510,RC,99394,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,50.50,97.97,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,inpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,,172.70,,,,,,,172.70,304.58,percent of total billed charges,
WEDGE EXN SKIN NAIL FOLD-TECH,72219,CDM,510,RC,11765,CPT,,,facility,outpatient,,,314.00000,298.30000,Amish/Mennonite,Amish Mennonite,,172.70,,,,,,,157.00,417.31,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
SHAVE LESN FEEYNOLMM 0.6-1CM-TECH,72220,CDM,510,RC,11311,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,104.00,207.54,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
VISIT PREV MED ESTAB AGE 40-64-TECH,72221,CDM,510,RC,99396,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,65.50,127.07,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,139.70,246.38,percent of total billed charges,
PSYCH DIAG EVAL W MED SVCS APNP-TECH,72222,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,127.00,246.38,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,inpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,,14.30,,,,,,,14.30,25.22,percent of total billed charges,
TRIM NAILS ANY NUMBER-TECH,72223,CDM,510,RC,11719,CPT,,,facility,outpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,,14.30,,,,,,,13.00,62.04,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,inpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,159.50,281.30,percent of total billed charges,
SHAVE LESN TR/LIMB >2CM-TECH,72224,CDM,510,RC,11303,CPT,,,facility,outpatient,,,290.00000,275.50000,Amish/Mennonite,Amish Mennonite,,159.50,,,,,,,145.00,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,inpatient,,,159.00000,151.05000,Amish/Mennonite,Amish Mennonite,,87.45,,,,,,,87.45,154.23,percent of total billed charges,
VISIT PREV MED INIT AGE 40-64-TECH,72225,CDM,510,RC,99386,CPT,,,facility,outpatient,,,159.00000,151.05000,Amish/Mennonite,Amish Mennonite,,87.45,,,,,,,79.50,154.23,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,220.19,percent of total billed charges,
SHAVE LESN S/N/H/F/G 0.6-1CM-TECH,72226,CDM,510,RC,11306,CPT,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,113.50,220.19,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
WND DEBRID 1ST 20 SQ CM-TECH,72227,CDM,510,RC,97597,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,207.54,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,inpatient,,,188.00000,178.60000,Amish/Mennonite,Amish Mennonite,,103.40,,,,,,,103.40,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 65+-TECH,72228,CDM,510,RC,99387,CPT,,,facility,outpatient,,,188.00000,178.60000,Amish/Mennonite,Amish Mennonite,,103.40,,,,,,,94.00,182.36,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
VISIT PREV MED INIT AGE 12-17-TECH,72229,CDM,510,RC,99384,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,56.50,109.61,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
STRAP UNNA BOOT BIL-TECH,72230,CDM,510,RC,29580,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,164.81,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,inpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,216.31,percent of total billed charges,
SHAVE LESN TR/LIMB 0.6-1CM-TECH,72231,CDM,510,RC,11301,CPT,,,facility,outpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,111.50,216.31,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
VISIT EST PAT LEVEL 2-TECH,72232,CDM,510,RC,99212,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,23.00,44.62,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
VISIT OP CONSULT LEVEL 5-TECH,72233,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,245.41,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,inpatient,,,946.00000,898.70000,Amish/Mennonite,Amish Mennonite,,520.30,,,,,,,520.30,917.62,percent of total billed charges,
RPR EYNEL 2.6-7.5CM CMPLX-TECH,72234,CDM,510,RC,13152,CPT,,,facility,outpatient,,,946.00000,898.70000,Amish/Mennonite,Amish Mennonite,,520.30,,,,,,,473.00,917.62,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,inpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,178.20,314.28,percent of total billed charges,
INC THROMBOSED HEMORR EXTERNAL-TECH,72235,CDM,510,RC,46083,CPT,,,facility,outpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,162.00,314.28,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,144.65,255.11,percent of total billed charges,
SHAVE LESN TR/LIMB 1.1-2CM-TECH,72236,CDM,510,RC,11302,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,131.50,255.11,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,inpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,164.45,290.03,percent of total billed charges,
SHAVE LESN FEEYNOLMM 1.1-2CM-TECH,72237,CDM,510,RC,11312,CPT,,,facility,outpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,149.50,417.31,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,58.30,102.82,percent of total billed charges,
VISIT PREV MED INIT AGE 5-11-TECH,72238,CDM,510,RC,99383,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,,58.30,,,,,,,53.00,102.82,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,42.35,74.69,percent of total billed charges,
VISIT NEW PAT LEVEL 2-TECH,72241,CDM,510,RC,99202,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,,42.35,,,,,,,38.50,74.69,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
REMOVAL OF INTRAUTERINE DEVICE-TECH,72242,CDM,510,RC,58301,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,95.50,317.72,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
VISIT OP CONSULT LEVEL 2-TECH,72243,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,inpatient,,,362.00000,343.90000,Amish/Mennonite,Amish Mennonite,,199.10,,,,,,,199.10,351.14,percent of total billed charges,
RPR EYNEL EA ADDL 5CM CMPLX-TECH,72244,CDM,510,RC,13153,CPT,,,facility,outpatient,,,362.00000,343.90000,Amish/Mennonite,Amish Mennonite,,199.10,,,,,,,181.00,351.14,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,inpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,319.00,562.60,percent of total billed charges,
RPR SATE 7.6-12.5CM INT-TECH,72245,CDM,510,RC,12034,CPT,,,facility,outpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,290.00,562.60,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
RPR SNAGTE 7.6-12.5 CM SMPL-TECH,72246,CDM,510,RC,12004,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,231.83,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,inpatient,,,296.00000,281.20000,Amish/Mennonite,Amish Mennonite,,162.80,,,,,,,162.80,287.12,percent of total billed charges,
RMVE NON-BIODEG DRUG DEL IMPL-TECH,72247,CDM,510,RC,11982,CPT,,,facility,outpatient,,,296.00000,281.20000,Amish/Mennonite,Amish Mennonite,,162.80,,,,,,,148.00,416.79,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,inpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,48.95,86.33,percent of total billed charges,
VISIT PREV MED ESTAB AGE 1-4-TECH,72248,CDM,510,RC,99392,CPT,,,facility,outpatient,,,89.00000,84.55000,Amish/Mennonite,Amish Mennonite,,48.95,,,,,,,44.50,86.33,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,inpatient,,,644.00000,611.80000,Amish/Mennonite,Amish Mennonite,,354.20,,,,,,,354.20,624.68,percent of total billed charges,
RPR FEEYNLMM 5.1-7.5CM INT-TECH,72249,CDM,510,RC,12053,CPT,,,facility,outpatient,,,644.00000,611.80000,Amish/Mennonite,Amish Mennonite,,354.20,,,,,,,322.00,624.68,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
VISIT NEW PAT LEVEL 5-TECH,72251,CDM,510,RC,99205,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,197.88,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,inpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,54.45,96.03,percent of total billed charges,
VISIT PREV MED INIT AGE 1-4-TECH,72252,CDM,510,RC,99382,CPT,,,facility,outpatient,,,99.00000,94.05000,Amish/Mennonite,Amish Mennonite,,54.45,,,,,,,49.50,96.03,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,inpatient,,,1540.00000,1463.00000,Amish/Mennonite,Amish Mennonite,,847.00,,,,,,,847.00,1493.80,percent of total billed charges,
STERNAL DEBRIDEMENT-TECH,72254,CDM,510,RC,21627,CPT,,,facility,outpatient,,,1540.00000,1463.00000,Amish/Mennonite,Amish Mennonite,,847.00,,,,,,,770.00,1493.80,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
VISIT EST PAT LEVEL 5-TECH,72255,CDM,510,RC,99215,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,76.50,148.41,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,inpatient,,,1074.00000,1020.30000,Amish/Mennonite,Amish Mennonite,,590.70,,,,,,,590.70,1041.78,percent of total billed charges,
UMBILECTOM OMPHALECT EXV UMBIL-TECH,72256,CDM,510,RC,49250,CPT,,,facility,outpatient,,,1074.00000,1020.30000,Amish/Mennonite,Amish Mennonite,,590.70,,,,,,,537.00,3686.08,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,inpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,264.55,466.57,percent of total billed charges,
RPR FEEYNLMM <=2.5CM INT-TECH,72257,CDM,510,RC,12051,CPT,,,facility,outpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,240.50,466.57,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
VISIT OP CONSULT LEVEL 3-TECH,72258,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
VISIT PREV MED ESTAB AGE 5-11-TECH,72259,CDM,510,RC,99393,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,46.50,90.21,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,inpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,80.85,142.59,percent of total billed charges,
VISIT PREV MED INIT AGE 18-39-TECH,72260,CDM,510,RC,99385,CPT,,,facility,outpatient,,,147.00000,139.65000,Amish/Mennonite,Amish Mennonite,,80.85,,,,,,,73.50,142.59,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,inpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,86.35,152.29,percent of total billed charges,
VISIT PREV MED ESTAB AGE 65+-TECH,72261,CDM,510,RC,99397,CPT,,,facility,outpatient,,,157.00000,149.15000,Amish/Mennonite,Amish Mennonite,,86.35,,,,,,,78.50,152.29,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,99.55,175.57,percent of total billed charges,
SHAVE LESN TR/LIMB <=0.5CM-TECH,72262,CDM,510,RC,11300,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,90.50,417.31,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,inpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,45.65,80.51,percent of total billed charges,
VISIT PREV MED ESTAB AGE <1-TECH,72265,CDM,510,RC,99391,CPT,,,facility,outpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,,45.65,,,,,,,41.50,80.51,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
RPR SNAGTE <=2.5CM SMPL-TECH,72266,CDM,510,RC,12001,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,83.50,207.54,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
WELCOME TO MEDICARE EXAM-TECH,72267,CDM,770,RC,G0402,HCPCS,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,81.00,157.14,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,inpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,116.05,204.67,percent of total billed charges,
SHAVE LESN FEEYNOLMM <=0.5CM-TECH,72268,CDM,510,RC,11310,CPT,,,facility,outpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,105.50,207.54,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,89.24,percent of total billed charges,
VISIT PREV MED INIT <1-TECH,72269,CDM,510,RC,99381,CPT,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,46.00,89.24,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,85.80,151.32,percent of total billed charges,
VISIT NEW PAT LEVEL 4-TECH,72270,CDM,510,RC,99204,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,78.00,151.32,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
REMOVAL FB CORNEA WO SLIT-TECH,72271,CDM,510,RC,65220,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,83.00,416.79,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
VISIT OP CONSULT LEVEL 4-TECH,72272,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,197.88,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,inpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,147.40,259.96,percent of total billed charges,
SHAVE LESN S/N/H/F/G 1.1-2CM-TECH,72273,CDM,510,RC,11307,CPT,,,facility,outpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,134.00,259.96,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,inpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,243.10,428.74,percent of total billed charges,
RPR NHFG <=2.5CM INT-TECH,72274,CDM,510,RC,12041,CPT,,,facility,outpatient,,,442.00000,419.90000,Amish/Mennonite,Amish Mennonite,,243.10,,,,,,,221.00,428.74,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2078.89000,1974.95000,Amish/Mennonite,Amish Mennonite,,1143.39,,,,,,,1018.66,2016.52,percent of total billed charges,
GRAFT VASC L30CM DIA8MM THOR CLLGN POLY WVN STR DBL VEL PASS,72277,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2078.89000,1974.95000,Amish/Mennonite,Amish Mennonite,,1143.39,,,,,,,954.21,2078.89,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA26MM IL DIA14.5MM IPSILATERAL LEG,72296,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,inpatient,,,11128.16000,10571.75000,Amish/Mennonite,Amish Mennonite,,6120.49,,,,,,,5452.80,10794.32,percent of total billed charges,
DRESSING BIO 5X4IN BVN CLGN GG POLYSILOXAN,72297,CDM,278,RC,Q4104,HCPCS,,,facility,outpatient,,,11128.16000,10571.75000,Amish/Mennonite,Amish Mennonite,,6120.49,,,,,,,5107.83,11128.16,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L19MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,72299,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,inpatient,1,mL,97.37000,92.50000,Amish/Mennonite,Amish Mennonite,,53.55,,,,,,,53.55,94.45,percent of total billed charges,
INSULIN DETEMIR 100 UNITS/ML SOL,72301,CDM,250,RC,J1815,HCPCS,00169643810,NDC,facility,outpatient,1,mL,97.37000,92.50000,Amish/Mennonite,Amish Mennonite,,53.55,,,,,,,1.49,94.45,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,inpatient,1,mL,486.83000,462.49000,Amish/Mennonite,Amish Mennonite,,267.76,,,,,,,267.76,472.23,percent of total billed charges,
AVELUMAB SOLN 20 MG/ML 10 ML,72302,CDM,636,RC,J9023,HCPCS,44087353501,NDC,facility,outpatient,1,mL,486.83000,462.49000,Amish/Mennonite,Amish Mennonite,,267.76,,,,,,,100.30,472.23,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,inpatient,1,EA,5750.00000,5462.50000,Amish/Mennonite,Amish Mennonite,,3162.50,,,,,,,3162.50,5577.50,percent of total billed charges,
COAGULATION FACTOR XA POWD-INJ (ANDEXXA) 200MG,72310,CDM,636,RC,J7169,HCPCS,69853010201,NDC,facility,outpatient,1,EA,5750.00000,5462.50000,Amish/Mennonite,Amish Mennonite,,3162.50,,,,,,,131.56,5577.50,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,inpatient,1,mL,1421.18000,1350.13000,Amish/Mennonite,Amish Mennonite,,781.65,,,,,,,781.65,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031801,NDC,facility,outpatient,1,mL,1421.18000,1350.13000,Amish/Mennonite,Amish Mennonite,,781.65,,,,,,,0.37000,1378.54,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,inpatient,1,mL,2524.14000,2397.93000,Amish/Mennonite,Amish Mennonite,,1388.28,,,,,,,1388.28,2448.42,percent of total billed charges,
FILGRASTIM-SNDZ SYRINGE 300 MCG/0.5 ML,72311,CDM,636,RC,Q5101,HCPCS,61314031810,NDC,facility,outpatient,1,mL,2524.14000,2397.93000,Amish/Mennonite,Amish Mennonite,,1388.28,,,,,,,0.37000,2448.42,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-16,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,inpatient,1,GM,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
SODIUM POLYSTYRENE SULFONATE POWD,72314,CDM,250,RC,11534-0166-15,NDC,,,facility,outpatient,1,GM,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.31,2.55,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA16MM 0.020IN PERIPH COMPLX L VOL STD FRME,72315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,41.36000,39.29000,Amish/Mennonite,Amish Mennonite,,22.75,,,,,,,20.27,40.12,percent of total billed charges,
PSTNR STNT 6FR 45CM URET RADOPQ,72316,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,41.36000,39.29000,Amish/Mennonite,Amish Mennonite,,22.75,,,,,,,18.98,41.36,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,436.80000,414.96000,Amish/Mennonite,Amish Mennonite,,240.24,,,,,,,214.03,423.70,percent of total billed charges,
SHEATH GD ANL1 CRV 6FR 2.2MM 90CM HDRPH FLXR,72318,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,436.80000,414.96000,Amish/Mennonite,Amish Mennonite,,240.24,,,,,,,200.49,436.80,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 90D 10MM 4FR 120CM NTNL AMPTZ GOS CATH,72319,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA20MM CATH L120CM GWIRE 0.035IN SHTH,72320,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA14MM CATH L80MM SHTH 9FR GWIRE,72321,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,72322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
GROUP A STREP-NAT-TECH,72323,CDM,300,RC,87651,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,35.09,1833.46,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20ML SDV,72324,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,2.31,12.33,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
METHOCARBAMOL 250 MG TAB,72325,CDM,250,RC,63739-0166-10-00050,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,inpatient,1,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,50268-0112-15,NDC,,,facility,outpatient,1,EA,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.25,2.43,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,inpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
BENAZEPRIL TAB 40 MG,72327,CDM,250,RC,65862-0118-01,NDC,,,facility,outpatient,1,EA,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,43547-0335-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,inpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,1.09,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,50268-0109-15,NDC,,,facility,outpatient,1,EA,1.98000,1.88000,Amish/Mennonite,Amish Mennonite,,1.09,,,,,,,0.99000,1.92,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,inpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.28050,0.49470,percent of total billed charges,
BENAZEPRIL TAB 5 MG,72328,CDM,250,RC,65162-0751-10,NDC,,,facility,outpatient,1,EA,0.51000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28050,,,,,,,0.25500,0.49470,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,TC,125.95,,,,,,,125.95,222.13,percent of total billed charges,
XR FACIAL BONES < 3 VIEWS-TECH,72341,CDM,320,RC,70140,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,TC,125.95,,,,,,,114.50,1153.87,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,inpatient,,,218.90000,207.95000,Amish/Mennonite,Amish Mennonite,90,120.39,,,,,,,120.39,212.33,percent of total billed charges,
SPOTTED FEVER SO TECH,72342,CDM,300,RC,86757,CPT,,,facility,outpatient,,,218.90000,207.95000,Amish/Mennonite,Amish Mennonite,90,120.39,,,,,,,19.99,1018.59,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,inpatient,,,219.20000,208.24000,Amish/Mennonite,Amish Mennonite,90,120.56,,,,,,,120.56,212.62,percent of total billed charges,
"SOLUBLE LIVER AG,IGG,AB SO TECH",72343,CDM,300,RC,83516,CPT,,,facility,outpatient,,,219.20000,208.24000,Amish/Mennonite,Amish Mennonite,90,120.56,,,,,,,11.91,594.19,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,inpatient,,,161.60000,153.52000,Amish/Mennonite,Amish Mennonite,90,88.88,,,,,,,88.88,156.75,percent of total billed charges,
"PYRUVIC ACID, CSF SO TECH",72344,CDM,300,RC,84210,CPT,,,facility,outpatient,,,161.60000,153.52000,Amish/Mennonite,Amish Mennonite,90,88.88,,,,,,,14.96,679.08,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,inpatient,,,240.30000,228.28000,Amish/Mennonite,Amish Mennonite,90,132.16,,,,,,,132.16,233.09,percent of total billed charges,
IGF-1 (SOMATOMEDIN) SO TECH,72345,CDM,300,RC,84305,CPT,,,facility,outpatient,,,240.30000,228.28000,Amish/Mennonite,Amish Mennonite,90,132.16,,,,,,,21.97,1103.49,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,inpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,90,115.33,,,,,,,115.33,203.41,percent of total billed charges,
ALPHA 1 ANTITRYPSIN S/Z SO TECH,72346,CDM,300,RC,82542,CPT,,,facility,outpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,90,115.33,,,,,,,24.89,1137.41,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,90,85.80,,,,,,,85.80,151.32,percent of total billed charges,
ALPHA-1 ANTITRYPSIN S/Z SO TECH,72347,CDM,300,RC,82103,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,90,85.80,,,,,,,13.89,696.05,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,90,47.30,,,,,,,47.30,83.42,percent of total billed charges,
"ALBUMIN,SERUM SO TECH",72349,CDM,300,RC,82040,CPT,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,90,47.30,,,,,,,5.11,254.68,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,inpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,90,49.50,,,,,,,49.50,87.30,percent of total billed charges,
"ALBUMIN, CSF SO TECH",72350,CDM,300,RC,82042,CPT,,,facility,outpatient,,,90.00000,85.50000,Amish/Mennonite,Amish Mennonite,90,49.50,,,,,,,7.27,373.51,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,inpatient,,,295.70000,280.91000,Amish/Mennonite,Amish Mennonite,90,162.63,,,,,,,162.63,286.83,percent of total billed charges,
"IGG,SER,CSF SO TECH",72351,CDM,300,RC,82784,CPT,,,facility,outpatient,,,295.70000,280.91000,Amish/Mennonite,Amish Mennonite,90,162.63,,,,,,,9.61,492.33,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,inpatient,,,161.60000,153.52000,Amish/Mennonite,Amish Mennonite,90,88.88,,,,,,,88.88,156.75,percent of total billed charges,
"BORRELIA,EA SO TECH",72352,CDM,300,RC,86618,CPT,,,facility,outpatient,,,161.60000,153.52000,Amish/Mennonite,Amish Mennonite,90,88.88,,,,,,,17.60,882.80,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,inpatient,,,99.50000,94.52000,Amish/Mennonite,Amish Mennonite,90,54.73,,,,,,,54.73,96.52,percent of total billed charges,
PREGABALIN SO TECH,72353,CDM,301,RC,80366,CPT,,,facility,outpatient,,,99.50000,94.52000,Amish/Mennonite,Amish Mennonite,90,54.73,,,,,,,49.75,1137.41,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,inpatient,,,2343.00000,2225.85000,Amish/Mennonite,Amish Mennonite,90,1288.65,,,,,,,1288.65,2272.71,percent of total billed charges,
PML/PARA GENE (PMLR) SO,72354,CDM,300,RC,81315,CPT,,,facility,outpatient,,,2343.00000,2225.85000,Amish/Mennonite,Amish Mennonite,90,1288.65,,,,,,,214.21,10831.07,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,188.60000,179.17000,Amish/Mennonite,Amish Mennonite,,103.73,,,,,,,92.41,182.94,percent of total billed charges,
SHTH TEAR AWAY LNG 8FR X 30CM,72357,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,188.60000,179.17000,Amish/Mennonite,Amish Mennonite,,103.73,,,,,,,86.57,188.60,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 25MM BOV PERICARD COCR ALLY POLY STENTED,72361,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,11738.92,25575.00,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,1496.25000,1421.44000,Amish/Mennonite,Amish Mennonite,,822.94,,,,,,,733.16,1451.36,percent of total billed charges,
CATHETER BLNOCC C.5ML 3FR 7MM 27CM PRUITT SYR,72364,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,1496.25000,1421.44000,Amish/Mennonite,Amish Mennonite,,822.94,,,,,,,686.78,1496.25,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,inpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,TC,144.10,,,,,,,144.10,254.14,percent of total billed charges,
XR TMJ UNILAT-TECH,72365,CDM,320,RC,70328,CPT,,,facility,outpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,TC,144.10,,,,,,,131.00,1331.91,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,inpatient,,,13067.00000,12413.65000,Amish/Mennonite,Amish Mennonite,,7186.85,,,,,,,7186.85,12674.99,percent of total billed charges,
NM SAMARIUM 153 TO 150MCI,72366,CDM,344,RC,A9604,HCPCS,,,facility,outpatient,,,13067.00000,12413.65000,Amish/Mennonite,Amish Mennonite,,7186.85,,,,,,,4314.91,12674.99,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,27.24000,25.88000,Amish/Mennonite,Amish Mennonite,,14.98,,,,,,,14.98,26.42,percent of total billed charges,
NONEL BINDER-EXTREM,72372,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,27.24000,25.88000,Amish/Mennonite,Amish Mennonite,,14.98,,,,,,,13.62,26.42,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,inpatient,,,191.30000,181.74000,Amish/Mennonite,Amish Mennonite,90,105.22,,,,,,,105.22,185.56,percent of total billed charges,
"POLIOVIRUS (TYPES1,3) ANTIBODIES, NEUT (FPOLO) SO",72373,CDM,300,RC,86382,CPT,,,facility,outpatient,,,191.30000,181.74000,Amish/Mennonite,Amish Mennonite,90,105.22,,,,,,,17.47,882.80,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,inpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00338070948,NDC,facility,outpatient,1,mL,0.12000,0.12000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,inpatient,1,mL,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00409707426,NDC,facility,outpatient,1,mL,0.15000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,00990707426,NDC,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,inpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.69300,1.22,percent of total billed charges,
POTASSIUM CHLORIDE 10 MEQ/100 ML PREMIX,72374,CDM,250,RC,J3480,HCPCS,14789010910,NDC,facility,outpatient,1,mL,1.26000,1.20000,Amish/Mennonite,Amish Mennonite,,0.69300,,,,,,,0.27217,1.22,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,inpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.18,2.09,percent of total billed charges,
PILOCARPINE TAB 2.5 MG,72378,CDM,250,RC,00527-1313-01-00050,NDC,,,facility,outpatient,1,EA,2.15000,2.04000,Amish/Mennonite,Amish Mennonite,,1.18,,,,,,,1.07,2.09,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,inpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-01,NDC,,,facility,outpatient,1,EA,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.47500,0.92150,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,inpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
FERROUS SULFATE 325 MG TAB-,72379,CDM,250,RC,00245-0108-11,NDC,,,facility,outpatient,1,EA,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,00904-7403-61,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,inpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,50268-0855-15,NDC,,,facility,outpatient,1,EA,0.66000,0.62000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,inpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.31350,0.55290,percent of total billed charges,
CYANOCOBALAMIN TAB 1000 MCG,72380,CDM,250,RC,77333-0938-10,NDC,,,facility,outpatient,1,EA,0.57000,0.54000,Amish/Mennonite,Amish Mennonite,,0.31350,,,,,,,0.28500,0.55290,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN SO-TECH,72381,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,24.89,1137.41,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,inpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
TIOTROPIUM INHALER 2.5 MCG/INH 4 GM (10 DOSE),72383,CDM,250,RC,00597-0100-51,NDC,,,facility,outpatient,1,EA,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,11.85,22.99,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,inpatient,1,EA,2450.87000,2328.32000,Amish/Mennonite,Amish Mennonite,,1347.98,,,,,,,1347.98,2377.34,percent of total billed charges,
INFLIXIMAB-DYYB POWD-INJ 100 MG (INFLECTRA),72385,CDM,636,RC,Q5103,HCPCS,00069080901,NDC,facility,outpatient,1,EA,2450.87000,2328.32000,Amish/Mennonite,Amish Mennonite,,1347.98,,,,,,,19.06,2377.34,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,inpatient,1,EA,5991.52000,5691.95000,Amish/Mennonite,Amish Mennonite,,3295.34,,,,,,,3295.34,5811.77,percent of total billed charges,
C1 ESTERASE INHIBITOR POWD-INJ 500 INTUNIT/10 ML (BERINERT),72386,CDM,636,RC,J0597,HCPCS,63833082502,NDC,facility,outpatient,1,EA,5991.52000,5691.95000,Amish/Mennonite,Amish Mennonite,,3295.34,,,,,,,75.86,5811.77,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,inpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.20,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,00904-7355-04,NDC,,,facility,outpatient,1,EA,2.19000,2.08000,Amish/Mennonite,Amish Mennonite,,1.20,,,,,,,1.09,2.12,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,inpatient,1,EA,149.44000,141.96000,Amish/Mennonite,Amish Mennonite,,82.19,,,,,,,82.19,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,63402-0302-30,NDC,,,facility,outpatient,1,EA,149.44000,141.96000,Amish/Mennonite,Amish Mennonite,,82.19,,,,,,,74.72,144.96,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,inpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,65162-0879-03,NDC,,,facility,outpatient,1,EA,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.05,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,inpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.67650,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,67877-0638-30,NDC,,,facility,outpatient,1,EA,1.23000,1.17000,Amish/Mennonite,Amish Mennonite,,0.67650,,,,,,,0.61500,1.19,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,inpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
LURASIDONE TAB 20 MG,72391,CDM,250,RC,72205-0207-30,NDC,,,facility,outpatient,1,EA,2.10000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,inpatient,1,EA,22.44000,21.31000,Amish/Mennonite,Amish Mennonite,,12.34,,,,,,,12.34,21.77,percent of total billed charges,
TAFLUPROST OPHTHALMIC 0.0015% SOLN,72392,CDM,250,RC,17478-0609-30,NDC,,,facility,outpatient,1,EA,22.44000,21.31000,Amish/Mennonite,Amish Mennonite,,12.34,,,,,,,11.22,21.77,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,inpatient,1,mL,5333.95000,5067.25000,Amish/Mennonite,Amish Mennonite,,2933.67,,,,,,,2933.67,5173.93,percent of total billed charges,
PALIPERIDONE SUSP 117 MG/0.75 ML (INVEGA SUSTENNA),72393,CDM,636,RC,J2426,HCPCS,50458056201,NDC,facility,outpatient,1,mL,5333.95000,5067.25000,Amish/Mennonite,Amish Mennonite,,2933.67,,,,,,,15.08,5173.93,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L20CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72397,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,inpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,TC,546.15,,,,,,,546.15,963.21,percent of total billed charges,
XR PORTOGRAM TRANSHEPATIC W/O HD-TECH,72401,CDM,320,RC,75887,CPT,,,facility,outpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,TC,546.15,,,,,,,420.81,17311.25,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6744.75000,6407.51000,Amish/Mennonite,Amish Mennonite,,3709.61,,,,,,,3304.93,6542.41,percent of total billed charges,
BLLN OCCL SCEPTER XC 4X11X150,72402,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6744.75000,6407.51000,Amish/Mennonite,Amish Mennonite,,3709.61,,,,,,,3095.84,6744.75,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,inpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-7.5 MG TAB,72403,CDM,250,RC,13107-0045-01,NDC,,,facility,outpatient,1,EA,0.48000,0.45000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,21.07,41.71,percent of total billed charges,
"PESSARY, NON RUBBER,ANY TYPE",72417,CDM,274,RC,A4562,HCPCS,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,21.50,81.82,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-0888-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,11.36,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,inpatient,1,mL,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,10.25,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00121-1016-42,NDC,,,facility,outpatient,1,mL,18.64000,17.71000,Amish/Mennonite,Amish Mennonite,,10.25,,,,,,,9.32,18.08,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,inpatient,1,mL,20.05000,19.05000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,11.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,00904-7064-25,NDC,,,facility,outpatient,1,mL,20.05000,19.05000,Amish/Mennonite,Amish Mennonite,,11.03,,,,,,,10.03,19.45,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,inpatient,1,mL,9.60000,9.12000,Amish/Mennonite,Amish Mennonite,,5.28,,,,,,,5.28,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,50268-0086-12,NDC,,,facility,outpatient,1,mL,9.60000,9.12000,Amish/Mennonite,Amish Mennonite,,5.28,,,,,,,4.80,9.31,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,inpatient,1,mL,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,12.50,22.04,percent of total billed charges,
ATOVAQUONE LIQ 750 MG/5 ML,72418,CDM,250,RC,66689-0062-18,NDC,,,facility,outpatient,1,mL,22.72000,21.58000,Amish/Mennonite,Amish Mennonite,,12.50,,,,,,,11.36,22.04,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,Amish/Mennonite,Amish Mennonite,,26.66,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON 50 MG TAB-,72419,CDM,250,RC,00469-2602-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,Amish/Mennonite,Amish Mennonite,,26.66,,,,,,,24.24,47.03,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,inpatient,1,mL,104.41000,99.19000,Amish/Mennonite,Amish Mennonite,,57.43,,,,,,,57.43,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,24208-0818-25,NDC,,,facility,outpatient,1,mL,104.41000,99.19000,Amish/Mennonite,Amish Mennonite,,57.43,,,,,,,52.20,101.28,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,inpatient,1,mL,95.21000,90.45000,Amish/Mennonite,Amish Mennonite,,52.37,,,,,,,52.37,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,61314-0224-05,NDC,,,facility,outpatient,1,mL,95.21000,90.45000,Amish/Mennonite,Amish Mennonite,,52.37,,,,,,,47.60,92.35,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,inpatient,1,mL,122.77000,116.63000,Amish/Mennonite,Amish Mennonite,,67.52,,,,,,,67.52,119.09,percent of total billed charges,
TIMOLOL GEL SOLN-OPHTH 0.25% 5 ML,72420,CDM,250,RC,62332-0545-05,NDC,,,facility,outpatient,1,mL,122.77000,116.63000,Amish/Mennonite,Amish Mennonite,,67.52,,,,,,,61.38,119.09,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
CHEMODENERVATION-TECH,72421,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,inpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,,286.55,,,,,,,286.55,505.37,percent of total billed charges,
CHEMODENERVATION SALIVARY GLANDS-TECH,72422,CDM,361,RC,,,,,facility,outpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,,286.55,,,,,,,286.55,5271.00,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,inpatient,1,mL,107.11000,101.75000,Amish/Mennonite,Amish Mennonite,,58.91,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC 100 UNITS/ML SOLN,72425,CDM,250,RC,00169-2662-11,NDC,,,facility,outpatient,1,mL,107.11000,101.75000,Amish/Mennonite,Amish Mennonite,,58.91,,,,,,,53.55,103.90,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,inpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,742.50,1309.50,percent of total billed charges,
CHEMODENERVATION ADD'L EXTREMITY-TECH,72426,CDM,361,RC,,,,,facility,outpatient,,,1350.00000,1282.50000,Amish/Mennonite,Amish Mennonite,,742.50,,,,,,,742.50,5271.00,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,inpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,1985.50,3501.70,percent of total billed charges,
XR ANGIOGRAM ADRENAL UNILATERAL-TECH,72428,CDM,320,RC,75731,CPT,,,facility,outpatient,,,3610.00000,3429.50000,Amish/Mennonite,Amish Mennonite,TC,1985.50,,,,,,,550.38,17311.25,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,inpatient,,,2929.00000,2782.55000,Amish/Mennonite,Amish Mennonite,,1610.95,,,,,,,1610.95,2841.13,percent of total billed charges,
CECOSTOMY BEDSIDE-TECH,72429,CDM,361,RC,,,,,facility,outpatient,,,2929.00000,2782.55000,Amish/Mennonite,Amish Mennonite,,1610.95,,,,,,,1610.95,5271.00,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,inpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,,1356.30,,,,,,,1356.30,2392.02,percent of total billed charges,
INSERT DRUG IMPLANT DEVICE-TECH,72430,CDM,361,RC,11981,CPT,,,facility,outpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,,1356.30,,,,,,,122.40,3163.00,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,Amish/Mennonite,Amish Mennonite,TC,1118.15,,,,,,,1118.15,1972.01,percent of total billed charges,
PH PROBE PLACEMENT-TECH,72431,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,Amish/Mennonite,Amish Mennonite,TC,1118.15,,,,,,,909.00,5271.00,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,inpatient,,,6986.00000,6636.70000,Amish/Mennonite,Amish Mennonite,,3842.30,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL OF IMPLANT SUPERFICIAL-TECH,72432,CDM,361,RC,,,,,facility,outpatient,,,6986.00000,6636.70000,Amish/Mennonite,Amish Mennonite,,3842.30,,,,,,,3842.30,6776.42,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
REMOVAL DRUG DELIVERY IMPLANT-TECH,72433,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,inpatient,,,738.00000,701.10000,Amish/Mennonite,Amish Mennonite,TC,405.90,,,,,,,405.90,715.86,percent of total billed charges,
ESTIM GUIDANCE W/CHEMODENERVATION-TECH,72434,CDM,922,RC,95873,CPT,,,facility,outpatient,,,738.00000,701.10000,Amish/Mennonite,Amish Mennonite,TC,405.90,,,,,,,369.00,715.86,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,790.55,percent of total billed charges,
CT  INJ ANES AGNT SCIATIC NERVE SGL LVL-TECH,72435,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,5271.00,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 27MM BOV PERICARD COCR ALLY POLY STENTED,72438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,11738.92,25575.00,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1653.75,3273.75,percent of total billed charges,
SHEATH INTRO 8.8FR 91.4CM NAGARE KVLR 73.7CM,72439,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1549.12,3375.00,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
ZINC GLUCONATE 25 MG TAB,72440,CDM,250,RC,00536-6671-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,inpatient,1,mL,107.11000,101.75000,Amish/Mennonite,Amish Mennonite,,58.91,,,,,,,58.91,103.90,percent of total billed charges,
INSULIN DEGLUDEC SOLN 100 UNITS/ML 3 ML PEN (EQV-TRESIBA),72441,CDM,250,RC,J1815,HCPCS,00169266015,NDC,facility,outpatient,1,mL,107.11000,101.75000,Amish/Mennonite,Amish Mennonite,,58.91,,,,,,,1.49,103.90,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,inpatient,1,GM,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.59,2.81,percent of total billed charges,
CETACAINE (BENZOCAINE/TETRACAINE) SPRAY 56 GM,72455,CDM,250,RC,10223-0201-01,NDC,,,facility,outpatient,1,GM,2.90000,2.75000,Amish/Mennonite,Amish Mennonite,,1.59,,,,,,,1.45,2.81,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,inpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
INDAPAMIDE 1.25 MG TAB,72457,CDM,250,RC,00228-2571-11-00050,NDC,,,facility,outpatient,1,EA,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,inpatient,,,688.00000,653.60000,Amish/Mennonite,Amish Mennonite,,378.40,,,,,,,378.40,667.36,percent of total billed charges,
CHEMO ADMIN INTRA ART PUSH-TECH,72460,CDM,331,RC,96420,CPT,,,facility,outpatient,,,688.00000,653.60000,Amish/Mennonite,Amish Mennonite,,378.40,,,,,,,314.95,667.36,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,inpatient,1,EA,24.48000,23.25000,Amish/Mennonite,Amish Mennonite,,13.46,,,,,,,13.46,23.75,percent of total billed charges,
FLUTICASONE FUROATE 200 MCG POWD,72466,CDM,250,RC,00173-0876-14,NDC,,,facility,outpatient,1,EA,24.48000,23.25000,Amish/Mennonite,Amish Mennonite,,13.46,,,,,,,12.24,23.75,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,inpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.90200,1.59,percent of total billed charges,
DOXYCYCLINE MONOHYDRATE 50 MG CAP,72468,CDM,250,RC,68382-0782-01,NDC,,,facility,outpatient,1,EA,1.64000,1.56000,Amish/Mennonite,Amish Mennonite,,0.90200,,,,,,,0.82000,1.59,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,inpatient,1,mL,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 20 GM,72470,CDM,636,RC,J1561,HCPCS,13533080024,NDC,facility,outpatient,1,mL,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,14.46,80.87,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,inpatient,1,GM,184.32000,175.11000,Amish/Mennonite,Amish Mennonite,,101.38,,,,,,,101.38,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-03,NDC,,,facility,outpatient,1,GM,184.32000,175.11000,Amish/Mennonite,Amish Mennonite,,101.38,,,,,,,92.16,178.79,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,inpatient,1,GM,131.67000,125.08000,Amish/Mennonite,Amish Mennonite,,72.42,,,,,,,72.42,127.72,percent of total billed charges,
TALC (STERILE) POWD 3 GM (INTRAPLEURAL),72472,CDM,250,RC,62327-0333-43,NDC,,,facility,outpatient,1,GM,131.67000,125.08000,Amish/Mennonite,Amish Mennonite,,72.42,,,,,,,65.83,127.72,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,inpatient,1,mL,285.68000,271.39000,Amish/Mennonite,Amish Mennonite,,157.12,,,,,,,157.12,277.11,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 10,000 UNITS/ML",72473,CDM,636,RC,Q5105,HCPCS,00069130810,NDC,facility,outpatient,1,mL,285.68000,271.39000,Amish/Mennonite,Amish Mennonite,,157.12,,,,,,,0.76000,277.11,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,inpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.09900,0.17460,percent of total billed charges,
BUPIVACAINE SOLN 0.25% 10 ML,72474,CDM,250,RC,J0665,HCPCS,0040911601801000,NDC,facility,outpatient,1,mL,0.18000,0.17000,Amish/Mennonite,Amish Mennonite,,0.09900,,,,,,,0.01550,0.17460,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,inpatient,1,mL,1762.49000,1674.37000,Amish/Mennonite,Amish Mennonite,,969.37,,,,,,,969.37,1709.62,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 1 ML,72477,CDM,636,RC,90375,HCPCS,13533031801,NDC,facility,outpatient,1,mL,1762.49000,1674.37000,Amish/Mennonite,Amish Mennonite,,969.37,,,,,,,266.44,1709.62,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,Amish/Mennonite,Amish Mennonite,,157.44,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-12,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,Amish/Mennonite,Amish Mennonite,,157.44,,,,,,,143.12,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,inpatient,1,mL,286.25000,271.94000,Amish/Mennonite,Amish Mennonite,,157.44,,,,,,,157.44,277.66,percent of total billed charges,
LIRAGLUTIDE SOLN 18 MG/3 ML PEN,72478,CDM,250,RC,00169-4060-13,NDC,,,facility,outpatient,1,mL,286.25000,271.94000,Amish/Mennonite,Amish Mennonite,,157.44,,,,,,,143.12,277.66,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,inpatient,1,mL,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.42350,0.74690,percent of total billed charges,
PHENYLEPHRINE NASAL 1% SPRA,72479,CDM,250,RC,00225-0810-47,NDC,,,facility,outpatient,1,mL,0.77000,0.73000,Amish/Mennonite,Amish Mennonite,,0.42350,,,,,,,0.38500,0.74690,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,51672-1282-02,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,inpatient,1,GM,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
TRIAMCINOLONE CREAM 0.1% 30 GM,72480,CDM,250,RC,67877-0251-30,NDC,,,facility,outpatient,1,GM,0.64000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,Amish/Mennonite,Amish Mennonite,,11951.94,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA30MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72482,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,Amish/Mennonite,Amish Mennonite,,11951.94,,,,,,,9974.44,21730.80,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,110.00,194.00,percent of total billed charges,
"XRAY/ABDOMEN,1 VIEW",72488,CDM,320,RC,74018,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,83.61,1614.89,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1881.86000,1787.77000,Amish/Mennonite,Amish Mennonite,,1035.02,,,,,,,922.11,1825.40,percent of total billed charges,
CATHETER VENT DRNGE L14CM OD2.7MM ID1.4MM BA SIL ANTIMIC,72494,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1881.86000,1787.77000,Amish/Mennonite,Amish Mennonite,,1035.02,,,,,,,863.77,1881.86,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,inpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00536-1272-22,NDC,,,facility,outpatient,1,GM,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,00904-7822-31,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,inpatient,1,GM,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,45802-0434-11,NDC,,,facility,outpatient,1,GM,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,inpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,51672-2002-02,NDC,,,facility,outpatient,1,GM,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,inpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CLOTRIMAZOLE TOPICAL 1% CREA,72495,CDM,250,RC,73750-0091-10,NDC,,,facility,outpatient,1,GM,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 20FR,72505,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,6.86,13.58,percent of total billed charges,
SLING UNIVERSAL,72519,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.00,13.58,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,inpatient,,,30.90000,29.35000,Amish/Mennonite,Amish Mennonite,,17.00,,,,,,,17.00,29.97,percent of total billed charges,
PPD READING ONLY,72524,CDM,510,RC,99199,CPT,,,facility,outpatient,,,30.90000,29.35000,Amish/Mennonite,Amish Mennonite,,17.00,,,,,,,15.45,29.97,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,154.55,272.57,percent of total billed charges,
"XRAY/CHEST,4 OR MORE VIEWS TC",72527,CDM,324,RC,71048,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,TC,154.55,,,,,,,140.50,1569.27,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
SODIUM ACETATE 2 MEQ/ML SOLN,72531,CDM,250,RC,00409-3299-46,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,inpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,00904-6356-02,NDC,,,facility,outpatient,1,GM,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,45802-0188-16,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,inpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MINERAL OIL/PETROLATUM/PHENYLEPHRINE TOPICAL 14%-74.9%-0.25% OINT,72534,CDM,250,RC,49348-0198-78,NDC,,,facility,outpatient,1,GM,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC .014IN 300CM FIELDER XT-R PTCA,72540,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,7443.72000,7071.53000,Amish/Mennonite,Amish Mennonite,,4094.05,,,,,,,3647.42,7220.41,percent of total billed charges,
LEAD PACE 4.4FR L88CM TRNSVEN STEROID ELUT IS-4 CONN QPLR,72541,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,7443.72000,7071.53000,Amish/Mennonite,Amish Mennonite,,4094.05,,,,,,,3416.67,7443.72,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM NYL COBRA 2 CRV TAPR,72542,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,382.91000,363.76000,Amish/Mennonite,Amish Mennonite,,210.60,,,,,,,187.63,371.42,percent of total billed charges,
ZIPWIRE STIFF .035IN ANGLE TIP BX 5,72543,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,382.91000,363.76000,Amish/Mennonite,Amish Mennonite,,210.60,,,,,,,175.76,382.91,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 6FR 100CM COR NYL LNCHR LG,72544,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L6CM DIA4MM 0.02IN PERIPH COMPLX SFT FILL,72545,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX SFT FILL L VOL,72546,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
METFORMIN 250 MG TAB-ER,72559,CDM,250,RC,67877-0159-01-00050,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,inpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CHLORHEXIDINE TOPICAL 0.12% LIQ,72560,CDM,250,RC,00116-2001-04,NDC,,,facility,outpatient,1,mL,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,inpatient,1,mL,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,2.57,4.54,percent of total billed charges,
LEVETIRACETAM 15 MG/ML SOLN,72567,CDM,250,RC,J1953,HCPCS,0040918860201500,NDC,facility,outpatient,1,mL,4.68000,4.44000,Amish/Mennonite,Amish Mennonite,,2.57,,,,,,,0.08005,4.54,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,72568,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L59MM DIA11-16MM CATH L80CM INTRO SHTH 8FR,72569,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 8FR 23CM,72570,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,inpatient,1,EA,26.01000,24.71000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,14.31,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,10147-0686-01,NDC,,,facility,outpatient,1,EA,26.01000,24.71000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,13.01,25.23,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,inpatient,1,EA,17.32000,16.45000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,9.53,16.80,percent of total billed charges,
METHYLPHENIDATE 36 MG/24 HR TAB-,72571,CDM,250,RC,62175-0312-37,NDC,,,facility,outpatient,1,EA,17.32000,16.45000,Amish/Mennonite,Amish Mennonite,,9.53,,,,,,,8.66,16.80,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,Amish/Mennonite,Amish Mennonite,,5478.08,,,,,,,4880.47,9661.35,percent of total billed charges,
"TACTICATH CNTCT FORC ABLAT CATH, SENS ENABLED",72572,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,Amish/Mennonite,Amish Mennonite,,5478.08,,,,,,,4571.71,9960.15,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,inpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,TC,150.70,,,,,,,150.70,265.78,percent of total billed charges,
X-RAY EXAM CHEST 3 VIEWS-TC,72577,CDM,324,RC,71047,CPT,,,facility,outpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,TC,150.70,,,,,,,137.00,1509.95,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
TRIMMING OF DYSTROPHIC NAILS-TECH,72578,CDM,510,RC,G0127,HCPCS,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,21.50,62.04,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,inpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
TROLAMINE SALICYLATE TOPICAL 10 % CREAM,72579,CDM,250,RC,41167-0570-01,NDC,,,facility,outpatient,1,GM,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,514.50,1018.50,percent of total billed charges,
KIT NRSTM 3.5IN INTSTM LD INTRO NDL DIL GRND PD,72580,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,481.95,1050.00,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,inpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,135.30,238.62,percent of total billed charges,
CATECHOLAMINES TECH,72582,CDM,300,RC,82384,CPT,,,facility,outpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,25.25,1324.17,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,inpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,130.90,230.86,percent of total billed charges,
WOUND VAC <50CM2 REUSABLE-TECH,72583,CDM,940,RC,97605,CPT,,,facility,outpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,119.00,230.86,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,inpatient,1,mL,8182.76000,7773.62000,Amish/Mennonite,Amish Mennonite,,4500.52,,,,,,,4500.52,7937.28,percent of total billed charges,
PALIPERIDONE SUSP 410 MG/1.315 ML (INVEGA TRINZA),72585,CDM,636,RC,J2427,HCPCS,50458060701,NDC,facility,outpatient,1,mL,8182.76000,7773.62000,Amish/Mennonite,Amish Mennonite,,4500.52,,,,,,,12.96,7937.28,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,inpatient,1,EA,254.49000,241.77000,Amish/Mennonite,Amish Mennonite,,139.97,,,,,,,139.97,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,42858-0493-40,NDC,,,facility,outpatient,1,EA,254.49000,241.77000,Amish/Mennonite,Amish Mennonite,,139.97,,,,,,,127.25,246.86,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,inpatient,1,EA,197.29000,187.43000,Amish/Mennonite,Amish Mennonite,,108.51,,,,,,,108.51,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,50742-0374-04,NDC,,,facility,outpatient,1,EA,197.29000,187.43000,Amish/Mennonite,Amish Mennonite,,108.51,,,,,,,98.64,191.37,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,inpatient,1,EA,330.51000,313.98000,Amish/Mennonite,Amish Mennonite,,181.78,,,,,,,181.78,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,59011-0751-04,NDC,,,facility,outpatient,1,EA,330.51000,313.98000,Amish/Mennonite,Amish Mennonite,,181.78,,,,,,,165.25,320.59,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,inpatient,1,EA,251.01000,238.46000,Amish/Mennonite,Amish Mennonite,,138.06,,,,,,,138.06,243.48,percent of total billed charges,
BUPRENORPHINE 10 MCG/HR TERF,72586,CDM,250,RC,69238-1203-02,NDC,,,facility,outpatient,1,EA,251.01000,238.46000,Amish/Mennonite,Amish Mennonite,,138.06,,,,,,,125.50,243.48,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,inpatient,1,EA,167.34000,158.97000,Amish/Mennonite,Amish Mennonite,,92.04,,,,,,,92.04,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,69238-1202-02,NDC,,,facility,outpatient,1,EA,167.34000,158.97000,Amish/Mennonite,Amish Mennonite,,92.04,,,,,,,83.67,162.32,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,inpatient,1,EA,169.66000,161.18000,Amish/Mennonite,Amish Mennonite,,93.31,,,,,,,93.31,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,42858-0750-40,NDC,,,facility,outpatient,1,EA,169.66000,161.18000,Amish/Mennonite,Amish Mennonite,,93.31,,,,,,,84.83,164.57,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,inpatient,1,EA,131.53000,124.95000,Amish/Mennonite,Amish Mennonite,,72.34,,,,,,,72.34,127.58,percent of total billed charges,
BUPRENORPHINE PATCH 5 MCG/HR,72587,CDM,250,RC,50742-0372-04,NDC,,,facility,outpatient,1,EA,131.53000,124.95000,Amish/Mennonite,Amish Mennonite,,72.34,,,,,,,65.77,127.58,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,inpatient,1,EA,237.52000,225.65000,Amish/Mennonite,Amish Mennonite,,130.64,,,,,,,130.64,230.39,percent of total billed charges,
BUPRENORPHINE 7.5 MCG/HR TERF,72588,CDM,250,RC,42858-0353-40,NDC,,,facility,outpatient,1,EA,237.52000,225.65000,Amish/Mennonite,Amish Mennonite,,130.64,,,,,,,118.76,230.39,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,inpatient,1,mL,8229.81000,7818.32000,Amish/Mennonite,Amish Mennonite,,4526.40,,,,,,,4526.40,7982.92,percent of total billed charges,
PALIPERIDONE SUSP 546 MG/1.75 ML (INVEGA TRINZA),72609,CDM,636,RC,J2427,HCPCS,50458060801,NDC,facility,outpatient,1,mL,8229.81000,7818.32000,Amish/Mennonite,Amish Mennonite,,4526.40,,,,,,,12.96,7982.92,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,inpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00096-0737-08,NDC,,,facility,outpatient,1,mL,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
COAL TAR TOPICAL 0.5% SHAM,72610,CDM,250,RC,00904-5259-44,NDC,,,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,inpatient,1,GM,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% GEL,72615,CDM,250,RC,10310-0283-13,NDC,,,facility,outpatient,1,GM,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,inpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,,149.05,,,,,,,149.05,262.87,percent of total billed charges,
NEG PRESSURE WOUND THERAPY W/DME-TECH,72624,CDM,940,RC,97606,CPT,,,facility,outpatient,,,271.00000,257.45000,Amish/Mennonite,Amish Mennonite,,149.05,,,,,,,135.50,417.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L10CM DST DIA27MM FEP NIT CONTRALATERAL LEG IL,72625,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,70.56,139.68,percent of total billed charges,
K WIRE FIX L127MM DIA1.5MM EL STD TIP FOR STBL SYS IJS,72627,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,66.10,144.00,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 60MM.,72628,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA8MM 0.02IN PERIPH COMPLX STD FRME,72629,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRT MN TRK II,72630,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM DURASTEEL PLMR,72631,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,inpatient,1,GM,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,4.11,7.25,percent of total billed charges,
"BETAMETHASONE TOPICAL DIPROPIONATE, AUGMENTED 0.05% OINT",72632,CDM,250,RC,00472-0382-45,NDC,,,facility,outpatient,1,GM,7.47000,7.10000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.73,7.25,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,inpatient,1,GM,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
LIDOCAINE TOPICAL 5% OINT,72634,CDM,250,RC,51672-3020-02,NDC,,,facility,outpatient,1,GM,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO,72641,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA 6FR L75CM BLLN L4CM DIA7MM,72642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,inpatient,1,EA,21.38000,20.31000,Amish/Mennonite,Amish Mennonite,,11.76,,,,,,,11.76,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,16714-0395-01,NDC,,,facility,outpatient,1,EA,21.38000,20.31000,Amish/Mennonite,Amish Mennonite,,11.76,,,,,,,10.69,20.74,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,inpatient,1,EA,11.79000,11.20000,Amish/Mennonite,Amish Mennonite,,6.48,,,,,,,6.48,11.44,percent of total billed charges,
CEFPODOXIME 200 MG TAB,72643,CDM,250,RC,67877-0879-20,NDC,,,facility,outpatient,1,EA,11.79000,11.20000,Amish/Mennonite,Amish Mennonite,,6.48,,,,,,,5.89,11.44,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,inpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
BISMUTH SUBSALICYLATE SUSP 262 MG/15 ML 120 ML,72644,CDM,250,RC,37000-0032-01,NDC,,,facility,outpatient,1,mL,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
LVP SOLUTION DEXTROSE 5% WITH 0.33% NACL SOLN,72646,CDM,250,RC,00338-0081-03,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,inpatient,1,mL,35308.12000,33542.71000,Amish/Mennonite,Amish Mennonite,,19419.47,,,,,,,19419.47,34248.88,percent of total billed charges,
PEGLOTICASE 8 MG/ML SOLN,72647,CDM,636,RC,J2507,HCPCS,75987008010,NDC,facility,outpatient,1,mL,35308.12000,33542.71000,Amish/Mennonite,Amish Mennonite,,19419.47,,,,,,,3638.86,34248.88,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,inpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.47850,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,60505-2656-01,NDC,,,facility,outpatient,1,EA,0.87000,0.83000,Amish/Mennonite,Amish Mennonite,,0.47850,,,,,,,0.43500,0.84390,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,inpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.43,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68084-0750-25,NDC,,,facility,outpatient,1,EA,2.60000,2.47000,Amish/Mennonite,Amish Mennonite,,1.43,,,,,,,1.30,2.52,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,inpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
HYDROCHLOROTHIAZIDE-TRIAMTERENE 25 MG-37.5 MG TAB,72648,CDM,250,RC,68382-0856-01,NDC,,,facility,outpatient,1,EA,0.65000,0.62000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,inpatient,,,451.40000,428.83000,Amish/Mennonite,Amish Mennonite,90,248.27,,,,,,,248.27,437.86,percent of total billed charges,
DPPX/MGLUR1 AB CBA SO TECH,72657,CDM,300,RC,86255,CPT,,,facility,outpatient,,,451.40000,428.83000,Amish/Mennonite,Amish Mennonite,90,248.27,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,inpatient,,,124.60000,118.37000,Amish/Mennonite,Amish Mennonite,90,68.53,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 AB IFA SO TECH,72658,CDM,300,RC,86255,CPT,,,facility,outpatient,,,124.60000,118.37000,Amish/Mennonite,Amish Mennonite,90,68.53,,,,,,,12.45,1539.22,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,inpatient,,,124.60000,118.37000,Amish/Mennonite,Amish Mennonite,90,68.53,,,,,,,68.53,120.86,percent of total billed charges,
DPPX/MGLUR1 IFA TITER SO TECH,72659,CDM,300,RC,86256,CPT,,,facility,outpatient,,,124.60000,118.37000,Amish/Mennonite,Amish Mennonite,90,68.53,,,,,,,12.45,1539.22,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,inpatient,,,176.70000,167.86000,Amish/Mennonite,Amish Mennonite,90,97.19,,,,,,,97.19,171.40,percent of total billed charges,
APOLIPOPROTEIN A/B SO TECH,72660,CDM,300,RC,82172,CPT,,,facility,outpatient,,,176.70000,167.86000,Amish/Mennonite,Amish Mennonite,90,97.19,,,,,,,21.79,984.66,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,inpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,90,75.35,,,,,,,75.35,132.89,percent of total billed charges,
ANTI-DNASE B TITER SO TECH,72661,CDM,300,RC,86215,CPT,,,facility,outpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,90,75.35,,,,,,,13.69,696.05,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,inpatient,,,332.20000,315.59000,Amish/Mennonite,Amish Mennonite,90,182.71,,,,,,,182.71,322.23,percent of total billed charges,
"MOLEC CYTOGEN, 10-30 SO TECH",72662,CDM,300,RC,88273,CPT,,,facility,outpatient,,,332.20000,315.59000,Amish/Mennonite,Amish Mennonite,90,182.71,,,,,,,35.97,1680.71,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,inpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,50.05,88.27,percent of total billed charges,
EAR LAVAGE-REQ INSTRUMENTATION-TECH,72663,CDM,510,RC,69210,CPT,,,facility,outpatient,,,91.00000,86.45000,Amish/Mennonite,Amish Mennonite,,50.05,,,,,,,45.50,88.27,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,inpatient,,,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,CPT,,,facility,outpatient,,,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,312.03,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,inpatient,1,mL,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,357.79,631.01,percent of total billed charges,
"RABIES VACCINE, PURIFIED POWD-INJ (RABAVERT)",72664,CDM,636,RC,90675,HCPCS,50632001001,NDC,facility,outpatient,1,mL,650.53000,618.00000,Amish/Mennonite,Amish Mennonite,,357.79,,,,,,,312.03,631.01,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,55.55,97.97,percent of total billed charges,
VENIPUNCTURE 3YR OR OLDER NECESS SKILL OF PHY OR HC PROF-TECH,72667,CDM,361,RC,36410,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,,55.55,,,,,,,55.55,5271.00,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
"VFC-FLUCELVAX,CCIIV4,0.5ML",72670,CDM,771,RC,90756,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,20.37,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
ADMINISTRATION FEE-FLU,72682,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,48.19,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,inpatient,1,mL,3.13000,2.98000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.72,3.04,percent of total billed charges,
LIDOCAINE GEL 2% 6 ML,72683,CDM,250,RC,25021-0673-76,NDC,,,facility,outpatient,1,mL,3.13000,2.98000,Amish/Mennonite,Amish Mennonite,,1.72,,,,,,,1.56,3.04,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4677.58000,4443.70000,Amish/Mennonite,Amish Mennonite,,2572.67,,,,,,,2292.01,4537.25,percent of total billed charges,
GRAFT VASC L50CM DIA30MM BRANCH DIA10MM THOR CLLGN BIFUR WVN,72684,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4677.58000,4443.70000,Amish/Mennonite,Amish Mennonite,,2572.67,,,,,,,2147.01,4677.58,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH  PEELAWY 24FR 13CM,72685,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,73.07,159.20,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 16FR,72686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD LARA CRV 5FR 100CM COR NYL LNCHR LG,72687,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2790.71000,2651.17000,Amish/Mennonite,Amish Mennonite,,1534.89,,,,,,,1367.45,2706.99,percent of total billed charges,
STENT BILI M L17MM BLLN L20MM DIA7MM CATH L80CM 10ATM GWIRE.,72688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2790.71000,2651.17000,Amish/Mennonite,Amish Mennonite,,1534.89,,,,,,,1280.94,2790.71,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM COMPLX SFT PERIPH FULL RETRCT RUBY,72689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 3.25-4MM L VOL DETACH FOR HI,72690,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 8-10MM L VOL DETACH FOR HI FLO,72691,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L15CM PK J SFT L VOL POD,72692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO,72693,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L80MM DIA18MM CATH L80CM GWIRE 0.035IN SHTH,72694,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,inpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,790.55,percent of total billed charges,
INJ NERVE BLOCK-TECH,72695,CDM,361,RC,,,,,facility,outpatient,,,815.00000,774.25000,Amish/Mennonite,Amish Mennonite,,448.25,,,,,,,448.25,5271.00,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
VERAPAMIL TAB 20 MG,72696,CDM,250,RC,23155-0059-01-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,inpatient,,,3561.00000,3382.95000,Amish/Mennonite,Amish Mennonite,,1958.55,,,,,,,1958.55,3454.17,percent of total billed charges,
AMPUTATION DIGIT-TECH,72700,CDM,361,RC,,,,,facility,outpatient,,,3561.00000,3382.95000,Amish/Mennonite,Amish Mennonite,,1958.55,,,,,,,1958.55,5271.00,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,inpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,,175.45,,,,,,,175.45,309.43,percent of total billed charges,
TONGUE CAUTERY-TECH,72701,CDM,361,RC,,,,,facility,outpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,,175.45,,,,,,,175.45,5271.00,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,inpatient,,,966.00000,917.70000,Amish/Mennonite,Amish Mennonite,,531.30,,,,,,,531.30,937.02,percent of total billed charges,
INCISION OF HEMORRHOID-TECH,72702,CDM,361,RC,,,,,facility,outpatient,,,966.00000,917.70000,Amish/Mennonite,Amish Mennonite,,531.30,,,,,,,531.30,5271.00,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,inpatient,1,mL,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.61,6.37,percent of total billed charges,
RUFINAMIDE 40 MG/ML SUSP,72703,CDM,250,RC,62856-0582-52-04000,NDC,,,facility,outpatient,1,mL,6.57000,6.24000,Amish/Mennonite,Amish Mennonite,,3.61,,,,,,,3.29,6.37,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,9.32000,8.85000,Amish/Mennonite,Amish Mennonite,,5.13,,,,,,,5.13,9.04,percent of total billed charges,
"SPLINT,PREFAB,DIGIT-TECH",72711,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,9.32000,8.85000,Amish/Mennonite,Amish Mennonite,,5.13,,,,,,,4.66,9.04,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,inpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.87,8.58,percent of total billed charges,
DICLOFENAC SOLN-OPHTH 0.1% 5 ML,72719,CDM,250,RC,61314-0014-05,NDC,,,facility,outpatient,1,mL,8.85000,8.41000,Amish/Mennonite,Amish Mennonite,,4.87,,,,,,,4.42,8.58,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,inpatient,1,EA,38.05000,36.14000,Amish/Mennonite,Amish Mennonite,,20.93,,,,,,,20.93,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-28,NDC,,,facility,outpatient,1,EA,38.05000,36.14000,Amish/Mennonite,Amish Mennonite,,20.93,,,,,,,19.02,36.91,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,inpatient,1,EA,44.05000,41.85000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,24.23,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,00310-0088-39,NDC,,,facility,outpatient,1,EA,44.05000,41.85000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,22.02,42.73,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,31722-0676-32,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
ROFLUMILAST 250 MCG TAB,72721,CDM,250,RC,72205-0201-24,NDC,,,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,7.90,15.33,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L15.3CM LOOP DIA9MM SPHR STRTCH RESIST FRME,72722,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L17.1CM LOOP DIA10MM SPHR STRTCH RESIST FRME,72723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L18.9CM LOOP DIA11MM SPHR STRTCH RESIST FRME,72724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1858.06,3678.20,percent of total billed charges,
SET URET STNT 6FR L24CM MET W/ POS SYS RESONANCE,72729,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1740.51,3791.96,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 6-8MM L VOL DETACH FOR HI FLO,72731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 10-12MM L VOL DETACH FOR HI,72732,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM PK J SFT L VOL POD,72733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L26CM MET W/ POS SYS RESONANCE,72734,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1740.51,3791.96,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,72735,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 6.1MM 16FR 33CM HDRPH GORE DRYSEAL,72736,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1018.98,2220.00,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,inpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,691.90,1220.26,percent of total billed charges,
BRACHYTHER ISODOSE PLAN;SIMPLE-TECH,7274,CDM,333,RC,77316,CPT,,,facility,outpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,629.00,7964.98,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,54838-0566-70,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
LAMIVUDINE 10 MG/ML SOLN,72740,CDM,250,RC,57237-0274-24,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,inpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.61050,1.08,percent of total billed charges,
INSULIN REGULAR 100 UNITS/NS 100 ML PREMIX,72742,CDM,250,RC,J1815,HCPCS,00338012612,NDC,facility,outpatient,1,mL,1.11000,1.05000,Amish/Mennonite,Amish Mennonite,,0.61050,,,,,,,0.55500,1.49,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,90,1812.80,,,,,,,1812.80,3197.12,percent of total billed charges,
"HER2 AMP R,MISC,FISH SO TECH",72743,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3296.00000,3131.20000,Amish/Mennonite,Amish Mennonite,90,1812.80,,,,,,,533.12,19453.17,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,26.40,46.56,percent of total billed charges,
ACTIVATED CLOTTING TIME TECH,72747,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,4.28,220.68,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,inpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
SALIVA SUBSTITUTES SPRAY 45 ML,72749,CDM,250,RC,48582-0001-55,NDC,,,facility,outpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.29100,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4706.00000,4470.70000,Amish/Mennonite,Amish Mennonite,90,2588.30,,,,,,,2588.30,4564.82,percent of total billed charges,
LUNG CA TARGETED GENE PWR SO TECH,72759,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4706.00000,4470.70000,Amish/Mennonite,Amish Mennonite,90,2588.30,,,,,,,597.91,28130.22,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,inpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,90,549.45,,,,,,,549.45,969.03,percent of total billed charges,
LUNG CA TARGETED GENE SLD SO TECH,72760,CDM,310,RC,88381,CPT,,,facility,outpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,90,549.45,,,,,,,499.50,8610.62,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,inpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
PREDNISOLONE (AS SODIUM PHOSPHATE) LIQ 15 MG/5 ML,72761,CDM,250,RC,J7512,HCPCS,6043202120800500,NDC,facility,outpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.00620,0.46560,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,inpatient,1,GM,66.56000,63.23000,Amish/Mennonite,Amish Mennonite,,36.61,,,,,,,36.61,64.56,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AERO,72762,CDM,250,RC,00173-0715-22,NDC,,,facility,outpatient,1,GM,66.56000,63.23000,Amish/Mennonite,Amish Mennonite,,36.61,,,,,,,33.28,64.56,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,inpatient,,,510.69000,485.16000,Amish/Mennonite,Amish Mennonite,,280.88,,,,,,,280.88,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,CPT,,,facility,outpatient,,,510.69000,485.16000,Amish/Mennonite,Amish Mennonite,,280.88,,,,,,,255.34,495.37,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,inpatient,1,mL,1021.38000,970.31000,Amish/Mennonite,Amish Mennonite,,561.76,,,,,,,561.76,990.74,percent of total billed charges,
"HUMAN PAPILLOMAVIRUS VACCINE, 9-VALENT SUSP (GARDASIL 9)",72764,CDM,250,RC,90651,HCPCS,00006412102,NDC,facility,outpatient,1,mL,1021.38000,970.31000,Amish/Mennonite,Amish Mennonite,,561.76,,,,,,,273.14,990.74,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,inpatient,1,GM,29.41000,27.94000,Amish/Mennonite,Amish Mennonite,,16.18,,,,,,,16.18,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,00574-4144-35,NDC,,,facility,outpatient,1,GM,29.41000,27.94000,Amish/Mennonite,Amish Mennonite,,16.18,,,,,,,14.71,28.53,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,inpatient,1,GM,46.98000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,25.84,45.57,percent of total billed charges,
BACITRACIN/HC/NEOMYCIN/POLYMYXIN B OPHTHALMIC 400 UNITS-10 MG-3.5 MG-10000 UNITS/G O,72770,CDM,250,RC,24208-0785-55,NDC,,,facility,outpatient,1,GM,46.98000,44.64000,Amish/Mennonite,Amish Mennonite,,25.84,,,,,,,23.49,45.57,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,inpatient,1,mL,108.46000,103.04000,Amish/Mennonite,Amish Mennonite,,59.65,,,,,,,59.65,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00065-0275-10,NDC,,,facility,outpatient,1,mL,108.46000,103.04000,Amish/Mennonite,Amish Mennonite,,59.65,,,,,,,54.23,105.21,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,inpatient,1,mL,93.71000,89.02000,Amish/Mennonite,Amish Mennonite,,51.54,,,,,,,51.54,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00591-2127-79,NDC,,,facility,outpatient,1,mL,93.71000,89.02000,Amish/Mennonite,Amish Mennonite,,51.54,,,,,,,46.85,90.90,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,inpatient,1,mL,92.53000,87.90000,Amish/Mennonite,Amish Mennonite,,50.89,,,,,,,50.89,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,00781-6014-70,NDC,,,facility,outpatient,1,mL,92.53000,87.90000,Amish/Mennonite,Amish Mennonite,,50.89,,,,,,,46.27,89.75,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,inpatient,1,mL,97.51000,92.63000,Amish/Mennonite,Amish Mennonite,,53.63,,,,,,,53.63,94.58,percent of total billed charges,
BRINZOLAMIDE OPHTHALMIC 1% SUSP,72776,CDM,250,RC,68682-0464-10,NDC,,,facility,outpatient,1,mL,97.51000,92.63000,Amish/Mennonite,Amish Mennonite,,53.63,,,,,,,48.76,94.58,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,inpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
MENTHOL TOPICAL 4% GE,72779,CDM,250,RC,59316-0102-28,NDC,,,facility,outpatient,1,mL,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,inpatient,,,1564.00000,1485.80000,Amish/Mennonite,Amish Mennonite,TC,860.20,,,,,,,860.20,1517.08,percent of total billed charges,
CT-MAXILLOFACIAL W/WO CONTR,7278,CDM,351,RC,70488,CPT,,,facility,outpatient,,,1564.00000,1485.80000,Amish/Mennonite,Amish Mennonite,TC,860.20,,,,,,,782.00,1820.00,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,inpatient,,,352.80000,335.16000,Amish/Mennonite,Amish Mennonite,,194.04,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,CPT,,,facility,outpatient,,,352.80000,335.16000,Amish/Mennonite,Amish Mennonite,,194.04,,,,,,,176.40,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,inpatient,1,EA,352.80000,335.16000,Amish/Mennonite,Amish Mennonite,,194.04,,,,,,,194.04,342.22,percent of total billed charges,
ZOSTER VACCINE POWD-INJ (SHINGRIX),72780,CDM,636,RC,90750,HCPCS,58160082311,NDC,facility,outpatient,1,EA,352.80000,335.16000,Amish/Mennonite,Amish Mennonite,,194.04,,,,,,,176.40,342.22,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,inpatient,1,GM,83.98000,79.78000,Amish/Mennonite,Amish Mennonite,,46.19,,,,,,,46.19,81.46,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 115 MCG-21 MCG/INH AERO,72791,CDM,250,RC,00173-0716-20,NDC,,,facility,outpatient,1,GM,83.98000,79.78000,Amish/Mennonite,Amish Mennonite,,46.19,,,,,,,41.99,81.46,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP SIM1 5FR 100CM,72792,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,14647.50000,13915.12000,Amish/Mennonite,Amish Mennonite,,8056.12,,,,,,,7177.27,14208.08,percent of total billed charges,
PACEMAKER CRT-P QUADRA ALLURE MP 15CC,72793,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,14647.50000,13915.12000,Amish/Mennonite,Amish Mennonite,,8056.12,,,,,,,6723.20,14208.08,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID NOTO 6FR,72794,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 30CM,72795,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1046.52,2280.00,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,inpatient,,,1647.00000,1564.65000,Amish/Mennonite,Amish Mennonite,TC,905.85,,,,,,,905.85,1597.59,percent of total billed charges,
"XR ANGIOGRAPHY, INTERNAL MAMMARY-TECH",72796,CDM,320,RC,75756,CPT,,,facility,outpatient,,,1647.00000,1564.65000,Amish/Mennonite,Amish Mennonite,TC,905.85,,,,,,,574.33,17311.25,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,inpatient,,,2881.00000,2736.95000,Amish/Mennonite,Amish Mennonite,TC,1584.55,,,,,,,1584.55,2794.57,percent of total billed charges,
XR VENOUS SMPLING CATH-TECH,72797,CDM,320,RC,75893,CPT,,,facility,outpatient,,,2881.00000,2736.95000,Amish/Mennonite,Amish Mennonite,TC,1584.55,,,,,,,457.64,29731.35,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,inpatient,,,4413.00000,4192.35000,Amish/Mennonite,Amish Mennonite,TC,2427.15,,,,,,,2427.15,4280.61,percent of total billed charges,
XR VENOGRAPHY ADRENAL BIL-TECH,72798,CDM,320,RC,75842,CPT,,,facility,outpatient,,,4413.00000,4192.35000,Amish/Mennonite,Amish Mennonite,TC,2427.15,,,,,,,498.74,29731.35,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,inpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,1002.10,1767.34,percent of total billed charges,
CT-UPPER EXTREMITY W/CONTR,7280,CDM,352,RC,73201,CPT,,,facility,outpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,911.00,1964.22,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,21730.80000,20644.26000,Amish/Mennonite,Amish Mennonite,,11951.94,,,,,,,10648.09,21078.88,percent of total billed charges,
OCCLUDER SEPT DIA25MM NIT WIRE FRME EPTFE MEM SFT CNFRM,72801,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,21730.80000,20644.26000,Amish/Mennonite,Amish Mennonite,,11951.94,,,,,,,9974.44,21730.80,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GD RNL 2 CRV 6FR 2.2MM 55CM FLXR T-B,72802,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,inpatient,,,2209.00000,2098.55000,Amish/Mennonite,Amish Mennonite,TC,1214.95,,,,,,,1214.95,2142.73,percent of total billed charges,
BRACHYTX ISODOSE PLAN CMPLX-TECH,7281,CDM,333,RC,77318,CPT,,,facility,outpatient,,,2209.00000,2098.55000,Amish/Mennonite,Amish Mennonite,TC,1214.95,,,,,,,1104.50,14176.04,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,inpatient,,,6409.00000,6088.55000,Amish/Mennonite,Amish Mennonite,,3524.95,,,,,,,3524.95,6216.73,percent of total billed charges,
PLACEMENT BIOGRD MTRL PROSTATE-TECH,72816,CDM,361,RC,55874,CPT,,,facility,outpatient,,,6409.00000,6088.55000,Amish/Mennonite,Amish Mennonite,,3524.95,,,,,,,2786.18,11015.00,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ DIAG OR THERA AGNT PARA-TECH,72817,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
XR INJ DIAG OR THERA AGNT PARA-TECH,72818,CDM,361,RC,64491,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,5271.00,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,inpatient,1,mL,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,25021030168,NDC,facility,outpatient,1,mL,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,0.59830,19.92,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,inpatient,1,mL,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,9.52,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,63323065104,NDC,facility,outpatient,1,mL,17.30000,16.44000,Amish/Mennonite,Amish Mennonite,,9.52,,,,,,,0.59830,16.78,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,inpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
ADENOSINE SOLN 3 MG/ML 4 ML,72819,CDM,250,RC,J0153,HCPCS,67457085404,NDC,facility,outpatient,1,mL,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,0.59830,7.66,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00338081104,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/LACTATED RINGERS W/ KCL 20 MEQ/L 1000 ML,72820,CDM,250,RC,J3480,HCPCS,00409711109,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
BENZOCAINE SPRAY 20% 56 GM (AMERICAINE EQUIV),72821,CDM,250,RC,63736-3788-20,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,inpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00550,0.00970,percent of total billed charges,
GLYCINE SOLN-IRR 1.5% 3000 ML,72822,CDM,250,RC,00338-0289-47,NDC,,,facility,outpatient,1,mL,0.01000,0.01000,Amish/Mennonite,Amish Mennonite,,0.00550,,,,,,,0.00500,0.00970,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,inpatient,1,mL,38.69000,36.75000,Amish/Mennonite,Amish Mennonite,,21.28,,,,,,,21.28,37.53,percent of total billed charges,
IRON SUCROSE SOLN 20 MG/ML 10 ML,72823,CDM,250,RC,J1756,HCPCS,00517231005,NDC,facility,outpatient,1,mL,38.69000,36.75000,Amish/Mennonite,Amish Mennonite,,21.28,,,,,,,0.35222,37.53,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,inpatient,1,mL,20.65000,19.61000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,11.36,20.03,percent of total billed charges,
PODOPHYLLUM RESIN TOPICAL LIQUID-TOPÏ¿½ 25% 15 ML,72828,CDM,00574-0601-15,NDC,,,,,facility,outpatient,1,mL,20.65000,19.61000,Amish/Mennonite,Amish Mennonite,,11.36,,,,,,,10.32,20.03,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00245-0213-11,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,inpatient,1,EA,3.39000,3.22000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,00904-6819-07,NDC,,,facility,outpatient,1,EA,3.39000,3.22000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.70,3.29,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,inpatient,1,EA,4.45000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.32,percent of total billed charges,
MIDODRINE TAB 10 MG,72830,CDM,250,RC,60687-0409-25,NDC,,,facility,outpatient,1,EA,4.45000,4.23000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.32,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,inpatient,1,mL,17.68000,16.80000,Amish/Mennonite,Amish Mennonite,,9.72,,,,,,,9.72,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,00536-1307-23,NDC,,,,,facility,outpatient,1,mL,17.68000,16.80000,Amish/Mennonite,Amish Mennonite,,9.72,,,,,,,8.84,17.15,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,inpatient,1,mL,11.12000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,6.12,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,58602-0007-39,NDC,,,,,facility,outpatient,1,mL,11.12000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,5.56,10.79,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,inpatient,1,mL,34.01000,32.31000,Amish/Mennonite,Amish Mennonite,,18.71,,,,,,,18.71,32.99,percent of total billed charges,
OLOPATADINE SOLN-OPHTH 0.2% 2.5 ML,72831,CDM,60505-0586-04,NDC,,,,,facility,outpatient,1,mL,34.01000,32.31000,Amish/Mennonite,Amish Mennonite,,18.71,,,,,,,17.00,32.99,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,inpatient,1,EA,170.64000,162.11000,Amish/Mennonite,Amish Mennonite,,93.85,,,,,,,93.85,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,00093-2165-68,NDC,,,,,facility,outpatient,1,EA,170.64000,162.11000,Amish/Mennonite,Amish Mennonite,,93.85,,,,,,,85.32,165.52,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,inpatient,1,EA,197.50000,187.62000,Amish/Mennonite,Amish Mennonite,,108.62,,,,,,,108.62,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0353-02,NDC,,,,,facility,outpatient,1,EA,197.50000,187.62000,Amish/Mennonite,Amish Mennonite,,108.62,,,,,,,98.75,191.57,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,inpatient,1,EA,71.08000,67.53000,Amish/Mennonite,Amish Mennonite,,39.09,,,,,,,39.09,68.95,percent of total billed charges,
NALOXONE SPRAY 4 MG/0.1 ML NASAL,72832,CDM,69547-0627-02,NDC,,,,,facility,outpatient,1,EA,71.08000,67.53000,Amish/Mennonite,Amish Mennonite,,39.09,,,,,,,35.54,68.95,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,inpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.40,5.99,percent of total billed charges,
MASTISOL LIQUID ADHESIVE LIQ-TOP 0.67 ML,72834,CDM,00496-0523-48,NDC,,,,,facility,outpatient,1,EA,6.18000,5.87000,Amish/Mennonite,Amish Mennonite,,3.40,,,,,,,3.09,5.99,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,Amish/Mennonite,Amish Mennonite,,623.93,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM AAFI SOLN 300 MCG/0.5 ML,72835,CDM,636,RC,Q5110,HCPCS,00069029101,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,Amish/Mennonite,Amish Mennonite,,623.93,,,,,,,0.29000,1100.39,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,inpatient,1,EA,68.99000,65.54000,Amish/Mennonite,Amish Mennonite,,37.94,,,,,,,37.94,66.92,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 5 GM,72837,CDM,250,RC,00310-1105-39,NDC,,,facility,outpatient,1,EA,68.99000,65.54000,Amish/Mennonite,Amish Mennonite,,37.94,,,,,,,34.49,66.92,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,inpatient,1,mL,27.94000,26.55000,Amish/Mennonite,Amish Mennonite,,15.37,,,,,,,15.37,27.10,percent of total billed charges,
PREDNISOLONE ACETATE SUSP-OPHTH 1% 10 ML,72839,CDM,61314-0637-10,NDC,,,,,facility,outpatient,1,mL,27.94000,26.55000,Amish/Mennonite,Amish Mennonite,,15.37,,,,,,,13.97,27.10,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,inpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,55150019920,NDC,facility,outpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,0.08525,2.75,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,inpatient,1,mL,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.90,percent of total billed charges,
ROPIVACAINE SOLN 0.75% 20 ML,72840,CDM,250,RC,J2795,HCPCS,63323028721,NDC,facility,outpatient,1,mL,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,0.08525,2.90,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,inpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,00121-0927-16,NDC,,,,,facility,outpatient,1,mL,0.09000,0.09000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,inpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
PROMETHAZINE LIQ 1.25 MG/ML,72841,CDM,60432-0608-16,NDC,,,,,facility,outpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,inpatient,1,EA,86.43000,82.10000,Amish/Mennonite,Amish Mennonite,,47.54,,,,,,,47.54,83.84,percent of total billed charges,
SODIUM ZIRCONIUM CYCLOSILICATE POWD 10 GM,72842,CDM,250,RC,00310-1110-39,NDC,,,facility,outpatient,1,EA,86.43000,82.10000,Amish/Mennonite,Amish Mennonite,,47.54,,,,,,,43.22,83.84,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,inpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,165.11,291.19,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (HYALGAN),72843,CDM,250,RC,J7321,HCPCS,89122072420,NDC,facility,outpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,114.64,291.19,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,inpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50111-0917-01-00025,NDC,,,facility,outpatient,1,EA,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,0.47530,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,inpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
TORSEMIDE TAB 5 MG,72847,CDM,250,RC,50268-0754-15,NDC,,,facility,outpatient,1,EA,1.13000,1.07000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,188.29,372.73,percent of total billed charges,
SHTH PERFRMR 18FR X 40CM,72848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,384.26000,365.05000,Amish/Mennonite,Amish Mennonite,,211.34,,,,,,,176.38,384.26,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,738.75000,701.81000,Amish/Mennonite,Amish Mennonite,,406.31,,,,,,,361.99,716.59,percent of total billed charges,
GUIDEWIRE VASC 45D 25CM .018IN 180CM HDRPH GLDWR,72849,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,738.75000,701.81000,Amish/Mennonite,Amish Mennonite,,406.31,,,,,,,339.09,738.75,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1665.00000,1581.75000,Amish/Mennonite,Amish Mennonite,,915.75,,,,,,,815.85,1615.05,percent of total billed charges,
LEAD PACE 5.3FR L52CM VENT SIL POLYUR INSUL STEROID ELUT,72850,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1665.00000,1581.75000,Amish/Mennonite,Amish Mennonite,,915.75,,,,,,,764.24,1615.05,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 18FR,72851,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,78.01,154.42,percent of total billed charges,
INTRO SHTH LG 22FR 13CM PERC PLWY 20CM DIL STRL,72852,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,159.20000,151.24000,Amish/Mennonite,Amish Mennonite,,87.56,,,,,,,73.07,159.20,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,inpatient,1,mL,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,15.90,28.04,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 40 GM,72853,CDM,636,RC,J1561,HCPCS,13533080040,NDC,facility,outpatient,1,mL,28.91000,27.47000,Amish/Mennonite,Amish Mennonite,,15.90,,,,,,,14.46,80.87,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,inpatient,1,GM,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.89,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,00168-0055-15,NDC,,,facility,outpatient,1,GM,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.45,8.63,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,inpatient,1,GM,7.65000,7.27000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,4.21,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,16714-0996-01,NDC,,,facility,outpatient,1,GM,7.65000,7.27000,Amish/Mennonite,Amish Mennonite,,4.21,,,,,,,3.83,7.42,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,inpatient,1,GM,7.42000,7.04000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,4.08,7.20,percent of total billed charges,
BETAMETHASONE TOPICAL DIPROPIONATE 0.05% CREAM,72854,CDM,250,RC,70710-1233-01,NDC,,,facility,outpatient,1,GM,7.42000,7.04000,Amish/Mennonite,Amish Mennonite,,4.08,,,,,,,3.71,7.20,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,inpatient,1,EA,3324.53000,3158.31000,Amish/Mennonite,Amish Mennonite,,1828.49,,,,,,,1828.49,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 15 MG,72862,CDM,636,RC,J9207,HCPCS,70020191001,NDC,facility,outpatient,1,EA,3324.53000,3158.31000,Amish/Mennonite,Amish Mennonite,,1828.49,,,,,,,138.67,3224.79,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,inpatient,1,EA,11037.06000,10485.21000,Amish/Mennonite,Amish Mennonite,,6070.38,,,,,,,6070.38,10705.95,percent of total billed charges,
IXABEPILONE POWD-INJ 45 MG,72863,CDM,636,RC,J9207,HCPCS,70020191101,NDC,facility,outpatient,1,EA,11037.06000,10485.21000,Amish/Mennonite,Amish Mennonite,,6070.38,,,,,,,138.67,10705.95,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,inpatient,1,mL,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 8 ML,72865,CDM,636,RC,J9400,HCPCS,00024584101,NDC,facility,outpatient,1,mL,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,7.98,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,inpatient,1,mL,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
ZIV-AFLIBERCEPT SOLN 25 MG/ML 4 ML,72867,CDM,636,RC,J9400,HCPCS,00024584001,NDC,facility,outpatient,1,mL,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,7.98,1004.92,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,inpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00121-0970-05,NDC,,,facility,outpatient,1,EA,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-07,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,inpatient,1,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,00536-1202-15,NDC,,,facility,outpatient,1,EA,3.96000,3.76000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.98,3.84,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,inpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,4.34,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,45611-0009-36,NDC,,,facility,outpatient,1,EA,7.90000,7.50000,Amish/Mennonite,Amish Mennonite,,4.34,,,,,,,3.95,7.66,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,inpatient,1,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,4.06,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-01,NDC,,,facility,outpatient,1,EA,7.39000,7.02000,Amish/Mennonite,Amish Mennonite,,4.06,,,,,,,3.69,7.17,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,inpatient,1,EA,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,2.15,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,46581-0830-06,NDC,,,facility,outpatient,1,EA,3.91000,3.71000,Amish/Mennonite,Amish Mennonite,,2.15,,,,,,,1.96,3.79,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,inpatient,1,EA,2.10000,1.99000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70000-0557-01,NDC,,,facility,outpatient,1,EA,2.10000,1.99000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.05,2.04,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,inpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.89,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70512-0812-30,NDC,,,facility,outpatient,1,EA,3.44000,3.27000,Amish/Mennonite,Amish Mennonite,,1.89,,,,,,,1.72,3.34,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,inpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.79,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,70677-1188-01,NDC,,,facility,outpatient,1,EA,3.25000,3.09000,Amish/Mennonite,Amish Mennonite,,1.79,,,,,,,1.62,3.15,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,inpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.68,4.72,percent of total billed charges,
LIDOCAINE PATCH 4%,72868,CDM,250,RC,71399-3884-06,NDC,,,facility,outpatient,1,EA,4.87000,4.63000,Amish/Mennonite,Amish Mennonite,,2.68,,,,,,,2.44,4.72,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,Amish/Mennonite,Amish Mennonite,,65.20,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-01,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,Amish/Mennonite,Amish Mennonite,,65.20,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,inpatient,1,EA,118.54000,112.61000,Amish/Mennonite,Amish Mennonite,,65.20,,,,,,,65.20,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,16714-0973-02,NDC,,,facility,outpatient,1,EA,118.54000,112.61000,Amish/Mennonite,Amish Mennonite,,65.20,,,,,,,59.27,114.98,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,inpatient,1,EA,212.90000,202.26000,Amish/Mennonite,Amish Mennonite,,117.09,,,,,,,117.09,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,60687-0381-94,NDC,,,facility,outpatient,1,EA,212.90000,202.26000,Amish/Mennonite,Amish Mennonite,,117.09,,,,,,,106.45,206.51,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,inpatient,1,EA,169.34000,160.87000,Amish/Mennonite,Amish Mennonite,,93.14,,,,,,,93.14,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,68682-0170-30,NDC,,,facility,outpatient,1,EA,169.34000,160.87000,Amish/Mennonite,Amish Mennonite,,93.14,,,,,,,84.67,164.26,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,inpatient,1,EA,71.12000,67.57000,Amish/Mennonite,Amish Mennonite,,39.12,,,,,,,39.12,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69097-0999-02,NDC,,,facility,outpatient,1,EA,71.12000,67.57000,Amish/Mennonite,Amish Mennonite,,39.12,,,,,,,35.56,68.99,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,inpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,69.52,122.61,percent of total billed charges,
PHYTONADIONE 5 MG TAB,72875,CDM,250,RC,69238-1051-03,NDC,,,facility,outpatient,1,EA,126.40000,120.08000,Amish/Mennonite,Amish Mennonite,,69.52,,,,,,,63.20,122.61,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
CALCIUM CARBONATE 1250 MG/5ML SUSP,72880,CDM,250,RC,00121-4766-05,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
TELEHEALTH ORIGINATING SITE FACILITY FEE,72883,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,20.00,38.80,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,inpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00591-5557-01,NDC,,,facility,outpatient,1,EA,1.91000,1.82000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,inpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
PROPRANOLOL 80 MG TAB,72886,CDM,250,RC,00603-5486-21,NDC,,,facility,outpatient,1,EA,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,inpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.69850,1.23,percent of total billed charges,
VENLAFAXINE 12.5 MG TAB,72892,CDM,250,RC,68084-0896-25-00050,NDC,,,facility,outpatient,1,EA,1.27000,1.21000,Amish/Mennonite,Amish Mennonite,,0.69850,,,,,,,0.63500,1.23,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 200 MG / 5 ML SUSP,72910,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,inpatient,1,mL,4.64000,4.41000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.55,4.50,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 2.5 MG-108 MG/5 ML,72913,CDM,250,RC,J8499,HCPCS,00121477205,NDC,facility,outpatient,1,mL,4.64000,4.41000,Amish/Mennonite,Amish Mennonite,,2.55,,,,,,,2.32,4.50,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
ROPINIROLE 0.125 MG TAB,72915,CDM,250,RC,00904-6373-61-00050,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,inpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,1747805400100030,NDC,facility,outpatient,1,mL,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.14409,0.56260,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,inpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE  0.2 MG/ML SOLN,72916,CDM,250,RC,J1171,HCPCS,70092111379,NDC,facility,outpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,0.14409,5.61,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L20CM HYDR+ RADPQ W/ TAPR TIP PGTL BLDR MRK,72922,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,26.40,46.56,percent of total billed charges,
"SYPHILIS, NEONATAL SCR < 1 MONTH-TECH",72923,CDM,300,RC,86593,CPT,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,4.40,237.65,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L13CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,72932,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L9.5CM DIA18MM CONTRALATERAL LEG FOR AAA EXCLUDER,72934,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,883.46000,839.29000,Amish/Mennonite,Amish Mennonite,,485.90,,,,,,,432.90,856.96,percent of total billed charges,
TUBE FEEDING GASTROJEJU 22FRX45CM,72936,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,883.46000,839.29000,Amish/Mennonite,Amish Mennonite,,485.90,,,,,,,405.51,883.46,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER SHOCKWAVE M IVL 5.5X60MM,72937,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.0X60MM,72938,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 4.0X40MM,72939,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6693.00000,6358.35000,Amish/Mennonite,Amish Mennonite,,3681.15,,,,,,,3279.57,6492.21,percent of total billed charges,
CATHETER CAT RX  5.3FRX140CM,72943,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6693.00000,6358.35000,Amish/Mennonite,Amish Mennonite,,3681.15,,,,,,,3072.09,6693.00,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,565.01000,536.76000,Amish/Mennonite,Amish Mennonite,,310.76,,,,,,,276.85,548.06,percent of total billed charges,
CATHETER URTH 16FR NTR RBR DDRGL BDX LBR 5CC 2W.,72944,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,565.01000,536.76000,Amish/Mennonite,Amish Mennonite,,310.76,,,,,,,259.34,565.01,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L22CM AXXCESS CATH 6FR PERCFLX HYDR+ FIRM,72945,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,312.86000,297.22000,Amish/Mennonite,Amish Mennonite,,172.07,,,,,,,153.30,303.47,percent of total billed charges,
ZIPWIRE .038IN STAIGHT TIP BX 5,72947,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,312.86000,297.22000,Amish/Mennonite,Amish Mennonite,,172.07,,,,,,,143.60,312.86,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 5MM COR CROSSFLEX2 TUNG TREK,72948,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,inpatient,,,1283.00000,1218.85000,Amish/Mennonite,Amish Mennonite,TC,705.65,,,,,,,705.65,1244.51,percent of total billed charges,
CT-PELVIS W/O CONTR,7295,CDM,352,RC,72192,CPT,,,facility,outpatient,,,1283.00000,1218.85000,Amish/Mennonite,Amish Mennonite,TC,705.65,,,,,,,584.87,1820.00,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
DEV ROTAPRO 1.50MM,72950,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM PK J SFT L VOL POD,72951,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2472.36,4894.26,percent of total billed charges,
BLLN OCCL SCEPTER C 4X20X150CM,72952,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,5045.63000,4793.35000,Amish/Mennonite,Amish Mennonite,,2775.10,,,,,,,2315.94,5045.63,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,inpatient,,,688.69000,654.26000,Amish/Mennonite,Amish Mennonite,,378.78,,,,,,,337.46,668.03,percent of total billed charges,
HEMODIALYSIS CATH PWRTRI 13FR,72953,CDM,278,RC,C1752,HCPCS,,,facility,outpatient,,,688.69000,654.26000,Amish/Mennonite,Amish Mennonite,,378.78,,,,,,,316.11,688.69,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L14CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,72954,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1858.06,3678.20,percent of total billed charges,
STENT URET 6FR L22CM MET W/ POS SYS RESONANCE,72955,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3791.96000,3602.36000,Amish/Mennonite,Amish Mennonite,,2085.58,,,,,,,1740.51,3791.96,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 4.0 7FR 100CM,72956,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,inpatient,1,mL,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.26950,0.47530,percent of total billed charges,
LINEZOLID 600 MG/300 ML NACL 0.9% PREMIX,72957,CDM,250,RC,J2021,HCPCS,00409488301,NDC,facility,outpatient,1,mL,0.49000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26950,,,,,,,0.24500,10.52,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,inpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00832-1358-11,NDC,,,facility,outpatient,1,EA,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.75500,1.46,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,inpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.49,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,00904-5524-61,NDC,,,facility,outpatient,1,EA,2.70000,2.57000,Amish/Mennonite,Amish Mennonite,,1.49,,,,,,,1.35,2.62,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,50268-0224-15,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,inpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68084-0862-01,NDC,,,facility,outpatient,1,EA,2.88000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.79,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,inpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.45650,0.80510,percent of total billed charges,
DOXAZOSIN TAB 4 MG,72958,CDM,250,RC,68382-0785-01,NDC,,,facility,outpatient,1,EA,0.83000,0.79000,Amish/Mennonite,Amish Mennonite,,0.45650,,,,,,,0.41500,0.80510,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,inpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,TC,94.05,,,,,,,94.05,165.87,percent of total billed charges,
ARTHCS ASP/INJ MJR JT WO US-TC,72959,CDM,510,RC,20610,CPT,,,facility,outpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,TC,94.05,,,,,,,85.50,165.87,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,inpatient,1,mL,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,10.86,19.16,percent of total billed charges,
SULFACETAMIDE SODIUM OPHTHALMIC 10% SOLN,72960,CDM,250,RC,60758-0018-05,NDC,,,facility,outpatient,1,mL,19.75000,18.76000,Amish/Mennonite,Amish Mennonite,,10.86,,,,,,,9.88,19.16,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,inpatient,1,mL,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.93500,1.65,percent of total billed charges,
MORPHINE SOLN-INJ 50 MG/ML 50 ML,72962,CDM,250,RC,J2270,HCPCS,00409113405,NDC,facility,outpatient,1,mL,1.70000,1.62000,Amish/Mennonite,Amish Mennonite,,0.93500,,,,,,,0.85000,7.69,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,inpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,TC,161.15,,,,,,,161.15,284.21,percent of total billed charges,
DOPPLER ECHO FETAL F-U/REP,7297,CDM,402,RC,76828,CPT,,,facility,outpatient,,,293.00000,278.35000,Amish/Mennonite,Amish Mennonite,TC,161.15,,,,,,,146.50,584.87,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,382.25,674.15,percent of total billed charges,
CT-GUID FOR PERCUTAN DRAINAGE,7298,CDM,350,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,298.87,1820.00,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,inpatient,,,551.00000,523.45000,Amish/Mennonite,Amish Mennonite,TC,303.05,,,,,,,303.05,534.47,percent of total billed charges,
DOPPLER ECHO FETAL COMPLETE,7299,CDM,402,RC,76827,CPT,,,facility,outpatient,,,551.00000,523.45000,Amish/Mennonite,Amish Mennonite,TC,303.05,,,,,,,275.50,584.87,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,inpatient,1,GM,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,60.83,107.28,percent of total billed charges,
STERILE TALC - POWDER,72991,CDM,250,RC,62327-0444-44,NDC,,,facility,outpatient,1,GM,110.60000,105.07000,Amish/Mennonite,Amish Mennonite,,60.83,,,,,,,55.30,107.28,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,inpatient,1,mL,435.00000,413.25000,Amish/Mennonite,Amish Mennonite,,239.25,,,,,,,239.25,421.95,percent of total billed charges,
SODIUM HYALURONATE OPHTHALMIC 8.5 MG / 0.85 ML LIQUID,72992,CDM,250,RC,05047-4636-98,NDC,,,facility,outpatient,1,mL,435.00000,413.25000,Amish/Mennonite,Amish Mennonite,,239.25,,,,,,,217.50,421.95,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,inpatient,,,27.90000,26.50000,Amish/Mennonite,Amish Mennonite,,15.35,,,,,,,15.35,27.06,percent of total billed charges,
OH FORM COMPLETION - APC,72995,CDM,960,RC,99199,CPT,,,facility,outpatient,,,27.90000,26.50000,Amish/Mennonite,Amish Mennonite,,15.35,,,,,,,13.95,27.06,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,inpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,00904-3232-61,NDC,,,facility,outpatient,1,EA,0.11000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,51645-0730-06,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,inpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04950,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,57896-0746-06,NDC,,,facility,outpatient,1,EA,0.09000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04950,,,,,,,0.04500,0.08730,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,inpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
CALCIUM CARBONATE 600 MG TAB,73000,CDM,250,RC,80681-0005-00,NDC,,,facility,outpatient,1,EA,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,inpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
LEVOTHYROXINE TAB 6.25 MCG (0.00625 MG),73012,CDM,250,RC,J8499,HCPCS,0007443419000025,NDC,facility,outpatient,1,EA,0.89000,0.84000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,inpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.10450,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,00555-0033-02,NDC,,,facility,outpatient,1,EA,0.19000,0.18000,Amish/Mennonite,Amish Mennonite,,0.10450,,,,,,,0.09500,0.18430,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,inpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.85800,1.51,percent of total billed charges,
CHLORDIAZEPOXIDE 10 MG CAP,73013,CDM,250,RC,51079-0375-20,NDC,,,facility,outpatient,1,EA,1.56000,1.48000,Amish/Mennonite,Amish Mennonite,,0.85800,,,,,,,0.78000,1.51,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 8.5FR 25CM ULTHNE AQ MCLC 6 SDPRT,73014,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,128.32,279.56,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DIA27MM CONTRALATERAL LEG FOR AAA EXCLUDER,73015,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.0 6FR,73018,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN AL1 4FR 100CM,73019,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,17.75,38.68,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 0.02IN PERIPH COMPLX SFT FILL,73020,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU4.5 CRV 6FR 100CM NYL LNCHR LG,73021,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL 5FR 5MM 130CM PCLTXL PLSRB SRB,73022,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,758.74,1502.00,percent of total billed charges,
LEAD PACE 5.3FR L58CM VENT SIL PLYR INSUL STEROID ELT,73024,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1548.45000,1471.03000,Amish/Mennonite,Amish Mennonite,,851.65,,,,,,,710.74,1502.00,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L30CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,73025,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,inpatient,,,12.60000,11.97000,Amish/Mennonite,Amish Mennonite,90,6.93,,,,,,,6.93,12.22,percent of total billed charges,
IBD SGI CRP P1800 SO-TECH,73028,CDM,300,RC,86140,CPT,,,facility,outpatient,,,12.60000,11.97000,Amish/Mennonite,Amish Mennonite,90,6.93,,,,,,,5.35,271.65,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00023-5459-10,NDC,,,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.58,3.07,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,inpatient,1,mL,3.27000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0454-07,NDC,,,facility,outpatient,1,mL,3.27000,3.11000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,inpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.56,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-0474-01,NDC,,,facility,outpatient,1,mL,2.84000,2.70000,Amish/Mennonite,Amish Mennonite,,1.56,,,,,,,1.42,2.75,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,inpatient,1,mL,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.24,2.19,percent of total billed charges,
OCULAR LUBRICANT - GEL,73029,CDM,250,RC,00065-8064-01,NDC,,,facility,outpatient,1,mL,2.26000,2.15000,Amish/Mennonite,Amish Mennonite,,1.24,,,,,,,1.13,2.19,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,inpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.16500,0.29100,percent of total billed charges,
CEFTRIAXONE 100 MG/ML SOLN,73030,CDM,250,RC,J0696,HCPCS,0040973380110000,NDC,facility,outpatient,1,mL,0.30000,0.29000,Amish/Mennonite,Amish Mennonite,,0.16500,,,,,,,0.15000,0.81340,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,inpatient,,,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,CPT,,,facility,outpatient,,,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,69.38,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,inpatient,1,mL,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,76.31,134.59,percent of total billed charges,
HEPATITIS A ADULT VACCINE SUSP PF 1440 UNITS/ML (HAVRIX),73032,CDM,250,RC,90632,HCPCS,58160082652,NDC,facility,outpatient,1,mL,138.75000,131.81000,Amish/Mennonite,Amish Mennonite,,76.31,,,,,,,69.38,134.59,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 1.5MM 150CM INFRAPOPLITEAL VSL,73034,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2MM 150CM INFRAPOPLITEL VSL,73037,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 2MM 150CM INFRAPOPLITEAL VSL,73038,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM L150CM INFRAPOPLITEAL VSL,73041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRAPOPLITEAL VSL,73045,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3MM 150CM INFRPOPLITEAL VSL,73046,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 2.5MM 150CM INFRAPOPLITEAL VSL,73048,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLNDIL 3MM 150CM INFRPOPLITEAL VSL,73049,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER PTCA L150CM BLLN L80MM DIA3MM 15ATM,73052,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BALNDIL 3.5MM 150CM INFRAPOPLITEAL VSL,73053,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,434.11,859.36,percent of total billed charges,
CATHETER BLLNDIL 4MM 150CM INFRAPOPLITEAL VSL.,73057,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,885.94000,841.64000,Amish/Mennonite,Amish Mennonite,,487.27,,,,,,,406.65,885.94,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO ANG 4FR 65CM PERI SS HDRPH,73089,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 100CM COR,73090,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO RADL TIG 4 CRV 5FR 100CM COR SS,73092,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER ANGIO SARAH RADL 4 CRV 5FR 100CM COR SS,73095,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,873.75000,830.06000,Amish/Mennonite,Amish Mennonite,,480.56,,,,,,,428.14,847.54,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 260CM GLDWR ADV,73097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,873.75000,830.06000,Amish/Mennonite,Amish Mennonite,,480.56,,,,,,,401.05,873.75,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,800.63000,760.60000,Amish/Mennonite,Amish Mennonite,,440.35,,,,,,,392.31,776.61,percent of total billed charges,
GUIDEWIRE VASC ANG 25CM .035IN 180CM GLDWR ADV,73098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,800.63000,760.60000,Amish/Mennonite,Amish Mennonite,,440.35,,,,,,,367.49,800.63,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,54.36000,51.64000,Amish/Mennonite,Amish Mennonite,,29.90,,,,,,,26.64,52.73,percent of total billed charges,
INTRO SHTH .038IN 11FR 12CM FSTCTH 50CM LG LUM,73099,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,54.36000,51.64000,Amish/Mennonite,Amish Mennonite,,29.90,,,,,,,24.95,54.36,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,72.32,143.17,percent of total billed charges,
KIT INTRO .038IN 50CM 6FR 18GA 13CM PRELUDE SNP,73100,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,67.75,147.60,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,17.64,34.92,percent of total billed charges,
INTRO SHTH .038IN J STRG STANDRAD 8FR 12CM,73101,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,56.84,112.52,percent of total billed charges,
SHEATH INTRO 8FR 10CM PN RO2 2.5CM RADOPQ DL,73102,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,53.24,116.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LESS N ADH LIQ,73105,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,3958.88,8625.00,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,4226.25,8366.25,percent of total billed charges,
KIT EMB GLUE 1.5ML 8% EVOH DMSO VI DMSO SYR LES N ADH LIQ,73106,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,3958.88,8625.00,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,inpatient,,,1944.00000,1846.80000,Amish/Mennonite,Amish Mennonite,TC,1069.20,,,,,,,1069.20,1885.68,percent of total billed charges,
ECHO FETAL CARD SYS F/U RPT-TECH,7312,CDM,483,RC,76826,CPT,,,facility,outpatient,,,1944.00000,1846.80000,Amish/Mennonite,Amish Mennonite,TC,1069.20,,,,,,,797.92,1885.68,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,807.19000,766.83000,Amish/Mennonite,Amish Mennonite,,443.95,,,,,,,395.52,782.97,percent of total billed charges,
DEVICE CLSR 5FR VASC CRDS MYNXGRIP 10ML BLN CATH.,73133,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,807.19000,766.83000,Amish/Mennonite,Amish Mennonite,,443.95,,,,,,,370.50,807.19,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,413.44,818.44,percent of total billed charges,
DEVICE CLSR 6FR ANGSL VIP STRL LF DISP,73134,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,387.28,843.75,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1569.38000,1490.91000,Amish/Mennonite,Amish Mennonite,,863.16,,,,,,,769.00,1522.30,percent of total billed charges,
COIL EMB L14CM LOOP DIA8MM 0.035IN HYDRGEL PUSHABLE 35,73135,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1569.38000,1490.91000,Amish/Mennonite,Amish Mennonite,,863.16,,,,,,,720.35,1569.38,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
"LONG ARM CAST,PED,FIBERGLASS",73143,CDM,271,RC,Q4008,HCPCS,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,19.58,63.05,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,140.80,248.32,percent of total billed charges,
PERIPHERAL ARTERY DISEASE REHAB-TECH,73144,CDM,480,RC,93668,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,56.40,248.32,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
MRI GADAVIST PER 0.1 ML-TECH,73145,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.40920,2.21,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATHETER ART WRK L110CM L60MM DIA7MM GWIRE,73152,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L25CM DIA7MM 0.020IN COMPLX L VOL DETACH STD FRME,73153,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA6MM 0.02IN PERIPH COMPLX SFT FILL,73154,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA8MM 0.02IN PERIPH COMPLX SFT FILL,73155,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L45CM PK J SFT L VOL POD,73157,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID XB 3.5 7FR 100CM,73158,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT SPINAL TAP DIAG W CT GUID-TECH,73178,CDM,350,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,372.50,1820.00,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,inpatient,,,2602.00000,2471.90000,Amish/Mennonite,Amish Mennonite,TC,1431.10,,,,,,,1431.10,2523.94,percent of total billed charges,
US VESSEL MAPPING PREOP AVF BILAT-TECH,73179,CDM,402,RC,93985,CPT,,,facility,outpatient,,,2602.00000,2471.90000,Amish/Mennonite,Amish Mennonite,TC,1431.10,,,,,,,384.16,2523.94,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,Amish/Mennonite,Amish Mennonite,,1634.05,,,,,,,1634.05,2881.87,percent of total billed charges,
XR SPINAL TAP THERAP W FLUORO GUID-TECH,73180,CDM,320,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,Amish/Mennonite,Amish Mennonite,,1634.05,,,,,,,581.10,2881.87,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,inpatient,,,812.00000,771.40000,Amish/Mennonite,Amish Mennonite,TC,446.60,,,,,,,446.60,787.64,percent of total billed charges,
XR ESOPHAGRAM W AIR-TECH,73181,CDM,320,RC,74221,CPT,,,facility,outpatient,,,812.00000,771.40000,Amish/Mennonite,Amish Mennonite,TC,446.60,,,,,,,406.00,4081.21,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,5115.55,9021.97,percent of total billed charges,
NM SPECT/CT 2AREA 1DAY/1AREA MLT DAY-TECH,73182,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,4467.66,9021.97,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,691.90,1220.26,percent of total billed charges,
US VESSEL MAPPING PREOP AVF UNI-TECH,73183,CDM,402,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,384.16,1220.26,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
XR SPINAL TAP DIAG W FLUORO GUID-TECH,73184,CDM,320,RC,62329,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,372.50,792.37,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,inpatient,,,7033.00000,6681.35000,Amish/Mennonite,Amish Mennonite,TC,3868.15,,,,,,,3868.15,6822.01,percent of total billed charges,
NM SPECT 2AREA 1DAY/1AREA MULTI DAY-TECH,73185,CDM,340,RC,78831,CPT,,,facility,outpatient,,,7033.00000,6681.35000,Amish/Mennonite,Amish Mennonite,TC,3868.15,,,,,,,3383.38,7180.14,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TC,85.80,,,,,,,85.80,151.32,percent of total billed charges,
PET MYOCARD METABOLIC EVAL W CT-78429 TC,73186,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TC,85.80,,,,,,,78.00,8022.25,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,Amish/Mennonite,Amish Mennonite,TC,2597.10,,,,,,,2597.10,4580.34,percent of total billed charges,
NM SPECT/CT SINGLE AREA 1 DAY-TECH,73187,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,Amish/Mennonite,Amish Mennonite,TC,2597.10,,,,,,,2288.22,7180.14,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,inpatient,,,2971.00000,2822.45000,Amish/Mennonite,Amish Mennonite,,1634.05,,,,,,,1634.05,2881.87,percent of total billed charges,
CT SPINAL TAP THERAP W CT GUID-TECH,73188,CDM,350,RC,62328,CPT,,,facility,outpatient,,,2971.00000,2822.45000,Amish/Mennonite,Amish Mennonite,,1634.05,,,,,,,657.58,2881.87,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,288.20,508.28,percent of total billed charges,
XR SMALL BOWEL WO KUB-TECH,73189,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,257.95,2630.66,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,inpatient,1,mL,1762.48000,1674.36000,Amish/Mennonite,Amish Mennonite,,969.36,,,,,,,969.36,1709.61,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 300 INTUNITS/ML 5 ML,73190,CDM,636,RC,90375,HCPCS,13533031805,NDC,facility,outpatient,1,mL,1762.48000,1674.36000,Amish/Mennonite,Amish Mennonite,,969.36,,,,,,,266.44,1709.61,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,inpatient,1,mL,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CEFTAZIDIME 100 MG/ML SOLN,73191,CDM,250,RC,J0713,HCPCS,0040950821610000,NDC,facility,outpatient,1,mL,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,2.71,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,inpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
MULTIVITAMIN 0.5 TAB TAB,73192,CDM,250,RC,00904-0530-61-00050,NDC,,,facility,outpatient,1,EA,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,inpatient,1,mL,185.02000,175.77000,Amish/Mennonite,Amish Mennonite,,101.76,,,,,,,101.76,179.47,percent of total billed charges,
METHADONE 10 MG/ML SOLN,73193,CDM,250,RC,J1230,HCPCS,61553014978,NDC,facility,outpatient,1,mL,185.02000,175.77000,Amish/Mennonite,Amish Mennonite,,101.76,,,,,,,32.41,179.47,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
NM TC99M MYOVIEW,73200,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,72.00,260.45,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,inpatient,1,mL,7691.77000,7307.18000,Amish/Mennonite,Amish Mennonite,,4230.47,,,,,,,4230.47,7461.02,percent of total billed charges,
ICATIBANT 10 MG/ML SOLN,73203,CDM,250,RC,54092-0702-02,NDC,,,facility,outpatient,1,mL,7691.77000,7307.18000,Amish/Mennonite,Amish Mennonite,,4230.47,,,,,,,3845.89,7461.02,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,inpatient,,,94.40000,89.68000,Amish/Mennonite,Amish Mennonite,90,51.92,,,,,,,51.92,91.57,percent of total billed charges,
"DRUG SCREEN 4, MECONIUM (809173) SO",73204,CDM,300,RC,80307,CPT,,,facility,outpatient,,,94.40000,89.68000,Amish/Mennonite,Amish Mennonite,90,51.92,,,,,,,47.20,3038.81,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,inpatient,,,2215.00000,2104.25000,Amish/Mennonite,Amish Mennonite,,1218.25,,,,,,,1218.25,2148.55,percent of total billed charges,
BIN HEARING AID DISPENSING FEE,73208,CDM,470,RC,V5160,HCPCS,,,facility,outpatient,,,2215.00000,2104.25000,Amish/Mennonite,Amish Mennonite,,1218.25,,,,,,,1107.50,2148.55,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
APPLICATION ON-BODY INJECTOR SUBC,73218,CDM,260,RC,96377,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,43.81,161.02,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,inpatient,,,882.84000,838.70000,Amish/Mennonite,Amish Mennonite,,485.56,,,,,,,485.56,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,,,facility,outpatient,,,882.84000,838.70000,Amish/Mennonite,Amish Mennonite,,485.56,,,,,,,393.87,856.35,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,inpatient,1,EA,998.46000,948.54000,Amish/Mennonite,Amish Mennonite,,549.15,,,,,,,549.15,968.51,percent of total billed charges,
AMINOLEVULINIC ACID  LIQ-TOP 20% (LEVULAN),73222,CDM,636,RC,J7308,HCPCS,67308010106,NDC,facility,outpatient,1,EA,998.46000,948.54000,Amish/Mennonite,Amish Mennonite,,549.15,,,,,,,393.87,968.51,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,inpatient,,,430.57000,409.04000,Amish/Mennonite,Amish Mennonite,,236.81,,,,,,,236.81,417.65,percent of total billed charges,
AFLEX 301 40MM X 70MM,73232,CDM,636,RC,Q4125,HCPCS,,,facility,outpatient,,,430.57000,409.04000,Amish/Mennonite,Amish Mennonite,,236.81,,,,,,,215.28,417.65,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,inpatient,,,2328.75000,2212.31000,Amish/Mennonite,Amish Mennonite,,1280.81,,,,,,,1280.81,2258.89,percent of total billed charges,
AFFINITY 1.5X1.5CM (AF-1150) Q4159,73242,CDM,636,RC,Q4159,HCPCS,,,facility,outpatient,,,2328.75000,2212.31000,Amish/Mennonite,Amish Mennonite,,1280.81,,,,,,,376.51,2258.89,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
BRIEF EMOTIONAL/BEH ASSESSMENT,73261,CDM,918,RC,96127,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,41.00,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,TC,1897.50,,,,,,,1897.50,3346.50,percent of total billed charges,
GASTRIC EMPTYING IMAGING STUDY,7327,CDM,340,RC,78264,CPT,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,TC,1897.50,,,,,,,1591.55,3346.50,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,108.90,192.06,percent of total billed charges,
DIAPHRAGM FOR CONTRACEPTVE USE,73280,CDM,279,RC,A4266,HCPCS,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,99.00,192.06,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,20.35,35.89,percent of total billed charges,
APPLICATION HOT/COLD PACKS,73287,CDM,420,RC,97010,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,18.50,264.00,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,inpatient,,,1236.00000,1174.20000,Amish/Mennonite,Amish Mennonite,,679.80,,,,,,,679.80,1198.92,percent of total billed charges,
CHEMO EXTEND IV INF W/PUMP,73290,CDM,280,RC,G0498,HCPCS,,,facility,outpatient,,,1236.00000,1174.20000,Amish/Mennonite,Amish Mennonite,,679.80,,,,,,,314.95,1198.92,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,inpatient,,,561.00000,532.95000,Amish/Mennonite,Amish Mennonite,TC,308.55,,,,,,,308.55,544.17,percent of total billed charges,
ECHOGRAPHY OPHTH BIOMETR A-SCN,7330,CDM,483,RC,76516,CPT,,,facility,outpatient,,,561.00000,532.95000,Amish/Mennonite,Amish Mennonite,TC,308.55,,,,,,,168.00,544.17,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,inpatient,,,40.55000,38.52000,Amish/Mennonite,Amish Mennonite,,22.30,,,,,,,22.30,39.33,percent of total billed charges,
"EOVIST,PER ML",73306,CDM,270,RC,A9581,HCPCS,,,facility,outpatient,,,40.55000,38.52000,Amish/Mennonite,Amish Mennonite,,22.30,,,,,,,20.27,39.33,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,inpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,,77.55,,,,,,,77.55,136.77,percent of total billed charges,
"AQUATIC THERAPY,EACH 15 MIN",73308,CDM,420,RC,97113,CPT,,,facility,outpatient,,,141.00000,133.95000,Amish/Mennonite,Amish Mennonite,,77.55,,,,,,,70.50,264.00,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,inpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,183.56,323.74,percent of total billed charges,
"APPL SHOULDER CST,ADULT,FIBERG",73319,CDM,271,RC,Q4004,HCPCS,,,facility,outpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,163.27,323.74,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,inpatient,,,744.63000,707.40000,Amish/Mennonite,Amish Mennonite,,409.55,,,,,,,409.55,722.29,percent of total billed charges,
EPICORD2X3CM EC5230,73338,CDM,636,RC,Q4187,HCPCS,,,facility,outpatient,,,744.63000,707.40000,Amish/Mennonite,Amish Mennonite,,409.55,,,,,,,372.31,722.29,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,inpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,TC,1538.90,,,,,,,1538.90,2714.06,percent of total billed charges,
CT-PELVIS W/WO CONTR,7336,CDM,352,RC,72194,CPT,,,facility,outpatient,,,2798.00000,2658.10000,Amish/Mennonite,Amish Mennonite,TC,1538.90,,,,,,,979.11,2714.06,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,inpatient,,,3.39000,3.22000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.86,3.29,percent of total billed charges,
EZ-DERM #131703,73360,CDM,636,RC,Q4136,HCPCS,,,facility,outpatient,,,3.39000,3.22000,Amish/Mennonite,Amish Mennonite,,1.86,,,,,,,1.70,3.29,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,inpatient,,,24.82000,23.58000,Amish/Mennonite,Amish Mennonite,,13.65,,,,,,,13.65,24.08,percent of total billed charges,
"EPOETIN ALFA,BIOSIM,1000 UNITS",73361,CDM,636,RC,Q5106,HCPCS,,,facility,outpatient,,,24.82000,23.58000,Amish/Mennonite,Amish Mennonite,,13.65,,,,,,,7.57,24.08,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,inpatient,,,95.07000,90.32000,Amish/Mennonite,Amish Mennonite,,52.29,,,,,,,52.29,92.22,percent of total billed charges,
"GAUNTLET CAST,ADULT,FIBERGLASS",73373,CDM,271,RC,Q4014,HCPCS,,,facility,outpatient,,,95.07000,90.32000,Amish/Mennonite,Amish Mennonite,,52.29,,,,,,,35.64,92.22,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
GADOBUTROL,73375,CDM,270,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,Amish/Mennonite,Amish Mennonite,TC,120.89,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY,7338,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,Amish/Mennonite,Amish Mennonite,TC,120.89,,,,,,,109.90,213.21,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,63.25,111.55,percent of total billed charges,
"APLIGRAF,PER SQ CM",73384,CDM,636,RC,Q4101,HCPCS,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,47.06,111.55,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,inpatient,,,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
HEARING AID BATTERIES,73387,CDM,271,RC,V5266,HCPCS,,,facility,outpatient,,,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.62500,1.21,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
"GA-67,PER MCI",73388,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,36.30,145.50,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,inpatient,,,710.00000,674.50000,Amish/Mennonite,Amish Mennonite,,390.50,,,,,,,390.50,688.70,percent of total billed charges,
"EXT COUNTERPULSATION,PER SESSION",73389,CDM,510,RC,G0166,HCPCS,,,facility,outpatient,,,710.00000,674.50000,Amish/Mennonite,Amish Mennonite,,390.50,,,,,,,122.40,688.70,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,inpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,186.45,328.83,percent of total billed charges,
GLUCOSE MONITOR;PATIENT PROV EQUIP,73390,CDM,920,RC,95249,CPT,,,facility,outpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,56.40,328.83,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,inpatient,,,4318.00000,4102.10000,Amish/Mennonite,Amish Mennonite,,2374.90,,,,,,,2374.90,4188.46,percent of total billed charges,
INDIUM IN-WBC,73403,CDM,343,RC,A9570,HCPCS,,,facility,outpatient,,,4318.00000,4102.10000,Amish/Mennonite,Amish Mennonite,,2374.90,,,,,,,1031.39,4188.46,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,inpatient,,,5.24000,4.98000,Amish/Mennonite,Amish Mennonite,,2.88,,,,,,,2.88,5.08,percent of total billed charges,
GADOB ENATE DIME,73406,CDM,636,RC,A9578,HCPCS,,,facility,outpatient,,,5.24000,4.98000,Amish/Mennonite,Amish Mennonite,,2.88,,,,,,,2.62,5.08,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
I-131 UPTAKE DS,73409,CDM,343,RC,A9528,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,75.00,155.84,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,6398.00000,6078.10000,Amish/Mennonite,Amish Mennonite,,3518.90,,,,,,,3518.90,6206.06,percent of total billed charges,
IND IN-111 PEN,73411,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,6398.00000,6078.10000,Amish/Mennonite,Amish Mennonite,,3518.90,,,,,,,1914.61,6206.06,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,inpatient,,,115.43000,109.66000,Amish/Mennonite,Amish Mennonite,,63.49,,,,,,,63.49,111.97,percent of total billed charges,
"INTERFERON BETA-1A,1MCG IV",73419,CDM,636,RC,Q3027,HCPCS,,,facility,outpatient,,,115.43000,109.66000,Amish/Mennonite,Amish Mennonite,,63.49,,,,,,,57.47,111.97,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
KOH TEST(S),73437,CDM,306,RC,Q0112,HCPCS,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,5.83,41.71,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,inpatient,,,3418.00000,3247.10000,Amish/Mennonite,Amish Mennonite,TC,1879.90,,,,,,,1879.90,3315.46,percent of total billed charges,
HEPATOBILIARY SYSTEM IMAG,7344,CDM,340,RC,78226,CPT,,,facility,outpatient,,,3418.00000,3247.10000,Amish/Mennonite,Amish Mennonite,TC,1879.90,,,,,,,1578.65,3315.46,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,107.80,190.12,percent of total billed charges,
"LONG ARM CAST,ADULT,FIBERGLASS",73442,CDM,271,RC,Q4006,HCPCS,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,39.18,190.12,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,inpatient,,,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,26.18,46.17,percent of total billed charges,
"GAUNTLET CAST,PED,FIBERGLASS",73450,CDM,271,RC,Q4016,HCPCS,,,facility,outpatient,,,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,17.81,46.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,inpatient,,,254.81000,242.07000,Amish/Mennonite,Amish Mennonite,,140.15,,,,,,,140.15,247.17,percent of total billed charges,
"LONG LEG CAST,ADULT,FIBERGLASS",73453,CDM,271,RC,Q4030,HCPCS,,,facility,outpatient,,,254.81000,242.07000,Amish/Mennonite,Amish Mennonite,,140.15,,,,,,,102.07,247.17,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,inpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,49.87,87.95,percent of total billed charges,
"LONG LEG CAST,PED,FIBERGLASS",73454,CDM,271,RC,Q4032,HCPCS,,,facility,outpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,45.34,87.95,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,inpatient,,,59.60000,56.62000,Amish/Mennonite,Amish Mennonite,,32.78,,,,,,,32.78,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,FIBERGLASS",73457,CDM,271,RC,Q4044,HCPCS,,,facility,outpatient,,,59.60000,56.62000,Amish/Mennonite,Amish Mennonite,,32.78,,,,,,,22.93,57.81,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,inpatient,,,28.13000,26.72000,Amish/Mennonite,Amish Mennonite,,15.47,,,,,,,15.47,27.29,percent of total billed charges,
"LONG LEG SPLINT,PED,PLASTER",73460,CDM,271,RC,Q4043,HCPCS,,,facility,outpatient,,,28.13000,26.72000,Amish/Mennonite,Amish Mennonite,,15.47,,,,,,,13.42,27.29,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,inpatient,,,41.60000,39.52000,Amish/Mennonite,Amish Mennonite,,22.88,,,,,,,22.88,40.35,percent of total billed charges,
"LONG ARM SPLINT,PED,FIBERGLASS",73464,CDM,271,RC,Q4020,HCPCS,,,facility,outpatient,,,41.60000,39.52000,Amish/Mennonite,Amish Mennonite,,22.88,,,,,,,9.78,40.35,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,inpatient,,,5292.00000,5027.40000,Amish/Mennonite,Amish Mennonite,,2910.60,,,,,,,2910.60,5133.24,percent of total billed charges,
IOD I-123 IOFL,73465,CDM,343,RC,A9584,HCPCS,,,facility,outpatient,,,5292.00000,5027.40000,Amish/Mennonite,Amish Mennonite,,2910.60,,,,,,,1388.02,5133.24,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,inpatient,,,6656.00000,6323.20000,Amish/Mennonite,Amish Mennonite,,3660.80,,,,,,,3660.80,6456.32,percent of total billed charges,
"I123 MIBG,15MCI",73466,CDM,343,RC,A9582,HCPCS,,,facility,outpatient,,,6656.00000,6323.20000,Amish/Mennonite,Amish Mennonite,,3660.80,,,,,,,2074.81,6456.32,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,inpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,21.41,37.76,percent of total billed charges,
"LONG ARM SPLINT,ADULT,PLASTER",73467,CDM,271,RC,Q4017,HCPCS,,,facility,outpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,12.21,37.76,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,inpatient,,,259.13000,246.17000,Amish/Mennonite,Amish Mennonite,,142.52,,,,,,,142.52,251.36,percent of total billed charges,
"HIP SPICA,PEDIATRIC,FIBERGLASS",73469,CDM,271,RC,Q4028,HCPCS,,,facility,outpatient,,,259.13000,246.17000,Amish/Mennonite,Amish Mennonite,,142.52,,,,,,,79.20,251.36,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,inpatient,,,55.73000,52.94000,Amish/Mennonite,Amish Mennonite,,30.65,,,,,,,30.65,54.06,percent of total billed charges,
"LONG LEG SPLINT,ADULT,PLASTER",73472,CDM,271,RC,Q4041,HCPCS,,,facility,outpatient,,,55.73000,52.94000,Amish/Mennonite,Amish Mennonite,,30.65,,,,,,,26.83,54.06,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,inpatient,,,83.07000,78.92000,Amish/Mennonite,Amish Mennonite,,45.69,,,,,,,45.69,80.58,percent of total billed charges,
"LONG ARM SPLINT,ADULT,FIBERGL",73473,CDM,271,RC,Q4018,HCPCS,,,facility,outpatient,,,83.07000,78.92000,Amish/Mennonite,Amish Mennonite,,45.69,,,,,,,19.47,80.58,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,inpatient,,,42.67000,40.54000,Amish/Mennonite,Amish Mennonite,,23.47,,,,,,,23.47,41.39,percent of total billed charges,
"LONG LEG CAST,PED,PLASTER",73474,CDM,271,RC,Q4031,HCPCS,,,facility,outpatient,,,42.67000,40.54000,Amish/Mennonite,Amish Mennonite,,23.47,,,,,,,19.37,41.39,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,inpatient,,,77.07000,73.22000,Amish/Mennonite,Amish Mennonite,,42.39,,,,,,,42.39,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,PED,FIB",73479,CDM,271,RC,Q4036,HCPCS,,,facility,outpatient,,,77.07000,73.22000,Amish/Mennonite,Amish Mennonite,,42.39,,,,,,,38.53,74.76,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,inpatient,,,216.94000,206.09000,Amish/Mennonite,Amish Mennonite,,119.32,,,,,,,119.32,210.43,percent of total billed charges,
"LONG LEG CYLINDER CAST,AD,FIB",73487,CDM,271,RC,Q4034,HCPCS,,,facility,outpatient,,,216.94000,206.09000,Amish/Mennonite,Amish Mennonite,,119.32,,,,,,,89.94,210.43,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,inpatient,,,40.28000,38.27000,Amish/Mennonite,Amish Mennonite,,22.15,,,,,,,22.15,39.07,percent of total billed charges,
"NON-RADIOACTIVE,ADJUNCT,1MG",73493,CDM,636,RC,Q9968,HCPCS,,,facility,outpatient,,,40.28000,38.27000,Amish/Mennonite,Amish Mennonite,,22.15,,,,,,,7.86,39.07,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
"LONG LEG SPLINT,ADULT,FIBERGL",73509,CDM,271,RC,Q4042,HCPCS,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,45.80,172.66,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,inpatient,,,61.47000,58.40000,Amish/Mennonite,Amish Mennonite,,33.81,,,,,,,33.81,59.63,percent of total billed charges,
"LONG ARM CAST,ADULT,PLASTER",73513,CDM,271,RC,Q4005,HCPCS,,,facility,outpatient,,,61.47000,58.40000,Amish/Mennonite,Amish Mennonite,,33.81,,,,,,,17.39,59.63,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,inpatient,,,30.67000,29.14000,Amish/Mennonite,Amish Mennonite,,16.87,,,,,,,16.87,29.75,percent of total billed charges,
"LONG ARM CAST,PED,PLASTER",73529,CDM,271,RC,Q4007,HCPCS,,,facility,outpatient,,,30.67000,29.14000,Amish/Mennonite,Amish Mennonite,,16.87,,,,,,,8.69,29.75,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT COMPLEX-TECH,7353,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,549.28,20208.37,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,inpatient,,,85.33000,81.06000,Amish/Mennonite,Amish Mennonite,,46.93,,,,,,,46.93,82.77,percent of total billed charges,
"LONG LEG CAST,ADULT,PLASTER",73565,CDM,279,RC,Q4029,HCPCS,,,facility,outpatient,,,85.33000,81.06000,Amish/Mennonite,Amish Mennonite,,46.93,,,,,,,38.77,82.77,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,inpatient,,,30.40000,28.88000,Amish/Mennonite,Amish Mennonite,,16.72,,,,,,,14.90,29.49,percent of total billed charges,
RADIOELEMENTS FOR BRACHYTHERAP,73582,CDM,278,RC,Q3001,HCPCS,,,facility,outpatient,,,30.40000,28.88000,Amish/Mennonite,Amish Mennonite,,16.72,,,,,,,13.95,30.40,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,inpatient,,,2245.00000,2132.75000,Amish/Mennonite,Amish Mennonite,,1234.75,,,,,,,1234.75,2177.65,percent of total billed charges,
PERSONAL FM/DM SYSTEM-MONAURAL,73588,CDM,271,RC,V5281,HCPCS,,,facility,outpatient,,,2245.00000,2132.75000,Amish/Mennonite,Amish Mennonite,,1234.75,,,,,,,1122.50,2177.65,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,inpatient,,,4544.00000,4316.80000,Amish/Mennonite,Amish Mennonite,,2499.20,,,,,,,2226.56,4407.68,percent of total billed charges,
PERM IMPL CONTRACEP DEV/DEL SY,73589,CDM,278,RC,A4264,HCPCS,,,facility,outpatient,,,4544.00000,4316.80000,Amish/Mennonite,Amish Mennonite,,2499.20,,,,,,,2085.70,4544.00,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,inpatient,,,97.73000,92.84000,Amish/Mennonite,Amish Mennonite,,53.75,,,,,,,53.75,94.80,percent of total billed charges,
"SHORT LEG CAST,ADULT,PLASTER",73593,CDM,271,RC,Q4037,HCPCS,,,facility,outpatient,,,97.73000,92.84000,Amish/Mennonite,Amish Mennonite,,53.75,,,,,,,22.03,94.80,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,85.80,151.32,percent of total billed charges,
"SHORT LEG CAST,PED,FIBERGLASS",73594,CDM,271,RC,Q4040,HCPCS,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,27.63,151.32,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
"SHORT ARM CAST,ADULT,PLASTER",73595,CDM,271,RC,Q4009,HCPCS,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,11.62,45.59,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,inpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.90,17.46,percent of total billed charges,
"SHORT LEG SPLINT,PED,PLASTER",73600,CDM,271,RC,Q4047,HCPCS,,,facility,outpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,7.75,17.46,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,inpatient,,,41.60000,39.52000,Amish/Mennonite,Amish Mennonite,,22.88,,,,,,,22.88,40.35,percent of total billed charges,
"SHORT ARM SPLINT,PED,FIBERGLAS",73601,CDM,271,RC,Q4024,HCPCS,,,facility,outpatient,,,41.60000,39.52000,Amish/Mennonite,Amish Mennonite,,22.88,,,,,,,8.17,40.35,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,inpatient,,,38.53000,36.60000,Amish/Mennonite,Amish Mennonite,,21.19,,,,,,,21.19,37.37,percent of total billed charges,
"SHORT LEG SPLINT,PED,FIBERGLAS",73602,CDM,271,RC,Q4048,HCPCS,,,facility,outpatient,,,38.53000,36.60000,Amish/Mennonite,Amish Mennonite,,21.19,,,,,,,12.54,37.37,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,inpatient,,,50.53000,48.00000,Amish/Mennonite,Amish Mennonite,,27.79,,,,,,,27.79,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,FIBERGLASS",73605,CDM,271,RC,Q4012,HCPCS,,,facility,outpatient,,,50.53000,48.00000,Amish/Mennonite,Amish Mennonite,,27.79,,,,,,,13.09,49.01,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,inpatient,,,23.60000,22.42000,Amish/Mennonite,Amish Mennonite,,12.98,,,,,,,12.98,22.89,percent of total billed charges,
"SHORT ARM CAST,PED,PLASTER",73609,CDM,271,RC,Q4011,HCPCS,,,facility,outpatient,,,23.60000,22.42000,Amish/Mennonite,Amish Mennonite,,12.98,,,,,,,5.79,22.89,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,inpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,58.85,103.79,percent of total billed charges,
SPEECH TREATMENT;GROUP,73621,CDM,440,RC,92508,CPT,,,facility,outpatient,,,107.00000,101.65000,Amish/Mennonite,Amish Mennonite,,58.85,,,,,,,53.50,264.00,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
TC99M-PERTECHN,73628,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,21.34,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,inpatient,,,19.47000,18.50000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,10.71,18.89,percent of total billed charges,
"SHORT ARM SPLINT,PED,PLASTER",73631,CDM,271,RC,Q4023,HCPCS,,,facility,outpatient,,,19.47000,18.50000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,4.54,18.89,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,3853.00000,3660.35000,Amish/Mennonite,Amish Mennonite,,2119.15,,,,,,,2119.15,3737.41,percent of total billed charges,
TC99M EXAM WB,73632,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,3853.00000,3660.35000,Amish/Mennonite,Amish Mennonite,,2119.15,,,,,,,1040.32,3737.41,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,inpatient,,,75805.34000,72015.07000,Amish/Mennonite,Amish Mennonite,,41692.94,,,,,,,41692.94,73531.18,percent of total billed charges,
"SIPULEUCEL-T,PER INFUSION",73639,CDM,636,RC,Q2043,HCPCS,,,facility,outpatient,,,75805.34000,72015.07000,Amish/Mennonite,Amish Mennonite,,41692.94,,,,,,,37902.67,94648.39,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,inpatient,,,2155.00000,2047.25000,Amish/Mennonite,Amish Mennonite,TC,1185.25,,,,,,,1185.25,2090.35,percent of total billed charges,
KIDNEY IMAGING W/FUNCT SINGLE ST,7364,CDM,340,RC,78707,CPT,,,facility,outpatient,,,2155.00000,2047.25000,Amish/Mennonite,Amish Mennonite,TC,1185.25,,,,,,,1006.74,2960.49,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,inpatient,,,19.47000,18.50000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,10.71,18.89,percent of total billed charges,
"LONG ARM SPLINT,PED,PLASTER",73643,CDM,271,RC,Q4019,HCPCS,,,facility,outpatient,,,19.47000,18.50000,Amish/Mennonite,Amish Mennonite,,10.71,,,,,,,6.12,18.89,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
POST-COITAL TEST,73650,CDM,300,RC,Q0115,HCPCS,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,7.66,156.25,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
TONE DECAY TEST,73657,CDM,471,RC,92563,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,37.27,149.38,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,inpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,21.41,37.76,percent of total billed charges,
"SHORT ARM SPLINT,ADULT,PLASTER",73675,CDM,271,RC,Q4021,HCPCS,,,facility,outpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,9.04,37.76,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,inpatient,,,42.76000,40.62000,Amish/Mennonite,Amish Mennonite,,23.52,,,,,,,23.52,41.48,percent of total billed charges,
"PESSARY,RUBBER,ANY TYPE",73690,CDM,270,RC,A4561,HCPCS,,,facility,outpatient,,,42.76000,40.62000,Amish/Mennonite,Amish Mennonite,,23.52,,,,,,,21.38,41.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,inpatient,,,357.20000,339.34000,Amish/Mennonite,Amish Mennonite,,196.46,,,,,,,196.46,346.48,percent of total billed charges,
TC99M-DTPA-46524,73697,CDM,270,RC,A9539,HCPCS,,,facility,outpatient,,,357.20000,339.34000,Amish/Mennonite,Amish Mennonite,,196.46,,,,,,,178.60,346.48,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
GLOBAL LAB/UREA BREATH TEST C-14,7370,CDM,340,RC,78267,CPT,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,9.88,184.30,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,inpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,TC,203.50,,,,,,,203.50,358.90,percent of total billed charges,
DOSIMETRY PLAN SMPL,73703,CDM,333,RC,77300,CPT,,,facility,outpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,TC,203.50,,,,,,,181.22,1865.95,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,inpatient,,,2901.00000,2755.95000,Amish/Mennonite,Amish Mennonite,TC,1595.55,,,,,,,1595.55,2813.97,percent of total billed charges,
RADIOTHER PLAN-3 DIMENSIONAL,73709,CDM,333,RC,77295,CPT,,,facility,outpatient,,,2901.00000,2755.95000,Amish/Mennonite,Amish Mennonite,TC,1595.55,,,,,,,1390.65,14479.11,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,inpatient,,,4368.00000,4149.60000,Amish/Mennonite,Amish Mennonite,TC,2402.40,,,,,,,2402.40,4236.96,percent of total billed charges,
REM AFTERLOADING;2-12 CHANNELS,73711,CDM,342,RC,77771,CPT,,,facility,outpatient,,,4368.00000,4149.60000,Amish/Mennonite,Amish Mennonite,TC,2402.40,,,,,,,2181.80,4236.96,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS-TECH,73721,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,148.57,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR INTERMITTENT MONITORING-TECH,73728,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR CONTINUOUS MONITORING-TECH,73729,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR-TECH,73730,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR UNMNTRED-TECH,73731,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
VEEG BY TECH 2-12 HR UN MONITORED-TECH,73732,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,Amish/Mennonite,Amish Mennonite,,8855.00,,,,,,,8855.00,15617.00,percent of total billed charges,
VEEG BY TECH EA INCR 12-26 HR CONT MNTR-TECH,73733,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,Amish/Mennonite,Amish Mennonite,,8855.00,,,,,,,966.05,15617.00,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,inpatient,1,EA,12.52000,11.90000,Amish/Mennonite,Amish Mennonite,,6.89,,,,,,,6.89,12.14,percent of total billed charges,
ALISKIREN 150 MG TAB,73734,CDM,250,RC,66993-0141-30,NDC,,,facility,outpatient,1,EA,12.52000,11.90000,Amish/Mennonite,Amish Mennonite,,6.89,,,,,,,6.26,12.14,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,inpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,382.80,675.12,percent of total billed charges,
CAT-US OB TRANSVAGINAL-TECH,73735,CDM,402,RC,76817,CPT,,,facility,outpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,348.00,675.12,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
US GUID VASC ACC- EVAL DOC VIS-TECH,73737,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,548.00,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,Amish/Mennonite,Amish Mennonite,,677.05,,,,,,,677.05,1194.07,percent of total billed charges,
DISPENSING FEE CROS,73749,CDM,470,RC,V5200,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,Amish/Mennonite,Amish Mennonite,,677.05,,,,,,,615.50,1194.07,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,290.40,512.16,percent of total billed charges,
FLUORODEOXYGLUCOSE F 18 FDG,73757,CDM,343,RC,A9552,HCPCS,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,,290.40,,,,,,,264.00,689.02,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
FINGER SPLINT FOAM,73759,CDM,271,RC,S8450,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,TC,102.85,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTOGRAPHY,73761,CDM,920,RC,92250,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,TC,102.85,,,,,,,93.50,181.39,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,TC,9127.25,,,,,,,9127.25,16097.15,percent of total billed charges,
IMRT DOSE VOLUME HISTOGRAMS,73764,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,TC,9127.25,,,,,,,7955.77,82746.35,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,inpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,TC,732.05,,,,,,,732.05,1291.07,percent of total billed charges,
KIDNEY IMAG W/VASC FLOW/FUNC,7377,CDM,340,RC,78708,CPT,,,facility,outpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,TC,732.05,,,,,,,644.24,2960.49,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,inpatient,,,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,23.32,46.17,percent of total billed charges,
FINGER SPLINT STATIC,73779,CDM,274,RC,Q4049,HCPCS,,,facility,outpatient,,,47.60000,45.22000,Amish/Mennonite,Amish Mennonite,,26.18,,,,,,,2.83,46.17,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,inpatient,,,1231.00000,1169.45000,Amish/Mennonite,Amish Mennonite,,677.05,,,,,,,677.05,1194.07,percent of total billed charges,
MONAURAL HEARING AID DISP FEE,73783,CDM,470,RC,V5241,HCPCS,,,facility,outpatient,,,1231.00000,1169.45000,Amish/Mennonite,Amish Mennonite,,677.05,,,,,,,615.50,1194.07,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,21.41,37.76,percent of total billed charges,
GORE TEX LINER 2 INCH,73785,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,19.46,37.76,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,TC,32.45,,,,,,,32.45,57.23,percent of total billed charges,
EXTERNAL OCULAR PHOTOGRAPHY,73786,CDM,920,RC,92285,CPT,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,TC,32.45,,,,,,,29.50,57.23,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,496.88000,472.04000,Amish/Mennonite,Amish Mennonite,,273.28,,,,,,,273.28,481.97,percent of total billed charges,
NUSHIELD 2X3 SQCM,73794,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,496.88000,472.04000,Amish/Mennonite,Amish Mennonite,,273.28,,,,,,,143.61,874.50,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,inpatient,,,3464.00000,3290.80000,Amish/Mennonite,Amish Mennonite,TC,1905.20,,,,,,,1905.20,3360.08,percent of total billed charges,
LYMPHOSCINTOGRAPHY-TECH,7380,CDM,340,RC,78195,CPT,,,facility,outpatient,,,3464.00000,3290.80000,Amish/Mennonite,Amish Mennonite,TC,1905.20,,,,,,,1611.84,3360.08,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,433.40,764.36,percent of total billed charges,
FLUORO GUID CVAD PLC REPL RM,73805,CDM,320,RC,77001,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,394.00,4298.79,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,8.36,14.74,percent of total billed charges,
CASTING MATL FIBERGLASS ROLL,73810,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,15.20000,14.44000,Amish/Mennonite,Amish Mennonite,,8.36,,,,,,,7.60,14.74,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,740.63000,703.60000,Amish/Mennonite,Amish Mennonite,,407.35,,,,,,,407.35,718.41,percent of total billed charges,
NUSHIELD 1.6CM DISC,73812,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,740.63000,703.60000,Amish/Mennonite,Amish Mennonite,,407.35,,,,,,,143.61,874.50,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,395.31000,375.54000,Amish/Mennonite,Amish Mennonite,,217.42,,,,,,,217.42,383.45,percent of total billed charges,
NUSHIELD 3X4 SQ CM,73817,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,395.31000,375.54000,Amish/Mennonite,Amish Mennonite,,217.42,,,,,,,143.61,874.50,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,TC,92.40,,,,,,,92.40,162.96,percent of total billed charges,
INTERR DEV EVAL IMPL LOOP REC,73831,CDM,480,RC,93291,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,TC,92.40,,,,,,,84.00,162.96,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,238.63000,226.70000,Amish/Mennonite,Amish Mennonite,,131.25,,,,,,,131.25,231.47,percent of total billed charges,
NUSHIELD 6X6 SQ CM,73840,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,238.63000,226.70000,Amish/Mennonite,Amish Mennonite,,131.25,,,,,,,119.31,874.50,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,inpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,TC,257.40,,,,,,,257.40,453.96,percent of total billed charges,
SPECIAL TELETHERAPY PORT PLAN,73842,CDM,333,RC,77321,CPT,,,facility,outpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,TC,257.40,,,,,,,234.00,2419.76,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,307.27000,291.91000,Amish/Mennonite,Amish Mennonite,,169.00,,,,,,,169.00,298.05,percent of total billed charges,
NUSHIELD 4X4 SQ CM,73848,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,307.27000,291.91000,Amish/Mennonite,Amish Mennonite,,169.00,,,,,,,143.61,874.50,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,inpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1247.95,2200.93,percent of total billed charges,
ECHOCARDIOGRPHY FETAL CARD SYS TC,7385,CDM,483,RC,76825,CPT,,,facility,outpatient,,,2269.00000,2155.55000,Amish/Mennonite,Amish Mennonite,TC,1247.95,,,,,,,1134.50,2200.93,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,33.56000,31.88000,Amish/Mennonite,Amish Mennonite,,18.46,,,,,,,16.44,32.55,percent of total billed charges,
SLING WITH COLLAR AND CUFF,73851,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,33.56000,31.88000,Amish/Mennonite,Amish Mennonite,,18.46,,,,,,,11.56,32.55,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
REPORT WORKER'S COMP WC16/B,73854,CDM,960,RC,99080,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,42.52000,40.39000,Amish/Mennonite,Amish Mennonite,,23.39,,,,,,,20.83,41.24,percent of total billed charges,
SLING,73855,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,42.52000,40.39000,Amish/Mennonite,Amish Mennonite,,23.39,,,,,,,11.56,41.24,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLU VAC PF QUAD,73861,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,421.88000,400.79000,Amish/Mennonite,Amish Mennonite,,232.03,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY AM 8 SQ CM,73862,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,421.88000,400.79000,Amish/Mennonite,Amish Mennonite,,232.03,,,,,,,157.76,409.22,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,703.13000,667.97000,Amish/Mennonite,Amish Mennonite,,386.72,,,,,,,386.72,682.04,percent of total billed charges,
PURAPLY AM 4 SQ CM,73864,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,703.13000,667.97000,Amish/Mennonite,Amish Mennonite,,386.72,,,,,,,157.76,682.04,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,TC,57.75,,,,,,,57.75,101.85,percent of total billed charges,
TECH TRT AID INTERM,73866,CDM,333,RC,77333,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,TC,57.75,,,,,,,52.50,4496.60,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,464.06,818.44,percent of total billed charges,
PURAPLY AM 1.6 DISC,73872,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,157.76,818.44,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,52,247.50,,,,,,,247.50,436.50,percent of total billed charges,
SCR MAMMO INCL CAD UNIL  MOBILE-TECH,73873,CDM,403,RC,77067,CPT,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,52,247.50,,,,,,,225.00,492.80,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,inpatient,,,18.48000,17.56000,Amish/Mennonite,Amish Mennonite,,10.16,,,,,,,9.06,17.93,percent of total billed charges,
WRIST SPLINT PADDED,73881,CDM,274,RC,S8451,HCPCS,,,facility,outpatient,,,18.48000,17.56000,Amish/Mennonite,Amish Mennonite,,10.16,,,,,,,8.48,17.93,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC FLU VAC ADMIN,73883,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,148.24,261.44,percent of total billed charges,
NUSHIELD 4X6 SQ CM,73888,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,134.76,874.50,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,358.80000,340.86000,Amish/Mennonite,Amish Mennonite,,197.34,,,,,,,197.34,348.04,percent of total billed charges,
PURAPLY AM 25 SQ CM,73889,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,358.80000,340.86000,Amish/Mennonite,Amish Mennonite,,197.34,,,,,,,157.76,348.04,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-FLULAVAL QUAD IIV4 0.5ML,73890,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,TC,89.10,,,,,,,89.10,157.14,percent of total billed charges,
MOLECULAR BREAST IMAGING-TECH,7390,CDM,340,RC,78800,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,TC,89.10,,,,,,,81.00,2210.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,inpatient,,,60.90000,57.85000,Amish/Mennonite,Amish Mennonite,TC,33.49,,,,,,,33.49,59.07,percent of total billed charges,
OPTICAL PACHYMETRY-TECH,73920,CDM,920,RC,92499,CPT,,,facility,outpatient,,,60.90000,57.85000,Amish/Mennonite,Amish Mennonite,TC,33.49,,,,,,,30.45,59.07,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,TC,334.95,,,,,,,334.95,590.73,percent of total billed charges,
ELECTROMYOGRPAHY W/CHEMODEN-TECH,73921,CDM,922,RC,95874,CPT,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,TC,334.95,,,,,,,304.50,590.73,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,inpatient,1,GM,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,00904-7751-27,NDC,,,facility,outpatient,1,GM,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
EMOLLIENT CREAM 454 GM (EQV-EUCERIN),73925,CDM,250,RC,54162-0600-01,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,inpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
NALTREXONE 25 MG TAB,73926,CDM,250,RC,68094-0853-62-00050,NDC,,,facility,outpatient,1,EA,3.32000,3.15000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.66,3.22,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,inpatient,1,EA,3695.71000,3510.92000,Amish/Mennonite,Amish Mennonite,,2032.64,,,,,,,2032.64,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,00517430001,NDC,facility,outpatient,1,EA,3695.71000,3510.92000,Amish/Mennonite,Amish Mennonite,,2032.64,,,,,,,12.12,3584.84,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,inpatient,1,EA,3270.72000,3107.18000,Amish/Mennonite,Amish Mennonite,,1798.90,,,,,,,1798.90,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,24979071051,NDC,facility,outpatient,1,EA,3270.72000,3107.18000,Amish/Mennonite,Amish Mennonite,,1798.90,,,,,,,12.12,3172.60,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,inpatient,1,EA,3314.32000,3148.61000,Amish/Mennonite,Amish Mennonite,,1822.88,,,,,,,1822.88,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,60505623004,NDC,facility,outpatient,1,EA,3314.32000,3148.61000,Amish/Mennonite,Amish Mennonite,,1822.88,,,,,,,12.12,3214.89,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,inpatient,1,EA,3634.14000,3452.43000,Amish/Mennonite,Amish Mennonite,,1998.78,,,,,,,1998.78,3525.12,percent of total billed charges,
PACLITAXEL PROTEIN-BOUND 100 MG POWD,73929,CDM,636,RC,J9264,HCPCS,68817013450,NDC,facility,outpatient,1,EA,3634.14000,3452.43000,Amish/Mennonite,Amish Mennonite,,1998.78,,,,,,,12.12,3525.12,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 185CM PT2 NTNL SS,73931,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,269.85000,256.36000,Amish/Mennonite,Amish Mennonite,,148.42,,,,,,,132.23,261.75,percent of total billed charges,
GUIDEWIRE VASC STRG DIST TPR .018IN 180CM CRDS,73933,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,269.85000,256.36000,Amish/Mennonite,Amish Mennonite,,148.42,,,,,,,123.86,269.85,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,395.63000,375.85000,Amish/Mennonite,Amish Mennonite,,217.60,,,,,,,193.86,383.76,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 180CM RUNTHROUGH NS,73935,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,395.63000,375.85000,Amish/Mennonite,Amish Mennonite,,217.60,,,,,,,181.59,395.63,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPHB,73937,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,30261.00000,28747.95000,Amish/Mennonite,Amish Mennonite,,16643.55,,,,,,,14827.89,29353.17,percent of total billed charges,
DEFIBRILLATOR CARD 72.9GM W5.73XH8.08CM D0.99CM RA IS-1 RV,73938,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,30261.00000,28747.95000,Amish/Mennonite,Amish Mennonite,,16643.55,,,,,,,13889.80,30261.00,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,73939,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L26CM PERCFLX HYDR+ PGTL TAPR TIP W/ ATTCH,73940,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX TREK 3.5X12MM,73941,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L13.5CM DST DIA18MM FEP NIT CONTRALATERAL LEG IL,73945,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,inpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,160.60,283.24,percent of total billed charges,
SHORT LEG CAST ADULT FIBERGLAS-TECH,73946,CDM,270,RC,Q4038,HCPCS,,,facility,outpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,55.26,283.24,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
PREV MED COUNSELING GRP 60MIN-TECH,73954,CDM,510,RC,99412,CPT,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,35.50,68.87,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,58.39000,55.47000,Amish/Mennonite,Amish Mennonite,,32.11,,,,,,,32.11,56.64,percent of total billed charges,
ACHILLES HEEL PAD,73960,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,58.39000,55.47000,Amish/Mennonite,Amish Mennonite,,32.11,,,,,,,29.20,56.64,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,52.36000,49.74000,Amish/Mennonite,Amish Mennonite,,28.80,,,,,,,28.80,50.79,percent of total billed charges,
ARM/LEG SPLINT/STRAP,73961,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,52.36000,49.74000,Amish/Mennonite,Amish Mennonite,,28.80,,,,,,,26.18,50.79,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
BANDIT THERAPEUTIC ELBOW BAND,73962,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,23.00,44.62,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,18.70,32.98,percent of total billed charges,
BEYOND KEGEL BALL,73964,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,17.00,32.98,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,inpatient,,,209.81000,199.32000,Amish/Mennonite,Amish Mennonite,,115.40,,,,,,,102.81,203.52,percent of total billed charges,
ANKLE FOOT ORTHOSIS PREFAB,73965,CDM,274,RC,L1906,HCPCS,,,facility,outpatient,,,209.81000,199.32000,Amish/Mennonite,Amish Mennonite,,115.40,,,,,,,104.91,203.52,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
AEROSOL MASK USED W/NEBULIZER,73966,CDM,271,RC,A7015,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,13.07000,12.42000,Amish/Mennonite,Amish Mennonite,,7.19,,,,,,,7.19,12.68,percent of total billed charges,
"ELASTIC BNDG,6""",73968,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,13.07000,12.42000,Amish/Mennonite,Amish Mennonite,,7.19,,,,,,,2.63,12.68,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,inpatient,,,172.04000,163.44000,Amish/Mennonite,Amish Mennonite,,94.62,,,,,,,84.30,166.88,percent of total billed charges,
BRACE HINGED ELBOW,73969,CDM,274,RC,L3710,HCPCS,,,facility,outpatient,,,172.04000,163.44000,Amish/Mennonite,Amish Mennonite,,94.62,,,,,,,86.02,180.06,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
ELASTIC WRIST BRACE/SPLINT,73970,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,14.00,27.16,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,NU,8.80,,,,,,,8.80,15.52,percent of total billed charges,
ELBOW ORTH(HEELBO),73971,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,NU,8.80,,,,,,,8.00,16.05,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,Amish/Mennonite,Amish Mennonite,,40.77,,,,,,,36.32,71.91,percent of total billed charges,
ABDOMINAL BINDER ELAST NON-RIG,73972,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,Amish/Mennonite,Amish Mennonite,,40.77,,,,,,,37.06,71.91,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,17.00000,16.15000,Amish/Mennonite,Amish Mennonite,NU,9.35,,,,,,,9.35,16.49,percent of total billed charges,
GEL HEEL/ELBOW PROTECTOR,73976,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,17.00000,16.15000,Amish/Mennonite,Amish Mennonite,NU,9.35,,,,,,,8.50,16.49,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,,259.88,,,,,,,231.53,458.32,percent of total billed charges,
FARROW WRAP CLASSIC LEGPIECE,73977,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,,259.88,,,,,,,216.88,458.32,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,inpatient,,,65.73000,62.44000,Amish/Mennonite,Amish Mennonite,,36.15,,,,,,,36.15,63.76,percent of total billed charges,
GEL SHEET DERM/EPI,73978,CDM,272,RC,A6025,HCPCS,,,facility,outpatient,,,65.73000,62.44000,Amish/Mennonite,Amish Mennonite,,36.15,,,,,,,32.87,63.76,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,Amish/Mennonite,Amish Mennonite,,17.67,,,,,,,17.67,31.17,percent of total billed charges,
ANKLE SUPPORT,73979,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,Amish/Mennonite,Amish Mennonite,,17.67,,,,,,,16.07,31.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,15.64000,14.86000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,8.60,15.17,percent of total billed charges,
"GLOVE,EDEMA,OPEN FINGER",73982,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,15.64000,14.86000,Amish/Mennonite,Amish Mennonite,,8.60,,,,,,,7.82,15.17,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,144.31000,137.09000,Amish/Mennonite,Amish Mennonite,,79.37,,,,,,,79.37,139.98,percent of total billed charges,
GRADIENT PRESSURE SLEEVE,73984,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,144.31000,137.09000,Amish/Mennonite,Amish Mennonite,,79.37,,,,,,,72.16,139.98,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,82.93000,78.78000,Amish/Mennonite,Amish Mennonite,,45.61,,,,,,,45.61,80.44,percent of total billed charges,
DARCO HEEL WEDGE,73986,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,82.93000,78.78000,Amish/Mennonite,Amish Mennonite,,45.61,,,,,,,41.47,80.44,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,inpatient,,,1245.79000,1183.50000,Amish/Mennonite,Amish Mennonite,,685.18,,,,,,,610.44,1208.42,percent of total billed charges,
"KO,DOUBLE UPRIGHT OTS",73988,CDM,274,RC,L1852,HCPCS,,,facility,outpatient,,,1245.79000,1183.50000,Amish/Mennonite,Amish Mennonite,,685.18,,,,,,,622.89,1208.42,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,167.80000,159.41000,Amish/Mennonite,Amish Mennonite,,92.29,,,,,,,92.29,162.77,percent of total billed charges,
KNEE ORTHOTIC,73989,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,167.80000,159.41000,Amish/Mennonite,Amish Mennonite,,92.29,,,,,,,83.90,162.77,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"ADMIN SET,NEBULIZER,DISPOSABLE",73990,CDM,271,RC,A7003,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,95.46000,90.69000,Amish/Mennonite,Amish Mennonite,,52.50,,,,,,,46.78,92.60,percent of total billed charges,
ANKLE CONTRAC SPLNT-OTS,73991,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,95.46000,90.69000,Amish/Mennonite,Amish Mennonite,,52.50,,,,,,,47.73,232.52,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,inpatient,,,31.33000,29.76000,Amish/Mennonite,Amish Mennonite,,17.23,,,,,,,15.35,30.39,percent of total billed charges,
"ORTH  SO,FIG 8,ABD RESTRAINER",73993,CDM,274,RC,L3650,HCPCS,,,facility,outpatient,,,31.33000,29.76000,Amish/Mennonite,Amish Mennonite,,17.23,,,,,,,15.66,90.87,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,inpatient,,,306.76000,291.42000,Amish/Mennonite,Amish Mennonite,,168.72,,,,,,,150.31,297.56,percent of total billed charges,
EO ADJ POS LOCKING JOINT OTS,73995,CDM,274,RC,L3761,HCPCS,,,facility,outpatient,,,306.76000,291.42000,Amish/Mennonite,Amish Mennonite,,168.72,,,,,,,153.38,630.65,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,32.13000,30.52000,Amish/Mennonite,Amish Mennonite,,17.67,,,,,,,17.67,31.17,percent of total billed charges,
NEOPRENE ELBOW SUPPORT,73997,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,32.13000,30.52000,Amish/Mennonite,Amish Mennonite,,17.67,,,,,,,16.07,31.17,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,inpatient,,,257.76000,244.87000,Amish/Mennonite,Amish Mennonite,,141.77,,,,,,,126.30,250.03,percent of total billed charges,
KO TRUPULL ADV OTS,74000,CDM,274,RC,L1812,HCPCS,,,facility,outpatient,,,257.76000,244.87000,Amish/Mennonite,Amish Mennonite,,141.77,,,,,,,81.64,250.03,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,50.06000,47.56000,Amish/Mennonite,Amish Mennonite,NU,27.53,,,,,,,27.53,48.56,percent of total billed charges,
"CRUTCHES,UNDERARM,OTH THN WOOD",74002,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,50.06000,47.56000,Amish/Mennonite,Amish Mennonite,NU,27.53,,,,,,,25.03,75.83,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,25.77000,24.48000,Amish/Mennonite,Amish Mennonite,,14.17,,,,,,,14.17,25.00,percent of total billed charges,
KNEE SUPPORT,74003,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,25.77000,24.48000,Amish/Mennonite,Amish Mennonite,,14.17,,,,,,,12.88,25.00,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,inpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG",74004,CDM,274,RC,A6536,HCPCS,,,facility,outpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,45.34,87.95,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,64.53000,61.30000,Amish/Mennonite,Amish Mennonite,,35.49,,,,,,,35.49,62.59,percent of total billed charges,
NEOPRENE ANKLE SUPP,74005,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,64.53000,61.30000,Amish/Mennonite,Amish Mennonite,,35.49,,,,,,,32.27,62.59,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,inpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.80,15.52,percent of total billed charges,
PHARM SUP FEE;SUBS PRESC 30DAY,74008,CDM,636,RC,Q0512,HCPCS,,,facility,outpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.00,17.60,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,inpatient,,,38.27000,36.36000,Amish/Mennonite,Amish Mennonite,,21.05,,,,,,,18.75,37.12,percent of total billed charges,
ACHILLES WEDGE,74009,CDM,274,RC,L3332,HCPCS,,,facility,outpatient,,,38.27000,36.36000,Amish/Mennonite,Amish Mennonite,,21.05,,,,,,,19.14,102.20,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,127.79000,121.40000,Amish/Mennonite,Amish Mennonite,,70.28,,,,,,,70.28,123.96,percent of total billed charges,
"LYMPHADEMA,GAUNTLET",74010,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,127.79000,121.40000,Amish/Mennonite,Amish Mennonite,,70.28,,,,,,,63.90,123.96,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,31.56000,29.98000,Amish/Mennonite,Amish Mennonite,,17.36,,,,,,,15.46,30.61,percent of total billed charges,
POST-OP SHOE W/WOODEN SOLE,74011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,31.56000,29.98000,Amish/Mennonite,Amish Mennonite,,17.36,,,,,,,14.49,30.61,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,inpatient,,,94.13000,89.42000,Amish/Mennonite,Amish Mennonite,,51.77,,,,,,,51.77,91.31,percent of total billed charges,
"PRSTH  ELST STCKNG,SRG WT",74012,CDM,272,RC,A6532,HCPCS,,,facility,outpatient,,,94.13000,89.42000,Amish/Mennonite,Amish Mennonite,,51.77,,,,,,,47.06,91.31,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,196.16000,186.35000,Amish/Mennonite,Amish Mennonite,NU,107.89,,,,,,,107.89,190.28,percent of total billed charges,
NECKPRO OVERDOOR TRACTN UNIT,74013,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,196.16000,186.35000,Amish/Mennonite,Amish Mennonite,NU,107.89,,,,,,,56.49,190.28,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
FOOT COMPRSN STCKNG,74014,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,20.00,43.75,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,inpatient,,,78.37000,74.45000,Amish/Mennonite,Amish Mennonite,,43.10,,,,,,,43.10,76.02,percent of total billed charges,
PRSTH  BK COMPR STKG,74015,CDM,272,RC,A6531,HCPCS,,,facility,outpatient,,,78.37000,74.45000,Amish/Mennonite,Amish Mennonite,,43.10,,,,,,,39.19,76.02,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,64.42000,61.20000,Amish/Mennonite,Amish Mennonite,,35.43,,,,,,,31.57,62.49,percent of total billed charges,
"MATERNITY SPRT,NON-RIGID",74016,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,64.42000,61.20000,Amish/Mennonite,Amish Mennonite,,35.43,,,,,,,32.21,62.49,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,inpatient,,,13.82000,13.13000,Amish/Mennonite,Amish Mennonite,,7.60,,,,,,,7.60,13.41,percent of total billed charges,
SELF-ADH BNDG,74017,CDM,272,RC,A6455,HCPCS,,,facility,outpatient,,,13.82000,13.13000,Amish/Mennonite,Amish Mennonite,,7.60,,,,,,,2.09,13.41,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,90.20,159.08,percent of total billed charges,
READYWRAP/KNEE,74018,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,82.00,159.08,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,NU,55.00,,,,,,,55.00,97.00,percent of total billed charges,
PADDED ELBOW SLEEVE,74019,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,NU,55.00,,,,,,,14.99,97.00,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
IMPACTO H/D KNEE PADS,74021,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,33.00,64.02,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,15.68,31.04,percent of total billed charges,
PEAK FLOW METER,74022,CDM,274,RC,A4614,HCPCS,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,16.00,38.21,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,53.73000,51.04000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,29.55,52.12,percent of total billed charges,
THERMAL ELBOW WRAP,74024,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,53.73000,51.04000,Amish/Mennonite,Amish Mennonite,,29.55,,,,,,,26.86,52.12,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,29.70,52.38,percent of total billed charges,
SHOULDER PULLEY W/DOOR ATTACH,74025,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,54.00000,51.30000,Amish/Mennonite,Amish Mennonite,,29.70,,,,,,,27.00,52.38,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,4""",74026,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,2.63,6.47,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,33.92000,32.22000,Amish/Mennonite,Amish Mennonite,,18.66,,,,,,,18.66,32.90,percent of total billed charges,
SOFT ULNR DEV INSERT W/O BRACE,74027,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,33.92000,32.22000,Amish/Mennonite,Amish Mennonite,,18.66,,,,,,,16.96,32.90,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,inpatient,,,96.88000,92.04000,Amish/Mennonite,Amish Mennonite,,53.28,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6534",74029,CDM,274,RC,A6534,HCPCS,,,facility,outpatient,,,96.88000,92.04000,Amish/Mennonite,Amish Mennonite,,53.28,,,,,,,48.44,93.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.94000,188.99000,Amish/Mennonite,Amish Mennonite,,109.42,,,,,,,97.48,192.97,percent of total billed charges,
READYWRAP/TOE CAP,74031,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.94000,188.99000,Amish/Mennonite,Amish Mennonite,,109.42,,,,,,,91.31,192.97,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,11.21000,10.65000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,6.17,10.87,percent of total billed charges,
URINARY LEG BAG;VINYL,74032,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,11.21000,10.65000,Amish/Mennonite,Amish Mennonite,,6.17,,,,,,,5.61,10.87,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,inpatient,,,76.89000,73.05000,Amish/Mennonite,Amish Mennonite,,42.29,,,,,,,37.68,74.58,percent of total billed charges,
"PRSTH  BK,GRAD STKG,18-30 MMHG",74033,CDM,274,RC,A6530,HCPCS,,,facility,outpatient,,,76.89000,73.05000,Amish/Mennonite,Amish Mennonite,,42.29,,,,,,,38.45,74.58,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG,2""",74034,CDM,272,RC,A6448,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,1.73,6.47,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,45.56000,43.28000,Amish/Mennonite,Amish Mennonite,,25.06,,,,,,,22.32,44.19,percent of total billed charges,
THUMB STAB SPLINT/OTS,74036,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,45.56000,43.28000,Amish/Mennonite,Amish Mennonite,,25.06,,,,,,,22.78,121.81,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,inpatient,,,197.06000,187.21000,Amish/Mennonite,Amish Mennonite,,108.38,,,,,,,96.56,191.15,percent of total billed charges,
STATIC PROGRESSIVE FLEXION SPT,74038,CDM,274,RC,L3925,HCPCS,,,facility,outpatient,,,197.06000,187.21000,Amish/Mennonite,Amish Mennonite,,108.38,,,,,,,77.37,191.15,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,247.54000,235.16000,Amish/Mennonite,Amish Mennonite,,136.15,,,,,,,136.15,240.11,percent of total billed charges,
NON-PNEUMATIC WALKING SPLINT,74039,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,247.54000,235.16000,Amish/Mennonite,Amish Mennonite,,136.15,,,,,,,123.77,240.11,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,inpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,13.20,23.28,percent of total billed charges,
PHARM SUP FEE;1ST PRESC 30 DAY,74041,CDM,636,RC,Q0511,HCPCS,,,facility,outpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,12.00,26.40,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,inpatient,,,96.88000,92.04000,Amish/Mennonite,Amish Mennonite,,53.28,,,,,,,47.47,93.97,percent of total billed charges,
"PRSTH  ELST STCKNG,AK,MED",74042,CDM,274,RC,A6533,HCPCS,,,facility,outpatient,,,96.88000,92.04000,Amish/Mennonite,Amish Mennonite,,53.28,,,,,,,48.44,93.97,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,inpatient,,,1579.84000,1500.85000,Amish/Mennonite,Amish Mennonite,,868.91,,,,,,,774.12,1532.44,percent of total billed charges,
"KO,ADJ KNEE JT-PF/CS",74043,CDM,274,RC,L1832,HCPCS,,,facility,outpatient,,,1579.84000,1500.85000,Amish/Mennonite,Amish Mennonite,,868.91,,,,,,,789.92,1532.44,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,46.20,81.48,percent of total billed charges,
THERACANE MASSAGER FOR BACK,74044,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,42.00,81.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,inpatient,,,608.74000,578.30000,Amish/Mennonite,Amish Mennonite,,334.81,,,,,,,298.28,590.48,percent of total billed charges,
SULLY SHOULDER STAB BRACE,74045,CDM,274,RC,L3675,HCPCS,,,facility,outpatient,,,608.74000,578.30000,Amish/Mennonite,Amish Mennonite,,334.81,,,,,,,206.75,590.48,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,inpatient,,,179.66000,170.68000,Amish/Mennonite,Amish Mennonite,,98.81,,,,,,,98.81,174.27,percent of total billed charges,
TUBULAR DRESSING,74046,CDM,272,RC,A6457,HCPCS,,,facility,outpatient,,,179.66000,170.68000,Amish/Mennonite,Amish Mennonite,,98.81,,,,,,,1.71,174.27,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,44.00,77.60,percent of total billed charges,
STOCKING DONNER,74047,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,40.00,77.60,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,,6.05,,,,,,,6.05,10.67,percent of total billed charges,
DIGIT CAP OR SLEEVE,74048,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,,6.05,,,,,,,5.50,10.67,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,inpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,27.44,54.32,percent of total billed charges,
"ORTH  WHO,WRST EXT CNTL COCK-UP",74049,CDM,274,RC,L3908,HCPCS,,,facility,outpatient,,,56.00000,53.20000,Amish/Mennonite,Amish Mennonite,,30.80,,,,,,,28.00,92.45,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
SHOULDER PULLEY BLUE RANGER,74050,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,29.10,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,92.48000,87.86000,Amish/Mennonite,Amish Mennonite,,50.86,,,,,,,50.86,89.71,percent of total billed charges,
KO ELASTIC/NEOPRENE,74051,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,92.48000,87.86000,Amish/Mennonite,Amish Mennonite,,50.86,,,,,,,46.24,89.71,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,55.84,98.47,percent of total billed charges,
NEOPRENE WRIST/THUMB WRAP,74052,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,50.76,98.47,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,inpatient,,,223.09000,211.94000,Amish/Mennonite,Amish Mennonite,,122.70,,,,,,,109.31,216.40,percent of total billed charges,
GRADIENT COMPR STK,74053,CDM,274,RC,A6540,HCPCS,,,facility,outpatient,,,223.09000,211.94000,Amish/Mennonite,Amish Mennonite,,122.70,,,,,,,111.55,216.40,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,218.81000,207.87000,Amish/Mennonite,Amish Mennonite,,120.35,,,,,,,107.22,212.25,percent of total billed charges,
READYWRAP/CALF,74054,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,218.81000,207.87000,Amish/Mennonite,Amish Mennonite,,120.35,,,,,,,100.43,212.25,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,inpatient,,,8.67000,8.24000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,4.77,8.41,percent of total billed charges,
INTERMITTENT URIN CATH;STR TIP,74055,CDM,272,RC,A4351,HCPCS,,,facility,outpatient,,,8.67000,8.24000,Amish/Mennonite,Amish Mennonite,,4.77,,,,,,,2.72,8.41,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
"ORTH  ELBOW,ELASTIC WITH STAYS",74056,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,118.34,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,inpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,18.15,32.01,percent of total billed charges,
"PHARM DISP FEE,INH DR,30 DAYS",74057,CDM,290,RC,Q0513,HCPCS,,,facility,outpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,16.50,36.30,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,inpatient,,,24.93000,23.68000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,13.71,24.18,percent of total billed charges,
"INDWELL,FOLEY;2-WAY,SILICONE",74058,CDM,272,RC,A4344,HCPCS,,,facility,outpatient,,,24.93000,23.68000,Amish/Mennonite,Amish Mennonite,,13.71,,,,,,,12.46,25.71,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,44.06000,41.86000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,24.23,42.74,percent of total billed charges,
KNEE SLEEVE/SUPPORT,74059,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,44.06000,41.86000,Amish/Mennonite,Amish Mennonite,,24.23,,,,,,,22.03,42.74,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,inpatient,,,185.09000,175.84000,Amish/Mennonite,Amish Mennonite,,101.80,,,,,,,90.69,179.54,percent of total billed charges,
"ORTH  SO,ACROMIOCLAV C/W",74060,CDM,274,RC,L3670,HCPCS,,,facility,outpatient,,,185.09000,175.84000,Amish/Mennonite,Amish Mennonite,,101.80,,,,,,,92.55,179.54,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,183.56,323.74,percent of total billed charges,
READYWRAP/THIGH,74061,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,166.88,323.74,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.90,17.46,percent of total billed charges,
RIB BELT,74062,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.00,17.46,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,inpatient,,,241.12000,229.06000,Amish/Mennonite,Amish Mennonite,,132.62,,,,,,,118.15,233.89,percent of total billed charges,
NON-PNEUM WALKING SPL-PF/CS,74064,CDM,274,RC,L4386,HCPCS,,,facility,outpatient,,,241.12000,229.06000,Amish/Mennonite,Amish Mennonite,,132.62,,,,,,,120.56,233.89,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,22.55,39.77,percent of total billed charges,
HOME RANGER SHOULDER PULLEY,74065,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,41.00000,38.95000,Amish/Mennonite,Amish Mennonite,,22.55,,,,,,,20.50,39.77,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,inpatient,,,19.20000,18.24000,Amish/Mennonite,Amish Mennonite,,10.56,,,,,,,10.56,18.62,percent of total billed charges,
"INDWELL CATH;FOLEY,2-WAY,LATEX",74066,CDM,272,RC,A4338,HCPCS,,,facility,outpatient,,,19.20000,18.24000,Amish/Mennonite,Amish Mennonite,,10.56,,,,,,,9.60,19.71,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,inpatient,,,300.00000,285.00000,Amish/Mennonite,Amish Mennonite,,165.00,,,,,,,147.00,291.00,percent of total billed charges,
"WHFO,RIGID W/JTS,BENIK CUST",74067,CDM,274,RC,L3808,HCPCS,,,facility,outpatient,,,300.00000,285.00000,Amish/Mennonite,Amish Mennonite,,165.00,,,,,,,150.00,449.21,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,inpatient,,,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,10.22,18.02,percent of total billed charges,
URINARY DRAINAGE BAG,74068,CDM,272,RC,A4357,HCPCS,,,facility,outpatient,,,18.58000,17.65000,Amish/Mennonite,Amish Mennonite,,10.22,,,,,,,9.29,18.02,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,11.00,19.40,percent of total billed charges,
DIGIWRAP,74069,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,10.00,19.40,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,inpatient,,,208.28000,197.87000,Amish/Mennonite,Amish Mennonite,,114.55,,,,,,,102.06,202.03,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG",74070,CDM,274,RC,A6539,HCPCS,,,facility,outpatient,,,208.28000,197.87000,Amish/Mennonite,Amish Mennonite,,114.55,,,,,,,101.76,202.03,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,67.80000,64.41000,Amish/Mennonite,Amish Mennonite,,37.29,,,,,,,37.29,65.77,percent of total billed charges,
EAR BANDIT,74072,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,67.80000,64.41000,Amish/Mennonite,Amish Mennonite,,37.29,,,,,,,33.90,65.77,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,206.25000,195.94000,Amish/Mennonite,Amish Mennonite,,113.44,,,,,,,113.44,200.06,percent of total billed charges,
READYWRAP/FOOT 5019,74073,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,206.25000,195.94000,Amish/Mennonite,Amish Mennonite,,113.44,,,,,,,103.12,200.06,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,inpatient,,,53.07000,50.42000,Amish/Mennonite,Amish Mennonite,,29.19,,,,,,,26.00,51.48,percent of total billed charges,
URIN DRAINAGE BAG-LEG/ABD LATX,74074,CDM,274,RC,A5112,HCPCS,,,facility,outpatient,,,53.07000,50.42000,Amish/Mennonite,Amish Mennonite,,29.19,,,,,,,26.54,54.64,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,79.96000,75.96000,Amish/Mennonite,Amish Mennonite,,43.98,,,,,,,43.98,77.56,percent of total billed charges,
READYWRAP EXTENSION,74075,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,79.96000,75.96000,Amish/Mennonite,Amish Mennonite,,43.98,,,,,,,39.98,77.56,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,106.89000,101.55000,Amish/Mennonite,Amish Mennonite,,58.79,,,,,,,52.38,103.68,percent of total billed charges,
"LO,FLEX,PREFAB-ELAS,NON-RIGID",74076,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,106.89000,101.55000,Amish/Mennonite,Amish Mennonite,,58.79,,,,,,,39.47,103.68,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,53.14000,50.48000,Amish/Mennonite,Amish Mennonite,,29.23,,,,,,,29.23,51.55,percent of total billed charges,
ORTHO WEDGE HEALING SHOE,74077,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,53.14000,50.48000,Amish/Mennonite,Amish Mennonite,,29.23,,,,,,,26.57,51.55,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,196.04000,186.24000,Amish/Mennonite,Amish Mennonite,,107.82,,,,,,,107.82,190.16,percent of total billed charges,
PNEUMATIC WALKING SPLINT,74078,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,196.04000,186.24000,Amish/Mennonite,Amish Mennonite,,107.82,,,,,,,98.02,190.16,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 3""",74079,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,2.63,6.47,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,inpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,TC,45.76,,,,,,,45.76,80.70,percent of total billed charges,
ILO-B READER TECH ONLY,7408,CDM,320,RC,76499,CPT,,,facility,outpatient,,,83.20000,79.04000,Amish/Mennonite,Amish Mennonite,TC,45.76,,,,,,,41.60,484.28,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,62.92000,59.77000,Amish/Mennonite,Amish Mennonite,,34.61,,,,,,,30.83,61.03,percent of total billed charges,
ULCER CARE STKG LINERS/BX 3,74080,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,62.92000,59.77000,Amish/Mennonite,Amish Mennonite,,34.61,,,,,,,28.88,61.03,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
HOME SHOULDER PULLEY SYSTEM,74081,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,14.40000,13.68000,Amish/Mennonite,Amish Mennonite,,7.92,,,,,,,7.92,13.97,percent of total billed charges,
UNIVERSAL WRISTLET,74083,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,14.40000,13.68000,Amish/Mennonite,Amish Mennonite,,7.92,,,,,,,7.20,13.97,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,14.65000,13.92000,Amish/Mennonite,Amish Mennonite,,8.06,,,,,,,7.18,14.21,percent of total billed charges,
POST-OP SHOE,74084,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,14.65000,13.92000,Amish/Mennonite,Amish Mennonite,,8.06,,,,,,,6.72,14.21,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
"FARROW BK SILVER LINERS,PAIR",74085,CDM,290,RC,A9270,HCPCS,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,72.00,139.68,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN 10.2FR 25CM ULTHNE HDRPH MCLC 6,74086,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,128.32,279.56,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3590.14000,3410.63000,Amish/Mennonite,Amish Mennonite,,1974.58,,,,,,,1759.17,3482.44,percent of total billed charges,
VALVE VENT ULT SM L20MM DIA11MM THK4MM POLYPR SIL ELASTMR,74087,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3590.14000,3410.63000,Amish/Mennonite,Amish Mennonite,,1974.58,,,,,,,1647.87,3590.14,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,20057.00000,19054.15000,Amish/Mennonite,Amish Mennonite,,11031.35,,,,,,,9827.93,19455.29,percent of total billed charges,
DEVICE THRMB 4MM 180CM SOLITARE 20MM SCFLD,74088,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,20057.00000,19054.15000,Amish/Mennonite,Amish Mennonite,,11031.35,,,,,,,9206.16,20057.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,74090,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA26MM IL DIA14.5MM IPSILATERAL,74091,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS4/DF1,74094,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13068.64000,12415.21000,Amish/Mennonite,Amish Mennonite,,7187.75,,,,,,,6403.63,12676.58,percent of total billed charges,
PACEMAKER CARD 22.5GM TI POLYUR SIL RUB 2 CHMBR AZRE XT,74095,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13068.64000,12415.21000,Amish/Mennonite,Amish Mennonite,,7187.75,,,,,,,5998.51,12676.58,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC 4CM J .014IN 180CM GRND SLAM,74096,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM SLIP-COAT SS,74097,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASCU STRG .014IN 300CM TRUTORQ HDRPHB,74098,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,232.37,506.25,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLMR,74099,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 300CM TRUTORQ,74100,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
NM PET NETSPOT GA 68,74101,CDM,343,RC,A9587,HCPCS,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,51.09,119.31,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,inpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.42900,0.75660,percent of total billed charges,
HYDROXYZINE PAMOATE 25 MG CAP,74102,CDM,250,RC,68084-0847-01,NDC,,,facility,outpatient,1,EA,0.78000,0.74000,Amish/Mennonite,Amish Mennonite,,0.42900,,,,,,,0.39000,0.75660,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SGL COIL ACT FIX DF-1 CONN SPRNT QUATTRO,74103,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM TRNSVEN L VENT POLYUR SI POLYIMIDE,74104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,2871.77,6256.58,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,36.18,71.62,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.032IN TAPR L8MM,74105,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,73.84000,70.15000,Amish/Mennonite,Amish Mennonite,,40.61,,,,,,,33.89,73.84,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,72.32,143.17,percent of total billed charges,
INTRO SHTH 7FR .092IN 13CM PRELUDE SNP RBST VLV,74106,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,147.60000,140.22000,Amish/Mennonite,Amish Mennonite,,81.18,,,,,,,67.75,147.60,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,Amish/Mennonite,Amish Mennonite,,3927.82,,,,,,,3499.34,6927.26,percent of total billed charges,
PACEMAKER CRD 20GM 10.4CC W50XH47MM THK6MM SGL CHMBR IS-1,74107,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,Amish/Mennonite,Amish Mennonite,,3927.82,,,,,,,3277.95,6927.26,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,9004.50000,8554.27000,Amish/Mennonite,Amish Mennonite,,4952.48,,,,,,,4412.20,8734.36,percent of total billed charges,
PACEMAKER CARD 20GM 10.4CC W50XH47MM THK6MM 2 CHMBR IS-1.,74108,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,9004.50000,8554.27000,Amish/Mennonite,Amish Mennonite,,4952.48,,,,,,,4133.07,8734.36,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,inpatient,1,mL,971.25000,922.69000,Amish/Mennonite,Amish Mennonite,,534.19,,,,,,,534.19,942.11,percent of total billed charges,
HYALURONAN SOLN 22 MG/ML 4ML (MONOVISC),74113,CDM,636,RC,J7327,HCPCS,59676082001,NDC,facility,outpatient,1,mL,971.25000,922.69000,Amish/Mennonite,Amish Mennonite,,534.19,,,,,,,485.62,1101.64,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,486.94,963.94,percent of total billed charges,
RESERVOIR DRN 7CM PHNX NEURO STRL LF DISP,74116,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,456.13,993.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM PT2 NTNL SS,74117,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,45.28,89.63,percent of total billed charges,
SHTH INTRO BRITE TP 6FR 23CM,74118,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,42.41,92.40,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA6MM CATH ID0.035IN LOOP 7.4 PERIPH,74120,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA8MM CATH ID0.035IN LOOP 5.6 PERIPH,74121,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 90CM,74122,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATH CXI STR .035 4FR 135CM,74123,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
PRB CRYO ICESPHERE 1.5 CX90 DE,74124,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,inpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,43.45,76.63,percent of total billed charges,
"OT COGNITIVE FUNCTION TRAINING, INTL 15 MIN",74125,CDM,430,RC,97129,CPT,,,facility,outpatient,,,79.00000,75.05000,Amish/Mennonite,Amish Mennonite,,43.45,,,,,,,39.50,264.00,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,42.20000,40.09000,Amish/Mennonite,Amish Mennonite,,23.21,,,,,,,20.68,40.93,percent of total billed charges,
GUIDEWIRE VASC 180CM 1.5MM RDS J CRV RSN TPR,74126,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,42.20000,40.09000,Amish/Mennonite,Amish Mennonite,,23.21,,,,,,,19.37,42.20,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 300CM APRCH CTO,74127,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,231.49,504.34,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,inpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,,314.05,,,,,,,314.05,553.87,percent of total billed charges,
RADIOPHARM TX BY INTRAARTER-TECH,74128,CDM,340,RC,79445,CPT,,,facility,outpatient,,,571.00000,542.45000,Amish/Mennonite,Amish Mennonite,,314.05,,,,,,,212.82,1232.72,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,inpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,41.25,72.75,percent of total billed charges,
"COGNITIVE FUNCTION TRAINING, ADDL 15 MIN-TECH",74136,CDM,430,RC,97130,CPT,,,facility,outpatient,,,75.00000,71.25000,Amish/Mennonite,Amish Mennonite,,41.25,,,,,,,37.50,264.00,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,inpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
ANALYSIS IMPL  NEUROST 1ST 15 MN-TECH,74137,CDM,920,RC,95983,CPT,,,facility,outpatient,,,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,77.50,150.35,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
ALCOHOL/SUBS ABUSE 15-30 MIN-TECH,74138,CDM,510,RC,99408,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,33.95,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,inpatient,,,533.00000,506.35000,Amish/Mennonite,Amish Mennonite,,293.15,,,,,,,293.15,517.01,percent of total billed charges,
ABLATN INF TURBINATES INTRAMUR-TECH,74139,CDM,510,RC,30802,CPT,,,facility,outpatient,,,533.00000,506.35000,Amish/Mennonite,Amish Mennonite,,293.15,,,,,,,266.50,1547.18,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
ANALY-NEUROST COMPLEX W/G-TECH,74140,CDM,920,RC,95972,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,inpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,,64.35,,,,,,,64.35,113.49,percent of total billed charges,
APP FGR SPLINT STATIC-TECH,74141,CDM,510,RC,29130,CPT,,,facility,outpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,,64.35,,,,,,,58.50,134.64,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,inpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,,150.70,,,,,,,150.70,265.78,percent of total billed charges,
APPLICATION OF LONG ARM CAST-TECH,74142,CDM,510,RC,29065,CPT,,,facility,outpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,,150.70,,,,,,,137.00,277.40,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,113.85,200.79,percent of total billed charges,
APP SHORT LEG SPLINT-TECH,74143,CDM,510,RC,29515,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,103.50,200.79,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,144.65,255.11,percent of total billed charges,
APPL SK GRF TO 100 SQ CM <25-TECH,74144,CDM,510,RC,15271,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,131.50,1910.62,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY OF PALATE-TECH,74145,CDM,510,RC,42100,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,141.50,1547.18,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,inpatient,,,491.00000,466.45000,Amish/Mennonite,Amish Mennonite,,270.05,,,,,,,270.05,476.27,percent of total billed charges,
BIOPSY EYELID & LID MARGIN-TECH,74146,CDM,510,RC,67810,CPT,,,facility,outpatient,,,491.00000,466.45000,Amish/Mennonite,Amish Mennonite,,270.05,,,,,,,245.50,476.27,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
APP LONG LEG SPLINT-TECH,74147,CDM,510,RC,29505,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,231.83,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,154.55,272.57,percent of total billed charges,
APPL SK GRF <100 SQ CM 1ST 100-TECH,74148,CDM,510,RC,15275,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,140.50,1910.62,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,inpatient,,,358.00000,340.10000,Amish/Mennonite,Amish Mennonite,,196.90,,,,,,,196.90,347.26,percent of total billed charges,
BIOPSY VESTIBULE OF MOUTH-TECH,74150,CDM,510,RC,40808,CPT,,,facility,outpatient,,,358.00000,340.10000,Amish/Mennonite,Amish Mennonite,,196.90,,,,,,,179.00,531.90,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,inpatient,,,724.00000,687.80000,Amish/Mennonite,Amish Mennonite,,398.20,,,,,,,398.20,702.28,percent of total billed charges,
BIOPSY SFT TISSUE LEG/ANK SPRF-TECH,74151,CDM,510,RC,27613,CPT,,,facility,outpatient,,,724.00000,687.80000,Amish/Mennonite,Amish Mennonite,,398.20,,,,,,,362.00,1692.33,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,inpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,95.15,167.81,percent of total billed charges,
ARTIFICIAL INSEM INTRA-UTERINE-TECH,74152,CDM,510,RC,58322,CPT,,,facility,outpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,86.50,210.12,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,155.65,274.51,percent of total billed charges,
BIOPSY FAT PAD-TECH,74153,CDM,510,RC,17999,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,141.50,274.51,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,inpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,164.45,290.03,percent of total billed charges,
BLADDER INSTIL-ANTICARCIN AGNT-TECH,74154,CDM,510,RC,51720,CPT,,,facility,outpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,149.50,697.17,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
APPL SK GRF ADL-TECH,74155,CDM,510,RC,15272,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,25.50,49.47,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,inpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,130.90,230.86,percent of total billed charges,
BIOPSY OF LIP-TECH,74156,CDM,510,RC,40490,CPT,,,facility,outpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,119.00,242.55,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,inpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,,258.50,,,,,,,258.50,455.90,percent of total billed charges,
BONE MARROW ASPIRATION-TECH,74157,CDM,510,RC,38220,CPT,,,facility,outpatient,,,470.00000,446.50000,Amish/Mennonite,Amish Mennonite,,258.50,,,,,,,235.00,1692.33,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,inpatient,,,632.00000,600.40000,Amish/Mennonite,Amish Mennonite,,347.60,,,,,,,347.60,613.04,percent of total billed charges,
BREAST BIOPSY INCISIONAL -TECH,74158,CDM,510,RC,19101,CPT,,,facility,outpatient,,,632.00000,600.40000,Amish/Mennonite,Amish Mennonite,,347.60,,,,,,,316.00,3999.66,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,inpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,408.37,percent of total billed charges,
BIOPSY PROSTRATE NEEDLE/PUNCH-TECH,74159,CDM,510,RC,55700,CPT,,,facility,outpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,210.50,2139.65,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,inpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,37.95,66.93,percent of total billed charges,
ANALY-NEUROST W/O REPROGRAM-TECH,74160,CDM,920,RC,95970,CPT,,,facility,outpatient,,,69.00000,65.55000,Amish/Mennonite,Amish Mennonite,,37.95,,,,,,,34.50,134.64,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,inpatient,,,773.00000,734.35000,Amish/Mennonite,Amish Mennonite,,425.15,,,,,,,425.15,749.81,percent of total billed charges,
BX SFT TISS THIGH/KNEE SUPFCL-TECH,74161,CDM,510,RC,27323,CPT,,,facility,outpatient,,,773.00000,734.35000,Amish/Mennonite,Amish Mennonite,,425.15,,,,,,,386.50,1692.33,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,inpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,,405.35,,,,,,,405.35,714.89,percent of total billed charges,
BX SOFT TISS BACK/FLANK SUPFCL-TECH,74162,CDM,510,RC,21920,CPT,,,facility,outpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,,405.35,,,,,,,368.50,1692.33,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,inpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,,98.45,,,,,,,98.45,173.63,percent of total billed charges,
BIOPSY VAGINAL MUCOSA SMPL-TECH,74163,CDM,510,RC,57100,CPT,,,facility,outpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,,98.45,,,,,,,89.50,909.48,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,inpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,,540.65,,,,,,,540.65,953.51,percent of total billed charges,
BX SUPFCL PEL/HIP-TECH,74164,CDM,510,RC,27040,CPT,,,facility,outpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,,540.65,,,,,,,491.50,1692.33,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,41.80,73.72,percent of total billed charges,
BX VULVA/PERINEUM ADD LESN-TECH,74165,CDM,510,RC,56606,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,38.00,73.72,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,163.90,289.06,percent of total billed charges,
BIOPSY OROPHARYNX-TECH,74166,CDM,510,RC,42800,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,149.00,1547.18,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,inpatient,,,316.00000,300.20000,Amish/Mennonite,Amish Mennonite,,173.80,,,,,,,173.80,306.52,percent of total billed charges,
BX TONGUE ANTERIOR TWO-THIRDS-TECH,74167,CDM,510,RC,41100,CPT,,,facility,outpatient,,,316.00000,300.20000,Amish/Mennonite,Amish Mennonite,,173.80,,,,,,,158.00,531.90,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
BX VULVA/PERINEUM 1 LESN-TECH,74168,CDM,510,RC,56605,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,83.00,909.48,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,inpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,,193.60,,,,,,,193.60,341.44,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE COMPLIC-TECH,74169,CDM,510,RC,51710,CPT,,,facility,outpatient,,,352.00000,334.40000,Amish/Mennonite,Amish Mennonite,,193.60,,,,,,,176.00,697.17,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,inpatient,,,389.00000,369.55000,Amish/Mennonite,Amish Mennonite,,213.95,,,,,,,213.95,377.33,percent of total billed charges,
APP LONG LEG CAST-TECH,74170,CDM,510,RC,29345,CPT,,,facility,outpatient,,,389.00000,369.55000,Amish/Mennonite,Amish Mennonite,,213.95,,,,,,,194.50,377.33,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
CANALITH REPOSITIONING-TECH,74171,CDM,510,RC,95992,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,136.95,241.53,percent of total billed charges,
CHANGE CYSTOSTOMY TUBE SIMPLE-TECH,74172,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,124.50,254.03,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,inpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,201.85,355.99,percent of total billed charges,
CHEMODENERV NECK MUSCLE -TECH,74173,CDM,510,RC,64616,CPT,,,facility,outpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,183.50,355.99,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,inpatient,,,418.00000,397.10000,Amish/Mennonite,Amish Mennonite,,229.90,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV ONE EXTR 1-4 MUSCL-TECH,74174,CDM,510,RC,64642,CPT,,,facility,outpatient,,,418.00000,397.10000,Amish/Mennonite,Amish Mennonite,,229.90,,,,,,,209.00,723.34,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,151.25,266.75,percent of total billed charges,
CHEMODENERV 1-4 ADL-TECH,74175,CDM,510,RC,64643,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,137.50,266.75,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,inpatient,,,443.00000,420.85000,Amish/Mennonite,Amish Mennonite,,243.65,,,,,,,243.65,429.71,percent of total billed charges,
CHEMODENERV TRUNK MUSC 1-5 MUS -TECH,74176,CDM,510,RC,64646,CPT,,,facility,outpatient,,,443.00000,420.85000,Amish/Mennonite,Amish Mennonite,,243.65,,,,,,,221.50,723.34,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,inpatient,,,341.00000,323.95000,Amish/Mennonite,Amish Mennonite,,187.55,,,,,,,187.55,330.77,percent of total billed charges,
CHEMODENERV PAROTID/SUBMAN GL-TECH,74177,CDM,510,RC,64611,CPT,,,facility,outpatient,,,341.00000,323.95000,Amish/Mennonite,Amish Mennonite,,187.55,,,,,,,170.50,330.77,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,inpatient,,,418.00000,397.10000,Amish/Mennonite,Amish Mennonite,,229.90,,,,,,,229.90,405.46,percent of total billed charges,
CHEMODENERV MSCL INNERVATED BI -TECH,74178,CDM,510,RC,64615,CPT,,,facility,outpatient,,,418.00000,397.10000,Amish/Mennonite,Amish Mennonite,,229.90,,,,,,,209.00,405.46,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,inpatient,,,951.00000,903.45000,Amish/Mennonite,Amish Mennonite,,523.05,,,,,,,523.05,922.47,percent of total billed charges,
CLSD TX BIMALOR ANK WO MANIP-TECH,74179,CDM,510,RC,27808,CPT,,,facility,outpatient,,,951.00000,903.45000,Amish/Mennonite,Amish Mennonite,,523.05,,,,,,,227.78,922.47,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,inpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,594.00,1047.60,percent of total billed charges,
CLSD TX CONDYL FX WO MANIP-TECH,74180,CDM,510,RC,24530,CPT,,,facility,outpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,227.78,1047.60,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,inpatient,,,622.00000,590.90000,Amish/Mennonite,Amish Mennonite,,342.10,,,,,,,342.10,603.34,percent of total billed charges,
CLSD TX CLAV FX WO MANIP-TECH,74181,CDM,510,RC,23500,CPT,,,facility,outpatient,,,622.00000,590.90000,Amish/Mennonite,Amish Mennonite,,342.10,,,,,,,227.78,603.34,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,inpatient,,,932.00000,885.40000,Amish/Mennonite,Amish Mennonite,,512.60,,,,,,,512.60,904.04,percent of total billed charges,
CLSD TX DIST RADL FX WO MANIP-TECH,74182,CDM,510,RC,25600,CPT,,,facility,outpatient,,,932.00000,885.40000,Amish/Mennonite,Amish Mennonite,,512.60,,,,,,,227.78,904.04,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,288.20,508.28,percent of total billed charges,
CLSD TX DIST PHAL WO MANIP EA-TECH,74183,CDM,510,RC,26750,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,227.78,508.28,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,inpatient,,,1550.00000,1472.50000,Amish/Mennonite,Amish Mennonite,,852.50,,,,,,,852.50,1503.50,percent of total billed charges,
CLSD TX DIST RADL FX W MANIP-TECH,74184,CDM,510,RC,25605,CPT,,,facility,outpatient,,,1550.00000,1472.50000,Amish/Mennonite,Amish Mennonite,,852.50,,,,,,,775.00,1671.62,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,inpatient,,,1494.00000,1419.30000,Amish/Mennonite,Amish Mennonite,,821.70,,,,,,,821.70,1449.18,percent of total billed charges,
CLSD TX FEM FX DIST WO MANIP-TECH,74185,CDM,510,RC,27508,CPT,,,facility,outpatient,,,1494.00000,1419.30000,Amish/Mennonite,Amish Mennonite,,821.70,,,,,,,227.78,1449.18,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,inpatient,,,866.00000,822.70000,Amish/Mennonite,Amish Mennonite,,476.30,,,,,,,476.30,840.02,percent of total billed charges,
CLSD TX CARP BN FX WO MANIP-TECH,74186,CDM,510,RC,25630,CPT,,,facility,outpatient,,,866.00000,822.70000,Amish/Mennonite,Amish Mennonite,,476.30,,,,,,,227.78,840.02,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,inpatient,,,419.00000,398.05000,Amish/Mennonite,Amish Mennonite,,230.45,,,,,,,230.45,406.43,percent of total billed charges,
CLSD TX GRT TOE FX WO MANIP-TECH,74187,CDM,510,RC,28490,CPT,,,facility,outpatient,,,419.00000,398.05000,Amish/Mennonite,Amish Mennonite,,230.45,,,,,,,209.50,406.43,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,inpatient,,,1476.00000,1402.20000,Amish/Mennonite,Amish Mennonite,,811.80,,,,,,,811.80,1431.72,percent of total billed charges,
CLSD TX FEMORAL SHAFT WO MANIP-TECH,74188,CDM,510,RC,27500,CPT,,,facility,outpatient,,,1476.00000,1402.20000,Amish/Mennonite,Amish Mennonite,,811.80,,,,,,,227.78,1431.72,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,inpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,,430.10,,,,,,,430.10,758.54,percent of total billed charges,
CLSD TX FGR DISLOC WO ANES-TECH,74189,CDM,510,RC,26770,CPT,,,facility,outpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,,430.10,,,,,,,227.78,758.54,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,inpatient,,,1017.00000,966.15000,Amish/Mennonite,Amish Mennonite,,559.35,,,,,,,559.35,986.49,percent of total billed charges,
CLSD TX HUM SHAFT FX WO MANIP-TECH,74190,CDM,510,RC,24500,CPT,,,facility,outpatient,,,1017.00000,966.15000,Amish/Mennonite,Amish Mennonite,,559.35,,,,,,,227.78,986.49,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,inpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX HUM EPICNDY WO MANIP-TECH,74191,CDM,510,RC,24560,CPT,,,facility,outpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,227.78,882.70,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,inpatient,,,912.00000,866.40000,Amish/Mennonite,Amish Mennonite,,501.60,,,,,,,501.60,884.64,percent of total billed charges,
CLSD TX MTCRPL FX W MANIP-TECH,74192,CDM,510,RC,26605,CPT,,,facility,outpatient,,,912.00000,866.40000,Amish/Mennonite,Amish Mennonite,,501.60,,,,,,,227.78,884.64,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,inpatient,,,872.00000,828.40000,Amish/Mennonite,Amish Mennonite,,479.60,,,,,,,479.60,845.84,percent of total billed charges,
CLSD TX PROX FIB WO MANIP-TECH,74193,CDM,510,RC,27780,CPT,,,facility,outpatient,,,872.00000,828.40000,Amish/Mennonite,Amish Mennonite,,479.60,,,,,,,227.78,845.84,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,inpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,,309.65,,,,,,,309.65,546.11,percent of total billed charges,
CLSD TX PHAL SHAFT FX WO MANIP-TECH,74194,CDM,510,RC,26720,CPT,,,facility,outpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,,309.65,,,,,,,227.78,546.11,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,inpatient,,,927.00000,880.65000,Amish/Mennonite,Amish Mennonite,,509.85,,,,,,,509.85,899.19,percent of total billed charges,
CLSD TX PROX HUM FX WO MANIP-TECH,74195,CDM,510,RC,23600,CPT,,,facility,outpatient,,,927.00000,880.65000,Amish/Mennonite,Amish Mennonite,,509.85,,,,,,,227.78,899.19,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,inpatient,,,743.00000,705.85000,Amish/Mennonite,Amish Mennonite,,408.65,,,,,,,408.65,720.71,percent of total billed charges,
CLSD TX RADL HD/NK FX WO MANIP-TECH,74196,CDM,510,RC,24650,CPT,,,facility,outpatient,,,743.00000,705.85000,Amish/Mennonite,Amish Mennonite,,408.65,,,,,,,227.78,720.71,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,inpatient,,,789.00000,749.55000,Amish/Mennonite,Amish Mennonite,,433.95,,,,,,,433.95,765.33,percent of total billed charges,
CLSD TX RADL ULNAR FX WO MANIP-TECH,74197,CDM,510,RC,25560,CPT,,,facility,outpatient,,,789.00000,749.55000,Amish/Mennonite,Amish Mennonite,,433.95,,,,,,,227.78,765.33,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CLSD TX ULNAR SHAFT WO MANIP-TECH,74198,CDM,510,RC,25530,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,227.78,722.65,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,inpatient,,,985.00000,935.75000,Amish/Mennonite,Amish Mennonite,,541.75,,,,,,,541.75,955.45,percent of total billed charges,
CLSD TX TIB SHAFT FX WO MANIP-TECH,74199,CDM,510,RC,27750,CPT,,,facility,outpatient,,,985.00000,935.75000,Amish/Mennonite,Amish Mennonite,,541.75,,,,,,,227.78,955.45,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,inpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,500.50,882.70,percent of total billed charges,
CLSD TX ULNAR STYLOID FX-TECH,74200,CDM,510,RC,25650,CPT,,,facility,outpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,227.78,882.70,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,inpatient,,,424.00000,402.80000,Amish/Mennonite,Amish Mennonite,,233.20,,,,,,,233.20,411.28,percent of total billed charges,
CLSR LACRIM PUNCTUM BY PLUG EA-TECH,74201,CDM,510,RC,68761,CPT,,,facility,outpatient,,,424.00000,402.80000,Amish/Mennonite,Amish Mennonite,,233.20,,,,,,,212.00,411.28,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,90.20,159.08,percent of total billed charges,
ANALYSIS NEUROST COMPLEX W/PROG-TECH,74202,CDM,920,RC,95977,CPT,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,82.00,159.08,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,inpatient,,,800.00000,760.00000,Amish/Mennonite,Amish Mennonite,,440.00,,,,,,,440.00,776.00,percent of total billed charges,
CLTX POST MALLEOL FX WO MANIP-TECH,74203,CDM,510,RC,27767,CPT,,,facility,outpatient,,,800.00000,760.00000,Amish/Mennonite,Amish Mennonite,,440.00,,,,,,,227.78,776.00,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,inpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,,317.35,,,,,,,317.35,559.69,percent of total billed charges,
CLSR OF LACRIMAL PUNCTUM -TECH,74204,CDM,510,RC,68760,CPT,,,facility,outpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,,317.35,,,,,,,283.85,559.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,inpatient,,,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,,427.35,,,,,,,427.35,753.69,percent of total billed charges,
CLSD TX RADL SHAFT FX WO MANIP-TECH,74205,CDM,510,RC,25500,CPT,,,facility,outpatient,,,777.00000,738.15000,Amish/Mennonite,Amish Mennonite,,427.35,,,,,,,227.78,753.69,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
COLPOSCOPY CERVIX W BX-TECH,74206,CDM,510,RC,57455,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,144.00,317.72,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,inpatient,,,644.00000,611.80000,Amish/Mennonite,Amish Mennonite,,354.20,,,,,,,354.20,624.68,percent of total billed charges,
COLPOSCOPY CERVIX W LOOP CONIZ-TECH,74207,CDM,510,RC,57461,CPT,,,facility,outpatient,,,644.00000,611.80000,Amish/Mennonite,Amish Mennonite,,354.20,,,,,,,322.00,3321.00,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
COLPOSCOPY CERVIX UPR/ADJ VAG-TECH,74208,CDM,510,RC,57452,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,213.40,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,124.30,219.22,percent of total billed charges,
COLPOSCOPY VULVA-TECH,74209,CDM,510,RC,56820,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,113.00,219.22,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
CORRECT TRICHIASIS EPIL FORCEP-TECH,74210,CDM,510,RC,67820,CPT,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,72.00,139.68,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,inpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,113.30,199.82,percent of total billed charges,
CURETTAGE ENDOCERVICAL-TECH,74211,CDM,510,RC,57505,CPT,,,facility,outpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,103.00,909.48,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,inpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,,409.20,,,,,,,409.20,721.68,percent of total billed charges,
CYSTOSCOPY W/CAL/DIL URETH STR-TECH,74212,CDM,510,RC,52281,CPT,,,facility,outpatient,,,744.00000,706.80000,Amish/Mennonite,Amish Mennonite,,409.20,,,,,,,372.00,2139.65,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,inpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,,365.75,,,,,,,365.75,645.05,percent of total billed charges,
CYSTOSCOPY W/FB REMOVAL-TECH,74213,CDM,510,RC,52310,CPT,,,facility,outpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,,365.75,,,,,,,332.50,2139.65,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,inpatient,,,630.00000,598.50000,Amish/Mennonite,Amish Mennonite,,346.50,,,,,,,346.50,611.10,percent of total billed charges,
CLSD TX METATARSAL FX WO MANIP-TECH,74214,CDM,510,RC,28470,CPT,,,facility,outpatient,,,630.00000,598.50000,Amish/Mennonite,Amish Mennonite,,346.50,,,,,,,227.78,611.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,inpatient,,,1130.00000,1073.50000,Amish/Mennonite,Amish Mennonite,,621.50,,,,,,,621.50,1096.10,percent of total billed charges,
CYSTOSCOPY-REMVL FB-COMPLICATD-TECH,74215,CDM,510,RC,52315,CPT,,,facility,outpatient,,,1130.00000,1073.50000,Amish/Mennonite,Amish Mennonite,,621.50,,,,,,,565.00,2139.65,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,inpatient,,,317.00000,301.15000,Amish/Mennonite,Amish Mennonite,,174.35,,,,,,,174.35,307.49,percent of total billed charges,
COLPOSCOPY ENTIRE VAG CX W BX-TECH,74216,CDM,510,RC,57421,CPT,,,facility,outpatient,,,317.00000,301.15000,Amish/Mennonite,Amish Mennonite,,174.35,,,,,,,158.50,909.48,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,inpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,32.45,57.23,percent of total billed charges,
CA SCREEN;PELVIC/BREAST EXAM-TECH,74217,CDM,510,RC,G0101,HCPCS,,,facility,outpatient,,,59.00000,56.05000,Amish/Mennonite,Amish Mennonite,,32.45,,,,,,,29.50,96.61,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,inpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,113.30,199.82,percent of total billed charges,
DBRD MASTOIDECTOMY SIMPLE-TECH,74218,CDM,510,RC,69220,CPT,,,facility,outpatient,,,206.00000,195.70000,Amish/Mennonite,Amish Mennonite,,113.30,,,,,,,103.00,207.54,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,inpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,,150.70,,,,,,,150.70,265.78,percent of total billed charges,
DEST LESN PENIS SMPL CRYOSURG-TECH,74219,CDM,510,RC,54056,CPT,,,facility,outpatient,,,274.00000,260.30000,Amish/Mennonite,Amish Mennonite,,150.70,,,,,,,137.00,265.78,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,inpatient,,,409.00000,388.55000,Amish/Mennonite,Amish Mennonite,,224.95,,,,,,,224.95,396.73,percent of total billed charges,
DBRD MASTOIDECTOMY COMPLEX-TECH,74220,CDM,510,RC,69222,CPT,,,facility,outpatient,,,409.00000,388.55000,Amish/Mennonite,Amish Mennonite,,224.95,,,,,,,204.50,531.90,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,inpatient,,,531.00000,504.45000,Amish/Mennonite,Amish Mennonite,,292.05,,,,,,,292.05,515.07,percent of total billed charges,
CONIZATION CX EXCISN LOOP ELEC-TECH,74221,CDM,510,RC,57522,CPT,,,facility,outpatient,,,531.00000,504.45000,Amish/Mennonite,Amish Mennonite,,292.05,,,,,,,265.50,3321.00,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,inpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,248.05,437.47,percent of total billed charges,
DESTR OF LESION CONJUNCTIVA -TECH,74222,CDM,510,RC,68135,CPT,,,facility,outpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,225.50,2436.76,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,inpatient,,,381.00000,361.95000,Amish/Mennonite,Amish Mennonite,,209.55,,,,,,,209.55,369.57,percent of total billed charges,
DESTRUC MAL LES -TECH,74223,CDM,510,RC,17282,CPT,,,facility,outpatient,,,381.00000,361.95000,Amish/Mennonite,Amish Mennonite,,209.55,,,,,,,188.67,369.57,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,inpatient,,,613.00000,582.35000,Amish/Mennonite,Amish Mennonite,,337.15,,,,,,,337.15,594.61,percent of total billed charges,
DESTRUCTION-LESION LID MARGIN -TECH,74225,CDM,510,RC,67850,CPT,,,facility,outpatient,,,613.00000,582.35000,Amish/Mennonite,Amish Mennonite,,337.15,,,,,,,306.50,1011.64,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,inpatient,,,422.00000,400.90000,Amish/Mennonite,Amish Mennonite,,232.10,,,,,,,232.10,409.34,percent of total billed charges,
DESTR LES PENIS EXTENSIVE -TECH,74226,CDM,510,RC,54065,CPT,,,facility,outpatient,,,422.00000,400.90000,Amish/Mennonite,Amish Mennonite,,232.10,,,,,,,211.00,1910.62,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,521.95,920.53,percent of total billed charges,
DISC SECNDRY MEMB CATARACT LSR-TECH,74227,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,474.50,920.53,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,inpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,,144.10,,,,,,,144.10,254.14,percent of total billed charges,
DEST MLG LESN FEEYNLMM <=0.5CM-TECH,74228,CDM,510,RC,17280,CPT,,,facility,outpatient,,,262.00000,248.90000,Amish/Mennonite,Amish Mennonite,,144.10,,,,,,,131.00,254.14,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,inpatient,,,456.00000,433.20000,Amish/Mennonite,Amish Mennonite,,250.80,,,,,,,250.80,442.32,percent of total billed charges,
DESTRUC MAL LES 2.1 TO 3.0CM -TECH,74229,CDM,510,RC,17283,CPT,,,facility,outpatient,,,456.00000,433.20000,Amish/Mennonite,Amish Mennonite,,250.80,,,,,,,228.00,442.32,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,inpatient,,,559.00000,531.05000,Amish/Mennonite,Amish Mennonite,,307.45,,,,,,,307.45,542.23,percent of total billed charges,
BIOPSY SALIVARY GLAND INCISION-TECH,74230,CDM,510,RC,42405,CPT,,,facility,outpatient,,,559.00000,531.05000,Amish/Mennonite,Amish Mennonite,,307.45,,,,,,,279.50,1547.18,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,inpatient,,,405.00000,384.75000,Amish/Mennonite,Amish Mennonite,,222.75,,,,,,,222.75,392.85,percent of total billed charges,
EPISTAXIS CONTROL ANTERIOR PAK-TECH,74231,CDM,510,RC,30903,CPT,,,facility,outpatient,,,405.00000,384.75000,Amish/Mennonite,Amish Mennonite,,222.75,,,,,,,122.40,392.85,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
DOCS PRO-PLUG-TECH,74232,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,297.55,524.77,percent of total billed charges,
DRAIN ABSC EXTERNAL EAR SIMPLE-TECH,74234,CDM,510,RC,69000,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,270.50,734.90,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,inpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,215.05,379.27,percent of total billed charges,
CHEMODERNERV FACIAL NERVE MUSC -TECH,74235,CDM,510,RC,64612,CPT,,,facility,outpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,195.50,379.27,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,inpatient,,,552.00000,524.40000,Amish/Mennonite,Amish Mennonite,,303.60,,,,,,,303.60,535.44,percent of total billed charges,
EXC LES VESTIBUL MOUTH SMP RPR-TECH,74237,CDM,510,RC,40812,CPT,,,facility,outpatient,,,552.00000,524.40000,Amish/Mennonite,Amish Mennonite,,303.60,,,,,,,276.00,1547.18,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,inpatient,,,359.00000,341.05000,Amish/Mennonite,Amish Mennonite,,197.45,,,,,,,197.45,348.23,percent of total billed charges,
EXC MALIG LESION T A L 0.5 CM OR LESS-TECH,74238,CDM,510,RC,11600,CPT,,,facility,outpatient,,,359.00000,341.05000,Amish/Mennonite,Amish Mennonite,,197.45,,,,,,,179.50,734.90,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,inpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,,546.15,,,,,,,546.15,963.21,percent of total billed charges,
EXC TMR SFT TISS-FC/SCL <2CM-TECH,74239,CDM,361,RC,21011,CPT,,,facility,outpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,,546.15,,,,,,,546.15,4686.00,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,inpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,,1113.20,,,,,,,1113.20,1963.28,percent of total billed charges,
ENDOMETRIAL ABLATION THERMAL-TECH,74240,CDM,510,RC,58353,CPT,,,facility,outpatient,,,2024.00000,1922.80000,Amish/Mennonite,Amish Mennonite,,1113.20,,,,,,,1012.00,5156.10,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,inpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,,459.25,,,,,,,459.25,809.95,percent of total billed charges,
CLSD TX MTCRPL FX WO MANIP-TECH,74241,CDM,510,RC,26600,CPT,,,facility,outpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,,459.25,,,,,,,227.78,809.95,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,inpatient,,,914.00000,868.30000,Amish/Mennonite,Amish Mennonite,,502.70,,,,,,,502.70,886.58,percent of total billed charges,
EXN BRST LESN OPEN >=1 LESN-TECH,74242,CDM,510,RC,19120,CPT,,,facility,outpatient,,,914.00000,868.30000,Amish/Mennonite,Amish Mennonite,,502.70,,,,,,,457.00,3999.66,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,inpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,212.85,375.39,percent of total billed charges,
EXN OF VAGINAL CYST/TUMOR-TECH,74243,CDM,510,RC,57135,CPT,,,facility,outpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,193.50,3321.00,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,inpatient,,,1333.00000,1266.35000,Amish/Mennonite,Amish Mennonite,,733.15,,,,,,,733.15,1293.01,percent of total billed charges,
EXN TMR PELV/HIP SUBQ >=3CM-TECH,74244,CDM,510,RC,27043,CPT,,,facility,outpatient,,,1333.00000,1266.35000,Amish/Mennonite,Amish Mennonite,,733.15,,,,,,,666.50,2989.39,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,inpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,154.55,272.57,percent of total billed charges,
DEST MLG LESN S/N/EXTR <=0.5CM-TECH,74245,CDM,510,RC,17270,CPT,,,facility,outpatient,,,281.00000,266.95000,Amish/Mennonite,Amish Mennonite,,154.55,,,,,,,140.50,272.57,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
FITTING DIAPHRAGM/CERV CAP-TECH,74246,CDM,510,RC,57170,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,210.12,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,inpatient,,,1611.00000,1530.45000,Amish/Mennonite,Amish Mennonite,,886.05,,,,,,,886.05,1562.67,percent of total billed charges,
EXC DESTR INTRANAS LES INTERNL-TECH,74247,CDM,510,RC,30117,CPT,,,facility,outpatient,,,1611.00000,1530.45000,Amish/Mennonite,Amish Mennonite,,886.05,,,,,,,805.50,3387.36,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
BIOPSY TANGENTIAL EA ADD LESION-TECH,74248,CDM,510,RC,11103,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,inpatient,,,607.00000,576.65000,Amish/Mennonite,Amish Mennonite,,333.85,,,,,,,333.85,588.79,percent of total billed charges,
FRENECTOMY IN DENTULOUS MAXILL-TECH,74249,CDM,510,RC,40819,CPT,,,facility,outpatient,,,607.00000,576.65000,Amish/Mennonite,Amish Mennonite,,333.85,,,,,,,303.50,1547.18,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,inpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,271.15,478.21,percent of total billed charges,
HEMORRHOIDECTOMY INTERNAL-TECH,74250,CDM,510,RC,46221,CPT,,,facility,outpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,246.50,952.28,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,22.37000,21.25000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,12.30,21.70,percent of total billed charges,
FAMILY CONF PT ABS LVL 1 CLIN-TECH,74251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,22.37000,21.25000,Amish/Mennonite,Amish Mennonite,,12.30,,,,,,,11.19,21.70,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,inpatient,,,426.00000,404.70000,Amish/Mennonite,Amish Mennonite,,234.30,,,,,,,234.30,413.22,percent of total billed charges,
EXN MLG+MARG TR/LIMB 0.6-1CM-TECH,74253,CDM,510,RC,11601,CPT,,,facility,outpatient,,,426.00000,404.70000,Amish/Mennonite,Amish Mennonite,,234.30,,,,,,,213.00,734.90,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,inpatient,,,727.00000,690.65000,Amish/Mennonite,Amish Mennonite,,399.85,,,,,,,399.85,705.19,percent of total billed charges,
BX SFT TISS FOREARM/WRST SPRF-TECH,74254,CDM,510,RC,25065,CPT,,,facility,outpatient,,,727.00000,690.65000,Amish/Mennonite,Amish Mennonite,,399.85,,,,,,,363.50,1692.33,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,inpatient,,,1005.00000,954.75000,Amish/Mennonite,Amish Mennonite,,552.75,,,,,,,552.75,974.85,percent of total billed charges,
CYSTOURETHROSCOPY WITH BIOPSY-TECH,74255,CDM,510,RC,52204,CPT,,,facility,outpatient,,,1005.00000,954.75000,Amish/Mennonite,Amish Mennonite,,552.75,,,,,,,502.50,2139.65,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,124.30,219.22,percent of total billed charges,
FX NASAL INF TURBINATE THERAP-TECH,74256,CDM,510,RC,30930,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,113.00,3387.36,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
EXCISION CHALAZION SINGLE-TECH,74259,CDM,510,RC,67800,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,183.00,355.02,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,Amish/Mennonite,Amish Mennonite,TC,5456.00,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W/WO CONTRAST,7426,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,Amish/Mennonite,Amish Mennonite,TC,5456.00,,,,,,,484.28,9622.40,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,inpatient,,,389.00000,369.55000,Amish/Mennonite,Amish Mennonite,,213.95,,,,,,,213.95,377.33,percent of total billed charges,
INCISION OF LINGUAL FRENUM-TECH,74260,CDM,510,RC,41010,CPT,,,facility,outpatient,,,389.00000,369.55000,Amish/Mennonite,Amish Mennonite,,213.95,,,,,,,194.50,1547.18,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,inpatient,,,1199.00000,1139.05000,Amish/Mennonite,Amish Mennonite,,659.45,,,,,,,659.45,1163.03,percent of total billed charges,
CL TRT DIST FIB FX W/MANIP-TECH,74261,CDM,510,RC,27788,CPT,,,facility,outpatient,,,1199.00000,1139.05000,Amish/Mennonite,Amish Mennonite,,659.45,,,,,,,227.78,1163.03,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,inpatient,,,1657.00000,1574.15000,Amish/Mennonite,Amish Mennonite,,911.35,,,,,,,911.35,1607.29,percent of total billed charges,
EXPL PENETR WOUND EXTREMITY-TECH,74262,CDM,510,RC,20103,CPT,,,facility,outpatient,,,1657.00000,1574.15000,Amish/Mennonite,Amish Mennonite,,911.35,,,,,,,828.50,1692.33,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,inpatient,,,864.00000,820.80000,Amish/Mennonite,Amish Mennonite,,475.20,,,,,,,475.20,838.08,percent of total billed charges,
CL TX CARPL SCAPH FX WO MANIP-TECH,74263,CDM,510,RC,25622,CPT,,,facility,outpatient,,,864.00000,820.80000,Amish/Mennonite,Amish Mennonite,,475.20,,,,,,,227.78,838.08,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,99.00,174.60,percent of total billed charges,
INJ ANES AGNT GRTR OCCIPTAL NV-TECH,74264,CDM,510,RC,64405,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,90.00,308.32,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,inpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,148.50,261.90,percent of total billed charges,
INJ ANES AGNT ILIOINGNL ILIOHY-TECH,74265,CDM,510,RC,64425,CPT,,,facility,outpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,135.00,723.34,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,72.60,128.04,percent of total billed charges,
INJ ANES OTHER PERIPHERAL NRV-TECH,74266,CDM,510,RC,64450,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,66.00,723.34,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,inpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,70.95,125.13,percent of total billed charges,
INIT TX BURN 1ST DEG LCL-TECH,74267,CDM,510,RC,16000,CPT,,,facility,outpatient,,,129.00000,122.55000,Amish/Mennonite,Amish Mennonite,,70.95,,,,,,,64.50,207.54,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,195.80,345.32,percent of total billed charges,
I&D ABSCESS PERITONSILLAR -TECH,74268,CDM,510,RC,42700,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,178.00,345.32,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,inpatient,,,873.00000,829.35000,Amish/Mennonite,Amish Mennonite,,480.15,,,,,,,480.15,846.81,percent of total billed charges,
IMPL NEUROST ELEC ARRAY SACRAL-TECH,74269,CDM,510,RC,64561,CPT,,,facility,outpatient,,,873.00000,829.35000,Amish/Mennonite,Amish Mennonite,,480.15,,,,,,,436.50,6854.91,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
"INJ,ANES AGENT/STEROID,PLANTAR-TECH",74270,CDM,510,RC,64455,CPT,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,72.00,308.32,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,inpatient,,,230.00000,218.50000,Amish/Mennonite,Amish Mennonite,,126.50,,,,,,,126.50,223.10,percent of total billed charges,
FNA W/O IMAG GUID-TECH,74271,CDM,510,RC,10021,CPT,,,facility,outpatient,,,230.00000,218.50000,Amish/Mennonite,Amish Mennonite,,126.50,,,,,,,115.00,417.31,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,inpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,135.30,238.62,percent of total billed charges,
I&D BARTHOLINS GLAND ABSCESS-TECH,74272,CDM,510,RC,56420,CPT,,,facility,outpatient,,,246.00000,233.70000,Amish/Mennonite,Amish Mennonite,,135.30,,,,,,,123.00,238.62,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,inpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,271.15,478.21,percent of total billed charges,
DIAG BONE MARROW BIOP/ASPIR-TECH,74273,CDM,510,RC,38222,CPT,,,facility,outpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,246.50,2989.39,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,inpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,,129.80,,,,,,,129.80,228.92,percent of total billed charges,
INJ SCLEROSING SOL SINGLE VEIN -TECH,74274,CDM,510,RC,36470,CPT,,,facility,outpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,,129.80,,,,,,,118.00,417.31,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,inpatient,,,1256.00000,1193.20000,Amish/Mennonite,Amish Mennonite,,690.80,,,,,,,690.80,1218.32,percent of total billed charges,
DRAIN SHOULDER LESION-TECH,74275,CDM,510,RC,23030,CPT,,,facility,outpatient,,,1256.00000,1193.20000,Amish/Mennonite,Amish Mennonite,,690.80,,,,,,,628.00,2989.39,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,158.95,280.33,percent of total billed charges,
INJ DIAG/THER SUB L/S W/IMAG-TECH,74276,CDM,510,RC,62323,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,144.50,723.34,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,101.75,179.45,percent of total billed charges,
INS OF INTRAUTERINE DEVICE-TECH,74277,CDM,510,RC,58300,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,92.50,179.45,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
DESTR LES PENIS ELECTRODESSIC-TECH,74278,CDM,510,RC,54055,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,114.00,1910.62,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,inpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,468.60,826.44,percent of total billed charges,
IRIDOTOMY BY PHOTOCOAGULATION -TECH,74279,CDM,510,RC,66761,CPT,,,facility,outpatient,,,852.00000,809.40000,Amish/Mennonite,Amish Mennonite,,468.60,,,,,,,426.00,826.44,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,inpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,115.50,203.70,percent of total billed charges,
LARYNGOSC FLEX FIB DIAGNOSTIC -TECH,74280,CDM,510,RC,31575,CPT,,,facility,outpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,105.00,203.70,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,110.00,194.00,percent of total billed charges,
PROLNG E&M SERVICE FIRST HOUR-TECH,74281,CDM,510,RC,99358,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,,110.00,,,,,,,100.00,194.00,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,inpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,154.00,271.60,percent of total billed charges,
MANIPULAT PALM CORD POST INJ-TECH,74282,CDM,510,RC,26341,CPT,,,facility,outpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,140.00,271.60,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,inpatient,,,741.00000,703.95000,Amish/Mennonite,Amish Mennonite,,407.55,,,,,,,407.55,718.77,percent of total billed charges,
LIG DIV EXC VAR VN CLUS 1 LEG-TECH,74284,CDM,510,RC,37785,CPT,,,facility,outpatient,,,741.00000,703.95000,Amish/Mennonite,Amish Mennonite,,407.55,,,,,,,370.50,3287.55,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,inpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,95.15,167.81,percent of total billed charges,
INJ SNGL TENDON ORIGIN/INSERT-TECH,74285,CDM,510,RC,20551,CPT,,,facility,outpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,86.50,308.32,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,inpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,510.40,900.16,percent of total billed charges,
HEMORRHOIDECT INT AND EXT SNGL-TECH,74286,CDM,510,RC,46255,CPT,,,facility,outpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,464.00,2864.41,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
NEG PRES DME WND TX <=50SCM-TECH,74287,CDM,510,RC,97605,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,207.54,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,inpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,504.90,890.46,percent of total billed charges,
CLSD TX PATLLR FX WO MANIP-TECH,74288,CDM,510,RC,27520,CPT,,,facility,outpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,227.78,890.46,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,163.90,289.06,percent of total billed charges,
COLPOSCOPY VULVA W BIOPSY-TECH,74289,CDM,510,RC,56821,CPT,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,149.00,317.72,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,inpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,500.50,882.70,percent of total billed charges,
EXC GANGLION WRIST PRIMARY-TECH,74291,CDM,510,RC,25111,CPT,,,facility,outpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,455.00,1671.62,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
"PROLONG E&M SERV, EA ADL 30 MIN-TECH",74292,CDM,510,RC,99359,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,97.00,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,inpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,8.25,14.55,percent of total billed charges,
PAP SCREEN COLLECTN/CONVEYANCE-TECH,74294,CDM,770,RC,Q0091,HCPCS,,,facility,outpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,7.50,25.57,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,155.65,274.51,percent of total billed charges,
INCISIONAL BIOPSY SKIN SINGLE LESION-TECH,74295,CDM,510,RC,11106,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,141.50,639.36,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,inpatient,,,1518.00000,1442.10000,Amish/Mennonite,Amish Mennonite,,834.90,,,,,,,834.90,1472.46,percent of total billed charges,
PROPHYLAXIS; PHOTOCOAGULATION-TECH,74296,CDM,510,RC,67145,CPT,,,facility,outpatient,,,1518.00000,1442.10000,Amish/Mennonite,Amish Mennonite,,834.90,,,,,,,520.92,1472.46,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,inpatient,,,423.00000,401.85000,Amish/Mennonite,Amish Mennonite,,232.65,,,,,,,232.65,410.31,percent of total billed charges,
NASAL POLYPS EXC UNIL -TECH,74297,CDM,510,RC,30110,CPT,,,facility,outpatient,,,423.00000,401.85000,Amish/Mennonite,Amish Mennonite,,232.65,,,,,,,211.50,1547.18,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,inpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
COLPOSCOPY ENTIRE VAG W CERVIX-TECH,74299,CDM,510,RC,57420,CPT,,,facility,outpatient,,,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,118.50,317.72,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PNT >=3 MUSC-TECH,74300,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,91.00,308.32,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,220.19,percent of total billed charges,
PUNC ASPIR HYDROCELE TUN VAGIN -TECH,74301,CDM,510,RC,55000,CPT,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,113.50,734.90,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,inpatient,,,377.00000,358.15000,Amish/Mennonite,Amish Mennonite,,207.35,,,,,,,207.35,365.69,percent of total billed charges,
HYMENECTOMY PARTIAL-TECH,74302,CDM,510,RC,56700,CPT,,,facility,outpatient,,,377.00000,358.15000,Amish/Mennonite,Amish Mennonite,,207.35,,,,,,,188.50,3321.00,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
PHYS SRV NEED FOR PWR MOB DEV-TECH,74303,CDM,510,RC,G0372,HCPCS,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,inpatient,,,967.00000,918.65000,Amish/Mennonite,Amish Mennonite,,531.85,,,,,,,531.85,937.99,percent of total billed charges,
REV PROSTH VAG GRFT VAG APPR-TECH,74304,CDM,510,RC,57295,CPT,,,facility,outpatient,,,967.00000,918.65000,Amish/Mennonite,Amish Mennonite,,531.85,,,,,,,483.50,3321.00,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBCUT PORT/PUMP-TECH,74305,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,1622.56,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,inpatient,,,851.00000,808.45000,Amish/Mennonite,Amish Mennonite,,468.05,,,,,,,468.05,825.47,percent of total billed charges,
CYSTOURETHROSC W/INJ CHEMODEN-TECH,74307,CDM,510,RC,52287,CPT,,,facility,outpatient,,,851.00000,808.45000,Amish/Mennonite,Amish Mennonite,,468.05,,,,,,,425.50,2139.65,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
REFRACTION-TECH,74309,CDM,510,RC,92015,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,20.37,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,inpatient,,,3654.00000,3471.30000,Amish/Mennonite,Amish Mennonite,TC,2009.70,,,,,,,2009.70,3544.38,percent of total billed charges,
MR GUIDE NEEDLE PLC-TECH,7431,CDM,610,RC,77021,CPT,,,facility,outpatient,,,3654.00000,3471.30000,Amish/Mennonite,Amish Mennonite,TC,2009.70,,,,,,,1487.04,3544.38,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,57.20,100.88,percent of total billed charges,
INJ INTRALESIONAL <=7 LESNS-TECH,74310,CDM,510,RC,11900,CPT,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,52.00,207.54,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
RMVE IMPL CONTRACEPTIVE CPSL-TECH,74311,CDM,510,RC,11976,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,133.50,734.90,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,inpatient,,,738.00000,701.10000,Amish/Mennonite,Amish Mennonite,,405.90,,,,,,,405.90,715.86,percent of total billed charges,
REPAIR COMPLEX TRUNK 2.6-7.5 CM-TECH,74312,CDM,510,RC,13101,CPT,,,facility,outpatient,,,738.00000,701.10000,Amish/Mennonite,Amish Mennonite,,405.90,,,,,,,369.00,715.86,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,inpatient,,,1153.00000,1095.35000,Amish/Mennonite,Amish Mennonite,,634.15,,,,,,,634.15,1118.41,percent of total billed charges,
RMVL IMPLANT DEEP-TECH,74313,CDM,510,RC,20680,CPT,,,facility,outpatient,,,1153.00000,1095.35000,Amish/Mennonite,Amish Mennonite,,634.15,,,,,,,576.50,2989.39,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,inpatient,,,1367.00000,1298.65000,Amish/Mennonite,Amish Mennonite,,751.85,,,,,,,751.85,1325.99,percent of total billed charges,
IRIDOPLASTY BY PHOTOCOAGULAT -TECH,74314,CDM,510,RC,66762,CPT,,,facility,outpatient,,,1367.00000,1298.65000,Amish/Mennonite,Amish Mennonite,,751.85,,,,,,,520.92,1325.99,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,inpatient,,,1426.00000,1354.70000,Amish/Mennonite,Amish Mennonite,,784.30,,,,,,,784.30,1383.22,percent of total billed charges,
OPN TX FGR/THUMB DIST FX-TECH,74315,CDM,510,RC,26765,CPT,,,facility,outpatient,,,1426.00000,1354.70000,Amish/Mennonite,Amish Mennonite,,784.30,,,,,,,713.00,3388.98,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,inpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,102.30,180.42,percent of total billed charges,
"TANGENTIAL BX,1ST LESION-TECH",74316,CDM,510,RC,11102,CPT,,,facility,outpatient,,,186.00000,176.70000,Amish/Mennonite,Amish Mennonite,,102.30,,,,,,,93.00,207.54,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
REMOVAL FB EYE SUPERFICIAL-TECH,74317,CDM,510,RC,65205,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,81.00,157.14,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,inpatient,,,1130.25000,1073.74000,Amish/Mennonite,Amish Mennonite,,621.64,,,,,,,621.64,1096.34,percent of total billed charges,
TENOTOMY FLX OPEN FINGER SING-TECH,74318,CDM,510,RC,26455,CPT,,,facility,outpatient,,,1130.25000,1073.74000,Amish/Mennonite,Amish Mennonite,,621.64,,,,,,,565.12,1671.62,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,inpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,10.45,18.43,percent of total billed charges,
PURE TONE SCREENING AIR ONLY-TECH,74319,CDM,471,RC,92551,CPT,,,facility,outpatient,,,19.00000,18.05000,Amish/Mennonite,Amish Mennonite,,10.45,,,,,,,9.50,18.43,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,inpatient,,,693.00000,658.35000,Amish/Mennonite,Amish Mennonite,,381.15,,,,,,,381.15,672.21,percent of total billed charges,
RMVL OF EMBEDDED FB EYELID-TECH,74320,CDM,510,RC,67938,CPT,,,facility,outpatient,,,693.00000,658.35000,Amish/Mennonite,Amish Mennonite,,381.15,,,,,,,283.85,672.21,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
RMVL OF CORNEAL EPITHELIUM-TECH,74321,CDM,510,RC,65435,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,114.50,1011.64,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,inpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,,325.05,,,,,,,325.05,573.27,percent of total billed charges,
RMVE FB UPR ARM/ELB SUBQ-TECH,74322,CDM,510,RC,24200,CPT,,,facility,outpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,,325.05,,,,,,,295.50,1692.33,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,inpatient,,,739.00000,702.05000,Amish/Mennonite,Amish Mennonite,,406.45,,,,,,,406.45,716.83,percent of total billed charges,
EXN SOFT TISS LSN EXTRNL CANAL-TECH,74323,CDM,510,RC,69145,CPT,,,facility,outpatient,,,739.00000,702.05000,Amish/Mennonite,Amish Mennonite,,406.45,,,,,,,369.50,2989.39,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,108.90,192.06,percent of total billed charges,
REMOVAL FB EYE SUBCONJUNCTIVAL-TECH,74324,CDM,510,RC,65210,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,99.00,416.79,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,inpatient,,,765.00000,726.75000,Amish/Mennonite,Amish Mennonite,,420.75,,,,,,,420.75,742.05,percent of total billed charges,
TX CLSD TUBEROS FX WO MANIP-TECH,74325,CDM,510,RC,23620,CPT,,,facility,outpatient,,,765.00000,726.75000,Amish/Mennonite,Amish Mennonite,,420.75,,,,,,,227.78,742.05,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,inpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,187.00,329.80,percent of total billed charges,
SCLEROTHER-SAME LEG MULT VEINS -TECH,74326,CDM,510,RC,36471,CPT,,,facility,outpatient,,,340.00000,323.00000,Amish/Mennonite,Amish Mennonite,,187.00,,,,,,,170.00,417.31,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,inpatient,,,982.00000,932.90000,Amish/Mennonite,Amish Mennonite,,540.10,,,,,,,540.10,952.54,percent of total billed charges,
TX RETINOPATHY PHOTOCOAG EXT-TECH,74328,CDM,510,RC,67228,CPT,,,facility,outpatient,,,982.00000,932.90000,Amish/Mennonite,Amish Mennonite,,540.10,,,,,,,491.00,952.54,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,inpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,201.85,355.99,percent of total billed charges,
THORAC NDL/CATH W/O IMAG GUID -TECH,74331,CDM,510,RC,32554,CPT,,,facility,outpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,183.50,645.77,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,inpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,162.25,286.15,percent of total billed charges,
INJECTION INTRAVITREAL-TECH,74333,CDM,510,RC,67028,CPT,,,facility,outpatient,,,295.00000,280.25000,Amish/Mennonite,Amish Mennonite,,162.25,,,,,,,147.50,346.44,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,inpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,97.90,172.66,percent of total billed charges,
WORK RELATED OR MED DISAB EXAM-TECH,74334,CDM,510,RC,99456,CPT,,,facility,outpatient,,,178.00000,169.10000,Amish/Mennonite,Amish Mennonite,,97.90,,,,,,,89.00,172.66,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,inpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,128.70,226.98,percent of total billed charges,
"PUNCH BX,1ST LESION-TECH",74335,CDM,510,RC,11104,CPT,,,facility,outpatient,,,234.00000,222.30000,Amish/Mennonite,Amish Mennonite,,128.70,,,,,,,117.00,417.31,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,inpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.90,17.46,percent of total billed charges,
OPHTHALMOSCOPY EXTENDED-TECH,74337,CDM,510,RC,92201,CPT,,,facility,outpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,,9.90,,,,,,,9.00,62.04,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,inpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,196.35,346.29,percent of total billed charges,
MYRINGOT INCL ASP/TUBE INFLATN-TECH,74338,CDM,510,RC,69420,CPT,,,facility,outpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,178.50,346.29,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,inpatient,,,931.00000,884.45000,Amish/Mennonite,Amish Mennonite,,512.05,,,,,,,512.05,903.07,percent of total billed charges,
SURG TRMT ANAL FISTULA SUBCUT-TECH,74339,CDM,510,RC,46270,CPT,,,facility,outpatient,,,931.00000,884.45000,Amish/Mennonite,Amish Mennonite,,512.05,,,,,,,465.50,2864.41,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
PREVENTIVE COUNSELING GRP-30MN-TECH,74340,CDM,510,RC,99411,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,21.00,40.74,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,inpatient,,,2601.00000,2470.95000,Amish/Mennonite,Amish Mennonite,,1430.55,,,,,,,1430.55,2522.97,percent of total billed charges,
RMVL INTERNAL DWEL URETERAL ST -TECH,74341,CDM,510,RC,50384,CPT,,,facility,outpatient,,,2601.00000,2470.95000,Amish/Mennonite,Amish Mennonite,,1430.55,,,,,,,1300.50,2522.97,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,inpatient,,,741.00000,703.95000,Amish/Mennonite,Amish Mennonite,,407.55,,,,,,,407.55,718.77,percent of total billed charges,
VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS-TECH,74342,CDM,510,RC,55250,CPT,,,facility,outpatient,,,741.00000,703.95000,Amish/Mennonite,Amish Mennonite,,407.55,,,,,,,370.50,2139.65,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,inpatient,,,377.00000,358.15000,Amish/Mennonite,Amish Mennonite,,207.35,,,,,,,207.35,365.69,percent of total billed charges,
TYMPANOSTOMY LOC/TOP ANES-TECH,74344,CDM,510,RC,69433,CPT,,,facility,outpatient,,,377.00000,358.15000,Amish/Mennonite,Amish Mennonite,,207.35,,,,,,,188.50,531.90,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,63.25,111.55,percent of total billed charges,
PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION-TECH,74346,CDM,510,RC,11105,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,57.50,111.55,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,17.60,31.04,percent of total billed charges,
PROSTATE CNC SCREENING;DIGITAL-TECH,74347,CDM,770,RC,G0102,HCPCS,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,16.00,31.04,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
SUBSEQUENT ANTEPARTUM CARE-TECH,74348,CDM,510,RC,99213,CPT,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,33.00,64.02,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,inpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,21.45,37.83,percent of total billed charges,
WND DEBRIDE NON SELECTIVE-TECH,74349,CDM,510,RC,97602,CPT,,,facility,outpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,19.50,207.54,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,inpatient,,,3683.00000,3498.85000,Amish/Mennonite,Amish Mennonite,TC,2025.65,,,,,,,2025.65,3572.51,percent of total billed charges,
HEPATOBILIARY SYS IM PHARMACOL,7435,CDM,340,RC,78227,CPT,,,facility,outpatient,,,3683.00000,3498.85000,Amish/Mennonite,Amish Mennonite,TC,2025.65,,,,,,,1841.50,3572.51,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,inpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,96.80,170.72,percent of total billed charges,
SUBC HOMONE PELLET IMPLANTATN -TECH,74351,CDM,510,RC,11980,CPT,,,facility,outpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,88.00,416.79,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,inpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,200.20,353.08,percent of total billed charges,
LABYRINTHOTOMY WITH PERFUSION-TECH,74352,CDM,510,RC,69801,CPT,,,facility,outpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,182.00,1547.18,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,433.40,764.36,percent of total billed charges,
EXC LES-EYELID WO/SIMPLE CLOSR-TECH,74353,CDM,510,RC,67840,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,394.00,1011.64,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,inpatient,1,EA,9729.00000,9242.55000,Amish/Mennonite,Amish Mennonite,,5350.95,,,,,,,5350.95,9437.13,percent of total billed charges,
THIOTEPA POWD-INJ 100 MG,74354,CDM,636,RC,J9340,HCPCS,70121163101,NDC,facility,outpatient,1,EA,9729.00000,9242.55000,Amish/Mennonite,Amish Mennonite,,5350.95,,,,,,,365.89,9437.13,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,inpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.24750,0.43650,percent of total billed charges,
CEFAZOLIN SOLN SD 100 MG/ML,74362,CDM,250,RC,J0690,HCPCS,6050507490510000,NDC,facility,outpatient,1,mL,0.45000,0.43000,Amish/Mennonite,Amish Mennonite,,0.24750,,,,,,,0.22500,1.39,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD W51XH71MM D13MM POLYUR SIL TI IS1/DF1,74363,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74366,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3562.99,7762.50,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 1.5 6FR,74377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 6.5X60MM,74380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L95CM L VENT SIL POLYUR ETFE TI PLAT IRIDIUM QPLR,74381,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,2850.39,6210.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.5X40MM,74383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4354.76,9487.50,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,12531.75,24807.75,percent of total billed charges,
VALVE AORT 29MM BOV PERICARD COCR ALLY POLY STENTED,74384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,25575.00000,24296.25000,Amish/Mennonite,Amish Mennonite,,14066.25,,,,,,,11738.92,25575.00,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 16FRX1.7X22CM,74391,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM 16MM S CRV INTRO 5FR L HRT IS4-LLLL CONN,74393,CDM,275,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2137.79,4517.77,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,inpatient,,,182.80000,173.66000,Amish/Mennonite,Amish Mennonite,90,100.54,,,,,,,100.54,177.32,percent of total billed charges,
BETA-2 MICROGLOB URINE SO-TECH,74400,CDM,300,RC,82232,CPT,,,facility,outpatient,,,182.80000,173.66000,Amish/Mennonite,Amish Mennonite,90,100.54,,,,,,,16.72,848.80,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
"BLOOD, URINE TECH",74402,CDM,300,RC,81003,CPT,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,2.25,118.82,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,inpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,90,689.15,,,,,,,689.15,1215.41,percent of total billed charges,
BACTERIAL IDENT BY SEQ SO-TECH,74403,CDM,300,RC,87153,CPT,,,facility,outpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,90,689.15,,,,,,,119.20,6026.72,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
WARM ABSORPTION TECH,74404,CDM,300,RC,86978,CPT,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,56.40,1714.64,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
ADMINISTRATION FEE-PNEUMOVAX,74409,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,inpatient,1,EA,26.02000,24.72000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,14.31,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,51079-0165-03-00025,NDC,,,facility,outpatient,1,EA,26.02000,24.72000,Amish/Mennonite,Amish Mennonite,,14.31,,,,,,,13.01,25.24,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
VORICONAZOLE 50 MG TAB,74473,CDM,250,RC,68462-0572-30,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,inpatient,1,EA,6233.30000,5921.63000,Amish/Mennonite,Amish Mennonite,,3428.32,,,,,,,3428.32,6046.30,percent of total billed charges,
LEUPROLIDE 45 MG/6 MONTHS (ELIGARD),74479,CDM,636,RC,J9217,HCPCS,62935046150,NDC,facility,outpatient,1,EA,6233.30000,5921.63000,Amish/Mennonite,Amish Mennonite,,3428.32,,,,,,,155.42,6046.30,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DFBRLLATR 8FR L65CM OPTIM EXT RET HELIX SGL COIL TRUE BPLR,74481,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3562.99,7762.50,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7.48000,7.11000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.67,7.26,percent of total billed charges,
VALVE FDTB LOPEZ ADLT ENTRL 2 LUM SUMP NS LF,74482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7.48000,7.11000,Amish/Mennonite,Amish Mennonite,,4.11,,,,,,,3.43,7.48,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L5CM PRI DIA0.02IN 2ND DIA3MM COMPLX STD FRME L VOL,74483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDIL .035IN 4MM 5FR 130CM LUTONIX,74484,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,124.85,220.19,percent of total billed charges,
"BLADDER IRRIGATION,SIMPLE INS-TECH",74485,CDM,510,RC,51700,CPT,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,,124.85,,,,,,,113.50,254.03,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 2.5X40MM,74487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4354.76,9487.50,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 3MM 150CM ULTRAVERSE 014 CK,74488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2MM 150CM ULTRAVERSE 014 CK,74489,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 2.5MM 150CM ULTRAVERSE 014,74490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,74491,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,Amish/Mennonite,Amish Mennonite,GP,33.66,,,,,,,33.66,59.36,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 3 OR MORE MUSCLES,74493,CDM,420,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,Amish/Mennonite,Amish Mennonite,GP,33.66,,,,,,,30.60,264.00,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,Amish/Mennonite,Amish Mennonite,GP,22.22,,,,,,,22.22,39.19,percent of total billed charges,
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S),74494,CDM,420,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,Amish/Mennonite,Amish Mennonite,GP,22.22,,,,,,,20.20,264.00,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,inpatient,1,mL,18.80000,17.86000,Amish/Mennonite,Amish Mennonite,,10.34,,,,,,,10.34,18.24,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409117630,NDC,facility,outpatient,1,mL,18.80000,17.86000,Amish/Mennonite,Amish Mennonite,,10.34,,,,,,,9.40,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,inpatient,1,mL,23.51000,22.33000,Amish/Mennonite,Amish Mennonite,,12.93,,,,,,,12.93,22.80,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00409136201,NDC,facility,outpatient,1,mL,23.51000,22.33000,Amish/Mennonite,Amish Mennonite,,12.93,,,,,,,11.76,25.89,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,inpatient,1,mL,7.29000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.07,percent of total billed charges,
MEPERIDINE 25 MG/ML SOLN,74497,CDM,250,RC,J2175,HCPCS,00641605225,NDC,facility,outpatient,1,mL,7.29000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,3.65,25.89,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,inpatient,1,mL,451.78000,429.19000,Amish/Mennonite,Amish Mennonite,,248.48,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 16 ML,74500,CDM,636,RC,Q5107,HCPCS,55513020701,NDC,facility,outpatient,1,mL,451.78000,429.19000,Amish/Mennonite,Amish Mennonite,,248.48,,,,,,,28.85,438.23,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,inpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LEVEL IL W/ CC,74507,CDM,682,RC,G0390,HCPCS,,,facility,outpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,1256.40,5253.52,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,inpatient,,,8064.00000,7660.80000,Amish/Mennonite,Amish Mennonite,,4435.20,,,,,,,4435.20,7822.08,percent of total billed charges,
TRAUMA LEVEL L W/ CC,74508,CDM,681,RC,G0390,HCPCS,,,facility,outpatient,,,8064.00000,7660.80000,Amish/Mennonite,Amish Mennonite,,4435.20,,,,,,,1256.40,7822.08,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,inpatient,,,559.00000,531.05000,Amish/Mennonite,Amish Mennonite,,307.45,,,,,,,307.45,542.23,percent of total billed charges,
CYSTOURETHROSCOPY-TECH,74509,CDM,510,RC,52000,CPT,,,facility,outpatient,,,559.00000,531.05000,Amish/Mennonite,Amish Mennonite,,307.45,,,,,,,279.50,697.17,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2392.00000,2272.40000,Amish/Mennonite,Amish Mennonite,TC,1315.60,,,,,,,1315.60,2320.24,percent of total billed charges,
CT-UPPER EXTREMITY W/WO CONTR,7451,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2392.00000,2272.40000,Amish/Mennonite,Amish Mennonite,TC,1315.60,,,,,,,979.11,2320.24,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3.5MM 150CM ULTRAVERSE 014,74513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 75CM ULTRAVERSE 035,74514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2.5MM 150CM ULTRAVERSE 014,74515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 3MM 320CM CRTD LWR,74516,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1635.19,3562.50,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.68000,47.20000,Amish/Mennonite,Amish Mennonite,,27.32,,,,,,,24.34,48.19,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .025IN 145CM,74517,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.68000,47.20000,Amish/Mennonite,Amish Mennonite,,27.32,,,,,,,22.80,49.68,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,inpatient,,,16100.00000,15295.00000,Amish/Mennonite,Amish Mennonite,,8855.00,,,,,,,8855.00,15617.00,percent of total billed charges,
EEG W/VIDEO CON MON EAC 12-26H-TECH,74588,CDM,740,RC,95716,CPT,,,facility,outpatient,,,16100.00000,15295.00000,Amish/Mennonite,Amish Mennonite,,8855.00,,,,,,,966.05,15617.00,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO CONT 2-12H-TECH,74591,CDM,740,RC,95713,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID CON MON 2-12H-TECH,74592,CDM,740,RC,95707,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID UNMON EA 12-26H-TECH,74593,CDM,740,RC,95708,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 12-26H-TECH,74594,CDM,740,RC,95715,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO INT MON 2-12H-TECH,74596,CDM,740,RC,95712,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 2-12H-TECH,74597,CDM,740,RC,95711,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID UNMON 2-12H-TECH,74598,CDM,740,RC,95705,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG W/VIDEO UNMON 12-26H-TECH,74599,CDM,740,RC,95714,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,inpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,717.75,1265.85,percent of total billed charges,
GLOBAL MEDICAL PHYSICS CONSULT,7460,CDM,333,RC,77370,CPT,,,facility,outpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,126.07,6798.73,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/O VID INT MON 2-12H-TECH,74602,CDM,740,RC,95706,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,295.69,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,inpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,2466.20,4349.48,percent of total billed charges,
EEG W/VIDEO SET-UP/EDUC-TECH,74603,CDM,740,RC,95700,CPT,,,facility,outpatient,,,4484.00000,4259.80000,Amish/Mennonite,Amish Mennonite,,2466.20,,,,,,,148.57,4349.48,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID CON MON EA12-26H-TECH,74604,CDM,740,RC,95710,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,inpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,4730.55,8342.97,percent of total billed charges,
EEG WO VID INT MON EA12-26H-TECH,74605,CDM,740,RC,95709,CPT,,,facility,outpatient,,,8601.00000,8170.95000,Amish/Mennonite,Amish Mennonite,,4730.55,,,,,,,503.83,8342.97,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,inpatient,1,mL,267.19000,253.83000,Amish/Mennonite,Amish Mennonite,,146.95,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 50 ML (TRUXIMA),74607,CDM,636,RC,Q5115,HCPCS,63459010450,NDC,facility,outpatient,1,mL,267.19000,253.83000,Amish/Mennonite,Amish Mennonite,,146.95,,,,,,,31.18,259.17,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ARTHCS ASP/INJ SM JT WO US-TECH,74608,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,308.32,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22CM HYDR+ FRM TAPR TIP HI RETEN COIL LP L,74609,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,900.38,1782.38,percent of total billed charges,
CATHETER NEURON MP 6 FR 80CM,74610,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1837.50000,1745.62000,Amish/Mennonite,Amish Mennonite,,1010.62,,,,,,,843.41,1837.50,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTMY 14FR 1.5 45CM,74611,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1046.52,2280.00,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,139.65,276.45,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 145CM TAD II MCGLD,74612,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,,156.75,,,,,,,130.81,285.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTORQ HDRPH,74613,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
BLLN SAPPHIRE II 1.0X5MM,74615,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,Amish/Mennonite,Amish Mennonite,TC,499.95,,,,,,,499.95,881.73,percent of total billed charges,
NM RADIOPHARM QUANT SGL AREA-TECH,74616,CDM,340,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,Amish/Mennonite,Amish Mennonite,TC,499.95,,,,,,,359.37,881.73,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74617,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JL4 6FR 125CM,74623,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID JR4 6FR 125CM.,74624,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,260.25,567.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 4.5X60MM,74625,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,inpatient,1,EA,11.13000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,6.12,10.80,percent of total billed charges,
THEOPHYLLINE 100 MG/24 HOURS CAP-,74626,CDM,250,RC,52244-0100-10,NDC,,,facility,outpatient,1,EA,11.13000,10.57000,Amish/Mennonite,Amish Mennonite,,6.12,,,,,,,5.57,10.80,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,39.20,77.60,percent of total billed charges,
K WIRE FIX L100MM DIA1.1MM,74633,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,36.72,80.00,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM TRNSVEN R VENT SIL W/ POLYUR DF4 CONN ACT,74634,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM HTRQ ESPRT SS,74635,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,inpatient,,,4020.00000,3819.00000,Amish/Mennonite,Amish Mennonite,TC,2211.00,,,,,,,2211.00,3899.40,percent of total billed charges,
APP INTERSTITIAL RADIATION CMPLX-TECH,7470,CDM,342,RC,77778,CPT,,,facility,outpatient,,,4020.00000,3819.00000,Amish/Mennonite,Amish Mennonite,TC,2211.00,,,,,,,2010.00,3899.40,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,Amish/Mennonite,Amish Mennonite,TC,1711.60,,,,,,,1711.60,3018.64,percent of total billed charges,
MULTI-LEAF COLLIMATOR DEV IMRT-TECH,7473,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,Amish/Mennonite,Amish Mennonite,TC,1711.60,,,,,,,1334.13,14413.40,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
ADJ OF GASTRIC BAND DIAMETER-TECH,74879,CDM,360,RC,S2083,HCPCS,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,5271.00,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.23000,103.77000,Amish/Mennonite,Amish Mennonite,,60.08,,,,,,,60.08,105.95,percent of total billed charges,
ALLODERM 132 SQ CM CM1520 FD,74881,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.23000,103.77000,Amish/Mennonite,Amish Mennonite,,60.08,,,,,,,51.64,105.95,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.92000,100.62000,Amish/Mennonite,Amish Mennonite,,58.26,,,,,,,58.26,102.74,percent of total billed charges,
ALLODERM 132 SQ CM MD CM1518,74882,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.92000,100.62000,Amish/Mennonite,Amish Mennonite,,58.26,,,,,,,51.64,102.74,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,Amish/Mennonite,Amish Mennonite,,41.93,,,,,,,41.93,73.95,percent of total billed charges,
ALLODERM 16X20MD RTU1518320P,74883,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,Amish/Mennonite,Amish Mennonite,,41.93,,,,,,,38.12,73.95,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20TK FD1520320,74884,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,37.01,71.80,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,109.22000,103.76000,Amish/Mennonite,Amish Mennonite,,60.07,,,,,,,60.07,105.94,percent of total billed charges,
ALLODERM 164 SQ CM CL1520 FD,74885,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,109.22000,103.76000,Amish/Mennonite,Amish Mennonite,,60.07,,,,,,,51.64,105.94,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,74.02000,70.32000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,40.71,71.80,percent of total billed charges,
ALLODERM 16X20 MD RTU1518320,74887,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,74.02000,70.32000,Amish/Mennonite,Amish Mennonite,,40.71,,,,,,,37.01,71.80,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,19.25,33.95,percent of total billed charges,
ALLERG IMMUNOTH 1 INSECT VENOM-TECH,74889,CDM,510,RC,95145,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,,19.25,,,,,,,17.50,48.19,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,inpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2502.50,4413.50,percent of total billed charges,
MYOCARD PERF TOMOG MULT STUDY,7489,CDM,340,RC,78452,CPT,,,facility,outpatient,,,4550.00000,4322.50000,Amish/Mennonite,Amish Mennonite,TC,2502.50,,,,,,,2150.56,7180.14,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,73.93000,70.23000,Amish/Mennonite,Amish Mennonite,,40.66,,,,,,,40.66,71.71,percent of total billed charges,
ALLODERM 640SQCM MD1518320BP,74890,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,73.93000,70.23000,Amish/Mennonite,Amish Mennonite,,40.66,,,,,,,36.97,71.71,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,46.75,82.45,percent of total billed charges,
ALLODERM 328SQCM LG CL1518BP,74891,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,85.00000,80.75000,Amish/Mennonite,Amish Mennonite,,46.75,,,,,,,42.50,82.45,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,,312.40,,,,,,,312.40,550.96,percent of total billed charges,
CATH COLLECTION OF SPECIMEN,74896,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,568.00000,539.60000,Amish/Mennonite,Amish Mennonite,,312.40,,,,,,,9.09,550.96,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,31.35,55.29,percent of total billed charges,
APPL TOPICAL FLUORIDE VARNISH,74897,CDM,512,RC,99188,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,,31.35,,,,,,,28.50,55.29,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,124.30,219.22,percent of total billed charges,
CAST APPLICATION FINGER-TECH,74899,CDM,510,RC,29086,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,113.00,219.22,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,inpatient,,,19.50000,18.52000,Amish/Mennonite,Amish Mennonite,,10.72,,,,,,,10.72,18.91,percent of total billed charges,
"CAST MATERIAL,SERIAL,FINGER",74902,CDM,270,RC,Q4049,HCPCS,,,facility,outpatient,,,19.50000,18.52000,Amish/Mennonite,Amish Mennonite,,10.72,,,,,,,2.83,18.91,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,inpatient,,,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,11.00,19.40,percent of total billed charges,
DIAB SELF-MNGMT TR-TECH,74911,CDM,942,RC,G0109,HCPCS,,,facility,outpatient,,,20.00000,19.00000,Amish/Mennonite,Amish Mennonite,,11.00,,,,,,,10.00,19.40,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-MSW-TECH,74916,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,Amish/Mennonite,Amish Mennonite,TC,1529.00,,,,,,,1529.00,2696.60,percent of total billed charges,
"ELECTROMYOGR-4 EXT,PARASP",74918,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,Amish/Mennonite,Amish Mennonite,TC,1529.00,,,,,,,1390.00,2696.60,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,inpatient,,,40.42000,38.40000,Amish/Mennonite,Amish Mennonite,,22.23,,,,,,,22.23,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 2-CLIN-TECH",74921,CDM,510,RC,99499,CPT,,,facility,outpatient,,,40.42000,38.40000,Amish/Mennonite,Amish Mennonite,,22.23,,,,,,,20.21,39.21,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,inpatient,,,57.77000,54.88000,Amish/Mennonite,Amish Mennonite,,31.77,,,,,,,31.77,56.04,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 3-CLIN-TECH",74925,CDM,510,RC,99499,CPT,,,facility,outpatient,,,57.77000,54.88000,Amish/Mennonite,Amish Mennonite,,31.77,,,,,,,28.89,56.04,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,inpatient,,,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,1.38,2.43,percent of total billed charges,
"FILGRASTIM-SNDZ,1 MICROGRAM",74927,CDM,636,RC,Q5101,HCPCS,,,facility,outpatient,,,2.51000,2.38000,Amish/Mennonite,Amish Mennonite,,1.38,,,,,,,0.37000,2.43,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
"FNA US GUIDANCE,EA ADD LESION-TECH",74928,CDM,402,RC,10006,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,56.50,548.00,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,inpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,TC,104.06,,,,,,,104.06,183.52,percent of total billed charges,
OM THREE VW CHEST-B READER-CMP,7493,CDM,320,RC,99199,CPT,,,facility,outpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,TC,104.06,,,,,,,94.60,183.52,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,inpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,TC,306.35,,,,,,,306.35,540.29,percent of total billed charges,
ESOPHAGEAL MOTILITY STUDY-TECH,74932,CDM,750,RC,91010,CPT,,,facility,outpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,TC,306.35,,,,,,,278.50,5271.00,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,inpatient,,,1070.00000,1016.50000,Amish/Mennonite,Amish Mennonite,,588.50,,,,,,,588.50,1037.90,percent of total billed charges,
"GRAFT AUTOL,LIPOSUC;50CC/LESS-TECH",74937,CDM,510,RC,15771,CPT,,,facility,outpatient,,,1070.00000,1016.50000,Amish/Mennonite,Amish Mennonite,,588.50,,,,,,,535.00,3823.86,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,4.25000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.12,percent of total billed charges,
GADOL BASED AG,74938,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,4.25000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.12,4.12,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,inpatient,,,1846.00000,1753.70000,Amish/Mennonite,Amish Mennonite,,1015.30,,,,,,,1015.30,1790.62,percent of total billed charges,
"HEARING AID DISPENSING FEE,BILATERAL",74941,CDM,271,RC,V5110,HCPCS,,,facility,outpatient,,,1846.00000,1753.70000,Amish/Mennonite,Amish Mennonite,,1015.30,,,,,,,923.00,1790.62,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,inpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,,137.50,,,,,,,137.50,242.50,percent of total billed charges,
"HEARING SERVICE, ZPOWER KIT",74944,CDM,471,RC,V5299,HCPCS,,,facility,outpatient,,,250.00000,237.50000,Amish/Mennonite,Amish Mennonite,,137.50,,,,,,,125.00,242.50,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
"H/B IND,EA ADL 15M-PHD-TECH",74946,CDM,914,RC,96159,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,18.00,264.00,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,57.75,101.85,percent of total billed charges,
"HLTH/BHV IND,INIT 30MIN-PHD-TECH",74952,CDM,914,RC,96158,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,,57.75,,,,,,,52.50,264.00,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1067.00000,1013.65000,Amish/Mennonite,Amish Mennonite,,586.85,,,,,,,586.85,1034.99,percent of total billed charges,
GRAFIX PL PRIME 16MM DISC,74957,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1067.00000,1013.65000,Amish/Mennonite,Amish Mennonite,,586.85,,,,,,,211.37,1034.99,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
I123SD IO100MCI,74964,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,inpatient,,,1300.00000,1235.00000,Amish/Mennonite,Amish Mennonite,,715.00,,,,,,,715.00,1261.00,percent of total billed charges,
LAB/FNA DEEP INTERP & REPORT,74966,CDM,311,RC,88173,CPT,,,facility,outpatient,,,1300.00000,1235.00000,Amish/Mennonite,Amish Mennonite,,715.00,,,,,,,50.73,7472.50,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,inpatient,,,751.00000,713.45000,Amish/Mennonite,Amish Mennonite,TC,413.05,,,,,,,413.05,728.47,percent of total billed charges,
ISCHEMIC LIMB EXERCISE TEST-TECH,74968,CDM,922,RC,95875,CPT,,,facility,outpatient,,,751.00000,713.45000,Amish/Mennonite,Amish Mennonite,TC,413.05,,,,,,,375.50,728.47,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,84.15,148.41,percent of total billed charges,
HLTH/BHV ASSESS-PHD-TECH,74972,CDM,918,RC,96156,CPT,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,,84.15,,,,,,,76.50,148.41,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,inpatient,,,38.20000,36.29000,Amish/Mennonite,Amish Mennonite,,21.01,,,,,,,21.01,37.05,percent of total billed charges,
I-131 THERAPY,74975,CDM,270,RC,A9517,HCPCS,,,facility,outpatient,,,38.20000,36.29000,Amish/Mennonite,Amish Mennonite,,21.01,,,,,,,19.10,37.05,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,inpatient,,,157.20000,149.34000,Amish/Mennonite,Amish Mennonite,TC,86.46,,,,,,,86.46,152.48,percent of total billed charges,
OM TWO VW CHEST-B READER-COMPL,7498,CDM,320,RC,99199,CPT,,,facility,outpatient,,,157.20000,149.34000,Amish/Mennonite,Amish Mennonite,TC,86.46,,,,,,,78.60,152.48,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,TC,33.55,,,,,,,33.55,59.17,percent of total billed charges,
OPHTHAL U.S. ECHO DX COR PACHY,7499,CDM,402,RC,76514,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,TC,33.55,,,,,,,30.50,548.00,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,inpatient,,,1129.00000,1072.55000,Amish/Mennonite,Amish Mennonite,,620.95,,,,,,,553.21,1095.13,percent of total billed charges,
NITIFLEX NITINOL/TITANIUM,75043,CDM,274,RC,L8613,HCPCS,,,facility,outpatient,,,1129.00000,1072.55000,Amish/Mennonite,Amish Mennonite,,620.95,,,,,,,440.69,1095.13,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,inpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,,2746.70,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST BIL W/WO CONTR/CAD,75044,CDM,614,RC,77049,CPT,,,facility,outpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,,2746.70,,,,,,,1272.04,4844.18,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,inpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,TC,526.35,,,,,,,526.35,928.29,percent of total billed charges,
OPHTHALMIC U.S. B-SCAN/QN A-SC,7505,CDM,402,RC,76510,CPT,,,facility,outpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,TC,526.35,,,,,,,384.16,928.29,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
PHOTODYNC THER DEST PREMAL LSN-TECH,75055,CDM,510,RC,96573,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,129.50,251.23,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,inpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,89.10,157.14,percent of total billed charges,
PSYCH TST EVAL;1ST HR-TECH,75062,CDM,918,RC,96130,CPT,,,facility,outpatient,,,162.00000,153.90000,Amish/Mennonite,Amish Mennonite,,89.10,,,,,,,81.00,325.26,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,inpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,67.65,119.31,percent of total billed charges,
PSYCH TST EVAL;ADL HR-TECH,75067,CDM,918,RC,96131,CPT,,,facility,outpatient,,,123.00000,116.85000,Amish/Mennonite,Amish Mennonite,,67.65,,,,,,,61.50,119.31,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90834-TECH",75069,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-MSW-90832-TECH",75071,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,56.00,264.00,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,inpatient,,,84.70000,80.47000,Amish/Mennonite,Amish Mennonite,,46.59,,,,,,,46.59,82.16,percent of total billed charges,
LEVONORGESTREL 1.5MG PO,75077,CDM,270,RC,A9150,HCPCS,,,facility,outpatient,,,84.70000,80.47000,Amish/Mennonite,Amish Mennonite,,46.59,,,,,,,42.35,82.16,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING,75078,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,197.00,382.18,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,inpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,,53.90,,,,,,,53.90,95.06,percent of total billed charges,
RMVL IMP CERUMEN SAME DAY TSTG-TECH,75079,CDM,510,RC,G0268,HCPCS,,,facility,outpatient,,,98.00000,93.10000,Amish/Mennonite,Amish Mennonite,,53.90,,,,,,,49.00,95.06,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,inpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,5253.60,9265.44,percent of total billed charges,
INTENSITY MOD RAD TRT DEL SMPL,7508,CDM,333,RC,77385,CPT,,,facility,outpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,549.28,20181.52,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,inpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,52,496.10,,,,,,,496.10,874.94,percent of total billed charges,
"SCREEN MAMMOGR,UNIL,CAD",75081,CDM,403,RC,77067,CPT,,,facility,outpatient,,,902.00000,856.90000,Amish/Mennonite,Amish Mennonite,52,496.10,,,,,,,257.00,874.94,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,inpatient,,,4722.00000,4485.90000,Amish/Mennonite,Amish Mennonite,TC,2597.10,,,,,,,2597.10,4580.34,percent of total billed charges,
SPECT/CT SINGLE AREA/1 DAY-TECH,75084,CDM,340,RC,78830,CPT,,,facility,outpatient,,,4722.00000,4485.90000,Amish/Mennonite,Amish Mennonite,TC,2597.10,,,,,,,2288.22,7180.14,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,,285.45,,,,,,,285.45,503.43,percent of total billed charges,
"TC MAA,<=10MCI",75089,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,519.00000,493.05000,Amish/Mennonite,Amish Mennonite,,285.45,,,,,,,48.58,503.43,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,inpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,216.70,382.18,percent of total billed charges,
PULMONARY STRESS TESTING-TECH,75093,CDM,460,RC,94618,CPT,,,facility,outpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,TC,216.70,,,,,,,197.00,382.18,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
SCABIES TEST(S)DERM,75094,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,5.87,113.69,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,290.95,513.13,percent of total billed charges,
TC99M-RBC,75099,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,173.99,513.13,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,227.15,400.61,percent of total billed charges,
"TC99M-DTPA,AER,TO 75MCI/DOSE",75100,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,33.63,400.61,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,200.75,354.05,percent of total billed charges,
TC99M-SESTAMBI,75102,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,182.50,743.46,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
"TC99M-CHOLECTEC,TO 15MCI/DOSE",75104,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,187.21,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,170.50,300.70,percent of total billed charges,
TC99M-SUL COLL,75105,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,155.00,1239.81,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US NEEDLE GUIDANCE-INTERV RAD,75106,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,,174.90,,,,,,,154.77,548.00,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,73.70,129.98,percent of total billed charges,
"TC99M-MDP,UP TO 30MCI/DOSE",75107,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,134.00000,127.30000,Amish/Mennonite,Amish Mennonite,,73.70,,,,,,,67.00,129.98,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,inpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,TC,111.65,,,,,,,111.65,196.91,percent of total billed charges,
"TLD/IN VIVO DOSIMETRY,SIMPLE-TECH",75109,CDM,333,RC,77331,CPT,,,facility,outpatient,,,203.00000,192.85000,Amish/Mennonite,Amish Mennonite,TC,111.65,,,,,,,101.50,1035.23,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,111.10,195.94,percent of total billed charges,
"US GUIDANCE,VASC ACC-INTER RAD-TECH",75112,CDM,402,RC,76937,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,TC,111.10,,,,,,,101.00,548.00,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,inpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,TC,1075.80,,,,,,,1075.80,1897.32,percent of total billed charges,
U.S.EXTREMITY+DOPPLER W/COMPR-TECH,75114,CDM,402,RC,76936,CPT,,,facility,outpatient,,,1956.00000,1858.20000,Amish/Mennonite,Amish Mennonite,TC,1075.80,,,,,,,384.16,1897.32,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1027.00000,975.65000,Amish/Mennonite,Amish Mennonite,TC,564.85,,,,,,,564.85,996.19,percent of total billed charges,
"XRAY/UGI SERIES,DOUBLE CONTRST-TECH",75115,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1027.00000,975.65000,Amish/Mennonite,Amish Mennonite,TC,564.85,,,,,,,513.50,5169.06,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,inpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,5115.55,9021.97,percent of total billed charges,
SPECT/CTMULTAREA1DAY/SGL>2DAY-TECH,75116,CDM,340,RC,78832,CPT,,,facility,outpatient,,,9301.00000,8835.95000,Amish/Mennonite,Amish Mennonite,TC,5115.55,,,,,,,4467.66,9021.97,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,inpatient,,,1110.00000,1054.50000,Amish/Mennonite,Amish Mennonite,TC,610.50,,,,,,,610.50,1076.70,percent of total billed charges,
OPTHALM B-SCAN ONE EYE,7513,CDM,402,RC,76512,CPT,,,facility,outpatient,,,1110.00000,1054.50000,Amish/Mennonite,Amish Mennonite,TC,610.50,,,,,,,384.16,1076.70,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,90.60000,86.07000,Amish/Mennonite,Amish Mennonite,,49.83,,,,,,,44.39,87.88,percent of total billed charges,
SHTH MICRO ACCESS 4FR X 10CM,75136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,90.60000,86.07000,Amish/Mennonite,Amish Mennonite,,49.83,,,,,,,41.59,90.60,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE NITRIX .014 X 80CM,75137,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,248.06,491.06,percent of total billed charges,
GWIRE COMMND 18 ST 4G .018 300.,75138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,232.37,506.25,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,24.50,48.50,percent of total billed charges,
CATH IMPRESS 4FR X 30CM,75139,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,50.00000,47.50000,Amish/Mennonite,Amish Mennonite,,27.50,,,,,,,22.95,50.00,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,inpatient,,,3480.00000,3306.00000,Amish/Mennonite,Amish Mennonite,TC,1914.00,,,,,,,1914.00,3375.60,percent of total billed charges,
INTESTINE IMAGING TC,7514,CDM,340,RC,78290,CPT,,,facility,outpatient,,,3480.00000,3306.00000,Amish/Mennonite,Amish Mennonite,TC,1914.00,,,,,,,1609.99,3375.60,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,321.56,636.56,percent of total billed charges,
GWIRE V18 STR .018 X 110CM,75140,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,301.22,656.25,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL STR 5FR 70CM,75141,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,127.72,278.25,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,23870.00000,22676.50000,Amish/Mennonite,Amish Mennonite,,13128.50,,,,,,,11696.30,23153.90,percent of total billed charges,
CATH WAVELINQ 4FR,75142,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,23870.00000,22676.50000,Amish/Mennonite,Amish Mennonite,,13128.50,,,,,,,10956.33,23870.00,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,inpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,2978.80,5253.52,percent of total billed charges,
TRAUMA LVL 2 WO PRE-NOTIFICATION,75143,CDM,459,RC,,,,,facility,outpatient,,,5416.00000,5145.20000,Amish/Mennonite,Amish Mennonite,,2978.80,,,,,,,2708.00,5253.52,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,inpatient,,,326.80000,310.46000,Amish/Mennonite,Amish Mennonite,90,179.74,,,,,,,179.74,317.00,percent of total billed charges,
MYCOPLASMA PNEUMONIAE BY PCR (MRPR) SO,75146,CDM,300,RC,87581,CPT,,,facility,outpatient,,,326.80000,310.46000,Amish/Mennonite,Amish Mennonite,90,179.74,,,,,,,36.26,1833.46,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,inpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,90,182.05,,,,,,,182.05,321.07,percent of total billed charges,
"MANGANESE, BLOOD SO TECH",75147,CDM,300,RC,83785,CPT,,,facility,outpatient,,,331.00000,314.45000,Amish/Mennonite,Amish Mennonite,90,182.05,,,,,,,27.54,1290.24,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,inpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,TC,340.45,,,,,,,340.45,600.43,percent of total billed charges,
OPHTH BIOMETRY ULTRASND A MODE,7515,CDM,402,RC,76519,CPT,,,facility,outpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,TC,340.45,,,,,,,309.50,600.43,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,inpatient,,,244.40000,232.18000,Amish/Mennonite,Amish Mennonite,90,134.42,,,,,,,134.42,237.07,percent of total billed charges,
INFLIXIMAB ABS REFLEX SO TECH,75150,CDM,300,RC,82397,CPT,,,facility,outpatient,,,244.40000,232.18000,Amish/Mennonite,Amish Mennonite,90,134.42,,,,,,,14.59,729.98,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,inpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,90,290.95,,,,,,,290.95,513.13,percent of total billed charges,
CNS DEMYLEINATING DIS SO,75151,CDM,300,RC,86255,CPT,,,facility,outpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,90,290.95,,,,,,,12.45,1539.22,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,inpatient,,,75.70000,71.92000,Amish/Mennonite,Amish Mennonite,90,41.63,,,,,,,41.63,73.43,percent of total billed charges,
MAGNESIUM RBC (65612) SO,75153,CDM,300,RC,83735,CPT,,,facility,outpatient,,,75.70000,71.92000,Amish/Mennonite,Amish Mennonite,90,41.63,,,,,,,6.92,356.54,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
AVUL NAIL PLT PRTL/COMPLT SMPL-TECH,75154,CDM,510,RC,11730,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,93.50,207.54,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,inpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,51.15,90.21,percent of total billed charges,
EVACUATION SUBUNGUAL HEMATOMA-TECH,75155,CDM,510,RC,11740,CPT,,,facility,outpatient,,,93.00000,88.35000,Amish/Mennonite,Amish Mennonite,,51.15,,,,,,,46.50,134.64,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,inpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,143.55,253.17,percent of total billed charges,
"ARTHROCENT,MAJ JT/BUR;U.S.GUID-TECH",75156,CDM,510,RC,20611,CPT,,,facility,outpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,130.50,308.32,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,inpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,292.60,516.04,percent of total billed charges,
"THORAC,NDL/CATH;W/IMAG GUID-TECH",75158,CDM,510,RC,32555,CPT,,,facility,outpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,266.00,645.77,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
INSERT NON-INDWELLING BLAD CATH-TECH,75159,CDM,510,RC,51701,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,75.00,145.50,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,inpatient,,,126.70000,120.36000,Amish/Mennonite,Amish Mennonite,TC,69.69,,,,,,,69.69,122.90,percent of total billed charges,
OM SNG VW CHEST-B READER-COMPL,7516,CDM,320,RC,99199,CPT,,,facility,outpatient,,,126.70000,120.36000,Amish/Mennonite,Amish Mennonite,TC,69.69,,,,,,,63.35,122.90,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
INSERTION TEMP INDWELL/CATHETR-TECH,75160,CDM,510,RC,51702,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,95.50,185.27,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,,132.00,,,,,,,132.00,232.80,percent of total billed charges,
INJ PROC-HYSTEROSALPINGOGRAM-TECH,75161,CDM,510,RC,58340,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,,132.00,,,,,,,120.00,232.80,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,inpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,,261.80,,,,,,,261.80,461.72,percent of total billed charges,
LUMBAR PUNCTURE DIAGNOSTIC-TECH,75162,CDM,510,RC,62270,CPT,,,facility,outpatient,,,476.00000,452.20000,Amish/Mennonite,Amish Mennonite,,261.80,,,,,,,238.00,723.34,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
"RMVL FB,EXTRNL EYE;CRNL W/SLIT-TECH",75163,CDM,510,RC,65222,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,95.50,185.27,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L26CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,75164,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 6MM 130CM ULTRAVERSE 018 CK,75168,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 75CM ULTRAVERSE 035,75169,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 75CM ULTRAVERSE 035,75170,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUIDE AL.75 CRV 6FR 100CM COR SS NYL PTFE,75172,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,inpatient,1,mL,451.78000,429.19000,Amish/Mennonite,Amish Mennonite,,248.48,,,,,,,248.48,438.23,percent of total billed charges,
BEVACIZUMAB-AWWB SOLN 25 MG/ML 4 ML,75176,CDM,636,RC,Q5107,HCPCS,55513020601,NDC,facility,outpatient,1,mL,451.78000,429.19000,Amish/Mennonite,Amish Mennonite,,248.48,,,,,,,28.85,438.23,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,inpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.70,13.58,percent of total billed charges,
SMOKING/TOBAC COUN VS >3-10MIN-TECH,75178,CDM,510,RC,99406,CPT,,,facility,outpatient,,,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.00,31.12,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,inpatient,,,27.00000,25.65000,Amish/Mennonite,Amish Mennonite,,14.85,,,,,,,14.85,26.19,percent of total billed charges,
SMOKING/TOBAC COUN VS>10 MIN-TECH,75179,CDM,510,RC,99407,CPT,,,facility,outpatient,,,27.00000,25.65000,Amish/Mennonite,Amish Mennonite,,14.85,,,,,,,13.50,31.12,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
"APHASIA ASSESSMENT,SLP-TECH",75180,CDM,444,RC,96105,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,93.50,264.00,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,inpatient,,,543.00000,515.85000,Amish/Mennonite,Amish Mennonite,,298.65,,,,,,,298.65,526.71,percent of total billed charges,
ABD PARACENTESIS;W/IMAG GUID-TECH,75181,CDM,510,RC,49083,CPT,,,facility,outpatient,,,543.00000,515.85000,Amish/Mennonite,Amish Mennonite,,298.65,,,,,,,271.50,979.27,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,inpatient,,,415.00000,394.25000,Amish/Mennonite,Amish Mennonite,,228.25,,,,,,,228.25,402.55,percent of total billed charges,
APPL-CLUBFOOT CAST-TECH,75182,CDM,510,RC,29450,CPT,,,facility,outpatient,,,415.00000,394.25000,Amish/Mennonite,Amish Mennonite,,228.25,,,,,,,149.83,402.55,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
"ARTER PUNC,WITHDRAW BLD FOR DX-TECH",75183,CDM,510,RC,36600,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,22.50,134.64,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
"APPL SK GRF,<100 SQ CM;ADL 25-TECH",75184,CDM,510,RC,15276,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,inpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,125.40,221.16,percent of total billed charges,
"ARTHORCENT,INT JT/BUR;U.S.GUID-TECH",75185,CDM,510,RC,20606,CPT,,,facility,outpatient,,,228.00000,216.60000,Amish/Mennonite,Amish Mennonite,,125.40,,,,,,,114.00,723.34,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,inpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,18.15,32.01,percent of total billed charges,
"ANNUAL DEPR SCREENING,15 MIN-TECH",75186,CDM,510,RC,G0444,HCPCS,,,facility,outpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,16.50,32.01,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
AMNIOCENTESIS;THERAPEUT FL RED-TECH,75187,CDM,510,RC,59001,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,317.72,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,inpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,109.45,193.03,percent of total billed charges,
"BIOPSY SALIVARY GLAND,NDL W/US-TECH",75188,CDM,510,RC,42400,CPT,,,facility,outpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,99.50,734.90,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,113.85,200.79,percent of total billed charges,
"ARTHROCENT,SM JT/BUR;U.S.GUID-TECH",75189,CDM,510,RC,20604,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,103.50,308.32,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,inpatient,,,890.00000,845.50000,Amish/Mennonite,Amish Mennonite,,489.50,,,,,,,489.50,863.30,percent of total billed charges,
CLSD TX DIST PHAL W MANIP EA-TECH,75190,CDM,510,RC,26755,CPT,,,facility,outpatient,,,890.00000,845.50000,Amish/Mennonite,Amish Mennonite,,489.50,,,,,,,227.78,863.30,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
ADDL SERVICES-AFTER HOURS-TECH,75191,CDM,510,RC,99050,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,25.50,49.47,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
BINOCULAR MICROSCOPY-SEP PROC-TECH,75192,CDM,510,RC,92504,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,23.50,45.59,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,inpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,,679.25,,,,,,,679.25,1197.95,percent of total billed charges,
CL TRT DISTAL RADIOULNR DISLOC-TECH,75193,CDM,510,RC,25675,CPT,,,facility,outpatient,,,1235.00000,1173.25000,Amish/Mennonite,Amish Mennonite,,679.25,,,,,,,227.78,1197.95,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,116.60,205.64,percent of total billed charges,
ASP BREAST CYST-ONE-TECH,75194,CDM,510,RC,19000,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,,116.60,,,,,,,106.00,734.90,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,inpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,28.05,49.47,percent of total billed charges,
ASP BRST CYS-EA ADL-TECH,75195,CDM,510,RC,19001,CPT,,,facility,outpatient,,,51.00000,48.45000,Amish/Mennonite,Amish Mennonite,,28.05,,,,,,,25.50,49.47,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,inpatient,,,893.00000,848.35000,Amish/Mennonite,Amish Mennonite,,491.15,,,,,,,491.15,866.21,percent of total billed charges,
CLTX FX WGHT BEARG ART POR FIX-TECH,75197,CDM,510,RC,27824,CPT,,,facility,outpatient,,,893.00000,848.35000,Amish/Mennonite,Amish Mennonite,,491.15,,,,,,,227.78,866.21,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,inpatient,,,467.00000,443.65000,Amish/Mennonite,Amish Mennonite,,256.85,,,,,,,256.85,452.99,percent of total billed charges,
CHALAZION (MULT SAME LID)-TECH,75198,CDM,510,RC,67801,CPT,,,facility,outpatient,,,467.00000,443.65000,Amish/Mennonite,Amish Mennonite,,256.85,,,,,,,233.50,1011.64,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,inpatient,,,1534.00000,1457.30000,Amish/Mennonite,Amish Mennonite,,843.70,,,,,,,843.70,1487.98,percent of total billed charges,
BRST BX;MAGNETIC RESON GUID-TECH,75199,CDM,610,RC,19086,CPT,,,facility,outpatient,,,1534.00000,1457.30000,Amish/Mennonite,Amish Mennonite,,843.70,,,,,,,767.00,2161.00,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,inpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,15.40,27.16,percent of total billed charges,
COUNSEL VISIT/ NEED FOR LNG SC-TECH,75200,CDM,510,RC,G0296,HCPCS,,,facility,outpatient,,,28.00000,26.60000,Amish/Mennonite,Amish Mennonite,,15.40,,,,,,,14.00,96.61,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,inpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,,181.50,,,,,,,181.50,320.10,percent of total billed charges,
CORNEAL SCRAPING-TECH,75201,CDM,510,RC,65430,CPT,,,facility,outpatient,,,330.00000,313.50000,Amish/Mennonite,Amish Mennonite,,181.50,,,,,,,165.00,416.79,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,inpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,138.60,244.44,percent of total billed charges,
BIOPSY OF NAIL UNIT-TECH,75203,CDM,510,RC,11755,CPT,,,facility,outpatient,,,252.00000,239.40000,Amish/Mennonite,Amish Mennonite,,138.60,,,,,,,126.00,734.90,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,inpatient,,,1077.00000,1023.15000,Amish/Mennonite,Amish Mennonite,,592.35,,,,,,,592.35,1044.69,percent of total billed charges,
"BRST BX;STEREOTAC,EA ADL-TECH",75204,CDM,320,RC,19082,CPT,,,facility,outpatient,,,1077.00000,1023.15000,Amish/Mennonite,Amish Mennonite,,592.35,,,,,,,538.50,1044.69,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,inpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,569.80,1004.92,percent of total billed charges,
"BRST BX;ULTRASOUND,EA ADL-TECH",75205,CDM,361,RC,19084,CPT,,,facility,outpatient,,,1036.00000,984.20000,Amish/Mennonite,Amish Mennonite,,569.80,,,,,,,569.80,5271.00,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,inpatient,,,956.00000,908.20000,Amish/Mennonite,Amish Mennonite,,525.80,,,,,,,525.80,927.32,percent of total billed charges,
CL TRT PHAL SHFT FX;W/MANIP-TECH,75206,CDM,510,RC,26725,CPT,,,facility,outpatient,,,956.00000,908.20000,Amish/Mennonite,Amish Mennonite,,525.80,,,,,,,227.78,927.32,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,inpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,203.50,358.90,percent of total billed charges,
CRYOSRG LASHES/TRICHIASIS-TECH,75207,CDM,510,RC,67825,CPT,,,facility,outpatient,,,370.00000,351.50000,Amish/Mennonite,Amish Mennonite,,203.50,,,,,,,185.00,358.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,inpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,,167.20,,,,,,,167.20,294.88,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17271-TECH",75208,CDM,510,RC,17271,CPT,,,facility,outpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,,167.20,,,,,,,152.00,294.88,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,inpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,319.00,562.60,percent of total billed charges,
CHALAZION (MULT DIFF LID)-TECH,75209,CDM,510,RC,67805,CPT,,,facility,outpatient,,,580.00000,551.00000,Amish/Mennonite,Amish Mennonite,,319.00,,,,,,,283.85,562.60,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,inpatient,,,694.00000,659.30000,Amish/Mennonite,Amish Mennonite,,381.70,,,,,,,381.70,673.18,percent of total billed charges,
CHEMODENERVATION EXTRAOCULAR M-TECH,75210,CDM,510,RC,67345,CPT,,,facility,outpatient,,,694.00000,659.30000,Amish/Mennonite,Amish Mennonite,,381.70,,,,,,,283.85,673.18,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,inpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,96.80,170.72,percent of total billed charges,
"DESTRUC,MAL LES;0.5CM OR LESS-TECH",75211,CDM,510,RC,17260,CPT,,,facility,outpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,88.00,207.54,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,238.70,420.98,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM-17266-TECH",75212,CDM,510,RC,17266,CPT,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,217.00,420.98,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
CHEMODENERV ECCR GL;BOTH AXIL-TECH,75213,CDM,510,RC,64650,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,114.50,308.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,inpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,195.80,345.32,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17263-TECH",75215,CDM,510,RC,17263,CPT,,,facility,outpatient,,,356.00000,338.20000,Amish/Mennonite,Amish Mennonite,,195.80,,,,,,,178.00,345.32,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,inpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,392.70,692.58,percent of total billed charges,
CLSD TX CALCANEAL FX WO MANIP-TECH,75216,CDM,510,RC,28400,CPT,,,facility,outpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,,392.70,,,,,,,227.78,692.58,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,inpatient,,,912.00000,866.40000,Amish/Mennonite,Amish Mennonite,,501.60,,,,,,,501.60,884.64,percent of total billed charges,
CL TRT TRIMAL ANK FX;WO MANIP-TECH,75217,CDM,510,RC,27816,CPT,,,facility,outpatient,,,912.00000,866.40000,Amish/Mennonite,Amish Mennonite,,501.60,,,,,,,227.78,884.64,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,inpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,212.85,375.39,percent of total billed charges,
"DESTRUC,MAL LES;2.1 TO 3.0CM-17273-TECH",75218,CDM,510,RC,17273,CPT,,,facility,outpatient,,,387.00000,367.65000,Amish/Mennonite,Amish Mennonite,,212.85,,,,,,,193.50,417.31,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,inpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,,129.80,,,,,,,129.80,228.92,percent of total billed charges,
DILATION/CATH SALIVARY DUCT-TECH,75219,CDM,510,RC,42660,CPT,,,facility,outpatient,,,236.00000,224.20000,Amish/Mennonite,Amish Mennonite,,129.80,,,,,,,118.00,531.90,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,inpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,147.40,259.96,percent of total billed charges,
"DESTRUC,MAL LES;0.6 TO 1.0CM-17261-TECH",75220,CDM,510,RC,17261,CPT,,,facility,outpatient,,,268.00000,254.60000,Amish/Mennonite,Amish Mennonite,,147.40,,,,,,,134.00,259.96,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,inpatient,,,1431.00000,1359.45000,Amish/Mennonite,Amish Mennonite,,787.05,,,,,,,787.05,1388.07,percent of total billed charges,
CLSD TX SPRA/TRNSCNDL FEM FX-TECH,75221,CDM,510,RC,27501,CPT,,,facility,outpatient,,,1431.00000,1359.45000,Amish/Mennonite,Amish Mennonite,,787.05,,,,,,,227.78,1388.07,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,inpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,158.95,280.33,percent of total billed charges,
DILATION OF LACRIMAL PUNCTUM-TECH,75222,CDM,510,RC,68801,CPT,,,facility,outpatient,,,289.00000,274.55000,Amish/Mennonite,Amish Mennonite,,158.95,,,,,,,144.50,416.79,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,inpatient,,,965.00000,916.75000,Amish/Mennonite,Amish Mennonite,,530.75,,,,,,,530.75,936.05,percent of total billed charges,
CL TX HUM CONDYL FX WO MANIP-TECH,75223,CDM,510,RC,24576,CPT,,,facility,outpatient,,,965.00000,916.75000,Amish/Mennonite,Amish Mennonite,,530.75,,,,,,,227.78,936.05,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
"DIL URETH STRICTR,MALE;INITIAL-TECH",75225,CDM,510,RC,53600,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,114.50,254.03,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,inpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,,210.10,,,,,,,210.10,370.54,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17264-TECH",75226,CDM,510,RC,17264,CPT,,,facility,outpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,,210.10,,,,,,,191.00,417.31,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
DEST PLANTAR DIGITAL NERVE-TECH,75227,CDM,510,RC,64632,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,129.50,308.32,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,HP,127.05,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-PHD-TECH,75228,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,HP,127.05,,,,,,,115.50,224.07,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,inpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,12.10,21.34,percent of total billed charges,
"FACE-TO-FACE COUNS,GRP,30MIN-TECH",75229,CDM,510,RC,G0473,HCPCS,,,facility,outpatient,,,22.00000,20.90000,Amish/Mennonite,Amish Mennonite,,12.10,,,,,,,11.00,31.12,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,inpatient,,,326.00000,309.70000,Amish/Mennonite,Amish Mennonite,,179.30,,,,,,,179.30,316.22,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17262-TECH",75230,CDM,510,RC,17262,CPT,,,facility,outpatient,,,326.00000,309.70000,Amish/Mennonite,Amish Mennonite,,179.30,,,,,,,163.00,316.22,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,53.35,94.09,percent of total billed charges,
ENDOMETRIAL SMPL CONJ W/COLPOS-TECH,75231,CDM,510,RC,58110,CPT,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,,53.35,,,,,,,48.50,94.09,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,inpatient,,,458.00000,435.10000,Amish/Mennonite,Amish Mennonite,,251.90,,,,,,,251.90,444.26,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17274-TECH",75232,CDM,510,RC,17274,CPT,,,facility,outpatient,,,458.00000,435.10000,Amish/Mennonite,Amish Mennonite,,251.90,,,,,,,229.00,444.26,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,inpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,190.85,336.59,percent of total billed charges,
"DESTRUC,MAL LES;1.1 TO 2.0CM-17272-TECH",75233,CDM,510,RC,17272,CPT,,,facility,outpatient,,,347.00000,329.65000,Amish/Mennonite,Amish Mennonite,,190.85,,,,,,,173.50,336.59,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,inpatient,,,1005.00000,954.75000,Amish/Mennonite,Amish Mennonite,,552.75,,,,,,,552.75,974.85,percent of total billed charges,
"CLIP,AXILLA W/IMAG 1 LESION-TECH",75234,CDM,320,RC,10035,CPT,,,facility,outpatient,,,1005.00000,954.75000,Amish/Mennonite,Amish Mennonite,,552.75,,,,,,,502.50,974.85,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,inpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,,207.90,,,,,,,207.90,366.66,percent of total billed charges,
"EXC SNG EXT PAPILLA/TAG,ANUS-TECH",75235,CDM,510,RC,46220,CPT,,,facility,outpatient,,,378.00000,359.10000,Amish/Mennonite,Amish Mennonite,,207.90,,,,,,,189.00,1231.54,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,inpatient,,,787.00000,747.65000,Amish/Mennonite,Amish Mennonite,,432.85,,,,,,,432.85,763.39,percent of total billed charges,
RPR EYNEL 1.1-2.5CM CMPLX-TECH,75237,CDM,510,RC,13151,CPT,,,facility,outpatient,,,787.00000,747.65000,Amish/Mennonite,Amish Mennonite,,432.85,,,,,,,393.50,763.39,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,inpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,17.05,30.07,percent of total billed charges,
FIT CNT LENS -TRT OCC SURF DS-TECH,75238,CDM,510,RC,92071,CPT,,,facility,outpatient,,,31.00000,29.45000,Amish/Mennonite,Amish Mennonite,,17.05,,,,,,,15.50,30.07,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,inpatient,,,37.65000,35.77000,Amish/Mennonite,Amish Mennonite,,20.71,,,,,,,20.71,36.52,percent of total billed charges,
GRANULOMA REMOVAL-TECH,75239,CDM,510,RC,69799,CPT,,,facility,outpatient,,,37.65000,35.77000,Amish/Mennonite,Amish Mennonite,,20.71,,,,,,,18.82,242.55,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,inpatient,,,1455.00000,1382.25000,Amish/Mennonite,Amish Mennonite,,800.25,,,,,,,800.25,1411.35,percent of total billed charges,
IMAGE-GUID FLUID COLL DR CATH-TECH,75242,CDM,510,RC,10030,CPT,,,facility,outpatient,,,1455.00000,1382.25000,Amish/Mennonite,Amish Mennonite,,800.25,,,,,,,668.09,1411.35,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
"FNA US GUIDANCE,1ST LESION-TECH",75244,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,734.90,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,inpatient,,,377.50000,358.62000,Amish/Mennonite,Amish Mennonite,,207.62,,,,,,,207.62,366.18,percent of total billed charges,
"HEMORRHOIDECT,SINGLE COLUMN, EXTRNL-TECH",75245,CDM,510,RC,46999,CPT,,,facility,outpatient,,,377.50000,358.62000,Amish/Mennonite,Amish Mennonite,,207.62,,,,,,,188.75,952.28,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,inpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,408.37,percent of total billed charges,
"GASTROS TUBE-CHG,PERC W/O REV-TECH",75246,CDM,510,RC,43762,CPT,,,facility,outpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,210.50,408.37,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,113.85,200.79,percent of total billed charges,
INJ PROC FOR PEYRONIE DISEASE-TECH,75248,CDM,510,RC,54200,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,,113.85,,,,,,,103.50,254.03,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,63.25,111.55,percent of total billed charges,
INJ PROC;RAD TRCR-ID SENTIN ND-TECH,75249,CDM,320,RC,38792,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,57.50,419.70,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,inpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,295.90,521.86,percent of total billed charges,
INJ PROC HIP ARTHROGR;WO/ANES-TECH,75250,CDM,510,RC,27093,CPT,,,facility,outpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,269.00,521.86,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,inpatient,,,87.75000,83.36000,Amish/Mennonite,Amish Mennonite,,48.26,,,,,,,48.26,85.12,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 4-CLIN-TECH",75251,CDM,510,RC,99499,CPT,,,facility,outpatient,,,87.75000,83.36000,Amish/Mennonite,Amish Mennonite,,48.26,,,,,,,43.88,85.12,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,inpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,,167.20,,,,,,,167.20,294.88,percent of total billed charges,
INJ PROC PERC TRT EXT PSEUDOAN-TECH,75252,CDM,510,RC,36002,CPT,,,facility,outpatient,,,304.00000,288.80000,Amish/Mennonite,Amish Mennonite,,167.20,,,,,,,152.00,645.77,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
"INJ,ENZYME,PALMAR FASCIAL CORD-TECH",75253,CDM,510,RC,20527,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,308.32,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,inpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,190.30,335.62,percent of total billed charges,
"FC,EARS,EYE,NS,LP,MEM;OVER 2CM-TECH",75254,CDM,510,RC,11313,CPT,,,facility,outpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,173.00,417.31,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,330.00,582.00,percent of total billed charges,
LUMBAR PUNCTURE(RADIOLOGY)-TECH,75255,CDM,510,RC,62272,CPT,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,300.00,723.34,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,inpatient,,,719.00000,683.05000,Amish/Mennonite,Amish Mennonite,,395.45,,,,,,,395.45,697.43,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;LUMBOSA-TECH,75256,CDM,510,RC,62304,CPT,,,facility,outpatient,,,719.00000,683.05000,Amish/Mennonite,Amish Mennonite,,395.45,,,,,,,359.50,825.21,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,inpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,,399.30,,,,,,,399.30,704.22,percent of total billed charges,
MYELOGR VIA LUMBAR INJ;CERVIC-TECH,75257,CDM,510,RC,62302,CPT,,,facility,outpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,,399.30,,,,,,,363.00,825.21,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,inpatient,,,482.00000,457.90000,Amish/Mennonite,Amish Mennonite,,265.10,,,,,,,265.10,467.54,percent of total billed charges,
"NASAL/SINUS ENDOSC,DIAG,MAXIL-TECH",75258,CDM,510,RC,31233,CPT,,,facility,outpatient,,,482.00000,457.90000,Amish/Mennonite,Amish Mennonite,,265.10,,,,,,,241.00,467.54,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,inpatient,,,786.00000,746.70000,Amish/Mennonite,Amish Mennonite,,432.30,,,,,,,432.30,762.42,percent of total billed charges,
LASER TRABECULOPLASTY-INITIAL-TECH,75259,CDM,510,RC,65855,CPT,,,facility,outpatient,,,786.00000,746.70000,Amish/Mennonite,Amish Mennonite,,432.30,,,,,,,393.00,762.42,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,inpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,,119.35,,,,,,,119.35,210.49,percent of total billed charges,
INCISION OF LABIAL FRENUM-TECH,75260,CDM,510,RC,40806,CPT,,,facility,outpatient,,,217.00000,206.15000,Amish/Mennonite,Amish Mennonite,,119.35,,,,,,,108.50,531.90,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,206.25,363.75,percent of total billed charges,
INJ PROC-SHOULDER ARTHROGRAPHY-TECH,75261,CDM,510,RC,23350,CPT,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,187.50,363.75,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,inpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,,256.30,,,,,,,256.30,452.02,percent of total billed charges,
INJ PROC WRIST ARTHROGRAPHY-TECH,75262,CDM,510,RC,25246,CPT,,,facility,outpatient,,,466.00000,442.70000,Amish/Mennonite,Amish Mennonite,,256.30,,,,,,,233.00,452.02,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,inpatient,,,423.00000,401.85000,Amish/Mennonite,Amish Mennonite,,232.65,,,,,,,232.65,410.31,percent of total billed charges,
"DESTR LESION(S),ANUS,SMPL;CRYO-TECH",75263,CDM,510,RC,46916,CPT,,,facility,outpatient,,,423.00000,401.85000,Amish/Mennonite,Amish Mennonite,,232.65,,,,,,,188.67,410.31,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,inpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,84.70,149.38,percent of total billed charges,
NASOPHARYNGOSCOPY W/ENDOSCOPE-TECH,75264,CDM,510,RC,92511,CPT,,,facility,outpatient,,,154.00000,146.30000,Amish/Mennonite,Amish Mennonite,,84.70,,,,,,,77.00,202.77,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,inpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,72.05,127.07,percent of total billed charges,
"INTRALESIONAL INJECTNS,8/MORE-TECH",75265,CDM,510,RC,11901,CPT,,,facility,outpatient,,,131.00000,124.45000,Amish/Mennonite,Amish Mennonite,,72.05,,,,,,,65.50,207.54,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,inpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,23.10,40.74,percent of total billed charges,
NEG PRESS WD TH-DME;>50SQ CM-TECH,75267,CDM,510,RC,97606,CPT,,,facility,outpatient,,,42.00000,39.90000,Amish/Mennonite,Amish Mennonite,,23.10,,,,,,,21.00,417.31,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,HP,100.10,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-MD-TECH,75268,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,HP,100.10,,,,,,,91.00,176.54,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,inpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,HP,76.45,,,,,,,76.45,134.83,percent of total billed charges,
NEUROPSY TST;ADL HR-PHD-TECH,75270,CDM,918,RC,96133,CPT,,,facility,outpatient,,,139.00000,132.05000,Amish/Mennonite,Amish Mennonite,HP,76.45,,,,,,,69.50,134.83,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,HP,78.65,,,,,,,78.65,138.71,percent of total billed charges,
NEUROBEH EXM-PHD;FIRST HOUR-TECH,75271,CDM,918,RC,96116,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,HP,78.65,,,,,,,71.50,138.71,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,HP,100.10,,,,,,,100.10,176.54,percent of total billed charges,
NEUROPSYCH TST EVAL;1ST HR-PHD-TECH,75272,CDM,918,RC,96132,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,HP,100.10,,,,,,,91.00,176.54,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,inpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,,396.00,,,,,,,396.00,698.40,percent of total billed charges,
MONITOR FLUID PRESSURE CMPRT-TECH,75273,CDM,510,RC,20950,CPT,,,facility,outpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,,396.00,,,,,,,360.00,734.90,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,inpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,186.45,328.83,percent of total billed charges,
PERC TENDON LAVAGE CALCIFIC-TECH,75274,CDM,510,RC,20999,CPT,,,facility,outpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,169.50,328.83,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,inpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,,157.30,,,,,,,157.30,277.42,percent of total billed charges,
NEG PRESS WND THER</=50SQ CM-TECH,75275,CDM,510,RC,97607,CPT,,,facility,outpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,,157.30,,,,,,,143.00,417.31,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,inpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,211.75,373.45,percent of total billed charges,
"NASAL ENDOSCOPY,DIAG,UNIL/BIL-TECH",75276,CDM,510,RC,31231,CPT,,,facility,outpatient,,,385.00000,365.75000,Amish/Mennonite,Amish Mennonite,,211.75,,,,,,,184.34,373.45,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,inpatient,,,968.00000,919.60000,Amish/Mennonite,Amish Mennonite,,532.40,,,,,,,532.40,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASOUND GUID-TECH,75277,CDM,402,RC,19285,CPT,,,facility,outpatient,,,968.00000,919.60000,Amish/Mennonite,Amish Mennonite,,532.40,,,,,,,384.16,938.96,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,inpatient,,,849.00000,806.55000,Amish/Mennonite,Amish Mennonite,,466.95,,,,,,,466.95,823.53,percent of total billed charges,
PL BR LOC DEV;ULTRASND;EA ADL-TECH,75278,CDM,402,RC,19286,CPT,,,facility,outpatient,,,849.00000,806.55000,Amish/Mennonite,Amish Mennonite,,466.95,,,,,,,384.16,823.53,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,inpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,,356.40,,,,,,,356.40,628.56,percent of total billed charges,
"PHLEBECTOMYS,<10 INCISIONS-TECH",75279,CDM,510,RC,37799,CPT,,,facility,outpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,,356.40,,,,,,,324.00,645.77,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,inpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,248.05,437.47,percent of total billed charges,
PLC BR LOC DEV;MAMMOGRAPHIC G-TECH,75280,CDM,401,RC,19281,CPT,,,facility,outpatient,,,451.00000,428.45000,Amish/Mennonite,Amish Mennonite,,248.05,,,,,,,225.50,1692.33,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,inpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,,173.25,,,,,,,173.25,305.55,percent of total billed charges,
PL BR LOC DEV;MAMMOGRAPHIC GD-TECH,75281,CDM,401,RC,19282,CPT,,,facility,outpatient,,,315.00000,299.25000,Amish/Mennonite,Amish Mennonite,,173.25,,,,,,,157.50,305.55,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,HP,35.20,,,,,,,35.20,62.08,percent of total billed charges,
PSYCH/NPSYCH TST;FIRST30 MIN-TECH,75282,CDM,918,RC,96136,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,HP,35.20,,,,,,,32.00,62.08,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,HP,28.60,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH-TECH;ADL 30 MIN-TECH,75283,CDM,918,RC,96139,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,HP,28.60,,,,,,,26.00,50.44,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,inpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,134.20,236.68,percent of total billed charges,
"PUNC ASP ABS,HEM,BUL,CYST-BRST-TECH",75284,CDM,510,RC,10160,CPT,,,facility,outpatient,,,244.00000,231.80000,Amish/Mennonite,Amish Mennonite,,134.20,,,,,,,122.00,417.31,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,inpatient,,,652.00000,619.40000,Amish/Mennonite,Amish Mennonite,,358.60,,,,,,,358.60,632.44,percent of total billed charges,
"REPAIR,COMPLEX,1.1-2.5 CM-TECH",75285,CDM,510,RC,13120,CPT,,,facility,outpatient,,,652.00000,619.40000,Amish/Mennonite,Amish Mennonite,,358.60,,,,,,,326.00,639.36,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,105.05,185.27,percent of total billed charges,
RMV/BIVALVE;FULL ARM/LEG CAST-TECH,75286,CDM,510,RC,29705,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,,105.05,,,,,,,95.50,277.40,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,inpatient,,,889.00000,844.55000,Amish/Mennonite,Amish Mennonite,,488.95,,,,,,,488.95,862.33,percent of total billed charges,
"REPAIR,COMPLEX,2.6-7.5 CM-TECH",75287,CDM,510,RC,13132,CPT,,,facility,outpatient,,,889.00000,844.55000,Amish/Mennonite,Amish Mennonite,,488.95,,,,,,,444.50,862.33,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,inpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,497.20,876.88,percent of total billed charges,
RPR LIP UP TO 1/2 VERT HT-TECH,75288,CDM,510,RC,40652,CPT,,,facility,outpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,452.00,876.88,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,inpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,389.40,686.76,percent of total billed charges,
RMVL IMPLANT;SUPERFICIAL-TECH,75289,CDM,510,RC,20670,CPT,,,facility,outpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,354.00,1692.33,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,HP,74.80,,,,,,,74.80,131.92,percent of total billed charges,
PSY/MED CONF EXAM/DATA RES-PHD-TECH,75290,CDM,900,RC,90887,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,HP,74.80,,,,,,,68.00,131.92,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,inpatient,,,987.00000,937.65000,Amish/Mennonite,Amish Mennonite,,542.85,,,,,,,542.85,957.39,percent of total billed charges,
"RMVL IMPLANT,HAND/FINGER-TECH",75291,CDM,510,RC,26320,CPT,,,facility,outpatient,,,987.00000,937.65000,Amish/Mennonite,Amish Mennonite,,542.85,,,,,,,493.50,1692.33,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,inpatient,,,639.00000,607.05000,Amish/Mennonite,Amish Mennonite,,351.45,,,,,,,351.45,619.83,percent of total billed charges,
SEVERING OF TARSORRHAPHY-TECH,75292,CDM,510,RC,67710,CPT,,,facility,outpatient,,,639.00000,607.05000,Amish/Mennonite,Amish Mennonite,,351.45,,,,,,,319.50,1011.64,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,Amish/Mennonite,Amish Mennonite,,1008.15,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTHERAPY OF FLUID COLLEC-TECH,75293,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,Amish/Mennonite,Amish Mennonite,,1008.15,,,,,,,916.50,1778.01,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,inpatient,,,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
SACCADIC MOVEMENT EXAM-TECH,75294,CDM,471,RC,92700,CPT,,,facility,outpatient,,,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,7.58,25.57,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,65.45,115.43,percent of total billed charges,
SUBCONJUNCTIVAL INJECTION-TECH,75295,CDM,510,RC,68200,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,,65.45,,,,,,,59.50,416.79,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,inpatient,,,492.00000,467.40000,Amish/Mennonite,Amish Mennonite,,270.60,,,,,,,270.60,477.24,percent of total billed charges,
TEMP CLOSURE-EYELIDS BY SUTURE-TECH,75296,CDM,510,RC,67875,CPT,,,facility,outpatient,,,492.00000,467.40000,Amish/Mennonite,Amish Mennonite,,270.60,,,,,,,246.00,1011.64,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,HP,33.00,,,,,,,33.00,58.20,percent of total billed charges,
PSYCH/NPSYCH;ADL 30 MIN-TECH,75297,CDM,918,RC,96137,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,HP,33.00,,,,,,,30.00,58.20,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,155.65,274.51,percent of total billed charges,
"SCLP,NK,HNDS,FT,GEN;OVER 2.0CM-TECH",75298,CDM,510,RC,11308,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,141.50,417.31,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
TRACH TB CHANGE PRIOR TO FISTU-TECH,75299,CDM,510,RC,31502,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,242.55,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,HP,28.60,,,,,,,28.60,50.44,percent of total billed charges,
PSYCH/NPSYCH TST-TECH;1ST 30MN-TECH,75300,CDM,918,RC,96138,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,HP,28.60,,,,,,,26.00,50.44,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
SNG/MULT INJ SCLER SOL;LMB/TRK-TECH,75301,CDM,510,RC,36468,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,104.00,417.31,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,inpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,183.70,323.98,percent of total billed charges,
TRACHEOBRONCHOSC THRU TRACHEOS-TECH,75302,CDM,510,RC,31615,CPT,,,facility,outpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,167.00,531.90,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,inpatient,,,198.50000,188.57000,Amish/Mennonite,Amish Mennonite,,109.17,,,,,,,109.17,192.54,percent of total billed charges,
TRANSD SPIDR VEIN LASER ABLATN-TECH,75303,CDM,510,RC,37799,CPT,,,facility,outpatient,,,198.50000,188.57000,Amish/Mennonite,Amish Mennonite,,109.17,,,,,,,99.25,645.77,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,inpatient,,,1511.00000,1435.45000,Amish/Mennonite,Amish Mennonite,,831.05,,,,,,,831.05,1465.67,percent of total billed charges,
SEC CLOSURE WOUND DEHISCENCE-TECH,75304,CDM,510,RC,13160,CPT,,,facility,outpatient,,,1511.00000,1435.45000,Amish/Mennonite,Amish Mennonite,,831.05,,,,,,,755.50,1910.62,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,inpatient,,,368.00000,349.60000,Amish/Mennonite,Amish Mennonite,,202.40,,,,,,,202.40,356.96,percent of total billed charges,
PROBING OF LACRIMAL CANALICULI-TECH,75306,CDM,510,RC,68840,CPT,,,facility,outpatient,,,368.00000,349.60000,Amish/Mennonite,Amish Mennonite,,202.40,,,,,,,184.00,356.96,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,inpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,178.20,314.28,percent of total billed charges,
THYROID BIOPSY-TECH,75307,CDM,510,RC,60100,CPT,,,facility,outpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,162.00,734.90,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,inpatient,,,622.00000,590.90000,Amish/Mennonite,Amish Mennonite,,342.10,,,,,,,342.10,603.34,percent of total billed charges,
CLTX TARSAL BN FX WO MANIP EA-TECH,75308,CDM,510,RC,28450,CPT,,,facility,outpatient,,,622.00000,590.90000,Amish/Mennonite,Amish Mennonite,,342.10,,,,,,,227.78,603.34,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,inpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.65450,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,60505-0159-00,NDC,,,facility,outpatient,1,EA,1.19000,1.13000,Amish/Mennonite,Amish Mennonite,,0.65450,,,,,,,0.59500,1.15,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,inpatient,1,EA,6.69000,6.36000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,3.68,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,00245-0013-01,NDC,,,facility,outpatient,1,EA,6.69000,6.36000,Amish/Mennonite,Amish Mennonite,,3.68,,,,,,,3.35,6.49,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,inpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.15,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,50268-0725-15,NDC,,,facility,outpatient,1,EA,2.09000,1.98000,Amish/Mennonite,Amish Mennonite,,1.15,,,,,,,1.04,2.03,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,inpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.12100,0.21340,percent of total billed charges,
SOTALOL TAB 120 MG,75310,CDM,250,RC,69584-0842-10,NDC,,,facility,outpatient,1,EA,0.22000,0.21000,Amish/Mennonite,Amish Mennonite,,0.12100,,,,,,,0.11000,0.21340,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,inpatient,1,mL,70300.00000,66785.00000,Amish/Mennonite,Amish Mennonite,,38665.00,,,,,,,38665.00,68191.00,percent of total billed charges,
BROLUCIZUMAB-DBLL SOLN 6 MG/0.05 ML (BEOVU),75311,CDM,636,RC,J0179,HCPCS,00078082761,NDC,facility,outpatient,1,mL,70300.00000,66785.00000,Amish/Mennonite,Amish Mennonite,,38665.00,,,,,,,346.19,68191.00,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
SODIUM CHLORIDE NASAL 0.65% GEL,75313,CDM,250,RC,00225-0528-48,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,251.25000,238.69000,Amish/Mennonite,Amish Mennonite,,138.19,,,,,,,123.11,243.71,percent of total billed charges,
GUIDEWIRE URO L150CM DIA0.035IN HYDRPHLC ANG,75314,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,251.25000,238.69000,Amish/Mennonite,Amish Mennonite,,138.19,,,,,,,115.32,251.25,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,358.31,709.31,percent of total billed charges,
GUIDEWIRE VASC .012IN 325CM COR VIPERWIRE ADV,75315,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,335.64,731.25,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX HYDR+ SFT PGTL TAPR TIP,75319,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 2MM 150CM ULTRAVERSE 014 CK,75320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L167MM DIA38MM SHTH OD7.1MM ID6MM PROX COMP,75321,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 30CM 3.5MM 150CM ULTRAVERSE 014,75322,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,18.95,37.52,percent of total billed charges,
CATH ANGIO INFIN 3DRC 4FR 100,75323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,38.68000,36.75000,Amish/Mennonite,Amish Mennonite,,21.27,,,,,,,17.75,38.68,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 2MM 150CM ULTRAVERSE 014 CK,75325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,inpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
SIMETHICONE 20 MG TAB-CHEW,75327,CDM,250,RC,63739-0225-10-00025,NDC,,,facility,outpatient,1,EA,0.07000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.50,9.70,percent of total billed charges,
HEARING AID BATTERY TESTER,75328,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,,5.50,,,,,,,5.00,9.70,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
FUNDUS PHOTO W/INTERP & REPORT,75329,CDM,361,RC,,,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,5271.00,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 5FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DURMTR,75330,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,Amish/Mennonite,Amish Mennonite,,175.91,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH SET 12.0,75331,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,Amish/Mennonite,Amish Mennonite,,175.91,,,,,,,146.81,319.84,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75332,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,436.80000,414.96000,Amish/Mennonite,Amish Mennonite,,240.24,,,,,,,214.03,423.70,percent of total billed charges,
INTRO SHEATH FLXR ANSEL 5FRX90CM,75333,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,436.80000,414.96000,Amish/Mennonite,Amish Mennonite,,240.24,,,,,,,200.49,436.80,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,inpatient,1,mL,34526.48000,32800.15000,Amish/Mennonite,Amish Mennonite,,18989.56,,,,,,,18989.56,33490.69,percent of total billed charges,
CANAKINUMAB SOLN 150 MG/ML (ILARIS),75350,CDM,636,RC,J0638,HCPCS,00078073461,NDC,facility,outpatient,1,mL,34526.48000,32800.15000,Amish/Mennonite,Amish Mennonite,,18989.56,,,,,,,141.00,33490.69,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,inpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,5.11,9.01,percent of total billed charges,
TICAGRELOR TAB 45 MG,75352,CDM,250,RC,00186-0777-39-00050,NDC,,,facility,outpatient,1,EA,9.29000,8.83000,Amish/Mennonite,Amish Mennonite,,5.11,,,,,,,4.64,9.01,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,inpatient,1,mL,267.19000,253.83000,Amish/Mennonite,Amish Mennonite,,146.95,,,,,,,146.95,259.17,percent of total billed charges,
RITUXIMAB-ABBS SOLN 10 MG/ML 10 ML (TRUXIMA),75354,CDM,636,RC,Q5115,HCPCS,63459010310,NDC,facility,outpatient,1,mL,267.19000,253.83000,Amish/Mennonite,Amish Mennonite,,146.95,,,,,,,31.18,259.17,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,Amish/Mennonite,Amish Mennonite,,490.88,,,,,,,437.32,865.73,percent of total billed charges,
DEV HNDL DETACH LP RUBY COIL.,75355,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,Amish/Mennonite,Amish Mennonite,,490.88,,,,,,,409.66,892.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 2CM,75358,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,116.86,231.34,percent of total billed charges,
INTRO FLXR ANSEL STR 6FR 55CM,75359,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,109.47,238.50,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,inpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,TC,2163.15,,,,,,,2163.15,3815.01,percent of total billed charges,
PARATHYROID PLAN SPECT/CT,7536,CDM,340,RC,78072,CPT,,,facility,outpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,TC,2163.15,,,,,,,1966.50,3815.01,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9780.75000,9291.71000,Amish/Mennonite,Amish Mennonite,,5379.41,,,,,,,4792.57,9487.33,percent of total billed charges,
CATH REPERFUS JET 7,75360,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9780.75000,9291.71000,Amish/Mennonite,Amish Mennonite,,5379.41,,,,,,,4489.36,9780.75,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC CS J CRV .014IN 190CM CS ACTY,75362,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PERI PLTN SS,75363,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,231.49,504.34,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,inpatient,1,EA,7882.93000,7488.79000,Amish/Mennonite,Amish Mennonite,,4335.61,,,,,,,4335.61,7646.44,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 420 MG MDV,75364,CDM,636,RC,Q5117,HCPCS,55513016401,NDC,facility,outpatient,1,EA,7882.93000,7488.79000,Amish/Mennonite,Amish Mennonite,,4335.61,,,,,,,43.25,7646.44,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 75CM ULTRAVERSE 035,75365,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 75CM ULTRAVERSE 035,75366,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 75CM ULTRAVERSE 035,75367,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 40MM.,75368,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L26CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,75369,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM SUPPORT,75370,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,inpatient,,,1327.58000,1261.20000,Amish/Mennonite,Amish Mennonite,,730.17,,,,,,,730.17,1287.75,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 1.5CM,75371,CDM,279,RC,C1889,HCPCS,,,facility,outpatient,,,1327.58000,1261.20000,Amish/Mennonite,Amish Mennonite,,730.17,,,,,,,663.79,1287.75,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA8MM 0.035IN NUMBER OF LOOP 2.8 PLAT,75372,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,152.81,332.93,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,163.14,322.94,percent of total billed charges,
MICROCOIL EMB L7CM DIA10MM 0.035IN NUMBER OF LOOP 2.2 PLAT,75373,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,152.81,332.93,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB MIC EXT EMBOLUS L20CM DIA16MM 0.035IN 4 LOOP PLAT,75374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA6MM 0.035IN GWIRE NEST,75375,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,152.81,332.93,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,10006-0730-27,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,inpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
ZINC SULFATE 220 MG TAB,75376,CDM,250,RC,57896-0865-01,NDC,,,facility,outpatient,1,EA,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,TC,29.15,,,,,,,29.15,51.41,percent of total billed charges,
"CALORIC VESTIB BIL,BITHER-AUD-TECH",75380,CDM,920,RC,92537,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,TC,29.15,,,,,,,26.50,51.41,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,96.25,169.75,percent of total billed charges,
SARS-COV-2 TECH,75385,CDM,306,RC,87635,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,51.31,2438.63,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,inpatient,1,EA,29396.04000,27926.24000,Amish/Mennonite,Amish Mennonite,,16167.82,,,,,,,16167.82,28514.16,percent of total billed charges,
TEPROTUMUMAB-TRBW POWD-INJ 500 MG (TEPEZZA),75386,CDM,636,RC,J3241,HCPCS,75987013015,NDC,facility,outpatient,1,EA,29396.04000,27926.24000,Amish/Mennonite,Amish Mennonite,,16167.82,,,,,,,359.09,28514.16,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,inpatient,1,mL,1417.48000,1346.61000,Amish/Mennonite,Amish Mennonite,,779.61,,,,,,,779.61,1374.96,percent of total billed charges,
NATALIZUMAB SOLN 20 MG/ML 15 ML,75387,CDM,636,RC,J2323,HCPCS,64406000801,NDC,facility,outpatient,1,mL,1417.48000,1346.61000,Amish/Mennonite,Amish Mennonite,,779.61,,,,,,,24.13,1374.96,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L20CM DIA7MM 360DEG SFT DETACH TARGET,75389,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 8.2MM 22FR 33CM HDRPH GORE DRYSEAL,75390,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1383.88,3015.00,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD 35CC W51XH73MM D13MM 80GM TI POLYUR SIL,75391,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,1002.10,1767.34,percent of total billed charges,
MRI BRAIN STEREOTACTIC FOR SURG PLAN,75393,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1822.00000,1730.90000,Amish/Mennonite,Amish Mennonite,TC,1002.10,,,,,,,484.28,2161.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 75CM ULTRAVERSE 035,75394,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 4MM 130CM ULTRAVERSE 035,75395,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GD STRG 6FR 119CM R2P DESTINATION SLNDR,75396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,550.80,1200.00,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L22CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75397,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2.5MM 150CM ULTRAVERSE 014,75409,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,TC,61.60,,,,,,,61.60,108.64,percent of total billed charges,
ORTHOPANTOGRAM,7541,CDM,320,RC,70355,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,TC,61.60,,,,,,,42.95,484.28,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,84.28,166.84,percent of total billed charges,
INTRO GLDESHTH 6FRX10CM 0.021,75410,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,78.95,172.00,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4648.88,9202.88,percent of total billed charges,
CATH SHOCKWAVE S IVL 3.0X40MM,75411,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,9487.50000,9013.12000,Amish/Mennonite,Amish Mennonite,,5218.12,,,,,,,4354.76,9487.50,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 190CM DURASTEL PLMR,75412,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYS CRYO VISUAL ICE,75413,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,83.60,147.44,percent of total billed charges,
PT SENSORY INTEGRATION,75414,CDM,420,RC,97533,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,,83.60,,,,,,,76.00,264.00,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,inpatient,,,9920.00000,9424.00000,Amish/Mennonite,Amish Mennonite,TC,5456.00,,,,,,,5456.00,9622.40,percent of total billed charges,
MRI WHOLE BODY W&WO CONTRAST-TECH,75415,CDM,610,RC,76498,CPT,,,facility,outpatient,,,9920.00000,9424.00000,Amish/Mennonite,Amish Mennonite,TC,5456.00,,,,,,,484.28,9622.40,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,inpatient,,,456.00000,433.20000,Amish/Mennonite,Amish Mennonite,,250.80,,,,,,,250.80,442.32,percent of total billed charges,
FB REMOVAL THROAT-TECH,75416,CDM,361,RC,,,,,facility,outpatient,,,456.00000,433.20000,Amish/Mennonite,Amish Mennonite,,250.80,,,,,,,250.80,5271.00,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,inpatient,1,EA,40006.82000,38006.48000,Amish/Mennonite,Amish Mennonite,,22003.75,,,,,,,22003.75,38806.62,percent of total billed charges,
INOTUZUMAB OZOGAMICIN POWD-INJ 0.9 MG,75417,CDM,636,RC,J9229,HCPCS,00008010001,NDC,facility,outpatient,1,EA,40006.82000,38006.48000,Amish/Mennonite,Amish Mennonite,,22003.75,,,,,,,2698.05,38806.62,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,inpatient,1,mL,9841.58000,9349.50000,Amish/Mennonite,Amish Mennonite,,5412.87,,,,,,,5412.87,9546.33,percent of total billed charges,
TALIMOGENE LAHERPAREPVEC SUSP-INJ 100 MILLIONPFU/ML (IMLYGIC),75418,CDM,250,RC,J9325,HCPCS,55513007901,NDC,facility,outpatient,1,mL,9841.58000,9349.50000,Amish/Mennonite,Amish Mennonite,,5412.87,,,,,,,73.55,9546.33,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,inpatient,1,GM,2.34000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
FLUTICASONE TOPICAL 0.005% OINT,75422,CDM,250,RC,45802-0221-11,NDC,,,facility,outpatient,1,GM,2.34000,2.23000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,inpatient,1,mL,271.28000,257.72000,Amish/Mennonite,Amish Mennonite,,149.20,,,,,,,149.20,263.14,percent of total billed charges,
BROMFENAC OPHTHALMIC 0.09% SOLN,75423,CDM,250,RC,62332-0508-17,NDC,,,facility,outpatient,1,mL,271.28000,257.72000,Amish/Mennonite,Amish Mennonite,,149.20,,,,,,,135.64,263.14,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 300CM TRUTRQ HDRPHB,75424,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 190CM SS HDRPHB HTRQ,75425,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 12MM 75CM ULTRAVERSE 035,75426,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,inpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,TC,1394.80,,,,,,,1394.80,2459.92,percent of total billed charges,
PLC PROX EXTEN PROSTH RPR AOR-TECH,75429,CDM,320,RC,75958,CPT,,,facility,outpatient,,,2536.00000,2409.20000,Amish/Mennonite,Amish Mennonite,TC,1394.80,,,,,,,990.94,2459.92,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,189.38000,179.91000,Amish/Mennonite,Amish Mennonite,,104.16,,,,,,,92.80,183.70,percent of total billed charges,
EXTENSION GW STD .035IN 155CM WH HTRQ STF PRFL,75432,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,189.38000,179.91000,Amish/Mennonite,Amish Mennonite,,104.16,,,,,,,86.93,189.38,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,inpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.31,percent of total billed charges,
ALPRAZOLAM TAB-DIS 0.25 MG,75438,CDM,250,RC,J8499,HCPCS,49884011074,NDC,facility,outpatient,1,EA,3.41000,3.24000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.31,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15 WASTE",75439,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,inpatient,,,14452.00000,13729.40000,Amish/Mennonite,Amish Mennonite,TC,7948.60,,,,,,,7948.60,14018.44,percent of total billed charges,
PET W/CT-WHOLE BODY,7544,CDM,404,RC,78816,CPT,,,facility,outpatient,,,14452.00000,13729.40000,Amish/Mennonite,Amish Mennonite,TC,7948.60,,,,,,,4549.00,14018.44,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML",75440,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 100ML WASTE",75441,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML",75442,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML WASTE",75443,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,JW,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML WASTE",75444,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,JW,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 125ML",75445,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML WASTE",75446,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 500ML",75447,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML",75448,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 300, 50ML WASTE",75449,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 100ML",75450,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE M200, 10 ML WASTE",75451,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.63085,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M200 TO 10ML,75452,CDM,254,RC,Q9966,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.63085,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD",75453,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.40920,2.21,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML",75454,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 50ML",75455,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT ISOVUE M300 TO 15ML,75456,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 75ML WASTE",75457,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370, 150ML",75458,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10",75459,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT ISOVUE 370,200ML",75460,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5",75461,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,2.79,7.08,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.99,12.33,percent of total billed charges,
MRI GADOLINIUM 1ML-WASTE,75462,CDM,254,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD",75463,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.40920,0.97000,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,inpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,26.95,47.53,percent of total billed charges,
MRI EOVIST 1 ML WASTE,75465,CDM,636,RC,A9581,HCPCS,,,facility,outpatient,,,49.00000,46.55000,Amish/Mennonite,Amish Mennonite,,26.95,,,,,,,22.80,47.53,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD",75466,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
"MRI GADAVIST.1ML,7.5MLSD WASTE",75467,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.40920,0.97000,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 150ML WASTE",75468,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,15MLSD WASTE",75469,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.40920,2.21,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 10 WASTE",75470,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"CT VISIPAQUE 320, 100ML WASTE",75471,CDM,254,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,inpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,6.99,12.33,percent of total billed charges,
MRI PROHANCE 1ML 20 ML SDV WASTE,75472,CDM,636,RC,A9579,HCPCS,,,facility,outpatient,,,12.71000,12.07000,Amish/Mennonite,Amish Mennonite,,6.99,,,,,,,2.31,12.33,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20 WASTE",75473,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 20",75474,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 15",75476,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,2.79,7.76,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,inpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,4.01,7.08,percent of total billed charges,
"MRI GAD MULTIHANCE 1ML, 5 WASTE",75477,CDM,254,RC,A9577,HCPCS,,,facility,outpatient,,,7.30000,6.93000,Amish/Mennonite,Amish Mennonite,,4.01,,,,,,,2.79,7.08,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,inpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,1.25,2.21,percent of total billed charges,
"MRI GADAVIST.1ML,10MLSD WASTE",75478,CDM,636,RC,A9585,HCPCS,,,facility,outpatient,,,2.28000,2.17000,Amish/Mennonite,Amish Mennonite,,1.25,,,,,,,0.40920,2.21,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2282.18,4517.77,percent of total billed charges,
LEAD DEFIB L86CM ENDOCARD L HRT S CRV PASS FIX QPLR STERD,75480,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,4657.50000,4424.62000,Amish/Mennonite,Amish Mennonite,,2561.62,,,,,,,2137.79,4657.50,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,inpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,5.00,percent of total billed charges,
FLUCONAZOLE 400 MG / 10 ML SUSP,75481,CDM,250,RC,16714-0696-01,NDC,,,facility,outpatient,1,mL,5.15000,4.89000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.58,5.00,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,907.50000,862.12000,Amish/Mennonite,Amish Mennonite,,499.12,,,,,,,444.68,880.27,percent of total billed charges,
TUBE ENDBR STD 7FR 65CM ARNDT PED 1 LUM VNT LP.,75483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,907.50000,862.12000,Amish/Mennonite,Amish Mennonite,,499.12,,,,,,,416.54,907.50,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,136.34,269.90,percent of total billed charges,
INTRO FLXR ANSEL MPA 5FR 70CM,75484,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,127.72,278.25,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHTH PINN STR 5FR 45CM,75485,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 2CM 6MM 130CM ULTRAVERSE 018 CK,75486,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER BLNDIL 25MM 100CM ZMED II 5CM RPD INFL,75487,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 2MM 150CM ULTRAVERSE 014 CK,75488,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L105MM DIA26MM SHTH OD6MM ID5.3MM PROX COMP,75489,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,17319.36,37732.80,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 3MM 150CM ULTRAVERSE 014 CK,75490,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM 5MM 150CM ULTRAVERSE 014 CK,75491,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,inpatient,,,1334.00000,1267.30000,Amish/Mennonite,Amish Mennonite,,733.70,,,,,,,733.70,1293.98,percent of total billed charges,
EXC TMR BACK FLANK SUBC >3CM-TECH,75492,CDM,510,RC,21931,CPT,,,facility,outpatient,,,1334.00000,1267.30000,Amish/Mennonite,Amish Mennonite,,733.70,,,,,,,667.00,1692.33,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,inpatient,,,474.00000,450.30000,Amish/Mennonite,Amish Mennonite,,260.70,,,,,,,260.70,459.78,percent of total billed charges,
NAS/SINUS ENDO SRG BX POLY DEB-TECH,75494,CDM,510,RC,31237,CPT,,,facility,outpatient,,,474.00000,450.30000,Amish/Mennonite,Amish Mennonite,,260.70,,,,,,,237.00,1801.19,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,inpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.37950,0.66930,percent of total billed charges,
LEVOTHYROXINE TAB 68.5 MCG (0.0685 MG),75497,CDM,250,RC,J8499,HCPCS,0078151919200050,NDC,facility,outpatient,1,EA,0.69000,0.66000,Amish/Mennonite,Amish Mennonite,,0.37950,,,,,,,0.34500,0.66930,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,inpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,,218.24,,,,,,,218.24,384.90,percent of total billed charges,
VESTIBULAR EVOKED MYOGENIC (VEMP),75499,CDM,471,RC,92700,CPT,,,facility,outpatient,,,396.80000,376.96000,Amish/Mennonite,Amish Mennonite,,218.24,,,,,,,23.25,384.90,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2797.00000,2657.15000,Amish/Mennonite,Amish Mennonite,90,1538.35,,,,,,,1538.35,2713.09,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE SO-TECH,75502,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2797.00000,2657.15000,Amish/Mennonite,Amish Mennonite,90,1538.35,,,,,,,266.02,13462.44,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,inpatient,,,177.50000,168.62000,Amish/Mennonite,Amish Mennonite,90,97.62,,,,,,,97.62,172.18,percent of total billed charges,
BULLOUS PEMP 180/230 IGG (BPAB) SO,75504,CDM,300,RC,83516,CPT,,,facility,outpatient,,,177.50000,168.62000,Amish/Mennonite,Amish Mennonite,90,97.62,,,,,,,11.91,594.19,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,inpatient,,,141.90000,134.80000,Amish/Mennonite,Amish Mennonite,90,78.05,,,,,,,78.05,137.64,percent of total billed charges,
ETHYLENE GLYCOL (ETGL) SO,75505,CDM,300,RC,80320,CPT,,,facility,outpatient,,,141.90000,134.80000,Amish/Mennonite,Amish Mennonite,90,78.05,,,,,,,70.95,1137.41,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,inpatient,,,147.90000,140.50000,Amish/Mennonite,Amish Mennonite,90,81.34,,,,,,,81.34,143.46,percent of total billed charges,
VOLATILE SCREEN SO TECH,75506,CDM,300,RC,80320,CPT,,,facility,outpatient,,,147.90000,140.50000,Amish/Mennonite,Amish Mennonite,90,81.34,,,,,,,73.95,1137.41,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,inpatient,,,166.60000,158.27000,Amish/Mennonite,Amish Mennonite,90,91.63,,,,,,,91.63,161.60,percent of total billed charges,
21-HYDROXYLASE AB SO,75509,CDM,300,RC,83516,CPT,,,facility,outpatient,,,166.60000,158.27000,Amish/Mennonite,Amish Mennonite,90,91.63,,,,,,,11.91,594.19,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,90,122.10,,,,,,,122.10,215.34,percent of total billed charges,
ETHYL GLUCURONIDE SCREEN SO,75511,CDM,300,RC,80307,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,90,122.10,,,,,,,63.40,3038.81,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,inpatient,,,2140.00000,2033.00000,Amish/Mennonite,Amish Mennonite,TC,1177.00,,,,,,,1177.00,2075.80,percent of total billed charges,
"CT-COLONGR,SCREENING,IM POSTPR-TECH",75514,CDM,350,RC,74263,CPT,,,facility,outpatient,,,2140.00000,2033.00000,Amish/Mennonite,Amish Mennonite,TC,1177.00,,,,,,,1070.00,2075.80,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,90,62.15,,,,,,,62.15,109.61,percent of total billed charges,
ETHYL GLUCURONIDE CONF SO,75515,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,90,62.15,,,,,,,56.50,788.42,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,inpatient,,,65.50000,62.22000,Amish/Mennonite,Amish Mennonite,90,36.02,,,,,,,36.02,63.53,percent of total billed charges,
"ALLERGEN, HYPERPNEUM SO",75518,CDM,300,RC,86001,CPT,,,facility,outpatient,,,65.50000,62.22000,Amish/Mennonite,Amish Mennonite,90,36.02,,,,,,,4.57,373.51,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,inpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,90,71.50,,,,,,,71.50,126.10,percent of total billed charges,
"PSEUDOCHOLINESTERATE, TOTAL SO",75519,CDM,300,RC,82480,CPT,,,facility,outpatient,,,130.00000,123.50000,Amish/Mennonite,Amish Mennonite,90,71.50,,,,,,,8.13,407.44,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,inpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,TC,459.25,,,,,,,459.25,809.95,percent of total billed charges,
XRAY/HYSTEROSALPINGOGRAM-TECH,75526,CDM,320,RC,74740,CPT,,,facility,outpatient,,,835.00000,793.25000,Amish/Mennonite,Amish Mennonite,TC,459.25,,,,,,,417.50,3942.79,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLING;>3 MUSCLES-TECH,75527,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,7.65,25.57,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,inpatient,1,mL,33.71000,32.03000,Amish/Mennonite,Amish Mennonite,,18.54,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 20 GM,75535,CDM,636,RC,J1459,HCPCS,44206043820,NDC,facility,outpatient,1,mL,33.71000,32.03000,Amish/Mennonite,Amish Mennonite,,18.54,,,,,,,16.86,83.21,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,281.28000,267.22000,Amish/Mennonite,Amish Mennonite,,154.70,,,,,,,154.70,272.84,percent of total billed charges,
AMNIOEXCL 3.5X3.5CM,75546,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,281.28000,267.22000,Amish/Mennonite,Amish Mennonite,,154.70,,,,,,,140.64,272.84,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,137.46000,130.59000,Amish/Mennonite,Amish Mennonite,,75.60,,,,,,,75.60,133.34,percent of total billed charges,
AMNIOEXCL 4X8CM,75555,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,137.46000,130.59000,Amish/Mennonite,Amish Mennonite,,75.60,,,,,,,68.73,192.52,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,79.20,139.68,percent of total billed charges,
"TC99M MYOVIEW, PER DOSE",75560,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,144.00000,136.80000,Amish/Mennonite,Amish Mennonite,,79.20,,,,,,,72.00,260.45,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,148.24,261.44,percent of total billed charges,
PRIMATRIX-4X4 SHEET,75570,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,101.38,261.44,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,inpatient,,,45.60000,43.32000,Amish/Mennonite,Amish Mennonite,90,25.08,,,,,,,25.08,44.23,percent of total billed charges,
LYTE & OSMOL CHLORIDE SO,75580,CDM,300,RC,82438,CPT,,,facility,outpatient,,,45.60000,43.32000,Amish/Mennonite,Amish Mennonite,90,25.08,,,,,,,5.17,254.68,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,inpatient,,,62.40000,59.28000,Amish/Mennonite,Amish Mennonite,90,34.32,,,,,,,34.32,60.53,percent of total billed charges,
LYTE & OSMOL MAGNESIUM SO,75581,CDM,300,RC,83735,CPT,,,facility,outpatient,,,62.40000,59.28000,Amish/Mennonite,Amish Mennonite,90,34.32,,,,,,,6.92,356.54,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,inpatient,,,45.20000,42.94000,Amish/Mennonite,Amish Mennonite,90,24.86,,,,,,,24.86,43.84,percent of total billed charges,
LYTE & OSMOL SODIUM SO,75582,CDM,300,RC,84302,CPT,,,facility,outpatient,,,45.20000,42.94000,Amish/Mennonite,Amish Mennonite,90,24.86,,,,,,,5.02,254.68,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,inpatient,,,44.20000,41.99000,Amish/Mennonite,Amish Mennonite,90,24.31,,,,,,,24.31,42.87,percent of total billed charges,
LYTE & OSMOL PHOSPHORUS SO,75583,CDM,300,RC,84100,CPT,,,facility,outpatient,,,44.20000,41.99000,Amish/Mennonite,Amish Mennonite,90,24.31,,,,,,,4.90,254.68,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,inpatient,,,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,90,1.10,,,,,,,1.10,1.94,percent of total billed charges,
LYTE & OSMOL SO,75584,CDM,300,RC,84999,CPT,,,facility,outpatient,,,2.00000,1.90000,Amish/Mennonite,Amish Mennonite,90,1.10,,,,,,,1.00,1.94,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,Amish/Mennonite,Amish Mennonite,90,195.58,,,,,,,195.58,344.93,percent of total billed charges,
CASPR2-IGG SO,75585,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,Amish/Mennonite,Amish Mennonite,90,195.58,,,,,,,12.45,1539.22,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,inpatient,,,355.60000,337.82000,Amish/Mennonite,Amish Mennonite,90,195.58,,,,,,,195.58,344.93,percent of total billed charges,
LGI1-IGG CBA SO,75586,CDM,300,RC,86255,CPT,,,facility,outpatient,,,355.60000,337.82000,Amish/Mennonite,Amish Mennonite,90,195.58,,,,,,,12.45,1539.22,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,inpatient,,,112.20000,106.59000,Amish/Mennonite,Amish Mennonite,90,61.71,,,,,,,61.71,108.83,percent of total billed charges,
HEMOGLOBIN PLASMA SO,75587,CDM,300,RC,83051,CPT,,,facility,outpatient,,,112.20000,106.59000,Amish/Mennonite,Amish Mennonite,90,61.71,,,,,,,4.90,373.51,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,inpatient,,,383.70000,364.52000,Amish/Mennonite,Amish Mennonite,90,211.03,,,,,,,211.03,372.19,percent of total billed charges,
CELIAC HLA2 SO,75588,CDM,310,RC,81382,CPT,,,facility,outpatient,,,383.70000,364.52000,Amish/Mennonite,Amish Mennonite,90,211.03,,,,,,,127.80,6468.09,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,inpatient,,,6329.00000,6012.55000,Amish/Mennonite,Amish Mennonite,90,3480.95,,,,,,,3480.95,6139.13,percent of total billed charges,
RED CELL GENOTYPING PANEL SO,75589,CDM,310,RC,0282U,HCPCS,,,facility,outpatient,,,6329.00000,6012.55000,Amish/Mennonite,Amish Mennonite,90,3480.95,,,,,,,2520.00,6139.13,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,inpatient,,,297.00000,282.15000,Amish/Mennonite,Amish Mennonite,,163.35,,,,,,,163.35,288.09,percent of total billed charges,
CIRCUMCISION W CLAMP/BLOCK-TECH,75592,CDM,510,RC,54150,CPT,,,facility,outpatient,,,297.00000,282.15000,Amish/Mennonite,Amish Mennonite,,163.35,,,,,,,148.50,2139.65,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,inpatient,,,1873.00000,1779.35000,Amish/Mennonite,Amish Mennonite,TC,1030.15,,,,,,,1030.15,1816.81,percent of total billed charges,
CT-T SPINE; W/CONTRAST-TECH,75593,CDM,352,RC,72129,CPT,,,facility,outpatient,,,1873.00000,1779.35000,Amish/Mennonite,Amish Mennonite,TC,1030.15,,,,,,,936.50,1820.00,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 6FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,75594,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 7FR 100CM,75595,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,277.83,549.99,percent of total billed charges,
CATH GUID MPA1 6FR 125CM,75596,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,567.00000,538.65000,Amish/Mennonite,Amish Mennonite,,311.85,,,,,,,260.25,567.00,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID JR5 6FR 100CM,75597,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA10MM CATH ID0.035IN LOOP 4.5 PERIPH,75598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO ANG MPA CRV 5FR 65CM SS NYL TRNB,75602,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 8MM 130CM ULTRAVERSE 035,75603,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,inpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,281.05,495.67,percent of total billed charges,
"PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)-TECH",75604,CDM,940,RC,99195,CPT,,,facility,outpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,,281.05,,,,,,,122.40,495.67,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
BSS PLUS SOLN 500 ML IRRIGATION,75605,CDM,250,RC,00065-0800-94,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,inpatient,,,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,,157.85,,,,,,,157.85,278.39,percent of total billed charges,
NEG PRESS WND THER;>50SQ CM-TECH,75606,CDM,510,RC,97608,CPT,,,facility,outpatient,,,287.00000,272.65000,Amish/Mennonite,Amish Mennonite,,157.85,,,,,,,143.50,417.31,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,inpatient,,,91836.00000,87244.20000,Amish/Mennonite,Amish Mennonite,,50509.80,,,,,,,50509.80,89080.92,percent of total billed charges,
"Y90 IBRITUMOMAB, RX",75607,CDM,344,RC,A9543,HCPCS,,,facility,outpatient,,,91836.00000,87244.20000,Amish/Mennonite,Amish Mennonite,,50509.80,,,,,,,45918.00,93760.51,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,inpatient,,,969.00000,920.55000,Amish/Mennonite,Amish Mennonite,TC,532.95,,,,,,,532.95,939.93,percent of total billed charges,
"RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY-TECH",75608,CDM,320,RC,73115,CPT,,,facility,outpatient,,,969.00000,920.55000,Amish/Mennonite,Amish Mennonite,TC,532.95,,,,,,,484.50,5445.97,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,Amish/Mennonite,Amish Mennonite,,5143.52,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA6MM CATH L120CM PTFE CVR ICAST.,75614,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,Amish/Mennonite,Amish Mennonite,,5143.52,,,,,,,4292.50,9351.85,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 6MM 75CM ULTRAVERSE 035,75616,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 75CM ULTRAVERSE 035,75617,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 75CM ULTRAVERSE 035,75618,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 40MM,75619,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 80CM ATLS AU 2CM,75621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,449.25,978.75,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X60X130,75622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,43.52000,41.34000,Amish/Mennonite,Amish Mennonite,,23.94,,,,,,,21.32,42.21,percent of total billed charges,
GUIDEWIRE VASC 15MM RDS J CRV TPR .038IN 145CM,75623,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,43.52000,41.34000,Amish/Mennonite,Amish Mennonite,,23.94,,,,,,,19.98,43.52,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 5MM 150CM ULTRAVERSE 014 CK,75624,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,inpatient,1,GM,9.60000,9.12000,Amish/Mennonite,Amish Mennonite,,5.28,,,,,,,5.28,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00115-1474-46,NDC,,,facility,outpatient,1,GM,9.60000,9.12000,Amish/Mennonite,Amish Mennonite,,5.28,,,,,,,4.80,9.31,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,inpatient,1,GM,6.88000,6.54000,Amish/Mennonite,Amish Mennonite,,3.78,,,,,,,3.78,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,00713-0637-37,NDC,,,facility,outpatient,1,GM,6.88000,6.54000,Amish/Mennonite,Amish Mennonite,,3.78,,,,,,,3.44,6.67,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,inpatient,1,GM,9.67000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,51672-4116-06,NDC,,,facility,outpatient,1,GM,9.67000,9.19000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,4.83,9.38,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,inpatient,1,GM,9.68000,9.20000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.39,percent of total billed charges,
METRONIDAZOLE TOPICAL 0.75% GEL,75625,CDM,250,RC,66993-0962-45,NDC,,,facility,outpatient,1,GM,9.68000,9.20000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,4.84,9.39,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 3MM 150CM ULTRAVERSE 014 CK,75626,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1745.62,3455.62,percent of total billed charges,
SYSTEM EMBL PRTC 3.2-4.2FR 4MM 320CM CRTD LWR,75627,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3562.50000,3384.38000,Amish/Mennonite,Amish Mennonite,,1959.38,,,,,,,1635.19,3562.50,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,inpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,34.76,61.30,percent of total billed charges,
CEFAZOLIN SOLN-OPHTH SD 180 MG/ML,75628,CDM,250,RC,J0690,HCPCS,2502101001018000,NDC,facility,outpatient,1,mL,63.20000,60.04000,Amish/Mennonite,Amish Mennonite,,34.76,,,,,,,1.28,61.30,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 9MM 130CM ULTRAVERSE 035,75629,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC STRG .014IN 182CM SS HDRPH LUGE 3,75630,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,11523-0096-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,inpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,45802-0395-04,NDC,,,facility,outpatient,1,GM,0.08000,0.07000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,65197-0401-01,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
VITAMIN A & D TOPICAL OINT,75631,CDM,250,RC,71399-0122-04,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
"ELECTRICAL STIMULATION, (UNATTENDED), CHRONIC",75632,CDM,420,RC,G0281,HCPCS,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10075.00000,9571.25000,Amish/Mennonite,Amish Mennonite,,5541.25,,,,,,,4936.75,9772.75,percent of total billed charges,
SYSTEM ATHRCMY HAWKONE H1-M,75633,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10075.00000,9571.25000,Amish/Mennonite,Amish Mennonite,,5541.25,,,,,,,4624.43,10075.00,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,inpatient,,,135.60000,128.82000,Amish/Mennonite,Amish Mennonite,90,74.58,,,,,,,74.58,131.53,percent of total billed charges,
COMPLEMENT 2 SO,75638,CDM,300,RC,86161,CPT,,,facility,outpatient,,,135.60000,128.82000,Amish/Mennonite,Amish Mennonite,90,74.58,,,,,,,12.40,628.12,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,inpatient,,,629.80000,598.31000,Amish/Mennonite,Amish Mennonite,90,346.39,,,,,,,346.39,610.91,percent of total billed charges,
PLASMA CELL PROLIFERATIVE DISORDER SO,75639,CDM,310,RC,88271,CPT,,,facility,outpatient,,,629.80000,598.31000,Amish/Mennonite,Amish Mennonite,90,346.39,,,,,,,20.36,1120.45,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,inpatient,,,223.90000,212.70000,Amish/Mennonite,Amish Mennonite,90,123.14,,,,,,,123.14,217.18,percent of total billed charges,
ADENOSINE DEAMINASE PF SO,75640,CDM,300,RC,84311,CPT,,,facility,outpatient,,,223.90000,212.70000,Amish/Mennonite,Amish Mennonite,90,123.14,,,,,,,8.37,373.51,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,inpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
VANCOMYCIN SOLN SD 50 MG/ML 0.5 ML INTRAOCULAR,75641,CDM,250,RC,J3370,HCPCS,6745703395005000,NDC,facility,outpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,3.24,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
"N-METHYLHISTAMINE,24HRU SO",75642,CDM,300,RC,82542,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,24.89,1137.41,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
VANCOMYCIN 500 MG/NS 500 ML RECTAL,75644,CDM,250,RC,67457-0339-50-50000,NDC,,,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,,309.65,,,,,,,309.65,546.11,percent of total billed charges,
AMNIOEXCEL 15MM DISC,75673,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,563.00000,534.85000,Amish/Mennonite,Amish Mennonite,,309.65,,,,,,,158.39,546.11,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,inpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,TC,2168.10,,,,,,,2168.10,3823.74,percent of total billed charges,
AORTIGRAPHY ABDOMINAL S+I-TECH,75674,CDM,320,RC,75625,CPT,,,facility,outpatient,,,3942.00000,3744.90000,Amish/Mennonite,Amish Mennonite,TC,2168.10,,,,,,,356.27,17311.25,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,inpatient,,,9708.00000,9222.60000,Amish/Mennonite,Amish Mennonite,TC,5339.40,,,,,,,5339.40,9416.76,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93459-TECH,75677,CDM,481,RC,93459,CPT,,,facility,outpatient,,,9708.00000,9222.60000,Amish/Mennonite,Amish Mennonite,TC,5339.40,,,,,,,4854.00,17574.00,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,inpatient,,,10317.00000,9801.15000,Amish/Mennonite,Amish Mennonite,TC,5674.35,,,,,,,5674.35,10007.49,percent of total billed charges,
CATH PLC COR ART RT/LT HRT CTH-TECH,75678,CDM,481,RC,93460,CPT,,,facility,outpatient,,,10317.00000,9801.15000,Amish/Mennonite,Amish Mennonite,TC,5674.35,,,,,,,5158.50,17574.00,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,987.13000,937.77000,Amish/Mennonite,Amish Mennonite,,542.92,,,,,,,542.92,957.52,percent of total billed charges,
MESHED 2X3 CM 4SQ CM,75680,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,987.13000,937.77000,Amish/Mennonite,Amish Mennonite,,542.92,,,,,,,240.68,957.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,inpatient,,,224.25000,213.04000,Amish/Mennonite,Amish Mennonite,,123.34,,,,,,,123.34,217.52,percent of total billed charges,
5X5CM BMW2021,75683,CDM,636,RC,Q4104,HCPCS,,,facility,outpatient,,,224.25000,213.04000,Amish/Mennonite,Amish Mennonite,,123.34,,,,,,,77.18,217.52,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1186.00000,1126.70000,Amish/Mennonite,Amish Mennonite,,652.30,,,,,,,652.30,1150.42,percent of total billed charges,
AMNIOEXCEL 12MM DISC,75684,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1186.00000,1126.70000,Amish/Mennonite,Amish Mennonite,,652.30,,,,,,,158.39,1150.42,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,TC,399.30,,,,,,,399.30,704.22,percent of total billed charges,
PENILE DOPPLER-TECH,75685,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,TC,399.30,,,,,,,363.00,704.22,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,inpatient,,,8822.00000,8380.90000,Amish/Mennonite,Amish Mennonite,TC,4852.10,,,,,,,4852.10,8557.34,percent of total billed charges,
CATH PLC COR ART LT HRT CATH 93458-TECH,75686,CDM,481,RC,93458,CPT,,,facility,outpatient,,,8822.00000,8380.90000,Amish/Mennonite,Amish Mennonite,TC,4852.10,,,,,,,4411.00,17574.00,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,35.20,62.08,percent of total billed charges,
PROLOTHERAPY SUBSEQUENT,75687,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,,35.20,,,,,,,32.00,62.08,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,inpatient,,,128.00000,121.60000,Amish/Mennonite,Amish Mennonite,,70.40,,,,,,,70.40,124.16,percent of total billed charges,
PROLOTHERAPY INITIAL,75688,CDM,940,RC,M0076,HCPCS,,,facility,outpatient,,,128.00000,121.60000,Amish/Mennonite,Amish Mennonite,,70.40,,,,,,,64.00,124.16,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,,526.35,,,,,,,526.35,928.29,percent of total billed charges,
TC99M MAG,75689,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,957.00000,909.15000,Amish/Mennonite,Amish Mennonite,,526.35,,,,,,,478.50,1267.58,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,inpatient,,,3352.00000,3184.40000,Amish/Mennonite,Amish Mennonite,TC,1843.60,,,,,,,1843.60,3251.44,percent of total billed charges,
SPECT SINGLE AREA/1DAY-TECH,75690,CDM,341,RC,78803,CPT,,,facility,outpatient,,,3352.00000,3184.40000,Amish/Mennonite,Amish Mennonite,TC,1843.60,,,,,,,1676.00,7180.14,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
TC99M PYP,75691,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,62.50,121.25,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,inpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,2302.85,4061.39,percent of total billed charges,
XRAY/VENOGRAPHY CAVAL INFERIOR-TECH,75693,CDM,320,RC,75825,CPT,,,facility,outpatient,,,4187.00000,3977.65000,Amish/Mennonite,Amish Mennonite,TC,2302.85,,,,,,,361.82,17311.25,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,inpatient,,,945.00000,897.75000,Amish/Mennonite,Amish Mennonite,TC,519.75,,,,,,,519.75,916.65,percent of total billed charges,
VENOGRAPHY EXTREMITY BILATERAL-TECH,75694,CDM,320,RC,75822,CPT,,,facility,outpatient,,,945.00000,897.75000,Amish/Mennonite,Amish Mennonite,TC,519.75,,,,,,,383.91,8543.92,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,inpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,TC,656.15,,,,,,,656.15,1157.21,percent of total billed charges,
XRY/ANGIOGRAPHY EXTREMITY UNI-TECH,75695,CDM,320,RC,75710,CPT,,,facility,outpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,TC,656.15,,,,,,,404.21,17311.25,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
10X16MD RTU15181016,75696,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
10X16TK RTU15191016,75697,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,98.24000,93.33000,Amish/Mennonite,Amish Mennonite,,54.03,,,,,,,54.03,95.29,percent of total billed charges,
10X20MD RTU15181020,75698,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,98.24000,93.33000,Amish/Mennonite,Amish Mennonite,,54.03,,,,,,,49.12,95.29,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
12X16TK RTU15191216,75699,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
12X16MD RTU 15181216,75700,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,288.75,509.25,percent of total billed charges,
24MM DISC GS 5024,75701,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.68,509.25,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,112.49000,106.87000,Amish/Mennonite,Amish Mennonite,,61.87,,,,,,,61.87,109.12,percent of total billed charges,
132SQ CM TK CM1520P,75702,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,112.49000,106.87000,Amish/Mennonite,Amish Mennonite,,61.87,,,,,,,51.64,109.12,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,412.50,727.50,percent of total billed charges,
18MM DISC GS 5180,75703,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,240.68,727.50,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,504.90,890.46,percent of total billed charges,
2CM X 2CM GS 5220,75704,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,240.68,890.46,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,241.88000,229.79000,Amish/Mennonite,Amish Mennonite,,133.03,,,,,,,133.03,234.62,percent of total billed charges,
2X4CM THIN 102010,75705,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,241.88000,229.79000,Amish/Mennonite,Amish Mennonite,,133.03,,,,,,,51.64,234.62,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,137.16,241.90,percent of total billed charges,
2X4 MEDIUM 102011,75706,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,51.64,241.90,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,76.24000,72.43000,Amish/Mennonite,Amish Mennonite,,41.93,,,,,,,41.93,73.95,percent of total billed charges,
320SQCM TK 1519320P,75707,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,76.24000,72.43000,Amish/Mennonite,Amish Mennonite,,41.93,,,,,,,38.12,73.95,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,684.00000,649.80000,Amish/Mennonite,Amish Mennonite,,376.20,,,,,,,376.20,663.48,percent of total billed charges,
3CM X 4CM GS 5340,75708,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,684.00000,649.80000,Amish/Mennonite,Amish Mennonite,,376.20,,,,,,,240.68,663.48,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,125.49000,119.22000,Amish/Mennonite,Amish Mennonite,,69.02,,,,,,,69.02,121.73,percent of total billed charges,
4X7THIN 402025,75709,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,125.49000,119.22000,Amish/Mennonite,Amish Mennonite,,69.02,,,,,,,51.64,121.73,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,,325.05,,,,,,,325.05,573.27,percent of total billed charges,
7CM X 7CM GS 5770,75710,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,591.00000,561.45000,Amish/Mennonite,Amish Mennonite,,325.05,,,,,,,240.68,573.27,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.93000,100.63000,Amish/Mennonite,Amish Mennonite,,58.26,,,,,,,58.26,102.75,percent of total billed charges,
8X16 TK FD 1520128,75711,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.93000,100.63000,Amish/Mennonite,Amish Mennonite,,58.26,,,,,,,51.64,102.75,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,115.05000,109.30000,Amish/Mennonite,Amish Mennonite,,63.28,,,,,,,63.28,111.60,percent of total billed charges,
6X12 XTK RTU 152272,75712,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,115.05000,109.30000,Amish/Mennonite,Amish Mennonite,,63.28,,,,,,,51.64,111.60,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,123.23000,117.07000,Amish/Mennonite,Amish Mennonite,,67.78,,,,,,,67.78,119.53,percent of total billed charges,
6X16 TK FD 1520616,75713,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,123.23000,117.07000,Amish/Mennonite,Amish Mennonite,,67.78,,,,,,,51.64,119.53,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
8X20MED RTU 1518160,75714,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK FD1520160,75715,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,inpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,58.29,102.80,percent of total billed charges,
8X20TK RTU1519160,75716,CDM,636,RC,Q4116,HCPCS,,,facility,outpatient,,,105.98000,100.68000,Amish/Mennonite,Amish Mennonite,,58.29,,,,,,,51.64,102.80,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,inpatient,,,757.00000,719.15000,Amish/Mennonite,Amish Mennonite,,416.35,,,,,,,416.35,734.29,percent of total billed charges,
ALVEOLOPLASTY 1 QUAD W/O EXT,75717,CDM,361,RC,D7320,HCPCS,,,facility,outpatient,,,757.00000,719.15000,Amish/Mennonite,Amish Mennonite,,416.35,,,,,,,416.35,5271.00,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,288.20,508.28,percent of total billed charges,
ADD ON SM BOWEL FOLLOW THRU-TECH,75719,CDM,320,RC,74248,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,TC,288.20,,,,,,,257.95,2630.66,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,inpatient,,,641.00000,608.95000,Amish/Mennonite,Amish Mennonite,,352.55,,,,,,,352.55,621.77,percent of total billed charges,
ALVEOPLASTY 1-3 TTH/SPACES,75720,CDM,361,RC,D7321,HCPCS,,,facility,outpatient,,,641.00000,608.95000,Amish/Mennonite,Amish Mennonite,,352.55,,,,,,,352.55,5271.00,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1207.50000,1147.12000,Amish/Mennonite,Amish Mennonite,,664.12,,,,,,,664.12,1171.28,percent of total billed charges,
AMNIOEXCEL 17MM DISC,75722,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1207.50000,1147.12000,Amish/Mennonite,Amish Mennonite,,664.12,,,,,,,158.39,1171.28,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,412.50,727.50,percent of total billed charges,
AMNIOEXCEL 18MM DISC,75723,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,158.39,727.50,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,288.75,509.25,percent of total billed charges,
AMNIOEXCEL 24MM DISC,75724,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,158.39,509.25,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,309.38,545.62,percent of total billed charges,
AMNIOEXCEL 2X3CM,75725,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,158.39,545.62,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,893.55000,848.87000,Amish/Mennonite,Amish Mennonite,,491.45,,,,,,,491.45,866.74,percent of total billed charges,
AMNIOEXCEL 2X2CM,75726,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,893.55000,848.87000,Amish/Mennonite,Amish Mennonite,,491.45,,,,,,,158.39,866.74,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,219.94000,208.94000,Amish/Mennonite,Amish Mennonite,,120.97,,,,,,,120.97,213.34,percent of total billed charges,
AMNIOEXCEL 4X4CM,75727,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,219.94000,208.94000,Amish/Mennonite,Amish Mennonite,,120.97,,,,,,,109.97,213.34,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,158.70000,150.76000,Amish/Mennonite,Amish Mennonite,,87.28,,,,,,,87.28,153.94,percent of total billed charges,
AMNIOEXCEL 5.5X5.5CM,75728,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,158.70000,150.76000,Amish/Mennonite,Amish Mennonite,,87.28,,,,,,,79.35,192.52,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,inpatient,,,706.00000,670.70000,Amish/Mennonite,Amish Mennonite,TC,388.30,,,,,,,388.30,684.82,percent of total billed charges,
ANORECTAL MANOMETRY-TECH,75729,CDM,750,RC,91122,CPT,,,facility,outpatient,,,706.00000,670.70000,Amish/Mennonite,Amish Mennonite,TC,388.30,,,,,,,353.00,5271.00,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,inpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,TC,291.50,,,,,,,291.50,514.10,percent of total billed charges,
AUTONOMIC PARASYMPATHETIC FUNC-TECH,75732,CDM,922,RC,95921,CPT,,,facility,outpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,TC,291.50,,,,,,,265.00,514.10,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,inpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,TC,190.30,,,,,,,190.30,335.62,percent of total billed charges,
BREATH HYDROGEN/METHANE TEST-TECH,75737,CDM,750,RC,91065,CPT,,,facility,outpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,TC,190.30,,,,,,,173.00,5271.00,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,TC,26.40,,,,,,,26.40,46.56,percent of total billed charges,
COMPUTERIZED CORNL TOPOGRAPHY-TECH,75750,CDM,920,RC,92025,CPT,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,TC,26.40,,,,,,,24.00,46.56,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,inpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,TC,226.60,,,,,,,226.60,399.64,percent of total billed charges,
CONSULTATION/REPRT-PREP SLIDES-TECH,75751,CDM,310,RC,88323,CPT,,,facility,outpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,TC,226.60,,,,,,,127.30,1245.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2365.00000,2246.75000,Amish/Mennonite,Amish Mennonite,TC,1300.75,,,,,,,1300.75,2294.05,percent of total billed charges,
CT LOWER EXTREMITY W/WO CONTRS-TECH,75752,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2365.00000,2246.75000,Amish/Mennonite,Amish Mennonite,TC,1300.75,,,,,,,979.11,2294.05,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,101.20,178.48,percent of total billed charges,
DIAGNOSTIC CASTS,75759,CDM,510,RC,D0470,HCPCS,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,92.00,178.48,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,inpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,691.90,1220.26,percent of total billed charges,
DUP SCAN ART/VEN HEMOD ACC-UNI-TECH,75764,CDM,921,RC,93986,CPT,,,facility,outpatient,,,1258.00000,1195.10000,Amish/Mennonite,Amish Mennonite,TC,691.90,,,,,,,629.00,1220.26,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,inpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,675.40,1191.16,percent of total billed charges,
ECHOCARD TRANSTHOR LTD SICU-TECH,75765,CDM,483,RC,93308,CPT,,,facility,outpatient,,,1228.00000,1166.60000,Amish/Mennonite,Amish Mennonite,TC,675.40,,,,,,,614.00,1191.16,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,inpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,TC,647.35,,,,,,,647.35,1141.69,percent of total billed charges,
ELECTROMYGR STDY(EMG) SPHINCT-TECH,75769,CDM,761,RC,51784,CPT,,,facility,outpatient,,,1177.00000,1118.15000,Amish/Mennonite,Amish Mennonite,TC,647.35,,,,,,,588.50,1141.69,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,inpatient,,,1416.00000,1345.20000,Amish/Mennonite,Amish Mennonite,TC,778.80,,,,,,,778.80,1373.52,percent of total billed charges,
ELECTROMYOGRAM 1 EXT PARASPINL-TECH,75771,CDM,922,RC,95860,CPT,,,facility,outpatient,,,1416.00000,1345.20000,Amish/Mennonite,Amish Mennonite,TC,778.80,,,,,,,708.00,1373.52,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,inpatient,,,2287.00000,2172.65000,Amish/Mennonite,Amish Mennonite,TC,1257.85,,,,,,,1257.85,2218.39,percent of total billed charges,
ELECTROMYOGRAM SINGLE FIBER-TECH,75772,CDM,922,RC,95872,CPT,,,facility,outpatient,,,2287.00000,2172.65000,Amish/Mennonite,Amish Mennonite,TC,1257.85,,,,,,,1143.50,2218.39,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,Amish/Mennonite,Amish Mennonite,TC,1093.95,,,,,,,1093.95,1929.33,percent of total billed charges,
ELECTROMYOGRAPHY 2 EXTREMITIES-TECH,75773,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,Amish/Mennonite,Amish Mennonite,TC,1093.95,,,,,,,994.50,1929.33,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,inpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,TC,93.50,,,,,,,93.50,164.90,percent of total billed charges,
ELECTRO-OCULOGRAM COMP-TECH,75774,CDM,761,RC,92270,CPT,,,facility,outpatient,,,170.00000,161.50000,Amish/Mennonite,Amish Mennonite,TC,93.50,,,,,,,85.00,164.90,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,TC,182.60,,,,,,,182.60,322.04,percent of total billed charges,
ELECTRORETINOGRAPHY FULL FIELD W/I&R TC-TECH,75776,CDM,510,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,TC,182.60,,,,,,,166.00,322.04,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,inpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,TC,116.60,,,,,,,116.60,205.64,percent of total billed charges,
FLUORESCEIN ANGIOGRAPHY-TECH,75784,CDM,920,RC,92235,CPT,,,facility,outpatient,,,212.00000,201.40000,Amish/Mennonite,Amish Mennonite,TC,116.60,,,,,,,106.00,205.64,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,Amish/Mennonite,Amish Mennonite,,695.20,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX CORE 1.5X2CM,75789,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,Amish/Mennonite,Amish Mennonite,,695.20,,,,,,,58.13,1226.08,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX CORE 3X4CM,75790,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,58.13,412.25,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,687.00000,652.65000,Amish/Mennonite,Amish Mennonite,,377.85,,,,,,,377.85,666.39,percent of total billed charges,
GRAFIX PRIME 2X3CM,75791,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,687.00000,652.65000,Amish/Mennonite,Amish Mennonite,,377.85,,,,,,,211.37,666.39,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX PRIME 5X5CM,75792,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,211.37,436.50,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,1264.00000,1200.80000,Amish/Mennonite,Amish Mennonite,,695.20,,,,,,,695.20,1226.08,percent of total billed charges,
GRAFIX PRIME1.5X2CM,75793,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,1264.00000,1200.80000,Amish/Mennonite,Amish Mennonite,,695.20,,,,,,,211.37,1226.08,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,247.50,436.50,percent of total billed charges,
GRAFIX CORE 5X5CM,75794,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,58.13,436.50,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,455.21000,432.45000,Amish/Mennonite,Amish Mennonite,,250.37,,,,,,,250.37,441.55,percent of total billed charges,
GRAFIXPLPRIME 3X3CM,75795,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,455.21000,432.45000,Amish/Mennonite,Amish Mennonite,,250.37,,,,,,,211.37,441.55,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,424.00000,402.80000,Amish/Mennonite,Amish Mennonite,,233.20,,,,,,,233.20,411.28,percent of total billed charges,
GRAFIX PL PRIME 3X4CM,75797,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,424.00000,402.80000,Amish/Mennonite,Amish Mennonite,,233.20,,,,,,,211.37,411.28,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,233.75,412.25,percent of total billed charges,
GRAFIX PRIME 3X4CM,75798,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,425.00000,403.75000,Amish/Mennonite,Amish Mennonite,,233.75,,,,,,,211.37,412.25,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,inpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,684.20,1206.68,percent of total billed charges,
LOW DOSE CT LUNG SURVEILLANCE-TECH,75815,CDM,352,RC,71250,CPT,,,facility,outpatient,,,1244.00000,1181.80000,Amish/Mennonite,Amish Mennonite,TC,684.20,,,,,,,584.87,1820.00,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,TC,121.00,,,,,,,121.00,213.40,percent of total billed charges,
MAXIMUM VOLUNTARY VENTILATION-TECH,75816,CDM,460,RC,94200,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,TC,121.00,,,,,,,110.00,213.40,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,537.00000,510.15000,Amish/Mennonite,Amish Mennonite,,295.35,,,,,,,295.35,520.89,percent of total billed charges,
MESHED 3.5X3.5 CM 8SQ CM,75817,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,537.00000,510.15000,Amish/Mennonite,Amish Mennonite,,295.35,,,,,,,240.68,520.89,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,366.85,646.99,percent of total billed charges,
MESHED 4X4.5CM 11SQ CM,75818,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,667.00000,633.65000,Amish/Mennonite,Amish Mennonite,,366.85,,,,,,,240.68,646.99,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3634.00000,3452.30000,Amish/Mennonite,Amish Mennonite,TC,1998.70,,,,,,,1998.70,3524.98,percent of total billed charges,
MRA SPINAL CANAL AND CONTENTS-TECH,75824,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3634.00000,3452.30000,Amish/Mennonite,Amish Mennonite,TC,1998.70,,,,,,,1396.56,3524.98,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3531.00000,3354.45000,Amish/Mennonite,Amish Mennonite,TC,1942.05,,,,,,,1942.05,3425.07,percent of total billed charges,
MRA UPPER EXTREMITY-TECH,75825,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3531.00000,3354.45000,Amish/Mennonite,Amish Mennonite,TC,1942.05,,,,,,,1339.64,3425.07,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,inpatient,,,1728.00000,1641.60000,Amish/Mennonite,Amish Mennonite,52,950.40,,,,,,,950.40,1676.16,percent of total billed charges,
MRI HYDROCEPHALUS EXAM LIMITED 70551-TECH,75828,CDM,610,RC,70551,CPT,,,facility,outpatient,,,1728.00000,1641.60000,Amish/Mennonite,Amish Mennonite,52,950.40,,,,,,,864.00,2032.87,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,1759.50000,1671.52000,Amish/Mennonite,Amish Mennonite,,967.73,,,,,,,967.73,1706.71,percent of total billed charges,
PRIMATRIX 14MM DISC,75840,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,1759.50000,1671.52000,Amish/Mennonite,Amish Mennonite,,967.73,,,,,,,101.38,1706.71,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,149.25000,141.79000,Amish/Mennonite,Amish Mennonite,,82.09,,,,,,,82.09,144.77,percent of total billed charges,
PRIMATRIX 5X5 SHEET,75841,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,149.25000,141.79000,Amish/Mennonite,Amish Mennonite,,82.09,,,,,,,74.62,144.77,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,615.25000,584.49000,Amish/Mennonite,Amish Mennonite,,338.39,,,,,,,338.39,596.79,percent of total billed charges,
PRIMATRIX 3X3,75842,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,615.25000,584.49000,Amish/Mennonite,Amish Mennonite,,338.39,,,,,,,101.38,596.79,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,239.49000,227.52000,Amish/Mennonite,Amish Mennonite,,131.72,,,,,,,131.72,232.31,percent of total billed charges,
PRIMATRIX 6X6 SHEET(36 SQ CM),75843,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,239.49000,227.52000,Amish/Mennonite,Amish Mennonite,,131.72,,,,,,,101.38,232.31,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,518.75000,492.81000,Amish/Mennonite,Amish Mennonite,,285.31,,,,,,,285.31,503.19,percent of total billed charges,
PRIMATRIX MESH 18MM DISC,75844,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,518.75000,492.81000,Amish/Mennonite,Amish Mennonite,,285.31,,,,,,,101.38,503.19,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,inpatient,,,1928.00000,1831.60000,Amish/Mennonite,Amish Mennonite,TC,1060.40,,,,,,,1060.40,1870.16,percent of total billed charges,
RECTAL SENSATION TONE COMPL TS-TECH,75849,CDM,750,RC,91120,CPT,,,facility,outpatient,,,1928.00000,1831.60000,Amish/Mennonite,Amish Mennonite,TC,1060.40,,,,,,,909.00,5271.00,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,inpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,113.85,200.79,percent of total billed charges,
SIGNAL AVERAGED ECG(SAECG)-TECH,75854,CDM,730,RC,93278,CPT,,,facility,outpatient,,,207.00000,196.65000,Amish/Mennonite,Amish Mennonite,TC,113.85,,,,,,,103.50,200.79,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,TC,48.40,,,,,,,48.40,85.36,percent of total billed charges,
SIMPLE UROFLOWMETRY-TECH,75855,CDM,761,RC,51736,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,TC,48.40,,,,,,,44.00,85.36,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,inpatient,,,896.00000,851.20000,Amish/Mennonite,Amish Mennonite,TC,492.80,,,,,,,492.80,869.12,percent of total billed charges,
SM BOWEL FOLLOWTHRU SGLCONTRST-TECH,75856,CDM,320,RC,74250,CPT,,,facility,outpatient,,,896.00000,851.20000,Amish/Mennonite,Amish Mennonite,TC,492.80,,,,,,,448.00,4437.28,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,200.75,354.05,percent of total billed charges,
TC99M SESTAMBI PER DDOSE MBI,75862,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,365.00000,346.75000,Amish/Mennonite,Amish Mennonite,,200.75,,,,,,,182.50,743.46,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,inpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,739.20,1303.68,percent of total billed charges,
THERMOREGULATORY SWEAT TEST-TECH,75866,CDM,922,RC,95923,CPT,,,facility,outpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,672.00,1303.68,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,inpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,178.20,314.28,percent of total billed charges,
TMJ SUBSEQUENT VISITS,75867,CDM,510,RC,D0140,HCPCS,,,facility,outpatient,,,324.00000,307.80000,Amish/Mennonite,Amish Mennonite,,178.20,,,,,,,122.37,314.28,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,433.40,764.36,percent of total billed charges,
UD GUID VISCERAL TISS ABLATN-TECH,75868,CDM,402,RC,76940,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,TC,433.40,,,,,,,327.36,764.36,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,inpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,396.00,698.40,percent of total billed charges,
URETHROCYSTOGRAPHY VOIDING-TECH,75870,CDM,320,RC,74455,CPT,,,facility,outpatient,,,720.00000,684.00000,Amish/Mennonite,Amish Mennonite,TC,396.00,,,,,,,360.00,4496.60,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,inpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,174.90,308.46,percent of total billed charges,
US GUIDANCE NEEDLE PLC-INT RAD-TECH,75872,CDM,402,RC,76942,CPT,,,facility,outpatient,,,318.00000,302.10000,Amish/Mennonite,Amish Mennonite,TC,174.90,,,,,,,154.77,548.00,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,inpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,491.70,867.18,percent of total billed charges,
US INFANT HIPS STATIC-TECH,75875,CDM,402,RC,76886,CPT,,,facility,outpatient,,,894.00000,849.30000,Amish/Mennonite,Amish Mennonite,TC,491.70,,,,,,,384.16,867.18,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,inpatient,,,731.00000,694.45000,Amish/Mennonite,Amish Mennonite,TC,402.05,,,,,,,402.05,709.07,percent of total billed charges,
VOIDING PRESSRE STDY INTRA-ABD-TECH,75878,CDM,761,RC,51797,CPT,,,facility,outpatient,,,731.00000,694.45000,Amish/Mennonite,Amish Mennonite,TC,402.05,,,,,,,365.50,709.07,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,inpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,282.15,497.61,percent of total billed charges,
XRAY/LONG BONE SURVEY-TECH,75882,CDM,320,RC,77074,CPT,,,facility,outpatient,,,513.00000,487.35000,Amish/Mennonite,Amish Mennonite,TC,282.15,,,,,,,234.65,2261.57,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,inpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,TC,443.30,,,,,,,443.30,781.82,percent of total billed charges,
XRAY/HIP ARTHROGRAPHY-TECH,75883,CDM,320,RC,73525,CPT,,,facility,outpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,TC,443.30,,,,,,,403.00,5188.83,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 5MM 4FR 120CM NTNL AGN 102CM CATH.,75884,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 11CM SPRG COIL .014IN 180CM,75886,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
KT GASTROSTMY TB 18FR BLLN 5ML STOMA L4CM SIL,75887,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM ACPT .014IN GW 4FR SHTH PTA,75888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 150CM ULTRAVERSE 014 CK,75889,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,,618.75,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BALNDIL LG DIA 18MM 80CM ATLS AU 4CM,75890,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,,618.75,,,,,,,516.38,1125.00,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 6CM,75891,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,449.25,978.75,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,212.73,421.12,percent of total billed charges,
NESTER EMB COIL,75892,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,199.27,434.14,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA12MM CATH ID0.035IN LOOP 3.7 PERIPH,75893,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,inpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
OMEPRAZOLE 40 MG CAP-,75895,CDM,250,RC,63739-0445-10,NDC,,,facility,outpatient,1,EA,2.45000,2.33000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
SYSTEM THRMB 4.6MM 15CM CLOTTRIEVER SHTH STRL LF,75896,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
BLLN ARMADA 35 14X40X135CM,75897,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 16MM 105CM CLOTTRIEVER STRL LF,75898,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA6MM CATH L120CM 0.035IN BLLN SELF,75899,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1024.14,2231.25,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 5MM 130CM ULTRAVERSE 035,75900,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER ASP 16FR 113CM TRIEVER20,75901,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,5240.55,10374.15,percent of total billed charges,
CATH SHOCKWAVE M IVL 5.0X60MM,75902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,10695.00000,10160.25000,Amish/Mennonite,Amish Mennonite,,5882.25,,,,,,,4909.01,10695.00,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,inpatient,,,52.60000,49.97000,Amish/Mennonite,Amish Mennonite,90,28.93,,,,,,,28.93,51.02,percent of total billed charges,
PREANALYSIS CELL SORTING SO,75911,CDM,311,RC,88184,CPT,,,facility,outpatient,,,52.60000,49.97000,Amish/Mennonite,Amish Mennonite,90,28.93,,,,,,,26.30,3186.14,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,inpatient,,,52.60000,49.97000,Amish/Mennonite,Amish Mennonite,90,28.93,,,,,,,28.93,51.02,percent of total billed charges,
PREANLYS SRT SO,75912,CDM,311,RC,88185,CPT,,,facility,outpatient,,,52.60000,49.97000,Amish/Mennonite,Amish Mennonite,90,28.93,,,,,,,26.30,1052.52,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,inpatient,,,147.20000,139.84000,Amish/Mennonite,Amish Mennonite,90,80.96,,,,,,,80.96,142.78,percent of total billed charges,
"CORTISOL, FREE SO",75913,CDM,300,RC,82530,CPT,,,facility,outpatient,,,147.20000,139.84000,Amish/Mennonite,Amish Mennonite,90,80.96,,,,,,,17.27,865.84,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,inpatient,,,367.40000,349.03000,Amish/Mennonite,Amish Mennonite,90,202.07,,,,,,,202.07,356.38,percent of total billed charges,
"2,3-DINOR PROSTAGLANDIN SO",75914,CDM,300,RC,80200,CPT,,,facility,outpatient,,,367.40000,349.03000,Amish/Mennonite,Amish Mennonite,90,202.07,,,,,,,16.67,848.80,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,inpatient,,,141.90000,134.80000,Amish/Mennonite,Amish Mennonite,90,78.05,,,,,,,78.05,137.64,percent of total billed charges,
TOBRAMYCIN SO,75915,CDM,300,RC,80200,CPT,,,facility,outpatient,,,141.90000,134.80000,Amish/Mennonite,Amish Mennonite,90,78.05,,,,,,,16.67,848.80,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,inpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,90,141.35,,,,,,,141.35,249.29,percent of total billed charges,
PARANEOPLASTIC IMMUNOBLOT SO,75916,CDM,300,RC,84182,CPT,,,facility,outpatient,,,257.00000,244.15000,Amish/Mennonite,Amish Mennonite,90,141.35,,,,,,,25.31,2286.16,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,inpatient,,,45.70000,43.42000,Amish/Mennonite,Amish Mennonite,90,25.14,,,,,,,25.14,44.33,percent of total billed charges,
"N-METHYLHISTAMINE,CREAT SO",75917,CDM,300,RC,82570,CPT,,,facility,outpatient,,,45.70000,43.42000,Amish/Mennonite,Amish Mennonite,90,25.14,,,,,,,5.35,271.65,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L35CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,75918,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L30CM DIA5MM 0.020IN PERIPH L VOL COMPLX STD FRME,75920,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 7MM 130CM ULTRAVERSE 035,75922,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,inpatient,1,mL,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.32,4.08,percent of total billed charges,
POVIDONE IODINE SOLN-OPHTH SD 2.5% 15 ML,75924,CDM,250,RC,00065-0411-30-00750,NDC,,,facility,outpatient,1,mL,4.21000,4.00000,Amish/Mennonite,Amish Mennonite,,2.32,,,,,,,2.10,4.08,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,inpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,,434.50,,,,,,,434.50,766.30,percent of total billed charges,
GRAFIX CORE 2X3 CM,75925,CDM,636,RC,Q4132,HCPCS,,,facility,outpatient,,,790.00000,750.50000,Amish/Mennonite,Amish Mennonite,,434.50,,,,,,,58.13,766.30,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X7,75926,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,22.50,43.65,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,inpatient,,,43.13000,40.97000,Amish/Mennonite,Amish Mennonite,,23.72,,,,,,,23.72,41.84,percent of total billed charges,
OASIS WOUND MTRX 3X3.5,75927,CDM,271,RC,Q4102,HCPCS,,,facility,outpatient,,,43.13000,40.97000,Amish/Mennonite,Amish Mennonite,,23.72,,,,,,,21.57,41.84,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,inpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,68.20,120.28,percent of total billed charges,
ANALY-IMPL NEUROST-PHY/HC PROV-TECH,75929,CDM,920,RC,95976,CPT,,,facility,outpatient,,,124.00000,117.80000,Amish/Mennonite,Amish Mennonite,,68.20,,,,,,,35.41,120.28,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,inpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,130.90,230.86,percent of total billed charges,
ANOGENITAL EXAM MAGNIFIED-TECH,75932,CDM,510,RC,99170,CPT,,,facility,outpatient,,,238.00000,226.10000,Amish/Mennonite,Amish Mennonite,,130.90,,,,,,,119.00,230.86,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
ANALYS NEUROST ADL 15MN-TECH,75934,CDM,920,RC,95984,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,67.50,130.95,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,78.65,138.71,percent of total billed charges,
ARTHROCENT INTERM JOINT W/CT-TECH,75936,CDM,510,RC,20605,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,,78.65,,,,,,,71.50,308.32,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,inpatient,,,1527.00000,1450.65000,Amish/Mennonite,Amish Mennonite,,839.85,,,,,,,839.85,1481.19,percent of total billed charges,
CONJUNCTIVAL FLAP-TECH,75941,CDM,510,RC,68360,CPT,,,facility,outpatient,,,1527.00000,1450.65000,Amish/Mennonite,Amish Mennonite,,839.85,,,,,,,763.50,3938.79,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,inpatient,,,5740.00000,5453.00000,Amish/Mennonite,Amish Mennonite,,3157.00,,,,,,,3157.00,5567.80,percent of total billed charges,
ENDOVEN ABLAT THER FIRST VEIN-TECH,75947,CDM,510,RC,36482,CPT,,,facility,outpatient,,,5740.00000,5453.00000,Amish/Mennonite,Amish Mennonite,,3157.00,,,,,,,2870.00,5646.22,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,inpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,220.00,388.00,percent of total billed charges,
ENDOVEN ABLAT THER SEP SITES-TECH,75950,CDM,510,RC,36483,CPT,,,facility,outpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,200.00,388.00,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,inpatient,,,592.00000,562.40000,Amish/Mennonite,Amish Mennonite,,325.60,,,,,,,325.60,574.24,percent of total billed charges,
EXC HYPERPLST ALVEOLAR MUCOSA-TECH,75954,CDM,510,RC,41828,CPT,,,facility,outpatient,,,592.00000,562.40000,Amish/Mennonite,Amish Mennonite,,325.60,,,,,,,296.00,1547.18,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
CHEMO ADM INTRALESN 8/MORE LSN-TECH,75957,CDM,331,RC,96406,CPT,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,80.00,220.07,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
CHEMO ADM INTRALES 1-7 LESIONS-TECH,75962,CDM,331,RC,96405,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,56.50,109.61,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,inpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,183.70,323.98,percent of total billed charges,
DEBR PREMAL LSN PHOTODYN THER-TECH,75963,CDM,510,RC,96574,CPT,,,facility,outpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,167.00,323.98,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,inpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,,168.85,,,,,,,168.85,297.79,percent of total billed charges,
FLUOR VASCULAR ANGIOGRAPHY-TECH,75964,CDM,920,RC,93998,CPT,,,facility,outpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,,168.85,,,,,,,23.25,297.79,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,inpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,,486.75,,,,,,,486.75,858.45,percent of total billed charges,
FNA CT GUIDANCE 1ST LESION-TECH,75968,CDM,350,RC,10009,CPT,,,facility,outpatient,,,885.00000,840.75000,Amish/Mennonite,Amish Mennonite,,486.75,,,,,,,442.50,1820.00,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,22.51,39.70,percent of total billed charges,
GORE-TEX LINER 3 INCH,75969,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,40.93000,38.88000,Amish/Mennonite,Amish Mennonite,,22.51,,,,,,,20.46,39.70,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
EXCHARGER,75970,CDM,271,RC,V5267,HCPCS,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,184.30,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,45.20000,42.94000,Amish/Mennonite,Amish Mennonite,,24.86,,,,,,,24.86,43.84,percent of total billed charges,
GORE-TEX LINER 4 INCH,75971,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,45.20000,42.94000,Amish/Mennonite,Amish Mennonite,,24.86,,,,,,,22.60,43.84,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
H/B FAM W/PT-ADL 15 MIN-PHD-TECH,75975,CDM,916,RC,96168,CPT,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,20.00,264.00,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,inpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,8.25,14.55,percent of total billed charges,
H/B GRP INIT 30 MIN-PHD-TECH,75977,CDM,915,RC,96164,CPT,,,facility,outpatient,,,15.00000,14.25000,Amish/Mennonite,Amish Mennonite,,8.25,,,,,,,7.50,264.00,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,inpatient,,,7.00000,6.65000,Amish/Mennonite,Amish Mennonite,,3.85,,,,,,,3.85,6.79,percent of total billed charges,
H/B GRP ADL 15M-PHD-TECH,75979,CDM,915,RC,96165,CPT,,,facility,outpatient,,,7.00000,6.65000,Amish/Mennonite,Amish Mennonite,,3.85,,,,,,,3.50,264.00,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
H/B FAM W/PT 30 MIN-PHD-TECH,75982,CDM,916,RC,96167,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,28.29,264.00,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,inpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,227.15,400.61,percent of total billed charges,
INJ CONRTR KNEE ARTHRO/ENH-TECH,75990,CDM,320,RC,27369,CPT,,,facility,outpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,206.50,400.61,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,inpatient,,,369.00000,350.55000,Amish/Mennonite,Amish Mennonite,,202.95,,,,,,,202.95,357.93,percent of total billed charges,
"MAGEC GROWING ROD LENGTHENING,SPINAL-TECH",75994,CDM,510,RC,22899,CPT,,,facility,outpatient,,,369.00000,350.55000,Amish/Mennonite,Amish Mennonite,,202.95,,,,,,,184.50,357.93,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX CT-TECH,75996,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,183.00,1692.33,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,inpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,180.95,319.13,percent of total billed charges,
INJ ANES AGNT LMB/SAC-RAD ONLY-TECH,75997,CDM,510,RC,64483,CPT,,,facility,outpatient,,,329.00000,312.55000,Amish/Mennonite,Amish Mennonite,,180.95,,,,,,,164.50,929.91,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,inpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,68.75,121.25,percent of total billed charges,
MYOCARD STRAIN IMAG SPECK ASMT-TECH,76004,CDM,510,RC,93356,CPT,,,facility,outpatient,,,125.00000,118.75000,Amish/Mennonite,Amish Mennonite,,68.75,,,,,,,62.50,121.25,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,62.15,109.61,percent of total billed charges,
NEUROBEH EXM-ADL HR-TECH,76016,CDM,918,RC,96121,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,,62.15,,,,,,,56.50,109.61,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,255.20,450.08,percent of total billed charges,
SACROILIAC JOINT INJ CT GUIDAN-TECH,76024,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,232.00,450.08,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,382.25,674.15,percent of total billed charges,
RMVL FOREIGN BODY SCROTUM-TECH,76028,CDM,510,RC,55120,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,347.50,2139.65,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,inpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,7.33,12.93,percent of total billed charges,
WALKING HEEL,76033,CDM,270,RC,Q4050,HCPCS,,,facility,outpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,6.67,12.93,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,inpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,104.50,184.30,percent of total billed charges,
ACNE SURGERY-TECH,76039,CDM,510,RC,10040,CPT,,,facility,outpatient,,,190.00000,180.50000,Amish/Mennonite,Amish Mennonite,,104.50,,,,,,,95.00,207.54,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,inpatient,1,EA,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,,9.68,,,,,,,9.68,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,00904-6732-04,NDC,,,facility,outpatient,1,EA,17.60000,16.72000,Amish/Mennonite,Amish Mennonite,,9.68,,,,,,,8.80,17.07,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,inpatient,1,EA,19.94000,18.94000,Amish/Mennonite,Amish Mennonite,,10.97,,,,,,,10.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,59467-0318-30,NDC,,,facility,outpatient,1,EA,19.94000,18.94000,Amish/Mennonite,Amish Mennonite,,10.97,,,,,,,9.97,19.34,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,inpatient,1,EA,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,11.82,20.85,percent of total billed charges,
COLCHICINE 0.6 MG CAP,76040,CDM,250,RC,60687-0358-25,NDC,,,facility,outpatient,1,EA,21.49000,20.41000,Amish/Mennonite,Amish Mennonite,,11.82,,,,,,,10.74,20.85,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 12MM 75CM ULTRAVERSE 035,76041,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 40.,76042,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 40MM.,76043,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 7MM 75CM PCLTXL LUTONIX 035 60MM.,76044,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,33.32,65.96,percent of total billed charges,
CATHETER ANGIO SM MPA CRV 4FR 100CM CEREBRUM NYL,76046,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,31.21,68.00,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA18MM CATH L80MM SHTH 10FR GWIRE.,76048,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,9476.46000,9002.64000,Amish/Mennonite,Amish Mennonite,,5212.05,,,,,,,4643.47,9192.17,percent of total billed charges,
CATHETER AXS CATALYST 7 0.068X132CM,76051,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,9476.46000,9002.64000,Amish/Mennonite,Amish Mennonite,,5212.05,,,,,,,4349.70,9476.46,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI AD L40MM DIA8MM CATH 6FR L80CM LIFESTENT,76052,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM TRNGS TUNG SIL MC SLK 2.7CM,76053,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,46.20,81.48,percent of total billed charges,
ALLERG IMMUNOTH 4 INSECT VENOM-TECH,76054,CDM,510,RC,95148,CPT,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,42.00,81.48,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,inpatient,,,2010.00000,1909.50000,Amish/Mennonite,Amish Mennonite,,1105.50,,,,,,,1105.50,1949.70,percent of total billed charges,
ADJ TISS TF/REARR;30.1-60SQ CM-TECH,76055,CDM,510,RC,14301,CPT,,,facility,outpatient,,,2010.00000,1909.50000,Amish/Mennonite,Amish Mennonite,,1105.50,,,,,,,1005.00,3823.86,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
ALLERGY MATERIAL-REFILL-TECH,76056,CDM,510,RC,95165,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,48.19,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
AMNIOCENTESIS;DIAGNOSTIC-TECH,76057,CDM,510,RC,59000,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,83.50,909.48,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,inpatient,,,554.00000,526.30000,Amish/Mennonite,Amish Mennonite,,304.70,,,,,,,304.70,537.38,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;1ST 100-TECH",76058,CDM,510,RC,15273,CPT,,,facility,outpatient,,,554.00000,526.30000,Amish/Mennonite,Amish Mennonite,,304.70,,,,,,,277.00,3823.86,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
"ALLERGY TESTING,W/DRUGS/BIOLOG-TECH",76060,CDM,924,RC,95018,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,41.00,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,124.30,219.22,percent of total billed charges,
APPLIC SHRT LEG CAST;WLKNG/AMB-TECH,76061,CDM,510,RC,29425,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,113.00,277.40,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,72.60,128.04,percent of total billed charges,
"APPL SK GRF,>100 SQ CM;ADL 100-TECH",76062,CDM,510,RC,15274,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,,72.60,,,,,,,66.00,128.04,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,inpatient,,,1836.00000,1744.20000,Amish/Mennonite,Amish Mennonite,,1009.80,,,,,,,1009.80,1780.92,percent of total billed charges,
"AMPUT,FINGER,THUMB;W/DIR CLOSR-TECH",76063,CDM,510,RC,26951,CPT,,,facility,outpatient,,,1836.00000,1744.20000,Amish/Mennonite,Amish Mennonite,,1009.80,,,,,,,918.00,3388.98,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,inpatient,,,388.00000,368.60000,Amish/Mennonite,Amish Mennonite,,213.40,,,,,,,213.40,376.36,percent of total billed charges,
APPL RIGID TTL CONTACT LEG CST-TECH,76064,CDM,510,RC,29445,CPT,,,facility,outpatient,,,388.00000,368.60000,Amish/Mennonite,Amish Mennonite,,213.40,,,,,,,194.00,376.36,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,inpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,693.00,1222.20,percent of total billed charges,
"BRST BX,PL LOC DEV;US GUID-TECH",76065,CDM,402,RC,19083,CPT,,,facility,outpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,384.16,1692.33,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,inpatient,,,671.00000,637.45000,Amish/Mennonite,Amish Mennonite,,369.05,,,,,,,369.05,650.87,percent of total billed charges,
BIOPSY OF LIVER;PERC NEEDLE-TECH,76067,CDM,510,RC,47000,CPT,,,facility,outpatient,,,671.00000,637.45000,Amish/Mennonite,Amish Mennonite,,369.05,,,,,,,335.50,1692.33,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,inpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,,64.35,,,,,,,64.35,113.49,percent of total billed charges,
ANALY-NEUROST;SIMPLE W/PROGRAM-TECH,76068,CDM,920,RC,95971,CPT,,,facility,outpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,,64.35,,,,,,,58.50,113.49,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,inpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,221.10,389.94,percent of total billed charges,
APPLIC LNG LEG CAST;WALKER/AMB-TECH,76069,CDM,510,RC,29355,CPT,,,facility,outpatient,,,402.00000,381.90000,Amish/Mennonite,Amish Mennonite,,221.10,,,,,,,201.00,389.94,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,inpatient,,,1672.00000,1588.40000,Amish/Mennonite,Amish Mennonite,,919.60,,,,,,,919.60,1621.84,percent of total billed charges,
"ASP VITREOUS,SUBRET/CHOROIDAL-TECH",76070,CDM,510,RC,67015,CPT,,,facility,outpatient,,,1672.00000,1588.40000,Amish/Mennonite,Amish Mennonite,,919.60,,,,,,,836.00,2382.20,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,inpatient,,,1238.00000,1176.10000,Amish/Mennonite,Amish Mennonite,,680.90,,,,,,,680.90,1200.86,percent of total billed charges,
BX/EXC-LYMPH NODES;DEEP AXILLA-TECH,76072,CDM,361,RC,38525,CPT,,,facility,outpatient,,,1238.00000,1176.10000,Amish/Mennonite,Amish Mennonite,,680.90,,,,,,,680.90,7803.00,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,inpatient,,,1131.00000,1074.45000,Amish/Mennonite,Amish Mennonite,,622.05,,,,,,,622.05,1097.07,percent of total billed charges,
"BX,SOFT TISSUE-THIGH/KNEE;DEEP-TECH",76073,CDM,510,RC,27324,CPT,,,facility,outpatient,,,1131.00000,1074.45000,Amish/Mennonite,Amish Mennonite,,622.05,,,,,,,565.50,2989.39,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,inpatient,,,482.00000,457.90000,Amish/Mennonite,Amish Mennonite,,265.10,,,,,,,265.10,467.54,percent of total billed charges,
"BONE MARROW BIOP,NEEDLE/TROCAR-TECH",76074,CDM,510,RC,38221,CPT,,,facility,outpatient,,,482.00000,457.90000,Amish/Mennonite,Amish Mennonite,,265.10,,,,,,,241.00,1692.33,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCLE,PERCUTANEOUS NDL-TECH",76075,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,inpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,201.85,355.99,percent of total billed charges,
"BIOPSY;NASOPHARYNX,VIS LES,SMP-TECH",76076,CDM,510,RC,42804,CPT,,,facility,outpatient,,,367.00000,348.65000,Amish/Mennonite,Amish Mennonite,,201.85,,,,,,,183.50,3387.36,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,166.65,293.91,percent of total billed charges,
"BX,ABD/RETROPER MASS,PERC NDLE-TECH",76077,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,151.50,1692.33,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,inpatient,,,1582.00000,1502.90000,Amish/Mennonite,Amish Mennonite,,870.10,,,,,,,870.10,1534.54,percent of total billed charges,
BX SOFT TISS SHOULDER;DEEP-TECH,76078,CDM,510,RC,23066,CPT,,,facility,outpatient,,,1582.00000,1502.90000,Amish/Mennonite,Amish Mennonite,,870.10,,,,,,,791.00,2989.39,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,inpatient,,,639.00000,607.05000,Amish/Mennonite,Amish Mennonite,,351.45,,,,,,,351.45,619.83,percent of total billed charges,
BRONCHOSCOPY W/REMOVAL FB-TECH,76079,CDM,510,RC,31635,CPT,,,facility,outpatient,,,639.00000,607.05000,Amish/Mennonite,Amish Mennonite,,351.45,,,,,,,319.50,1801.19,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,inpatient,,,388.00000,368.60000,Amish/Mennonite,Amish Mennonite,,213.40,,,,,,,213.40,376.36,percent of total billed charges,
CARDIOVERSION-TECH,76080,CDM,510,RC,92960,CPT,,,facility,outpatient,,,388.00000,368.60000,Amish/Mennonite,Amish Mennonite,,213.40,,,,,,,194.00,683.50,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,inpatient,,,1510.00000,1434.50000,Amish/Mennonite,Amish Mennonite,,830.50,,,,,,,830.50,1464.70,percent of total billed charges,
"BIOPSY,BONE,TROCAR/NDL;DEEP-CT-TECH",76081,CDM,510,RC,20225,CPT,,,facility,outpatient,,,1510.00000,1434.50000,Amish/Mennonite,Amish Mennonite,,830.50,,,,,,,755.00,1692.33,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,inpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,166.65,293.91,percent of total billed charges,
BIOPSY ABDOMEN-RETRO-CT-TECH,76083,CDM,510,RC,49180,CPT,,,facility,outpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,,166.65,,,,,,,151.50,1692.33,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,inpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,,185.35,,,,,,,185.35,326.89,percent of total billed charges,
"CHEMODENERV;ADL,/MORE MUSC-TECH",76084,CDM,510,RC,64645,CPT,,,facility,outpatient,,,337.00000,320.15000,Amish/Mennonite,Amish Mennonite,,185.35,,,,,,,168.50,326.89,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,inpatient,,,862.00000,818.90000,Amish/Mennonite,Amish Mennonite,,474.10,,,,,,,474.10,836.14,percent of total billed charges,
"CHEMICAL PEEL,FACIAL;EPIDERMAL-TECH",76085,CDM,510,RC,15788,CPT,,,facility,outpatient,,,862.00000,818.90000,Amish/Mennonite,Amish Mennonite,,474.10,,,,,,,379.37,836.14,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,inpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,,1064.80,,,,,,,1064.80,1877.92,percent of total billed charges,
"BRST BX,;MAGNETIC RESON GUID-TECH",76086,CDM,610,RC,19085,CPT,,,facility,outpatient,,,1936.00000,1839.20000,Amish/Mennonite,Amish Mennonite,,1064.80,,,,,,,968.00,2161.00,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,inpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,264.55,466.57,percent of total billed charges,
CHEMODENERV 1 EXTR;5>MORE MUSC-TECH,76088,CDM,510,RC,64644,CPT,,,facility,outpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,240.50,723.34,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,inpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,372.35,656.69,percent of total billed charges,
"BIOPSY,MUSCL,PERCUTAN NDL-U.S.-TECH",76089,CDM,510,RC,20206,CPT,,,facility,outpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,338.50,1692.33,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,inpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,,816.20,,,,,,,816.20,1439.48,percent of total billed charges,
"BIOPSY,BONE,OPEN;DEEP-TECH",76090,CDM,510,RC,20245,CPT,,,facility,outpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,,816.20,,,,,,,742.00,2989.39,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,inpatient,,,935.00000,888.25000,Amish/Mennonite,Amish Mennonite,,514.25,,,,,,,514.25,906.95,percent of total billed charges,
CAUTERY OF BOWMANS MEMBRANE-TECH,76092,CDM,510,RC,65450,CPT,,,facility,outpatient,,,935.00000,888.25000,Amish/Mennonite,Amish Mennonite,,514.25,,,,,,,283.85,906.95,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,inpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,,266.75,,,,,,,266.75,470.45,percent of total billed charges,
BIOPSY BONE NEEDLE SUPERFCL CT-TECH,76093,CDM,510,RC,20220,CPT,,,facility,outpatient,,,485.00000,460.75000,Amish/Mennonite,Amish Mennonite,,266.75,,,,,,,242.50,1692.33,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,inpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,257.40,453.96,percent of total billed charges,
"CL TRT FX,PHAL;W/MANIP-TECH",76094,CDM,510,RC,28515,CPT,,,facility,outpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,227.78,453.96,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,inpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,,306.35,,,,,,,306.35,540.29,percent of total billed charges,
"BRONCHOSCOPY,DIAGNOSTIC-TECH",76095,CDM,510,RC,31622,CPT,,,facility,outpatient,,,557.00000,529.15000,Amish/Mennonite,Amish Mennonite,,306.35,,,,,,,278.50,1801.19,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,inpatient,,,1528.00000,1451.60000,Amish/Mennonite,Amish Mennonite,,840.40,,,,,,,840.40,1482.16,percent of total billed charges,
CL TRT TIB SHAFT FX;W/MANIP-TECH,76096,CDM,510,RC,27752,CPT,,,facility,outpatient,,,1528.00000,1451.60000,Amish/Mennonite,Amish Mennonite,,840.40,,,,,,,764.00,1671.62,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,inpatient,,,858.00000,815.10000,Amish/Mennonite,Amish Mennonite,,471.90,,,,,,,471.90,832.26,percent of total billed charges,
"CL TRT TIBIAL FX,PROXIMAL-TECH",76097,CDM,510,RC,27530,CPT,,,facility,outpatient,,,858.00000,815.10000,Amish/Mennonite,Amish Mennonite,,471.90,,,,,,,227.78,832.26,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,inpatient,,,826.00000,784.70000,Amish/Mennonite,Amish Mennonite,,454.30,,,,,,,454.30,801.22,percent of total billed charges,
"CL TRT ULN FX,PROX END;WO MANI-TECH",76098,CDM,510,RC,24670,CPT,,,facility,outpatient,,,826.00000,784.70000,Amish/Mennonite,Amish Mennonite,,454.30,,,,,,,227.78,801.22,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,inpatient,,,685.00000,650.75000,Amish/Mennonite,Amish Mennonite,,376.75,,,,,,,376.75,664.45,percent of total billed charges,
CYSTOSCOPY W/RMV URETERAL CALC-TECH,76099,CDM,510,RC,52320,CPT,,,facility,outpatient,,,685.00000,650.75000,Amish/Mennonite,Amish Mennonite,,376.75,,,,,,,342.50,3602.42,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,inpatient,,,1094.00000,1039.30000,Amish/Mennonite,Amish Mennonite,,601.70,,,,,,,601.70,1061.18,percent of total billed charges,
"CL TRT TROCHAN FX,W/O MANIP-TECH",76100,CDM,510,RC,27246,CPT,,,facility,outpatient,,,1094.00000,1039.30000,Amish/Mennonite,Amish Mennonite,,601.70,,,,,,,227.78,1061.18,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,inpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,,522.50,,,,,,,522.50,921.50,percent of total billed charges,
CL TRT MED MAL FX;W/O MANIP-TECH,76101,CDM,510,RC,27760,CPT,,,facility,outpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,,522.50,,,,,,,227.78,921.50,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,inpatient,,,1329.00000,1262.55000,Amish/Mennonite,Amish Mennonite,,730.95,,,,,,,730.95,1289.13,percent of total billed charges,
CL TRT BIMALL ANK FX;W/MAN-TECH,76102,CDM,510,RC,27810,CPT,,,facility,outpatient,,,1329.00000,1262.55000,Amish/Mennonite,Amish Mennonite,,730.95,,,,,,,664.50,1671.62,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,inpatient,,,683.00000,648.85000,Amish/Mennonite,Amish Mennonite,,375.65,,,,,,,375.65,662.51,percent of total billed charges,
"CYSTOURETHROS,W/FULG;SMALL TMR-TECH",76104,CDM,510,RC,52234,CPT,,,facility,outpatient,,,683.00000,648.85000,Amish/Mennonite,Amish Mennonite,,375.65,,,,,,,341.50,3602.42,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,inpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,504.90,890.46,percent of total billed charges,
DEBRID OPN FX;SKIN/SUBCUT TISS-TECH,76105,CDM,510,RC,11010,CPT,,,facility,outpatient,,,918.00000,872.10000,Amish/Mennonite,Amish Mennonite,,504.90,,,,,,,459.00,890.46,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,inpatient,,,1879.00000,1785.05000,Amish/Mennonite,Amish Mennonite,,1033.45,,,,,,,1033.45,1822.63,percent of total billed charges,
"CYSTOURETHROSC,W/FULG MNR LESN-TECH",76106,CDM,510,RC,52224,CPT,,,facility,outpatient,,,1879.00000,1785.05000,Amish/Mennonite,Amish Mennonite,,1033.45,,,,,,,939.50,3602.42,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,inpatient,,,754.00000,716.30000,Amish/Mennonite,Amish Mennonite,,414.70,,,,,,,414.70,731.38,percent of total billed charges,
"BIOPSY,SOFT TISSUE NECK/THORAX-TECH",76107,CDM,510,RC,21550,CPT,,,facility,outpatient,,,754.00000,716.30000,Amish/Mennonite,Amish Mennonite,,414.70,,,,,,,377.00,1692.33,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,inpatient,,,1288.00000,1223.60000,Amish/Mennonite,Amish Mennonite,,708.40,,,,,,,708.40,1249.36,percent of total billed charges,
"DEEP DISSEC,INF FOOT;SNG BURSA-TECH",76108,CDM,510,RC,28002,CPT,,,facility,outpatient,,,1288.00000,1223.60000,Amish/Mennonite,Amish Mennonite,,708.40,,,,,,,644.00,1671.62,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,inpatient,,,588.00000,558.60000,Amish/Mennonite,Amish Mennonite,,323.40,,,,,,,323.40,570.36,percent of total billed charges,
"DEBRIDEMT,BONE;1ST 20 SQ CM-TECH",76109,CDM,510,RC,11044,CPT,,,facility,outpatient,,,588.00000,558.60000,Amish/Mennonite,Amish Mennonite,,323.40,,,,,,,294.00,1692.33,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,inpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,153.45,270.63,percent of total billed charges,
BIOPSY OF FLOOR OF MOUTH-TECH,76110,CDM,510,RC,41108,CPT,,,facility,outpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,139.50,1692.33,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,313.50,552.90,percent of total billed charges,
COLPOSCOPY;LOOP ELEC BX(LEEP)-TECH,76111,CDM,510,RC,57460,CPT,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,285.00,3321.00,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,inpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,,546.15,,,,,,,546.15,963.21,percent of total billed charges,
"CNSTRCT FISTULA,INS PROSTHESIS-TECH",76112,CDM,510,RC,31611,CPT,,,facility,outpatient,,,993.00000,943.35000,Amish/Mennonite,Amish Mennonite,,546.15,,,,,,,496.50,3387.36,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,inpatient,,,789.00000,749.55000,Amish/Mennonite,Amish Mennonite,,433.95,,,,,,,433.95,765.33,percent of total billed charges,
CYSTOURETHRSC;W/TRT URET STRIC-TECH,76113,CDM,510,RC,52341,CPT,,,facility,outpatient,,,789.00000,749.55000,Amish/Mennonite,Amish Mennonite,,433.95,,,,,,,394.50,3602.42,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,inpatient,,,1302.00000,1236.90000,Amish/Mennonite,Amish Mennonite,,716.10,,,,,,,716.10,1262.94,percent of total billed charges,
"BRST BX,PLC LOC DEV;STEREOTAC-TECH",76114,CDM,320,RC,19081,CPT,,,facility,outpatient,,,1302.00000,1236.90000,Amish/Mennonite,Amish Mennonite,,716.10,,,,,,,651.00,1692.33,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,inpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,75.35,132.89,percent of total billed charges,
"DEBR,MSC/FASC;EA ADL 20 SQ CM-TECH",76115,CDM,510,RC,11046,CPT,,,facility,outpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,68.50,132.89,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,46.20,81.48,percent of total billed charges,
CAR SEAT/BED TSTG;ADL 30 MIN-TECH,76116,CDM,460,RC,94781,CPT,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,,46.20,,,,,,,42.00,81.48,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,inpatient,,,842.00000,799.90000,Amish/Mennonite,Amish Mennonite,,463.10,,,,,,,463.10,816.74,percent of total billed charges,
CYSTOURETHROSCOPY W/URETEROSCP-TECH,76117,CDM,510,RC,52351,CPT,,,facility,outpatient,,,842.00000,799.90000,Amish/Mennonite,Amish Mennonite,,463.10,,,,,,,421.00,3602.42,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,inpatient,,,1475.00000,1401.25000,Amish/Mennonite,Amish Mennonite,,811.25,,,,,,,811.25,1430.75,percent of total billed charges,
CL TRT RAD/ULN SHFT FX;W/MANIP-TECH,76118,CDM,510,RC,25565,CPT,,,facility,outpatient,,,1475.00000,1401.25000,Amish/Mennonite,Amish Mennonite,,811.25,,,,,,,737.50,1671.62,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,inpatient,,,1269.00000,1205.55000,Amish/Mennonite,Amish Mennonite,,697.95,,,,,,,697.95,1230.93,percent of total billed charges,
BX SFT TISS BACK/FLANK;DEEP-TECH,76119,CDM,510,RC,21925,CPT,,,facility,outpatient,,,1269.00000,1205.55000,Amish/Mennonite,Amish Mennonite,,697.95,,,,,,,634.50,1692.33,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,inpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,,210.10,,,,,,,210.10,370.54,percent of total billed charges,
BIOPSY PENIS;CUTANEOUS-TECH,76120,CDM,510,RC,54100,CPT,,,facility,outpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,,210.10,,,,,,,191.00,1692.33,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,inpatient,,,1539.00000,1462.05000,Amish/Mennonite,Amish Mennonite,,846.45,,,,,,,846.45,1492.83,percent of total billed charges,
DESTRUC LOCAL LESION CHOROID-TECH,76121,CDM,510,RC,67220,CPT,,,facility,outpatient,,,1539.00000,1462.05000,Amish/Mennonite,Amish Mennonite,,846.45,,,,,,,520.92,1492.83,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,inpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,190.30,335.62,percent of total billed charges,
"DESTR LES,PENIS;SURGICAL EXC-TECH",76123,CDM,510,RC,54060,CPT,,,facility,outpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,173.00,1910.62,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,inpatient,,,1118.00000,1062.10000,Amish/Mennonite,Amish Mennonite,,614.90,,,,,,,614.90,1084.46,percent of total billed charges,
CHELATION-CORNEAL LESION-TECH,76124,CDM,510,RC,65436,CPT,,,facility,outpatient,,,1118.00000,1062.10000,Amish/Mennonite,Amish Mennonite,,614.90,,,,,,,559.00,2436.76,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,inpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,,291.50,,,,,,,291.50,514.10,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17276-TECH",76125,CDM,510,RC,17276,CPT,,,facility,outpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,,291.50,,,,,,,265.00,514.10,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
BRIEF FACE-TO-FACE COUNS ALCOH-TECH,76126,CDM,770,RC,G0443,HCPCS,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,23.50,96.61,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,inpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,91.85,161.99,percent of total billed charges,
"CHEMOTHER,SUBARACHN/INTRAVENTR-TECH",76127,CDM,331,RC,96542,CPT,,,facility,outpatient,,,167.00000,158.65000,Amish/Mennonite,Amish Mennonite,,91.85,,,,,,,83.50,346.44,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,inpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,125.95,222.13,percent of total billed charges,
"DESTR VAG LESN;SMPL,OTH METH-TECH",76128,CDM,510,RC,57061,CPT,,,facility,outpatient,,,229.00000,217.55000,Amish/Mennonite,Amish Mennonite,,125.95,,,,,,,114.50,3321.00,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,inpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,,441.10,,,,,,,441.10,777.94,percent of total billed charges,
"CYSTOURETHROS,W/FULG;MED TMRS-TECH",76129,CDM,510,RC,52235,CPT,,,facility,outpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,,441.10,,,,,,,401.00,3602.42,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,inpatient,,,811.00000,770.45000,Amish/Mennonite,Amish Mennonite,,446.05,,,,,,,446.05,786.67,percent of total billed charges,
DESTR CUTANEOUS LES;10-50SQ CM-TECH,76130,CDM,510,RC,17107,CPT,,,facility,outpatient,,,811.00000,770.45000,Amish/Mennonite,Amish Mennonite,,446.05,,,,,,,405.50,786.67,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,inpatient,,,171.25000,162.69000,Amish/Mennonite,Amish Mennonite,,94.19,,,,,,,94.19,166.11,percent of total billed charges,
CECOS/JEJUNAL TB RPLC W/O SCP-TECH,76131,CDM,510,RC,44799,CPT,,,facility,outpatient,,,171.25000,162.69000,Amish/Mennonite,Amish Mennonite,,94.19,,,,,,,85.62,979.27,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
CAR SEAT/BED TESTING;60 MIN-TECH,76132,CDM,460,RC,94780,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,37.27,197.88,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,inpatient,,,985.00000,935.75000,Amish/Mennonite,Amish Mennonite,,541.75,,,,,,,541.75,955.45,percent of total billed charges,
"CYSTO,W/URET/PYELO;RM/MNP CALC-TECH",76133,CDM,510,RC,52352,CPT,,,facility,outpatient,,,985.00000,935.75000,Amish/Mennonite,Amish Mennonite,,541.75,,,,,,,492.50,3602.42,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,inpatient,,,405.25000,384.99000,Amish/Mennonite,Amish Mennonite,,222.89,,,,,,,222.89,393.09,percent of total billed charges,
DILATION STOMAL STENOSIS-TECH,76134,CDM,510,RC,44799,CPT,,,facility,outpatient,,,405.25000,384.99000,Amish/Mennonite,Amish Mennonite,,222.89,,,,,,,202.62,979.27,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,inpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,,656.15,,,,,,,656.15,1157.21,percent of total billed charges,
DESTR CUTAN LES;OVER 50SQ CM-TECH,76135,CDM,510,RC,17108,CPT,,,facility,outpatient,,,1193.00000,1133.35000,Amish/Mennonite,Amish Mennonite,,656.15,,,,,,,596.50,1910.62,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,inpatient,,,1308.00000,1242.60000,Amish/Mennonite,Amish Mennonite,,719.40,,,,,,,719.40,1268.76,percent of total billed charges,
"CYSTOURETHROS,INT URETH;MALE-TECH",76136,CDM,510,RC,52275,CPT,,,facility,outpatient,,,1308.00000,1242.60000,Amish/Mennonite,Amish Mennonite,,719.40,,,,,,,654.00,2139.65,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,inpatient,,,1330.00000,1263.50000,Amish/Mennonite,Amish Mennonite,,731.50,,,,,,,731.50,1290.10,percent of total billed charges,
"CYSTOURETHROSC,W/URETERAL STNT-TECH",76137,CDM,510,RC,52332,CPT,,,facility,outpatient,,,1330.00000,1263.50000,Amish/Mennonite,Amish Mennonite,,731.50,,,,,,,665.00,3602.42,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,inpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,89.65,158.11,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62370-TECH",76138,CDM,510,RC,62370,CPT,,,facility,outpatient,,,163.00000,154.85000,Amish/Mennonite,Amish Mennonite,,89.65,,,,,,,81.50,313.26,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,inpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,143.55,253.17,percent of total billed charges,
"BIOPSY,EXTERNAL AUDITORY CANAL-TECH",76139,CDM,510,RC,69105,CPT,,,facility,outpatient,,,261.00000,247.95000,Amish/Mennonite,Amish Mennonite,,143.55,,,,,,,130.50,1547.18,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,inpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,139.70,246.38,percent of total billed charges,
"DESTR LES,PENIS;CHEMICAL-TECH",76140,CDM,510,RC,54050,CPT,,,facility,outpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,127.00,417.31,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,inpatient,,,620.00000,589.00000,Amish/Mennonite,Amish Mennonite,,341.00,,,,,,,341.00,601.40,percent of total billed charges,
"DRAIN,EXT EAR,ABS/HEMAT-COMPLC-TECH",76141,CDM,510,RC,69005,CPT,,,facility,outpatient,,,620.00000,589.00000,Amish/Mennonite,Amish Mennonite,,341.00,,,,,,,310.00,1692.33,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,inpatient,,,857.00000,814.15000,Amish/Mennonite,Amish Mennonite,,471.35,,,,,,,471.35,831.29,percent of total billed charges,
"DELAY OF FLAP,SECTION PEDICLE-TECH",76142,CDM,510,RC,15630,CPT,,,facility,outpatient,,,857.00000,814.15000,Amish/Mennonite,Amish Mennonite,,471.35,,,,,,,428.50,1910.62,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,56.65,99.91,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/REPR-TECH",76143,CDM,510,RC,62368,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,51.50,313.26,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,inpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,433.40,764.36,percent of total billed charges,
ENDOVEN ABL THER INCOM VN;1ST-TECH,76144,CDM,510,RC,36478,CPT,,,facility,outpatient,,,788.00000,748.60000,Amish/Mennonite,Amish Mennonite,,433.40,,,,,,,394.00,3287.55,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,inpatient,,,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,367.95,648.93,percent of total billed charges,
"DESTRUC,MAL LES;OVER 4.0CM 17286-TECH",76145,CDM,510,RC,17286,CPT,,,facility,outpatient,,,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,334.50,648.93,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,inpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,229.35,404.49,percent of total billed charges,
DRAINAGE SCROTAL WALL ABSCESS-TECH,76147,CDM,510,RC,55100,CPT,,,facility,outpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,208.50,1692.33,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
"DEBRID,BONE;EA ADL 20 SQ CM-TECH",76148,CDM,510,RC,11047,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,inpatient,,,948.00000,900.60000,Amish/Mennonite,Amish Mennonite,,521.40,,,,,,,521.40,919.56,percent of total billed charges,
ENDOVEN ABL THER;1ST VN TREATD-TECH,76149,CDM,510,RC,36475,CPT,,,facility,outpatient,,,948.00000,900.60000,Amish/Mennonite,Amish Mennonite,,521.40,,,,,,,474.00,3287.55,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,U6,127.05,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-QTT-PHD 90791-TECH,76150,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,U6,127.05,,,,,,,115.50,224.07,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;W/O REP-TECH",76152,CDM,510,RC,62367,CPT,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,37.00,313.26,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,inpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,404.25,712.95,percent of total billed charges,
"CYSTO,DIRECT VISION INT URETHR-TECH",76153,CDM,510,RC,52276,CPT,,,facility,outpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,367.50,2139.65,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,inpatient,,,849.00000,806.55000,Amish/Mennonite,Amish Mennonite,,466.95,,,,,,,466.95,823.53,percent of total billed charges,
"EXC EXT EAR,PARTIAL,SMPL RPR-TECH",76154,CDM,510,RC,69110,CPT,,,facility,outpatient,,,849.00000,806.55000,Amish/Mennonite,Amish Mennonite,,466.95,,,,,,,424.50,2989.39,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,inpatient,,,284.00000,269.80000,Amish/Mennonite,Amish Mennonite,,156.20,,,,,,,156.20,275.48,percent of total billed charges,
CHEMODENERV ECCR GL;OTHR AREAS-TECH,76155,CDM,510,RC,64653,CPT,,,facility,outpatient,,,284.00000,269.80000,Amish/Mennonite,Amish Mennonite,,156.20,,,,,,,142.00,308.32,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,inpatient,,,1631.00000,1549.45000,Amish/Mennonite,Amish Mennonite,,897.05,,,,,,,897.05,1582.07,percent of total billed charges,
EX LES TND SHTH/JNT CAPSL HND/FG -TECH,76156,CDM,510,RC,26160,CPT,,,facility,outpatient,,,1631.00000,1549.45000,Amish/Mennonite,Amish Mennonite,,897.05,,,,,,,815.50,1671.62,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,inpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,122.10,215.34,percent of total billed charges,
"DIL URETHR STRICTR,MALE;SUBSEQ-TECH",76157,CDM,510,RC,53601,CPT,,,facility,outpatient,,,222.00000,210.90000,Amish/Mennonite,Amish Mennonite,,122.10,,,,,,,111.00,215.34,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,inpatient,,,1107.00000,1051.65000,Amish/Mennonite,Amish Mennonite,,608.85,,,,,,,608.85,1073.79,percent of total billed charges,
DRAINAGE OF FELON-TECH,76158,CDM,510,RC,26011,CPT,,,facility,outpatient,,,1107.00000,1051.65000,Amish/Mennonite,Amish Mennonite,,608.85,,,,,,,553.50,1692.33,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,inpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,119.90,211.46,percent of total billed charges,
EXAM UNDER ANES-TECH,76159,CDM,510,RC,57410,CPT,,,facility,outpatient,,,218.00000,207.10000,Amish/Mennonite,Amish Mennonite,,119.90,,,,,,,109.00,3321.00,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,57.20,100.88,percent of total billed charges,
"ELEC ANALY PRG,IMP PMP;REP/REF 62369-TECH",76160,CDM,510,RC,62369,CPT,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,52.00,313.26,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,inpatient,,,379.00000,360.05000,Amish/Mennonite,Amish Mennonite,,208.45,,,,,,,208.45,367.63,percent of total billed charges,
EXC OF TORUS MANDIBULARIS-TECH,76161,CDM,510,RC,21031,CPT,,,facility,outpatient,,,379.00000,360.05000,Amish/Mennonite,Amish Mennonite,,208.45,,,,,,,189.50,3387.36,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,inpatient,,,459.00000,436.05000,Amish/Mennonite,Amish Mennonite,,252.45,,,,,,,252.45,445.23,percent of total billed charges,
ENDOVEN ABL THER;SUBSEQ VNS-TECH,76162,CDM,510,RC,36476,CPT,,,facility,outpatient,,,459.00000,436.05000,Amish/Mennonite,Amish Mennonite,,252.45,,,,,,,229.50,445.23,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,inpatient,,,1281.00000,1216.95000,Amish/Mennonite,Amish Mennonite,,704.55,,,,,,,704.55,1242.57,percent of total billed charges,
"EXC TUMOR,LEG/ANKLE,SUBC;<3CM-TECH",76163,CDM,510,RC,27618,CPT,,,facility,outpatient,,,1281.00000,1216.95000,Amish/Mennonite,Amish Mennonite,,704.55,,,,,,,640.50,1692.33,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,inpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,717.75,1265.85,percent of total billed charges,
"EXC TUMOR,THIGH,KNEE,SUBC;<3CM-TECH",76164,CDM,510,RC,27327,CPT,,,facility,outpatient,,,1305.00000,1239.75000,Amish/Mennonite,Amish Mennonite,,717.75,,,,,,,652.50,1692.33,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,inpatient,,,1432.00000,1360.40000,Amish/Mennonite,Amish Mennonite,,787.60,,,,,,,787.60,1389.04,percent of total billed charges,
"EXC, TMR/FASC MALF,SUBC;<1.5CM-TECH",76165,CDM,510,RC,26115,CPT,,,facility,outpatient,,,1432.00000,1360.40000,Amish/Mennonite,Amish Mennonite,,787.60,,,,,,,716.00,1692.33,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,inpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,220.00,388.00,percent of total billed charges,
EXC LESION OF TONGUE WO CLOSUR-TECH,76166,CDM,510,RC,41110,CPT,,,facility,outpatient,,,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,200.00,3387.36,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,inpatient,,,1509.00000,1433.55000,Amish/Mennonite,Amish Mennonite,,829.95,,,,,,,829.95,1463.73,percent of total billed charges,
CL TRT ACETABULUM FX;WO MANIP-TECH,76167,CDM,510,RC,27220,CPT,,,facility,outpatient,,,1509.00000,1433.55000,Amish/Mennonite,Amish Mennonite,,829.95,,,,,,,227.78,1463.73,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,inpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,,987.25,,,,,,,987.25,1741.15,percent of total billed charges,
"CYSTOURETHROSCOPY,W/FULGARATN-TECH",76168,CDM,510,RC,52214,CPT,,,facility,outpatient,,,1795.00000,1705.25000,Amish/Mennonite,Amish Mennonite,,987.25,,,,,,,897.50,3602.42,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,inpatient,,,1181.00000,1121.95000,Amish/Mennonite,Amish Mennonite,,649.55,,,,,,,649.55,1145.57,percent of total billed charges,
"EXC,TMR,LEG/ANKLE,SUBCUT;>3CM-TECH",76169,CDM,510,RC,27632,CPT,,,facility,outpatient,,,1181.00000,1121.95000,Amish/Mennonite,Amish Mennonite,,649.55,,,,,,,590.50,2989.39,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,inpatient,,,1020.00000,969.00000,Amish/Mennonite,Amish Mennonite,,561.00,,,,,,,561.00,989.40,percent of total billed charges,
CYSTOURETHROSC/W IRR/EVAC CLOT-TECH,76171,CDM,510,RC,52001,CPT,,,facility,outpatient,,,1020.00000,969.00000,Amish/Mennonite,Amish Mennonite,,561.00,,,,,,,510.00,3602.42,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-PHD 90846-TECH",76172,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,90.00,264.00,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,inpatient,,,1245.00000,1182.75000,Amish/Mennonite,Amish Mennonite,,684.75,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;<3CM-TECH",76173,CDM,510,RC,22902,CPT,,,facility,outpatient,,,1245.00000,1182.75000,Amish/Mennonite,Amish Mennonite,,684.75,,,,,,,622.50,1692.33,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,inpatient,,,1245.00000,1182.75000,Amish/Mennonite,Amish Mennonite,,684.75,,,,,,,684.75,1207.65,percent of total billed charges,
"EXC,TMR,ABD WALL,SUBC;>3CM-TECH",76174,CDM,510,RC,22903,CPT,,,facility,outpatient,,,1245.00000,1182.75000,Amish/Mennonite,Amish Mennonite,,684.75,,,,,,,622.50,2989.39,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
DIAGNOSTIC EVAL-MSW/MS-TECH,76175,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,inpatient,,,407.00000,386.65000,Amish/Mennonite,Amish Mennonite,,223.85,,,,,,,223.85,394.79,percent of total billed charges,
EXC LOCAL LESION OF PALATE-TECH,76176,CDM,510,RC,42104,CPT,,,facility,outpatient,,,407.00000,386.65000,Amish/Mennonite,Amish Mennonite,,223.85,,,,,,,203.50,3387.36,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,inpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,438.35,773.09,percent of total billed charges,
ENDOSC INJ IMP MAT URETH/BLADR-TECH,76177,CDM,510,RC,51715,CPT,,,facility,outpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,398.50,3602.42,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,288.20,508.28,percent of total billed charges,
"EXC DERMOID CYST,NOSE,SIMPLE-TECH",76178,CDM,510,RC,30124,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,,288.20,,,,,,,262.00,1547.18,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,inpatient,,,752.00000,714.40000,Amish/Mennonite,Amish Mennonite,,413.60,,,,,,,413.60,729.44,percent of total billed charges,
DRAINAGE-FINGER ABSCESS;SIMPLE-TECH,76180,CDM,510,RC,26010,CPT,,,facility,outpatient,,,752.00000,714.40000,Amish/Mennonite,Amish Mennonite,,413.60,,,,,,,188.67,729.44,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,inpatient,,,966.00000,917.70000,Amish/Mennonite,Amish Mennonite,,531.30,,,,,,,531.30,937.02,percent of total billed charges,
"EXC,TMR,SFT TISS FC/SCLP;>2CM-TECH",76182,CDM,361,RC,21012,CPT,,,facility,outpatient,,,966.00000,917.70000,Amish/Mennonite,Amish Mennonite,,531.30,,,,,,,531.30,4686.00,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,inpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,,732.05,,,,,,,732.05,1291.07,percent of total billed charges,
"EXC TUMOR,SHOULDER;SUBC;<3CM-TECH",76183,CDM,510,RC,23075,CPT,,,facility,outpatient,,,1331.00000,1264.45000,Amish/Mennonite,Amish Mennonite,,732.05,,,,,,,665.50,1692.33,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,inpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,,217.80,,,,,,,217.80,384.12,percent of total billed charges,
"EXC LESION,VESTIBULE OF MOUTH-TECH",76184,CDM,510,RC,40810,CPT,,,facility,outpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,,217.80,,,,,,,198.00,3387.36,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER W/O PT,50 MIN-MD 90846-TECH",76185,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,90.00,264.00,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,inpatient,,,1181.00000,1121.95000,Amish/Mennonite,Amish Mennonite,,649.55,,,,,,,649.55,1145.57,percent of total billed charges,
"EXPL RMVL DP FB,FOREARM/WRIST-TECH",76186,CDM,510,RC,25248,CPT,,,facility,outpatient,,,1181.00000,1121.95000,Amish/Mennonite,Amish Mennonite,,649.55,,,,,,,590.50,1671.62,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,inpatient,,,681.00000,646.95000,Amish/Mennonite,Amish Mennonite,,374.55,,,,,,,374.55,660.57,percent of total billed charges,
CANTHOTOMY-TECH,76187,CDM,510,RC,67715,CPT,,,facility,outpatient,,,681.00000,646.95000,Amish/Mennonite,Amish Mennonite,,374.55,,,,,,,340.50,2436.76,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
"DIAGNOSTIC EVALUATION,LMFT-MS 90791-TECH",76188,CDM,900,RC,90791,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,115.50,224.07,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,inpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,340.45,600.43,percent of total billed charges,
CERVICAL CONIZATION W/WO D&C-TECH,76189,CDM,510,RC,57520,CPT,,,facility,outpatient,,,619.00000,588.05000,Amish/Mennonite,Amish Mennonite,,340.45,,,,,,,309.50,3321.00,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,inpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,148.50,261.90,percent of total billed charges,
DEST AGENT;OTH PERIPH NRV/BRAN-TECH,76190,CDM,510,RC,64640,CPT,,,facility,outpatient,,,270.00000,256.50000,Amish/Mennonite,Amish Mennonite,,148.50,,,,,,,135.00,929.91,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,61.05,107.67,percent of total billed charges,
"FIT CNT LENS MGMNT KERATOC,IN-TECH",76191,CDM,510,RC,92072,CPT,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,55.50,107.67,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,inpatient,,,739.00000,702.05000,Amish/Mennonite,Amish Mennonite,,406.45,,,,,,,406.45,716.83,percent of total billed charges,
CL TRT NASAL BN FX;W/STABILIZ-TECH,76192,CDM,510,RC,21320,CPT,,,facility,outpatient,,,739.00000,702.05000,Amish/Mennonite,Amish Mennonite,,406.45,,,,,,,369.50,3387.36,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,inpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,151.25,266.75,percent of total billed charges,
DRS/DEBRID PRT-THK BURNS;MED-TECH,76193,CDM,510,RC,16025,CPT,,,facility,outpatient,,,275.00000,261.25000,Amish/Mennonite,Amish Mennonite,,151.25,,,,,,,137.50,266.75,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,inpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,25.85,45.59,percent of total billed charges,
"H/B FAM W/O PT-,ADL 15 MIN-PHD-TECH",76194,CDM,916,RC,96171,CPT,,,facility,outpatient,,,47.00000,44.65000,Amish/Mennonite,Amish Mennonite,,25.85,,,,,,,23.50,264.00,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,LMFT-MS 90847-TECH",76195,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,93.50,264.00,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,99.00,174.60,percent of total billed charges,
"FAMILY THER,W/O PT,50MN-MSW/MS 90846-TECH",76197,CDM,916,RC,90846,CPT,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,90.00,264.00,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,inpatient,,,1359.00000,1291.05000,Amish/Mennonite,Amish Mennonite,,747.45,,,,,,,747.45,1318.23,percent of total billed charges,
"EXC TMR,FREARM/WRST;SUBC;<3CM-TECH",76198,CDM,510,RC,25075,CPT,,,facility,outpatient,,,1359.00000,1291.05000,Amish/Mennonite,Amish Mennonite,,747.45,,,,,,,679.50,1692.33,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,inpatient,,,1905.00000,1809.75000,Amish/Mennonite,Amish Mennonite,,1047.75,,,,,,,1047.75,1847.85,percent of total billed charges,
FLAP;ISLAND PEDICLE-TECH,76199,CDM,510,RC,15740,CPT,,,facility,outpatient,,,1905.00000,1809.75000,Amish/Mennonite,Amish Mennonite,,1047.75,,,,,,,952.50,1910.62,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-MSW/MS 90853-TECH,76200,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,26.50,264.00,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,17.60,31.04,percent of total billed charges,
HAIR MICROSCOPY(TRICHOGRAM)-TECH,76201,CDM,940,RC,96902,CPT,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,16.00,31.04,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,U6,102.85,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,QTT-PHD 90847-TECH",76202,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,U6,102.85,,,,,,,93.50,264.00,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,inpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,500.50,882.70,percent of total billed charges,
EXC LIP;V-EXC W/PRIM LINR CLSR-TECH,76203,CDM,510,RC,40520,CPT,,,facility,outpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,455.00,3387.36,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
CONJUNCTIVAL BIOPSY-TECH,76204,CDM,510,RC,68100,CPT,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,243.50,2436.76,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,inpatient,,,1589.00000,1509.55000,Amish/Mennonite,Amish Mennonite,,873.95,,,,,,,873.95,1541.33,percent of total billed charges,
"FACE,NECK,HANDS-TO 100 SQ CM-TECH",76205,CDM,510,RC,15120,CPT,,,facility,outpatient,,,1589.00000,1509.55000,Amish/Mennonite,Amish Mennonite,,873.95,,,,,,,794.50,3823.86,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,inpatient,,,1623.00000,1541.85000,Amish/Mennonite,Amish Mennonite,,892.65,,,,,,,892.65,1574.31,percent of total billed charges,
"EXT TENDON RPR,FINGER,SINGLE-TECH",76206,CDM,510,RC,26418,CPT,,,facility,outpatient,,,1623.00000,1541.85000,Amish/Mennonite,Amish Mennonite,,892.65,,,,,,,811.50,1671.62,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,inpatient,,,437.00000,415.15000,Amish/Mennonite,Amish Mennonite,,240.35,,,,,,,240.35,423.89,percent of total billed charges,
"DESTRUCTN-LESION,PALATE/UVULA-TECH",76208,CDM,510,RC,42160,CPT,,,facility,outpatient,,,437.00000,415.15000,Amish/Mennonite,Amish Mennonite,,240.35,,,,,,,218.50,3387.36,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,inpatient,,,887.00000,842.65000,Amish/Mennonite,Amish Mennonite,,487.85,,,,,,,487.85,860.39,percent of total billed charges,
"FASCIOTOMY,PALMAR;PERCUTANEOUS-TECH",76209,CDM,510,RC,26040,CPT,,,facility,outpatient,,,887.00000,842.65000,Amish/Mennonite,Amish Mennonite,,487.85,,,,,,,443.50,1671.62,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,inpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,74.25,130.95,percent of total billed charges,
INCISIONAL BX EA ADDTL LESION-TECH,76210,CDM,510,RC,11107,CPT,,,facility,outpatient,,,135.00000,128.25000,Amish/Mennonite,Amish Mennonite,,74.25,,,,,,,67.50,130.95,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,inpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,,317.35,,,,,,,317.35,559.69,percent of total billed charges,
HEMORRHOIDEC;2/MORE COL/GRPS-TECH,76211,CDM,510,RC,46946,CPT,,,facility,outpatient,,,577.00000,548.15000,Amish/Mennonite,Amish Mennonite,,317.35,,,,,,,288.50,2864.41,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,inpatient,,,627.00000,595.65000,Amish/Mennonite,Amish Mennonite,,344.85,,,,,,,344.85,608.19,percent of total billed charges,
I&D VAGINAL HEMATOMA;NON-OB-TECH,76213,CDM,510,RC,57023,CPT,,,facility,outpatient,,,627.00000,595.65000,Amish/Mennonite,Amish Mennonite,,344.85,,,,,,,313.50,2989.39,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,inpatient,,,851.00000,808.45000,Amish/Mennonite,Amish Mennonite,,468.05,,,,,,,468.05,825.47,percent of total billed charges,
"I&D ABSC;RETRO/PARAPHARYN,ORAL-TECH",76214,CDM,510,RC,42720,CPT,,,facility,outpatient,,,851.00000,808.45000,Amish/Mennonite,Amish Mennonite,,468.05,,,,,,,425.50,3387.36,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,inpatient,,,2092.00000,1987.40000,Amish/Mennonite,Amish Mennonite,,1150.60,,,,,,,1150.60,2029.24,percent of total billed charges,
"EXC,TMR,BACK/FLANK,SUBFAS;>5CM-TECH",76216,CDM,510,RC,21933,CPT,,,facility,outpatient,,,2092.00000,1987.40000,Amish/Mennonite,Amish Mennonite,,1150.60,,,,,,,1046.00,2989.39,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90837-TECH",76217,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,112.00,264.00,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,92.40,162.96,percent of total billed charges,
ING CHALL TEST;INIT 120 MIN-TECH,76219,CDM,924,RC,95076,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,84.00,554.21,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,inpatient,,,659.00000,626.05000,Amish/Mennonite,Amish Mennonite,,362.45,,,,,,,362.45,639.23,percent of total billed charges,
"FX/SCAPULA,N/R-TECH",76220,CDM,510,RC,23570,CPT,,,facility,outpatient,,,659.00000,626.05000,Amish/Mennonite,Amish Mennonite,,362.45,,,,,,,227.78,639.23,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,inpatient,,,1744.00000,1656.80000,Amish/Mennonite,Amish Mennonite,,959.20,,,,,,,959.20,1691.68,percent of total billed charges,
"FTSG-FHD,CHKS,CHN,MOUTH,NECK-TECH",76221,CDM,510,RC,15240,CPT,,,facility,outpatient,,,1744.00000,1656.80000,Amish/Mennonite,Amish Mennonite,,959.20,,,,,,,872.00,1910.62,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
GROUP THERAPY-APNP 90853-TECH,76222,CDM,915,RC,90853,CPT,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,26.50,264.00,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,inpatient,,,1895.00000,1800.25000,Amish/Mennonite,Amish Mennonite,,1042.25,,,,,,,1042.25,1838.15,percent of total billed charges,
"FTSG-EYELIDS,NOSE,LIPS,EARS-TECH",76224,CDM,510,RC,15260,CPT,,,facility,outpatient,,,1895.00000,1800.25000,Amish/Mennonite,Amish Mennonite,,1042.25,,,,,,,947.50,1910.62,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,Amish/Mennonite,Amish Mennonite,,244.75,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR;EXIST-TECH,76225,CDM,510,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,Amish/Mennonite,Amish Mennonite,,244.75,,,,,,,222.50,697.17,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
"INDIVIDUAL; THERAPY,LMFT-MS 90834-TECH",76226,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,264.00,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-PHD 90847-TECH",76227,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,93.50,264.00,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,inpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,276.10,486.94,percent of total billed charges,
INJ PROC-CYSTOGRAPHY-TECH,76228,CDM,510,RC,51600,CPT,,,facility,outpatient,,,502.00000,476.90000,Amish/Mennonite,Amish Mennonite,,276.10,,,,,,,251.00,486.94,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,inpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,,140.25,,,,,,,140.25,247.35,percent of total billed charges,
"FULL THCKNS SKIN GRFT,ADL 20CM-TECH",76229,CDM,510,RC,15221,CPT,,,facility,outpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,,140.25,,,,,,,127.50,247.35,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
"FORESKIN MANIP,PREPUT STRETCHG-TECH",76230,CDM,510,RC,54450,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,254.03,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,inpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,,111.10,,,,,,,111.10,195.94,percent of total billed charges,
"INJ,ANES AGNT;TRIGEMINAL NERVE-TECH",76231,CDM,510,RC,64400,CPT,,,facility,outpatient,,,202.00000,191.90000,Amish/Mennonite,Amish Mennonite,,111.10,,,,,,,101.00,308.32,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,inpatient,,,1078.00000,1024.10000,Amish/Mennonite,Amish Mennonite,,592.90,,,,,,,592.90,1045.66,percent of total billed charges,
CLSR ORAL-NASAL FISTULA-TECH,76233,CDM,510,RC,30600,CPT,,,facility,outpatient,,,1078.00000,1024.10000,Amish/Mennonite,Amish Mennonite,,592.90,,,,,,,539.00,6178.88,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,inpatient,,,672.00000,638.40000,Amish/Mennonite,Amish Mennonite,,369.60,,,,,,,369.60,651.84,percent of total billed charges,
"FC,MM,EAR,EYELD,NS,LP,7.6-12.5-TECH",76234,CDM,510,RC,12054,CPT,,,facility,outpatient,,,672.00000,638.40000,Amish/Mennonite,Amish Mennonite,,369.60,,,,,,,336.00,651.84,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
"H/B FAM W/O PT,30MIN-PHD-TECH",76236,CDM,916,RC,96170,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,63.50,264.00,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,inpatient,,,556.00000,528.20000,Amish/Mennonite,Amish Mennonite,,305.80,,,,,,,305.80,539.32,percent of total billed charges,
"INSERTION,NASAL SEPTUM BUTTON-TECH",76237,CDM,510,RC,30220,CPT,,,facility,outpatient,,,556.00000,528.20000,Amish/Mennonite,Amish Mennonite,,305.80,,,,,,,278.00,1547.18,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,189.75,334.65,percent of total billed charges,
"FULL THCKNS GRAFT,ADDL 20 CM-TECH",76238,CDM,510,RC,15241,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,172.50,334.65,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MSW/MS 90791-TECH,76239,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,inpatient,,,14438.00000,13716.10000,Amish/Mennonite,Amish Mennonite,TC,7940.90,,,,,,,7940.90,14004.86,percent of total billed charges,
PET/CT SK BASE TO MID-THIGH-TECH,7624,CDM,404,RC,78815,CPT,,,facility,outpatient,,,14438.00000,13716.10000,Amish/Mennonite,Amish Mennonite,TC,7940.90,,,,,,,4549.00,14004.86,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,inpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,160.60,283.24,percent of total billed charges,
INJ PROC/RETRGRD URTHROCYSTOGR-TECH,76240,CDM,510,RC,51610,CPT,,,facility,outpatient,,,292.00000,277.40000,Amish/Mennonite,Amish Mennonite,,160.60,,,,,,,146.00,283.24,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
INTRODUCTION OF LONG GI TUBE-TECH,76241,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,23.00,979.27,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,92.40,162.96,percent of total billed charges,
"INJ,MUSCL-CT IMAGE-TECH",76242,CDM,510,RC,20550,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,,92.40,,,,,,,84.00,308.32,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-MD 90785-TECH,76243,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,inpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,264.55,466.57,percent of total billed charges,
"LARYNGOSCOPY,FLEX;THER INJ,UNI-TECH",76245,CDM,510,RC,31573,CPT,,,facility,outpatient,,,481.00000,456.95000,Amish/Mennonite,Amish Mennonite,,264.55,,,,,,,240.50,1801.19,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
INTRANASAL BIOPSY-TECH,76246,CDM,510,RC,30100,CPT,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,129.50,1547.18,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,inpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,139.70,246.38,percent of total billed charges,
DIAG EVAL W/MEDICAL SRV-MD-TECH,76247,CDM,900,RC,90792,CPT,,,facility,outpatient,,,254.00000,241.30000,Amish/Mennonite,Amish Mennonite,,139.70,,,,,,,127.00,246.38,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-PHD 90785-TECH,76248,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,inpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,,226.60,,,,,,,226.60,399.64,percent of total billed charges,
"LARYNGOSC,FLEX FIB;W/BIOPSY-TECH",76249,CDM,510,RC,31576,CPT,,,facility,outpatient,,,412.00000,391.40000,Amish/Mennonite,Amish Mennonite,,226.60,,,,,,,206.00,1801.19,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,inpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,189.75,334.65,percent of total billed charges,
"INC CONJUNCTIVA,DRAINAGE CYST-TECH",76251,CDM,510,RC,68020,CPT,,,facility,outpatient,,,345.00000,327.75000,Amish/Mennonite,Amish Mennonite,,189.75,,,,,,,172.50,1011.64,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,inpatient,,,498.00000,473.10000,Amish/Mennonite,Amish Mennonite,,273.90,,,,,,,273.90,483.06,percent of total billed charges,
LYSIS/EXC PENILE POST-CIRC ADH-TECH,76252,CDM,510,RC,54162,CPT,,,facility,outpatient,,,498.00000,473.10000,Amish/Mennonite,Amish Mennonite,,273.90,,,,,,,249.00,2139.65,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,inpatient,,,1153.00000,1095.35000,Amish/Mennonite,Amish Mennonite,,634.15,,,,,,,634.15,1118.41,percent of total billed charges,
"EXC,TMR,UPR ARM/ELB,SUBC;>3CM-TECH",76253,CDM,510,RC,24071,CPT,,,facility,outpatient,,,1153.00000,1095.35000,Amish/Mennonite,Amish Mennonite,,634.15,,,,,,,576.50,2989.39,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,inpatient,,,1321.00000,1254.95000,Amish/Mennonite,Amish Mennonite,,726.55,,,,,,,726.55,1281.37,percent of total billed charges,
FILLETED FINGER/TOE FLAP-TECH,76254,CDM,510,RC,14350,CPT,,,facility,outpatient,,,1321.00000,1254.95000,Amish/Mennonite,Amish Mennonite,,726.55,,,,,,,660.50,1910.62,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,inpatient,,,1152.00000,1094.40000,Amish/Mennonite,Amish Mennonite,,633.60,,,,,,,633.60,1117.44,percent of total billed charges,
MOHS TECH;1ST STAGE TO 5 BLCKS-TECH,76255,CDM,510,RC,17313,CPT,,,facility,outpatient,,,1152.00000,1094.40000,Amish/Mennonite,Amish Mennonite,,633.60,,,,,,,576.00,1117.44,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,inpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,102.85,181.39,percent of total billed charges,
"FAMILY THERAPY,50 MIN-MSW/MS 90847-TECH",76256,CDM,916,RC,90847,CPT,,,facility,outpatient,,,187.00000,177.65000,Amish/Mennonite,Amish Mennonite,,102.85,,,,,,,93.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,382.25,674.15,percent of total billed charges,
MOHS TECH;EA ADL ST 17314-TECH,76257,CDM,510,RC,17314,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,347.50,674.15,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,inpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,15.95,28.13,percent of total billed charges,
INTERACTIVE COMPLEXITY-APNP 90785-TECH,76258,CDM,900,RC,90785,CPT,,,facility,outpatient,,,29.00000,27.55000,Amish/Mennonite,Amish Mennonite,,15.95,,,,,,,14.50,28.13,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
MOHS TECH;EA ADL ST 17315-TECH,76259,CDM,510,RC,17315,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,144.53,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,inpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,,677.60,,,,,,,677.60,1195.04,percent of total billed charges,
"MOHS TECH;1ST STAGE,TO 5 BLCKS-TECH",76261,CDM,510,RC,17311,CPT,,,facility,outpatient,,,1232.00000,1170.40000,Amish/Mennonite,Amish Mennonite,,677.60,,,,,,,581.24,1195.04,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,inpatient,,,102.75000,97.61000,Amish/Mennonite,Amish Mennonite,,56.51,,,,,,,56.51,99.67,percent of total billed charges,
IMMIGRATION PHYSICAL EXAM-TECH,76262,CDM,510,RC,99499,CPT,,,facility,outpatient,,,102.75000,97.61000,Amish/Mennonite,Amish Mennonite,,56.51,,,,,,,51.38,99.67,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,inpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,121.00,213.40,percent of total billed charges,
"INJ,ANES AGNT;SUPRASCAPULAR NV-TECH",76263,CDM,510,RC,64418,CPT,,,facility,outpatient,,,220.00000,209.00000,Amish/Mennonite,Amish Mennonite,,121.00,,,,,,,110.00,723.34,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,96.25,169.75,percent of total billed charges,
INJ CORPORA CAVERNOSA W/PHARM-TECH,76264,CDM,510,RC,54235,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,87.50,254.03,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,inpatient,,,1135.00000,1078.25000,Amish/Mennonite,Amish Mennonite,,624.25,,,,,,,624.25,1100.95,percent of total billed charges,
MULT PUNCTURES OF ANTER CORNEA-TECH,76265,CDM,510,RC,65600,CPT,,,facility,outpatient,,,1135.00000,1078.25000,Amish/Mennonite,Amish Mennonite,,624.25,,,,,,,567.50,2436.76,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,inpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,,6.05,,,,,,,6.05,10.67,percent of total billed charges,
"INTRACUT TESTS,ALLERGENIC EXTR-TECH",76266,CDM,924,RC,95024,CPT,,,facility,outpatient,,,11.00000,10.45000,Amish/Mennonite,Amish Mennonite,,6.05,,,,,,,5.50,62.04,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,inpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,,522.50,,,,,,,522.50,921.50,percent of total billed charges,
"MANIPULATION,FINGER JT,UNDR AN-TECH",76267,CDM,510,RC,26340,CPT,,,facility,outpatient,,,950.00000,902.50000,Amish/Mennonite,Amish Mennonite,,522.50,,,,,,,475.00,1671.62,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MSW/MS 90849-TECH,76268,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,22.50,264.00,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
LYMPH NODE NEEDLE BX SUPRFI-US-TECH,76269,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,183.00,1692.33,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,inpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,,739.20,,,,,,,739.20,1303.68,percent of total billed charges,
"EXC TUMOR,BACK/FLANK;<3CM-TECH",76270,CDM,510,RC,21930,CPT,,,facility,outpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,,739.20,,,,,,,672.00,1692.33,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,inpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,200.20,353.08,percent of total billed charges,
NASAL ENDOSC;MAXILLARY ANTROST-TECH,76271,CDM,510,RC,31256,CPT,,,facility,outpatient,,,364.00000,345.80000,Amish/Mennonite,Amish Mennonite,,200.20,,,,,,,182.00,3851.00,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,inpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,,342.65,,,,,,,342.65,604.31,percent of total billed charges,
"LARYNGOSC,DIR,W/INJ VOC CRD-TECH",76273,CDM,510,RC,31570,CPT,,,facility,outpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,,342.65,,,,,,,311.50,3851.00,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,inpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,271.15,478.21,percent of total billed charges,
NASAL SYNECHIA LYSIS-TECH,76274,CDM,510,RC,30560,CPT,,,facility,outpatient,,,493.00000,468.35000,Amish/Mennonite,Amish Mennonite,,271.15,,,,,,,246.50,531.90,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
OSTEOPTH MANIP TRT;1-2 REGIONS-TECH,76275,CDM,530,RC,98925,CPT,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,21.50,41.71,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,inpatient,,,1187.00000,1127.65000,Amish/Mennonite,Amish Mennonite,,652.85,,,,,,,652.85,1151.39,percent of total billed charges,
PERC SKEL FIX DISTL PHAL FX-TECH,76276,CDM,510,RC,26756,CPT,,,facility,outpatient,,,1187.00000,1127.65000,Amish/Mennonite,Amish Mennonite,,652.85,,,,,,,593.50,3388.98,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,24.75,43.65,percent of total billed charges,
MULTI FAMILY GROUP THER-MD 90849-TECH,76277,CDM,916,RC,90849,CPT,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,,24.75,,,,,,,22.50,264.00,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,inpatient,,,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,712.25,1256.15,percent of total billed charges,
"MYRINGOPLAST,DRUMHD/DONOR AREA-TECH",76278,CDM,510,RC,69620,CPT,,,facility,outpatient,,,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,647.50,3387.36,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN-PHD 90832-TECH",76279,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,56.00,264.00,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,inpatient,,,134.25000,127.54000,Amish/Mennonite,Amish Mennonite,,73.84,,,,,,,73.84,130.22,percent of total billed charges,
"FAMILY CONF,PT ABS-LVL 5-CLIN-TECH",76280,CDM,510,RC,99499,CPT,,,facility,outpatient,,,134.25000,127.54000,Amish/Mennonite,Amish Mennonite,,73.84,,,,,,,67.12,130.22,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,inpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,80.30,141.62,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN,E/M-APNP 90836-TECH",76281,CDM,914,RC,90836,CPT,,,facility,outpatient,,,146.00000,138.70000,Amish/Mennonite,Amish Mennonite,,80.30,,,,,,,73.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-MSW/MS 90834-TECH",76282,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,264.00,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,inpatient,,,343.00000,325.85000,Amish/Mennonite,Amish Mennonite,,188.65,,,,,,,188.65,332.71,percent of total billed charges,
PARACEN/ANT CHAMB-EYE;DX ASPIR-TECH,76283,CDM,510,RC,65800,CPT,,,facility,outpatient,,,343.00000,325.85000,Amish/Mennonite,Amish Mennonite,,188.65,,,,,,,171.50,2382.20,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,inpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,56.65,99.91,percent of total billed charges,
PATH PC  PATH CONSULT DURING SG-TECH,76284,CDM,310,RC,88329,CPT,,,facility,outpatient,,,103.00000,97.85000,Amish/Mennonite,Amish Mennonite,,56.65,,,,,,,51.50,1787.56,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,inpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.95,8.73,percent of total billed charges,
"PERC TESTS,ALLERGENIC EXTRACTS-TECH",76285,CDM,924,RC,95004,CPT,,,facility,outpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.50,1062.65,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
"INTRO NEEDLE/INTRACATH,VEIN-TECH",76286,CDM,510,RC,36000,CPT,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,118.34,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-PHD 90834-TECH",76287,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,264.00,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,inpatient,,,724.00000,687.80000,Amish/Mennonite,Amish Mennonite,,398.20,,,,,,,398.20,702.28,percent of total billed charges,
MOHS TECH;EA ADL ST 17312-TECH,76288,CDM,510,RC,17312,CPT,,,facility,outpatient,,,724.00000,687.80000,Amish/Mennonite,Amish Mennonite,,398.20,,,,,,,362.00,702.28,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
NEEDLE BX LYMPH NODE-AXILLA-TECH,76289,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,183.00,1692.33,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,inpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,,260.15,,,,,,,260.15,458.81,percent of total billed charges,
"NAS/SINUS ENDO,SRG;CNTRL EPIST-TECH",76290,CDM,510,RC,31238,CPT,,,facility,outpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,,260.15,,,,,,,236.50,1801.19,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-PHD 90837-TECH",76291,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,112.00,264.00,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,60 MIN-MSW/MS 90837-TECH",76292,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,112.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,Amish/Mennonite,Amish Mennonite,,927.30,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-CT-TECH",76294,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,Amish/Mennonite,Amish Mennonite,,927.30,,,,,,,843.00,1692.33,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,inpatient,,,390.00000,370.50000,Amish/Mennonite,Amish Mennonite,,214.50,,,,,,,214.50,378.30,percent of total billed charges,
MIDDLE EAR POLYP REMOVAL-TECH,76295,CDM,510,RC,69540,CPT,,,facility,outpatient,,,390.00000,370.50000,Amish/Mennonite,Amish Mennonite,,214.50,,,,,,,195.00,1547.18,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,inpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,201.30,355.02,percent of total billed charges,
"NEEDLE BX,LYMPH NODE-CVIR-TECH",76297,CDM,510,RC,38505,CPT,,,facility,outpatient,,,366.00000,347.70000,Amish/Mennonite,Amish Mennonite,,201.30,,,,,,,183.00,1692.33,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,U6,61.60,,,,,,,61.60,108.64,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90832-TECH",76298,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,U6,61.60,,,,,,,56.00,264.00,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,inpatient,,,610.00000,579.50000,Amish/Mennonite,Amish Mennonite,,335.50,,,,,,,335.50,591.70,percent of total billed charges,
RECTAL BIOPSY-TECH,76299,CDM,510,RC,45100,CPT,,,facility,outpatient,,,610.00000,579.50000,Amish/Mennonite,Amish Mennonite,,335.50,,,,,,,305.00,2864.41,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,inpatient,,,1234.00000,1172.30000,Amish/Mennonite,Amish Mennonite,,678.70,,,,,,,678.70,1196.98,percent of total billed charges,
"REPL GASTROS/C ECOS TBE,FLUORO-TECH",76300,CDM,510,RC,49450,CPT,,,facility,outpatient,,,1234.00000,1172.30000,Amish/Mennonite,Amish Mennonite,,678.70,,,,,,,617.00,1196.98,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,inpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,510.40,900.16,percent of total billed charges,
RMVL INTACT BREAST IMPLANT-TECH,76301,CDM,510,RC,19328,CPT,,,facility,outpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,464.00,3999.66,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,inpatient,,,2738.00000,2601.10000,Amish/Mennonite,Amish Mennonite,,1505.90,,,,,,,1505.90,2655.86,percent of total billed charges,
RAD RESEC TMR NECK/THOR;<5CM-TECH,76302,CDM,510,RC,21557,CPT,,,facility,outpatient,,,2738.00000,2601.10000,Amish/Mennonite,Amish Mennonite,,1505.90,,,,,,,1369.00,2989.39,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,inpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,186.45,328.83,percent of total billed charges,
RMVL INDW  TUN PLEUR CATH/CUFF-TECH,76303,CDM,510,RC,32552,CPT,,,facility,outpatient,,,339.00000,322.05000,Amish/Mennonite,Amish Mennonite,,186.45,,,,,,,169.50,645.77,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
PSYCHOTHERAPY-30 MIN-MSW/MS 90832-TECH,76304,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,56.00,264.00,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,inpatient,,,1686.00000,1601.70000,Amish/Mennonite,Amish Mennonite,,927.30,,,,,,,927.30,1635.42,percent of total billed charges,
"RENAL BIOPSY,PERCUTANEOUS-TECH",76305,CDM,510,RC,50200,CPT,,,facility,outpatient,,,1686.00000,1601.70000,Amish/Mennonite,Amish Mennonite,,927.30,,,,,,,843.00,1692.33,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,inpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,61.05,107.67,percent of total billed charges,
"PSYCHOTHER-CRISIS,ADL 30MN-PHD 90840-TECH",76306,CDM,914,RC,90840,CPT,,,facility,outpatient,,,111.00000,105.45000,Amish/Mennonite,Amish Mennonite,,61.05,,,,,,,55.50,264.00,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,inpatient,,,1729.00000,1642.55000,Amish/Mennonite,Amish Mennonite,,950.95,,,,,,,950.95,1677.13,percent of total billed charges,
RPR ECTROPION;EXTENSIVE-TECH,76307,CDM,510,RC,67917,CPT,,,facility,outpatient,,,1729.00000,1642.55000,Amish/Mennonite,Amish Mennonite,,950.95,,,,,,,864.50,2436.76,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,inpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,196.35,346.29,percent of total billed charges,
"SLIT PREPUCE,DORSAL/LAT;NOT NB-TECH",76309,CDM,510,RC,54001,CPT,,,facility,outpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,178.50,2139.65,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
INGESTN CHALL TST;ADL 60 MIN-TECH,76310,CDM,924,RC,95079,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,inpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,95.15,167.81,percent of total billed charges,
PUNCT SHUNT TUBE FOR ASP/INJ-TECH,76311,CDM,510,RC,61070,CPT,,,facility,outpatient,,,173.00000,164.35000,Amish/Mennonite,Amish Mennonite,,95.15,,,,,,,86.50,723.34,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,inpatient,,,218.50000,207.57000,Amish/Mennonite,Amish Mennonite,,120.17,,,,,,,120.17,211.94,percent of total billed charges,
TARSAL TUNNEL INJECTION-TECH,76312,CDM,510,RC,28899,CPT,,,facility,outpatient,,,218.50000,207.57000,Amish/Mennonite,Amish Mennonite,,120.17,,,,,,,109.25,250.56,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,U6,170.50,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY-CRISIS QTT-PHD 90839-TECH,76313,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,U6,170.50,,,,,,,155.00,300.70,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,inpatient,,,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,367.95,648.93,percent of total billed charges,
"NCK,HND,FT,GENIT,7.6-12.5 CM-TECH",76314,CDM,510,RC,12044,CPT,,,facility,outpatient,,,669.00000,635.55000,Amish/Mennonite,Amish Mennonite,,367.95,,,,,,,334.50,648.93,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,inpatient,,,986.00000,936.70000,Amish/Mennonite,Amish Mennonite,,542.30,,,,,,,542.30,956.42,percent of total billed charges,
"TENOTOMY,ACHILLES TNDN,SUBCUT-TECH",76315,CDM,510,RC,27605,CPT,,,facility,outpatient,,,986.00000,936.70000,Amish/Mennonite,Amish Mennonite,,542.30,,,,,,,493.00,1671.62,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,inpatient,,,1876.00000,1782.20000,Amish/Mennonite,Amish Mennonite,,1031.80,,,,,,,1031.80,1819.72,percent of total billed charges,
"LARYNGOSCOPY,FLEX;INJ AUG,UNIL-TECH",76316,CDM,510,RC,31574,CPT,,,facility,outpatient,,,1876.00000,1782.20000,Amish/Mennonite,Amish Mennonite,,1031.80,,,,,,,938.00,1819.72,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,inpatient,,,1296.00000,1231.20000,Amish/Mennonite,Amish Mennonite,,712.80,,,,,,,712.80,1257.12,percent of total billed charges,
I&D DEEP ABSC/HEMATOM-NK/THOR-TECH,76317,CDM,510,RC,21501,CPT,,,facility,outpatient,,,1296.00000,1231.20000,Amish/Mennonite,Amish Mennonite,,712.80,,,,,,,648.00,2989.39,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,inpatient,,,1056.00000,1003.20000,Amish/Mennonite,Amish Mennonite,,580.80,,,,,,,580.80,1024.32,percent of total billed charges,
RPR LIP OVER 1/2 VERT HEIGHT-TECH,76318,CDM,510,RC,40654,CPT,,,facility,outpatient,,,1056.00000,1003.20000,Amish/Mennonite,Amish Mennonite,,580.80,,,,,,,528.00,1547.18,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,inpatient,,,1132.00000,1075.40000,Amish/Mennonite,Amish Mennonite,,622.60,,,,,,,622.60,1098.04,percent of total billed charges,
"TENOTOMY,OPEN,FLEXOR;TOE,SINGL-TECH",76319,CDM,510,RC,28232,CPT,,,facility,outpatient,,,1132.00000,1075.40000,Amish/Mennonite,Amish Mennonite,,622.60,,,,,,,566.00,1671.62,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,inpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,500.50,882.70,percent of total billed charges,
"INS VEN DEV,SUBCUT PORT;>5YRS-TECH",76320,CDM,510,RC,36571,CPT,,,facility,outpatient,,,910.00000,864.50000,Amish/Mennonite,Amish Mennonite,,500.50,,,,,,,455.00,3287.55,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,inpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,,893.75,,,,,,,893.75,1576.25,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14021-TECH",76321,CDM,510,RC,14021,CPT,,,facility,outpatient,,,1625.00000,1543.75000,Amish/Mennonite,Amish Mennonite,,893.75,,,,,,,812.50,1910.62,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,inpatient,,,1856.00000,1763.20000,Amish/Mennonite,Amish Mennonite,,1020.80,,,,,,,1020.80,1800.32,percent of total billed charges,
OPN TRT RADIAL HEAD/NECK FRAC-TECH,76322,CDM,510,RC,24665,CPT,,,facility,outpatient,,,1856.00000,1763.20000,Amish/Mennonite,Amish Mennonite,,1020.80,,,,,,,928.00,7461.59,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,inpatient,,,1318.00000,1252.10000,Amish/Mennonite,Amish Mennonite,,724.90,,,,,,,724.90,1278.46,percent of total billed charges,
REPAIR OF ENTROPION;SUTURE-TECH,76323,CDM,510,RC,67921,CPT,,,facility,outpatient,,,1318.00000,1252.10000,Amish/Mennonite,Amish Mennonite,,724.90,,,,,,,659.00,2436.76,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,inpatient,,,1896.00000,1801.20000,Amish/Mennonite,Amish Mennonite,,1042.80,,,,,,,1042.80,1839.12,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14061-TECH",76325,CDM,510,RC,14061,CPT,,,facility,outpatient,,,1896.00000,1801.20000,Amish/Mennonite,Amish Mennonite,,1042.80,,,,,,,948.00,1910.62,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,inpatient,,,1556.00000,1478.20000,Amish/Mennonite,Amish Mennonite,,855.80,,,,,,,855.80,1509.32,percent of total billed charges,
STAB PHLEBECT;MORE THAN 20 INC-TECH,76326,CDM,510,RC,37766,CPT,,,facility,outpatient,,,1556.00000,1478.20000,Amish/Mennonite,Amish Mennonite,,855.80,,,,,,,778.00,3287.55,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
OSTEOPTH MANIP TRT;7-8 REGIONS-TECH,76327,CDM,530,RC,98928,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,24.02,97.00,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,inpatient,,,1493.00000,1418.35000,Amish/Mennonite,Amish Mennonite,,821.15,,,,,,,821.15,1448.21,percent of total billed charges,
DESTRUCT LES/RETINA;PHOTOCOAG-TECH,76328,CDM,510,RC,67210,CPT,,,facility,outpatient,,,1493.00000,1418.35000,Amish/Mennonite,Amish Mennonite,,821.15,,,,,,,520.92,1448.21,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,inpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,281.60,496.64,percent of total billed charges,
"INC/REM FB,SUBCUT TISSUE;COMPL-TECH",76329,CDM,510,RC,10121,CPT,,,facility,outpatient,,,512.00000,486.40000,Amish/Mennonite,Amish Mennonite,,281.60,,,,,,,256.00,1692.33,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,inpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1183.05,2086.47,percent of total billed charges,
RESUTURING OF OPERATIVE WOUND-TECH,76330,CDM,510,RC,66250,CPT,,,facility,outpatient,,,2151.00000,2043.45000,Amish/Mennonite,Amish Mennonite,,1183.05,,,,,,,1075.50,2436.76,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,inpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,255.20,450.08,percent of total billed charges,
"LARYNG,INJ VOC;OP MICRO/TELESC-TECH",76331,CDM,510,RC,31571,CPT,,,facility,outpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,232.00,3851.00,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,inpatient,,,3133.00000,2976.35000,Amish/Mennonite,Amish Mennonite,,1723.15,,,,,,,1723.15,3039.01,percent of total billed charges,
RMVL/REPL INTERN DWEL URET STN-TECH,76332,CDM,510,RC,50385,CPT,,,facility,outpatient,,,3133.00000,2976.35000,Amish/Mennonite,Amish Mennonite,,1723.15,,,,,,,1566.50,3039.01,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,inpatient,,,2190.00000,2080.50000,Amish/Mennonite,Amish Mennonite,,1204.50,,,,,,,1204.50,2124.30,percent of total billed charges,
LITHOLOPAXY-TECH,76333,CDM,510,RC,52317,CPT,,,facility,outpatient,,,2190.00000,2080.50000,Amish/Mennonite,Amish Mennonite,,1204.50,,,,,,,1095.00,3602.42,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,inpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,,168.85,,,,,,,168.85,297.79,percent of total billed charges,
"SIGMOIDOSC,FLEX;SCREENING-TECH",76334,CDM,510,RC,G0104,HCPCS,,,facility,outpatient,,,307.00000,291.65000,Amish/Mennonite,Amish Mennonite,,168.85,,,,,,,153.50,952.28,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,inpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,372.35,656.69,percent of total billed charges,
W/URETERAL MEATOTOMY-TECH,76335,CDM,510,RC,52290,CPT,,,facility,outpatient,,,677.00000,643.15000,Amish/Mennonite,Amish Mennonite,,372.35,,,,,,,338.50,2139.65,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,inpatient,,,1549.00000,1471.55000,Amish/Mennonite,Amish Mennonite,,851.95,,,,,,,851.95,1502.53,percent of total billed charges,
"RMVL FOREIGN BODY,FOOT;COMPL-TECH",76336,CDM,510,RC,28193,CPT,,,facility,outpatient,,,1549.00000,1471.55000,Amish/Mennonite,Amish Mennonite,,851.95,,,,,,,774.50,1692.33,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,inpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,115.50,203.70,percent of total billed charges,
PATH PC  CONSULT/REPORT-SLIDES-TECH,76337,CDM,310,RC,88321,CPT,,,facility,outpatient,,,210.00000,199.50000,Amish/Mennonite,Amish Mennonite,,115.50,,,,,,,37.27,4190.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,35.75,63.05,percent of total billed charges,
SERIAL TONOMETRY-SEPARATE PROC-TECH,76338,CDM,510,RC,92100,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,,35.75,,,,,,,32.50,63.05,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,inpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,63.25,111.55,percent of total billed charges,
"PSYCHOTHERAPY,30 MIN,E/M-APNP-TECH",76339,CDM,914,RC,90833,CPT,,,facility,outpatient,,,115.00000,109.25000,Amish/Mennonite,Amish Mennonite,,63.25,,,,,,,57.50,264.00,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,U6,81.95,,,,,,,81.95,144.53,percent of total billed charges,
"PSYCHOTHERAPY,45 MIN-QTT 90834-TECH",76342,CDM,914,RC,90834,CPT,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,U6,81.95,,,,,,,74.50,264.00,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,inpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,,140.25,,,,,,,140.25,247.35,percent of total billed charges,
"RVML ANAL SETON,OTHER MARKER-TECH",76345,CDM,510,RC,46030,CPT,,,facility,outpatient,,,255.00000,242.25000,Amish/Mennonite,Amish Mennonite,,140.25,,,,,,,127.50,1231.54,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,34.65,61.11,percent of total billed charges,
OSTEOPTH MANIP TRT;3-4 REGIONS-TECH,76346,CDM,530,RC,98926,CPT,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,24.02,61.11,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,inpatient,,,4100.00000,3895.00000,Amish/Mennonite,Amish Mennonite,,2255.00,,,,,,,2255.00,3977.00,percent of total billed charges,
PLC AMNIOTIC MEMB;W/O SUTURES-TECH,76347,CDM,510,RC,65778,CPT,,,facility,outpatient,,,4100.00000,3895.00000,Amish/Mennonite,Amish Mennonite,,2255.00,,,,,,,919.67,3977.00,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,inpatient,,,2189.00000,2079.55000,Amish/Mennonite,Amish Mennonite,,1203.95,,,,,,,1203.95,2123.33,percent of total billed charges,
RPR RETINAL DETACH;INJ AIR/GAS-TECH,76348,CDM,510,RC,67110,CPT,,,facility,outpatient,,,2189.00000,2079.55000,Amish/Mennonite,Amish Mennonite,,1203.95,,,,,,,1094.50,2382.20,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,inpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,138.05,243.47,percent of total billed charges,
SPINAL TAP W/CHEMOTHERAPY-TECH,76349,CDM,331,RC,96450,CPT,,,facility,outpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,125.50,346.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,inpatient,,,752.00000,714.40000,Amish/Mennonite,Amish Mennonite,,413.60,,,,,,,413.60,729.44,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15004-TECH,76350,CDM,510,RC,15004,CPT,,,facility,outpatient,,,752.00000,714.40000,Amish/Mennonite,Amish Mennonite,,413.60,,,,,,,376.00,729.44,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,inpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,255.20,450.08,percent of total billed charges,
"SACROILIAC JOINT INJ,FLUORO-TECH",76351,CDM,510,RC,27096,CPT,,,facility,outpatient,,,464.00000,440.80000,Amish/Mennonite,Amish Mennonite,,255.20,,,,,,,232.00,450.08,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,inpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,229.35,404.49,percent of total billed charges,
TISS TF/REARR;EA ADL 30 SQ CM-TECH,76352,CDM,510,RC,14302,CPT,,,facility,outpatient,,,417.00000,396.15000,Amish/Mennonite,Amish Mennonite,,229.35,,,,,,,208.50,404.49,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,inpatient,,,1423.00000,1351.85000,Amish/Mennonite,Amish Mennonite,,782.65,,,,,,,782.65,1380.31,percent of total billed charges,
"TISS TRSF/REARR,TO 10 SQ CM-TECH",76353,CDM,510,RC,14040,CPT,,,facility,outpatient,,,1423.00000,1351.85000,Amish/Mennonite,Amish Mennonite,,782.65,,,,,,,711.50,1910.62,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,inpatient,,,1107.00000,1051.65000,Amish/Mennonite,Amish Mennonite,,608.85,,,,,,,608.85,1073.79,percent of total billed charges,
"TENOTOMY,EXT,HAND/FINGER,SINGL-TECH",76354,CDM,510,RC,26460,CPT,,,facility,outpatient,,,1107.00000,1051.65000,Amish/Mennonite,Amish Mennonite,,608.85,,,,,,,553.50,1671.62,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,inpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,171.05,301.67,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISC;PKG-TECH,76355,CDM,510,RC,12021,CPT,,,facility,outpatient,,,311.00000,295.45000,Amish/Mennonite,Amish Mennonite,,171.05,,,,,,,155.50,417.31,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,inpatient,,,1763.00000,1674.85000,Amish/Mennonite,Amish Mennonite,,969.65,,,,,,,969.65,1710.11,percent of total billed charges,
"TISS TRSF/REARR,10.1-30 SQ CM 14041-TECH",76356,CDM,510,RC,14041,CPT,,,facility,outpatient,,,1763.00000,1674.85000,Amish/Mennonite,Amish Mennonite,,969.65,,,,,,,881.50,1910.62,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,inpatient,,,581.00000,551.95000,Amish/Mennonite,Amish Mennonite,,319.55,,,,,,,319.55,563.57,percent of total billed charges,
RMVL FB MUSC/TNDN SHEATH;SIMPL-TECH,76357,CDM,510,RC,20520,CPT,,,facility,outpatient,,,581.00000,551.95000,Amish/Mennonite,Amish Mennonite,,319.55,,,,,,,290.50,1692.33,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,inpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,45.10,79.54,percent of total billed charges,
OSTEOPTH MANIP TRT;5-6 REGIONS-TECH,76358,CDM,530,RC,98927,CPT,,,facility,outpatient,,,82.00000,77.90000,Amish/Mennonite,Amish Mennonite,,45.10,,,,,,,24.02,79.54,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,inpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,138.05,243.47,percent of total billed charges,
SHUNT CHECK FOR CSF FLOW-TECH,76359,CDM,510,RC,64999,CPT,,,facility,outpatient,,,251.00000,238.45000,Amish/Mennonite,Amish Mennonite,,138.05,,,,,,,125.50,308.32,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,inpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,438.35,773.09,percent of total billed charges,
SRG CLSR TRACH/FIST;WO PL RPR-TECH,76360,CDM,510,RC,31820,CPT,,,facility,outpatient,,,797.00000,757.15000,Amish/Mennonite,Amish Mennonite,,438.35,,,,,,,398.50,3387.36,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,inpatient,,,21.92000,20.82000,Amish/Mennonite,Amish Mennonite,,12.06,,,,,,,12.06,21.26,percent of total billed charges,
SMELL IDENTIFICATION TEST-TECH,76361,CDM,510,RC,30999,CPT,,,facility,outpatient,,,21.92000,20.82000,Amish/Mennonite,Amish Mennonite,,12.06,,,,,,,10.96,242.55,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,U6,123.20,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY,QTT-PHD  90837-TECH",76362,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,U6,123.20,,,,,,,112.00,264.00,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,inpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,,517.00,,,,,,,517.00,911.80,percent of total billed charges,
VERMILIONECTOMY W/MUCOSAL ADV-TECH,76364,CDM,510,RC,40500,CPT,,,facility,outpatient,,,940.00000,893.00000,Amish/Mennonite,Amish Mennonite,,517.00,,,,,,,470.00,3387.36,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,inpatient,,,715.00000,679.25000,Amish/Mennonite,Amish Mennonite,,393.25,,,,,,,393.25,693.55,percent of total billed charges,
"TYMPANIC MEMBR RPR,W/WO PATCH-TECH",76365,CDM,510,RC,69610,CPT,,,facility,outpatient,,,715.00000,679.25000,Amish/Mennonite,Amish Mennonite,,393.25,,,,,,,357.50,1547.18,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,inpatient,,,269.00000,255.55000,Amish/Mennonite,Amish Mennonite,,147.95,,,,,,,147.95,260.93,percent of total billed charges,
URETHRA MEATOTOMY (EXC INFT)-TECH,76366,CDM,510,RC,53020,CPT,,,facility,outpatient,,,269.00000,255.55000,Amish/Mennonite,Amish Mennonite,,147.95,,,,,,,134.50,2139.65,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,inpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,183.70,323.98,percent of total billed charges,
"RPR,FRHD,CHKS,CHN,MTH,NK,AX,GN-TECH",76367,CDM,510,RC,13133,CPT,,,facility,outpatient,,,334.00000,317.30000,Amish/Mennonite,Amish Mennonite,,183.70,,,,,,,167.00,323.98,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,inpatient,,,1317.00000,1251.15000,Amish/Mennonite,Amish Mennonite,,724.35,,,,,,,724.35,1277.49,percent of total billed charges,
"TARSORRHAPHY,INTERMARG LID ADH-TECH",76369,CDM,510,RC,67880,CPT,,,facility,outpatient,,,1317.00000,1251.15000,Amish/Mennonite,Amish Mennonite,,724.35,,,,,,,658.50,2436.76,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,inpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,109.45,193.03,percent of total billed charges,
"URETHRAL MEATOTOMY,INFANT-TECH",76370,CDM,510,RC,53025,CPT,,,facility,outpatient,,,199.00000,189.05000,Amish/Mennonite,Amish Mennonite,,109.45,,,,,,,99.50,2139.65,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
"RPR VEN DEV,CENTRL/PERIPH SITE-TECH",76371,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,645.77,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,inpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,521.95,920.53,percent of total billed charges,
YAG LASER CAPS-EXT SHARE CARE-TECH,76372,CDM,510,RC,66821,CPT,,,facility,outpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,474.50,920.53,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,inpatient,,,647.00000,614.65000,Amish/Mennonite,Amish Mennonite,,355.85,,,,,,,355.85,627.59,percent of total billed charges,
SRG PREP/CREATION;1ST 100SQCM 15002-TECH,76373,CDM,510,RC,15002,CPT,,,facility,outpatient,,,647.00000,614.65000,Amish/Mennonite,Amish Mennonite,,355.85,,,,,,,323.50,1910.62,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,inpatient,,,675.00000,641.25000,Amish/Mennonite,Amish Mennonite,,371.25,,,,,,,371.25,654.75,percent of total billed charges,
"TENOTOMY,SUBCUTAN,TOE;SINGLE-TECH",76374,CDM,510,RC,28010,CPT,,,facility,outpatient,,,675.00000,641.25000,Amish/Mennonite,Amish Mennonite,,371.25,,,,,,,337.50,1671.62,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,inpatient,,,1585.00000,1505.75000,Amish/Mennonite,Amish Mennonite,,871.75,,,,,,,871.75,1537.45,percent of total billed charges,
TRIGGER FINGER REPAIR-TECH,76376,CDM,510,RC,26055,CPT,,,facility,outpatient,,,1585.00000,1505.75000,Amish/Mennonite,Amish Mennonite,,871.75,,,,,,,792.50,1671.62,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,inpatient,,,2916.00000,2770.20000,Amish/Mennonite,Amish Mennonite,,1603.80,,,,,,,1603.80,2828.52,percent of total billed charges,
"RAD RESEC TMR,BACK/FLANK;<5CM-TECH",76377,CDM,510,RC,21935,CPT,,,facility,outpatient,,,2916.00000,2770.20000,Amish/Mennonite,Amish Mennonite,,1603.80,,,,,,,1458.00,2989.39,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,inpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,199.65,352.11,percent of total billed charges,
"RECON NAIL BED,SIMPLE-TECH",76378,CDM,510,RC,11760,CPT,,,facility,outpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,,199.65,,,,,,,181.50,639.36,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,inpatient,,,1196.00000,1136.20000,Amish/Mennonite,Amish Mennonite,,657.80,,,,,,,657.80,1160.12,percent of total billed charges,
REPAIR OF ORO-ANTRAL FISTULA-TECH,76379,CDM,510,RC,30580,CPT,,,facility,outpatient,,,1196.00000,1136.20000,Amish/Mennonite,Amish Mennonite,,657.80,,,,,,,598.00,6178.88,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,inpatient,,,813.00000,772.35000,Amish/Mennonite,Amish Mennonite,,447.15,,,,,,,447.15,788.61,percent of total billed charges,
"TENOTOMY,ACHILLES TND;GEN ANES-TECH",76380,CDM,510,RC,27606,CPT,,,facility,outpatient,,,813.00000,772.35000,Amish/Mennonite,Amish Mennonite,,447.15,,,,,,,406.50,3388.98,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,inpatient,,,1452.00000,1379.40000,Amish/Mennonite,Amish Mennonite,,798.60,,,,,,,798.60,1408.44,percent of total billed charges,
"UP TO 10 SQ CM EYELIDS, NOSE-TECH",76381,CDM,510,RC,14060,CPT,,,facility,outpatient,,,1452.00000,1379.40000,Amish/Mennonite,Amish Mennonite,,798.60,,,,,,,726.00,1910.62,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,inpatient,,,1837.00000,1745.15000,Amish/Mennonite,Amish Mennonite,,1010.35,,,,,,,1010.35,1781.89,percent of total billed charges,
REPAIR OF BROW PTOSIS-TECH,76382,CDM,510,RC,67900,CPT,,,facility,outpatient,,,1837.00000,1745.15000,Amish/Mennonite,Amish Mennonite,,1010.35,,,,,,,918.50,2436.76,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,inpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,101.75,179.45,percent of total billed charges,
WINDOWING OF CAST-TECH,76384,CDM,510,RC,29730,CPT,,,facility,outpatient,,,185.00000,175.75000,Amish/Mennonite,Amish Mennonite,,101.75,,,,,,,92.50,179.45,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,inpatient,,,1274.00000,1210.30000,Amish/Mennonite,Amish Mennonite,,700.70,,,,,,,700.70,1235.78,percent of total billed charges,
STAB PHLEBECT;10-20 STAB INC-TECH,76385,CDM,510,RC,37765,CPT,,,facility,outpatient,,,1274.00000,1210.30000,Amish/Mennonite,Amish Mennonite,,700.70,,,,,,,637.00,3287.55,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,inpatient,,,1271.00000,1207.45000,Amish/Mennonite,Amish Mennonite,,699.05,,,,,,,699.05,1232.87,percent of total billed charges,
"TENOTOMY,OP,FLX,FOOT,ONE/MORE-TECH",76386,CDM,510,RC,28230,CPT,,,facility,outpatient,,,1271.00000,1207.45000,Amish/Mennonite,Amish Mennonite,,699.05,,,,,,,635.50,1671.62,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,inpatient,,,536.00000,509.20000,Amish/Mennonite,Amish Mennonite,,294.80,,,,,,,294.80,519.92,percent of total billed charges,
"INJ,ANTERIOR CHAMB;AIR/LIQUID-TECH",76387,CDM,510,RC,66020,CPT,,,facility,outpatient,,,536.00000,509.20000,Amish/Mennonite,Amish Mennonite,,294.80,,,,,,,268.00,2382.20,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,inpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,124.30,219.22,percent of total billed charges,
"RPR,CMPLX,TRNK;EA ADL 5CM/LESS-TECH",76388,CDM,510,RC,13102,CPT,,,facility,outpatient,,,226.00000,214.70000,Amish/Mennonite,Amish Mennonite,,124.30,,,,,,,113.00,219.22,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,inpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,116.05,204.67,percent of total billed charges,
TRANSCUTANEOUS PO2 MEASUREMENT-TECH,76389,CDM,920,RC,93998,CPT,,,facility,outpatient,,,211.00000,200.45000,Amish/Mennonite,Amish Mennonite,,116.05,,,,,,,23.25,204.67,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,inpatient,,,1298.00000,1233.10000,Amish/Mennonite,Amish Mennonite,,713.90,,,,,,,713.90,1259.06,percent of total billed charges,
"UP TO 10 SQ CM SCALP,ARMS,LEG-TECH",76390,CDM,510,RC,14020,CPT,,,facility,outpatient,,,1298.00000,1233.10000,Amish/Mennonite,Amish Mennonite,,713.90,,,,,,,649.00,1910.62,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,inpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,164.45,290.03,percent of total billed charges,
"TYMPANOSTOMY,GEN ANES,W/TUBE-TECH",76391,CDM,510,RC,69436,CPT,,,facility,outpatient,,,299.00000,284.05000,Amish/Mennonite,Amish Mennonite,,164.45,,,,,,,149.50,1547.18,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,inpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,,430.10,,,,,,,430.10,758.54,percent of total billed charges,
"REPAIR,INTMED,20.1-30.0 CM-TECH",76392,CDM,510,RC,12036,CPT,,,facility,outpatient,,,782.00000,742.90000,Amish/Mennonite,Amish Mennonite,,430.10,,,,,,,391.00,758.54,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,inpatient,,,443.00000,420.85000,Amish/Mennonite,Amish Mennonite,,243.65,,,,,,,243.65,429.71,percent of total billed charges,
REF/MAINT PMP/RES;REQ PHY SKIL-TECH,76394,CDM,335,RC,95991,CPT,,,facility,outpatient,,,443.00000,420.85000,Amish/Mennonite,Amish Mennonite,,243.65,,,,,,,221.50,429.71,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
"POST TIB NEUROST,PERC NDL ELEC-TECH",76395,CDM,510,RC,64566,CPT,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,44.00,308.32,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,inpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,170.50,300.70,percent of total billed charges,
PSYCHOTHERAPY FOR CRISIS-PHD 90839-TECH,76396,CDM,914,RC,90839,CPT,,,facility,outpatient,,,310.00000,294.50000,Amish/Mennonite,Amish Mennonite,,170.50,,,,,,,152.56,300.70,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,inpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,,398.75,,,,,,,398.75,703.25,percent of total billed charges,
W/URETERAL CATHETERIZATION-TECH,76397,CDM,510,RC,52005,CPT,,,facility,outpatient,,,725.00000,688.75000,Amish/Mennonite,Amish Mennonite,,398.75,,,,,,,362.50,2139.65,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,inpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,155.65,274.51,percent of total billed charges,
WEDGING OF CAST-TECH,76398,CDM,510,RC,29740,CPT,,,facility,outpatient,,,283.00000,268.85000,Amish/Mennonite,Amish Mennonite,,155.65,,,,,,,141.50,277.40,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,inpatient,,,1355.00000,1287.25000,Amish/Mennonite,Amish Mennonite,,745.25,,,,,,,745.25,1314.35,percent of total billed charges,
"PERC SKEL FIX METACAR FX,EA BN-TECH",76399,CDM,510,RC,26608,CPT,,,facility,outpatient,,,1355.00000,1287.25000,Amish/Mennonite,Amish Mennonite,,745.25,,,,,,,677.50,3388.98,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,inpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1741.85,3071.99,percent of total billed charges,
MYOCARD PERF TOMOG SNG STD,7640,CDM,340,RC,78451,CPT,,,facility,outpatient,,,3167.00000,3008.65000,Amish/Mennonite,Amish Mennonite,TC,1741.85,,,,,,,1488.32,7180.14,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,inpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,295.90,521.86,percent of total billed charges,
TRMT SUPERFIC WOUND DEHISCENCE-TECH,76400,CDM,510,RC,12020,CPT,,,facility,outpatient,,,538.00000,511.10000,Amish/Mennonite,Amish Mennonite,,295.90,,,,,,,269.00,639.36,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,inpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,245.30,432.62,percent of total billed charges,
SIMPLE TREATMENT-ANAL CONDYLMA-TECH,76401,CDM,510,RC,46900,CPT,,,facility,outpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,223.00,432.62,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,inpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,521.95,920.53,percent of total billed charges,
EXC SKIN NOSE/RHINOPHYMA-TECH,76402,CDM,510,RC,30120,CPT,,,facility,outpatient,,,949.00000,901.55000,Amish/Mennonite,Amish Mennonite,,521.95,,,,,,,474.50,3387.36,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,inpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,61.60,108.64,percent of total billed charges,
"INDIVIDUAL THERAPY,LMFT-MS  90832-TECH",76404,CDM,914,RC,90832,CPT,,,facility,outpatient,,,112.00000,106.40000,Amish/Mennonite,Amish Mennonite,,61.60,,,,,,,56.00,264.00,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,inpatient,,,436.00000,414.20000,Amish/Mennonite,Amish Mennonite,,239.80,,,,,,,239.80,422.92,percent of total billed charges,
SUBMAND DUCT CALC RMVL-TECH,76405,CDM,510,RC,42330,CPT,,,facility,outpatient,,,436.00000,414.20000,Amish/Mennonite,Amish Mennonite,,239.80,,,,,,,218.00,3387.36,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,inpatient,,,1437.00000,1365.15000,Amish/Mennonite,Amish Mennonite,,790.35,,,,,,,790.35,1393.89,percent of total billed charges,
"FULL THCKNS SKIN GRFT,TO 20 CM-TECH",76406,CDM,510,RC,15220,CPT,,,facility,outpatient,,,1437.00000,1365.15000,Amish/Mennonite,Amish Mennonite,,790.35,,,,,,,718.50,1910.62,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,inpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,153.45,270.63,percent of total billed charges,
INJ/THER AGENT-TENON'S CAPSULE-TECH,76407,CDM,510,RC,67515,CPT,,,facility,outpatient,,,279.00000,265.05000,Amish/Mennonite,Amish Mennonite,,153.45,,,,,,,139.50,312.24,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,inpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,,286.55,,,,,,,286.55,505.37,percent of total billed charges,
"DESTRUC,MAL LES;3.1 TO 4.0CM-17284-TECH",76408,CDM,510,RC,17284,CPT,,,facility,outpatient,,,521.00000,494.95000,Amish/Mennonite,Amish Mennonite,,286.55,,,,,,,260.50,639.36,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,inpatient,1,mL,87.06000,82.71000,Amish/Mennonite,Amish Mennonite,,47.88,,,,,,,47.88,84.45,percent of total billed charges,
APREPITANT 20 MG/ML SUSP,76409,CDM,250,RC,00006-0464-10-02000,NDC,,,facility,outpatient,1,mL,87.06000,82.71000,Amish/Mennonite,Amish Mennonite,,47.88,,,,,,,43.53,84.45,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,inpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
MEMANTINE TAB 2.5 MG,76412,CDM,250,RC,00904-6505-61-00050,NDC,,,facility,outpatient,1,EA,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,inpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.11550,0.20370,percent of total billed charges,
HYDROXYZINE HYDROCHLORIDE 5 MG TAB,76413,CDM,250,RC,63739-0483-10-00050,NDC,,,facility,outpatient,1,EA,0.21000,0.20000,Amish/Mennonite,Amish Mennonite,,0.11550,,,,,,,0.10500,0.20370,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L40MM DIA7MM CATH L80CM LIFESTENT,76417,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 20MMX120CM,76418,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L12CM DIA5MM 0.02IN PERIPH COMPLX STD FRME,76419,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,inpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
HYDROXYCHLOROQUINE 200 MG TAB,76420,CDM,250,RC,42292-0011-06-02500,NDC,,,facility,outpatient,1,mL,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,inpatient,,,1579.00000,1500.05000,Amish/Mennonite,Amish Mennonite,90,868.45,,,,,,,868.45,1531.63,percent of total billed charges,
SPINAL MUSCULAR ATROPHY SO,76424,CDM,310,RC,81329,CPT,,,facility,outpatient,,,1579.00000,1500.05000,Amish/Mennonite,Amish Mennonite,90,868.45,,,,,,,109.60,6451.13,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,inpatient,,,361.10000,343.04000,Amish/Mennonite,Amish Mennonite,90,198.60,,,,,,,198.60,350.27,percent of total billed charges,
SPINAL MUSC ATROPHY RFLEX SO,76425,CDM,310,RC,81479,CPT,,,facility,outpatient,,,361.10000,343.04000,Amish/Mennonite,Amish Mennonite,90,198.60,,,,,,,180.55,350.27,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,inpatient,,,2880.00000,2736.00000,Amish/Mennonite,Amish Mennonite,90,1584.00,,,,,,,1584.00,2793.60,percent of total billed charges,
B-CELL HYPRMUTATION AN SO,76426,CDM,310,RC,81263,CPT,,,facility,outpatient,,,2880.00000,2736.00000,Amish/Mennonite,Amish Mennonite,90,1584.00,,,,,,,304.33,15397.76,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,inpatient,1,EA,1348.98000,1281.53000,Amish/Mennonite,Amish Mennonite,,741.94,,,,,,,741.94,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290101,NDC,facility,outpatient,1,EA,1348.98000,1281.53000,Amish/Mennonite,Amish Mennonite,,741.94,,,,,,,6.35,1308.51,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,inpatient,1,EA,1552.65000,1475.02000,Amish/Mennonite,Amish Mennonite,,853.96,,,,,,,853.96,1506.07,percent of total billed charges,
REMDESIVIR POWD-INJ 100 MG,76427,CDM,636,RC,J0248,HCPCS,61958290102,NDC,facility,outpatient,1,EA,1552.65000,1475.02000,Amish/Mennonite,Amish Mennonite,,853.96,,,,,,,6.35,1506.07,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,inpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,90,92.40,,,,,,,92.40,162.96,percent of total billed charges,
ALPHA1 ANTITRYPSIN PHNO SO,76429,CDM,300,RC,82104,CPT,,,facility,outpatient,,,168.00000,159.60000,Amish/Mennonite,Amish Mennonite,90,92.40,,,,,,,14.94,763.98,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,inpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,82.67,145.79,percent of total billed charges,
"INTERLEUKIN-6,SERUM SO",76430,CDM,300,RC,83529,CPT,,,facility,outpatient,,,150.30000,142.78000,Amish/Mennonite,Amish Mennonite,90,82.67,,,,,,,17.85,823.21,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID 5FR DIA0.058IN SHFT NYL AL 1,76431,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 8MM 130CM ULTRAVERSE 035,76432,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 14MM 80CM ATLS AU 6CM,76433,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 6MM 130CM ULTRAVERSE 035,76434,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,486.94,963.94,percent of total billed charges,
CATHETER DRN 13CM RT ANG STD 2.2MM 1.1MM 5CM,76436,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,993.75000,944.06000,Amish/Mennonite,Amish Mennonite,,546.56,,,,,,,456.13,993.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BALNDIL LG DIA 12MM 80CM ATLS AU 2CM,76437,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,Amish/Mennonite,Amish Mennonite,90,1299.10,,,,,,,1299.10,2291.14,percent of total billed charges,
T-CELL RECEPTOR GEN REARR AMPL V (TCGRV) SO,76440,CDM,300,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,Amish/Mennonite,Amish Mennonite,90,1299.10,,,,,,,215.88,10915.96,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,90,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
T-CELL REPT GEN REARR DISPR V SO,76442,CDM,300,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,90,1252.90,,,,,,,208.21,10525.49,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,inpatient,,,2566.00000,2437.70000,Amish/Mennonite,Amish Mennonite,TC,1411.30,,,,,,,1411.30,2489.02,percent of total billed charges,
"PLANAR,2>MORE/1 OR>DAY-TECH",76446,CDM,340,RC,78801,CPT,,,facility,outpatient,,,2566.00000,2437.70000,Amish/Mennonite,Amish Mennonite,TC,1411.30,,,,,,,1283.00,2489.02,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,inpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,1.74,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,43598017215,NDC,facility,outpatient,1,mL,3.16000,3.00000,Amish/Mennonite,Amish Mennonite,,1.74,,,,,,,0.27125,3.07,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,inpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
PHENYLEPHRINE SOLN 100 MCG/ML 5 ML,76447,CDM,636,RC,J2372,HCPCS,71863020206,NDC,facility,outpatient,1,mL,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,0.27125,6.13,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,inpatient,1,mL,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,2.54,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00143925425,NDC,facility,outpatient,1,mL,4.62000,4.39000,Amish/Mennonite,Amish Mennonite,,2.54,,,,,,,1.06,4.48,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,inpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.53350,0.94090,percent of total billed charges,
DOPAMINE SOLN 40 MG/ML 10 ML,76449,CDM,250,RC,J1265,HCPCS,00409910420,NDC,facility,outpatient,1,mL,0.97000,0.92000,Amish/Mennonite,Amish Mennonite,,0.53350,,,,,,,0.48500,1.18,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,inpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,TC,175.45,,,,,,,175.45,309.43,percent of total billed charges,
XRAY/FISTULA/SINUS TRCT STUDY-TECH,76451,CDM,320,RC,76080,CPT,,,facility,outpatient,,,319.00000,303.05000,Amish/Mennonite,Amish Mennonite,TC,175.45,,,,,,,159.50,3015.65,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,inpatient,,,36.27000,34.46000,Amish/Mennonite,Amish Mennonite,,19.95,,,,,,,19.95,35.18,percent of total billed charges,
"SHORT LEG SPLINT,ADULT,PLASTER",76452,CDM,271,RC,Q4045,HCPCS,,,facility,outpatient,,,36.27000,34.46000,Amish/Mennonite,Amish Mennonite,,19.95,,,,,,,15.58,35.18,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,,618.75,,,,,,,551.25,1091.25,percent of total billed charges,
CATHETER BLNDIL 18MM 120CM ATLS AU 4CM ACPT .035,76453,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,,618.75,,,,,,,516.38,1125.00,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,824.89000,783.65000,Amish/Mennonite,Amish Mennonite,,453.69,,,,,,,404.20,800.14,percent of total billed charges,
KIT GASTRM 8FR HALYRD SFT-PEXY T INTRO DL,76455,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,824.89000,783.65000,Amish/Mennonite,Amish Mennonite,,453.69,,,,,,,378.62,824.89,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 75CM ULTRAVERSE 035,76456,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,15.52,30.73,percent of total billed charges,
INTRO SHTH AVANTI+ 6.5FRX11CM,76457,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,31.68000,30.10000,Amish/Mennonite,Amish Mennonite,,17.42,,,,,,,14.54,31.68,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
"PSYCHOTHERAPY, QTT-MSW 90837-TECH",76458,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,112.00,264.00,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,inpatient,,,167.90000,159.50000,Amish/Mennonite,Amish Mennonite,90,92.34,,,,,,,92.34,162.86,percent of total billed charges,
HEPATITIS D VIRUS TOTAL AB (AHDV) SO,76460,CDM,300,RC,86692,CPT,,,facility,outpatient,,,167.90000,159.50000,Amish/Mennonite,Amish Mennonite,90,92.34,,,,,,,17.73,899.77,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,86.79,153.07,percent of total billed charges,
"ALLERGEN, PEANUT COMPONENTS SO",76462,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,17.71,933.70,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,inpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,90,45.65,,,,,,,45.65,80.51,percent of total billed charges,
"ALLERGEN, PANEL SO",76464,CDM,300,RC,86003,CPT,,,facility,outpatient,,,83.00000,78.85000,Amish/Mennonite,Amish Mennonite,90,45.65,,,,,,,4.57,271.65,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,inpatient,,,80.10000,76.09000,Amish/Mennonite,Amish Mennonite,90,44.05,,,,,,,44.05,77.70,percent of total billed charges,
"ALLERGEN, SINGLE SO",76465,CDM,300,RC,86003,CPT,,,facility,outpatient,,,80.10000,76.09000,Amish/Mennonite,Amish Mennonite,90,44.05,,,,,,,4.57,271.65,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,inpatient,,,452.70000,430.06000,Amish/Mennonite,Amish Mennonite,90,248.99,,,,,,,248.99,439.12,percent of total billed charges,
"ADALIMUMAB, QNT (ADALX) SO",76466,CDM,300,RC,80145,CPT,,,facility,outpatient,,,452.70000,430.06000,Amish/Mennonite,Amish Mennonite,90,248.99,,,,,,,30.85,439.12,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,inpatient,,,308.60000,293.17000,Amish/Mennonite,Amish Mennonite,90,169.73,,,,,,,169.73,299.34,percent of total billed charges,
ADALIMUMAB AB SO,76467,CDM,300,RC,83520,CPT,,,facility,outpatient,,,308.60000,293.17000,Amish/Mennonite,Amish Mennonite,90,169.73,,,,,,,17.85,814.87,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,inpatient,,,400.10000,380.10000,Amish/Mennonite,Amish Mennonite,90,220.06,,,,,,,220.06,388.10,percent of total billed charges,
"APIXABEN, ANTI-XA SO",76468,CDM,300,RC,80299,CPT,,,facility,outpatient,,,400.10000,380.10000,Amish/Mennonite,Amish Mennonite,90,220.06,,,,,,,19.26,882.80,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,inpatient,1,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
ROSUVASTATIN 2.5 MG TAB,76469,CDM,250,RC,60687-0256-01-00013,NDC,,,facility,outpatient,1,EA,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.27500,0.53350,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML WASTE",76472,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"VISIPAQUE 320, 50ML",76473,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,23155-0605-03,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,inpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.48,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,60505-2527-03,NDC,,,facility,outpatient,1,EA,6.32000,6.00000,Amish/Mennonite,Amish Mennonite,,3.48,,,,,,,3.16,6.13,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,inpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.51,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,62332-0386-30,NDC,,,facility,outpatient,1,EA,10.02000,9.52000,Amish/Mennonite,Amish Mennonite,,5.51,,,,,,,5.01,9.72,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,inpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
MODAFINIL 200 MG TAB,76491,CDM,250,RC,65862-0602-30,NDC,,,facility,outpatient,1,EA,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,136.95,241.53,percent of total billed charges,
RPR F/E/EY/N/L/MM 5.1-7.5CM SMPL-TECH,76494,CDM,510,RC,12014,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,124.50,241.53,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,inpatient,,,1035.00000,983.25000,Amish/Mennonite,Amish Mennonite,,569.25,,,,,,,569.25,1003.95,percent of total billed charges,
CLSD TX DISLOC ELB WO ANES-TECH,76495,CDM,510,RC,24600,CPT,,,facility,outpatient,,,1035.00000,983.25000,Amish/Mennonite,Amish Mennonite,,569.25,,,,,,,227.78,1003.95,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,inpatient,,,514.00000,488.30000,Amish/Mennonite,Amish Mennonite,,282.70,,,,,,,282.70,498.58,percent of total billed charges,
CLSD TX GRT TOE FX W MANIP-TECH,76496,CDM,510,RC,28495,CPT,,,facility,outpatient,,,514.00000,488.30000,Amish/Mennonite,Amish Mennonite,,282.70,,,,,,,227.78,498.58,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,inpatient,,,625.00000,593.75000,Amish/Mennonite,Amish Mennonite,,343.75,,,,,,,343.75,606.25,percent of total billed charges,
EXC LESION OF FLOOR OF MOUTH-TECH,76498,CDM,510,RC,41116,CPT,,,facility,outpatient,,,625.00000,593.75000,Amish/Mennonite,Amish Mennonite,,343.75,,,,,,,312.50,3387.36,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
SHEATH INARI CLOTTRIEVER 16FR 15,76500,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER ASP 20FR 95CM TRIEVER20,76501,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 4MM 130CM ULTRAVERSE 035,76502,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG SM AD 5FR L100CM COR NYL,76503,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 75CM ULTRAVERSE 035,76504,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BLNDIL LG DIA 16MM 120CM ATLS AU 4CM,76505,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,479.59,949.39,percent of total billed charges,
CATHETER BALNDIL LG DIA 16MM 80CM ATLS AU 4CM,76506,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,978.75000,929.81000,Amish/Mennonite,Amish Mennonite,,538.31,,,,,,,449.25,978.75,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER BLNDIL LG DIA 14MM 120CM ATLS AU 4CM,76507,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA16MM CATH L80CM GWIRE 0.035IN SHTH.,76508,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GD EBU3 CRV 7FR 100CM COR NYL LNCHR LG,76518,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,513.38000,487.71000,Amish/Mennonite,Amish Mennonite,,282.36,,,,,,,251.56,497.98,percent of total billed charges,
TUBE JEJUNAL 20FR,76519,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,513.38000,487.71000,Amish/Mennonite,Amish Mennonite,,282.36,,,,,,,235.64,513.38,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 7FR L28CM AXXCESS CATH 6FR SFT PERCFLX HYDR+,76520,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,inpatient,,,769.00000,730.55000,Amish/Mennonite,Amish Mennonite,,422.95,,,,,,,422.95,745.93,percent of total billed charges,
RMVL IMPL INTRATHEC/EPID CATH-TECH,76924,CDM,510,RC,62355,CPT,,,facility,outpatient,,,769.00000,730.55000,Amish/Mennonite,Amish Mennonite,,422.95,,,,,,,384.50,2039.65,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
ANTIPARIETAL CELL ANTIBODY  TECH,76925,CDM,300,RC,86255,CPT,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,12.05,1539.22,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,inpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,292.60,516.04,percent of total billed charges,
"DRUG DEFINITIVE 1-7 CLASS, COCAINE TECH",76926,CDM,301,RC,G0480,HCPCS,,,facility,outpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,63.95,788.42,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,90,158.40,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, FREE M83686 SO-TECH",76927,CDM,300,RC,84402,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,90,158.40,,,,,,,26.32,1324.17,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,inpatient,,,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,90,156.69,,,,,,,156.69,276.35,percent of total billed charges,
"TEST, TOTAL M83686 SO-TECH",76928,CDM,300,RC,84403,CPT,,,facility,outpatient,,,284.90000,270.65000,Amish/Mennonite,Amish Mennonite,90,156.69,,,,,,,26.67,1341.13,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,90,158.40,,,,,,,158.40,279.36,percent of total billed charges,
"TEST, BIOAV M83686 SO-TECH",76929,CDM,300,RC,84410,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,90,158.40,,,,,,,52.99,2682.34,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,112.31,198.07,percent of total billed charges,
"FAT AC PROF, ESS C12-22 (FAPEP) SO",76930,CDM,300,RC,82725,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,90,112.31,,,,,,,18.72,882.80,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,11764.50000,11176.27000,Amish/Mennonite,Amish Mennonite,,6470.48,,,,,,,5764.60,11411.57,percent of total billed charges,
CATHETER ATHRCM 1.25MM 6FR 1.45MM 135CM COR,77347,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,11764.50000,11176.27000,Amish/Mennonite,Amish Mennonite,,6470.48,,,,,,,5399.91,11764.50,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,inpatient,,,14543.00000,13815.85000,Amish/Mennonite,Amish Mennonite,TC,7998.65,,,,,,,7998.65,14106.71,percent of total billed charges,
PET BRAIN IMAG METABOLIC EVAL,7774,CDM,404,RC,78608,CPT,,,facility,outpatient,,,14543.00000,13815.85000,Amish/Mennonite,Amish Mennonite,TC,7998.65,,,,,,,4549.00,14106.71,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,Amish/Mennonite,Amish Mennonite,,5412.44,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L60MM DIA10MM CATH 8.5FR L194CM GWIRE 0.035IN MTL,77963,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,Amish/Mennonite,Amish Mennonite,,5412.44,,,,,,,4516.93,9840.80,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,inpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
POVIDONE IODINE LIQ-TOP 10% 240 ML,77972,CDM,250,RC,00904-1103-09,NDC,,,facility,outpatient,1,mL,0.05000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 3MM 150CM ULTRAVERSE 014 CK,77973,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA7MM CATH L80CM LIFESTENT,77974,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 5MM 130CM ULTRAVERSE 035,77975,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI L80MM DIA7MM CATH L80CM SELF EXPND OTW NIT,77976,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1006.93,2193.75,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,49.84000,47.35000,Amish/Mennonite,Amish Mennonite,,27.41,,,,,,,24.42,48.34,percent of total billed charges,
GUIDEWIRE VASC 3MM RDS J CRV TPR .038IN 80CM,77977,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,49.84000,47.35000,Amish/Mennonite,Amish Mennonite,,27.41,,,,,,,22.88,49.84,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,247.13,489.21,percent of total billed charges,
GUIDEWIRE VASC MIC TPR .014IN 190CM PER PLTN SS,77978,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,504.34000,479.12000,Amish/Mennonite,Amish Mennonite,,277.39,,,,,,,231.49,504.34,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L72CM SPRNT QUATTRO SECUR S,77979,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,inpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,TC,156.75,,,,,,,156.75,276.45,percent of total billed charges,
XRAY/SACROIL JT;3/MORE VIEWS-TECH,77981,CDM,320,RC,72202,CPT,,,facility,outpatient,,,285.00000,270.75000,Amish/Mennonite,Amish Mennonite,TC,156.75,,,,,,,142.50,1450.63,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,inpatient,,,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,8.41,14.84,percent of total billed charges,
DRY NEEDLE >3 MUSC CHR LBP-TECH,77984,CDM,510,RC,20561,CPT,,,facility,outpatient,,,15.30000,14.54000,Amish/Mennonite,Amish Mennonite,,8.41,,,,,,,7.65,25.57,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,inpatient,1,mL,541.98000,514.88000,Amish/Mennonite,Amish Mennonite,,298.09,,,,,,,298.09,525.72,percent of total billed charges,
SIPULEUCEL-T SUSP INJ 50 MILLION AUTOLOGOUS CD54+ CELLS,77986,CDM,636,RC,Q2043,HCPCS,30237890006,NDC,facility,outpatient,1,mL,541.98000,514.88000,Amish/Mennonite,Amish Mennonite,,298.09,,,,,,,270.99,94648.39,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
"ISOVUE 370,150ML WASTE",77987,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,inpatient,,,892.00000,847.40000,Amish/Mennonite,Amish Mennonite,,490.60,,,,,,,490.60,865.24,percent of total billed charges,
CLSD TX SHLDR DISLOC WO ANES-TECH,77988,CDM,510,RC,23650,CPT,,,facility,outpatient,,,892.00000,847.40000,Amish/Mennonite,Amish Mennonite,,490.60,,,,,,,227.78,865.24,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,inpatient,,,1366.00000,1297.70000,Amish/Mennonite,Amish Mennonite,,751.30,,,,,,,751.30,1325.02,percent of total billed charges,
GRFT EAR CARTLG TO NOSE/EAR-TECH,77989,CDM,510,RC,21235,CPT,,,facility,outpatient,,,1366.00000,1297.70000,Amish/Mennonite,Amish Mennonite,,751.30,,,,,,,683.00,6178.88,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC MIC 300CM COR ASAHI GAIA SEC JTP,77994,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 9MM 130CM ULTRAVERSE 035,77995,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,inpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,5.21,9.20,percent of total billed charges,
HYDROMORPHONE SOLN 0.2 MG/ML,77996,CDM,250,RC,J1171,HCPCS,76045012111,NDC,facility,outpatient,1,mL,9.48000,9.01000,Amish/Mennonite,Amish Mennonite,,5.21,,,,,,,0.14409,9.20,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 014 2X100X150,77998,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,254.36000,241.64000,Amish/Mennonite,Amish Mennonite,,139.90,,,,,,,124.64,246.73,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN STR TIP FLPY,77999,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,254.36000,241.64000,Amish/Mennonite,Amish Mennonite,,139.90,,,,,,,116.75,254.36,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATH ANGIO JR4 5FR 100CM,78001,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,inpatient,,,4631.00000,4399.45000,Amish/Mennonite,Amish Mennonite,,2547.05,,,,,,,2547.05,4492.07,percent of total billed charges,
TRAUMA LVL 1 WO PRE-NOTIFICATION,78002,CDM,459,RC,,,,,facility,outpatient,,,4631.00000,4399.45000,Amish/Mennonite,Amish Mennonite,,2547.05,,,,,,,2315.50,4492.07,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,inpatient,,,8100.00000,7695.00000,Amish/Mennonite,Amish Mennonite,,4455.00,,,,,,,4455.00,7857.00,percent of total billed charges,
DILATION AND CURETTAGE (D&C),78003,CDM,450,RC,,,,,facility,outpatient,,,8100.00000,7695.00000,Amish/Mennonite,Amish Mennonite,,4455.00,,,,,,,4050.00,7857.00,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X20MM,78004,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,inpatient,1,EA,12.60000,11.97000,Amish/Mennonite,Amish Mennonite,,6.93,,,,,,,6.93,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,00378876793,NDC,facility,outpatient,1,EA,12.60000,11.97000,Amish/Mennonite,Amish Mennonite,,6.93,,,,,,,6.30,12.22,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,inpatient,1,EA,28.38000,26.96000,Amish/Mennonite,Amish Mennonite,,15.61,,,,,,,15.61,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,12496120803,NDC,facility,outpatient,1,EA,28.38000,26.96000,Amish/Mennonite,Amish Mennonite,,15.61,,,,,,,14.19,27.53,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,inpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,11.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,47781035703,NDC,facility,outpatient,1,EA,20.01000,19.01000,Amish/Mennonite,Amish Mennonite,,11.01,,,,,,,10.01,19.41,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,inpatient,1,EA,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.89,8.63,percent of total billed charges,
BUPRENORPHINE-NALOXONE FILM 8 MG-2 MG,78005,CDM,250,RC,J0574,HCPCS,50742036430,NDC,facility,outpatient,1,EA,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.45,8.63,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,629.05,1245.27,percent of total billed charges,
TUBE FEEDING GASTROMY JEJU 22FRX45CM,78006,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1283.78000,1219.59000,Amish/Mennonite,Amish Mennonite,,706.08,,,,,,,589.26,1283.78,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,inpatient,1,mL,1142.71000,1085.57000,Amish/Mennonite,Amish Mennonite,,628.49,,,,,,,628.49,1108.43,percent of total billed charges,
"EPOETIN ALFA-EPBX SOLN PF 40,000 UNITS/ML",78316,CDM,250,RC,Q5105,HCPCS,00069130904,NDC,facility,outpatient,1,mL,1142.71000,1085.57000,Amish/Mennonite,Amish Mennonite,,628.49,,,,,,,0.76000,1108.43,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
AMOXICILLIN TAB-CHEW 125 MG,78872,CDM,250,RC,J8499,HCPCS,00093226701,NDC,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,5050.68,9998.27,percent of total billed charges,
SHEATH KT LASER 25-80HZ 16FR 11.5FR 12.5FR 17.2FR 50CM,78875,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,10307.50000,9792.12000,Amish/Mennonite,Amish Mennonite,,5669.12,,,,,,,4731.14,10307.50,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
CATHETER ANGIO SIM1 CRV 5FR 65CM CRBRL SS NYL,78877,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,76.00,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 8FR L22CM PERCFLX N COAT RADPQ INT/EXT DBL,78878,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,294.00,582.00,percent of total billed charges,
CATHETER BLNDIL 9MM 135CM PERI DORADO CK 4CM 3,78879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,600.00000,570.00000,Amish/Mennonite,Amish Mennonite,,330.00,,,,,,,275.40,600.00,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1093.31,2164.31,percent of total billed charges,
INTRODUCER SHTH WORLEY BRD JUMBO 9FRX50CM,78880,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1024.14,2231.25,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,inpatient,1,mL,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,6.57,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,05446-0607-01,NDC,,,facility,outpatient,1,mL,11.94000,11.35000,Amish/Mennonite,Amish Mennonite,,6.57,,,,,,,5.97,11.58,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,inpatient,1,mL,11.08000,10.53000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,6.09,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1135-44,NDC,,,facility,outpatient,1,mL,11.08000,10.53000,Amish/Mennonite,Amish Mennonite,,6.09,,,,,,,5.54,10.75,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,inpatient,1,mL,43.42000,41.25000,Amish/Mennonite,Amish Mennonite,,23.88,,,,,,,23.88,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,70092-1611-44,NDC,,,facility,outpatient,1,mL,43.42000,41.25000,Amish/Mennonite,Amish Mennonite,,23.88,,,,,,,21.71,42.12,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,inpatient,1,mL,13.51000,12.84000,Amish/Mennonite,Amish Mennonite,,7.43,,,,,,,7.43,13.10,percent of total billed charges,
LET GEL (LIDOCAINE-EPI-TETRACAINE 4-0.05-0.5%) 3 ML,78883,CDM,250,RC,71266-6286-03,NDC,,,facility,outpatient,1,mL,13.51000,12.84000,Amish/Mennonite,Amish Mennonite,,7.43,,,,,,,6.75,13.10,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,inpatient,1,GM,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.21450,0.37830,percent of total billed charges,
BENZOCAINE TOPICAL 20% OINT,78884,CDM,250,RC,63736-0037-51,NDC,,,facility,outpatient,1,GM,0.39000,0.37000,Amish/Mennonite,Amish Mennonite,,0.21450,,,,,,,0.19500,0.37830,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,inpatient,1,mL,162.98000,154.83000,Amish/Mennonite,Amish Mennonite,,89.64,,,,,,,89.64,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,60505-1005-04,NDC,,,facility,outpatient,1,mL,162.98000,154.83000,Amish/Mennonite,Amish Mennonite,,89.64,,,,,,,81.49,158.09,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,inpatient,1,mL,184.83000,175.59000,Amish/Mennonite,Amish Mennonite,,101.66,,,,,,,101.66,179.29,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 2.5 ML (ONCE DAILY FORMULATION),78885,CDM,250,RC,68682-0045-25,NDC,,,facility,outpatient,1,mL,184.83000,175.59000,Amish/Mennonite,Amish Mennonite,,101.66,,,,,,,92.42,179.29,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 5MM 130CM ULTRAVERSE 035,78886,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GD XB4.5 CRV 6FR 100CM COR SS NYL PTFE,78887,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X12MM,78888,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,78889,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,inpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 180 MG-4000 MG-500 MG/100 SOLN-IRR,78893,CDM,250,RC,51552-1345-01-00500,NDC,,,facility,outpatient,1,mL,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,inpatient,1,mL,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.41,4.26,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 15 ML,78894,CDM,250,RC,J8499,HCPCS,54838050115,NDC,facility,outpatient,1,mL,4.39000,4.17000,Amish/Mennonite,Amish Mennonite,,2.41,,,,,,,2.19,4.26,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,inpatient,,,1048.00000,995.60000,Amish/Mennonite,Amish Mennonite,,576.40,,,,,,,576.40,1016.56,percent of total billed charges,
"EXC BRANCHL CLFT CYST,VEST,FIS-TECH",78897,CDM,510,RC,42815,CPT,,,facility,outpatient,,,1048.00000,995.60000,Amish/Mennonite,Amish Mennonite,,576.40,,,,,,,524.00,6178.88,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,inpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
TRIHEXYPHENIDYL 1 MG TAB,78898,CDM,250,RC,16571-0160-10-00050,NDC,,,facility,outpatient,1,EA,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,337.50000,320.62000,Amish/Mennonite,Amish Mennonite,,185.62,,,,,,,165.38,327.38,percent of total billed charges,
STENT URET 6FR L22-32CM LUBRICIOUS HYDRPHLC TAPR TIP SMOOTH.,78899,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,337.50000,320.62000,Amish/Mennonite,Amish Mennonite,,185.62,,,,,,,154.91,337.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
NM GALLIUM 67-12 MCI PER MCI,78900,CDM,343,RC,A9556,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,36.30,145.50,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,275.62,545.62,percent of total billed charges,
GWIRE VIPER FLEX 18 DMDBK,78901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,258.19,562.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X15MM,78903,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X12MM,78904,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L40MM DIA14MM CATH L80CM GWIRE 0.035IN SHTH 9FR.,78905,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALLOON NC EUPHORA 2.5X12MM,78906,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 6MM 75CM PCLTXL LUTONIX 035 60MM.,78907,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 10CM ACPT .014IN GW 4FR SHTH PTA,78908,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,inpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.80850,1.43,percent of total billed charges,
OMEPRAZOLE 2 MG/ML SUSP,78909,CDM,250,RC,65628-0070-03,NDC,,,facility,outpatient,1,mL,1.47000,1.40000,Amish/Mennonite,Amish Mennonite,,0.80850,,,,,,,0.73500,1.43,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,inpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.51150,0.90210,percent of total billed charges,
MAGIC MOUTHWASH 119 ML,78910,CDM,250,RC,65628-0050-04,NDC,,,facility,outpatient,1,mL,0.93000,0.88000,Amish/Mennonite,Amish Mennonite,,0.51150,,,,,,,0.46500,0.90210,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,inpatient,1,mL,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.99,percent of total billed charges,
HYDROMORPHONE SOLN 2 MG/ML 20 ML,78911,CDM,250,RC,J1171,HCPCS,00641234141,NDC,facility,outpatient,1,mL,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,0.14409,2.99,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,inpatient,,,2033.00000,1931.35000,Amish/Mennonite,Amish Mennonite,TC,1118.15,,,,,,,1118.15,1972.01,percent of total billed charges,
"ESOPH,GASTROESO TST;NASAL CATH-TECH",78930,CDM,750,RC,91034,CPT,,,facility,outpatient,,,2033.00000,1931.35000,Amish/Mennonite,Amish Mennonite,TC,1118.15,,,,,,,909.00,5271.00,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,TC,601.15,,,,,,,601.15,1060.21,percent of total billed charges,
"CRANIAL NRV SPLD MUSCL(S),UNIL-TECH",78931,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,TC,601.15,,,,,,,546.50,1060.21,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,inpatient,,,539.00000,512.05000,Amish/Mennonite,Amish Mennonite,TC,296.45,,,,,,,296.45,522.83,percent of total billed charges,
REPETITIVE STIMULATN-BASE FEE,78932,CDM,920,RC,95937,CPT,,,facility,outpatient,,,539.00000,512.05000,Amish/Mennonite,Amish Mennonite,TC,296.45,,,,,,,269.50,522.83,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,inpatient,,,210.40000,199.88000,Amish/Mennonite,Amish Mennonite,90,115.72,,,,,,,115.72,204.09,percent of total billed charges,
PROTEIN S ANTIGEN SO,78933,CDM,300,RC,85305,CPT,,,facility,outpatient,,,210.40000,199.88000,Amish/Mennonite,Amish Mennonite,90,115.72,,,,,,,12.00,611.15,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,inpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,90,160.05,,,,,,,160.05,282.27,percent of total billed charges,
PROTEIN C ANTIGEN SO,78934,CDM,300,RC,85302,CPT,,,facility,outpatient,,,291.00000,276.45000,Amish/Mennonite,Amish Mennonite,90,160.05,,,,,,,12.41,628.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
STENT NEPHURET 10FR L26CM PERCFLX N COAT RADPQ INT/EXT DBL,78950,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,412.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X20MM,78953,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 6MM 75CM ULTRAVERSE 035,78954,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X20MM,78955,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 6FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,78957,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X15MM,78958,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
PROBE CRYO ICEPEARL L90 2.1 CX,78959,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,37.61,74.46,percent of total billed charges,
INTRO SHEATH .035IN MN HEXACUSPID 4FR 5.5CM BRCHL.,78960,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,35.23,76.76,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,inpatient,,,134.90000,128.16000,Amish/Mennonite,Amish Mennonite,90,74.19,,,,,,,74.19,130.85,percent of total billed charges,
ACTIVATED PROTEIN RESISTANCE SO,78963,CDM,300,RC,85307,CPT,,,facility,outpatient,,,134.90000,128.16000,Amish/Mennonite,Amish Mennonite,90,74.19,,,,,,,15.83,797.91,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,inpatient,1,EA,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,42.22,74.46,percent of total billed charges,
CEFEPIME 2 GM/D5W 50 ML PREMIX,78966,CDM,250,RC,J0703,HCPCS,00264319511,NDC,facility,outpatient,1,EA,76.76000,72.92000,Amish/Mennonite,Amish Mennonite,,42.22,,,,,,,7.82,74.46,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,inpatient,,,188.40000,178.98000,Amish/Mennonite,Amish Mennonite,90,103.62,,,,,,,103.62,182.75,percent of total billed charges,
DIABETES MELLITUS EVAL AB (DBS1) SO,78967,CDM,300,RC,86337,CPT,,,facility,outpatient,,,188.40000,178.98000,Amish/Mennonite,Amish Mennonite,90,103.62,,,,,,,22.12,1120.45,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,inpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,90,199.65,,,,,,,199.65,352.11,percent of total billed charges,
IDENT BY PCR SO,78972,CDM,300,RC,87798,CPT,,,facility,outpatient,,,363.00000,344.85000,Amish/Mennonite,Amish Mennonite,90,199.65,,,,,,,36.26,1833.46,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,inpatient,1,mL,1400.41000,1330.39000,Amish/Mennonite,Amish Mennonite,,770.23,,,,,,,770.23,1358.40,percent of total billed charges,
SEMAGLUTIDE 2 MG/1.5 ML SOLN,78978,CDM,250,RC,00169-4132-12,NDC,,,facility,outpatient,1,mL,1400.41000,1330.39000,Amish/Mennonite,Amish Mennonite,,770.23,,,,,,,700.21,1358.40,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 24FR L33CM OD8.8MM ID8MM,78979,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1383.88,3015.00,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.80000,197.41000,Amish/Mennonite,Amish Mennonite,90,114.29,,,,,,,114.29,201.57,percent of total billed charges,
DIABETES MELLITUS EVAL ISLET SO,78983,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.80000,197.41000,Amish/Mennonite,Amish Mennonite,90,114.29,,,,,,,19.88,1103.49,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,inpatient,,,162.90000,154.76000,Amish/Mennonite,Amish Mennonite,90,89.59,,,,,,,89.59,158.01,percent of total billed charges,
LUTEINIZING HORMONE SO,78984,CDM,301,RC,83002,CPT,,,facility,outpatient,,,162.90000,154.76000,Amish/Mennonite,Amish Mennonite,90,89.59,,,,,,,19.14,967.70,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X15MM,78986,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
MICROCOIL EMB L14CM DIA4MM CATH ID0.035IN LOOP 11.1 PERIPH,78987,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X12MM,78989,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM PCLTXL LUTONIX 035 40MM.,78990,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X12MM,78991,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X15MM,78992,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO,78993,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,inpatient,,,5600.00000,5320.00000,Amish/Mennonite,Amish Mennonite,TC,3080.00,,,,,,,3080.00,5432.00,percent of total billed charges,
XR SPLENOPORTOGRAPHY-TECH,78995,CDM,320,RC,75810,CPT,,,facility,outpatient,,,5600.00000,5320.00000,Amish/Mennonite,Amish Mennonite,TC,3080.00,,,,,,,2751.30,21823.18,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,inpatient,1,mL,1673.67000,1589.99000,Amish/Mennonite,Amish Mennonite,,920.52,,,,,,,920.52,1623.46,percent of total billed charges,
"DARATUMUMAB-HYALURONIDASE 1800 MG-30,000 UNITS/15 ML SOLN",78997,CDM,636,RC,J9144,HCPCS,57894050301,NDC,facility,outpatient,1,mL,1673.67000,1589.99000,Amish/Mennonite,Amish Mennonite,,920.52,,,,,,,54.67,1623.46,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,inpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,90,259.88,,,,,,,259.88,458.32,percent of total billed charges,
COPEPTIN PROAVP (CPAVP) SO,79000,CDM,300,RC,84588,CPT,,,facility,outpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,90,259.88,,,,,,,35.07,1765.53,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,inpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,,51.70,,,,,,,51.70,91.18,percent of total billed charges,
"OXYGEN SATURATION, MEASURED TECH",79006,CDM,301,RC,82810,CPT,,,facility,outpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,,51.70,,,,,,,9.77,458.40,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1226.25000,1164.94000,Amish/Mennonite,Amish Mennonite,,674.44,,,,,,,600.86,1189.46,percent of total billed charges,
CATHETER BLNDIL .035IN 6MM 190CM FSN TTN 4CM BIL,79008,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1226.25000,1164.94000,Amish/Mennonite,Amish Mennonite,,674.44,,,,,,,562.85,1226.25,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2273.00000,2159.35000,Amish/Mennonite,Amish Mennonite,TC,1250.15,,,,,,,1250.15,2204.81,percent of total billed charges,
CT SOFT TISSUE NECK W/WO CONTR-TECH,79019,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2273.00000,2159.35000,Amish/Mennonite,Amish Mennonite,TC,1250.15,,,,,,,1136.50,2204.81,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,inpatient,,,674.00000,640.30000,Amish/Mennonite,Amish Mennonite,90,370.70,,,,,,,370.70,653.78,percent of total billed charges,
HAIR EXP DRUG 5 PANEL SO,79028,CDM,300,RC,80307,CPT,,,facility,outpatient,,,674.00000,640.30000,Amish/Mennonite,Amish Mennonite,90,370.70,,,,,,,63.40,3038.81,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,inpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,36.13,63.73,percent of total billed charges,
"COXSACK B & ECHOVIRYS, EACH SO",79029,CDM,300,RC,86658,CPT,,,facility,outpatient,,,65.70000,62.42000,Amish/Mennonite,Amish Mennonite,90,36.13,,,,,,,8.17,679.08,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,317.40000,301.53000,Amish/Mennonite,Amish Mennonite,,174.57,,,,,,,174.57,307.88,percent of total billed charges,
PURAPLY 5X5,79036,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,317.40000,301.53000,Amish/Mennonite,Amish Mennonite,,174.57,,,,,,,155.27,307.88,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
HEALING ABUTMENT,79038,CDM,761,RC,D6011,HCPCS,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,inpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.35200,0.62080,percent of total billed charges,
METRONIDAZOLE 125 MG TAB,79073,CDM,250,RC,00904-1453-61-00050,NDC,,,facility,outpatient,1,EA,0.64000,0.60000,Amish/Mennonite,Amish Mennonite,,0.35200,,,,,,,0.32000,0.62080,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,144.38,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 4MM 75CM ULTRAVERSE 035,79074,CDM,279,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,131.25,254.62,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X12MM,79075,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2683.84,5312.90,percent of total billed charges,
COIL EMB L3CM DIA1.5MM 360DEG ULT DETACH HELI NANO TARGET,79076,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5477.22000,5203.36000,Amish/Mennonite,Amish Mennonite,,3012.47,,,,,,,2514.04,5477.22,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB L10CM DIA4MM X SFT COMPLX RNDM STRTCH RESIST GALAXY.,79080,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 7FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79082,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,inpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00338080704,NDC,facility,outpatient,1,mL,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.34860,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,inpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
DEXTROSE 5%/0.9% NACL W/ KCL 40 MEQ/L 1000 ML,79093,CDM,250,RC,J3480,HCPCS,00409710909,NDC,facility,outpatient,1,mL,0.03000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.34860,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.5 GM/300 ML PREMIX,79094,CDM,250,RC,J3370,HCPCS,70594004302,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,3.24,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,inpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.13750,0.24250,percent of total billed charges,
VANCOMYCIN 1 GM/200 ML PREMIX,79095,CDM,250,RC,J3372,HCPCS,70594004203,NDC,facility,outpatient,1,mL,0.25000,0.24000,Amish/Mennonite,Amish Mennonite,,0.13750,,,,,,,0.12500,10.86,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,inpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
RIBOFLAVIN 100 MG TAB,79114,CDM,250,RC,74312-0006-40,NDC,,,facility,outpatient,1,EA,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,491.00000,466.45000,Amish/Mennonite,Amish Mennonite,,270.05,,,,,,,270.05,476.27,percent of total billed charges,
"CANNABINOIDS, URINE, CONFIRM BY GCMS",79116,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,491.00000,466.45000,Amish/Mennonite,Amish Mennonite,,270.05,,,,,,,63.95,788.42,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
ZZAP PRETREATMN,79117,CDM,300,RC,86970,CPT,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,56.40,1426.03,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,inpatient,,,9960.15000,9462.14000,Amish/Mennonite,Amish Mennonite,,5478.08,,,,,,,4880.47,9661.35,percent of total billed charges,
CATH ABLAT D-F CRV BIDIR TACTICATH CNTCT,79118,CDM,278,RC,C1888,HCPCS,,,facility,outpatient,,,9960.15000,9462.14000,Amish/Mennonite,Amish Mennonite,,5478.08,,,,,,,4571.71,9960.15,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26931.87000,25585.28000,Amish/Mennonite,Amish Mennonite,,14812.53,,,,,,,13196.62,26123.91,percent of total billed charges,
STENT PERIPH L20MM OD4MM CATH L135CM OD3.5FR GWIRE L300CM,79121,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26931.87000,25585.28000,Amish/Mennonite,Amish Mennonite,,14812.53,,,,,,,12361.73,26931.87,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GWIRE SYNCHRO 2/14 215CM PRESH,79123,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X40X130,79124,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,6722.33000,6386.21000,Amish/Mennonite,Amish Mennonite,,3697.28,,,,,,,3293.94,6520.66,percent of total billed charges,
CATH AXS CATALYST 5 058X115CM,79125,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,6722.33000,6386.21000,Amish/Mennonite,Amish Mennonite,,3697.28,,,,,,,3085.55,6722.33,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA1MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79126,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L2CM DIA2MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79127,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1451.62,2873.62,percent of total billed charges,
COIL EMB L4CM DIA3MM 3D COMPLX SHP SFT DETACH RESHEATHABLE.,79128,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2962.50000,2814.38000,Amish/Mennonite,Amish Mennonite,,1629.38,,,,,,,1359.79,2962.50,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATH THROMCTMY TRIEVER24 OD24 FR,79129,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE EBU3.5 5FR 100CM,79130,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,Amish/Mennonite,Amish Mennonite,,5313.00,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L64CM IROX TIP SIL BODY BACKFILLED,79134,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,Amish/Mennonite,Amish Mennonite,,5313.00,,,,,,,4433.94,9660.00,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,inpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,292.60,516.04,percent of total billed charges,
INJ FOR PRIAPRISM,79135,CDM,450,RC,,,,,facility,outpatient,,,532.00000,505.40000,Amish/Mennonite,Amish Mennonite,,292.60,,,,,,,266.00,516.04,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1515.94,3000.94,percent of total billed charges,
SHEATH INTRO 8.5FR L71CM 8.5FR DIL GUIDEWIRE,79136,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1420.03,3093.75,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3296.47,6525.68,percent of total billed charges,
SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5,79137,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3087.92,6727.50,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
GUIDEWIRE ESCP COONS STRG TPR .038IN 260CM SS,79138,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 5MM 150CM ULT-CX ULTRAVERSE 014,79139,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM ACPT .014IN GW 5FR SHTH PTA,79142,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 5MM 130CM ULTRAVERSE 018 CK,79143,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 15CM 6MM 130CM ULTRAVERSE 018 CK,79144,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI AD L26MM DIA7MM CATH 6FR L80CM SS OTW BLLN SELF,79145,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1024.14,2231.25,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L24CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,79146,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,701.37,1528.05,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATH BEACON TIP C2 5FR 100CM,79148,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 7.2MM 4.0-7.0MMX190CM,79149,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATH IMPULSE IM 5FR 125CM,79151,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 3CM 16FR ENTRL SIL MC SLK 5ML,79152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,inpatient,,,3488.00000,3313.60000,Amish/Mennonite,Amish Mennonite,TC,1918.40,,,,,,,1918.40,3383.36,percent of total billed charges,
NM CEREBROSPINAL FLUID SCAN-TECH,79153,CDM,340,RC,78630,CPT,,,facility,outpatient,,,3488.00000,3313.60000,Amish/Mennonite,Amish Mennonite,TC,1918.40,,,,,,,1648.68,3383.36,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,inpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,,399.30,,,,,,,399.30,704.22,percent of total billed charges,
US DUPLEX ART/VEN PENILE-TECH,79154,CDM,920,RC,93980,CPT,,,facility,outpatient,,,726.00000,689.70000,Amish/Mennonite,Amish Mennonite,,399.30,,,,,,,100.97,704.22,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,inpatient,1,GM,341.49000,324.41000,Amish/Mennonite,Amish Mennonite,,187.82,,,,,,,187.82,331.25,percent of total billed charges,
TIOTROPIUM 2.5 MCG/INH AEROS,79175,CDM,250,RC,00597-0100-61,NDC,,,facility,outpatient,1,GM,341.49000,324.41000,Amish/Mennonite,Amish Mennonite,,187.82,,,,,,,170.75,331.25,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,4232.12000,4020.51000,Amish/Mennonite,Amish Mennonite,,2327.67,,,,,,,2073.74,4105.16,percent of total billed charges,
CATH AXS OFFSET ASSIST 050X150,79178,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,4232.12000,4020.51000,Amish/Mennonite,Amish Mennonite,,2327.67,,,,,,,1942.54,4232.12,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 2 GM/400 ML PREMIX,79183,CDM,250,RC,J3372,HCPCS,70594004402,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,10.86,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,inpatient,,,42.42000,40.30000,Amish/Mennonite,Amish Mennonite,,23.33,,,,,,,23.33,41.15,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,CPT,,,facility,outpatient,,,42.42000,40.30000,Amish/Mennonite,Amish Mennonite,,23.33,,,,,,,21.21,47.59,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,inpatient,0.5,EA,84.84000,80.60000,Amish/Mennonite,Amish Mennonite,,46.66,,,,,,,46.66,82.29,percent of total billed charges,
DIPHTHERIA-TETANUS-PERTUSSIS (DTAP) VACCINE SUSP (DAPTACEL),79184,CDM,250,RC,90700,HCPCS,49281028610,NDC,facility,outpatient,0.5,EA,84.84000,80.60000,Amish/Mennonite,Amish Mennonite,,46.66,,,,,,,42.42,82.29,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,inpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,94.05,165.87,percent of total billed charges,
LAB/SANE SPERM ASSESSMENT,79186,CDM,300,RC,89321,CPT,,,facility,outpatient,,,171.00000,162.45000,Amish/Mennonite,Amish Mennonite,,94.05,,,,,,,12.05,628.12,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID EBU3.75 5FR 100CM,79196,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X20MM,79197,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X6MM,79198,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,inpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,TC,308.00,,,,,,,308.00,543.20,percent of total billed charges,
XR RENAL CYST STUDY-TECH,79199,CDM,320,RC,74470,CPT,,,facility,outpatient,,,560.00000,532.00000,Amish/Mennonite,Amish Mennonite,TC,308.00,,,,,,,280.00,3015.65,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,Amish/Mennonite,Amish Mennonite,,3273.19,,,,,,,2916.11,5772.71,percent of total billed charges,
XTRNFX AGEE DGTWDGT STRL LTX DISP PIP JNT.,79200,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,Amish/Mennonite,Amish Mennonite,,3273.19,,,,,,,2731.62,5951.25,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 40MM 10MM 130CM ULTRAVERSE 035,79201,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,310.01000,294.51000,Amish/Mennonite,Amish Mennonite,,170.51,,,,,,,151.90,300.71,percent of total billed charges,
GUIDEWIRE VASC TPR .035IN 260CM SFTJ SS PTFE 7CM,79219,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,310.01000,294.51000,Amish/Mennonite,Amish Mennonite,,170.51,,,,,,,142.29,310.01,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM 5MM 130CM ULTRAVERSE 018 CK,79224,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 250MM 6MM 130CM ULTRAVERSE 035,79226,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,319.30000,303.34000,Amish/Mennonite,Amish Mennonite,,175.62,,,,,,,175.62,309.72,percent of total billed charges,
PURAPLY 6X9,79239,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,319.30000,303.34000,Amish/Mennonite,Amish Mennonite,,175.62,,,,,,,155.27,309.72,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,inpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,224.07,395.18,percent of total billed charges,
"BK VIRUS PCR, QUAL, PLASMA SO",79240,CDM,300,RC,87798,CPT,,,facility,outpatient,,,407.40000,387.03000,Amish/Mennonite,Amish Mennonite,90,224.07,,,,,,,36.26,1833.46,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,00472-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,inpatient,1,GM,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,51672-2001-01,NDC,,,facility,outpatient,1,GM,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,inpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.20900,0.36860,percent of total billed charges,
MICONAZOLE CREAM 2% 14 GM,79261,CDM,250,RC,61269-0735-14,NDC,,,facility,outpatient,1,GM,0.38000,0.36000,Amish/Mennonite,Amish Mennonite,,0.20900,,,,,,,0.19000,0.36860,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,inpatient,1,GM,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
PETROLATUM TOPICAL 100% OI,79264,CDM,250,RC,00904-5731-82,NDC,,,facility,outpatient,1,GM,0.02000,0.02000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,inpatient,1,EA,3070.66000,2917.13000,Amish/Mennonite,Amish Mennonite,,1688.86,,,,,,,1688.86,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022305,NDC,facility,outpatient,1,EA,3070.66000,2917.13000,Amish/Mennonite,Amish Mennonite,,1688.86,,,,,,,155.42,2978.54,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,inpatient,1,EA,3116.66000,2960.83000,Amish/Mennonite,Amish Mennonite,,1714.16,,,,,,,1714.16,3023.16,percent of total billed charges,
LEUPROLIDE 22.5 MG/3 MONTHS (ELIGARD),79265,CDM,636,RC,J9217,HCPCS,62935022710,NDC,facility,outpatient,1,EA,3116.66000,2960.83000,Amish/Mennonite,Amish Mennonite,,1714.16,,,,,,,155.42,3023.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,inpatient,1,EA,33331.78000,31665.19000,Amish/Mennonite,Amish Mennonite,,18332.48,,,,,,,18332.48,32331.83,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 140 MG,79267,CDM,636,RC,J9309,HCPCS,50242010501,NDC,facility,outpatient,1,EA,33331.78000,31665.19000,Amish/Mennonite,Amish Mennonite,,18332.48,,,,,,,136.23,32331.83,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,inpatient,1,EA,13.13000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 36.25 MG-145 MG CAP-,79268,CDM,250,RC,64896-0662-01,NDC,,,facility,outpatient,1,EA,13.13000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,6.57,12.74,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,inpatient,,,128.57000,122.14000,Amish/Mennonite,Amish Mennonite,,70.71,,,,,,,70.71,124.71,percent of total billed charges,
"PRIMATRIX,8X8 SHEET",79316,CDM,636,RC,Q4110,HCPCS,,,facility,outpatient,,,128.57000,122.14000,Amish/Mennonite,Amish Mennonite,,70.71,,,,,,,64.28,124.71,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,inpatient,,,909.00000,863.55000,Amish/Mennonite,Amish Mennonite,TC,499.95,,,,,,,499.95,881.73,percent of total billed charges,
"RADIOPHARM QUANTIFIC MGMT,SNG-TECH",79318,CDM,409,RC,78835,CPT,,,facility,outpatient,,,909.00000,863.55000,Amish/Mennonite,Amish Mennonite,TC,499.95,,,,,,,359.37,881.73,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,136.98,271.17,percent of total billed charges,
CATHETER DRN .038IN 12FR 25CM ULTHNE HDRPH MCLC,79322,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,279.56000,265.58000,Amish/Mennonite,Amish Mennonite,,153.76,,,,,,,128.32,279.56,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 8.5FR L7CM GWIRE 0.035IN MIN ACC CHN 3.2MM POLY,79323,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X15MM,79324,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X15MM,79325,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,Amish/Mennonite,Amish Mennonite,,13426.88,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF1 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79327,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,Amish/Mennonite,Amish Mennonite,,13426.88,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,24412.50000,23191.88000,Amish/Mennonite,Amish Mennonite,,13426.88,,,,,,,11962.12,23680.12,percent of total billed charges,
DEFIBRILLATOR CARD DF4 VR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79328,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,24412.50000,23191.88000,Amish/Mennonite,Amish Mennonite,,13426.88,,,,,,,11205.34,24412.50,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF4 CONN W/ BLUESYNC TECH SHOCK REDUC,79329,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,Amish/Mennonite,Amish Mennonite,,14501.02,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF4 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79330,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,Amish/Mennonite,Amish Mennonite,,14501.02,,,,,,,12101.76,26365.50,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,15500.00000,14725.00000,Amish/Mennonite,Amish Mennonite,,8525.00,,,,,,,7595.00,15035.00,percent of total billed charges,
ELECTRODE DEFIB FOR EMBLEM S ICD IMAGEREADY,79331,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,15500.00000,14725.00000,Amish/Mennonite,Amish Mennonite,,8525.00,,,,,,,7114.50,15500.00,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE GASTROSTOMY 16FR 5.0 45CM,79332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT IS4-LLLL CONN QPLR ELECTRD STR,79333,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,2871.77,6256.58,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,3065.72,6068.88,percent of total billed charges,
LEAD PACE 5.3FR L88CM L VENT SIL POLYUR IS-4 CONN QPLR,79334,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6256.58000,5943.75000,Amish/Mennonite,Amish Mennonite,,3441.12,,,,,,,2871.77,6256.58,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2MM 145CM PEBAX HDRCT MN TREK II,79336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L10CM GWIRE 0.035IN POLYETH CRV TAPR TIP,79337,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID CONVEY LEFTBU3.75 6F,79339,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L5CM PK J SFT L VOL POD,79340,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,26365.50000,25047.22000,Amish/Mennonite,Amish Mennonite,,14501.02,,,,,,,12919.09,25574.53,percent of total billed charges,
DEFIBRILLATOR CARD DF1 DR W/ BLUESYNC TECHNOLOGY MRI FOR TAB,79341,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,26365.50000,25047.22000,Amish/Mennonite,Amish Mennonite,,14501.02,,,,,,,12101.76,26365.50,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,inpatient,,,27825.00000,26433.75000,Amish/Mennonite,Amish Mennonite,,15303.75,,,,,,,13634.25,26990.25,percent of total billed charges,
SYSTEM TRANSCATHETER PACE 1 PACE CAP 1 DEL CATH AND 1 INTRO,79342,CDM,278,RC,C1786,HCPCS,,,facility,outpatient,,,27825.00000,26433.75000,Amish/Mennonite,Amish Mennonite,,15303.75,,,,,,,12771.67,27825.00,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,inpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,2746.70,4844.18,percent of total billed charges,
MRI-BREAST UNIL W/WO CONTR/CAD-TECH,79344,CDM,614,RC,77048,CPT,,,facility,outpatient,,,4994.00000,4744.30000,Amish/Mennonite,Amish Mennonite,TC,2746.70,,,,,,,1288.05,4844.18,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,inpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
PIOGLITAZONE 7.5 MG TAB,79360,CDM,250,RC,51079-0513-20-00050,NDC,,,facility,outpatient,1,EA,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.28,2.49,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,inpatient,1,EA,2442.69000,2320.56000,Amish/Mennonite,Amish Mennonite,,1343.48,,,,,,,1343.48,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,00480145308,NDC,facility,outpatient,1,EA,2442.69000,2320.56000,Amish/Mennonite,Amish Mennonite,,1343.48,,,,,,,10.94,2369.41,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,inpatient,1,EA,2827.18000,2685.82000,Amish/Mennonite,Amish Mennonite,,1554.95,,,,,,,1554.95,2742.36,percent of total billed charges,
RISPERIDONE POWD-INJ 50 MG/2 WEEKS (RISPERDAL CONSTA),79361,CDM,636,RC,J2794,HCPCS,50458030811,NDC,facility,outpatient,1,EA,2827.18000,2685.82000,Amish/Mennonite,Amish Mennonite,,1554.95,,,,,,,10.94,2742.36,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,inpatient,1,EA,21354.33000,20286.61000,Amish/Mennonite,Amish Mennonite,,11744.88,,,,,,,11744.88,20713.70,percent of total billed charges,
LEUPROLIDE 11.25 MG/3 MONTHS (LUPRON DEPOT-PED),79362,CDM,636,RC,J1950,HCPCS,00074377903,NDC,facility,outpatient,1,EA,21354.33000,20286.61000,Amish/Mennonite,Amish Mennonite,,11744.88,,,,,,,1737.10,20713.70,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA10MM CATH L80CM GWIRE 0.035IN SHTH 8FR.,79372,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID CHAMP 0.5 6FR,79373,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,321.56,636.56,percent of total billed charges,
KT PERI DLYS IR,79374,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,656.25000,623.44000,Amish/Mennonite,Amish Mennonite,,360.94,,,,,,,301.22,656.25,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L20MM DIA7MM CATH L80CM LIFESTENT,79375,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,inpatient,1,GM,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
MICONAZOLE TOPICAL 2% POWD,79376,CDM,250,RC,00316-0225-15,NDC,,,facility,outpatient,1,GM,0.28000,0.26000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,99.22,196.43,percent of total billed charges,
CATHETER GUID 6FR L55CM BLU PTFE RDC II,79377,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,,111.38,,,,,,,92.95,202.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L4MM DIA9MM SHTH,79378,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,3731.25000,3544.69000,Amish/Mennonite,Amish Mennonite,,2052.19,,,,,,,1828.31,3619.31,percent of total billed charges,
MICROCATHETER GUIDE 2.8-3.1FR L150CM ID0.027IN,79379,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,3731.25000,3544.69000,Amish/Mennonite,Amish Mennonite,,2052.19,,,,,,,1712.64,3731.25,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBRILLATOR CARD DF1 CONN W/ BLUESYNC TECH SHCK RDC,79380,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,inpatient,1,GM,297.08000,282.23000,Amish/Mennonite,Amish Mennonite,,163.39,,,,,,,163.39,288.17,percent of total billed charges,
GANCICLOVIR OPHTHALMIC 0.15% GEL,79383,CDM,250,RC,24208-0535-35,NDC,,,facility,outpatient,1,GM,297.08000,282.23000,Amish/Mennonite,Amish Mennonite,,163.39,,,,,,,148.54,288.17,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .018IN GW 4FR SHTH PTA,79386,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L60CM TARGET VES 12-14MM L VOL DETACH FOR HI,79387,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,39270.00000,37306.50000,Amish/Mennonite,Amish Mennonite,,21598.50,,,,,,,19242.30,38091.90,percent of total billed charges,
NEUROSTIMULATOR DBS 61GM H68XL51MM 2 CHN PRI CELL BTTRY,79389,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,39270.00000,37306.50000,Amish/Mennonite,Amish Mennonite,,21598.50,,,,,,,18024.93,39270.00,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,inpatient,1,EA,3774.55000,3585.83000,Amish/Mennonite,Amish Mennonite,,2076.00,,,,,,,2076.00,3661.31,percent of total billed charges,
NALTREXONE POWD-INJ 380 MG EXTENDED RELEASE,79390,CDM,636,RC,J2315,HCPCS,65757030001,NDC,facility,outpatient,1,EA,3774.55000,3585.83000,Amish/Mennonite,Amish Mennonite,,2076.00,,,,,,,4.24,3661.31,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4985.25000,4735.99000,Amish/Mennonite,Amish Mennonite,,2741.89,,,,,,,2442.77,4835.69,percent of total billed charges,
PERCEPT PATIENT PROGRAMMER,79391,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4985.25000,4735.99000,Amish/Mennonite,Amish Mennonite,,2741.89,,,,,,,2288.23,4985.25,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,inpatient,1,EA,9775.80000,9287.01000,Amish/Mennonite,Amish Mennonite,,5376.69,,,,,,,5376.69,9482.53,percent of total billed charges,
BLINATUMOMAB POWD-INJ 35 MCG,79399,CDM,636,RC,J9039,HCPCS,55513016001,NDC,facility,outpatient,1,EA,9775.80000,9287.01000,Amish/Mennonite,Amish Mennonite,,5376.69,,,,,,,163.21,9482.53,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,inpatient,1,EA,13.13000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,7.22,12.74,percent of total billed charges,
CARBIDOPA-LEVODOPA 23.75 MG-95 MG CAP-,79400,CDM,250,RC,J8499,HCPCS,64896066101,NDC,facility,outpatient,1,EA,13.13000,12.47000,Amish/Mennonite,Amish Mennonite,,7.22,,,,,,,6.57,12.74,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,inpatient,1,mL,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.52,4.44,percent of total billed charges,
MEROPENEM SOLN SD 50 MG/ML,79401,CDM,250,RC,00409-3505-01-05000,NDC,,,facility,outpatient,1,mL,4.58000,4.35000,Amish/Mennonite,Amish Mennonite,,2.52,,,,,,,2.29,4.44,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,inpatient,,,10207.00000,9696.65000,Amish/Mennonite,Amish Mennonite,90,5613.85,,,,,,,5613.85,9900.79,percent of total billed charges,
CHROMOSOMAL MICROARRAY SO TECH,79403,CDM,310,RC,81229,CPT,,,facility,outpatient,,,10207.00000,9696.65000,Amish/Mennonite,Amish Mennonite,90,5613.85,,,,,,,608.00,54562.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28637.91000,27206.01000,Amish/Mennonite,Amish Mennonite,,15750.85,,,,,,,14032.58,27778.77,percent of total billed charges,
DEV RECON EMBLC COIL ARCH W10.6MM ANEUR NK W10MM VES 211D,79433,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28637.91000,27206.01000,Amish/Mennonite,Amish Mennonite,,15750.85,,,,,,,13144.80,28637.91,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DFBRLLTR CRD DF4 CNN W/ BLSYNC TCH SHCK RDC,79434,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,inpatient,,,1024.00000,972.80000,Amish/Mennonite,Amish Mennonite,TC,563.20,,,,,,,563.20,993.28,percent of total billed charges,
"VENOGRAPHY, ADRENAL, UNILATERAL-TECH",79435,CDM,320,RC,75840,CPT,,,facility,outpatient,,,1024.00000,972.80000,Amish/Mennonite,Amish Mennonite,TC,563.20,,,,,,,433.70,17311.25,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,inpatient,,,3151.00000,2993.45000,Amish/Mennonite,Amish Mennonite,TC,1733.05,,,,,,,1733.05,3056.47,percent of total billed charges,
ENDOVASCULAR REPAIR OF DESCENDING THORACIC-TECH,79436,CDM,320,RC,75956,CPT,,,facility,outpatient,,,3151.00000,2993.45000,Amish/Mennonite,Amish Mennonite,TC,1733.05,,,,,,,1575.50,3056.47,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN .9MM .049IN 150CM PERI,79437,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 18FR 3CM ENTRL SIL MC SLK LOPRFL FD,79438,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 150MM 5MM 75CM ULTRAVERSE 035,79439,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1986.34,3932.14,percent of total billed charges,
CATHETER BLNDIL 5MM 75CM PCLTXL LUTONIX 035 60MM,79440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4053.75000,3851.06000,Amish/Mennonite,Amish Mennonite,,2229.56,,,,,,,1860.67,4053.75,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA36MM STD RUBY COIL,79441,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA40MM STD RUBY COIL,79442,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,inpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,90,618.75,,,,,,,618.75,1091.25,percent of total billed charges,
"MGMT PROMOTER METHYL,T SO",79465,CDM,310,RC,81287,CPT,,,facility,outpatient,,,1125.00000,1068.75000,Amish/Mennonite,Amish Mennonite,90,618.75,,,,,,,83.09,5856.94,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,inpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,90,62.15,,,,,,,62.15,109.61,percent of total billed charges,
"MGMT PROMOTER METHYL,DIS SO",79466,CDM,310,RC,88381,CPT,,,facility,outpatient,,,113.00000,107.35000,Amish/Mennonite,Amish Mennonite,90,62.15,,,,,,,56.50,8610.62,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,inpatient,,,421.88000,400.79000,Amish/Mennonite,Amish Mennonite,,232.03,,,,,,,232.03,409.22,percent of total billed charges,
PURAPLY 2X4,79474,CDM,636,RC,Q4195,HCPCS,,,facility,outpatient,,,421.88000,400.79000,Amish/Mennonite,Amish Mennonite,,232.03,,,,,,,155.27,409.22,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,163.14,322.94,percent of total billed charges,
COIL EMB L7CM DIA4MM 0.035IN GWIRE NEST,79482,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,332.93000,316.28000,Amish/Mennonite,Amish Mennonite,,183.11,,,,,,,152.81,332.93,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE SYNCHRO 2/14 300CM SUPRT,79483,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1518.14,3307.50,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,inpatient,,,6126.00000,5819.70000,Amish/Mennonite,Amish Mennonite,TC,3369.30,,,,,,,3369.30,5942.22,percent of total billed charges,
ENDOMYOCARDIAL BIOPSY-TECH,79489,CDM,480,RC,93505,CPT,,,facility,outpatient,,,6126.00000,5819.70000,Amish/Mennonite,Amish Mennonite,TC,3369.30,,,,,,,3063.00,5942.22,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,110.25,218.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.035IN STR FLPY SHP,79492,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,103.28,225.00,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 20MM 10MM 130CM ULTRAVERSE 035,79494,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,inpatient,1,mL,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,4.27,7.54,percent of total billed charges,
VANCOMYCIN LIQ 50 MG/ML 2.5 ML,79497,CDM,250,RC,67877-0751-81-00250,NDC,,,facility,outpatient,1,mL,7.77000,7.38000,Amish/Mennonite,Amish Mennonite,,4.27,,,,,,,3.88,7.54,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,238.70,420.98,percent of total billed charges,
LUTATHERA 1MCI,79498,CDM,344,RC,A9513,HCPCS,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,,238.70,,,,,,,217.00,488.81,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,inpatient,1,mL,2194.08000,2084.37000,Amish/Mennonite,Amish Mennonite,,1206.74,,,,,,,1206.74,2128.26,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 1200 MG-600 MG-30,000 UNITS/15 ML",79499,CDM,636,RC,J9316,HCPCS,50242024501,NDC,facility,outpatient,1,mL,2194.08000,2084.37000,Amish/Mennonite,Amish Mennonite,,1206.74,,,,,,,63.39,2128.26,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
PANTOPRAZOLE SUSP SD 2 MG/ML,79500,CDM,250,RC,68084-0813-09-00200,NDC,,,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TC,85.80,,,,,,,85.80,151.32,percent of total billed charges,
"MYOCARD PET-CT IMAG,METAB EVAL-TECH",79503,CDM,404,RC,78429,CPT,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,TC,85.80,,,,,,,78.00,8022.25,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 10FR L7CM 0.035IN ACC CHN 3.7MM PLAS,79505,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,inpatient,,,53550.00000,50872.50000,Amish/Mennonite,Amish Mennonite,,29452.50,,,,,,,26239.50,51943.50,percent of total billed charges,
GENERATOR PLSE 2.9-2.95V H80XL47.5MM THK14.6MM IMPL REMEDE,79506,CDM,278,RC,C1823,HCPCS,,,facility,outpatient,,,53550.00000,50872.50000,Amish/Mennonite,Amish Mennonite,,29452.50,,,,,,,24579.45,53550.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD RESPISTIM R RIGHT 60CM,79507,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X60X130,79508,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT BILI AD L80MM DIA10MM CATH 6FR L80CM LIFESTENT,79509,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1006.93,2193.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.5X8MM,79510,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
STENT URET 4.8FR L22-30CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,79511,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM ACPT .014IN GW 4FR SHTH PTA,79512,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA9MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79514,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,inpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,90,392.70,,,,,,,392.70,692.58,percent of total billed charges,
UREAPLASMA PLASMA SO TECH,79517,CDM,300,RC,87798,CPT,,,facility,outpatient,,,714.00000,678.30000,Amish/Mennonite,Amish Mennonite,90,392.70,,,,,,,36.26,1833.46,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,inpatient,,,1525.00000,1448.75000,Amish/Mennonite,Amish Mennonite,90,838.75,,,,,,,838.75,1479.25,percent of total billed charges,
OREXIN-A/HYPOCRET-1 SO,79518,CDM,301,RC,83519,CPT,,,facility,outpatient,,,1525.00000,1448.75000,Amish/Mennonite,Amish Mennonite,90,838.75,,,,,,,19.00,1479.25,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X12MM,79529,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,inpatient,,,56.72000,53.88000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,31.20,55.02,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,CPT,,,facility,outpatient,,,56.72000,53.88000,Amish/Mennonite,Amish Mennonite,,31.20,,,,,,,28.36,60.01,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,inpatient,1,mL,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,62.39,110.03,percent of total billed charges,
TETANUS-DIPHTHERIA (TD) VACCINE SUSP PF (TENIVAC),79531,CDM,250,RC,90714,HCPCS,49281021515,NDC,facility,outpatient,1,mL,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,52.64,110.03,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,inpatient,1,EA,11.46000,10.88000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,6.30,11.12,percent of total billed charges,
UREA POWD 15 GM,79534,CDM,250,RC,62530-0000-11,NDC,,,facility,outpatient,1,EA,11.46000,10.88000,Amish/Mennonite,Amish Mennonite,,6.30,,,,,,,5.73,11.12,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,inpatient,1,EA,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,85.25,150.35,percent of total billed charges,
BREXPIPRAZOLE TAB 0.5 MG,79536,CDM,250,RC,59148-0036-13,NDC,,,facility,outpatient,1,EA,155.00000,147.25000,Amish/Mennonite,Amish Mennonite,,85.25,,,,,,,77.50,150.35,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,inpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.39050,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00031-8743-20,NDC,,,facility,outpatient,1,EA,0.71000,0.67000,Amish/Mennonite,Amish Mennonite,,0.39050,,,,,,,0.35500,0.68870,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,inpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1323-34,NDC,,,facility,outpatient,1,EA,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,inpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.23100,0.40740,percent of total billed charges,
DEXTROMETHORPHAN 15 MG CAP,79537,CDM,250,RC,00536-1334-34,NDC,,,facility,outpatient,1,EA,0.42000,0.39000,Amish/Mennonite,Amish Mennonite,,0.23100,,,,,,,0.21000,0.40740,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L8CM CTRL REL UNCOVERED EVOLUTION,79541,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4487.78,9777.30,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,424.06000,402.86000,Amish/Mennonite,Amish Mennonite,,233.23,,,,,,,233.23,411.34,percent of total billed charges,
AMNIOEXCL 3X4CM,79552,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,424.06000,402.86000,Amish/Mennonite,Amish Mennonite,,233.23,,,,,,,158.39,411.34,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,80.12000,76.11000,Amish/Mennonite,Amish Mennonite,,44.07,,,,,,,39.26,77.72,percent of total billed charges,
CATHETER ANGIO PGTL CRV 4FR 65CM SFVU RADOPQ,79562,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,80.12000,76.11000,Amish/Mennonite,Amish Mennonite,,44.07,,,,,,,36.78,80.12,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 26MM ULT TRANSCATHETER HRT TRILEAFLET BOV,79563,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,31326.75,68250.00,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 30MMX120CM,79565,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X8MM,79566,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X20MM,79567,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,inpatient,1,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,4.20,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,50742-0362-60,NDC,,,facility,outpatient,1,EA,7.63000,7.25000,Amish/Mennonite,Amish Mennonite,,4.20,,,,,,,3.81,7.40,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,inpatient,1,EA,31.40000,29.83000,Amish/Mennonite,Amish Mennonite,,17.27,,,,,,,17.27,30.46,percent of total billed charges,
IVABRADINE 5 MG TAB,79569,CDM,250,RC,55513-0800-60,NDC,,,facility,outpatient,1,EA,31.40000,29.83000,Amish/Mennonite,Amish Mennonite,,17.27,,,,,,,15.70,30.46,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L12CM DST DIA23MM FEP NIT CONTRALATERAL LEG IL,79573,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
STIMULATOR DP BRAIN BOR PLUG US EMAN,79575,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,152.51,301.91,percent of total billed charges,
"PART THREAD GUIDEWIRE, 2.8X300",79577,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,142.86,311.25,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,inpatient,,,984.00000,934.80000,Amish/Mennonite,Amish Mennonite,,541.20,,,,,,,541.20,954.48,percent of total billed charges,
XR INJ W/FLUOR EVAL CV DEVICE-TECH,79591,CDM,320,RC,36598,CPT,,,facility,outpatient,,,984.00000,934.80000,Amish/Mennonite,Amish Mennonite,,541.20,,,,,,,200.06,954.48,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,inpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,26.40,46.56,percent of total billed charges,
LAB/ACTIVATED CLOTTING TIME-ISTAT,79592,CDM,300,RC,85347,CPT,,,facility,outpatient,,,48.00000,45.60000,Amish/Mennonite,Amish Mennonite,,26.40,,,,,,,4.28,220.68,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,657.80000,624.91000,Amish/Mennonite,Amish Mennonite,,361.79,,,,,,,361.79,638.07,percent of total billed charges,
EPIFIX 2CM X3CM(GS-5230),79596,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,657.80000,624.91000,Amish/Mennonite,Amish Mennonite,,361.79,,,,,,,240.68,638.07,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,inpatient,1,GM,10.04000,9.53000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.52,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,51672-1279-03,NDC,,,facility,outpatient,1,GM,10.04000,9.53000,Amish/Mennonite,Amish Mennonite,,5.52,,,,,,,5.02,9.74,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
FLUOCINONIDE TOPICAL 0.05% GEL,79613,CDM,250,RC,52565-0054-60,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM ECNTRC 5FR 1.4MM 135CM ELCA RX,79618,CDM,278,RC,C1885,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24404.10000,23183.89000,Amish/Mennonite,Amish Mennonite,,13422.25,,,,,,,11958.01,23671.98,percent of total billed charges,
GRAFT EVAR L10CM DIA12MM NIT EPTFE FEP BIFUR EXT LEG INT ART,79620,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24404.10000,23183.89000,Amish/Mennonite,Amish Mennonite,,13422.25,,,,,,,11201.48,24404.10,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X20X130,79621,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X20X130,79622,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,Amish/Mennonite,Amish Mennonite,,4364.25,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM .08IN 2MM .081IN 150CM TRBO-PWR,79623,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,Amish/Mennonite,Amish Mennonite,,4364.25,,,,,,,3642.16,7935.00,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,495.00000,470.25000,Amish/Mennonite,Amish Mennonite,,272.25,,,,,,,242.55,480.15,percent of total billed charges,
GW ESCP L200CM FLX TP S-GSS NS,79624,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,495.00000,470.25000,Amish/Mennonite,Amish Mennonite,,272.25,,,,,,,227.21,495.00,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,267.75000,254.36000,Amish/Mennonite,Amish Mennonite,,147.26,,,,,,,131.20,259.72,percent of total billed charges,
1.1MM GUIDEWIRE 150MM TROCAR,79627,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,267.75000,254.36000,Amish/Mennonite,Amish Mennonite,,147.26,,,,,,,122.90,267.75,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,65862021801,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,inpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.68200,1.20,percent of total billed charges,
CEFDINIR LIQ 25 MG/ML,79646,CDM,250,RC,J8499,HCPCS,68180072205,NDC,facility,outpatient,1,mL,1.24000,1.18000,Amish/Mennonite,Amish Mennonite,,0.68200,,,,,,,0.62000,1.20,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X20MM CATH 16FR POLY NIT STNT HYDRPHLC,79656,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,5939.18,12939.40,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,Amish/Mennonite,Amish Mennonite,,14417.48,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA36X14MM CATH 20FR POLY NIT STNT,79657,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,Amish/Mennonite,Amish Mennonite,,14417.48,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT COLON L10CM BODY DIA25MM FLNG DIA30MM ACC CHN 3.7MM,79658,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4487.78,9777.30,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,220.50,436.50,percent of total billed charges,
STENT URET 8FR L22-32CM MULTILENGTH W/O GWIRE INLAY OPTMA.,79659,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,206.55,450.00,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,inpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,182.60,322.04,percent of total billed charges,
FULL FIELD ERG W/I&R,79661,CDM,740,RC,92273,CPT,,,facility,outpatient,,,332.00000,315.40000,Amish/Mennonite,Amish Mennonite,,182.60,,,,,,,166.00,325.26,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,inpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,,460.35,,,,,,,460.35,811.89,percent of total billed charges,
MUSCLE TEST NONPARASPINAL,79663,CDM,922,RC,95870,CPT,,,facility,outpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,,460.35,,,,,,,122.40,811.89,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,inpatient,,,1310.00000,1244.50000,Amish/Mennonite,Amish Mennonite,TC,720.50,,,,,,,720.50,1270.70,percent of total billed charges,
SOMATOSENSORY TESTING TRUNK/HEAD,79664,CDM,740,RC,95927,CPT,,,facility,outpatient,,,1310.00000,1244.50000,Amish/Mennonite,Amish Mennonite,TC,720.50,,,,,,,655.00,1270.70,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,inpatient,,,1538.00000,1461.10000,Amish/Mennonite,Amish Mennonite,TC,845.90,,,,,,,845.90,1491.86,percent of total billed charges,
MUSCLE TEST CRAN NERVE BILAT,79666,CDM,922,RC,95868,CPT,,,facility,outpatient,,,1538.00000,1461.10000,Amish/Mennonite,Amish Mennonite,TC,845.90,,,,,,,769.00,1491.86,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,inpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,,377.30,,,,,,,377.30,665.42,percent of total billed charges,
MUSCLE TEST LARYNX,79667,CDM,740,RC,95865,CPT,,,facility,outpatient,,,686.00000,651.70000,Amish/Mennonite,Amish Mennonite,,377.30,,,,,,,122.40,665.42,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,inpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,TC,110.00,,,,,,,110.00,194.00,percent of total billed charges,
MULTIFOCAL ERG W/I&R,79668,CDM,740,RC,92274,CPT,,,facility,outpatient,,,200.00000,190.00000,Amish/Mennonite,Amish Mennonite,TC,110.00,,,,,,,100.00,194.00,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,inpatient,,,1812.00000,1721.40000,Amish/Mennonite,Amish Mennonite,TC,996.60,,,,,,,996.60,1757.64,percent of total billed charges,
ANAL/URINARY MUSCLE STUDY,79670,CDM,740,RC,51785,CPT,,,facility,outpatient,,,1812.00000,1721.40000,Amish/Mennonite,Amish Mennonite,TC,996.60,,,,,,,906.00,1757.64,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,822.25,1450.15,percent of total billed charges,
ELECTRODE STIMULATION BRAIN,79671,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,747.50,1450.15,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,inpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,,601.15,,,,,,,601.15,1060.21,percent of total billed charges,
MUSCLE TEST CRAN NERV UNILAT,79672,CDM,922,RC,95867,CPT,,,facility,outpatient,,,1093.00000,1038.35000,Amish/Mennonite,Amish Mennonite,,601.15,,,,,,,295.69,1060.21,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,inpatient,,,1006.00000,955.70000,Amish/Mennonite,Amish Mennonite,,553.30,,,,,,,553.30,975.82,percent of total billed charges,
ELECTRODE STIM BRAIN ADD-ON,79675,CDM,740,RC,95962,CPT,,,facility,outpatient,,,1006.00000,955.70000,Amish/Mennonite,Amish Mennonite,,553.30,,,,,,,503.00,975.82,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,inpatient,1,mL,25.54000,24.27000,Amish/Mennonite,Amish Mennonite,,14.05,,,,,,,14.05,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,00065-0397-15,NDC,,,facility,outpatient,1,mL,25.54000,24.27000,Amish/Mennonite,Amish Mennonite,,14.05,,,,,,,12.77,24.77,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,inpatient,1,mL,12.79000,12.15000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,7.03,12.41,percent of total billed charges,
CYCLOPENTOLATE SOLN-OPHTH 2% 15 ML,79681,CDM,250,RC,17478-0097-12,NDC,,,facility,outpatient,1,mL,12.79000,12.15000,Amish/Mennonite,Amish Mennonite,,7.03,,,,,,,6.39,12.41,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,inpatient,1,mL,2462.57000,2339.44000,Amish/Mennonite,Amish Mennonite,,1354.41,,,,,,,1354.41,2388.69,percent of total billed charges,
DUPILUMAB SOLN 300 MG/2 ML (DUPIXENT),79682,CDM,250,RC,J3590,HCPCS,00024591401,NDC,facility,outpatient,1,mL,2462.57000,2339.44000,Amish/Mennonite,Amish Mennonite,,1354.41,,,,,,,1231.29,2388.69,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,inpatient,1,EA,1284.64000,1220.41000,Amish/Mennonite,Amish Mennonite,,706.55,,,,,,,706.55,1246.10,percent of total billed charges,
INCOBOTULINUMTOXINA POWD-INJ 100 UNITS,79685,CDM,636,RC,J0588,HCPCS,00259161001,NDC,facility,outpatient,1,EA,1284.64000,1220.41000,Amish/Mennonite,Amish Mennonite,,706.55,,,,,,,5.31,1246.10,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,inpatient,1,mL,2259.81000,2146.82000,Amish/Mennonite,Amish Mennonite,,1242.90,,,,,,,1242.90,2192.02,percent of total billed charges,
"PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-ZZXF 600 MG-600 MG-20,000 UNITS/10 ML",79691,CDM,636,RC,J9316,HCPCS,50242026001,NDC,facility,outpatient,1,mL,2259.81000,2146.82000,Amish/Mennonite,Amish Mennonite,,1242.90,,,,,,,63.39,2192.02,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,inpatient,1,EA,1367.29000,1298.92000,Amish/Mennonite,Amish Mennonite,,752.01,,,,,,,752.01,1326.27,percent of total billed charges,
LEVOTHYROXINE POWD-INJ 500 MCG,79710,CDM,250,RC,J0650,HCPCS,63323064810,NDC,facility,outpatient,1,EA,1367.29000,1298.92000,Amish/Mennonite,Amish Mennonite,,752.01,,,,,,,11.25,1326.27,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,inpatient,1,mL,7668.27000,7284.86000,Amish/Mennonite,Amish Mennonite,,4217.55,,,,,,,4217.55,7438.22,percent of total billed charges,
SECUKINUMAB SOLN 150 MG/ML (COSENTYX),79711,CDM,636,RC,C9166,HCPCS,00078063998,NDC,facility,outpatient,1,mL,7668.27000,7284.86000,Amish/Mennonite,Amish Mennonite,,4217.55,,,,,,,3834.14,7438.22,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,inpatient,1,mL,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,45.19,79.70,percent of total billed charges,
REMDESIVIR SOLN 5 MG/ML 20 ML,79712,CDM,636,RC,J0248,HCPCS,61958290201,NDC,facility,outpatient,1,mL,82.16000,78.05000,Amish/Mennonite,Amish Mennonite,,45.19,,,,,,,6.35,79.70,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,inpatient,,,59.20000,56.24000,Amish/Mennonite,Amish Mennonite,,32.56,,,,,,,32.56,57.42,percent of total billed charges,
HAND/WRIST SPLINT,79714,CDM,271,RC,S8451,HCPCS,,,facility,outpatient,,,59.20000,56.24000,Amish/Mennonite,Amish Mennonite,,32.56,,,,,,,29.60,57.42,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
KIT GSTRM 20FR 4.5CM SIL MC SLK LOPRFL RCS DIST,79715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,33442.50,66202.50,percent of total billed charges,
SYSTEM AORT VLV H19MM DIA27MM NIT FRME BOV PERICARD DEPTH,79718,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X8MM,79719,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X12MM,79720,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 10MM 130CM ULTRAVERSE 035,79722,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1433.85000,1362.16000,Amish/Mennonite,Amish Mennonite,,788.62,,,,,,,702.59,1390.83,percent of total billed charges,
STENT URET L80CM DIA6FR STR FIRM OPN PERCFLX LUERLOCK ADPT,79723,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1433.85000,1362.16000,Amish/Mennonite,Amish Mennonite,,788.62,,,,,,,658.14,1433.85,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,166.16000,157.85000,Amish/Mennonite,Amish Mennonite,,91.39,,,,,,,81.42,161.18,percent of total billed charges,
CATHETER EP 5MM SPC JSPHSN CRV 6FR 120CM SPRM,79753,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,166.16000,157.85000,Amish/Mennonite,Amish Mennonite,,91.39,,,,,,,76.27,166.16,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L122MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN,79754,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L82MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,79755,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,408.37,percent of total billed charges,
PUNCH BIOPSY SKIN-TECH,79756,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,5271.00,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.25 GM/250 ML PREMIX,79763,CDM,250,RC,J3372,HCPCS,70594005702,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,10.86,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L56MM DIA13MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,79764,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X8MM,79765,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONIX 035,79767,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,,169.78,,,,,,,151.26,299.44,percent of total billed charges,
1.4 MM GUIDE WIRE 150 TROCAR,79768,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,,169.78,,,,,,,141.69,308.70,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
LEAD NEUROSTIM L28CM DIA2.16MM SACR PLEXUS INTERSTIM,79769,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,inpatient,,,8474.00000,8050.30000,Amish/Mennonite,Amish Mennonite,,4660.70,,,,,,,4660.70,8219.78,percent of total billed charges,
EXMOBILE CARDIOVASC TELEMETRY-TECH,79770,CDM,732,RC,93229,CPT,,,facility,outpatient,,,8474.00000,8050.30000,Amish/Mennonite,Amish Mennonite,,4660.70,,,,,,,295.69,8219.78,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,inpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,497.20,876.88,percent of total billed charges,
F18/1MCI AXUMIN,79784,CDM,343,RC,A9588,HCPCS,,,facility,outpatient,,,904.00000,858.80000,Amish/Mennonite,Amish Mennonite,,497.20,,,,,,,268.42,876.88,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,inpatient,,,48.67000,46.24000,Amish/Mennonite,Amish Mennonite,,26.77,,,,,,,26.77,47.21,percent of total billed charges,
"SHORT LEG CAST,PED,PLASTER",79791,CDM,271,RC,Q4039,HCPCS,,,facility,outpatient,,,48.67000,46.24000,Amish/Mennonite,Amish Mennonite,,26.77,,,,,,,11.05,47.21,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,inpatient,,,106.68000,101.35000,Amish/Mennonite,Amish Mennonite,,58.67,,,,,,,58.67,103.48,percent of total billed charges,
"DERMAGRAFT,SQ CM",79799,CDM,636,RC,Q4106,HCPCS,,,facility,outpatient,,,106.68000,101.35000,Amish/Mennonite,Amish Mennonite,,58.67,,,,,,,53.34,103.48,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,inpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
CEFAZOLIN 2 GM/NS 100 ML PREMIX,79800,CDM,250,RC,J0690,HCPCS,70092101803,NDC,facility,outpatient,1,mL,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,1.39,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,inpatient,1,EA,34.59000,32.86000,Amish/Mennonite,Amish Mennonite,,19.02,,,,,,,19.02,33.55,percent of total billed charges,
FLUTICASONE-UMECLIDINIUM-VILANTEROL INHALER 100 MCG-62.5 MCG-25 MCG/INH 14 DOSE,79801,CDM,250,RC,00173-0887-14,NDC,,,facility,outpatient,1,EA,34.59000,32.86000,Amish/Mennonite,Amish Mennonite,,19.02,,,,,,,17.30,33.55,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,inpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,00904-7001-61,NDC,,,facility,outpatient,1,EA,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,60687-0506-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,inpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.17050,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,69238-1313-09,NDC,,,facility,outpatient,1,EA,0.31000,0.29000,Amish/Mennonite,Amish Mennonite,,0.17050,,,,,,,0.15500,0.30070,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,inpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07700,0.13580,percent of total billed charges,
PREGABALIN 100 MG CAP,79810,CDM,250,RC,76282-0571-90,NDC,,,facility,outpatient,1,EA,0.14000,0.13000,Amish/Mennonite,Amish Mennonite,,0.07700,,,,,,,0.07000,0.13580,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,inpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.83,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,00527-3012-48,NDC,,,facility,outpatient,1,EA,5.14000,4.88000,Amish/Mennonite,Amish Mennonite,,2.83,,,,,,,2.57,4.99,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,inpatient,1,EA,15.15000,14.40000,Amish/Mennonite,Amish Mennonite,,8.33,,,,,,,8.33,14.70,percent of total billed charges,
MESALAMINE TAB-EC 1.2 GM,79812,CDM,250,RC,16714-0830-01,NDC,,,facility,outpatient,1,EA,15.15000,14.40000,Amish/Mennonite,Amish Mennonite,,8.33,,,,,,,7.58,14.70,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,inpatient,1,mL,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.73,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-1119-44,NDC,,,facility,outpatient,1,mL,3.14000,2.98000,Amish/Mennonite,Amish Mennonite,,1.73,,,,,,,1.57,3.05,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,inpatient,1,mL,4.46000,4.24000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.45,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,70092-9119-44,NDC,,,facility,outpatient,1,mL,4.46000,4.24000,Amish/Mennonite,Amish Mennonite,,2.45,,,,,,,2.23,4.33,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,inpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,2.08,3.68,percent of total billed charges,
KETAMINE SOLN-INJ 10 MG/ML 5 ML,79817,CDM,250,RC,71266-9080-02,NDC,,,facility,outpatient,1,mL,3.79000,3.60000,Amish/Mennonite,Amish Mennonite,,2.08,,,,,,,1.90,3.68,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,inpatient,1,mL,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.44000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092100736,NDC,facility,outpatient,1,mL,0.80000,0.76000,Amish/Mennonite,Amish Mennonite,,0.44000,,,,,,,0.40000,0.77600,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,inpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.28600,0.50440,percent of total billed charges,
DILTIAZEM 125 MG/D5W 125 ML PREMIX,79821,CDM,250,RC,J3490,HCPCS,70092157536,NDC,facility,outpatient,1,mL,0.52000,0.49000,Amish/Mennonite,Amish Mennonite,,0.28600,,,,,,,0.26000,0.50440,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,inpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,TC,405.35,,,,,,,405.35,714.89,percent of total billed charges,
ELEC STIM FOR GUID W/CHEMODEN-TECH,79827,CDM,922,RC,95873,CPT,,,facility,outpatient,,,737.00000,700.15000,Amish/Mennonite,Amish Mennonite,TC,405.35,,,,,,,368.50,714.89,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,inpatient,1,mL,61.62000,58.54000,Amish/Mennonite,Amish Mennonite,,33.89,,,,,,,33.89,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,17478001502,NDC,facility,outpatient,1,mL,61.62000,58.54000,Amish/Mennonite,Amish Mennonite,,33.89,,,,,,,18.70,59.77,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,inpatient,1,mL,38.30000,36.38000,Amish/Mennonite,Amish Mennonite,,21.07,,,,,,,21.07,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,00641617310,NDC,facility,outpatient,1,mL,38.30000,36.38000,Amish/Mennonite,Amish Mennonite,,21.07,,,,,,,18.70,37.15,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,inpatient,1,mL,132.81000,126.17000,Amish/Mennonite,Amish Mennonite,,73.05,,,,,,,73.05,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,58914008052,NDC,facility,outpatient,1,mL,132.81000,126.17000,Amish/Mennonite,Amish Mennonite,,73.05,,,,,,,18.70,128.83,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,inpatient,1,mL,38.87000,36.92000,Amish/Mennonite,Amish Mennonite,,21.38,,,,,,,21.38,37.70,percent of total billed charges,
DICYCLOMINE SOLN 10 MG/ML 2 ML,79828,CDM,250,RC,J0500,HCPCS,72266012705,NDC,facility,outpatient,1,mL,38.87000,36.92000,Amish/Mennonite,Amish Mennonite,,21.38,,,,,,,18.70,37.70,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,inpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.95700,1.69,percent of total billed charges,
POTASSIUM BICARBONATE 20 MEQ TAB-,79829,CDM,250,RC,51801-0012-30,NDC,,,facility,outpatient,1,EA,1.74000,1.65000,Amish/Mennonite,Amish Mennonite,,0.95700,,,,,,,0.87000,1.69,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,inpatient,1,EA,48.48000,46.06000,Amish/Mennonite,Amish Mennonite,,26.66,,,,,,,26.66,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,00469-2601-30,NDC,,,facility,outpatient,1,EA,48.48000,46.06000,Amish/Mennonite,Amish Mennonite,,26.66,,,,,,,24.24,47.03,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,inpatient,1,EA,41.87000,39.78000,Amish/Mennonite,Amish Mennonite,,23.03,,,,,,,23.03,40.61,percent of total billed charges,
MIRABEGRON TAB-ER 25 MG,79831,CDM,250,RC,68180-0151-06,NDC,,,facility,outpatient,1,EA,41.87000,39.78000,Amish/Mennonite,Amish Mennonite,,23.03,,,,,,,20.93,40.61,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATH GUID JCL RAD 3.5 6 FR,79833,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,50.96,100.88,percent of total billed charges,
INTRO CATH 6FR .025IN 8.5CM RDS POLY ENGAGE TR,79834,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,47.74,104.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X12MM,79835,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X12MM,79836,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X8MM,79837,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,inpatient,,,1740.00000,1653.00000,Amish/Mennonite,Amish Mennonite,,957.00,,,,,,,957.00,1687.80,percent of total billed charges,
US -SCLEROTHERAPY OF A FLUID COLLECTION -TECH,79838,CDM,402,RC,49185,CPT,,,facility,outpatient,,,1740.00000,1653.00000,Amish/Mennonite,Amish Mennonite,,957.00,,,,,,,384.16,1692.33,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 6FR 25CM HDRPH GLIDESHETH 80CM,79839,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,78.95,172.00,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,542.90000,515.76000,Amish/Mennonite,Amish Mennonite,,298.60,,,,,,,298.60,526.61,percent of total billed charges,
AMNIOEXCL+3X3CM,79851,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,542.90000,515.76000,Amish/Mennonite,Amish Mennonite,,298.60,,,,,,,158.39,526.61,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,inpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,48.40,85.36,percent of total billed charges,
INJ OCTAFLUORO MICRO PER ML,79855,CDM,636,RC,Q9956,HCPCS,,,facility,outpatient,,,88.00000,83.60000,Amish/Mennonite,Amish Mennonite,,48.40,,,,,,,44.00,85.36,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,inpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,408.37,percent of total billed charges,
DESTRUCTION LESION,79856,CDM,361,RC,,,,,facility,outpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,,231.55,,,,,,,231.55,5271.00,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,Amish/Mennonite,Amish Mennonite,,1127.12,,,,,,,1127.12,1987.82,percent of total billed charges,
NM PET DETECTNET PER DOSE,79857,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,Amish/Mennonite,Amish Mennonite,,1127.12,,,,,,,595.10,1987.82,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,1032.93,2044.79,percent of total billed charges,
CATHETER BLNDIL 16MM 100CM TSHK II 4CM LOPRFL,79858,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2108.03000,2002.63000,Amish/Mennonite,Amish Mennonite,,1159.42,,,,,,,967.59,2108.03,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA10MM 0.035IN GWIRE NEST,79859,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,199.27,434.14,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,212.73,421.12,percent of total billed charges,
COIL EMB L20CM DIA12MM 0.035IN GWIRE NEST,79860,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,434.14000,412.43000,Amish/Mennonite,Amish Mennonite,,238.78,,,,,,,199.27,434.14,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X100X130,79861,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X12MM,79862,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X8MM,79863,CDM,275,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,236.44,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,inpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.65,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,00904-7002-61,NDC,,,facility,outpatient,1,EA,3.00000,2.85000,Amish/Mennonite,Amish Mennonite,,1.65,,,,,,,1.50,2.91,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,inpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,43598-0295-66,NDC,,,facility,outpatient,1,EA,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,2.14,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,inpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.34,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,60687-0517-01,NDC,,,facility,outpatient,1,EA,4.26000,4.04000,Amish/Mennonite,Amish Mennonite,,2.34,,,,,,,2.13,4.13,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,inpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.17600,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,69238-1314-09,NDC,,,facility,outpatient,1,EA,0.32000,0.30000,Amish/Mennonite,Amish Mennonite,,0.17600,,,,,,,0.16000,0.31040,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,inpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.12650,0.22310,percent of total billed charges,
PREGABALIN 150 MG CAP,79865,CDM,250,RC,72205-0015-90,NDC,,,facility,outpatient,1,EA,0.23000,0.22000,Amish/Mennonite,Amish Mennonite,,0.12650,,,,,,,0.11500,0.22310,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,inpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,1.05,1.85,percent of total billed charges,
LACTOBACILLUS RHAMNOSUS GG - POWD,79866,CDM,250,RC,49100-0400-08,NDC,,,facility,outpatient,1,EA,1.91000,1.81000,Amish/Mennonite,Amish Mennonite,,1.05,,,,,,,0.95500,1.85,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,inpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
DEXTROMETHORPHAN-GUAIFENESIN 20 MG-200 MG/10 ML LIQU,79867,CDM,250,RC,63739-0506-10,NDC,,,facility,outpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,0.70810,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,inpatient,1,EA,33.88000,32.19000,Amish/Mennonite,Amish Mennonite,,18.63,,,,,,,18.63,32.86,percent of total billed charges,
UMECLIDINIUM 62.5 MCG,79868,CDM,250,RC,00173-0873-06,NDC,,,facility,outpatient,1,EA,33.88000,32.19000,Amish/Mennonite,Amish Mennonite,,18.63,,,,,,,16.94,32.86,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,inpatient,1,mL,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,2.06,3.63,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 15 ML,79869,CDM,250,RC,09958-0346-06,NDC,,,facility,outpatient,1,mL,3.74000,3.55000,Amish/Mennonite,Amish Mennonite,,2.06,,,,,,,1.87,3.63,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,inpatient,1,EA,8541.32000,8114.25000,Amish/Mennonite,Amish Mennonite,,4697.73,,,,,,,4697.73,8285.08,percent of total billed charges,
LEUPROLIDE 15 MG/MONTH POWD,79872,CDM,250,RC,J9217,HCPCS,00074244003,NDC,facility,outpatient,1,EA,8541.32000,8114.25000,Amish/Mennonite,Amish Mennonite,,4697.73,,,,,,,155.42,8285.08,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,inpatient,1,EA,33.71000,32.03000,Amish/Mennonite,Amish Mennonite,,18.54,,,,,,,18.54,32.70,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (PRIVIGEN) 5 GM,79873,CDM,636,RC,J1459,HCPCS,44206043605,NDC,facility,outpatient,1,EA,33.71000,32.03000,Amish/Mennonite,Amish Mennonite,,18.54,,,,,,,16.86,83.21,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1856.25,3273.75,percent of total billed charges,
DILATE  ANAL SPHINCHTER,79874,CDM,361,RC,,,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1856.25,5271.00,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,502.50000,477.38000,Amish/Mennonite,Amish Mennonite,,276.38,,,,,,,246.22,487.43,percent of total billed charges,
INTRODUCER ESCP 8.5FR 5FR 195CM 1,79875,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,502.50000,477.38000,Amish/Mennonite,Amish Mennonite,,276.38,,,,,,,230.65,502.50,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,84.28,166.84,percent of total billed charges,
KIT INTRO .021IN 5FR 25CM HDRPH GLIDESHETH 80CM,79876,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,172.00000,163.40000,Amish/Mennonite,Amish Mennonite,,94.60,,,,,,,78.95,172.00,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35.16000,33.40000,Amish/Mennonite,Amish Mennonite,,19.34,,,,,,,17.23,34.11,percent of total billed charges,
K WIRE 2X150MM TRCR PT SS,79878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35.16000,33.40000,Amish/Mennonite,Amish Mennonite,,19.34,,,,,,,16.14,35.16,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X15MM,79881,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 6MM 130CM ULTRAVERSE 018 CK,79882,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L30CM TARGET VES 4-5MM L VOL DETACH FOR HI FLO,79883,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 750 MG/150 ML PREMIX,79885,CDM,250,RC,J3372,HCPCS,70594005603,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,10.86,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 500 MG/100 ML PREMIX,79886,CDM,250,RC,J3372,HCPCS,70594004103,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,10.86,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,inpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.57200,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1108-36,NDC,,,facility,outpatient,1,mL,1.04000,0.99000,Amish/Mennonite,Amish Mennonite,,0.57200,,,,,,,0.52000,1.01,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-1504-36,NDC,,,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,1.35,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,inpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.71500,1.26,percent of total billed charges,
FENTANYL 2 MCG/ML-ROPIVACAINE 0.2% 100 ML,79887,CDM,250,RC,70092-7108-36,NDC,,,facility,outpatient,1,mL,1.30000,1.23000,Amish/Mennonite,Amish Mennonite,,0.71500,,,,,,,0.65000,1.26,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 2 GM/NS 100 ML PREMIX,79888,CDM,636,RC,J0612,HCPCS,80830236309,NDC,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.06404,1.21,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,inpatient,1,mL,2421.77000,2300.69000,Amish/Mennonite,Amish Mennonite,,1331.97,,,,,,,1331.97,2349.12,percent of total billed charges,
"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNITS/5 ML",79890,CDM,636,RC,J9356,HCPCS,50242007701,NDC,facility,outpatient,1,mL,2421.77000,2300.69000,Amish/Mennonite,Amish Mennonite,,1331.97,,,,,,,62.97,2349.12,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,inpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,TC,2558.05,,,,,,,2558.05,4511.47,percent of total billed charges,
SURF APPL LOW DOSE RATE RADION-TECH,79895,CDM,342,RC,77789,CPT,,,facility,outpatient,,,4651.00000,4418.45000,Amish/Mennonite,Amish Mennonite,TC,2558.05,,,,,,,380.83,4511.47,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,90,72.60,,,,,,,72.60,128.04,percent of total billed charges,
"INFLUENZA, EACH SO",79902,CDM,300,RC,86710,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,90,72.60,,,,,,,14.00,713.01,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,inpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,90,64.35,,,,,,,64.35,113.49,percent of total billed charges,
IMMUNODIFFUS SO,79903,CDM,300,RC,86331,CPT,,,facility,outpatient,,,117.00000,111.15000,Amish/Mennonite,Amish Mennonite,90,64.35,,,,,,,12.38,628.12,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,inpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,90,31.35,,,,,,,31.35,55.29,percent of total billed charges,
IMMUNE COMPLEX ASSAY SO,79904,CDM,300,RC,86632,CPT,,,facility,outpatient,,,57.00000,54.15000,Amish/Mennonite,Amish Mennonite,90,31.35,,,,,,,8.17,662.12,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,inpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,90,72.60,,,,,,,72.60,128.04,percent of total billed charges,
AUTOIMUN DYS SO,79905,CDM,300,RC,83519,CPT,,,facility,outpatient,,,132.00000,125.40000,Amish/Mennonite,Amish Mennonite,90,72.60,,,,,,,19.00,865.84,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,90,69.85,,,,,,,69.85,123.19,percent of total billed charges,
AUTOIMUN DYST IMMUN QNT SO,79906,CDM,300,RC,83520,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,90,69.85,,,,,,,17.85,814.87,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,inpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,90,87.78,,,,,,,87.78,154.81,percent of total billed charges,
AUTOIMUN DYST ISLET AB SO,79907,CDM,300,RC,86341,CPT,,,facility,outpatient,,,159.60000,151.62000,Amish/Mennonite,Amish Mennonite,90,87.78,,,,,,,19.88,1103.49,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,90,64.90,,,,,,,64.90,114.46,percent of total billed charges,
AUTOIM DYST SO,79908,CDM,300,RC,86255,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,90,64.90,,,,,,,12.45,1539.22,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,inpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.85,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00054-0400-13,NDC,,,facility,outpatient,1,EA,3.36000,3.19000,Amish/Mennonite,Amish Mennonite,,1.85,,,,,,,1.68,3.26,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,inpatient,1,EA,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.69,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,00591-3659-30,NDC,,,facility,outpatient,1,EA,3.08000,2.93000,Amish/Mennonite,Amish Mennonite,,1.69,,,,,,,1.54,2.99,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,inpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.32,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-33,NDC,,,facility,outpatient,1,EA,2.40000,2.28000,Amish/Mennonite,Amish Mennonite,,1.32,,,,,,,1.20,2.33,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,inpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.31,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,51991-0311-90,NDC,,,facility,outpatient,1,EA,2.39000,2.27000,Amish/Mennonite,Amish Mennonite,,1.31,,,,,,,1.20,2.32,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,inpatient,1,EA,6.77000,6.43000,Amish/Mennonite,Amish Mennonite,,3.72,,,,,,,3.72,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,60687-0607-21,NDC,,,facility,outpatient,1,EA,6.77000,6.43000,Amish/Mennonite,Amish Mennonite,,3.72,,,,,,,3.38,6.57,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,inpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.77,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,70436-0012-04,NDC,,,facility,outpatient,1,EA,3.22000,3.06000,Amish/Mennonite,Amish Mennonite,,1.77,,,,,,,1.61,3.12,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,inpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-30,NDC,,,facility,outpatient,1,EA,1.53000,1.46000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.76500,1.48,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,inpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.81400,1.44,percent of total billed charges,
DESVENLAFAXINE TAB-ER 50 MG,79909,CDM,250,RC,72888-0143-90,NDC,,,facility,outpatient,1,EA,1.48000,1.41000,Amish/Mennonite,Amish Mennonite,,0.81400,,,,,,,0.74000,1.44,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1012.50000,961.88000,Amish/Mennonite,Amish Mennonite,,556.88,,,,,,,496.12,982.12,percent of total billed charges,
CATHETER EP 6FR L110CM SPC 2-5-2MM M CRV.,79913,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1012.50000,961.88000,Amish/Mennonite,Amish Mennonite,,556.88,,,,,,,464.74,1012.50,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
CATHETER PACE 5FR L110CM ELECTRD SPC 1 FLX,79914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,91.23,198.75,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 6FR L10CM MINI GWIRE L45CM,79915,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X6MM,79919,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X10MM,79920,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X20MM,79921,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X20MM,79922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM UNCONSTRAINED DIA8-6MM DEL SYS L136CM,79923,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3246.28,7072.50,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,266.25000,252.94000,Amish/Mennonite,Amish Mennonite,,146.44,,,,,,,130.46,258.26,percent of total billed charges,
GUIDEWIRE PERIPH 145CM STD HI TORQ VERSACORE,79924,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,266.25000,252.94000,Amish/Mennonite,Amish Mennonite,,146.44,,,,,,,122.21,266.25,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,220.50,436.50,percent of total billed charges,
GUIDEWIRE VASC L300CM STD HI TORQ VERSACORE,79925,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,450.00000,427.50000,Amish/Mennonite,Amish Mennonite,,247.50,,,,,,,206.55,450.00,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,25.48,50.44,percent of total billed charges,
GWIRE VASC L260CM DIA0.035IN RAD 3MM J TIP,79926,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,23.87,52.00,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 2 MG/0.1 ML,79927,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,17.64,34.92,percent of total billed charges,
GWIRE VASC L150CM DIA0.035IN J RAD 3MM FLX,79928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,16.52,36.00,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,45.08,89.24,percent of total billed charges,
SHEATH INTRO AD 10FR L25CM DIL L2.5CM COR,79929,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,42.23,92.00,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,Amish/Mennonite,Amish Mennonite,,515.62,,,,,,,459.38,909.38,percent of total billed charges,
GWIRE TRACE STR .035X450CM,79932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,Amish/Mennonite,Amish Mennonite,,515.62,,,,,,,430.31,937.50,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO AD 5FR L10CM DIL L2.5CM GWIRE,79933,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,inpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.68750,1.21,percent of total billed charges,
CALCIUM GLUCONATE 1 GM/NS 50 ML PREMIX,79935,CDM,250,RC,J0613,HCPCS,44567062024,NDC,facility,outpatient,1,mL,1.25000,1.19000,Amish/Mennonite,Amish Mennonite,,0.68750,,,,,,,0.11780,1.21,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,inpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,70092109436,NDC,facility,outpatient,1,mL,0.68000,0.65000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,inpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
FENTANYL PCA 20 MCG/ML 100 ML PREMIX,79936,CDM,250,RC,J3490,HCPCS,71266504001,NDC,facility,outpatient,1,mL,0.72000,0.68000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,inpatient,1,mL,1373.47000,1304.79000,Amish/Mennonite,Amish Mennonite,,755.41,,,,,,,755.41,1332.27,percent of total billed charges,
ATEZOLIZUMAB 840 MG/14 ML SOLN,79937,CDM,636,RC,J9022,HCPCS,50242091801,NDC,facility,outpatient,1,mL,1373.47000,1304.79000,Amish/Mennonite,Amish Mennonite,,755.41,,,,,,,91.02,1332.27,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,inpatient,1,mL,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,2.01,3.55,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,00944049304,NDC,facility,outpatient,1,mL,3.66000,3.47000,Amish/Mennonite,Amish Mennonite,,2.01,,,,,,,1.83,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,inpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.60,2.82,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,0094404930200050,NDC,facility,outpatient,1,mL,2.91000,2.76000,Amish/Mennonite,Amish Mennonite,,1.60,,,,,,,1.46,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,inpatient,1,mL,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.53,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,44206025110,NDC,facility,outpatient,1,mL,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.30,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,inpatient,1,mL,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521602,NDC,facility,outpatient,1,mL,2.94000,2.80000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,inpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.85,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68516521608,NDC,facility,outpatient,1,mL,2.94000,2.79000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.47,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,inpatient,1,mL,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.36,2.41,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,68982064302,NDC,facility,outpatient,1,mL,2.48000,2.36000,Amish/Mennonite,Amish Mennonite,,1.36,,,,,,,1.24,35.24,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,inpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.22,2.14,percent of total billed charges,
ALBUMIN HUMAN SOLN 25% 100 ML,79938,CDM,636,RC,P9046,HCPCS,76125079210,NDC,facility,outpatient,1,mL,2.21000,2.10000,Amish/Mennonite,Amish Mennonite,,1.22,,,,,,,1.10,35.24,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,inpatient,,,49.36000,46.89000,Amish/Mennonite,Amish Mennonite,,27.15,,,,,,,27.15,47.88,percent of total billed charges,
AERO/OPTI CHAMBER,79944,CDM,271,RC,A4627,HCPCS,,,facility,outpatient,,,49.36000,46.89000,Amish/Mennonite,Amish Mennonite,,27.15,,,,,,,24.68,47.88,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,352.50000,334.88000,Amish/Mennonite,Amish Mennonite,,193.88,,,,,,,193.88,341.93,percent of total billed charges,
AMT MINI ONE BUTTON,79945,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,352.50000,334.88000,Amish/Mennonite,Amish Mennonite,,193.88,,,,,,,47.62,341.93,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,inpatient,,,261.94000,248.84000,Amish/Mennonite,Amish Mennonite,,144.07,,,,,,,128.35,254.08,percent of total billed charges,
ADV ATTACHMENT MED/LAT PULL CS,79946,CDM,274,RC,L2800,HCPCS,,,facility,outpatient,,,261.94000,248.84000,Amish/Mennonite,Amish Mennonite,,144.07,,,,,,,130.34,254.08,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,inpatient,,,245.10000,232.84000,Amish/Mennonite,Amish Mennonite,RR,134.81,,,,,,,134.81,237.75,percent of total billed charges,
AMBIT PCA PUMP,79955,CDM,271,RC,E0781,HCPCS,,,facility,outpatient,,,245.10000,232.84000,Amish/Mennonite,Amish Mennonite,RR,134.81,,,,,,,122.55,346.38,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,inpatient,,,228.95000,217.50000,Amish/Mennonite,Amish Mennonite,RR,125.92,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP RENTAL -MONTHLY,79958,CDM,291,RC,E0470,HCPCS,,,facility,outpatient,,,228.95000,217.50000,Amish/Mennonite,Amish Mennonite,RR,125.92,,,,,,,114.47,242.15,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,inpatient,,,52.36000,49.74000,Amish/Mennonite,Amish Mennonite,,28.80,,,,,,,28.80,50.79,percent of total billed charges,
CHIN STRAP,79959,CDM,272,RC,A7036,HCPCS,,,facility,outpatient,,,52.36000,49.74000,Amish/Mennonite,Amish Mennonite,,28.80,,,,,,,26.18,50.79,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,Amish/Mennonite,Amish Mennonite,UE,1679.42,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,USED EQUIP",79960,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,Amish/Mennonite,Amish Mennonite,UE,1679.42,,,,,,,1526.74,2961.89,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,inpatient,,,6.24000,5.93000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,3.43,6.05,percent of total billed charges,
COMPRILAN COMP BNDG,79964,CDM,272,RC,A6443,HCPCS,,,facility,outpatient,,,6.24000,5.93000,Amish/Mennonite,Amish Mennonite,,3.43,,,,,,,0.41800,6.05,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,,684.19,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,USED EQ-MEDICAID",79965,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,,684.19,,,,,,,621.99,1206.66,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,inpatient,,,515.78000,489.99000,Amish/Mennonite,Amish Mennonite,RR,283.68,,,,,,,283.68,500.31,percent of total billed charges,
BIPAP W/B-UP-RENTAL,79969,CDM,291,RC,E0471,HCPCS,,,facility,outpatient,,,515.78000,489.99000,Amish/Mennonite,Amish Mennonite,RR,283.68,,,,,,,257.89,545.53,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,NU,684.19,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,NEW EQUIP",79971,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,NU,684.19,,,,,,,621.99,1206.66,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,50.82,89.63,percent of total billed charges,
CUNNINGHAM CLAMP,79972,CDM,272,RC,A4356,HCPCS,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,46.20,89.63,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,228.95000,217.50000,Amish/Mennonite,Amish Mennonite,,125.92,,,,,,,125.92,222.08,percent of total billed charges,
BIPAP W/O HUMIDIFIER TEMP RENT,79973,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,228.95000,217.50000,Amish/Mennonite,Amish Mennonite,,125.92,,,,,,,114.47,222.08,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,60.76000,57.72000,Amish/Mennonite,Amish Mennonite,,33.42,,,,,,,33.42,58.94,percent of total billed charges,
CRAD FT/ARM POSI,79974,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,60.76000,57.72000,Amish/Mennonite,Amish Mennonite,,33.42,,,,,,,30.38,58.94,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,,684.19,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCH,NEW EQUIP-MEDICAID",79976,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,,684.19,,,,,,,621.99,1206.66,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,31.90,56.26,percent of total billed charges,
"CUSH NASAL MASK INTERFACE,REPL",79980,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,58.00000,55.10000,Amish/Mennonite,Amish Mennonite,,31.90,,,,,,,29.00,56.26,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,inpatient,,,69.72000,66.23000,Amish/Mennonite,Amish Mennonite,NU,38.35,,,,,,,38.35,67.63,percent of total billed charges,
"CANE,QUAD OR 3 PRONG,ALL MATLS",79982,CDM,271,RC,E0105,HCPCS,,,facility,outpatient,,,69.72000,66.23000,Amish/Mennonite,Amish Mennonite,NU,38.35,,,,,,,34.86,74.36,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,inpatient,,,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.40,4.23,percent of total billed charges,
"EXT DRN TUBING,ANY TYP,ANY LNG",79983,CDM,272,RC,A4331,HCPCS,,,facility,outpatient,,,4.36000,4.14000,Amish/Mennonite,Amish Mennonite,,2.40,,,,,,,2.18,5.11,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,inpatient,,,51.33000,48.76000,Amish/Mennonite,Amish Mennonite,,28.23,,,,,,,28.23,49.79,percent of total billed charges,
"DIAB,DIR FORM,PREFAB,PER SHOE",79989,CDM,272,RC,A5510,HCPCS,,,facility,outpatient,,,51.33000,48.76000,Amish/Mennonite,Amish Mennonite,,28.23,,,,,,,25.66,49.79,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,inpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,163.90,289.06,percent of total billed charges,
FULL FACE MASK,79990,CDM,271,RC,A7030,HCPCS,,,facility,outpatient,,,298.00000,283.10000,Amish/Mennonite,Amish Mennonite,,163.90,,,,,,,149.00,289.06,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,Amish/Mennonite,Amish Mennonite,UE,3784.10,,,,,,,3784.10,6673.78,percent of total billed charges,
BIPAP W/B-UP PURCH-USED EQUIP,79991,CDM,271,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,Amish/Mennonite,Amish Mennonite,UE,3784.10,,,,,,,3440.09,6673.78,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,inpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,NU,53.35,,,,,,,53.35,94.09,percent of total billed charges,
"FACE MASK INTERFACE,REPL ONLY",79992,CDM,272,RC,A7031,HCPCS,,,facility,outpatient,,,97.00000,92.15000,Amish/Mennonite,Amish Mennonite,NU,53.35,,,,,,,43.58,94.09,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,inpatient,,,6.80000,6.46000,Amish/Mennonite,Amish Mennonite,,3.74,,,,,,,3.74,6.60,percent of total billed charges,
"FILTER,NONDISPOSABLE",79993,CDM,272,RC,A7039,HCPCS,,,facility,outpatient,,,6.80000,6.46000,Amish/Mennonite,Amish Mennonite,,3.74,,,,,,,3.40,6.60,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,inpatient,,,3053.49000,2900.82000,Amish/Mennonite,Amish Mennonite,NU,1679.42,,,,,,,1679.42,2961.89,percent of total billed charges,
"BIPAP PURCHASE,NEW EQUIP",79996,CDM,271,RC,E0470,HCPCS,,,facility,outpatient,,,3053.49000,2900.82000,Amish/Mennonite,Amish Mennonite,NU,1679.42,,,,,,,1526.74,2961.89,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,37.24,73.72,percent of total billed charges,
GARTER BELT,79999,CDM,274,RC,A6544,HCPCS,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,34.88,73.72,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,inpatient,,,920.00000,874.00000,Amish/Mennonite,Amish Mennonite,,506.00,,,,,,,506.00,892.40,percent of total billed charges,
"HELMET,PROTEC,SOFT,CUST FABRIC",80003,CDM,271,RC,A8002,HCPCS,,,facility,outpatient,,,920.00000,874.00000,Amish/Mennonite,Amish Mennonite,,506.00,,,,,,,460.00,892.40,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,,203.82,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,USED-MEDICAID",80007,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,,203.82,,,,,,,185.29,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,NU,203.82,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE,NEW EQUIP",80008,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,NU,203.82,,,,,,,177.13,359.46,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.22000,0.38800,percent of total billed charges,
EXTRA-RIGID THERAPEUTIC TAPE,80010,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,0.40000,0.38000,Amish/Mennonite,Amish Mennonite,,0.22000,,,,,,,0.20000,0.38800,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,121.07000,115.02000,Amish/Mennonite,Amish Mennonite,,66.59,,,,,,,66.59,117.44,percent of total billed charges,
CPAP UNIT/HUMIDIFIER TEMP RENT,80013,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,121.07000,115.02000,Amish/Mennonite,Amish Mennonite,,66.59,,,,,,,60.53,117.44,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
"HUMIDIFIER CHAMBER,CLEANABLE",80014,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,30.00,58.20,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,inpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,7.33,12.93,percent of total billed charges,
"HYDROGEL DRS,16 SQ.IN. OR LESS",80017,CDM,272,RC,A6242,HCPCS,,,facility,outpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,6.67,12.93,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,inpatient,,,336.75000,319.91000,Amish/Mennonite,Amish Mennonite,NU,185.21,,,,,,,185.21,326.65,percent of total billed charges,
HEAVY DUTY WALKER W/O WHEELS,80018,CDM,271,RC,E0148,HCPCS,,,facility,outpatient,,,336.75000,319.91000,Amish/Mennonite,Amish Mennonite,NU,185.21,,,,,,,114.55,326.65,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,inpatient,,,30.40000,28.88000,Amish/Mennonite,Amish Mennonite,,16.72,,,,,,,16.72,29.49,percent of total billed charges,
"INDWELLING CATH,FOLEY;3-WAY",80019,CDM,272,RC,A4346,HCPCS,,,facility,outpatient,,,30.40000,28.88000,Amish/Mennonite,Amish Mennonite,,16.72,,,,,,,15.20,31.25,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,,203.82,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER PURCH,NEW-MEDICAID",80023,CDM,271,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,,203.82,,,,,,,185.29,359.46,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,inpatient,,,30380.00000,28861.00000,Amish/Mennonite,Amish Mennonite,NU,16709.00,,,,,,,14886.20,29468.60,percent of total billed charges,
"INFUS PUMP,IMPL,PROG,NEW PURCH",80028,CDM,278,RC,E0783,HCPCS,,,facility,outpatient,,,30380.00000,28861.00000,Amish/Mennonite,Amish Mennonite,NU,16709.00,,,,,,,12765.57,30380.00,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,93.29000,88.63000,Amish/Mennonite,Amish Mennonite,,51.31,,,,,,,51.31,90.49,percent of total billed charges,
CPAP UNIT W/O HUMIDIF TEMP RNT,80029,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,93.29000,88.63000,Amish/Mennonite,Amish Mennonite,,51.31,,,,,,,46.65,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,inpatient,,,93.29000,88.63000,Amish/Mennonite,Amish Mennonite,RR,51.31,,,,,,,51.31,90.49,percent of total billed charges,
CPAP RENTAL MONTHLY,80030,CDM,291,RC,E0601,HCPCS,,,facility,outpatient,,,93.29000,88.63000,Amish/Mennonite,Amish Mennonite,RR,51.31,,,,,,,46.65,98.67,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,inpatient,,,6880.19000,6536.18000,Amish/Mennonite,Amish Mennonite,,3784.10,,,,,,,3784.10,6673.78,percent of total billed charges,
"BIPAP PURCH,USED EQ(MEDICAID)",80031,CDM,290,RC,E0471,HCPCS,,,facility,outpatient,,,6880.19000,6536.18000,Amish/Mennonite,Amish Mennonite,,3784.10,,,,,,,3440.09,6673.78,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,inpatient,,,12.13000,11.52000,Amish/Mennonite,Amish Mennonite,,6.67,,,,,,,6.67,11.77,percent of total billed charges,
"LEG STRAP,FOAM/FABRIC,PER SET",80034,CDM,272,RC,A5114,HCPCS,,,facility,outpatient,,,12.13000,11.52000,Amish/Mennonite,Amish Mennonite,,6.67,,,,,,,6.07,12.52,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,inpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,UE,684.19,,,,,,,684.19,1206.66,percent of total billed charges,
"CPAP PURCHASE,USED EQUIP",80040,CDM,271,RC,E0601,HCPCS,,,facility,outpatient,,,1243.98000,1181.78000,Amish/Mennonite,Amish Mennonite,UE,684.19,,,,,,,621.99,1206.66,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,inpatient,,,33.36000,31.69000,Amish/Mennonite,Amish Mennonite,,18.35,,,,,,,18.35,32.36,percent of total billed charges,
INDWELL CATHETER;SPEC TYPE,80041,CDM,272,RC,A4340,HCPCS,,,facility,outpatient,,,33.36000,31.69000,Amish/Mennonite,Amish Mennonite,,18.35,,,,,,,16.68,51.01,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,inpatient,,,217.88000,206.99000,Amish/Mennonite,Amish Mennonite,NU,119.83,,,,,,,119.83,211.34,percent of total billed charges,
"DAYS FOREARM CRUTCHES,PAIR",80043,CDM,271,RC,E0110,HCPCS,,,facility,outpatient,,,217.88000,206.99000,Amish/Mennonite,Amish Mennonite,NU,119.83,,,,,,,108.94,211.34,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,inpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,,6.60,,,,,,,6.60,11.64,percent of total billed charges,
INSERT TRAY W/O DRN BAG/CATH,80045,CDM,272,RC,A4310,HCPCS,,,facility,outpatient,,,12.00000,11.40000,Amish/Mennonite,Amish Mennonite,,6.60,,,,,,,6.00,12.41,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,40.13000,38.12000,Amish/Mennonite,Amish Mennonite,NU,22.07,,,,,,,22.07,38.93,percent of total billed charges,
INVACARE WALKER SEAT COMBO,80046,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,40.13000,38.12000,Amish/Mennonite,Amish Mennonite,NU,22.07,,,,,,,20.07,38.93,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,inpatient,,,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,9.69,19.18,percent of total billed charges,
"CPAP LABOR,PER 15 MINUTE UNIT",80051,CDM,274,RC,K0739,HCPCS,,,facility,outpatient,,,19.77000,18.78000,Amish/Mennonite,Amish Mennonite,,10.87,,,,,,,9.88,22.52,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,inpatient,,,80.09000,76.09000,Amish/Mennonite,Amish Mennonite,NU,44.05,,,,,,,44.05,77.69,percent of total billed charges,
"CANE,OF ALL MATLS,ADJUST/FIXED",80053,CDM,271,RC,E0100,HCPCS,,,facility,outpatient,,,80.09000,76.09000,Amish/Mennonite,Amish Mennonite,NU,44.05,,,,,,,28.30,77.69,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,256.72000,243.88000,Amish/Mennonite,Amish Mennonite,,141.20,,,,,,,141.20,249.02,percent of total billed charges,
BIPAP/HUMIDIFIER TEMP RENTAL,80056,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,256.72000,243.88000,Amish/Mennonite,Amish Mennonite,,141.20,,,,,,,128.36,249.02,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,inpatient,,,575.26000,546.50000,Amish/Mennonite,Amish Mennonite,,316.39,,,,,,,316.39,558.00,percent of total billed charges,
"DIAB,SHOE MOLDED FROM CAST,FT",80058,CDM,272,RC,A5501,HCPCS,,,facility,outpatient,,,575.26000,546.50000,Amish/Mennonite,Amish Mennonite,,316.39,,,,,,,286.24,558.00,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,inpatient,,,27.78000,26.39000,Amish/Mennonite,Amish Mennonite,,15.28,,,,,,,15.28,26.95,percent of total billed charges,
HEATED HUMIDIFIER TEMP RENT,80059,CDM,291,RC,K0462,HCPCS,,,facility,outpatient,,,27.78000,26.39000,Amish/Mennonite,Amish Mennonite,,15.28,,,,,,,13.89,26.95,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,45.73000,43.44000,Amish/Mennonite,Amish Mennonite,,25.15,,,,,,,25.15,44.36,percent of total billed charges,
MEDIHONEY PASTE 1.5 OZ,80060,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,45.73000,43.44000,Amish/Mennonite,Amish Mennonite,,25.15,,,,,,,22.86,44.36,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,85.52000,81.24000,Amish/Mennonite,Amish Mennonite,NU,47.04,,,,,,,47.04,82.95,percent of total billed charges,
HEMI WALKER,80061,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,85.52000,81.24000,Amish/Mennonite,Amish Mennonite,NU,47.04,,,,,,,42.76,86.57,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,inpatient,,,938.00000,891.10000,Amish/Mennonite,Amish Mennonite,NU,515.90,,,,,,,515.90,909.86,percent of total billed charges,
APEX M BLADDER TRTMT DEVICE,80066,CDM,271,RC,E0740,HCPCS,,,facility,outpatient,,,938.00000,891.10000,Amish/Mennonite,Amish Mennonite,NU,515.90,,,,,,,469.00,909.86,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,inpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,7.33,12.93,percent of total billed charges,
"MALE EXT CATH,DISP",80069,CDM,272,RC,A4349,HCPCS,,,facility,outpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,3.01,12.93,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,107.80,190.12,percent of total billed charges,
MED PED WISP CUSHION,80071,CDM,272,RC,A7032,HCPCS,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,98.00,190.12,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,inpatient,,,197.20000,187.34000,Amish/Mennonite,Amish Mennonite,,108.46,,,,,,,96.63,191.28,percent of total billed charges,
NONCORROSIVE FINISH,80072,CDM,274,RC,L2780,HCPCS,,,facility,outpatient,,,197.20000,187.34000,Amish/Mennonite,Amish Mennonite,,108.46,,,,,,,81.91,191.28,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,inpatient,,,27.78000,26.39000,Amish/Mennonite,Amish Mennonite,RR,15.28,,,,,,,15.28,26.95,percent of total billed charges,
HUMIDIFIER RENTAL-MONTHLY,80073,CDM,291,RC,E0562,HCPCS,,,facility,outpatient,,,27.78000,26.39000,Amish/Mennonite,Amish Mennonite,RR,15.28,,,,,,,13.89,29.38,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,inpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,7.33,12.93,percent of total billed charges,
"MICROFOAM TAPE 1"" X 5.5 YD",80074,CDM,272,RC,A4450,HCPCS,,,facility,outpatient,,,13.33000,12.66000,Amish/Mennonite,Amish Mennonite,,7.33,,,,,,,6.67,12.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,inpatient,,,352.50000,334.88000,Amish/Mennonite,Amish Mennonite,,193.88,,,,,,,193.88,341.93,percent of total billed charges,
ORAL/NASAL MASK,80079,CDM,271,RC,A7027,HCPCS,,,facility,outpatient,,,352.50000,334.88000,Amish/Mennonite,Amish Mennonite,,193.88,,,,,,,176.25,341.93,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,inpatient,,,40.53000,38.50000,Amish/Mennonite,Amish Mennonite,,22.29,,,,,,,22.29,39.31,percent of total billed charges,
"MULT DENSITY INS,FOR DIAB ONLY",80081,CDM,272,RC,A5512,HCPCS,,,facility,outpatient,,,40.53000,38.50000,Amish/Mennonite,Amish Mennonite,,22.29,,,,,,,20.27,41.68,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,inpatient,,,3400.00000,3230.00000,Amish/Mennonite,Amish Mennonite,,1870.00,,,,,,,1870.00,3298.00,percent of total billed charges,
ORL DEVC/APPL RED UP AIRWAY CO,80082,CDM,271,RC,E0486,HCPCS,,,facility,outpatient,,,3400.00000,3230.00000,Amish/Mennonite,Amish Mennonite,,1870.00,,,,,,,1700.00,3298.00,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,inpatient,,,382.22000,363.11000,Amish/Mennonite,Amish Mennonite,,210.22,,,,,,,187.29,370.75,percent of total billed charges,
"ORTH  LE ADDN,KNEE,H-D JT,EA",80084,CDM,274,RC,L2385,HCPCS,,,facility,outpatient,,,382.22000,363.11000,Amish/Mennonite,Amish Mennonite,,210.22,,,,,,,190.18,370.75,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,inpatient,,,51.87000,49.28000,Amish/Mennonite,Amish Mennonite,,28.53,,,,,,,28.53,50.31,percent of total billed charges,
MORGAN LENS,80085,CDM,271,RC,V2797,HCPCS,,,facility,outpatient,,,51.87000,49.28000,Amish/Mennonite,Amish Mennonite,,28.53,,,,,,,25.93,50.31,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,17.60,31.04,percent of total billed charges,
"NASAL PILLOWS,REPL ONLY,PAIR",80086,CDM,271,RC,A7029,HCPCS,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,16.00,31.04,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,,259.88,,,,,,,259.88,458.32,percent of total billed charges,
ORION WARRANTED LENS,80088,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,472.50000,448.88000,Amish/Mennonite,Amish Mennonite,,259.88,,,,,,,236.25,751.69,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,inpatient,,,107.52000,102.14000,Amish/Mennonite,Amish Mennonite,,59.14,,,,,,,52.68,104.29,percent of total billed charges,
"ORTH  FOOT,SPENCO",80089,CDM,274,RC,L3001,HCPCS,,,facility,outpatient,,,107.52000,102.14000,Amish/Mennonite,Amish Mennonite,,59.14,,,,,,,53.76,183.28,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.93,5.17,percent of total billed charges,
PEDIFX SILCN TAPE,80090,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,5.33000,5.06000,Amish/Mennonite,Amish Mennonite,,2.93,,,,,,,2.67,5.17,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,inpatient,,,305.06000,289.81000,Amish/Mennonite,Amish Mennonite,,167.78,,,,,,,149.48,295.91,percent of total billed charges,
"ORTH ADDN KNEE JT-LFT,LOOP",80091,CDM,274,RC,L2492,HCPCS,,,facility,outpatient,,,305.06000,289.81000,Amish/Mennonite,Amish Mennonite,,167.78,,,,,,,151.81,295.91,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,inpatient,,,95.96000,91.16000,Amish/Mennonite,Amish Mennonite,,52.78,,,,,,,52.78,93.08,percent of total billed charges,
LUMBAR OR CERV ROLL,80093,CDM,271,RC,E0190,HCPCS,,,facility,outpatient,,,95.96000,91.16000,Amish/Mennonite,Amish Mennonite,,52.78,,,,,,,47.98,93.08,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,inpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,195.94,345.56,percent of total billed charges,
ORAL CPAP MASK,80094,CDM,272,RC,A7044,HCPCS,,,facility,outpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,178.12,345.56,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,inpatient,,,45.21000,42.95000,Amish/Mennonite,Amish Mennonite,,24.87,,,,,,,24.87,43.85,percent of total billed charges,
"PILLOWS,NASAL CANNULA INTERFAC",80096,CDM,294,RC,A7033,HCPCS,,,facility,outpatient,,,45.21000,42.95000,Amish/Mennonite,Amish Mennonite,,24.87,,,,,,,22.61,43.85,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,436.07000,414.27000,Amish/Mennonite,Amish Mennonite,NU,239.84,,,,,,,239.84,422.99,percent of total billed charges,
"PLATFORM ATT WALKER,UNIVERSAL",80099,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,436.07000,414.27000,Amish/Mennonite,Amish Mennonite,NU,239.84,,,,,,,67.27,422.99,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,inpatient,,,12.40000,11.78000,Amish/Mennonite,Amish Mennonite,,6.82,,,,,,,6.82,12.03,percent of total billed charges,
HYDROCOLLOID DRSG,80100,CDM,272,RC,A6237,HCPCS,,,facility,outpatient,,,12.40000,11.78000,Amish/Mennonite,Amish Mennonite,,6.82,,,,,,,6.20,12.71,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,16.50,29.10,percent of total billed charges,
POWDER DRYLITE,80102,CDM,272,RC,A6250,HCPCS,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,,16.50,,,,,,,15.00,29.10,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,inpatient,,,245.44000,233.17000,Amish/Mennonite,Amish Mennonite,,134.99,,,,,,,120.27,238.08,percent of total billed charges,
"PRSTH  LEOTARDS,EL STCKNG A6541",80103,CDM,274,RC,A6541,HCPCS,,,facility,outpatient,,,245.44000,233.17000,Amish/Mennonite,Amish Mennonite,,134.99,,,,,,,122.72,238.08,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,inpatient,,,2021.78000,1920.69000,Amish/Mennonite,Amish Mennonite,NU,1111.98,,,,,,,1111.98,1961.13,percent of total billed charges,
SAUNDERS HOME CERV TRACT UNIT,80104,CDM,290,RC,E0849,HCPCS,,,facility,outpatient,,,2021.78000,1920.69000,Amish/Mennonite,Amish Mennonite,NU,1111.98,,,,,,,1010.89,1961.13,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,inpatient,,,66.67000,63.34000,Amish/Mennonite,Amish Mennonite,NU,36.67,,,,,,,36.67,64.67,percent of total billed charges,
"SEAT ATTACHMENT,WALKER",80105,CDM,271,RC,E0156,HCPCS,,,facility,outpatient,,,66.67000,63.34000,Amish/Mennonite,Amish Mennonite,NU,36.67,,,,,,,21.38,64.67,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,inpatient,,,3430.67000,3259.14000,Amish/Mennonite,Amish Mennonite,,1886.87,,,,,,,1681.03,3327.75,percent of total billed charges,
"LUMB-SAC ORTH,SAG-COR,CUST",80106,CDM,274,RC,L0638,HCPCS,,,facility,outpatient,,,3430.67000,3259.14000,Amish/Mennonite,Amish Mennonite,,1886.87,,,,,,,1707.07,3327.75,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,inpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,39.60,69.84,percent of total billed charges,
"ORAL CUSHION,REPLACEMENT ONLY",80107,CDM,271,RC,A7028,HCPCS,,,facility,outpatient,,,72.00000,68.40000,Amish/Mennonite,Amish Mennonite,,39.60,,,,,,,36.00,69.84,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,inpatient,,,1941.00000,1843.95000,Amish/Mennonite,Amish Mennonite,,1067.55,,,,,,,951.09,1882.77,percent of total billed charges,
OA SNGL UPRIGHT KNEE BRACE/OTS,80108,CDM,274,RC,L1851,HCPCS,,,facility,outpatient,,,1941.00000,1843.95000,Amish/Mennonite,Amish Mennonite,,1067.55,,,,,,,699.50,1882.77,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,inpatient,,,292.69000,278.06000,Amish/Mennonite,Amish Mennonite,NU,160.98,,,,,,,160.98,283.91,percent of total billed charges,
"PLATFORM ATTACH,WLK",80109,CDM,271,RC,E0154,HCPCS,,,facility,outpatient,,,292.69000,278.06000,Amish/Mennonite,Amish Mennonite,NU,160.98,,,,,,,67.27,283.91,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
SELF-ADH BNDG <3 INCH PER YARD,80110,CDM,272,RC,A6453,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,0.94600,6.47,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,inpatient,,,7.28000,6.92000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,4.00,7.06,percent of total billed charges,
SELF-ADH BNDG >/=3IN AND <5IN,80111,CDM,272,RC,A6454,HCPCS,,,facility,outpatient,,,7.28000,6.92000,Amish/Mennonite,Amish Mennonite,,4.00,,,,,,,1.18,7.06,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,inpatient,,,69.07000,65.62000,Amish/Mennonite,Amish Mennonite,,37.99,,,,,,,33.84,67.00,percent of total billed charges,
"PRSTH  AK,ELASTIC STCKNG A6535",80114,CDM,274,RC,A6535,HCPCS,,,facility,outpatient,,,69.07000,65.62000,Amish/Mennonite,Amish Mennonite,,37.99,,,,,,,34.53,80.76,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,inpatient,,,976.08000,927.28000,Amish/Mennonite,Amish Mennonite,,536.84,,,,,,,478.28,946.80,percent of total billed charges,
"PRSTH  UE ADD,FLEX WRIST",80117,CDM,274,RC,L6620,HCPCS,,,facility,outpatient,,,976.08000,927.28000,Amish/Mennonite,Amish Mennonite,,536.84,,,,,,,485.68,946.80,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,inpatient,,,14.34000,13.62000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,7.89,13.91,percent of total billed charges,
"SPEC ABSORPTIVE DRSG,>16 SQ IN",80120,CDM,272,RC,A6252,HCPCS,,,facility,outpatient,,,14.34000,13.62000,Amish/Mennonite,Amish Mennonite,,7.89,,,,,,,4.88,13.91,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"IRRIGATION SYRINGE,BULB/PISTON",80122,CDM,272,RC,A4322,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,6.47,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,inpatient,,,11.87000,11.28000,Amish/Mennonite,Amish Mennonite,,6.53,,,,,,,6.53,11.51,percent of total billed charges,
POLYMEM 4X4 W/O ADH BORDER,80125,CDM,272,RC,A6209,HCPCS,,,facility,outpatient,,,11.87000,11.28000,Amish/Mennonite,Amish Mennonite,,6.53,,,,,,,5.93,12.01,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,36.30,64.02,percent of total billed charges,
PHARM DISP FEE INH DR;PER 90DY,80127,CDM,636,RC,Q0514,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,33.00,72.60,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.55550,0.97970,percent of total billed charges,
HYPAFIX DRSG RETENTION SHEETS,80129,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.01000,0.96000,Amish/Mennonite,Amish Mennonite,,0.55550,,,,,,,0.50500,0.97970,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,inpatient,,,1219.00000,1158.05000,Amish/Mennonite,Amish Mennonite,,670.45,,,,,,,597.31,1182.43,percent of total billed charges,
STAT/PROG HINGED KNEE BRACE,80135,CDM,274,RC,E1811,HCPCS,,,facility,outpatient,,,1219.00000,1158.05000,Amish/Mennonite,Amish Mennonite,,670.45,,,,,,,559.52,1182.43,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,inpatient,,,20.24000,19.23000,Amish/Mennonite,Amish Mennonite,,11.13,,,,,,,11.13,19.63,percent of total billed charges,
SUREPRESS BANDAGE HIGH COMPR,80139,CDM,272,RC,A6452,HCPCS,,,facility,outpatient,,,20.24000,19.23000,Amish/Mennonite,Amish Mennonite,,11.13,,,,,,,8.86,19.63,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,inpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,44.00,77.60,percent of total billed charges,
STOMA PLUG OR SEAL,80142,CDM,272,RC,A5081,HCPCS,,,facility,outpatient,,,80.00000,76.00000,Amish/Mennonite,Amish Mennonite,,44.00,,,,,,,4.97,77.60,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,NU,56.10,,,,,,,56.10,98.94,percent of total billed charges,
TUBE HEATED ASSEMBLY,80154,CDM,272,RC,A4604,HCPCS,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,NU,56.10,,,,,,,51.00,98.94,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,inpatient,,,916.18000,870.37000,Amish/Mennonite,Amish Mennonite,,503.90,,,,,,,448.93,888.69,percent of total billed charges,
"UE ADDITION,REMOVABLE INSERT",80156,CDM,274,RC,L6691,HCPCS,,,facility,outpatient,,,916.18000,870.37000,Amish/Mennonite,Amish Mennonite,,503.90,,,,,,,455.88,888.69,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,inpatient,,,1431.00000,1359.45000,Amish/Mennonite,Amish Mennonite,,787.05,,,,,,,701.19,1388.07,percent of total billed charges,
"PRSTH  SOCKET INSERT,SYME",80157,CDM,274,RC,L5654,HCPCS,,,facility,outpatient,,,1431.00000,1359.45000,Amish/Mennonite,Amish Mennonite,,787.05,,,,,,,508.43,1388.07,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,inpatient,,,341.25000,324.19000,Amish/Mennonite,Amish Mennonite,,187.69,,,,,,,187.69,331.01,percent of total billed charges,
VALLEY CONTAX WARRANTED LENS,80161,CDM,271,RC,V2531,HCPCS,,,facility,outpatient,,,341.25000,324.19000,Amish/Mennonite,Amish Mennonite,,187.69,,,,,,,170.62,751.69,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,inpatient,,,139.36000,132.39000,Amish/Mennonite,Amish Mennonite,NU,76.65,,,,,,,76.65,135.18,percent of total billed charges,
"WALKER,FLDG,ADJ OR FIXED HEIGH",80163,CDM,272,RC,E0135,HCPCS,,,facility,outpatient,,,139.36000,132.39000,Amish/Mennonite,Amish Mennonite,NU,76.65,,,,,,,63.78,135.18,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,inpatient,,,176.52000,167.69000,Amish/Mennonite,Amish Mennonite,NU,97.09,,,,,,,97.09,171.22,percent of total billed charges,
HIGH FREQUENCY CHEST WALL OSCILLATION SYSTEM EACH E0484,80164,CDM,271,RC,E0484,HCPCS,,,facility,outpatient,,,176.52000,167.69000,Amish/Mennonite,Amish Mennonite,NU,97.09,,,,,,,55.44,171.22,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,inpatient,,,49.62000,47.14000,Amish/Mennonite,Amish Mennonite,NU,27.29,,,,,,,27.29,48.13,percent of total billed charges,
"WHL ATTACH,RIG PICK-UP WLKR AT",80165,CDM,271,RC,E0155,HCPCS,,,facility,outpatient,,,49.62000,47.14000,Amish/Mennonite,Amish Mennonite,NU,27.29,,,,,,,24.81,48.13,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,inpatient,,,364.24000,346.03000,Amish/Mennonite,Amish Mennonite,NU,200.33,,,,,,,200.33,353.31,percent of total billed charges,
"WALKER,HVY DUTY,WHEELED,ANY TY",80166,CDM,271,RC,E0149,HCPCS,,,facility,outpatient,,,364.24000,346.03000,Amish/Mennonite,Amish Mennonite,NU,200.33,,,,,,,182.12,353.31,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,inpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,NU,24.75,,,,,,,24.75,43.65,percent of total billed charges,
WATER CHAMBER,80167,CDM,272,RC,A7046,HCPCS,,,facility,outpatient,,,45.00000,42.75000,Amish/Mennonite,Amish Mennonite,NU,24.75,,,,,,,17.89,43.65,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,inpatient,,,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,,7.15,,,,,,,7.15,12.61,percent of total billed charges,
"SPACER,BAG OR RESERVOIR",80169,CDM,272,RC,A4627,HCPCS,,,facility,outpatient,,,13.00000,12.35000,Amish/Mennonite,Amish Mennonite,,7.15,,,,,,,6.50,12.61,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,inpatient,,,306.75000,291.41000,Amish/Mennonite,Amish Mennonite,NU,168.71,,,,,,,168.71,297.55,percent of total billed charges,
"WALKER,FOLDING,SINGLE BUTTON",80170,CDM,271,RC,E0135,HCPCS,,,facility,outpatient,,,306.75000,291.41000,Amish/Mennonite,Amish Mennonite,NU,168.71,,,,,,,63.78,297.55,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,inpatient,,,7.73000,7.34000,Amish/Mennonite,Amish Mennonite,,4.25,,,,,,,4.25,7.50,percent of total billed charges,
"URIN CATH ANCH DEV,LEG STRAP",80171,CDM,272,RC,A4334,HCPCS,,,facility,outpatient,,,7.73000,7.34000,Amish/Mennonite,Amish Mennonite,,4.25,,,,,,,3.87,7.90,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,inpatient,,,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,4.99,8.80,percent of total billed charges,
"URIN CATH ANCH DEV,ADH SKN ATT",80174,CDM,272,RC,A4333,HCPCS,,,facility,outpatient,,,9.07000,8.62000,Amish/Mennonite,Amish Mennonite,,4.99,,,,,,,3.33,8.80,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,inpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,UE,203.82,,,,,,,203.82,359.46,percent of total billed charges,
"HUMIDIFIER,PURCHASE USED EQUIP",80175,CDM,293,RC,E0562,HCPCS,,,facility,outpatient,,,370.58000,352.05000,Amish/Mennonite,Amish Mennonite,UE,203.82,,,,,,,132.85,359.46,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,inpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,17.60,31.04,percent of total billed charges,
TUBING,80176,CDM,272,RC,A7037,HCPCS,,,facility,outpatient,,,32.00000,30.40000,Amish/Mennonite,Amish Mennonite,,17.60,,,,,,,16.00,31.04,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,inpatient,,,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.97900,1.73,percent of total billed charges,
"KINESIO TEX TAPE,PER 18 SQ CM",80180,CDM,272,RC,A4452,HCPCS,,,facility,outpatient,,,1.78000,1.69000,Amish/Mennonite,Amish Mennonite,,0.97900,,,,,,,0.89000,1.73,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,inpatient,,,6478.28000,6154.37000,Amish/Mennonite,Amish Mennonite,,3563.05,,,,,,,3174.36,6283.93,percent of total billed charges,
WRIST MLD SOCKET FIX HNG TRIPD,80183,CDM,274,RC,L6050,HCPCS,,,facility,outpatient,,,6478.28000,6154.37000,Amish/Mennonite,Amish Mennonite,,3563.05,,,,,,,3223.54,6283.93,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,inpatient,,,461.88000,438.79000,Amish/Mennonite,Amish Mennonite,NU,254.03,,,,,,,254.03,448.02,percent of total billed charges,
"CRUTCHES,FOREARM;PAIR",80185,CDM,272,RC,E0110,HCPCS,,,facility,outpatient,,,461.88000,438.79000,Amish/Mennonite,Amish Mennonite,NU,254.03,,,,,,,116.46,448.02,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,inpatient,1,mL,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.51700,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,00143938010,NDC,facility,outpatient,1,mL,0.94000,0.90000,Amish/Mennonite,Amish Mennonite,,0.51700,,,,,,,0.19995,0.91180,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,44567061110,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.19995,0.92150,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,inpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.47300,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092103036,NDC,facility,outpatient,1,mL,0.86000,0.82000,Amish/Mennonite,Amish Mennonite,,0.47300,,,,,,,0.19995,0.83420,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MIDAZOLAM 100 MG/NS 100 ML PREMIX,80191,CDM,250,RC,J2250,HCPCS,70092141836,NDC,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.19995,0.76630,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,inpatient,1,mL,70.06000,66.56000,Amish/Mennonite,Amish Mennonite,,38.53,,,,,,,38.53,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088510,NDC,facility,outpatient,1,mL,70.06000,66.56000,Amish/Mennonite,Amish Mennonite,,38.53,,,,,,,6.30,67.96,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,inpatient,1,mL,47.36000,44.99000,Amish/Mennonite,Amish Mennonite,,26.05,,,,,,,26.05,45.94,percent of total billed charges,
LEVOTHYROXINE  SOLN 20 MCG/ML 5 ML,80193,CDM,636,RC,J0651,HCPCS,63323088514,NDC,facility,outpatient,1,mL,47.36000,44.99000,Amish/Mennonite,Amish Mennonite,,26.05,,,,,,,6.30,45.94,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,inpatient,,,3725.18000,3538.92000,Amish/Mennonite,Amish Mennonite,,2048.85,,,,,,,1825.34,3613.42,percent of total billed charges,
CLOSUREFAST CF7-7-100/PK/MIS-7,80195,CDM,278,RC,C1886,HCPCS,,,facility,outpatient,,,3725.18000,3538.92000,Amish/Mennonite,Amish Mennonite,,2048.85,,,,,,,1709.86,3725.18,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,inpatient,,,1687.00000,1602.65000,Amish/Mennonite,Amish Mennonite,90,927.85,,,,,,,927.85,1636.39,percent of total billed charges,
"IMMUNOGLOBULIN GENE REARRANGEMENT, V (BCGRV) SO",80196,CDM,310,RC,81264,CPT,,,facility,outpatient,,,1687.00000,1602.65000,Amish/Mennonite,Amish Mennonite,90,927.85,,,,,,,162.98,8131.76,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,inpatient,,,2238.00000,2126.10000,Amish/Mennonite,Amish Mennonite,90,1230.90,,,,,,,1230.90,2170.86,percent of total billed charges,
"IMMUNOGLOBULIN GENE REPLACEMENT, V (BCGRV) #2 SO",80197,CDM,310,RC,81261,CPT,,,facility,outpatient,,,2238.00000,2126.10000,Amish/Mennonite,Amish Mennonite,90,1230.90,,,,,,,204.58,10355.70,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
VANCOMYCIN 1.75 GM/350 ML PREMIX,80199,CDM,250,RC,J3372,HCPCS,70594005802,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,10.86,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,inpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,00404651205,NDC,facility,outpatient,1,mL,0.33000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,inpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.62700,1.11,percent of total billed charges,
"LIDOCAINE-EPI SOLN 2% -1  100,000 1.7 ML (DENTAL CARTRIDGE)",80201,CDM,250,RC,J2004,HCPCS,50227103005,NDC,facility,outpatient,1,mL,1.14000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62700,,,,,,,0.57000,1.11,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 5 MG/0.25 ML,80202,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,inpatient,1,mL,78.08000,74.18000,Amish/Mennonite,Amish Mennonite,,42.94,,,,,,,42.94,75.74,percent of total billed charges,
TRACE ELEMENTS - ADULT,80204,CDM,250,RC,00517-9305-25,NDC,,,facility,outpatient,1,mL,78.08000,74.18000,Amish/Mennonite,Amish Mennonite,,42.94,,,,,,,39.04,75.74,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L39MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,80207,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X8MM,80208,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L120MM DIA4.5MM CATH 6FR L120CM NIT SELF EXPND,80209,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2454.50,5347.50,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN VENT PIG,80210,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L185CM DIA0.014IN TIP L2CM SS,80211,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,405.56000,385.28000,Amish/Mennonite,Amish Mennonite,,223.06,,,,,,,198.72,393.39,percent of total billed charges,
CATH PICC 5FR L55CM GWIRE L70CM 0.018IN.,80212,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,405.56000,385.28000,Amish/Mennonite,Amish Mennonite,,223.06,,,,,,,186.15,405.56,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,67.10,118.34,percent of total billed charges,
SET INTRO .018IN STRG MIC 7FR 21GA 7CM 2.75IN GW,80214,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,122.00000,115.90000,Amish/Mennonite,Amish Mennonite,,67.10,,,,,,,61.00,118.34,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,inpatient,,,779.00000,740.05000,Amish/Mennonite,Amish Mennonite,,428.45,,,,,,,428.45,755.63,percent of total billed charges,
AUTOLOGOUS BLOOD SALVAGE,80222,CDM,309,RC,86891,CPT,,,facility,outpatient,,,779.00000,740.05000,Amish/Mennonite,Amish Mennonite,,428.45,,,,,,,389.50,6858.56,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE 0.4 MG / 1 ML LIQUID,80225,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,inpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,44567-0640-10,NDC,,,facility,outpatient,1,mL,0.47000,0.44000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,0.45590,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,inpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.13200,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1033-05,NDC,,,facility,outpatient,1,mL,0.24000,0.23000,Amish/Mennonite,Amish Mennonite,,0.13200,,,,,,,0.12000,0.23280,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,inpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,70092-1650-05,NDC,,,facility,outpatient,1,mL,0.27000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,inpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
NOREPINEPHRINE 4 MG/NS 250 ML PREMIX,80226,CDM,250,RC,81298-9659-03,NDC,,,facility,outpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.17000,0.32980,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,inpatient,,,1028.00000,976.60000,Amish/Mennonite,Amish Mennonite,,565.40,,,,,,,503.72,997.16,percent of total billed charges,
BRACHYTHER HIGH DOSE,80229,CDM,278,RC,C1717,HCPCS,,,facility,outpatient,,,1028.00000,976.60000,Amish/Mennonite,Amish Mennonite,,565.40,,,,,,,325.11,1028.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 2.0X15MM,80231,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,inpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,TC,785.40,,,,,,,785.40,1385.16,percent of total billed charges,
ANGIOGRAPHY PULMONARY NONSELECTIVE CATH-TECH,80233,CDM,320,RC,75746,CPT,,,facility,outpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,TC,785.40,,,,,,,463.75,17311.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X15MM,80234,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1755.00000,1667.25000,Amish/Mennonite,Amish Mennonite,,965.25,,,,,,,859.95,1702.35,percent of total billed charges,
INTRODUCER LAT VEIN L62CM OD5.5FR ADV TELSCP,80235,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1755.00000,1667.25000,Amish/Mennonite,Amish Mennonite,,965.25,,,,,,,805.54,1755.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X12MM,80236,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X15MM,80237,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X20MM,80238,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X15MM,80239,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X12MM,80240,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X20MM,80241,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2620.28,5187.07,percent of total billed charges,
STENT PERIPH L100MM DIA4.5MM CATH 6FR L120CM NIT OTW SELF,80242,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2454.50,5347.50,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,inpatient,1,EA,4.94000,4.69000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.72,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00054-0326-56,NDC,,,facility,outpatient,1,EA,4.94000,4.69000,Amish/Mennonite,Amish Mennonite,,2.72,,,,,,,2.47,4.79,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,inpatient,1,EA,8.22000,7.80000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.52,7.97,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 100 - 50 MCG 60 DOSE,80249,CDM,250,RC,00173-0695-00,NDC,,,facility,outpatient,1,EA,8.22000,7.80000,Amish/Mennonite,Amish Mennonite,,4.52,,,,,,,4.11,7.97,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,inpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,3.30,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,25021040304,NDC,facility,outpatient,1,mL,6.00000,5.70000,Amish/Mennonite,Amish Mennonite,,3.30,,,,,,,0.33945,5.82,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,inpatient,1,mL,6.86000,6.51000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.65,percent of total billed charges,
"HEPARIN SOLN 10,000 UNITS/ML 4 ML",80252,CDM,250,RC,J1644,HCPCS,71288040405,NDC,facility,outpatient,1,mL,6.86000,6.51000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,0.33945,6.65,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,905.96000,860.66000,Amish/Mennonite,Amish Mennonite,,498.28,,,,,,,443.92,878.78,percent of total billed charges,
KIT 20FR 16FR LOPRFL SYR DIL INTRO BTN MCKY,80253,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,905.96000,860.66000,Amish/Mennonite,Amish Mennonite,,498.28,,,,,,,415.84,905.96,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
KIT LD L28CM 4.32MM SPC INTERSTIM SURESCAN MRI,80254,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 7MM L130CM PCLTXL LUTONX 035,80255,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,Amish/Mennonite,Amish Mennonite,,501.19,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE VASC L205CM OD0.035IN HYDRPHLC STR TIP ACROBAT 2,80256,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,Amish/Mennonite,Amish Mennonite,,501.19,,,,,,,418.26,911.25,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q4 PTFE,80257,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X15MM,80260,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG L100CM OD5FR AR MOD INFIN TL,80262,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER ANGIO 6FR L125CM FEM NYL JR 4 STD,80263,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,inpatient,,,4079.00000,3875.05000,Amish/Mennonite,Amish Mennonite,TC,2243.45,,,,,,,2243.45,3956.63,percent of total billed charges,
EP EVAL;RT ATRIAL/VENTR PAC/RC-TECH,80265,CDM,480,RC,93620,CPT,,,facility,outpatient,,,4079.00000,3875.05000,Amish/Mennonite,Amish Mennonite,TC,2243.45,,,,,,,2039.50,52322.00,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,inpatient,,,1952.00000,1854.40000,Amish/Mennonite,Amish Mennonite,TC,1073.60,,,,,,,1073.60,1893.44,percent of total billed charges,
EP DRUG INFUSION-PACING HEART STIM-TECH,80268,CDM,480,RC,93623,CPT,,,facility,outpatient,,,1952.00000,1854.40000,Amish/Mennonite,Amish Mennonite,TC,1073.60,,,,,,,976.00,52322.00,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,inpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.90,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,00378-9070-93,NDC,,,facility,outpatient,1,EA,5.27000,5.00000,Amish/Mennonite,Amish Mennonite,,2.90,,,,,,,2.63,5.11,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,inpatient,1,EA,35.83000,34.04000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,19.71,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,47781-0304-03,NDC,,,facility,outpatient,1,EA,35.83000,34.04000,Amish/Mennonite,Amish Mennonite,,19.71,,,,,,,17.91,34.76,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,inpatient,1,EA,13.44000,12.77000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,7.39,13.04,percent of total billed charges,
RIVASTIGMINE 4.6 MG/24 HR TERF,80275,CDM,250,RC,70710-1196-07,NDC,,,facility,outpatient,1,EA,13.44000,12.77000,Amish/Mennonite,Amish Mennonite,,7.39,,,,,,,6.72,13.04,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN 3CM,80282,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X6MM,80283,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 1.5X10MM,80284,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,28350.00000,26932.50000,Amish/Mennonite,Amish Mennonite,,15592.50,,,,,,,13891.50,27499.50,percent of total billed charges,
GNRTR ICD GALLANT VR SGL CDFA500Q,80285,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,28350.00000,26932.50000,Amish/Mennonite,Amish Mennonite,,15592.50,,,,,,,13012.65,27499.50,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,inpatient,,,2371.00000,2252.45000,Amish/Mennonite,Amish Mennonite,,1304.05,,,,,,,1304.05,2299.87,percent of total billed charges,
CT INJ PARAVERT JNT L/S 3RD LVL,80286,CDM,361,RC,64495,CPT,,,facility,outpatient,,,2371.00000,2252.45000,Amish/Mennonite,Amish Mennonite,,1304.05,,,,,,,1304.05,5271.00,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,inpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,577.50,1018.50,percent of total billed charges,
CT ASP/INJ SYNOVIAL CYST L SPINE,80287,CDM,361,RC,64999,CPT,,,facility,outpatient,,,1050.00000,997.50000,Amish/Mennonite,Amish Mennonite,,577.50,,,,,,,280.29,5858.00,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,3810.53000,3620.00000,Amish/Mennonite,Amish Mennonite,,2095.79,,,,,,,1867.16,3696.21,percent of total billed charges,
FILTER VASC L49MM DIA30MM INTRO 7FR L65CM CATH L79CM VENA,80291,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,3810.53000,3620.00000,Amish/Mennonite,Amish Mennonite,,2095.79,,,,,,,1749.03,3810.53,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11005.00000,10454.75000,Amish/Mennonite,Amish Mennonite,,6052.75,,,,,,,5392.45,10674.85,percent of total billed charges,
SYSTM NEUROPROTECTION TRANSCAROTID ANG TIP,80292,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11005.00000,10454.75000,Amish/Mennonite,Amish Mennonite,,6052.75,,,,,,,5051.30,11005.00,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,275.62,545.62,percent of total billed charges,
KIT ACCS PERIPH TRANSCAROTID W/ NDL 21GA 7CM,80293,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,258.19,562.50,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,519.30000,493.33000,Amish/Mennonite,Amish Mennonite,,285.62,,,,,,,254.46,503.72,percent of total billed charges,
CATHETER EP DIAG MAP M CRV DECAPOLAR 2-5-2MM,80294,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,519.30000,493.33000,Amish/Mennonite,Amish Mennonite,,285.62,,,,,,,238.36,519.30,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,inpatient,1,EA,265.32000,252.05000,Amish/Mennonite,Amish Mennonite,,145.93,,,,,,,145.93,257.36,percent of total billed charges,
VENETOCLAX 100 MG TAB,80295,CDM,250,RC,00074-0576-11,NDC,,,facility,outpatient,1,EA,265.32000,252.05000,Amish/Mennonite,Amish Mennonite,,145.93,,,,,,,132.66,257.36,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,inpatient,1,EA,15105.00000,14349.75000,Amish/Mennonite,Amish Mennonite,,8307.75,,,,,,,8307.75,14651.85,percent of total billed charges,
LURBINECTEDIN POWD-INJ 4 MG,80296,CDM,636,RC,J9223,HCPCS,68727071201,NDC,facility,outpatient,1,EA,15105.00000,14349.75000,Amish/Mennonite,Amish Mennonite,,8307.75,,,,,,,206.13,14651.85,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
CASIRIVIMAB/IMDEVIMAB INFUSION,80298,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,inpatient,,,1046.00000,993.70000,Amish/Mennonite,Amish Mennonite,,575.30,,,,,,,512.54,1014.62,percent of total billed charges,
WHO NONTOR JNTS PREC-PF/CS,80300,CDM,274,RC,L3915,HCPCS,,,facility,outpatient,,,1046.00000,993.70000,Amish/Mennonite,Amish Mennonite,,575.30,,,,,,,523.00,1014.62,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CALCIUM ACETATE 667 MG TAB,80304,CDM,250,RC,J8499,HCPCS,71321080320,NDC,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,inpatient,1,mL,38.61000,36.68000,Amish/Mennonite,Amish Mennonite,,21.24,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 5 GM,80305,CDM,636,RC,J1561,HCPCS,13533080020,NDC,facility,outpatient,1,mL,38.61000,36.68000,Amish/Mennonite,Amish Mennonite,,21.24,,,,,,,19.30,80.87,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,inpatient,1,mL,38.61000,36.68000,Amish/Mennonite,Amish Mennonite,,21.24,,,,,,,21.24,37.45,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMUNEX-C) 2.5 GM,80306,CDM,636,RC,J1561,HCPCS,13533080015,NDC,facility,outpatient,1,mL,38.61000,36.68000,Amish/Mennonite,Amish Mennonite,,21.24,,,,,,,19.30,80.87,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,Amish/Mennonite,Amish Mennonite,,20.13,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,00456-1140-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,Amish/Mennonite,Amish Mennonite,,20.13,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,inpatient,1,EA,26.11000,24.81000,Amish/Mennonite,Amish Mennonite,,14.36,,,,,,,14.36,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,16729-0354-10,NDC,,,facility,outpatient,1,EA,26.11000,24.81000,Amish/Mennonite,Amish Mennonite,,14.36,,,,,,,13.05,25.33,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,inpatient,1,EA,9.68000,9.20000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,5.32,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,69097-0982-02,NDC,,,facility,outpatient,1,EA,9.68000,9.20000,Amish/Mennonite,Amish Mennonite,,5.32,,,,,,,4.84,9.39,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,inpatient,1,EA,21.05000,20.00000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 40 MG,80307,CDM,250,RC,72603-0127-01,NDC,,,facility,outpatient,1,EA,21.05000,20.00000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,10.53,20.42,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,inpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,7.17,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,00480-3565-01,NDC,,,facility,outpatient,1,EA,13.04000,12.39000,Amish/Mennonite,Amish Mennonite,,7.17,,,,,,,6.52,12.65,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,inpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,22.47,39.62,percent of total billed charges,
LISDEXAMFETAMINE 10 MG CAP,80310,CDM,250,RC,59417-0101-10,NDC,,,facility,outpatient,1,EA,40.85000,38.80000,Amish/Mennonite,Amish Mennonite,,22.47,,,,,,,20.43,39.62,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,inpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,74.91,132.11,percent of total billed charges,
"LYME DIS AB, IMMUNOBLOT SO",80312,CDM,300,RC,86617,CPT,,,facility,outpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,16.01,814.87,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,inpatient,,,710.00000,674.50000,Amish/Mennonite,Amish Mennonite,,390.50,,,,,,,390.50,688.70,percent of total billed charges,
ECMO DAILY CHARGE,80313,CDM,360,RC,,,,,facility,outpatient,,,710.00000,674.50000,Amish/Mennonite,Amish Mennonite,,390.50,,,,,,,390.50,5271.00,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,inpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,29696.15,52373.21,percent of total billed charges,
ECMO CANNULATION BEDSIDE-TECH,80320,CDM,360,RC,,,,,facility,outpatient,,,53993.00000,51293.35000,Amish/Mennonite,Amish Mennonite,,29696.15,,,,,,,4607.00,52373.21,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,,104.06,,,,,,,92.71,183.52,percent of total billed charges,
SYSTEM INTRO SHTH 6FR L25CM GRN HUB,80321,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,189.20000,179.74000,Amish/Mennonite,Amish Mennonite,,104.06,,,,,,,86.84,189.20,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR INSIDE DIA0.07IN AL Q3.5,80322,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATH ANGIO 5FR L65CM COMPATIBLE GWIRE 0.038IN,80323,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM OD2.5MM 360DEG ULT DETACH LSR ABLATED DARKER,80324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L14CM AORT DIA23MM IL DIA14.5MM IPSILATERAL,80325,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X20MM,80327,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X30MM,80328,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30690.00000,29155.50000,Amish/Mennonite,Amish Mennonite,,16879.50,,,,,,,15038.10,29769.30,percent of total billed charges,
DEFIBRILLATR CARD 31CC W51XH12XL69MM 71GM 45J DF4-LLHH/IS1,80329,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30690.00000,29155.50000,Amish/Mennonite,Amish Mennonite,,16879.50,,,,,,,14086.71,30690.00,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,97.02,192.06,percent of total billed charges,
CATHETER GUID 6FR L100CM Q5 CRV PTFE LNR RND,80330,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,90.88,198.00,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM CLS4.5 CRV PTFE LNR,80331,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,424.88000,403.64000,Amish/Mennonite,Amish Mennonite,,233.68,,,,,,,208.19,412.13,percent of total billed charges,
TRAY CATH 5FR 55CM PICC PU P PICC 70CM 2 LUM GW.,80332,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,424.88000,403.64000,Amish/Mennonite,Amish Mennonite,,233.68,,,,,,,195.02,424.88,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,Amish/Mennonite,Amish Mennonite,,1592.25,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L150CM 0.014IN LP,80333,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,Amish/Mennonite,Amish Mennonite,,1592.25,,,,,,,1328.81,2895.00,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1747.46000,1660.09000,Amish/Mennonite,Amish Mennonite,,961.10,,,,,,,856.26,1695.04,percent of total billed charges,
CABLE SUR L635MM DIA1.8MM COCR ASSEMB,80335,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1747.46000,1660.09000,Amish/Mennonite,Amish Mennonite,,961.10,,,,,,,802.08,1747.46,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BALNDIL 3.5MM COR CROSSFLEX2 TUNG TREK,80336,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,inpatient,,,9642.75000,9160.61000,Amish/Mennonite,Amish Mennonite,,5303.51,,,,,,,4724.95,9353.47,percent of total billed charges,
PROBE CRYOSURGICAL LG HEAT EXTR CRYO NRV BLK,80337,CDM,278,RC,C2618,HCPCS,,,facility,outpatient,,,9642.75000,9160.61000,Amish/Mennonite,Amish Mennonite,,5303.51,,,,,,,4426.02,9642.75,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,911.25000,865.69000,Amish/Mennonite,Amish Mennonite,,501.19,,,,,,,446.51,883.91,percent of total billed charges,
GUIDEWIRE ESCP 260CM 025IN CLBRT,80338,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,911.25000,865.69000,Amish/Mennonite,Amish Mennonite,,501.19,,,,,,,418.26,911.25,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 6FR L22CM FIRM TRI LAYR DSGN RAW COLORANT RADPQ,80339,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,701.37,1528.05,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE JJNSTM LOPRFL TPR 22FR 3CM TRNGS TNG SIL,80342,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,235.20,465.60,percent of total billed charges,
KIT PERICARDCENT W/ 8.3FR PGTL CATH DIL ANES,80343,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,220.32,480.00,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,inpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.06050,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,00904-5154-60,NDC,,,facility,outpatient,1,EA,0.11000,0.10000,Amish/Mennonite,Amish Mennonite,,0.06050,,,,,,,0.05500,0.10670,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,inpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03300,0.05820,percent of total billed charges,
GUAIFENESIN 200 MG TAB,80345,CDM,250,RC,10135-0681-01,NDC,,,facility,outpatient,1,EA,0.06000,0.06000,Amish/Mennonite,Amish Mennonite,,0.03300,,,,,,,0.03000,0.05820,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
OMEPRAZOLE 20 MG / 10 ML LIQUID,80346,CDM,250,RC,68084-0128-01-01000,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
"THER PROC INCRSE RESP MUSC, EA 15 MIN",80347,CDM,410,RC,G0237,HCPCS,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,23.25,197.88,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,inpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,1.01,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,00781-2167-60,NDC,,,facility,outpatient,1,EA,1.83000,1.74000,Amish/Mennonite,Amish Mennonite,,1.01,,,,,,,0.91500,1.78,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,inpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
ZIPRASIDONE 60 MG CAP,80349,CDM,250,RC,16714-0837-01,NDC,,,facility,outpatient,1,EA,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12220.20000,11609.19000,Amish/Mennonite,Amish Mennonite,,6721.11,,,,,,,5987.90,11853.59,percent of total billed charges,
GRAFT EVAR L93MM DIA16X16MM CATH 14FR POLY NIT STNT HYDRPHLC.,80350,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12220.20000,11609.19000,Amish/Mennonite,Amish Mennonite,,6721.11,,,,,,,5609.07,12220.20,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,33442.50,66202.50,percent of total billed charges,
VALVE AORT 23MM ULT TRANSCATHETER HRT TRILEAFLET BOV,80351,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,68250.00000,64837.50000,Amish/Mennonite,Amish Mennonite,,37537.50,,,,,,,31326.75,68250.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,63000.00000,59850.00000,Amish/Mennonite,Amish Mennonite,,34650.00,,,,,,,30870.00,61110.00,percent of total billed charges,
CATHETER GUID STEER G4 MITRACLIP,80352,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,63000.00000,59850.00000,Amish/Mennonite,Amish Mennonite,,34650.00,,,,,,,28917.00,63000.00,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,9136.78,18087.10,percent of total billed charges,
SYSTEM EVAR CATH 5.4FR TREAT ZONE 12CM GWIRE,80353,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,18646.50000,17714.18000,Amish/Mennonite,Amish Mennonite,,10255.58,,,,,,,8558.74,18646.50,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,239.40000,227.43000,Amish/Mennonite,Amish Mennonite,,131.67,,,,,,,117.31,232.22,percent of total billed charges,
GUIDE WIRE 0.8 X 100MM,80354,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,239.40000,227.43000,Amish/Mennonite,Amish Mennonite,,131.67,,,,,,,109.88,239.40,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,inpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,75.90,133.86,percent of total billed charges,
MYOCRD STRAIN IMG SPCKL TRCK-TECH,80362,CDM,483,RC,93356,CPT,,,facility,outpatient,,,138.00000,131.10000,Amish/Mennonite,Amish Mennonite,,75.90,,,,,,,69.00,133.86,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L12CM GWIRE 0.035IN MIN ACC.,80363,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA20MM 0.020IN PERIPH COMPLX L VOL STD FRME,80364,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,inpatient,1,mL,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.30250,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,00409930010,NDC,facility,outpatient,1,mL,0.55000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30250,,,,,,,0.08525,0.53350,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,inpatient,1,mL,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.84150,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,63323028513,NDC,facility,outpatient,1,mL,1.53000,1.45000,Amish/Mennonite,Amish Mennonite,,0.84150,,,,,,,0.08525,1.48,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,inpatient,1,mL,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.85250,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006110,NDC,facility,outpatient,1,mL,1.55000,1.47000,Amish/Mennonite,Amish Mennonite,,0.85250,,,,,,,0.08525,1.50,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,inpatient,1,mL,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.83050,1.46,percent of total billed charges,
ROPIVACAINE SOLN 0.2% 10 ML,80366,CDM,250,RC,J2795,HCPCS,70069006125,NDC,facility,outpatient,1,mL,1.51000,1.44000,Amish/Mennonite,Amish Mennonite,,0.83050,,,,,,,0.08525,1.46,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,inpatient,1,mL,119.99000,113.99000,Amish/Mennonite,Amish Mennonite,,65.99,,,,,,,65.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,17478-0045-32,NDC,,,facility,outpatient,1,mL,119.99000,113.99000,Amish/Mennonite,Amish Mennonite,,65.99,,,,,,,59.99,116.39,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,inpatient,1,mL,134.30000,127.59000,Amish/Mennonite,Amish Mennonite,,73.86,,,,,,,73.86,130.27,percent of total billed charges,
TETRACAINE SOLN 1% 2 ML,80367,CDM,250,RC,54288-0127-10,NDC,,,facility,outpatient,1,mL,134.30000,127.59000,Amish/Mennonite,Amish Mennonite,,73.86,,,,,,,67.15,130.27,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,inpatient,1,mL,2.45000,2.32000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.35,2.38,percent of total billed charges,
FENTANYL 50 MCG/ML SOL,80368,CDM,250,RC,J3010,HCPCS,70092109949,NDC,facility,outpatient,1,mL,2.45000,2.32000,Amish/Mennonite,Amish Mennonite,,1.35,,,,,,,1.23,2.38,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,inpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,59.61,105.14,percent of total billed charges,
SELENIUM 60 MCG/ML SOL,80369,CDM,250,RC,00517-6560-25,NDC,,,facility,outpatient,1,mL,108.39000,102.97000,Amish/Mennonite,Amish Mennonite,,59.61,,,,,,,54.20,105.14,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,inpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.25850,0.45590,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SOL,80370,CDM,250,RC,J1815,HCPCS,0000282151700100,NDC,facility,outpatient,1,mL,0.47000,0.45000,Amish/Mennonite,Amish Mennonite,,0.25850,,,,,,,0.23500,1.49,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,inpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,2.75,4.85,percent of total billed charges,
DEXAMETHASONE CONC LIQ 5 MG/5 ML,80371,CDM,250,RC,J8540,HCPCS,00054317644,NDC,facility,outpatient,1,mL,5.00000,4.75000,Amish/Mennonite,Amish Mennonite,,2.75,,,,,,,0.03202,4.85,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,inpatient,1,mL,17.80000,16.91000,Amish/Mennonite,Amish Mennonite,,9.79,,,,,,,9.79,17.27,percent of total billed charges,
OXYCODONE CONC LIQ 5 MG/0.25 ML,80372,CDM,250,RC,00527-1426-36,NDC,,,facility,outpatient,1,mL,17.80000,16.91000,Amish/Mennonite,Amish Mennonite,,9.79,,,,,,,8.90,17.27,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,10625.41,21033.97,percent of total billed charges,
VALVE MI DIA27MM 3 BOV PERICARD LEAFLET COCR ALLY STNT ULT,80374,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X12MM,80375,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3490.74000,3316.20000,Amish/Mennonite,Amish Mennonite,,1919.91,,,,,,,1710.46,3386.02,percent of total billed charges,
KIT CATH 9.3FR 45CM APPLAUSE HEP QUATTRO HEAT,80377,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3490.74000,3316.20000,Amish/Mennonite,Amish Mennonite,,1919.91,,,,,,,1602.25,3490.74,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,72.60000,68.97000,Amish/Mennonite,Amish Mennonite,,39.93,,,,,,,35.57,70.42,percent of total billed charges,
CATHETER SFT-VU N-BRAID OMNI FLSH 4F X 65 CM,80378,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,72.60000,68.97000,Amish/Mennonite,Amish Mennonite,,39.93,,,,,,,33.32,72.60,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD7FR .038IN GWIRE HEMSTAS,80379,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,39.47,86.00,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.5X8MM,80380,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,355.69000,337.91000,Amish/Mennonite,Amish Mennonite,,195.63,,,,,,,174.29,345.02,percent of total billed charges,
KIT INTRO PEG 20FR PUL METHD SFTY MIC,80381,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,355.69000,337.91000,Amish/Mennonite,Amish Mennonite,,195.63,,,,,,,163.26,355.69,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,25668.00000,24384.60000,Amish/Mennonite,Amish Mennonite,,14117.40,,,,,,,12577.32,24897.96,percent of total billed charges,
DEFIBRILLATOR CARD 30CC W51XH12XL63MM 69GM 40J DF4-LLHH CONN,80382,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,25668.00000,24384.60000,Amish/Mennonite,Amish Mennonite,,14117.40,,,,,,,11781.61,25668.00,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR AAA CVR TRUNK IPSILATERAL LEG 28.5MM X 14.5MM X,80385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,42.14,83.42,percent of total billed charges,
INTRO SHTH L25CM OD6FR .038IN GWIRE HEMSTAS,80386,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,39.47,86.00,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,603.75000,573.56000,Amish/Mennonite,Amish Mennonite,,332.06,,,,,,,295.84,585.64,percent of total billed charges,
INTRODUCER SHTH 8FR L63CM GWIRE 0.038IN SIDE,80387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,603.75000,573.56000,Amish/Mennonite,Amish Mennonite,,332.06,,,,,,,277.12,603.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1653.75,3273.75,percent of total billed charges,
CATHETER ABLAT 7FR L110CM 2-5-2MM SPC 8MM TIP,80388,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1549.12,3375.00,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
CATHETER EP 6FR L110CM 1MM TIP 2-5-2MM SPC L,80389,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,53.16000,50.50000,Amish/Mennonite,Amish Mennonite,,29.24,,,,,,,26.05,51.57,percent of total billed charges,
GWIRE VASC L180CM DIA0.018IN FLPY TIP L6CM,80391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,53.16000,50.50000,Amish/Mennonite,Amish Mennonite,,29.24,,,,,,,24.40,53.16,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L60MM DIA8MM 0.035IN,80393,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON GSTRM 18FR 2.5CM ENTRL SIL MC SLK 5ML,80395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,inpatient,,,97.10000,92.24000,Amish/Mennonite,Amish Mennonite,90,53.41,,,,,,,53.41,94.19,percent of total billed charges,
"RUFINAMIDE, SERUM (RUFI) SO",80404,CDM,301,RC,80210,CPT,,,facility,outpatient,,,97.10000,92.24000,Amish/Mennonite,Amish Mennonite,90,53.41,,,,,,,21.69,1289.24,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,inpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,90.20,159.08,percent of total billed charges,
FELBAMATE TECH,80405,CDM,300,RC,80167,CPT,,,facility,outpatient,,,164.00000,155.80000,Amish/Mennonite,Amish Mennonite,,90.20,,,,,,,14.91,885.37,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,inpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,158.40,279.36,percent of total billed charges,
"ANALGESICS,1-2,DEFINITIVE TECH",80409,CDM,301,RC,80329,CPT,,,facility,outpatient,,,288.00000,273.60000,Amish/Mennonite,Amish Mennonite,,158.40,,,,,,,144.00,1137.41,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ALCOHOL(ETHANOL) TECH,80411,CDM,301,RC,82077,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,13.82,823.21,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,inpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,97.35,171.69,percent of total billed charges,
SALICYLATE TECH,80413,CDM,301,RC,80179,CPT,,,facility,outpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,14.91,885.37,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,inpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,96.80,170.72,percent of total billed charges,
ACETAMINOPHIN TECH,80415,CDM,301,RC,80143,CPT,,,facility,outpatient,,,176.00000,167.20000,Amish/Mennonite,Amish Mennonite,,96.80,,,,,,,14.91,885.37,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,inpatient,1,EA,2.95000,2.81000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.62,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,62332-0365-06,NDC,,,facility,outpatient,1,EA,2.95000,2.81000,Amish/Mennonite,Amish Mennonite,,1.62,,,,,,,1.48,2.86,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,inpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,00555-0095-96,NDC,,,facility,outpatient,1,EA,2.96000,2.81000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.48,2.87,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,inpatient,1,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.83,percent of total billed charges,
CLONAZEPAM 0.25 MG TAB,80417,CDM,250,RC,49884-0307-02,NDC,,,facility,outpatient,1,EA,2.92000,2.77000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.46,2.83,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,inpatient,,,577.50000,548.62000,Amish/Mennonite,Amish Mennonite,,317.62,,,,,,,282.98,560.17,percent of total billed charges,
SLVRRING BOUTONNIERE LAT 1SIDE,80419,CDM,274,RC,L3927,HCPCS,,,facility,outpatient,,,577.50000,548.62000,Amish/Mennonite,Amish Mennonite,,317.62,,,,,,,41.23,560.17,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,126.04000,119.74000,Amish/Mennonite,Amish Mennonite,,69.32,,,,,,,69.32,122.26,percent of total billed charges,
HIP ABDUCTION PILLOW OTS,80421,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,126.04000,119.74000,Amish/Mennonite,Amish Mennonite,,69.32,,,,,,,63.02,122.26,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,inpatient,1,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.11,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-41,NDC,,,facility,outpatient,1,EA,2.02000,1.92000,Amish/Mennonite,Amish Mennonite,,1.11,,,,,,,1.01,1.96,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,inpatient,1,EA,2.04000,1.94000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.12,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,33342-0088-45,NDC,,,facility,outpatient,1,EA,2.04000,1.94000,Amish/Mennonite,Amish Mennonite,,1.12,,,,,,,1.02,1.98,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,inpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.44,2.53,percent of total billed charges,
RIZATRIPTAN 10 MG TAB,80424,CDM,250,RC,67877-0262-18,NDC,,,facility,outpatient,1,EA,2.61000,2.48000,Amish/Mennonite,Amish Mennonite,,1.44,,,,,,,1.30,2.53,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,inpatient,,,1411.00000,1340.45000,Amish/Mennonite,Amish Mennonite,TC,776.05,,,,,,,776.05,1368.67,percent of total billed charges,
DUPL EXTRACRAN LTD SICU,80425,CDM,920,RC,93882,CPT,,,facility,outpatient,,,1411.00000,1340.45000,Amish/Mennonite,Amish Mennonite,TC,776.05,,,,,,,705.50,1368.67,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,inpatient,1,EA,36.60000,34.77000,Amish/Mennonite,Amish Mennonite,,20.13,,,,,,,20.13,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,00456-1120-30,NDC,,,facility,outpatient,1,EA,36.60000,34.77000,Amish/Mennonite,Amish Mennonite,,20.13,,,,,,,18.30,35.50,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,inpatient,1,EA,26.10000,24.80000,Amish/Mennonite,Amish Mennonite,,14.36,,,,,,,14.36,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,16729-0353-10,NDC,,,facility,outpatient,1,EA,26.10000,24.80000,Amish/Mennonite,Amish Mennonite,,14.36,,,,,,,13.05,25.32,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,inpatient,1,EA,3.55000,3.38000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.95,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72205-0261-30,NDC,,,facility,outpatient,1,EA,3.55000,3.38000,Amish/Mennonite,Amish Mennonite,,1.95,,,,,,,1.77,3.44,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,inpatient,1,EA,21.05000,19.99000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,11.58,20.42,percent of total billed charges,
VILAZODONE TAB 20 MG,80426,CDM,250,RC,72603-0126-01,NDC,,,facility,outpatient,1,EA,21.05000,19.99000,Amish/Mennonite,Amish Mennonite,,11.58,,,,,,,10.53,20.42,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,199.44000,189.47000,Amish/Mennonite,Amish Mennonite,,109.69,,,,,,,109.69,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG ARM SLEEVE",80430,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,199.44000,189.47000,Amish/Mennonite,Amish Mennonite,,109.69,,,,,,,99.72,193.46,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,inpatient,,,250.65000,238.12000,Amish/Mennonite,Amish Mennonite,,137.86,,,,,,,137.86,243.13,percent of total billed charges,
"LYMPHAD,EXOSTRONG GAUNTLET",80431,CDM,271,RC,S8428,HCPCS,,,facility,outpatient,,,250.65000,238.12000,Amish/Mennonite,Amish Mennonite,,137.86,,,,,,,125.33,243.13,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,inpatient,,,2750.00000,2612.50000,Amish/Mennonite,Amish Mennonite,,1512.50,,,,,,,1347.50,2667.50,percent of total billed charges,
DYNAMIC PECTUS CARINATUM BRACE,80432,CDM,274,RC,L1499,HCPCS,,,facility,outpatient,,,2750.00000,2612.50000,Amish/Mennonite,Amish Mennonite,,1512.50,,,,,,,1262.25,2667.50,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D RECORDING,80438,CDM,731,RC,93246,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,37.27,161.02,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECG REC >7D <15D SCAN ALYS W/RPRT,80440,CDM,731,RC,93247,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,122.40,327.86,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,inpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,91.30,161.02,percent of total billed charges,
EXTERNAL ECG REC >48HRS <7D RECORDING,80445,CDM,731,RC,93242,CPT,,,facility,outpatient,,,166.00000,157.70000,Amish/Mennonite,Amish Mennonite,,91.30,,,,,,,37.27,161.02,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .014IN 1.7MM .072IN 150CM PERI,80448,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 7FR L45CM HYDRPHLC STR STYL XCUT,80449,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,693.75000,659.06000,Amish/Mennonite,Amish Mennonite,,381.56,,,,,,,339.94,672.94,percent of total billed charges,
GWIRE ENDOSCP L480CM OD0.035IN AQUA COAT BILI,80450,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,693.75000,659.06000,Amish/Mennonite,Amish Mennonite,,381.56,,,,,,,318.43,693.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X15MM,80451,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X20MM,80452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUID AD 5FR L100CM 0.058IN COR,80453,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,inpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,185.90,327.86,percent of total billed charges,
EXTERNAL ECD REC 48HR <7D SCANNING ALYS W/RPRT,80455,CDM,731,RC,93243,CPT,,,facility,outpatient,,,338.00000,321.10000,Amish/Mennonite,Amish Mennonite,,185.90,,,,,,,122.40,327.86,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,TC,19.80,,,,,,,19.80,34.92,percent of total billed charges,
"REMOTE PHYS/QHP INTERP, DET/MON-TECH",80458,CDM,920,RC,92228,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,TC,19.80,,,,,,,18.00,34.92,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,inpatient,1,EA,106.41000,101.09000,Amish/Mennonite,Amish Mennonite,,58.53,,,,,,,58.53,103.22,percent of total billed charges,
SILDENAFIL 25 MG TAB,80459,CDM,250,RC,00069-4210-30-00050,NDC,,,facility,outpatient,1,EA,106.41000,101.09000,Amish/Mennonite,Amish Mennonite,,58.53,,,,,,,53.20,103.22,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,inpatient,,,713.00000,677.35000,Amish/Mennonite,Amish Mennonite,TC,392.15,,,,,,,392.15,691.61,percent of total billed charges,
EXER TST-BRONCHOSP W/ELECTR RE-TECH,80467,CDM,460,RC,94617,CPT,,,facility,outpatient,,,713.00000,677.35000,Amish/Mennonite,Amish Mennonite,TC,392.15,,,,,,,356.50,691.61,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,inpatient,,,1651.00000,1568.45000,Amish/Mennonite,Amish Mennonite,TC,908.05,,,,,,,908.05,1601.47,percent of total billed charges,
CARDIAC SHUNT IMAGING/DETECTION,80474,CDM,340,RC,78428,CPT,,,facility,outpatient,,,1651.00000,1568.45000,Amish/Mennonite,Amish Mennonite,TC,908.05,,,,,,,805.84,2210.07,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,inpatient,,,534.00000,507.30000,Amish/Mennonite,Amish Mennonite,TC,293.70,,,,,,,293.70,517.98,percent of total billed charges,
"EXERC TST BRONCHOSPASM,WO REC-TECH",80477,CDM,460,RC,94619,CPT,,,facility,outpatient,,,534.00000,507.30000,Amish/Mennonite,Amish Mennonite,TC,293.70,,,,,,,267.00,517.98,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,inpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,60.50,106.70,percent of total billed charges,
"RHYTHM ECG,1-3 LEADS;TRACING",80485,CDM,730,RC,93041,CPT,,,facility,outpatient,,,110.00000,104.50000,Amish/Mennonite,Amish Mennonite,,60.50,,,,,,,55.00,106.70,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
STERNOCLAV JNTS W/WO CNT CT-DX-TECH,80487,CDM,350,RC,71270,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,TC,1252.90,,,,,,,979.11,2209.66,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,inpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,1016.40,1792.56,percent of total billed charges,
STERNOCLAV JNTS W CONT CT-DX-TECH,80490,CDM,352,RC,71260,CPT,,,facility,outpatient,,,1848.00000,1755.60000,Amish/Mennonite,Amish Mennonite,TC,1016.40,,,,,,,924.00,1820.00,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
CATHETER BLNDIL 7MM 130CM PCLTXL LUTONX 035,80495,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
GUIDEWIRE VASC DIA0.014IN SS HYDRPHLC DST TIP,80496,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,284.01,618.75,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,inpatient,,,781.00000,741.95000,Amish/Mennonite,Amish Mennonite,90,429.55,,,,,,,429.55,757.57,percent of total billed charges,
MOG-IGG1 FACS ASSAY SO,80499,CDM,300,RC,86363,CPT,,,facility,outpatient,,,781.00000,741.95000,Amish/Mennonite,Amish Mennonite,90,429.55,,,,,,,12.05,1786.28,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,inpatient,,,126.20000,119.89000,Amish/Mennonite,Amish Mennonite,90,69.41,,,,,,,69.41,122.41,percent of total billed charges,
5' NUCLEOTIDASE SO,80500,CDM,301,RC,83915,CPT,,,facility,outpatient,,,126.20000,119.89000,Amish/Mennonite,Amish Mennonite,90,69.41,,,,,,,11.52,577.23,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,inpatient,,,971.00000,922.45000,Amish/Mennonite,Amish Mennonite,90,534.05,,,,,,,534.05,941.87,percent of total billed charges,
BRAF MELAN DISSECT SO,80501,CDM,310,RC,81210,CPT,,,facility,outpatient,,,971.00000,922.45000,Amish/Mennonite,Amish Mennonite,90,534.05,,,,,,,143.40,8250.66,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,90,816.20,,,,,,,816.20,1439.48,percent of total billed charges,
BRAF MELANOMA SO,80502,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1484.00000,1409.80000,Amish/Mennonite,Amish Mennonite,90,816.20,,,,,,,664.97,8610.62,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,inpatient,1,EA,4864.22000,4621.01000,Amish/Mennonite,Amish Mennonite,,2675.32,,,,,,,2675.32,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148001871,NDC,facility,outpatient,1,EA,4864.22000,4621.01000,Amish/Mennonite,Amish Mennonite,,2675.32,,,,,,,7.24,4718.29,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,inpatient,1,EA,4120.10000,3914.10000,Amish/Mennonite,Amish Mennonite,,2266.05,,,,,,,2266.05,3996.50,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 300 MG (ABILIFY MAINTENA),80503,CDM,636,RC,J0401,HCPCS,59148004580,NDC,facility,outpatient,1,EA,4120.10000,3914.10000,Amish/Mennonite,Amish Mennonite,,2266.05,,,,,,,7.24,3996.50,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,inpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
HALOPERIDOL CONC LIQ 2 MG/ML 1ML,80504,CDM,250,RC,00121-0581-04,NDC,,,facility,outpatient,1,mL,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,inpatient,1,mL,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.88,3.32,percent of total billed charges,
CLONIDINE/EPINEPHRINE/KETOROLAC/ROPIVACAINE 0.04 MG-0.25 MG-15 MG-123 MG/50 ML SOLN,80505,CDM,250,RC,70092-1433-50,NDC,,,facility,outpatient,1,mL,3.42000,3.25000,Amish/Mennonite,Amish Mennonite,,1.88,,,,,,,1.71,3.32,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,inpatient,1,mL,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.63,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,00121154440,NDC,facility,outpatient,1,mL,2.97000,2.82000,Amish/Mennonite,Amish Mennonite,,1.63,,,,,,,1.49,2.88,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
HYDROCODONE-ACETAMINOPHEN LIQ 5 MG-217 MG/10 ML,80506,CDM,250,RC,J8499,HCPCS,66689000550,NDC,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA28.5MM ID24-26MM AORT EXT EXCLUDER,80507,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,4721.18,10285.80,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,237.04,469.24,percent of total billed charges,
BUTTON GSTRM APPLE 14FR 2.7CM MN 1 BLN LOPRFL,80508,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,222.04,483.75,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC J CRV .014IN 300CM DURASTEEL PLM,80509,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 10MM 115CM FLOWTRIEVER STRL LF,80510,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THRMB 18MM 115CM FLOWTRIEVER STRL LF,80511,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
CATHETER THRMB 25MM 115CM FLOWTRIEVER STRL LF,80512,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X10MM,80513,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.0X6MM,80514,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X12MM,80515,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,19033.18,37677.92,percent of total billed charges,
DEFIBLTR CARD DF1 CONN W/ BLUESYNC TECH SHCK REDC,80516,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,38843.22000,36901.06000,Amish/Mennonite,Amish Mennonite,,21363.77,,,,,,,17829.04,38843.22,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,982.50000,933.38000,Amish/Mennonite,Amish Mennonite,,540.38,,,,,,,481.43,953.02,percent of total billed charges,
BALLOON DIL 30-33-36FR L5.5CM INFLATED DIA10-11-12MM,80518,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,982.50000,933.38000,Amish/Mennonite,Amish Mennonite,,540.38,,,,,,,450.97,982.50,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,358.31,709.31,percent of total billed charges,
KIT DCMPRS .035IN 14FR 6FR 175CM CLN 10 DRN,80519,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,731.25000,694.69000,Amish/Mennonite,Amish Mennonite,,402.19,,,,,,,335.64,731.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014/0.009IN SPR,80520,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,inpatient,,,2049.30000,1946.84000,Amish/Mennonite,Amish Mennonite,,1127.12,,,,,,,1127.12,1987.82,percent of total billed charges,
DETECTNET/PER MCI,80529,CDM,343,RC,A9592,HCPCS,,,facility,outpatient,,,2049.30000,1946.84000,Amish/Mennonite,Amish Mennonite,,1127.12,,,,,,,595.10,1987.82,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,inpatient,,,36.64000,34.81000,Amish/Mennonite,Amish Mennonite,,20.15,,,,,,,20.15,35.54,percent of total billed charges,
SOFT ULNAR DEVI INSERT W/BRACE,80530,CDM,272,RC,A9900,HCPCS,,,facility,outpatient,,,36.64000,34.81000,Amish/Mennonite,Amish Mennonite,,20.15,,,,,,,18.32,35.54,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,inpatient,1,EA,7781.61000,7392.53000,Amish/Mennonite,Amish Mennonite,,4279.89,,,,,,,4279.89,7548.16,percent of total billed charges,
POLATUZUMAB VEDOTIN-PIIQ POWD-INJ 30 MG,80531,CDM,636,RC,J9309,HCPCS,50242010301,NDC,facility,outpatient,1,EA,7781.61000,7392.53000,Amish/Mennonite,Amish Mennonite,,4279.89,,,,,,,136.23,7548.16,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,inpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,21.45,37.83,percent of total billed charges,
PROLONGED OFFICE/OUTPT E/M SVC EA 15 MIN-TECH,80533,CDM,510,RC,99417,CPT,,,facility,outpatient,,,39.00000,37.05000,Amish/Mennonite,Amish Mennonite,,21.45,,,,,,,19.50,37.83,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,inpatient,,,184.60000,175.37000,Amish/Mennonite,Amish Mennonite,90,101.53,,,,,,,101.53,179.06,percent of total billed charges,
FACTOR XIII AG SO,80534,CDM,305,RC,85290,CPT,,,facility,outpatient,,,184.60000,175.37000,Amish/Mennonite,Amish Mennonite,90,101.53,,,,,,,16.88,848.80,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
INTRO LONG GI TUBE W FLUORO-TECH,80535,CDM,510,RC,44500,CPT,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,23.00,979.27,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,inpatient,1,EA,5033.44000,4781.76000,Amish/Mennonite,Amish Mennonite,,2768.39,,,,,,,2768.39,4882.44,percent of total billed charges,
SACITUZUMAB GOVITECAN-HZIY POWD-INJ 180 MG,80540,CDM,636,RC,J9317,HCPCS,55135013201,NDC,facility,outpatient,1,EA,5033.44000,4781.76000,Amish/Mennonite,Amish Mennonite,,2768.39,,,,,,,36.26,4882.44,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,inpatient,1,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
PROPAFENONE 75 MG TAB,80541,CDM,250,RC,53489-0551-01-00050,NDC,,,facility,outpatient,1,EA,1.16000,1.11000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,inpatient,,,3278.00000,3114.10000,Amish/Mennonite,Amish Mennonite,TC,1802.90,,,,,,,1802.90,3179.66,percent of total billed charges,
WHOLE BODY/1 DAY-TECH,80542,CDM,341,RC,78802,CPT,,,facility,outpatient,,,3278.00000,3114.10000,Amish/Mennonite,Amish Mennonite,TC,1802.90,,,,,,,1489.61,7180.14,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,inpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
TRIHEXYPHENIDYL 0.5 MG TAB,80545,CDM,250,RC,16571-0160-10-00025,NDC,,,facility,outpatient,1,EA,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,68382-0020-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,inpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.58850,1.04,percent of total billed charges,
VENLAFAXINE 50 MG TAB,80546,CDM,250,RC,16714-0657-01,NDC,,,facility,outpatient,1,EA,1.07000,1.02000,Amish/Mennonite,Amish Mennonite,,0.58850,,,,,,,0.53500,1.04,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,inpatient,1,EA,42.44000,40.32000,Amish/Mennonite,Amish Mennonite,,23.34,,,,,,,23.34,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,16714-0867-01,NDC,,,facility,outpatient,1,EA,42.44000,40.32000,Amish/Mennonite,Amish Mennonite,,23.34,,,,,,,21.22,41.17,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,inpatient,1,EA,6.86000,6.51000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,27808-0223-01,NDC,,,facility,outpatient,1,EA,6.86000,6.51000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.43,6.65,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,inpatient,1,EA,38.63000,36.70000,Amish/Mennonite,Amish Mennonite,,21.25,,,,,,,21.25,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,43975-0350-03,NDC,,,facility,outpatient,1,EA,38.63000,36.70000,Amish/Mennonite,Amish Mennonite,,21.25,,,,,,,19.32,37.47,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,inpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.77,6.64,percent of total billed charges,
PALIPERIDONE 3 MG TAB-,80547,CDM,250,RC,65162-0281-03,NDC,,,facility,outpatient,1,EA,6.85000,6.50000,Amish/Mennonite,Amish Mennonite,,3.77,,,,,,,3.42,6.64,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,inpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,43547-0345-06,NDC,,,facility,outpatient,1,EA,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.66500,1.29,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,inpatient,1,EA,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,15.55,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,50474-0598-66,NDC,,,facility,outpatient,1,EA,28.28000,26.87000,Amish/Mennonite,Amish Mennonite,,15.55,,,,,,,14.14,27.43,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,inpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.29,2.27,percent of total billed charges,
LEVETIRACETAM TAB-ER 500 MG,80549,CDM,250,RC,60505-3280-06,NDC,,,facility,outpatient,1,EA,2.34000,2.22000,Amish/Mennonite,Amish Mennonite,,1.29,,,,,,,1.17,2.27,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1194.38,2364.38,percent of total billed charges,
GUIDEWIRE  OMNIWIRE SRG 185CM STRG TIP PRSS GW,80550,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2437.50000,2315.62000,Amish/Mennonite,Amish Mennonite,,1340.62,,,,,,,1118.81,2437.50,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
SNR AMPLTZ GOOSENK 25MMX120CM,80553,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25659.63000,24376.65000,Amish/Mennonite,Amish Mennonite,,14112.80,,,,,,,12573.22,24889.84,percent of total billed charges,
DEV TREVO XP 6MMX25MM,80554,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25659.63000,24376.65000,Amish/Mennonite,Amish Mennonite,,14112.80,,,,,,,11777.77,25659.63,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
SYS EMBL 5.0MM 2.5-4.8MMX190CM,80555,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X20MM,80556,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X10MM,80557,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X10MM,80558,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X15MM,80559,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC 315CM .014IN FLX TP RADOPQ RX,80561,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID 6FR L45CM DIA2.2MM 0.018/0.038IN,80562,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,30.87,61.11,percent of total billed charges,
GWIRE VASC L180CM DIA0.035IN TAPR L7CM TIP,80563,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,63.00000,59.85000,Amish/Mennonite,Amish Mennonite,,34.65,,,,,,,28.92,63.00,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER PTCA L20MM DIA4.5MM BLLN NYL BLEND,80564,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA9MM CATH L57CM CROSSING PROF 6FR,80567,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1470.00,2910.00,percent of total billed charges,
BLLN ANGIOSCULPT RX 3.5X15MM,80568,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3000.00000,2850.00000,Amish/Mennonite,Amish Mennonite,,1650.00,,,,,,,1377.00,3000.00,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L20CM TARGET VES 3MM L VOL DETACH FOR HI FLO,80569,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 12CM ACPT .014IN GW 4FR SHTH PTA,80570,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,76.44,151.32,percent of total billed charges,
CATHETER ESCP 2.3MM 240CM TFLN ASP PERM LL ADP,80571,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,71.60,156.00,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,inpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,510.40,900.16,percent of total billed charges,
CT INJ EPIDURAL BLOOD PATCH-TECH,80573,CDM,361,RC,62273,CPT,,,facility,outpatient,,,928.00000,881.60000,Amish/Mennonite,Amish Mennonite,,510.40,,,,,,,510.40,3163.00,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,inpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,TC,166.65,,,,,,,166.65,293.91,percent of total billed charges,
INTERROGATION PACEMAKER-TECH,80574,CDM,480,RC,93724,CPT,,,facility,outpatient,,,303.00000,287.85000,Amish/Mennonite,Amish Mennonite,TC,166.65,,,,,,,151.50,293.91,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,,820.60,,,,,,,820.60,1447.24,percent of total billed charges,
US DRAIN BL W/CATH INSERT-TECH,80575,CDM,320,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,,820.60,,,,,,,746.00,2139.65,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,inpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,90,35.20,,,,,,,35.20,62.08,percent of total billed charges,
"PORPHOBILINOGEN, QUANT (PBGU) SO",80578,CDM,301,RC,84110,CPT,,,facility,outpatient,,,64.00000,60.80000,Amish/Mennonite,Amish Mennonite,90,35.20,,,,,,,8.72,441.37,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,inpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,,157.30,,,,,,,157.30,277.42,percent of total billed charges,
AUTOLOGOUS PACK TECH,80584,CDM,300,RC,86890,CPT,,,facility,outpatient,,,286.00000,271.70000,Amish/Mennonite,Amish Mennonite,,157.30,,,,,,,143.00,4855.31,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT ENDOPROS L5CM DIA7MM CATH 8FR L120CM 0.035IN VES,80585,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4661.42,10155.60,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,2030.96000,1929.41000,Amish/Mennonite,Amish Mennonite,,1117.03,,,,,,,995.17,1970.03,percent of total billed charges,
NEPHROMAX BALLOON 12FRX30FR,80586,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,2030.96000,1929.41000,Amish/Mennonite,Amish Mennonite,,1117.03,,,,,,,932.21,2030.96,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA8MM CATH L57CM CROSSING PROF 5FR,80587,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,748.74,1482.21,percent of total billed charges,
STENT URET 4.8FR L28CM FIRM W/O GWIRE TRIA,80588,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1528.05000,1451.65000,Amish/Mennonite,Amish Mennonite,,840.43,,,,,,,701.37,1528.05,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2715.00000,2579.25000,Amish/Mennonite,Amish Mennonite,,1493.25,,,,,,,1330.35,2633.55,percent of total billed charges,
CATHETER BALLOON GORE TRI-LOBE,80589,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2715.00000,2579.25000,Amish/Mennonite,Amish Mennonite,,1493.25,,,,,,,1246.18,2715.00,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,558.75000,530.81000,Amish/Mennonite,Amish Mennonite,,307.31,,,,,,,273.79,541.99,percent of total billed charges,
GUIDEWIRE ENDOSCP L250CM SAVARY-GILLIARD.,80591,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,558.75000,530.81000,Amish/Mennonite,Amish Mennonite,,307.31,,,,,,,256.47,558.75,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,64.40000,61.18000,Amish/Mennonite,Amish Mennonite,,35.42,,,,,,,31.56,62.47,percent of total billed charges,
GWIRE VASC STD L80CM DIA0.035IN TAPR L15CM,80592,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,64.40000,61.18000,Amish/Mennonite,Amish Mennonite,,35.42,,,,,,,29.56,64.40,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM SS HYDROPHOBIC RADPQ J,80593,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X30MM,80594,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X12MM,80595,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.25X8MM,80596,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,Amish/Mennonite,Amish Mennonite,,6238.60,,,,,,,5558.02,11002.61,percent of total billed charges,
STENT PERIPH L100MM DIA 6MM CATH L120CM VASC W/ RADPQ MRK,80597,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,Amish/Mennonite,Amish Mennonite,,6238.60,,,,,,,5206.39,11342.90,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2906.25000,2760.94000,Amish/Mennonite,Amish Mennonite,,1598.44,,,,,,,1424.06,2819.06,percent of total billed charges,
CATHETER EP 7FR L115CM 2MM SPC STEER XL SWP,80598,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2906.25000,2760.94000,Amish/Mennonite,Amish Mennonite,,1598.44,,,,,,,1333.97,2906.25,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,136.34,269.90,percent of total billed charges,
SHTH INTRO L70CM OD6FR ID2.2MM 0.035IN AQ MP,80599,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,127.72,278.25,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,163.68000,155.50000,Amish/Mennonite,Amish Mennonite,,90.02,,,,,,,90.02,158.77,percent of total billed charges,
AMNIOEXCL 10X10CM,80604,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,163.68000,155.50000,Amish/Mennonite,Amish Mennonite,,90.02,,,,,,,81.84,192.52,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,inpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.18,percent of total billed charges,
VERAPAMIL TAB-ER 90 MG (12-HOUR),80609,CDM,250,RC,51079-0899-20-00050,NDC,,,facility,outpatient,1,EA,3.28000,3.12000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.18,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,inpatient,1,mL,992.83000,943.19000,Amish/Mennonite,Amish Mennonite,,546.06,,,,,,,546.06,963.05,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 3ML INTRA-ARTICULAR (GEL-ONE),80610,CDM,250,RC,J7321,HCPCS,87541030091,NDC,facility,outpatient,1,mL,992.83000,943.19000,Amish/Mennonite,Amish Mennonite,,546.06,,,,,,,114.64,963.05,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,727.50000,691.12000,Amish/Mennonite,Amish Mennonite,,400.12,,,,,,,356.48,705.67,percent of total billed charges,
INTRO TRANSSEPTAL GUID 8FR L63CM DIL 8FR,80618,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,727.50000,691.12000,Amish/Mennonite,Amish Mennonite,,400.12,,,,,,,333.92,727.50,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,529.20,1047.60,percent of total billed charges,
CATHETER EP MAP L110CM OD6FR ELECTRD TIP 2MM,80619,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,1080.00000,1026.00000,Amish/Mennonite,Amish Mennonite,,594.00,,,,,,,495.72,1080.00,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
SHEATH GUID 6FR L45CM HYDRPHLC XCUT VLV STR ATRAUM TIP,80620,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,Amish/Mennonite,Amish Mennonite,,750.75,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L40CM DIA9FR 0.035IN STD CRV,80621,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,Amish/Mennonite,Amish Mennonite,,750.75,,,,,,,626.53,1365.00,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,00536-1052-24,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,inpatient,1,GM,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05500,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,45802-0868-02,NDC,,,facility,outpatient,1,GM,0.10000,0.09000,Amish/Mennonite,Amish Mennonite,,0.05500,,,,,,,0.05000,0.09700,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,43386-0312-08,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,inpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04400,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,49348-0143-70,NDC,,,facility,outpatient,1,GM,0.08000,0.08000,Amish/Mennonite,Amish Mennonite,,0.04400,,,,,,,0.04000,0.07760,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,inpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03850,0.06790,percent of total billed charges,
POLYETHYLENE GLYCOL 3350 - POWD,80625,CDM,250,RC,57896-0489-14,NDC,,,facility,outpatient,1,GM,0.07000,0.07000,Amish/Mennonite,Amish Mennonite,,0.03850,,,,,,,0.03500,0.06790,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,inpatient,1,mL,2.33000,2.22000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.28,2.26,percent of total billed charges,
"LIDOCAINE-EPI SOLN PF 1% - 1  200,000 10 ML",80626,CDM,250,RC,J2004,HCPCS,63323048717,NDC,facility,outpatient,1,mL,2.33000,2.22000,Amish/Mennonite,Amish Mennonite,,1.28,,,,,,,1.17,2.26,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,inpatient,,,3427.00000,3255.65000,Amish/Mennonite,Amish Mennonite,TC,1884.85,,,,,,,1884.85,3324.19,percent of total billed charges,
EP EVAL;TSTNG CARDIO-DEFIB GEN-TECH,80631,CDM,480,RC,93641,CPT,,,facility,outpatient,,,3427.00000,3255.65000,Amish/Mennonite,Amish Mennonite,TC,1884.85,,,,,,,1713.50,3324.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,inpatient,,,7997.10000,7597.24000,Amish/Mennonite,Amish Mennonite,,4398.40,,,,,,,3918.58,7757.19,percent of total billed charges,
RECHARGER WIRELESS,80634,CDM,278,RC,L8689,HCPCS,,,facility,outpatient,,,7997.10000,7597.24000,Amish/Mennonite,Amish Mennonite,,4398.40,,,,,,,2236.93,7997.10,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1488.71000,1414.27000,Amish/Mennonite,Amish Mennonite,,818.79,,,,,,,729.47,1444.05,percent of total billed charges,
NEEDLE BX LVR STRL.,80636,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1488.71000,1414.27000,Amish/Mennonite,Amish Mennonite,,818.79,,,,,,,683.32,1488.71,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,inpatient,,,805.00000,764.75000,Amish/Mennonite,Amish Mennonite,TC,442.75,,,,,,,442.75,780.85,percent of total billed charges,
US ENDOMYOCARDIAL BX,80638,CDM,402,RC,76932,CPT,,,facility,outpatient,,,805.00000,764.75000,Amish/Mennonite,Amish Mennonite,TC,442.75,,,,,,,318.45,780.85,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,inpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,97.35,171.69,percent of total billed charges,
XR LONG GI TUBE PLCMNT,80639,CDM,361,RC,44500,CPT,,,facility,outpatient,,,177.00000,168.15000,Amish/Mennonite,Amish Mennonite,,97.35,,,,,,,97.35,3163.00,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L182CM DIA0.014IN TIP L3CM,80640,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,25.99,51.45,percent of total billed charges,
CATHETER DIAG AD 5FR L100CM GRY HYDRPHLC NYL.,80641,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,53.04000,50.39000,Amish/Mennonite,Amish Mennonite,,29.17,,,,,,,24.35,53.04,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA4MM.,80642,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,937.50000,890.62000,Amish/Mennonite,Amish Mennonite,,515.62,,,,,,,459.38,909.38,percent of total billed charges,
GUIDEWIRE VASC L450CM DIA0.025IN HYDRPHLC ANG,80643,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,937.50000,890.62000,Amish/Mennonite,Amish Mennonite,,515.62,,,,,,,430.31,937.50,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,2786.25000,2646.94000,Amish/Mennonite,Amish Mennonite,,1532.44,,,,,,,1365.26,2702.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-5-2MM SPC M CURL,80644,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,2786.25000,2646.94000,Amish/Mennonite,Amish Mennonite,,1532.44,,,,,,,1278.89,2786.25,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,inpatient,,,20382.81000,19363.67000,Amish/Mennonite,Amish Mennonite,,11210.55,,,,,,,9987.58,19771.33,percent of total billed charges,
PACEMAKER CARD W46.5XH59MM D11MM 30GM TI POLYUR SIL RUB,80649,CDM,278,RC,C2621,HCPCS,,,facility,outpatient,,,20382.81000,19363.67000,Amish/Mennonite,Amish Mennonite,,11210.55,,,,,,,9355.71,20382.81,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X12MM,80651,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
"VFC ROTAVIRUS, 2 DOSE, SCHED, ORAL",80657,CDM,636,RC,90681,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,182.97,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,inpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,00574-0240-01,NDC,,,facility,outpatient,1,EA,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,0.61110,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,inpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.53900,0.95060,percent of total billed charges,
REPAGLINIDE 0.5 MG TAB,80658,CDM,250,RC,65862-0670-01,NDC,,,facility,outpatient,1,EA,0.98000,0.93000,Amish/Mennonite,Amish Mennonite,,0.53900,,,,,,,0.49000,0.95060,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,inpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,2.10,3.71,percent of total billed charges,
LIPID EMULSION 10% 50 ML (OMEGAVEN),80659,CDM,250,RC,J3490,HCPCS,63323020550,NDC,facility,outpatient,1,mL,3.82000,3.63000,Amish/Mennonite,Amish Mennonite,,2.10,,,,,,,1.91,3.71,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X12MM,80662,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X6MM,80663,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X8MM,80664,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L100CM ID0.056IN WRP CRV,80665,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,248.06,491.06,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SPR COIL,80666,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,506.25000,480.94000,Amish/Mennonite,Amish Mennonite,,278.44,,,,,,,232.37,506.25,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,36.72000,34.88000,Amish/Mennonite,Amish Mennonite,,20.20,,,,,,,17.99,35.62,percent of total billed charges,
CATH ANGIO ST JL4 6FR 100CM,80667,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,36.72000,34.88000,Amish/Mennonite,Amish Mennonite,,20.20,,,,,,,16.85,36.72,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 24MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 27MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80669,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70.56000,67.03000,Amish/Mennonite,Amish Mennonite,,38.81,,,,,,,34.57,68.44,percent of total billed charges,
CATHETER ANGIO 5FR L65CM GWIRE 0.038IN ANG,80671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70.56000,67.03000,Amish/Mennonite,Amish Mennonite,,38.81,,,,,,,32.39,70.56,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN DURASTEEL,80672,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,826.88,1636.88,percent of total billed charges,
CATH THROMCTMY 7FR L145CM STD ALONE EXPORT,80673,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1687.50000,1603.12000,Amish/Mennonite,Amish Mennonite,,928.12,,,,,,,774.56,1687.50,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L135CM DIA4FR 0.035IN SUPP DAV TIP,80674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN CHOICE EXTRA,80675,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1515.94,3000.94,percent of total billed charges,
INTRO VASC 8.5FR LUMN L91CM CURL 50MM SHTH,80677,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1420.03,3093.75,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,32.34,64.02,percent of total billed charges,
CATHETER ANGIO 6FR L125CM ID0.056IN FL4 CRV,80679,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,66.00000,62.70000,Amish/Mennonite,Amish Mennonite,,36.30,,,,,,,30.29,66.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,588.00,1164.00,percent of total billed charges,
GWIRE VASC L330CM DIA0.014IN SPR TIP L2.8CM,80682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,550.80,1200.00,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,233.36,461.96,percent of total billed charges,
CATH DIAG L135CM TAPR TIP CROSSING SUPP,80683,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,218.60,476.25,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 6FR L100CM PTFE NYL SS XBLAD 4 67006200,80684,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA8MM CATH L57CM CROSSING PROF 5FR,80688,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,372.60000,353.97000,Amish/Mennonite,Amish Mennonite,,204.93,,,,,,,204.93,361.42,percent of total billed charges,
PURAPLYAM 4X4,80690,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,372.60000,353.97000,Amish/Mennonite,Amish Mennonite,,204.93,,,,,,,157.76,361.42,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,227.15,400.61,percent of total billed charges,
PURAPLYAM 3X4,80691,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,413.00000,392.35000,Amish/Mennonite,Amish Mennonite,,227.15,,,,,,,157.76,400.61,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,inpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,TC,517.55,,,,,,,517.55,912.77,percent of total billed charges,
EP FOLLOW-UP STUDY-TECH,80693,CDM,480,RC,93624,CPT,,,facility,outpatient,,,941.00000,893.95000,Amish/Mennonite,Amish Mennonite,TC,517.55,,,,,,,470.50,912.77,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2184.38000,2075.16000,Amish/Mennonite,Amish Mennonite,,1201.41,,,,,,,1070.35,2118.85,percent of total billed charges,
CATH GUID 1.8FR L130CM COR SS TAPR MICROGUIDE.,80695,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2184.38000,2075.16000,Amish/Mennonite,Amish Mennonite,,1201.41,,,,,,,1002.63,2184.38,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L60MM DIA20MM CATH L80CM GWIRE 0.035IN SHTH.,80696,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.75X8MM,80698,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,inpatient,,,2117.00000,2011.15000,Amish/Mennonite,Amish Mennonite,TC,1164.35,,,,,,,1164.35,2053.49,percent of total billed charges,
XR LYMPHANGIOGRAM EXT UNI,80699,CDM,320,RC,75801,CPT,,,facility,outpatient,,,2117.00000,2011.15000,Amish/Mennonite,Amish Mennonite,TC,1164.35,,,,,,,1058.50,11495.30,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,inpatient,,,2717.00000,2581.15000,Amish/Mennonite,Amish Mennonite,TC,1494.35,,,,,,,1494.35,2635.49,percent of total billed charges,
XR LYMPHANGIOGRAM ABD/PEL UNI,80700,CDM,320,RC,75805,CPT,,,facility,outpatient,,,2717.00000,2581.15000,Amish/Mennonite,Amish Mennonite,TC,1494.35,,,,,,,1358.50,17311.25,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM ACPT .018IN GW 5FR SHTH PTA,80701,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,inpatient,1,EA,6485.63000,6161.35000,Amish/Mennonite,Amish Mennonite,,3567.10,,,,,,,3567.10,6291.06,percent of total billed charges,
ARIPIPRAZOLE POWD-INJ 400 MG (ABILIFY MAINTENA),80702,CDM,636,RC,J0401,HCPCS,59148007280,NDC,facility,outpatient,1,EA,6485.63000,6161.35000,Amish/Mennonite,Amish Mennonite,,3567.10,,,,,,,7.24,6291.06,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,inpatient,1,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.66550,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,00121-0853-40,NDC,,,facility,outpatient,1,mL,1.21000,1.15000,Amish/Mennonite,Amish Mennonite,,0.66550,,,,,,,0.60500,1.17,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200 MG-40 MG/5 ML SUSP,80703,CDM,250,RC,65862-0496-47-02000,NDC,,,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,1.16,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,inpatient,1,mL,2392.75000,2273.11000,Amish/Mennonite,Amish Mennonite,,1316.01,,,,,,,1316.01,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513088002,NDC,facility,outpatient,1,mL,2392.75000,2273.11000,Amish/Mennonite,Amish Mennonite,,1316.01,,,,,,,12.00,2320.97,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,inpatient,1,mL,2460.93000,2337.88000,Amish/Mennonite,Amish Mennonite,,1353.51,,,,,,,1353.51,2387.10,percent of total billed charges,
ROMOSOZUMAB-AQQG SOLN 105 MG/1.17 ML (EVENITY),80704,CDM,636,RC,J3111,HCPCS,55513099802,NDC,facility,outpatient,1,mL,2460.93000,2337.88000,Amish/Mennonite,Amish Mennonite,,1353.51,,,,,,,12.00,2387.10,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,inpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
PYRIDOXINE 12.5 MG TAB,80705,CDM,250,RC,00536-4406-01-00050,NDC,,,facility,outpatient,1,EA,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.02910,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,9528.90000,9052.46000,Amish/Mennonite,Amish Mennonite,,5240.90,,,,,,,4669.16,9243.03,percent of total billed charges,
CATHETER ABLAT 8FR L115CM ELECTRD TIP 3.5MM,80719,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,9528.90000,9052.46000,Amish/Mennonite,Amish Mennonite,,5240.90,,,,,,,4373.77,9528.90,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,2250.00000,2137.50000,Amish/Mennonite,Amish Mennonite,,1237.50,,,,,,,1102.50,2182.50,percent of total billed charges,
CATH EP 2-8-2MM 6FR 65CM,80720,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,2250.00000,2137.50000,Amish/Mennonite,Amish Mennonite,,1237.50,,,,,,,1032.75,2250.00,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,675.00000,641.25000,Amish/Mennonite,Amish Mennonite,,371.25,,,,,,,330.75,654.75,percent of total billed charges,
SET CATH STRG 12.5FR 24CM SIL HMCTH CRC LM BSC,80722,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,675.00000,641.25000,Amish/Mennonite,Amish Mennonite,,371.25,,,,,,,309.82,675.00,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,194.78,385.57,percent of total billed charges,
INTRO SHEATH AD 7FR L45CM RDC GUID KINK RESIST.,80723,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,397.50000,377.62000,Amish/Mennonite,Amish Mennonite,,218.62,,,,,,,182.45,397.50,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,inpatient,,,1989.00000,1889.55000,Amish/Mennonite,Amish Mennonite,,1093.95,,,,,,,1093.95,1929.33,percent of total billed charges,
MUSCLE TEST 2 LIMBS,80725,CDM,922,RC,95861,CPT,,,facility,outpatient,,,1989.00000,1889.55000,Amish/Mennonite,Amish Mennonite,,1093.95,,,,,,,122.40,1929.33,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
CATHETER EP 2FR L130CM ELECTRD SPC 5-5-5MM,80726,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9840.80000,9348.76000,Amish/Mennonite,Amish Mennonite,,5412.44,,,,,,,4821.99,9545.58,percent of total billed charges,
STENT BILI L80MM DIA10MM CATH 8.5FR L194CM  0.035IN MTL,80727,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9840.80000,9348.76000,Amish/Mennonite,Amish Mennonite,,5412.44,,,,,,,4516.93,9840.80,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X150X130,80728,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,inpatient,,,445.31000,423.04000,Amish/Mennonite,Amish Mennonite,,244.92,,,,,,,244.92,431.95,percent of total billed charges,
NUSHIELD 2X4 SQ CM,80729,CDM,636,RC,Q4160,HCPCS,,,facility,outpatient,,,445.31000,423.04000,Amish/Mennonite,Amish Mennonite,,244.92,,,,,,,143.61,874.50,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,inpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.56,4.51,percent of total billed charges,
OXYCODONE CAP 5 MG,80731,CDM,250,RC,68308-0145-01,NDC,,,facility,outpatient,1,EA,4.65000,4.41000,Amish/Mennonite,Amish Mennonite,,2.56,,,,,,,2.33,4.51,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,inpatient,1,GM,77.47000,73.60000,Amish/Mennonite,Amish Mennonite,,42.61,,,,,,,42.61,75.15,percent of total billed charges,
BUDESONIDE-FORMOTEROL 160 MCG-4.5 MCG/INH AERO,80734,CDM,250,RC,00310-7370-20,NDC,,,facility,outpatient,1,GM,77.47000,73.60000,Amish/Mennonite,Amish Mennonite,,42.61,,,,,,,38.73,75.15,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,inpatient,,,2780.00000,2641.00000,Amish/Mennonite,Amish Mennonite,TC,1529.00,,,,,,,1529.00,2696.60,percent of total billed charges,
MUSCLE TEST 4 LIMBS,80736,CDM,922,RC,95864,CPT,,,facility,outpatient,,,2780.00000,2641.00000,Amish/Mennonite,Amish Mennonite,TC,1529.00,,,,,,,1390.00,2696.60,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X15MM,80737,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,468.56,927.56,percent of total billed charges,
CATHETER PTCA 7FR L75CM BLLN L4CM DIA12MM,80738,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,956.25000,908.44000,Amish/Mennonite,Amish Mennonite,,525.94,,,,,,,438.92,956.25,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 12-13.5-12MM 36-40.5-45FR 8CM.,80739,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,385.56,840.00,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,49.74,98.47,percent of total billed charges,
SET INTRO OUTER CATH 4FR L10CM NDL 21GA L7CM,80740,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,101.52000,96.44000,Amish/Mennonite,Amish Mennonite,,55.84,,,,,,,46.60,101.52,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,inpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,264.00,465.60,percent of total billed charges,
REPROGRAM SHUNT,80741,CDM,361,RC,,,,,facility,outpatient,,,480.00000,456.00000,Amish/Mennonite,Amish Mennonite,,264.00,,,,,,,264.00,5271.00,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID L100CM OD6FR ID0.070IN XBLAD3 L COR,80742,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,111.17,220.07,percent of total billed charges,
KIT INTRO 7FR L10CM MINI WRE L45CM DIA0.021IN,80743,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,226.88000,215.54000,Amish/Mennonite,Amish Mennonite,,124.78,,,,,,,104.14,226.88,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,inpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,154.00,271.60,percent of total billed charges,
BFB TRAINING 1ST 15 MIN,80744,CDM,420,RC,90912,CPT,,,facility,outpatient,,,280.00000,266.00000,Amish/Mennonite,Amish Mennonite,,154.00,,,,,,,126.65,271.60,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,inpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,90,62.70,,,,,,,62.70,110.58,percent of total billed charges,
"MYOGLOBIN,U/S SO",80745,CDM,300,RC,83874,CPT,,,facility,outpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,90,62.70,,,,,,,13.35,679.08,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,inpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,90,5.50,,,,,,,5.50,9.70,percent of total billed charges,
AG RSP MDWST SO,80746,CDM,300,RC,86003,CPT,,,facility,outpatient,,,10.00000,9.50000,Amish/Mennonite,Amish Mennonite,90,5.50,,,,,,,4.57,271.65,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,inpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,90,105.05,,,,,,,105.05,185.27,percent of total billed charges,
ALLERGEN RESP MIDWEST SO,80747,CDM,301,RC,82785,CPT,,,facility,outpatient,,,191.00000,181.45000,Amish/Mennonite,Amish Mennonite,90,105.05,,,,,,,17.01,865.84,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,inpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,90,34.10,,,,,,,34.10,60.14,percent of total billed charges,
ALK PHOSPHATASE TOTAL/ISOZ (ALKP) SO,80748,CDM,301,RC,84075,CPT,,,facility,outpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,90,34.10,,,,,,,5.35,271.65,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,inpatient,,,176.90000,168.06000,Amish/Mennonite,Amish Mennonite,90,97.30,,,,,,,97.30,171.59,percent of total billed charges,
ALK PHOSPH TOTAL/ISOZ SO,80749,CDM,301,RC,84080,CPT,,,facility,outpatient,,,176.90000,168.06000,Amish/Mennonite,Amish Mennonite,90,97.30,,,,,,,15.27,780.94,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,inpatient,,,98.20000,93.29000,Amish/Mennonite,Amish Mennonite,90,54.01,,,,,,,54.01,95.25,percent of total billed charges,
"STRONGYLOIDES AB, IGG (STRNG) SO",80750,CDM,300,RC,86682,CPT,,,facility,outpatient,,,98.20000,93.29000,Amish/Mennonite,Amish Mennonite,90,54.01,,,,,,,8.17,679.08,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,inpatient,,,178.30000,169.38000,Amish/Mennonite,Amish Mennonite,90,98.06,,,,,,,98.06,172.95,percent of total billed charges,
"HAEMOPHILUS INFLUENZAE TYPE B AB, IGG (HIBSG) SO",80751,CDM,300,RC,86684,CPT,,,facility,outpatient,,,178.30000,169.38000,Amish/Mennonite,Amish Mennonite,90,98.06,,,,,,,16.37,831.84,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,inpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,90,320.10,,,,,,,320.10,564.54,percent of total billed charges,
JAK2 EXON 12 SO,80752,CDM,310,RC,0027U,HCPCS,,,facility,outpatient,,,582.00000,552.90000,Amish/Mennonite,Amish Mennonite,90,320.10,,,,,,,291.00,839.96,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,inpatient,,,343.70000,326.52000,Amish/Mennonite,Amish Mennonite,90,189.03,,,,,,,189.03,333.39,percent of total billed charges,
PROCOLLAGEN I INT-N TER SO,80753,CDM,301,RC,83519,CPT,,,facility,outpatient,,,343.70000,326.52000,Amish/Mennonite,Amish Mennonite,90,189.03,,,,,,,19.00,865.84,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,237.04,469.24,percent of total billed charges,
SHEATH INTRO 6FR L90CM NYLN PTFE SS,80754,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,222.04,483.75,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
CATH EXTR L145CM DIA6FR 0.014IN OPTIMAL DSGN,80755,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,19.60,38.80,percent of total billed charges,
CATHETER DIAG 6FR L100CM COR NYL JUDKINS R 5.,80756,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,18.36,40.00,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,643.12,1273.12,percent of total billed charges,
EXTENSION LEAD 70CM BLDG THREADABLE HNDL LCK,80757,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1312.50000,1246.88000,Amish/Mennonite,Amish Mennonite,,721.88,,,,,,,602.44,1312.50,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA28MM SHTH OD7.7MM ID6.7MM AORT VES,80758,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L18CM AORT DIA28.5MM IL DIA14.5MM IPSILATERAL,80759,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,298.41,590.73,percent of total billed charges,
CATH DIAG L90CM DIA4FR 0.035IN SUPP DAV TIP,80761,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,609.00000,578.55000,Amish/Mennonite,Amish Mennonite,,334.95,,,,,,,279.53,609.00,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,2995.31000,2845.54000,Amish/Mennonite,Amish Mennonite,,1647.42,,,,,,,1467.70,2905.45,percent of total billed charges,
FIBER LASER 550UM 6J 80HZ 120W D/F/L FOR LITHO,80762,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,2995.31000,2845.54000,Amish/Mennonite,Amish Mennonite,,1647.42,,,,,,,1374.85,2995.31,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,inpatient,,,548.10000,520.70000,Amish/Mennonite,Amish Mennonite,,301.45,,,,,,,301.45,531.66,percent of total billed charges,
STRAVIX 3X6,80765,CDM,636,RC,Q4133,HCPCS,,,facility,outpatient,,,548.10000,520.70000,Amish/Mennonite,Amish Mennonite,,301.45,,,,,,,211.37,531.66,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,inpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,TC,507.10,,,,,,,507.10,894.34,percent of total billed charges,
XRAY/AORTOGRAM-TECH,80766,CDM,320,RC,75605,CPT,,,facility,outpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,TC,507.10,,,,,,,391.31,29731.35,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,inpatient,1,mL,9.14000,8.69000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,5.03,8.87,percent of total billed charges,
INSULIN LISPRO 10 UNIT(S) / 1 ML SOLN,80768,CDM,250,RC,J1815,HCPCS,0000275101701000,NDC,facility,outpatient,1,mL,9.14000,8.69000,Amish/Mennonite,Amish Mennonite,,5.03,,,,,,,1.49,8.87,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,Amish/Mennonite,Amish Mennonite,,681.45,,,,,,,681.45,1201.83,percent of total billed charges,
"FLUOROESTRADIOL F 18, DIAG, 1 MC",80770,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,Amish/Mennonite,Amish Mennonite,,681.45,,,,,,,498.67,1201.83,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,inpatient,1,mL,4.57000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,2.51,4.43,percent of total billed charges,
INSULIN LISPRO 5 UNIT(S) / 1 ML SOLN,80771,CDM,250,RC,J1815,HCPCS,0000275101700500,NDC,facility,outpatient,1,mL,4.57000,4.34000,Amish/Mennonite,Amish Mennonite,,2.51,,,,,,,1.49,4.43,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC WATCHMAN TRSL SHTH DIL STRL LF DISP,80776,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 5FR L150CM HYDRPHLC PV,80777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,331.88000,315.29000,Amish/Mennonite,Amish Mennonite,,182.53,,,,,,,162.62,321.92,percent of total billed charges,
GUIDEWIRE VASC L350CM DIA0.035IN 45DEG STIFF,80778,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,331.88000,315.29000,Amish/Mennonite,Amish Mennonite,,182.53,,,,,,,152.33,331.88,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,Amish/Mennonite,Amish Mennonite,,1143.45,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 80CM,80779,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,Amish/Mennonite,Amish Mennonite,,1143.45,,,,,,,954.26,2079.00,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.75000,359.81000,Amish/Mennonite,Amish Mennonite,,208.31,,,,,,,185.59,367.39,percent of total billed charges,
GUIDEWIRE VASC L400CM DIA0.035IN 45DEG STIFF,80780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.75000,359.81000,Amish/Mennonite,Amish Mennonite,,208.31,,,,,,,173.85,378.75,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLOON L40MM DIA4MM.,80781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN METACROSS RX 6X60X200CM.,80782,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,900.00000,855.00000,Amish/Mennonite,Amish Mennonite,,495.00,,,,,,,441.00,873.00,percent of total billed charges,
DEVICE CLSR 6-12FR BIOABSRB THROMBOGENIC CLLGN PLUG FOR PERC,80783,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,900.00000,855.00000,Amish/Mennonite,Amish Mennonite,,495.00,,,,,,,413.10,900.00,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,8607.75000,8177.36000,Amish/Mennonite,Amish Mennonite,,4734.26,,,,,,,4217.80,8349.52,percent of total billed charges,
CATHETER TIGEREYE 6FR 140CM,80784,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,8607.75000,8177.36000,Amish/Mennonite,Amish Mennonite,,4734.26,,,,,,,3950.96,8607.75,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH R2P DEST SLENDER GUIDNG 6FR 75CM.,80785,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,550.80,1200.00,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA7MM CATH L57CM CROSSING PROF 5FR,80786,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1887.98000,1793.58000,Amish/Mennonite,Amish Mennonite,,1038.39,,,,,,,925.11,1831.34,percent of total billed charges,
NEPHROMAX BALLOON 15FRX30FR,80787,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1887.98000,1793.58000,Amish/Mennonite,Amish Mennonite,,1038.39,,,,,,,866.58,1887.98,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA14.5MM CONTRALATERAL LEG W/ C3,80789,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT ENDOPROS L12CM DST DIA12MM CONTRALATERAL LEG W/ C3 DEL,80793,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 4FR L10CM COR HYDRPHLC MINI GWIRE,80794,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,411.60,814.80,percent of total billed charges,
DIL BLLN HERCULES ESOPH 7FR 15-16.5-18MM 45-49.5-54FR 8CM,80795,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,840.00000,798.00000,Amish/Mennonite,Amish Mennonite,,462.00,,,,,,,385.56,840.00,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,416.20,823.90,percent of total billed charges,
STENT URET 6FR L24CM PERCFLX FIRM DUROMETER DBL PGTL TAPR,80796,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,849.38000,806.91000,Amish/Mennonite,Amish Mennonite,,467.16,,,,,,,389.87,849.38,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L18CM AORT DIA23MM IL DIA14.5MM INFRARENAL TRUNK,80797,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4976.24,9850.93,percent of total billed charges,
STENT PERIPH L5CM DIA6MM CATH L120CM 0.035IN HEP BIOACTIVE,80798,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10155.60000,9647.82000,Amish/Mennonite,Amish Mennonite,,5585.58,,,,,,,4661.42,10155.60,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
IMAGING RETINA PHYSICIAN MONITORING,80800,CDM,361,RC,,,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,5271.00,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,inpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,,51.70,,,,,,,51.70,91.18,percent of total billed charges,
NICU IMAGING RETINA POC AUTO ANALYSIS,80801,CDM,361,RC,,,,,facility,outpatient,,,94.00000,89.30000,Amish/Mennonite,Amish Mennonite,,51.70,,,,,,,51.70,5271.00,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,103.82,205.52,percent of total billed charges,
CATHETER ANGIO 4FR L150CM PGTL HYDRPHLC,80802,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,211.88000,201.29000,Amish/Mennonite,Amish Mennonite,,116.53,,,,,,,97.25,211.88,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,233.36,461.96,percent of total billed charges,
CATHETER DIAG L150CM 0.035IN CROSSING SUPP,80804,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,218.60,476.25,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 80MM 8MM 130CM ULTRAVERSE 035,80806,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,inpatient,,,117.80000,111.91000,Amish/Mennonite,Amish Mennonite,90,64.79,,,,,,,64.79,114.27,percent of total billed charges,
BETA CROSSLAPS SO,80808,CDM,300,RC,82523,CPT,,,facility,outpatient,,,117.80000,111.91000,Amish/Mennonite,Amish Mennonite,90,64.79,,,,,,,14.65,984.66,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,inpatient,,,1239.00000,1177.05000,Amish/Mennonite,Amish Mennonite,,681.45,,,,,,,681.45,1201.83,percent of total billed charges,
NM PET CERIANNA PER MCI,80809,CDM,343,RC,A9591,HCPCS,,,facility,outpatient,,,1239.00000,1177.05000,Amish/Mennonite,Amish Mennonite,,681.45,,,,,,,498.67,1201.83,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,inpatient,,,73500.00000,69825.00000,Amish/Mennonite,Amish Mennonite,,40425.00,,,,,,,36015.00,71295.00,percent of total billed charges,
SYSTEM BAROSTIM NEO IPG & CSL,80811,CDM,278,RC,C1825,HCPCS,,,facility,outpatient,,,73500.00000,69825.00000,Amish/Mennonite,Amish Mennonite,,40425.00,,,,,,,33736.50,73500.00,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,inpatient,,,5128.00000,4871.60000,Amish/Mennonite,Amish Mennonite,,2820.40,,,,,,,2820.40,4974.16,percent of total billed charges,
IMAGE CATH FLUID TRNA/VGNL,80813,CDM,402,RC,49407,CPT,,,facility,outpatient,,,5128.00000,4871.60000,Amish/Mennonite,Amish Mennonite,,2820.40,,,,,,,384.16,4974.16,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,Amish/Mennonite,Amish Mennonite,,3795.00,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L58MM DIA9MM CATH L135CM 0.035IN VASC SS EPTFE,80814,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,Amish/Mennonite,Amish Mennonite,,3795.00,,,,,,,3167.10,6900.00,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,inpatient,,,1365.00000,1296.75000,Amish/Mennonite,Amish Mennonite,,750.75,,,,,,,668.85,1324.05,percent of total billed charges,
GUID COR SNUS L135CM DIA0.035IN SHTH L50CM,80815,CDM,278,RC,C1892,HCPCS,,,facility,outpatient,,,1365.00000,1296.75000,Amish/Mennonite,Amish Mennonite,,750.75,,,,,,,626.53,1365.00,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,inpatient,,,4396.00000,4176.20000,Amish/Mennonite,Amish Mennonite,,2417.80,,,,,,,2417.80,4264.12,percent of total billed charges,
CMOTOR EVOKED UPR&LWR LIMBS,80816,CDM,740,RC,95939,CPT,,,facility,outpatient,,,4396.00000,4176.20000,Amish/Mennonite,Amish Mennonite,,2417.80,,,,,,,966.05,4264.12,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,inpatient,,,445.00000,422.75000,Amish/Mennonite,Amish Mennonite,,244.75,,,,,,,244.75,431.65,percent of total billed charges,
INJ PROC ANTEGR NEPH/UR EX-FL-TECH,80818,CDM,361,RC,50431,CPT,,,facility,outpatient,,,445.00000,422.75000,Amish/Mennonite,Amish Mennonite,,244.75,,,,,,,244.75,3163.00,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,488.05000,463.65000,Amish/Mennonite,Amish Mennonite,,268.43,,,,,,,268.43,473.41,percent of total billed charges,
AMNIOEXCL+4X5CM,80829,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,488.05000,463.65000,Amish/Mennonite,Amish Mennonite,,268.43,,,,,,,158.39,473.41,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,inpatient,,,120.40000,114.38000,Amish/Mennonite,Amish Mennonite,90,66.22,,,,,,,66.22,116.79,percent of total billed charges,
QUETIAPINE MTOX423 SO,80830,CDM,300,RC,80342,CPT,,,facility,outpatient,,,120.40000,114.38000,Amish/Mennonite,Amish Mennonite,90,66.22,,,,,,,60.20,1137.41,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 7FR L10CM MINI GWIRE L45CM,80831,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10064.34000,9561.12000,Amish/Mennonite,Amish Mennonite,,5535.39,,,,,,,4931.53,9762.41,percent of total billed charges,
STEM HUM L200MM DIA14MM SHLDR COCR MOLY UNIV MOD REV PRI CEM,80832,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10064.34000,9561.12000,Amish/Mennonite,Amish Mennonite,,5535.39,,,,,,,4619.53,10064.34,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,136.34,269.90,percent of total billed charges,
INTRO SHTH .035IN 6FR .087IN 70CM CKFL FLXR ANL0,80833,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,127.72,278.25,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 35MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80834,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,50.96,100.88,percent of total billed charges,
CATHETER ANGIO 6.7FR L100CM 0.038IN POLYETH,80835,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,47.74,104.00,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT PERIPH L19MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80836,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L29MM DIA7X11MM CATH L135CM INTRO SHTH 7FR,80837,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11169.30000,10610.83000,Amish/Mennonite,Amish Mennonite,,6143.11,,,,,,,5472.96,10834.22,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 1-6-2MM SPC TIP,80838,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11169.30000,10610.83000,Amish/Mennonite,Amish Mennonite,,6143.11,,,,,,,5126.71,11169.30,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,4623.00000,4391.85000,Amish/Mennonite,Amish Mennonite,,2542.65,,,,,,,2265.27,4484.31,percent of total billed charges,
CATHETER MAP 7FR L115CM 2-6-2 SPC D CRV 22,80839,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,4623.00000,4391.85000,Amish/Mennonite,Amish Mennonite,,2542.65,,,,,,,2121.96,4623.00,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,988.88000,939.44000,Amish/Mennonite,Amish Mennonite,,543.88,,,,,,,484.55,959.21,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10,80840,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,988.88000,939.44000,Amish/Mennonite,Amish Mennonite,,543.88,,,,,,,453.90,988.88,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L96MM DIA26MM SHTH OD7.1MM ID6MM AORT VES DIA22MM,80841,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,inpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,739.20,1303.68,percent of total billed charges,
INS MARK ABD/PEL FOR RT PERQ-TECH,80842,CDM,350,RC,49411,CPT,,,facility,outpatient,,,1344.00000,1276.80000,Amish/Mennonite,Amish Mennonite,TC,739.20,,,,,,,672.00,1820.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X30MM,80845,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,inpatient,,,707.00000,671.65000,Amish/Mennonite,Amish Mennonite,,388.85,,,,,,,388.85,685.79,percent of total billed charges,
XR NJX PX NFROSGRM& URTRGRM-TECH,80846,CDM,320,RC,50431,CPT,,,facility,outpatient,,,707.00000,671.65000,Amish/Mennonite,Amish Mennonite,,388.85,,,,,,,353.50,697.17,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,765.00000,726.75000,Amish/Mennonite,Amish Mennonite,,420.75,,,,,,,374.85,742.05,percent of total billed charges,
CATHETER EP 6FR L110CM 2-5-2MM SPC QPLR L CRV,80847,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,765.00000,726.75000,Amish/Mennonite,Amish Mennonite,,420.75,,,,,,,351.13,765.00,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,104.64000,99.41000,Amish/Mennonite,Amish Mennonite,,57.55,,,,,,,51.27,101.50,percent of total billed charges,
INTRO SHTH L30CM L37CM OD8FR .038IN SET,80848,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,104.64000,99.41000,Amish/Mennonite,Amish Mennonite,,57.55,,,,,,,48.03,104.64,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 3MM 150CM ULTRAVERSE 014 CK,80849,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,381.56000,362.48000,Amish/Mennonite,Amish Mennonite,,209.86,,,,,,,186.96,370.11,percent of total billed charges,
KT PERICARDCENT L60CM DIA6FR PGTL CATH,80850,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,381.56000,362.48000,Amish/Mennonite,Amish Mennonite,,209.86,,,,,,,175.14,381.56,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,3637.50000,3455.62000,Amish/Mennonite,Amish Mennonite,,2000.62,,,,,,,1782.38,3528.38,percent of total billed charges,
SHTH VERSACROSS RF TRANSSEPTAL,80851,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,3637.50000,3455.62000,Amish/Mennonite,Amish Mennonite,,2000.62,,,,,,,1669.61,3637.50,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,inpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,TC,460.35,,,,,,,460.35,811.89,percent of total billed charges,
ELECTROMYOGRM LIM SPEC MUSC-TECH,80859,CDM,922,RC,95869,CPT,,,facility,outpatient,,,837.00000,795.15000,Amish/Mennonite,Amish Mennonite,TC,460.35,,,,,,,418.50,811.89,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI L26MM DIA9MM CATH 6FR L80CM SS BLLN SELF EXPND,80860,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1024.14,2231.25,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,367.50,727.50,percent of total billed charges,
CATH VIPERCATH XC STR 5FR 200,80863,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,750.00000,712.50000,Amish/Mennonite,Amish Mennonite,,412.50,,,,,,,344.25,750.00,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3912.30000,3716.68000,Amish/Mennonite,Amish Mennonite,,2151.76,,,,,,,1917.03,3794.93,percent of total billed charges,
CATHETER DIAG L162CM OD0.035IN ID0.021IN,80864,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3912.30000,3716.68000,Amish/Mennonite,Amish Mennonite,,2151.76,,,,,,,1795.75,3912.30,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 5.0X15MM,80865,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,Amish/Mennonite,Amish Mennonite,,12589.50,,,,,,,11216.10,22203.30,percent of total billed charges,
SYSTEM NEUROSTIM 2.8CUCM 7.3GM H17XL47MM 2.16MM SPC MIC,80866,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,Amish/Mennonite,Amish Mennonite,,12589.50,,,,,,,10506.51,22890.00,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,509.06000,483.61000,Amish/Mennonite,Amish Mennonite,,279.98,,,,,,,279.98,493.79,percent of total billed charges,
TUBE JEJUSTMY 16FR BLLN 7-10ML SIL SECURELOK  0200-16,80867,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,509.06000,483.61000,Amish/Mennonite,Amish Mennonite,,279.98,,,,,,,44.30,493.79,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,inpatient,,,241.50000,229.42000,Amish/Mennonite,Amish Mennonite,,132.82,,,,,,,118.33,234.25,percent of total billed charges,
BREAST SWIM FORM PROSTH,80869,CDM,274,RC,L8030,HCPCS,,,facility,outpatient,,,241.50000,229.42000,Amish/Mennonite,Amish Mennonite,,132.82,,,,,,,120.75,485.24,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,Amish/Mennonite,Amish Mennonite,,208.72,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 3X4CM,80870,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,Amish/Mennonite,Amish Mennonite,,208.72,,,,,,,157.76,368.12,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,inpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,,507.10,,,,,,,507.10,894.34,percent of total billed charges,
"CHEMICAL PEEL,NONFACIAL;DERMAL-TECH",80871,CDM,510,RC,15793,CPT,,,facility,outpatient,,,922.00000,875.90000,Amish/Mennonite,Amish Mennonite,,507.10,,,,,,,379.37,894.34,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10192.80000,9683.16000,Amish/Mennonite,Amish Mennonite,,5606.04,,,,,,,4994.47,9887.02,percent of total billed charges,
GRAFT EVAR L7CM DIA14.5MM INT IL EXCLUDER,80874,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10192.80000,9683.16000,Amish/Mennonite,Amish Mennonite,,5606.04,,,,,,,4678.50,10192.80,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 20MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80875,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE LAAC 31MM NIT FRME PET DST FLUOROSCOPIC MRK W/ 12FR,80876,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR 2 CRV PBAX PTFE SHTH DIL,80877,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200MM STNT L32MM DIA4MM,80878,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12077.43,26312.49,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA6MM,80879,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L60MM DIA8MM,80880,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,12555.00000,11927.25000,Amish/Mennonite,Amish Mennonite,,6905.25,,,,,,,6151.95,12178.35,percent of total billed charges,
PACEMAKER CARD W4.45XH5.02CM D0.75CM 13.7CC 24.8GM DR STD 2,80881,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,12555.00000,11927.25000,Amish/Mennonite,Amish Mennonite,,6905.25,,,,,,,5762.74,12178.35,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,Amish/Mennonite,Amish Mennonite,,246.68,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH 18GA 10CM POWERGLIDE PRO REINF TIP FULL,80882,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,Amish/Mennonite,Amish Mennonite,,246.68,,,,,,,205.86,448.50,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,inpatient,1,GM,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.64,4.66,percent of total billed charges,
LIDOCAINE TOPICAL 5% OIN,80884,CDM,250,RC,51672-3008-03,NDC,,,facility,outpatient,1,GM,4.80000,4.56000,Amish/Mennonite,Amish Mennonite,,2.64,,,,,,,2.40,4.66,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,inpatient,1,GM,59.25000,56.29000,Amish/Mennonite,Amish Mennonite,,32.59,,,,,,,32.59,57.47,percent of total billed charges,
OLODATEROL-TIOTROPIUM 2.5 MCG-2.5 MCG/INH AER,80887,CDM,250,RC,00597-0155-70,NDC,,,facility,outpatient,1,GM,59.25000,56.29000,Amish/Mennonite,Amish Mennonite,,32.59,,,,,,,29.62,57.47,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,inpatient,1,EA,12.89000,12.25000,Amish/Mennonite,Amish Mennonite,,7.09,,,,,,,7.09,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,00143975325,NDC,facility,outpatient,1,EA,12.89000,12.25000,Amish/Mennonite,Amish Mennonite,,7.09,,,,,,,0.26000,12.50,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,inpatient,1,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,8.34,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,43598012725,NDC,facility,outpatient,1,EA,15.17000,14.41000,Amish/Mennonite,Amish Mennonite,,8.34,,,,,,,0.26000,14.71,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,inpatient,1,EA,19.21000,18.25000,Amish/Mennonite,Amish Mennonite,,10.57,,,,,,,10.57,18.63,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 40 MG,80888,CDM,636,RC,J2919,HCPCS,63323025503,NDC,facility,outpatient,1,EA,19.21000,18.25000,Amish/Mennonite,Amish Mennonite,,10.57,,,,,,,0.26000,18.63,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,inpatient,,,471.00000,447.45000,Amish/Mennonite,Amish Mennonite,,259.05,,,,,,,259.05,456.87,percent of total billed charges,
B CELLS,80889,CDM,300,RC,86355,CPT,,,facility,outpatient,,,471.00000,447.45000,Amish/Mennonite,Amish Mennonite,,259.05,,,,,,,37.73,1969.25,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,inpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.27500,0.48500,percent of total billed charges,
SUCRALFATE 500 MG TAB,80890,CDM,250,RC,51079-0753-20-00050,NDC,,,facility,outpatient,1,EA,0.50000,0.47000,Amish/Mennonite,Amish Mennonite,,0.27500,,,,,,,0.25000,0.48500,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX",80891,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,249.71,14445.56,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,inpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,5253.60,9265.44,percent of total billed charges,
IMRT DELIVERY; COMPLEX,80892,CDM,333,RC,77386,CPT,,,facility,outpatient,,,9552.00000,9074.40000,Amish/Mennonite,Amish Mennonite,,5253.60,,,,,,,549.28,20208.37,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,Amish/Mennonite,Amish Mennonite,TC,836.00,,,,,,,836.00,1474.40,percent of total billed charges,
TELETH ISODOSE PLN CPLX W/BASIC DOSIMETRY,80894,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,Amish/Mennonite,Amish Mennonite,TC,836.00,,,,,,,726.61,7529.89,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,Amish/Mennonite,Amish Mennonite,,813.45,,,,,,,813.45,1434.63,percent of total billed charges,
TELETH ISODOSE PLN SMPL W/DOSIMETRY CALC,80895,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,Amish/Mennonite,Amish Mennonite,,813.45,,,,,,,347.60,8423.93,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2366.70,4685.10,percent of total billed charges,
STENT PERIPH L100MM DIA16MM CATH L80MM SHTH 10FR GWIRE.,80897,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4830.00000,4588.50000,Amish/Mennonite,Amish Mennonite,,2656.50,,,,,,,2216.97,4830.00,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.0X20MM,80898,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,inpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,245.30,432.62,percent of total billed charges,
HIGH RESOLUTION,80899,CDM,310,RC,88289,CPT,,,facility,outpatient,,,446.00000,423.70000,Amish/Mennonite,Amish Mennonite,,245.30,,,,,,,34.43,1799.53,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,inpatient,,,1208.00000,1147.60000,Amish/Mennonite,Amish Mennonite,,664.40,,,,,,,664.40,1171.76,percent of total billed charges,
REMOVE LESION,80900,CDM,450,RC,,,,,facility,outpatient,,,1208.00000,1147.60000,Amish/Mennonite,Amish Mennonite,,664.40,,,,,,,604.00,1171.76,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,inpatient,,,1957.00000,1859.15000,Amish/Mennonite,Amish Mennonite,TC,1076.35,,,,,,,1076.35,1898.29,percent of total billed charges,
BREAST UNILAT W/O CONTRAST-TECH,80902,CDM,614,RC,77046,CPT,,,facility,outpatient,,,1957.00000,1859.15000,Amish/Mennonite,Amish Mennonite,TC,1076.35,,,,,,,978.50,2032.87,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,inpatient,,,1952.00000,1854.40000,Amish/Mennonite,Amish Mennonite,TC,1073.60,,,,,,,1073.60,1893.44,percent of total billed charges,
MRI-BREAST BILAT W/O CONTRAST-TECH,80903,CDM,614,RC,77047,CPT,,,facility,outpatient,,,1952.00000,1854.40000,Amish/Mennonite,Amish Mennonite,TC,1073.60,,,,,,,976.00,2032.87,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
"ISOVUE-M200,1ML",80906,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,99.55,175.57,percent of total billed charges,
REMOVAL IUD-ED/UC USE ONLY,80908,CDM,450,RC,58301,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,,99.55,,,,,,,90.50,317.72,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,64.90,114.46,percent of total billed charges,
RADIOLOGY PORT IMAGES(S),80909,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,59.00,619.83,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6900.00000,6555.00000,Amish/Mennonite,Amish Mennonite,,3795.00,,,,,,,3381.00,6693.00,percent of total billed charges,
STENT PERIPH L38MM DIA9MM CATH L80CM 0.035IN VASC SS EPTFE,80910,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6900.00000,6555.00000,Amish/Mennonite,Amish Mennonite,,3795.00,,,,,,,3167.10,6900.00,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1511.25000,1435.69000,Amish/Mennonite,Amish Mennonite,,831.19,,,,,,,740.51,1465.91,percent of total billed charges,
INTRO SHTH 20FR 40CM CKFL 56CM DIL ACPT .035IN,80912,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1511.25000,1435.69000,Amish/Mennonite,Amish Mennonite,,831.19,,,,,,,693.66,1511.25,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,24370.50000,23151.97000,Amish/Mennonite,Amish Mennonite,,13403.77,,,,,,,11941.55,23639.38,percent of total billed charges,
GRAFT EVAR L124MM DIA28MM SHTH OD7.7MM ID6.7MM ABD AORT WVN,80913,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,24370.50000,23151.97000,Amish/Mennonite,Amish Mennonite,,13403.77,,,,,,,11186.06,24370.50,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26213.60000,24902.92000,Amish/Mennonite,Amish Mennonite,,14417.48,,,,,,,12844.66,25427.19,percent of total billed charges,
GRAFT EVAR L103MM DIA28X14MM CATH 18FR POLY NIT STNT.,80914,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26213.60000,24902.92000,Amish/Mennonite,Amish Mennonite,,14417.48,,,,,,,12032.04,26213.60,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,Amish/Mennonite,Amish Mennonite,,7075.75,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA6MM CATH L135CM GWIRE 0.035IN CVR BLLN,80917,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,Amish/Mennonite,Amish Mennonite,,7075.75,,,,,,,5905.03,12865.00,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,12865.00000,12221.75000,Amish/Mennonite,Amish Mennonite,,7075.75,,,,,,,6303.85,12479.05,percent of total billed charges,
STENT PERIPH L26MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,80918,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,12865.00000,12221.75000,Amish/Mennonite,Amish Mennonite,,7075.75,,,,,,,5905.03,12865.00,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHTH GUID AD L45CM OD7FR ID2.5MM,80919,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID 7FR L100CM L COR SS PTFE XBLAD3.5,80920,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 6MM 75CM ULTRAVERSE 035,80922,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 4CM 1.5MM 150CM ULTRAVERSE 014,80923,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,,2163.15,,,,,,,1927.17,3815.01,percent of total billed charges,
SHEATH INTRO 8.8MM 24FR 65CM HDRPH GORE DRYSEAL,80924,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3933.00000,3736.35000,Amish/Mennonite,Amish Mennonite,,2163.15,,,,,,,1805.25,3933.00,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L14CM AORT DIA23MM IL DIA12MM INFRARENAL TRUNK,80925,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,inpatient,,,379.50000,360.52000,Amish/Mennonite,Amish Mennonite,,208.72,,,,,,,208.72,368.12,percent of total billed charges,
PURAPLY AM EF 4X4CM,80926,CDM,636,RC,Q4196,HCPCS,,,facility,outpatient,,,379.50000,360.52000,Amish/Mennonite,Amish Mennonite,,208.72,,,,,,,157.76,368.12,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,inpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,TC,248.60,,,,,,,248.60,438.44,percent of total billed charges,
ROTATIONAL CHAIR-TECH,80930,CDM,471,RC,92546,CPT,,,facility,outpatient,,,452.00000,429.40000,Amish/Mennonite,Amish Mennonite,TC,248.60,,,,,,,226.00,438.44,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,inpatient,,,23.07000,21.92000,Amish/Mennonite,Amish Mennonite,,12.69,,,,,,,12.69,22.38,percent of total billed charges,
INSERTION TRAY;INDWELLING CATH,80932,CDM,272,RC,A4311,HCPCS,,,facility,outpatient,,,23.07000,21.92000,Amish/Mennonite,Amish Mennonite,,12.69,,,,,,,11.54,23.80,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,inpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,2.02,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,00527-5513-37,NDC,,,facility,outpatient,1,EA,3.67000,3.49000,Amish/Mennonite,Amish Mennonite,,2.02,,,,,,,1.83,3.56,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,inpatient,1,EA,17.16000,16.30000,Amish/Mennonite,Amish Mennonite,,9.44,,,,,,,9.44,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,60687-0509-25,NDC,,,facility,outpatient,1,EA,17.16000,16.30000,Amish/Mennonite,Amish Mennonite,,9.44,,,,,,,8.58,16.65,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,inpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
AMPHETAMINE-DEXTROAMPHETAMINE 20 MG CAP-ER,80935,CDM,250,RC,66993-0597-02,NDC,,,facility,outpatient,1,EA,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,3.38,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,inpatient,,,10.40000,9.88000,Amish/Mennonite,Amish Mennonite,,5.72,,,,,,,5.72,10.09,percent of total billed charges,
URINARY LEG BAG,80936,CDM,272,RC,A4358,HCPCS,,,facility,outpatient,,,10.40000,9.88000,Amish/Mennonite,Amish Mennonite,,5.72,,,,,,,5.20,10.66,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,70.44000,66.92000,Amish/Mennonite,Amish Mennonite,,38.74,,,,,,,38.74,68.33,percent of total billed charges,
"DJ CROSS STRAP,KNEE",80937,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,70.44000,66.92000,Amish/Mennonite,Amish Mennonite,,38.74,,,,,,,35.22,68.33,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,inpatient,,,99.47000,94.50000,Amish/Mennonite,Amish Mennonite,,54.71,,,,,,,48.74,96.49,percent of total billed charges,
WRIST WIDGET,80938,CDM,274,RC,L3906,HCPCS,,,facility,outpatient,,,99.47000,94.50000,Amish/Mennonite,Amish Mennonite,,54.71,,,,,,,49.73,639.03,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,87.25000,82.89000,Amish/Mennonite,Amish Mennonite,,47.99,,,,,,,47.99,84.63,percent of total billed charges,
ULNAR COMPR WRAP,80939,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,87.25000,82.89000,Amish/Mennonite,Amish Mennonite,,47.99,,,,,,,43.62,84.63,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,78.40000,74.48000,Amish/Mennonite,Amish Mennonite,,43.12,,,,,,,43.12,76.05,percent of total billed charges,
KNEEDIT W/O MAGNETC,80940,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,78.40000,74.48000,Amish/Mennonite,Amish Mennonite,,43.12,,,,,,,39.20,76.05,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,11.78000,11.19000,Amish/Mennonite,Amish Mennonite,,6.48,,,,,,,6.48,11.43,percent of total billed charges,
"DIGITS STRAP,NONEL",80941,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,11.78000,11.19000,Amish/Mennonite,Amish Mennonite,,6.48,,,,,,,5.89,11.43,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,69.33000,65.86000,Amish/Mennonite,Amish Mennonite,,38.13,,,,,,,38.13,67.25,percent of total billed charges,
POSTURE SUPPORT CORRECTOR,80942,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,69.33000,65.86000,Amish/Mennonite,Amish Mennonite,,38.13,,,,,,,34.66,67.25,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,36.13000,34.32000,Amish/Mennonite,Amish Mennonite,,19.87,,,,,,,19.87,35.05,percent of total billed charges,
HAND-BASED IN-LINE SPLINT,80943,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,36.13000,34.32000,Amish/Mennonite,Amish Mennonite,,19.87,,,,,,,18.07,35.05,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,153.40000,145.73000,Amish/Mennonite,Amish Mennonite,,84.37,,,,,,,84.37,148.80,percent of total billed charges,
NEOPRENE SHOULDER SUPPORT SNG,80944,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,153.40000,145.73000,Amish/Mennonite,Amish Mennonite,,84.37,,,,,,,76.70,148.80,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.53000,29.00000,Amish/Mennonite,Amish Mennonite,,16.79,,,,,,,16.79,29.61,percent of total billed charges,
SLV CALF OR THIGH,80945,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.53000,29.00000,Amish/Mennonite,Amish Mennonite,,16.79,,,,,,,15.27,29.61,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,81.40,143.56,percent of total billed charges,
SHOULDER SUPPORT,80946,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,148.00000,140.60000,Amish/Mennonite,Amish Mennonite,,81.40,,,,,,,74.00,143.56,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,209.31000,198.84000,Amish/Mennonite,Amish Mennonite,,115.12,,,,,,,115.12,203.03,percent of total billed charges,
KUHL SHIELDS BRACE,80947,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,209.31000,198.84000,Amish/Mennonite,Amish Mennonite,,115.12,,,,,,,104.66,203.03,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,160.90000,152.85000,Amish/Mennonite,Amish Mennonite,,88.50,,,,,,,88.50,156.07,percent of total billed charges,
BREAST BINDER,80948,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,160.90000,152.85000,Amish/Mennonite,Amish Mennonite,,88.50,,,,,,,80.45,156.07,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,40.67000,38.64000,Amish/Mennonite,Amish Mennonite,,22.37,,,,,,,22.37,39.45,percent of total billed charges,
MIDFOOT COMPR WRAP,80949,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,40.67000,38.64000,Amish/Mennonite,Amish Mennonite,,22.37,,,,,,,20.34,39.45,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,49.47000,47.00000,Amish/Mennonite,Amish Mennonite,,27.21,,,,,,,27.21,47.99,percent of total billed charges,
ANKLE SLEEVE,80950,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,49.47000,47.00000,Amish/Mennonite,Amish Mennonite,,27.21,,,,,,,24.73,47.99,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,370.50000,351.97000,Amish/Mennonite,Amish Mennonite,,203.78,,,,,,,203.78,359.38,percent of total billed charges,
G TUBE PROTECTIVE BELT,80951,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,370.50000,351.97000,Amish/Mennonite,Amish Mennonite,,203.78,,,,,,,185.25,359.38,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.20000,41.04000,Amish/Mennonite,Amish Mennonite,,23.76,,,,,,,23.76,41.90,percent of total billed charges,
GEL ACHILLES SLEEVE,80953,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.20000,41.04000,Amish/Mennonite,Amish Mennonite,,23.76,,,,,,,21.60,41.90,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,59.60000,56.62000,Amish/Mennonite,Amish Mennonite,,32.78,,,,,,,32.78,57.81,percent of total billed charges,
SMART GLOVE,80954,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,59.60000,56.62000,Amish/Mennonite,Amish Mennonite,,32.78,,,,,,,29.80,57.81,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.80,15.52,percent of total billed charges,
ATHLETIC SUPPORTER,80955,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.00,15.52,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,182.76000,173.62000,Amish/Mennonite,Amish Mennonite,,100.52,,,,,,,100.52,177.28,percent of total billed charges,
PO VEST W/CUPS NON-MASTECT PT,80956,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,182.76000,173.62000,Amish/Mennonite,Amish Mennonite,,100.52,,,,,,,91.38,177.28,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,inpatient,,,15.60000,14.82000,Amish/Mennonite,Amish Mennonite,NU,8.58,,,,,,,8.58,15.13,percent of total billed charges,
FOAM HEEL AND ANKLE PROT,80957,CDM,271,RC,E0191,HCPCS,,,facility,outpatient,,,15.60000,14.82000,Amish/Mennonite,Amish Mennonite,NU,8.58,,,,,,,7.80,16.05,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,inpatient,,,80.44000,76.42000,Amish/Mennonite,Amish Mennonite,,44.24,,,,,,,39.42,78.03,percent of total billed charges,
AFO PRE-FAB SPLINT,80959,CDM,274,RC,L1930,HCPCS,,,facility,outpatient,,,80.44000,76.42000,Amish/Mennonite,Amish Mennonite,,44.24,,,,,,,40.22,349.06,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,inpatient,,,29.60000,28.12000,Amish/Mennonite,Amish Mennonite,,16.28,,,,,,,14.50,28.71,percent of total billed charges,
ANKLE STR RPLC ONLY,80961,CDM,274,RC,L4002,HCPCS,,,facility,outpatient,,,29.60000,28.12000,Amish/Mennonite,Amish Mennonite,,16.28,,,,,,,14.80,28.71,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,inpatient,,,20.27000,19.26000,Amish/Mennonite,Amish Mennonite,,11.15,,,,,,,11.15,19.66,percent of total billed charges,
"ANTI-EMBOL STKG,CALF 18-MMHG",80962,CDM,271,RC,A4500,HCPCS,,,facility,outpatient,,,20.27000,19.26000,Amish/Mennonite,Amish Mennonite,,11.15,,,,,,,10.13,19.66,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.68000,92.80000,Amish/Mennonite,Amish Mennonite,,53.72,,,,,,,53.72,94.75,percent of total billed charges,
ANKLE CONTRACTURE SPLINT,80964,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.68000,92.80000,Amish/Mennonite,Amish Mennonite,,53.72,,,,,,,48.84,94.75,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,,43.34,,,,,,,38.61,76.44,percent of total billed charges,
BACK SUPPORT RIGID,80965,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,,43.34,,,,,,,39.40,76.44,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,Amish/Mennonite,Amish Mennonite,,35.46,,,,,,,35.46,62.55,percent of total billed charges,
AQUASHIELD CAST BNDG PROTECTOR,80966,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,Amish/Mennonite,Amish Mennonite,,35.46,,,,,,,32.24,62.55,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,89.56000,85.08000,Amish/Mennonite,Amish Mennonite,,49.26,,,,,,,49.26,86.87,percent of total billed charges,
AIRCAST AIR HEEL,80967,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,89.56000,85.08000,Amish/Mennonite,Amish Mennonite,,49.26,,,,,,,44.78,86.87,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,671.26000,637.70000,Amish/Mennonite,Amish Mennonite,,369.19,,,,,,,369.19,651.12,percent of total billed charges,
BARIATRIC ROOKE BOOT,80968,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,671.26000,637.70000,Amish/Mennonite,Amish Mennonite,,369.19,,,,,,,335.63,651.12,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,104.10000,98.89000,Amish/Mennonite,Amish Mennonite,,57.26,,,,,,,57.26,100.98,percent of total billed charges,
BIG BUTLER,80969,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,104.10000,98.89000,Amish/Mennonite,Amish Mennonite,,57.26,,,,,,,52.05,100.98,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,inpatient,,,66.50000,63.17000,Amish/Mennonite,Amish Mennonite,NU,36.58,,,,,,,36.58,64.50,percent of total billed charges,
CERVICAL TRACTION KIT,80970,CDM,292,RC,E0860,HCPCS,,,facility,outpatient,,,66.50000,63.17000,Amish/Mennonite,Amish Mennonite,NU,36.58,,,,,,,33.25,64.50,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,100.08000,95.08000,Amish/Mennonite,Amish Mennonite,,55.04,,,,,,,49.04,97.08,percent of total billed charges,
ANKLE CONTRACTURE SPLINT-PF/CS,80971,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,100.08000,95.08000,Amish/Mennonite,Amish Mennonite,,55.04,,,,,,,50.04,232.52,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
BELOTERO GEL 1.0ML,80973,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,inpatient,,,30.53000,29.00000,Amish/Mennonite,Amish Mennonite,,16.79,,,,,,,16.79,29.61,percent of total billed charges,
"ANTI-EMBOL STKG,THIGH 18-MMHG",80974,CDM,271,RC,A4495,HCPCS,,,facility,outpatient,,,30.53000,29.00000,Amish/Mennonite,Amish Mennonite,,16.79,,,,,,,15.27,29.61,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,19.97000,18.97000,Amish/Mennonite,Amish Mennonite,,10.98,,,,,,,9.79,19.37,percent of total billed charges,
BK STOCKING,80975,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,19.97000,18.97000,Amish/Mennonite,Amish Mennonite,,10.98,,,,,,,9.17,19.37,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,20.30000,19.28000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,11.16,19.69,percent of total billed charges,
CLASSIC ELEC BREASTPUMP KIT,80976,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,20.30000,19.28000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,10.15,19.69,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,23.33000,22.16000,Amish/Mennonite,Amish Mennonite,,12.83,,,,,,,12.83,22.63,percent of total billed charges,
"COMPRILAN BDG 3.1""",80980,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,23.33000,22.16000,Amish/Mennonite,Amish Mennonite,,12.83,,,,,,,2.63,22.63,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,268.98000,255.53000,Amish/Mennonite,Amish Mennonite,,147.94,,,,,,,147.94,260.91,percent of total billed charges,
CPAP HEADGEAR,80982,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,268.98000,255.53000,Amish/Mennonite,Amish Mennonite,,147.94,,,,,,,134.49,260.91,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,21.70000,20.61000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,11.94,21.05,percent of total billed charges,
COMFORT GEL HYDROGEL PADS/SET,80984,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,21.70000,20.61000,Amish/Mennonite,Amish Mennonite,,11.94,,,,,,,10.85,21.05,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,inpatient,,,321.94000,305.84000,Amish/Mennonite,Amish Mennonite,NU,177.07,,,,,,,177.07,312.28,percent of total billed charges,
"CRUTCHES,UNDRARM,HD,OTH THN WOOD",80985,CDM,271,RC,E0114,HCPCS,,,facility,outpatient,,,321.94000,305.84000,Amish/Mennonite,Amish Mennonite,NU,177.07,,,,,,,70.83,312.28,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,79.20000,75.24000,Amish/Mennonite,Amish Mennonite,,43.56,,,,,,,43.56,76.82,percent of total billed charges,
EVENUP SHOE LEVELER,80988,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,79.20000,75.24000,Amish/Mennonite,Amish Mennonite,,43.56,,,,,,,39.60,76.82,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,276.53000,262.70000,Amish/Mennonite,Amish Mennonite,,152.09,,,,,,,152.09,268.23,percent of total billed charges,
EXOSOFT GLOVE,80990,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,276.53000,262.70000,Amish/Mennonite,Amish Mennonite,,152.09,,,,,,,138.26,268.23,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,401.25000,381.19000,Amish/Mennonite,Amish Mennonite,,220.69,,,,,,,220.69,389.21,percent of total billed charges,
FARROW CLASSIC THIGH PIECE,80991,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,401.25000,381.19000,Amish/Mennonite,Amish Mennonite,,220.69,,,,,,,200.62,389.21,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,63.80,112.52,percent of total billed charges,
FARROW STRONG EXTRA LEG BAND,80992,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,58.00,112.52,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,359.81000,341.82000,Amish/Mennonite,Amish Mennonite,,197.90,,,,,,,197.90,349.02,percent of total billed charges,
FARROW 1/2 FIN/GL,80993,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,359.81000,341.82000,Amish/Mennonite,Amish Mennonite,,197.90,,,,,,,179.91,349.02,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,702.00000,666.90000,Amish/Mennonite,Amish Mennonite,,386.10,,,,,,,386.10,680.94,percent of total billed charges,
EAR WELL BILAT CORRECTION,80995,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,702.00000,666.90000,Amish/Mennonite,Amish Mennonite,,386.10,,,,,,,351.00,680.94,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,inpatient,,,251.80000,239.21000,Amish/Mennonite,Amish Mennonite,,138.49,,,,,,,123.38,244.25,percent of total billed charges,
CUSTOM LOWER LEG ORTHOSIS,80996,CDM,274,RC,L2999,HCPCS,,,facility,outpatient,,,251.80000,239.21000,Amish/Mennonite,Amish Mennonite,,138.49,,,,,,,115.58,244.25,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,96.04,190.12,percent of total billed charges,
FARROW WRAP 4000,80998,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,89.96,190.12,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,233.36,461.96,percent of total billed charges,
FARROW WRAP CUST CLS LEG 30-40,80999,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,476.25000,452.44000,Amish/Mennonite,Amish Mennonite,,261.94,,,,,,,218.60,461.96,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,73.50,145.50,percent of total billed charges,
CPAP NASAL MASK W/O HEADGEAR,81000,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,68.85,145.50,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,517.50000,491.62000,Amish/Mennonite,Amish Mennonite,,284.62,,,,,,,253.57,501.98,percent of total billed charges,
FARROW WRAP CUSTCLS LEG 35-39,81001,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,517.50000,491.62000,Amish/Mennonite,Amish Mennonite,,284.62,,,,,,,237.53,501.98,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,13.80000,13.11000,Amish/Mennonite,Amish Mennonite,,7.59,,,,,,,7.59,13.39,percent of total billed charges,
CONTACT NIPPLE SHIELD,81002,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,13.80000,13.11000,Amish/Mennonite,Amish Mennonite,,7.59,,,,,,,6.90,13.39,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,351.10000,333.54000,Amish/Mennonite,Amish Mennonite,,193.10,,,,,,,193.10,340.57,percent of total billed charges,
EARWELL UNILAT CORRECTION,81003,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,351.10000,333.54000,Amish/Mennonite,Amish Mennonite,,193.10,,,,,,,175.55,340.57,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,22.00,38.80,percent of total billed charges,
EXERCISE BALL-65CM,81007,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,40.00000,38.00000,Amish/Mennonite,Amish Mennonite,,22.00,,,,,,,20.00,38.80,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,inpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,142.45,251.23,percent of total billed charges,
HEADGEAR,81008,CDM,290,RC,A7035,HCPCS,,,facility,outpatient,,,259.00000,246.05000,Amish/Mennonite,Amish Mennonite,,142.45,,,,,,,129.50,251.23,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,137.16,241.90,percent of total billed charges,
HEEL MEDIX BOOT XL,81010,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,249.38000,236.91000,Amish/Mennonite,Amish Mennonite,,137.16,,,,,,,124.69,241.90,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,181.40000,172.33000,Amish/Mennonite,Amish Mennonite,,99.77,,,,,,,88.89,175.96,percent of total billed charges,
HEEL RELIEF SHOE,81011,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,181.40000,172.33000,Amish/Mennonite,Amish Mennonite,,99.77,,,,,,,83.26,175.96,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,inpatient,,,18.56000,17.63000,Amish/Mennonite,Amish Mennonite,,10.21,,,,,,,9.09,18.00,percent of total billed charges,
HAMMER TOE CRESTS,81012,CDM,274,RC,A9270,HCPCS,,,facility,outpatient,,,18.56000,17.63000,Amish/Mennonite,Amish Mennonite,,10.21,,,,,,,8.52,18.00,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,195.08000,185.33000,Amish/Mennonite,Amish Mennonite,,107.29,,,,,,,95.59,189.23,percent of total billed charges,
FARROW WRAP TOE CAP,81014,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,195.08000,185.33000,Amish/Mennonite,Amish Mennonite,,107.29,,,,,,,89.54,189.23,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,inpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,275.62,545.62,percent of total billed charges,
DOBBS QUICK RELEASE BAR,81016,CDM,274,RC,L3150,HCPCS,,,facility,outpatient,,,562.50000,534.38000,Amish/Mennonite,Amish Mennonite,,309.38,,,,,,,105.37,545.62,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,59.90000,56.90000,Amish/Mennonite,Amish Mennonite,,32.95,,,,,,,29.35,58.10,percent of total billed charges,
"FOOT;ARCH SUPPORT,EACH",81017,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,59.90000,56.90000,Amish/Mennonite,Amish Mennonite,,32.95,,,,,,,29.95,65.22,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,584.33000,555.11000,Amish/Mennonite,Amish Mennonite,,321.38,,,,,,,321.38,566.80,percent of total billed charges,
FUNCTION FOAM ARM ELEVATOR,81018,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,584.33000,555.11000,Amish/Mennonite,Amish Mennonite,,321.38,,,,,,,292.17,566.80,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,inpatient,,,356.30000,338.48000,Amish/Mennonite,Amish Mennonite,,195.97,,,,,,,195.97,345.61,percent of total billed charges,
"HELMET,PROTEC,HARD,PREFABRIC",81019,CDM,290,RC,A8001,HCPCS,,,facility,outpatient,,,356.30000,338.48000,Amish/Mennonite,Amish Mennonite,,195.97,,,,,,,178.15,345.61,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,152.51,301.91,percent of total billed charges,
FARROW WRAP CUST CLASSIC FOOT,81020,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,311.25000,295.69000,Amish/Mennonite,Amish Mennonite,,171.19,,,,,,,142.86,301.91,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,97.39,192.79,percent of total billed charges,
"JUXTA-FIT,THIGH",81021,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,198.75000,188.81000,Amish/Mennonite,Amish Mennonite,,109.31,,,,,,,91.23,192.79,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,55.07000,52.32000,Amish/Mennonite,Amish Mennonite,,30.29,,,,,,,30.29,53.42,percent of total billed charges,
"HEEL/ELBOW PROTECTOR,EACH",81022,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,55.07000,52.32000,Amish/Mennonite,Amish Mennonite,,30.29,,,,,,,27.54,53.42,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,926.00000,879.70000,Amish/Mennonite,Amish Mennonite,,509.30,,,,,,,509.30,898.22,percent of total billed charges,
JUVDRMVOLUMAXC 1ML,81023,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,926.00000,879.70000,Amish/Mennonite,Amish Mennonite,,509.30,,,,,,,463.00,898.22,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,596.00000,566.20000,Amish/Mennonite,Amish Mennonite,,327.80,,,,,,,292.04,578.12,percent of total billed charges,
JUXTA-PREM CALF/FOOT,81024,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,596.00000,566.20000,Amish/Mennonite,Amish Mennonite,,327.80,,,,,,,273.56,578.12,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,228.79000,217.35000,Amish/Mennonite,Amish Mennonite,,125.83,,,,,,,125.83,221.93,percent of total billed charges,
KNEE WRAP W/O HINGES,81026,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,228.79000,217.35000,Amish/Mennonite,Amish Mennonite,,125.83,,,,,,,114.39,221.93,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,263.81000,250.62000,Amish/Mennonite,Amish Mennonite,NU,145.10,,,,,,,145.10,255.90,percent of total billed charges,
INVACARE WHEELED WALKER COMBO,81028,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,263.81000,250.62000,Amish/Mennonite,Amish Mennonite,NU,145.10,,,,,,,62.66,255.90,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,inpatient,,,87.08000,82.73000,Amish/Mennonite,Amish Mennonite,,47.89,,,,,,,42.67,84.47,percent of total billed charges,
IMAK ELBOW SUPPORT,81029,CDM,274,RC,L3762,HCPCS,,,facility,outpatient,,,87.08000,82.73000,Amish/Mennonite,Amish Mennonite,,47.89,,,,,,,43.54,135.57,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,76.44,151.32,percent of total billed charges,
HEALING ABUTMENT L8499,81030,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,156.00000,148.20000,Amish/Mennonite,Amish Mennonite,,85.80,,,,,,,71.60,151.32,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,25.10000,23.84000,Amish/Mennonite,Amish Mennonite,,13.80,,,,,,,13.80,24.35,percent of total billed charges,
HAND CONE TERRY CLOTH/PLASTIC,81031,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,25.10000,23.84000,Amish/Mennonite,Amish Mennonite,,13.80,,,,,,,12.55,24.35,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,100.44000,95.42000,Amish/Mennonite,Amish Mennonite,,55.24,,,,,,,49.22,97.43,percent of total billed charges,
LSO WARM/FORM W/RIGID INSERT,81032,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,100.44000,95.42000,Amish/Mennonite,Amish Mennonite,,55.24,,,,,,,39.47,97.43,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,98.67000,93.74000,Amish/Mennonite,Amish Mennonite,,54.27,,,,,,,54.27,95.71,percent of total billed charges,
"LYMPHADEMA SLEEVE,ARM",81033,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,98.67000,93.74000,Amish/Mennonite,Amish Mennonite,,54.27,,,,,,,49.34,95.71,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,507.00000,481.65000,Amish/Mennonite,Amish Mennonite,,278.85,,,,,,,278.85,491.79,percent of total billed charges,
CRYOCUFF AND COOLER W/O PUMP,81034,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,507.00000,481.65000,Amish/Mennonite,Amish Mennonite,,278.85,,,,,,,253.50,491.79,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,Amish/Mennonite,Amish Mennonite,,94.16,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-PELVIC SEC ONLY,81035,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,Amish/Mennonite,Amish Mennonite,,94.16,,,,,,,85.60,166.06,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,inpatient,,,159.90000,151.90000,Amish/Mennonite,Amish Mennonite,,87.94,,,,,,,87.94,155.10,percent of total billed charges,
"MIC TUBE,STANDARD, ANY MATL",81037,CDM,272,RC,B4087,HCPCS,,,facility,outpatient,,,159.90000,151.90000,Amish/Mennonite,Amish Mennonite,,87.94,,,,,,,44.30,155.10,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,inpatient,,,231.38000,219.81000,Amish/Mennonite,Amish Mennonite,,127.26,,,,,,,113.38,224.44,percent of total billed charges,
"FOREARM SPLINT,CUSTOM",81040,CDM,274,RC,L3999,HCPCS,,,facility,outpatient,,,231.38000,219.81000,Amish/Mennonite,Amish Mennonite,,127.26,,,,,,,106.20,224.44,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
NASAL INTERFACE,81041,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,104.00,201.76,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,inpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,107.80,190.12,percent of total billed charges,
MIRAGE ACTIVA FRAME ASSEMBLY,81042,CDM,271,RC,A7034,HCPCS,,,facility,outpatient,,,196.00000,186.20000,Amish/Mennonite,Amish Mennonite,,107.80,,,,,,,98.00,190.12,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULPL 0.4ML,81043,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,inpatient,,,39.80000,37.81000,Amish/Mennonite,Amish Mennonite,,21.89,,,,,,,21.89,38.61,percent of total billed charges,
NORCO COMPRES GLOVE,81044,CDM,271,RC,S8427,HCPCS,,,facility,outpatient,,,39.80000,37.81000,Amish/Mennonite,Amish Mennonite,,21.89,,,,,,,19.90,38.61,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,193.71000,184.02000,Amish/Mennonite,Amish Mennonite,,106.54,,,,,,,94.92,187.90,percent of total billed charges,
NASAL INTERFACE W/OR W/O STRAP,81045,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,193.71000,184.02000,Amish/Mennonite,Amish Mennonite,,106.54,,,,,,,88.91,187.90,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,101.20,178.48,percent of total billed charges,
NOSE GUARD,81046,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,,101.20,,,,,,,92.00,178.48,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,inpatient,,,74.13000,70.42000,Amish/Mennonite,Amish Mennonite,,40.77,,,,,,,40.77,71.91,percent of total billed charges,
"MAT BELT,ULT SUPPORT NON-RIGID",81047,CDM,271,RC,L0625,HCPCS,,,facility,outpatient,,,74.13000,70.42000,Amish/Mennonite,Amish Mennonite,,40.77,,,,,,,37.06,71.91,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,inpatient,,,333.00000,316.35000,Amish/Mennonite,Amish Mennonite,,183.15,,,,,,,183.15,323.01,percent of total billed charges,
"HELMET,PROTEC,SOFT,PREFABRIC",81049,CDM,271,RC,A8000,HCPCS,,,facility,outpatient,,,333.00000,316.35000,Amish/Mennonite,Amish Mennonite,,183.15,,,,,,,166.50,323.01,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.40,7.76,percent of total billed charges,
FILTER DISPOSABLE,81050,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,8.00000,7.60000,Amish/Mennonite,Amish Mennonite,,4.40,,,,,,,4.00,7.76,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.67,6.47,percent of total billed charges,
"ELASTIC BNDG 4""",81051,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,2.63,6.47,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,inpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,21.41,37.76,percent of total billed charges,
"ISOBAND BNDG,5.9""",81052,CDM,272,RC,A6450,HCPCS,,,facility,outpatient,,,38.93000,36.98000,Amish/Mennonite,Amish Mennonite,,21.41,,,,,,,2.63,37.76,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,41.33000,39.26000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,22.73,40.09,percent of total billed charges,
"ORTH  WHFO,ELAS,PREFAB,FIT/ADJ",81053,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,41.33000,39.26000,Amish/Mennonite,Amish Mennonite,,22.73,,,,,,,20.66,40.09,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
JUVDRMULXC 0.4ML,81054,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,21.47000,20.40000,Amish/Mennonite,Amish Mennonite,,11.81,,,,,,,10.52,20.83,percent of total billed charges,
"ORTH AMBULATORY SRGCL BOOT,EA",81055,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,21.47000,20.40000,Amish/Mennonite,Amish Mennonite,,11.81,,,,,,,9.85,20.83,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,inpatient,,,197.33000,187.46000,Amish/Mennonite,Amish Mennonite,,108.53,,,,,,,108.53,191.41,percent of total billed charges,
EXOSOFT ARM SLEEVE,81056,CDM,271,RC,S8424,HCPCS,,,facility,outpatient,,,197.33000,187.46000,Amish/Mennonite,Amish Mennonite,,108.53,,,,,,,98.67,191.41,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,267.68000,254.30000,Amish/Mennonite,Amish Mennonite,,147.22,,,,,,,131.16,259.65,percent of total billed charges,
FOREFOOT RELIEF ORTHOSIS,81057,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,267.68000,254.30000,Amish/Mennonite,Amish Mennonite,,147.22,,,,,,,122.87,259.65,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,30.44000,28.92000,Amish/Mennonite,Amish Mennonite,,16.74,,,,,,,16.74,29.53,percent of total billed charges,
"ORTH  EO,ELAS,PREFAB,W/O STAYS",81058,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,30.44000,28.92000,Amish/Mennonite,Amish Mennonite,,16.74,,,,,,,15.22,29.53,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
JUVDEMULPLXC 1.0ML,81061,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,inpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.27,6.47,percent of total billed charges,
"METATARSAL PAD,EA",81062,CDM,274,RC,L3050,HCPCS,,,facility,outpatient,,,6.67000,6.34000,Amish/Mennonite,Amish Mennonite,,3.67,,,,,,,3.33,65.22,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,inpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,163.54,323.74,percent of total billed charges,
PEDIATRIC WISP NASAL MASK,81063,CDM,274,RC,A7034,HCPCS,,,facility,outpatient,,,333.75000,317.06000,Amish/Mennonite,Amish Mennonite,,183.56,,,,,,,153.19,323.74,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,inpatient,,,51.63000,49.05000,Amish/Mennonite,Amish Mennonite,,28.40,,,,,,,25.30,50.08,percent of total billed charges,
"ORTH  FTWEAR,SRG BOOT/SHOE,EACH",81064,CDM,274,RC,L3260,HCPCS,,,facility,outpatient,,,51.63000,49.05000,Amish/Mennonite,Amish Mennonite,,28.40,,,,,,,23.70,50.08,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,14.08,24.83,percent of total billed charges,
P-CELL INSERT NON-MOD A9283,81065,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,25.60000,24.32000,Amish/Mennonite,Amish Mennonite,,14.08,,,,,,,12.80,24.83,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,,99.66,,,,,,,88.79,175.76,percent of total billed charges,
"LUMB ORTHO NON-EL PREFAB,RIGID",81066,CDM,274,RC,L0625,HCPCS,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,,99.66,,,,,,,39.47,175.76,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,254.66000,241.93000,Amish/Mennonite,Amish Mennonite,,140.06,,,,,,,140.06,247.02,percent of total billed charges,
POWER SUP W/POWER CORD REPL,81068,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,254.66000,241.93000,Amish/Mennonite,Amish Mennonite,,140.06,,,,,,,127.33,247.02,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,97.33000,92.46000,Amish/Mennonite,Amish Mennonite,,53.53,,,,,,,53.53,94.41,percent of total billed charges,
HEEL MEDIX BOOT,81069,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,97.33000,92.46000,Amish/Mennonite,Amish Mennonite,,53.53,,,,,,,48.66,94.41,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,inpatient,,,16.40000,15.58000,Amish/Mennonite,Amish Mennonite,,9.02,,,,,,,8.04,15.91,percent of total billed charges,
"ORTH  CERVICAL,FOAM COLLAR",81070,CDM,274,RC,L0120,HCPCS,,,facility,outpatient,,,16.40000,15.58000,Amish/Mennonite,Amish Mennonite,,9.02,,,,,,,8.20,36.65,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,645.11000,612.85000,Amish/Mennonite,Amish Mennonite,,354.81,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO, BARIATRIC-PF/CS",81071,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,645.11000,612.85000,Amish/Mennonite,Amish Mennonite,,354.81,,,,,,,217.19,625.76,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,694.00000,659.30000,Amish/Mennonite,Amish Mennonite,,381.70,,,,,,,381.70,673.18,percent of total billed charges,
"PRAFO, BARIATRIC",81072,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,694.00000,659.30000,Amish/Mennonite,Amish Mennonite,,381.70,,,,,,,347.00,673.18,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,inpatient,,,67.73000,64.34000,Amish/Mennonite,Amish Mennonite,,37.25,,,,,,,37.25,65.70,percent of total billed charges,
FOOT/HEEL PROTECTOR,81073,CDM,290,RC,A9283,HCPCS,,,facility,outpatient,,,67.73000,64.34000,Amish/Mennonite,Amish Mennonite,,37.25,,,,,,,33.87,65.70,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,56.84,112.52,percent of total billed charges,
PRSTH  EXT BREAST PROS GARMENT,81074,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,116.00000,110.20000,Amish/Mennonite,Amish Mennonite,,63.80,,,,,,,58.00,112.52,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,15.70000,14.91000,Amish/Mennonite,Amish Mennonite,,8.63,,,,,,,8.63,15.23,percent of total billed charges,
IT STAYS BODY ADH,81075,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,15.70000,14.91000,Amish/Mennonite,Amish Mennonite,,8.63,,,,,,,7.85,15.23,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
PROSTHETIC FOOT COVER,81077,CDM,274,RC,L8499,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,363.75,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,inpatient,,,184.19000,174.98000,Amish/Mennonite,Amish Mennonite,,101.30,,,,,,,90.25,178.66,percent of total billed charges,
PO VEST W/CUPS MASTECTOMY PT,81078,CDM,274,RC,L8015,HCPCS,,,facility,outpatient,,,184.19000,174.98000,Amish/Mennonite,Amish Mennonite,,101.30,,,,,,,77.73,178.66,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,inpatient,,,399.94000,379.94000,Amish/Mennonite,Amish Mennonite,,219.97,,,,,,,195.97,387.94,percent of total billed charges,
"PRAFO,PREFAB-PF/CS",81079,CDM,274,RC,L4396,HCPCS,,,facility,outpatient,,,399.94000,379.94000,Amish/Mennonite,Amish Mennonite,,219.97,,,,,,,199.97,387.94,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,131.96000,125.36000,Amish/Mennonite,Amish Mennonite,,72.58,,,,,,,72.58,128.00,percent of total billed charges,
OSSUR CTI GEAR GUARDS PKG 2,81080,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,131.96000,125.36000,Amish/Mennonite,Amish Mennonite,,72.58,,,,,,,65.98,128.00,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE GEL,81081,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE REFY,81082,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,347.50,674.15,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,381.20000,362.14000,Amish/Mennonite,Amish Mennonite,,209.66,,,,,,,209.66,369.76,percent of total billed charges,
ORAL CPAP MASK STRAP ATTACHMNT,81083,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,381.20000,362.14000,Amish/Mennonite,Amish Mennonite,,209.66,,,,,,,190.60,369.76,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,inpatient,,,2903.00000,2757.85000,Amish/Mennonite,Amish Mennonite,,1596.65,,,,,,,1422.47,2815.91,percent of total billed charges,
ORTH CRANIAL REMOLDING ORTHOS,81084,CDM,274,RC,S1040,HCPCS,,,facility,outpatient,,,2903.00000,2757.85000,Amish/Mennonite,Amish Mennonite,,1596.65,,,,,,,1332.48,2815.91,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,64.48000,61.26000,Amish/Mennonite,Amish Mennonite,,35.46,,,,,,,35.46,62.55,percent of total billed charges,
SHOWER COVER,81085,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,64.48000,61.26000,Amish/Mennonite,Amish Mennonite,,35.46,,,,,,,32.24,62.55,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,62.72000,59.58000,Amish/Mennonite,Amish Mennonite,,34.50,,,,,,,34.50,60.84,percent of total billed charges,
SILIPOS GEL STRAPS OR SLEEVE,81086,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,62.72000,59.58000,Amish/Mennonite,Amish Mennonite,,34.50,,,,,,,31.36,60.84,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,108.80000,103.36000,Amish/Mennonite,Amish Mennonite,,59.84,,,,,,,59.84,105.54,percent of total billed charges,
SILOPAD 4X4,81087,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,108.80000,103.36000,Amish/Mennonite,Amish Mennonite,,59.84,,,,,,,54.40,105.54,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,179.28000,170.32000,Amish/Mennonite,Amish Mennonite,,98.60,,,,,,,98.60,173.90,percent of total billed charges,
"PO BRA, NON-MASETECTOMRY PT",81088,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,179.28000,170.32000,Amish/Mennonite,Amish Mennonite,,98.60,,,,,,,89.64,173.90,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,inpatient,,,88.50000,84.08000,Amish/Mennonite,Amish Mennonite,,48.67,,,,,,,48.67,85.84,percent of total billed charges,
SUPINE C-TRAX TMJ HALTER,81090,CDM,290,RC,E0860,HCPCS,,,facility,outpatient,,,88.50000,84.08000,Amish/Mennonite,Amish Mennonite,,48.67,,,,,,,44.25,85.84,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,40.70,71.78,percent of total billed charges,
SUPPLEMENTAL NURSING SYSTEM,81091,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,74.00000,70.30000,Amish/Mennonite,Amish Mennonite,,40.70,,,,,,,37.00,71.78,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,43.36000,41.19000,Amish/Mennonite,Amish Mennonite,,23.85,,,,,,,23.85,42.06,percent of total billed charges,
PATELLA TENDON STRAP,81092,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,43.36000,41.19000,Amish/Mennonite,Amish Mennonite,,23.85,,,,,,,21.68,42.06,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,49.88000,47.39000,Amish/Mennonite,Amish Mennonite,,27.43,,,,,,,27.43,48.38,percent of total billed charges,
PRE-FAB FOOT ORTH/PEG-ASSIST,81094,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,49.88000,47.39000,Amish/Mennonite,Amish Mennonite,,27.43,,,,,,,24.94,48.38,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,386.21000,366.90000,Amish/Mennonite,Amish Mennonite,,212.42,,,,,,,212.42,374.62,percent of total billed charges,
SEVERE ANKLE PILLOW,81096,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,386.21000,366.90000,Amish/Mennonite,Amish Mennonite,,212.42,,,,,,,193.10,374.62,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,77.00,135.80,percent of total billed charges,
TUBE HEATED HMDFFR UPGRADE KIT,81097,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,140.00000,133.00000,Amish/Mennonite,Amish Mennonite,,77.00,,,,,,,70.00,135.80,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,inpatient,,,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.99,3.51,percent of total billed charges,
TOE SEPARATORS/SPREADERS,81098,CDM,270,RC,A9270,HCPCS,,,facility,outpatient,,,3.62000,3.44000,Amish/Mennonite,Amish Mennonite,,1.99,,,,,,,1.81,3.51,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,inpatient,,,326.25000,309.94000,Amish/Mennonite,Amish Mennonite,,179.44,,,,,,,179.44,316.46,percent of total billed charges,
READYWRAP/ARM,81100,CDM,271,RC,S8429,HCPCS,,,facility,outpatient,,,326.25000,309.94000,Amish/Mennonite,Amish Mennonite,,179.44,,,,,,,163.12,316.46,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,356.81000,338.97000,Amish/Mennonite,Amish Mennonite,NU,196.25,,,,,,,196.25,346.11,percent of total billed charges,
"WALKER,ROLLATOR W/SEAT COMBO",81101,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,356.81000,338.97000,Amish/Mennonite,Amish Mennonite,NU,196.25,,,,,,,62.66,346.11,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,inpatient,,,104.83000,99.59000,Amish/Mennonite,Amish Mennonite,,57.66,,,,,,,57.66,101.69,percent of total billed charges,
WEIL OSTEOTOMY STRAP,81102,CDM,290,RC,A9900,HCPCS,,,facility,outpatient,,,104.83000,99.59000,Amish/Mennonite,Amish Mennonite,,57.66,,,,,,,52.41,101.69,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
RESTYLANE 1ML,81104,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,560.66,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,inpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,110.25,218.25,percent of total billed charges,
SI BELT EVERGREEN 621,81105,CDM,274,RC,L0621,HCPCS,,,facility,outpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,67.53,218.25,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,inpatient,,,314.21000,298.50000,Amish/Mennonite,Amish Mennonite,,172.82,,,,,,,153.96,304.78,percent of total billed charges,
METAGRIP CMS PUSH ORTHOSIS,81106,CDM,274,RC,L3924,HCPCS,,,facility,outpatient,,,314.21000,298.50000,Amish/Mennonite,Amish Mennonite,,172.82,,,,,,,113.78,304.78,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,inpatient,,,29.47000,28.00000,Amish/Mennonite,Amish Mennonite,,16.21,,,,,,,14.44,28.59,percent of total billed charges,
SHOULDER IMMOBILIZER/SLING,81107,CDM,274,RC,A4565,HCPCS,,,facility,outpatient,,,29.47000,28.00000,Amish/Mennonite,Amish Mennonite,,16.21,,,,,,,11.56,28.59,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,1683.30000,1599.13000,Amish/Mennonite,Amish Mennonite,,925.82,,,,,,,925.82,1632.80,percent of total billed charges,
SAUNDERS LUMBAR HOME TX DEVICE,81108,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,1683.30000,1599.13000,Amish/Mennonite,Amish Mennonite,,925.82,,,,,,,841.65,1632.80,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,inpatient,,,92.30000,87.68000,Amish/Mennonite,Amish Mennonite,,50.77,,,,,,,50.77,89.53,percent of total billed charges,
ICE WRAP,81109,CDM,270,RC,A9273,HCPCS,,,facility,outpatient,,,92.30000,87.68000,Amish/Mennonite,Amish Mennonite,,50.77,,,,,,,46.15,89.53,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,58.68000,55.75000,Amish/Mennonite,Amish Mennonite,,32.27,,,,,,,32.27,56.92,percent of total billed charges,
SLIM-FIT BUNION SLEEVE,81110,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,58.68000,55.75000,Amish/Mennonite,Amish Mennonite,,32.27,,,,,,,29.34,56.92,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,33.00,58.20,percent of total billed charges,
"UNIV HEADGEAR,UM II,QUATTRO",81111,CDM,271,RC,A7035,HCPCS,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,,33.00,,,,,,,30.00,58.20,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,6.92,13.71,percent of total billed charges,
GC STKG CALF 8-16MM,81112,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,14.13000,13.42000,Amish/Mennonite,Amish Mennonite,,7.77,,,,,,,6.49,13.71,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,inpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.80,15.52,percent of total billed charges,
"FILTER,DISPOSABLE",81113,CDM,271,RC,A7038,HCPCS,,,facility,outpatient,,,16.00000,15.20000,Amish/Mennonite,Amish Mennonite,,8.80,,,,,,,8.00,15.52,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,inpatient,,,608.74000,578.30000,Amish/Mennonite,Amish Mennonite,,334.81,,,,,,,334.81,590.48,percent of total billed charges,
"ORTH  SO,SNG,ELAS,PREFAB,FIT/AD",81114,CDM,271,RC,A4467,HCPCS,,,facility,outpatient,,,608.74000,578.30000,Amish/Mennonite,Amish Mennonite,,334.81,,,,,,,304.37,590.48,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,51.20000,48.64000,Amish/Mennonite,Amish Mennonite,,28.16,,,,,,,28.16,49.66,percent of total billed charges,
P-CELL INSERT MOD A9283,81116,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,51.20000,48.64000,Amish/Mennonite,Amish Mennonite,,28.16,,,,,,,25.60,49.66,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,inpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,44.43,87.95,percent of total billed charges,
"PRSTH  F/L,ELASTIC STCKNG A6537",81117,CDM,274,RC,A6537,HCPCS,,,facility,outpatient,,,90.67000,86.14000,Amish/Mennonite,Amish Mennonite,,49.87,,,,,,,45.34,98.18,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,inpatient,,,39.52000,37.54000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,19.36,38.33,percent of total billed charges,
SPENCO 3/4 ORTHOTIC,81118,CDM,274,RC,L3040,HCPCS,,,facility,outpatient,,,39.52000,37.54000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,19.76,65.22,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,192.18000,182.57000,Amish/Mennonite,Amish Mennonite,NU,105.70,,,,,,,105.70,186.41,percent of total billed charges,
"WALKER,FOLDING,WHEELED,ADJ/FXD",81120,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,192.18000,182.57000,Amish/Mennonite,Amish Mennonite,NU,105.70,,,,,,,62.66,186.41,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,171.20000,162.64000,Amish/Mennonite,Amish Mennonite,,94.16,,,,,,,83.89,166.06,percent of total billed charges,
HIP ABD LNR-THIGH SECTION ONLY,81122,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,171.20000,162.64000,Amish/Mennonite,Amish Mennonite,,94.16,,,,,,,85.60,166.06,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,inpatient,,,57.96000,55.06000,Amish/Mennonite,Amish Mennonite,,31.88,,,,,,,31.88,56.22,percent of total billed charges,
"UNDERSLEEVE,COTTON OR NEOPRENE",81123,CDM,290,RC,A9999,HCPCS,,,facility,outpatient,,,57.96000,55.06000,Amish/Mennonite,Amish Mennonite,,31.88,,,,,,,28.98,56.22,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,inpatient,,,95.32000,90.55000,Amish/Mennonite,Amish Mennonite,,52.43,,,,,,,46.71,92.46,percent of total billed charges,
STABLIZE SPEEDPRO ANKLE BRACE,81124,CDM,274,RC,L1902,HCPCS,,,facility,outpatient,,,95.32000,90.55000,Amish/Mennonite,Amish Mennonite,,52.43,,,,,,,47.66,103.42,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.95,8.73,percent of total billed charges,
THERAPY PUTTY,81126,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.50,8.73,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,335.63000,318.85000,Amish/Mennonite,Amish Mennonite,,184.60,,,,,,,184.60,325.56,percent of total billed charges,
ROOKE BOOT,81127,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,335.63000,318.85000,Amish/Mennonite,Amish Mennonite,,184.60,,,,,,,167.81,325.56,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,inpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,18.15,32.01,percent of total billed charges,
SCAR TISSUE MASSAGE TOOL,81128,CDM,290,RC,A9300,HCPCS,,,facility,outpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,16.50,32.01,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,inpatient,,,645.11000,612.85000,Amish/Mennonite,Amish Mennonite,,354.81,,,,,,,316.10,625.76,percent of total billed charges,
"PRAFO,BARIAT-OTS",81129,CDM,274,RC,L4397,HCPCS,,,facility,outpatient,,,645.11000,612.85000,Amish/Mennonite,Amish Mennonite,,354.81,,,,,,,217.19,625.76,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,inpatient,,,436.46000,414.64000,Amish/Mennonite,Amish Mennonite,,240.05,,,,,,,240.05,423.37,percent of total billed charges,
TIBIAL ANKLE FOOT ORTHOSES A9283,81130,CDM,271,RC,A9283,HCPCS,,,facility,outpatient,,,436.46000,414.64000,Amish/Mennonite,Amish Mennonite,,240.05,,,,,,,218.23,423.37,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,inpatient,,,51.48000,48.91000,Amish/Mennonite,Amish Mennonite,,28.31,,,,,,,28.31,49.94,percent of total billed charges,
SHOULDER PULLEY,81131,CDM,271,RC,A9300,HCPCS,,,facility,outpatient,,,51.48000,48.91000,Amish/Mennonite,Amish Mennonite,,28.31,,,,,,,25.74,49.94,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,382.25,674.15,percent of total billed charges,
RESTYLANE DEFY,81132,CDM,636,RC,A9270,HCPCS,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,,382.25,,,,,,,347.50,674.15,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,inpatient,,,29.04000,27.59000,Amish/Mennonite,Amish Mennonite,,15.97,,,,,,,14.23,28.17,percent of total billed charges,
TAILORS BUNION SLEEVE,81133,CDM,274,RC,L3649,HCPCS,,,facility,outpatient,,,29.04000,27.59000,Amish/Mennonite,Amish Mennonite,,15.97,,,,,,,13.33,28.17,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,inpatient,,,145.36000,138.09000,Amish/Mennonite,Amish Mennonite,,79.95,,,,,,,71.23,141.00,percent of total billed charges,
REPL SFT INTERF MATL;ANKL CONT,81135,CDM,274,RC,K0672,HCPCS,,,facility,outpatient,,,145.36000,138.09000,Amish/Mennonite,Amish Mennonite,,79.95,,,,,,,72.68,141.00,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,inpatient,,,11.20000,10.64000,Amish/Mennonite,Amish Mennonite,,6.16,,,,,,,6.16,10.86,percent of total billed charges,
"DERMAFIT >3"" <5""/YD",81136,CDM,272,RC,A6449,HCPCS,,,facility,outpatient,,,11.20000,10.64000,Amish/Mennonite,Amish Mennonite,,6.16,,,,,,,2.63,10.86,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,inpatient,1,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,29.46,51.96,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 5 GM,81139,CDM,636,RC,J1569,HCPCS,00944270004,NDC,facility,outpatient,1,mL,53.57000,50.89000,Amish/Mennonite,Amish Mennonite,,29.46,,,,,,,26.79,78.87,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,inpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,90,196.35,,,,,,,196.35,346.29,percent of total billed charges,
MYCOPLASMA GENITALM PCR SO,81140,CDM,300,RC,87563,CPT,,,facility,outpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,90,196.35,,,,,,,28.07,346.29,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,446.70000,424.36000,Amish/Mennonite,Amish Mennonite,,245.69,,,,,,,245.69,433.30,percent of total billed charges,
"OPIATES, URINE, CONFIRM ONLY BY GCMS",81141,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,446.70000,424.36000,Amish/Mennonite,Amish Mennonite,,245.69,,,,,,,63.95,788.42,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,inpatient,1,mL,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.50050,0.88270,percent of total billed charges,
INSULIN LISPRO 1 UNIT/ML SOLN,81142,CDM,250,RC,J1815,HCPCS,0000275101700100,NDC,facility,outpatient,1,mL,0.91000,0.87000,Amish/Mennonite,Amish Mennonite,,0.50050,,,,,,,0.45500,1.49,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC 1MM MIC J CRV .014IN 190CM,81143,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE CONFIANZA PRO 12 180CM,81145,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE GJ 18FRX3.0X45CM,81146,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,inpatient,,,2376.00000,2257.20000,Amish/Mennonite,Amish Mennonite,,1306.80,,,,,,,1306.80,2304.72,percent of total billed charges,
CT CHOLECYSTOSTOMY PERC W GUID,81147,CDM,361,RC,47490,CPT,,,facility,outpatient,,,2376.00000,2257.20000,Amish/Mennonite,Amish Mennonite,,1306.80,,,,,,,1306.80,7803.00,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,455.36000,432.59000,Amish/Mennonite,Amish Mennonite,,250.45,,,,,,,250.45,441.70,percent of total billed charges,
OMNIGRAFT 2.5 X 2.5 CM,81153,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,455.36000,432.59000,Amish/Mennonite,Amish Mennonite,,250.45,,,,,,,36.03,441.70,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,inpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,148.24,261.44,percent of total billed charges,
OMNIGRAFT 4X4 CM,81154,CDM,636,RC,Q4105,HCPCS,,,facility,outpatient,,,269.53000,256.05000,Amish/Mennonite,Amish Mennonite,,148.24,,,,,,,36.03,261.44,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,inpatient,,,176.02000,167.22000,Amish/Mennonite,Amish Mennonite,,96.81,,,,,,,96.81,170.74,percent of total billed charges,
OMNIGRAFT 7X7 CM,81155,CDM,270,RC,Q4105,HCPCS,,,facility,outpatient,,,176.02000,167.22000,Amish/Mennonite,Amish Mennonite,,96.81,,,,,,,88.01,170.74,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,inpatient,,,3030.00000,2878.50000,Amish/Mennonite,Amish Mennonite,TC,1666.50,,,,,,,1666.50,2939.10,percent of total billed charges,
REM AFTERLOADING M/2CM/2 CH-TECH,81156,CDM,342,RC,77768,CPT,,,facility,outpatient,,,3030.00000,2878.50000,Amish/Mennonite,Amish Mennonite,TC,1666.50,,,,,,,1515.00,2939.10,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
BURR DEV ROTAPRO 1.75MM,81159,CDM,278,RC,C1724,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,78.40,155.20,percent of total billed charges,
.062 X 7IN GUIDEWIRE,81160,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,73.44,160.00,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,38272.50000,36358.88000,Amish/Mennonite,Amish Mennonite,,21049.88,,,,,,,18753.53,37124.32,percent of total billed charges,
GENERATOR PULSE IMPL MR CONDTNL INSPIRE IV,81161,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,38272.50000,36358.88000,Amish/Mennonite,Amish Mennonite,,21049.88,,,,,,,17567.08,38272.50,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,inpatient,,,981.00000,931.95000,Amish/Mennonite,Amish Mennonite,,539.55,,,,,,,539.55,951.57,percent of total billed charges,
BURN DRESSING APPLICATION AND DEBRIDEMENT,81162,CDM,361,RC,,,,,facility,outpatient,,,981.00000,931.95000,Amish/Mennonite,Amish Mennonite,,539.55,,,,,,,539.55,5271.00,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,inpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,11.55,20.37,percent of total billed charges,
VFC-PPSV23,81164,CDM,771,RC,90471,CPT,,,facility,outpatient,,,21.00000,19.95000,Amish/Mennonite,Amish Mennonite,,11.55,,,,,,,10.50,74.34,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,inpatient,,,419.33000,398.36000,Amish/Mennonite,Amish Mennonite,NU,230.63,,,,,,,230.63,406.75,percent of total billed charges,
WALKER CAREXS FLD WHLD ADJ/FXD,81169,CDM,271,RC,E0143,HCPCS,,,facility,outpatient,,,419.33000,398.36000,Amish/Mennonite,Amish Mennonite,NU,230.63,,,,,,,62.66,406.75,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,inpatient,1,EA,34562.60000,32834.47000,Amish/Mennonite,Amish Mennonite,,19009.43,,,,,,,19009.43,33525.72,percent of total billed charges,
TRIPTORELIN POWD-INJ 22.5 MG (TRIPTODUR),81176,CDM,636,RC,J3316,HCPCS,24338015020,NDC,facility,outpatient,1,EA,34562.60000,32834.47000,Amish/Mennonite,Amish Mennonite,,19009.43,,,,,,,3772.85,33525.72,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,10462.50000,9939.38000,Amish/Mennonite,Amish Mennonite,,5754.38,,,,,,,5126.62,10148.62,percent of total billed charges,
LEAD RESP EFFRT SENS L45CM PRSS SENS MEM STD CONN,81177,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,10462.50000,9939.38000,Amish/Mennonite,Amish Mennonite,,5754.38,,,,,,,4802.29,10462.50,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,inpatient,,,219.80000,208.81000,Amish/Mennonite,Amish Mennonite,,120.89,,,,,,,120.89,213.21,percent of total billed charges,
FUSION DOSIMETRY-TECH,81178,CDM,333,RC,77399,CPT,,,facility,outpatient,,,219.80000,208.81000,Amish/Mennonite,Amish Mennonite,,120.89,,,,,,,109.90,213.21,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3803.62,7529.62,percent of total billed charges,
LEAD DEFIB 8FR L58CM TRNSVEN TACHYARRHYTHMIA STEROID ELUT,81179,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,7762.50000,7374.38000,Amish/Mennonite,Amish Mennonite,,4269.38,,,,,,,3562.99,7762.50,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
STENT PERIPH L16MM DIA7MM CATH L135CM GWIRE 0.035IN CVR BLLN,81180,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,30132.00000,28625.40000,Amish/Mennonite,Amish Mennonite,,16572.60,,,,,,,14764.68,29228.04,percent of total billed charges,
CATH CAT12 XTORQ 100CM.,81181,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,30132.00000,28625.40000,Amish/Mennonite,Amish Mennonite,,16572.60,,,,,,,13830.59,30132.00,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X12MM,81182,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,inpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,TC,59.95,,,,,,,59.95,105.73,percent of total billed charges,
VITAL CAPACITY PULM MECHANI,81184,CDM,410,RC,94150,CPT,,,facility,outpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,TC,59.95,,,,,,,54.50,105.73,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,inpatient,1,EA,5576.35000,5297.53000,Amish/Mennonite,Amish Mennonite,,3066.99,,,,,,,3066.99,5409.06,percent of total billed charges,
FAM-TRASTUZUMAB DERUXTECAN-NXKI POWD-INJ 100 MG,81186,CDM,636,RC,J9358,HCPCS,65597040601,NDC,facility,outpatient,1,EA,5576.35000,5297.53000,Amish/Mennonite,Amish Mennonite,,3066.99,,,,,,,30.00,5409.06,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,inpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.11000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00178-0320-03,NDC,,,facility,outpatient,1,GM,0.20000,0.19000,Amish/Mennonite,Amish Mennonite,,0.11000,,,,,,,0.10000,0.19400,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,inpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MENTHOL-METHYL SALICYLATE TOPICAL 1%-15% CREA,81188,CDM,250,RC,00536-1101-45,NDC,,,facility,outpatient,1,GM,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,74.80,131.92,percent of total billed charges,
ARTHROCENT ASP INJ-SM JT-CT-TECH,81192,CDM,510,RC,20600,CPT,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,68.00,308.32,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,inpatient,1,EA,3147.55000,2990.17000,Amish/Mennonite,Amish Mennonite,,1731.15,,,,,,,1731.15,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,50881001303,NDC,facility,outpatient,1,EA,3147.55000,2990.17000,Amish/Mennonite,Amish Mennonite,,1731.15,,,,,,,14.08,3053.12,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,inpatient,1,EA,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1518.00,2677.20,percent of total billed charges,
TAFASITAMAB-CXIX POWD-INJ 200 MG,81193,CDM,636,RC,J9349,HCPCS,73535020801,NDC,facility,outpatient,1,EA,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,14.08,2677.20,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L190CM DIA0.014IN 3CM STR TIP,81202,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA4MM.,81204,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,588.00,1164.00,percent of total billed charges,
SHEATH GUIDING 6 FR L 149 CM R2P DEST STRL.,81205,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,1200.00000,1140.00000,Amish/Mennonite,Amish Mennonite,,660.00,,,,,,,550.80,1200.00,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA3MM,81206,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA5MM,81207,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 135CM,81208,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,inpatient,,,11573.00000,10994.35000,Amish/Mennonite,Amish Mennonite,,6365.15,,,,,,,6365.15,11225.81,percent of total billed charges,
I&D ABD/PERITONEAL/RETROPERIONEAL,81213,CDM,361,RC,,,,,facility,outpatient,,,11573.00000,10994.35000,Amish/Mennonite,Amish Mennonite,,6365.15,,,,,,,4607.00,11225.81,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L20MM DIA8MM,81214,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X20MM,81215,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.75X20MM,81216,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER AGILIS HISPRO 10.5FR REG,81217,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2612.86,5692.50,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,27304.80000,25939.56000,Amish/Mennonite,Amish Mennonite,,15017.64,,,,,,,13379.35,26485.66,percent of total billed charges,
GRAFT EVAR L166MM DIA28X13MM CATH 18FR POLY NIT STNT,81218,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,27304.80000,25939.56000,Amish/Mennonite,Amish Mennonite,,15017.64,,,,,,,12532.90,27304.80,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GWIRE VASC L180CM DIA0.014IN SPR COIL AG14M060,81220,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATH PTCA L75CM BLLN L40CM OD3MM 8ATM NOM,81221,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GWIRE VASC L190CM DIA0.014IN DURASTEEL CVR,81223,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,Amish/Mennonite,Amish Mennonite,,483.45,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRTMT AID SIMPLE,81226,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,Amish/Mennonite,Amish Mennonite,,483.45,,,,,,,96.44,2659.05,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 1.2CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81227,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,inpatient,1,GM,1230.25000,1168.74000,Amish/Mennonite,Amish Mennonite,,676.64,,,,,,,676.64,1193.34,percent of total billed charges,
STERILE TALC 2 GM POWDER,81228,CDM,250,RC,62327-0222-42,NDC,,,facility,outpatient,1,GM,1230.25000,1168.74000,Amish/Mennonite,Amish Mennonite,,676.64,,,,,,,615.12,1193.34,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,inpatient,1,mL,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 5 ML,81229,CDM,250,RC,J9260,HCPCS,05446150505,NDC,facility,outpatient,1,mL,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,3.62,153.26,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
BAMLAN/ETESEV INFUSION,81231,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,inpatient,1,EA,111.42000,105.85000,Amish/Mennonite,Amish Mennonite,,61.28,,,,,,,61.28,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,00409233725,NDC,facility,outpatient,1,EA,111.42000,105.85000,Amish/Mennonite,Amish Mennonite,,61.28,,,,,,,12.72,108.08,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,inpatient,1,EA,130.19000,123.68000,Amish/Mennonite,Amish Mennonite,,71.60,,,,,,,71.60,126.28,percent of total billed charges,
DEFEROXAMINE POWD-INJ 2 GM,81232,CDM,250,RC,J0895,HCPCS,63323059930,NDC,facility,outpatient,1,EA,130.19000,123.68000,Amish/Mennonite,Amish Mennonite,,71.60,,,,,,,12.72,126.28,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,inpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,1.04,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,65862-0459-60,NDC,,,facility,outpatient,1,EA,1.90000,1.80000,Amish/Mennonite,Amish Mennonite,,1.04,,,,,,,0.95000,1.84,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,inpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.14,2.01,percent of total billed charges,
GALANTAMINE 8 MG TAB,81233,CDM,250,RC,70436-0005-06,NDC,,,facility,outpatient,1,EA,2.07000,1.96000,Amish/Mennonite,Amish Mennonite,,1.14,,,,,,,1.03,2.01,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
LEPTOSPERMUM HONEY OINT 44 ML,81235,CDM,250,RC,80995-8033-61,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,inpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.66000,1.16,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082667,NDC,facility,outpatient,1,mL,1.20000,1.14000,Amish/Mennonite,Amish Mennonite,,0.66000,,,,,,,0.60000,15.80,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,inpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,3.13,5.52,percent of total billed charges,
ZOLEDRONIC ACID SOLN 4 MG/100 ML PREMIX,81237,CDM,250,RC,J3489,HCPCS,25021082682,NDC,facility,outpatient,1,mL,5.69000,5.40000,Amish/Mennonite,Amish Mennonite,,3.13,,,,,,,2.85,15.80,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,inpatient,1,EA,736.75000,699.91000,Amish/Mennonite,Amish Mennonite,,405.21,,,,,,,405.21,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-20,NDC,,,facility,outpatient,1,EA,736.75000,699.91000,Amish/Mennonite,Amish Mennonite,,405.21,,,,,,,368.38,714.65,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,inpatient,1,EA,769.75000,731.26000,Amish/Mennonite,Amish Mennonite,,423.36,,,,,,,423.36,746.66,percent of total billed charges,
"THROMBIN TOPICAL BOVINE 20,000 INTL UNITS POWD",81239,CDM,250,RC,60793-0217-22,NDC,,,facility,outpatient,1,EA,769.75000,731.26000,Amish/Mennonite,Amish Mennonite,,423.36,,,,,,,384.88,746.66,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,inpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.63800,1.13,percent of total billed charges,
OCULAR LUBRICANT - GE,81242,CDM,250,RC,00023-4554-30,NDC,,,facility,outpatient,1,EA,1.16000,1.10000,Amish/Mennonite,Amish Mennonite,,0.63800,,,,,,,0.58000,1.13,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF BAMLANIVIMAB/ETESEVIMAB,81244,CDM,771,RC,M0245,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA5FR BLLN L40MM DIA5MM,81245,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA 6FR L130CM BLLN L40MM DIA6MM,81246,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,Amish/Mennonite,Amish Mennonite,,938.44,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC L L15CM DIA32MM STR WVN DBL VEL HEMSHLD PLAT,81247,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,Amish/Mennonite,Amish Mennonite,,938.44,,,,,,,783.17,1706.25,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,168.07,332.72,percent of total billed charges,
COIL EMB L4CM DIA3MM CATH DIA0.038IN INCONEL XLN FBR RADPQ,81248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,343.01000,325.86000,Amish/Mennonite,Amish Mennonite,,188.66,,,,,,,157.44,343.01,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,6340.31,12551.22,percent of total billed charges,
GRAFT EVAR L93MM DIA16X13MM CATH 14FR POLY NIT STNT HYDRPHLC,81249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,12939.40000,12292.43000,Amish/Mennonite,Amish Mennonite,,7116.67,,,,,,,5939.18,12939.40,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
SHEATH GD 90DX.032IN SMTH CRV 8FR 63CM TRNSPT,81250,CDM,278,RC,C1893,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,284.01,618.75,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L74MM DIA11MM INTRO SHTH OD5.4MM ID4.7MM WVN POLY,81251,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,156.19,309.19,percent of total billed charges,
GUIDEWIRE VASC STRG .018IN 300CM HTORQ CNCT FLX,81252,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,318.75000,302.81000,Amish/Mennonite,Amish Mennonite,,175.31,,,,,,,146.31,318.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X6MM,81253,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X30MM,81254,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER DIAG L65CM 0.035IN SS STR TIP,81256,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,393.31,856.88,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATH PTCA 6FR L200CM BLLN CATHETER L60MM DIA5MM.,81257,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 5FR L200CM BLLN L100MM DIA2MM.,81258,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40740.00000,38703.00000,Amish/Mennonite,Amish Mennonite,,22407.00,,,,,,,19962.60,39517.80,percent of total billed charges,
DEFIBRILLATOR CARD 32.5ML 73.8GM W5.37XH8.18CM D0.99CM RA,81259,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40740.00000,38703.00000,Amish/Mennonite,Amish Mennonite,,22407.00,,,,,,,18699.66,40740.00,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATHETER GUID AD 6FR L100CM GRN NYL PTFE 3DRC,81260,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,116.86,231.34,percent of total billed charges,
SHTH GUID L55CM DIA0.100IN INTRO 7FR 0.035IN,81261,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,109.47,238.50,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,221.25000,210.19000,Amish/Mennonite,Amish Mennonite,,121.69,,,,,,,108.41,214.61,percent of total billed charges,
SHTH INTRO AD 5FR L70CM ID1.9MM GWIRE 0.038IN,81262,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,221.25000,210.19000,Amish/Mennonite,Amish Mennonite,,121.69,,,,,,,101.55,221.25,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,230.10000,218.59000,Amish/Mennonite,Amish Mennonite,,126.56,,,,,,,112.75,223.20,percent of total billed charges,
INTRO SHTH 12FR L13CM ID4MM COMPATIBLE GWIRE,81264,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,230.10000,218.59000,Amish/Mennonite,Amish Mennonite,,126.56,,,,,,,105.62,230.10,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP JB1 5FR 100CM,81265,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
BLLN ZMED II 26MMX4CMX100CM,81266,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE 12FR SIL MED PORT RADOPQ.,81267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,262.76,520.16,percent of total billed charges,
CATHETER ANGIO PGTL CRV 5FR 70CM ACVU 20CM,81268,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,536.25000,509.44000,Amish/Mennonite,Amish Mennonite,,294.94,,,,,,,246.14,536.25,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,inpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,79.75,140.65,percent of total billed charges,
"RENDERING-3D,MRI;NO IMAG-TECH",81269,CDM,350,RC,76376,CPT,,,facility,outpatient,,,145.00000,137.75000,Amish/Mennonite,Amish Mennonite,TC,79.75,,,,,,,72.50,1820.00,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,inpatient,,,68.34000,64.92000,Amish/Mennonite,Amish Mennonite,,37.59,,,,,,,37.59,66.29,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,CPT,,,facility,outpatient,,,68.34000,64.92000,Amish/Mennonite,Amish Mennonite,,37.59,,,,,,,34.17,137.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,inpatient,1,EA,136.68000,129.85000,Amish/Mennonite,Amish Mennonite,,75.17,,,,,,,75.17,132.58,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO-HAEMOPHILUS VACCINE SUSP (PENTACEL)",81271,CDM,250,RC,90698,HCPCS,49281051105,NDC,facility,outpatient,1,EA,136.68000,129.85000,Amish/Mennonite,Amish Mennonite,,75.17,,,,,,,68.34,137.03,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,inpatient,1,EA,269.42000,255.95000,Amish/Mennonite,Amish Mennonite,,148.18,,,,,,,148.18,261.34,percent of total billed charges,
ALPROSTADIL SOLN 10 MCG (EDEX),81272,CDM,250,RC,J0270,HCPCS,52244001002,NDC,facility,outpatient,1,EA,269.42000,255.95000,Amish/Mennonite,Amish Mennonite,,148.18,,,,,,,134.71,261.34,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,inpatient,1,EA,1846.15000,1753.84000,Amish/Mennonite,Amish Mennonite,,1015.38,,,,,,,1015.38,1790.77,percent of total billed charges,
LEUPROLIDE 1 MG/0.2 ML KIT,81273,CDM,250,RC,J9218,HCPCS,00781400332,NDC,facility,outpatient,1,EA,1846.15000,1753.84000,Amish/Mennonite,Amish Mennonite,,1015.38,,,,,,,14.79,1790.77,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,inpatient,1,GM,66.04000,62.74000,Amish/Mennonite,Amish Mennonite,,36.32,,,,,,,36.32,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL CFC FREE 45 MCG-21 MCG/INH AER,81276,CDM,250,RC,00173-0715-20,NDC,,,facility,outpatient,1,GM,66.04000,62.74000,Amish/Mennonite,Amish Mennonite,,36.32,,,,,,,33.02,64.06,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,inpatient,1,GM,115.79000,110.00000,Amish/Mennonite,Amish Mennonite,,63.68,,,,,,,63.68,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,00173-0717-20,NDC,,,facility,outpatient,1,GM,115.79000,110.00000,Amish/Mennonite,Amish Mennonite,,63.68,,,,,,,57.90,112.32,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,inpatient,1,GM,18.26000,17.35000,Amish/Mennonite,Amish Mennonite,,10.04,,,,,,,10.04,17.71,percent of total billed charges,
FLUTICASONE-SALMETEROL INHALER 230 - 21 MCG 12 GM (120 DOSE),81277,CDM,250,RC,66993-0088-96,NDC,,,facility,outpatient,1,GM,18.26000,17.35000,Amish/Mennonite,Amish Mennonite,,10.04,,,,,,,9.13,17.71,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,inpatient,1,mL,129.01000,122.56000,Amish/Mennonite,Amish Mennonite,,70.96,,,,,,,70.96,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,00023-9211-05,NDC,,,facility,outpatient,1,mL,129.01000,122.56000,Amish/Mennonite,Amish Mennonite,,70.96,,,,,,,64.50,125.14,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,inpatient,1,mL,112.05000,106.45000,Amish/Mennonite,Amish Mennonite,,61.63,,,,,,,61.63,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,60505-6225-00,NDC,,,facility,outpatient,1,mL,112.05000,106.45000,Amish/Mennonite,Amish Mennonite,,61.63,,,,,,,56.02,108.69,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,inpatient,1,mL,80.89000,76.85000,Amish/Mennonite,Amish Mennonite,,44.49,,,,,,,44.49,78.46,percent of total billed charges,
BRIMONIDINE-TIMOLOL  SOLN-OPHTH 0.2%-0.5% 5 ML,81279,CDM,250,RC,82182-0455-05,NDC,,,facility,outpatient,1,mL,80.89000,76.85000,Amish/Mennonite,Amish Mennonite,,44.49,,,,,,,40.45,78.46,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,inpatient,1,mL,12896.29000,12251.47000,Amish/Mennonite,Amish Mennonite,,7092.96,,,,,,,7092.96,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 1ML,81282,CDM,636,RC,J9307,HCPCS,48818000101,NDC,facility,outpatient,1,mL,12896.29000,12251.47000,Amish/Mennonite,Amish Mennonite,,7092.96,,,,,,,388.83,12509.40,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,inpatient,1,mL,11683.35000,11099.18000,Amish/Mennonite,Amish Mennonite,,6425.84,,,,,,,6425.84,11332.85,percent of total billed charges,
PRALATREXATE SOLN 20 MG/ML 2 ML,81283,CDM,636,RC,J9307,HCPCS,48818000102,NDC,facility,outpatient,1,mL,11683.35000,11099.18000,Amish/Mennonite,Amish Mennonite,,6425.84,,,,,,,388.83,11332.85,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,inpatient,1,mL,728.31000,691.89000,Amish/Mennonite,Amish Mennonite,,400.57,,,,,,,400.57,706.46,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,24201010104,NDC,facility,outpatient,1,mL,728.31000,691.89000,Amish/Mennonite,Amish Mennonite,,400.57,,,,,,,364.15,2397.95,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,inpatient,1,mL,1149.90000,1092.40000,Amish/Mennonite,Amish Mennonite,,632.45,,,,,,,632.45,1115.40,percent of total billed charges,
VALRUBICIN SOLN 40 MG/ML 5 ML,81284,CDM,636,RC,J9357,HCPCS,67979000101,NDC,facility,outpatient,1,mL,1149.90000,1092.40000,Amish/Mennonite,Amish Mennonite,,632.45,,,,,,,574.95,2397.95,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,inpatient,1,mL,81.79000,77.70000,Amish/Mennonite,Amish Mennonite,,44.98,,,,,,,44.98,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00065-4147-27,NDC,,,facility,outpatient,1,mL,81.79000,77.70000,Amish/Mennonite,Amish Mennonite,,44.98,,,,,,,40.90,79.34,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,inpatient,1,mL,75.33000,71.57000,Amish/Mennonite,Amish Mennonite,,41.43,,,,,,,41.43,73.07,percent of total billed charges,
BRIMONIDINE-BRINZOLAMIDE OPHTHALMIC 0.2%-1% SUSP,81286,CDM,250,RC,00078-0904-38,NDC,,,facility,outpatient,1,mL,75.33000,71.57000,Amish/Mennonite,Amish Mennonite,,41.43,,,,,,,37.66,73.07,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,inpatient,1,mL,2474.98000,2351.23000,Amish/Mennonite,Amish Mennonite,,1361.24,,,,,,,1361.24,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 1064 MG/3.9 ML (ARISTADA),81287,CDM,636,RC,J1944,HCPCS,65757040403,NDC,facility,outpatient,1,mL,2474.98000,2351.23000,Amish/Mennonite,Amish Mennonite,,1361.24,,,,,,,3.33,2400.73,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,inpatient,1,mL,2500.42000,2375.40000,Amish/Mennonite,Amish Mennonite,,1375.23,,,,,,,1375.23,2425.41,percent of total billed charges,
ARIPIPRAZOLE LAUROXIL SUSP INJ 441 MG/1.6 ML (ARISTADA),81288,CDM,636,RC,J1944,HCPCS,65757040103,NDC,facility,outpatient,1,mL,2500.42000,2375.40000,Amish/Mennonite,Amish Mennonite,,1375.23,,,,,,,3.33,2425.41,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,inpatient,1,mL,49140.33000,46683.32000,Amish/Mennonite,Amish Mennonite,,27027.18,,,,,,,27027.18,47666.12,percent of total billed charges,
LANREOTIDE SOLN 90 MG/0.3 ML (SOMATULINE DEPOT),81289,CDM,636,RC,J1930,HCPCS,15054109004,NDC,facility,outpatient,1,mL,49140.33000,46683.32000,Amish/Mennonite,Amish Mennonite,,27027.18,,,,,,,36.66,47666.12,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,inpatient,1,mL,414.62000,393.89000,Amish/Mennonite,Amish Mennonite,,228.04,,,,,,,228.04,402.18,percent of total billed charges,
"PENICILLIN G BENZ SUSP INJ 600,000 UNITS/ML 1 ML",81290,CDM,636,RC,J0561,HCPCS,60793070010,NDC,facility,outpatient,1,mL,414.62000,393.89000,Amish/Mennonite,Amish Mennonite,,228.04,,,,,,,29.30,402.18,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,inpatient,1,mL,32751.19000,31113.63000,Amish/Mennonite,Amish Mennonite,,18013.15,,,,,,,18013.15,31768.65,percent of total billed charges,
TILDRAKIZUMAB-ASMN SOLN 100 MG/ML (ILUMYA),81291,CDM,636,RC,J3245,HCPCS,47335017795,NDC,facility,outpatient,1,mL,32751.19000,31113.63000,Amish/Mennonite,Amish Mennonite,,18013.15,,,,,,,126.24,31768.65,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1944.08,3848.47,percent of total billed charges,
KIT EP RESPON CATH 6FR L120CM 2-5-2MM SPC,81292,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,3967.50000,3769.12000,Amish/Mennonite,Amish Mennonite,,2182.12,,,,,,,1821.08,3967.50,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,inpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.44,6.07,percent of total billed charges,
POTASSIUM PHOSPHATE 3 MMOL/ML SOLN,81293,CDM,250,RC,65219-0056-29,NDC,,,facility,outpatient,1,mL,6.26000,5.94000,Amish/Mennonite,Amish Mennonite,,3.44,,,,,,,3.13,6.07,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,inpatient,1,mL,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,1.07,1.89,percent of total billed charges,
CHLOROPROCAINE SOLN 2% 30 ML,81296,CDM,250,RC,J2401,HCPCS,63323047637,NDC,facility,outpatient,1,mL,1.95000,1.85000,Amish/Mennonite,Amish Mennonite,,1.07,,,,,,,0.06045,1.89,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,inpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.57750,1.02,percent of total billed charges,
CEFDINIR 125 MG/5 ML PO,81297,CDM,250,RC,65862-0218-60,NDC,,,facility,outpatient,1,mL,1.05000,1.00000,Amish/Mennonite,Amish Mennonite,,0.57750,,,,,,,0.52500,1.02,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,inpatient,1,mL,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,2.05,3.61,percent of total billed charges,
CEFTAZIDIME 280 MG/ML SOLN,81299,CDM,250,RC,J0713,HCPCS,0040950821628000,NDC,facility,outpatient,1,mL,3.72000,3.53000,Amish/Mennonite,Amish Mennonite,,2.05,,,,,,,1.86,3.61,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,inpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,132.00,232.80,percent of total billed charges,
XR SPINE THORACOLUMBAR 2/MORE VWS,81301,CDM,320,RC,72080,CPT,,,facility,outpatient,,,240.00000,228.00000,Amish/Mennonite,Amish Mennonite,TC,132.00,,,,,,,120.00,1272.59,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
TRIEVER 20 CATHETER 20 FR 105 CM,81302,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 16X60MM 80CM OTW DEL SYS,81303,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X25MM,81310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER INARI FLOW TRIEVER 2 6-16MM,81311,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
CATH CARAVEL 1.9FR 150CM,81312,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT GJ TB 18FR JEJU L45CM STOMA L3.5CM SIL LP,81313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,inpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,216.31,percent of total billed charges,
EXTRACTION  DENTAL,81315,CDM,361,RC,,,,,facility,outpatient,,,223.00000,211.85000,Amish/Mennonite,Amish Mennonite,,122.65,,,,,,,122.65,5271.00,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 22CM 5MM 130CM ULTRAVERSE 018 CK,81320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3296.47,6525.68,percent of total billed charges,
LEAD STIMLTN UP AIRWAY FOR SLEEP STUDY,81321,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3087.92,6727.50,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,inpatient,1,EA,6334.20000,6017.49000,Amish/Mennonite,Amish Mennonite,,3483.81,,,,,,,3483.81,6144.17,percent of total billed charges,
ENFORTUMAB VEDOTIN-EJFV POWD-INJ 20 MG,81322,CDM,636,RC,J9177,HCPCS,51144002001,NDC,facility,outpatient,1,EA,6334.20000,6017.49000,Amish/Mennonite,Amish Mennonite,,3483.81,,,,,,,36.66,6144.17,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,inpatient,1,EA,8023.11000,7621.96000,Amish/Mennonite,Amish Mennonite,,4412.71,,,,,,,4412.71,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 25 MG (REBLOZYL),81324,CDM,636,RC,J0896,HCPCS,59572071101,NDC,facility,outpatient,1,EA,8023.11000,7621.96000,Amish/Mennonite,Amish Mennonite,,4412.71,,,,,,,41.96,7782.42,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,inpatient,1,EA,22092.57000,20987.94000,Amish/Mennonite,Amish Mennonite,,12150.91,,,,,,,12150.91,21429.79,percent of total billed charges,
LUSPATERCEPT-AAMT POWD-INJ 75 MG  (REBLOZYL),81325,CDM,636,RC,J0896,HCPCS,59572077501,NDC,facility,outpatient,1,EA,22092.57000,20987.94000,Amish/Mennonite,Amish Mennonite,,12150.91,,,,,,,41.96,21429.79,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,inpatient,1,EA,3037.03000,2885.18000,Amish/Mennonite,Amish Mennonite,,1670.37,,,,,,,1670.37,2945.92,percent of total billed charges,
TRASTUZUMAB-ANNS POWD-INJ 150 MG,81326,CDM,636,RC,Q5117,HCPCS,55513014101,NDC,facility,outpatient,1,EA,3037.03000,2885.18000,Amish/Mennonite,Amish Mennonite,,1670.37,,,,,,,43.25,2945.92,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,inpatient,1,mL,2458.76000,2335.82000,Amish/Mennonite,Amish Mennonite,,1352.32,,,,,,,1352.32,2385.00,percent of total billed charges,
"EPOETIN ALFA 40,000 UNITS/ML PRESERVATIVE-FREE SOLN",81327,CDM,636,RC,J0885,HCPCS,59676034001,NDC,facility,outpatient,1,mL,2458.76000,2335.82000,Amish/Mennonite,Amish Mennonite,,1352.32,,,,,,,7.68,2385.00,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,inpatient,1,mL,3612.56000,3431.94000,Amish/Mennonite,Amish Mennonite,,1986.91,,,,,,,1986.91,3504.18,percent of total billed charges,
EPTINEZUMAB-JJMR SOLN 100 MG/ML,81328,CDM,636,RC,J3032,HCPCS,67386013051,NDC,facility,outpatient,1,mL,3612.56000,3431.94000,Amish/Mennonite,Amish Mennonite,,1986.91,,,,,,,19.85,3504.18,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,inpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.82,6.74,percent of total billed charges,
LEUCOVORIN 10 MG/ML SOLN,81330,CDM,250,RC,J0640,HCPCS,63323063110,NDC,facility,outpatient,1,mL,6.95000,6.60000,Amish/Mennonite,Amish Mennonite,,3.82,,,,,,,3.48,6.74,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,inpatient,,,548.00000,520.60000,Amish/Mennonite,Amish Mennonite,,301.40,,,,,,,301.40,531.56,percent of total billed charges,
INJ PROC-MYEL/TOM-TECH,81331,CDM,510,RC,62284,CPT,,,facility,outpatient,,,548.00000,520.60000,Amish/Mennonite,Amish Mennonite,,301.40,,,,,,,274.00,531.56,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,inpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.49,percent of total billed charges,
ROPIVACAINE 0.2 % SOLN,81332,CDM,250,RC,J2795,HCPCS,71449007959,NDC,facility,outpatient,1,mL,2.57000,2.44000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,0.08525,2.49,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,inpatient,1,mL,2.93000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,1.61,2.84,percent of total billed charges,
ROPIVACAINE 0.2% SOL,81334,CDM,250,RC,J2795,HCPCS,71449007957,NDC,facility,outpatient,1,mL,2.93000,2.78000,Amish/Mennonite,Amish Mennonite,,1.61,,,,,,,0.08525,2.84,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,inpatient,1,mL,399.99000,379.99000,Amish/Mennonite,Amish Mennonite,,219.99,,,,,,,219.99,387.99,percent of total billed charges,
ISATUXIMAB-IRFC SOLN 20 MG/ML 5 ML,81335,CDM,636,RC,J9227,HCPCS,00024065401,NDC,facility,outpatient,1,mL,399.99000,379.99000,Amish/Mennonite,Amish Mennonite,,219.99,,,,,,,82.86,387.99,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,inpatient,1,mL,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,220.00,388.00,percent of total billed charges,
ISATUXIMAB IRFC 20 MG/ML SOL,81336,CDM,636,RC,J9227,HCPCS,00024065601,NDC,facility,outpatient,1,mL,400.00000,380.00000,Amish/Mennonite,Amish Mennonite,,220.00,,,,,,,82.86,388.00,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,inpatient,1,mL,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.53,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00069303120,NDC,facility,outpatient,1,mL,6.41000,6.09000,Amish/Mennonite,Amish Mennonite,,3.53,,,,,,,3.21,6.22,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,inpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.91,3.38,percent of total billed charges,
DOXORUBICIN SOLN 2 MG/ML 10 ML,81338,CDM,250,RC,J9000,HCPCS,00143937001,NDC,facility,outpatient,1,mL,3.48000,3.30000,Amish/Mennonite,Amish Mennonite,,1.91,,,,,,,1.74,5.23,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,inpatient,1,mL,226.51000,215.18000,Amish/Mennonite,Amish Mennonite,,124.58,,,,,,,124.58,219.71,percent of total billed charges,
RITUXIMAB-PVVR SOLN 10 MG/ML 10 ML (RUXIENCE),81339,CDM,636,RC,Q5119,HCPCS,00069023801,NDC,facility,outpatient,1,mL,226.51000,215.18000,Amish/Mennonite,Amish Mennonite,,124.58,,,,,,,26.50,219.71,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,inpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.76450,1.35,percent of total billed charges,
COSYNTROPIN 1 MCG/ML SOLN,81340,CDM,250,RC,J0834,HCPCS,0054859000000100,NDC,facility,outpatient,1,mL,1.39000,1.32000,Amish/Mennonite,Amish Mennonite,,0.76450,,,,,,,0.69500,55.44,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,inpatient,1,mL,13220.83000,12559.79000,Amish/Mennonite,Amish Mennonite,,7271.46,,,,,,,7271.46,12824.21,percent of total billed charges,
PEGFILGRASTIM-CBQV SOLN 6 MG/0.6 ML,81341,CDM,636,RC,Q5111,HCPCS,70114010101,NDC,facility,outpatient,1,mL,13220.83000,12559.79000,Amish/Mennonite,Amish Mennonite,,7271.46,,,,,,,136.04,12824.21,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,inpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.52250,0.92150,percent of total billed charges,
PROPOFOL 10 MG/ML EMU,81342,CDM,250,RC,J2704,HCPCS,63323026910,NDC,facility,outpatient,1,mL,0.95000,0.90000,Amish/Mennonite,Amish Mennonite,,0.52250,,,,,,,0.14409,0.92150,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,inpatient,1,EA,56.21000,53.40000,Amish/Mennonite,Amish Mennonite,,30.92,,,,,,,30.92,54.52,percent of total billed charges,
CIPROFLOXACIN-FLUOCINOLONE OTIC 0.3%-0.025% SOLN,81343,CDM,250,RC,24338-0080-14,NDC,,,facility,outpatient,1,EA,56.21000,53.40000,Amish/Mennonite,Amish Mennonite,,30.92,,,,,,,28.11,54.52,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,,260.15,,,,,,,260.15,458.81,percent of total billed charges,
"OXYCODONE, URINE, CONFIRM ONLY BY GCMS",81345,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,473.00000,449.35000,Amish/Mennonite,Amish Mennonite,,260.15,,,,,,,63.95,788.42,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,inpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,78.21,137.93,percent of total billed charges,
PENTOBARBITAL SOLN-INJ 50 MG/ML 50 ML MDV,81346,CDM,250,RC,J2515,HCPCS,25021067650,NDC,facility,outpatient,1,mL,142.20000,135.09000,Amish/Mennonite,Amish Mennonite,,78.21,,,,,,,37.52,137.93,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,inpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.36850,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,51079-0866-20,NDC,,,facility,outpatient,1,EA,0.67000,0.64000,Amish/Mennonite,Amish Mennonite,,0.36850,,,,,,,0.33500,0.64990,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,inpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LAMOTRIGINE 200 MG TAB,81349,CDM,250,RC,65862-0230-60,NDC,,,facility,outpatient,1,EA,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,inpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,TC,16.50,,,,,,,16.50,29.10,percent of total billed charges,
CALORIC VESTIB;MONOTHER-AUD,81350,CDM,920,RC,92538,CPT,,,facility,outpatient,,,30.00000,28.50000,Amish/Mennonite,Amish Mennonite,TC,16.50,,,,,,,15.00,29.10,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,inpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,382.80,675.12,percent of total billed charges,
HIGH ALT STIM TST;SUP OXY TITR-TECH,81360,CDM,460,RC,94453,CPT,,,facility,outpatient,,,696.00000,661.20000,Amish/Mennonite,Amish Mennonite,TC,382.80,,,,,,,348.00,675.12,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,inpatient,,,71.65000,68.07000,Amish/Mennonite,Amish Mennonite,,39.41,,,,,,,39.41,69.50,percent of total billed charges,
EZ-DERM 2X2 CM,81364,CDM,270,RC,Q4036,HCPCS,,,facility,outpatient,,,71.65000,68.07000,Amish/Mennonite,Amish Mennonite,,39.41,,,,,,,35.83,69.50,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,inpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,741.08,percent of total billed charges,
CT BIOPSY LYMPH NODE,81368,CDM,361,RC,38505,CPT,,,facility,outpatient,,,764.00000,725.80000,Amish/Mennonite,Amish Mennonite,,420.20,,,,,,,420.20,4686.00,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,TC,549.45,,,,,,,549.45,969.03,percent of total billed charges,
XR VENOGRAM HEPATIC WO HD,81369,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,TC,549.45,,,,,,,422.60,17311.25,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,inpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,41.71,percent of total billed charges,
COMPUTERIZED OPTHALMIC IMAGING,81371,CDM,361,RC,,,,,facility,outpatient,,,43.00000,40.85000,Amish/Mennonite,Amish Mennonite,,23.65,,,,,,,23.65,5271.00,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,inpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,2990.51,percent of total billed charges,
TREAT PLEURODESIS W/AGENT,81372,CDM,361,RC,,,,,facility,outpatient,,,3083.00000,2928.85000,Amish/Mennonite,Amish Mennonite,,1695.65,,,,,,,1695.65,5271.00,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,inpatient,,,94.77000,90.03000,Amish/Mennonite,Amish Mennonite,,52.12,,,,,,,52.12,91.93,percent of total billed charges,
INJ WHOLE BLOOD W/WO US-TECH,81375,CDM,361,RC,20999,CPT,,,facility,outpatient,,,94.77000,90.03000,Amish/Mennonite,Amish Mennonite,,52.12,,,,,,,52.12,5858.00,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,inpatient,1,mL,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,13.04,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,14789025110,NDC,facility,outpatient,1,mL,23.70000,22.52000,Amish/Mennonite,Amish Mennonite,,13.04,,,,,,,11.85,22.99,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,inpatient,1,mL,7.81000,7.41000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,4.30,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,51754425003,NDC,facility,outpatient,1,mL,7.81000,7.41000,Amish/Mennonite,Amish Mennonite,,4.30,,,,,,,3.90,7.58,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,inpatient,1,mL,14.71000,13.98000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,8.09,14.27,percent of total billed charges,
EPHEDRINE SOLN 5 MG/ML 5 ML,81376,CDM,250,RC,J3490,HCPCS,70092147844,NDC,facility,outpatient,1,mL,14.71000,13.98000,Amish/Mennonite,Amish Mennonite,,8.09,,,,,,,7.36,14.27,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,inpatient,,,3112.00000,2956.40000,Amish/Mennonite,Amish Mennonite,TC,1711.60,,,,,,,1711.60,3018.64,percent of total billed charges,
DESIGN MLC DEVICE FOR IMRT,81377,CDM,333,RC,77338,CPT,,,facility,outpatient,,,3112.00000,2956.40000,Amish/Mennonite,Amish Mennonite,TC,1711.60,,,,,,,1334.13,14413.40,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,inpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,,9127.25,,,,,,,9127.25,16097.15,percent of total billed charges,
RADIOTHERAPY DOSE PLAN IMRT,81378,CDM,333,RC,77301,CPT,,,facility,outpatient,,,16595.00000,15765.25000,Amish/Mennonite,Amish Mennonite,,9127.25,,,,,,,1299.22,106944.98,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
BIOPSY RECTUM,81379,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AD 6FR L100CM 0.070IN GRN PTFE COR,81380,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1804.69,3182.81,percent of total billed charges,
CATHETER INTERVENTIONAL 7FR 100CM 7CM ENDOVENOUS SAPHENOUS VEIN REFLUX LATEX FREE CLOSUREFAST ACCEPT,81381,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3281.25000,3117.19000,Amish/Mennonite,Amish Mennonite,,1804.69,,,,,,,1640.62,3182.81,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7935.00000,7538.25000,Amish/Mennonite,Amish Mennonite,,4364.25,,,,,,,3888.15,7696.95,percent of total billed charges,
CATHETER ATHRCM 2.3MM .091IN 120CM TRBO-PWR LSR,81382,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7935.00000,7538.25000,Amish/Mennonite,Amish Mennonite,,4364.25,,,,,,,3642.16,7935.00,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1437.79,2846.23,percent of total billed charges,
CATHETER VALVULOPLASTY 9FR L100CM BLLN L5CM,81383,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,2934.26000,2787.55000,Amish/Mennonite,Amish Mennonite,,1613.84,,,,,,,1346.83,2934.26,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,3025.99,5990.23,percent of total billed charges,
COIL EMB PRI L50CM TARGET VES 5-6MM L VOL DETACH FOR HI FLO,81384,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6175.50000,5866.72000,Amish/Mennonite,Amish Mennonite,,3396.53,,,,,,,2834.55,6175.50,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1845.00000,1752.75000,Amish/Mennonite,Amish Mennonite,,1014.75,,,,,,,904.05,1789.65,percent of total billed charges,
KIT INSTR INCL 2 GUIDEWIRES DEPTH G DRLBT,81387,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1845.00000,1752.75000,Amish/Mennonite,Amish Mennonite,,1014.75,,,,,,,846.86,1845.00,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,360.00000,342.00000,Amish/Mennonite,Amish Mennonite,,198.00,,,,,,,176.40,349.20,percent of total billed charges,
GUIDEWIRE VASC L260CM DIA0.035IN MICROGLIDE,81388,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,360.00000,342.00000,Amish/Mennonite,Amish Mennonite,,198.00,,,,,,,165.24,360.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1620.67,3208.28,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN DST SEG 35CM,81389,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1518.14,3307.50,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 45CM SIL MC SLK 7-10ML 3CM TPR,81390,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,105.66,209.16,percent of total billed charges,
GUIDEWIRE VASC STRG .035IN 260CM PERI NTNL PU,81391,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,98.97,215.63,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 16FR 30CM TRNGS TUNG SIL MC SLK 1.5CM,81392,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L18CM GWIRE 0.035IN POLYETH CRV TAPR TIP,81393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L30MM DIA9MM CATH L57CM CROSSING PROF 6FR,81394,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4310.77,8533.58,percent of total billed charges,
STENT TRANSCAROTID L40MM DIA10MM CATH L57CM CROSSING PROF,81395,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,8797.50000,8357.62000,Amish/Mennonite,Amish Mennonite,,4838.62,,,,,,,4038.05,8797.50,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,116.86,231.34,percent of total billed charges,
SHEATH GUID 6FR L55CM DIA2.2MM GWIRE 0.035IN,81396,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,109.47,238.50,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 12X60MM 80CM OTW DEL SYS,81398,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,Amish/Mennonite,Amish Mennonite,,3413.60,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT ZILVER VENA 14X100X80CM,81399,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,Amish/Mennonite,Amish Mennonite,,3413.60,,,,,,,2848.81,6206.55,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT EVAR L29MM DIA8-16MM CATH L135CM 0.035IN PROX DST IL,81400,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1713.75000,1628.06000,Amish/Mennonite,Amish Mennonite,,942.56,,,,,,,839.74,1662.34,percent of total billed charges,
CATHETER DIAG 3.5X3.5-2.1FR L135CM DST TIP,81401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1713.75000,1628.06000,Amish/Mennonite,Amish Mennonite,,942.56,,,,,,,786.61,1713.75,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,inpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,44567-0642-10,NDC,,,facility,outpatient,1,mL,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,inpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.26400,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,70092-1468-05,NDC,,,facility,outpatient,1,mL,0.48000,0.46000,Amish/Mennonite,Amish Mennonite,,0.26400,,,,,,,0.24000,0.46560,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,inpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.45100,0.79540,percent of total billed charges,
NOREPINEPHRINE 16 MG/NS 250 ML PREMIX,81411,CDM,250,RC,81298-9658-03,NDC,,,facility,outpatient,1,mL,0.82000,0.78000,Amish/Mennonite,Amish Mennonite,,0.45100,,,,,,,0.41000,0.79540,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,41.80,73.72,percent of total billed charges,
SILICA CLOTTING TIME,81413,CDM,300,RC,85732,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,6.47,339.51,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,inpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.30,2.30,percent of total billed charges,
HYDROXYUREA 40 MG/ML SUSP,81414,CDM,250,RC,68084-0284-11-04000,NDC,,,facility,outpatient,1,mL,2.37000,2.25000,Amish/Mennonite,Amish Mennonite,,1.30,,,,,,,1.19,2.30,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,inpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.55000,0.97000,percent of total billed charges,
SOTALOL 20 MG TAB,81416,CDM,250,RC,68084-0654-01-00025,NDC,,,facility,outpatient,1,EA,1.00000,0.95000,Amish/Mennonite,Amish Mennonite,,0.55000,,,,,,,0.50000,0.97000,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,inpatient,1,EA,76.72000,72.89000,Amish/Mennonite,Amish Mennonite,,42.20,,,,,,,42.20,74.42,percent of total billed charges,
METHYLPREDNISOLONE NA SUCC POWD-INJ 500 MG,81417,CDM,636,RC,J2919,HCPCS,00009075801,NDC,facility,outpatient,1,EA,76.72000,72.89000,Amish/Mennonite,Amish Mennonite,,42.20,,,,,,,0.26000,74.42,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,inpatient,1,EA,4092.00000,3887.40000,Amish/Mennonite,Amish Mennonite,,2250.60,,,,,,,2250.60,3969.24,percent of total billed charges,
DALBAVANCIN POWD-INJ 500 MG,81418,CDM,636,RC,J0875,HCPCS,57970010001,NDC,facility,outpatient,1,EA,4092.00000,3887.40000,Amish/Mennonite,Amish Mennonite,,2250.60,,,,,,,15.55,3969.24,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,TC,418.55,,,,,,,418.55,738.17,percent of total billed charges,
XRAY/ELBOW ARTHROGRAPHY-TECH,81424,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,TC,418.55,,,,,,,380.50,4635.02,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,inpatient,1,EA,34.64000,32.91000,Amish/Mennonite,Amish Mennonite,,19.05,,,,,,,19.05,33.60,percent of total billed charges,
FLUTICASONE/UMECLIDINIUM/VILANTEROL 100 MCG-62.5 MCG-25 MCG/INH POW,81428,CDM,250,RC,00173-0887-10,NDC,,,facility,outpatient,1,EA,34.64000,32.91000,Amish/Mennonite,Amish Mennonite,,19.05,,,,,,,17.32,33.60,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,inpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,130.35,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,00143909801,NDC,facility,outpatient,1,EA,237.00000,225.15000,Amish/Mennonite,Amish Mennonite,,130.35,,,,,,,2.55,229.89,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,inpatient,1,EA,1548.82000,1471.38000,Amish/Mennonite,Amish Mennonite,,851.85,,,,,,,851.85,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,10019099101,NDC,facility,outpatient,1,EA,1548.82000,1471.38000,Amish/Mennonite,Amish Mennonite,,851.85,,,,,,,2.55,1502.36,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,inpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,356.12,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,43598042660,NDC,facility,outpatient,1,EA,647.50000,615.12000,Amish/Mennonite,Amish Mennonite,,356.12,,,,,,,2.55,628.08,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,inpatient,1,EA,738.15000,701.24000,Amish/Mennonite,Amish Mennonite,,405.98,,,,,,,405.98,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,55150033701,NDC,facility,outpatient,1,EA,738.15000,701.24000,Amish/Mennonite,Amish Mennonite,,405.98,,,,,,,2.55,716.01,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,inpatient,1,EA,582.75000,553.61000,Amish/Mennonite,Amish Mennonite,,320.51,,,,,,,320.51,565.27,percent of total billed charges,
BORTEZOMIB POWD-INJ 3.5 MG,81429,CDM,250,RC,J9041,HCPCS,71288011810,NDC,facility,outpatient,1,EA,582.75000,553.61000,Amish/Mennonite,Amish Mennonite,,320.51,,,,,,,2.55,565.27,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
INJ DX/TX SUB LMBR/SAC WO IMG-TECH,81430,CDM,510,RC,62322,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,929.91,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,inpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,90,231.55,,,,,,,231.55,408.37,percent of total billed charges,
"MUCOPOLYSAC, QNT (MPSQU) SO",81431,CDM,301,RC,83864,CPT,,,facility,outpatient,,,421.00000,399.95000,Amish/Mennonite,Amish Mennonite,90,231.55,,,,,,,28.00,1341.13,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,inpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,90,57.75,,,,,,,57.75,101.85,percent of total billed charges,
"MUCOPOLYSAC ASSAY, QNT (MPSQU) SO",81432,CDM,301,RC,82570,CPT,,,facility,outpatient,,,105.00000,99.75000,Amish/Mennonite,Amish Mennonite,90,57.75,,,,,,,5.35,271.65,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,inpatient,,,116.30000,110.48000,Amish/Mennonite,Amish Mennonite,90,63.97,,,,,,,63.97,112.81,percent of total billed charges,
"ALLERGEN,ALPHA-GEL SO",81433,CDM,300,RC,86003,CPT,,,facility,outpatient,,,116.30000,110.48000,Amish/Mennonite,Amish Mennonite,90,63.97,,,,,,,4.57,271.65,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,inpatient,,,84.60000,80.37000,Amish/Mennonite,Amish Mennonite,90,46.53,,,,,,,46.53,82.06,percent of total billed charges,
"THROMBIN TIME, PLASMA (TTSC) SO",81434,CDM,300,RC,85670,CPT,,,facility,outpatient,,,84.60000,80.37000,Amish/Mennonite,Amish Mennonite,90,46.53,,,,,,,20.20,305.58,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,267.85,472.39,percent of total billed charges,
"ETHYL GLUCURONIDE, URINE",81435,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,487.00000,462.65000,Amish/Mennonite,Amish Mennonite,,267.85,,,,,,,63.95,788.42,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,inpatient,1,EA,6.13000,5.83000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.37,5.95,percent of total billed charges,
FLUTICASONE-SALMETEROL 250 MCG-50 MCG POWD,81436,CDM,250,RC,00378-9321-32,NDC,,,facility,outpatient,1,EA,6.13000,5.83000,Amish/Mennonite,Amish Mennonite,,3.37,,,,,,,3.06,5.95,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,inpatient,,,11828.00000,11236.60000,Amish/Mennonite,Amish Mennonite,TC,6505.40,,,,,,,6505.40,11473.16,percent of total billed charges,
SLEEP W/O PRESSURE <6YRS OLD,81437,CDM,920,RC,95782,CPT,,,facility,outpatient,,,11828.00000,11236.60000,Amish/Mennonite,Amish Mennonite,TC,6505.40,,,,,,,1929.64,11473.16,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,inpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,TC,418.55,,,,,,,418.55,738.17,percent of total billed charges,
XR ARTHROGRAM ELBOW,81438,CDM,320,RC,73085,CPT,,,facility,outpatient,,,761.00000,722.95000,Amish/Mennonite,Amish Mennonite,TC,418.55,,,,,,,380.50,4635.02,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,inpatient,,,2963.00000,2814.85000,Amish/Mennonite,Amish Mennonite,,1629.65,,,,,,,1629.65,2874.11,percent of total billed charges,
CT DX BONE MARROW ASPIRATIONS,81439,CDM,361,RC,38220,CPT,,,facility,outpatient,,,2963.00000,2814.85000,Amish/Mennonite,Amish Mennonite,,1629.65,,,,,,,1538.48,4686.00,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X10MM,81440,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.25X12MM,81441,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 2.5X6MM,81442,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,4226.25,8366.25,percent of total billed charges,
CATHETER INTRO 10.5X7FR L38CM STEER DEFL,81443,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,8625.00000,8193.75000,Amish/Mennonite,Amish Mennonite,,4743.75,,,,,,,3958.88,8625.00,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,676.99000,643.14000,Amish/Mennonite,Amish Mennonite,,372.34,,,,,,,331.73,656.68,percent of total billed charges,
CATHETER NEPHSTMY L27CM DIA12FR LOK LOOP,81444,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,676.99000,643.14000,Amish/Mennonite,Amish Mennonite,,372.34,,,,,,,310.74,676.99,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 2 .014 190CM GWIRE,81445,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER BEACON TIP H1 5FR 100CM,81446,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L120MM DIA6MM.,81447,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA7MM.,81448,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA7MM,81449,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BALLN L40MM DIA8MM.,81450,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA L200CM 5FR BALLOON L100MM DIA6MM,81452,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L10CM OD5MM 360DEG ULT DETACH LSR ABLATED DARKER,81454,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,inpatient,,,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.48950,0.86330,percent of total billed charges,
CONTRAST ISOVUE 250 100ML,81455,CDM,636,RC,Q9966,HCPCS,,,facility,outpatient,,,0.89000,0.85000,Amish/Mennonite,Amish Mennonite,,0.48950,,,,,,,0.44500,0.86330,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L111MM DIA32MM SHTH OD7.7MM ID6.7MM AORT VES,81457,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,174.56,345.56,percent of total billed charges,
GWIRE ASAHI EXTENSION 165CM,81458,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,356.25000,338.44000,Amish/Mennonite,Amish Mennonite,,195.94,,,,,,,163.52,356.25,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,inpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,820.60,1447.24,percent of total billed charges,
CT DRAIN BL W/CATH INSERTION,81461,CDM,361,RC,51102,CPT,,,facility,outpatient,,,1492.00000,1417.40000,Amish/Mennonite,Amish Mennonite,TC,820.60,,,,,,,820.60,6003.00,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2079.00000,1975.05000,Amish/Mennonite,Amish Mennonite,,1143.45,,,,,,,1018.71,2016.63,percent of total billed charges,
SHEATH AXS INFINITY LS 90CM,81463,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2079.00000,1975.05000,Amish/Mennonite,Amish Mennonite,,1143.45,,,,,,,954.26,2079.00,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRMT DEL => 1 MEV; SIMPLE,81464,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,103.97,7859.04,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,inpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,523.69,1036.69,percent of total billed charges,
KIT SNR 15MM 6FR 120CM NTNL AGN 102CM CATH,81465,CDM,278,RC,C1773,HCPCS,,,facility,outpatient,,,1068.75000,1015.31000,Amish/Mennonite,Amish Mennonite,,587.81,,,,,,,490.56,1068.75,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE VASC STRG TPR .014IN 190CM SLIP-COAT,81467,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,63.58,125.87,percent of total billed charges,
TUBE GASTRM 24FR SIL MC SLK 7-10ML MED PORT,81468,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,129.76000,123.27000,Amish/Mennonite,Amish Mennonite,,71.37,,,,,,,59.56,129.76,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,TC,356.40,,,,,,,356.40,628.56,percent of total billed charges,
XR URETHRO RETROGRADE,81469,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,TC,356.40,,,,,,,324.00,2941.42,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,137.81,272.81,percent of total billed charges,
GUIDEWIRE VASC L300CM 10CM INTMED SEGMENTS,81470,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,281.25000,267.19000,Amish/Mennonite,Amish Mennonite,,154.69,,,,,,,129.09,281.25,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
GUIDEWIRE VASC L300CM MICROGLIDE COAT STR,81471,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2958.38,5856.38,percent of total billed charges,
STENT VEN SELF EXPND 14X60MM 80CM OTW DEL SYS,81473,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6037.50000,5735.62000,Amish/Mennonite,Amish Mennonite,,3320.62,,,,,,,2771.21,6037.50,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1117.20,2211.60,percent of total billed charges,
TUBE FEED 18FR L45CM STOMA L4.4CM GAST JEJU,81474,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2280.00000,2166.00000,Amish/Mennonite,Amish Mennonite,,1254.00,,,,,,,1046.52,2280.00,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,3042.90,6023.70,percent of total billed charges,
LEAD PACE L86CM L VENT SIL PLYR ETFE TI PLAT IRIDIUM QPLR,81475,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,6210.00000,5899.50000,Amish/Mennonite,Amish Mennonite,,3415.50,,,,,,,2850.39,6210.00,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L44MM DIA4MM,81476,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1093.31,2164.31,percent of total billed charges,
STENT BILI 6FR L26MM DIA8MM CATH L120CM 0.035IN BLLN SELF,81477,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2231.25000,2119.69000,Amish/Mennonite,Amish Mennonite,,1227.19,,,,,,,1024.14,2231.25,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2388.60000,2269.17000,Amish/Mennonite,Amish Mennonite,,1313.73,,,,,,,1170.41,2316.94,percent of total billed charges,
SET XTRN DRN 3-15CM 1.9MM 35CM BA CDMN BCTSL,81478,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2388.60000,2269.17000,Amish/Mennonite,Amish Mennonite,,1313.73,,,,,,,1096.37,2388.60,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,inpatient,,,319.84000,303.85000,Amish/Mennonite,Amish Mennonite,,175.91,,,,,,,156.72,310.24,percent of total billed charges,
SUPRAPUBIC CATH 8.5,81479,CDM,278,RC,C2627,HCPCS,,,facility,outpatient,,,319.84000,303.85000,Amish/Mennonite,Amish Mennonite,,175.91,,,,,,,146.81,319.84,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3296.47,6525.68,percent of total billed charges,
INTERSTIM SMRT PRGMR (FOR PT),81480,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,6727.50000,6391.12000,Amish/Mennonite,Amish Mennonite,,3700.12,,,,,,,3087.92,6727.50,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,inpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,,549.45,,,,,,,549.45,969.03,percent of total billed charges,
"XRY/HEP VENOGR,W/O HEMODYN EV-TECH",81496,CDM,320,RC,75891,CPT,,,facility,outpatient,,,999.00000,949.05000,Amish/Mennonite,Amish Mennonite,,549.45,,,,,,,422.60,17311.25,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,Amish/Mennonite,Amish Mennonite,,3317.60,,,,,,,3317.60,5851.04,percent of total billed charges,
"AMYVID,UP TO 10MCI",81498,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,Amish/Mennonite,Amish Mennonite,,3317.60,,,,,,,2194.62,5851.04,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,Amish/Mennonite,Amish Mennonite,,4767.95,,,,,,,4767.95,8408.93,percent of total billed charges,
PYLARIFY IV 9MCI,81501,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,Amish/Mennonite,Amish Mennonite,,4767.95,,,,,,,4334.50,8408.93,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,inpatient,,,137.23000,130.37000,Amish/Mennonite,Amish Mennonite,,75.48,,,,,,,75.48,133.11,percent of total billed charges,
SITZMARKS CAPSULE,81502,CDM,254,RC,A9698,HCPCS,,,facility,outpatient,,,137.23000,130.37000,Amish/Mennonite,Amish Mennonite,,75.48,,,,,,,68.61,133.11,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,inpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.40150,0.70810,percent of total billed charges,
AMIODARONE 1.8 MG SOLN,81504,CDM,250,RC,J0283,HCPCS,43066036020,NDC,facility,outpatient,1,mL,0.73000,0.69000,Amish/Mennonite,Amish Mennonite,,0.40150,,,,,,,0.36500,4.31,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,inpatient,1,GM,31.19000,29.63000,Amish/Mennonite,Amish Mennonite,,17.15,,,,,,,17.15,30.25,percent of total billed charges,
ALUMINUM POTASSIUM SULFATE - POWD,81506,CDM,250,RC,24357-0300-30,NDC,,,facility,outpatient,1,GM,31.19000,29.63000,Amish/Mennonite,Amish Mennonite,,17.15,,,,,,,15.60,30.25,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,inpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.54450,0.96030,percent of total billed charges,
LIPID EMULSION 20% 100 ML (INTRALIPID),81507,CDM,250,RC,J3490,HCPCS,00338051958,NDC,facility,outpatient,1,mL,0.99000,0.94000,Amish/Mennonite,Amish Mennonite,,0.54450,,,,,,,0.49500,0.96030,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,inpatient,,,10723.00000,10186.85000,Amish/Mennonite,Amish Mennonite,TC,5897.65,,,,,,,5897.65,10401.31,percent of total billed charges,
"XRAY/TRANSCATH THER,EMBOL-TECH",81513,CDM,320,RC,75894,CPT,,,facility,outpatient,,,10723.00000,10186.85000,Amish/Mennonite,Amish Mennonite,TC,5897.65,,,,,,,5057.86,51844.17,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,inpatient,1,EA,288.61000,274.18000,Amish/Mennonite,Amish Mennonite,,158.74,,,,,,,158.74,279.95,percent of total billed charges,
BARICITINIB TAB 2 MG,81520,CDM,250,RC,00002-4182-30,NDC,,,facility,outpatient,1,EA,288.61000,274.18000,Amish/Mennonite,Amish Mennonite,,158.74,,,,,,,144.31,279.95,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,inpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,1030.70,1817.78,percent of total billed charges,
IV INF CASIRIVIMAB/IMDEVIMAB,81525,CDM,771,RC,M0243,HCPCS,,,facility,outpatient,,,1874.00000,1780.30000,Amish/Mennonite,Amish Mennonite,,1030.70,,,,,,,937.00,1817.78,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 5X100X200CM.,81527,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.5X12MM,81528,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,6687.63,14570.00,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4.5CM 18FR RADOPQ LOPRFL PROX ANRFLX V,81529,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,inpatient,,,3264.00000,3100.80000,Amish/Mennonite,Amish Mennonite,TC,1795.20,,,,,,,1795.20,3166.08,percent of total billed charges,
PULMONARY VENTILATION/PERF IM,8153,CDM,340,RC,78582,CPT,,,facility,outpatient,,,3264.00000,3100.80000,Amish/Mennonite,Amish Mennonite,TC,1795.20,,,,,,,1527.07,3166.08,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM .081IN 2MM .081IN 150CM PRSTM,81530,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3487.31000,3312.94000,Amish/Mennonite,Amish Mennonite,,1918.02,,,,,,,1708.78,3382.69,percent of total billed charges,
PLT BNE PBC SYMP6 H 78MM SS LP PLV SYS /3.5MM COAXL CMB HLS,81533,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3487.31000,3312.94000,Amish/Mennonite,Amish Mennonite,,1918.02,,,,,,,1600.68,3487.31,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,Amish/Mennonite,Amish Mennonite,,761.06,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L52CM BPLR AV STR INGEVITY+,81534,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,Amish/Mennonite,Amish Mennonite,,761.06,,,,,,,635.14,1342.24,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,Amish/Mennonite,Amish Mennonite,,1008.32,,,,,,,898.32,1778.30,percent of total billed charges,
CATHETER DIL 5.8FR L75CM BLLN 18FR L4CM GWIRE,81535,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,Amish/Mennonite,Amish Mennonite,,1008.32,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2276.25000,2162.44000,Amish/Mennonite,Amish Mennonite,,1251.94,,,,,,,1115.36,2207.96,percent of total billed charges,
GRAFT BIO W5XL10CM THK0.2-0.6MM BOV PERICARD FLX SFT PLIABLE,81536,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2276.25000,2162.44000,Amish/Mennonite,Amish Mennonite,,1251.94,,,,,,,1044.80,2276.25,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY L200CM STNT L36MM DIA3MM,81538,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12077.43,26312.49,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,448.50000,426.08000,Amish/Mennonite,Amish Mennonite,,246.68,,,,,,,219.76,435.05,percent of total billed charges,
KIT CATH POWERGLIDE PRO 18G X 8CM REINFORCE TIP FULL,81539,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,448.50000,426.08000,Amish/Mennonite,Amish Mennonite,,246.68,,,,,,,205.86,448.50,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L40MM DIA8MM CATH L132CM 0.014IN NIT RX LP,81540,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3246.28,7072.50,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,inpatient,,,6032.00000,5730.40000,Amish/Mennonite,Amish Mennonite,,3317.60,,,,,,,3317.60,5851.04,percent of total billed charges,
NM AMYVID BRAIN PET 10MCI,81541,CDM,343,RC,A9586,HCPCS,,,facility,outpatient,,,6032.00000,5730.40000,Amish/Mennonite,Amish Mennonite,,3317.60,,,,,,,2194.62,5851.04,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 2.5X12MM,81542,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,6687.63,14570.00,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 3.0X12MM,81543,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,6687.63,14570.00,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1477.35,2924.55,percent of total billed charges,
SHEATH INTRO 7.5MM 20FR 33CM HDRPH GORE DRYSEAL,81544,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,3015.00000,2864.25000,Amish/Mennonite,Amish Mennonite,,1658.25,,,,,,,1383.88,3015.00,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,inpatient,,,3408.00000,3237.60000,Amish/Mennonite,Amish Mennonite,TC,1874.40,,,,,,,1874.40,3305.76,percent of total billed charges,
ELECTROPHYSIO EVAL-CARDIOVERT-TECH,81546,CDM,480,RC,93640,CPT,,,facility,outpatient,,,3408.00000,3237.60000,Amish/Mennonite,Amish Mennonite,TC,1874.40,,,,,,,1704.00,3305.76,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,inpatient,1,EA,19551.00000,18573.45000,Amish/Mennonite,Amish Mennonite,,10753.05,,,,,,,10753.05,18964.47,percent of total billed charges,
FACTOR VIIA 5000 MCG (NOVOSEVEN),81547,CDM,636,RC,J7189,HCPCS,00169720501,NDC,facility,outpatient,1,EA,19551.00000,18573.45000,Amish/Mennonite,Amish Mennonite,,10753.05,,,,,,,2.65,18964.47,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10121.50000,9615.42000,Amish/Mennonite,Amish Mennonite,,5566.82,,,,,,,4959.53,9817.85,percent of total billed charges,
SPACEOAR HYDROGEL,81550,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10121.50000,9615.42000,Amish/Mennonite,Amish Mennonite,,5566.82,,,,,,,4645.77,10121.50,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,inpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,37.40,65.96,percent of total billed charges,
TZANK TEST,81552,CDM,300,RC,87207,CPT,,,facility,outpatient,,,68.00000,64.60000,Amish/Mennonite,Amish Mennonite,,37.40,,,,,,,5.99,1216.68,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
KOH TEST,81553,CDM,300,RC,Q0112,HCPCS,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,5.83,44.62,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,inpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,2619.00,percent of total billed charges,
SHAVE LESION-TECH,81554,CDM,361,RC,,,,,facility,outpatient,,,2700.00000,2565.00000,Amish/Mennonite,Amish Mennonite,,1485.00,,,,,,,1485.00,5271.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,inpatient,1,EA,250.52000,238.00000,Amish/Mennonite,Amish Mennonite,,137.79,,,,,,,137.79,243.00,percent of total billed charges,
BARICITINIB TAB 1 MG,81555,CDM,250,RC,00002-4732-30,NDC,,,facility,outpatient,1,EA,250.52000,238.00000,Amish/Mennonite,Amish Mennonite,,137.79,,,,,,,125.26,243.00,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,inpatient,1,EA,90046.64000,85544.31000,Amish/Mennonite,Amish Mennonite,,49525.65,,,,,,,49525.65,87345.24,percent of total billed charges,
HISTRELIN 50. MG IMPLANT,81556,CDM,636,RC,J9226,HCPCS,67979000201,NDC,facility,outpatient,1,EA,90046.64000,85544.31000,Amish/Mennonite,Amish Mennonite,,49525.65,,,,,,,45023.32,87345.24,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,inpatient,1,EA,1289.61000,1225.13000,Amish/Mennonite,Amish Mennonite,,709.29,,,,,,,709.29,1250.92,percent of total billed charges,
ALPHA 1-PROTEINASE INHIBITOR HUMAN SOLN 1000MG/20ML (PROLASTIN-C),81557,CDM,636,RC,J0256,HCPCS,13533070501,NDC,facility,outpatient,1,EA,1289.61000,1225.13000,Amish/Mennonite,Amish Mennonite,,709.29,,,,,,,5.19,1250.92,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,inpatient,1,mL,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,2.58,4.56,percent of total billed charges,
INSULIN REGULAR 1 UNIT(S) / 1 ML SO,81558,CDM,250,RC,J1815,HCPCS,0000282151701000,NDC,facility,outpatient,1,mL,4.70000,4.46000,Amish/Mennonite,Amish Mennonite,,2.58,,,,,,,1.49,4.56,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,inpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.14300,0.25220,percent of total billed charges,
EMOLLIENT PASTE 113 GM (REMEDY CALAZIME),81561,CDM,250,RC,53329-0165-44,NDC,,,facility,outpatient,1,GM,0.26000,0.25000,Amish/Mennonite,Amish Mennonite,,0.14300,,,,,,,0.13000,0.25220,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,inpatient,,,6.70000,6.36000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.69,6.50,percent of total billed charges,
PHENAZOPYR 200MG PO,81564,CDM,636,RC,J8499,HCPCS,,,facility,outpatient,,,6.70000,6.36000,Amish/Mennonite,Amish Mennonite,,3.69,,,,,,,3.35,6.50,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,inpatient,,,1803.00000,1712.85000,Amish/Mennonite,Amish Mennonite,,991.65,,,,,,,991.65,1748.91,percent of total billed charges,
CAUTERY CONJUNCTIVAL-PROF,81570,CDM,960,RC,68399,CPT,,,facility,outpatient,,,1803.00000,1712.85000,Amish/Mennonite,Amish Mennonite,,991.65,,,,,,,283.85,1748.91,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,inpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,413.44,818.44,percent of total billed charges,
"SPINE BRACE,VISTA CTO 2 POST",81574,CDM,274,RC,L0180,HCPCS,,,facility,outpatient,,,843.75000,801.56000,Amish/Mennonite,Amish Mennonite,,464.06,,,,,,,421.88,818.44,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,inpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
VITAMIN A & D TOPICAL - OINTM,81590,CDM,250,RC,57896-0112-14-00000,NDC,,,facility,outpatient,1,GM,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,inpatient,1,EA,51.13000,48.57000,Amish/Mennonite,Amish Mennonite,,28.12,,,,,,,28.12,49.60,percent of total billed charges,
LINAGLIPTIN 5 MG TAB,81591,CDM,250,RC,00597-0140-30,NDC,,,facility,outpatient,1,EA,51.13000,48.57000,Amish/Mennonite,Amish Mennonite,,28.12,,,,,,,25.57,49.60,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,inpatient,1,mL,2753.56000,2615.88000,Amish/Mennonite,Amish Mennonite,,1514.46,,,,,,,1514.46,2670.95,percent of total billed charges,
OMALIZUMAB 75 MG/0.5 ML SOLN,81592,CDM,636,RC,J2357,HCPCS,50242021401,NDC,facility,outpatient,1,mL,2753.56000,2615.88000,Amish/Mennonite,Amish Mennonite,,1514.46,,,,,,,40.56,2670.95,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,inpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,1.16,2.05,percent of total billed charges,
PREDNISONE LIQ 40 MG/40 ML,81593,CDM,250,RC,J7512,HCPCS,0005437225004000,NDC,facility,outpatient,1,mL,2.11000,2.00000,Amish/Mennonite,Amish Mennonite,,1.16,,,,,,,0.00620,2.05,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,inpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,83.98,148.12,percent of total billed charges,
"CYTAL,PER SQ CM",81594,CDM,636,RC,Q4166,HCPCS,,,facility,outpatient,,,152.70000,145.06000,Amish/Mennonite,Amish Mennonite,,83.98,,,,,,,33.32,148.12,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,inpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,4.95,8.73,percent of total billed charges,
MATRIX MICR.1MG,81601,CDM,636,RC,Q4118,HCPCS,,,facility,outpatient,,,9.00000,8.55000,Amish/Mennonite,Amish Mennonite,,4.95,,,,,,,3.96,8.73,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,inpatient,1,mL,51.13000,48.57000,Amish/Mennonite,Amish Mennonite,,28.12,,,,,,,28.12,49.60,percent of total billed charges,
HYDROCORTISONE/NEOMYCIN/POLYMYXIN B OPHTH 1%-0.35%-10000 UNITS/ML SUSP,81603,CDM,250,RC,61314-0641-75,NDC,,,facility,outpatient,1,mL,51.13000,48.57000,Amish/Mennonite,Amish Mennonite,,28.12,,,,,,,25.57,49.60,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,inpatient,1,mL,4909.73000,4664.25000,Amish/Mennonite,Amish Mennonite,,2700.35,,,,,,,2700.35,4762.44,percent of total billed charges,
RAVULIZUMAB-CWVZ SOLN 100 MG/ML 3 ML (ULTOMIRIS),81604,CDM,636,RC,J1303,HCPCS,25682002501,NDC,facility,outpatient,1,mL,4909.73000,4664.25000,Amish/Mennonite,Amish Mennonite,,2700.35,,,,,,,225.19,4762.44,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,inpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,25.30,44.62,percent of total billed charges,
"LUMASON IV,PER ML",81610,CDM,636,RC,Q9950,HCPCS,,,facility,outpatient,,,46.00000,43.70000,Amish/Mennonite,Amish Mennonite,,25.30,,,,,,,23.00,44.62,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
GLYCOPYRROLATE SOLN 0.2 MG/ML 20 ML,81615,CDM,250,RC,J1596,HCPCS,00143967910,NDC,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,0.43000,18.39,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,inpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,50.60,89.24,percent of total billed charges,
COLD ABSORPTION,81627,CDM,300,RC,86978,CPT,,,facility,outpatient,,,92.00000,87.40000,Amish/Mennonite,Amish Mennonite,,50.60,,,,,,,46.00,1714.64,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,inpatient,1,EA,8520.12000,8094.11000,Amish/Mennonite,Amish Mennonite,,4686.07,,,,,,,4686.07,8264.52,percent of total billed charges,
FACTOR VIIA 2000 MCG (NOVOSEVEN),81631,CDM,636,RC,J7189,HCPCS,00169720201,NDC,facility,outpatient,1,EA,8520.12000,8094.11000,Amish/Mennonite,Amish Mennonite,,4686.07,,,,,,,2.65,8264.52,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,inpatient,1,mL,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,4.12,7.27,percent of total billed charges,
ZINC CHLORIDE 1 MG/ML SOLN,81632,CDM,250,RC,00409-4090-01,NDC,,,facility,outpatient,1,mL,7.49000,7.11000,Amish/Mennonite,Amish Mennonite,,4.12,,,,,,,3.75,7.27,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,inpatient,1,mL,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.50,2.64,percent of total billed charges,
DIPHENHYDRAMINE 25 MG / 0.5 ML SOLN,81633,CDM,250,RC,J1200,HCPCS,0064103762500050,NDC,facility,outpatient,1,mL,2.72000,2.58000,Amish/Mennonite,Amish Mennonite,,1.50,,,,,,,1.02,2.64,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,inpatient,,,322.90000,306.75000,Amish/Mennonite,Amish Mennonite,,177.59,,,,,,,177.59,313.21,percent of total billed charges,
WASHING CELLS P,81636,CDM,300,RC,86999,CPT,,,facility,outpatient,,,322.90000,306.75000,Amish/Mennonite,Amish Mennonite,,177.59,,,,,,,23.25,313.21,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,inpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,81.95,144.53,percent of total billed charges,
FFP-CRYOPRECIPITATE REDUC,81637,CDM,300,RC,P9044,HCPCS,,,facility,outpatient,,,149.00000,141.55000,Amish/Mennonite,Amish Mennonite,,81.95,,,,,,,74.50,153.86,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,inpatient,1,mL,147.89000,140.49000,Amish/Mennonite,Amish Mennonite,,81.34,,,,,,,81.34,143.45,percent of total billed charges,
PERFLUTREN (PROTEIN-TYPE A MICROSPHERES) SUSP INJ 3 ML (OPTISON),81638,CDM,250,RC,Q9956,HCPCS,00407270718,NDC,facility,outpatient,1,mL,147.89000,140.49000,Amish/Mennonite,Amish Mennonite,,81.34,,,,,,,64.92,143.45,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,453.75000,431.06000,Amish/Mennonite,Amish Mennonite,,249.56,,,,,,,222.34,440.14,percent of total billed charges,
FARROW WRAP CLASSIC 30-40,81641,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,453.75000,431.06000,Amish/Mennonite,Amish Mennonite,,249.56,,,,,,,208.27,440.14,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,inpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,202.12,400.12,percent of total billed charges,
CIRCAID KIT COMP WRAP THIGH,81642,CDM,274,RC,A6549,HCPCS,,,facility,outpatient,,,412.50000,391.88000,Amish/Mennonite,Amish Mennonite,,226.88,,,,,,,189.34,400.12,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
CIRCAID REDUCTION KIT-LOBE,81644,CDM,272,RC,A4465,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,80.00,155.20,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,39.52000,37.54000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,19.36,38.33,percent of total billed charges,
CATHETER ANGIO 4FR 80CM LEN ID1.02MM VASC,81645,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,39.52000,37.54000,Amish/Mennonite,Amish Mennonite,,21.74,,,,,,,18.14,39.52,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,Amish/Mennonite,Amish Mennonite,,2110.02,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM M CRV 22MM SIL,81648,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,Amish/Mennonite,Amish Mennonite,,2110.02,,,,,,,1760.91,3836.40,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,inpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,859.65,1516.11,percent of total billed charges,
RAD TRT DEL >1MEV SIMPLE-PAR,8165,CDM,333,RC,77402,CPT,,,facility,outpatient,,,1563.00000,1484.85000,Amish/Mennonite,Amish Mennonite,,859.65,,,,,,,103.97,7859.04,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRV CLOT REVASCULARIZATION DEV,81655,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,9953.19,21684.50,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,32799.06000,31159.11000,Amish/Mennonite,Amish Mennonite,,18039.48,,,,,,,16071.54,31815.09,percent of total billed charges,
STENT VASC L15MM DIA4MM FLO DIVERTER SURPS,81656,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,32799.06000,31159.11000,Amish/Mennonite,Amish Mennonite,,18039.48,,,,,,,15054.77,32799.06,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3836.40000,3644.58000,Amish/Mennonite,Amish Mennonite,,2110.02,,,,,,,1879.84,3721.31,percent of total billed charges,
SHEATH GUID 11.5X8.5FR L71CM L CRV 50MM SIL,81657,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3836.40000,3644.58000,Amish/Mennonite,Amish Mennonite,,2110.02,,,,,,,1760.91,3836.40,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,17391.00000,16521.45000,Amish/Mennonite,Amish Mennonite,,9565.05,,,,,,,8521.59,16869.27,percent of total billed charges,
CATHETER THROMCTMY L130CM LIGHTNING ASPIR,81658,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,17391.00000,16521.45000,Amish/Mennonite,Amish Mennonite,,9565.05,,,,,,,7982.47,17391.00,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,9280.50000,8816.48000,Amish/Mennonite,Amish Mennonite,,5104.27,,,,,,,4547.44,9002.08,percent of total billed charges,
KIT CATH W/ TIP LIGHTNING ASPIR TBNG 7FR SHTH.,81659,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,9280.50000,8816.48000,Amish/Mennonite,Amish Mennonite,,5104.27,,,,,,,4259.75,9280.50,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,inpatient,1,mL,1032.24000,980.63000,Amish/Mennonite,Amish Mennonite,,567.73,,,,,,,567.73,1001.27,percent of total billed charges,
RABIES IMMUNE GLOBULIN SOLN 150 INTUNIT/ML 2 ML (IMOGAM RABIES-HT),81661,CDM,636,RC,90376,HCPCS,49281019020,NDC,facility,outpatient,1,mL,1032.24000,980.63000,Amish/Mennonite,Amish Mennonite,,567.73,,,,,,,347.32,1001.27,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,inpatient,1,mL,453.41000,430.74000,Amish/Mennonite,Amish Mennonite,,249.38,,,,,,,249.38,439.81,percent of total billed charges,
SODIUM HYALURONATE SOLN 10 MG/ML 2 ML INTRA-ARTICULAR (EUFLEXXA),81662,CDM,636,RC,J7323,HCPCS,55566410001,NDC,facility,outpatient,1,mL,453.41000,430.74000,Amish/Mennonite,Amish Mennonite,,249.38,,,,,,,114.48,439.81,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,inpatient,1,mL,20.79000,19.75000,Amish/Mennonite,Amish Mennonite,,11.43,,,,,,,11.43,20.17,percent of total billed charges,
REMDESIVIR SOLN SD 1.25 MG/ML,81664,CDM,636,RC,J0248,HCPCS,6195829010100125,NDC,facility,outpatient,1,mL,20.79000,19.75000,Amish/Mennonite,Amish Mennonite,,11.43,,,,,,,6.35,20.17,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,inpatient,,,7334.70000,6967.96000,Amish/Mennonite,Amish Mennonite,,4034.09,,,,,,,3594.00,7114.66,percent of total billed charges,
CATHETER EP 7FR L115CM 2-6-2MM SPC 20 ELECTRD,81667,CDM,278,RC,C1730,HCPCS,,,facility,outpatient,,,7334.70000,6967.96000,Amish/Mennonite,Amish Mennonite,,4034.09,,,,,,,3366.63,7334.70,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,3086.00000,2931.70000,Amish/Mennonite,Amish Mennonite,,1697.30,,,,,,,1697.30,2993.42,percent of total billed charges,
"PLATELETS, PHERESIS, PATHOGEN-REDUCED, EACH UNIT",81668,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,3086.00000,2931.70000,Amish/Mennonite,Amish Mennonite,,1697.30,,,,,,,557.65,2993.42,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,inpatient,1,mL,299.83000,284.84000,Amish/Mennonite,Amish Mennonite,,164.91,,,,,,,164.91,290.84,percent of total billed charges,
SODIUM HYALURONATE 10 MG/ML SO,81669,CDM,250,RC,J7321,HCPCS,89130444401,NDC,facility,outpatient,1,mL,299.83000,284.84000,Amish/Mennonite,Amish Mennonite,,164.91,,,,,,,114.64,290.84,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,inpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,152.35,268.69,percent of total billed charges,
"LAB/DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81671,CDM,300,RC,80307,CPT,,,facility,outpatient,,,277.00000,263.15000,Amish/Mennonite,Amish Mennonite,,152.35,,,,,,,62.14,3038.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,inpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,290.95,513.13,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 1-7 DRUG CLASSES, PER DAY",81672,CDM,300,RC,G0480,HCPCS,,,facility,outpatient,,,529.00000,502.55000,Amish/Mennonite,Amish Mennonite,,290.95,,,,,,,63.95,788.42,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,inpatient,,,673.00000,639.35000,Amish/Mennonite,Amish Mennonite,,370.15,,,,,,,370.15,652.81,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 8-14 DRUG CLASSES, PER DAY",81673,CDM,300,RC,G0481,HCPCS,,,facility,outpatient,,,673.00000,639.35000,Amish/Mennonite,Amish Mennonite,,370.15,,,,,,,98.39,1078.91,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,inpatient,,,1508.00000,1432.60000,Amish/Mennonite,Amish Mennonite,,829.40,,,,,,,829.40,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 15-21 DRUG CLASSES, PER DAY",81674,CDM,300,RC,G0482,HCPCS,,,facility,outpatient,,,1508.00000,1432.60000,Amish/Mennonite,Amish Mennonite,,829.40,,,,,,,132.80,1462.76,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,inpatient,,,1840.00000,1748.00000,Amish/Mennonite,Amish Mennonite,,1012.00,,,,,,,1012.00,1784.80,percent of total billed charges,
"LAB/DRUG TEST, DEFINITIVE, 22+ DRUG CLASSES, PER DAY",81675,CDM,300,RC,G0483,HCPCS,,,facility,outpatient,,,1840.00000,1748.00000,Amish/Mennonite,Amish Mennonite,,1012.00,,,,,,,172.18,1784.80,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,inpatient,,,350.40000,332.88000,Amish/Mennonite,Amish Mennonite,90,192.72,,,,,,,192.72,339.89,percent of total billed charges,
"LAB/SO DRUG TEST, PRESUMPTIVE, BY INSTRUMENT CHEMISTRY ANALYSER, PER DATE",81676,CDM,300,RC,80307,CPT,,,facility,outpatient,,,350.40000,332.88000,Amish/Mennonite,Amish Mennonite,90,192.72,,,,,,,63.40,3038.81,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA5MM.,81677,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1383.41000,1314.24000,Amish/Mennonite,Amish Mennonite,,760.88,,,,,,,677.87,1341.91,percent of total billed charges,
BASKET RETRIEVAL 4 WIRE SEGURA 2.4FR,81678,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1383.41000,1314.24000,Amish/Mennonite,Amish Mennonite,,760.88,,,,,,,634.99,1383.41,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L8CM DIA4MM 360DEG SFT DETACH TARGET,81681,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
STANDARD STR GWIRE W/ HYDRPHLC COAT,81682,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA3MM 360DEG SFT DETACH TARGET,81683,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L6CM DIA2MM 360DEG SFT DETACH TARGET,81684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 2.5MMX4CM,81685,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L4CM DIA3MM 360DEG DETACH TARGET,81686,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC L215CM DIA0.014IN DST WIRE,81687,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,81.96000,77.86000,Amish/Mennonite,Amish Mennonite,,45.08,,,,,,,40.16,79.50,percent of total billed charges,
CATH URETH 20FR 30CC BLLN HEMA F 3 W LNG RND,81693,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,81.96000,77.86000,Amish/Mennonite,Amish Mennonite,,45.08,,,,,,,37.62,81.96,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3550.05,7027.65,percent of total billed charges,
CATHETER ATHRCM 1.4MM 150CM PERI TRBO ELT RX,81694,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,7245.00000,6882.75000,Amish/Mennonite,Amish Mennonite,,3984.75,,,,,,,3325.45,7245.00,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 120MM 5MM 75CM ULTRAVERSE 035,81695,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,288.60000,274.17000,Amish/Mennonite,Amish Mennonite,,158.73,,,,,,,141.41,279.94,percent of total billed charges,
CATHETER MIDLN 18GA L8CM W/ REINF TIP BASIC,81696,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,288.60000,274.17000,Amish/Mennonite,Amish Mennonite,,158.73,,,,,,,132.47,288.60,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
DEVICE OCCL CLP L45MM PRELD FOR THORACOSCOPIC PROC GILLINOV,81697,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L90MM DIA20MM SHTH OD6MM ID5.3MM,81699,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,14081.13,27874.89,percent of total billed charges,
GRAFT EVAR L95MM DIA36MM SHTH OD8.5MM ID7.3MM AORT VES,81700,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,28737.00000,27300.15000,Amish/Mennonite,Amish Mennonite,,15805.35,,,,,,,13190.28,28737.00,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,34469.40000,32745.93000,Amish/Mennonite,Amish Mennonite,,18958.17,,,,,,,16890.01,33435.32,percent of total billed charges,
DEFIBRILLATOR CARD 80GM W51XH68MM D13MM 2 CHMBR BLUESYNC,81701,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,34469.40000,32745.93000,Amish/Mennonite,Amish Mennonite,,18958.17,,,,,,,15821.45,33435.32,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE LIQ SD 0.2 MG/0.5 ML,81702,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 2X40X200CM.,81705,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,Amish/Mennonite,Amish Mennonite,,6492.64,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION L115CM 1-6-2MM 8FR SPC TIP,81706,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,Amish/Mennonite,Amish Mennonite,,6492.64,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L80MM DIA6MM.,81707,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER PTCA L75CM BLLN L100MM OD8MM GWIRE,81708,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L24CM LOOP DIA8MM 0.029IN DETACH CRSS SECT OCCL 35.,81709,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,1927.18,4198.65,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,inpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,300.85,530.59,percent of total billed charges,
RADIOPHARM THER; BY ORAL ADMIN-TECH,8171,CDM,340,RC,79005,CPT,,,facility,outpatient,,,547.00000,519.65000,Amish/Mennonite,Amish Mennonite,TC,300.85,,,,,,,273.50,1232.72,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L17CM LOOP DIA6MM 0.029IN DETACH CRSS SECT OCCL 35.,81710,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,1927.18,4198.65,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,13950.00000,13252.50000,Amish/Mennonite,Amish Mennonite,,7672.50,,,,,,,6835.50,13531.50,percent of total billed charges,
MONITOR CARD 3GM W7.2XH44.8MM D4MM INSERTABLE LEADLESS,81712,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,13950.00000,13252.50000,Amish/Mennonite,Amish Mennonite,,7672.50,,,,,,,6403.05,13950.00,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L120MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF.,81714,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1642.07,3577.50,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11342.90000,10775.75000,Amish/Mennonite,Amish Mennonite,,6238.60,,,,,,,5558.02,11002.61,percent of total billed charges,
GRAFT EVAR L100MM DIA7MM CATH L120CM DIA8FR 0.035IN HEP,81715,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11342.90000,10775.75000,Amish/Mennonite,Amish Mennonite,,6238.60,,,,,,,5206.39,11342.90,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,461.55,913.67,percent of total billed charges,
SET URET STNT 8FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ SFT,81716,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,941.93000,894.83000,Amish/Mennonite,Amish Mennonite,,518.06,,,,,,,432.35,941.93,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1653.75,3273.75,percent of total billed charges,
GUIDEWIRE VASC 0.024INX200CM MICROFABRICATED,81717,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3375.00000,3206.25000,Amish/Mennonite,Amish Mennonite,,1856.25,,,,,,,1549.12,3375.00,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI L60MM DIA8MM CATH 6FR L80CM SELF EXP OTW NIT,81719,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FRX5CM ACC CHN 2MM ZMMN,81720,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10741.50000,10204.42000,Amish/Mennonite,Amish Mennonite,,5907.82,,,,,,,5263.34,10419.25,percent of total billed charges,
SPACER RADIOTHERAPY POS PROST HYDRGEL ABSRB,81721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10741.50000,10204.42000,Amish/Mennonite,Amish Mennonite,,5907.82,,,,,,,4930.35,10741.50,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12893.12,25523.12,percent of total billed charges,
RETRIEVER THROMCTMY 6X38MM PROVUE TREVO NXT,81722,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,26312.49000,24996.87000,Amish/Mennonite,Amish Mennonite,,14471.87,,,,,,,12077.43,26312.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
STENT PERIPH L39MM DIA6X8MM CATH L135CM INTRO SHTH 7FR GWIRE,81723,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,4048.75,8014.87,percent of total billed charges,
LATERA 20MM ABSRB NSL IMPL SYS,81724,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8262.75000,7849.61000,Amish/Mennonite,Amish Mennonite,,4544.51,,,,,,,3792.60,8262.75,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB TARGET 360 NANO 1.5MMX4CM,81725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L9CM DIA3MM 360DEG SFT DETACH TARGET,81726,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 4MMX12CM,81727,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL EMB L15CM DIA5MM 360DEG SFT DETACH TARGET XL,81728,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2343.75000,2226.56000,Amish/Mennonite,Amish Mennonite,,1289.06,,,,,,,1148.44,2273.44,percent of total billed charges,
GUIDEWIRE VASC L200CM DIA0.014IN SUPP PROF,81729,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2343.75000,2226.56000,Amish/Mennonite,Amish Mennonite,,1289.06,,,,,,,1075.78,2343.75,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1515.94,3000.94,percent of total billed charges,
GUIDEWIRE ARISTOTLE STANDARD .018 200CM,81731,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3093.75000,2939.06000,Amish/Mennonite,Amish Mennonite,,1701.56,,,,,,,1420.03,3093.75,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,10230.00000,9718.50000,Amish/Mennonite,Amish Mennonite,,5626.50,,,,,,,5012.70,9923.10,percent of total billed charges,
PULSE GENRTR CARD 2.8V 21.5GM 9.7CUCM 0.92AH,81732,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,10230.00000,9718.50000,Amish/Mennonite,Amish Mennonite,,5626.50,,,,,,,4695.57,9923.10,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2568.75000,2440.31000,Amish/Mennonite,Amish Mennonite,,1412.81,,,,,,,1258.69,2491.69,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN SUPP PROF.,81733,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2568.75000,2440.31000,Amish/Mennonite,Amish Mennonite,,1412.81,,,,,,,1179.06,2568.75,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,286.88000,272.54000,Amish/Mennonite,Amish Mennonite,,157.78,,,,,,,140.57,278.27,percent of total billed charges,
SHEATH INTRO 6FR L10CM NDL 21GA L38MM DIL,81734,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,286.88000,272.54000,Amish/Mennonite,Amish Mennonite,,157.78,,,,,,,131.68,286.88,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,29826.53000,28335.20000,Amish/Mennonite,Amish Mennonite,,16404.59,,,,,,,14615.00,28931.73,percent of total billed charges,
DEVICE EMBOTRAP III 6.5MMX45MM,81735,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,29826.53000,28335.20000,Amish/Mennonite,Amish Mennonite,,16404.59,,,,,,,13690.38,29826.53,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13814.10000,13123.40000,Amish/Mennonite,Amish Mennonite,,7597.76,,,,,,,6768.91,13399.68,percent of total billed charges,
SPACER SPNL W18XH10XL50MM 6DEG TI PEEK IF,81736,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13814.10000,13123.40000,Amish/Mennonite,Amish Mennonite,,7597.76,,,,,,,6340.67,13814.10,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4664.40000,4431.18000,Amish/Mennonite,Amish Mennonite,,2565.42,,,,,,,2285.56,4524.47,percent of total billed charges,
EXPANDR TISS 250CC W11XH10CM P4.9CM MD HT,81738,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4664.40000,4431.18000,Amish/Mennonite,Amish Mennonite,,2565.42,,,,,,,2140.96,4664.40,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,inpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,118.60,209.16,percent of total billed charges,
KIT CATH EXP NDL L6IN CATH L5IN T PEEL ON Q,81739,CDM,272,RC,A4306,HCPCS,,,facility,outpatient,,,215.63000,204.85000,Amish/Mennonite,Amish Mennonite,,118.60,,,,,,,107.81,209.16,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,inpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
DEXAMETHASONE 4 MG/ML SOLN,81740,CDM,250,RC,J1100,HCPCS,0064161462500300,NDC,facility,outpatient,1,mL,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.14415,0.57230,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,inpatient,1,EA,2879.90000,2735.90000,Amish/Mennonite,Amish Mennonite,,1583.94,,,,,,,1583.94,2793.50,percent of total billed charges,
ROMIPLOSTIM POWD-INJ 125 MCG,81741,CDM,636,RC,J2802,HCPCS,55513022301,NDC,facility,outpatient,1,EA,2879.90000,2735.90000,Amish/Mennonite,Amish Mennonite,,1583.94,,,,,,,11.00,2793.50,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,inpatient,1,mL,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,12.15,21.43,percent of total billed charges,
METHADONE-NACL 0.9% SOLN PF 1MG/ML,81744,CDM,250,RC,J1230,HCPCS,70092157343,NDC,facility,outpatient,1,mL,22.09000,20.98000,Amish/Mennonite,Amish Mennonite,,12.15,,,,,,,11.04,37.80,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,inpatient,1,EA,14.82000,14.07000,Amish/Mennonite,Amish Mennonite,,8.15,,,,,,,8.15,14.38,percent of total billed charges,
CHLORPROMAZINE 50 MG TAB,81745,CDM,250,RC,Q0161,HCPCS,00781591501,NDC,facility,outpatient,1,EA,14.82000,14.07000,Amish/Mennonite,Amish Mennonite,,8.15,,,,,,,7.41,14.38,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,inpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.22550,0.39770,percent of total billed charges,
CARBIDOPA-LEVODOPA 0.5 TAB(5 MG-50 MG) TAB,81748,CDM,250,RC,00378-0078-01-00050,NDC,,,facility,outpatient,1,EA,0.41000,0.39000,Amish/Mennonite,Amish Mennonite,,0.22550,,,,,,,0.20500,0.39770,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1620.67,3208.28,percent of total billed charges,
SUPPORT PRE-SHP GWIRE W/ HYDRPHLC COAT,81749,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,3307.50000,3142.12000,Amish/Mennonite,Amish Mennonite,,1819.12,,,,,,,1518.14,3307.50,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 8X80X200CM.,81750,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA7MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,81751,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1642.07,3577.50,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,inpatient,1,EA,4547.65000,4320.27000,Amish/Mennonite,Amish Mennonite,,2501.21,,,,,,,2501.21,4411.22,percent of total billed charges,
THYROTROPIN ALFA  POWD-INJ 0.9 MG,81752,CDM,636,RC,J3240,HCPCS,58468003002,NDC,facility,outpatient,1,EA,4547.65000,4320.27000,Amish/Mennonite,Amish Mennonite,,2501.21,,,,,,,2113.24,4411.22,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,inpatient,,,4229.70000,4018.21000,Amish/Mennonite,Amish Mennonite,,2326.34,,,,,,,2072.55,4102.81,percent of total billed charges,
CATHETER EP 7FR L115CM 2-8-2MM SPC TIP 2MM 10 ELECTRD D CRV,81753,CDM,278,RC,C2630,HCPCS,,,facility,outpatient,,,4229.70000,4018.21000,Amish/Mennonite,Amish Mennonite,,2326.34,,,,,,,1941.43,4229.70,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF4,81772,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,20528.18,43381.99,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,11804.80000,11214.56000,Amish/Mennonite,Amish Mennonite,,6492.64,,,,,,,5784.35,11450.66,percent of total billed charges,
CATHETER ABLATION 8FR L115CM YEL BLK 3.5MM TIP ELECTRD 1-6-2MM,81773,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,11804.80000,11214.56000,Amish/Mennonite,Amish Mennonite,,6492.64,,,,,,,5418.40,11804.80,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUIDE 6FR L100CM WRP W/ SIDE H,81774,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,66.64,131.92,percent of total billed charges,
GUIDEWIRE VASC L150CM DIA0.035IN L3CM NIT COR STR E FLX,81775,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,136.00000,129.20000,Amish/Mennonite,Amish Mennonite,,74.80,,,,,,,62.42,136.00,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER PTCA L150CM BLLN L22CM OD2.5MM SHTH,81776,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2895.00000,2750.25000,Amish/Mennonite,Amish Mennonite,,1592.25,,,,,,,1418.55,2808.15,percent of total billed charges,
CATHETER INTVENT 5FR L135CM SHFT 2.9FR TIP 1.6FR GWIRE,81777,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2895.00000,2750.25000,Amish/Mennonite,Amish Mennonite,,1592.25,,,,,,,1328.81,2895.00,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,136.34,269.90,percent of total billed charges,
SHTH GUID L70CM DIA0.100IN INTRO 7FR 0.035IN,81778,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,278.25000,264.34000,Amish/Mennonite,Amish Mennonite,,153.04,,,,,,,127.72,278.25,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,113.92,225.53,percent of total billed charges,
CATHETER GUID 6FR L100CM MP2 CRV PTFE LNR RND,81779,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,232.50000,220.88000,Amish/Mennonite,Amish Mennonite,,127.88,,,,,,,106.72,232.50,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE SYNCHRO SEL 14 SUPRT 215,81780,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 2.5MM 145CM PEBAX HDRCT TREK 15,81781,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,Amish/Mennonite,Amish Mennonite,,72.53,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 8FR L12CM USED DURING HYPOSPADIAS EPISPADIAS REP,81782,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,Amish/Mennonite,Amish Mennonite,,72.53,,,,,,,60.53,131.88,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,131.88000,125.29000,Amish/Mennonite,Amish Mennonite,,72.53,,,,,,,64.62,127.92,percent of total billed charges,
STENT URETH 6FR L12CM FOR HYPOSPADIAS AND EPISPADIAS REP,81783,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,131.88000,125.29000,Amish/Mennonite,Amish Mennonite,,72.53,,,,,,,60.53,131.88,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,inpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00338070348,NDC,facility,outpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.34860,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
POTASSIUM CHLORIDE 40 MEQ/100 ML SOLN,81784,CDM,636,RC,J3480,HCPCS,00990707726,NDC,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.34860,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,inpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08800,0.15520,percent of total billed charges,
MORPHINE (USE FOR DOSES < OR = 0.1 LIQUID,81785,CDM,250,RC,66689-0032-16-00040,NDC,,,facility,outpatient,1,mL,0.16000,0.15000,Amish/Mennonite,Amish Mennonite,,0.08800,,,,,,,0.08000,0.15520,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,10625.41,21033.97,percent of total billed charges,
SNARE RETRIEVER CLOT REVASCULARIZATION DEV,81786,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,21684.50000,20600.27000,Amish/Mennonite,Amish Mennonite,,11926.48,,,,,,,9953.19,21684.50,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X6MM,81787,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1819.12,3601.12,percent of total billed charges,
COIL EMB L10CM DIA4MM 0.02IN PERIPH COMPLX STD FRME,81788,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3712.50000,3526.88000,Amish/Mennonite,Amish Mennonite,,2041.88,,,,,,,1704.04,3712.50,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L80MM DIA6MM,81790,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,inpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.46,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,00703952601,NDC,facility,outpatient,1,mL,2.65000,2.52000,Amish/Mennonite,Amish Mennonite,,1.46,,,,,,,1.32,2.57,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,inpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,2.11,3.72,percent of total billed charges,
SULFAMETHOXAZOLE-TMP (MG TRIMETHOPRIM) SOLN 80 MG-16 MG/ML 30ML,81791,CDM,250,RC,J3490,HCPCS,70069036301,NDC,facility,outpatient,1,mL,3.84000,3.65000,Amish/Mennonite,Amish Mennonite,,2.11,,,,,,,1.92,3.72,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,inpatient,1,mL,436.17000,414.36000,Amish/Mennonite,Amish Mennonite,,239.89,,,,,,,239.89,423.08,percent of total billed charges,
ETELCALCETIDE SOLN 2.5 MG/0.5ML,81792,CDM,250,RC,J0606,HCPCS,55513074010,NDC,facility,outpatient,1,mL,436.17000,414.36000,Amish/Mennonite,Amish Mennonite,,239.89,,,,,,,218.09,423.08,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,inpatient,1,mL,1265.76000,1202.47000,Amish/Mennonite,Amish Mennonite,,696.17,,,,,,,696.17,1227.79,percent of total billed charges,
DULAGLUTIDE 1.5 MG/0.5 ML SOLN,81793,CDM,250,RC,00002-1434-80,NDC,,,facility,outpatient,1,mL,1265.76000,1202.47000,Amish/Mennonite,Amish Mennonite,,696.17,,,,,,,632.88,1227.79,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,inpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VANCOMYCIN SOLN-OPHTH 25 MG/ML 10 ML,81794,CDM,250,RC,J3370,HCPCS,6745703395002500,NDC,facility,outpatient,1,EA,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,3.02,15.33,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,395.06,782.06,percent of total billed charges,
VISIGLIDE GUIDEWIRE .025 45 STRAIGHT,81795,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,806.25000,765.94000,Amish/Mennonite,Amish Mennonite,,443.44,,,,,,,370.07,806.25,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,Amish/Mennonite,Amish Mennonite,,17158.68,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD CO XT VR MRI DF4,81796,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,Amish/Mennonite,Amish Mennonite,,17158.68,,,,,,,14319.70,31197.60,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10551.84000,10024.25000,Amish/Mennonite,Amish Mennonite,,5803.51,,,,,,,5170.40,10235.28,percent of total billed charges,
COIL EMB L11.5CM LOOP DIA4MM SPHR STRTCH RESIST FRME,81797,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10551.84000,10024.25000,Amish/Mennonite,Amish Mennonite,,5803.51,,,,,,,4843.29,10551.84,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
COIL EMB 4MMX8CM 14 MIC NEUROVASC MICRUSFRAME,81798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,4027.90,7973.60,percent of total billed charges,
MICROCOIL VASC L17CM DIA7MM PRI DIA0.0135IN STRTCH RESIST,81799,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8220.21000,7809.20000,Amish/Mennonite,Amish Mennonite,,4521.12,,,,,,,3773.08,8220.21,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1690.50,3346.50,percent of total billed charges,
SYSTEM ACC 14FR 12FR ANT CRV PBAX PTFE SHEATH DIL,81803,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3450.00000,3277.50000,Amish/Mennonite,Amish Mennonite,,1897.50,,,,,,,1583.55,3450.00,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,inpatient,1,mL,33.52000,31.85000,Amish/Mennonite,Amish Mennonite,,18.44,,,,,,,18.44,32.51,percent of total billed charges,
INSULIN LISPRO 100 UNITS/ML SOLN,81804,CDM,250,RC,J1815,HCPCS,00002879959,NDC,facility,outpatient,1,mL,33.52000,31.85000,Amish/Mennonite,Amish Mennonite,,18.44,,,,,,,1.49,32.51,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,inpatient,1,EA,82.92000,78.77000,Amish/Mennonite,Amish Mennonite,,45.61,,,,,,,45.61,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00264315511,NDC,facility,outpatient,1,EA,82.92000,78.77000,Amish/Mennonite,Amish Mennonite,,45.61,,,,,,,0.76415,80.43,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,inpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.62150,1.10,percent of total billed charges,
CEFTRIAXONE 2 GM/50 ML DEXTROSE PREMIX,81808,CDM,250,RC,J0696,HCPCS,00338500341,NDC,facility,outpatient,1,EA,1.13000,1.08000,Amish/Mennonite,Amish Mennonite,,0.62150,,,,,,,0.56500,1.10,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,inpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.31900,0.56260,percent of total billed charges,
METHIMAZOLE 2.5 MG TAB,81809,CDM,250,RC,68084-0275-01-00050,NDC,,,facility,outpatient,1,EA,0.58000,0.55000,Amish/Mennonite,Amish Mennonite,,0.31900,,,,,,,0.29000,0.56260,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL TARGET 360 NANO 1.5MMX2CM,81810,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML,81811,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,JW,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 300 100 ML WASTE,81813,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,JW,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML,81814,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,inpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.73150,1.29,percent of total billed charges,
CT OMNIPAQUE 350 50 ML WASTE,81815,CDM,636,RC,Q9967,HCPCS,,,facility,outpatient,,,1.33000,1.26000,Amish/Mennonite,Amish Mennonite,,0.73150,,,,,,,0.22165,1.29,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT ENDOPROS L3.3CM DIA26MM ID22-23MM AORT EXT EXCLUDER,81816,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,4721.18,10285.80,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,inpatient,1,EA,62.19000,59.08000,Amish/Mennonite,Amish Mennonite,,34.20,,,,,,,34.20,60.32,percent of total billed charges,
CEFEPIME 1 GM/D5W 50 ML PREMIX,81817,CDM,636,RC,J0703,HCPCS,00264319311,NDC,facility,outpatient,1,EA,62.19000,59.08000,Amish/Mennonite,Amish Mennonite,,34.20,,,,,,,7.82,60.32,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,5040.04,9977.23,percent of total billed charges,
GRAFT EVAR L3.3CM OD23MM ID19-21MM AORT EXT FOR AAA EXCLUDER,81821,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10285.80000,9771.51000,Amish/Mennonite,Amish Mennonite,,5657.19,,,,,,,4721.18,10285.80,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,14312.70000,13597.07000,Amish/Mennonite,Amish Mennonite,,7871.98,,,,,,,7013.22,13883.32,percent of total billed charges,
GRFT ENDO EXTENDER 23MMX4.5CM,81823,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,14312.70000,13597.07000,Amish/Mennonite,Amish Mennonite,,7871.98,,,,,,,6569.53,14312.70,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4902.45,9704.85,percent of total billed charges,
GRAFT EVAR L80MM DIA8MM SHTH 8FR CVR STR STNT COVERA,81824,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10005.00000,9504.75000,Amish/Mennonite,Amish Mennonite,,5502.75,,,,,,,4592.30,10005.00,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,inpatient,1,mL,1746.98000,1659.63000,Amish/Mennonite,Amish Mennonite,,960.84,,,,,,,960.84,1694.57,percent of total billed charges,
SEMAGLUTIDE 0.5 MG/0.5 ML (0.5 MG DOSE) SOLN,81825,CDM,250,RC,00169-4505-14,NDC,,,facility,outpatient,1,mL,1746.98000,1659.63000,Amish/Mennonite,Amish Mennonite,,960.84,,,,,,,873.49,1694.57,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,inpatient,1,mL,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.58,2.78,percent of total billed charges,
IOHEXOL 300 MG/ML SOL,81826,CDM,250,RC,00407-1413-87,NDC,,,facility,outpatient,1,mL,2.87000,2.73000,Amish/Mennonite,Amish Mennonite,,1.58,,,,,,,1.44,2.78,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,inpatient,1,mL,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.75,3.09,percent of total billed charges,
IOHEXOL 350 MG/ML SOLN,81829,CDM,250,RC,00407-1414-89,NDC,,,facility,outpatient,1,mL,3.19000,3.03000,Amish/Mennonite,Amish Mennonite,,1.75,,,,,,,1.59,3.09,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,inpatient,1,mL,3836.56000,3644.73000,Amish/Mennonite,Amish Mennonite,,2110.11,,,,,,,2110.11,3721.46,percent of total billed charges,
DUPILUMAB SOLN 200 MG/1.14 ML,81832,CDM,250,RC,00024-5918-01,NDC,,,facility,outpatient,1,mL,3836.56000,3644.73000,Amish/Mennonite,Amish Mennonite,,2110.11,,,,,,,1918.28,3721.46,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
LACTATED RINGERS 250 ML,81833,CDM,250,RC,J7120,HCPCS,00264775020,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,4.06,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,3360.00000,3192.00000,Amish/Mennonite,Amish Mennonite,,1848.00,,,,,,,1646.40,3259.20,percent of total billed charges,
NTRODUCER SHTH 8.5FR L82CM DIL 8.5FR 0.032IN,81834,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,3360.00000,3192.00000,Amish/Mennonite,Amish Mennonite,,1848.00,,,,,,,1542.24,3360.00,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3465.53,6860.32,percent of total billed charges,
STENT CAR L30MM DIA5MM ACCULINK,81835,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,7072.50000,6718.88000,Amish/Mennonite,Amish Mennonite,,3889.88,,,,,,,3246.28,7072.50,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,4135.30,8186.21,percent of total billed charges,
COIL EMB L30CM DIA7MM 360DEG STD DETACH TARGET,81836,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8439.39000,8017.42000,Amish/Mennonite,Amish Mennonite,,4641.66,,,,,,,3873.68,8439.39,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,712.50000,676.88000,Amish/Mennonite,Amish Mennonite,,391.88,,,,,,,349.12,691.12,percent of total billed charges,
CATHETER EMB 4FR L80CM INFLATED BLLN DIA9MM ART RED SFT RND,81837,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,712.50000,676.88000,Amish/Mennonite,Amish Mennonite,,391.88,,,,,,,327.04,712.50,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,inpatient,1,mL,69.71000,66.22000,Amish/Mennonite,Amish Mennonite,,38.34,,,,,,,38.34,67.62,percent of total billed charges,
EPOETIN ALFA EPBX 2000 UNITS/ML PRESERVATIVE-FREE SOLN,81838,CDM,636,RC,Q5106,HCPCS,00069130510,NDC,facility,outpatient,1,mL,69.71000,66.22000,Amish/Mennonite,Amish Mennonite,,38.34,,,,,,,7.57,67.62,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,inpatient,1,mL,379.44000,360.46000,Amish/Mennonite,Amish Mennonite,,208.69,,,,,,,208.69,368.06,percent of total billed charges,
CYCLOPHOSPHAMIDE  SOLN 200 MG/ML 2.5 ML,81839,CDM,636,RC,J9073,HCPCS,50742051902,NDC,facility,outpatient,1,mL,379.44000,360.46000,Amish/Mennonite,Amish Mennonite,,208.69,,,,,,,1.16,368.06,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,inpatient,,,155.60000,147.82000,Amish/Mennonite,Amish Mennonite,90,85.58,,,,,,,85.58,150.93,percent of total billed charges,
"(NEW)MYASTHENIA GRAVIS EVAL, MUSK REFLEX (MGMR) SO",81841,CDM,300,RC,83519,CPT,,,facility,outpatient,,,155.60000,147.82000,Amish/Mennonite,Amish Mennonite,90,85.58,,,,,,,19.00,865.84,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-PAPP GENE SO,81842,CDM,300,RC,84163,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,15.55,780.94,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,inpatient,,,257.50000,244.62000,Amish/Mennonite,Amish Mennonite,90,141.62,,,,,,,141.62,249.78,percent of total billed charges,
"11-DEOXYCORTISOL, SERUM SO",81843,CDM,301,RC,82634,CPT,,,facility,outpatient,,,257.50000,244.62000,Amish/Mennonite,Amish Mennonite,90,141.62,,,,,,,30.26,1527.89,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,inpatient,,,161.80000,153.71000,Amish/Mennonite,Amish Mennonite,90,88.99,,,,,,,88.99,156.95,percent of total billed charges,
(NEW)MYASTHENIA GRAVIS/LAMBERT SYNDROME EVALUATION (MGLE) SO,81844,CDM,300,RC,83519,CPT,,,facility,outpatient,,,161.80000,153.71000,Amish/Mennonite,Amish Mennonite,90,88.99,,,,,,,19.00,865.84,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,inpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,137.72,242.89,percent of total billed charges,
25-HYDROXYVITAMIN D2 AND D3 SO,81845,CDM,300,RC,82306,CPT,,,facility,outpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,30.59,1544.85,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,inpatient,,,211.80000,201.21000,Amish/Mennonite,Amish Mennonite,90,116.49,,,,,,,116.49,205.45,percent of total billed charges,
"ACYLGLYCINES, QNT, UR (AGU20) SO",81846,CDM,300,RC,82542,CPT,,,facility,outpatient,,,211.80000,201.21000,Amish/Mennonite,Amish Mennonite,90,116.49,,,,,,,24.89,1137.41,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,inpatient,,,101.60000,96.52000,Amish/Mennonite,Amish Mennonite,90,55.88,,,,,,,55.88,98.55,percent of total billed charges,
ACEYLCHOLINE RECEPTOR MODULATION AB SO,81847,CDM,300,RC,86043,CPT,,,facility,outpatient,,,101.60000,96.52000,Amish/Mennonite,Amish Mennonite,90,55.88,,,,,,,9.64,98.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,inpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,90,281.05,,,,,,,281.05,495.67,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPAGF (BILL ONLY) SO",81848,CDM,300,RC,86353,CPT,,,facility,outpatient,,,511.00000,485.45000,Amish/Mennonite,Amish Mennonite,90,281.05,,,,,,,50.66,2563.44,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,inpatient,,,130.20000,123.69000,Amish/Mennonite,Amish Mennonite,90,71.61,,,,,,,71.61,126.29,percent of total billed charges,
"ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY, FLOW CYTOMETRY SO",81849,CDM,300,RC,86255,CPT,,,facility,outpatient,,,130.20000,123.69000,Amish/Mennonite,Amish Mennonite,90,71.61,,,,,,,12.45,1539.22,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,536.80,946.72,percent of total billed charges,
AEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81850,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,119.20,6026.72,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,inpatient,,,73.30000,69.63000,Amish/Mennonite,Amish Mennonite,90,40.31,,,,,,,40.31,71.10,percent of total billed charges,
ADDITIOAL IDENTIFICATION PROCEDURE (BILL ONLY) SO,81851,CDM,300,RC,87077,CPT,,,facility,outpatient,,,73.30000,69.63000,Amish/Mennonite,Amish Mennonite,90,40.31,,,,,,,8.35,424.40,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,inpatient,,,23.40000,22.23000,Amish/Mennonite,Amish Mennonite,90,12.87,,,,,,,12.87,22.70,percent of total billed charges,
"ALLERGEN, PEPPER CAYENNE, IGE SO",81852,CDM,300,RC,86003,CPT,,,facility,outpatient,,,23.40000,22.23000,Amish/Mennonite,Amish Mennonite,90,12.87,,,,,,,4.57,271.65,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,inpatient,,,458.30000,435.38000,Amish/Mennonite,Amish Mennonite,90,252.06,,,,,,,252.06,444.55,percent of total billed charges,
"ADDITIONAL FLOW STIMULANT, LPMGF (BILL ONLY) SO",81853,CDM,300,RC,86353,CPT,,,facility,outpatient,,,458.30000,435.38000,Amish/Mennonite,Amish Mennonite,90,252.06,,,,,,,50.66,2563.44,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,inpatient,,,5277.00000,5013.15000,Amish/Mennonite,Amish Mennonite,90,2902.35,,,,,,,2902.35,5118.69,percent of total billed charges,
"ALPHA GLOBIN GENE SEQUENCING, VARIES SO",81854,CDM,310,RC,81259,CPT,,,facility,outpatient,,,5277.00000,5013.15000,Amish/Mennonite,Amish Mennonite,90,2902.35,,,,,,,480.00,28232.08,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,32.12,56.65,percent of total billed charges,
1 TRIM SCR NT-HCG GENE SO,81855,CDM,300,RC,84704,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,15.80,780.94,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,inpatient,,,65.30000,62.03000,Amish/Mennonite,Amish Mennonite,90,35.91,,,,,,,35.91,63.34,percent of total billed charges,
AFP 1ST TRIMEST SCN SO,81856,CDM,300,RC,82105,CPT,,,facility,outpatient,,,65.30000,62.03000,Amish/Mennonite,Amish Mennonite,90,35.91,,,,,,,17.33,882.80,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SPINAL FLUID SO",81857,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,inpatient,,,118.10000,112.19000,Amish/Mennonite,Amish Mennonite,90,64.95,,,,,,,64.95,114.56,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE,SERUM SO",81858,CDM,301,RC,82103,CPT,,,facility,outpatient,,,118.10000,112.19000,Amish/Mennonite,Amish Mennonite,90,64.95,,,,,,,13.89,696.05,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,inpatient,,,579.00000,550.05000,Amish/Mennonite,Amish Mennonite,TC,318.45,,,,,,,318.45,561.63,percent of total billed charges,
"AMYLOID PROTEIN IDENTIFICATION, PARAFFIN, LC-MS/MS TC",81859,CDM,310,RC,88313,CPT,,,facility,outpatient,,,579.00000,550.05000,Amish/Mennonite,Amish Mennonite,TC,318.45,,,,,,,121.00,3027.62,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,53.52,94.38,percent of total billed charges,
ANNATTO SEED (BIXA ORELLANA) IGE SO,81860,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,4.57,271.65,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"ALPHA INTERNEXIN, CELL BINDING ASSAY, SERUM SO",81861,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,Amish/Mennonite,Amish Mennonite,,1860.65,,,,,,,1860.65,3281.51,percent of total billed charges,
AUTOPSY LIMITED REGION,81862,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,Amish/Mennonite,Amish Mennonite,,1860.65,,,,,,,370.62,4872.27,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"ANTIGLIAL/NEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81863,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,inpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,163.24,287.90,percent of total billed charges,
BACTERIAL IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81865,CDM,300,RC,87798,CPT,,,facility,outpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANEL, SERUM AND PLASMA SO",81866,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,12.40,628.12,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,90,338.25,,,,,,,338.25,596.55,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DETECTION, FLOW CYTOMETRY, BONE MARROW SO",81867,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,90,338.25,,,,,,,307.50,3186.14,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,90,111.38,,,,,,,111.38,196.43,percent of total billed charges,
"B-CELL LYMPHOBLASTIC LEUKEMIA MONITORING, MINIMAL RESIDUAL DISEASE DET, FLOW CYTOMETRY, BONE MARROW SO",81868,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,90,111.38,,,,,,,77.53,1052.52,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY, IMMUNOBLOT, SPINAL FLUID SO",81869,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,inpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,389.40,686.76,percent of total billed charges,
BETA-GLOBIN GENE SEQ (WBSQR) SO,81870,CDM,310,RC,81364,CPT,,,facility,outpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,259.66,15261.97,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,inpatient,,,132.40000,125.78000,Amish/Mennonite,Amish Mennonite,90,72.82,,,,,,,72.82,128.43,percent of total billed charges,
"ASPERGILLUS FUMIGATUS, IGG ANTIBODIES, SERUM SO",81871,CDM,300,RC,86606,CPT,,,facility,outpatient,,,132.40000,125.78000,Amish/Mennonite,Amish Mennonite,90,72.82,,,,,,,8.17,780.94,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,inpatient,,,194.30000,184.58000,Amish/Mennonite,Amish Mennonite,90,106.86,,,,,,,106.86,188.47,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY PANEL, YEAST, VARIES SO",81872,CDM,300,RC,87186,CPT,,,facility,outpatient,,,194.30000,184.58000,Amish/Mennonite,Amish Mennonite,90,106.86,,,,,,,8.94,458.40,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,inpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,13.20,23.28,percent of total billed charges,
"B2B PREGNANCY,QUAL-URINE",81873,CDM,300,RC,99199,CPT,,,facility,outpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,12.00,23.28,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,inpatient,,,645.00000,612.75000,Amish/Mennonite,Amish Mennonite,90,354.75,,,,,,,354.75,625.65,percent of total billed charges,
"AMPA-R AB CBA, S (AMPCS) SO",81874,CDM,300,RC,86255,CPT,,,facility,outpatient,,,645.00000,612.75000,Amish/Mennonite,Amish Mennonite,90,354.75,,,,,,,12.45,1539.22,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,inpatient,,,174.70000,165.96000,Amish/Mennonite,Amish Mennonite,90,96.08,,,,,,,96.08,169.46,percent of total billed charges,
"C3 COMPLEMENT, FUNCTIONAL, SERUM SO",81875,CDM,300,RC,86161,CPT,,,facility,outpatient,,,174.70000,165.96000,Amish/Mennonite,Amish Mennonite,90,96.08,,,,,,,12.40,628.12,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,90,55.00,,,,,,,55.00,97.00,percent of total billed charges,
ARIPIPRAZOLE SO,81876,CDM,300,RC,80342,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,90,55.00,,,,,,,50.00,1137.41,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,inpatient,,,116.90000,111.06000,Amish/Mennonite,Amish Mennonite,90,64.30,,,,,,,64.30,113.39,percent of total billed charges,
"C6 COMPLEMENT, FUNCTIONAL, SERUM SO",81877,CDM,300,RC,86161,CPT,,,facility,outpatient,,,116.90000,111.06000,Amish/Mennonite,Amish Mennonite,90,64.30,,,,,,,12.40,628.12,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,69.96,123.38,percent of total billed charges,
"C5 COMPLEMENT, FUNCTIONAL, SERUM SO",81878,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,12.40,628.12,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1075.00000,1021.25000,Amish/Mennonite,Amish Mennonite,90,591.25,,,,,,,591.25,1042.75,percent of total billed charges,
"CELIAC ASSOCIATED HLA-DQ ALPHA 1 AND DQ BETA 1 DNA TYPING, BLOOD SO",81879,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1075.00000,1021.25000,Amish/Mennonite,Amish Mennonite,90,591.25,,,,,,,126.29,6383.20,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,207.24,365.50,percent of total billed charges,
"BK VIRUS PCR, QNT, PLASMA (PBKQN) SO",81880,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,44.27,2240.90,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,169.78,299.44,percent of total billed charges,
"CHLAMYDIA TRACHOMATIS, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",81881,CDM,300,RC,87491,CPT,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,36.26,1833.46,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,inpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,55.83,98.45,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMPLEMENT PANL, SERUM AND PLASMA SO",81882,CDM,300,RC,86161,CPT,,,facility,outpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,12.40,628.12,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,inpatient,,,160.40000,152.38000,Amish/Mennonite,Amish Mennonite,90,88.22,,,,,,,88.22,155.59,percent of total billed charges,
ARIXTRA LEVEL SO,81883,CDM,300,RC,85130,CPT,,,facility,outpatient,,,160.40000,152.38000,Amish/Mennonite,Amish Mennonite,90,88.22,,,,,,,12.29,628.12,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,inpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,90,55.55,,,,,,,55.55,97.97,percent of total billed charges,
"COCCIDIOIDES AB, COMPF/IMMDIFF, S (SCOC) SO",81884,CDM,300,RC,86635,CPT,,,facility,outpatient,,,101.00000,95.95000,Amish/Mennonite,Amish Mennonite,90,55.55,,,,,,,8.17,594.19,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,90,86.90,,,,,,,86.90,153.26,percent of total billed charges,
"CLOBAZAM AND METABOLITE, SERUM SO",81885,CDM,301,RC,80339,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,90,86.90,,,,,,,79.00,1137.41,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,inpatient,,,38.00000,36.10000,Amish/Mennonite,Amish Mennonite,90,20.90,,,,,,,20.90,36.86,percent of total billed charges,
CHILD ADV 11DRG PANEL SO,81886,CDM,300,RC,80307,CPT,,,facility,outpatient,,,38.00000,36.10000,Amish/Mennonite,Amish Mennonite,90,20.90,,,,,,,19.00,3038.81,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,Amish/Mennonite,Amish Mennonite,90,86.57,,,,,,,86.57,152.68,percent of total billed charges,
B-LYMPHOBLAST LEUKEMIA (BALLF) SO,81887,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,Amish/Mennonite,Amish Mennonite,90,86.57,,,,,,,20.36,1120.45,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,inpatient,,,157.40000,149.53000,Amish/Mennonite,Amish Mennonite,90,86.57,,,,,,,86.57,152.68,percent of total billed charges,
"B-CELL LYMPHOMA, FISH BLD/BM (BLPF) SO",81888,CDM,310,RC,88271,CPT,,,facility,outpatient,,,157.40000,149.53000,Amish/Mennonite,Amish Mennonite,90,86.57,,,,,,,20.36,1120.45,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,inpatient,,,3810.00000,3619.50000,Amish/Mennonite,Amish Mennonite,TC,2095.50,,,,,,,2095.50,3695.70,percent of total billed charges,
"BILIARY TRACH MALIGNANCY, FISH TC",81889,CDM,310,RC,88377,CPT,,,facility,outpatient,,,3810.00000,3619.50000,Amish/Mennonite,Amish Mennonite,TC,2095.50,,,,,,,533.12,16173.22,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,inpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,TC,217.80,,,,,,,217.80,384.12,percent of total billed charges,
CONSULT - TECH ONLY,81890,CDM,310,RC,88323,CPT,,,facility,outpatient,,,396.00000,376.20000,Amish/Mennonite,Amish Mennonite,TC,217.80,,,,,,,127.30,1245.05,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,inpatient,,,432.00000,410.40000,Amish/Mennonite,Amish Mennonite,,237.60,,,,,,,237.60,419.04,percent of total billed charges,
COV19 AND FLU A/B,81892,CDM,306,RC,87636,CPT,,,facility,outpatient,,,432.00000,410.40000,Amish/Mennonite,Amish Mennonite,,237.60,,,,,,,142.63,6772.31,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,inpatient,,,952.00000,904.40000,Amish/Mennonite,Amish Mennonite,,523.60,,,,,,,523.60,923.44,percent of total billed charges,
BRAIN (CRANIAL) REMOVAL,81893,CDM,310,RC,88037,CPT,,,facility,outpatient,,,952.00000,904.40000,Amish/Mennonite,Amish Mennonite,,523.60,,,,,,,329.46,4329.05,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",81894,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"AMPA-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",81895,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,inpatient,,,171.80000,163.21000,Amish/Mennonite,Amish Mennonite,90,94.49,,,,,,,94.49,166.65,percent of total billed charges,
"ATYPICAL HEMOLYTIC UREMIC SYNDROME (AHUS) COMP PANEL, SERUM AND PLASMA SO",81896,CDM,300,RC,86162,CPT,,,facility,outpatient,,,171.80000,163.21000,Amish/Mennonite,Amish Mennonite,90,94.49,,,,,,,21.00,1069.56,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.40000,303.43000,Amish/Mennonite,Amish Mennonite,90,175.67,,,,,,,175.67,309.82,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, SLOWLY GROWING, VARIES SO",81897,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.40000,303.43000,Amish/Mennonite,Amish Mennonite,90,175.67,,,,,,,8.94,458.40,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,inpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,50.82,89.63,percent of total billed charges,
"AMYLASE, RANDOM URINE (RAMSU) SO",81898,CDM,300,RC,82150,CPT,,,facility,outpatient,,,92.40000,87.78000,Amish/Mennonite,Amish Mennonite,,50.82,,,,,,,6.48,339.51,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,536.80,946.72,percent of total billed charges,
ANAEROBE IDENTIFICATION BY SEQUENCING (BILL ONLY) SO,81899,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,119.20,6026.72,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,91.80,161.89,percent of total billed charges,
"ANTIMICROBIAL SUSCEPTIBILITY, ACID-FAST BACILLI, RAPIDLY GROWING, VARIES SO",81900,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,8.94,458.40,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,inpatient,,,655.00000,622.25000,Amish/Mennonite,Amish Mennonite,,360.25,,,,,,,360.25,635.35,percent of total billed charges,
BETA-GLOBIN DEL/DUP (WBDDR) SO,81901,CDM,310,RC,81363,CPT,,,facility,outpatient,,,655.00000,622.25000,Amish/Mennonite,Amish Mennonite,,360.25,,,,,,,161.92,9523.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,inpatient,,,2638.00000,2506.10000,Amish/Mennonite,Amish Mennonite,90,1450.90,,,,,,,1450.90,2558.86,percent of total billed charges,
"BCR/ABL1, TYROSINE KINASE INHIBITOR RESISTANCE, KINASE DOMAIN MUTATION SCREEN, SANGER SEQUENCING, VARIES SO",81902,CDM,310,RC,81170,CPT,,,facility,outpatient,,,2638.00000,2506.10000,Amish/Mennonite,Amish Mennonite,90,1450.90,,,,,,,195.07,14107.52,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,inpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,404.25,712.95,percent of total billed charges,
ALPHA-GLOBIN GENE SEQ (WASQR) SO,81903,CDM,310,RC,81259,CPT,,,facility,outpatient,,,735.00000,698.25000,Amish/Mennonite,Amish Mennonite,,404.25,,,,,,,367.50,28232.08,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,inpatient,,,43.30000,41.13000,Amish/Mennonite,Amish Mennonite,90,23.82,,,,,,,23.82,42.00,percent of total billed charges,
BETA LACTAMASE (BILL ONLY) SO,81904,CDM,300,RC,87185,CPT,,,facility,outpatient,,,43.30000,41.13000,Amish/Mennonite,Amish Mennonite,90,23.82,,,,,,,4.91,254.68,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,inpatient,,,113.40000,107.73000,Amish/Mennonite,Amish Mennonite,90,62.37,,,,,,,62.37,110.00,percent of total billed charges,
BLASTOMYCES ANTIBODY (BLAST) SO,81905,CDM,300,RC,86612,CPT,,,facility,outpatient,,,113.40000,107.73000,Amish/Mennonite,Amish Mennonite,90,62.37,,,,,,,8.17,679.08,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,inpatient,,,255.30000,242.54000,Amish/Mennonite,Amish Mennonite,90,140.41,,,,,,,140.41,247.64,percent of total billed charges,
"B-LYMPHOBLASTIC LEUKEMIA/LYMPHOMA, CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",81906,CDM,310,RC,88271,CPT,,,facility,outpatient,,,255.30000,242.54000,Amish/Mennonite,Amish Mennonite,90,140.41,,,,,,,20.36,1120.45,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,inpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,86.79,153.07,percent of total billed charges,
CASHEW COMPONENT RANA O 3 SO,81907,CDM,300,RC,86008,CPT,,,facility,outpatient,,,157.80000,149.91000,Amish/Mennonite,Amish Mennonite,90,86.79,,,,,,,17.71,933.70,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
AMPA-R AB IF TITER (AMPIS) SO,81908,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,inpatient,,,227.90000,216.50000,Amish/Mennonite,Amish Mennonite,90,125.34,,,,,,,125.34,221.06,percent of total billed charges,
ANTIDEPR URINE QNT SO,81909,CDM,300,RC,80335,CPT,,,facility,outpatient,,,227.90000,216.50000,Amish/Mennonite,Amish Mennonite,90,125.34,,,,,,,113.95,1137.41,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",81910,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,inpatient,,,105.70000,100.41000,Amish/Mennonite,Amish Mennonite,90,58.13,,,,,,,58.13,102.53,percent of total billed charges,
ANAEROBE SUSCEP BATTERY (BILL ONLY) SO,81912,CDM,300,RC,87186,CPT,,,facility,outpatient,,,105.70000,100.41000,Amish/Mennonite,Amish Mennonite,90,58.13,,,,,,,8.94,458.40,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,inpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,69.96,123.38,percent of total billed charges,
"C8 COMPLEMENT, FUNCTIONAL, SERUM SO",81913,CDM,300,RC,86161,CPT,,,facility,outpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,12.40,628.12,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,inpatient,,,119.40000,113.43000,Amish/Mennonite,Amish Mennonite,90,65.67,,,,,,,65.67,115.82,percent of total billed charges,
ALPHA-SUBUN PITUITARY (APGH) SO,81914,CDM,301,RC,82397,CPT,,,facility,outpatient,,,119.40000,113.43000,Amish/Mennonite,Amish Mennonite,90,65.67,,,,,,,14.59,729.98,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,inpatient,,,855.00000,812.25000,Amish/Mennonite,Amish Mennonite,,470.25,,,,,,,470.25,829.35,percent of total billed charges,
"COV19, FLU A/B AND RSV (DIASORIN)",81915,CDM,306,RC,87637,CPT,,,facility,outpatient,,,855.00000,812.25000,Amish/Mennonite,Amish Mennonite,,470.25,,,,,,,142.63,6772.31,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,Amish/Mennonite,Amish Mennonite,90,67.27,,,,,,,67.27,118.63,percent of total billed charges,
"C7 COMPLEMENT, FUNCTIONAL, SERUM SO",81917,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,Amish/Mennonite,Amish Mennonite,90,67.27,,,,,,,12.40,628.12,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,inpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,90.03,158.79,percent of total billed charges,
AMNIO ANEUPLOIDY FISH SO (PADF) SO,81918,CDM,310,RC,88271,CPT,,,facility,outpatient,,,163.70000,155.51000,Amish/Mennonite,Amish Mennonite,90,90.03,,,,,,,20.36,1120.45,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,inpatient,,,199.20000,189.24000,Amish/Mennonite,Amish Mennonite,90,109.56,,,,,,,109.56,193.22,percent of total billed charges,
"ALVEOLAR SOFT PART SARCOMA (ASPS)/RENAL CELL CARCINOMA (RCC), XP11.23 (TFE3), FISH, TISSUE SO",81919,CDM,310,RC,88271,CPT,,,facility,outpatient,,,199.20000,189.24000,Amish/Mennonite,Amish Mennonite,90,109.56,,,,,,,20.36,1120.45,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1635.00000,1553.25000,Amish/Mennonite,Amish Mennonite,90,899.25,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLOOD SO",81921,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1635.00000,1553.25000,Amish/Mennonite,Amish Mennonite,90,899.25,,,,,,,157.98,9082.50,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,inpatient,,,95.20000,90.44000,Amish/Mennonite,Amish Mennonite,90,52.36,,,,,,,52.36,92.34,percent of total billed charges,
"ANTITHROMBIN ANTIGEN, PLASMA SO",81922,CDM,305,RC,85301,CPT,,,facility,outpatient,,,95.20000,90.44000,Amish/Mennonite,Amish Mennonite,90,52.36,,,,,,,11.17,560.26,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,inpatient,,,74.80000,71.06000,Amish/Mennonite,Amish Mennonite,90,41.14,,,,,,,41.14,72.56,percent of total billed charges,
BACTERIA IDENTIFICATION (BILL ONLY) SO,81924,CDM,300,RC,87077,CPT,,,facility,outpatient,,,74.80000,71.06000,Amish/Mennonite,Amish Mennonite,90,41.14,,,,,,,8.35,424.40,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,inpatient,,,111.80000,106.21000,Amish/Mennonite,Amish Mennonite,90,61.49,,,,,,,61.49,108.45,percent of total billed charges,
"C1Q COMPLEMENT, FUNCTIONAL, SERUM SO",81925,CDM,300,RC,86161,CPT,,,facility,outpatient,,,111.80000,106.21000,Amish/Mennonite,Amish Mennonite,90,61.49,,,,,,,12.40,628.12,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,inpatient,,,20708.00000,19672.60000,Amish/Mennonite,Amish Mennonite,90,11389.40,,,,,,,11389.40,20086.76,percent of total billed charges,
"CONGENITAL NEUTROPENIA, PRIMARY IMMUNODEFICIENCY DISORDER PANEL (18 GENES), NEXT-GENERATION SEQUENCING, VARIES SO",81926,CDM,310,RC,81443,CPT,,,facility,outpatient,,,20708.00000,19672.60000,Amish/Mennonite,Amish Mennonite,90,11389.40,,,,,,,8569.96,115186.20,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,inpatient,,,3383.00000,3213.85000,Amish/Mennonite,Amish Mennonite,,1860.65,,,,,,,1860.65,3281.51,percent of total billed charges,
BRAIN (CRANIAL) AUTOPSY (W DIMENTIA),81927,CDM,310,RC,88036,CPT,,,facility,outpatient,,,3383.00000,3213.85000,Amish/Mennonite,Amish Mennonite,,1860.65,,,,,,,370.62,4872.27,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2812.00000,2671.40000,Amish/Mennonite,Amish Mennonite,TC,1546.60,,,,,,,1546.60,2727.64,percent of total billed charges,
"B-CELL LYMPHOMA TISSUE, FISH (BLYM) SO TECH",81928,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2812.00000,2671.40000,Amish/Mennonite,Amish Mennonite,TC,1546.60,,,,,,,533.12,16173.22,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,inpatient,,,170.40000,161.88000,Amish/Mennonite,Amish Mennonite,90,93.72,,,,,,,93.72,165.29,percent of total billed charges,
"C4 COMPLEMENT, FUNCTIONAL, SERUM SO",81929,CDM,300,RC,86161,CPT,,,facility,outpatient,,,170.40000,161.88000,Amish/Mennonite,Amish Mennonite,90,93.72,,,,,,,12.40,628.12,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,inpatient,,,213.50000,202.82000,Amish/Mennonite,Amish Mennonite,90,117.42,,,,,,,117.42,207.09,percent of total billed charges,
"CATECHOLAMINE FRACTIONATION, FREE, 24 HOUR, URINE SO",81931,CDM,301,RC,82384,CPT,,,facility,outpatient,,,213.50000,202.82000,Amish/Mennonite,Amish Mennonite,90,117.42,,,,,,,26.09,1324.17,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,inpatient,,,241.80000,229.71000,Amish/Mennonite,Amish Mennonite,90,132.99,,,,,,,132.99,234.55,percent of total billed charges,
"CHIKUNGUNYA IGM AND IGG, AB (CHIKV) SO",81932,CDM,300,RC,86790,CPT,,,facility,outpatient,,,241.80000,229.71000,Amish/Mennonite,Amish Mennonite,90,132.99,,,,,,,45.08,679.08,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,inpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,90,540.65,,,,,,,540.65,953.51,percent of total billed charges,
"COXIELLA BURNETII (Q FEVER) PCR, (CBBRP) SO",81933,CDM,300,RC,87798,CPT,,,facility,outpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,90,540.65,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,inpatient,,,459.10000,436.14000,Amish/Mennonite,Amish Mennonite,90,252.50,,,,,,,252.50,445.33,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IGG, WESTERN BLOT, SPINAL FLUID SO",81934,CDM,301,RC,84182,CPT,,,facility,outpatient,,,459.10000,436.14000,Amish/Mennonite,Amish Mennonite,90,252.50,,,,,,,25.31,2286.16,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,inpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,69.96,123.38,percent of total billed charges,
"ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM SO",81935,CDM,301,RC,82104,CPT,,,facility,outpatient,,,127.20000,120.84000,Amish/Mennonite,Amish Mennonite,90,69.96,,,,,,,14.94,763.98,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,inpatient,,,334.30000,317.58000,Amish/Mennonite,Amish Mennonite,90,183.87,,,,,,,183.87,324.27,percent of total billed charges,
"COENZYME Q10, REDUCED AND TOTAL, PLASMA (Q10) SO",81936,CDM,300,RC,82542,CPT,,,facility,outpatient,,,334.30000,317.58000,Amish/Mennonite,Amish Mennonite,90,183.87,,,,,,,24.89,1137.41,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,inpatient,,,226.40000,215.08000,Amish/Mennonite,Amish Mennonite,90,124.52,,,,,,,124.52,219.61,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81938,CDM,300,RC,86356,CPT,,,facility,outpatient,,,226.40000,215.08000,Amish/Mennonite,Amish Mennonite,90,124.52,,,,,,,27.67,1392.10,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,inpatient,,,158.90000,150.96000,Amish/Mennonite,Amish Mennonite,90,87.39,,,,,,,87.39,154.13,percent of total billed charges,
"CARBOHYDRATE DEFICIENT TRANSFERRIN, ADULT, SERUM SO",81939,CDM,301,RC,82373,CPT,,,facility,outpatient,,,158.90000,150.96000,Amish/Mennonite,Amish Mennonite,90,87.39,,,,,,,10.38,950.66,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,inpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,55.83,98.45,percent of total billed charges,
"C5 COMPLEMENT, ANTIGEN, SERUM SO",81940,CDM,300,RC,86160,CPT,,,facility,outpatient,,,101.50000,96.42000,Amish/Mennonite,Amish Mennonite,90,55.83,,,,,,,12.40,628.12,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,Amish/Mennonite,Amish Mennonite,90,807.40,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 1-5 (BILL ONLY) SO",81941,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,Amish/Mennonite,Amish Mennonite,90,807.40,,,,,,,179.44,8692.03,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,inpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) 87591 SO,81942,CDM,300,RC,87591,CPT,,,facility,outpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,36.26,1833.46,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,inpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,90,342.65,,,,,,,342.65,604.31,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANT ASSESSMENT BY FLOW CYTOMETRY, BLOOD SO",81943,CDM,300,RC,86359,CPT,,,facility,outpatient,,,623.00000,591.85000,Amish/Mennonite,Amish Mennonite,90,342.65,,,,,,,38.99,1969.25,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,inpatient,,,700.00000,665.00000,Amish/Mennonite,Amish Mennonite,90,385.00,,,,,,,385.00,679.00,percent of total billed charges,
DES-GAMMA-CARBOXY PROTHROMBIN (DCP) SO,81944,CDM,300,RC,83951,CPT,,,facility,outpatient,,,700.00000,665.00000,Amish/Mennonite,Amish Mennonite,90,385.00,,,,,,,66.55,3361.35,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,Amish/Mennonite,Amish Mennonite,TC,469.15,,,,,,,469.15,827.41,percent of total billed charges,
EGFR W/ ALK REF TUMOR (EGFRR) TECH,81945,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,Amish/Mennonite,Amish Mennonite,TC,469.15,,,,,,,426.50,7351.18,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1483.00000,1408.85000,Amish/Mennonite,Amish Mennonite,90,815.65,,,,,,,815.65,1438.51,percent of total billed charges,
"CELL-FREE DNA BRAF V600, BLOOD SO",81946,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1483.00000,1408.85000,Amish/Mennonite,Amish Mennonite,90,815.65,,,,,,,143.40,8250.66,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,inpatient,,,1635.00000,1553.25000,Amish/Mennonite,Amish Mennonite,90,899.25,,,,,,,899.25,1585.95,percent of total billed charges,
"CELL-FREE DNA KRAS 12, 13, 61,146, BLD SO",81947,CDM,310,RC,81276,CPT,,,facility,outpatient,,,1635.00000,1553.25000,Amish/Mennonite,Amish Mennonite,90,899.25,,,,,,,116.74,9082.50,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"ANTINEURONAL NUCLEAR ANTIBODY-TYPE 2, IMMUNOBLOT, SPINAL FLUID SO",81948,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,inpatient,,,4042.00000,3839.90000,Amish/Mennonite,Amish Mennonite,TC,2223.10,,,,,,,2223.10,3920.74,percent of total billed charges,
RESPIR MOTION MGMT SIMULATION-TECH,8195,CDM,333,RC,77293,CPT,,,facility,outpatient,,,4042.00000,3839.90000,Amish/Mennonite,Amish Mennonite,TC,2223.10,,,,,,,1836.07,19225.77,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,Amish/Mennonite,Amish Mennonite,90,85.69,,,,,,,85.69,151.13,percent of total billed charges,
"AMPHIPHYSIN ANTIBODY ASSAY, SERUM SO",81950,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,Amish/Mennonite,Amish Mennonite,90,85.69,,,,,,,12.45,1539.22,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,inpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,163.24,287.90,percent of total billed charges,
CHLAMYDIA/GONORRHOEAE AMPLIFIED RNA(CGRNA) SO,81951,CDM,300,RC,87491,CPT,,,facility,outpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,36.26,1833.46,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,Amish/Mennonite,Amish Mennonite,90,81.56,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C3 (C3) SO,81952,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,Amish/Mennonite,Amish Mennonite,90,81.56,,,,,,,12.40,628.12,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,inpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,207.24,365.50,percent of total billed charges,
EPSTEIN-BARR VIRUS DNA DETECTION/QUANT (EBVQN) SO,81953,CDM,300,RC,87799,CPT,,,facility,outpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,44.27,2240.90,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",81954,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,inpatient,,,85.70000,81.41000,Amish/Mennonite,Amish Mennonite,90,47.13,,,,,,,47.13,83.13,percent of total billed charges,
"C2 COMPLEMENT, FUNCTIONAL, SERUM SO",81955,CDM,300,RC,86161,CPT,,,facility,outpatient,,,85.70000,81.41000,Amish/Mennonite,Amish Mennonite,90,47.13,,,,,,,12.40,628.12,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,inpatient,,,10203.00000,9692.85000,Amish/Mennonite,Amish Mennonite,90,5611.65,,,,,,,5611.65,9896.91,percent of total billed charges,
"CHROMMICRO, T, FFPE (CMAPT) SO",81956,CDM,310,RC,81277,CPT,,,facility,outpatient,,,10203.00000,9692.85000,Amish/Mennonite,Amish Mennonite,90,5611.65,,,,,,,928.00,9896.91,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLUID SO",81957,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,12.45,1539.22,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION,SERUM SO",81958,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,19.88,1103.49,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,inpatient,,,108.70000,103.26000,Amish/Mennonite,Amish Mennonite,90,59.78,,,,,,,59.78,105.44,percent of total billed charges,
"EHRLICHIA CHAFFEENSIS AB, IGG (EHRC) SO",81959,CDM,300,RC,86666,CPT,,,facility,outpatient,,,108.70000,103.26000,Amish/Mennonite,Amish Mennonite,90,59.78,,,,,,,8.17,526.26,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,inpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,,338.25,,,,,,,338.25,596.55,percent of total billed charges,
"FACTOR X CHROMOGENIC ACTIVITY ASSAY, PLASMA (FXCH) SO",81960,CDM,300,RC,85260,CPT,,,facility,outpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,,338.25,,,,,,,17.90,933.70,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,inpatient,,,205.30000,195.04000,Amish/Mennonite,Amish Mennonite,90,112.92,,,,,,,112.92,199.14,percent of total billed charges,
DEXAMETHASONE SO,81961,CDM,301,RC,80299,CPT,,,facility,outpatient,,,205.30000,195.04000,Amish/Mennonite,Amish Mennonite,90,112.92,,,,,,,19.26,882.80,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,inpatient,,,203.40000,193.23000,Amish/Mennonite,Amish Mennonite,90,111.87,,,,,,,111.87,197.30,percent of total billed charges,
"CULTURE REFERRED FOR IDENTIFICATION, MYCOBACTERIUM AND NOCARDIA, VARIES SO",81962,CDM,300,RC,87118,CPT,,,facility,outpatient,,,203.40000,193.23000,Amish/Mennonite,Amish Mennonite,90,111.87,,,,,,,15.10,679.08,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
"CULTURE SENSI, ANAEROBIC",81963,CDM,300,RC,87181,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,4.75,254.68,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,inpatient,,,660.00000,627.00000,Amish/Mennonite,Amish Mennonite,,363.00,,,,,,,363.00,640.20,percent of total billed charges,
"COV19, FLU A/B AND RSV (CEPHEID)",81964,CDM,310,RC,0241U,HCPCS,,,facility,outpatient,,,660.00000,627.00000,Amish/Mennonite,Amish Mennonite,,363.00,,,,,,,35.91,891.44,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,inpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,TC,99.55,,,,,,,99.55,175.57,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88350",81965,CDM,310,RC,88350,CPT,,,facility,outpatient,,,181.00000,171.95000,Amish/Mennonite,Amish Mennonite,TC,99.55,,,,,,,90.50,2993.62,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,inpatient,,,148.30000,140.88000,Amish/Mennonite,Amish Mennonite,90,81.56,,,,,,,81.56,143.85,percent of total billed charges,
COMPLEMENT C4 (C4) SO,81966,CDM,300,RC,86160,CPT,,,facility,outpatient,,,148.30000,140.88000,Amish/Mennonite,Amish Mennonite,90,81.56,,,,,,,12.40,628.12,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4707.00000,4471.65000,Amish/Mennonite,Amish Mennonite,90,2588.85,,,,,,,2588.85,4565.79,percent of total billed charges,
"CYSTIC FIBROSIS MUTATION ANALYSIS, 106-MUTATION PANEL, VARIES SO",81968,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4707.00000,4471.65000,Amish/Mennonite,Amish Mennonite,90,2588.85,,,,,,,210.00,26177.94,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,inpatient,,,236.40000,224.58000,Amish/Mennonite,Amish Mennonite,90,130.02,,,,,,,130.02,229.31,percent of total billed charges,
"ESTRADIOL, MASS SPEC SO",81969,CDM,300,RC,82670,CPT,,,facility,outpatient,,,236.40000,224.58000,Amish/Mennonite,Amish Mennonite,90,130.02,,,,,,,28.87,1459.96,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,inpatient,,,212.80000,202.16000,Amish/Mennonite,Amish Mennonite,90,117.04,,,,,,,117.04,206.42,percent of total billed charges,
"ESTRIOL, UNCONJUGATED, SERUM SO",81970,CDM,301,RC,82677,CPT,,,facility,outpatient,,,212.80000,202.16000,Amish/Mennonite,Amish Mennonite,90,117.04,,,,,,,24.99,1256.24,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,inpatient,,,172.80000,164.16000,Amish/Mennonite,Amish Mennonite,90,95.04,,,,,,,95.04,167.62,percent of total billed charges,
"DENGUE VIRUS AB, IGG AND IGM (DENGM) SO",81971,CDM,300,RC,86790,CPT,,,facility,outpatient,,,172.80000,164.16000,Amish/Mennonite,Amish Mennonite,90,95.04,,,,,,,45.08,679.08,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,inpatient,,,4895.00000,4650.25000,Amish/Mennonite,Amish Mennonite,90,2692.25,,,,,,,2692.25,4748.15,percent of total billed charges,
CYSTIC FIBROSIS EXPANDED MUTATION ANALYSIS SO,81972,CDM,310,RC,81220,CPT,,,facility,outpatient,,,4895.00000,4650.25000,Amish/Mennonite,Amish Mennonite,90,2692.25,,,,,,,210.00,26177.94,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,inpatient,,,319.60000,303.62000,Amish/Mennonite,Amish Mennonite,90,175.78,,,,,,,175.78,310.01,percent of total billed charges,
"FIBROBLAST CULTURE,TISSUE SO",81973,CDM,310,RC,88240,CPT,,,facility,outpatient,,,319.60000,303.62000,Amish/Mennonite,Amish Mennonite,90,175.78,,,,,,,9.83,611.15,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,114.02,201.08,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION,SERUM SO",81974,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,19.88,1103.49,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,inpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,90,43.34,,,,,,,43.34,76.44,percent of total billed charges,
ENCEPH ST LO SO,81975,CDM,300,RC,86653,CPT,,,facility,outpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,90,43.34,,,,,,,8.17,696.05,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,inpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,18.15,32.01,percent of total billed charges,
DIP-POC,81976,CDM,300,RC,81002,CPT,,,facility,outpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,,18.15,,,,,,,3.48,169.79,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,inpatient,,,154.30000,146.58000,Amish/Mennonite,Amish Mennonite,90,84.86,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT HA P4000 SO,81977,CDM,300,RC,83520,CPT,,,facility,outpatient,,,154.30000,146.58000,Amish/Mennonite,Amish Mennonite,90,84.86,,,,,,,17.85,814.87,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,inpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,140.80,248.32,percent of total billed charges,
CROSSMATCH ANTIGLOBULIN,81978,CDM,300,RC,86922,CPT,,,facility,outpatient,,,256.00000,243.20000,Amish/Mennonite,Amish Mennonite,,140.80,,,,,,,128.00,1833.46,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,inpatient,,,672.00000,638.40000,Amish/Mennonite,Amish Mennonite,TC,369.60,,,,,,,369.60,651.84,percent of total billed charges,
"CUTANEOUS IMMFLUOR, AB (CIFS) TECH 88346",81979,CDM,312,RC,88346,CPT,,,facility,outpatient,,,672.00000,638.40000,Amish/Mennonite,Amish Mennonite,TC,369.60,,,,,,,336.00,4266.89,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,90,238.70,,,,,,,238.70,420.98,percent of total billed charges,
"CONTACTIN-ASSOCIATED PROTEIN-LIKE-2 (CASPR2)-IGG, SPINAL FLUID SO",81980,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,90,238.70,,,,,,,12.45,1539.22,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,99.66,175.76,percent of total billed charges,
"CHROMOSOMAL MICROARRAY (CMA) FAMILIAL TESTING, FISH SO",81981,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,20.36,1120.45,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,inpatient,,,1355.00000,1287.25000,Amish/Mennonite,Amish Mennonite,TC,745.25,,,,,,,745.25,1314.35,percent of total billed charges,
BRAF V600E/V600K MUT (BRAFD) TECH,81982,CDM,310,RC,88381,CPT,,,facility,outpatient,,,1355.00000,1287.25000,Amish/Mennonite,Amish Mennonite,TC,745.25,,,,,,,664.97,7351.18,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,58.30,102.82,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SERUM SO",81983,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,inpatient,,,49.10000,46.64000,Amish/Mennonite,Amish Mennonite,90,27.00,,,,,,,27.00,47.63,percent of total billed charges,
FIBROS CHOL L550140 SO,81984,CDM,300,RC,82465,CPT,,,facility,outpatient,,,49.10000,46.64000,Amish/Mennonite,Amish Mennonite,90,27.00,,,,,,,4.49,220.68,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,169.78,299.44,percent of total billed charges,
"ENTEROVIRUS PCR, (ENTP) SO",81985,CDM,300,RC,87498,CPT,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,36.26,1833.46,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 NEURONAL (CRMP-5-IGG), SERUM SO",81986,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,12.45,1539.22,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,inpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,90,655.05,,,,,,,655.05,1155.27,percent of total billed charges,
"FIBROBLAST CULTURE, TISSUE SO",81987,CDM,310,RC,88233,CPT,,,facility,outpatient,,,1191.00000,1131.45000,Amish/Mennonite,Amish Mennonite,90,655.05,,,,,,,70.04,7350.89,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,inpatient,,,290.50000,275.97000,Amish/Mennonite,Amish Mennonite,90,159.78,,,,,,,159.78,281.79,percent of total billed charges,
"CITRATE, 24 HR URINE SO",81988,CDM,300,RC,82507,CPT,,,facility,outpatient,,,290.50000,275.97000,Amish/Mennonite,Amish Mennonite,90,159.78,,,,,,,28.73,1459.96,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,inpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,297.55,524.77,percent of total billed charges,
FIBROBLAST CULTURE FOR GENETIC TEST (CULFB) SO,81989,CDM,310,RC,88233,CPT,,,facility,outpatient,,,541.00000,513.95000,Amish/Mennonite,Amish Mennonite,,297.55,,,,,,,70.04,7350.89,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,inpatient,,,80.90000,76.86000,Amish/Mennonite,Amish Mennonite,90,44.49,,,,,,,44.49,78.47,percent of total billed charges,
COLD AGGLUTININS TITER SO,81990,CDM,300,RC,86157,CPT,,,facility,outpatient,,,80.90000,76.86000,Amish/Mennonite,Amish Mennonite,90,44.49,,,,,,,8.17,424.40,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,inpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,114.02,201.08,percent of total billed charges,
"ENCEPHALOPATHY, AUTOIMMUNE EVALUATION, SPINAL FLD SO",81991,CDM,300,RC,86341,CPT,,,facility,outpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,19.88,1103.49,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,inpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,39.05,68.87,percent of total billed charges,
FERN TEST POC,81992,CDM,300,RC,Q0114,HCPCS,,,facility,outpatient,,,71.00000,67.45000,Amish/Mennonite,Amish Mennonite,,39.05,,,,,,,9.74,68.87,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,inpatient,,,184.30000,175.08000,Amish/Mennonite,Amish Mennonite,,101.36,,,,,,,101.36,178.77,percent of total billed charges,
FIBROBLAST CULTR FOR GENETIC TEST (CULFB) SO,81993,CDM,310,RC,88240,CPT,,,facility,outpatient,,,184.30000,175.08000,Amish/Mennonite,Amish Mennonite,,101.36,,,,,,,9.83,611.15,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,inpatient,,,199.30000,189.34000,Amish/Mennonite,Amish Mennonite,90,109.61,,,,,,,109.61,193.32,percent of total billed charges,
"GLUTAMIC ACID DECARBOXYLASE (GAD65) ANTIBODY ASSAY, SPINAL FLUID SO",81994,CDM,300,RC,86341,CPT,,,facility,outpatient,,,199.30000,189.34000,Amish/Mennonite,Amish Mennonite,90,109.61,,,,,,,19.88,1103.49,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,inpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,90,35.75,,,,,,,35.75,63.05,percent of total billed charges,
FIBROS TRIG L550140 SO,81995,CDM,300,RC,84478,CPT,,,facility,outpatient,,,65.00000,61.75000,Amish/Mennonite,Amish Mennonite,90,35.75,,,,,,,5.93,305.58,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,99.66,175.76,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL SO",81996,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,20.36,1120.45,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,inpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,90,33.00,,,,,,,33.00,58.20,percent of total billed charges,
FIBROS ALT L550140 SO,81997,CDM,300,RC,84460,CPT,,,facility,outpatient,,,60.00000,57.00000,Amish/Mennonite,Amish Mennonite,90,33.00,,,,,,,5.48,271.65,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,inpatient,,,81.30000,77.24000,Amish/Mennonite,Amish Mennonite,90,44.72,,,,,,,44.72,78.86,percent of total billed charges,
FIBROS GGTP L550140 SO,81998,CDM,300,RC,82977,CPT,,,facility,outpatient,,,81.30000,77.24000,Amish/Mennonite,Amish Mennonite,90,44.72,,,,,,,7.44,373.51,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,TC,1593.35,,,,,,,1593.35,2810.09,percent of total billed charges,
"HER2 AMP, BREAST CANCER, FISH, TISSUE (H2BR) TECH",81999,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,TC,1593.35,,,,,,,533.12,16173.22,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,inpatient,,,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,90,24.42,,,,,,,24.42,43.07,percent of total billed charges,
FIBROS GLUC L550140 SO,82000,CDM,300,RC,82947,CPT,,,facility,outpatient,,,44.40000,42.18000,Amish/Mennonite,Amish Mennonite,90,24.42,,,,,,,4.06,203.72,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,inpatient,,,106.50000,101.17000,Amish/Mennonite,Amish Mennonite,90,58.58,,,,,,,58.58,103.31,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, LEAD, URINE SO",82001,CDM,300,RC,83655,CPT,,,facility,outpatient,,,106.50000,101.17000,Amish/Mennonite,Amish Mennonite,90,58.58,,,,,,,12.51,628.12,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,inpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,267.30,471.42,percent of total billed charges,
COV19 AND FLU A/B (CEPHEID),82002,CDM,310,RC,0240U,HCPCS,,,facility,outpatient,,,486.00000,461.70000,Amish/Mennonite,Amish Mennonite,,267.30,,,,,,,35.91,891.44,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,inpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,90,291.50,,,,,,,291.50,514.10,percent of total billed charges,
"CYTOMEGALOVIRUS (CMV) CD8 T-CELL IMMUNE COMPETENCE, QUANTITATIVE ASSESS BY FLOW CYTOMETRY, BLOOD SO",82003,CDM,300,RC,86352,CPT,,,facility,outpatient,,,530.00000,503.50000,Amish/Mennonite,Amish Mennonite,90,291.50,,,,,,,100.54,7096.21,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82004,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,32.12,56.65,percent of total billed charges,
FIBROS AST L550140 SO,82005,CDM,300,RC,84450,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,5.35,271.65,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82006,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,inpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,90,288.20,,,,,,,288.20,508.28,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY, CELL-BINDING ASSAY, SPINAL FLUID SO",82007,CDM,300,RC,86255,CPT,,,facility,outpatient,,,524.00000,497.80000,Amish/Mennonite,Amish Mennonite,90,288.20,,,,,,,12.45,1539.22,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,inpatient,,,2799.00000,2659.05000,Amish/Mennonite,Amish Mennonite,90,1539.45,,,,,,,1539.45,2715.03,percent of total billed charges,
HIV-1 GENOTYPIC PROTEAS SO,82008,CDM,300,RC,87901,CPT,,,facility,outpatient,,,2799.00000,2659.05000,Amish/Mennonite,Amish Mennonite,90,1539.45,,,,,,,266.02,13462.44,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,inpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,40.15,70.81,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S(FRTUP) SO",82009,CDM,300,RC,84479,CPT,,,facility,outpatient,,,73.00000,69.35000,Amish/Mennonite,Amish Mennonite,,40.15,,,,,,,6.47,339.51,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,inpatient,,,379.70000,360.71000,Amish/Mennonite,Amish Mennonite,90,208.84,,,,,,,208.84,368.31,percent of total billed charges,
"FRAGILE X, FOLLOW UP ANALYSIS (FUFXS) SO",82010,CDM,310,RC,81244,CPT,,,facility,outpatient,,,379.70000,360.71000,Amish/Mennonite,Amish Mennonite,90,208.84,,,,,,,46.38,2105.11,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,inpatient,,,556.00000,528.20000,Amish/Mennonite,Amish Mennonite,,305.80,,,,,,,305.80,539.32,percent of total billed charges,
HARDWARE/DEVICE REMOVAL,82012,CDM,310,RC,88099,CPT,,,facility,outpatient,,,556.00000,528.20000,Amish/Mennonite,Amish Mennonite,,305.80,,,,,,,278.00,539.32,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,inpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,90,18.15,,,,,,,18.15,32.01,percent of total billed charges,
GALACTOSE A-1 (APGAL) SO,82013,CDM,300,RC,86003,CPT,,,facility,outpatient,,,33.00000,31.35000,Amish/Mennonite,Amish Mennonite,90,18.15,,,,,,,4.57,271.65,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,58.35,102.92,percent of total billed charges,
"EPILEPSY, AUTOIMMUNE EVALUATION, SERUM SO",82014,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,inpatient,,,56.80000,53.96000,Amish/Mennonite,Amish Mennonite,90,31.24,,,,,,,31.24,55.10,percent of total billed charges,
FIBROS BILI L550140 SO,82015,CDM,300,RC,82247,CPT,,,facility,outpatient,,,56.80000,53.96000,Amish/Mennonite,Amish Mennonite,90,31.24,,,,,,,4.24,254.68,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SERUM SO",82016,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,Amish/Mennonite,Amish Mennonite,90,238.04,,,,,,,238.04,419.82,percent of total billed charges,
"FISH, B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA PANEL, SO",82017,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,Amish/Mennonite,Amish Mennonite,90,238.04,,,,,,,52.89,2410.69,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,inpatient,,,201.60000,191.52000,Amish/Mennonite,Amish Mennonite,,110.88,,,,,,,110.88,195.55,percent of total billed charges,
"FLUORIDE, PLASMA (FL) SO",82018,CDM,300,RC,82735,CPT,,,facility,outpatient,,,201.60000,191.52000,Amish/Mennonite,Amish Mennonite,,110.88,,,,,,,18.54,967.70,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,inpatient,,,154.30000,146.58000,Amish/Mennonite,Amish Mennonite,90,84.86,,,,,,,84.86,149.67,percent of total billed charges,
FIBROSPECT TIMP P4000 SO,82019,CDM,300,RC,82397,CPT,,,facility,outpatient,,,154.30000,146.58000,Amish/Mennonite,Amish Mennonite,90,84.86,,,,,,,14.59,729.98,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82020,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,inpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,58.35,102.92,percent of total billed charges,
"HBC TOTAL AB, W/REFLEX, (CORAB) SO",82021,CDM,300,RC,86704,CPT,,,facility,outpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,12.45,628.12,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,inpatient,,,211.70000,201.11000,Amish/Mennonite,Amish Mennonite,90,116.44,,,,,,,116.44,205.35,percent of total billed charges,
"HIV-1/-2 AG AND AB DIAGNOSTIC, (HIVDX) SO",82022,CDM,300,RC,87389,CPT,,,facility,outpatient,,,211.70000,201.11000,Amish/Mennonite,Amish Mennonite,90,116.44,,,,,,,24.88,1256.24,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,inpatient,,,49.60000,47.12000,Amish/Mennonite,Amish Mennonite,90,27.28,,,,,,,27.28,48.11,percent of total billed charges,
"FLOW CYTOMETRY, CELL SURFACE, ADDITIONAL (BILL ONLY) SO",82023,CDM,311,RC,88185,CPT,,,facility,outpatient,,,49.60000,47.12000,Amish/Mennonite,Amish Mennonite,90,27.28,,,,,,,24.80,1052.52,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,inpatient,,,142.10000,134.99000,Amish/Mennonite,Amish Mennonite,90,78.16,,,,,,,78.16,137.84,percent of total billed charges,
FIBROS HAPT L550140 SO,82025,CDM,300,RC,83010,CPT,,,facility,outpatient,,,142.10000,134.99000,Amish/Mennonite,Amish Mennonite,90,78.16,,,,,,,13.00,662.12,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,inpatient,,,164.70000,156.46000,Amish/Mennonite,Amish Mennonite,,90.58,,,,,,,90.58,159.76,percent of total billed charges,
"HALOPERIDOL, SERUM (HALO) SO",82026,CDM,300,RC,80173,CPT,,,facility,outpatient,,,164.70000,156.46000,Amish/Mennonite,Amish Mennonite,,90.58,,,,,,,15.78,763.98,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82028,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,inpatient,,,175.10000,166.34000,Amish/Mennonite,Amish Mennonite,90,96.31,,,,,,,96.31,169.85,percent of total billed charges,
FIBROS APOA L550140 SO,82029,CDM,300,RC,82172,CPT,,,facility,outpatient,,,175.10000,166.34000,Amish/Mennonite,Amish Mennonite,90,96.31,,,,,,,21.79,984.66,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,inpatient,,,2586.00000,2456.70000,Amish/Mennonite,Amish Mennonite,TC,1422.30,,,,,,,1422.30,2508.42,percent of total billed charges,
SIM-AIDED FLD SETTING SMPL-TECH,8203,CDM,333,RC,77280,CPT,,,facility,outpatient,,,2586.00000,2456.70000,Amish/Mennonite,Amish Mennonite,TC,1422.30,,,,,,,1293.00,13397.25,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,inpatient,,,101.90000,96.81000,Amish/Mennonite,Amish Mennonite,90,56.05,,,,,,,56.05,98.84,percent of total billed charges,
"HBC TOTAL AB, (HBC) SO",82030,CDM,300,RC,86704,CPT,,,facility,outpatient,,,101.90000,96.81000,Amish/Mennonite,Amish Mennonite,90,56.05,,,,,,,12.45,628.12,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,inpatient,,,259.70000,246.71000,Amish/Mennonite,Amish Mennonite,90,142.84,,,,,,,142.84,251.91,percent of total billed charges,
"HISTAMINE, WHOLE BLOOD SO",82031,CDM,301,RC,83088,CPT,,,facility,outpatient,,,259.70000,246.71000,Amish/Mennonite,Amish Mennonite,90,142.84,,,,,,,30.51,1544.85,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,90,65.45,,,,,,,65.45,115.43,percent of total billed charges,
HELICOBACTER PYLORI CULTURE (HELIS) SO,82032,CDM,300,RC,87081,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,90,65.45,,,,,,,6.85,339.51,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,inpatient,,,153.70000,146.01000,Amish/Mennonite,Amish Mennonite,90,84.53,,,,,,,84.53,149.09,percent of total billed charges,
FIBROS A2MACRO L550140 SO,82033,CDM,300,RC,83883,CPT,,,facility,outpatient,,,153.70000,146.01000,Amish/Mennonite,Amish Mennonite,90,84.53,,,,,,,14.05,713.01,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,inpatient,,,79.80000,75.81000,Amish/Mennonite,Amish Mennonite,90,43.89,,,,,,,43.89,77.41,percent of total billed charges,
"FOOD PANEL #2, SERUM SO",82034,CDM,300,RC,86003,CPT,,,facility,outpatient,,,79.80000,75.81000,Amish/Mennonite,Amish Mennonite,90,43.89,,,,,,,4.57,271.65,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,inpatient,,,77.70000,73.82000,Amish/Mennonite,Amish Mennonite,,42.73,,,,,,,42.73,75.37,percent of total billed charges,
"FREE THYOXINE INDEX (FTI), S (FRTUP) SO",82035,CDM,300,RC,84436,CPT,,,facility,outpatient,,,77.70000,73.82000,Amish/Mennonite,Amish Mennonite,,42.73,,,,,,,6.87,356.54,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,inpatient,,,1468.00000,1394.60000,Amish/Mennonite,Amish Mennonite,90,807.40,,,,,,,807.40,1423.96,percent of total billed charges,
"COLONIES, 6+ (BILL ONLY) SO",82036,CDM,310,RC,88269,CPT,,,facility,outpatient,,,1468.00000,1394.60000,Amish/Mennonite,Amish Mennonite,90,807.40,,,,,,,179.44,8692.03,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,inpatient,,,145.40000,138.13000,Amish/Mennonite,Amish Mennonite,90,79.97,,,,,,,79.97,141.04,percent of total billed charges,
"HYPOGLYCEMIC AGENT SCREEN, SERUM SO",82037,CDM,301,RC,80377,CPT,,,facility,outpatient,,,145.40000,138.13000,Amish/Mennonite,Amish Mennonite,90,79.97,,,,,,,72.70,1137.41,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGG ASIALO GM1 TITER, SERUM  (IGATS) SO",82038,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,inpatient,,,2846.00000,2703.70000,Amish/Mennonite,Amish Mennonite,90,1565.30,,,,,,,1565.30,2760.62,percent of total billed charges,
HLA ANTIBODY ID CLASS I HIGH RESOLUTION (2226) SO,82039,CDM,300,RC,86832,CPT,,,facility,outpatient,,,2846.00000,2703.70000,Amish/Mennonite,Amish Mennonite,90,1565.30,,,,,,,139.23,15227.97,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"GLIAL FIBRILLARY ACIDIC PROTEIN ALPHA SUBUNIT ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82040,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,inpatient,,,455.80000,433.01000,Amish/Mennonite,Amish Mennonite,,250.69,,,,,,,250.69,442.13,percent of total billed charges,
"HUNTINGTON DISEASE, MOLECULAR ANALYSIS (HAD) SO",82041,CDM,310,RC,81271,CPT,,,facility,outpatient,,,455.80000,433.01000,Amish/Mennonite,Amish Mennonite,,250.69,,,,,,,109.60,6451.13,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,inpatient,,,792.00000,752.40000,Amish/Mennonite,Amish Mennonite,90,435.60,,,,,,,435.60,768.24,percent of total billed charges,
"GABA-B-R AB CBA, S (GABCS) SO",82042,CDM,300,RC,86255,CPT,,,facility,outpatient,,,792.00000,752.40000,Amish/Mennonite,Amish Mennonite,90,435.60,,,,,,,12.45,1539.22,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,inpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,90,391.60,,,,,,,391.60,690.64,percent of total billed charges,
"IDENTIFICATION, NEXT-GENERATION SEQUENCING (BILL ONLY) SO",82043,CDM,300,RC,87798,CPT,,,facility,outpatient,,,712.00000,676.40000,Amish/Mennonite,Amish Mennonite,90,391.60,,,,,,,36.26,1833.46,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,37.56,66.25,percent of total billed charges,
IDENT BY MALDI-TOF MASS SPEC (BILL ONLY) SO,82044,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,8.35,424.40,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,inpatient,,,193.40000,183.73000,Amish/Mennonite,Amish Mennonite,90,106.37,,,,,,,106.37,187.60,percent of total billed charges,
"DENGUE VIRUS NS1 AG, (DNSAG) SO",82046,CDM,300,RC,86790,CPT,,,facility,outpatient,,,193.40000,183.73000,Amish/Mennonite,Amish Mennonite,90,106.37,,,,,,,45.08,679.08,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,inpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,207.24,365.50,percent of total billed charges,
"HBV DNA DETECT/QUANT, (HBVQN) SO",82047,CDM,300,RC,87517,CPT,,,facility,outpatient,,,376.80000,357.96000,Amish/Mennonite,Amish Mennonite,90,207.24,,,,,,,44.27,2240.90,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,90,1593.35,,,,,,,1593.35,2810.09,percent of total billed charges,
"HEMATOLOGIC NEOPLASMS, TP53 SOMATIC MUTATION, DNA SEQUENCING EXONS 4-9, VARIES SO",82048,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,90,1593.35,,,,,,,329.51,15625.93,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,inpatient,,,121.30000,115.23000,Amish/Mennonite,Amish Mennonite,90,66.72,,,,,,,66.72,117.66,percent of total billed charges,
HISTOPLASMA ANTIBODY SO,82049,CDM,300,RC,86698,CPT,,,facility,outpatient,,,121.30000,115.23000,Amish/Mennonite,Amish Mennonite,90,66.72,,,,,,,14.25,645.08,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"BILE ALCOHOLS, URINE SO",82051,CDM,300,RC,82542,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,24.89,1137.41,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,inpatient,,,85.30000,81.03000,Amish/Mennonite,Amish Mennonite,90,46.91,,,,,,,46.91,82.74,percent of total billed charges,
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SO,82052,CDM,300,RC,82955,CPT,,,facility,outpatient,,,85.30000,81.03000,Amish/Mennonite,Amish Mennonite,90,46.91,,,,,,,10.02,509.30,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,inpatient,,,161.80000,153.71000,Amish/Mennonite,Amish Mennonite,90,88.99,,,,,,,88.99,156.95,percent of total billed charges,
FIBROSPECT AMG P4000 SO,82053,CDM,300,RC,83883,CPT,,,facility,outpatient,,,161.80000,153.71000,Amish/Mennonite,Amish Mennonite,90,88.99,,,,,,,14.05,713.01,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,inpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,58.30,102.82,percent of total billed charges,
ID  MALDI-TOF MASS SPEC YEAST (BILL ONLY) SO,82055,CDM,300,RC,87106,CPT,,,facility,outpatient,,,106.00000,100.70000,Amish/Mennonite,Amish Mennonite,90,58.30,,,,,,,10.66,543.22,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,inpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,37.56,66.25,percent of total billed charges,
IDENTIFICATION STAPHYLOCOCCUS (BILL ONLY) SO,82056,CDM,300,RC,87077,CPT,,,facility,outpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,8.35,424.40,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGG MONOS GM1 TITER, SERUM  (IGMTS) SO",82057,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,inpatient,,,238.60000,226.67000,Amish/Mennonite,Amish Mennonite,,131.23,,,,,,,131.23,231.44,percent of total billed charges,
"IODINE CREATININE RATIO, RANDOM URINE (ICRU) SO",82058,CDM,300,RC,83789,CPT,,,facility,outpatient,,,238.60000,226.67000,Amish/Mennonite,Amish Mennonite,,131.23,,,,,,,24.11,1137.41,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"GABA-B-R AB IF TITER ASSAY, S (GABIS) SO",82059,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82061,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,inpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,90,78.65,,,,,,,78.65,138.71,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, MERCURY, URINE SO",82063,CDM,300,RC,83825,CPT,,,facility,outpatient,,,143.00000,135.85000,Amish/Mennonite,Amish Mennonite,90,78.65,,,,,,,16.80,848.80,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,inpatient,,,122.60000,116.47000,Amish/Mennonite,Amish Mennonite,,67.43,,,,,,,67.43,118.92,percent of total billed charges,
"HEMOGLOBIN S, SCREEN (SDEX) SO",82064,CDM,300,RC,85660,CPT,,,facility,outpatient,,,122.60000,116.47000,Amish/Mennonite,Amish Mennonite,,67.43,,,,,,,5.51,288.61,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGM DISIALO GD1B TITER, SERUM  (IMDTS) SO",82065,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,inpatient,,,5712.00000,5426.40000,Amish/Mennonite,Amish Mennonite,90,3141.60,,,,,,,3141.60,5540.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81292, VARIES SO",82066,CDM,310,RC,81292,CPT,,,facility,outpatient,,,5712.00000,5426.40000,Amish/Mennonite,Amish Mennonite,90,3141.60,,,,,,,270.25,31763.22,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,90,114.40,,,,,,,114.40,201.76,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, CADMIUM, URINE SO",82068,CDM,300,RC,82300,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,90,114.40,,,,,,,24.43,1205.34,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,inpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,389.40,686.76,percent of total billed charges,
GAMMA-GLOBIN GENE SEQ (WGSQR) SO,82070,CDM,310,RC,81479,CPT,,,facility,outpatient,,,708.00000,672.60000,Amish/Mennonite,Amish Mennonite,,389.40,,,,,,,354.00,686.76,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2794.00000,2654.30000,Amish/Mennonite,Amish Mennonite,TC,1536.70,,,,,,,1536.70,2710.18,percent of total billed charges,
"HER2 AMP, GASTROESOPH, FISH, TISSUE (H2GE) TECH",82071,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2794.00000,2654.30000,Amish/Mennonite,Amish Mennonite,TC,1536.70,,,,,,,533.12,16173.22,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,inpatient,,,103.50000,98.32000,Amish/Mennonite,Amish Mennonite,90,56.92,,,,,,,56.92,100.39,percent of total billed charges,
HEPATITIS B CORE IGM SO,82072,CDM,300,RC,86705,CPT,,,facility,outpatient,,,103.50000,98.32000,Amish/Mennonite,Amish Mennonite,90,56.92,,,,,,,12.16,611.15,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,inpatient,,,275.40000,261.63000,Amish/Mennonite,Amish Mennonite,90,151.47,,,,,,,151.47,267.14,percent of total billed charges,
"IMMUNOFIXATION DELTA AND EPSILON, SERUM SO",82073,CDM,300,RC,86334,CPT,,,facility,outpatient,,,275.40000,261.63000,Amish/Mennonite,Amish Mennonite,90,151.47,,,,,,,23.08,2082.45,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,inpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,91.80,161.89,percent of total billed charges,
"HEAVY METAL SCRN W/REFLEX, 24 HR, ARSENIC, URINE SO",82074,CDM,300,RC,82175,CPT,,,facility,outpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,19.60,984.66,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,inpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,QW,59.95,,,,,,,59.95,105.73,percent of total billed charges,
HBA1C-POC,82075,CDM,300,RC,83036,CPT,,,facility,outpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,QW,59.95,,,,,,,9.71,509.30,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGM ASIALO GM1 TITER, SERUM  (IMATS) SO",82076,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,inpatient,,,2906.00000,2760.70000,Amish/Mennonite,Amish Mennonite,TC,1598.30,,,,,,,1598.30,2818.82,percent of total billed charges,
"HER2 AMP, MISC TUMOR, FISH, TISSUE (H2MT) TECH",82077,CDM,310,RC,88377,CPT,,,facility,outpatient,,,2906.00000,2760.70000,Amish/Mennonite,Amish Mennonite,TC,1598.30,,,,,,,533.12,16173.22,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,inpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,163.24,287.90,percent of total billed charges,
"HERPES SIMPLEX VIRUS PCR, VARIES (HERPV) SO",82078,CDM,300,RC,87529,CPT,,,facility,outpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,36.26,1833.46,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGM MONOS GM1 TITER, SERUM  (IMMTS) SO",82080,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,inpatient,,,5428.00000,5156.60000,Amish/Mennonite,Amish Mennonite,90,2985.40,,,,,,,2985.40,5265.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81298, VARIES SO",82082,CDM,310,RC,81298,CPT,,,facility,outpatient,,,5428.00000,5156.60000,Amish/Mennonite,Amish Mennonite,90,2985.40,,,,,,,230.26,30184.37,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,inpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE SUGARS SO,82083,CDM,301,RC,84377,CPT,,,facility,outpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,5.68,372.96,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,inpatient,,,398.80000,378.86000,Amish/Mennonite,Amish Mennonite,90,219.34,,,,,,,219.34,386.84,percent of total billed charges,
LYMPH PROLIF AG SO,82084,CDM,300,RC,86353,CPT,,,facility,outpatient,,,398.80000,378.86000,Amish/Mennonite,Amish Mennonite,90,219.34,,,,,,,50.66,2563.44,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,inpatient,,,162.80000,154.66000,Amish/Mennonite,Amish Mennonite,,89.54,,,,,,,89.54,157.92,percent of total billed charges,
"IMMUNOGLOBULIN D (IGD), SERUM (IGD) SO",82085,CDM,300,RC,82784,CPT,,,facility,outpatient,,,162.80000,154.66000,Amish/Mennonite,Amish Mennonite,,89.54,,,,,,,9.30,492.33,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,169.78,299.44,percent of total billed charges,
"HUMAN HERPESVIRUS-6, MOLECULAR DETECTION, PCR, PLASMA SO",82086,CDM,300,RC,87532,CPT,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,36.26,1833.46,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,inpatient,,,282.30000,268.18000,Amish/Mennonite,Amish Mennonite,90,155.26,,,,,,,155.26,273.83,percent of total billed charges,
"ESTRONE, SERUM (E1) SO",82087,CDM,300,RC,82679,CPT,,,facility,outpatient,,,282.30000,268.18000,Amish/Mennonite,Amish Mennonite,90,155.26,,,,,,,25.78,1307.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,inpatient,,,2560.00000,2432.00000,Amish/Mennonite,Amish Mennonite,90,1408.00,,,,,,,1408.00,2483.20,percent of total billed charges,
HEPATITIS C VIRUS GENOTYPE RESOLUTION SO,82088,CDM,300,RC,87902,CPT,,,facility,outpatient,,,2560.00000,2432.00000,Amish/Mennonite,Amish Mennonite,90,1408.00,,,,,,,266.02,13462.44,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,inpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,90,101.20,,,,,,,101.20,178.48,percent of total billed charges,
"MDM2 (12Q15) AMPLIFICATION, WELL-DIFFERENTIATED LIPOSARCOMA/ATYPICAL LIPOMATOUS TUMOR, FISH, TISSUE SO",82089,CDM,310,RC,88271,CPT,,,facility,outpatient,,,184.00000,174.80000,Amish/Mennonite,Amish Mennonite,90,101.20,,,,,,,20.36,1120.45,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,Amish/Mennonite,Amish Mennonite,90,4186.60,,,,,,,4186.60,7383.64,percent of total billed charges,
"LYNCH SYNDROME PANEL 81228, VARIES SO",82090,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,Amish/Mennonite,Amish Mennonite,90,4186.60,,,,,,,516.91,42339.61,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SERUM SO",82091,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82092,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,inpatient,,,1098.00000,1043.10000,Amish/Mennonite,Amish Mennonite,90,603.90,,,,,,,603.90,1065.06,percent of total billed charges,
"KIT ASP816VAL MUTATION ANALYSIS, VARIES SO",82093,CDM,310,RC,81273,CPT,,,facility,outpatient,,,1098.00000,1043.10000,Amish/Mennonite,Amish Mennonite,90,603.90,,,,,,,73.92,5873.90,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,inpatient,,,1721.00000,1634.95000,Amish/Mennonite,Amish Mennonite,90,946.55,,,,,,,946.55,1669.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81319, VARIES SO",82094,CDM,310,RC,81319,CPT,,,facility,outpatient,,,1721.00000,1634.95000,Amish/Mennonite,Amish Mennonite,90,946.55,,,,,,,177.33,9574.83,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,inpatient,,,92.90000,88.25000,Amish/Mennonite,Amish Mennonite,90,51.09,,,,,,,51.09,90.11,percent of total billed charges,
LEPTIN RUO SO,82095,CDM,300,RC,84999,CPT,,,facility,outpatient,,,92.90000,88.25000,Amish/Mennonite,Amish Mennonite,90,51.09,,,,,,,46.45,90.11,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,inpatient,,,283.10000,268.94000,Amish/Mennonite,Amish Mennonite,90,155.71,,,,,,,155.71,274.61,percent of total billed charges,
"KARYOTYPES, >1 (BILL ONLY) SO",82096,CDM,310,RC,88280,CPT,,,facility,outpatient,,,283.10000,268.94000,Amish/Mennonite,Amish Mennonite,90,155.71,,,,,,,34.58,1578.85,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,inpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,,115.33,,,,,,,115.33,203.41,percent of total billed charges,
"IODINE, SERUM (IOD) SO",82097,CDM,300,RC,83789,CPT,,,facility,outpatient,,,209.70000,199.21000,Amish/Mennonite,Amish Mennonite,,115.33,,,,,,,24.11,1137.41,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,inpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,96.36,169.94,percent of total billed charges,
"IGG DISIALO GD1B TITER, SERUM  (IGDTS) SO",82098,CDM,300,RC,83520,CPT,,,facility,outpatient,,,175.20000,166.44000,Amish/Mennonite,Amish Mennonite,90,96.36,,,,,,,17.85,814.87,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,inpatient,,,5721.00000,5434.95000,Amish/Mennonite,Amish Mennonite,90,3146.55,,,,,,,3146.55,5549.37,percent of total billed charges,
"LYNCH SYNDROME PANEL 81317, VARIES SO",82099,CDM,310,RC,81317,CPT,,,facility,outpatient,,,5721.00000,5434.95000,Amish/Mennonite,Amish Mennonite,90,3146.55,,,,,,,625.03,31831.15,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,inpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,TC,65.45,,,,,,,65.45,115.43,percent of total billed charges,
"MGMT PROMOTER METHYLATION, TUMOR (MGMT) TECH",82100,CDM,310,RC,88381,CPT,,,facility,outpatient,,,119.00000,113.05000,Amish/Mennonite,Amish Mennonite,TC,65.45,,,,,,,59.50,7351.18,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,inpatient,,,134.60000,127.87000,Amish/Mennonite,Amish Mennonite,90,74.03,,,,,,,74.03,130.56,percent of total billed charges,
ID MALDI-TOF MASS SPEC AFB (BILL ONLY) SO,82102,CDM,300,RC,87118,CPT,,,facility,outpatient,,,134.60000,127.87000,Amish/Mennonite,Amish Mennonite,90,74.03,,,,,,,15.10,679.08,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,inpatient,,,122.30000,116.18000,Amish/Mennonite,Amish Mennonite,90,67.27,,,,,,,67.27,118.63,percent of total billed charges,
"C9 COMPLEMENT, FUNCTIONAL, SERUM SO",82103,CDM,300,RC,86161,CPT,,,facility,outpatient,,,122.30000,116.18000,Amish/Mennonite,Amish Mennonite,90,67.27,,,,,,,12.40,628.12,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,inpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,90,540.65,,,,,,,540.65,953.51,percent of total billed charges,
"MECA MOLECULAR DETECTION, PCR (BILL ONLY) SO",82104,CDM,300,RC,87150,CPT,,,facility,outpatient,,,983.00000,933.85000,Amish/Mennonite,Amish Mennonite,90,540.65,,,,,,,36.26,1833.46,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,inpatient,,,654.00000,621.30000,Amish/Mennonite,Amish Mennonite,90,359.70,,,,,,,359.70,634.38,percent of total billed charges,
"HLA-27, PCR (2271) SO",82105,CDM,310,RC,81374,CPT,,,facility,outpatient,,,654.00000,621.30000,Amish/Mennonite,Amish Mennonite,90,359.70,,,,,,,76.81,3802.79,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,inpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,56.10,98.94,percent of total billed charges,
METAB PANEL BASIC W ION CA,82106,CDM,300,RC,80047,CPT,,,facility,outpatient,,,102.00000,96.90000,Amish/Mennonite,Amish Mennonite,,56.10,,,,,,,11.89,645.08,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,inpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,,112.31,,,,,,,112.31,198.07,percent of total billed charges,
HB VARIANT (MASS) SO,82107,CDM,300,RC,83789,CPT,,,facility,outpatient,,,204.20000,193.99000,Amish/Mennonite,Amish Mennonite,,112.31,,,,,,,24.11,1137.41,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,90,894.85,,,,,,,894.85,1578.19,percent of total billed charges,
MLH1 HYPERMETHYLATION ANALYSIS (BILL ONLY) SO,82108,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,90,894.85,,,,,,,164.96,9048.50,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,Amish/Mennonite,Amish Mennonite,90,68.86,,,,,,,68.86,121.44,percent of total billed charges,
"MELANOMA,NG,MICRODISECT (MELP) SO",82109,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,Amish/Mennonite,Amish Mennonite,90,68.86,,,,,,,62.60,8610.62,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,inpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,163.24,287.90,percent of total billed charges,
MYCOBACTERIA PROBE IDENT SOLID (BILL ONLY) SO,82110,CDM,300,RC,87150,CPT,,,facility,outpatient,,,296.80000,281.96000,Amish/Mennonite,Amish Mennonite,90,163.24,,,,,,,36.26,1833.46,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82111,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,inpatient,,,216.20000,205.39000,Amish/Mennonite,Amish Mennonite,90,118.91,,,,,,,118.91,209.71,percent of total billed charges,
"METHADONE & METAB, SERA (MDNS) SO",82112,CDM,300,RC,80358,CPT,,,facility,outpatient,,,216.20000,205.39000,Amish/Mennonite,Amish Mennonite,90,118.91,,,,,,,108.10,1137.41,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,inpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MUCOP SO,82113,CDM,301,RC,83864,CPT,,,facility,outpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,28.00,1341.13,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,Amish/Mennonite,Amish Mennonite,90,51.48,,,,,,,51.48,90.79,percent of total billed charges,
MINT (MENTHA PIPERITA) IGE SO,82114,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,Amish/Mennonite,Amish Mennonite,90,51.48,,,,,,,4.57,271.65,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,inpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE MASS S SO,82115,CDM,301,RC,83789,CPT,,,facility,outpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,24.91,1137.41,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,169.78,299.44,percent of total billed charges,
"NEISSERIA GONORRHOEAE, MISCELLANEOUS SITES, NUCLEIC ACID AMPLIFICATION, VARIES SO",82116,CDM,300,RC,87591,CPT,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,36.26,1833.46,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,inpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,211.47,372.96,percent of total billed charges,
LYSOMAL STORAGE CREAT SO,82117,CDM,301,RC,82570,CPT,,,facility,outpatient,,,384.50000,365.28000,Amish/Mennonite,Amish Mennonite,90,211.47,,,,,,,5.35,372.96,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,inpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,90,46.20,,,,,,,46.20,81.48,percent of total billed charges,
FUNGAL IDENT PANEL B (BILL ONLY) SO,82118,CDM,300,RC,87107,CPT,,,facility,outpatient,,,84.00000,79.80000,Amish/Mennonite,Amish Mennonite,90,46.20,,,,,,,10.66,543.22,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82120,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,inpatient,,,618.00000,587.10000,Amish/Mennonite,Amish Mennonite,90,339.90,,,,,,,339.90,599.46,percent of total billed charges,
IDENTIFICATION BY PCR (BILL ONLY) SO,82121,CDM,300,RC,87150,CPT,,,facility,outpatient,,,618.00000,587.10000,Amish/Mennonite,Amish Mennonite,90,339.90,,,,,,,36.26,1833.46,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,inpatient,,,345.50000,328.22000,Amish/Mennonite,Amish Mennonite,90,190.03,,,,,,,190.03,335.13,percent of total billed charges,
"LOW-GRADE FIBROMYXOID SARCOMA (LGFMS), 16P11.2 (FUS OR TLS) REARRANGEMENT, FISH, TISSUE SO",82122,CDM,310,RC,88271,CPT,,,facility,outpatient,,,345.50000,328.22000,Amish/Mennonite,Amish Mennonite,90,190.03,,,,,,,20.36,1120.45,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82124,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,inpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,90,238.70,,,,,,,238.70,420.98,percent of total billed charges,
"LEUCINE-RICH GLIOMA INACTIVATED PROTEIN-1 (LGI1) IGG, SPINAL FLUID SO",82125,CDM,300,RC,86255,CPT,,,facility,outpatient,,,434.00000,412.30000,Amish/Mennonite,Amish Mennonite,90,238.70,,,,,,,12.45,1539.22,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,inpatient,,,431.20000,409.64000,Amish/Mennonite,Amish Mennonite,90,237.16,,,,,,,237.16,418.26,percent of total billed charges,
"LYMPHOCYTE PROLIFERATION TO MITOGENS, BLOOD SO",82126,CDM,300,RC,86353,CPT,,,facility,outpatient,,,431.20000,409.64000,Amish/Mennonite,Amish Mennonite,90,237.16,,,,,,,50.66,2563.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,inpatient,,,125.20000,118.94000,Amish/Mennonite,Amish Mennonite,90,68.86,,,,,,,68.86,121.44,percent of total billed charges,
NEUROONC EXP GENPA TUM(NONCP) SO,82127,CDM,310,RC,88381,CPT,,,facility,outpatient,,,125.20000,118.94000,Amish/Mennonite,Amish Mennonite,90,68.86,,,,,,,62.60,8610.62,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,inpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,90,894.85,,,,,,,894.85,1578.19,percent of total billed charges,
"MLH1 HYPERMETHYLATION ANALYSIS, TUMOR SO",82128,CDM,310,RC,81288,CPT,,,facility,outpatient,,,1627.00000,1545.65000,Amish/Mennonite,Amish Mennonite,90,894.85,,,,,,,164.96,9048.50,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,inpatient,,,109.40000,103.93000,Amish/Mennonite,Amish Mennonite,90,60.17,,,,,,,60.17,106.12,percent of total billed charges,
"MYCOBACTERIAL CULTURE, BLOOD ONLY SO",82129,CDM,300,RC,87116,CPT,,,facility,outpatient,,,109.40000,103.93000,Amish/Mennonite,Amish Mennonite,90,60.17,,,,,,,11.16,560.26,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,inpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,TC,283.25,,,,,,,283.25,499.55,percent of total billed charges,
SPECIAL TREATMENT PROC-TECH,8213,CDM,333,RC,77470,CPT,,,facility,outpatient,,,515.00000,489.25000,Amish/Mennonite,Amish Mennonite,TC,283.25,,,,,,,138.83,1411.00,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,inpatient,,,285.50000,271.22000,Amish/Mennonite,Amish Mennonite,90,157.03,,,,,,,157.03,276.94,percent of total billed charges,
MYCOPLASMA HOMINIS (MHPRP) SO,82130,CDM,300,RC,87798,CPT,,,facility,outpatient,,,285.50000,271.22000,Amish/Mennonite,Amish Mennonite,90,157.03,,,,,,,36.26,1833.46,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,inpatient,,,101.20000,96.14000,Amish/Mennonite,Amish Mennonite,90,55.66,,,,,,,55.66,98.16,percent of total billed charges,
METHYLPHENIDATE BLD SO,82131,CDM,300,RC,80360,CPT,,,facility,outpatient,,,101.20000,96.14000,Amish/Mennonite,Amish Mennonite,90,55.66,,,,,,,50.60,1137.41,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SERUM SO",82132,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SERUM SO",82133,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"METABOTROPIC GLUTAMATE RECEPTOR 1 (MGLUR1) ANTIBODY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82134,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,12.45,1539.22,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,inpatient,,,3228.00000,3066.60000,Amish/Mennonite,Amish Mennonite,90,1775.40,,,,,,,1775.40,3131.16,percent of total billed charges,
"LYNCH SYNDROME PANEL 81295, VARIES SO",82135,CDM,310,RC,81295,CPT,,,facility,outpatient,,,3228.00000,3066.60000,Amish/Mennonite,Amish Mennonite,90,1775.40,,,,,,,103.62,17961.21,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"DIPEPTIDYL-PEPTIDASE-LIKE PROTEIN-6 (DPPX) ANTIBODY, IMMUNOFLUORESCENCE, SPINAL FLUID SO",82137,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,12.45,1539.22,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,Amish/Mennonite,Amish Mennonite,,76.89,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,Amish/Mennonite,Amish Mennonite,,76.89,,,,,,,12.05,1786.28,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,inpatient,,,139.80000,132.81000,Amish/Mennonite,Amish Mennonite,90,76.89,,,,,,,76.89,135.61,percent of total billed charges,
MOGTS FACS TITER (MOGTS) SO,82138,CDM,300,RC,86363,CPT,,,facility,outpatient,,,139.80000,132.81000,Amish/Mennonite,Amish Mennonite,90,76.89,,,,,,,12.05,1786.28,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT IGG, IMMUNOFLUORESCENCE TITER ASSAY, SPINAL FLUID SO",82139,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,inpatient,,,58.30000,55.38000,Amish/Mennonite,Amish Mennonite,90,32.06,,,,,,,32.06,56.55,percent of total billed charges,
LEGIONELLA CULTURE (LEGI) SO,82140,CDM,300,RC,87081,CPT,,,facility,outpatient,,,58.30000,55.38000,Amish/Mennonite,Amish Mennonite,90,32.06,,,,,,,6.85,339.51,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,inpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,37.56,66.25,percent of total billed charges,
ID MALDI-TOF MASS SPEC ANAEROBE (BILL ONLY) SO,82141,CDM,300,RC,87076,CPT,,,facility,outpatient,,,68.30000,64.88000,Amish/Mennonite,Amish Mennonite,90,37.56,,,,,,,8.35,424.40,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,inpatient,,,100.50000,95.47000,Amish/Mennonite,Amish Mennonite,,55.27,,,,,,,55.27,97.48,percent of total billed charges,
OM HEALTH RISK ASSESSMENT LIPID,82142,CDM,300,RC,99999,CPT,,,facility,outpatient,,,100.50000,95.47000,Amish/Mennonite,Amish Mennonite,,55.27,,,,,,,50.25,97.48,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,inpatient,,,4214.00000,4003.30000,Amish/Mennonite,Amish Mennonite,90,2317.70,,,,,,,2317.70,4087.58,percent of total billed charges,
NOTCH3 (CADASIL) SEQUENCING TEST SO,82143,CDM,310,RC,81406,CPT,,,facility,outpatient,,,4214.00000,4003.30000,Amish/Mennonite,Amish Mennonite,90,2317.70,,,,,,,282.88,13309.69,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,Amish/Mennonite,Amish Mennonite,TC,469.70,,,,,,,469.70,828.38,percent of total billed charges,
ISOCITRATE DEHYDROGENASE 1 & 2  (IDH12) TECH,82144,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,Amish/Mennonite,Amish Mennonite,TC,469.70,,,,,,,427.00,7351.18,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,inpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,90,1593.35,,,,,,,1593.35,2810.09,percent of total billed charges,
"NEXT-GEN SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82145,CDM,310,RC,81352,CPT,,,facility,outpatient,,,2897.00000,2752.15000,Amish/Mennonite,Amish Mennonite,90,1593.35,,,,,,,329.51,15625.93,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,inpatient,,,2602.00000,2471.90000,Amish/Mennonite,Amish Mennonite,90,1431.10,,,,,,,1431.10,2523.94,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAP GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82146,CDM,310,RC,81121,CPT,,,facility,outpatient,,,2602.00000,2471.90000,Amish/Mennonite,Amish Mennonite,90,1431.10,,,,,,,236.63,13920.84,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,inpatient,,,5275.00000,5011.25000,Amish/Mennonite,Amish Mennonite,90,2901.25,,,,,,,2901.25,5116.75,percent of total billed charges,
NEUROONC EXP GENPA TUM (NONCP) SO,82147,CDM,310,RC,81457,CPT,,,facility,outpatient,,,5275.00000,5011.25000,Amish/Mennonite,Amish Mennonite,90,2901.25,,,,,,,2637.50,5605.44,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,inpatient,,,1456.00000,1383.20000,Amish/Mennonite,Amish Mennonite,90,800.80,,,,,,,800.80,1412.32,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUT PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82148,CDM,310,RC,81245,CPT,,,facility,outpatient,,,1456.00000,1383.20000,Amish/Mennonite,Amish Mennonite,90,800.80,,,,,,,132.74,7792.26,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"IGLON FAMILY MEMBER 5 ANTIBODY, IMMUNOFLUORESCENCE TITER ASSAY, SERUM SO",82149,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT HEAVY CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82150,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,inpatient,,,1483.00000,1408.85000,Amish/Mennonite,Amish Mennonite,90,815.65,,,,,,,815.65,1438.51,percent of total billed charges,
"MYD88, L265P, SOMATIC GENE MUTATION, DNA ALLELE-SPECIFIC PCR, VARIES SO",82151,CDM,310,RC,81305,CPT,,,facility,outpatient,,,1483.00000,1408.85000,Amish/Mennonite,Amish Mennonite,90,815.65,,,,,,,140.32,8250.66,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,20.35,35.89,percent of total billed charges,
OM SCREENING CBC W/AUTODIFF,82153,CDM,300,RC,99999,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,,20.35,,,,,,,18.50,35.89,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,inpatient,,,321.00000,304.95000,Amish/Mennonite,Amish Mennonite,90,176.55,,,,,,,176.55,311.37,percent of total billed charges,
"EVEROLIMUS, BLOOD (EVROL) SO",82154,CDM,300,RC,80169,CPT,,,facility,outpatient,,,321.00000,304.95000,Amish/Mennonite,Amish Mennonite,90,176.55,,,,,,,14.19,713.01,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,inpatient,,,854.00000,811.30000,Amish/Mennonite,Amish Mennonite,TC,469.70,,,,,,,469.70,828.38,percent of total billed charges,
LUNG CANCER GENE PNL (LNGPR) TECH,82156,CDM,310,RC,88381,CPT,,,facility,outpatient,,,854.00000,811.30000,Amish/Mennonite,Amish Mennonite,TC,469.70,,,,,,,427.00,7351.18,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,Amish/Mennonite,Amish Mennonite,90,421.30,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY, CELL BINDING ASSAY, SPINAL FLUID SO",82157,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,Amish/Mennonite,Amish Mennonite,90,421.30,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
"NMDA-RECEPTOR ANTIBODY TITER ASSAY BY IMMUNOFLUORESCENCE, SPINAL FLUID SO",82158,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,inpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,536.80,946.72,percent of total billed charges,
MYCOBACTERIA IDENT BY SEQUENCING (BILL ONLY) SO,82159,CDM,300,RC,87153,CPT,,,facility,outpatient,,,976.00000,927.20000,Amish/Mennonite,Amish Mennonite,90,536.80,,,,,,,119.20,6026.72,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,inpatient,,,152.40000,144.78000,Amish/Mennonite,Amish Mennonite,,83.82,,,,,,,83.82,147.83,percent of total billed charges,
OM MEASLES IMMUNE STATUS,82160,CDM,300,RC,86732,CPT,,,facility,outpatient,,,152.40000,144.78000,Amish/Mennonite,Amish Mennonite,,83.82,,,,,,,15.00,713.01,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,inpatient,,,134.50000,127.77000,Amish/Mennonite,Amish Mennonite,90,73.97,,,,,,,73.97,130.47,percent of total billed charges,
"OXALATE,24 HR URINE SO",82161,CDM,300,RC,83945,CPT,,,facility,outpatient,,,134.50000,127.77000,Amish/Mennonite,Amish Mennonite,90,73.97,,,,,,,14.93,679.08,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,inpatient,,,153.50000,145.82000,Amish/Mennonite,Amish Mennonite,90,84.42,,,,,,,84.42,148.90,percent of total billed charges,
OLANZSO MTOX756 SO,82162,CDM,300,RC,80342,CPT,,,facility,outpatient,,,153.50000,145.82000,Amish/Mennonite,Amish Mennonite,90,84.42,,,,,,,76.75,1137.41,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,inpatient,,,154.10000,146.39000,Amish/Mennonite,Amish Mennonite,,84.75,,,,,,,84.75,149.48,percent of total billed charges,
OM MUMPS IMMUNE STATUS,82163,CDM,300,RC,86735,CPT,,,facility,outpatient,,,154.10000,146.39000,Amish/Mennonite,Amish Mennonite,,84.75,,,,,,,13.05,679.08,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,inpatient,,,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.89,8.63,percent of total billed charges,
OM CDL DIPSTICK,82164,CDM,300,RC,81099,CPT,,,facility,outpatient,,,8.90000,8.46000,Amish/Mennonite,Amish Mennonite,,4.89,,,,,,,4.45,8.63,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,inpatient,,,56.20000,53.39000,Amish/Mennonite,Amish Mennonite,,30.91,,,,,,,30.91,54.51,percent of total billed charges,
"IODINE CREATININE RATIO, RANDM URINE (ICRU) SO",82165,CDM,300,RC,82570,CPT,,,facility,outpatient,,,56.20000,53.39000,Amish/Mennonite,Amish Mennonite,,30.91,,,,,,,5.18,271.65,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,inpatient,,,1567.00000,1488.65000,Amish/Mennonite,Amish Mennonite,90,861.85,,,,,,,861.85,1519.99,percent of total billed charges,
"LYNCH SYNDROME PANEL 81403, VARIES SO",82166,CDM,310,RC,81403,CPT,,,facility,outpatient,,,1567.00000,1488.65000,Amish/Mennonite,Amish Mennonite,90,861.85,,,,,,,185.20,8708.99,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,inpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,196.35,346.29,percent of total billed charges,
"MYCOPLASMA HOMINIS, PCR (MHRP) SO",82167,CDM,300,RC,87798,CPT,,,facility,outpatient,,,357.00000,339.15000,Amish/Mennonite,Amish Mennonite,,196.35,,,,,,,35.09,1833.46,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,inpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,87.23,153.84,percent of total billed charges,
NMDA-R AB IF TITER (NMDIS) SO,82168,CDM,300,RC,86256,CPT,,,facility,outpatient,,,158.60000,150.67000,Amish/Mennonite,Amish Mennonite,90,87.23,,,,,,,12.45,1539.22,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,inpatient,,,766.00000,727.70000,Amish/Mennonite,Amish Mennonite,90,421.30,,,,,,,421.30,743.02,percent of total billed charges,
"NMDA-R AB CBA, S (NMDCS) SO",82169,CDM,300,RC,86255,CPT,,,facility,outpatient,,,766.00000,727.70000,Amish/Mennonite,Amish Mennonite,90,421.30,,,,,,,12.45,1539.22,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,inpatient,,,217.80000,206.91000,Amish/Mennonite,Amish Mennonite,,119.79,,,,,,,119.79,211.27,percent of total billed charges,
INTRINSIC FACTOR BLOCKING ANTIBODY (IFBA) SO,82170,CDM,300,RC,86340,CPT,,,facility,outpatient,,,217.80000,206.91000,Amish/Mennonite,Amish Mennonite,,119.79,,,,,,,14.28,780.94,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,inpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,90,98.45,,,,,,,98.45,173.63,percent of total billed charges,
NICOTINE & METABOLITES (NICOS) SO,82171,CDM,300,RC,80323,CPT,,,facility,outpatient,,,179.00000,170.05000,Amish/Mennonite,Amish Mennonite,90,98.45,,,,,,,89.50,1137.41,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,inpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,37.78,66.64,percent of total billed charges,
OM VZV IMMUNE STATUS,82173,CDM,300,RC,86787,CPT,,,facility,outpatient,,,68.70000,65.26000,Amish/Mennonite,Amish Mennonite,,37.78,,,,,,,8.17,679.08,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,inpatient,,,11319.00000,10753.05000,Amish/Mennonite,Amish Mennonite,90,6225.45,,,,,,,6225.45,10979.43,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GENERATION SEQUENCING (NGS), VARIES SO",82174,CDM,310,RC,81460,CPT,,,facility,outpatient,,,11319.00000,10753.05000,Amish/Mennonite,Amish Mennonite,90,6225.45,,,,,,,1287.00,60538.53,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,inpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,,74.91,,,,,,,74.91,132.11,percent of total billed charges,
NMO/AQP4 TITER (NMOTS) SO,82175,CDM,300,RC,86256,CPT,,,facility,outpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,,74.91,,,,,,,12.05,1539.22,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,inpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,169.78,299.44,percent of total billed charges,
"PNEUMOCYSTIS JIROVECI, MOLECULAR DETECTION, PCR, VARIES (PNRP) SO",82176,CDM,300,RC,87594,CPT,,,facility,outpatient,,,308.70000,293.26000,Amish/Mennonite,Amish Mennonite,90,169.78,,,,,,,28.07,299.44,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,inpatient,,,8234.00000,7822.30000,Amish/Mennonite,Amish Mennonite,90,4528.70,,,,,,,4528.70,7986.98,percent of total billed charges,
"MITOCHONDRIAL FULL GENOME ANALYSIS, NEXT-GEN SEQUENCING (NGS), VARIES SO",82177,CDM,310,RC,81465,CPT,,,facility,outpatient,,,8234.00000,7822.30000,Amish/Mennonite,Amish Mennonite,90,4528.70,,,,,,,936.00,44037.28,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,inpatient,,,340.70000,323.66000,Amish/Mennonite,Amish Mennonite,90,187.38,,,,,,,187.38,330.48,percent of total billed charges,
"PDGFB (22Q13), DERMATOFIBROSARCOMA PROTUBERANS/GIANT CELL FIBROBLASTOMA, FISH, TISSUE SO",82178,CDM,310,RC,88271,CPT,,,facility,outpatient,,,340.70000,323.66000,Amish/Mennonite,Amish Mennonite,90,187.38,,,,,,,20.36,1120.45,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,inpatient,,,193.00000,183.35000,Amish/Mennonite,Amish Mennonite,,106.15,,,,,,,106.15,187.21,percent of total billed charges,
PAP-THIN PREP (NEW CODE FOR PRICE DESCRIPANCY),82179,CDM,311,RC,88142,CPT,,,facility,outpatient,,,193.00000,183.35000,Amish/Mennonite,Amish Mennonite,,106.15,,,,,,,20.26,1052.52,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,inpatient,,,879.00000,835.05000,Amish/Mennonite,Amish Mennonite,TC,483.45,,,,,,,483.45,852.63,percent of total billed charges,
TECH TRT AID SIMPLE-TECH,8218,CDM,333,RC,77332,CPT,,,facility,outpatient,,,879.00000,835.05000,Amish/Mennonite,Amish Mennonite,TC,483.45,,,,,,,96.44,1292.36,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,inpatient,,,170.10000,161.60000,Amish/Mennonite,Amish Mennonite,,93.56,,,,,,,93.56,165.00,percent of total billed charges,
OM RUBELLA IMMUNE STATUS,82180,CDM,300,RC,86762,CPT,,,facility,outpatient,,,170.10000,161.60000,Amish/Mennonite,Amish Mennonite,,93.56,,,,,,,14.39,746.94,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,53.52,94.38,percent of total billed charges,
PARROT AUSTRALIAN (BUDGERIGAR) FEATHERS IGE SO,82181,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,inpatient,,,63.80000,60.61000,Amish/Mennonite,Amish Mennonite,,35.09,,,,,,,35.09,61.89,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA (PKU) SO",82182,CDM,300,RC,84030,CPT,,,facility,outpatient,,,63.80000,60.61000,Amish/Mennonite,Amish Mennonite,,35.09,,,,,,,5.50,288.61,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,inpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,90,210.10,,,,,,,210.10,370.54,percent of total billed charges,
"M-PROTEIN ISOTYPE, SERUM SO",82183,CDM,310,RC,0077U,HCPCS,,,facility,outpatient,,,382.00000,362.90000,Amish/Mennonite,Amish Mennonite,90,210.10,,,,,,,152.01,370.54,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,inpatient,,,3120.00000,2964.00000,Amish/Mennonite,Amish Mennonite,TC,1716.00,,,,,,,1716.00,3026.40,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOD SO",82184,CDM,310,RC,88348,CPT,,,facility,outpatient,,,3120.00000,2964.00000,Amish/Mennonite,Amish Mennonite,TC,1716.00,,,,,,,1560.00,14719.32,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,inpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,19.80,34.92,percent of total billed charges,
ONCOLOGY PROTEIN URINE SCREEN,82185,CDM,300,RC,81002,CPT,,,facility,outpatient,,,36.00000,34.20000,Amish/Mennonite,Amish Mennonite,,19.80,,,,,,,3.48,169.79,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,inpatient,,,61.50000,58.42000,Amish/Mennonite,Amish Mennonite,,33.83,,,,,,,33.83,59.66,percent of total billed charges,
OM SCREENING BLOOD LEAD,82186,CDM,300,RC,99999,CPT,,,facility,outpatient,,,61.50000,58.42000,Amish/Mennonite,Amish Mennonite,,33.83,,,,,,,30.75,59.66,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,inpatient,,,1700.00000,1615.00000,Amish/Mennonite,Amish Mennonite,90,935.00,,,,,,,935.00,1649.00,percent of total billed charges,
"NEXT-GENERATION SEQUENCING ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82187,CDM,310,RC,81120,CPT,,,facility,outpatient,,,1700.00000,1615.00000,Amish/Mennonite,Amish Mennonite,90,935.00,,,,,,,154.60,9082.50,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,inpatient,,,846.00000,803.70000,Amish/Mennonite,Amish Mennonite,90,465.30,,,,,,,465.30,820.62,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81479, VARIES SO",82188,CDM,310,RC,81479,CPT,,,facility,outpatient,,,846.00000,803.70000,Amish/Mennonite,Amish Mennonite,90,465.30,,,,,,,423.00,820.62,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,inpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,32.12,56.65,percent of total billed charges,
"NTX-TELOPEPTIDE, URINE (NTXPR) SO",82191,CDM,300,RC,82570,CPT,,,facility,outpatient,,,58.40000,55.48000,Amish/Mennonite,Amish Mennonite,90,32.12,,,,,,,5.35,271.65,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,inpatient,,,280.70000,266.66000,Amish/Mennonite,Amish Mennonite,90,154.38,,,,,,,154.38,272.28,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, ANAEROBIC BACTERIA SO",82193,CDM,300,RC,87076,CPT,,,facility,outpatient,,,280.70000,266.66000,Amish/Mennonite,Amish Mennonite,90,154.38,,,,,,,8.35,424.40,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,inpatient,,,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,,30.86,,,,,,,30.86,54.42,percent of total billed charges,
OM SCREENING MPC,82195,CDM,300,RC,99999,CPT,,,facility,outpatient,,,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,,30.86,,,,,,,28.05,54.42,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,inpatient,,,155.70000,147.92000,Amish/Mennonite,Amish Mennonite,90,85.64,,,,,,,85.64,151.03,percent of total billed charges,
"NEURONAL VOLTAGE-GATED POTASSIUM CHANNEL-COMPLEX AUTOANTIBODY, SPINAL FLUID SO",82196,CDM,301,RC,83519,CPT,,,facility,outpatient,,,155.70000,147.92000,Amish/Mennonite,Amish Mennonite,90,85.64,,,,,,,19.00,865.84,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,inpatient,,,105.50000,100.22000,Amish/Mennonite,Amish Mennonite,90,58.02,,,,,,,58.02,102.33,percent of total billed charges,
"PORPHYRINS EVALUATION, WHOLE BLOOD SO",82197,CDM,301,RC,84311,CPT,,,facility,outpatient,,,105.50000,100.22000,Amish/Mennonite,Amish Mennonite,90,58.02,,,,,,,8.37,373.51,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,inpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,58.35,102.92,percent of total billed charges,
"PARANEOPLASTIC, AUTOANTIBODY EVALUATION, SPINAL FLUID SO",82198,CDM,300,RC,86255,CPT,,,facility,outpatient,,,106.10000,100.79000,Amish/Mennonite,Amish Mennonite,90,58.35,,,,,,,12.45,1539.22,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,inpatient,,,2324.00000,2207.80000,Amish/Mennonite,Amish Mennonite,90,1278.20,,,,,,,1278.20,2254.28,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81404, VARIES SO",82199,CDM,310,RC,81404,CPT,,,facility,outpatient,,,2324.00000,2207.80000,Amish/Mennonite,Amish Mennonite,90,1278.20,,,,,,,274.83,12936.18,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,inpatient,,,2548.00000,2420.60000,Amish/Mennonite,Amish Mennonite,90,1401.40,,,,,,,1401.40,2471.56,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81405, VARIES SO",82200,CDM,310,RC,81405,CPT,,,facility,outpatient,,,2548.00000,2420.60000,Amish/Mennonite,Amish Mennonite,90,1401.40,,,,,,,301.35,14175.45,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,inpatient,,,730.00000,693.50000,Amish/Mennonite,Amish Mennonite,90,401.50,,,,,,,401.50,708.10,percent of total billed charges,
"NEXT-GENERATION SEQ ACUTE MYELOID LEUKEMIA, THERAPEUTIC GENE MUTATION PANEL (FLT3, IDH1, IDH2, TP53), VARIES SO",82201,CDM,310,RC,81246,CPT,,,facility,outpatient,,,730.00000,693.50000,Amish/Mennonite,Amish Mennonite,90,401.50,,,,,,,85.76,3904.65,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,inpatient,,,432.80000,411.16000,Amish/Mennonite,Amish Mennonite,90,238.04,,,,,,,238.04,419.82,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88275 SO",82202,CDM,310,RC,88275,CPT,,,facility,outpatient,,,432.80000,411.16000,Amish/Mennonite,Amish Mennonite,90,238.04,,,,,,,52.89,2410.69,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,inpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,90,365.75,,,,,,,365.75,645.05,percent of total billed charges,
"PRADER-WILLI/ANGELMAN SYNDROME, MOLECULAR ANALYSIS, VARIES SO",82204,CDM,310,RC,81331,CPT,,,facility,outpatient,,,665.00000,631.75000,Amish/Mennonite,Amish Mennonite,90,365.75,,,,,,,52.77,2410.69,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,inpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,TC,62.70,,,,,,,62.70,110.58,percent of total billed charges,
"MELANOMA, NEXTGEN, TUMOR (MELP) TECH",82205,CDM,310,RC,88381,CPT,,,facility,outpatient,,,114.00000,108.30000,Amish/Mennonite,Amish Mennonite,TC,62.70,,,,,,,57.00,7351.18,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,inpatient,,,1382.00000,1312.90000,Amish/Mennonite,Amish Mennonite,,760.10,,,,,,,760.10,1340.54,percent of total billed charges,
NARCOLEPSY ASSOCIATED ANTIGEN (NARC) SO,82206,CDM,310,RC,81376,CPT,,,facility,outpatient,,,1382.00000,1312.90000,Amish/Mennonite,Amish Mennonite,,760.10,,,,,,,122.22,6383.20,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,inpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,90,224.40,,,,,,,224.40,395.76,percent of total billed charges,
"OLIGOSACCHARIDE SCREEN, RANDOM, URINE SO",82207,CDM,301,RC,84377,CPT,,,facility,outpatient,,,408.00000,387.60000,Amish/Mennonite,Amish Mennonite,90,224.40,,,,,,,5.68,395.76,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,inpatient,,,233.40000,221.73000,Amish/Mennonite,Amish Mennonite,90,128.37,,,,,,,128.37,226.40,percent of total billed charges,
"POSACONAZOLE, SERUM (POSA) SO",82209,CDM,300,RC,80187,CPT,,,facility,outpatient,,,233.40000,221.73000,Amish/Mennonite,Amish Mennonite,90,128.37,,,,,,,21.69,226.40,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,Amish/Mennonite,Amish Mennonite,90,183.59,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (SLL) (BILL ONLY) SO",82210,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,Amish/Mennonite,Amish Mennonite,90,183.59,,,,,,,166.90,19453.17,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,inpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,90,42.35,,,,,,,42.35,74.69,percent of total billed charges,
POLLOCK WHITE (POLLACHIUS VIRENS) IGE SO,82211,CDM,300,RC,86003,CPT,,,facility,outpatient,,,77.00000,73.15000,Amish/Mennonite,Amish Mennonite,90,42.35,,,,,,,4.57,271.65,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,inpatient,,,120.70000,114.66000,Amish/Mennonite,Amish Mennonite,,66.39,,,,,,,66.39,117.08,percent of total billed charges,
"PHENYLALANINE AND TYROSINE, PLASMA(PKU) SO",82212,CDM,300,RC,84510,CPT,,,facility,outpatient,,,120.70000,114.66000,Amish/Mennonite,Amish Mennonite,,66.39,,,,,,,10.63,543.22,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,inpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,90,443.30,,,,,,,443.30,781.82,percent of total billed charges,
"POLYCYTHEMIA VERA, JAK2 V617F WITH REFLEX TO JAK2 EXON 12-15, SEQUENCING FOR ERYTHROCYTOSIS, VARIES SO",82214,CDM,310,RC,81270,CPT,,,facility,outpatient,,,806.00000,765.70000,Amish/Mennonite,Amish Mennonite,90,443.30,,,,,,,94.71,4787.38,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,inpatient,,,569.00000,540.55000,Amish/Mennonite,Amish Mennonite,,312.95,,,,,,,312.95,551.93,percent of total billed charges,
PROSTAGLANDIN D2 (FPGD2) SO,82215,CDM,300,RC,84999,CPT,,,facility,outpatient,,,569.00000,540.55000,Amish/Mennonite,Amish Mennonite,,312.95,,,,,,,284.50,551.93,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2393.00000,2273.35000,Amish/Mennonite,Amish Mennonite,90,1316.15,,,,,,,1316.15,2321.21,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81406, VARIES SO",82216,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2393.00000,2273.35000,Amish/Mennonite,Amish Mennonite,90,1316.15,,,,,,,282.88,13309.69,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,inpatient,,,252.90000,240.26000,Amish/Mennonite,Amish Mennonite,90,139.09,,,,,,,139.09,245.31,percent of total billed charges,
MASS SPECTRMETRY (BILL ONLY) SO,82217,CDM,300,RC,82542,CPT,,,facility,outpatient,,,252.90000,240.26000,Amish/Mennonite,Amish Mennonite,90,139.09,,,,,,,24.89,1137.41,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE 1, IMMUNOBLOT, SPINAL FLUID SO",82218,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 2 (PCA-2), SERUM SO",82219,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,12.45,1539.22,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,inpatient,,,333.80000,317.11000,Amish/Mennonite,Amish Mennonite,90,183.59,,,,,,,183.59,323.79,percent of total billed charges,
"PROBE, EACH ADDITIONAL (TLYM) (BILL ONLY) SO",82220,CDM,310,RC,88377,CPT,,,facility,outpatient,,,333.80000,317.11000,Amish/Mennonite,Amish Mennonite,90,183.59,,,,,,,166.90,19453.17,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,inpatient,,,590.40000,560.88000,Amish/Mennonite,Amish Mennonite,90,324.72,,,,,,,324.72,572.69,percent of total billed charges,
PNEUMOCOCCAL AB PANEL (23 SEROTYPE) (401835P) SO,82221,CDM,300,RC,86581,CPT,,,facility,outpatient,,,590.40000,560.88000,Amish/Mennonite,Amish Mennonite,90,324.72,,,,,,,295.20,572.69,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,inpatient,,,4864.00000,4620.80000,Amish/Mennonite,Amish Mennonite,90,2675.20,,,,,,,2675.20,4718.08,percent of total billed charges,
"MELANOMA,NEXTGEN,TUMOR (MELP) SO",82222,CDM,310,RC,81445,CPT,,,facility,outpatient,,,4864.00000,4620.80000,Amish/Mennonite,Amish Mennonite,90,2675.20,,,,,,,597.91,28130.22,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,inpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,290.40,512.16,percent of total billed charges,
"NEURONAL INTERMEDIATE FILAMENT LIGHT CHAIN, CELL BINDING ASSAY, SPINAL FLUID SO",82224,CDM,300,RC,86255,CPT,,,facility,outpatient,,,528.00000,501.60000,Amish/Mennonite,Amish Mennonite,90,290.40,,,,,,,12.45,1539.22,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,inpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,135.85,239.59,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY-TYPE TR, IMMUNOBLOT, SPINAL FLUID SO",82227,CDM,301,RC,84182,CPT,,,facility,outpatient,,,247.00000,234.65000,Amish/Mennonite,Amish Mennonite,90,135.85,,,,,,,25.31,2286.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,inpatient,,,934.00000,887.30000,Amish/Mennonite,Amish Mennonite,,513.70,,,,,,,513.70,905.98,percent of total billed charges,
"RAS/RAF TARGETED GENE PNEL, TUMOR (RASFP) SO",82228,CDM,310,RC,88381,CPT,,,facility,outpatient,,,934.00000,887.30000,Amish/Mennonite,Amish Mennonite,,513.70,,,,,,,467.00,8610.62,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,inpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,,785.40,,,,,,,785.40,1385.16,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) SO",82229,CDM,310,RC,81210,CPT,,,facility,outpatient,,,1428.00000,1356.60000,Amish/Mennonite,Amish Mennonite,,785.40,,,,,,,143.40,8250.66,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,99.66,175.76,percent of total billed charges,
"PROBE, EACH ADDITIONAL (CLLDF) (BILL ONLY) 88271SO",82230,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,20.36,1120.45,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,inpatient,,,250.50000,237.98000,Amish/Mennonite,Amish Mennonite,90,137.78,,,,,,,137.78,242.99,percent of total billed charges,
"PROTOPORPHYRINS, FRACTIONATION, WHOLE BLOOD SO",82232,CDM,300,RC,82542,CPT,,,facility,outpatient,,,250.50000,237.98000,Amish/Mennonite,Amish Mennonite,90,137.78,,,,,,,24.89,1137.41,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,inpatient,,,220.90000,209.85000,Amish/Mennonite,Amish Mennonite,90,121.50,,,,,,,121.50,214.27,percent of total billed charges,
"ORGANISM REFERRED FOR IDENTIFICATION, AEROBIC BACTERIA SO",82233,CDM,300,RC,87077,CPT,,,facility,outpatient,,,220.90000,209.85000,Amish/Mennonite,Amish Mennonite,90,121.50,,,,,,,8.35,424.40,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,inpatient,,,7612.00000,7231.40000,Amish/Mennonite,Amish Mennonite,90,4186.60,,,,,,,4186.60,7383.64,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS,VARIES SO",82234,CDM,310,RC,81228,CPT,,,facility,outpatient,,,7612.00000,7231.40000,Amish/Mennonite,Amish Mennonite,90,4186.60,,,,,,,516.91,42339.61,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,inpatient,,,2501.00000,2375.95000,Amish/Mennonite,Amish Mennonite,90,1375.55,,,,,,,1375.55,2425.97,percent of total billed charges,
"POSTMORTEM NOONAN AND RELATED PANEL 81311, VARIES SO",82235,CDM,310,RC,81311,CPT,,,facility,outpatient,,,2501.00000,2375.95000,Amish/Mennonite,Amish Mennonite,90,1375.55,,,,,,,175.10,13920.84,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,inpatient,,,27.00000,25.65000,Amish/Mennonite,Amish Mennonite,,14.85,,,,,,,14.85,26.19,percent of total billed charges,
"RHC URINE, DIPSTICK ONLY",82236,CDM,300,RC,81003,CPT,,,facility,outpatient,,,27.00000,25.65000,Amish/Mennonite,Amish Mennonite,,14.85,,,,,,,2.25,118.82,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,inpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,179.03,315.74,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE TR, SERUM SO",82237,CDM,300,RC,86255,CPT,,,facility,outpatient,,,325.50000,309.22000,Amish/Mennonite,Amish Mennonite,90,179.03,,,,,,,12.45,1539.22,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,inpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,QW,19.25,,,,,,,19.25,33.95,percent of total billed charges,
RAPID STREP ANTIGEN-POINT OF CARE (RICE LAKE),82238,CDM,300,RC,87880,CPT,,,facility,outpatient,,,35.00000,33.25000,Amish/Mennonite,Amish Mennonite,QW,19.25,,,,,,,16.53,780.94,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,inpatient,,,96.60000,91.77000,Amish/Mennonite,Amish Mennonite,90,53.13,,,,,,,53.13,93.70,percent of total billed charges,
RISPERIDONE + METAB SO,82239,CDM,300,RC,80342,CPT,,,facility,outpatient,,,96.60000,91.77000,Amish/Mennonite,Amish Mennonite,90,53.13,,,,,,,48.30,1137.41,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,inpatient,,,263.80000,250.61000,Amish/Mennonite,Amish Mennonite,90,145.09,,,,,,,145.09,255.89,percent of total billed charges,
"PROF-CHROMOSOME ANALYSIS, AMNIOTIC FLUID (CHRAF) SO",82240,CDM,310,RC,81291,CPT,,,facility,outpatient,,,263.80000,250.61000,Amish/Mennonite,Amish Mennonite,90,145.09,,,,,,,131.90,3072.74,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,inpatient,,,37.10000,35.24000,Amish/Mennonite,Amish Mennonite,90,20.41,,,,,,,20.41,35.99,percent of total billed charges,
"RAPID PLASMA REAGIN TITER, SERUM SO",82241,CDM,300,RC,86593,CPT,,,facility,outpatient,,,37.10000,35.24000,Amish/Mennonite,Amish Mennonite,90,20.41,,,,,,,4.55,237.65,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,inpatient,,,233.70000,222.01000,Amish/Mennonite,Amish Mennonite,,128.53,,,,,,,128.53,226.69,percent of total billed charges,
"PREGNENOLONE, SERUM (PREGN) SO",82242,CDM,300,RC,84140,CPT,,,facility,outpatient,,,233.70000,222.01000,Amish/Mennonite,Amish Mennonite,,128.53,,,,,,,20.67,1086.52,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,inpatient,,,1574.00000,1495.30000,Amish/Mennonite,Amish Mennonite,,865.70,,,,,,,865.70,1526.78,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR(RASFP) SO",82243,CDM,310,RC,81275,CPT,,,facility,outpatient,,,1574.00000,1495.30000,Amish/Mennonite,Amish Mennonite,,865.70,,,,,,,157.98,9082.50,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,inpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,69.85,123.19,percent of total billed charges,
"SEMEN, QUALITATIVE",82245,CDM,300,RC,83921,CPT,,,facility,outpatient,,,127.00000,120.65000,Amish/Mennonite,Amish Mennonite,,69.85,,,,,,,21.21,1001.63,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,inpatient,,,291.20000,276.64000,Amish/Mennonite,Amish Mennonite,,160.16,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGETED GENE PANL, TUMOR (RASFP) SO",82247,CDM,310,RC,81311,CPT,,,facility,outpatient,,,291.20000,276.64000,Amish/Mennonite,Amish Mennonite,,160.16,,,,,,,145.60,13920.84,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,inpatient,,,853.00000,810.35000,Amish/Mennonite,Amish Mennonite,TC,469.15,,,,,,,469.15,827.41,percent of total billed charges,
"RAS/RAF TARGETED GENE PANEL, TUMOR (RASFP) TECH",82248,CDM,310,RC,88381,CPT,,,facility,outpatient,,,853.00000,810.35000,Amish/Mennonite,Amish Mennonite,TC,469.15,,,,,,,426.50,7351.18,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,inpatient,,,291.20000,276.64000,Amish/Mennonite,Amish Mennonite,,160.16,,,,,,,160.16,282.46,percent of total billed charges,
"RAS/RAF TARGTED GENE PANEL, TUMOR (RASFP) SO",82249,CDM,310,RC,81403,CPT,,,facility,outpatient,,,291.20000,276.64000,Amish/Mennonite,Amish Mennonite,,160.16,,,,,,,145.60,8708.99,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,inpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,,14.30,,,,,,,14.30,25.22,percent of total billed charges,
RHC HEMOGLOBIN,82250,CDM,300,RC,85018,CPT,,,facility,outpatient,,,26.00000,24.70000,Amish/Mennonite,Amish Mennonite,,14.30,,,,,,,2.37,118.82,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,inpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CREATININE SO,82251,CDM,300,RC,82570,CPT,,,facility,outpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,5.35,271.65,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,inpatient,,,3526.00000,3349.70000,Amish/Mennonite,Amish Mennonite,90,1939.30,,,,,,,1939.30,3420.22,percent of total billed charges,
"RESPIRATORY PANEL, PCR (RP) SO",82252,CDM,310,RC,0202U,HCPCS,,,facility,outpatient,,,3526.00000,3349.70000,Amish/Mennonite,Amish Mennonite,90,1939.30,,,,,,,1458.73,3420.22,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,inpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK CALCIUM SO,82253,CDM,300,RC,82340,CPT,,,facility,outpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,6.23,322.54,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,inpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,13.20,23.28,percent of total billed charges,
RHC GLUCOSE,82254,CDM,300,RC,82962,CPT,,,facility,outpatient,,,24.00000,22.80000,Amish/Mennonite,Amish Mennonite,,13.20,,,,,,,3.28,152.82,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,inpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,114.02,201.08,percent of total billed charges,
"RNA POLYMERASE III ANTIBODIES, IGG, SERUM (RNAP) SO",82255,CDM,300,RC,83516,CPT,,,facility,outpatient,,,207.30000,196.94000,Amish/Mennonite,Amish Mennonite,90,114.02,,,,,,,11.91,594.19,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,inpatient,,,98.10000,93.19000,Amish/Mennonite,Amish Mennonite,90,53.95,,,,,,,53.95,95.16,percent of total billed charges,
T4 FREE E500314 SO,82256,CDM,300,RC,84439,CPT,,,facility,outpatient,,,98.10000,93.19000,Amish/Mennonite,Amish Mennonite,90,53.95,,,,,,,9.32,475.37,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,inpatient,,,283.60000,269.42000,Amish/Mennonite,Amish Mennonite,,155.98,,,,,,,155.98,275.09,percent of total billed charges,
"ROS1 (6Q22) REARRANGEMENT, FISH, TISSUE (ROS1F) SO",82257,CDM,310,RC,88271,CPT,,,facility,outpatient,,,283.60000,269.42000,Amish/Mennonite,Amish Mennonite,,155.98,,,,,,,20.36,1120.45,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,inpatient,,,438.90000,416.96000,Amish/Mennonite,Amish Mennonite,,241.40,,,,,,,241.40,425.73,percent of total billed charges,
"RETINOL BINDING PROTEIN, URINE (RRBP) SO",82258,CDM,300,RC,84999,CPT,,,facility,outpatient,,,438.90000,416.96000,Amish/Mennonite,Amish Mennonite,,241.40,,,,,,,219.45,425.73,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,inpatient,,,123.40000,117.23000,Amish/Mennonite,Amish Mennonite,90,67.87,,,,,,,67.87,119.70,percent of total billed charges,
STONE RISK URIC CITRATE SO,82259,CDM,300,RC,82507,CPT,,,facility,outpatient,,,123.40000,117.23000,Amish/Mennonite,Amish Mennonite,90,67.87,,,,,,,28.73,1459.96,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,inpatient,,,12.10000,11.49000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.66,11.74,percent of total billed charges,
OM SCREENING URINE DIPSTICK,82260,CDM,300,RC,99199,CPT,,,facility,outpatient,,,12.10000,11.49000,Amish/Mennonite,Amish Mennonite,,6.66,,,,,,,6.05,11.74,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,inpatient,,,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,90,30.86,,,,,,,30.86,54.42,percent of total billed charges,
SUSCEPTIBILITY (BILL ONLY) SO,82261,CDM,300,RC,87181,CPT,,,facility,outpatient,,,56.10000,53.30000,Amish/Mennonite,Amish Mennonite,90,30.86,,,,,,,4.91,254.68,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,inpatient,,,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,90,27.11,,,,,,,27.11,47.82,percent of total billed charges,
STONE RISK SULFATE SO,82262,CDM,300,RC,84392,CPT,,,facility,outpatient,,,49.30000,46.83000,Amish/Mennonite,Amish Mennonite,90,27.11,,,,,,,5.67,254.68,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,inpatient,,,320.60000,304.57000,Amish/Mennonite,Amish Mennonite,90,176.33,,,,,,,176.33,310.98,percent of total billed charges,
"THYROGLOBULIN MASS SPECTROMETRY, SERUM (TGMS) SO",82263,CDM,301,RC,84432,CPT,,,facility,outpatient,,,320.60000,304.57000,Amish/Mennonite,Amish Mennonite,90,176.33,,,,,,,16.59,831.84,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,inpatient,,,61.80000,58.71000,Amish/Mennonite,Amish Mennonite,90,33.99,,,,,,,33.99,59.95,percent of total billed charges,
URINE S-SULFOCYSTEINE 82570 SO,82264,CDM,300,RC,82570,CPT,,,facility,outpatient,,,61.80000,58.71000,Amish/Mennonite,Amish Mennonite,90,33.99,,,,,,,5.35,271.65,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,inpatient,,,116.30000,110.48000,Amish/Mennonite,Amish Mennonite,90,63.97,,,,,,,63.97,112.81,percent of total billed charges,
SERTRALINE SO,82265,CDM,300,RC,80332,CPT,,,facility,outpatient,,,116.30000,110.48000,Amish/Mennonite,Amish Mennonite,90,63.97,,,,,,,58.15,1137.41,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,inpatient,,,425.70000,404.41000,Amish/Mennonite,Amish Mennonite,90,234.13,,,,,,,234.13,412.93,percent of total billed charges,
"STEROLS, 7-DEHYDROCHOLESTEROL SO",82267,CDM,300,RC,82542,CPT,,,facility,outpatient,,,425.70000,404.41000,Amish/Mennonite,Amish Mennonite,90,234.13,,,,,,,24.89,1137.41,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,inpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,90,59.95,,,,,,,59.95,105.73,percent of total billed charges,
"VARICELLA-ZOSTER AB, IGM AND IGG SO",82268,CDM,300,RC,86787,CPT,,,facility,outpatient,,,109.00000,103.55000,Amish/Mennonite,Amish Mennonite,90,59.95,,,,,,,8.17,679.08,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,inpatient,,,75.10000,71.34000,Amish/Mennonite,Amish Mennonite,90,41.30,,,,,,,41.30,72.85,percent of total billed charges,
"SUSCEPTIBILITY, MIC (BILL ONLY) SO",82269,CDM,300,RC,87186,CPT,,,facility,outpatient,,,75.10000,71.34000,Amish/Mennonite,Amish Mennonite,90,41.30,,,,,,,8.94,458.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,inpatient,,,1479.00000,1405.05000,Amish/Mennonite,Amish Mennonite,TC,813.45,,,,,,,813.45,1434.63,percent of total billed charges,
TELETHERAPY ISODOSE PLAN SMPL-TECH,8227,CDM,333,RC,77306,CPT,,,facility,outpatient,,,1479.00000,1405.05000,Amish/Mennonite,Amish Mennonite,TC,813.45,,,,,,,401.07,4167.07,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,inpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,90,84.15,,,,,,,84.15,148.41,percent of total billed charges,
"RAPID PLASMA REAGIN SCREEN RESPONSE TO THERAPY, SERUM SO",82270,CDM,310,RC,0065U,HCPCS,,,facility,outpatient,,,153.00000,145.35000,Amish/Mennonite,Amish Mennonite,90,84.15,,,,,,,63.32,148.41,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,inpatient,,,49.70000,47.22000,Amish/Mennonite,Amish Mennonite,90,27.34,,,,,,,27.34,48.21,percent of total billed charges,
TISSUE PROCESSING (BILL ONLY) SO,82271,CDM,300,RC,87176,CPT,,,facility,outpatient,,,49.70000,47.22000,Amish/Mennonite,Amish Mennonite,90,27.34,,,,,,,6.08,305.58,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,inpatient,,,59.50000,56.52000,Amish/Mennonite,Amish Mennonite,90,32.73,,,,,,,32.73,57.72,percent of total billed charges,
STONE RISK OXALATE SO,82272,CDM,300,RC,83945,CPT,,,facility,outpatient,,,59.50000,56.52000,Amish/Mennonite,Amish Mennonite,90,32.73,,,,,,,14.93,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,inpatient,,,271.50000,257.92000,Amish/Mennonite,Amish Mennonite,90,149.32,,,,,,,149.32,263.36,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), CHILDREN'S ONCOLOGY GROUP ENROLLMENT TESTING, FISH, VARIES SO",82273,CDM,310,RC,88271,CPT,,,facility,outpatient,,,271.50000,257.92000,Amish/Mennonite,Amish Mennonite,90,149.32,,,,,,,20.36,1120.45,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,inpatient,,,292.10000,277.50000,Amish/Mennonite,Amish Mennonite,90,160.66,,,,,,,160.66,283.34,percent of total billed charges,
"PURINES AND PYRIMIDINES PANEL, URINE SO",82274,CDM,300,RC,82542,CPT,,,facility,outpatient,,,292.10000,277.50000,Amish/Mennonite,Amish Mennonite,90,160.66,,,,,,,24.89,1137.41,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,inpatient,,,903.00000,857.85000,Amish/Mennonite,Amish Mennonite,90,496.65,,,,,,,496.65,875.91,percent of total billed charges,
"ZINC TRANSPORTER 8 (ZNT8) ANTIBODY, SERUM SO",82275,CDM,300,RC,86341,CPT,,,facility,outpatient,,,903.00000,857.85000,Amish/Mennonite,Amish Mennonite,90,496.65,,,,,,,19.88,1103.49,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,inpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,90,43.34,,,,,,,43.34,76.44,percent of total billed charges,
WST NILE-SLH SO,82276,CDM,300,RC,86788,CPT,,,facility,outpatient,,,78.80000,74.86000,Amish/Mennonite,Amish Mennonite,90,43.34,,,,,,,8.17,882.80,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,inpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK SODIUM SO,82277,CDM,300,RC,84300,CPT,,,facility,outpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,5.23,254.68,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,inpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,137.72,242.89,percent of total billed charges,
SUSCEPTIBILITY NOCARDIA SPECIES (BILL ONLY) SO,82278,CDM,300,RC,87186,CPT,,,facility,outpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,inpatient,,,59.40000,56.43000,Amish/Mennonite,Amish Mennonite,90,32.67,,,,,,,32.67,57.62,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82570 SO,82279,CDM,300,RC,82570,CPT,,,facility,outpatient,,,59.40000,56.43000,Amish/Mennonite,Amish Mennonite,90,32.67,,,,,,,5.35,271.65,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,inpatient,,,179.50000,170.52000,Amish/Mennonite,Amish Mennonite,90,98.72,,,,,,,98.72,174.12,percent of total billed charges,
"THIAMINE (VITAMIN B1), WHOLE BLOOD SO",82280,CDM,301,RC,84425,CPT,,,facility,outpatient,,,179.50000,170.52000,Amish/Mennonite,Amish Mennonite,90,98.72,,,,,,,21.94,1103.49,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,inpatient,,,2812.00000,2671.40000,Amish/Mennonite,Amish Mennonite,,1546.60,,,,,,,1546.60,2727.64,percent of total billed charges,
WILSON DISEASE FULL GENE (WDZ) SO,82281,CDM,310,RC,81406,CPT,,,facility,outpatient,,,2812.00000,2671.40000,Amish/Mennonite,Amish Mennonite,,1546.60,,,,,,,282.88,13309.69,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,inpatient,,,319.30000,303.34000,Amish/Mennonite,Amish Mennonite,90,175.62,,,,,,,175.62,309.72,percent of total billed charges,
SUSCEPTIBILITY SLOW GROWER (BILL ONLY) SO,82282,CDM,300,RC,87186,CPT,,,facility,outpatient,,,319.30000,303.34000,Amish/Mennonite,Amish Mennonite,90,175.62,,,,,,,8.94,458.40,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,inpatient,,,93.60000,88.92000,Amish/Mennonite,Amish Mennonite,90,51.48,,,,,,,51.48,90.79,percent of total billed charges,
TILAPIA IGE SO,82283,CDM,300,RC,86003,CPT,,,facility,outpatient,,,93.60000,88.92000,Amish/Mennonite,Amish Mennonite,90,51.48,,,,,,,4.57,271.65,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,inpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK PHOSPHOROUS SO,82284,CDM,300,RC,84105,CPT,,,facility,outpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,5.97,271.65,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,Amish/Mennonite,Amish Mennonite,90,81.84,,,,,,,81.84,144.34,percent of total billed charges,
"VENLAFAXINE, SERUM (VENLA) SO",82285,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,Amish/Mennonite,Amish Mennonite,90,81.84,,,,,,,19.26,882.80,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,inpatient,,,5074.00000,4820.30000,Amish/Mennonite,Amish Mennonite,90,2790.70,,,,,,,2790.70,4921.78,percent of total billed charges,
"PTEN GENE, FULL GENE ANALYSIS, VARIES SO",82286,CDM,310,RC,81321,CPT,,,facility,outpatient,,,5074.00000,4820.30000,Amish/Mennonite,Amish Mennonite,90,2790.70,,,,,,,480.56,28232.08,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,inpatient,,,78.90000,74.96000,Amish/Mennonite,Amish Mennonite,90,43.40,,,,,,,43.40,76.53,percent of total billed charges,
SYN CANN SCR MTOX19216 SO,82287,CDM,300,RC,80307,CPT,,,facility,outpatient,,,78.90000,74.96000,Amish/Mennonite,Amish Mennonite,90,43.40,,,,,,,39.45,3038.81,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,inpatient,,,57.70000,54.81000,Amish/Mennonite,Amish Mennonite,90,31.73,,,,,,,31.73,55.97,percent of total billed charges,
STONE RISK AMMONIUM SO,82288,CDM,300,RC,82140,CPT,,,facility,outpatient,,,57.70000,54.81000,Amish/Mennonite,Amish Mennonite,90,31.73,,,,,,,15.06,763.98,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,inpatient,,,210.20000,199.69000,Amish/Mennonite,Amish Mennonite,90,115.61,,,,,,,115.61,203.89,percent of total billed charges,
"TOXOCARA ANTIBODY, IGG, SERUM SO",82289,CDM,300,RC,86682,CPT,,,facility,outpatient,,,210.20000,199.69000,Amish/Mennonite,Amish Mennonite,90,115.61,,,,,,,8.17,679.08,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,inpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,99.66,175.76,percent of total billed charges,
"T-CELL ACUTE LYMPHOBLASTIC LEUKEMIA (T-ALL), FISH, VARIES SO",82290,CDM,310,RC,88271,CPT,,,facility,outpatient,,,181.20000,172.14000,Amish/Mennonite,Amish Mennonite,90,99.66,,,,,,,20.36,1120.45,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,inpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,29.15,51.41,percent of total billed charges,
WET PREP,82291,CDM,300,RC,Q0111,HCPCS,,,facility,outpatient,,,53.00000,50.35000,Amish/Mennonite,Amish Mennonite,,29.15,,,,,,,5.87,113.69,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,inpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,90,124.85,,,,,,,124.85,220.19,percent of total billed charges,
"TESTOSTERONE, TOTAL, MASS SPECTROMETRY, SERUM SO",82292,CDM,301,RC,84403,CPT,,,facility,outpatient,,,227.00000,215.65000,Amish/Mennonite,Amish Mennonite,90,124.85,,,,,,,26.67,1341.13,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,inpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,53.52,94.38,percent of total billed charges,
TURMERIC (CURCUMA LONGA) IGE SO,82293,CDM,300,RC,86003,CPT,,,facility,outpatient,,,97.30000,92.43000,Amish/Mennonite,Amish Mennonite,90,53.52,,,,,,,4.57,271.65,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,inpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,90,111.38,,,,,,,111.38,196.43,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING,VARIES SO",82294,CDM,310,RC,88185,CPT,,,facility,outpatient,,,202.50000,192.38000,Amish/Mennonite,Amish Mennonite,90,111.38,,,,,,,77.53,1052.52,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,inpatient,,,141.20000,134.14000,Amish/Mennonite,Amish Mennonite,90,77.66,,,,,,,77.66,136.96,percent of total billed charges,
"SCHISTOSOMA AB, IGG, (BILHA) SO",82295,CDM,300,RC,86682,CPT,,,facility,outpatient,,,141.20000,134.14000,Amish/Mennonite,Amish Mennonite,90,77.66,,,,,,,8.17,679.08,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,inpatient,,,637.00000,605.15000,Amish/Mennonite,Amish Mennonite,,350.35,,,,,,,350.35,617.89,percent of total billed charges,
VAGINAL PH,82296,CDM,300,RC,84112,CPT,,,facility,outpatient,,,637.00000,605.15000,Amish/Mennonite,Amish Mennonite,,350.35,,,,,,,90.57,4617.66,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,inpatient,,,31.30000,29.74000,Amish/Mennonite,Amish Mennonite,90,17.21,,,,,,,17.21,30.36,percent of total billed charges,
WEAKRHD WKUP SO,82297,CDM,300,RC,86901,CPT,,,facility,outpatient,,,31.30000,29.74000,Amish/Mennonite,Amish Mennonite,90,17.21,,,,,,,3.09,152.82,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,inpatient,,,576.00000,547.20000,Amish/Mennonite,Amish Mennonite,90,316.80,,,,,,,316.80,558.72,percent of total billed charges,
WEAK RHD WKUP SO,82298,CDM,310,RC,81479,CPT,,,facility,outpatient,,,576.00000,547.20000,Amish/Mennonite,Amish Mennonite,90,316.80,,,,,,,288.00,558.72,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,inpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,30.25,53.35,percent of total billed charges,
SWEAT CHLORIDE,82299,CDM,300,RC,82438,CPT,,,facility,outpatient,,,55.00000,52.25000,Amish/Mennonite,Amish Mennonite,,30.25,,,,,,,5.00,254.68,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,inpatient,,,248.90000,236.45000,Amish/Mennonite,Amish Mennonite,90,136.90,,,,,,,136.90,241.43,percent of total billed charges,
"VASCULAR ENDOTHELIAL GROWTH FACTOR, PLASMA (VEGF) SO",82300,CDM,300,RC,83520,CPT,,,facility,outpatient,,,248.90000,236.45000,Amish/Mennonite,Amish Mennonite,90,136.90,,,,,,,17.85,814.87,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,inpatient,,,329.50000,313.02000,Amish/Mennonite,Amish Mennonite,90,181.22,,,,,,,181.22,319.62,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER REFLEX, SERUM SO",82301,CDM,300,RC,86800,CPT,,,facility,outpatient,,,329.50000,313.02000,Amish/Mennonite,Amish Mennonite,90,181.22,,,,,,,16.44,831.84,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,inpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,57.20,100.88,percent of total billed charges,
SMOOTH MUSCLE ACTIN TITER,82302,CDM,300,RC,86256,CPT,,,facility,outpatient,,,104.00000,98.80000,Amish/Mennonite,Amish Mennonite,,57.20,,,,,,,12.05,1539.22,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,inpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,90,338.25,,,,,,,338.25,596.55,percent of total billed charges,
"TP53 GENE SOMATIC MUTATION PRE-ANALYSIS CELL SORTING, VARIES SO",82303,CDM,310,RC,88184,CPT,,,facility,outpatient,,,615.00000,584.25000,Amish/Mennonite,Amish Mennonite,90,338.25,,,,,,,307.50,3186.14,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,inpatient,,,86.90000,82.56000,Amish/Mennonite,Amish Mennonite,90,47.80,,,,,,,47.80,84.29,percent of total billed charges,
T3 REVERSE (RT3) SO,82304,CDM,300,RC,84482,CPT,,,facility,outpatient,,,86.90000,82.56000,Amish/Mennonite,Amish Mennonite,90,47.80,,,,,,,10.82,831.84,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,inpatient,,,2362.00000,2243.90000,Amish/Mennonite,Amish Mennonite,,1299.10,,,,,,,1299.10,2291.14,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD (TCGR) SO",82305,CDM,310,RC,81340,CPT,,,facility,outpatient,,,2362.00000,2243.90000,Amish/Mennonite,Amish Mennonite,,1299.10,,,,,,,208.92,10915.96,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,inpatient,,,238.40000,226.48000,Amish/Mennonite,Amish Mennonite,90,131.12,,,,,,,131.12,231.25,percent of total billed charges,
"TIAGABINE (GABITRIL), SERUM SO",82306,CDM,301,RC,80199,CPT,,,facility,outpatient,,,238.40000,226.48000,Amish/Mennonite,Amish Mennonite,90,131.12,,,,,,,19.70,1273.27,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,inpatient,,,253.30000,240.64000,Amish/Mennonite,Amish Mennonite,90,139.31,,,,,,,139.31,245.70,percent of total billed charges,
"SEX-DETERMINING REGION Y, YP11.3 DELETION, FISH SO",82307,CDM,310,RC,88271,CPT,,,facility,outpatient,,,253.30000,240.64000,Amish/Mennonite,Amish Mennonite,90,139.31,,,,,,,20.36,1120.45,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,inpatient,,,1837.00000,1745.15000,Amish/Mennonite,Amish Mennonite,90,1010.35,,,,,,,1010.35,1781.89,percent of total billed charges,
"TERT PROMOTER, TUMOR (TERT) SO",82308,CDM,310,RC,81345,CPT,,,facility,outpatient,,,1837.00000,1745.15000,Amish/Mennonite,Amish Mennonite,90,1010.35,,,,,,,648.20,8708.99,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,inpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,90,9.90,,,,,,,9.90,17.46,percent of total billed charges,
STONE RISK URIC PH SO,82309,CDM,300,RC,83986,CPT,,,facility,outpatient,,,18.00000,17.10000,Amish/Mennonite,Amish Mennonite,90,9.90,,,,,,,3.70,186.75,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,inpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK MAGNESIUM SO,82310,CDM,300,RC,83735,CPT,,,facility,outpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,6.92,356.54,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,inpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,41.80,73.72,percent of total billed charges,
"RHC PREGNANCY, QUAL-URINE",82311,CDM,300,RC,81025,CPT,,,facility,outpatient,,,76.00000,72.20000,Amish/Mennonite,Amish Mennonite,,41.80,,,,,,,8.61,407.44,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,inpatient,,,155.80000,148.01000,Amish/Mennonite,Amish Mennonite,90,85.69,,,,,,,85.69,151.13,percent of total billed charges,
"PURKINJE CELL CYTOPLASMIC ANTIBODY, TYPE 1 (PCA-1), SERUM SO",82312,CDM,300,RC,86255,CPT,,,facility,outpatient,,,155.80000,148.01000,Amish/Mennonite,Amish Mennonite,90,85.69,,,,,,,12.45,1539.22,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,inpatient,,,111.90000,106.31000,Amish/Mennonite,Amish Mennonite,90,61.55,,,,,,,61.55,108.54,percent of total billed charges,
SYPHILIS TOTAL ANTIBODY BILL ONLY 1 (BILL ONLY) SO,82313,CDM,300,RC,86780,CPT,,,facility,outpatient,,,111.90000,106.31000,Amish/Mennonite,Amish Mennonite,90,61.55,,,,,,,11.13,696.05,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,inpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,28.60,50.44,percent of total billed charges,
SWEAT CHLORIDE COLLECTION,82315,CDM,300,RC,89230,CPT,,,facility,outpatient,,,52.00000,49.40000,Amish/Mennonite,Amish Mennonite,,28.60,,,,,,,10.42,177.63,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,inpatient,,,109.70000,104.22000,Amish/Mennonite,Amish Mennonite,90,60.34,,,,,,,60.34,106.41,percent of total billed charges,
"TROPONIN T, 5TH GENERATION, PLASMA SO",82316,CDM,301,RC,84484,CPT,,,facility,outpatient,,,109.70000,104.22000,Amish/Mennonite,Amish Mennonite,90,60.34,,,,,,,12.89,594.19,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,inpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,74.91,132.11,percent of total billed charges,
"PLATELET TRANSMISSION ELECTRON MICROSCOPIC STUDY, WHOLE BLOOD SO",82317,CDM,305,RC,85390,CPT,,,facility,outpatient,,,136.20000,129.39000,Amish/Mennonite,Amish Mennonite,90,74.91,,,,,,,7.27,2581.26,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,inpatient,,,145.60000,138.32000,Amish/Mennonite,Amish Mennonite,90,80.08,,,,,,,80.08,141.23,percent of total billed charges,
"RESPIRATORY PROFILE, REGION 7, NORTHERN MIDWEST (MI, MN, WI), SERUM SO",82318,CDM,301,RC,82785,CPT,,,facility,outpatient,,,145.60000,138.32000,Amish/Mennonite,Amish Mennonite,90,80.08,,,,,,,17.01,865.84,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,inpatient,,,165.50000,157.22000,Amish/Mennonite,Amish Mennonite,90,91.03,,,,,,,91.03,160.53,percent of total billed charges,
"VIRAL SMEAR, HELL VIAL (BILL ONLY) SO",82319,CDM,300,RC,87254,CPT,,,facility,outpatient,,,165.50000,157.22000,Amish/Mennonite,Amish Mennonite,90,91.03,,,,,,,7.06,1018.59,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,inpatient,,,273.70000,260.02000,Amish/Mennonite,Amish Mennonite,90,150.53,,,,,,,150.53,265.49,percent of total billed charges,
URINE S-SULFOCYSTEINE 82131 SO,82320,CDM,300,RC,82131,CPT,,,facility,outpatient,,,273.70000,260.02000,Amish/Mennonite,Amish Mennonite,90,150.53,,,,,,,21.01,1086.52,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,inpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,14.69,25.90,percent of total billed charges,
STONE RISK URIC ACID SO,82322,CDM,300,RC,84560,CPT,,,facility,outpatient,,,26.70000,25.36000,Amish/Mennonite,Amish Mennonite,90,14.69,,,,,,,5.25,254.68,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,inpatient,,,75.70000,71.92000,Amish/Mennonite,Amish Mennonite,90,41.63,,,,,,,41.63,73.43,percent of total billed charges,
"TRAZODONE, S/P SO",82323,CDM,300,RC,80338,CPT,,,facility,outpatient,,,75.70000,71.92000,Amish/Mennonite,Amish Mennonite,90,41.63,,,,,,,37.85,73.43,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,inpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,12.81,22.60,percent of total billed charges,
STONE RISK POTASSIUM SO,82324,CDM,300,RC,84133,CPT,,,facility,outpatient,,,23.30000,22.13000,Amish/Mennonite,Amish Mennonite,90,12.81,,,,,,,4.89,220.68,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,inpatient,,,318.30000,302.38000,Amish/Mennonite,Amish Mennonite,90,175.06,,,,,,,175.06,308.75,percent of total billed charges,
"THYROGLOBULIN, TUMOR MARKER BY IMMUNOASSAY, SERUM SO",82325,CDM,301,RC,84432,CPT,,,facility,outpatient,,,318.30000,302.38000,Amish/Mennonite,Amish Mennonite,90,175.06,,,,,,,16.59,831.84,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,inpatient,,,128.00000,121.60000,Amish/Mennonite,Amish Mennonite,90,70.40,,,,,,,70.40,124.16,percent of total billed charges,
"THYROPEROXIDASE ANTIBODIES, SERUM (TPO) SO",82326,CDM,300,RC,86376,CPT,,,facility,outpatient,,,128.00000,121.60000,Amish/Mennonite,Amish Mennonite,90,70.40,,,,,,,15.03,763.98,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,inpatient,,,148.80000,141.36000,Amish/Mennonite,Amish Mennonite,,81.84,,,,,,,81.84,144.34,percent of total billed charges,
"SULFAMETHOXAZOLE, SERUM (SFZ) SO",82327,CDM,300,RC,80299,CPT,,,facility,outpatient,,,148.80000,141.36000,Amish/Mennonite,Amish Mennonite,,81.84,,,,,,,18.64,882.80,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,inpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,,1252.90,,,,,,,1252.90,2209.66,percent of total billed charges,
"T-CELL RECEPTOR GENE REARRANGE, BLD(TCGR) SO",82329,CDM,310,RC,81342,CPT,,,facility,outpatient,,,2278.00000,2164.10000,Amish/Mennonite,Amish Mennonite,,1252.90,,,,,,,201.50,10525.49,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,inpatient,,,4578.00000,4349.10000,Amish/Mennonite,Amish Mennonite,TC,2517.90,,,,,,,2517.90,4440.66,percent of total billed charges,
UROVYSION FOR BLADDER CANCER DETECTION (FUROC) TECH,82330,CDM,310,RC,88120,CPT,,,facility,outpatient,,,4578.00000,4349.10000,Amish/Mennonite,Amish Mennonite,TC,2517.90,,,,,,,533.12,24865.24,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,inpatient,,,144.40000,137.18000,Amish/Mennonite,Amish Mennonite,90,79.42,,,,,,,79.42,140.07,percent of total billed charges,
VITAMIN B3 NIACIN IN PLASMA SO,82331,CDM,301,RC,84591,CPT,,,facility,outpatient,,,144.40000,137.18000,Amish/Mennonite,Amish Mennonite,90,79.42,,,,,,,16.32,797.91,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,inpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,91.80,161.89,percent of total billed charges,
SUSCEPTIBILITY RAPID GROWER (BILL ONLY) SO,82333,CDM,300,RC,87186,CPT,,,facility,outpatient,,,166.90000,158.56000,Amish/Mennonite,Amish Mennonite,90,91.80,,,,,,,8.94,458.40,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,inpatient,,,276.10000,262.30000,Amish/Mennonite,Amish Mennonite,90,151.85,,,,,,,151.85,267.82,percent of total billed charges,
URINE HEX4 BIOMARKER FOR POMPE DIS HEXOSE TETRASACCHARIDE 82542 SO,82334,CDM,300,RC,82542,CPT,,,facility,outpatient,,,276.10000,262.30000,Amish/Mennonite,Amish Mennonite,90,151.85,,,,,,,24.89,1137.41,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,inpatient,,,57.20000,54.34000,Amish/Mennonite,Amish Mennonite,,31.46,,,,,,,31.46,55.48,percent of total billed charges,
B2B-FERRITIN,82335,CDM,300,RC,99199,CPT,,,facility,outpatient,,,57.20000,54.34000,Amish/Mennonite,Amish Mennonite,,31.46,,,,,,,28.60,55.48,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,inpatient,,,79.80000,75.81000,Amish/Mennonite,Amish Mennonite,,43.89,,,,,,,43.89,77.41,percent of total billed charges,
OM-SCREENING C19,82336,CDM,300,RC,84999,CPT,,,facility,outpatient,,,79.80000,75.81000,Amish/Mennonite,Amish Mennonite,,43.89,,,,,,,39.90,77.41,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,inpatient,,,398.70000,378.76000,Amish/Mennonite,Amish Mennonite,,219.28,,,,,,,219.28,386.74,percent of total billed charges,
GENERAL HEALTH PANEL TECH,82338,CDM,300,RC,80050,CPT,,,facility,outpatient,,,398.70000,378.76000,Amish/Mennonite,Amish Mennonite,,219.28,,,,,,,144.13,2223.94,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,inpatient,,,65.50000,62.22000,Amish/Mennonite,Amish Mennonite,90,36.02,,,,,,,36.02,63.53,percent of total billed charges,
AMTRIP-NORTRIP (AMTRP) SO,82342,CDM,300,RC,80299,CPT,,,facility,outpatient,,,65.50000,62.22000,Amish/Mennonite,Amish Mennonite,90,36.02,,,,,,,19.26,882.80,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,inpatient,1,GM,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.94,14.00,percent of total billed charges,
CADEXOMER IODINE TOPICAL 0.9% PAD,82343,CDM,250,RC,40565-0122-51,NDC,,,facility,outpatient,1,GM,14.43000,13.71000,Amish/Mennonite,Amish Mennonite,,7.94,,,,,,,7.21,14.00,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,inpatient,1,GM,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.61,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,00187-3204-47,NDC,,,facility,outpatient,1,GM,4.74000,4.50000,Amish/Mennonite,Amish Mennonite,,2.61,,,,,,,2.37,4.60,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,inpatient,1,GM,8.13000,7.73000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.47,7.89,percent of total billed charges,
FLUOROURACIL CREAM 5% 40 GM,82345,CDM,250,RC,51672-4118-06,NDC,,,facility,outpatient,1,GM,8.13000,7.73000,Amish/Mennonite,Amish Mennonite,,4.47,,,,,,,4.07,7.89,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,inpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.99550,1.76,percent of total billed charges,
MORPHINE CONC LIQ 20 MG/1 ML,82346,CDM,250,RC,00054-0517-44,NDC,,,facility,outpatient,1,mL,1.81000,1.72000,Amish/Mennonite,Amish Mennonite,,0.99550,,,,,,,0.90500,1.76,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,inpatient,1,mL,45.79000,43.50000,Amish/Mennonite,Amish Mennonite,,25.18,,,,,,,25.18,44.42,percent of total billed charges,
IMMUNE GLOBULIN SOLN 10% (GAMMAGARD) 1 GM,82347,CDM,636,RC,J1569,HCPCS,00944270002,NDC,facility,outpatient,1,mL,45.79000,43.50000,Amish/Mennonite,Amish Mennonite,,25.18,,,,,,,22.89,78.87,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,inpatient,1,mL,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.13,1.99,percent of total billed charges,
POTASSIUM CHLORIDE,82349,CDM,250,RC,00121-2520-00,NDC,,,facility,outpatient,1,mL,2.05000,1.95000,Amish/Mennonite,Amish Mennonite,,1.13,,,,,,,1.02,1.99,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,inpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.39600,0.69840,percent of total billed charges,
CALCIUM CARBONATE 500 MG TAB-,82350,CDM,250,RC,50268-0149-13,NDC,,,facility,outpatient,1,EA,0.72000,0.69000,Amish/Mennonite,Amish Mennonite,,0.39600,,,,,,,0.36000,0.69840,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,inpatient,1,mL,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,25.38,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,00065-0397-05,NDC,,,facility,outpatient,1,mL,46.14000,43.83000,Amish/Mennonite,Amish Mennonite,,25.38,,,,,,,23.07,44.76,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,inpatient,1,mL,24.67000,23.44000,Amish/Mennonite,Amish Mennonite,,13.57,,,,,,,13.57,23.93,percent of total billed charges,
CYCLOPENTOLATE OPHTHALMIC 2% SOLN,82351,CDM,250,RC,17478-0097-10,NDC,,,facility,outpatient,1,mL,24.67000,23.44000,Amish/Mennonite,Amish Mennonite,,13.57,,,,,,,12.34,23.93,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,inpatient,1,mL,122.89000,116.74000,Amish/Mennonite,Amish Mennonite,,67.59,,,,,,,67.59,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,00023-9321-05,NDC,,,facility,outpatient,1,mL,122.89000,116.74000,Amish/Mennonite,Amish Mennonite,,67.59,,,,,,,61.45,119.20,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,inpatient,1,mL,112.07000,106.47000,Amish/Mennonite,Amish Mennonite,,61.64,,,,,,,61.64,108.71,percent of total billed charges,
BRIMONIDINE OPHTHALMIC 0.1% SOLN,82352,CDM,250,RC,60505-0577-01,NDC,,,facility,outpatient,1,mL,112.07000,106.47000,Amish/Mennonite,Amish Mennonite,,61.64,,,,,,,56.03,108.71,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,inpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
ISOPROPYL ALCOHOL OTIC 95% LIQU,82353,CDM,250,RC,00168-0126-91,NDC,,,facility,outpatient,1,mL,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,inpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.09350,0.16490,percent of total billed charges,
CALMOSEPTINE OINT 71 GM,82355,CDM,250,RC,00799-0001-02,NDC,,,facility,outpatient,1,GM,0.17000,0.16000,Amish/Mennonite,Amish Mennonite,,0.09350,,,,,,,0.08500,0.16490,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,inpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,2.16,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,17478-0288-11,NDC,,,facility,outpatient,1,mL,3.93000,3.73000,Amish/Mennonite,Amish Mennonite,,2.16,,,,,,,1.97,3.81,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,inpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.39,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,60758-0801-10,NDC,,,facility,outpatient,1,mL,2.53000,2.40000,Amish/Mennonite,Amish Mennonite,,1.39,,,,,,,1.26,2.45,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,inpatient,1,mL,4.47000,4.24000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.46,4.34,percent of total billed charges,
TIMOLOL SOLN-OPHTH 0.5% 10 ML,82356,CDM,250,RC,61314-0227-10,NDC,,,facility,outpatient,1,mL,4.47000,4.24000,Amish/Mennonite,Amish Mennonite,,2.46,,,,,,,2.23,4.34,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,inpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,10.43,18.39,percent of total billed charges,
TETRACAINE SOLN-OPHTH 0.5% 5 ML,82357,CDM,250,RC,68682-0920-05,NDC,,,facility,outpatient,1,mL,18.96000,18.01000,Amish/Mennonite,Amish Mennonite,,10.43,,,,,,,9.48,18.39,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,inpatient,1,mL,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.84,3.25,percent of total billed charges,
IODIXANOL 320 MG/ML SOLN,82358,CDM,250,RC,00407-2223-64,NDC,,,facility,outpatient,1,mL,3.35000,3.18000,Amish/Mennonite,Amish Mennonite,,1.84,,,,,,,1.68,3.25,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,inpatient,1,mL,28.33000,26.92000,Amish/Mennonite,Amish Mennonite,,15.58,,,,,,,15.58,27.48,percent of total billed charges,
GADOBUTROL SOLN 1 MMOL/ML 7.5 ML,82359,CDM,250,RC,A9585,HCPCS,50419032527,NDC,facility,outpatient,1,mL,28.33000,26.92000,Amish/Mennonite,Amish Mennonite,,15.58,,,,,,,0.40920,27.48,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,inpatient,1,EA,16163.08000,15354.93000,Amish/Mennonite,Amish Mennonite,,8889.69,,,,,,,8889.69,15678.19,percent of total billed charges,
RISANKIZUMAB-RZAA SOLN 75 MG/0.83 ML (SKYRIZI),82360,CDM,250,RC,J3490,HCPCS,00074204202,NDC,facility,outpatient,1,EA,16163.08000,15354.93000,Amish/Mennonite,Amish Mennonite,,8889.69,,,,,,,8081.54,15678.19,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,inpatient,1,mL,30.39000,28.87000,Amish/Mennonite,Amish Mennonite,,16.71,,,,,,,16.71,29.48,percent of total billed charges,
METHYLPREDNISOLONE ACETATE SUSP INJ 40 MG/ML 5 ML,82362,CDM,636,RC,J1010,HCPCS,00009028002,NDC,facility,outpatient,1,mL,30.39000,28.87000,Amish/Mennonite,Amish Mennonite,,16.71,,,,,,,0.12000,29.48,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,inpatient,1,mL,286.22000,271.90000,Amish/Mennonite,Amish Mennonite,,157.42,,,,,,,157.42,277.63,percent of total billed charges,
"BENZATHINE PENICILLIN-PROCAINE PENICILLIN 600,000 UNITS-600,000 UNITS/2 ML SUSP",82364,CDM,636,RC,J0558,HCPCS,60793060010,NDC,facility,outpatient,1,mL,286.22000,271.90000,Amish/Mennonite,Amish Mennonite,,157.42,,,,,,,17.37,277.63,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,inpatient,,,1821.00000,1729.95000,Amish/Mennonite,Amish Mennonite,TC,1001.55,,,,,,,1001.55,1766.37,percent of total billed charges,
MRI BRAIN STEREOTACT SURG PLAN-TECH,82365,CDM,610,RC,76498,CPT,,,facility,outpatient,,,1821.00000,1729.95000,Amish/Mennonite,Amish Mennonite,TC,1001.55,,,,,,,484.28,2161.00,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,inpatient,,,77.40000,73.53000,Amish/Mennonite,Amish Mennonite,90,42.57,,,,,,,42.57,75.08,percent of total billed charges,
CLOMIPRAMINE(ANAFRANIL) SO,82367,CDM,300,RC,80335,CPT,,,facility,outpatient,,,77.40000,73.53000,Amish/Mennonite,Amish Mennonite,90,42.57,,,,,,,38.70,1137.41,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,419.87,831.17,percent of total billed charges,
CATH NAVICROSS ANG .035 4FR 90,82368,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,393.31,856.88,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,inpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,165.11,291.19,percent of total billed charges,
BEZLOTOXUMAB SOLN 25 MG/ML 40 ML,82369,CDM,636,RC,J0565,HCPCS,00006302500,NDC,facility,outpatient,1,mL,300.20000,285.19000,Amish/Mennonite,Amish Mennonite,,165.11,,,,,,,39.83,291.19,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,inpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.41,2.48,percent of total billed charges,
"FIBRINOGEN CONCENTRATE, HUMAN POWD-INJ (FIBRYGA)",82370,CDM,636,RC,J7177,HCPCS,68982034701,NDC,facility,outpatient,1,EA,2.56000,2.43000,Amish/Mennonite,Amish Mennonite,,1.41,,,,,,,1.21,2.48,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,464.18000,440.97000,Amish/Mennonite,Amish Mennonite,,255.30,,,,,,,255.30,450.25,percent of total billed charges,
AMNIOEXCL+5X8CM,82373,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,464.18000,440.97000,Amish/Mennonite,Amish Mennonite,,255.30,,,,,,,158.39,450.25,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,inpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,,689.15,,,,,,,689.15,1215.41,percent of total billed charges,
TC99M-TILMANOC <=0.5MCI,82393,CDM,343,RC,A9520,HCPCS,,,facility,outpatient,,,1253.00000,1190.35000,Amish/Mennonite,Amish Mennonite,,689.15,,,,,,,626.50,1215.41,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,Amish/Mennonite,Amish Mennonite,,7189.98,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124 MM DIA16X13 MM CATH 14FR POLY NIT STENT,82395,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,Amish/Mennonite,Amish Mennonite,,7189.98,,,,,,,6000.37,13072.70,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 4.0X6MM,82397,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.0X30MM,82398,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,Amish/Mennonite,Amish Mennonite,,5683.01,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY L140CM NOSECONE L3.5CM SHTH,82399,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,Amish/Mennonite,Amish Mennonite,,5683.01,,,,,,,4742.73,10332.75,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,inpatient,,,10332.75000,9816.11000,Amish/Mennonite,Amish Mennonite,,5683.01,,,,,,,5063.05,10022.77,percent of total billed charges,
CATHETER ATHRCTMY NOSECONE L6CM L110CM SHTH,82400,CDM,278,RC,C1714,HCPCS,,,facility,outpatient,,,10332.75000,9816.11000,Amish/Mennonite,Amish Mennonite,,5683.01,,,,,,,4742.73,10332.75,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L50CM DIA16MM COMPLX SFT PERIPH FULL RETRCT RUBY,82401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA28MM 0.020IN PERIPH COMPLX L VOL STD FRME,82402,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2180.74,4316.98,percent of total billed charges,
COIL EMB L60CM DIA32MM 0.020IN PERIPH COMPLX L VOL STD FRME,82403,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4450.50000,4227.97000,Amish/Mennonite,Amish Mennonite,,2447.78,,,,,,,2042.78,4450.50,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF4 BLUESYNC,82404,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,18511.22,40329.45,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9660.00000,9177.00000,Amish/Mennonite,Amish Mennonite,,5313.00,,,,,,,4733.40,9370.20,percent of total billed charges,
LEAD DEFIB 7.3FR L59CM IROX TIP SIL BODY BACKFILLED,82406,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9660.00000,9177.00000,Amish/Mennonite,Amish Mennonite,,5313.00,,,,,,,4433.94,9660.00,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX100MMX90CM,82408,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 16MMX100MMX90CM,82409,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6206.55000,5896.22000,Amish/Mennonite,Amish Mennonite,,3413.60,,,,,,,3041.21,6020.35,percent of total billed charges,
STENT VEN SELF EXPND 12X100MM 80CM OTW DEL,82410,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6206.55000,5896.22000,Amish/Mennonite,Amish Mennonite,,3413.60,,,,,,,2848.81,6206.55,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,inpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.18700,0.32980,percent of total billed charges,
DIATRIZOATE SOLN 18% 300 ML,82411,CDM,250,RC,Q9958,HCPCS,00270141030,NDC,facility,outpatient,1,mL,0.34000,0.32000,Amish/Mennonite,Amish Mennonite,,0.18700,,,,,,,0.11207,0.32980,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,inpatient,,,698.00000,663.10000,Amish/Mennonite,Amish Mennonite,,383.90,,,,,,,383.90,677.06,percent of total billed charges,
SPERM SWIM-UP PROCEDURE,82412,CDM,300,RC,89261,CPT,,,facility,outpatient,,,698.00000,663.10000,Amish/Mennonite,Amish Mennonite,,383.90,,,,,,,50.73,677.06,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,inpatient,1,EA,4155.55000,3947.77000,Amish/Mennonite,Amish Mennonite,,2285.55,,,,,,,2285.55,4030.88,percent of total billed charges,
LEUPROLIDE 30 MG/4 MONTHS (ELIGARD),82430,CDM,636,RC,J9217,HCPCS,62935030640,NDC,facility,outpatient,1,EA,4155.55000,3947.77000,Amish/Mennonite,Amish Mennonite,,2285.55,,,,,,,155.42,4030.88,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,inpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,,105.60,,,,,,,105.60,186.24,percent of total billed charges,
LAB/PSA SCREENING-MIL,82442,CDM,300,RC,G0103,HCPCS,,,facility,outpatient,,,192.00000,182.40000,Amish/Mennonite,Amish Mennonite,,105.60,,,,,,,19.31,186.24,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,inpatient,,,1804.00000,1713.80000,Amish/Mennonite,Amish Mennonite,,992.20,,,,,,,992.20,1749.88,percent of total billed charges,
SOTROVIMAB INFUSION,82444,CDM,260,RC,M0247,HCPCS,,,facility,outpatient,,,1804.00000,1713.80000,Amish/Mennonite,Amish Mennonite,,992.20,,,,,,,902.00,1749.88,percent of total billed charges,
ROOM/BED   ICU-CRITICAL CARE,82445,CDM,200,RC,,,,,facility,inpatient,,,4204.00000,3993.80000,Amish/Mennonite,Amish Mennonite,,2312.20,,,,,,,2312.20,4077.88,percent of total billed charges,
ROOM/BED   MED-SURG,82446,CDM,111,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,Amish/Mennonite,Amish Mennonite,,1109.35,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   HOME RECOVERY,82448,CDM,161,RC,,,,,facility,inpatient,,,1805.00000,1714.75000,Amish/Mennonite,Amish Mennonite,,992.75,,,,,,,992.75,1750.85,percent of total billed charges,
ROOM/BED   NICU LEVEL 4,82449,CDM,174,RC,,,,,facility,inpatient,,,8326.00000,7909.70000,Amish/Mennonite,Amish Mennonite,,4579.30,,,,,,,4579.30,8076.22,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 2,82450,CDM,172,RC,,,,,facility,inpatient,,,2073.00000,1969.35000,Amish/Mennonite,Amish Mennonite,,1140.15,,,,,,,1140.15,2010.81,percent of total billed charges,
ROOM/BED   NEWBORN,82451,CDM,170,RC,,,,,facility,inpatient,,,1779.00000,1690.05000,Amish/Mennonite,Amish Mennonite,,978.45,,,,,,,978.45,1725.63,percent of total billed charges,
ROOM/BED   NICU LEVEL 2,82452,CDM,172,RC,,,,,facility,inpatient,,,5606.00000,5325.70000,Amish/Mennonite,Amish Mennonite,,3083.30,,,,,,,3083.30,5437.82,percent of total billed charges,
ROOM/BED   NICU LEVEL 3,82453,CDM,173,RC,,,,,facility,inpatient,,,7149.00000,6791.55000,Amish/Mennonite,Amish Mennonite,,3931.95,,,,,,,3931.95,6934.53,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 4,82454,CDM,174,RC,,,,,facility,inpatient,,,3875.00000,3681.25000,Amish/Mennonite,Amish Mennonite,,2131.25,,,,,,,2131.25,3758.75,percent of total billed charges,
ROOM/BED   PICU,82455,CDM,203,RC,,,,,facility,inpatient,,,5446.00000,5173.70000,Amish/Mennonite,Amish Mennonite,,2995.30,,,,,,,2995.30,5282.62,percent of total billed charges,
ROOM/BED   REHAB,82456,CDM,118,RC,,,,,facility,inpatient,,,1724.00000,1637.80000,Amish/Mennonite,Amish Mennonite,,948.20,,,,,,,948.20,2638.00,percent of total billed charges,
ROOM/BED   NURSERY LEVEL 3,82457,CDM,173,RC,,,,,facility,inpatient,,,2969.00000,2820.55000,Amish/Mennonite,Amish Mennonite,,1632.95,,,,,,,1632.95,2879.93,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,47.30,83.42,percent of total billed charges,
ROOM/BED   OBSERVATION,82458,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,86.00000,81.70000,Amish/Mennonite,Amish Mennonite,,47.30,,,,,,,43.00,6456.00,percent of total billed charges,
ROOM/BED   WOMEN'S HEALTH,82459,CDM,112,RC,,,,,facility,inpatient,,,2017.00000,1916.15000,Amish/Mennonite,Amish Mennonite,,1109.35,,,,,,,1109.35,1956.49,percent of total billed charges,
ROOM/BED   TELEMETRY,82460,CDM,110,RC,,,,,facility,inpatient,,,2054.00000,1951.30000,Amish/Mennonite,Amish Mennonite,,1129.70,,,,,,,1129.70,1992.38,percent of total billed charges,
ROOM/BED   SWING BED,82461,CDM,120,RC,,,,,facility,inpatient,,,1052.00000,999.40000,Amish/Mennonite,Amish Mennonite,,578.60,,,,,,,578.60,1020.44,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,inpatient,,,4256.00000,4043.20000,Amish/Mennonite,Amish Mennonite,TC,2340.80,,,,,,,2340.80,4128.32,percent of total billed charges,
"ECHOCARDIOGRAPHY,TRANSESOPHAG-TECH",82488,CDM,483,RC,93318,CPT,,,facility,outpatient,,,4256.00000,4043.20000,Amish/Mennonite,Amish Mennonite,TC,2340.80,,,,,,,2128.00,4128.32,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,inpatient,1,mL,730.38000,693.86000,Amish/Mennonite,Amish Mennonite,,401.71,,,,,,,401.71,708.47,percent of total billed charges,
ADUCANUMAB SOLN-AVWA 100 MG/ML 1.7 ML (ADUHELM),82489,CDM,636,RC,J0172,HCPCS,64406010101,NDC,facility,outpatient,1,mL,730.38000,693.86000,Amish/Mennonite,Amish Mennonite,,401.71,,,,,,,5.98,708.47,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,inpatient,,,2454.00000,2331.30000,Amish/Mennonite,Amish Mennonite,TC,1349.70,,,,,,,1349.70,2380.38,percent of total billed charges,
INTRAVASC DOPP VEL;INIT VESSEL-TECH,82502,CDM,481,RC,93571,CPT,,,facility,outpatient,,,2454.00000,2331.30000,Amish/Mennonite,Amish Mennonite,TC,1349.70,,,,,,,1227.00,5271.00,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,inpatient,,,7396.00000,7026.20000,Amish/Mennonite,Amish Mennonite,TC,4067.80,,,,,,,4067.80,7174.12,percent of total billed charges,
CATH PLC CORONARY ART-COR ANG-TECH,82508,CDM,481,RC,93454,CPT,,,facility,outpatient,,,7396.00000,7026.20000,Amish/Mennonite,Amish Mennonite,TC,4067.80,,,,,,,3698.00,17574.00,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,inpatient,,,555.00000,527.25000,Amish/Mennonite,Amish Mennonite,,305.25,,,,,,,305.25,538.35,percent of total billed charges,
ARTERIAL LINE ACTIVITY INSERT,82512,CDM,510,RC,36620,CPT,,,facility,outpatient,,,555.00000,527.25000,Amish/Mennonite,Amish Mennonite,,305.25,,,,,,,277.50,538.35,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,inpatient,1,mL,20.30000,19.29000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,11.16,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088221905,NDC,facility,outpatient,1,mL,20.30000,19.29000,Amish/Mennonite,Amish Mennonite,,11.16,,,,,,,0.92000,19.69,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,inpatient,1,mL,89.60000,85.12000,Amish/Mennonite,Amish Mennonite,,49.28,,,,,,,49.28,86.91,percent of total billed charges,
INSULIN GLARGINE 100 UNITS/ML SOLN,82513,CDM,636,RC,J1815,HCPCS,00088502005,NDC,facility,outpatient,1,mL,89.60000,85.12000,Amish/Mennonite,Amish Mennonite,,49.28,,,,,,,0.92000,86.91,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,inpatient,1,EA,2370.47000,2251.95000,Amish/Mennonite,Amish Mennonite,,1303.76,,,,,,,1303.76,2299.36,percent of total billed charges,
ETONOGESTREL SYRINGE 68 MG IMP (NEXPLANON),82514,CDM,250,RC,J7307,HCPCS,78206014501,NDC,facility,outpatient,1,EA,2370.47000,2251.95000,Amish/Mennonite,Amish Mennonite,,1303.76,,,,,,,1185.23,2299.36,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,inpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,88.00,155.20,percent of total billed charges,
HEPATITIS C ANTIBODY SCREENING,82515,CDM,300,RC,G0472,HCPCS,,,facility,outpatient,,,160.00000,152.00000,Amish/Mennonite,Amish Mennonite,,88.00,,,,,,,46.35,319.35,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,inpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,,216.70,,,,,,,216.70,382.18,percent of total billed charges,
HPV AMPLIFIED SCREENING,82516,CDM,300,RC,G0476,HCPCS,,,facility,outpatient,,,394.00000,374.30000,Amish/Mennonite,Amish Mennonite,,216.70,,,,,,,35.09,382.18,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,inpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,110.55,194.97,percent of total billed charges,
FECAL OCCULT SCREENING IMMUNOASSY,82517,CDM,300,RC,G0328,HCPCS,,,facility,outpatient,,,201.00000,190.95000,Amish/Mennonite,Amish Mennonite,,110.55,,,,,,,18.05,194.97,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,96.25,169.75,percent of total billed charges,
"HIV I/II ANTIBODY EIA, SCREENING",82518,CDM,300,RC,G0475,HCPCS,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,,96.25,,,,,,,24.08,169.75,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,inpatient,,,522.00000,495.90000,Amish/Mennonite,Amish Mennonite,,287.10,,,,,,,287.10,506.34,percent of total billed charges,
SPERM WASH TECHNIQUE CHARGE ONLY,82519,CDM,300,RC,89260,CPT,,,facility,outpatient,,,522.00000,495.90000,Amish/Mennonite,Amish Mennonite,,287.10,,,,,,,50.73,506.34,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,inpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,TC,441.10,,,,,,,441.10,777.94,percent of total billed charges,
THYROID UPTAKE SNG/MULT QUANT,8252,CDM,340,RC,78012,CPT,,,facility,outpatient,,,802.00000,761.90000,Amish/Mennonite,Amish Mennonite,TC,441.10,,,,,,,389.35,2210.07,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,Amish/Mennonite,Amish Mennonite,,201.77,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 24FR 30CM,82520,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,Amish/Mennonite,Amish Mennonite,,201.77,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 10MM 75CM PCLTXL LUTONIX 035 60.,82521,CDM,278,RC,C2623,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13072.70000,12419.07000,Amish/Mennonite,Amish Mennonite,,7189.98,,,,,,,6405.62,12680.52,percent of total billed charges,
GRAFT EVAR L124MM DIA16X24MM CATH 16FR POLY NIT STNT,82522,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13072.70000,12419.07000,Amish/Mennonite,Amish Mennonite,,7189.98,,,,,,,6000.37,13072.70,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT BILI 7FR L13CM 0.035IN ACC CHN 2.8MM PLAS.,82523,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
BUTTON GAST 14FR L5CM SIL LP EXT BOLST G GRN FEED PRT SUP,82524,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,inpatient,,,1383.75000,1314.56000,Amish/Mennonite,Amish Mennonite,,761.06,,,,,,,678.04,1342.24,percent of total billed charges,
LEAD SPC L59CM BPLR AV STR INGEVITY+,82525,CDM,275,RC,C1898,HCPCS,,,facility,outpatient,,,1383.75000,1314.56000,Amish/Mennonite,Amish Mennonite,,761.06,,,,,,,635.14,1342.24,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,Amish/Mennonite,Amish Mennonite,,28.37,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 10 MG TAB,82527,CDM,250,RC,64764-0730-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,Amish/Mennonite,Amish Mennonite,,28.37,,,,,,,25.79,50.03,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,inpatient,,,4712.00000,4476.40000,Amish/Mennonite,Amish Mennonite,TC,2591.60,,,,,,,2591.60,4570.64,percent of total billed charges,
SIM-AIDED FLD SETTING COMPLX-TECH,8254,CDM,333,RC,77290,CPT,,,facility,outpatient,,,4712.00000,4476.40000,Amish/Mennonite,Amish Mennonite,TC,2591.60,,,,,,,2210.90,23155.09,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,8125.15,14329.81,percent of total billed charges,
STEREOTACTIC BODY RAD THER,8255,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,1667.31,67198.78,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,inpatient,,,31197.60000,29637.72000,Amish/Mennonite,Amish Mennonite,,17158.68,,,,,,,15286.82,30261.67,percent of total billed charges,
DEFIBRILLATOR CARD ICD COBAL XT VR MRI IS1 DF1,82561,CDM,278,RC,C1722,HCPCS,,,facility,outpatient,,,31197.60000,29637.72000,Amish/Mennonite,Amish Mennonite,,17158.68,,,,,,,14319.70,31197.60,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,inpatient,,,30271.50000,28757.92000,Amish/Mennonite,Amish Mennonite,,16649.33,,,,,,,14833.03,29363.35,percent of total billed charges,
DEFIBRILLATOR CARD W51XH66IN D13MM POLYUR SIL TI DF4,82562,CDM,278,RC,C1721,HCPCS,,,facility,outpatient,,,30271.50000,28757.92000,Amish/Mennonite,Amish Mennonite,,16649.33,,,,,,,13894.62,30271.50,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD 14.5FR CATHETER L36CM INSERT L31CM STR POLYUR CATH,82564,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,578.34,1260.00,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,617.40,1222.20,percent of total billed charges,
KIT HAD CATH 14.5FR L24CM INSRT L19CM STD,82565,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1260.00000,1197.00000,Amish/Mennonite,Amish Mennonite,,693.00,,,,,,,578.34,1260.00,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,inpatient,1,mL,19494.00000,18519.30000,Amish/Mennonite,Amish Mennonite,,10721.70,,,,,,,10721.70,18909.18,percent of total billed charges,
ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN SOLN 10 MG/0.5 ML (RYLAZE),82567,CDM,636,RC,J9021,HCPCS,68727090003,NDC,facility,outpatient,1,mL,19494.00000,18519.30000,Amish/Mennonite,Amish Mennonite,,10721.70,,,,,,,55.30,18909.18,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,inpatient,1,mL,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.83,3.22,percent of total billed charges,
CEFAZOLIN SOLN SD 330 MG/ML (IM DILUTION),82568,CDM,250,RC,J0690,HCPCS,00143926225,NDC,facility,outpatient,1,mL,3.32000,3.16000,Amish/Mennonite,Amish Mennonite,,1.83,,,,,,,1.28,3.22,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 82.1GM W51XH73IN D13MM DF4 BLUESYNC,82569,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,18511.22,40329.45,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF4,82570,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,20528.18,44723.70,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 45 LENGTH, 10",82571,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,144.65,255.11,percent of total billed charges,
BONE LNG STD CT-TECH,82576,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,TC,144.65,,,,,,,131.50,1668.14,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,inpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,108.90,192.06,percent of total billed charges,
INJ ANES AGT;INTERSCT NV SNG US-TECH,82578,CDM,510,RC,64420,CPT,,,facility,outpatient,,,198.00000,188.10000,Amish/Mennonite,Amish Mennonite,,108.90,,,,,,,99.00,723.34,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,inpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,TC,83.60,,,,,,,83.60,147.44,percent of total billed charges,
U.S.AMNIOCENTESIS TECHNICAL,8258,CDM,402,RC,76946,CPT,,,facility,outpatient,,,152.00000,144.40000,Amish/Mennonite,Amish Mennonite,TC,83.60,,,,,,,76.00,548.00,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,inpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,146.85,258.99,percent of total billed charges,
INJ ANS AG;INT ML US-TECH,82582,CDM,510,RC,64421,CPT,,,facility,outpatient,,,267.00000,253.65000,Amish/Mennonite,Amish Mennonite,,146.85,,,,,,,133.50,929.91,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S US-TECH,82583,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,inpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
INJ TRIG PT-S XR-TECH,82585,CDM,510,RC,20552,CPT,,,facility,outpatient,,,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,79.00,308.32,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,inpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,100.10,176.54,percent of total billed charges,
INJ TRIGGER PT(S);3 MRE US-TECH,82589,CDM,510,RC,20553,CPT,,,facility,outpatient,,,182.00000,172.90000,Amish/Mennonite,Amish Mennonite,,100.10,,,,,,,91.00,308.32,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,inpatient,,,19.28000,18.32000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,10.60,18.70,percent of total billed charges,
PERCUSSOR CUP PEDS 47 MM,82593,CDM,271,RC,E1399,HCPCS,,,facility,outpatient,,,19.28000,18.32000,Amish/Mennonite,Amish Mennonite,,10.60,,,,,,,9.64,18.70,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,inpatient,,,571.56000,542.98000,Amish/Mennonite,Amish Mennonite,,314.36,,,,,,,314.36,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,CPT,,,facility,outpatient,,,571.56000,542.98000,Amish/Mennonite,Amish Mennonite,,314.36,,,,,,,285.78,554.41,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,inpatient,1,mL,1143.11000,1085.95000,Amish/Mennonite,Amish Mennonite,,628.71,,,,,,,628.71,1108.82,percent of total billed charges,
"PNEUMOCOCCAL VACCINE, 20-VALENT SUSP-INJ (PREVNAR 20)",82594,CDM,636,RC,90677,HCPCS,00005200010,NDC,facility,outpatient,1,mL,1143.11000,1085.95000,Amish/Mennonite,Amish Mennonite,,628.71,,,,,,,485.00,1108.82,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,inpatient,1,EA,205.24000,194.98000,Amish/Mennonite,Amish Mennonite,,112.88,,,,,,,112.88,199.08,percent of total billed charges,
DARUNAVIR 800 MG TAB,82596,CDM,250,RC,56979-0566-30,NDC,,,facility,outpatient,1,EA,205.24000,194.98000,Amish/Mennonite,Amish Mennonite,,112.88,,,,,,,102.62,199.08,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,inpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,190.30,335.62,percent of total billed charges,
HEP B SCREEN HIGH RISK,82597,CDM,300,RC,G0499,HCPCS,,,facility,outpatient,,,346.00000,328.70000,Amish/Mennonite,Amish Mennonite,,190.30,,,,,,,28.27,335.62,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1611.00000,1530.45000,Amish/Mennonite,Amish Mennonite,,886.05,,,,,,,886.05,1562.67,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-US-TECH,82598,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1611.00000,1530.45000,Amish/Mennonite,Amish Mennonite,,886.05,,,,,,,805.50,1692.33,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,Amish/Mennonite,Amish Mennonite,,15506.98,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H6MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82599,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,Amish/Mennonite,Amish Mennonite,,15506.98,,,,,,,12941.28,28194.50,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 4X40X200CM,82600,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN CROSSTELLA RX 3X40X200CM,82601,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,28194.50000,26784.77000,Amish/Mennonite,Amish Mennonite,,15506.98,,,,,,,13815.31,27348.67,percent of total billed charges,
CAGE SPNL SM H7MM 12X14MM 6DEG LORD ANT CERV IF TI NANOLOCK,82602,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,28194.50000,26784.77000,Amish/Mennonite,Amish Mennonite,,15506.98,,,,,,,12941.28,28194.50,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,261.11000,248.05000,Amish/Mennonite,Amish Mennonite,,143.61,,,,,,,127.94,253.28,percent of total billed charges,
CATHETER DRNGE 10.2FR L25CM GWIRE 0.038IN SIL,82604,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,261.11000,248.05000,Amish/Mennonite,Amish Mennonite,,143.61,,,,,,,119.85,261.11,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,8814.75000,8374.01000,Amish/Mennonite,Amish Mennonite,,4848.11,,,,,,,4319.23,8550.31,percent of total billed charges,
CATHETER NAVISTAR 4MM D-F CRV 7FR,82605,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,8814.75000,8374.01000,Amish/Mennonite,Amish Mennonite,,4848.11,,,,,,,4045.97,8814.75,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L80MM DIA8MM W/ 6FR SHTH L200CM SHFT SELF EXPND,82606,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1642.07,3577.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X18MM,82607,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X23MM,82608,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X8MM,82609,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X15MM,82610,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X28MM,82611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X33MM,82612,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X12MM,82613,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X15MM,82614,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X18MM,82615,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X38MM,82616,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X8MM,82617,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X15M,82618,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X15MM,82619,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,inpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,1570.80,2770.32,percent of total billed charges,
RAD TRT DEL >1MEV COMPLEX-PAR,8262,CDM,333,RC,77412,CPT,,,facility,outpatient,,,2856.00000,2713.20000,Amish/Mennonite,Amish Mennonite,,1570.80,,,,,,,249.71,14445.56,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X18MM,82620,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X33MM,82621,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X12MM,82622,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,inpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,131.45,231.83,percent of total billed charges,
FNA BREAST US GUD 1ST LESION-TECH,82623,CDM,402,RC,10005,CPT,,,facility,outpatient,,,239.00000,227.05000,Amish/Mennonite,Amish Mennonite,,131.45,,,,,,,119.50,734.90,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,inpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,114.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/O CONT OXIMETRY,82630,CDM,948,RC,94625,CPT,,,facility,outpatient,,,208.00000,197.60000,Amish/Mennonite,Amish Mennonite,,114.40,,,,,,,56.40,201.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,inpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,169.40,298.76,percent of total billed charges,
PULMONARY REHAB OUTPATIENT W/ CONT OXIMETRY,82631,CDM,948,RC,94626,CPT,,,facility,outpatient,,,308.00000,292.60000,Amish/Mennonite,Amish Mennonite,,169.40,,,,,,,56.40,298.76,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X15MM,82633,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X23MM,82634,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X23MM,82635,CDM,278,RC,C1784,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT COR DRG ELUT L28MM DIA3MM EVEROLIMUS CT CCR RX,82636,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.0X33MM,82637,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X28MM,82638,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON COMPONENT-TECH,82639,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 NEW - BASED ON TIME 99243-TECH,82640,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,inpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,83.05,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 3 ESTAB - BASED ON TIME 99243-TECH,82641,CDM,510,RC,99243,CPT,,,facility,outpatient,,,151.00000,143.45000,Amish/Mennonite,Amish Mennonite,,83.05,,,,,,,75.50,146.47,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 NEW - BASED ON TIME 99245-TECH,82642,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON COMPONENTS-TECH,82643,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,inpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,139.15,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 5 ESTAB - BASED ON TIME 99245-TECH,82644,CDM,510,RC,99245,CPT,,,facility,outpatient,,,253.00000,240.35000,Amish/Mennonite,Amish Mennonite,,139.15,,,,,,,126.50,245.41,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON COMPONENTS-TECH,82647,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 ESTAB - BASED ON TIME 99242-TECH,82648,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,inpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,66.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 2 NEW - BASED ON TIME 99242-TECH,82649,CDM,510,RC,99242,CPT,,,facility,outpatient,,,120.00000,114.00000,Amish/Mennonite,Amish Mennonite,,66.00,,,,,,,60.00,116.40,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON COMPONENTS-TECH,82650,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 ESTAB - BASED ON TIME 99244-TECH,82651,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,inpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,112.20,197.88,percent of total billed charges,
OFFICE CONSULT LEVEL 4 NEW - BASED ON TIME 99244-TECH,82652,CDM,510,RC,99244,CPT,,,facility,outpatient,,,204.00000,193.80000,Amish/Mennonite,Amish Mennonite,,112.20,,,,,,,102.00,197.88,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X18MM,82654,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X18MM,82655,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X23MM,82656,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X38MM,82657,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X28MM,82659,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,inpatient,1,EA,3362.49000,3194.36000,Amish/Mennonite,Amish Mennonite,,1849.37,,,,,,,1849.37,3261.62,percent of total billed charges,
SILTUXIMAB POWD-INJ 100 MG,82660,CDM,636,RC,J2860,HCPCS,73090042001,NDC,facility,outpatient,1,EA,3362.49000,3194.36000,Amish/Mennonite,Amish Mennonite,,1849.37,,,,,,,161.96,3261.62,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,inpatient,1,mL,22.42000,21.30000,Amish/Mennonite,Amish Mennonite,,12.33,,,,,,,12.33,21.75,percent of total billed charges,
TRIAMCINOLONE ACETONIDE SUSP INJ 40 MG/ML 10 ML,82661,CDM,250,RC,J3301,HCPCS,00003029328,NDC,facility,outpatient,1,mL,22.42000,21.30000,Amish/Mennonite,Amish Mennonite,,12.33,,,,,,,1.35,21.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X15MM,82665,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X8MM,82666,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X38MM,82667,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X12MM,82668,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,inpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.64,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,13517-0113-01,NDC,,,facility,outpatient,1,EA,2.99000,2.84000,Amish/Mennonite,Amish Mennonite,,1.64,,,,,,,1.50,2.90,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,inpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.38500,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,16571-0668-01,NDC,,,facility,outpatient,1,EA,0.70000,0.66000,Amish/Mennonite,Amish Mennonite,,0.38500,,,,,,,0.35000,0.67900,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,inpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
PHENOBARBITAL TAB 97.2 MG,82669,CDM,250,RC,75826-0142-10,NDC,,,facility,outpatient,1,EA,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.50X8MM,82670,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X23MM,82671,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X8MM,82672,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,7193.25000,6833.59000,Amish/Mennonite,Amish Mennonite,,3956.29,,,,,,,3524.69,6977.45,percent of total billed charges,
CATHETER GD 3.2FR 135CM HDRPH STINGRY LP STRL,82673,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,7193.25000,6833.59000,Amish/Mennonite,Amish Mennonite,,3956.29,,,,,,,3301.70,7193.25,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1406.25000,1335.94000,Amish/Mennonite,Amish Mennonite,,773.44,,,,,,,689.06,1364.06,percent of total billed charges,
CATHETER GUID 6FR L150CM DST EXTN L25CM HYDRPHLC SL RX PLAT,82674,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1406.25000,1335.94000,Amish/Mennonite,Amish Mennonite,,773.44,,,,,,,645.47,1406.25,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX80MMX90CM,82675,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 18MMX100MMX90CM,82676,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1303.15,2579.72,percent of total billed charges,
GUIDEWIRE VASC SYNCHRO2 SELECT SUPPORT PRESHAPE 215,82677,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,2659.50000,2526.52000,Amish/Mennonite,Amish Mennonite,,1462.72,,,,,,,1220.71,2659.50,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,inpatient,1,GM,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.58,8.07,percent of total billed charges,
GENTAMICIN TOPICAL 0.1% CREAM,82680,CDM,250,RC,45802-0056-11,NDC,,,facility,outpatient,1,GM,8.32000,7.91000,Amish/Mennonite,Amish Mennonite,,4.58,,,,,,,4.16,8.07,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,inpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,675.95,1192.13,percent of total billed charges,
SLEEP ST/HOME/TYPE3/4 CHANNEL TECHG0399,82684,CDM,920,RC,G0399,HCPCS,,,facility,outpatient,,,1229.00000,1167.55000,Amish/Mennonite,Amish Mennonite,TC,675.95,,,,,,,316.68,1447.00,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,inpatient,,,4796.00000,4556.20000,Amish/Mennonite,Amish Mennonite,TC,2637.80,,,,,,,2637.80,4652.12,percent of total billed charges,
SLEEP ST/ATT VENT/RSPEFRT 6+H TECH95807,82685,CDM,920,RC,95807,CPT,,,facility,outpatient,,,4796.00000,4556.20000,Amish/Mennonite,Amish Mennonite,TC,2637.80,,,,,,,1929.64,4652.12,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,inpatient,,,6365.00000,6046.75000,Amish/Mennonite,Amish Mennonite,TC,3500.75,,,,,,,3500.75,6174.05,percent of total billed charges,
PSG W/ATT>=6YR>=4P 6+HR SPLIT NGT TECH95811,82686,CDM,920,RC,95811,CPT,,,facility,outpatient,,,6365.00000,6046.75000,Amish/Mennonite,Amish Mennonite,TC,3500.75,,,,,,,1929.64,6174.05,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,inpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,152.90,269.66,percent of total billed charges,
OXIMETRY OVERNIGHT MONITOR TECH 94762,82687,CDM,920,RC,94762,CPT,,,facility,outpatient,,,278.00000,264.10000,Amish/Mennonite,Amish Mennonite,,152.90,,,,,,,139.00,269.66,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,inpatient,,,1446.00000,1373.70000,Amish/Mennonite,Amish Mennonite,TC,795.30,,,,,,,795.30,1402.62,percent of total billed charges,
SLEEP ST/UNATT/RSPAN/SLPTM6+H TECH95800,82688,CDM,920,RC,95800,CPT,,,facility,outpatient,,,1446.00000,1373.70000,Amish/Mennonite,Amish Mennonite,TC,795.30,,,,,,,316.68,1447.00,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,inpatient,1,mL,4864.58000,4621.36000,Amish/Mennonite,Amish Mennonite,,2675.52,,,,,,,2675.52,4718.64,percent of total billed charges,
TEZEPELUMAB-EKKO SOLN 210 MG/1.91 ML,82689,CDM,636,RC,J2356,HCPCS,55513011201,NDC,facility,outpatient,1,mL,4864.58000,4621.36000,Amish/Mennonite,Amish Mennonite,,2675.52,,,,,,,18.30,4718.64,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,inpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,TC,539.00,,,,,,,539.00,950.60,percent of total billed charges,
U.S.EXTREMITY NONVASC R-T CMPL,8269,CDM,402,RC,76881,CPT,,,facility,outpatient,,,980.00000,931.00000,Amish/Mennonite,Amish Mennonite,TC,539.00,,,,,,,384.16,950.60,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,inpatient,1,mL,110.58000,105.05000,Amish/Mennonite,Amish Mennonite,,60.82,,,,,,,60.82,107.26,percent of total billed charges,
TRIAMCINOLONE 20 MG/ML SUSP,82690,CDM,250,RC,J3490,HCPCS,59137057001,NDC,facility,outpatient,1,mL,110.58000,105.05000,Amish/Mennonite,Amish Mennonite,,60.82,,,,,,,55.29,107.26,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56700.00000,53865.00000,Amish/Mennonite,Amish Mennonite,,31185.00,,,,,,,27783.00,54999.00,percent of total billed charges,
SET VNTRC AST RT HRT IMPELLA RP PMP STRL LF DISP,82692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56700.00000,53865.00000,Amish/Mennonite,Amish Mennonite,,31185.00,,,,,,,26025.30,56700.00,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,inpatient,,,241.67000,229.59000,Amish/Mennonite,Amish Mennonite,,132.92,,,,,,,132.92,234.42,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,CPT,,,facility,outpatient,,,241.67000,229.59000,Amish/Mennonite,Amish Mennonite,,132.92,,,,,,,120.83,240.53,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,inpatient,1,EA,483.34000,459.17000,Amish/Mennonite,Amish Mennonite,,265.84,,,,,,,265.84,468.84,percent of total billed charges,
MEASLES-MUMPS-RUBELLA-VARICELLA VIRUS VACCINE POWD-INJ (PROQUAD),82694,CDM,250,RC,90710,HCPCS,00006417100,NDC,facility,outpatient,1,EA,483.34000,459.17000,Amish/Mennonite,Amish Mennonite,,265.84,,,,,,,240.53,468.84,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,inpatient,,,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,62.39,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,CPT,,,facility,outpatient,,,113.43000,107.76000,Amish/Mennonite,Amish Mennonite,,62.39,,,,,,,56.72,110.03,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,inpatient,1,mL,226.86000,215.52000,Amish/Mennonite,Amish Mennonite,,124.77,,,,,,,124.77,220.05,percent of total billed charges,
"DIPHTHERIA-TETANUS-PERTUSSIS,ACEL-POLIO VACCINE SUSP (KINRIX)",82695,CDM,250,RC,90696,HCPCS,58160081252,NDC,facility,outpatient,1,mL,226.86000,215.52000,Amish/Mennonite,Amish Mennonite,,124.77,,,,,,,113.43,220.05,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00168-0357-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,inpatient,1,GM,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.87450,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,00574-2042-30,NDC,,,facility,outpatient,1,GM,1.59000,1.51000,Amish/Mennonite,Amish Mennonite,,0.87450,,,,,,,0.79500,1.54,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,inpatient,1,GM,8.39000,7.97000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.61,8.14,percent of total billed charges,
LIDOCAINE 2.5% AND PRILOCAINE 2.5% CREAM 30 GRAMS,82703,CDM,250,RC,62332-0582-31,NDC,,,facility,outpatient,1,GM,8.39000,7.97000,Amish/Mennonite,Amish Mennonite,,4.61,,,,,,,4.20,8.14,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,inpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,QW,20.35,,,,,,,20.35,35.89,percent of total billed charges,
RAPID STREP POC,82705,CDM,300,RC,87880,CPT,,,facility,outpatient,,,37.00000,35.15000,Amish/Mennonite,Amish Mennonite,QW,20.35,,,,,,,16.53,780.94,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,inpatient,,,1895.00000,1800.25000,Amish/Mennonite,Amish Mennonite,,1042.25,,,,,,,1042.25,1838.15,percent of total billed charges,
BACTERIAL CULTURE ID CHARGE,82706,CDM,300,RC,87154,CPT,,,facility,outpatient,,,1895.00000,1800.25000,Amish/Mennonite,Amish Mennonite,,1042.25,,,,,,,12.05,10344.80,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
ELEC MUSCLE STIMULATION,82710,CDM,420,RC,97014,CPT,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,inpatient,,,506.00000,480.70000,Amish/Mennonite,Amish Mennonite,RT,278.30,,,,,,,278.30,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO ADDL,82716,CDM,401,RC,19284,CPT,,,facility,outpatient,,,506.00000,480.70000,Amish/Mennonite,Amish Mennonite,RT,278.30,,,,,,,253.00,490.82,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,inpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,RT,1356.30,,,,,,,1356.30,2392.02,percent of total billed charges,
MA BREAST DEVICE PLCMT STEREO,82717,CDM,401,RC,19283,CPT,,,facility,outpatient,,,2466.00000,2342.70000,Amish/Mennonite,Amish Mennonite,RT,1356.30,,,,,,,1233.00,2392.02,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,847.16000,804.80000,Amish/Mennonite,Amish Mennonite,,465.94,,,,,,,415.11,821.75,percent of total billed charges,
GUIDEWIRE ENDOSCP 0.035IN X 450CM HYDRPHLC,82719,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,847.16000,804.80000,Amish/Mennonite,Amish Mennonite,,465.94,,,,,,,388.85,847.16,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,inpatient,,,8669.00000,8235.55000,Amish/Mennonite,Amish Mennonite,,4767.95,,,,,,,4767.95,8408.93,percent of total billed charges,
NM PYLARIFY PROST PET 9MCI,82721,CDM,343,RC,A9597,HCPCS,,,facility,outpatient,,,8669.00000,8235.55000,Amish/Mennonite,Amish Mennonite,,4767.95,,,,,,,4334.50,8408.93,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,inpatient,,,4416.00000,4195.20000,Amish/Mennonite,Amish Mennonite,,2428.80,,,,,,,2163.84,4283.52,percent of total billed charges,
CATHETER US 8FR L90CM GRN TIP OVERLAY,82722,CDM,278,RC,C1759,HCPCS,,,facility,outpatient,,,4416.00000,4195.20000,Amish/Mennonite,Amish Mennonite,,2428.80,,,,,,,2026.94,4416.00,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,inpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.34650,0.61110,percent of total billed charges,
CEFAZOLIN 3 GM/NS 100 ML PREMIX,82726,CDM,250,RC,J0690,HCPCS,70092162303,NDC,facility,outpatient,1,mL,0.63000,0.60000,Amish/Mennonite,Amish Mennonite,,0.34650,,,,,,,0.31500,1.39,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,6555.00000,6227.25000,Amish/Mennonite,Amish Mennonite,,3605.25,,,,,,,3211.95,6358.35,percent of total billed charges,
"IDENTITI PC POROUS TI SPACER, 9 X 10 X 30 MM, 10",82727,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,6555.00000,6227.25000,Amish/Mennonite,Amish Mennonite,,3605.25,,,,,,,3008.74,6555.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 6 HEIGHT, 18 WIDTH, 55 LENGTH, 10",82728,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATHETER ANGIO L100CM OD6FR AD JUDKINS L 5.,82733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,inpatient,,,1466.00000,1392.70000,Amish/Mennonite,Amish Mennonite,,806.30,,,,,,,806.30,1422.02,percent of total billed charges,
"ENTERIC PARASITE PANEL, NAT",82734,CDM,300,RC,87505,CPT,,,facility,outpatient,,,1466.00000,1392.70000,Amish/Mennonite,Amish Mennonite,,806.30,,,,,,,128.29,6705.74,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 14FR FOR FEM ART IN EVAR CATH PROC MANTA,82735,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1290.94,2812.50,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,inpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.08250,0.14550,percent of total billed charges,
PETROLATUM TOPICAL - OINT,82736,CDM,250,RC,43553-3249-03,NDC,,,facility,outpatient,1,GM,0.15000,0.14000,Amish/Mennonite,Amish Mennonite,,0.08250,,,,,,,0.07500,0.14550,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,inpatient,1,EA,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.70,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,33342-0447-11,NDC,,,facility,outpatient,1,EA,14.00000,13.30000,Amish/Mennonite,Amish Mennonite,,7.70,,,,,,,7.00,13.58,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,inpatient,1,EA,13.21000,12.55000,Amish/Mennonite,Amish Mennonite,,7.27,,,,,,,7.27,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,61748-0012-06,NDC,,,facility,outpatient,1,EA,13.21000,12.55000,Amish/Mennonite,Amish Mennonite,,7.27,,,,,,,6.61,12.81,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,inpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.90,13.94,percent of total billed charges,
PYRAZINAMIDE 500 MG TAB,82738,CDM,250,RC,70954-0484-10,NDC,,,facility,outpatient,1,EA,14.37000,13.65000,Amish/Mennonite,Amish Mennonite,,7.90,,,,,,,7.18,13.94,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,inpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.15400,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,67877-0544-88,NDC,,,facility,outpatient,1,mL,0.28000,0.27000,Amish/Mennonite,Amish Mennonite,,0.15400,,,,,,,0.14000,0.27160,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
CEPHALEXIN 250 MG/5 ML POWD,82740,CDM,250,RC,68180-0440-01,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,inpatient,,,152.78000,145.14000,Amish/Mennonite,Amish Mennonite,,84.03,,,,,,,84.03,148.20,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,CPT,,,facility,outpatient,,,152.78000,145.14000,Amish/Mennonite,Amish Mennonite,,84.03,,,,,,,76.39,195.41,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,inpatient,1,mL,76.39000,72.57000,Amish/Mennonite,Amish Mennonite,,42.01,,,,,,,42.01,74.10,percent of total billed charges,
"ROTAVIRUS VACCINE, PENTAVALENT SUSP (ROTATEQ)",82741,CDM,636,RC,90680,HCPCS,00006404741,NDC,facility,outpatient,1,mL,76.39000,72.57000,Amish/Mennonite,Amish Mennonite,,42.01,,,,,,,38.20,195.41,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1378.12,2728.12,percent of total billed charges,
DEVICE VASC CLSR 18FR OTW DSGN MANTA,82743,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2812.50000,2671.88000,Amish/Mennonite,Amish Mennonite,,1546.88,,,,,,,1290.94,2812.50,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
WATCHMAN FLX PRO PROCEDURE DEVICE,82746,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,inpatient,1,EA,2588.14000,2458.73000,Amish/Mennonite,Amish Mennonite,,1423.48,,,,,,,1423.48,2510.50,percent of total billed charges,
LEVONORGESTREL INTRAUTERINE DEVICE 52 MG (MIRENA),82747,CDM,250,RC,J7298,HCPCS,50419042301,NDC,facility,outpatient,1,EA,2588.14000,2458.73000,Amish/Mennonite,Amish Mennonite,,1423.48,,,,,,,1294.07,2510.50,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,inpatient,1,mL,66.57000,63.24000,Amish/Mennonite,Amish Mennonite,,36.61,,,,,,,36.61,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030102,NDC,facility,outpatient,1,mL,66.57000,63.24000,Amish/Mennonite,Amish Mennonite,,36.61,,,,,,,0.77000,64.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,inpatient,1,mL,60.38000,57.36000,Amish/Mennonite,Amish Mennonite,,33.21,,,,,,,33.21,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426030104,NDC,facility,outpatient,1,mL,60.38000,57.36000,Amish/Mennonite,Amish Mennonite,,33.21,,,,,,,0.77000,58.57,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,inpatient,1,mL,69.89000,66.40000,Amish/Mennonite,Amish Mennonite,,38.44,,,,,,,38.44,67.79,percent of total billed charges,
BUPIVACAINE-MELOXICAM SOLN 400 MG-12 MG/14 ML EXTENDED RELEASE,82748,CDM,636,RC,C9088,HCPCS,47426050102,NDC,facility,outpatient,1,mL,69.89000,66.40000,Amish/Mennonite,Amish Mennonite,,38.44,,,,,,,0.77000,67.79,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14399.50000,13679.52000,Amish/Mennonite,Amish Mennonite,,7919.73,,,,,,,7055.76,13967.51,percent of total billed charges,
MONITOR CARD 3.4GM W8XH45.1MM D4.2MM.,82752,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14399.50000,13679.52000,Amish/Mennonite,Amish Mennonite,,7919.73,,,,,,,6609.37,14399.50,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,inpatient,,,606.00000,575.70000,Amish/Mennonite,Amish Mennonite,,333.30,,,,,,,333.30,587.82,percent of total billed charges,
TIXAGEV AND CILGAV INJ MONCLON,82753,CDM,771,RC,M0220,HCPCS,,,facility,outpatient,,,606.00000,575.70000,Amish/Mennonite,Amish Mennonite,,333.30,,,,,,,303.00,587.82,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,inpatient,,,214.40000,203.68000,Amish/Mennonite,Amish Mennonite,90,117.92,,,,,,,117.92,207.97,percent of total billed charges,
"ARSENIC W/REFLEX, 24 HR, URINE SO",82756,CDM,300,RC,82175,CPT,,,facility,outpatient,,,214.40000,203.68000,Amish/Mennonite,Amish Mennonite,90,117.92,,,,,,,19.60,984.66,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,inpatient,,,136.80000,129.96000,Amish/Mennonite,Amish Mennonite,90,75.24,,,,,,,75.24,132.70,percent of total billed charges,
"LEAD, URINE (PBU) SO",82757,CDM,300,RC,83655,CPT,,,facility,outpatient,,,136.80000,129.96000,Amish/Mennonite,Amish Mennonite,90,75.24,,,,,,,12.51,628.12,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,inpatient,,,1100.00000,1045.00000,Amish/Mennonite,Amish Mennonite,,605.00,,,,,,,605.00,1067.00,percent of total billed charges,
AMNIOEXCL 1.5X1.5CM,82773,CDM,636,RC,Q4137,HCPCS,,,facility,outpatient,,,1100.00000,1045.00000,Amish/Mennonite,Amish Mennonite,,605.00,,,,,,,158.39,1067.00,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,inpatient,,,117.28000,111.42000,Amish/Mennonite,Amish Mennonite,,64.50,,,,,,,57.47,113.76,percent of total billed charges,
CUFFLESS TRACH TUBE,82779,CDM,274,RC,A7520,HCPCS,,,facility,outpatient,,,117.28000,111.42000,Amish/Mennonite,Amish Mennonite,,64.50,,,,,,,58.64,113.76,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,inpatient,,,71282.00000,67717.90000,Amish/Mennonite,Amish Mennonite,,39205.10,,,,,,,39205.10,69143.54,percent of total billed charges,
PLUVICTO PER DOSE,82781,CDM,344,RC,A9699,HCPCS,,,facility,outpatient,,,71282.00000,67717.90000,Amish/Mennonite,Amish Mennonite,,39205.10,,,,,,,35641.00,74614.73,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,inpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,822.25,1450.15,percent of total billed charges,
FUNC CORTICAL MAPPING;INIT HR,82792,CDM,740,RC,95961,CPT,,,facility,outpatient,,,1495.00000,1420.25000,Amish/Mennonite,Amish Mennonite,TC,822.25,,,,,,,747.50,1450.15,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,inpatient,,,1833.00000,1741.35000,Amish/Mennonite,Amish Mennonite,,1008.15,,,,,,,1008.15,1778.01,percent of total billed charges,
SCLEROTH FLUID COLLEC/US GUIDE-TECH,82797,CDM,510,RC,49185,CPT,,,facility,outpatient,,,1833.00000,1741.35000,Amish/Mennonite,Amish Mennonite,,1008.15,,,,,,,916.50,1778.01,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,inpatient,,,82.50000,78.38000,Amish/Mennonite,Amish Mennonite,,45.38,,,,,,,45.38,80.03,percent of total billed charges,
"INJ AVSOLA, 10MG",82803,CDM,636,RC,Q5121,HCPCS,,,facility,outpatient,,,82.50000,78.38000,Amish/Mennonite,Amish Mennonite,,45.38,,,,,,,20.89,80.03,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,inpatient,,,1404.00000,1333.80000,Amish/Mennonite,Amish Mennonite,,772.20,,,,,,,772.20,1361.88,percent of total billed charges,
INTRAVEN INJ BEBTELOVIMAB,82805,CDM,260,RC,M0222,HCPCS,,,facility,outpatient,,,1404.00000,1333.80000,Amish/Mennonite,Amish Mennonite,,772.20,,,,,,,702.00,1361.88,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,13175.00000,12516.25000,Amish/Mennonite,Amish Mennonite,,7246.25,,,,,,,6455.75,12779.75,percent of total billed charges,
PACEMAKER CARD 14.2CC W4.45XH5.88CM D0.75CM 29.2GM 2 CHMBR,82808,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,13175.00000,12516.25000,Amish/Mennonite,Amish Mennonite,,7246.25,,,,,,,6047.32,12779.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X12MM,82810,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X38MM,82811,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,inpatient,,,1069.00000,1015.55000,Amish/Mennonite,Amish Mennonite,,587.95,,,,,,,587.95,1036.93,percent of total billed charges,
XR INJ PROC SINUS TRACT STUDY,82812,CDM,320,RC,20501,CPT,,,facility,outpatient,,,1069.00000,1015.55000,Amish/Mennonite,Amish Mennonite,,587.95,,,,,,,247.20,1036.93,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,178.04000,169.14000,Amish/Mennonite,Amish Mennonite,,97.92,,,,,,,87.24,172.70,percent of total billed charges,
SHTH PERFORMER .038 18FR 13CM,82815,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,178.04000,169.14000,Amish/Mennonite,Amish Mennonite,,97.92,,,,,,,81.72,178.04,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2389.84000,2270.35000,Amish/Mennonite,Amish Mennonite,,1314.41,,,,,,,1171.02,2318.14,percent of total billed charges,
GRAFT BNE SUB L12MM UNICORTICAL CANC DWL,82816,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2389.84000,2270.35000,Amish/Mennonite,Amish Mennonite,,1314.41,,,,,,,1096.94,2389.84,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,inpatient,,,631.13000,599.57000,Amish/Mennonite,Amish Mennonite,,347.12,,,,,,,309.25,612.20,percent of total billed charges,
TRAY PICC CATH OD5FR GWIRE L70CM 3L NIT INTVENT RAD,82817,CDM,278,RC,C1751,HCPCS,,,facility,outpatient,,,631.13000,599.57000,Amish/Mennonite,Amish Mennonite,,347.12,,,,,,,289.69,631.13,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV L7MM DIA12MM SHTH 7FR 45X180DEG CRV MUSCULAR VSD.,82818,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA4MM DISC DIA9MM NIT INTERWOVEN.,82819,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA6MM DISC DIA14MM NIT INTERWOVEN.,82820,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA10MM DISC DIA18MM NIT INTERWOVEN.,82821,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA20X30MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82822,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9305.77,20274.00,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA18X28MM SHTH 9FR 45 OR 180DEG CRV PI.,82823,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9305.77,20274.00,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,21296.39000,20231.57000,Amish/Mennonite,Amish Mennonite,,11713.01,,,,,,,10435.23,20657.50,percent of total billed charges,
KIT SND PROC COCHLEAR 2 NAIDA CI SKY M90,82827,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,21296.39000,20231.57000,Amish/Mennonite,Amish Mennonite,,11713.01,,,,,,,10648.19,27182.63,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,inpatient,,,784.00000,744.80000,Amish/Mennonite,Amish Mennonite,TC,431.20,,,,,,,431.20,760.48,percent of total billed charges,
"US,ELASTOGRAPHY,FIRST TARG LSN-TECH",82838,CDM,402,RC,76982,CPT,,,facility,outpatient,,,784.00000,744.80000,Amish/Mennonite,Amish Mennonite,TC,431.20,,,,,,,384.16,760.48,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,inpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,QW,96.25,,,,,,,96.25,169.75,percent of total billed charges,
TER OSMOLARITY (POC),82839,CDM,300,RC,83861,CPT,,,facility,outpatient,,,175.00000,166.25000,Amish/Mennonite,Amish Mennonite,QW,96.25,,,,,,,22.48,1052.52,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,inpatient,,,1520.00000,1444.00000,Amish/Mennonite,Amish Mennonite,TC,836.00,,,,,,,836.00,1474.40,percent of total billed charges,
TELETHERAPY ISODOSE PLAN CMPLX-TECH,8284,CDM,333,RC,77307,CPT,,,facility,outpatient,,,1520.00000,1444.00000,Amish/Mennonite,Amish Mennonite,TC,836.00,,,,,,,726.61,7529.89,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9934.26,19665.78,percent of total billed charges,
OCCLUDER CV L10MM DIA22X32MM SHTH 10FR 45DEG CRV PI MUSCULAR.,82843,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,20274.00000,19260.30000,Amish/Mennonite,Amish Mennonite,,11150.70,,,,,,,9305.77,20274.00,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,22890.00000,21745.50000,Amish/Mennonite,Amish Mennonite,,12589.50,,,,,,,11216.10,22203.30,percent of total billed charges,
INTERSTIM X INS,82846,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,22890.00000,21745.50000,Amish/Mennonite,Amish Mennonite,,12589.50,,,,,,,10506.51,22890.00,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2789.32,5521.73,percent of total billed charges,
INTERSTIM SMART PROGRAMMER KT,82847,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2612.86,5692.50,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,34353.61000,32635.93000,Amish/Mennonite,Amish Mennonite,,18894.49,,,,,,,16833.27,33323.00,percent of total billed charges,
ELECTRODE COCHLEAR SLIM J ULT 3D IMPL,82849,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,34353.61000,32635.93000,Amish/Mennonite,Amish Mennonite,,18894.49,,,,,,,17176.81,34353.61,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,inpatient,1,mL,619.01000,588.06000,Amish/Mennonite,Amish Mennonite,,340.46,,,,,,,340.46,600.44,percent of total billed charges,
HYALURONAN SOLN 15 MG/ML 2 ML (ORTHOVISC),82850,CDM,636,RC,J7324,HCPCS,59676036001,NDC,facility,outpatient,1,mL,619.01000,588.06000,Amish/Mennonite,Amish Mennonite,,340.46,,,,,,,97.70,600.44,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,inpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.43450,0.76630,percent of total billed charges,
MENTHOL GEL 4% 3 ML,82852,CDM,250,RC,59316-0102-11,NDC,,,facility,outpatient,1,mL,0.79000,0.75000,Amish/Mennonite,Amish Mennonite,,0.43450,,,,,,,0.39500,0.76630,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,inpatient,1,mL,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.37400,0.65960,percent of total billed charges,
CARDIOPLEGIA HTK (CUSTODIOL),82853,CDM,250,RC,25767-0735-45,NDC,,,facility,outpatient,1,mL,0.68000,0.64000,Amish/Mennonite,Amish Mennonite,,0.37400,,,,,,,0.34000,0.65960,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,inpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,55.00,97.00,percent of total billed charges,
RPR VEN DEV CNTRL/PERPH ST XR-TECH,82856,CDM,510,RC,36575,CPT,,,facility,outpatient,,,100.00000,95.00000,Amish/Mennonite,Amish Mennonite,,55.00,,,,,,,50.00,645.77,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,inpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,215.05,379.27,percent of total billed charges,
RMV TUN VEN CTH WO PUMP/PRT XR-TECH,82861,CDM,510,RC,36589,CPT,,,facility,outpatient,,,391.00000,371.45000,Amish/Mennonite,Amish Mennonite,,215.05,,,,,,,195.50,645.77,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,inpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,317.90,560.66,percent of total billed charges,
RMV TUN DEV W/SUBC PRT/PUMP XR-TECH,82863,CDM,510,RC,36590,CPT,,,facility,outpatient,,,578.00000,549.10000,Amish/Mennonite,Amish Mennonite,,317.90,,,,,,,289.00,1622.56,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,inpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,136.95,241.53,percent of total billed charges,
CHNGE CYSTOSTOMY TUBE SIMPL XR-TECH,82865,CDM,510,RC,51705,CPT,,,facility,outpatient,,,249.00000,236.55000,Amish/Mennonite,Amish Mennonite,,136.95,,,,,,,124.50,254.03,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,279.23000,265.27000,Amish/Mennonite,Amish Mennonite,,153.58,,,,,,,136.82,270.85,percent of total billed charges,
GUIDEWIRE UROLOGICAL L150CM DIA0.035IN 3CM TAPR NIT,82869,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,279.23000,265.27000,Amish/Mennonite,Amish Mennonite,,153.58,,,,,,,128.17,279.23,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,inpatient,,,2518.00000,2392.10000,Amish/Mennonite,Amish Mennonite,TC,1384.90,,,,,,,1384.90,2442.46,percent of total billed charges,
THYROID IMAG SNG/MULT UPT QUAN,8287,CDM,340,RC,78014,CPT,,,facility,outpatient,,,2518.00000,2392.10000,Amish/Mennonite,Amish Mennonite,TC,1384.90,,,,,,,1163.40,2442.46,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
DEVICE OCCL DIA16MM L ATR APPENDAGE AMPLATZER AMULET,82870,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W13-15MM LOBE L7.5MM D10MM DISC OD24MM 18 DEL,82871,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,inpatient,1,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01100,0.01940,percent of total billed charges,
MELATONIN 0.25 MG TAB,82872,CDM,250,RC,74312-0028-32-00025,NDC,,,facility,outpatient,1,EA,0.02000,0.01000,Amish/Mennonite,Amish Mennonite,,0.01100,,,,,,,0.01000,0.01940,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,inpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,8.69,15.33,percent of total billed charges,
VASOPRESSIN SD 0.12 UNIT/NS 3 ML (DIABETES INSIPIDUS WT < 5 KG),82874,CDM,250,RC,J2598,HCPCS,4202301642500004,NDC,facility,outpatient,1,mL,15.80000,15.01000,Amish/Mennonite,Amish Mennonite,,8.69,,,,,,,2.02,15.33,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,inpatient,1,mL,515.41000,489.64000,Amish/Mennonite,Amish Mennonite,,283.48,,,,,,,283.48,499.95,percent of total billed charges,
ETHANOL 99% SOLN,82876,CDM,250,RC,54288-0105-15,NDC,,,facility,outpatient,1,mL,515.41000,489.64000,Amish/Mennonite,Amish Mennonite,,283.48,,,,,,,257.70,499.95,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,inpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02200,0.03880,percent of total billed charges,
ACETIC ACID TOPICAL 0.25% SOLN 7913584,82877,CDM,250,RC,00264-2304-10,NDC,,,facility,outpatient,1,mL,0.04000,0.04000,Amish/Mennonite,Amish Mennonite,,0.02200,,,,,,,0.02000,0.03880,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,inpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02750,0.04850,percent of total billed charges,
PETROLATUM TOPICAL - OINT 7913432,82878,CDM,250,RC,00521-2326-00,NDC,,,facility,outpatient,1,GM,0.05000,0.05000,Amish/Mennonite,Amish Mennonite,,0.02750,,,,,,,0.02500,0.04850,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,inpatient,1,mL,96.55000,91.72000,Amish/Mennonite,Amish Mennonite,,53.10,,,,,,,53.10,93.65,percent of total billed charges,
SULFACETAMIDE NA-PREDNISOLONE  SUSP-OPHTH 10%-0.2% 10 ML,82879,CDM,250,RC,11980-0022-10,NDC,,,facility,outpatient,1,mL,96.55000,91.72000,Amish/Mennonite,Amish Mennonite,,53.10,,,,,,,48.27,93.65,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,inpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
PETROLATUM OINT 100% 18 GM,82880,CDM,250,RC,08884-4301-00,NDC,,,facility,outpatient,1,GM,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,inpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,331.10,583.94,percent of total billed charges,
US INJ TENDON ORIGIN/INSERT,82882,CDM,360,RC,20551,CPT,,,facility,outpatient,,,602.00000,571.90000,Amish/Mennonite,Amish Mennonite,,331.10,,,,,,,280.29,3163.00,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,40880.70000,38836.66000,Amish/Mennonite,Amish Mennonite,,22484.38,,,,,,,20031.54,39654.28,percent of total billed charges,
VANTA SCS NEUROSTIM 2 CHN W1.1CM RECHRG FREE TYP BTTRY,82884,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,40880.70000,38836.66000,Amish/Mennonite,Amish Mennonite,,22484.38,,,,,,,18764.24,40880.70,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,inpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,7139.30,14132.90,percent of total billed charges,
CATHETER SHOCKWAVE C2 IVL 4.0X12MM,82887,CDM,278,RC,C1761,HCPCS,,,facility,outpatient,,,14570.00000,13841.50000,Amish/Mennonite,Amish Mennonite,,8013.50,,,,,,,6687.63,14570.00,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,116.86,231.34,percent of total billed charges,
INTRO SHTH ANL1 CRV 8.8FR 7FR 55CM HDRPH CKFL,82888,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,238.50000,226.57000,Amish/Mennonite,Amish Mennonite,,131.18,,,,,,,109.47,238.50,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,134.06,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X20MM,82889,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,121.88,236.44,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,inpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,64.90,114.46,percent of total billed charges,
THERAPEUTIC RAD PORT FILMS,8289,CDM,333,RC,77417,CPT,,,facility,outpatient,,,118.00000,112.10000,Amish/Mennonite,Amish Mennonite,,64.90,,,,,,,59.00,619.83,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,inpatient,,,1675.00000,1591.25000,Amish/Mennonite,Amish Mennonite,,921.25,,,,,,,921.25,1624.75,percent of total billed charges,
NEEDLE CORE BX LUNG/MEDIAST-CT-TECH,82890,CDM,510,RC,32408,CPT,,,facility,outpatient,,,1675.00000,1591.25000,Amish/Mennonite,Amish Mennonite,,921.25,,,,,,,837.50,1692.33,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,18331.42000,17414.85000,Amish/Mennonite,Amish Mennonite,,10082.28,,,,,,,8982.40,17781.48,percent of total billed charges,
VALVE VENT MIC W/ RICKHAM RESVR HAKIM,82891,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,18331.42000,17414.85000,Amish/Mennonite,Amish Mennonite,,10082.28,,,,,,,8414.12,18331.42,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA16MM DISC DIA24MM NIT INTERWOVEN.,82892,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA18MM DISC DIA26MM NIT INTERWOVEN.,82893,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X12MM,82894,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,inpatient,1,GM,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.14850,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,00536-1109-45,NDC,,,facility,outpatient,1,GM,0.27000,0.26000,Amish/Mennonite,Amish Mennonite,,0.14850,,,,,,,0.13500,0.26190,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,inpatient,1,GM,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.20350,0.35890,percent of total billed charges,
UREA TOPICAL 20% CREA,82899,CDM,250,RC,58980-0610-30,NDC,,,facility,outpatient,1,GM,0.37000,0.35000,Amish/Mennonite,Amish Mennonite,,0.20350,,,,,,,0.18500,0.35890,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SION STR 190CM,82900,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI RG3 STR 330CM,82901,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
CATHETER BLNDIL 8CM 6MM 130CM ULTRAVERSE 018 CK,82902,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W19-22MM LOBE L10MM D12MM DISC OD32MM 25,82904,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
GUIDEWIRE VASC IMAG L190CM DIA0.014IN SPR,82905,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,inpatient,,,2290.00000,2175.50000,Amish/Mennonite,Amish Mennonite,,1259.50,,,,,,,1259.50,2221.30,percent of total billed charges,
GASTRO PATHOGEN (6-11 TARGETS),82907,CDM,300,RC,87506,CPT,,,facility,outpatient,,,2290.00000,2175.50000,Amish/Mennonite,Amish Mennonite,,1259.50,,,,,,,232.94,12375.92,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,inpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,712.25,1256.15,percent of total billed charges,
INFLIXIMAB-AXXQ POWD-INJ 100 MG (AVSOLA),82908,CDM,636,RC,Q5121,HCPCS,55513067001,NDC,facility,outpatient,1,EA,1295.00000,1230.25000,Amish/Mennonite,Amish Mennonite,,712.25,,,,,,,20.89,1256.15,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,inpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,224.07,percent of total billed charges,
CT DRAINAGE FLUID COLL SOF TIS BY NDL,82909,CDM,360,RC,10160,CPT,,,facility,outpatient,,,231.00000,219.45000,Amish/Mennonite,Amish Mennonite,,127.05,,,,,,,127.05,3163.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X38MM,82910,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9357.04000,8889.19000,Amish/Mennonite,Amish Mennonite,,5146.37,,,,,,,4584.95,9076.33,percent of total billed charges,
PROSTHESIS PENILE 65ML INHIBZN ERECTILE RESTR INFL RESVR MS,82911,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9357.04000,8889.19000,Amish/Mennonite,Amish Mennonite,,5146.37,,,,,,,4294.88,9357.04,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,inpatient,,,7036.72000,6684.88000,Amish/Mennonite,Amish Mennonite,,3870.20,,,,,,,3447.99,6825.62,percent of total billed charges,
CATHETER BLNOCC 120CM NTNL CRDS OUTBACK ELT,82913,CDM,278,RC,C2628,HCPCS,,,facility,outpatient,,,7036.72000,6684.88000,Amish/Mennonite,Amish Mennonite,,3870.20,,,,,,,3229.85,7036.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,inpatient,,,582.19000,553.08000,Amish/Mennonite,Amish Mennonite,,320.20,,,,,,,320.20,564.72,percent of total billed charges,
2CM X 4CM GS-5240,82914,CDM,636,RC,Q4186,HCPCS,,,facility,outpatient,,,582.19000,553.08000,Amish/Mennonite,Amish Mennonite,,320.20,,,,,,,240.68,564.72,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 1 .014 190CM GWIRE,82918,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
ASAHI GAIA NEXT 3 .014 190CM GWIRE,82919,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,inpatient,1,mL,25103.16000,23848.00000,Amish/Mennonite,Amish Mennonite,,13806.74,,,,,,,13806.74,24350.07,percent of total billed charges,
GUSELKUMAB SOLN 100 MG/ML (TREMFYA),82920,CDM,636,RC,J1628,HCPCS,57894064001,NDC,facility,outpatient,1,mL,25103.16000,23848.00000,Amish/Mennonite,Amish Mennonite,,13806.74,,,,,,,74.86,24350.07,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,inpatient,1,EA,18.49000,17.56000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,10.17,17.94,percent of total billed charges,
CEFAZOLIN POWD-INJ 2 GM/20 ML,82921,CDM,250,RC,J0690,HCPCS,60505623105,NDC,facility,outpatient,1,EA,18.49000,17.56000,Amish/Mennonite,Amish Mennonite,,10.17,,,,,,,1.28,17.94,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,inpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,11.30,19.92,percent of total billed charges,
ALOGLIPTIN TAB 25 MG,82922,CDM,250,RC,J8499,HCPCS,45802015065,NDC,facility,outpatient,1,EA,20.54000,19.51000,Amish/Mennonite,Amish Mennonite,,11.30,,,,,,,10.27,19.92,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,inpatient,,,588.75000,559.31000,Amish/Mennonite,Amish Mennonite,,323.81,,,,,,,323.81,571.09,percent of total billed charges,
INJ NYVEPRIA 0.5 MG,82924,CDM,636,RC,Q5122,HCPCS,,,facility,outpatient,,,588.75000,559.31000,Amish/Mennonite,Amish Mennonite,,323.81,,,,,,,132.04,571.09,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,inpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06600,0.11640,percent of total billed charges,
ACETIC ACID TOPICAL 5% SOLN,82925,CDM,250,RC,51552-0055-06,NDC,,,facility,outpatient,1,mL,0.12000,0.11000,Amish/Mennonite,Amish Mennonite,,0.06600,,,,,,,0.06000,0.11640,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA14MM DISC DIA22MM NIT INTERWOVEN.,82926,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,inpatient,1,EA,39.92000,37.92000,Amish/Mennonite,Amish Mennonite,,21.96,,,,,,,21.96,38.72,percent of total billed charges,
ASENAPINE 5 MG TAB,82927,CDM,250,RC,00052-2139-04,NDC,,,facility,outpatient,1,EA,39.92000,37.92000,Amish/Mennonite,Amish Mennonite,,21.96,,,,,,,19.96,38.72,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12835.55,25409.15,percent of total billed charges,
OCCLUDER CV WAIST L7MM DIA8MM DISC DIA16MM NIT INTERWOVEN.,82928,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26195.00000,24885.25000,Amish/Mennonite,Amish Mennonite,,14407.25,,,,,,,12023.50,26195.00,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,inpatient,1,EA,51.56000,48.98000,Amish/Mennonite,Amish Mennonite,,28.36,,,,,,,28.36,50.01,percent of total billed charges,
CEFOXITIN 1 GM/50 ML PREMIX,82929,CDM,250,RC,J0694,HCPCS,00264312311,NDC,facility,outpatient,1,EA,51.56000,48.98000,Amish/Mennonite,Amish Mennonite,,28.36,,,,,,,7.77,50.01,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,inpatient,1,EA,29.86000,28.37000,Amish/Mennonite,Amish Mennonite,,16.42,,,,,,,16.42,28.96,percent of total billed charges,
DACARBAZINE POWD-INJ 100 MG,82931,CDM,250,RC,J9130,HCPCS,63323012710,NDC,facility,outpatient,1,EA,29.86000,28.37000,Amish/Mennonite,Amish Mennonite,,16.42,,,,,,,6.12,28.96,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 PRE 190CM,82932,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,inpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,86.90,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,00409012001,NDC,facility,outpatient,1,EA,158.00000,150.10000,Amish/Mennonite,Amish Mennonite,,86.90,,,,,,,0.04803,153.26,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,inpatient,1,EA,717.43000,681.56000,Amish/Mennonite,Amish Mennonite,,394.59,,,,,,,394.59,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017915,NDC,facility,outpatient,1,EA,717.43000,681.56000,Amish/Mennonite,Amish Mennonite,,394.59,,,,,,,0.04803,695.91,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,inpatient,1,EA,169.28000,160.82000,Amish/Mennonite,Amish Mennonite,,93.10,,,,,,,93.10,164.20,percent of total billed charges,
DAPTOMYCIN POWD-INJ 350 MG,82933,CDM,250,RC,J0878,HCPCS,25021017967,NDC,facility,outpatient,1,EA,169.28000,160.82000,Amish/Mennonite,Amish Mennonite,,93.10,,,,,,,0.04803,164.20,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,257.25,509.25,percent of total billed charges,
GUIDEWIRE ASAHI SUOH 03 STR 190CM,82934,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,525.00000,498.75000,Amish/Mennonite,Amish Mennonite,,288.75,,,,,,,240.97,525.00,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,inpatient,1,mL,1202.80000,1142.66000,Amish/Mennonite,Amish Mennonite,,661.54,,,,,,,661.54,1166.72,percent of total billed charges,
DARBEPOETIN ALFA SOLN 60 MCG/ML,82935,CDM,636,RC,J0881,HCPCS,55513000404,NDC,facility,outpatient,1,mL,1202.80000,1142.66000,Amish/Mennonite,Amish Mennonite,,661.54,,,,,,,3.00,1166.72,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,inpatient,1,EA,36.67000,34.84000,Amish/Mennonite,Amish Mennonite,,20.17,,,,,,,20.17,35.57,percent of total billed charges,
ERYTHROMYCIN 250 MG TAB,82937,CDM,250,RC,24338-0102-03,NDC,,,facility,outpatient,1,EA,36.67000,34.84000,Amish/Mennonite,Amish Mennonite,,20.17,,,,,,,18.34,35.57,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,inpatient,1,EA,44.03000,41.83000,Amish/Mennonite,Amish Mennonite,,24.22,,,,,,,24.22,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,00004-0801-85,NDC,,,facility,outpatient,1,EA,44.03000,41.83000,Amish/Mennonite,Amish Mennonite,,24.22,,,,,,,22.02,42.71,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,inpatient,1,EA,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.35,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,33342-0257-66,NDC,,,facility,outpatient,1,EA,6.09000,5.79000,Amish/Mennonite,Amish Mennonite,,3.35,,,,,,,3.04,5.91,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,inpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.95,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,68180-0676-11,NDC,,,facility,outpatient,1,EA,12.64000,12.01000,Amish/Mennonite,Amish Mennonite,,6.95,,,,,,,6.32,12.26,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,inpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.87,5.05,percent of total billed charges,
OSELTAMIVIR 45 MG CAP,82938,CDM,250,RC,72205-0043-11,NDC,,,facility,outpatient,1,EA,5.21000,4.95000,Amish/Mennonite,Amish Mennonite,,2.87,,,,,,,2.60,5.05,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,inpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.41800,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,42858-0104-01,NDC,,,facility,outpatient,1,EA,0.76000,0.73000,Amish/Mennonite,Amish Mennonite,,0.41800,,,,,,,0.38000,0.73720,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,inpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,2.18,3.85,percent of total billed charges,
ACETAMINOPHEN-OXYCODONE 325 MG-10 MG TAB,82939,CDM,250,RC,50268-0646-15,NDC,,,facility,outpatient,1,EA,3.97000,3.77000,Amish/Mennonite,Amish Mennonite,,2.18,,,,,,,1.99,3.85,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W15-17MM LOBE L7.5MM D10MM DISC OD26MM 20 DEL,82941,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLUDER CV ZONE W17-19MM LOBE L7.5MM D10MM DISC OD28MM 22,82942,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X28MM,82944,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W22-25MM LOBE L10MM D12MM DISC OD35MM 28 DEL.,82949,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCLDER CV ZONE W25-28MM LOBE L10MM D12MM DISC OD38MM 31.,82950,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,inpatient,,,1380.75000,1311.71000,Amish/Mennonite,Amish Mennonite,,759.41,,,,,,,759.41,1339.33,percent of total billed charges,
ENDSC REPAIR ANASTOM LEAK-TECH,82951,CDM,510,RC,43999,CPT,,,facility,outpatient,,,1380.75000,1311.71000,Amish/Mennonite,Amish Mennonite,,759.41,,,,,,,690.38,1339.33,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,17493.00,34629.00,percent of total billed charges,
OCCL CV ZONE W28-31MM LOBE L10MM D12MM DISC OD41MM 34 DEL,82952,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,35700.00000,33915.00000,Amish/Mennonite,Amish Mennonite,,19635.00,,,,,,,16386.30,35700.00,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1181.25000,1122.19000,Amish/Mennonite,Amish Mennonite,,649.69,,,,,,,578.81,1145.81,percent of total billed charges,
GUIDEWIRE VASC L300CM DIA0.014IN 1CM FLX ANG,82953,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1181.25000,1122.19000,Amish/Mennonite,Amish Mennonite,,649.69,,,,,,,542.19,1181.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,inpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,123.75,218.25,percent of total billed charges,
ON TRACK KNEE SYSTEM,82955,CDM,272,RC,A4467,HCPCS,,,facility,outpatient,,,225.00000,213.75000,Amish/Mennonite,Amish Mennonite,,123.75,,,,,,,112.50,218.25,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,inpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,144.65,255.11,percent of total billed charges,
CT BONE LENGTH STUDY,82963,CDM,320,RC,77073,CPT,,,facility,outpatient,,,263.00000,249.85000,Amish/Mennonite,Amish Mennonite,,144.65,,,,,,,100.97,2441.08,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT L/S ADDL W GUID,82964,CDM,761,RC,64484,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,372.50,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,inpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,409.75,722.65,percent of total billed charges,
CT INJ ANES AGNT CER/THOR SGL LVL W GUID,82965,CDM,761,RC,64479,CPT,,,facility,outpatient,,,745.00000,707.75000,Amish/Mennonite,Amish Mennonite,,409.75,,,,,,,372.50,929.91,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,inpatient,,,2449.00000,2326.55000,Amish/Mennonite,Amish Mennonite,LT,1346.95,,,,,,,1346.95,2375.53,percent of total billed charges,
US RF ABLATION GENICULAR NERVE,82972,CDM,761,RC,64624,CPT,,,facility,outpatient,,,2449.00000,2326.55000,Amish/Mennonite,Amish Mennonite,LT,1346.95,,,,,,,1224.50,2375.53,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,inpatient,,,1281.00000,1216.95000,Amish/Mennonite,Amish Mennonite,LT,704.55,,,,,,,704.55,1242.57,percent of total billed charges,
US INJ GENICULAR NERVE BRANCH,82977,CDM,761,RC,64454,CPT,,,facility,outpatient,,,1281.00000,1216.95000,Amish/Mennonite,Amish Mennonite,LT,704.55,,,,,,,640.50,1242.57,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,inpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,82.50,145.50,percent of total billed charges,
US INJ SGL/MULT TRIGGER POINTS,82980,CDM,761,RC,20552,CPT,,,facility,outpatient,,,150.00000,142.50000,Amish/Mennonite,Amish Mennonite,,82.50,,,,,,,75.00,308.32,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,inpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,257.95,454.93,percent of total billed charges,
US INJ SGL/MUL TRIGGR PTS 3/MORE,82983,CDM,761,RC,20553,CPT,,,facility,outpatient,,,469.00000,445.55000,Amish/Mennonite,Amish Mennonite,,257.95,,,,,,,234.50,454.93,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,inpatient,,,3153.00000,2995.35000,Amish/Mennonite,Amish Mennonite,TC,1734.15,,,,,,,1734.15,3058.41,percent of total billed charges,
THYROID CARCINOMA METAS IMAG,8299,CDM,340,RC,78018,CPT,,,facility,outpatient,,,3153.00000,2995.35000,Amish/Mennonite,Amish Mennonite,TC,1734.15,,,,,,,1479.13,3058.41,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,inpatient,1,EA,343.71000,326.53000,Amish/Mennonite,Amish Mennonite,,189.04,,,,,,,189.04,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-01,NDC,,,facility,outpatient,1,EA,343.71000,326.53000,Amish/Mennonite,Amish Mennonite,,189.04,,,,,,,171.85,333.40,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,inpatient,1,EA,309.79000,294.30000,Amish/Mennonite,Amish Mennonite,,170.38,,,,,,,170.38,300.50,percent of total billed charges,
BICTEGRAVIR-EMTRICITABINE-TENOFOVIR TAB 50 MG-200 MG-25 MG (BIKTARVY),82998,CDM,250,RC,61958-2501-03,NDC,,,facility,outpatient,1,EA,309.79000,294.30000,Amish/Mennonite,Amish Mennonite,,170.38,,,,,,,154.90,300.50,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X38MM,82999,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X23MM,83000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.50X33MM,83001,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X12MM,83002,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.75X8MM,83003,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X12MM,83004,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X18MM,83005,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 3.25X23MM,83006,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X15MM,83007,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X18MM,83008,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X28MM,83009,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,inpatient,1,mL,1134.42000,1077.70000,Amish/Mennonite,Amish Mennonite,,623.93,,,,,,,623.93,1100.39,percent of total billed charges,
FILGRASTIM-AAFI SOLN 480 MCG/0.8 ML,83010,CDM,636,RC,Q5110,HCPCS,00069029201,NDC,facility,outpatient,1,mL,1134.42000,1077.70000,Amish/Mennonite,Amish Mennonite,,623.93,,,,,,,0.29000,1100.39,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,inpatient,1,mL,12429.17000,11807.71000,Amish/Mennonite,Amish Mennonite,,6836.04,,,,,,,6836.04,12056.29,percent of total billed charges,
PEGFILGRASTIM-APGF SOLN 6 MG/0.6 ML,83011,CDM,636,RC,Q5122,HCPCS,00069032401,NDC,facility,outpatient,1,mL,12429.17000,11807.71000,Amish/Mennonite,Amish Mennonite,,6836.04,,,,,,,132.04,12056.29,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER DIL L75CM BLLN L5CM DIA6MM SHTH 6FR 40 ATM ULT HI,83012,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,inpatient,,,169.40000,160.93000,Amish/Mennonite,Amish Mennonite,90,93.17,,,,,,,93.17,164.32,percent of total billed charges,
DIPTHERIA TOXOID IGG ANTIBODY SO,83013,CDM,300,RC,86317,CPT,,,facility,outpatient,,,169.40000,160.93000,Amish/Mennonite,Amish Mennonite,90,93.17,,,,,,,15.49,780.94,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER PTCA L75CM BLLN L6CM DIA6MM SHTH 6FR GWIRE 0.035IN,83014,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER NEUROVASC 8FR L95CM BLLN STR 2 PRT LUER HUB.,83015,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2612.86,5692.50,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,126.79,250.99,percent of total billed charges,
SHEATH GUID INTRO 5FR L45CM DIA0.074IN DIL,83016,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,258.75000,245.81000,Amish/Mennonite,Amish Mennonite,,142.31,,,,,,,118.77,258.75,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,44.84,88.77,percent of total billed charges,
CATHETER ANGIO 5FR L65CM ACC GWIRE 0.038IN C1 TIP BEAC TIP,83017,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,91.52000,86.94000,Amish/Mennonite,Amish Mennonite,,50.34,,,,,,,42.01,91.52,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2789.32,5521.73,percent of total billed charges,
CATHETER GUID 90CM BLLN 087 WALRUS,83018,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,5692.50000,5407.88000,Amish/Mennonite,Amish Mennonite,,3130.88,,,,,,,2612.86,5692.50,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 0",83019,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 55 LENGTH, 10",83020,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
SPACER SPNL W18XH8XL60MM 10DEG POR TI LUM IF,83021,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5696.25,11276.25,percent of total billed charges,
"IDENTITI, LIF SPACER, 8 HEIGHT, 18 WIDTH, 50 LENGTH, 10",83022,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,11625.00000,11043.75000,Amish/Mennonite,Amish Mennonite,,6393.75,,,,,,,5335.88,11625.00,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,76.32000,72.50000,Amish/Mennonite,Amish Mennonite,,41.98,,,,,,,37.40,74.03,percent of total billed charges,
CATHETER ANGIO 5FR L90CM 0.038IN PGTL FLSH,83023,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,76.32000,72.50000,Amish/Mennonite,Amish Mennonite,,41.98,,,,,,,35.03,76.32,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1352.40,2677.20,percent of total billed charges,
SHEATH CATH L80CM OD5.5MM ID4.7MM 45X45DEG HRT DEL SGL USE,83024,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1266.84,2760.00,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1352.40,2677.20,percent of total billed charges,
SHTH CATH L80CM OD4.8MM ID4.0MM 45X45DEG HRT DEL SGL US.,83025,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,2760.00000,2622.00000,Amish/Mennonite,Amish Mennonite,,1518.00,,,,,,,1266.84,2760.00,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,inpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2620.28,5187.07,percent of total billed charges,
CATH FRZR 3 MED CRV 7FR 108CM,83026,CDM,278,RC,C1733,HCPCS,,,facility,outpatient,,,5347.50000,5080.12000,Amish/Mennonite,Amish Mennonite,,2941.12,,,,,,,2454.50,5347.50,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3.5X100X130,83027,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.0X25MM,83028,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATH CORSAIR PRO XS 2.9FR 150,83029,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,85.57,169.40,percent of total billed charges,
CATH GUID AL1 8FR 100CM,83030,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,174.64000,165.91000,Amish/Mennonite,Amish Mennonite,,96.05,,,,,,,80.16,174.64,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,inpatient,,,136.51000,129.68000,Amish/Mennonite,Amish Mennonite,,75.08,,,,,,,75.08,132.41,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,CPT,,,facility,outpatient,,,136.51000,129.68000,Amish/Mennonite,Amish Mennonite,,75.08,,,,,,,68.25,144.20,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,inpatient,1,EA,273.02000,259.37000,Amish/Mennonite,Amish Mennonite,,150.16,,,,,,,150.16,264.83,percent of total billed charges,
YELLOW FEVER VACCINE POWD-INJ (YF-VAX),83033,CDM,250,RC,90717,HCPCS,49281091501,NDC,facility,outpatient,1,EA,273.02000,259.37000,Amish/Mennonite,Amish Mennonite,,150.16,,,,,,,136.51,264.83,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,inpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,75.35,132.89,percent of total billed charges,
OT WOUND DEBRIDE NON-SELECT UNITS,83035,CDM,430,RC,97602,CPT,,,facility,outpatient,,,137.00000,130.15000,Amish/Mennonite,Amish Mennonite,,75.35,,,,,,,68.50,264.00,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,inpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,33.55,59.17,percent of total billed charges,
OT WOUND DEBRIDE <20 CM UNITS,83036,CDM,430,RC,97597,CPT,,,facility,outpatient,,,61.00000,57.95000,Amish/Mennonite,Amish Mennonite,,33.55,,,,,,,30.50,264.00,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
PT ESTIM UNATTD WND OTHER ULCER UNITS,83038,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,inpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,88.55,156.17,percent of total billed charges,
OT ESTIM UNATTD WND OTHER ULCER,83039,CDM,430,RC,G0282,HCPCS,,,facility,outpatient,,,161.00000,152.95000,Amish/Mennonite,Amish Mennonite,,88.55,,,,,,,80.50,264.00,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,inpatient,,,40.40000,38.38000,Amish/Mennonite,Amish Mennonite,GO,22.22,,,,,,,22.22,39.19,percent of total billed charges,
"OT DRY NEEDLING, 1-2 MUSCLES UNITS",83040,CDM,430,RC,20560,CPT,,,facility,outpatient,,,40.40000,38.38000,Amish/Mennonite,Amish Mennonite,GO,22.22,,,,,,,20.20,264.00,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,inpatient,,,61.20000,58.14000,Amish/Mennonite,Amish Mennonite,GO,33.66,,,,,,,33.66,59.36,percent of total billed charges,
"OT DRY NEEDLING, 3+ MUSCLES UNITS",83041,CDM,430,RC,20561,CPT,,,facility,outpatient,,,61.20000,58.14000,Amish/Mennonite,Amish Mennonite,GO,33.66,,,,,,,30.60,264.00,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +16.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83043,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83044,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +20.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83045,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83046,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +21.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83047,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83048,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83049,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +22.5 DIOPT L13MM DIA6MM NAT UV ABSRB,83050,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83051,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +24.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83052,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +23.5 DIOPT L13MM DIA6MM 0DEG HAPTIC,83053,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +19.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83054,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +14.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83057,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,inpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,382.25,674.15,percent of total billed charges,
RAD GUID/PERC DRAIN-FLUORO,8306,CDM,320,RC,75989,CPT,,,facility,outpatient,,,695.00000,660.25000,Amish/Mennonite,Amish Mennonite,TC,382.25,,,,,,,298.87,3487.84,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,303.19,600.19,percent of total billed charges,
LENS IO +15.0 DIOPT L13MM DIA6MM 0DEG HAPTIC,83060,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,618.75000,587.81000,Amish/Mennonite,Amish Mennonite,,340.31,,,,,,,153.47,600.19,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,inpatient,,,2470.00000,2346.50000,Amish/Mennonite,Amish Mennonite,TC,1358.50,,,,,,,1358.50,2395.90,percent of total billed charges,
ELECTROMYOGRAPHY;3 EXTREMITIES-TECH,83064,CDM,922,RC,95863,CPT,,,facility,outpatient,,,2470.00000,2346.50000,Amish/Mennonite,Amish Mennonite,TC,1358.50,,,,,,,1235.00,2395.90,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,inpatient,,,3096.00000,2941.20000,Amish/Mennonite,Amish Mennonite,,1702.80,,,,,,,1702.80,3003.12,percent of total billed charges,
"PTROUS APICECT,INC RAD-TECH",83065,CDM,510,RC,69530,CPT,,,facility,outpatient,,,3096.00000,2941.20000,Amish/Mennonite,Amish Mennonite,,1702.80,,,,,,,1548.00,6178.88,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,inpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,3.18,5.61,percent of total billed charges,
HYDROMORPHONE SOLN 4 MG/ML,83068,CDM,250,RC,J1171,HCPCS,00409130431,NDC,facility,outpatient,1,mL,5.78000,5.49000,Amish/Mennonite,Amish Mennonite,,3.18,,,,,,,0.14409,5.61,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,inpatient,,,214.12000,203.41000,Amish/Mennonite,Amish Mennonite,,117.77,,,,,,,117.77,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,CPT,,,facility,outpatient,,,214.12000,203.41000,Amish/Mennonite,Amish Mennonite,,117.77,,,,,,,107.06,207.70,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,inpatient,1,mL,428.24000,406.83000,Amish/Mennonite,Amish Mennonite,,235.53,,,,,,,235.53,415.39,percent of total billed charges,
"MENINGOCOCCAL VACCINE, CONJUGATE SOLN (MENQUADFI)",83069,CDM,250,RC,90619,HCPCS,49281059010,NDC,facility,outpatient,1,mL,428.24000,406.83000,Amish/Mennonite,Amish Mennonite,,235.53,,,,,,,214.12,415.39,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,inpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.24200,0.42680,percent of total billed charges,
LABETALOL 200 MG/D5W 200 ML PREMIX,83071,CDM,250,RC,J1921,HCPCS,00143936610,NDC,facility,outpatient,1,mL,0.44000,0.42000,Amish/Mennonite,Amish Mennonite,,0.24200,,,,,,,0.22000,2.29,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,inpatient,,,113.40000,107.73000,Amish/Mennonite,Amish Mennonite,90,62.37,,,,,,,62.37,110.00,percent of total billed charges,
KIDNEY STONE ANALYSIS (KIDST) SO,83073,CDM,300,RC,82365,CPT,,,facility,outpatient,,,113.40000,107.73000,Amish/Mennonite,Amish Mennonite,90,62.37,,,,,,,13.33,679.08,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,inpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,137.72,242.89,percent of total billed charges,
DISACCHARIDASE ACTIVITY PANEL (DSAC) SO,83074,CDM,300,RC,82657,CPT,,,facility,outpatient,,,250.40000,237.88000,Amish/Mennonite,Amish Mennonite,90,137.72,,,,,,,22.91,1035.56,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,inpatient,1,mL,11.48000,10.91000,Amish/Mennonite,Amish Mennonite,,6.31,,,,,,,6.31,11.14,percent of total billed charges,
METHOTREXATE SOLN 25 MG/ML 2 ML,83080,CDM,250,RC,J9260,HCPCS,61703035038,NDC,facility,outpatient,1,mL,11.48000,10.91000,Amish/Mennonite,Amish Mennonite,,6.31,,,,,,,3.62,11.14,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,inpatient,1,EA,156.07000,148.27000,Amish/Mennonite,Amish Mennonite,,85.84,,,,,,,85.84,151.39,percent of total billed charges,
LUMATEPERONE 42 MG CAP,83092,CDM,250,RC,72060-0142-30,NDC,,,facility,outpatient,1,EA,156.07000,148.27000,Amish/Mennonite,Amish Mennonite,,85.84,,,,,,,78.03,151.39,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,inpatient,,,123.97000,117.77000,Amish/Mennonite,Amish Mennonite,,68.18,,,,,,,68.18,120.25,percent of total billed charges,
NON SURG SOFT BAND BAHA FIT-TECH,83099,CDM,470,RC,92700,CPT,,,facility,outpatient,,,123.97000,117.77000,Amish/Mennonite,Amish Mennonite,,68.18,,,,,,,23.25,120.25,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,inpatient,1,mL,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.80,3.17,percent of total billed charges,
BUPIVACAINE 0.5% AMPOULES 5 ML,83102,CDM,250,RC,59923-0718-05,NDC,,,facility,outpatient,1,mL,3.27000,3.10000,Amish/Mennonite,Amish Mennonite,,1.80,,,,,,,1.64,3.17,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,892.50000,847.88000,Amish/Mennonite,Amish Mennonite,,490.88,,,,,,,437.32,865.73,percent of total billed charges,
HANDLE INST RUBY DTCH COIL,83110,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,892.50000,847.88000,Amish/Mennonite,Amish Mennonite,,490.88,,,,,,,409.66,892.50,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,inpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,1.45,2.55,percent of total billed charges,
HYDROXOCOBALAMIN SOLN 1000 MCG/ML 30ML,83111,CDM,250,RC,J3425,HCPCS,00591288830,NDC,facility,outpatient,1,mL,2.63000,2.50000,Amish/Mennonite,Amish Mennonite,,1.45,,,,,,,0.01000,2.55,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,inpatient,1,mL,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.59950,1.06,percent of total billed charges,
LIPID EMULSION 20% 100 ML (CLINOLIPID),83114,CDM,250,RC,00338-9540-05,NDC,,,facility,outpatient,1,mL,1.09000,1.04000,Amish/Mennonite,Amish Mennonite,,0.59950,,,,,,,0.54500,1.06,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (CLINOLIPID),83115,CDM,250,RC,00338-9540-06,NDC,,,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,inpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.18150,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (SMOFLIPID),83116,CDM,250,RC,63323-0820-74,NDC,,,facility,outpatient,1,mL,0.33000,0.31000,Amish/Mennonite,Amish Mennonite,,0.18150,,,,,,,0.16500,0.32010,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,inpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.33000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,00338051909,NDC,facility,outpatient,1,mL,0.60000,0.57000,Amish/Mennonite,Amish Mennonite,,0.33000,,,,,,,0.30000,0.58200,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,inpatient,1,mL,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.30800,0.54320,percent of total billed charges,
LIPID EMULSION 20% 250 ML (INTRALIPID),83117,CDM,250,RC,J3490,HCPCS,65219053325,NDC,facility,outpatient,1,mL,0.56000,0.53000,Amish/Mennonite,Amish Mennonite,,0.30800,,,,,,,0.28000,0.54320,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,inpatient,1,EA,57.15000,54.29000,Amish/Mennonite,Amish Mennonite,,31.43,,,,,,,31.43,55.44,percent of total billed charges,
VANCOMYCIN POWD-INJ 1.5 GM,83119,CDM,636,RC,J3370,HCPCS,00409351501,NDC,facility,outpatient,1,EA,57.15000,54.29000,Amish/Mennonite,Amish Mennonite,,31.43,,,,,,,3.02,55.44,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3198.75000,3038.81000,Amish/Mennonite,Amish Mennonite,,1759.31,,,,,,,1567.39,3102.79,percent of total billed charges,
KIT EXTN L60CM EMAN LJ53 W/ MRK FOR DP BRAIN STIM SENSIGHT.,83120,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3198.75000,3038.81000,Amish/Mennonite,Amish Mennonite,,1759.31,,,,,,,1468.23,3198.75,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,3168.75000,3010.31000,Amish/Mennonite,Amish Mennonite,,1742.81,,,,,,,1552.69,3073.69,percent of total billed charges,
KIT EXTENSION L60CM EMAN LJ53 FOR DP BRAIN STIM SENSIGHT.,83121,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,3168.75000,3010.31000,Amish/Mennonite,Amish Mennonite,,1742.81,,,,,,,1454.46,3168.75,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BALLOON DILATION CONQ 40 7X6X75,83138,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,506.93000,481.58000,Amish/Mennonite,Amish Mennonite,,278.81,,,,,,,248.40,491.72,percent of total billed charges,
FARROW THIGHPIECE,83140,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,506.93000,481.58000,Amish/Mennonite,Amish Mennonite,,278.81,,,,,,,232.68,491.72,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,inpatient,,,179.60000,170.62000,Amish/Mennonite,Amish Mennonite,,98.78,,,,,,,88.00,174.21,percent of total billed charges,
FARROW BAS FOOTPIEC,83141,CDM,274,RC,A6545,HCPCS,,,facility,outpatient,,,179.60000,170.62000,Amish/Mennonite,Amish Mennonite,,98.78,,,,,,,82.44,174.21,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L24CM AXXCESS CATH 6FR PERCFLX HYDR+ DBL,83143,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,382.50000,363.38000,Amish/Mennonite,Amish Mennonite,,210.38,,,,,,,187.43,371.02,percent of total billed charges,
KIT TORQ WRNCH LD CAP LJ53 FOR DP BRAIN STIM SENSIGHT,83154,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,382.50000,363.38000,Amish/Mennonite,Amish Mennonite,,210.38,,,,,,,175.57,382.50,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,7141.50000,6784.42000,Amish/Mennonite,Amish Mennonite,,3927.82,,,,,,,3499.34,6927.26,percent of total billed charges,
STENT ES L10CM BODY DIA18MM FLNG DIA23MM FLARE Y FULL CVR,83159,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,7141.50000,6784.42000,Amish/Mennonite,Amish Mennonite,,3927.82,,,,,,,3277.95,7141.50,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,inpatient,,,5951.25000,5653.69000,Amish/Mennonite,Amish Mennonite,,3273.19,,,,,,,2916.11,5772.71,percent of total billed charges,
VERSACROSS TRNSSEPT SHTH LEN 71 CM CRV M DIL CRV D1,83160,CDM,278,RC,C1766,HCPCS,,,facility,outpatient,,,5951.25000,5653.69000,Amish/Mennonite,Amish Mennonite,,3273.19,,,,,,,2731.62,5951.25,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,2043.75000,1941.56000,Amish/Mennonite,Amish Mennonite,,1124.06,,,,,,,1001.44,1982.44,percent of total billed charges,
MICROCATHETER GUID 2.9FR SHFT 2.4FR CROSSING PROF L135CM,83161,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,2043.75000,1941.56000,Amish/Mennonite,Amish Mennonite,,1124.06,,,,,,,938.08,2043.75,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,inpatient,1,EA,10207.88000,9697.49000,Amish/Mennonite,Amish Mennonite,,5614.33,,,,,,,5614.33,9901.64,percent of total billed charges,
RASBURICASE 7.5 MG POWD,83163,CDM,250,RC,J2783,HCPCS,00024515175,NDC,facility,outpatient,1,EA,10207.88000,9697.49000,Amish/Mennonite,Amish Mennonite,,5614.33,,,,,,,376.48,9901.64,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,inpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.55,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,60687-0722-01,NDC,,,facility,outpatient,1,EA,2.81000,2.67000,Amish/Mennonite,Amish Mennonite,,1.55,,,,,,,1.41,2.73,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,inpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.53,2.71,percent of total billed charges,
OXCARBAZEPINE 300 MG TAB,83167,CDM,250,RC,68084-0853-01,NDC,,,facility,outpatient,1,EA,2.79000,2.65000,Amish/Mennonite,Amish Mennonite,,1.53,,,,,,,1.40,2.71,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,88.20,174.60,percent of total billed charges,
CATHETER GUIDE L100CM OD5FR ID0.058IN NYL COR NOTO L LUMEN FLX,83168,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,180.00000,171.00000,Amish/Mennonite,Amish Mennonite,,99.00,,,,,,,82.62,180.00,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,inpatient,1,EA,53.80000,51.11000,Amish/Mennonite,Amish Mennonite,,29.59,,,,,,,29.59,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00264315311,NDC,facility,outpatient,1,EA,53.80000,51.11000,Amish/Mennonite,Amish Mennonite,,29.59,,,,,,,0.76415,52.19,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,inpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.32450,0.57230,percent of total billed charges,
CEFTRIAXONE 1 G/50 ML-ISO-OSMOTIC DEXTROSE SOLN,83169,CDM,250,RC,J0696,HCPCS,00338500241,NDC,facility,outpatient,1,EA,0.59000,0.56000,Amish/Mennonite,Amish Mennonite,,0.32450,,,,,,,0.29500,0.81340,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,inpatient,1,EA,51.58000,49.00000,Amish/Mennonite,Amish Mennonite,,28.37,,,,,,,28.37,50.03,percent of total billed charges,
VORTIOXETINE 20 MG TAB,83175,CDM,250,RC,64764-0750-30,NDC,,,facility,outpatient,1,EA,51.58000,49.00000,Amish/Mennonite,Amish Mennonite,,28.37,,,,,,,25.79,50.03,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,inpatient,1,EA,64.37000,61.15000,Amish/Mennonite,Amish Mennonite,,35.40,,,,,,,35.40,62.44,percent of total billed charges,
EMPAGLIFLOZIN 10 MG TAB,83176,CDM,250,RC,00597-0152-90,NDC,,,facility,outpatient,1,EA,64.37000,61.15000,Amish/Mennonite,Amish Mennonite,,35.40,,,,,,,32.19,62.44,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,inpatient,1,EA,61.33000,58.26000,Amish/Mennonite,Amish Mennonite,,33.73,,,,,,,33.73,59.49,percent of total billed charges,
DAPAGLIFLOZIN 5 MG TAB,83177,CDM,250,RC,00310-6205-30,NDC,,,facility,outpatient,1,EA,61.33000,58.26000,Amish/Mennonite,Amish Mennonite,,33.73,,,,,,,30.66,59.49,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,inpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.92950,1.64,percent of total billed charges,
BENZOCAINE TOPICAL 20 % GEL-ORAL,83178,CDM,250,RC,60640-9200-01,NDC,,,facility,outpatient,1,EA,1.69000,1.60000,Amish/Mennonite,Amish Mennonite,,0.92950,,,,,,,0.84500,1.64,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,inpatient,1,mL,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.70950,1.25,percent of total billed charges,
PENTAFLUOROPROPANE-TETRAFLUOROETHANE TOPICAL - SPRA,83179,CDM,250,RC,00386-0008-04,NDC,,,facility,outpatient,1,mL,1.29000,1.22000,Amish/Mennonite,Amish Mennonite,,0.70950,,,,,,,0.64500,1.25,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,inpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.07150,0.12610,percent of total billed charges,
TPN-CLINIMIX E 4.25/5 W/ ELECTROLYTES 2 LITER,83181,CDM,250,RC,00338-1113-04,NDC,,,facility,outpatient,1,mL,0.13000,0.12000,Amish/Mennonite,Amish Mennonite,,0.07150,,,,,,,0.06500,0.12610,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,inpatient,1,mL,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.88000,1.55,percent of total billed charges,
AMINOPHYLLINE 25 MG/ML SOLN,83182,CDM,250,RC,J0280,HCPCS,00409592201,NDC,facility,outpatient,1,mL,1.60000,1.52000,Amish/Mennonite,Amish Mennonite,,0.88000,,,,,,,0.80000,18.34,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,inpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,25021041882,NDC,facility,outpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,inpatient,1,mL,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.36300,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,51754010803,NDC,facility,outpatient,1,mL,0.66000,0.63000,Amish/Mennonite,Amish Mennonite,,0.36300,,,,,,,0.33000,0.64020,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,inpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.35750,0.63050,percent of total billed charges,
TRANEXAMIC ACID 10 MG/ML-NACL 0.7% SOLN,83183,CDM,250,RC,J3490,HCPCS,80830232903,NDC,facility,outpatient,1,mL,0.65000,0.61000,Amish/Mennonite,Amish Mennonite,,0.35750,,,,,,,0.32500,0.63050,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,inpatient,1,mL,95.59000,90.81000,Amish/Mennonite,Amish Mennonite,,52.57,,,,,,,52.57,92.72,percent of total billed charges,
DEXAMETHASONE/KETOROLAC/MOXIFLOXACIN OPHTHALMIC 1 MG-0.4 MG-0.5 MG/ML SOLN,83184,CDM,250,RC,71384-0513-01,NDC,,,facility,outpatient,1,mL,95.59000,90.81000,Amish/Mennonite,Amish Mennonite,,52.57,,,,,,,47.80,92.72,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,inpatient,1,EA,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,3.49,6.16,percent of total billed charges,
PROTHROMBIN COMPLEX POWD-INJ 1000 UNIT (KCENTRA),83185,CDM,636,RC,J7168,HCPCS,63833038702,NDC,facility,outpatient,1,EA,6.35000,6.03000,Amish/Mennonite,Amish Mennonite,,3.49,,,,,,,2.14,6.16,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,inpatient,1,mL,4.34000,4.12000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,2.39,4.21,percent of total billed charges,
"HEPARIN 7,500 UNITS/0.75 ML SOLN",83186,CDM,250,RC,J1644,HCPCS,2502104036600075,NDC,facility,outpatient,1,mL,4.34000,4.12000,Amish/Mennonite,Amish Mennonite,,2.39,,,,,,,0.33945,4.21,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,inpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,123.20,217.28,percent of total billed charges,
PSYTX 60 MIN MD-TECH,83188,CDM,914,RC,90837,CPT,,,facility,outpatient,,,224.00000,212.80000,Amish/Mennonite,Amish Mennonite,,123.20,,,,,,,112.00,264.00,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,29.92000,28.42000,Amish/Mennonite,Amish Mennonite,,16.46,,,,,,,14.66,29.02,percent of total billed charges,
CATHETER URETH 8FR 3ML F PED PLIABLE FRM TIP 2 W LG SMTH EYE,83190,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,29.92000,28.42000,Amish/Mennonite,Amish Mennonite,,16.46,,,,,,,13.73,29.92,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.5",83191,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X1.7",83192,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.0",83193,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.3",83194,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.5",83195,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X2.7",83196,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.0",83197,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X3.5",83198,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.0",83199,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,inpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,266.06,469.24,percent of total billed charges,
"BALLOON,GASTRO MINIONE 16X4.4",83200,CDM,272,RC,B4088,HCPCS,,,facility,outpatient,,,483.75000,459.56000,Amish/Mennonite,Amish Mennonite,,266.06,,,,,,,47.62,469.24,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,821.25000,780.19000,Amish/Mennonite,Amish Mennonite,,451.69,,,,,,,402.41,796.61,percent of total billed charges,
CATHETER DLYS PERI INF COIL 2 CUF ARC 42CM,83201,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,821.25000,780.19000,Amish/Mennonite,Amish Mennonite,,451.69,,,,,,,376.95,821.25,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,52.32000,49.70000,Amish/Mennonite,Amish Mennonite,,28.78,,,,,,,25.64,50.75,percent of total billed charges,
CATHETER URET 5FR L70CM PVC OPN END TIP,83203,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,52.32000,49.70000,Amish/Mennonite,Amish Mennonite,,28.78,,,,,,,24.01,52.32,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM DIA6FR HYDR+ PERCFLX TAPR TIP DBL PGTL THRD,83204,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L20CM OD7FR PERCFLX HYDR+ COAT 2 DUROMETER,83205,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
SET URETH STENT 6FR L26CM AXXCSS CATH 6FR PRCFLX HYDR+ DBL,83206,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 6FR L30CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83207,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L22CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83208,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L24CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83210,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L26CM HYDR+ COAT PERCFLX 2 DUROMETER DBL PGT,83211,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET 7FR L28CM PERCFLX HYDR+ DBL PGTL THRD 2 DUROMETER,83212,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,522.71,1034.76,percent of total billed charges,
STENT URET L30CM OD7FR PERCFLX HYDR+ DBL PGTL THRD 2,83213,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1066.76000,1013.42000,Amish/Mennonite,Amish Mennonite,,586.72,,,,,,,489.64,1066.76,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,inpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,2028.60,4015.80,percent of total billed charges,
KIT CHRG SYS W/ CHRG BASE STN AC DC PWR SUPL M BELT,83214,CDM,278,RC,C1820,HCPCS,,,facility,outpatient,,,4140.00000,3933.00000,Amish/Mennonite,Amish Mennonite,,2277.00,,,,,,,1900.26,4140.00,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,44.64000,42.41000,Amish/Mennonite,Amish Mennonite,,24.55,,,,,,,21.87,43.30,percent of total billed charges,
CATHETER URET 4FR L70CM 0.025IN OPN END TIP FOR DRNGE RG,83218,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,44.64000,42.41000,Amish/Mennonite,Amish Mennonite,,24.55,,,,,,,20.49,44.64,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,46.08000,43.78000,Amish/Mennonite,Amish Mennonite,,25.34,,,,,,,22.58,44.70,percent of total billed charges,
CATHETER URET 3FR L70CM GWIRE 0.018IN OPN END TIP FOR DRNGE,83219,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,46.08000,43.78000,Amish/Mennonite,Amish Mennonite,,25.34,,,,,,,21.15,46.08,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,inpatient,,,308.50000,293.08000,Amish/Mennonite,Amish Mennonite,90,169.68,,,,,,,169.68,299.25,percent of total billed charges,
"MYCOPLASMA GENITALIUM, TMA (AMGEN) SO",83220,CDM,300,RC,87563,CPT,,,facility,outpatient,,,308.50000,293.08000,Amish/Mennonite,Amish Mennonite,90,169.68,,,,,,,28.07,299.25,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,inpatient,1,GM,13.05000,12.40000,Amish/Mennonite,Amish Mennonite,,7.18,,,,,,,7.18,12.66,percent of total billed charges,
SUCCIMER 98 % POWDER,83221,CDM,250,RC,38779-0780-04,NDC,,,facility,outpatient,1,GM,13.05000,12.40000,Amish/Mennonite,Amish Mennonite,,7.18,,,,,,,6.53,12.66,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,inpatient,1,mL,42.10000,40.00000,Amish/Mennonite,Amish Mennonite,,23.16,,,,,,,23.16,40.84,percent of total billed charges,
DEXMEDETOMIDINE 100 MCG/ML SOLN,83222,CDM,250,RC,44567-0601-04,NDC,,,facility,outpatient,1,mL,42.10000,40.00000,Amish/Mennonite,Amish Mennonite,,23.16,,,,,,,21.05,40.84,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,inpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.26,3.99,percent of total billed charges,
LIDOCAINE SOLN 2% 2 ML,83223,CDM,250,RC,J2003,HCPCS,63323020202,NDC,facility,outpatient,1,mL,4.11000,3.90000,Amish/Mennonite,Amish Mennonite,,2.26,,,,,,,2.06,3.99,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,inpatient,1,mL,15.52000,14.74000,Amish/Mennonite,Amish Mennonite,,8.54,,,,,,,8.54,15.05,percent of total billed charges,
EPINEPHRINE/LIDOCAINE/TETRACAINE TOPICAL 0.18%-4%-0.5% GEL,83225,CDM,250,RC,71266-6290-01,NDC,,,facility,outpatient,1,mL,15.52000,14.74000,Amish/Mennonite,Amish Mennonite,,8.54,,,,,,,7.76,15.05,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,inpatient,1,mL,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.63250,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,00409930310,NDC,facility,outpatient,1,mL,1.15000,1.09000,Amish/Mennonite,Amish Mennonite,,0.63250,,,,,,,0.08525,1.12,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,inpatient,1,mL,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,1.97,3.48,percent of total billed charges,
ROPIVACAINE SOLN 1% 10 ML,83226,CDM,250,RC,J2795,HCPCS,63323028811,NDC,facility,outpatient,1,mL,3.59000,3.41000,Amish/Mennonite,Amish Mennonite,,1.97,,,,,,,0.08525,3.48,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1561.88,3091.88,percent of total billed charges,
CATHETER PTCA L130CM DIA6FR BLLN L150MM,83227,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,3187.50000,3028.12000,Amish/Mennonite,Amish Mennonite,,1753.12,,,,,,,1463.06,3187.50,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,inpatient,,,24.68000,23.45000,Amish/Mennonite,Amish Mennonite,,13.57,,,,,,,13.57,23.94,percent of total billed charges,
WAX BNE 2.5GM NAT DISP FOR WND CLSR.,83230,CDM,272,RC,A4649,HCPCS,,,facility,outpatient,,,24.68000,23.45000,Amish/Mennonite,Amish Mennonite,,13.57,,,,,,,12.34,23.94,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2844.79000,2702.55000,Amish/Mennonite,Amish Mennonite,,1564.63,,,,,,,1393.95,2759.45,percent of total billed charges,
GRAFT VASC L400MM DIA20MM BRANCH DIA10MM UNIV CLLGN DBL VEL,83231,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2844.79000,2702.55000,Amish/Mennonite,Amish Mennonite,,1564.63,,,,,,,1305.76,2844.79,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,3522.97000,3346.82000,Amish/Mennonite,Amish Mennonite,,1937.63,,,,,,,1726.26,3417.28,percent of total billed charges,
MCTH CERBRVASC 2.3-2.8FR .021IN 150CM PTFE HDRPH,83233,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,3522.97000,3346.82000,Amish/Mennonite,Amish Mennonite,,1937.63,,,,,,,1617.04,3522.97,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,7444.62,14737.31,percent of total billed charges,
GRAFT EVAR L11.5CM DST DIA16MM FEP NIT CONTRALATERAL LEG IL,83234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,15193.10000,14433.44000,Amish/Mennonite,Amish Mennonite,,8356.20,,,,,,,6973.63,15193.10,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4790.88,9483.98,percent of total billed charges,
STENT DUODENAL L6CM BODY DIA22MM FLNG DIA27MM ACC CHN 3.7MM.,83235,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9777.30000,9288.43000,Amish/Mennonite,Amish Mennonite,,5377.52,,,,,,,4487.78,9777.30,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT EVAR L17CM AORT DIA31MM IL DIA14.5MM IPSILATERAL LEG,83236,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11949.78,23655.68,percent of total billed charges,
GRAFT ENDOPROS L16CM AORT DIA23MM IL DIA12MM IPSILATERAL LEG,83237,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24387.30000,23167.93000,Amish/Mennonite,Amish Mennonite,,13413.01,,,,,,,11193.77,24387.30,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,inpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01650,0.02910,percent of total billed charges,
MAGNESIUM SULFATE 40 G/1000 ML-STERILE WATER SOLN,83238,CDM,250,RC,J3475,HCPCS,63323010610,NDC,facility,outpatient,1,mL,0.03000,0.03000,Amish/Mennonite,Amish Mennonite,,0.01650,,,,,,,0.01500,0.82500,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,inpatient,1,mL,45962.56000,43664.43000,Amish/Mennonite,Amish Mennonite,,25279.41,,,,,,,25279.41,44583.68,percent of total billed charges,
USTEKINUMAB SOLN 90 MG/ML (STELARA),83239,CDM,636,RC,J3357,HCPCS,57894006103,NDC,facility,outpatient,1,mL,45962.56000,43664.43000,Amish/Mennonite,Amish Mennonite,,25279.41,,,,,,,157.68,44583.68,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,6486.00000,6161.70000,Amish/Mennonite,Amish Mennonite,,3567.30,,,,,,,3178.14,6291.42,percent of total billed charges,
SEPARATOR THRMB 8 .072IN 150CM INDG LF,83240,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,6486.00000,6161.70000,Amish/Mennonite,Amish Mennonite,,3567.30,,,,,,,2977.07,6486.00,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,Amish/Mennonite,Amish Mennonite,,31.34,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 290 MCG CAP,83243,CDM,250,RC,00456-1202-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,Amish/Mennonite,Amish Mennonite,,31.34,,,,,,,28.49,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,inpatient,1,EA,56.98000,54.13000,Amish/Mennonite,Amish Mennonite,,31.34,,,,,,,31.34,55.27,percent of total billed charges,
LINACLOTIDE 145 MCG CAP,83244,CDM,250,RC,00456-1201-30,NDC,,,facility,outpatient,1,EA,56.98000,54.13000,Amish/Mennonite,Amish Mennonite,,31.34,,,,,,,28.49,55.27,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,176.73,349.86,percent of total billed charges,
BUTTON 4CM 16FR RADOPQ LOPRFL PROX ANRFLX V RCS,83246,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,360.68000,342.65000,Amish/Mennonite,Amish Mennonite,,198.37,,,,,,,165.55,360.68,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,229.69,454.69,percent of total billed charges,
CATHETER ANGIO 5FR 75CM AZYGOS RT PU IMPRS,83247,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,468.75000,445.31000,Amish/Mennonite,Amish Mennonite,,257.81,,,,,,,215.16,468.75,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2408.96,4768.76,percent of total billed charges,
CATHETER BLNDIL 12MM 75CM PCLTXL LUTONIX 035 40.,83248,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,4916.25000,4670.44000,Amish/Mennonite,Amish Mennonite,,2703.94,,,,,,,2256.56,4916.25,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,128.62,254.62,percent of total billed charges,
CATHETER BLNDIL 200MM 4MM 130CM ULTRAVERSE 035,83249,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,262.50000,249.38000,Amish/Mennonite,Amish Mennonite,,144.38,,,,,,,120.49,262.50,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATHETER BLNDIL 3MM 145CM PEBAX HDRCT TREK 15MM,83250,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,305.02,603.83,percent of total billed charges,
CATHETER BLNDIL 8MM 75CM CONQ 40 6CM RADOPQ RPD.,83251,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,622.50000,591.38000,Amish/Mennonite,Amish Mennonite,,342.38,,,,,,,285.73,622.50,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3254.21,6442.01,percent of total billed charges,
CATHETER BLNDL 7MM 130CM PCLTXL LUTONX 035,83252,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,6641.25000,6309.19000,Amish/Mennonite,Amish Mennonite,,3652.69,,,,,,,3048.33,6641.25,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,419.87,831.17,percent of total billed charges,
CATHETER SUPP DIA0.035IN L65CM 30DEG ANG,83253,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,856.88000,814.04000,Amish/Mennonite,Amish Mennonite,,471.28,,,,,,,393.31,856.88,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,inpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,19761.43,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD 83GM W51XH74IN D13MM DF1 BLUESYNC,83254,CDM,275,RC,C1882,HCPCS,,,facility,outpatient,,,40329.45000,38312.98000,Amish/Mennonite,Amish Mennonite,,22181.20,,,,,,,18511.22,39119.57,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF MRI IS1 DF1,83255,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,20528.18,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,21914.61,43381.99,percent of total billed charges,
DEFIBRILLATOR CARD CO XT HF QUAD MRI IS4 DF1,83256,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,44723.70000,42487.51000,Amish/Mennonite,Amish Mennonite,,24598.03,,,,,,,20528.18,43381.99,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5834.48,11549.89,percent of total billed charges,
GRAFT EVAR L107MM DIA13MM SHTH OD5.4MM ID4.7MM,83257,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11907.10000,11311.74000,Amish/Mennonite,Amish Mennonite,,6548.90,,,,,,,5465.36,11907.10,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,Amish/Mennonite,Amish Mennonite,,23557.38,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L10CM DIA26X26MM INTENDED AORT DIA19.5-24MM,83258,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,Amish/Mennonite,Amish Mennonite,,23557.38,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L155MM DIA32MM SHTH OD7.1MM ID6MM PROX COMP,83259,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,17319.36,37732.80,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,inpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,TC,356.40,,,,,,,356.40,628.56,percent of total billed charges,
URETHROCYSTOGRAPHY RETROGRADE-TECH,8326,CDM,320,RC,74450,CPT,,,facility,outpatient,,,648.00000,615.60000,Amish/Mennonite,Amish Mennonite,TC,356.40,,,,,,,324.00,2941.42,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,42831.60000,40690.02000,Amish/Mennonite,Amish Mennonite,,23557.38,,,,,,,20987.48,41546.65,percent of total billed charges,
GRAFT EVAR L15CM DIA37X37MM INTENDED AORT DIA29-34MM,83260,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,42831.60000,40690.02000,Amish/Mennonite,Amish Mennonite,,23557.38,,,,,,,19659.70,42831.60,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,18489.07,36600.82,percent of total billed charges,
GRAFT EVAR L161MM DIA36MM SHTH OD7.1MM ID6MM PROX COMP,83261,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,37732.80000,35846.16000,Amish/Mennonite,Amish Mennonite,,20753.04,,,,,,,17319.36,37732.80,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,33730.20000,32043.69000,Amish/Mennonite,Amish Mennonite,,18551.61,,,,,,,16527.80,32718.29,percent of total billed charges,
GRAFT EVAR L180MM DIA36MM SHTH 6X16FR STNT PRO FRM ZENITH,83262,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,33730.20000,32043.69000,Amish/Mennonite,Amish Mennonite,,18551.61,,,,,,,15482.16,33730.20,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,10372.60000,9853.97000,Amish/Mennonite,Amish Mennonite,,5704.93,,,,,,,5082.57,10061.42,percent of total billed charges,
GRAFT EVAR L7CM DIA10MM IL EXT W/ C3 DEL SYS FOR AAA,83264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,10372.60000,9853.97000,Amish/Mennonite,Amish Mennonite,,5704.93,,,,,,,4761.02,10372.60,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,27875.40000,26481.63000,Amish/Mennonite,Amish Mennonite,,15331.47,,,,,,,13658.95,27039.14,percent of total billed charges,
GRAFT EVAR STNT L12CM DIA20X12MM RECOMMENDED INTRO SHTH 15FR,83265,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,27875.40000,26481.63000,Amish/Mennonite,Amish Mennonite,,15331.47,,,,,,,12794.81,27875.40,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4880.55,9661.49,percent of total billed charges,
GRAFT EVAR STNT L39MM DIA8-11MM CATH L135CM INTRO SHTH 7FR,83266,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9960.30000,9462.28000,Amish/Mennonite,Amish Mennonite,,5478.16,,,,,,,4571.78,9960.30,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1706.25000,1620.94000,Amish/Mennonite,Amish Mennonite,,938.44,,,,,,,836.06,1655.06,percent of total billed charges,
GRAFT VASC STR WVN DBL VEL 28MM DIAX15CM L HEMSHLD PLAT,83268,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1706.25000,1620.94000,Amish/Mennonite,Amish Mennonite,,938.44,,,,,,,783.17,1706.25,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,229.32,453.96,percent of total billed charges,
INTRO LD VERT CRV TPR 5FR .046IN 75CM WORLEY ERG,83270,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,468.00000,444.60000,Amish/Mennonite,Amish Mennonite,,257.40,,,,,,,214.81,468.00,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
KIT JJNSTM 18FR 45CM TRNGS TNG SIL MC SLK 2.5CM,83271,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
KIT NRSTM 50CM NEVRO STY STRL LF DISP,83272,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,13671.00,27063.00,percent of total billed charges,
LEAD NEUROSTIM L65CM RESPISTIM LQS,83275,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,27900.00000,26505.00000,Amish/Mennonite,Amish Mennonite,,15345.00,,,,,,,12806.10,27900.00,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,26427.50000,25106.12000,Amish/Mennonite,Amish Mennonite,,14535.12,,,,,,,12949.48,25634.67,percent of total billed charges,
OCCLUDER CV 32MM CATH 10FR L80CM CARDIOFORM ASD,83280,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,26427.50000,25106.12000,Amish/Mennonite,Amish Mennonite,,14535.12,,,,,,,12130.22,26427.50,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1087.80,2153.40,percent of total billed charges,
SHEATH INTRO 15FR L33CM OD5.6MM ID5MM,83281,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,2220.00000,2109.00000,Amish/Mennonite,Amish Mennonite,,1221.00,,,,,,,1018.98,2220.00,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2535.75,5019.75,percent of total billed charges,
STENT ABRE 14MMX120MMX90CM,83284,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,5175.00000,4916.25000,Amish/Mennonite,Amish Mennonite,,2846.25,,,,,,,2375.32,5175.00,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,1056.56,2091.56,percent of total billed charges,
STENT BILI DIA8.0MM L80CM NIT SELF EXP OTW LIFESTENT,83285,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2156.25000,2048.44000,Amish/Mennonite,Amish Mennonite,,1185.94,,,,,,,989.72,2156.25,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4653.95,9212.91,percent of total billed charges,
STENT EVAR L15MM DIA6-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83287,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9497.85000,9022.96000,Amish/Mennonite,Amish Mennonite,,5223.82,,,,,,,4359.51,9497.85,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5380.30,10650.79,percent of total billed charges,
STENT EVAR L79MM DIA5-8MM CATH L80CM INTRO SHTH 7FR 0.035IN,83288,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,10980.20000,10431.19000,Amish/Mennonite,Amish Mennonite,,6039.11,,,,,,,5039.91,10980.20,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,inpatient,,,3472.43000,3298.81000,Amish/Mennonite,Amish Mennonite,,1909.84,,,,,,,1701.49,3368.26,percent of total billed charges,
STENT NASAL 370UG MOMETASONE FUROATE BIOABSRB.,83289,CDM,278,RC,S1091,HCPCS,,,facility,outpatient,,,3472.43000,3298.81000,Amish/Mennonite,Amish Mennonite,,1909.84,,,,,,,1593.85,3472.43,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,143.32,283.73,percent of total billed charges,
STENT PANCREAS 5FR 7CM LEN CNTOUR W/ DST FLAP POLYETH N,83290,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,292.50000,277.88000,Amish/Mennonite,Amish Mennonite,,160.88,,,,,,,134.26,292.50,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1074.94,2127.94,percent of total billed charges,
STENT PERIPH BILI DIA9MM L80MM BARE MTL STR SELF EXP OTW 6FR,83291,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2193.75000,2084.06000,Amish/Mennonite,Amish Mennonite,,1206.56,,,,,,,1006.93,2193.75,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 2.25X33MM,83292,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X33MM,83293,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,780.94,1545.94,percent of total billed charges,
STENT XIENCE SKYPNT 4.0X38MM,83294,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,1593.75000,1514.06000,Amish/Mennonite,Amish Mennonite,,876.56,,,,,,,731.53,1593.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,inpatient,,,1875.00000,1781.25000,Amish/Mennonite,Amish Mennonite,,1031.25,,,,,,,918.75,1818.75,percent of total billed charges,
SYSTEM DEL 35CM OUTER GUID CATH W/ 120DEG BEND DST SHP 65CM,83295,CDM,278,RC,C1887,HCPCS,,,facility,outpatient,,,1875.00000,1781.25000,Amish/Mennonite,Amish Mennonite,,1031.25,,,,,,,860.62,1875.00,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,288.75000,274.31000,Amish/Mennonite,Amish Mennonite,,158.81,,,,,,,141.49,280.09,percent of total billed charges,
SYSTEM GWIRE L260CM DIA0.035IN STD STEER,83296,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,288.75000,274.31000,Amish/Mennonite,Amish Mennonite,,158.81,,,,,,,132.54,288.75,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,63.05,124.82,percent of total billed charges,
TUBE GASTROSTMY BOLUS 14FR,83297,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,128.68000,122.25000,Amish/Mennonite,Amish Mennonite,,70.77,,,,,,,59.06,128.68,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,378.86000,359.92000,Amish/Mennonite,Amish Mennonite,,208.37,,,,,,,185.64,367.49,percent of total billed charges,
ZIPWIRE .018IN STRAIGHT TIP BX5,83299,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,378.86000,359.92000,Amish/Mennonite,Amish Mennonite,,208.37,,,,,,,173.90,378.86,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,inpatient,,,9351.85000,8884.26000,Amish/Mennonite,Amish Mennonite,,5143.52,,,,,,,4582.41,9071.29,percent of total billed charges,
STENT TRACHBRONCH L38MM DIA5MM CATH 7FR L120CM SS PTFE CVR.,83300,CDM,278,RC,C1894,HCPCS,,,facility,outpatient,,,9351.85000,8884.26000,Amish/Mennonite,Amish Mennonite,,5143.52,,,,,,,4292.50,9351.85,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,1672.50000,1588.88000,Amish/Mennonite,Amish Mennonite,,919.88,,,,,,,819.52,1622.33,percent of total billed charges,
GUIDEWIRE VASC .014IN 185CM COR HDRPH STINGRAY,83302,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,1672.50000,1588.88000,Amish/Mennonite,Amish Mennonite,,919.88,,,,,,,767.68,1672.50,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,279.30,552.90,percent of total billed charges,
BLLN ULTRAVER 018 3X80X130,83303,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,570.00000,541.50000,Amish/Mennonite,Amish Mennonite,,313.50,,,,,,,261.63,570.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,12348.00,24444.00,percent of total billed charges,
CATHETER THROMBECTOMY 14MM 115CM FLOWTRIEVER STERIL LF,83304,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,25200.00000,23940.00000,Amish/Mennonite,Amish Mennonite,,13860.00,,,,,,,11566.80,25200.00,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.5X6MM,83305,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 2.75X15MM,83306,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X6MM,83307,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.25X10MM,83308,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 3.5X6MM,83309,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN RX EUPHORA 4.0X10MM,83310,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,119.44,236.44,percent of total billed charges,
CATH BLLN NC EUPHORA 3.25X6MM,83311,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,243.75000,231.56000,Amish/Mennonite,Amish Mennonite,,134.06,,,,,,,111.88,243.75,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,inpatient,,,28138.24000,26731.33000,Amish/Mennonite,Amish Mennonite,,15476.03,,,,,,,13787.74,27294.09,percent of total billed charges,
DEVICE EMBOTRAP III 5X37 ET309537.,83312,CDM,278,RC,C1757,HCPCS,,,facility,outpatient,,,28138.24000,26731.33000,Amish/Mennonite,Amish Mennonite,,15476.03,,,,,,,12915.45,28138.24,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,18698.80000,17763.86000,Amish/Mennonite,Amish Mennonite,,10284.34,,,,,,,9162.41,18137.84,percent of total billed charges,
STENT GI L10MM DIA20MM W/ ELECTROCAUTERY ENH DEL SYS FOR US,83313,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,18698.80000,17763.86000,Amish/Mennonite,Amish Mennonite,,10284.34,,,,,,,8582.75,18698.80,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,16.66,32.98,percent of total billed charges,
CATH ANGIO ST JL6 6FR 100CM,83314,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,34.00000,32.30000,Amish/Mennonite,Amish Mennonite,,18.70,,,,,,,15.61,34.00,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2981.25000,2832.19000,Amish/Mennonite,Amish Mennonite,,1639.69,,,,,,,1460.81,2891.81,percent of total billed charges,
PROBE LITHO 1.9FR L375CM BILI BPLR EHL,83315,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2981.25000,2832.19000,Amish/Mennonite,Amish Mennonite,,1639.69,,,,,,,1368.39,2981.25,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,645.04,1276.91,percent of total billed charges,
TUBE FEED 16FR 45X2CM TRANSGASTRIC JEJU LP,83316,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1316.40000,1250.58000,Amish/Mennonite,Amish Mennonite,,724.02,,,,,,,604.23,1316.40,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,inpatient,,,5789.10000,5499.65000,Amish/Mennonite,Amish Mennonite,,3184.01,,,,,,,2836.66,5615.43,percent of total billed charges,
CATHETER ABLAT 8FR L115CM 2-5-2MM SPC TIP,83317,CDM,278,RC,C1732,HCPCS,,,facility,outpatient,,,5789.10000,5499.65000,Amish/Mennonite,Amish Mennonite,,3184.01,,,,,,,2657.20,5789.10,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,366.86000,348.52000,Amish/Mennonite,Amish Mennonite,,201.77,,,,,,,179.76,355.85,percent of total billed charges,
CATH NEPHOSTY MLCT 18FR 30CM,83318,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,366.86000,348.52000,Amish/Mennonite,Amish Mennonite,,201.77,,,,,,,168.39,366.86,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
CATHETER PTCA 6FR L200CM BLLN L40MM DIA6MM.,83320,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,584.33,1156.72,percent of total billed charges,
BLLN METACROSS RX 7X40X200CM,83321,CDM,278,RC,C1725,HCPCS,,,facility,outpatient,,,1192.50000,1132.88000,Amish/Mennonite,Amish Mennonite,,655.88,,,,,,,547.36,1192.50,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1752.97,3470.18,percent of total billed charges,
STENT PERIPH L40MM DIA6MM W/ 6FR SHTH L200CM SHFT SELF EXPND.,83322,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3577.50000,3398.62000,Amish/Mennonite,Amish Mennonite,,1967.62,,,,,,,1642.07,3577.50,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,27830.25000,26438.74000,Amish/Mennonite,Amish Mennonite,,15306.64,,,,,,,13636.82,26995.34,percent of total billed charges,
DEFIBRILLATOR CARD W51XH64IN D13MM DF4 CONN BLUESYNC,83323,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,27830.25000,26438.74000,Amish/Mennonite,Amish Mennonite,,15306.64,,,,,,,12774.08,26995.34,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L32CM LOOP DIA16MM 0.029IN DETACH CRSS SECT OCCL 35.,83324,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,1927.18,4198.65,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,2057.34,4072.69,percent of total billed charges,
COIL EMB L39CM LOOP DIA20MM 0.029IN DETACH CRSS SECT OCCL 35.,83325,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4198.65000,3988.72000,Amish/Mennonite,Amish Mennonite,,2309.26,,,,,,,1927.18,4198.65,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,5865.00000,5571.75000,Amish/Mennonite,Amish Mennonite,,3225.75,,,,,,,2873.85,5689.05,percent of total billed charges,
SYSTEM VEN SELF EXPND STNT 20MM X 150MM ABRE,83328,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,5865.00000,5571.75000,Amish/Mennonite,Amish Mennonite,,3225.75,,,,,,,2692.03,5865.00,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,5084.24,10064.73,percent of total billed charges,
COIL TARGET XL 360 SFT 5MMX10CM,83329,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,10376.01000,9857.21000,Amish/Mennonite,Amish Mennonite,,5706.81,,,,,,,4762.59,10376.01,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,21.56,42.68,percent of total billed charges,
SHTH INTRO 9FR L10CM MINI GWIRE L45CM,83331,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,44.00000,41.80000,Amish/Mennonite,Amish Mennonite,,24.20,,,,,,,20.20,44.00,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,inpatient,,,1833.30000,1741.63000,Amish/Mennonite,Amish Mennonite,,1008.32,,,,,,,898.32,1778.30,percent of total billed charges,
CATH DIL 5.8FR L75CM BLLN L4CM DIA4MM 0.038IN,83332,CDM,278,RC,C1726,HCPCS,,,facility,outpatient,,,1833.30000,1741.63000,Amish/Mennonite,Amish Mennonite,,1008.32,,,,,,,841.48,1833.30,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3915.41000,3719.64000,Amish/Mennonite,Amish Mennonite,,2153.48,,,,,,,1918.55,3797.95,percent of total billed charges,
GRAFT BNE SUB 6CC DBM FBR INJ GRFT,83333,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3915.41000,3719.64000,Amish/Mennonite,Amish Mennonite,,2153.48,,,,,,,1797.17,3915.41,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,10260.30000,9747.28000,Amish/Mennonite,Amish Mennonite,,5643.16,,,,,,,5027.55,9952.49,percent of total billed charges,
GRAFT BNE SUB 5CC CA PHSPTE HA INJ HYDROSET,83334,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,10260.30000,9747.28000,Amish/Mennonite,Amish Mennonite,,5643.16,,,,,,,4709.48,10260.30,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,inpatient,,,30.04000,28.54000,Amish/Mennonite,Amish Mennonite,,16.52,,,,,,,14.72,29.14,percent of total billed charges,
CATH URETH 24FR 30ML BLLN F INDWL 2 W SPEC M.,83335,CDM,278,RC,C1758,HCPCS,,,facility,outpatient,,,30.04000,28.54000,Amish/Mennonite,Amish Mennonite,,16.52,,,,,,,13.79,30.04,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,183.75,363.75,percent of total billed charges,
GUIDEWIRE VASCULAR L300CM DIA0.014IN TIP L3CM SS,83336,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,375.00000,356.25000,Amish/Mennonite,Amish Mennonite,,206.25,,,,,,,172.12,375.00,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,inpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,TC,1862.30,,,,,,,1862.30,3284.42,percent of total billed charges,
EP - UP/LOW SEP UNI 95938,83337,CDM,740,RC,95938,CPT,,,facility,outpatient,,,3386.00000,3216.70000,Amish/Mennonite,Amish Mennonite,TC,1862.30,,,,,,,1693.00,3284.42,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,inpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,34.10,60.14,percent of total billed charges,
OT VASOPNEUMATIC DEVICE (97016),83338,CDM,430,RC,97016,CPT,,,facility,outpatient,,,62.00000,58.90000,Amish/Mennonite,Amish Mennonite,,34.10,,,,,,,31.00,264.00,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,inpatient,,,84.28000,80.07000,Amish/Mennonite,Amish Mennonite,,46.35,,,,,,,41.30,81.75,percent of total billed charges,
GUIDEWIRE VASC CRV .035IN 145CM SFTJ TEFCOR TFLN,83339,CDM,278,RC,C1769,HCPCS,,,facility,outpatient,,,84.28000,80.07000,Amish/Mennonite,Amish Mennonite,,46.35,,,,,,,38.68,84.28,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L55CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83340,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4873.71,9647.96,percent of total billed charges,
LEAD DEFIB L62CM SIL POLYUR SCR IN FIX RV PACE QPLR DF4 CONN,83341,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9946.35000,9449.03000,Amish/Mennonite,Amish Mennonite,,5470.49,,,,,,,4565.37,9946.35,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,inpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,8125.15,14329.81,percent of total billed charges,
STEROTACTIC BODY RAD THER,83344,CDM,333,RC,77373,CPT,,,facility,outpatient,,,14773.00000,14034.35000,Amish/Mennonite,Amish Mennonite,,8125.15,,,,,,,1667.31,67198.78,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC,C1725,HCPCS,,,facility,inpatient,,,7590.00000,7210.50000,Amish/Mennonite,Amish Mennonite,,4174.50,,,,,,,3719.10,7362.30,percent of total billed charges,
CATHETER PRFSN 24MM 14FR 110CM TRFLW 3.5CM VLVPL,83346,CDM,278,RC